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No 1 (2017)

Articles

Topical issues of the treatment discussed at the XXXIII World congress of internists

Martynov A.I., Andreeva L.A., Panchenkova L.A.

Abstract

В обзоре приводятся данные XXXIII Всемирного конгресса по внутренней медицине, который проходил с 22 по 25 августа 2016 года в Бали (Индонезия) под девизом «Переосмысление внутренней медицины: новые вызовы и возможности». Крупнейший мировой форум, объединяющий специалистов по внутренней медицине, проводится раз в два года. В его работе приняли участие более 3500 делегатов из 69 стран мира.
Therapy. 2017;(1):6-10
pages 6-10 views
pages 11-16 views

Clinical guidelines «Management of patients with osteoarthritis and comorbidity in general practice»

Myasoedova S.Y.

Abstract

В рамках XI Национального конгресса терапевтов, прошедшего в ноябре 2016 года в Москве, были утверждены обновленные клинические рекомендации «Ведение больных с остеоартритом и коморбидностью в общей врачебной практике».
Therapy. 2017;(1):17-18
pages 17-18 views

The complexity of the diagnosis of pneumonia in patients with acute vascular events

Odintsova D.V., Malyavin A.G., Zairatyants O.V.

Abstract

Study objective. To evaluate the clinical and laboratory and instrumental signs of pneumonia in patients with acute myocardial infarction and acute ischemic stroke. Study design. A retrospective analysis. Materials and methods. Authors reviewed archive data of 140 autopsy reports and medical histories of patients died from cardiovascular events to determine the frequency of pneumonia. The statistical analysis was used to associate fever, auscultatory changes, leukocytosis, chest radiography with pneumonia. Results and discussion. The study included 140 patients, of whom 84 (60.0%) with stroke in ischemic type 33 (23.6%) with stroke hemorrhagic type, and 23 (16.4%) with acute myocardial infarction. In patients with pneumonia auscultatory changes were in 86% of cases, fever in 87% of patients, leukocytosis in 87% of cases. Chests radiography changes of pneumonia were in 29 cases, and they were all patients with confirmed pneumonia in a retrospective analysis. Conclusion. Hyperthermia, leukocytosis and chest radiography changes were significantly more frequently encountered in patients with pneumonia, but their absence does not exclude pneumonia in patients with cardiovascular events.
Therapy. 2017;(1):20-25
pages 20-25 views

Modern approaches to the treatment of patients with acute tonsillopharyngitis

Edzhe M.A., Ovchinnikov A.Y., Khon Y.M.

Abstract

The review deals with the analysis of current guidelines for the treatment of acute tonsillopharyngitis (OTF). It is noted that antibiotic therapy is strictly indicated only when OTF caused by ß-hemolytic streptococcus group A (BGSA). Given current algorithms, allowing the doctor to conduct a differential diagnosis between OTF of viral and bacterial etiology. The features of the use of drugs of first choice in the treatment of OTF BGSA-caused are described, according to Russian clinical guidelines. The authors draw attention to the fact that macrolide resistance is a major problem in the choice of therapy of BGSA-induced OTF. The most common errors in the treatment strategy of BGSA-OTF, that are the main causes of unsatisfactory results of the prescribed treatment.
Therapy. 2017;(1):26-30
pages 26-30 views

Acute bronchitis: diagnosis and treatment

Zaitsev A.A.

Abstract

The article presents an overview of modern methods of diagnosis, treatment and prevention of acute bronchitis (AB). The prevalence of viral AB is emphasized; it raises questions about advisability of appointing antibacterial agents. The use of antibiotics for viral AB to prevent bacterial complications is also doubtful because effectiveness of this approach has no serious evidence. Influenzal bronchitis requires antiviral therapy using neuraminidase inhibitors. The choice of antitussives based on their mechanism of action and antitussive activity is discussed.
Therapy. 2017;(1):31-35
pages 31-35 views

The use of zinc and vitamin С for the prevention and adjuvant therapy of acute respiratory diseases

Gromova O.A., Torshin I.Y., Moiseev V.S., Sorokina M.A., Limanova O.A.

Abstract

Zinc and vitamin C are accumulating in lymphocytes intensively, and are required to support the immune system. Evidence-based studies confirm the usefulness of zinc and vitamin C to reduce the overall duration of acute respiratory diseases (influenza, adenovirus infections, etc.), including regression and relief of the patient's individual symptoms (runny nose, nasal congestion, throat irritation, hoarseness, cough, muscle ache).
Therapy. 2017;(1):36-46
pages 36-46 views

Bronchoobstructive syndrome in modern therapeutic practice

Babak S.L., Gorbunova M.V., Malyavin A.G.

Abstract

Bronchoobstructive syndrome (BOS) is a collective term that includes a number of symptoms of clinical manifestations of bronchial obstruction with underlying narrowing or occlusion of the airway. Clinically severe bronchoobstructive syndrome is most common in children, especially young children, but it is not a rare disease among the adult population. Its emergence and development is influenced by various factors, primarily respiratory viral infection. Early diagnosis and treatment of BOS in a therapeutic practice can significantly reduce the number of complications of the disease, improve survival and quality of life of patients.
Therapy. 2017;(1):47-53
pages 47-53 views

The basis of modern pharmacotherapy of bronchial asthma in adults

Zaitsev A.A.

Abstract

The article deals with the modern treatment of bronchial asthma (BA). In details the main types of asthma pharmacotherapy are presented. The options for the initial therapy of controlling asthma in adults are presented, as well as the principles of a graded approach to pharmacotherapy in patients with asthma are described. The results of clinical studies and meta-analyzes that evaluate the efficacy of combinations of inhaled corticosteroids and long-acting β2-agonists are presented. It is noted that a great advantage of fixed combinations is not only their high effectiveness in achieving control of asthma symptoms, but also a good compliance due to connection of two drugs in the same inhaler.
Therapy. 2017;(1):54-59
pages 54-59 views

Is there a relationship between bronchial asthma and arterial hypertension?

Kuznetsov A.N., Grigorieva N.Y., Ilyushina T.P., Mayorova M.V.

Abstract

The article describes the current state of problem of the prevalence of bronchial asthma and arterial hypertension, their pathogenetic interaction and features of therapy of patients with this comorbid pathology. Hypothesis of genesis of symptomatic «pulmogenic» arterial hypertension, which develops against the background of bronchoobstructive diseases, is discussed. The arguments against the hypothesis given, in favor of the theory of increased blood pressure in patients with bronchial asthma as manifestations of arterial hypertension, are considered. The lack of consensus on this subject among experts, requiring further research, is emphasized.
Therapy. 2017;(1):60-64
pages 60-64 views

Correction of systemic inflammation, oxidative stress and antioxidant defense using rosuvastatin in patients with chronic obstructive pulmonary disease

Samorukova Y.I., Adasheva T.V., Pavlov S.V.

Abstract

Chronic obstructive pulmonary disease (COPD) - is a disease with still increased mortality. This article presents the results of evaluation of the effectiveness of rosuvastatin in patients with COPD and assessment its effect on systemic inflammation, oxidative stress, antioxidant defense, and clinical course of COPD (the number of exacerbations, severity of symptoms, the severity of dyspnea, exercise tolerance).
Therapy. 2017;(1):65-73
pages 65-73 views

Antibacterial therapy of cOpd exacerbations: prescribe or not prescribe

Dvoretsky L.I., Sergeeva Y.V.

Abstract

The article discusses the strategy and tactics of antibacterial therapy in patients with acute exacerbation of COPD. The presence of infectious and non-infectious exacerbations requires an individualized approach to the addressing the issue of the appointment of antibacterial drug (AD). The majority of cases of infectious exacerbations are caused by bacterial pathogens, less frequently - by viruses. Selection of AD is based on antimicrobial activity against key bacterial causative agents, minimal risk of antibiotic resistance, optimal pharmacokinetics, and safety. AD efficiency is established in placebo-controlled studies in patients with severe infectious exacerbations of COPD. In assessing the effectiveness of AD in patients with exacerbations of COPD, the main criterion is the duration of recurrence-free period, which is determined by the eradication ability of AD.
Therapy. 2017;(1):74-81
pages 74-81 views

Metagenomic analysis of oropharyngeal microbiota in patients with different phenotypes of chronic obstructive pulmonary disease

Karnaushkina M.A., Fedosenko S.V., Petrov V.A., Malyavin A.G., Strutynskaya A.D., Cherkasova N.A., Ogorodova L.M.

Abstract

Background. Chronic obstructive pulmonary disease (COPD) is characterized by progressive limitation of airflow rate of the respiratory tract to noxious particles. It is shown that FEV1, which characterizes the speed limit airflow, not allows with high probability to predict the rate of progression of COPD. Aims. To characterize the features of the taxonomic composition ща oropharyngeal microbiota in patients with COPD. Materials and methods. The study included 98 patients with COPD. On each of 2 visits, according to the study protocol, aft patients were conducted clinical and functional examination. In addition, at the first visit, during stable period of disease, smears were collected. The taxonomic identification of microbiota was carried out using sequence analysis of conservative sites of bacterial 16S pRNA. To determine the taxonomic differences between groups of samples a method based on linear regression analysis, adjusted for metagenomic data, was applied. For assessment of the trends in changing the microbiota under influence of frequency of exacerbations and dyspnea generalized linear model was used. Results. The results of the study demonstrated a number of significant differences in the ratio of its various microbes, depending on the clinical and functional characteristics of COPD, including the frequency of exacerbations, dyspnea and COPD phenotype.
Therapy. 2017;(1):83-90
pages 83-90 views

Results of applying A-Flex therapy in patients obstructive sleep apnea and metabolic syndrome

Gorbunova M.V., Babak S.L., Malyavin A.G.

Abstract

Study objective. To investigate 6-month effects of CPAP therapy with auto-adaptation to inhalation and exhalation of obstructive sleep apnea (OSA) patient with MS (A-FLex therapy) on carbohydrate metabolism, lipid metabolism and blood pressure (BP). Materials and methods. To the prospective single-center study were included 30 (19 male [63,3%] и 11 female [36,7%], 51,70±11,54 year) OSA patients with MS and apnea-hypopnea index (AHI) >15 events/hour. The night polygraphy study (PG) was performed to calculate AHI, oxygen desaturation index (ODI), mean nocturnal saturation (Sp02 mean) by the rules of American academy of sleep medicine. Endothelial function of blood vessels determined by finger test was measured according to peripheral arterial tone (PAT). The reactive hyperemia index (RHI) and augmentation index (AI) was calculated. Optimal level of A-Flex therapy was adjusted at home. AHI, the level of air leakage, average pressure and compliance to CPAP treatment were established in accordance with international requirements. Results. After 6 months of A-Flex therapy we found a significant decrease of level of systolic and diastolic blood pressure (p=0,004), normalization of the level of glycated hemoglobin (HbA10 (p=0,03), normalization index of reactive hyperemia (RHI) (p=0.004), normalization of the augmentation index (AI) (p=0.003). There was statistically significant moderate strength (r=0.53; p<0.01) correlation between severity of sleep apnea (AHI) and level of vessel endothelium damage (RHI). There was a modest correlation (r=0,49; p<0.01) between severity of oxygen desaturations (ODI) and level of arterial stiffness (AI), associated with increased level of central BP and post load of the myocardium of the left ventricle. Conclusions. 6-month A-Flex therapy in OSA patients with MS has a significant therapeutic effect of stabilization systolic and diastolic blood pressure, level of blood lipids and glycated hemoglobin, level of endothelial dysfunction. The 6-month A-Flex therapy has to able to reduce the risks of cardiovascular events in moderate and severe OSA patients with acute metabolic manifestations.
Therapy. 2017;(1):91-97
pages 91-97 views

Potentials for the additional medical correction cytoprotectors in patients with chronic heart fa and nonalcoholic fatty liver disease

Statsenko M.Y., Turkina S.V., Shilina N.N., Kosivtsova M.A.

Abstract

The prospective randomized open-label 16-week trials studied 2-ethyl-6-methyl-3-hydroxypyridine succinat and trimetazidine succinate (part of complex treatment) effects in patients with chronic heart failure and type 2 diabetes mellitus, on structural and functional parameters of the сог and liver. Including of 2-ethyl-6-methyl-3-hydroxypyridine succinat and trimetazidine succinate in basis therapy of chronic heart failure and diabetes mellitus type 2 statistically significant increase ejection fraction of left ventricle, reduce triglycerids, decrease the level of fasting glucose, glycated hemoglobin and insulin resistance. Hepatoprotecive facilities of 2-ethyl-6-methyl-3-hydroxypyridine succinat were demonstrated.
Therapy. 2017;(1):98-105
pages 98-105 views

System analysis of endothelium dysfunction in pat with arterial hypertension, the inhabitants of highlands

Kurdanova M.K., Martynov A.I., Beslaneev I.A., Batyrbekova L.M., Kurdanov H.A.

Abstract

The paper presents the results of a system analysis of the functional state of the endothelium in healthy individuals and patients with arterial hypertension (AH), the inhabitants of the highlands, conducted on the basis of structural and morphological analysis of the main systems of the endothelium on the concentration of nitric oxide (NO) and its metabolites in the blood of nitrite (NO- 2) and nitrates (NO- 3), heart rate variability (HRV), the morphological structure of the myocardium and hemodynamic parameters. The mountain Prielbrusya surveyed 195 indigenous people - 50 healthy persons and patients with arterial hypertension (AH) 145 different degree. All. patients, but clinical, instrumental and biochemical research. The obtained results are systematized with the help of multiple regression equations and factor analysis. The dependences of the absolute and relative values of indicators and indices of HRV, gemodynamics, the morphological structure of the myocardium on the concentration of NO in the blood and the level of mean arterial pressure (MAP). Systematic analysis of the most important factors that allowed to show the contribution of the most important factors in the variation of resultant signs and assess the results of actions of their set objectives.
Therapy. 2017;(1):106-113
pages 106-113 views

Modern aspects of diagnosis and treatment of chi heart failure: what’s new?

Shaposhnik I.I.

Abstract

This review article is devoted to new trends in the diagnosis and treatment of chronic heart failure (CHF). In contrast to previous years, arterial hypertension predominates in the etiological structure of CHF. Among methods of diagnosis of CHF, determination of natriuretic peptide levels and ultrasound examination of the heart play leading role. The revised criteria for diagnosis of systolic and diastolic myocardial dysfunction using echography and Doppler sonography are presented. Background therapy of CHF therapy is based on the use of three groups of drugs: angiotensin converting enzyme inhibitors, ß-blockers and mineralocorticoid receptor antagonists. The new perspectives in the treatment of CHF related to the use of ivabradine and neprilysin inhibitor in combination with sartans are discussed.
Therapy. 2017;(1):114-120
pages 114-120 views

Modern potentials for use of candesartan in prevention and treatment of cardiovascular diseas

Batishcheva G.A., Mubarakshina O.A., Somova M.N., Yevstigneeva A.S.

Abstract

Sartans represent a relatively new group of antihypertensive drugs, but their effectiveness is well documented in many clinical situations. Candesartan is one of the most studied sartans; it has a strong and long-lasting antihypertensive effect. Candesartan's advantage compared to other drugs of the same group includes favorable pharmacokinetic profile. Candesartan has proved effectiveness in treating prehypertension, reduction of left ventricular hypertrophy, protection from stroke, slowing of the progression of chronic heart failure, and prevention of the development of paroxysmal atrial fibrillation. These properties of candesartan were confirmed in a number of clinical studies.
Therapy. 2017;(1):122-128
pages 122-128 views

Place of captopril in the therapy of uncompli hypertensive crisis

Taratukhin Y.O., Luchinkina Y.Y.

Abstract

The article is devoted to new information about captopril (Capoten) - a quick-relief drug for the treatment of uncomplicated hypertensive crisis. The epidemiological data on the issue are presented; modern literature on studies of this drug is considered. Pleiotropic effects of captopril and its potential use outside the hypertension are discussed.
Therapy. 2017;(1):129-134
pages 129-134 views

On the pharmacological interactions of antibiotics magnesium and on the magnesium deficiency ar as a result of antibiotic treatment

Gromova O.A., Torshin I.Y., Moiseev V.S., Sorokina M.A.

Abstract

There are antagonistic interaction between magnesium ions and certain antibiotics (especially aminoglycosides and fluoroquinolones). Firstly, antibiotics cause severe loss of magnesium that necessitates administration of magnesium preparations. Secondly, magnesium ions reduce the effectiveness of fluoroquinolones and aminoglycosides due to chelation. Therefore, separate intake of antibiotics and of magnesium preparations has to be stipulated in order to increase the efficiency and the safety of antibiotic therapy.
Therapy. 2017;(1):135-143
pages 135-143 views

Back pain: burden of comorbidities and selectic effective therapy

Azimova Y.E.

Abstract

Back pain (dorsafgia) is the most common disease and is an actual problem of neurofogy; it most commonly leads to the development of temporary disability and limitation of activity in the working age population. Despite the fact that the earfy start of adequate therapy is crucial for the prognosis of dorsafgia, many patients seff-medicate and seek medical advice only in the case of ineffectiveness or development of side effects. Non-steroidaf anti-inffammatory drugs (NSAIDs) are drugs of choice for the refief of acute back pain, but there are fimits for use of NSAIDs, particufarfy in patients at high gastrointestinaf and cardiovascufar risk. Afternatives to NSAIDs incfude the use of sefective activators of neuronaf K-channefs. Their representative ffupirtine (Nofodatak) has anafgesic and myorefaxation effects. Some studies have shown that ffupirtine had non-inferior efficacy compared to NSAIDs, but superior safety.
Therapy. 2017;(1):144-148
pages 144-148 views

Efficacy of therapy of moderate ulcerative colitis MMX mesalazine

Knyazev O.V., Belyakov N.I., Kagramanova A.V., Fadeeva N.A., Parfenov A.I.

Abstract

Ulcerative colitis (UC) is a chronic disease characterized by immune diffuse inflammation of the mucous membrane of the colon with the obligatory involvement of the rectum in the inflammatory process. Choosing the type of conservative or surgical treatment is determined by the severity of the attack, the length of lesions of the colon, the presence of extra-intestinal manifestations, disease duration, efficacy and safety of prior therapy, and the risk of developing UC complications. In Russia and abroad, mesalazine is actively used for the treatment and prevention of recurrence of UC, because it has a minimum of side effects associated with individual intolerance to the drug. Currently, pharmacological specialized manufacturing technologies provide targeted delivery of mesalazine to the affected area, maintaining its high concentration throughout the colon.
Therapy. 2017;(1):150-158
pages 150-158 views

Alexey Petrovich Golikov (1921-2017)

- -.

Abstract

Президиум Российского научного медицинского общества терапевтов скорбит по поводу кончины выдающегося отечественного ученого-клинициста в области неотложной терапии и кардиологии, академика Российской академии наук, заслуженного деятеля науки Российской Федерации Алексея Петровича Голикова.
Therapy. 2017;(1):159-159
pages 159-159 views

The Memory Of Khairutdin Efendievich Hajiyev

- -.

Abstract

27 декабря 2016 года ушел из жизни Хайрутдин Эфендиевич Гаджиев, патриарх дагестанской медицины, знаменитый ученый и врач, известный общественный деятель, почетный член Российского научного медицинского общества терапевтов.
Therapy. 2017;(1):160-160
pages 160-160 views

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