Vol 85, No 3 (2013)


A current model for training a pulmonologist

Chuchalin A.G.


The paper gives data on the importance of the results of genomic and postgenomic studies and the wide practical introduction of up-to-date diagnostic imaging techniques for improving the scientific and practical branches of modern pulmonology. Great attention is paid to the initiative of the European Respiratory Society for harmonized education in respiratory medicine and for improvement of the knowledge and skills of entry-level specialists.
Terapevticheskii arkhiv. 2013;85(3):4-13
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Bone mineral density in patients with chronic obstructive pulmonary disease

Kochetova E.V., Vezikova N.N.


AIM: To study of bone mineral density (BMD) in patients with chronic obstructive pulmonary disease (COPD)/MATERIAL AND METHODS: 104 patients with COPD were examined. A study group comprised men with a long smoking history. BMD of the lumbar spine in the frontal view and that of the proximal femur (the neck, Ward's area, greater trochanter) were studied by dual-energy X-ray absorptiometry using a Lunar DPX-NT densitometer/RESULTS: Osteoporosis of the lumbar spine was most frequently detected in patients with COPD (37.2%). That of the femoral neck was diagnosed in 19.77% of the patients with COPD. In the advanced stage of COPD, the BMD values in all areas were significantly decreased/CONCLUSION: Osteoporosis is a significant disease in patients with COPD.
Terapevticheskii arkhiv. 2013;85(3):14-16
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Role of endothelial dysfunction, the interface between hemostatic and system inflammatory responses in the pathogenesis of an infectious inflammation-dependent exacerbation of chronic obstructive pulmonary disease

Tseĭmakh I.I., Momot A.P., Kostiuchenko G.I., Mamaev A.N., Filonova I.A., Kornilova T.A., Chuchalin A.G.


AIM: To analyze the systemic manifestations of vascular endothelial damage, the activation of hemostatic and inflammatory responses in patients with an infectious inflammation-dependent exacerbation of chronic obstructive pulmonary disease (COPD)/MATERIAL AND METHODS: The paper provides the data of examinations of 111 patients with the clinical signs of an infectious inflammation-dependent exacerbation of COPD who had 2 or 3 positive criteria elaborated by N. Anthonisen et al. (1987). The patients were divided into 2 phenotypically different subgroups: 1) 92 (82.9%) COPD patients without clinical manifestations of bronchoectasis; 2) 19 (17.1%) patients with COPD concurrent with documented bronchiectasis. The patient subgroups were matched for smoking status and the characteristics of COPD and respiratory failure. The investigators assessed the time course of changes in the serum level of endothelin-1 (ET-1), the aggregation function of platelets, and the plasma concentrations of D-dimers and homocysteine in patients with COPD compared to healthy, never smokers (n=35) and smokers (n=27)/RESULTS: An increase in the levels of the endothelial dysfunction markers ET-1 and homocysteine was found in patients with COPD, which was comparable with the changes in these indicators in the group of smokers. In both subgroups, the rise in plasma D-dimer levels was more pronounced in the patients with a COPD exacerbation than in the smokers. Its therapy with systemic and inhaled glucocorticosteroids reduced C-reactive protein and ET-1 levels in both patient subgroups and in D-dimers in subgroup 1. Elevated D-dimer levels remained when achieving remission, which points to the risk of thrombogenic and thromboembolic events in the patients with an infectious inflammation-dependent exacerbation of COPD and concomitant circulatory system diseases/CONCLUSION: The patients with an infectious inflammation-dependent exacerbation of COPD are observed to have elevated peripheral blood markers of endothelial dysfunction and thrombinemia. These changes are pathogenetically caused by smoking or neutrophilic inflammation and associated with a higher risk of thrombogenic events.
Terapevticheskii arkhiv. 2013;85(3):17-22
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Change in the blood cytokine spectrum in patients with pulmonary sarcoidosis

Terpigorev S.A., Novikov A.A., Él' Zeĭn B.A., Aleksandrova E.N., Iazdovskiĭ V.V., Moskalets O.V., Paleev F.N.


AIM: To assess cytokine spectrum changes in different types of pulmonary sarcoidosis (PS)/MATERIAL AND METHODS: Twenty-seven PS patients without signs of pulmonary fibrosis and 14 patients with sarcoidosis complicated by pulmonary fibrosis were examined. Baseline serum Th1 and Th2 cytokine concentrations were studied. A control group comprised 30 healthy donors/RESULTS: A higher interleukin (IL)-4/IL-2 ratio was found in the peripheral blood of the patients with pulmonary fibrosis-complicated sarcoidosis than in the other patients (326.4±122.6 and 88.2±28.6%, respectively; р=0.002). The sarcoidosis patients with signs of pulmonary fibrosis and no symptoms of disease inflammatory activity had elevated blood IL-1 levels whereas an IL-1 receptor antagonist was decreased/CONCLUSION: In the patients with PS, the development and progression of pulmonary fibrosis occur with a shift in the Th1/Th2 balance towards Th2, which manifests itself as a higher IL-4/IL-2 ratio in the peripheral blood. At the same time, the signs of systemic inflammatory activity remain.
Terapevticheskii arkhiv. 2013;85(3):23-27
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Predictors of osteopenic syndrome in idiopathic pulmonary fibrosis

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


AIM: To evaluate the functional state of bone tissue in patients with idiopathic pulmonary fibrosis (IPF), waiting for lung transplantation, and to determine possible predictors of lower bone mineral density (BMD) in this pathology in the pre-transplantation period/MATERIAL AND METHODS: Forty-nine IPF patients waiting for lung transplantation were examined. The patients' mean age was 53.4±6.4 years. BMD in the lumbar spine (LII-LIV) and femoral neck (FN) was estimated using dual-energy X-ray absorptiometry. All the patients underwent external respiratory function test, pulmonary diffusing capacity (DLCO), gasometry, and 6-minute walk test (6'WT)/RESULTS: Osteopenia was recorded in 77% of the examinees, of them 28% had osteoporosis (OP). Normal BMD in both LII-LIV and FN was found only in 13% of the patients. The T score in LII-LIV was directly related to body mass index. There was a direct correlation between BMD in LII-LIV and FN, forced vital capacity (FVC), DLCO, and arterial blood oxygen saturation (SaO2) and an inverse correlation with arterial carbon dioxide partial pressure (pCO2). No significant correlation was found between the distance covered in 6'WT, FEV1, pO2, and BMD in both LII-LIV and FN. Six (15%) subjects had atraumatic fractures at different sites/CONCLUSION: Osteopenia is a common systemic manifestation in patients with IPF in the pre-transplantation period. BMI, FVC, exercise desaturation, and DLCO may be considered as predictors for the development of OP initiated by IPF.
Terapevticheskii arkhiv. 2013;85(3):28-31
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The clinical features of cystic fibrosis in adult patients with carbohydrate metabolic disturbances

Samoĭlenko V.A., Krasovskiĭ S.A., Marchenkov I.V., Chikina S.I., Babadzhanova G.I., Nagornyĭ A.B., Chuchalin A.G.


AIM: To investigate the clinical features of cystic fibrosis (CF) in adult patients with carbohydrate metabolic disturbances (CMD). Material and methods. CF was diagnosed on the basis of its clinical picture and a positive sweat test, and/or genetic study. Clinical, anthropometric, functional, microbiological data were compared with the results of imaging diagnosis in CF patients with and without CMD/RESULTS: The data of 350 patients were retrospectively analyzed. An oral glucose tolerance test was randomly performed in 154 CF patients without CMD. There was normal carbohydrate metabolism in 92 (59.7%) patients with CF, impaired glucose tolerance (IGT) in 44 (28.6%), CF-dependent diabetes mellitus (CFDDM) in 18 (11.7%). The latter had been previously diagnosed in 37 (10.6%) other patients with CF. Three groups of patients were formed: 1) 92 patients without CMD; 2) 44 with IGT, and 3) 55 with CFDDM. The patients with CFDDM had lower stature, weight, and lung function, significantly more common bronchiectases, a lower Staphylococcus aureus colonization with a tendency toward a higher Burkholderia cepacia colonization than those without CMD. As compared with the patients without CMD, those with this disorder were found to have a high rate of severe mutations; mild mutations were absent in the patients with CFDDM/CONCLUSION: CMD in CF is characterized by its high rates and latent course. The patients with CMD have retarded physical development, more pronounced morphofunctional disorders in the bronchopulmonary system, lower lung functional parameters, and more aggressive sputum microbial composition.
Terapevticheskii arkhiv. 2013;85(3):32-37
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First clinical experience with endothelin receptor antagonist bosentan used in patients with pulmonary hypertension: results of a one-year study

Avdeev S.N., Tsareva N.A., Nekliudova G.V., Chuchalin A.G.


AIM: To evaluate the efficiency and safety of long-term (12-month) treatment with the endothelin receptor antagonist bosentan (tracleer (Actelion, Switzerland)) in patients with pulmonary hypertension (PH)/MATERIAL AND METHODS: The prospective observational study enrolled 10 patients (8 with idiopathic PH and 2 with PH and systemic scleroderma). The patients' mean age was 50.0±6.9 years; mean pulmonary artery pressure (mPAP) 65±12 mm Hg; cardiac output (CO) 3.4±0.8 l/min; 6-minute walk test (6'WT) distance, 318±94 m. Before and 3, 6, and 12 months after the treatment, the patients underwent Doppler echocardiography, arterial blood gas analysis, external respiratory function test, and dyspnea evaluation using the MRC scale and 6'WT. The initial dose of bosentan was 62.5 mg b.i.d., then 125 mg b.i.d. following 4 weeks/RESULTS: Bosentan treatment resulted in a reduction in pulmonary artery systolic pressure and mPAP (at 12 months: 76.8±11.5 and 58.8±11.4 mm Hg, respectively; p<0.01) and an increase in CO (at 12 months: 4.2±1.2 l/min; р=0.002). Six patients were observed to have a lower WHO classification functional class (FC). Lung diffusing capacity tended to improve (at 12 months, the increment was more than 6% of the reference value; p=0.059). In the patients, dyspnea was relieved as shown by MRS scores from 3.1±0.7 (at baseline) to 2.1±0.6 (at 12 months); p=0.002. The 6'WT distance increased up to 342±67 m (at 12 months); p=0.005. The drug was well tolerated; only one patient had a transient increase in the activity of liver enzymes/CONCLUSION: The long-term bosentan treatment in patients with PH leads to improvements in pulmonary hemodynamics, WHO classification functional class, a reduction in dyspnea, and a rise in exercise tolerance.
Terapevticheskii arkhiv. 2013;85(3):38-43
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Analysis of fatal outcomes from pulmonary thromboembolism in young subjects

Fesenko O.V., Sinopal'nikov A.I., Glechikov A.V.


AIM: To investigate the risk factors and main clinical signs of fatal pulmonary thromboembolism (PTE) in young subjects/MATERIAL AND METHODS: Medical case reports and postmortem examination results were retrospectively analyzed in 32 patients (all males) who had died from PTE in different Moscow health care facilities in 2002 to 2010/RESULTS: No idiopathic thromboembolism cases were found. Each patient had at least two risk factors. Most patients developed generalized obstruction of the pulmonary vascular bed, by involving mainly the great arteries, which resulted in right ventricular failure and sudden death/CONCLUSION: The findings may be used not only to assess the clinical probability of PTE diagnosis, but also to choose adequate preventive measures.
Terapevticheskii arkhiv. 2013;85(3):44-50
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Type D personality in chronic lung diseases: Prevalence, psychological features

Sumin A.N., Nedoseĭkina E.V., Arkhipov O.G.


AIM: To estimate the prevalence and impact of Type D personality on the psychological status and quality of life (QL) of patients with chronic lung diseases/MATERIAL AND METHODS: 117 patients (105 men and 12 women; mean age 59.6±0.9 years) with chronic lung diseases were examined. The DS14 questionnaire was used to identify Type D personality. According to the tes/RESULTS: the patients were divided into 2 groups: 1) 39 Type D patients; 2) 78 non-Type D patients. The levels of depression and anxiety and QL were additionally determined using the SF-36 questionnaire. Clinical and laboratory parameters, spirometric data, and 6-minute walk test (6'WT) distance were estimated/RESULTS: The Type D versus non-Type D patients had higher levels of situational (46.6±1.7 and 41.2±1.2 scores; р=0.01) and personality (47.6±1.5 and 43.7±0.9 scores; р=0.02) anxiety and depression (42.9±1.6 and 35.9±0.8 scores; р=0.00004), as well as lower QL levels in the vitality (42.2±2.2 and 52.2±1.9 scores; р=0.002), emotional function (20.5±4.0 and 36.8±4.4 scores; р=0.02), and mental health (56.2±1.9 and 63.4±1.9 scores; р=0.006) scales. The 6'WT distance was less in the Type D patients (463.3±17.2 m) than in non-Type D patients (504.1±8.7 m); р=0.02/CONCLUSION: Type D personality is encountered in 33% of patients with chronic lung diseases associated with the higher level of psychological distress in the patients, with the worsening of a mental component of QL, and with the reduction in exercise tolerance.
Terapevticheskii arkhiv. 2013;85(3):51-57
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TNF-α, IL-10, and еNOS gene polymorphisms in patients with influenza A/H1N1 complicated by pneumonia

Romanova E.N., Govorin A.V.


AIM: To study the specific features of cytokine gene polymorphisms (such as TNF G308A, IL10 C592A, IL10 C819T, IL10 G1082A) and vascular tone regulatory gene polymorphism (еNOS C786T) in patients with influenza A/H1N1 complicated by pneumonia/MATERIAL AND METHODS: Patients treated for pneumonia in the presence of influenza A/H1N1, divided into 3 groups: 1) 37 patients with severe pneumonia; 2) 74 with mild pneumonia; and 3) 68 healthy individuals, were examined. Molecular genetic testing was made using a polymerase chain reaction technique. Serum TNFα, IL-10 and s-ICAM-1 concentrations were measured by enzyme immunoassay/RESULTS: As compared to the control group, the patients with influenza-related pneumonia were more frequently homozygous for the G allele of the TNF 308 G/A polymorphism. The IL-10 G allele (1082 G/A) was considerably prevalent as homozygous carriage and the IL-10 G allele (592 G/A) was as a homozygous type to a greater extent. An abnormal zygote of the eNOS T/T (786 C/T) polymorphism was found to be prevalent among the patients with influenza-related pneumonia; on the contrary, there were mainly heterozygous C/T carriers in the control group. In the C/T genotype group, the level of soluble intercellular adhesion molecule 1 (sICAM-1) was lower than in other polymorphic variants (786 C/T)/CONCLUSION: The study of the patients' genetic status in influenza A/H1N1 will be able to evaluate the severity of the disease and to predict possible complications.
Terapevticheskii arkhiv. 2013;85(3):58-62
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Impact of the intake of cardiac drugs on adaptation to high temperatures in patients with cardiovascular diseases under the conditions of the abnormally hot summer of 2010

Ageev F.T., Smirnova M.D., Svirida O.N., Kuzmina A.E., Shatalina L.S.


AIM: To evaluate the impact of intake of cardiac drugs on adaptation to abnormal heat in patients with cardiovascular diseases (CVD)/MATERIAL AND METHODS: The study covered 188 patients with CVD, who had visited the Research Dispensary Department in January 2011. General clinical examination, biochemical blood analysis, and electrocardiography were made; the hospital anxiety and depression scale, the visual analog scale, and the questionnaire specially developed for this investigation were used. The authors considered acute myocardial infarction, acute stroke, hospital admission, a medical emergency team call, temporary disability (days), hypertensive crises, and unplanned visits to a doctor as estimated outcomes (endpoints) and the number of undesirable reactions a week during the abnormal heat and from September to December 2010 as a combined endpoint/RESULTS: There were a larger number of weekly adverse reactions than usual and a reduction in quality of life (QL) during the abnormal heat. Both an increase and a reduction in the dose of cardiac drugs during the abnormal heat were associated with its worse tolerability. The use of angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers (CCB) was an independent factor associated with the smaller number of complications during the abnormal heat. That of diuretics was an independent factor that was associated with a more decrease in QL in elderly patients during the heat. The intake of angiotensin receptor blockers (ARB) or nitrates was an independent factor associated with the larger number of complications during the abnormal heat/CONCLUSION: The use of ACE inhibitors and CCB is associated with fewer complications during the abnormal heat of 2010. The intake of diuretics in patients over 65 years of age and that of ARB or nitrates was associated with worse heat tolerance.
Terapevticheskii arkhiv. 2013;85(3):63-69
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Risk of cardiovascular death in relation to blood pressure levels in Tyumen men and women: results of a 12-year prospective study

Akimova E.V., Pushkarev G.S., Gafarov V.V., Kuznetsov V.A.


AIM: To evaluate the effect of blood pressures (BP) on the risk of cardiovascular death (CVD) in a Tyumen open population through a 12-year prospective follow-up study/MATERIAL AND METHODS: Standard methods were used to make a cardiac screening of a representative sample of 25-to-64-year-old Tyumen citizens in 1996. The response rate was 80.4% or 1608 persons. CVD cases were recorded in 85 (10.69%) men and 33 (4.06%) women during the 12-year subsequent prospective follow-up study. The Cox regression model was used to assess the relative risk (RR) for CVD. Survival rates were analyzed with the Kaplan-Meier method/RESULTS: In the men, RR for CVD statistically significant increased from the 4th quintile of the distribution of systolic blood pressure (SBP) (2.88) and from the 3rd quintile of that of diastolic BP (DBP) (2.33). The women showed a statistically significant increase in RR for CVD only in the 5th quintile both of SBP and DBP (11.0 and 7.95%, respectively). Analysis of the absolute risk showed that SBP made a greater contribution to CVD that DBP in both the men and women (52.8 and 46.9% for the men and 92 and 83.8% for the women, respectively)/CONCLUSION: The open population from Tyumen was ascertained to have a high RR for CVD starting with a SBP of ≥141 mm Hg and a DBP ≥86 mm Hg for the men and with a SBP of ≥152 mm Hg and a DBP of ≥95 mm Hg for the women, which determined a lower survival in the population with elevated SBP and elevated DBP.
Terapevticheskii arkhiv. 2013;85(3):70-74
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Homocysteine levels and platelet aggregation in patients with cerebral circulatory disorders

Sabaliauskiene Z., Gribauskas P., Gaigalaite V., Ptašekas J., Ojeraitene V., Kalibatene D.


AIM: To reveal platelet functional changes manifesting as abnormal rate of platelet aggregation in patients with acute cerebral circulatory disorders (ischemic stroke, transient ischemic attack), to evaluate the effect of homocysteine (Hc) on platelet aggregation, depending on the degree of cerebral blood flow disturbances, patients' gender and age, and to estimate the diagnostic value of their associations/MATERIAL AND METHODS: 50 patients aged 33 to 98 years (mean age, 63.7±2.1 years; 20 men and 30 women) with acute cerebral circulatory disorders (18 with transient ischemic attack and 32 with ischemic stroke) were examined. The diagnosis was verified by the results of computed tomography and other clinical examinations. Adenosine diphosphate-, epinephrine-, and collagen-induced platelet aggregation was assessed in platelet-rich plasma; serum Hc concentrations were also studied/RESULTS: Comparison of platelet aggregation and Hc concentration revealed a statistically significant correlation between platelet aggregation with collagen and elevated Hc levels (r=0.376; p<0.01). There was no statistically significant correlation with other inducers. Blood Hc concentrations increased with advancing age (r=0.357; p=0.015). No statistically significant correlation was found between age and platelet aggregation (p>0.05). The levels of Hc were statistically significantly higher as cerebral circulatory disorders progressed/CONCLUSION: There was a statistically significantly relationship between collagen-induced platelet aggregation and Hc concentration. The Hc levels were statistically significantly related to the severity of cerebral circulatory disorders and age.
Terapevticheskii arkhiv. 2013;85(3):75-79
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The morphological and immunochemical features of nephropathies in multiple myeloma and severe renal failure

Rekhtina I.G., Golitsina E.P., Varlamova E.I., Varshavskiĭ V.A., Kireeva A.A., Biriukova L.S., Savchenko V.G.


AIM: To study the pathomorphology of kidneys in patients with multiple myeloma (MM) and severe renal failure (RF) and to compare the results of morphological, immunohistochemical, and electron microscopic examinations of nephrobiopsy specimens with the pattern of monoclonal secretion and the type of proteinuria and paraproteinuria/MATERIAL AND METHODS: A study group comprised 25 patients with MM and severe RF; 22 of them underwent programmed hemodialysis. Immunochemical study of serum and urine proteins, renal puncture biopsy with light, immunofluorescence and electron microscopy examination of its specimens were performed in all the patients/RESULTS: Cast nephropathy (CN) is the most common type of renal impairment in patients with MM and severe RF. CN concurrent with monoclonal immunoglobulin deposition disease was identified in 32% of cases. In the mixed lesion, it is CN that is a determinant in the development of acute and chronic RF. Rare variants of nephropathies as fibrillary glomerulonephritis, immunotactoid nephropathy, and crystalline histiocytosis were found in 16% of cases. In most cases, severe RF in MM develops in case of low monoclonal secretion. However, there are a larger number of secreted and excreted monoclonal light chains in CN than in other variants of kidney lesion. Urinary paraprotein G excretion suggests that the glomerular filter is damaged. Degenerative changes in the podocytes and a reduction in their small processes were detected in the majority of cases. In glomerular or mixed proteinuria, there were also unorganized and organized deposits in the glomerular basement membrane/CONCLUSION: The pattern of nephropathy does not determine a renal response after chemotherapy. The reversibility of CN in MM depends on the magnitude of interstitial fibrosis and podocyte changes. The pronounced changes in the podocytes as a reduction in their small processes serves as a poor sign in achieving renal responses following chemotherapy.
Terapevticheskii arkhiv. 2013;85(3):80-85
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Psychosomatic relationships in postmenopausal women

Lareva N.V., Govorin A.V.


AIM: To study the prevalence of depressive and anxiety disorders in postmenopausal disorders and their relationship with the manifestations of climacteric syndrome/MATERIAL AND METHODS: The study enrolled 203 women, including 142 patients with surgical menopause and 61 with natural menopause. Psychometric testing using the Hamilton depression rating scale and the Spielberger test anxiety inventory, and 24-hour blood pressure (BP) monitoring with assessment of the 24-hour BP profile were performed/RESULTS: Depressive disorders (DD) were found in 82.5% of the postmenopausal women; all the patients had higher levels of situational and personality anxiety. The women with natural menopause developed moderate and severe DD and those who had undergone ovariectomy had mild DD. The prevalence of DD was higher in patients with essential hypertension (EH) than in those with normal BP (88.6 and 78.3%, respectively; р<0.01); DD was more marked in these patients. The severity of DD also depended on the type of diurnal BP variations; the highest level of depression was recorded in patients without nocturnal BP reduction. The same group was found to have the highest level of personality and situational anxiety/CONCLUSION: The magnitude of DD depends on the type of menopause, the presence of EH, and the specific features of diurnal BP variations. The findings necessitate a detail examination of postmenopausal women for identification of affective disorders and their further correction.
Terapevticheskii arkhiv. 2013;85(3):86-89
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Effect of homocysteine on left ventricular structural and functional parameters in patients on programmed hemodialysis

Kharlamova U.V., Il'icheva O.E.


AIM: To determine the effect of plasma homocysteine (Hc) on the structure and function of the left ventricle (LV) in patients treated by programmed hemodialysis/MATERIAL AND METHODS: 109 patients on programmed hemodialysis were examined. Blood Hc levels were determined and echocardiography was performed in all the patients/RESULTS: In the patients on programmed hemodialysis, Hc concentrations were significantly higher than in apparently healthy individuals; there was a preponderance of mild (49.5%) and moderate (43.1%) hyperhomocysteinemia. LV hypertrophy was diagnosed in 90.8% of the patients. A positive relationship was found between the concentrations of Hc and the E/A ratio (r=0.34; р=0.05), isovolumetric relaxation time (IRT) (r=0.32; р=0.03), and LV mass (LVM) (r=0.3; p=0.05). Multivariate regression analysis indicated that the level of Hc had an independent impact on the E peak (R2=0.3; р=0.05), LV relative wall thickness (RWT) (R2=0.38; р=0.03), and LV IRT (R2=0.3; р=0.06)/CONCLUSION: Elevated plasma Hc levels were found to be related to LVM, LV RWT, LV IRT, E peak, and E/A ratio, suggesting that Hc had an unfavorable effect on the LV structure and function in patients on hemodialysis.
Terapevticheskii arkhiv. 2013;85(3):90-93
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A case of effective psychogenic ventricular arrhythmia treatment with the anxiolytic adaptol

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


The paper presents a clinical case of idiopathic ventricular arrhythmia developing in a 27-year-old young woman with anxiety neurosis successfully treated with the anxiolytic Adaptol used in daili dosage 1500 mg during a month.
Terapevticheskii arkhiv. 2013;85(3):94-97
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Easyhalers in practice for treating patients with asthma

Panina N.T., Il'kovich M.M.


A comparative investigation was conducted to study the therapeutic effect of using two powder inhalers (the new-generation device - an easyhaler as well as an aerolyser inhaler) in daily practice for treating patients with moderate asthma. It showed the pharmacological equivalence, efficiency, and safety of applying a combination of the easyhalers budesonide and formoterol, as well as the simplicity and convenience to use the inhalers of this type.
Terapevticheskii arkhiv. 2013;85(3):98-101
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Pharmacotherapy of acute respiratory viral infections

Zaĭtsev A.A.


The paper deals with the etiology, diagnosis, and treatment of acute respiratory viral infections (ARVI). It considers the currently available methods of etiotropic treatment and the tactics of antiviral therapy. Taking into consideration the fact that ARVI treatment is so far a considerable challenge associated with both the unreasonably widespread use of antibiotics and the giant market saturation with pharmaceuticals for the symptomatic therapy for ARVI, the author gives a critical analysis of medications used for the pharmacotherapy of respiratory viral infections.
Terapevticheskii arkhiv. 2013;85(3):102-106
pages 102-106 views

Mucoactive therapy in pulmonological practice: Current aspects

Shmeleva N.M., Shmelev E.I.


The paper describes the causes of mucostasis and the mechanisms of its development. It presents classifications of mucolytic drugs. A group of combination mucolytic drugs is identified by indicating the standard of their design and usage. The characteristics of the drugs including the combination agent ascoril are described in detail and information on the successful results of its use is given.
Terapevticheskii arkhiv. 2013;85(3):107-109
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Immunotropic therapy for tuberculosis infection

Sukhanov D.S.


The review summarizes current views on the immunopathogenesis of tuberculosis infection. It shows the leading role of a Th1 cytokine response in the formation of antituberculosis protective immunity and the impact of cytokine balance on disease outcomes. Data on the efficacy of current groups of immunomodulators used in the therapy of tuberculosis (immunomodulators, peptides, cytokine preparations, and synthetic immunomodulators of different chemical structures) are considered. Particular emphasis is placed on a group of interferon inducers as drugs for pathogenetic therapy, of which cycloferon is most important. The data of studies of the effect of cycloferon on the elaboration of interferon-γ that is able to activate a Th1 immune response, which promotes the shorter time of abacillation and decay cavity closure and positive X-ray changes, are given.
Terapevticheskii arkhiv. 2013;85(3):110-117
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Ibuprofen: safety and efficiency of its use in wide clinical practice

Morozova T.E., AndruShchishina T.B., Antipova E.K.


The paper presents data on the pharmacokinetics of the nonsteroidal anti-inflammatory drug ibuprofen and a review of the evidence base that suggests its clinical efficacy and safety in different categories of patients and discusses new, potentially possible indications for the use of this drug. Ibuprofen has marked anti-inflammatory, analgesic, and antipyretic effects, which along with its good tolerability, predictability of side effects, and a low risk of complications, allows it to be widely use in clinical practice. There are various ibuprofen formulations on the drug market. There may be not only an oral formulation of ibuprofen, but its topical (gel), rectal (suppositories), and parenteral (solution for intravenous injection) ones. More than 40 years' experience with ibuprofen used as an over-the-counter drug in wide clinical practice in approximately 80 countries worldwide serves as an illustrative example of the efficacy and safety of this agent.
Terapevticheskii arkhiv. 2013;85(3):118-124
pages 118-124 views

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