Vrach

Human Specific Hyperimmune Globulins (HIG) are dosage forms of the concentrated purified protein fraction of immunoglobulin G against a specific viral or bacterial antigen. Effective and safe methods of the antibody’s purification makes possible to consider HIG as a preventive and curative agent, for the viral infections, against which there is no specific preventive or antiviral therapy, as well as bacterial infectious diseases due to increasing resistance to antibacterial drugs, especially in persons with immunodeficiencies.

The article presents a review of the literature on the relationship of peripheral artery diseases and cardiovascular complications. According to modern concepts, peripheral artery diseases are classified as markers of very high cardiovascular risk. The most important aspect of the therapy of patients in this category, in addition to correcting specific symptoms of vascular lesions of the lower extremities, is to reduce the risk of developing cardiovascular diseases and their prevention, and treatment of patients in this category should be carried out in accordance with the recommendations for secondary prevention of cardiovascular complications, the most important part of which is the control of serum lipids. Statins are the most widely used class of drugs for the correction of hypercholesterolemia, but the frequency of their appointment as a strategically important class of drugs to prevent the development of atherosclerotic cardiovascular complications in high- and very high-risk individuals in the Russian Federation, as in other countries, remains low. The basic principles of lipid-lowering therapy in patients with peripheral artery diseases are described: strategies, goals and issues of therapy control.

High level of prevalence of the arterial hypertension (AH) demands use of new technologies of early disease verification.

Purpose. Develop a visual-exercise method of diagnostics of AH: bicycle-stressful doppler sonography of a renal-vascular blood-groove with assessment of the vascular motion status and definition of diagnostic criteria of disease.

Materials and methods. The cohort (n=48) of healthy subjects and patients with AH I-II degree is surveyed. Bicycle-stressful research of renal-vascular reactivity included initial measurement and exercise monitoring of peak speed of a blood-groove (V_ps) and the resistant index (RI) in renal artery (RA). Calculation the index of the pressor and high-speed relation (IPHSR) on a formula was carried out: IPHSR = Systolic BP/ V_ps RA.

Results. At peak bicycle-stressful test the V_psRA at patients with AH increased only 8% (2.8–11.0%) while at healthy volunteers – 27% (21.4–37.0%). Significantly differed IPHSR: at patients with AH it was measured 2.38–3.23 units (2.8 [2.650–2.892] units), and healthy volunteers 1.72–2.37 units (2.03 [1.91–2.16] units) (p=0,0001). The sensitivity of IPHSR was 91%, specificity – 88%, accuracy – 93%. The decrease of cortically kidney perfusion (increase in RI RA) in group of control was less expressed, than group of patients with AH: 8,6% (4.3–11.0) and 14.7% (9.7–23.2] respectively (r=0,0004).

Conclusion. In the course of bicycle-exercise at patients with AH load the small growth of peak speed (<10%) and the essential growth of vascular resistance (>25%), the IPHSR is highly sensitive (91%) and highly specific (88%) criterion of AH with differential border of 2,5 units.

Non-communicable diseases are the main problem of modern society. This review represent data on chronical diseases and their risk factors among working women. It also describes the global trends of main risk factors among working young women and the manifestation of non-infectious diseases, including coronary heart disease, overweight/obesity, arterial hypertension, diabetes mellitus and mental health problems. Long working hours, workload and stress at work were identified as the risk factors of non-communicable diseases. The double burden of work and household duties increased the risk of non-communicable diseases among working women in comparing with working men. State-level strategies were proposed to improve the situation of reducing the prevalence of non-communicable diseases and their prevention. For example, the strategy for the prevention of chronical pathology among working women, included the search of risk factors, strengthening of health policy, the interventions at the working place, including adherence to timetable, the balance between work and personal life.

The features of the immune profile and cytokine regulation in vibration disease (VD) from exposure to local vibration and its combination with osteoarthritis (OA) are described. The prognostic significance of changes in the immune profile and cytokine regulation in VD from exposure to local vibration and its combination with OA has been established. It has been proven that when exposed to industrial vibration, there is a change in all indicators characterizing the quality of life, most pronounced in grade II VB from exposure to local vibration and its combination with OA.

Balo's concentric sclerosis (BCS) is a rare demyelinating disease of the central nervous system, characterized by concentric areas of demyelination alternating with areas of preserved myelin in the form of a pathognomonic pathomorphological substrate of varying degrees of severity in the form of «annual rings on a tree cut». The pathogenesis of BCS is diverse and complex, today there are several theories of its occurrence, among which hypoxic, vascular and closely related genetic, as well as a number of other theories are distinguished. The BCS clinic is variable, represented by both focal neurological manifestations and general cerebral symptoms. The diagnosis is based on the data of magnetic resonance imaging of the brain. The drugs of choice for BCS therapy are glucocorticosteroids (prednisolone or methylprednisolone).

Objective. To study the dynamics of selenium level and some indexes of oxidative status of blood serum in patients with the moderate form of tick-borne rickettsiosis caused by Rickettsiaе heilongjiangensis, in Khabarovsk Region, depending on the treatment in order to optimize the pathogenetic therapy.

Materials and methods. Comparative analysis of combinations of treatment by basic means (antibiotics, detoxication therapy) and in combination with organic selenium was carried out on the basis of determination of nutrient selenium level and some parameters of oxidative status in blood serum of patients with tick-borne rickettsiosis determined by R. heilongjiangensis without accompanying chronic diseases at decompensation stage.

Results. The daily dosage of «paprika» powder at a dose of 60 mcg/day allowed to level the selenium deficiency to a suboptimal level of supply. Besides, analysis of chemiluminescence of blood sera of patients who received organic selenium as a part of complex treatment showed activation of antioxidant antiradical protection and decrease of free radicals production against the background of improvement of clinical status.

Conclusions. Thus, the complementary therapy with organic selenium promotes normalization of antioxidant protection processes and reliably restores suboptimal provision of selenium and can be recommended for treatment of tick-borne rickettsiosis patients caused by R. heilongjiangensis

Chronic heart failure (CHF) is a common disease in patients of older age groups. Often these patients experience depressive disorders that affect the course of chronic diseases and their standard of living.

Purpose. To study methods for increasing the effectiveness of treatment of CHF against the background of depressive disorders in patients of older age groups.

Material and methods. The study involved 100 patients aged 60–87 years with functional class II–III CHF and mild to moderate depressive disorders. Patients were divided into groups depending on the therapy received: 1^st (n=25) – standard therapy for CHF; 2^nd (n=25) – standard therapy for CHF + antidepressant; 3^rd (n=25) – standard therapy for CHF + phototherapy; 4^th (n=25) – standard therapy for CHF + placebo. The effectiveness of CHF therapy was assessed after 3 and 6 weeks during clinical examination using a 6-minute walk test, ECG, echocardiography, and a clinical condition rating scale. To diagnose depressive disorders, the Geriatric Depression Scale, HADS, Beck scale, and consultations with a psychotherapist were used.

Results. After 6 weeks of therapy, patients of all groups noted a decrease in shortness of breath and chest pain, and an increase in tolerance to physical activity. At the same time, the decrease in the level of anxiety and depression was most pronounced in groups 2 and 3 – in 84 and 100% of cases, respectively.

Objective. To study the effect of basic pathogenetic therapy of osteoporosis and nutritional support using HDBA organic complex with vitamin D and calcium on the effectiveness and duration of maintaining the effect of medical rehabilitation, bone mineral density and the incidence of falls in patients with osteoporosis.

Material and methods. The study included 119 patients aged 50 to 80 years, admitted to the inpatient stage of medical rehabilitation and diagnosed with osteoporosis according to one of the three diagnostic criteria formulated in the clinical recommendations of the Russian Ministry of Health, which were randomized in 3 groups. Patients in group 1 (n=41) were prescribed pathogenetic antiresorptive therapy for osteoporosis (bisphosphonates or denosumab) for 12 months, depending on the severity and clinical features of osteoporosis, contraindications to various types of therapy and the patient’s preferences regarding the frequency and mode of administration of the drug for the treatment of osteoporosis, in combination with nutritional support of the dietary supplement Osteomed Forte, containing an organic HDBA complex with vitamin D and calcium. Patients in group 2 (n=39) were prescribed only nutritional support with the dietary supplement Osteomed Forte in the same dosage. Patients of the third group made up the comparison group (n=39), in which patients did not receive any interventions. A control examination was carried out after completion of the rehabilitation course – 20 days after inclusion in the study, as well as 6 and 12 months after the start of treatment.

Results. Long-term nutritional support of patients with osteoporosis using HDBA organic complex with vitamin D and calcium helps maintain muscle strength values achieved during rehabilitation for up to 6 months, indicators of quality of life and balance for up to 12 months after completion of rehabilitation, as well as significant increase in bone mineral density after 12 months compared to the baseline: in combination with pathogenetic therapy for osteoporosis – by 4.2% in the spine, by 3.0% in the femoral neck and by 2.7% in the proximal femur, without antiresorptive therapy – by 1.8% in the spine.

Conclusion. Nutritional support in the form of correction of dietary calcium deficiency and vitamin D deficiency and the prescription of pathogenetic therapy for osteoporosis should be a mandatory part of complex rehabilitation measures in patients with osteoporosis to increase bone mineral density, improve efficiency and long-term maintenance of the results of medical rehabilitation.

Samara State Medical University, Ministry of Health of Russia

Inhalation therapy is the introduction of a medicinal substance directly into the respiratory tract using special inhalers. To date, more than 200 devices for inhalation therapy have been developed. The purpose of the work is to review modern devices for inhalation therapy, to clarify their advantages and disadvantages. Interest in inhalation therapy can be explained by several reasons. Let's list them. First, you can inject the drug directly into the respiratory system. Secondly, the therapeutic effect comes quickly. Thirdly, the drug is almost not absorbed into the blood, so there are no systemic side effects. In addition, the patient can do inhalation independently at home. At the same time, inhalation therapy has several disadvantages. Sometimes it is difficult for the patient to understand how to use the inhaler. The doctor should show, explain and control inhalation. The particle size of the aerosol is very important, as is the patient's inspiratory flow rate.

Unplanned pregnancy can end with artificial or spontaneous termination, as well as it is also associated with the risk of complications that jeopardize safe motherhood in the future. One of the main trends in modern reproductology is the improvement and wider application of methods for planned and emergency contraception. The frequency of abortions in Russia is one of the highest worldwide; the reason of which is the poor awareness of the population about contraception devices and techniques. The significance of the problem is undeniable and important in preserving a women’s health. To solve this problem, it is necessary to increase the level of health education for both women and men in contraception and birth control. The paper presents the main known contraception types with their methods of application, advantages and disadvantages.