[THE HISTORY OF DEPARTMENT OF FACULTY THERAPY, AT THE VORONEZH HIGHER EDUCATION INSTITUTION (ON THE OCCASION OF THE CENTENARY ANNIVERSARY OF N.N. BURDENKO VORONEZH STATE MEDICAL UNIVERSITY)].

The article is devoted to the history of the Department of Faculty Therapy, N.N. Burdenko Voronezh State Medical University. The history of its creation is inextricably linked to the Derpth (Yurievsky) University that was transferred to Voronezh in 1918. While the Department of Faculty Therapy remained in Voronezh, it several times changed location making use of various city hospitals as its branches. It simultaneously expanded its activities by organizing courses of physical therapy, endocrinology, and other medical disciplines. The article focuses on the events pertaining to the formation and development of the Department of Faculty Therapy, main directions and achievements of its scientific work.

[Clinical manifestations of asthma during combination therapy using ceruloplasmin].

AIM: To estimate the time course of clinical changes in patients with asthma during combination therapy using ceruloplasmin (CP). MATERIALS AND METHODS: A total of 92 asthmatic patients were examined. Their medical history data were collected; external lung function testing and clinical, laboratory, and instrumental examinations, involving the determination of the indicators of lipid peroxidation (LPO) (malonic dialdehyde (MDA), methemoglobin, carboxyhemoglobin) and the antioxidant system (superoxide dismutase (COD), sulfhydryl groups), were performed in all the patients over time. According to the therapy used, the patients were divided into 2 groups matched for gender, age, and clinical manifestations of the disease. A study group consisted of 45 patients who took CP in addition to conventional therapy. A comparison group included 47 patients receiving standard therapy. RESULTS: During the combination therapy using CP, the asthmatic patients showed a reduction in the elevated concentrations of MDA, methemoglobin, and carboxyhemoglobin and increases in the activity of COD and in the levels of sulfhydryl groups, which was followed by a considerable clinical improvement. During the conventional therapy, the indicators of LPO remained high and those of the antioxidant system did low, suggesting permanent oxidative stress. CONCLUSION: CP incorporation into the combination therapy of asthmatic patients contributes to elimination of prooxidant-antioxidant imbalance, which is followed by a marked positive clinical effect.

[CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ANEMIA: CLINICAL MANIFESTATIONS AND THERAPEUTIC STRATEGY].

Anemia refers to manifestations of systemic inflammation in chronic obstructive pulmonary disease (COPD) and a factor aggravating the disease. Objective: To study gender characteristics of anemia in patients with COPD, to increase the effectiveness of treatment through the use of pharmacological agents erythropoietin and enteral iron. Materials and methods: The paper presents clinical data on 74 patients with stage II/III COPD and anemia along with results of the treatment of 49 patients who received standard therapy in addition to epoetin and Sorbiferdurules. Results: Patients with COPD much more frequently presented with iron deficiency anemia (IDA): 63 patients (85.1%) dominated by women (39 or 61.9% ) with men accounting only for 24 or 38.1% of the total. 11 patients (14.9%) had normochromic normocytic anemia with the parameters of anemia of chronic disease. The incidence of IDA in both groups correlated with age; it was largely a moderately severe condition that much more frequently occurred in women (24 out of 39 patients - 61,5%) than in men in whom the mild form of iron deficiency prevailed (14 of 24 patients - 58,3%). Conclusion: The overall prevalence of anemia concomitant with COPD was estimated at 26.5%. It was documented in44 women (33.7%), i.e. in each third patient. It occurred less frequently in men (30 or 20,7%). The presence of anemia deteriorates conditions of the patients, especially female ones, who more often suffer from shortness of breath, impaired general health status , fatigue, and depression; moreover, they more frequently need hospitalization. Correction of anemia with erythropoietin and iron preparations for the internal use can improve physical endurance of the patients, reduce cough intensity and shortness of breath, promote positive dynamics of physical tolerance for a prolonged period after the completion of antianemic therapy.

[ANTIOXIDANT THERAPY OF BRONCHIAL ASTHMA].

This paper summarizes results of the investigations into the influence of antioxidants on the clinical picture of bronchial asthma. This disease is known to be accompanied by hyperactivation of lipid peroxidation. The use of antioxidants permits to correct free-radical oxidation (peroxidation) and enhances effectiveness of control over clinical symptoms. Moreover they more effectively improve external [Russian word: see text] than conventional therapy.

[PROINFLAMMATORY CYTOKINES IN COMBINATION OF CORONARY HEART DISEASE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE].

Chronic obstructive pulmonary disease and coronary heart disease frequently occur in combination. Systemic inflammation concomitant with protracted COPD is the pathogenetic mechanism of CHD. High concentration of the markers of systemic inflammation is associated with deterioration of atherosclerosis, its complications, and CHD progression.

[Comparison of data from registries of acute coronary syndromes RECORD and RECORD-2: management of patients and its results in noninvasive hospitals].

Positive changes are declared to occur during recent years in management of hospitalized patients with acute coronary syndromes (ACS) in Russia. Most of these changes are related to availability of invasive treatment. But considerable portion of patients (pts) are still treated in hospitals without facilities for invasive myocardial revascularization (noninvasive hospitals - NIHs). Aim of this study was to compare some characteristics of management of ACS in NIHs which participated in ACS registries RECORD (2007-2008, 8 NIHs from 6 cities; n=381) and RECORD-2 (2009-2011, 3 NIHs from 3 cities, n=680). Results. Groups of pts recruited in these NIHs had similar mean age and portion of women (67.6 and 66.5 years, 51.1 and 53.1 % in RECORD-2 and RECORD, respectively, p=0.64). Time from symptoms onset to hospitalization was shorter in RECORD-2 (3.2 vs 4.1 hours for ST-elevation [STE], =0.03; 4.0 vs 6.5 hours for non ST elevation [NSTE] ACS, <0.0001). Among RECORD-2 NSTEACS pts more had ST depressions (50.6 vs 28.7%, <0.0001), high risk of death according to GRACE score (39.1 vs 20.9 %, <0.0001), but less Killip class >II (15.0 vs 21.6%, p=0.025). No such differences existed among STEACS pts. Thrombolysis was more often used in RECORD-2 (62.6 vs 34.1%, <0.0001). Both STEACS and NSTEACS RECORD-2 pts more often received clopidogrel (63.5 vs 18.8%, p<0.0001, and 41.6 vs 11.1%, <0.0001, respectively). More NSTEACS RECORD-2 pts were given parenteral anticoagulants (93.4 vs 80.4%, <0.0001), low molecular weight heparins (23.4 vs. 3.4%, <0.0001) and fondaparinux (10.4 vs 0.7%, <0.0001), but still in 20% of NSTEACS RECORD-2 pts unfractionated heparin was given subcutaneously. Twenty RECORD-2 pts (2.9%) were transferred to invasive hospital but none during first 24 hours. There were no significant differences between registers in hospital mortality (20.0 vs 21.2%, =0.84; 4.2 vs 2.7%, =0.24 in STE and NSTE ACS pts of RECORD-2 and RECORD, respectively). Conclusions. Despite some improvement in management of pts occurring in 2-3 years NIHs mortality in STEACS remained very high. Numerically higher mortality in NSTEACS could be partially attributed to higher risk of RECORD-2 pts.

[Adherence to guidelines on management of acute coronary syndrome in Russian hospitals and outcomes of hospitalization (data from the RECORD-2 Registry)].

BACKGROUND: Complete following existing guidelines for management of acute coronary syndrome (ACS) is known to be associated with better outcomes. Partly this is explained by lesser adherence to recommendations in high risk patients. Aim of our study was to assess relationship between degree of following current guidelines and in hospital outcomes independently from initial assessment of risk. METHODS: Each key recommendation from guidelines issued between 2008 and 2011 (13 for STE ACS, 12 for NSTE ACS) was given weight of 1. Sum of these units constituted index of guideline adherence (IGA). IGA was retrospectively calculated for 1656 patients included in Russian independent ACS registry RECORD-2 (7 hospitals, duration 04.2009 to 04.2011). The patients were divided into 2 groups according to quartiles of IGA distribution: 1) low adherence group (quartiles I-II); 2) high adherence group (quartiles III-IV). RESULTS: In low adherence compared with high adherence group there were significantly more patients more or equal 65 years (=0.0007), with chronic heart failure [CHF] (<0.0001), previous stroke (<0.0001), atrial fibrillation [AF] (=0.0002), Killip class more or equal II (=0.0065), high risk of death by GRACE score (=0.035). Inhospital mortality was 9.3 and 2.4% in low and high adherence group, respectively (p<0.0001). The following independent predictors of inhospital death were identified: IGA quartiles I-II (odds ratio [OR] 4.0; 95% confidence interval [CI] 2.3-7.1; <0.0001), high GRACE score (OR 3.3; 95% CI 1.8-6.0; <0.0001), admission systolic BP less or equal 100 mm Hg (OR 3.1; 95% CI 1.8-5.4; <0.0001), admission serum glucose more or equal 8 mmol/l (OR 2.9; 95% CI 1.8-4.7; <0.0001), age more or equal 65 years (OR 2.3; 95% CI 1.3-4.0; =0.005), ST elevation more or equal 1 mm on first ECG (OR 1.7; 95% CI 1.1-2.5; =0.013). From groups with low and high adherence to guidelines we selected pairs of patients (n=588) with similar (or close) age, type of ACS, GRACE score, Killip class, presence of other important risk factors (CHF, AF, previous stroke), and formed 2 equal subgroups without significant differences in important demographic, anamnestic, clinical and laboratory data. Hospital mortality was 7.8 and 2.7% in low and high adherence subgroup, respectively (p<0.0001). CONCLUSIONS: In RECORD-2 ACS registry low adherence to guidelines was more frequent among high risk patients and was independent predictor of inhospital death. Association between degree of guidelines adherence and outcomes persisted after equalizing groups by some factors of risk of mortality.

[Electrocardiographic predictors of in-hospital outcomes of acute coronary syndrome].

AIM: To estimate the time course of changes in basic electrocardiographic (ECG) parameters in patients with acute coronary syndrome (ACS) as possible predictors of in-hospital outcomes. MATERIALS AND METHODS: The data of 277 patients with acute coronary syndrome (ACS) were used; QT-interval duration was studied by means of an EC12C-01 cardioanalyzer; ST-segment deviation (sigmaST), elevation (sigmaST-E), and depression (sigmaST-D) sums, and corrected QT-interval dispersion (DQTc) were calculated. RESULTS: There were highly significant differences of sigmaST in all the patients groups at admission and differences of DQTc in ACS patients with and without ST-segment elevation. The survival rates were significantly different depending on the value of ECG parameters, such as sigmaST, sigmaST-D, and DQTc. CONCLUSION: The cardioanalyzer can automatically improve the estimation of in-hospital ECG changes and to determine predictors of an ACS outcome.

[Acquired androgen deficiency in men with chronic cardiac failure].

This review concerns the role of acquired androgen deficiency in pathogenesis of chronic cardiac failure (CCF) in men. It shows that patients with CCF and CHD suffer reduced testosterone production that correlates with impaired contractile activity of myocardium. It means that androgen deficiency due to combined bronchopulmonary and cardiovascular pathology promotes the early development of CCF.

[Anemia in patients with chronic cardiac failure].

The number of patients with chronic cardiac failure (CCF) grows continuously in the last decades especially among aged subjects compared with younger ones. Mortality and hospitalization rates among elderly subjects are also higher Hence, the importance of early diagnosis and treatment of concomitant diseases aggravating CCF, e.g. anemia. Reduced hemoglobin level may cause progression of CCF and deteriorate its prognosis. Correction of anemia with stimulators of erythropoiesis (erythropoietin, intravenous iron preparations) may be a useful auxiliary therapy for patients refractory to standard treatment. Oral iron preparations do not produce the desirable effect whereas combination of intravenous iron and erythropoietin has been reported to increase ejection fraction, reduce requirements for high-dose diuretics and necessity of repeated hospitalization, improve renal function, and decreases left ventricular hypertrophy. In other words, correction of anemia has beneficial effect on the clinical course of CCF and improves its prognosis.

[Ventricular extrasystole in patients with metabolic syndrome].

The aim of the study was to evaluate the prevalence and characteristics of ventricular extrasystole in patients developing metabolic syndrome. 24 hour echoCG monitoring was performed in 112 subjects above 15 yr meeting AHA/NHILBI 2005 criteria for metabolic syndrome corrected for the European population and in 107 metabolically neutral subjects. Significant differences were documented in the frequency of polytopic extrasystole (63.4 vs 46.2%; p = 0.01), morphology number (4.7 +/- 0.5 vs 2.3 +/- 0.7; p = 0.02), frequency of paired/group extrasystole (31.2 vs 18.7%; p = 0.02), number of extrasystoles in the longest chain (8.5 +/- 3.1 vs 3.7 +/- 2.2; p = 0.04). Strong (r < 0.5) positive correlation between the mean heart rate (HR) per 1 hour and the number of paired/group extrasystoles proved a highly specific sign of metabolic syndrome (100 and 89.5% respectively). Patients with metabolic syndrome more frequently had polytopic/group ventricular extrasystole associated with elevated mean HR.

[The role of erythrocytes in the system of controlled transport of pharmaceutical agents].

In the last decades, the possibility to use blood cells for delivery of pharmaceutical agents directly into a lesioned tissue has been given increasingly more attention. In the context of extracorporeal pharmacotherapy, the most promising approach is the use of autoerythrocytes possessed of unique morphological and physiological characteristics. Application of erythrocytes as containers for various drugs decreases the risk of side effects and pathologic immune reactions against encapsulated agents, permits to modify their pharmacokinetic and pharmacodynamic properties for reducing single and corse doses and intervals between them. The efficiency and safety of pharmaceutical agents introduced into erythrocytes have been confirmed in thousands of in vivo studies.

[Rhythm and conductivity disorders in patients at the initial stages of metabolic syndrome].

The aim of the work was to evaluate the prevalence of cardiac rhythm and conductance disturbances in patients with early manifestations of metabolic syndrome (MS). 24-hour ECG monitoring was undertaken in 105 patients meeting AHA/NHLBI (2005) MS criteria and in 79 healthy subjects. Exclusion criteria were the presence of diabetes mellitus, CHD, and obesity (body mass index > 40 kg/m2). MS was associated with an increased number of supraventicular extrasystoles (628.9 +/- 49.5 vs 415.9 +/- 57.9, p < 0.05) and ventricular extrasystoles (34.4 +/- 9.9 vs 11.8 +/- 6.5 for paired ones and 9.5 +/- 3.7 vs 2.2 +/- 4.0 for group ones, p < 0.05), higher frequency of tachyarrhythmia (supraventicular tachycardia: 18.1 vs 7.6%, p < 0.05; atrial fibrillation: 9.5 vs 2.5, p < 0.05; sinus node arrest: 6.7 vs 0%, p < 0.05). Regression analysis revealed significant correlation between arrhythmias and the number of components of the disease. It is concluded that cause-and-effect relationship between MS and cardiac rhythm disturbances is apparent at the early stage of the disease.

[Effect of ACE inhibitors on the mental status of elderly patients with chronic cardiac insufficiency].

This paper reviews prevalence of chronic cardiac insufficiency and effects of depression and anxiety conditions on its clinical course and prognosis. Clinical and experimental findings are discussed with reference to the role of the rennin-angiotensin-aldosterone system in pathogenesis of chronic cardiac insufficiency, depression, and certain psychic and nervous diseases. Special attention is given to the influence of CAE inhibitors on mental health of elderly subjects.

[Effects of metabolic syndrome on the phenomenon of electrophysiological atrioventricular conduction curve gap in the course of programmed transesophageal pacing].

AIM: To examine electrophysiological characteristics of the phenomenon of the atrioventricular curve gap (ACG) in patients with metabolic syndrome (MS). MATERIAL AND METHODS: The study included patients aged over 15 years with ACG. Electrophysiological characteristics of this phenomenon were compared in 55 patients with MS (by NCEP ATP III 2001 criteria) and 47 free of MS. Patients with coronary heart disease and/or diabetes mellitus were not included. RESULTS: MS was associated with increased gaps and their duration. Gap distribution by the curve in MS-free patients was extreme. Most gaps occurred in the zone close to effective refractory period of atrioventricular connection. In MS this phenomenon occurred along the whole curve. CONCLUSION: MS influences characteristics of ACG. This must be taken into consideration in conduction of electrophysiological test.

[Testosterone level in male patients with coronary heart disease and essential hypertension].

The study was undertaken to ascertain the prevalence of age-related androgen deficiency in patients with coronary heart disease (CHD) and essential hypertension under the age of 60 years and its association with some risk factors. The study covered 107 patients (mean age 50.2±7.2 years). Of them 35 patients had essential hypertension and 72 had CHD, angina on exertion. The blood concentrations of testosterone and cholesterol were measured; the presence and type of adiposity and the level of depression were determined. The mean level of testosterone in patients with CHD and essential hypertension (9.2±0.96 n/mol/l) corresponded to an androgen-deficient state. There was a direct correlation of testosterone concentrations with waist circumference and an inverse correlation with the levels of atherogenic lipoproteins and depression.

[Age-related androgen deficiency in men with ischemic heart disease].

The purpose of the research was to evaluate the age-related androgenic state in men with CHD and its relations with some risk factors. In this research 118 patients were included (average age 51.1 +/- 4.2 years). Testosterone and cholesterol serum levels were estimated. The presence and type of adiposity, depression level were determined. It has been established that the average testosterone level in patients (272 +/- 23.4 ng/dl) corresponded to androgen deficiency condition. Direct correlation of serum testosterone level with abdominal type of adiposity and inverse one with atherogenic lipoprotein level and depressions has been revealed.

[Acquired androgenic deficit and coronary heart disease].

This review is dedicated to the role of age-related acquired androgenic deficit in coronary heart disease (CHD) pathogenesis. The analysis of literature show that decrease of testosterone production in males leads to development of dyslipidemia, coronary atherosclerosis, obesity and to increase of blood trombus potential. Thus, androgen deficit potentiates early CHD development in males.

[Effects of age-related androgen deficiency on clinical and psychological characteristics of patients with ischemic heart disease].

AIM: To study prevalence of androgen deficiency and its relations with clinicopsychological disorders in males with ischemic heart disease (IHD). MATERIAL AND METHODS: A total of 87 males aged 31-60 years (58 with stable angina of effort FCII-III, 29 with progressive angina of effort) participated in the study. Clinical symptoms of androgen deficiency, severity of anxiety and depression, quality of life were characterized with scales AMS, HADS, D. M. Aronov and V.P. Zaitsev method (2002), respectively. Left ventricular myocardial mass (L VMM) was calculated according to R. Devereux and N. Reichek formula. RESULTS: Symptoms of male sexual hormones deficiency were seen in 67.8% examinees. In the age groups 31-40, 41-50, 51-60 years androgenic deficiency was diagnosed in 50, 85.7 and 82.9% patients, respectively. A direct correlation was found between androgenic deficiency and total cholesterol (R=0.38), prothrombin index (R=0.39), LVMM index (R=0.48), severity of depression (R=0.71), anxiety (R=0.5) and inverse correlation--between androgenic deficiency and quality of life (R = -0.69). CONCLUSION: Young and middle-aged patients with ischemic heart disease have symptoms of androgenic deficiency in 67.8% cases. This fact necessitates screening testing of such patients with AMS questionnaire. Male sex hormones deficiency is associated with high anxiety and depression, while quality of life is subnormal.

[The condition of pulmonary protective functions in patients with pneumonia accompanied by chronic viral hepatitis B].

Two groups of patients with pneumonia were observed: the main group consisted of patients with pneumonia accompanied by chronic viral hepatitis B (CVHB), and the control group contained patients without CVHB. Main group patients displayed higher activity of lysosomal and redox enzymes, as well as imbalance in the proteinase-inhibitory system and bronchial lavage phospholipid spectrum. Concomitant CVHB impaired the protective function of the lungs and thus delayed the resolution of pneumonia.