Vol 86, No 10 (2014)

Articles
Personalized therapy for diabetes mellitus: the path from disease to the patient
Dedov I.I., Shestakova M.V.
Abstract
The paper gives quick-look data on the new area in the diagnosis and treatment of diabetes mellitus (DM) - personalized medicine. It describes difficulties in the diagnosis of DM, its heterogeneity in children and adults, which may be identified by molecular genetic, immunological, hormonal, and metabolic studies. Data on the possibilities of predicting the individual, familial, and population risks of types 1 and 2 DM are presented. Prospects for choosing the most effective and safest glucose-lowering therapy on the basis of a pharmacogenetic analysis of the susceptibility of patients to specific drugs are outlined.
Terapevticheskii arkhiv. 2014;86(10):4-9
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Secretion of incretin hormones in people having risk factors for type 2 diabetes mellitus
Shestakova E.A., Il'in A.V., Shestakova M.V., Dedov I.I.
Abstract
AIM. To study the secretion of glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon-like peptide 2 (GLP-2) in response to a carbohydrate load in people with risk factors for type 2 diabetes mellitus (DM2) in relation to the type of carbohydrate metabolic disturbances and age. MATERIALS AND METHODS. One hundred and twenty-seven patients having DM2 risk factors who had not previously received glucose-lowering therapy underwent an oral glucose tolerance test (OGTT). The plasma levels of glucose, insulin, glucagon, GLP-1, GIP, and GLP-2 were determined at 0, 30, and 120 minutes of the test. RESULTS. According to the findings, the patients were divided into 3 groups: 1) normal glucose tolerance; 2) prediabetic states (impaired glucose tolerance and/or impaired fasting glycemia); 3) new-onset DM2. OGTT showed that the secretion of GLP-1 was lower and that of GIP and GLP-2 was higher in patients with DM2. GLP-1 secretion decreased with patient age. CONCLUSION. During OGTT, there is a statistically significantly difference in the secretion of incretin hormones in persons with varying degrees of carbohydrate metabolic disturbances: the peak GLP-1 secretion is the highest in healthy individuals and lowest in the patients with DM2; on the contrary, the peak GLP2 and GIP secretions are the highest in the patients with DM2. This may suggest that GLP-1 and the two other hormones (GLP-2 and GIP) show opposite effect in the regulatory mechanisms of carbohydrate metabolism. GLP-1 secretion is decreased with age, which may be one of the reasons for the higher prevalence of DM2 among the elderly.
Terapevticheskii arkhiv. 2014;86(10):10-14
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Comparative analysis of the changing pattern of thyroid disease in patients with type 2 diabetes mellitus in the Perm Region after 10 years
Tereshchenko I.V., Suslina A.A.
Abstract
AIM. To comparatively analyze thyroid abnormalities in patients with type 2 diabetes mellitus (DM2) in the past 10 years. MATERIALS AND METHODS. The thyroid state 10 years ago and presently was evaluated in 166 and 101 patient with DM2, respectively. The patients underwent in-depth physical examination and thyroid hormone functions were evaluated. RESULTS. The pattern of thyroid disease has changed in the patients with DM2 over a 10-year period. During recent mass and individual iodine deficiency prophylaxis, iodine-deficiency goiter had become substantially less frequent in DM2; the T3/T4 ratio has normalized. The prevalence of nodular goiter has remained unchanged. However, the incidence of autoimmune thyroiditis and hypothyroidism, the subclinical form of the latter in particular, has increased statistically significantly. Hypothyroidism has occurred more often during treatment with glucose-lowering sulfanilamides than during metformin treatment or combined glucose-lowering therapy. Hypothyroidism was generally recognized untimely in the examinees, in elderly patients in particular: the clinical signs of thyroid disease were regarded as manifestations of DM2. Our preliminary data support other authors' opinion that thyroid insufficiency accelerates the rate of development and progression of vascular complications of DM2. The contrinsular effect of Levothyroxine was not recorded during replacement therapy for thyroid insufficiency. CONCLUSION. Although the incidence of thyroid abnormality is increasing in patients with DM2 in the world, its causes are yet to be explained. The diagnosis of hypothyroidism in patients with DM2 is commonly untimely. At a follow-up of patients with DM2, it is necessary to systematically monitor thyroid function and to initiate levothyroxine replacement therapy in proper time.
Terapevticheskii arkhiv. 2014;86(10):15-19
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Risk factors for and prognostic value of multifocal atherosclerosis in patients with diabetes mellitus
Gracheva S.A., Biragova M.S., Glazunova A.M., Klefortova I.I., Shamkhalova M.S., Dzhavelidze M.I., Soldatova T.V., Il'in A.V., Shestakova M.V., Tugeeva É.F., Buziashvili I.I.
Abstract
AIM. To study the prognostic value of multifocal atherosclerosis (MFA) in patients with diabetes mellitus (DM) at high risk for myocardial ischemia who need coronary angiography (CAG). MATERIALS AND METHODS. The investigation included 148 patients: 25 with type 1 DM (DM1), 73 with type 2 DM (DM2), and 50 without DM who had undergone CAG. Duplex ultrasound scanning of lower limb vessels and brachiocephalic and renal arteries was carried out in all the patients. RESULTS. Involvement of two or more vascular beds was noted in 60% of the patients with DM1, in 68.4% of those with DM2, and in 34% of those without DM (p < 0.05). Regression analysis showed that the risk factors of MFA were defined to be myocardial infarction (MI) in the history (OR=2.4; p=0.02), DM (OR=3.9; p=0.0002), smoking (OR=2.4; p=0.05), elevated creatinine (OR=6.5; p=0.002) and fibrinogen (OR=6.8, p=0.004) levels. Among the DM patients, there were 26.5% of those who had achieved a main assessment criterion (a combined end point (CEP)), such as death, urgent hospitalization for heart failure, nonfatal MI, nonfatal stroke, lower extremity amputation, double creatinine levels, and achievement of end-stage renal failure during a 24-month follow-up. In patients without carbohydrate metabolic disturbances, this indicator was 12% (p=0.01). During the prospective study, a total of 6.1% of patients died in the DM group; all the patients in the non-DM group completed the study. Calculation of survival rates by the Kaplan-Meier method indicated that the DM patients with concurrent atherosclerotic lesion had achieved CEP significantly more frequently than the comparison group. Such differences were absent among the persons without carbohydrate metabolic disturbances. CONCLUSION. The regression analysis has shown that prior MI, DM, smoking, creatinine and fibrinogen levels are factors associated with the development of MFA in the examined groups. In the patients with DM, concurrent atherosclerosis of two or more vascular beds is an important factor for the progression of cardiovascular and renal diseases.
Terapevticheskii arkhiv. 2014;86(10):20-26
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Adiponectin and parameters of glucose and lipid metabolism at different clinical and morphological stages of non-alcoholic fatty liver disease in patients with abdominal obesity
Komshilova K.A., Troshina E.A., Ershova E.V., Mazurina N.V., Platonova N.M.
Abstract
AIM. To compare clinical, laboratory, and morphological parameters in patients with abdominal obesity and non-alcoholic fatty liver disease (NAFLD) and to assess the relationship between the degree and stage of the disease and the cardiometabolic risk factors of type 2 diabetes mellitus and cardiovascular diseases. MATERIALS AND METHODS. Eighty patients aged 30 to 50 years with abdominal obesity were examined. NAFLD was diagnosed after liver puncture biopsy. The parameters of carbohydrate and lipid metabolism and the activity of hepatic transaminases and the protective adipocytokine adiponectin were investigated. RESULTS. NAFLD was verified in 77 examinees. Metabolic disturbances were found in the majority of the examinees with abdominal obesity and NAFLD; they were concurrent and increased in their rate and degree with the progression of NAFLD, obesity, and insulin resistance. The patients with NAFLD had a significantly decreased adiponectin level that got worse as NAFLD progressed. CONCLUSION. The investigation has revealed that NAFLD is associated with cardiometabolic disorders (dyslipidemia, carbohydrate metabolic disturbances, and insulin resistance) increasing in their rate and degree with the progression of NAFLD and the lower adiponectin level reducing as NAFLD worsens.
Terapevticheskii arkhiv. 2014;86(10):27-32
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The levels of resistin and other adipokines in patients with hypothyroidism
Verbovaia N.I., Kapralova I.I., Verbovoĭ A.F.
Abstract
AIM. To investigate the relationship of resistin, adiponectin, leptin, and hormone metabolic parameters in patients with hypothyroidism. MATERIALS AND METHODS. Ninety-three women aged 58.0 (53.0-63.0) years with hypothyroidism were examined. A control group consisted of 10 women aged 48 (47-50) years. Anthropometric characteristics, glucose and lipid metabolic parameters, and leptin, resistin, adiponectin levels were studied. RESULTS. The patients with hypothyroidism were found to have statistically significantly enhanced insulin resistance (IR) and compensatory hyperinsulinemia in the presence of android fat distribution. The found atherogenic dyslipidemia manifested itself as an increase in the levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol, and atherogenic index and as a reduction in high-density lipoprotein cholesterol. The concentration of leptin and resistin was increased and that of adiponectin was reduced in the patients with hypothyroidism. There was a correlation of leptin and adiponectin with fat metabolic parameters. CONCLUSION. The women with hypothyroidism had enhanced IR, as well as compensatory hyperinsulinemia in the presence of android fat distribution. Hypothyroidism is accompanied by the development of atherogenic dyslipidemia. The concentration of leptin and resistin was elevated and that of adiponectin was reduced in the examinees.
Terapevticheskii arkhiv. 2014;86(10):33-35
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Modifying effect of physical activity on genetic predisposition to obesity
Egorova É.S., Mustafina M.M., Gabbasov R.T., Borisova A.V., Akhmetov I.I.
Abstract
AIM. To evaluate the modifying effect of physical activity on the association of ADRB3, CLOCK, FABP2, FTO, PPARA, PPARD, PPARG, PPARGC1A, SHBG, UCP2 and UCP3 gene polymorphisms with body mass index (BMI), body fat mass, and risk of obesity. MATERIALS AND METHODS. The investigation enrolled 582 students and 215 athletes who showed moderate and high physical activities, respectively. The students' body composition was estimated with a DIAMANT-AST bioimpedance analyzer. Gene polymorphisms were determined by polymerase chain reaction (PCR) or real-time PCR. RESULTS. No differences in the rate of obesity risk alleles were found between normal-weight, and overweight or obese students. Correlation analysis in the total group of students revealed an association of the A allele of the FTO gene with BMI (р=0.0011) and body fat mass (р=0.0031). Comprehensive analysis summarizing the total number of obesity risk alleles for 7 polymorphisms of the PPARA, PPARD, PPARG, PPARGC1A, FTO, FABP2, and UCP2) genes in each individual showed that a subgroup of male students having a large number of obesity risk alleles (4-9) had higher BMI (22.6±2.73 kg/m2) than that of students having a small number of obesity risk alleles (20.8±2.81 kg/m2; р=0.0209). This pattern was not observed in the group of athletes regardless of gender and sports specialization. CONCLUSION. This investigation has demonstrated that physical activity has modifying effects on individuals who are genetically predisposed to obesity. Moderate and high physical activity considerably reduces the risk of obesity even in the presence of genetic risk factors.
Terapevticheskii arkhiv. 2014;86(10):36-39
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Effect of erythropoietin and its combination with hypoxic altitude chamber training on the clinical and functional manifestations of chronic glomerulonephritis
Kaliev R., Murkamilov I.T., Fomin V.V., Kaliev K.R., Aver'ianova N.I.
Abstract
AIM. To evaluate the efficiency of treatment for renal anemia in patients with chronic glomerulonephritis (CGN), by using erythropoietin and its combination with hypoxic altitude chamber training (HACT). MATERIALS AND METHODS. Sixty-three patients (41 men and 22 women) (mean age 37.1±13.3 years) with CGN during the predialysis phase of chronic kidney disease (CKD) complicated by anemia. Hemoglobin (Hb), packed cell volume (PCV), and red blood cell indices (mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC)), platelet count, serum iron, fibrinogen, C-reactive protein (CRP) and creatinine levels were determined in all the patients at baseline and during a prospective follow-up. Glomerular filtration rate (GFR) was measured using with the Rehberg-Tareev test. Along with standard renal protective therapy, all the patients received either epoetin beta (n=31; Group 1) or its combination with HACT (n=32; Group 2). In Group 1 patients (n=31), erythropoietin (EPO) was given in an initial dose of 20-50 IU/kg thrice daily, followed by the dose being adjusted until the target Hb level was reached. Group 2 patients (n=32) received HACT cycles by the standard procedure in combination with EPO given in lower doses (20-50 IU/kg once weekly). A prospective follow-up of the patients was carried out during one year. RESULTS. Following one year, the number of patients who had achieved the target Hb level was 74.1% in Group 1 and 87.5% in Group 2. Over time, there were increases in the concentration of Hb (from 108.6±19.4 to 124.5±14.09 g/l; p<0.05), PCV, and red blood cell indices (MCV, MCHC) in the patients receiving EPO (Group 1). Besides an anti-anemic effect, there was a significant decrease in the concentrations of fibrinogen from 6655 (4884-7634) to 3776 (3330-4884) mg/dL; (p<0.05), serum creatinine from 159 (89-261) to 138 (79-258) µmol/l (p<0,05), proteinuria from 2.955 (1.024-6.745) to 2.069 (0.539-4.279) (p<0.05), which was accompanied by an increase in GFR from 62.3 (37.0-107.4) to 76.9 (46.0-96.0) ml/min (p<0.05). In Group 2, the rise in the concentration of Hb (from 114.1±11.7 to 132.0±16.5 g/l (p<0.05), PCV, MCV, and MCHC proved to be more pronounced than that in Group 1 (p<0.05) and accompanied by an elevation in the counts of platelets (from 222.7±19.8·109/l to 249.3±21.9·109/l (p<0.05)) and red blood cells (from 4.0±0.4·1012/l to 4.34±0.3·1012/l (p<0.05)). There was a more marked reduction in the degree of proteinuria from 3.092 (0.764-7.694) g at baseline to 1.600 (0.677-4.078) g one year later (p<0.05) than that in Group 1 (p<0.05). The increase in GFR from 60.1 (46.0-96.0) to 79.4 (44.0-120.0) ml/min (p<0.05) and the fall in the concentration of fibrinogen from 5555 (4884-7770) to 4107 (3776-5328) mg/dL (p<0.05) and serum creatinine from 166 (92-273) to 147 (92-152) µmol/L (p<0.05), which were observed in Group 2, were comparable to those in Group 1. CONCLUSION. Epoetin beta used in patients with CGN has an anti-anemic effect and leads to improved renal nitrogen-excretory function. Erythropoietin in combination with HACT used in CGN provides a higher anti-anemic efficacy and a more pronounced antiproteinuric effect.
Terapevticheskii arkhiv. 2014;86(10):40-46
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Comparative characteristics of carotid atherosclerosis in patients with hypertension concurrent with chronic coronary heart disease among the indigenous and non-indigenous population of the Yamal-Nenets Autonomic District
Gapon L.I., Sereda T.V., Leont'eva A.V., Gul'tiaeva E.P.
Abstract
AIM. To evaluate the degree of carotid artery (CA) atherosclerotic lesion and lipid metabolic disturbances in patients with hypertension and in those with hypertension concurrent with coronary heart disease (CHD) in the indigenous and non-indigenous population living in the Yamal-Nenets Autonomic District. MATERIALS AND METHODS. Two hundred men and women aged 21 to 55 years (mean age 48.2±0.7 years), who resided in the Far North, were examined. The patients were divided into 4 gender-and age-matched groups of 50 persons in each: 1) natives; 2) newcomers with hypertension only; 3) natives with CHD and hypertension; 4) non-natives with the above conditions. To study CA involvement, all the patients underwent duplex scanning of the brachiocephalic arteries at the extracranial level and blood lipid analysis in an outpatient setting (Salekhard). RESULTS. In all the patients, common CA intima-media thickness was significantly greater than the upper limit of the normal range defined in the Guidelines, this indicator proved to be highest in the groups of indigenous people (p<0.001). The latter with CHD and hypertension more commonly tended to have atherosclerotic lesion in the left CA (p=0.06) than the non-indigenous people whereas the number of stenosis in other CAs was similar. In the natives versus the newcomers with CHD and hypertension, the atherogenic blood lipid composition was due to the higher levels of total cholesterol and low-density lipoproteins. In the non-indigenous patients with CHD and hypertension, the atherogenicity of the blood lipid composition was characterized by the higher levels of triglycerides (p=0.04) and very low-density lipoproteins (p=0.02) with the lower concentrations of high-density lipoproteins as compared to those in the natives with CHD and hypertension.
Terapevticheskii arkhiv. 2014;86(10):47-51
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The 2013-2014 epidemic season. Hospital monitoring and antiviral therapy for influenza
Kolobukhina L.V., Burtseva E.I., Shchelkanov M.I., Al'khovskiĭ S.V., Prilipov A.G., Merkulova L.N., Kisteneva L.B., Vartanian R.V., Kruzhkova I.S., Trushakova S.V., Krasnoslobovtsev K.G., Avdeev S.N., Sutochnikova O.A., Bazarova M.V., Kelli E.I., Ambrosi O.E., Malyshev N.A., L'vov D.K., Chuchalin A.G.
Abstract
AIM. To characterize the 2013-2014 epidemic season from the results of detection of influenza infection in patients; to provide the molecular genetic characteristics of the strains isolated from deceased patients. MATERIALS AND METHODS. The investigators examined 1203 patients (387 children, 509 people older than 16 years of age, 307 pregnant women) admitted to Moscow Clinical Infectious Diseases Hospital One with the clinical signs of acute respiratory viral diseases. Nasal lavage and autopsy specimens were used to isolate viral strains, then to sequence genomic fragments, and to determine receptor specificity. RESULTS. Out of the 1203 examinees, 284 (23.6%) were influenza-positive: 221 (77.8%), 24 (8.5%), and 39 (13.7%) patients had influenza A(H3N2), influenza A(H1N1)pdm09, and influenza B, respectively. Influenza was notified in 42,7% of the pregnant women. There was a preponderance of its moderate form; its severe form developed in single cases having comorbidities. One fatal outcome was registered. The intake of antiviral medications in the first 48 hours of the disease could prevent complications. The investigators revealed mutations in the strain isolated from the bronchoalveolar lavage fluid of a patient with severe pneumonia complicated by acute respiratory distress syndrome. CONCLUSION. There is evidence that there are mutant A(H1N1)pdm09 viruses that have high pneumotropicity. The high risk of their circulation in the population and the risk of severe influenza forms involving the lower respiratory tract remain. Early antiviral therapy in the first 36-48 hours diminishes the clinical manifestations of influenza and reduces the risk of developing complications.
Terapevticheskii arkhiv. 2014;86(10):52-59
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Preliminary results of an open-label observational study evaluating the efficacy and safety of Prolia used in women with postmenopausal osteoporosis
Ershova O.B., Lesniak O.M., Belova K.I., Nazarova A.V., Manovitskaia A.V., Musaeva T.M., Mustaev R.M., Nurlygaianov R.Z., Rozhinskaia L.I., Skripnikova I.A., Toroptsova N.V.
Abstract
AIM. To evaluate the efficacy and safety of Denosumab (Prolia), a first-line osteoporosis (OP) medication that is a fully human monoclonal antibody to the receptor activator of nuclear factor κВ ligand (RANKL), within an open-label observational study. MATERIALS AND METHODS. Patients aged 50 years or older with postmenopausal OP, who were treated with Prolia in clinical practice, were examined. The concentrations of the bone resorption (BR) marker of C-terminal telopeptide and other laboratory indicators (total serum calcium, total alkaline phosphatase, and creatinine) were measured following 3 months. Adverse drug reactions were recorded. RESULTS. Three months after initiation of the investigation, there was a significant decrease in the BR marker C-terminal telopeptide (by 89%; p<0.0001). There were rare adverse reactions: hypocalcemia in 3 (5.9%) patients, arthralgias in 2 (3.9%), and eczema in 1 (1.9%). There were neither serious adverse events nor study withdrawal cases. CONCLUSION. The preliminary results of the open-label study of Prolia in postmenopausal OP suggest that the significantly lower BR activity determines the efficacy of this drug and its high safety.
Terapevticheskii arkhiv. 2014;86(10):60-64
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Clinical efficacy of the antimicrobial drug furamag in nosocomial urinary tract infections
Iakovlev S.V., Suvorova M.P., Kolendo S.E., Burmistrova E.N., Sergeeva E.V., Cherkasova N.A., Eremina L.V.
Abstract
AIM. To evaluate the efficacy of the combined drug furamag (furasidine potassium and magnesium hydroxycarbonate) in combination with the third-generation cephalosporin cefotaxime versus cephalosporin monotherapy for nosocomial urinary tract infections (NUTI). MATERIALS AND METHODS. The randomized open-label comparative parallel group clinical trial enrolled 52 male and female patients aged over 18 years with a documented diagnosis of NUTI. Group 1 (a study group) took oral furamag 300 mg/day in combination with intravenous cefotaxime 6 g/day; Group 2 (a control group) received cefotaxime monotherapy. The duration of therapy in both groups was 7 to 10 days until the efficiency levels were achieved. RESULTS. A final efficiency analysis was made in 24 and 25 patients from Groups 1 and 2 who had different forms of NUTI (catheter-associated NUTI, cystitis, pyelonephritis). On day 3 of treatment, most patients were noted to have a decreased systemic inflammatory response; lower C-reactive protein and procalcitonin levels being in the study group patients. The clinical efficiency of antibacterial therapy, which had been evaluated both immediately after treatment termination and during further control, did not substantially differ in the furamag/cefotaxime combination and control groups although there was an obvious tendency towards the more marked effect of combined therapy 7-14 days after treatment (11.8% efficiency differences; p>0.05). Analysis of bacteriological efficacy revealed its most pronounced and clinically significant differences between the groups: the cefotaxime/furamag combination led to higher pathogen eradication in all follow-up periods: after 3 days of treatment (82.6%) and following a complete therapy cycle (95.8%) versus the cefotaxime monotherapy group (43.5 and 70.8%, respectively; p<0.01). Microbiological results showed that the major NUTI pathogens (Escherichia coli, enterococci) were more susceptible to potassium furasidine (furamag) versus cefotaxime. The in vitro higher activity of furamag versus cefotaxime was attended by the significantly higher eradication of one of the two important NUTI pathogens - Enterococcus faecalis. CONCLUSION. Furamag used in combination with the third-generation cephalosporin cefotaxime showed a higher bacteriological efficacy and a rapider reduction in the symptoms of a systemic inflammatory response in patients with NUTI. On the basis of the findings, the above combination of furamag and cefotaxime may be recommended as first-line therapy for NUTI when multidrug-resistant nosocomial infection pathogens are widely distributed now.
Terapevticheskii arkhiv. 2014;86(10):65-72
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Latent forms of adult-onset autoimmune polyglandular syndrome: Diagnosis and management of patients
Larina A.A., Troshina E.A.
Abstract
Autoimmune polyglandular syndromes (APS) are an autoimmune involvement of two or more endocrine glands, which are characterized by multiple organ dysfunction. Four major types of APS are presently identified. There are APS types 2, 3, and 4 in adults. There are also latent and incomplete forms of adult-onset APS, the prevalence of which in the population is well above that of clinically apparent diseases. Latent disease may strongly affect the compensation and risk of complications of the underlying condition. The examination of APS risk-group patients includes the detection of genetic (HLA Class II haplotypes, CTLA-4, PTPN22, and FOXP3 genes, etc.) and immunological (antibodies) markers in autoimmune diseases and the determination of the residual function of the target organ. The treatment of autoimmune diseases in adult-onset APS is based on general principles; however, there are a number of specific features of using drugs for the concurrence of a few endocrine diseases. In this connection, the timely identification of risk groups for developing the clinical forms of APS in patients with one autoimmune endocrine disease.
Terapevticheskii arkhiv. 2014;86(10):73-76
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The problem of viral hepatitis C in the Russian Federation
Iushchuk N.D., Znoĭko O.O., Dudina K.R., Belyĭ P.A.
Abstract
The incidence of chronic viral hepatitides (CVH) has increased 2.2-fold in the Russian Federation over the past decade. This increase is mainly determined by an almost threefold rise in the incidence of chronic hepatitis C (CHC): from 12.9 in 1999 to 39.1 per 100,000 population in 2012. The calculated data of hepatitis C burden in the Russian Federation show that in 2010 the total medical and social losses and expenses associated with hepatitis C and its implications were 48.47 billion rubles or 0.108% of the gross domestic product, the direct medical costs were 17.1 billion (35.28%) rubles, GDP losses were 26.05 billion (53.75%) rubles, and the disability payments were 5.32 billion (10.97%) rubles. The patients (mean age 45 years) with liver cirrhosis (LC) were 15.2% in the structure of the CHC patients (mean age 37 years) admitted to Moscow infectious diseases hospitals in 2010. Analysis of the regional registers of the Russian Federation, the proportion of patients with LC among those with CHC was 18%. The existing forms for recording morbidity and mortality from poor CHC outcomes cannot significantly estimate the true disease stage distribution of patients and hepatitis C-associated disability and mortality rates. In this connection, it is necessary to introduce a federal register and to change recording forms for patients with viral hepatitides. Standard interferon, pegylated interferon alpha 2a and pegylated alpha 2b, and the HCV protease inhibitors telaprevir, boceprevir, and simeprevir have been registered for the treatment of hepatitis C in the Russian Federation.
Terapevticheskii arkhiv. 2014;86(10):77-81
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Students' free work at the Department of Internal Propedeutics is an important part of an educational process
Él'garov A.A., Kalmykova M.A., Él'garov M.A.
Abstract
The paper presents different forms of students' free work, which have been approved at the Department of Internal Propedeutics, such patient examination; preparation of a piece and an academic case history; night duties in a clinic; attending conferences on deontology; training in the simulation center, medical practice, assessment of practical skills and knowledge at the examination. These work forms enhance the efficiency of an educational process and extend the capabilities of mastering clinical examination methods and molding deontological culture in students.
Terapevticheskii arkhiv. 2014;86(10):82-86
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Multiple endocrine neoplasia type 1 variants and phenocopies
Mamedova E.O., Mokrysheva N.G., Przhiialkovskaia E.G., Pigarova E.A., Rozhinskaia L.I., Tiul'pakov A.N.
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant hereditary disease due to a mutation in the MEN1 tumor suppressor gene. The risk of the disease in first-degree relatives of MEN1 mutation carriers is 50%. MEN1 gene mutations are not identified in 10-30% of familiar MEN1 patients and in 60-80% of sporadic MEN1 cases, which can be explained by mutations in the noncoding regions of the MEN1 gene, large gene deletions or mutations in other yet unknown genes. Molecular genetic testing can exclude the diagnosis of MEN1 in patients who do not harbor the MEN1 mutation, thus revealing a MEN1 phenocopy. This obviates the need for annual screening for the early detection of other remaining components of the disease and its risk in progeny.
Terapevticheskii arkhiv. 2014;86(10):87-91
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Thyroid dysfunction and the hemostatic system
Platonova N.M., Sviridonova M.A., Troshina E.A.
Abstract
Whether there is a link between thyroid dysfunction and different impairments in the hemostatic system is discussed. The level of thyroid hormones is an essential factor that influences the coagulation system. Thyroid dysfunction affects the balance between coagulation and fibrinolysis, by increasing the risk of thrombosis and hemorrhage in hyperthyroidism. However, there is no consensus of opinion regarding the mechanisms of the described hemostatic changes in the literature.
Terapevticheskii arkhiv. 2014;86(10):92-96
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Simultaneous pancreas-kidney transplantation: patients' perspectives
Glazunova A.M., Shamkhalova M.S., Moĭsiuk I.G.
Abstract
Type 1 diabetes mellitus (DM1) is a chronic disease that may affect survival and quality of life in patients due to the development of acute and chronic complications. This review highlights the publications during the past decade on survival and the degree (stabilization/regression) of complications, such as diabetic retinopathy, nephropathy, neuropathy, and macrovascular events in DM1 patients with end-stage renal disease after simultaneous pancreas-kidney transplantation.
Terapevticheskii arkhiv. 2014;86(10):97-102
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Antithrombotic therapy after X-ray endovascular treatment: Are there specific features in patients with diabetes mellitus?
Bondarenko I.Z., Shirshina I.A., Kalashnikov V.I.
Abstract
According to the current guidelines for the intervention treatment of patients with coronary heart disease, the primary and secondary prevention of cardiovascular events is long-term pharmacotherapy with platelet function inhibitors. Although undeniable progress has been made in the use of this group of medicaments, there are, however, issues calling for further investigation in the population of diabetic patients in particular. Along with the general principles of thrombosis, there are mechanisms that cause additional platelet hyperactivity in the presence of insulin deficiency and insulin resistance, metabolic and cellular disorders induced by hyperglycemia. The risk of resistance to standard antithrombotic therapy suggests a search for alternative ways to inhibit platelet aggregation, which is particularly relevant in diabetic patients.
Terapevticheskii arkhiv. 2014;86(10):103-108
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Gestational diabetes mellitus: Yesterday, today, tomorrow
Burumkulova F.F., Petrukhin V.A.
Abstract
Gestational diabetes mellitus (GDM) is hyperglycemia that is first detected during pregnancy and does not meet the criteria for manifest diabetes. The incidence of GDM worldwide varies from 1 to 14% and that in Russia is as high as 4%. Hyperglycemia during pregnancy is associated with the development of preeclampsia, the birth of a big baby, emergency cesarean section, birth trauma, and neonatal hypoglycemia. The fact that there is no well-organized screening for GDM in our country leads to that the diagnosis of this condition is delayed for 4-20 weeks in 50-60% of cases. The risk group distribution of pregnant women leads to the diagnosis of GDM only in 50% of cases. At the same time, pregnancy is accompanied by physiological insulin resistance so the latter itself is a clinically important risk factor for carbohydrate metabolic disturbances. The Hyperglycemia and Adverse Pregnancy Outcomes (HYPO) study has indicated that the previously used diagnostic criteria for GDM require reconsideration. There is a need for uniform standards for the diagnosis and treatment of carbohydrate metabolic disturbances during pregnancy. The concepts "diabetes mellitus (DM)" and "manifest (new-onset DM during pregnancy" and directly "GDM" require clear clinical and laboratory definitions. Furthermore, GDM is a risk factor for obesity, type 2 DM and cardiovascular diseases in the mother and her offspring in future.
Terapevticheskii arkhiv. 2014;86(10):109-115
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Current approaches to diagnosing and treating nonalcoholic fatty liver disease
Drapkina O.M., Deeva T.A., Volkova N.P., Ivashkin V.T.
Abstract
Nonalcoholic fatty liver disease (NAFLD) is associated with major cardiovascular risk factors, such as type 2 diabetes mellitus, obesity, dyslipidemia, hypertension, and insulin resistance, and has been recently considered to be a new component of metabolic syndrome and it serves as a criterion for the hepatic manifestation of the latter. The review considers the present-day views and approaches to diagnosing and treating NAFLD and its dangerous manifestation - fibrosis (sclerosis), which may lead to cirrhosis and hepatocellular carcinoma. Fibrogenesis is a widespread and universal process that is a final path of chronic inflammation of and damage to different tissues (including those of the liver and cardiovascular system). Although the mechanisms for developing NAFLD remain unclear, insulin resistance, an obesity-related slowly progressive inflammatory response, and elevated levels of free fatty acids with their lipotoxicity along with possible genetic, dietary, and environmental (lifestyle) factors play a key role in the pathogenesis of this disease. So it is important for patients at high risk for NAFLD or with existing liver disease to pay attention to their life style, proper balanced diet, and slow and gradual weight loss. At present there are drugs that can improve liver function. Success in NAFLD therapy will be determined by the identification of the most significant pathogenetic factors in a specific patient and by the purposeful action on them.
Terapevticheskii arkhiv. 2014;86(10):116-123
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Full-dose combinations of antihypertensive drugs: What has changed in experts' guidelines?
Fomin V.V., Svistunov A.A.
Abstract
The 2013 European Society of Hypertension guidelines, including treatment policy changes presupposing that one two-component combination of antihypertensive agents may be substituted for another and their full-dose combinations may be prescribed if monotherapy is ineffective, are discussed. A rationale is provided for the most effective two-component full-dose combinations of antihypertensive drugs.
Terapevticheskii arkhiv. 2014;86(10):124-127
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Rinsing in the combination therapy of tonsillopharyngitis
Nosulia E.V.
Abstract
The paper gives the current aspects of the etiology and pathogenesis of acute tonsillopharyngitis and its complications. Correct evaluation of the clinical manifestations of the disease is noted to be of importance in choosing adequate treatment policy and preventing unfavorable trends in the development of the disease. Antibacterial therapy for streptococcal tonsillopharyngitis is emphasized to be of significance. The paper shows that it is expedient to perform irrigation procedures (different types of rinsing) that ensure a significant contact area and optimal conditions for the better local effect of antibacterial solutions, in particular furasol, a nitrofuran derivative (the active ingredient is furasidine potassium; the excipient is sodium chloride). There are clinical findings suggesting that furasol has a positive effect on the intensity and duration of oropharyngeal inflammatory changes, suggesting that it is advisable to use it in respective clinical situations.
Terapevticheskii arkhiv. 2014;86(10):128-131
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