No 19 (2011)

Depression is one of the factors that can impair the functional outcome in patients after stroke. The article highlights the problems of diagnosis, clinical manifestation and approaches to the treatment of poststroke depression. Currently, selective serotonin reuptake inhibitors (SSRIs) are more widely used for the treatment of depression in patients with stroke. These include citalopram, escitalopram, fluoxetine, etc. Some authors consider prophylactic use of antidepressants from SSRI group for prevention of development of poststroke depression as reasonable method of treatment, particularly in patients with depressive disorders in anamnesis.

The article discusses the role of citicoline in reparative and neuroprotective processes developing in the cell in postischemic period. Data on the effectiveness of the drug in the experimental conditions, as well as in patients with ischemic and hemorrhagic stroke are summarized. Citicoline showed significant positive effects on recovery processes in all considered studies.

A fundamental aspect of the problem of pain is its division into two types - acute and chronic; mechanisms of development and approaches to treatment of these types of pain are fundamentally different. To date, more than 30 compounds involved in the mechanisms of excitation and inhibition of nociceptive neurons in the central nervous system are identified. Reduction of synthesis of inflammatory mediators leads to significant analgetic effect. Non-narcotic analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) have such mechanism of action. In modern medicine, priority is given to NSAID that selectively inhibits cyclooxygenase-2 (COX-2); in contrast to the nonselective COX inhibitors, they have significantly less side effects.

Use of headache diary in everyday outpatient practice offers new perspectives not only in terms of diagnosis of primary headaches, but also in terms of the correct choice of patient management. Results of an international multicenter Eurohead study showed efficiency and convenience of use of such a diary, especially in the diagnosis of migraine and abuse headaches. Experience of the use of the drug Nomigren in a specialized headache Сenter extends the potentials for the treatment of patients with migraine.

Treatment of acute and chronic inflammatory disease of joints in children is a challenge for the pediatrician and rheumatologist. Traditionally, therapeutic algorithms of treatment of arthritis in children include non-steroidal anti-inflammatory drugs, which have a unique combination of anti-inflammatory, analgesic and antipyretic action. The article summarizes the available results of use of ibuprofen in juvenile arthritis in children. Application of ibuprofen is characterized by good tolerability and rare development of adverse events. Permit for use of ibuprofen from the age of 3 months and older allows to consider it as drug of choice for initial therapy of inflammatory diseases of joints in children.

A comparative analysis of the effectiveness of local therapy of gonarthrosis by hyaluronic acid preparations (HA) of different molecular weight (Fermatron and Sinokrom forte) against the background of oral administration of chondroprotector Teraflex (glucosamine hydrochloride + chondroitin sulfate) was performed. Prospective follow-up of patients after a course of intra-articular injections showed the superiority of preparation of high molecular weight HA Sinokrom forte over preparation of medium molecular weight HA Fermatron for improvement of functional activity of the joints at 6 months. Sustainable pain management at rest and on movement was achieved in the group receiving Fermatron.

The article presents an analysis of the performance of the Samara regional antiepileptic center in 2010. Adequate therapy allows to achieve remission of epilepsy in most patients, especially among young people. The application of available conventional antiepileptic drugs (valproate, carbamazepine, lamotrigine) has a positive result. In pregnant women with epilepsy, further use of drug, which has the greatest therapeutic effect, is recommended.

Scientific Research Centre, Department of Pathology of Autonomic Nervous System, Moscow According to the classification registers, panic disorder (PD) is a mental illness, but most of the patients refer to internal medicine specialists. Using the SF-36 questionnaire, we evaluated the quality of life (QOL) of 70 patients with PD and 50 healthy individuals. Compared with the healthy population, patients with PD have a low overall QOL - 52,4 points vs 84,7 in healthy subjects (p = 0,0001) due to reducing the physical and mental health components. In patients with severe PD (disease duration of more than five years, social maladjustment, comorbid agoraphobia), subjective measurement of deteriorating physical health component worsened. The conviction of patients that a their violation of activity is primarily caused by disorder of physical health may explain the preference that patients with PD give to general practitioners, resulting in inadequate treatment of this category of patients.

According to randomized clinical trials ALADIN III (1999), SIDNEY (2003) and study performed by D. Ziegler et al. (2009), "cost-effectiveness" ratio in the treatment of diabetic polyneuropathy with thioctic acid and Actovegin showed an economic advantage of thioctic acid in the short-term use (21 days), while Actovegin has demonstrated clinical and economic benefit in long-term therapy (5-6 months).