[Cardiovascular syphilis (current state of the problem and analysis of own observations)].

A description of two cases of cardiovascular syphilis is presented. The introduction discusses the relevance of visceral syphilis. The literary review is constructed in a chronological format and reflects the stages of studying the problem of cardiovascular syphilis. It emphasizes that cardiovascular syphilis is currently a rare pathology and internists are more likely to encounter it. Verification of the pathology of the cardiovascular system, including aortic aneurysm, during the early stages of syphilis (early latent) does not exclude the option of combined pathology. Early forms of syphilis in patients with diseases of the cardiovascular system should be considered a factor that complicates diagnosis. Such patients should be carefully examined to determine the cause of the disease. Rationale for the diagnosis of cardiovascular syphilis requires a comprehensive assessment of the results of clinical, laboratory and instrumental examination of the patient. A preliminary diagnosis of the specific etiology of an aortic aneurysm should be based on the following criteria: 1) relatively young age of patients with socially inappropriate sexual behavior; 2) sudden onset and rapid progression of the main signs of the disease. All patients with newly diagnosed aortic aneurysm at the outpatient stage should perform a serological examination. The diagnosis of cardiovascular syphilis, namely a syphilitic mesaortitis, can be established or confirmed by an autopsy.

[The Experience of Use Triple Antithrombotic Therapy in Patients With Acute Coronary Syndrome and Atrial Fibrillation].

AIM: In real life to evaluate the effectiveness and safety of apixaban with double antiplatelet therapy for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation and the recent episode of acute coronary syndrome without ST segment elevation. MATERIALS AND METHODS: 8 patients with atrial fibrillation and the recent (8-14 days after the onset of symptoms of ACS) episode of acute coronary syndrome without ST segment elevation were involved into the research. The effectiveness (deaths, stroke and systemic embolism) and the safety (major clinically significant and not significant bleeding) were investigated within 3 months. RESULTS: There were no any strokes, systemic embolism, deaths during observational period. Nasal and mild gingival hemorrhages (not requiring medical intervention) were noted in 2 patients during the first month of treatment and two patients experienced non-permanent petechiae. Major and clinically significant bleeding was not registered. onclusions: the use of oral anticoagulant apixaban 5 mg BID or 2.5 mg BID with double antiplatelet therapy in patients with non-valvular atrial fibrillation and the recent episode of acute coronary syndrome without ST segment elevation is effective and safe for the prevention of stroke and systemic embolism during 3 months of treatment. Future researches are required.

[Clinical and metabolic features of nonalcoholic fatty liver disease in men and women]. / Klinicheskie i metabolicheskie osobennosti nealkogol'noi zhirovoi bolezni pecheni u muzhchin i zhenshchin.

AIM: To evaluate clinical features and metabolic disorders in men and women with non-alcoholic fatty liver disease (NAFLD).

NON-ALCOHOLIC FATTY LIVER DISEASE IN ELDERLY.

AIM: The study of the clinical course and metabolic disorders in patients nonalcoholic fatty liver disease (NAFLD) elderly. SUBJECTS AND METHODS: 153 patients with NAFLD was investigated, including 97 men and 56 women. In comparative terms we studied clinical manifestations of NAFLD. All patients NAFLD was verified for the first time. We studied the functional state of the liver function, lipid, carbohydrate and porphyrin metabolism, insulin resistance. RESULTS: Revealed comorbid pathology, which is predominantly observed in elderly patients. Disturbances in lipid metabolism and insulin resistance hyperinsulinemiya and proved to be more significant in young patients. Disorders of porphyrin metabolism observed in most patients. Disorders are variable. Do young people have dominated the initial disorder, on the other hand more often in elderly patients were observed faction (later) porphyrin metabolism disorders. CONCLUSION: Studies suggest that the main pathophysiologic and pathogenetic processes of formation of NAFLD (insulin resistance and dyslipidemia) significantly more pronounced in younger patients. This fact suggests that NAFLD is mainly formed at a young age. Elderly patients have comorbid pathology.

[ALLELES C282Y AND H63D HFE GENE, INSULIN RESISTANCE AND SUSCEPTIBILITY TO DISTURBANCE OF PORPHYRIN METABOLISM IN NON-ALCOHOLIC FATTY LIVER DISEASE].

THE PURPOSE OF THE STUDY: The aim of the present work was to study the frequency of genotypes and alleles of C282Y and H63D HFE gene that may be associated with impaired porphyrin metabolism, as well as possible reasons for the formation of dysmetabolism porphyrins with NAFLD. MATERIALS AND METHODS: The study involved 65 patients (52 men and 13 women) aged 21 to 69 years (mean age 48.5±1.5 years). Excretion uroporphyrin, coproporphyrin, 6-aminolevulinic acid of porphobilinogen in urine was determined by chromatography and spectrophotometry calculated total excretion of porphyrins. Allele frequencies C282Y and H63D were determined during the molecular genetic analysis of DNA using the polymerase chain reaction followed by analysis of length polymorphism restraktsionnyh fragments. Condition of carbohydrate metabolism was evaluated by the level of fasting blood glucose and standard glucose tolerance test. Diagnosis of insulin resistance was performed according to the criteria proposed by the European Group for the Study of insulin resistance (EGIR). RESULTS: Skill test for the C282Y mutation carriage and H63D in the HFE gene in 65 patients with non-alcoholic fatty liver disease. Disturbances in the metabolism of porphyrins were recorded in 43 (66.2%) patients. H63D and C282Y mutations were found in 18 (27.7%) patients, of whom 13 (72.2%) people with different options dismetabolism porphyrins and signs of insulin resistance. In 47 (72.3%) patients without mutations studied porphyrin metabolism disorders were detected in 30 (63.8 %), of which insulin resistance is registered only in 16 (34.0 %). CONCLUSION: Detection of mutations C282Y and H63D in the HFE gene in combination with disorders of porphyrin metabolism on the background of insulin resistance is likely to allow such patients considered as candidates for inclusion in the higher risk of formation of diabetes.

[Porphyrin metabolism in women with metabolic syndrome].

A total of 47 women with metabolic syndrome (MS) were examined with the fractional determination of porphyrins in urine (uroporphyrin and coproporphyrin) and feces (coproporphyrin and protoporphyrin) as well as their precursors (5-aminolevulinic acid and porphobilinogen). Disorders of porphyrin metabolism were documented in 29 (61.7%) women All patients had elevated levels of porphyrin precursors. Five women exhibited qualitative changes in the form of abnormal ratios of different porphyrin fractions(coproporphyrin/uroporphyrin < 1--0.8 ± 0.1 vs normal ratio 3.6 ± 0.4). 21 patients suffered quantitative changes in porphyrin metabolism in the form of manifold increase of porphyrin levels in urine and/or feces and formation of biochemical syndromes of secondary coproporphyrinuiria, symptomatic rise in porphyrin content in feces, and chronic latent hepatic porfiria. Disorders of porphyrin metabolism were associated with insulin resistance. Changes of porphyrin metabolism in MS extend the spectrum of concomitant disturbances and can be regarded as an additional criterion.

[Coenzyme q10 in complex therapy of patients with ischemic heart disease].

The paper contains results of assessment of clinical efficacy and safety of coenzyme Q10 in patients with ischemic heart disease. Coenzyme Q10 (60 mg/day for 8 weeks) added to basic treatment of patients with stable class II-III angina significantly improved clinical status of these patients without clinically significant side effects.

[Dynamics of changes of blood inflammatory-oxidative biomarkers in acute coronary syndrome].

Some inflammatory cytokines and parameters of low density lipoproteins (LDL) oxidative modification were studied in blood of 250 acute coronary syndrome (ACS) patients--Siberian inhabitants, men and women with myocardial infarction (MI) or unstable angina on first, tenth and thirtieth days of disease. The inflammatory biomarkers in men and women with MI are: increased concentrations of interleukin (IL)-6, IL-8 and C-reactive protein (CRP), especially on the first day of disease. The most significant inflammatory biomarker of ACS is increased CRP level, especially in women. Oxidative biomarkers in men with ACS are increased basal level of LDL lipid peroxidation (LPO) products and decreased LDL resistance to oxidation. Inflammatory-oxidative biomarkers IL-6, IL-8, CRP and basal level of LDL LPO products are correlated and independently associated with MI.

[Non-medicamentous correction of metabolic and functional disorders in the biliary tract of patients with metabolic syndrome].

This study included 49 patients with coronary heart disease (CHD) and arterial hypertension (AH) in whom comprehensive medical examination revealed metabolic syndrome (MA). The objective of the work was to ascertain the possibility of therapy courses using chloride-hydrocarbonate-sodium mineral water and to evaluate its corrective effect on metabolic processes and functional disturbances of the biliary tract. It was shown that mineral water has beneficial effect in patients with functional incompetence of the biliary tract. Elimination of pain syndrome and resolution of dyspeptic symptoms was associated with the improvement of physico-chemical characteristics of the bile in the majority of the patients. These changes developed 1.5-2 times sooner than in the absence of therapy which substantially improved quality of life of the patients. Another positive result of mineral water consumption was the reduced level of blood lipids, in the first place that of total cholesterol and triglycerides. The efficiency of corrective action of non-medicamentous treatment modalities, such as courses of intake of chloride-hydrocarbonate-sodium mineral water, in patients with functional disturbances of the biliary tract is comparable with that of recommended drug therapy. The hypolipidemic effect of chloride-hydrocarbonate-sodium mineral water demonstrated in the present study allows it to be recommended as a tool for non-medicamentous correction of hyperlipidemia known to be not only a risk factor of CHD and AH but also as a constituent component of metabolic syndrome. The data obtained suggest the possibility to improve efficiency of the treatment of motor dysfunction of the biliary tract and metabolic disorders inherent in metabolic syndrome.

[Porphirin metabolism in non-alcoholic steatohepatitis].

AIM: To study porphirin metabolism in non-alcoholic steatohepatitis (HASH). MATERIAL AND METHODS: The trial enrolled 66 patients with verified diagnosis of HASH. Patients with chronic viral hepatitis and chronic alcohol intoxication were not included in the trial. Aminolevulinic acid (ALA), porphobilinogen (PBG), uroporphirin (UP) and coproporphirin (CP) were assayed in urine, protoporphirin (PP) and CP--in the stool. Total content of porphirins and proportions CP/UP and PP/CP were estimated. RESULTS: 17 patients had normal total porphirin excretion with urine but high levels of ALA, PBG, UP fraction, changed fractions proportion. 21 patients had high content of urinary and fecal porphirin fractions. Biochemical syndromes of high fecal porphirin concentration, secondary coproporphirinuria, chronic latent hepatic porphiria were under development. The above disorders were associated with carbohydrate, lipid and iron disbolism. In porphirin disbolism histological signs of liver fibrosis occurred more frequently. 56 (84.8%) patients had signs of metabolic syndrome. CONCLUSION: Disorders of porphirin metabolism in HASH patients are characterized by many nonspecific abnormalities and metabolic disturbances. Patients with different variants of porphirin disbolism developed hepatic fibrosis more frequently.

[Use of chloride-hydrocarbonate sodium mineral water in the combined therapy of cardiovascular diseases].

Ability and efficiency of use of chloride-hydrocarbonate sodium mineral water Karachinskaya in the combined therapy of coronary heart disease (CHD) and arterial hypertension (AH) were studied. Mineral water was used in regimen of 1000 ml in a day for 10 days. This intake of mineral water did not have a negative influence on the course of CHD and AH. Hypocholesteremic action of the mineral water was registered. Probable pathogenetic mechanisms of hypocholesteremic action of the mineral water are analyzed. Detected effects make possible to recommend use of chloride-hydrocarbonate sodium mineral water Karachinskaya to improve health reserves and prevent cardiovascular diseases.

[The prospectivity of permanent cardiostimulation for prevention of atrial fibrillation].

Possibility of prevention of atrial fibrillation in patients with permanent pacemakers was analyzed taking into account induction mechanisms. Patients with bradicardiac and ectopic mechanisms of atrial fibrillation induction seem to be optimal candidates for pacemaker therapy. Right ventricular pacing was an independent predictor of arrhythmic events.

[The combination of carbohydrate and porphyrinic exchange disturbances: is it a chance or regularity?].

The subjects of the study were 399 patients with internal diseases and metabolic disturbances. Carbohydrate exchange parameters (fasting level of capillary blood glucose and glucose tolerance test), and porphyrin fractions in urine (uroporphyrin, coproporphyrin), and feces (protoporphyrin, coproporphyrin) were measured. Hepatic type of porphyrinic dysmetabolism was registered in 201 (50.4%) patients. Out of these patients, 38 had disturbances corresponding to the criteria of symptomatic elevation of fecal porphyrin level, 28 had secondary coproporphyrinuria, 40 had latent, and 95 had manifest late cutaneous porphyria. In patients with normal porphyrinic exchange, the frequency of carbohydrate exchange disturbances did not exceed 6%, while in patients with different variants of porphyrinic dysmetabolism it was almost 40%. The results show that patients with hepatic type of porphyrinic dysmetabolism should be considered to have a higher risk of the development of diabetes mellitus and other carbohydrate disorders.

[Porphyrin metabolism in men with metabolic syndrome].

Forty-three patients with metabolic syndrome (MS) were examined. The urinary (uroporphyrin--UP and coproporphyrin--CP) and fecal (CP and protoporphyrin) fractions of porphyrin, as well as the urinary excretion of porphyrin precursors (S-aminolevulinic acid and porphobilinogen) were measured. Porphyrin metabolic disturbances were registered in 33 (76.7%) patients. Nine of these patients displayed such qualitative changes as fraction mismatch (CP/UP < 1; the normal value is 2.1 +/- 0.4), and an increase in the level of porphyrin precursors, while their total urinary porphyrin level was normal. In 24 patients pathological changes in porphyrin exchange were characterized by such quantitative changes as a many-fold increase in urinary and/or fecal porphyrin fraction as well as the development of secondary biochemical coproporphyrinuria syndromes, symptomatic elevation of fecal porphyrin level, and latent late cutaneous porphyria. Changes in porphyrin exchange in patients with metabolic syndrome broaden the scope of disturbances occurring in this syndrome, and allow considering these changes as additional criteria.

[Differential diagnosis of specific gastric lesions in early syphilis patients with helicobacter infection].

AIM: To evaluate differential-diagnostic significance of different clinical signs, endoscopic and serological studies in making diagnosis of early gastric syphilis (EGS) in patients with helicobacter infection. MATERIAL AND METHODS: Thirty patients were hospitalized with diagnosis of gastric and/or duodenal ulcer. Helicobacter pylori was identified morphologically or with a rapid urease test. Syphilis was rejected when microprecipitation reaction was negative and confirmed with Wassermann reaction. The patients received standard treatment including a course of eradication therapy. RESULTS: Endoscopic examination discovered single and multiple ulcers in 25 and 5 patients, respectively, located in the stomach and duodenum. A rapid test for syphilis produced negative and positive results in 28 and 2 patients, respectively. Twenty two patients tolerated eradication therapy well. Positive results were achieved in 19 (84.6%) patients. Six patients had side effects (pruritus, urticaria, dyspepsia) on eradication treatment day 2-3. Jarisch-Herxheimer reaction (elevated body temperature 38-38.6 degrees C) and roseola eruption were observed in 2 (6.7%) patients with positive serological reactions for syphilis on the first day of eradication therapy. CONCLUSION: Diagnostic criteria of EGS are the following: serologically confirmed manifest or latent syphilis, poor effect of standard antiulcer treatment, rapid elimination of the disease symptoms in antisyphilis therapy and positive changes in pathological alterations in gastric mucosa.

[Myocardial infarction in women: risk factors and clinical features]. / Faktory riska i osobennosti techeniia infarkta miokarda u zhenshchin.

The course of myocardial infarction (MI) in women, especially 60 years of age and older, is characterized by such severe complications as cardiorrhexis, hypovolemic cardiogenic shock, asystole, recurrent ventricular fibrillation and electromechanic dissociation responsible for the majority of lethal outcomes. Especially high MI lethality is in women at the age 70-79 years who have also the highest incidence of recurrent macrofocal MI while small-focal MI occurs in women over 80 years of age (80-89) more frequently than in 60-year-olds and younger. Dominating MI risk factors in women were the following: arterial hypertension detected in 81% patients under 60 and 90.8% cases over 60 years; abnormal lipid spectrum of blood including hypercholesterolemia (HCE), hypertriglyceridemia (HTE) and low concentration of HDLP cholesterol. HCE and HTE closely correlated with abdominal obesity irrespectively of age. Early menopause in women under 60 and diabetes mellitus of type 2 in older women, accumulation of two and more factors of risk contribute to development of coronary heart disease and MI, in females.