Prevalence of Heart Failure in a Megalopolis.

Aim      To assess the prevalence of heart failure (HF) in St. Petersburg from 2019 through 2021 based on medical reports.Material and methods  Medical records of 146 912 patients with HF who were managed in St. Petersburg from 2019 through 2021 were analyzed. Prevalence of HF was assessed using a standard ICD-10 I 50.x code for this disease. Also, expanded HF coding was used with ICD-10 codes I09.9, I11.0, I13.0, I13.2, I25.5, I42.0, I42.9, I43.0, I43.1, I43.8, I42.5, I42.7, and I42.8. An additional analysis was performed for mortality from cardiovascular diseases (CVD) as a whole and from HF in particular (n=192 133).Results From 2019 through 2021, the number of both male and female patients with HF increased by 18.14 %. The greatest number of HF patients was in the age group of 75-89 years in 2019-2020 and 60-74 years in 2021, with females prevailing. The HF incidence increased in the age group of 45-59 years with a peak morbidity at age of 60-74 for men and 75-89 for women, which was consistent with the life expectancy of each gender. The expanded coding allowed a more complete presentation of HF prevalence and also to take into account patients with HF caused not only by myocardial infarction or acute cardiac pathology but also by rheumatic heart disease, arterial hypertension, myocarditis, and cardiomyopathies. Cardiovascular mortality significantly increased by 20.1% during the period from 2019 through 2021. The HF prevalence for deceased patients also was steadily increasing during 3 years. Analysis of associated pathology in HF patients revealed, in most cases, hypertension, ischemic heart disease, cerebrovascular diseases, diabetes mellitus, and obesity.Conclusion      The increase in HF prevalence and mortality draws attention and calls for managing measures to change the current situation in health care. A registry is required to characterize a typical patient with HF and to present an unbiased picture of HF prevalence. It is also necessary to develop programs for outpatient follow-up of patients in this category and for providing current, highly effective medicines. Education of patients and improving the knowledge of therapists in diagnosis and treatment of HF are most relevant for enhancing the quality and duration of patients' life and for reducing the number of hospitalizations and the HF mortality.

[Ontogenetic forms of rheumatoid arthritis and behavioral type A.]

Disease onset and type A behavioral pattern (TABP) are important characteristics of the clinical manifestations of chronic diseases. The aim of this work is to study the prevalence and role of TABP in patients with rheumatoid arthritis (RA) with the onset of the disease at different periods of ontogenesis. 82 patients were examined, which were divided into groups depending on the age of RA onset. The first group included patients with RA onset at reproductive age (from 18 to 44 years). The second group included patients with the onset of RA in the middle age (from 45 to 59 years). The third group consisted of patients with the onset of RA in old age (from 60 to 74 years). The fourth group consisted of patients with the onset of RA in old age (75 years and older). Diagnosis of TABP was carried out using a special questionnaire. The group with a debut in the reproductive period had the largest number of patients with RA of the 1st and 2nd line of relationship, as well as the highest incidence of TABP, which was associated with a greater expression of such personal qualities as ambition and hostility. This group had the highest number of ankylosis, as well as the highest frequency of systemic lesions. The second group demonstrated classic rheumatoid patterns. The third group with debut in old age had the most favorable clinical picture, incl. the lowest immunological activity in terms of the сirculating immune complexes (CICs) level, associated with the lowest severity of articular syndrome, with the lowest number of erosions and the frequency of systemic manifestations. The fourth group with a debut in old age demonstrated the highest inflammatory activity and specific immunological activity in terms of rheumatoid factor and CICs levels, as well as the highest clinical severity of the articular syndrome. Thus, the ontogenetic debut of RA determines its clinical and laboratory features and is associated with the presence and characteristics of TABP.

[Iron deficiency anemia in elderly and senile patients.]

Anemic syndrome is common in 1/3 of the population, including iron deficiency anemia - in 1,5 billion people. Geriatric patients are one of the main risk group for anemia. Iron deficiency and iron deficiency anemia lead to a decrease in quality of life, an increase in morbidity and mortality, what requires timely diagnosis and treatment. The diagnostic algorithm includes the analysis of iron metabolism, inflammation markers and instrumental tests to verify the cause of anemia. Modern oral and parenteral iron preparations are used for treatment under control of blood indexes and iron metabolism parameters.

[Features of the ontogenetic forms of rheumatoid arthritis associated with autoimmune thyroiditis.]

Ontogenetic debut of diseases can determine clinico-pathogenetic differences in disease variants. The aim of the study was to determine the clinical and laboratory features of the variants of rheumatoid arthritis (RA) associated with autoimmune thyroiditis (AIT) in patients with various ontogenetic debut of the disease. A total of 53 patients with a combination of RA and AIT (mean age 63,92±1,6 years, 92% of patients - women, duration of rheumatoid arthritis - 10,0±1,11 years, disease activity on the DAS28 scale - 5,67±0,14 points). Patients with the debut of joint syndrome in the reproductive period had the highest antibody titer to the cyclic citrullinated peptide (ACCP) and close correlation between the titer of rheumatoid factor (RF) and tobacco smoking experience. Patients with debut joint syndrome in the menopausal period were characterized by geroprotective status, having the largest number of centenarians in the family and a significant negative correlation between the titre of ACCP and this significative, and also the greatest vulnerability to the action of other trigger factors of arthritis, which was confirmed by a close correlation of specific rheumatoid immunological parameters with smoking experience and the presence of an infectious disease in the period preceding the articulate debut of the RA, and also least rate of glomerular filtration. Patients with the debut of the joint syndrome in the early involutionary period were characterized by the presence of a gerontological immunological phenotype, which was manifested by the highest level of RF in the serum, as well as by the faster course of the disease from the joint debut to the unfolded clinical picture. CONCLUSIONS: The ontogenetic analysis of the features of RA associated with AIT showed the presence of ontogenetic clinico-pathogenetic forms of the disease, which may further have implications for clinical practice.

[Clinical and organizational way of innovative development of regenerative medicine in security agencies].

The article covers organizational aspects of development of innovative technologies in the field of regenerative medicine. It is shown that for the effective design and implementation into medical practice of regenerative medicine requires a united complex of military health care, military medical research and education. The main goal is to formate a biological insurance of personnel to treat different consequences of radiological incidents, burn disease, identification of the remains of the victims; the maximum returning to action after disturbed as a result of health services. Proposes the creation of "Interdepartmental Clinical Research and Education Center for Regenerative Medicine", combining research, clinical, industrial and educational potential of the leading institutions of various departments that will enhance the national security of the Russian Federation.

[ANEMIC SYNDROME AND ITS SPECIFICS IN SENIOR PATIENTS].

Clinical practice confirms high frequency of anemic syndrome. Anemia is diagnosed more often in senior patients than on the average. The most prevalent type of anemia in senior groups are iron deficiency anemia and B12-deficiency anemia, anemia of chronic diseases and anemia caused by kidney diseases. The cause of anemic syndrome in 25% of senior patients remains unclear. Anemia leads to impairment of life quality, increased morbidity and mortality in senior people except for patients with anemia of unknown origin.

[ Modern condition and prospects of development of cardiac surgery in the Armed Forces].

Authors consider the problem of delivery cardiac surgical care to contingent of the Defence Ministry. Perspective directions of development of cardiac surgery in the Armed Forces of the Russian Federation are the development of minimally invasive cardio surgery, endovascular development of modern methods of diagnosis and treatment, further development of electrophysiological methods for diagnosis and treatment of disorders of rhythm and conduction, the introduction of various kinds of auxiliary mechanical circulatory support systems in acute and chronic heart failure, development of transplantation in cardiac surgery, improvement of algorithm selection and referral of patients requiring cardiac care by providing primary health care to troop central military medical institutions, creating a single register of cardiac patients as part of the Armed Forces in order to determine the order and place of treatment, etc.

[Concept of the biological register of the Ministry of Defense as a biological insurance system of the health of soldiers at the present stage of the development of Russian armed forces].

The concept of regenerative medicine has acquired a considerable progress especially in NATO armies. Regenerative medicine with its innovative technologies becomes a powerful tool in solving ensuring problems of military medical institutions with medicines on the basis of donor blood, tissues and artificial skin. The centers of regenerative medicine and cell therapy developed by many of the leading research institutions in our country and abroad. Foundation of a Biological Register of Russian Armed Forces with a Centre of Cellular and Genetic technologies based at the Military Medical Academy will satisfy needs of military medicine in cellular technologies. Scientific research works in experimental biology and clinical studies of stem cells will enable to generate biological safety of servicemen.

[Sergey Petrovich Botkin is the founder of Russian therapeutic school].

The paper gives basic facts from the life and work of Sergey Petrovich Botkin, one of the coryphaei of Russian medicine, who played a prominent role in the formation and development of Russian clinical medicine and became the founder of the most well-known therapeutic school in Russia. S.P. Botkin's greatest merit is emphasized to be his neurogenic theory of medicine, which has played a great role in the understanding of physiological and pathological processes in the entire organism.

[Transplantation of mesenchymal stem cells in multiple sclerosis].

To assess safety and tolerability of treatment with autologic multipotent mesenchymal stem cells (MSC) in multiple sclerosis (MS), we have obtained autologic red bone marrow-derived MSC from 8 patients. Proliferation, immunophenotype and caryotype of MSC, their sterility, the absence of hemopoetic cells, chromosomal aberrations and signs of aging were controlled during the cell growth. The inverse injection of MSC in patient's blood was conducted in accordance to the elaborated protocol in a short intravenous infusion in dose 2.0 x 10(6)/kg of body mass once in 30 days. The duration of treatment was from 4 to 8 months. The efficacy of treatment was assessed after 4, 8 and 12 months. All patients tolerated repeated intravenous infusions of autologic MSC well with no significant side-effects as in the early as well in the remote periods of treatment. The distinct positive effect was seen in some cases 2 months after the beginning of treatment. The improvement of 0.5 point on EDSS was seen in 5/8 patients after 4 months. After 12 months, the improvement of 0.5-1 point on EDSS was seen in 6/8, stabilization in 1/8, progression in 1/8. These results revealed the safety of the elaborated protocol of treatment and the moderate clinical efficacy of treatment in non-curable patients or those with poor response to treatment that suggested continuing the study and enrollment of new patients.

[The results of the baseline therapy of the rheumatoid arthritis].

Retrospective comparative analysis of therapy of the rheumatoid arthritis was undertaken. The following variants of antiphlogistic prescription: inactive tactics (long-lasting administration of one medicine), tactics of protracted treatment (separate courses of disease-modifying antirheumatic drugs with long breaks between them), tactics of first aid (at the beginning "passive treatments", after the appearance of complications begun active therapy with cytostatics); tactics of pyramid (the order of the prescription of medicines corresponds to classical strategy of baseline therapy with short breaks during the treatment), tactics of active therapy (the early beginning of baseline therapy with consistent change of medicine); effectiveness and safety of long-lasting administration of antiphlogistic in complex therapy of the rheumatoid arthritis.

[Renal protection in the patients with idiopathic hypertensia: the possibilities of the combined blockade of the reninangiotensinaldosterone system].

Reninangiotensinaldosterone system is a key link in regulation of blood pressure and causes the target organ damage in hypertensive patients. For many years is not lost interest in the pharmacological blockade of RAAS in order to achieve target levels of BP and prevent damage target organs, particularly kidneys. Most recently recommended for clinical application of direct rennin inhibitor--aliskiren, a number of researcher have proven expressed nephroprotective effect. However, at present there is no unequivocal answer to the question whether there are advantages in combined RAAS blockade in hypertensive patients with use of aliskiren and angiotensinconverting enzyme inhibitor or angiotensin receptor blocker.

[Economic assessment of the use of biological medications in military medicine].

By the example of rheumatoid arthritis was considered the methods of economic assessment of advisability of modern biological medication usage in military medicine. The usage of these medications leads to quick clinical response, decrease of the additional medication intake, decrease of the average duration of treatment, "move aside" time of permanent disablement. Modern active therapy can increase the effectiveness of treatment; improve the quality of life, decrease the average duration of hospital stay, following treatment expense and welfare payment for this category of ill.

[Adrenergic innervation of the myocardium in patients with cardiac syndrome X]. / Issledovanie adrenergicheskoi innervatsii miokarda u bol'nykh kardial'nym sindromom X.

11 syndrome X patients and 8 healthy controls were investigated by myocardial scintigraphy (SPECT) with 123-I-MIBG. Regional defects in cardiac 123-I-MIBG uptake were found in 90% syndrome X patients. Total cardiac 123-I-MIBG uptake appeared significantly higher in syndrome X patients. Perfusion defects on stress 99m-Tc-MIBI scintigraphy were found in 10 syndrome X patients who had also abnormal 123-I-MIBG scintigrams. It is suggested that impairment of efferent cardiac adrenergic nerve fiber function in syndrome X patients may contribute to pathophysiologic and clinical features of syndrome X.

Heat shock proteins in cardiosurgery patients.

OBJECTIVE: Cytoplasmic members of the heat shock protein HSP70, family, inducible HSP72 and constitutive HSC73, are known to protect cells and organisms against harmful factors including ischemia, trauma, etc. The up-regulation of HSP70 was shown to greatly increase resistance of myocardial cells in vitro as well as in transgenic animals. It seems reasonable to expect that in patients undergoing open heart surgery cytoplasmic HSP70 should play a protective role, reducing the risk of the myocardial cell injury. METHODS: Using Western blotting, we determined levels of HSP72 and HSC73 in myocardium and peripheral blood lymphocytes of 51 patients with coronary and valvular diseases. In all the cases, HSP70 was detected in samples of the right atria before and after cardiopulmonary bypass. RESULTS: Induction of HSP72 was observed in 40% of all patients and correlated with the endurance of cardiopulmonary bypass and with disease duration in 33 patients with coronary artery disease. The cardioprotective effect of the elevated pre-operational level of HSP72 was shown to correlate with the lower activity of cardiospecific enzymes in the coronary disease patients. The HSC73 level in the right atria did not depend on conditions of the open heart surgery, while in some cases, it was increased after bypass. No correlation has been found between preoperational content of HSP72/HSC73 in lymphocytes and its pre- or post-bypass content in myocardium. CONCLUSION: HSP72 is implicated in cardioprotection in combination with some other factors, and its pre-operational level, among other parameters, might be of prognostic value.

[Role of heat-shock proteins in cardioprotection of patients operated on for ischemic heart disease]. / Rol' belka teplovogo shoka v kardioprotektsii u bol'nykh, operirovannykh po povodu ishemicheskoi bolezni serdtsa.

Major stress protein HSP72 is known to participate in protecting cells and organisms against harmful factors including ischemia, trauma etc. Under study was the level of HSP72 in the myocardium of 32 patients with coronary disease operated in Military-medical academy. HSP72 was detected in probes of the right atria before and after pre-cardiopulmonary bypass in all cases induction of HSP72 was observed in 40% of patients, and directly correlated with the time of cardiopulmonary bypass and standing of the disease. The cardioprotective effect of the elevated pre-operational level of HSP72 was shown to be proportionate to the lower activity of cardiospecific enzymes, creatine phosphokinase (CK-MB). It is suggested that HSP72 is involved in the mechanism of cardioprotection during cardiopulmonary bypass.