The review presents the anatomical and physiological features of the system of brachiocephalic arteries (BCA) ofatherosclerotic and non-atherosclerotic nature. The prevalence of various types of BCA anomalies and the possible impact on the development of cerebral and coronary events are estimated. The modern diagnostic methods and approaches to the treatment of the problem under study are described. The need to prevent ischemia of the brain and heart in individuals with asymptomatic BCA diseases is discussed, as well as an understanding of the anatomy of the abnormal structure and variability of the BCA course, which is of paramount importance during surgical interventions.

The concept of resistant arterial hypertension was introduced many years ago and confirmed in the updated scientific statement of the American Heart Association (AHA) 2018 and the latest recommendations of the European Society of Cardiology (ESC) 2018. Special attention to this group of patients is due to the high risk of adverse outcomes compared with controlled hypertension. In this review, we want to highlight not only the difficulties in identifying, assessing and optimizing therapy for patients with RH, but to a greater extent focus on the main mechanisms of the formation of true resistance, their identification and the search for the optimal path of action.

Based on the thematic review of the Russian and foreign studies the analysis of the contemporary views on the occupational psychosocial and traditional factors as the determinants of stress in healthcare workers was conducted. The data on the stress-induced health disorders with the psychosomatic pathology, in particular, cardiovascular diseases and occupational burnout syndrome, is provided. The prospects of primary prevention of health disorders based on the use of stress markers to prevent the development of diseases of the circulatory system and occupational burnout in the medical environment are considered

This review is devoted to the analysis of the published results of studies conducted in Africa, which studied the clinical and epidemiological features of epilepsy disease in the countries of the African continent. Continental geographic subregions have been identified where the prevalence of epilepsy is particularly high. The relationship between the incidence of epilepsy and the presence of endemic neuroinfections is described. It is concluded that the strengthening of measures aimed at the prevention of infections of the central nervous system can be one of the most effective ways to reduce the morbidity and mortality from epilepsy in Africa

Objectives: to determine the causes of ineffective observation and poor prognosis in patients undergoing ADHF, in real clinical practice and to consider the basics of the formation of specialized medical care for patients with heart failure (HF).

Materials and methods: the study was conducted based on the City Center for the treatment of heart failure (center HF), N. Novgorod. The study consistently included 942 patients with heart failure (HF) at the age of 18 years and older who underwent ADHF and received inpatient treatment in center HF between March 4, 2016 and March 3, 2017. Based on the decisions of patients to continue outpatient monitoring in center HF, two groups of patients were distinguished: patients who continued to be monitored in center HF (group I, n = 510) and patients who continued to be monitored in outpatient clinics at the place of residence (group II, n = 432). The assessment of adherence to treatment, overall mortality, survival and re-admission to a depth of two years of observation was carried out. Statistical data processing was performed using Statistica 7.0 for Windows and the software package R.

Results: all patients in the study groups had high comorbidity. Group 2 patients turned out to be statistically significantly older, more often had III functional class (FC) HF, lower the baseline test score of 6-minute walk, and higher the baseline clinical assessment scale. After 2 years of follow-up in group II, there was a significant deterioration in adherence to basic therapy of HF compared with group I. According to the results of multifactorial proportional risk Cox models, it was shown that observation of patients in the group 1 is an independent factor increasing the risk of overall mortality by 2.8 times by the end of the second year of observation. Survival after two years of follow-up was: in group I — 89.8 %, and in group II — 70.1 % of patients (OR = 0.3, 95 % CI 0.2 – 0.4; p1/2 < 0.001). After two years of follow-up, the proportion of re-hospitalized patients in group II was greater (78.0 % of patients) versus group 1 (50.6 % of patients, OR = 3.5, 95 % CI 2.6 – 4.6; p1/2 <0.001). The independent risk of re-hospitalization according to multinominal logit regression was 3.4 times higher in group II and 2.4 times for III – IV FC HF. Conclusions: the inclusion of patients with HF in the system of specialized medical care improves adherence to treatment, prognosis of life and reduces the risk of repeated hospitalizations. Patients of an older age and with an initially greater clinical severity refused specialized supervision in center HF.

Objectives: to assess the functional state of the kidneys and cardiovascular risk in relation to the level of leptin and adiponectin in patients with chronic heart failure (CHF) and obesity.

Materials and methods: a total of 116 patients with CHF of I-III functional class (FC) 45-65 years old were examined, which were divided into three comparable groups depending on body mass index (BMI).

Results: a statistically significant decrease in glomerular filtration rate (GFR), a significant increase in the level of albuminuria (AC) and β2-microglobulins (β2-MG) among patients with chronic heart failure and obesity were revealed. The leptin level significantly increased from the 1st to the 3rd group, the adiponectin concentration decreased from the 1st to the 3rd group. Significant correlations were established between the concentrations of adipokines, HOMA-IR and GFR, AC, β2-MG in the group of individuals with heart failure and obesity.

Conclusions: reliable deterioration of renal functional parameters in patients with CHF, statistically significant relationships between GFR, AC, β2-MG and adipokines, HOMA-IR with increasing body weight, as well as an increase in the combined risk of CKD progression and the development of cardiovascular complications with comparable FC were established.

Objectives: to study the relationship between high-frequency electrocardiography (ECG) and selective coronary angiography data.

Materials and methods: the study was conducted on 125 patients with a diagnosis of coronary heart disease (CHD), who were sent for selective coronary angiography. Patients were divided into groups: I group - young age, II group 2- middle age, III group — senile and elderly age. All patients were recorded high-frequency ECG in 12 common leads using a computer electrocardiograph, the data obtained were analyzed by special software.

Results: according to the selective coronary angiography data, hemodynamically insignificant lesions of the coronary arteries were present in 34 (27.2%) people, and in 49 (39.2 %) people - hemodynamically significant lesions of the coronary arteries. Hemodynamically significant coronary artery stenoses are more often detected in elderly and senile patients. Stenotic lesions of the coronary arteries were more common in group 3 as opposed to group 2 (p = 0.002). High-frequency ECG analysis revealed a significant difference in the amount of RAZ between elderly and senile patients compared to young and middle-aged patients (p 1–2 = 0.373; p 1–3 = 0.006; p 2–3 = 0.008). The RAZ parameter of a high-frequency ECG in 12 common leads has a relationship with the age of patients, the number of coronary arteries with stenotic lesions, and the number of hemodynamically significant stenoses.

Conclusion: the results of the study show that high-frequency ECG can be further developed as an additional method for diagnosing myocardial ischemia.

Objective: to study the influence of dosed walking on the course of hypertension and quality of life in patients with chronic obstructive pulmonary disease.

Materials and methods: the study included 85 patients with a combination of arterial hypertension and chronic obstructive pulmonary disease, with an average age of 60.9 ± 1.06 years. Group A patients were prescribed dosed walking in addition to medication, while group B patients received only antihypertensive medications, statins, and basic treatment for chronic obstructive pulmonary disease. The effectiveness of treatment was determined after 6 weeks based on a standard examination, daily monitoring of blood pressure and ECG, and quality of life indicators. Long-term results were evaluated after 6 months.

Results: patients whose treatment plan included physical training, in contrast to patients receiving only medication, noted a decrease in complaints of headache (p=0.034), dizziness (p=0.041), tachycardia (p=0.029), general weakness (p=0.003), head noise and tinnitus (p=0.018), sleep disturbance (p=0.010) and shortness of breath (p=0.004). They had normalization of all indicators of quality of life according to the SF-36 questionnaire: scales physical functioning (p<0.001), role functioning due to physical condition (p<0.001), pain intensity (p<0.001), general health (p=0.002), vital activity (p=0.001), social functioning (p=0.013), role functioning due to emotional state (p<0.001), mental health (p=0.008), physical component of health in general (p<0.001) and the mental health component (p=0.002). Improvement of well-being was accompanied by normalization of lipidogram indicators, daily heart rate and blood pressure: reduction of average daily indicators of blood pressure (p<0.001), pressure load index (p<0.001), blood pressure variability (p<0.05), pulse pressure (p<0.001) and the rate of morning rise in blood pressure (p<0.001).

Conclusion: addition to standard medical therapy of dosed walking has a positive effect on the course of arterial hypertension in patients with chronic obstructive pulmonary disease.

Objective: to assess the effect of the baseline hemostasiogram and comorbid background on the development of thrombosis and bleeding in the early postoperative period in patients receiving combined hemostatic and anticoagulant pharmacoprophylaxis after arthroplasty of the knee and hip joints.

Materials and Methods: A retrospective analysis of 253 case histories of patients with hip or knee arthroplasty performed. The patients received combined pharmacoprophylaxis with hemostatics and anticoagulants. Two groups were identified according to the time interval (TI) between the appointment of hemostatic and anticoagulant drugs. The first group (57,31%) - n=145 (112 women and 33 men), TI≤17 h, the second group (42,68%) — n=108 (78 women and 30 men), TI 18-24 h. In patients, we analyzed the effect of comorbidity and baseline values of the coagulogram on the risk of thrombosis or bleeding in the early postoperative period.

Results: Thrombohemorrhagic complications were registered in 27 (10,67%) patients, of which 22 (81,48%) were in the first group. Thrombosis in the first group developed in the regimens with tranexamic acid (p=0,038), and their frequency was 2,2 times higher than in the second group (p=0,023). In the first group, the risk of thrombosis in women was increased by the initially low level of international normalized ratio (INR) (relative risk (RR)=13,333, p=0,00032) and activated partial thromboplastin time (APTT) (RR=5,8, p=0,037). The risk of bleeding in the first group among men and women increased with an increased preoperative APTT level (RR=18, p=0,0012 and RR=28, p=0,00022, respectively), and separately for women - with a reduced content of fibrinogen (RR=23,25, p=0,00065) and platelets (RR=10,2, p=0,038). The development of thrombosis as influenced by: degree 2 obesity (RR=8,75, p=0,037), type 2 diabetes mellitus (RR=21, p=0,00001), myocardial infarction (RR=16,875, p=0,00002), venous pathology (RR=8,1, p=0,045), moderate decline in renal function (RR=6,231, p=0,0465) and age over 75 years (RR=6,8, p=0,029). Age over 75 years increased the risk of bleeding 12-fold (RR=12, p=0,015).

Conclusions: to minimize the risk of thrombosis and bleeding after endoprosthetics of large joints of the lower extremities, especially in patients with the above risk factors, in particular, when using tranexamic acid as a hemostatic, it is recommended to observe the TI between hemostatic and anticoagulant pharmacoprophylaxis of at least 18 hours.

Purpose: to determine the optimal therapy regimens in patients with CLL, depending on age, comorbidity, prognostic (genetic) factors, clinical picture. Materials and methods: analysis of case histories of 400 patients with CLL observed at the Rostov State Medical University, Ministry of Health of the Russian Federation from 2010 to 2020.

Results: Immunochemotherapy according to the FCR and FCR-Lite regimens has shown high efficiency in primary and pre-treated patients in terms of the frequency of achieving complete and partial remissions and achieving progression-free survival. In untreated patients, complete remissions were obtained in 61 (71.7%), partial remissions - in 14 (16.4%); among pre-treated patients, respectively - 40 (20.5%) and 65 (33.8%).

Conclusion: combination therapy according to the FCR and FCR-Lite regimens is an affordable and effective method of treatment for most patients with CLL. When the level of leukemic blood cells with 17p13 deletion is less than 15%, rituximab should be used in the first line of immunochemotherapy, and ibrutinib (imbruvica) in case of more than 15%. In mono-regimen, rituximab is effective in supportive - anti-relapse therapy and in the treatment of autoimmune complications.

The article presents as an introduction a short review on the problem of membranous nephropathy. A patient suffering from membranous nephropathy that is resistant to traditional therapy with glucocorticoids and cyclophosphane, as well as cyclosporine, was selected as a clinical case. The use of rituximab at a dose of 375 mg/m² twice with a difference of one week led to the development of remission in the patient, normalization of clinical and laboratory parameters. No side effects of rituximab were detected.

Purpose: to attract the attentio n of therapeutists, gastroenterologists, and infectious disease specialists to the problem of treating the combined course of inflammatory bowel diseases (IBD) and chronic viral hepatitis.

Fundamentals: the rate of ulcerative colitis (UC) detection in the population tends to increase. We are accumulating experience in treating patients with IBD and concomitant diseases (oncopathology, tuberculosis, and viral hepatitis). The implementation of standards of treatment for IBD is undoubtedly difficult due to the presence of many contraindications dictated by the presence of a concomitant disease.

Conclusion: timely decision on antiviral therapy in patients with a combination of IBD and HCV improves the prognosis of the disease, allows to prolong remission, prevent complications, and has an impact on performance, quality and life expectancy.

The article presents historical material revealing the activities of the Rostov Regional Scientific Medical Society of Therapists from its origins to the present day. The chronicle of the scientific therapeutic school is inextricably linked with the history of the development of Don medicine, at the origins of which were outstanding scientists and internists of the South of Russia. In October 2020, the Rostov Regional Scientific Medical Society of Therapists celebrated its 90th anniversary.

The article is devoted to the participation of A.P. Chekhov in the fight against the cholera epidemic of 1892, as well as the first summer he spent at the Melikhovo estate. Today Melikhovo is one of the main Chekhov museums. The materials contain excerpts from the letters of A.P. Chekhov for 1892, as well as the recollections of his friends about this period of the writer's life.