Vol 91, No 12 (2019)


Evolution of pathogenetic therapy of pulmonary arterial hypertension

Chazova I.E., Yarovoy S.Y., Danilov N.M.


Pulmonary arterial hypertension (PAH) is a severe, disabling disease characterized by an increase pressure in the pulmonary artery (PA), an increase pressure in the right atrium, and a decrease of the cardiac output. It combines several diseases: idiopathic pulmonary hypertension, inherited pulmonary hypertension, PAH induced by medication and toxins, PAH associated with systemic diseases of connective tissue, HIV infection, portal hypertension, congenital heart defects, schistosomiasis. In the absence of treatment, PAH quickly leads to insufficiency of the right heart and premature death. An effective PAH therapy did not exist for a long time. However, in 1987 there was established a positive effect of taking large doses of calcium channel blockers in patients, who “responded” to their prescription in the short term, and in recently several groups of specific drugs have been developed and approved for the treatment of this pathology: prostacyclin analogues and prostacyclin receptors agonists, endothelin receptor antagonists, phosphodiesterase type 5 inhibitors and soluble guanylate cyclase stimulators. Modern studies of treatment of PAH are based on the latest data of the molecular transmission mechanisms of intracellular and intercellular signals, the action of hormones and tissue enzymes. The available results of these studies allow to suggest the inclusion to clinical guidelines several new drugs for the pathogenetic treatment of PAH in the near future: receptor tyrosine kinase inhibitors, Rho - kinase inhibitors, immunosuppressants and type 2 activin receptor agonists, protein kinase C inhibitors, aromatase inhibitors and estrogen receptor antagonists, poly-(ADP-ribose)-polymerase inhibitors and bromodomain protein 4, elastase inhibitors. Some of the drugs have already passed the III phase of clinical trials (imatinib), others are at the preclinical stage or at the I-II phase tests (olaparib, enzastaurin, elafin).
Terapevticheskii arkhiv. 2019;91(12):4-9
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Does the lack of left ventricular reverse remodeling always mean non - response to cardiac resynchronization therapy?

Kuznetsov V.A., Soldatova A.M., Enina T.N., Krinochkin D.V., Dyachkov S.M.


Aim. To evaluate clinical, morphological, functional features and mortality level in patients with different value of left ventricular reverse remodeling after cardiac resynchronization therapy (CRT). Materials and methods. The study enrolled 112 patients (mean age 54.6±9.9 years, 83.5% men) with left ventricular ejection fraction (LVEF) І35%, NYHA functional class II-IV. We enrolled patients with QRS width >120 ms or QRS <120 ms + 3 parameters of mechanical dyssynchrony by echocardiography. Clinical, electrocardiographic and echocardiographic parameters were evaluated at baseline, 1, 3 months and each 6 months after implantation. Three patients with increase of left ventricular end - systolic volume (LVESV) were excluded from prospective trial due to lack of full follow - up data. According to the best decrease of LVESV (mean follow - up period 34.8±16.7 months) patients were classified as non - progressors (n=18; decrease in LVESV <15%), responders (n=41; decrease in LVESV 15-29%) and super - responders (SR) (n=50; reduction in LVESV ≥30%). Results. At baseline groups were matched for main clinical characteristics, the proportion of patients with atrial fibrillation, width of the QRS complex, and the presence of left bundle - branch block. Echocardiographic parameters didn’t differ between the groups. All groups demonstrated significant reverse remodeling of the left ventricle, increase in LVEF, increase in 6-minute walking distance. SR demonstrated the best improvement of clinical and functional parameters after CRT. However, improvement in LVEF, LVESV, NYHA functional class between responders and non - progressors were found similar. Dynamics of these parameters were comparable. The survival rates were 100% in SR, 80% in responders and 88.9% in non - progressors (Log-Rank test p=0.001). Survival rates in responders and non - progressors didn’t differ significantly (Log-Rank test p=0.150). Conclusion. Patients with reduction in LVESV less than 15% demonstrate improvement in clinical status, LVEF and survival rates compared to subjects with reduction in LVESV 15-29%. Non - progressors demonstrate similar survival as responders in long - term period. Taking into account the natural course of CHF functional stabilisation and absence of CHF progression in patients with lack of left ventricular reverse remodelling is a variant of good response and these patients should not be identified as non - responders.
Terapevticheskii arkhiv. 2019;91(12):10-15
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Peculiarities of heart risk in patients with non - alcoholic fatial liver disease

Mosina L.M., Stolyarova V.V., Esina M.V., Titojkina Y.V., Korobkov D.M.


Aim. The purpose of the study is to assess the characteristics of heart risk variability in patients with non - alcoholic fatty liver disease (NAFLD). Materials and methods. The study included 103 patients. All patients were divided into three groups. The first group is 34 healthy patients. The second group - 34 patients with a diagnosis of coronary artery disease; exertional angina II-III FC. The third group - 35 patients diagnosed with NAFLD and type 2 diabetes. An assessment of abdominal circumference, body mass index, ALT, AST, XC, HDL, LDL, TG, glucose and the level of glycated hemoglobin (HbA1c), liver ultrasound and daily ECG monitoring with the determination of HRV were evaluated. Evaluated HRV using statistical analysis: avNN, ms; pNN 50%; SDNNidx, ms; SDNN, ms; SDNNidx, ms; RMSSD, ms. HRV characteristics were evaluated: VLF, LF, HF, LF/HF. Results. Compared with the first group, the increase in cholesterol in patients in the second group was noted by 38.8%, in the third group - by 43.7%, TG - by 34.6 and 41.95%. In patients with NAFLD + DM of the second type, SDNN and SDNNidx decreased in comparison with the healthy patients by 15% (p<0.05) and 14.7% (p<0.05), respectively. A tendency towards sympatovagal displacement of the LF/HF balance in the group NAFLD + type 2 diabetes towards sympathoadrenal effects compared with the group of healthy and IHD patients by 34 and 40% (p<0.1) was revealed. Conclusion. Patients with NAFLD and diabetes of the second type showed a decrease in total HRV, which indicates an increase in their risk of sudden cardiac death. Reduction of HRV in NAFLD and diabetes of the second type can be a predictor of the development and progression of cardiovascular diseases.
Terapevticheskii arkhiv. 2019;91(12):16-20
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Damage to periarticular soft tissues in real clinical practice: frequency, nature, effectiveness of non - steroidal anti - inflammatory drugs

Karateev A.E., Lila A.M., Zagorodni N.V., Pogozheva E.Y.


Damage to periarticular soft tissues is a common pathology that causes severe pain and impaired function of the musculoskeletal system. Aim. To determine the frequency, nature and clinical features of damage to periarticular soft tissues in real clinical practice, as well as the effectiveness of non - steroidal anti - inflammatory drugs (NSAIDs) in the debut of treatment of this pathology. Materials and methods. During the observational study, the frequency of defeat of the periarticular soft tissues in the structure of visits to 68 outpatient orthopedic surgeons in different cities of Russia for 1 month was estimated. Assessed the nature and dynamics of clinical manifestations during treatment in 1227 patients with defeat of the periarticular soft tissues. NSAIDs, mainly the original meloxicam, were used as a “first line” treatment for damage of the periarticular soft tissues. The results of treatment were evaluated after 10-14 days at a repeat visit of patients. Results. The proportion of patients with damage of the periarticular soft tissues was 15.8% of the total number of people who applied for outpatient care. Among 1227 patients (men 57.5%, average age 51.3±15.5 years) who were observed in the dynamics, prevailed were those with damage of the periarticular soft tissues of the knee joint area (knee joint enthesopathy, prepatellar bursitis, tendonitis/ bursitis of the goose foot area) - 21.2%, feet (plantar fasciitis, calcaneal spur) - 16.9%, shoulder (tendonitis of the muscles of the shoulder rotators) - 16.4% and the elbow (lateral and medial epicondylitis) - 15.3%. During treatment, there was a significant decrease in the total severity of pain - from 6.58±1.61 to 2.48±1.60 points on an 11-point numerical rating scale (p<0.001), a decrease in the intensity of pain during movement, at rest, at night and palpation, as well as the severity of functional disorders. The need for local injection of glucocorticoids arose in 22.1% of patients. Significant improvement was noted with all defeat of the periarticular soft tissues localizations, with 68.1% of patients rated the treatment result as “good” and “excellent”. Adverse reactions were noted in 15.0% of patients; no serious complications were recorded. Conclusion defeat of the periarticular soft tissues ranks third in the frequency of visits after injuries and osteoarthritis of large joints in the practice of outpatient orthopedic surgeons. The use of NSAIDs in the maximum therapeutic dose for 10-14 days allows for significant improvement in defeat of the periarticular soft tissues of various localization.
Terapevticheskii arkhiv. 2019;91(12):21-28
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Features of central hemodynamics in patients with community - acquired pneumonia depending on the course of the disease and cardiovascular comorbidity

Titova O.N., Kuzubova N.A., Aleksandrov A.L., Perley V.E., Volchkova E.V., Baryshnikova K.A.


Aim. The study of intracardiac hemodynamics and blood flow in the pulmonary circuit in patients with community - acquired pneumonia, depending on the presence of concomitant pathology of the cardiovascular system and the severity of the pathological process. Materials and methods. In 43 patients with community - acquired pneumonia (22 men, 21 women, mean age 67±17 years), the functional state of pulmonary - cardiac hemodynamics was assessed by echodoplerography. All subjects were divided into 2 groups: 1st group - 25 patients with community - acquired pneumonia (mean age 49±18 years) without concomitant pathology of the cardiovascular system and 2nd group - 18 patients with community - acquired pneumonia (mean age 70.1±11 years) with concomitant cardiovascular disease. Results. The main ultrasound parameters did not differ from the normal values in patients from the 1st group. In patients from the 2nd group there was a significant deterioration of several pulmonary - cardiac hemodynamics parameters, decrease of left ventricular ejection fraction, significant myocardial hypertrophy of the left ventricle and left atrium size increase. Regarding the right heart chambers it was revealed dilatation of the right ventricle, increasing of the estimated systolic pressure in the right ventricle, deterioration of right ventricle myocardial diastolic function, increase of the: RV/LV size ratio, LV eccentricity index, RV myocardium thickness, diameter of the pulmonary artery, velocity of pulmonary regurgitation and the area right atrium size. In addition, the amplitude of systolic displacement of the tricuspid valve ring and the intensity of inspiratory collapse of the inferior vena cava decreased. Correlation analysis of clinical and laboratory parameters, which are markers of endogenous intoxication, oxygen saturation of arterial blood (SpO2), separately for two groups of patients with community - acquired pneumonia, showed a reliable correlation with a number of informative and used in the practice echocardiography parameters of pulmonary cardiac hemodynamics, characterizing systolic (systolic movement amplitude of the tricuspid valve ring - TAPSE), as well as diastolic function (E/A of the right ventricle) of the heart. Conclusion. The relationship between the severity of pulmonary - cardiac hemodynamics disturbances in patients with community - acquired pneumonia, having comorbid pathology, contributing to the deterioration of pulmonary - cardiac hemodynamics and more severe course of the disease with markers of the inflammatory process and oxygen saturation of arterial blood decrease is revealed.
Terapevticheskii arkhiv. 2019;91(12):29-34
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Heart - type fatty acid binding protein in prognosis of ischemic stroke at the hospital stage

Lyang O.V., Kochetov A.G., Zhirova I.A., Novozhenova Y.V., Ivoylov O.O., Stakhovskaya L.V.


Heart - type fatty acid binding protein (h-FABP), in addition to myocardium, is also contained in the brain cells. The blood concentration of h-FABP in cerebral ischemia can be a marker of ischemic stroke course. Aim. To investigate the importance of h-FABP in the prognosis of ischemic stroke (IS). Materials and methods. The study included 302 patients in the acute period of ischemic stroke. All patients were determined the concentration of h-FABP in the serum 1 day by enzyme immunoassay. SPSS and Microsoft Excel software were used for statistical data processing. Results. The most frequent adverse events at the hospital stage were lethal outcome (LO), thrombotic complications and pneumonia. Statistically significant differences in the level of h-FABP between the groups of presence and absence of LO were revealed both by confidence intervals of Central values and by statistical criteria. The ROC analysis values of h-FABP in the presence of the LO confirmed its predictive value, area under the curve amounted to 0.776±0.061 (0.655-0.896), p<0.001. The calculated threshold value of h-FABP was 2757 pg/ml with a sensitivity of 80% and specificity of 74.4%. Prognostic value of a positive result of h-FABP in the prediction of LO was 71%, the negative predictive value of the result is 83%. Odds ratio LO the threshold value of h-FABP was 11.6 (3.68-36.5). Conclusion. Results of the study showed that h-FABP is a significant laboratory biomarker in the prediction of lethal outcome in patients with ischemic stroke. In the absence of any statistically significant effect on the concentration of h-FABP the treatment modality, causes of death and cardiovascular diseases in anamnesis increase the concentration of h-FABP above the threshold 2757 pg/ml can be considered an independent risk factor lethal outcome patients with ischemic stroke.
Terapevticheskii arkhiv. 2019;91(12):35-40
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Intravascular ultrasound with virtual histology in assessment of atherosclerotic plaque composition in patients with coronary artery disease and type 2 diabetes mellitus

Zakharov A.S., Michurova M.S., Terekhin S.A., Kalashnikov V.Y., Smirnova O.M., Shestakova M.V., Dedov I.I.


Type 2 diabetes mellitus (T2DM) is a serious medical and social problem leading to early disability of patients and high mortality from cardiovascular complications. The development of cardiovascular events is associated not only with the degree of coronary artery stenosis, but also with the structure of the atherosclerotic plaque. Aim. This study aimed to characterize structure and composition of coronary artery atherosclerotic plaque in target lesion of T2DM patients and patients without diabetes using intravascular ultrasound (IVUS) and IVUS with virtual histology (IVUS-VH). Materials and methods. We observed 25 patients with coronary artery disease (CAD) with T2DM and without T2DM, which admitted to Endocrinology Research Centre to perform percutaneous coronary intervention (PCI). Patients with CAD and T2DM were included at group 1 and patients with CAD and without T2DM were included at group 2. IVUS and IVUS-VH assessment of target lesion were performed prior to stent implantation. We observed 24 plaques at group 1 and 10 plaques at group 2. Results. In grey - scale IVUS 2D analysis there were no differences in mean cross - sectional area of the vessel (12.5 [10.4; 15.8] mm2 vs. 13.5 [12,7; 16.5] mm2; p=0.223, respectively) and lumen area (3.71 [2.5; 4.5] mm2 vs. 3.2 [2.7; 3.8] mm2; p=0.589, respectively). Plaque burden were higher in patients without T2DM (71.6 [65.5; 75.7] % vs. 77.6 [74.4; 80.4] %; p=0.008, respectively). IVUS-VH analysis showed that percent of necrotic core and dense calcium areas were significantly higher in the T2DM group (31.3 [25.3; 36.5] % vs. 21.65 [14.3; 27.8] %; p=0.01 and 4.7 [2.3; 7.8] % vs. 2.45 [1.2; 4.05] %; p=0.046, respectively). Percent of the fibrotic tissue were higher in non-T2DM group (55.35 [49.7; 63.6] % vs 67.7 [61.8; 76.5] %; p=0.004, respectively). There were no differences in percent of lipidic tissue in both groups. Conclusions. IVUS-VH assessment of coronary artery atherosclerotic plaques showed greater amount of necrotic core and dense calcium in patients with T2DM compared to patients without diabetes.
Terapevticheskii arkhiv. 2019;91(12):41-46
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Clinical and economic analysis of Reslizumab use in the treatment of patients with severe allergic eosinophilic asthma

Kolbin A.S., Avdeev S.N., Zhuravleva M.V., Gomon Y.M., Balykina Y.E., Matveyev N.V., Proskurin M.A., Fedosenko S.V.


Asthma is a heterogeneous chronic disease of airways. One of its endotypes is eosinophilic asthma, accompanied by both peripheral blood and airway eosinophilia, where severe eosinophilia is usually associated with more severe asthma. Anti - interleukin-5 (IL-5) monoclonal antibodies (MAb) can reduce eosinophil counts in peripheral blood and tissues in asthma patients. The first drug of this class registered in Russia was reslizumab. Aim. Comparative clinical and economic analysis of reslizumab use in patients with allergic asthma and eosinophilia. Materials and methods. Omalizumab was chosen as a reference drug, because until now it was the only MAb for the treatment of severe asthma in Russia. The study population included patients with allergic asthma with both high levels of IgE and high eosinophil counts in peripheral blood, i.e. individuals eligible for both omalizumab and reslizumab treatment. A decrease in the number of exacerbations requiring prescription of systemic corticosteroids and an increase in QALY index was used as efficacy criteria. An indirect comparative study was used, because no direct comparison has been conducted to date. As a result, reslizumab demonstrated a statistically significant reduction in the frequency of clinically significant asthma exacerbations compared with omalizumab. The utility of the both asthma treatment strategies was compared using Markov models, taking into account the frequency of exacerbations, their severity, as well as decrease in QALYs due to exacerbations. The time horizon was 12 months. Results. Reslizumab treatment was 37.2% less expensive compared with omalizumab for the patients who are equally eligible for the both drugs. The calculated cost - effectiveness and cost - utility ratios were in favor of reslizumab. Budget impact analysis showed a significant effect of reslizumab on reducing budget costs. If reslizumab is used in 4250 patients (an estimated number of patients with severe allergic asthma and eosinophilia in Russia), this would reduce the costs for their treatment by up to 4896 million rubles per year. Conclusions. For patients with severe allergic eosinophilic asthma who are equally eligible for the both drugs, reslizumab can be considered a more reasonable medical technology in terms of pharmacoeconomics when compared with omalizumab.
Terapevticheskii arkhiv. 2019;91(12):47-56
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The effectiveness of target therapy in patients with severe allergic asthma

Skorokhodkina O.V., Valeeva A.R., Luntsov A.V., Pozdnyak V.A.


The purpose of study was to analyze own clinical experience and assess the effectiveness in treatment of severe very poorly controlled allergic asthma patients with omalizumab. The effectiveness of biologic treatment with omalizumab was analyzed in 10 patients with severe very poorly controlled allergic asthma. It has been shown that indication of anti-IgE therapy in case of severe allergic asthma resulted in decrease of day and night asthma symptoms, symptoms of allergic rhinitis, dose of other anti - inflammatory asthma medications, discontinuation of systemic corticosteroids which led to good and partial control of the disease. Anti-IgE therapy is a highly effective treatment in asthma patients with atopic phenotype.
Terapevticheskii arkhiv. 2019;91(12):57-62
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Peripheral nervous system lesion in systemic vasculitis - issues of diagnosis and treatment

Golovach I.Y., Yehudina Y.D.


Vasculitis is a clinically diverse group of diseases with histopathological signs of blood vessel inflammation, which contributes to vascular damage and ischemic damage to the affected tissues. Vasculitic neuropathy is a common complication of the primary systemic vasculitides, such as polyartertis nodosa and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, systemic diseases of the connective tissue - systemic lupus erythematosus and Sjogren syndrome, vasculitis associated with infection, most often viral hepatitis C and B and non - systemic vasculitis neuropathy. Vessels of medium and small caliber are involved in the pathological process in these diseases. With all vasculitis, except for those caused by the direct effect of the infectious trigger on the blood vessel walls, the main pathogenetic mechanism is an autoimmune process with the development of vasa nervorum vasculitis - small arteries and vessels that supply peripheral nerves, and the outcome - nerve ischemia. The classic clinical presentation is an acute or subacute painful multifocal neuropathy that has a predilection for the lower extremities, affects two or more named nerves, and progresses in a step wise manner. However, vasculitic neuropathy can manifest in a variety of ways, including asymmetric polyneuropathies and distal symmetric sensory neuropathies, and it also can be slowly progressive, particularly in cases of nonsystemic vasculitic neuropathy (NSVN), a form of vasculitis that clinically remains restricted to peripheral nerves. Nerve biopsy can help establish the diagnosis of a systemic vasculitis, particularly when other organ involvement is not clinically apparent, and is required for diagnosis of NSVN. Neuropathy due to systemic vasculitis should be treated in accordance with the recommendations for the treatment of the underlying disease. In NSVH, the main medicine of choice are glucocrticoids, and in severe/progressive cases, pulse therapy with cyclophosphamide.
Terapevticheskii arkhiv. 2019;91(12):63-69
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Psychosocial factors and coronary heart disease

Kubareva M.I., Ibatov A.D.


Article is devoted to a research of interrelation of psychosocial factors and courses of coronary heart disease (CHD). The anxiety, a depression, social isolation of patients with CHD is considered. Need of identification of psychosocial factors at patients with CHD for the purpose of their correction and improvement of the forecast of sick CHD and quality of their life is shown.
Terapevticheskii arkhiv. 2019;91(12):70-74
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Hyperuricemia, gout and high cardiovascular risk - how to manage them in clinical practice

Fomin V.V., Morosova T.E., Tsurko V.V.


In recent years, the relationship of hyperuricemia and gout with a high risk of cardiovascular disease has been widely discussed. Therefore, it is important to systematically examine patients in order to diagnose comorbidities, among which cardiovascular disease and its complications occupy a leading place and consider mandatory treatment of patients with hyperuricemia and gout with high cardiovascular risk with lowering drugs, which fully reflects the provisions of the latest European recommendations for the management and treatment of patients with gout.
Terapevticheskii arkhiv. 2019;91(12):75-83
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Non - alcoholic fatty liver disease and enteral insufficiency: comorbidity of their development

Vakhrushev Y.M., Suchkova E.V., Lukashevich A.P.


The article reflects current literature data on the epidemiology and risk factors of non - alcoholic fatty liver disease. An important aspect is the description of the modern views of combined lesions of the hepatobiliary tract and small intestine. Disorders of the intestinal microbiota play a special role in the development of non - alcoholic fatty liver disease. The value of enterohepatic circulation of bile acids in the development of intestinal and liver diseases was shown. It seems relevant to further study the comorbidity of the development of non - alcoholic fatty liver disease and enteropathy for the development of pathogenetically substantiated therapy.
Terapevticheskii arkhiv. 2019;91(12):84-89
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Left ventricular non - compaction: contemporary view of genetic background, clinical course, diagnostic and treatment

Streltsova A.A., Gudkova A.Y., Kostareva A.A.


This review highlights and discusses recent advances in understanding left ventricular non - compaction (LVNC). Clinical profile, prognosis and even diagnosis are still a great challenge faced by the world. The population prevalence of left ventricular non - compaction remains unknown. High variability of clinical manifestations, genetic heterogenity with overlap of different phenotypes, variability of hereditary patterns suggests that LVNC seems to be rather an isolated trait or a part of phenotypic expression of different cardiac diseases or complex genetic syndromes.
Terapevticheskii arkhiv. 2019;91(12):90-97
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Diseases of biliary tract in the context of association with oncological diseases of the digestive system

Osadchuk M.A., Svistunov A.A., Mironova E.D., Vasil’eva I.N., Kireeva N.V.


Cancers of the gastrointestinal tract are widespread among the population and cause significant damage to the health care system. In order to improve the strategy of preventive measures and the detection of oncological diseases at the early stages, it is necessary to provide timely impact on possible risk factors contributing to the onset and progression of malignant neoplasms. This review demonstrates the association between the pathology of the biliary tract and oncological diseases of the digestive system, discusses the possible mechanisms of the influence of cholelithiasis and cholecystectomy on the development of malignant neoplasms of various parts of the gastrointestinal tract.
Terapevticheskii arkhiv. 2019;91(12):98-104
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A systematic review as a method of gathering scientific evidence into clinical guidelines: CHEST-2019 guideline for the therapy pulmonary arterial hypertension in adults

Shmalts A.A., Gorbachevsky S.V.


The updated fourth version of the CHEST guideline presents the evidence base and treatment algorithm for pulmonary arterial hypertension in adults. The CHEST approach to creating clinical guidelines differs from the European one (ESC/ERS) and, in fact, consists in a systematic review of clinical trials and a sammary of their postulates.
Terapevticheskii arkhiv. 2019;91(12):105-114
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Diabetes mellitus and chronic liver diseases. Literature review (part 2): treatment features

Kalmykova Z.A., Kononenko I.V., Mayorov A.Y.


Diabetes mellitus (DM) and chronic liver disease (CLD) are pathological conditions associated with each other and reaching epidemic proportions. There is a strong pathogenetic relationship of carbohydrate metabolism disorders and a number of CLD. Common mechanisms that provoke metabolic and autoimmune disorders in the development of various CLD, leading to steatosis, insulin resistance (IR), impaired glucose tolerance and the development of DM are described. Effective glycemic control can have a beneficial effect on the treatment of these patients, and, conversely, there is evidence of a positive effect of CLD therapy on carbohydrate metabolism. This review discusses the correction of carbohydrate metabolism in patients with CLD, the main groups of modern hypoglycemic drugs, mechanisms of their action, the impact on the physiology of the liver, the possibility of using each of these pharmacological groups in patients with impaired liver function. The modern approaches and possibilities of drug effects on the process of fibrogenesis in CLD, the effect of these drugs on carbohydrate metabolism are listed.
Terapevticheskii arkhiv. 2019;91(12):115-121
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Muramyldipeptide - based compounds in current medicine: focus on glucosaminylmuramyl dipeptide

Ushkalova E.A., Zyryanov S.K., Zatolochina K.E.


The role of immune mechanisms in the pathogenesis of almost all human diseases shown in recent decades, increase in antibiotic resistance and secondary immunodeficiency, aging of the population and widespread use of immunosuppressive drugs and procedures suggest a wider use of immunomodulators in current clinical practice, but the use of most of them limits the lack of knowledge. The most promising compounds for the development as immunomodulating agents and adjuvants for a wide range of vaccines are low molecular weight fragments of peptidoglycan - muramylpeptides. The article describes the mechanisms of action of muramylpeptides, their biological effects and properties of medicines developed on their basis. Special emphasis is placed to glucosaminylmuramyl dipeptide registered in the Russian Federation under the trade name Likopid, which is currently the best - studied drug in its group. The results of Likopid studies when used as a prophylactic and therapeutic agent for infections of various localization in adults and children, for oncological diseases and complications of chemotherapy and radiation therapy, psoriasis, atopic and other diseases are presented. It is emphasized that in diseases associated with human papillomavirus and plaque psoriasis, according to current criteria of evidence - based medicine, Likopid should be classified as drug with level A efficacy (high efficiency in 80-100% of patients). High safety of Likopid in adults and children, including newborns, is noted.
Terapevticheskii arkhiv. 2019;91(12):122-127
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Do the patients with peripheral atherosclerosis need to a medical therapy before the revascularization?

Barbarash O.L., Kashtalap V.V.


In the review article are provided the approaches to the therapy for improvement of prognosis in patients with peripheral and multifocal atherosclerosis which are available now; some limitations and a real situation are designated for the antithrombotic therapy in this category of patients. According to the clinical trial COMPASS the prospects of wide use of a combination of acetylsalicylic acid and a rivaroxsaban of 2.5 mg 2 times a day in the patients with chronic coronary heart disease and/or symptom peripheral atherosclerosis are designated.
Terapevticheskii arkhiv. 2019;91(12):129-134
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The clinical status and treatment options for osteoarthritis in patients with frailty

Naumov A.V., Khovasova N.O., Moroz V.I., Tkacheva O.N., Shavlovskaya O.A.


Aging is an independent risk factor for the development of many diseases and geriatric syndromes. Osteoarthritis (OA), as the most common joint disease in the elderly, can be attributed to age - associated conditions. And the most significant geriatric syndrome, which dramatically affects the management and prognosis of an elderly, is frailty. The review provides current information on the prevalence of OA and frailty, their clinical and prognostic significance, and also shows the mutually aggravating role of these two conditions. The difference between non - and medication management of patients with OA and frailty is emphasized.
Terapevticheskii arkhiv. 2019;91(12):135-141
pages 135-141 views

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