No 20 (2012)

The estimation of intestinal dysbiosis by identification of the O-antigens of pathogens of acute intestinal infections (AII), markers of Clostridium difficile toxins A and B and Shiga toxin in 78 patients with erysipelas who received antibiotic therapy for the underlying disease was performed. Coagglutination reaction on glass and plates was used. On admission, O-antigens were identified in 75 % of patients, C. difficile A and B toxins - in 72,5 %, Shiga toxin - in 45 %, moreover, high titers - in 20 % of patients. Growth of C. difficile toxins A and B antigen titers in stool was detected in half of patients treated with cefazolin and gentamicin, and in one third of patients treated with benzylpenicillin. The results indicated the presence of intestinal dysbiosis (subclinical) in patients with erysipelas, which is aggravated against the background of antibiotic treatment; this fact should be considered during the treatment of erysipelas, and during follow-up.

Migraine and epilepsy are most common neurological diseases, manifested with paroxysmal disorders. The prevalence of epilepsy in people with migraine varies from 1 to 17% with a median of 5.9%, that is significantly higher than the average in the population (0.5%), and the prevalence of migraine in epileptic patients is 8-15%. Clinical manifestations of migrainous and epileptic attacks may be similar, making difficult differential diagnosis, for which the most important tool is history-taking. Electroencephalography (EEG) may be useful for patients with headache and signs of epilepsy, such as atypical aura or episodes of unconsciousness. Prolonged video-EEG monitoring is used as a differential diagnosis for migrainous and epileptic aura and objectification a comorbide migraine and epilepsy or migralepsy syndrome. In case of combination of migraine and epilepsy, drugs effective in both disorders (valproate and topiramate) should be preferred

Prevention of stroke and recurrent cerebrovascular events is the actual problem of modern medicine. Diabetes mellitus increases the risk of stroke by 2-4 times. Atherothrombosis is one of the key points for the development of stroke, and the presence of diabetic throm-bocytopathy and angiopathy accelerates the formation of blood clots. According to the European Stroke Association recommendations, antiplatelet (antiaggregant) therapy is the first line of prevention of this disease. As reported by international studies, clopidogrel is the drug of choice in high-risk patients, including patients with diabetes mellitus.

Due to the influence of postinfarction cardiosclerosis (PICS) on disease progression and survival in this group of patients, development of therapeutic approaches and evaluation of its effectiveness in patients with PICS is one of the most important problems of modern cardiology. The results of the analysis of the dynamics of functional and laboratory parameters in 68 patients with PICS (43 men and 25 women) who received the recommended drug treatment in real-life clinical practice are presented. Mean follow-up was 8,1 ± 5 years. All patients with PICS had comorbidity. Pharmacotherapy in patients with prior myocardial infarction included β-blockers (82,4 %), ACE inhibitors (80,9 %), antiplatelet agents (94 %), diuretics, nitrates, and statins. During treatment a decrease in blood pressure (BP) which reached the target level in 46,7 % of patients was reported. Decreased left ventricular mass index (LVMI), reduced proportion of patients with concentric and eccentric hypertrophy of the left ventricle (LV) were achieved, normal LV geometry was recovered in some patients. Renal function, glucose and lipid metabolism have not changed. Thus, pharmacotherapy in patients with prior myocardial infarction mostly corresponded to Society of Cardiology of Russian Federation recommendations; insufficient administration of lipid-lowering therapy was noted. Reduction in BP and LVMI was achieved, the proportion of patients with poor type of myocardium remodeling was decreased.

In recent decades, research on the mechanism of malignant transformation led to the identification of a number of signaling pathways responsible for the regulation of tumor cell proliferation. Initiated by growth factors, hormones or cytokines, such signaling pathways usually start with tyrosine kinase cascade and result in activation of various families of transcription factors that control gene expression in cell division. Identification of these activated signaling pathways in carcinogenesis and suppression of their activity is one of the urgent problems of modern systemic targeted therapy. A description of the key role of PI3K/Akt/mTOR signaling cascade in the pathogenesis of tuberous sclerosis, that responsible for the integration of proliferative stimuli and activation of protein translation, has allowed to plan and begin clinical studies on the effectiveness of mTOR inhibitors as drugs for pathogenetic therapy tuberous sclerosis.

This article describes current principles of diagnosis and treatment of uncomplicated and complicated hypertensive crises during prehospital stage. Special attention is paid to differential approach to the treatment of patients with hypertensive crisis, which takes into account individual characteristics of the disease, pattern of target organ damage and existence of comorbidity.

The article considers the main reasons for the decline in bone mineral density in patients with gastrointestinal disorders, especially inflammatory bowel diseases (IBD). The role of secondary hyperparathyroidism, a vitamin D deficiency, inflammatory activity, and drugs (glucocorticosteroids) in the development of osteoporosis in these patients is described. The possible role of vitamin D deficiency in the development of colorectal cancer in IBD patients is discussed.