The association of the MTNR1B and the СYP1А1 gеnе pоlymоrphisms with the lеvеl оf melatonin and the risk оf оbstruсtivе slееp аpnеа/hypоpnеа syndrome development
V.I. Shyshkо, А.А. Kаrpоviсh, V.А. Snеzhitskiy, I.А. Kurstаk
The article discusses the prevalence of polymorphic variants of the MTNR1B gene and the C6310T locus of the CYP1A1 gene in patients with obstructive sleep apnea syndrome (OSAS) and analyzes their association with melatonin levels and the risk of developing OSAS.
2021 Том 5, №2
Morphological changes in tissues during application bipolar coagulation and neodimate laser in gynecology
K. Agabekov, O. Lоbachevskaya, O. Yudina
The article is devoted to a comparative analysis of morphological changes in the tissues of the reproductive system of women under the influence of a neodymium laser and bipolar coagulation during laparoscopic operations. The results of assessing the reliability of dif ferences in morphometric indicators of tissue damage (sections of the fallopian tubes, fragments of ovarian tissue, membranes of benign cystic formations of the ovaries, leiomyomatous nodes of the body of the uterus) under the influence of electromagnetic radiation of various wavelengths are presented. The recorded changes directly depend both on the applied heat or light energy, and on the histological structure of the tissue under study. Fundamental differences in artifactual changes in tissues of the reproductive system were revealed when using bipolar coagulation and laser radiation in surgical practice, and the dependence of morphological changes on the wavelength of a neodymium laser was established for the first time.
2021 Том 5, №2
A contemporary outlook on the potentialities of microcirculatory bed evaluation and methods for correcting disorders
A. Birulya
Investigation of the microcirculatory bed (MVB) has induced heightened interest both theoretical and practical in the medical world of the XX–XXI century. Evaluation of the MVB state has been widely used for revealing pathogenesis and developing an efficient treatment plan in cardiology, diabetology, oncology, dermatovenereology, dentistry, surgery, nephrology, urology, resuscitation and other branches of medicine. It’s worth noticing that evaluation of the microcirculatory parameters should be included into COVID-19 management for optimal medication of the patients especially in severe cases. The ar ticle provides a description of the microcirculator y bed, its structure, functions, mechanisms of regulation, causes of damage, and methods for diagnosing disorders. Proper consideration is given to the current techniques used to improve microcirculatory readings. Non-invasive techniques applied in the Republic of Belarus for improving the microcirculatory readings include the method of enhanced external counterpulsation and gravity therapy.
2021 Том 5, №2
Anatomy of scrotal vessels and their pathological changes as the basis of clinical manifestations of varicocele
M. Doronin, I. Dub, S. Stoma, A. Beizerov
Varicocele is found in 8–40% of young men between the ages of 15 and 40. In 25.4% of cases, it is combined with a violation of reproductive function and in 40% of cases it causes pain syndrome in the scrotum. The etiology and pathogenesis of the disease are associated with various disorders in venous hemodynamics of the upstream vascular network. The peculiarity of venous blood outflow from the organs of the scrotum is the presence of a developed network of anastomoses and collaterals at the level of the scrotum, the inguinal region and the retroperitoneal space.
2021 Том 5, №2
Surgical treatment of varicocele: shunting, occlusive and endovascular interventions
I. Dub, M. Doronin, S. Stoma, R. Kurlenko
The frequency of recurrence after surgical treatment of varicocele reaches 29%. This circumstance encourages the medical community to search for the optimal surgical aid to prevent pathological reflux of blood into the venous plexuses of the testicle from the overlying parts of the vascular network. The operation is indicated in case of presence of the clinical symptoms, the development of orchopathy and disorders of spermatogenesis, regardless of the degree of development of varicocele (WHO classification 2010). Operations aimed at eliminating varicocele are divided into 2 large groups: the first group – preserving the renocaval shunt or shunting operations and the second group – not preserving the renocaval shunt or occlusive operations. Shunting operations include the creation of intervenous anastomoses: proximal, distal and bidirectional. Proximal anastomoses are aimed at eliminating renal venous hypertension as the direct cause of the disease. The imposition of bidirectional and distal anastomoses is considered inappropriate, since in the first case, the time of surgical intervention increases, and in the second case, renal hypertension is not eliminated. Occlusive operations are indicated for primary varicocele and the absence of pronounced venous hypertension. According to the level of vein ligation, they are divided into supra-inguinal and sub-inguinal, by selectivity into selective and non-selective, and by operative access into open, laparoscopic and endovascular. The lowest number of relapses and postoperative complications is observed in sub-inguinal selective and endovascular techniques. They are the most universal ones and eliminate all hemodynamic types of varicocele. Supra-inguinal selective techniques show their high effectiveness in the renospermatic type of varicocele and, unlike sub-inguinal operations, there is no risk of damage to the testicular artery during the operation. Thus, a differentiated approach to choosing the type of surgery reduces the risk of postoperative complications and prevents recurrence of the disease.
2021 Том 5, №2
Cardiac magnetic resonance imagining in viral myocarditis in patients with COVID-19: unsolved problems
T. Ilyina, A. Pleshko, T. Korotkaya, N. Mitkovskaya
Cardiac manifestations in COVID-19, including myocardial injury with elevated troponin levels, are common. Myocarditis has been reported as a possible complication in coronavirus patients, but direct evidence for SARS-CoV-2 myocarditis remains limited. The described series of histopathological confirmations of myocarditis in COVID-19 differ in severity and interpretation. Clinical manifestations of non-ischemic myocardial injury are nonspecific, differential diagnosis is even more difficult due to the complications after viral pneumonia. Cardiac Magnetic Resonance Imaging (CMRI) is a powerful tool for studying structural and functional changes in myocardial injury. New pulse sequences of parametric mapping with determination of the T1 and T2 relaxation times of the myocardium are a unique method for quantitative assessment of the myocardium tissue. Within 6 months in 2021, we retrospectively analyzed the CMRI results of 45 patients with COVID-19 at the Republican Scientific and Practical Center “Cardiology”. The percentage of patients with positive criteria for Lake Louise myocarditis was 18% (n = 8). The elevated reference values of T2 ≥ 2σ up to 33% was the most frequent pathological change in myocardial tissue characteristics. There is significant variability in the published data collection as to the prevalence of myocarditis associated with different research methodologies in studies and discrepancies in the interpretation of MRI-mapping data. This brief review is aimed at revising and summarizing current knowledge on myocarditis in COVID-19 patients and highlight the problems of CMRI diagnostics.
2021 Том 5, №2
An elderly patient with acute coronary syndrome: management during COVID-19 pandemic
N.L. Tsapaeva, Е.B. Petrova, A.A. Pleshko
An increased number of elderly people in the medical terms means the predominance of pathology in the morbidity structure, which is determined by comorbidity, systemic lesions and an unfavorable prognosis. Comorbid patients are the most vulnerable group with a particularly high risk of adverse outcomes. In the presented review, the problem of management of acute coronary syndrome (ACS) in elderly patients in the context of the COVID-19 pandemic is addressed. The review demonstrates results of randomized clinical trials and registries of recent years, which purposefully included patients with ACS aged ≥ 75 years. Particular attention is paid to the need for a geriatric assessment of patients, the presence and severity of senile asthenia and its influence on the choice of treatment tactics and prognosis. The problem of choosing a method of myocardial revascularization and drug therapy schemes in elderly patients is considered under pandemic conditions. Issues related to drug interactions between drugs for the treatment of acute forms of coronary heart disease and drugs for the treatment of COVID-19 are reflected. In this situation, taking into account the risks of possible drug-drug interactions is of particular importance, which is especially challenging in elderly comorbid patients. Based on the available data, we have analyzed the main trends in the choice of treatment tactics for elderly patients with ACS during the COVID-19 pandemic.
2021 Том 5, №2
Rheumatoid arthritis and heart disease – is it really relevant?
Andrey P. Rebrov
The article presents data on clinically significant heart impairment in patients with rheumatoid arthritis (RA), as well as features of the development of ischemic and non-ischemic heart disease with a significant increase in the risk of adverse cardiovascular events. Patients with RA are characterized by an increased risk of developing myocardial infarction, heart failure, rhythm disturbances, sudden cardiac death, and general cardiovascular death. The paper emphasizes the possibility of a fairly rapid development of myocardial dysfunction in patients with RA from the moment of manifestation of the disease, the development and progression of atherosclerosis of the coronary arteries. Besides, in case of the development of a coronary artery disease in RA patients, the worst survival rate after a heart attack was established. The available findings suggest that rheumatoid arthritis is a disease that makes a significant contribution to cardiovascular morbidity and mortality.
2021 Том 5, №2
Pancreatogenic morphostructural changes in the heart, lungs and other target organs in destructive pancreatitis
P. Koshevsky, S. Alekseyev, O. Popkov, V. Ginyuk, N. Bovtiuk
Introduction. Pathomorphological changes in destructive pancreatitis develop both in the pancreas and in various organs and tissues, it determining the clinical course and outcome of the disease. Most often in destructive pancreatitis, the cardiopulmonary system is affected, as well as the liver, kidneys, and brain. Damage to these target organs is one of the main elements of pathogenesis and thanatogenesis in destructive pancreatitis and is of interest not only for surgeons, but also for other clinical specialists, including cardiologists. Aim. To conduct a retrospective analysis of the most common morphostructural changes in the cardiopulmonary system and other target organs based on the results of autopsy reports of the deceased from destructive forms of acute and chronic pancreatitis and to identify the most characteristic morphostructural changes in the target organs.
2021 Том 5, №1
Coronavirus infection (SARS-CoV-2): focus on COVID-19 associated coagulopathy
A.A. Pleshko, E.B. Petrova, S.V. Gunich, S.V. Rakovich, E.A. Grigorenko, N.P. Mitkovskaya
Officially announced by the World Health Organization (WHO) in March 2020, the coronavirus disease 2019 (COVID-19) pandemic is terrifying with the unimaginable rate of spreading and the large number of deaths. Morethan 171 million COVID-19 cases including more than 3,6 million deaths have been confirmed worldwide since the start of the pandemic. The high incidence of venous thromboembolic events and non-ARDS (acute respiratory distress syndrome) associated death of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, despite prophylactic antithrombotic therapy, may indicate the need for a more intensified personalized regime of preventive measures.
2021 Том 5, №1
Justification of technologies for organizing medical care for patients with high cardiovascular risk on the example of the Brest region (Part 1)
N. Pabivantsava
In order to substantiate organizational measures for early detection and tertiary prevention of cardiovascular diseases, the causal relationships of high morbidity, disability, and mortality due to cardiovascular diseases, coronary heart disease and its complications were studied in the population of the Brest region in the period from 2006 to 2010. Measures to improve the organization of preventive medical examination of patients from cardiovascular risk groups with prognostically unfavorable outcomes were suggested. Through the implementation of an organizational experiment in 2012–2017, it was possible to achieve a positive medical and social effect, expressed in increasing the availability of multi-level and hightech care to patients in need, as well as in improving the medical and demographic indicators of the Brest region in general and in the diseases of the circulatory system in particular, which formed the basis of the second part of this article.
2021 Том 5, №1
Implementation and evaluation of the effect of technologies for organizing medical care for patients with high cardiovascular risk on the example of the Brest region (part 2)
N.F. Pabivantsava, M.Yu. Surmach
The article shows how organizational measures were implemented to improve the organization of medical examinations of patients from cardiovascular risk groups with prognostically unfavorable outcomes on the example of the Brest region. By studying the health indicators of the region’s population before and after implementation, the paper analyzes the effectiveness of new organizational technologies. It is established that due to the adopted preventive measures at each territorial site and monitoring the patient’s route through databases from the district to the regional level of care, there is a decrease in the cardiovascular primary incidence, including coronary heart disease, with a significant decrease in the rate of acute conditions (acute coronary syndrome). The increase in prevalence indicates increased monitoring of all patients with circulatory diseases and coronary heart disease who were invited for conducting dynamic follow-up (dispensarization) in order to stratify the risks of their complications.
2021 Том 5, №1
Exercise tolerance tests in the diagnosis of coronary heart disease, testing of patients with myocardial infarction and revascularization
L. Ushakova, E. Vertinsky, M. Shtonda, I. Semenenkov
Exercise tolerance test is one of the most commonly used non-invasive cardiac tests used to diagnose coronary heart disease, determine prognosis, and evaluate treatment. Treadmill test or bicycle ergometry allows determining how much more expensive and complex follow-up examination is necessary for the patient: myocardial perfusion scintigraphy with stress, stress echocardiography, multispiral computed tomography, as well as defining more clearly the indications for coronary angiography. The article presents modern ideas about a differentiated approach to performing exercise tolerance tests in patients with coronary heart disease, myocardial infarction, and revascularization.
2021 Том 5, №1
Рulse waves рropagation in small vessels: measurement results and modelling approaches
A.I. Kubarko, V.A. Mansurov, A.D. Svetlichny, L.D. Ragunovich
The objective of the research work was to develop devices and algorithm for synchronous recording of pulse waves and ECG for measuring the delay time of pulse waves in the branches of various arteries relative to the R wave on an ECG, and to carry out computer simulation of the pulse wave propagation process to determine the dependence of the pulse wave propagation velocity on branching and other hemodynamic and morphological parameters of blood vessels.
2020 Том 4, №2
Cardioprotective efficiency of the combined application of remote ischemic pre- and post-conditioning in rats in case of miocardial ischemia/reperfusion
V.V. Sevrukevitch, F.I. Vismont
The cardioprotective efficacy of the combined use of remote ischemic preconditioning (RIPreC) and remote ischaemic postconditioning (RIPostC) in experimental myocardial ischemia/reper fusion was studied in rats. Experimental myocardial ischemia/reperfusion was reproduced by a 30-minute occlusion of the left coronary artery followed by a period of 120-minute reperfusion. Remote ischemic conditioning was reproduced by short-term occlusion of both femoral arteries followed by reperfusion of the extremities beginning at the following time points: RIPreC – 25 minutes before the end of the myocardial ischemia period, RIPostC – 10 minutes after the end of the myocardial ischemia period, RIPreC + RIPostC – 25 minutes before the start and 10 minutes after the end of myocardial ischemia. It was shown that the combined use of RIPreC and RIPostC had a comparable cardioprotective effect in comparison with each of these methods taken separately. Possible reasons explaining the lack of potentiation of the cardioprotective effect of the combined use of RIPreC with RIPostC can presumably be attributed to: 1) achieving maximum cardioprotection, i.e. the impossibility to further reduce the area of myocardial ischemia, 2) the effect on similar intracellular cardioprotective mechanisms in different conditioning modes.
2020 Том 4, №2
Medical prevention of post-transfusion complications after transfusion therapy applied in case of severe obstetric blood loss
F.N. Karpenko, A.V. Novik, E.D. Rasyuk, V.V. Pasyukov, V.N. Bordakov, T.V. Vaganova, O.V. Karpenko
The article presents an analysis of the modern approach to the treatment of acute obstetric hemorrhage. Some features of the preparation of leukodepleted and pathogen-reduced blood components are shown and indications for use in severe obstetric blood loss are determined. It has been shown that the pathogen reduction of blood components leads to a decrease the level of coagulation factors (coagulation factor VIII, fibrinogen in fresh frozen plasma) by 20–30 %, the activity and number of platelets by 15–20 % in platelet concentrate, does not affect the morphological usefulness of platelets. A “package” of blood components for the provision of emergency transfusion therapy for obstetric bleeding has been calculated. The need for a given quantity of blood components was determined – 2.3 “packages” per 1000 births. The proposed “emergency obstetric care packages” and the organization of their centralized delivery to medical healthcare organizations ensure a high degree of readiness of the blood service to comply with the “golden hour” rule for treating acute severe obstetric hemorrhage and minimize post-transfusion reactions and complications when using them. Pathogen-reduced blood components are expensive. Therefore, their use in clinical practice is indicated for the decreed contingents of recipients: for organ and tissue transplantation, in neonatology, oncohematology and for recipients with “multiple transfusions of blood, its components”, in cardiac surgery and obstetric practice.
2020 Том 4, №2
Transdermal delivery of drugs and its role in therapy of cardiovascular diseases
N.S. Golyak
Introduction. Transdermal delivery of medicinal substances is based on the penetration of the active pharmaceutical ingredient through the intact skin, its further entry into the systemic bloodstream and, thereafter, to the target organ. Currently, gels, ointments, emulsions and transdermal therapeutic systems (transdermal patches) are used as transdermal agents. Transdermal patches are able to provide a target constant concentration of medicinal substances in blood plasma for a long time (from 1 to 7 days). Transdermal delivery has a number of advantages: increased bioavailability of medicinal substances due to the elimination of losses associated with metabolism in the gastrointestinal tract and in the liver; reducing the risk of adverse reactions which can be caused by leveling of concentration jumps of the medicinal substances in the blood; painlessness and convenience; possibility to change the dose by varying the area of the patch and the duration of use; possibility to stop the treatment at any time, etc. For patients with chronic diseases requiring constant repeated oral administration of drugs, suffering from dysphagia and diseases of the gastrointestinal tract, the transdermal route of administration is the most optimal. In some cases, when the patient is unconscious, suffers from sclerosis, or has impaired vital functions (for example, the ability to breathe and swallow independently), transdermal delivery is optimal and in some cases is the only alternative. Purpose. To analyze the current range of drugs for transdermal delivery, to assess the role and prospects of using transdermal delivery in the treatment of cardiovascular diseases. Methods. The search for literary data was carried out using the PubMed and Google search engines among Russian – and English-language original articles. The search of registered drugs in the form of transdermal patches was carried out using drugs registries of the United States and other countries. When searching, the terms «transdermal delivery», «transdermal patch», «bisoprolol», «clopidogrel», «transdermal delivery», «transdermal patch» were used. Conclusion. In the global pharmaceutical market, transdermal delivery is used for a limited number of medicinal substances of different pharmacotherapeutic groups, of which only three medicinal substances (nitroglycerin, clonidine, bisoprolol) are used in the treatment of cardiovascular diseases. Many attempts have been made to obtain and evaluate transdermal patches with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, antiplatelet agents used in the treatment of cardiovascular diseases, but the volume of these studies is insufficient for registration and clinical use.
2020 Том 4, №2
Herbal medicines for treatment of cardiovascular diseases marketed in the Republic of Belarus
I.L. Kurs, N.S. Gurina
Aim. Marketing research in the segment of herbal medicines for the treatment of the diseases of the cardiovascular system in the Republic of Belarus. Methods. The study of the healthcare market was carried out using analytical and statistical methods by analyzing data from the State Register of Medicines of the Republic of Belarus (as of 01.01.2020) and the database of sales of medicines and biologically active food additives «IQVIA» (data on the sale of medicines for 2019). Data processing was carried out using the Microsoft Office Excel 2016 software package. Results. As of 01.01.2020, 51 herbal medicines from group C (according to the anatomical-therapeutic-chemical classification «Cardiovascular system») were registered in the Republic of Belarus by 29 manufacturers from 10 countries. Most herbal medicines for treatment of cardiovascular diseases are imported (54.90%). According to originality criterion generic herbal medicines from this segment prevail, both in terms of the number of registered names (78.43%) and sales volumes in cash (53.86%) and in kind (96.49%). In terms of composition, monocomponent herbal medicines prevail (56.86%). Among monocomponent medicines the majority of herbal medicines for the treatment of cardiovascular diseases are domestic (31.37% of the total number of registered herbal medicines for the treatment of cardiovascular diseases), while among the combined ones the greater part is imported (33.33%). In terms of sales in kind, monocomponent herbal medicines prevail (74.98%), whereas in monetary terms combined ones predominate (40.65%). Conclusion. It is a promising perspective for domestic enterprises to develop combined herbal medicines for the treatment of cardiovascular diseases in order to provide the population with more affordable medicines from this segment, as well as to implement the principles of import substitution in the healthcare market of the Republic of Belarus.
2020 Том 4, №2
The role of x-ray endovascular surgery in the treatment of obliterating atherosclerosis of the lower extremity arteries in elderly and senile patients
S.V. Mshar, V.А. Yanushko
Obliterating atherosclerosis ranks third in the system of cardiovascular disease. With age the incidence of peripheral artery disease increases and makes 3–5% in general population. The most difficult group of patients with peripheral artery disease (PAD) or obliterating atherosclerosis is elderly patients. Currently there is a tendency to increase the life expectancy and aging of the Belarusian population. Elderly and senile patients with obliterating atherosclerosis (PAD) are characterized by a multi-level lesion and damage to the distal parts of the arterial bed, an increase in the number of comorbidities, a high risk of cardiovascular death, and seeking medical help often at the stage of critical lower limb ischemia. Patients at high risk of cardiovascular complications with intermittent lameness are subject to conservative treatment. When developing a clinic for critical lower limb ischemia, due to the low effectiveness of conservative methods of treatment, it is worth considering revascularization of the lower limb arteries. Open surgical methods of treatment are associated with a high risk of complications and mortality. X-ray endovascular methods of treatment of patients of the older age group are characterized by a lower risk of complications, lower injury rate. The use of low-injury x-ray endovascular and hybrid methods of treatment in elderly and senile patients can improve the results of treatment (reduce the frequency of amputations, reduce the risk of complications, improve the quality of life).
2020 Том 4, №2

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