Vol 90, No 3 (2018)

The aim is to study pulse wave velocity (PWV) and other parameters of arterial stiffness in patients with comorbid arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD). Materials and methods. 32 patients with a combination of AH and COPD (group 1), 30 patients with isolated hypertension (group 2), 18 patients with isolated COPD (group 3), 30 healthy subjects (control group) were examined. Applanation tonometry and pulse wave contour analysis at the carotid-femoral segment were made by SphygmoCor (AtCor Medical). Results. Aortic systolic blood pressure in patients with the combination of hypertension and COPD was higher compared to the group of the patients with isolated hypertension by 9.83% (p=0.02), and the patients with COPD by 41.5% (p = 0.000042), respectively. Central pulse pressure in the first group was higher compared to the second group by 29.58% (p=0.00022), in the third group - by 53.4% (p=0.0029). The combination of hypertension and COPD (β=0.42, p=0.00019), age (β=0.39, p=0.0002) and the level of aortic pulse pressure (β=0.54, p=0.001) were marked as independent factors of PWV increasing according to the multiple regression analysis. Conclusion. In patients with a combination of hypertension and COPD the increase in PWV, systolic and pulse pressure in the ascending aorta was observed, compared to patients with isolated hypertension, isolated COPD and the control group during applanation tonometry.

Aim. To study the expression level of the genes DROSHA and DICER in peripheral blood leukocytes (PBL) of patients with sarcoidosis of the lungs Materials and methods. The study included 32 patients diagnosed with persistent lung sarcoidosis (mean age 41.56±1.27 years) and 36 healthy donors (control; mean age 42.79±1.95 years). The level of expression of messenger RNA (mRNA) of the genes DROSHA and DICER were determined in PBL of healthy donors and patients with sarcoidosis of the lung by polymerase chain reaction in real time. Results. As a result of the conducted researches it is established that the level of drosha gene expression in PBL patients with sarcoidosis of lungs is significantly reduced in comparison with the control (p<0.01). We also found a significant decrease in the number of Dicker gene transcripts in the PBL of the study group of patients (p<0.01). Conclusion. According to the results of the conducted studies, a significant decrease in the number of DROSHA and DICER transcripts in PBL patients with the development of lung sarcoidosis has been found, which can contribute to the pathogenesis of this disease.

Aim. Determination of the level of zinc and its fractions, as well as the enzyme neutrophilic elastase and albumin in persons suffering from chronic obstructive pulmonary disease (COPD), as well as smoking actively and passively. Materials and methods. The study involved 30 patients with a diagnosis of COPD and 90 healthy persons (60 of them smoking at the present time, 30 - no) who underwent spirometry and determination of zinc levels and its pools, albumin, and neutrophil elastase. All data are subject to statistical processing. Results. It is determined that the studied parameters differ significantly in the groups of smokers with COPD, healthy smokers and non-smokers, and correlate with the volume of forced exhalation for 1 second as a percentage of the due. Conclusion. The revealed regularities make it possible to consider the indicator "share of bound zinc fraction" introduced in the study as a screening criterion in diagnosing COPD in smokers.

The results of a clinical study showing the importance of surfactant proteins A and D in assessing the activity and progression of idiopathic pulmonary fibrosis and chronic lung sarcoidosis are presented. Aim. To study the clinical significance of SP-A, SP-D in assessing the activity of idiopathic pulmonary fibrosis and sarcoidosis. We examined 81 patients with morphologically confirmed diagnoses of idiopathic pulmonary fibrosis (ILF) and sarcoidosis, a control group of 20 healthy individuals. The MSCT of the thoracic organs of the chest was performed, the diffusivity of the lungs was examined, oxygen saturation was determined. In the serum, the surfactant proteins SP-A and SP-D were determined by the enzyme-linked immunosorbent assay. Results. A significant increase in SP-A and SP-D (p<0.05) was observed in patients compared with patients in the control group, a direct correlation was found with signs of activity: SP-A with alveolitis (p<0.05), SP- D with progressive fibrosis (p<0.05), inverse correlation of surfactant proteins with respiratory function indices (p<0.05). Conclusion. Serological parameters of SP-A and SP-D reflect the activity of alveolitis and the progression of pulmonary fibrosis in patients with ILF and sarcoidosis.

Aim. To study the links between the standard mortality rate of the population from circulatory system diseases (CSD) with factors: weather-climatic (inter-day jumps in air temperature and atmospheric pressure by seasons and for the year) and social (average annual income per person and the number of doctors of all specialties) in Russia for the period 1995-2015. Materials and methods. According to station data and data of reanalysis, seasonal and annual amounts of day-to-day jumps in air temperature were calculated more than the absolute value of 4° and 6°C and the atmospheric pressure more than the absolute value of 8 GPa. The links between climate variables and the mortality rate of the population, taking into account social factors, were investigated using factor analysis, including regression and variance analyses. Results. Annual amounts of temperature (pressure) jumps of different signs vary greatly on the territory: the maximum amounts are 3-4 times higher than the minimum ones. The geographical distribution of air temperature fluctuations differs from the distribution of atmospheric pressure fluctuations. The sum of temperature jumps in the absolute value of more than 6°C is about twice less than the sum of jumps more than 4°C, but they are characterized by similarity of geographical distribution. The sum of the jumps of temperature (pressure) is reduced during the summer is approximately two times compared to the winter. The maximum jumps are observed mainly in the Northern regions with low population density, but with high per capita income, while the minimum is observed in the South-Western parts of the European part of the country with high population density, as well as middle and low income. Global warming does not significantly affect the reduction of annual amounts of temperature (pressure) jumps. Factor analysis of social and climatic variables in the territory for each year indicates the dominance of the influence of the social factor (per capita income) on the mortality rate from CSD. Conclusion. Factor analysis is integrated in the annual scale climatic and social variables showed a dominant effect on the coefficient of mortality from CSD, the factor of standard of living (per capita income of the population). Then the significance of the impact factors is consistently reduced: negative atmospheric pressure jumps, average seasonal pressure, health care level, positive pressure jumps. The significance of temperature variables is the smallest.

The frequency of cardiovascular diseases is increasing progressively with age, and the global aging of the population poses the problem of treatment of patients of older age groups in a row with other relevant medical and socio-economic problems. Aim. In the present study was to investigate the quality of medical care for patients with acute coronary syndrome (ACS) old age and compliance of the treatment current guidelines. The data is exported from the system of the Federal register OKS. Materials and methods. Analyzed medical history 33 893 patients with ACS entered in the system registry of ACS for the period from 01.01.2016 to 31.12.2016. a comparison was made of the quality of care in patients with ACS elderly (75 years and older, n=8773) and in younger patients. Results. The results of the study showed that in patients of senile age, when compared with younger patients, comorbid conditions are significantly more often observed, as well as a significantly higher risk of hospital and 6-month death, calculated on the GRACE scale. Conclusion. Patients of senile age with ACS are almost twice less likely to undergo percutaneous coronary interventions than younger ones, which worsens the prognosis in these patients and increases mortality.

Literature data of chronic obstructive pulmonary disease (COPD) and cerebrovascular diseases (CVD) comorbidity are represented in this review. Key aspects of this interaction and its importance for clinical medicine have been considered. CVD and COPD are the main mortality factors in adults, which contribute to great economic wastes. The incidence of chronic cerebral ischemia for COPD patients is almost three times as high as for general population. The incidence of ischemic stroke for COPD patients is 1,2 times higher than in general population. For hemorrhagic stroke and subarachnoid haemorrhages, this figures are 1,3 and 1,46 respectively. Chronic systemic inflammation, tissue hypoxia and oxidative stress play the crucial role in respiratory and cerebrovascular comorbidity. Metabolites of these processes (especially proinflammatory cytokines, reactive oxygen species, C-reactive protein and some neurotrophins) increase the permeability of blood-brain barrier, destroy brain cells and activate atherogenesis in pre - and intracerebral arteries. Endothelial dysfunction affects autoregulation of cerebral circulation. Systemic symptoms of COPD are closely associated with different structural-functional disorders of the brain such as reduction in white matter integrity, grey matter volume reduction and cerebral microbleeds. Also, venous encephalopathy is developed as a result of intrathoracic pressure elevation and stasis in superior vena cava system. These processes result in neurological symptomatology. The intensity of symptoms depends on COPD severity. The occurrence of cognitive impairment, psychic tension, depression, panic disorders also increases. However COPD and CVD comorbidity is an important problem of modern medicine, pathophysiologic mechanisms and clinic aspects of this problem remain unresolved. Understanding of their role opens perspectives for rational pharmacotherapy.

Intestinal lymphangiectasia is a very rare pathology, characterized by the presence of enlarged lymphatic vessels in all layers of the intestinal wall and in the mesentery. As a result, "lymphatic lakes" are formed, through which lymph exudates into the lumen of the intestine. The main manifestation is hypoproteinemic edema. Diagnosis of the disease is based on laboratory-instrumental methods of investigation, including by determining in the stool α-1 antitrypsin as a screening test. Treatment includes: a diet rich in calcium, trace elements, be sure to use medicinal foods enriched with medium chain triglycerides, substitution and symptomatic therapy.

The iron overload syndrome can be associated with various acquired states and hereditary factors. Hereditary hemochromatosis is the most common genetic disorder. Without therapeutic intervention the disease can lead to the development of life-threatening complications such as cirrhosis, hepatocellular carcinoma. The article presents data on pathogenesis, diagnosis and treatment of hereditary hemochromatosis. Own clinical observation is given.