Constipation is a serious medical and social problem due to the widespread prevalence of this condition, a decrease in the quality of life and social activity of patients. For the successful treatment of constipation, it is necessary to establish the causes leading to the violation of the stool in the patient. And this task is a priority for the doctor at the outpatient stage.The clinical features of constipation largely depend on their cause, duration, severity and characteristics of intestinal damage. Constipation is often accompanied by general somatic and other gastroenterological symptoms.Within the framework of the review article, the main conditions and diseases are considered, in the clinical picture of which there is constipation syndrome, which must be considered by the doctor at the outpatient stage when conducting differential diagnosis and prescribing appropriate treatment, which also presupposes impact on causal factors. Currently, drugs based on high molecular weight polyethylene glycol 4000 are widely used to treat chronic constipation in adults and children in most countries of the world. Preparations based on polyethylene glycol 4000 are affordable and easy to use, they can be used both on an outpatient basis and in a hospital. Polyethylene glycol 4000 preparations act quickly, are highly effective and well tolerated, have a high safety profile (practically does not affect homeostasis) both for adult patients and in pediatric practice. International clinical trials have shown the possibility of long-term use of polyethylene glycol 4000 preparations.Current international clinical guidelines and domestic clinical guidelines for the treatment of constipation recommend the use of polyethylene glycol 4000 preparations instead of lactulose and volume-forming laxatives in the symptomatic treatment of constipation in children and adults. In the second part of the review, the possibilities of polyethylene glycol 4000 and the first domestic drug polyethylene glycol 4000 in the treatment of chronic constipation are considered.

Constipation is a serious medical and social problem due to the widespread prevalence of this condition, a decrease in the quality of life and social activity of patients. For the successful treatment of constipation, it is necessary to establish the causes leading to the violation of the stool in the patient. And this task is a priority for the doctor at the outpatient stage. The clinical features of constipation largely depend on their cause, duration, severity and characteristics of intestinal damage. Constipation is often accompanied by general somatic and other gastroenterological symptoms. Within the framework of the review article, the main conditions and diseases are considered, in the clinical picture of which there is constipation syndrome, which must be considered by the doctor at the outpatient stage when conducting differential diagnosis and prescribing appropriate treatment, which also presupposes impact on causal factors. Currently, drugs based on high molecular weight polyethylene glycol 4000 are widely used to treat chronic constipation in adults and children in most countries of the world. Preparations based on polyethylene glycol 4000 are affordable and easy to use, they can be used both on an outpatient basis and in a hospital. Polyethylene glycol 4000 preparations act quickly, are highly effective and well tolerated, have a high safety profile (practically does not affect homeostasis) both for adult patients and in pediatric practice. International clinical trials have shown the possibility of long-term use of polyethylene glycol 4000 preparations. Current international clinical guidelines and domestic clinical guidelines for the treatment of constipation recommend the use of polyethylene glycol 4000 preparations instead of lactulose and volume-forming laxatives in the symptomatic treatment of constipation in children and adults. In the second part of the review, the possibilities of polyethylene glycol 4000 and the first domestic drug polyethylene glycol 4000 in the treatment of chronic constipation are considered.

Dermatomyositis is a progressive systemic disease clinically manifested by a muscle lesion with impaired motor function as well as skin rashes, often in the form of erythema. In some cases, dermatomyositis can be the onset of cancer. In this regard, the doctor is required to be highly alert and focused on detecting the tumor process in patients with progressive muscle weakness and characteristic skin manifestations of dermatomyositis. The article presents a clinical case of paraneoplastic dermatomyositis co‐existing with small cell lung cancer. The malignancy was diagnosed during cancer screening in a patient with classic manifestations of dermatomyositis. Improvement of clinical manifestations of dermatomyositis appeared with glucocorticosteroid therapy and surgical treatment, but the patient died, since small cell lung cancer has an aggressive clinical course with an unfavorable prognosis.

Spontaneous dissection of the vessels of the neck is one of the main causes of ischemic stroke in young patients under 45 years of age. According to morphological studies, dissection of the vessels of the neck can be based on dysplastic changes in the arterial wall in arteriopathies, Marfan syndrome, Ehlers-Danlos syndrome, undifferentiated connective tissue dysplasia. The article presents a case of spontaneous dissection of the internal carotid artery in a 30-year-old patient with clinical manifestations of undifferentiated connective tissue dysplasia and carriage of homozygous variants of candidate genes: 4G/4G of the PAI-1 (-675, 4G/5G), T/T of the MTHFR C677T, 5A/5A of the MMP-3 (-1171 5A/6A) and A/A of the MMP-9 (8202A/G).

There is a higher prevalence of performed transplants of solid organs in Russia. Liver transplantation (LT) is the most effective way to treat liver diseases at advanced stages, and for many patients -the only effective one. Marked improvement in the surgery leads to the advances in LT techniques and the increase of overall number of LTs performed. However the number of recipients with metabolic disorders requiring medical interventions increases as well. LT can be accompanied by several complications. The most common one is diabetes mellitus (DM). New onset DM after LT increases the risk of transplant rejection, infection, adverse cardiovascular outcomes and reduces the survival of patients. An early diagnostics of carbohydrate metabolism disturbances in patients who underwent LT might be achieved with rigorous identification of the risk factors associated with DM development after and proper screening performed before the intervention. Beyond these, in a particular group of solid organs recipients a rational administration of drug therapy for DM, which is based on evidence of treatment outcome, safety and drug interactions with immunosuppressive therapy, should improve the number of adverse outcomes and contribute to effective blood glucose control in a postoperative period after LT.

In order to evaluate the effectiveness mildronate in rehabilitative treatment in connective tissue dysplasia examined 240 patients (24,41 ± 7,62 years, 130 men). All patients were treated with 5 ml of mildronate 10% intravenously for 10 days, then 1 capsule (250 mg), 2 times per day for 4 months. The therapy showed a significant decrease in asthenic complaints, reducing the incidence of violations repolarization I (p<0.05) and II infarction (p<0.05), a significant increase in end-diastolic volume (p<0.05), stroke volume (p<0.05), left ventricular ejection fraction (p<0.05) by echocardiography, increased exercise tolerance with the normalization of reaction to physical stress on a dystonic normotonichesky, improved quality of life. During the treatment was not recorded adverse events in patients receiving the drug. Portability mildronate majority of patients described as good to very good (average 8.67 points).

To assess the efficacy and safety of bisoprolol to monitor heart rate (HR) in young patients with connective tissue dysplasia (CTD) examined 58 patients (22,3 + 3,47 years, 38 men). Bisoprolol drug was administered at an initial dose of 1.25 mg/day, with a further increase to 2.5 mg/day in 2 weeks, etc. to achieve the level of heart rate 59-69 beats/min. Average effective dose was 7.27 ± 2.08 mg/day. Target heart rate,improvement of health and the pumping function of the heart, reducing the activation of the sympathetic nervous system and of anxiety achieved the absolute majority of patients. During treatment unit observed transient manifestations of general weakness, headache, episodes of vertigo in the selection of the dose, cases of bradycardia and hypotension pathological registered for the time of ingestion. Thus, the use of mandatory bisoprolol gradual careful titration, starting with 1.25 mg/day as a means to control the heart rate in young patients with CTD with sinus tachycardia, the manifestations of autonomic nervous system dysfunction, safely and effectively in relation to adverse orthostatic reactions.

The article describes the two main methods of determining the content of magnesium in patients with connective tissue dysplasia. The most informative technique that can reliably establish a deficiency of magnesium in the body.

Aim. To assess the impact of non-specific congenital connective tissue disorders (CCTD) on the changes in arterial stiffness and endothelial function; to study the role of CCTD as an independent predictor of structural and functional arterial changes.Material and methods. The study included 147 18–50-year-old men and women with CCTD and 85 healthy volunteers, comparable by age and gender (controls). All participants underwent a screening assessment of cardiovascular risk factors (RFs) and the assessment of heart rate variability (HRV), pulse wave velocity (PWV) at baseline (PWVbas) and after sublingual administration of nitroglycerin (PWVntg), and endothelium-dependent vasodilatation (EDVD), assessed by photopletismography.Results. Compared to the control group, CCTD patients had lower values of body mass index (p<0,001), waist circumference, WC (p<0,001), hip circumference, HC (p<0,001), WC/HC ratio (p<0,005), systolic blood pressure (p<0,05), total cholesterol (p<0,001), low-density lipoprotein cholesterol (p<0,005), atherogenicity index (p<0,05), and triglycerides (p<0,005). Moreover, CCTD patients were characterized by sympathetic activation, increased PWVbas (p<0,001), PWVntg (p<0,05), and EDVD (p<0,001). According to the results of stepwise multivariate analyses of the whole sample data, CCTD was a significant independent predictor of PWVbas (p<0,001), PWVntg (p<0,005), and EDVD (p<0,005 and <0,05 in men and women, respectively).Conclusion. Patients with CCTD demonstrated increased arterial stiffness and endothelium-dependent vasodilatation, compared to healthy controls. Independently from cardiovascular RFs and autonomic dysregulation, CCTD is a significant predictor of structural and functional arterial changes and can also have a prognostic value. These findings should be taken into account in the studies which assess vascular parameters.

We studied dependences of structural and functional changes of the arteries in 232 patients with connective tissue dysplasia. The increase of indicators of arterial stiffness and endothelial function in young patients with connective tissue dysplasia. With age, those with connective tissue dysplasia remain higher values of arterial stiffness, compared with the control group, and endothelial function is greatly reduced. These results confirm the effect of connective tissue dysplasia in the structure and function of the arteries.

Summary. This article presents results of examination of 50 young patients with connective tissue dysplasia not having any acute or chronic respiratory disease. All patients underwent inspiratory and expiratory helical CT with density gradient determination in different parts of the lungs. Typical CT findings were subpleural apical bullae and bleby (16 %), peribronchial fibrosis (40 %), local fibrosis (18 %), plevroapikal spikes (62 %), emphysema (4 %), air traps (18 %). The density gradient between exhalation and inhalation was reduced in the upper and lower lobes of the lungs.

The article reviews the influence of connective tissue dysplasia in the formation of vascular wall rigidity on the basis of literature. Substantiates the importance of studying the role and prospects of connective tissue dysplasia in changing the elastic properties of the arteries in the population.

Research on evaluation of clinical symptoms, the level of anxiety and quality of life in 30 patients (23 men, 7 women, mean age 24 ± 4.87 years) with syndrome of autonomic nervous system dysfunction on the background of connective tissue dysplasia. Taking the drug Mexicor for 60 days were significantly corrective action on the autonomic nervous system, which contributed to significant improvement in subjectively assessed clinical status of patients, reducing personal and reactive anxiety, with a significant positive impact on the quality of life of patients with good tolerability.

Our aim was to study the influence of autonomic nervous system and other factors on arterial stiffness in young individuals at low cardiovascular risk. The study involved 136 healthy individuals (mean age 23.5±6.7 years, 89 men and 47 women). The examination included: cardiovascular risk factors screening, heart rate variability (HRV), vascular stiffness, and endothelial function evaluation. Stiffness index was measured at baseline (SIbl) and after 500 mcg of sublingual trinitroglycerin (SItng). Endothelial function was determined as the change of resistance index after inhalation of 400 mcg of salbutamol (EF). Vascular responses were calculated from digital pulse waves (DPW) registered using photoplethysmography. Vascular parameters did not differ between men and women. On multivariate analysis age and diastolic blood pressure were the only determinants of SIbl among the conventional risk factors (R=0.37, R2=0.14, p<0.001). Age, systolic blood pressure, and EF were independent predictors of SItng (R=0.57, R2=0.33, p<0.001). Among HRV parameters added to the above models low parasympathetic activity and elevated sympathetic activity evaluated by pNN50 and low frequency waves spectrum (LF), respectively, were independent predictors of higher levels of SIbl (p<0.00001 for each parameter). The model explained nearly 40

To assess the autonomic regulation features in patients with connective tissue dysplasia (CTD) 55 patients (18males and 37 females, mean 23±7.25 years old) were included into the study. A statistically significant heart rate parasympathetic influences reduction was observed in combination with a considerable sympathetic autonomic nervous system contribution in the cardiovascular activity regulation. The results confirm that initially low level of the vagal tonus in patients with CTD is unable to fully restrain the growth of sympathetic activity in orthostasis and, apparently, in all other situations, accompanied with physiological autonomic tonus activation.

Our aim was to compare the changes of arterial stiffness (AS), endothelial function (EF) and metabolic parameters in patients with essential hypertension on treatment with combination of perindopril with either indapamide-retard or hydrochlorothiazide. The study involved 40 patients (mean age 52,4±7,1 years) who were randomly assigned to perindopril 5–10 mg o.d. in combination with indapamide-retard (P+IR) 1.5 mg o.d. (n=20) or with hydrochlorothiazide (P+HT) 25 mg o.d. (n=20). EF determined as the change of resistance index after inhalation of 400 mcg of salbutamol, AS measured as mean stiffness index after 500 mcg of sublingual trinitroglycerin (SItng), blood lipids and glucose were evaluated at baseline and 6 months thereafter. Vascular responses were calculated from digital pulse waves registered using photoplethysmography. Dynamics of BP after 6 months did not differ significantly between groups (−19.3

Aim of the study was to evaluate morphological changes, elasticity and endothelial function in young subjects with connective tissue dysplasia (CTD). The crossectional study involved 92 apparently healthy individuals from 18 to 35 years of age. Atherosclerosis risk factor and CTD signs screening, evaluation of pulse wave velocity (PWV) and endotheliumdependent vasodilation (EDVD) by means of peripheral pulse wave contour analysis were performed. Postmortem study involved 56 persons with CTD signs and 20 control persons age and sex matched. Phenotypic signs of CTD were found in all healthy individuals (range from 1 to 15). Values of PWV were significantly higher in 2, 3, and 4 quartiles of patients distribution by grade of CTD (p