Prescribed Drug Therapy Research Articles

Experience of using lenvatinib in the treatment of hepatocellular cancer at the Republican Oncology Center of the Republic of North Ossetia-Alania in 2018–2022. Balance of efficiency and accessibility in regional practice

The overall incidence of liver cancer in the Republic of North Ossetia-Alania has remained stable over the past five years. Moreover, the initial diagnostic of HCC occurs at widespread stage, which limits the possibilities of cured therapy. The Republican Oncology Clinic has accumulated experience in using the drug lenvatinib for advanced and metastatic hepatocellular cancer. In the realities of a small regional dispensary, and has to find a balance between efficiency and availability of therapeutic options to provide effective therapy for all patients. The authors conducted a single-center retrospective analysis of the effectiveness and safety of lenvatinib in real clinical practice in patients with hepatocellular cancer at the Republican Oncology Center of the Republic of North Ossetia Alania. The analysis included 18 patients with HCC who received lenvatinib monotherapy. 11(61%) patients had concomitant viral hepatitis B or C, 15 (83%) had distant metastases to the lymph nodes, lungs, adrenal glands or other organs. A feature of this patient population is the long period of time from the prescription of drug therapy for HCC to its actual start – on average 46 days, with a range from 5 to 100 days. We believe that a delay in initiating therapy may affect the results obtained. Median PFS in 1st line of lenvatinib therapy was 10.1 months (2.3 months to 13.1 months). Median PFS2 (defined as the time from 1st line treatment on lenvatinib to progression on first subsequent therapy) was 19.1 months. 6 (33%) patients received lenvatinib in the second line after progression on another drug therapy. The median second-line PFS in this case was 5.9 months (3.8 months‑7.7 months). Lenvatinib had a manageable and predictable tolerability profile. No new safety signals were identified.Conclusion: The use of lenvatinib as monotherapy in adult patients with advanced or unresectable hepatocellular carcinoma has proven to be an effective strategy that balances clinical benefit and availability of the drug.

Diagnosis and Treatment of Generalized Anxiety Disorder in Japan: Psychiatric Specialist Survey.

Generalized anxiety disorder (GAD) is a suboptimally managed chronic recurring psychiatric condition with a lifetime prevalence of 2.6% in Japan. We assessed the current status of GAD management in Japan. This was an observational, cross-sectional study conducted through an anonymous web-based survey in Japan from December 12-16, 2022. Psychiatrists and psychosomatic medicine physicians who agreed to participate and saw ≥10 outpatients in the previous month were eligible. Survey questionnaire comprised 37 single/multiple choice, numerical entry, or open-ended questions in Japanese. Among 509 participants (493 psychiatrists and 16 psychosomatic medicine physicians), 96.9% were aware of GAD. On average, 12.4 outpatients and 1.0 inpatient were diagnosed with GAD per physician per month. Of 433 physicians having patients diagnosed with GAD, 46.9% used operational diagnostic tools; among these, DSM-5 diagnostic criteria were used by 81.5% physicians. The majority (54.7%) of participants did not use a self-administered rating scale; depression scales were used more than anxiety scales. Among these 433 physicians, 96.8% used selective serotonin reuptake inhibitors for GAD management, and 79.2% used it as the first choice; of 431 physicians who prescribed drug therapy, 54.3% gave antidepressant monotherapy as first choice. The most frequent symptom in patients diagnosed with GAD was excessive anxiety/worry (96.5%); depression was the most commonly reported comorbidity (84.3%) as per physicians aware of GAD (N=508). This study illustrates that although GAD awareness is high among Japanese psychiatric specialists, GAD is not frequently diagnosed using operational diagnostic approaches. Due to a lack of Japanese guidelines for GAD diagnosis and treatment, diverse international guidelines are followed, with similar treatment paradigms as that of depression. This may not be an optimal approach given cultural/geographical differences. These findings highlight the need for uniform diagnosis and treatment recommendations for GAD management in Japan. UMIN-CTR: UMIN000049572.

Effects of clinical interventions through a comprehensive medication management program: A retrospective study among outpatients in a private hospital

IntroductionThe intricate nature of certain diseases necessitates complex medication regimens, utilization including high-cost medications, and continual vigilance to avoid potential complications. To address these exigencies, numerous healthcare institutions have instituted multidisciplinary management teams, exemplified in pharmaceutical care through Comprehensive Medication Management (CMM) programs. These programs oversee diverse facets such as patient education, medication adherence promotion, clinical monitoring, dose adjustments, and scrutiny of prescribed drug therapies. Given the emphasized significance, it is relevant to possess evidence to continue endorsing these initiatives from management positions within health centers, and it is for this reason that this study aims to evaluate the clinical and economic benefits provided by a CMM program within a private hospital in Latin America, by analyzing the effects of clinical interventions. MethodsA retrospective examination was conducted involving documented pharmaceutical interventions in an outpatient setting from January 2019 to September 2022. To assess the interventions' repercussions, a retrospective analysis was undertaken. The collated data included patients' basic characteristics, a comprehensive pharmacist-generated description of interventions, potential associated complications, and avoided medical services. Multiple clinical projections, which were endorsed by internal medicine physicians, were developed to explore potential scenarios in the absence of pharmaceutical care. These projections were associated with conceivable complications, aligned with the most plausible circumstances. Subsequently, utilizing the average cost of healthcare within a private hospital in Latin America, the cumulative savings were quantified. These savings were then attributed to the intrinsic advantages offered by pharmaceutical care. ResultsThe study discloses demographic trends among patients within distinct age groups in the CMM program. Rheumatology predominated as the main referral source, and interventions centering on monitoring emerged as the pivotal drug-related concern. This encompassed a collaborative approach, involving interdisciplinary efforts toward patient education and critical parameter monitoring. Of the total 347 pharmaceutical interventions, 66.3% (N = 230) specialty office visits, 14.1% (N = 49) general practitioner consultations, 12.4% (N = 43) hospitalizations, and 7.2% (N = 25) ER visits were avoided. The economic analysis underscores cost savings ensuing from pharmaceutical interventions, amounting to a cumulative 603,792.82 USD. Extrapolating these findings to a patient cohort of 400 enrolled in the pharmaceutical care program approximates per-patient savings of 361.47 USD. ConclusionThis study reveals the significant clinical and economic benefits of CMM programs, led by multidisciplinary pharmaceutical professionals. The findings provide compelling evidence for hospital management to consider promoting such programs, drawing from the patient-centered care model in the United States applicable to Latin America.

Pharmacist-Led Follow-Up Program for Rural Patients with Acute Coronary Syndrome: The PLURAL-ACS Pilot Program.

Patients living in rural settings have poorer access to care and more frequent readmissions after treatment for acute coronary syndrome (ACS) than patients in urban settings. It is unclear what types of medication-related issues are encountered by this cohort and whether pharmacist-led care could resolve them. To describe the issues related to cardiac medications encountered by rural patients after treatment for ACS and the impact of a pharmacist-led virtual follow-up pilot program in this population. A quality improvement initiative was developed whereby a cardiology pharmacist provided follow-up to post-ACS rural patients in Alberta, Canada, between March and May 2022. For each patient, the pharmacist identified and resolved cardiac medication-related issues through regular telephone visits over a 30-day period following hospital discharge. The primary outcome was the number of cardiac medication-related issues identified. Secondary outcomes included the types of medication-related issues identified and actions taken by the pharmacist to resolve them. During the 15-week program, 40 patients received care, and 139 virtual visits were completed. The median time spent per visit was 60 (interquartile range [IQR] 50-80) minutes. In total, 255 cardiac medication-related issues (6 per patient, IQR 3.75-8.25) were identified, of which 233 (91%) were resolved by the pharmacist. Prescription errors, adverse effects, and drug therapy optimization were the most common issues identified on days 1, 10, and 30, respectively. The pharmacist commonly undertook patient counselling (n = 126, 54%) and medication prescribing (n = 63, 27%) to address medication-related issues. A substantial number of cardiac medication-related issues were identified and resolved through a pharmacist-led virtual follow-up program in rural post-ACS patients. These findings could assist in the development of future follow-up programs to improve care for this high-risk population.

ФІКСОВАНА КОМБІНАЦІЯ ЕКСТРАМІЛКОДИСПЕРСНОГО БЕКЛОМЕТАЗОНУ ДИПРОПІОНАТУ ТА ФОРМОТЕРОЛУ — НОВІ МОЖЛИВОСТІ В ПОКРАЩЕННІ КОНТРОЛЮ АСТМИ

Despite the great work done in recent years on the dissemination and implementation of asthma recommendations, the level of control of the disease in the world and in Europe remains unsatisfactory in a significant percentage of patients. Factors associated with the treatment failure in patients with obstructive lung diseases are not only the low adherence to the prescribed drug therapy, incorrect use of the device (poor inhalation technique), insufficient communication between the physician and the patient, inadequate drug treatment. There are other factors associated with the disease: asthma and COPD are inflammatory disorders of the entire bronchial tree, including the peripheral airways. Their involvement may remain functionally and clinically silent until signs of air trapping and hyperinflation become apparent, resulting in a lack of symptom control despite conventional treatment. Inflammatory and functional changes in the small airways (<2 mm in diameter) contribute significantly to the pathogenesis of asthma in terms of bronchoconstriction and hyperreactivity. Today, the awareness of their role in the development of asthma is increasing and they are considered as a potential target for therapy aimed at achieving and maintaining optimal disease control. The determination of the role of the distal parts of the respiratory tract predicted the need for the development of a new generation inhalers that could generate aerosols with extra-fine particles of drugs for more effective penetration of the aerosol to the periphery of the lungs. The recent appearance of inhaled extra-fine particles inhaled drugs allows for a more uniform distribution of the active substance throughout the respiratory tract, including the peripheral airways. These drugs are more effective and require a lower nominal dose to achieve the same effect on lung function and symptoms compared to equipotent doses of non-extra-fine aerosols. Extra-fine fixed combination of beclomethasone dipropionate and formoterol 100/6 mcg (FOSTER) was the first registered metered dose inhaler for the MART regimen in asthma. Key words: asthma, distal airways, inhalers, asthma control, exacerbation.

Refusal of prescribed drug therapy (absolute non-adherence) after acute myocardial infarction/unstable angina: data from prospective observation in the LIS-3 registry

Aim. Within the LIS-3 register of acute coronary syndrome (ACS), to evaluate the phenomenon of complete refusal of treatment (absolute non-adherence) after discharge from the hospital of patients diagnosed with acute myocardial infarction (AMI)/unstable angina (UA): to study the characteristics of absolutely nonadherent patients, disease outcomes after 2.5 years after first contact.Material and methods. The study was conducted within the framework of the LIS-3 register. This part of the study included patients who survived ACS and were discharged from the hospital in the first 9 months of 2014 (104 people) and patients who survived ACS and were discharged from the hospital in the first 9 months of 2018 (223 people). Of the 327 patients who survived after AMI/UA, 226 patients remained alive by the time of the first survey (on average 3 years after discharge). The created questionnaire was used, which includes questions about possible long-term outcomes, adherence to visits to medical and preventive institutions (health facilities) and adherence to drug therapy. 221 people answered questions about treatment, 11 (5%) of them did not take any drug therapy (absolutely non-adherent). On average, 29 months (2.5 years) after the initial survey, a repeat survey of completely non-adherent patients or their relatives was carried out, information was collected on the vital status of these patients, repeated cardiovascular events and on the use of recommended drug therapy, about visiting a health facility.Results. When comparing the clinical and demographic characteristics of patients who were adherent and completely non-adherent to the prescribed therapy, no significant differences were noted. By the time of the repeat survey, 4 patients from among those who were completely non-adherent had died, 2 had suffered ACS. Of the 6 patients who survived, at the time of re-contact, 2 had not started taking medications, explaining that they were feeling well, 2 had resumed taking medications in full, 2 — partially, contact with 1 patient was lost.Conclusion. A certain proportion of patients who have suffered AMI/UA completely refuse the prescribed treatment, mainly because they feel well. The likelihood of death and recurrent cardiovascular events in such patients is extremely high.

Adherence to ESC guidelines for antihypertensive drug therapy: real-world survey from an EU country

Abstract Background Achieving optimal BP control in hypertensive patients (pts) remains a continuous challenge worldwide. Multiple factors are responsible for the low rates of BP control with suboptimal drug choice playing a key role. Practice guidelines should serve as evidence based foundation for optimal antihypertensive drug therapy but their impact in the real-world is variable. Purpose This retrospective study aimed: 1. To assess the prescription pattern of main classes of antihypertensive drugs and its association with comorbidities. 2. To compare prescription before and after the publication of the 2018 ESC/ESH guidelines for management of arterial hypertension, translated into local language (in 2019). Thus, prescriptions in the years 2018 and 2020 were compared. Dual combination of ACEi/ARB + CCB/thiazide-like diuretics (THI) or triple combination of ACEi/ARB + CBB + THI were considered as guidelines directed first line drugs (FLAD) i.e. adherence to guideline. Spironolactone (MRA) was considered as recommended drug for patients requiring ≥4 drugs. Methods We analysed prescribed drug therapy in a large patient cohort from the years 2018 and 2020 with 264 237 and 272 934 hypertensive pts, respectively. Pts were considered hypertensive after meeting at least one of two criteria: 1. Having been prescribed ≥ 121 standard drug doses of antihypertensive drugs in the year before the studied period. 2. Having at least 2 medical visits with the diagnosis of hypertension within 2 years before the studied period. Following comorbidities were considered as potential modifiers of drug therapy: ischemic heart disease (IHD), chronic heart failure (CHF), atrial fibrillation (AF), diabetes (DM) and chronic kidney disease (CKD). Results Overall, first line therapy was prescribed to 21.5% and 22.4% of pts in the year 2018 and 2020, respectively (p<0.0001). In pts taking ≥3 drugs 30.4% did not use THI, in those taking ≥4 drugs only 10.7% used spironolactone (MRA). Selected results are in the attached table. Conclusion Adherence to guideline recommended FLAD in this large survey improved but remained low during the first year after publishing ESC 2018 guidelines: only 22.4% of pts received FLAD in this cohort where 58.6% were free of comorbidities. In pts with AF, the use of FLAD was the lowest with 7.3%. Preferred use of BB and low use of THI and MRA were mostly behind this trend. BB (alone or in combination) were the most prescribed drug group – to 57.3% of pts both in 2018 and 2020. Their prescription was high in all pts with comorbidities, notably worrisome for diabetic pts (66.0%). Continuous efforts to improve dissemination of knowledge of FLAD according to guidelines appear mandatory.Attached table

Diagnosis and treatment of prediabetes as prevention of type 2 diabetes: A review

Prediabetes is defined as a disorder in which the criteria for diabetes mellitus are not met, but normal blood glucose values are exceeded; this intermediate hyperglycemia is associated with a high risk of developing diabetes and cardiovascular disease. The number of patients with diabetes mellitus continues to grow steadily, and therefore the role of timely interventions at the stage of prediabetes is obvious. A modern approach to preventing the progression of prediabetes includes correcting risk factors for cardiovascular diseases, arterial hypertension, dyslipidemia, weight loss and/or prevention of weight gain, and improving the quality of life. The first-line therapy for prediabetes is lifestyle modification, which includes changes in diet, physical activity, weight management, bad habits, and sleep hygiene. Thus, a non-pharmacological approach to the treatment of patients, aimed at reducing excess weight, plays a major role. In conditions of insufficient effectiveness of measures to change lifestyle, it is advisable to prescribe drug therapy. Metformin is the first-line drug for preventing the progression of carbohydrate metabolism disorders. In addition to lifestyle modification, orlistat, drugs from the group of GLP-1 analogues, thiazolidinediones, and acarbose have also demonstrated their effectiveness. Bariatric surgery is associated with improved glycemic control in prediabetic patients.

Clinical Significance of Quantitative Viral Load in Patients Positive for SARS-CoV-2

Cycle threshold (CT) refers to the number of cycles in a reverse transcriptase polymerase chain reaction (RT-PCR) assay needed to amplify viral RNA and can be used to indicate viral load. CT is inversely related to viral load, where lower CT values indicate higher viral levels. Data suggest lower CT scores are associated with worse outcomes in COVID; however, quantitative CT scores are not typically reported to patients. This retrospective analysis examined the use of CT scores in patient counseling for positive COVID results and suggests that higher viral loads were associated with greater need for prescription drug therapy in the outpatient setting. Patient perception of CT score was found to influence masking and quarantine behavior. We hypothesize that a quantitative threshold for viral load such as CT can be useful in patient counseling, estimating need for drug therapy, and influencing behavior toward public health concerns.

Клинический случай применения пембролизумаба у пациента с метастатическим поражением лимфатических узлов, головного мозга без выявленного первичного очага

Treatment of patients with metastases of a malignant tumor without an identified primary focus (HPV) occurs on an individual basis, taking into account clinical and morphological data. The correct prescription of drug therapy depends on the final histological, immunohistochemical and molecular genetic studies. The article presents a clinical case of the use of immunotherapy in a patient without HPV with high PD-L1 expression.

The problem is the prescription of drug therapy to reduce the risk of fractures and its solution

The older people with osteoporosis, especially those with low-energy fractures, are the most vulnerable group of geriatric patients. They are shown the appointment of anti-osteoporotic therapy, which should be effective and safe. Unfortunately, the real prescription of medical treatment of osteoporosis in the world barely reaches 20%. This is due not only to low adherence to therapy by elderly patients, but also to financial and economic difficulties in obtaining drugs. For most patients, drug therapy for osteoporosis is quite expensive, especially given its long-term, often lifelong, course of action. However, new opportunities have now emerged to provide certain anti-osteoporotic drugs not only to patients in the preferential category, but also without disabilities. This will not only increase the number of patients receiving treatment for osteoporosis, but also reduce the risk of fractures, both primary and recurrent, the risk of falls, injuries and premature death among the elderly population. The article presents modern possibilities of providing medicines to patients with osteoporosis and its complications in the form of pathological fractures using clinical and statistical groups (CSG) as new methods of payment for inpatient and hospital-replacing care in the Russian Federation.

Лікування пацієнта з дилатаційною кардіоміопатією із застосуванням мезенхімальних стовбурових клітин

Наведено 3-річне спостереження за пацієнтом з дилатаційною кардіоміопатією, для лікування якого були застосовані мезенхімальні стовбурові клітини пуповинної крові. У пацієнта після тяжкого перебігу хронічного міокардиту розвинулася дилатаційна кардіоміопатія. Лікування позитивно вплинуло на динаміку клінічного стану, поліпшення показників скорочувальної функції лівого шлуночка, поліпшення якості життя. Пацієнт був знятий з листа очікування трансплантації серця. Спостереження за хворим триває.

Practical recommendations for the treatment of patients with breast cancer (article 2)

Background. Breast cancer is one of the most widespread malignant diseases among women in the world. For the last few years, its rate has constituted about 20% of all tumor diseases in women. The annual standardized morbidity growth rate in Ukraine was 1,8% in the last decade. The cumulative risk of breast cancer development is 5,4% given that the life duration is 74 years. Treatment of patients with breast cancer. The treatment must be planned by several medical specialists including a surgical oncologist, a radiation therapist, a chemotherapist, and, if possible, a pathologist. This will allow local and systematic tumor therapy methods to be combined in the best way possible.
 Purpose – to systematize, generalize, and present the research data on modern approaches to diagnostic measures, movement of patients, and sequence of treatment approaches for locally advanced and metastatic breast cancer from the perspective of the Ukrainian healthcare system. Materials and methods. The article covers modern full-text publications, screening, and treatment protocols of patients with breast cancer, which were obtained from international and domestic sources and databases (e-catalog of Vernadsky National Library of Ukraine, Web of Science, Core Collection, Pubmed).
 Results. Місцево-поширений первинно-неоперабельний інвазивний рак грудної залози РГЗ, в тому числі інфільтративно-набрякова форма є первинно неоперабельними і вимагають призначення медикаментозної терапії на першому етапі лікування. Locally advanced primarily inoperable invasive breast cancer, including infiltrativeedematous form, is primarily inoperable and requires the prescription of drug therapy at the first stage of the treatment. Triple-negative and HER-2-dependent tumors also require presurgical drug therapy. Local treatment (surgery, radiation therapy) at the first stage is not indicated. The main goal of drug therapy in primarily inoperable forms of breast cancer is the reduction in the size of the tumor in order to achieve an operable condition. Presurgical drug therapy in primarily inoperable forms of breast cancer is carried out under the same rules as in primarily operable ones. Therapy of isolated local recurrences is aimed at full recovery and must be performed similarly to the treatment of primary tumor and involve necessary diagnostic and treatment methods (the diagrams are given in article 1). The treatment of advanced, disseminated breast cancer is palliative and intended to improve the quality of life and increase its duration. The main treatment method for metastatic disease is drug therapy. There is no single treatment standard for metastatic breast cancer. Selection of the drug therapy option is performed taking into account biological markers and clinical-anamnestic features of the patient. On the condition that individual approaches to the treatment of patients with breast cancer are used, the following improvements are quite possible: an increase in both recurrence-free and overall survival, a decrease in the number of complications and toxic manifestations, better compliance of the patients and improvement of their life quality. Systematization and individualization of treatment regimens, depending on the stage of the tumor process and biological features of the tumor, allow the practicing physician to plan and predict the types and the sequence of antitumor therapy.
 Conclusions. The deepening of our knowledge of breast cancer pathogenesis will contribute to the deeper implementation of individual approaches to the treatment of patients with this pathology. Continuous search will certainly lead to the appearance of new groups of drugs which may change the existing standards of treatment. The use of new pathogenetically relevant methods of biological, hormonal, and target therapy in the modern standards of treatment will allow both recurrence-free and overall survival of the patients to be increased.

Analysis of drug prescriptions of patients with atrial fibrillation in combination with chronic kidney disease for compliance with STOPP/START criteria

The percentage of elderly and senile patients is growing every year. Among this cohort of patients, atrial fibrillation (AF) is one of the most common rhythm disorders. At the same time, AF repeatedly increases the risk of thromboembolic complications. The course of AF in elderly patients is often complicated by chronic kidney disease (CKD). When managing patients of this group, we often encounter polypragmasia, which affects the patient’s quality of life, increases the risk of falls, and potentially reduces life expectancy. In order to optimize pharmacotherapy, STOPP/ START criteria were developed.The purpose of the study was the analysis of drug prescriptions in patients over 65 years of age with AF and CKD for compliance with the STOPP/ START criteria.Material and methods. 339 case histories of the cardiology department and 180 case histories of patients of the therapeutic department of the Veterans of Wars multidisciplinary hospital were analyzed. In each department, patients were divided into 2 groups: patients with AF in combination with CKD C3a and patients with AF in combination with CKD C3b and C4.Results. In the therapeutic department, 96.1% of the first group and 100.0% of the second group of patients were not prescribed drugs that are recommended for elderly patients (START criteria). 64.7% of patients from the first group and 53.8% of patients from the second group have potentially not recommended, but prescribed drugs (STOPP criteria) in the appointment lists In the cardiology department, the percentage of patients who did not have the recommended drugs (START criteria) in drug therapy was 92% in group 3, 97% in group 4. The percentage of patients who were prescribed potentially non-recommended drugs (STOP criteria) in group 3 45%, in group 4 48%.Conclusion. Most elderly and senile patients with AF in combination with CKD have both START and STOPP criteria, which dictates a thorough analysis of the prescribed drug therapy.

Текущий статус метафилактики мочекаменной болезни в Российской Федерации

Urolithiasis is one of the most common urological diseases in adults. Increased life expectancy of the population in developed countries, make urolithiasis topical issue and requires close attention. Due to the high risk of recurrent stone formation causing repeated surgical interventions, the issue of effective urinary stone metaphylaxis is very important today.To study the current state of the problem of urolithiasis metaphylaxis among Russian urologists, an anonymous questionnaire was applied. A 25-question questionnaire was sent to e-mail to more than 4,000 Russian urologists. A total of 1,238 specialists completed the questionnaire. The database compiled from the received responses was processed and presented with descriptive statistics in the form of tables and charts.According to the survey, more than half of the 831 (67.1%) specialists specialized in the treatment of urolithiasis. It was noted that 626 (86%) inpatient urologists and 205 (40%) outpatient urologists specialized in the treatment of urolithiasis. Only 521 (69.6%) urologists specializing in surgical treatment of urolithiasis give a patient a stone fragment to analyze its chemical composition. At the same time, half of the respondents reported that less than 10% of patients come to them for further metaphylaxis. One of the main reasons for not analyzing the chemical composition of the stone was the fact that 877 (70,84%) specialists indicated the inaccessibility of analysis under the state guarantee program, 503 (40,63%) specialists indicated the patients satisfaction with the results of minimally invasive surgical treatment and lack of sufficient motivation for further examinations. At the same time, less than 3% of specialists can perform stone analysis within the framework of the state guaranty program. 1180 (96,8%) respondents practiced the prophylaxis of recurrent calculi formation, but only 336 (28,47%) performed comprehensive metabolic examination of all patients followed by prescription of drug therapy and appropriate diet.Our survey revealed low involvement of urologists at the outpatient level in the process of conservative treatment and metaphylaxis of urolithiasis, low activity of urologists in performing complex metabolic study and comprehensive prevention of recurrent stone formation, low percentage of performing chemical composition analysis of stone and low activity of urologists in performing primary litholytic therapy of urate stones. Based on this analysis of the responses of most Russian urologists, it is possible to formulate recommendations to remove the obstacles to providing patients with urolithiasis with quality medical care in terms of conservative therapy and metaphylaxis of urolithiasis.

The Role of Bisphosphonates and Prostaglandins for the Treatment of Subchondral Insufficiency Fractures of the Knee: An Evidenced-Based Opinion

Subchondral Insufficiency Fractures of the Knee (SIFK) can result in accelerated cartilage degeneration and poor outcomes. The presence of SIFK is difficult to manage and can cause persistent knee swelling, pain, and prolonged disability. Pharmacologic agents to suppress extensive bone remodeling, improve blood supply, and reduce pain have been suggested as treatment for these lesions. Nonoperative management with prostaglandins and bisphosphonates has emerged as a potentially efficacious intervention for symptom reduction and resolution of knee bone marrow edema. However, previous reports of potential serious adverse effects including atypical femoral fractures of the proximal femur raise concerns for clinical safety. This evidence-based opinion article demonstrates the potential clinical efficacy of various pharmacologic therapies, including prostaglandins and bisphosphonates, for the treatment of SIFK. The overall rate of reporting adverse effects in the literature is high (47.3%), while significant clinical improvements have been identified in 66% to 100% of the patient population. This collective information may help guide physicians during prescription drug therapy for the treatment of SIFK.

Uric Acid as a Risk Factor for Cardiovascular Diseases

Recently, hyperuricemia and its association with cardiovascular disease have been receiving more and more attention. The article talks about the role of uric acid in the body, the reasons for its increase and the impact of elevated uric acid levels on the cardiovascular system. The mechanisms of influence of hyperuricemia on the development and progression of cardiovascular diseases are presented. Medicinal and non-drug ways to reduce the level of uric acid in the blood are considered. From non-drug methods, attention is focused on the hypopurine diet, adequate drinking regimen and normalization of body weight. Separately, the effect on the level of uric acid of various drugs used in clinical practice is considered. In the light of current clinical guidelines, the issue of the need to prescribe drug therapy for asymptomatic hyperuricemia is discussed.

Remote monitoring of patients with chronic consciousness impairment: from needs to capabilities. Cohort study

The problem of providing rehabilitation assistance to the population has been repeatedly discussed in the global community. One of the important events in recent years was the meeting of participants in Rehabilitation 2030: Call to Action, where the problem of increasing dissatisfaction in rehabilitation services worldwide, especially in low- and middle-income countries, was discussed. The upward trend in the need for rehabilitation activities will increase in line with global trends in demographic change associated with the aging population and an increase in the number of people living with sequellae of diseases and injuries. The prevalence of health conditions associated with severe functional limitations, of which many are caused by non-communicable diseases, increased by 9.9% and affected almost 14 million people from 2006 to 2016 in the World Health Organization European Region. Devices for monitoring vital signs can become one of the potentially important components of effective rehabilitation with an increased number of technical means of rehabilitation. The constant transfer of these parameters to the cloud storage, followed by machine learning algorithm processing, will determine the prescribed drug therapy efficiency and determine the need for timely hospitalization for a medical organization. This study aimed to assess the needs of patients with a chronic consciousness impairment, and relatives caring for them, using the possibilities of remote monitoring. The study showed that the use of hospital-replacing outpatient equipment that records the vital signs of patients opens up new opportunities for consolidating the information into a big data archive to assess the treatment efficiency and the characteristics of patient rehabilitation with the implementation of the most optimal measures to influence the rehabilitation process approach.

Clinical features of the course of Graves' disease in children

Aim. To evaluate the features of the course and treatment of Graves' disease in children at the present stage.
 Materials and methods. Thirty two children diagnosed with Graves' disease aged 5.5 to 16.5 years were examined; 19 girls and 5 boys were admitted to the department for the first time, 6 girls and 2 boys with relapses of the disease. The duration of the disease in these children ranged from 2 to 8 years, the number of relapses was from 2 to 4, the intervals for the onset of relapse of the disease ranged from 6 months to 2 years. The examination algorithm included the study of the anamnesis of life and disease, the assessment of objective data. Thyroid ultrasound was performed on a GE Healthcare Medical Systems Vivid machine. The level of thyroid hormones was determined: triiodothyronine, thyroxine, thyroid-stimulating hormone (TSH), the level of antibodies to the microsomal fraction with the IMMULITE 2000 XPi and ARCHTESTo2000SR kits (Siemens, Abbott, Germany) and antibodies to the TSH receptor with the ARCHTESTo2000SR kits (Abbott, USA).
 Results. During an objective examination, tachycardia was determined in all children, an increase in the thyroid gland was noted. Almost all children had eye symptoms. The level of thyroid hormones was elevated in all children, both newly diagnosed and those admitted with a relapse of the disease. The level of TSH in all patients was reduced. The antibody titer was high for both the microsomal fraction and the TSH receptor. All patients admitted for the first time were prescribed drug therapy with thyreostatics. Three out of eight children with a recurrence of the disease were referred for radioactive iodine treatment and 1 for surgical treatment. The remaining four children continued drug treatment with thyreostatics, due to the parents' disagreement with other methods of treatment.
 Conclusion. Thus, despite the pronounced manifestations of Graves' disease, almost all children had a late diagnosis of the disease: from the moment the complaints appeared to the diagnosis and start of treatment, it took from 4 months to 1 year. Initially, the children were treated and treated by specialists in various fields. Relapses of the disease, as a rule, developed after discontinuation of therapy, either after the end of the recommended treatment period (2 years), or at different times, due to self-cessation of treatment. In some patients, unreasonably long treatment with thyreostatics was noted, despite the development of: 34 relapses of the disease and the ineffectiveness of conservative therapy.

Assessment of the Quality of Drug Therapy in Patients with Stable Coronary Artery Disease in the Second Stage of the ALIGN Study

Aim. To assess adjusted pharmacotherapy for prescribing drugs of the main classes, according to clinical guidelines, and achieving target levels of lowdensity lipoprotein cholesterol (LDL-C) in patients with stable coronary heart disease (CHD).Material and methods. Of the 73 patients included in the ALIGN study, 64 patients (53 males and 11 females; mean age 68,2±9,4 years) with stable coronary artery disease attended a second visit (3 months after the initial treatment adjustment). Prescribed drug therapy, its compliance with clinical guidelines, achievement of lipid profile and blood pressure (BP) targets were studied in all patients.Results. An increase in the frequency of taking beta-blockers (p=0.002), lipid-lowering drugs (p=0.008) by patients was found during the second visit. The proportion of patients taking all 4 groups of drugs according to clinical guidelines (statins, antiplatelet agents, beta-blockers, angiotensinconverting enzyme inhibitors / angiotensin II receptor blockers) increased from 44% to 65.5% (p<0.001) after correction of therapy, as well as an increase in the proportion of patients taking 1 antianginal drug in the presence of exertional angina from 75% to 89% (p<0.001) was found. About 90% of hypertensive patients achieved the target level of systolic blood pressure (p<0.001). Achievement of the target level of cholesterol low density lipoprotein (<1.8 mmol/l) during the second visit was found in half of the patients (p=0.004).Conclusion. Despite the initial correction of drug therapy by the staff of the cardiology department, the prescribed treatment for patients with stable coronary artery disease did not in all cases comply with clinical guidelines due to insufficient adherence of doctors and insufficient adherence of patients to prescribed medical recommendations.Working group of the register PROFILE: Voronina V. P., Dmitrieva N. A., Komkova N. A., Zagrebelny A.V., Kutishenko N.P., Lerman O.V., Lukina Yu. V., Tolpygina S.N., Martsevich S.Yu.