Therapy

Peer-review scientific medical journal

Editor-in-chief

  • professor Anatoliy I. Martynov, MD, doctor of medical sciences, Academician of the Russian academy of sciences; professor of the Department of Hospital Therapy № 1, Medical Faculty of A.I. Yevdokimov Moscow State Medical and Dental University; president of Russian scientific medical society of internal medicine (RSMSIM).

Publisher

  • LLC “Bionika Media”

Founder

  • Autonomous non-profit organization of additional vocational training "Training Center of Russian Scientific Medical Society of Internal Medicine"

WEB official

Aims and Scope

THERAPY – peer-reviewed scientific and practical medical journal; since 2015, it is the official publication of the Russian scientific medical society of internal medicine (RSMSIM).

The Therapy journal sets sights on contribution to the most comprehensive and complete development of national health care, medical research and education, professional development of health professionals in the research, teaching and practical work in the field of therapy and related disciplines. Each issue of journal is thematic and dedicated to a particular medical specialty (cardiology, neurology, gastroenterology, rheumatology, endocrinology, etc.). Targeted audience: therapists of outpatient and inpatient facilities, general practitioners, highly specialized doctors.

The Therapy journal publishes clinical guidelines/consensuses, original articles, reviews, clinical cases, lectures & reports, reviews of new releases in specialized literature, as well as materials about RSMSIM activities.


Current Issue

Open Access Open Access  Restricted Access Access granted  Restricted Access Subscription or Fee Access

Vol 9, No 10 (2023)

Cover Page

Full Issue

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

CLINICAL GUIDELINES/ CONSENSUSES

Expert consensus: diagnosis of osteoporosis and sarcopenia in elderly and senile patients (abridged version)
Sharashkina N.V., Naumov A.V., Dudinskaya E.N., Khovasova N.O., Tokareva L.G., Polyanskaya A.R., Onuchina Y.S., Lysenkov M.Y., Demenok D.V., Sorokina A.V., Runikhina N.K., Tkacheva O.N.
Abstract

As a person is aging, he is getting a progressive decline in bone mineral density, muscle mass, and strength, which is predisposing to the risk of osteoporosis and sarcopenia. Osteoporosis could be characterized by low bone mass and bone microarchitecture deterioration, while sarcopenia represents loss of muscle mass, strength, and function. Consequences for an individual suffering from both conditions together include an increased risk of falls, fractures, frequent hospitalizations and a high risk of death. Of particular interest in the current situation is a new method for diagnosing osteoporosis – radiofrequency echographic multispectrometry (REMS), which has a number of advantages, such as safety due to the absence of radiation exposure and portability, as well as relatively low cost. Presented consensus describes epidemiology, clinical consequences, and current methods for diagnosing osteoporosis and sarcopenia in the elderly.

Therapy. 2023;9(10):7-20
pages 7-20 views

ORIGINAL STUDIES

Meta-analysis of observational cohort studies on the relationships of asymptomatic hyperuricemia with chronic kidney disease
Mazurov V.I., Drapkina O.M., Martynov A.I., Sayganov S.A., Bashkinov R.A., Gaydukova I.Z., Sapozhnikov K.V., Tolkacheva D.G., Sableva N.A., Tsinserling A.Y.
Abstract

Studying the relationship between the level of uric acid (UA) and glomerular filtration rate (GFR) is a pressing interdisciplinary problem in the clinic of internal medicine.

Objective: to evaluate the effect of serum UA levels on GFR in patients with initially normal and reduced renal function using a systematic review of cohort observational studies and evaluation of its results based on meta-analysis.

Material and methods. A systematic search and selection of publications was carried out in the Embase, PubMed, Cochrane Library, and eLibrary databases. During the first stage of the study, the relationship between the level of UA in the blood serum and GFR was determined based on the initial data of patients when included in observation. At the second stage, the dynamics of GFR was analyzed in a population of patients mixed by the presence of chronic kidney disease (CKD) over observation periods of up to 6 years and from 6 to 10 years. The meta-analysis assessed the clinical and methodological heterogeneity of the included studies, as well as publication bias and risk of bias.

Results. The meta-analysis included 23 eligible clinical trials (involving 216,479 patients). As a result of the analysis, it was revealed that an increase in the level of UA in the blood serum by 1 mg/dL leads to a decrease in GFR by 1,18 (95% CI from -1,24 to -1,12) ml/min/1,73 m2 in individuals with initially normal renal function and by 1,87 (95% CI from -1,90 to -1,83) ml/min/1,73 m2 in a cohort of patients mixed by the presence of CKD. Moreover, data were obtained that demonstrated a statistically significant decrease in GFR by 4,44 (95% CI from -7,65 to -1,23) ml/min/1,73 m2 during 6 years of follow-up and by 6,21 (95% CI from -8,09 to -4,34) ml/min/1,73 m2 over a follow-up period of more than 6 years in a mixed CKD population of patients suffering from asymptomatic hyperuricemia (AHU).

Conclusion. The results of this meta-analysis showed a statistically significant negative effect of increasing serum UA levels on GFR both in individuals with initially normal renal function and in a cohort of patients mixed in terms of the presence of CKD. Along with this, it was found that a decrease in the filtration function of the kidneys against the background of hyperuricemia in a population of patients mixed in terms of the presence of CKD tends to progress with a longer period of observation. Thus, therapeutic measures aimed at reducing the level of sUA in the blood serum in individuals with AHU can serve as an additional factor of nephroprotection to prevent the development and progression of kidney pathology.

Therapy. 2023;9(10):21-39
pages 21-39 views
Epidemiology of atherosclerotic cardiovascular diseases in some regions of the Russian Federation, clinical characteristics of patients and estimation of the efficacy of lipid-lowing therapy: study of real clinical practice
Tuaeva I.B., Astakhova Z.T.
Abstract

Atherosclerotic cardiovascular diseases (ASCVD) are traditionally leading in the structure of mortality in the world and in Russia.

The aim of the research is estimation of the incidence of ASCVD from 2016 to 2021 in the general population and by strata (acute/chronic ASCVD, age, gender), prevalence of these diseases by years; comparison of demographic and clinical characteristics of patients with and without ASCVD; study of applied lipid-lowering therapy regimens and its efficacy in clinical practice.

Material and methods. The source of data for the study were anonymized medical records from the EHR of patients in healthcare facilities for the period from 01/01/2016 to 02/28/2022 in 10 territorial entities of the Russian Federation. ICD-10 codes were used to identify patient subgroups (acute/chronic ASCVD). Epidemiological part of the research for study the incidence and prevalence of ASCVD in the Russian Federation for the period 2016–2021 included 1,591,126 patients from the Kirov region; clinical part of the research for study the efficacy of lipid-lowering therapy regimens for ASCVD included 293,803 patients from 10 territorial entities of the Russian Federation.

Results. Among all patients included in the epidemiological part of the study, only 14,1% were diagnosed with ASCVD. The group of ASCVD patients differed significantly from the group without ASCVD in age parameters: 68,5±12,1 versus 41,9±23,9 years old. The initial level of LDL cholesterol on statin monotherapy was 3,27±1,18 mmol/l. No significant dynamics of this index was found in patients with ASCVD during lipid-lowering therapy after 3–6 (2,93±1,16 mmol/l) and 6–12 (2,96±1,08 mmol/l) months. In the statin monotherapy group, the proportion of patients who did not achieve the target LDL cholesterol level <1,4 mmol/l after 3–6 months was 95,83%, and after 6–12 months – 96,06%. At the same time, the frequency of failure to achieve LDL cholesterol levels in the range of 1,4–1,8 mmol/l was slightly lower and after 3–6 months was 90,22%, and after 6–12 months – 91,63%. Combined lipid-lowering therapy statin + ezetimibe was prescribed in total to 52 patients with ASCVD.

Conclusion. Currently, in real clinical practice in 10 subjects of the Russian Federation, a clinical inertia in achieving target LDL cholesterol levels in ASCVD patients takes place, which requires more active implementation of innovative lipid-lowering medicaments use.

Therapy. 2023;9(10):40-47
pages 40-47 views
24-hour blood pressure monitoring during treatment with free and fixed combinations of antihypertensive drugs
Gumerov F.R., Mayanskaya S.D., Malysheva E.V.
Abstract

According to modern clinical recommendations, for effective blood pressure (BP) control from the 2nd stage of arterial hypertension (AH), a combination of at least two antihypertensive drugs (AHDs) with different mechanisms of action should be used. For therapy adherence improving, it is preferable to prescribe fixed combinations (FC) of medicines. Despite the fact that fixed and free combinations of AHDs have been well studied, there are still not enough studies making their comparative analysis.

The aim of the research is a comparative estimation of daily BP profile in patients with stage 2–3 AH while taking a free combination and FC of blockers of angiotensin II receptor and a calcium antagonist.

Material and methods. 60 patients with grade 2–3 of AH, randomized into two groups of 30 people each were involved in the study. The 1st group received FC of losartan with amlodipine, the 2nd group received a free combination of valsartan and amlodipine. The study was carried out over 3 months. At the first and second visits, participants underwent ABPM procedure.

Results. After 3 months from the start of the treatment, the dynamics of ABPM indexes in patients of both groups practically had no difference. A significant decrease in most of the main parameters of the daily BP profile was revealed, with the exception of the rate of morning rise in SBP and DBP, as well as the degree of nighttime decrease in SBP in group 1 and indicators of BP variability in group 2. An intergroup comparison of ABPM parameters revealed a more noticeable difference in all main indicators of SBP and DBP in patients taking FC.

Conclusion. Statistically significant decrease in the main ABPM parameters was observed both when taking the free combination of valsartan and amlodipine, and the FC of losartan with amlodipine. When comparing between groups, a statistically more significant decrease in most ABPM parameters was observed when using FC of losartan with amlodipine. This indicates a more expressed effect of FC at the daily blood pressure profile, which is apparently takes place due not only to increased patients’ adherence to such therapy and its economic feasibility, but also to the additional additive antihypertensive efficacy of AHDs FC.

Therapy. 2023;9(10):48-55
pages 48-55 views
Analysis of the efficacy of providing medical care for acute coronary syndrome patients with ST segment elevation
Lityushkina M.I.
Abstract

Patients with acute coronary syndrome (ACS) require hospitalization, continuous medical supervision, treatment and diagnostical measures that meet modern standards.

The aim: to analyze the prehospital management tactics of ACS patients with ST-segment elevation.

Material and methods. An analysis of 245 ambulance call cards for ACS patients with ST segment elevation for 2019 (Emergency Medical Care Station, Republic of Mordovia) was carried out.

Results. Without taking into account the time for delivery to the hospital, total time for medical care providing to the studied patients took 28,9±4,7 minutes, time interval from the call to the ambulance service up to the delivery to emergency department was 53±5,1 minutes. Analysis of drug therapy showed that nitrates were used in 60,8%, narcotic analgesics in 81,9%, anticoagulants in 67,3%, antiplatelet therapy in 70,1%, fibrinolytic therapy in 8,9%, beta blockers in 18,7%, oxygen therapy in 36,3% of patients.

Conclusion. Patients with ACS at the prehospital stage received medical care in accordance with clinical recommendations; the low percentage of thrombolytic therapy was associated with the presence of contraindications to its performing.

Therapy. 2023;9(10):56-59
pages 56-59 views
Clinical course of repeated myocardial infarction in previously stented patients
Lutsik E.A., Skorodumova E.A., Kostenko V.A., Skorodumova E.G., Siverina A.V.
Abstract

Widespread implementation of percutaneous coronary interventions (PCI) has made a significant contribution to reducing mortality in patients with myocardial infarction (MI). However, according to the data of various research works, the development of restenosis limits the clinical efficacy of PCI in 30–42% of patients.

The aim: to compare the peculiarities of recurrent MI clinical course in patients with thrombosis/stenosis in a previously installed stent and obstruction of coronary artery outside it in addition to the progression of atherosclerosis.

Material and methods. Patients with recurrent MI who underwent stenting of the infarct-related coronary artery during the previous and current hospitalization were studied. They were divided into two groups: 1st – 110 persons with thrombosis/stenosis in the stent, 2nd – 102 persons with stenosis outside the previously installed stent. The participants had predominantly male gender; average age of them was 66,4±1,2 years old.

Results. Reinfarction in patients in group 1 developed on average after 3,9 years, in group 2 – after 5,5 years (p=0,04). Type 2 diabetes mellitus and chronic kidney disease were more common in group 1. In 90,8% of patients in the total sample, mostly large arteries were stenotic. Patients in group 2 were characterized by multi-vessel coronary lesions (p=0,03). LVEF in patients of group 1 was on average lower than in patients of group 2. Patients in group 1 had higher levels of large platelets and thrombocrit indexes, a significantly higher level of CRP and worse renal function. A high level of LDL cholesterol as a potential factor of atherosclerosis progression and significantly lower level of HDL cholesterol in the blood at the time of intervention and later could stimulate a more active development of atherosclerosis precisely at the site of stent implantation. Hospital mortality was 3 times higher in patients of group 1 comparatively to patients of group 2.

Therapy. 2023;9(10):60-66
pages 60-66 views
Study of colon microbiological culture in patients considering themselves to be healthy
Krylova I.A., Lyamin A.V.
Abstract

Detection of chronic non-infectious diseases (CNIDs) as early as possible is one of the priority tasks of the world healthcare services. A factorial prevention strategy is considered to be the basis, at which the general conditions for chronic CNIDs development are determined. Influence of quantitative and qualitative composition of the intestinal microbiota at occurrence and supporting of chronic diseases has been proven, but its influence is not taken into account in modern programs for prevention and prophylactic medical examination service.

The aim: to determine the species diversity of colonic luminal microbiotic culture in outpatients who consider themselves to be healthy.

Material and methods. Survey, examination, anthropometry assessment, collection of clinical and laboratory data of outpatients (n=114) aged from 18 to 72 years were carried out. Species composition of the luminal intestinal microbiota was analyzed with the identification of all grown microorganisms using MALDI-ToF mass spectrometry methodic.

Results. About 50% of patients who considered themselves healthy and did not apply to a doctor had elevated body mass index values. The composition of the luminal intestinal microbiota showed a tendency towards a decrease in bacterization in general and a decrease in the content of bifidobacteria with increasing of patients’ age. Normal body weight of patients was found in case of the presence of bacteroids and lactobacilli in luminalis microbiota. The dependence of patient’s well-being on the species diversity of the present luminal microbiota was found.

Conclusion. Basing on the results of the study, it could be assumed that the determination of the colonal luminal microbiota as a part of prevention and clinical examination programs can provide additional important information about the risk factors for CNIDs presence in patients.

Therapy. 2023;9(10):68-73
pages 68-73 views
The use of probiotics containing a combination of Lactobacillus acidophilus LA-5 and Bifidobacterium animalis subsp. lactis BB-12 strains: Meta-analysis of efficacy in the prevention of antibiotic-associated diarrhea and in Helicobacter pylori eradication therapy
Gorelov A.V., Andreeva I.V., Zakharenko S.M., Sinopalnikov A.I.
Abstract

The efficiency of probiotics in the prevention of antibiotic-associated diarrhea (AAD) and H. pylori eradication therapy remains the subject of debate.

The primary objectives of this systematic review and meta-analysis were to access the effectiveness of the use of combination of Lactobacillus acidophilus LA-5 and Bifidobacterium animalis subsp. lactis BB-12, including as a part of other probiotics in the prevention of AAD and as well as in H. pylori eradication therapy.

Material and methods. We searched in PubMed database from January 1, 2000 to December 31, 2022. Additionally, we performed an extensive search in the literature references on the relevant topic. Screening of studies, selection, evaluation of the quality and suitability of studies for inclusion in a systematic review were performed by two independent experts. Data analysis and extraction were carried out using the PRISMA flowchart. The RevMan 5.4.1 program was used for the meta-analysis. The included publications were full-text articles with detailed information about clinical studies using a combination of LA-5 and BB-12, including as part of other probiotics.

Results. A total of 278 studies met the inclusion criteria were identified. 7 studies (n=1052) were included in the meta-analysis of AAD risk. Use of LA-5 and BB-12 combination decreased AAD risk by 46% (RR 0,54; 95% CI: 0,33–0,91; 5 studies, n=742). Three studies (n=339) were included in the meta-analysis of H. pylori eradication outcomes. The use of combination of LA-5 and BB-12 led to a statistically significant increase in the chances of successful eradication of H. pylori (OR 2,42; 95% CI: 1,34–4,34), risk of adverse events was decreased by 70% (RR 0,30; 95% CI: 0,20–0,46; 2 studies, n=201), and diarrhea risk was lowered by 65% (RR 0,35; 95% CI: 0,19–0,65; 3 studies, n=339).

Conclusion. The results of the meta-analysis showed that the use of probiotics in the form of combination of LA-5 and BB-12 strains is associated with a reduced risk of AAD, including patients undergoing H. pylori eradication infection, as well as with a lower frequency of adverse events during eradication therapy.

Therapy. 2023;9(10):74-82
pages 74-82 views
Correlation between vitamin D concentration and severity of community-acquired pneumonia in patients from the Amur region
Luchnikova T.A., Prikhodko O.B., Voytsekhovskiy V.V.
Abstract

Currently available data on the effect of vitamin D at the clinical course of pneumonia are insufficiently reliable and contradictory.

The aim: to identify or refute the correlation between serum vitamin D concentrations and the severity of community-acquired pneumonia (CAP).

Material and methods. Main study group included 86 patients with CAP (53,4% males and 46,51% females), who were divided into two subgroups: 1st – 48 patients with moderate CAP; 2nd – 38 patients with severe CAP. The control group consisted of 50 relatively healthy volunteers. All patients underwent a standard examination according to existing recommendations. Vitamin D levels ≥30 ng/ml were considered to be sufficient, between 29–20 as insufficient, <20 as vitamin D deficiency, <10 as severe deficiency.

Results. Total concentration of vitamin D in the blood serum in patients with CAP was significantly lower than in control group – 15,02 (8,47–21,64) versus 27,47 (24,25–30,15) ng/ml (р=0,00001). Moreover, among patients with pneumonia, sufficient levels of vitamin D were observed in 15%, insufficient – in 17%, deficiency – in 42%, severe deficiency – in 26% of cases. In severe CAP, the average vitamin D level was significantly lower than in patients with moderate CAP: 11,08 (9,95–11,72) versus 19,08 (14,01–26,83) ng/ml (p <0,05). In addition, vitamin D levels were significantly lower in patients with bilateral or multisegmental lung damage (p=0,0001). All patients who died from CAP (n=6) had severe vitamin D deficiency – 4,89 (3,38–7,06) ng/ml. It was found that lower serum vitamin D levels were associated with longer overall disease duration and with longer radiographic resolution of pneumonia (r=-0,47, p=0,04).

Conclusion. The study found that vitamin D deficiency in blood serum can affect the severity of CAP and increase the risk of unfavorable outcomes and death.

Therapy. 2023;9(10):84-89
pages 84-89 views
Peculiarities of clinical and radiological parameters, indexes of systemic inflammation and immune status in vaccinated patients with COVID-19
Mineeva E.S., Demko I.V., Sobko E.A., Kruglova O.S., Kudryavtsev Y.I.
Abstract

Since 2021, an active vaccination campaign against COVID-19 is performing worldwide.

The aim: to evaluate clinical and radiological parameters, indexes of systemic inflammation and immune status in vaccinated patients with COVID-19.

Materials and methods. The study included 137 individuals. Group 1 consisted of patients with COVID-19 who received preventive vaccination (n=74). Group 2 included patients with COVID-19 who had not been vaccinated (n=63). All patients underwent general clinical examination, MSCT of chest organs, general and biochemical blood tests, interleukin 6, ferritin, procalcitonin, D-dimer, and immunogram assessment.

Results. In the group of unvaccinated patients, in a third of patients a volume of lung tissue damage equal to CT 3–4 was registered, while in group 1, CT values of 3–4 were observed in less than 25% of patients (p=0,038). Also in group 2, patients had a longer stay duration in the hospital, including that on oxygen support. In both groups, patients who required ICU treatment were registered, but in a greater percentage of cases this need occurred in non-immunized individuals. Among patients who did not undergo vaccination, death was observed in 25,00%; in the group of vaccinated patients, mortality rate was significantly lower – 6,45% (p=0,039). Indicators of systemic inflammation were higher than normal in both groups, but more evident changes were observed in unvaccinated patients. When assessing the immune status, dysfunction of T-cell component of immunity was found in a cohort of unvaccinated patients.

Conclusion. Vaccinated patients have a more favorable course of COVID-19 comparatively to unvaccinated patients, characterized by a less volume of lung tissue damage and less number of hospital bed days, including those on oxygen support. Vaccinated individuals are characterized by a more favorable prognosis of the disease: thus, the incidence of deaths was significantly more often recorded among patients of group 2nd. In both groups, the course of COVID-19 and the need for respiratory support were associated with indexes of systemic inflammation, volume of lung tissue damage, immune status and outcome of the disease.

Therapy. 2023;9(10):90-98
pages 90-98 views

REVIEWS

Mineral density bone tissue disorder in case of inflammatory bowel diseases (literature review)
Abdulganieva D.I., Kupkenova L.M., Yangurazova A.R., Myasoutova E.R.
Abstract

Article presents literature data on the incidence and risk factors for the development of bone mineral density (BMD) disorder in case of inflammatory bowel diseases (IBD – Crohn’s disease and ulcerative colitis). Separately, the issues of the correlation between genetics, immune inflammation in IBD, micronutrient deficiency, use of systemic glucocorticosteroids, genetically engineered biological drugs and BMD disorders are considered. Directions for further research work to predict the development and prevention of osteoporosis in IBD patients are outlined in common. Current review expands for physicians the frames of understanding the management of IBD patients having risk of osteoporosis developing.

Therapy. 2023;9(10):100-107
pages 100-107 views
Diagnosis of atrophic gastritis and prevention of its complications
Didigova R.T., Malsagova I.Y., Buzurtanova M.B., Ugurchieva P.O., Magomaeva K.V., Teboeva M.B.
Abstract

The purpose of current work is systematization of information concerning manifestations and early diagnosis of atrophic gastritis. In most countries, including Russia, mortality rates from stomach cancer are close to the incidence rates of stomach cancer, but are highly dependent on early diagnosis and successful treatment of the disease. All this makes the problem of atrophic gastritis to be acute and actual as a clinical and morphological marker of an increased risk of stomach cancer developing.

Therapy. 2023;9(10):108-113
pages 108-113 views
Cardiac manifestations of undifferentiated connective tissue dysplasia: the role of genetics, molecules fibrosis and inflammation
Khlynova O.V., Karpunina N.S., Soloviev O.V., Gordiychuk R.N., Shumovich I.V.
Abstract

A review of the literature on the role of serum markers of fibrosis and myocardial inflammation in patients with mesenchymal dysplasia in arrhythmogenesis is presented. It has been proven that collagen accumulation occurs in the heart muscle of this cohort of patients, that type I, an increase in the serum content of terminal propeptides of procollagen type I, proteolytic activity of matrix metalloproteinase-9 over a tissue inhibitor of matrix metalloproteinases-1, hyperexpression of profibrotic microRNAs above the level of antifibrotic microRNAs, an increase in serum parameters of proinflammatory cytokines. It is associated with progression of connective tissue and electrophysiological remodeling of the myocardium.

Therapy. 2023;9(10):114-122
pages 114-122 views
Etiopathogenesis and possibilities of minimally invasive diagnostics of chronic diffuse liver diseases: literature review
Bulatova I.A., Shchekotova A.P., Paducheva S.V., Gulyaeva I.L., Sobol A.A.
Abstract

The most common etiological factors of chronic diffuse liver diseases (CDLD) are alcoholic liver disease, chronic viral hepatitis and non-alcoholic fatty liver disease. The main way of CDLD progression from hepatitis to cirrhosis leading to hepatic damage is the processes of fibro- and steatogenesis activation. To determine the prognosis of development and select the optimal treatment tactics for HDLD, regardless of etiology, an accurate assessment of the stage of steatosis/fibrosis/cirrhosis of liver is necessary. The review covers etiology, pathogenesis of CDLD development and progression, minimally invasive diagnostic methods based on the identification of direct and indirect serum markers in combination with biometric parameters. Optimization of well known and creation of new approaches to liver diseases diagnosis makes it possible to timely carry out therapeutic measures aimed at prevention of their progression.

Therapy. 2023;9(10):123-131
pages 123-131 views

CL INICAL CASE

A clinical case of early diagnosis of giant cell arteritis (Horton’s disease) in the practice of a general practitioner
Alieva A.M., Baykova I.E., Teplova N.V., Reznik E.V., Kotikova I.A., Nikitina O.S., Shabatina T.M., Nikitin I.G.
Abstract

Giant cell arteritis (GCA) is a systemic vasculitis, the morphological feature of which is the frequent presence of giant multinucleated cells in the wall of the affected vessels. Although awareness of GCA has increased in recent years, its varied course still leads to diagnostic uncertainty. A high index of suspicion is a critical factor for early diagnosis. Clear diagnostic criteria, accessible specialist consultations and informative management recommendations are essential for rapid diagnosis and appropriate initiation of treatment. Timely administration of drug therapy helps prevent complications. Our article describes a clinical case of GCA in a 68-year-old patient. The interest of the clinical case is due, first of all, to early diagnosis, which made it possible to prescribe pathogenetic therapy in a short time, and, ultimately, to avoid the formidable complications characteristic of giant cell arteritis.

Therapy. 2023;9(10):132-138
pages 132-138 views

LECTURES & REPORTS

From empirical medicine – to analytical medicine
Volkova N.I., Volkov A.V.
Abstract

The article examines the crisis in medical science and practice caused by the contradiction between the volume of accumulated knowledge and the methodology for its development, and proposes a methodological approach to the further development of the general theory of medicine. The concepts of the object, subject and method of medicine are clarified, a definition of health is given as the body’s ability to function indefinitely. Two forms of ill health are identified – disease and functional failure, while the term «disease» is interpreted as a set of processes leading to a loss of balance in the body and disruption of its recovery. Along with this, an analytical method for diagnosing a disease is described, a classification of diseases from the standpoint of analytical medicine is proposed, and urgent tasks of medical semiotics are outlined.

Therapy. 2023;9(10):139-147
pages 139-147 views

HELPING PRACTICING PHYSICIAN

Resolution of the expert council «Possibilities of neuroprotective therapy in patients with arterial hypertension and cognitive disorders»
Martynov A.I., Tanashyan M.M., Malyavin A.G., Bogolepova A.N., Borovkova N.Y., Eliseeva L.N., Zhuravleva M.V., Zakharov V.V., Koryagina N.A., Mikhin V.P., Osipova I.V., Ostroumova O.D., Pozdnyak A.O., Portnyagina U.S., Statsenko M.E., Tyrenko V.V., Chesnikova A.I.
Therapy. 2023;9(10):148-158
pages 148-158 views
pages 160-164 views
pages 166-170 views

ACTUAL ISSUES OF PHARMACOTHERAPY AND PREVENTIVE TREATMENT

Neurorehabilitation after a stroke: what a therapist should know
Shishkova V.N., Shishkov V.A.
Abstract

Neurorehabilitation treatment is an interdisciplinary system of medical, neuropsychological, medical-pedagogical, medical-social programs aimed at the complete restoration or development of compensatory mechanisms for impaired functions, as well as psychological and social readaptation of patients with damage to the nervous system of various etiologies. The neurorehabilitation process after a cerebrovascular accident can be organized in three stages: Stage I begins in the vascular department or in the intensive care unit, Stage II is carried out in a neurological rehabilitation hospital, Stage III is carried out in the outpatient department. At all stages, all modern methods of neurorehabilitation are used, including drug treatment. Among the relevant medicines, one can note the domestic drug nicotinoyl-gamma-aminobutyric acid (Picamilon), whose high effectiveness has been repeatedly demonstrated in the treatment of cognitive, psycho-emotional and motor disorders, as well as asthenic conditions of various origins.

Therapy. 2023;9(10):171-176
pages 171-176 views

ACTIVITIES OF RSMSIM

pages 177-180 views
pages 182-184 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies