ВИЧ-ассоциированные заболевания внутренних органов достаточно многообразны, среди них именно патология сердечно-сосудистой системы является одной из непосредственных причин гибели пациентов с ВИЧ-инфекцией. Наблюдательные исследования показали, что ВИЧ-инфицированные лица имеют высокий риск неблагоприятных сердечно-сосудистых событий по сравнению с остальной популяцией. Сердечно-сосудистые заболевания, обусловленные атеросклерозом, в том числе инфаркт миокарда и инсульт, представляют одну из основных причин смертности среди ВИЧ-положительных больных. Ряд исследований указывают на ускорение процессов атерогенеза вследствие ВИЧ-инфекции. В качестве возможных причин обсуждаются как прямое воздействие ВИЧ, так и другие факторы, которые имеют место у данной категории лиц: побочные эффекты антиретровирусной терапии, злоупотребление наркотическими средствами, сопутствующие заболевания, связанные с ВИЧ. Помимо специфических факторов риска у пациентов с ВИЧ-инфекцией могут присутствовать и традиционные — курение, гиподинамия, ожирение, гиперхолестеринемия. Результаты различных исследований показывают, что существует большой научный и практический интерес к проблеме атеросклероза у пациентов с ВИЧ-инфекцией.

Abstract Background Chronic infection by HIV evolves with a vascular inflammatory action causing endothelial dysfunction. The action of the virus as well as the side effects of antiretroviral drugs contributes to the progression of cardiovascular diseases. The study aimed to characterise the changes of the structure of the coronary wall and the thickening of the intima by Optical Coherence Tomography in HIV-infected patients with or without symptoms of coronary heart disease. Methods Fifty-two HIV-infected individuals had a mean age of 49.8±11.4 years. There were 75% men, diabetes 30,8%, hypertension 30,8%, smokers 34,62% and 7,7% with cholesterol levels ≥99 mg/dl. Control group included 120 non-HIV-infected controls with coronary heart disease. All the participants from HIV-group receive ART, 100% of participants had plasma HIV RNA <20 copies/mL and 78,85% of them have symptoms of coronary artery disease. Results The average diffuse homogeneous thickening of the intima in patients with HIV was 0.67±0.24 mm, and 0.34±0.18 mm in control group, with normal values not exceeding 0.05 mm. There was impaired three-layer structure of coronary wall in 90,4% (47 of 52) HIV-infected participants and in 60% of control group, atherosclerotic plaque had only 34,62% of HIV group. All HIV-infected patients receive ART more than 5 years. Conclusion The coronary angiography and OCT demonstratedthat the inflammatory process resulting from HIV-infection or HAART may be relevant in the changes of coronary arteries in HIV-positive patients. The changes are predominantly represented by thickening of the intima, impaired three-layer structure of arterial wall and accelerating atherosclerosis. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Russian National Research Medical University named after N.I. PirogovCentral Clinical Hospital of Russian Academy of Science, Moscow, Russia

Background and Aims: Chronic infection by HIV evolves with a vascular inflammatory action causing endothelial dysfunction. The action of the virus as well as the side effects of antiretroviral drugs contributes to the progression of cardiovascular diseases. The present study aimed to evaluate the changes of the structure of the coronary wall and the thickening of the intima by Optical Coherence Tomography in HIV-infected patients with or without symptoms of coronary heart disease.

Short bowel syndrome is a pathological symptom complex that occurs after removal (resection) of the small intestine (more than 25% of its length), or when there is a signifi cant violation of its function. The most common cause of short bowel syndrome is adhesions of the small intestine that occur after surgical interventions on the abdominal organs. A description of the clinical observation of short bowel syndrome with severe manifestations of enteric insufficiency in a 41-year old patient is given. The patient was admitted to the surgical Department of FGBUZ Central clinical of the hospital Russian Academy of Sciences with com-plaints of General weakness, pain, spastic nature in the abdomen without clear localization, pain in the area of operational wound (for 4 months had 4 surgery for adhesive intestinal obstruction), abdominal distention, thirst, dry mouth, semiliquid chair 3–4 times a day, weight loss for the last 7 months before the hospitalization at 22 kg, the body mass index was 17.3 kg/m2. After the last surgical intervention, ileostomy of the ascending colon was applied using the Brooke method in connection with adhesive small bowel obstruction. The functioning segment of the jejunum was anastomosed with the ascending colon and was 22 cm long. At admission, the state of moderate severity, moderately emaciated, dehydrated. Liquid stool up to 6 times a day, without pathological impurities. MSCT of abdominal organs from 03.05.2018 with contrast: in meso — and hypogastria (mainly on the left), expanded loops of the small intestine (up to a maximum of 37–38 mm) fi lled with liquid content were visualized, the contrast preparation in the above described loops of the small intestine was not visualized. Additionally, non-expanded loops of the small intestine were visualized in the hypogastria and did not contain contrast. Non-functional loops of the small intestine in the meso — and hypogastrium. Liver, biliary system, pancreas, spleen — without features. On the background of complex therapy, the stabilization of clinical and laboratory indicators was achieved, which allowed to plan surgical treatment-laparotomy, closure of ileostomy, imposition of small intestine anastomosis in the large intestine. A laparotomy was performed with the right pararectal access. Continuous viscero-visceral and of viscero-peritoneal splices were found in the abdominal cavity. With technical difficulties caused by fi brous-calcifi ed splices, it was possible to separate the ascending colon and the part of the jejunum that goes to the anterior abdominal wall to the site of the bred jejunostomy. The intersection of the jejunum stoma was performed in close contact with the anterior abdominal wall. A double-row “end-to-side” anastomosis was formed with the middle third of the ascending colon. When performing laparotomy with left pararectal access under conditions of a pronounced adhesive process, it was possible to isolate a section of the sigmoid colon and a loop of the small intestine that was previously disabled (during the previous operation). Ileosigmoidostomy formed a double row “side to side”. The preserved portion of the small intestine was 85 cm. In the postoperative period, there were signs of endogenous intoxication. Against the background of intestinal paresis and severe intoxication, there was an increase in the markers of infl amemation and pancytopenia. Complex therapy with parenteral mixtures, prebiotics and antimicrobial drugs stopped the symptoms of intoxication, the activity of infl ammation, and improved laboratory parameters, which allowed us to gradually switch to oral food intake. Semi-formed stool 1–2 times a day. She was discharged on the 10th day after the operation for outpatient treatment under the supervision of a surgeon and gastroenterologist. One-year rehabilitation period with a positive effect, which indicates the uniqueness of this clinical observation.

Aim. To study the effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, alirocumab, on lipid levels in patients who receive secondary prevention of cardiovascular diseases (CVD) and require enhanced lipid-lowering therapy.Material and methods. The study included 49 patients (aged of 61.53±1.14 years; 31 [63.3%] men) receiving alirocumab who did not reach the target low density lipoprotein cholesterol (LDL-C) concentrations despite the ongoing optimal lipid-lowering therapy. In all patients, the initial level of lipids was evaluated, as well as their parameters after subsequent alirocumab injections.Results. LDL-C serum level significantly decreased after the first injection compared to the initial level from 2.92±0.22 to 1.65±0.19 mmol/L (p<0.001; Δ45.31±3.61%) and down to 1.74±0.17 mmol/L for the entire study period (p<0.001; Δ41.52±2.69%). The change in LDL-C level between injections did not show statistically significant differences (p=0.141). A direct strong statistically significant correlation between the LDL-C level after the first injection and its average values for the entire observation period was found (r=0.958, p<0.001).Conclusion. The results of the study indicate that the PCSK9 inhibitor, alirocumab, in patients who need secondary prevention of CVD shows a significant additional decrease in the concentration of LDL-C after the first injection. At the same time, approximately half of the patients were able to achieve the recommended levels of LDL-C. The persistence of the achieved low LDL-C levels over time demonstrated that the average concentration of LDL-C during the observation corresponded to the values after the first injection. This finding shows that there is no need for constant monitoring of lipid metabolism parameters when prescribing such therapy.

The article analyzes properties of potassium and magnesium, which may exert vasodilatory, anti-inflammatory, anti-ischemic, antiaggregant, and antiarrhythmic effects. These are extremely important microelements and potentially beneficial therapeutic agents for treatment of cardiovascular diseases.

Updates of clinical guidelines and publication of new research results entail changes in our approaches to diagnosing diseases and treating patients, as well as revising the criteria for choosing a particular drug to a specific patient. We are based on the fact that when managing patients with hypertension it is immediately necessary to use those classes of drugs and individual molecules that have proven to be highly effective, safe and adherent throughout the entire cardiovascular continuum. It is understood that the drugs should be shown in IHD and CHF. Among the ACE inhibitors, ramipril meets this requirement. Often, the choice falls precisely on ramipril because a convenient intake once a day at any time of the day and regardless of the meal increases the patient’s adherence to therapy. A wide range of indications, such as hypertension, chronic heart failure, post-infarction patients, diabetic and non-diabetic nephropathy, as well as a reduction in the risk of cardiovascular accidents, including in patients undergoing cardiac surgery, are a serious additional argument in favor of a wide range of ramipril. Moreover, ramipril can reduce the risk of developing new cases of diabetes mellitus and end-stage renal failure.

The incidence of Caroli disease is estimated to be 1 case per 1 million people; as a result, there are very few available clinical observations. At the moment, the treatment of Caroli disease is limited to symptomatic therapy and the prevention of complications, as well as to corrective surgery and liver transplantation.Aim. The aim of this observation is to describe one case of a rare congenital liver disease – Caroli disease – characterised by a segmented non-obstructive fibrocystic dilation of the intrahepatic bile ducts.Key findings. A 21-year-old woman was hospitalised with the signs of a systemic inflammatory reaction, hepatosplenomegaly, jaundice, portal hypertension, hepatocellular insufficiency, as well as with the manifestations of cytolytic and cholestatic syndromes. At the age of 8, she was diagnosed with a cyst of the bile ducts, which was treated with cystoenteroanastomosis. At the age of 20, in connection with high portal hypertension, portocaval shunting was performed and a mesenteric-caval anastomosis was applied. During the present hospitalisation, an expansion of the intrahepatic bile ducts was revealed by ultrasound and MSCT of the abdominal cavity with contrast, which made it possible to diagnose Caroli disease.Conclusion. A case of Caroli disease is described, which resulted in continuously recurrent cholangitis and biliary cirrhosis. This state required liver transplantation. Caroli disease should be included in differential diagnosis in patients suffering from the fever of unknown origin and cholestasis syndrome. An early diagnosis of Caroli disease is important for preventing complications, improving the quality of life and increasing the life expectancy of patients suffering from this rare disease.

The existing approaches to treating epilepsy can be classified as therapeutic and/or surgical. In most cases, a patient with epilepsy is examined by a neurologist (or psychiatrist) and receives antiepileptic drugs (AEDs) in order to control seizures. And it is the neurologist who decides on referring the patient to the surgeon for further treatment if the medications have no effect. Undoubtedly, there are situations when, during the initial examination, the doctor reveals life-threatening lesions or brain abnormalities, which unequivocally indicate the necessity of surgical treatment. The present article addresses the issues of professional caution required from the neurologist in less-obvious clinical cases, when the doctor has to rely on his/her own clinical judgement in order to identify the “surgical” situations and refer the patient to a neurosurgeon for an adequate treatment.

At present, treatment recommendations are developed considering the principles of evidence-based medicine. General practitioners (GP) are offered a choice of different medications with the known characteristics of efficacy and tolerance. For a GP, the right choice of the optimal drug from the proposed list may become a problem. Therefore, it is important not only to provide complete information on all treatment options for a patient with epilepsy, but also discuss a scheme of the proposed therapy (“key”) so to guide a GP through the treatment options and assess the possibility of alternative treatment strategies. Contrary to the trial and error method, when the drug efficacy and safety is assessed during the treatment, the proposed optimized approach allows for achieving a maximal therapeutic effect in patients with epilepsy.