Real-life clinical application of anticoagulant drugs is currently one of the most promising trends in cardiology. With relation to initial prescription of anticoagulants, the updated 2016  guidelines  on the management  of patients with atrial fibrillation (AF) highlight direct oral anticoagulants (DOAC) rather than vitamin K antagonists, but, unfortunately, they are not clear about whether different DOAC have the same clinical effect of there is a significant difference.

Material and methods. We conducted a comparative analysis of the safety of DOAC in patients with non-valvular AF and attempted to identify the potential predictors of hemorrhagic events in order to assess  the predictive value of bleeding risk scores. For this purpose, we observed 117 patients with non-valvular AF who received DOAC to prevent TEC for 2 years (24 months).

Results. Over the entire period of follow-up, no major bleeding or thromboembolic complications were recorded, supporting the good efficacy and safety profile of DOAC. We analysed the prognostic value of various scores and found that HAS-BLED had the highest predictive value in the group of patients treated with the direct thrombin inhibitor (dabigatran). Treatment with factor Xa inhibitors (rivaroxaban and apixaban) did not demonstrate a similar trend.

Conclusion. Over the 2-year follow-up of 117 patients treated with DOAC, we were able to show that this group of drugs in patients with non-valvular AF is effective and safe given that adequate doses in accordance with the instructions are administered; this is true for both direct thrombin inhibitors (dabigatran) and factor Xa inhibitors (rivaroxaban and apixaban). HAS-BLED was prognostically more accurate when the direct thrombin inhibitor dabigatran was administered.

Fixed combinations of antihypertensive drugs are more actively used in practice for therapy of arterial hypertension and on the whole are positively assessed by doctors and by patients. The accumulated experience of separate application of drugs allowed defining variants of their rational combination and to formulate the following major criteria of joint application: presence of different and mutually reinforcing mechanisms of actions; validity of the greater effectiveness  of combination with proof of good tolerability and presence of the fewer side effects. Currently the process of development of new fixed combinations of antihypertensive drugs is going on and the strategy of their application is made more precise taking into account the degree of the disease severity and the cardiovascular risk.

Modern standards of treatment prefer one of the most popular non-selective NSAIDs – diclofenac, which is the ratio efficiency/ safety is rightly called the «gold standard» analgesic therapy. In recent years in the treatment of joint pain widely used Voltaren Emulgel 1% and 2%. Currently, there is a convincing evidence base testifying to its analgesic and anti-inflammatory action, as in traumatic injuries of the ligaments and muscles, accompanied by severe pain syndrome, and chronic inflammatory processes in the joints, patients of all ages.

The article is devoted to the diabetic polyneuropathy – frequency, possibilities of diagnostics, including those with use of instrumental methods. Own data about possibilities to detect asymptomatic lesion of the peripheral nervous system in diabetes mellitus patients are provided. Effectiveness of the therapy of this state with the help of one of the drugs of the thioctic acid based drugs (Berlithione®).

The article examines the results of the integrated treatment of discogenic radiculopathy in athletes using the paravertebral administration of the drug containing chondroitin sodium sulphate (Hondrogard) and traction of the lumbar-sacral spine. Evidence of a higher efficiency of this combination based on subjective and objective control of treatment compared to schemes that do not use these techniques are provided.

The article provides an experience of use of the new antidepressant with the precognitive action – Vortioxetine. High therapy compliance was demonstrated. The drug is effective in relief of depression, improves cognitive functions in neurologic patients and presumably has pain-killing action.

This article presents a review of the efficacy and safety of three oral drugs for multiple sclerosis, which are registered in the Russian Federation: teriflunomide, dimethylfumarate, fingolimod.

The article highlights the main differential diagnostic criteria for acute respiratory viral infection, acute tonsillopharyngitis and acute rhinosinusitis, and the differences in the clinical course of viral and bacterial forms of the diseases. The necessity and time frames for antibacterial therapy are discussed; medications for the initial empirical therapy of the diseases are suggested.

Till today, the duration of antibiotic therapy for community-acquired pneumonia (EP) remains a subject of debate. In different clinical guidelines  the  duration of antibiotic administration varies. Meanwhile, there is growing evidence  that short-term antibiotic regimens for non-severe respiratory infections of the lower respiratory tract seem attractive and promising.

The article provides issues of epidemiology, etiopathogenesis and therapy of infectious and inflammatory diseases of the ENT organs with focus at rational and safe choice of systemic antibacterial therapy taking into account experience of Russian and foreign authors.

The relevance of effective therapy of community-acquired pneumonia (CAP) with a view to improving the prognosis in severe and complicated course of the disease requires a reasonable correction. In this paper, based on the results of earlier clinicalimmunological studies the authors formulate algorithms for diagnosis of immune reactivity in severe CAP, justify immunocorrection the drug with immunomodulating effects on the whole range of violations. Examples clinical and immunological effectiveness of immunocorrection provided.

Тhe article is devoted to discussion of use of rational antibacterial therapy of diseases of ENTorgans. The start of antibacterial therapy is a key to success of efficiency of treatment, leads to an eradication of bacteria and decrease of risk of chronic infections. Choosing antibacterial therapy we have to consider the previous therapy by antibiotics, hospitalization, associated diseases. All these factors will define starting antibacterial therapy. We will show in the article some questions of interaction of antibacterial drugs, and also questions of clinical importance of use of non-steroidal anti-inflammatory drugs in therapy of ENT diseases.

Allergic rhinitis as one of the most common non-infectious respiratory inflammatory diseases is a global public health problem. The course of allergic rhinitis, its effect on the pathology of other organs and systems, the likelihood of complications and many other aspects of this pathology are largely determined by timely diagnosis and adequate treatment. At the heart of the pathogenesis of allergic rhinitis is the immediate allergic reaction. Histamine is the most important biogenic amine, the physiological regulator of the activity of various cells and systems and one of the main mediators of allergic reactions of immediate type. In the treatment of allergic rhinitis, one of the key places is occupied by antihistamines. One of such highly effective modern antihistamines is levocetirizine – a blocker of H1 histamine receptors of the second generation. Leveltzetirizine affects the histamine-dependent stage of allergic reactions, reduces vascular permeability and eosinophil migration, limits the release of inflammatory mediators, significantly influences the formation of edema of the tissues and the production of mucus, prevents development and greatly facilitates the course of the allergic reaction, has antiexudative, antipruritic and anti-inflammatory effects, and a pronounced ability to eliminate nasal obstruction in patients with seasonal allergic rhinitis. The drug levocetirizine Allerway®, bioequivalent to the original drug, is of definite interest to physicians of various specialties.

Atopic dermatitis remains an important medico-social problem, whose significance is determined by the steady increase in morbidity, recurrent course and often low therapeutic efficacy. In recent years, the number of patients suffering from severe forms of atopic dermatitis has increased [1–3]. One of the most important causes of the complication of an allergic disease is the combination of allergies and secondary immune deficiency syndrome characterized by reversible (as a rule) disturbances of the functions and adaptation mechanisms of the immune system [4, 5].

The article provides epidemiologic data on acne in women, an interrelation of the disease with hormonal processes and disturbances is described. Results of complex therapy of 49 patients with acne by folate-containing oral contraceptives. Therapy effect not only on the skin process but on the psychoemotional and physical status of patients is noted. The subjective evaluation of patients confirms high effectiveness of the proposed therapy.

The article provides the data of epidemiologic studies on frequency of symptoms of the gastroesophageal reflux disease (GERD), risk factors and GERD manifestations. Special emphasis is made on the individual therapeutic approach and choice of the modern effective drug for therapy – PPI Dexlansoprazol.

Objective of the review: Coverage of current aspects of diagnosis and treatment of functional biliary disorders. Basic provisions. The article analyses information about the functional disorders of the gall bladder and the sphincter of Oddi, the principles of treatment of patients with peculiarities in the gall bladder, the main drugs for the functional disorders of the biliary system are provided, possibilities of the domestic drug ursodeoxycholic acid (UDCA) Urdoxa are provided.

Conclusion: According to modern recommendations, the use of the Urdoxa drug is the basis for initial therapy for patients with biliary sludge and for functional disorders of the gall bladder and sphincter of Oddi.

Antibacterial drugs as many other drugs have side effects, one of which is antibiotic-associated diarrhea  (AAD). In addition to light idiopathic forms the practicing clinicians faces AAD grave forms. The major causative agent of grave forms is bacterium Clostridium difficile. Clostridium-induced  diarrhea is inclined to recurrences. In addition to etiotropic therapy of Clostridium infection probiotics are effective drugs for prevention and therapy of AAD.

The article provides historic development of ideas about the protective mucous barrier in the stomach, a modern vision of the cytoprotection in the stomach is provided, and possibilities of pharmacologic cytorpotective drugs are described. Cytoprotective properties of the bismuth salt based drugs are stated.

The clinical criteria of the irritated bowel syndrome are well-defined and well-known. But often practicing doctors come to this judgement without support of criteria. Meanwhile diagnosis of chronic colitis is out of fashion, is not established by clinicians to prevent their acknowledgement as doctors lagging behind modern trends. This leads to hyperdiagnosis of one state and hypodiagnosis of the other state and, as a consequence, to the  erroneous therapeutic approach. The case further demonstrates an erroneous diagnosis and consequences to which it led.

The most common reason for a patient to contact a doctor is the pain accompanying about 70% of all known diseases. The article introduces the basic principles for treating acute and chronic pain. The role of inflammation in pathogenesis of acute and chronic pain is shown. It provides information on the effectiveness and safety of a non-steroid anti-inflammatory drug (NSAIDs) Nimesulide in the treatment of acute and chronic pain. Information is provided on the variety of Nimesulide mechanisms that allow it to be used in various rheumatic diseases as well as in other areas of medicine. The results of clinical research and analyses are presented that confirm the high efficiency and good tolerability of Nimesulide. The years of experience in the application of the granular form of Nimesulide (Nimesil®) by domestic clinicians indicate a high rate of development and a expressed anagesic, anti-inflammatory effects combined with good tolerability, which makes it possible to use the drug successfully in treating acute and chronic pain.

The problem of infectious endocarditis (IE) continues to be relevant because of the high mortality rates and the development of severe complications. The modern IE is a polyetiologic disease, the emergence and development of which can be attributed to an extremely extensive list enlarged almost every year. At the same time, the growing resistance of IE to antibiotics, as well as the increasing etiologic role of infectious agents that recently were very rare become serious barriers to effective antimicrobial therapy. The timely information of doctors about modern methods of IE treatment is of great practical importance. This article introduces the basic principles of treatment and prevention of from, taking into account the latest recommendations of European Cardiac Society experts in 2015.

The article is devoted to the combined indication of chondroitin drugs – Arthradol and glucosamine – ArthraCam in therapy of ostheoorthrosis. A symptom-modifying  effect in monotherapy and in course therapy by Arthradol and ArthroCam on the background of non-steroid anti-inflammatory drugs.

Purpose of review: to demonstrate that in addition to the certain morphologic separation and functional independence of pancreatic islets and acinar tissue of the pancreas there is a strong interrelation between them.

Major provisions:  the pancreas is an integrated and robust organ, all components of which are closely interrelated and possible interchangeable. A morphologic substrate of this single endocrine-exocrine-ductal axis includes an intrapancreatic portal capillary system an enzyme and hormonal system and ultra-structural peculiarities of the acinar-islet cells, which ensures the maximum effectiveness of this organ.

Conclusion: the knowledge of these interrelations is very important as it might be used in the clinical practice. It’s possible that the future in the therapy of the extra-secretory pancreatic insufficiency and diabetes mellitus belongs not to the gland or its fragments transplantation but to biotechnological methods.

Relevance: diabetic cardiovascular autonomic neuropathy (CAN) is considered as one diabetes-associated mechanism complicating the course and prognosis of myocardial infarction (MI). Objective:  to assess the effect of thioctic acid (TA) on the dynamics of indices of heart rate variability  (HRV) in patients with Type 2 diabetes mellitus 2 type (DM2) after acute IM.

Materials and methods: we conducted an open randomized prospective study. It included 50 patients with T2DM after MI. For 10–14 days from the date of MI development a study of heart rate variability was done. Group 1 consisted of 10 patients with CAN, and they received TA (Thiogamma, Worwag Pharma GmbH & Co. KG (Germany) oral tablets at a dose of 600 mg per day for 3 months, 19 patients with CAN (Group 2) and 20 patients without CAN (Group 3) didn’t receive TA, 1 patient dropped out.

Results: improvement of HRV after 3 months were in groups with low baseline area of the scatterogram clouds: in Group 1 the baseline value is 290 ms2 [202; 415] vs. 1025,5 ms2 [620; 1546] after 3 months (p = 0.005); in Group 2: 238 ms2 [162; 239] vs 531 ms2 [339; 795], p < 0.001. In Group 3 no significant changes were identified: 948,5 MS2 [783; 1642] vs 1220 MS2 [805; 1610] (p = 0,88). In patients with CAN, the largest increase of parameters of HRV was found in the group of TA intake: 706 ms2 [285; 1131]  in group 1 vs 284 ms2 [80; 506] in Group 2, p = 0,02.

Conclusions: the use of TA at a dose of 600 mg for 3 months to treat a CAN in DM2 patients after acute MI is accompanied by a significant improvement of HRV indices.

According to the IDF (2016) 1 of 11 adult patients suffers from diabetes mellitus (DM). The total number of diabetic patients is 415 million. By 2040, according to analysts of the International Diabetes Federation, the number of the sick increases and the disease will affect 1 in 10 people. It is extremely important to maintain all indicators of carbohydrate metabolism (fasting glucose and postprandial, HbA1c) within the target values. Currently existing recommendations are not obligatory and do not give the strict guidance on the priority use of a group of hypoglycemic drugs and other drugs. The choice of patient-orientated approach, based on the effectiveness and safety of drugs. On the basis of numerous clinical studies have proven the effectiveness and safety of Alogliptin in the treatment of patients with type 2 diabetes.

The possibilities of treatment of diabetic polyneuropathy with Actovegin® are discussed in this publication.  In the multicenter, randomized, double-blind trial 567  patients  with type 2  diabetes  received 20  intravenous infusions of 20% solution  of Actovegin® or placebo followed by 1800  mg of Actovegin® in tablets or placebo for 140 days. The effectiveness was assessed by changes of Total Symptom Score and vibration perception as primary outcomes, neuropathy impaired score of the lower limbs (NIS-LL) and quality of life as secondary end points. Treatment with Actovegin resulted in significant improvement in TSS (p = 0,0003), sensory component of NIS-LL (p = 0,021), improvement of vibration perception (р = 0,08) and mental domain of quality of life. Thus, treatment of diabetic distal polyneuropathy with Actovegin® in type 2 diabetic patients improves different functions of peripheral nervs.

Currently glycaemia is proved to be an independent risk factor of cardiovascular events in diabetes mellitus patients. The article considers potential hypoglycaemia action mechanisms on the cardiovascular system and glycaemia self-control issues in diabetes mellitus.

The incidence of chronic kidney disease (CKD) in Type 2 Diabetes Mellitus patients accounts for 34,6–40%  of cases. The importance of glycemic control for the prevention of kidney damage and progression of nephropathy in T2DM patients is proven in numerous studies. The presence of CKD significantly limits the choice of antidiabetic drugs and requires changes in dosages. Sitagliptin-DPP-4 inhibitor is approved for use at any stage of CKD. Clinical studies involving Sitagliptin provide a powerful base demonstrating the effectiveness and safety of the drug in CKD. The article presents the data of clinical and experimental studies indicating the protective role of Sitagliptin in the development of renal damage. The animal experiments revealed that the suppression of the activity of DPP-4 by Sitagliptin in kidneys leads to regression of renal damage, with reduced markers of inflammation and endothelial dysfunction.

Urolithiasis is a common urological disease the prevalence of which tends to increase. The main targets of therapy for patients with uric acid nephrolithiasis include normalization of purine metabolism, dissolution of stones, and prevention of stone formation. Oral administration  of a citrate mixture or sodium bicarbonate results in urine alkalinization and dissolution of the uric acid stone. The article demonstrates the results of the recent Russian studies of the efficacy and safety of litholytic therapy for uric acid nephrolithiasis both as monotherapy and in combination with remote lithotripsy. The studies show that citrate therapy is a highly effective, non-invasive method for the treatment and metaphylaxis of uric acid nephrolithiasis.

Combined oral contraceptives (COC) – the most popular reversible method to prevent unwanted pregnancy used in the whole world. The popularity of COC remains unchanged since the moment of their appearance [1]. Thus, in the US COC are used by each 4 out of 5 women using combined hormonal contraceptives [2]. In Russia the whole diversity is available now: of various dosage forms of hormonal contraceptives (tablets, vaginal rings, patches, implants, intrauterine hormonal releasing systems), and of formulations (use of ethinyl estradiol and estrogens analogous to natural ones, use of progestogens of all types) and intake regimes as well (one-time and urgent, daily, monthly, for several years) that allows the doctor in cooperation with the female patient to conduct the informed choice of the most optimal method of contraception. But in Russia the situation that is extremely untypical for other countries remains. On the one hand, complete availability of hormonal contraceptives, on the other hand, the degree of their use and indication remains on the sufficiently low level.

The article focuses on the identification of causal relationships between dysmenorrhea, endometrioid and tumor processes. Studies have shown that dysmenorrhea, apart from a decline in the quality of life, can be the cause of development of a number of serious health disturbances, including endometriosis, adenomyosis and even tumoral diseases. Non-steroidal anti-inflammatory drugs are not only the effective means of therapy for dysmenorrhea patients, but also a pathogenetically reasonable approach to prevent the outbreak of the disease.

The article provides the data of the clinical study on effectiveness  of application of the systemic enzyme therapy in patients with varicose veins of lower extremities of C6 clinical class by CEAP classification. The study was conducted in 2 groups. In the major group (20 patients) the protocol of the conservative therapy included systemic enzyme therapy (Flogenzyme MUCOS Emulsions GmbH, Germany), the control group included only conservative therapy including modern wound coverings adapted to the stage of the wound process, elastic compression and micronized purified fraction of flavonoids. The duration of therapy was 1 month. As a result of therapy complete ulcer healing was registered in 18(90%) of patients, in the control group – in 9 patients (50%). The analysis of immune hemostasis values affecting the inflammatory process showed considerable reduction of absolute and relative content of CD4+CD25Bright-cells and increase of T-lymphocytes with phenotype CD4+CD45RO+ in the major group, which corresponded to the positive changes in the clinical pattern. Inclusion in the therapeutic protocol of the systemic enzyme therapy drug Flogenzyme contributed to quick regression of the clinical symptoms of the chronic venous insufficiency and acceleration of the process of regeneration of the venous trophic ulcers at stage I-III of the wound process.

An experience of combined therapy (by Venflaxin and cognitive-behavioral psychotherapy) of post-stroke depressions of the rehabilitation inpatient department patients. 38 patients with organic depressive disturbance of various severity degree by ICD-10 were examined. By the domineering effect the patients were divided in 4 groups – with predominance of the anxiety component, melancholy-anxiety combined variant, “classical” melancholic depression and astheno-depressive syndrome with the unstable main effect. With use of the psychometric scales HADS, HARS, CGI-S и CGI-I effectiveness of the combined therapy was demonstrated with respect to all components of the post-stroke depression, advanced reduction of the anxiety component was observed. Good tolerability and safety of Venlafaxin was noted. A conclusion about the rationality to use Venflaxin in a combination with a cognitive-behavioral psychotherapy and rehabilitation of neurologic patients in the post-stroke period.

Strokes are one of the most frequent reasons of population disability, that’s why rehabilitation of post-stroke patients is an urgent medical and social problem of modern healthcare system. In a considerable share of patients affected by stroke various disturbances of the higher psychic functions develop, including attention deficit, memory reduction, deceleration of thinking and quickness of psychic processes, up to dementia development. This aspect of stroke consequences is downplayed, at the same time CD to a great share predetermine the outcome of rehabilitation measures and the quality of the patient life. The article considers modern approaches to diagnostics and principles of therapy of moderate cognitive disturbances of vascular genesis.

Statins have been used since the second half of the XXth century. It’s been a while time to understand the importance of statins in the treatment of cardiovascular disorders.Statins therapy in HFPEF is a new area that contributes significantly to the treatment of heart disease.

The article provides an overview of modern methods of psoriasis therapy. Presents the results of a study aimed at optimizing therapy for severe forms of psoriasis. Presents the developed algorithm for assigning plasmapheresis procedures depending on the form and clinical manifestations of the disease, as well as the developed practical recommendations of combined appointment of plasmapheresis and injections of methotrexate for severe psoriasis.