No 15 (2011)

The article discusses the potentials for use of angiotensin II receptor blockers (ARB) in the treatment of cardiorenal syndrome, including in type 2 diabetes mellitus (DM2). The article presents the results of studies showing that these drugs (in particular, olmesartan) can claim the role of independent strategy of management of cardiorenal syndrome, including its prognostically unfavorable variants, such as type 2 diabetes mellitus, preventing the appearance of microalbuminuria. In this regard, the advisability of early use of ARB can be considered in the presence of risk factors for cardiorenal syndrome (arterial hypertension, type 2 diabetes mellitus, metabolic syndrome). Ability to prevent the key manifestations of cardiorenal syndrome, in particular, microalbuminuria, defines the main approaches to increasing long-term renal and cardiovascular prognosis in patients.

Abdominal pain is one of the most common reasons why people seek medical care, and is often due to spasm of intra-abdominal visceral organs. Hyoscine butylbromide (HBB) is a quaternary ammonium compound which blocks the action of acetylcholine at parasympathetic sites (both muscarinic and nicotinic receptors) in smooth muscle, and in secretory glands. It causes decreased motility of the gastrointestinal tract and the urogenital tracts, and is useful in the treatment of spasms in these regions. Evidence exists to support its use in the management of non-specific colicky abdominal pain (in adults and children); irritable bowel syndrome; labor and delivery; dysmenorrhea; and to facilitate improved resolution in certain imaging techniques. Also HBB may be useful in injection form (not registered in the Russian Federation), in certain procedures, such as colonoscopy and sigmoidoscopy, and may be useful in the management of renal colic.

The reasons for reduction of hemoglobin level in patients with chronic heart failure (CHF) are numerous and varied. Possible causes of the decrease in hemoglobin level in CHF are decreased kidney function (cardio-renal anemia syndrome); hemodilution; iron deficiency associated with chronic blood loss against the background of application of antiplatelet drugs; the use of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists; activation of pro-inflammatory cytokines and associated bone marrow dysfunction. The variety of causes leading to a decrease in hemoglobin level in patients with CHF makes difficult a choice of treatment tactics. As a possible method of treatment of anemia in patients with CHF, the use of iron preparations (especially intravenous), EPO and their combination is considered.

The article presents the current state of problem of systemic manifestations of ulcerative colitis (UC) and Crohn's disease (CD), and the results of authors own long-term (1980-2011) prospective study. Study group included 519 patients (UC - 277, CD - 42). Complicated forms of inflammatory bowel disease (IBD) were observed in 35,4 % of cases. Primary sclerosing cholangitis (PSC) was detected more than in half (67,7 %) cases of all extraintestinal manifestations and has determined poor prognosis. Some consistent patterns of combination of PSC and IBD were revealed: 1) total or subtotal lesion of the colon in cases of UC, 2) total involvement of colon in the process in cases of BC, and 3) mild course of IBD with significant activity of the process in the liver. Treatment programs of IBD depending on the presence or absence of systemic manifestations are described.

The article justifies the use of probiotic fermented milk foods for purposes of maintenance of microecology of the human gastrointestinal tract. The most common basis for their creation is traditional fermented milk products enriched by strains of probiotic microorganisms, mainly bifidobacteria and lactobacillus. The clinical studies confirming the usefulness of probiotic products Actimel and Activia are presented. It is emphasized that probiotic fermented milk products can be widely used among both healthy and sick people as a treatment and prevention of a number of diseases.

The main nosological forms of lower respiratory tract infections are infectious exacerbation of chronic bronchitis and chronic obstructive pulmonary disease (COPD), and community-acquired pneumonia (CAP). The major antibacterial drugs (AD) in the treatment of above-mentioned diseases are β-lactam antibiotics (aminopenicillins, including inhibitor-protected penicillins, II - III generation cephalosporins), macrolides, and respiratory fluoroquinolones. Clinical and microbiological efficacy of inhibitor-protected penicillins, macrolides, and respiratory fluoroquinolones is equal. The clinical situation, in particular the severity of COPD exacerbations and severity of CAP, the factors of poor response, the risk of antibiotic resistance, availability of dosing schedule, safety and tolerability of drug should be taking into account before choosing the antibiotics.

The article substantiates the use of drugs based on interferon for acute respiratory diseases. The results of several studies using drug Genferon Light containing interferon alpha and taurine, and Viferon containing interferon alpha, in the treatment of patients with ARVI (including children) and acute bronchitis are presented. It was found that the use of interferon alpha in combination with taurine, which has antioxidant, anti-inflammatory, restorative, metabolic action and increases the activity of interferon, allows to achieve several clinical effects simultaneously; this treatment can be considered as so-called effective multitargeted monotherapy. The combination of interferon alpha and taurine allow to reduce the dose of active ingredients, that lead to reduction of drug load and minimization of adverse clinical outcomes.

The article considers modern views on the types of constipation, presents the treatment approaches taking into account features of development of constipation and its pathogenic characteristics, and provides a detailed classification of laxatives with the description of their mechanisms of action. The authors propose an algorithm of treatment of constipation and selection of laxatives based on the etiopathogenetic parameters of constipation. The advantages and disadvantages of different groups of laxatives are described; correct use of stimulant laxatives is emphasized.

Course application of biologically active food supplement Hepaguard in dietary nutrition of patients with chronic hepatitis being formed adaptive responses to homeostatic systems at various levels leading to positive changes of lipid peroxidation, normalization of cholesterol metabolism, improving of physical and psychological aspects of quality of life in patients with chronic hepatitis