Principles for diagnosis and treatment of pulmonary embolism.

Pulmonory embolism takes the third place in cardiovascular mortality structure. Separate clinical symptoms don't have adequate sensibility and specificity for pulmonary embolism verification. For pulmonary embolism diagnosis are usually used clinical probability scales. Clinical markers, pulmonic ventricle dysfunction markers, and myocardial injury markers determine risk stratification. Methods for diagnosis and treatment of pulmonary embolism are based on risk levels. In case of suspected pulmonary embolism the treatment should be prescribed immediately without waiting for diagnosis approval. Pulmonary embolism. accompanied with shock and hypotension is. an absolute thrombolytic therapy indication. According to data, provided by authors, efficacy and safety of prourokinase appeared to be as effective and safe as alteplase according to clinical and instrumental criteria. Alteplase effectiveness is higher than prourokinase in case of short anamnesis (<3 days), while in case of long anamnesis (>3 days) proukinase has the advantage of alteplase., To prevent repeated venous thromboembolism should be prescribed indirect anticoagulant (Vitamin K antaonist) or factor Xa inhibitor oral inticoagulant rivaroxaban.

[Corrrelation between blood pressure levels in patients with glaucoma (Literature review)].

The problem of correlation between blood pressure levels and intraocular pressure is one of the most talked about. Both, Russian and foreign literature, reflects the heterogeneity of views on the impact of blood pressure changes into the level of intraocular. pressure. At the same time it underestimated the role of systemic cardiovascular changes in the deterioration of visual function in case of primary open-angle glaucoma. Numerous data demonstrate the role of additional factors than average blood pressure levels in advance of glaucoma. More and more researchers tend to assess not only intraocular pressure, but also perfusion pressure as a risk predictor of advance of glaucoma. Correlation between blood pressure level and intraocular pressure has a particular relevance due to the significant improvement of the range of cardiovascular drugs that can affect on intraocular pressure indictors. A number of literature data confirm the need to research variations in blood pressure levels during the day and types of therapy that patients receive.

[Modern approaches to diagnosis and treatment of tachyarrhythmia at military-medical organizations].

Modem approaches to diagnosis and treatment of tachyarrhythmia at military-medical organizations.. The article describes the principles of differential diagnosis and treatment of tachyarrhythmia. Developed algorithms of diagnostics and treatment of cardiac arrhythmias in the military-medical institutions. The algorithm relief hemodynamically stable rhythmic tachycardia. The results of interventional -treatment in 462 patients with tachyarrhythmia heart. The high efficacy and safety of radiofrequency ablation technique in patients with tachyarrhythmia heart.

[Chronic HCV infection: An internist's opinion (Part 2)]. / Khronicheskaia HCV-infektsiia: vzgliad internista (II chast').

Hepatitis C virus (HCV) infection results in not only chronic hepatitis and subsequent complications as liver cirrhosis and hepatocellular carcinoma, but also in a significant number of other diseases, the so-called extrahepatic manifestations of chronic HCV infection. In addition to lymphoproliferative and autoimmune disorders discussed in Part 1 of this review, many other diseases turned to be associated with chronic HCV infection. Part 2 of this review is dedicated to the analysis of the relationship of chronic HCV-infection to the development of some endocrine diseases, such as thyroiditis and diabetes mellitus, and cardiovascular disorders. It also provides the characteristics of the currently available antiviral agents and considers whether they may be used in patents with extrahepatic manifestations of chronic HCV infection.

[Chronic hepatitis C virus infection: An internist's opinion (Part 1)]. / Khronicheskaia HCV-infektsiia: vzgliad internista (I chast').

Hepatitis C virus (HCV) infection results in not only chronic hepatitis and subsequent complications as liver cirrhosis and hepatocellular carcinoma, but also in a significant number of other diseases, the so-called extrahepatic manifestations of chronic HCV infection. This is because of viral hepatotropicity and lymphotropicity. The most striking example of the course of chronic HCV infection, in which the infectious and inflammatory processes are concurrent with autoimmune disorders and carcinogenesis, is mixed cryoglobulinemia and B-cell non-Hodgkin's lymphoma. The pathogenesis of these diseases is based on the clonal expansion of B cells, which occurs under their prolonged stimulation with the virus or viral proteins. Part 1 of this review is devoted to the analysis of a correlation of chronic HCV infection with lymphoproliferative and autoimmune disorders, as well as its association with kidney injury.

[The historical experience of therapeutic service in the Army and Navy during the Great Patriotic War].

The author presents the experience of therapeutic services of the army and navy during the Great Patriotic War (1941-1945) and its importance for the present. This experience became a-general methodological framework-for the development of principles for the organization of work of military physicians in a modern warfare and the application of new weapons. The history of development, aims and objectives of the new section of Military Medicine--the Military Field Therapy as a unified system of organization and delivery of health care to servicemen based on the principles of a unified military field medical doctrine. A problem of organization of new health facilities (hospitals, hospital databases), their acquisition of trained personnel, especially the structure of internal medicine in the war years, the treatment and the early rehabilitation of wounded and sick, between the military and civilian medical institutions-is highlighted. There is an information that 90.6%, or more than 6.5 million soldiers and officers who were treated in hospitals with various diseases, were returned to duty. The experience of the medical service in World War II and the actual demand and is now planning for a package of measures aimed at further improvement of the health status of military-personnel.

[Clinical guidelines for management of patients with acute chronic obstructive pulmonary disease].

The treatment of acute chronic obstructive pulmonary disease is aimed at minimizing the manifestations of this aggravation and prevention of its progression. This article covers the information about the etiology of acute illness and its diagnosis criteria, recommendations about methods of assessing of exacerbations, place of treatment of this pathology and definition of treatment policy. The data about preferrable means of pharmacotherapy--bronchial spasmolytics, corticosteroids and antibacterial drugs, is given. Recommendations concerning oxygen therapy, respiratory support, mucoactive therapy and prevention of thromboembolic complications are given. An algorithm for the management of patients on an outpatient basis in a hospital is presented.

[RHEUTMATIC MYALGIA COMPLICATED BY AA-AMYLOIDOSIS].

Rheumatic myalgia is associated with intense inflammation and, unlike other diseases, is very rarely complicated by AA- amyloidosis. Only 12 such cases have been described worldwide, most of them in combination with giant cell arteritis. The present article reports the first case of rheumatic myalgia complicated by AA-amyloidosis encountered in Russia and the relevant literature review.

[PULMONARY THROMBOEMBOLISM IN WOMEN USING ORAL HORMONAL CONTRACEPTIVES].

Pulmonay thromboembolism is a common difficult-to-diagnose pathology not infrequently with a lethal outcome. There are many factors leading to hypercoagulation. One of them is intake of hormonal contraceptives to which doctors sometimes do not pay due attention. This paper reports two cases of acute coagulopathy with massive pulmonary thromboembolism in young women using these agents during a long period.

[A case of adenovirus infection complicated by gram-negative polymicrobial sepsis: A clinical and morphological observation].

Among respiratory infections, adenovirus infection (ADVI), in the presence of which there may be severe pneumonia that frequently results in a fatal outcome, occupies particular attention. ADVI in patients without immunodeficiency is usually mild and shows a limited extent of injury. At the same time the disease in immunocompromised individuals may be severe, presenting with viremia, evolving sepsis, and high death rates. The paper gives a characteristic example of severe ADVI and its fatal outcome.

[Burnout syndrome: diagnosis, principles of treatment, prophylaxis].

Burnout syndrome is a socio-psychological phenomenon of emotional, motivational, and physical exhaustion as a result of chronic occupational stress. It is manifested as long-term emotional exhaustion, depersonalization and diminished personal and professional achievements. Burnout syndrome is common among health care workers, 'due to their high dedication, empathy for suffering patients, and decision-making related to life and health of patients. Personal, role and organizational factors influence on development of burnout. The clinical picture of burnout is multifactorial and can be described as a set of psychosomatic and somatic disorders, symptoms of social dysfunction. Diversity and non-specific symptoms of burnout syndrome determine the need for an interdisciplinary approach to its diagnosis. The leading role in solving problems related to stress and emotional burnout plays psychotherapy. The paper presents diagnostic criteria, risk factors, and methods of prevention and treatment of emotional burnout.