Vol 88, No 3 (2016)

Articles
Pneumonia: The urgent problem of 21st century medicine
Chuchalin A.G.
Abstract
The paper analyzes the systematic reviews and meta-analyses on the strategic issues of pneumonia, which have been published in the past 3 years. It discusses the prevalence and mortality rates of acquired pneumonia, hospital-acquired (nosocomial) pneumonia, healthcare-associated pneumonia, ventilator-associated pneumonia, and Mycoplasma pneumonia, and the specific features of their etiology, diagnosis, and treatment. A large number of investigations emphasize the relevance of this problem in current clinical practice.
Terapevticheskii arkhiv. 2016;88(3):4-12
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Pneumonia at a multidisciplinary hospital
Vertkin A.L., Oralbekova Z.M.
Abstract
Aim. To reveal the clinical and morphological features and predictors of a fatal outcome in patients with community-acquired pneumonia. Materials and methods. The results of almost 6,500 autopsies were studied; out of them there were 1631 (25%) deaths from pneumonia: 134 and 1497 cases occurring at home and at hospital, respectively. Results. Both groups were considered in terms of pneumonia as a primary disease or as a fatal complication, with 6.4% having the former and 93.6% having a fatal complication of chronic obstructive pulmonary disease, chronic alcohol intoxication, cardiovascular diseases, or cancers. After negative prognosis assessment using the CURB-65 scale, pneumonia was rated as severe and requiring admission to the intensive care unit in 92% of the cases; PORT scale assessment showed that 60% cases of pneumonia necessitated hospitalizations to these units. The major clinical and morphological form of pneumonia was established to be disseminated, lobular, or overwhelming. Conclusion. In practice, risk factors for death are underestimated; the disease course is not monitored; current diagnostic and therapeutic approaches are inadequately applied.
Terapevticheskii arkhiv. 2016;88(3):13-17
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Morphometric characteristics of the bronchial tree in smokers with and without chronic obstructive pulmonary disease
Kremis I.S., Bukreeva E.B., Gereng E.A.
Abstract
Aim. To reveal the tissue, cellular, and molecular predictors leading to the development of chronic obstructive pulmonary disease (COPD) in smokers on the basis of a morphometric analysis of bronchial biopsy specimens. Subjects and methods. A cross-sectional study was conducted in 115 smokers aged 40 to 60 years (58.3±3.24 years) with a male predominance of 90.9%. Morphological examination of bronchial biopsy specimens was first made in the smoking patients with and without COPD. Results. The smokers with COPD versus those without this condition were found to have a statistically significant increase in a number of indicators: the specific volume (SV) of the surface epithelium (p=0.017), SV of basal epitheliocytes (p=0.008), the height of the epithelium (p=0.001), and the thickness of the basal membrane (p=0.006) due to impaired regeneration processes in the bronchial epithelium and to fibrosis of the lamina propria of the bronchi with a concurrent increase in the total number of fibroblasts. The group of smokers with COPD, unlike the comparison group, showed signs of vascular remodeling and microcirculatory disorders as the increased connective tissue volumetric density of the lamina propria of the bronchi with predominant perivascular localization. This was followed by reductions in the relative volume of capillaries (p=0.016), in the SV of micropinocytic vesicles (p=0.005), and the size of Weibel-Palade bodies (p=0.004) in the endotheliocytes. In the COPD patients, the total density of cell infiltrate per mm2 of the lamina propria of the bronchi was statistically significantly (p<0.001) greater than that in the comparison group at the expense of neutrophils, lowly and moderately granulated basophils, macrophages, plasma cells with a simultaneous rise in their interepithelial forms. Conclusion. Compensatory structural changes without signs of bronchial wall remodeling were recorded in the smokers without signs of bronchial disease. The smokers with the examined nosological entity were observed to have morphological signs of hemodynamic disorders, as well as perivascular fibrosis, atrophy, and squamous cell metaplasia of the bronchial epithelial lining.
Terapevticheskii arkhiv. 2016;88(3):18-23
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Nebulized budesonide in the treatment of exacerbations of chronic obstructive pulmonary disease: Efficacy, safety, and effects on the serum levels of soluble differentiation molecules
Makarova E.V., Varvarina G.N., Menkov N.V., Czapaeva M.Y., Lazareva E.S., Kazatskaya Z.A., Novikov V.V., Karaulov A.V.
Abstract
Aim. To investigate the efficacy and safety of nebulized budesonide and systemic glucocorticosteroids (GCS) (SGCS) in the treatment of an exacerbation of chronic obstructive pulmonary disease (COPD) and their effects on the serum concentration of soluble leukocyte differentiation antigens. Subjects and methods. Seventy-eight hospitalized patients with an acute exacerbation of COPD were randomized into two groups: 1) 37 patients took nebulized budesonide 4 mg/day; 2) 41 patients received intravenous prednisolone. The symptoms of COPD, forced expiratory volume in one second (FEV1) and other spirometric indicators, peripheral blood oxygen saturation (SpO2), and adverse events were studied. The serum levels of the soluble adhesion molecules CD50 (sCD50) and CD54 (sCD54) and the lymphocyte activation molecules CD38 (sCD38) and CD25 (sCD25) were investigated by an enzyme immunoassay. Results. There was a significant resolution of the symptoms of COPD, FEV1, and SpO2 in both groups after treatment. The incidence of hyperglycemia episodes was lower in the budesonide group than in the sGCS group. GCSs caused a decrease in the serum level of soluble interleukin-2 receptor (sCD25) in both groups. A prednisolone cycle, unlike a budesonide one, was found to reduce the concentrations of sCD54, sCD50, and sCD38. Conclusion. Nebulized budesonide is an effective and safe alternative to SGCS in treating an exacerbation of COPD. Inhaled GCSs, unlike SGCSs, exhibit anti-inflammatory activity, but exert no immunosuppressive activity.
Terapevticheskii arkhiv. 2016;88(3):24-31
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Pathogenetic effects of low-intensity laser therapy for chronic obstructive pulmonary disease
Aksenova I.Z., Burduli N.M.
Abstract
Aim. To study the impact of low-intensity laser therapy (LILT) on typical pathological processes of impairments in platelet aggregation and microcirculation (MC) in patients with chronic obstructive pulmonary disease (COPD). Subjects and methods. A photo optical aggregatometric method was used to investigate platelet aggregation function in patients with COPD and MC was estimated by laser Doppler flowmetry over time. Results. There were muitidirectional changes in platelet aggregation function with a predominance of hyperaggregation, as well as a significant improvement in aggregation indicators during LILT; the latter was shown to have a correcting impact on MC disorders in patients with COPD in the presence of the spastic and stagnant-stasic types of MC, which were prevalent in the majority of patients. Conclusion. Laser therapy used in the combination treatment of patients with COPD promotes correction of the typical pathological processes.
Terapevticheskii arkhiv. 2016;88(3):32-35
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Clinical manifestations of asthma during combination therapy using ceruloplasmin
Provotorov V.M., Budnevsky A.V., Filatova Y.I.
Abstract
Aim. To estimate the time course of clinical changes in patients with asthma during combination therapy using ceruloplasmin (CP). Subjects and methods. A total of 92 asthmatic patients were examined. Their medical history data were collected; external lung function testing and clinical, laboratory, and instrumental examinations, involving the determination of the indicators of lipid peroxidation (LPO) (malonic dialdehyde (MDA), methemoglobin, carboxyhemoglobin) and the antioxidant system (superoxide dismutase (COD), sulfhydryl groups), were performed in all the patients over time. According to the therapy used, the patients were divided into 2 groups matched for gender, age, and clinical manifestations of the disease. A study group consisted of 45 patients who took CP in addition to conventional therapy. A comparison group included 47 patients receiving standard therapy. Results. During the combination therapy using CP, the asthmatic patients showed a reduction in the elevated concentrations of MDA, methemoglobin, and carboxyhemoglobin and increases in the activity of COD and in the levels of sulfhydryl groups, which was followed by a considerable clinical improvement. During the conventional therapy, the indicators of LPO remained high and those of the antioxidant system did low, suggesting permanent oxidative stress. Conclusion. CP incorporation into the combination therapy of asthmatic patients contributes to elimination of prooxidant-antioxidant imbalance, which is followed by a marked positive clinical effect.
Terapevticheskii arkhiv. 2016;88(3):36-39
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Functional and laboratory characteristics in the concomitance of asthma and obesity at a young age
Sobko E.A., Solovyeva I.A., Demko I.V., Kraposhina A.Y., Ishchenko O.P., Razzakova N.M., Egorov S.A., Vtyurina S.S., Prugova V.L.
Abstract
Aim. To study the peripheral blood level of leptin and adiponectin and their possible effect on the functional status of the respiratory system in young asthmatic patients in relation to body mass index (BMI) for the optimization of asthma therapy. Subjects and methods. Examinations were made in 133 people, including a study group of 93 patients with asthma who were divided into 2 groups according to BMI: 1) those with a BMI of less 25 kg/m2 and 2) those with a BMI of 30 kg/m2 or more, as well as a control group of 40 apparently healthy patients. The investigators studied external respiratory function (ERF), the peripheral blood levels of leptin and adiponectin, the biochemical composition of plasma, by determining total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. Results. Lipid metabolic disorders as dyslipidemia and hypercholesterolemia, increased severity of disease, and decreased ERF were recorded in the concomitance of obesity and asthma. The peripheral blood level of leptin in young asthmatic patients with obesity was found to be associated with higher BMI. Conclusion. A more severe course of disease presenting with decreased ERF, impaired lipid metabolism, and elevated peripheral blood leptin levels were noted in the concomitance of asthma and obesity at a young age.
Terapevticheskii arkhiv. 2016;88(3):40-46
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Association of decreased external pulmonary function with cognitive impairments
Kovalkova N.A., Ragino Y.I., Shishkin S.V., Voevoda M.I.
Abstract
Aim. To examine the association between the basic indicators of external respiratory function (ERF) and cognitive impairments (CIs). Subjects and methods. The materials of a population-based cross-sectional study were used in the investigation; a representative sample consisted of 3818 men and women aged 45-69 years. Forced expiratory volume in the first second (FEV1), the ratio of FEV1 to forced vital capacity (FVC) were determined to assess ERF. CIs were evaluated using the 10-word test described by A.R. Luria, Cog-sum indices (the sum of correctly reproduced words with 3 attempts), and Cog-mean=Cog-sum/3. Results. In patients with an FEV1/FVC <70%, the probability of a Cog-sum of <20 scores was twice higher than in those with an FEV1/FVC ≥70%; in patients with an FEV1 <80%, the probability of a Cog-sum of <20 scores was also 2 times higher than in those with an FEV1 ≥80%. Multiple regression analysis revealed no significant associations between Cog-sum index and smoking index, body mass index, and blood pressure. Cog-sum was inversely related to age and directly related to FEV1 and female sex. Binary logistic regression analysis showed that gender, age, and FEV1 were statistically significant variables. The relative risk of a Cog-sum of <20 that was 1.7 times higher in the men than in the women, 1.8 times higher in the patients with an FEV1 <80% than in those with an FEV1 ≥80% (model 1), 1.7 times higher in the patients with an FEV1/FVC <70% than in those with FEV1/FVC ≥70% (model 2) increased with age. Conclusion. The decrease in the basic indicators of ERF (FEV1, FEV1/FVC) is an independent predictor of CIs.
Terapevticheskii arkhiv. 2016;88(3):47-51
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Current characteristics of all-cause and circulatory disease mortality in the Azerbaijan Republic
Azizov V.A., Khatamzade E.M.
Abstract
Aim. To prove the value of summary data from the State Statistics Commission to characterize of risk of death from circulatory system diseases (CSD). Materials and methods. The official data of the State Statistics Commission of the Azerbaijan Republic, which are available at its website (www.stat.gov.az), were analyzed using descriptive statistical procedures to identify qualitative signs. Results. The population-level CSD death rates in 2011—2013 ranged from 362.7 to 379.60/0000, amounting to 61.1—63.8% of the all-cause mortality in the population. There were definite differences in male and female deaths due to CSD (377.2—392.0 and 348.4—367.40/0000) and in its proportion among all-cause mortality rates (58.4—60.5 and 64.1—66.4%). The death rates from CSD in the urban (361.1—380.80/0000) and rural (364.5—378.30/0000) populations and its proportion among all-cause mortality rates in these populations (60.6—62.7 and 61.6—62.8%) were similar. The male and female working-age population showed essentially dissimilar CSD mortality rates (169.2—179.8 and 51.8—57.10/0000), the men being at greater risk of death (3.14—3.27). The ratio of all-cause mortality rates in the male and female working-age populations (2.62—2.67) differed from that of CSD-specific ones in these populations (3.14—3.27). There was a slight difference in CSD-specific mortality rates in the urban and rural working-age populations (116.1—125.0 and 104.9—114.70/0000). There was also evidence for their similarity in the proportion of CSD among the all-cause mortality rates (43.2—46.2 and 45.0—49.6%). Conclusion. The existing characteristics of mortality in the population (a growth tendency due to CSD) suggest the priority of preventing these diseases.
Terapevticheskii arkhiv. 2016;88(3):52-55
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The role of immune factors in the progression of chronic kidney diseases in HIV infection
Yushchuk N.D., Gadzhikulieva M.M., Balmasova I.P., Volgina G.V., Gultyaev M.M.
Abstract
Aim. To determine the significance of immune factors in the pathogenesis of kidney injuries in HIV infection, by investigating the cellular and cytokine components of an immune response. Subjects and methods. Thirty HIV-infected patients (mean age 31.7±6.2 years) with chronic kidney disease (CKD) were examined. A comparison group consisted of 10 HIV-infected patients without signs of kidney injury. A control group included 24 healthy individuals to analyze immune status and 15 people to estimate the normal values of the cytokine composition. The cellular composition of lymphocytes on a typical immunogram was determined on a flow cytofluorometer; the serum concentrations of cytokines were measured on a multichannel photometer. Results. The HIV-infected patients with kidney injury displayed significant reductions in the absolute (0.2·109/l and 0.4·109/l, respectively; р=0.015) and relative (14.75 and 22%, respectively; р=0.005) counts of CD3+/CD4+ cells and in the immunoregulatory index (0.2 and 0.4, respectively; р=0.014) as compared to those in HIV-infected patients without kidney disease (р≤0.05) with a rise in the number of cytotoxic T cells (CD3+/CD8+). The HIV-infected patients showed a preponderance of immunosuppressive cytokine compositions, as indicated by the high levels of transforming growth factor-β (a more than 50-fold increase) and by a statistically significant rise in the level of tumor necrosis factor-α (TNF-α) (with CD4+ lymphocyte counts more or less than 200 cells/µl — 19.0 and 24.2 pg/ml, respectively; p=0.017; with HIV RNA levels more and less than 100,000 copies/ml — 24.4 and 19.7 pg/ml, respectively; p=0.012). Conclusion. The HIV-infected patients with CKD developed kidney injury in the presence of a more pronounced decrease in blood T helper lymphocyte subpopulation levels with a predominance of proinflammatory and immunosuppressive responses. TNF-α in combination with immunosuppression and high viral loads was established to play a leading role in the development of kidney injury in HIV infection.
Terapevticheskii arkhiv. 2016;88(3):56-61
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Resistance to protease inhibitors and efficiency of antiviral therapy in patients with chronic hepatitis C
Batskikh S.N., Karandashova I.V., Neverov A.D., Chulanov V.P.
Abstract
Aim. To clarify the role of virus resistance in the efficiency of antiviral therapy with protease inhibitors (PIs) chronic hepatitis C (CHC) patients, with moderate sensitivity to interferon-α. Subjects and methods. Eight Caucasian patients (4 men and 4 women) aged 21 to 65 years (median 52.5 years) with genotype 1b hepatitis C virus (HCV) infection were included in the study. Two patients were diagnosed with liver cirrhosis; 4 had been ineffectively treated with peginterferon in combination with ribavirin. None of the patients had obesity and/or insulin resistance. All the 8 patients received triple therapy with PIs (boceprevir (n=3), telaprevir (n=4), and simeprevir (n=1)) and as a result failed to achieve a sustained virologic response. All the participants were studied to identify mutations in HCV NS3/4A region. Results. Five of the 8 patients were found to have mutations in HCV NS3/4A region (substantially reducing drug susceptibility in 3 cases). Conclusion. In CHC patients who are moderately sensitive to interferon-α and receive therapy with PIs, resistance to the latter is critically important for the efficiency of therapy and the timely identification of resistance mutations can contribute to the choice of an optimal treatment policy.
Terapevticheskii arkhiv. 2016;88(3):62-67
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Possible influence of epidemiological risk factors on the development of urolithiasis
Imamverdiev S.B., Gusein-zade R.T.
Abstract
Aim. To study the epidemiological factors participating in the development of urolithiasis as risk factors. Subjects and methods. The results of the 2007—2011 examinations and follow-ups of 2305 patients diagnosed with urolithiasis, who had been treated at the bases of the Department of Urology, Azerbaijan Medical University, at the Acad. M.A. Mirkasimov Republican Clinical Hospital, and at the central hospitals in the North and North West regions of the Republic of Azerbaijan, were analyzed. Results. In most cases, the 16—30- and 41—50-year age groups were at high risk for urolithiasis; an association was found between body mass index and the development of this disease. The mineral salt composition of stones was characterized by oxalate content in the majority of cases; urates ranked second. Urolithiasis was considered to be predominantly related to poor and satisfactory living conditions in most cases. Calculogensis in urolithiasis was most common in the people who had sedentary jobs, or in the unemployed. Examining the association of calculogenesis in urolithiasis patients with their geographical site type showed that the majority of these patients lived in the rural areas. Conclusion. The males who are older, overweight, lead a sedentary lifestyle or are unemployed, specifically those who live in the rural area, must more carefully implement preventive measures.
Terapevticheskii arkhiv. 2016;88(3):68-72
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Effect of Remaxol on the efficiency of standard treatment for infiltrative pulmonary tuberculosis
Volchegorsky I.A., Novoselov P.N., Ushkareva E.V.
Abstract
Aim. To investigate the effect of Remaxol on the efficiency of standard treatment in patients with infiltrative pulmonary tuberculosis (IPT). Subjects and methods. The results of treatment were analyzed in 90 patients with new-onset IPT in the phase of decay who received basic tuberculosis treatment regimens I, IIb, and IV. In addition, a study group of 45 patients used dropwise intravenous Remaxol 400 ml daily and a control group 45 patients had dropwise intravenous 5% glucose solution 400 ml daily. All the patients underwent clinical, laboratory and instrumental (X-ray) examinations over time. Results. The incorporation of remaxol into the combination treatment of IPT enhanced the efficiency of therapy, which manifested as reductions in the hepatotoxicity of etiotropic drugs and in the degree of dysproteinemia and as accelerated destructive regression in tuberculous infiltrates with a subsequent decrease in the need for phthisiosurgical care. Remaxol included into the standard complex treatment regimens for IPT contributed to the rapider normalization of laboratory parameters of the liver and to the accelerated regression of destructive changes in the tuberculous infiltrates. Conclusion. Incorporation of remaxol into the combination treatment of patients with IPT enhances the efficiency of its therapy, promotes the rapider normalization of laboratory indices of the liver and the accelerated regression of destructive changes in tuberculous infiltrates, which reduces the need for phthisiosurgical care.
Terapevticheskii arkhiv. 2016;88(3):73-78
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Population characteristics of metabolic syndrome components in 25—64-year-old males of an average urbanized Siberian town
Akimova E.V., Kayumov R.K., Gakova E.I., Zagorodnykh E.Y., Gafarov V.V., Kuznetsov V.A.
Abstract
Aim. To establish the population characteristics of the components of metabolic syndrome (MS) in the age range of 25—64-year-old males in an average urbanized Siberian town. Subjects and methods. A cross-sectional epidemiological survey was conducted in a representative sample of the electorate of a Tyumen administrative district among 1000 males, with 250 being in each of 4 life decades (25—34, 35—44, 45—54, and 55—64 years). There were 850 (85%) responses. The IDF criteria (2005) were used to evaluate MS. Results. In the Tyumen open population of 25—64-year-old men, the population characteristics of systolic blood pressure (BP) and waist circumference (WC) were shifted to the right in the normal distribution range, which determined the high prevalence of hypertension and abdominal obesity (AO). In the 25—64-year-old men with the high prevalence of hypertension (a standardized rate of 59.8%) and AO (a standardized rate of 42.6%), the age was positively related to systolic BP in the third to fifth decades of life, diastolic BP, and WC at all ages. Conclusion. Examining the epidemiological situation regarding the prevalence of MS components necessitates the elaboration of a scientifically sound prevention program in the specific conditions of an average urbanized Siberian town.
Terapevticheskii arkhiv. 2016;88(3):79-83
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Recurrent tracheal papillomatosis concurrent with asthma
Korovkina E.S., Magarshak O.O.
Abstract
A thorough collection of complaints and history data, physical examination, and lung function tests are necessary to confirm the diagnosis of asthma. The latter must be differentiated from different diseases in the majority of patients according to age. Recurrent respiratory papillomatosis is caused by human papillomavirus and involves mainly the upper respiratory tract. The paper describes a case of tracheal papillomatosis concurrent with atopic asthma.
Terapevticheskii arkhiv. 2016;88(3):84-88
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Coexistence of pulmonary sarcoidosis and primary Sjögren’s syndrome
Myachikova V.Y., Maslyansky A.L., Shlyakhto E.V., Lapin S.V., Novikova A.N., Trishina I.N., Vorobieva O.A., Fionik A.M., Grozov R.V., Gurkov A.S.
Abstract
The paper describes a case of a rare coexistence of primary Sjögren’s syndrome (PSS) and sarcoidosis in a 41-year-old female with histologically verified lung and locomotor system diseases and keratoconjunctivitis sicca. PSS was diagnosed based on the 2012 ACR classification criteria, in the framework of which serological, histological, and gland function tests and instrumental diagnostic methods were performed. The diagnosis of sarcoidosis was based on clinical, radiographic, and histological findings.
Terapevticheskii arkhiv. 2016;88(3):89-92
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Choice of an antihistamine administration route in the treatment of allergic diseases
Luss L.V.
Abstract
Allergic diseases (AD) are an interdisciplinary problem in practical health care and characterized by high prevalence, severity, and huge financial costs of their treatment, prevention, and rehabilitation in patients. In this connection, control of allergy symptoms attracts the meticulous attention of physicians of all specialties. The efficiency of pharmacotherapy in clinical practice frequently depends not only on what medication, but also what mode of its delivery (administration) is used. Clinicians are well aware of the fact that oral administration of some drugs, antihistamines in particular, may be lowly effective or ineffective and their parenteral route gives rise to their sufficient clinical effect. This communication presents for general practitioners a pathogenetic rationale for prescribing histamines and indications for their parenteral administration in AD.
Terapevticheskii arkhiv. 2016;88(3):93-95
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Anemias in chronic obstructive pulmonary disease
Budnevsky A.V., Esaulenko I.E., Ovsyannikov E.S., Zhusina Y.G.
Abstract
According to different studies, anemia occurs in 8—33% of patients with chronic obstructive pulmonary disease (COPD). The paper describes the most important various causes of anemia in COPD, such as systemic inflammation and endocrine disorders, the use of some medications (theophylline, angiotensin-converting enzyme inhibitors), frequent COPD exacerbations, and long-term oxygen therapy. Lower hemoglobin levels in COPD patients are accompanied by increased shortness of breath, reduced exercise tolerance, and lower quality of life. Furthermore, some investigations have shown that anemia is an independent predictor of death in patients with COPD. In spite of the fact that anemia may be successfully in these patients, the evidence suggesting the importance of its impact on the prognosis of COPD is limited.
Terapevticheskii arkhiv. 2016;88(3):96-99
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Possible side effects of drugs in elderly patients with chronic obstructive pulmonary disease and comorbidity
Malykhin F.Т., Baturin V.A.
Abstract
The papers gives data on the positive effects and adverse reactions of drugs used to treat chronic obstructive pulmonary disease (COPD) and its comorbidity, first of all cardiovascular disease. The authors present alternative points of views based on both the data available in the literature and their findings. They propose to modify pharmacotherapy for COPD in the presence of comorbidity in patients of old age groups.
Terapevticheskii arkhiv. 2016;88(3):100-107
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Differential diagnosis of focal osteoplastic masses in the lung of miners
Bondarev O.I., Razumov V.V., Bugaeva M.S.
Abstract
The paper reviews literature on the current aspects of the diagnosis and expert appraisal of focal osteoplastic masses in the lung upon dust exposure. to dust factors. It considers different aspects of the pathogenesis of osteoplastic changes in the tissue structural elements of pulmonary histione. Current views on the prevalence, etiology, and pathogenesis, as well as morphological changes in the development of this abnormality, its association with the dust damaging effects of human activities are reflected.
Terapevticheskii arkhiv. 2016;88(3):108-110
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Preclinical and clinical trials of the new tuberculosis drug perchlozon
Yablonskiy P.K., Vinogradova T.I., Levashev Y.N., Pavlova M.V., Zilber E.K., Starshinova A.A., Sapozhnikova N.V., Chernokhaeva I.V., Archakova L.I., Zabolotnykh N.V., Vitovskaya M.L.
Abstract
The paper sets forth the stages of design and introduction of the new Russian tuberculosis (TB) drug perchlozon registered in the Russian Federation in 2012. Based on the results of Phases I-III clinical trials, the authors evaluate the efficacy and safety of the agent and consider the adverse effects of its treatment for respiratory TB. The use of perchlozon as a component of combination therapy versus standard chemotherapy regimens significantly reduces abacillation time in pulmonary TB caused by its drug-resistant pathogen. In terms of the higher prevalence of TB induced by its pathogen resistant to many drugs (with multiple and broad-spectrum drug resistance), perchlozon is an essential drug that has antituberculous activity mainly against multidrug-resistant Mycobacterium tuberculosis strains and gives patients with the severest and epidemiologically poor form of TB the chance to recover.
Terapevticheskii arkhiv. 2016;88(3):111-115
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Lipid metabolism in patients with hematologic cancers
Vladimirova S.G., Tarasova L.N.
Abstract
It is considered that hypercholesterolemia is life-threatening and low cholesterol levels are a positive factor. However, taking into consideration the fact that cholesterol plays a key role in cell proliferation, it should be remembered that its low blood level may be linked to high cholesterol demands from neoplastic cells. The literature review analyzes the results of recent investigations of lipid metabolism in patients with hematologic cancers and their other types. All given investigations show a significant reduction in the serum levels of total cholesterol and high-density lipoproteins in patients with hematological disease at its onset. The data for other indicators of the lipid transport system are ambiguous. Such changes have been elucidated to be associated with the accumulation of cholesterol in the leukemia cells due to enhanced synthesis de novo, a more active absorption from circulation and blocked release of its surplus. If the disease runs a favorable course, lipid metabolic parameters become normalized and, in case of remission, correspond to those seen in healthy individuals. They continue to decline in patients with disease progression. This allows the consideration of cholesterol, its fractions, and apolipoproteins as biochemical prognostic markers in hematological cancer patients and as indicators for assessment of treatment results. In addition, there is evidence for the effect of chemotherapeutic agents on lipid metabolism. Recent attempts to elaborate new treatment strategies, by using the current knowledge on the role of lipid metabolism in cancers, are considered.
Terapevticheskii arkhiv. 2016;88(3):116-120
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