The articles deals with the analysis of clinical situations in patients with atrial fibrillations in the aspect of choice of the anticoagulant therapy with apixaban use in relation with the recent (2015) recommendations of the European Heart Rhythm Association. The authors conduct analysis of necessity and possibility to use the oral anticoagulant apixaban to prevent stroke in patients with non-valvular atrial fibrillation. On the whole, new oral anticoagulants exceed the warfarin therapy in he capability to reduce the risk of thrombolytic complications and iatrogenic hemorrhagic stroke in patients with non-valvular atrial fibrillations. The article demonstrates justification of situations of predominant apixaban selection in certain clinical settings.

Arterial hypertension (AH) complicates the course of diabetes mellitus (DM) of both the 1st and 2nd type. In patients with diabetes type 1, the main cause of AH is diabetic nephropathy. In diabetes type 2, on the other hand, essential hypertension is diagnosed in 70-80% of cases. The choice of antihypertensive therapy in patients with diabetes is not easy; when selecting the best anti-hypertensive drug for a diabetes patient, the associated vascular complications should always be considered. Angiotensin-convertingenzyme inhibitors are the most common treatment of hypertension in diabetic patients. Damage of the nervous system - diabetic polyneuropathy (DPN) – is a key element in the clinical picture of diabetes. In the treatment of DPN, activation of neural regeneration (reinnervation) and pain management are crucial. Neurotropic B vitamins with multimodal effect play a key role in this.

Low back pain is one of the most common complaints of people seeking medical aid. Evidence-based approach to main causes, principles of diagnosis and treatment of patients with acute and chronic nonspecific low back pain is described. The article demonstrates high efficacy of non- steroidal anti-inflammatory drugs, muscle relaxants and for chronic pain - antidepressants, as well as physical therapy and cognitive-behavioral therapy as components of multidisciplinary treatment. The authors share own experience in treating patients with chronic back pain using cognitive- behavioral therapy.

A situation stress – induced insomnia has a relatively favorable forecast and independently resolves as far as the emotional tension reduces. But in many persons insomnia that developed as a response to the stressful situation acquires chronic features and retains after the stress resolution. This category of patients requires therapy at an early stage, at development of first symptoms. The work considers predictors and insomnia chronization mechanisms, as well as possibilities of doxylamine in sleep disturbance arresting.

Dorsopathy is skeletal and muscular pain syndrome very wide-spread in the population. Non-steroid anti-inflammatory drugs are used for therapy of patients with dorsopathies. As a rule, they produce pronounced analgetic and anti-inflammatory effects, but their use is associated with a risk of side effects development, especially high in patients with polymorbidity requiring simultaneous administration of several drugs. A possibility to use a transdermal form of diclofenac (Voltaren Emulgel) in dorsopathy patients. Study results devoted to study of the drug biological availability, its effectiveness and tolerability are provided.

Analysis of outcomes in 211 patients with acute cerebral stroke hospitalized in the neuro rehabilitation in Filatov Municipal Clinical Hospital No. 15 of Mos cow in 2012-2013 who received artificial lung ventilation (ALV) due to respiratory disturbances was performed. Laboratory criteria and terms of patient transfer to ALV at acute stroke were detected. It was established that a riterion of patients transfer to AL V is not only manifestation of respiratory insufficiency clinical pattern but indicators of acid-base blood state. Objective clinical and laboratory criteria allowing timely transfer to ALV and forec ast of the unfavourable outcome are set out.

Macrolides are antibiotics the chemical structure of which has a macrocyclic lactone ring. Macrolides have several advantages over other groups of antibiotics. They are characterized by high antibacterial activity against intracellular pathogens and have anti-inflammatory, immunomodulatory effects and regulate the mucus. The article names five reasons to prescribe macrolides for diseases of the upper respiratory tract: cross sensitivity to penicillin antibiotics; combination of inflammatory disease of the upper respiratory tract and ear with allergic disease; infections caused by atypical microorganisms (chlamydia, mycoplasma, etc.); upper respiratory tract infection characterized by biofilm formation; chronic rhinosinusitis with or without polyps, with
persistent course, frequent relapses and low efficiency of surgical treatment.

The article deals with modern ideas about etiology and pathogenesis of acute rhinitis, various therapeutic options are considered, the most frequently used pharmaceuticals are characterized. Practical guidance on application of topic drugs (Otrivin) for acute rhinitis therapy is provided.

The paper summarizes findings on the place of decongestants in current treatment approaches for various types of rhinitis, their benefits and disadvantages, as well as feasibility of combination with drugs in other pharmacological groups, in particular with the anticholinergic drug ipratropium bromide. Indications for use of xylometazoline in combination with ipratropium bromide are substantiated. The reviewed literature demonstrates that clinical use of the combination scheme with equal effectiveness in eliminating nasal congestion allows to significantly decrease rhinorrhea.

The issue of diagnostics and therapy of chronic tonsillitis remains the most difficult and urgent in otorhinolaryngology. Detection of titers to streptolysin Beta-hemolytic streptococcus when determining the therapeutic tactics and management of patients with chronic tonsillitis is a sufficiently frequent diagnostic criterion in the RF. When analyzing the literature data and results of own studies a dubious value of Antistreptolysin O for determination of the degree of the inflammatory process degree in palatine tonsils and making up a plan of therapeutic measures based on this value was identified.

A regime of the single inhaler for basic therapy and arresting of asthma with the help of a fixed combination of budesonide and formoterol is an effective, safe and convenient method of treatment for patients. Bronchial asthma in pregnant women requires use of drugs with a high safety and effectiveness profile. A clinical study of the long-term successful use of Symbicort in the regime of a single inhaler, including during pregnancy.

In a review based on an analysis of numerous studies the expediency of incorporating drugs essential phospholipids (eg, dietary supplements Hepaguard Active ®) at a range of therapeutic and preventive measures in general therapeutic practice in patients with obesity, in the presence of conditions / diseases and complications associated with it, and especially metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD). Recently described prebiotic effect of Hepaguard active ®allows you to expand the scope of its application and use in patients with impaired intestinal microbiocenosis.

The excessive bacterial growth syndrome (EBGS) is a rather complicated, important and currently actively studied problem in the clinical practice. Currently there are no strict recommendations in respect of EBGS diagnostics. Respiratory tests have been extensively used of late that have various specificity and sensitivity. It’s difficult to diagnose and to conduct differential diagnostics of EBGS but important as well as it allows optimization of the patient therapy.

Since 1980 when L. Ludwig et al. [1] identified changes in the liver characteristic of alcohol-induced hepatitis in persons who didn’t misuse alcohol, intense study of non-alcoholic fatty liver disease (NAFLD) started. The definition of NAFLD has two major principles: a morphological pattern in biopsy ma terial microscopy completely corresponds to changes induced by alcoholic pathology and the major etiologic factors is lacking – alcoholic at hepatotoxic dosages. Obligatory condition is to rule out viral, drug, metabolic and other reasons [2].

Urolithiasis (UL) currently remains a relevant healthcare and social problem. According to epidemiological studies, urolithiasis is more common in men than in women. Recently, there has been a trend towards a steady increase in morbidity [1, 2]. Despite the development and improvement of surgical techniques such as remote and contact lithotripsy, laparoscopic ureterolithotomy, according to many authors, conservative treatment aimed at dissolution and self-discharge of stones should also be used [3].

Acute pyelonephritis belongs to the wide-spread inflammatory diseases in the oncourological inpatient clinic. Escherichia coli continues to be the leading causal agent of urinary tract infections. Obstructive uropathies (including urinary bladder tumours), foreign bodies, vesico-ureteral reflux contribute to ascending development of the urinary tract infection. The choice of the antimicrobial drug in the majority of cases is done speculatively, on the basis of data about domineering causative agents and their regional resistance. In case of complicated pyelonephritis the duration of the antimicrobial therapy must be 7-14 (sometimes up to 21) days. The drugs of choice for the starting empirical therapy of the complicated pyelonephritis are fluoroquinolones (ciprofloxacin, ofloxacin and levofloxacin), ticarcillin/clavulanate, third generation cephalosporins, aminoglucosides, ertapenem.

Acute rheumatic fever (ARF) remains a healthcare challenge. The global burden of ARF in children aged 5–14 years totals 336 thousand of new cases annually. The main symptom of ARF is carditis which determines the severity and outcome of the disease. Heart involvement in the form of isolated myocarditis without valvulitis is not regarded as typical of rheumatic fever. It should be borne in mind that post-streptococcal rheumatic myocarditis may also develop. No less important is the problem of neurological disorders in ARF including PANDAS syndrome. Analysis of the updated (2015) diagnostic Jones criteria showed that their application in Russia is problematic due to large inter-regional differences in the frequency of ARF. Amendments to the existing Russian classification and nomenclature of ARF seem untimely. Adequate primary prevention of rheumatic fever is still based on timely diagnosis and rational antimicrobial therapy of GABHS - tonsillitis/pharyngitis.

The study evaluated the quality of life and incidence of recurrent cystitis in perimenopausal women who had received the first course of herbal vitamin complex 5 years ago, followed by the annual two-month course (twice a year). The initial study included 29 patients of which 18 were followed-up. The patients completed a special questionnaire which focused on the degree of dysuria, dyspareunia (only in patients who had sexual intercourse) and quality of life with respect to the urogenital problems which occurred 5 years back when the study was undertaken. Additionally, outpatient medical records and history were analyzed to confirm the incidence of recurrent cystitis over the past 5 years.

Insufficient supply of pregnant women with micronutrients leads to the development of a number of congenital malformations of the fetus. The consumption of vitamins and minerals in pregnant women in the Russian Federation does not reach recommended norms. The high incidence of combined deficiency of vitamins among pregnant women, the existence of vitamin functional interactions, are the basis for the multivitamins intake especially in low production of vitamin-enriched food of mass consumption. The simultaneous intake of vitamins is more effective than separate or isolated destination of each of them. Evidence exist that the multivitamins are more efficient than using folic acid and iron. Multivitamins supplementation during pregnancy improves the supply of vitamins and minerals of women, reduces the risk of birth defects and determines the longterm health of children. The main requirements for the multivitamins for pregnant are full composition of vitamins and minerals, the lack of which is detected most frequently in doses covering the increased needs of women. 

It is known that at DM2 is raised considerably risk of development of myocardial infarction (MI) and mortality from it. For decrease these risk it is important reduction not only glucose level, but also of glycemic variability (GV) and of hypoglycemia (HG). It demands involving of the new drugs in management of glycemia during the acute period of MI, which are capable to provide the decision of these problems and additionally cardioprotection. Glucagon like peptide-1 receptors agonists exenatide) can become possible candidates for it. The purpose of the present research was an estimation of glycemic and non-glycemic exenatide effects in patients with DM2 and MI.

Drug- and alcohol-induced liver injuries are the most common reason for the chronic liver diseases. For the past 10years, in Russia ademetionine products have been used in treatment of such diseases to provide detoxification and antioxidant effects, normalize the permeability of the cell membranes, accelerate regeneration of liver cells and slow down the development of fibrosis. The numerous studies showed that the use of ademetionine improves a protein synthesis in the liver, reduces the severity of lipid exchange violations, contributes to positive dynamics of serum biochemical parameters (ALP, GGTP, ALT, AST, bilirubin) and regresses clinical manifestations of the astenovegetative and dyspeptic syndromes, while tolerability of ademetionine is favorable [15, 17, 18].

The problem of functional intestine diseases has been a discussion subject for many years. Diagnostic criteria of FID presuppose no morphological and biochemical disturbances. But search of substrates for verification of this pathology continue till now.

The effect of the body weight reduction on the life quality and appearance of patients is studied after gastric banding at pronounced obesity in the first two years after the post-surgical period. It was demonstrated that in the first two years post surgery 90.7 of obesity patients are satisfied with their appearance after the surgery, 70.4% -increase their physical activity in day-to-day life and 43.9% - engage in sports activities more actively. It was established that the body weight loss is related to improvement of self-esteem but at the same time it’s necessary to take into account a risk of development of disturbances related to the new diet and a strict eating control.