Vol 90, No 1 (2018)

The Aim of the BEREG Registry was to analyze the prevalence and structure of cardiovascular diseases, associated comorbid conditions and assess their effects on pregnancy and perinatal outcomes in real clinical practice.In Tula city regional perinatal center the observation study named "Assessment of the clinical condition of the pregnant women with cardiovascular disease during gestation, at child delivery, at the early postpartum period and at twelve months after childbirth and assesment of perinatal outcomes, condition of the fetus and the newborn and the quality of treatment of these patients groups.All eligibly pregnant women hospitalized in 2014 to "Tula regional perinatal center" have been recruited in the Registry. Clinical and demographic data at admission, obstetric history, laboratory and instrumental examination data, previous medical history have been investigated. The following endpoints were evaluated: maternal mortality, death of the fetus and newborn baby; preeclampsia or/and eclampsia, heart failure, arrhythmia, thromboembolism events.Statistical processing of obtained data was carried out using the software package STATISTICA10.0 (StatSoft, USA).The study included 3214 women delivered babies in the perinatal center in 2014, of which 691 (21,4%) were diagnosed with cardiovascular disease (CVD) in most cases (451 women, 65,9%) - these were different clinical variants of arterial hypertension (AH). Five women (0.7%) had acquired and 23 women ( 3.3%,) congenital heart defect, non-significant heart development abnormities were found in 80 subjects, (11.6%). and Cardiac arrhythmias and conductivity disturbance have beenrevealed in 116 and 16 cases (16.8% and 2.3%) correspondingly.Patients with CVD were significantly older than women without CVD and more often had a variety of disorders of carbohydrate metabolism, overweight, obesity and chronic varicose disease of the lower extremities. Pregnancy in women with CVD significantly more often was complicated by the threat of interruption, placental insufficiency, preterm and operative babies delivery.Arterial hypertension as well as obesity, placental insufficiency and threatened miscarriage became prognostically unfavorable conditions that contributed of premature birth and fetal death. Fetal death or newborn babies death took place in 1,3% of all the subjects enrolled. In this cohort antenatal death have been registered in 43,2%, intrapartum one in 2.3% and neonatal death in 54.5%.Negative rognostic factors for low birth-weight babies were: placental insufficiency, various clinical variants of AH, obesity and infectious diseases; less input had endocrine diseases and risk of abortion.Adverse factors for the fetus death or newborn death were different clinical variants of arterial hypertension and the risk of abortion in any trimestre of pregnancy.

In order to assess the impact of influenza vaccination and pneumococcal infection (PI) were studied seasonal morbidity and mortality because of influenza, acute respiratory viral infections (ARVI) and pneumonia among the population of the Russian Federation during 2012-2016 timeframe.The methods. There were analyzed the data of Federal service for surveillance in consumer rights protection and human welfare (Rospotrebnadzor) on influenza vaccination and PI and ARVI morbidity (including influenza), diseases of the respiratory system (DRS). The information on mortality of the population of Russia because of these diseases received from official publications of the Federal State statistics service (Rosstat) and The Ministry of health of the Russian Federation (Ministry of Health of Russia) on the mortality rates of the population of Russia because of these illnesses. Results: the analysis revealed that compared to 2015, in 2016 the incidence rate of ARVI in total Russian population was increased to 5,7%. The incidence rate of influenza in 2016 reached 60,5 cases per 100 thousand of the total population and was higher than the 1,8 times than in 2015 (34,01 on 100 thousand people). The incidence rate of pneumonia in total population was increased by 24,0% in 2016 compared to 2015. According to Rosstat data, the increase of deaths because of influenza and ARVI was mainly in the first semester of 2016, which was associated with influenza epidemic. Mortality because of pneumonia dropped by 10,8% and from other DRS - by 6,9%, which might indicate on the improvement of the quality of medical care and prevention of DRS. Reduction in the mortality rate because of pneumonia also was due to significant influenza vaccination coverage and the increasing number of children and adults vaccinated against PI.

The aim of the study was to establish associations of the prevalence of coronary artery disease (CAD), metabolic syndrome (MS) and arterial hypertension (AH) with family stress in open male population of Tyumen aged 25-64 years. Materials and methods. Cross-sectional epidemiological survey was conducted on representative sample of 1000 individuals (250 in every 4 decades: 25-34, 35-44, 45-54, 55-64 years) formed from the election list of males in one of the administrative districts of Tyumen. The response to cardiac screening was 85.0% - 850 patients. Different types of CAD were defined based on standard methods in epidemiological surveys. "Certain" CAD and "possible" CAD were determined according to extended epidemiological criteria. IDF criteria (2005) were used for the MS assessment, AH was considered as a component of the MS. A questionnaire of WHO MONICA «Knowledge and attitude to health» was used to analyze stress in families. The results of the study showed that more than 80% of males in open urban population, mostly older individuals, had a stable marital status last twelve months, while one-third of the male population had conflicts in their families and the fifth part did not have the opportunity to relax at home. Male patients with CAD had family stress more frequently during last 12 months on extended epidemiological criteria. In the open male population aged 25-64 years with MS and AH there was found more stable marital status versus comparison groups. Conclusion. Standardized methods and the accumulated database should be used to continue objective monitoring of the epidemiological situation of cardiovascular diseases and psychosocial risk factors in open urban population during regional preventive program.

Aim. To study the production and genetic factors affecting the cardiovascular system (CVS) in the petrochemical industry workers. Subjects and methods. There was carried out an assessment of the working conditions and the state of health of 860 workers of petrochemical plants males, including 548 apparatchiks (main group) and 312 fitters of instrumentation and automation (comparison group). The main risk factors with subsequent assessment of cardiovascular risk (SSR) on the scale SCORE (Sistematic COronary Risk Evaluation) were studied. The analysis of the frequency distribution of deletion polymorphisms of GSTM1 and GSTT1 glutathione among the workers of the basic trades involving patients with cardiovascular disease (CVD) and practically healthy workers. Results. The development and progression of CVD in petrochemical production workers affects a complex working environment hazards and the labor process, corresponding, according to R2.2.2006-05, classes, working conditions 3.1-3.3 Labor intensity. The most common form of cardiovascular nosology was hypertonic disease (HD), identified in 46,9% of apparatchiks and 29,2% of fitters of instrumentation and automation. Determination of the relative risk etiological share of the working environment factors in the development of HD showed high degree of professional conditioning of the disease in a group of apparatchiks (RR=1,58, and EF=36,7%). Molecular genetic factor predisposing to the development of CVD, is the deletion of the GSTM1 gene. This genetic marker could be used as a predictor of individual risk criterion CVD. Conclusion. A comprehensive assessment of working conditions of workers of petrochemical plants showed that the priority factors of occupational risk for apparatchiks are air pollution of the working area with harmful substances (class 3.1-3.2), noise (class 3.1) and labor intensity (class 3.1). It has been established that in the formation of cardiovascular diseases under the influence of production factors, genetic factors can participate.

The article presents a clinical observation of two patients with generalized sarcoidosis. The woman typical granulomatous changes in the lungs and lymph nodes combined with atrial fibrillation, kidney failure and hereditary thrombophilia, men with atherosclerotic coronary arteries, re-myocardial infarction, cholestasis, tubulointerstitial nephritis. The accession of systemic manifestations was accompanied by increase of level of angiotensin-converting enzyme in the blood serum, morphological examination of lung tissue in both cases there were high histological activity of vasculitis and granulomatous inflammation. Extrapulmonary symptoms regressed when conducting immunosuppressive therapy. Discusses modern aspects of diagnosis of sarcoidosis in clinical practice.

Recurrentpolyhedritis is a rare rheumatic disorder with a wave-like course, presumably ofautoimmune nature,characterizedbya widespread inflammatorylesion of the cartilaginous structures and other connective tissue of the ears, joints, nose, larynx, trachea, eyes, valvular heart, kidneys and blood vessels.The description of the own observation of recurrent polychondritis.

Systemic vasculitis is a heterogeneous group of inflammatory diseases, which are classified according to the diameter of the affected vessels. The treatment of systemic vasculitis is no longer empirical, because of increasing number of randomized clinical trials in this field. In recent years, there was a trend to limit the cumulative dose of glucocorticosteroids and immunosuppressive drugs, partially through biological drugs usage. However, biologic therapy is not always superior to combination of glucocorticosteroids and cytotoxic drugs. The efficacy of different biologic drugs varies in patients with different forms of systemic vasculitis, which creates the ground forpersonalized therapy of these diseases. Another serious problem is the absence of strict criteria to immunosuppressive therapy intensification, especially in vasculitis, affecting large vessels, due to the lack of reliable laboratory markers of disease activity. The article reviews modern approaches to the treatment of some types of systemic vasculitis, including ANCA-associated vasculitides, giant cell arteritis, Takayasu`s arteritis and cryoglobulinemic vasculitis.