No 15 (2017)

Cervical dystonia (CD) is a local form of muscular dystonia; its pathogenesis involves central and peripheral sensorimotor mechanisms, leading to abnormal posture, imbalance, ambulation disorders, and pain. Combination of botulinotherapy and rehabilitation methods is the most effective strategy for the treatment of CD. The main methods of rehabilitation include biological feedback, multimodal kinesiotherapy programs, relaxation, vibration, and transcutaneous electrical nerve stimulation, other methods physiotherapy, active exercises for increasing muscle strength and posture correction, methods of muscle stretching, mobilization and vestibular stimulation. Each of these methods has its own pathophysiological justification for use in CD. The review presents a modern view of approaches to the therapy of CD.

The article describes an example of the use of a amlodipine/lisinopril fixed-dose combination in real clinical practice. Its high antihypertensive efficacy, favorable effect on the daily blood pressure profile, as well as the pronounced organoprotective properties, in particular, the ability to reduce the degree of left ventriclar myocardial hypertrophy and improve the resilient-elastic properties of the left heart are demonstrated.

The prospective randomized trial included 167 patients with chronic heart failure (CHF) of II-III functional classes with preserved left ventricular ejection fraction (LVEF) against the background of III stage arterial hypertension. In addition to antihypertensive therapy with perindopril and verapamil SR (n=85) or amlodipine (n=82), atorvastatin was prescribed, which was regularly taken by 50.6 and 48.8% of patients, respectively. After 12 months, in each treatment group, the clinical status and quality of life improved, and the distance covered in the 6-minute walk test increased. Patients receiving atorvastatin had significantly reduced N-terminal pro-brain natriuretic peptide levels; there was a tendency to improvement of diastolic LV function. Addition of atorvastatin to the treatment of CHF with preserved LVEF is advisable in connection with the potential opportunity to improve the prognosis of patients.

The article presents the results of a retrospective pharmacoepidemiological study devoted to the analysis of changes in the prescribed antianginal therapy for patients with stable angina in a specialized cardiac outpatient clinic over a five-year period. This study revealed a number of positive changes in the field of medical prophylaxis of anginal attacks at the outpatient level, to some extent consistent with national and international standards. The frequency of recommendations of cardioselective β-adrenoblockers in optimal doses increased. As to group of dihydropyridine calcium antagonists, specialists began to recommend amlodipine more often, also in higher doses. A decrease in the frequency of administration of organic nitrates and trimetazidine has been noted.

The article presents a clinical case illustrating the improvement of cognitive functions, an increase in cerebral blood flow, a decrease in the left ventricular myocardial mass index against the background of treatment of a patient with a previously untreated uncomplicated hypertension with a fixed combination of an angiotensin-converting enzyme inhibitor perindopril arginine and a diuretic indapamide. The possibilities of antihypertensive therapy, in particular, the combination of perindopril with indapamide in the correction of cognitive impairments in arterial hypertension and their pathogenetic mechanisms are discussed.

Untimely hospitalization of patients due to ignorance of the main stroke symptoms leads to high mortality and inefficiency of treatment. Primary prophylaxis is an effective method of preventing and reducing the consequences of this disease, because it is aimed at identifying and reducing the severity of modifiable risk factors (RFs). For successful prevention, it is necessary to take into account not only medical, but also social aspects, including related to raising awareness of the population about RFs and stroke symptoms. School awareness programs in this area are a new way of delivering the necessary information not only to the children, but also to their parents. The review includes the experience of both foreign and domestic studies in conducting similar educational programs for children. The lecture or conversation conducted by a neurologist or a teacher is the common method of providing the children with necessary knowledge in the prevention of stroke and other acute cardiovascular events. The role playing is also possible. As additional materials, brochures, leaflets, magnets, comic books, animated cartoons, and video games can be used. The main methods for assessing of acquisition of knowledge of stroke symptoms and RFs include tests that respondents complete before participating in the program and after training at different time intervals, depending on the purpose of the assessment. Educational programs aimed at increasing the awareness of schoolchildren about stroke symptoms and RFs, meet the objectives and have repeatedly confirmed effectiveness in various studies.