No 19 (2016)

The review is devoted to modern approaches to the prevention of osteoporosis (OP) and its consequences - fractures. Prevention of OP, as well as other chronic non-communicable diseases, is the main way to reduce the incidence rate. Despite the fact that the OP is more common in old age, disease prevention should begin in childhood and its purpose should be to build a strong skeleton, preventing or slowing the loss of bone mass. Scientific concept of prevention of OP after reaching the peak bone mass includes the concept of risk factors. The main attention in the development of primary prevention measures is paid to modifiable risk factors that can be corrected or eliminated. It focuses on the correction of behavioral risk factors such as good nutrition and exercise, especially the use of synthetic nutrients for the prevention of OP and fractures.

The article provides a literature overview on a rather rare kind of primary cephalgia - cluster headache. The review provides information on the current diagnostic criteria, epidemiology and pathogenic mechanisms of this nosology. The clinical presentation of this disease and differences from headaches with similar symptoms are described. In addition, the main approaches to the treatment of this clinical form are discussed.

The article presents the results of survey of physicians of 6 specialties involved in the treatment of osteoporosis, and patients suffering from this disease. A survey of doctors has showed that they appoint alfacalcidol to 27% of patients, including as a monotherapy in 8% of cases. Among patients, 25% of the respondents received alfacalcidol in combination with other drugs for the treatment of osteoporosis (22%), or as monotherapy (3%). In addition, article presents the analysis of the literature, which is justified the advantages of alfacalcidol from the perspective of evidence-based medicine.

The article presents the results of the evaluation of the effectiveness of Cellex in patients with acute ischemic stroke. The data indicate the effectiveness of Cellex, because administration of this drug in stroke patients has led to significant improvement in the patients’ condition by the end of the observation period (20 days), and it was confirmed by the dynamics of NIHSS score (total score; movement) and «Speech Questionnaire» score.

Microcirculatory disorders are one of the most important pathogenetic factors for chronic inflammatory dermatoses. Pharmacotherapy and physical therapy for the correction of vascular changes are traditionally included in the comprehensive treatment of dermatoses of various etiologies. The optimal choice of angiotropic therapy and minimization of the risk of polypharmacy, however, require adequate assessment of the degree of vascular disorders in the skin of the patient with dermatosis, especially at the early stage of development of pathology. In this regard, technique for determining the titers of natural antibodies to tissue autoantigens, allowing early diagnosis of vascular disorders, is of particular interest. For the correction of microcirculatory disorders, complex treatment of dermatoses should be supplemented with angioprotective and antiplatelet drugs.

The article presents a review of the scientific data on the issue of polypharmacy, particularly unfavorable combination of diuretics and blockers of the renin-angiotensin-aldosterone system (RAAS) with non-steroidal anti-inflammatory drugs (NSAIDs). Nephrotoxic side effects of NSAIDs (analgesic nephropathy) are well known. The use of NSAIDs significantly increases the risk of acute kidney damage in patients with cardiovascular disease who are taking diuretics and RAAS blockers. The combination of diuretics and NSAIDs may be accompanied by adverse renal impairment as a result of the interaction of the pharmacodynamic effects on renal hemodynamics, vascular tone and volaemia. Combination of NSAIDs with angiotensin converting enzyme inhibitors (ACE inhibitors), which have nephroprotective effect, leads to the counteraction of NSAIDs influence on the kidney. However, the triple combination of an ACE inhibitor+NSAIDs+ diuretics leads to acute renal dysfunction - iatrogenic kidney disease, which can be fatal. This combination is called «triple whammy», and recognized by the World Health Organization as an unfavorable combination, requiring special monitoring of renal function and the need to avoid the use in clinical practice.

Degenerative changes in periarticular tissues with inflammatory process, called tendinopathies or tendinosis, are frequent pathology of the musculoskeletal system. Tendinopathy - a major cause of morbidity and temporary disability in the population. Steroidal and nonsteroidal anti-inflammatory drugs are most commonly used for this pathology, but they have a number of side effects and limitations of use. The optimal direction of pharmacotherapy of this disease includes not only a modulation of the inflammatory process, but also the activation of regenerative processes in damaged tissues. Traumeel S fully meets these requirements, and its efficacy and safety in patients with tendinopathies have been demonstrated in numerous multi-center, randomized clinical trials.