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Asthenia and fatigue are the most common syndromes in patients with liver disease, which significantly affects their quality of life. The prevalence of fatigue in chronic liver diseases is from 50% to 85%. While some progress has been made in understanding the processes that can cause fatigue in general, the underlying causes of fatigue associated with liver disease remain not well understood. In particular, many data suggest that fatigue associated with liver disease likely results from changes in neurotransmission in the brain against the background of hyperammonemia. Hyperammonemia is a metabolic state characterized by an increased level of ammonia, a nitrogen-containing compound. The present review describes hyperammonemia, which is likely important in the pathogenesis of fatigue associated with liver disease. Ammonia is a potent neurotoxin, its elevated blood levels can cause neurological signs and symptoms that can be acute or chronic, depending on the underlying pathology. Hyperammonemia should be recognized early, and immediately treated to prevent the development of life-threatening complications, such as, swelling of the brain and coma. The article gives pathophysiological mechanisms of influence of hyperammonemia on state of psychovegetative status of patients with liver diseases, also lists basic principles of treatment. A significant part of the article is devoted to L-ornithine-L-aspartate, which is effective in asthenia and fatigue to reduce the level of hyperammonemia through a variety of well-studied mechanisms in chronic liver diseases.

Aim. To assess the prognostic role of cardiac biomarkers (galectin-3, soluble ST2 (sST2), and N-terminal pro-brain natriuretic peptide (NT-proBNP)) in risk stratification of adverse cardiovascular events (CVEs) in patients with heart failure (HF) after implantation of an automatic implantable cardioverter-defibrillator (AICD) within 12-month follow-up period.Material and methods. The study included 57 patients (men, 41; mean age, 65 (59; 68) years) with coronary artery disease and NYHA class II-III HF with left ventricular ejection fraction of 34 [26; 40]%. All patients were implanted with AICD. Serum levels of NT-proBNP, sST2, and galectin-3 were determined by enzyme immunoassay prior to AICD implantation.Results. It has been established that in order to stratify the risk of unfavorable HF in patients after AICD implantation for 12-month follow-up, all three studied biomarkers can be considered as prognostic factors. Thus, an increase in the level of NT-proBNP ≥1046,6 pg/ml (AUC=0,68; p=0,009), sST2 ≥34,43 ng/ml (AUC=0,78; p

Rationale. Coronary artery disease (CAD) is the most common cardiovascular disease, being responsible for the largest number of deaths and disabilities. The use of lipid-lowering drugs is one of the most important aspects of pharmacological rehabilitation of patients with CAD.Objective of the work. Study the features of pharmacological rehabilitation of patients with chronic heart failure (CHF) associated with type 2 diabetes mellitus (DM) using a combination therapy of lipid-lowering Ezetimibe and Rosuvastatin. Materials and methods. 70 patients with coronary artery disease with a clinical picture of moderate CHF and concomitant type 2 diabetes were enrolled in the study. The patients enrolled in the study were recommended to change their lifestyle, including quitting smoking, increasing physical activity, and adhering to a cholesterol-free diet. After a month, the patients were divided into 2 groups of 35 people each by a simple randomization method. The comparison group (n = 35) received a combination of Rosuvastatin 20 mg/day and Ezetimibe 10 mg/day, the control group (n = 35) received only Rosuvastatin 20 mg/day. The duration of the study was 12 months. The follow-up visits were scheduled at 1, 3, 6 and 12 months after they started taking drugs.Results. At the end of the study, there were no statistically significant differences between the study groups in the number of adverse cardiovascular events (14.3% vs 20.0%, respectively, p = 0.751). There were differences in the total number of hospitalizations caused by cardiovascular diseases (14.3% vs 40%, respectively, p = 0.032).Conclusions. The prescription of combination lipidemic therapy with Rosuvastatin at a dose of 20 mg/day and Ezetimibe at a dose of 10 mg/day results in decreased hospitalizations caused by cardiovascular diseases.

Objective: to comparatively study several nonsteroidal anti-inflammatory drugs (NSAIDs) (their analgesic effect; dynamics of quality of life; side effects, such as NSAID-gastropathy and gastric dyspepsia) in acute pain in the neck and back (dorsalgia).Patients and methods. The investigators followed up 120 patients (4 groups, each having 30 people) with acute dorsalgia who took different oral NSAIDs for 7 days: long-acting ketoprofen, aceclofenac, naproxen, and dexketoprofen (Flamadex). To evaluate their possible side effects, dyspepsia symptoms were monitored and blood pressure (BP) was measured daily; gastroscopy was repeated after completion of a treatment cycle. The Nottingham Quality of Life Questionnaire and the Visual Analogue Scale (VAS) for pain were used.Results and discussion. A gradual and substantial reduction in pain measured according to VAS was noted in all the NSAID-treated groups. The intensity of pain syndrome decreased faster in the dexketoprofen group; the analgesic effect of naproxen and long-acting aceclofenac was significantly less (p=0.012 and 0.002, respectively). This patient group showed a tendency to maximum improvement according to the Nottingham Quality of Life Questionnaire and VAS. Elevated BP was observed in all the groups, but statistically significantly more frequently in the naproxen group (p=0.05). Gastric dyspepsia was also registered in all the groups, but a tendency to its lower frequency was seen in thedexketoprofen group. Conclusion. Dexketoprofen showed fewer side effects and a more pronounced analgesic effect than ketoprofen, aceclofenac, and naproxen in acute dorsalgia.

Psyllium is a predominantly soluble fiber among other natural plant-based dietary fiber used in food and pharmaceuticals and is sold as a laxative fiber. Isphagula (lat. ispaghula)– international nonproprietary name of a medicine of «psyllium». Accordingly to ATX belongs to the group of «Laxatives», subgroup «A06AC «Laxatives increasing volume of intestinal contents» (Bulking laxatives) and has the following code and name: «A06AC01 «Ispaghula» (plantain oval seeds)». Isphagula is a medical dietary fiber; in the context of gastrointestinal problems in terms of «ispaghula» and «psyllium» are synonymous. Psyllium flour has virtually no digestible carbohydrates. This fact is a significant advantage of psyllium over oat bran, in which such carbohydrates are more than 60%. A distinctive feature of psyllium is that it is almost completely (80–85%) consists of fiber (about 70% of which is soluble), which in contact with water turns into a soft gel. Only 1 gram of fiber ground fiber flour is able to absorb up to 45 ml of water. In the colon, psyllium is resistant to fermentation, remains intact in the feces and significantly increases the water content in the feces, providing a laxative effect. Psyllium softens hard stools in constipation, normalizes loose stools in diarrhea, and normalizes stool shape in patients with IBS, relieving gastrointestinal symptoms. Dietary supplement «Fitomucil® Norm» contains 4.5 g of psyllium (Plantago psyllium), and dry pulp of prunes (Prunus domestica) – 0.5 g. This combination of psyllium and prunes can be widely used in patients with constipation and other functional digestive disorders in different age groups, including pregnant and lactating women, as a first-line remedy.

Currently, one of the most discussed issue in medicine is importance of omega-3 fatty acids for human body. There are several types of omega fatty acids: omega-9, omega-6 and omega-3 polyunsaturated lipids. There are clear distinctions among them, both by chemical structure, and by influence on human body. It is the excess of omega-6 that leads to sluggish inflammatory process in the vascular walls, joints, heart and brain. The article covers action mechanisms and effects of omega-3 fatty acids in different diseases. The questions of correlation of omega-6 and omega-3 polyunsaturated fatty acids in nutrition are considered, as well as norms of consuming omega-3 fatty acids in prevention and treatment of different diseases.

Currently, one of the most discussed issue in medicine is importance of omega-3 fatty acids for human body. There are several types of omega fatty acids: omega-9, omega-6 and omega-3 polyunsaturated lipids. There are clear distinctions among them, both by chemical structure, and by influence on human body. It is the excess of omega-6 that leads to sluggish inflammatory process in the vascular walls, joints, heart and brain. The article covers action mechanisms and effects of omega-3 fatty acids in different diseases. The questions of correlation of omega-6 and omega-3 polyunsaturated fatty acids in nutrition are considered, as well as norms of consuming omega-3 fatty acids in prevention and treatment of different diseases.

The limited amount of financing of the budget and insurance of health care system necessitates the introduction of special techniques into practical health care, aimed at rationalizing therapeutic measures. The study showed the economic efficiency of complex cardiac rehabilitation at all stages of rehabilitation treatment of patients with chronic heart falure, on the background of type 2 diabetes mellitus.

Aim. The purpose of this study was to examine the association of increasing concentrations of endothelin-1 and soluble forms of ST2 protein (sST2) in the blood plasma of patients with chronic heart failure (CHF) who underwent implantation of a cardioverter-defibrillator, with the development of cardiovascular events (death from cardiovascular diseases, decompensated CHF, acute coronary syndrome or acute ischemic stroke) to determine whether these biomarkers can be used as predictors of an unfavorable course of the disease.Material and methods. A 6-month cohort study included 40 patients with CHF who received an ICD 4-12 weeks before their inclusion in the study. At the beginning of the study the concentrations of endothelin-1 and sST2 in plasma by ELISA were analyzed, along with conventional diagnostic techniques typical of a specialized cardiology clinic.Results. Phenotype with a favorable course of the disease was identified in 21 patients (group 1), and with a unfavorable course was seen in 19 (group 2). The concentration of endothelin-1 and sST2 in the blood plasma of the 2nd group patients was higher than in patients of the 1st group. The link of cardiovascular events with high levels of soluble ST2 protein and endothelin-1 in blood plasma has been identified. Variation of the decision rule threshold on the ROC-curve has allowed sST2 concentration of 34.93 ng/ml to be determined as a cutoff point. Accuracy of two-class classification (determination of the posterior probability of cardiovascular events) after identifying such cut-off point was characterized by 93% sensitivity and 72% specificity (area under ROC-curve – 0.87). If the value of the plasma concentrations of sST2 more 34.93 ng/ml the relative risk of cardiovascular events was 4.4 (95% CI 1.7–11.1). The use of endothelin-1 surplus in plasma (cut-off point – 0.34 fmol/ml) in predicting cardiovascular events was lower: the sensitivity – 88%, specificity – 68% (area under ROC-curve – 0.74). When the concentration of endothelin-1 in blood plasma was more than 0.34 fmol/ml the relative risk of cardiovascular events was 2.7 (95% CI 1.2–6.3).Conclusion. The increase in the sST2 and endothelin-1 concentration in blood plasma may be considered as a predictor of cardiovascular events in CHF patients after implantation of cardioverter-defibrillator.

Aim. To study the efficacy of rosuvastatin and ezetimibe combination in patients with moderate clinical signs of chronic heart failure.Material and methods. We incllded outpatients (n=70) >40 y.o. with clinical picture of moderate heart failure (functional class by NYHA II), with comorbid diabetes 2 type, carotid atherosclerosis and hypercholesterolemia. Patients were randomized to 2 groups, 35 persons in each. In the 1st group threatment was performed with rosuvastatin 20 mg daily, with ezetimibe 20 mg daily, in the 2nd — only rosuvastatin 20 mg daily. During one year of study we collected primary endpoints: death, myocardial infarction, stroke, hospitalizations; and secondary endpoints: the amount of those reached target level of low density lipoproteides cholesterol (LDL), changes of lipidogram, C-reactive protein (CRP), intima-media thickness of internal carotid artery.Results. Significant decrease of LDL comparing to baseline, occured in both groups by the end of the first month and remained until the end of study. The most significant LDL decrease (mediana >50%) occured in 1st group by 12 months of the study. Also, since the 3 month, we observed the decrease of LDL more than 45%. In the 2nd group this parameter was not more than 40%. The decrease of CRP by 12 months of the study was found only in the 1st group: mediana of baseline value 3,2 mg/L, end of study mediana 2,2 mg/L, mediana of changes 31,25% (p=0,028). Hospitalizations related to cardiovascular diseases were at level 14,3% in 1 group, and 40% in the 2nd st (р=0,032).Conclusion. Prescription of combination hypolipidemic therapy by rosuvastatin and ezetimibe at dose 20 mg/daily leads to more prominent decrease of LDL in blood, decrease of CRP, number of hospitalizations for cardiovascular diseases comparing to single use of rosuvastatin 20 mg/daily.

Currently there is enough evidence for that the use of omega-3-faty acids compounds in ischemic heart disease is followed by the decrease of mortality, and the efficacy of this usage in multivessel coronary lesions after primary percutaneous intervention (PCI) has not been studied.Aim. To evaluate the efficacy of long-term intake of the omega-3-polyunsaturated fatty acids compounds on the course of ischemic heart disease at the background of multiple coronary lesion after primary PCI.Material and methods. Totally 101 patient included at the age of 35-70 y.o., who had underwent primary PCI for the myocardial infarction with ST elevation and multiple vessel lesion of coronary arteries. The patients were selected into 2 groups: 1 group (n=68) — conservative tactics with the standard pharmacotherapy; 2nd group (n=33) — Omacor was added to the standard therapy.Results. In 36 months of follow-up in the Omacor group there was significant decrease of repeated myocardial infarctions, decompensating heart failure, angina progression and rhythm disorders. In 2nd group patients during the 36-month follow-up a better antiischemic effect achieved with 80,9% decrease of angina from the baseline (p

The article analyzes the effectiveness and safety of treatment cytoprotectant meldonium dihydrate and inotropic stimulator of levosimendan on an annual prognosis in patients with myocardial infarction complicated by acute heart failure II-III class Killip, subjected to percutaneous transluminal coronary angioplasty.