Vol 87, No 8 (2015)


Clinical pharmacology and pharmacotherapy: Problems and disputable issues

Moiseev V.S., Kobalava Z.D.


The paper discusses the current problems of internal medicine: the use of biologicals not only in rheumatology, but also in cardiology and pulmonology; current antiviral therapy for diseases of not only the liver, but also the heart (controversial issues); recent clinical data regarding LCZ (versus enalapril) and ivabradine (heart rate reduction).
Terapevticheskii arkhiv. 2015;87(8):4-8
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Significance of papillary muscle function of the mitral valve and adjacent left ventricular segments in the progression of ischemic mitral regurgitation in patients with coronary heart disease after surgical treatment

Buziashvili Y.I., Koksheneva I.V., Abukov S.T., Abdullaev A.A.


Aim. To determine the significance of papillary muscle (PM) dysfunction of the mitral valve (MV) and adjacent left ventricular (LV) segments in the genesis of ischemic mitral regurgitation (MR) by myocardial tissue Doppler (MTD) in patients with coronary heart disease (CHD) after surgical treatment. Subjects and methods. One hundred and one CHD patients with moderate (grade I—II) MR were examined before surgical treatment. For analysis, the patients were divided into 4 groups: 1A) 40 patients without progressive, none or moderate MR after isolated aortocoronary bypass surgery (ACBS); 1B) 17 patients with progressive MR to its clinically relevant degree after isolated ACBS; 2A) 30 patients without progressive, none, or moderate MR after ACBS and surgical repair of postinfarction LV aneurysm; 2B) 14 patents with progressive MR to its clinically relevant degree after ACBS and surgical LV repair. The mean follow-up after surgery was 5.35±0.58 years. Results. MTD analysis of the PM function of the MV and adjacent LV segments in the patients with CHD after surgical treatment indicated that those with progressive MR had 1) a decrease in the contractility of both PMs and adjacent LV segments; 2) a restrictive pattern of segmental diastolic dysfunction caused by the high myocardial rigidity of both PMs and adjacent LV segments; 3) an inverse correlation of the posterior PM systolic velocity S with the severity of MR, which is suggestive of the clinically important contribution of posterior PM contractility to the development of MR. There were correlations indicating that the high LV and PM rigidities leading to the restrictive pattern of myocardial diastolic impairments are involved in the development of MR in the patients with CHD. Conclusion. The results confirm that PM and adjacent LV segment dysfunctions are of significance in the mechanisms of progressive ischemic MR in the patients with CHD after surgical treatment.
Terapevticheskii arkhiv. 2015;87(8):9-15
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The use of cardiointervalography for diagnostic screening and evaluation of the efficiency of correction of magnesium deficiency and comorbid conditions

Egorova E.Y., Torshin I.Y., Gromova O.A., Martynov A.I.


Aim. To detect chronic diseases comorbid to magnesium (Mg) deficiency (ICD-10 E61.2) by the data of heart rate variability (HRV). Subjects and methods. The investigation enrolled 398 student patients from a university preventorium (52% youngsters; mean age, 18±9 years; height, 157±28 cm; weight, 54±20 kg). The database for each patient included anthropometric, dynamometric, electrooculometric, HRV and blood pressure monitoring data, plasma levels of vitamins, and collected scores of all stress items of the IDIX scale, MFI-20, asthenia rating scale, HAM test, a questionnaire for deficiency of Mg, vitamins, etc., i.e. a total of 521 parameters. A data sample for 398 patents was randomized into a learning subsample (n = 198) that was used to calculate the discussed sets of logical rules and an independent control sample (n = 200) that was employed to test the obtained sets of logical rules in order to determine their sensitivity and specificity. Results. Based on the analysis of the collected database, the investigators established the pattern of diseases comorbid to Mg deficiency in the examined sample, elaborated diagnostic rules for a number of abnormalities, and checked the obtained sets of rules on the control subsample. The presence of more than half the diagnoses given below may be recognized on the basis of HRV and dynamometric, clinical, and laboratory findings and history data with a sensitivity of 70-95% and a specificity of 75-95%. It is shown that HRV data allow detection of a number of chronic diseases comorbid to Mg deficiency (ICD-10 E61.2) with a high degree of accuracy (on average of 80%) and selectivity (about 80%). Conclusion. The diagnostic method based on HRV measured by cardiointervalography has been developed, which, among other processes, permits the noninvasive evaluation of electrolyte balance and the identification of Mg, K, Na, and Ca deficiencies. The advantage of this method is that it can assess the body’s overall functional possibilities in health, as well as early abnormalities that may gradually progress to serious diseases if no necessary preventive measures are implemented. The practical value of the developed method is demonstrated, by using Magnerot in vegetative dystonia concurrent with hypomagnesium.
Terapevticheskii arkhiv. 2015;87(8):16-28
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Preventive cytoprotection in social diseases

Skotnikov A.S., Gorokhovskaya G.N., Shilov A.M., Yun V.L., Khamurzova M.A.


Among many cytoprotective drugs, only a few of them that have a targeted metabolic effect include agents that partially inhibit oxidation of free fatty acids, the so-called p-FOX inhibitors (partial fatty acid oxidation inhibitors). Aim. To develop a procedure for the preventive use of meldonium dihydrate in day-hospital patients with comorbidity. Subjects and methods. The investigation enrolled 189 patients (116 men and 73 women; mean age, 55.9±4.4 years) who were followed up for initial manifestations of cardiovascular and/or another somatic disease and were at high risk for unfavorable cardio- and cerebrovascular events, as well as complications of emergency alcohol-related conditions. The investigation of the efficacy and safety of meldonium dihydrate was planned as an open-label clinical trial in three parallel groups different in the directivity patterns of potential complications («Cardio», «Cerebro», «Alco»). The drug’s dosage averaged 500 to 1000 mg/day. Results. The day-hospital use of meldonium dihydrate demonstrated high safety profile and a positive role in the prevention of cardio- and cerebrovascular catastrophes and complications of emergency alcohol-related conditions and chronic alcoholic visceropathy, leading to delayed dyslipidemia progression, diminished insulin resistance, improved blood rheological properties, and suppressed chronic systemic inflammation and also proving its role in the prevention of renal vascular injury and toxic (ethanol) encephalopathy. Meldonium therapy showed positive effects in delaying the progression of dyslipidemia, diminishing insulin resistance, improving blood rheological properties, and suppressing chronic systemic inflammation and also proved its role in preventing renal vascular injury and toxic (ethanol) encephalopathy, which confirmed the versatility of the cytoprotective effect of meldonium. Conclusion. The drug has proved to be effective and safe in hemodynamic, electrolytic, hepatic, and other parameters, which makes it expedient to include meldonium in the day-hospital formulary of drugs for a preventive parenteral cycle according to the developed regimen (a 10-day cycle at least 1—2 times a year) for patients at high risk for social diseases and their complications.
Terapevticheskii arkhiv. 2015;87(8):29-43
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Chronic obstructive pulmonary disease concurrent with hypertension: Evaluation of the therapeutic effect of prolonged-release indapamide

Ovcharenko S.I., Morozova T.E., Nersesyan Z.N.


Aim. To provide a rationale for the clinical efficacy and safety of prolonged-release indapamide used in the combination therapy of patients with chronic obstructive pulmonary disease concurrent (COPD) concurrent with hypertension. Subjects and methods. Sixty-five patients (50 men and 15 women) with Stages I—IV COPD and grades 1—3 elevated blood pressure (BP) in whom prior antihypertensive therapy had proved insufficiently effective were examined. Results. Prolonged-release indapamide demonstrated a high efficacy in achieving and maintaining goal BP, in normalizing its daily profile, and in reducing increased variability and the rate of morning rise in BP, without negatively affecting the clinical manifestations of COPD, pulmonary ventilatory function, and serum potassium levels. The drug was shown to have additional pleiotropic effects in lowering the activity of inflammatory markers (high-sensitivity C-reactive protein, intercellular adhesion molecules-1) and the level of endothelial dysfunction markers (endothelin-1, sP-selectin). Another commonly clinically used diuretic hydrochlorothiazide was chosen as a compared drug. Conclusion. The high antihypertensive efficacy and additional pleiotropic properties of prolonged-release indapamide that exerts no negative effect on the clinical manifestations of COPD, bronchial patency, and serum potassium levels demonstrate that it is expedient to incorporate prolonged-release indapamide into the combination therapy of patients with COPD concurrent with hypertension.
Terapevticheskii arkhiv. 2015;87(8):44-50
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Genetic determinants of antibiotic resistance in oropharyngeal streptococci in patients with chronic obstructive pulmonary disease and in those with asthma

Fedosenko S.V., Ogorodova L.M., Ilyina E.N., Senina M.E., Lisitsina E.S., Karnaushkina M.A., Kostryukova E.S., Govorun V.M., Deev I.A., Kulikov E.S., Kirillova N.A.


Aim. To identify oropharyngeal Streptococcus species and to analyze the genetic determinants of antibiotic resistance in patients with asthma and in those with chronic obstructive pulmonary disease (COPD). Materials and methods. An experimental diagnostic Streptopol+ (Lytech Co. LTD) panel based on a multiplex real-time PCR was applied to investigate the representation of antimicrobial resistance genes (mef and ermB) and the species composition of streptococci isolated from oropharyngeal swab samples from 89 patients with stable COPD and from 51 patients with asthma. Results. In the stable disease period, the oropharyngeal swabs were found to contain Streptococcus pneumoniae in 7.8% of the patients with asthma and in 6.74% of those with COPD; the common feature of these groups was a tendency towards a severe disease course and recurrent exacerbations requiring antibiotics. S. pyogenus was detected in 42.9% of the oropharyngeal swabs from COPD and asthma patients without exacerbations. The oropharyngeal swabs showed the mef gene in 100% of the patients with asthma and in 100% of those with COPD; the ermB gene was encountered in 91% of the patients with COPD and in 82.4% of those with asthma. The COPD patients displayed a direct correlation between the representation of the ermB gene and sputum production and smoking index. The mef and ermB genes were directly correlated with the frequency of exacerbations in patients with COPD. Conclusion. The identified streptococci are a reservoir of antimicrobial resistance genetic determinants – the mef and ermB genes encoding the mechanisms of streptococcal macrolide resistance. The representation of the above genes directly correlates with the frequency of exacerbations and the number of antimicrobial drug uses.
Terapevticheskii arkhiv. 2015;87(8):51-57
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Use of a regional registry of chronic hepatitis patients to optimize antiviral therapy

Tkachenko L.I., Maleev V.V., Sannikova I.V., Titorenko M.V.


Aim. To determine the general characteristics of patients with chronic viral hepatitis C (CVHC) from the data of a registry of patients with viral hepatitis (VH) in the Stavropol Territory and to estimate possible predictors for the inefficiency of antiviral therapy (AVT) for treatment optimization. Subjects and methods. The results of examining and treating patients with CVHC were retrospectively analyzed from the data of the registry of HV patients in the Stavropol Territory in 2008—2013. Results. The chronic hepatitis registry includes 1811 patients with CVHC; out of them there are 64% who have its virus genotype 1. According to the registry, there is cirrhosis in 244 (13.5%) patients, fibrosis (METAVIR F2-F3 in 724 (39.97%), and fibrosis (METAVIR F0-F1) in the remaining 843. Carbohydrate and fat metabolic disturbances (obesity, insulin resistance (IR), and diabetes mellitus (DM)) have been found in 615 (34%) patients; every three patients have gastrointestinal diseases and comorbidity is absent in 24% of the patients. The results of AVT were analyzed in 493 patients with CHC virus genotype 1. The analysis showed the most important predictors for the inefficiency of AVT; these included HOMA-IR >2, the presence of IR (HOMA-IR >2.77), and type 2 DM, as well as patient age over 45 years, male sex, a viral load of ≥6 log10 IU/ml, and liver fibrosis (METAVIR ≥F3). Conclusion. The analysis of VH morbidity in the Stavropol Territory, the making of a registry of patients with chronic VH, its columns of IR, body mass index, virologic response changes during therapy could clarify the actual need in AVT and improve activities in the prophylactic medical examination and treatment optimization in this patient group in the areas of this region.
Terapevticheskii arkhiv. 2015;87(8):58-66
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Efficacy of the infusion hepatotropic drug remaxol in the pathogenetic therapy for cirrhotic stage chronic viral hepatitides

Stelmakh V.V., Kozlov V.K., Ivanova V.F., Samusenko I.A.


Aim. To investigate the impact of therapy with the infusion hepatoprotector remaxol on liver function in cirrhosis in the outcome of chronic viral hepatitides (CVH): HCV, HBV, HCV+HBV, and HBV+HDV. Subjects and methods. Sixty-five patients aged 26 to 76 years, who had been diagnosed as having liver cirrhosis (LC) in the outcome of CVH: HCV, HBV, HCV+HBV, and HBV+HDV were examined. During infusion therapy, every day 32 cirrhotic patients in the outcome of CVH B or C received intravenous remaxol 400 ml in a jetwise manner once daily for 11 days. A comparison group comprised 33 patients with the similar condition who had intravenous ademetionine 400 mg in a jetwise fashion during infusion therapy with crystalloids (400 ml of isotonic sodium chloride solution, Ringer’s solution) for 11 days. Results. After an infusion therapy cycle, the study group patients were recorded to have more significantly reduced cytolytic and cholestatic parameters. The pronounced hepatotropic effect of the drug was confirmed by the rate of a decline in the average concentrations of alanine aminotransferase, aspartate aminotransferase, and total bilirubin. In the study group patients, the relative values of a decrease in the levels of these biochemical parameters were 29, 29, and 40% versus 15, 20, and 9% in the control patients. Conclusion. Infusion therapy with remaxol in the combination treatment of the patients with viral LC not only improves liver function (reduces the degree of cytolysis, cholestasis), but also exerts a cytoprotective effect on peripheral blood cells (leukocytes, lymphocytes, platelets).
Terapevticheskii arkhiv. 2015;87(8):67-72
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Use of biological therapy in patients with rheumatoid arthritis in the Republic of Kazakhstan

Nogaeva M.G., Amanzholova A.S.


Aim. To evaluate the clinical efficacy and safety of infliximab (IFM) in patients with rheumatoid arthritis (RA). Subjects and methods. Twelve inpatients (10 women and 2 men) aged 23 to 65 years with a valid diagnosis of RA, the duration of which was 3 years or more, were retrospectively analyzed. DAS28 for RA corresponded to grades II and III in 4 (33.3%) and 8 (66.7%) patients, respectively. Long before the investigation, all the patients used methotrexate in a weekly dose of 15 mg and nonsteroidal anti-inflammatory drugs; 6 patients received methipred in a daily dose of 4-8 mg. IFM was administered intravenously dropwise on the basis of 3 mg/kg weight in 250 ml of isotonic sodium hydrochloride solution during 2 hours at 0, 2, and 6 weeks after therapy initiation and then every 8 weeks. Results. During combination therapy after the first IFM infusion, all the 12 patients were noted to have a positive clinical effect as a significant reduction in the number of tender joints and swollen joints, morning stiffness, erythrocyte sedimentation rate, C-reactive protein, regression of the clinical manifestations of the disease, and its laboratory activity. The therapy was tolerated well by all the patients. According to the EULAR criteria, a good therapeutic effect was observed in 10 (83%) patients and clinical remission was achieved in 2 (17%) patients. According to the ACR criteria, 50 and 70% improvement was seen in 1 (8%) and 9 (75%) patients, respectively. Two (17%) patients achieved remission. Conclusion. Combination therapy with IFM and MT for RA is highly effective, suppresses disease inflammatory activity and joint destruction; furthermore, there may be remission induction.
Terapevticheskii arkhiv. 2015;87(8):73-76
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Diagnosis and treatment in patients with B-cell lymphoma unclassified that is intermediate between diffuse large B-cell lymphoma and Burkitt’s lymphoma

Baryakh E.A., Misyurina A.E., Kovrigina A.M., Obukhova T.N., Gemdzhyan E.G., Vorobyev V.I., Mangasarova Y.K., Polyakov Y.Y., Magomedova A.U., Klyasova G.A., Misyurin V.A., Yatsyk G.A., Shevelev A.A., Kostina I.E., Vorobyev A.I., Kravchenko S.K.


Aim. To characterize a group of patients with B-cell lymphoma (BCLU) unclassified that is intermediate between diffuse large B-cell lymphoma and Burkitt’s lymphoma, to identify poor prognostic factors, and to evaluate therapeutic efficiency in patients with BCLU. Subjects and methods. Twenty-five patients with BCLU were examined. Double-hit lymphoma (DHL) was diagnosed in 8 (32%) patients. According to the Ann-Arbor classification of lymphoma, its stages II, III, and IV were diagnosed in 3 (12%), 2 (8%), and 20 (80%) patients, respectively. MYC rearrangement was observed in 11 (48%) out of 23 patients: single-hit lymphoma in 3 patients and DHL in 8 (BCL2+/MYC+ in 6 cases and BCL6+/MYC+ in 2). The expression of с-MYC (cut off ≥40%) was revealed in 17 (74%) out of 23 patients; that of BCL2 (cut off ≥50%) was detected in 14 (58%) out of 24 patients; coexpression of both proteins was seen in 12 (52%) out of 23 patients. The DHL group showed a correlation between the rearrangement of the BCL2+/MYC+ genes and the expression of MYC and BCL2 proteins in 5 out of 6 patients. Taking into account the heterogeneity of the entire patient group, DHL and non-DHL subgroups were considered separately. Both subgroups were comparable by clinical characteristics. BCLU patients younger than 60 years of age received treatment according to the LB-M-04 ± rituximab; those aged 60 or older had CHOP-like regimens ± rituximab. Autologous stem cell transplantation (auto-SCT) was performed in 5 patients belonging to a high-risk group. Results. The 3-year overall survival (OS) was 62% and the 3-year event-free survival (EFS) was 51%. The 3-year OS was lower for the DHL group than that for the non-DHL group (43 and 75%, respectively). Conclusion. In the DHL group, both OS and EFS are significantly lower (the risk of poor outcome, including death, is higher) than those in the non-DHL group. It is conceivable that intensified chemotherapy with auto-SCT increases treatment results in patients with BCLU; however, a larger number of observations are needed to obtain valid data.
Terapevticheskii arkhiv. 2015;87(8):77-85
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Investigation of the association between the HindIII polymorphism of the LPL gene and the Taq1b polymorphism of the CETP gene with the risk of atherothrombotic stroke in the dwellers of Central Russia

Bushueva O.Y., Stetskaya T.A., Korogodina T.V., Ivanov V.P., Polonikov A.V.


Aim. To investigate the association between LPL HindIII (rs320) and CETP Taq1b (rs708272) polymorphisms with the risk of atherothrombotic stroke (ATS) in the population of Central Russia. Materials and methods. A total of 832 DNA samples obtained from 417 patients with ATS and from 415 healthy individuals of the corresponding gender and age were investigated. The polymorphisms were genotyped by a real-time PCR assay using TaqMan probes. Results. The carriage of heterozygous LPL +495TG genotype was found to be associated with the lower risk of ATS (odds ratio (OR)=0.71; 95% CI: 0.53—0.94; p=0.02). A gender-stratified analysis showed that in the men the variant LPL +495TG genotype was associated with the increased risk of ATS (OR=2.06; 95% CI: 1.03—4.14; р=0.04) while the heterozygous +495GG genotype had a protective effect against the risk of stroke (OR=0.66; 95% CI: 0.45—0.97; р=0.04). Variance analysis established that this polymorphism was found to be associated with the increased prothrombin index in the men with ATS (p=0.01). Conclusion. This study was the first to reveal the association of the LPL HindIII (rs320) polymorphism with the increased prothrombin index and the risk of ATS in the Russian male population.
Terapevticheskii arkhiv. 2015;87(8):86-91
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IgG4-related salivary gland lesions

Vasilyev V.I., Sokol E.V., Rodionova E.B., Palshina S.G., Aleksandrova E.N., Radenska-lopovok S.G., Probatova N.A., Kokosadze N.V., Kovrigina A.M., Safonova T.N., Borovskaya A.B., Gaiduk I.V.


Aim. To provide the demographic, clinical, laboratory, radiological, morphological, and immunomorphological characteristics of IgG4-related sialoadenitis (IgG4-S), which allow the differential diagnosis with neuroendocrine, granulomatous, blood cancer lesions of the salivary gland (SG). Subjects and methods. In the period 2004 to 2014, IgG4-S was diagnosed in 32 (11%) out of 289 patients with significantly enlarged parotid and submandibular glands (PG and SMG). Only 4 (9%) patients had isolated IgG4-related disease (IgG4-D) whereas involvement of a few organs ran as an IgG4-SD systemic disease in 29 (91%) patients. Results. There was a slight preponderance of women with a median onset age of 42 years. Enlargement of the SMG (52.7%), lesions of the nasal cavity and paranasal sinuses (37.2%), and enlargement of the lacrimal gland and orbital pseudotumors (31%) are the most common clinical manifestations at disease onset. A follow-up study indicated that along with involvements of SMG (97%), PG (72%), eye sockets (72%), nasal cavity and paranasal sinuses (56%), one third of the patients were found to have generalized lymphadenopathy, to frequently develop pulmonary, hepatic, pancreatic, renal injuries; and the disease ran within IgG4-SD. The laboratory manifestations were characterized by moderate eosinophilia and elevated blood IgE levels in one-third of the patients and by moderately higher erythrocyte sedimentation rate and hypergammaglobulinemia in 50%. The increased blood level of IgG (84%) and its subclass IgG4 (86.4%) is an indication for further verification of IgG4-D in patients with involvement of the major SG. Immunohistochemical examination, by measuring the concentration of IgG4-secreting plasma cells (PCs), and determination of B-cell clonality in biopsy specimens should be done to verify a diagnosis with IgG4-D. Conclusion. The determination of blood IgG4 (>2 g/l) in patients with considerably enlarged major SG may suggest the presence of IgG4-S. Minimally invasively incised PG and SMG biopsies with their subsequent morphological and immunomorphological examinations should be performed to make an accurate diagnosis. More than 40% of IgG4-secreting PCs detected in SG tissue is evidence to diagnose IgG4-D.
Terapevticheskii arkhiv. 2015;87(8):92-102
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Helicobacter pylori infection and extragastroduodenal diseases

Maev I.V., Andreev D.N., Kucheryavyi Y.A.


At present, the clinical significance of Helicobacter pylori infection has been validly determined within the development of a diversity of gastroduodenal diseases, including chronic gastritis, gastroduodenal ulcer, MALT lymphoma, and gastric adenocarcinoma. The Expert Council’s Maastricht IV consensus (2010) determining international standards for the diagnosis and treatment of H. pylori infection is that there is evidence that the latter may be associated with the development of a number of extragastroduodenal diseases (EGDDs) presented by iron-deficiency anemia of unspecified etiology, idiopathic thrombocytopenic purpura, and vitamin B12 deficiency. In these diseases, it is recommended that infection with H. pylori be diagnosed and, if the test is positive, this microorganism be eradicated. A large number of investigations have been recently conducted to examine the association of H. pylori infection with other EGDDs. This paper reviews theoretical and epidemiological data on the association of H. pylori with diseases of the cardiovascular (atherosclerosis, myocardial infarction) and central nervous (Alzheimer’s disease, Parkinson’s disease) systems, pancreas (autoimmune pancreatitis, pancreatic cancer), oncological (colonic adenomas, colorectal cancer, hepatocellular carcinoma), dermatological (chronic spontaneous urticaria), and other EGDDs. The review highlights the potential protective role of H. pylori in diseases with the atopic element of genesis and a complicated course of gastroesophageal reflux disease (Barrett’s esophagus, esophageal adenocarcinoma).
Terapevticheskii arkhiv. 2015;87(8):103-110
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Cachexia syndrome: The present state of the problem and importance in clinical practice

Ballyuzek M.F., Mashkova M.V.


Available updates have changed our idea about cachexia as a terminal condition, which could consider it as a combined metabolic syndrome that gives rise to the worse course of the underlying disease, the lower efficiency of specific therapy, and higher death rates. Chronic inflammatory factors are recognized to be the main mechanisms for the development of cachexia syndrome (CS). In addition, diagnostic criteria for this pathological condition are well defined. These criteria are rather simple for use in clinical practice and they should be assessed by physicians at all stages of a follow-up of patients with severe chronic diseases, since cachexia may develop long before the appearance of the so-called extreme emaciation. The earlier the physician will anticipate the onset of CS, the more successful attempts to correct the latter and accordingly the better prognosis of the underlying disease will be. Available updates on the possibilities of correcting cachexia — anorexia are considered although there are no established standards for the management and treatment of patients with CS now. The elaboration of a step-by-step algorithm for following up the patients and a search for medications with proven clinical efficacy are relevant.
Terapevticheskii arkhiv. 2015;87(8):111-118
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The development of functional gastrointestinal diseases: Genetic aspects

Akhmedov V.A.


Motility disorders of the upper and lower gastrointestinal tract encompass a very wide range of structurally different diseases. Functional dyspepsia and irritable bowel syndrome (IBS) are the most common functional gastrointestinal disorders in clinical practice. In spite of the considerable prevalence of these functional diseases, the knowledge of their development mechanisms is very scarce. Recent investigations of the impact of the motor and sensory components of the pathogenesis of these diseases have demonstrated that the development of IBS is associated with serotonin transporter gene (5-HTTLPR) impairment and that the patients with IBS show the inadequate response to nonselective cannabinoid receptor agonists, which is caused by cannabinoid receptor gene (CNR1) polymorphism. Most investigations (mainly trials with small sample sizes) dealing with the identification of pharmacogenetic features have indicated that there is a preponderance of patients with intermediary metabolism among those with functional gastrointestinal diseases. However, larger investigations are necessary for a more exact understanding of this aspect.
Terapevticheskii arkhiv. 2015;87(8):119-123
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Type 2 diabetes mellitus: Clinical aspects of genetics, nutrigenetics, and pharmacogenetics

Ametov A.S., Kamynina L.L., Akhmedova Z.G.


The review gives modern knowledge of the genetics, pharmacogenetics and nutrigenetics of type 2 diabetes mellitus. The knowledge of genetic determinants can refine our understanding of the pathogenesis of this disease and introduce pharmacogenetic and nutrigenetic approaches to its effective therapy and prevention.
Terapevticheskii arkhiv. 2015;87(8):124-131
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Change in the organ of vision in somatic diseases

Trukhan D.I., Lebedev O.I.


The functional or morphological changes associated with systemic diseases make up the bulk of eye pathology. Accordingly, systemic drug therapy for these diseases can affect the eye. Changes of the organ of vision and appropriate ophthalmological advice can assist an internist to diagnose and adequately treat the patient. The article considers possible changes in the organ of vision in the presence of somatic diseases, as well as alterations resulting from drug therapy for these diseases.
Terapevticheskii arkhiv. 2015;87(8):132-136
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