Vol 87, No 4 (2015)

Aim. To study the impact of a polymorphic variant of the matrix metalloproteinase-3 (MMP-3) gene on the development and course of chronic heart failure (CHF) in patients with coronary heart disease. Subjects and methods. A total of 277 patients with New York Heart Association (NYHA) Functional Class (FC) II—IV CHF were examined. MMP-3 –1171 5A/6A genetic polymorphism was studied by polymerase chain reaction. A control group included 136 patients (mean age 53.6±4.8 years) with no signs of cardiovascular diseases, as evidenced by the examination. Results. The frequency of the 5A allele and the 5A/5A genotype of the 1171 5A/6A polymorphic locus in the MMP-3 gene proved to be higher in the patients with CHF than that in the control group. Thus, the variability of the 5A allele (odds ratio (OR), 1.39; 95% confidence interval (CI): 1.033 to 1.869; p=0.03) and the 5A/5A genotype (OR, 2.15; 95% CI: 1.131 to 4.070; p=0.02) was associated with increased risk for CHF. There were significant differences in the frequency of MMP-3 alleles and genotypes in relation to FC of CHF. The frequency of the 5A/5A genotype was substantially higher in the patients with NYHA FC IV CHF than that in those with NYHA FC II CHF (32.8% versus 15.2%; р=0.039). The frequency of the 5A allele was significantly higher in the patients with NYHA FC IV CHF than that in those with NYHA FC II CHF (55.5% and 39.3%; respectively; р=0.019). Thus, the carriage of the 5A allele and the 5A/5A genotype of the 1171 5A/6A polymorphic locus in the MMP-3 gene is a risk factor of severe CHF. Conclusion. The determination of ММР-3 –1171 5A/6A polymorphism may be recommended for the early prediction of a risk for the development and severe course of CHF.

Aim. To estimate the prognostic value of risk factors for cardiovascular events and target organ damages for the occurrence of resistant hypertension (RH). Subjects and methods. The 2008—2013 survey covered 7959 members of locomotive crews of the Transbaikal Railway whose medical expert examination revealed risk factors for cardiovascular diseases and target organ damages. Results. During the survey, a group of 7959 people with final outcomes included 21 RH cases to be statistically analyzed. Atherosclerotic plaques in the carotids arteries, proteinuria, creatininemia, overweight, left ventricular hypertrophy, a family history of early cardiovascular diseases, and stress were the major predictors of RH. Conclusion. The association of the established predictors must be considered in the treatment of patients with RH.

Aim. To study the specific features of the development and course of hypertension in patients with systemic lupus erythematosus (SLE). Subjects and methods. A total of 106 age- and sex-matched patients, including 47 with SLE and 55 with hypertensive disease (HD), were examined. In all the patients, plasma renin levels were determined; serum von Willebrand factor antigen concentrations were estimated; desquamated endothelial cell counts were calculated; and 24-hour blood pressure (BP) monitoring (BPM) and Doppler ultrasound of carotid arteries performed. Results. In the patients with SLE and hypertension compared to those with HD, the mean diastolic BP (DBP) was 86.5 (79.5—93.5) mm Hg versus 80.5 (77—90) mm Hg (daytime) and 78 (69—91.5) mm Hg versus 72.5 (64—78) mm Hg (nighttime) (p<0.05), and there was also a decrease in daily DBP index (5 [0.5—15]% versus 11 [7.5—18]% (p<0.02)). The plasma renin levels were 1.67 (0.78—2.47) and 0.49 (0.25—0.81) ng/ml/h in the patients with SLE and in those with HD, respectively, р=0.04 and 0.42 (0.36—0.47) ng/ml/h in the control group (р=0.0001). An atherosclerotic vascular lesion was found in 52 and 32% of the patients with SLE and those with HD, respectively. The von Willebrand factor antigen levels were 1.63 (0.81—3.36) and 0.29 (0.23—2.8) IU/ml in these patients, respectively (p=0.04). The plasma circulating endothelial cell counts were also significantly higher in the patients with SLE and hypertension than in those with HD (8 [7—10]∙104/l and 5 [3—8]∙104/l (p<0.01). Conclusion. The patients with SLE and hypertension show a high rate of its hyper-renin states, a propensity for nocturnal hypertension, an increase in DBP, and obvious vascular endothelial regulatory dysfunction.

Aim. To investigate clinical manifestations and diagnostic difficulties in patients with HIV/AIDS in the practice of therapeutic units of a multidisciplinary hospital. Subjects and methods. The investigation included 65 HIV/AIDS patients admitted to the therapy units of a Saratov Regional clinical hospital in 2007 to 2011. The clinical features of HIV/AIDS, immunological status, and viral load were studied. Results. The structure of the clinical manifestation of HIV/AIDS showed a preponderance of lung injury in 45 (69%) patients. There were hematological disorders in 38 (58%) patients and nephropathy in 33 (51%); 11 (17%) patients were diagnosed with infective endocarditis. Rheumatic symptoms and syndromes mimicking HIV/AIDS were found in 10 (15.4%) patients. The degree of immune disorders was most severe in patients with pulmonary dissemination and rheumatic masks and mutually related to the rate of cutaneous manifestations. The specific features of lung injury, infective endocarditis, pulmonary hypertension, rheumatic symptoms, and kidney injury were discussed in HIV/AIDS patients having different causes for admission to specialized therapy units. Conclusion. In connection with the clinical polymorphism of HIV/AIDS, physicians of all specialties should be alert for the possible clinical manifestations of this disease to timely examine patients.

Aim. To define the rate and type distribution of dyssynergic defecation (DD) in patients with primary chronic constipation (CC) and to evaluate the efficiency of biofeedback (BFB) therapy. Subjects and methods. One hundred and thirty-two 18-to-89-year-old patients treated in the Moscow Clinical Research and Practical Center for primary CC were examined using proctological examination, colonofibroscopy, anorectal manometry (ARM), and the balloon expulsion test. Results. Different types of DD were identified in 44.69% of the patients. Defecation disorder type 1 was prevalent (in 64.4% of the patients with DD). The positive result of BFB therapy was noted in the patients with DD and fecal incontinence. Conclusion. The timely detection of functional defecation disorders can recover the lost function of pelvic floor muscles by BFB therapy and exclude the uncontrolled patient use of laxatives.

Aim. To elucidate the safety profile and symptom-modifying effect of Аlflutop and diacerein in the treatment of Kellgren—Lawrence Stages II—III knee osteoarthrosis (OA) in patients with oxalate nephropathy and Stages I—II chronic kidney disease (CKD) and to refine the effect of these drugs on urinary syndrome and renal function as compared to a response to nonsteroidal anti-inflammatory drugs — cyclooxygenase inhibitors (diclofenac). Subjects and methods. This open-label comparative randomized trial enrolled 86 female patients with Kellgren—Lawrence Stages II—III primary gonarthritis concurrent with oxalate nephropathy and Stages I—II CKD. The patients were randomized into 3 groups: 1) 20 patients took diclofenac sodium 100 mg/day; 2) 30 received a complex pharmaceutical on the basis of glycozaminoglycans Аlflutop injection 1 ml per day for 20 days, then 2 ml intraartricular twice weekly in the following month; 3) 36 had diacerein (diaflex, «Rompharm Company») in a dose of 50 mg twice daily for 3 months. On day 30 and day 90 of treatment, the symptom-modifying effect was evaluated from changes in the joint pain and morning stiffness domains of the WOMAC index. Renal function was measured using the estimated glomerular filtration rate (GFR), uric acid clearance (Cua), and urinary sediment. Results. On day 30 of treatment, the patients taking diclofenac were found to have nephrotoxic effects (lower GFR, Cua, evolving secondary hyperuricemia, progressive proteinuria, emerging microhematuria, elevated urinary levels of total lipid hydroperoxides, and enhanced calcium oxalate crystalluria). Alflutop and diacerein exerted no negative effects on renal function. On day 30 day of treatment, all the patient groups showed a reduction in the WOMAC pain score. The diclofenac group displayed a more marked decrease in the pain score than did the two other groups by day 30. Otherwise by day 90 of therapy with Аlflutop and diacerein, the pain scores were reduced by 60 and 67%, respectively, which was similar to those in the diclofenac group by day 30 of a follow-up. By day 30 day of treatment, the stiffness score was also observed to fall in all the groups and achieved even lower values in the Аlflutop and diacerein groups compared with diclofenac group.. Conclusion. Alflutop and diacerein used by patients with knee OA do not produce nephrotoxic effects and by day 90 demonstrated similar to diclofenac symptom-modifying effect by reducing pain and stiffness scores. Diclofenac administration contributed to oxalate nephropathy progress.

Complications of cirrhosis are a main cause of death in the immediate and late follow-up periods in these patients. Portal hypertension, edematous-ascitic syndrome, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy are poor predictors. The sociomedical importance of these complications is obvious for reasons of the high risk of death in these patients in the immediate period (15—30 days). This review represents a set of practical algorithms whose basis is the most effective methods to diagnose, treat, and prevent complications of cirrhosis.

B-cell lymphoma that is unclassifiable and intermediate between diffuse large B-cell lymphoma (DLBCL) and Burkitt’s lymphoma (BL) — (UBL) is an aggressive lymphoma that has simultaneously morphological, immunophenotypical, and cytogenetic signs of both DLBCL and LB. At the same time due to its biological characteristics and clinical manifestations, UBL cannot be referred to as one of the above nosological entities. UBL has been first identified as an individual nosological entity in the 2008 World Health Organization classification. The review details the epidemiology, clinical manifestations, morphological pattern, immunophenotypic and karyotypic features, as well as therapeutic approaches and prognostic factors.