No 7 (2013)

The problem of the development of cognitive impairments in cerebrovascular diseases is discussed. Cognitive decline worsens the condition of the patients, and reduces their functionality and quality of life. Strategy of treatment of vascular cognitive impairments consists of adequate correction of cardiovascular risk factors, especially arterial hypertension, and improvement of cerebral perfusion, the use of neuroprotective agents and drugs stimulating cognitive function. Special attention is paid to the use of a combination of neuroprotective agents Actovegin and citicoline.

The article considers the problem of hyperexcitability in children, associated with magnesium deficiency. As an example, the different clinical situations typical of specific age periods are presented. The potentials for the dietary (nutritional) correction of magnesium status and the role of magnesium orotate (Magnerot) in their treatment in children are discussed.

Pineal hormone melatonin influences various functions of the human body, having a chronobiological, gonadotropic, immunomodulatory and other effects. Potential for the reduction of the size of the ischemic brain injury, which is associated with its antioxidant properties, is one of the important effects of melatonin. Its neuroprotective effect has been demonstrated in animal experiments. Although the data on its use in ischemic stroke in humans are limited, it was shown, however, that melatonin and melatonin agonists may be effective in stroke-associated pathological conditions (delirium, insomnia).

Chronic persistent pain, associated with degenerative-dystrophic rheumatic diseases (eg osteoarthrosis - OA) in elderly patients, can cause difficulties for a practicing physician at the stages of its recognition, diagnosis, treatment, and monitoring the effectiveness and tolerability of pharmacological agents used. In OA, non-steroidal antiinflammatory drugs (NSAIDs) are the most common drugs used. An empirical approach to the selection of the preparation and dose leads to necessity for changes of NSAIDs. In this connection, NSAID with different dose delivery systems for their combined use (topically, orally or by injection) are preferable, because the simultaneous use of two agents from different chemical groups is contraindicated. The drug ketoprofen (Ketonal) meets these requirements. The variety of dose delivery systems of Ketonal provides reliable pain relief with low risk of side effects against the background of its long-term use.

From 2008 to 2011, 244 patients (68 % - women) with pain in the knee joint were treated in the Department of Treatment of Pain Syndromes (DTPS). The average age of the patients was 67,0 ± 16,3 years. The intensity of pain ranged from 4 to 10 points according to the Visual Analogue Scale (VAS), duration of pain ranged from 2 weeks to 6 months. After the examination, the patients were divided into two groups: main group (A) - with high intensity of pain, and control group (B) - with moderate pain. All patients have received a common pathogenetical therapy with COX (cyclooxygenase)-2 selective nonsteroidal anti-inflammatory drugs, central muscle relaxants, and chondroprotectors. In patients with high intensity of pain, blockades of knee joints using small doses of local anesthetics and corticosteroids in addition to the standard drug therapy were performed. Drugs of choice for standard medical therapy were nimesulide, tizanidine, and glucosamine + chondroitin sulfate. Blockades were performed using betamethasone with a local anesthetic. Outcomes were evaluated at 7, 14 and 30 days. The gait performance, joint range of motions, VAS score, and results of psychological testing according to Knee Injury and Osteoarthritis Outcome Score were analyzed. Comparison of the results of treatment in the two groups revealed that long-term use of the Nise (nimesulide) has not only fast anti-inflammatory, decongestant and analgesic effects, but also is well tolerated by elderly patients.

The main purpose of the “40 х 40" study was to evaluate the lipid-lowering efficacy, safety and tolerability of Mertenil (rosuvastatin, company “Gedeon Richter") in the maximum dose of 40 mg/day for 24 weeks in the treatment of very high cardiovascular risk patients who did not reach the target level of LDL cholesterol against the background of the current statin therapy in routine clinical practice.

The article discusses the problem of the treatment of patients with osteoarthrosis (OA). Among pharmaceutical treatments for OA, nonsteroidal anti-inflammatory drugs (NSAIDs) continue to occupy a leading position due to pronounced anti-inflammatory and analgesic effects, good tolerability and safety when properly used. One of the NSAID used for the treatment of OA is lornoxicam (Xefocam). This preparation refers to oxicams and is balanced inhibitor COX1/COX2. Xefocam (lornoxicam) is effective and safe NSAID for the treatment of patients with OA. The drug is well tolerated, comparable to other commonly used non-selective NSAIDs, and the emergence of new forms for intra-articular administration can further expand the therapeutic potential of this drug.

The article presents a case of debut juvenile ankylosing spondylitis, characterized by rapid development of asymmetric poliarticular syndrome, sacroiliitis, disability of patient, and low quality of life of the child and his family. Suppression of the activity of the pathological process was achieved due to the successful application of soluble receptors for tumor necrosis factor α, etanercept. The function of affected joints was completely recovered, and quality of life was significantly improved. Inactive phase of the disease during treatment with etanercept was recorded after 4 weeks, remission - at 7th month of treatment.