No 13 (2010)

The article is dedicated to the characteristics of Nimesulide (Nise) in comparison with other nonsteroidal anti-inflammatory drugs (NSAIDs). It was found that Nimesulide belongs to the partially selective NSAIDs, which are characterized by the preferential inhibition of COX-2. The mechanisms of action of Nimesulide in rheumatic diseases, in particular in osteoarthrosis are discussed. The data for its high clinical efficacy and safety are presented. It is emphasized that Nimesulide is an effective drug for the treatment of diseases of the joints and spine due to rapid and pronounced analgesic and anti-inflammatory actions without chondrotoxic properties, and the frequency of side effects is comparable to the most popular NSAIDs.

Vertebral lumbosacral radiculopathy is one of main causes of proof disability. The article contains contemporary representations about epidemiology, pathophysiology, methods of diagnosis of vertebral lumbosacral radiculopathy and approaches to its treatment due to evidence-based medicine principles. On the basis of the data of the clinical research estimating long-term efficiency of combined preparations of vitamins B, possibilities of their application for treatment of the given disease are considered.

Parkinson's disease (PD) is the second most common neurodegenerative disease, which affects 1 to 2% of people over 60 years. Treatment of PD includes the symptomatic methods, and neuroprotective strategies remain elusive. Razagiline - a new, potent and irreversible monoamine oxidase type B inhibitor (MAO-B) which was approved for the treatment of PD. Razagiline more effective inhibits MAO-B as compared with selegiline, and the ability to use once a day is its advantage. Few large, randomized, placebo-controlled clinical trials have demonstrated the effectiveness of razagiline use as monotherapy at early stages of PD and as combination therapy for advanced stages of PD. The studies in vitro and in vivo have demonstrated the additional neuroprotective effects of rasagiline. Recently completed study ADAGIO with the inclusion of groups with delayed treatment (delayed disease progression against the background of use of razagiline once a day) have shown the potential of rasagaline for modification of clinical course dose 1 mg/day.

The article discusses the features of acute myocardial infarction (AMI) in elderly patients and pharmacotherapy of AMI with relation to improvement of long-term prognosis and minimization of risk of adverse events. In particular, the benefits of long-term use of acetylsalicylic acid (ASA) are considered. It was shown that the use of ASA can reduce the number of deaths by 26 in every 1000 patients with AMI during the first 35 days since its onset. Chronic usage of ASA significantly reduces the cost of primary prevention of cardiovascular complications. The use of ASA in elderly patients with AMI is justified, especially in the context of pathogenesis: experimental studies have demonstrated that this drug reduces the severity of aging-associated endothelial dysfunction. In the context of the risk of gastrointestinal hemorrhage, enteric form of ASA in a dose of 50-100 mg, which has proven efficacy (Thrombo ASS), may be safer and have special benefits specifically in elderly patients with AMI.

The present article is concerned with main forms of lupus erythematosus: chronic cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus and systemic lupus erythematosus; clinical and histological features of each disease subtype are considered; basic directions in the treatment of lupus erythematosus in light of current recommendations are discussed. Drug therapy includes antimalarial medicines (in particular, hydroxychloroquine), steroids, immunosuppressive drugs, vitamins, locally - sunscreen creams, ointments and creams with steroids.

Among the variety of immune disorders that underlie the development of autoimmune diseases, the examination of defects in cell regulation is of particular interest, especially in the context of the development of new pathogenetically justified approaches to treatment. The use of anti-B-cell preparations, namely the single registered to date preparation of this group - rituximab, is considered as a new method of treatment of rheumatoid arthritis. The case report of successful treatment by rituximab of young patient with severe rheumatoid arthritis resistant to the standard schemes of basic therapy is presented.

The article presents the results of pharmacoepidemiological study of arterial hypertension (AH) in Russia PIFAGOR III. 3030 valid questionnaires completed by patients with AH (63% men, 35% women) were analyzed. The mean age of patients was 58.3 years (from 20 to 95 years). 79% of patients regularly use antihypertensive drugs (AHD), the mean number of used AHD - 2,22 per 1 patient. Distribution of AHD by classes: angiotensin converting enzyme inhibitors (ACEI) - 33.2%, β-blockers - 20.3%, diuretics - 19.7%, calcium channel blockers - 13.4%, angiotensin-2 receptor antagonists - 3.1% , central acting drugs - 2.9%. In the group of ACE inhibitors, 3 drugs dominate: enalapril (44%), lisinopril (15%), perindopril (10.3%). In the group of β-blockers, bisoprolol (41,3%) and metoprolol (27,5%) are often used. In the group of diuretics, 67.0% was accounted for indapamide, 23.7% - hydrochlorothiazide. Amlodipine (53.4%) take the lead in the group of calcium channel blockers. Among the central acting drugs, clonidine share is 28%, rezerpine-containing drugs - 31%, and moxonidine - 32%. Overall, 161 brand-name drugs are used by patients, and only 39% of AHD are innovator drugs. The motivation and treatment compliance have increased: 83% of patients controls blood pressure (BP) at home, 16% - attends AH school, and 69% of patients have target BP levels. The positive trends in the quality and effectiveness of pharmacotherapy of AH are revealed. However, problems of provision and availability of different AHD for patients are not resolved.

This article discusses the use of β-blockers in the treatment of arterial hypertension (AH). The results of study aimed to evaluation of efficacy of cardioselective beta-blocker Bisogamma (Bisoprolol) in the treatment of 48 hypertensive patients show metabolic neutrality of this drug, ability to improve the blood rheological properties and prevent the progression of changes in the arterial vessels in such patients.

Degenerative disc disease is one of the most important problems of clinical medicine. Our previous systematic analysis of the molecular mechanisms showed the paramount significance of magnesium in maintenance of structure and function of connective tissue. The present work is the first experimental and clinical study of trace-element composition of herniation of intervertebral disc and influence of therapy with magnesium orotate on the course of the disease. The study, which included 60 patients with manifest degenerative spine pathology, showed that they all have obvious signs of connective tissue dysplasia on a background of magnesium deficiency, which greatly aggravates clinical symptoms of degenerative spine pathology and leads to exasperation and chronification of pain syndrome. Significant decrease in clinical manifestations of magnesium deficiency was observed in patients treated with magnesium orotate; patients reported improved sleep, stabilized blood pressure, regression of chest discomfort, arrhythmias, and convulsions in the legs. Fundamental difference in the histology of the connective tissue of hernias was established: Type 1 -loose, fragile and friable tissue, Type 2 - dense, viscous, and rubbery tissue. The Type 1 hernias are accompanied by lower content of magnesium, boron, zinc and lithium in the hair. As shown in the present study, the correlation of clinical and histological manifestations of the disease with the microelement status of the patient can be used to predict the patient's condition and order individual entry, including magnesium preparations.

The article continues discussion of the problems of legal regulation of drug therapy [1, 2]. The options for legal confirmation of patient's consent to drug therapy in the primary medical records in accordance with current legislation of Russia are discussed. Degree of liability of subjects of medico-legal relations in attainment of informed consensus for proposed drug therapy is considered.