No 1 (2018)

Long-time medical observations of ambroxol use attract more and more attention nowadays. It is ambroxol, which belongs to mucolytics and solventias (expectorants) is considered to be a substance, having an active influence at basic mechanisms of bronchial mucus pbysiological production and transportation. Due to these features the main indication to its prescribtion is "secretolytic" therapy of acute and chronic pulmonary diseases, associated with tracheobronchial secret hypersecretion and disorder of its transportation. The aim of current review is estimation of pharmacological and clinical data concerning secretolytic and mucokinetic activity of ambroxol and grounding of a new strategy of its use in practice of internal medicine. Retrospective analysis of the results of pharmacological and clinical research works of national and foreign authors for the period from 1967 to 2017 was used. The research data with adequate design from "proper clinical practice" positions (GCP) and evidentary medicine were included. It was made a conclusion, that ambroxol as a medicament has a row of original characteristics including: 1) high secretolytic activity stimulating the mucosal clearance, expectoration of the secret and reduce of productive cough, 2) antiinflammatory and antioxidative activity, 3) local analgesic (anaestetic) effect by means of blocking of sodium channels of cellular membranes. The reduce of frequency of chronic obstructive pulmonary disease recidives proves the significance of ambroxol clinical effects. Effect of tunicas mucosa anaesthesia is related to a new pharmacological effect of ambroxol, which could be useful in acute bronchitis and ARVI infection therapy. The efficacy and safety of ambroxol clinical practice use has been tested by almost half-century experience of its prescribtion. Modern strategy of mucolytic therapy is able to improve significantly the quality of treatment and prognosis of patients with acute and chronic pulmonary diseases with tracheobronchial secret hypersecretion, mucociliar clearance disorders and non-productive cough.

The publication is devoted to actual aspects of epidemiology, diagnostics and treatment of community-acquired pneumonia. Data of its etiology, key points of diagnostics and directions of start antimicrobal therapy are introduced there.

Cough is one of the most often occurring reasons for getting medical help at outpatient stage. Article considers the questions concerning differential diagnostics and treatment of cough at the primary medical aid stage performance. In particular, the data about the possibility of use while coughing such herbal formulations as Evkabal syrup and Evkabal balsam C are introduced. Pharmacologic features of these medicines, their efficacy and safety in pediatric and therapeutic practice let to consider them as symptomatic remedies against the cough in adults and infants and recommend for wider use in adult group of patients at primary medical-sanitary care stage.

The article is focused on the novel drug for congestive heart failure management - combination of valsartan and sacubitril, that has recently became available on pharmaceutical market, and has been included in the European Guidelines due to proven efficacy and safety. In the article, natriuretic system is described and the place of neprilysin in it. Mechanism of sacubitril is presented and rationale for its combination with valsartan. The data from the main clinical trials is given, as some recent references on the drug clinical usage.

This article is devoted to the methodological issues of the application of artificial intelligence techniques in preventive medicine. We showed a specific example of the neural network application allows not only to diagnose cardiovascular diseases, but also on a quantitative basis to predict their emergence and development in future periods of life. This allows you to select the optimal strategy for the prevention and treatment of patients based on their individual parameters. The article concluded: recommendations for the prevention and treatment of cardiac patients should be given strictly individually, taking into account physiological peculiarities of the organism of patients. If for some patients it is useful to give up Smoking, limit the consumption of sweets, take drugs, reduce blood pressure, etc., for other patients, these recommendations may cause harm. Our intelligent system helps to identify such non-standard patients and to avoid incorrect recommendations. The prototype of the proposed system laid out in the «Projects» section on the website www.PermAi.ru.