Сardiovascular disease (СVD) is the most common complication of chronic kidney disease (СKD). In patients with the earlier stages of CKD, the risk of death from CVD greatly exceeds the risk of progression to end-stage renal disease. In recent years, accumulated data suggest that chronic kidney disease — mineral and bone disorders (CKD-MBD) are strongly associated with cardiovascular events and mortality. Among cardiovascular damage in CKD, both, the progressive cardiac remodeling and vascular calcifi cation, contribute immensely, and lead to an urgently high cardiovascular mortality in patients with CKD. Clarifi cation of CKD progression mechanisms and possible early markers of CVD has led to interest in studying the identifi ed factors such as fi broblast growth factor-23 (FGF-23), Klotho and sclerostin in recent years. Results of studies show that disorders in the system of FGF-23–Klotho–sclerostin correlate with the frequency and severity of hypertension, cardiac remodeling, vascular calcifi cation, anaemia, malnutrition, infl ammation, and strongly aggravate cardiovascular risk in CKD. This review represents an analysis of the available data showing the potential association of СVD with established (phosphate, parathyroid hormone (PTH), Vitamin D) and newer (FGF-23, Klotho, sclerostin) СKD-MBD biomarkers. In addition, it has been shown that renoprotective therapy, including renin-angiotensin blockers, low-protein diet with amino/keto acid supplementation, phosphate binders, erythropoiesis stimulators, vitamin D metabolites used to reach the target levels of blood pressure, serum phosphorus, haemoglobin, PTH and nutritional status disorders, can aff ect CKD-MBD biomarkers and reduce the risk of cardiovascular events in CKD patients.

The review refl ects modern data on the epidemiology of acute rheumatic fever and chronic rheumatic heart disease in Russia and the world at present, as well as the dynamics of the prevalence of these diseases over the past decades. Much attention is paid to the issues of modern diagnostics of these conditions by physical, laboratory and instrumental methods. The focus is on the Jones criteria in the diagnosis of acute rheumatic fever in accordance with their revision by the American Heart Association experts in 2015. Taking into account the fact that damage to the valvular apparatus of the heart in acute rheumatic fever is the main disabling outcome of carditis at the present stage, a special place in the article is devoted to the discussion of echocardiographic criteria for valvulitis. The recommendations of the International Expert Council of the World Heart Federation aimed at detecting chronic rheumatic heart disease in patients without a history of acute rheumatic fever diagnosed by ultrasound imaging are also given. Criteria for pathological aortic and mitral regurgitation are presented. The authors believe that extrapolation of modern principles of ultrasound diagnostics of chronic rheumatic heart disease in Russia and their use as screening programs in young people and adolescents will contribute to its early detection and timely selection of patients for secondary prevention of benzathine with benzylpenicillin.

Objective: to study the role of free radical processes, disturbances in nitric oxide homeostasis and cholesterol metabolism in the formation of endothelial disorders in patients with chronic heart disease (CHD) with eff ort angina pectoris functional class II (FC); to substantiate the complex correction of disorders. 
Material and methods. The study included 75 patients with coronary artery disease and eff ort angina FC II at the age of 50.1 ± 10 years old in the course of a year. The patients were divided into 4 groups: 1st group — control, 2nd group — data obtained on the background of basic therapy; 3rd group — basic therapy + atorvastatin; 4th group — a combination of basic therapy with atorvastatin and coenzyme Q₁₀. In all patients, the intensity of lipid peroxidation, the activity of the antioxidant system, the content of NO metabolites and cholesterol metabolism were determined. To assess the functional state of the heart, an ECG study, daily ECG monitoring with the use of the Microvit MT-101 Holter system and blood pressure were performed. 
Results. The data showed the development of oxidative stress, inhibition of AOD cells and a decrease in the NO metabolites content and impairment of its bioavailability due to atherogenic changes in the vascular wall. Metabolic changes were accompanied by hypertension, ECG changes and anginal attacks. Combined therapy with atorvastatin and coenzyme Q₁₀ against the background of basic therapy caused a positive dynamics of metabolic and functional disorders. 
Conclusion. The results of complex therapy with an inhibitor of HMG-CoA reductase and coenzyme Q₁₀ proved the effi cacy of the infl uence on oxidation-reduction reactions, endothelial function, total cholesterol, LDL cholesterol, HDL cholesterol and functional parameters of the heart.

Рurpose. To increase the treatment eff ectiveness of patients with various forms of nephrolithiasis based on the development and integration of interdisciplinary approaches to the choice of surgical access. 
Materials and methods. The study was based on clinical and laboratory data and the results of surgical treatment of 133 patients with various forms of urolithiasis. 
Results. The analysis of complications of percutaneous surgery is shown by the example of 133 patients with various forms of nephrolithiasis, who underwent PCNL (percutaneous nephrolithotomy). The inclusion of highly informative methods of visualization of urinary stones, multispiral computed tomography with 3D-visualization and densitometry namely in the algorithm of examination of patients with nephrolithiasis is justifi ed. The possibilities of interventional radiology in the elimination of hemorrhagic complications of percutaneous surgery of urolithiasis, including staghorn nephrolithiasis, are presented. 
Conclusion. The eff ectiveness of the creation of multidisciplinary surgical teams, including specialists in the fi eld of interventional radiology, for the interpretation of diagnostic results, as well as the prevention and elimination of intra- and postoperative hemorrhagic complications, is proven.

The purpose of the study was to examine susceptibility of the Kazakhstan strains of infl uenza A/H1N1 and type B viruses, isolated from various regions of Kazakhstan in 2018–2019, to antiviral drugs. 
Materials and methods. The susceptibility analysis of 20 strains of infl uenza A/H1N1 and B viruses was carried out with chemotherapeutic agents including Remantadine, Tamifl u, Arbidol, and Ingavirin. Viruses were cultured in the allantoic cavity of developing 10-day-old chicken embryos for 48 hours at 36 °C. The hemagglutinating activity was determined according to the conventional method on 96-well plates using 0.75% chicken red blood cell suspension; the infectivity was calculated by the Reed-Muench method. The sensitivity of virus strains to diff erent concentrations of antiviral drugs was evaluated by the level of reproductive suppression of 100 lg EID50/0.2 ml of virus in chicken embryos. Statistical analysis was performed with the use of Microsoft Offi ce Excel 2010 software. 
Results. A study of sensitivity to chemotherapeutic agents demonstrated heterogeneity of Kazakhstan 2018–2019 infl uenza A and B viruses population on this feature. The sensitivity to Tamifl u was found in all Kazakhstan strains of infl uenza A/H1N1 virus and three type B strains (inhibitory concentration was 0.44–25.38 μg/mL). The reproduction of most viruses was eff ectively inhibited by tamifl u at a concentration of 0.68–3.23 μg/mL. The inhibitory concentration for the three strains of A/H1N1 virus was 7.23–25.38 μg/mL. Remantadin inhibited the reproduction of viruses at higher doses (12.60–25.55 μg/mL). All viruses under study were resistant to Arbidol and Ingavirin. One type B infl uenza virus was found to be weakly sensitive to Ingavirin. 
Conclusion. The heterogeneity of the infl uenza virus population in their sensitivity to antiviral drugs indicates the need for constant epidemiological surveillance in order to identify drug-resistant variants. 

Objective. Compare the eff ect of combination therapy with nebivolol or carvedilol on the functional state of patients with chronic heart failure (CHF) and preserved ejection fraction (pEF) of the left ventricle (LV). 
Material and methods. The study involved 80 patients with diastolic CHF, who were randomized into two groups. In group I was appointed of nebivolol (7.7 ± 2.4 mg/day, n = 40), in group II — carvedilol (30.5 ± 8.7 mg/day, n = 40). As part of the combination therapy, quinapril was prescribed (13.7 ± 2.7 mg/day, n = 40 and 13.5 ± 2.6 mg/day, n = 40), and if indicated — atorvastatin (15.3 ± 4.6 mg/day, n = 17 and 16.2 ± 5.2 mg/day, n = 17) and acetylsalicylic acid in the intestinal soluble shell (96.4 ± 13.4 mg/day, n = 14 and 93.8 ± 13.3 mg/day, n = 13), respectively. Initially and after 6 months of therapy were carried out: quantitative assessment of regulatory-adaptive status (RAS) (by means of a sample of cardiac-respiratory synchronism), echocardioscopy, treadmill test, test with a six-minute walk, subjective assessment of quality of life, determination of the level of the N-terminal fragment of the brain natriuretic peptide in blood plasma, daily monitoring of blood pressure. 
Results. Both schemes of combined therapy comparably improved the structural and functional state of the heart, controlled arterial hypertension. In comparison with carvedilol, nebivolol diff ered positive eff ect on the RAS, more increased tolerance to physical activity and improved quality of life. 
Conclusion. In patients with CHF pEF LV in combination therapy, the use of nebivolol, in comparison with carvedilol, may be preferable due to the more pronounced positive eff ect on the functional state.

Due to the fact that cardiovascular diseases (CVD) are the leading cause of death worldwide, reducing risk factors and maintaining a healthy lifestyle play an important role in primary and secondary prevention of CVD development and improving prognosis. 
The purpose of the study. To study the eff ectiveness of carbon dioxide baths and water training in the primary prevention program for people with CVD risk factors. 
Material and methods. 60 patients (43 women and 17 men) with CVD risk factors were examined before and after a course of carbon dioxide baths and aquatic therapy. The hardware and software complex «Physiocontrol-R» was used. It includes, in addition to psychological testing (Spielberger, SAN, Lüscher tests, сardiointervalography (CIG) for the study of the autonomic regulation of the cardiovascular system, the study of the state of central and peripheral hemodynamics, Bioelectrical impedance analysis (BIA) for the study of body composition. 
Results. In the group of patients who took a complex of carbon dioxide baths and water training, in contrast to the control group, there was an improvement in the clinical condition, hemodynamic parameters, normalization of sympathicovagal balance and body composition. 
Conclusion. The aquatic therapy program in the pool and the use of HCV led to an improvement in the patients ‘ psychoemotional state, improvement of central and peripheral hemodynamics, and sympathico-vagal balance, which is associated with a reduced risk of developing CVD.

Benign lipomatous formations rank second in frequency among primary cardiac tumors. According to the degree of encapsulation, they are divided into two groups — adipose tumors and lipomatous hypertrophies of interatrial septum. Cases of lipomatosis of the heart and lipomatous hypertrophy of interatrial septum were described in scientifi c editions in years past. Interest in this pathology is related to the question: is it necessary to perform preventive surgical intervention before the appearance of clinical signs of endocardial hemodynamics disturbance? Moreover, the risk associated with surgery is much higher than the existence of a benign hyperplastic process in the anatomical structures of the heart.

A new coronavirus infection poses a challenge to infectious disease specialists, health care administrators, and subspecialty physicians in the search for the most eff ective treatment options. The past year has allowed us to clarify the main aspects of pathogenesis with a focus on the most severe versions of the COVID-19 course. Most signifi cant is to understand that the severe course is associated with prolonged viremia and T-cell lymphocyte defi ciency leading to activation of innate immunity, manifested by a burst of macrophage activity known as the “cytokine storm”. This inadequate response is a major factor in both pulmonary and multiple organ failure. Fever, pulmonary infi ltrates with leukocytosis and neutrophilia are traditionally perceived by doctors as indications for antibiotic therapy, which is nevertheless erroneous in the absence of signs of bacterial infection. We present a case that illustrates the severe course of pseudomembranous colitis and secondary myocarditis in an elderly woman with comorbid pathology and massive antibiotic therapy received during hospitalization for COVID-19.

The article presents a clinical observation of long-term (18 years) artifi cial ventilation in a patient in a chronic vegetative state.

The article represents data during the rule of Paul I, his military reforms, the creation of military camps and the construction of station hospitals. The role of Paul I in the establishment of the Medicosurgical Academies and the construction of the Moscow Military Hospital is shown.

The new data about immune-infl ammatory rheumatic diseases pathogenesis with the participation of the processes of autoimmunity and autoinfl ammation attract attention to the heterogeneity of systemic angiitis, their nomenclature, classifi cation, pathogenesis and the approaches to the therapy. Recommendations of the second International Chapel Hill Consensus Conference (CHCC2012) and EULAR recommendation (2016, 2018) regarding diagnostics and treatment of SA are discussed. The data of 141 patients with various forms of SA and 18 patients with the diseases, which relate to the group of autoinfl ammatory processes as well as the retrospective analysis of 130 patients with the hyperimmunoglobulinemia E are given.