The problem of chronic heart failure (CHF) and especially CHF with reduced ejection fraction is one of the most significant for modern healthcare systems. This is due to the high mortality rate, reduced quality of life, frequent hospitalizations and marked comorbidity of patients with this pathology. Involvement of the kidneys in the pathological process is one of the most common comorbid conditions in cardiovascular disease. There are a large number of pathogenetic mechanisms of mutually negative impact of heart failure and renal dysfunction, reflected in the concept of «Cardiorenal syndrome». Moreover, drug therapy of CHF can be one of the causes of kidney damage. Episodes of acute circulatory decompensation as well as a new coronavirus infection (COVID-19) are particularly threatening conditions. The aim of this review is to consolidate the international literature on the problem of acute kidney injury in patients with CHF.

Non-alcoholic fatty liver disease (NAFLD) is widespread in the population and is the leading cause of cirrhosis and hepatocellular carcinoma. NAFLD includes a continuum from steatosis to non-alcoholic steatohepatitis with rapidly progressive fibrosis. NAFLD has a bidirectional relationship with components of metabolic syndrome and type 2 diabetes, increasing the risk of complications. The main causes of death in NAFLD are cardiovascular disease and extrahepatic malignancy, but advanced liver fibrosis is a key prognostic marker, and the risk of death can be assessed using a combination of non-invasive tests. There is currently no approved therapy for NAFLD, although several drugs are in advanced stages of development. An analysis of clinical studies, their meta-analyzes and literature reviews from the PubMed and MEDLINE databases was carried out for 18 keywords corresponding to the review topic, more than 5000 articles published in recent years were studied. The current understanding of epidemiology, natural history, pathogenesis, diagnosis, risk assessment, prevention and treatment of NAFLD is summarized.

The purpose of this review is to combine evidence from studies based on environmental impacts on inflammatory bowel disease. The review reflects the environmental factors influencing the incidence of IBD, and also considers the predictors that modify the course of the diseases.

Aim: to assess self-care skills and quality of life in patients with chronic coronary syndromes (CCS). Material and methods: the study involved 100 consecutive patients with stable coronary heart disease (CHD) admitted to cardiology departments. All patients admitted to the clinic underwent standard examination and treatment, taken in the management of patients with CCS. Besides, we assessed socio-demographic properties (marital status, education level, profession, disability for all reasons, income level), quality of life (using SF-36, SAQ questionnaires), levels of anxiety and depression (HADS scale), type D personality (DS-14 questionnaire), treatment adherence (Four-Item Morisky-Green-Levine medication adherence scale), Charlson comorbidity index, The Self Care of Coronary Heart Disease Inventory. Data processing was carried out using descriptive statistics, correlation and variance analysis. results: type D personality was identified in 60 patients (10.2 ± 5.6) on the scale of negative excitability, in 59 people (10.4 ± 3.7) — on the scale of social inhibition. An increased level of anxiety was found in 48 patients (7.6 ± 3.5), depression — in 49 people (7.1 ± 3.4). The average values of the physical component of the quality of life according to the SF-36 questionnaire were 36.9 ± 18.7 and 45.9 ± 19.6 points, respectively. The quality of life associated with exertional angina pectoris, according to the SAQ questionnaire, was 48.8 ± 19.7 points on the scale of limiting physical activity, 49.7 ± 28.2 points for seizure stability, and 70.5 ± 17.8 points for satisfaction with treatment. Treatment adherence according to the Morisky-Green scale was, on average, 2.6 ± 1.2 (Me: 2, [2.4]). Self-care skills on the scale A was 61.3 ± 12.2 points, on the scale B — 49.0 ± 16.2 points, on the scale C — 32.3 ± 14.5 points. In groups of CCS, significant (p <0.05) differences were found on the scales A and B. Significant differences in the self-care skills were obtained among the groups of patients with and without a history of postinfarction cardiosclerosis. Conclusion: the capacity for self-care skills and the quality of life of Russian comorbid patients with CCS is unsatisfactory, which requires active medical intervention and the development of tools for their effective modification.

objective: assess the risk of cardiotoxicity of chemotherapy in breast cancer patients and prevention options according to the Nizhny Novgorod Local Register, as well as assess the prevalence of cardiovascular risk factors, cardiovascular status and baseline cardioprotective therapy of patients included in the register depending on the stage of chemotherapy treatment. Materials and Methods: a local retrospective-prospective register of breast cancer patients receiving polychemotherapy has been created. According to the retrospective part from November 2018 to February 2020, 150 high or very high cardiovascular risk patients with breast cancer receiving chemotherapy treatment are included in the register. Follow-up continued for 4 or 8 courses depending on the prescribed chemotherapy regimen. Cardiotoxicity of chemotherapy was assessed by echocardiography and troponin I (TnI) levels. Results: the register was dominated by patients of high (82%) and very high cardiovascular risk (18%). There were also no significant differences in therapy composition at the time patients were included in the register. After 4 courses of polychemotherapy (PCT), 28 patients (18.9%) showed objective signs of cardiotoxicity. In 22 patients (14.8%) — signs of early cardiotoxicity (18 patients — an increase in the level of TnI, 4 — the appearance of diastolic dysfunction after PCT). In 4 patients (2.7%) — the appearance of heart failure (HF) symptoms without reducing left ventricular ejection fraction (LVEF) and increasing biochemical markers. In 2 patients (1.3%), the development of symptomatic HF with low LVEF. During the follow-up in the cardiotoxicity group, cardioprotective therapy was prescribed. Against the background of the prescription of cardioprotective therapy, 16 patients (88.8%) showed normalization of the level of TnI, on average by 6 courses of PCT. Conclusions: breast cancer patients receiving polychemotherapy with anthracycline antibiotics included in the regimen have a significant risk of cardiotoxic effect, especially early biochemical cardiotoxicity. Timely prescription of cardioprotective therapy allows correcting early signs of biochemical carditoxicity and continuing chemotherapeutic treatment.

Objective: of article was to study the level of cerebral natriuretic peptide in patients with type 2 diabetes mellitus with diastolic dysfunction and with various types of left ventricular remodeling. Materials and methods: 256 patients with type 2 diabetes mellitus (DM) who had moderate arterial hypertension (AH) and no clinical signs of chronic heart failure were examined. The control group consisted of 30 practically healthy persons, comparable in age and sex with the examined patients. All patients were determined the concentration of brain natriuretic peptide (BNP) in blood plasma. The structural and functional parameters of the heart were determined by echocardiography in B- and M-modes according to the standard technique. Results: in patients with type 2 diabetes and diastolic dysfunction, the BNP concentration was 156 (84; 228) pg / ml, in patients without diastolic filling disorders — 24 (12; 38) pg / ml. The highest BNP values were found in the subgroup of patients with a restrictive type of transmitral flow. Also, BNP values were higher in the group of patients with concentric and eccentric left ventricular (LV) hypertrophy. Conclusion: in all patients with type 2 diabetes and concomitant moderate hypertension, even in the absence of clinical signs of CHF, there is an increase in the BNP level compared to the control group. The highest BNP values were observed in patients with severe diastolic dysfunction and unfavorable variants of LV remodeling.

Objective: identifying age-related changes in the variability of the heart rhythm (HRV) in individuals with arterial hypertension (AG) associated with psychological stress and physical activity (FA) for targeted prevention and rehabilitation. Material and methods: the survey of the main groups consisting of 37 people’s persons (26 young men and 11 girls at the age of 22,2 years) and 94 - 2nd middle age (35 men and 59 women aged 56,0 years) included: questioning, anthropometry, clinical and instrumental examination, electrocardiography, HRV monitoring. Control groups for young people (n = 72) and persons of the 2nd middle age (n = 10) were comparable with the main ones and sex. Results: the frequency of excess body and obesity, low facilities, as well as the average and high levels of psychological stress in young people with AG amounted to 51,4%, 64,1%, and 59,5%, and in middle-aged people with AG — 87,2%, 55,4% and 41,5%, respectively. With AG in persons of the 2nd middle age, in contrast to young people, HRV were characterized at a low level of psychological stress with smaller values of the parameters of SDNN, RMSSD, PNN (50) and VP, which were indicated to a smaller HRV and low parasympathetic activity and, on the contrary, higher the value of the voltage index (VI) reflecting the intensity of the control processes of the heart rhythm; with an average and high levels of stress, statistically significant differences in the above parameters were supplemented by a lower value of the triangular index, which integrally reflects the decrease in WRC. The presence of hypertension in the patients of the 2nd middle age, in contrast to young people and at a low level, and at a moderate and high levels of the FA, was accompanied by a decrease in SDNN, RMSSD, PNN (50) values, which indicated the smaller general HRV, low parasympathetic activity the vegetative nervous system; on the contrary, higher VI confirmed the participation of the central contour and the intensity of the regulation of the rhythm of the heart. Conclusion: determination of the predictors of the development of AG reflecting the general HRV, the sympathy-vagal balance and the tension of the rhythm of the heart rhythm associated with the levels of psychological stress and physical activity, as well as age, can be broadcast in an outpatient practice to designate targets of preventive and rehabilitation activities.

Objective: improving the effectiveness of hypertension control in patients after COVID-19 with manifestations of depression. Materials and methods: the study included 48 patients with hypertension who had suffered a coronavirus infection. The criterion for inclusion in the study was effective control of blood pressure when using two-component antihypertensive therapy before the development of coronavirus disease and its absence when using the same therapy at the time of inclusion in the study. To identify the symptoms of depression, a study was conducted using the Beck Depression questionnaire. Group A consisted of patients with arterial hypertension with manifestations of depression and group B-patients with arterial hypertension without symptoms of depression. In both groups, a combination of a renin-angiotensin-aldosterone system blocker, a diuretic and a calcium channel blocker were used. The observation was carried out for 4 weeks, the dynamics of blood pressure and its daily parameters, manifestations of depression were evaluated. Results: the presence of symptoms of depression was detected in 39.5% of patients. At the time of inclusion in the study, office blood pressure exceeded the target level in all patients, there was an insufficient decrease in systolic and diastolic blood pressure during the day and at night, an increase in most indicators of blood pressure variability. The use of three-component therapy made it possible to achieve the target blood pressure level in 93.1% of patients without symptoms of depression. In the group of patients with depression, only 21.0% of patients reached the target blood pressure level. The analysis of daily blood pressure indicators showed a decrease in the effectiveness of antihypertensive therapy in the group of patients with depression. All daily blood pressure indicators were statistically significantly higher than in group B. Conclusion: in patients who have suffered a coronavirus infection, it is necessary to identify depression as a possible factor of ineffective control of arterial hypertension and a decrease in adherence to the recommended therapy.

Objective: to study the effect of testosterone (T) levels on laboratory and instrumental markers of endothelial dysfunction (ED). Materials and methods: the study included 276 male patients with type 2 diabetes mellitus (DM). General clinical studies were carried out, analysis of parameters of carbohydrate metabolism, the content of hormones (total T, SHBG, free T, estradiol, LH, FSH, prolactin, TSH, DHEA) were performed. Endothelial secretory function was assessed using markers such as: nitric oxide (NO), endothelial NO synthase type 3, endothelin, ICAM-1, VCAM-1, p- and e-selectins, cadherin, PAI-1, VEGF-1. Additionally, the content of biologically active substances affecting endothelial function was studied: homocysteine B, C-reactive protein (CRP), osteoprotegerin, leptin, resistin, adiponectin. The vasomotor function of the endothelium was assessed by ultrasound examination of the endothelium-dependent vasodilation (EDVD) of the brachial artery (BA) during the reactive hyperemia test; in addition, the thickness of the intima-media complex (TIM) of the carotid arteries was measured. Correlation analysis was performed using Spearman’s method. Results: the level of total T is interrelated with the instrumental parameters of the endothelial function: the TIM of the carotid arteries (r = -0.26; p = 0.009), the time of maximum BA vasodilation development (r = -0.41; p <0.001), EDVD (r = 0 , 28; p = 0.004), as well as laboratory markers of ED: ICAM-1 (r = -0.45; p <0.001), VCAM-1 (r = -0.29; p <0.001), cadherin (r = -0.36; p <0.001), NO (r = 0.32; p = 0.002), VEGF (r = -0.23; p = 0.001), CRP (r = -0.29; p <0.001) and adipohormones: leptin (r = -0.26; p = 0.01), resistin (r = -0.24; p <0.001) and adiponectin (r = 0.28; p = 0.007). Conclusion: T deficiency is associated with a deterioration in the vasomotor function of the endothelium: a decrease in EDVD along with an increase in the time of maximum BA vasodilation development and impaired endothelial secretory function: an increase in the concentrations of VCAM-1, ICAM-1, cadherin, VEGF and, on the contrary, a decrease in NO levels. A decrease in T levels is accompanied by an increase in the content of CRP, resistin, leptin and a decrease in adiponectin, which aggravates the dysfunction of the endothelium.

Objective: to analyze the effect of adhesion molecules (ICAM-1, VCAM-1) and blood heparan sulfate in combination with clinical and morphological signs on the likelihood of remission in glomerulonephritis. Material and methods: 80 patients with glomerulonephritis aged 35.7±10.9 years were included. Serum levels of ICAM-1, VCAM-1 and heparan sulfate were determined in all patients by quantitative enzyme immunoassay. Puncture nephrobiopsy was performed with verification of the form of nephritis and determination of signs of TIC, TIV, glomerulosclerosis. Results: It was shown that high values of heparan sulfate and uric acid in the blood reduce the likelihood of achieving remission in glomerulonephritis. Also, high values of heparan sulfate in the blood against the background of pronounced TIC or TIV were accompanied by a decrease in the probability of remission. An increase in the level of ICAM-1 in the blood, combined with an increase in age, the level of fibrinogen in the blood, as well as an increase in the phenomena of TIC, TIV and glomerulosclerosis, reduce the likelihood of achieving remission in glomerulonephritis. It was also shown that an increase in the level of VCAM-1 in the blood against the background of an increase in the patient’s age, hyperuricemia, an increase in the phenomena of TIV, TIC and glomerulosclerosis is accompanied by a decrease in the probability of achieving remission. We have compiled nomograms for assessing the prognosis of remission development. Conclusion: the assessment of the levels of heparan sulfate, ICAM-1 and VCAM-1 in the blood, together with a number of clinical and morphological signs, is an important tool for predicting the effectiveness of glomerulonephritis therapy.

Takotsubo cardiomyopathy is a relatively benign condition characterized by stress-induced hypo- and akinesis of the apical segments of the myocardium against the background of intact function of the basal segments. With the addition of obstruction of the left ventricular outflow tract (LVOT) due to hyperkinesis of the basal segments, the patient’s condition and prognosis significantly worsens. In terms of hemodynamic parameters, this situation is similar to obstruction of LVOT in patients with hypertrophic cardiomyopathy, however, due to its rapid development, it can lead to the formation of acute heart failure against the background of low ejection syndrome and acute mitral insufficiency. This article presents a literature review, information on the epidemiology, pathophysiology and diagnosis of this disease, as well as a clinical case of the development of acute heart failure with obstruction of the left ventricular outflow tract and progression of takotsubo syndrome.

Presents a clinical case of a patient developing secondary biliary cirrhosis due to prolonged extrahepatic cholestasis caused by cholelithiasis and the presence of choledocholithiasis, which is rare. The article describes the characteristics of secondary biliary cirrhosis of the liver. The course of the disease is considered, the data of laboratory and instrumental studies carried out on the patient in various clinics are analyzed.

In real clinical practice more and more often doctors treat comorbid patients. The high prevalence of cardiovascular diseases with various comorbid conditions contributes to the progressive increase in the number of patients with a concurrence of several diseases. A comorbid patient is a serious problem for any clinician, since in this case it is necessary to take into account several components of therapy, which makes it difficult to control treatment efficiency, contributes to an increase in polypharmacy, the risk of local and systemic side effects of drugs, and reduces adherence to therapy. A comorbid patient is a serious problem for any clinician. The paper describes and discusses the clinical case of a comorbid patient, who admitted to the cardiological department initially but he had also rheumatological problems (gout), kidney affection.

The article is devoted to the quality of medical care from the point of view of the legal consequences of conflict situations arising during the provision of medical services. The authors made an attempt to analyze the most typical conflict situations with possible legal consequences of their resolution based on examples from official sources of information.

«Each of us has a Master. The first teacher to teach us how to read and write, add numbers and solve problems. The school teachers who taught us to love the Motherland and life, make friends and cherish beauty. Life teachers who taught us the lessons of love and hate, good and evil. Apart from the number of teachers who gave us general knowledge of life, there are People who taught us the great art of healing, who gave us professional foundations, who revealed to us the secret mysteries of healing. Each of us will name dozens of such Teachers, who have invested reasonable and light in us, who have given us a piece of their soul. But among them there is the very main Teacher who was able to consider in you only the visible sprouts of knowledge, the inclinations of a future doctor, the ability to master the profession. The very main Teacher who gave you all his knowledge and experience, taught you the art of healing, which became the basis of your profession, the meaning of your whole life. Tatiana Igorevna Zavadskaya was such a teacher», — recalled one of her many students, Yuri Ivanovich Zudbinov.
The article is dedicated to the 100th anniversary of the birth of Zavadskaya T.I. - Associate Professor of the Hospital Therapy Department of the Rostov State Medical Institute, an experienced clinician, an enthusiastic scientist, a talented teacher and an outstanding personality.