Background. Hyperlipidemia is one of the most important risk factors for the onset and progression of cardiovascular diseases. Currently, several classes of drugs are used in lipid-lowering therapy, which have proven their effectiveness over the past decades. However, in a number of patients there is an intolerance to these drugs or it is not possible to achieve the target levels of the lipid spectrum against the background of the use of maximum doses and combination therapy. This dictates the need to create new lipid-lowering drugs. Aim. To present data on the proven efficacy of widely used drugs in the treatment of hyperlipidemia and the prospects for therapy of this pathology. Materials and methods. We analysed literature sources, included European and Russian guidelines in the last 10 years. Results. The article presents the results of multicenter international randomized clinical trials that studied the efficacy and safety of the main classes of lipid-lo-wering drugs, both in the form of mono- and combination therapy. The indications for the administration of fibrates, ezetimibe omega-3-fats and PCSK9 inhibitors, depending on clinical situations, are discussed. Information on the mechanisms of action of new lipid-lowering drugs – bempedoic acid and inclisiran is presented. The results of clinical trials studying the efficacy and safety of these drugs are presented. Conclusion. Achieving the target levels of lipid metabolism in patients with cardiovascular diseases is an important link in the program to reduce the risk of de-velopment and progression of cardiovascular diseases. At the moment, statins remain the main drugs for the treatment of hyperlipidemia. But in some patients, in order to achieve the goal, the appointment of a combination therapy is required, in which both the long-used fibrates, ezetimibe, omega-3-fats, and the most recent drugs: PCSK9 inhibitors, bempedoic acid and inclisiran can be used.
The article presents modern views on the problem of falls in the elderly. There is a global trend of changing the demographic situation - the permanent increase in the proportion of elderly and senile people in the general population, the issues of geriatrics as one of the medical specialties are becoming the most relevant. Among the problems that geriatricians and all specialists involved in the treatment of elderly patients have to solve, one of the most serious is the problem of falls. The article provides a medical review of the assessment of the frequency of falls depending on gender, age, diseases and external factors. The main risk factors for falls and their prevention measures are discussed in detail. Special attention is given to the fear of falls as a significant risk factor. The methods of validation the risk factor with the use of unified questionnaires - “The scale of assessment of the fear of fa lls” and “the Falls efficacy scale” are presented. The purpose of this article is to attract the attention of practitioners to the problem of falls and the fear of falls as one of the significant risk factors, methods of its identification and prevention
РезюмеВ статье приводится обсуждение клинического случая заболевания новой коронавирусной инфекцией пациента с длительным анамнезом и тяжелым течением болезни Крона (БК). Рассматриваются вопросы сложности диагностики болезни Крона при нетипичном течении (гастродуоденальной форме), алгоритм подбора базисной терапии при тяжелом течении заболевания. Вторая проблема, рассмотрение которой представлено в статье -тактика ведения пациентов с COVID-19 на фоне сочетанной базисной иммуносупрессорной терапии аутоиммунных заболеваний.Ключевые слова. Болезнь Крона, COVID-19, адалимумаб Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.
Aim. To evaluate the effectiveness of the student science club (SSC) in a medical university to prepare students for future professional activities. To achieve this aim, the task was to analyze pedagogical methods and their impact on increasing the motivation to participate in the SSC work, the emergence of interest in scientific activities, and the deepening of knowledge in outpatient internal medicine.Material and methods. A survey of 25 SSC participants was conducted. The questionnaire was developed by the curator and graduate of the SSC. Data collection was carried out using an online survey, the form of which was created on the Google Forms basis. The questionnaire contained 14 questions regarding motivation to attend meetings, the benefits of the SSC, evaluation of the effectiveness and efficiency of classes. University graduates working in medical institutions were asked additional questions regarding the practical application of the acquired knowledge and the impact of work in the SSC on their choice of future specialty.Results. The underlying motive for participation in the SSC work was personal scientific enrichment. Also, the majority of respondents noted the effectiveness of the club format, which includes short informative blocks and a vigorous debate. The most important aspects of the effectiveness of the SSC work have the practical significance of the acquired knowledge (average score, 10 out of 10), increased motivation to study (9,2), and improved level of theoretical training (9,1).Conclusion. Identification of the main motivation factors and effectiveness of SSC classes can be useful for chiefs in drawing up a work plan, choosing the optimal meeting format, preparing reports, and organizing scientific work. The greatest attention in the SSC of the Department of Polyclinic Therapy should be given to clinical reviews of patients with complex diagnoses and problems in the selection of therapy, work with real examination results, including ECG, the continuity of the theoretical knowledge gained with their practical application. A significant factor in the SSC success is the development of a structure for classes that increases their effectiveness, and the creation of a favorable psychic atmosphere that helps increase motivation to attend meetings and actively participate in the work.
Basis. The problem of multimorbidity and related polypragmasia is highly relevant for health practitioners. Providing treatment a doctor should keep in mind itsall possible negative consequences that might exacerbate other diseases. One of the most current problems of modern pharmacotherapy is the development of gastropatia and other gastrointestinal lesions because of drug intake. It is extremely important for rheumatologic patients, especially elderly ones, due to side effects of nonsteroidal anti-inflammatory drugs and glucocorticoids. Reasonable approach to the prescription of this therapy and side effects prevention is a significant factor of the preventive work of the therapist and the general practitioner of the outpatient service. In patients with rheumatic polymyalgia we showed an approach to long-term treatment of corticosteroids in elderly patients, the aim of which is to achieve a stable remission of the disease and to minimize the undesirable effect of the medication on the gastrointestinal tract.Aim. Provide an algorithm for the approach to identifying the risk factors of medicinal gastrointestinal lesions and methods for their prevention.Material and methods. We analyzed literature sources, including Russian guidelines over the last 10 years.Results. In the article we present an algorithm for detecting the risk of developing gastrointestinal tract lesions against the background of corticosteroid therapy in elderly patients and ways of preventing it.Conclusion. The prevention of unwanted drug reactions is an important aspect of a doctor’s work, especially in the treatment of elderly patients. The presented algorithm for identification of risk groups and prevention of side effects is intended to help the practical doctor in working with this category of patients.
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