Vol 87, No 5 (2015)

Articles
Rheumatic diseases and multimorbidity
Nasonov E.L., Gordeev A.V., Galushko E.A.
Abstract
In the past decade, investigators’ undeniable and justified interest has not been fading in comorbidities in the presence of rheumatic diseases. The terms «comorbidity» and «multimorbidity» are frequently and not always consciously used as interinterchangeable, confusing the terminology and accordingly the elaboration of strategies for further researches. The concepts «co-occurring disease» and «multimodality» are not mutually exclusive or contradictory, but these should be considered from another point of view than «comorbidity». The problem of multimorbid disease is the rule rather than the exception for clinicians treating primarily «typical» rheumatic patients. Recent researches could outline a few key areas for further study of the concept of multimorbidity in rheumatologic practice, which will be able to turn the international research community from rheumatic disease to the patient as a whole.
Terapevticheskii arkhiv. 2015;87(5):4-9
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Time course of changes in the clinical manifestations of gout in men: Data of a 7-year retrospective follow-up
Eliseev M.S., Barskova V.G., Denisov I.S.
Abstract
Aim. To estimate the time course of changes in the clinical manifestations of gout and their risk factors during a long-term follow-up. Subjects and methods. A total of 160 male patients with gout were examined and followed up for a mean of 6.9±2.0 years. Their clinical assessment included determination of the type of arthritis over time, the frequency of arthritis attacks during one year prior to the examination, the presence and number of subcutaneous tophi, inflamed joints, comorbid or co-occurring diseases (CD), allopurinol adherence, dietary compliance, frequency of taking non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, and alcohol. The serum levels of uric acid (UA), glucose, total cholesterol, and glomerular filtration rate were estimated. Results. The number of patients taking allopurinol increased from 19% to 64% (р<0.0001), its average daily dose was 167.6±94.6 mg. The serum level of UA decreased; 16% of the patients achieved its target level. The number of patients with chronic arthritis was not significantly changed. Their serum level of UA was unchanged; the detection rate of subcutaneous tophi and CD rose. During one year, arthritis attacks were absent in 13% of the patients; 90% of them took allopurinol. In these patients, serum UA levels and body mass index significantly declined and the rate of CD was unchanged. None of 18 patients who had their diet and no allopurinol achieved the target level of UA. Conclusion. Among the gouty patients, 36% refrain from the use of allopurinol, only 23% out of them require that its dose be adjusted to achieve the target level of UA. Dietary compliance is insufficient to reach the target level of UA. Chronic arthritis is associated with the increased incidence of CD.
Terapevticheskii arkhiv. 2015;87(5):10-15
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Left and right ventricular diastolic dysfunction in patients with early rheumatoid arthritis before prescribing disease-modifying antirheumatic therapy
Kirillova I.G., Novikova D.S., Popkova T.V., Gorbunova Y.N., Markelova E.I., Korsakova Y.O., Volkov A.V., Alexandrova E.N., Novikov A.A., Fomicheva O.A., Luchikhina E.L., Karateev D.E., Nasonov E.L.
Abstract
Aim. To estimate the rate of diastolic dysfunction (DD) of the left and right ventricles (LV and RV) in patients with early rheumatoid arthritis (RA) before using disease-modifying antirheumatic drugs (DMARDs) therapy and to investigate its association with traditional risk factors (TRFs) for cardiovascular diseases (CVD) and inflammatory markers. Subjects and methods. The investigation enrolled 74 patients with a valid diagnosis of RA, including 56 (74%) women (median age, 54 years; disease duration, 7 months); the patients who were seropositive for rheumatoid factor (RF) (87%) and/or anti-cyclic citrullinated peptide (anti-CCP) antibodies (100%) who had not been on DMARDs or glucocorticosteroids. TRFs for CVD and carotid artery atherosclerosis were assessed from duplex scanning data and echocardiography was performed in all the patients with early RA before starting the therapy. The ratio of the maximum blood flow velocity during early diastolic filling (E) to that during atrial systole (A) was used as a criterion for LVDD and RVDD. There were 3 types of impaired ventricular filling: 1) E/A <1; 2) E/A = 1—2; 3) E/A >2. Results. LVDD and RVDD were detected in 35 (48%) and 17 (23%) patients, respectively. RVDD was recorded only in conjunction with LVDD. Among LVDD and RVDD, the former was prevalent. All the patients with early RA were divided into 3 groups: 1) patients with LVDD and RVDD; 2) those with LVDD; 3) those without ventricular DD. All the three groups were matched for the level of DAS28, anti-CCP antibodies, and RF. The incidence of arterial hypertension, dyslipidemia, and abdominal obesity was higher in the patients of Groups 1 and 2 than in those of Group 3. There was a progressive decrease in high-density lipoprotein (HDL) cholesterol concentrations and increases in triglyceride (TG) levels and atherogenic index from Group 3 to Group 1, with the concentrations of total cholesterol and low-density lipoprotein cholesterol being similar in the 3 groups. Coronary heart disease was recorded more frequently in Group 2 than in Group 3. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) proved to be also significantly higher in the patients with DD than in those without DD. Correlations were found between LV E/A and ESR, CRP, HDL cholesterol, TG, RV E/A and ESR, DAS28, TG. Conclusion. The patients with early-stage RA were found to have high incidence rates of LVDD and RVDD, which is related to the high prevalence of CVD, the high spread of TRF for CVD, and the high activity of an inflammatory process.
Terapevticheskii arkhiv. 2015;87(5):16-23
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Clinical and hemodynamic characteristics and possibilities for therapy in patients with severe (functional class IV) pulmonary arterial hypertension associated with diffuse connective tissue diseases
Nikolaeva E.V., Yudkina N.N., Kurmukov I.A., Novikova D.S., Markelova E.I., Volkov A.V.
Abstract
Aim. To study the clinical and hemodynamic characteristics of a group of patients with Functional Class (FC) IV pulmonary arterial hypertension (PAH) developing in the presence of diffuse connective tissue diseases (DCTD) and to evaluate the efficacy of intravenous iloprost. Subjects and methods. The study enrolled 59 patients with PAN-DCTD, including 7 who had FC IV and 8 who developed this condition during a follow-up. The diagnosis of PAH was based on pulmonary artery catheterization findings. FC IV was diagnosed using the conventional New York Heart Association classification. All the patients received PAH-specific therapy (bosentan, sildenafil); the patients with FC IV had combined therapy; 4 patients were treated with intravenous iloprost calculated with reference to 0.5—2.5 ng/kg/min for 15 days. In addition to the patients with FC IV, 3 patients with unstable FC III were given iloprost. Besides targeted therapy, all the patients received standard treatment, including diuretics, and ionotropic therapy. Results. Evaluation of hemodynamics in patients with different FCs revealed the most important differences in right atrial pressure, cardiac output, cardiac index, and pulmonary vascular resistance. A linear relationship was seen between the level of this indicator and FC, the closest correlation being for hemodynamic parameters characterizing right ventricular systolic function. There were no changes in mean pulmonary artery pressure; only the patients with FC IV were found to have its slight elevation (from 52±15 to 55±11 mm Hg). Pulmonary artery wedge pressure remained unchanged regardless of FC. Intravenous iloprost was noted to have an obvious positive effect on both clinical and hemodynamic parameters. Catheterization verified improvement in 6 out of the 7 patients; no hemodynamic changes were found in 1 patient during 15-day therapy. Conclusion. The patients with FC IV PAH-DCTD have clinical and hemodynamic features responsible for a fatal prognosis. The results of using intravenous iloprost in patients with decompensated PAH associated with scleroderma systematica convince to use its PAH-specific tablets in cases of verified clinical deterioration when taking its dosage form.
Terapevticheskii arkhiv. 2015;87(5):24-32
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Microscopic polyangiitis associated with antineutrophil cytoplasmic antibodies: Clinical features
Beketova T.V.
Abstract
Aim. To study the clinical features of early- and extended-stage microscopic polyangiitis (MPA) and its outcomes on the basis of a long-term follow-up in a rheumatologist’s practice. Subjects and methods. The clinical features of early- and extended-stage MPA were studied in detail and the premorbid background and possible precipitating factors were analyzed in 70 patients with MPA and the proven hyperproduction of antineutrophil cytoplasmic antibodies (anti-proteinase-3 (anti-PR3) antibodies in 55% and anti-myeloperoxidase (anti-MPO) antibodies in 45%) who had been followed up for more than a year. Results. There is evidence for the nosological unity of the two immunological types of MPA associated with anti-PR-3 or anti-MPO antibodies. MPA has been demonstrated to be an aggressive, polysyndromic disease prone to recurrences (52%), the typical manifestation of which is glomerulonephritis (94%) that is rapidly progressive in every four cases and accompanied by hemorrhagic alveolitis (69%) and involvement of other organs. ENT organs and lungs have been noted to be commonly involved in early-stage MPA, which was observed in 61% of the patients in the premorbid period, and to become the first manifestation of MPA (63%) concurrent with body temperature rises (64%), arthralgia or arthritis (41%). Respiratory tract involvement in MPA may be asymptomatic. Anti-PR-3-associated MPA may manifest itself more aggressively and in the first 2 years it is characterized by a poorer prognosis than of anti-MPO-associated MPA (survival rates, 82 and 94%, respectively; p=0.04). With time, the differences were levelled off; recurrences in the patients with anti-PR-3 and anti-MPO develop equally frequently and proceed showing the similar clinical picture; the survival curves converge by age 3. Anti-MPO-associated MPA is characterized by the highest rate of lung involvement in the clinical phase of the disease (61%) and by a propensity to develop hemorrhagic alveolitis, diffuse interstitial (22%) or circumscribed pulmonary fibrosis in the outcome. Conclusion. The findings emphasize how important to diagnose MPA early and to prescribe long-term active treatment using the entire current arsenal of medications as soon as possible until severe injury to organs and systems develops. To specify regularities in the development of MPA may be of value for the better diagnosis of the disease and the further elaboration of optimal treatment policy.
Terapevticheskii arkhiv. 2015;87(5):33-46
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Efficacy and safety of intravenous methylprednisolone in the treatment of patients with active ankylosing spondylitis: Results of a 12-week, prospective, open-label, pilot (METALL) study
Gaydukova I.Z., Rebrov A.P., Poddubnyi D.A.
Abstract
Aim. To evaluate the efficacy and safety of intravenous methylprednisolone (MP) 500 mg in patients with active ankylosing spondylitis (AS) and the inefficiency, intolerability of or contraindications to treatment with 2 or more non-steroidal anti-inflammatory drugs (NSAIDs). Subjects and methods. The investigation enrolled 20 patients (age, 35.35±8.19 years) with a 10.2±9.2year history of AS who met the modified New York criteria) and had its activity defined as the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥4 scores and an inadequate response to and intolerance of ≥2 NSAIDs; there were 13 (65%) men. MP was given in a single intravenous dose of 500 mg. The main efficiency criterion (primary study endpoint) was considered to be the number of patients who had achieved an ASAS20 response at week 2. Additional rating criteria (secondary endpoints) (improved BASDAI/ASDAS; decreased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels; the number of patients achieving ASAS20/40/5/6 responses and ASAS partial remission, and improved ASDAS) were calculated 2, 4, and 12 weeks after MP administration. Safety was monitored estimating the frequency of adverse events (AEs) and controlling vital functions and laboratory indicators. Results. Nine (45%) patients achieved an ASAS40 response at week 2. ASDAS was 3.48 at baseline and 2.21 at week 2 (p<0.0001). ASDAS clinical improvement was established in 11 (55%) patients at week 2. There were decreases in BASDAI from 6.6 to 3.7 at week 2, to 3.5 at week 4, and to 3.2 at week 12 (p<0.001). CRP levels declined from 6.1 to 3.15 mg/l at week 2 (p<0.05), to 2.85 mg/l at week 4 (p<0.001), and to 4.6 mg/l at week 12 (p<0.05). ESR was 6.5 mm/h at baseline, 5.5 mm/h at week 2 (p<0.05), 6.0 mm/h at week 4, and 7.0 mm/h at week 12 (p > 0.05). A total of 13 AEs were recorded and no serious AEs were noted. Conclusion. Pulse therapy with MP 500 mg is safe and effective in the short-term treatment of patients with active AS who have achieved no benefits of NSAIDs.
Terapevticheskii arkhiv. 2015;87(5):47-52
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Cerebrovascular risks and prediction of complications in patients with backache during therapy with nonsteroidal anti-inflammatory drugs
Poverennova I.E., Zolotovskaya I.A.
Abstract
Subjects and methods. The follow-up included 66 patients (34 women and 32 men) who took NSAIDs for emergent low back pain. Results. The findings may suggest that etoricoxib-based therapy is highly effective and relatively safe for the management of acute nonspecific backache in patients with comorbidity. The important feature is the established tendency towards BP destabilization in patients with chronic cerebrovascular diseases treated with NSAIDs (diclofenac, meloxicam, to a lesser extent, nimesulide). After completion of drug intake for 14 days or longer, acute cerebral circulatory disorder and acute cerebrovascular event developed within 4.5 months in 3 and 2 patients, respectively. Conclusion. Thus, the spectrum of possible adverse cardiovascular effects of NSAIDs is rather broad. It is advisable to identify two major groups of NSAID-associated complications: 1) destabilized hypertension; 2) cardiovascular and cerebrovascular events.
Terapevticheskii arkhiv. 2015;87(5):53-57
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Analysis of the state-of-the-art of consulting medical care to patients with glucocorticoid-induced osteoporosis or its risk according to the data of a questionnaire survey (GLUCOST study)
Baranova I.A., Ershova O.B., Anaev E.K., Anokhina T.N., Anoshenkova О.N., Batyn S.Z., Belyaeva E.A., Bolshakova T.Y., Volkorezov I.A., Eliseeva L.N., Kashnazarova E.V., Kinyaikin M.F., Kirpikova M.N., Klyuchnikova E.P., Korolev M.A., Kuneevskaya I.V., Masneva L.V., Muradyants A.A., Otteva E.N., Petrachkova T.N., Peshekhonova L.K., Povzun A.S., Raskina T.A., Smirnova M.L., Toroptsova N.V., Khasanova R.B., Shamsutdinova N.G., Shaporova N.L., Shitova N.S., Shkireeva S.Y., Shostak N.A., Lesnyak O.M.
Abstract
Aim. To analyze the state-of-the-art of consulting medical care to Russian patients with glucocorticoid-induced osteoporosis (GCOP) or its risk. Subjects and methods. This GLUCOST study was organized and conducted by the Russian Association of Osteoporosis. A total of 1129 patients with chronic inflammatory diseases, who had been taking oral glucocorticosteroids (OGCSs) a long time (3 months or more), were examined. The patients filled out an anonymous questionnaire on their own. Whether the measures taken to diagnose, prevent, and treat GCOP complied with the main points of Russian clinical guidelines was assessed. Results. 61.8% of the patients knew that the long-term treatment of GCOP might cause osteoporosis. 48.1% of the respondents confirmed the results of bone densitometry; 78.1% of the patients reported that they had been prescribed calcium and vitamin D supplements by their physician, but their regular intake was confirmed by only 43.4%; 25.4% of the patients had sustained one low-energy fracture or more. Treatment for GCOP was prescribed for 50.8% of the patients at high risk for fractures, but was actually received by 40.2%. Therapeutic and diagnostic measures were implemented in men less frequently than in women. When the patient was aware of GCOP, the probability that he/she would take calcium and vitamin D supplements rose 2.7-fold (95% CI; 2.1 to 3.5; p=0.001) and that he/she would follow treatment recommendations did 3.5-fold (95% CI; 2.3 to 5.3; p=0.001). Bone densitometry increased the prescription rate for antiosteoporotic medication and patient compliance. Conclusion. According to the data of Russia’s large-scale GLUCOST survey, every four patients with chronic inflammatory disease who are on long-term OGCS therapy have one low-energy fracture or more. Due to inadequate counseling, the patients are little aware of their health and do not get the care required to prevent the disease. Less than 50% of patients who have GCOP and a high risk for fractures undergo examination and necessary treatment aimed at preventing fractures.
Terapevticheskii arkhiv. 2015;87(5):58-64
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Osteoarthritis in the adult population of the Republic of Kazakhstan
Nogaeva M.G.
Abstract
Aim. To analyze overall and new-onset osteoarthritis (OA) morbidity among the adult population in the Republic of Kazakhstan in 2011—2012. Subjects and methods. The data of annual statistical reports «On Population Health and Public Health System» (Form No. 12) in 2011—2012 were analyzed. The indicators in the Republic of Kazakhstan were taken from the statistical collected articles «Population Health in the Republic of Kazakhstan and Activities of Healthcare Facilities». Results. A comparative analysis of the indicators revealed a rising trend in overall morbidity by 1%, including in the incidence of musculoskeletal diseases (MSD) by 3% (the increase rate per 100,000 population was 2%). An analysis of the incidence of MSD per 100,000 population in some regions of the Republic of Kazakhstan showed an upward trend in the Almaty Region: the incidence increased among the women and the 18 or more year olds by 23 and 16%, respectively. Among the adults (aged 18 years or older) and women, the number of patients with a newly diagnosed coxarthrosis (CA) increased by 43 and 18%, respectively; the number of those with gonarthrosis (GA) rose by 36 and 33%, respectively. The people older than 60 years of age and women showed 122 and 82% rises in the number of patients with a newly diagnosed CA; there were 78% increment rates in the patients with GA and 68% in the women. Conclusion. In the Republic of Kazakhstan, there was a high incidence of OA in both the people aged 18 years or older with newly diagnosed CA, GA and the people over 60 years of age, in women in particular.
Terapevticheskii arkhiv. 2015;87(5):65-68
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Neurogenic copulative dysfunction in men: Theoretical aspects, differential diagnosis, and rational therapy
Zhivolupov S.A., Bardakov S.N., Samartsev I.N., Ponomarev V.V.
Abstract
Neurogenic copulative dysfunction (CD) is observed in different diseases and injuries of both the central and peripheral nervous system. CD concurrent with actual nervous system diseases has been established to be an important psychotraumatic factor that significantly reduces quality of life in these patients. Aim. To investigate the effect of aminophenylbutyric acid (Noophen) on male copulative function. Subjects and methods. Forty patients with chronic lumbosacral radiculopathy on an exacerbation and mild and moderate closed head injury were examined. Results. The findings suggest that Noophen is effective in the combination therapy of neurogenic CD. Conclusion. The drug can normalize an autonomic control over nerve centers involved in the regulation of copulative function, and improve the psychoemotional status of patients.
Terapevticheskii arkhiv. 2015;87(5):69-75
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Evaluation of endothelial function and estimation of the degree of apoptosis in patients with metabolic syndrome and non-alcoholic fatty liver disease
Drapkina O.M., Deeva T.A., Ivashkin V.T.
Abstract
Aim. To evaluate endothelial function (EF) and to estimate the level of a serum apoptosis marker (caspase-8) in patients with metabolic syndrome (MS) and in those with non-alcoholic fatty liver disease (NAFLD). Subjects and methods. The investigation enrolled 76 patients: 43 with MS (out of them, 72.1% were found to have NAFLD) and 33 without MS and NAFLD. All the patients underwent evaluation of EF by photoplethysmography; the level of caspase-8 as one of the apoptosis markers was studied in all. Results. Increased arterial stiffness was more common in a group of patients with MS. Systolic duration was higher in these patients (p<0.05). In these patients, an occlusion test revealed the significantly more marked signs of endothelial dysfunction (ED), which correlated with some cardiovascular diseases (CVD), and hepatic steatosis (p<0.05). The mean level of caspase-8 was significantly higher in the group of MS patients (p<0.05). There was a positive correlation between caspase-8 levels and hepatic and pancreatic steatosis, obesity, aortic atherosclerosis, type 2 diabetes mellitus, and gastroesophageal reflux disease (p<0.05). Conclusion. The study group of MS patients (among whom, there was a preponderance of those with NAFLD) had, firstly, higher arterial stiffness more frequently (as evidenced by photoplethysmography), secondly, longer systolic duration, which may be a risk factor for CVD; thirdly, more pronounced ED. Fourthly, according to the data of a study of caspase-8 levels, its indicator may serve as a prognostic marker for the development of CVD and NAFLD. It was, fifthly, shown that the administration of statins might reduce the degree of apoptosis.
Terapevticheskii arkhiv. 2015;87(5):76-83
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Hemophagocytic syndrome in patients with adult-onset Still’s disease: Diagnostic problems
Zakharova A.Y., Mutovina Z.Y., Gordeev A.V., Shestakova I.N.
Abstract
Hemophagocytic syndrome (HPS) is a rare life-threatening condition caused by massive cytokine release from activated macrophages and lymphocytes. The paper depicts the development of HPS in different infections, malignancies, and autoimmune diseases. It describes a clinical case of hemophagocytic syndrome in a 63-year-old female patient with adult-onset Still’s disease and high fever accompanied by neutrophil leukocytosis and a drastic left leukocyte count shift, high procalcitonin levels, hepatosplenomegaly, edematous syndrome, and progressive multiple organ dysfunction with the development of disseminated intravascular coagulation and adult respiratory distress syndrome. The diagnosis of HPS was established according to the diagnostic criteria and verified by autopsy: phagocytes in liver and lung tissues.
Terapevticheskii arkhiv. 2015;87(5):84-89
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Primary hepatic lymphoma in a female patient with Sjögren’s disease: A case report and literature review
Gorodetskiy V.R., Probatova N.A., Vasilyev V.I., Vardaev L.I., Ipatkin R.V., Gabunia Z.R., Petukhova S.V., Ivannikov I.O.
Abstract
The paper describes a case of primary hepatic diffuse large B-cell lymphoma in a 52-year-old woman with a 27-year history of Sjögren’s disease. It gives the data available in the literature on the etiology, diagnosis, and morphological characteristics of primary hepatic lymphoma and touches upon the issues of differential diagnosis.
Terapevticheskii arkhiv. 2015;87(5):90-94
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Behçet’s disease and malignization: Literature review and authors’ data
Alekberova Z.S., Gorodetsky V.R., Talybova E.Т., Radenska-lopovok S.G., Izmailova F.T., Evsikova М.D., Timoshin N.M.
Abstract
The paper describes cancers (enteric adenocarcinoma in one case and acute leukemia in the other) in 2 patients with Behçet’s disease (BD) followed up at the V.A. Nasonova Research Institute of Rheumatology. It gives the data available in the literature on BD concurrent with malignant tumors. This concurrence is noted to substantially worsen the prognosis of the disease as a whole.
Terapevticheskii arkhiv. 2015;87(5):95-99
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Systemic vasculitides: Some debatable aspects of the problem
Shilkina N.P.
Abstract
A new nomenclature of systemic vasculitides (SV) and current approaches to their treatment have necessitated the discussion of some debatable questions on this condition. The paper gives the data of examining 325 patients with different forms of SV, followed up in the Interregional Consulting Center for SV patients, and the results of testing the American College of Rheumatology classification criteria for SV and the authors’ criteria, by taking into account the International Chapel Hill Consensus Conference, USA (1994 and 2011) guidelines for CV nomenclature. It discusses the etiological factors and pathogenetic components of SV, morphological aspects, and relationships between the local and systemic forms of SV. The findings were compared with the data available in the literature. It is concluded that differentially diagnostic criteria for CV should be elaborated to specify the stage of the disease, the activity and use of adapted therapy regimens.
Terapevticheskii arkhiv. 2015;87(5):100-105
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Algorithm for the management of patients with ventricular arrhythmias
Shlyakhto E.V., Treshkur T.V., Tulintseva T.E., Zhdanova O.N., Tikhonenko V.M., Tsurinova E.A., Ilyina D.Y., Los M.M.
Abstract
The paper proposes an original algorithm for the management of patients with ventricular arrhythmia from its first registration to choice of treatment policy. Using modern diagnostic methods, much attention is paid to the identification of myocardial structural and ischemic changes and also to the involvement of the autonomic and central nervous systems in ventricular arrhythmogenesis. The diagnostic problems are solved step-by-step. The role of psychological diagnosis is accentuated. Longitudinal electrocardiogram monitoring with telemetric data transmission can promptly initiate treatment of patients in an outpatient setting and, in a number of cases, without discontinuing work. The key point of the algorithm proposed is to prevent sudden cardiac death.
Terapevticheskii arkhiv. 2015;87(5):106-112
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Biological agents and fracture risk
Vetkova E.S., Dydykina I.S., Nasonov E.L.
Abstract
In patients with chronic inflammatory diseases, including rheumatic ones, the risk of fractures exceeds that in the population. Chronic inflammation is one of the most discussed and most important pathogenic factors of reduced bone mineral density (BMD), its worse quality and increased fracture risk. The chronic inflammatory process contributes to the imbalance of bone remodeling toward bone resorption. The use of biological agents in patients with rheumatic and other autoimmune diseases effectively suppresses systemic inflammation and increases BMD. However, the effect of the biological agents in lessening the risk of fractures remains unproven.
Terapevticheskii arkhiv. 2015;87(5):113-117
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Alginates in therapy for gastroesophageal reflux disease
Avdeev V.G.
Abstract
This article presents evidence of the prevalence of gastroesophageal reflux disease (GERD) and highlights its main treatment options. Among its medications, particular emphasis is laid on alginates and their main mechanisms of action are described. There is information on the efficacy of alginates, including the alginate-antacid Gaviscon Double Action, in treating GERD. Recommendations for how to administer these drugs are given.
Terapevticheskii arkhiv. 2015;87(5):118-121
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Role of animal gastric Helicobacter species in human gastropathology
Pozdeev O.K., Pozdeeva A.O., Pozdnyak A.O., Saifutdinov R.G.
Abstract
Animal Helicobacter species other than Helicobacter pylori are also able to cause human gastritis, gastric ulcers, and MALT lymphomas. Animal Helicobacter species are presented with typical spiral fastidious microorganisms colonizing the gastric mucosa of different animals. Bacteria initially received their provisional name Helicobacter heilmannii, and out of them at least five species colonizing the gastric mucosa of pigs, cats, and dogs were isolated later on. A high proportion of these diseases are shown to be zoonotic. Transmission of pathogens occurs by contact. The factors of bacterial pathogenicity remain little studied.
Terapevticheskii arkhiv. 2015;87(5):122-126
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Place of probiotics in the prevention and treatment of antibiotic-associated diarrhea
Plotnikova E.Y., Zakharova Y.V.
Abstract
The paper gives data on the prevalence and etiopathogenesis of antibiotic-associated diarrhea and describes the major pathogens of this disease and methods for their diagnosis. It considers treatment policy in detail, with an emphasis on the use of probiotics for both the prevention and therapy of the disease described. Russian investigations on the alleged topic of a Linex probiotic complex, as well as the authors’ original trial of this medication are presented.
Terapevticheskii arkhiv. 2015;87(5):127-131
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