[Agomelatine (valdoxan) in treatment of endogenous depression in day patient department]. / Terapiya agomelatinom (val'doksan) endogennykh depressii v usloviyakh dnevnogo statsionara.

AIM: Naturalistic psychopharmacological study of efficacy and tolerability of agomelatine (valdoxan) in treatment of endogenous depressions (in the framework of schizophrenia, schizoaffective and bipolar disorder) in day patient department. MATERIAL AND METHODS: Study sample consisted of 37 patient (59.4% female, mean age 41.6±3.7 years). RESULTS AND CONCLUSION: CDS total score significantly reduced after 8 weeks of treatment 44.9% compared to baseline (р<0.001); HAM-D total score decreased on 51.3% compared to baseline (р<0.001). The proportion of responders at the 8th week of treatment was 54.1%. Agomelatine (valdoxan) had favorable safety profile. Follow-up study (up to 24 months) showed stable antidepressive effect and good tolerability profile of agomelatine (valdoxan). There was no withdrawal syndrome after treatment discontinuation.

[Conventional and novel cardiovascular risk factors and predisposition to the development of atherosclerosis].

This population-based cross-sectional study included 472 apparently healthy study participants with an increased risk of cardiovascular disease, including 300 patients with hypercholesterolemia. To assess the susceptibility to the development of atherosclerosis, an ultrasonic evaluation of common carotid arteries was used. It has been confirmed that there exists the geographical gradient of carotid intima-media thickness (cIMT), and it has been shown that this gradient is highly correlated th the known gradient of cardiovascular mortality. It was found that the combination of conventional cardiovascular risk factors can help explaining only 21% variability of cIMT, the marker of generalized atherosclerosis. It was found that a predisposition to atherosclerosis, as measured by a pathological increase in cIMT, should be due to the interaction not only conventional cardiovascular risk factors, but also to genetic and environmental factors.

[Treatment of delirium in the early postoperative period after cardiac surgery].

OBJECTIVE: To assess efficacy and safety of dexmedetomidine for treatment of delirium in cardiac surgery. METHODS: We performed an open, prospective comparative study in 60 patients, who received surgery on the heart or major vessels under general anaesthesia. In the early postoperative period, all patients suffered from delirium. All patients were divided into two groups. The patients in group-I (30 patients) received dexmedetomidine (0.2-1.4 mcg/kg/ hour), 20 of them received dexmedetomidine only and 10 received a combination of dexmedetomidine with haloperidol and midazolam. Patients in group-2 received haloperidol 5 mg 3 times a day intramuscularly and 0.1 mg/kg intravenously separately and in combination with benzodiazepines (midazolam, relanium). All patients received analgesia with ketoprofen 100 mg each 12 hours and trimeperidin 20 mg intramuscularly. RESULTS: In 67% of all patients the symptoms of delirium occurred on the 1st or 2nd day after surgery. A hyperactive type of delirium dominated (> 77%). The average lasting time of delirium was 26.5 hours in group-I and 36.3 hours in group-2 (p = 0.001). Spontaneous breathing occurred in 26 patients (87%) out of group-I and in 18 patients (60%) out of group-2 (p = 0.04). The duration of stay in the ICU was 2.73 days in group-I and 3.5 days in group-2 (p = 0.04). Dexmedetomidine provided an average target level of sedation better according to RASS-scale (p = 0.001). 10 patients (33%) of group-I and 12 patients (40%) of group-2 received opioids (p = 0.8). Bradycardia as a side effect predominated in group-I (p = 0.01). Respiratory depression predominated in group-I (p = 0.005). CONCLUSIONS: Dexmedetomidine provides an average target level of sedation, decreases duration of delirium and duration of stay in the ICU. Dexmedetomidine does not cause depression of respiration which allows keeping a verbal contact with patients and improving a diagnostics of pain syndrome. The most common side effect of the dexmedetomidine use is a dose-depending bradycardia.

[Dexmedetomidine use for intravenous sedation and delirium treatment during early postoperative period in cardio-surgical patients].

OBJECTIVE OF THE STUDY: to analyze the efficiency and safety of Dexmedetomidine infusion for a short-term controlled sedation and treatment of delirium in the early postoperative period in patients after cardiac surgery. METHODS: open, randomized, prospective study of 28 patients undergoing surgery on the heart or main blood vessels under general anaesthesia. In the early postoperative period all patients received an infusion of Dexmedetomidine (0.2-1.4 microg kg(-1) per hour) for sedation. The analgesia was carried out with Ketoprofen according to the protocol and Trimeperidine if VAS was > or = 3. Sedation and agitation levels were measured by Ramsay and RAAS scales, speed of awaking by Aldrete score. Duration of mechanical ventilation, length of stay in ICU, need for analgesics (VAS scale), type and frequency of side effects and vital signs (Harward standart) were recorded. Type of delirium, time of onset (days after surgery), dose and duration of psychomotor agitation were evaluated in patients with delirium (n = 9). RESULTS: Dexmedetomidine infusion in the medium therapeutic doses resulted mild or moderate sedation remaining up to 12 hours after the infusion. More than 50% of patients had retrograde amnesia. The pain intensity did not exceed 1 point on VAS scale in 96% of patients. 23% of patients required an additional administration of Trimeperidine. The most common side effects were bradycardia (39%) and arterial hypotension (36%). The therapy with Dexmedetomidine provided the most optimal level of sedation compared to other combinations of drugs (haloperidol, midazolam, propofol) in patients with delirium according to sedation-agitation and awaking scales. CONCLUSIONS: Dexmedetomidine provides dose-dependent sedation and retrograde amnesia without altering the verbal contact, does not cause respiratory depression. The drug has independent analgesic effect and proved to be effective in the treatment of delirium. The most frequent side effects of Dexmedetomidine are bradycardia and arterial hypotension.

[Effect of clarithromycin on the systemic inflammatory response syndrome severity in patients after myocardial revascularization surgery].

The aim is to investigate the effectiveness of SIRS pharmacological correction in patients after CABG when adding clarithromycin to the standard antibacterial therapy. Patients of the 1st group (n=25) received Klacid- CP ("Abbott") in perioperative period plus to standard antibacterial therapy (3rd generation cephalosporins), patients of 2nd group received standard therapy. At 1st screening stage, as well as on the 2-nd and 4-th day after operation were recorded data of an anamnesis, concomitant pathology, examination, were measured the level of white blood cells, LII, biochemical blood analysis (CRP), defined the concentration of interleukins (IL-1, 6, 8,10,12) and TNF - a. In all studied patients, laboratory' and physical data did not go beyond the reference values, intraoperation data, blood loss and ALV duration did not statistically differ. According to the results of research in patients of both groups there were manifestations of SIRS in the form of reliable significant increase in body temperature, as well as the level of Il-6, IL-8, CRP, LII, TNF - a, leukocytosis. While in the clarithromycin group body temperature was significantly lower in all time points. The level of CRP for the 4th day in 1.5 times, and TNF in 4 times less than in the control group, and the values of anti-inflammatory IL-10 to the 2nd day, on the contrary almost in 2 times higher than those in the control group. Thus, the obtained data confirmed that the CABG is accompanied by non-inflammatory SIRS development. At the same time clarithromycin gives an independent proven anti-inflammatory effect and can be recommended for application in the schemes of prophylactic antimicrobial therapy during perioperative period in this category of patients.

[Comparative characteristics of lipid components of gallbladder and liver bile fractions in children with chronic cholecystitis]. / Sravitel'naia kharakteristika lipidnykh komponentov puzyrnoi i pechenochnoi fraktsii zhelchi u detei s khronicheskim kholetsistitom.

In the course of this research we studied indices of lipid components--neutral lipids, phospholipids of biliary and fatty acids--and made their comparative assessment in the cystic and hepatic bile fractions in 25 children with chronic cholecystitis (CC). Chronic cholecystitis is characterized by dislipoproteinemia in the cystic and hepatic bile fractions, which is displayed as a reduction of the level of tauroacids and augmentation of glycocholic acid at a simultaneous increase in levels of primary and secondary biliary acids, as an increase in the ratio of levels of free fatty acids and cholesterol esters (CE) against the background of the decreasing number of monoglycerides and CE; as an increase in the ratio of levels of lysophosphatidylcholine (lysoPTC) and phosphatidylcholine against the background of augmentation of lysoPTC and phosphatidylethanolamine; as augmentation of polyene fatty acids in the composition of general lipid bile fractions. It is assumed that the obtained results can be used as indices of efficacy of drugs and non-medicinal preparations prescribed with the purpose of correction of lipid metabolic imbalances in case of chronic cholecystitis in children.

[Lipid metabolism in cholecystitis]. / Metabolizm lipidov pri kholetsistite.

The survey of sources presented discusses the results of the research on lipid metabolism in cases of such a common disease as acute and chronic cholecystitis. The application of modern analytical methods for studying individual lipids of different classes enabled to acquire a better comprehension of metabolism of these major cell membrane components and the main gall-bladder compounds--biliary acids. The role of biliary alcohols in the inflammation process development is studied alongside with that of the known lipid fractions.

[Administration of various dosages of retard isosorbide-5-mononitrate in patients with stable angina pectoris on combined therapy]. / Primenenie razlichnykh dozirovok retardnoi formy izosorbida-5-mononitrata u bol'nykh stabil'noi stenokardiei.

We studied efficiency of a retard form of isosorbide-5-mononitrate (Mono Mac 50D) in patients with stable angina pectoris (NYHA class II and III). This efficiency was assessed by clinical examinations and 24-h Holter ECG monitoring before and after the treatment. 16 patients with angina of functional class II and 12 patients with functional class III received combined treatment: prolonged mononitrate (Mono Mac 50D), disaggregants, beta-blockers, ACE inhibitors and calcium antagonists (on demand). In angina functional class II Mono Mac 50D was given in a single dose 50 mg/day (1 tablet) in the morning for 4 weeks, in functional class III angina the drug was taken for 2 weeks in a dose 50 mg/day, the next two weeks in a dose 100 mg/day once in the morning. The other drugs were taken in moderate recommended doses. After two weeks of treatment with 50 mg/day Mono Mac 50D angina symptoms attenuated (in functional class II) and the patients' condition improved (in functional class III). In elevation of the dose to 100 mg/day the latter patients improved still greater. We think it valid to use a single 50 mg/day dose in angina functional class II and 100 mg once a day in functional class III.

[The use of Cordanum in combination with Corinfar-Retard for the treatment of ectopic arrhythmias in the sick sinus syndrome in patients with ischemic heart disease]. / Primenenie kordanuma v sochetanii s korinfarom-retard dlia lecheniia éktopicheskikh aritmii pri sindrome slabosti sinusovogo uzla u bol'nykh ishemicheskoi bolezn'iu serdtsa.

38 patients with ischemic heart disease (IHD) and sick sinus syndrome (SSS) received combined therapy with nifedipine (Corinfar-Retard) and talinolol (Cordanum). The former drug had a positive chronotropic effect on the heart, the latter's chronotropic effect was slightly negative. All the patients had sinus bradycardia and ectopic arrhythmia which needed therapeutic correction: supraventricular and ventricular extrasystoles, fibrillation paroxysms or/and atrial flutter, paroxysmal supraventricular tachycardia, ventricular tachycardia. Cordanum was given in a dose 50 mg twice a day, Corinfar-Retard 20 mg twice a day for 16 days. 30 patients responded to the treatment. In addition to good subjective response, episodes of extrasystoles, paroxysms, flutter and fibrillation occurred much less frequently. Side effects resulted in the treatment discontinuation in 3 patients.

[Present-day diagnosis of pulmonary thromboembolism]. / O sovremennoi diagnostike tromboémbolii legochnoi arterii.

Main complains, clinical appearance of the disease and laboratory findings have been evaluated for 28 patients with pulmonary embolism and its complications. The diagnosis made at x-ray and computed tomography examination proved valid in 85% of cases confirming the efficiency of their combined use in this disease. The author believe a comprehensive approach promising in solving the problem of pulmonary embolism.