Репозиторий Университета

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. In the clinical practice a physician quite often is at a loss due to “freedom of choice” granted by availability of direct oral anticoagulants (DOAC). If a patient with nonvalvular atrial fibrillation (AF) has indications for therapy with anticoagulants which DOAC should be preferred? What are benefits for a patient with ischemic heart disease and AF when definite NOAC is chosen and what are risks inherent of this choice? Answers to such questions are given in this paper.

The article analyzes the anatomy, morphological and neurochemical connections and functions of the brain histaminergic system, one of the leading systems in the mechanism maintaining wakefulness. The possibilities of histaminergic system modulating for the treatment of various sleep/wake cycle disorders are discussed. The data of clinical trials on the influence of the histamine H1 receptor antagonist doxylamine on sleep in healthy volunteers and patients with insomnia are considered. The evidence-based efficacy of the drug in sleep disorders is discussed.

Narcolepsy is a hardly known and obscure disease for Russian doctors while the first description and studying of the disease in Russia occurred almost simultaneously with the rest of the world. The contribution of Russian neurology in the studying of narcolepsy remains underestimated, especially in identifying the clinical features (A. Vein's 'narcoleptic pentad'), the concept of the pathogenesis (hypothalamic syndrome), the determination of provoking factors (postinfectious, postvaccinal reacions) and the use of effective medications (sodium oxybate).

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Background: Literature data on hepcidin (H) level - the main regulator of systemic iron homeostasis in patients with chronic heart failure (CHF) - are contradictory. Relationships of H with markers of inflammation elevated level of which is characteristic of CHF are insufficiently studied. The latter problem remains practically unexplored in elderly and very old patients with CHF. Aim: to study the role of H in formation of anemia of chronic disease (ACD) and iron deficiency anemia (IDA) in elderly and very old patients with CHF. Material and methods: We examined 65 elderly and very old patients with ischemic heart disease (IHD) (35 with CHF and ACD, 10 with CHF and IDA, 20 without CHF, ACD, and IDA [control group]). H level in blood serum was measured using competitive solid-phase immunoenzyme assay. Results and discussion: In patients with CHF and ACD mean H levels were significantly high relative to those in patients with CHF and IDA, while in the latter group H levels were insignificantly low relative to those in patients of control group. High H level, high level of inflammatory tests as well as positive correlations between them, and negative correlation between H and hemoglobin (Hb) are indicative of inflammation as a cause of H level elevation, which in turn facilitates development of anemia in elderly and very old patients with CHF and ACD. Low H level, normal levels of inflammatory tests, absence of links between them, as well as absence of correlation between H and Hb are indicative of lack of H role in development of anemia in these patients with CHF and IDA. We did not study influence on development of anemia of each of possible causes (inflammation, decompensation of CHF) separately, therefore contribution of each of them is unknown. The data obtained also do not exclude effect of other not investigated in this work and presently unknown factors. Received by us data indicate to necessity of precise identification of origin of anemia in every case in an elderly or very old patient with CHF with the aim of elimination of its cause and conduct of pathogenetically valid therapy.

The most frequent among the symptoms and syndromes, which are comorbid to panic disorder, are sleep disorders, primarily, insomnia, persisting in 60-80% of patients in this category. Panic disorder and insomnia have bilateral relationships. On one hand, there is a clear correlation between disease severity and accompanying sleep disorders. On the other, the conditionality of sleep disturbances with pathological anxiety has been demonstrated. Treatment of insomnia in panic disorder includes a set of measures aimed at harmonizing the emotional state and stopping insomnia as a syndrome. A comprehensive approach, which includes, along with adequate pharmacotherapy, a wide range of methods of psychotherapeutic treatment, is the key for the success of therapy for sleep disturbances in panic disorder.

Physiology of breathing during sleep predisposes to the development or worsening of the respiratory disorders in patients with chronic obstructive pulmonary disease (COPD) even if waking respiratory function remains relatively normal. Physicians, who assess patient's state only during the day, in some cases can underestimate this problem. Respiratory abnormalities can provoke insomnia, which additionally affects patient's quality of life. Supplemental oxygen and pressure support ventilation improve blood gases during sleep, but in many cases, insomnia persists. In many cases, such patients need the treatment with hypnotics. Widely used drugs in insomnia are benzodiazepines. They are rather effective but can cause respiratory depression and respiratory failure in patients with COPD. Z-hypnotics are comparable to classical benzodiazepines but much more safe and rarely worsen respiratory parameters. Melatonin and melatonin receptor agonists, antihistamines, antidepressants and neuroleptics can be effective in some patients with insomnia, but insufficient data about their safety in case of respiratory pathology restrict the use of these drugs in patients with COPD. The orexin receptor antagonist suvorexant is a novel hypnotic with the potential benefits for patients with COPD because it strongly improves sleep but does not depress respiration and has a minimal negative impact on daytime cognitive function.

Symptoms of sleep disruption are widely prevalent in general population, but they are not necessarily form the full clinical presentation of insomnia. Diagnostic process should consider somatic diseases usually accompanied by sleep disruption. This review presents the data on insomnia symptoms in gynecological diseases: menstrual cycle related disorders, endometriosis, peri- and postmenopausal symptoms.

AIM: To clarify the indications for reconstructive surgery in patients with diaphragmatic hernia. MATERIAL AND METHODS: Retrospective trial has included 36 patients with diaphragmatic hernia for the period 1963-2017. There were 23 (63.9%) women and 13 (36.1%) men. The majority of patients (83%) underwent surgery at able-bodied age (18-60 years). 27 (75%) patients had hernia of weak diaphragmatic zones, 9 (25%) - posttraumatic hernia. Diaphragm repair was performed with primary suture. In 2 cases of posttraumatic hernia mesh endoprosthesis was used. RESULTS: All patients were discharged. Postoperative complications arose in 4 (11.1%) patients, including 2 cases of mesh endoprosthesis deployment. Long-term outcome was followed-up in 15 patients from 6 months to 17 years. Recurrent hernia was absent in all cases. CONCLUSION: Primary suture is acceptable for diaphragmatic hernia repair. Alloplastic repair is indicated for large defect, when primary suture is impossible or risk of its failure is high.

© Ruslania 2018. All rights reserved. Drug toxidermia is one of the most common skin diseases. Traditional therapy of drug toxidermia, which includes antihistamines and desensitizing agents, cannot stop manifestations of the pathological process in many cases, while the forced appointment of systemic glucocorticoids can lead to the development of un-desired complications. The review gives a detailed description of various mechanisms of drug toxidermia and provides information about the development of tests to identify patients with increased risk of drug toxidermia.

© 2018, Silicea-Poligraf. All rights reserved. The current population is characterized by a high prevalence of risk factors for the development of chronic kidney disease: hypertension, diabetes, obesity, metabolic syndrome, physical inactivity, smoking. The development of severe complications and a close connection with potentially fatal cardiovascular disorders make this disease a socially and economically significant problem. Treatment of chronic kidney disease in advanced stages belong to nephrologist duties. However, the success of preventive interventions depends on the time of their onset, which makes it relevant to identify the disease. The use of nephroprotective approaches by physicians of different specialties (general practitioners, cardiologists, gerontologists, nephrologists, endocrinologists) can significantly improve the prognosis of both those at risk of developing renal dysfunction and the existing disease. The review presents data on the clinical and laboratory efficacy of angiotensin-renin blocker use, as well as the combination of angiotensin II receptor blockers with calcium antagonists. Using the combination of the angiotensin II receptor blocker irbesartan and amlodipine as an example, we demonstrated the possibilities of nephroprotective therapy in patients with renal dysfunction.

© 2018 EBSCO Information Services. Background. Reported levels of hepcidin, the major regulator of systemic iron homeostasis in CHF patients, are controversial. Relationship of hepcidin with inflammation markers, which are typically increased in CHF, is understudied; this issue is practically unstudied in old and older CHF patients. Aim. To study the role of hepcidin in development of anemia of chronic disease (ACD) and the association of hepcidin with inflammation in old and older CHF patients. Materials and methods. Ninety old and older patients with IHD were evaluated. 35 of these patients had CHF and ACD and 35 patients had CHF without ACD. The control group (CG) consisted of 20 IHD patients without CHF and ACD. Serum concentration of hepcidin was measured using ELISA by the competitive binding principle. Results. Patients with severe, congestive FC IV CHF prevailed among CHF patients with ACD, and their CHF was characterized with longer duration, more frequent hospitalizations, and lower compliance with the treatment. Significantly higher mean levels of hepcidin, C-reactive protein (CRP), erythrocyte sedimentation rate, and insignificantly higher levels of ferritin were observed in CHF patients with than without ACD. The high hepcidin, indexes of inflammation tests, and a significant positive correlation of hepcidin with hemoglobin levels suggested inflammation as a cause for the increased hepcidin, which induced anemia in old and older CHF patients with ACD.

© 2018, Dynasty Publishing House. All rights reserved. This review analyzes the role of viral miRNAs produced by representatives of the Herpesviridae subfamilies (including Alphaherpesvirinae, Betaherpesvirinae, and Gammaherpesvirinae) in the development of herpesvirus infection. In all three subfamilies, microRNAs are involved in the regulation of latency, i.e. transition of lytic to latent infection. In CMV and HHV-8, miRNAs play an important role in escaping innate immunity. Moreover, viral miRNAs can be transferred to non-infected cells via exosomes.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Objective: to study potantial of remote ischemic preconditioning (RIP) as method of cardioprotection during coronary artery bypass surgery with cardiopulmonary bypass (CPB) and anesthesia with propofol. Materials and methods. We included in this study 87 patients (7 were excluded) with ischemic heart disease, hospitalized in the clinic of aortic and cardiovascular surgery of the I. M. Sechenov First Moscow State Medical University clinical hospital № 1. All patients had indications for direct myocardial revascularization by coronary artery bypass surgery. One day before operation patients were randomly assigned to 2 groups depending on preparation scheme: main group of RIP and the control group. The frequency of complications during surgery and in the postoperative period was assessed. Troponin I level was measured before, and in 2 and 24 hours after surgery. The level of lactate in the venous blood was measured before and after surgery. Results. Numbers of intraoperative and early postoperative complications in the main and control groups were similar. There were no differences between groups in troponin I and lactate levels after surgery. Conclusions. Remote ischemic preconditioning has no effect on the outcome of coronary artery bypass surgery with cardiopulmonary bypass and anesthesia with propofol.

© 2018, Dynasty Publishing House. All rights reserved. Objective: to assess parents’ attitude toward vaccines and the degree of their awareness about vaccination using a specially designed questionnaire. Materials and methods. We conducted an anonymous survey of 360 parents who stayed in a hospital to take care of their children. The questionnaire included 34 questions on parents' awareness about vaccination and their general attitude toward vaccines. Results. Our survey demonstrated that 282 children were partly or fully vaccinated, whereas 78 children were not vaccinated. A total of 79% of parents believe that vaccination is the most effective method of preventing infectious diseases. The majority of parents (80%) understand that vaccinated children are less likely to develop severe illness than those who have not been vaccinated. Almost two-thirds of parents (60%) responded that they would like to expand their knowledge on immunization and believe that measures taken to inform people about vaccines are insufficient. Results. Our findings suggest that the majority of parents have a generally positive attitude toward vaccination. However, our respondents demonstrated lack of awareness about vaccines. Therefore, educational events should be planned to raise awareness about vaccination among parents.

© 2018 Stavropol State Medical University. All Rights Reserved. Diverticular colon disease, taking into account the increase in the proportion of older people in the total population of the planet, is one of the most important problems of modern health care, due to the need for constant monitoring of patients due to the possible development of complications such as diverticulitis, perforation, bleeding and malignancy. From these positions, it becomes relevant to develop early prognostic criteria for the severity of the diverticular colon disease based on the study of the main indicators of proliferation, such as Kisspeptin (KiSS1), p53, chromogranin-A (CgA).

Chronic obstructive pulmonary disease (COPD) is one of the main causes of disease and death incidences worldwide. Different organs and systems are involved in COPD activating tissue hypoxia. It affects especially tissue functioning with the high level of intensity of metabolic processes, and the nervous system suffers first. Neuroimaging studies show white and grey matter damage and cerebral atrophy, which may clinically manifest themselves in different neurological symptoms depended on vascular system lesions, and cognitive and affective impairments. Despite of its potential importance, encephalopathy in COPD remains a little-studied concomitant pathology. Application of cytoprotective drugs is pathogenetically justified in this case and must be included in COPD complex therapy. In particular, the inclusion of mexicor in the treatment of patients with chronic pulmonary heart increases the efficacy of treatment of the main and associated diseases (chronic cerebral ischemia, cardiac insufficiency and arrhythmia).

Under the modern market conditions, the process of development of the methods for the combined rehabilitation of the patients is becoming increasingly more complicated. For the reduction of potential risks and leveling the factors responsible for the uncertain market situation influencing the creation of new methods, it is necessary to carry out the full-scale pilot studies with the use of the marketing analysis methods. The objective of the present work was to create and elaborate the rationale for the graphological structure (the scheme) of the process of exploratory research with a view to the development of the combined rehabilitation methods as exemplified by phyto- and physiotherapeutic modalities. The work is based on the application of the existing approaches to the structural, comparative, systemic, and situational analyses. The proposed graphological structure (scheme) of the exploratory research process consists of 6 stages. Its distinctive features are as follows: a fractional stage by stage evaluation of a variety of issues including the study of physical factors, characteristic of the means of herbal medicine with special reference to the mechanisms of their production and application under the current market conditions, monitoring the marketing environment with the constant focus on the trends and behavior of the target market, the parallel pursuing of serial studies with the application of the iterative procedures; the use of the previously created data bank to expand medical services at the stages of development and maturation of the life cycle, the evaluation of the possibility of establishment of the industry of parapharmaceutical products.

© 2018 Ima-Press Publishing House. All Rights Reserved. Information about a favorable prognosis for a patient, recommendations for activities, and optimal pharmacotherapy are a mainstay in the effective treatment of acute nonspecific low back pain (NLBP). Standard pharmacotherapy for acute NLBP includes nonsteroidal anti-inflam-matory drugs (NSAIDs). However, the longer their administration and larger doses, the higher the risk of side effects are. NSAIDs are contraindicated in some cases. In this connection, it has become necessary to search for new opportunities for the pharmacotherapy of acute NLBP. The results of experimental studies have demonstrated the analgesic and anti-inflammatory effects of high-dose B vitamins. Clinical trials have confirmed the efficacy of Vitamin B complex (thiamine, pyridoxine, and cyanocoba lamin) in the treatment of acute NLBP. The paper considers the practical significance of concomitant administration ofB vitamins and NSAIDs in NLBP and notes the efficacy of milgamma used both alone and in combination with NSAIDs in the treatment of acute NLBP.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. A special place among liver diseases is occupied by various tumors and tumor-like lesions. In recent years in clinical practice the possibilities of correct diagnosis have increased significantly as a result of the introduction of advanced diagnostic equipment and wide usage of various contrast agents at studies of the abdominal cavity using the ultrasound method (US), multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). In addition, the differential diagnosis of benign and malignant lesions has been simplified even when the size of the lesions is less than 1 cm. This scientific review describes the capabilities of the "routine" method of the liver diagnostics – US, as well as the latest techniques that are being introduced into the modern practice such as: US with intravenous contrast enhancement, US elastography and perfusion CT and MRI. The advantages of each method are presented as well as the limitations of their use in clinical practice.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Thiscreatic Featuresarticlehead, ofpresentsthisthat clinicalwas theoperated clinicalcase arecasetwice, difficultiesofbut patientfirst in pre-withoperation andneuroendocrineintraoperativedid not lead tumortopicalto recovery. ofdiag-pan-nosis of small size insulinoma. The authors came to the conclusion that topical diagnostics should be complex.