No 7-8 (2018)

Сложности рационального применения антибактериальных средств, совершенствование терапии жизненно важных пульмонологических заболеваний относятся и еще долго будут относиться к числу наиболее острых медицинских тем. Поэтому вполне объяснимо, что среди многообразных семинаров в рамках XIII Национального конгресса терапевтов большое внимание гостей привлек симпозиум «Лечение заболеваний нижних и верхних дыхательных путей: проблема резистентности и новые подходы в лечении астмы и ХОБЛ», организованный компанией ГлаксоСмитКляйн (GSK).

In the last decade, the initiation of interdisciplinary medicine has been taking place in order to study the borderline forms of pathology staying at the borderline of somatic and neurological disorders. In this regard, it is necessary to improve the knowledge and practical skills of doctors for the early detection of neurological disease and the prescription of timely treatment. The proposed article reflects the basic principles of neurological examination.

The review presents data on the etiology and pathogenesis of fibromyalgia, its clinical manifestations, current diagnostic criteria and recommendations for therapy based on the principles of evidence-based medicine. In the section, devoted to the treatment of the disease, both non-drug and drug methods with a high degree of evidence are considered in details. The proven effectiveness of multidisciplinary therapeutic programs suggests that the combination of medicamentous treatment, physical exercises and cognitive-behavioral component is the method of choice for treating all patients with fibromyalgia.

The article deals with the problem of pain syndromes in various neurological disorders: cervical dystonia, chronic migraine, myofascial pain syndrome, bruxism. It contains the data of clinical studies, as well as systematic reviews, justifying the effectiveness and safety of botulinum therapy for these diseases and conditions. Data on the antinociceptive action of type A botulinum neuroprotein are introduced, and new areas of its clinical application are indicated.

Article contains the characteristics of anxiety disorders from the standpoint of etiopathogenesis, classification, clinical features, pathomorphosis. The etiopathogenetic correlation between somatic diseases and anxiety disorders is shown. The necessity of complex approach to the treatment of anxiety disorders, which, in parallel with appropriate pharmacotherapy, includes a wide range of psychotherapeutic, physiotherapeutic and social rehabilitation measures, is grounded.

Vascular parkinsonism (VP) refers to secondary parkinsonism: it develops with the damage of subcorticat nuclei, white substance of the deeper regions of brain hemispheres and is more common in older age group individuals. In our country overdiagnosis of vascular parkinsonism is often taking place, because neurologists have a strong conviction that parkinsonism has vascular genesis. The difficulty of vascular parkinsonism diagnosing is associated with insufficiently developed criteria of diagnostics, as well as the medical care organization imperfection. Incorrect diagnosis leads to non-compliance with treatment standards. The aim of the study is to identify clinical signs causing diagnostical errors of vascular parkinsonism, also estimation of the quality of outpatient care for patients. Material and methods. In the course of the study, 162 patients with movement disorders with various neurological diagnoses were examined for the period from 01/16/2016 to 06/31/2018. Results. The diagnosis of vascular parkinsonism was established in 34 (21%) cases; in 128 (79%) patients the diagnosis is worked out in details. Common errors in the curation of patients with vascular parkinsonism include: overdiagnosis, irrational prescription of levodopa, unreasonable use of vasoactive and nootropic medicaments, hospitalizations. Conclusion. The results can serve as a provement for the organization and performing of educational programs for primary care physicians on the issues of rational diagnosis and treatment of vascular parkinsonism.

Scientific data of recent years confirm the efficacy of intraarticular injection of hyaluronic acid-based medicines in the treatment of primary and post-traumatic osteoarthritis (OA) of the knee joints (KJ). A number of clinical studies, including randomized ones, have demonstrated the anti-inflammatory and analgesic effects of intra-articular injections of sodium hyaluronate (GN). However, large-scale controlled clinical trials to assess the effectiveness and tolerability of GN in combination with chondroitin sulfate (CS) for intraarticular administration were not performed. Purpose of the study. Evaluation of the efficacy, tolerability and safety of intra-articular injections of the combined GN medicine and cholesterol in patients with primary and post-traumatic OA of KJ. Material and methods. The open controlled randomized single-center clinical trial included 142 patients with primary and / or post-traumatic OA of KJ. They were randomized into 2 groups using random numbers. The first (main) group included 72 patients who were on outpatient treatment and received a single intra-articular injection of the combined GN medicament and chondroitin sulfate (60/90 mg in a prefilled syringe of 3 ml) into the knee joint cavity. The comparison (control) group included 70 patients who received only the oral form of a symptomatic slow-acting medicine (chondroitin sulfate 1000 mg/ day) for 6 months. Results. When analyzing the total efficacy within 6 months after a single intrasynovial injection of GN in combination with chondroitin sulfate, an improvement or significant improvement was observed in 89% of patients of the 1st group. In the 2nd group, this figure was only 69%. In the 1st group, pain reduction was significantly more fixed on the visual analogue scale (VAS) and the total WOMAC index. Conclusion. GN in combination with chondroitin sulfate for intrasynovial injections is an effective and safe medicine for knee joint OA treatment. The medicine has excellent tolerability. A single intraarticular injection of it reliably reduces pain, morning stiffness and improves the functional activity of the joints for 6 months.

The purpose of the study is to assess the quality of thrombolytic therapy (TLT) in acute coronary syndrome with ST-segment elevation (OCCPST) at prehospital stage over 5 years dynamics. Material and methods. A retrospective study of patients with acute coronary syndrome with ST-segment elevation who applied for emergency medical care (SMP) at the ambulance station municipal budgetary institution of Yekaterinburg and received TLT with tenecteplase medicine at pre-hospital stage during 2013-2017 was made. Study group included 753 persons, the average age of patients was 57.3 ± 11.8 years. All acute coronary syndrome patients with ST-segment elevation were hospitalized in specialized hospitals with round-clock possibility of invasive treatment methods, each patient got medical aid according to the existing standards of the emergency medical system, clinical protocols and the professional standard "Ambulance physician". The quality of prehospital TLT was determined by a patented method that includes a complex estimation of such indexes as rationality, effectiveness, safety, timeliness of therapy, legal correctness of filling in documentation, accessibility, qualifications of medical personnel and patient satisfaction. Results. All indicators of TLT in case of acute coronary syndrome at pre-hospital stage have improved over the years of observation, due to the accumulated experience of the ambulance doctors and educational activities, as well as due to the appearance of emergence standards and clinical protocols (recommendations) for providing the emergency medical care to the population. Conclusion. The proposed by the authors indicators of prehospital TLT quality in case of acute coronary syndrome with ST-segment elevation can be taken as a basis for estimation the prehospital thrombolysis quality by an expert of any level.

The problem of primary immunodeficiency (PID) in adults becomes more and more important in recent years, as the number of such kind of patients over 18 years of age has been steadily increasing; the number of them amounts to 30-40% of PID registers in different countries. Due to low awareness of this group of diseases, they are characterized by low detectability and late diagnosis. The article discusses the most common forms of PID which are character for persons over 18 years old, also the actual aspects of clinic, diagnosis and treatment are represented.

A modern doctor faces a huge number of similar or overlapping sympthoms and syndromes that comprise a disease pattern and need a thorough differential-diagnostic approach while diagnosis verification. In this connection a mixed connective tissue disease (MCTD) takes pride of place. Sharp's syndrome is an autoimmune mixed connective tissue disease which is characterized by the presence of separate symptoms of systemic lupus erythematosus (SLE), systemic sclerosis (SSc), polymyositis (PM) and rheumatoid arthritis (RA), in combination with a high titer of anti-U 1 ribonucleoprotein (RNP) antibodies. As a rule the prognosis of Sharp's syndrome is favourable and a clinical remission is possible. However the presence of pulmonary hypertension, renal damage and severe Raynaud's syndrome causes worse prognosis, which is described in the below mentioned clinical event.