Vol 6, No 3-4 (2012)

The article discusses the main aspects of registers use to evaluate the effectiveness and safety of drugs. It is noted that the results of the randomized clinical trials are currently constitute the highest level of evidence in medicine, but they have several limitations. Besides, in many
cases evidence based on the results of the randomized clinical trials (RCTs) is simply missing. In this connection need for observational studies that, despite some limitations often supplement the information obtained in the RCT is discussed. Registers as the way to study the effectiveness and safety of drugs could help overcome some limitations of observational studies. The examples of both Russian and foreign studies held within registers in order to study the effectiveness of drugs in cardiology are provided. The framework for RCTs and registries contribution in studying effectiveness and safety of a drug is proposed.

Objective: to evaluate morphofunctional changes in the cardiovascular system of pregnant women with arterial hypertension (AH) to detect
chronic AH - hypertensive disease.

Subjects and methods. 126 pregnant women with AH (at 28–34 weeks gestation; mean age 26.1 ± 1.7 years) were examined. All the pregnant
women underwent assessment of risk factors for AH, double measurement of office blood pressure, 24-hour blood pressure monitoring, electrocardiography, carotid ultrasonography, a microalbumin urine test, and eyeground examination. The pattern of AH was specified 12 weeks after childbirth.

Results. Chronic AH – hypertensive disease – was diagnosed in 51 % of the examined pregnant women with AH. There was a considerable spread of risk factors for AH in this patient group. 26 % of them were found to have lesions of target organs (heart and/or arterial vessels); the rate of microalbuminuria registration was 41 %.

Conclusion. Among our examined group of pregnant patients with AH, the prevalence of hypertensive disease is 51 %. In the identified patient
group, cardiac and arterial vascular changes that could be considered as target organ lesions were found in almost a third of cases. Pregnant women with AH need to be meticulously examined and followed up by a therapist and a cardiologist in the postpartum period.

The paper considers main ideas on the prevalence, course, and therapy of chronic pain syndrome. It describes its manifestations, different course variants, and approaches to treating the diseases accompanied by chronic pain. Different approaches to long-term therapy, which involve combination treatment options, are discussed. Data on the use of nonsteroidal antinflammatory drugs as the most common agents to relieve both acute and chronic pain syndrome are given in detail. The data of numerous trials evaluating both the analgesic and anti-inflammatory effects of nonsteroidal anti-inflammatory drugs are presented.

Stress-induced cardiomyopathy or Takotsubo cardiomyopathy that generally runs with the clinical manifestations of acute coronary syndrome and left ventricular asynergy, which are caused by emotional, psychological, or physical stress, is most frequently encountered among the unclassified cardiomyopathies. A clinical case of this myocardial lesion without clinical manifestations, but with transient electrocardiographic changes and evident impairment of left ventricular contraction is described.

Sufficient information indicating the implication of dysfunction of interleukins (IL-6 and IL-1 in particular) in the pathogenesis of amyloidosis in a number of autoinflammatory, rheumatic, and autoimmune diseases, including those in periodic disease (PD), has been recently accumulated. Its genetic defect – pirin mutation – gives rise to an alternative innate immune response (phagocytic cell activation) to secrete IL-1 by macrophages and to activate T-helper cells. This causes imbalance in the synthesis of proinflammatory (IL-6, IL-8, and TNF-α) and anti-inflammatory (IL-4, IL-10, and IL-1 receptor antagonist) cytokines. Moreover, the uncontrolled macrophage (monocyte) secretion of a great deal of IL-6 that together with IL-1 is a mediator of the synthesis of the serum amyloid fibril protein precursor SAA by hepatocytes, neutrophils, and fibroblasts plays one of the key roles in the pathogenesis of PD through amyloidosis. With this, IL-6 stimulates the inflammatory process, by enhancing the release of lysosomal enzymes, reactive oxygen species, and eicosanoids (prostaglandins, leukotrienes, thromboxane) from the polymorphic nuclear leukocytes, macrophages, endotheliocytes, and fibroblasts and by augmenting the chemotaxis of macrophages and neutrophils, and the degranulation of the latter, i.e. through its action on the effector cells of inflammation, and prepares the tissue basis for amyloid deposits in this fashion. Thus, the analysis of literary and own materials gives grounds to suggest that pirin mutation is a trigger of the synthesis of IL-1 and IL-6 in PD and their hypersecretion is an initial link of the synthesis of SAA.

Panniculitides are a group of heterogenic inflammatory diseases that involve the subcutaneous fat. Treatment for panniculitides, idiopathic ones in particular, has not been conclusively developed and is generally performed empirically. The paper describes a case successfully treated with glucocorticosteroids in combination with azathioprine for the plaque form of Weber–Christian panniculitis.

The paper considers the epidemiology, morphology, and clinical manifestations of diabetic encephalopathy. It shows the differences of diabetic encephalopathy in types 1 and 2 diabetes mellitus. Pathogenetic treatment options for diabetic encephalopathy are given.

Aim. To evaluate in the comparative aspect of the symptomatic effectiveness of therapy chondroitin sulfate and it’s combination with glucosamine hydrochloride in patients with osteoarthritis in outpatient conditions and determine the most rational scheme of the treatment.

Materials and methods. 65 patients with osteoarthritis of the knee and hip joints, of which 35 were chondroitin sulfate and 30 – chondroitin sulfate in combination with glucosamine hydrochloride according to the scheme in the course of 3 months. Additionally carried out x-ray and ultrasound study of the affected joints.

Results. The use of these drugs has led to the reduction of pain, the improvement of function of joints and quality of life of patients, which
allowed to reduce the need for receiving nonsteroidal anti-inflammatory drugs.

Conclusion. In the outpatient setting can be applied widely chondroitin sulfate in combination with glucosamine hydrochloride, in connection with higher efficiency and lower cost.

The given review considers the mechanisms underlying the development and maintenance of atrial fibrillations (AF). It is noted that the processes of atrial fibrosis, ion channel remodeling, inflammation, apoptosis, impaired intercellular interactions, and myocardiocyte hypertrophy may give rise to atrial structural and functional changes in AF. The efficacy of angiotensinonverting enzyme inhibitors and angiotensin receptor antagonists is justified in patients with left ventricular systolic dysfunction.