Vol 9, No 8 (2023)

A number of studies have clearly demonstrated an increase in the effectiveness of therapy for a number of infectious diseases with the additional use of antioxidants as part of complex therapy.

The objective of the work is to assess the parameters of bioelectrical activity of the myocardium in patients with recurrent tonsillitis against the background of the introduction of ethylmethylhydroxypyridine succinate into complex therapy.

Material and methods. All patients were undergoing inpatient treatment in the infectious diseases hospital. ECG was recorded upon admission and discharge of patients. Patients were divided into two groups. Group 1 received standard basic therapy, group 2 was additionally prescribed ethylmethylhydroxypyridine succinate 5% 4,0 ml IV drip No. 5. The average, minimum, maximum duration of the P wave, PQ, QT intervals were assessed. The duration of QT, corrected by heart rate (QTc), dispersion of indicators DР, DРQ, DQT, DQTс were calculated. The results obtained were assessed depending on the preserved or reduced ejection fraction (EF) according to echocardioscopy.

Results and conclusion. Upon admission, the indicators QTc, DP, DPQ, DQT, DQTc exceeded those of healthy volunteers. By the time of discharge, in patients of group 1, the studied indicators remained at the same high level (with EF <55%) or even significantly increased (with EF >55%), despite the treatment. This proved the preservation of arrhythmogenic readiness of the myocardium. In patients of group 2, there was a decrease in indicators and achievement of the level of healthy volunteers, including patients with an initially reduced ejection fraction.

In modern clinical practice, the analysis of preventive therapy after recanalization of the femoral artery in patients with lower extremity arterial diseases (LEAD) caused by atherosclerotic lesions seems to be a pressing issue.

Objective: dynamic assessment of results after recanalization of the femoral artery and preventive therapy in patients with LEAD.

Material and methods. Long-term results of recanalization, risk factors, and adherence to an individual approach were studied in 30 patients after 3, 6 and 9 months.

Results. Most patients with LEAD have comorbid pathology and a combination of several risk factors (smoking, arterial hypertension, excess body weight, increased LDL levels). In 80% of patients with LEAD over 9 months of observation, there was no deterioration in the clinical picture achieved after revascularization. There was low adherence to preventive treatment, which decreased with increasing time after discharge from hospital. An important reason for non-compliance with recommendations is low patient awareness of the need for preventive therapy and the significance of risk factors for the prognosis of the disease.

Conclusion. There is significant unrealized potential in the treatment of patients with LEAD to improve outcomes after revascularization. There is a need to more strictly monitor the implementation of recommendations for secondary prevention of the disease and to increase patient awareness of the importance of smoking, excess body weight, achieving the target level of blood pressure and lipid spectrum indicators on the course and prognosis of the disease.

The presence of senile asthenia syndrome (SAS) and chronic heart failure (CHF) in patients with arterial hypertension (AH) makes adjustments to the tactics of antihypertensive therapy (AHT).

The aim: estimation of the efficacy of AH outpatient treatment in elderly patients depending on CHF and SAS presence.

Material and methods. 320 patients with arterial hypertension over 80 years of age were divided into 4 groups taking into account CHF and SAS presence: 1A – a group with AH, SAS and CHF (n=84); 1B – with AH and SAS without CHF (n=84); 2A – with hypertension and CHF without SAS (n=77); 2B – with AH without CHF and without SAS (n=75). The target level of systolic blood pressure (SBP) in patients with senile asthenia is 140–150 mmHg.

Results. Patients in group 1A were more likely to have no AHT and AH monotherapy (ACE inhibitors), as well as less frequent use of triple therapy. In «strong» patients (i.e., without SAS), combination therapy was more often used to treat hypertension. Thus, in group 2B, comparatively with 2A group, the frequency of two-component therapy was higher, and when compared with group 1B, not only two-, but also three-component therapy was registered in a higher percentage of cases. In the presence of SAS in patients with hypertension, the risk of hospitalization increased by 3.57 (p=0,0002), with CHF – by 4,39 (p <0,0001), and with a combination of CHF and SAS – by 7,26 times (p <0,0001).

Conclusion. The presence of CHF and SAS worsens the AHT efficacy in hypertensive patients over 80 years old, leading to a more frequent development of orthostatic hypotension and hospitalizations due to cardiovascular events.

Low doses of acetylsalicylic acid (ASA) are widely used to prevent preeclampsia and associated pregnancy complications. A common mechanism underlying these pregnancy complications is uteroplacental insufficiency. Since preeclampsia increases both morbidity and mortality, primary prevention is the main goal of optimizing both short-term and long-term health of mother and child. Secondary prevention in women with previous hypertensive disorders during pregnancy is also justified due to the increased risk of relapse during the next pregnancy. Despite the fact that the mechanism of influence of ASA is not definitively known, it is believed that it improves placentation due to its antithrombotic and vasodilating action, as well as restoring the imbalance of thromboxane and prostacyclin in endothelial cells. This review systematizes modern studies devoted to the study of the effect of ASA on the prevention of pregnancy complications from the standpoint of evidence-based medicine.

Improving of modern technologies for curation of patients with cardiovascular pathology, in particular use of antiplatelet agents, anticoagulants and their combinations, has made it possible to achieve a significant increase in life expectancy of the population. However, along with positive trends, taking antithrombotic and anticoagulant drugs is associated with an increased risk of damage of upper digestive tract mucous membrane, including formation of erosive and ulcerative defects and bleeding. Current review was prepared to systematize data on risk factors for the development of drug-induced gastropathy associated with use of antiplatelet agents and anticoagulants, about its main manifestations, including clinical, endoscopic and histological stigmas.

Current review presents the data of numerous studies on hyperammonemia (HA) performed over the past few years. As practice shows, the use of medicamentous therapy aimed at reducing elevated levels of ammonia in human organism, as well as relieving HA clinical manifestations, such as asthenia, fatigue, and hepatic encephalopathy, is becoming increasingly important. L-ornithine-L-aspartate currently plays a leading role in the treatment of this pathology. At the same time, active searches for new effective methods for treating HA are continuing.

Currently, due to the increasing life expectancy of the population and the aging of the population, an increase in the number of comorbid patients with ≥2 pathologies is observed in clinical practice. The presence of mutually aggravating diseases, chronic clinical course and specific manifestations of most of them complicate making diagnosis, adjusting further tactics for patient’s management and drug therapy selection. Article presents the history of the disease of an 88-year-old female patient who was urgently hospitalized with clinical manifestations of gastric bleeding from a newly diagnosed acute ulcer, development of severe posthemorrhagic anemia, complicated by acute anterior widespread myocardial infarction (type 2 according to ESC). The severity of her condition was aggravated by the long course of type 2 diabetes mellitus, diabetic polyneuropathy, angiopathy, and nephropathy. The complexity of diagnostic search, multidisciplinary approach to the management of a comorbid patient, teamwork of highly specialized specialists with the formation of a common opinion, as well as the development of treatment tactics with careful compliance to the requirements of rational pharmacotherapy are described.

About 2/3 of identified colorectal cancer (CRC) clinical cases in Russia occur in patients with stages III and IV of the disease, which leads to high mortality during the first year after diagnosis verification. Tendency towards an increase in morbidity in persons under 50 years of age determines the necessity of improving methods for timely CRC diagnosis, training medical staff in organizing screening examinations with identification of target groups of patients, and also the necessity of performing work concerning increase of awareness and motivation for population to undergo CRC screening. It is recommended to perform a two-stage screening - estimation of occult blood in the patient’s stool samples by immunochemical method, followed by endoscopic examination in case of a positive result. Screening test must be non-invasive, safe, easily accessible, convenient and inexpensive, and have high sensitivity and specificity. It should be remembered that CRC runs asymptomatically for a long time, and its late diagnosis is associated with the risk of an unfavorable outcome of the disease.

A serious problem in infectious diseases combating is the anti-vaccination movement. Especially important that becomes during periods of a pandemic, including COVID-19 one, when the prospects for its ending are closely connected with wide coverage of population by vaccination. Anti-vaccination movement is often caused by a decreased sense of danger among the population towards those infectious diseases that have become less common, and also by a lack of proper understanding of the fact that the reduction in infectious morbidity takes place largely due to vaccination, as, for example, in the cases of measles, diphtheria or poliomyelitis. Reluctance to get vaccinated may be caused by fear of possible side effects of vaccines and the negative role of some media personalities and bloggers who create anti-advertising for vaccinations. Work with the population by specialists in various fields with the support of government authorities, aimed at increasing medical literacy, can help to overcome the anti-vaccination movement and increase vaccination coverage among the population.

On September 30, 2023, a launch symposium of the Glenmark company was held in Moscow, dedicated to current issues in cough therapy. A separate thread of discussion at the event was the effectiveness and safety of the new drug combination ambroxol + guaifenesin + levosalbutamol in the treatment of acute bronchitis and productive cough.

Diabetes mellitus prevalence is increasing worldwide, followed by growing mortality from cardiovascular diseases. Antithrombotic therapy is a key component of pharmacological cardiovascular prevention for patients with diabetes. Patients with diabetes have enhanced thrombotic risk, attributed to chronic inflammation and hypercoagulable status. The aim of this review is to discuss current antithrombotic approaches in diabetes according to the latest guidelines and studies.

Chronic cerebral ischemia (CCI) is one of the most common neurological pathologies. Its development is influenced by many factors, among which arterial hypertension (AH) occupies a special place. CCI contributes to cognitive impairments manifestation, negatively affects life quality of patients and leads to motor and psychoemotional disorders. In terms of the treatment of this condition, an important role belongs to neuroprotectors and, in particular, to the use of ethylmethylhydroxypyridine succinate (drug Mexidol^®, Pharmasoft LLC, Russia), which has a multimodal effect and has confirmed its high efficacy in a large number of clinical studies. Evidentiary basis of ethylmethylhydroxypyridine succinate, obtained also in the MEMO study, indicates a particularly high efficacy of that medicine among CCI patients with hypertension: in them Mexidol^® significantly improves cognitive functions, reduces the level of anxiety and asthenia and improves the quality of life. Taking this into account, this drug can be recommended for use in complex therapy of CCI, especially in patients with arterial hypertension.

24 октября 2023 г. в возрасте 77 лет после долгой борьбы с тяжелым хроническим заболеванием ушел из жизни доктор медицинских наук, профессор, профессор кафедры внутренних болезней № 1 Ростовского государственного медицинского университета, заслуженный врач РФ, полномочный представитель РНМОТ в ЮФО Владимир Петрович Терентьев.