REVIEWS OF THE LECTURES
 

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
Chronic obstructive pulmonary disease and cardiovascular diseases: pathogenetic mechanisms of comorbidity and pharmacological interactions
D.Yu. Ruzanov, E.I. Davidovskaya, A.A. Pleshko, E.A. Grigorenko, I.V. Buynevich
The publication provides a brief overview of the most significant pathogenetic and pathophysiological mechanisms that will explain the phenomenon of comorbidity of chronic obstructive pulmonary disease (COPD) and cardiovascular pathology (CVD). Moreover, in this review is considered the potential impact of the recommended treatment of COPD on the risks and course of cardiovascular diseases from the perspective of evidence-based medicine. It has been shown that COPD and cardiovascular diseases share single risk factors, common pathogenetic mechanisms, unidirectional pathophysiological processes, similar clinical symptoms and effects synergistically with respect to adverse events and outcomes, which allows us to attribute this combination to category of comorbid pathology. The presented results of randomized clinical trials and meta-analyzes demonstrate that currently no COPD guidelines contain detailed clinical recommendations for assessing cardiovascular risk in this category of patients, nor are there enough guidelines for the treatment of COPD in patients with cardiovascular disease or vice versa. In terms of international experience, it is substantiated that the comorbid pathology of COPD and CVD should not be considered isolated from each other.
2020 Том 4, №2
Current aspects of drug therapy of chronic heart failure syndrome
T.V. Statkevich, N.P. Mitkovskaya
Chronic heart failure (CHF) is an important problem for the country, which has both medical and socio-economic aspects. The presence of the syndrome not only significantly increases the risks of an unfavorable course of diseases underlying its etiological basis, but in itself, through the development of decompensation, causes a high frequency of deaths. Despite all the advances in pharmacotherapy, the prognosis of heart failure remains poor. More than 40% of patients die within 4 years after the diagnosis of heart failure, and the one-year mortality rate for patients with severe CHF (NYHA class IV) exceeds 50%. The foregoing determines the need and importance of using all possible drug and non-drug therapy technologies aimed at reducing mortality, increasing the duration and quality of life of patients with CHF, as well as reducing the number and likelihood of decompensation and related hospitalizations, and makes this direction one of the priorities in medicine. The article describes current approaches to the treatment of patients with CHF syndrome from the perspective of evidence-based medicine and taking into account the recommendations of leading international organizations for the treatment and prevention of cardiovascular diseases. The drugs used were analyzed in terms of their influence on clinical symptoms, quality of life of patients, the risk of hospitalization due to decompensation of CHF, and mortality rates. The emphasis is made on the possibilities, mechanism of action and further prospects for the use of a new class of drugs in the treatment of CHF, acting at the level of the renin-angiotensin-aldosterone system and the system of neutral endopeptidases – inhibitors of angiotensin-neprilisin receptors.
2020 Том 4, №2
The pathogenesis of cell aging: gene polymorphism and renin-angiotensin-aldosterone system activity
O.S. Pavlova, I.Yu. Korobko, M.M. Liventseva, O.A. Barbuk, I.I. Russkikh, M.G. Kaliadka, A.M. Gorkavaya, S.E. Ogurtsova
The aim of the study was to determine the correlation of genetic polymorphism and renin-angiotensin-aldosterone system (RAAS) components with the relative leukocyte telomere length (TL) in individuals with normal or optimal blood pressure.
2020 Том 4, №1
Cholin and its metabolite feasibilities in hyperhomocysteinemia correction and cardiovascular pathology decrease
O.V. Panasiuk, E.V. Mogilevets, А.V. Naumov
Homocysteine is a cyto- and neurotoxic amino acid. The raise of its level in blood plasma is called hyperhomocysteinemia. This pathological state leads to the development and progressive course of cardiovascular diseases. Homocysteine utilization involves its transulfurization to cysteine or remethylation to methionine. Choline and its metabolite (betaine) increased intake leads to enhanced processes of remethylation and decreased homocysteine level in blood plasma. Thus, choline and betaine may be considered as substances capable of influencing hyperhomo-cysteinemia and lowering the level of cardiovascular disease development.
2020 Том 4, №1
Risk assessment and venous thromboembolism prophylaxis strategy in neurosurgical patients
L.N. Gavrilenko, I.S. Romanova, I.N. Kozhanova, O.G. Sadovskaya, A.E. Baranovsky
Venous thromboembolism (VTE) causes 25,000 in-hospital deaths every year in the United Kingdom. Approximately one-third of the total of 150,000 to 200,000 of VTE-related deaths per year in the United States occur following surgery. The VTE risk varies widely in neurosurgical patients depending on the type of intervention, the patient’s condition, comorbidity, and methods of thromboprophylaxis used. Neurosurgical patients’ characteristics (high prevalence of hypovolemia and hemoconcentration, paralysis and paresis, the use of high doses of glucocorticoids, the long duration of surgical interventions), high bleeding risk associated with pharmacological prophylaxis, and relatively few high-quality studies require development of a uniform decision-making approach regarding thromboprophylaxis in neurosurgery. This article presents a VTE prophylaxis strategy in neurosurgical patients developed on the basis of the latest international guidelines.
2020 Том 4, №1
Modern opportunities for diagnosis and treatment of systemic vasculitis with kidney involvement in children: review of literature (part 1)
I.A. Kazyra, A.V. Sukalo
The article presents current literature data on the problem of systemic vasculitis (SV) with kidney involvement in children. SV is rare in childhood, but is characterized by a severe progressive course, ultimately leading to early disability. This is a group of diseases with a wide range of clinical manifestations, the most important pathomorphological sign of which is inflammation of the blood vessel wall with the development of thrombosis, necrosis, and sclerotic lesions.
2020 Том 4, №1
Sepsis in children: clinical and laboratory diagnosis
E.N. Serhiyenka, O.N. Romanova
Diagnosis of sepsis in intensive care requires an interdisciplinary approach. There is no doubt that the clinical picture is also important when making a diagnosis. However, signs such as fever, tachypnea, tachycardia, etc. are not specific. This is why the use of integrated diagnostic and prognostic scales and monitoring of metabolism, hemodynamics, microcirculation, and specific biomarkers are more important for practitioners.
2020 Том 4, №1
Possibilities of the volume sphygmography method in identification of atherosclerotic arterial damage markers in elderly and senile people
E.А. Siamushina, L.A. Zhilevich, L.M. Sychik
The article describes the potential of the method of volume sphygmography (VS) using the VaSera VS-1500N apparatus (Fukuda Denshi, Japan) in identifying a combination of markers of atherosclerotic arterial lesions in centenarians. For this purpose, we conducted a survey of 36 centenarians at the Republican Clinical Hospital for Disabled Veterans of the Great Patriotic war named after P. M. Masherov.
2019 Том 3, №2
Psychometric analysis of the questionnaire «the quantification inventory for somatoform syndromes» (QUISS)
Т.Е. Tomashchyk
Somatoform disorders represent a group of psychiatric disorders manifested primarily in physical symptoms, which are clinically unexplained. Diagnosis of somatoform disorders requires taking into account not only the somatic symptoms and their severity, but also additional emotional, cognitive, behavioral and psychosocial aspects. The questionnaire “The quantification inventory for somatoform syndromes” (QUISS) meets the above-mentioned requirements. The questionnaire exists in the English version and requires standardization for the Belarusian population of patients, as well as compliance with current psychometrics.
2019 Том 3, №2

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