No 6 (2014)

The article presents the results of duplex scanning of the common carotid arteries (CCA) and assessment of structural and functional state of the vasculature in 47 women with arterial hypertension (AH), dyslipidemia and estrogen deficiency in late fertile period (LFP). Using detailed duplex scanning of CCA, it was found that patients with arterial hypertension and dyslipidemia in the LFP with reduced estradiol levels had an expansion of the CCA lumen, reduced blood flow in the carotid arteries with direct course without hemody-namically relevant stenosis, indicating structural and functional changes in the vascular wall in the form of arteriosclerosis. In patients with arterial hypertension and dyslipidemia in the LFP and poor hormonal profile, during the test of postocclusive reactive hyperemia before treatment, on the background of significant reduction of vasomotor endothelial function, in almost every second case (46.7 %) inertial type of vasomotor response is revealed, indicating the contribution of dyslipidemia in the progression of arterial hypertension in dyshormonosis, primarily due to an increase of arterial stiffness and development of endothelial dysfunction. Combination therapy with Mertenil (rosuvastatin) and Ekvator (lisinopril, amlodipine) has significantly better effect on the structural and functional changes in the CCA vascular wall, endothelial dysfunction, and reduces arterial stiffness compared to the therapy with Ekvator (p < 0.05).

The article is devoted to the pharmacotherapeutic approaches to the treatment of gastroesophageal reflux disease (GERD). The article presents the results of recent randomized clinical trials evaluating the impact of GERD on the quality of life of patients. It is conclude that improving the quality of life is one of the main goals of GERD patients and is considered as an endpoint in evaluating the success of treatment. The development of new dosage forms may contribute to improve the patient’s satisfaction of treatment. Enterosoluble tablet formulation of esomeprazole in the form of preparation Neo-zekst ® is one of these forms.

The article discusses the current approaches to the stroke prevention in patients with atrial fibrillation. The results of ROCKETAF study, illustrating the advantages of the new oral anticoagulant rivaroxaban (Xarelto) over warfarin are presented. With specific references, the issues of risk assessment for thromboembolic complications and bleeding when selecting antithrombotic therapy for the prevention of ischemic cerebrovascular disorders are analyzed. The importance of the treatment compliance of patients treated with oral anticoagulants as a factor that largely determines the efficacy and safety of therapy is emphasized.

The article describes the current data on the physiology and pathophysiology of vitamin absorption in the human small intestine, clinical manifestations of vitamin deficiency caused by malabsorption, and their treatment.

Acute otitis media (AOM) is the most common cause of systemic antibiotic therapy in pediatric practice. The high prevalence of the disease and the objective difficulties of adequate diagnosis of AOM dictate the need to development of systematic approach to the diagnosis and treatment strategies. In this regard, reputable pediatric communities have developed a number of guidance documents. Accumulation of new evidence leads to the revision of a number of positions, as demonstrated by the example of the Recommendations on the diagnosis and treatment of AOM in children by the American Academy of Pediatrics (AAP). According to the opinion of ADA, the most relevant criteria for diagnosing of AOM, tactics for determination of the indications for systemic antibiotic therapy, drug selection and duration of therapy are presented.

The article is devoted to the one of the most severe pathologies in pediatric gastroenterology - ulcerative colitis (UC). Despite progress in the evaluation of the pathogenesis, diagnosis and treatment of this disease, individualized and, at the same time, a systematic approach to the therapy has not been developed. This is particularly due to the lack of algorithms for the prediction of course of disease, which largely determines the tactics of treatment. Based on a retrospective analysis, the authors have identified a mathematical predictors of recurrent and continuous course of UC, and have presented the scheme for the stage-by-stage prediction, from outpatient settings to specialized centers, taking into account the availability of information. Mathematical prediction model and differentiated therapeutic tactics based on this model will optimize therapy in these pediatric patients.

In the structure of infectious diseases among children, acute intestinal infections (AII) took second place. Currently in Russia, there are no consistent approaches to therapy. The article presents the World Gastroenterological Association recommendations for the hospitalization with infectious diarrhea, describes the basic principles of therapy and evidence of the effectiveness of key therapeutic interventions. The authors note that the use of antibiotics is not always safe and effective tactic in bacterial diarrhea, and may lead to rapid development of resistance and allergic reactions. A significant role of antibacterial action of bacteriophages as a possible therapy of bacterial intestinal infections is emphasized.