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Aim. To evaluate the influence of target BP achievement on clinical course and outcomes of pregnancy in pregnant women with arterial hypertension (AH).Material and methods. A cohort study with prospective cohort. Totally 300 pregnant women included; of those in to the 1st group 103 included with AH, who had not reached target BP; into the 2nd – 97 women with AH, who had reached target BP; control consisted of 100 women without AH. Women underwent clinical examination and observation, analysis of medical data, standard laboratory and instrumental investigation, genetic investigation by polymerase chain reaction.Results. Women who had not reached target BP pregnancy complicated more often with fetus development retardation and pre-eclampsy, and in pregancy outcomes there were preterm delivery and antenatal fetus death, newborns from this group had lower weight and height; also they had more often mutation of D-allele of ACE gene (I/D) and mutant C-allele of receptor 1 type angiotensine II gene (ATR11166 A/C) comparing to the group with achieved BP and with controls. By the result of logistic regression study the factor independently associated with total worse outcome, were premature deliveries in anamnesis - increase the risk almost 6 times (OR=5,93, 95% CI 1,83-19,2; p=0,003), pre-eclampsy during current preganancy – increases risk 3,7 times (OR=3,68, 95% CI 1,48-9,16; p=0,005), and target BP acievement (less than 140/90 mmHg) decreases the risk of total negative outcome 8 times (OR=0,12, 95% CI 0,05-0,28; p<0,001).Conclusion. Target BP achievement in pregnant women with AH might be an independent factor influencing the prevalence of obstetric complications and negative outcomes of pregnancy. A definite impact on target BP levels achievement make genetic polymorphisms of renin-angiotensin system genes.

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Modern professional education of internists is being updated at an intensive pace. This is primarily due to the fact that medicine and its technologies do not stand still, rushing into a high-tech future. In this regard, people have great hopes for highly effective conservative care, including for hematological diseases. Basic research on the mechanisms of blood clotting has greatly improved the knowledge of complex pathophysiology. These advances have led to a more complex decision-making process, which is reflected in the complex effect of hemostasis imbalance on the complement system, immunity and inflammation, and hence on the treatment of hemostasis disorders. Given this rapidly changing context, optimal educational activities are needed to disseminate knowledge among health professionals and develop their competencies in this field. Specialized professional associations can provide support and training offerings that facilitate access to relevant resources and tools to enable high-quality, up-todate basic and clinical research.

Objective: to improve diagnostic and therapeutic tactics in patients with cholelithiasis in combination with NAFLD, taking into account the impact of comorbidity. Materials and methods: We examined 180 people who applied to the Lotos Medical Center in Chelyabinsk in the period 2018-2020 with cholelithiasis and NAFLD at the age of 19 to 65 years. The study included 128 women (72%) and 52 men (28%). The mean age of the participants was 51.3±9 years. The work took into account anamnestic (comorbid pathology) anthropometric data (height, body weight, body mass index, waist circumference). All patients underwent general clinical, biochemical blood tests, ultrasound of the abdominal cavity, MSCT of the abdominal cavity with an assessment of the density of liver tissue, bile and gallbladder stones. Results of the study: The study showed that among patients with cholelithiasis in combination with NAFLD, 56% had comorbidity. Gallstones of low density were found in 41.6%, high density in 58.4%. Comorbid pathology was represented by obesity, cardiovascular diseases, pathology of the endocrine system, diseases of the gastrointestinal tract and diseases of the kidneys and urinary system. In the group of patients with gallstones with a density of more than 75 Hounsfield units, comorbid pathology was more common, and the degree of liver steatosis and fibrosis was higher. During treatment with UDCA 15 mg/kg, positive dynamics was observed in patients with low-density stones: a decrease in stone density and size (effective litholysis), normalization of liver density, normalization of cytolysis, cholestasis, and carbohydrate metabolism. In patients with gallstones over 75 Hounsfield units, there was a decrease in bile density without effective litholysis, normalization of cytolysis stigmas, cholestasis, correction of lipid and carbohydrate metabolism. Conclusion: in patients with cholelithiasis in combination with NAFLD, comorbid pathology is more common, which negatively affects the effectiveness of litholysis and worsens the prognosis in these patients. Medical litholysis in these patients is possible only at the initial stage of the disease in the presence of stones of low density and size. UDCA therapy makes it possible to control the density of bile and the size of gallbladder stones, the activity of the inflammatory process in the liver, preventing the progression and complications of NAFLD and cholelithiasis in comorbid patients.