Vol 86, No 3 (2014)

Articles
Biological markers of respiratory diseases
Chuchalin A.G.
Terapevticheskii arkhiv. 2014;86(3):4-13
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New-onset chronic obstructive pulmonary disease and its clinical significance in patients with ST-segment elevation myocardial infarction
Polikutina O.M., Slepynina I.S., Bazdyrev E.D., Karetnikova V.N., Barbarash O.L.
Abstract
AIM: To estimate the prevalence of new-onset chronic obstructive pulmonary disease (COPD) and its clinical significance in patients with ST-segment elevation myocardial infarction (STEMI) on an electrocardiogram/MATERIAL AND METHODS: The trial enrolled 154 patients with STEMI who underwent external respiratory function examination with a bronchodilatation test, as well as body plethysmography. The level of high-sensitivity C-reactive protein (CRP) was determined 10-14 days after the onset of clinical manifestations of STEMI/RESULTS: Thirty-four (22%) of the 154 patients were known to have a history of COPD. Our examination was first to reveal irreversible postbronchodilatation airway obstruction and to diagnose COPD in 24 (20%) of 120 patients having no evidence of lung pathology in the history. All patients with new-onset obstructive pulmonary disease had varying degrees of respiratory symptoms before this hospitalization; however, they did not seek medical advice. The patients with STEMI concurrent with COPD were recorded to have lower diffusing lung capacity, higher CRP levels, more frequent recurrences of myocardial infarction, early postinfarction angina, but the incidence rate of pneumonia in in-hospital myocardial infarction achieved significant differences/CONCLUSION: The trial has disclosed that screening spirometry should be performed to detect COPD in patients with ischemic lung disease, which will be able to reduce the risk of complications and to improve prognosis in this patient group.
Terapevticheskii arkhiv. 2014;86(3):14-19
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Biochemical markers of endothelial dysfunction in chronic obstructive pulmonary disease concurrent with hypertensive disease or coronary heart disease
Akhmineeva A.K.
Abstract
AIM: To evaluate the vascular endothelium in patients with cardiopulmonary disease, by studying the levels of endothelin-1 (ET-1) and C-type natriuretic peptide (CNP)/MATERIAL AND METHODS: Examinations were conducted in 212 dwellers of the Astrakhan Region, including 40 patients with chronic obstructive pulmonary disease (COPD) concurrent with hypertensive disease (HD), 40 patients with COPD concurrent with coronary heart disease (CHD), 27 somatically healthy individuals, 35 patients with Stage II HD, 35 patients with Functional Classes II and III CHD, and 35 patients with moderate and severe COPD/RESULTS: The patients with COPD concurrent with HD and CHD were found to have endothelial dysfunction manifesting itself in the overproduction of ET-1 and CNP. The level of CNP was statistically significantly higher in the COPD + HD group than in the HD and COPD groups whereas in the COPD + HD group the level of ET-1 remained comparable to that in the COPD and HD groups. This indicates that CNP is a more sensitive indirect marker of endothelial dysfunction and that nitric oxide deficiency is aggravated in the concurrence of COPD and HD as compared to a mononosological entity (HD, COPD)/CONCLUSION: The concurrence of COPD and CHD is more unfavorable for the development and severity of endothelial dysfunction, which may lead to mutual aggravation syndrome, the rapider progression of the diseases, and the increased frequency of complications.
Terapevticheskii arkhiv. 2014;86(3):20-23
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Cardiac comorbidity in patients with chronic obstructive pulmonary disease: Diagnosis and economics
Akramova É.G., Khamitova R.I.
Abstract
AIM: To provide a clinical and economic rationale for the comprehensive examination of patients with chronic obstructive pulmonary disease (COPD), by using functional and ultrasound methods for the early detection of cardiac comorbidity/MATERIAL AND METHODS: Three hundred and sixteen patients (33 with COPD, 44 with COPD + hypertension, 73 with COPD + coronary heart disease (CHD), 36 with hypertension, 50 with CHD, 19 with asthma, and 28 with asthma + hypertension) and 33 apparently healthy individuals were examined using 611 indicators obtained directly or by calculation during echocardiography, carotid artery duplex scanning, and 24-hour electrocardiographic (ECG) and blood pressure (BP) monitoring/RESULTS: Cardiovascular diseases develop in patients with COPD in its early stages. In cardiac comorbidity, the length of hospital stay increases by 1-1.5 days in patients with COPD; the number of people admitted to hospital more than once every 3 years rises from 14 to 28%; the cost of a pharmacotherapy cycle is 1.35- and 2.95-fold higher when COPD is concurrent with hypertension and CHD, respectively/CONCLUSION: In addition to ECG and spirometry, the management standard for patients with COPD should include echocardiography, 24-hour ECG and BP monitoring, and, according to thei/RESULTS: carotid artery duplex scanning.
Terapevticheskii arkhiv. 2014;86(3):24-27
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The clinical aspects of efficiency of the prevention of pneumococcal infection with vaccines in chronic obstructive pulmonary disease patients living in the West Siberian Region
Kostinov M.P., Ryzhov A.A., Magarshak O.O., Zhirova S.N., Protasov A.D., Erofeev I.V., Migunova O.V., Tolokonnikova I.N., Liverko E.V.
Abstract
AIM: To evaluate the impact of vaccination against pneumococcal infection on the clinical aspects of the underlying disease in patients with chronic obstructive pulmonary disease (COPD)/MATERIAL AND METHODS: The study conducted in the West Siberian Region (Omsk and Tyumen) enrolled 200 COPD patients aged 30 to 55 years, of whom 50 people in each city were vaccinated with Pneumo 23, as well as 50 unvaccinated persons in each city formed a comparison group. Physical examination, questionnaire survey, and medical history data collection were made during a year before vaccination and after it. Changes in the number of COPD exacerbations, hospital admissions, and disability days were compared in the groups of Pneumo 23-vaccinated and unvaccinated patients/RESULTS: In Pneumo 23-vaccinated patients with COPD, the number of its exacerbations, hospital admissions, and disability days within a year of starting the study were fewer than in the unvaccinated patients, with the more effect being seen in the Omsk dwellers, which had a beneficial effect on the clinical state of the vaccinated/CONCLUSION: Incorporation of pneumococcal vaccine along with antirecurrent, standard therapy may serve as one of the tools to alleviate COPD.
Terapevticheskii arkhiv. 2014;86(3):28-33
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The features of risk factors, systemic inflammation, and endothelial dysfunction in patients with asthma concurrent with coronary heart disease
Belan O.V., Kaĭdashev I.P., Borzykh O.A.
Abstract
AIM: To identify risk factors (RFs), to evaluate the impact of systemic inflammation and endothelial dysfunction on the development of asthma concurrent with coronary heart disease (CHD), and to determine the degree of control of the disease/MATERIAL AND METHODS: The clinical trial included 50 asthmatics aged 40-75 years with CHD. All the patients underwent external respiratory function (ERF) test, ECG, blood pressure and anthropometric measurements, and bicycle ergometry. Their medical and allergy history data were collected and RFs and basic therapy were assessed. Laboratory blood and urine values and endothelial function were estimated determining the brachial artery diameter and the time-averaged maximal linear velocity (TAMX) of blood flow in endothelium-dependent and endothelium independent vasodilation (VDV and VIDV)/RESULTS: The development of asthma in the presence of CHD was found to be associated with RFs, such as female gender (66%), hereditary asthma (40%) and CHD (76%), hypertension (86%), obesity (42%), smoking (7%), occupational exposures (20%), and dyslipidemia. Laboratory tests in the asthmatic patients with CHD revealed a positive C-reactive protein reaction (CRP) in 16 (32%) patients and increased serum cholesterol levels. Reactive hyperemia and nitroglycerin tests in the patients with asthma concurrent with CHD showed that the BA diameter was significantly increased up to 4.27±0.3 and 4.54±0.03 mm, respectively, as compared to the baseline values (p<0.01). Most patients were observed to have marked and frequent symptoms of the disease, frequent asthma exacerbations, and impaired ERF and to need "rescue" bronchodilators/CONCLUSION: RFs, such as female gender, family history, hypertension, obesity and dyslipidemia play an important role in the development of asthma concurrent with CHD. Impaired TAMX, VDV, and VIDV, hypercholesterolemia and higher CRP levels were detected. Basic therapy in the patients with asthma concurrent with CHD was not optimal or rather effective since disease control was not achieved in 70% of the patients.
Terapevticheskii arkhiv. 2014;86(3):34-39
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Possibility of achieving and maintaining asthma control in patients with bronchial cold hyperreactivity
Kolosov V.P., Pirogov A.B., Perel'man I.M., Mal'tseva T.A., Prikhod'ko A.G.
Abstract
AIM: To evaluate the clinical efficiency of tactics to widen the scope of monotherapy with inhaled glucocorticosteroids (IGCS) in asthmatic patients with bronchial cold hyperreactivity (BCHR) during winter to achieve control of the disease in real clinical practice/MATERIAL AND METHODS: An open-label longitudinal study was conducted in a cold period in 106 asthmatics divided into 2 groups: 1) those with BCHR and 2) those with unchanged bronchial reactivity to a cold stimulus. The study involved monitoring the symptoms by the asthma control test, peak expiratory flow rate (PEFR), and spirometry results before and after cold bronchoprovocation testing; assessment of the pattern of bronchial inflammation from the ratios of induced sputum (IS) cell populations; and estimation of the number of asthma exacerbations and emergency care recourses. Group 1 used a stepwise increase of the scope of basic therapy with beclomethasone dipropionate 1000 µg/day until asthma control was achieved, which was followed by the therapy with the stable dose. Group 2 received monotherapy with beclomethasone dipropionate as the stable dosage of ≥500 µg/day/RESULTS: After the first 12 weeks of a follow-up, Group 1 showed the most marked positive changes in the intensity of clinical symptoms, forced expiratory volume in one second, and PEFR that remained within the following 12 weeks during the continued therapy with the stable dose of the drug. A preponderance of the eosinophilic and neutrophilic pattern of inflammation was seen in the patients of this group. By the end of the study, there was a decline in the number of IS inflammatory cells. A discriminant model was developed as a tool to predict asthma control achievement in patients with BCHR/CONCLUSION: A stepwise increase in the scope of IGCS monotherapy in asthmatic patients with BCHR during winter can yield the results of disease control and the incidence of exacerbations, which are similar to those seen in asthmatics with no signs of BCHR (53 and 49%, respectively).
Terapevticheskii arkhiv. 2014;86(3):40-44
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Clinical manifestations of Legionella pneumonia in hematology patients
Galstian G.M., Kostina I.É., Katrysh S.A., Kliasova G.A., Karpova T.I., Tartakovskiĭ I.S.
Abstract
AIM: To detect the most common clinical manifestations of Legionella pneumonia (LP) in immunocompromized patients/MATERIAL AND METHODS: Clinical manifestations, the results of investigation of bronchoalveolar lavage fluid (BALF) and urine, and the data of lung computed tomography (CT) were studied in patients with blood system diseases and acute respiratory failure (ARF)/RESULTS: The diagnosis of LP was verified in 8 (10.5%) of 76 patients with blood system diseases and ARF. The disease manifested as fever, higher concentrations of inflammatory markers (procalcitonin, fibrinogen), ARF, hypoxemia, and infiltrative lung injury. Six of the 8 patients were switched to mechanical ventilation. Lung CT showed no pathognomonic signs. Five of the 8 patients were observed to have renal dysfunction. The diagnosis of LP was made on the basis of the results of BALF examination in 7 patients and urinary antigen detection in 1. The disease was caused by Legionella pneumophila serogroup 1 in 3 patients and by L. pneumophila of other serogroups in the other patients. Therapy with respiratory fluoroquinolones was performed in 5 patients. Three patients died from progressive ARF and hypoxemia. BALF results were obtained after their death and therapy for legionellosis was not initiated/CONCLUSION: The incidence of LP is 10.5% in hematology patients. The clinical manifestations of legionellosis are nonspecific; its diagnosis requires bacteriological and/or serological evidence. Due to the high risk of death, it is reasonable to preuse respiratory fluoroquinolones or macrolides in immunocompromized patients with progressive ARF and suspected Legionella pneumonia before diagnosis.
Terapevticheskii arkhiv. 2014;86(3):45-52
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Clinical manifestations of anemia syndrome and its significance in the course of chronic heart failure in elderly patients
Larina V.N., Bart B.I.
Abstract
AIM: To define the practical significance of anemia in the course of chronic heart failure (CHF) in elderly outpatients/MATERIAL AND METHODS: One hundred and sixty-four patients aged 60 to 85 years with NYHA classification Functional Class (FC) II-IV CHF due to coronary heart disease and arterial hypertension were examined. Clinical, laboratory, and echocardiographic parameters were assessed; admissions and fatal outcomes were recorded. The follow-up was 2.5±2.1 years/RESULTS: Anemia syndrome was recorded in 32.9% of the patients (women were 43.5% and men were 26.5%) (p=0.024). There was an association between decreased hemoglobin levels and renal dysfunction (odds ratio (OR) 2.04; 95% confidence interval, 1.05 to 3.98; p=0.036). In all the patients, anemia was mild and similar in its pattern and etiology, regardless of gender. Because of decompensated CHF, 46.3% of the patients with anemia and 22.7% of those without this condition were admitted to hospital (p=0.002). The survival rates of the elderly CHF patients with and without anemia were equal (p=0.549); however, comparison of only the patients with anemia showed a difference in male and female survival rates (p=0.005). FC III-IV CHF (OR 4.37), chronic kidney disease (OR 2.27%), and a left ventricular ejection fraction of <35% (OR 2.74) were predictors of a poor outcome in the elderly patients with CHF and anemia/CONCLUSION: Anemia was encountered in 32.9% of the elderly outpatients with CHF. Anemia was more common in the women than in the men and mild and similar in its pattern and etiology, regardless of gender. The disease prognosis was more favorable in the females than in the males.
Terapevticheskii arkhiv. 2014;86(3):53-58
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Hemostasiological, lipidemic, and hemodynamic indicators associated with the risk of cardiovascular death in high- and very high-risk patients according to the SCORE scale
Kachkovskiĭ M.A., Simerzin V.V., Rubanenko O.A., Kirichenko N.A.
Abstract
AIM: To identify lipidemic, hemostasiological, and hemodynamic indicators associated with the risk of cardiovascular death in high- and very high-risk patients/MATERIAL AND METHODS: One hundred and forty-eight patients whose mean age was 50.8±4.4 years were examined. All the patients were divided into high (1 group) and very high (2 group) cardiovascular death risk groups according to the SCORE scale. Lipid metabolism, hemostatic system parameters (fibrinogen, time of ADP-induced platelet aggregation initiation, D-dimer), endothelial dysfunction markers (von Willebrand factor), and echocardiographic findings were studied/RESULTS: Multivariate regression analysis showed that the odds ratio for a cardiovascular death risk was 1.8 (95% confidence interval (CI), 1.1 to 4.2; p=0.04) in patients with a D-dimer level of greater than 1 mg/ml, 0.77 (95% CI, 0.6 to 0.97; p=0.03) in those with an ADP-induced platelet aggregation initiation time of 13.5 sec, 1.04 (95% CI, 1.01 to 1.07; p=0.02) in those with an end-diastolic volume of more than 123 ml, 1.1 (95% CI, 1.04 to 1.2; p=0.003) in those with an end-diastolic dimension of more than 51 mm, 1.5 (95% CI, 1.1 to 2.0; p=0.009) in those with a ventricular septal thickness of more than 11.5 mm, and 2.1 (95% CI, 1.03 to 3.2; p=0.0032) in those with a von Willebrand factor level of more than 140%/CONCLUSION: The high levels of von Willebrand factor, D-dimer, ADP-induced platelet aggregation, triglycerides, end-diastolic volume, end-diastolic dimension, and ventricular septal thickness are independent predictors of cardiovascular death in very high-risk patients. These indicators bear out a close relationship between lipid metabolic and hemostatic disturbances and between endothelial dysfunction and intracardiac hemodynamic worsening in these patients.
Terapevticheskii arkhiv. 2014;86(3):59-64
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Evaluation of coronary artery lesion in men with osteopenic syndrome and coronary artery disease
Kokov A.N., Maliuta E.B., Masenko V.L., Sigareva A.A., Fanaskov V.B., Tarasov R.S., Raskina T.A., Shibanova I.A., Barbarash O.L.
Abstract
AIM: To examine the relation between coronary atherosclerosis (CA), coronary artery calcification (CAC), and bone mineral density (BMD) in men with coronary artery disease (CAD)/MATERIAL AND METHODS: The investigation included 74 males aged 60.1 (range, 55-70) years with verified CAD. All the patients underwent X-ray contrast-enhanced selective coronary angiography and coronary artery calcium score (CS) and BMD measurements by osteodensitometry. The severity of a coronary artery lesion was evaluated using the SYNTAX score. According to the T score, the patients were divided into 3 groups: 1) 23 patients with osteoporosis (OP), 2) 30 patients with osteopenia, and 3) 21 patients with normal BMD/RESULTS: Osteopenic syndrome (OS) (OP and osteopenia) was found in 71.6% of the patients with angiographically confirmed CAD. Single-vessel lesion in the coronary bed (CB) was more frequently recorded in the normal BMD group than in the OP one (p=0.023). Severe CB lesion was more common for the patients with OP (p=0.029). There were statistically significant differences between the osteopenia and normal BMD groups in the severe degree of CB lesion (p=0.042). Differences were noted in total CS between Groups 1 and 2 (p=0.0122). CS significantly correlated with the severity of CA lesion according to the SYNTAX score (r=0.53; p=0.002)/CONCLUSION: Severe CB lesion in males correlates with CAC and is associated with decreased BMD, suggesting the commonness of the pathogenetic components of AS and OS.
Terapevticheskii arkhiv. 2014;86(3):65-70
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The specific features of the immunophenotype of blast cells in patients with de novo normal karyotype acute myeloid leukemia and FLT3-ITD mutation
Gritsaev S.V., Martynkevich I.S., Chubukina Z.V., Petrova E.V., Kostroma I.I., Ivanova M.P., Martynenko L.S., Potikhonova N.A., Bubnova L.N., Abdulkadyrov K.M.
Abstract
AIM: To study the specific features of de novo acute myeloid leukemia (AML) with FLT3-ITD mutation/MATERIAL AND METHODS: The results of examination were analyzed in 101 patients. Bone marrow morphological specimens were stained with Pappenheim stain. The karyotype was investigated using the standard GTG-banding method. Blast cells were immunotyped in a five-color analysis on a Cytomics FC 500 laser flow cytofluorometer/RESULTS: FLT3-ITD mutation was identified in 21 patients who had a varying morphological nature of blasts, different karyotype variants, and frequently additional NPM1 gene mutation. The distinctive property of 10 patients with normal karyotype and FLT3-ITD mutation (without NPM1 gene mutation) was the larger number of cases with high expression of HLA-DR and CD7 than in the control group that included 18 patients with normal karyotype AML without FLT3-ITD nutation: 50% versus 6.2% (p=0.007) and 100% versus 55.6% (p=0.014), respectively/CONCLUSION: Normal karyotype AML with FLT3-ITD mutation is a group that is homogeneous in the biological phenotype of leukemia cells.
Terapevticheskii arkhiv. 2014;86(3):71-77
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Mechanisms of comorbidity in hemophilia patients
Kosiakova I.A., Davydkin I.L., Zorenko V.I.
Abstract
AIM: To study the somatic status of patients with varying degrees of hemophilia, the mechanisms of comorbidity from the results of studies of systemic microcirculation (MC), body composition, and key metabolic parameters/MATERIAL AND METHODS: One hundred and twenty hemophilia patients were examined. The authors studied their viscera; MC by laser Doppler flowmetry; body composition parameters by bioelectrical impedance; and blood cholesterol, albumin, and iron levels/RESULTS: The incidence of chronic diseases of the kidney, digestive system, and myocardium (from electrocardiographic findings), and liver was found to be proportional to the severity of hemophilia. The number of diseases per patient with mild, moderate, or severe hemophilia was 1.0±0.02, 1.5±0.02, and 2.5±0.03, respectively. Four and two systems were ascertained to be commonly affected in patients with severe and mild hemophilia, respectively. The investigators studied the comorbidity mechanisms that included changed systemic MC; a decreased perfusion associated with excess fat mass; evolving iron-deficiency; anemia; protein and mineral deficiencies; and a tendency to lower blood cholesterol levels, which reflected energoplastic wastes in hemophilia patients/CONCLUSION: The detection of comorbidity and mechanisms of its development in hemophilia makes it possible to improve the prevention of hemorrhage and visceral pathology in these patients and their quality of life.
Terapevticheskii arkhiv. 2014;86(3):78-82
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Delirium in the clinical practice of a therapist
Kutlubaev M.A., Akhmadeeva L.R.
Abstract
Delirium is a neuropsychiatric condition that may complicate any visceral disease. Its rate is especially high among patients with inflammatory diseases or metabolic disturbances and in the elderly. Brain injury concurrent with an abnormal stress response underlies the development of delirium. The clinical picture of delirium is characterized by clouding of consciousness accompanied by global cognitive and behavioral changes. According to the nature of changes in motor behavior, delirium is divided into hyperactive, hypoactive, and mixed subtypes. Special scales, such as Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), are used to identify delirium. Management of delirium includes specific therapy for the underlying disease and adequate care. Low-dose neuroleptics, haloperidol in particular, are recommended to correct behavioral changes.
Terapevticheskii arkhiv. 2014;86(3):83-87
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Choice of novel endpoints in clinical trials evaluating the efficiency of drug therapy in patients with pulmonary hypertension
Avdeev S.N.
Abstract
Pulmonary hypertension (PH) is characterized by a poor prognosis: the three-year survival rate in patients with PH is not greater than 60% as evidenced by current national registries. In the past decade, there have been drugs that are able to relieve symptoms of the disease, to slow down its progression, and improve quality of life. Historically, clinical trials dealing with PH have had a fixed and rather short-tern period and most commonly used the index "the change in the distance covered in the 6-minute walk test" as a primary endpoint. Further optimization of PH therapy requires that the efficacy of drugs and the strategies of therapy be evaluated with respect to their effects on morbidity and mortality, i.e. on prognosis. The SERAPHIN trial is now the only completed and published clinical trial using the combined index of morbidity and mortality as a primary endpoint. It demonstrates that that therapy with the novel drug macitentan causes a reduction in morbidity and mortality in patients with PH.
Terapevticheskii arkhiv. 2014;86(3):88-93
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Eradication therapy for Helicobacter pylori infection: Review of world trends
Maev I.V., Kucheriavyĭ I.A., Andreev D.N., Barkalova E.V.
Abstract
The literature review gives current views on the treatment of Helicobacter pylori infection. The rising antibiotic resistance of H. pylori in the first decade of the 21st century entailed the decreased efficiency of common eradication therapy (ET) regimens, by determining the higher interest in this problem. The paper summarizes data on the efficiency of current ET regimens in different regions of the world in the past 3 years. The prospects of alternative ET regimens are considered. The existing and promising ways of optimizing the current ET regimens are presented.
Terapevticheskii arkhiv. 2014;86(3):94-99
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Role of probiotics in the prevention and treatment of diarrhea of various genesis: Focus on Linex
Ushkalova E.A.
Abstract
The paper gives an update on the role of the microbiota in the maintenance of human health and in the pathogenesis of diseases. There is evidence for the efficacy and safety of probiotics in the treatment and prevention of diarrhea of various genesis. The place of linex in the therapy of diarrhea syndrome is discussed on the basis of the results of clinical trials.
Terapevticheskii arkhiv. 2014;86(3):100-105
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Metabolic syndrome and coronary heart disease
Gurgenian S.V., Vatinian S.K., Zelveian P.A.
Abstract
The literature review presents current views on micro- and macrovascular disorders in metabolic syndrome characterized by silent myocardial ischemia detectable only during exercise and myocardial radionuclide scintigraphy.
Terapevticheskii arkhiv. 2014;86(3):106-110
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Sepsis markers. XXI Century
BogachEva V.V., Gardovska D.X.
Abstract
Sepsis remains a leading cause of death in all age groups worldwide. Diagnosis, process monitoring, and timely appropriate treatment are all that are a fairly complex problem due to the heterogeneity of the disease itself. Diagnostic biomolecular markers could greatly simplify, accelerate, and objectify the entire healing process, from diagnosis and process monitoring to verification and timely correction of therapy. Today, as a result of technological development of laboratory studies, more than 100 biological units in the general concept of systemic inflammation and infection are being studied as diagnostic markers. The nature of sepsis still remains a mystery.
Terapevticheskii arkhiv. 2014;86(3):111-114
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