No 5 (2010)

The article presents review of current data for clinical manifestations and pathophysiology of various forms of dyscirculatory encephalopathy (DE). The main goals in the treatment of DE are correction of risk factors, the compensation of chronic cerebral ischemia, and the prevention of recurrent cerebrovascular events. The present article considers the main guidelines in the treatment of DE. It is emphasized that the principal direction in the prevention of ischemic cerebral lesions is antiplatelet therapy. Various options of antiplatelet therapy with acetylsalicylic acid (ASA), clopidogrel, ticlopidine, and dipyridamole are discussed. The advisability of a combination of ASA + dipyridamole is proved. This combination should be used as first-line secondary prevention of ischemic stroke, especially in patients with unstable course of arterial hypertension, predisposition to hypertensive crisis, gastric ulcer and duodenal ulcer, and high risk of bleeding.

Cognitive impairments secondary to various neurological, psychiatric, somatic and endocrine-metabolic diseases very often develop in older persons. The main stages of the evolution of cognitive failure in the elderly are mild, moderate and severe cognitive impairments. Moderate cognitive impairments (MCI) are clinically delineated syndrome of derangement of memory and other higher brain functions that are beyond the scope of age norms, but do not cause disadaptation in daily living. Prevalence of MCI is 11-17% in persons aged 65 years and older, and 44% in neurological outpatients. The clinical performance may be represented in the form of memory impairment or other cognitive impairments, as determined by the underlying disease. MCI is eventually transforms into dementia more than in half of the cases. Treatment includes correction of cerebral ischemia, optimization of microcirculation, neurometabolic therapy, and compensation of available neurotransmitter deficiency.

The present article discusses the importance of prebiotics and probiotics in the treatment of the gastrointestinal diseases. The review of recent experimental and clinical studies is presented. Results of studies led to the significantly improvement of understanding of the mechanisms of effect of probiotics and prebiotics and more reasonable administration of these drugs in various pathological conditions.

It was shown that cystic fibrosis (CF) is related to chronic rhinosinusitis (CRS) and nasal polyposis. It is emphasized that the presence of CRS greatly aggravate the course of CF, leads to a decline in lung function, increase of colonization of Pseudomonas aeruginosa and its chronic infection. The pathogenesis, clinical symptoms and diagnostics of polypous CRS are considered. Conservative and surgical methods of treatment of this disease, including the development CRS secondary to CF are discussed in detail.

Rasagiline (azilect) is next generation inhibitor of monoamine oxidase type B. Its potential to reduce the severity of main parkinsonian symptoms in patients with Parkinson's disease (PD) was previously demonstrated in some controlled trials (TEMPO, PRESTO, LARGO). Design and results of the ADAGIO study - first clinical trial with a delayed start for BP, which confirmed the neuroprotective effect of rasagiline in this disease - are discussed. It is important to emphasize the safety of rasagiline, confirmed in a study ADAGIO: tolerability of rasagiline and placebo was comparable.

Hyperprolactinemia is one of the most important syndromes of reproductive endocrine diseases. The frequency of endocrine infertility due to hyperprolactinemia is estimated at 40 to 80%. The mechanisms of formation of excessive secretion of prolactin in various forms of the disease, and the features of effect of hyperprolactinemia on the reproductive system of women are discussed. The fundamental principle of drug therapy of hyperprolactinemia is the restoration of action of dopamine, which suppress excessive activity of lactotrophics. The present article considers the tactics of treatment of different variants of the disease with the use of dopamine agonists - bromocriptin, quinagolide hydrochloride and cabergoline.

In recent years, there are more and more evidences that the disease of old age and oxidative stress are associated with significant cerebrovascular changes. Peroxidation is one of the most important parts of gene activation reactions coding apoptosis, which suggests therapeutic benefit of antioxidants in the acute and chronic stages of cerebral ischemia. At least three main effects of Mexidol - antioxidant, antihypoxic and hypolipodemic - may be useful in the treatment of ischemic brain damage. The groups of patients with dyscirculatory encephalopathy from the perspective of advisability of mexidol administration are discussed.

We investigated the effects of low doses of simvastatin (original and generic products in the average daily dose of 18 mg), atorvastatin (13 mg/day), rosuvastatin (11 mg/day) and simvastatin (12 mg/day) in combination with ezetimibe (10 mg/day) in patients with carotid atherosclerosis without marked hyperlipidemia. We assessed lipid levels, levels of markers of inflammation, and the thickness of the intima-media complex (IMT) according to duplex ultrasonography screening of brachycephalic arteries. Within 36 weeks 180 patients were observed. 150 patients received active treatment, 30 entered in control group. Treatment with low doses of statins and the use of a combination of simvastatin with ezetimibe led to decrease of low density lipoprotein cholesterol levels by at least 30% that led to the achievement of the target values in some patients. Most hypolipodemic effect was achieved against the background of combination of simvastatin and ezetimibe, and monotherapy with rosuvastatin. The level of C-reactive protein in the blood against the background of monotherapy with statins has not changed, and in the group of combination therapy with simvastatin and ezetimibe was significantly reduced. Treatment with low doses of statins, and combination of simvastatin with ezetimibe did not lead to significant change of IMT, indicating inhibition of the atherosclerosis progression, whereas IMT in the control group was significantly increased.

The numerous studies have shown that cardiovascular disease and non-alcoholic fatty liver disease (NAFLD) are widespread in the general population and are linked by common pathogenetic mechanisms. Therefore their combination is typical for obesity and metabolic syndrome. The results of the study, whose goal was to study the clinical course, diagnosis and treatment of arterial hypertension (AH) in patients with non-alcoholic steatohepatitis (NASH - NAFLD stage) are presented. It was found that concomitant NASH leads to more severe course of arterial hypertension. It is emphasized that in patients with arterial hypertension and NAFLD comprehensive approach to treatment, aimed at the various components of metabolic syndrome is justified. In addition to antihypertensive treatment, drugs improving liver function (essential phospholipids, ursodeoxycholic acid), lipid-lowering drugs (statins), and, if necessary, hypoglycemic agents (metformin), should be used.

The article presents data for the pharmacopeial dosage form tinctures and decoctions: historical data, sources of raw materials, the State Pharmacopoeia requirements for the use of herbal raw material, and guidelines for formulation of water extractions. The indications and contraindications to the use of tinctures and decoctions in clinical practice are discussed.

The current legislation of Russia has no single statute governing the use of medicines. However, this does not mean that in the Russian Federation there is no regulatory and legal framework for legitimate drug administration. Based on analysis of the current legislation of Russia, the author has developed medical-legal standard for drug therapy.