The treatment algorithm for pulmonary arterial hypertension (PAH) includes three main stages: general measures; induction drug therapy; combined drug therapy and intervention  methods  for patients  who fail to respond adequately  to induction therapy. The specific therapy includes endothelin receptor antagonists  (ARE), prostanoids, phosphodiesterase type 5 inhibitor (PT5I) and soluble guanylate cyclase stimulators (rGCS). The combined specific therapy, which means the simultaneous  use of more than one class of specific drugs, is an attractive approach, taking into account the malignancy and complexity of PAH pathogenesis, and the successful experience  in using medication combinations in the treatment of systemic arterial hypertension  and heart failure. The article shows that down to recent times the issues  of necessity and timeliness of the combined PAH-specific therapy, and the choice of rational combinations, require further study. The COMPASS-2 randomized study did not prove that the adding bosentan to the stable sildenafil therapy is more effective than sildenafil monotherapy, and extends  the time to the development  of the first morbidity event/ mortality in PAH patients. The meta-analysis  of H.l. Liu et al. showed that the monotherapy leads to a significant reduction in mortality in patients with PAH, improvement of functional and hemodynamic status compared with the placebo or standard therapy. The combined therapy is associated  with a significant improvement in functional and hemodynamic status, but the mortality of patients did not decrease reliably compared with the monotherapy. The combined therapy is associated with a significant increase in cancellation frequency due to adverse effects as compared with the monotherapy.

The concept  of the advantage  of rGC stimulants  over PT5I was studied  in an international multicentre  open-label  IIIb phase  RESPITE (Riociguatum Сlinical Effects Studied in Patients With Insufficient Treatment Response  to PDE5) study of the safety and efficacy of the transition from the PT5I therapy to riociguatum therapy in patients with PAH who did not achieve the treatment goals when using PT5I. The study included patients with functional capacity III (WHO),  a distance of 165–440 m in the 6-min walk distance (6MWD), cardiac index <3.0  l/min/m², pulmonary vascular resistance>  400  dyne*s *cm^-5, the average pressure in the pulmonary artery > 30  Hg mm despite receiving stable doses  of sildenafil in the highest  dose of 80 mg 3 times a day or tadalafil in the highest  dose of 40 mg 1 once a day. A part of patients also received an endothelin  receptor antagonist  (ERA). The clinical endpoints included changes in 6MWD, hemodynamics from baseline  to Week 24  of therapy, WHO FC, the NT-proBNP levels,  the quality of life evaluation, and % patients  developing  clinical worsening from baseline to Week 12 and 24 of therapy.

After cancellation of PDE5i, the patients received riociguat. The interim analysis of the study showed that 50% of patients had improved to WHO FC II from III, increased 6MWD from 353  ± 78 to 392  ± 112  m (n = 25); improved hemodynamic parameters and NT-proBNP levels by Week 24, which may indicate that patients with an insufficient response  to PDE5i therapy may benefit  from a transition to riociguat. This approach should be further investigated,  as suggested by 2016 Russian Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension.

Нeart failure is common both in cardiac and noncardiac disease. We conducted a study that showed high efficacy and safety of meldonium in patients with heart failure and comorbidity. The ability of meldonium reduce the severity of heart failure, improve the quality of life of patients, have a beneficial effect on lipid and carbohydrate metabolism, renal function in patients with concomitant  diabetes  mellitus.  Marked positive  impact on  meldonium  autonomic  manifestations  of  cardiac autonomic neuropathy and for diabetic peripheral sensorimotor neuropathy. In addition, meldonium use in patients with hypertension has a  positive effect on cognitive status. Мeldonium reduces the degree of heart failure, improves the quality of life, lipid and carbohydrate metabolism,  renal  function, manifestation  of  autonomic  cardiac neuropathy and  for  diabetic  peripheral sensorimotor neuropathy in patients with concomitant diabetes mellitus, Application meldonium in patients with hypertension have a positive impact on cognitive status.

The article discusses the pathogenesis, diagnosis and treatment of myofascial pain. The analysis of the effectiveness of muscle relaxants in patients with myofascial pain syndrome is provided.

The article is dedicated to the diagnosis, classification, and rehabilitation of various forms of speech disorders in poststroke patients. It is considered the most common types of expressive and impressive speech disorders. The main diagnostic signs of most frequent forms of aphasia and dysarthria are given. A plan for the rehabilitation program with the inclusion of a medication (Ceraxon®) and non-pharmacological methods of correcting speech disorders after stroke is offered.

The literature review summarizes modern data on the prevalence, epidemiology, clinical features, diagnosis of the bocavirus infection over the last 10 years.

One of prospective tendencies is introduction into the clinical practice combined medicines with antiviral, resolvent and antihistamine mechanisms of action.

Contemporary glimpses of the inflammation pathogenesis are based on understanding different protective mechanisms, preventing invasion of pathogen into the mucous, its colonization and development of local, then systemic inflammation. Currently applicable medicines act not only against the pathogen, but also modulate inflammation  process, induce local and systemic immune responce, both specific and non-specific. To the later group of medicines, acting through non-specific immune system factors relate Anaferon, Anaferon for children and Ergoferon. It should be noted that Ergoferon has complex (antiviral, resolvent and antihistamine) pharmacological action. Long-term experience of their usage corroborates their high effectiveness and safety in treatment and prevention of ARVI including flu in patients with chronic obstructive pulmonary disease.

The growing resistance of microorganisms caused by a wide use of antimicrobial therapy (AMT) is a huge problem. Only 10–15 years ago, it seemed that medical science was able to cope with almost any severe infection, because physician’s arsenal was equipped with a large number of antibiotics. However, clinicians are confused by the current situation with antibiotic resistance, since the effectiveness and feasibility of most antibiotics face doubtful future. This means that in the next 10–12 years we will not come up with fundamentally new antibiotics and should try to keep the ones that we have today [1, 2].

The article focuses on the current pharmacotherapy for exacerbations of chronic obstructive pulmonary disease. The author describes the  exacerbation criteria, the  amount of recommended examinations, indications for hospitalization, treatment approaches; antimicrobial therapy regimens determined by the type of the potential pathogen and depending on the severity of COPD are highlighted.

In the Russian Federation, the incidence of influenza and other acute viral respiratory infections (ARVI) increases every year during the autumn-winter period. The most common ARVI are parainfluenza, adenoviral and respiratory-syncytial infection. The constant mutability of influenza viruses and emergence of new ARI pathogens are especially dangerous. Medications from various groups including interferon inducers, particularly Kagocel, are recommended for the treatment and prevention of influenza and ARVI.

Acute respiratory viral infection(ARVI) are the most common diseases  in the world. Acute respiratory viral infections (ARI), including influenza, include a group of infectious diseases of the respiratory tract with a viral etiology and are predominantly airborne transmission. SARS and flu are manifested in the diversity of respiratory symptoms. One of the rules of the medicine is the desired effect with a minimum number of indicated drugs. However, the patient is forced to administer a number of drugs aimed at the relief of coughing, running nose, headache, decrease in temperature, as well as antiviral, antihistamine and other medications. On the background of such polypharmacy use of combined drugs is reasonable.

The results of domestic epidemiological studies on the prevalence of gallstone disease (GSD) indicate that it amounts to 10–15% of the adult population. The frequency increases in young adults and even in children [1]. The effectiveness of conservative therapy, despite certain achievements in this area remains low. Analysis of the results of treatment with ursodeoxycholic acid (UDCA) in patients with GSD showed that complete dissolution of stones in different periods occurred in 77 of 210 patients (36%) and dissolution in part – in 55 (26%) [2]. According to our data, dissolution of small (<5 mm) stones is more effective (71,5%) [5]. In general, the causes of the low efficiency lies in the long duration of treatment, its high costs and relatively low compliance of patients.

Functional gastrointestinal disorders is currently considered as the most common pathology of the gastrointestinal tract, which is based on the combined morphological and physiological abnormalities associated with visceral hypersensitivity, impaired gastrointestinal motility, the protective mucosal barrier, immune function and composition of the intestinal microbiota, and disorders of the central nervous system (CNS).

Treatment of patients with functional gastrointestinal disorders remains a challenge. Due to comorbidities and chiasm syndrome often necessary simultaneous administration of several drugs, which in turn may cause side reactions. This leads to the search for additional, or alternative, therapeutic interventions. Among the promising therapeutic effects include the use of mineral water. The article considers  the  possibility of  drinking mineral water «Donat Mg» bowel  disease  and other  functional gastrointestinal disorders.

The article outlines the diagnostic criteria for chronic constipation, provides epidemiological data on the prevalence of the condition among the population, and specifies the main types of laxatives. The author presents own findings on the possibility of combined treatment with trimebutine and a combination microenema laxative for patients with “lazy bowel” syndrome which develops against a background of long-term use of irritant laxatives. The author concludes on the good tolerability and positive efficacy of the combination therapy involving drugs which normalize intestinal motility and micro-enemas containing sodium citrate, sodium lauryl sulfoacetate and sorbitol solution in such patients.

Helicobacter pylori (Hp) is a widespread gram-negative, spiral microorganism with flagella that infects the stomach lining. In 1994, the International Agency for Research on Cancer included H. pylori in the list of group 1 carcinogens. Therapeutic options for the treatment of infections caused by H. pylori and aimed at its complete eradication include various combinations of a proton pump inhibitor with two or three antibiotics. This integrated approach is basically associated with a high risk of side effects and non-compliance with treatment. According to the 5 Maastricht Treaty, in order to reduce the risk of side effects on the gastrointestinal tract microbiocenosis and increase the eradication efficacy, it is recommended to complement eradication schemes with probiotics. The ability of certain strains of probiotics to promote eradication during monotherapy has been proved. However, the analysis of findings in subgroups showed that only certain strains including different strains of Lactobacillus could maintain clinical significance. Lactobacillus reuteri DSMZ17648 (Pylopass, a part of the Helinorm trade name) demonstrated a decrease in the level of H. pylori colonization and can be used in eradication schemes to enhance the effectiveness and safety of treatment.

In the last decade there has been a very active study of large microbial community in the human gut. The concept appeared explaining the development and persistence of symptoms in irritable bowel syndrome due to disturbances of the intestinal microbial landscape. Manipulation of the intestinal microflora represents a new strategy for treatment of this polietiologic disease. The modulation of the intestinal bacterial  at which beneficial (Lactobacilli and Bifidobacteria) bacteria are increased and pathogenic bacteria (Clostridium, Escherichia coli, Salmonella, Shigella and Pseudomonas) are reduced should reduce the symptoms of the irritable bowel syndrome.  In this conceptual framework, probiotics are the optimal option in terms of efficacy and safety, and they attract the attention of specialists prebiotics, synbiotics, antibiotics and fecal transplantation.

The article tells about the prevalence and etiopathogenesis of antibiotic-associated diarrhea and the main pathogens focusing on Clostridium difficile. The methods of treatment of the disease are described. The article is largely an overview of research reports on the use of probiotics for the prevention and treatment of antibiotic-associated diarrhea. In accordance with the declared topic, the author’s original study of the probiotic complex Linex® Forte is presented.

Drug-induced drug liver lesion  (DILL)  means the pathology of a wide spectrum – from clinically asymptomatic laboratory changes in liver function tests to fulminant acute hepatic insufficiency as a result of application of drugs, herbs or dietary supplements. There are two main options of DILL when direct (dose-dependent)  and indirect damage (idiosyncratic) effect is exerted.  Direct damage  DILL  cases  are predictable, the  more rare idiosyncratic variant can appear quite  unexpectedly. Idiosyncratic DILL is more complex to diagnose and treat. The most common reason for DILL are use of antibiotics, nonsteroidal anti-inflammatory drugs and immunosuppressants. The diagnosis of DILL is stated by a mehod of elimination. The treatment begins with the immediate discontinuation of the administration of drugs, herbal medication or dietary supplements that can cause liver damage. There are no specific antidotes for the treatment of idiopathic DILL, symptomatic treatment is administered. In case of cholestasis ursodeoxycholic acid is often used. With the development of acute liver failure the positive forecast is significantly improved only by liver transplantation.

Functional gastrointestinal disorders are currently being considered as the most common pathology of the gastrointestinal tract. Symptoms that may be related to the gastroduodenal region, represent one of the major subgroups among functional gastrointestinal disorders, in which the functional dyspepsia rightly maintains leading positions syndrome. Pathogenetic factors of functional dyspepsia and other functional gastrointestinal disorders, which can be regarded as proven at the moment, are the dysmotility of the gastrointestinal tract, which determines the feasibility of using in the basic treatment of these  diseases medications that affect motor function of the gastrointestinal tract and preventing anastaltic contractions of the smooth muscles, which are combined into a group of prokinetic. With comorbidity positions, clinical efficacy and drug safety is a priority itopride hydrochloride prokinetics in treatment of functional dyspepsia and other related functional gastrointestinal disorders.

The analysis of modern data about the effectiveness of rabeprazole in the treatment of acid-related diseases is performed. The European Consensus Maastricht 5 recommends a preferred use of rabeprazole in the schemes of eradication of Helicobacter pylori. Clinical studies confirmed the high efficiency of rabeprazole for the treatment of GERD, and prevention of NSAID-induced gastropathy. Modern and effective generic of rabeprazole is Rabiet.

This article describes the most frequent diseases of periarticular tissues of the upper and lower extremities, back: enthesitis, tenosynovitis,  ligamentity,  fasciitis, bursitis. Described problems of  their  etiology,  pathogenesis,  clinical  manifestations, diagnosis, differential diagnosis. Presented pathogenetic therapy of these diseases.

The article presents the current international and domestic guidelines for the management of patients with osteoarthritis. We discuss the possibilities of pain reduction in OA, the effects of slow drugs on the structures of the joint, the place the combination of chondroitin sulfate and glucosamine in treating OA.

In the present-day rheumatology, comorbid infections represent a relevant issue; their formation is caused both by the rheumatic disease (RD) and the need to use drugs with immunosuppressive action. Numerous problems caused by infections in rheumatology and other branches of clinical medicine can not be solved only by using a large number of anti-infective drugs that are available today. Therefore, in the near future, a critical role will belong to the development, improvement and prompt (if possible) introduction of various vaccines into clinical practice. The current review touches upon questions relating to the use of vaccines against influenza and pneumococcal infections in patients with RD, and formulates the prospects for further implementation of vaccination in rheumatology.

In patients with Type 2 diabetes mellitus 2 (DM2) the active course of atherosclerosis, increased risk of stroke and cognitive impairment are observed. The cerebrovascular or neurodegenerative disorders, metabolic disorders, hypoglycemic episodes can play the part in the development of cognitive impairment.

Objective: to evaluate carbohydrate metabolism and identification of hypoglycemic conditions for patients with T2DM and ischemic cerebrovascular disease.

Materials and methods. 99 patients were studied, among them 46 (46.5 per cent) men and 53 (53,5%) women, average age 64 ± 8.3 years. Of these 46 patients with dyscirculatory encephalopathy (DE) and 53 with a history of ischemic stroke.

Results. Patients showed cognitive changes. All patients had evidence of atherosclerosis of the main arteries of the head, signicant stenoses were observed in 42.4 per cent, and multiple atherosclerotic changes – 39.4% of the patients. The T2DM disease duration was 8.4 ± 6 years, HbA1c – a 7.8 ± 1.9 percent. Hypoglycemia is marked on the background antidiabetic therapy in 15% of patients, 7 of them are unrecognizable. In patients with hypogycemic episodes of disease duration and frequency of reduced GFR was significantly higher.

Conclusions. Ischemic cerebrovascular disease in DM2 patients takes place on the background of atherosclerosis of the main arteries of the head, hypertension, renal dysfunction and are accompanied by the risk of iatrogenic hypoglycemia. Hypoglycemic states often develop with increasing duration of the disease of type 2 diabetes and reduction of the glomerular filtration rate. It is recommendable to regularly control blood glucose to reduce the risk of hypoglycemic conditions.

Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease with airborne pathogen transmission, characterized by systemic lesions of small vessels, hemorrhagic diathesis, hemodynamic disorders and kidney failure. In Russia, HFRS causative agents include 6 hantaviruses:  Puumala, Kurkino and Sochi in the European part, Hantaan, Amur and Seoul in the Far East. Wild rodents are the natural hosts of hantaviruses and the source of HFRS infection for humans.

HFRS clinical manifestations are acute onset, cyclic course, syndromes of fever and intoxication, hemorrhagic manifestations, pain in the lower back and abdomen, and acute renal failure which develops by day 4-5. Other typical features include leukocytosis with left shift, thrombocytopenia, elevated urea and creatinine, proteinuria, hematuria and decreased relative density of urine. In severe disease, the following complications develop: haemorrhage, toxic shock, pulmonary edema, rupture of renal capsule. Depending on the etiology, clinical forms of HFRS markedly  vary by their severity and mortality.

Neurotrophic keratitis (NK) is a degenerative disease of the cornea characterized by a certain complex of symptoms, including decrease in its sensitivity, spontaneous  instability of the corneal epithelium with a significant deterioration of the healing process. The development of keratopathy  (KP) is accompanied by such complaints as fluctuation of visual acuity, photophobia and lacrimation, and pain of varying severity. Being one of the most densely innervated tissues  of the body, the cornea is sufficiently sensitive to innervation with the development of severe trophic keratitis and ulcers.

There are many reasons for the  development  of  neurotrophic corneal changes, and they are not  only in the  sphere of ophthalmologic pathologies. Eye reasons of the NK development can include herpetic keratitis, the condition after certain eye surgeries, wearing of contact lenses.  Non-ophthalmologic reasons for the NK development  of NK include surgeries as the primary reason, prolonged anesthesia, post-acute disorders of cerebral circulation.

NK diagnosis is quite hard work, combining a thorough history, a detailed ophthalmic examination with assessment of corneal sensitivity and high-tech diagnostics, using confocal biomicroscopy.

Depending on the severity NK are divided into the keratopathy, the confluent corneal erosion and corneal ulcers.

The algorithm of NK therapy should be based on the severity of clinical presentations and is aimed at accelerating healing of the cornea and preventing disease progression with the development of deeper layers involvement. Treatment can be both conservative and surgical, such as amniotic membrane transplantation or a conjunctival flap.

This article presents data of clinical observations potentially promising in the treatment of NK by Visomitin drug.

The past XX century and early XXI century are marked by a widespread increase in viral infections, regardless of the level of socio-economic development of the country. The infections are noted for a more severe clinical course, resistance and torpidity to the applied etiotropic therapy. The most common and socially significant infections include influenza, ARVI, viral hepatitis, herpes infection and others. Influenza and acute respiratory viral infections (ARVI) account for 90% of all infectious diseases.

Purpose of the study. To study the clinical efficacy and safety of iron(III)-hydroxide polymaltose (Maltofer) in the treatment of iron deficiency anemia in children.

Material and methods. A retrospective study of medical records of pediatic patients with iron deficiency anemia who received iron(III)-hydroxide polymaltose in standard doses during the course of inpatient treatment.

Results. Administraton of iron(III)-hydroxide polymaltose was associated with a positive dynamics of the studied hematological parameters. No adverse reactions were reported. Girls demonstrated a more significant increase in hemoglobin levels and a more significant increase in the color index and mean cell hemoglobin compared to boys.

Treatment of rheumatoid arthritis is one of the promising directions for the clinical application of human placenta hydrolysates (HPH). HPH peptide components can contribute to a significant acceleration of recovery of connective tissue due to antiinflammatory and trophic effects. The results of experimental studies of HPH-containing medications for the treatment of arthritis models are presented. The prospects  for clinical applications  of HPH-containing preparations for the treatment of arthritis are discussed.

The article presents the history of the development of the cryotherapy method from antiquity to the present day, materials of clinical use of cryosurgery for endoscopic diagnosis and treatment of lung and bronchial tumors at the present stage, features of the advanced equipment for cryosurgery. The article also describes the first clinical experience in using cryorecanalization in obstructing tumors of the tracheobronchial tree in Russia using an advanced cryosurgical device. Three clinical examples of cryorecanalization are provided. The preliminary results of the clinical studies show that cryorecanalization using the advanced medical equipment and a new cryoprobe model is an effective method for recanalization to restore airway patency, which can be used in combination with electrodestruction, argon-plasma and laser coagulation, as compared with older cryosurgery devices.

The article presents the results of a study of patients undergoing treatment with permanent orthodontic structures (POS). Lately the number of adults seeking orthodontic consultation also increases as well as the number of complications arising in the process of orthodontic correction. The aim of this article was to study the prevalence and intensity of dental caries in the dynamics of individuals undergoing orthodontic treatment. A survey of 50 patients aged from 18 to 35 years with POS undergoing orthodontic treatment within 1 month was performed. Repeated examinations were carried out after 1, 6 and 12 months. After 12 months from the onset of the study there was an increase of the index «C» in the structure of the index of the CPU(s) by 2 times due to the emergence of new carious lesions in the hard tissues of the teeth. The prevalence of dental caries for 12 months was 100%, which corresponds to a high prevalence of dental caries.