News. Findings and events
CARDIOLOGY
The article presents the results of the study of endothelial function (EF) and lipid spectrum in 114 patients with chronic rheumatic heart disease (CRHD) during 5 years. The average age of the patients was 58.68 ±0.47 years; 18 men (15.8%) and 96 women (84.2%). Angioscan-01 apparatus was used to study EF. The occlusion index amplitude was reduced in all patients with CRHD. The minimum values of EF in the system of small resistive arteries were in patients with I functional class (FQ of chronic heart failure: 1.39 ± 0.07, and the maximum with II FO 1.73 ± 0.16. In the system of large conductive arteries, on the contrary, more pronounced changes are noted in II FC (-10,36 ± 2,07) and III FC (-8,94 ± 2,23), and the smallest in I FC (1,46 ± 6,69). The augmentation index showed high rigidity of the vascular wall and tended to decrease from the group with FC I (15,65 ± 2,05%) to the group with FC III (13,06 ± 2,35), but the difference was statistically insignificant. The age of the vascular wall varied significantly from 62.88 ± 3.46 years (I FC) to 70.71 ± 2.74 years (III FC). The values of total cholesterol (5.14 ± 0.12 and 5.48 ± 0.20 mm/l, after 5 years) and low-density lipoproteins (2.75 ± 0.09 and 2.72 ± 0.12 mm/l, after 5 years) did not change. Thus, patients with СRHD have EF disorders both in large conductive arteries (phase shift -6.64 ± 1.95 and -4.42 ± 2.29 ms, after 5 years) and in the microcirculation system (occlusion index 1.40 ± 0.09 and 1.46 ± 0.08, after 5 years) without significant dynamics during 5 years of observation.
NEUROLOGY
The article is devoted to the urgent problem of additional methods in the treatment of pain syndromes, in particular a vitamin B complex combined with choline and uridine monophosphate. The use of such complexes in clinical practice is associated with combinational analgesic, reparative, and protective effects. The paper highlights a new direction of therapy based on the uridine monophosphate effect on purine receptors and the indirect effect on nociceptive pain syndromes combined with the protective effect of remyelination and the additional analytical effect of choline in combination with the neurotropic vitamin B complex. The author presents data on a new preparation in this class - dietary supplement Neurouridin (Unipharm), which combined effect is based on the pathogenetic approach and will help strengthen the clinical effects of traditional ionic treatments.
Back pain is one of the most common causes of medical treatment and temporary disability, which makes the problem of rational therapy particularly relevant. The main means of treatment of acute nonspecific back pain (NBS) are nonsteroidal anti-inflammatory drugs (NSAIDs) and myorelaxants. A number of studies have been conducted to evaluate the efficacy and safety of NSAIDs such as dexketoprofen (Dexalgin), which is equivalent to inhibit cyclooxygenase-1 (COX-1) and COX-2, and nimesulide (Nimesil), which preferential inhibits COX-2. The clinical efficacy of dexketoprofen in NBS, osteoarthritis (OA) of different localization was shown. The scheme of administration of Dexalgin is used - intramuscular injections of 2 ml (50 mg) for 1-2 days, then oral administration of 1 tablet or sachet (25 mg) 3 times a day for 3-5 days. The efficiency of Nimesil administration in OA in patients with high risk of complications from the gastrointestinal tract (GIT) is shown. The scheme of nimesil - 1 sachet (100 mg) is used 2 times a day for no more than 15 days. Perhaps the combined appointment of Dexalgin - the first 2 days of injection, then - the transition to oral nimesil 7-10 days.
This review presents and discusses evidence demonstrating the importance of mitochondria and related processes in the pathogenesis of Alzheimer's disease. Mitochondrial dysfunction is currently emerging as a potential therapeutic target in the treatment of Alzheimer's disease and other neurodegenerative diseases. This paper also reviews various drug strategies aimed at mitochondrial dysfunction and the development of oxidative stress.
Pain syndromes in the region of the back are currently a widespread problem. According to our understanding of the pathophysiology, pain can be divided into nociceptive and neuropathic pain, but both of these components are often present in the overall picture of the pain syndrome. The prescription of effective drug complexes based on the pathogenetic dominant of the disease is the priority of the therapeutic strategy for this type of pain.
Every second patient has sleep disorder. Outcomes of decreased quality of sleep lead to serious medical and socioeconomic value. Population studies identify the main causes of sleep problems: stress, poor sleep hygiene, somatic disorders. The effect of stress on sleep is noted by 75% of responders. The most frequently sleep disorders are insomnia, obstructive sleep apnea and restless legs. Treatment of insomnia based on current standards for the management of patients with insomnia. The main methods for the treatment of chronic insomnia are cognitive behavioral therapy, short-term hypnotic pharmacotherapy or a combination of both. Z-hypnotics, benzodiazepine receptors agonists, melatonine and melatonine receptors agonists, antihistamines, antidepressants, neuroleptics, herbal and antiepileptic drugs are recommended for the treatment of chronic insomnia. Most of them are in tablet form. Cases of gradual cancellation of hypnotics, an increase in half-life of the drug and refusal of hypnotic drug for fear of lack of hypnotic side effects control, require individual selection of the dosage. Liquid form (in drops) of doxilamine from antihistamines group -Valocardine®-Doxilamine (Krewel Meuselbach GmbH, Germany) enables convenient dosing with addition potentiation of the effect due to combination with ethanol and mint oil.
BRONCHOPULMONOLOGY
According to the forecast of WHO, by 2020 every second child will have allergic diseases. Allergic rhinitis occupies one of the leading positions in structure of allergic diseases of the person. The special attention of scientific and practical health care to this question is caused by the whole range of both medical, and social aspects. Treatment of allergic rhinitis demands the reasonable and integrated approach considering pathogenesis of a disease.
Allergic rhinitis is a common disease that affects people regardless of age, place of residence and social status. The mucous membrane of the nasal cavity often acts as a portal for allergen entry. The latest data suggest that nearly 30% of humanity are currently suffering from AR. The prevalence of AR varies from 13 to 24% in different regions of the Russian Federation. AR is one of the main risk factors for the development of bronchial asthma, as well as its exacerbations, has a significant negativeimpact on the quality of life. Therefore, the timely start of rational therapy of AR is so important. The article focuses on the drugs for local and systemic treatment of AR, discusses the issue of prescribing different groups of drugs depending on the severity of the course of AR, and shows the pros and cons of different groups of antihistamines. Ebastine is one of the modern antihistamine drugs, to which a brief overview of the treatment of AR is devoted. We can recommend this drug for the treatment of year-round AR.
Respiratory diseases are a widespread group of pathological processes that affect people of different ages. Inflammatory changes of various etiologies on the surface of the respiratory epithelium are accompanied by a violation of mucociliary clearance, and therefore the rate of evacuation of the secret decreases, its production increases, and the rheological properties of the mucin change. Significant accumulation of thick mucus is a clinical feature of many respiratory diseases, including acute rhinosinusitis. Appointment to patients with pathology of the respiratory system of drugs that affect the evacuation, properties and production of mucus, is pathogenetically justified. Phytopreparations GeloMirtol® and GeloMirtol® forte are effective in treating patients with rhinosinusitis of various ages, including children from 6 and 10, respectively. The active component of these drugs - Myrtle standardized - distillate eucalyptus oil (main ingredient - 66% of the total), myrtle, sweet orange and lemon, has a complex mechanism of action, has an expectorant, anti-inflammatory, bacteriostatic effect, helps clean the respiratory tract and restore normal mucous function shell. GeloMirtol® and GeloMirtol® forte simultaneously affect several parts of the development of the pathological process, increasing the results of complex treatment of respiratory diseases.
It is estimated that 50-75% of bronchial asthma cases have mild (intermittent or persistent) severity of asthma. Despite the minimal number of daily symptoms, endobronchial inflammation and a high risk of exacerbations have been demonstrated in a significant proportion of patients. According to the current guidelines, anti-inflammatory drugs - inhaled glucocorticosteroids - maintenance therapy is only added at stage 1, which is characterized by an insufficient level of control and repeated exacerbations due to the use of short-acting в-agonists to be taken as required. Inhaled glucocorticosteroids in low doses become the drugs of choice at stage 2 for patients with mild persistent bronchial asthma. As-needed use of inhaled glucocorticosteroids combined with в-agonists, which has a rapid onset of action (salbutamol or formoterol) may become an alternative to the daily used of drugs. The choice of such type of management should be justified by the low risk of exacerbation (based on an assessment of risk factors for adverse clinical out-comes/exacerbations of bronchial asthma). The as-needed use of such combination can provide a high patient commitment to medical recommendations, create a sufficient anti-inflammatory effect, reduce the likelihood of exacerbations and reduce the risk of adverse effects.
GASTROENTEROLOGY
The principles that we apply to control the functional state of the body are used by the body itself for self-regulation. As we know, at the core of the self-management of the body is a periodic regularity of development of reactions and states of non-responsiveness, the principle of discreteness, etc. It should be highlighted that we achieve the effect precisely because we use the regularities that are inherent to the body itself, and do not act against them. We would like to emphasize the role of the «resonant» energy the body receives from the external environment apparently in accordance with the natural frequencies of the body and its subsystems in various adaptive reactions and states of reactivity. The ability of the body to choose a factor of very small magnitude in a resonant way as a controlling factor makes it possible to self-maintain the state, i.e. is at the core of self-regulation. It also makes it possible to maintain a favourable state in a targeted manner using appropriate efforts of both vibrational and non-vibrational nature.
The relationship between non-alcoholic fatty liver disease (NAFLD) and cardiovascular diseases (CVD) is considered. The main mechanisms for increasing the cardiovascular risks induced by NAFLD are insulin resistance, oxidative stress, endothelial dysfunction and inflammation. Dyslipidemia, arterial hypertension, type 2 diabetes mellitus, often present in patients with NAFLD, also contribute to an increase in cardiovascular risks. It is shown that with the progression of NAFLD, the risk of developing CVDs increases. Mortality of patients with NAFLD is mainly due to the development of CVD complications. Thus, NAFLD should be considered as an independent risk factor for CVD.
Treatment of NAFLD includes lifestyle modification (diet therapy, physical activity), as well as the use of drugs from different groups: omega-3 polyunsaturated fatty acids, statins, S-adenosylmethionine, essential phospholipids, ursodeoxycholic acid, metadoxine, glycyrrhizic acid, vitamin E, herbal drugs. In particular, the use of phospholipides, which has a high safety profile and is well tolerated when used, including with a combination of NAFLD and CVD, is justified.
Acid-dependent diseases are an urgent problem of modern gastroenterology. Antisecretory agents are first-line drugs in the treatment of this pathology, the leaders among which are proton pump inhibitors (PPI). Due to the wide representation of this group of drugs in the pharmaceutical market, the doctor is faced with a choice of destination of a PPI and in most cases the choice is determined by aspects of clinical efficacy, safety and profitability. A number of numerous studies have shown the clinical and economic feasibility of using one of the modern representatives of PPI lansoprazole. The use of this drug is presented in a clinical example.
RHEUMATOLOGY
A large number of studies conducted throughout the world showed that gout and hyperuricemia were independent predictors of a high risk for the development of comorbid pathology, including cardiovascular lesions.
Hyperuricemia is associated with all metabolic syndrome components, such as lipid storage disease, high body mass index, arterial hypertension, glucose metabolism disorders. On the other hand, in addition to the high level of uric acid, gout is characterized by chronic inflammation; the combined effect of these factors has a pathological effect on the vascular bed and is an additional risk factor for the development of atherosclerosis and associated diseases.
This article discusses the possible mechanisms of influence of uric acid levels and gout on the development of cardiovascular pathology, and provides an analysis of works demonstrating the beneficial effect of urate-lowering therapy on outcomes.
Chronic pain among the elderly aged 60 years and above is one of the «big» geriatric syndromes, and has great prognostic significance in relation to cognitive, functional and physical status.
The loss of muscle strength, mass (sarcopenia) is one of the important components of chronic pain syndromes in elderly patients. Pathological findings were demonstrated by own observation of 116 patients in the geriatric unit aged 75,667.98 years (110 women, 94.8%). Most patients had a combination of several geriatric syndromes, an average of which accounted for 6.6. Among them, there were falls - 72 (62.1%), chronic pain - 85 (73.3%), senile asthenia - 51 (43.9%), etc. In most cases, chronic pain was due to osteoarthritis. According to the dynamometry data, a decrease in muscle strength was found in 45.9% of cases, without chronic pain syndrome in 9.7% of cases among patients with chronic pain syndrome. Thus, prevalence rates of decreased muscle strength were higher in patients with chronic pain, than in patients without pain. In addition, a significantly lower walking speed was found, which indicates a poor prognosis in patients of older age groups.
Sarcopenia and chronic pain treatment programs for elderly patients contain a number of evidence points: therapeutic exercises, adequate intake of calories and protein, vitamin D3, reduction of the number of drugs, chondroitin sulfate (Chondrogard), glucosamine sulfate (Sustagard Artro). This program, being multicomponent, should be long and regular.
Endocrinology
The morbidity of diabetes mellitus is steadily increasing worldwide. Most of the patients with type 2 diabetes, many of whom already have complications when diagnosed. Strategy and tactics of treatment of patients with DM2 today are one of the priorities of modern medicine.
The aim of the study. To assess the role of early postoperative examination in the prognosis of cd remission 1 year after TSS.
Patients and methods. 101 Patients (12 men, 89 women, mean age 41,2 years (15-72) with confirmed cd were included. Midnight and morning serum cortisol and plasma ACTH, late night salivary cortisol, 24-h urinary free cortisol (ufc) excretion were performed at the days 2-3 and 12-14 after the TSS. Hypercortisolism remission status was estimated one year after surgery. The optimal threshold values of ACTH and cortisol parameters at 2-3 and 12-14 days after surgery to prediction of cd remission after TSS were calculated by roc-analysis.
Results. One year after surgery cd remission was confirmed in 63 patients, whereas in 38 patients hypercortisolism persisted. Postoperative parameters of cortisol and ACTH secretion had comparable high specificity and sensitivity at 2-3 and 12-14 days after surgery for prediction cd remission.
Conclusion. According to our data, morning serum cortisol ≤388 nmol/l and plasma ACTH ≤20 pg/ml at 2-3 d after TSS may be used as a prognostic criterion for cd remission 1 year after surgery with sensitivity and specificity 94,9%, 75,9% and 83,3%, 95,8%, respectively.
DERMATOLOGY
One of the goals of psoriasis therapy is to achieve sustainable remission. Currently, genetically engineered biological drugs are most effective in the treatment of psoriasis. However, there is a certain proportion of patients with insufficient efficiency of genetic engineering biological therapy. One of the reasons for reducing the therapeutic response in patients with psoriasis may be the presence of metabolic syndrome.
Objective: to study the therapeutic efficacy of ustekinumab in patients with psoriasis with metabolic syndrome.
Materials and methods: 52 patients with plaque psoriasis receiving ustekinumab therapy were observed: 25/52 (48.0%) patients with metabolic syndrome, 27/52 (52.0%) - without metabolic syndrome. The proportion of patients who reached PASI75 by the 12th week among patients with psoriasis with and without metabolic syndrome was 17/25 (68.0%) and 23/27 (85.2%) (p>0.05), respectively; 24th week - 15/25 (60.0%) and 25/27 (92.6%) (p<0.05), respectively; 48th week-14/25 (56.0%) and 24/27 (88.9%) (p<0.05).
Conclusion: therapeutic efficacy of ustekinumab is higher in patients with psoriasis without metabolic syndrome than in patients with metabolic syndrome.
Topical antimycotic agents are used in the treatment of foot mycosis. Numerous studies have shown the efficacy of terbinafine. Fungistatic activity of the medication is provided by blockade of action of squalene epoxidase enzyme and subsequent inhibition of squalene transformation into squalene epoxy. Further accumulation of squalene inside the fungal cell with its subsequent rupture and death occurs. Various medicinal forms of terbinafine have been developed, which can be used at different stages and at different forms of foot mycosis. The present study shows high efficacy and safety of 1% film-forming solution of Lamisil UNO in therapy in patients suffering from foot mycosis for a long time. The unique form of the drug allows limiting treatment to one application.
GYNECOLOGY
Exclusive breastfeeding in the first 6 months of life is recommended by the World Health Organization, since breast milk provides the baby with all the nutrients and elements necessary for normal development and growth. In the first weeks of lactation, women can often face a number of problems, such as pain in the breasts and nipples, nipple cracks and mastitis. These problems make feeding difficult and, in some cases, lead to the cessation of breastfeeding. Mastitis is a terrible complication of the postpartum period and the basis for the cessation of lactation. Counseling and support of mothers, prevention of lactostasis, nipple cracks and teaching techniques to properly attach the child, reduce the complications of lactation. Timely diagnosis and adequate therapy of mastitis, helps to preserve breastfeeding and improve the health of the mother and child.
The article represents the main problems of diagnosis and treatment of patients with vulvovaginal candidiasis (VVC). It is noted that C. albicans causes candidiasis in 75-80% of cases. Clinical forms of VVC include acute VVC and chronic (recurrent) vulvovaginal candidiasis (HRVVC). The main diagnostic approaches in the treatment and prevention of disease recurrence are described. The article presents data on the use of Clotrimazole vaginal cream 2% (Esparma) to treat VVC.
The high recurrence rate, despite antimicrobial therapy, led to the search for alternative therapies that could be prescribed in conjunction with drugs already used or as monotherapy. Therefore, in cases of dysbiosis, logical and physiological, according to the regulatory influence on the microflora and the mechanism of therapeutic activity, is the appointment of probiotics. The article provides case studies of the use of probiotic Vagilak.
PHLEBOLOGY
The article discusses up-to-date concepts of the prevalence, pathogenesis and clinical manifestations of chronic venous diseases and chronic venous insufficiency of the lower extremities. It discusses the current views on the mechanism of action of various phlebotrophic drugs used in the symptomatic treatment of chronic venous diseases of the lower extremities and chronic venous insufficiency, updates data on the advantages of micronized purified flavonoid fraction for the treatment of all clinical classes of chronic venous diseases.
UROLOGY
Different statistical studies showed that chronic prostatitis (CP) is the most common urological disease among men aged 20 to 40 years. The etiological nature of intracellular pathogens in the development of CP is currently finding more and more evidence. The prostate extract acting on various pathogenesis units is of particular interest, taking into account the variety of pathogenetic mechanisms of the development of CP. A study of the efficacy and safety of prostate extract (rectal suppositories) combined with josamycin was conducted. Findings. Patients with CP caused by intracellular pathogens received josamycin therapy. The prostate extract was included in the treatment (rectal suppositories) in Group I. Both groups showed a significant improvement in symptoms and quality of life on the NIH-CPSI scale, both in total and in individual domains, and the differences between the groups were statistically insignificant. The number of leukocytes in the prostate gland secret reduced more significantly in the active treatment group.
Thus, the use of prostate extract increased the clinical efficacy of treatment, which correlates with data from the previous studies.
Practice
Average group of patients in North-West region of Russian Federation has a Vitamin D deficiency condition. It is characterizes in decrease of straight and mediated effects of Vitamin D on various viscus systems. Authors put forward the thesis about specific mechanisms of inflammation and reparative healing in patients with Vitamin D deficiency and orofacial region diseases. Retrospective analyses of studies has been performed. Data has been ordered and presented in this article.
DISSERTANT
Objective: to assess the climatic and seasonal characteristics of vitamin D status in the population of different cities of the Russian Federation.
Material and methods. The study was conducted from September 2014 to June 2018. Surveyed 104321 serum of patients (one hundred four thousand three hundred twenty-one) of the 105 cities of the Russian Federation. Of them women: 80738, which was 77.4% of men 23583 - 22,6%. To determine the concentration of 25(OH)D in serum electrochemiluminescent method was used. The analysis was performed on the automatic analyzer Cobas 8000 (Switzerland).
Results. The concentration of calcidiol (25 (OH) D) in patients living in cities located in different climategeographic regions of the Russian Federation varied from 3.0 to 536.10 ng/ml. the Average concentration of 25(OH) D was the lowest in Makhachkala (19.26 ± 0.53 ng/ml), the maximum in Surgut (42.5 ± 0.44 ng/ml). Only 18% of the cities average concentration of 25(OH)D reached the lower limit of positive level of 30 ng/ml. More than half of the patients (60,1-81.7 per cent) of all regions, the concentration of 25(OH)D was below normal - less than 30 ng/ml. Vitamin d deficiency (<20 ng / ml) was found in almost a third of the Russian population (24.1-65.7%). The statistically significant highest level of 25(OH)D was detected in the autumn months (30,30 ± 0,30 ng/ml), and the lowest - in the spring (27,11 ± 0,25 ng/ml). The frequency of serum detection, where calcidiol concentration was lower than normal (<30 ng/ml), even in autumn was observed in more than half (57.5%) of the entire population.
Conclusion. Thus, the data indicate a serious deficiency and even deficiency of vitamin D in the population of the Russian Federation. Us there is no correlation between the average level of vitamin D in the blood serum and the geographical latitude of the settlement. However, the dependence of the concentration of 25 (OH) D on the time of year, when the patient's blood is taken for analysis.
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