Vol 6, No 2 (2012)

This article addresses issues of classification, and objective assessment of the pain, clinical variants of pain are described, modern methods of pain therapy are presented.

Aim – to identify the most affordable way of physical training (PT) in patients with ischemic heart disease (IHD), promoting effective control of the intensity of inactivity and has a high level of adherence in physical training of CHD patients on an outpatient basis – outpatient rehabilitation stage. Materials and methods. The study included 76 male patients with coronary artery disease aged from 49 to 64 years. Results. Among the PE methods used in the study, moderate-intensity treadmill exercises at least thrice weekly are most effective as they promote the most increased exercise tolerance (ET), but in 3 months there is a noticeable reduction in adherence to this PE method. The heavyweight walking method assists in increasing the ET comparable to that of treadmill exercises and in effectively correcting the degree of hypodynamia and preserves high adherence to PE even after 6 months of their regular performance. Conclusion. Hypodynamia as a risk factor for cardiovascular diseases is common and encountered in 86 % of the CHD patients who have undergone percutaneous coronary interventions and myocardial infarction with the baseline exercise capacity being 7 METs or more, as evidenced by treadmill tests. Therefore this category of patients must be actively involved into the programs of cardiac rehabilitation and secondary prevention. On choosing PE methods, preference should be given to the method that aids in increasing ET and adherence to PT and in effectively correcting hypodynamia.

Aim – to perform comprehensive analysis of the risk factors of diabetes mellitus (DM) in patients with chronic pancreatitis (CP). Materials and methods. All examined patients with chronic pancreatitis (CP) were divided into 2 groups. The first group – 38 patients with the progression of the diabetes in the first 3 years of the CP, the second – 44 people with no diabetes after 10 years of disease. Formation of CP etiologic groups based on the mandatory presence of one of two factors: alcohol abuse, the presence of disease of biliary system. The combination of two etiological factors wasl exclusion criteria. Results and conclusion. Among the examined patients biliary form of CP occurred in 52 patients, alcohol – in 30 patients. It was found that in the first three years of CP risk of diabetes is not associated with family history, obesity, number of exacerbations, but in the form of alcoholic CP DM formed almost two times more often than in the biliary. When combined with CP in patients with diabetes were significantly more common strain of the main flow and structural changes in the tail of the pancreas.

The retrospective study analyzed the glomerular filtration rate (GFR) calculated using the formulas of Cockcroft–Gault (ml/min) and Modification of Diet in Renal Disease (MDRD) (ml/min/1.73 м2) in 1504 patients. The patients had been selected from 7124 visitors to the outpatient unit in 2010: those were overweight (body mass index (BMI) 25.0–29.9 kg/m2;n = 657), obese (BMI ≥ 30 kg/m2; n = 615), and normal-weight (BMI 18.5–24.9 kg/м; n = 236) who formed a control group. All the patients were examined in the outpatient unit and the V.Kh. Vasilenko Clinic of Internal Propedeutics, Gastroenterology and Hepatology.Analysis of the mean values of GFR calculated using the Cockcroft Gault formula (ml/min) established that the mean GFR increased with BMI from 95 ml/min in overweight persons to 135 ml/min in morbid obesity; in the control group the mean GFR was 82.5 ml/min. The correlation coefficient was 0.35; р < 0.05. There was a reduction in the GFR calculated using the MDRD formula (ml/min/1.73 м²) in the obese patients compared to the controls (69 and 79.4 ml/min/1.73 м2, respectively). The correlation coefficient was 0.15; р < 0.05. Analysis of the distribution of the stages of chronic kidney disease (CKD) in obese patients with the GFR estimated using the Cockcroft Gault formula (ml/min) ascertained that in the obesity groups there was a preponderance of patients with high GFR; the number of these patients increased with higher BMI from 53 % in overweight to 91.5 % in morbid obesity. The correlation coefficient was 0.26; р < 0.05. Analysis of the distribution of the stages of CKD in obese patients with the GFR calculated using the MDRD formula showed a rise in the number of patients with Stage III CKD (from 12 % in overweight to 22.8 % in obesity; 4.7 % in the control group). Moreover, a group of patients (2 %) with Stage IV CKD in morbid obesity was identified. The correlation coefficient was 0.15; р < 0.05.

Moscow Aim – to study the prevalence of arterial hypertension (AH) and left ventricular hypertrophy among male liquidators (ML) of Chernobyl accident consequences and a group of unorganized males (UM) from one of the Moscow regions. Materials and methods. The results of examining a random representative sample of three hundred and ninety-five 35–64-year-old Mos-cow Registry MLs of Chernobyl accident consequences (n = 395; 79 % response rate) were analyzed. A random sample of males from one of the Moscow regions (n = 382; 70 % response rate) was used to make up an age-matched comparison group.Results. The age-adjusted prevalence rate (AAPR) of AH according to the expanded WHO criteria (> 140/90 Hg mm) was substantially higher among MLs than among UMs (64.9 and 54.7 %, respectively; p < 0.01). The prevalence of AH was associated with the men’s age in both populations. Thus, this among MLs and UMs in the 35–44 year age group was 54.6 and 47.2 %, respectively and in the 55–64 year age group 80 and 62.2 % (i.e. the incidence of AH increased by 1.3 (р < 0.01) and 1.2 (р < 0.05) times, respectively). Conclusion. AAPR of AH among the liquidators was significantly higher than that in the control group (64.9 % versus 54.7 %, respectively). In the compared groups, that of left ventricular hypertrophy did not differ and was 25 and 25.6 %, respectively; significant differences were found in the degree of left ventricular hypertrophy: certain (concentric) left ventricular hypertrophy was more common in the liquidators than in the comparison group (12.9 % versus 7.4 %, respectively). In the ML group compared to the control group, there was much higher awareness of having AH (59.1 % versus 46 %, respectively), drug treatment was performed in 38.7 % versus 7.9 %; effective BP control in the patients was 13.1 % versus 4.7 %, respectively.

Osteoporosis and related fractures are one of the major causes of disability and premature death in the elderly. The timely diagnosis of osteoporosis is the basis of effective therapy in the patients. The paper presents approaches to diagnosing osteoporosis, its primary and secondary forms, as well as its differential diagnosis with other skeletal diseases. 

The clinical case is of clinical interest in terms of the complexity of diagnosis of fungal infection complicating the course of severe destructive Staphylococcus pneumonia.

Aim – to evaluate the effectiveness of immunomodulating drug Galavit in patients with uncomplicated influenza. Materials and methods. Non-randomized single-center comparative study was performed. Patients with influenza (male, average age – 25,1 ± 1,3 years, n = 45) were divided into 2 groups. Study group (n = 20) from the time of admission received the drug Galavit in addition to symptomatic and detoxification therapy. Patients in the control group (n = 25) received only symptomatic and detoxication therapy. The criterion of effectiveness of the preparation was positive dynamics of clinical symptoms and the results of clinical blood. Results. For the 2nd day of the disease 15 % of patients of the group returned to normal body temperature (in the control group, none of the patients had normal body temperature to the 2nd day of illness). By the 5th day of observation, 95 % of the study group patients showed normalization of body temperature (in the control group – 84 % of patients). Catarrhal symptoms resolved faster in patients of the main group than in patients of control group. Patients treated with Galavit observed normal levels of white blood cells and ESR by the moment of hospital discharge, in the control group leukocytosis and increased ESR remained. Conclusion. Galavit drug reduces the duration of catarrhal and intoxication syndrome in patients with influenza, effect positively on hematological parameters: helps reduce the number of white blood cells, stab shift, normalization of ESR.

The article presents review of literature dedicated to the contemporary view on the cellular-molecular mechanisms of the bone remodeling and pathogenesis of the osteoporosis. The discovery of the cytokine RANKL-RANK-OPG system and significant role of the cathepsin K in process bone remodeling has made progress in understanding the mechanisms development disease and possible to development drugs of the new generation – denosumab, a fully human RANKL monoclonal antibody and inhibitor cathepsin K odanacatib that inhibits of the bone resorption.

The results of major clinical trials and an overview of the guidelines update presented at the European Congress of Cardiology are described in the paper.