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Chronic pain (CP) is still one of the urgent problems of modern medicine. The paper provides a review of the main pharmacotherapeutic approaches from the standpoint of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) guidelines. When preparing this material, the authors have analyzed the publications available in the resources: PubMed, EMBASE, Cochrane, and еLIBRARY. The paper presents the main pathogenetic mechanisms of pain syndrome development in osteoarthritis (OA), including synovial inflammation and associated immune disorders. It considers the types of development of pain syndrome and the main prognostic outcomes according the mechanism of pain, providing a rationale for the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or chondroprotectors (CPs). In accordance with the ESCEO guidelines, it is noted that when starting OA therapy, CPs should be considered as the first step (in their long-term prescription and pharmaceutical quality), then NSAIDs should be added (topically), then (if ineffective) orally, by excluding patients with hip OA. It is known that the intramuscular administration of CPs (chondroitin sulfate (CS) in particular) can increase their bioavailability. The use of glucosamine sulfate (GS) is recommended for patients over 60 years of age. According to the recommendations of the 2019 ESCEO experts, CS and GS should be used as a disease-modifying OA drug from the first step and at all subsequent stages.

The paper provides a review of the data available in the literature on the relationship of pain to the risk of OA progression. Network analyses and numerous studies, including those conducted at the V.A. Nasonova Research Institute of Rheumatology, have confirmed that pain syndrome is one of the significant predictors of knee OA progression. The major class of medications for OA pain includes nonsteroidal anti-inflammatory drugs. The paper gives data on the efficacy of meloxicam in OA patients, which is widely used in both Russia and other countries of the world. Meloxicam is characterized by a good safety profile in the gastrointestinal tract, cardiovascular and renal systems. It is the drug of choice in patients with musculoskeletal diseases, in particular OA. Good results in severe pain syndrome have been shown by a step-by-step regimen of meloxicam when the injection formulation of the drug is used in the first days of treatment, and then, to consolidate what has been gained from therapy, its oral dosage form is administered in terms of concomitant diseases.

The paper reviews of the data available in the literature on the clinical efficacy and safety of tofacitinib (TOFA) in the treatment of psoriatic arthritis (PsA). It considers the mechanism of action of TOFA, which is mainly in the selective inhibition of signal transmission due to its effect on the activity of JAK3 and/or JAK1, the enzymes that ensure the function of turning on and turning off the signals transmitted by cytokines. TOFA is noted to directly or indirectly act on a wide range of a number of molecules that play an important role in the pathogenesis of PsA.The paper analyzes the current data on the clinical efficacy of TOFA in treating PsA, which have been obtained in the 12-month OPAL Broaden study including patients with PsA and an inadequate response to synthetic disease-modifying anti-rheumatic drugs and in the 6-month OPAL Beyond study enrolling those with PsA and an inadequate response to tumor necrosis factor-α (TNF-α) inhibitors. It is noted that the results of these studies confirmed the efficacy of the drug in treating PsA not only according to the data of objective (medical) monitoring, but also to the subjective characteristics of pain, to the global assessment of disease activity, fatigue, as well as the mental and physical components of the SF-36 quality of life questionnaire.It is concluded that the current findings allow JAK inhibitors to be recommended as a new pathogenetically sound approach to treating PsA and suggest that TOFA has benefits in managing patients unresponsive to therapy with TNF-α inhibitors.

The paper discusses the possibilities of administering hyaluronic acid in osteoarthritis. It is noted that the therapeutic efficacy of this drug class has been demonstrated in experimental and clinical studies and confirmed by the practical activities of specialists dealing with issues of arthrology. Along with the use of foreign hyaluronic acid solutions, Russian rheumatologists can prescribe high-quality Russian analogues that include INTRAJECT®. The authors pres ent their own clinical observations that confirm that the drug may be administered. The paper is illustrated with photos and radiographs.

Introduction. The paper presents modern insights into the pathogenesis and role of inflammatory reactions in the developmentof the respiratory pathology. The safety and high potential of the use of complex bioregulatory drugs as elements of pathogenetic and symptomatic therapy of the respiratory diseases have been substantiated. The authors present the results of their own clinical observations on the use of a complex bioregulatory drug as an anti-inflammatory agent to treat acute respiratory diseases in young children.Clinical case 1. The observation included 102 children aged 1 to 3 years with the symptoms of acute respiratory viral infection, who underwent outpatient treatment. 53 children of them received a complex bioregulatory drug as a symptomatic antiinflammatory and antipyretic therapy according to the treatment regimen set out in the patient information leaflet. The comparison group consisted of 49 children, who received acetaminophen derivatives to relieve the similar symptoms at least once per day. The findings showed that the bioregulatory drug, when used according to the treatment regimen, effectively relieved the symptoms of fever in 46 children (87%), the same indicator in the comparison group was 44 children (89%) (p > 0.05%).Clinical case 2.We observed 26 children aged 9 to 18 months with teething syndrome, which was treated with a bioregulatory drug as a symptomatic therapy. The therapy lasted 3 to 7 days. The results showed that the bioregulatory drug effectively relieved the whole complex of teething symptoms.Сonclusion. Viburcol has been shown to be highly effective as an antipyretic agent, as well as a drug to relieve symptoms during teething. No children who used the drug showed side effects. The authors advise the widespread use of complex bioregulatory drugs in routine paediatric practice.

The paper gives the current definition of osteoarthritis (OA), which reflects the pathogenetic and clinical characteristics of this disease, as well as general principles for choosing an OA treatment. It describes the effect of glucosamine and chondroitin on the key pathogenetic mechanisms of OA. It is noted that one of the promising areas of therapy for OA is the intra-articular administration of biopolymer-based hydrogels that provide not only an anti-inflammatory, but also regenerative effect that has been experimentally confirmed during their injection into the tendon sheaths. There are data on the efficacy and safety of the Russian drug Sphero®gel, a biopolymer-based microheterogeneous collagen-containing hydrogel that belongs to a class of multicomponent biopolymer-based extracellular matrix mimetics. It consists of the cross-linked farm animal tissue-derived collagen microparticles placed in the gel base. The gel is not only a structural base for collagen microparticles; it also has its own therapeutic potential, since it is structurally similar to the natural extracellular matrix. The drug contains collagen, biologically active components of the extracellular matrix, such as proteoglycans, glycoproteins, uronic acids, growth factors, monosaccharides, and chondroitin sulfate. Extended-release symptomatic agents, Sphero®gel among them, are currently recommended for the treatment of OA. Application of Sphero®gel contributes to increased joint mobility and reduced pain, which allows the limited use of nonsteroidal anti-inflammatory drugs that cause adverse reactions, especially in the presence of comorbid diseases.

The most common form of peripheral nervous system damage in diabetes mellitus is distal symmetric sensorimotor polyneuropathy (DSSMPN). Chronic hyperglycemia, dyslipidemia, and impaired microcirculation are considered to be the key mechanisms for the development of DSSMPN, but its pathogenesis is still unclear and continues to be studied. The paper analyzes the issues of diagnosis of DSSMPN and the effective principles of patient treatment. It also discusses the use of alpha-lipoic acid (ALA) as a drug for the pathogenetic treatment of DSSMPN and describes the results of clinical trials of its treatment with ALA preparations.

Drug dependence is one of important social problems in modern society. It became more actual because of the high morbidity in young working-age patients. The central nervous system is the main target for psychoactive substances. Long-term drug intoxication results in functional and structural brain alterations, it leads to cognitive impairment and disturbances of higher mental functions rendering patients’ disadapted in their work and daily life activities. Eye disorders due to drug abuse are multifaceted and can vary from conjunctival damage to severe endogenous endophthalmitis. Opioid dependence can result not only from intentional self-administration of narcotic drugs, but also from long-term prescribed use of these medicinal products owing to their potent analgesic effect exhibited in somatically ill patients with severe chronic pain. Opioid derivatives act as partial or full agonists of three types of opioid receptors (δ, κ, and µ) extensively expressed by the neurons of the central and, to a lesser extent, peripheral nervous system. The most dangerous complication of intoxication with this group narcotic drugs is opioid induced-respiratory depression resulting in hypoxaemia and hypercapnia. The paper presents a case report of bilateral optic nerve atrophy that developed in a young female patient after a long period of intravenous heroin use. There are practically no reports of optic nerve damage due to heroin intoxication in the current literature. Possible optic nerve atrophy mechanisms under discussion include generalized hypoxia developing against a background of chronic heroin intoxication and direct toxicity of admixtures used to dilute home-made narcotic drugs. In view of the growing use of these substances, physicians have to consider their effects in the differential diagnosis in patients with atypical eye disorders.

Levodopa remains the gold standard of treating Parkinson's disease (PD). However, the inevitable complication of levodopa therapy is druginduced dyskinesias, which significantly limits the therapeutic capabilities of this group of drugs and requires treatment adjustment. At the same time, patients with PD show not only a wide interindividual variability in the response to levodopa treatment, but also differences in the frequency and time to onset of drug-induced dyskinesias. Therefore, genetic predisposition can play an important role in the development of complications of levodopa therapy. The paper reviews modern literature on the impact of mutations in the genes, the products of which are involved in the exchange of levodopa and are capable of provoking or, conversely, levelling the development of drug-induced dyskinesias in order to determine the possibilities of expanding the personalized approach to treating patients with PD.

The paper describes two patients with prolonged disorders of consciousness (PDC) because of non-traumatic brain injury, in whom a clear neurodynamic response to Zolpidem was observed.In order to illustrate systemic cerebral responses to administration of this drug in LIC patients, an analysis of clinical and electrophysiological changes has been undertaken.It has been shown that the result of Zolpidem applications in patients with prolonged disorders of consciousness (PDC) should be assessed not only by consciousness dynamics, but with the help of electroencephalogram (EEG) monitoring, too. Distinct response to Zolpidem during different periods of recovery in one patients was found.Zolpidem can render various effects in patients in vegetative state/with unresponsive wakefulness syndrome (VS/UWS) and in minimally conscious state (MCS). In one patient, sedation with EEG activation was observed, which was a sign of favorable prognosis. The other patient developed more than once local convulsions after Zolpidem administration followed by contact augmentation on the next day.The mechanism of action, necessary doses of drugs, and markers of forecasting the successful effect of that drug are yet to be further studied.

This review presents and discusses evidence demonstrating the importance of mitochondria and related processes in the pathogenesis of Alzheimer's disease. Mitochondrial dysfunction is currently emerging as a potential therapeutic target in the treatment of Alzheimer's disease and other neurodegenerative diseases. This paper also reviews various drug strategies aimed at mitochondrial dysfunction and the development of oxidative stress.

Introduction.The development of new and highly effective antitumor therapy is one of the priorities of pharmacology. The paper presents one of the solutions to the problem related to the development of transport forms of antitumor drugs.The aimof the study was to study the ability of various fractions of plasma lipoproteins (VLDLP, LDL, HDL) to interact with actinomycin D and show the role of HDL as a transport form of actinomycin D in the body cells.Material and methods. The studies were conducted using unlabeled and tritium-labeled actinomycin D, preparative ultracentrifugation of the rat plasma lipoprotein fractions, chromatography, and in vivo experiments with intravenous administration of HDL complexes with labeled actinomycin D.Results.The important role of HDL in the formation of complexes with actinomycin D in comparison with LDL and LPA was shown. The basic physicochemical characteristics of the interaction of HDL and apolipoprotein A-I with actinomycin were obtained. The constants of the association were of the order of 105 M-1, and the number of binding sites for the drug was 26 for HDL and 12 for apolipoprotein A-I. In vivo studies on rats, the highest radioactivity after intravenous injection of HDL complexes with tritium-labelled actinomycin D was observed in the adrenal glands, then in the liver and kidneys. The uptake of tritium-labelled actinomycin D was twice lower in the lungs, adipose tissue, thymus and spleen. The low uptake of the label was observed in the myocardial tissue.Conclusion.The results obtained demonstrate the feasibility of using HDL as a transport form of actinomycin D in body cells.

The high prevalence of skin and soft tissue infections (SSTI) urges healthcare professionals to improve the traditional (operative and pharmacological) methods of their treatment, and to find new methods that are applicable in outpatient practice, which can reduce the period of disability and reduce the number of complications. The choice of the right drug for such infections to influence the local infectious process is one of the most important objectives of the local wound therapy. The paper presents data on the effectiveness of Povidone-Iodine (Betadine) for external use with a broad spectrum of action, intended for the treatment of SSTI, including abscesses, furuncles, carbuncles, infected traumatic lesions of the skin and trophic ulcers in Phases 1 to 2 of the wound process. The drug has a pronounced combined effect: antimicrobial (bactericidal, bacteriostatic), wound healing, regenerating, local anesthetic and protective. This brings us to the conclusion about the advantages of Betadine and provide a rationale for its use to treat surgical infections of the skin and soft tissues in the outpatient setting.

One of the most important procedures in the ophthalmologist’s work is to determine the patient’s refraction. This procedure is necessary for patients of any age, because it helps to obtain information about whether the patient has refractive errors, whether they can become an obstacle to the normal formation of visual activity and binocular vision in preschool children, whether refractive errors are the cause of complaints of decreased vision and loss of visual performance (asthenopia) in older patients. The correct determination of static refraction, when the patient’s accommodation is completely relaxed, is not only of great importance at the time of deciding whether to prescribe optical correction — the obtained values are the basis for the clinical prescription itself. The paper presents modern methods for determining refraction, identifies indications for drug refractive cycloplegia, shows mydriatic and cycloplegic activity of M-cholinolytics, provides a comparative evaluation of different cycloplegic agents, recommended schemes of drug refractive cycloplegia., Одной из важнейших процедур в работе офтальмолога является определение рефракции пациента. Данная процедура необходима пациентам любого возраста, ведь именно она помогает получить информацию о том, имеет ли пациент аномалии рефракции, могут ли они стать препятствием для нормального формирования зрительной активности и бинокулярного зрения у детей дошкольного возраста, являются ли именно аномалии рефракции причиной жалоб пациентов более старшего возраста на снижение зрения и потерю зрительной работоспособности (астенопию). Правильное определение статической рефракции, когда аккомодация пациента полностью расслаблена, не только имеет огромное значение в момент принятия решения о необходимости назначения оптической коррекции — полученные значения являются основанием для самого клинического назначения. В работе представлены современные методы определения рефракции, определены показания к медикаментозной рефракционной циклоплегии, показана мидриатическая и циклоплегическая активность М-холинолитиков, проведена сравнительная оценка различных циклоплегических агентов, рекомендованы схемы медикаментозной рефракционной циклоплеги, Однією з найважливіших процедур у роботі офтальмолога є визначення рефракції пацієнта. Дана процедура необхідна пацієнтам будь-якого віку, адже саме вона допомагає отримати інформацію про те, чи має пацієнт аномалії рефракції, чи можуть вони стати перешкодою для нормального формування зорової активності та бінокулярного зору в дітей дошкільного віку, чи є саме аномалії рефракції причиною скарг пацієнтів більш старшого віку на зниження зору і втрату зорової працездатності (астенопію). Правильне визначення статичної рефракції, коли акомодація пацієнта повністю розслаблена, не тільки має величезне значення в момент прийняття рішення про необхідність призначення оптичної корекції — отримані значення є підставою для самого клінічного призначення. В роботі подані сучасні методи визначення рефракції, визначені показання до медикаментозної рефракційної циклоплегії, показана мідріатична й циклоплегічна активність М-холінолітиків, проведена порівняльна оцінка різних циклоплегічних агентів, рекомендовані схеми медикаментозної рефракційної циклоплегії.

Drug allergy is one of the most common issues not only in ophthalmology, but in the general medicine. Drug-induced conjunctivitis is an inflammatory reaction of the conjunctiva, allergic or toxic, caused by the use of medicines. The frequency and severity of drug-induced conjunctivitis continuously increase as the arsenal of biologically active drugs increases. The purpose of the paper is to compare the efficacy of eye drops Opatanol (0.1 % olopatadine) and Vizallergol (0.2 % olopatadine) in the therapy of drug conjunctivitis. Materials and methods. Clinical observation involved 42 patients (26 women and 16 men) with drug conjunctivitis aged 28 to 56, which were divided into two groups. Group 1 (22 patients) received 2 drops of Opatanol twice a day, whill group 2 (20 patients) received 2 drops of Vizallergol once a day. The clinical observation included careful collection of history data, visometry andbiomicroscopy with the assessment of the condition of the eyelids and conjunctiva, taking into account the follicular reaction on a 3-point scale. Results. In the process of treatment, subjective sensations (itching, burning, discomfort) were found to gradually reduce in both clinical groups. The average duration of treatment in group 1 was 11 ± 0.1 days, in group 2 - 9 ± 0.3 days. Conclusion. The therapeutic effect of Vizallergol was somewhat higher than that of Opatanol, which is explained by a higher concentration of the main active substance, olopatadine. For citations: Jani E.V., Pozdnyakova V.V., Seliverstova K.E. New opportunities of the therapy of medicinalophthalmic allergies. Russian ophthalmological journal. 2017; 10 (3): 108-112. doi: 10.21516/2072-0076-2017-10-3-108-112 (in Russian).

The paper describes a clinical case of severe systemic juvenile idiopathic arthritis (JIA) in a child with an early disease onset, which is resistant to multicomponent therapy (glucocorticoids, methotrexate, the tumor necrosis factor-α inhibitor etanercept), and the successful use of the anti-interleukin 6 receptor monoclonal antibody tocilizumab with the achievement of sustained (30-month) drug remission. The therapy with tocilizumab was accompanied by unpredictable adverse events (chronic osteomyelitis of the clavicle, macrophage activation syndrome) and their timely treatment permitted avoidance of life-threatening consequences. The presented case shows difficulties in the follow-up of patients with systemic JIA in clinical practice, requiring alertness to the risk of infectious complications and development of macrophage activation syndrome.

Vitamin B complex is widely used therapeutically and prophylactically in neurology; they are often prescribed for long-term treatment (for weeks and months). In this connection, it is important to comprehensively estimate the feasibility and safety of its use, especially at high (therapeutic) doses. The paper discusses the potential anticancer effects of vitamin B complex. Objective: to evaluate the effect of thiamine disulfide, pyridoxine hydrochloride, and cyanocobalamin (neurobion 110 mg/kg/day) on the growth and metastatic spread of malignant tumors in mice. Material and methods. Experiments were carried out in 25 F1 hybrid male mice (aged 2.5–3 months; body weight, 23–26 g). Transplantable Lewis lung epidermoid carcinoma (LLC) was used as a tumor model Results and discussion. The experimental animals tolerated the drug well; there were no symptoms of intoxication. The drug's effects lasting up to 21 days of LLC development were accompanied by a growing trend towards tumor growth inhibition by 10–20% (p=0.059). Conclusion. After subchronic intragastric administration of B12 at a daily dose of 110 mg/kg to tumor-bearing animals, there is a steady tendency to LLC growth inhibition. No antimetastatic activity was found.

The paper deals with the problem of the interchangeability of brand-name and generic drugs. Touching upon official terminology and the normative documents that govern the registration of generics in Russia and foreign countries, the authors state that there is no concerted approach to estimating drug interchangeability, indicate that there are some disadvantages of using a method for proving the bioequivalence of the compared drugs as evidence for their therapeutic equivalence, and point out that Russia’s legal regulation of drug circulation lacks attention to the proper use of generics. The problem of interchangeability is particularly acute when prescribing narrow therapeutic range drugs, including anticonvulsant drugs. The results of the investigations discussed in the article demonstrate the need for a very cautious approach to using generic drugs in the therapy of epilepsy due to the fact that the disease may worsen. The authors come to the conclusion that treatment with less expensive generic drugs is far from always more economical. The change from a brand-name for a generic drug should be carefully approached, basing on the data of properly designed and conducted studies of therapeutic equivalence.

The paper gives an update on the pathogenesis of acute respiratory diseases, the basis for which is inflammation of the airway mucosal lining. It reflects the results of a comparative clinical trial of the efficacy and safety of the anti-inflammatory drug fenspiride used in the combination therapy for respiratory diseases in children. The findings allow one to recommend the use of fenspiride to treat this condition in children.

The early administration of methotrexate (MTX) and the use of its high (by the rheumatology practice standards) doses contribute to the enhanced efficiency of therapy and the reduced severity of rheumatoid arthritis (RA). One of the important merits of MTX in the treatment of RA is the possibility of adjusting its dose and choosing its (oral or subcutaneous) administration routes, which makes it possible to individualize treatment. Particular emphasis has been recently placed just on a subcutaneous MTX formulation that creates prerequisites for substantially improving the efficiency of RA therapy. The paper gives the data of the REMARCA (Russian investigation of methotrexate and biologicals for early active arthritis) trial assessing the results of RA treatment in the use of the subcutaneous MTX dosage form as a first-line drug and in the elaboration of management tactics for this disease. Subjects and methods. The investigation included 191 patients (34 men and 157 women) with active RA; of whom 51.8% had very early RA (< 6 months' disease duration). 115 patients with RA completed a 24-month follow-up period; and their data were analyzed in more detail. Results and discussion. The findings may substantiate treatment policy based on the prescription of subcutaneous MTX (without previously administering its oral formulation) in patients with early RA and high disease activity, starting the drug at 15 mg/week and rapidly escalating with the highest tolerable doses during 4-8 weeks, which allows remission (or low disease activity) in the majority of patients without using glucocorticoids and biological agents.

The paper depicts the author's view on how a neurologist/epileptologist chooses an antiepileptic drug in his practice under present-day conditions. It considers possible clinical situations and therapeutic tactics in relation to the efficiency of performed therapy, as well as methods for switching to other antiepileptic drugs if the previous/first monotherapy is ineffective. The author gives main international and Russian guidelines in terms of the type of epileptic seizure/form of epilepsy/epilepsy syndrome. Despite its almost semicentennial history of effective clinical application, valproate is shown to be now a first-line choice drug for the therapy of undifferentiated, cryptogenic, and symptomatic partial epilepsies in patients of different age groups. The properties of valproate, such as efficacy against different types of seizures and forms of epilepsy, good tolerability, minimal aggravation risk, high monotherapy retention rates, various dosage forms, including the brand-name extendedrelease drug Depakine chrono or Depakine chronosphere and its intravenous formulation, favorable pharmacokinetic and pharmacodynamics profiles, make it indispensable at the present developmental stage of epileptology.

Today, it is generally accepted that it is necessary to achieve clinical remission in rheumatoid arthritis (RA) or as minimum a low disease activity. The paper describes a clinical case of a female patient diagnosed with RA who was observed to have inefficiency of standard disease-modifying antirheumatic therapy with methotrexate 25 mg/week, secondary inefficiency of tumor necrosis factor-α inhibitors (adalimumab), and inefficiency/poor tolerance of the interlukin-6 receptor antagonist tocilizumab. This determined the need to use fofacitinib (TOFA), a drug with another mechanism of action. TOFA is the first agent from a new group of immunomodulatory and anti-inflammatory drugs, intracellular kinase inhibitors. Disease remission could be achieved during therapy with TOFA, which enables one to consider this synthetic drug as a therapy option that potentially competes with therapy with biologicals.

Levodopa remains the most effective drug for the treatment of Parkinson's disease. The paper considers the mechanism of action, recommended levodopa doses, the time of therapy initiation, and risk factors for motor complications. A few dosage forms of levodopa are currently being used. The results of comparative trials of levodopa-benserazide and levodopa-carbidopa and the clinical experience with Levodopa/Benserazide-Teva are given. An open-label multicenter trial of Levodopa/Benserazide-Teva has shown its high efficacy and good tolerability.

Pain control is a fundamental task in the management of patients with locomotor diseases. Analgesic therapy holds the most important position in treating common diseases, such as osteoarthritis, nonspecific spinal pain, and rheumatic diseases of juxtaarticular soft tissues. Pain development and chronization in these conditions are determined by a uniform pathogenetic mechanism, the key component of which should be considered to be inflammation. This necessitates the use of antiinflammatory drugs, first of all, nonsteroidal antiinflammatory drugs (NSAIDs). When the latter are used, the risk of their adverse reactions should be necessarily taken into account and the choice of a specific drug should be based on an efficacy-safety ratio. Aceclofenac may be legally regarded as one of the most balanced NSAIDs in this respect. The paper reviews the data available in the literature on the use of this drug, including the largest clinical and epidemiological studies.

The paper considers whether b-adrenoblockers may be used in the therapy of hypertension. It views in more detail the specific features of nebivolol, a third-generation highly selective b-adrenoblocker that has properties of acting on endothelial function and stimulating NO synthesis. The possible mechanism for the angioprotective activity of the drug is described. There is evidence for its antihypertensive efficacy. The effect of nebivolol on target organs in hypertension, its metabolic effects, and the possibilities of using the drug in patients with comorbidities are considered.

The paper is devoted to the questions of usage of one of the popular antipyretic and anesthetic drug in pediatric practice — ibuprofen. In the article there are generalized literature data and own experience in ibuprofen dose titration in single dose 5 and 10 mg/kg depending on clinical situation., Статья посвящена вопросам применения одного из наиболее популярных жаропонижающих и обезболивающих средств в педиатрической практике — ибупрофена. В работе обобщены данные литературы и собственный опыт касательно принципов дозирования ибупрофена в разовой дозе 5 и 10 мг/кг, в зависимости от клинической ситуации., Стаття присвячена питанням застосування одного з найбільш популярних жарознижувальних та знеболювальних засобів у педіатричній практиці — ібупрофену. У роботі узагальнено дані літератури та власний досвід щодо принципів дозування ібупрофену в разовій дозі 5 і 10 мг/кг, залежно від клінічної ситуації.

The paper gives the results of an open-label trial of the Uralyt-U citrate used in 30 patients with gout and nephrolithiasis. In addition to rapid urine pH optimization, the use of the drug is shown to cause a reduction in the serum level of uric acid, correlating with its enhanced excretion. The use of the agent features good compliance and fails to affect renal functional parameters.

The paper reviews the data available in the literature on the use of ketorolac in clinical practice. Ketorolac is a highly effective analgesic that has proven to be the best drug in the treatment of pronounced acute pain (during monotherapy and combination analgesic therapy) in the postoperative period or after serious injuries. The drug is excellently combined with narcotic analgesics, which permits reductions in the dose of opioids and in the risk of their adverse reactions. When given in standard doses and used for a short period, Ketorolac is reasonably safe, which makes it the drug of choice to relieve acute pain in therapeutic practice. It may be successfully used in cases of acute lower back pain, toothache, migraine, renal and hepatic colics, and in many other situations requiring prompt and potent analgesia, but it is inexpedient to administer narcotic analgesics. Ketorolac should be regarded as a good alternative to metamizole (analgin) that is still popular in our country.

The paper gives data on the use of the nonsteroidal anti-inflammatory drug (NSAID) aceclofenac (Airtal) for nonspecific back pain and other diseases. Aceclofenac is noted to be as effective as the most known nonselective NSAIDs (diclofenac, naproxen, indomethacin), at the same time it causes much lower rate of adverse gastrointestinal reactions, including hemorrhage. The authors also provide an analysis of serious side effects of NSAIDs in several countries, which shows that aceclofenac is one of the safest NSAIDs.

The paper presents the results of a trial of the efficacy and safety of the nonsteroidal anti-inflammatory drug Amelotex® (meloxicam) used to prevent episodes of arthritis in patients with gout during initiation of allopurinol therapy. The study has demonstrated that one-month therapy with Amelotex® can minimize the risk of arthritis exacerbations when allopurinol is used. Amelotex® shows a good tolerability and causes the low rates of side effects

The paper reviews the literature on the use of L-lysine aescinate in the treatment of central nervous system (CNS) diseases. It describes the positive experience of neurologists of Ukraine in using L-lysine aescinate for stroke, brain and spinal cord injuries. It shows that it is necessary to conduct multicenter placebo-controlled trials of the efficacy and safety of the drug in CNS diseases.

The paper considers the major effects of cyclosporin A (CsA) in rheumatic diseases (RD). CsA is noted to be effective for a number of RDs and all types of rheumatoid arthritis (RA), including in early RA in adults and juvenile RA; uveitis associated with Behcet's disease (BD) (as the drug of choice); in combination with other disease-modifying drugs; in RD with concomitant viral hepatitis C. The diagnostic criteria for (BD) and the efficacy of CsA for this disease are given according to different authors.

The paper presents the results of a trial of the efficacy and safety of the nonsteroidal anti-inflammatory drug Amelotex® (international nonproprietary name meloxicam) in patients with pyrophosphate arthropathy (PA). One-month Amelotex® therapy is shown to have a good clinical effect in patients with different forms of PA, to improve quality-of-life indices, and to show good tolerability.

The paper presents the results of a trial of the efficacy and safety of the nonsteroidal anti-inflammatory drug amelotex® (meloxicam) in patients with gonarthrosis. One-month meloxicam therapy is shown to have a good analgesic effect and tolerability and to improve quality of life in the patients.

Rheumatoid arthritis (RA) is one of the most common and severe chronic inflammatory diseases. The paper reviews the recent studies evaluating the efficacy of rituximab (MabThera®), chimeric anti-CD20 monoclonal antibodies in B cells, in patients with RA. It has been shown that Rituximab is an extremely effective and relatively safe drug for the treatment of RA and may be considered to be a prototype for a new line in the management of autoimmune diseases, the basis for which is B-cell immunity modulation.

The paper presents the results of a study of the efficiency and safety of using the nonsteroidal anti-inflammatory drug Amelotex® (international nonproprietary name meloxicam) in patients with osteoarthrosis. A short course of therapy with the drug is demonstrated to have a good analgesic effect, to be well tolerated, and to result in better quality of life in patients with gonarthrosis.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in complex therapy for pain syndrome in rheumatology. The paper describes the pathophysiological mechanisms responsible for the development of chronic and acute pain. It details the action of cyclooxygenase types 1 and 2 (COG 1 and COG 2), shows the key role of COG 2 in pain induction and transmission. The data of clinical trials of meloxicam that inhibits mainly COG 2 are given. The drug is highly effective in treating rheumatic diseases, particularly in old-age group patients with osteoporosis. The combined use of different meloxicam formulations makes it possible to choose adequate, maximally individualized treatment and to relieve the pain syndrome in the shortest possible time. Among NSAIDs, meloxicam shows an optimum efficacy-safety ratio.

The paper gives data on the basic mechanisms of action of nimesulide, a nonsteroidal anti-inflammatory drug that has anti-inflammatory, analgesic, and antipyretic activities in a broad spectrum of morbid states. It shows the rate of effect occurrence after administration of different nimesulide formulations in gouty arthritis and considers the aspects of its safety and tolerability in rheumatic diseases.

The paper presents an algorithm for the empirical selection of antibiotics in the treatment of acute respiratory infections in children, depending on the characteristics of their modern etiological structure and resistance to antibiotics. It is shown that amoxicillin remains the first-line drug in the pediatric outpatient practice for the treatment of acute upper respiratory tract infections, bacterial bronchitis, community-acquired pneumonia caused by the major pathogens (pneumococcus, streptococcus, Haemophilus influenzae). When choosing a drug, dispersible form of amoxicillin — Flemoxin Solutab® (amoxicillin trihydrate) should be preferred, it has high bioavailability of the active substance, comparable to injection (93 %), providing a high efficiency of therapy in more than 90 % of cases, which guarantees patient’s recovery., В статье представлен алгоритм эмпирического выбора антибиотиков при лечении острых респираторных инфекций у детей в зависимости от особенностей их современной этиологической структуры и резистентности к антибиотикам. Показано, что амоксициллин по-прежнему остается препаратом первого ряда в педиатрической амбулаторной практике для лечения острых инфекций лор-органов, бактериального бронхита, внебольничных пневмоний, вызванных основными возбудителями (пневмококком, стрептококком, гемофильной палочкой). При выборе лекарственного препарата предпочтение следует отдавать диспергируемой форме амоксициллина Флемоксин Солютаб® (амоксициллин тригидрат), которая обладает высокой биодоступностью действующего вещества, сопоставимой с инъекционным введением (93 %), обеспечивая высокую эффективность терапии в более чем 90 % случаев, что гарантирует выздоровление пациента., У статті наданий алгоритм емпіричного вибору антибіотиків при лікуванні гострих респіраторних інфекцій у дітей залежно від особливостей їх сучасної етіологічної структури й резистентності до антибіотиків. Показано, що амоксицилін, як і раніше, залишається препаратом першого ряду в педіатричній амбулаторній практиці для лікування гострих інфекцій лор-органів, бактеріального бронхіту, позалікарняних пневмоній, викликаних основними збудниками (пневмококом, стрептококом, гемофільною паличкою). При виборі лікарського препарату перевагу слід віддавати диспергованій формі амоксициліну Флемоксин Солютаб® (амоксицилін тригідрат), що має високу біодоступність діючої речовини, порівнянну з ін’єкційним уведенням (93 %), яка забезпечує високу ефективність терапії в більше ніж 90 % випадків, що гарантує одужання пацієнта.

The paper presents data on the prospects for clinical use of the nonsteroidal anti-inflammatory drug Amelotex® (meloxicam) in patients with osteoarthrosis. It also gives the results of a study showing a good efficacy and tolerability of Amelotex® in patients with gonarthrosis.

The paper is devoted to a problem of bronchial obstruction in infants. There have been considered the pathogenesis of this pathology, its clinical manifestation and complications, features of treatment focusing on combined therapy use (medication Berodual containing β2-agonist of fenoterol hydrobromide and anticholinergic drug ipratropium bromide)., Статья посвящена проблеме бронхиальной обструкции у детей раннего возраста. Рассматриваются патогенез, клинические проявления и осложнения этого состояния, уделено внимание вопросам лечения с акцентом на применение комбинированной терапии (препарат Беродуал, содержащий β2-агонист фенотерола гидробромид и холинолитик ипратропия бромид)., Стаття присвячена проблемі бронхіальної обструкції в дітей раннього віку. Розглядаються патогенез, клінічні прояви й ускладнення цього стану, приділяється увага питанням лікування з акцентом на застосування комбінованої терапії (препарат Беродуал, що містить ­β2-агоніст фенотеролу гідробромід і холінолітик іпратропію бромід).