No 16 (2015)

The article analyzes the various options for local therapy of osteoarthrosis adopted in the polyclinic of CCH. The following types of local therapies were tested: applications, injections, medicinal iontophoresis with perifocal drugs’ deposition. Joint ultrasound examination for local injection therapy optimization is presented. According to the author, these methods were used in an outpatient setting to relieve knee osteoarthritis exacerbations and proved to be of high clinical effectiveness. Ease of use, safety, good clinical results of various methods of local therapy obtained by the author, allowed him to give local therapy a very high assessment in the treatment of osteoarthritis. Apizartron, as an integral part of the local therapy, is widely and positively established itself in the treatment of musculoskeletal diseases.

This review presents evidence of the clinical efficacy of the complex preparation Traumeel S and its components, taking into account a wide range of indications. The main indications include bruises, fractures, epicondylitis, diseases of the musculoskeletal system, tendonitis, and tendinopathy. In addition, the review discusses the mechanisms of drug action - bioregulatory, immunomodulatory and anti-inflammatory effects. A total of 6 randomized controlled trials, 19 nonrandomized controlled trials, 4 cohort studies and numerous case reports confirm the reasonability of clinical application of Traumeel S in certain indications; few controlled studies also indicate the respective activity of components rnntained in Traumeel S.

The article presents current recommendations for pharmacotherapy of severe sepsis (SevS) and septic shock (SepS), reflecting the interdisciplinary experience of experts in more than 30 associations united in the initiative «Surviving Sepsis Campaign». The treatment program is based on an initial and subsequent stages of treatment. The aim of initial stage includes achievement of target parameters of hemodynamics and oxygen status; along with adequate surgical control of the source of infection, it is is implemented by hemodynamic and respiratory support, as well as the optimal mode of antibacterial therapy. A number of provisions of the treatment program in SevS and SEPS has the highest level of reliability: crystalloids are infusion solutions of the choice; hydroxyethyl starches should not be used for infusion therapy; noradrenaline - vazopressor of choice; dobutamine is considered as the drug of choice to increase cardiac output; restrictive strategy in relation to the use of corticosteroids, blood products, and muscle relaxants; per protocol glycemic control to achieve the target level ≤110 mg/dL; pharmacoprophylaxis of venous thromboembolic complications with the preferred use of low molecular weight heparins, and pharmacoprophylaxis of stress gastric ulcers with proton pump inhibitors.

The article considers the key mechanisms of development of acute ischemic stroke (IS) comprising a sequence of biochemical and pathophysiological processes characteristic of acute and delayed brain injury under the ischemic conditions. The importance of reparative and regenerative processes underlying neuroplasticity required for compensation of disturbed functions is emphasized. The results of clinical trials of the use of domestic drug Cellex for the treatment of patients with acute IS are analyzed. The results of the study involving 240 patients with acute IS have demonstrated the feasibility of using of Cellex as a drug for the complex treatment of patients with IS.

The efficiency of endovasal laser obliteration (EVLO) as a radical method of treatment of lower limb varicosity was evaluated. Comparative analysis of results of treatment of 75 patients with C-4, -5, -6 functional classes chronic venous disease according to CEAR was performed; in the treatment of these patients EVLO techniques and surgical phlebectomy were applied. As phlebotonic, Aescusan was applied - preparation having antioxidant, anti-edema, capillaroprotective and venotonic actions. It is shown that the use of EVLO using wavelength 1470 nm in veins with a diameter of up to 1 cm have a 100% efficiency; in a diameter of venous trunks more than 1 cm, there is a risk of long-term recanalization of obliterated vein. In the treatment of such category of patients, EVLO has advantages over phlebectomy, including more rapid disappearance of patients’ complaints, decrease of swelling of legs and trophic disorders and ulcers. Regardless of the type of surgical treatment in the pre- and postoperative periods with prophylactic and therapeutic purposes, the use of Aescusan as pharmacotherapy is the most effective.

The article presents results of the 12-month prospective study of women with postmenopausal osteoporosis treated by genetically engineered drug denosumab. A year later, there was a significant increase in bone mineral density of the lumbar spine, femoral neck and total hip index by 4.98%, 3.2 and 3.0%, respectively. That effect was not significantly dependent on whether before prescribing denosumab the patients were given other anti-osteoporotic medications. There were no fracture cases during the follow-up. Only 5% of patients refused to continue treatment after 6 months, which was not associated with the medication side effects.

Despite advances in the treatment of patients with cardiovascular diseases, optimization of prevention and rehabilitation remain one of the most urgent problems in cardiology. By summarizing and generalizing data from clinical and experimental studies on the drug morpholino-methyl-triazolin-thioacetate (Thiotriazoline), it can be concluded that Thiotriazoline is preparation having the prospects for clinical practice. Cardioprotective and organoprotective actions of Thiotriazoline determine its widespread use in the treatment, prevention and rehabilitation of patients with cardiovascular diseases. Proven safety and efficacy of Thiotriazoline, having anti-ischemic, antioxidant, membrane stabilizing, cytoprotective, immunomodulatory effects, greatly expand the category of patients for long-term use of the drug Thiotriazoline both in therapy and in the prevention and rehabilitation, including patients with cardiosomatic conditions.

Antifungal agents (AA) for systemic use can be categorized as life-saving drugs. The increase in the number of IFI requires not only competent diagnostic actions, but also the timely appointment of adequate clinical and pharmacological characteristics of antifungal therapy. Despite the small number of available AA for systemic use, they have a number of fundamental differences that should be considered when choosing a drug. Now five main groups of AA are available: the polyenes, azoles, echinocandins, allylamines and fluoropyrimidines. Each group has its own characteristics in the spectrum of activity, pharmacokinetics, safety, and indications for use, including differences within the one class that is most characteristic of azoles. Knowledge of the epidemiology of the sensitivity of fungal pathogens is another important component of an adequate choice of therapy.

The article describes in detail the mechanisms of quality management of dermatovenereological care implemented at the present stage. In 2005, high-tech medical care (HTMC) on the «Dermatology» profile was included in the list of the types of care, which were examples to the transition to the state order for the provision of the medical care and for testing a new system of payment for medical services -«for the treated patients». In 2002-2014, by «Dermatology» profile more than 25.5 thousand. patients have been treated with HTMC. Since 2006, planning of provision of HTMC for children occurred for the first time. In 2006-2013, 5 thousand children were treated by the «Dermatoveneorology» profile. An important direction for the assurance of the quality of medical care and its availability to the population is the introduction of modern forms and methods of training of medical and pharmaceutical specialists. Separate set of measures of quality management system for medical care includes approaches to drug provision for the population of the Russian Federation. The main activities in the field of drug provision for Russian citizens are implemented in the framework of the Strategy of the drug provision for the population of the Russian Federation for the period till 2025 and the State program of the Russian Federation «The development of the pharmaceutical and medical industry». At the same time as part of the sustainable economic development and social stability in 2015, program of import substitution of drugs is implemented.