[Pleiotropic effects of phlebotropic drugs: from pharmacological advantages to adverse drug interaction]. / Pleiotropnye éffekty flebotropnykh preparatov: ot farmakologicheskikh preimushchestv do nezhelatel'nogo lekarstvennogo vzaimodeistviia.

A distinctive property of phlebotropic drugs consists in their intrinsic capability of exerting pronounced pleiotropic (multiple) effects. The authors discuss the fundamental mechanisms of pleiotropy, advantages and disadvantages of various types of targeted therapy (mono- and polytargeted therapy) in treatment of chronic venous diseases. Special attention is paid to analysing the nature of adverse drug interactions, methods of reducing the risk of their development. An electronic service known as the Drug Interactions Checker is proposed as a tool for assessing drug interactions in everyday practice of the angiologist/phlebologist.

[Pneumonia at a multidisciplinary hospital].

AIM: To reveal the clinical and morphological features and predictors of a fatal outcome in patients with community-acquired pneumonia. MATERIAL AND METHODS: The results of almost 6,500 autopsies were studied; out of them there were 1631 (25%) deaths from pneumonia: 134 and 1497 cases occurring at home and at hospital, respectively. RESULTS: Both groups were considered in terms of pneumonia as a primary disease or as a fatal complication, with 6.4% having the former and 93.6% having a fatal complication of chronic obstructive pulmonary disease, chronic alcohol intoxication, cardiovascular diseases, or cancers. After negative prognosis assessment using the CURB-65 scale, pneumonia was rated as severe and requiring admission to the intensive care unit in 92% of the cases; PORT scale assessment showed that 60% cases of pneumonia necessitated hospitalizations to these units. The major clinical and morphological form of pneumonia was established to be disseminated, lobular, or overwhelming. CONCLUSION: In practice, risk factors for death are underestimated; the disease course is not monitored; current diagnostic and therapeutic approaches are inadequately applied.

[Optimization of the treatment of chronic obstructive pulmonary disease in men with androgen deficiency].

Chronic obstructive pulmonary disease (COPD) is a widespread condition markedly deteriorating quality of life; it is the fourth most frequent cause of death after cardiovascular diseases, diabetes mellitus and injuries. There is significant association between the severity of androgen deficiency occurrence, duration and pharmacotherapy of COPD. Androgen deficiency in men should be regarded as a new systemic pathogenetic mechanism of COPD complicating its clinical course, prognosis of the disease and concomitant pathologies. Therefore, pharmacotherapy of COPD should be prescribed taking into account the androgenic status of the patients.

[Hypertensive crisis: pathogenesis, clinic, treatment].

Contemporary data on mechanisms of development, types, and clinical picture of hypertensive crisis (HC) are presented. Algorithms of rational therapy of uncomplicated and complicated HC are considered. Appropriateness of the use in HC of antihypertensive drugs with multifactorial action is stressed. These drugs include urapidil - an antihypertensive agent with complex mechanism of action. Blocking mainly the postsynaptic 1-adrenoreceptors urapidil attenuates vasoconstrictor effect of catecholamines and decreases total peripheral resistance. Stimulation of 5HT1-receptors of medullary vasculomotor center promotes lowering of elevated vascular tone and prevents development of reflex tachycardia.

[Experience in the pre-hospital treatment of acute coronary syndrome with metoprolol succinate].

Patients with acute coronary syndrome and elevated ST segment in the pre-hospital phase were treated with metoprolol succinate (MS) and thrombolytic therapy. Severe and moderate pain decreased by 54.1 and 16.1% respectively within 60 min after MS intake. Systolic (SAP) and diastolic (DAP) arterial pressure dropped by 35.7 and 16.8 mmHg during the same period. The heart rate (HR) decreased by 25.1 beats/min. 21.8 and 25.3% of the patients showed positive dynamics of ST segment 90 and 180 min after intake of MS. The height of the ST segment was normal in 18.4 and 31.0% of the patients respectively. No cases of external heart rupture were documented at autopsy whereas it was a cause of death in 39.1% of the patients given standard thrombolytic therapy. It is concluded that the use of MS starting from the pre-hospital stage in patients with acute coronary syndrome decreases pain intensity. HR, DAP and SAP and helps to prevent heart rupture.

[Prehospital stage of medical aid to patients with acute coronary syndrome and elevated ST segment].

We studied effect of time on the outcome of acute coronary syndrome and elevated ST segment at the prehospital stage. Logistic regression analysis revealed two time-dependent predictors: "symptom-needle" time and total call service time. In patients undergoing prehospital thrombolysis, these indices (88 and 85 min respectively) reliably predicted the probability of fatal outcome. Their values of 71 and 77 min respectively predicted the risk of unfavourable outcome. The total call service time may serve as an indicator of the quality of work of an ambulance crew at the prehospital stage of management of acute coronary syndrome with elevated ST segment.

[Hypogonadism and chronic obstructive pulmonary disease].

Chronic obstructive pulmonary disease (COPD) is a systemic disease that affects not only the respiratory system. Sex hormones deficiency in men can be correlated with the COPD stages and make a negative contribution during its progression. Up to date, there are no long-term trials evaluating the effects of androgens on the parameters of respiratory function in patients with COPD. Changes of testosterone levels in patients with COPD correlate with forced expiratory volume, and hypoxemia and hypercapnia levels. Glucocorticosteroids exacerbate androgen deficiency in patients with COPD, and the use of hormone replacement therapy with testosterone in these patients is justified. Androgens, in particular drug nebido, testosterone depot, can be effectively used in treatment and rehabilitation of patients with COPD.

[Effect of combined hormonal oral contraception on the somatic and psychic status of women of reproductive age].

The paper is devoted to the topical problem of maintaining somatic and psychic health of the women of reproductive age by rational pregnancy planning and prevention of abortions by modern methods of contraception including combined oral hormonal contraception. Unfortunately, this approach is rarely employed in this country (5-6%). Results of retrospective analysis of medical documentation, clinical efficacy and safety of modern combined oral hormonal contraception are presented.

[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.

[Osteoarthritis and cardiovascular diseases in elderly patients: clinical and pathogenetic interrelationship].

Osteoarthritis (OA) is one of the most common medical conditions in elderly people. This article presents the survey data on a problem of poly-morbidities (co-morbidities) at osteoarthritis. Special attention is paid to a combination of osteoarthritis with cardiovascular pathology, and also the data testifying the association between osteoarthritis and the increased death rate from cardiovascular pathology. On the basis of the literature data analysis a hypothesis about an etiopathogenic interrelation between osteoarthritis and cardiovascular pathology is presented. According to the authors, potential pathogenetic links include a chronic nonspecific inflammation and metabolic infringements. There are also evidences that vascular pathology may initiate and/or worsen the disease progression. The important factors aggravating a current cardiovascular disease in patients with osteoarthritis are: the restriction of physical activities and irrational pharmacotherapy of osteoarthritis clinical symptoms (increased risk of cardiovascular accidents is considered as a class-specific side-effect for all NSAIDs). The authors present the own data on rational pharmacotherapy of patients with osteoarthritis and somatic pathology by means of SYSADOA influencing the disease symptoms and being able to modify structural changes (glucosamine, chondroitine sulphate - ARTRA).

[Benign prostate hyperplasia as an age-related problem].

The incidence of genitourological diseases is greater that that of circulatory disorders, benign prostate hyperplasia (BPH) is the commonest urological disease in the elderly and senile males. According to the results of the authors' clinicomorphological study, BPH has been detectable in 69% of the males who died at the age of above 60 years. BPH frequently occurs in patients with arterial hypertension, diabetes mellitus, coronary heart disease, and metabolic syndrome, which necessitates a search for the commonness of causes or mechanisms of development of these diseases. The most important complication of BPH is acute urinary retention. Its major causes in therapeutic clinic are recurrent chronic prostatitis, decompensation of circulatory insufficiency, and emergencies generally resulting from alcohol abuse. As this takes place, the worst prognosis is observed in elderly patients with the complicated comorbid status, particularly in the presence of chronic alcohol intoxication. Patients with BPH are at high and surgical treatment-unassociated risks for pulmonary arterial thromboembolism (PATE). In these patients, the causes of PATE are pelvic deep vein thromboses whose incidence in clinical practice is underestimated.

[Safety of long-term replacement hormonal therapy in patients with erectile dysfunction and androgen deficiency].

Safety of testosterone undecanoate in relation to initiation of cancer and prostatic adenoma (PA) in patients with androgenic deficiency and erectile dysfunction (ED) was studied for 12 months in 49 patients aged 57 to 73 years treated with intramuscular testosteron injections. The size of the prostate in patients with adenoma was 46.34 +/- 21.12 cm3 while in adenoma-free patients--19.11 +/- 6.57 sm3. Diabetes mellitus of type 2 (DM-2) was diagnosed in 46.9% patients. All the patients had documented hypogonadism and ED. Tests for PSA and transrectal ultrasound investigation was made in all the patients. 12 month testosterone therapy produced normalization of a mean level of testosterone in both groups, index of erectile function increased. In one patient PSA rose higher than normal value. None of the patients developed obstruction of the urinary tract. Body mass index, lipid spectrum and carbohydrate metabolism also improved. Thus, long-term therapy with testosterone undecanoate has no effect on PSA level, does not induce urinary obstruction with enlarged prostate. The presence of DM-2 is not a contraindication for androgen therapy in adenoma patients. By reducing body mass index, total cholesterol, triglycerides and LDLP, testosterone therapy lowers the risk of prostatic cancer.

[Foreign experience in registering and analyzing the poor outcomes of treatment].

Negative consequences of treatment are observed at least in 16% patients at multidisciplinary hospitals and may result from the causes that are independent of medical staff, but more frequently from errors and inadequate treatment standards due to human factors. Systematic improvement of professionalism, which should be started from some educational reforms at medical institutes, is needed.

[Nebivolol effects on the cardiovascular system and the kidneys in pregnant and puerperal women with hypertension].

AIM: To study nebivolol efficacy in pregnant and puerperal women with hypertension. MATERIAL AND METHODS: Monitoring of endothelial function, central and peripheral hemodynamics (HD), myocardial function, intrarenal circulation and microalbuminuria (MAU) was performed in 90 pregnant (67 hypertensive and 23 normotensive) and 18 puerperal women who were diagnosed to have hypertension in pregnancy. The above parameters were estimated in 23 hypertensive gravidas and 18 puerperas treated with nebivolol. RESULTS: Hypertensive gravidas had marked endothelial dysfunction (ED), impaired intrarenal HD, MAU, high total peripheral vascular resistance and left ventricular myocardial mass index (LVMMI). The puerperas with hypertension had ED, MAU, frequently HD disorders and a trend to a LVMMI rise. Nebivolol effectively reduced blood pressure, had a nephroprotective action, and improved HD and endothelial function. CONCLUSION: Nebivolol (a highly selective beta 1-adrenoblocker) administration is effective pathogenetic treatment of pregnant and puerperal women with hypertension and may improve short- and long-term prognoses of such patients.