XVI конгресс Европейского общества витреоретинальных специалистов (EURETINA-2016). Будущее уже сегодня.

The EAS/ESC recommendations 2016 for therapy of dyslipidemia evidence that statin therapy retains its key positions. When determining a very high cardiovascular risk level in a patient the ChLDL should be reduced to lower than 1.8 mmol/l regardless of the age and gender. In ACS high-intensity statin therapy should be prescribed in the absence of contraindications and risk of complications immediately after admission or within 1–4 days regardless of the initial level of ChLDL. High-intensity statin therapy means prescribing of atorvastatin 40–80 mg or rosuvastatin at a dose of 20–40 mg/day. In PCI in patients with stable angina or ACS without ST-segment elevation the strategy of high dose of statin prior to the procedure is used. The treatment goal is the achievement of the target level of ChLDL or decrease from the original one by 50%. Re-determination of the ChLDL level is recommended after 4–6 weeks of treatment. If the maximum tolerated doses of statin therapy is insufficiently effective it’s possible to add the second drug: ezetimibe or PCSK9 inhibitor. Adding omega-3 polyunsaturated fatty acids currently cannot be recommended in clinical practice of patient treatment after ACS and percutaneous coronary interventions. A clinical example of treatment of the patient with coronary and brachiocephalic arteries atherosclerosis aimed at PCI is provided. 

Objective. To assess the frequency of prescribing of different groups of antihypertensive drugs (AHD) in the treatment of patients with arterial hypertension (AH) among patients of the Krasnoyarsk territory according to the Russian epidemiological studies ESSE-RF.

Materials and methods. 1,603 persons aged 25–64 years, selected through systematic stratified multistage randomization among the population attached to the four outpatient clinics of Krasnoyarsk and Berezovsky district hospital were studied. All included subjects were subjected to a detailed survey of office blood pressure measurements. Results. The proportion of those on monotherapy was 53.4%. The most commonly accepted AHD, including in the combination therapy, were angiotensin-converting enzyme inhibitors (ACEI) – in 51% of cases, beta-blockers – 28.9 percent, angiotensin receptor blockers (ARBS) – 25,2%, diuretics – 23,2%, calcium channel blockers (CCB) – 11.9%, central action drugs – 2.0% and alpha-blockers – 0.4 percent. Beta-blockers often were taken by those of younger age – 38.1 per cent, mainly men aged 25–34 years (50.0 per cent). Among the combinations of AHD the most frequently encountered combination was ACEI + diuretic (6,8%), followed by rthe frequency of prescription by ARBS + diuretic, beta-blocker + diuretics, ARBS + CCB, ACE-I + CCB.

Conclusion. The frequent prescription of ACE inhibitors and insignificant use of central action is noted. The high level of violence of use of AHD monotherapy in patients with hypertension (53,4%) is alarming, which may be one of the reason for the relatively low efficiency of antihypertensive therapy (31.6 percent). Beta-blockers were indicated unreasonably often for young men with hypertension aged 25–34 years. 

α-Lipoic acid (thioctic) (ALA) is the most applicable pharmacological drug for treatment of diabetic polyneuropathy. The articles explores the results of experimental studies on α-Lipoic acid effect upon formation mechanisms of peripheral nerves affection under hyperglycemia and also the data of numerous randomized controlled trials and meta-analyses on studying ALA efficiency under symptomatic diabetic polyneuropathy. It was proved that amelioration of patients with diabetic polyneuropathy is observed both while using ALA infusions and tableted form of the drug. The authors conclude that α-lipoic acid is a drug for treatment of pathogenetic development mechanisms of diabetic polyneuropathy with the most demonstrated efficiency. 

Sleep disturbance (insomnia) is one of the most frequent state accompanying functional and organic disturbances in the human body. There are the following types of disturbances of this cycle: insomnia (a disturbance related to difficulties of the beginning or maintenance of sleep), hypersomnia (increased requirement in sleep, in this case duration of sleep during a day might exceed 12 hours) and disturbance of the sleep rhythm (change of the sleep time distribution during a day, which manifests itself in displacement of the falling asleep time – more early or more late or even sleep-awake state cycle inversion, i.e. falling asleep at day time and staying awake at night). By various calculations 90% of people of various age and sex have sleep disturbance during life time [1]. 

The main issues of poststroke cognitive impairment’s etiology and pathogenesis are considered in this article. Historical stages of the poststroke dementia definition are presented. Approaches to prevention and therapeutic correction of poststroke cognitive impairment are discussed. Opportunities of neurotrophic therapy by the example of citicoline are considered. 

Chronic pharyngitis is one of the most common diseases in ENT practice. [1] Experts have not yet come to a consensus on how to treat chronic pharyngitis. The search for combination drugs which are effective in the treatment of chronic pharyngitis is determined, first, by an attempt to prevent polypharmacy and complications caused by treatment, and, second, by the problem of antibiotic resistance. The role of medications with combined action, including the immunomodulating effect, cannot be overestimated. One of the most commonly used drugs today is Tonsilgon® N (Bionorica SE, Germany). [2] 

Diseases caused by viral infections of the respiratory tract occupy the first place in prevalence among all viral pathologies. Pathogens such as influenza virus, respiratory syncytial virus, rhinovirus and others that are dangerous not only due to their direct negative effect on the human body, but by the fact that they strengthen the course of other inflammatory diseases of the respiratory tract, for example bronchial asthma. Development of new molecular research methods in immunology allowed revealing in detail the peculiarities of the life cycle of certain respiratory viruses, and understanding of the mechanisms of antiviral defense. According to modern concepts the immune system is a delicate and complicated mechanism of the antiviral response, in which one of the main roles is played by cells containing on their surface CD4-receptors. Also many studies proved the key role of interferon I, II and III type as the first line of antiviral defense. The knowledge accumulated as of today in the field of virology and immunology allows us to implement a comprehensive approach in the development of new antiviral drugs with the aim to achieve greater efficiency. This approach was successfully implemented with the creation of the drug Ergoferon containing a combination of affinity purified antibodies to CD4, interferon-γ and histamine in a releaseactive form with antiviral, anti-inflammatory and antihistamine activity. Influence on the CD4-receptors enables the drug to activate the cascade of immunologic responses aimed at improving the protective properties of the body – to fight infectious agents, primarily viral in origin. Effects on the IFN system make an equivalent contribution to the effect on CD4-receptor to the antiviral properties of the drug. A unique combination of properties, high level of evidence of clinical efficacy, good tolerability and no adverse drug effects can refer Ergoferon to effective and safe drugs for treatment of the main respiratory viral infections. 

The urgency of the acute rhinosinusitis problem is justified by the high incidence rate of this pathology as well as by the trend to the prevalence rate of this disease. The article describes etiopathogenetic peculiarities of this disease, major principles of acute rhinosinusitis therapy in accordance with European, American as well as domestic approval documents. Special attention is given to the problem of the antibiotic therapy of acute bacterial rhinosinusitis. 

Development and course of many pathological processes, including infectious and inflammatory, are accompanied by disturbances in functioning of the body immune system [1]. The traditional etiotropic therapy of infectious diseases is complicated by development of resistance of pathogens to antimicrobials [2]. Due to this methods of therapy based on modulation of the immune response have been widely used [3–7]. 

This article deals with a modern view of the pathophysiology and the course of acute inflammatory diseases of the paranasal sinuses, complicated by the presence in a patient of chronic rhinitis of vasomotor etiology. The article covers various clinical situations and factors predisposing to chronic angiopathy, special emphasis is placed on differential diagnostics of chronic vasomotor and allergic rhinitis, as well as on the need for adequate and science-based selection of pathogenetic therapy. The article provides a detailed clinical picture of chronic rhinitis, including chronic vasomotor rhinitis with the indication of characteristic symptoms. We also offer the algorithm for treatment of acute inflammatory diseases of paranasal sinuses, complications of chronic vasomotor rhinitis tested in our clinic. During 2016 under our supervision there were 42 patients with chronic vasomotor rhinitis and acute sinusitis. The patients were divided into 2 groups. Each patient received as etiotropic therapy antibiotics of the protected penicillins group, as a basic system component of pathogenetic therapy – a blocker of histamine receptors, a gentle diuretic herbal tea and Afobazol. Additionally, patients received local therapy: in the experimental group – Otrivin® Complex spray; in the control group – a hypertonic solution of sea water in the form of a spray. 

The article is devoted to the actual problem of clinical allergy – diagnosis and treatment of allergic rhinitis (AR). The article highlights the issues of prevalence of AR, discusses classification, etiology, pathogenesis of the disease. Detailed discussion of approaches to its diagnosis and treatment, depending on the severity of AP and the presence of comorbidities. The mechanism of action of the drug desloratadine – non-sedating, long-acting antihistamine that has high affinity for H1-receptors. On the basis of a number of studies have shown that desloratadine is highly effective in relieving the symptoms of allergic rhinitis, is well tolerated and improves the quality of life of patients. 

Allergic rhinitis (AR) – this is a serious medical and social problems associated with increasing incidence of allergic rhinitis, delayed diagnosis of AR, frequent complications, high economic health costs, reduced quality of life and disability of patients. Despite the popularity of this disease, doctors often are not fully aware of the treatment, so it is often not achieved disease control 

The article presents the results of major international studies (STARTMRK, ACTG A5257, SPRING 2, the SINGLE and FLAMINGO), which convincingly demonstrated the effectiveness and safety of drugs from the group of integrase inhibitors (raltegravir and dolutegravir) as part of ART regimens in HIV-infected patients who are just beginning treatment (first line regimens). Comparisons within 2–5 years regimens that included II or EFV, showed comparable or greater virological and immunological efficacy of RAL and DTG at a substantially lower incidence of adverse events with the use of these drugs. Preparations of the RAL group and DTG are the drugs of choice and special categories of patients with HIV infection (patients with tuberculosis or chronic hepatitis C). The article presents the results of two studies carried out in Russia, on the efficacy and safety of raltegravir in ART regimens in patients with HIV infection and tuberculosis, and in patients with HIV infection and chronic hepatitis C. 

Gastrointestinal disorders have always been and remain among the most common diseases both in adults and children. Diarrhea or heartburn, bloating and the accompanying flatulence or belching are the common complaints. All of these are explained by two major causes: either excessive formation of acid and (or) prolonged exposure of the stomach and esophagus to the acid, or intestinal disorders due to organic or functional lesions. 

Among functional diseases of the gastrointestinal tract (GIT) the irritable bowel syndrome (IBS) by the right retains leading positions. According to recommendations of a group of international experts (1999) Roman Criteria II, IBS means functional disturbances of the stomach at which pains in the stomach combine with defecation or changes in the stool nature, usually with some disturbances, in combination with flatulency [1]. 

The article provides foreign and Russian epidemiological data on constipation incidence, their reasons and classifications are considered in detail. The section Constipation Therapy describes non-pharmacological principles as well as groups of drugs that are used for this pathology. An analysis of the Russian pharmaceutical market of laxative drugs in the recent years is presented. Stimulating laxatives are used by patients more often. Sodium picosulphate is one of the major drugs from group of stimulating laxatives. Authors cite results of several studies on effectiveness of sodium picosulphate and discuss why this drug is one of the most frequently used for constipations. 

The role of oxidative stress in the development and progression of age-related diseases in ophthalmology sufficiently studied and proven. However application mitohondrail antioxidant is not enough studied under these pathologies.

Objective: To investigate the clinical efficacy Vizomitin with age-related cataract and its influence on the parameters of hydrodynamics eyes.

Materials and methods. A clinical study of 2 groups of patients (age 63,8 ± 4,3 years). One group – with age-related cataract in the initial stage, which was appointed Vizomitin® 1–2 drops 3 times a day. Patients of the second group received instillation hypromellose. Results. After 4 months of treatment, the difference in the visual acuity in the study group became true and was 0.1 in podruppe I and 0.05 in the subgroup II (p < 0.05 relative to the same sub-groups at the beginning of treatment). Patients with Vizomitin group after the first month and 4 months after the application was observed a slight tendency to increased intraocular pressure. Also, patients in group I ease the outflow coefficient during the initial survey was 0,28 ± 0,01 and decreased during the second examination after 1 month to 0,25 ± 0,01 difference was not significant. Minute volume of chamber moisture in group I patients at initial assessment was 1,9 ± 0,2 and increased after 1 month to 2,46 ± 0,2 (p < 0.05) and remained the same over the next 3 months.

Conclusion. Appointment Vizomitin in patients with an initial stage of cataract leads to a positive therapeutic effect (increase in visual acuity). Patients who used Vizomitin significantly change the hydrodynamic performance. After a month of application is increased production of intraocular fluid and increases its outflow in 4 months. 

The article tells about the potential of nimesulide in patients with acute pain caused by lesions of the musculoskeletal system. The pharmacodynamic characteristics, mechanisms of action and high safety profile allow to consider Nimesulide to be an effective and fast-acting remedy for acute pain and inflammation. 

The attitude of obstetricians-gynecologists to intrauterine hematoma has undergone a serious metamorphosis over the past 15–20 years. The first systematic surveys did not detect a risk of hemorrhage for a future pregnancy, if the embryo/fetus «survived» the threat of rejection. At the same time, the importance of exogenous causes of threatened miscarriage was exaggerated to the detriment of understanding of the endogenous processes that lead to disturbances of hormonal-immune interaction and dialogue between the mother and the fetus. As far as accumulation of evidence of late gestational complications the hollowness of well-being in pregnancy after intrauterine resolution of hematomas became apparent. Retrochorial hematomas that occurred in the first trimester of pregnancy are of particular importance. Today no one doubts that threatened miscarriage, the essence of which is detachment of the chorion, must be treated not by bed rest and antispasmodics, but by applying means acting on the universal reason of the gestational sac rejection – progestogens. 

Objective: study of effectiveness and safety of indication of a combination 17β-estradiol/drospirenon in patients with various manifestations of the climacteric syndrome and risk of the metabolic syndrome development.

Materials and methods. Results of two-year therapy of climacteric syndrome by 17β-estradiol/drospirenon drug in 21 patient in post-menopause.

Results. As a result of two-year administration of the 17β-estradiol/drospirenon drug in patients with a risk of metabolic syndrome development a significant reduction of Kuppermann index was observed as well as improvement of the skin and mucous tunic state. No negative effect of the drug on lipid exchange values and homeostasis parameters, arterial pressure value, growth of myomatous nodules and thickness of endometrium.

Conclusions. A combination of 17β-estradiol/drospirenon is effective and safe in therapy of climacteric disturbances and might be a drug of choice for patients with a risk of metabolic syndrome development. 

The article deals with terminology and modern views relating to vaginal dysbiosis and urogenital endogenous infection. Endogenous and exogenous trigger factors leading to disturbance of the vaginal microbiocenosis are characterized. Mechanisms of development of some obstetrical pathology in this infectious process are considered. Diagnostic and therapeutic approaches to correct dysbisosis with determination of the place of the system enzymotherapy in a complex therapy of this pathology are provided. 

The inflammatory chronic abacterial prostatis/chronic pelvic pain syndrome accounts for 60-65% of all cases of chronic prostatitis. The etiology of the chronic abacterial prostatis/chronic pelvic pain syndrome remains unstudied to the full. The major objective of clinical study is to rule out possible organic urologic diseases. The inflammatory chronic abacterial prostatis/ chronic pelvic pain syndrome is characterized by the inflammatory reaction in the prostate secretion in absence of bacteria in the diagnostics titer in the urine and the prostate secretion. Cyclogenase-2 inhibitors reduce the content of prostaglandins in the sperm and urine, pain sensation and edema of the prostate gland. Use of nimesulide in patients of this category allows removing pelvic pains, increasing blood flow in the prostate gland at low percentage of adverse events. 

Diabetes mellitus (DM) is a complex disease the key component of which is dysglycemia leading to development of late complications. The necessary condition to achieve the glycemic control in conditions of day-to-day life is blood glucose selfcontrol. But for the team doctor-patient determination of the self-control aim is not a simple task. For its solution a variety of randomized controlled studies were conducted and their analysis provoked a number of new issues. The indisputable fact is that self-control helps in achievement of the long-term glycemic control in patients of DM2, contributes to prevention of acute and late diabetic complications development. 

Chronic respiratory diseases (CRD), and in particular chronic obstructive pulmonary disease (COPD), pose a relevant healthcare and social problem globally, reflecting the upward trend in the morbidity and mortality from diseases related to tobacco consumption. Tobacco smoking is the main and only modifiable risk factor for the development of CRD including COPD. The current understanding of the problem suggests that COPD develops in 50% of tobacco users and not in 15% as previously thought; that the disease may have originated even before birth or in early childhood; that capturing the mechanisms of the disease development is essential for timely prevention. Prevention of CRD, particularly COPD, should be aimed at overcoming tobacco consumption and take into account all the other risk factors for these diseases. The current smoking cessation treatments involve behavior counselling in combination with first-line pharmacotherapies such as NCT or varenicline. Patients with COPD need greater support than healthy smokers, and interventions for cessation of tobacco consumption are the most cost-effective in reducing the rates of the lung function deterioration and decreasing morbidity and mortality from the disease. 

Evaluation of effectiveness of application of various types of liposuction as an accessory method of contour plastic correction in patients with massive obesity was performed. It was established that if the subcutaneous fatty cellular tissue prevails over the visceral one, use of liposuction in combination with bariatric interventions is an effective method to achieve satisfactory cosmetic results. 

Congenital infection is one of most frequent complications of early neonatal period in newborns with fetal growth restriction. The use of molecular genetic testing in this group of patients may promote the development of new methods of prophylaxis and treatment.

Objective. To detect cytokines genes polymorphisms in pregnant women and newborns with fetal growth restriction and congenital infection. Materials and methods. The investigation of distribution of alleles and genotypes of cytokines genes polymorphic loci in 196 pairs «mother-newborn».

Results. Congenital i nfection risk factors in pregnant women with fetal growth restriction are: chronic urinary tract diseases (chronic pyelonephritis and chronic cystitis), history of spontaneous abortion and hydramnios in current pregnancy. The presence of A/A IL10 gene polymorphism: -592 A > C in a newborn is associated with increased risk of congenital infection in pregnancies complicated by fetal growth restriction and chronic fetal hypoxia (p = 0,031,OR = 18.9 (1.7–215.2)).

Conclusion: Results of the study suggest the use of clinical predictors for revealing the group of fetal growth restriction patients with high risk of congenital infection and subsequent genetic screening of newborns in this group of patients.