The relevance of prescribing triple neurohormonal blockade in real clinical practice: the role of mineralocorticoid receptor antagonists

In the article is outlined the main concepts use of the mineralocorticoids receptors antagonists in the treatment of congestive heart failure and systolic dysfunction after acute myocardial infarction. Claimed the pivotal role of eplerenone in the long-term treatment strategy due to decrease of mortality and improving the clinical outcomes.

Kidneys and covid-19

For citation: Kidneys and COVID-19. Interview with N.F. Frolova. Consilium Medicum. 2021; 23 (1): 7–10. DOI: 10.26442/20751753.2021.1.200781

Endoscopic stenting of refractory benign esophageal strictures (review)

Despite the fact that the overwhelming majority of benign esophageal strictures, although long-term, but effectively stop with the help of endoscopic recanalization, 10% of them recur. Such strictures are a major problem in thoracic surgery. Disabled surgical methods of treatment are associated with a sufficiently high mortality rate and do not guarantee the formation of new anastomotic strictures. Esophageal stenting against the background of a limited endoscopic arsenal of methods for recanalization of benign strictures is the last option. A lot of different models of esophageal stents with their own individual characteristics and features have appeared since the introduction of the first stents in clinical practice. All were investigated in an attempt to identify the optimal stent type and design for the treatment of refractory benign strictures. The review is devoted to the current state of stenting in recurrent benign esophageal stenosis. The review reflects the efficacy and disadvantages of various types of stents and their comparison with a focus on new biodegradable stents used in the treatment of benign esophageal strictures.

Properties and safety of combined dietary supplement Uronext in complex treatment of acute (recrudescence of chronic) cystitis in women with bacterial vaginosis

Aim. To analyze modern approaches to the conservative therapy of acute (exacerbation of chronic) cystitis in women in combination with bacterial vaginosis. To emphasize the importance of Esherichia coli as the main causative agent of urinary tract infection (UTI) due to the presence of virulence factors that not only affect the affinity of the pathogen to the urothelium, but also hinder the development of an immune response. To emphasize the importance of bacterial vaginosis as a factor contributing to the development and maintenance of acute cystitis in women. To substantiate the need for a differential approach to the appointment of antimicrobial drugs in patients with UTI and bacterial vaginosis, as well as the use of safe natural medicines in the complex therapy of UTI. Materials and methods. The properties and safety of the biologically active additive Uronext (NPO Petrovax Pharm, LLC, Russia) were studied in women with complex, together with medications, treatment of acute (exacerbations of chronic) cystitis against the background of bacterial vaginosis. A post-marketing comparative study was conducted in parallel groups. The study lasted for 4 months and included 60 patients aged 18 to 65 years (average age 39.4 years). Results. The severity of differential symptoms of acute cystitis was significantly lower in the study group compared with the control group – the frequency of the evaluation mode in the study group was significantly higher than in the control group: 29 and 22 respectively (p<0.01). In both groups, there was a significant improvement in the quality of life of patients (ACSS score) after treatment (the median value and the mode of the sum of points in the control group decreased from 7 to 3; p<0.01, in the study group – from 7 to 1; p<0.01). The quality of life of patients in the study group after treatment was significantly higher than in the control group (p<0.01). It is important to note that the frequency of relapses after treatment was significantly lower in the study group compared to the control group (31.6 and 13.3% respectively; p<0.01). Conclusion. Modern dietary supplements as part of the complex therapy of lower urinary tract infection provide a significant reduction in the severity of differentiated symptoms of acute cystitis, as well as a significant improvement in the quality of life of patients.

Prevention of post coital cystitis: the role of D-mannose. Case report

Recurrent lower urinary tract infections are common among women. One of the important factors of their genesis is sexual activity: there is a positive correlation between sexual intercourse frequency and recurrences of lower urinary tract infections. Post coital cystitis accounts for 30–40% of all chronic recurrent cystitis and occurs in about 25–30% of women of reproductive age. One of the methods for the prevention of post coital cystitis is the use of D-mannose, the effectiveness of which was demonstrated with a clinical example.

Use of lubricants to correct sexual dysfunction in women

A literature review focuses on the use of lubricants in women for sexual dysfunction. The use of lubricants is intended to prevent trauma to the lining of the vagina during intercourse and to facilitate the insertion of pessaries. Along with substances that optimize the action of lubricants, they include a number of compounds that can cause negative reaction mechanisms and aggravate existing discomfort. In addition, an increased pH of the lubricant can have a cytotoxic effect on the epithelium of the female genital tract. Unfortunately, the awareness of obstetricians and gynecologists about the properties and range of lubricants is insufficient. Therefore, knowledge of the initial state of a woman, the reasons for the development of sexual dysfunction, the nature of contraception, and no less important, the structure of the composition of the lubricant will competently make it possible to select the optimal means to improve the quality of sexual contacts without developing side effects and improving the condition of a woman.

Complex therapy of a multimorbid patient: focus on the reproducible drugs

Chronic noncommunicable diseases are associated with high mortality and high costs of medical care, and therefore require safe, effective and affordable therapy. When choosing a generic drug, a doctor may be guided by the assumption that the bioequivalence of medicinal substances is an indirect confirmation of their therapeutic efficacy. Absolute confidence in the same efficacy of original and generic drugs can only emerge after welldesigned studies comparing therapeutic equivalence. The results of the Russian multicenter, open, randomized KARDIOKANON study, the purpose of which was to compare two options for complex therapy based on the use of only original or only generic drugs in persons with stable coronary artery disease, showed the comparability of the effectiveness of original and reproducible drugs of the pharmaceutical company “Canonpharma Production” in achieving the target value of arterial pressure, heart rate, low density lipoprotein and impact on quality of life. A sufficient variety of drugs produced by this pharmaceutical company opens up opportunities for the appointment of any of them, but further large controlled studies are needed to finally confirm the bioequivalence, therapeutic efficacy and interchangeability of original and reproducible drugs.

Biomarkers of acute kidney disease. potential application in practice

Acute kidney injury (AKI) is a common clinical syndrome. Its variety of presentation explains the absence of “kidney troponin”. Many research projects of new biomarkers are ongoing now. The enormous number of biomarkers has been identified already. It makes difficult to choose the correct test and dictates the importance of the fastest and most accurate introduction of AKI biomarkers into clinical practice. The integration of appropriately selected biomarkers in routine clinical practice for high-risk patients of AKI is very important. Currently, serum creatinine (sCr) and urine output are used to define AKI in accordance with the definition of KDIGO (Kidney Disease: Improving Global Outcomes), which have a number of significant limitations for practitioners, including the inability to diagnose AKI before serum creatinine levels increase. Practitioners need systematic information about the latest AKI markers and possible situations, when and for which patient groups they can be used. This is the main goal of our review. Keywords: acute kidney injury, biomarkers, NGAL, TIMP-2, IGFBP7, cystatin C, markers, injury, kidney stress For citation: Schelkanovtseva ES, Mironova OIu, Fomin VV. Biomarkers of acute kidney disease. Potential application in practice. Consilium Medicum. 2021; 23 (1): 15–19. DOI: 10.26442/20751753.2021.1.200729

A patient with lacrimation at an otorhinolaryngologist consultation

Lacrimation is one of the most common symptoms in ophthalmic practice. Most patients first visit an ophthalmologist, but the otorhinolaryngologist also plays an important role in determining the etiology of the disease and in the choice of management for such patients. This review presents a literature search that addresses the diagnosis and treatment of patients with epiphora. Identifying the cause of lacrimation is the main factor in making the correct diagnosis and choosing the optimal treatment method. Endonasal dacryocystorhinostomy is of particular importance. The multidisciplinary approach of the ophthalmologist and otorhinolaryngologist allows for the success of the epiphora treatment.

Tactics of managing patients with primarily detected nasopharyngeal neoplasm. Case reports

In 5% of cases in the nasopharynx of an adult can be found a neoplasm with benign or malignant nature. Clinical manifestations of such pathology are next: persistent dysfunction of the auditory tubes, nasalness and postnasal drip syndrome. Endoscopy of the nasopharynx, computed tomography of the sinuses and magnetic resonance imaging of the head are the main diagnostic criteria for detecting neoplasms in this area. The tactics of treatment depends on the dysplasia type of the pathological process and varies from endoscopic one-stage resection to chemoradiation treatment. Using the example of two clinical cases, we will consider an algorithm for diagnosis and treatment the patients.