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№ 3 (2010)
- Жылы: 2010
- Мақалалар: 17
- URL: https://journals.eco-vector.com/2073-4034/issue/view/6673
Articles
Russian consensus on diabetes mellitus therapy in children and adolescents
Аннотация
The Russian consensus on the treatment of children and adolescents with diabetes mellitus (DM) presents the modern requirements for compensation of DM in this category of patients - the most important and unique way for prevention of development of specific vascular complications, as well as ways to achieve compensation using modern methods of insulin therapy. The guidance manual contains information for the pharmacokinetics of modern forms of insulin, the schemes of their administration, the problems of insulin therapy and ways to their decision. Particular attention is paid to the most modern and effective treatments for diabetes - short-acting insulin analogues and insulin analogues with prolonged action, as well as insulin pumps. Developed Consensus is based on data from large international studies and international experience, as well as the results own research and experience of clinical practice taking into account the standards of the WHO experts at the Institute of pediatric endocrinology FSI ERC RMT, which concentrates the most complex contingent of diabetic patients from different regions of our country.
Pharmateca. 2010;(3):7-14
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Use of long-acting insulin analogues in type 2 diabetes mellitus treatment (according to the data of international and Russian registries)
Аннотация
The article is concerned with issues of insulin therapy in patients with type 2 diabetes mellitus (DM2). Indications for early insulin therapy in these patients are presented. Algorithm for treatment of DM2 considers insulin as a antihyperglycemic drug with greatest efficiency. The data for the possible use in DM2 of insulin glargine (Lantus) - a long-acting insulin analogue providing the need for a basal insulin for 24 hours - are presented. It is shown that one injection of insulin glargine in addition to the everyday treatment of DM2 in patients treated with oral antihyperglycemic drugs, who not achieve target values of blood glucose - a simple and effective way to rapid and lasting results. The use of insulin glargine is accompanied by improved glycemic control, lower levels of glycated hemoglobin, reduced risk of nocturnal hypoglycemia, and increased patient's complacency.
Pharmateca. 2010;(3):16-21
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Sulfonylurea drugs and risk of cardiovascular complications - much ado about nothing?
Аннотация
Cardiovascular complications are the main causes of mortality in patients with type 2 diabetes mellitus. Importance of accurate glycemic control aimed to prevention of these complications is proved. However, the use of some oral hypoglycemic agents, particularly sulfonylurea derivates (SUD), is accompanied by increase of cardiovascular risk, which can be explained by closure of ATP-dependent potassium channels. Whereas in the pancreas this mechanism leads to the stimulation of insulin secretion, it suppresses the phenomenon of ischemic preconditioning in the heart - an endogenous cardioprotective mechanism for prevention of fatal myocardium infarct. However, the effects of SUD on KATP channels in experimental studies are contradictory, and their clinical significance is not clear. Despite the structural differences in SUD and their varying ability to binding to the heart KATP channel receptor, to date there is no clinical evidences allowing to confirm the benefits of cardioprotective effect of any given SUD. This review is concerned with issues of molecular and cellular pharmacodynamics of SUD and data for their effects on the heart in patients with diabetes mellitus, with particular emphasis on glibenclamide - the most widely used SUD, which has the highest affinity for the KATP channel receptors in heart.
Pharmateca. 2010;(3):22-31
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Advance - movement forward
Аннотация
The article is dedicated to the problems of type 2 diabetes mellitus. New results of ADVANCE study, related to glycemic control and prediction of cardiovascular risk in patients with diabetes mellitus are presented. Use of gliclazide MR in a dose of 120 mg lead to reduction of glycosylated hemoglobin to the target level regardless of the clinical characteristics of patients and the previously prescribed treatment. Based on data of ADVANCE study, new model for calculating the cardiovascular risk was suggested. This model is based on such factors as sex, patient's age at diagnosis, duration of diabetes, blood pressure and pulse pressure levels, albumin/creatinine ratio, etc.
Pharmateca. 2010;(3):32-38
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Osteoporosis in the practice of the physician-endocrinologist: modern methods of treatment
Аннотация
Modern data on the nature of osteoporosis (OP) are presented. Forms of osteoporosis associated with endocrine diseases (thyroid pathology, diabetes mellitus, Cushing's basophilism, hyperparathyroidism) are considered. It is emphasized that the endocrinologist in the clinical practice uses the whole arsenal of medicines for treatment and prophylaxis of OP, such as both hormonal and nonhormonal methods for therapy of primary and secondary forms of OP. We discuss the modern methods of pathogenetic therapy and prophylaxis of OP using bisphosphonates, strontium ranelate, active metabolite of vitamin D, and several other drugs. Administration of these drugs can effectively prevent bone fractures in the OP.
Pharmateca. 2010;(3):39-45
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Diabetic enteropathy
Аннотация
Diabetic enteropathy is infrequent, but severe and more resistant to treatment manifestation of diabetes mellitus. The pathogenesis of diabetic enteropathy, including neuropathy, clinical manifestations, diagnostic methods and treatment approaches are discussed. In diabetic polyneuropathy, causal treatment (targeted normoglycemia) is basis of treatment strategy; various preparations of alpha-lipoic acid and B vitamins, including soluble forms of thiamine (benfotiamine, Milgamma) are widely used due to high bioavailability and neurotropic activity.
Pharmateca. 2010;(3):46-49
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Clinical and genetic features of multiple endocrine neoplasia type 1 syndrome and principles of its treatment
Аннотация
The article is dedicated to modern concepts of epidemiology, pathogenesis and clinical presentation of multiple endocrine neoplasia syndrome type 1 (MEN 1). MEN-1 is a rare congenital autosomal dominant syndrome caused by mutation of the MEN1 gene, localized on chromosome 11q13. Combination of tumors of parathyroid glands, pituitary and pancreas is typical for MEN-1. The algorithm for diagnosis of MEN-1syndrome is considered, the possibility of its treatment, including the use of somatostatin analogs is discussed. It is emphasized that in patients with various manifestations of MEN-1 syndrome due to accurate diagnosis and modern methods of surgical and medical treatment prognosis is significantly improved and life expectancy is increased in recent years.
Pharmateca. 2010;(3):50-56
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New possibilities for diabetic peripheral neuropathy treatment
Аннотация
Diabetic peripheral neuropathy (DPN) is frequent and prognostically important complication of diabetes mellitus. Modern diabetology pay great attention to the issues of early treatment of DPN. The data for risk factors, prognosis, pathogenesis, clinical presentation and the principles of diagnosis of DPN are presented. It is emphasized that therapeutic and preventive measures in DPN should begin as early as possible and should be carried out against the background of carbohydrate metabolism compensation. We consider the modern treatment of DPN with the use of pathogenetic and symptomatic therapy. Clinical data supporting the efficacy of the drug Actovegin in patients with DPN are presented.
Pharmateca. 2010;(3):58-63
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Use of somastatin analogues in the treatment of patients with acromegaly: options for the drug Somatuline® Autogel® use
Аннотация
We consider the modern potentials for use of selective somatostatin analogs in the treatment of acromegaly. The comparative data for the analogues widely used in clinical practice (preparations of octreotide and lanreotide) are presented. The results of clinical studies aimed to evaluation of effectiveness of selective analogue of somatostatin with prolonged action - Somatuline®Autogel® - in acromegaly are considered. Mechanisms of antisecretory and antiproliferative effects of the drug and the optimal scheme of its use are discussed.
Pharmateca. 2010;(3):64-67
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Comparison of treatment with insulin glargine and insulin Humulin NPH
Аннотация
The comparative analysis of the effectiveness of basal insulin analog (glargine) and classical longer-acting insulin - neutral protamine Hagedorn (Humulin NPH) is presented. The data indicates that glycemic control by these drugs led to similar levels of glycosylated hemoglobin in patients. The mitogenic potential of insulin glargine requires additional investigation. Cost benefit analysis show much lower cost of insulin Humulin NPH, and extensive experience of its safe use was demonstrated.
Pharmateca. 2010;(3):68-72
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Innovative approaches to the treatment of type 2 diabetes mellitus: the role of specialized product for enteral nutrition "Glucerna SR"
Аннотация
The feasibility of the use of specialized products for enteral nutrition (EN) for the purpose of glycemic control and blood lipid profiles in patients with diabetes mellitus (DM) is well-founded. The authors performed comparative examination of the magnitude and duration of postprandial glucose (PPG) in 34 patients with type 2 diabetes mellitus (DM2) against the background of consumption of specialized product for the EP "Glucerna SR" and conventional food load. Evaluation of PPG and the areas under the glycemic curves in DM2 patients showed less postalimentary glycemic response as a result of "Glucerna SR" consumption. The findings suggest that specialized product for the EP "Glucerna SR" can be used in the diet of patients with DM2 as an additional source of energy and micronutrients.
Pharmateca. 2010;(3):73-78
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Metabolism changes and reproductive function state during Dibicor use in women with polycystic ovary syndrome
Аннотация
The article discusses the first experience of use of the native drug Dibicorum (Taurine) for the correction of metabolic and reproductive disorders in women with infertility secondary to polycystic ovarian syndrome (PCOS). It is known that the use of insulin-sensitizing agents, indirectly, on the background of improvement of sensitivity to the hormone, in some cases can lead to reduction of available reproductive disorders and improvement of fertility. However, not all patients tolerate this therapy (eg, women with low body weight). In addition, these drugs have contraindications for use. These factors formed the basis for assessment of taurine effects in this cohort of patients. The authors surveyed 51 women with diagnosed PCOS before and after treatment with Dibicorum at dose of 1000 mg for 12 weeks. The reliable findings showed that Dibicorum modulates metabolic disorders in patients with PCOS by decrease of β-cell dysfunction. It leads to decrease of degree of hyperinsulinemia and activation of selection of leading follicles in patients with anovulatory ovarian dysfunction.
Pharmateca. 2010;(3):79-86
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New possibilities for type 2 diabetes mellitus therapy. Results of a pilot observation program of efficacy and safety of the drug «Galvus» (vildagliptin) therapy in Moscow and in the regions of the Russian Federation
Аннотация
The results of the study aimed to examination of efficacy and safety of drug Galvus (vildagliptin) in 1109 patients with type 2 diabetes mellitus (DM2) in the Russian clinical practice are presented. The findings showed that the use of the drug Galvus as monotherapy and in combination with metformin or sulfonylurea medications lead to significantly improvement of glycemic control in patients with DM2. This drug has no effect on body weight, can reduce body weight against the background of low-calorie diet and increasing physical activity. Vildagliptin is well tolerated, have no severe side effects and does not cause hypoglycemic state.
Pharmateca. 2010;(3):87-90
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Verification of the class of carbohydrate metabolism disorders in patients with hyperglycemia first detected on the background of acute coronary syndrome
Аннотация
Among patients with hyperglycemia first detected secondary to acute coronary syndrome (ACS), there are many persons with various carbohydrate metabolism disorders (diabetes mellitus type 2, impaired glucose tolerance) at the first 6 months after coronary event. Newly diagnosed increase of blood glucose level during admission for ACS requires further examination to verify carbohydrate metabolism disorders after the regression of acute state. Examination of fasting blood glucose levels over time and glucose tolerance test before discharge from hospital no later than 6 months of observation on posthospital stage are necessary. For the purpose of correction of hyperglycemia in emergency settings, particulary in ACS, intravenous short-acting insulin infusion is recommended.
Pharmateca. 2010;(3):91-94
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Possibilities for coronary blood flow restoration and prophylaxis of reperfusion myocardial damage in patients with acute myocardial infarction
Аннотация
The main purposes of drug therapy of coronary heart disease are the reduction of myocardial oxygen demand or increase of oxygen delivery through vasodilation. Metabolic therapy is of greatest interest, because it can solve the problem of reduction of oxygen demand and significantly improve the efficiency of its utilization in myocardial ischemia. The study was aimed to evaluation of efficacy of prehospital use of cytoprotector Mexicor with subsequent intracoronary administration during first hours in patients with acute myocardial infarction (AMI). 82 patients with AMI admitted in hospital within 4 hours of onset were examined. According to the results, successful angioplasty of infarct-associated coronary artery and intracoronary administration of cardioprotector Mexicor leads to significantly improvement of clinical efficacy of the restoration of the coronary circulation and prevention of myocardial reperfusion injury.
Pharmateca. 2010;(3):95-100
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Stellwag's sign
Аннотация
The clinical significance of Stellwag's sign (rare blinking, exophthalmos) specific to hyperthyroidism is discussed. For the first time this symptom was described by the Austrian ophthalmologist Carl Stellwag von Karion. The symptom is especially important for those specialists (ophthalmologist, internist, cardiologist, neurologist), which initially may contact with patient suffering from hyperthyroidism.
Pharmateca. 2010;(3):103-103
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