Vol 84, No 12 (2012)


Science and clinical practice

Chazov E.I.


The paper discusses issues related to the role of basic studies in the development of practical medicine and to the integration of basic science and medical treatment.
Terapevticheskii arkhiv. 2012;84(12):5-7
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Microcirculatory parameters in patients with myocardial infarction

Striuk R.I., Tektova A.S., Berns S.A., Golikova A.A., Epifanov A.V.


AIM: To estimate the prognostic value of the parameters of the microcirculatory bed for the assessment of risk for in-hospital death and cardiovascular events in patients with myocardial infarction (MI) /MATERIAL AND METHODS: Thirty (62.5%) and 18 (37.5%) of 48 patients (mean age 63.5±10.2 years) admitted to an intensive care unit for acute coronary syndrome subsequently developed MI in the anterior and lower walls of the left ventricle (LV), respectively. /RESULTS: According to the GRACE scale, 28 (58.3%), 7 (14.6%), and 13 (18.1%) patients had high, low, and moderate risks for in-hospital death, respectively. Uncomplicated MI was noted in 18 (37.5%) of the patients; acute LV aneurysm was formed in 12 (25%); 14 (29.1%) had cardiac arrhythmias as frequent ventricular and supraventricular premature beats, paroxysms of ventricular fibrillation, ventricular tachycardia, atrial fibrillation and flutter. Early post-infarction angina pectoris was noted in 2 (4.2%) patients, Killip Class I and II heart failure in 36 (75%) and 12 (25%), respectively; 3 patients died (2 from myocardial rupture and 1 from ventricular fibrillation). According to GRACE scores, complicated MI was significantly more frequently encountered in patients at high risk for in-hospital death (75% versus 28.5% in those at low risk; p = 0.03). Analysis of the microcirculatory bed revealed substantial changes in microcirculation (MC), which reflected its hypereremic type and characterized high perfusion and high MC flow index. Moreover, the coefficient of variation (CV) was significantly higher than that in the control; on days 4 and 20 it did not virtually differ from that in the control on day 2. /CONCLUSION: The found changes in MC parameters (MC value and CV) may suggest the higher influence of active mechanisms for regulation of vascular tone as a response to myocardial necrosis. The role of the autonomic nervous system in the regulation of vascular tone is supported by the significant change in the normalized amplitudes of low- and high-frequency oscillations while the intravascular resistance index remained considerably higher at all follow-up stages, which may suggest that central hemodynamics is unstable in patients with MI and necessitates monitoring of their clinical status.
Terapevticheskii arkhiv. 2012;84(12):8-12
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Consistence of the radial artery as a conduit used in aortocoronary bypass surgery, a possibility of preventing shunt spasm

Ripp T.M., Kondrat'eva D.S., Mordovin V.F., Afanas'ev S.A., Kozlov B.N., Suslova T.E.


AIM: To develop a new procedure to evaluate the functional consistence of the radial artery (RA) as a conduit used in aortocoronary bypass surgery (ACBS), to verify the prognostic value of the changed diameter of RA, and to prevent its spasm. /MATERIAL AND METHODS: The study enrolled 34 patients aged 59.4±8.6 years with coronary artery stenoses, who underwent ACBS using a RA conduit. While preparing them for surgery, endothelium-dependent vasodilation (EDVD) of RA, i.e. the magnitude of a change in its diameter (ΔD) was assessed; RA tone and nitric oxide (NO) concentrations were estimated during surgery; RA EDVD was re-estimated in 12 lercanidipine-treated patients with ΔD <8% /RESULTS: The patients were primarily divided into 2 groups: 1) ΔD ≥8% (RA spasm intra- and postoperatively); 2) EDVD ΔD <8% (RA spasm). Significant differences between Groups 1 and 2 were intraoperatively recorded in vascular wall tone (U=1.0; Z = -2.3; р=0.02) and NO concentrations (p=0.0); a relationship was found between these parameters. After lercanidipine treatment, the degree of ΔD=4.36±1.89% increased to 11.32±2.22% (р=0.0) and RA tone dropped from -1.68 to -3.9 mm in Group 2a with the baseline decreased vasodilating activity of RA /CONCLUSION: Ultrasound assessment of the vasodilating activity of RA provides adequate evidence about its arterial wall tone during surgery. ΔD <8% is prognostically unfavorable and serves as a contraindication to the use of RA as a conduit during ACBS. The administration of lercanidipine allows effective correction of the dilatory capacities of an arterial conduit.
Terapevticheskii arkhiv. 2012;84(12):13-17
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Quality of life in patients with coronary heart disease associated with metabolic syndrome: Results of factor analysis

Kaliuzhin V.V., Tepliakov A.T., Riazantseva N.V., Bespalova I.D., Kamaev D.I., Kaliuzhina E.V.


AIM: To identify the factors most substantially influencing the quality of life (QL) in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS), by using the principal component method. /MATERIAL AND METHODS: One hundred and two male patients (mean age 48.6±1.02 years) with CHD associated with MS, who had experienced large-focal myocardial infarction not earlier than 6 months before, were examined. Estimation of QL (EORTC QLQ CORE 30) and emotional-personal sphere (brief multifactorial personality questionnaire test and Spielberg's trait anxiety inventory) was made along with the complete clinical, laboratory, and instrumental examination accepted in specialized clinical practice of cardiology /RESULTS: A factor analysis of the variables obtained after a thorough examination of the patients could identify 4 common QL determinants, such as postinfarction cardiac remodeling, neurotization, obesity, and the degree of heart and coronary failure /CONCLUSION: MS in patients with CHD appreciably determines the total score of physical, emotional, and social well-being. In the cluster of MS components, obesity is a major factor that influences QL in patients who have sustained myocardial infarction.
Terapevticheskii arkhiv. 2012;84(12):18-22
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Aspects of risk stratification in acute coronary syndrome (Part II): Prognostic value of evaluation of exercise-induced myocardial ischemia according to the data of pharmacological stress echocardiography

Gukasian V.A., Matskeplishvili S.T., Ioshina V.I., Aripov M.A., Shakhnazarian L.S., Asymbekova É.U., Zhertovskaia E.V., Buziashvili I.I.


AIM: To define the prognostic value of evaluation exercise-induced myocardial ischemia according to the data of pharmacological (dobutamine or dipyridamole) stress echocardiography (EchoCG) in patients with acute coronary syndrome (ACS). /MATERIAL AND METHODS: The results of examinations were analyzed in a total of 91 patients with ACS. An analysis of events in the established follow-up period (mean 14.3±0.7 months) took into consideration outcomes, such as death from cardiac diseases, a recurrent acute coronary episode (nonfatal myocardial infarction (MI), unstable angina (UA) /RESULTS: Pharmacological stress EchoCG showed a positive result in 40 (44%) patients (Group 1) and a negative one in 51 (56%) patients (Group 2). Thus, the sensitivity and specificity of the pharmacological test in determining the risk for cardiac events were 89.3 and 76.2%, respectively; the prognostic value of positive and negative results was 62.5 and 94.1%, respectively. Analysis of EchoCG parameters used to identify poor prognostic factors in patients with ACS has indicated that the most important predictors of death and major cardiac events (cardiac death, acute MI, UA) are resting impaired segmental contractility index (ISCI), number of asynergic segments, and total ejection fraction (TEF) at baseline; TEF, ISCI, ΔISCI (as compared to the baseline data), and the number of segments with a negative response after low-dose drug infusion; a positive or negative result, TEF, ΔTEF (as compared to the baseline data), and ISCI at the test peak /CONCLUSION: Pharmacological stress EchoCG is a safe noninvasive diagnostic method in a group of patients with ACS. When the latter is diagnosed, it may be performed in the earliest periods (on day 4 after onset of the disease) to estimate its prognosis and to decide whether aggressive treatments should be used.
Terapevticheskii arkhiv. 2012;84(12):23-29
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Cerebral blood flow and endothelial functional activity in patients with coronary heart disease and arterial hypertension during therapy with ivabradine in combination with perindopril

Musikhina N.A., Gapon L.I., Utesheva A.B., Petelina T.I., Kolesnikova S.N.


AIM: To investigate the effects of ivabradine in combination with perindopril on cerebral blood flow and endothelial functional activity. /MATERIAL AND METHODS: Sixty-four patients with coronary heart disease (CHD) and arterial hypertension (AH) were examined. Group 1 (n=38) patients took ivabradine in combination with perindopril and Group 2 (n=26) received metoprolol. At baseline and 8 weeks after therapy, 24-hour blood pressure (BP) monitoring and electrocardiography were done, cerebral blood flow was estimated by Doppler ultrasound, reactive hyperemia and nitroglycerin tests were performed, and plasma nitrite levels were determined /RESULTS: With a comparable decrease in BP and heart rate in the internal carotid artery basin in both groups over time, there was a fall in peak systolic blood flow velocity; Group 1 showed a reduction in pulsatility index (PI) and systolic/diastolic ratio (ISP). After 8 weeks, there was an increase in endothelium-independent vasodilation and baseline blood flow velocity in the brachial artery in Group 1 and a rise in endothelium-dependent vasodilation in Group 2; in both groups, reactive hyperemia were higher in the brachial artery basin. No changes in nitrite levels were recorded during therapy. There was an inverse correlation between PG and PI in Group 1 and between PG and ISP in Group 2 /CONCLUSION: By unidirectionally affecting the vasomotor function of the endothelium, ivabradine in combination with perindopril versus metoprolol has a more favorable effect on circulatory resistance and blood flow velocity in the brachiocephalic arteries of patients with CHD and AH.
Terapevticheskii arkhiv. 2012;84(12):30-34
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In search of optimal treatment for nonischemic ventricular arrhythmia in patients with anxiety disorders

Treshkur T.V., Tsurinova E.A., Tulintseva T.É., Parmon E.V., Il'ina D.I.


AIM: To assess whether arrhythmias may be corrected with the anxiolytic Adaptol in subjects with anxiety disorders. /MATERIAL AND METHODS: On the basis of the data of psychological and mental testing (Stroop test) and the results of Holter monitoring, the authors selected among 59 patients with non-coronarogenic ventricular arrhythmias (VA) and an inadequate response to antiarrhythmic therapy 21 patients with manifest anxiety disorders, in whom a psychogenic factor had played a significant role in the genesis of VA, which served as an indication for Adaptol use. Reexaminations were made 30 days after initiation of therapy with Adaptol 500 mg t.i.d /RESULTS: Adaptol used to treat VA in patients with high anxiety, unlike the controls, exerted a significant antiarrhythmic effect: the average daily and average hourly number of ventricular ectopic complexes significantly decreased while there were no changes in the control group (untreated with Adaptol). In 95% of the patients, the positive Stroop mental test became negative, i.e. it failed to provoke arrhythmia (р≤0.01), made test performance easy, and diminished a blood pressure response to the test. The number of patients with moderate and high situational anxiety decreased by 3 times (р≤0.01); the general condition improved in the majority of patients /CONCLUSION: The psychogenic factor plays a significant and sometimes determining role in the genesis of non-coronarogenic VA. When used alone and in combination with antiarrthythmics, Adaptol proved to be effective in treating non-coronarogenic VA in patients with higher anxiety.
Terapevticheskii arkhiv. 2012;84(12):35-39
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Association between adipokines and the development of osteopenic syndrome in end-stage lung disease

Kochetkova E.A., Ugaĭ L.G., Buria K.A., Nevzorova V.A., Massard J.


AIM: To study of an association between adipokines, nutritional status, and bone mineral density (BMD) in end-stage lung disease (ESLD). /MATERIAL AND METHODS: Forty-seven patients aged 26 to 62 years with ESLD were examined. BMD in the lumbar spine (LII-LIV) and left femoral neck (FN) was estimated using dual-energy X-ray absorptiometry (DXA). The serum levels of adipokines (leptin, adiponectin resistin, tumor necrosis factor-α (TNF-α), and its receptors sTNFR I, II) were determined. A control group consisted of 45 healthy volunteers matched for age and gender /RESULTS: Osteopenic syndrome (T-score <-1 SD) was recorded in 43 (91%) of the 47 examined patients with ESLD. In lung diseases, the concentrations of adiponectin, resistin, TNF-α, and its receptors were higher and the level of leptin was lower than in the control group. There was a positive correlation between the content of leptin (r=0.64, p=0.0002; r=0.52, p=0.009) and a negative correlation between adiponectin (r=-0.54, p=0.009; r=-0.47, p=0.003), TNF-α (r=-0.43, p=0.03; r=-0.41, p=0.04), and BMD in FN and FN LII-LIV. Correlation analysis showed a positive correlation between the level of resistin (r=0.57; p=0.004), sTNFR I (r=0.42; p=0.03), sTNFR II (r=0.44; p=0.04), and BMD in LII-LIV only. The serum leptin level was positively correlated with body mass index (BMI) (r=0.82; p<0.0001) and total fat mass (TFM) (r=0.84; p<0.0001). On the contrary, the level of adiponectin was inversely correlated with BMI (r=-0.68; p<0.001), serum resistin concentration (r=-0.57; p=0.004), sTNFR I (r=-0.58; p=0.007), and sTNFR II (r=-0.53; p=0.006). It was stated that there was a strong inverse correction between the levels of leptin and adiponectin (r=-0.67; p=0.0008) /CONCLUSION: The found associations between adipokines and BMD may suggest that these markers are implicated in the pathogenesis of osteopenic syndrome in ESLD.
Terapevticheskii arkhiv. 2012;84(12):40-44
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Efficacy of ceruloplasmin in patients with asthma

Farkhutdinov U.R., Farkhutdinov S.U.


AIM: To evaluate the efficacy ceruloplasmin (Cp) used in the combination therapy of patients with an asthma exacerbation. /MATERIAL AND METHODS: The trial included 37 asthmatic patients. Chemiluminescence (ChL) registration was used to study the production of reactive oxygen species (ROS) in the patients blood. Nineteen patients with asthma received conventional treatment. Cp was used as part of combination therapy in 18 asthmatic patients /RESULTS: ChL intensity was increased the blood of patients with an asthma exacerbation. Cp treatment resulted in a reduction in the generation of ROS in the blood and contributed to positive changes in the clinical symptoms of asthma. In the patients receiving conventional therapy, the high ChL intensity of blood was retained and the clinical symptoms of the disease reduced /CONCLUSION: The use of Cp in patients with an asthma exacerbation corrects free radical oxidation processes and enhances therapeutic effectiveness.
Terapevticheskii arkhiv. 2012;84(12):45-48
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Use of nebivolol in patients with idiopathic pulmonary hypertension: Results of the pilot study

Martyniuk T.V., Konosova I.D., Chazova I.E.


AIM: Тo study the impact of 24-week therapy with nebivolol in a dose of 5 mg/day on the clinical and functional status of patients with idiopathic pulmonary hypertension (IPH), echocardiographic parameters, and blood levels of vasoactive mediators and nitric oxide (NO) metabolite. /MATERIAL AND METHODS: During continuous standard therapy comprising dihydropyridine calcium antagonists, warfarin, and diuretics, 12 patients with IPH and functional class (FC) II-III received nebivolol in a dose of 5 mg/day for 24 weeks. According to the data of right heart catheterization, all the patients had a positive acute pharmacological test with a vasodilator (NO). Six-minute walk test (6'WT), estimation of the Borg dyspnea index (BDI) and FC, transthoracic echocardiography (EchoCG), and measurements of the levels of NO metabolites, endothelin-1, (ET-1), thromboxane B2 (TxB2), and 6-keto-prostaglandin F1α (6-ketoPG F1α) were done at baseline and after 12 and 24 weeks of the therapy /RESULTS: Following 24-week nebivolol treatment, there was a statistically significant increase in 6'WT distance (from 473±47.6 to 516.7±58.4 m; р<0.0001) and a drop in BDI (from 3.4±2.2 to 1.1±0.7; р<0.05) and FC (from 2.9±0.4 to 1.7±0.2; р<0.05). Doppler EchoCG showed that pulmonary artery systolic pressure statistically significantly decreased (91.6±30 to 78.3±39 mm Hg; р=0.05) at 12 weeks and slightly increased up to 83.2±32.4 mm Hg at 24 weeks. After 24-week treatment, the anteroposterior dimensions of the right ventricle (RV) statistically significantly reduced (from 4.4±0.6 to 3.8±1.2 cm; р<0.05). The other EchoCG parameters remained substantially unchanged. There was a statistically reduction in the level of ET-1 (from 2.99±1.1 to 2.17±0.8 µmol/l; р<0.05). The concentrations of 6-ketoPG F1α, TxB2, and NO metabolite remained substantially unchanged at 24 weeks of treatment with nebivolol. There were no adverse reactions requiring that the dose of the drug be discontinued or reduced. Heart rate tended to be lower at a 24-week follow-up. All the patients continued taking nebivolol after completion of the study /CONCLUSION: Therapy with nebivolol in a dose of 5 mg/day for 24 weeks led to a significant functional improvement in the patients with IPH and reductions in RV dimensions and blood ET-1 levels. The therapy did not cause adverse reactions.
Terapevticheskii arkhiv. 2012;84(12):49-53
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The specific features of pancreatic incretory dysfunction in chronic pancreatitis

Vinokurova L.V., Shuliat'ev I.S., Drozdov V.N., Berezina O.I., Varvanina G.G., Nevmerzhitskiĭ V.I.


AIM: To reveal the specific features of pancreatogenic diabetes mellitus (DM) and to discuss the principles of its medical therapy. /MATERIAL AND METHODS: Sixty-six patients (55 men and 11 women) aged 30 to 65 years with chronic pancreatitis (CP) were examined. The disease was accompanied with pancreatic calcification and cyst formation in 22 and 13 patients, respectively; 5 patients were found to have a pseudotumorous form of CP and 10 had clinically and laboratorily verified DM. 14 resections and 11 drainages for complicated CP were performed. Its diagnosis was established on the basis of clinical, instrumental, and laboratory findings. Pancreatic exocrine function was evaluated from the results of the 13C-trioctanain breath test (BT) that is designed for its in vivo diagnosis. The level of C-peptide was studied by an enzyme immunoassay /RESULTS: The findings suggest that pancreatic exocrine function is diminished in CP patients both with and without complications as compared with the normal value in 44% (24.3±1.7 and 26.6±1.3%, respectively), as shown by BT. According to the results of BT, a substantial decrease in the total proportion of a released label was noted in patients with CP and pancreatic calcification, diabetes mellitus, after resection operations for complications of CP and there were also significant differences, as compared to a group of CP patients without complications. In these patient groups, the level of C-peptide fell to a larger extent than that in CP patients without complications and in patients with CP and DM it was decreased to 0.11±0.02 ng/ml, the normal level being 0.7-1.9 ng/ml. There was a direct correlation between C-peptide levels and BT results in the patients with CP after resection operations. Insulin antibodies were absent in all the examined patients with CP, which proves the specific type of DM in CP. These are detectable only in type 1 DM. Seven patients with CP and DM were found to have calcification, 5 underwent resection operations, 3 had calcification and underwent pancreatic resection operations /CONCLUSION: The development of DM may be predicted in CP patients with formation of pancreatic calcification and resections. In these patients, pancreatic exocrine dysfunction achieves a severe degree.
Terapevticheskii arkhiv. 2012;84(12):54-57
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Impact of laser therapy on PGE2 level, 24-hour pH-metry changes, and quality of life in patients with gastroesophageal reflux disease

Burduli N.M., Tadtaeva D.I.


AIM: To study the impact of low-intensity laser irradiation on 24-hour pH-metry parameters and prostaglandin E2 (PGE2) levels in patients with gastroesophageal reflux disease (GERD). /MATERIAL AND METHODS: One hundred and twelve patients aged 19 to 79 years with GERD were examined. Seventy-eight patients received a 10-day course of continuous intravenous laser therapy using a Matrix VLOK laser therapy apparatus (Matrix, Russia) with a wavelength of 0.405 µm, radiation power at the exit of a main light guide 1-1.5 mW, pulse rate 80 Hz. The indicators under study were determined before and after treatment /RESULTS: After treatment, the intravenous laser therapy group showed a significant increase in PGE2 (1376±93 pg/ml) to the levels typical of those in healthy individuals and a significant decrease in all esophageal pH-metry parameters; the DeMeester score achieved normal values, and all quality of life (QL) indicators, except for physical function index, significantly improved (10.2±5.7; р<0.05) /CONCLUSION: The findings are suggestive of elevated PGE2 levels and improved QL during laser therapy.
Terapevticheskii arkhiv. 2012;84(12):58-61
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The role of the small intestine in the development of metabolic syndrome

Vakhrushev I.M., Liapina M.V.


AIM: To comprehensively investigate the function of the small intestine (SI) in metabolic syndrome (MS). /MATERIAL AND METHODS: Seventy-eight patients with MS were examined using, in addition to clinical studies, comprehensive ones of the function of SI: evaluation of its motor, digestive, and absorptive functions. The specific features of the hormonal and autonomic status were studied in the patients with MS /RESULTS: Clinical local and common signs of SI lesion were seen in 82.9% of the patients. Examination of SI function revealed its impairments at all stages of hydrolysis and resorption in the presence of hypomotor dyskinesia in the postprandial period and hypersympaticotonia in the patients with MS. New pathogenic patterns were found in relation to the role of hormones in intestinal digestive and absorptive dysfunctions in MS /CONCLUSION: The findings may suggest that SI functional changes found in MS are an important component of its complex pathogenetic circle.
Terapevticheskii arkhiv. 2012;84(12):62-65
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Use of the immunopotentiator N-acetyl-glucosamine-N-acetylmuramyl dipeptide during triple anti-Helicobacter pylori therapy

Konorev M.R.


AIM: To evaluate the efficiency of first-line Helicobacter pylori eradication therapy with glucosаminylmuramyldipeptide (Licopid JSC "Peptek", Russia). /MATERIAL AND METHODS: Eradication therapy was performed in 128 patients (84 men and 34 women; mean age 44.1±13.5 years) with duodenal bulb ulcer associated with H. pylori. The latter was detected in the gastroduodenal mucosa by a morphological study and rapid urease test before and 6-8 weeks after treatment and discontinuation of all drugs. Gastric metaplasia areas in the duodenum were revealed by periodic acid-Schiff and Alcian blue staining. The patients were divided into 4 groups according to the treatment protocol: 1) omeprazole (O) 0.04 g/day, clarithromycin (C) 1 g/day, amoxicillin (A) 2 g/day for 7 days (ОCА7; n=33); 2) the above drugs for 14 days (ОCА14; n=34); 3) O 0.04 g/day, C 1 g/day, A 2.0 g/day for 7 days, and glucosаminylmuramyldipeptide (Licopid) (L) 0.001 g/day for a day (ОCА7L1; n=34) and 4) the above drugs and L 0.01 g/day for 10 (ОCА7L10; n=27) /RESULTS: According to the data of intention-to-treat analysis and per protocol, the H. pylori eradication rate was 81.8 and 87.1% for ОCА7; 82.4 and 93.3% for ОCА14; 88.2 and 93.8% for ОCА7L1; 88.9 and 96% for ОCА7L10 after PT and RRT, respectively. The rate of side effects was as follows: 6.1% for ОCА7; 17.6% for ОCА14 (5.9% stopped treatment); 5.9% for ОCА7L1; 7.4% for ОCА7L10. The cost of the treatment protocols was $ 32 for ОCА7; $ 64 for ОCА14; $ 40 for ОCА7L1; $ 67 for ОCА7L10. The intake of glucosаminylmuramyldipeptide (licopid) 0.001 g/day during 7-day triple anti-Helicobacter pylori therapy increased eradication by 6.4% (ITT) and 6.7% (PP), without raising the rate of side effects /CONCLUSION: Н. рylori-positive patients with duodenal bulb ulcer should be given glucosаminylmuramyldipeptide (Licopid) 0.001 g/day during 7-day first-line eradication therapy as alternative to the 14-day treatment regimen.
Terapevticheskii arkhiv. 2012;84(12):66-70
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Eating behavior in patients with diabetes mellitus

Sapozhnikova I.E., Tarlovskaia E.I., Vedenskaia T.P.


AIM: To study the specific features of eating behavior (EB) in patients with diabetes mellitus (DM). /MATERIAL AND METHODS: One hundred and seventy-eight patients, including 128 with type 2 DM and 50 with type 1 DM, were examined. Questionnaire survey, general clinical, and laboratory studies were conducted /RESULTS: The patient groups did not differ in educational level and gender. In the patients with type 1 DM, the duration of the disease was longer and the incidence of complications was higher than in those with type 2 DM. Carbohydrate metabolism was decompensated in the majority of the patients with types 1 and 2 DM. A higher normative score if only by one of the disordered EB (DEB) scales (according to the DEBQ), was found in 68 and 78.9% with type 1 and type 2 DM, respectively. The patients with type 2 DM were more frequently ascertained to have restrictive EB. The patients with type 2 DM and restrictive EB were more aware of the disease, more often checked blood glucose levels themselves, and were better compensated. The proportion of patients with external and emotiogenic EB did not differ between the groups, the latter type was registered less frequently /CONCLUSION: Disordered EBs were detected in many patients with DM. The found features of EB may be taken into account while teaching the patients.
Terapevticheskii arkhiv. 2012;84(12):71-75
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Glycemic control and psychoemotional alteration in patients with different clinical characteristics of diabetes mellitus

Soplevenko A.A., Ametov A.S.


AIM: To determine the pattern and changes of psychoemotional states in 94 patients with diabetes mellitus (DM) and to study their relationship to glycemic values in its different clinical characteristics. /MATERIAL AND METHODS: Ninety-four patients (63 women and 31 men) with type 1 (n=20) and type 2 (n=74) DM who had received a course of planned hospital treatment in the Vladikavkaz Endocrinology Dispensary in the period 2006 to 2010 were examined. The psychodiagnostic procedure "GSAM" to evaluate their general state, activity, and mood and the Lüscher color test were used /RESULTS: Determinants of the psychoemotional pattern were identified in the patients with DM. These included: 1) age that determined general state and mood; 2) glycemia that affected the evaluation of general state and activity in middle-aged patients; 3) the type of DM that affected the evaluation of general state; 4) insulin dependence that determined mood. The activity factor related to the mechanisms of development of hyperglycemia was separated out in the very pattern of a psychoemotonal state /CONCLUSION: The low self-rating of general state, activity, and mood among diabetic patients is most common in elderly patients who have type 2 DM and receive sugar-lowering drugs.
Terapevticheskii arkhiv. 2012;84(12):76-81
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Experience with "AlfaVit Diabetes" used in the treatment of diabetic peripheral polyneuropathy in adolescents

Azova E.A., Vorob'eva V.A., Chekalova S.A., Okulova O.V., Azov N.A., Kolbasina E.V., Belotserkovskaia O.E., Severukhina T.A., Sladkova I.V.


AIM: To evaluate the efficiency of using the vitamin and mineral complex (VMC) AlfaVit Diabetes in the combination therapy of diabetic polyneuropathy (DPNP) in adolescents. /MATERIAL AND METHODS: A study group comprised 30 children with diabetic peripheral polyneuropathy, whose combination therapy included AlfaVit Diabetes as one tablet t.i.d. for 2 months. A comparison group consisted of 20 adolescents with DPNP who did not take the complex. Before and 2 months after the study, the children's state was assessed from the data of a physical examination with mandatory blood pressure and pulse measurements and a neurological study, from carbohydrate (basal glycemia, glycemic variability, glycated hemoglobin) and lipid (total cholesterol and its fractions) metabolic parameters, and from the findings of electromyography (EMG) /RESULTS: Incorporation of the VMC AlfaVit Diabetes into the combination therapy contributed to the ameliorated clinical manifestations of DPNP. There were positive electrophysiological changes, as evidenced by EMG. The VMC AlfaVit Diabetes showed good tolerability and caused no adverse reactions /CONCLUSION: The performed trials have indicated that it is expedient to use the VMC AlfaVit Diabetes in adolescents with type 1 diabetes mellitus and DPNP.
Terapevticheskii arkhiv. 2012;84(12):82-84
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The specific features of copper and manganese metabolism in the use of iron-containing preparations

Zaĭtseva I.P., Nasolodin V.V., Zaĭtsev O.N., Gladkikh I.P., Dvorkin V.A.


AIM: To comparatively evaluate the efficiency of preventive treatment with various iron preparations on copper, manganese, and iron metabolic features in adult athletes. /MATERIAL AND METHODS: Forty adult highly qualified sambo wrestlers were examined and divided into 4 groups of 10 persons in each. Group 1 athletes took iron-containing Sorbifer Durules in combination with ascorbic acid; Group 2 received Ferro Gradumet Vitamin C; Group 3 had Hemofer and ascorbic acid; Group 4 took ascorbic acid tablets. The latter group served as a control. Blood samples (15-20 ml) to be tested were taken at the beginning and end of 2-week use of iron preparations. The daily balance of iron, copper, and manganese was estimated following 7-day intake of these preparations /RESULTS: The use of iron-containing preparations in combination with ascorbic acid was ascertained to be accompanied by an increment in the plasma concentration of iron and blood corpuscles, indicating an increased need for this biotic and its deficiency in athletes. When the dose of iron was increased in the iron preparations, there was a substantial rise in the excretion of copper, manganese in particular, through the gastrointestinal tract and kidney and a negative balance of these trace elements in the body /CONCLUSION: Dietary addition of foods containing large amounts of ferrous iron, copper, and manganese is indicated for athletes exposed to higher intensity exercises.
Terapevticheskii arkhiv. 2012;84(12):85-87
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Rituximab therapy for systemic manifestations and MALT lymphomas of the parotid gland in Sjögren's disease: Preliminary data

Logvinenko O.A., Vasil'ev V.I., Sedyshev S.K., Safonova T.N., Rodionova E.B., Kokosadze N.V., Aleksandrova E.N., Cherkasova M.V., Radenska-Lopovok S.G., Nasonov E.L.


AIM: To evaluate the efficacy of rituximab (RT) in cryoglobulinemic vasculitis (CGV) and MALT lymphomas of the parotid gland (PG) in patients with Sjögren's disease (SD). /MATERIAL AND METHODS: RT therapy was performed in 13 patients with SD and CGV and in 17 with SD and PG MALT lymphoma. Eleven patients with SD received RT monotherapy and 19 with this disease had combined therapy with RT and cyclophosphan (CP). RT was used intravenously dropwise at a dose of 500 mg weekly or once every two weeks in combination with intravenous dropwise CP 1000 mg the next day with 4-6 per course. For the diagnosis of MALT lymphomas, all the patients with SD underwent incisional PG biopsy under local anesthesia at the Research Institute of Rheumatology, Russian Academy of Medical Sciences. PG biopsy specimens were histologically and immunohistochemically studied at the Russian Cancer Research Center, Russian Academy of Medical Sciences. In 11 cases, B-cell clonality was identified from immunoglobulin (Ig) heavy chain genes rearrangements, by using polymerase chain reaction at the Hematology Research Center, Ministry of Health and Social Development of the Russian Federation /RESULTS: Cutaneous manifestations of vasculitis disappeared in 75% of cases after monotherapy with RT and in 100% of cases after combination therapy with RT and CP. At 6-month follow-up, a complete response to therapy remained in 25% of the patients after a course of monotherapy and in 83% after combined therapy. Serum monoclonal Ig cryoglobulins and their urinary light chains ceased to be detectable in 75% of the patients in both groups at 3 months. At 6 months, a recurrence of mixed monoclonal cryoglobulinemia was seen in 50 and 43% of cases after monotherapy and combined therapy, respectively. The clinical and laboratory response of cryoglobunemic glomerulonephritis to combined therapy with RT and CP was complete in 60% of cases at 6-month follow-up. After RT monotherapy, the patients with SD and PG MALT lymphoma achieved a complete clinical response in 88%, of whom histological and immunohistochemical reexaminations of PG biopsy specimens revealed no signs of MALT lymphoma in 71% of cases. B-cell clonality remained in the PG biopsy specimens following RT monotherapy. After the combination of RT and CP, a complete clinical response to therapy was observed in 100% of the patients, a complete histological response and a complete molecular one were seen in 83 and 60%, respectively /CONCLUSION: RT showed its efficacy in treating SD patients with CGV and PG MALT lymphomas.
Terapevticheskii arkhiv. 2012;84(12):88-96
pages 88-96 views

Clinical aspects of antimicrobial therapy used in patients with urogenital infections

Vialov S.S., Vasina T.A.


Aim. To study the clinical aspects of using the furasidine potassium in combination with basic magnesium carbonate (furamag) and phosphomycin trometamol (monural) as antimicrobial agents most frequently used in outpatient practice during combination therapy for acute and chronic urinary tract (UT) diseases. Subjects and methods. To study the specific features of therapy for UT infections, 60 patients were randomized to 2 groups: l) 30 patients received a course therapy with furasidine potassium (furamag) in a dose of 50 mg t.i.d. for 7 days (a study group) and 2) 30 had phosphomycin trometamol (monural) in a single dose of 3 g for pulse therapy (a comparison group). The clinical efficacy of the drugs, symptom disappearance rates, bacterial changes, and laboratory and instrumental findings were assessed. The patient's opinion was mainly used to evaluate outpatient pharmacoeconomic efficiency. Patient compliance with the given therapy was estimated by taking into account the specific features of prehospital care. Results. During therapy, both groups showed positive clinical changes. In the study group, the symptoms of dysuria resolved 0.5 days more quickly and a complete clinical remission was achieved 0.8 days more promptly; the latter within the first 72 hours was achieved by 7.5% more of the patients; the symptoms of bacteriuria resolved 0.6 days more rapidly. With the similar average price of the packs of furasidine potassium (furamag) 50 mg (30 capsules) and phosphomycin trometamol (monural) 1 g (a sachet) being 350 and 370 rubles, the average costs of required treatment were 482 and 546 rubles, respectively. No case of adverse reactions was recorded during the study. Conclusion. Patients with infectious and inflammatory diseases of UT should be given furasidine potassium in the standard dose of 50 mg t.i.d for 7 days.
Terapevticheskii arkhiv. 2012;84(12):97-102
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Complete elimination of cytomegalovirus without antiviral therapy after systemic mesenchymal stromal cell transplantation in a patient with ulcerative colitis (a clinical case)

Kniazev O.V., Lazebnik L.B., Parfenov A.I., Ruchkina I.N., Shcherbakov P.L., Konopliannikov A.G., Mikhaĭlova Z.F., Khomeriki S.G.


Cytomegalovirus (CMV) is one of the common pathogens of opportunistic infections in patients with inflammatory bowel diseases. When the patients are treated with immunosuppressants that make them more susceptible to CMV, the course of ulcerative colitis (UC) becomes considerably worse. Antiviral therapy sometimes can reduce the risk of complications and the rate of colectomies. At the same time, antiviral therapy is not mandatory for all UC patients with CMV infection, as shown by the results of numerous investigations. One of the properties of mesenchymal stromal cells (MSC) is to suppress the body's immune reactions to allostimulation, rather than to infection invasion. In vivo and in vitro studies have demonstrated that MSCs have antiviral and antimicrobial activities. The described clinical case shows that clinical improvement occurred and a drastic activation of proliferative processes in the colonic mucosa was detected in the patient with UC after MSC transplantation. Administration of cultured MSCs also promoted the elimination of CMV without antiviral therapy and the overcoming of hormone dependence/resistance in the patient with UC.
Terapevticheskii arkhiv. 2012;84(12):103-107
pages 103-107 views

Current guidelines for oxygen therapy in emergency care

Avdeev S.N.


Hypoxemia can cause damage to any tissue in the human body. Tissue hypoxia is a condition in which oxygen (O2) delivery to the tissues does not meet their metabolic needs. The major goal in the treatment of patients with hypoxemic acute respiratory failure (ARF) is to ensure normal oxygenation of the body. The leading therapy option for ARF is the use of O2. The paper gives the basic principles of emergency O2 therapy: indications, treatment goals, monitoring guidelines, methods for delivery of O­2, and measures to prevent its toxic effects.
Terapevticheskii arkhiv. 2012;84(12):108-114
pages 108-114 views

An external respiratory failure classification: scientific rationale for its clinical use

Tetenev F.F.


The paper presents an external respiratory failure (ERF) classification, a scientific rationale for its use in the clinical practice of departments of different profiles. The setting up of interclinical functional diagnostic laboratories and preventive health care facilities for the preclinical diagnosis of ERF is substantiated. The introduction of the classification of ERF into wide clinical practice is intended to form a social order for the design and purchase of diagnostic equipment for therapeutic-and-prophylactic institutions and to stimulate researches in clinical respiratory physiology, and to improve physicians' knowledge of this section of clinical science.
Terapevticheskii arkhiv. 2012;84(12):115-119
pages 115-119 views

Interpretation of the concentrations of procalcitonin during infectious and inflammatory processes

Piatnitskiĭ I.A., Sharandak A.P., Zokina T.G., Berner L.P.


The paper analyzes the most important clinical studies dealing with the measurement of procalcitonin concentrations in patients with lower respiratory tract infections or sepsis. Procalcitonin is a marker of bacterial infection, which is successfully used for diagnosis and antimicrobial therapy monitoring in patients with pneumonia or in septic states. The review presents the latest algorithms for interpreting the concentrations of procalcitonin in clinical practice.
Terapevticheskii arkhiv. 2012;84(12):120-124
pages 120-124 views

Rheumatoid arthritis: Psychosomatic aspects

Grekhov R.A., Kharchenko S.A., Suleĭmanova G.P., Aleksandrov A.V., Zborovskiĭ A.B.


The review considers the results of studies of the psychosomatic aspects of rheumatoid arthritis (RA), which have been published in the past 5 years. In particular, there is evidence for the impact of chronic pain on the psychological status of patients with RA, for that of the disease on quality of life in the patients, their sociopsychological and interpersonal relationships; trials of the efficiency of additional treatment options for RA are given.
Terapevticheskii arkhiv. 2012;84(12):125-130
pages 125-130 views

A relationship between analgesic and neurotropic effects by the example of milgamma

Zhuravleva M.V., Shikh E.V., Makhova A.A.


Combined vitamin preparations containing thiamine (vitamin B1), pyridoxine (vitamin B6), and cyanocobalamin (vitamin B12) are widely used in medical practice. The results of investigations have confirmed that it is expedient to potentiate an analgesic effect due to the concurrent use of vitamin B group and nonsteroidal anti-inflammatory drugs given to relieve significant neuropathic pain. Milgamma compositum (Wörwag Pharma, Germany) is one of the most studied drugs on the Russian market, which contains a combination of vitamin B group (including benfotiamin).
Terapevticheskii arkhiv. 2012;84(12):131-134
pages 131-134 views

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