[PERSONALIZED MEDICINE IN INTERNAL MEDICINE].

Personalized medicine - a new direction in medicine, which is based on the study of various biomarkers and the use of new methods of molecular analysis (primarily evaluating the activity of isoenzymes of cytochrome P450), allowing individualized approach to the selection of both the drugs and the selection of the dosing regimen for the purpose of maximize the effectiveness and safety of pharmacotherapy. This personalized medicine is to change the development and use of preventive and curative interventions. Genetic polymorphism isozymes of cytochrome P450 may determine the individual activity of a particular isozyme, and thus, to predict the clinical effectiveness, and in some cases, the risk of adverse reactions. The article is an example of the use of information on the activity of cytochrome P450 in clinical practice in matters of diagnosis, treatment and prevention of diseases. The scheme of the five best-known activity of isoenzymes of cytochrome P450 is shown.

[Comparison of linezolid and vancomycin in nosocomial pneumonia: results of the multicenter double-blind study]. / Linezolid pri nozokomial'nykh pnevmoniiakh: rezul'taty mnogotsentrovogo dvoinogo slepogo issledovaniia v sravnenii s vankomitsinom.

The results of multicenter, randomized, double-blind comparative study of linezolid and vancomycin efficacy, safety and tolerability in the treatment of nosocomial pneumonia are presented. The trial was performed on 69 patients. Clinical efficacy of linezolid was 83 per cent, of vancomycin--79 per cent. Bacteriological effect (pathogen eradication) was 83 per cent for linezolid group and 86 per cent for vancomycin group. During the study good clinical tolerability of linezolid was demonstrated along with lower side effects incidence and shortened recovery period when compared to vancomycin.

[Two cases of diagnosis of right ventricular myocardial infarction]. / Dva sluchaia diagnostiki infarkta miokarda pravogo zheludochka.

Right ventricular myocardial infarction (RVMI) occurs rather rarely, under the mask of various diseases and is not easy to detect. Hypo-vate prognosis. Intravital diagnosis of RVMI was successful in 4 patients. Location of the lesion and its extent were determined. This article reports two cases of the four. The disease onset manifested with dyspnea, dry cough, attacks of night asphyxia then symptoms of right ventricular failure arose and intensified. The clinical picture, typical ECG signs suggested the RVMI diagnosis. However, its verification, precise localization and estimation of the lesion size were possible only after balanced radioventriculography.

[Aerophytotherapy with olesan oil in the treatment of patients with chronic obstructive bronchitis and bronchial asthma]. / Aérofitoterapiia olesan-oil v lechenii bol'nykh khronicheskim obstruktivnym bronkhitom i bronkhial'noi astmoi.

Positive clinical changes were found in 28 (64%) of 44 patients with chronic obstructive pulmonary diseases (COPD) treated with olesan-oil as aerophytotherapy. These patients improved also external respiration function.

[Complex assessment of inhacort effectiveness in bronchial asthma]. / Kompleksnaia otsenka éffektivnosti ingakorta pri lechenii bol'nykh bronkhial'noi astmoi.

AIM: To investigate efficiency of inhacort in long-term (6 months to 2 years) treatment of bronchial asthma (BA). MATERIALS AND METHODS: 67 inpatients and 65 outpatients with moderate BA were divided into two groups. 96 patients of group 1 had received standard combined treatment without glucocorticosteroids (GCS), 36 patients of group 2 had received GCS. Inpatients were given inhacort in a dose 1000 micrograms/day, outpatients took inhacort in a daily dose 500 micrograms/day. The examination scheme included assessment of external respiration function (ERF), blood hydrocortisone, sputum rheology and diagnosis of candidosis. RESULTS: Inhacort treatment has reduced frequency of asphyxia attacks 2.5-fold 30 and 25% of the patients stopped taking sympathomimetics and GCS, respectively. None of the patients had asphyxia as a status. ERF, sputum viscosity improved, hydrocortisone secretion was unchanged. Only 3.8% of the patients developed oral candidosis. CONCLUSION: Inhacort in a dose 1 mg controls BA. 73% of the patients treated outpatiently had no need in hospitalization.

[A complex evaluation of the efficacy of aldecin in treating bronchial asthma patients]. / Kompleksnaia otsenka éffektivnosti al'detsina pri lechenii bol'nykh bronkhial'noi astmoi.

AIM: Study of efficiency of inhalation glucocorticosteroid Aldecine. MATERIALS AND METHODS: A 4-week trial of 30 patients with bronchial asthma. Treatment results were evaluated by clinical symptoms, demand of inhalation sympathomimetics, external respiration, viscosity and elasticity of bronchial secretion, concentrations of hydrocortisone and thyroid hormones. RESULTS: Aldecine produced a good clinical effect, improved external respiration, allowed to reduce doses of inhalation beta-adrenomimetics. No deterioration of either bronchial secretion rheology or inhibition of adrenal and thyroid function was seen. Candidiasis was clinically negligible. CONCLUSION: Aldecine proved highly effective and tolerable in patients with bronchial asthma.

[The effect of salben on the rheological properties of the bronchial secretion]. / Vliianie sal'bena na reologicheskie svoistva bronkhial'nogo sekreta.

AIM: Assessment of the effect of a new Russian selective sympathomimetic salben (powder for inhalations) on bronchial secretion viscosity and adhesion. MATERIALS AND METHODS: Salben or placebo (sodium bensoate) were given to 82 and 30 patients (control) with bronchial asthma, respectively. The response was assessed by clinical, laboratory and instrumental findings. RESULTS: A statistically significant (p < 0.05) reduction of the viscosity and adhesion (by 15 and 20%, respectively) was noted in the salben group which also demonstrated improved external respiration. CONCLUSION: Salben induced positive effect on bronchial secretion viscosity and adhesion.

[Evaluation of the hormonal status of patients with bronchial asthma by using various drug doses]. / Otsenka gormonal'nogo statusa u bol'nykh bronkhial'noi astmoi pri razlichnykh farmakologicheskikh nagruzkakh.

Drug loads were used to diagnose impairments of the hypothalamic-pituitary-adrenal system in 209 patients with bronchial asthma. A thyroid-releasing hormone test made in patients with moderate bronchial asthma who were taking no corticosteroids (CS) demonstrated a high level of thyroid-stimulating hormone at min 60 of the agent administration, which was indicative of decreased hypothalamic function. In 67.8% of patients, the vasopressin test was positive and suggested that the pituitary preserved its functional capacities. The decreased secretion of hydrocortisone and its active forms was observed in patients with severe bronchial asthma when CS was used in the daily dose adequate to 10-15 mg of prednisolone for 5 years. The 20-day therapy with dexamethasone demonstrated that the agent reduced the synthesis of hydrocortisone to a greater extent than that of corticosterone. The administration of depot-synacthen 24 hours later elevated the content of all hydrocortisone fractions and biologically active corticosterone. Depot-synacthen exerted an active stimulating action on the adrenal cortex.

[A comparative evaluation of methods of determining melanogen in the urine of patients with steroid-dependent bronchial asthma]. / Sravitel'naia otsenka metodov opredeleniia melanogena v moche u bol'nykh steroidozavisimoi bronkhial'noi astmoi.

Fifty-four patients with steroid-dependent asthma of varying severity during exacerbation were examined to compare the efficacies of urinary melanogen measurement techniques. Jaksch's, Tormelen's methods, and the technique with 2M sulfuric acid were used. The tests were positive in but 3 (15%) patients with a medium severe course of the process and in 23 (68%) ones with a grave condition. Jaksch's and Tormelen's tests were similar in sensitivity, and the hydrochloric acid test was less demonstrative. Melanuria manifestation may be regarded as an early preclinical sign of adrenal insufficiency. Pigment metabolism studies in patients treated with steroids for a long time may be used as an extra method for the assessment of adrenocortical function and for monitoring the course of glucocorticosteroid therapy.