Vol 10, No 3 (2018)

The article describes the main functions of a clinical pharmacologist in preventive medicine institution according to the draft “Professional standart “clinical pharmacologist”. The role of clinical pharmacologist and its importance in the work of medical organization according to the orders of Ministry of Health (No. 131 of May 05, 1997; No. 494 of October 22, 2003; No. 575н of November 02, 2012) was shown.

The review summarizes the current understanding of the role of cytokines in the pathogenesis of osteoarthritis. The imbalance of pro-inflammatory and anti-inflammatory cytokines in the joint tissues leads to the development of inflammation and cartilage damage, which leads to progressive degeneration of the joints.

Aim — to reveal the connection between the initial morphofunctional characteristics of patients and the dynamics of changes in the diastolic function at the time of, as well as during 6 months of observation after the episode of acute decompensated heart failure against the background of standard therapy and with adding the If-channel blocker ivabradine.

Material and methods. We examined 127 patients hospitalized with the episode of the acute decompensated heart failure with a sinus rhythm and heart rate more than 85 beats per minute. Among them 67 patients received ivabradine in addition to standard therapy, 60 patients were in control group. A 6-minute walk test, echocardiography assessment of systolic and diastolic function, electrocardiography (heart rate and rhythm) were performed on the day of admission (except for the 6-minute walk test), in 1 and 6 months later.

Results. A scoring of the chance for positive dynamics of diastolic function was obtained in patients with acute decompensated heart failure, in the presence of certain initial characteristics of patients, such as: systolic pulmonary artery pressure < 37 mmHg (p < 0.005), heart rate < 95 beats per minute (p < 0.05), end diastolic size < 50 mm (p < 0.005), VE /Em* < 18 (p < 0.0005), end systolic size < 40 mm (p < 0.0005), and end systolic volume index < 40 ml/m2 (p < 0.0005), end diastolic volume index < 73 ml/m2 (p < 0.005), ejection fraction > 50% (p < 0.005), ivabradine intake (p < 0.05), relative wall thickness > 0,46 (p < 0.005), female. A relationship between improvement in diastolic function and improvement in results of 6-minute walk test was found: with a positive dynamics of diastolic function, patients began to walk a distance in the 6-minute walk test by 6,9 ± 2,9 meters more (p < 0.0005).

Conclusion. The data obtained in our study confirm the advisability of adding ivabradine to the standard therapy of patients with acute decompensated heart failure with the determined “useful” morphofunctional characteristics.

This article is devoted to the analysis of hypertesive crises in patients with adrenal incidentalomas. Such patients, as a rule, have no symptoms of primary hyperaldosteronism or Cushing’s syndrome. In the meanwhile, sudden elevation of blood pressure suggests an idea of a pheochromocytoma. However this diagnosis is not always confirmed during further studies. According to the conducted research authors came to a conclusion that crises of arterial hypertension in these patients could be most often caused by idiopathic hypertensia, somatoform disorder and, less frequently, sudden emission of catecholamins in a blood stream by a pheochromocytoma. The results of the analysis show the fact that even the correctly reached diagnosis doesn’t exclude the need for the undergoing complete evaluation of patients.

Objective. To study the association of polymorphism rs1801282 of the PPARγ gene with different components of metabolic syndrome (MS).

Materials and methods. 145 subjects with newly diagnosed MS were examined. All subjects underwent a clinical examination, including general clinical, laboratory and instrumental methods; presence of polymorphism rs1801282 of the PPARγ gene was also determined.

Results. In the group of subjects with rs1801282 polymorphism, hyperglycemia was observed less frequently compared with the rest of subjects the incidence was 53.8% and 79.8% cases respectively (p = 0.005). A decrease in the risk of arterial hypertension was also observed in subjects with polymorphic allele: an increase in blood pressure was noted in 70.6% of rs1801282 group and 96.2% for wild type PPARγ (p < 0.001). When analyzing levels of triglycerides and high-density lipoproteins, an increase in these parameters was noted in the group of subjects with rs1801282
polymorphism.

Conclusion. The results of the study indicate the association of rs1801282 polymorphism in subjects with metabolic syndrome with a number of clinical features of the disease, dyslipidemia and a reduction of the risk of hyperglycemia and hypertension.

In the article the characteristics of combined inguinal hernia is given and the rare clinical case of diagnosis is introduced as well as successful surgical treatment of combined inguinal hernia with three hurnial gates with the help of endovideosurgical method with mesh explant.

EEG in the intensive care unit in critically ill patients can be provisionally allocated to a special type of research — EEG of critical states. The article deals with the methodological features of EEG performance in the intensive care, as well as general patterns of EEG changes in patients in coma. The analysis of the patterns of the EEG in intensive care unit is described. Parameters of responsiveness of the central nervous system are given. An algorithm for describing epileptiform changes is presented. The criteria for the diagnosis of nonconvulsive status epilepticus in unconscious patients are discussed, as well as a prognosis of the outcome of a long unconscious state in the presence of epileptiform changes in the EEG. Data on the parameters of periodic patterns are collected, their description and diagnostic criteria are given. The role and possibilities of EEG in the diagnosis of brain death are considered.