Admission of certain medications (drugs) can cause the development of atrial fibrillation (AF) in patients having non-evident cardiovascular disease (CVD). Also, it can accelerate the onset of AF in patients with pre-existing CVD. It is important to realize medications as potential cause of AF, especially in elderly people, since aging is associated with comorbidity and use of many medications simultaneously, that can lead to higher incidence of druginduced AF (DI AF). The article provides literature review on medications used to treat CVD, the admission of which can lead to the development of DI AF. Its onset can be associated with the use of cardiotonic, antiarrhythmic and antianginal medications, calcium channel blockers, diuretics, antiplatelet agents and some others with different evidence levels. The frequency, mechanisms of DI AF development and methods for its correction are described.

Primary percutaneous coronary intervention (PPCI) is the gold standard of treating patients with acute coronary syndrome (ACS). The results
of major clinical trials on ACS patients’ treatment are reflected in modern guidelines, where PPCI is of high evidence level and is superior to conservative therapy in long-term treatment results. Treatment of elderly patients over 75 years old is carried due to modern clinical guidelines, even though few patients of this age group are included in the studies. The increase in population average life expectancy causes the increase in number of elderly ACS patients with comorbid pathology. In its turn, it affects both the choice of treatment tactics and PPCI volume. Therefore, a study of this age group is required. The present review reflects the main clinical studies and analysis of elderly patients’ treatment

Edoxaban is a new generation of oral anticoagulant; it is selective, direct and reversible inhibitor of activated blood coagulation factor X (F Xa), serine
protease responsible for thrombin formation. Edoxaban is used to prevent stroke in non-valvular atrial fibrillation, to treat deep vein thrombosis and pulmonary embolism. The purpose of the review is to analyze the associative studies of OHB of CYP3A4 / 5 and ABCB1 genes, as well as to search for new candidate genes reflecting the efficacy and safety of edoxaban. The search for full-text publications in Russian and English over the past two decades was carried out in eLibrary, PubMed, Web of Science, OMIM databases using the following keywords: edoxaban, pharmacokinetics, pharmacogenetics, efficacy, and safety. The review covers pharmacokinetics of edoxaban, as well as pharmacogenetic features of the drug metabolism in details. Candidate genes influencing concentration of edoxaban are genes encoding key enzymes of its metabolism – CES1, CYP3A4 / 5, ABCB1, and, to a lesser extent, SLCO1B1. By present day, numerous NVS of candidate genes have been identified. They potentially affect pharmacokinetics of edoxaban, but their role in real clinical practice requires further study

Drug-induced liver damage (DILD) is a common condition that can lead in some cases to acute liver failure and unfavorable patient outcomes.
DILD development mechanisms are of two main types. The first is a direct dose-dependent type and the second is dose-independent idiosyncratic one.
Cytochrome P450 system is of great importance in the genesis of direct DILD, since during drugs metabolism highly toxic metabolites can be formed in this
liver enzymatic system. As a result, hepatocytes die destructing mitochondria and thus blocking the production of cell energy substrates, triggering oxidative stress and lipid peroxidation. It also leads to direct DNA damage and activation of signaling pathways for apoptosis. In most cases idiosyncratic DILD is associated with individual genetically determined predisposition with a wide range of clinical manifestations. In case of this type of DILD, the immune cells are sensitized to hepatocytes activating humoral and cellular immune response and rather often forming antibodies to some structural element of hepatocytes. The structure of antigens of the main histocompatibility complex as well as receptor-mediated interactions with Fas-ligand participation, interferon gamma and tumor necrosis factor play a certain role in the development of idiosyncratic DILD. By present, hypotheses of immune system activation in idiosyncratic
DILD have been proposed, including haptenization hypothesis; the hypothesis of direct interaction of drugs with the molecules of major histocompatibility
complex and subsequent activation of the immune system; the hypothesis of changes in structural sequences of endogenous biologically active peptides
with impaired interaction in the backbones of major histocompatibility complex and occurrence of autoimmune reactions. Finally, there is the hypothesis of multiple determinants, which postulates that there are various risk factors (for example, genetic polymorphisms, gender, age, etc.) that contribute to DILD onset in case of comorbidity. DILD mechanisms can also be considered according to clinical and morphological type of liver damage. One can distinguish cholestatic DILD type, vascular type, steatosis, and the type when liver tumor develops. The cholestatic DILD type is clinically expressed by cholestasia or inability of bile to enter the lumen of small intestine as a result of abnormal secretion of bile acids by hepatocytes or obstruction of biliary tract. Hepatic steatosis is histologically determined as deposition of triglycerides within hepatocytes. Drug-induced steatosis is reversible unless steatohepatitis or cirrhosis has developed. Vascular DILD type is associated with damage of stellate and endothelial liver cells, lining sinusoidal capillaries. Edema, thrombosis of small intrahepatic vessels, develop as a result of it, leading to obstruction of venous outflow (and impaired lymph outflow), expansion of sinusoids, pressure overload
and hepato-hepatic necrosis, and, in some cases, to centrilobular fibrosis. This pathology is known as sinusoidal obstruction syndrome or venous-occlusive disease. DILD type with the development of liver tumor includes hepatocellular adenoma, hepatocellular carcinoma, cholangiocarcinoma. Awareness of pathogenetic DILD correlations is important in real clinical practice, since, on the one hand, it allows to optimize the diagnostic search for the cause of liver disease, and on the other hand, it increases the effectiveness of approaches to treat and prevent such conditions.

The aim of the research is to study and to analyze the prevalence of recurrent strokes in the Russian regions included in Federal program from 2009 to 2016 on reorganization of care for patients with stroke in different age groups.
Material and methods. The research method is territory and population register. The study included seven territories with 7124 of cases of recurrent stroke in total. The examined patients were divided into four age groups: of young age - 25-44 years old; of average age - 45-59 years old; of old age - 60-74 years old, and of senile - 75 years and older. Statistical analysis was carried out using programming language for statistical calculations R version 3.3.2.
Results. The maximum number of recurrent stroke cases was registered in old age (46.6%), and the minimum number of cases of recurrent stroke was among young people (2.4%). When analyzing the incidence of recurrent strokes, depending on the year, the most systematic percentage decrease of recurrent strokes was observed among elderly people. The highest percentage of recurrent strokes was determined among the elderly people in 2013 - 26.38%; and the lowest percentage of recurrent strokes was recorded among young people.
Conclusion. Among the surveyed age groups statistically significant decrease in recurrent strokes among young, middle-aged and elderly people was revealed
during 2009 - 2016. It is the criterion for the effectiveness of recurrent stroke prevention conducted in the studied areas. There was no statistically significant
decrease in the prevalence of recurrent stroke among elderly people by 2016. It indicates that the prevention of recurrent strokes in old age is a difficult task
due to concomitant diseases and associated pathology in these patients.

The aim of the research is to determine the levels and frequency of antibodies popularity to cyclic citrullinated peptide (APCCP), rheumatoid factor (RF), anti-Sa antibodies and antibodies to heterogeneous nuclear ribonucleoprotein K (anti-gRNP K) in rheumatoid arthritis (RA) and to compare their diagnostic characteristics, and also to determine sensitivity and specificity of anti-Sa antibodies, anti-hRNP K in seronegative RA.
Material and methods. The study included 270 patients with RA and 50 healthy individuals. The levels of ACCP, anti-Sa, anti-hRNP K were assessed in blood serum samples from patients by enzyme-linked immunosorbent assay using commercial test systems. RF levels were assessed by kinetic nephelometry on automatic analyzer.
Results. The levels and popularity frequency of the studied antibodies in patients with RА were significantly higher than in healthy individuals (p <0.05). Tests based on ADCP detection had the highest indices of sensitivity and specificity for RA diagnosis; sensitivity - 78.01%, specificity - 100.00%, and RF - 70.64%, specificity 96.97%. In case of serogegative APCCP and RA RF, diagnostic sensitivity of anti-Sa antibodies determination was 50.00%, specificity was 96.77%, sensitivity of anti-hRNP K antibodies determination was 55.56%, and specificity was 100.00%.
Conclusion. Considering high specificity of tests for anti-Sa and anti-hRNP K antibodies in seronegative RA, they can be considered as additional confirmatory diagnostic tests.

The aim of the research is the analysis of basic clinical laboratory and instrumental parameters of patients suffering from CHF with intermediate left ventricular ejection fraction (LEF), developed as a result of ischemic heart disease and arterial hypertension associated with RA compared to patients without RA; assessment of indicators of morphological and functional parameters of myocardium and possible associations with indicators of RA inflammation activity.
Material and methods. The study group included 134 patients with HFFV associated with RA; the comparison group was of 122 patients with HFFV without RA. CHF functional class of patients who took part in the study according to NYHA I-II. RA was diagnosed based on X-ray and serological studies, which included determination of rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (ACCP), C - reactive protein (CRP). Inflammatory process activity was assessed by DAS28 index and visual analogue pain scale (VAS). X-ray RA stage included the studied I-III patients according to Steinbrocker classofication. CHF treatment medications were compared in groups. The basic anti-inflammatory medication for RA treatment is methotrexate. Patients who did not take methotrexate due to side effects and / or individual intolerance took leflunomide at a dosage of 20 mg per day. Moreover, NSAIDs were used (enterally, parenterally, locally). Hematological, biochemical and instrumental studies were carried out. The processing was carried out in STATISTICA 10.0 program. The work presents statistically significant results. The critical level of significance when testing statistical hypotheses is p <0.05.
Results. Comparative analysis revealed statistically significant differences in the levels of ESR and CRP, with a predominance of values in the study group, which naturally reflects the intensity of inflammatory process. Furthermore, statistically significant differences in the levels of creatinine and GFR were revealed. It can be due to the influence of chronic inflammation and regular intake of NSAIDs. In the group of patients with CHF on the background of RA, statistically significant decrease in hemoglobin level was found. Statistically significant predominance of TG, LDL-C concentration, as well as a decrease in HDL-C in the study group in relation to the comparison group were obtained. Statistically significant predominance of atherogenic coefficient was revealed in the study group. NT-proBNP concentration in the study groups differed significante: in the group of patients with CHF associated with RA, the level was 306.7 (225; 391) pg / ml; in the CHF group without RA - 488.7 (355; 638) (p = 0.02). A direct association of the DAS28 index and NT-proBNP was found (r = 0.04; p = 0.02).
Conclusion. Patients with CHF associated with RA are reasonably recommended to increase the dosage of statins with more frequent monitoring of lipid profile. An assessment of NT-proBNP level is required for more detailed assessment of morphological and functional parameters of myocardium.

The aim of the research is to study the content of some key pro / anti-inflammatory cytokines in patients with osteoarthritis and to evaluate their role in predicting atherogenesis in this category of patients.
Material and methods. Patients with primary osteoarthritis of I-III radiological stages were examined. Doppler vessels ultrasound (Doppler ultrasound) of
the neck, upper and lower extremities was performed; blood levels of pro / anti-inflammatory cytokines were examined: IL-1β, TNF-α, IL-6, IL- 8, IL-18,
MCP-1, IL-17, IL-10, IL-33 by flow cytometry.
Results. According to the thickness of intima - media complex, the patients were divided into 2 groups: with a normal thickness of intima - media complex and with atherosclerotic plaque. A significant increase in pro-inflammatory cytokines was revealed in patients with osteoarthritis associated with atherosclerosis compared with those having osteoarthritis with normal thickness of intima-media complex. The level of pro / anti-inflammatory cytokines along with atherosclerosis are closely interconnected.
Conclusion. According to the results of the studies obtained, it was found that a long-term subclinical inflammatory process leads to multidirectional disturbances in cytokine balance in patients with osteoarthritis, which probably contributes to the progression of both osteoarthritis and atherosclerosis. A possible factor of early atherosclerosis development in patients with osteoarthritis was also identified.

The aim of the research is to study the dynamics of fibrosing markers of C-terminal procollagen, type I propeptide (PICP) and N-terminal propeptide type III procollagen (PIIINP) in patients with ST-segment elevation myocardial infarction (STEMI); to identify possible correlation between concentration of PICP and PIIINP with the degree of cardiac fibrosis and diastolic dysfunction (DD) in a year after MI.
Material and methods. The analyzed sample included STEMI patients with preserved contractility of the left ventricular myocardium (LV). During MI 1-st day the ejection fraction due to Simpson method was ≥50%. On the 1-st and 12-th days of the disease, as well as in a year, the concentration of PICP, PIIINP in venous blood serum was determined in all the studied participants. Standard echocardiographic study was performed with an assessment of LV diastolic function and determination of the following parameters: e’ (septal part displacement), Em (lateral part displacement), and IOLP (indexed left atrium volume). In a year after STEMI, all patients underwent magnetic resonance imaging (MRI) with a contrast agent to determine the severity of fibrotic myocardial damage.
Results. PICP concentration significantly decreased by annual stage relative to hospital period (p <0.001). Changes in PIIINP concentration were revealed
during the 1s-t and 12-th days (p <0.001), and during the 12-th day and a year (p = 0.002). Both markers showed increased values on the 1-st day of the disease and did not decrease throughout the study. According to MRI results, it turned out that 57% (n = 49) of the observed patients had no signs of cardiac fibrosis (CF) in a year after myocardial infarction, while 10.5% of patients had a lesion ≥ 16% (n = 9). Significant correlations were obtained between CF ≥16% and PIIINP concentration on the 12-th day of MI (r = 0.72, p = 0.041), between CF ≥16% and e’ (cm / s) on the 12-th day (r = -0.66, p = 0.006).
Conclusion. One can assume that it is possible to reveal developing CF risk group and, therefore, the development of DD in a year after STEMI determining the concentration of fibrosis markers at hospital stage.

The aim of the research is to study the morbidity by appealability and some characteristics of congenital heart diseases in children of Zabaikalsky Territory.
Material and methods. A retrospective clinical and anamnestic analysis of children with congenital heart diseases without surgical treatment, who were hospitalized, was carried out. The analysis included 3 year-observation. CHD diagnosed is an inclusion criterion; while surgical treatment of heart diseases is exclusion criterion. Statistical data processing was carried out using Microsoft Excel 2007, Statistica v.10.0 software package. χ2 test (Pearson) was used to compare two independent groups by qualitative characteristics. The results were considered statistically significant (reliable) at the achieved significance level of p <0.05.
Results. In Zabaikalsky Territory, approximately 200 children with congenital heart disease without surgical treatment are hospitalized annually; the average age is 3 years. Fifty-three per cent of children applied for inpatient care for the first time, 44% of them were children at their first year. Gender distribution indicates the highest incidence of the pathology in girls. In CHD structure, atrial septal defects are on the first place, while interventricular septal defects are on the second. Combination of ASD and IVSD was observed with approximately equal frequency. Chronic heart failure associated with CHD was registered in 77% of children. In most cases CHF, stage 1, was diagnosed (63%). In 2/3 of cases, pulmonary hypertension of various severity was detected. Analysis of place of residence of
children with CHD in the Zabaikalsky Territory shows that children from areas with the highest population density are hospitalized more often. 
Conclusion. The problem of congenital heart diseases in children of Zabaikalsky Territory is of current importance due to the widespread prevalence and high specific gravity among all internal organ defects in children of this region.

The aim of the research is to study clinical, hemodynamic, affective disorders in ST-segment elevation acute coronary syndrome (STEACS); to identify gender risk factors affecting the outcomes.
Material and methods. The study included 90 males and 90 females with ST-segment elevation acute coronary syndrome. All patients underwent echocardiography, coronary angiography (CAG), and a set of laboratory examinations. Spielberger test, CES-D scales, Morisky-Green test, and Montreal Cognitive Function Scale were uses to study psycho-emotional status of 75 males and females. The treatment was carried out in accordance with current clinical protocols, clinical guidelines and standards. The prognosis was assessed in a year. The results were processed using nonparametric statistics methods.
Results. It was revealed that the females, included in the study, were older than males; they more often suffered from coronary artery disease, hypertension, type 2 diabetes, constitutive obesity (before the index event); they more regularly underwent antihypertensive therapy; they more often reached target BP values. There were no differences in features of coronary anatomy, frequency of invasive treatment, but females were significantly more likely to undergo thrombolytic therapy. Males smoked more often; asked for medical help earlier from the onset of anginal syndrome; they were more susceptible to dilatation of the left ventricular cavity. Females more often than males had high and medium level of personal anxiety, as well as high level of situational anxiety. Predictors of worsening prognosis in females are 4-vascular lesion of coronary bed, cardiogenic shock upon admission, decreased hemoglobin, dilatation of the left atrium, decreased cognitive functions, smoking. In males the predictors are: 3-vascular damage, cardiogenic shock, renal failure.
Conclusion. It was found that in STEACS there are differences between males and females in several clinical, anatomical and functional characteristics. Risk factors for an unfavorable prognosis are gender specific. The revealed facts can be useful in individualized treatment, rehabilitation and secondary prevention programs.

The aim of the research is to evaluate the informativeness of methods for assessing analgesia qNOX and ANI level.
Material and methods. The study included 24 patients who were operated on the spine under general anesthesia. The patients were divided into 2 groups; in 12 patients the level of analgesia was assessed using qNOX index, and in 12 patients using ANI index. Hemodynamic parameters were assessed in patients, among them: blood pressure and heart rate. Statistical analysis was carried out using Statistica 20.0 Software package.
Results. Intravenous dose of fentanyl of 2.4 ± 0.4 μg / kg made it possible to reach ANI 50 level in 4.2 ± 0.6 minutes since the moment of its administration. At stage II, ANI reached 65. After intravenous fentanyl administration qNOX reached 39 in 4.1 ± 0.5 min. At stage II, 15.3% of qNOX decrease was noted.
Conclusion. qNOX and ANI values are equally objective criteria for the adequacy of analgesia, objectively reflecting the achieved level of nociceptive protection

The aim of the research. Research subject is psychological reactions of people. The theme is “Psychological reactions of people with different living world resistance during COVID-19 pandemia”. The aim of the article is to identify psychological reactions of people with different living world resistance during COVID-19 pandemia.
Material and methods. For empirical research we used: 1) author methodology “Study of human living world resistance” (Loginova, 2012); 2) symptomatic questionnaire SCL-90-R (Simptom Check List-90-Revised). The total sample size was 210 people: 70 people in each group according to the nature of living world resistance (constructive, stagnant and non-constructive). The study was on from March 30 to May 28, 2020.
Results. Data on psychological reactions of people with living world resistance during COVID-19 pandemia were obtained for the first time. Key factor
for the representatives of constructive nature of living world resistance are the preservation of activity, changing the regime according to current situation, adequate level of anxiety, sensitivity, hostility and somatization. People with stagnant nature of living world resistance are characterized by depressed mood, melancholy, loss of strength, lethargy, desire to detach from what is happening. Representatives of non-constructive nature of the living world resistance show anxiety, irritability, increased level of anxiety, inconsistency and inconsistency of actions.
Conclusion. The presented research data allow psychologists to take the results into account when working with people who have experienced difficulties during COVID-19 pandemia, keeping these parameters as targets of psychological assistance in focus. The obtained data actualize the need to develop special programs of psychological support when leaving special epidemiological pandemic regime.

The aim of the research is to analyze life circumstances, activity results and to give a social portrait of Professor Zh. Zh. Rapoport, Doctor of Medical Sciences. For the first time we present information about active longevity and work continuation of a doctor, a teacher and a scientist of Krasnoyarsk Medical Institute, who continues to cooperate with Krasnoyarsk Medical University and Institute of Medical Problems of the North.
Material and methods. Historical documents, parents and family memories, information on work after graduation from Odessa Medical Institute, publications about him, memoirs of employees of Pediatrics Department of Krasnoyarsk Medical Institute Studied are studied. Historical and biographical method was used.
Results. There are examples of his formation as a doctor, considering his family medical dynasty, achievements during the period of work in Krasnoyarsk Territory. Features of his pedagogical activity and formation of pediatric school are given. Scientific genealogy and its continuation in students are described. The facts of maintaining high level of psychological mood for a long active period of life are presented.
Conclusion. It is proposed to use the mentioned experience in professional motivating medical students, improving pedagogical process, in the ability to
conduct practically significant scientific research during the period of work and to transfer experience and knowledge after retirement.