Journal «MEDICINA» 2/2017

The article considers the problem of choosing the most appropriate drugs for replacement therapy of endocrine pancreatic insufficiency. The possible consequences for the budget of the Russian Federation of including in the VED lists a new drug for substitution therapy, Creon^® Micro, are assessed. Authors conclude that the widespread use of this drug will provide for significant budget savings while maintaining the effectiveness of treatment.

Key words: Cystic Fibrosis, Enzyme Therapy, Creon^® Micro, pancreatic enzymes, enteric-cleavage capsules

Purpose: To evaluate a visual acuity dynamics in patients with combined primary open-angle glaucoma (POAG) and non-exudative age-related macular degeneration (ARMD) with a long-term continuous use of lutein-containing drugs.

To evaluate informativeness of visual acuity estimation methods (charts of Sivtsev-Golovin and EDTRS).

Methods: 32 patients (64 eyes) with combined pathology of POAG (initial and advanced stages) and ARMD (AREDS I-II) were divided equally into two groups. The study group received lutein-containing drug Superoptic (Akrikhin, Poland), 1 capsule per day with the meals during 1 year. The control group didn’t receive any lutein-containing drugs during all the study period.

Data received was processed in R Core Team.

Results. By the moment of study beginning in the control group visual acuity (VA) and best corrected visual acuity (BCVA) defined by Sivtsev-Golovin charts was 0,44±0,29 and 0,65±0.26, respectively. In 3 months VA and BCVA have improved and were 0,47±0,30 and 0,68±0,25. In 6 months VA and BCVA were 0,48±0,30 and 0,68±0.26. In a year VA and BCVA were 0,47±0,31 and 0,68±0.26.

Defined by EDTRS, VA and BCVA by the beginning of the study were 31,44±16,40 and 43,84±11,79 respectively. In 3 months VA and BCVA have improved and were 35,69±15,64 and 46,84±11,69. In 6 months VA and BCVA were 37,62±14,35 and 46,81±10,28. In a year VA and BCVA were 38,38±14,74 and 48,69±10,12.

In the control group VA and BCVA, determined by Sivtsev-Golovin chart, by the moment of study beginning were 0,45±0,31 and 0,71±0.21 respectively. During the study, there were insignificant changes in VA and BCVA. In 3 months they were 0,46±0,30 and 0,71±0.20, in 6 months 0,46±0,31 and 0,71±0.20, and in 12 months 0,42±0,27 and 0,71±0.19, respectively.

Defined by EDTRS, VA and BCVA in the control group were 27,78±16,79 and 41,25±9,16; in 3 months they were 27,81±16,68 and 41,09±9,22, in 6 months they were 27,91±16,68 and 1,00±9,04, and in 12 months VA and BCVA were 27,31±16,21 и 40,94±9,04.

Conclusion: Long-term continuous use of lutein-containing drugs in patients with combined pathology of POAG and ARMD leads to the visual acuity improvement.

Using of modified ETRDS charts with Russian optotypes allows to perform a visual acuity examination more precisely.

Key words: glaucoma, age-related macular degeneration, lutein-containing drugs, EDTRS

The aim of the study was to clarify the characteristics of crystallogenic activity of the urine in children with dismetabolic nephropathy and urolithiasis. We used method of classic crystalloscopy for the estimation of crystallogenic properties of urine samples from 44 healthy children and children with dismetabolic nephropathy (n=22) and urolithiasis (n=26). It is established that crystallogenic properties of urine of children are transformed significantly and specific under nephrological pathology, including dismetabolic nephropathy and urolithiasis.

Key words: crystallization, urine, children, dismetabolic nephropathy, urolithiasis

Functional outcomes of rhegmatogenous retinal detachment (RRD) surgery depend on several factors: the duration of the detachment existence, its area, the presence of macular detachment, the stage of proliferative vitreoretinopathy, the presence of early and late postoperative complications, and degree of ischemia of the ocular posterior segment. Indices of blood flow in macular area after surgical treatment of RRD has not been studied enough.

The article presented the microcirculation indices of retinal macular zone following endovitreal surgery of rhegmatogenous retinal detachment studied by means of OCT-angiography. The study included 20 patients (40 eyes) divided into 2 groups. The main group consisted of 20 eyes with primary RRD with the macular zone affected, where the endovitreal surgery was performed. The control group (20 eyes) included the companion eyes without retinal detachment in the same patients. All patients underwent standard ophthalmic examination and additionally OCT-angiography (RTVue 100, Optovue, USA).

It was noted that the blood flow of the «exterior» retina [2] in the operated eyes was less than in the control group and at the time of discharge from the clinic was 1.214±0.141 mm². On the other hand, we observed the increase in the foveal avascular zone in the superficial vascular plexus of the retina, amounting, on the average, to 0,497±0,267 mm². It was also noted that foveal thickness was less in the main group than in the controls one, reaching 219 (196; 251) mkm.

It was revealed that the blood flow area of the «exterior» retina in the operated eyes was lesser than in the control group. We noted the increase in the foveal avascular zone in the superficial vascular plexus of the retina. The thickness of the fovea in the main group was less than in the control one.

Key words: ophthalmology, OCT-angiography, endovitreal surgery, rhegmatogenous retinal detachment

In a last years there has been progress made in introduction of a new drugs for the treatment of uncontrolled focal epilepsy, one of which is brivaracetam. Network meta-analyses show that it has same effectiveness compared with other new drugs and, possibly, better safety profile. Cost minimization analysis show that annual cost of treatment with brivaracetam is 21 thousand rubles lower than treatment with lacosamide, 25 thousand rubles lower than with eslicarbazepine and 95 thousand rubles lower than with perampanel. Gradual replacement of principal drugs used today with brivaracetam will cut Russian Federation budget expenses from 187 million rubles (30% replacement) to 468 million rubles (75% replacement).

Key words: uncontrolled focal epilepsy, brivaracetam, lacosamide, eslicarbazepine, cost-minimization analysis, budget impact analysis

The paper discusses modern diagnostic methods for choroidal neovascularization. Special attention is paid to the state-of-the-art method of diagnosing – optical coherence tomography-angiography (OCT-angiography). It is non-invasive and allows the examination of the vascular structures in three-dimensional regimen. It has high sensitivity and specificity in the choroidal neovascularization detection in macular pathology and presents a feasible alternative to the diagnosing methods of contrast investigation.

Key words: ophthalmology, age-related macular degeneration, choroidal neovascularization, optical coherence tomography-angiography

Over the past decade, the Russian Federation has made significant progress in reducing the prevalence of tobacco consumption. This is the result of adoption in 2010 of the Concept of Implementation of the State Policy on Counteracting Tobacco Use for 2010-2015, and then, in 2013, of Federal Law No. 15-FZ «On the Protection of the Health of Citizens from Exposure of Surrounding Tobacco Smoke and the Effects of Tobacco Use». The principal measures for tobacco control included in the Federal Law are the protection of people from tobacco smoke exposure, assistance to tobacco use cessation, awareness measures regarding tobacco-related harms, introduction of a total ban on advertising, promotion and sponsorship of tobacco products, constantly rising taxes on tobacco products. To continuously provide for the effectiveness of the measures introduced, accurate measurements of the prevalence of tobacco use and a number of other key indicators are needed. Thus, a system of monitoring and evaluation of the effectiveness of measures, based on the standardized and scientifically valid methods of data collection and analysis, has been introduced in parallel to measures for tobacco control. The Global Tobacco Surveillance System (GTSS), developed by the World Health Organization, provides representative and periodic data on key indicators of tobacco use. The Ministry of Health of the Russian Federation, within the framework of this system, conducted two Global Adult Tobacco Surveys in 2009 (GATS 2009) and 2016 (GATS 2016). As a result of the study, when comparing data obtained by using identical samples of two surveys (in 60 regions), significant trends in tobacco use reduction were identified. The prevalence of tobacco consumption among the adult population decreased from 39.4% in 2009 to 30.9% in 2016 (from 60.7% to 50.9% among men, and from 21.7% to 14.3% among women).

Key words: Global Adult Tobacco Survey, tobacco consumption prevalence monitoring, GATS, tobacco consumption prevalence, tobacco smoking, risk factors, epidemiology, tobacco control, anti-smoking law

One of the most common and modern methods of the treatment of early keratoconus is the implantation of intrastromal corneal ring segments (ICRS). The paper addresses published data on recent progress in methods which facilitate ICRS implantation. Femtosecond laser and ICRS of various shape and structure simplify surgical technique and provide adequate effect when correcting irregular astigmatism. Long-term randomized controlled studies in patients with obviously progressive keratoconus are required to demonstrate the stabilization of keratectasia after ICRS implantation.

Key words: corneal collagen cross-linking, femtosecond laser, intrastromal corneal ring segments, keratoconus, corneal ectasia

Aim. Analysis of quality of life indicators in patients with different types of multiple sclerosis and their relationship with disease duration, degree of disability and the damage of functional systems. Material and Methods. We examined 200 patients with different types of multiple sclerosis course. The quality of life was surveyed using the SF-36 questionnaire. Neurological status was assessed according to Kurtzke's functional systems scale and EDSS disability score scale. Results. In patients with MS, all quality of life indicators significantly decreased, with maximum effect in physical and emotional functioning. The deterioration in quality of life begins in the early stages of the disease (up to 5 years). With prolonged disease duration, severity of the course and progressive disability, significant decrease in physical and emotional functioning is observed, at the same time social functioning is preserved. Conclusion. Life quality parameters stronger correlate to degree of disability as compared to disease duration. The relationship between indicators of physical health with the duration of the disease and the degree of disability is more significant than that of mental health. In the primary-progressive type of disease course, these changes develop in a shorter time, and are more pronounced than in other types of disease course.

Key words: multiple sclerosis, quality of life, clinical type of multiple sclerosis, EDSS disability scale, functional systems' scale

In this research serum albumins were studied depending on the type of the training process. A total of 110 athletes (men and women) aged 15 to 20 years of different sports qualification (I sports category, Candidate Master of Sports and Master of Sports) were examined. Control group consisted of 34 persons of the same age and sex. Depending on the type of the training process 3 groups were defined: sports that develops mainly endurance (rowing); sports of complex nature (football, volleyball, handball and nordic combined); and complex coordinated sports (gymnastics). The research had shown that the most distinct decrease in total and effective albumin concentration is observed in men athletes in sport mainly developing endurance, due to the high demand for its detoxification capacity maintaining homeostasis.

Key words: serum albumin, endogenous intoxication, metabolism, athletes, adaptation