This review deals with the necessary and relevant measures for primary and secondary prevention of cardiovascular diseases in Russia. The latest European and American guidelines emphasize that statins are the main class of drugs to be used to improve prognosis. The use of rosuvastatin is justified among the categories of moderate and high risk of developing cardiovascular complications, especially in severe hypercholesterolemia. The use of acetylsalicylic acid is undoubtedly useful for the secondary and, which is more controversial, for the primary prevention of cardiovascular diseases. Over the last few years, major clinical studies on the prevention of cardiovascular, hemorrhagic and oncological complications enable to rely on the expediency of combined, safe use of rosuvastatin and acetylsalicylic acid in individuals over 50 years of age with moderate and high cardiovascular risk. The use of both drugs in one tablet (the original drug Rosulip ASA®, EGIS Pharmaceuticals PLC, Hungary) will significantly increase the compliance with the vital therapy and significantly expand the use of rosuvastatin in clinical practice, which means further reduction in morbidity and mortality from atherosclerotic cardiovascular diseases.

The review focuses on the main aspects of the use of antithrombotic agents in women during pregnancy and lactation. It summarises the reasons for frequent development of gestational hypercoagulable state, which provokes some obstetric complications (preeclampsia, etc.) and increases the possibility of the occurrence of serious clinical situations such as lower extremity deep vein thrombosis and pulmonary embolism, thrombotic/thromboembolic complications in thrombophilia and antiphospholipid syndrome of various genesis, as well as prosthetic heart valves. It provides a brief description of antithrombotic agent groups and advanced approaches to the selection of antithrombotic agents in pregnant and lactating women. This article discusses in details individual clinical situations during which the agents under discussion may be used during pregnancy and lactation (prevention of preeclampsia, treatment of thrombotic and thromboembolic complications, prophylaxis of the latter, if patients are required to be on bed rest for more than 24 hours, planning for caesarean section and epidural anaesthesia, and in thrombophilia, antiphospholipid syndrome, prosthetic heart valves) according to the current Guidelines.

Pharmacotherapy of insomnia is an integral part of the treatment of this clinical syndrome. The range of drugs used for the treatment of sleep disorders is quite extensive, and not all of them are “true” sleeping pills”. Such pills often belong to the various classes of psychotropic medications. Advanced sleeping pills taken in compliance with the necessary rules provide the necessary sleeping effect without accompanied negative changes in the sleep structure and the quality of the subsequent waking. The domestic and foreign studies, the leading professional community guidelines (the Russian Society of Somanologists – 2016, the European Sleep Research Society – 2017, the American Academy of Sleep Medicine – 2017, the American College of Physicians – 2016) show that normalization of sleep in patients with insomnia by various methods, including pharmacotherapy, neutralizes its negative effects, improves the adaptive capacity of the individual and prevents the chronic sleep disorders with severe adverse effects.

The article highlights the issues of pharmacotherapy of Alzheimer’s disease based on the guidelines of the USA National Institute on Aging. It discusses the potential of early diagnosis in preclinical stages of the disease using laboratory and betaamyloid neuroimaging markers, neuronal damage. The role of NMDA receptors antagonist memantine in the regulation of excitotoxicity in dementia of the Alzheimer’s type was determined. The efficacy of memantine approved in the US and Europe for the treatment of moderate and severe Alzheimer’s disease is demonstrated. The paper notes its compatibility with other drugs used in the combination therapy, favourable safety profile and good drug tolerance.

The review of modern works of russian and foreign authors on a subject of gender features of the back pain is carried out. Data of own researches of gender features and results of treatment with Dexketopropheni are provided. Authors draw a conclusion that when developing the plan of therapeutic actions it is necessary to take into consideration a difference in approaches to treatment of men and women.

Spinal disorders are one of the leading causes of disability worldwide. Back pain is one of the most important factors that reduce the patients’ quality of life. The right choice of pharmacotherapy in conjunction with other medical technologies is the key to successful treatment. In addition to drugs that relieve pain, much attention should be paid to the restoration of cartilage in the spine. This paper presents a comparative pharmacoeconomic analysis of the use of chondroitin and glucosamine as the adjunctive therapy.

Up to 646,000 people worldwide die from seasonal influenza-related respiratory illnesses each year. According to new estimates by WHO, the prevalence of three strains of the influenza virus is expected in the 2017-2018 epidemic season:  Influenza A (H1N1), A (H3N2), and influenza B viruses. In this regard, the issue of prescribing rational etiotropic antiviral therapy becomes particularly topical. Neuraminidase inhibitors are currently the first line drugs that are recommended by WHO for the treatment and prevention of influenza.

The article presents the diagnostic and therapeutic features of acute tonsillopharyngitis (ATP) taking into account the viral and bacterial aetiology of the disease. It discusses the cases when the systemic antibacterial therapy should be prescribed, considers various approaches to assessing the aetiology of ATP, evaluation of clinical signs and symptoms included in the Centor scores and rapid diagnostics tests. It stresses that the use of antibiotics should be strictly justified taking into account the proven bacterial aetiology of the disease or suspicion on the same. In most cases, systemic antibiotic therapy is not necessary, since viral tonzillofaringitis is more common than bacterial. At the same time, drugs for local therapy - antiseptics, topical antibiotics, nonsteroidal anti-inflammatory drugs, which reduce local manifestations of inflammatory reaction in the pharynx, become more important. The efficacy of Septolete total tablets containing a non-steroidal anti-inflammatory agent benzidamine and an antiseptic agent cetylpyridinium chloride is proved on clinical cases.

The paper is devoted to the problem of clinical efficacy and pharmacoeconomic evaluation of Spiolto Respimat. The results of clinical trials prove that Spiolto Respimat in patients with COPD improves spirometric values, symptoms of dyspnea and health-related quality of life, compared with placebo, tiotropium bromide (5 μg) and olodaterol (5 μg). According to conducted in European countries pharmacoeconomic analysis «cost-utility» therapy with Spiolto Respimat results in quality-adjusted life-year gained comparing to tiotropium bromide (5 μg). Also Spiolto Respimat is an effective option of COPD therapy comparing to the other combinations of long-acting muscarinic antagonist – long-acting beta2-adrenergic agonist.

Despite numerous activities, healthcare efforts and scientific advances, acute respiratory viral infections (ARVIs) and influenza remain poorly controlled diseases. This is due to the polyethyologicity of viruses, the mixed nature of infections, the lack of specific therapy, except for vaccination against the flu, virus antigenic variation, high contagiousness and development of antiviral drug resistance.

The article provides the peculiarities of mycoplasmal pneumonia and state-of-the-art capability of its laboratory diagnostics. Problems and mistakes in the clinical diagnosis of mycoplasmal pneumonia, difficulties in differential diagnosis between mycoplasmal and mild typical pneumonia and approaches to therapy, taking into account the growth of antimicrobial drugs resistance in pathogens are illustrated by two clinical follow-ups.

The article presents modern views on the microbiological findings of acute purulent sinusitis and acute purulent otitis media in identified in conjunction with clinical course. It shows the role of Haemophilus influenzae in the development of a protracted, recurrent, and chronic course of the process. The therapeutic potentials of Pancef (cefixim) for the treatment and prevention of these conditions are presented.

Epidemiological studies conducted throughout the world show that the inflammatory diseases of the nasal cavity and paranasal sinuses are the leading cause of otorhinolaryngology (ENT) hospital admissions and outpatient clinic referral. Although the most common cause of acute rhinosinusitis is viral infection, antibiotics are prescribed in more than 80% of cases, which may lead to the development of antimicrobial resistance. The topical inhalation therapy with PARI SINUS device (сompressor Pari Sinus and Pari LC Sinus nebuliser) may provide better treatment options for patients who suffer from the diseases of the nasal cavity and paranasal sinuses. Purpose of the study is to evaluate the efficacy of topical inhalation treatment of acute bacterial rhinosinusitis using pulsating aerosol in comparison with systemic antibiotic therapy. Materials and methods. 60 adult patients at the age from 19 to 62 years with the diagnosis uncomplicated moderate acute bacterial rhinosinusitis has been included in opened randomized controlled trial. 30 patients have been treated with nasal nebulizer inhalation with N-acetyl-cysteine in combination with thiamphenicol on 500 mg once daily for 7 days using pulsating aerosol. Pulsating aerosol was obtained by PARI SINUS device. Controls - 30 patients have been treated with antibiotic therapy of acute bacterial rhinosinusitis using 875/125 mg oral amoxicillin/clavulanate twice daily for 7 days. The result was evaluated by the dynamics of the symptoms of acute bacterial rhinosinusitis (nasal congestion, blockage, facial pain and reduction of smell), active anterior rhinomanometry and nasal endoscopy. Results. For main symptoms of acute bacterial rhinosinusitis was no significant benefit of antibiotic therapy as compared to topical inhalation therapy using pulsating aerosol. Both treatment options were effective against acute bacterial rhinosinusitis, which is confirmed by the improvement of symptoms, active anterior rhinomanometry and nasal endoscopy. Conclusion. The topical nebulizer therapy of acute bacterial rhinosinusitis may provide better treatment options, because systemic antibiotics can be associated with different adverse effects.

Taking into account the numerous metabolic functions of microflora, violation of its colonization resistance is considered as a trigger factor in the development of a number of different diseases. Thus, studies conducted in recent years demonstrate a significant relationship of dysbiotic intestinal microflora disorders with the pathogenesis of NAFLD, caused by damage to the mitochondria. It is proved that mitochondrial dysfunction plays a significant role not only in the development of SEX, which leads to membrane damage, necrosis and apoptosis of hepatocytes, but also to the progression of steatosis. Clinical signs of acute and chronic liver disease suggests that, regardless of their etiology, clinical manifestations, come to the fore phenomena are typical for mitochondrial dysfunction. The data presented in the article demonstrate the importance of dysbiotic changes in the development of mitochondrial dysfunction, the formation of steatosis in non-alcoholic fatty liver disease, with its subsequent transformation into steatohepatitis and progression to fibrosis and cirrhosis.

Gastroesophageal reflux disease is one of the most common diseases of the gastroenterological profile. There are several forms of illness, including non-erosive forms, erosive esophagitis, Barrett esophagus. The article provides an overview of the drugs used to treat the erosive form of GERD and long-term supportive therapy from the perspective of evidence-based medicine. The main objectives of the treatment of erosive esophagitis are to heal esophagus mucosa lesions, achieve long-term remissions, and normalize the patients’ life quality. The proton pump inhibitors (PPIs) have steadily become the mainstay in treatment of erosive esophagitis. These drugs are used at all stages of treatment, both for the relief of symptoms and healing of oesophagus mucosa lesions, and as the long-term supportive therapy. Due to the need for long-term use of IPI, their safety are open to question. The recent publications reported an increased risk of chronic kidney disease, myocardial infarction, pneumonia, calcium, magnesium, iron, vitamin B12 deficiency. At the same time, the analysis of studies underlying the risks of long-term PPI use detected some significant disadvantages that reduce their evidence-based value. This paper provides data on the most frequently discussed risks and critical assessment of them.

While use of high doses of alcohol is a proven risk factor for various organs and systems, use of small and moderate doses bears evidence of the opposite data. Thus, regularly drinking a small amount of alcoholic drinks could reduce a person’s chances of developing coronary heart disease, stroke, type 2 diabetes, non-alcoholic fatty liver disease, osteoporosis and some other diseases, and also reduce overall mortality. Small doses of alcohol suppress the inflammation and peroxidation, normalize hemocoagulation, improve the lipid profile, favourably affect blood vessel tone and the insulin-signaling pathways. Positive effects of wine are the most studied, which is usually explained by the fact that it contains polyphenols, while positive effects of beer are studied to a lesser extent; however, it should be borne in mind that the studies were aimed at different types of alcoholic beverages. Thus, it can be considered inappropriate to completely prohibit the use of alcohol to persons without dependence and specific organ damage.

This review article was designed to systematize the literature data concerning the role of targeted therapy in the treatment of patients with inflammatory bowel diseases. It presents the data of the latest randomized clinical trials and meta-analyses evaluating the efficacy and safety of targeted drugs for the treatment of Crohn’s disease and ulcerative colitis.

Chronic pain in joints and back is almost constant component of the comorbidities. The comorbidities are caused by the systemic inflammation syndrome, which activity affects the degree of pathology mediating the progression of chronic pain as well. The pathogenesis pattern of systemic inflammation differs in having the whole range of transcriptional proteins, which activity is associated with the level of synthesis of pro-inflammatory mediators. Many recent studies showed that vitamin D3 deficiency and insufficiency increases the activity of these transcriptional proteins, increasing the progression and intensity of comorbidity components, including pain syndrome. Fundamental research demonstrates anti-inflammatory and anti-erosive vitamin D3 effects in cartilage and bone tissue.

Diabetes mellitus (DM) is a severe chronic disease which prevalence continues to increase steadily worldwide. According to the latest data, the number of patients with DV worldwide has more than doubled over the past 10 years and by the end of 2015 reached 415 million people. The government expenditure on the treatment of patients who have developed diabetes complications significantly outweigh the expenditure on patients without complications. Timely diagnosis, efficient and safe modern therapy, including insulin therapy with the use of next generation insulin, make it possible to optimize control over the economic burden of DM.

Nonalcoholic fatty liver disease (NAFLD) – a common chronic disease of the liver, the main feature of which is the accumulation of fat in hepatocytes, is not related to alcohol abuse. NAFLD is associated with obesity, especially abdominal, metabolic syndrome and various metabolic markers of risk for cardiovascular disease and type 2 diabetes, which affects the incidence, prognosis and life expectancy of patients with obesity. This lecture describes the main causes of the disease, its pathogenesis, clinical presentation, diagnosis and treatment.

Experts believe that self-monitoring of glycemia can prevent episodes of hypoglycemia, adapt the dose of drugs and the level of physical activity, and ensure the prevention of acute and late complications of diabetes. However, there is still disagreement over the need for and frequency of self-monitoring of glycemia in patients with type 2 diabetes mellitus on tableted and combination hypoglycemic therapy regimens. And the development of high-tech methods for managing glycemia in patients with type 1 diabetes mellitus makes the prospects for using conventional self-monitoring methods dubious. The attitude of patients towards self-monitoring of glycemia remains controversial. 

The paper presents data on the prevalence of PVI, the recurrence rate of this infection. It discusses various therapy protocols of the disease including the use of destructive methods in the treatment and combination of the above methods with immunomodulating therapy. The own observation data are provided.

Management of patients with alopecia is still a challenging task. Minoxidil is a pyrimidine derivative, a potent KATP channel opener, and has been shown to act as a vasodilating agent. Minoxidil enhances the synthesis of growth factors, not only VEGF (vascular endothelial growth factor), but also FGF (fibroblast growth factor), IGF-1 (insulin-like growth factor), which stimulate growth processes in the hair follicle and trigger the anagen phase. The topical minoxidil formulations have been proven to be particularly efficient to a greater extent in androgenic alopecia (AGA) and to a lesser extent in nasal alopecia (GA).The best hair regrowth has been detected in early stages of alopecia. It generally takes 4-6 months before results are visible, and 12 months to stabilize the hair growth, which is maintained by a regular use of minoxidil. The level of the sulfotransferase enzyme in the hair follicles may predict the outcome of topical minoxidil therapy. The topical use of minoxidil does not cause any systemic side effects, and adverse effects in the form of skin reactions, irritation and dryness are short-term and rare. The article also presents the data of its own clinical experience in using minoxidil for the treatment of alopecia.

The article presents the results of long-term prospective clinical research on uteroplacental and fetal blood flow of pregnant women. In the research they made a special in-depth analysis of single disturbance of blood flow in uterine artery basin according to Doppler measure data after 18-week gestation. They connect uteroplacental perfusion disturbance with chronic infection nidi (focus) of different location in the organism of pregnant woman. They made comparative analysis of correcting therapy, when there is an uteroplacental perfusion disturbance, including detection and elimination of persistent infection nidi (asymptomatic forms as well), and also application of medicaments that influence vascular tone and rheological properties of blood. They showed efficiency of Diripidamol when used for idiopathic disturbances of uteroplacental perfusion.

Healthy aging (anti-aging) involves the prevention of illness and disability, keeping mental and physical activity in tip-top shape, maintaining the meaning and purpose of life. Women refuse to age and want to look younger as long as possible. The skin is the only organ which condition can be assessed visually, a peculiar mirror that reflects age-dependent changes that take place in the human body and the state of health as a whole. All regular age-dependent changes that occur at the cellular level happen in the skin, therefore, it is often used as a convenient model for studying the biological mechanisms of human aging as a whole [1]. An increase in life expectancy and a stable age of menopause has led to the fact that modern women spend more and more years in postmenopausal state. The direct effects of menopause-related sex hormone production slowing down include loss of fertility, vasomotor symptoms, and the long-term ones such as osteoporosis, cardiovascular disease (CVD) and skin aging, which causes marked discomfort, especially for women [2, 3].

Sociological aspects of psychological mechanisms of medical errors are discussed. Features of medical errors of our time are given. On the basis of the concept and researches of the Nobel Prize laureate D. Kahneman characteristics of conditional cogitative Systems (System 1 and System 2) are stated. In relation to clinical practice options of cognitive mistakes according to D. Kahneman are described (cognitive illusion; wrong coherence; cognitive ease; availability heuristics; effect of substitution; representativeness errors; effect of priming; mistakes of experts). The psychology of medical errors is a medico-social problem.

The internal picture of the disease is “everything that is experienced and underwent by the patient. The whole complex of feelings, the general state of health, self-observation, his idea of his illness, its causes ... the entire vast world of the patient, which consists of the very complex combinations of perception and sensation, emotions, affects, conflicts, mental experiences and traumas” [4–6]. The internal picture of the disease should be viewed as a single acting system, all components of which are closely interrelated and constantly interact with each other. When analysing the structure of the internal picture of the disease, it is important not only to separate its individual components, but also to differentiate them.

The article is intended for starting primary care practitioners and senior students of medical schools. The authors provide the main principles of choosing and prescribing drugs in general medical practice on the ground of personal medical and teaching experience, and modern domestic and foreign literature. Practical advice is provided with up-to-date references to available electronic resources containing important background information on the key issues of modern pharmacotherapy. Reading the presented material will help to avoid making some typical mistakes and enhance the professional competence of a practitioner who starts working in the primary health care.

This paper deals with the second phase of the prospective, randomized comparative study of the efficacy and safety of the hybrid eradication therapy (ET) regimen in patients with H. pylori-associated gastroduodenal ulcer. Objective: Evaluation of the acid-forming function of the stomach with a pharmacological proton pump inhibitor (PPI) test in patients with H. pylori-associated gastroduodenal ulcer disease and no response to eradication therapy. Materials and methods. 19 patients were enrolled in this study after the failed ET using any of the following three regimens: standard triple regimen, four-component therapy with bismuth agents, hybrid regimen; in all regimens, omeprazole (20 mg b.i.d.) was used as an IPP. All patients underwent a 48-hour intragastric pH-meter (Gastroscan-GEM device, Istok-System, Russia) to assess the initial state of the acid-forming function of the stomach during the first day and the subsequent pharmacological PPI test (omeprazole 20 mg b.i.d.) on the second day. The minimum, maximum and average pH values in the cardia and body of the stomach, as well as the time with pH> 4 in the body of the stomach during the entire study period (48 hours) were analysed. Results. Median time average with pH> 4 in the body of the stomach for the first day of the study (before PPI administration) was 1.0 hour (IQR from 0.0 to 1.5), and against a pharmacological test – 15.5 hours (IQR from 11.1 to 16.5). At the same time, an adequate alkalization of the gastric environment under pressure of IPP therapy was identified in 12 patients, when the pH level> 4 in the body of the stomach was maintained for 16–17 hours. In 7 patients, pH> 4 was maintained for less than 16 hours, which is a symptom of insufficient antisecretory effect. During this study, no PPI resistance was revealed. The conclusion. Evaluation of the state of the acid-forming function of the stomach with pharmacological tests upon conduct of the 48-hour pH-metry makes it possible to evaluate the antisecretory effect of the used PPI and, thus, to predict the probability of effective eradication.

This article presents the clinical case of Lyell’s syndrome in a 35-year-old patient who was hospitalized in an infectious disease department. This example justifies the need for increased alertness to infectious disease doctors and general practitioners in interpreting clinical symptoms of the disease.