Vol 86, No 12 (2014)

The paper presents the new principles relative to adequate diagnosis, management tactics, and rational treatment regimens in patients with gastroesophageal reflux disease (GERD) complicated by the development of Barrett's esophagus. The paper contains up-to-date, mainly original information on the pathological physiology, clinical picture, and principles of diagnosis of this form of GERD. It outlines data on approaches to the early diagnosis and prevention of neoplastic progression in Barrett's esophagus, by taking into account recent advances in pharmacotherapy.

AIM. To estimate central (aortic) blood pressure (BP) and arterial stiffness and their prognostic value in the development of preeclampsia (PE) in pregnant women with different forms of hypertension. MATERIALS AND METHODS. The study included 106 patients with chronic hypertension, 21 with the latter concurrent with PE, 63 with gestational hypertension, 10 with PE, and 100 without hypertension. All the women underwent 24-hour BP monitoring by an oscillometric method to estimate central (aortic) BP and arterial stiffness at 16-22 weeks' gestation. RESULTS. The highest average daily central systolic and diastolic BP was in the pregnant women with PE. ROC analysis showed that the average daily aortic systolic BP greater than 115 mm Hg was most significant for the prediction of PE. The highest values of arterial stiffness (augmentation index, stiffness, maximum rate of blood pressure rise) were detected in the pregnant women with PE in the presence of chronic hypertension. Conclusion. 24-four BP monitoring in pregnant women can provide additional characteristics that reflect the stiffness of the aorta and peripheral arteries, which may be used to predict PE.

AIM. To reveal an association of the prevalence of coronary heart disease (CHD) and metabolic syndrome (MS) with a high level of depression in the open population of 25-64-year-old men in an average urbanized Siberian town. MATERIALS AND METHODS. The survey was conducted on a representative sample formed from the voting list of 25-64-year-old men in one of the administrative districts of Tyumen. The standard WHO MONICA-psychosocial questionnaire was used to study associations of the prevalence of CHD and MS with a high level of depression within cardiologic screening. RESULTS. The age-adjusted prevalence of depression was 4.6% (a high rate) and 19% (a moderate rate) in the 25-64-year-old men of the average urbanized town of West Siberia. With advancing age, the high level of depression increased, peaking in a 55-64-year-old group. In high depression and CHD in the 25-64-year-old men, the odds ratio (OR) was 21.07 for high depression and 39.84 for a definite CHD form. High depression was significantly more common in MS patients in the open population of 25-64-year-old people of the average urbanized Siberian town and in the 55-64 year old age group. An association was found between high depression and a combination of MS components: a concurrence of abdominal obesity, hypertriglyceridemia, and lower high-density lipoprotein cholesterol (OR 13.13). Conclusion. The epidemiological criteria revealed by standardized survey methods for psychosocial factors, depression in particular, should be used during the preventive examinations of a male population and during the selection of able-bodied people with cardiovascular disease to undergo in-depth examination and follow-up.

AIM. To evaluate the efficiency and safety of monotherapy with bendamustine (B) and therapy with B in combination with rituximab (B + R) in patients with chronic lymphocytic leukemia (CLL) accompanied by renal failure (RF). MATERIALS AND METHODS. The prospective pilot study included 8 patients (6 men, 2 women) with CLL concurrent with RF. The patients' median age was 63 years (51-77 years). The Binet classification stage of CLL corresponded to B in 2 cases and C in 6. The mean (± standard error) pretreatment concentration of creatinine was 218±92 µmol/l and the glomerular filtration rate (GFR) was 33±20 ml/min. The efficiency of monotherapy with B (n=5) and combination therapy with B + R (n=3) was evaluated. In progressive CLL, therapy was performed in specific treatment-naïve patients (n=5) and in pretreated patients refractory to alkylating agents (cyclophosphan, chlorambucil) (n=3). A total of cycles of B and B + R were carried out. RESULTS. After B monotherapy, one of the 5 cases achieved a complete remission, 3 a partial remission, and 1 a nodular partial remission. Three patients developed recurrence. In the B monotherapy group, the cumulative risk of recurrence was 70% at a median follow-up of 22 months and at a maximum follow-up of 27 months. In the B + R therapy group, all the 3 patients achieved a complete remission. The median follow-up was 7 months; the maximum follow-up was 1 year. There were no deaths or recurrences. During B monotherapy and B + R combination therapy, there was improved kidney function: the mean concentration of creatinine decreased from 218±92 to 140±57 µmol/l (p<0.05); GFR increased from 33±20.0 to 54±25 ml/min; the mean increment was 20 ml/min (p<0.01). Mild and moderate anemia and thrombocytopenia were most common during B and B + R therapies. Neutropenia with mild infection complications, as well as nonhematologic complications were detected in some cases. The drugs were observed to have no nephrotoxic effects. Conclusion. The performed pilot prospective indicated that the B + R combination therapy was effective in patients with RF-associated CLL. No toxic effect of B on kidney function was seen. During B therapy, there was better kidney function manifesting itself as a statistically and clinically important decrease in creatinine concentrations and a statistically and clinically important increase in GFR as compared to the baseline values.

AIM. To evaluate the efficiency and safety of using statins in combination with ursodeoxycholic acid (UDCA) in patients with this or another liver disease at high risk for cardiovascular events (CVE). MATERIALS AND METHODS. A register of 262 patients at high risk for CCE who needed statin therapy and have concomitant chronic liver and biliary tract diseases was created in 5 cities of the Russian Federation. RESULTS. After addition of statins or adjustment of their doses, the patients were recommended to include UDCA into their therapy. Six months after stabilization of the dose of statins, the whole group showed a significant reduction in the levels of total cholesterol and low-density lipoprotein (LDL) cholesterol. Assessment of the laboratory parameters responsible for the safety of statin intake revealed no deterioration in the trend in the activity of alanine aminotransferase, aspartate aminotransferase, creatine phosphokinase, lactate dehydrogenase, as well as an increase in the serum level of bilirubin. The data obtained using a special questionnaire indicated that 196 patients had taken UDCA and 56 had not. The UDCA and non-UDCA subgroups did not differ in age, weight, or baseline lipid metabolic disturbances. An additional analysis showed that by the end of 6 months, the goal levels of LDL cholesterol in the UDCA and non-UDCA groups were reached in 37 and 20%, respectively (p=0.01). Conclusion. UDCA added to statin therapy in patients at high risk for CVE and concurrent liver diseases contributes to an additional reduction in total cholesterol and LDL cholesterol and prevents enhanced hepatic transaminase activities.

AIM. To study cognitive and emotional impairments in patients with anxiety-phobic disorders (APDs), to comparatively analyze the clinical manifestations of acute (less than one-year) and protracted (1-to-5-year) forms of this disease, and to evaluate the efficacy of noofen used to treat this pathology. MATERIALS AND METHODS. Sixty-two patients aged 18 to 50 years with APDs were examined. The investigators collected clinical history data, performed neurological examination, and assessed autonomic disorders in accordance with the questionnaire to reveal their signs, anxiety using the Hamilton anxiety rating scale, memory impairment employing the methods developed by A.R. Luria, attention disorders applying the test of variables of attention, and diagnosed emotional intelligence using the Mayer-Salovey-Caruso emotional intelligence test. Noofen 1000 mg/day was used to treat the patients. RESULTS. Protracted APDs were shown to be characterized by the higher degree of psychosomatic symptoms and by more pronounced impairments in attention, memory, and emotional intelligence. The data of posttreatment clinical and psychological studies are indicative of improvements in 73.3% of cases. Conclusion. The findings may lead to the conclusion that noofen is highly effective in the treatment of patients with protracted APDs.

AIM. To study the impact of simulated climatic conditions of the 2010 summer in Moscow on the telomere repeats of chromosomes in human blood cells. MATERIALS AND METHODS. The climatic conditions of July-August 2010 in Moscow were simulated at the Medical Technical Complex, Institute of Biomedical Problems, Russian Academy of Sciences. The relative length of the telomeric repeats of blood cell chromosomes from 6 apparently healthy volunteers was measured by quantitative real-time polymerase chain reaction. RESULTS. These conditions were ascertained to lead to a statistically significant decline in the length of telomere repeats in the terminal portions of chromosomes by 15%. Conclusion. Environmental changes and abnormal temperature rises may result in oxidative stress accompanied by telomere shortening, which can be, in turn, a factor of premature aging.

The paper describes a clinical case of the efficacy of a fixed-dose combination of perindopril and amlodipine used in a hypertensive patient. It shows its clinical effectiveness with no impact on blood lipid and glucose levels. 24-hour blood pressure monitoring revealed a reduction in daily blood pressure, including its variability, in pulse wave propagation velocity and central aortic pressure.

The review gives the results of a many-sided study of the basic properties of the therapeutic molecule of azoximer bromide (polyoxidonium). It analyzes our experience with the immunomodulator used to treat acute respiratory infections. Polyoxidonium has marked immunomodulatory (including interferon-producing) activity and a nonspecific protective effect against a broad range of pathogens, which is based on the regulation of systemic immunity rather than the direct inhibition of microorganisms. In addition, the drug has antitoxic and antioxidant properties. Azoximer bromide is used in combination with etiotropic therapy in the acute phase of disease and as monotherapy for rehabilitation or immunoprophylaxis of respiratory infections.

The paper considers the consequences and causes of magnesium deficiency in patients with cardiovascular diseases. The features of magnesium metabolism in atherosclerosis, hypertension, and heart failure are described. Prospects of magnesium therapy in cardiology practice are discussed.

The role of the ghrelin-obestatin system in health and disease is multifaceted and new ample evidence has been recently accumulated. Ghrelin was discovered much earlier than obestatin so the biological, physiological and pathophysiological, pharmacological aspects of its activity could be studied far better than obestatin. There is no question that these hormones are not antagonists and they are a uniform system. However, there is a need for further studies of the role of this system in the body's vital functions in health and disease. The paper analyzes the accumulated information on the ghrelin-obestatin system in health and disease, assesses the possibility of their use in clinical practice, and pays attention to the unsolved problems to be explored and solved.

The term mastocytosis (MC) encompasses a group of rare diseases characterized by the tumorous proliferation of clonal mast cells and the infiltration of one or several organs. The clinical picture of MC is extremely diverse from skin lesions that can spontaneously regress to the aggressive disease forms associated with organ dysfunction and short survival. Nowadays, the 2008 WHO classification identifies 7 MC subtypes. The disease is diagnosed on the basis of its clinical manifestations and detection of tumorous mast cell infiltrations via morphological, immunohistochemical, immunophenotypic, genetic, and molecular examinations. Abnormal mast cells are characterized by the atypical morphology and pathological expression of CD25 and CD2 antigens. Enhanced serum tryptase activity is a common sign in all MC subtypes. More than 90% of the patients have D816V KIT mutations in the mast cells. This paper reviews the literature. Three cases are described as a clinical example in patients with different MC subtypes.