[Antiastenic effect of sequential levocarnitine and acetylcarnitine therapy in patients with cardiovascular diseases]. / Antiastenicheskii effekt posledovatel'noi terapii levokarnitinom i atsetilkarnitinom patsientov s serdechno-sosudistoi patologiei.

OBJECTIVE: Evaluation of the antiasthenic effect of sequential therapy with levocarnitine (LC) and acetylcarnitine (ALC) in patients with arterial hypertension and/or ischemic heart disease (CHD) with asthenic syndrome (AS). MATERIAL AND METHODS: An open comparative study included 120 patients aged 54-67 years in patients with arterial hypertension and/or coronary artery disease with AS. Patients of group1 (n=60), in addition to basic therapy for the underlying disease, received LC (Elcar solution for intravenous and intramuscular injection of 100 mg/ml, the company PIQ-PHARMA) intravenously for 10 days at a dose of 1000 mg/day, followed by a transition to oral administration of ALC (Carnicetine, the company PIQ-PHARMA) 500 mg (2 capsules) 2 times a day for 2 months. Group2 patients (n=60) received only basic therapy for major diseases. The duration of observation was 70 days. The severity of AS was assessed using the MFI-20 questionnaire (MultidiMensional Fatigue Inventory) and the visual analog scale VAS-A (Visual Analog Scale Measuring fatigue). RESULTS: In patients of group1, a statistically significant decrease in various manifestations of AS was noted. The differences were significant both in comparison with the baseline level and in comparison with the 2nd group. The endothelium-protective effect of LC and ALC has been established. CONCLUSION: The results obtained indicate that in such comorbid patients, the use of LC and ALC reduces the severity of AS manifestations, and the established endotheliotropic properties of the drugs allow them to be recommended as part of the complex personalized therapy of patients with cardiovascular diseases.

[Possibilities of sequential levocarnitin and acetylcarnitin treatment in correcting cognitive deficiency in patients with cardiovascular diseases]. / Vozmozhnosti posledovatel'noi terapii levokarnitinom i atsetilkarnitinom v korrektsii kognitivnogo defitsita u patsientov s serdechno-sosudistoi patologiei.

OBJECTIVE: To evaluate the effectiveness of sequential therapy with levocarnitine and acetylcarnitine in patients with cardiovascular pathology (arterial hypertension and/or coronary heart disease) and moderate cognitive deficits. MATERIAL AND METHODS: The study included 120 patients aged 54-67 years. The main group of patients (n=60) in addition to the basic treatment of the underlying disease received l-carnitine (Elkar solution for intravenous and intramuscular injection of 100 mg/ml, the company «PIK-FARMA¼)/jet during 10 days in a dose of 1000 mg/day, with following transition to oral administration of acetyl-l-carnitine (Carnitin, the company «PIK-FARMA¼), 500 mg (2 cap Sula) 2 times a day for 2 months. The comparison group (n=60) received basic therapy for major diseases. The total duration of follow-up was 70 days. RESULTS: The results obtained indicate that in such comorbid patients, the use of levocarnitine and acetylcarnitine reduces the severity of cognitive deficits. An important aspect of their pathogenetic effect on the severity of cognitive deficits may be the possibility of correcting endothelial dysfunction. The use of levocarnitine and acetylcarnitine in patients with cardiovascular pathology has demonstrated good tolerability and safety.

[Effect of Tadalafil SZ on endothelial function in patients with erectile dysfunction].

The aim of the study was to assess the efficacy and safety of taking tadalafil at a dose of 5 mg per day or 20 mg "on demand" for the state of endothelial function, the severity of erectile dysfunction (ERD) and urodynamics in men with mild to moderate ERD. MATERIALS AND METHODS: The study included 60 male patients with benign prostatic hyperplasia aged 44 to 60 years with erectile dysfunction and cardiovascular pathology (arterial hypertension, ischemic heart disease). All patients were divided into 3 groups of 20 people. Patients of the 1st group for the treatment of ERD were prescribed tadalafil (Tadalafil SZ, NAO Severnaya Zvezda) in a daily dose of 5 mg / day. Men of the 2nd group took tadalafil 20 mg "on demand", but at least 1 time per week. The third group, in which tadalafil was not prescribed, served as a control. The duration of the study was 4 weeks. RESULTS: A significant effect of tadalafil on indicators of endothelial dysfunction (endothelin-1, nitric oxide, stiffness and reflection index, endothelial function indicator) was demonstrated. The use of tadalafil at a dose of 5 mg daily for four weeks has been shown to be advantageous compared to the use of 20 mg "on demand". Daily intake of tadalafil at a dose of 5 mg and 20 mg "on demand" was safe for patients with cardiovascular disease. CONCLUSION: The data obtained make it possible to recommend this drug for the correction of endothelial dysfunction in patients with benign prostatic hyperplasia, including patients with concomitant cardiovascular diseases.

[Influence of Therapy With Fixed Combination of Perindopril and Amlodipine on Parameters of Elasticity of Main Vessels and Microcirculation in Patients With Arterial Hypertension and Type 2 Diabetes Mellitus].

OBJECTIVE: to assess in patients with arterial hypertension and type 2 diabetes the effect of perindopril / amlodipine fixed combination on arterial wall stiffness (AWF) and microcirculation, and relationship between AWF parameters and the state microcirculation. MATERIALS AND METHODS: We included in this study 30 patients aged 45-65 years. All patients received fixed perindopril arginine / amlodipine besylate combination for 12 weeks. Examination included measurement of AWF of main arterial blood vessels and evaluation of the state of microcirculation. RESULTS: Target blood pressure was achieved in 100 % of patients. Mean values of pulse wave velocity of elastic and muscle-type vessels decreased by 8.5 and 10.3 %, respectively; number of patients with paradoxical test also significantly decreased (p>0.05). Shunting index and myogenic tone significantly decreased by 21 and 33.6 %, respectively. We also observed significant reduction of endothelium-dependent tone component (Δ%=36.3 %), significant rise of mean value of perfusion (Δ%=19.7 %), and significant increase of the respiratory test index (Δ%=4.5 %). There was a statistically significant redistribution of patients by types of microcirculation: the percentage of patients with hyperemic type increased from 26.7 to 43.3 %. CONCLUSION: In patients with arterial hypertension and type 2 diabetes mellitus perindopril arginine / amlodipine besylate fixed combination demonstrated high antihypertensive efficacy, positive effect on parameters of elasticity of main vessels and microcirculation.

BOWEL DISORDERES IN PREGNANT WOMEN: CONSTIPATION DURING PREGNANCY.

Constipation is a common symptom during pregnancy. The majority of cases are simple constipation that occurs due to a combination of hormonal and mechanical factors affecting normal GI function. However, a number of women suffer from constipation prior to conception and find their symptoms worsen during pregnancy. Patients with simple constipation can usually be treated by diet recomendation, physical activity. Medications are best avoided but if necessary should be taken under supervision using best available evidence, It is important that all patients be evaluated by detailed history, physical examination and basic investigations to outrule GI pathology that may be present in a small number of cases.

[The clinical significance of insulin resistance, impaired carbohydrate and lipid metabolism in the development of microcirculation pathology in patients with chronic heart failure and type 2 diabetes mellitus].

Patients with chronic heart failure and diabetes mellitus type 2 experience continuous progression of organ damage as a result of hemodynamic and metabolic disorders. An important role in pathogenesis of organ damage belongs to pathological types of microcirculation, endothelial dysfunction and insulin resistance. But the role of insulin resistance and its contribution to the formation of endothelial dysfunction and peculiarities of microcirculation in patients with chronic heart failure and type 2 diabetes mellitus is unknown. This study shows significant association between insulin resistance, disorders of carbohydrate and lipid metabolism, development of microcirculatory disturbances and endothelial dysfunction.

[Unsolved problems of cytoprotective therapy in patients with coronary heart disease].

The paper gives data on the proven efficiency of myocardial cytoprotection with the pFOX inhibitors trimetazidine and meldonium for coronary heart disease. However, no algorithm has been defined for their differentiated use at different ischemic remodeling stages in these patients in terms of the mechanism of metabolic effects. Sequential use of meldonium and trimetazidine in different periods of acute and chronic myocardial ischemia may become one of the possible ways to increase the efficacy of the pFOX inhibitors.

[Use of meldonium in the combination treatment of patients with heart failure in the early postinfarction period].

AIM: To evaluate the impact of 10-14-day intravenous administration of meldonium as part of combination therapy in patients with chronic heart failure in the early post-infarction period on the recovery period, structural and functional parameters, and heart rate variability (HRV). SUBJECTS AND METHODS: The investigation enrolled 60 patients (men and women) aged 45 to 75 years at weeks 3-4 after post-myocardial infarction with symptoms of Functional Class II-III heart failure. All the patients underwent 24-hour electrochocardiography monitoring, cardiac echocardiography, and HRV study. After dividing the patients into 2 groups, Group 1 (a study group) (n = 30) was given intravenous meldonium (idrinol) 1000 mg/day in addition to the basic therapy of coronary heart disease. The patients in the study and control (Group 2; n = 30) groups were at baseline matched for age, gender, disease severity, and basic therapy pattern. RESULTS: Following 10-14 days of treatment, both groups showed clinical improvement and the favorable changes in cardiac structural and functional parameters and HRV values, which were more pronounced in the patients receiving meldonium. CONCLUSION: The patients with CHF using meldonium as part of combination therapy in the early post-infarction period were observed to have clinical improvement, a significant reduction in the rate of angina attacks and in the need for nitrates, a decrease in the number of arrhythmic and ischemic episodes, and favorable changes in cardiac structural and functional parameters and HRV values.

[Role of pFox inhibitors in the treatment of patients with acute myocardial ischemia].

AIM: To evaluate the anti-ischemic and anti-anginal efficacy of meldonium (Idrinol) in its short-term use as part of combination therapy in patients with chronic heart failure in the early post-infarction period. SUBJECTS AND METHODS: The investigation enrolled 60 patients (men and women) aged 45 to 75 years at weeks 3-4 after postmyocardial infarction with symptoms of Functional Class II-III heart failure. All the patients underwent physical examination, 24-hour ECG monitoring, heart rate variability (HRV) study, and quality of life assessment using the Seattle questionnaire. After randomization of the patients into 2 groups, Group 1 (a study group) (n = 30) was given intravenous Idrinol 1000 mg/day in addition to the basic therapy of coronary heart disease. The study and control (Group 2; n = 30) groups were matched for age, gender, disease severity, and basic therapy pattern. RESULTS: Following 10-14 days of treatment, both groups showed clinical improvement and the autonomically normalizing effect of meldonium (Idrinol), which were more pronounced in Group 1 patients. CONCLUSION: Meldonium (Idrinol) was effective when parenterally administered in a dose of 1000 mg/day for 10-14 days as part of combination therapy in the early post-infarction period, which showed up as clinical improvement, a significant reduction in the frequency of angina attacks and in the need to use nitroglycerin, a decrease in the number of arrhythmia episodes, and its normalizing effect of HRV.

[Additional advantages of mexicor used in combined therapy of coronary heat disease and diabetes mellitus of 2nd type].

This open prospective randomized 16-week study of combined therapy of coronary heat disease (CHD) and and diabetes mellitus of 2nd type (DM2) with secondary non-alcoholic fatty liver disease (NAFLD) including mexicor was designed to estimate structural and functional liver characteristics. Mexicor was shown to act as a hepatoprotector reducing the frequency of cytolithic syndrome when used together with statins in combined therapy of atherogenic dyslipidemia. It also significantly decreased the number of patients with elevated levels of gamma-glutamyltranspeptidase. These changes suggest favourable prognosis for patients with CHD and DM2 because enhanced activity of this enzyme is believed to be a predictor of high cardiovascular risk. Mexicor promoted combined hypolipidemic effect, reduced the degree of insulin resistance, improved hepatic metabolism, and lowered cardiovascular risks in patients with CHD and DM2.

[Impaired cardiac structural and functional parameters in patients with chronic heart failure and diabetic cardiac autonomic neuropathy].

AIM: To reveal the specific cardiac structural and functional features in patients with chronic heart failure (CHF) and diabetic cardiac autonomic neuropathy (CAN). SUBJECTS AND METHODS: Ninety patients aged 45-70 years with Functional Class I-III CHF in the early post-myocardial infarction period and with type 2 diabetes mellitus (DM2) were examined. A study group of 60 patients had signs of CAN (Group 1); a control group of 60 patients presented with CHF and DM2 without signs of CAN (Group 2). RESULTS: The patients with CHF and DM2 with the manifestations of CAN were found to have higher left ventricular mass indices and greater QT dispersion than those with CHF and DM2 without CAN; there was a significant decrease in heart rate variability and a statistically significant preponderance of hypersympathicotonia. CONCLUSION: A clinically important relationship was found between cardiac autonomic dysregulation, CAN severity in patients with CHD and DM2 and cardiac structural and functional parameters.

[Mildronate effects on oxidant stress in type 2 diabetic patients with diabetic peripheral (sensomotor) neuropathy].

AIM: To clarify mildronate effects on oxidant stress and tissue oxygen in combined treatment of peripheral (sensomotor) neuropathy in patients with type 2 diabetes mellitus (DM). MATERIAL AND METHODS: An open randomized trial investigated 70 matched patients with type 2 DM and sensomotor neuropathy. They were randomized into two groups. The study group received basic anti-diabetic treatment, alpha-lipoic acid and mildronate for 3 months. Patients of the control group received the same treatment but mildronate. RESULTS: Mildronate administration improved clinical condition of the study group patients vs controls by neuropathy and symptoms count scales, electrophysiological properties of the nerve fibers, optimization of oxygen tissue balance, reduced production of lipid peroxidation products and activated enzymes of antioxidant defense. CONCLUSION: It is recommended to add 1 g/day mildronate to standard schemes of treatment for diabetes and sensomotor neuropathy.

[The interrelationship of the intensity of free-radical oxidation to the level of serum bilirubin in lesions of the hepatobiliary system]. / Vzaimosviaz' intensivnosti svobodnoradikal'nogo okisleniia s urovnem syvorotochnogo bilirubina pri porazheniiakh gepatobiliarnoi sistemy.

The level of lipid peroxidation (LPO) products increases in the blood of patients with chronic diseases of the liver and acute cholecystitis with mechanical jaundice. The values normalize after surgery for acute cholecystitis, whereas therapy for chronic diseases of the liver virtually does not correct them. These data demonstrate the relationship between intensity of free-radical oxidation and severity of hepatobiliary process and between plasma content of LPO products and level of serum bilirubin.