No 2 (2016)

The article presents modern data on prevalence, basic mechanisms of development and tactics of conducting patients with gastroesophageal reflux disease (GERD). Effectiveness of primary and maintenance therapy with proton pump inhibitors (PPI) was analyzed. Author demonstrates the role of kinetic disorders and especially the composition of reluctate, in particular the presence of duodenal contents, in the lack of effectiveness of treatment of patients with GERD. The necessity of adding to antisecretory therapy PPI and prokinetics drugs ursodesoxycholic-howling acid for the correction of these pathogenetic mechanisms is justified.

The article analyzes the terminological interpretation of changes of intestinal microbiota in health and disease. The role of the microbiota in vital metabolic processes in the human body is discussed. Characteristics of probiotics and their importance in the therapy of socially significant diseases are given. The special role of probiotics in the prevention of antibioticassociated lesions of the digestive tract is emphasized.

Erosive and ulcerative gastroduodenal bleeding (GDB) in patients with cardiac pathology is threatening complication, in which the mortality rate ranges from 9,6 to 80%, reaching the highest numbers of patients of elderly and senile age. The need for acceptance of pathogenetic therapy, including antiplatelet agents, nonsteroidal anti-inflammatory drugs and anticoagulants of direct action greatly complicates the treatment of erosive and ulcerative GDB, which in itself is also a threat to the life of the patient. All this dictates the need for a rational treatment strategies for these patients to minimize the threat of the death of the patients from both the GDB and from heart disease. Designed by the authors of the algorithm treatment of different variants of the GDB allowed to reduce the mortality rate to 16,2%. Treatment of patients with this comorbidity requires a differentiated approach, depending on the nature and intensity of bleeding or the threat of its recurrence in the background of the need for pathogenetic therapy of the underlying disease.

The article focuses on torasemide as a drug of choice for arterial hypertension management. Diuretics are a first line group in pharmacotherapy of this pathology, however the group is highly geterogenic. Preference for torasemide is based upon its pharmacokinetic specifics and blockage of aldosterone effects, that it leads to pleiotropic positive effects. Evidence data is considered for torasemide prescription in arterial hypertension, as the aspects of its effect in cardiovascular comorbidities.

Neck pain is a common cause of referring the patient to the doctor. The most common type of pain is nonspecific ("mechanical", axial) pain in the neck. The disease may be different, but most patients are completely rid of the disturbing symptoms. For relief of acute back pain most widely used nonsteroidal antiinflammatory drugs. In principle, a new class of drugs for the treatment of pain syndromes, incl neck pain, are selective activators of neuronal potassium channels - SNEPCO (Selective Neuronal Potassium Channel Opener). Representative of this class of drugs is flupirtine (Nolodatak) with a wide range of pharmacological actions. The effectiveness of flupirtine was demonstrated in many randomized controlled trials in which it was compared with other analgesics or placebo. Several studies carried out in patients with degenerative diseases of the spine and myofascial syndrome. In these diseases flupirtine has a pronounced analgesic effect and reduces initially increased muscle tone.

Clinical observation of unusual case of vulvar cancer with metastatic lesion of the heart and non-infective thrombotic endocarditis with a fatal outcome in a young woman is presented. Emphasizes the need for knowledge of common diagnostic criteria of various diseases and algorithms for diagnosis and treatment approved in the recommendations and guidelines, for knowledge of epidemiology of certain diseases, for presence for doctors of any specialty wide clinical outlook that goes beyond the profile of the department in which they works.

The authors on the basis of historical documents, memoirs of contemporaries, the analysis of previous studies substantiate the possibility of a genetic pathology - androgen insensitivity syndrome in famous historical figure Joan of Arc.