Vol 85, No 10 (2013)

Editorial
Component-resolved diagnosis is a new era in clinical allergology
Mokronosova M.A., Korovkina E.S.
Abstract
The paper describes the fundamentals and benefits of a new allergy diagnostic technique based on recent advances in molecular biology and biotechnology. Component-resolved diagnosis allows IgE antibodies against purified molecules (individual allergen components) to be revealed. Microanalysis is made using microarrays with applied molecules (allergen components) obtained in a recombinant fashion or extracted from natural raw materials. The authors present a current classification of animal and plant allergens and show the value of component-resolved diagnosis in clinical practice, by using specific clinical examples.
Terapevticheskii arkhiv. 2013;85(10):4-8
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Possibilities of rational combination antihypertensive therapy: Results of HEMERA international clinical trial
Chazova I.E., Martyniuk T.V.
Abstract
AIM: To evaluate the efficiency and safety of two treatment regimens using ramipril or losartan in combination with hydrochlorothiazide (HCT) and amlodipine in grade 1-2 arterial hypertension (AH)/MATERIAL AND METHODS: The prospective, international, multicenter, randomized, open-label, controlled trial with parallel groups included 347 AH patients in Russia (n=166), Croatia, and Ukraine. The follow-up was 12 weeks in patients not receiving antihypertensive therapy (AHT) and 13 weeks in those who had previously received AHT with regard to a washout period. The basis for two treatment regimens was ramipril or losartan. If no target blood pressure (BP) was achieved, amlodipine or HCT was added at week 4 and a third antihypertensive drug (AHD) was used 8 weeks later/RESULTS: At the inclusion, clinical BP was 157.64/95.5 mm Hg in 332 (61%) AH patients aged 55.9±11 years. At week 4 of monotherapy with ramipil 5 mg or losartan 50 mg, BP was reduced to 141.9/87.4 mm Hg. Addition of a second AHD further lowered BP to 131.8/81.9 mm Hg (to 127.6/79.7 at 12 weeks of treatment; p<0.001). After 4 weeks of treatment with ramipril 5 mg or losartan 50 mg, 35% of the patients achieved target BP. At weeks 8 and 12, double or triple AHT increased the number of patients achieving the target level up to 75 and 94%, respectively. When losartan was used as monotherapy, about one third of the patients achieved target BP; 20 and 22% of the patients required the addition of a second AHD (HCT and amlodipine, respectively). Only 10% of the patients needed to take a combination of three AHDs. Nearly one third of the patients achieved target BP during monotherapy with losartan or ramipril. Double AHT involving ramipril or losartan in combination with the diuretic or amlodipine was used in 18 and 20% and in 22 and 24% of the patients, respectively. 28 and 19% of the patients received triple therapy including ramipril or losartan, amlodipine, and HCT. The most common adverse reactions were dizziness (2.4%), fatigue (1.8%), and coughing (1.2%)/CONCLUSION: In the patients with grades 1-2 AH, the treatment regimens using basic therapy with ramipril or losartan proved to be highly effective and allowed target BP to be achieved in 94% of cases. Both treatment regimens were comparable in view of safety; slight side effects occurred rarely (in less than 2.5% of the patients) and required that the treatment should not be discontinued.
Terapevticheskii arkhiv. 2013;85(10):10-22
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Impaired cardiac structural and functional parameters in patients with chronic heart failure and diabetic cardiac autonomic neuropathy
Statsenko M.E., Turkina S.V., Shalaeva S.S., Vinnikova A.A.
Abstract
AIM: To reveal the specific cardiac structural and functional features in patients with chronic heart failure (CHF) and diabetic cardiac autonomic neuropathy (CAN)/MATERIAL AND METHODS: Ninety patients aged 45-70 years with Functional Class II-III CHF in the early post-myocardial infarction period and with type 2 diabetes mellitus (DM2) were examined. A study group of 60 patients had signs of CAN (Group 1); a control group of 60 patients presented with CHF and DM2 without signs of CAN (Group 2)/RESULTS: The patients with CHF and DM2 with the manifestations of CAN were found to have higher left ventricular mass indices and greater QT dispersion than those with CHF and DM2 without CAN; there was a significant decrease in heart rate variability and a statistically significant preponderance of hypersympathicotonia/CONCLUSION: A clinically important relationship was found between cardiac autonomic dysregulation, CAN severity in patients with CHD and DM2 and cardiac structural and functional parameters.
Terapevticheskii arkhiv. 2013;85(10):23-28
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Prothrombotic state in patients with metabolic syndrome: an association with inflammation
Kaliuzhin V.V., Sibireva O.F., Bespalova I.D., Kaliuzhina E.V., Tkalich L.M., Milovanova T.A., Osikhov I.A., Murashev B.I.
Abstract
AIM: To comprehensively study hemostasis pathology and its association with the laboratory markers and mediators of inflammation in patients with metabolic syndrome (MS)/MATERIAL AND METHODS: One hundred and eleven patients with type 2 diabetes mellitus, who were diagnosed as having MS, were examined. Vascular-platelet and secondary hemostases and anticoagulant and fibrinolytic systems were evaluated, by performing the complete clinical, laboratory, and instrumental study accepted in a specialized endocrinology clinic. The blood concentrations of high-sensitivity C-reactive protein and proinflammatory cytokines were determined in all the patients with MS and control persons (n=50)/RESULTS: It was found that in patients with MS, hemostasis pathology that might be classified as the combined form of a prethrombotic state, which was caused by different types of a constellation of vascular-platelet and plasma hemostases, as well as physiological anticoagulant deficiency, was linked to the laboratory markers and mediators of subclinical inflammation/CONCLUSION: In the patients with MS, subclinical systemic inflammation is of substantial importance for the mechanisms of a prethrombotic state.
Terapevticheskii arkhiv. 2013;85(10):29-33
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Cerebrovascular diseases and metabolic syndrome
Tanashian M.M., Lagoda O.V., Orlov S.V., Telenkova N.G., Maksiutkina L.N., Petrukhina S.I.
Abstract
AIM: To study various aspects of cerebrovascular diseases (CVD) in the presence of metabolic syndrome (MS)/MATERIAL AND METHODS: A comprehensive clinical, laboratory, ultrasound, and neuroimaging study was conducted in 514 patients with symptomatic and asymptomatic atherosclerotic lesion of the internal carotid artery and MS/RESULTS: MS was found and proven to affect the following factors: a) the course and progression of carotid artery (CA) atherosclerotic lesion with transformation of its asymptomatic to symptomatic state; b) the structure and instability of an atherosclerotic plaque; c) the magnitude of blood rheological changes; d) endothelial dysfunction; e) white matter changes; f) the clinical features of both acute and chronic CVD and the development of cognitive impairments/CONCLUSION: The association of the atherogenic activity of major components of MS, such as hyperinsulinemia, hypertension, dyslipidemia, and obesity, in the presence of dysregulated hemostasis and blood rheology substantially increases the risk of a progressive CA atherosclerotic process even in its asymptomatic course and accordingly favors the development and progression of different manifestations of CVD.
Terapevticheskii arkhiv. 2013;85(10):34-42
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Dilated cardiomyopathy in patients with schizophrenia
Volkov V.S., Volkov V.P.
Abstract
AIM: To study the frequency of pathoanatomic and some clinical signs of dilated cardiomyopathy (DCM) in schizophrenic patients (SPs)/MATERIAL AND METHODS: Autopsy records were studied in 838 SPs treated at a psychiatric hospital in 1952 to 2007. The records were used to select DCM cases (n=74) and sudden deaths (n=101) and to examine 339 electrocardiograms (ECG). The 2006-2007 information obtained in the dissecting rooms of three Tver hospitals (1413 sections) was analyzed/RESULTS: DCM was absent (neuroleptics were not used) before 1956. With the application of neuroleptics, the diagnosis of DCM cases significantly increased and its rate was 14.2% among the dead SPs. DCM might be a cause of sudden death in 21.8% of SPs. The rate of pathological ECG signs noticeably increased with the longer use of neuroleptics. In the hospital-wide network, the detection rate for DCM was 0.5% of the autopsies/CONCLUSION: The use of neuroleptics, in SPs in particular, may lead to the development of DCM.
Terapevticheskii arkhiv. 2013;85(10):43-46
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Pregnancy and labor problems in patients with acute porphyria
Pustovoĭt I.S., Karpova I.V., Shmakov R.G., Makhinia S.A.
Abstract
AIM: To evaluate the impact of developing pregnancy on porphyrin metabolism in reproductive-aged women with acute porphyria (AP)/MATERIAL AND METHODS: The prospective clinical data of 33 pregnancies were analyzed in 28 patients with the established diagnosis of AP. The latter was verified by the quantitative analysis of 24-hour urinary porphyrin excretion and the diminished activity of the pathognomonic enzyme/RESULTS: Each case was analyzed in detail according to different criteria. Poor prognostic factors for pregnancy are identified in AP. The used curation policy for pregnant patients is described. The pregnant women with occurring AP episodes are subdivided into clinical groups requiring different curation approaches. The scheme for the used working protocol is given/CONCLUSION: The accumulated experience with curating the patients with AP will be able to avoid the existing prohibitory practice, providing a way to develop a new quality of life in the patients' families.
Terapevticheskii arkhiv. 2013;85(10):47-55
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Treatment for acute promyelocytic leukemia during pregnancy
Troitskaia V.V., Parovichnikova E.N., Sokolov A.N., Kokhno A.V., Makhinia S.A., Galstian G.M., Konstantinova T.S., Mazurok L.A., Goriachok I.G., Korobkin A.V., Liubchenko M.A., Latyshkevich O.A., Zvereva A.V., Kurtser M.A., Savchenko V.G.
Abstract
AIM: To study the experience in managing patients with acute promyelocytic leukemia (APL) diagnosed in different periods of pregnancy/MATERIAL AND METHODS: Nine women with APL were treated in 1998-2013. When APL was diagnosed in the first trimester of pregnancy, the latter was terminated (n=1); when its diagnosis was made in the second trimester, chemotherapy (CT) followed by delivery (D) was performed (n=3); when it was done in the third trimester, D followed by CT was done in relation to gestational age (n=2) or these were performed at a later gestational age (n=1). APL was treated in 5 and 1 patients according to the AIDA protocol and the 7+3 plus ATRA one, respectively/RESULTS: All the patients with APL achieved remission after the first cycle of induction CT; 5 of the 6 patients did at the moment of delivery; one patient underwent emergency delivery during cytopenia after the cycle. The gestational age at delivery after CT was 34 (34-40) weeks. Spontaneous term labor occurred in 2 patients at an obstetric hospital. Cesarean section was made in 4 of the 6 patients. All babies were born alive, healthy, and without developmental abnormalities. Their age at the time of analyzing the results was 2.5 months to 15 years. Four of the 9 patients are presently alive. Late recurrences occurred in 3 (33%) patients. The median overall survival is 26 (0.25-128) months; the median relapse-free survival is 17.5 (0-127) months/CONCLUSION: APL treatment in pregnant women, which is aimed at saving two lives, is effective and reasonable.
Terapevticheskii arkhiv. 2013;85(10):56-63
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The vascular wall in postmenopausal women with hypothyroidism and hypertension
Riabtseva O.I., Orlova I.A., Blankova Z.N., Chazova T.E., Ageev F.T.
Abstract
AIM: To study a relationship between thyroid function and the stiffness of great arteries in postmenopausal women with arterial hypertension (AH)/MATERIAL AND METHODS: The trial enrolled 76 postmenopausal patients with clinical hypothyroidism (CHT) (n=24) or subclinical hypothyroidism (SCHT) (n=52) and AH; a control group consisted of 40 postmenopausal women with euthyroidism. Body mass index (BMI), waist and hip circumferences, blood pressure (BP), thyroid-stimulating hormone (TSH), free thyroxine, free triiodothyronine, total cholesterol, triglycerides were determines; volumetric sphygmography was performed. Brachial-ankle pulse wave velocity (baPWV) was measured; cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) were determined/RESULTS: The patients with CHT or SCHT and the controls were matched for age, BMI, BP, and heart rate. TSH levels in patients with SCHT (6.23 (5.27; 8.22) µU/ml) and in those with CHT (11.8 (9.09; 22.7) µU/ml) were statistically significantly higher than in the control group (2.25 (1.5; 2.72) µU/ml) (p<0.05). BaPWV in the patients with SCHT (14.35 (12.5; 15.5) m/sec) and in those with CHT (13.75 (13.05; 15.25) m/sec) was also statistically significantly higher than in the control group (12.85 (12; 13.9) m/sec) (p<0.05). Comparison of ABI and CAVI revealed no significant differences between the groups. Univariate analysis of the findings showed a significant impact on higher arterial stiffness in the SCHT and the CHT groups. Total cholesterol levels were significantly higher in the SCHT group than in the control one/CONCLUSION: The patients with AH and hypothyroidism versus their peers with AH and without thyroid function had significant rises in blood cholesterol levels and arterial stiffness. The rise in lipid levels was significantly marked only in the patients with SCHT; and baPWV equally increased in both the SCHT and the CHT groups.
Terapevticheskii arkhiv. 2013;85(10):64-69
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Optimization of an approach to solving the problem of a barren marriage in secretory azoospermic men
Sukhikh G.T., Gamidov S.I., Popova A.I., Ovchinnikov R.I., Shcherbakov D.V., Krasova O.M., Izhbaev S.K., Shchegolev A.I., Dubova E.A., Mishieva N.G., Abubakirov A.N., Kamaletdinov N.S.
Abstract
AIM: To compare the efficiency of using different interventional procedures for a barren marriage in case of secretory azoospermia (SAS)/MATERIAL AND METHODS: The trial enrolled 110 patients aged 25 to 54 years with SAS. The levels of sexual hormones were determined; ovarian punch biopsy was performed/RESULTS: Decreased volume of the ovaries was noted in 85.3% of the patients; diffuse or focal changes in their parenchyma were seen in 65.7%. There was an increase of follicle-stimulating hormone levels and a reduction in testosterone ones. Hyperestrogenemia was identified in 26.5% of the patients. The level of inhibin B was lower in all the patients. The efficiency of standard testicular sperm extraction for cryopreservation was achieved in 28.7% of the patients and that of a microsurgical technique was in 56.7%. The wives of 37 out of the 57 patients included in an assisted reproductive technology program were more than 12 weeks pregnant after 95 intracytoplasmic sperm injection cycles/CONCLUSION: The microsurgical technique is most effective in achieving the successful treatment of patients with azoospermia in order to prevent male infertility.
Terapevticheskii arkhiv. 2013;85(10):70-75
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Experience with selenium used to recover adrenocortical function in patients taking glucocorticosteroids long
Voĭtsekhovskaia I.G., Orlikov G.A., Voskresenskaia N., Umnova L.M., Ivanov I.V., Gredzena P., Karpov I.G., Ianovskaia I., Voĭtsekhovskiĭ V.V., Maulin'sh É.
Abstract
AIM: To study the effect of selenium on adrenocortical function in patients taking glucocorticosteroids (GCS) long/MATERIAL AND METHODS: The study included 56 patients who had been long taking oral GCS for the underlying disease. Adrenocortical function was evaluated by a short synacthen test; adrenal insufficiency (mean cortisol level 8.2 µg/dl) was identified in 52 patients. A study group of patients (n=35) was given selenium 200 µg/day. A control group (n=17) with the detected adrenal insufficiency did not take it. All the patients (n=52) continued to receive standard therapy for the underlying disease, including oral GCS/RESULTS: Adrenal function was reexamined 6 months later; the two paired-samples t-test indicated a statistically significant increase in cortisol levels up to 23.20±4.2 µg/dl (p≤0.05) in the patient group receiving selenium in addition to the basic therapy. In the control group, the function did not recover (cortisol levels were 8.6 and 9.8 µg/dl at baseline and at 6 months, respectively; p≤0.05)/CONCLUSION: The experience with selenium 200 µg/day given long to patients with adrenal insufficiency caused by the long-term use of GCS shows that the agent is effective in recovering adrenocortical function.
Terapevticheskii arkhiv. 2013;85(10):76-78
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Circadian rhythm sleep disorders in megalopolis dwellers
Buzunov R.V., Tsareva E.V.
Terapevticheskii arkhiv. 2013;85(10):79-82
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Chronic obstructive pulmonary disease exacerbation. Do we use all possibilities of outpatient therapy?
Leshchenko I.V.
Abstract
Chronic obstructive pulmonary disease (COPD) exacerbations are evaluated from a history of the disease, its clinical symptoms, and laboratory tests. The most common causes of a COPD exacerbation are upper respiratory tract and tracheobronchial infections. The exacerbation severity usually corresponds to the magnitude of clinical manifestations of COPD during its stable course. Successful treatment in patients with a COPD exacerbation is determined by its timely diagnosis. When treating patients with a mild or moderate exacerbation of Stages I-II COPD in an outpatient setting, it is advisable to use ascoril having broncholytic, mucolytic, and mucokinetic properties along with antibiotics and glucocorticosteroids, if clinically indicated.
Terapevticheskii arkhiv. 2013;85(10):83-87
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Erectile dysfunction and obesity
Ametov A.S., Stel'makh M.V.
Abstract
The review considers the relationship between obesity and erectile dysfunction (ED). Obesity is associated with the high prevalence of ED; however, the pathophysiological link between these conditions has yet to be adequately investigated. Visceral obesity leads to the enhanced activity of inflammatory responses and, thus, endothelial dysfunction and decreased plasma testosterone levels, which favors the development of hypogonadism and increases the risk of vascular diseases. Endothelial dysfunction and androgen deficiency in turn give rise to ED.
Terapevticheskii arkhiv. 2013;85(10):88-93
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Antiviral therapy and risk for hepatocellular carcinoma in chronic viral hepatitis
Abdurakhmanov D.T.
Abstract
Hepatocellular carcinoma (HCC) is one of the most common human malignancies in incidence and mortality, which develops in the majority of patients in the stage of cirrhosis. Because of the major etiological role of hepatitis viruses, the prevention of HCC is vaccination against hepatitis B virus and successful antiviral therapy for chronic hepatitis B and C.
Terapevticheskii arkhiv. 2013;85(10):94-97
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Impact of bariatric surgery on the absorption of nutrients in patients with obesity
Bodunova N.A., Sabel'nikova E.A., Parfenov A.I.
Abstract
The review considers disturbed metabolism of vitamins, minerals, and protein in patients following bariatric surgery. The positive effect of the surgery is proven; however, postresection syndromes that may further occur determine not only a patient follow-up, but also timely therapeutic interventions to prevent hypovitaminoses, anemia, and mineral metabolic disturbances. There are conflicting data on the incidence of these abnormalities. No guidelines for their treatment and prevention have been elaborated.
Terapevticheskii arkhiv. 2013;85(10):98-104
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Medical and psychological rehabilitation of patients and disabled persons
Zaĭtsev V.P.
Abstract
The paper unveils the concept of medical rehabilitation and defines its place in clinical medicine. It underlines the inextricable link and interaction of different components of a rehabilitation system. The value of the psychological aspect of rehabilitation is considered. Categories of patients and disabled persons who need psychological rehabilitation are identified; a classification of personal reactions to disease and the changes in the psychological state of patients in different periods after disease onset are given. The factors influencing the process of psychological readjustment in patients and the disabled are analyzed. The psychological rehabilitation system for patients and disabled persons is considered in detail. Data on its medical and socioeconomic efficiency are presented.
Terapevticheskii arkhiv. 2013;85(10):105-110
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Headache associated with sexual activity: diagnostic difficulties and management tactics
Ekusheva E.V., Damulin I.V.
Abstract
Headache associated with sexual activity (HASA) is a common and benign form of primary headache in most cases and has a favorable prognosis. However, even a single episode of primary headache is a cause for an immediate and thorough examination to rule out the secondary nature of cephalgia. The paper considers the pathogenesis, differential diagnosis, and principles in the treatment of patients with this disease.
Terapevticheskii arkhiv. 2013;85(10):111-115
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Relationship between visceral diseases and oral health
Gazhva S.I., Igolkina N.A.
Abstract
The paper analyzes the literature showing that there is not only a phylogenetic relationship, but also a functional one between visceral diseases and oral health. It gives data on the unity of the occurrence of somatic and dental diseases. There is evidence for cause-and-effect relationships between them, which arise from immune imbalance, interleukin dysregulation, and nonspecific inresistance. There was a negative comorbidity of visceral diseases and oral health, namely, a relationship of dental diseases to the patients' general condition, as well as the impact of the foci of chronic oral infection on the development of systemic diseases. Mechanisms of a relationship between oral infection and secondary systemic manifestations are also described. It has been established that transient bacteremia odontogenic is detected at a dental visit and conditions for its transformation to any infectious diseases are also outlined. Unified systems approaches to treating polymorbidity are found to be needed.
Terapevticheskii arkhiv. 2013;85(10):116-118
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Tracheal diverticula
Marchenkov I.V.
Abstract
Tracheal diverticula (TD) are a rare congenital or acquired condition. The diagnosis of TD is based on the data of multislice spiral computed tomography and fibrotracheal bronchoscopy. DTs are most frequently located in the right, may be solitary or multiple, uni- or multilocular. Uncomplicated DTs generally have no characteristic clinical features. Their symptoms can arise from the compression of adjacent organs or the addition of secondary bacterial infection and most commonly appear as cough. Differential diagnosis is mainly made with pharyngeal and laryngeal cysts and pharyngoesophageal diverticula. Asymptomatic TDs usually require no treatment. Surgical TD excision is possible in case of compression of adjacent organs and infection.
Terapevticheskii arkhiv. 2013;85(10):119-121
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