Vol 88, No 4 (2016)


Video capsule endoscopy is one more step towards improving the diagnosis of small intestinal diseases

Parfenov A.I., Akopova A.O., Shcherbakov P.L., Mikheeva O.M., Khomeriki S.G.


Aim. To estimate the value of video capsule endoscopy (VCE) in the diagnosis of small intestine (SI) diseases. Subjects and methods. A total of 134 patients, including 72 (53.7%) women and 62 (46.3%) men whose mean age was 41.48±9.33 years. Group 1 included 73 patients who were examined using an algorithm for the diagnosis of SI diseases, 61 patients underwent VCE by the referrals handed in other healthcare facilities. Results. In the patients of Group 1, pathological SI changes were revealed by VCE by almost 4 times more frequently than in those of Group 2. VCE provides a possibility of establishing the sources of bleeding, Crohn’s disease, and other inflammatory diseases, which are inaccessible to other diagnostic methods. SI arteriovenous malformations, polyps, and diverticula, parasitic infections, and nonsteroidal anti-inflammatory drug-associated enteropathy may be causes of obscure SI bleeding and anemia. In celiac disease, VCE may estimate the extent of SI mucosal atrophy and reveal its disintegration as erosions and ulcers, which are inherent in its refractory form. Conclusion. VCE is a highly informative method for examining the SI, but, in view of the specific features of its performance and the high cost of hardware, VCE is recommended to be performed in accordance with the proposed diagnostic algorithm.
Terapevticheskii arkhiv. 2016;88(4):4-8
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Diagnostic value of the stimulating growth factor ST2 during hospitalization for myocardial infarction

Gruzdeva O.V., Akbasheva O.E., Uchasova E.G., Dyleva Y.A., Fedorova N.V., Karetnikova V.N., Kashtalap V.V., Barbarash O.L.


Aim. To determine the concentration of the stimulating growth factor ST2 and its relationship to the clinical course of myocardial infarction (MI) over time during hospitalization. Subjects and methods. Eighty-eight MI patients whose mean age was 59±8.36 years were examined. On days 1 and 12 of MI, the serum levels of ST2 and N-terminal pro-brain natriuretic peptide (NT-proBNP) were determined by ELISA. A control group consisted of 30 people. Results. On day 1 of hospitalization for MI, the concentrations of ST2 and NT-proBNP were higher 2.4 and 4.5 times, respectively, than those in the controls; by day 12, there was a statistically significant decrease in the level of ST2 while that of NT-proBNP was unchanged. During hospitalization, the investigators recorded MI complications, according to which the patients were divided into favorable and unfavorable MI groups. On day 1 of hospitalization, the level of ST2 in the patients with unfavorable MI was twice higher than in those with favorable MI and 3.7 times higher than in the control group. On day 12, both favorable and unfavorable MI groups showed a reduction in the level of the marker. On day 1 of MI, the concentration of NT-proBNP in the patients with a poor prognosis was 6.8 times greater than in the controls and 1.8 times more than in the patients with a good prognosis. On day 12, NT-proBNP levels remained elevated in both groups. Logistic regression analysis revealed that the determination of ST2 in combination with NT-proBNP increased their diagnostic significance (odds ratio, 1.92; 95% CI, 1.7—3.2; area under characteristic curve, 0.89; p=0.004). Conclusion. The level of ST2 was a more sensitive indicator of hospitalization for MI than that of NT-proBNP. The combined use of ST2 and NT-proBNP was found to have a high diagnostic sensitivity and specificity.
Terapevticheskii arkhiv. 2016;88(4):9-15
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Electrocardiogram readings in different degrees of secondary atrial septal defect

Abdyzhaparova E.K., Dzhishambaev E.D., Usupbaeva D.A.


Aim. To study the electrocardiographic characteristics of secondary atrial septal defect (ASD) depending on its size. Subjects and methods. A total of 80 patients (32 men and 48 women; mean age 23.5±2.7 years) with this defect were examined and divided into three groups according to its size relative to body surface area. Results. The degree of electrocardiographic changes in secondary ASD depended on its size: a significant positive correlation was established between defect size and P wave amplitude (r=0.8; p<0.005), as well as its duration (r=0.5; p<0.001). A positive correlation was noted between defect size and R wave amplitude in lead V1 (r=0.6; p<0.04), that and S wave amplitude in lead V5 (r=0.3; p<0.02); between the size of the defect and the degree of an increase in the total index RV1+SV5,V6 (r=0.7; p<0.02); and that and the degree of electrical heart axis (EHA) deviation to the right (r=0.3; p<0.03). Conclusion. The degree of electrocardiographic changes in secondary ASD depends on its size. Giant defects are characterized by a frequent EHA deviation to the right, pronounced signs of right ventricular hypertrophy, and a higher prevalence of right bundle branch block.
Terapevticheskii arkhiv. 2016;88(4):16-19
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Arterial bed stiffness in patients with different cardiovascular risk factors

Nosov A.E., Baydina A.S., Ivashova Y.A., Vlasova E.M., Alekseev V.B.


Aim. To investigate the specific features of changes in the arterial wall stiffness (AWS) parameters obtained by sphygmomanometry in patients with different risk factors (RFs) for cardiovascular events (CVEs). Subjects and methods. A total of 208 mining enterprise workers who had cardiovascular RFs, such as hypertension, abdominal obesity, and smoking, were examined. A comparison group consisted of 75 workers of this enterprise who had no these RFs. AWS was examined using a VaSera VS-1500 (Fukuda Denshi, Japan) to determine CAVI, ABI, UT, %МАР, AI, tb, and tba. Results. The group of patients with a combination of RFs versus the comparison group showed a statistically significant prevalence of virtually all sphygmomanometric indices characterizing AWS, which is suggestive of a less favorable long-term prognosis in this category of patients. Conclusion. The patients having abnormal AWS parameters should be included in a group at risk for cardiovascular diseases and CVEs and their existing RFs be further assessed in detail for a preventive purpose. It is appropriate to incorporate volumetric sphygmomanometry in screening examination programs.
Terapevticheskii arkhiv. 2016;88(4):20-23
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Role of assessment of arterial wall stiffness in predicting carotid artery atherosclerosis in patients with abdominal obesity

Druzhilova O.Y., Druzhilov M.A., Otmakhov V.V., Andreeva E.S., Kuznetsova T.Y.


Aim. To estimate the possibility of using arterial wall stiffness (AWS) parameters as predictors for carotid artery atherosclerotic plaques (CAAPs) in patients with abdominal obesity (AO). Subjects and methods. A total of 132 patients (72% men; mean age, 45.0±5.3 years) with normal blood pressure (BP) and AO, and no cardiovascular diseases (CVD) at a SCORE risk of <5% were examined. The investigators analyzed lipid composition of blood, its levels of glucose, uric acid, and creatinine, by calculating glomerular filtration rate and performed 24-hour BP monitoring, by estimating AWS parameters, and triplex scanning of the brachiocephalic arteries. Results. CAAPs were detected in 20 (15.2%) patients. A subgroup of persons with an aortic pulse wave velocity (PWV) of ≥75th percentile (8.0 m/sec for persons aged 31—45 years; 8.3 m/sec for those aged 46—55 years) showed higher rates of carotid atherosclerosis (CA) (44.1% versus 15.2%; p<0.01). The predictors of CAAPs were aortic PWV, average daily aortic systolic BP, and the blood levels of glucose on an empty stomach and uric acid. Conclusion. The analysis of AWS parameters in patients with AO and no CVD at a low SCORE risk may become a potential tool to estimate the likelihood of CAAPs. When the aortic PWV equal or greater than 8.0 m/sec for persons aged 31—45 years and 8.3 m/sec for those aged 46—55 years, CA screening is appropriate for possible further risk reclassification.
Terapevticheskii arkhiv. 2016;88(4):24-28
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The status of large vessels in overweight and obesity according to ultrasound findings

Khovaeva Y.B., Batalova A.A., Golovskoy B.V., Gerasimova А.V.


Aim. To investigate the impact of overweight and obesity on the structure and function of large arteries in apparently healthy individuals; to estimate the magnitude of atherosclerotic lesions of the vessels. Subjects and methods. Sixty-one apparently healthy individuals with varying weights were randomly examined. All the examinees were divided into 3 groups according to their body mass index (BMI) and blood pressure (BP). They all underwent ultrasonography of the brachiocephalic arteries at the extracranial level, as well as the abdominal aorta and femoral arteries. Results. The overweight and obese persons have increased diameters and thickness of the intima-media complex of the common carotid arteries and aorta. These changes are maximally pronounced in obesity in conjunction with high normal BP (systolic BP, 130—139 mm Hg; diastolic BP, 85—89 mm Hg). At the same time, there is a reduction in blood flow velocities and an increase in arterial wall stiffness. More marked structural and functional changes are observed in persons with abdominal obesity. The femoral artery belonging to muscular ones exhibited no structural changes, but displayed reduced blood flow velocities in obesity concurrent with high normal BP. In all the groups, the spread of atherosclerotic plaques is equal; the latter are recorded in one third of the examinees. However, the degree and incidence of vascular atherosclerosis are higher in overweight and obesity concurrent with high normal BP. Conclusion. The overweight and obese persons without cardiovascular diseases were found to have eccentric remodeling of elastic and muscular-and-elastic vessels: the carotid arteries and aorta in conjunction with increased intima-media thickness, reduced blood flow velocities, and atherosclerotic vascular changes. These changes are most pronounced in the obese persons with high normal BP. In all the groups, atherosclerotic changes are encountered mainly in the brachiocephalic arteries at the extracranial level.
Terapevticheskii arkhiv. 2016;88(4):29-34
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Renal function estimation formulas in predicting long-term cardiovascular outcomes in patients with myocardial infarction concurrent with diabetes mellitus

Karetnikova V.N., Osokina A.V., Evseeva M.V., Kalaeva V.V., Gruzdeva O.V., Kashtalap V.V., Zykov M.V., Avramenko O.E., Barbarash O.L.


Aim. To comparatively assess formulas for estimating glomerular filtration rate (GFR) in the prediction of poor outcomes in patients with type 2 diabetes mellitus (DM) within one year after myocardial infarction (MI). Subjects and methods. The investigators examined 89 patients with ST-segment elevation myocardial infarction (STEMI) within 24 hours after the onset of clinical symptoms of the disease. All the patients underwent standard laboratory and instrumental tests. GFR was calculated using the Modified of Diet in Renal Diseases (MDRD) formulas in terms of serum creatinine levels, the Hoek equation: GFR [ml/min/1.73 m2] = (80.35/cystatin C [mg/l]) — 4.3 (CKD-EPI), as well as from cystatin C levels, and the creatinine clearance rate was determined using the Cockcroft and Gault formula (ml/min). During a year after STEMI, the investigators recorded cardiovascular events (CVEs), such as death, recurrent MI, progressive angina pectoris, emergency coronary revascularization, and decompensated chronic heart failure (CHF). The examinees were divided into two groups: 1) 70 (78.6%) patients with MI and no DM; 2) 19 (21.3%) patients with MI and DM. Results. Comparative analysis revealed a tendency towards a difference in the detection rate of GFR <60 ml/min/1.73 m2 calculated using the Hoek formula from cystatin C levels: 42.1% in Group 2 and 21.4% in Group 1 (р=0.067). There were no great differences in the GFR estimated using other formulas. Logistic regression analysis was carried out to determine the most sensitive formula for estimating GFR to assess the risk of CVEs in the patients within a year after MI concurrent with and without type 2 DM. A univariate analysis showed that GFR calculations using the CKD-EPI (odds ratio (OR), 13.5; p=0.046) and MDRD (OR, 6.5; р=0.040) formulas and creatinine clearance estimation (OR, 2.4; p=0.025) were most sensitive in selecting MI patients without DM and with poor outcomes. This analysis revealed that GFR estimates using the Hoek formula from cystatin C levels (OR, 6.15; p=0.018) were most sensitive for patients with MI concurrent with type 2 DM. In both models, multivariate analysis included none of the analyzed indicators. Conclusion. To estimate cardiovascular risk in the long-term post-infarction period, the CKD-EPI formula in the patients without type 2 DM and the Hoek formula from cystatin C levels were noted to be of the greatest prognostic value in patients with DM.
Terapevticheskii arkhiv. 2016;88(4):35-40
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The serum level of the morphogenetic protein fibroblast growth factor 23 (FGF-23) as a marker for the efficiency of hyperphosphatemia therapy with phosphate-binding agents in chronic kidney disease

Mukhin N.A., Milovanov Y.S., Kozlovskaya L.V., Dobrosmyslov I.A., Milovanova L.Y.


Aim. To study whether the excessive production of serum fibroblast growth factor 23 (FGF-23) may be reduced with phosphate-binding agents to treat hyperphosphatemia in patients with Stage VD chronic kidney disease (CKD). Subjects and methods. The investigation enrolled 25 patients with Stage VD CKD on regular hemodialysis (HD) (12 patients with chronic glomerulonephritis, 8 with tubulointerstitial nephritis, and 5 with hypertensive nephrosclerosis); among them there were 15 men and 10 women at the age of 21 to 65 years; their mean age at inclusion in the study was 43±4.5 years. The clinical, laboratory, and instrumental examination similar to that in patients with the early stages of CKD was done. Serum FGF-23 levels (Human FGF-23 ELISA kit using monoclonal antibodies to the full FGF-23 molecule) were investigated in all the 25 patients. A whole blood sample was taken 2 days after the last session of HD before initiation of its regular procedure. Results. The elevated serum FGF-23 concentrations in the patients on regular HD correlated with their HD duration (r=0.508; p<0.001). Along with this, a strong direct correlation (r=0.522; p<0.001) was found between the concentration of FGF-23 in the serum and inorganic phosphorus; at the same time hyperphosphatemia was less significantly associated with higher serum intact parathyroid hormone (PTH) levels (r=0.398; p<0.05). Lower FGF-23 and PHT levels were noted in a group of patients who could achieve and maintain the target serum inorganic phosphorus level (0.9—1.45 mmol/l) compared to that of patients with uncorrected hyperphosphatemia (>1.45 mmol/l) (p<0.01). A decrease in FGF-23 and PHT levels was achieved chiefly in the patients who had used phosphate-binders that contained no calcium (sevelamer hydrochloride). Conclusion. Lower FGF-23 levels were observed in the patients with CHD on regular HD who can achieve and maintain the target serum inorganic phosphorus level when using phosphate-binders that do not contain calcium than in those with uncorrected hyperphosphatemia (p<0.01).
Terapevticheskii arkhiv. 2016;88(4):41-45
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Multivariate analysis of genealogical markers in adults with primary immunodeficiencies

Karakina M.L., Shershnev V.N.


Aim. To study the genealogy of adult patients with primary immunodeficiencies (PID) and to analyze its data in the relatives of these patients. Subjects and methods. A genealogical analysis was carried out in 74 adult patients with PID and 200 adults without this condition, by examining groups of signs in the relatives in at least 4 generations, the genealogical markers were an atypical infectious and inflammatory process; allergic diseases; autoimmune diseases; the presence of relatives with cancers; cases of reproductive dysfunction; deaths from infectious diseases and/or cancers in children; and congenital malformations. The percentage of relatives with the above genealogical markers of the total number of the relatives in 4 generations was used as an indicator. The analysis applied nonparametric methods, such as quartile analysis, Spearman’s correlation coefficient, and Mann-Whitney test to verify the statistical significance of differences between the independent groups. Multifactor prediction models were based on the decision theory (Wald-Bayesian analysis) and classification trees. At Stage 1, the investigators made a univariate analysis, the data of which were used to perform a correlation analysis of the indicators. Multifactor prediction models were based on the decision theory (Wald—Bayesian analysis) and classification trees. Results. The genealogical markers were identified and analyzed using different statistical methods and conclusions were made on prognostically significant indicators. Conclusion. The findings may be recommended for practical use in order to enhance the efficiency of work with patients having various immunopathological syndromes.
Terapevticheskii arkhiv. 2016;88(4):46-52
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Experience in investigating splenic red pulp lymphoma

Al-radi L.S., Moiseeva T.N., Julhakyan H.L., Ntanishyan K.I., Kovrigina A.M., Glebova S.M., Lugovskaya S.A., Dvirnyk V.N., Khvastunova A.N., Yakutik I.A., Savchenko V.G.


Aim. To generalize hematologists’ experience of the diagnosis and differential diagnosis of splenic red pulp lymphoma (SRPL). Materials and methods. Eighty-seven splenic biopsy specimens taken from patients with different B-cell lymphoproliferative diseases were examined in the Hematology Research Center in 2013—2014. The diagnosis of SRPL was based on the morphological, immunohistochemical, immunophenotypic, and molecular examinations of the splenic biopsy specimens, blood and bone marrow (BM) tests in 4 (4.6%) cases. Results. There was significant splenomegaly in all SRPL cases, lymphocytosis in 56 to 94% (leukocytes, 55 and 75·109/l in 2 cases), circulation of hairy lymphocytes with the phenotypes CD20+ (markedly), CD11c+/±, CD103+/± (weakly), LAIR-1+, CD25–, CD5–, CD10–, and CD23–, which did not contain tartate-resistant acid phosphatase, without BRAFV600E mutation, BM with insignificant lymphoid infiltration of CD20+, CD25–, Annexin 1–, and Cyclin D1–. The weight of the spleen averaged 3900 g (1450-9500 g); its tissue exhibited lymphoid infiltration of the red pulp with the phenotypes CD20+, DBA.44+, CD25–, Annexin1–, Cyclin D1–, CD103–, CD123–, CD27–, focal СD11c±, and TRAP±. Four patients (2 after splenectomy (SE) and 2 after SE and chemotherapy with cladribine and rituximab) are being followed up in remission. Conclusion. SRPL is a rare disease that should be presumed to be in significant splenomegaly and lymphocytosis with hairy lymphocytes, which have only some markers for classical hairy cell leukemia (HCL), in minor BM lesion. SE is the standard for diagnosis and treatment. The differential diagnosis of SRPL with HCL has clear criteria and that with HCL-v is undetected.
Terapevticheskii arkhiv. 2016;88(4):53-60
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Differential diagnosis of anemia in true and functional iron deficiency in patients with chronic diseases (malignant tumors)

Zubrikhina G.N., Blindar V.N., Matveeva I.I.


Aim. To make a differential diagnosis of true and functional iron deficiency (ID) in anemia of chronic diseases (ACD). Subjects and methods. A total of 540 patients (785 investigations) and 311 healthy individuals (a control group) were examined. Among them, there were 118 cancer patients admitted for surgical treatment and 226 for chemotherapy (CT), 56 blood cancer patients, 86 with breast diseases without anemia, and 54 workers of the institute with the signs of ID. An enzyme immunoassay was used to determine the plasma levels of ferritin (FR), soluble transferrin receptor (sTFR), and endogenous erythropoietin (EPO). Results. 183 cancer patients did not receive specific treatment, 161 had different cycles of CT. In true ID, anemia was microcytic (average red blood cell size, <80.0 fl) and hypochromic (mean corpuscular hemoglobin concentration, <27.0 pg) with low FR levels (less than 20 ng/ml) and high sTFR concentrations (more than 4.0 µg/ml). The EPO level corresponded to the degree of anemia and was 4—5-fold the normal values. In ACDs, 292 (55%) patients had normocytic normochromic anemia with high FR levels (more than 100 ng/ml), the level of sTFR was low and that of EPO did not correspond to the degree of anemia in 74% of the patients. Functional ID was detected in 108 (37%) cancer patients in the presence of ACD. Despite high FR levels and low sTFR, anemia in Hodgkin’s and non-Hodgkin’s lymphomas was hypochromic microcytic, which may be considered as severe functional ID in ACD. Conclusion. In addition to a clinical blood test, the pharmacokinetic parameters (FR, sRFR, and EPO) should be determined for the differential diagnosis of true and functional ID.
Terapevticheskii arkhiv. 2016;88(4):61-67
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Duodenal motor function in health and some diseases: A hypothesis

Levin M.D., Korshun Z., Mendelson G.


Aim. To investigate duodenal motor function according to radiological findings. Subjects and methods. Radiological studies of the upper digestive tract were retrospectively analyzed in 116 patients aged 55 to 92 years, including 83 patients in whom the study was conducted using conventional barium suspension (Group 11). Three grams of vitamin C were added to 200 ml of standard barium sulfate suspension in 8 patients (Group 2). Group 3 included 25 patients with primary duodenal diverticula. Group 4 included radiographs from 35 articles on superior mesenteric artery syndrome (SMAS). The width of the duodenum and the length of the sphincters were imaged. Results. Sphincters (bulboduodenal sphincter, sphincter of Kapanci, sphincter of Ochsner) were found to play an important role in the physiology of the duodenum. This could hypothesize that duodenal motor function determines its basic patterns. Conclusion. The proposed hypothesis explains how the duodenum performs its functions and is implicated in the pathogenesis of SMAS, acquired duodenal diverticula and sphincter of Oddi dysfunction.
Terapevticheskii arkhiv. 2016;88(4):68-74
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The efficiency and safety of anti-Helicobacter pylori therapy in patients with concomitant chronic hepatitis C

Andreev D.N., Maev I.V., Kucheryavyi Y.A., Dicheva D.T., Partsvania-vinogradova E.V.


Aim. To evaluate the efficiency and safety of two eradication therapy (ET) regimens for Helicobacter pylori infection in patients with concomitant chronic hepatitis C (CHC) in relation to the stage of liver fibrosis (LF). Subjects and methods. A prospective clinical trial was conducted in parallel groups. Group 1 included 50 HCV-negative patients with H. pylori-associated peptic ulcer of the stomach or duodenum; Group 2 consisted of 50 HCV-positive patients with H. pylori-associated peptic ulcer of the stomach or duodenum concurrent with CHC. Each group was divided in 2 subgroups according to the used triple ET (a proton pump inhibitor (PPI) in a standard dose + amoxicillin 1000 mg twice daily + clarithromycin 500 mg twice daily for 10 days) or sequential therapy (PPI in a standard dose + amoxicillin 1000 mg twice daily within the first 5 days and then PPI in a standard dose + clarithromycin 500 mg twice daily + metronidazole 500 mg twice daily for the next 5 days). LF was assessed using indirect elastometry. The efficiency of ET was evaluated by a breath test (after 4 weeks) and an analysis depending on intention-to-treat (ITT) and per-protocol (PP) treatments. A patients recorded adverse events in specially developed diaries. Results. The efficiency of ET was 74% (ITT) and 80.4% (PP) in Group 1 and 76 (ITT) and 79.1% (PP) in Group 2. Both groups displayed a tendency towards an 11.9—12.4% increase in the efficiency of the sequential therapy versus the classical triple (PP) one. The rate of totally found side effects was 20% in Group 1 and 28% in Group 2. During sequential therapy, the rate of side effects was lower than that during the classical one. The efficiency of ET did not significantly depend on the stage of LF. Only the presence of concomitant type 2 diabetes mellitus and the use of macrolides (12 months before treatment) significantly lowered the efficiency of ET (OR 0,21; 95% CI 0,06—0,69, p=0,0102 and OR 0,27 95% CI 0,08—0,9, p=0,0342). LF regardless of its magnitude significantly determined the risk of adverse events during ET (OR 3,33 95% CI 1,19—9,31, p=0,0217). A group at the highest risk of adverse events included patients with liver cirrhosis (OR 4,87; 95% CI 1,01—23,5, p=0,0492). Conclusion. It is appropriate to prescribe a sequential ET regimen as more effective and safe for patients with concomitant CHC during therapy for H. pylori infection-associated diseases. LF increases the risk of adverse events during ET.
Terapevticheskii arkhiv. 2016;88(4):75-81
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A place of intravenous immunoglobulins in current clinical practice: Privigen is a novel 10% immunoglobulin

Latysheva T.V., Latysheva E.A., Martynova I.A.


Intravenous immunoglobulins (IVIGs) were initially designed to treat patients with primary immunodeficiencies (PID). Due to the multidirectional effect of IVIGs on the immune system, a range of nosological entities, in which these agents are successfully administered, is steadily expanding. As of now, IVIGs are successfully used in neurology, rheumatology, hematology, and oncology and they are essential drugs for many patients. In spite of the long experience with IVIGs, their mechanism of action remains unclear, numerous investigations for their clinical introduction are being continued. Therefore, there is a growing need to increase the production of the drugs, which gives rise to the emergence of novel medications, which differ in their composition and manufacture technologies, on the pharmacological market. The 10% intravenous immunoglobulin privigen, the safety and efficacy of which has been proven in foreign practice, is a novel drug on the Russian market.
Terapevticheskii arkhiv. 2016;88(4):82-87
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The cytoprotective drug rebamipide in therapy for inflammatory and erosive-ulcerative lesions of the gastrointestinal tract

Yakovenko E.P., Agafonova N.A., Ivanov A.N., Yakovenko A.V., Aldiyarova M.A., Volosheinikova T.V., Grigoryeva Y.V., Soluyanova I.P.


Rebamipide is a cytoprotесtive drug that stimulates the generation of endogenous prostaglandins in the gastric and small intestinal mucosa and accelerates the healing of erosions and ulcers caused by Helicobacter pylori infection and NSAID administration. The major properties of rebamipide include stimulation of prostaglandins and synthesis of muсus glycoproteins, inhibition of reactive oxygen species, inflammatory cytokines, and chemokines, and suppression of neutrophil activation. This paper shows the ability of rebamipide to enhance the efficiency of therapy for Helicobacter pylori-induced infection, to reduce inflammation, including that after infection eradication, to accelerate ulcer healing, and to prevent the progression of preneoplastic lesions.
Terapevticheskii arkhiv. 2016;88(4):88-92
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Chronic cerebral circulatory insufficiency: A clinical case report

Zakharov V.V., Vakhnina N.V., Gromova D.O., Tarapovskaya A.V.


Chronic cerebral circulatory insufficiency (CCCI) is a result of cerebral microangiopathy, most commonly due to uncontrolled hypertension. In this case, the brain is affected due to recurrent silent infarcts and/or microbleedings without clinical manifestations of stroke and chronic brain ischemia. Progressive cognitive impairments with a preponderance of inadequate attention and lower rates of cognitive performance, with impaired planning and control abilities in relative preservation of memory serve as the main manifestation of chronic progressive non-stroke vascular lesion in the brain. The above impairments are generally associated with emotional changes as affective lability and depression. The paper gives an account of a characteristic clinical case of CCCI, analyzes the mechanisms for the development of neurological symptoms, and sets forth current approaches to managing these patients.
Terapevticheskii arkhiv. 2016;88(4):93-99
pages 93-99 views

The 2015 Federal Clinical Guidelines for Antimicrobial Therapy and Prevention of Infections of the Kidney, Urinary Tract, and Male Genitals

Perepanova T.S.


This paper reviews the latest federal guidelines published in 2015. Emphasis is placed on the etiology and pathogenesis of uncomplicated lower urinary tract infection (uLUTI). There are data of the last Russian Darmis-2011 study of urinary tract infection pathogens and their resistance to essential antibiotics. The paper reveals the causes of persistence of uropathogenic Escherichia coli, the main pathogen of uLUTI, and shows the occurrence of intracellular bacterial communities in the superficial layer of the bladder mucosa, which are characteristic of recurrent cystitis. There are justified treatment and prevention regimens using both first-line and alternative drugs for uLUTI and recurrent iLUTI.
Terapevticheskii arkhiv. 2016;88(4):100-104
pages 100-104 views

Myocardial injury associated with chronic hepatitis C: Clinical types and pathogenetic components

Strizhakov L.A., Karpov S.Y., Fomin V.V., Lopatkina T.N., Tanashchuk E.L., Taranova M.V.


Heart injury is one of the extrahepatic manifestations of chronic hepatitis C (CHC). The paper gives Russian and foreign authors’ data on a relationship between CHC and myocardial injury. It discusses different pathogenetic components (the direct effect of the virus, immunological components), through which hepatitis C virus can induce myocarditis and cardiomyopathies in patients with CHC.
Terapevticheskii arkhiv. 2016;88(4):105-111
pages 105-111 views

Promising markers for the risk and prognosis of gestational diabetes mellitus

Prokhorenko T.S., Saprina T.V., Budeeva S.V.


The review provides information on the molecular genetic mechanisms for the development gestational diabetes mellitus (GDM). It gives data on the genetic identity of GDM and type 2 diabetes mellitus and considers a role of some adipokines and incretin hormones in the development of GDM. There is evidence for the role of magnesium and vitamin D deficiencies in the pathogenesis of gestational carbohydrate metabolic disturbances.
Terapevticheskii arkhiv. 2016;88(4):112-116
pages 112-116 views

Molecular genetics of maturity-onset diabetes of the young

Voevoda M.I., Ivanova A.A., Shakhtshneider E.V., Ovsyannikova A.K., Mikhailova S.V., Astrakova K.S., Voevoda S.M., Rymar O.D.


To verify the type of diabetes mellitus (DM) remains an extremely important problem in endocrinology, as along with types 1 and 2 DM there are rarer hereditary types of DM, including maturity-onset diabetes of the young (MODY). The latter is a genetic type of DM, which is characterized by an autosomal dominant inheritance. Eleven types of MODY (MODY 1 to MODY13) are identified; each is associated with mutations in the certain gene: HNF4A, GCK, HNF1A, PDX1, HNF1B, NEUROD1, KLF11, CEL, PAX4, INS, BLK, KCNJ11 and ABCC8. A molecular genetic testing for suspected MODY is conducted to verify the diagnosis and to define a subtype of MODY, patient management tactics, to predict the outcome of the disease and its complications in relation to the found subtype of MODY. It is also important to seek mutation causing MODY in terms of the early detection of MODY in the first-degree relatives of a proband, appropriate therapy of the disease, and prevention of its complications
Terapevticheskii arkhiv. 2016;88(4):117-124
pages 117-124 views

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