Vol 85, No 12 (2013)

Editorial
Organization of medical care for patients with non-ST-segment elevation acute coronary syndrome in regional vascular centers and primary vascular units in 2009-2012 (according to the data of the ACS register)
Oshchepkova E.V., Dmitriev V.A., Gridnev V.I., Dovgalevskiĭ P.I.
Abstract
AIM: To study clinical characteristics of non-ST-segment elevation acute coronary syndrome (NSTEACS) and to assess the quality of medical health in patients with this condition who were treated in the regional vascular centers and primary vascular units from 48 subjects of the Russian Federation in 2009-2012. Materials and methods. The medical records of 68 467 patients with the verified diagnosis of NSTEACS, which were entered in the ACS Register database on January 1, 2009, to January 1, 2013, were analyzed. The investigation included data on patients aged at least 18 years at admission to hospital with a presumptive diagnosis of ACS, myocardial infarction, or unstable angina pectoris in the case histories. The data were introduced from the completed case histories. In the patients with NSTEACS, the risk of hospital and 6-month deaths was calculated using the GRACE scale. In these patients, the risk of bleeding was estimated using the CRUSADE scale/RESULTS: History data on the presence of risk factors for cardiovascular diseases and prior diseases before ACS were collected from 42,000 patients with NSTEACS. The patients' median age was 66 years; males were 60.6% and women were 59.4%. Smokers were 21.7%. 35.1% of the patients with NSTEACS were found to have a family history of early-onset coronary heart disease (CHD). There were a large proportion of patients at high risk for hospital death according to the GRACE scale. In the period 2009-2012, the proportion of patients with NSTEACS at low risk for hospital death decreased from 30.6 to 25.3% and that of patients at high risk for hospital death proportionally increased from 41.2 to 44.9%. Analysis of the risk for 6-month death by the GRACE scale indicated that the proportion of patients at high risk was twice higher than that of patients at low and moderate risks taken together and did not reduce in the analyzed period of time. The patients with NSTEACS at high risk for hospital and 6-month death (2012) amounted to 44.9 and 61.7%, respectively. In this category of patients, the rate of percutaneous coronary interventions was not greater than 9%. There were a considerable proportion of patients at high and very high risk for bleeding during their hospital stay according to the CRUSADE/CONCLUSION: By and large, the Russian ACS Register assesses the clinical characteristics of patients with NSTEACS, the risk of hospital and 6-month deaths, as well as that of bleedings, the nature of performed drug therapy and generally gives an estimate of treatment compliance by patients with NSTEAC.
Terapevticheskii arkhiv. 2013;85(12):4-8
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ST-segment elevation acute coronary syndrome (according to the data of the district cardiac dispensary register of Surgut)
Urvantseva I.A., Salamatina L.V., Andreeva I.A., Milovanova E.V., Zorina L.S., Shepilova I.B.
Abstract
AIM: To analyze the individual indicators of emergency medical care in ST-segment elevation (STSE) acute coronary syndrome (ACS) according to the data of the ACS Register of the District Cardiology Dispensary, Center for Diagnosis and Cardiovascular Surgery, Khanty-Mansi Autonomic District-Yugra, Surgut, over time from 2008-2010 and 2011 versus the data of health care facilities taking part in the ACS Register. Materials and methods. The quality of medical care for patients with STSE ACS was considered and analyzed in accordance with "The information analytical system user's guide for the integrated rapid assessment of the quality and level of organization of medical care for patients with acute coronary syndrome to "The Federal Register of Patients with ACS"/RESULTS: The data of the ACS Register of the Surgut District Cardiology Dispensary indicate that the majority of patients with STSE ACS are males (86.9%); the patients' median age is 56.0 (range 51.0-61.0) years. The scope of performed drug therapy is comparable with the data of the European Registers: aspirin (97.6%), clopidogrel (93.7%), anticoagulants (98.5%), angiotensin-converting enzyme inhibitors (96.6%), Β-blockers (96.1%), and statins (87.4%). In STSE ACS, percutaneous coronary intervention is performed in 93.7% of cases; thrombolytic therapy in 14.6%; emergency coronary bypass surgery in more than 3%/CONCLUSION: The individual indicators characterizing the level of medical care for STSE ACS were analyzed using the ACS Register.
Terapevticheskii arkhiv. 2013;85(12):9-13
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Relationships between serum lipid composition and acetylator status as markers of energy metabolism in women with coronary heart disease, metabolic syndrome, and type 2 diabetes mellitus
Matveeva S.A.
Abstract
AIM: To study relationships between the indicators of serum lipid composition (SLC) and the markers of acetylator (energy) status (AS) in women with coronary heart disease (CHD), stable exertional angina (SEA), metabolic syndrome (MS), type 2 diabetes mellitus (DM) (according to the data multivariate correlation analysis)/MATERIAL AND METHODS: One hundred and eight women aged 54.9±0.7 years with CHD, Functional Class I-III SEA, MS, and type 2 DM were examined. SLC was studied, by determining the levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), high-density lipoprotein cholesterol (HDL-C), atherogenic coefficient (AC), triglyceride coefficient (TC) (TC=TG/HDL-C). AS markers, such as blood acetylation degree (BAD) and the total acetylating capacity of the body (TACB), were concurrently determined. Correlations of each individual indicator of a lipidogram (TC, TG, LDL-C, VLDL-C, HDL-C, AC, and TC) and an AS marker (BAD, TACB) were analyzed in tandem/RESULTS: Examination of the relationships between SLC the indicators and AS markers in women with CHD, MS, and type 2 DM could establish that the values of a variant, ≤10th and >90th percentiles of SLC indicators (TC, TG, LDL-C, VLDL-C, HDL-C, AC, and TC) showed a significant strong direct (positive) relationship to those of the variant, ≤10th and >90th percentiles of AS markers (BAD, TACB). A significant inverse (negative) correlation was found between the values of the ≤10th percentile of SLC indicators (TC, TG, LDL-C, VLDL-C, HDL-C, AC, and TC) and those of >90th percentile of AS markers (BAD, TACB), as well as between the values of >90th percentile of SLC indicators (TC, TG, LDL-C, VLDL-C, HDL-C, AC, and TC) and those of ≤10th percentile of AS markers (BAD, TACB)/CONCLUSION: The heterogeneity in the association was ascertained between the values of ≤10th percentile/>90th percentile/variant of SLC and AS markers. The genetic polymorphism of AS - the phenotypes of slow/fast/ intermediate acetylators (a three modal distribution) was stated. Knowledge of the patterns of relationships between BAD/AS and the polymorphism of the phenotypes of slow/fast/intermediate acetylators may contribute to the formation of differentiated groups at risk for cardiovascular and concomitant diseases and to adequate prevention and treatment.
Terapevticheskii arkhiv. 2013;85(12):14-20
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Impact of combination antihypertensive therapy on heart rate variability parameters and target organ status in patients with arterial hypertension and type 2 diabetes mellitus
Statsenko M.E., Derevianchenko M.V., Titarenko M.N., Mikhaleva A.V.
Abstract
AIM: To evaluate the impact of combination antihypertensive therapy with ekvator on heart rate variability (HRV) parameters and target organ status in patients with arterial hypertension (AH) and type 2 diabetes mellitus (T2DM)/MATERIAL AND METHODS: The investigation enrolled 30 patients aged 40-65 years with Stages II-III AH concurrent with T2DM. All the patients received combination antihypertensive therapy with amlodipine + lisinopril for 12 weeks. HRV parameters, baseline autonomic tone, and autonomic responsiveness were studied, by analyzing ECG reading of their hearts in the 5-minute segments. Echocardiography was performed and arterial elastic properties and renal functional were examined/RESULTS: 12-week ekvator therapy showed a high (93.3%) rate of achieved goal blood pressure (BP) levels. There was a statistically significant reduction in resting tension index by 66% and during an active orthostatic test by 43.5% during combination antihypertensive therapy with amlodipine and lisinopril. Twelve weeks after treatment, the normal type of autonomic responsiveness was prevalent (53.4%) in patients with AH and T2DM, with a significant decline in the number of persons with asympaticotonic autonomic responsiveness. There was a significant decrease in left ventricular mass index by 10.7% and microalbuminuria by 27.7% and a 30% decline in the number of patients with a higher pulse wave velocity along the elastic arteries. There were close highly significant correlations between the parameters of HRV and the status of target organs (heart, kidney, and vessels)/CONCLUSION: 12-week ekvator treatment not only normalizes effectively BP and has a favorable impact on target organs, but also improves HRV parameters in the patients with AH and T2DM, in this connection, HRV may be, in our opinion, regarded as another combination antihypertensive therapy target.
Terapevticheskii arkhiv. 2013;85(12):21-26
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Immuno-inflammatory changes (myocarditis?) in chronic heart failure in alcoholic patients
Moiseev V.S., Goncharov A.S., Terebilina N.N., Panchenko L.F., Kiiakbaev G.K., Traianova T.G., Aleksandriia L.G., Boronets V.I.
Abstract
AIM: To estimate the contribution of immuno-inflammatory changes to the formation of clinical and hemodynamic features in alcoholic patients with chronic heart failure (CHF)/MATERIAL AND METHODS: Forty-five males with CHF in the presence of alcohol-induced heart damage (AIHD) who had been admitted to therapeutic units for decompensated heart failure were examined. A control group consisted of 20 men with the CHF severity comparable with the NYHA classification in the presence of prior myocardial infarction. All the patients underwent examination of the immune-inflammatory status - the cytokines: interleukin (IL) 6, IL-8, IL-12, tumor necrosis factor-α (TNF-α), transforming growth factor-Β1, endotoxin, cellular immune parameters, and cardiac structure and function by echocardiography/RESULTS: The patients with CHF in the presence of AIHD, as compared to those with ischemic cardiomyopathy, showed the higher levels of inflammatory cytokines (IL-6, TNF-α, IL-12, and endotoxin) and cell-mediated immunity changes (the smaller count of suppressor T cells, natural killer cells, and a shift of the T-helper/T-suppressor ratio towards the T-helper population). The magnitude of these changes correlated with the severity of CHF and cardiac morphofunctional changes/CONCLUSION: The relationship of immuno-inflammatory changes to the severity of CHF and the morphofunctional state of the heart irrespective of the etiology of heart failure demonstrated the role of immune inflammation in its pathogenesis particularly in alcoholic patients who were found to have more marked immuno-inflammatory changes than in those with ischemic cardiomyopathy.
Terapevticheskii arkhiv. 2013;85(12):27-35
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The clinical and diagnostic significance of intima-media thickness in chronic obstructive pulmonary disease
Akramova É.G.
Abstract
AIM: To estimate changes in common carotid artery (CCA) intima-media thickness (TIM) in patients with the isolated form of chronic obstructive pulmonary disease (COPD) or that concurrent with coronary heart disease (CHD) and arterial hypertension (AH)/MATERIAL AND METHODS: Carotid duplex scanning, echocardiography, electrocardiogram (ECG) Holter monitoring, and spirometry were performed in 150 patients with COPD, COPD + AH, or COPD + CHD and in 33 apparently healthy men and women aged 39-77 years/RESULTS: An increase in TIM (more than 0.9 mm) was determined in 54.5% of the patients with isolated COPD, in 76.7% of those with COPD + CHD, and in 68.2% of those with COPD + AH. The correlation coefficient between TIM and age varied from 0.3 to 0.49 (controls 0.66) whereas that with the degree of bronchial obstruction (forced expiratory volume in one second) was statistically insignificant. In isolated COPD, the increase in CCA TIM was determined from the presence of right ventricular hypertrophy. Hemodynamic relevant supraventricular and ventricular premature beats were more frequently recorded in the presence of increased TIM and only in the COPD + AH group. Changed heart rate variability with the predominance of sympathetic tone over parasympathetic one was observed in all the patients with COPD and increased TIM/CONCLUSION: The widespread increase in CCA TIM in patients with COPD shows the need for carotid duplex scanning in this contingent of patients, primarily in persons over the age of 50 years with Stage III-IV COPD concurrent with CHD or AH.
Terapevticheskii arkhiv. 2013;85(12):36-40
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Antibiotic therapy regimens for mild community-acquired pneumonia in patients with risk factors for ineffective treatment: Clinical and economic comparisons
Zaĭtsev A.A., Makarevich A.M., Kondrat'eva T.V., Kalugin V.V.
Abstract
AIM: To evaluate the clinical efficiency, tolerance, and pharmacoeconomic parameters of treatment for mild community-acquired pneumonia (CAP) in patients with risk factors for ineffective treatment with levofloxacin (Glevo) versus original levofloxacin and standard pharmacotherapy regimens for mild pneumonia (real practice)/MATERIAL AND METHODS: An open-label comparative randomized trial was conducted in parallel groups of 147 patients aged ≥18 years with mild CAP and risk factors for ineffective treatment. Group 1 included 61 patients (59 men and 2 women; mean age 23.3±11.2 years) receiving levofloxacin (Glevo) 500 mg/day; Group 2 comprised 41 patients (39 men and 1 woman; mean age 26.4±13.4 years) treated with original levofloxacin 500 mg/day; Group 3 consisted of 45 patients (all men; mean age 23,7±9,9 years) on standard therapy. The trial was performed in 3 pulmonology centers/RESULTS: The use of the respiratory fluoroquinolone levofloxacin to treat mild CAP in the patients with risk factors for failure for its therapy demonstrated a higher efficiency than the antibiotic regimens used in real clinical practice. This suggests that physicians underestimate risk factors and do not always make a rational choice of an antimicrobial agent in the given clinical situation/CONCLUSION: The generic form of levofloxacin (Glevo) is as clinically effective as its original drug in the treatment of CAP and characterized by its optimal pharmacoeconomic parameters.
Terapevticheskii arkhiv. 2013;85(12):41-46
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Experience with outpatient treatment for thromboses and thrombophilias
Vasil'ev S.A., Vinogradov V.L., Gemdzhian É.G., Orel E.B., Shevelev A.A., Margolin O.V.
Abstract
AIM: To evaluate the efficiency of diagnosis and treatment of thromboses in patients with thrombophilia in an outpatient setting/MATERIAL AND METHODS: One hundred and seventy-two patients with different forms of thrombophilic states were examined. One hundred and thirty-two patients were found to have genetic mutations, of them 125 patients had multiple mutations. Thromboses were diagnosed in 130 patients with genetic disorders/RESULTS: The most common laboratory markers of thrombophilias were hyperhomocysteinemia (55%), sticky platelet syndrome (41%), and laboratory findings of antiphospholipid syndrome. Thrombogenic mutations, such as plasminogen activator plasminogen inhibitor-1 (73%), methylene tetrahydrofolate reductase (60%), platelet glycoprotein Ia receptors (50%), and fibrinogen (42%), were most often diagnosed. The efficiency of treatment was shown to largely depend on the duration of an initial thrombotic process/CONCLUSION: Outpatient treatment for thromboses is more economical and comfortable for patients. To avoid hospital admissions, it is necessary to time detect the disease and to start its treatment as soon as possible. The concurrent use of ultrasonography, genetic and laboratory diagnostic methods accelerates the identification and localization of the pathology, which facilitates its treatment and frequently rules out the need for patient hospitalization.
Terapevticheskii arkhiv. 2013;85(12):47-50
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Clinical and endoscopic features and treatment problems in patients with duodenal ulcer after its perforation
Liubskaia L.A., Kolesnikova I.I., Grigor'eva I.V.
Abstract
AIM: To compare clinical and endoscopic findings and standard therapy results in duodenal ulcer disease (DUD) patients with and without a history of perforated ulcer/MATERIAL AND METHODS: One hundred and thirteen patients with recurrent DUD, including 61 patients with uncomplicated DUD (Group 1) and 52 patients with a history of perforated ulcer (Group 2) were examined. Esophagogastroduodenoscopy (EGDS) and 24-hour pH-metry were performed in addition to physical examination. Ulcer scarring was evaluated during control EGDS/RESULTS: 75% of the patients with uncomplicated DUD were observed to have classical pain syndrome and the pain was milder, more extensive, and food-unrelated in the patients who had sustained perforation. Decreased appetite was more common in uncomplicated DUD (35%). EGDS showed that complicated DUD was accompanied by a significantly higher detection rate of erosive esophagitis (20%), gastritis (52%), duodenitis (25%), multiple ulcers (28%), and larger ulcer sizes. 35% of the patients who had experienced duodenal ulcer perforation exhibited an inadequate antisecretory effect of standard omeprazole doses, which was followed by the increase in ulcer scarring time by an average of 1.2 days/CONCLUSION: In the patients with perforated DUD, the history was typified by less pronounced, more extended, and food-unrelated pain, esophageal and gastroduodenal erosive damages, multiple ulcerative defects, large ulcer sizes than in those with uncomplicated DUD, as well as resistance to standard omeprazole dose in one third of the cases, and delayed ulcer scarring.
Terapevticheskii arkhiv. 2013;85(12):51-54
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Immune response to biological therapy for inflammatory bowel diseases
Kniazev O.V., Parfenov A.I., Ruchkina I.N., Lazebnik L.B., Sagynbaeva V.É.
Abstract
AIM: To study biological (cell and anticytokine) therapy-induced changes in the levels of proinflammatory cytokines in patients with inflammatory bowel diseases (IBD)/MATERIAL AND METHODS: Forty-four patients with chronic continuous or chronic recurrent IBD were examined. According to the performed therapy, the patients were divided into 3 groups: 1) 16 patients who took infliximab; 2) 14 patients who received combination anti-inflammatory therapy with the cultured mesenchymal stromal cells (MSC) being administered; 3) 14 patients who had standard anti-inflammatory therapy with 5-aminosalycilic acid preparations and glucocorticosteroids. The concentrations of tumor necrosis factor-α (TNF-α), interferon-γ (INF-γ), and interleukins (IL)-2, -5, -8, -12, and -15 were determined in the patients' sera before and 2 months after therapy initiation/RESULTS: The elevation in the serum levels of the proinflammatory cytokines TNF-α, INF-γ, and IL-2, -5, -8, -12, and -15 indicates their implication in the pathogenesis of ulcerative colitis and Crohn's disease. Their levels may evaluate both the activity of an inflammatory process and the efficiency of the therapy. The higher level of these cytokines is accompanied by the enhanced activity of diseases, which may be used to diagnose their activity, to predict the course of IBD, and to perform adequate therapy. The decreased level of the proinflammatory cytokines is indicative of the efficiency of the therapy in patients with IBD/CONCLUSION: By reducing TNF-α levels, infliximab therapy results in a decrease in the concentrations of other proinflammatory cytokines (IL-1, -2, -5, -8), thus lowering the inflammatory activity of IBD. MSC transplantation also reduces the level of most proinflammatory cytokines, thus diminishing the intensity of immunopathological processes, which is shown by positive changes in the clinical picture of the disease.
Terapevticheskii arkhiv. 2013;85(12):55-59
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Evaluation of the efficacy of prucalopride (resolor) in the treatment of patients with chronic constipation
Osipenko M.F., Bikbulatova E.A., Skalinskaia M.A., Kulygina I.A., Pankova L.I.
Abstract
AIM: To evaluate the efficacy of the enterokinetic prucalopride (resolor) in patients with chronic constipation. Subjects. The effect of treatment with prucalopride (resolor) in 109 patients with chronic constipation was analyzed/RESULTS: The effect was noted in 82% of the patients; 61 patients were fully satisfied with treatmen/RESULTS: Among the adverse reactions, headache that was particularly significant on the first days of use, diarrhea, and cramping abdominal pain were reported by 35, 17, and 13% of the included patients, respectively. The authors' experience with prucalopride demonstrated that the patients with chronic constipation displayed the good efficacy of the drug in both the frequency of stool and the elimination of all other constipation symptoms (straining effort, incomplete bowel emptying sensation, solid stool, bloating), and its good tolerability/CONCLUSION: Prucalopride (resolor) exerts a predictable effect, can extend a physician's capacity to arrest chronic constipation, and, when the drug is used, requires no long-term dose adjustment.
Terapevticheskii arkhiv. 2013;85(12):60-64
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Myocardial remodeling in systemic lupus erythematosus and scleroderma systematica
Shilkina N.P., Driazhenkova I.V.
Abstract
AIM: To define the significance of myocardial remodeling and its association with the activity of an inflammatory process in systemic lupus erythematosus (SLE) and scleroderma systematica (SDS)/MATERIAL AND METHODS: One hundred and sixty-seven patients, including 102 with SLE and 65 with SDS, were examined. Intracardiac hemodynamic parameters were estimated by ultrasonography on an Acuson 128 XP/10 computed sonography system, by using 3.5-MHz frequency ultrasound transducers in accordance with the standard procedure recommended by the American Echocardiography Association (1987). The Systemic Lupus Activity Measurement (SLAM) and European Consensus Lupus Activity Measurement (ECLAM) scales were used to estimate the activity of SLE and its stages in SDS/RESULTS: In patients with rheumatic diseases (RD), the spectrum of heart changes varied from latent diastolic dysfunction (DD) to the development of myocardial remodeling with signs of chronic heart failure. Examination of the types of myocardial remodeling in the patients with RD revealed all 4 geometric cardiac model types. There was a normal cardiac model in 59.2%, eccentric left ventricular (LV) hypertrophy in 18.4%, concentric hypertrophy in 19.5%, and concentric remodeling in 2.9%. In SLE, the disease activity determined the magnitude of LV hypertrophic processes (r=0.57; p=0.005) and DD (r=-0.43; p=0.023). In the patients with SDS, the high activity was also associated with LV hypertrophy (r=0.52; p=0.015), but DD was primarily determined from the duration of disease (r=-0.44; p=0.024). The patients with RD had LV DD no matter whether hypertension was present or absent/CONCLUSION: There is evidence for myocardial remodeling and intracardiac hemodynamic disorders in SLE and SDS and their association with the activity of the process.
Terapevticheskii arkhiv. 2013;85(12):65-70
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Renal anemia and cardiac remodeling in patient with chronic glomerulonephritis
Murkamilov I.T., Lunegova O.S., Kaliev R.R.
Abstract
AIM: To study the pattern of cardiac remodeling and its association with anemia in patients with chronic glomerulonephritis (CGN)/MATERIAL AND METHODS: Sixty patients aged 21 to 58 years (mean age 38.1±9.8 years) with the hypertensive form of CGN were examined. According to the presence of anemia, the patients were divided into 2 groups with 30 persons in each. All the patients underwent physical examination with verification of the diagnosis, estimation of the volume of red blood cells, and echocardiography/RESULTS: The patients with anemia as compared to those with CGN and without anemia were found to have a statistically significant increase in the left atrial size (3.6±0.6 cm versus 3.3±0.3 cm; p<0.05), left ventricular (LV) end-diastolic size (5.4±0.6 cm versus 5.1±0.4 cm; p<0.05), LV end-systolic size (3.7±0.7 cm versus 3.3±0.5 cm; p<0.05), and LV mass index (141.8±60.5 g/m2 versus 113.5±30.8 g/m2; p<0.05). Correlation analysis revealed statistically significant correlations between red blood cell levels, LV end-systolic and end-diastolic sizes and ejection fraction (EF) in the anemia group while this correlation was absent in the non-anemia group. Group 1 showed a correlation between blood pressure (BP) (mainly diastolic BP), LV sizes and wall thickness/CONCLUSION: The patients with chronic glomerulonephritis complicated with anemia exhibited LV remodeling as LV dilatation.
Terapevticheskii arkhiv. 2013;85(12):71-74
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Comparative efficacy of nitrofurans in children and adolescents with pyelonephritis in presence of crystalluria
Aver'ianova N.I., Balueva L.G., Ivanova N.V.
Abstract
AIM: To evaluate the efficacy of nitrofurans in children and adolescents with pyelonephritis in the presence of crystalluria/MATERIAL AND METHODS: The study included 50 patients aged 4-14 years with chronic pyelonephritis in the presence of dysmetabolism. The patients underwent general blood test, general urinalysis with an urocytogram, bacteriological examination of urine, biochemical test of serum (uric acid, calcium, phosphorus, magnesium, urea, and creatinine) and 24-hour urinary excretion (uric acid, oxalates, calcium, phosphorus, and magnesium) at hospital admission and over time. The treatment regimen for Group 1 patients after antibiotic therapy involved furamag, Group 2 received furagin. The drugs were used in a dosage of 2 mg/kg/day in 2 divided doses for 14 days. Complaints, major clinical manifestations, crystalluria patterns, and a number of laboratory findings were analyzed over time/RESULTS: The urinary sediment showed leukocyturia and bacteriuria in all the patients, oxaluria in 70% of the patients, uraturia in 10%, and mixed crystalluria in 20%. The main etiological agent of pyelonephritis was Escherichia coli (48.4%). Increased serum uric acid concentrations were revealed in 14% of the patients. Daily urine tests revealed hyperoxaluria, hyperuricosuria, and hypercalciuria in 86, 18, and 8% of the patients, respectively; urinary magnesium excretion was reduced in 86%. After treatment, Group 1 patients showed a more marked therapeutic effect in terms of a number of indicators (leukocyturia, crystalluria, uricosuria, magnesuria)/CONCLUSION: The results of the study showed that the antibacterial therapy involving antibiotics and nitrofurans for an exacerbation of chronic pyelonephritis in the presence of crystalluria not only provides an anti-inflammatory effect, but also leads to reductions in the level of crystalluria and the urinary content of uric acid and calcium. There was a significantly marked reduction in crystalluria, serum uric acid, and urinary oxalates and calcium in the children taking furamag. Out of nitrofurans, furamag may be recommended as the drug of choice to treat urinary tract infections in the presence of crystalluria.
Terapevticheskii arkhiv. 2013;85(12):75-78
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The burden of viral hepatitides in the Russian Federation and ways of its reduction for the long term (in case of hepatitis C)
Iushchuk N.D., Znoĭko O.O., Iakushechkina N.A., Zyrianov S.K., Shut'ko S.A., Belyĭ P.A., Kozina A.N., Chapurin S.A., Churilin I.I., Lugovskikh E.A.
Abstract
AIM: To evaluate the impact of using the innovative antiviral drugs in patients with chronic hepatitis C (CHC) on the disease burden in the long term. Materials and methods. A program was developed to increase the availability of innovative antiviral therapy (AVT) in patients with CHC covering the period from 2013 to 2020. To evaluate the impact of the program on the burden of hepatitis C (HC) in the Russian Federation, a Markov model of the disease progression was developed till 2030. Calculations were made in medical and social perspectives/RESULTS: The implementation of the program will allow to decrease the medical costs by RBL 2 billion and budget costs, including disability payments, by RBL 3.8 billion by 2030. During this period, in GDP losses will decrease by RBL 1.1 trillion and the total burden of HC taking into account the cost of the program by RBL 1 trillion/CONCLUSION: For the first time it was shown that the expanding coverage of CHC patients with innovative AVT will allow to reduce the costs of health and social services.
Terapevticheskii arkhiv. 2013;85(12):79-85
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Endothelial dysfunction markers (VCAM-1, vWF) in chronic hepatitis C
Antonova T.V., Romanova M.A., Lymar' I.V.
Abstract
AIM: To estimate the blood levels of endothelial factors (soluble vascular adhesion molecule 1 (sVCAM-1) and von Willebrand factor (vWF:Ag)) in relation to the magnitude of the biochemical, histological, and virological characteristics of chronic hepatitis C (CHC)/MATERIAL AND METHODS: The investigation enrolled 69 patients with asymptomatic CHC. The mean age of the examined was 33.6±7.8 years. Laboratory examination included a standard set of clinical and biochemical parameters for chronic hepatitides. The stage of hepatic fibrosis (HF) and the degree of histological activity were determined by the METAVIR scale based on histological examination of liver biopsy specimens, by using the calculated FibroTest (BioPredictive, France) and indirect ultrasonic liver elastometric assay (Fibroscan). The serum content of sVCAM-1 and vWF:Ag were measured by ELISA/RESULTS: Elevated sVCAM-1 and/or vWF:Ag levels were found in 33.3% of the patients with CHC. There was a significantly higher increase in blood sVCAM-1 levels in patients with cytolytic syndrome than in those with normal alanine aminotransferase activity. Particularly high sVCAM-1 levels (more than twice higher) were recorded in the CHC patients with severe HF (F3-F4) than in those with milder HF (F0-F2) (1966.98 (1299.79, 3451.73) and 975.98 (888.94, 1226.13) ng/ml (p<0.001). There were higher blood levels of vWF:Ag in the patients with severe HF (F3-F4) than in those with early-stage HF (F0-F2) - 1.61 (1.29; 1.81) and 1.31 (1.15, 1.45) U/ml; p<0.05)/CONCLUSION: In the patients with HCH, the found elevated blood sVCAM-1 and vWF:Ag levels related to the biochemical activity of hepatitis and, to a greater extent, with the degree of HF can judge the implication of endothelial dysfunction in the pathogenesis of chronic HCV infection.
Terapevticheskii arkhiv. 2013;85(12):86-89
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Investigation of Β-endorphin concentrations in patients with hemophilia
Shutov S.A., Danishian K.I., Karagiulian S.R., Gemdzhian É.G., Levina A.A., Iakovleva E.V., Zhuravlev V.V., Savchenko V.G.
Abstract
AIM: To study changes in the plasma concentration of Β-endorphin (Β-E) in patients with hemophilia A and B (in the presence of bleeding and in the absence of hemorrhagic syndrome) and in whole blood and plasma donors before and after donation and to investigate the factors associated with (Β-E) concentration changes/MATERIAL AND METHODS: The prospective study of Β-E concentration changes (and related factors) enrolled 38 persons: 12 patients with hemophilia after acute blood loss, 11 patients with hemophilia without hemorrhagic syndrome, and 15 whole blood and plasma donors. Β-E concentrations were measured by enzyme immunoassay/RESULTS: In blood loss, the patients with hemophilia were found to have elevated serum Β-E concentration: 9.6 pg/ml (95% confidence interval (CI), 6.1 to 13.0 pg/ml) versus 5.2 pg/ml (95% CI, 1.4 to 8.9 pg/ml). After donation, the concentration of Β-E in the group of donors was higher than before donation: 7.3 pg/ml (95% CI, 4.9 to 9.7 pg/ml) versus 4.7 pg/ml (95% CI, 3.2 to 6.3 pg/ml). In the group of patients with hemophilia, the elevation of Β-E concentrations is steady-state (lasted at least 10 days); at this time, the Β-E value variability (estimated by mean square deviation) increased as compared with that in remission: 7.7 pg/ml (95% CI, 5.5 to 13.1 pg/ml) versus 2.4 pg/ml (95% CI, 1.7 to 4.4 pg/ml). The above differences are statistically significant (p=0.05)/CONCLUSION: In blood loss, there is an increase in plasma Β-E concentrations in the patients with hemophilia and donors. The increase in Β-E concentrations and the variability of its values were greater in the patients with hemophilia and blood loss than in the donors. The Β-E concentration elevation accompanying hemorrhage is characterized by steadiness in the patients with hemophilia.
Terapevticheskii arkhiv. 2013;85(12):90-94
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Characteristics of stromal cell precursors in patients after allogeneic bone marrow transplantation
Petinati N.A., Shipunova I.N., Bigil'deev A.E., Kuz'mina L.A., Saribekian R.A., Gal'tseva I.V., Misiurin A.V., Parovichnikova E.N., Savchenko V.G., Drize N.I.
Abstract
AIM: To study the elements of the mesenchymal stromal cell compartment (multipotent mesenchymal stromal cells (MMSCs)) and their more mature progenies of fibroblast colony-forming units (CFU-F) in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT)/MATERIAL AND METHODS: The total production of MMSCs after 5 passages, the time of their growth, and the concentration of CFU-F in the bone marrow from patients were determined using the control sections before transplantation and over time for 2 years after allo-HSCT. What is more, the genetic affiliation of the MMSCs from the patients after allo-HSCT and their immunophenotype were studied/RESULTS: The MMSCs from the patients after allo-HSCT belong to a recipient and have the immunophenotype that meets the international standard for these cells. The total production of MMSCs in the cultures obtained from the bone marrow of the patients with hematologic diseases was decreased. Not all the samples from the patients after allo-HSCT are able to undergo 5 passages. In addition, the time of growth substantially increases and the total production of cells decreases in all the analyzed cultures. These indicators are gradually restored; however, they never achieve the mean values in donors. The concentration of CFU-F in the bone marrow from the patients are reduced as compared to that in the donors prior to transplantation and decreased still further after allo-HSCT. These cell precursors are not restored for at least 2 years following allo-HSCT/CONCLUSION: Both examined categories of the cell precursors of the stromal environment suffer from both the disease itself and allo-HSCT in the patients with hematologic diseases.
Terapevticheskii arkhiv. 2013;85(12):95-99
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Possibilities of antioxidant therapy for asthenia and cognitive deficit in elderly patients with chronic brain ischemia
Duma S.N.
Abstract
AIM: To evaluate the effect of the antioxidant mexidol on the oxidant-antioxidant potential of low-density lipoprotein (LDL), asthenic and anxious symptoms, and cognitive function of neurodynamic type in elderly patients with chronic brain ischemia (CBI)/MATERIAL AND METHODS: Thirty women (mean age 66.7 years) with grade 1-2 dyscirculatory encephalopathy (DE) were examined. Trends for asthenic, anxious, and cognitive symptoms of neurodynamic type were estimated using the standard tests (MFI-20, Hamilton Anxiety Rating Scale, Schulte Tables, Wechsler test) on days 1, 15, and 60 of mexidol treatment (for 60 days). LDLs were isolated from blood by heparin precipitation. The baseline level of lipid peroxidation products was determined and the concentrations of fat-soluble antioxidants (α-tocopherol, retinol, Β-carotene, and xanthins) were examined in the isolated LDLs on days 1 and 5 of the study/RESULTS: A 60-day mexidol therapy cycle statistically significantly caused a reduction in asthenic and anxious symptoms in elderly patients with CBI and induced positive changes in the symptoms of cognitive neurodynamics. Assessing the specific features of the pharmacodynamics of the antioxidant mexidol used in the elderly patients for 15 days revealed a statistically significant positive effect on the oxidative potential of LDLs as a decreased predisposition to their antioxidative processes in vivo. The drug's effect in elevating the levels of α-tocopherol and Β-carotene was altered insignificantly (without statistically significant changes), which reflects the pharmacodynamic features of the drug in the elderly patients/CONCLUSION: The 60-day cycle of therapy with the antioxidant mexidol has a positive impact on asthenic and neurotic symptoms in the elderly patients with CBI. Mexidol is well tolerated and safe when used long.
Terapevticheskii arkhiv. 2013;85(12):100-105
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Significance of allelic variants of interleukin-28B gene in chronic hepatitis C
Tikhonova N.I., Burnevich É.Z., Krasnova T.N.
Abstract
Chronic hepatitis C remains one of the most urgent problems of today's medicine. The review unravels the current view of the role of a single nucleotide polymorphism of the interleukin-28B (IL-28B) gene in different aspects of hepatitis C virus infection. Major attention is paid to the discussion of the value of the allelic variants of IL-28B during standard double and current triple antiviral therapy for chronic hepatitis C. Furthermore, the paper covers the biological role of interferon-λ, a product of IL-28A, B, and IL-29 gene expression, other associations of the allelic variants of the IL-28B gene with different clinical signs, as well as the possibilities of practical use of this genetic marker in chronic hepatitis C today and futures prospects.
Terapevticheskii arkhiv. 2013;85(12):106-113
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Treatment of patients with HBV cirrhosis: Successes, unsolved problems
Bakulin I.G., Khaĭmenova T.I., Sidorova I.O.
Abstract
Annually 0.5-1 million people die from terminal liver injuries or hepatocellular carcinoma, which are associated with hepatitis B virus (HBV); 5-10% of liver transplantations are performed due to the outcomes of HBV infections. All patients with liver cirrhosis in the outcome of replication-phase chronic hepatitis B need antiviral therapy. At present, there is convincing evidence for amelioration of hepatic fibrosis and cirrhosis, a reduction in the risk for the decompensation of liver function and the development of hepatocellular carcinoma, and an increase in survival rates in patients with HBV cirrhosis long treated with nucleotide analogues. Adequate selection of patients to be treated with antiviral drugs from different groups enables the most successful results and optimizes the economic costs of treatment.
Terapevticheskii arkhiv. 2013;85(12):114-118
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Prevention of heart embolic complications in atrial fibrillation: Possibilities of using rivaroxaban
Iavelov I.S.
Abstract
The review analyzes the role of atrial fibrillation concurrent with stable manifestations of coronary heart disease when novel oral anticoagulants are used. It gives the results of comparison of the efficacy and safety of warfarin and rivaroxaban in such patients in the large controlled ROCKET-AF trial.
Terapevticheskii arkhiv. 2013;85(12):119-126
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Role of the endothelin receptor antagonist bosentan in the treatment of patients with pulmonary hypertension
Tsareva N.A.
Abstract
The paper reviews current views of the problem of pulmonary hypertension. It shows the classification of pulmonary hypertension and considers the general issues of its pathogenesis, morphological changes, clinical picture, and main approaches to treating patients with pathology. Particular emphasis is placed on the review of clinical trials of the class of endothelin receptor antagonists.
Terapevticheskii arkhiv. 2013;85(12):127-136
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Mineralocorticoid receptor antagonists in the treatment of patients with heart failure after myocardial infarction and those with chronic heart failure
Tereshchenko S.N., Zhirov I.V., Osmolovskaia I.F.
Abstract
The mineralocorticoid receptor antagonists spironolactone and eplerenone have become part of standard medical therapy for heart failure (HF). Randomized clinical trials have shown the clinical efficacy of spironolactone and eplerenone, which lead to lower death rates in patients with systolic HF. Whether these two drugs are equivalent and able to exert a positive effect in patients with clinical HF, including chronic HF with retained left ventricular systolic function remains to be answered.
Terapevticheskii arkhiv. 2013;85(12):137-143
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Hypoglycemia in patients with type 2 diabetes mellitus: Safe solution of the dangerous problem
Shestakova M.V., Khalimov I.S.
Abstract
The review gives detailed information on the state-of-the-art of hypoglycemia (HG) and the results of its Russian and international trials. It is noted that HG should be now regarded as an extremely undesirable glucose-lowering therapy complication that is closely related to the risk of cardiovascular events and higher mortality rates, worse glycemic control, and poorer quality of life in patients with type 2 diabetes mellitus (T2DM). The priority effective therapy tactics for T2DM is to manage the latter without any risk of HG, which can be implemented by the wide clinical application of incretins, dipeptidyl peptidase-4 inhibitors in particular, which have the glucose-lowering activity comparable with that shown by metformin and sulfonylurea drugs, are practically safe when used as monotherapy and significantly enhance the efficiency of therapy without substantially increasing the risk of severe HG when co-administered with other medications.
Terapevticheskii arkhiv. 2013;85(12):144-150
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