Vol 22, No 12 (2020)


Leonardo da Vinci and medicine. A glimpse from the past

Dvoretsky L.I.


The article is devoted to the creative role of Leonardo da Vinci in human anatomy, medicine and pathology. It discusses main discoveries of Leonardo in various fields of medicine from the standpoint of modern scientific and practical medicine. The nature of Leonardo's illness and the possible causes of his death are discussed.
Consilium Medicum. 2020;22(12):9-14
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Assessment of the duration of QT interval in patients with COVID-19 during treatment with hydroxychloroquine and azithromycin

Orlov F.A., Zaitsev A.A., Kubenskii G.E., Pantiukhova T.N.


At the end of 2019, an outbreak of a novel coronavirus infection occurred in PRC, the causative agent of which was given the temporary name 2019-nCoV. COVID-19 is a complex multisystem disease which causes harmful effects not only on the lungs, but also on the cardiac conduction system. Aim. To assess the duration of corrected QT interval in patients with COVID-19 during treatment with hydroxychloroquine and azithromycin, and to identify the relationship between this indicator and the severity of interstitial pneumonitis. Materials and methods. We studied medical records of 40 men and 4 women, who were treated in the infectious diseases department of Acad. N.N. Burdenko Main Military Clinical Hospital from March 20 to May 20, 2020. All patients underwent resting digital 12-lead electrocardiography: at the time of admission to the hospital and after 6 days of therapy using the "Myocard-12" system. In our study, 30 patients were treated with azithromycin at a total daily dose of 500 mg for 5 to 10 days; 21 patients - with hydroxychloroquine at a dose of 400 mg 2 times a day on the 1st day of treatment and 200 mg 2 times a day for the next 5 days; and 7 patients received azithromycin and hydroxychroloquine combination. Results. To assess the duration of corrected QT interval depending on the severity of patient's status and the degree of lung damage, we compared the mean QT interval depending on the degree of lung damage on computed tomography. There was no significant difference in this indicator in patients with pneumonia of varying severity. However, when using the combination of azithromycin and hydroxychloroquine after 6 days, there was a significant increase in the mean corrected QT interval compared to its baseline value (before treatment). Conclusion. Patients hospitalized with COVID-19 have an initially prolonged corrected QTinterval. The combined use of azithromycin and hydroxychloroquine in a short time causes a significant increase in the corrected QT interval in patients with COVID-19.
Consilium Medicum. 2020;22(12):15-19
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Hyperuricemia in patients with stable coronary artery disease and arterial hypertension and percutaneous coronary interventions

Mironova O.l., Fomin V.V.


Aim. To assess the influence of hyperuricemia on the risk of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) and arterial hypertension. Materials and methods. Patients receiving optimal medical therapy and with indications for coronary angiography and possible coronary angioplasty, with stable CAD and arterial hypertension were included in the study. We conducted an observational open prospective cohort study, that was registered in clinicaltrials.gov with ID NCT04014153. Results. We included 1023 patients with chronic CAD. 863 had arterial hypertension. Hyperuricemia was diagnosed in 31 patients, 832 had normal levels of uric acid on admission. Contrast-induced acute kidney injury developed in 2 (6.5%) patients suffering from hyperuricemia. In patients with stable CAD, AH and no hyperuricemia the rate of CI-AKI was 107 (12.9%) patients. The difference between groups was not statistically significant (95% CI -0.056-0.183, p=0.292). We built a multiple linear regression model that included age, weight, female gender, heart failure, diabetes mellitus, kidney diseases in past medical history, proteinuria, anemia, baseline glomerular filtration rate, contrast volume and difference between baseline creatinine and creatinine after contrast administration. No risk factor showed any statistical significance in the model. Conclusion. Contrast-induced acute kidney injury developed in 2 (6.5%) patients suffering from hyperuricemia. The rate of CI-AKI in patients without hyperuricemia was twice higher but the results were not statistically significant. Among the risk factors included in the multiple linear regression model none was statistically significant.
Consilium Medicum. 2020;22(12):20-22
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Association of fibroblast growth factor 21 with metabolic phenotype and fat depots in young adults with abdominal obesity

Zheleznova E.A., Zhernakova J.V., Shariia M.A., Blinova N.V., Azimova M.O., Sharf T.V., Masenko V.P., Chazova I.E.


Fibroblast Growth Factor 21 (FGF21) is a hormone-like protein involved in the regulation of energy balance and glucose and lipid homeostasis. The study of the association of this factor with the metabolic phenotype - metabolically healthy (MHAO) and metabolically unhealthy abdominal obesity (AO) and different fat depots (visceral, subcutaneous, epicardial, perivascular) in young people is of undoubted scientific and practical interest. Aim. To determine serum FGF21 levels and match it with the distribution of adipose tissue in young people with AO. Outcomes and methods. The study enrolled 132 people (mean age 37.59±6.35 years). 3 groups were formed: 0th - 16 conditionally healthy volunteers; 1st -46 people of 40 years [34; 43] with MHAO; 2nd - 70 people of 40 years [35; 44] with metabolic syndrome (MS). All subjects underwent measurement of height, body weight, waist circumference, calculation of body mass index. The FGF21 levels (ELISA KIT, BCM Diagnostics, Germany), lipid profile, 2-hour glucose tolerance test, glucose, insulin, leptin, adiponectin levels and HOMA-IR were assessed. Daily monitoring of blood pressure was performed. The volumes of subcutaneous, visceral, perivascular, epicardial fat, as well as subcutaneous fat to visceral fat ratio were determined with computed tomography. Additionally, for subanalysis, all patients (132 people, mean age 37.59±6.35 years) were divided into 6 groups depending on the presence of AO and the number of risk factors (RF): AO-0/FR-0 (n=16); AO-1/FR-0 (n=3); AO-1/FR-1 (n=40); AO-1/FR-2 (n=37); AO-1/FR-3 (n=14); AO-1/FR-4 (n=5). In each group, FGF21 levels was assessed. Results. The FGF21 levels was significantly higher in the groups of persons with MHAO (294.4 pg/ml) and MS (245.7 pg/ml) compared with the control group (110.2 pg/ml); р=0.04 and р=0.05, respectively. According to the correlation analysis data, there was significant weak association of FGF21 with age (r=0.22, р<0.05), waist circumference (r=0.18, р<0.05), hip circumference (r=0.26, р<0.05), body mass index (r=0.3, р<0.01). FGF21 was found to be associated with visceral (r=0.2, р<0.05) and subcutaneous (r=0.2, р<0.05) fat depots. A significant association of FGF21 with triglycerides (r=0.21, р<0.05) and leptin (r=0.24, p<0.05) was registered. The FGF21 level >345.8 pg/ml reflected a 3-fold increase in the risk of MS in young people (AuROC 0.74, sensitivity 78.6%, specificity 75.0%, р<0.0001). The FGF21 levels >294.4 pg/ml was a risk marker for MHAO (AuROC 0,70, sensitivity 67.4%, specificity 75.0%, р<0.0001). According to the results of subanalysis, a significant (р<0.01) increase in the FGF21 concentration was revealed in the groups with an increase in the number of MS components. Conclusions. The FGF21 levels increases with the worsening of the metabolic phenotype; its increase is seen long before the formation of MS (in persons with MHAO). FGF21 in young people is associated with visceral and subcutaneous fat depots, triglyceride levels and leptin. FGF21>345.8 pg/ml can be considered a predictor of MS in young people, but further research is required.
Consilium Medicum. 2020;22(12):23-30
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Nonsteroidal anti-inflammatory drugs and ibuprofen for COVID-19: a systematic review

Leonova M.V.


COVID-19 pandemic is currently the most pressing public health problem worldwide. Despite growing knowledge about the nature of SARS-CoV-2-assosiated severe acute respiratory syndrome, the treatment options are still poorly defined. The safety of nonsteroidal anti-inflammatory drugs (NSAIDs), in particular ibuprofen, has been questioned without any supporting evidence. This has contributed to a number of observational studies evaluating the effect of ibuprofen on COVID-19 disease outcomes. A search of publications was carried out and a systematic review of 9 studies was presented, pharmacodynamic effects of ibuprofen were considered in terms of the effect on angiotensin-converting enzyme 2 and cyclooxygenase. The studies data have shown no direct interaction between ibuprofen and SARS-CoV-2, no evidence that ibuprofen affects the up-regulation of angiotensin-converting enzyme 2 as a COVID-19 receptor in human studies. Observational studies have not found evidence that ibuprofen, when used chronically before COVID-19 or when acutely used to relieve symptoms of COVID-19, contributes to infection or increases the risk of adverse outcomes (mortality, risk of hospitalization, risk of mechanical ventilation). Subsequently, international regulatory authorities (World Health Organization, European Medical Agency, FDA) concluded that there is no link between the more severe course of COVID-19 and NSAID treatment; paracetamol and other NSAIDs (ibuprofen) are recommended to treat the symptoms of COVID-19; patients on chronic NSAID treatment are warned not to discontinue it, as their condition may worsen.
Consilium Medicum. 2020;22(12):31-36
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Proand synbiotics in the treatment of intestinal diseases: what effects can we expect?

Gaus O.V., Livzan M.A.


The relationship between intestinal microbiota and human health is widely recognized. The advent of molecular and genetic diagnostic methods has made it possible to make truly revolutionary discoveries in the field of understanding the role of the digestive tract microbiome. Many studies have proved the association of the composition of microbiota with the development of a number of diseases of the digestive tract, such as inflammatory bowel diseases, functional gastrointestinal disorders and some types of cancer. The food and pharmaceutical industry has presented a huge selection of food products, dietary supplements and medicines containing prebiotic and probiotic components. The use of agents that affect microbiota in the treatment of intestinal diseases in real clinical practice should be carried out strictly in accordance with the indications, in recommended doses.
Consilium Medicum. 2020;22(12):37-43
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Extraoesophageal symptoms of gastroesophageal reflux disease: laryngopharyngeal reflux in focus

Trukhan D.I., Chusova N.A., Drokina O.V.


Gastroesophageal reflux disease (GERD) ranks first among gastroenterological diseases in terms of prevalence. GERD can also manifest with extraesophageal (atypical) symptoms, which include: cardiac, pulmonary, otorhinolaryngological and dental symptoms. In some cases, extraesophageal manifestations can come to the fore in the clinical picture. Moreover, in 25% of cases, GERD clinically occurs only with extraesophageal symptoms, which fits into one of the main features of modern real clinical practice - various diseases are increasingly losing their mononosological character, acquiring the status of comorbidity and multimorbidity. The presence of extraesophageal symptoms in patients with GERD is due to extraesophageal (or, more precisely, gastroesophagolaryngopharyngeal) reflux, which is referred to in the international medical literature as laryngopharyngeal reflux (LFR). Currently, LFR is considered as a condition of inflammation of the mucous membrane of the upper digestive and respiratory tracts associated with direct and indirect (reflex) effects of gastroduodenal refluctate, which can cause morphological changes in the mucous membrane. Over the past decade, two approaches to the treatment of LFR have emerged. The first approach involves the use of proton pump inhibitors (PPIs) as monotherapy along with dietary and lifestyle modification. The second comprehensive approach to LFR therapy involves dual therapy (PPI + alginate/antacid or PPI + prokinetic) or triple therapy (PPI + alginate/antacid + prokinetic). In this review, both approaches to the treatment of LFR are considered, and the possibilities of alginates in the treatment of LFR are considered.
Consilium Medicum. 2020;22(12):44-51
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Endoscopic stenting for malignant respiratory-digestive fistulas

Ivanov A.I., Popov V.A., Burmistrov M.V.


The paper presents a review of foreign literature at the present stage on the use of endoscopic stenting of the trachea and esophagus in malignant respiratory-digestive fistulas. Based on the data of foreign literature demonstrating the effectiveness of stenting, indications and contraindications for stenting, approaches for choosing a stent are presented, as well as the advantages, disadvantages, frequency of possible complications and endoscopic methods for their elimination. In conditions of limited life expectancy, patients with malignant fistulas need timely and effective choice of palliative care, which restores the patency of the esophagus, seals the fistula and improves the quality of life. Stenting with this pathology is the optimal method of choice. Due to the limited availability of internal information, given the rarity of the occurrence of malignant esophago-respiratory fistulas, the foreign experience was generalized in this work.
Consilium Medicum. 2020;22(12):53-56
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The importance of glycemic control in patients with early forms of carbohydrate metabolism disorders in order to prevent type 2 diabetes mellitus and cardiovascular pathology

Kochergina I.I.


The article presents data on the prevalence of diabetes and prediabetes; the high compatibility of diabetes mellitus and cardiovascular pathology; high mortality among patients with diabetes mellitus and coronary heart disease, in the presence of both acute and chronic cardiovascular complications; on the important role of glucose- and lipotoxicity in the progression of carbohydrate metabolism from prediabetes to type 2 diabetes mellitus, the role of hyperglycemia in the development of insulin resistance, atherosclerosis, hypertension, liver, kidney, endothelial dysfunction, the role of hyper- and hypoglycemia in the development of acute vascular complications - myocardial infarction, stroke, gangrene of the lower extremities; on the protective role of adiponectin - a predictor of type 2 diabetes mellitus, on the importance of glycemic control for the timely detection of early disorders of carbohydrate metabolism - impaired glucose tolerance and impaired fasting glucose; on the role of metformin in the prevention of progression of prediabetes to type 2 diabetes and cardiac pathology; on the gluco- and cardioprotective role of modern sugar-lowering drugs.
Consilium Medicum. 2020;22(12):57-62
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Application of information technology to optimize treatment of urolithiasis

Tumanian S.S., Luk'ianov I.V., Loran O.B.


Urolithiasis is one of the most common pathologies in urological practice. To ensure a personalized approach in the treatment of urolithiasis by taking into account the specific characteristics of each individual patient and various alternative methods of treatment, mathematical models and algorithms are increasingly being used that significantly improve the quality of medical care. One of the most promising directions in the field of creating mathematical computer models is the development and implementation into daily practice predictive models based on the so-called artificial neural networks. They combine the complex properties of neurons of the human brain to analyze and process the information received. An analysis of domestic and foreign literature has been carried out showed that there is an active development of computer technologies using neural network models that allow rationalizing the tactics of treating patients, in particular with urolithiasis. In order to personalize the approach to the management of patients with urolithiasis and increase the reliability of predicting treatment results on the basis of the urological department of the State Clinical Hospital of S.P. Botkin within the framework of the research work of the Department of Urology and Surgical Andrology of Medical Academy of Continuous Professional Education along with the National Research University of Electronic and Technology “MIET” it has been planned to develop a program based on neural network modeling. This program will allow to standardize the choice of the method of treatment of ureteral stones and will help urologists make difficult decisions in non-standard situations, which will lead to an increase in the efficiency and quality of medical care.
Consilium Medicum. 2020;22(12):63-68
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Targeted prostate biopsy in the diagnosis of prostate cancer: results from a prospective cohort study

Okishev A.V., Govorov A.V., Vasilyev A.O., Sadchenko A.V., Kolontarev K.B., Bormotin A.V., Kim Y.A., Kizun B.A., Ramazanov K.K., Pushkar D.Y.


Background. Detection of prostate cancer by various targeting methods of prostate biopsy is an important problem now. Aim. To improve the detection of prostate cancer (PCa), compare the methods of targeted biopsy - cognitive biopsy guided by MRI with biopsy guided by histos-canning, using a randomized biopsy of the prostate from twelve cores as a control method. Materials and methods. A total of 145 respondents who underwent a randomized biopsy of the prostate in combination with targeted techniques were divided into 3 samples in accordance with the methods of targeted biopsy. In the results, the detectability by targeted methods was compared with each other and with a randomized biopsy as a control method. The results were subjected to statistical processing in order to form the conclusions of the study. Results. The detection rate of prostate cancer in the cognitive biopsy group was 64.4%, in the histofusion group - 51.1%, in the cognitive biopsy with histofusion group - 69% (p<0.05). The detection of PCa when comparing positive targeted biopsies did not differ statistically significantly between the methods (38 and 36%, p=0.05). The percentage of positive biopsies was higher with histofusion biopsy (34.2%) than with cognitive biopsy (29.7%), the incidence of clinically significant cancer was higher according to the results of targeted methods compared with randomized biopsy (73% vs 37.5%, p<0.05). The highest complication rate with the combined use of the studied targeting techniques was 13.6%, while all complications belonged to the 1st category according to Clavien-Dindo. Conclusion. To optimize the diagnosis of prostate cancer, it is advisable to use a combination of targeted and “randomized” cores. The combination of the targeted methods studied has been shown to be effective and safe. Carrying out a histofusion biopsy using a unified technique allows obtaining information on the clinical and morphological characteristics of prostate adenocarcinoma, which in terms of prognostic value is practically not inferior to the data of a cognitive biopsy performed taking into account the results of MRI. The use of targeted prostate biopsy methods increases the detection of clinically significant prostate cancer without adversely affecting the safety of the procedure in conjunction with standard prostate biopsy.
Consilium Medicum. 2020;22(12):69-73
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Sarcoidosis induced by a color tattoo

Golousenko I.Y.


The article describes a case of skin sarcoidosis that began 3 years later at the site of a colored tattoo with further involvement of the intra-thoracic lymph nodes and pulmonary interstitium in the pathological process. Data on the composition of paints used for tattooing, the role of deposition of antigenic material in the dermis, leading to a specific immune response, are presented. The clinic and diagnosis of this form of sarcoidosis are described in detail.
Consilium Medicum. 2020;22(12):74-76
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Medical and social assistance elderly persons (literature review)

Korolev M.A.


Providing medical and social assistance to elderly people requires a special approach due to the age and social characteristics of this population. Due to the steady aging of the population, more and more people in this age group require special services. The analysis of the literature shows that the main problems in this area are the insufficient number of inpatient medical and social institutions, understaffing of outpatient clinics with geriatric doctors, the lack of medical social workers, the need to improve the quality of care for geriatric patients, the development of infrastructure and modern equipment.
Consilium Medicum. 2020;22(12):77-80
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Features of senile asthenia syndrome and systemic interleukin profile in elderly patients with combined glaucoma and cataract

Yablokov M.M.


The syndrome of senile asthenia in elderly patients with combined glaucoma and cataracts on the background of interleukin imbalance has not been practically studied. Aim. To study the features of senile asthenia syndrome and systemic interleukin profile in elderly patients with combined glaucoma and cataract. Materials and methods. In clinical conditions, the senile asthenia syndrome was studied in 220 patients aged 60-74 years with primary glaucoma combined with cataract, using the questionnaire "Age is not a hindrance". The content of interleukins was determined in the blood by flow cytometry. Results. Senile asthenia syndrome among elderly patients with combined glaucoma and cataracts was detected in 33.1% of cases, with senile preasthenia syndrome - in 30.9% of cases. The value of the senile asthenia index is 0.53±0.07, which corresponds to severe senile asthenia. The formation of senile asthenia in the examined patients with comorbid ophthalmic diseases is mainly due to the presence of chronic diseases, low self-esteem of their own health and inability to walk fast. Changes in the systemic interleukin profile in elderly patients with glaucoma and cataracts are characterized by hyperproduction of anti-inflammatory interleukins and, above all, blood interleukins 17 and 2, as well as a significant decrease in the content of anti-inflammatory interleukins. Conclusion. Therefore, the presence of senile asthenia syndrome in elderly patients with glaucoma and cataracts is associated with an imbalance of interleukin status.
Consilium Medicum. 2020;22(12):81-83
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Clinical-functional features and problems of rehabilitation in patients with osteoporosis of the elderly age in combination with accompanying pathology

Dymnova S.E., Sergeeva V.V.


Osteoporosis is one of the most common metabolic diseases of the skeleton that develops with age. Close attention to osteoporosis is explained by its high prevalence, as well as often severe medical, social and economic consequences, in the form of fractures of the vertebrae and peripheral bones, which lead not only to disability, but also high mortality, especially among elderly patients. To date, there is no unified and clear method of treatment and rehabilitation of patients of older age groups, taking into account their clinical and functional characteristics against the background of concomitant diseases. As a result, many patients do not receive the treatment they need, or the effect of treatment is often lower than expected. Aim. To analyse of clinical and functional characteristics, quality of life and the main directions of rehabilitation of elderly patients with osteoporosis in combination with concomitant pathology in the form of impaired carbohydrate metabolism. Materials and methods. The study included 188 elderly patients diagnosed with osteoporosis. The control methods were general clinical examination, ECG and 24-hour ECG monitoring, ECHO CG, analysis of BMD using dual-energy X-ray absorptiometry - densitometry (dualenergy X-ray absorbtiometry - DXA). Assessment of the degree of development of the atherosclerotic process by ultrasonic duplex scanning (USDS). In order to determine the structural and functional state of the abdominal organs, all patients underwent ultrasound examination. All patients were examined by related specialists: an ophthalmologist, neurologist, cardiologist. To diagnose diabetic neuropathy, the following diagnostic scales were used: the Neuropathy Symptom Score (NSS). The quality of life (QOL) of patients was assessed using the MOS SF-36 questionnaire (modified version for Russia). Results. The features of the clinical picture of osteoporosis, complicated and not complicated by pathological fractures of various localization, are highlighted, taking into account the age characteristics of patients and the influence of concomitant pathology. Difficulties in the treatment and rehabilitation of patients with osteoprosis and its consequences, accompanied by limitation of physical activity, pain syndrome, psychoemotional disorders, resulting in a decrease in the quality of life, are described. Conclusion. Modern methods of treatment and rehabilitation provide great opportunities for restoring working capacity and significantly improving the quality of life in patients with osteoporosis and its consequences. However, existing programs of treatment and rehabilitation should be developed individually, taking into account age, severity of structural and functional disorders, as well as the presence and severity of concomitant diseases.
Consilium Medicum. 2020;22(12):84-88
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Impact of rehabilitation measures on cognitive dysfunction in older patients after surgical treatment of nuclear cataract

Popova E.V.


Background. The high prevalence of nuclear cataracts in older age groups is accompanied by a simultaneous decrease in cognitive abilities as a result of this ophthalmic disease, and other General somatic polymorbid pathology. Aim. To study the cognitive abilities of elderly and senile patients with nuclear cataracts during medical rehabilitation. Materials and methods. In clinical conditions, 68 elderly and senile patients with nuclear cataract underwent femtolaser-assisted cataract phacoemulsification with intraocular lens implantation, and in the postoperative period, medical and non-drug rehabilitation was performed (the main group). The control group consisted of 65 patients with nuclear cataract of the same age who also underwent the above-mentioned surgery without rehabilitation measures. The MMSE scale was used to assess cognitive impairment. Results. 9 months after surgical treatment, the cognitive status of patients in the main group improved from 17.4±0.2 to 20.7±0.3 points (p>0.05). Moderate initial cognitive dysfunction in patients of the main group changed to mild after 9 months, while in the control group it remained the same. At the same time, the proportion of patients with moderate cognitive impairment decreased significantly in the main group from 61.71±5.9% before rehabilitation to 13.2±4.1% after it was completed, and the number of patients with no cognitive deficit increased (p<0.001). In the control group, the number of patients with moderate cognitive impairment decreased from 60.0±6.0 to 46.2±6.2% (p>0.05). Conclusion. The implementation of rehabilitation measures in the postoperative period helps to improve the cognitive status of older patients with nuclear cataracts.
Consilium Medicum. 2020;22(12):89-92
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Comorbid patient with bronchopulmonary pathology: focus on microcirculation disorders

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Respiratory diseases are highly prevalent, represent one of the leading causes of mortality worldwide and are characterized by high levels of comorbidity, which all creates certain difficulties for their diagnosis and treatment. The common link in pathogenesis of respiratory diseases and concomitant pathologies are micro-circulatory disorders. It was that issue the symposium "Comorbid Patient with Bronchopulmonary Pathology: Focus on Microcirculation Disorders" was dedicated to. It was held within the framework of online XXX National Congress on Respiratory Diseases (October 27-30). Leading pulmonologists of Russia made presentations at the symposium: Professor V.I. Trofimov (St. Petersburg), professor I.I. Nestorovich (St. Petersburg), employee of the Department of General Medical Practice of the FSBEI of HE “acad. I.P Pavlova First St Petersburg SMU" O. A. Lazovskaya (St. Petersburg), employee of the Inpatient Emergency Department of the Research Institute of Surgery and Emergency Medicine of the FSBEI of HE “acad. I.P. Pavlova First St Petersburg SMU" A.A. Lebedeva (St. Petersburg).
Consilium Medicum. 2020;22(12):93-96
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Venous Thromboembolism: What's New in Treatment and Prevention"

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Prepared with the support of Pfizer.
Consilium Medicum. 2020;22(12):97-101
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New data in the treatment of patients with atrial fibrillation

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Prepared with the support of Pfizer.
Consilium Medicum. 2020;22(12):102-109
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Chronic heart failure 2020: new treatment options

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Consilium Medicum. 2020;22(12):110-112
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Cardiology 2020. The patient with chronic heart failure: a new trajectory of life

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The issue of helping patients suffering from chronic heart failure brought together leading cardiologists to participate in the satellite symposium “A patient with chronic heart failure: a new trajectory of life”, held as a part of Russian National Congress of Cardiology with the support of AstraZeneca.
Consilium Medicum. 2020;22(12):113-114
pages 113-114 views

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