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Idiopathic pulmonary fibrosis (IPF) is usually characterized by a chronic and slowly progressive course. According to several studies, a small number of patients with IPF (about 515%) develops an acute deterioration of deasese exacerbation of IPF. Exacerbations of IPF can occur at any time of the disease and sometimes becomes the first manifestation of IPF. Pulmonary hypertension in IPF is a fairly frequent complication, which leads to severe violations of gas exchange and reduced tolerance to physical stress. Currently, proven effective treatments for exacerbations of IPF do not exist, the management of this condition is based on supportive therapy (oxygen, respiratory support) and interventions with inadequate evidences (corticosteroids, immunosuppressant). During exacerbation of IPF a careful search of all the possible triggers is justified. In the presented clinical case of exacerbation of IPF there was demonstrated the efficacy of complex therapy including antifibrotic therapy, PAH-specific medicines and enhanced oxygen therapy.Идиопатический легочный фиброз (ИЛФ) обычно характеризуется хроническим и медленно прогрессирующим течением. Согласно исследованиям, у небольшого числа (порядка 515%) больных ИЛФ наблюдаются острые ухудшения состояния обострения ИЛФ, которые могут развиваться на фоне пневмонии, аспирации, тромбоэмболии легочной артерии, пневмоторакса, сердечной недостаточности. Обострение может возникать в любой момент заболевания и иногда становится первым проявлением ИЛФ. Легочная гипертензия при ИЛФ является довольно частым осложнением, приводит к тяжелым нарушениям газообмена и снижению толерантности к физическим нагрузкам. В настоящее время доказанные эффективные методы лечения обострений ИЛФ отсутствуют: рассматривается только поддерживающая терапия (кислородотерапия, респираторная поддержка) и вмешательства, не имеющие достаточной доказательной базы (глюкокортикостероиды, иммуносупрессанты). При обострении ИЛФ необходимы тщательный поиск всех возможных причин обострения ИЛФ и их коррекция. В представленном клиническом случае продемонстрирована эффективность комплексной терапии базисной, ЛАГ-специфической и усиленного режима кислородотерапии у пациента с обострением ИЛФ и тяжелой легочной гипертензией.

Ovarian cancer ranks first in the mortality causes pattern of female reproductive cancers in Russia. Treatment of relapsed ovarian cancer remains a significant challenge to practicing oncologists. Introduction of PARP inhibitors in clinical practice are the most significant achievements in this area. The use of drugs of this class significantly reduced the relative risk of tumour progression in relapsed ovarian cancer and increased the relapse-free duration. At the same time, many issues related to the practical use of PARP inhibitors remain unresolved. This review presents practical approaches to determining the categories of patients, who receive the greatest benefit from the use of drugs of this class. The article addresses epidemiology of BRCA-associated ovarian cancer. The authors presented information on modern methods for genetic testing, classification of mutations depending on proposed class of pathogenicity, and reviews the problems associated with identification of «variants of unknown clinical relevance». The mechanisms of action of PARP inhibitor are described in detail here. The evidence base demonstrating the efficacy and safety of olaparib, the only PARP inhibitor approved for clinical use in the Russian Federation as supportive therapy for platinum-sensitive relapsed BRCA-associated ovarian cancer, is discussed. The article detailed information on the spectrum of potential toxicity that is most commonly faced by oncologists prescribing olaparib and other PARP inhibitors. The main aspects of management of adverse events during olaparib therapy are also presented.

Purpose. To improve the technology of cancer patients' rehabilitation in the multidisciplinary hospital using an interdisciplinary approach at the stages of combined treatment of malignant tumors. Patients and methods . The analysis of 845 cases of admission of cancer patients in a multidisciplinary clinic for oncological rehabilitation, including treatment of complications and co morbid diseases, diagnosis and palliative care, on the specialized treatment stages was made. Based on the diagnosis, clinical status, determination of the clinical potential of these patients the need in medical rehabilitation of cancer patients based on the principles of an interdisciplinary approach was established. Results. A low commitment of oncologists to refer patients to multidisciplinary hospitals for supporting general medical treatment programs, which involve the work of multidisciplinary rehabilitation teams, especially at the initial stages of cancer, was revealed. In 94.1% of cases, based on oncologists' recommendation patients were presented to the multidisciplinary hospital only in the advanced stage of malignant disease. However, 64.8% of patients who came only for the purpose of "hospice" or palliative care treatment were able to continue their anticancer treatment. In 4.9% of cases among patients, who were referred for palliative care, the severity of their condition was mistakenly regarded as a relapse of cancer, whereas it was caused by comorbid pathology. The low interest of cancer patients in rehabilitation programs in the absence of recommendations from oncologists was revealed. It was shown that supportive therapy based on the principles of interdisciplinary approach is not only needed for patients with far-ongoing manifestations of cancer process, but also for patients with stage I-II of cancer, since even at this stage various complications of cancer disease, the consequences of its treatment and also manifestations of a combined pathology are often encountered. Conclusion . A classification of medical problems of cancer patients was proposed. Based on the newly developed methodology, the algorithm of personified rehabilitation support programs of oncological patients' and guidelines for managing patients at the stages of specialized and rehabilitative treatment using principles of an interdisciplinary approach, were created.

Gastroesophageal reflux disease is one of the most common diseases of the gastroenterological profile. There are several forms of illness, including non-erosive forms, erosive esophagitis, Barrett esophagus. The article provides an overview of the drugs used to treat the erosive form of GERD and long-term supportive therapy from the perspective of evidence-based medicine. The main objectives of the treatment of erosive esophagitis are to heal esophagus mucosa lesions, achieve long-term remissions, and normalize the patients’ life quality. The proton pump inhibitors (PPIs) have steadily become the mainstay in treatment of erosive esophagitis. These drugs are used at all stages of treatment, both for the relief of symptoms and healing of oesophagus mucosa lesions, and as the long-term supportive therapy. Due to the need for long-term use of IPI, their safety are open to question. The recent publications reported an increased risk of chronic kidney disease, myocardial infarction, pneumonia, calcium, magnesium, iron, vitamin B12 deficiency. At the same time, the analysis of studies underlying the risks of long-term PPI use detected some significant disadvantages that reduce their evidence-based value. This paper provides data on the most frequently discussed risks and critical assessment of them.

Recently, an increase in the incidence of severe forms of prostate cancer, in particular castration-resistant prostate cancer (CRPC) has been noticed. Treatment of CRPC patients is associated with increasing expenses and thus impacts the healthcare budgets at various levels. The aim was to study the pharmacoeconomic aspects of using enzalutamide, cabazitaxel and abiraterone for the second-line therapy of CRPC (after treatment with docetaxel) in the Russian Federation . Materials and Methods . A cost effectiveness analysis of patient management was conducted for each of the three drugs. The direct costs included the costs of visiting the doctor, the diagnostic tests and procedures, the best supportive therapy with other drugs in accordance with the standards, the treatment of adverse events, the end-of-life palliative therapy in hospital, and the costs of prescribing one of the three drugs in question. Results. The expenses for diagnosing, maintaining the treatment regimen, consulting, monitoring and nurse caring in patients with CRPC were 15-20% lower with enzalutamide compared to abiraterone and two-fold lower than that with cabazitaxel. The general assessment of direct costs without the cost of the above drugs showed that the use of enzalutamide was 10% less expensive than abiraterone and 35% less expensive than cabazitaxel. The pharmacoeconomic advantages of enzalutamide over the two other agents are supported by the «decision tree» model and by the cost/effectiveness ratio. Conclusion. The use of enzalutamide is associated with lower direct costs of care, treatment, diagnostic and supportive procedures as compared with abiraterone and cabazitaxel.

The article presents the result of study of the effectiveness of a new drug dexlansoprazole in combination with the drug ursodeoxycholic acid in the group of patients with erosive esophagitis, with mixed reflux, as defined by results of 24-hour pHimpedance metering. Dynamics of clinical symptoms and endoscopic pattern when taking different doses of UDCA of primary and supportive therapy is monitored.

Aim. To assess the efficacy of regional system of multidisciplinary care in pulmonary hypertension (PH). Material and methods . In a single-center, pro and retrospective cohort study, 2001-2015, the epidemiological characteristics and yearly mortality from PH were assessed in the created in late 1990s multiple system of PH management in the Udmurt Republic. According to the specific drug therapy tactics, there were three periods of observation: in 2001-2005 PH patients received, by indication calcium channel blockers and supportive therapy; in 2006-2010 sildenafil was added; from 2011 pulmonary arterial hypertension (PAH) patients also received bosentan, ambrisentan, and in chronic thromboembolic PH — inhaled iloprost. Rеsults. In the cardiology and rheumatology clinic of the Udmurt Republic, a multidisciplinary system of PH management was shaped, with three-stage individualized care of patients, beginning from newborn period (1st stage — pre-hospital, 2nd — hospital, 3rd — rehabilitation). Within the first 5 years of follow-up, mortality of PH patients was 15-12% per year, from 2006 to 2010 — 10-7,5% per year, in 2011-2015 — 5,6–3,8% (р2015-2001=0,008). Conclusion. Interprofessional approach to PH patients care in the circumstances of regional center and therapy by PAH-specific drugs significantly increased survival rate of patients.

From 2001 to 2013 eleven patients with relapsed acute promyelocytic leukemia (APL) (median age – 30 years) received arsenicum trioxide (ATO). ATO was administered as a 2nd line relapse therapy in 9 patients, as 1st line relapse therapy in 2 patients. ATO was administered in a dose of 0.1 mg/kg in 7 patients, 0.15 mg/kg – in 4 patients. The induction duration was 14 days in 3 patients, 24–35 days in 2 patients, 60 days in 6 patients. From the 1st day of ATO patients received 45 mg/m2 all trans retinoic acid (ATRA) (1 patient – from day 29 of ATO therapy). Maintenance therapy ATO + ATRA (10–14 days courses, every four weeks) patients were receiving during 10–15 months. 2 from 3 patients with molecular relapses achieved remission lasting 57 and 89 months after the 14-day ATO courses. 1 from 2 patients with bone marrow relapse achieved remission lasting 27 months after the 24–35-day ATO courses. 60-day courses were effective in 5 of 6 patients: in 4 of which remission are retained during 16, 19, 27, 57 months; 1 patient was relapsed after 12 months; 1 patient did not achieve molecular remission. 3 patients received allogeneic hematopoietic stem cell transplantation (alloHSCT), 2 of which alive in remission. 1 patient received autologous hematopoietic stem cell transplantation in the 2nd molecular remission (alive in remission). 4 patients died: 1 – in the 3rd relapse (duration of 2nd remission – 9 months), 1 – in remission from complications after alloHSCT, 1 – from APL progression, 1 – sudden death in 2nd remission lasting 72 months. ATO + ATRA for 60 days with supportive therapy are more effective than chemotherapy in the treatment of APL relapse. Interferon α + ATRA are inappropriate treatment of APL molecular and cytogenetic relapse. Using autologous HSCT in 2nd molecular remission will improve the results of APL relapse treatment.