Vol 86, No 1 (2014)

Articles
The contribution of current investigations to understanding the nature of type 2 diabetes mellitus, and treatment perspectives
Ametov A.S.
Abstract
The paper discusses the key issues of modern diabetology: a concept of pathogenesis, genetic aspects, novel drugs and devices for the therapy of diabetes mellitus, and its treatment perspectives.
Terapevticheskii arkhiv. 2014;86(1):4-9
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Estimation of immune response parameters in patients with frequent premature ventricular contractions without signs of organic pathology of the cardiovascular system
Rogova M.M., Mironova N.A., Malkina T.A., Kuznetsova T.V., Rvacheva A.V., Agafonov V.E., Zykov K.A., Deev A.D., Masenko V.P., Golitsyn S.P.
Abstract
Aim. To study the specific features of an immune response and the role of infectious pathogens in the occurrence, development, and maintenance of ventricular ectopic activity in patients without signs of organic disease of the cardiovascular system (CVS). Subjects and methods. The investigation enrolled 91 patients (27 men and 64 women with a mean age of 36.5±11.5 years) with premature ventricular contractions (PVC) without signs of organic CVS pathology. A control group comprised 31 healthy volunteers. In addition to standard physical examination, a study of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cellular and humoral immune parameters was performed and the serological and molecular genetic markers of infections were determined in all the patients. Results. The persons with PVC, as compared to the control group, were recorded to have a higher NT-proBNP level (49.2 pg/ml versus 25.4 pg/ml; p=0.001) accompanied by an increase in both the total number of PVC and the number of coupled PVC and the episodes of ventricular tachycardia. They were also found to have elevated CD3+HLA-DR+ (2.4% versus 1.56%) and CD3+CD95+ (27.6% versus 18.8%) counts (p=0.001). In patients with a C-reactive protein level of more than 2 mg/l, the total number of PVC was larger than that in the other patients (p=0.065). The patients with PVC did not show a statistically significant difference from the controls in the levels of antiviral and antibacterial antibodies. The people with PVC displayed a number of relationships between the infectious pathogen antibody titers and the ECG Holter monitoring and echocardiography readings. Conclusion. In the patients with PVC without signs of organic CVS pathology, the parameters of an immune response were not different from those obtained in the control group, which was likely to be associated with the involvement of the immune system in the development and maintenance of ventricular arrhythmias.
Terapevticheskii arkhiv. 2014;86(1):10-17
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The clinical manifestations of atherosclerosis in familial hypercholesterolemia
Korneva V.A., Kuznetsova T.I., Mandel'shtam M.I., Konstantinov V.O., Vasil'ev V.B.
Abstract
Aim. To study the specific features of manifestations of atherosclerosis in Karelia dwellers with familial hypercholesterolemia (FH). Subjects and methods. The examination of 196 patients with FH involved laboratory tests, electrocardiography, echocardiography, triplex scanning of the arteries, exercise testing, and coronarography as indicated. Genetic examination was performed in 109 (55.6%) patients. Results. The examinees' mean age was 48±2.3 years; there was a female predominance (68.7%). All the patients were found to have significant hypercholesterolemia due to elevated low-density lipoprotein levels. There was arcus lipoides corneae in 26% of cases, tendinous xanthomas in 17%, and xanthelasma palpebrarum in 34.9%. Carotid stenosis and lower extremity atherosclerosis obliterans were detected in 26.3 and 4.6%, respectively. 27.5% of the patients were diagnosed with coronary heart disease (CHD) (mean age at onset 45 years): exertional angina pectoris (10.2%), acute myocardial infarction (AMI) (14.8%), and an arrhythmic form (5.6%). 65.5% of the patients who had developed the first AMI were aged younger than 55 years. The most common site of AMI was the anterior wall of the left ventricle (55%); 51.7% of cases had transmural AMI. 24.1% of the patients sustained recurrent AMI. Complicated AMI was noted in 13.8% of cases. One third of the patients could achieve target blood lipid levels. Conclusion. The characteristics of the patients with FH in Karelia are a mean age of 48 years and a female predominance; the main criterion for the diagnosis of FH is significant dyslipidemia while its stigmas are rarely encountered. The specific features of CHD in the patients with FH are as follows: the age at onset is 45 years; AMI develops at the ages of less than 55 and 40 years in 65.5 and 26.3%, respectively; the rate of recurrent AMI is as high as 24%; transmural AMIs occur in 51.7% of the patients; 26.3% had signs of brachiocephalic artery stenotic lesion; 4.6% present with lower extremity atherosclerosis obliterans; one third of the patients could achieve target blood lipid levels.
Terapevticheskii arkhiv. 2014;86(1):18-22
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A home exercise training program after acute coronary syndrome and/or endovascular coronary intervention: efficiency and a patient motivation problem
Bubnova M.G., Aronov D.M., Krasnitskiĭ V.B., Ioseliani D.G., Novikova N.K., Rodzinskaia E.M.
Abstract
AIM: To analyze the impact of a home exercise training (ET) program on quality of life, motor activity (MA), dietary habit, functional and biochemical parameters, and clinical course of the disease in patients who have experienced acute coronary syndrome (ACS) and/or endovascular coronary intervention (ECI). Subjects and method. The trial included 100 patients after ECI who were randomized into 2 groups: those who had gone through Patient School (PS) and received a 6-week course of controlled ET (a study group (Group S)) and those who had gone through PS only (a control group (Group C). The patients of both groups were recommended a home ET program and, according to its implementation, they formed 2 subgroups: Subgroup A (home ET+) comprising 51 patients who had trained themselves at home) and Subgroup B (home ET-) consisting of 46 patients who had not. The follow-up lasted 1 year. Quality of life, risk factors, lifestyle and clinical parameters were assessed/RESULTS: As time elapsed, the patients' motivation to perform home ET; and, accordingly, the proportion of those who had trained themselves decreased in Group S to 67 and 61% and in Group C to 39 and 40% after 6 and 12 months, respectively. Among the reasons for refusal to perform home ET, disease was reported by only 5.6% of the patients (by all from Group C). The comprehensive physical rehabilitation program (RP) (controlled ET in combination with home ET) produced the best effect in raising the level of daily MA, exercise performance with a 21.3-fold increase in cardiac performance (p<0.05) and a 14.3-fold decrease in heart rate increment in response to exercises. Group C patients who had refused the home ET program, as compared to those in the same group who had trained themselves at home, showed the worst daily MA levels, none body mass index reduction, and a rise in the low-density lipoprotein cholesterol (by 20.3%; p<0.05) and in the number of angina attacks (by 1.9 times; p<0.05)/CONCLUSION: RP in the early-stage, which encompasses an educational program (PS), a short-term course of controlled ET and home ET used in patients with ACS, including in those after ECI, has clear clinical benefits. The participation of patients with coronary heart disease (CHD) in the home ET programs increases their motivation and, hence, the proportion of those who participate in therapeutic and rehabilitation measures. Home patient physical rehabilitation is one of the important components of different rehabilitation and prevention programs in patients with CHD after ACS and ECI.
Terapevticheskii arkhiv. 2014;86(1):23-32
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The course of coronary heart disease concurrent with peptic ulcer disease: Clinical and pathogenetic aspects
Simonova Z.G., Martusevich A.K., Tarlovskaia E.I.
Abstract
AIM: To make a comprehensive evaluation of the efficiency of eradication therapy in patients with coronary heart disease (CHD) concurrent with peptic ulcer disease (PUD)/MATERIAL AND METHODS: The results of treatment were studied in 112 patients with CHD concurrent with PUD who were randomized into 3 groups: 1) adequate eradication therapy during treatment for CHD; 2) antisecretory therapy; 3) treatment for CHD only. The trend in the clinical symptoms of the diseases and the results of an exercise test were assessed/RESULTS: After eradication therapy, Group 1 patients displayed a reduction in the frequency of angina attacks by 62.6% and weekly nitroglycerin needs by 70.4% and an increase in exercise tolerance by 45.3%. In Group 2 patients on antisecretory therapy, the similar indicators changed by 30.7, 21.2, and 26.5%, respectively. Group 3 patients showed no significant change in the study indicators/CONCLUSION: The findings suggest that eradication therapy has a positive impact on the course of CHD, which manifests itself as an antianginal effect and hence a change in the clinical picture.
Terapevticheskii arkhiv. 2014;86(1):33-36
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Prognostic factors for progression of mitral regurgitation in patients with coronary heart disease after aortocoronary bypass surgery alone and in combination with surgical left ventricular reconstruction
Buziashvili I.I., Koksheneva I.V., Khutsurauli E.M., Asymbekova É.U., Shakhnazarian L.S., Abukov S.T.
Abstract
AIM: To identify risk and prognostic factors for mitral regurgitation (MR) progression after aortocoronary bypass surgery (ACBS) alone and in combination with surgical left ventricular (LV) reconstruction/MATERIAL AND METHODS: Data on 101 patients with coronary heart disease who had undergone surgical treatment: ACBS alone in 57 (56%) patients and that in combination with surgical LV reconstruction in 44 (44%)/RESULTS: In the late periods after ACBS alone, there was reduced or no MR in 18% of the patients; no substantial changes in MR in 52%, the latter being moderate; progression to significant mitral insufficiency (MI) in 30%. In the same periods after ACBS in combination with surgical LV reconstruction, there was a reduction in MR to its minimum or complete absence in 14% of the patients; no substantial change in the degree of MR in 54%, and progression to significant MI in 32%. The prognostic factors of MI progression after ACBs alone and in combination with surgical LV reconstruction were a more than 32-mm fibrous ring of the mitral valve (MV) (χ2=11.62; р=0.0001); a LV sphericity index of more than 0.65 cm (χ2=3.38; р=0.06); a myocardial scar lesion extent of more than 30% of the LV segments (χ2=4.7; р=0.03); a myocardial reserve of less than 25% (χ2=3.1; р=0.07) (when taking low-dose dobutamine)/CONCLUSION: Myocardial revascularization should be combined with MV intervention in patients with moderate MR and risk factors for its progression, such as significant LV remodeling (LV sphericity index of more than 0.65 cm), extensive LV scar lesion (more than 30% of the segments), a low myocardial reserve (less than 25%) during dobutamine test, and a MV fibrous ring of more than 32 mm).
Terapevticheskii arkhiv. 2014;86(1):37-44
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Adipokines and the metabolism of key nutrients in patients with obesity
Kirillova O.O., Vorozhko I.V., Gapparova K.M., Chekhonina I.G., Sentsova T.B., Tutel'ian V.A.
Abstract
AIM: To study the effect of adipokines on the metabolism of key nutrients in patients with obesity/MATERIAL AND METHODS: Ninety patients aged 18 to 66 years old who were treated at the Department of Preventive and Rehabilitative Nutrition, Research Institute of Nutrition, Russian Academy of Medical Sciences, were examined. Carbohydrate and lipid metabolisms were assessed by turbidimetry and spectrophotometry. The levels of adipokines, insulin, and oxidized low-density lipoproteins (LDL) were measured by ELISA. Insulin resistance was assessed with HOMA-IR in all the patients/RESULTS: It was found that there were discoordinated changes in the content of adipokines. The patients with Grade 1 obesity, as compared to the control group, had a statistically significant decrease in the serum concentrations of adiponectin (5.94±0.90 and 15.34±0.45 µg/ml; p<0.05) and ghrelin (215.50±104.50 and 540.67±0.76 pg/ml; (p<0.05) and resistin levels above the normal values (7.34±1.24 and 5.12±0.22 ng/ml; р<0.05; respectively). There was an inverse correlation between the content of adiponectin and ghrelin, and body mass index in obese patients (r1=-0.25, r2=-0.15; p<0.05). There was evidence that there was also an inverse correlation between the levels of adiponectin, triglycerides, LDL, particularly oxidized LDL (p<0.05). Adipokine-induced insulin resistance appeared as increases in the concentrations of glucose, insulin, and HOMA-IR, as compared to those in the control group/CONCLUSION: A comprehensive approach to evaluating metabolic disorders and adipokine synthesis in obese patients makes it possible to optimize the diagnosis of type 2 diabetes mellitus and cardiovascular diseases and to personalize diet therapy.
Terapevticheskii arkhiv. 2014;86(1):45-48
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Association of leptin with obesity and hypertension in an ethnic Kyrgyz group
Kerimkulova A.S., Lunegova O.S., Mirrakhimov A.É., Alibaeva N.T., Neronova K.V., Baĭramukova A.A., Mirrakhimov É.M.
Abstract
AIM: To study an association of the level of leptin, obesity, and hypertension in a group of ethnic Kyrgyz/MATERIAL AND METHODS: Three hundred and twenty-two Kyrgyz people (145 men and 177 women) who were aged above 30 years and resided in the Kyrgyz Republic were examined. They underwent physical examination involving the collection of complaints and medical history data, objective examination, and anthropometric (height, weight, waist and hip circumference (WC and HC), body mass index (BMI)) and blood pressure (BP) measurements. The persons filled out the Finnish Diabetes Risk Assessment Form including data on vegetable consumption (daily or every other day) and exercise (more or less than 30 min per day). Fasting plasma glucose and serum leptin levels were determined/RESULTS: All the study participants were allocated to 4 groups according the quartile of leptin levels: <2.2, 2.2-4.2, 4.3-6.34, and >6.34 ng/ml for men and <8.05, 8.05-13.4; 13.5-19.09, and >19.09 ng/ml for women. The persons in the highest leptin quartile were found to have higher BMI, WC, systolic and diastolic BP (SBP and DBP), and blood glucose levels than those in the lowest quartile. Elevated leptin levels were associated with the higher risk of hypertension. Leptin levels correlated with BMI (r=0.719; p<0.001 for men and r=0.74; p<0.001 for women) and WC (r=0.684; p<0.001 for men; and r=0.649; p<0.001 for women). There was also a correlation of leptin levels with SBP (r=0.355; p<0.001 and r=0.277; p<0.001) and DBP (r=0.426; p<0.001 and r=0.228; p<0.01) in men and women, respectively/CONCLUSION: Leptin levels were associated with obesity and hypertension in the group of ethnic Kyrgyz people.
Terapevticheskii arkhiv. 2014;86(1):49-53
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Role of pFox inhibitors in the treatment of patients with acute myocardial ischemia
Statsenko M.E., Turkina S.V., Shilina N.N.
Abstract
AIM: To evaluate the anti-ischemic and anti-anginal efficacy of meldonium (Idrinol) in its short-term use as part of combination therapy in patients with chronic heart failure in the early post-infarction period/MATERIAL AND METHODS: The investigation enrolled 60 patients (men and women) aged 45 to 75 years at weeks 3-4 after post-myocardial infarction with symptoms of Functional Class II-III heart failure. All the patients underwent physical examination, 24-hour ECG monitoring, heart rate variability (HRV) study, and quality of life assessment using the Seattle questionnaire. After randomization of the patients into 2 groups, Group 1 (a study group) (n=30) was given intravenous Idrinol 1000 mg/day in addition to the basic therapy of coronary heart disease. The study and control (Group 2; n=30) groups were matched for age, gender, disease severity, and basic therapy pattern/RESULTS: Following 10-14 days of treatment, both groups showed clinical improvement and the autonomically normalizing effect of meldonium (Idrinol), which were more pronounced in Group 1 patients/CONCLUSION: Meldonium (Idrinol) was effective when parenterally administered in a dose of 1000 mg/day for 10-14 days as part of combination therapy in the early post-infarction period, which showed up as clinical improvement, a significant reduction in the frequency of angina attacks and in the need to use nitroglycerin, a decrease in the number of arrhythmia episodes, and its normalizing effect of HRV.
Terapevticheskii arkhiv. 2014;86(1):54-59
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Current possibilities of correcting subchondral bone resorption as a major pathogenetic factor for progressive osteoarthrosis
Naumov A.V.
Abstract
The paper considers the current pathogenesis, by choosing the actual targets of pharmacotherapy with available drugs. It reflects the cytokine mechanisms responsible for lesion of the synovial membranes, cartilage, and subchondral bone. Particular emphasis is laid on the role of chondroitin sulfate, glucosamine, vitamin D3 as drugs that affect the key components of pathogenesis, including the volume of resorptive cavities in the subchondral bone.
Terapevticheskii arkhiv. 2014;86(1):60-65
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Creation of a Russian Federation's register for assessing the physician adherence to the guidelines for the diagnosis and treatment of chronic heart failure
Oshchepkova E.V., Lazareva N.V., Satlykova D.F., Tereshchenko S.N.
Abstract
The paper reviews existing chronic heart failure (CHF) registers, a number of randomized trials, and meta-analyses on CHF. It provides a rationale for the need to create a CHF register in the Russian Federation, which will be able to assess the physician adherence to the guidelines for the guidelines for and the quality of medical care.
Terapevticheskii arkhiv. 2014;86(1):66-70
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Role of atrial structural and functional changes in the development and progression of atrial fibrillation
Aparina O.P., Chikhireva L.N., Mironova N.A., Mironova E.S., Bakalov S.A.
Abstract
Atrial fibrillation (AF) is one of the most common reasons for decreased life quality and increased mortality rates. Experimental and clinical data show that atrial structural and functional changes contribute to the development and progression of AF. The survey article considers the role of the systemic and local activities of the renin-angiotensin-aldosterone system and inflammatory mediators in the development of atrial structural remodeling, which may be a cause and a consequence of AF.
Terapevticheskii arkhiv. 2014;86(1):71-77
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Peroxisome proliferator-activated receptors-alpha (PPAR-α) and chronic heart failure: Is there a reason to discuss the metabolic strategy of treatment?
Zhirov I.V., Zaseeva A.V., Masenko V.P., Tereshchenko S.N.
Abstract
Despite improved prognosis in patients with heart failure (HF) treated with neurohumoral activation-suppressing drugs (such as angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, Β-adrenergic receptor antagonists, aldosterone receptor antagonists), mortality from heart failure remains high, myocardial contractile dysfunction progresses, and the left ventricle becomes enlarged. This leads to the need to elaborate novel approaches to treating HF. The latter is obviously due to impaired myocardial energy substrate metabolism. The mechanisms underlying this phenomenon are numerous and complex. These include reduced myocardial expression and activity of key free fatty acid oxidative enzymes. The expression of these enzymes is controlled by peroxisome proliferator-activated receptors-α (PPAR-α). Thus, PPAR-α activation is a direct method to regulate myocardial fatty acid metabolism. Evidence for the efficiency of therapeutic strategies based on the fact that fatty acid metabolism may be modulated is controversial, which indicates that there may be more complex molecular/biochemical changes than supposed before. The data available in the literature suggest the promises of the above strategy and its serious therapeutic potential.
Terapevticheskii arkhiv. 2014;86(1):78-82
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The therapeutic efficacy of cycloferon and the pharmacological activity of interferon inhibitors
Romantsov M.G., Ershov F.I., Kovalenko A.L., Belova O.G.
Abstract
The review describes endogenous interferon inductors that belong to antiviral drugs and contain different chemical compounds. Among the groups identified by the authors, there are promising and most effective medicines inducing different types of interferon in the body, as well as their mechanism of action. The paper shows the synthesis of endogenous interferon and the level of its accumulation in the organs and tissues. The clinical effects of methylglucamine acridonacetate (cycloferon) are depicted in patients with major viral (influenza, acute respiratory viral and arboviral infections, and viral hepatitis) and bacterial (brucellosis, tuberculosis) infections, or endometrial hyperplastic processes. Cycloferon is shown to be used as an etiotropic and antipathogenic drug.
Terapevticheskii arkhiv. 2014;86(1):83-88
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Some aspects of the treatment of adult patients with Epstein-Barr virus infection
Iushchuk N.D., Shestakova I.V.
Abstract
The review analyzes the basic aspects of treatment policy in patients with different forms of Epstein-Barr virus infection. Practical recommendations are given on the basis of the extensive literature data published in the past 20 years.
Terapevticheskii arkhiv. 2014;86(1):89-94
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The significance of natriuretic peptides in the evaluation of water-salt metabolism in chronic kidney disease
Pulin A.A., Kustova T.I., Fomin V.V., Mukhin N.A.
Abstract
The paper discusses the molecular, biochemical, and physiological properties of natriuretic peptides, including the clinical applications of their synthetic formulations, as well as the renal and extrarenal mechanisms of water-salt metabolism in chronic kidney disease.
Terapevticheskii arkhiv. 2014;86(1):95-102
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Pain treatment in patients with hemophilia
Levchenko O.K.
Abstract
Pain in patients with hemophilia is an urgent problem. The possibilities of using analgesic drugs are interesting by virtue of the specific features of pain syndrome and the problems of treatment in these patients. Foreign and Russian trials using current analgesics are analyzed; difficulties in choosing analgesic therapy and in performing anesthesia mode in patients with congenital hypocoagulation and hyperalgesia are discussed.
Terapevticheskii arkhiv. 2014;86(1):103-106
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Burning mouth syndrome (glossalgia)
Maksimova M.I., Sineva N.A., Vodop'ianov N.P., Suanova E.T.
Abstract
Burning mouth syndrome (glossalgia) is manifested by oral pin and tingling sensations, numbness and even burning and severe pains, more frequently in the tongue. Unpleasant sensations may involve the anterior two thirds of the tongue or be extended to the front part of the hard palate and the mucous membrane of the lower lip. This condition is characterized by "mirror" and "food dominant" symptoms, disordered salivation, dysgeusia, or psychological disorders. The disease shows a chronic course. Its etiology may be multifactorial. There are no universally accepted diagnostic criteria; the diagnosis of glossalgia is made to rule out all other causes. A thorough examination should be conducted to establish a differential diagnosis. Glossalgia occurs primarily in middle-aged and elderly people. Women get sick much more frequently than men of the same age. Glossalgia remains difficult to treat. Continuous symptomatic treatment and follow-up help relieve its symptoms.
Terapevticheskii arkhiv. 2014;86(1):107-110
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