Role of thiazide diuretics in treatment of arterial hypertension and their influence on long-term prognosis of patients according to the results of placebo-controlled clinical studies are described

Evolution of concepts of pathogenesis and treatment of heart and kidney involvement as integrated continuum are described

Aim of the study. Evaluation of influence of anemia of various severity of central hemodynamics parameters in patients with chronic heart failure.
Methods. 60 patients with chronic heart failure and anemia (age 72,3+9,0 years) were included into the study. Hemoglobin level was 36-112 g/1. Echocardiography was performed in all patients in the 1st and 26th days of hospitalization. In all patients hemoglobin level, erythrocyte count, erythrocyte indices (MCH, MCV), hematocrit level and serum iron concentration were determined.
Results. All patients were divided into 2 group: 1st with hemoglobin level <70 g/1, 2nd - with hemoglobin level >70 g/1. Median hemoglobin level was 52,8+11,0 g/1 in 1st group and 91,0± 12,9 g/1 in 2nd group (p<0,01 ). Patients with more severe anemia had higher values of myocardial contractile parameters: left ventricular ejection fraction (LVEF) was 70,6±13,2%, stroke volume (SV) - 75,0+17,5 ml. In group with less severe anemia LVEF was 41,0+6,3%, SV - 37,8+4,3 ml. After complex treatment of anemia and chronic heart failure in 1st group LVEF (70,6± 13,2 and 55,6+8,0%; /?<0,01) and SV (75,0± 17,5 and 58,3+11,3 ml; p<0,05) decreased. In 1st group treatment did not result in sighnificant changes of LVEF and SV.
Conclusion. Severe anemia in patients with chronic heart failure promotes reversible remodeling of central hemodynamics in hyperkinetic type, less severe anemia does not influence significantly the systolic parameters of left ventricle.

Aim. Study of diagnostic significance of serum level of tumor necrotizing factor a (TNF-a), C-reactive protein (C-RP) and procalcitonin (PCT) in infective endocarditis (IE).
Methods. 66 patients with IE (60,6% male, 39,4% female), 35 with primary IE, 31 - with secondary IE, were included into the study. Clinical and laboratory investigation included determination of serum concentration of TNF-a, C-RP and PCT.
Results. Dynamics of serum concentration of TNF-a, C-RP and PCT were described, types of changes of this parameters, which showed an unfavorable prognosis of infective endocarditis, were distinguished.
Conclusion. Determination of serum level of TNF-a, C-RP and PCT can be used for description of the disease severity.

Therapeutic approaches to treatment of patients with obesity and arterial hypertension are discussed

Aim. Assessment of functional status of muscles of pelvic floor and conductive ability of corticospinal tract in healthy men and patients with erectile dysfunction (ED) with compiling the database of electromyography parameters.
Methods. 52 patients with ED (age 23-67 years) and 12 healthy volunteers, serve as controls, were included into the study. Acicular electromyography of muscles of pelvic floor and magnetic stimulation of cortical and spinal centers with registration of induced motor response were performed.
Results. In healthy volunteers referent database of electromyography parameters was developed - latence of cortical and segmental period of motor response, period of central motor conduction, amplitude of action potential. Patients with ED were characterized with disturbances of conduction in corticospinal tract - increase of latency of period of cortical and segmental motor response >10%, prolongation of period of central motor conduction >15%, and decrease of motor unit potential amplitude. Among electromyography parameters spontaneous activity of muscle fibers and poliphasy of motor unit potential demonstrated ongoing process of denervation. In 80% patients with ED and chronic pelvic pain signs of ongoing denervation-renervation process were revealed. In patients with ED and inflammatory diseases of lower urinary tract signs of denervation- renervation are rare and, if present, are minimal.
Conclusion. Denervation processes in pelvic floor muscles should be considered in clinical assessment of patients with ED.

Etiology, pathogenesis and treatment strategies in diuretic-resistant oedema are discussed

Aim. Optimization of pharmacotherapy of patients with metabolic syndrome and chronic kidney disease according to the nephroprotective properties of antihypertensive drugs.
Methods. 81 patients (38 male, 43 female, age 29-79 years, mean age 53,4± 11,6 years) with metabolic syndrome and normal kidney function were included into the study. In all patients estimated glomerular filtration rate (eGFR) according to the Cockroft-Gault formula and microalbuminuria were determined. Antihypertensive and nephroprotective efficacy of zofenopril, losartan, nebivolol and fixed combination of lisinopril and hydrochlorothiazide were assessed.
Results. 57 (70,4%) patients with metabolic syndrome had renal function deterioration: 19 (23,5%) - hyperfiltration (eGFR >110 ml/min/1,73 m2), 38 (46,9%) - hypofiltration (eGFR <90 ml/min/1,73 m2). Progression of chronic kidney disease was connected with increasing age. Endothelin-1 concentration increased according to blood pressure rise. Zofenopril, losartan, nebivolol and fixed combination of lisinopril and hydrochlorothiazide demonstrated antihypertensive and nephroprotective effect in methabolic syndrome.
Conclusion. Changes in eGFR can be found up to 2/ 3 patients with metabolic syndrome and can be corrected by antihypertensive drugs.

Aim. Study of Toll-like receptors (TLR) role and microorganisms of bioptopes of genitourinary tract in pathogenesis of genitourinary chlamydiasis.
Methods. 41 female patients with acute genitourinary chlamydiasis; 29 - with chronic genitourinary chlamydiasis; 30 with genitourinary chlamydiasis in ananamnesis were included into the study; 32 healthy women served as controls. Beyond standard clinical and laboratory investigation, expression of TLR in genitourinary mucous membrane was studied.
Results. Elevation of expression of TLR-2 and TLR-4 genes in cervical canal and urethra, associated with both Chlamydia and other microorganisms (exciters of sexually transmitted infections and opportunistic), correlating with clinical severity, was detected in acute genitourinary chlamydiasis. In chronic and/or asymptomatic genitourinary chlamydiasis TLR-2 and TLR-4 genes expression was lower, than in normal conditions.
Conclusion. TLR-2 and TLR-4 genes expression can be considered as stratification criteria for determination of severity of inflammatory process in genitourinary tract, induced by Chlamydia. Low levels of TLR-2 and TLR-4 expression can indicate the start of chronic phase of Chlamydia infection.

Aim. Assessment of efficacy of frenuloplasty modifications in patients with premature ejaculation, associated with short frenulum of penis.
Methods. Prospective study included 68 patients with primary premature ejaculation, associated with short frenulum of penis. 1st group consisted of 33 patients (age 20,4±3,7 years), in whom standard frenuloplasty was performed. 2nd group included 35 patients (age 21,9±4,6 years) in whom z-shaped frenuloplasty was performed. Before and in 1 month after start of sexual life premature ejaculation profile (PEP) questionnaire was used, time of intravaginal delay of ejaculation was measured, vibration sensitivity of penis was determined. All patients by themselves measured changes of ejaculation after treatment.
Results. PEP values become sighnificantly better in both treatment groups (/><0,001), but in 2nd groups parameters of 1-4 questions were higher (/><0,001). Time of intravaginal delay of ejaculation increased in both groups (69,9±22,8 and 360,3± 125,5 sec; /><0,001 in 1st; 68,5+21,4 and 355,1 ± 124,3 sec; /><0,001 in 2nd). Vibration sensitivity of penis also significantly increased in both groups (/><0,001). Glandular tactile sensitivity threshold increased more significantly in patients, undergone z-shaped frenulopalsty. Self measures changes of ejaculation after treatment were more prominent in patients, undergone z-shaped frenulopalsty (2,3+0,7 vs 1,8±0,8 points, /7=0,032).
Conclusion. Z-shaped frenuloplasty is one of the most effective approaches to treatment of premature ejaculation, associated with short frenulum of penis.

Aim of the study. To determine causes of recurrent strictures of bile ducts after reconstructive surgical operations and indications for precise and framework biliodigestive anasthomosis.
Material and methods. 2 groups of patients were analyzed. Group 1 (1979-1989) consisted of 179 patients, who underwent framework drainage of biliodigestive anasthomosis, group 2 (1990-2008) consisted of 215 patients with precise biliodigestive anasthomosis. Group of patients did not differ from each other according to major clinical parameters.
Results. Precise biliodigestive anasthomosis in comparison with framework biliodigestive anasthomosis is associated with less frequency of intraoperative hemorrhage (2,8 vs 5,0%), purulent cholangitis (2,8 vs 13,4%), recurrent strictures (6,4 vs 11,8%) and tendency for diminishing of mortality (2,8 vs 5,0%). No cases of haemobilia was seen in group 2, in group 1 it was detected in 4,5% patients.
Conclusion. Precise biliodigestive anasthomosis is one of the most effective and safe approaches to treatment of cicatricial stricture of the bile ducts. The indications for frame drainage is the impossibility of excising all scar tissue, the presence of pus formation in the area created by the anastomosis, liver cirrhosis with portal hypertension.

Aim. Assessment of role of HBV viral proteins in liver disease progression in chronic HCV-infected patients.
Methods. 2934 patients were included into the study, in whom serological markers of HBV- and HCV-infection were evaluated. 80 patients were randomly selected for determination of role of anti-HBcor in progression of HCV-induced chronic liver disease. Role of latent HBV-infection in development of hepato-cellular carcinoma was assessed in 28 liver transplant recipients with chronic HCV-infection.
Results. Serological markers of HBV- and/or HCV-infection were detected in 28%. Presence of anti-HBcor IgG was significantly oftener registered in patients with anti-HCV-antibodies (81 vs 17% in absence of anti-HCV-antibodies, p<0,05). Presense of anti-HBcor antibodies did not influenced significantly the activity of liver damage. In HCV-infected liver transplant recipients HBV DNA in liver tissue could be detected in absence of HBs-antigene. anti-HBcor was associated with trend of increasing of risk of hepato-cellular carcinoma development.
Conclusion. All potential liver donors should be examined for anti-HBV- and anti-HCV-antibodies presence.

Modern view on extreme and terminal conditions with special emphasis on etiology, pathogenesis and approaches to treatment are described.

Interrelations between clinical epidemiology and evidence-based medicine are discussed. Demonstrated that epidemiological studies are the methodological basis of clinical epidemiology and evidence-based medicine. Areas of application of evidence-based medicine in clinical and social medicine, as well as in healthcare management and medical education are shown. The sources of the information system accessible evidence-based medicine are given.

Aim. Description of morphological characteristics of alopecia areata according to the disease activity.
Methods. Skin biopsies from scalp of patients with alopecia areata were studied: expression of CD4+, CD8+, CD68+, interleukin-2 (IL-2), interferon-y (IFN-y) and tumor necrosis factor a (TNF-a) was assessed.
Results. In alopecia areata local inflammatory CD4+- and CD8+-mediated cytotoxic immune response develops with participation of proinflammatory cytokins (IL-2, IFN-y, TNF-a). Corellation between clinical and morphological signs of alopecia areata activity can be seen.
Conclusion. Local skin immune-mediated inflammatory response in alopecia areata can be considered as target for pathogenetic therapy.