CLINICAL AND FUNCTIONAL STATE OF THE THYROID GLAND IN WOMEN OF PERI- AND POSTMENOPAUSAL AGE WITH METABOLIC SYNDROME.

The article deals with the problem of the clinical and functional relationship between the state of the thyroid gland in women of menopausal age and the components of the metabolic syndrome (MS). The purpose of the study: to assess the relationship between thyroid dysfunction and various components of MS in women of peri- and postmenopausal age. 80 menopausal women (mean age 55 years) were examined, of which 40 people with MS constituted the main group, and the comparison group - a similar number of women without MS. The inclusion criterion in the study was the presence of signs of abdominal obesity (AO) according to the WHO criteria (2008). Anthropometric, functional (BP), laboratory (lipidogram, TSH, freeT4, antibodies to TPO, FSH, LH, urinary iodine concentration) and instrumental (ultrasound of the thyroid gland) data, statistical analysis using the program SPSSStatistics version 20 were evaluated. The women were divided into two age groups: group 1 - perimenopausal and group 2 - postmenopausal. There were 40 people in each group (20 women with MS and 20 women without MS). It has been shown that peri- and postmenopausal women with MS have subclinical hypothyroidism. The influence of peripheral blood TSH levels in peri- and postmenopausal women with MS on body weight, carbohydrate and lipid metabolism, and sex hormones was established.

[ERRORS IN THE DIAGNOSTICS AND TREATMENT OF PATIENTS WITH GOUT AND THE ALGORITHM OF THERAPEUTIC TACTICS IN DIFFERENT PERIODS OF THE DISEASE (CLINICAL CASE)].

Difficulties and errors in the treatment of patients with the gout arise, mainly, during urate-lowering therapy. The article discusses possible medical errors in acute gouty arthritis and during chronic tophaceous gout in the light of the updated international recommendations of the American College of Rheumatology (ACR) and the European Antirheumatic League (EULAR 2018). As an example of inadequate treatment, the authors describe a case of a patient with chronic tophaceous gout. Errors in the diagnosis and treatment of the patient caused various complications and unjustified surgical intervention - amputation of the right finger and removal of a large tophus in the left forearm. Based on the analysis of mistakes made in the diagnosis and treatment of gout, the authors propose an algorithm for therapeutic tactics in different periods of the disease. So, for the relief of exacerbation in acute gouty arthritis, it is recommended to take the following drugs at starting doses: colchicine at a dose of 1.8 mg/day (1.2 mg immediately followed by 0.6 mg 1 hour later during 7-10 days or until complete relief of the gout attack), non-steroidal anti-inflammatory drugs (nimesulide up to 200 mg/day) or glucocorticosteroids (prednisolone at a dose of 30 mg/day for 3-5 days with subsequent withdrawal). The first-line urate-lowering drugs for chronic tofaceous gout are xanthine oxidase inhibitors - allopurinol and febuxostat. Allopurinol is prescribed no earlier than 2 weeks after the arthritis attack has stopped at a starting dose of no more than 100 mg/day, the dose is gradually increased to the minimum effective. The starting dose of febuxostat is 40 mg/day. Also, together with allopurinol or febuxostat, it is recommended to take uricosuric drugs (probenecid 500 mg/day or benzbromarone 50-200 mg/day). At the same time, the authors draw attention to the inadmissibility of the combination of allopurinol and febuxostat. In case of gout that does not respond to the main methods of therapy, treatment with pegloticase is recommended. When prescribing urate-lowering therapy, dose titration is necessary, to avoid the development of toxic effects.

[INDICATORS OF CARDIOHEMODYNAMICS OF RHYTHM DISTURBANCES IN ELDERLY PEOPLE WITH CHRONIC HEART FAILURE].

The aim of our study was to study and analyze the electrophysiological indicators of rhythm disturbances in heart failure in elderly people who participated in the elimination of the consequences of the Chernobyl accident in the distant period. In order to assess the functional features, 50 elderly patients (65-74 years old) who participated in the liquidation of the consequences of the Chernobyl accident were examined. Patients were divided into 4 groups depending on the length of stay in an environmentally disadvantaged zone: group 1 (April-June 1986) - 8 (16%) people; 2 (June-December 1986) -14 (28%); 3 (1987-1989) -17 (34%) and group 4 (1990-91gg) -11 (22%) people. All patients were on basic therapy. To study cardiogemodynamics in this category of patients, the following electrophysiological research methods were performed: ECG, XM ECG, SMAD, EchoCG. When analyzing electrophysiological studies, the MSExcel and Statistica programs were used. The examined patients showed a high incidence of left ventricular hypertrophy and cardiac arrhythmias. So in the 1st and 2nd groups, atrial fibrillation, sinus tachy and bradycardia, AV blockade of 1-2 degrees were reliably detected. In groups 3 and 4, left ventricular hypertrophy and arrhythmias were detected with a lower frequency. It should be noted that these changes were observed in individuals participating in the LPA from April to December 1986, i.e. in the first year after the accident. According to echocardiography, diastolic dysfunction of the left ventricle was found mainly in individuals of 1-2 groups. High high indices of KDR, BWW and KSO in 1-2 groups are noted. LVMI exceeds its norm in all studied groups. Thus, statistically significant differences of some indicators are revealed with electrophysiological research methods in all groups of elderly patients with heart failure participating in the liquidation of the Chernobyl accident, as well as the high incidence of rhythm disturbances in patients with Chernobyl nuclear power plants.

[CLINICAL, MORPHOLOGICAL AND MOLECULAR GENETIC FEATURES AND PROGNOSTIC FACTORS OF PRIMARY MYELOFIBROSIS. A CASE OF PRIMARY MYELOFIBROSIS TRANSFORMATION INTO ACUTE MYELOID LEUKEMIA].

Primary myelofibrosis is a common disease from the group of Ph-negative myeloproliferative diseases. The article presents modern data on the pathogenesis of Ph-negative myeloproliferative diseases, as well as diagnostic criteria, treatment tactics and prognosis factors for primary myelofibrosis. A clinical case of transformation of primary myelofibrosis into acute myeloid leukemia is described. Purpose of the study - to present up-to-date information on the pathogenesis, diagnostic criteria, principles of treatment and prognostic factors of primary myelofibrosis, as well as to present a clinical case of transformation of primary myelofibrosis into acute myeloblastic leukemia. According to modern concepts, for the early diagnosis of primary myelofibrosis, along with the clinical and morphological methods of examining patients, molecular genetic verification of the disease is extremely important. To improve the survival rate of patients with primary myelofibrosis, molecular genetic verification of the disease and stratification for the choice of treatment tactics are necessary.

[ARTERIAL HYPERTENSION AMONG WORKERS OF A URANIUM PROCESSING ENTERPRISE OF THE REPUBLIC OF KAZAKHSTAN: PREVALENCE, RELATIVE RISKS AND PREDICTORS OF THE DEVELOPMENT].

The aim of this study was to establish the prevalence, relative risks, and predictive factors of the development of arterial hypertension (AH) in workers of a uranium processing enterprise (UPE). An open cross-sectional comparative study of 809 UPE workers was conducted. The compared them to the 696 workers of the bearing plant, located at a distance of 10 km from UPE. Stratification was performed and odds ratios (OR), gross (RR) and standardized relative (SRR) risks of hypertension were calculated. Our results revealed a high prevalence of hypertension among UPE workers (24.8%), as well as greater risk of development of hypertension among workers of UPE in comparison to the personnel of the non-uranium enterprise: RR=2.4 and SRR=2.9. The most significant predictors of hypertension were burdened heredity (OR = 13.6), total radiation dose (OR=1.5), overweight (OR=1.1), high anxiety (OR=0.5) and systematic use of alcohol (OR=0.5). Thus, among workers chronically exposed to radiation toxicity, high prevalence of hypertension, excessive RR and SRR of developing hypertension and the presence of risk factors for hypertension were established.

[Ways of optimization in teaching of internal diseases in a medical institute].

A method of practical clinical games (PCG) performing is represented. For the PCG themes the extreme and urgent situations requiring the doctors of various specialities (especially on the cardiology and hematology cycles) are selected. A model of specific clinical situation, where students play roles, corresponding to the duties of speciality under conditions, maximally approximating to reality, is reproduced.

[Clinicofunctional characteristics of primary mitral prolapse in adolescents]. / Kliniko-funktsional'nye osobennosti pervichnogo prolapsa mitral'nogo klapana u podrostkov.

To investigate clinicofunctional features of primary mitral prolapse (PMP) in adolescents, 60 patients were examined (42 adolescent girls and 18 adolescent boys aged 14 to 20 years). Control group consisted of 15 healthy adolescents of the same age. PMP in adolescents was characterized by marked manifestations of connective tissue dysplasia (CTD) and vegetative dysfunction (VD). As shown by echocardiography, 71.7% patients had bilateral prolapse with mitral regurgitation of degree I and II. 18.7% examinees with pronounced CTD and VD had asymptomatic variant of PMP.

[Clinical value of measuring the activity of serum cholinesterase and its isoenzyme in chronic hepatitis and liver cirrhosis]. / Klinicheskoe znachenie opredeleniia aktivnosti kholinésterazy i ee izoform v syvorotke krovi pri khronicheskom gepatite i tsirroze pecheni.

Examination was performed of 48 chronic sufferers with persistent hepatitis (PH), 70 with active hepatitis (AH) and 179 with hepatic cirrhosis (HC) by activity of cholinesterase (CE). Lowering of total CE activity proportional to hepatic cellular insufficiency was seen in decompensated HC and chronic AN. CE isoforms (7 in healthy subjects) furnished additional information about its activity. Marked hepatic cell insufficiency in HC patients warrants disappearance of 3-4 CE isoforms. The presence of only one or two of them suggests a lethal outcome. In chronic AN four or less CE isoforms predict development of HC.