No 18 (2016)

The article presents an analytical review of the scientific literature on the evaluation of mechanisms of influence of meldonium on the autonomic nervous system. Cholinergic and β-adrenosensibilizing properties of this drug open possibilities for effective intervention in the pathogenesis of many diseases associated with autonomic imbalance.

The purpose of the study was to assess the possibility of regression/stabilization of carotid atherosclerosis (CA) under the influence of short-term intensive lipid-lowering therapy with statins in patients at very high cardiovascular risk (VHCVR) according to the threedimensional ultrasound. After a preliminary screening, the study included 80 VHCVR patients with dyslipidemia and the presence of atherosclerosis in CA (presence of atherosclerotic plaques in CA narrowing the lumen of the vessel by 20 to 70%). Patients were randomized into two groups of 40 people: the first group was assigned to receive rosuvastatin at the dose of 40 mg/day (Group A), the second group continued to receive statins at standard doses (Group B, simvastatin 20-40 mg/day or other statins at equivalent doses). The study lasted 12 weeks. In Group A, there was a significant decrease in total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels by 35.5 and 47.9%, respectively. In Group B, decrease in total cholesterol and LDL-C levels was also significant and amounted to 26.0 and 36.3%. In group A, recommended target LDL-C level <1.8 mmol/L was achieved in 65% of patients, which was significantly higher than in the standard therapy group - 35% (p<0.007). Patients in Group A had marked decrease in total atheroma volume from 85.0 [54.5; 196.0] mmз to 83.5 [56.0; 192.0] mmз(p=0.045), in group B - from 51.0 [22.0; 133.5] to 50 [21.5; 132.0] mmз (p<0.0001). Thus, short-term intensive therapy with rosuvastatin at the dose of 40 mg/day and a standard statin therapy in VHCVR patients accompanied by a significant reduction in the median of the total volume of atherosclerotic plaques in CA along with a marked decrease in the level of lipid parameters; there were no significant differences in the effect on dynamics of atheroma volume between the groups. Both groups had a good tolerability and safety of statin therapy.

At the premises of SBHCI AR ARCH, 10 patients with the main clinical diagnosis - myofascial face pain syndrome (ICD-10: G.50.1) were examined. To verify the clinical diagnosis, the following diagnostic maneuvers were performed: analysis of anamnestic data; clinical and neurological examination and imaging procedures; pharmacological blockade of the painful areas of the masticatory muscles. As one of the leading and promising methods of treatment for such patients, the use of botulinum toxin type A (BTA) was applied for the first time on the territory of the Arkhangelsk region. Clinical observations have shown that intramuscular injections of BTA contributed to a decrease in the intensity of facial muscle pain and improvement of the quality of life in general.

Currently, insomnia is the most frequent and clinically significant form of sleep disorder that can significantly reduce the quality of life of patients. Among considerable list of the causes of this syndrome, chronic cerebral hyperactivation with cognitive, electrophysiological and metabolic manifestations plays the most important role. According to the Third Edition of the International Classification of Sleep Disorders, there are three main forms of insomnia: acute, chronic and unspecified form. For effective treatment of insomnia, the comprehensive approach involving psychotherapeutic and pharmacological treatments is used.

The review is devoted to clinical recommendations of the European Society of Cardiology and the Heart Failure Association on diagnosis and treatment of acute and chronic heart failure 2016. The attention is focused on the pharmacotherapy of heart failure with reduced left ventricular ejection fraction. The data of a number of meta-analyses, randomized clinical trials and indications for use of the new drug, sacubitril/ valsartan combining neprilysin inhibitor (neutral endopeptidase) and angiotensin II receptor (type I) blocker are discussed in detail.

The article discusses the principles of long-term prevention of cardiovascular complications using acetylsalicylic acid (ASA). Careful determination of indications and choice of an appropriate dose allow to successfully improve patient’s prognosis. Arguments for the choice of a particular pharmaceutical form of ASA among the many available forms are presented.

The review deals with the analysis of the biochemical mechanisms of febrile syndrome in terms of modern ideas about its pathogenesis. It is noted that the classic antipyretics prescribed to children with febrile syndrome should not be used without medical supervision. As an alternative agent with higher safety profile, homeopathic preparation Viburcol in the form of rectal suppositories is considered. It is shown that all the components of Viburcol are well known and have long been used in children. In addition, due to a special production technology, all the active ingredients of Viburcol are presented at ultra-low doses, which, on the one hand, help to prevent depression of the natural immune system and induce its action, and on the other - to improve drug safety profile.