Vol 20, No 12 (2018)

Systemic amyloidosis is a relatively rare multisystem disease caused by the deposition of misfolded protein in various tissues and organs. The deposits are derived from several amyloidogenic precursor proteins, and the prognosis of the disease is determined both by the organ(s) involved and the type of amyloid. Cardiac involvement is a leading cause of morbidity and mortality, especially in AL- and ATTR-amyloidosis. The last decade has seen considerable progress in understanding of cardiac amyloidosis. This review focuses on changes in intracardiac hemodynamics and their evaluation using novel diagnostic approaches (strain and speckle tracking imaging, cardiovascular magnetic resonance and cardiac biomarkers). New histological typing techniques and current treatments are discussed

Objective - to compare the value of serum creatinine and cystatin dynamics for early diagnosis of chronic kidney disease progression in patients with acute decompensation of chronic heart failure. Materials and methods. The study included 125 patients with acute decompensation of chronic heart failure who received treatment in the therapy department. The dynamics of glomerular filtration rate was monitored by level of serum creatinine and cystatin C at the beginning and at the end of treatment. Results. Upon admission to the hospital, 14 cases of progression of chronic kidney disease in terms of creatinine and 39 in terms of cystatin C. The increase in creatinine levels was accompanied by an increase in cystatin C levels in 100% of cases. At the end of treatment, elevated cystatin C levels persisted in 34 patients. This was accompanied by an increase in creatinine levels in 100% of cases. There were identified 11 new cases of progression of chronic kidney disease; 6 cases on two indicators, 5 cases on one indicator. Conclusion. Evaluation of glomerular filtration rate by serum cystatin C level allowed to identify progression of chronic kidney disease at early stages in patients with acute decompensation of chronic heart failure 2.4 times more often than evaluation serum creatinine level

Atrial fibrillation is the most common and clinically significant cardiac arrhythmias. Most patients with atrial fibrillation who need treatment are elderly persons with a comorbid pathology. The review article presents data on the choice of strategy and tactics for managing such patients, the selection of antiarrhythmic drug therapy aimed at restoring and maintaining the sinus rhythm, or at decreasing the ventricular rhythm frequensy. The possibilities of using radiofrequency ablation of atria and the subsequent administration of antiarrhythmic drugs are considered taking into account the existing international recommendations

Nitrates are still widely used in treatment of different types of ischemic heart disease. The trend to reduction of prolonged di- and mononitrate forms use that is coming from new antianginal medications development cannot be considered justified. In both outpatient and hospital practice, it is impossible to abandon the use of the positive properties of these medicines in the combined treatment of cardiac diseases. Along with nitrates, effect of metabolic cytoprotection use in complex treatment was proven to be statistically significant in a number of studies. It results in decreased length of hospital stay, angina frequency, and nitrate use reduction as well as in patients’ exercise tolerance increase, disease course modification, and disease prognosis improvement

In the present article antihypertensive therapy (AT) properties in patients with type 2 diabetes mellitus and chronic kidney disease are discussed from the perspective of modern European guidelines 2018. Calcium channel blocker nitrendipine and thiazid-like diuretic indapamide place in AT is discussed and their advantages of use in combination therapy in these patients are presented

Systemic vasculitis is a group of rare diseases characterized by unfavorable prognosis without correct therapy. Today survival rate in this patient increased due to usage of modern immunosuppressive therapy (IST) which consists of combinations of glucocorticosteroids, cytostatic agents and biological drugs. Unfortunately, its use can also be associated with development of serious complications. The review discusses the basic IST regimen of vasculitis treatment their complexity and perspectives

The article presents modern view on mucosal epithelial barrier structure and its permeability. Interrelation of gastrointestinal tract dysfunction and tight junctions’ structural damage is discussed. Diagnostic possibilities of epithelium permeability and barrier function study in everyday practice and clinical studies are analyzed. Contribution of permeability disturbances in pathogenesis of different gastrointestinal tract functional disorders is discussed

Hepatic encephalopathy (HE) is a frequent complication and one of the most debilitating manifestations of liver disease, severely affecting the lives of patients and their caregives. Furthermore, cognitive impairment associated with cirrhosis results in utilization of more health care resources in adults than other manifestations of liver disease. The aim of the study: To study the incidence and degrees of hepatic encephalopathy in patients with drug-induced liver disease (DILD) during chemotherapy (CT) of breast cancer (BC) and ovarian cancer (OC) and in patients with rheumatoid arthritis (RA) receiving long-term methotrexate therapy, depending on the presence of diabetes mellitus (DM), and evaluate the efficacy of HE treatment with L-Ornithine-L-aspartate. Materials and methods. The study groups included 52 patients with OC and 53 patients with breast cancer who developed DILD on the background of chemotherapy, as well as 88 patients with RA whose DILD developed on the background of long-term (more than 5 years) methotrexate therapy. The degree of hepatic encephalopathy was determined using the West-Haven scale and the critical flicker frequency test (CFF) using the HepatonormTM (Germany) hepatoanalyzer at 0 (initially) and 8 (at the end of the treatment) weeks of study. Patients with HE received L-ornithine-L-aspartate therapy for 1 packet of granules, previously dissolved in 200 ml of liquid, 3 times a day. Results. Hepatic encephalopathy (in particular, minimal HE) is a frequent manifestation of DILD in the group of patients with rheumatoid arthritis who have been receiving long-term methotrexate therapy, and in patients undergoing CT for breast and ovarian cancer. Diabetes mellitus is a risk factor for DILD, which adversely affects the degree of HE. Conclusions. Treatment with L-ornithine-L-aspartate for 8 weeks proved to be effective in cupping of HE manifestations, which is confirmed by the results of CFF test

The article presents differential diagnosis of osteoarthritis and gout, aspects of clinical presentation, laboratory and instrumental studies results. Algorithm on osteoarthritis management and renewed European League Against Rheumatism (EULAR) guidelines on gout treatment are presented. Aims and main principles of gout and osteoarthritis therapy are discussed. Data on mechanism of action, characteristics, clinical effectiveness and safety of diacerein (interleukine-1 inhibitor) are presented. Results of clinical studies of febuxostat (selective inhibitor of xanthinoxidase) are presented, its effectiveness in uric acid level control, possibilities of use in patients with chronic kidney disease, non-responsive or allergic to allopurinol therapy, are shown

Introduction. Nowadays type 1 diabetes mellitus (DM) therapy includes insulin replacement therapy with exogenous insulin use like many years ago. Modern technologies of insulin production techniques offer medications with improved characteristics that are designed for basal as well as prandial secretion simulation. Basal-bolus insulin therapy is mostly used in type 1 DM patients. Continuous subcutaneous insulin infusion (CSII) with portative insulin pump (IP) allows to simulate insulin therapy to the rhythm of pancreatic gland physiological secretion. Objective. To evaluate effectiveness of type 1 DM therapy with the use of IP Accu-Chek Spirit Combo in comparison with multiple insulin injections (MII). Study problems. To form a group of type 1 DM patients using IP Accu-Chek Spirit Combo; to form a group of patients using MII comparable by numbers, age and gender composition, and disease duration using IP Accu-Chek Spirit Combo; to perform a statistical analysis of acquired data. Materials and methods. Using data from Moscow Diabetes Mellitus Federal Register (DMFR) a group of 139 patients (group 1) with type 1 DM receiving insulin therapy with IP Accu-Chek Spirit Combo was formed. Control group included 139 patients (group 2) receiving basal-bolus insulin therapy. Statistical analysis was performed using Excel 2016 software. Results. According to Moscow DMFR data 139 patients - 64 (46.0%) male and 75 (54.0%) female with type 1 DM received insulin therapy with IP Accu-Chek Spirit Combo. Mean age of patients was 32.8 (±12.7) years, disease duration - 16.5 (±10.1) years. Mean body mass index was 23.5 (±3.9) kg/m2. Mean glycated hemoglobin level (HbA1c) in patients with type 1 DM receiving IP therapy was 7.4% (±1.1%). A control group with type 1 DM on basal-bolus insulin therapy was formed (n=139). НbA1с level in patients with type 1 DM using IP Accu-Chek Spirit Combo was significantly lower (by 0.6%) than in patients on basal-bolus insulin therapy (p<0.05). Percent of patients with НbАс1<7.0% was significantly higher in patients with type 1 DM using IP (33.8 and 12.9% respectively, p<0.05), and percent of patients with НbА1с≥8.0% was higher in patients on basal-bolus insulin therapy (46.0 and 28.1% respectively, p<0.05). K