No 11 (2010)

The features of the mechanisms of action and indications for use of carvedilol are discussed. Its pharmacological properties, not directly associated with beta-adrenoblocking action, are considered. Carvedilol have peripheral vasodilator effect, caused by concomitant antagonism to alpha1-adrenoreceptors. Its special feature is the ability to bind free radicals (trapping phenomenon). The data for controlled clinical studies, which evaluated the efficacy and safety of carvedilol, are presented.

The article deals with problems of onychomycoses - fungal nail infections which are most prevalent and often resistant to treatment in dermatology. The data for the epidemiology, etiology, pathogenesis, clinical characteristics and principles of therapy of dermatoses are presented. Indications and contraindications to the systemic, local and combined therapy of onychomycosis are discussed. The particular attention is focused on the local therapy as definitive treatment of onychomycoses due to its high safety, accessibility and usability. The current evidences of the efficacy and safety of local therapy of onychomycoses with 8 % Ciclopirox nail lacquer based on numerous foreign and domestic studies are presented.

The use of combined drug - thiamphenicol glycinate acetylcysteinate (TGA), consisting of the universal mucolytic (N-acetylcysteine) and broad-spectrum antibiotic (thiamphenicol) at a dose of 500 mg in infectious-inflammatory diseases of the respiratory system is justified. Outlined case history of the use of TGA in the treatment of exacerbation of bronchiectatic disease demonstrated high therapeutic efficacy of the drug. The advantages of nebulizer route of administration of TGA is emphasized.

Renal impairment substantially limits the choice of basal antirheumatic therapy (BART) of rheumatoid arthritis (RA). Elderly age and presence of renal disease on the background of a long course of RA are the risk factors for side effects of BART. Thus, rheumatologist in practice often solve nonconventional challenge of searching the golden mean between the need for early initiation of aggressive BART and minimizing the risk of adverse effects against the background of its administration. Leflunomide is a unique basis antirheumatic drug, which can be used in patients with chronic renal insufficiency, including those on program hemodialysis.

The article is dedicated to the problem of adverse effects by cardiovascular system against the background of use of nonsteroidal anti-inflammatory drugs (NSAIDs) in elderly patients, particularly in patients with osteoarthritis in combination with arterial hypertension. In this case, use of non-selective NSAIDs is associated with increased risk of cardiovascular complications and leads to significant limitation of administration of antihypertensive drugs. Selective NSAID nimesulide (Nise) has no such effects, therefore it can be considered as a drug of choice for the management of acute and chronic joint syndrome in patients with arterial hypertension.

The article is dedicated to the effectiveness and safety of long-acting analogue of somatostatin - Sandostatin Lar in long-term use (up to 5 years) in 163 patients with acromegaly in the active stage, the possibility of its use as a primary therapy of acromegaly. It was shown that Sandostatin LAR as a safe medicine can reduce the secretion of somatotrophic hormon (STH) and insulin-like growth factor (IGF-1) in 93,3 % of patients, and provides a safe levels of STH and normal level of IGF-1 in more than half of patients. The drug is effective and safe as an independent mean of medical therapy for acromegaly, and allows controlling the size of pituitary tumors in most patients.

The present article is dedicated to the results of the study aimed to examination of efficacy of new methodology for the evaluation of the pathogenesis and clinical presentation of depression using US Center for Epidemiologic Studies Depression Scale (CES-D - Center for Epidemiologic Studies - Depression). The study enrolled 105 patients with psoriasis and two control groups of patients with other dermatoses and somatic diseases (n = 153 and n = 2053, respectively). According to the results of study, findings were as follows: CES-D scale should be used for the diagnosis of depression in patients with psoriasis; the secondary depression which appear linked to the main disease is dominated in patients with psoriasis; use of antidepressants is necessary given that depression adversely affect on the course of psoriasis. Heptral (ademetionine) may be recommended as the drug of choice due to antianxiety properties, because anxiety is one of the most pronounced manifestations of depression in patients with psoriasis. Moreover, this drug is effective in the treatment of concomitant functional hepatobiliary disorders and hepatotoxicity caused by immunosuppressive drugs in patients with psoriasis. Heptral also has an impact on affected cartilaginous tissue with mild variants of psoriatic arthritis; serotonin 2A receptors inhibiting the activity of tumor necrosis factor, which is one of the key inflammation mediators; beta2-adrenergic receptors of immune cells providing their proliferation.

One of the most urgent problems of the legitimacy of professional activity of health workers is execution of patient's informed consent for conservative treatment. This article discusses the available options (verbal and written) to inform the patient before medical intervention, including drug therapy. The advantages of combined method using the standard (unified) forms, which would allow explain the nature of the problem by specialist and clearly document patient's decision, are accented.

The article presents history of the description, clinical and prognostic significance of Loefgren syndrome. This syndrome is associated with an acute course of sarcoidosis. Its main symptom is erythema nodosum. Erythema nodosum, as well as Loefgren syndrome - is marker of favorable course of sarcoidosis with low risk of progression of pulmonary interstitial lesions.