SYSTEMIC IMMUNOTHERAPY WITH RECOMBINANT IL-2 IN A COMPLEX TREATMENT OF ABDOMINAL SEPSIS

ANISIMOV ANDREI YU., ORCID: 0000-0003-4156-434X; D. Med. Sci., professor, Head of the Department of emergency medical care of Kazan State Medical Academy – branch of Russian Medical Academy of Continuing Professional Education; Chief freelance specialist surgeon and transplant surgeon of the Ministry of Health of Tatarstan Republic; Chief specialist in surgery of City Clinical Hospital No 7, Russia, 420012, Kazan, Butlerov str., 36, tel. +7-987-297-16-54, e-mail: aanisimovbsmp@yandex.ru

ANDREEV ANDREI I., ORCID: 0000-0003-0788-9845; C. Med. Sci., Head of the Department of surgery No 4 of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: aandreyi@yandex.ru

IBRAGIMOV RINAT A., ORCID: 0000-0003-0788-9845; C. Med. Sci., surgeon of the Department of surgery No 4 of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: rinatibr@mail.ru

LOGINOV ALEXANDER V., ORCID: 0000-0002-0999-5943; C. Med. Sci., emergency department surgeon of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: 613310@bk.ru

GALEEV BULAT R., ORCID: 0000-0002-3470-9603; surgeon of the Department of surgery No 4 of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: krankel@mail.ru

KALIMULLIN IREK A., ORCID: 0000-0002-8519-8700; surgeon of the Department of surgery No 4 of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: dr.kia@bk.ru

Abstract. Aim. Тo study the clinical efficacy of recombinant human IL-2 in complex treatment of diffuse peritonitis complicated by abdominal sepsis. Material and methods. In accordance with evidence-based medicine recommendations, a single blind, randomized, controlled study of 64 patients with secondary advanced purulent peritonitis complicated by sepsis defined by ACCP/SCCM classification was performed. Subjects were placed into two groups: study group (20 patients) in a comprehensive treatment program with recombinant human IL-2 injection and control group (44 patients) who underwent traditional intensive therapy. The effects of the two treatment regimens on outcome such as clinical effect, predicted and actual mortality, number and nature of immediate postoperative period complications, the detoxification and immunocorrective effect were investigated. Results and discussion.Patients received recombinant human IL-2 in two doses of 500 000 ED every 48 hours by intravenous injections had decrease APACHE II score from 21,3+0,6 to 10,1+0,4; reduced the number of complications in the immediate postoperative period, from 68,2 to 35,0%; reduced fatality rate from 22,7 to 15,0%; reduces length of hospitalization in patients with a favorable outcome from (29,4±4,6) to (19,7±3,7) days. No serious side effects have been reported when using recombinant human IL-2. The drug was well tolerated by patients with abdominal sepsis and was convenient in emergency abdominal surgery practice. Conclusion. Systemic immunotherapy with recombinant human IL-2 showed not only detoxifying, but also immunocorrecting effect, and possibly provided gastrointestinal tract motility stimulation. Systemic immunotherapy recombinant human IL-2 is not a single method of treatment. It should be combined with the rest of the routine treatment complex.

Key words: peritonitis, abdominal sepsis, systemic immunotherapy, recombinant IL-2.

For reference: Anisimov AYu, Andreev AI, Ibragimov RA, Loginov AV, Galeev BR, Kalimullin IA. Systemic immunotherapy with recombinant il-2 in a complex treatment of abdominal sepsis. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 7-14. DOI: 10.20969/VSKM.2019.12(5).7-14.

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 PROGNOSIS IN PATIENTS WITH HEART FAILURE AND CONCOMITANT CHRONIC OBSTRUCTIVE PULMONARY DISEASE

GAZIZYANOVA VIOLETTA M., ORCID ID: 0000-0002-5601-8360; C. Med. Sci., assistant of professor of the Department of propedeutic internal disease of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: sunnу.gazizyanova@list.ru

BULASHOVA OLGA V., ORCID ID: 0000-0002-7228-5848; D. Med. Sci., professor of the Departmen of propedeutic internal disease of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: boulashova@yandex.ru

SHAIKHUTDINOVA ZULFIA A., deputy Head physician of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54

YAFAROVA RUMIA A., Head of the Department of therapy No 2 of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54

Abstract. Multimorbidity is a specific characteristic of the modern patient with chronic heart failure (CHF) which significantly changes clinical course, prognosis, leads to socio-economic losses. The goal is to study the clinical featuresand prognosis of patients with CHF in combination with chronic obstructive pulmonary disease (COPD). Material and methods. The study included 183 patients with stable CHF, including 105 with CHF combined with COPD. The clinical phenotype evaluated by 6-minute walk test (6-MWT), spirometry, echocardioscopy, clinical condition scale and quality of life assessment. The end points during the year were the following: all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, pulmonary embolism, and hospitalization rates due to acute decompensation of CHF.Results and discussion.The clinical phenotype of CHF combined with COPD was characterized by a high frequency of smoking, low quality of life and poor exercise tolerance. Cardiovascular mortality in comorbid pathology was 4,0%, in CHF without COPD – 4,6%; myocardial infarction was observed 1,7 times more often with lung disease than in patients with CHF only (16,8 and 10,8%); stroke was observed exclusively in comorbid pathology (8,9%). The combined endpoint (all cardiovascular events) with CHF in combination with COPD was achieved 2,3 times more often in comparison with patients with CHF only (29,7 and 15,4%; p<0,05). Hospitalization due to acute decompensation of CHF occurred 2 times more often with CHF in combination with COPD than without it (32,7 and 15,4%). Conclusion. The results ofthe study demonstrate that COPD contributes to the formation of the clinical phenotype of CHF from the standpoint of the mutual influence of the characteristics of the cardiovascular and respiratory systems, and also aggravates the prognosis that requires an integrated approach to the differential diagnosis and individualization of pharmacotherapy.

Key words: prognosis, chronic heart failure, chronic obstructive pulmonary disease.

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 DESTRUCTIVE FORMS OF DIABETIC OSTEOARTHROPATHY. SURGICAL ASPECTS

KOREJBA KONSTANTIN A., ORCID ID 0000-0002-0821-2249; C. Med. Sci., associate professor of the Department
of surgical diseases of Kazan State Medical University; Head manager of center «Diabetic foot», Russia, 420012, Kazan, Butlerov str., 49, tel. 8-917-259-47-47, e-mail: konkor038@gmail.com

Abstract. The purpose of the study was to evaluate the effectiveness surgical treatment of tissue defects in diabetic foot syndrome, based on the principles of evidence-based medicine and considering clinically significant phenomena – outcomes, based on a mathematical model for evaluating effectiveness. Material and methods. The study included25 patients treated from diabetic foot syndrome with bone structure abnormalities at «Diabetic Foot» center in Kazan and in the department of purulent surgery at the Clinic of the Medical University of Kazan in 2018–2019. According to the Wagner classification patients had grade 3, and 2–3 degree of arterial disease of the lower limbs of chronic arterial obstruction, according to the Fontein–Larissa–Pokrovsky classification. These patients were managed according to the method of treatment of the defect. Results and discussion. We evaluated clinically significant outcomes for patients: favorable and unfavorable, and various indicators of relative and absolute risks when using various treatment methods. We used mathematical formulas developed and adapted according to the principles of evidence-based medicine for data analysis. Conclusion. Treatment of bone and articular structures in diabetic foot syndrome with bioplastic material based on 15% of the gel form of native type 1 collagen and autologous growth factors is most justified decision. Tissue repair and relief of clinical manifestations of the disease, leaded to favorable outcomes in 90% of cases. In the treatment of bone and articular without the use of this technology, the adverse clinical outcome was 86%.

Key words: diabetic neuroosteoarthropathy, autologous growth factors, bioplastic materials, evaluation of the effectiveness of treatment of defects.

For reference: Korejba KA. Destructive forms of diabetic osteoarthropathy. Surgical aspects. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 35-40. DOI: 10.20969/VSKM.2019.12(5).35-40.

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11. Kotel’nikov GP, Shpigel’ AS. Dokazatel’naya meditsina; Nauchno-obosnovannaya meditsinskaya praktika: Monografiya [Evidence based medicine; EvidenceBased Medical Practice: Monograph]. Samara; SamGMU [Samara Samara State Medical University]. 2000; 19-24.

12. Voronin AS. Razrabotka i eksperimental’no-klinicheskoye obosnovaniye ispol’zovaniya fitoterapevticheskikh ranevykh pokrytiy v mestnom lechenii ran i ranevoy infektsii kozhi i myagkikh tkaney : avtoreferat dissertatsii [Development and experimental-clinical substantiation of the use of phytotherapeutic wound dressings in the local treatment of wounds and wound infections of the skin and soft tissues: abstract of the dissertation]. Volgograd: Volgogradskiy gosudarstvennyy meditsinskiy universitet [Volgograd: Volgograd State Medical University]. 2012; 22 p.

 THE ROLE OF HOSPITAL NURSES IN TRAINING AND REHABILITATION PATIENTS WITH BRONCHIAL ASTHMA

PALMOVA LYUBOV YU., C. Med. Sci., assiociate professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: palmova@bk.ru

ISHMURZIN GENNADY P., C. Med. Sci., assiociate professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49

PODOLSKAYA ALLA A., C. Med. Sci., the Head of the Department therapeutic of City Clinical Hospital No 7 of Kazan; associate professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49

Abstract. The aim of the research was to study satisfaction of patients with bronchial asthma with the educational role of nurses in therapeutic practice. Material and methods. A survey of 30 bronchial asthma (BA) patients was carried out in Therapeutic Department of Kazan Hospital with a 18 questions form. 10 nurses of the same Therapeutic Department were surveyed at the 2nd stage of the study. The questionnaire was anonymous and contained 10 closedended questions. The average age of patients was (60,5±3,07) years, among them were 18 women and 12 men.Results and discussion. The volume and quality of prescribed pharmacotherapy do not only determine BA course and control of asthma achievement, but also a various of non-drug factors. In achieving the necessary level of awareness, a significant role is given to nurses. The correctness of their actions directly determines the effectiveness of training, medical rehabilitation, and secondary prevention in patients with bronchial asthma. This study demonstrated an insufficient visiting of educational Asthma-schools (33%) by patients with BA, a low adherence of peak flow measurements, keeping a self-control diary (50%), nor doing physical exercise and breathing exercises (30%). Conclusions. Most patients with BA satisfied with educational activities carried out by nurses, but more than the half of them do not attend Asthma-schools (67%). Adherence to the implementation of the peak flow measurements and keeping a diary of self-control was also poor. These methods do not need large financial investments and should be close to 100% coverage of patients of this group. For higher efficiency of medical rehabilitation, it is necessary to systematize short-term recommendations and tips in specially developed programs of training schools by nurses.

Key words: bronchial asthma, nurse, training, rehabilitation.

For reference: Palmova LYu, Ishmurzin GP, Podolskaya AA. The Role of hospital nurses in training and rehabilitation patients with bronchial asthma. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 41-45. DOI: 10.20969/ VSKM.2019.12(5).41-45.

1. Ponomarenko GN. Medicinskaya reabilitaciya [Medical rehabilitation]. Moskva: GEOTAR-Media [Moscow: GEOTAR-Media]. 2014; 360 p.

2. Nenasheva NM. Obostrenie bronhial’noj astmy: lechenie i profilaktika [Exacerbation of bronchial asthma: treatment and prevention]. Russkij medicinskij zhurnal [Russian medical journal]. 2013; 21 (29): 1490-1495. Islamova DA. Lechebnaya fizkul’tura kak element lecheniya i profilaktiki bronhial’noj astmy [Physical therapy as an element of treatment and prevention of bronchial asthma]. Voprosy nauki i obrazovaniya [Science and education]. 2017; 1: 107-109.

3. Belevskij AS. Vzaimodejstvie vracha i medicinskoj sestry pri vedenii bol’nogo bronhial’noj astmoj [Interaction ofa doctor and a nurse in the management of a patientwith bronchial asthma]. Atmosfera; Pul’monologiya i allergologiya [Atmosphere; Pulmonology and Allergology]. 2008; 2: 60-62.

4. Global’naya strategiya lecheniya i profilaktiki bronhial’noj astmy (peresmotr 2014) [Global strategy for the treatment and prevention of bronchial asthma (revision 2014)]. Perevod s angliiskogo AS Belevskogo [Translation from English AS Belevsky]. Moskva: Rossijskoe respiratornoe obshchestvo [Moscow: Russian respiratory society]. 2015; 148 p.

5. Rogachikov AI. Tekhnika ingalyacii lekarstvennyh sredstv i kontrol’ nad bronhial’noj astmoj [Technique of inhalation medicines and the control over bronchial asthma]. Rossijskij mediko-biologicheskij vestnik imeni akademika IP Pavlova [Russian medical and biological Bulletin named by academician IP Pavlov]. 2016; 24 (3): 86-91.

UDC 616.12-008.46-036.12

 CHRONIC HEART FAILURE IN REAL CLINICAL PRACTICE

PODOLSKAYA ALLA A., C. Med. Sci., Head of the Department of therapeutic of City Clinical Hospital No 7; associate professor of the Department of internal diseases of Kazan State Medical University, Russia, 420103, Kazan, Chuikov str., 54

PALMOVA LYUBOV YU., C. Med. Sci., associate professor of the Department of internal diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: palmova@bk.ru

SHAIKHUTDINOVA ZULFIYA A., deputy Head physician for the medical part of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

Abstract. Aim. The aim of the study was to analyze the cases of decompensation of chronic heart failure (CHF), NYHA III-IV functional class, requiring hospitalization in the therapeutic Department of a multidisciplinary hospital. Materialand methods. 422 medical histories of patients with decompensated CHF (31,3%) from 1345 (100%) hospitalized patients per year were analyzed. Mathematical analysis of the data was carried out using a computer-based Student’s t-test with cutoffs at p value less than 0,05. Results and discussion. Тhere were significantly more hospitalized women admitted for CHF decompensation (58%) than men (42%). The mean age of patients was (74,9±10,5) years [men – (69,6±10,2) years, women – (75,6±8,8) years; p<0,0001]. Mortality from CHF was 7,4%, 54 patients (mean age – 69,2 years; 16 men and 38 women) died during the reporting period (12 months). Repeated hospitalizations for CHF were 7,1% (30 patients). Retrospectively, according to clinical recommendations, only 18,5% of hospitalized patients received continuous therapy during the last year. The remaining 81,5% of patients did not receive complex therapy for CHF at the outpatient stage. Conclusions. the main etiological causes of decompensation of CHF in patients with NYHA III-IV functional class are postinfarction cardiosclerosis, chronic atrial fibrillation associated with ineffective heart rate and blood pressure control. Hospital mortality from CHF was 7,4%, an unfavorable prognosis was associated with a low use of a combination of essential drugs in the treatment of CHF, its insufficient dose, frequent interruption of treatment at the prehospital stage. To improve the prognosis and quality of life in patients with CHF, it is necessary to conduct CHF schools for patients and their relatives in the hospital, in the polyclinic to obtain information about the disease, acquire self-control skills related to dietary recommendations, physical activity, strict adherence to drug therapy, monitoring the symptoms of heart failure and seeking medical care in case of their strengthening.

Key words: chronic heart failure, causes, decompensation.

For reference: Podolskaya AA, Palmova LYu, Shaikhutdinova ZA. Chronic heart failure in real clinical practice. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 45-49. DOI: 10.20969/VSKM.2019.12(5).45-49.

2. Belenkov YuN, Fomin IV, Mareev VYu, et al. Rasprostranennost xronicheskoj serdechnoj nedostatochnosti v Evropejskoj chasti Rossijskoj Federaczii dannye EPOXA– XSN (chast 2) [Prevalence of chronic heart failure in the European part of the Russian Federation – Data of AGE-CHF (part II)]. ZHurnal Serdechnaya Nedostatochnost’ [Russian Heart Failure Journal]. 2016; 7 (3): 3–7.

3. Fomin IV. Epidemiologiya hronicheskoj serdechnoj nedostatochnosti v Rossijskoj Federacii V: Hronicheskaya serdechnaya nedostatochnost’ [Epidemiology of chronic heart failure in the Russian Federation B:Chronic heart failure]. Moskva: GEOTAR-Media [Moscow: GEOTAR-Media]. 2010; 7-77.

4. Polyakov DS, Fomin IV, Valikulova FYu, Weisberg AR, Kraiem N, badin YuV, et al. Epidemiologicheskaya programma EPOHA–HSN: dekompensaciya hronicheskoj serdechnoj nedostatochnosti v real’noj klinicheskoj praktike (EPOHA–D–HSN)] [Epidemiological program EPOCH-CHF: decompensation of chronic heart failure in real clinical practice (EPOCH-D-CHF)]. ZHurnal Serdechnaya Nedostatochnost’ [Russian Heart Failure Journal]. 2016; 17 (6): 299– 305.

5. Koziolova NA, Nikonova YuN, Shilova YaE, Agafonov AV, Polyanskaya EA. Harakteristika hronicheskoj serdechnoj nedostatochnosti na fone permanentnoj formy fibrillyacii predserdij [Characteristics of chronic heart failure on the background of permanent atrial fibrillation]. ZHurnal Serdechnaya Nedostatochnost’ [Russian Heart Failure Journal]. 2013; 14 (1): 14–21.

6. Mareev VYu, Fomin IV, Ageev FT, et al. Klinicheskie rekomendacii OSSN-RKO – RNMOT. Serdechnaya nedostatochnost’: hronicheskaya (HSN) i ostraya dekompensirovannaya (ODSN); Diagnostika, profilaktika i lechenie [Russian Heart Failure Society, Russian Society of Cardiology; Russian Scientific Medical Society of Internal Medicine; Guidelines for Heart failure:chronic (CHF) and acute decompensated (ADHF); Diagnosis, prevention and treatment]. Cardiology [Kardiologiya]. 2018; 58 (6S): 8-164.

7. Dickstein K, Cohen-Solal A, Filippatos G, et al. ESCguidelines for the diagnosis and treatment of acute andchronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology; Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail. 2008; 10: 933–989.

8. Rekomendacii ESC po diagnostike i lecheniyu ostroj i hronicheskoj serdechnoj nedostatochnosti 2016 [ESCguidelines for the diagnosis and treatment of acute andchronic heart failure 2016]. Rossijskij kardiologicheskij zhurnal [Russian journal of cardiology]. 2016; 1 (141): 7–81.

9. Kirichenko AA, Ebzeeva EYu. Hronicheskaya serdechnaya nedostatochnost’ v praktike terapevta: trudno li ee raspoznat’? [Chronic heart failure in the practice of the therapist: is it difficult to recognize it?]. Consilium medicum [Consilium medicum]. 2019; 21 (1): 46-49.

10. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology; Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012; 33: 1787–1847.

11. Galyavich AS. [Diagnostika i lechenie hronicheskoj serdechnoj nedostatochnosti segodnya [Diagnosis and treatment of chronic heart failure today]. Rusckij medicinskij zhurnal [Russian medical journal]. 2014; 12: 867-873.

 INFLUENCE OF THE HISTORY OF GESTATIONAL HYPERTENSION ON TOTAL CARDIOVASCULAR RISK IN MENOPAUSAL WOMEN

SADYKOVA AIDA R., ORCID ID: 0000-0001-8324-2424; C. Med. Sci., associate professor of the Department of introduction to internal diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: aidasad@mail.ru

SHAMKINA AYGUL R., C. Med. Sci., assistant of professor of the Department of introduction to internal diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: schamkina.aigul@yandex.ru

SADYKOVA ALSU M., ultrasound diagnostic doctor of the Department of ultrasound diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54, e-mail: alsiwise@gmail.com

SADYKOVA DIANA R., 5th year student of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: radiana2007@yandex.ru

Abstract. Aim – to evaluate total cardiovascular risk (CVR) in menopausal women depending on the history of gestational hypertension (HGH). Material and methods. 167 menopausal women aged 42–59; 22 normotensives (NT), 25 with high normal blood pressure (HNBP) and 120 hypertensives (HT) with average duration of hypertension (15,8±10,3) years were considered in the present analysis. Mean age of HT was (51,5±4,2) years. Patients with secondary hypertension were excluded. All the participants underwent questioning, complete physical examination, biochemical blood and urine investigation, standard ECG and echocardiography (standard protocol). All surveyed have been divided into 2 groups depending on presence of HGH. CVR was stratified according to ESC-ESH 2018 guidelines. Statistical analysis was performed using the «Statistica 13.0» software package. Results and discussion. No significant difference was found in frequency and mean number of risk factors in the HNBP and HT groups depending on presence of HGH. Significantly higher frequency (p<0,05 according Fisher exact method) of subclinical organ damage, established CVD and of very high risk was found (100% versus 16,7%; p<0,001; 19% versus 0%; p<0,05; 56,6% versus 0%; p<0,001 respectively) in HT with HGH comparing with HNBP without HGH. Significantly higher CVR was found in HT with and without HGH comparing with HNBP without HGH (3,3±0,9 versus 1,5±1,0; p<0,001 according Mann – Whitney U-test). Conclusion.HGH is associated with significantly higher (p<0,05) frequency of subclinical organ damage, established CVD and of very high risk and also higher values of total CVR in menopausal women.

Key words: gestational hypertension, cardiovascular risk, women, menopause.

For reference: Sadykova AR, Shamkina AR, Sadykova AM, Sadykova DR. Influence of the history of gestational hypertension on total cardiovascular risk in menopausal women. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 49-54. DOI: 10.20969/VSKM.2019.12(5).49-54.

1. Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics – 2006 update: a report from the American heart association statistics committee and stroke statistics subcommittee. Circulation. 2006; 113: e85–151.

 CHANGE IN MEMORY DISORDERS AND COMPLIANCE IN PATIENTS WITH ANEMIA

SALIMOVA LILIYA M., ORCID ID: 0000-0003-4186-6049; assistant of professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7-927-246-40-59, e-mail: calimova.lili@gmail.com

OKURLU ALFIYA F., ORCID ID: 0000-0001-8890-1468; C. Med. Sci., assistant of professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7-432-245-13, e-mail: alfiaf@yandex.ru

KHAMITOV RUSTEM F., ORCID ID: 0000-0001-8821-0421; D. Med. Sci., professor, Head of the Department of internal diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7-917-272-96-72, e-mail: rhamitov@mail.ruMOLOSTVOVA ALSU F., ORCID ID: 0000-0001-6996-9985; assistant of professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7-904-672-81-19, e-mail: alsuvesna@mail.ru

ZAKHAROVA IRINA A., ORCID ID: 0000-0002-8678-9780; 5th year student of the pediatric faculty of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7-960-056-44-16, e-mail: 79600564416@yandex.ru

Abstract. Aim. To identify the presence of memory disorders and cognitive impairements in patients with various types of anemia compared with healthy individuals. Material and methods. A total of 72 people, 36 of whom had various severity anemia (15 men and 21 women) participated in this study. The comparison group consisted of 36 people without anemia. The exclusion criteria were oncological diseases, acute purulent-inflammatory diseases, an acute period of myocardial infarction and cerebrovascular accident. The average age of participants was 55 years. The study used McNair and Kahn validated memory self-assessment questionnaires and Moriski – Green test for treatment compliance assessing in patients with anemia. Results and discussion. In patients with anemia, a memory loss was detected compared with the control group, which suggests casual relationships between memory safety and blood counts. Conclusion. In case of anemia, it is necessary to identify memory disorders, which can affect the course of treatment. Anemia management features and adherence to therapy should be discussed with patients.

Key words: memory, compliance, anemia.

For reference: Salimova LM, Okurlu AF, Khamitov RF, Molostvova AF, Zakharova IA. Changes in memory and compliance in patients with anemia. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 55-58. DOI: 10.20969/ VSKM.2019.12(5).55-58.

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2. Shavrina ES. Osobennosti kognitivnogo statusa u zhenshchin molodogo vozrasta pri zhelezodefficitnoj anemii legkoj i srednej stepeni tyazhesti [Features of cognitive status in young women with mild and moderate iron deficiency anemia]. Permskij medicinskij zhurnal [ Perm Medical Journal]. 2015; 32 (3): 57-62.

3. YuNISEF, Universitet Organizacii Obʹedinennyh Nacij, VOZ. Zhelezodeficitnaya anemiya: ocenka, profilaktika i control’: rukovodstvo dlya rukovoditelej program [Iron deficiency anemia: assessment, prevention and control: program Manager Guide]. Zheneva: Vsemirnaya organizaciya zdravoohraneniya [Geneva: World Health Organization]. 2001; 114 p.

4. Egorova NS. Gendernye osobennosti kognitivnyh narushenij u lic zrelogo vozrasta [Gender characteristics of cognitive impairment in adults]. Perm’: PGMA [Perm: PSMA]. 2011: 21 p.

5. Rumyancev AG, Zaharova IN, Chernov VM, Tarasova IS, Zaplatnikov AL, Korovina NA, Borovik TE, Zvonkova NG. Rasprostranenost’ zhelezodeficitnyh sostoyanij i faktory, na nee vliyayushchie [The prevalence of iron deficiency conditions and factors affecting it]. Medicinskij sovet [Medical Council]. 2015; 6: 62-66.

6. Shostka GD. Deficit zheleza: principy diagnostiki i lecheniya [Iron deficiency: principles of diagnosis and treatment]. Anemiya; Zhurnal rabochej gruppy po anemii [Anemia; Journal of the working group on anemia]. 2004; 1: 11-18.

7. Levin OS. Diagnostika i lechenie demencii v klinicheskoj praktike [Diagnosis and treatment of dementia in clinical practice]. Moskva: MEDpressinform [Moscow: MEDpressinform]. 2014; 4: 256 p.

 CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH ISCHEMIC HEART DISEASE

FROLOVA ELVIRA B., ORCIDID 0000-0002-4653-1734; C. Med. Sci., deputy Head physician of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: frolova.67@mail.ru

KUROCHKIN SERGEY V., ORCIDID 0000-0002-8043-3871; C. Med. Sci., Head of the Department of X-ray of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: kurochkin.70@bk.ru

TSYBULKIN NIKOLAY A., ORCIDID 0000-0002-1343-0478; C. Med. Sci., associate professor of the Department of cardiology, rentgenendovascular and cardiovascular surgery of Kazan State Medical Academy – brauch of Russian Medical Academy of Continuing Professional Education, Russia, 420012, Kazan, Butlerov str., 36, e-mail: kdkgma@mail.ru

GAYNUTDINOVA LEYSAN I., ORCIDID 0000-0002-5859-8776; C. Med. Sci., Head of the Department of HMT of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: orgmetod.rkb3@mail.ru

RYCHKOVA VERONIKA S., ORCIDID 0000-0002-8523-1056; biophysicist of Institute of fundamental medicine and biology of Kazan Federal University, Russia, 420008, Kazan, Kremlevskaya str., 18, e-mail: roniveroni22@gmail.com

Abstract. Aim. To present an overview of the current state of coronary computed tomography angiography (CCTA). To compare coronary computed tomography angiography (CCTA) and coronary angiography in diagnostics of atherosclerosis and congenital coronary arteries anomalies in patients with ischemic heart disease (IHD). Material and methods.Scientific medical literature searched for articles with clinical relevance on CCTA in diagnostics of coronary artery disease and retrospective study 162 patients with chronic IHD was performed. Results and discussion. CCTA allows to visualize heart vascular network structure, coronary arteries distribution pattern, define congenital heart diseases, and atherosclerotic coronary walls impairment. CCTA is used for visualization of coronary arteries stenosis, restenosis after previous coronary interventions, shunts patency, and coronary wall calcium accumulation. In 93% of cases CCTA findings were as follows: absence of stenosis in 16% of cases, hemodynamically insignificant stenosis in 24%, and hemodynamically significant stenosis in 60% of cases. Conclusion. CCTA is useful not only planning patients for coronary angiography (CAG), but also in an exclusion from CAG.

Key words: coronary computed tomography angiography, coronary atherosclerosis, diagnostics.

For reference: Frolova EB, Kurochkin SV, Tsybulkin NA, Gaynutdinova LI, Rychkova VS. Coronary computed tomography angiography in patients with ischemic heart disease. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 58-63. DOI: 10.20969/VSKM.2019.12(5).58-63.

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 FACTORS ASSOCIATED WITH CONTRAST-INDUCED ACUTE KIDNEY INJURE AFTER ENDOVASCULAR INTERVENTION ON THE CORONARY ARTERIES

IN PATIENTS WITH MYOCARDIAL INFARCTION

YAKUPOV ISKANDER F., C. Med. Sci., Head of the Department of intensive care unit of City Clinical Hospital No 7, Russia, 420103, Kazan, Chyikov str., 54, tel. 8-937-615-35-68, e-mail: isyakup2000@mail.ru

MELNICHUK MARINA A., resident of the Department of introduction into internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: melmarimel@yandex.ru

SAMSONOVA DARIA S., resident of the Department of introduction into internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: darya.sergeevna.26@mail.ru

KHASTIEVA DILYARA R., resident of the Department of introduction into internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: dilyara_khastieva@mail.ru

SHAMSUTDINOVA DILYARA M., resident of the Department of introduction into internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: polka8aclass@yandex.ru

KHASANOV NIYAZ R., D. Med. Sci., Head of the Department of introduction into internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: ybzp@mail.ru

Abstract. Aim. The aim of the study was to determine the factors associated with contrast-induced acute kidney injury (AKI) after coronary arteries endovascular intervention in patients with myocardial infarction in clinical practice. Material and methods. The study included 311 patients with myocardial infarction treated in City Hospital No 7 in 2018–2019. All patients underwent coronary angiography and percutaneous coronary intervention. We selected data from general clinical examination, left ventricular ejection fraction measured by echocardiography, blood plasma creatinine, glomerular filtration rate calculated with CKD-EPI equation. Results and its discussion. Contrast volume increase in coronary angiography and transcutaneous coronary intervention was associated with contrast-induced AKI. Contrast volume was inversely correlated with the left ventricular ejection fraction. Conclusions. Our data supports the presumptionthat contrast-induced AKI in coronary angiography and transcutaneous coronary intervention is predicted by contrast volume. We suggest to perform the ventricular ejection fraction assessement by echocardiography in patients with myocardial infarction prior to coronary angiography and transcutaneous coronary intervention

Key words: myocardial infarction, contrast-induced acute kidney injury, left ventricular ejection fraction.

For reference: Yakupov IF, Melnichuk MA, Samsonova DS, Khastieva DR, Shamsutdinova DM, Khasanov NR. Factors associated with contrast-induced acute kidney injure after endovascular intervention on the coronary arteries in patients with myocardial infarction. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 63-67. DOI: 10.20969/ VSKM.2019.12(5).63-67.

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 PECTINATE MUSCLES OF THE RIGHT ATRIUM

IBRAGIMOVA GULNARA Z., doctor of ultrasonic diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: morgens_vesna@mail.ru

BILALOVA RESEDA R., doctor of functional diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

SHAYKHUTDINOVA ZULFIYA A., C. Med. Sci., Honored Doctor of the Republic of Tatarstan, deputy Head physician for medical section of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54

Abstract. With the most widespread use, ultrasound is not only a control study of pathology, but also a method of mandatory research in complex clinical cases. In terms of sensitivity and specificity, echocardiography is a well-researched method, for investigation the morphological and functional changes in the heart and its valvular apparatus. Small heart anomalies differ from the normal morphology do not violate hemodynamics. One of the methods of differential diagnosis of small anomalies and formations of the right atrium is echocardiography. The aim of the study was to study the anatomy and structure of the right atrium, the right atrium pectinate muscles and its differential from thrombus and tumor.Material and method. A review of the literature on anatomy, ultrasound diagnosis of right atrium structure, right atrial pectinate muscles, right atrial hypertrophy was conducted. Results and discussion. Hypertrophied pectinate muscles can imitate hyperechogenic thrombus or tumor metastasis. One of the main features in the diagnosis of pectinate muscles abnormalities is its structure in echo apical four-chamber position. Differentiating hypertrophy of pectinate muscles in the right atrium from thrombus or metastasis is one of the urgent tasks. Conclusion. Pectinate muscles hypertrophy is a small anomaly, and a thrombus or tumor in the cavity is a pathology. Therefore, during ultrasound investigation it’s important to perform an integrated approach in differential diagnosis using not only transthoracic echocardiography, but also transesophageal diagnostic method, the class of ultrasound diagnostics, as well as the skills and experience of the doctor.

Key words: pectinate muscle, right atrium, echocardiography.

For reference: Ibragimova GZ, Bilalova RR, Shaikhutdinova ZA. Pectinate muscles of the right atrium. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 73-76. DOI: 10.20969/VSKM.2019.12(5).73-76.

DOI: 10.20969/VSKM.2019.12(5).76-80

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 DYSPNEA IN PATIENTS OF THERAPEUTIC PROFILE: ISSUES OF TERMINOLOGY, PATHOGENESIS, ASSESSMENT PROGNOSIS

KHAZOVA ELENA V., ORCID ID: 0000-0001-8050-2892; SCOPUS Author ID: 57205153574; C. Med. Sci., associate professor of the Department of propaedeutics of internal diseases named after professor S.S. Zimnitsky of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-905-313-97-10, e-mail: hazova_elena@mail.ru

BULASHOVA OLGA V., ORCID ID: 0000-0002-7228-5848; SCOPUS Author ID: 6507198087; D. Med. Sci., professor of the Department of propaedeutics of internal diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. (843)296-14-03, e-mail: boulashova@yandex.ru

FROLOVA ELVIRA B., C. Med. Sci., deputy Head physician or diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. 8-917-267-73-25, e-mail: frolova.67@mail.ru

MALKOVA MARIA I., C. Med. Sci., assistant of professor of the Department of propaedeutics of internal diseases named after professor S.S. Zimnitsky of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49; Head of the Department of functional diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. 8-960-051-61-16, e-mail: marimalk@yandex.ru

ZAYNULLINA JULIANA I., ORCID ID: 0000-0002-0932-3987; student of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-987-237-94-58, e-mail: zaynullina_yuliana@mail.ru

Abstract. Despite the successes of modern medicine, it is often difficult to find the causes of chronic shortness of breath in the practical work of a doctor. Dyspnea is one of the main reasons limiting physical activity and deteriorating quality of life for patients. The severity of this symptom varies, does not always correspond to the objective data of pulmonary or cardiac pathology and is associated with an unfavorable outcome. The low specificity and etiology of chronic dyspnea factors leads to difficulties in diagnosing its causes and often require detailed, long-term examination. Aim. To review aspects of terminology, mechanisms of development, evaluation of dyspnea of various etiology. Material and methods. To review the publications of the etiology, pathogenesis, and methods of diagnosing dyspnea. Results and discussion. Complaintsof shortness of breath make every second patient admitted to the hospital on an emergency basis and every fourth who needed an outpatient care. Dyspnea, as a patient’s subjective feeling, may vary due to the presence of depression, increased fatigue, as well as a general perception of health. The prevalence of dyspnea on the MRC scale (3–5 points) in the general population of elderly patients is (8,2–32,3)%, reaching 45,3% in men aged 80 and over, and 43% in women. The mean value of dyspnea in patients with chronic obstructive pulmonary disease (COPD) on a MRC scale was (3,33±0,16) points, with chronic heart failure (CHF) – (3,30±0,17) points, and in obesity – (1,55±0,25) points (p<0,001). It has been established that patients with shortness of breath, regardless of the presence of coronary heart disease (CHD) in history, have an increased risk of cardiovascular mortality HR=1,9 (with 95% CI 1,5–2,4) for patients with CHD and HR=2,9 (with 95% CI 1,7–5,1) for patients without a history of CHD. Conclusion. The epidemiological, pathophysiological aspects of dyspnea, its prognostic significance according to the data of clinical studies is considered in this article. The significance of the quantitative and qualitative determination of dyspnea in patients is highlighted.

Key words: dyspnoea, MRC, the language of dyspnoea, congestive heart failure, chronic obstructive pulmonary disease.

For reference: Khazova EV, Bulashova OV, Frolova EB, Malkova MI, Zaynullina JI. Dyspnea in patients of therapeutic profile: issues of terminology, pathogenesis, assessment prognosis. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 92-99. DOI: 10.20969/VSKM.2019.12(5).92-99.

 THE ROLE OF A NURSE OF MANAGEMENT PATIENTS WITH POLYTRAUMA IN EMEREGENCY DEPARTMENT IN A MULTIDISCIPLINARY HOSPITAL

CHIKAEV VYACHESLAV F., D. Med. Sci., professor of the Department of traumatology, orthopedics and emergencysurgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: prof.chikaev@gmail.com

KLYUSHKIN IVAN V., D. Med. Sci., professor of the Department of general surgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: hirurgivan@rambler.ru

MELNIKOV EVGENIY A., D. Med. Sci., deputy Head physician for surgery of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54

SADRIEV RAFAT R., D. Med. Sci., main specialist in anesthesiology and resuscitation of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54

ZINATULLINA NADYIA YA., Head nurse of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuykov str., 54

Abstract. Aim. To evaluate the role of paramedics in managing patients with polytrauma in emergency department in multidisciplinary hospitals. Material and methods. We performed a retrospective analysis of work organization in ED and nurses role in diagnostic and treatment of patients in a multidisciplinary City Clinical Hospital No 7 in Kazan. We evaluated the features of diagnosis and treatment of 343 patients with combined trauma selected from the entire cohort of patients. Results and discussion. All patients with combined trauma were immediately hospitalized in ED. The delivery time by the ambulance crew ranged from 10 to 40 min and averaged (31±8) min. It is also very important to clearly implement the standards of diagnostic and therapeutic procedures at all levels. An important role in the readiness of anti-shock plays paramedics. There were 2 steps of preparation. At the first step, the responsible nurse with head of ED prepares surgical kits and medicines kits for all cases: surgical, neurosurgical, traumatological, reanimation. At the second step, upon receipt of the information, the responsible nurse informs the head of the ED or the responsible surgeon about the transportation of severe patient. Adopted Clinic Protocol defines a clear consistent implementation of standards of professional activity at all levels – both doctors and nurses. In patients with combined trauma, one of the emergencies is blood loss. 45% of patients who died for the first 72 hours died from hemorrhagic shock. To reduce the blood group determining time, on admission enters we do this immediately in ED ward using two-way pneumatic tube system MVX Medic. Blood delivery time to the laboratory averages (1,5±0,5) min. Determination of blood group with phenotype averages (40±2) min. The standard diagnostic examination of patients with combined trauma and stable hemodynamics is whole body CT-scan. Time of preparation for blood components transfusion is (30±2,0) min. Conclusions. In the work of ED, an important role is played by personnel action algorithm adopted in the clinic, based on current guidelines and recommendations. Nurses play an important role in the preparation of ED and patients admission.

Key words: combined trauma, injury, nurse, emergency department.

For reference: Chikaev VF, Klyushkin IV, Melnikov EA, Sadriev RR, Zinatullina NYa. The role of a nurse of management patients with polytrauma in emeregency department in a multidisciplinary hospital. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 100-103. DOI: 10.20969/VSKM.2019.12(5).100-103.

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6. Chikaev VF, Akhtyamov IF, Ziatdinov BG, Galyautdinov FS. Organizatsionnyye aspekty raboty protivoshokovoy paty priyemnogo otdeleniya pri gospitalizatsii postradavshikh s politravmoy [Organisational aspects of the anti-shock opening in the admissions Department at admission of patients with polytrauma]. Politravma [Polytrauma]. 2017; 3: http://poly-trauma.ru/index.php/pt/article/view/39/113

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 CORONARY, BUT NOT ISCHEMIC ANEMIA MASKS

OSLOPOV VLADIMIR N., ORCID ID: 0000-0003-2901-0694; SCOPUS Author ID: 6602523658; D. Med. Sci., professor of the Department of propaedeutics of internal diseases named after professor S.S. Zimnitsky of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, 8-905-316-25-35, e-mail: kpvbol@yandex.ru

KHAZOVA ELENA V., ORCID ID: 0000-0001-8050-2892; SCOPUS Author ID: 57205153574; C. Med. Sci., associate professor of the Department of propaedeutics of internal diseases named after professor S.S. Zimnitsky of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-905-313-97-10, e-mail: hazova_elena@mail.ru

KHABIBULLINA RAMZIYА T., deputy Head physician of City Clinical Hospital No 11, Russia, 420127, Kazan, Maksimov str., 34/24, tel. 8-843-571-42-81, e-mail: gb11Kazan@mail.ru

OSLOPOVA DARYA V., student of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, тел. 8-965-597-77-66, e-mail: dasha.xexe@mail.ru

KHANAPHIEVA ALBINA L., ORCID ID: 0000-0003-4964-4432; student of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-908-335-55-02, e-mail: hhllaa@bk.ru

OSLOPOVA JULIA V., ORCID ID: 0000-0002-9752-8703; C. Med. Sci., associate professor of the Department of the fundamentals of clinical medicine of Institute of fundamental medicine and biology of Kazan Federal University, Russia, 420008, Kazan, Kremlovskaya str., 18, tel. 8-917-287-94-56, e-mail: oslopovajul@mail.ru

MALKOVA MARIA I., C. Med. Sci., assistant of professor of the Department of propaedeutics of internal diseases named after professor S.S. Zimnitsky of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49; Head of the Department of functional diagnostics of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. 8-960-051-61-16, e-mail: marimalk@yandex.ru

DELIAN ARTHUR M., Head physician оf City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. (843) 237-91-78, e-mail: gkb7@bk.ru

Abstract. The question of the relationship between anemia and IHD is still relevant. A various severity anemia can cause clinical and electrocardiographic changes, similar to findings in case of coronary artery disease exacerbation. The literature data considers the relationship of these 2 diseases, and shows the complexity of diagnostic search, especially if it happens in urgent situation. Cardiac and ECG changes in anemia per se, mainly represented in the publications of South-East Asia and based on pediatric trials. South-Eastern data shows that severe anemia in malaria causeschanges in the ST segment and lengthens the QTc interval, which indicates the threat of arrhythmia. A 2-fold increase in troponin T levels was found in children who died of anemia, suggesting that severe anemia causes myocardial damage (injury). Aim. This publication presents our own interesting case of clinical and electrocardiographic findings in patient A., who suffered from iron deficiency anemia for many years. Results and discussion. Exacerbations of anemia were treated as manifestations of CHD – first as angina pectoris, then as a myocardial infarction until coronary angiography was done, with intact («clean») coronary arteries. Diagnoses of CHD exacerbations were revised and treatment was changed. An enhanced iron supplementation, improved patient’s condition, and the angina disappeared. ECG changes that misleaded doctors also disappeared. Conclusion. Thus, in clinical practice, it is necessary to allow the existence of «coronary masks» of anemia and to search for the true face of the pathology.

Key words: anemia, hemoglobin, hemic hypoxia, myocardial ischemia, angina pectoris, electrocardiographic changes.

For reference: Oslopov VN, Khazova EV, Khabibullina RT, Oslopova DV, Khanaphieva AL, Oslopova YuV, Malkova MI, Delian AM. Coronary, but not ischemic anemia masks. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 104-118. DOI: 10.20969/VSKM.2019.12(5).104-118.

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 COMBINED DISTURBANCES OF HEART RHYTHM IN CARDIOLOGY DEPARTMENT

FROLOVA ELVIRA B., ORCID ID: 0000-0002-4653-1734; C. Med. Sci., deputy Head physician of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: frolova.67@mail.ru

TSYBULKIN NIKOLAY A., ORCID ID: 0000-0002-1343-0478; C. Med. Sci., associate professor of the Department of cardiology, rentgenendovascular and cardiovascular surgery of Kazan State Medical Academy – branch of RMACPE, Russia, 420012, Kazan, Butlerov str., 36, e-mail: kdkgma@mail.ru

SLEPUKHA ELENA G., ORCID ID: 0000-0002-5122-7235; Head of the Department of cardiology No 3 of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, tel. +7(843)237-91-76, e-mail: slepuha_elena@mail.ru

GAYNUTDINOVA LEYSAN I., ORCID ID: 0000-0002-5859-8776; C. Med. Sci., Head of the Department of HMT of City Clinical Hospital No 7, Russia, 420103, Kazan, Chuikov str., 54, e-mail: orgmetod.rkb3@mail.ru

Abstract. Aim. To review the modern ideas of the combined heart rhythm disturbances in patients with cardiovascular disease. Material and methods. The purpose of this article is to explore modern ideas of combined heart rhythm disturbances in patients with cardiovascular disease and to demonstrate a clinical case. Results and discussion.Cardiac arrhythmias are one of the most common symptoms in practice of cardiologist. Arrhythmias caused by heart diseases, including an ischemic heart disease. The origins of arrhythmias underlie in disturbances of various electrophysiological properties and conduction disorders. Heart rhythm disturbances continue to be the most common causes of mortality in cardiovascular diseases. Heart diseases can lead to development of various arrhythmias based on different pathophysiological processes. Heart rhythm disturbances management can be medical or preventive. Treatment is based on medicinal therapy, invasive procedures, and pacemakers implantation. Preventive methods also include cardioverter defibrillators installation. Conclusion. Demonstrated clinical case shows a combination of various rhythm and conductivity disturbances in patient with absence of convincing evidence of cardiovascular disease. Thirddegree atrioventricular block followed by increased arrhythmic activity of a right ventricle developed. The myocardial infarction, myocarditis and an ischemic syndrome due to block of distal subdivisions of small branches of coronary arteries are probable causes. Perhaps, a combination of different factors, including of genetic predisposition led to the development of arrhythmia.

 CLINICAL CASE OF ACUTE COMPLICATION IN PATIENT WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

KHAMITOV RUSTEM F., ORCID ID: 0000-0001-8821-0421; D. Med. Sci., professor, Head of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-917-272-96-72, e-mail: rhamitov@mail.ru

SALIMOVA LILIA M., assistant of professor of the Department of internal diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-917-232-86-63, e-mail: calimova.lili@gmail.com

MINGALEEVA GULNAZ F., assistant of professor of the Department of internal diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-987-292-55-37, e-mail: m.gulnaz.f@mail.ru

ZINNATULLINA AIGUL R., assistant of professor of the Department of internal diseases of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-905-039-35-57, e-mail: aigoul-zinnatullina.rust@mail.ru

FATYKHOVA KIRA R., assistant of professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-987-221-83-50, e-mail: kira_sulbaeva@mail.ru

MOLOSTVOVA ALSU F., assistant of professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-904-672-81-19, e-mail: alsuvesna@mail.ru

KHAIRULLINA ADELYA R., assistant of professor of the Department of internal medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-917-911-22-23, e-mail: adelyminsafy@gmail.com

ZAKIROVA ALFIA K., Head of the Department of internal diseases of Central City Clinical Hospital No 18, Russia, 420107, Kazan, Mavliutov str., 2, tel. 8-917-883-99-49

Abstract. Aim. To show the possible impact of minimally invasive thoracic procedures on the survival rate in patients with severe chronic obstructive pulmonary disease COPD. Material and methods. A clinical case of complicated course of COPD, required readmission and additional minimally invasive endoscopic manipulations is reviewed. Results and discussion. A patient with emphysema phenotype of very severe COPD had sudden breathlessness on the day of discharge. Spontaneous pneumothorax was considered as a possible cause of respiratory failure progression. During the diagnostic search, a giant bulla of the left lung with a mediastinal shift was founded. The bulla was formed by the merge of small upper lobe bullae. Due to comorbidity and morpho-functional state of the lungs open thoracotomy was a great risk. A bronchoscopic valvular bronchial blocker installed in left proximal bronchus. This minimally invasive manipulation was crucial for the survival of the patient. Conclusion. In cases of severe and very severe complicated course of COPD in patients with significant comorbidities the selection of adequate medical and oxygen therapy, must be accompanied with the opportunities of pulmonologists and thoracic surgeons cooperation.

Key words: COPD, complication, valvular bronchial blocker.

For reference: Khamitov RF, Salimova LM, Mingaleeva GF, Zinnatullina AR, Fatykhova KR, Molostvova AF, Khairullina AR, Zakirova AK. Clinical case of acute complication in patient with chronic obstructive pulmonary disease. The Bulletin of Contemporary Clinical Medicine. 2019; 12 (5): 128-134. DOI: 10.20969/VSKM.2019.12(5).128-134.

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