[Disorders of vitamin D metabolism in clinical practice].

Results of recent studies give evidence of a pandemic of vitamin D deficiency due largely to insufficient exposure to sunlight. Epidemiological surveys demonstrated that vitamin B deficiency corresponding to blood calcidiol levels below 75 nmol/l or 30 ng/ml has negative effect on human health, increases the risk of cardiovascular disorders, malignant neoplasm, autoimmune and infectious diseases in proportion to the severity of deficit. Patients with extreme deficiency (calcidiol levels below 25 nmol/l or 10 ng/ ml) suffer osteomalation/rickets, diffuse muscular pain, myodystrophy, and enhanced risk of osteoporosis. Vitamin D replenishment reduces the risk of bone fracture, neoplastic growth, diabetes of both types, infectious, cardiovascular and autoimmune diseases. Being devoid of toxicity, vitamin D may be prescribed in a wide range of doses to patients from a variety of populations.

[Clinical significance of disturbed calcium metabolism].

The authors present literature data on the role of Ca-P metabolism and its regulators in the development of bone and cardiovascular pathology, intrauterine development, organogenesis, cell growth and differentiation. A large number of agents are currently available to modify Ca-P metabolism. (calcium and vitamin Dpreparations, PTH, calcitonin, stimulators of Ca-sensitive receptors, calcitriol receptor ligands, etc.) although their application is hampered by the dificulty of laboratory control and the lack of basic knowledge. It is maintained that raising awareness among practitioners about these issues may improve diagnostics of Ca-P metabolic disorders (in the first place, calcium and vitamin D deficiency, secondary hyperthyroidism) and promote their medicamental and non-medicamental therapy.

[Polymyalgia rheumatica and giant-cell arteritis].

The subjects of the study were 112 patients with rheumatic polymyalgia (RPM) and giant-cell arteritis (GSA). The study shows that RPM and GSA are complicated by cerebral flow disturbances and myocardial infarction. Therapy with prednisolone and non-steroid antiinflammatory drugs reduces the risk of these complications and lethal outcome in patients with RPM and GSA.

[Comparative effectiveness of antibacterial drugs in the treatment of reactive arthritis]. / Sravnitel'naia éffektivnost' antibakterial'nykh preparatov v lechenii reaktivnogo artrita.

The authors have studied efficacy of various antibacterial drugs in reactive arthritis (RA). A comparative randomized trial was made of efficacy of doxocycline (DC) in a dose 200 mg/day, erythromycin (EM) in a dose 2 g/day, co-trimoxazole (CT) in a dose 1920 mg/day, cyprofloxacin (CF) in a dose 1 g/day in 79 RA patients. Each of the drug was given as two three-week courses with a 3-week interval. The patients were followed up for 12 months. The assessment of the drugs effect on the articular syndrome and the symptoms of the infectious focus was made with the use of computer questionnaire. 3-month remission was achieved in 9 DC patients (43%), 5 EM patients (24%), 6 CF patients (32%) and only in one CT patient (6%). Suppression of the infectious foci was similar for all the drugs tested during the follow-up period. Within the first three months of the trial DC had significant advantages over the other antibiotics in management of the articular syndrome. CF was highly effective (p < 0.001) in patients with RA running up to one year. The conclusion is made that suppression of the symptoms of the focal infection is not sufficient for RA effective treatment, antibiotics vary significantly by their effect on the course of the articular process.

[Antibacterial drugs in the treatment of osteoarthrosis: results of a prospective randomized trial]. / Ispol'zovanie antibakterial'nykh preparatov v lechenii osteoartroza: rezul'taty prospektivnogo randomizirovannogo issledovaniia.

65 patients with knee and hip joints osteoarthrosis with concomitant urinary infection and/or irritable colon syndrome were randomized into three groups: group 1 (21 patients) received doxicyclin 200 mg/day with nistatine for three weeks with 3-week interval between the courses and bifidum-bacterin administration between the courses and after the treatment; group 2 (22 patients) received biseptol 1920 mg for 3 weeks then 960 mg 10 days a month; group 3 (22 patients) consisted of controls who received no antibacterial drugs. The effect was assessed upon randomization, 3 weeks, 3, 6 and 12 months after the treatment. It was established that antibacterial treatment not only attenuated dysuria and dyspepsia but also had a significant positive effect on osteoarthrosis especially in patients with x-ray stage II, allowed to reduce doses of nonsteroid antiinflammatory drugs. Further studies will help specify the role of the infection factor in development of osteoarthrosis and potential of antibacterial treatment.

[Clinical aspects of trimetazidine (preductal) administration as an antianginal drug]. / Klinicheskie aspekty primeneniia trimetazidina (preduktala) v kachestve antianginal'nogo preparata.

AIM: To study antianginal effectiveness of trimetazidine (TMS) in monotherapy and combined antianginal therapy; to design approaches to prediction of its effect. MATERIAL AND METHODS: An open cross-over randomised trial enrolled 29 anginal patients. They were given a single TMS dose (60 mg) and its effect was compared to that of placebo, propranolol, verapamil, isosorbide dinitrate, nifedipine). The effect was estimated by an increment of bicycle exercise (BE) duration necessary to depress ST segment by 1 mm. 10 patients retained signs of myocardial ischemia at BE though they were treated with specially selected antianginal drugs. In them, we assessed additional benefit of adjuvant TMS. The drugs were tried under acute test and one-month treatment. RESULTS: In acute test a significant antianginal effects of TMS were registered against the placebo. Differences in efficiency of the antianginal drugs were insignificant. The addition of TMS to the selected drugs gave rise to the trend to prolongation of time to ST segment depression by 1 mm. We found a strong correlation between TMS efficiency in acute pharmacological test and in long-term administration. This enables using BE for prediction of long-term effect of the drug. CONCLUSION: TMS has a significant antianginal effect. It is especially beneficial in cases of insufficient effectiveness of conventional antianginal drugs or when their use is problematic because of marked disturbances of hemodynamics.

[Extrahepatic syndromes (vascular manifestations) in patients HCV infection]. / Vnepechenochnye sindromy (sosudistye proiavleniia) u patsientov, infitsirovannykh virusom gepatita C.

The authors report 4 cases with hepatitis C infection running with vascular disorders: Raynaud syndrome (3 cases), mixed cryoglobulinemia (1 case), primary pulmonary hypertension (1 patient). Whether hepatitis C virus contributes to vascular disturbances is discussed and relevant literature is reviewed.

[Etiology and treatment of temporal arteritis]. / K étiologii i lecheniiu visochnogo arterita.

A questionnaire survey covered 11 females with temporal arteritis (CA) and 20 healthy controls. Gastrointestinal, joint and spinal complaints were significantly more frequent in CA patients. Clinical characteristics of joint and spinal disorders in CA patients are close to those of chronic reactive arthritis. It is suggested that Horton's disease may be lacking as a stage of the infectious process in elderly patients (chronic intestinal and/or urinary infection-reactive arthritis-CA). A case is reported where CA developed after intestinal and urinary infection. Administration of antibiotics for treatment of the recurrence induced a continuous remission under reduced doses of glucocorticoids. In another case biseptol + glucocorticoids brought about a persistent remission allowing glucocorticoid discontinuation.

[The antianginal efficacy of calcium antagonists in men and women at 60 and older. Approaches to predicting the effect of the preparations]. / Antianginal'naia éffektivnost' antagonistov kal'tsiia u muzhchin i zhenshchin v vozraste 60 let i starshe. Podkhody k prognozirovaniiu éffekta preparatov.

20 mg of nifedipine, 160 mg of verapamil and 120 mg of diltiazem were given to 53 patients aged 60-90 (33 males and 20 females) with stable angina pectoris and painless myocardial ischemia. Bicycle exercise tests employed to evaluate antianginal activity of the above drugs showed them to significantly prolong the period of exercise free of a 1-mm depression of the ST segment. This was true both for males and females. In females nifedipine produced the weakest effect. Anti-ischemic activity of the drugs appeared to depend on the presence of arterial hypertension and voltage signs of left ventricular hypertrophy, initial exercise tolerance and heart rate, blood triglyceride concentrations, left ventricular end-diastolic volume, the size of the left atrium, interventricular septum thickness, etc. To prognosticate the effect of each of the 3 drugs as well as nifedipine paradoxical action in some patients the authors propose to use classification trees, providing a significant branching virtually in all relevant points.

[The tourniquet test in evaluating the analgesic action of antianginal preparations]. / Turniketnyi test v otsenke obezbolivaiushchego deistviia antianginal'nykh preparatov.

Twenty-two patients with coronary heart disease (CHD) were examined for pain threshold and pain tolerance by a tourniquet test. The relationships between pain and ST segment depression were studied simultaneously during bicycle exercise. Pain sensitivity was measured in response to action of various antianginal drugs (isosorbide dinitrate, verapamil, nifedipine, diltiazem, propranolol, atenolol) and placebo. Reproducibility of the tourniquet test proved satisfactory. There were significant correlations between tourniquet test evidence and clinical patterns of ischemic myocardial episodes: significant differences in the values of pain threshold and pain tolerance in patients with painful myocardial ischemia, in combination of angina of effort with painless myocardial ischemia (p < 0.0001). Significant were also correlations between tourniquet test findings at bicycle exercise and value describing the proportion of ST depression to pain. As for the drugs, verapamil appeared most active in the tourniquet test (p < 0.02 and p < 0.05 for pain threshold and pain tolerance, respectively). Pain tolerance changes due to isosorbide dinitrate were somewhat greater than for placebo (p = 0.06). The study provided evidence in support of the adequacy of the tourniquet test for assessment of general pain sensitivity and pain sensitivity to myocardial ischemia as well as of analgetic effects of the drugs. Verapamil and isosorbide dinitrate are suggested to have analgetic activity.