No 3 (2018)

Cough is one of the most common reasons for seeking medical help at outpatient stage. The article considers the questions of differential diagnostics and treatment of cough at the stage of primary healthcare. In particular, the data on the possible use of phytopreparations Eucabal® syrup and Eucabal® balsam S in coughing are presented. The pharmacological properties of these preparations, their efficacy and safety in pediatric and therapeutic practice allow them to be considered as symptomatic cough suppressants in adults and children and recommend for more extensive use by adult patients at the stage of primary healthcare.

Until now, amiodarone is widely used worldwide antiarrhythmic drug due to its therapeutic effectiveness. However, the relatively high incidence of side effects complicates the safe use of this drug in clinical practice. From the prognostic point of view, pneumotoxicity is the most serious side effect of amiodarone therapy. «Amiodarone» pneumopathy refers to a dose-dependent variant and develops on average after 18-24 months of therapy. Interstitial lung involvement is considered the most frequent option. The clinical and radiologic picture is non-specific and requires careful analysis of the medical history. «Amiodarone» pneumopathy is a diagnosis that requires the elimination of infectious lesions of lung tissue and other possible causes of interstitial lung disease (ILD). With the purpose of early diagnosis of ILD in patients receiving amiodarone, computed tomography should be performed prior to the appointment of the drug and should be performed regularly every 6-12 months. In the case of the development of the «amiodarone» lung, amiodarone should be withdrawn, and therapy with prednisolone should be prescribed. With early diagnosis of amiodarone-induced lung injury and timely therapeutic intervention, the prognosis is favorable in most cases. The literature review is supplemented by three authors’ own observations of the late diagnosis of the «amiodarone» lung.

The publication discusses the rational pharmacotherapy of acute respiratory viral infections (ARVI). The results of the evaluation of the clinical efficacy of Influnet in the treatment of acute respiratory viral infection in 84 adults are presented; the frequency of development of asthenic syndrome in patients with acute respiratory viral infection is analyzed. It is shown that, the use of combined drugs for symptomatic therapy of acute respiratory viral infections can successfully cope with the symptoms of the disease.

Long-term medical observations of the use of ambroxol show that, in addition to expectorative effect, it actively affects the basic mechanisms of physiological production and transport of bronchial mucus. The leading indication for the use of ambroxol is secretolityc therapy of acute and chronic bronchopulmonary diseases associated with abnormal mucus secretion and disruption of its transport. The purpose of this analysis is a modern assessment of the chemical, pharmacological and clinical data on the secretolityc and mucokinetic activity of ambroxol with the justification of its importance for modern mucolytic therapy. Methods. In this paper, a method of analysis of the results of publications on the pharmacological and clinical properties of ambroxol in domestic and foreign sources for the period from 1977 to 2017 was used. The analysis included the results of studies with adequate design from the standpoint of «good clinical practice» (GCP) and evidence-based medicine. Conclusion. The substance ambroxol has a number of the following properties: 1) high secretolytic activity (promotes mucus clearance, facilitates expectoration of sputum, reduces productive cough); 2) antiinflammatory and antioxidant activity; 3) local analgesic (anesthetic) effect through blockade of sodium channels of cell membranes. The reduction in the number of exacerbations of chronic obstructive pulmonary disease serves as evidence of the importance of the clinical effects of ambroxol. The effect of mucosal anesthesia is attributed to the new pharmacological action of ambroxol, useful in the therapy of acute respiratory tract infections. The effecacy and safety of ambroxol in clinical practice is confirmed by the half-century experience of its use. Modern mucolytic therapy can significantly improve the quality of treatment and the prognosis for patients with hypersecretion of the tracheobronchial secretion, mucociliary clearance disorders and unproductive cough.

Purpose of the study: to evaluate the activity of peroxidic homeostasis in the case of moderate and severe influenza against the conventional therapy and with the additional use of a preparation with antioxidant properties, 2-ethyl-6-methyl-3-hydroxypyridine succinate. Methods. Patients with moderate and severe influenza were examined in 2 groups: the main group (n=45) and the comparison group (n=47). The comparison group received conventional therapy. The main group in addition to conventional therapy received a preparation with antioxidant properties - 2-ethyl-6-methyl-3-hydroxypyridine succinate. Results. In the case of influenza, a pronounced activity of lipid peroxidation reactions is observed throughout the entire observation period, even with clinical recovery, which is indicated by an excess of diene conjugates (DCo) levels by 1.93 times, diene ketones (DKe) by 2.1 times, and plasma malonic dialdehyde (plMDA) - by 3.76 times. In severe form, DCo levels were 2.48 times higher than control values, DKe - by 3.36 times, and plMDA - by 4.18 times. At a severe form of influenza, the peroxidation product levels were significantly higher than in the case of moderate ones. Deficiency of antioxidant protection was confirmed by low activity of enzymes in both moderate and severe conditions: plasma catalase (plC) level was reduced by 2.9 and 3.7 times, erythrocyte catalase of (erC) - by 1,98 and 2,8 times, superoxide dismutase (SOD) - by 1.4 and 2.0 times, respectively. The use of the drug with an antioxidant action contributed to the relief of clinical manifestations of influenza and the correction of imbalance of peroxide homeostasis. This was confirmed by a decrease in the level of lipid peroxidation products in the case of moderate course: DCo by 29.3%, DKe by 43.1%, plMDA by 42%, erMDA by 19.5%, in severe form: DCo by 21.2%, DKe by 38.3%, plMDA by 21%, erMDA by 16.3%. At the same time, the activity of antioxidant protection enzymes increased: in moderate influenza, plC - by 17.4%, erC - by 94.8%, SOD - by 52.2%; in severe course: plC - by 27%, erC - by 70.6%, SOD -by 74.2%. Conclusions. In the phase of clinical recovery of influenza, the activity of lipid pero-xidation and the deficit of antioxidant protection remain. Complex pathogenetic therapy with the use of 2-ethyl-6-methyl-3-hydroxypyridine succinate had a positive effect, reducing the clinical symptoms of the disease and reducing the activity of lipid peroxidation processes. This was confirmed by a decrease in the level of peroxidic homeostasis products - DKe and DCo, plMDA and erMDA, as well as an increase in the activity of antioxidant system enzymes: SOD, plC and erC. This drug can be recommended in clinical practice as a pathogenetic agent for the correction of oxidative stress in influenza.

Due to the screening of newborns for cystic fibrosis and the improvement of genetic diagnostic methods, previously unrecognized mutations in the CFTR gene are identified. A complex clinical examination of three children aged 3, 8 and 9 years with the presence of rare 3272-16T> A mutation in the genotype was carried out. In one patient, 3272-16T>A mutation was in the homozygous position. The phenotype with 3272-16T>A mutation was characterized by a classic course of cystic fibrosis, positive parameters of immunoreactive trypsinogen and sweat chlorides, but with little involvment in the pathological process in pancreas.