Terapevt Arkh
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Atrial fibrillation (AF) and heart failure (HF) often accompany each other, as they share similar risk factors and pathophysiological mechanisms. AF in patients with HF is known to increase hospitalizations and worsen prognosis. A combination of AF and HF translates into high risks of thromboembolic complications, which renders anticoagulants an important aspect of therapy for these patients. ⋯ At the same time, patients with HF often require a personalized approach when choosing an anticoagulant due to increased risks of thromboembolic complications and bleeding, as well as multiple comorbidities. The article presents the results of sub-analyses of key studies on the efficacy and safety of DOACs vs vitamin K antagonists in patients with HF and AF. It also explores DOACs use in patients with chronic kidney disease.
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Often ill people are, first of all, patients with recurrent infectious and inflammatory diseases of the upper respiratory tract (URT). They put a significant financial burden on the healthcare system. The leading etiological factors of recurrent inflammatory diseases of URT, in addition to pathogenic bacterial microflora, are viral agents (viruses of the viral respiratory infections group, herpes viruses). ⋯ In order to optimize therapeutic and preventive measures for frequently ill adults and children, the most promising is the use of immunotherapy and immunoprophylaxis. The immunomodulator inosine pranobex, due to its unique combined (immunotropic and antiviral) properties, demonstrates effectiveness in the complex treatment of viral respiratory infections, including in combination with herpes viruses, and is successfully used to prevent frequent relapses of infectious and inflammatory diseases of the URT. The domestic analogue of inosine pranobex Normomed® [JSC "Valenta Pharm"», ЛП-№(002470)-(РГ-RU), ЛП-№(005542)-(РГ-RU)], has a good safety and bioequivalence profile, and occupies a worthy field in the Russian pharmaceutical market among drugs recommended for the treatment of viral infections in adults and children.
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The article is devoted to a form of botulism that has been little studied in our country and is registered exclusively in infants. The fundamental difference between this form and the most common foodborne botulism is that infants become infected by ingestion of spores, followed by their germination, colonization of the intestines and production of botulinum toxin in situ, which leads to the development of life-threatening flaccid paralysis. ⋯ The article discusses in detail the issues of diagnosis and laboratory verification of the etiology of the disease. Current data on the treatment of infant botulism are presented.
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Cognitive impairment is a very common comorbidity in patients with heart failure (HF). Patients with HF show signs of memory decline, difficulty concentrating, and attention deficits. Cognitive dysfunction in HF is associated with a poor prognosis. ⋯ Neuropsychological screening tests are available to screen for cognitive impairment, but they are used infrequently. Therefore, it is of practical interest to search for magnetic resonance equivalents of cognitive disorders. The use of magnetic resonance imaging as a tool for identifying and quantifying neural correlates of cognitive functions is discussed.
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Acute coronary syndrome remains the leading cause of death in both patients with coronary artery disease and patients with other diseases (such as diabetes mellitus, chronic kidney disease, inflammatory diseases of various etiologies, and others). Early diagnosis of cardiomyocyte damage and necrosis opens up wide opportunities to improve the prognosis of patients with atherosclerotic lesions of the coronary arteries, and also makes it possible to discharge patients without acute cardiovascular pathology from intensive care units with a high degree of probability. The article discusses the evolution of the research and introduction into broad clinical practice of markers of myocardial damage and necrosis, which have largely improved modern clinical practice.