No 19 (2013)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used class of pharmacological agents. They allow treating acute pain and controlling chronic pain; so, they are often appointed by a variety of specialists. Almost since the introduction of this class of drugs in clinical practice, doctors are aware of the fact that the positive effects of these drugs are associated with a number of side effects, and one of the most serious side effects is the damage of gastrointestinal tract and the development of bleeding. Pharmacologists had several attempts to create a NSAIDs that do not have side effects on the gastrointestinal tract. The article presents a new non-selective NSAID, amtolmetin guacil, and the the mechanism of its action. Gastroprotective properties of the drug associated with increased concentration of nitrogen oxide in the gastric mucosa are emphasized. The data of the efficacy and safety compared to other NSAIDs are discussed.

The article presents the results of the evaluation of therapeutic efficacy and safety of drugs Ketorol® gel 2.0 % and Fastum® Gel 2.5 % through a comparative study of their use as a symptomatic treatment of patients with diseases of the musculoskeletal system, accompanied by pain, in outpatient settings. The study included 240 patients: 120 - with lower back pain (mean age - 52.5 ± 11.3 years) and 120 - with gonarthrosis (mean age - 52.5 ± 11.0 years). All patients received topically Ketorol® gel or Fastum® gel on the affected area of the knee joint or the area of maximum pain in the lower back for 10 days, respectively. Evaluation criteria were follows: pain at rest, pain on movement (VAS, mm), evaluation of the effectiveness of treatment by the patient and physician, and tolerability of the treatment and the development of adverse events. Topical administration of Ketorol® gel and Fastum® gel in patients with gonarthrosis and with lower back pain resulted in a statistically significant reduction in pain intensity according to the VAS score at rest and in motion, and was accompanied by improvement of general condition according to assessment by the doctor and the patient. The vast majority (98 %) of patients in the Ketorol® group reported «excellent» and «good» results of treatment. One patient in Ketorol® group and one patient in the Fastum® group have developed mild dermatitis at the site of the application of drugs. Unpredictable side effects in the study groups have not been identified. Ketorol® gel has distinct analgesic effect, provides the desired therapeutic effect, has a favorable safety profile and can be used alone in the treatment of diseases of the musculoskeletal system, accompanied by moderate pain.

The purpose of this study was to assess the tolerability profiles, safety and analgesic activity of the drug Artradol in patients with osteoarthrosis of the knee. The study included 30 patients with gonarthrosis stage II-III. All patients were previously treated with different chondroprotectors, which were used not more than 6 months due to their inefficiency. Patients were assigned to receive artradol. Study duration was 4 months: 2 months - the period of treatment, and 2 months - the period of observation. Analysis of the effectiveness was performed in accordance with the assessment of the WOMAC (Western Ontario and McMaster Universities osteoarthritis Index) index. Four months after study, efficacy of treatment was evaluated according to the physician’s and the patient’s opinions. The obtained results indicate the good tolerability of the drug and allow to conclude that Artradol has significant effect on pain and functional activity.

This review discusses the problem of asthenic disorders as part of the vascular disease. The definition of asthenia, as well as classification and clinical criteria and prevalence of asthenic disorders are presented. It is emphasized that clinical manifestation of the initial degree of chronic cerebral ischemia (vascular encephalopathy) is characterized by signs of asthenic syndrome. The following rationale was made: therapy of asthenic syndrome in cerebrovascular diseases should include preparations with neurometabolic actions, such as Actovegin and citicoline. The data of studies evaluating the efficacy of monotherapy and combined therapy using Actovegin and Ceraxon (citicoline) in cerebrovascular diseases are presented. The effects of these drugs on the manifestations of asthenic disorders in patients with mild cognitive impairment as a manifestation of chronic cerebral ischemia are described.

Combined vitamin supplements containing thiamin (vitamin Bi), pyridoxine (vitamin Be), and cyanocobalamin (vitamin B12), are widely used in the treatment of back pain. Studies have confirmed the feasibility of combined use of B vitamins and non-steroidal anti-inflammatory drugs (NSAIDs) due to influence on biotransformation of NSAIDs that leads to more effective therapy. One of well-studied drugs in the domestic market, comprising a combination of B vitamins (including benfotiamine), is Milgamma compositum manufactured by the Woerwag Pharma pharmaceutical company.

The article presents scientifically based and practically confirmed differences of the original innovation composition of phenotropil or (RS)-2-(2-oxo-4-phenylpyrrolidine-1-yl)acetamide, as the founder of the systemically important direction and the ancestor of class of modulators with balanced influence, from earlier known products based on a compound with undisclosed composition of active ingredients, or unreliable disclosed composition, which were described in the different sources of information.

One of the latest achievements of clinical neurology in the treatment of ischemic stroke was the introduction of thrombolytic therapy (TLT) into routine practice. The analysis of the efficacy of TLT was based on the results of work of cardiovascular centers in the Republic of Tatarstan. By 2013, the number of thrombolysises in cardiovascular centers of republic was 918. Analysis of activity of cardiovascular centers revealed reduction in bleeding complications rate after TLT. An inverse relationship between mortality after TLT and the number of thrombolysises was observed. This experience suggests that a good result from treatment using modern methods can be achieved only in the case of optimal organization of work with minimizing of preperfusion period and strict compliance with the TLT protocol.

The article presents the case of primary idiopathic polymyositis with high activity complicated by peripheral thrombosis and acute respiratory failure. Differential diagnosis was performed between thromboembolism of pulmonary artery branches and the defeat of the respiratory muscles. The complex survey, including clinical evaluation of the patient (respiratory rate and heart rate, blood pressure), pulse oximetry in both vertical and horizontal positions, the definition of height and mobility of the diaphragm by X-ray method, chest CT scan, electromyography of intercostal muscles, has allowed to make a differential diagnosis, determine the cause of acute respiratory failure, and prevent poor outcome.