Vol 8, No 6 (2022)

The discussion material contains several ways of optimizing the work of physicians at the present stage, concerning both the practical activity of physicians and approaches to their training and professional development.

Currently, the negative role of asymptomatic hyperuricemia (HU) in the development and progression of cardiovascular pathology, metabolic disorders and chronic kidney disease is generally recognized. At the same time, there are few data in the literature on the effect of HU on the course of comorbid pathology (CP) in patients with rheumatoid arthritis (RA). The aim of the study was to study the effect of HU on the frequency and structure of CP in patients with RA. Material and methods. The data of 262 patients with RA and HU and 262 with RA without HU (comparison group) included in the City Register from January 2000 to April 2020 were analyzed. Information was entered on demographic characteristics (gender, age), diagnosis, presence and duration of HU, presence of CP and CP therapy. HU was understood as a recorded increase in the level of uric acid (UA) in the blood serum >360 mmol/l by И time. Results. The data of 524 patients (440 women and 84 men, the average age 60,0±13,6 years) with RA for the period from January 2000 to April 2020 were analyzed. Patients with HU were divided into two subgroups: the first - the level of UA less than 500 mmol/l, the second - the level of UA more than 500 mmol/l. Patients with HU had a high incidence of arterial hypertension (84,21, 80,91 and 51,14 %), atrial fibrillation/flutter (9,21, 8,18 and 4,19 %), chronic heart failure of functional class I-III (23,68, 20 and 8,78 %), hypercholesterolemia (62,5, 67,27 and 34,4 %), prediabetes (18,42, 17,27 and 4,96 %), type 2 diabetes mellitus (25, 25,45 and 11,45 %), obesity of 1-3 degrees (32,89, 22,73 and 4,96 %), cholelithiasis (24,34, 21,82 and 11,07 %), non-alcoholic fatty liver disease (23,03, 23,64 and 6,49 %), urolithiasis (14,47, 16,36 and 8,78 %), kidney cysts (17,76, 20 and 9,16%), chronic kidney disease of stages 1-4 (58,55, 57,27 and 35,5 %) in comparison with patients without HU (p <0,05). Conclusions. 1) HU in patients with RA is associated with a higher frequency of cardiovascular diseases, metabolic disorders and chronic kidney disease. 2) Arterial hypertension (84%), hypercholesterolemia (62%) and chronic kidney disease (58%) were most often detected.

Currently, there are only sporadic reports on the informative value of traditional risk scales for thrombosis and bleeding in patients with novel coronavirus infection (NCI) COVID-19 in the presence of COVID-associated coagulopathy. The aim of the research was to assess the predictive ability of conventional thrombosis and bleeding prognostication scales in the cohort of NCI COVID-19 patients, and to develop the own predictive thrombosis scale. Material and methods. The work was carried out on the basis of the Center for treatment of patients with NCI of I.P. Pavlov State medical university: medical records of 945 patients hospitalized in the Center from November 01, 2020 to March 05, 2021 were retrospectively analyzed, cases of hospitalization accompanied by thrombotic and hemorrhagic events were verified. To determine the efficacy of predicting the development of these complications before they occur, the parameters of all those examined persons at the time of admission were evaluated using the commonly known probability scales for thrombosis and bleeding. Results. Twenty-seven thrombotic and 44 hemorrhagic events were identified, all of them were registered in patients with severe infection. The IMPROVEDD scale (AUC=0,83) was the most preferable for predicting thrombosis in patients with NCI COVID-19, according to the results of the accuracy and completeness analysis. When assessing hemorrhagic scales, the ATRIA scale had the highest AUC (0,92). The most significant parameters associated with thrombotic events were disease severity, extent of changes according to CT, type of anticytokine therapy, D-dimer and procalcitonin levels. AUC of the developed thrombosis scale was 0,92, which was significantly higher than the data of the best conventional models. Conclusion. The commonly known thrombotic events prognostication scales have insufficient predictive accuracy in NCI COVID-19 patients, which makes the task of developing a special thrombosis scale relevant. Our proposed thrombosis scale is superior to the traditional scales in these characteristics, but requires prospective validation on a wide sample of patients with NCI COVID-19 infection.

Despite advances in the diagnosis and treatment of cardiovascular diseases, they remain the leading cause of death worldwide. An in-depth study of the pathophysiological aspects of cardiovascular disease will undoubtedly make it possible to more accurately predict adverse outcomes and influence them with the help of new drugs and techniques. In recent decades, the relationship of new factors and mediators of inflammation, neoangiogenesis, tissue destruction, thrombus formation with cardiovascular pathology has been rapidly studied. Thus, the identification of new biological markers as potential therapeutic targets remains one of the priority areas in cardiology. This literature review shows the role of members of the interleukin 12 family in the pathogenesis of cardiovascular diseases, and discusses the issues of their introduction into clinical practice as potential diagnostic and prognostic factors. It seems to us that further studies can demonstrate the possibility of using representatives of this family as an additional laboratory tool.

The article presents a clinical case of a patient with anaplastic thyroid cancer diagnosed in therapeutic hospital conditions. This example is intended to draw the attention of doctors of various specialities to the need for cancer alertness when detecting any neoplasms in the neck area. Careful examination of the patient according to protocols for the management of suspected thyroid malignancy allows a timely diagnosis to be made and appropriate treatment to be given, which significantly improves the prognosis for the patient's life.

The lecture presents the classification, clinical picture and course of liver cirrhosis (LC), which includes not only hepatic syndromes of previous chronic liver damage, but portal hypertension (PH) syndrome is the leading one for diagnosis. For the tactics of treatment of cirrhosis and prognosis, it is necessary to identify the stage of the disease, which characterizes compensation, decompensation, and the terminal state. The stratification of stages is determined by the severity of PH and the presence of complications of the disease in the form of refractory ascites, hepatic encephalopathy, bleeding from varicose esophagogastric veins, infectious manifestations, hepatorenal syndrome, hepatic cardiomyopathy, hepatopulmonary syndrome, dilutional hyponatremia, portal vein thrombosis, hypersplenism, ospeoporosis, sarcopenia, hepatocellular carcinoma. The diagnostic criteria for complications and the tactics of their treatment are characterized. General principles of cirrhosis treatment, assessment of cirrhosis prognosis and indications for liver transplantation are given.

The experience of many years' research of morphofunctional parameters of bulbar conjunctiva microvasculature using OKO ophthalmic capillaroscope is presented in the review. The description of this medical device, as well as the technique of carrying out the research with division into zones where measurements are carried out are given. The cases of the most typical microcirculatory disturbances revealed by bulbar capillaroscopy in patients with such common diseases as hypertension, diabetes mellitus etc. are reviewed. The effect of angioprotective therapy on microcirculatory indexes is shown using a patient with chronic cerebral ischaemia as an example. The authors conclude that OKO capillaroscope use serves as an accessible method for microcirculatory disturbances degree estimation and makes it possible to individually select angioprotective therapy, to evaluate its efficacy and duration.

The history of the use of heparins dates back to the 30s of the last century. Commercial heparins are produced from different raw materials and by different technological methods, which determines the difference in their anticoagulant properties. Low molecular weight heparins (LMWH) inhibit mainly the Xa active factor. LMWH have not only an antithrombotic effect. They also have nonanticoagulant properties: inhibition of complement activity; modulation of growth factor; modulation of adhesion molecules and leukocyte migration. In clinical practice in non-surgical patients, LMWH is used for the prevention and treatment of venous thromboembolic complications (VTEC). Such treatment is carried out in therapeutic patients hospitalized with severe heart failure, with severe lung disease with respiratory failure; in patients who are forced to observe bed rest and have one of the following risk factors for VTEC. Moreover, LMWH nadroparin calcium is used to treat COVID-19 in adults. According to a randomized, blind, cross-sectional study of 60 elderly bedridden patients, the tolerance of nadroprin was significantly better than enoxaparin.

Acute bronchitis (AB) is one of the most common conditions encountered in outpatient clinical practice. Before the COVID-19 pandemic, the U.S. Centers for Disease Control estimated that acute bronchitis accounted for about 10% of GP visits, or about 100 million visits per year. Ambroxol has mucokinetic and mucociliary effects that have been shown in clinical studies involving adult patients with respiratory disease, and therefore has potential for use in both OB and COVID-19. The aim of this review is to analyze clinical data on the use of ambroxol in actual medical practice in patients with AB. Comparatively convincing data on the effectiveness of ambroxol as a component of symptomatic and pathogenetic therapy of AB are presented. Studies on the efficacy of ambroxol administration in patients with COVID-19 have great prospects for introduction into clinical practice and are under active study.