Vol 17, No 2 (2015)


Screening method for examination of patient with aphasia

Scherbakova M.M., Kotov S.V.


We developed a method to aphasia disorders by testing speech production in patients with brain lesions. A distinctive feature of the proposed method is that the examination includes independent modules, which are grouped in several units according to the forms of aphasia. Each unit tests the type and degree of speech disorder by analysis of observed symptoms. The method allows stating a precise diagnosis and excludes subjective estimation of a patient by a specialist.
Consilium Medicum. 2015;17(2):8-11
pages 8-11 views

Clinical bedside evaluation of dizzy patients

Palchun V.T., Guseva A.L., Levina Y.V.


Primary clinical examination of the patient with dizziness conducted in a short time does not require special equipment and can quickly reveal the supposed cause of vestibular disorders, which is necessary to determine the subsequent examination and treatment algorithm. The article presents a sample of the methods used in otoneurologist practice, which, according to the authors, are sufficient for initial diagnosis, and being the simplest in execution, do not require time-consuming and complex equipment, in other words, are available for any specialty physician during the examination of the patient with dizziness in the conditions of outpatient visits. The detailed review of the methodology and evaluation of such tests as the study of spontaneous nystagmus when looking straight and abduction sight, saccades, smooth pursuit, optokinetic test of the head rotation, dynamic visual acuity, head shaking test, the positional tests for benign paroxysmal positional vertigo, Romberg test, Unterberger test, demonstrative tests and others.
Consilium Medicum. 2015;17(2):12-17
pages 12-17 views

Case debut of Parkinson's disease on the panic disorder and depression background

Pilipovich A.A.


Institute of Professional Education I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2This article describes the clinical case debut of motor symptoms of Parkinson's disease on the panic disorder and depression background; the diagnostic approach and therapeutic tactics of using drugs of the selective serotonin reuptake inhibitors and dopamine receptor agonists are also described.
Consilium Medicum. 2015;17(2):18-20
pages 18-20 views

Algorithm of management of patients with suspected statininduced myopathy (clinical case of severe congenital myopathy developed along with of long-term statin therapy)

Deeva T.A., Drapkina O.M.


The purpose of clinical supervision is to demonstrate a case of severe congenital myopathy and liver injury for patient of older age, that took statins (simvastatin) for a long time; to discuss the algorithm of management of patients with suspected pathology of the muscular system (rhabdomyolysis); in order to draw the attention of physicians to the need for a thorough and detailed examination of the patients with persistent high numbers creatinephosphokinase (CPK) and transaminase blood after discontinuation of statins to exclude more rare diseases - congenital myopathies. This clinical case demonstrates the development of hereditary myopathy, which for a long time, masked itself as statininduced myopathy pathology.Peculiarities of the clinical observations. The patient with high numbers of cholesterol (LDL) had been prescribed statins. During 4 years (since 2006), she regularly took these drugs and controlled biochemical parameters of blood, which remained within normal values, the cholesterol level was normalized. For the last year before admission to the Clinic of internal diseases named after Vasilenko for survey about different diseases, she has received many drugs that enhance hepatotoxic and myotoxicity action of statins. Since 2010, the patient noted the emergence of gradually increasing neurological symptoms. 6-7-fold increase in transaminases was marked in the blood during this period. For a long time, the patient was not studied CPK level, when myopathy was suspected first time, the CPK level was 13 upper limits of normal. But even after discontinuation of statins the CPK level had not normalized, but had continued steadily to increase. Differential diagnosis was conducted and possible diseases with increased levels of transaminases and CPK were excluded. According to the algorithm for management of patients with suspected statininduced defeat muscular system, the patient had been conducted electroneuromyography, liver biopsy and skeletal muscle, resulting in the unlikelihoodof statininduced myopathy as a diagnosis. Positron emission tomography and studied the tumor markers were conducted for patient to exclude a paraneoplastic process. Data for cancer process hadnot been received. Finally, the patient had been sent to the Research center of neurology RAMS, where the following diagnosis had been formulated after a survey: "oculopharyngeal muscular dystrophy" (hereditary-degenerative disease characterized by progressive muscular weakness and atrophy).Conclusion. As of today, statins are an integral component of primary and secondary prevention and treatment of cardiovascular diseases and their complications. This class of drugs confirmed and proved its effectiveness and safety by multicenter studies. However, making a decision about the need for statin use, the nature of their regime and dose, it is necessary to consider their interactions with other prescribed drugs, characteristics of the patient, which can increase the risk of statin induced myopathy. In addition, assessing the potential risk of adverse effects of statins, preference must be given to hydrophilic statins with the lowest risk of toxic effects on hepatobiliary and muscular system.
Consilium Medicum. 2015;17(2):21-26
pages 21-26 views

Nonsteroidal anti-inflammatory drugs through the prism comorbidity and drug safety: in focus amtolmetin guatsil

Trukhan D.I.


Drug safety and comorbidity are closely intertwined with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), which are among the most common drugs. Since NSAIDs associated a range of different complications. One of the most common complications is NSAIDs gastropathy. The main areas to ensure drug safety in the use of NSAIDs include: 1) identification ofpatients at increased riskof complications; 2) tread therapy; 3) selection of the best drug with efficacy and safety positions. Promising drug from the group of NSAIDs with the efficacy and drug safety products is amtolmetin guacil.
Consilium Medicum. 2015;17(2):27-33
pages 27-33 views

Modern analgetics. Strive for efficiency and safety

Amelin A.V.


Nonsteroidal anti-inflammatory drugs (NSAIDs), such as metamizole (Analgin), paracetamol (acetaminophen), flupirtine, anticonvulsants, antidepressants and local anesthetics are widely used for the treatment of different pathogenetic types of pain. Means for selecting a pain treatment should take into account the presence of concomitant diseases of the gastrointestinal tract, the cardiovascular system, etc. Currently, the medical practitioner is required to «balance» between gastroenterology and cardiovascular safety of NSAIDs or search for drugs outside of this class. Flupirtine is a proof of informed choice of analgesic depending on the particular clinical situation.
Consilium Medicum. 2015;17(2):34-35
pages 34-35 views

On the issue of non-steroidal anti-inflammatory drugs and their safety: a rational choice

Pakhomova I.G., Khoroshinina L.P.


Nonsteroidal anti-inflammatory drugs (NSAIDs) present quite an effective means of pathogenetic therapy of acute or chronic pain arising as a result of tissue damage and inflammation in many diseases and pathological conditions that led to the widespread use of NSAIDs in clinical practice and everyday life. However, these drugs are capable of specifically exert an adverse effect on the mucous membrane of the gastrointestinal tract. For the prevention of these complications NSAIDs with the least number of adverse events should be prescribed, with not only efficacy, but safety taken into account as well.
Consilium Medicum. 2015;17(2):36-40
pages 36-40 views

Syndrome of mild cognitive impairment

Kotova O.V.


Mild cognitive impairment (MCI) is commonly known by an impaired memory and other higher brain functions, as a rule, demonstrated in elderly persons who are outside the age-related standard range, but do not lead to social exclusion, by not causing dementia. MCI are a polyetiologic syndrome that may develop within a wide range of neurological diseases. Most often a clinical MCI diagnosis of the syndrome matches the pathological markers of neurodegeneration and cerebral vascular insufficiency. It has been shown that clinical and subclinical orthostatic hypotension are associated with impaired cognitive function, decreased activity, motivation and an increased risk of dementia, diabetes and Parkinson's disease. Pronoran (piribedil) combines the dopaminergic and noradrenergic properties; its effectiveness has been studied and has been proven in more than 15 clinical studies, which were attended by a total of more than 7 thousand patients from around the world.
Consilium Medicum. 2015;17(2):41-46
pages 41-46 views

Approaches to non-radicular chronic/recurrent back pain therapy

Vorobyova O.V.


In approximately 40% of cases the cause of chronic back pain is the facet syndrome and this percentage increases in the older age population of patients. Patients in whom spondyloarthrosis pain occurs several times a year and episodes of exacerbation of pain tend towards elongation.Currently the arsenal of a doctor has a large number of drugs for pain, which differ in speed of onset of effect, pronounced analgesic effect and safety. The article discusses the possibility of using chondroprotectors in patients with recurrent back pain, in particular the results of a large-scale open prospective study of efficacy and safety of glucosamine, chondroitin sulfate (arthritis).
Consilium Medicum. 2015;17(2):47-51
pages 47-51 views

Back pain caused by disorders of the intervertebral discs

Isaykin A.I., Chernenko O.A., Ivanova M.A., Stitsenko A.N.


The article is devoted to the actual problem - the role of discogenic factor in the development of low back pain. Presented is an updated description of CTF- classification of pathological changes of discs (2014) and MSU-classification of disc herniation. We discuss the pathogenesis, clinical manifestations, diagnosis and additional differential treatment (conservative and operative) of the two most common manifestations of discogenic lumbar pathologies: axial discogenic pain and disco-radicular conflict. Emphasized is the role of inflammation in the development, maintenance of discogenic pain and regression of herniated disc. Materials presented the first evidence-based guidelines for the diagnosis and treatment of disc herniation with radiculopathy symptoms of the expert group North American Spine Society's - NASS (2012). Discussed are also the treatment of discogenic pain, selection of optimal drug groups.
Consilium Medicum. 2015;17(2):52-60
pages 52-60 views

The value of food macro and micronutrients in optimizing bone mineral density

Pogozheva A.V.


At the present time, the shortage of macro - and microelements, which contributes to the development of various pathological conditions, including osteoporosis and osteopenia is a very topical problem. In this review the results of clinical and experimental studies that prove the necessity of nutritional deficiency correction of macro - and micronutrients through the use of vitamin-mineral complexes containing osteotrophic minerals (magnesium, zinc, copper, manganese, boron) for the prevention and treatment of osteopenia and osteoporosis are presented and discussed.
Consilium Medicum. 2015;17(2):61-65
pages 61-65 views

The effectiveness of the combined drugs in the treatment of osteoarthritis

Balabanova R.M.


Osteoarthritis is the most common disease among the diseases of the musculoskeletal system. The main antiarthrosis drugs are similar in structure of cartilage of tissue-chondroitin sulfate and glucosamine, the mechanism of which is based on increasing the synthesis of proteoglycans and hyaluronic acid, reducing apoptosis of chondrocytes inhibiting the synthesis of aggressive metalloprotease. The article presents research data show the effectiveness and safety of a combined preparation Teraflex, , analgesic effect which is not inferior to non-steroidal anti-inflammatory drugs. The possibility of NSAIDs dosage decrease with Theraflex Advance being prescribed for minimizing the pain in osteoarthritic patients.
Consilium Medicum. 2015;17(2):66-69
pages 66-69 views

How to prevent chronic back pain: the role of chondroprotectors

Levin O.S.


The article presents data on the causes of chronic back pain and the possibilities of its prevention. Along with the more rapid relief of pain in the acute period, rational psychotherapy, measures aimed at correcting kynesiophobias and maladaptive pain behaviors and perspectives of application of chondroprotectors to prevent chronic back pain. The data presents a 2 year follow-up of patients who after participating in a study of the effectiveness of Alflutop continued to regularly introduce Alflutop or stopped its introduction. It is shown that in the context of the regular administration of Alflutop for 2 times a year and more often, a significantly lower number of exacerbations, than in the absence of chondroprotectors use was noted.
Consilium Medicum. 2015;17(2):75-78
pages 75-78 views

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