No 18 (2013)

The review presents the data from studies of statins in acute coronary syndrome (ACS). Based on results of studies, pleiotropic and lipid mechanisms of action of statins in ACS with regard to the development of cardiovascular complications are analyzed. The practical aspects of treatment with statins at the early stages of hospitalization of patients with ACS are discussed.

The lecture is devoted to the current state of problem of treatment of patients with stable angina. The approaches to the improvement of prognosis and reduction of frequency of angina attacks and ischemia are discussed. It is emphasized that for the successful treatment of patients with angina pectoris, control of the main hemodynamic parameters such as blood pressure and heart rate is required. The place of myocardial cytoprotectors is considered. Particular attention is paid to the issues of rational combinations of antianginal drugs.

Against the background of increased incidence of biliary tract pathology in recent years, an increase in the proportion of functional pathology of the gall bladder and the sphincter of Oddi is noted, which accounts for 15% of all diseases of biliary tract. The article describes the pathogenesis of primary and secondary dysfunctional disorders of biliary tract; classification of gall bladder dysfunction and methods of laboratory and instrumental evaluation of the biliary tract dysfunction and dysfunction of sphincter of Oddi are presented. The methods for the correction of digestive disorders against the background of biliary tract dysfunctions are proposed. The advantages of use of the enzyme preparation Ermytal and the features of dose selection are described; data on clinical trials are presented.

The article presents the substantiation and scheme of application of Lavenum gel in the complex treatment of patients with closed fractures of the limbs of different locations. Clinical, physiological and laboratory results demonstrating the effectiveness of the gel are discussed. Application of Lavenum gel in the treatment of patients with closed fractures of the limbs contributed to optimizing the regenerative processes in the tissues of the damaged segment, leading to shorter fixation at device by an average of 7-10 days compared with patients who were treated without the use of a gel.

This study was aimed to the assessment of the efficacy of Actovegin in patients with neurological manifestations of lumbar osteochondrosis. The study included 60 patients with the acute vertebrogenic lumboischialgia (32 men and 28 women aged 30 to 60 years). Vertobroneurological diagnosis was performed according to the H. Hall criteria. Patients were divided into 2 groups: Group 1 - 30 patients receiving traditional comprehensive medical treatment and intravenous transfusion of 20% Actovegin, Group 2 - 30 patients receiving only traditional complex conservative treatment (no Actovegin). Rating of the results of treatment was performed by a doctor; the dynamics of pain was assessed by patients using visual analogue scale; quantitative assessment of vertebral syndrome was carried out using G. Waddel scale.

The article presents data on the prevalence, causes, in particular metabolic causes (insulin resistance, obesity, diabetes), and the basic mechanisms of the pathogenesis of nonalcoholic fatty liver disease; the main features of the clinical manifestations and diagnosis of this disease are described. Particular attention is paid to the complex treatment of patients with nonalcoholic fatty liver disease, which should include recommendations on optimization of diet and lifestyle, pharmacologic correction of hyperglycemia (metformin, etc.), dyslipidemia (statins), oxidative stress (antioxidants), and the use of hepatoprotectors, such as metadoxin. The article presents the results of experimental and clinical studies proving the effectiveness of this drug in the treatment of nonalcoholic fatty liver disease.

The distribution of genotype and allele frequencies of 4a/4b eNOS gene polymorphism in patients with idiopathic sick sinus syndrome (men, women, probands) compared with the control group was analyzed. Significant predominance of homozygous genotype for a rare 4b allele in all study subgroups was reported. Recommendations for the choice of drug therapy depending on the genotype were discussed.

The article analyzes the current data on the methods of diagnosis and principles of treatment of non-alcoholic fatty liver disease (NAFLD), a disease accompanied by the accumulation of fat in the liver more than 5 % of the hepatocyte number. NAFLD is a diagnosis of exclusion, the definition of which is possible only after a careful analysis of all possible specific reasons (alcohol, hepatitis viruses, genetic diseases, etc.) and confirmation of the nature of metabolic disease. Screening for NAFLD is necessarily required in patients with obesity. For diagnosis of NAFLD, the determination of appropriate symptoms of liver diseases, biochemical analysis, including conventional liver function tests, tests characterizing lipid and carbohydrate metabolism, liver ultrasound, elastography and, if necessary, morphological examination are required. Treatment of NAFLD includes low-calorie diet with sufficient level of polyunsaturated fats and dietary fibers, graduated exercise to reduce body weight, the use of insulin-sensitizing agents, the use of essential phospholipids and antioxidants. Principles of diagnosis and treatment of NAFLD are developing rapidly, which requires the attention of physicians and gastroenterologists.

Angiotensin II receptor blockers are considered as one of the three major classes of antihypertensive drugs in the treatment of arterial hypertension in patients with metabolic syndrome. Each representative of this group (losartan, valsartan, candesartan, irbesartan, telmisartan) has clinical and pharmacological features and nuances of clinical applications. Based on their analysis, the algorithm of differential selection of a specific drug is presented.

Until recently, vitamin K antagonist warfarin was a main drug for systemic anticoagulation in atrial fibrillation (AF). The emergence of new anticoagulants - dabigatran, rivaroxaban and apixaban - greatly expanded the approaches to the prevention of stroke in patients with AF. This article highlights the practical aspects of selection of antithrombotic therapy in AF from a perspective of efficacy and safety.

The progressive increase in the number of patients with hepatic failure (HF), high morbidity, disability and mortality of these patients indicate a lack of effectiveness of the existing conservative and surgical treatment of this disease and the need for the search of new, more effective treatments. Currently, liver transplantation is the only effective method of treatment, but the ever-increasing deficit of donor organs and the increasing number of patients needing for transplants do not allow wide use of this method of treatment for all patients with HF. The use of stem cells for the treatment of liver diseases represents a new approach to the strategy of treatment of HF. This article focuses on the current state of the problem of treatment of HF using cellular technology through the use of stem/progenitor cells of the bone marrow.