A large contribution to the development of kidney pathology, including the progression of chronic kidney disease, is made by risk factors associated, among other things, with impaired metabolic processes. These include disorders of carbohydrate metabolism (prediabetes, diabetes mellitus), dyslipidemia, overweight, obesity, metabolic syndrome, hyperuricemia. Timely identification of these factors and their correction can be crucial for the patient in the context of kidney damage. The review presents data on the impact of disorders of carbohydrate, lipid and purine metabolism, overweight and obesity on the formation of kidney pathology.

Non-alcoholic fatty liver disease (NAFLD) is currently a widespread disease among the adult population and, being a component of the metabolic syndrome (MS), is often associated with obesity, insulin resistance (IR), type 2 diabetes mellitus (DM2), cardiovascular diseases (CVD). Many authors in scientific studies have found that hyperuricemia (HU) can be considered as a predictor of non-alcoholic fatty liver disease (NAFLD), as well as other diseases associated with metabolic syndrome (MS).

The article presents data on the incidence of pain in patients with chronic kidney disease of various stages, the main causes of acute and chronic pain, the frequency of use of non-steroidal anti-inflammatory drugs (NSAIDs) by patients for pain relief. The article discusses the possible risks of an adverse effect of NSAIDs on kidney health. Unfortunately, often patients do not know about their CKD and take NSAIDs on their own, and doctors underestimate the condition of the kidneys when prescribing drugs to relieve pain.

This review will present an analysis of the mechanisms of PCSK9 influence on lipid metabolism and its role in the development of cardiovascular pathology, an assessment of the effectiveness and safety of PCSK9 inhibitors, the place of PCSK9 inhibitors in the clinical recommendations of the European, Russian Cardiological Society and the American College of the Heart.

Objective: to estimate the survival of patients in the heart transplantation waiting list (HTx WL) at Almazov National Medical Research Centre (V.A. Almazov NMRC), Saint-Petersburg, Russia, from 2010 to 2018 and to define factors for death among these patients.

Materials and methods: it was a single-centre retrospective study involving 151 patients with end-stage chronic heart failure (CHF) classes III-IV (NYHA) in the HTx WL.

Results: the dynamic of decreasing mortality was revealed. Based on the results of constructing the discriminant function, four factors predicting the survival of patients in the HTx WL, namely, ACE inhibitors/ARBs, beta-blockers, status 1 of UNOS, CHF NYHA class IV, were pointed out. The model has sufficient resolving power but is not capable of predicting the outcome in the presence of acute decompensation of CHF.

Conclusion: mortality in the HTx WL for the period 2010-2018 decreased that was associated with an active implementation of cardiac surgical methods as a «bridge» to transplant and optimal medical therapy, including ACE inhibitors/ARBs and beta-blockers in patients supported with inotropes (UNOS 1B). The greatest risk of mortality was found in CHF class IV and status 1 by UNOS.

Objective: To assess the relationship of arrhythmic events such as supraventricular arrhythmias and asymptomatic arrhythmias and their long-term association with adverse events among patients undergoing chronic hemodialysis.

Materials and methods: a study was conducted involving 87 patients undergoing chronic hemodialysis with a 10-year follow-up period. At the inclusion stage, sinus rhythm was registered in all patients. A total of 87 patients (47 men and 40 women; mean age 56.3±16.1 years) took part. All patients underwent Holter monitoring (HM) of the ECG after each hemodialysis procedure, 6 times in a row, and the indicators obtained during the echocardiographic study were also evaluated.

Results: after evaluating the results obtained and statistically processing the data, it was found that 71.2% of patients had arterial hypertension, 30.6% had type 2 diabetes mellitus. During HM, supraventricular arrhythmias were detected in 43 patients (49.4%); these arrhythmias were short-term, asymptomatic and stopped on their own. Age (hazard ratio [HR], 1.07 per year; 95% confidence interval [95% CI], 1.02 to 1.09) and right atrial enlargement (hazard ratio [HR] 4.31; 95 % CI 1.33 to 14.12), which showed a direct association with supraventricular arrhythmia in multivariate analysis. During 48 months, 67 patients died, the main cause of death of which was cardiovascular disease (58.4%). In the Cox model, the variables associated with all-cause mortality were C-reactive protein (RR, 1.03 per 1 mg/l; 95% confidence interval from 1.00 to 1.08), age (RR, 1.07 per year; 95% CI, 1.00 to 1.08), supraventricular arrhythmias (RR 3.42; 95% CI, 1.34 to 7.91). Patients with supraventricular arrhythmia had a significantly higher risk of non-fatal cardiovascular events (hazard ratio, 4.41; 95% confidence interval, 2.18–8.89).

Conclusion: a direct relationship has been demonstrated between the presence of supraventricular arrhythmias during chronic hemodialysis and symptomatic AF, which will develop in these patients in the future. The main aggravating factors associated with mortality in patients on dialysis were supraventricular arrhythmias, advanced age, and elevated C-reactive protein.

Objective: to estimate of the effect of diosmin in complex antihypertensive therapy on renal function in patients with hypertension and impaired renal venous blood flow.

Materials and methods: we observed 147 patients with hypertension aged 40.86±8.27 with signs of bilateral impairment of venous blood flow in the kidneys, which, depending on the amount of therapy, were divided into 2 groups and 2 subgroups. The comparison group consisted of 57 AH patients with unchanged venous blood flow in both kidneys.

Results: in the presence of impaired venous blood flow in the renal veins, the use of additional administration of diosmin allows maintaining or improving the filtration capacity of the kidneys. Additional monitoring of patients with impaired venous blood flow in the kidneys is required to assess the effectiveness of antihypertensive therapy with individual drugs with and without venoactive agents.

Conclusion: the additional inclusion of diosmin in the complex antihypertensive therapy of patients with arterial hypertension and impaired venous blood flow to the kidneys can preserve and improve kidney function with normalization of GFR.

Objective: to analyze the prevalence of smoking in the population of conditionally healthy residents of Primorsky Krai included in the regional stage of the ESSAY–RF study and establish its relationship with traditional cardiovascular risk factors.

Materials and methods: the work uses the database of the study «Epidemiology of cardiovascular diseases in various regions of the Russian Federation» (ESSAY-RF) in Primorsky Krai. In the study population, age, gender, smoking fact, pack/years index (PYI), body mass index (BMI), systolic (SBP) and diastolic blood pressure (DBP) levels, heart rate (HR), lipid spectrum (total cholesterol (TC), low lipoproteins (LDL) and high-density lipoproteins (HDL), non-high-density lipoproteins (non-HDL), triglycerides (TG)), uric acid level (UA) were analyzed. Statistical data processing was carried out using the StatTech v. 2.7.1 program (developed by Stattech LLC, Russia).

Results: predictors of the development of chronic non-communicable diseases (CNCD) in groups of smokers (n=327) and non-smokers (n=1160) were studied. In the general group of smokers, an increase in the level of UA was found. When dividing the group of smokers into subgroups depending on the intensity of smoking (I-A with a low-medium degree of nicotine dependence at PYI<10, and I-B with a high degree of nicotine dependence at PYI>10), higher values of SBP, DBP, HR, TG, UA and lower values of HDL between groups I-B and non-smokers. The conducted correlation analysis showed the presence of a direct relationship between the intensity of smoking and the indicators of SBP, DBP, HR, TG and the reverse — with the level of HDL. The use of the method of paired linear regression with the condition of an increase in PYI by 1 in intensely smoking individuals showed a slight effect on the growth of SBP, DBP, UA, TG and HDL. Obviously, a high degree of nicotine dependence per se is a factor closely associated with an increase in the level of SBP, DBP, HR, UA, TG content and a decrease in HDL. With its even greater increase, the change in the predictors of CNCD occurs less noticeably and may be influenced by other positions, indicating the need for complete cessation of smoking at the stage of the presence of risk factors.

Conclusion: taking into account the established relationships, it is necessary to strengthen preventive-oriented measures and motivating the population to completely give up smoking, and it is also necessary to monitor the main and additional significant predictors in the framework of outpatient follow-up.

Objective: to assess the frequency and nature of prescribing antibiotics to patients with confirmed COVID-19 at the outpatient stage.

Material and methods: a survey was conducted of 104 patients with confirmed COVID-19 and their medical records were analyzed. Patients received treatment in various outpatient facilities in the city of Saratov.

Results: most of the patients sought medical help 6-7 days after the onset of the disease. Most patients (65-62.5%) had a mild course of COVID-19, and moderate and severe course was found in 28 (26.9%) and 11 (10.6%) patients, respectively. Before seeking medical help, 87 (83.6%) patients began to receive antibiotics on their own. After visiting the doctor, antibiotics were additionally prescribed to 6 more patients who had not previously taken them. Most often, aminopenicillins (17 patients), macrolides (49 patients), respiratory fluoroquinolones (27 patients) and cephalosporins (41 patients) were used. Combinations of two and sometimes three antibiotics were used in 46 (44%) patients. The most commonly prescribed antibiotics were azithromycin (44 patients), levofloxacin (27 patients), and parenteral antibiotic ceftriaxone (41 patients).

Conclusion: in patients with an established diagnosis of COVID-19, a fairly frequent use of antibacterial drugs at the outpatient stage was revealed. The overwhelming majority of patients (83.6%) started using ABP on their own, before seeking medical help. Moreover, 44% of patients received combinations of two or three drugs. There are currently no convincing data on the feasibility of such a widespread use of ABP in outpatient practice in the vast majority of patients with diagnosed COVID-19.

Objective: to study the frequency and intensity of abdominal pain that occurs in professional and amateur athletes during endurance sports.

Materials and methods: a single-stage cross-sectional study was carried out. A questionnaire was developed, the questionnaire included questions about the training process and about the presence and nature of abdominal pain. The intensity of abdominal pain have been assessed by a 7-point scale. The survey involved 107 people aged 18 to 29 years (average age 21.58 ± 2.86 years). Participation in the study was offered to students of the Siberian State University of Physical Culture and Sports (SibGUFC) and the Omsk Olympic Reserve School (UOR Omsk), who are professionally engaged in endurance sports (long-distance running, cycling and swimming), as well as amateur athletes who study at Omsk State Medical University (OmSMU). Among the respondents, 43 (40.19%) were men and 64 (59.81%) were women. 45 (42.68%) people are engaged in professional sports, and 62 (57.94%) amateur athletes were surveyed.

Results: abdominal pain occurred in 37 (82.22%) professional athletes and 22 (83.87%) amateur athletes. When comparing the intensity of pain during training in professional athletes (3.75±2.32) and amateurs (2.5+-1.42), it was revealed that the intensity of pain is greater in professional athletes (p=0.004). 22 (59.46%) people among professionals and 34 (65.38%) among amateurs noted the localized nature of pain. The majority of the questionnaire participants in two groups indicated the stabbing nature of pain - 21 (56.76%) professionals, 28 (53.85%) amateur athletes. 26 (70.27%) and 34 (65.38%) respondents in the groups of professional and amateur athletes, respectively, note that they had to reduce the intensity of exercise.

Conclusion: sports are associated with the development of abdominal pain among both amateur and professional athletes, which requires a reduction in the intensity of physical activity. The intensity of abdominal pain is higher in professional athletes engaged in endurance sports. The results obtained require the development of appropriate measures to prevent the development of abdominal pain in athletes during exercise.

Objective: to study the formation of neurovascular conflicts of two types in patients with classical trigeminal neuralgia, depending on the influence of the environment of the Rostov region.

Materials and methods: a retrospective study of the features of neurovascular conflict was conducted in 175 patients from the Rostov region who suffered from classical trigeminal neuralgia. The diagnosis of a variant of neurovascular conflict was carried out using spiral computed tomography on the device «Philips Ingenuity Core 128» The variant of neurovascular conflict was verified intraoperatively, when performing microvascular decompression of the trigeminal nerve root.

Results: neurovascular conflict, both of the first and second types, occurs twice as often in women as in men. The development of the adhesive process in the zone of neurovascular conflict, which brings the root even closer to the artery that injures it, is due to the duration of the pathological process, during which inflammatory diseases of the paranasal sinuses, carious teeth, persistent herpesvirus infection play a significant role.

Conclusions: variants of the syntopia of the trigeminal nerve root with the superior cerebellar artery in neurovascular conflict do not depend on environmental factors, and the frequency of occurrence of one type or another, as well as the gender ratio, correspond to the population.

The difficulties of diagnosis and management of patients with alcohol-induced heart lesions, features of the clinic of alcoholic cardiomyopathy are highlighted. Excessive and prolonged alcohol consumption increases the risk of developing acute and chronic heart failure, cardiac arrhythmias and aggravates existing cardiovascular diseases. At the same time, due to insufficient assessment of the origin of cardiac manifestations (patients often hide or downplay the fact of alcohol abuse), patients do not always receive specific treatment. The management of such patients presents significant difficulties, taking into account, among other things, the defeat of the gastrointestinal tract, central and peripheral nervous system and should be carried out jointly with doctors of other specialties.

We want to draw the attention of clinical therapists, endocrinologists and gastroenterologists to the problem of e⁄ective drug therapy for diabetes mellitus type 2 combined with non-alcoholic fatty liver disease, which can improve the life quality and achieve compliance with this category of patients. Type 2 diabetes mellitus is a carbohydrate metabolism disorder caused by insulin resistance, which may be accompanied by relative insulin de‹ciency or not. Type 2 diabetes mellitus is often combined with certain diseases, one of which is non-alcoholic fatty liver disease. This imposes certain limitations in the treatment of type 2 diabetes mellitus, which must be taken into account in order to maintain e⁄ective clinical managment. Understanding the genetically individualized risks allows the doctor to remain wary of these patients and treat them with the appropriate clinical methods. The combination of e⁄ective drug therapy and patient's awareness of the necessity for the lifestyle changes makes it possible to achieve signi‹cant improvements in the treatment of type 2 diabetes mellitus combined with non-alcoholic fatty liver disease. This treatment allows to improve the patient's life quality and prognosis of the disease as well as to avoid various risks and complications that can lead to irreversible consequences such as the need for liver transplantation.

This article presents a new method of essential determination of the nosological type of disease, which allows to uniquely identify the type of disease. The classi‹cation of processes that make up the form of any disease is given and the methodology of its description in the graphic form is proposed.

In the diagnosis of diseases of the blood system, an important place is given to the patient's complaints, a carefully collected anamnesis, an objective examination, and, along with the use of special laboratory and instrumental studies, routine blood and urine tests. It is necessary to pay attention to the change in the color of urine, which is observed during hemolysis, cold, marching, paroxysmal nocturnal hemoglobinuria, autoimmune hemolytic anemia, porphyria and other conditions. Hematuria is characteristic of disorders of coagulation and platelet hemostasis of hereditary and acquired origin, von Willebrand disease of mild and moderate severity, overdose of anticoagulants and inhibitors of platelet hemostasis. Proteinuria is a characteristic syndrome in paraproteinemic hemoblastoses, AL-amyloidosis, Immerslund-Gresbeck disease, etc. Competent interpretation of the urine test in combination with the clinical picture is the key to a successful diagnosis.

The article reflects the necessity and role of the reception of law in modern legal science in general, and in particular in the field of medical law, capable of effectively responding to emerging challenges. The analysis of legal norms relating to medicine in ancient Rome was carried out.