The concept of high-risk pulmonary artery embolism determines that verification of the occlusion of the pulmonary arterial bed requires urgent restoration of pulmonary blood flow in such patients. Thrombolytic therapy is currently recognized as the main treatment for pulmonary artery thromboembolism. It can save patients’ lives, prevent the development of chronic post embolic pulmonary hypertension and thromboembolism recurrence. The literature review presents thrombolytic medications used in the treatment of pulmonary thromboembolism, describes indications for thrombolytic therapy, comparative efficiency and safety of various thrombolytics. The main complications of thrombolytic therapy are described and the issues of increasing its safety are raised. Criteria for the success of thrombolysis are early diagnosis, accurate risk stratification, and adequate use of reperfusion agents in patients with high-risk or transitionally high-risk of pulmonary embolism.

The rate of thromboembolic complications associated with thrombophilia is very high; therefore the detection of thrombophilia mutations in the high-risk group of patients is important for the prevention of morbidity, mortality and obstetric losses. The problem of thrombophilia is dealt with by doctors of various specialties: laboratory stuff, geneticists, vascular surgeons, hematologists, neurologists, cardiologists and obstetricians-gynecologists. At the same time, patients with spontaneous thrombosis are followed-up for years without proper examination for thrombophilia. Considering that pregnancy is a condition associated with a high probability of re-thrombosis, it is advisable to determine the cause and tactics of management and treatment of pregnant women as early as possible during the period of pregnancy.

Proximal gastric resection (PGR) is still one of the most difficult and dangerous surgical interventions, and it is the only method of curative treatment of diseases of the cardiac part of the stomach in many cases. 5 types of gastrointestinal reconstruction are mainly performed after PRG: submerged rectal esophagogastroanastomosis, antireflux interposition of the jejunal segment, interposition of the jejunal segment of the jejunal pocket, interposition of the jejunal segment as a double tract and reconstruction with the formation of a gastric tube. Modern literature includes many works devoted to the development of methods of physiological reconstruction after subtotal and total removal of the stomach; however, none of the existing methods is recognized as optimal. Among the main indicators characterizing the effectiveness of PGR are the frequency and severity of the development of a large group of functional disorders, characterized as «diseases of the operated stomach», or «post-gastro-resection disorders», which significantly worsen the quality of life (QOL) and reduce the working capacity, which causes disability of the operated patients Assessment of QoL after surgery for diseases of the cardiac stomach is a fundamentally important component of monitoring the effectiveness of treatment and, therefore, allows one to determine the indications for certain types of interventions. The available world scientific literature does not provide convincing data on the assessment of QOL in patients after proximal resection for cardiac part of the stomach diseases, since there are no clear criteria for its assessment depending on the chosen methods and methods of reconstruction of gastrointestinal tract (GIT). In this regard, there is a need for further study of proximal resection with reconstruction of the gastrointestinal tract in surgical diseases of the cardiac part of the stomach on the basis of analysis of immediate and long-term results, as well as the quality of life of patients who underwent these surgical interventions.

Coronary heart disease (CHD) is the main cause of the occurrence and progression of heart failure, as well as mortality among the adult population, both in Russia and around the world. Determining the functional state of the myocardium before surgery allows one to choose the right treatment strategy, methods of surgical correction of coronary disorders, and predict outcomes.

Aim. The research aims at the improvement of methods for predicting revascularization outcomes by creating a mathematical model depending on the number of viable myocardium.

Material and methods. We examined 118 patients with a diagnosis of CHD who underwent surgical correction of coronary blood fl ow disorders with the use of direct and indirect revascularization methods at the Pirogov National Medical Center. We analyzed correlation between gated-SPECT, Echocardiography and operation results.

Results. An inverse strong correlation has been found between LV contractility after surgery and the preoperative amount of scar myocardium and the end diastolic volume (EDV) LV (p < 0.05, Spearman criterion). A direct correlation has been determined between the improvement of EF and the volume of the hibernated myocardium (p < 0.05, Spearman criterion). There is a model for predicting EF after revascularization: Ejection fraction (after revascularization)(%) = 70.99126 − 0.10490 × EDV (ml) + 0.38827 × hibernated myocardium(%) − – 0,50137 × scar myocardium (%).

Conclusion. Statistical modeling based on quantitative and qualitative assessment of the functional state of the myocardium in patients with CHD with the use of gated-SPECT and Echocardiography is an actual and necessary way to fi nd optimal solutions in the treatment and rehabilitation of patients with CHD.

Deficiency of vitamins is a risk factor for the development of various diseases of the gastrointestinal tract (GIT), and, on the contrary, diseases serve as the cause of the deficiency of these micronutrients. Data on the actual vitamin status of gastrointestinal patients are necessary to develop measures for its improvement.

Material and methods. The blood serum level of vitamins C, A, E, B₂ and β-carotene in 29 patients (10 men and 19 women) 22–80 years old with gastrointestinal diseases has been determined. The first group consisted of 14 patients with irritable bowel syndrome (IBS). The second group included patients with gastrointestinal diseases of various etiologies.

Results. There was no significant difference in vitamins C, A, E, B₂ and β-carotene sufficiency in patients with IBS and those with other gastrointestinal diseases. The characteristic features of the vitamin status of patients in both groups were the absence of individuals optimally provided with all vitamins, and a rather high frequency of occurrence (27.6%) of multiple deficiency of 3 vitamins and β-carotene. When the evaluation using 3 indicators at the same time (absolute concentration of vitamins C, E and their molar ratio) was carried out, only two patients in each group were optimally provided with vitamins C and E, and only three of them were optimally provided with β-carotene. Four patients in each group were adequately provided with all the vitamins studied. A combined deficiency of 3 micronutrients (any two vitamins and β-carotene) was found in two patients; combined deficiency of two vitamins or one vitamin and β-carotene was noted in 24.1% of the examined.

Conclusion. A purposeful development of vitamin complexes with effective doses for gastrointestinal patients is necessary.

Rationale. The search for a more effective therapy for vasospastic angina pectoris, taking into account clinical and economic indicators.

Objective. To compare the clinical and economic efficiency of therapy with metoprolol tartrate and metoprolol succinate in patients with vasospastic angina.

Materials and methods. A randomized study involving 77 patients with a follow-up period of 12 months was conducted. The results were compared in terms of antianginal efficacy parameters between a group of patients (n = 41) with vasospastic angina pectoris who received metoprolol tartrate (Еgilok at a dose of 25 mg 2 times a day) for standard therapy with a calcium antagonist (Norvasc), with a similar group of patients (n = 36) who received metoprolol succinate (Betaloc ZOK 50 mg). The primary endpoints were cardiovascular death, development of AMI, stroke, secondary endpoints — the number of clinically significant angina attacks, patients were followed up for 12 months (over 15 minutes, cases requiring hospitalization or calling an ambulance team).

Results. During the observation period, a significant difference was obtained in the incidence of clinically significant angina attacks (p = 0.043) with an advantage in the group of patients receiving metoprolol succinate. According to the primary endpoints, there was no significant difference in the groups of metoprolol tartrate and succinate: in the number of cardiovascular mortality (p = 0.94), development of AMI (p = 0.89), stroke (p = 0.53).

Conclusion. There are no significant differences in the incidence of adverse cardiovascular events, such as AMI, stroke, including those leading to death in the groups of patients with vasospastic angina taking metoprolol tartrate or succinate. However, there is a significant difference in the incidence of clinically significant anginal attacks with the advantage of succinate salt. Metoprolol tartrate has great pharmacoeconomic advantages.

This review discusses the role of various foods in the onset of functional dyspepsia (FD) clinical symptoms. Currently, the ability of fats to cause a feeling of fulness in the epigastric area and nausea in these patients has been proven. The significance of other food products in the development of dyspeptic symptoms is evaluated inconsistently. A few conducted studies have not confirmed the effectiveness of the gluten-free diet and. the diet with low content of oligosaccharides, disaccharides, monosaccharides and polyols in the treatment of patients. The role of nutrition in the development of FD and the possibility of dietary therapy for this disease require further research.

The objective of the study was to investigate the prevalence of smoking and its influence on the parameters of arterial stiff ness in men of working age.

Material and methods. The study included 86 men aged 37.6 ± 7.6. The prevalence and intensity of smoking was assessed. Among the experimental subjects, 48 people were selected and divided into two groups (smokers and non-smokers) comparable due to other cardiovascular risk factors. In both groups, arterial rigidity was studied by volumetric sphygmography.

Results and discussion. The prevalence of tobacco smoking was 46.5%, and half of the smokers had a smoking index greater than 10 packs/years. The CAVI index in smokers was 7.0 ± 1.2; in non-smokers — 6.3 ± 0.5 (p = 0.02). CAVI was increased above the age limit in 22% of smokers, and there were no deviations from the norm in the other group. There was a positive correlation of the CAVI index with both smoking duration (r = 0.67, p < 0.0001) and the pack/years index (r = 0.36, p = 0.04).

Conclusion. The prevalence of tobacco smoking among men of working age remains high: about half of them are smokers. Every fifth male smoker has an increase in vascular stiffness above the age norm, which may indicate vascular remodeling.

Aim: to study the risk factors, clinical peculiarities, diagnosis and treatment of young patients with myocardial infarction (≤ 44 years).

Material and methods. The research included 189 patients, who had MI in the period from January 1, 2015 to December 31, 2019 at the age of ≤ 44; 92.1% of patients were men. The average age of all patients was 41,2 (37.3; 43.6).

Results. Most frequent risk factors for the development of MI were: smoking — in 77.8%, essential hypertension — in 73.5%, burdened inheritance — in 49.2%, obesity — in 39.7% and pancreatic diabetes — in 10.6% of all cases. ST segment elevation was registered on the electrocardiogram in 87,8% of patients; 4.2% of them had only thrombolytic therapy; thrombolytic therapy was followed by coronarography with the intention of performing percutaneous coronary intervention (PCI) in 30.7% of cases; coronarography with the intention of performing primary PCI was applied to 54.2% of patients. PCI was performed in 76.5% of patients. 12.2% of patients had acute coronary syndrome without ST-segment elevation, and 95.7% of them had coronarography with the intention of performing percutaneous coronary intervention. PCI was performed in 73.9% of patients. Assignment frequency of beta-adrenergic blocking agent prescription was 95,2% (178 out of 187), аngiotensin-convertingenzyme inhibitors and sartans — 95.2% (178 out of 187), statins — 99.5% (188 of 189), dual antiplatelet therapy — 99.5% (188 out of 189), mineral corticoid receptor antagonists with ejection fraction of left ventricle of heart ≤ 40% — 28.6% (2 of 7).

Conclusion. The conducted research aims at the discussion of the vital topic of young patients with myocardial infarction management. It focuses on risk factors, clinical and angiographic presentation, and secondary prevention.

Clinicians have noted an increase in the level of hepatic transaminase in patients with the new coronavirus infection COVID-19 a number of times, and an unambiguous answer to the question of what caused this change in laboratory indices has not been received yet. The course of COVID-19 is often complicated by the development of haemophagocytic syndrome, and preventive anti-inflammatory therapy is required for its treatment, which is represented by biologic drugs (interleukin-6 inhibitors or JAK-kinase blockers) and glucocorticosteroids. It has been noted that the level of ALT and AST increases against the background of biological therapy.

The objective of the present study was to analyze the possible effect of biological therapy on the functional state of the liver.

Material and methods. The study randomly included 38 patients diagnosed with ICD-10 U07.1 (18 women and 20 men). Inclusion criteria were control of aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin at least three times during the period of hospitalization, as well as an increase in these indicators above the reference values. This study was carried out while prescribing preventive anti-inflammatory therapy.

Results. The median (Me ± SD) age of the patients was 57 ± 14.67. Mann–Whitney U-test showed no significant difference in the activity of liver enzymes and total bilirubin upon admission to the infectious diseases hospital (p> 0.05). A statistically significant difference in indicators evaluation at admission and at discharge was determined using the Wilcoxon test for ALT levels in the group receiving biologic drugs (p = 0.004). In other cases, there was no statistically significant difference (p > 0.05). When analyzing the level of enzymes for the entire period of hospitalization with the use of Friedman criterion, the level of changes in hepatic transaminases in the group with the use of biologic drugs turned out to be equal for ALT p = 0.001. When assessing changes over the entire period of hospitalization by the de Ritis coefficient, the p-value was also significant (0.001) in this group.

Conclusion. This study shows the necessity to control the level of hepatic transaminase, especially when prescribing biological therapy for haemophagocytic syndrome.

Pulmonary arterial hypertension (PAH) is an orphan disease characterized by an increase in pulmonary vascular resistance (PVR). PAH is a pathology, difficult to diagnose due to the non-specificity of its first strokes. The prognosis of PAH is extremely unfavorable without early diagnosis and treatment, as with systemic scleroderma, 60% of patients die in the first 2 years. In the Republic of Sakha (Yakutia), there are currently 38 patients with PAH, and a tendency towards an increase in their number is noted. The necessity to conduct scientific research on PAH patients living in the Republic of Sakha (Yakutia) is urgent due to the fact. The article represents a 1.5-year clinical observation of a 45-year-old patient with PAH associated with systemic scleroderma, which demonstrates difficulties in the differential diagnosis of PAH, late initiation of PAH-specific pharmacotherapy. The article discusses the efficiency of the original PAH-specific drugs use, and their generics.

Тhis article is devoted to the achievement of medical scientists in hero-city Leningrad, who conducted scientific research and obtained unique results during the tragic days of the siege.