Vol 23, No 4 (2012)

Cardiac embolic strokes (CES) that are responsible for about 20% of all ischemic brain lesions are one of the important aspects of stroke. In patients with atrial fibrillation (AF), CES can be adequately prevented only when using oral anticoagulants, out of which warfarin is most widely used. However, its use entails a number of difficulties: undesirable food-drug interactions, a narrow therapeutic window, etc. Its alternative is dabigatran that compares well with warfarin in reducing the risk of stroke in subjects with AF; however, when given in a dose of 150 mg/day, it causes massive gastrointestinal bleeding more frequently than does warfarin. In the ROCKET trial, the direct factor Xa inhibitor rivaroxaban demonstrated to be more effective than warfarin in reducing the risk of acute stroke and extracerebral embolism in patients with AF and it did not differ from warfarin in safety parameters. Thus, rivaroxaban may become a promising alternative to warfarin for preventing acute stroke in subjects with AF.

The present article provides a review of the novel guidelines that were prepared by the European Respiratory Society (ERS) and European Society of Clinical Microbiology and Infectious Disease (ESCMID) for the management of lower respiratory tract infections in adult patients.

The possibilities of 24-hour blood pressure monitoring and analysis of heart rate variability (HRV) were studied in hypertensive crisis (versus uncomplicated hypertensive disease) and acute cerebral circulatory disorders. The HRV criteria associated with a high risk of death from brain stroke were identified.

The paper describes the pathogenesis of entrapment or compression-and-ischemic neuropathies, by providing a rationale for pathogenetic therapy. It gives the clinical manifestations of tunnel syndromes and methods for their diagnosis and treatment. The author dwells upon the use of Milgamma compositum that contains 100 mg of benfotiamine and 100 mg of pyridoxine. These two neutropic components of the drug improve the speed of nerve impulse conduction and enhance the capability of the nerve for regeneration.

The paper considers the pathophysiology and diagnosis of postural orthostatic tachycardia syndrome and the possibility of effective use of ivabradine in this syndrome.

The review analyzes trials of the efficacy of dimethindene maleate in patients with different diseases unaccompanied by itch.

The paper gives the current views of the problem of insomnias, their classification, and basic drug treatments. It emphasizes the role of the objective study of sleep - polysomnography. The administration of hypnotics and the minimized use of benzodiazepines are most important in the pharmacotherapy of insomnia. The authors present the data of foreign and their clinical and polysomnographic studies of the effect of doxylamine (Donormyl) on patients with insomnia. The subjective evaluation of the positive effect of a 10-day course of Donormyl is confirmed by the objective studies of the sleep pattern undergoing positive changes that involve the most important indicators of the sleep pattern (shorter duration of falling asleep; longer rapid eye movement sleep; better sleep quality index). In terms of its high safety and tolerability, Donormyl may be appreciated as an effective agent to treat insomnia.

Cerebrovascular diseases (CVD), acute cerebral circulatory disorders in particular, are one of the most complex problems in medicine. The task of current drug therapy for CVD is not only to choose effective and safe drugs, but also to study their different combinations and, above all, combinations with multidirectional neuroprotective activity. The paper provides a pathogenetic rationale for the use of the most common neuroprotectors and their combinations in outpatient practice.

The paper discusses whether the development of acute post-infarction heart aneurysm may be predicted. Trimetazidine (Preductal MB) is shown to positively affect post-infarction cardiac remodeling in patients with type 2 diabetes mellitus.

Investigations of altered immunological reactivity provide a key for understanding the atopic disease. Multisite receptor interactions of first-generation antihistamines like clemastine offer rapid therapeutic efficacy in allergology and pediatry ward.

The performed trial ascertained that the 3-month administration of Valdoxan in the rehabilitation period after myocardial infarction was effective in relieving affective disorders and improving sleep in patients with type 2 diabetes mellitus and chronic heart failure. The rate of angina attacks significantly decreased, exercise endurance increased, the manifestations of autonomic dysfunction diminished, cardiac morphofunctional parameters changed positively, and quality of life significantly increased in the patients receiving combination therapy involving Valdoxan drugs.

Twelve-week treatment with psyllium (Mucofalk) was studied for its impact on the clinical picture of the disease and quality of life (QL) in patients with uncomplicated diverticular disease, the time course of changes in fecal short-chain fatty acids. The drug was found to have hypolipidemic activity, to be well tolerated, to cause no side effects, to improve QL, to normalize intestinal motility, and to reduce pain syndrome and tympanism. The prebiotic effect of Mucofalk was evidenced by elevated fecal short-chain fatty acid concentrations and a lower anaerobic index. The drug significantly decreases hyperlipidemic parameters and may be recommended as a hypolipidemic agent as monotherapy if the baseline level of total cholesterol is <6.4 mmol/l.

The paper considers a public health system in different countries of the world. The Russian Federation’s existing budget-estimate and insurance models for financing health care facilities do not accord in full measure with the purposes and tasks of the innovation development of the branch or form mechanisms for the effective use of resources.