Vol 85, No 1 (2013)

Editorial
Results of implementation of a hypertension control program in Russia in 2002-2012
Chazova I.E., Oshchepkova E.V.
Terapevticheskii arkhiv. 2013;85(1):4-10
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The prehospital diagnosis of unstable angina pectoris in case of a mid-urbanized town of West Siberia: Results of a population-based study
Ziablov I.I., Okrugin S.A., Garganeeva A.A.
Abstract
AIM: To assess the prehospital diagnosis of unstable angina pectoris (UAP) in the population of a mid-urbanized town in West Siberia/MATERIAL AND METHODS: The study was conducted using the WHO epidemiological program "The acute myocardial infarction registry" that had been implemented in Tomsk since 1984. All the registered patients aged 20 to 70 years who had been diagnosed as having unstable (progressive) angina pectoris before admission to hospital and after its discharge were examined/RESULTS: A total of 2760 cases of suspected UAP were registered over the 2-year study period. 2139 (77.5%) patients were examined, which allows the findings to be considered to be significant. UAP was verified in 1477 (69.1%) patients. During the follow-up period, 1175 (79.5%) of the examined patients sought medical advice for acute UAP, most did at an emergency care station and regional polyclinics. The detection rate of the disease was 82.4% during the primary examination. In accordance with the diagnosis made, 65.48% of the patients were sent to hospital, including 81.42% who were to the therapy hospitals operating around the clock. 406 subjects were non-hospitalized; of them 313 (77.09%) refused hospitalization; in this connection, they were referred for a cardiology dispensary to receive outpatient treatment/CONCLUSION: The prehospital diagnosis of UAP was found to have a rather high level while only every five patients with verified UAP were admitted to a specialized hospital.
Terapevticheskii arkhiv. 2013;85(1):11-13
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Impact of angiotensionogen and angiotensin II receptor type 1 gene polymorphisms on the development and course of chronic heart failure
Tepliakov A.T., Shilov S.N., Berezikova E.N., Efremov A.V., Safronov I.D., Pustovetova M.G., Maianskaia S.D., Torim I.I., Karpov R.S.
Abstract
AIM: To study the impact of angiotensinogen (AGT) and angiotensin II receptor type 1 (AGTR1) gene polymorphisms on the development and course of chronic heart failure (CHF) in patients with coronary heart disease (CHD)/MATERIAL AND METHODS: Two hundred and twenty-six patients (149 men and 77 women; mean age 55.9±5.8 years) with CHF were examined. Genotypes were identified by the restriction fragment length polymorphism analysis of polymerase chain reaction products. A control group comprised 136 subjects (63 men and 73 women; mean age 53.6±4.8 years) without signs of cardiovascular diseases, as evidenced by the examination/RESULTS: The T allele of the M235T polymorphism in the AGT gene was found to be associated with the development and unfavorable course of CHF in patients with CHD. At the same time, carriage of the M allele of the M235T polymorphism in the AGT gene reflected the favorable course of this disease. That of the C allele and A/C genotype of the A1166C polymorphism in the AGTR1 gene was associated with the development of CHF and the A allele and A/A genotype manifested themselves as protective factors. According to the severity of CHF and the nature of its course, the distribution of frequencies of the genotypes and alleles of the A1166C polymorphism in the AGTR1 gene showed no significant differences between the patient groups/CONCLUSION: There were associations of the polymorphisms of the AGT gene (the M235T polymorphic marker) and the AGTR1 gene (the A1166C polymorphic marker) with the development of CHF in patients with CHD.
Terapevticheskii arkhiv. 2013;85(1):14-19
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Relationship of subclinical atherosclerosis indicators to exercise tolerance in patients with coronary heart disease
Noskov S.M., Zavodchikov A.A., Evgen'eva A.V., Lavrukhina A.A., Chamorovskiĭ A.N., Prokopenko O.N., Poletaeva V.S.
Abstract
AIM: To study the spread of a number of indicators of subclinical atherosclerosis in patients with coronary heart disease (CHD) and the pattern of their relationship to their functional state and muscle mass/MATERIAL AND METHODS: Twenty patients with chronic forms of CHD were examined. Vascular wall stiffness was judged from pulse wave velocity (PWV) along elastic-type vessels, by calculating the carotid-femoral index (CFI). Endothelial function was estimated by endothelium-dependent vasodilation (EDV) in a reactive hyperemia test. Ultrasound scanning of the common carotid artery was used to estimate intima-media thickness. All the patients underwent bicycle ergometry; their exercise tolerance (ET) was determined by the amount of consumed oxygen when the metabolic equivalent (MET) was calculated; the percentages of active cell mass (ACM%) and lean mass (LM%) of total body weight were determined; the levels of total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides were estimated. A control group comprised 20 matched persons without CHD/RESULTS: A prognostically unfavorable increase of >12 m/sec in CFI was revealed in 20% of the patients with CHD and in 10% of the controls; endothelial vasomotor dysfunction (EDV <10%) in 65 and 50%; a more than 0.9-mm increase in 55 and 15%, respectively. A low ET was stated in the majority of patients with abnormal vascular stiffness and endothelial vasomotor dysfunction. The CHD patients with a low ET were found to have significant correlations of CFI with ACM% and LM%, EDV and ACM% and LM%, CFI and EDV. The control patients with a low ET also showed correlations of EDV and ACM% and LM%. There was a correlation of ACM% and LM% with MET in both groups/CONCLUSION: EDV and PWV reflect a more decrease in physical activity and dysadapted functional status than in the degree of subclinical atherosclerosis.
Terapevticheskii arkhiv. 2013;85(1):20-24
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Effect of bosentan on the clinical status and cellular immunity of patients with idiopathic pulmonary hypertension
Martyniuk T.V., Zykov K.A., Antonova O.I., Rvacheva A.V., Arkhipova O.A., Kobal' E.A., Masenko V.P., Chazova I.E.
Abstract
AIM: To study the effect of bosentan on the clinical status and cellular immunity of patients with idiopathic pulmonary hypertension (IPH)/MATERIAL AND METHODS: The study enrolled 35 patients with Functional Class (FC) II and IV IPH who had received conventional therapy for 3 months. All the patients took bosentan 125 mg/day for 4 weeks. Then they were randomized to have bosentan 125 or 250 mg/day (Groups 1 and 2). FC was assessed and 6-minute walk test (6MWT), transthoracic echocardiography (EchoCG), and right heart catheterization (RHC) were performed at baseline and after 12 weeks. Peripheral blood lymphocytes were immunophenotyped and the functional activity of neutrophils was determined by their ability to absorb latex particles at baseline and following 3 and 12 weeks/RESULTS: After 12 weeks of treatment, both groups showed a statistically significant increase in the distance covered during the 6MWT. The Borg index and FC also decreased statistically significantly. EchoCG demonstrated a statistically significant reduction in systolic pulmonary artery pressure (SPAP) in Group 1; and in Group 2, SPAP was lower at baseline and remained substantially unchanged (it statistically significantly decreased as evidenced by RHC). Bosentan statistically significantly diminished pulmonary vascular resistance in both groups. No adverse reactions were noted. At baseline, the patients showed a statistically significant elevation in NKT-like lymphocytes up to 10.79±6.2%. The other indicators of peripheral blood lymphocyte phenotyping did not exceed the normal range. The count of NKT-like lymphocytes remained significantly above the normal levels throughout the follow-up in both groups and slightly dropped in Group 1 patients only after 12 weeks of treatment. In Group 2, the level of CD3+CD25+ lymphocytes rose as compared to the normal levels at 3 and 12 weeks of treatment. At 3 weeks of treatment, there was a statistically significant difference between the groups in phagocytic number/CONCLUSION: Bosentan treatment statistically significantly improves the clinical status of patients with IPH and it is characterized by good tolerability. Bosentan does not exceed the normal count of peripheral blood NKT-like lymphocytes, but it has a direct or indirect positive effect on the B-lymphocytic component of the immune system in patients with IPH.
Terapevticheskii arkhiv. 2013;85(1):25-31
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Sclerodegenerative aortic valve lesions and hereditary connective tissue disorders
Zemtsovskiĭ É.V., Parfenova N.N., Khasanova S.I., Mitrofanova L.B.
Abstract
AIM: To estimate the role of different dysplastic syndromes and phenotypes in the development of sclerodegenerative lesions and calcific stenosis of the aortic valve (AV)/MATERIAL AND METHODS: One hundred and fifty patients (82 men and 68 women) aged 42 to 83 years were examined. A study group consisted of 89 patients (mean age 60.7±8.9 years) with clinical and echocardiographic signs of sclerodegenerative AV lesions (SDAVL). A control group included 61 patients (mean age 61.3±7.6 years) who had no clinical, physical, or echocardiographic signs of SDAVL. Twenty-five patients with critical calcific aortic stenosis (CAS) underwent histological examination of removed aortic semilunar valves after prosthetic AV replacement/RESULTS: Persons with a Marfanoid habitus (18%) and mitral valve prolapse (10.7%) are most common in older age groups. An association has been found between the bone signs of dysmorphogenesis and the development of SDAVL and CAS. onclusion. Three or more signs of bone dysmorphogenesis and the Marfanoid habitus should be viewed as a predictor of SDAVL.
Terapevticheskii arkhiv. 2013;85(1):32-36
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Electrocardiographic predictors of in-hospital outcomes of acute coronary syndrome
Provotorov V.M., Shevchenko I.I.
Abstract
AIM: To estimate the time course of changes in basic electrocardiographic (ECG) parameters in patients with acute coronary syndrome (ACS) as possible predictors of in-hospital outcomes. Materials and methods. The data of 277 patients with acute coronary syndrome (ACS) were used; QT-interval duration was studied by means of an EC12C-01 cardioanalyzer; ST-segment deviation (ΣST), elevation (ΣST-E), and depression (ΣST-D) sums, and corrected QT-interval dispersion (DQTc) were calculated/RESULTS: There were highly significant differences of ΣST in all the patients groups at admission and differences of DQTc in ACS patients with and without ST-segment elevation. The survival rates were significantly different depending on the value of ECG parameters, such as ΣST, ΣST-D, and DQTc/CONCLUSION: The cardioanalyzer can automatically improve the estimation of in-hospital ECG changes and to determine predictors of an ACS outcome.
Terapevticheskii arkhiv. 2013;85(1):37-41
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Specific features of rehabilitation in patients with gluten-sensitivity celiac disease
Sabel'nikova E.A., Krums L.M., Parfenov A.I., Vorob'eva N.N., Gudkova R.B.
Abstract
AIM: To elaborate recommendations for rehabilitation of patients with gluten-sensitivity celiac disease (GCD) on the basis of a long-term follow-up/MATERIAL AND METHODS: Eighty-seven patients with GCD were followed up for as long as 31 years. Of those, 72.4% of the patients kept strictly to their gluten-free diet (GFD) throughout the follow-up; 9.2% did not follow the diet periodically; and 18.4% did not at all. The sera from 71 patients were tested for IgA and IgG anti-gliadin antibodies (AGAb) and anti-tissue transglutaminase antibodies (AтTGAb) at as long as 19-year follow-up. AGAb and AтTGAb were estimated by enzyme immunoassay (IMMCO Diagnostics). All the patients underwent endoscopic and histological examinations of the small bowel mucosa (SBM)/RESULTS: To support the validity of keeping to the GFD, the time course of clinical, laboratory, and morphological changes were analyzed in 63 and 24 GFD followers and non-followers, respectively. The GFD non-followers were more frequently found to have diarrheic syndrome, symptoms of malabsorption syndrome, lower serum concentrations of hemoglobin, total protein, iron, and calcium; no SBM structural recovery was seen in any patient. When the GFD was long adhered to, there was also a reduction in detection rates and AGAb and AтTGAb concentrations/CONCLUSION: The adherence to the GFD was ascertained to contribute to fuller rehabilitation in the patients. However, even the patients who had strictly kept to their GFD showed periods of an exacerbation and incomplete SBM structural recovery. Therefore, the rehabilitation system for patients with GCD must involve diagnostic, therapeutic, and organizational measures that promote not only rapid clinical recovery, but also better quality of life in these patients.
Terapevticheskii arkhiv. 2013;85(1):42-47
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The porphyrin metabolism in liver cirrhosis
Krivosheev A.B., Kondratova M.A., Krivosheeva T.A., Kupriianova L.I., Khvan L.A.
Abstract
AIM: To comparatively study porphyrin metabolic disturbances in liver cirrhosis (LC) of varying etiology and to estimate the diagnostic and prognostic value of the detected disorders/MATERIAL AND METHODS: Seventy-one patients were examined; among them 34, 15, and 22 patients were diagnosed as having alcoholic, viral, and alcoholic-and-viral LC, respectively. Its predictors and porphyrin fractions were determined in their urine and feces/RESULTS: Porphyrin metabolic disturbances were recorded in 62 (87.3%) patients and found in the majority of patients with viral (86.7%), alcoholic (94.1%), and mixed (77.3%) LC. The detected abnormalities corresponded to 4 variants of porphyrin dysmetabolism: elevation of porphyrin predictors, biochemical syndromes of symptomatic elevation of fecal porphyrins, secondary coproporphyrinuria, and latent chronic hepatic porphyria (LCHP). Some patients were found to have comorbidities, suggesting the stepwise development of porphyrin dysmetabolism. The disturbances were identified in patients with LC irrespective of the Child-Pugh class. The prognostically less favorable biochemical syndrome LCHP was recorded only in the presence of progressive hepatocellular failure in Child's class C decompensated LC. This trend should be considered to be prognostically unfavorable, preceding or occurring in the presence of decompensated LC that is more often a cause of death in this contingent of patients/CONCLUSION: Porphyrin metabolism should be regarded as a highly sensitive indicator. The differential assessment of the porphyrin excretory profile may be referred to as additional diagnostic and prognostic criteria indicating the Child-Pugh class.
Terapevticheskii arkhiv. 2013;85(1):48-55
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The clinical efficacy of a succinate-containing infusion drug during pharmacotherapy for hepatic lesions of varying genesis: results of meta-analysis
Mazina N.K., Mazin P.V., Sukhanov D.S.
Abstract
AIM: To pool the published results of trials of the new infusion hepatoprotector remaxol for the integral quantification of the magnitude of its clinical efficacy/MATERIAL AND METHODS: The authors made a systematized review of the published results of randomized clinical trials of the succinate-containing infusion hepatoprotector remaxol in diseases associated with hepatic lesions (chronic hepatitis B and C, severe ethanol intoxication in the presence of alcohol dependence, drug-induced liver lesion during treatment of tuberculosis, and metabolic syndrome). The pooled database included information on 935 patients. The combined control group (n=447) received traditional pharmacotherapy drugs (active placebo), the treatment group (n=628) additionally took remaxol/RESULTS: Meta-analysis of the frequency characteristics of positive outcomes (the rate of disappearance of major clinical symptoms and complications) and the activity range for the enzymes characterizing hepatocyte cytolysis (alanine aminotransferase and aspartate aminotransferase) and cholestasis (alkaline phosphatase and γ-glutamate transpeptidase) in the compared groups could provide an integral evaluation of the clinical efficacy of remaxol, which was 1.57 for enzymatic activity and 1.78 for the frequency characteristics of outcomes. The odds ratio of positive outcomes was 2.9 (range 1.9 to 3.9) and the number of patients who needed to be treated with remaxol during the follow-up to prevent a poor outcome in one patient was 6 (range 4 to 8)/CONCLUSION: The succinic acid-based infusion hepatoprotector remaxol provides a statistically and clinically significant therapeutic effect in the drug correction of hepatic lesions of varying genesis.
Terapevticheskii arkhiv. 2013;85(1):56-61
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The prevalence and clinical aspects of Barrett's esophagus in the population of Eastern Siberia
Butorin N.N., Bichurina T.B., Tsukanov V.V., Kasparov É.V., Kuklin D.V., Timoshenko V.O., Shtygasheva O.V., Maady A.S., Vasiutin A.V.
Abstract
AIM: To study the prevalence and clinical aspects of Barrett's esophagus (BE) in natives and newcomers in East Siberia/MATERIAL AND METHODS: Clinical examinations and esophagogastroduodenoscopy were performed in 12975 Caucasoids and 1489 Khakases in Abakan (Khakasia), 1861 Caucasoids and 5829 Tuvinians in Kyzyl (Republic of Tuva), and 1177 Caucasoids in Dudinka (Taimyr). The diagnosis of BE was verified by morphological study/RESULTS: Among the Caucasoids, the total prevalence of BE was 1.6% (2.4% in men and 0.8% in women; odds ratio (OR) was 3.21 with 95% CI 2.40-4.29; p<0.001); among the Mongoloids, that was 3.1% (4.5% in men and 2% in women; OR, 2.3 with 95% CI 1.75-3.04; p<0.001). Heartburn and other typical symptoms was more prevalent in patients with BE. The risk factors of BE in all the examined populations were male sex, age over 40 years, smoking more than 20 cigarettes a day for 10 years or more in men, and obesity/CONCLUSION: There were ethnic differences in the prevalence of BE, which were prevalent in East Siberia in the Mongoloids as compared to the Caucasoids.
Terapevticheskii arkhiv. 2013;85(1):62-65
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The diagnosis and treatment of common diseases detected during medical examination of male oil-extracting industry workers
Berdichevskiĭ V.B., Bykova I.N.
Abstract
AIM: To study the health status of male shift workers engaged in oil-extracting industry in the Tyumen Region through prophylactic medical examination, to elaborate measures for the diagnosis and treatment of the most common diseases of the viscera and urogenital system (UGS)/MATERIAL AND METHODS: In 2009, the exit team of the Unit of Preventive Examinations, Tyumen Regional Clinical Hospital, examined 1120 male shift workers of the oil-field facilities of the Tyumen Region/RESULTS: The health of the examined shift workers was generally better than the national and regional indices. At the same time a number of observations demonstrated that shift work had a negative impact on the function of the viscera and UGS in the men, as evidenced by this clinical examination revealing arterial hypertension in 20 men and chronic bacterial prostatitis in 91. All patients with the newly identified diseases were registered to be followed up. In the extrashift period, they were successfully treated at the Diagnostic Center of the Tyumen Regional Hospital according to the national standards/CONCLUSION: The prophylactic medical examination of shift oil-field workers is substantiated by not only the compulsory specialized examination for the early diagnosis of evolving diseases, but also by the fact that during their visits to specialists the men can really increase their awareness of their current health and the methods of its promotion.
Terapevticheskii arkhiv. 2013;85(1):66-68
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Clinical and laboratory evaluation of the efficiency of chronic hemodialysis treatment using acidosuccinate in patients with terminal renal failure
Smirnov A.V., Nesterova O.B., Suglobova E.D., Golubev R.V., Vasil'ev A.N., Vasil'eva I.A., Verbitskaia E.V., Korosteleva N.I., Kostereva E.M., Lebedeva É.B., Levykina E.N., Starosel'skiĭ K.G., Lazeba V.A.
Abstract
AIM: To evaluate the efficiency of using a succinate-containing dialysis solution (SCDS) in terminal renal failure patients treated with chronic hemodialysis (CHD)/MATERIAL AND METHODS: Ninety patients from two hemodialysis units took part in the crossover study and were allocated to 2 groups. For 6 months, study group patients received CHD using SCDS and control group patients had CHD with a standard bicarbonate dialysis solution after 3-month washout period followed by decussation. The time course of changes in blood biochemical parameters, 24-hour ECG monitoring data, and quality of life indicators were estimated in the patients/RESULTS: After using acidosuccinate during hemodialysis, there was a significant reduction in the predialysis serum level of inorganic phosphate, a calcium phosphate product, γ-glutamyl transpeptidase, urea, and aldosterone as compared to the control group. The blood concentration of total protein was also increased. After 6-month administration of acidosuccinate, the patients showed reductions in systolic blood pressure, heart rate, and the frequency and duration of ST-segment depression episodes. There were positive changes in the quality of life of patients according to the KDQOL-SF questionnaire/CONCLUSION: The use of SCDS in patients with CHD causes positive changes in a number of laboratory parameters and improves the physical and general status, and quality of life of patients.
Terapevticheskii arkhiv. 2013;85(1):69-75
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Plasminogen activator inhibitor type 1 gene polymorphism and thromboses in patients with antiphospholipid syndrome
Reshetniak T.M., Ostriakova E.V., Patrusheva2 N.L., Patrushev L.I., Aleksandrova E.N., Seredavkina N.V., Volkov A.V., Nasonov E.L.
Abstract
AIM: To estimate the prevalence of plasminogen activator inhibitor type 1 (PAI-1) gene polymorphism in patients with antiphospholipid syndrome (APS) and its implication in vascular disorders/MATERIAL AND METHODS: The investigation enrolled 138 patients: 103 with APS, including 47 with systemic lupus erythematosus (SLE) + APS and 56 with primary APS (PAPS), 15 with SLE without APS, 20 with idiopathic thrombosis (IT), a control group (30 apparently healthy individuals). Thrombosis at various sites was recorded in 91 (88%) of the 103 patients with APS. The authors analyzed both the presence of thrombotic events in all the groups and the number of cases of thrombosis in each patient. Antiphospholipid antibodies, such as lupus anticoagulant, anticardiolipin antibodies, and anti-Β2-glycoprotein type 1 antibodies, were studied in all the patients. To diagnose a genotype in patients by the code encoding for PAI-1, DNA isolated from peripheral blood by standard methods was used and further investigated by real-time polymerase chain reaction/RESULTS: Out of 91 patients with APS and thrombosis, 27 (30%) had the 4G/4G genotype, which corresponded to homozygous mutation in the PAI-1 gene, 50 (55%) had the 4G/5G genotype (heterozygous mutation), and 14 (15%) had the 5G/5G (a normal genotype). The PAI-1 4G/5G genotype was present in 22 (70%) of 31 patients with SLE + APS and lower limb deep vein thrombosis versus 17 (47%) of 36 patients with PAPS (odds ratio (OR) 2.73; 95% confidence interval (CI), 0.89 to 8.59; р=0.08) and in 9 (90%) of 10 patients with SLE + APS and pulmonary artery thromboembolism versus 8 (40%) of 20 patients with PAPS (OR 13,5; 95% CI, 1.23 to 344.98; р=0,02). The incidence of thrombosis per 100 person-years was higher in the PAI-1 4G/4G and 4G/5G groups: 35.4 and 28.1 cases per 100 person-years, respectively. Thromboses were least often in the group of patients with the PAI-1 5G/5G genotype (18.6)/CONCLUSION: The prevalence of the PAI-1 5G/5G genotype in patients with APS and thrombosis was significantly lower than in those with SLE without APS or thrombosis. The 4G/5G polymorphism in APS in the presence of SLE was associated with venous thromboembolisms whereas in PAPS there was no relationship between the PAI-1 genotype, a history of thrombosis, and its localization.
Terapevticheskii arkhiv. 2013;85(1):76-84
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Heart failure in cardiorenal syndromes
Kharchenko E.P.
Abstract
This review considers the classification of cardiorenal syndromes (CRS), the pathogenesis of heart failure, and a search for therapeutic targets for its treatment, biomarkers for heart and kidney failure, difficulties in therapy and reversion of the pathogenetic continuum of CRS, and promises for the use of some new technologies to treat this condition.
Terapevticheskii arkhiv. 2013;85(1):85-91
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Multislice spiral computed tomography of coronary arteries: procedure development stages and clinical application
Likov I.V., Morozov S.P.
Abstract
The paper analyzes the data available in the literature on the possibility of using multislice spiral computed tomography in patients with acute coronary syndrome. The authors give the results of their study of the diagnostic value of 64-slice c8omputed tomography in patients with presumptive coronary heart disease (CHD) and its high risk according to the Framingham risk scale (Group 1) versus those with its already established diagnosis (Group 2). The sensitivity of 64-slice computed tomography was 97.8 and 90.2 in Groups 1 and 2, respectively; its specificity was 98.6 and 78.2% in these groups.
Terapevticheskii arkhiv. 2013;85(1):92-97
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Nonglycemic effects of dipeptidyl peptidase-4 inhibitors
Ametov A.S., Kamynina L.L.
Abstract
The review considers the major nonglycemic effects of dipeptidyl peptidase-4 inhibitors commonly used in diabetological practice, by using as an example sitagliptin, the first and most investigated representative of this class.
Terapevticheskii arkhiv. 2013;85(1):98-102
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Antihistamine drugs, quinuclidine derivatives, in allergic diseases. What is their benefit?
Luss L.V., Shartanova N.V.
Abstract
The extensive rise in the prevalence of allergic diseases (AD), which among the planet's population is now 15 to 30% or more, occupies the great attention of different specialists' to the mechanisms for the development and control of the symptoms of allergy. In view of the most important role of histamine in the pathogenesis of allergic diseases, antihistamines are first-line line drugs in the pharmacotherapy of AD. Quinuclidine derivatives that combine the most useful properties of the first and second generations occupy a special place among histamines. The paper gives the data of clinical trials of the efficacy of the antihistamines quinuclidine derivatives in the treatment of various allergic diseases.
Terapevticheskii arkhiv. 2013;85(1):103-106
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