[Preventive cytoprotection in social diseases]. / Preventivnaya tsitoprotektsiya pri sotsial'no znachimykh zabolevaniyakh.

UNLABELLED: Among many cytoprotective drugs, only a few of them that have a targeted metabolic effect include agents that partially inhibit oxidation of free fatty acids, the so-called p-FOX inhibitors (partial fatty acid oxidation inhibitors). AIM: To develop a procedure for the preventive use of meldonium dihydrate in day-hospital patients with comorbidity. SUBJECTS AND METHODS: The investigation enrolled 189 patients (116 men and 73 women; mean age, 55.9±4.4 years) who were followed up for initial manifestations of cardiovascular and/or another somatic disease and were at high risk for unfavorable cardio- and cerebrovascular events, as well as complications of emergency alcohol-related conditions. The investigation of the efficacy and safety of meldonium dihydrate was planned as an open-label clinical trial in three parallel groups different in the directivity patterns of potential complications («Cardio¼, «Cerebro¼, «Alco¼). The drug's dosage averaged 500 to 1000 mg/day. RESULTS: The day-hospital use of meldonium dihydrate demonstrated high safety profile and a positive role in the prevention of cardio- and cerebrovascular catastrophes and complications of emergency alcohol-related conditions and chronic alcoholic visceropathy, leading to delayed dyslipidemia progression, diminished insulin resistance, improved blood rheological properties, and suppressed chronic systemic inflammation and also proving its role in the prevention of renal vascular injury and toxic (ethanol) encephalopathy. Meldonium therapy showed positive effects in delaying the progression of dyslipidemia, diminishing insulin resistance, improving blood rheological properties, and suppressing chronic systemic inflammation and also proved its role in preventing renal vascular injury and toxic (ethanol) encephalopathy, which confirmed the versatility of the cytoprotective effect of meldonium. CONCLUSION: The drug has proved to be effective and safe in hemodynamic, electrolytic, hepatic, and other parameters, which makes it expedient to include meldonium in the day-hospital formulary of drugs for a preventive parenteral cycle according to the developed regimen (a 10-day cycle at least 1-2 times a year) for patients at high risk for social diseases and their complications.

[Peculiarities of clinical course, treatment and prognostication of acute coronary syndrome without ST segment elevation in patients with iron deficiency anemia].

Combined therapy with antiaggregants and anticoagulants is a routine practice in the management of acute coronary syndrome without ST segment elevation (AC-ST) in patients with iron deficiency anemia. But some of these patients are at high risk of hemorrhagic complications. This work is aimed at choosing the therapeutic strategy for such patients. The retrospective analysis of medical cards of 2473 patients referred to the Department of Cardiac Animation with diagnosis of AC-ST included the estimation of the efficacy and safety of anticoagulant dalteparin sodium introduced in the treatment of iron deficiency anemia in terms of the frequency of thrombotic and hemorrhagic complications and prognosis of the outcome compared with the patients given no anticoagulants. The prospective study included 83 patients. The antithrombotic treatment should be prescribed to such patients taking account of the risk of thrombotic complications. High frequency of iron deficiency anemia in patients with CS-ST necessitates elucidation and assessment of hemorrhage risk factors (CRUSADE scale) the results of which determine the choice of modalities for further treatment.

[Comorbidity].

Terminology and synonyms of comorbidity are discussed in much detail along with historical prerequisites of combined pathology, factors influencing its development and progression, and classifications of its variants. A review of advantages and drawbacks of the most popular models of comorbidity and methods of its evaluation based on standard scales is presented. Much attention is given to the structure of definitive diagnosis and principles of its formulation.

[Medical and social implications of sexual dysfunction and safety of antihypertensive therapy in hypertensive patients].

To determine the effect of valsartan on the androgen status and erectile function in hypertensive patients. 60 hypertensive patients of 40-65 years of age were included in the study. All patients filled in the questionnaire on aging male symptoms scale and international index of erectile function before and 3 months after the course of antihypertensive therapy. Patients of the first group received angiotensin II receptor antagonist (valsartan) as monotherapy. Valsacor was administered starting from the first 24 hours after destabilization of blood pressure, and the dose was titrated from 80 up to 160 mg/day. Traditional treatment of hypertension including angiotensin converting enzyme inhibitors, calcium antagonists, diuretics and beta-blockers was prescribed to controls. Valsacor treatment reduced the intensity of the symptoms of erectile dysfunction in hypertensive males (by 11,3 against 2,2% in the control group, p<0,05). In addition, this therapy led to a decrease in androgen deficiency symptoms (20,2 against 12,1%, respectively, p < 0,05). Systolic and diastolic blood pressure reduction was comparable in both groups. There was an increase in the number of "dippers" at valsacor treatment, while the number of other categories ("over-dipper", "non-dipper", "night-peaker") decreased (p<0,05). In the control group, circadian blood pressure profile was not changed. Thus, therapy with valsartan normalizes diurnal variations in blood pressure, reduces the symptoms of androgen deficiency and does not contribute to erectile dysfunction.