卷 28, 编号 13 (2021)

According to the 2019 National Survey on Drug Use and Health, 85.6 percent of people ages 18 and older reported driank alcohol at some point in their lives, 69.5 percent reported. that they drank alcohol in the last year and 54.9 percent reported that they drank alcohol in the last month. Also, in the US in 2015-2016, 45.8% of the population used at least one prescription drug in the past 30 days, most of which belonged to the drugs used for the treatment of cardiovascular diseases and antibiotics. Potentially, these drugs can enter into pharmacodynamic or pharmacokinetic interactions. For example, a suppression of activity of alcohol dehydrogenase in the stomach due to consumption of acetylsalicylic acid, that can lead to an increase in Cmax and average AUC of ethanol, and therefore- to increase its toxicity! Another example of an interaction is a decrease in the serum concentration of amiodarone and a decrease in its effectiveness due to the consumption of a large doses or long-term use of ethanol. Alcohol can also affect the effectiveness of antibiotic therapy. For example, ethanol can change the rate, but not the degree of absorption of amoxicillin; reduce Cmax and AUC of erythromycin; increase the bioavailability of tetracycline. Thus, the risks of complications or insufficient effectiveness are extremely high in patients taking alcohol and drugs at the same time for the treatment of diseases of the cardiovascular system, gastrointestinal tract or infectious diseases. To reduce the risks of complications, the potential interactions of alcohol and drugs should be taken into account when choosing drug therapy, but it is still more effective strategies to exclude the combined use of alcohol and drugs.

Facet syndrome (FS) is the main cause of pain in 10-15% of young adult patients with chronic low back pain and much more often in older populations (according to various sources, from 40 to 85-90%). Each spine segment consists of the intervertebral disc, vertebral bodies, and posterior paired synovial joints, which make up a «three-component complex», where each component affects the other two, allowing a variety of movements, and the spine is a flexible mobile structure. Many authors have demonstrated pathological degenerative changes in these joints over time, as well as the associated inflammatory changes. The most common cause of facet joint disease is degenerative changes in the spine. FS is characterized by a relapsing course, gradual development, slow regression of each painful episode, a tendency to lengthening and aggravation of each subsequent exacerbation. A clinical case of a patient with chronic low back pain is presented. After examination and appropriate treatment, the patient noted an improvement. Conclusion. The clinical assessment of patients with suspected FS is based on the features of the clinical picture, «pain pattern», special tests that allow correct differential diagnosis with similar nosological forms and prescribe an optimal treatment.

Ischemic heart disease (IHD) is the leading cause of death and disability worldwide. The high mortality rate in patients with IHD is primarily due to the presence of comorbid conditions that can mutually aggravate each other’s course and significantly worsen the prognosis. The most common concomitant pathology in patients with IHD is considered to be chronic heart failure (CHF). The combination of IHD and CHF reduces the quality of life of patients and increases the risk of death. In this regard, drug therapy in this clinical situation should be not only optimal in terms of safety, but also effective. However, the existing approaches to the treatment of IHD, including in the presence of CHF, do not demonstrate the desired results in reducing mortality and the incidence of cardiovascular events, therefore, there is a need to improve the tactics of managing patients with IHD and CHF. Currently, there is convincing evidence that metabolic disorders in the myocardium, including mitochondrial dysfunction, play an important role in the development and progression of IHD and CHF. In this regard, metabolic therapy aimed at increasing the energy efficiency of the myocardium is of particular interest in the treatment of patients of this category. One of the most studied metabolic drugs is trimetazidine. The aim of this review was to study the literature data on the possibility of using trimetazidine in the treatment of patients with a combination of IHD and CHF.

The novel SARS-CoV-2 coronavirus infection (COVID-19) has become one of the global problems of the modern world community. An analysis of the factors associated with the severe course and poor prognosis of COVID-19 indicates an important role for comorbid pathology. Cardiac arrhythmias are one of the most common cardiovascular complications of coronavirus infection, and both supraventricular and ventricular arrhythmias can be diagnosed on an ECG. The most common arrhythmia in COVID-19 is atrial fibrillation (AF); in some patients, newly diagnosed AF cases occur during the acute course of coronavirus infection or in the first months after hospital discharge. It has been shown that the prevalence of AF among patients with coronavirus infection is approximately 2 times higher than in the general population, and reaches 8%. The onset of AF leads to an increase in thromboembolic complications and worsens the prognosis of patients with COVID-19. At the same time, the severity of coronavirus infection directly affects the incidence of AF. The administration of anticoagulant therapy is one of the most important directions in the treatment of patients with novel SARS-CoV-2 coronavirus infection. Anticoagulant therapy is indicated for all COVID-19 patients with newly diagnosed AF or a history of AF without exception. The drugs of IC and III classes are recommended to restore sinus rhythm in AF paroxysm in patients with stable hemodynamics. The choice of an antiarrhythmic drug for the relief and prevention of AF in patients with SARS-CoV-2 coronavirus infection should be based on an assessment of the severity of damage to the cardiovascular system.

Background. One of the pathogenetic mechanisms of essential arterial hypertension (AH) is a genetically determined violation of the transmembrane transport of calcium ions in smooth muscle cells of resistance vessels. It is known that the parathyroid glands are among the main regulators of calcium metabolism in the body. Objective. Assessment of the structural and functional remodeling of the heart and blood vessels in the presence of primary subclinical hyperparathyroidism in patients with essential AH. Methods. A cross-sectional clinical study included 88 patients (51 men and 37 women) with uncomplicated/asymptomatic AH I-II degree. In the examined subjects, the blood parathyroid hormone (PTH) levels were in the reference range for age and ranged from 5 to 78 pg/mL. The patients were divided into 3 groups: in group 1 (28 patients) PTH levels ranged from 0 to 20 pg/mL, in group 2 (37 patients) - from 21 to 55 pg/mL, and in group 3 (23 patients) - from 56 pg/mL to the upper reference value. All patients underwent echocardiography and 24-hour blood pressure monitoring, and also determination of the flow-mediated vasodilation of the brachial artery and the daily calciuresis. Results. The detection rate of left ventricular (LV) hypertrophy in group 3 compared to group 1 was significantly higher: 65.2 versus 39.3% (p=0.036). In addition, the value of daily calciuresis, total and free blood calcium in the group 3 was significantly higher than in the group 1. The parameters of the LV myocardial mass index, the interventricular septum thickness and the LV posterior wall thickness in the group 3 significantly (p<0.05) exceeded those in the group 1. In the group 2 and 3, the most pronounced LV diastolic dysfunction was revealed. It was shown that the PTH level directly correlates with the thickness of the intima-media complex of the carotid artery (R=0.57; p<0.001) and the LV myocardial mass index (R=0.29; p=0.006), inversely - with the value of the endothelium-dependent vasodilation (R= -0.33; p=0.002). Conclusion. It was revealed that the blood PTH level, which is the 90th percentile of the reference range, correlates with signs of cardiac and vascular remodeling in patients with uncomplicated/asymptomatic essential AH.

Background. Healthcare practitioners represent one of the most significant professional groups, the number of which in Russia is more than 3 million people. The work of healthcare practitioners is associated with the impact of a variety of unfavorable factors of the working environment. The first place in the structure of occupational pathology of healthcare practitioners is consistently occupied by infectious diseases, accounting for 80.2% on average in Russia. Until now, among the infectious diseases of healthcare practitioners, tuberculosis and viral hepatitis prevailed. Healthcare practitioners are a group at increased risk of infection with the SARS-CoV-2 virus during the provision of medical care in modern conditions. A novel coronavirus infection in healthcare practitioners can be considered an occupational disease if the introduction of infection occurred during the course of their professional duties. In 2020, in the group of occupational diseases caused by the influence of biological factors, the first place is occupied by diseases caused by a novel coronavirus infection. The presence of severe complications and disability determine the relevance of the analysis of the features of occupational diseases in healthcare practitioners in order to improve their diagnosis, prevention, treatment and rehabilitation. Objective. Evaluation of the state of occupational morbidity of healthcare practitioners in the Samara region over the past 3 years (2018-2020) to determine the main trends in its dynamics, to analyze the structure, taking into account nosological forms, professions, and their features in the context of a pandemic of the novel coronavirus infection COVID-19 in 2020-2021. Methods. The analysis of the state of occupational morbidity of healthcare practitioners in the Samara region was carried out according to the data of the Samara Regional Center for Occupational Pathology for the period 2018-2020 based on expert, reporting and statistical methods. Results. Occupational morbidity in the Samara region remains at a high level and exceeds the national average ones. In 2018-2019, overexertion-caused diseases (45.6%) occupied a leading position among the nosological forms of occupational diseases of healthcare practitioners in the Samara region. Allergic pathology was in second place during this period (32.25%); diseases associated with exposure to biological factors accounted for 16.12% (tuberculosis - 60% and viral hepatitis - 40%). In 2020, the ratio of acute and chronic occupational morbidity changed due to the COVID-19 pandemic. In the structure of nosological forms of occupational diseases, the first place was taken by diseases associated with the influence of biological factors - 51.21%, with leading position of diseases caused by a novel coronavirus infection (92.3%). In the period from 2020 to October 2021, medical workers in the Samara region were diagnosed with 152 cases of acute occupational disease, a novel coronavirus infection COVID-19 (74 cases with temporary disability, 78 fatal) and 5 cases of chronic occupational diseases, associated with the coronavirus infection, which determined the permanent disability. Conclusion. Currently, the working environment of healthcare practitioners does not exclude a further increase in occupational morbidity. In the context of the spread of the novel coronavirus infection around the world, it is necessary to direct more efforts to increase knowledge and study of COVID-19 from the perspective of occupational medicine in order to preserve the health of healthcare practitioners as a socially significant category of citizens that ensures the maintenance and improvement of public health.

Objective. Assessment of the effect of the new blood substitute rheoambrasol on the hypoxia-inducible factor (HIF-1a) level, lipid peroxidation (LPO) and the antioxidant system in toxic hypoxia. Methods. The model of toxic hypoxia was performed in outbred male rats. In the blood of experimental animals, the HIF-1α level, biochemical parameters using HUMAN test systems (HUMAN Gmbh, Germany), the intensity of lipid peroxidation by the level of malondial-dehyde, the activity of enzymes of the antioxidant system (AOS): catalase, superoxide dismutase, glutathione reductase and glutathione peroxidase were determined. Results. The action of rheoambrasol was clearly manifested and showed that the new blood substitute restores biochemical parameters and reduces the HIF-1α level and the balance of the LPO/AOS system in toxic hypoxia more effectively than rheopolyglucin. The biologically active composition, including a polysaccharide and a bioenergetic substrate, has good antihypoxic, antioxidant, detoxifying, membrane protective effects, which makes it possible to recommend it for various hypoxic toxic conditions. Conclusion. The created new blood substitute rheoambrasol, containing a polysaccharide and a bioenergetic substrate, restored the structural and functional parameters of the liver, which was manifested by a slowdown in the process of cytolysis, cholestasis in toxic hypoxia. The new blood substitute has an antihypoxic effect, reducing the level of hypoxia-inducible factor HIF-1α by 4.5 times (pi<0.05). Rheoambrasol has an antioxidant effect, reduces the intensity of LPO processes and restores the activity of AOS enzymes.