Aim.Clinical guidelines for the management of adult patients suffering from drug-induced liver injuries (DILI) are intended for all medical specialists, who treat such patients in their clinical practice.Key findings.The presented recommendations contain information about the epidemiological data, terminology, diagnostic principles, classification, prognosis and management of patients with DILI. The recommendations list pharmacological agents that most commonly cause DILI, including its fatal cases. Dose-dependent and predictable (hepatotoxic), as well as dose-independent and unpredictable (idiosyncratic) DILI forms are described in detail, which information has a particular practical significance. The criteria and types of DILI are described in detail, with the most reliable diagnostic and prognostic scales and indices being provided. The pathogenesis and risk factors for the development of DILI are considered. The clinical and morphological forms (phenotypes) of DILI are described. The diseases that are included into the differential diagnosis of DILI, as well as the principles of its implementation, are given. The role and significance of various diagnostic methods for examining a patient with suspected DILI is described, with the liver biopsy role being discussed. Clinical situations, in which DILI can acquire a chronic course, are described. A section on the assessment of causal relationships in the diagnosis of DILI is presented; the practical value of using the CIOMS-RUCAM scale is shown. All possible therapeutic measures and pharmacological approaches to the treatment of patients with various DILI phenotypes are investigated in detail. A particular attention is paid to the use of glucocorticosteroids in the treatment of DILI.Conclusion.The presented clinical recommendations are important for improving the quality of medical care in the field of hepatology.

The article is devoted to current scientific data on the cholelithiasis pathogenesis and opportunities for optimizing litholytic therapy. It is shown that cholelithiasis should be considered as a topical manifestation of systemic disorders of metabolic and inflammatory genesis throughout the body. The article shows the key role in the development of its insulin resistance, imbalanced cholesterol and bile acid metabolism, biliary dyskinesia, and the production of inflammatory mediators. There are factors that cause cholelithiasis comorbidity with cardiovascular diseases, cerebrovascular diseases, gastrointestinal cancer of various localization, and liver diseases. The role of cholelithiasis as a risk factor and a criterion for an adverse prognosis is justified. Pathogenetically justified method for improving oral litholysis, which provides a complex therapy effect, is considered; the rationality of using a fixed combination of ursodeoxycholic acid and glycyrrhizic acid is justified. KEYWORDS: gallstone disease, cholelithiasis, cholesterol stones, oral litholysis, ursodeoxycholic acid, glycyrrhizic acid, complex therapy, metabolic disorders. FOR CITATION: Nikitin I.G., Volnukhin A.V. Cholelithiasis: epidemiological data, key aspects of the pathogenesis and comorbidity, relevant therapeutic targets. Russian Medical Inquiry. 2020;4(5):290–296. DOI: 10.32364/2587–6821–2020–4-5-290-296.

Cardiac amyloidosis (amyloid cardiomyopathy) is a disease damage to the heart caused by extracellular amyloid deposition. In some cases, there may be local damage to the structures of the heart, for example, the atria; more often, heart damage is part of a systemic (generalized) pathology. Depending on the amyloid precursor protein, 36 types of amyloidosis are described, among which hereditary and acquired forms are distinguished. Cardiac amyloidosis is diagnosed 1) in the case of the amyloid infiltration in the myocardial bioptates or 2) in the case of non-cardiac amyloid deposition and the left ventricular wall thickening >12 mm without arterial hypertension and other reasons. The heart is most often affected in AL-, ATTR-, AA-, AANF-types of amyloidosis. Cardiac amyloidosis should be considered in patients with a heart failure with an unclear etiology, especially with preserved left ventricular ejection fraction, refractory to treatment, with proteinuria and CKD 4-5, in patients with idiopathic atrial fibrillation and conduction disturbances, in patients with left ventricular wall thickening of unclear etiology, low ECG voltage, unexplained arterial hypotension and pulmonary hypertension. Screening for cardiac amyloidosis should include non-invasive methods such as electrophoresis and immunofixation of blood and urine proteins, the free light lambda and kappa chains of immunoglobulins, 99Tc-DPD scintigraphy, genetic testing (if hereditary variants of amyloidosis are suspected), as well as a histological examination of biopsy samples stained with Congo red and polarizing microscopy.

Высокая эффективность современной химиолучевой терапии позволила добиться больших успехов в лечении онкогематологических заболеваний. Основой многих схем полихимиотерапии первой линии лечения остаются антрациклиновые антибиотики. Эффективное лечение основного заболевания в ряде случаев сопровождается развитием различных осложнений со стороны сердечно-сосудистой системы, в том числе очень тяжелых, с развитием летального исхода. Необходимо учитывать возможность развития не только острой кардиотоксичности, но и различных осложнений со стороны сердечно-сосудистой системы после завершения противоопухолевого лечения. Алго-ритм подготовки пациентов к химиолучевой терапии, должен обязательно включать обследование сердечно-сосудистой системы до начала лечения, в дальнейшем необходимо регулярное обследование на протяжении терапии. Профилактика и лечение кардиотоксичности являются сложными клиниче-скими задачами в силу необратимости и прогрессирующего характера боль-шинства изменений со стороны сердечно-сосудистой системы. Важным аспектом является тесное взаимодействие кардиолога и онколога при веде-нии больных. Необходимо длительное динамическое наблюдения за пациен-тами, получавшими химиолучевую терапию для максимально ранней диагно-стики сердечно-сосудистых осложнений в отдаленном периоде после оконча-ния противоопухолевого лечения.

The prevalence of the chronic heart failure is increasing due to the success of cardiology and the increase in life expectancy of the population. A greater number of patients live up to the clinically pronounced stages of the chronic heart failure. This issue leads to an increasing in the absolute number of the patients in whom there is a lack of efficacy of optimally prescribed drug therapy. These patients are considering initiating cardiac resynchronization therapy (CRT). CRT is recommended for the patients with chronic heart failure II-IV functional class with severe left ventricular systolic dysfunction and prolonged QRS complex. Despite careful selection of patients for CRT implantation, the device does not lead to the expected result in one third of cases. To increase the effectiveness of this intervention, the procedure should be performed in accordance with current guidelines only for compliant patients who have been at least 3 months on selected optimal drug therapy, should use the optimal strategies and modes of stimulation and the adequate drug support after the intervention. The number of patients with long-term use of CRT is constantly growing. More and more patients with installed devices come into the field of vision of general practitioners and cardiologists of ambulatory clinics and hospitals, for whom it is extremely important to understand the specifics of the methods and tactics of managing such patients. This publication is dedicated to this.

госпитальной терапии № 2 лечебного факультета Федерального государственного бюджетного образовательного учреждения высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения,

The article presents results of analysis of the register of out-patients and in-patients with atrium fibrillation (n=1624) observed in 2009-2015. The retrospective data analysis and prospective observation of certain percentage of patients were applied to evaluate rate and conformity of implementation of various groups of anti-thrombotic medications in conditions of real practice of polyclinics and hospitals of Moscow. The results are compared with data of national studies of this issue during recent years.

In this paper, the erythrocytes of healthy donors and people with a confirmed diagnosis of COVID-19 were tested by Raman spectroscopy and laser interference microscopy. We argue that erythrocytes (red blood cells) in COVID-19 patients have an irregular shape, and their morphometric characteristics are impaired in comparison to healthy red blood cells. Raman spectroscopy also allows us to detect a decreased oxygen transport function of these erythrocytes. The combination of these methods—Raman spectroscopy and laser interference microscopy—is a highly effective method for the diagnosis of SARS-CoV-2.