Репозиторий Университета

© 2018, Dynasty Publishing House. All rights reserved. At present the incidence rates of urogenital chlamydiosis maintain the leading positions among sexually transmitted infections. Special attention to this infection is conditioned by a high risk for development of complications on the part of the reproductive system in both women and men. The ability of Chlamydia to affect various tissues accounts for a broad spectrum of clinical manifestations of urogenital pathologies: urethritis, vulvovaginitis, cervicitis, endometritis, salpingitis, epididymitis, prostatitis, proctitis, and also extragenital forms of disease. Taking into account a possibility of transition of Chlamydia infection into a latent stage with subsequent development of a chronic persisting course, early and adequate management of infection is of considerable importance. Etiotropic therapy of Chlamydia infection employs antibacterial drugs capable of penetrating into cells. Tetracycline antibiotics are the most effective drugs of choice administered as part of complex therapy. Minolexin is a tetracycline antibiotic that demonstrates the best effectiveness in the fight against infectious agents affecting the urogenital tract. The article presents the author’s clinical experience of using minolexin for management of urogenital chlamydiosis in 60 patients.

© 2018 Cardiovascular Therapy and Prevention. Modern appropriate treatment of hypertension involves the use of combination antihypertensive therapy. According to updated version of European Society of Cardiology 2018 guidelines, renin-angiotensinaldosterone system blockers must be used as first-line drugs, including in combination with hydrochlorothiazide. This article presents the algorithms for the management of patients with uncomplicated and asymptomatic (with target lesions) arterial hypertension. It also described the management of patients with concomitant cardiovascular, cerebrovascular, renal pathology and diabetes mellitus, and use of fixed combination of candesartan and hydrochlorothiazide. The article presents research data that confirmed not only the high antihypertensive efficacy of this combination, but also demonstrated its neutral metabolic profile, organ-protective effects, the ability to use in patients with chronic kidney disease, chronic heart failure, prior stroke, as well as high tolerability and treatment adherence.

BACKGROUND: The relevance of this ensues from the fact that despite the numerous currently available health promotion training programs for the reduction of body weight, there is still the need for the development of the new forms of the efficacious physical training programs and the methods of motivation for compliance with them among the people of different age, sex and social status. AIM: The objective of the present study was to determine the role of motivational factors, including the assessment of the biological age, in the improvement of the effectiveness of the health promotion training programs for the reduction of the excess body weight. MATERIAL AND METHODS: A total of 82 students with overweight and first-degree obesity at the age from 17 to 21 years (average age 18.5±1.4 years) were examined. 42 girls included in the first (main) group spent 9 months performing health promotion training programs on an individual basis developed taking into consideration the motivational factors. The physical training programs included the aerobic exercise in the form of dance classes. 40 students in the control group were engaged in physical training envisaged by the academic curriculum of the university. The third group (the group of comparison) was comprised of 36 practically healthy girls having the normal body weight. We studied the components of the body composition with the use of bioimpedanceometry, evaluated the physical working capacity (the PWC-170 test) and the adaptive reserves of the body (heart rate variability test as proposed by R.M. Baevskyi, Garkavi test). In addition, the psycho-emotional status of the participants was estimated making use of the Lusher test and SAN. The biological age was determined by the original method based on the combination of the morphological and functional indices. RESULTS: The excess body weight in the students comprising group 1 was reduced by 10% on the average; simultaneously the physical working capacity among these students increased by an average of 24.5% while the level of emotional stability and self-esteem increased by 20% and 24%, respectively. We also documented a decrease in the initially increased biological age by 5 years on the average. The students included in group II did not experience any significant changes in the parameters of interest. CONCLUSION: The consideration of the motivational factors for the development of the training programs designed to promote the reduction of the excessive body weight significantly increases their effectiveness, as evidenced by the improvement of the morpho-functional and psychological characteristics in the students of the first group and its absence in their counterparts included in group II.

© 2018 Inderscience Enterprises Ltd. Increase in academic performance of medical universities' students is one of the most significant tasks of the modern education and healthcare systems as a factor contributing to high quality of the future doctors' qualification. Increased level of anxiety and depression negatively correlate with the level of the students' academic performance. Such a method of physiotherapy as mesodiencephalic modulation takes a stabilising effect on psychoemotional state of a person. The paper contains the analysis of emotional state of the students from the Faculty of Dentistry, defines the level of anxiety and depression, and notes their correlational interconnection with the level of academic performance in their study. The authors have practically stated positive influence of the mesodiencephalic modulation sessions on psychoemotional state of the students and indirectly on the level of their educational academic performance.

© 2018 by the authors; licensee Modestum Ltd., UK. Objective: A considerable proportion of the population due to both economic reasons and traditions appear to be experiencing chronic deficit in micronutrients, which may be deteriorated on the background of drug therapy being performed. The purpose of our study was to optimize pharmacotherapy of patients with first-ever prescribed diuretic-containing combined therapy for arterial hypertension (AH) by means of adding a vitamin-mineral complex. Method: To determine B-group vitamins (thiamine, riboflavin, pyridoxine) in blood plasma by means of high-performance liquid chromatography (HPLC) and, on achieving the target values of arterial pressure (AP), to analyse the patients’ quality of life by means of such neuropsychological tests as the General Health Questionnaire – 36 (GHQ-36) and WAM (wellbeing, activity, mood) questionnaire. Results: The group of patients receiving antihypertensive therapy alone demonstrated a decrease in blood plasma thiamine, riboflavin and pyridoxine from 34.5±4.2 to 25.4±3.2 ng/ml (p<0.05), from 11.3±1.5 to 7.8±1.1 ng/ml (p<0.05) and from 13.4±1.5 to 9.1±1.3 ng ng/ml, respectively. In patients receiving the vitamin-mineral complex additionally to drug therapy of AH, no significant alterations in the content of micronutrients in blood plasma were revealed. We noted more pronounced dynamics in the scores by the GHQ-36 and a more pronounced increase in the patients’ activity by the WAM test, amounting to 28,9 Δ % and 15.51 Δ %, respectively (p<0.05). Conclusion: Supplementing antihypertensive pharmacotherapy with a vitamin-mineral complex makes it possible not only to maintain the level of micronutrients at the level of the physiological requirements but to improve the patients’ quality of life as assessed by neuropsychological scales.

© 2018 by the authors; licensee Modestum Ltd., UK. Objective: High prevalence of ischemic heart disease (IHD) is currently both of medical and social concern, thus requiring treatment with drugs capable of influencing not only the prognosis of the disease but also quality of life of patients. This study was undertaken to investigate the possibilities of antianginal therapy with nicorandil and isosorbide dinitrate in order to improve quality of life of patients with stable angina pectoris. Method: The authors carried out a comprehensive examination of a total of eighty-four 44-to-76-year-old patients suffering from IHD with functional class 2-3 stable angina of effort and followed up in ambulatory settings. The patients were randomized into two groups of treatment to receive either nicorandil or isosorbide dinitrate as antianginal agents added to basic therapy. The groups of patients did not significantly differ by anamnestic and demographic characteristics. The duration of follow up amounted to 24 months. We determined the physical and mental components of health-related quality of life and their dynamics on the background of antianginal therapy with nicorandil and isosorbide dinitrate. The parameters of quality of life were evaluated by the findings of two screening tools: the General Health Questionnaire (GHQ-28) and Seattle Angina Questionnaire (SAQ). Results: The findings obtained within the timeframe of the study demonstrated that patients suffering from FC 2-3 stable angina of effort and taking standard therapy with beta-adrenoblokers, calcium antagonists, and antiplatelet drugs were found to have a decrease in their quality of life. The lowest scores were observed by the scales reflecting the psychological component of health, whereas the scores of physical limitation, angina stability, and angina frequency were considerably better. After 24 weeks of treatment with nicorandil and isosorbide dinitrate, the patients of both groups were found to have significantly improved scores for quality of life assessed by the SAQ on all scales. Initially high scores by the GHQ characterizing the patient’s psychological discomfort were revealed in both groups of patients, with no statistically significant differences between the groups. The highest score was revealed by the scales of somatic symptoms and social dysfunction in both the nicorandil group (11.8 and 13.2 points, respectively) and isosorbide dinitrate group (12.1 and 13.5 points, respectively). The mentioned alterations underline the significance of such disease as IHD in adaptation of the patient to the social environment. Angina attacks, physical limitations lead to deterioration of the emotional state and interfere with daily activity. High scores by the scales of anxiety and depression suggested a low level of mental health of IHD patients with stable angina pectoris. After 24 months of treatment, manifestations of anxiety and depression in patients of both groups significantly decreased (with the results comparable in both groups), with clear advantage in the nicorandil group. Conclusion: Nicorandil turned out to be superior to isosorbide dinitrate in improvement of physical and psychological components of quality of life of patients with stable angina of effort.

© 2018 Media Sphera Publishing Group. All rights reserved. Development and use of new anticancer drugs has resulted in the improving of 5-year survival rates in patients with cancer. However, many of the modern chemotherapies are associated with cardiovascular toxicities that increases cardiovascular risk in cancer patients, including hypertension, heart failure, thrombosis and thromboembolism, cardiomyopathy, and arrhythmias. These side effects limitation restrict treatment options and farther perspectives. With increasing use of modern chemotherapies and prolongation of the cancer patients survival, the incidence of cardiovascular disease in this patient population will continue to increase. Accordingly,careful assessment and management of cardiovascular risk factors in cancer patients by oncologists and cardiologists working together is essential for optimal care.

© 2018 Media Sphera Publishing Group.All Rights Reserved. The goal is to present the possibilities of diagnosis verification, the features of the clinical picture of tuberculous pericarditis in the therapeutic clinic and the results of its treatment. Materials and methods. The paper presents clinical observation and a general analysis of 10 cases of tuberculous pericarditis in patients aged 31-79 (mean age 58.0 ± 15.1 years), 6 women and 4 men. Diagnostic puncture pericardium was performed on two patients, pleural puncture - on three Thoracoscopic biopsy of hilar lymph nodes and lung (n=1), pleura (n=1), supraclavicular lymph node biopsy (n=1). Dyskin test was carried out, as well as sputum examination, multispiral computed tomography, oncological search. Results. A 31-year-old patient with a massive effusion in the pericardial cavity, pleural lesion, arthritis of the left knee joint, whose results of the pericardial effusion and sputum were not diagnosed, tuberculosis was detected only with thoracoscopic biopsy of the lung and intrathoracic lymph nodes; the treatment via prednisolone and subtotal pericardectomy was performed. Among 10 patients with MSCT of the lung, changes were noted in general, but in only one case they were highly specific. Diaskin test is positive in 70%. In the study of punctata, bronchoalveolar flushing, Koch bacteria were not detected; at sputum in microscopy and biological sample BC was detected in two patients. The lymphocytic character of effusion in the pericardium / pleura is noted in 4 out of 5 cases. At a biopsy of lymphonoduses and a lung at 2 patients the picture of a granulomatous inflammation with a caseous necrosis. Pericarditis was predominantly large (from 2 cm and more) effusion, signs of constriction were noted in 50% of patients. Conclusion. Tuberculosis is one of the frequent causes of pericarditis in the Moscow therapeutic clinic. The most lymphocytic effusion with fibrin and the development of constriction. The negative results of all laboratory tests for tuberculosis do not exclude a diagnosis, It is necessary to use invasive morphological diagnostics, including thoracoscopic biopsy.

© Bionika Media Ltd. The author has carried out a systems analysis of the data available in the current literature on the participation of vitamin D in the physiology of bone metabolism, the pathogenesis of osteoporosis, and the possibilities of osteoporosis therapy with active vitamin D metabolites. The paper describes the mechanisms of vitamin D participation in the processes of bone metabolism and calcium homeostasis. It presents the effects of vitamin D on connective and muscle tissues. Its deficiency is shown to play a role in the pathogenesis of osteoporosis and in the increased risk of low-trauma fractures. There are clinical trial findings that confirm the possibility of using active vitamin D metabolites for the therapy of osteoporosis and for the prevention of low-trauma fractures. Active vitamin D metabolites used alone or in combination with antiresorptive therapy for osteoporosis is an effective measure to prevent low-trauma fractures and can be prescribed for menopausal osteoporosis.

© 2018, Media Sphera Publishing Group. All rights reserved. Venous surgery prescribed to the patients receiving anticoagulation therapy for the treatment of atrial fibrillation especially with the use of warfarin is considered to constitute a serious challenge due to the increased risk of the development of venous thromboembolism and other hemorrhagic complications in case of withdrawal of the anticoagulant. A clinical case of successful perioperative management of the patient with varicose veins with the use of long-term warfarin therapy for the management of atrial fibrillation is presented. Several surgical clinics refused to treat the patient on a regular basis on the ground of impracticability of any invasive procedures because of the patient’s condition taking into consideration the involuntary intake of the anticoagulation agent and the concomitant cardiac pathology. We performed the primary clinical examination and duplex ultrasound study of the patient who was found to have varicose veins in right lower extremity (С2, 3S, Ер, Аs, p, Pr2,18, LII) with the international normalized ratio (INR) being 3,64. We confirmed the indication for the surgical treatment and offered the patient high ligation, stripping and phlebectomy. Prior to surgery, the patient was switched to a subcutaneous injection of enoxaparin. After reducing INR down to less the 2.0, we performed surgery under spinal anesthesia. The anticoagulation treatment was restarted 12 hours after the operation. No complications was documented within the first weeks after the intervention. The patient was switched back to warfarin therapy.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The right drug at the right dose administered to a patient in time is the goal which all medical specialists aim at when prescribing medicines to patients. Pregnancy is a condition when the principle of personalized pharmacotherapy is especially relevant. Due to the developing fetus and the occurring changes in the maternal organism, the selection of drug therapy during pregnancy is especially difficult for a clinician. This issue is tightly intertwined with clinical pharmacogenetics since the genetic code of a woman that determines the activity of the liver cytochrome, the fetus-placental barrier, and renal clearance contributes to the peculiarities of the drug metabolism during pregnancy. Additional data provides the opportunities to form therapeutic models and to determine the ways of personifying pharmacotherapy in pregnancy. The purpose of this review is to summarize the available data on the pharmacogenetics of antihypertensive drugs used during pregnancy.

© 2018 Media Sphera Publishing Group. All rights reserved. Pharmacotherapy of resistant arterial hypertension represents a serious problem, because today there are no clear algorithms of action in this clinical situation. The review discusses the key works in which the authors propose a solution to this problem. The variants of a differentiated approach to treatment based on hemodynamic type, plasma renin activity, as well as a number of empirical strategies, including the predominant use of mineralocorticoid receptor antagonists, are discussed.

© 2018, Media Sphera Publishing Group. All Rights Reserved. Objective. To develop therapeutic programs for treatment of depression with panic attacks on the basis of their clinical and psychopathological features. Material and methods. A total of 100 in-and outpatients, aged from 18 to 60 years, with depression of mild and moderate severity with panic attacks were studied. The investigation was carried out using clinical, psychopathological and psychometric (the Atypical Depression Diagnostic Scale (ADDS), the Montgomery—Asberg Depression Rating Scales (MADRS), and the Sheehan Anxiety Rating Scale (ShARS)) methods. The patients were assessed on admission, on the 1st, 2nd, 4th and 8th weeks with subsequent processing and defining standard indicators. Three therapeutic groups were formed: the 1st group received therapy combining an antidepressant and a tranquilizer; the 2nd group an antidepressant, a tranquilizer and a mood stabilizer; and the 3rd group an antidepressant, a tranquilizer and an antipsychotic agent. The time course of expression of the signs of depression, anxiety and frequency of panic attacks was analyzed. Results. The highest efficacy in the form of reduced signs of depression and anxiety was observed in the 3rd group on the 1st week of therapy. No significant differences in reduction of depression and anxiety were found between the 1st and 2nd groups. In the 1st therapeutic group, there was an increase in the frequency of panic attacks together with the reduction in their expression and decrease in the severity of depression as compared to the 2nd and 3rd groups. At the same time the 3rd therapeutic group was characterized by a maximally expressed decrease in the frequency of panic attacks already on the 1st week of therapy. Conclusion. The study has shown that the use of antipsychotic drugs in addition to therapy with antidepressants and tranquilizers is the most effective way to stop depression.

© 2018 Dynasty Publishing House. All rights reserved. The objective: To study the effectiveness and long-term outcomes of sclerotherapy for ovarian endometriomas and to substantiate the conditions and indications for minimally invasive intervention. Patients and methods: We analysed 124 interventions performed by the technique of aspiration (sclerosing) therapy of endometrioid ovarian cysts. The patients' age varied from 18 to 42 years, averaging 26.4 ± 4.2 years. The mean diameter of ovarian endomeriomas varied from 25 to 65 mm. In 84 (67.7%) of observations, pathological process was unilateral, in 72.3% - bilateral. 43 (34.6%) women had disease recurrence after previously performed cystectomy, in 28 (22.6%) endometrioid cysts were located in the only ovary and in 7 (5.6%) patients ultrasonography found that the ovary contralateral to endometrioid tumour was sharply decreased and its sections lacked the signs of antral follicles after preceding cystectomy. In fact, in 35 (28.2%) patients endometrioma was diagnosed in the only ovary. All patients after aspiration therapy of endometriomas received dienogest (2 mg) + ethinylestradiol (0.03 mg) (Siluette®, «Gedeon Richter»). Results: The recurrence rate of endometriomas during the first 12 months of follow-up was 38.7%, during the first 3 months of follow-up this parameter did not exceed 9.7%. Within 7-12 months after intervention spontaneous pregnancy occurred in 36.3% (46) of women, ending with childbirth in all cases (with the use of contraception 25 patients - 46%). Conclusion: Sclerotherapy of ovarian endometriomas with ultrasound monitoring of intervention is a minimally invasive method of treating women of reproductive age, ensuring preservation of ovarian reserve. It is not a monotherapy, its outcome is in many respects determined by the adequacy of postoperative hormonal treatment.

© 2018 Ima-Press Publishing House. All Rights Reserved. Based on the data available in the literature, the author has first systematized in detail the main stages of the design and clinical introduction of serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants. Theoretical prerequisites for their emergence are described. The evaluation of the efficiency of depression therapy with drugs of this group in clinical trials and post-marketing studies is analyzed in the historical context. The reasons for temporary restrictions on their wide use are considered. There are data on the design of novel representatives of SNRI antidepressants.

© 2018 Ima-Press Publishing House. All Rights Reserved. Objective: to investigate the effectiveness of cognitive and motor training as an additional method to basic therapy in patients with Alzheimer's disease (AD) and vascular cognitive impairment (VCI). Patients and methods: The investigation enrolled 41 patients (15 women and 26 men; mean age. 73.59±6.3 years), including 32 patients with AD (mean age 74.94±5.15 years) and 9 patients with VCI (mean age, 72.31±4.98 years). Cognitive impairment (CI) corresponded to mild dementia in 15 patients (5 women and 10 men; mean age 74.6±2.8 years) and to moderate dementia in 29 (10 women and 19 men; mean age 72.1±3.2 years). The patients were randomly assigned to individual, group, and mixed (individual and then group) cognitive training groups. Quantitative scales were used to assess changes in CI and emotional and behavioral disorders after 1.5, 3, and 6 months of therapy. Results and discussion: During cognitive and motor training, all the groups showed a significant decrease in the severity of CI (p < 0.05), depression, anxiety, and apathy. The effectiveness of the training was further influenced by the severity of concomitant cardiovascular disease, the degree of apathy, adherence to the training, and the early initiation of basic symptomatic therapy. The greatest positive changes in anxiety and depressive disorders were noted in the patients receiving group cognitive and motor training. Conclusion: The results of the investigation allow group cognitive and motor training to be recommended as a mainstay in the therapy of patients with CI concurrent with emotional disorders.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. To improve diagnostics and effectiveness of treatment in patients with unresectable cholangiocarcinoma complicated by obstructive jaundice. Materials and methods. A total of 28 patients (100%) with unresectable or functionally inoperable cholangiocarcinomas complicated by obstructive jaundice were diagnosed and treated. All patients underwent percutaneous drainage of the ducts under the ultrasound control and fluoroscopy. After reduction of jaundice video fluorescent diagnostic was performed. There was used a special module for that, by means of which a video fluorescent image of the bile ducts tumor was obtained and the degree of photosensitizer accumulation in the tissues was determined. Following photosensitizers were used: Photosens, Radachlorin (Russia) and Photolon (Belorussia). After the videofluorescence diagnostics photodynamic therapy of tumor stricture was conducted. Photodynamic therapy was performed using a fiber-optic system, if necessary, a controllable balloon catheter on the distal segment was used allowing to conduct therapy throughout the stricture more evenly. For the restoration of biliary evacuation nitinol stents were used. Results. In all patients a videofluorescent image of the bile duct tumor was obtained and a high degree of photosensitizer accumulation was determined. At the same time 23 patients (82%) had a malignant lesion confirmed morphologically. The effectiveness of combined treatment in unresectable cholangiocarcinoma was evaluated by life expectancy, the highest was 29 months (mean 14±5 months), but some of patients were under dynamic control for a period of 6 to 17 months. Conclusions. Usage of interventional treatment methods for patients with cholangiocarcinoma complicated by obstructive jaundice improves liver function and decreases jaundice. The combined use of minimally invasive technologies with fluorescent diagnostics and photodynamic therapy allows to increase the median life expectancy and improve the quality of patient’s life.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article deals with the modern tactics of pulmonary hypertension therapy, used in case of unsatisfactory clinical response to previous therapy. All classes of pathogenetic therapy of pulmonary hypertension are presented, as well as modern views on the risk stratification of annual mortality of patients. Switching to a more effective drug both within one group of pathogenetic PAHtherapy, and to drugs of other classes is discussed. The latest classification of pulmonary hypertension (Nice, 2018) is presented.

Numerous studies have demonstrated the efficacy of anti-VEGF medications for exudative (wet) age-related macular degeneration (AMD). Significant IOP elevation is one of the side effects of anti-VEGF intravitreal injection. PURPOSE: To study the changes in the parameters of anterior segment of the eyeball against acute IOP elevation after repeated intravitreal injections (IVI) of anti-VEGF medication. MATERIAL AND METHODS: The study was conducted on a random sample of 45 patients (45 eyes) diagnosed with exudative (wet) form of AMD. All patients received two 0.05 ml intravitreal injections of ranibizumab with one-month interval. Measurements of IOP were performed with rebound tonometer Icare-Pro (ICare, Finland) before intravitreal injection, then one minute, 30 minutes and 3 hours after. The parameters of the ocular anterior segment, namely thickness and optical density of the cornea, volume and angle of the anterior chamber were evaluated by Scheimpflug imaging (Pentacam HR, Oculus, Germany) before IVI, and 15 minutes after. RESULTS: Statistically significant (p<0.05) elevation of IOP to 40 mm Hg (confidence interval 32-48 mm Hg) was recorded one minute after injecting 0.05 mL of ranibizumab solution into the vitreous cavity with IOP having the tendency for gradual normalization. When measured 15 minutes after IVI, the following parameters of the ocular anterior segment structures had reliably changed in the setting of elevated IOP: corneal thickness had increased to 27 µm (confidence interval 14-38 µm), corneal optical density - to 16.7 (confidence interval 10.4-19.5). No significant changes of either volume or angle of anterior chamber were revealed. Comparative analysis showed no significant changes of parameters after the 1st and the 2nd IVI. CONCLUSION: The revealed changes were transient in nature and did not require any corrections since all parameters returned to baseline after each injection.