2. Khisamiyev RSh, Ginyatullina LR, Amirov NB. Vedomstvennoye zdravookhraneniye MVD po Respublike Tatarstan: realii i perspektivy [Departmental health care of the Ministry of Internal Affairs in the Republic of Tatarstan: realities and prospects]. Vestnik sovremennoy klinicheskoy meditsiny [Bulletin of modern clinical medicine]. 2014; 7 (1): 11-15.

3. Amirov NB, Potapova MV, Sabirov LF, Ginyatullina LR. Preimushchestva sovmestnoy raboty klinicheskikh kafedr v vedomstvennoy meditsine MVD na primere mediko-sanitarnoy chasti MVD po Respublike Tatarstan [Advantages of joint work of clinical departments indepartmental medicine of the Ministry of Internal Affairson the example of the medical and sanitary unit of the Ministry of Internal Affairs in the Republic of Tatarstan]. Fundamental’nyye issledovaniya [Fundamental research]. 2011; 10: 257-260.

4. Khisamiyev RSh, Ginyatullina LR, Amirov NB. Opytorganizatsii deyatel’nosti mediko-sanitarnoy chasti v period provedeniya krupnykh mezhdunarodnykh i massovykhsportivnykh meropriyatiy (na primere FKUZ «MSCH MVDRossii po Respublike Tatarstan» v period podgotovki iprovedeniya XXVII Vsemirnoy letney universiady) [The experience of organizing the activities of the medical and sanitary unit during the period of major international and mass sports events (on the example of the FKUZ«Medical unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan» during the preparation andholding of the XXVII World Summer Universiade)]. Vestnik sovremennoy klinicheskoy meditsiny [Bulletin of modern clinical medicine]. 2013; 6 (1): 4-9.

5. Amirov NB, Vizel’ AA, Sabirov LF. II Vserossiyskaya konferentsiya vrachey mediko-sanitarnykh chastey MVD i vrachey Respubliki Tatarstan [II All-Russian conferenceof doctors of medical and sanitary units of the Ministry ofInternal Affairs and doctors of the Republic of Tatarstan]. Vestnik sovremennoy klinicheskoy meditsiny [Bulletin of modern clinical medicine]. 2009; 2 (4): 67-72.

6. Rasporyazheniye Ministra vnutrennikh del RossiyskoyFederatsii, generala politsii V.A. Kolokol’tseva ot 31 yanvarya 2020 g. No1/984 «O komplekse mer popreduprezhdeniyu rasprostraneniya koronavirusnoyinfektsii» [Order of the Minister of internal Affairs of the Russian Federation, General of police V. A. Kolokoltsev dated January 31, 2020 No. 1/984 “on a set of measures to prevent the spread of coronavirus infection”].

7. Postanovleniye Glavnogo gosudarstvennogo sanitarnogo vracha Rossiyskoy Federatsii A.Yu. Popovoy ot 24 yanvarya 2020 goda No2 «O dopolnitel’nykh meropriyatiyakhpo nedopushcheniyu zavoza i rasprostraneniya novoykoronavirusnoy infektsii, vyzvannoy 2019-nCoV» [Resolution of the Chief state sanitary doctor of the Russian Federation A. Y. Popova dated January 24, 2020 No. 2«on additional measures to prevent the import and spreadof a new coronavirus infection caused by 2019-nCoV»].

DOLINSKAYA ELVIRA A., the Head of Medical Care unit of the Ministry of Internal Affairs of Russia for Sakha Republic (Yakutia), colonel of internal service, Russia, 677005, Yakutsk, Sverdlov str., 1/2, tel. 8-411-245-40-98, e-mail: elvi.67@mail.ru

GUBKO ROMAN V., deputy head of the Hospital of Medical Care unit of the Ministry of Internal Affairs of Russia for Sakha Republic (Yakutia), internal service major, Russia, 677005, Yakutsk, Sverdlov str., 1/2, tel. 8-411-245-49-61, e-mail: gubkor@mail.ru

KONONOVA MARINA I., medical psychologist of the Center for psychophysiological diagnostics of Medical Care unit of the Ministry of Internal Affairs of Russia for the Sakha Respublic (Yakutia), senior lieutenant of the internal service, Russia, 677005, Yakutsk, Sverdlov str. 1/2, tel. 8-411-245-40-62, e-mail: milk_1106@mail.ru

Abstract. Aim. The aim of the study was to analyze lethal cases among law enforcement of cers in the Republic of Sakha (Yakutia). Identi cation of the main leading causes of lethality, and comparison with various law enforcement agencies. Material and methods. The materials contain indicators of the health status of the population, activities and resources of medical institutions of the Republic of Sakha (Yakutia), statistical data of the Ministry of Health of the Russian Federation, information-analytical review of the health status of employees of the internal affairs bodies,the main indicators of the health status of employees of IABs and activities of health organizations of the system ofthe Ministry of Internal Affairs of the Russian Federation, protocols of research of candidates for the service of the Centre of Psychophysiological Diagnostics of the Federal Clinical University «Medical Unit of the Ministry of Internal Affairs of Russia for SR (Yakutia)», and data of the Department of Internal Affairs of the Ministry of Internal Affairs of the Russian Federation. Results and discussion. Assessment of mortality among law enforcement agencies andtheir main causes will prevent sudden losses among the personnel. The heads of departments, divisions, structural units, departments are to pay great attention to the health of personnel. Conclusion. The mortality analysis should be conducted annually in medical institutions of departmental subordination. Special attention should be paid to the issues of moral and psychological activities in departments. Heads of agencies and departments are to update the health issues with medical institutions of departmental subordination.

1. Osnovnyye pokazateli sostoyaniya zdorov’ya naseleniya,deyatel’nost’ i resursy meditsinskikh organizatsiy zdra-vookhraneniya Respubliki Sakha (Yakutiya) za 2016-2019 goda: statisticheskiy sbornik [Main indicators of the health status of the population, activities and resources medical organizations of the health care of the Respublic of Sakha (Yakutia) for 2016 – 2019]. GBU RS (YA) «Yakutskiy respublikanskiy meditsinskiy informatsionno-analiticheskiytsentr». – Yakutsk [SBLBU RS (Y) «Yakutsk Republican Medical Information analytical centr»]. 2020; 39 p.

2. Statisticheskiye materialy Ministerstva zdravookhraneniya RF, Departament monitoringa, analiza i strategicheskogo razvitiya zdravookhraneniya [Statistical materials of the Ministry of Health of the Russian Federation, Department of monitoring, analysis and strategic development of Health]. Moskva [Moscow]. 2019.

3. Informatsionno-analiticheskiy obzor sostoyaniyazdorov’ya sotrudnikov organov vnutrennikh del (2019god), UMO DMT i MO MVD Rossii [Information and analyticalreview of the state of health of the internal affairs bod-ies (2019), UMO DT and the Ministry of internal Affairs of Russia].

4. Osnovnyye pokazateli sostoyaniya zdorov’ya sotrudnikov OVD i deyatel’nosti mediko-sanitarnykh organizatsiy sistemy MVD RF za 2019 god, UMO DMT i MO MVD Rossii [The main indicators of the Health status of police of cersand the activities of medical and sanitary organizations of the system of the Ministry of internal Affairs of Russiafor 2019, UMO DT and the Ministry of internal Affairs of Russia]. 2020.

5. Protokoly issledovaniy kandidatov na sluzhbu TSPD FKUZ «MSCH MVD Rossii po RS (YA)» [Protocol of research ofcandidates for the service of the Center psychophysiologi-cal diagnostics Federal Unitary Enterprise Medical Unit of the Ministry of internal Affairs of Russia for the Sakha Respublic]. Yakutsk. 2017-2019.

6. Materialy instrumental’nykh issledovaniy Tsentra luche-voy diagnostiki OOO «Kayzen» [Material of instrumental studies of the center for radiation Diagnostics of LLC «KAIZEN»]. Blagoveshchensk [Blagoveshensk]. 2018.

 CERTAIN ASPECTS OF MEDICAL EXAMINATION OF MIA EMPLOYEES WHO HAVE EXPERIENCED CRANIOCEREBRAL TRAUMA

ISHKINEEV FARID I., deputy head of Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, the Head of military physician board, Russia, 420111, Kazan, Lobachevsky str., 13, tel. 8 (843)291-21-42, e-mail: ifi2001@mail.ru

ZARIPOVA ALINA I., neurologist of military physician board of the Medical Care unit of the Ministry of Internal Affairs of Russia for the Republic of Tatarstan, Russia, 420111, Kazan, Lobachevsky str., 13, tel. 8 (843)291-34-74, e-mail: alinochka_636@mail.ru

PAVLOV ALEXANDER A., neurologist of military physician board of the Medical Care unit of the Ministry of Internal Affairs of Russia for the Republic of Tatarstan, Russia, 420111, Kazan, Lobachevsky str., 13, tel. 8 (843)291-22-64, e-mail: alex-pav@list.ru

Abstract. Craniocerebral trauma (CCT) is estimated at 1/3 in the injury structure. At the present stage of technical progress development when the in uence of machines and high speeds is increasing the steady increase in the incidence and severity of craniocerebral trauma is common. Annual mortality rate from CCT in the world is about 1,5 million people, which exceeds this rate for cardiovascular diseases by 10 times and for cancer by 20 times. In correlation CCT is most common in men (2–3 times more than in women) of the working age (from 20 to 44 years). It often leads to disability, becoming a threat to the demographic and economic indicators in the country. Aim. The aim of the study was to analyze the incidence of traumatic brain lesions of varying degrees of severity and to identify the nature of neurologicalsyndromes. Material and methods. The analysis of activities of the Medical Unit of the Ministry of Internal Affairs of Russia for the Republic of Tatarstan on consequences of CCT in employees in the period from 2016 to 2018 was carried out. In total, 95 employees of senior age (30 years and older) were examined with regard to the consequences of the CCT. It included a comprehensive examination as part of the military physician board examination (collecting the data on complaints, history data, neurological status, blood biochemical study, and electroencephalography). The diagnosis was veri ed by means of magnetic resonance imaging (MRI) of the brain (1,5 Tesla). Results and discussion. Thecorrelation analysis of the military physician board activity for the period from 2016 to 2018 on making conclusions on the consequences of CCT was carried out. The result showed those injuries and their consequences consistently take 2-3rd places among all traumas received by the employees. The group of surveyed patients included 95 patients aged 30 to 57 years (mean age ~43,5). All patients of the studied group were neuroimaged. In 98% of patients general cerebral symptoms were observed. In 16% of patients cysts (of post-traumatic nature and different localization) were revealed according to neuroimaging data. In 84% of patients cystogliotic changes followed by different focal neurological symptoms were veri ed. Conclusion. According to the results of annual medical examinations, there is a tendency to increase the issuance of military physician board conclusions on the consequences of CCT. It is necessary to develop an algorithm for the management of patients who have undergone CCT in both outpatient and inpatient conditions, as well as to monitor their timely and quality follow-up.

1. Makarov AYu. Klinicheskaja nevrologija s osnovami MSJe, rukovodstvo dlja vrachej [Clinical Neurology with the Basics of MSE, a guide for physicians]. SPb: Zolotoj vek [SPb: Golden Age]. 1998; 594 p.

2. Konovalov AN, Samotokin BA, Vasin NYa, Likhterman LB, Potapov AA, Kostanian VZh, Dobrokhotov TA, Khitrin LKh. Nauchno-issledovatel’skiy institut neyrokhirurgii im. akademika N.N. Burdenko [Clinical classi cation of acute traumatic brain injury Scienti c Research Institute of Neurosurgery named after Academician NN Burdenko]. 2015; 1 (2): 37-48.

3. Potapov AA, Likhterman LB, Kravchuk AD, Okhlop-kov VA, Aleksandrova EV, Filatova MM, Maryakhin AD, Latyshev YaA. Logkaya cherepno-mozgovaya travma: klinicheskiye rekomendatsii [Mild traumatic brain injury: clinical guidelines]. Meditsinskaya gazeta [Likhterman medical newspaper]. 2011; 20: 43-23

4. Gusev EI, Avakyan GN, Nikiforov AS. Epilepsiya i yeye lecheniye [Epilepsy and its treatment]. Moskva: «GEOTAR-Media [Moscow: «GEOTAR-Media»]. 2016; 2: 320 p.

5. Postanovleniye Pravitel’stva RF ot 4 iyulya 2013 goda No 565 «Ob utverzhdenii Polozheniya o voyenno-vrachebnoy ekspertize» [Decree of the Government of the Russian Federation of July 4, 2013 No 565 «On the approval of the Regulations on military medical examination»]. 2013.

6. Prikaz MVD Rossii ot 14 iyunya 2018 gоda No 370 «Obutverzhdenii Instruktsii po organizatsii deyatel’nostivoyenno-vrachebnykh komissiy v sisteme MVD RF» [Order of the Ministry of Internal Affairs of Russia of June 14, 2018 No370 «On approval of the Instruction fororganizing the activities of military medical commissions in the system of the Ministry of Internal Affairs of the RussianFederation»]. 2018.

7. Prikaz MVD Rossii ot 2 aprelya 2018 goda No 190 «O trebovaniyakh k sostoyaniyu zdorov’ya grazhdan, postupayushchikh na sluzhbu v organy vnutrennikhdel Rossiyskoy Federatsii, i sotrudnikov organov vnutrennikh del Rossiyskoy Federatsii, perechnyakhdopolnitel’nykh obyazatel’nykh diagnosticheskikhissledovaniy, provodimykh do nachala meditsinskogo osvidetel’stvovaniya, formakh dokumentatsii, neob-khodimykh dlya deyatel’nosti voyenno-vrachebnykhkomissiy, poryadke provedeniya kontrol’nogo obsle-dovaniya i povtornogo osvidetel’stvovaniya i o priznanii utrativshimi silu nekotorykh normativnykh pravovykhaktov» [Order of the Ministry of Internal Affairs of Russia dated April 2, 2018 No 190 «On the requirements for thestate of health of citizens entering the service of the internalaffairs bodies of the Russian Federation and employees of the internal affairs bodies of the Russian Federation, listsof additional mandatory diagnostic tests carried out beforethe start of a medical examination , forms of documentation required for the activities of military medical commissions, the procedure for conducting a control examination and re-examination, and on recognizing as invalid some regulatory legal acts»]. 2018.

 SELECTED PROPOSALS FOR OPTIMIZING THE STAFFING OF THE RUSSIAN FEDERATION’S INTERNAL AFFAIRS AGENCIES (based on the experience of the Military and medical commission for the Chelyabinsk region)

KOROL’KOV VLADIMIR V., the Head of Medical Care unit of the Ministry of Internal Affairs of Russia for the Chelyabinsk region, Honored Doctor of the Russian Federation, C. Med. Sci., associate professor, high level certificate physician in «Health Management and public health», Russia, 454091, Chelyabinsk, Kommuna str., 66, e-mail: vlkorolkov@yandex.ru

KOL’TSOVA TATIANA A., deputy head of the Medical Care unit, the Head of Commission (Military and medical), physician of the Medical Care unit of the Ministry of Internal Affairs of Russia for the Chelyabinsk Region, Russia, 454080, Chelyabinsk, Ternopolskaya str., 4

Abstract. Aim. The aim of the study was to reveal the impact of preliminary monitoring of documentation submitted by candidates for service in the internal affairs agencies in the process of optimizing the performance of the militarymedical commission. Material and methods. The data were generated on the basis of statistical reports of the MilitaryMedical Commission (MMC) of the Medical Unit of the Ministry of Internal Affairs of Russia for the Chelyabinsk region for 2015–2019. The results of the preliminary monitoring of the documentation provided to the MMC by candidates for service in the internal affairs bodies were considered and analyzed. Results and discussions. The data allow us toconclude that the percentage of those found by the military medical commission to be un t for service in the internal affairs agencies within 3 years (since the introduction of preliminary monitoring) is gradually decreasing and is much lower than in the Ural Federal District and the average for the Ministry of Internal Affairs of the Russian Federation (MIA). Promptness and quality of resolution of issues related to the conduct of military medical expertise during the examination of citizens to determine the category of tness for service in the bodies of internal affairs is possible only ina systematic and close cooperation between the military medical commission and personnel territorial subdivisions underthe general guidance of the Department for Work with Personnel of the Main Department (DWP of the Main Department) and the Medical Unit (MU). Conclusion. Introduction of the electronic queue and preliminary control of documents isa rather effective mechanism that allows to reduce the time of preparation and submission of documents at the expert stage of MMC examination, to improve the quality of the conducted examination, to exercise control over all stages and terms of passing the examination by the candidate (employee) on the part of DWP departments of the Department of Management and MU and to ensure interaction between stakeholders up to the moment of receiving the conclusion.

Key words: medical examination, military and medical commission.

1. Sidorenko VA. Opyt vnedreniya avtomatizirovannykhsistem upravleniya v obespechenii deyatel’nosti voyenno-vrachebnykh komissiy sistemy MVD Rossii [Experience ofintroduction of the automated control systems in maintenance of activity of the military medical commissions of the system of the Ministry of Internal Affairs of Russia (inRussian)]. Vestnik sovremennoy klinicheskoy meditsiny [Bulletin of modern clinical medicine]. 2016; 9 (6): 156-162.

2. Proyekt: Yedinaya sistema informatsionno-analiticheskogo obespecheniya deyatel’nosti MVD RF [Project: Uni edsystem of information and analytical support of the Ministryof Internal Affairs of the Russian Federation]. URL: www. tadviser.ru (date of address: 10.06.2019).

3. Ganishev AV. Obucheniye noveyshim informatsionno-kommunikatsionnym tekhnologiyam dlya organizatsii meditsinskogo osvidetel’stvovaniya v organakh vnutren-nikh del [Training of the newest information and communication technologies for organization of the medicalexamination in the internal affairs bodies]. Meditsinskiy vestnik MVD [Medical bulletin of Ministry of Internal Af-fairs]. 2015; 3 (76): 2-3.

4. Ganishev AV, Shutko GV. Organizatsiya deyatel’nostivoyenno-vrachebnykh komissiy organov vnutrennikh deli chastnyye voprosy voyenno-vrachebnoy ekspertizy: uchebnoe posobiye [Organization of activity of the militarymedical commissions of the internal affairs bodies and pri-vate issues of the military medical examination: a training manual]. Domodedovo: VIPK MVD Rossii [Domodedovo: VICK of the Ministry of Internal Affairs of Russia]. 2015; 23 p.

5. Mezhdunarodnyy standart ISO/TR20514:2005; Informat-sionnyye tekhnologii v meditsine – elektronnaya medit-sinskaya zapis’ – Elektronnyy document [International Standard ISO/TR20514:2005; Information technologies in medicine – electronic medical record]. URL: https://www. iso.org/ru/standard/39525.html.

6. GOST R 52636-2006 Elektronnaya istoriya bolezni [GOST R 52636-2006 Electronic case history; Introduction 2008-01-01]. Moskva: Standartinform [Moscow: Standardin-form]. 2006; 20 p.

7. Sidorenko VA. Voyenno-vrachebnaya ekspertiza v or-ganakh vnutrennikh del Rossiyskoy Federatsii [Military and medical expertise in the internal affairs bodies of the Russian Federation]. Meditsinskiy vestnik MVD [Medical bulletin of Ministry of Internal Affairs]. 2016; 4 (83): 2-3.

UDC 616.24-002-092(470.57-25)

DOI: 10.20969/VSKM.2020.13(6).28-32

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 ARTERIAL HYPERTENSION, CORONARY HEART DISEASE AND KIDNEY FUNCTION IN A LONG-TERM OBSERVATION

OSHCHEPKOVA OLGA B., ORCID ID: 0000-0002-9845-0266; the Head of the Department of cardiology of Clinical Hospital of Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgskiy trakt str., 132, e-mail: oschepkova.kazan@mail.ru

ARKHIPOV EVGENY V., ORCID ID: 0000-0003-0654-1046; SCOPUS Author ID: 56997299700; C. Med. Sci., associate professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: jekaland@mail.ru

MUKHAMETGALIEVA GULNAZ M., ORCID ID: 0000-0001-6391-7316; cardiologist of the Department of cardiology of Clinical Hospital of Medical Care unit of the Ministry of Internal Affairs of Russia for the Republic of Tatarsan, Russia, 420059, Kazan, Orenburgskiy tract str., 132, e-mail: gulnaz.munirovna@mail.ru

MIKHOPAROVA OLGA YU., ORCID ID: 0000-0002-5592-8450; the Head of the Department of functional diagnostics of Clinical Hospital of Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgskiy trakt str., 132, e-mail: olga-mihoparova@rambler.ru

Abstract. Aim. The aim of the study was to analyze kidney function in patients with cardiovascular diseases in prospectiveobservation. Material and methods. Prospective analysis of kidney function has been conducted in 42 patients from arterial hypertension and coronary heart disease aged 39 to 72 years suffering. Clinical and diagnostic examination was carried out. It included examination and history collection, blood biochemical test and common urine analysis performance, glomerular ltration rate determination, as well as monitoring of clinical condition and laboratory tests during 32–36 months. Patients with associated diseases, or severe inner organs diseases were not enrolled in the study.Results and discussion. In patients with arterial hypertension and coronary heart disease, the main factors affecting development of renal dysfunction are smoking, obesity, dyslipidemia and arterial hypertension itself. In case of history of arterial hypertension of more than 10 years there is a decrease in glomerular ltration rate, hypostenuria and decrease in the average kidney volume. Conclusion. The study results con rm that smoking, obesity, dyslipidemia and arterialhypertension affect kidney function with subsequent development of hypertensive nephropathy and chronic kidneydisease in persons with the history of arterial hypertension exceeding 10 years. Hypotensive therapy and achievement of target blood pressure levels provide nephroprotective effect.

Key words: arterial hypertension, kidney function, chronic kidney disease, progression.

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UDC 616.98:578.834.1:159.942.5-057.36:616.891-057.36

DOI: 10.20969/VSKM.2020.13(6).38-42

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 PROMISING AREAS OF NONINVASIVE DIAGNOSTICS, CONSERVATIVE TREATMENT AND PREVENTION OF ATHEROSCLEROSIS

FATYKHOV RENAT G., ORCID ID: 0000-0001-5651-8341; the Head of Clinical Hospital of Medical Care unit of the Ministry of Internal Affairs of Russia for the Republic of Tatarstan, Russia, 420000, Kazan, Orenburgskiy tract str., 132, tel. 8 (843) 291-26-82, e-mail: rfatykhov5@mvd.ru

FADEEV GRIGORY A., ORCID ID: 0000-0002-0213-8631; deputy head of Clinical Hospital of Medical Careunit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgskiy tract str., 132, e-mail: Dr.GrigoryFadeev@yandex.ru

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

MIKHOPAROVA OLGA YU., ORCID ID: 0000-0002-5592-8450; the Head of the Department of functional diagnostics of Clinical Hospital of Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgskiy tract str.,132, e-mail: olga-mihoparova@rambler.ru

OSHCHEPKOVA OLGA B., ORCID ID: 0000-0002-9845-0266; the Head of the Department of cardiology of Clinical Hospital of Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgskiy tract str., 132, e-mail: oschepkova.kazan@mail.ru

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9. Cibul’kin NA, Abdrahmanova AI, Abdul’yanov IV, et al. Ostryj koronarnyj sindrom pri revmatoidnom artrite [Acute coronary syndrome with rheumatoid arthritis]. Prakticheskaya medicina [Practical medicine]. 2019; 2 (17): 32-36.

 SURGICAL TREATMENT OF HIGH-RISK PULMONARY EMBOLISM IN A GROUP OF ONCOUROLOGICAL PATIENTS

FEDOROV SERGEY A., ORCID ID: 0000-0002-5930-3941; C. Med. Sci., cardiovascular surgeon of Specialized heart surgery clinical hospital named after Academician B.A. Korolev, Russia, 603950, Nizhny Novgorod, Vaneev str., 209, e-mail: Sergfedorov1991@yandex.ru

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 CRYOTHERAPY APPLICATION SPECIFICS

SAKOVETS TATIANA G., C. Med. Sci., associate professor of the Department of neurology and rehabilitation of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: tsakovets@yandex.ru

BARYSHEVA ELENA N., the Head of the Department of physiotherapy of Clinical Hospital of Medical Care unit of the Ministry of Internal Affairs of Russia for the Republic of Tatarstan, Russia, 420012, Kazan, Orenburgskiy trakt str., 132, e-mail: e.barysheva@mail.ru

Abstract. Cryotherapy is the application of low temperatures to cool tissues for therapeutic purposes. Wide use of both local and general cryotherapy with the help of various refrigerants refers to the modern period of time. Cryofactors are represented by various gaseous chemical substances (chloroethyl, ammonium nitrate, carbon dioxide, nitrogen, ice) the temperature of which can reach -180°C. The action of cryotherapy is exercised through central and segmentaryre exive levels of exposure to physiotherapeutic factor. Aim. The aim of the study is to investigate the speci cs of cryotherapy application in the treatment of various pro le patients. Material and methods. Review of the domestic andforeign literature devoted of the application of cryotherapy is carried out. Results and discussion. Local cryotherapy has found its clinical application in the treatment of soft tissue and skin injuries, musculoskeletal system, joint diseases of various origins, the consequences of trauma, the treatment of spastic syndrome in patients with stroke, multiple sclerosis, and degenerative-dystrophic conditions of the spine. At present, general cryotherapy is used to treat diseases and consequences of injuries of the musculoskeletal system, psychosomatic disorders, neuroses, depression and stress, professional rehabilitation of patients whose occupations are associated with increased risk to life, and extreme conditions. In athletes, cryosauna has not shown its effectiveness as a therapeutic physical factor contributing to the improvement of pre-start training, but it has been proved expedient to use local cryotherapy for sports injuries.Conclusion. Thus, cryotherapy is effective in treatment of a wide range of diseases. Its’ application has been shown feasible in sports medicine.

Key words: cryotherapy, thermal factors, methods of cryotherapy application.

For reference: Sakovets TG, Barysheva EN. Cryotherapy application speci cs. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (6): 57-61. DOI: 10.20969/VSKM.2020.13(6).57-61.

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 INFLAMMATORY MECHANISMS IN GENESIS OF ATHEROSCLEROSIS

FADEEV GRIGORY A., ORCID ID: 0000-0002-0213-8631; deputy head of Clinical Hospital of Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgskiy tract str., 132, e-mail: Dr.GrigoryFadeev@yandex.ru

FATYKHOV RENAT G., ORCID ID: 0000-0001-5651-8341; the Head of the Clinical Hospital of Medical Care unit of the Ministry of Internal Affairs of Russia for the Republic of Tatarstan, Russia, 420000, Kazan, Orenburgskiy tract str., 132, tel. 8 (843) 291-26-82, e-mail: rfatykhov5@mvd.ru

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

MIKHOPAROVA OLGA YU., ORCID ID: 0000-0002-5592-8450; the Head of the Department of functional diagnostics of Clinical Hospital of Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgskiy tract str., 132, e-mail: olga-mihoparova@rambler.ru

OSHCHEPKOVA OLGA B., ORCID ID: 0000-0002-9845-0266; the Head of the Department cardiology of Clinical Hospital of Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgskiy trakt str., 132, e-mail: oschepkova.kazan@mail.ru

ABDRAKHMANOVA ALSU I., ORCID ID: 0000-0003-0769-3682; SCOPUS Author ID: 57192296744; C. Med. Sci., associate professor of Institute of Biology and Fundamental Medicine of Kazan Federal University, Russia, 420012, Kazan, Karl Marx str., 74, e-mail: alsuchaa@mail.ru

Abstract. Aim. Description of modern ideas about pathogenetic mechanisms of atherosclerosis development was the aim of our study. Material and methods. Review of scienti c medical literature on the subject of pathogenesis and clinical manifestations of atherosclerosis was performed. Results and discussion. Atherosclerosis, the clinical manifestations of which are myocardial infarction, brain stroke and acute arterial failure of the lower limbs, is a systemic in ammatory process. Atherogenesis is caused by the accumulation of cholesterol in the intima of arterial vessels. One of the factors of this process is the in ammatory activation of endothelium. Cytokines and adhesion moleculesproduced by leukocytes and endothelial cells contribute to the accumulation of macrophages and lymphocytes in thearterial wall with their subsequent activation. Macrophages express receptors that mediate the capture of cholesterol, which leads to the production of «foam cells». Receptors transmit intracellular activation signals that lead to the release of cytokines, proteases and other in ammatory molecules. Lymphocytes also participate in atherogenesis. They help maintain in ammation and further growth of the atherosclerotic plaque. An intense in ammatory reaction created in this way can lead to a local rupture of the plaque. This, in turn, causes the emergence of an intravascular clot, leading to acute cardiovascular complications. The in ammatory mechanism in the pathogenesis of atherosclerosis may be a diagnostic marker of chronic subclinical diseases of atherogenic nature, as well as a target for basic long-term drug therapy for clinical manifestations of atherosclerosis. Conclusion. Clinical manifestations of atherosclerosis aremajor chronic cardiovascular diseases such as coronary heart disease, cerebrovascular disease and peripheral artery atherosclerosis. Understanding the in ammatory mechanisms of atherosclerosis contributes to the development and study of practical applications of new therapeutic approaches, according to which a reduction in vascular in ammation can reduce the risk of cardiovascular complications.

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 LIVER, NON-ALCOHOLIC FATTY LIVER DISEASE AND DYSLIPIDEMIA. IS THERE A CONNECTION?

GIMALETDINOVA IRINA A., gastroenterologist of the Clinical Hospital of the Ministry of internal Affairs of Russia for the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky tract str., 132, tel. +7-903-313-12-27, e-mail: iren-kaz@mail.ru

AMIROV NAIL B., ORCID ID: 0000-0003-0009-9103; SCOPUS Author ID: 7005357664; D. Med. Sci., professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: namirov@mail.ru

ABSALYAMOVA LAILA R., Head of the Department of gastroenterology of Clinical Hospital of the Ministry of internal Affairs of Russia for the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky tract str., 132, tel. +7-965-608-72-73, e-mail: absalyamova1956@mail.ru

Abstract. Currently, the prevalence of non-alcoholic fatty liver disease is already a pandemic and occupies a solid position in the list of the most common liver diseases. Cardiovascular disease is the leading cause of death in patients with non-alcoholic fatty liver disease. Aim. The article deals with the metabolism of lipids in the liver, the classi cation of dyslipidemias, the pathogenesis of non-alcoholic fatty liver disease, the role of dyslipidemia in the development of non-alcoholic fatty liver disease, the relationship of non-alcoholic fatty liver disease with dyslipidemia, atherosclerosis, cardiovascular diseases. Material and methods. A clinical case of a patient with type IIa dyslipidemia is presented.Results and its discussion. The presented clinical case demonstrates an example of familial type IIa hyperlipidemia, most likely caused by unfavorable factors in the prenatal period, which makes it possible to recommend examination of children at an earlier age with changes in the biochemical blood test. Conclusion. In accordance with modern concepts, this disorder of lipid metabolism (type IIа HLP) usually occurs due to monogenic autosomal dominant mutations in one of three genes. This is the only type in which there is no increase in plasma triglycerides.

Key words: non-alcoholic liver disease, hyperlipidemia, atherogenic dyslipidemia, atherosclerosis, cardiovascular disease.

1. Butorova LI. Nealkogol’naya zhirovaya bolezn’ pecheni kak proyavleniye metabolicheskogo sindroma: epidemiologiya, patogenez, osobennosti klinicheskogo proyavleniya, prin-tsipy diagnostiki, sovremennyye vozmozhnosti lecheniya [Non-alcoholic fatty liver disease as a manifestation of metabolic syndrome: epidemiology, pathogenesis, features of clinical manifestation, principles of diagnosis, modern treatment options]. Moskva: Forte print [Moscow: Forte print]. 2012; 52 p.

2. Galeyeva ZM, Gimaletdinova IA, Amirov NB. Neal-kogol’naya zhirovaya bolezn’ pecheni i aterogennayadislipidemiya; Kakiye problemy voznikayut u kardiologa? [Non-alcoholic fatty liver disease and atherogenic dyslip-idemia; What problems does a cardiologist have?] Vestnik sovremennoy klinicheskoy meditsiny [Bulletin of modern clinical medicine]. 2014; 7 (1): 55-59.

3. Giovanni Targher, Christopher D Byrne, Amedeo Lonar-do, Giacomo Zoppini, Corrado Barbui. Nealkogol’nayazhirovaya bolezn’ pecheni i risk serdechno-sosudistykhzabolevaniy: metaanaliz [Non-alcoholic fatty liver dis-ease and the risk of cardiovascular disease: a meta-analysis]. Journal of Hepatology (Russkoye izdaniye) [Journal of Hepatology (Russian edition)]. 2016; 2, 6 (65): 589–600.

4. Mayev IV, Andreyev DN, Kucheryavyy YuA, Dicheva DT, Kuznetsova YeI. Nealkogol’naya zhirovaya bolezn’ pecheni s pozitsii sovremennoy meditsiny [Non-alcoholic fatty liver disease from the standpoint of modern medicine]. Moskva [Moscow]. 2020; 7-35.

5. Yudzhin R Shiff, Maykl F Sorrel, Uillis S Meddrey Bolezni pecheni po Shiffu; Tsirroz pecheni i yego oslozhneniya; Transplantatsiya pecheni [Liver diseases according to Schiff; Liver cirrhosis and its complications; Liver trans-plantation]. Moskva: GEOTAR-Media [Moscow: GEOTAR-Media]. 2012; 583 p.

6. François Mach, Colin Baigent, Alberico L. Catapano, et al. 2019 ESC/EAS Guidelines for themanagement of dyslipidaemias: lipid modi cation to reduce cardiovascular risk. Russian Journal of Cardiology. 2020; 25(5): 121-193. doi:10.15829/1560-4071-2020-3826

 HENOCH–SCHÖNLEIN PURPURA IN ADULTS (a clinical case and a review)

SHAYMURATOV RUSTEM I., ORCID ID: 0000-0002-5940-1656; Web of Science Researcher ID: Q-3122-2019; C. Med. Sci., assistant professor of the Department of phthisiopulmonology of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: russtem@gmail.com

SHARIPOVA ROZALIA R., physician of the Department of internal medicine of Clinical Hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky tract str., 132, e-mail: sharipova.7@mail.ru

SAFARGALIYEVA LILYA KH., Head of the Department of internal medicine of Clinical Hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky tract str., 132, e-mail: Safargalieva.lilia@mail.ru

YAGFAROVA RITA R., physician of the Department of internal medicine of Clinical Hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgsky tract str., 132

Abstract. Hemorrhagic vasculitis (Henoch-Schönlein purpura) is a disease rarely seen in adults. Aim. Overview clinical disease manifestations, pathophysiology and differential diagnosis of Henoch–Schönlein purpura and to demonstrate a clinical observation. Material and methods. A systematic search of the literature was performed in PubMed and Elibrary databases. A clinical case of a patient with systemic disease was reviewed. Results and its discussion.Henoch–Schönlein purpura is a small-vessel systemic vasculitis characterized by vascular immunoglobulin A deposits in the capillaries of the skin, joints, kidneys, and the gastrointestinal tract. In adults, Henoch-Schönlein purpura rarely occurs, with an incidence less than 2 per 100 thousand of the population; the prognosis of diseases is generally favorable. Patient X., 32 years old, was admitted to the therapeutic department with a diagnosis of Wegener’s granulomatosis. Patient demonstrated a pattern of multisystemic disease. Due to lack of progressive renal damage, non-typical for Wegener’s changes in the lungs and overall successful course we carefully studied all data and reviewed the diagnosis. Conclusion. Diagnosis of systemic vasculitis without biopsy is possible but always dif cult, our diagnosis was based on EULAR/PRINTO/PRES revised criteria.

Key words: adult Henoch–Schönlein purpura, vasculitis, differential diagnostics.

For reference: Shaymuratov RI, Sharipova RR, Safargaliyeva LKh, Yagfarova RR. Henoch–Schönlein purpura in adults: a clinical case and a review. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (6): 75-79.DOI: 10.20969/ VSKM.2020.13(6).75-79.

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5. Baranov AA Sistemnyye vaskulity: sovremennyye standarty diagnostiki i lecheniya [Systemic vasculitis: modern standards of diagnosis and treatment]. Russkiy Meditsinskiy Zhurnal [Russian Medical Journal]. 2005; 13 (24): 1577-1582.

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8. Hočevar A, Rotar Z, Jurčić V, et al. IgA vasculitis in adults: the performance of the EULAR/PRINTO/PRES classification criteria in adults. Arthritis Res Ther. 2016;18:58. Published 2016 Mar 2.

9. Hetland LE, Susrud KS, Lindahl KH, Bygum A. Henoch-Schönlein Purpura: A Literature Review. Acta Derm Venereol. 2017;97(10):1160-1166.

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 CLINICAL CASE OF A NONCOMPACT LEFT VENTRICULAR MYOCARDIUM

GARAEVA LILIA A., ORCID ID: 0000-0002-9427-6037; C. Med. Sci., assistant of professor of the Department of cardiology, endovascular and cardiovascular surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36; cardiologist, rehabilitation specialist of the Department of physiotherapy of Interregional Clinical Diagnostic Center, Russia, 420101, Kazan, Karbyshev str., 12a, e-mail: garaevalily@gmail.com

ABDULYANOV ILDAR V., ORCID ID: 0000-0003-2892-2827; C. Med. Sci., cardiosurgeon, the Head of the Department of cardiology, endovascular and cardiovascular surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, е-mail: ildaruna@mail.ru

MUKHAMETGALIEVA GULNAZ M., ORCID ID: 0000-0001-6391-7316; cardiologist of the Department of cardiology of Medical Care unit of the Ministry of Internal Affairs of Russia for the Republic of Tatarstan, Russia, 420059, Kazan, Orenburgskiy tract str., 132, e-mail: gulnaz.munirovna@mail.ru

ABDRAKHMANOVA ALSU I., ORCID ID: 0000-0003-0769-3682; SCOPUS Author ID: 57192296744; C. Med. Sci., associate professor of the Department of clinical medicine fundamental basis of the Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, Karl Marx str., 74; cardiologist of Interregional Clinical Diagnostic Center, Russia, 420101, Kazan, Karbyshev str., 12a, e-mail: alsuchaa@mail.ru

AMIROV NAIL B., ORCID ID: 0000-0003-0009-9103; SCOPUS Author ID: 7005357664; D. Med. Sci., professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: namirov@mail.ru

АTSEL EVGENIA А., ORCID ID: 0000-0002-1640-5411; C. Med. Sci., professor of the Department of internal medicine, geriatrics and family medicine of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Mushtari str., 11, e-mail: atzel@mail.ru

Abstract. Aim.The aim of the study was to describe a clinical case of non-compact cardiomyopathy in a patient withconcomitant coronary heart disease, to review the available data on etiology, pathogenesis and methods of disease diagnostics, to assess the features of course and diagnostics of cardiomyopathy in concomitant diseases, as well as to develop a diagnostic algorithm based on instrumental testing methods. Material and methods. Patient F., who was long observed with cardiological disease, was admitted to inpatient treatment with the diagnosis of coronary heart disease. During the hospitalization he was also diagnosed with non-compact cardiomyopathy according to the instrumental methods of investigation of the present and previous periods. The patient was conducted laboratory tests, standard ECG, daily ECG and AD monitoring, EchoCG, as well as perfusion scintigraphy and coronary angiography for differential diagnosis of non-compact cardiomyopathy and stress angina. In addition, the patient also had instrumental study data for long-term observation of cardiac disease. Results and discussion. The data from coronary angiography andperfusion scintigraphy indicate that the patient has coronary atherosclerosis and chronic coronary syndrome, while thedata from cardiac ultrasound at the time of hospitalization and in dynamics suggest that the patient has a non-compactmyocardial area. At the same time, the dynamics of clinical manifestations in relation to the dynamics of indicators ofinstrumental methods of investigation indicates the mutual involvement of coronary heart disease and non-compactcardiomyopathy in the development of pain syndrome. In addition, the absence of the patient’s characteristic clinicalmanifestations of substandard cardiomyopathy and the possible polyethiological emergence of rhythm disorders arealso noteworthy. In addition, according to the history, there is a large disparity in the ndings of the ultrasound cardiac examination, which indicates the need for a single diagnostic algorithm. Conclusion. The presence of a non-compactcardiomyopathy in a patient requires a thorough differential diagnosis with another cardiological problem. A review of available data on etiology, pathogenesis, and methods of disease diagnostics was carried out, and a common algorithm for the diagnosis of non-compact cardiomyopathy was developed.

Key words: noncompact cardiomyopathy, chronic coronary heart disease, echocardiography.

For reference: Garayeva LA, Abdulyanov IV, Mukhametgalieva GM, Abdrakhmanova AI, Amirov NB, Atsel EA. Clinical case of a noncompact left ventricular myocardium. The Bulletin of Contemporary Clinical Medicine. 2020; 13 (6): 80-86.DOI: 10.20969/VSKM.2020.13(6).80-86.

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12. Jenni R, Wyss CA, Oechslin EN, et al. Isolatedventricularnoncompaction is associated with coronarymicrocirculatorydysfunction. J Am Coll Cardiol. 2002; 39: 450–454.

13. Erochina MG. Nekompaktnyy miokard levogo zheludochka: strukturno-funktsional’noye sostoyaniye miokarda i osobennosti klinicheskikh proyavleniy [Uncompact left ventricular myocardium: structural and functional state of the myocardium and features of clinical manifestations]. Moskva: Uchebno-nauchnyy tsentr Meditsinskogo tsentra upravleniya delami Prezidenta RF [Moscow: Educational and Scientific Center of the Medical Center of the Presidential Administration of the Russian Federation]. 2009; 27 p.

 FUNCTIONAL STATE OF ENDOTHELIUM IN YOUNG WOMEN WITH OBESITY AND ARTERIAL HYPERTENSION

GALIKHANOVA LILIA I., assistant of professor of the Department of advanced internal medicine No 1 of Bashkir State Medical University, Russia, 450000, Ufa, Lenin str., 3

MUTALOVA ELVIRA G., ORCID ID: 0000-0002-7454-9819; D. Med. Sci., professor, the Head of the Department of advanced internal medicine No 1 of Bashkir State Medical University, Russia, 450000, Ufa, Lenin str., 3, e-mail: emutalova@mail.ru

Abstract. Aim. The aim of the study was an evaluation of the functional state of endothelium in young women withobesity and arterial hypertension. Material and methods. We examined 170 young women aged 18 to 45 years [mean age (36,2±3,8) years] with obesity and metabolic syndrome development. Anthropometric study was carried out with the evaluation of such indicators as waist circumference (WC, cm), hip circumference (HC, cm), WC/HC ratio, lipidogram, blood insulin concentration, immunosuppressive insulin (II), uric acid, and insulin resistance index Noma-IR. Functional activity of endothelium was estimated indirectly by the level of endothelin-1 vasoconstrictor mediator. Vascular-motor function of the endothelium was estimated by the Celermajeretal method. Early markers of endothelial dysfunction were analyzed. The data obtained were processed using standard statistical methods using Statistica 10 and Microsoft Excel 2010. The differences in indicators were considered statistically signi cant at p<0,05. Results and discussion.Changes in the indicators of endothelial functional state, indicating the presence of marked endothelial dysfunction in arterial hypertension patients with obesity, were revealed. The degree of endothelial dysfunction in arterial hypertension patients with obesity was growing with increasing blood pressure and blood uric acid concentration. Conclusion.Patients with arterial hypertension and obesity are characterized by the presence of disorders of the functional state of endothelium, which is manifested by a decrease in the degree of endothelium dependent vasodilation according to the sample with reactive hyperemia and increases in the blob endothelin-1 level. In patients with arterial hypertension andobesity the degree of endothelial dysfunction grows with an increase in blood pressure and as well as in blood uric acidconcentration, the elevated level of which is an endothelium-damaging factor, as evidenced by statistically signi cant correlations of the uric acid level with the indicators of the endothelium functional state.