Terapevticheskii arkhiv

The article is devoted to an overview of the current stage of development of the movement of doctors, which received the Nobel Peace Prize in 1985 and was founded by Evgeny Ivanovich Chazov and Bernard Lown. In the year of the fortieth anniversary of the Chernobyl disaster, it is extremely important for the entire medical community to remember the stages of the organization's development, as well as to understand the current state of medical and scientific diplomacy, the development of which is the key to the continued existence of mankind and the protection of the health of the population as a whole.

In recent years, studies have been carried out that have expanded the understanding of the role of pathophysiological mechanisms underlying impaired regulation of aldosterone and activation of mineralocorticoid receptors in arterial hypertension. The aim of this consensus is to consider the association between aldosterone dysregulation and the development of cardiovascular complications, as well as to assess the effectivity and safety of novel nonsteroidal mineralocorticoid receptor antagonists, to expand the understanding of their potential in ensuring the prevention of target organ damage and cardiovascular complications in the treatment of patients with hypertension, to analyze the potential of a new class of drugs – aldosterone synthase inhibitors – in ensuring the suppression of genomic and non-genomic effects of aldosterone and their adverse effects in patients with hypertension, to assess the efficacy of drug therapy including nonsteroidal mineralocorticoid receptor antagonists and aldosterone synthase inhibitors in the category of patients at high cardiovascular risk – in hypertension due to primary hyperaldosteronism.

Aim. Testing of therapeutic drug monitoring in the treatment of drug-resistant tuberculosis.

Materials and methods. We conducted a pilot prospective study including 15 patients with drug-resistant tuberculosis. Serum concentrations of bedaquiline, linezolid, fluoroquinolone, cycloserine, delamanid (C_2h) were determined by high-performance liquid chromatography and mass spectrometry. The influence of clinical and pharmacogenetic factors were evaluated.

Results. In most patients, C_2h of the drugs were subtherapeutic (57.1% for bedaquiline, 73.3% for linezolid). C_2h of bedaquiline were higher in patients with homozygous rs776746 in the CYP3A5 gene (p=0.04), in case of simultaneous omeprazole (p=0.015), high drug load (p=0.005); linezolid – in patients with rs776746 in the CYP3A5 gene (p=0.038) and rs34351236 in the P-glycoprotein gene (p=0.014). The course of chemotherapy was effective in 14 of 15 patients. A factor for cavity closure was a C_2h/critical concentration ratio above 1.0 for fluoroquinolone (odds ratio 3.5, 95% confidence interval 1.08–11.24).

Conclusion. Therapeutic drug monitoring is a perspective tool for personalized approach to improve treatment outcomes in high-risk drug-resistant tuberculosis patients.

The article describes the history of the development and implementation of stress tests in cardiology for the diagnosis of coronary heart disease, with a particular attention to the creation, implementation and development of the treadmill test.