Background. During the restoration of blood flow in the ischemic area of the myocardium, viable cardiomyocytes are damaged over a few minutes of tissue reperfusion (reperfusion myocardial damage). It is known that ischemic mitral regurgitation (IMR) develops in 11–19 % of patients who have undergoing percutaneous coronary intervention (PCI) in symptomatic coronary heart disease (CHD). To present day, the influence of myocardial reperfusion on IMR in patients with acute myocardial infarction (AMI) is not fully understood.Objective. To study dynamics of quantitative indicators of IMR in patients with AMI after myocardial reperfusion.Materials and methods. We included in this study 68 patients with AMI and IMR aged 36–79 years, who were hospitalized in cardiac intensive care unit of the Moscow S. S. Yudin hospital in 2016. All patients before and on the 7th day after PCI underwent doppler echocardiography study with calculation of quantitative parameters of IMR and index of local contractility (ILC) of the left ventricle (LV).Results. Three groups of patients were identified based on the analysis of the dynamics of quantitative parameters of IMR after myocardial reperfusion: group 1 – patients who had a decrease in IMR (n=23, 33.8 %), group 2 – patients with increase of IMR (n=28, 41.1 %), group 3 – patients with unchanged IMR (n=17, 25.1 %). The study of systolicLV function in all patients before PCI revealed moderately decreased ejection fraction (EF) (mean 49.05±1.19 %). On day 7 after myocardial reperfusion in group 2 we detected significant increases of end-diastolic volume (EDV), end-systolic volume (ESV), and the volume of the left atrium (LA), while in groups 1 and 3 these indexes remained unchanged. LV ILC did not differ between three groups, both at admission and on day 7 after reperfusion (p>0.05). There was no correlation between severity of IMR and ILC (correlation coefficient 0.24).Conclusion. Dynamics of quantitative parameters of IMR in 7 days after myocardial reperfusion in patients with AMI without endogenous and drug protection of the myocardium from reperfusion injury was multidirectional. IMR decreased in 33.8, increased in 41.1 and did not change in 25.1 % of patients. Systolic function and LV ILC underwent no significant dynamics.

Post-reperfusion syndrome is a chronic multi-factorial syndrome, caused by restoration of coronary blood flow of de novo in patients after coronary stenting. Pathophysiological processes occurring in stenting segment (incomplete endothelization of vessel, excessive regeneration of neointima, formation of neoatherosclerosis) the risk of partial or total stent thrombosis due to the low level of compliance of the patient, as well as local changes in blood flow to the myocardium and modification of hemodynamics in stented arteries have a significant impact on the clinical course and prognosis of the disease. In contrast to the syndrome of reperfusion occurring after restoration of blood flow in the infarct-dependent coronary artery syndrome and postischemic reperfusion syndrome in patients with acute myocardial infarction after spontaneous or therapeutic thrombolysis, post-reperfusion syndrome is characterized by prolonged course (months and years). Clinical symptoms depend of the localization of pathological process (in stented arteries or in other non-stented arteries of the heart), as well as the presence of comorbidity and the factors of risk of the coronary heart disease.

Резюме. У 264 взрослых больных, госпитализированных с острой диареей в форме средней тяжести, проведено сопоставление клинической симптоматики с результатами выявления энтеропатогенов различными метода-ми диагностики. В период эпидемиологического неблагополучия по дизентерии (2002-2004 гг.) для детекции энтеропатогенов у 91 пациента использовали: культуральный метод (клинический материал -фекалии) и ме-тод выявления специфических сывороточных антител (для детекции Shigella spp. и Salmonella spp.); метод ИФА (для детекции ротавирусного антигена в фекалиях). В период эпидемиологического благополучия по дизенте-рии (2009-2011 гг.) исследование клинического материала 173 больных, у которых в симптоматике ОКИ был документирован синдром колита (по результатам копроцитоскопического и/или ректороманоскопического исследования), проводили выше названными методами и дополнительно методом ПЦР (клинический мате-риал -фекалии) набором «Амплисенс ® ОКИ скрин-FL» (Интерлабсервис, Россия). Выявили, что у пациентов, у которых в период эпидемиологического неблагополучия по дизентерии обнаруживали только ротавирусный антиген (РВА), и тех, у кого наряду с РВА выявляли Shigella spp. культуральным методом, отсутствовали су-щественные отличия клинически значимых количественных и частотных показателей (в том числе частота наличия синдрома колита). Это позволило предположить возможную гиподиагностику микст-ОКИ при не-выявленном использованными методами бактериальном возбудителе. Дополнительное использование ПЦР-метода позволило выявить Campylobacter spp. и диагносцировать протекавший по типу острой диареи кампи-лобактериоз, расцененный как основное заболевание и преимущественно в виде моноинфекции -у каждого пятого больного (20,8%), а как сопутствующее при микст-ОКИ -у 4% больных. При наличии в симптоматике синдрома колита использование ПЦР-метода позволило выявить Salmonella spp., Campylobacter spp. у каждо-го третьего больного, а Shigella spp. и ассоциации энтеропатогенов -у каждого 5-го пациента. Прицельный анализ выявленных энтеропатогенов у обследованных в период эпидемиологического благополучия по дизен-терии 15 больных с положительным результатом на ротавирус показал, что у 6 из них (40% пациентов) име-ла место детекция ассоциации ротавируса с маркерами других, в подавляющем большинстве бактериальных (у 5 из 6 человек), патогенов. Таким образом, у взрослых больных острой диареей с синдромом колита целесо-образно комплексное (с включением ПЦР-метода) обследование для расширения возможности детектировать не только вирусные, но и бактериальные способные вызывать колит, энтеропатогены.

The paper suggests the results of retrospective cohort study. We analyzed the results of clinical and laboratory examination of 102 hospitalized adult patients with acute diarrhea (AD) of moderate severity and positive feces test for rotavirus. Specific examination for the detection of various pathogens of AD along with standard cultural, serologic (based on the determination of specific antibodies) and ELISA methods included the study of the patient’s feces by PCR. It was found that the use of a complex of modern methods of specific diagnosis allows in 67.2% of individuals along with markers of rotavirus simultaneously identify markers of other pathogens, including bacterial – 51% of patients. Among the examined persons hospitalized on the 4th day of the disease and later, there are 2 times more patients with concomitant diseases of the gastrointestinal tract and 2.4 times more patients taking antimicrobial drugs at the prehospital stage than among those who admitted for the 1st three days of the disease. The cases in adult patients with concomitant non-infectious pathology of the gastrointestinal tract compared to those without it turned to be significantly rarer simultaneously positive for rotavirus and Campylobacter spp. In the examined patients with colitis syndrome there is an apparent trend of more frequent detection of a positive cultural test for Salmonella spp. In the absence of markers of bacterial enteropathogens in the clinical material in the group of adult patients with only detected rotavirus, colitis syndrome is documented 2 times more often than in patients with a positive combined reaction to rota- and norovirus.

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