Vol 86, No 12 (2014)

Editorial
Prospects for improving the management tactics for patients with gastroesophageal reflux disease complicated by Barrett's esophagus
Maev I.V., Trukhmanov A.S.
Abstract
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.
Terapevticheskii arkhiv. 2014;86(12):5-9
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Capabilities of 99mTc-pyrphotech single-photon emission computed tomography in combination with myocardial perfusion scintigraphy in the evaluation of inflammatory changes in the heart of patients with persistent atrial fibrillation
Sazonova S.I., Lishmanov I.B., Batalov R.E., Popov S.V., Il'iushenkova I.N., Rogovskaia I.V., Idrisov M.Z.
Abstract
AIM. To estimate the capabilities of 99mTc-pyrphotech single-photon emission computed tomography (SPECT) in the diagnosis of myocardial inflammatory changes in patients with persistent atrial fibrillation (AF). MATERIALS AND METHODS. Nineteen patients (11 males and 8 females, mean age 47.46±9.92 years) with persistent idiopathic AF underwent preoperative complete clinical and instrumental examination. 99mTc-pyrphotech SPECT was performed to identify foci of myocardial inflammatory changes. After completing 99mTC-pyrphotech scanning, resting myocardial perfusion scintigraphy with 99mTC-methoxyisobutylisonitrile (99mTc-MIBI) was performed in accordance with the standard protocol. The scintigrams obtained in both studies were then combined using the applied programs Jet Stream Workspace Release 2.5 (Philips) and the application Fusion. During invasive intervention, endomyocardial samples were intraoperatively taken from all the patients for histological and immunohistochemical examinations. RESULTS. Abnormal 99mTc-pyrphotech myocardial accumulation was found in 7 (36.8%) of the examinees, multiple foci in 3 cases and single foci in 4. Analysis of perfusion scintigrams indicated that the mean abnormal accumulation of 99mTc-MIBI in the left ventricle was 3.75±0.88% (maximum 9%).Histological examination of endomyocardial samples from 19 patients with persistent AF verified myocarditis in 4 (21%) patients and myocardial sclerosis concurrent with other abnormalities in 15 (78.9%) patients. CONCLUSION. Latent lymphocytic or polymorphic cellular myocarditis of viral etiology is a cause of idiopathic AF in 20% of the cases. 99mTc-pyrphotech scintigraphy may be one of the primary noninvasive diagnostic techniques for the detection of myocardial inflammation in this form of arrhythmia.
Terapevticheskii arkhiv. 2014;86(12):10-14
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Estimation of central blood pressure and arterial stiffness in pregnant women with different forms of hypertension
Chulkov V.S., Vereina N.K., Sinitsyn S.P., Dolgushina V.F.
Abstract
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.
Terapevticheskii arkhiv. 2014;86(12):15-19
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Trends in hospitalizations of patients with acute coronary syndrome and indicators of the atmospheric state in Moscow in 2009-2012
Kozlovskaia I.L., Bulkina O.S., Lopukhova V.V., Kolmakova T.E., Karpov I.A., Starostin I.V., Baratashvili V.L., Rubinshteĭn K.G., Emelina S.V., Borovikov V.P.
Abstract
AIM. To identify the meteorological factors or their combinations, which are most significant for the development of acute coronary syndrome (ACS) in different seasons. MATERIALS AND METHODS. A Statistica package was used to make an exploration analysis of the data of the A.S. Puchkov Central Emergency Medical Care Station on 63,412 admissions of patients diagnosed with acute myocardial infarction (AMI) to Moscow hospitals in 2009-2012 and those of the Hydrometeorology Center of Russia on weather conditions in the period under study. RESULTS. Among the 63,412 patients, there were more men than women (p<0.000005). Two long frost periods and three long abnormal heat periods were recorded in 2009-2012. In summer, the number of patients with a prehospital diagnosis of AMI was an average 19-22% less than in the other seasons. There was no peak in the number of hospitalizations during the abnormally hot summer of 2010. Air temperature proved to be a factor that was most strongly associated with the trend in AMI hospitalizations in men (MS=1011.52, MSor=27.27; p<0.00005) and women (MS=895.36, MSor=25.37; p<0.00005). The number of hospitalizations was negatively associated with daily average temperature in its positive range. In summer, the interdaily temperature difference turned out to be statistically significant; the highest number of hospitalizations was noted when it grew 6 °C colder. On days off, the number of admitted patients was 25% less than that on weekdays. Conclusion. The trend in hospitalizations for a referral diagnosis of AMI has a significant seasonal component. Their number was minimal in summer, including in the abnormally hot summer of 2010. Air temperature is the most important factor. Positive temperature was found to be strongly negatively correlated with diagnosed AMI hospitalizations.
Terapevticheskii arkhiv. 2014;86(12):20-26
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Associations of the prevalence of cardiovascular diseases with a high level of depression in the open population of an average urbanized Siberian town
Akimova E.V., Kuznetsov V.A., Kaiumova M.M., Gafarov V.V., Kaiumov R.K., Gakova E.I., Smaznov V.I.
Abstract
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.
Terapevticheskii arkhiv. 2014;86(12):27-32
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Use of high-frequency chest wall oscillation in an exacerbation of chronic pyo-obstructive bronchitis in adult patients with cystic fibrosis
Amelina E.L., Krasovskiĭ S.A., Usacheva M.V., Krylova N.A.
Abstract
AIM. To evaluate the efficiency of high-frequency chest wall oscillation in the treatment of an exacerbation of chronic pyo-obstructive bronchitis in adult patients with cystic fibrosis (CF). MATERIALS AND METHODS. A simple open-label comparative study enrolled 31 patients with CF. C-reactive protein (CRP), spirometric indicators (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow), hemoglobin oxygen saturation, anthropometric data, six-minute walk test, and dyspnea rating by the MRC scale were assessed before treatment and on the last day of hospitalization. All the patients received conventional drug therapy; the study group patients (n=15) had the latter in combination with vibration-compression therapy for 15 minutes twice daily at a vibration frequency of 9-12 Hz and at an amplitude of 6-9 bars; the treatment cycle lasted 12-14 days. RESULTS. Both groups showed significant changes in spirometric and pulsometric readings, 6-minute walk test results, and MRC score. Body mass index increased and CRP decreased in the majority of patients in both groups. There were significant group differences in functional and anthropometric changes: 10.0±4.6 and 6.9±3.6% for FEV1 (p=0.04) and 9.5±4.8 and 5.9±3.8% for FVC (p=0.03) in the study and control groups, respectively. Conclusion. Incorporation of vibration-compression therapy (Vest vibro drainage) into the combination treatment of adult patients with CF results in significantly improved bronchial patency and more effective abolishment of an exacerbation.
Terapevticheskii arkhiv. 2014;86(12):33-36
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Chronic lymphocytic leukemia accompanied by renal failure
Dzhumabaeva B.T., Biriukova L.S., Gemdzhian É.G., Kravchenko S.K., Melikian A.L., Roshchina L.S.
Abstract
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.
Terapevticheskii arkhiv. 2014;86(12):37-41
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Etoricoxib in the treatment of active sacroiliitis in patients with axial spondyloarthritis, including ankylosing spondylitis
Gaĭdukova I.Z., Rebrov A.P., Nam I.F., Kirsanova N.V.
Abstract
AIM. To study a trend in active sacroiliitis (ASI) in patients with axial spondyloarthritis (axSpA) during different short-term regimens using etoricoxib (ET) 90 mg. MATERIALS AND METHODS. Forty patients with axSpA, including 30 with ankylosing spondyloarthritis), and ASI (sacroiliac joint (SIJ) osteitis as evidenced by magnetic resonance imaging) were examined and then randomized to 2 groups: 1) 20 patients who took ET 90 mg four days or more a week; 2) 20 patients who received ET 90 mg 3 days or less a week. Osteitis was measured in 4 quadrants of each SIJ (0-3 scores). Its main criterion was considered to be a decrease in total osteitis activity (TOA) 12 week later. RESULTS. In all the patients (n=40), TOA decreased from 6.5 (4; 9) to 2 (0; 5) scores (p<0.0001). In Group 1 (n=20), that reduced from 6.5 (4; 8.5) to 0 (0; 3) scores (p<0.0001). In Group 2 (n=20), that did from 6.5 (4; 10) to 4 (1; 8) scores (p=0.49). At 12 weeks, in in Groups 1 and 2, the difference in final TOA achieved no statistical significance (p=0.056). In these groups, there were 19 (95%) and 14 (70%) treatment-responsive patients, respectively. Conclusion. The intake of ET 90 mg for 12-weeks is associated with a reduction in the degree of ASI in patients with axSpA. The use of ET 4 times or more a week is more effective in diminishing osteitis than that of ET 3 days or less.
Terapevticheskii arkhiv. 2014;86(12):42-47
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Ursodeoxycholic acid-enhanced efficiency and safety of statin therapy in patients with liver, gallbladder, and/or biliary tract diseases: The RACURS study
Martsevich S.I., Kutishenko N.P., Drozdova L.I., Lerman O.V., Nevzorova V.A., Reznik I.I., Shavkuta G.V., Iakhontov D.A.
Abstract
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.
Terapevticheskii arkhiv. 2014;86(12):48-52
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The prevalence of anxiety and depression in different regions of the Russian Federation and its association with sociodemographic factors (according to the data of the ESSE-RF study)
Shal'nova S.A., Evstifeeva E.S., Deev A.D., Artamonova G.V., Gatagonova T.M., Dupliakov D.V., Efanov A.I., Zhernakova I.V., Konradi A.O., Libis R.A., Minakov É.V., Nedogoda S.V., Oshchepkova E.V., Romanchuk S.V., Rotar' O.P., Trubacheva I.A., Shliakhto E.V., Boĭtsov S.A.
Abstract
AIM. To study the prevalence of anxiety and depression by psychometric methods (the Hospital Anxiety and Depression Scale (HADS) in different regions of the Russian Federation (RF), which are characterized by various climatic, geographic, economic, and demographic indicators. MATERIALS AND METHODS. The investigation used the data of the multicenter epidemiological survey of cardiovascular diseases in different regions of the Russian Federation - the ESSE-RF study. The subjects of the study were representative samples from unorganized male and female populations aged 25-64 years from 10 RF regions. The survey included a total 16,877 people (6244 men and 10,623 women). All the examinees were interviewed using a standard questionnaire. An analysis involved their gender, age, education level, place and region of residence, and income and morbidity level. The HADS validated in Russia was used to rate the level of anxiety/depression. RESULTS. The total prevalence of higher anxiety and depression averaged 46.3 and 25.6%, respectively. Respondents with clinical anxiety/depression constituted more than one third of those who had a higher level of these conditions. In the examined population, the moderate level of anxiety/depression was 7.5±0.06 and 5.1±0.04, respectively. The population of Volgograd, Samara, Saint Petersburg, and Tomsk had the similar values of the moderate level of anxiety/depression (p>0.05). The lowest level of anxiety/depression (p<0.0001) was seen in the dwellers of Tyumen (5.9±0.1 and 3.4±0.1, respectively) and the highest in the Republic of North Ossetia-Alania (NOA) (8.4±0.1 and 6.8±0.1, respectively). These regions showed the lowest and highest prevalence of higher anxiety (22% in Tyumen and 59.8% in the Republic of NOA (p<0.0001). Conclusion. All the 10 selected RF regions differing in demographic, economic, climatic, and geographical parameters are characterized by a high level of anxiety that remains statistically significant after adjusting for gender and age, so are parameters, such as income and morbidity levels are present in only 4 of the 10 regions.
Terapevticheskii arkhiv. 2014;86(12):53-60
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Cognitive and emotional impairments in patients with protracted anxiety-phobic disorders
Chutko L.S., Surushkina S.I., Iakovenko E.A., Nikishena I.S., Anisimova T.I., Bondarchuk I.L.
Abstract
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.
Terapevticheskii arkhiv. 2014;86(12):61-65
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Association of Т174М polymorphism of the angiotensinogen gene with the higher risk of cerebral stroke in women
Stetskaia T.A., Bushueva O.I., Bulgakova I.V., Vialykh E.K., Shuteeva T.V., Biriukov A.E., Ivanov V.P., Polonikov A.V.
Abstract
AIM. To study the association of M235T (rs699) and T174M (rs4762) polymorphisms of the angiotensinogen (AGT) gene with the risk of cerebral stroke (CS) in the Russians of the Central Chernozem Region. MATERIALS AND METHODS. A total of 638 DNA samples obtained from 353 patients with CS and 285 sex- and age-matched healthy individuals were examined. The polymorphisms were genotyped by polymerase chain reaction (T174M) and TaqMan allelic discrimination (M235T) assays. RESULTS. Heterozygous AGT 174TM genotype carriers were found to be at a higher risk for CS (odd ratio (OR)=1.52; 95% confidence interval (CI), 1.08-2.15; p=0.02). A gender-stratified analysis showed that the mutant 174M allele (OR=1.86; 95% CI, 1.14-3.03, p=0.01) and variant 174TM and 174MM genotypes (OR=1.86; 95% CI, 1.09-3.20; p=0.02) were associated with the higher risk of cerebral stroke in women. Conclusion. The association of AGT T174M polymorphism with the risk of CS was first found; but the higher risk of the disease in the carriers of variant alleles and genotypes was observed in the women only.
Terapevticheskii arkhiv. 2014;86(12):66-71
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Direct human DNA damage by unfavorable environmental and climatic factors
Doroshchuk N.A., Postnov A.I., Doroshchuk A.D., Khasanova Z.B., Konovalova N.V., Khesuani I.D., Osiaeva M.K., Rodnenkov O.V., Chazova I.E.
Abstract
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.
Terapevticheskii arkhiv. 2014;86(12):72-77
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Nephrotic syndrome in a female patient with Rapunzel syndrome
Umbetalina N.S., Turgunov E.M., Turgunova L.G., Baesheva T.A., Bacheva I.V.
Abstract
The Rapunzel syndrome is a rare complication of gastric trichobezoar, which may be long insidious. Systemic hair eating gradually leads to bezoar growth, gastritis, gastric mucosal ulcerations, and evacuatory disorders. The Rapunzel syndrome may cause acute and chronic bowel obstruction, peritonitis, pancreatitis, appendicitis, anemia, hypoalbuminemia, and allergic manifestations. Neither proteinuria nor nephrotic syndrome is depicted in any of the 38 Rapunzel syndrome cases described in the literature. The authors present the first case of gastric trichobezoar extending to the small bowel (its total length was 118 cm), which gave rise to chronic recurrent partial bowel obstruction, causing intoxication nephrotic syndrome in a 20-year-old women with trichotillomania. The nephrotic syndrome became a reason for her admission to a nephrology department and had specific features: it was unaccompanied by hypercholesterolemia, it rapidly regressed and completely disappeared after surgical removal of the trichobezoar weighing 1980 g.
Terapevticheskii arkhiv. 2014;86(12):78-80
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Efficacy of a fixed-dose combination of perindopril and amlodipine in the treatment of hypertensive patients. A clinical case
Poteshkina N.G., Khashieva F.M.
Abstract
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.
Terapevticheskii arkhiv. 2014;86(12):81-84
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Cough: Differential diagnosis and rational pharmacotherapy
Zaĭtsev A.A., Okovityĭ S.V.
Abstract
This publication deals with topical problems in the management of patients with cough. It presents its epidemiology and clinical classification, an analysis of its causes, a list of required diagnostic techniques, and areas of pharmacotherapy. Emphasis is laid on the differential diagnosis of different abnormalities and diseases, the leading clinical sign of which is cough. The authors provide the detailed characteristics of medicaments for its treatment and the principles of rational antitussive and mucoactive pharmacotherapy.
Terapevticheskii arkhiv. 2014;86(12):85-91
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Immunomodulators for the prevention and treatment of acute respiratory infections: Efficacy of azoximer bromide
Bulgakova V.A.
Abstract
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.
Terapevticheskii arkhiv. 2014;86(12):92-97
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Antiplatelet therapy with acetylsalicylic acid: Approaches to reducing the frequency of gastrointenstinal adverse reactions
Onuchina E.V.
Abstract
Acetylsalicylic acid (ASA) is highly effective in preventing cardiovascular events, but associated with increased risk for digestive adverse reactions. The paper provides an update on the epidemiology, mechanisms, and risk factors of esophagogastroduodeno- and enteropathies during long-term low-dose ACA therapy. It outlines the key principles of their prevention.
Terapevticheskii arkhiv. 2014;86(12):98-103
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Magnesium deficiency in cardiology
Drapkina O.M., Gegenava B.B.
Abstract
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.
Terapevticheskii arkhiv. 2014;86(12):104-106
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Hypolipidemic and pleiotropic effects of a combination of simvastatin and ezetimibe in patients with different types of hyperlipidemia
Sumarokov A.B., Kukharchuk V.V.
Abstract
The review considers trials dealing with the efficiency of combination hypolipidemic therapy with simvastatin and ezetimibe. Its synergistic potentiating effect can cause a considerable decrease in the level of total cholesterol, low-density lipoproteins, triglycerides, and C-reactive protein, which are important participants in the atherogenic process. This effect promotes the achievement of hypolipidemic therapeutic goals in many cases when this cannot be attained by high-dose statin monotherapy. The authors consider the results of trials of combination hypolipidemic therapy with simvastatin and ezetimibe performed as basic ones done in both previous and recent years
Terapevticheskii arkhiv. 2014;86(12):107-115
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The ghrelin-obestatin system in health and disease
TereShchenko I.V., Kaiushev P.E.
Abstract
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.
Terapevticheskii arkhiv. 2014;86(12):116-120
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The modern concepts of pyoderma gangrenosum
El'kin V.D., Mitriukovskiĭ L.S., Plotnikova E.V.
Abstract
The review provides an update on pyoderma ganrenosum, a rare chronic disease from a group of neutrophilic dermatoses. It considers its pathogenesis, its association with background visceral disease, and the specific features of skin and visceral involvement. Major and minor diagnostic criteria and differential treatment approaches are given.
Terapevticheskii arkhiv. 2014;86(12):121-126
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Mastocytosis. Review of the literature and description of clinical cases
Melikian A.L., Subortseva I.N., Goriacheva S.R., Kolosheĭnova T.I., Vakhrusheva M.V., Kovrigina A.M., Sudarikov A.B., Dvirnyk V.N., Obukhova T.N.
Abstract
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.
Terapevticheskii arkhiv. 2014;86(12):127-134
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Aging and pain: Specific features of neuropathy treatment in the elderly
Barinov A.N., Parkhomenko E.V., Makhinov K.A.
Abstract
The changes in the somatosensory system in aging and peripheral neuropathies are similar. Higher pain sensitivity thresholds in the presence of axonopathy are accompanied by paradoxically decreased pain tolerance associated with neuroplastic changes in the spinal cord and brain. The symptomatic treatment of neuropathic pain syndrome with antidepressants, anticonvulsants, and opioids is related to the lower quality of life in elderly patients and to the high risk of severe side effects. The pathogenetic treatment of polyneuropathies frequently increases the intensity of neuropathic pain at its beginning; however, it can recover the function of an axon and reduce the degree of deficiency states. The paper discusses methods for increasing the safety of treatment for neuropathic pain in elderly patients, a relationship between the pathogenesis of nervous system aging and distal diabetic polyneuropathy, and ways of their correction.
Terapevticheskii arkhiv. 2014;86(12):135-141
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