Vol 86, No 8 (2014)

Articles
New approaches to diagnosing and treating Crohn's disease
Maev I.V., Andreev D.N.
Abstract
The paper presents current views on the diagnosis and medical treatment of Crohn's disease (CD). It considers the present-day principles in the classification, evaluation of the severity of the disease, and its diagnostic criteria. There are actual medical treatment regimens for CD, regulated by the project of Russian clinical guidelines for the diagnosis and treatment of CD in adults (2013), which were drawn up by leading Russian experts relying on the European evidence-based consensus on the diagnosis and management of CD (2010). Promising treatment options for CD, which affect the key molecules of the pathogenesis of this disease, are considered.
Terapevticheskii arkhiv. 2014;86(8):4-12
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Discrete plasmapheresis for coronary heart disease
Solov'eva I.N., Mikhaĭlov I.E., Andrianova M.I.
Abstract
AIM. To provide a rationale for the expediency and efficiency of discrete plasmapheresis (PA) in the package of therapeutic measures for coronary heart disease (CHD). MATERIALS AND METHODS. 585 sessions or 120 cycles of low-volume therapeutic PA were performed in 91 patients with CHD. The parameters of blood lipid composition, hemocoagulation, rheology, and endotoxicosis were studied. RESULTS. Removal of 100% circulating plasma volume per treatment cycle could achieve a significant positive result of abnormally higher homeostatic parameters. The levels of high-density lipoprotein cholesterol, antithrombin III, and albumin did not decrease significantly. CONCLUSION. Low-volume discrete PA is a pathogenetically sound and effective method to affect homeostasis in CHD.
Terapevticheskii arkhiv. 2014;86(8):13-17
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Clinical features of chronic hepatitis B in the presence of metabolic syndrome and insulin resistance
Tkachenko L.I., Maleev V.V.
Abstract
AIM. To assess the relationship of different components of metabolic syndrome (MS), viral load, and HBeAg status to the risk for cirrhosis of the liver in patients with chronic hepatitis B (CHB). MATERIALS AND METHODS. Fifty-three patients with CHB were examined according to the conventional criteria for patients with chronic hepatitis (the 2012 EASL guidelines). Analysis is made in relation to the degree of liver fibrosis (LF), the presence of MS, abdominal obesity, and insulin resistance (IR). RESULTS. MS was detected in 22.6% of the patients with CHB. The duration of the latter in MS was noted to be longer; the patients with MS were accordingly older than those without MS. The patients of this category were significantly more frequently observed to have type 2 diabetes mellitus (DM2), and IR, hepatic steatosis, and >3 METAVIR scores for LF, and elevated activity of hepatic enzymes (alanine aminotransferase, aspartate aminotransferase). Marked LF was associated with a high viral load, obesity, DM2, patient age, and MS. The patients with MS showed a higher activity of hepatic enzymes than those with abdominal obesity without MS. CONCLUSION. The percentage of CHB patients with MS increases with disease duration and patient age. High viral load, disease duration, MS, obesity, and DM2 are associated with score >3 METAVIR scores for significant LF.
Terapevticheskii arkhiv. 2014;86(8):18-22
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Interstitial pulmonary fibrosis: The role of angiogenic factors, the inhibitory pathways of progression
Popova E.N., Lebedeva M.V., PonomarEv A.B., Popova I.A., Fomin V.V.
Abstract
AIM. To assess the role of angiogenic factors (vascular endothelial growth factor (VEGF) and endothelin-1 (ET-1) in interstitial lung diseases (ILD), such as fibrosing alveolitis, sarcoidosis. MATERIALS AND METHODS. The blood levels of endothelial dysfunction and neoangiogenesis markers (ET-1 and VEGF) were investigated in 96 patients with different clinical forms of ILD at it different stages; the found changes were compared with the clinical and morphological manifestations of the disease. RESULTS. It has been ascertained that regardless of the clinical type of ILD, there is a correlation between the blood levels of VEGF and ET-1 and the intensity of lung neoangiogenesis, the expression of VEGF by the endothelium of newly formed blood vessels, the production of angiogenic factors, the degree of endothelial dysfunction, the extent of pulmonary fibrosis, the degree of pulmonary vascular remodeling, and the severity of pulmonary hypertension. The findings suggest that the markers of neoangiogenesis play an important role in the mechanisms of ILD progression. CONCLUSION. The study of these parameters in the blood may be used to clarify the activity and prognosis of ILD.
Terapevticheskii arkhiv. 2014;86(8):23-28
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Matrix metalloproteinases and clinical and functional status in smokers with persistent asthma
Gnoevykh V.V., Gening T.P., Portnova I.A., Abakumova T.V., Smirnova A.I., Dolgova D.R.
Abstract
AIM. To assess the role of matrix metalloproteinases (MMP) in the clinical and functional status of smoking patients with persistent asthma. MATERIALS AND METHODS. Examinations were made in 16 healthy smokers (a control group), 22 healthy nonsmoking volunteers (a volunteer group), and 16 patients with endogenous (n=6) and mixed (n=10) persistent asthma (a study group) with varying disease control. The investigators used the following techniques: spirometry; determination of airway resistance and FeCO in the expired air; 30-minute percutaneous monitoring of blood oxygenation and 6-minute walk test; enzyme immunoassay for matrix metalloproteinase levels. RESULTS. The longer duration and higher intensity of smoking increase airway inflammation in the asthmatic patients and the length of blood oxygenation within the very low range. The combined negative influence of tobacco smoking and the underlying disease leads to a clinically significant decrease in pulmonary ventilation ability and basic levels of blood oxygenation, the occurring asthma control reduction being correlating with the longer duration of treatment. The investigators revealed the predictors of lowering the mean level of blood oxygenation (MMP-9, FeCO, and airway resistance), as well as the factors that negatively influence the level of dyspnea and fatigue in asthmatic smokers. CONCLUSION. The serum levels of FeCO and MMP-9 may serve as markers reflecting the intensity of airway inflammation in smokers with persistent asthma.
Terapevticheskii arkhiv. 2014;86(8):29-34
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Use of itopride in the symptoms of functional dyspepsia in Russia: Results of a Phase IV prospective open-label multicenter clinical trial
Kas'ianenko V.I., Denisov N.L., Vasil'ev I.V.
Abstract
AIM. To evaluate the efficacy and safety of itopride used to treat the symptoms of functional dyspepsia (FD) of the upper gastrointestinal tract. MATERIALS AND METHODS. A prospective, open-label, multicenter trial using as a control the placebo response obtained in the previous investigations enrolled 96 adult patients. The diagnosis of FD corresponded to its Rome II criteria. Patients received itopride (Ganaton) oral tablets (50 mg) 3 times daily for 8 weeks. When included into the trial, the patients were orally given itopride (ganaton) tablets (50 mg) thrice daily before meals for 8 weeks. The patients' status was evaluated during (at weeks 4 and 8) and after (at week 12) treatment. Treatment response was assessed using the Global Patient Assessment (GPA) and the Leeds Dyspepsia Questionnaire (LDQ). To evaluate the safety of itopride use, the investigators studied the frequency of adverse events and carried out laboratory tests (renal and liver function tests) and electrocardiography (ECG). RESULTS. The GPA showed that 53.76, 85.71, and 82.22% of the patients achieved a therapeutic effect of itopride at weeks 4, 8, and 12, respectively. The proportion of the patients who achieved the therapeutic effect (86%) at week 8 was higher than the historical placebo controls in the previous studies - 45% (86% vs 45%; χ2=68.868, df=3; p<0.001). The mean LDQ score at week 8 was significantly lower than that at baseline (2.09 and 9.36 scores; p<0.001); 6 nonserious adverse events occurred in 3 (3.12%) of the 96 patients. During the follow-up period, there was a mild adverse event that was related to the test drug (atrial extrasystole as evidenced by ECG) and resolved a few days later. CONCLUSION. Itopride is an effective and well-tolerated drug in the treatment of functional dyspepsia in the Russian patients.
Terapevticheskii arkhiv. 2014;86(8):35-41
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Role of psychological correction in the combination treatment of patients with gastroesophageal reflux disease
Iurenev G.L., Sirota N.A., Dicheva D.T., Bitkova E.N., Maev I.V.
Abstract
AIM. To evaluate the efficiency of psychotherapeutic methods on the clinical course of gastroesophageal reflux disease (GERD), quality of life (QL), esophagogastroduodenoscopic findings and 24-hour pH monitoring readings in patients with this condition. MATERIALS AND METHODS. Sixty patients with GERD were divided into equal groups according to performed therapy: standard drug treatment or its combination with psychotherapeutic methods. The investigators estimated the degree of esophageal mucosal damage by esophagogastroduodenoscopy, esophageal acidity by 24-hour pH monitoring, and the magnitude of clinical manifestations by the Likert scale and assessed QL by the SF-36 questionnaire. The psychoemotional health component was analyzed using the clinical questionnaire for the identification and evaluation of neurotic states (CQIENS), the Leonhard-Shmichek characterological questionnaire, and the individual typological questionnaire. RESULTS. The patients with GERD were found to have individual personal traits and a definite psychological response. Incorporation of psychotherapeutic methods into the combination therapy was ascertained to have an additional therapeutic effect against the clinical manifestations of GERD, psychological responses in the patients, and QL indicators. There was a direct relationship between the psychological component of QL and the data of the CQIENS questionnaire. The most significant correlation was found between the CQIENS anxiety scores and the psychological component of QL (r=0.73; p=0.00004). Correlation analysis in the patients with GERD showed a relationship between the CQIENS anxiety scores and the clinical index (r=-0.68; p=0.0001). CONCLUSION. The use of psychotherapeutic methods in addition to standard drug therapy improves both the physical and psychological states in patients with GERD and has some impact on a reduction in the magnitude of clinical symptomatology. This may contribute to the prompter recovery of patients and create prerequisites for improving their QL.
Terapevticheskii arkhiv. 2014;86(8):42-49
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AIM. To evaluate the efficiency and safety of Livodexa monotherapy in patients with reflux esophagitis (RE) after gastric resection or gastrectomy.
Minushkin O.N., Maslovskiĭ L.V., Shuleshova A.G., Nazarov N.S.
Abstract
MATERIALS AND METHODS. The investigators examined 30 patients (16 men, 14 women) after gastrectomy (n = 15) or gastric resection (n = 15) who had anacidity as shown by pH-metry and the clinical and/or endoscopic signs of RE. During 4 months, Groups 1 and 2 patients received the drug in doses of 10 and 15 mg/kg/day, respectively. Maintenance treatment was performed for 2 months. The maintenance therapy group included 25 patients, including 12 patients who took Livodexa in a dose of 2.5 mg/kg/day (Group 1) and 13 patients who had 5 mg/kg/day (Group 2) during 2 months. RESULTS. Treatment with ursodeoxycholic acid (Livodexa) resulted in the significantly reduced frequency and intensity of the major symptoms of the disease (heartburn, retrosternal pain, bitter eructation), by achieving a maximum effect at 4 months of therapy. Endoscopic remission was observed in 63.3 and 83.3% of the patients at 4 and 6 months of treatment, respectively. There was a significant and steady rise in the quality of life as evidenced by a visual analogue scale. The ursodeoxycholic acid dose of 10 mg/kg was effective in patients with grade 1 RE (single erosions) while it should be increased up to 15 mg/kg in those with more significant esophageal mucosal injury (grades 2-3 RE). Some patients receiving a maintenance dose of 2.5 mg/kg/day were recorded to have recurrent reflux disease with a relapse of clinical manifestations and a morphological substrate as catarrhal esophagitis. The group of patients receiving maintenance therapy (5 mg/kg/day) retained the achieved clinical and morphological remission. CONCLUSION. The findings suggest that Livodexa is effective in patients of this category.
Terapevticheskii arkhiv. 2014;86(8):50-55
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Pharmacoeconomic evaluation of treatment in patients with Helicobacter pylori-associated diseases
Samsonov A.A., Grechushnikov V.B., Andreev D.N., Iurenev G.L., Korovina T.I., Lezhneva I.A., Maev I.V.
Abstract
AIM. To estimate the pharmacoeconomic parameters of treatment in patients with Helicobacter pylori-associated diseases when using 6 eradication therapy (ET) regimens. MATERIALS AND METHODS. The investigation enrolled a total of 231 patients who received anti-Helicobacter pylori therapy according to the intention-to-treat (ITT) principle, including 229 patients who met the protocol requirements, i.e. who completed the prescribed per-protocol (PP) treatment: 106 patients with duodenal bulb ulcer disease, 2 with gastric ulcer, 90 with erosive gastritis, and 31 patients with non-atrophic gastritis. In an outpatient setting, the patients received one of the 6 ET regimens: OAC, RBMA, RBCA, EBCA, sequential OACM therapy, and modified sequential OACMB therapy (O - omeprazole; A - amoxicillin; C - clarithromycin; B - bismuth tripotassium dicitrate, R - rabeprazole; M - metronidazole; E - esomeprazole). Treatment costs were calculated only from direct drug expenditures. The effective cost coefficient (Keff) was determined from the cost/treatment efficiency ratio: Keff=cos/eff, where the cost was the average total costs; the eff was efficiency (%). RESULTS. The modified sequential OACMB therapy has proven to be more cost-efficient than the other regimens as it has a lower Keff (14). The RBMA regimens can overcome an 80% ET barrier (82.4%); however, in this case the Keff is 21.5. the sequential OACM therapy can also overcome an 80% ET barrier (84.8%); the Keff being 10.8. Incorporation of the bismuth preparation can achieve a more noticeable therapeutic effect up to 95.4%. The EBCA regimen has turned out to be most expensive with the highest Keff of 36.9. The RBCA regimen is most effective with the least Keff of 29; the therapeutic effect is 96.7%. CONCLUSION. The clinical cost-efficiency of ET is enhanced by the incorporation of the bismuth preparation for the treatment of patients with H. pylori-associated diseases. The modified sequential OACMB therapy can overcome resistance to clarithromycin and metronidazole with a good cost-efficiency.
Terapevticheskii arkhiv. 2014;86(8):56-61
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Clinical efficacy of functional foods in patients with gastrointestinal disorders
Shcherbakov P.L., Shcherbakova M.I., Parfenov A.I., Ruchkina I.N., Kuz'mina T.N.
Abstract
AIM. To identify micronutrient deficiencies in patients with functional bowel diseases (FBD) and to reveal their correction with functional foods and probiotics. MATERIALS AND METHODS. The health status was evaluated in 90 patients aged 18 to 67 years with FBD. All the patients were randomized into 3 groups according to the treatment regimen. Group 1 took Amaltea goat's milk 200 ml/day during basic therapy; Group 2 received multispecies and multistrain RioFlora Balance probiotics in addition to the above components; Group 3 (a control group) had traditional basic dietary therapy. All the groups continued their treatment for 14 days. RESULTS. The performed examinations have demonstrated that diet-based treatment fortified with goat's milk and multispecies probiotics makes it possible to more promptly achieve remission and to level off clinical manifestations than in the control group. The patients using multispecies probiotics versus the control group showed a reduction in fat-soluble vitamin deficiencies and a considerable improvement in quality of life. CONCLUSION. FBD lacks a specific clinical picture and may be masked as lactase deficiency, which commonly leads to noticeable limitations in patients' diet and favors the development of vitamin deficiency. Of particular concern is the development of vitamin D deficiency in young patients, which may result in the early development of osteoporosis in the future. To specify the composition of enzymes in the patients gives grounds to refuse restricted diets, and the dietary addition of functional foods (goat's milk fortified with vitamins and minerals), particularly in combination with multistrain probiotics, produces a pronounced clinical effect and eliminates fat-soluble vitamin deficiencies.
Terapevticheskii arkhiv. 2014;86(8):62-69
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Possibilities for the tool monitoring of neuralgia therapy
Gnezdilov A.V., Syrovegin A.V., Samoĭlova N.V., Zagorul'ko O.I., Goncharov D.I., Medvedeva L.A.
Abstract
AIM. To study the possibility of using a paired (test) H-reflex recovery test in the expert assessment of the intensity of acute pain syndromes and in the control of performed therapy. MATERIALS AND METHODS. The authors analyzed 40 patients treated for radicular pain syndrome (RPS) caused by disk protrusion or herniation at the lumbar spine with the pain intensity of up to 9 points on digital rank scale of pain. As a clinical model they used a pathogenetically sound therapeutic blockade method including glucocorticosteroids for the therapy of acute neuralgia and basic medical therapy with Arcoxia 120 mg/day. Investigations were conducted to study the specific features of early recovery of test H-reflex caused in pair with a conditioning H-reflex in both healthy volunteers and patients with obvious RPS. RESULTS. There were different features of paired H-reflex recovery in healthy individuals and patients with RPS during different treatment options. Recovery of test H-reflex in the range of 150-200 msec can be a criterion for a pain state. CONCLUSION. The clinical test reflex recovery technique may be used in the diagnosis and monitoring of the performed therapy of acute pain syndromes, as well as in the expert examination of pain states.
Terapevticheskii arkhiv. 2014;86(8):70-74
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The risk of developing atherosclerosis and osteoporosis in post-oophorectomy women during hormone replacement therapy
Maĭchuk E.I., Voevodina I.V., Makarova I.A., Mitrokhina T.V., Iureneva S.V.
Abstract
AIM. To study the formation of and trends in risk factors (RFs) for cardiovascular disease (CVD), their influence on the occurrence of early (preclinical) atherosclerotic lesions, a combination of these changes with osteoporosis (OP) in women following bilateral oophorectomy depending on whether hormone replacement therapy (HRT) is performed. MATERIALS AND METHODS. The investigation enrolled 50 women with surgical menopause after bilateral oophorectomy in combination with hysterectomy who received estrogen monotherapy (a study group) and 37 patients who underwent the same operation, but had no HRT (a control group). The study group patients were examined twice (before and 10 years after HRT); the comparison group was examined once in the same period postsurgery. The investigators conducted Doppler study of the great arteries of the head and neck and measured pulse wave velocity, as well as they made dual-energy X-ray densitometry to estimate bone mineral density and a detailed analysis of the most common RFs for CVD. RESULTS. There was an increase in the prevalence of RFs for CVD and a change in their structure, which were particularly marked in the women who received no HRT, their impact on the development of early atherosclerotic changes naturally progressing with the number of RFs. The similar trend was observed for bone tissue changes: a higher incidence of osteopenia and OP during the follow-up. CONCLUSION. The high percentage of a concurrence of osteoporosis and atherosclerosis argues for that there are common pathogenic mechanisms.
Terapevticheskii arkhiv. 2014;86(8):75-79
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Efficacy of metformin in abdominal obesity
Mkrtumian A.M., Markova T.N., Kichigin V.A., Podachina S.V., Zhuchkova S.M.
Abstract
AIM. To study the effect of metformin on metabolic parameters, body weight (BW), and waist circumference (WC) in patients with abdominal obesity (AO). MATERIALS AND METHODS. The results of using metformin 2000 mg daily for 3 months in 46 patients with АО. The comparison group consisted of 50 people. BW, WC, and blood pressure (BP) were measured; lipid profile parameters and blood insulin concentrations were determined; and Homeostasis Model Assessment (HOMA) estimates were calculated. Metabolic syndrome (MS) and AO were judged by the 2005 International Diabetes Federation (IDF) criteria. RESULTS. The study and comparison groups showed were reductions in BW by 4.2 and 1.7 kg and in WC by 4.2 and 1.1 cm, respectively. Metformin used in the patients with AO contributed to a more significant improvement in the lipid profile than in those who received no medication. A decrease in the HOMA index was observed only in the metformin group. The effects of the drug were more pronounced in MS and insulin resistance. The use of metformin in the patients with AO decreased lower BW and HOMA index and improved lipid metabolism even in the absence of MS. CONCLUSION. The trial has demonstrated that the people with AO may take metformin could be used in to reduce BW and WC and to treat and prevent MS.
Terapevticheskii arkhiv. 2014;86(8):80-84
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Effect of dipeptidyl peptidase-4 inhibitors on fat metabolism in patients with type 2 diabetes mellitus
Ametov A.S., Gusenbekova D.G.
Abstract
AIM. To evaluate the effect of sitagliptin in combination with metformin on glucose toxicity and lipotoxicity in patients with type 2 diabetes mellitus. MATERIALS AND METHODS. Eighty-two overweight and dyslipidemic patients (mean age 55.3±9.1 years) who had not achieved the goal levels of glycated hemoglobin (HbA1c) (mean level 8.3±1.6%) during metformin therapy and dietotherapy were examined. Group 1 patients received sitagliptin 100 mg/day in combination with metformin 2 g/day; Group 2 took metformin 1.5-2 g/day. The levels of fasting plasma glucose (FPG) levels, postprandial glycemia (PPG), HbA1c, body weight, body mass index, waist circumference, and waist-to-hip ratio, blood lipid composition, and the levels of insulin, leptin, adiponectin, HOMA-IR, and HOMA-Β were estimated at baseline and 6 months later. Visceral fat (VF) magnetic resonance imaging (MRI) was carried out. RESULTS. Following 6 months, both groups showed positive changes in FPG, PPG, and HbA1c levels. HbA1c decreased from 8.3±1.6 to 6.6±1.24% in Group 1 and from 8.35±1.75 to 7.62±1.39% in Group 2. PPG and FPG reduced by an average of 2.67 and 3.3 mmol/l in Group 1 and by 2.1 and 1.8 mmol/l in Group 2. HOMA-Β increased by 23.4. conventional units (CU) in Group 1 and by 4.8 CU in Group 2. HOMA-IR was noted to display positive changes in both groups. The level of adiponectin rose by 1.9 ng/ml in Group 1 and by 0.49% ng/ml in Group 2 and that of leptin fell by 7.37 and 1.21 ng/ml, respectively. There were significant differences between the groups in anthropometric changes. MRI revealed a significant VF drop by 20.6±13.5 cm2 (7.5%) in Group 1 and by 5.7±3.75 см2 (1.76%) in Group 2. CONCLUSION. Combined therapy with sitagliptin and metformin caused reductions in glucose toxicity and lipotoxicity.
Terapevticheskii arkhiv. 2014;86(8):85-89
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Correction of endothelial dysfunction in hypertensive patients with type 2 diabetes mellitus during combined antihypertensive therapy
Statsenko M.E., Derevianchenko M.V.
Abstract
AIM. To evaluate the impact of 6-month antihypertensive therapy with the combined drug amlodipine + lisinopril (ekvator) on endothelial dysfunction (ED) and carbohydrate metabolic parameters in patients with hypertension and type 2 diabetes mellitus (DM). MATERIALS AND METHODS. The investigation enrolled 30 patients aged 40-65 years with Stages II-III hypertension concurrent with type 2 DM. All the patients received combined antihypertensive therapy with amlodipine + lisinopril for 24 weeks. Endothelial function (EF) was studied from the serum and urine concentrations of the metabolites nitric oxide (NO) and endothelin-1 (ET-1) and from occlusion test RESULTS. Carbohydrate metabolic parameters were estimated. Insulin resistance (IR) was judged from basal insulin concentrations, followed by the calculations of the Homeostasis Model Assessment (HOMA) index. RESULTS. Following 24 weeks of therapy with amlodipine + lisinopril and close adherence to dietary recommendations, all the patients achieved the target levels of blood pressure and glycated hemoglobin (HbA1c). There was a significant improvement in EF in hypertensive patients with type 2 DM: NO production was increased in both the serum and urine (by 122.8 and 65.8%, respectively). ET-1 secretion was naturally decreased in both the serum and urine (by 26.1 and 76.1%, respectively; p<0.05). Analysis of the vascular component of EF during treatment with the combined drug amlodipine + lisinopril revealed a statistically significant patient redistribution by the types of microcirculation and the results of an occlusion test, by calculating the responsiveness of large arteries: the number of patients with normal microcirculation increased from 13.3 to 86.7% and that of patients with hyperemic microcirculation declined from 66.7 to 0. The number of patients with a paradoxical occlusion test significantly reduced from 46.7% at baseline to 20% after 24 weeks of treatment with the combined medication amlodipine + lisinopril. Fasting blood glucose levels and HOMA index were decreased by 22.1 and 22.4%, respectively (p<0.05). There were statistically significant correlations between the HOMA index and the concentrations of NO in the urine (r=-0.45) and blood (r=-0.54) and those of ET-1 in the blood (r=-0.54). CONCLUSION. Twenty-four-week combined antihypertensive therapy with the drug amlodipine + lisinopril is safe and highly effective in EF recovery and favorably affects carbohydrate metabolic parameters in the hypertensive patients with type 2 DM.
Terapevticheskii arkhiv. 2014;86(8):90-93
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Alcohol-related mortality in the assessments of hospital unit physicians and pathologists: Analysis of accounting medical documents
Solov'ev A.G., Viaz'min A.M., Mordovskiĭ É.A., Krasil'nikov S.V.
Abstract
AIM. To make a comparative analysis of the data available in the accounting medical documents drawn up at a multidisciplinary hospital on the level and structure of alcohol-related mortality (ARM) and to evaluate the efficiency of its accounting. MATERIALS AND METHODS. Accounting medical documents, such as 453 inpatient cards (Form 003/у), 453 postmortem protocols (cards) (Form 013/н-80), and 453 death certificates (Form 106/у-08), were chosen as the basis for the study. The data of the final clinical and postmortem diagnoses in the patients who had died at hospital and their primary cause of death were comparatively analyzed. RESULTS. According to Form 003/у, ARM was 5.5%; the detection rate of alcohol-related disease (ARD) was 11% (95% confidence interval (CI), 8.3 to 14.3%); according to Form 013/н-80, ARM was 7.1% (95% CI, 4.9 to 9.8%) and the detection rate of ARD was 12.6% (95% CI, 9.7 to 16%). The consistency of the diagnoses of ARD as a main cause of death, made by hospital unit physicians and pathologists, is estimated as the mean - the Cohen's kappa coefficient (κ) is 0.570) (p<0.001). CONCLUSION. The results of the investigation suggest that there are 3 types of ARM, which differ in its level and structure: ARM in the assessments of hospital unit physicians; that in the assessments of pathologists, and that according to the death certificates drawn up. The consistency index for the diagnosis of ARD as a main cause of death indicates that the hospital unit physicians only determine the etiology of alcohol-related cause of death, without identifying it specifically.
Terapevticheskii arkhiv. 2014;86(8):94-98
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A clinical example of medical management in a female patient with manifest primary hyperparathyroidism
Mokrysheva N.G., Peretokina E.V., Rozhinskaia L.I.
Abstract
The problems of the timely diagnosis and treatment of primary hyperparathyroidism (PHPT) have recently attracted more and more attention because this disease now ranks third in incidence rates among endocrine diseases. Older women form a group at risk for this disease. Surgical removal of the source of parathyroid hormone hypersecretion is the only radical treatment option for this disease, which is performed in the majority of patients with PHPT. Occasionally, surgical treatment is contraindicated or unadvisable. In these cases, the possibilities of long-term medical treatment become relevant. For this, there are several groups of drugs available, such as bisphosphonates to maintain bone tissue, calcium-sensing receptor agonists (calcium mimetics) that are effective in reducing blood calcium levels. The patients frequently require combined therapy to control the major manifestations of the disease. There are limited data on the long-term medical management of patients with manifest PHPT in the literature.
Terapevticheskii arkhiv. 2014;86(8):99-101
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Pathogenetic approaches to treating constipations
Luzina E.V.
Abstract
Constipation affects 15-25% of people. Its mechanisms are various. There are constipations due to intestinal dyskinesia (functional constipation, irritated bowel syndrome), slow transit (colonic inertia), and muscular apparatus discoordination ensuring defecation (dyssynergic defecation). The treatment of different types of constipation uses prokinetics (type 4 serotonin receptor agonists, chlorine channels activators and guanylate cyclase C channel activators) or spasmolytics, among which pinaverium bromide (dicetel) has demonstrated its high efficacy. Biofeedback therapy or surgical techniques may be used. There is a need to prescribe laxatives in any type of constipation. A pathogenetic approach to treating constipation is most efficient. The paper characterizes stimulant, osmotic, volume, and emollient laxatives and agents stimulating the urge to defecate. It also gives the data of meta-analyses evaluating the efficacy of different drug groups. Particular emphasis is laid of the effect of lactulose and its first preparation - duphalac.
Terapevticheskii arkhiv. 2014;86(8):102-105
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Use of antihistamines in a physician's clinical practice
Luss L.V.
Abstract
Histamine that belongs to one of the most important mediators involved in the regulation of the body's vital functions plays a great role in the pathogenesis of different diseases. Histamine is released during inflammatory and allergic reactions, anaphylactic and anaphylactoid shock, pseudoallergic reactions, and others. Acting through histamine receptors, it leads to increased intracellular concentration of cyclic guanosine monophosphate, enhanced chemotaxis of eosinophils and neutrophils, production of prostaglandins and thromboxane B, suppressed synthesis of lymphokines, etc. and causes contraction of smooth muscles of particularly the bronchi and intestine, dilation of vessels and their increased permeability, mucus hypersecretion in the upper airways, lower blood pressure, angioedema and itch, etc. In this connection, antihistamines that block histamine-induced reactions in various ways: by inhibiting its biosynthesis, enhancing its neutralization, blocking the access to receptors, and suppressing the release from mast cells, occupy a prominent place in clinical practice. The review covers the classification, main mechanisms of pharmacological action, and indications for the use of antihistamines that not only have the well-known antihistamine properties, but have also a broad spectrum of anti-inflammatory activity. There are data on the benefits of a group of antihistamines, the quinuclidine derivatives (quifenadine, sequifenadine) that were designed by Academician M.D. Mashkovsky and are one of the first examples of designing new classes of multifunctional non-sedating antihistamines, which combines a high selective activity to block histamine type 1 receptors and an ability to block serotonin and to break down histamine directly in tissues.
Terapevticheskii arkhiv. 2014;86(8):106-109
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Sociological analysis of delivery of healthcare in Russia's regions with violent natural conditions (in case of the Republic of Altai)
Kozhevnikov A.A.
Abstract
The paper describes the results of a sociological study of delivery of healthcare in the Republic of Altai to search for ways to improve its quality and to provide access to the local population. Analysis was made with regard to an interdisciplinary, comprehensive approach to considering the range of problems associated with not only the health of local residents and identifying risk factors leading to diseases, but also by determining the possibilities that could promote the minimization of causes that have a considerable impact on the occurrence of diseases and also hamper healthcare delivery in the human settlements of Gornyi Altai, which are difficult of access. The investigation has used sociological and statistical methods. It has been ascertained that the available healthcare forces and means should be today employed at the regional level, by applying the principles of necessary sufficiency in conjunction with the local population's social motivation to be involved in the activity associated with the rendering of medical services. In addition, it is necessary to systemically use mobile medical units as a significant factor for the optimization of medical care to the population living in Russia's regions which are difficult of access.
Terapevticheskii arkhiv. 2014;86(8):110-112
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Neuroprotection in hypertensive patients: Minimization of poor prognosis
Shishkova V.N.
Abstract
The paper discusses approaches to optimizing pharmacotherapy in patients with hypertension associated with cerebrovascular diseases. Possible indications for neuroprotectors and a pathogenetic rationale for their mechanism of action in patients with prior cerebral stroke are detailed.
Terapevticheskii arkhiv. 2014;86(8):113-118
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Thyroid dysfunction in patients with type 2 diabetes mellitus
Tereshchenko I.V., Suslina A.A.
Abstract
The paper gives an update on type 2 diabetes mellitus concurrent with thyroid dysfunction and on the development of vascular events, atherogenesis and evaluates the impact of therapy on the course of both diseases. It points out the need for annual screening for thyroid dysfunction in patients with type 2 diabetes mellitus.
Terapevticheskii arkhiv. 2014;86(8):119-123
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Role of Helicobacter pylori eradication in the prevention of gastric cancer
Tsukanov V.V., Amel'chugova O.S., Kasparov É.V., Butorin N.N., Vasiutin A.V., Tonkikh I.L., Tret'iakova O.V.
Abstract
The review deals with the current aspects of prevention of non-cardia gastric cancer (GC). Helicobacter pylori is the most common cause of non-cardia GC. The Correa cascade remains a major pattern of the pathogenesis of non-cardia GC as before. The key moments in gastric carcinogenesis are H. pylori infection; genes associated with cell recognition of bacteria; an immune response and the activation of an inflammatory response. The prevention of GC requires H. pylori eradication as primary prevention in combination with screening for this pathology as secondary prevention of gastric malignancies. Standard three-component therapy is a first-line major regimen for H. pylori eradication.
Terapevticheskii arkhiv. 2014;86(8):124-127
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Arterial hypertension in metabolic syndrome: Pathophysiological aspects
Gurgenian S.V., Vatinian S.K., Zelveian P.A.
Abstract
Arterial hypertension (AH) is one of the basic components of metabolic syndrome that is caused by four factors: autonomic sympathetic dysfunction; activation of the hypothalamic-pituitary-adrenal axis; that of the renin-angiotensin-aldosterone system; and endothelial dysfunction (ED). AH is a slowly progressive hemodynamic disease, the natural course of which is characterized by not only elevated blood pressure (BP), but also by left ventricular hypertrophy, arterial remodeling, and a progressive increase in total peripheral resistance. ED and arterial remodeling play a key role in the pathogenesis of AH in metabolic syndrome. Remodeling of resistant arteries raises peripheral resistance and stabilizes BP and that of large arteries increases their stiffness and a reflected wave, resulting in increased pulse BP, systolic BP, and enhanced left ventricular hypertrophy. Insulin resistance and hyperinsulinemia increase the activity of the renin-angiotensin-aldosterone system and, by enhancing the expression of angiotensinogen, angiotensin II and its type 1 receptors, favors the development of AH, proinflammation, atherosclerosis, and congestive heart failure. Hyperleptinemia, which, by stimulating the activity of the sympathetic nervous system, elevates BP, plays a certain role in the development of AH in metabolic syndrome and obesity.
Terapevticheskii arkhiv. 2014;86(8):128-132
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Panic disorder: Clinical features and treatment approaches
Chutko L.S., Surushkina S.I.
Abstract
The paper reviews scientific publications on studies of the epidemiology, etiology, pathogenesis, and main clinical manifestations of panic disorders and approaches to their treatment.
Terapevticheskii arkhiv. 2014;86(8):133-137
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The contribution of T. Sydenham (1624-1689) to the formation of modern Western medicine (on the occasion of the 390th anniversary of his birth)
Stochik A.M., Zatravkin S.N.
Abstract
The article is devoted to the contribution of the English physician T. Sydenham to the formation of modern Western medicine. Based on the analysis of his major works, the authors concluded The contribution of T. Sydenham (1624-1689) to the formation of modern Western medicine (on the occasion of the 390th anniversary of his birth) that T. Sydenham's main merit was not the application of an empirical approach to studying human diseases, but the development of two theoretical concepts in the 1660s to 1680s, which introduced new ideas about the causes of diseases and epidemics. Recognition of T. Sydenham`s ideas by the majority of the medical community led to a fundamental revision of the views on illnesses, to the emergence of qualitatively new approaches to the study, diagnosis, treatment and prevention of human diseases, by giving rise to a new subject of medical study, such as physical and social environmental factors in man along with his body in health and disease.
Terapevticheskii arkhiv. 2014;86(8):138-142
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