Summary:

Patterns of the psycho-emotional state in patients with atopic dermatitis

D.A. Mukhacheva, K.I. Raznatovsky, A.V. Sobolev I.I.

Mechnikov North-Western State Medical University, St. Petersburg 

Aim: to assess the level of serotonin in adult patients with atopic dermatitis (AD) and to study their psycho-emotional state depending on the concentration of serum serotonin during AD exacerbation and remission.

Patients and Methods: 168 patients with AD selected as a result of screening — 105 (62.5%) female patients and 63 (37.5%) male patients aged 18 to 84 years (mean age 34.9±13.5 years) underwent psychodiagnostic (indicators of life quality, anxiety and depression) and clinical laboratory examination in the follow-up (at the exacerbation stage and at discharge (achieving remission)). To detect the association of serotonin content in acute AD with the indicator of the patient’s psycho-emotional state, all patients, depending on the serum serotonin content, were divided into subgroups: subgroup 1 (n=85) — with serum serotonin content above the reference values; subgroup 2 (n=6) — with serum serotonin content below the level of reference values; subgroup 3 (n=77) — with AD and serum serotonin content at the stage of hospitalization within the reference values. The control group consisted of healthy volunteers (n=37, 21 (56.7%) women and 16 (43.2%) men, aged 18 to 74 years, mean age 37.1±15.6 years).

Results: evaluation of the results concerning psychodiagnostic and laboratory-clinical examination in the follow-up revealed a decrease in all indicators on the assessment scales of psycho-emotional state, serotonin content, as well as the spread area and severity of the rash at the stage of discharge versus the baseline values at the exacerbation stage. Nevertheless, the analysis of subgroups with different serotonin content in patients with AD demonstrated higher rates of anxiety and depression with a decrease in the Dermatology Life Quality Index (DLQI) in the subgroup with low serotonin content (subgroup 1) versus the control group and other subgroups.

Conclusion: the present study revealed a lower level of psycho-emotional state in patients with AD at the exacerbation stage of the pathological process, especially in the group with low serotonin levels (subgroup 1). The obtained data can serve as a basis for further use of serotonin as a biomarker of changes in the psycho-emotional state of patients and the AD severity.

Keywords: atopic dermatitis, biomarkers, neurotransmitters, serotonin, psycho-emotional state, quality of life.

For citation: Mukhacheva D.A., Raznatovsky K.I., Sobolev A.V. Patterns of the psycho-emotional state in patients with atopic dermatitis. RMJ. 2023;3:10–14.

Summary:

Pentoxifylline in vascular pathology

A.V. Chupin¹, N.V. Pizova², D.A. Korshunov^{1 1}A.V. Vishnevsky Institute of Surgery, Moscow

²Yaroslavl State Medical University, Yaroslavl 

Atherosclerosis as a systemic disease affects large and medium arteries and becomes the cause of coronary heart disease, strokes and peripheral artery diseases (POAs). At the same time, the problem of POA is insufficiently studied and underestimated versus other atherosclerotic diseases. The detection frequency of POA and cerebrovascular diseases in one patient is quite high, since atherosclerotic diseases have similar risk factors, which determines a unified approach to patient management using non-pharmacological and pharmacological measures. Drug therapy includes the use of various drug groups, including pentoxifylline, which has long proven to be an effective, safe drug with good tolerability. The article describes the main drug effects (vasodilating, antithrombotic, endothelioprotective, immunomodulatory, etc.), allowing its use in patients with multilocus atherosclerotic vascular disease. The article also presents the clinical study results demonstrating the pentoxifylline efficacy in the treatment of patients with intermittent claudication, critical limb ischemia, coronary heart disease, cardiac failure of various etiologies, chronic and acute cerebrovascular insufficiency.

Keywords: atherosclerosis, cardiovascular diseases, peripheral artery diseases, intermittent claudication, pentoxifylline.

For citation: Chupin A.V., Pizova N.V., Korshunov D.A. Pentoxifylline in vascular pathology. RMJ. 2023;3:15–20.

Summary:

Obese patient: focus on cognitive health

E.V. Ekusheva^1,2, F.Kh. Dzgoeva³, K.P. Tuzhikov¹ 

¹Academy of Postgraduate Education under Federal Research and Clinical Center of the Federal Medical-Biological Agency, Moscow

²Belgorod State University, Belgorod

³National Medical Research Center of Endocrinology, Moscow 

Obesity is a chronic multifactorial disease that has a negative impact on almost all organs and systems in the body and contributes to the occurrence of concomitant diseases and pathological conditions that significantly worsen the life quality of these patients. The majority of obese and overweight patients have cognitive impairments (CI) of varying severity up to dementia, which necessitates their timely diagnosis even before the development of clinical dementia. That is because it allows the use of targeted, pathogenetically based therapy which slows down the current pathological process, and in some cases significantly affects the further cognitive functioning of patients. The article presents the data of a multicenter randomized clinical trial on BRAINMAX^® with the inclusion of young and middle-aged patients, the use of which led to a significant improvement in cognitive performance (concentration and vigilance, working memory, volume and speed of attention switch, information processing speed and executive functions), a decrease in the severity of asthenic manifestations and an improvement in the life quality, while a better effect was observed after 2 courses of the studied preparation. The data obtained allowed to recommend the use of BRAINMAX^® for the treatment of CI in obese and overweight patients to reduce the severity of existing CIs and improve their life quality.

Keywords: obesity, overweight, cognitive impairment, non-dementia disorders, therapy of cognitive impairment.

For citation: Ekusheva E.V., Dzgoeva F.Kh., Tuzhikov K.P. Obese patient: focus on cognitive health. RMJ. 2023;3:21–24.

Summary:

Chondroguard^® (chondroitin sulfate) in the treatment of patients with osteoarthritis and comorbid diseases

O.A. Shavlovskaya¹, O.A. Gromova², I.D. Romanov³, I.A. Bokova⁴ 

¹International University of Rehabilitation Medicine, Moscow

²Federal Research Center "Computer Science and Management" of the Russian Academy of Sciences, Moscow

³MD Clinic LLC, Moscow

⁴I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 

Сomorbid pathology prevalence has become one of the most important problems of clinical medicine. Comorbidity cannot be considered as the coexistence of different nosological units in one patient, since many pathogenetic and pathophysiological processes of these diseases are interrelated, and commonly mutually burden each other. Many studies have confirmed the efficacy and safety of chondroitin sulfate (CS) in the injectable form in patients with osteoarthritis (OA) and comorbid diseases accompanied by cardiovascular risk, atherosclerosis, lung and gastrointestinal diseases (including lung cancer), kidney diseases, type 2 diabetes mellitus, sarcopenia. CS has a significant systemic anti-inflammatory effect (by inhibiting the pro-inflammatory cytokine activity), inhibit the signaling cascade of nuclear factor kappa-β, which carries out the biological effects of tumor necrosis factor-α (TNF-α), triggering a complex hierarchy of changes in the proteome and the activity of the corresponding molecular cascades. CS has an oncoprotective effect, inhibiting the metastases invasion in various forms of cancer. The data obtained allow the use of CS (Chondroguard®) in a wide range of patients with OA and comorbidity.

Keywords: osteoarthritis, comorbid diseases, chondroitin sulfate, Chondroguard, sarcopenia, atherosclerosis, cardiovascular diseases, lung diseases, kidney diseases, diabetes mellitus.

For citation: Shavlovskaya O.A., Gromova O.A., Romanov I.D., Bokova I.A. Chondroguard® (chondroitin sulfate) in the treatment of patients with osteoarthritis and comorbid diseases. RMJ. 2023;3:26–30.

Summary:

Reflex asystolic syncope (clinical lecture)

A.S. Kotov, K.V. Firsov M.F. Vladimirskiy 

Moscow Regional Research and Clinical Institute, Moscow 

Reflex asystolic syncope — episodes of loss of consciousness and non-epileptic postural tone due to short-term reflex cardiac asystole caused by vagus nerve disorder and leading to subsequent transient cerebral hypoperfusion. Reflex asystolic syncope is characterized by rapid development, short duration and spontaneous recovery. Most commonly found in infants (first and second year of life). The condition is differentiated with epilepsy, syncope of another etiology, affective-respiratory attacks of the blue type, somatic diseases. During physical examination, special attention should be paid to the state of the cardiovascular system to suggest organic heart disease. History and physical examination data commonly reveal a possible cause of syncope. A small number of children need pharmacological therapy either with very frequent episodes in response to relatively minor triggers, or in cases of significant parental anxiety.

Keywords: epilepsy, seizures, asystole, syncope, fainting, apnea, breathing.

For citation: Kotov A.S., Firsov K.V. Reflex asystolic syncope (clinical lecture). RMJ. 2023;3:31–34.

Summary:

Clinical experience in patient management with anxiety disorder

P.V. Aronov¹, G.N. Belskaya¹, I.A. Nikiforov² 

¹Research Center of Neurology, Moscow

²Federal Scientific and Clinical Center of the Federal Medical Biological Agency of Russia, Moscow 

These days, the number of patients with anxiety disorders has been growing, which has become the most common group of mental and behavioral disorders. The overwhelming number of such patients turn not to psychiatrists, but to internists, as somatic disorders commonly come to the fore. In this regard, doctors of various specialties should have knowledge concerning this pathology for timely detection and correction, while in more complex cases, should refer patients to psychotherapists and psychiatrists. The article presents 3 clinical cases of patients with various manifestations of anxiety and the choice patterns of patient management. The article also brings an example presenting the successful use of modern anxiolytics (buspirone, tofisopam) in the complex therapy. The features of the action spectrum of buspiron cause its wide clinical use of "small" psychiatry: in various asthenic disorders, including in the setting of postcovid syndrome; in anxiety disorders associated with stress, including mild variants of panic disorder and generalized anxiety disorder; in the presence of expectation neurosis in patients with a somatic disorder; in as part of the therapy of organic anxiety disorder, in the treatment of anxiety in elderly patients.

Keywords: anxiety disorders, panic disorder, anxiolytics, COVID-19, stress, neurotic level, psychopathological conditions, antidepressants, buspirone, tofisopam.

For citation: Aronov P.V., Belskaya G.N., Nikiforov I.A. Clinical experience in patient management with anxiety disorder. RMJ. 2023;3:35–38.

Summary:

Neuronal ceroid lipofuscinosis type 6: clinical case

L.M. Shchugareva^1,2, O.V. Poteshkina^1,2, E.L. Dumov¹

¹Children City Multidisciplinary Clinical Specialized Center of High Medical Technologies, St. Petersburg

²I.I. Mechnikov North-Western State Medical University, St. Petersburg 

Neuronal ceroid lipofuscinoses (NCLs, CLN6, Batten disease) are a group of genetically determined progressive neurodegenerative diseases with a predominantly autosomal recessive inheritance type, lipidoses caused by abnormal accumulation of lipofuscin-like substances in cells. NCLs are characterized by age-dependent onset, predominant CNS damage with the progression of myoclonic epilepsy, intellectual and motor disorders, as well as damage to the visual organ. The disease pathogenetic mechanism is based on a disorder of the lipofuscin pigment removal, which normally accumulates in the body tissues, but much more slowly. In the case of NCL, the pigment accumulation occurs rapidly and leads to tissue atrophy.

Currently, this group of diseases is considered within the framework of the "genetic disorder" concept, in which genetic classification is used. There are 14 types of NCLs depending on the damage of the "responsible" gene, while the same genotype can give different clinical phenotypes and vice versa, i.e. there is a phenotypic convergence of genetic heterogeneity diseases. Recently, due to the development of neurophysiology, genetics, neuropharmacology and the development of NCL targeted therapy, timely and accurate diagnosis of the genetic disease type and mutation of the "responsible" gene is especially relevant.

The article presents a clinical case concerning a disease type, the late diagnosis of which was due to the use of selective biomarker panels instead of whole exome sequencing.

Keywords: neuronal ceroid lipofuscinosis, progressive neurodegenerative diseases, myoclonic epilepsy, whole exome sequencing.

For citation: Shchugareva L.M., Poteshkina O.V., Dumov E.L. Neuronal ceroid lipofuscinosis type 6: clinical case. RMJ. 2023;3:39–44.

Summary:

Comparative analysis of indicators of neuropsychological status and serotonin content in blood serum in patients with balance disorders

I.I. Borodulina^1,2, Yu.V. Karakulova¹, A.M. Elovikov¹ 

¹Academician E.A. Vagner Perm State Medical University, Perm

²Perm Regional Clinical Hospital, Perm 

Background: dizziness is one of the most common symptoms in medical practice. The article discusses the issue of association between vestibular and psychological mechanisms of dizziness, where anxiety and depressive disorders are widely represented in the clinic of balance disorders.

Aim: to study the patterns of the psycho-emotional state and the peripheral serotonin content in patients with various balance disorders (systemic and non-systemic dizziness).

Patients and Methods: 62 patients were included in the study. 47 patients with peripheral systemic vestibulopathy (vertigo) and 15 patients with complaints of feeling lightheaded (non-systemic dizziness). The control group consisted of 15 healthy patients. Psycho-emotional state and life quality were assessed using the Hospital Anxiety and Depression Scale (HADS), the CES-D questionnaire scale, the Spielberger-Hanin test, a questionnaire for detecting change indicators in the autonomic nervous system (ANS), and the Vestibular Rehabilitation Benefits Questionnaire (VRBQ). For an additional assessment of the psycho-emotional state, the serotonin content in the blood serum was studied.

Results: according to the HADS, patients with vertigo had signs of subclinical anxiety and no signs of depression. Patients with instability had signs of both clinical anxiety and depression. According to the CES-D, no signs of depression were detected in patients with vertigo, and instability was accompanied by mild depression. Testing of the reactive and personal anxiety levels showed a moderate reactive and personal anxiety in vertigo, and a high level of both personal and reactive anxiety in patients with instability. There were signs of changes in the ANS in both groups. Serotonin content in the blood serum of patients significantly differed versus the control group and between groups of patients, being the lowest in the group with non-systemic vertigo.

Conclusion: patients with a balance disorder had signs of anxiety and depression. Anxiety and depressive disorders are most significant in patients with non-systemic dizziness. In patients with systemic and non-systemic dizziness, the serotonin content in the blood is reduced, which in some cases correlates with disorders of the psycho-emotional sphere.

Keywords: psycho-emotional state, anxiety, depression, balance disorders, dizziness, serotonin.

For citation: Borodulina I.I., Karakulova Yu.V., Elovikov A.M. Comparative analysis of indicators of neuropsychological status and serotonin content in blood serum in patients with balance disorders. RMJ. 2023;3:4–9.

Summary:

Nonketotic hyperglycinemia: rare metabolic disease in a newborn

N.Kh. Gabitova¹, I.N. Cherezova¹, N.R. Valeeva² 

¹Kazan State Medical University, Kazan

²Children Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan 

Nonketotic hyperglycinemia is a rare neurometabolic disease with an autosomal recessive inheritance. Hereditary metabolic diseases are characterized by an acute onset with irreversible damage to the nervous system and high infant mortality. There is no effective etiotropic treatment for this disease, the outcome depends on the clinical type. The article presents a brief overview of the disease pathogenetic mechanism, age-related features of various forms and clinical types of glycine encephalopathy, diagnostic criteria of the disease, clinical classification and treatment principles. The author presents his clinical case concerning the neonatal form of a rare metabolic disease in a newborn. The presented clinical case demonstrates the complexity of the diagnostic search due to the non-specificity of the clinical manifestations of metabolic disorders, similar to other diseases accompanied by damage to the nervous system. The presented clinical case demonstrates the complexity of the diagnostic search in view of the nonspecific clinical manifestations of metabolic disorders similar to other diseases accompanied by damage to the nervous system and an unfavorable outcome.

Keywords: glycine encephalopathy, newborn, children, inherited metabolic disorders, treatment, outcome.

For citation: Gabitova N.Kh., Cherezova I.N., Valeeva N.R. Nonketotic hyperglycinemia: rare metabolic disease in a newborn. RMJ. 2023;3:45–48.

Summary:

Comorbid patient at a neurologist’s office. Questions and solutions 

The interdisciplinary conference with international participation Veynov Readings was held from February 8–10, 2023 in Moscow. As part of the conference, there was a symposium devoted to the topic «Comorbid patient at a neurologist’s office. Questions and solutions», dedicated to the use of peptides in the clinical practice of neurologists. The symposium presented an algorithm for the therapy of a comorbid patient with chronic cerebral ischemia (CCI) using preparations based on polypeptides of the cerebral cortex of cattle (PCCC) and cytochrome C. The principles of rational pharmacotherapy of a patient with postcovid syndrome (PCS) were considered, since PCS is commonly accompanied by the nervous system disorders, including vegetative, and can accompanied by the CI. The issues of the efficacy concerning the inclusion of PCCC and cytochrome C in the patient management with PCS were discussed. Since the problem of polypragmasia is relevant in modern neurology, the final report was devoted to how to avoid polypragmasia when prescribing peptide drugs. The proposed combination of cytochrome C and PCCC peptide preparations allows to summarize the therapeutic effects of non-selective cytoprotectors with significant antihypoxic properties and neuroprotectors affecting neuroplasticity and neurotrophy.

Keywords: polypeptides of the cerebral cortex of cattle, cytochrome C, chronic cerebral ischemia, postcovid syndrome, polypragmasia, neuroplasticity.

For citation: Shchukin I.A., Zhuravleva M.V., Putilina М.V. Comorbid patient at a neurologist’s office. Questions and solutions. RMJ. 2023;3:49–56.

Summary:

The place of DPP-4 inhibitors in the treatment of type 2 diabetes mellitus

N.A. Demidov 

Shcherbinsk City Hospital, Shcherbinka, Moscow 

Treatment tactics in type 2 diabetes mellitus (DM2) have undergone significant changes over the past 15 years. The emergence of new hypoglycemic drug classes has led to a transformation of clinical methods and a change in the therapy goals. The administration into clinical practice (2005) of incretin-based pharmacotherapies made it possible to significantly increase the efficacy of hypoglycemic therapy with simultaneous improvement of its safety parameters. To date, dipeptidyl peptidase 4 (DPP-4) inhibitors occupy a leading place among all new classes of hypoglycemic drugs. Over the past 10 years, the vector of hypoglycemic therapy has shifted towards the widespread use of drugs with proven cardio-nephroprotective properties (sodium-glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists). Despite the change in clinical methods to the treatment of DM2, the efficacy and safety of DPP-4 inhibitors determine their widespread use in real clinical practice. A new drug from the DPP-4 inhibitor group, evogliptin, demonstrates efficacy and safety comparable to the reference, well-studied drugs of this class (sitagliptin, linagliptin) and can be widely adopted in the therapy of DM2.

Keywords: type 2 diabetes mellitus, dipeptidyl peptidase 4 inhibitors, incretins, evogliptin.

For citation: Demidov N.A. The place of DPP-4 inhibitors in the treatment of type 2 diabetes mellitus. RMJ. 2023;2:12–15.

Summary:

CARE recommendations for describing cases of real clinical practice

O.S. Elsukova^1,2 

¹Kirov State Medical University, Kirov

²Kirov Clinical Hospital No. 7, Kirov 

Accessible and understandable descriptions of clinical cases help to obtain new data about diseases, as well as about the possible benefits and adverse events of medicinal products, and provide information for clinical and scientific work. Such descriptions are supplemented by clinical recommendations which are actively integrated into medical education. The probability of preparing a qualitative description of a clinical case and its value for medicine increases if the authors follow certain rules for writing such articles. In 2011-2012, a group of clinicians, scientists and journal editors developed recommendations for the accurate presentation of information when describing cases, which resulted in the provision and checklist of CARE (CAse Report), presented in 2013 at the International Congress on Peer Review and Scientific Biomedical Publications, supported by numerous medical journals and translated into 9 languages. The purpose of this article is to introduce and spread the use of the CARE checklist in the preparation and publication of case reports by clinicians. Explanations are given to each item of the CARE checklist, as well as the attached examples from clinical practice. Explanations and an example of a case description from clinical practice on the use of the insulin glargine biosimilar in type 2 diabetes mellitus in this publication together with the provisions and the CARE checklist from 2013, presented on the official website (www.care-statement.org) and the EQUATOR Group website (www.equator-network.org), can help clinicians improve completeness and transparency of case descriptions from real clinical practice.

Keywords: clinical case, case description, CARE checklist, type 2 diabetes mellitus, biosimilar, morbid obesity.

For citation: Elsukova O.S. CARE recommendations for describing cases of real clinical practice. RMJ. 2023;2:16–24.

Summary:

Insulinoma. Case report

I.V. Druk¹, S.S. Safronova¹, E.N. Podolsky², A.A. Marikyan², A.G. Shimanskaya¹, S.I. Mozgovoy¹, S.B. Glatko³, A.V. Kononov¹, O.O. Mironova², I.I. Minaev³, A.Yu. Hamburg¹ 

¹Omsk State Medical University, Omsk

²West Siberian Medical Center of Federal Medical-Biological Agency of Russian Federation, Omsk

³Clinical Oncological Dispensary, Omsk 

Insulinoma is the most common pancreatic neuroendocrine tumor that causes the development of a hypoglycemia due to endogenous hyperinsulinism. In 85-90% of cases, insulinoma is a solitary benign tumor. Multiple synchronous or metachronous insulinomas can occur in multiple endocrine neoplasia type 1. The gold standard of diagnostics is a 72-hour fast, the purpose of which is to provoke the pathognomonic Whipple’s triad. Imaging techniques include computed tomography, magnetic resonance imaging, transabdominal and endoscopic ultrasound, and molecular imaging techniques. The radical treatment method is surgical, namely, tumor enucleation or pancreatectomy. The operation in the vast majority of cases provides a complete cure. Conservative treatment tactics are considered when the patient’s health condition significantly increases the risk of surgical intervention. The article presents a description concerning the clinical case of insulinoma, demonstrating the standard course of benign insulinoma, the information value of the main laboratory and instrumental methods of diagnostic search, including typical results of a fasting test, the first stage of imaging and immunohistochemistry, as well as the efficacy of surgical treatment as a method of treatment tactics for solitary benign insulinoma. Organic hyperinsulinism masked the clinical manifestations of type 2 diabetes mellitus in a patient with risk factors.

Keywords: neuroendocrine tumors, endogenous hyperinsulinism, insulinoma, pancreas, diagnosis, treatment.

For citation: Druk I.V., Safronova S.S., Podolsky E.N. et al. Insulinoma. Case report. RMJ. 2023;2:25–32.

Summary:

Patterns of changes in the antioxidant / prooxidant system in patients with type 1 and type 2 diabetes mellitus complicated by distal neuropathy and diabetic foot syndrome

A.S. Denisyukova, I.I. Pavlyuchenko, L.A. Ivanova, Z.S. Popov, V.I. Popov

Kuban State Medical University, Krasnodar

Aim: to study the patterns of changes in the antioxidant / prooxidant system in patients with type 1 and type 2 diabetes mellitus (DM) complicated by distal neuropathy and diabetic foot syndrome.

Patients and Methods: 149 patients with type 1 and type 2 DM in the decompensation stage complicated by distal polyneuropathy and/or diabetic foot syndrome were examined, who were divided into 4 groups. Group I consisted of patients with type 1 diabetes mellitus complicated by distal polyneuropathy (n=23, 45±5 years, 11 male patients). Group II included patients with type 2 DM and distal polyneuropathy (n=58, 55±5 years, 23 male patients). Group III included patients with type 1 DM accompanied by distal polyneuropathy and diabetic foot syndrome (n=12, 47±7 years, 7 male patients). Group IV included patients with type 2 diabetes mellitus complicated by distal polyneuropathy and diabetic foot syndrome (n=56, 59±9 years, 30 male patients). The control group consisted of 19 practically healthy individuals (50±5 years, 9 men). To assess the indicators of the antioxidant / prooxidant system, a biochemistry laboratory study was conducted, in which the activity of catalase, superoxide dismutase, glutathione transferase and the level of malondialdehyde in blood plasma were evaluated.

Results: among patients with DM, the level of malondialdehyde was significantly increased, which indicated a significant oxidative stress. In group 3, the activity of superoxide dismutase and glutathione S-transferase was lower than in group 4, indicating more significant oxidative stress in group 3. Catalase activity in all groups differed slightly from the control.

Conclusion: significant changes in the antioxidants/prooxidants system were revealed in patients with type 1 and type 2 diabetes mellitus with complicated distal polyneuropathy and diabetic foot syndrome.

Keywords: diabetes mellitus, distal polyneuropathy, diabetic foot syndrome, antioxidants, prooxidants, catalase, superoxide dismutase, malondialdehyde, glutathione S-transferase.

For citation: Denisyukova A.S., Pavlyuchenko I.I., Ivanova L.A. et al. Patterns of changes in the antioxidant / prooxidant system in patients with type 1 and type 2 diabetes mellitus complicated by distal neuropathy and diabetic foot syndrome. RMJ. 2023;2:3–6.

Summary:

Cognitive impairment no dementia in young and middle-aged patients: potential benefits of the drug BRAINMAX^® (case report)

E.V. Ekusheva^1,2, V.B. Voitenkov^1,3 

¹Academy of Postgraduate Education of the Federal Scientific and Clinical Center of the Federal Medical Biological Agency of Russian Federation, Moscow

²Belgorod State National Research University, Belgorod

³Children’s Scientific Clinical Center of Infectious Diseases of the Federal Medical Biological Agency of Russia, St. Petersburg 

Physicians of different specialties in their clinical practice may deal with patients who have cognitive disorders (CIs) that require timely diagnosing and administering pathogenetic therapy. Recent years have seen an increasing trend in the prevalence of CIs among young and middle-aged patients which have a significant impact on their quality of life, affecting the professional and social adaptation. The article describes the clinical case of a 43-year-old patient complaining about distraction, absent-mindedness, difficulty focusing, impaired concentration and reduced working capacity in the professional activity. The above changes have occurred in the last 2–3 years and aggravated after the patient had COVID-19 twice that did not require hospitalization. The physical status was affected by stage 2 arterial hypertension, stage 1 obesity, and hyperlipidemia. The testing results (MoCA, MMSE, MFI-20, Schulte test, DSST and SF-36) demonstrated the presence of moderate CI. Patient’s compliance with the recommendations (a balanced diet, body weight control and moderate physical load, regular use of antihypertensive medications, statins, and two 2-week courses with the drug BRAINMAX^® administered 10 days apart) contributed to the positive changes demonstrated by the re-testing results. The received data suggest that the drug BRAINMAX^® can be recommended for a broader use in the treatment of CI no dementia cases.

Keywords: cognitive functions, cognitive impairment no dementia, neuroprotector, quality of life, COVID-19.

For citation: Ekusheva E.V., Voitenkov V.B. Cognitive impairment no dementia in young and middle-aged patients: potential benefits of the drug BRAINMAX® (case report). RMJ. 2023;2:33–36.

Summary:

Nonspecific back pain young patient at the neurologist’s visit. Diagnostic algorithm

O.A. Shavlovskaya International University of Restorative Medicine, Moscow In 27–40% of cases, inflammation or degenerative changes of the facet joints (FJ) are the generator of chronic lower back pain (cLBP). At the same time, lumbar FJ osteoarthritis (OA) is registered in 24–82% of cases in persons younger than 40 years. In 2022, age gradations were determined according to the WHO classification, in which the age of 18–44 years corresponded to the age period «youth». In this regard, the active identification of young patients with nonspecific back pain is of particular relevance, since ignoring this complaint subsequently leads to the formation of cLBP. The presented algorithm can help the doctor to choose the tactics of managing nonspecific back pain young patient, prescribe therapy and carry out preventive measures aimed at relapses preventing and pain syndrome chronization.

Keywords: lower back pain, young patient, osteoarthritis, facet joint, spine, algorithm.

For citation: Shavlovskaya O.A. Nonspecific back pain young patient at the neurologist’s visit. Diagnostic algorithm. RMJ. 2023;2:37–37.

Summary:

Tenoxicam in active axial spondyloarthritis: clinical and laboratory response to therapy

A.P. Rebrov, N.M. Nikitina, N.A. Magdeeva, L.R. Bogdalova 

V.I. Razumovskiy Saratov State Medical University, Saratov 

Aim: to study the clinical and laboratory response to tenoxicam (Texared^®) therapy in patients with active axial spondyloarthritis (SpA).

Patients and Methods: the study included 26 patients with active axial SpA and BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) ≥4.0 who had previously taken various nonsteroidal anti-inflammatory drugs (NSAIDs). After a preliminary examination, in accordance with the inclusion criteria, patients were prescribed the regular administration of tenoxicam (Texared^®) 20 mg/day orally. Initially and after 30 days, patients filled out electronic questionnaires to assess the disease activity, the severity of pain and stiffness. The patients assessed the pain in the lower back in general and the intensity of pain at night in particular on a visual analog scale (VAS). The doctor calculated BASDAI, ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score-CRP), the disease activity, the efficacy and therapy tolerability. Initially and after 30 days, blood chemistry value, complete blood count and urine test, levels of interleukin 6 (IL-6), interleukin 17 (IL-17), tumor necrosis factor α (TNF-α) were examined in all patients.

Results: there was a decrease in the disease activity in the setting of therapy with tenoxicam in patients with axial SpA of high and very high activity, who had previously taken various NSAIDs. With regular administration of Texared, the effect developed within the first 2 weeks. After 4 weeks, the pain severity in the lower back and the duration of morning stiffness clearly decreased, as well as the BASDAI index. Besides, in the setting of Texared therapy for 30 days, patients showed a decrease in the levels of C-reactive protein (CRP), IL-6 and IL-17.

Conclusion: the positive effect on the disease course, the trend of changes in the levels of CRP, IL-6 and IL-17 during Texared^® therapy for only 4 weeks inspired some optimism when planning further studies of the treatment efficacy of active axial SPA.

Keywords: axial spondyloarthritis, nonsteroidal anti-inflammatory drugs (NSAIDs), tenoxicam, regular administration of NSAIDs, interleukin 6, interleukin 17, tumor necrosis factor α.

For citation: Rebrov A.P., Nikitina N.M., Magdeeva N.A., Bogdalova L.R. Tenoxicam in active axial spondyloarthritis: clinical and laboratory response to therapy. RMJ. 2023;2:38–42.

Summary:

New composition of pharmaceutical nutraceutical for antigen-specific prevention and adjunctive therapy of musculoskeletal diseases

I.V. Sarvilina¹, A.M. Lila^2,3, O.A. Gromova^4,5 

¹Medical Center «Novomedicina» LLC, Rostov-on-Don

²V.A. Nasonova Research Institute of Rheumatology, Moscow

³Russian Medical Academy of Continuous Professional Education, Moscow

⁴Federal Research Center «Informatics and Management» of the Russian Academy of Science, Moscow

⁵Lomonosov Moscow State University, Moscow 

The article discusses the current possibilities of using a new composition of pharmaceutical nutraceutical agent, including chondroitin sulfate, glucosamine sulfate and undenatured type II collagen, given the new molecular data on the disease pathogenesis, as well as data on the mechanism of action, pharmacokinetics, efficacy and safety of each of the pharmaceutical nutraceutical components. Special attention is paid to the mechanisms for induction of oral tolerance underlying the development of targeted antigen-specific prevention and adjunctive therapy of osteoarthritis (OA), as well as the interaction of the pharmaceutical nutraceutical components with the immune system in OA. The article shows prospects for the development and administration of new pharmaceutical nutraceuticals due to the widespread prevalance of diseases associated with cartilage degeneration and musculoskeletal system disorder, on the one hand, and the insufficient efficacy of known symptomatic drugs of sustained release, on the other hand. The article also discusses the modern possibilities of patient management with OA based on clinical research data and individual pharmaceutical nutraceutical support.

Keywords: osteoarthritis, chondroitin sulfate, glucosamine sulfate, undenatured type II collagen, pharmaceutical nutraceuticals, oral tolerance.

For citation: Sarvilina I.V., Lila A.M., Gromova O.A. New composition of pharmaceutical nutraceutical for antigen-specific prevention and adjunctive therapy of musculoskeletal diseases. RMJ. 2023;2:44–50.

Summary:

Patients with premature skin aging. Patient management and risk forecasting

N.N. Potekaev^1,2, O.B. Borzykh³, E.I. Karpova¹, M.M. Petrova³, N.A. Schneider^3,4, D.V. Dmitrenko³, O.M. Demina¹, M.A. Zatolokina⁵, E.E. Timechko³ 

¹Pirogov Russian National Research Medical University, Moscow

²Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow

³Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk

⁴V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg

⁵Kusrk State Medical University, Kursk

Aim: to search for indicators of premature aging, as well as to develop treatment tactics for patient management with premature skin aging.

Patients and Methods: the study included 78 patients aged 35 to 45 years without a cosmetic history, who underwent physical, instrumental and laboratory studies, as well as studies with an assessment of age-related skin changes and biological age. The index of involution-induced changes was calculated with identified indicators of premature skin aging. A blind comparative randomized placebo-controlled study was also conducted on the efficacy of the following biorevitalization agents: native hyaluronic acid (HA) 1.8%, a complex preparation with HA, amino acids, vitamins, antioxidants and minerals, collagen.

Results: the threshold level of the total index concerning age-related skin changes in patients aged 35–45 years was calculated: 21 points and below — normal skin aging; 22 points and above — premature skin aging. 18 indicators of premature aging were also identified. It was found that patients with premature aging have an increased risk of adverse events during aesthetic procedures. The efficacy of collagen-based drugs and a complex preparation with HA was statistically significantly higher than the efficacy of native HA or placebo according to ultrasound and clinical evaluation, while the overall patient satisfaction level after a course of intradermal collagen administration was higher.

Conclusion: the index of involution-induced changes >22 was an indicator of premature aging in women 35–45 years old without a cosmetic history. For other patients, it was possible to use indicators to identify patients at high risk of premature aging. The developed index of involution-induced changes, predictors of premature aging and the patient management algorithm can be used in clinical practice for the patients with involution-induced skin changes. For patients with normal aging, the action of native HA is sufficient, while for patients with premature aging / at high risk of premature aging, it is necessary to use a collagen preparation or the complex preparation with HA.

Keywords: skin aging, premature aging, predictors of aging, hyaluronic acid, collagen, intradermal injection, biorevitalization agent.

For citation: Potekaev N.N., Borzykh O.B., Karpova E.I. et al. Patients with premature skin aging. Patient management and risk forecasting. RMJ. 2023;2:52–57.

Summary:

Skin biopsy during clinical and morphological verification of inflammatory dermatosis

M.M. Tlish, A.V. Sycheva, N.L. Sycheva, P.S. Osmolovskaya

Kuban State Medical University, Krasnodar

Background: the main task of skin histology is to establish a diagnosis with the determination of the disease stage and its activity. The process of establishing a clinical and morphological diagnosis of inflammatory dermatosis is fundamentally different from the verification of various skin neoplasms since inflammatory diseases have a nonspecific histological picture.

Aim: to evaluate the diagnostic significance of histological changes in the verification of inflammatory dermatosis based on the data of skin biopsy.

Patients and Methods: a retrospective analysis of 1216 skin biopsy specimens performed by patients with dermatological pathology was conducted. A punch biopsy was used to collect pathological material. To determine the diagnostic significance of histological changes, the clinical data of each patient was compared with the results of their histopathology.

Results: the main variants of the diagnostic significance concerning histological changes were identified when considering clinical and pathological parallel patterns: high diagnostic significance of the histological picture, when a very similar clinical picture is observed; moderate diagnostic significance of the histological picture, when it confirms the clinical diagnosis, but is not decisive; low diagnostic significance with a similar histological picture, when a differential diagnosis is made based on the clinical picture.

Conclusion: the selected variants of the diagnostic significance of histological changes when considering clinical and pathological parallel patterns showed that not in all cases histology data were crucial in the verification of inflammatory dermatosis.

Keywords: biopsy, histology, inflammatory dermatosis, differential diagnosis, diagnosis verification, biopsy specimen.

For citation: Tlish M.M., Sycheva A.V., Sycheva N.L., Osmolovskaya P.S. Skin biopsy during clinical and morphological verification of inflammatory dermatosis. RMJ. 2023;2:58–61.

Summary:

Possibilities and potential of bacteriophages in the treatment of atopic dermatitis in children

S.F. Gladkov¹, N.K. Perevoshchikova² 

¹Clinic of Allergology and Immunology LLC, Yurga

²Kemerov State Medical University, Kemerovo 

Aim: to determine the efficacy of selective phage decontamination (SPD) from excessive growth of Staphylococcus aureus, Klebsiella pneumoniae and Klebsiella oxytoca as the main trigger mechanism of atopic dermatitis (AD).

Patients and Methods: the study prospectively included 47 children (mean age 4.57±0.71 weeks) who were treated at the clinic with the Allergy and Immunology Department with a diagnosis of AD in the period of 2019–2021 (group 1). All patients in this group underwent SPD in the form of monotherapy. A group of 38 children (mean age 13.92±3.44 months) who visited the clinic of the Allergy and Immunology Department with a diagnosis of AD in the same period (group 2) was also retrospectively formed. Patients of this group did not undergo SPD at the disease onset. The study evaluated the efficacy of SPD in children at the start of the atopic march (AM).

Results: the conducted SPD, based on the results of microbiological stool analysis, revealed the associations presence of S. aureus 6.59±0.90 lg CFU/g, K. pneumoniae 5.48±0.85 lg CFU/g and K. oxytoca 5.00±1.78 lg CFU/g in children of the group 1. It allowed for the complete elimination of intestinal colic already on the 2nd or 3rd day. Reduction of pathological impurities in feces and normalization of the defecation frequency occurred after 3.82±0.63 days, a significant decrease in the severity of the skin syndrome — after 5.29±0.85 days of phage therapy. The SCORAD index at the time of the initial visit in group 1 averaged 15.5±2.4 points. At the end of the first course it was 0 points in 36 (76.5%) children, after the second course — in 11 (23.4%). SPD conducted in all children of group 1 allowed to prevent the recurrence of the disease and stop AM, which was confirmed by the follow-up in the catamnesis. A retrospective analysis of the AM progression in group 2 revealed the absence of positive trend due to the annual increase in the spectrum of sensitization. The analysis of control bacterial inoculation showed a significant decrease in the titer of S. aureus, K. pneumoniae and K. oxytoca in children of group 1.

Conclusion: phage therapy, even in the form of monotherapy, aimed at decontamination of the gastrointestinal tract from S. aureus, K. pneumoniae and K. oxytoca in children at the AD onset, allowed to effectively reduce the titers of these microorganisms, which, in turn, made it possible to effectively manage AM.

Keywords: atopic dermatitis, atopic march, intestinal microbiota, bacteriophages, decontamination, treatment.

For citation: Gladkov S.F., Perevoshchikova N.K. Possibilities and potential of bacteriophages in the treatment of atopic dermatitis in children. RMJ. 2023;2:63–66.

Summary:

Acute tonsillopharyngitis of streptococcal etiology in children: the importance of rapid diagnosis

I.N. Zakharova¹, I.V. Berezhnaya¹, I.D. Maykova², N.F. Dubovets², D.K. Dmitrieva¹ 

¹Russian Medical Academy of Continuous Professional Education, Moscow

²Z.A. Bashlyaeva Children City Clinical Hospital, Moscow 

The article is devoted to acute tonsillopharyngitis (ATP) and the most common cause of bacterial ATP — β-hemolytic group A streptococcus (BHGAS) — a pathogen transmitted by airborne droplets and affecting, exceptionally, humans. It affects up to 35% of pediatric patients, most commonly occurs in school-age children with a peak incidence of 7–8 years. The diagnosis complexity of ATP in BHGAS etiology is due to the symptoms similarity of the viral and streptococcal disease forms. It is noted that the irrational use of antibacterial therapy increases the risk of antibiotic resistance, the complications development in the patient, increases the burden on medical workers and the healthcare system. At the same time, the antibacterial treatment of acute streptococcal tonsillopharyngitis, conducted according to clinical recommendations, practically eliminates BHGAS in the pharynx and, thereby, significantly reduces the risk of complications. The importance concerning the active implementation of diagnostic tests, allowing in a short time (5–10 minutes), is substantiated to differentiate the viral and streptococcal cause of ATP. A simple and reliable way to confirm the streptococcal etiology of ATP is rapid test to detect group A streptococcus antigen in a smear from the posterior pharyngeal wall using test systems based, in particular, on the method of immunochromatography («Streptatest^®») — the gold standard for the diagnosis of streptococcal ATP, which does not require additional briefing for medical personnel. The results of the Streptatest allow timely and adequate prescribing of the necessary treatment to the patient.

Keywords: acute tonsillopharyngitis, β-hemolytic group A streptococcus, diagnosis, rapid test, immunochromatography.

For citation: Zakharova I.N., Berezhnaya I.V., Maykova I.D. et al. Acute tonsillopharyngitis of streptococcal etiology in children: the importance of rapid diagnosis. RMJ. 2023;2:67–71.

Summary:

Suppressive therapy for differentiated thyroid cancer: theoretical foundations, clinical use and complications

E.Yu. Gritskevich¹, V.A. Zhivotov², A.A. Gritskevich³, L.G. Novgorodtseva², N.V. Shirokova²

¹Medical Center "MirA" LLC, Moscow

²Pirogov National Medical and Surgical Center, Moscow

³RUDN University, Moscow 

Differentiated thyroid cancer (DTC) is a hormone-dependent tumor, and in the treatment of high- and intermediate-risk patients, long-term inhibition of thyroid-stimulating hormone (TSH) is used to suppress the thyroid-dependent growth of residual tumor cells. The issues of the TSH degree and inhibition duration, risk stratification and selection of patients who need such therapy are still debatable. A literature search was conducted to illustrate the role of TSH in oncogenesis, the grounds for the use of suppressive therapy and the various effects of TSH inhibition by levothyroxine on organs and tissues. The conducted studies indicate that TSH is involved in oncogenesis and progression of prostate cancer. Suppressive therapy reduces the rate of progression, reduces the frequency of relapses and cancer-specific mortality in patients with high-risk thyroid cancer. However, prolonged suppression of TSH as a result of iatrogenic subclinical thyrotoxicosis can lead to adverse outcomes, such as osteoporosis, fractures, cardiovascular diseases, including atrial fibrillation. Thus, the use of suppressive therapy should be based on the initial risk of the disease, whereas a dynamic evaluation of this risk should be conducted.

Keywords: differentiated thyroid cancer, suppressive therapy, osteoporosis, atrial fibrillation, thyrotoxicosis, relapse.

For citation: Gritskevich E.Yu., Zhivotov V.A., Gritskevich A.A. et al. Suppressive therapy for differentiated thyroid cancer: theoretical foundations, clinical use and complications. RMJ. 2023;2:7–11.

Summary:

Predicting the efficacy of anti-inflammatory therapy in COVID-19

I.M. Sukhomlinova^1,2, I.G. Bakulin¹, M.Yu. Kabanov^1,2 

¹North-Western State Medical University named after I.I. Mechnikov, St. Petersburg

²St. Petersburg Hospital for War Veterans, St. Petersburg

Background: in the 20^th century, the development of prognosis methods became an integral part of science and the result of the combined experience in the world scientific community. Proactive administration of anti-inflammatory drugs (dexamethasone, olokizumab, baricitinib and tocilizumab) has become the leading direction of pathogenetic therapy. Nevertheless, the issue of predicting the therapy outcomes with these drugs is poorly understood.

Aim: to form the methods for predicting the efficacy of anti-inflammatory therapy (AIT) with dexamethasone, baricitinib, olokizumab and tocilizumab by multiple regression analysis, decision tree (neural network) and their clinical testing.

Patients and Methods: a retrospective analysis of 229 cases concerning severe and moderate course of COVID-19 requiring AIT was conducted. 2 methods of predicting the therapy outcome have been formed (multiple regression analysis and neural network in python 3.8.10). In order to test the created methods, a prospective comparative study was conducted with the inclusion of 108 patients.

Results: the dependence of AIT outcomes on age-sex characteristics, comorbidity and disease severity, data from instrumental and laboratory studies, anamnesis and objective examination of patients by the time of the AIT initiation was established. A computer program has been developed based on a decision tree (neural network) "Index for predicting the efficacy of anti-inflammatory therapy in COVID-19» and «Method for predicting the risk of fatal outcome in patients with severe and moderate COVID-19 during proactive AIT" (multiple regression analysis), with a computer program developed on its basis «Assessment prognosis of the efficacy of anti-inflammatory therapy in COVID-19» (multiple regression analysis). During retrospective and prospective studies, it was found that the use of dexamethasone as monotherapy for severe COVID-19 is impractical due to its low efficacy. In the absence of positive trend of the patient’s condition during therapy with tocilizumab, olokizumab, it is necessary to consider the possibility of repeated administration of anticytokine drugs for vital indications due to their significant effect on reducing the severity progression of the disease (p<0.00001). In the course of a prospective study, it was revealed that in conditions of changes in the disease course or methods to pathogenetic treatment, a program based on a decision tree seems more promising.

Conclusion: the development of artificial intelligence and neural networks allows to significantly improve the quality of predictive models, especially in clinical practice in the absence of standards or clinical recommendations.

Keywords: COVID-19, efficacy prediction, anti-inflammatory therapy, dexamethasone, olokizumab, baricitinib, tocilizumab.

For citation: Sukhomlinova I.M., Bakulin I.G., Kabanov M.Yu. Predicting the efficacy of anti-inflammatory therapy in COVID-19. RMJ. 2023;2:72–76.

Summary:

Cerebral aspergillosis as a complication of COVID-19 (case report)

E.I. Busalaeva^1,2, I.B. Bashkova¹, R.S. Maksimov^1,3, T.V. Shchukina^1,3, E.N. Ignatieva⁴, N.E. Ivanova^1,3 

¹Chuvash State University named after I.N. Ulyanov, Cheboksary

²Chuvash Republic Postgraduate Doctors’ Training Institute, Cheboksary

³City Clinical Hospital No. 1, Cheboksary

⁴Republican Bureau of Forensic Medical Examination, Cheboksary 

Aspergillus fumigatus is a saprophytic fungus which is widespread in the environment. Most people inhale its spores daily, but aspergillosis develops mainly in immunocompromised persons. Invasive mycoses, including aspergillosis, complicating the COVID-19 course, are severe and have high mortality even in patients who had no previous risk factors for the mycotic lesions. This article presents a clinical case of the aspergillosis development in the setting of COVID-19 in the absence of other risk factors for invasive mycoses. Infection with fungal mold could occur in two ways: through the nasal passages (aerogenic way) or through the eyeball. Lesions of the lungs, pancreas and immune organs in the setting of COVID-19 contributed to the development of aspergillosis, diagnosed during postmortem study.

Keywords: aspergillosis, neuroaspergillosis, invasive mycosis, coronavirus infection, COVID-19, complications.

For citation: Busalaeva E.I., Bashkova I.B., Maksimov R.S. et al. Cerebral aspergillosis as a complication of COVID-19 (case report). RMJ. 2023;2:77–82.

Summary:

GERD quadrotherapy: a new method to an old problem

S.N. Mekhtiev^1,2, O.A. Mekhtieva^1,2, O.M. Berko² 

¹Pavlov First Saint-Petersburg State Medical University, St. Petersburg

²Gastroenterology Center Expert LLC, St. Petersburg 

It is known that the standard treatment of gastroesophageal reflux disease (GERD), consisting in taking proton pump inhibitors (PPIs), is commonly not effective enough both in achieving clinical and/or endoscopic remission and in preventing subsequent exacerbations. The article discusses a variant of the pathogenetically optimal treatment regimen for patients with newly diagnosed GERD, given the cases of possible refractoriness to standard PPI monotherapy. The regimen includes rabeprazole, rebamipid, trimebutin and ursodeoxycholic acid (UDCA). Rabeprazole has the greatest acid suppressive ability compared to other PPIs. Results of numerous studies have shown its efficacy and safety, including during long-term administration. The addition of rebamipid to PPIs in the treatment of GERD allows to achieve better control of reflux symptoms and more effectively prevent their recurrence, and also has an oncoprophylactic effect. A prokinetic agent inclusion in the GERD therapy regimen, for example, trimebutin, increases the therapy efficacy. The basis for the use of UDCA is the presence of its cytoprotective effect, which allows to achieve reduction of clinical symptoms and endoscopic signs of damage to the mucous membranes. The proposed quadrotherapy regimen can also be used in the case of refractory GERD.

Keywords: proton pump inhibitor, gastroesophageal reflux disease, duodenogastroesophageal reflux, non-erosive reflux disease, rabeprazole, rebamipid, trimebutin, ursodeoxycholic acid, quadrotherapy.

For citation: Mekhtiev S.N., Mekhtieva O.A., Berko O.M. GERD quadrotherapy: a new method to an old problem. RMJ. 2023;2:83–87.

Summary:

Nonsteroidal anti-inflammatory drugs and the risk of heart failure

P.R. Kamchatnov¹, A.V. Chugunov¹, D.T. Chipova², A.Yu. Kazakov¹

¹Pirogov Russian National Research Medical University, Moscow

²City Clinical Hospital, Nalchik

Musculoskeletal pain syndromes, in particular, dorsalgia, are a common cause of temporary disability and a decrease in the life quality of patients. Frequent recurrence of pain syndrome with the need for repeated therapy courses, the presence of concomitant diseases and risk factors for the development of adverse events during treatment require a carefully balanced approach to the treatment tactics. The article discusses the results of a large-scale study on the association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of heart failure (HF). The study showed an increased risk of hospitalization in HF during selective and non-selective COX inhibitors administration, while the degree of risk depended on the specific drug and its dose (risk assessment was not fully performed for NSAIDs, the most rarely used in clinical practice). Given the increased risk of hospitalizations in HF, it is important to choose NSAIDs with a favorable benefit-risk ratio. An example of such a drug is flurbiprofen. The article notes a combination of sufficient efficacy and safety of flurbiprofen for the treatment of patients with dorsalgia.

Keywords: musculoskeletal pain syndrome, dorsalgia, heart failure, flurbiprofen, NSAIDs, safety.

For citation: Kamchatnov P.R., Chugunov A.V., Chipova D.T., Kazakov A.Yu. Nonsteroidal anti-inflammatory drugs and the risk of heart failure. RMJ. 2023;2:88–95.

Summary:

Intuitive use of multi-dose dry powder inhalers: a comparative study

I.Yu. Vizel¹, A.I. Rezyapova^1,2, A.A. Vizel¹ 

¹Kazan State Medical University, Kazan

²Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan 

Aim: to determine the correct use concerning the intuitive use of four multi-dose dry powder inhalers — Turbuhaler, Genuair, Spiromax and Ellipta.

Patients and Methods: 208 subjects were included in the study. 100 patients (48.1%) had chronic obstructive lung disease (COPD) and 108 (51.9%) had asthma (A). Initially, the correct use was evaluated in three stages: 1) intuitive use before reading the medical leaflet for the dry powder inhaler (DPI); 2) after reading the medical leaflet; 3) after learning the technique of inhalation by a study doctor. Then the factors influencing the intuitive use of each of the inhalers in COPD and A were evaluated.

Results: in COPD, on an intuitive level, the Spiromax and Ellipta DPIs were three times more likely to achieve the correct technique compared to Turbuhaler and Genuair. After firmly applying the recommendations for the Genuair, Spiromax and Ellipta DPIs, patients achieved more than 80% correct use of inhalers, while in this practice the correct use of Turbuhaler reached 43%. After briefing by a doctor, Genuair, Spiromax and Ellipta were used correctly by patients with COPD in 100%, and Turbuhaler — in 93% of cases. In A, on an intuitive level, the Spiromax and Ellipta DPIs were two times more likely to achieve the correct technique compared to Turbuhaler and Genuair. Spiromax was the most intuitive (63%), whereas Genuair was the least intuitive (16.7%). After firmly applying the recommendations for the Genuair, Spiromax and Ellipta DPIs, patients achieved more than 80% correct use of inhalers, while in this practice the correct use of Turbuhaler reache d 43%. Patients with A most commonly correctly used Spiromax (95.4%) after reading the medical leaflet, and less commonly Turbuhaler (72.2%). Briefing by a doctor allowed to achieve success for all DPIs above 99%. On an intuitive level, the frequency of correct use differed between patients with COPD and A by the factors such as cognitive abilities and adherence to treatment.

Conclusion: the correct intuitive use of different DPIs of the same class and between patients with different diagnoses (COPD and A) varied, which requires an individual approach to each patient. The individual briefing by a doctor, preferably with the achievement of the maximum possible end result, plays a crucial role in the correct use of DPIs and eliminating differences in the frequency of DPI correct use.

Keywords: dry powder inhaler, chronic obstructive pulmonary disease, asthma, inhalation technique, Turbuhaler, Genuair, Spiromax, Ellipta.

For citation: Vizel I.Yu., Rezyapova A.I., Vizel A.A. Intuitive use of multi-dose dry powder inhalers: a comparative study. RMJ. 2023;1:12–17.

Summary:

Atypical videothoracoscopic lung resection in focal tumors

D.N. Pilkevich^1,2, M.A. Chekasina², S.S. Anufrieva³ 

¹Ural State Medical University, Ekaterinburg

²National Medical Research Center of Phtisiopulmonology, Moscow

³South Ural State Medical University, Chelyabinsk 

Aim: to analyze the immediate results of atypical videothoracoscopic lung resections in focal tumors.

Patients and Methods: the study included 94 patients who underwent 96 video-assisted atypical lung resections in 2005–2021. There were 43 (46%) women and 51 (54%) men in the study group. The mean age was 40±12,3 years. Indications for surgical intervention: pulmonary tuberculosis in 34 patients, in 10 — lung metastases, in 52 — non-specific lung tumors. Single lung resection was performed in 80 cases, combined resection — in 16 cases.

Results: the average duration of surgeries was 34.2±13.3 minutes, the average blood loss — 8.3±4.2 ml, the average duration of drainage — 4.4±2.2 days. The postoperative period proceeded with no complictions. Conversion to video-assisted mini-thoracotomy was required in 3 cases when it was necessary to expand the scope of the surgery to lobectomy.

Conclusion: when analyzing the immediate results of atypical videothoracoscopic lung resections for the diagnosis and treatment of focal tumors, high efficacy, minimal injury, cosmetic effect and absence of postoperative complications are shown.

Keywords: videothoracoscopy, atypical lung resection, focal formations in the lungs.

For citation: Pilkevich D.N., Chekasina M.A., Anufrieva S.S. Atypical videothoracoscopic lung resection in focal tumors. RMJ. 2023;1:18–21.

Summary:

Functional and radiological assessment of the respiratory system in patients who experienced a new coronavirus infection with lung damage (annual follow-up)

T.V. Glushkova¹, I.V. Leshchenko^1-3, A.V. Saveliev¹, S.N. Skornyakov¹ 

¹Ural Scientific Research Institute of Phtysiopulmonology — Branch of the National Medical Research Center of Phtysiopulmonology, Yekaterinburg

²Ural State Medical University, Yekaterinburg

³Novaya Bolnitsa LLC, Yekaterinburg 

Aim: to evaluate the functional and radiological outcomes for the respiratory system in patients who experienced COVD-19 in moderate and severe form, 6 and 12 months after the first symptoms of the disease.

Patients and Methods: the study included 89 hospitalized patients who had a confirmed COVID-19 with viral lung damage. The exclusion criterion was the presence of the chronic respiratory disease in the history or detected for the first time at examination. 6 and 12 months after the first symptoms of COVID-19, patients underwent a functional study of the respiratory system (spirometry, body plethysmography, and diffusing capacity of the lungs for carbon monoxide (Dlco)) and high-resolution computed tomography of the chest organs (HRCT CO).

Results: after 6 and 12 months, a functional study was performed in 50 and 44 patients out of 89 included in the study, respectively. Spirometry and body plethysmography indicators were within normal values on the 176^th (132-195) and 370^th (364-386) days of the study, regardless of the COVID-19 severity. The Dlco level after 6 and 12 months was 71 (66-73) % and 72 (67-76) % of the required level for patients who had experienced the moderate COVID-19 form, for severe form — 57 (50-60) % and 62 (57-70) %, respectively. Dlco <80% of the required level was commonly associated with severe COVID-19, hospitalization in the intensive care unit (ICU) and high flow oxygen therapy (HFOT) (p<0.05). Dlco values <60% of the required level were determined only among patients who had suffered a severe disease form. Changes in the lungs by the type of ground-glass opacities and parenchymal bands are the most common X–ray patterns recorded after 6 and 12 months. In 2 (10.0%) and 2 (8.3%) patients who had severe COVID-19 pain, cellular rearrangement of lung tissue was registered at 6 and 12 months, respectively.

Conclusion: the severe form of COVID-19, hospitalization in the ICU and HFOT are likely risk factors for long-term disorder of Dlco and significant residual changes in lung tissue.

Keywords: new coronavirus infection, COVID-19, diffusing capacity of the lungs, Dlco, computed tomography, viral pneumonia.

For citation: Glushkova T.V., Leshchenko I.V., Saveliev A.V., Skornyakov S.N. Functional and radiological assessment of the respiratory system in patients who experienced a new coronavirus infection with lung damage (annual follow-up). RMJ. 2023;1:2–5.

Summary:

Predictability of facial nerve stimulation in candidates for cochlear implant surgery based on the analysis of topographic and anatomical patterns of temporal bones according to computed tomography

V.E. Kuzovkov, A.S. Lilenko, S.B. Sugarova, V.A. Tanaschishina 

Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg

Aim: to evaluate the effect of the average wall thickness of the cochlear basal coil at the site of the facial nerve maximum approach to it, as well as the density of bone tissue in this area on the probability of facial nerve stimulation (FNS) in candidates for cochlear implant surgery (CIS).

Patients and Methods: in the period from 2017 to 2021, 1954 CISs were conducted on the basis of the St. Petersburg Research Institute of Ear, Throat, Nose and Speech. For a retrospective study, 1000 computed tomography (CT) scans of temporal bones were selected in patients with normal cochlear anatomy or acquired pathology of the inner ear with a maximum section thickness of 0.6 mm. Out of 1000 selected patients with analyzed temporal bone CT scans: in 24 of 971 (2.5%) cases with normal cochlear anatomy, FNS was registered, with altered cochlear anatomy — in 4 of 29 (13.8%) cases: in a history of meningitis — in 2 out of 19 cases, with temporal bone injury — in 1 case of 6, in the cochlear otosclerosis — in 1 case of 4. In total, this complication occurred in 28 cases out of 1000 (3%).

Results: according to the results of the measurements, the minimum average bone density of the cochlear basal coil was revealed in a patient with a cochlear otosclerosis — 389 HU, the maximum — in a patient with normal cochlear anatomy (2918 HU). The average values of bone density in patients with congenital and progressive idiopathic hearing loss was 1703±341 HU. When comparing the results of measurements with clinical data on FNS of specific patients, it was found that the average values of the bone density of the cochlear basal coil less than 1096±192 HU leads to an increased risk of FNS in the postoperative period. The average wall thickness of the cochlear basal coil in patients with congenital and progressive idiopathic hearing loss was 1.7±0.04 mm and the minimum thickness was 0.8 mm. The threshold value that caused facial nerve stimulation in this group of patients was 0.9 mm. When determining the location top of the electrodes relative to the f acial nerve channel, according to CT scans of the temporal bones performed in the postoperative period, the closest possible location of 4–7 electrodes (out of 12) to the facial nerve was revealed.

Conclusion: in patients with normal inner ear anatomy, the risk of FNS increases significantly when the bone density of the cochlea otic capsule is less than 1096 HU and the thickness is less than 0.9 mm. In the cochlear ossification caused by the acquired pathology of the inner ear, there is no increase in the bone density of the cochlea otic capsule, and FNS may be a consequence when using higher thresholds during configuring the speech processor of the cochlear implant. In patients with the cochlear otosclerosis, the risk of FNS is associated with a low density of the bone tissue of the cochlear otic capsule (average density 569±222 HU).

Keywords: cochlear implant surgery, facial nerve stimulation, temporal bone CT scans, bone density.

For citation: Kuzovkov V.E., Lilenko A.S., Sugarova S.B., Tanaschishina V.A. Predictability of facial nerve stimulation in candidates for cochlear implant surgery based on the analysis of topographic and anatomical patterns of temporal bones according to computed tomography. RMJ. 2023;1:22–26.

Summary:

Tendency of laboratory urine parameters in the postoperative period in patients with chronic tonsillitis with and without kidney diseases

S.A. Karpishchenko, O.M. Kolesnikova, Yu.V. Legkov, P.V. Ignatovich

I.P. Pavlov First Saint-Petersburg State Medical University, St. Petersburg 

Aim: to evaluate the dynamics of some indicators concerning urine test (protein, ketones, specific gravity) in patients with and without kidney disease within three days after bilateral tonsillectomy under general anesthesia.

Patients and Methods: the study included 40 patients aged 18 to 56 years (mean age 32.10±7.98 years) with chronic decompensated tonsillitis who admitted to the clinic for planned surgical treatment. The patients were divided in two groups of 20 persons. The main group had a history of renal pathology, the other (comparison group) had a history of kidney diseases. In the perioperative period, all patients followed a concerned food intake that included complete rejection of oral food and water on the day of surgery. From the next day, patients were prescribed a sparing diet. After the surgery, the patients underwent a daily study of the urine test (first-void urine, midstream urine) for three days using test strips "vChem 10 SG", the following indicators were evaluated: ketone bodies, protein and specific gravity.

Results: in patients with no history of kidney pathology, proteinuria, ketonuria and an increased urine specific gravity were noted in the postoperative follow-up period after tonsillectomy. The highest concentration of the average protein level in the urine test in patients was observed on the first day after surgery to 0.3 g/L, the manifestation of ketones in the urine was detected in 70% of patients, the urine specific gravity index increased to 1035 g/L at an initial level of 1020 g/L. Further, the average levels of these indicators in the urine analysis decreased and corresponded to the norm (specific gravity) or were completely absent (ketones) by the third day, which was probably due to forced dehydration of the body due to refusal of oral food and water intake on the day of surgery. In patients with a history of kidney disease, the average protein level of the urine test was increased (0.74 g/L) before surgery due to the existing kidney pathology and practically did not change in the tendency of the study. The index of ketones and the urine specific gravity did not change.

Conclusion: body dehydration due to refusal of oral food and water intake on the day of surgery, in our opinion, is the cause of a transient increase in some urine indicators in patients without kidney pathology (protein, ketones, specific gravity), is functional and does not require treatment. In patients with a history of kidney disease, the average protein level of the urine test was increased before surgery due to the existing kidney pathology and practically did not change in the tendency of the study, and the indicators of ketones and the urine specific gravity did not change, which is most likely due to impaired functional activity of the kidneys in this pathology.

Keywords: general anesthesia, impaired kidney function, chronic tonsillitis, tonsillectomy, proteinuria, ketonuria.

For citation: Karpishchenko S.A., Kolesnikova O.M., Legkov Yu.V., Ignatovich P.V. Tendency of laboratory urine parameters in the postoperative period in patients with chronic tonsillitis with and without kidney diseases. RMJ. 2023;1:27–31.

Summary:

Patterns of pathogenetic antibacterial therapy concerning ENT organs in modern conditions

S.A. Eremin, V.V. Dvorianchikov, S.V. Ryazantsev, S.S. Pavlova, S.I. Sitnikov

Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, St.-Petersburg 

Inflammatory diseases of the ENT organs are the most common diseases in the world. In most cases, there is a primary viral infection that provokes pathology. However, despite the tendency to self-resolution and the absence of the need in antibiotics, the latter are widely used in the therapy of ENT organs. The article summarizes the data of modern Russian and foreign literature on the available possibilities in antimicrobial therapy of the upper respiratory tract and ear, as well as its efficacy. Attention is focused on the problem of the antibiotic resistance increase, methods of rational use concerning antibacterial drugs at the present stage, as well as aspects that prevent the correct treatment from being prescribed. It has been shown that the combination of amoxicillin with clavulanic acid is effective in the treatment of infections caused not only by monocultures of virulent bacterial strains, but also by their associations, which is especially importan t in the treatment of chronic diseases and their prevention. In conditions of increasing antibiotic resistance to penicillin, the group of beta-lactam antibiotics and macrolides, the combination of amoxicillin with clavulanic acid retains one of the highest efficiency indicators, which has not significantly changed over time.

Keywords: upper respiratory tract infections, antibiotic resistance, bacterial agents, systemic antibacterial drugs, amoxicillin, clavulanic acid.

For citation: Eremin S.A., Dvorianchikov V.V., Ryazantsev S.V. et al. Patterns of pathogenetic antibacterial therapy concerning ENT organs in modern conditions. RMJ. 2023;1:32–37.

Summary:

Sequence of clinical symptoms and vestibular disorders in patients with Ramsay Hunt syndrome: literature review and clinical case

A.A. Vavilova^1,2, G.A. Kochergin¹ 

¹Nikiforov’s All-Russian Center for Emergency and Radiation Medicine, St. Petersburg

²AVA-PETER LLC, St. Petersburg 

The article examines the sequence concerning the manifestation of symptoms in the clinical picture of Ramsay Hunt syndrome (RHS), such as vestibular disorders, pain, facial nerve palsy (FNP), herpes rash, according to the literature and on the example of clinical case. The etiology, diagnosis and treatment of RHS associated with the disorder of the cranial nerve VII (CN), Varicella-zoster virus (VZV), are also covered.

Commonly, RHS begins with a single symptom — pain in the ear area. After a few days, facial nerve is affected, increasing the possibility of cochleovestibular disorders. As a rule, herpes rash appears later, complicating the early diagnose of the disease. Timely diagnosis of RHS and early initiation of antiviral therapy improve the prognosis in FN disorder. That is why a special role in the early diagnosis of this disease belongs to the otorhinolaryngologist, whom the patient visits with ear pain. In the absence of typical herpes rash, it is important not to miss the comorbid symptoms: FNP, vestibulocochlear disorders, neuropathy of other facial nerves. This article presents a clinical case of a patient with vestibular disorders, the results of his otoneurological examination and vestibulometry using videonystagmography.

Keywords: Ramsay Hunt syndrome, Varicella-zoster virus, herpes zoster, facial nerve palsy, cranial neuropathy, dizziness, vestibular dysfunction, vestibulopathy, videoculography, videonystagmography.

For citation: Vavilova A.A., Kochergin G.A. Sequence of clinical symptoms and vestibular disorders in patients with Ramsay Hunt syndrome: literature review and clinical case. RMJ. 2023;1:39–44.

Summary:

Modern solution in the treatment of acute tonsillopharyngitis

S.A. Karpischenko, O.M. Kolesnikova 

Pavlov First Saint-Petersburg State Medical University, St. Petersburg 

Clinical recommendations for doctors concerning the treatment of acute tonsillopharyngitis (ATP) are focused on the detection of group A β-hemolytic streptococcus (GABHS) and the restriction of systemic antibacterial therapy without indications. The article presents a number of clinical cases of ATP with an atypical clinical picture, in which only the implementation of extra examination methods led to the correct diagnosis, treatment tactics and rapid recovery of patients with the prevention of complications. In the first clinical case, despite the negative rapid test for GABHS and the compliance of the clinical picture with only 3 points according to the McIsaac score, only systemic antibacterial therapy led to a rapid recovery of the patient. In the second case, there was a subclinical picture of streptococcal ATP. The lack of pathogen verification led to the development of late post-streptococcal complications. A clinical case of viral ATP with vivid clinical symptoms was also presented, in which systemic antibacterial therapy was required according to clinical recommend ations. Thus, it is very difficult to standardize treatment methods of ATP. Future developments of multi-pathogen rapid tests are needed, which can provide improved diagnostics and benefit from antibacterial therapy. Moreover, there is a need in further research and clarification elaboration of existing recommendations regarding antimicrobial therapy of ATP of various etiologies.

Keywords: acute tonsillopharyngitis, topical therapy, clinical recommendations, group A beta-hemolytic streptococcus, benzyldimethyl-myristoylamino-propylammonium, aerosol.

For citation: Karpischenko S.A., Kolesnikova O.M. Modern solution in the treatment of acute tonsillopharyngitis. RMJ. 2023;1:46–50.

Summary:

Modern possibilities of drug therapy concerning voice disorders in children

A.A. Krivopalov^1,2, S.V. Ryazantsev¹, T.V. Gotovyakhina¹, A.I. Glushchenko¹

¹Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg

²I.I. Mechnikov North-Western State Medical University, St. Petersburg

The child’s voice changes subsequent to the growth of the vocal apparatus. Disorder of voice formation can occur at any stage of a child’s development. The most common complaint is hoarseness, so the issues of treatment and prevention of voice disorders occupy one of the leading places in otorhinolaryngology. To select an effective therapy, it is important to determine the cause of voice function disorders. For diagnostic purposes, a standard otorhinolaryngological examination is performed, and additional modern methods of laryngeal visualization are used to clarify the condition of the vocal apparatus. Treatment of dysphonia should be aimed at relieving the underlying disease, as well as preventing the development of adverse complications. Recently, much attention has been paid to the safety, accessibility and convenience of taking medicines, therefore, there remains an urgent need to consecrate data on the treatment of voice disorders in children. The article reflects the indicators concerning the epidemiology of dysphonia, as well as the patterns of the clinical picture and treatment. The results concenring the use of a multicomponent homeopathic drug for the treatment of hoarseness are presented. The drug characteristic is reflected in the mechanism of action, properties, information about its safety and efficacy. It is safe, effective, has good tolerability and can be recommended both for therapeutic and preventive purposes in voice disorders.

Keywords: dysphonia, hoarseness, vocal function, vocal disorder, homeopathy, multicomponent drug.

For citation: Krivopalov A.A., Ryazantsev S.V., Gotovyakhina T.V., Glushchenko A.I. Modern possibilities of drug therapy concerning voice disorders in children. RMJ. 2023;1:51–55.

Summary:

The results of an observational study evaluating the treatment of patients with productive cough after COVID-19

I.V. Leshchenko^1-3, N.A. Esaulova^1,3 

¹Ural State Medical University, Yekaterinburg

²Ural Scientific Research Institute of Phtysiopulmonology — Branch of the National Medical Research Center of Phtysiopulmonology, Yekaterinburg

³Medical Association "New Hospital", Yekaterinburg 

Aim: the comprehensive assessment of clinical, laboratory and functional indicators was performed in patients with productive cough after COVID-19 to evaluate the efficacy of therapy with the fixed-dose combination of salbutamol, bromhexine, guaifenesin (Ascoril in tablet form) and to determine the patient satisfaction with the treatment.

Patients and Methods: fifty patients (both men and women) with productive cough after COVID-19 were examined from July 2022 to October 2022. Their health assessment included spirometry parameters, total blood count, biochemical blood test, sputum analysis, chest X-ray, and a questionnaire for determining the severity of clinical symptoms and the patient satisfaction with the provided therapy. Also, the safety and tolerability of the treatment were evaluated.

Results: during the treatment of post-COVID cough with the fixed-dose combination of salbutamol, bromhexine, guaifenesin in tablet form, a statistically significant increase in post-bronchodilator forced expiratory volume in one second and post-bronchodilator vital capacity was demonstrated. "Optimal effect" was defined as a relief of each of the patient’s symptoms. Such optimal effect of the therapy was observed in 49 (98%) patients. A complete relief from frequent daytime cough that reduces activity, severe daytime cough that prevents daytime activity, and nocturnal cough that interrupts sleep more than 2 times, interrupts sleep frequently, or prevents sleep was reported in all of patients who had these symptoms at the baseline. Satisfaction with the efficacy of the assessed medication was reported by 42 (84%) of patients; 49 (98%) of patients were satisfied with the tolerability and convenience of use; and 45 (90%) of patients expressed their satisfaction with the medication price-quality ratio. The overall percentage of patients satisfied with the treatment the fixed-dose combination of salbutamol, bromhexine, guaifenesin in tablet form was 46 (92%). The vital signs and the findings of total blood count and biochemical blood test did not show any significant changes during the treatment. No patients were excluded from the study due to adverse events. All patients reported that the therapy was well tolerated.

Conclusion: the high efficacy and safety of the fixed-dose combination of salbutamol, bromhexine, guaifenesin in tablet form was demonstrated in the treatment of post-infection cough.

Keywords: COVID-19, post-COVID conditions, productive cough, post-infection cough, mucoactive drugs, fixed-dose combination of salbutamol, bromhexine, guaifenesin in tablet form.

For citation: Leshchenko I.V., Esaulova N.A. The results of an observational study evaluating the treatment of patients with productive cough after COVID-19. RMJ. 2023;1:6–11.

Summary:

Efficacy and tolerability of lercanidipine in the treatment of patients with arterial hypertension after acute coronary syndrome and/or myocardial revascularization

O.Yu. Korennova^1,2, I.V. Druk¹, Yu.E. Yukhina^1,2, M.V. Savchenko^1,2, E.P. Prikhod’ko^1,2, S.N. Starinskaya², P. Yu. Shkurko², E.N. Loginova¹, L.V. Shukil¹ 

¹Omsk State Medical University, Omsk, Russian Federation

²Clinical Cardiologic Dispensary, Omsk, Russian Federation 

Aim: to assess the efficacy, safety and tolerability of lercanidipine in the treatment of patients with arterial hypertension (AH) after acute coronary syndrome (ACS) and/or myocardial revascularization.

Patients and Methods: the study enrolled 80 patients (mean age: 59.4±9.6 years), 59 (73.7%) of them were males. For patients included in the study, the treatment with amlodipine was replaced by lercanidipine. Treatment switching occurred because of non-achievement of the target blood pressure or the onset of adverse events (AE). At the starting point and during the treatment, a lercanidipine dose was administered/titrated by the attending physician in sole discretion. Before lercanidipine administration, one and three months after its addition to the therapy, the results of BP self-control (BPSC), office BP measurement and daily BP monitoring (DBPM) were assessed. Also, the number of angina attacks per week, pain intensity of angina attacks by visual analogue scale (VAS) and the Cardio-Ankle Vascular Index (CAVI) were used in the assessment.

Results: the target BP was achieved in all patients at 3 months after the therapy initiation. In 56 (70%) patients the target blood pressure was achieved with lercanidipine at a therapeutic dose of 10 mg, in 24 (30%) — at a dose of 20 mg. After 3 months of lercanidipine treatment, the normalization of SBP variability was reported in 80 (100%) and DBP in 78 (97.5%) patients (versus the baseline values of SBP and DBP, p≤0.001). During lercanidipine treatment, the number of patients with angina attacks decreased and the pain intensity reduced according to VAS measurements. No significant changes in CAVI were found. The studied drug was well tolerated by patients. No patients were withdrawn from the study because of an adverse event. During the study, no AEs related to lercanidipine intake were reported.

Conclusion: lercanidipine is effective for achieving and maintaining target SBP and DBP levels, decreasing the rate and intensity of angina attacks and ensuring stable therapeutic effect in patients with arterial hypertension who survived ACS and myocardial revascularization. Since lercanidipine does not cause AEs that are common for the group of calcium antagonists, it can be considered as an alternative to other drugs from this group.

Keywords: arterial hypertension, acute coronary syndrome, blood pressure, lercanidipine, calcium antagonist, CAVI.

For citation: Korennova O.Yu., Druk I.V., Yukhina Yu.E. et al. Efficacy and tolerability of lercanidipine in the treatment of patients with arterial hypertension after acute coronary syndrome and/or myocardial revascularization. RMJ. 2022;9:11–16.

Summary:

Interleukin 15 as a biological marker of cardiovascular diseases

A.M. Alieva¹, E.V. Reznik^{1, 2}, N.V. Teplova¹, L.R. Sarakaeva³, R.K. Valiev⁴, M.N. Sariyev⁴, M.Ya. Shavaeva⁵, A.M. Rakhaev⁵, D.A. Elmurzaeva⁵, I.G. Nikitin¹ 

¹Pirogov Russian National Research Medical University, Moscow

²City Clinical Hospital No. 31, Moscow

³V.A. Almazov National Medical Research Center, St. Petersburg

⁴A.S. Loginov Moscow Clinical Research Center, Moscow

⁵Kh.M. Berbekov Kabardian-Balkar State University, Nalchik 

Cardiovascular diseases are an important public health issue and one of the leading causes of mortality, decline or complete loss of work ability, and disability. According to the World Health Organization, more than 17 million people die from the complications of cardiovascular diseases every year, representing approx. 32% of all global deaths. Cardiovascular diseases represent a major socioeconomic burden in terms of healthcare resource use associated with the provision of medical care to patients and the mortality rate among the working-age population. Currently, an increasing number of novel biological markers have been identified to serve as a laboratory diagnostic tool and to predict the clinical course of cardiovascular disease, but only brain natriuretic peptide, its precursors, and cardiac troponins are most used in clinical practice. The article presents the results of a literature review of the promising biological marker interleukin 15 (IL-15) and its role in cardiovascular diseases. There is a growing body of evidence demonstrating the value of IL-15 as a novel biomarker for diagnosis and prognosis in patients with cardiac diseases. IL-15 may play an important role due to its cardioprotective effects. The final proof of the diagnostic, predictive and potential therapeutic implications of this marker would be received in the future large-scale prospective studies.

Keywords: cardiovascular diseases, biological marker, interleukin 15, atherosclerosis, ischemic heart disease, myocardial infarction, myocarditis.

For citation: Alieva A.M., Reznik E.V., Teplova N.V. et al. Interleukin 15 as a biological marker of cardiovascular diseases. RMJ. 2022;9:17–21.

Summary:

Characteristics of clinical presentation, medical history and structure of hospital-acquired complications in patients with various types of myocardial infarction

V.I. Kinash^1,2, A.S. Vorobiev^1,2, I.A. Urvantseva^1,2, L.V. Kovalenko², V.V. Kashtalap^3,4 

¹District Cardiology Dispensary "Center for Diagnosis and Cardiovascular Surgery", Surgut

² Surgut State University, Surgut

³ Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo

⁴ Kemerovo State Medical University, Kemerovo 

Aim: to assess characteristics of clinical presentation, medical history, and hospital outcomes in patients with myocardial infarction of various types.

Patients and Methods: this prospective study included 1,325 patients hospitalized in the District Cardiology Dispensary "Center for Diagnosis and Cardiovascular Surgery" with retrosternal painchest pains in the period from January to November 2021.Invasive coronary angiography (ICA) was performed in 254 (19.1%) of 1,325 patients. In the group with type 1 MI, invasive coronary angiography was performed in 194 (100%) patients, and in the group with type 2 MI — in 60 (72.3%) patients. In the group of patients with type 2 MI, intravascular ultrasound (IVUS) imaging of the coronary arteries was carried out in 2 (2.4%) cases, and magnetic resonance imaging of the heart (MRI) — in 10 (12.04%) cases.

Results: out of 1,325 hospitalized patients, the diagnosis of acute coronary syndrome was established in 1,293 (97.5%) cases. The total number of patients with diagnosed myocardial infarction was 277 (21.4%). At the same time, the diagnosis of type 1 MI was established in 194 (15.0%) patients, type 2 MI — in 83 (6.4%) patients, and unstable angina was diagnosed in 1016 (78.5%) patients based on the results of additional testing. Patients with type 2 MI were older than patients with type 1 MI (median ages: 62 and 57 years, respectively; p<0.01). In the group of type 2 MI female patients prevailed (30.1% and 17.53%; p=0.02). Also, patients with type 2 MI had a higher prevalence of kidney diseases (18.8% and 11.4%; p<0.05), chronic obstructive pulmonary disease (COPD) (14.0% and 2.06%; p<0.001), diabetes mellitus (DM) (39.76% and 19.59%; p<0.001), peripheral artery disease (PAD) (38.55% and 10.82%; p<0.001), MI in the medical history (30.12% and 10.82%; p<0.001). Among all patients with MI, early hospital-acquired complications developed in 20 (7.2%) persons, and there was no difference in their prevalence between the groups.

Conclusion: characteristics of patients with type 2 myocardial infarction included the following: an older age; a higher number of female patients; a higher frequency of atypical clinical manifestations of the disease and cardiovascular and somatic comorbidities, as compared with type 1 MI patients. However, patients with type 1 myocardial infarction are more likely to develop complications in the acute stage of the disease.

Keywords: myocardial infarction, type 2 myocardial infarction, clinical characteristics, comorbidity, hospital-acquired complications.

For citation: Kinash V.I., Vorobiev A.S., Urvantseva I.A. et al. Characteristics of clinical presentation, medical history and structure of hospital-acquired complications in patients with various types of myocardial infarction. RMJ. 2022;9:2–6.

Summary:

Two drugs — one target: ramipril and a fixed dose combination of ramipril and amlodipine in the treatment of arterial hypertension

M.L. Maksimov^1–3, A.G. Obrezan^4,5, A.A. Zvegintseva^1,6,7, A.P. Kondrakhin² 

¹Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education, Kazan

²Pirogov Russian National Research Medical University, Moscow

³Russian Medical Academy of Continuous Professional Education, Moscow

⁴LLC SOGAZ International Medical Center, Saint Petersburg

⁵Saint Petersburg State University, Saint Petersburg

⁶Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan

⁷City Clinical Hospital, Kazan

The article presents the most recent information on selecting a fixed dose combination for the treatment of patients with arterial hypertension (AH) based on the current national and international guidelines. The rating of a unique fixed dose combination of ramipril and amlodipine has been established in comparison with other antihypertensive drugs used for achieving the therapeutic target in patients with arterial hypertension. The discussed benefits of the fixed dose combination of ramipril and amlodipine include a wide range of indications and the efficacy in the treatment of patients with AH and such comorbidities as chronic kidney disease and metabolic syndrome. The emphasis is made on specific characteristics of the fixed dose combination of ramipril and amlodipine: it is helpful for achieving the target blood pressure (BP), improving patients’ compliance with medication, reducing the prevalence of administration of additional antihypertensive drugs, and increasing patients’ satisfaction with the treatment. In patients with diabetes mellitus and metabolic syndrome the fixed dose combination of ramipril and amlodipine is effective for reaching BP targets, reducing heart rate, improving biochemistry markers of lipid and carbohydrate metabolism, as well as renal function test results. Ramipril is commonly used in patients with arterial hypertension, and its combination with amlodipine can be considered as an option of choice for the treatment of patients with AH co-occurring with diabetes mellitus, chronic kidney disease and metabolic syn drome.

Keywords: arterial hypertension, fixed combination, ramipril, amlodipine, patients’ compliance with medication, metabolic syndrome, chronic kidney disease, diabetes mellitus.

For citation: Maksimov M.L., Obrezan A.G., Zvegintseva A.A., Kondrakhin A.P. Two drugs — one target: ramipril and a fixed dose combination of ramipril and amlodipine in the treatment of arterial hypertension. RMJ. 2022;9:22–28.

Summary:

Specific aspects of using apixaban in outpatient physician practice

A.D. Erlikh 

Pirogov Russian National Research Medical University, Moscow

N.E. Bauman City Clinical Hospital No. 29, Moscow 

The article identifies and describes the tasks of an outpatient physician (general practitioner, therapist, cardiologist and other specialists) associated with the use of oral anticoagulants with a focus on apixaban. The authors highlight special aspects of the decision-making process associated with the initiation of anticoagulant therapy in patients with atrial fibrillation and emphasize the need for selecting the right dose of each on non-vitamin K direct oral anticoagulants (DOAC). The article presents a set of factors which should be evaluated by a physician prior to DOAC administration to minimize the risk of future therapy complications. It also describes approaches to the management of patients taking DOAC, follow-up visit schedules, and factors to be taken into consideration during follow-up of such patients. The authors outline criteria for changing DOAC dosages during the treatment w hich is essential for patients with decreased glomerular filtration rate and individuals receiving combination therapy (antiaggregant agent and DOAC) after the recent acute myocardial infarction and/or percutaneous coronary intervention. The emphasis is made on the management of patients who survived an episode of acute thromboembolism of pulmonary artery and/or had deep vein thrombosis of the legs.

Keywords: direct oral anticoagulant, atrial fibrillation, TEPA, myocardial infarction, outpatient treatment, outpatient physician.

For citation: Erlikh A.D. Specific aspects of using apixaban in outpatient physician practice. RMJ. 2022;9:29–34.

Summary:

Down syndrome and cardiovascular problems: clinical case and literature review

E.V. Reznik^1,2, T.L. Nguyen¹, T.S. Ilyina¹, E.S. Tokmakova¹, E.M. Dzhobava³, G.N. Golukhov^1,2 

¹Pirogov Russian National Research Medical University, Moscow

²City Clinical Hospital No. 31, Moscow

³Crede Experto Clinic, Moscow 

Complete or partial trisomy of chromosome 21 (Down syndrome) is the most prevalent aneuploidy compatible with the life, occurring with a frequency of approx. 1 of 800 live births. Down syndrome is also the most common genetic disorder associated with congenital heart disease (CHD). At least 50% of all patients with Down syndrome have CHD. The average life expectancy of persons with this disease has increased significantly, from 25 years to 53–58 years. However, cardiovascular complications are still considered as the main factor affecting the life expectancy of these patients, both in childhood and later periods of life. This article describes a clinical case of a 59-year-old female patient with Down syndrome, who had conduction disorders (AVB III, condition after pacemaker implantation) and severe manifestations of multisystem diseases. Also, the authors present an overview of the spectrum and pathogenesis of cardiovascular problems found in patients with this disease. Understanding the multisystem involvement and the specific clinical manifestations of Down syndrome, and timely treatment of cardiovascular disorders would significantly improve the quality of life and increase the longevity of such patients.

Keywords: Down syndrome, congenital heart defects, mental retardation, trisomy 21, chimerism, atrioventricular septal defect, acquired cardiovascular diseases, mitral valve prolapse, aortic regurgitation, premature aging, atherosclerosis, arterial hypertension, ischemic heart disease, pulmonary hypertension, arrhythmia.

For citation: Reznik E.V., Nguyen T.L., Ilyina T.S. et al. Down syndrome and cardiovascular problems: clinical case and literature review. RMJ. 2022;9:35–40.

Summary:

Changes in vascular endothelial function and blood lipid levels in young healthy volunteers receiving diets with different amounts of palm oil versus butter

Yu.I. Belous, L.V. Yakubova 

Grodno State Medical University, Grodno, Republic of Belarus

Aim: to evaluate changes in vascular endothelial function and blood lipid levels in young healthy volunteers receiving diets with different amounts of palm oil versus butter.

Patients and Methods: the study included young healthy individuals (n=137), 20.1±0.6 years old, who were divided into 5 groups: receiving a regular diet — control group (CG) (n=34), receiving 25 grams of palm oil (PM) — GO (n=32), 25 grams of butter — GS (n=30), 15 grams of PM –GO-1 (n=20) and 7.5 grams of PM–GO-2 (n=21). The observation period was 12 weeks.

Results: after 12 weeks of the study, the endothelium-dependent vasodilation (EDV) became significantly worse in the GS and GO volunteers compared with that at the baseline. The highest rate of EDV decline was observed in the GO group, but it did not significantly differ from that in the GS volunteers. Endothelium disfunction (ED) was found in 96% of the GO and GS group subjects, and in 55% of the CG subjects (p=0.028). Total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels increased vs their baseline values in the GO and GS groups. LDL-C level in the GO-1 group individuals was higher than that in the CG individuals. After 12 weeks of the follow-up the highest increase in TC and LDL-C levels occurred in the GO group volunteers. The level of triglycerides did not change in the groups which received an excessive amount of palm oil and butter (p>0.05). In the GO-1 subjects a negative correlation was revealed between TC level and EDV.  Based on the regression analysis, a dose-dependent relationship was found between the differentiated daily consumption of palm oil and the lipid panel.

Conclusion: an excessive daily consumption (25 g) of butter and palm oil during 12 weeks by healthy volunteers contributed to the deterioration of EDV and to the increase in TH, LDL-C and high-density lipoprotein cholesterol (HDL-C) levels. In the GO-1 subjects who consumed 15 g of palm oil every day, a negative correlation was found between the TC level and EDV which can be considered as a risk factor of ED development.

Keywords: endothelial function, lipids, dyslipidemia, endothelium-dependent vasodilation, palm oil, saturated fats.

For citation: Belous Yu.I., Yakubova L.V. Changes in vascular endothelial function and blood lipid levels in young healthy volunteers receiving diets with different amounts of palm oil versus butter. RMJ. 2022;9:7–10.

Summary:

Modern methods for irrigation therapy using saline solutions with silver ions for the prevention of acute respiratory infections, as well as for the complex therapy of ENT diseases (literature review)

R.S. Zainiddinova 

Mediametrix Radio, Moscow 

At present, in the routine clinical practice of the otorhinolaryngologist, therapist and pediatrician, prevention and treatment of acute upper respiratory tract infections remain an urgent problem. Special attention is paid to the prevention and treatment of acute respiratory infections (ARI) in young and older children. The existing regulatory and evidence base for the prevention and treatment of ARI regulates the administration of drugs that improve nasal breathing to patients of any age. The regimen of complex treatment of ENT-diseases includes elimination and irrigation therapy (washing of the nasal cavity), which leads to the elimination of bacteria, allergens, substances acting on the mucous membrane, as well as its mechanical purification. The article presents data on the use of irrigation preparations based on saline solution containing sea salt in patients with inflammatory pathology of the nasal cavity and paranasal sinuses for preventive and therapeutic purposes. The article also discusses the anti-inflammatory, decongestant, microbicidal and fungicidal effects of Ag⁺ ions, their ability to potentiate the action of some antibacterial and antiviral drugs against resistant pathogens. The justification concerning the use of nasal irrigation sprays based on natural mineral water of the Altai Territory containing HCO₃^- (350–450 mg/L), Ca²⁺ (70–110 mg/L), SO₄ ^2- (65 mg/L), Cl^-(20 mg/L), Na⁺ and K⁺ (<40 mg/L), Mg²⁺ (15.0–35.0 mg/L), Ag⁺ (<0.03 mg/L). Its peculiarity is the high content of natural silver ions (Ag⁺) and sea salt.

Keywords: irrigation therapy, symptomatic treatment of ARI, ARI prevention, children, upper respiratory tract infections, nasal mucosa, elimination and irrigation therapy, mineral water, silver ions, sea salt.

For citation: Zainiddinova R.S. Modern methods for irrigation therapy using saline solutions with silver ions for the prevention of acute respiratory infections, as well as for the complex therapy of ENT diseases (literature review). RMJ. 2022;8:12–14.

Summary:

The effect of Bifidobacterium longum 35624^® long-term intake on the symptoms and life quality of patients with irritable bowel syndrome: the results of an observational trial

O.I. Solovyova, A.S. Nekrasova, Yu.G. Topalova, V.A. Ponomarenko, D.B. Tsurtsumiya, I.G. Ilyashevich

I.I. Mechnikov North-Western State Medical University, St. Petersburg

Background: in recent years, a significant role in the irritable bowel syndrome (IBS) pathogenesis of the intestinal microbiocenosis condition has been proven. The Bifidobacterium longum 35624^® strain has the greatest evidence base for use in IBS.

Aim: to study the efficacy of a long-term (12 weeks) use of the Bifidobacterium longum 35624^® strain (Symbiosis Alflorex probiotic) in patients with IBS in real clinical practice.

Patients and Methods: the follow-up program included 42 patients with a verified diagnosis of moderate and severe IBS. All patients remained on stable baseline therapy for at least 2 weeks prior to inclusion in the trial and received the probiotic Bifidobacterium longum 35624^®, 1 capsule containing ¹⁰⁹ CFU, once a day for 12 weeks. The tendency of the IBS symptoms severity was assessed using the visual analog scale (VAS), the visceral sensitivity index (VSI), the IBS severity according to the IBS-SSS questionnaire, life quality indicators according to the IBS-QoL questionnaire scales. The indicators were evaluated at the inclusion visit, on the 14^th, 28^th, 56^th, 84^th days of probiotic intake and on the 112^th day (28 days after taking the last dose of Bifidobacterium longum 35624^®).

Results: a significant positive effect of the Bifidobacterium longum 35624^® probiotic on the IBS course was demonstrated. There was a significant decrease in the severity of symptoms such as abdominal pain, bloating, and stool disorders starting from the 14^th day of probiotic intake. At the same time, the severity of visceral hypersensitivity continued to decrease until the end of the probiotic intake, reaching its minimum value at the visit during the follow-up period (28 days after the last dose). The overall severity of IBS significantly decreased after 28 days of taking the probiotic, but its lowest value was observed 3 months (day 84) after the inclusion visit. At the inclusion visit, the severity of IBS corresponded to moderate and severe severity — 16 (38.1%) and 26 (61.9%) patients, respectively. After 56 days of taking the probiotic, 19 (47%) patients had mild IBS, and 21 (53%) had moderate IBS. After 84 days of follow-up, 15 (38%) patients had remission, 18 (45%) had mild IBS and only 7 (17%) — moderate severity. A similar ratio was maintained 28 days after the end of the probiotic intake. The analysis of life quality indicators using the IBS-QoL questionnaire also revealed a significant improvement on all scales during probiotic intake. Moreover, according to such scales as "Health concerns", "Food restrictions", "Body condition", "Sexuality", the indicators after 3 months of probiotic use were significantly higher than at the visit after 2 months. All changes were persistent by the time of the visit during the follow-up period (day 112).

Conclusions: the addition of Bifidobacterium longum 35624^® to basic therapy in patients with IBS demonstrated high efficacy with positive trend of IBS symptoms by the 14^th day of probiotic intake. The preservation and prolongation of a significant positive effect 28 days after the end of administration for the indicators of IBS symptoms, course severity and effect on the main indicators of life quality was shown.

Keywords: irritable bowel syndrome, probiotics, Bifidobacterium longum 35624^®, visceral hypersensitivity, visual-analog scale, life quality.

For citation: Solovyova O.I., Nekrasova A.S., Topalova Yu.G. et al. The effect of Bifidobacterium longum 35624® long-term intake on the symptoms and life quality of patients with irritable bowel syndrome: the results of an observational trial. RMJ. 2022;8:15–22.

Summary:

Chronic pancreatitis: a debut or a risk factor for pancreatic cancer?

K.A. Krasnov^1,2, V.V. Anishchenko^3,4, S.V. Pugachev¹, A.O. Krasnov¹, N.V. Krasnova^1,2, E.Yu. Plotnikova² 

¹Kemerovo Clinical Emergency Hospital, Kemerovo

²Kemerovo State Medical University, Kemerovo

³Novosibirsk State Medical University, Novosibirsk

⁴AVICENNA Medical Center, Novosibirsk 

Chronic pancreatitis (CP) is a fibroinflammatory disease of the exocrine pancreas with various etiologies and a wide range of clinical manifestations: from asymptomatic course to debilitating chronic pain, and exocrine and endocrine insufficiency. CP is a quite common disease (manifestation according to various data varies from 7–14 to 120–143 cases per 100 thousand population), frequently requiring invasive methods of diagnosis and treatment, and surgical interventions. CP is also a known risk factor for pancreatic cancer, which can be considered in the context of early diagnosis and improvement of the treatment results of the latter. Long-term inflammation increases cellular metabolism and stellate cell proliferation, and in CP it creates differentiation disorders of pancreatic tissues, which contribute to carcinogenesis. Acute pancreatitis may be the earliest clinical manifestation of pancreatic cancer. Ho wever, the association between acute pancreatitis and the risk of pancreatic cancer remains unclear due to inconsistent and contradictory research results. This article highlights the modern options for diagnosis and treatment of both diseases, provides literature data on their association, discusses methods of differential diagnosis and possible simultaneous treatment.

Keywords: chronic pancreatitis, acute pancreatitis, pancreatic cancer, risk factors, genetic markers, surgical treatment.

For citation: Krasnov K.A., Anishchenko V.V., Pugachev S.V. et al. Chronic pancreatitis: a debut or a risk factor for pancreatic cancer? RMJ. 2022;8:23–29.

Summary:

Anaerobic infections caused by cultures of the Desulfovibrio genus (literature review)

N.G. Kulikova¹, A.A. Ploskireva^1,2 

¹Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow

²Pirogov Russian National Research Medical University, Moscow 

Bacteria of the Desulfovibrio spp genus belong to sulfate-reducing bacteria (CRP) and are indicated as a curved rod with polar flagella that does not form spores. The article discusses the prevalence of Desulfovibrio spp., its effect on intestinal microbiocenosis, as well as infections associated with Desulfovibrio spp. The presence of the Desulfovibrio spp. bacteria in the intestine is associated with various diseases. At present, there are published data on 20 cases of bacterial infection caused by Desulfovibrio spp. Human infection with Desulfovibrio spp is rare, which may be due to the low manifestation of Desulfovibrio spp invasion. The authors have considered in detail the methods of detection and identification of Desulfovibrio spp. Simple tests available in most microbiological laboratories, such as wet motility, the presence of H₂S on SIM medium and the observation of red shift fluorescence in alkaline pH under UV light indicate Desulfovibrio spp. The article also presents possible therapeutic regimens for the treatment of infections caused by these microorganisms. Studying the properties of Desulfovibrio spp. and the infections caused by them, as well as the development of new methods for patient management are urgent tasks of modern medicine, since the effect on the intestinal microbiocenosis may become a possible treatment of patients with various diseases in the future.

Keywords: sulfate-reducing bacteria, Desulfovibrio spp, microorganism identification, microorganism detection, anaerobic culture, intestinal microbiocenosis.

For citation: Kulikova N.G., Ploskireva A.A. Anaerobic infections caused by cultures of the Desulfovibrio genus (literature review). RMJ. 2022;8:30–33.

Summary:

Sensitization to Alternaria spp. in patients with pollinosis in Samara

K.S. Mazokha, M.V. Manzhos, L.R. Khabibulina, E.V. Aseeva, E.Yu. Syrtsova 

Medical University "Reaviz," Samara 

Aim: to assess the prevalence and to describe the clinical features of allergic sensitization to Alternaria spp. in patients with pollinosis in Samara.

Patients and Methods: clinical and allergological examination was carried out in 494 patients, 3–70 years old, who had symptoms of allergic rhinitis (AR) and asthma. To assess the prevalence of combined fungal and pollen sensitization, 140 patients with the presence of specific IgE-Abs against Alternaria and pollen allergens were selected. Component-resolved diagnostics was used in 50 patients with sensitization to pollen and symptoms of AR and asthma in July-September — sIgE to nArt v1, nAmb a1, rAlt a1. The assessment included measurements of Ambrosia trifida (Amb t) extract-specific IgE.

Results: fungal sensitization was revealed in 32.1% of pediatric and 20.3% of adult patients, pollen sensitization in 39.9% of children and 46.8% of adults with AR/asthma manifestations. The structure of fungal sensitization was characterized by dominating hypersensitivity to Alternaria spp., which occurred in 97.2% of children and 81.3% of adults. Combined sensitization to pollen and Alternaria allergens was found in 17.6% of children and 10.1% of adults who had symptoms of AR/asthma. As regards the structure of sensitization to Alternaria spp., combined hypersensitivity to pollen was found in 56.2% of children and 61.5% of adults. In children with combined sensitization to Alternaria spp. and plant pollen, the prevalence of comorbidity (AR+asthma) was 2.6 times higher than in patients without a co-occurring pollen allergy. Co-sensitization to Alternaria spp. and plant pollen is a risk factor for developing childhood asthma, increasing its probability by 44%. Using component-resolved allergy diagnostics, the elevated levels of sIgE to rAlt a1 were determined in 10% of patients with mugwort sensitization.

Conclusion: the study findings will help to optimize diagnosing, management and prevention of respiratory allergic diseases in patients with combined fungal and pollen sensitization in Samara.

Keywords: pollinosis, allergic rhinitis, asthma, Alternaria, fungal sensitization, pollen sensitization, comorbidities.

For citation: Mazokha K.S., Manzhos M.V., Khabibulina L.R. et al. Sensitization to Alternaria spp. in patients with pollinosis in Samara. RMJ. 2022;8:35–38.

Summary:

Erythema marginatum as a precursor of hereditary angioedema

L.L. Lazarenko^1,2, A.M. Milichkina¹, M.A. Saitgalina¹, Yu.V. Ostankova¹, T.P. Sess², I.V. Khamitova¹, A.A. Totolyan^1,2 

¹Pasteur Research Institute of Epidemiology and Microbiology, St. Petersburg

²Pavlov First Saint-Petersburg State Medical University, St. Petersburg 

The presented clinical case is intended to familiarize with the clinical manifestations of hereditary angioedema, including prodromal symptoms, such as erythema marginatum. The disease pattern is the estrogen-dependent nature of edema (debut during pregnancy, condition deterioration during the use of oral contraceptives) and the presence of erythema marginatum. The female patient with a diagnosis of "allergy of unclear etiology" participated in a follow-up for a long period of time. Difficulties in the differential diagnosis of angioedema and erythema marginatum delayed the correct diagnosis for 6 years. Laboratory diagnostics and genetic study were used to establish the diagnosis. A decrease in the concentration and activity of the C1 complement inhibitor, a missense mutation in exon 7 of the SERPING1 (C1NH) gene was revealed. Besides, it was found that the patient’s mother suffered from similar edema from her youth. Prescribed treatment with a bradykinin B2 receptor antagonist (icatibant) contributed to the rapid resolution of angioedema and erythema marginatum. A carefully collected medical history, including family, allergological, pharmacological, detailed examination, the use of all kinds of laboratory diagnostics, including genetic studies, helped in the diagnosis of hereditary angioedema.

Keywords: hereditary angioedema, erythema marginatum, prodromal symptoms, diagnosis, genetic studies, treatment, icatibant.

For citation: Lazarenko L.L., Milichkina A.M., Saitgalina M.A. et al. Erythema marginatum as a precursor of hereditary angioedema. RMJ. 2022;8:39–42.

Summary:

Hidradenitis suppurativa (acne inversa). Diagnostic criteria, modern therapy

Yu.A. Gallyamova, A.S. Kravchenko

Russian Medical Academy of Continuous Professional Education, Moscow 

The article presents a literature review devoted to a serious disease — hidradenitis suppurativa (acne inversa) (HS/AI), which modern diagnosis, classification and therapy are considered in detail. Despite the long-term study of the problem, there is no integrated approach to the treatment of HS/AI, characterized by a long-lasting torpid course with difficult achievement of remissions. This article is addressed to medical practitioners in order to help in the differential diagnosis and determination of the disease severity. The article also describes the main clinical differential diagnostic criteria of HS/AI, since the diagnosis is still made on the basis of the clinical picture (not the histological), due to the absence of specific changes in the latter. Based on the modern literature data, various treatment approaches concerning the use of various drug groups (antibiotics, retinoids, corticosteroids, cytostatics and biological drugs) are analyzed, depen ding on the severity of HS/AI and the response to treatment. Contradictions in the efficacy evaluation of a number of drugs and insufficient evidence in favor of using different laser types are also noted. The article outlines the main directions of modern research on the disease pathogenesis, which can open up new therapy possibilities.

Keywords: hidradenitis suppurativa, acne inversa, acne conglobate, follicular occlusion syndrome, pilonidal cyst.

For citation: Gallyamova Yu.A., Kravchenko A.S. Hidradenitis suppurativa (acne inversa). Diagnostic criteria, modern therapy. RMJ. 2022;8:43–47.

Summary:

Pathogenetic aspects concerning the usage of the main methods in aesthetic medicine for involutional skin changes

N.N. Potekaev^1,2, O.B. Borzykh³, E.I. Karpova¹, M.M. Petrova³, N.A. Schneider^3,4, O.M. Demina¹, M.A. Zatolokina⁵ 

¹Pirogov Russian National Research Medical University, Moscow

²Moscow Research and Practical Center for Dermatovenerology and Cosmetology, Moscow

³Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk

⁴V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg

⁵Kursk State Medical University, Kursk

With an increase in the total life expectancy, the need for long-term maintenance of the organ physiological functions, including the skin, increases too. The skin is not only a protective barrier for internal organs but also a source of information about a person’s health and age for others. Thus, its social function is manifested. In this regard, it is not surprising that the number of aesthetic procedures aimed at correcting age-related skin changes is steadily growing worldwide. There are more and more new methods that promise grandiose results. Different methods of aesthetic medicine realize their rejuvenating effects through various mechanisms. Only the Global Aesthetic Improvement Scale (GAIS) is not enough for a real evaluation of the procedure efficacy. It is necessary to understand the changes occuring at the tissue, cellular and even molecular l evel. In order to prescribe a comprehensive treatment of involutional skin changes, a cosmetologist and a dermatologist need to understand the pathogenetic aspects of skin aging in combination with those pathogenetic changes that occur during using certain methods of aesthetic correction. The aim of this review was to combine the available information on pathogenetic changes during skin aging with the available information on the effects of the main techniques used in cosmetology. Special attention is paid to histological, cellular and molecular changes in the use of biorevitalization and collagen stimulators.

Keywords: skin aging, aesthetic medicine, rejuvenation, cosmetology, biorevitalization, collagen stimulators, hyaluronic acid, collagen.

For citation: Potekaev N.N., Borzykh O.B., Karpova E.I. et al. Pathogenetic aspects concerning the usage of the main methods in aesthetic medicine for involutional skin changes. RMJ. 2022;8:48–54.

Summary:

Reduced antibiotic use after initial treatment of acute respiratory infections with phytopharmaceuticals – a retrospective cohort study

D. Martin¹, M. Konrad², Ch.Ch. Adarkwah^3,4, K. Kostev⁵ 

¹Integrative and Anthroposophic Medicine, University of Witten/Herdecke, Witten, Germany

²Health & Social, FOM University of Applied Sciences for Economics and Management, Frankfurt Am Main, Germany

³Faculty of Life Sciences, University of Siegen, Siegen, Germany

⁴Department of General Practice, Philipps University of Marburg, Marburg, Germany

⁵Epidemiology, IQVIA, Frankfurt Am Main, Germany

Aim: we examined the relationship between the initial treatment of acute lower and upper tract respiratory infections with phytopharmaceuticals and the duration of the disease as well as between the initial treatment and the use of antibiotics in the further course of the disease.

Patients and Methods: outpatients from the IMS^® Disease Analyzer database with diagnoses of acute respiratory infections between January 2015 and March 2019 were observed for 30 days. Patients who had been prescribed phytopharmaceuticals on the day of their diagnosis were matched with controls who had not received such prescriptions by treating practice, diagnosis, age, sex, insurance status, index year, and Charlson comorbidity score. Patients antibiotic precriptions on the day of diagnosis were excluded. Logistic regression was used to investigate the relationship between phytopharmaceutical prescription, antibiotic prescription in the further course of the disease, and duration of sick leave. Data are presented as odds ratio (OR) (95% confidence interval).

Results: a total of 117,182 patients who had been prescribed phytopharmaceuticals and an equal number of controls were available for analysis. Phytotherapeutics were associated with fewer antibiotic prescriptions. Extract of Pelargonium sidoides root OR 0.49 (0.43–0.57)) and thyme extract (OR 0.62 (0.49–0.76)) exhibited the strongest effect among patients treated by general practitioners, while Pelargonium sidoides root extract (OR 0.57 (0.38–0.84)), thyme and ivy extract (OR 0.66 (0.60–-0.73)), and thyme and primrose root extract (OR 0.67 (0.47–0.96)) proved most effective in pediatric patients. Patients receiving phytopharmaceuticals had a significantly lower risk of prolonged periods of sick leave. The risk of sick leave durations of >7 days was most markedly reduced in patients taking cineole (OR 0.74 (0.63–0.86)) and Pelargonium root extract (OR 0.79 (0.54–0.96)).

Conclusion: the use of selected phytopharmaceuticals for acute respiratory infections is associated with a significantly reduced need for antibiotic prescriptions in the further course of the disease, as well as significantly shorter sick leaves.

Keywords: phytopharmaceuticals, antibiotics, acute respiratory infections, sick leave, acute infections of the upper respiratory tract, acute infections of the lower respiratory tract.

For citation: Martin D., Konrad M., Adarkwah Ch.Ch., Kostev K. Reduced antibiotic use after initial treatment of acute respiratory infections with phytopharmaceuticals – a retrospective cohort study. RMJ. 2022;8:5–11.

Summary:

Association of combinations of single-nucleotide polymorphisms in noncommunicable diseases and adverse outcomes in women with premature ovarian insufficiency

S.V. Lopukhov, E.V. Filippov 

Ryazan State Medical University, Ryazan

Aim: to identify associations between premature ovarian insufficiency (POI) of idiopathic and iatrogenic origin and a number of gene polymorphisms (Met235Thr, C807T, C786T, 455G-A, Leu59Pro, 5G(‑675)4G, G(-572)C, Lys198Asn) of noncommunicable diseases and their adverse outcomes, in women versus the control group.

Patients and Methods: 399 women were selected for the study, who were divided into three groups of 133 subjects: patients with primary POI, with secondary POI and healthy patients. The material for the study was the freshly collected venous blood. The study method was polymerase chain reaction (PCR) and agarose gel electrophoresis (EF) of PCR products.

Results: a significant difference in the relative risk and the association degree between primary (idiopathic) POI and gene polymorphisms was revealed: the AGT gene polymorphism (Met235Thr) RR=2.2, OR=7.7; the ITGA2 gene polymorphism (C807T) RR=2.0, OR=4.5; the NOS3 gene polymorphism (C786T) RR=2.1, OR=4.4; FGB gene polymorphism (455G-A) RR=2.8, OR=4.4; ITGB3 gene polymorphism (Leu59Pro) RR=3.6, OR=6; SERPINE (PAI) 1 gene polymorphism (5G(-675)4G) RR=1.7, OR=8.6; IL6 gene polymorphism (G(-572)C) RR=3.9, OR=4.3; EDN1 gene polymorphism (Lys198Asn) RR=3.8, OR=13.9. Despite that in patients with secondary (iatrogenic) POI the reference value was exceeded by 1, it ranged from <0.1 to 0.8, which, due to the limited sample, could not serve as a reliable criterion for the presence of an association between these phenomena and, as a result of an increase in the risk of their occurrence. At the same time, the study of gene polymorphisms in the control group revealed no significant population differences from their average prevalence among white Europeans.

Conclusion: female patients with primary (idiopathic) POI had a significantly (p<0.05) higher percentage in occurrence of the studied gene polymorphisms, as well as an increase in the relative risk of gene polymorphism occurrence, and the degree of their association.

Keywords: premature ovarian insufficiency, hypoestrogenism, gene polymorphisms, mutations, cardiovascular diseases.

For citation: Lopukhov S.V., Filippov E.V. et al. Association of combinations of single-nucleotide polymorphisms in noncommunicable diseases and adverse outcomes in women with premature ovarian insufficiency. RMJ. 2022;8:56–60.

Summary:

Bacterial vaginosis: modern anti-relapse treatment tactics

Yu.E. Dobrokhotova, V.D. Kazantseva, K.R. Bondarenko 

Pirogov Russian National Research Medical University, Moscow 

Bacterial vaginosis (BV) is a disorder of the vaginal microflora resulting from the replacement of normal microbiota with high concentrations of anaerobic bacteria. Taking into account the frequency of bacterial vaginosis relapses, treatment and prevention are considered an important problem of pharmacotherapy. The inefficacy of antimicrobial drugs arises from the lack of a complete understanding of the bacterial vaginosis pathogenesis, as well as the causes of its relapses, which affects the treatment efficacy. This review examines the latest data on the bacterial vaginosis pathogenesis, treatment methods, as well as possible treatment tactics to reduce disease relapses. At the moment, new tactics to improve the treatment efficacy include changing the drug dose, the duration of treatment, long-term preventive regimens and the use of agents destructing the biofilm. A number of studies have established the positive effect of using high doses of suppositories c ontaining metronidazole in combination with an antifungal agent, commonly miconazole, which is also useful for mixed, bacterial and fungal vaginal infections. It is likely that in the future, for the purpose of treatment efficacy, therapy will include the simultaneous use of several components, including combinations of antibiotics, antibiotic agents and probiotics.

Keywords: bacterial vaginosis, vaginal microflora, biofilms, treatment, relapse, metronidazole, miconazole, suppositories.

For citation: Dobrokhotova Yu.E., Kazantseva V.D., Bondarenko K.R. Bacterial vaginosis: modern anti-relapse treatment tactics. RMJ. 2022;8:61–65.

Summary:

Neuropsychiatric developmental disorders in children with attention deficit hyperactivity syndrome: clinical cases

D.D. Guynetdinova¹, A.P. Skoromets², E.Yu. Kryukov^3,4 

¹Kazan State Medical University, Kazan

²I.P. Pavlov First St. Petersburg State Medical University, St. Petersburg

³I.I. Mechnikov North-Western State Medical University, St. Petersburg

⁴Children’s City Hospital No.1, St. Petersburg 

The prevalence of attention-deficit hyperactivity disorder (ADHD) in Russia is as high as 16% and therefore it is considered a major social problem. In 50% of patients with ADHD occurring in childhood, the condition continues in adulthood, though its symptoms change over time as a person ages. ADHD is linked to the delayed maturation of functionally connected brain structures regulating the process of behavioral management and self-control. Nootropics and neurometabolic drugs have been traditionally used in the RF for ADHD treatment. So far, the issues relating to the efficacy and tolerability of these groups of drugs remain disputable. Taking into considerations the disadvantages of the available dugs used for the treatment of childhood ADHD, it is necessary to propose novel effective and well-tolerable treatment options. The drug Prospekta is one of the next- generation nootropics. It modifies the functional activity of brain-specific S-100 protein and regulates the interaction of ligands with serotonin, dopamine, and γ-aminobutyric acid (GABA) receptors, ensuring the realization of nootropic action of the drug. The article presents clinical cases of successful ADHD treatment, demonstrating the efficacy and safety of using the drug Prospekta in children. Even during the first month of therapy, a significant improvement of memory and attention concentration were reported in all the described clinical cases. The drug had a beneficial impact on the children’s school performance, while their restlessness, distraction and hyperactivity decreased.

Keywords: attention-deficit hyperactivity disorder, children, neuropsychiatric development, brain-specific S-100 protein, GABA, nootropic.

For citation: Guynetdinova D.D., Skoromets A.P., Kryukov E.Yu. Neuropsychiatric developmental disorders in children with attention deficit hyperactivity syndrome: clinical cases. RMJ. 2022;8:66–71.

Summary:

L.N. Kostyuchenko, T.A. Vasina, G.S. Mikhaylyants, A.E. Lychkova A.S. Loginov 

Moscow Clinical Research Center, Moscow 

Aim: to evaluate the possibilities of metabolic correction after extensive intestinal resections.

Patients and Methods: the study included 96 patients (47 men and 49 women) with combined extensive small bowel resection with right hemicolectomy. Metabolic condition was assessed in all patients with the help of alimentary and volitive diagnosis. The assessment of metabolic shifts was conducted according to plasma parameters and bioelectrical impedance analysis of body composition. Reparative processes were confirmed by morphological data and the results of Cathepsin L determination in serum by enzyme immunoassay.

Results: when registering electrical activity in the anastomosis zone, it was noted that the electric wave from the areas lying above the resection site "jumped" to the areas below the anastomosis site, without changing its amplitude-frequency characteristics. There was a little recovery of epithelial cells and their functions in 65–90% of patients in the long-term period (depending on the resection volume and level). In terms of up to 2 years, there were transient dyspeptic disorders, reduced working capacity, metabolic complications, whereas, in terms of more than 2 years — minor morphologically confirmed adaptations, weight stabilization. These symptoms correlated with the residual limb volume. The clinical and biochemical blood parameters were comparable with the integral characteristics reflecting the metabolic condition. Thus, 41% of patients needed metabolic correction in the group with resection less than 4 m and right hemic olectomy within less than 2 years after surgery (according to the NRS-2002 scale), and in the later period (over 2 years) — only 7%, due to the adaptive mechanisms of the digestive system. And in the group with resection of more than 4 m and right hemicolectomy, the number of patients requiring metabolic correction was significantly higher.

Conclusion: to stimulate adaptive and regenerative processes in the intestine in the structure of nutritional regimens, it is advisable to use teduglutide (GLP-2 analog). In case of inefficiency, surgical correction may be recommended.

Keywords: metabolic correction, intestinal resection, short bowel syndrome, postcolectomy syndrome, consequences of combined small bowel resections.

For citation: Kostyuchenko L.N., Vasina T.A., Mikhaylyants G.S., Lychkova A.E. Nutritional correction after extensive combined intestinal resections. RMJ. 2022;7:–21.

Summary:

Etiology of the surgical site infection after open-heart surgery: single-center ten-year follow-up

A.V. Stepin 

Ural Institute of Cardiology, Yekaterinburg 

Background: surgical site infection (SSI) is a serious complication after cardiac surgery. The study of the structure and resistance of microorganisms plays an important role in the context of a multifactorial analysis of the SSI etiology for further prevention and treatment of nosocomial infections.

Aim: to assess the prevalence of SSIs, species composition and antibiotic resistance of wound microbiology after an open-heart surgery for the period from 2010 to 2019.

Patients and Methods: a retrospective descriptive study was performed, the subject of which was the prevalence and etiology of SSI after the open-heart surgery for the period from 2010 to 2019, including the structure and resistance of isolated microorganisms. The study based on the Ural Institute of Cardiology.

Results: the prevalence of SSIs during the study period was 4.5%. A total of 42 (0.9%) cases of deep wound infection and 178 (3.6%) cases of superficial infection were registered. The main pathogens identified in SSIs were staphylococci (19.5%). Coagulase-negative staphylococci dominated among them, isolated in 15.9% of cases (35 cultures). Antibiotic resistance was detected in 34% of all positive cultures. Methicillin-resistant S. epidermidis (13 cultures) were sensitive to ceftaroline, daptomycin, vancomycin, linezolid, tigecycline. Extended-spectrum beta-lactamases in 6 cases were represented by E. coli, in 2 cases by E. cloacae and were sensitive to imipenem, tigecycline, ceftazidime + [avibactam], cefepime.

Conclusion: coagulase-negative staphylococci are the most commonly isolated microorganisms in the development of SSI. The existing antibiotic prophylaxis regimens remain relevant despite the existence of resistant flora. The first-line drugs for the treatment of infection caused by gram-positive flora are vancomycin, ceftaroline, daptomycin, linezolid, and gram-negative — imipenem, tigecycline, ceftazidim + [avibactam], cefepim.

Keywords: nosocomial infection, surgical site infection, cardiac surgery, antibiotic resistance, retrospective study.

For citation: Stepin A.V. Etiology of the surgical site infection after open-heart surgery: single-center ten-year follow-up. RMJ. 2022;7:–6.

Summary:

Comparative evaluation concerning the efficacy and safety of the use of mineral-vegetable complex Rotaprost in comprehensive therapy for patients with chronic bacterial and abacterial prostatitis

A.S. Al-Shukri, A.V. Maximova 

I.P. Pavlov First St. Petersburg State Medical University, St. Petersburg Background: at present, the attention of urologists to chronic prostatitis is kept up without any reduction. The complexity of this disease pathogenesis requires an integrated approach to diagnosis and treatment.

Aim: to evaluate the efficacy of the mineral-vegetable complex in the comprehensive therapy of chronic bacterial (CBP) and abacterial (CAP) prostatitis.

Patients and Methods: a single-center prospective study included 60 male patients aged 20 to 55 years (mean age 38.2 years) with a confirmed diagnosis of CBP and pathozoospermia (group I), as well as 72 male patients aged 20 to 55 years (mean age 41.5 years) with a diagnosis of CAP / chronic pelvic pain syndrome and pathozoospermia (group II). In all cases, the diagnosis was established for the first time. Depending on the received therapy, the patients were divided into 4 subgroups: in subgroups IA and IIA, patients received standard therapy (ciprofloxacin and rectal suppositories with regulatory peptides, respectively), supplemented with the intake of a mineral-vegetable complex Rotaprost; in subgroups IB and IIB — only standard therapy. The course duration of treatment was 4 weeks. All patients filled in NIH-CPSI, I-PSS, QoL and IIEF-5 questionnaires. Besides, spermogram, ROS-test and MAR-test, Doppler ultrasound of prostate vessels, and uroflowmetry were performed to determine the peak urine flow rate. The studies were conducted at the stage of inclusion and 4 weeks afte r the therapy initiation.

Results: statistically significant positive dynamics was noted for all the studied indicators in the subgroups of complex treatment versus the indicators both before treatment and in the corresponding subgroups of monotherapy.

Conclusion: complex therapy of patients with newly diagnosed CBP and CAP using a mineral-vegetable complex provides a more significant effect versus the monotherapy. At the same time, a decrease in the severity of the disease symptoms contributes to improving the life quality of male patients with CP.

Keywords: chronic prostatitis, antisperm antibodies, oxidative stress, uroflowmetry, life quality.

For citation: Al-Shukri A.S., Maximova A.V. Comparative evaluation concerning the efficacy and safety of the use of mineral-vegetable complex Rotaprost in comprehensive therapy for patients with chronic bacterial and abacterial prostatitis. RMJ. 2022;7:22–27.

Summary:

The effect of systemic ischemia-reperfusion injury on the level of gluco- and mineralocorticoid receptors of the kidneys

L.A. Balykova¹, G.A. Bayburina², T.V. Tarasova¹, L.M. Mosina¹, A.G. Stachuk³, D.A. Khaidar³, D.E. Bayburina², N.V. Karaseva³, R.S. Tarasov^{1 1}Ogarev Mordovia State University, Saransk

²Bashkir State Medical University, Ufa

³Russian University of Peoples’ Friendship, Moscow 

Background: sudden blood flow disturbance through the renal artery causes ischemic organ damage. Such changes in blood flow can occur when the systemic blood supply is disrupted. During the ischemia elimination and restoration of renal blood flow, reperfusion is restored. Upon this period, there is a nonspecific alteration of physiological and biochemical processes both in the organ itself and in the body as a whole. The kidney is restored under the action of coriticosteroid hormones.

Aim: to identify the effect of systemic ischemia-reperfusion injury on the level of gluco- and mineralocorticoid receptors of the kidneys.

Materials and Methods: 80 male white rats were included in the study. All animals were divided into two groups: the main group (n=70; 10 rats for each follow-up stage) and the control group (n=10). In the main study group, we created a model of systemic ischemia-reperfusion injury. In all animals, we determined the level of serum glucocorticoids and mineralocorticoids. We also examined the number of gluco- and mineralocorticoid receptors in the kidneys. Follow-up of animals was conducted on 1, 3, 5, 7, 14, 21 and 35 days.

Results: on the first day of follow-up, the main group had a sharp jump in the content of serum gluco- and mineracorticoids in response to systemic kidney disease. By the third day, the level of these hormones dropped sharply and did not recover to its baseline values for 30 days. The number of receptors for these hormones in the kidney was the lowest also on the third day (p<0.05). The tendency of corticosteroid receptor recovery was 3 times faster versus mineralocorticoid receptors.

Conclusion: ischemia-reperfusion injury of the kidney occurs with a sharp release of gluco- and mineracorticoids after the systemic circulation stops. The level of corticosteroid receptors in the kidneys of rats approaches the baseline values closer to the 30^th day and is due to the recovery time after ischemia-reperfusion injury, which ensures the tolerance of the subject to hypoxia.

Keywords: corticosteroids, glucocorticoid receptors, mineralocorticoid receptors, ischemia-reperfusion injury, kidney disease.

For citation: Balykova L.A., Bayburina G.A., Tarasova T.V. et al. The effect of systemic ischemia-reperfusion injury on the level of gluco- and mineralocorticoid receptors of the kidneys. RMJ. 2022;7:28–31.

Summary:

Issues of surgical treatment of acute biliary pancreatitis

Z.E. Eldarova¹, I.A. Kaprin¹, A.G. Mylnikov², V.P. Glabai¹ 

¹I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

²V.V. Vinogradov City Clinical Hospital, Moscow 

The article presents a review of national and foreign literature on the diagnosis and treatment of patients with acute pancreatitis with an assessment and systematization of the existing surgical treatment in acute biliary pancreatitis (ABP). The review of the special literature conducted by the authors was aimed at highlighting modern approaches to the management of patients with ABP. It is noted that biliary etiology is one of the most common in the structure of acute pancreatitis, and, therefore, the task of finding optimal methods for the treatment of ABP is of particular relevance. Various hypotheses of the ABP pathogenesis are discussed. At present, numerous studies have confirmed the efficacy and safety of an early cholecystectomy in mild ABP, however, the problem of optimizing surgical treatment tactics in moderate and severe cases of this disease requires further careful study. According to the authors, much depends on an adequate assessment of the role of endoscopic retrograde cholangiopancreatography with endoscopic papillosphincterotomy in the treatment of severe ABP, depending on the concomitant damage to the bile ducts, as well as the cholecystectomy implementation date.

Keywords: surgery, acute pancreatitis, acute biliary pancreatitis, endoscopic papillosphincterotomy, endoscopic retrograde cholangiopancreatography, infected pancreatic necrosis, surgical aids.

For citation: Eldarova Z.E., Kaprin I.A., Mylnikov A.G., Glabai V.P. Issues of surgical treatment of acute biliary pancreatitis. RMJ. 2022;7:–35.

Summary:

Case history of a systemic pyrimidine derivative in the complex therapy of trophic ulcers of the lower extremities

K.S. Petrova¹, S.V. Nemirova¹, A.A. Karpenko¹, E.V. Proydakova², N.K. Schennikova¹ 

¹Volga Research Medical University, Nizhny Novgorod

²Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod 

Trophic disturbances are a common companion of many diseases and can occur due to the pathology of the microcirculatory bed, neural regulation patterns, hypoxia, inflammatory process, organ failure, as well as metabolic disorders and malignant tissue degeneration. In the treatment of trophic ulcers, both methods aimed at eliminating the main etiological factor and removing non-viable tissues are used, as well as means that prevent the development of complications and improve tissue regeneration. The work was performed at the clinical bases of the Volga Research Medical University. Clinical examples of complex therapy aimed at persistent trophic defects of two diabetic patients with more than 5 years of disease course and one patient with pyoderma gangrenosum are presented in a pilot study. In all cases, during the prescription of the pyrimidine series of hydroxyethyl-dimethyl-dihydropyrimidine in the complex therapy (in tablets, 250 mg), a distinct positive tendency was recorded in t he form of a decrease in the inflammatory process, closure of the ulcerative defect, and epithelialization. Polyetiological ulcers can persist for a long time even during the multicomponent therapy with probability of progression. The preparation of hydroxyethyl-dimethyl-dihydropyrimidine has a complex effect that allows achieving a better clinical effect by the treatment of the inflammatory process, improving microcirculation and stimulating tissue regeneration, regardless of the ulcerative defect etiology and a combination of drugs used concomitantly. Given the drug mechanism of action, it can be recommended for use by specialists of various profiles.

Keywords: trophic ulcers, ulcerative defect, hydroxyethyl-dimethyl-dihydropyrimidine, pyrimidine derivative, trophic disturbances, tissue regeneration.

For citation: Petrova K.S., Nemirova S.V., Karpenko A.A. et al. Case history of a systemic pyrimidine derivative in the complex therapy of trophic ulcers of the lower extremities. RMJ. 2022;7:36–41.

Summary:

Principle of Occam’s razor in differential diagnosis. A series of clinical cases

E.V. Kulchavenya^1–3, D.P. Kholtobin^1,3, E.M. Zhukova¹ 

¹Novosibirsk Research Institute of Tuberculosis, Novosibirsk

²Novosibirsk State Medical University, Novosibirsk

³AVICENNA Medical Center, Novosibirsk 

Genitourinary tuberculosis (GUTB) over the past 14 years has fallen from the first position in the structure of the extrapulmonary tuberculosis prevalance to the second. This led to the formation of a misperception about the relevance loss concerning GUTB, but it does not correspond to reality. In recent years, several diseases have been diagnosed more and more commonly in one patient, showing mutually aggravating effect of concomitant pathologies.

The article provides the following several clinical cases. Patient A., female, 48 years old, complained of pain in the right kidney and frequent urination. Urolithiasis and secondary pyelonephritis was diagnosed 25 years ago. Tuberculosis was suspected only in the microcystis manifestation. Patient G., male, 54 years old, had cavernous pulmonary tuberculosis. The penile ulcer was initially regarded as tuberculosis of the penis. The lack of effect from antitubercular therapy prompted to perform a marginal biopsy, histologically confirmed cancer. Patient T., male, 33 years old, diagnosed with tuberculosis of the respiratory organs and the mass in the left kidney, which was also initially attributed to the role of tuberculosis. During antitubercular chemotherapy, nephrectomy was performed, and kidney cancer was histologically detected.

GUTB has no pathognomonic symptoms. Clinical picture and laboratory manifestations, along with the high oncological vigilance, can make think about cancer first. Nonspecific infections of the genitourinary system and malignant tumors can precede tuberculosis, accompany it or develop after the tuberculosis treatment. Besides, multimorbidity makes it difficult to diagnose GUTB in a timely manner.

Keywords: genitourinary tuberculosis, kidney cancer, penile cancer, urolithiasis, diagnosis.

For citation: Kulchavenya E.V., Kholtobin D.P., Zhukova E.M. Principle of Occam’s razor in differential diagnosis. A series of clinical cases. RMJ. 2022;7:42–45.

Summary:

On the efficacy of the parenteral form of highly purified chondroitin sulfate in the mode of perioperative preparation for total knee arthroplasty

I.V. Sarvilina¹, T.B. Minasov², A.M. Lila^3,4, O.A. Gromova⁵, A.G. Nazarenko⁶, N.V. Zagorodniy^6,7 

¹Medical Center "Novomedicina" LLC, Rostov-on-Don

²Bashkir State Medical University, Ufa

³V.A. Nasonova Research Institute of Rheumatology, Moscow

⁴Russian Medical Academy of Continuous Professional Education, Moscow

⁵Federal Research Center "Informatics and Management" of the Russian Academy of Science, Moscow

⁶N.N. Priorov National Medical Research Center for Trauma and Orthopedics, Moscow

⁷Russian University of Peoples’ Friendship, Moscow 

Aim: to evaluate the efficacy and safety of an optimized therapy regimen with highly purified chondroitin sulfate (CS) in parenteral form in patients with decompensated knee osteoarthritis (OA) under conditions of total knee arthroplasty (TKA) based on clinical phenotyping and laboratory endotyping.

Patients and Methods: an open prospective controlled randomized study included 67 patients, 43 of them women, aged 41 to 73 years with Kellgren—Lawrence grade III knee OA and grade II functional joint disability, with the absence of any joint diseases before the manifestation of knee OA in two groups: control group (CG; n=35) and main group (MG; n=32). All patients received NSAIDs (celecoxib, diclofenac, meloxicam) at the standard daily dose when included in the study. MG received a parenteral form of CS, a course of 25 injections lasting 50 days 2 months before the TKA. Initially, upon discharge from the hospital and 3 months after the TKA, pain intensity was assessed by VAS, KOOS, WOMAC index, knee joint functional state and activity of the patient in daily and sports life (WOMAC, Leken’s indices), knee radiography, knee MRI with assessment of articular cartilage according to the ICRS and T2-relaxation time. A morphologica l study of the biospecimens of the subchondral bone, articular cartilage of the femur and tibia, and the articular capsule was performed. The content of hyaluronic acid, ultra-sensitive CRP, TNF-α, IL-6, leptin, adipsin, PIIANP, CTX-1, osteocalcin, MMP-3 and -13, COMP, sclerostin, 25(OH)D₃ was determined in the blood.

Results: anti-inflammatory, analgesic and long-term structural-modifying (cartilage tissue, subchondral bone) effects of parenteral form of СS have been demonstrated. There was a significant decrease in the pain severity according to VAS at rest and during walk, KOOS, the WOMAC index; a decrease in the level of functional knee disability according to the WOMAC and Leken’s indices; preservation of T2-relaxation time on MRI; a significant decrease in the level of all biomarkers in the blood with an increase in the concentrations of osteocalcin and 25(OH)D₃ upon discharge from the hospital and 3 months after TKA, in contrast to the patients of CG who took only NSAIDs. Besides, the MG revealed signs of stress shielding in all layers of hyaline cartilage and a decrease in the inflammation severity in the synovial membrane at the time of the TKA, whereas in CG in hyaline cartilage there was an increase in the content of dystrophically altered chondrocytes, loosely located granular component (proteoglycans), individual thin collagen fibrils and high-level exudative inflammation in synovial membrane.

Conclusion: the data obtained allow to recommend the use of the parenteral form of CS in the established effective and safe mode 2 months before the TKA to improve the immediate and long-term functional results of surgical intervention.

Keywords: osteoarthritis, biomarkers, hyaline cartilage, synovial membrane, morphology, chondroitin sulfate, arthroplasty.

For citation: Sarvilina I.V., Minasov T.B., Lila A.M. et al. On the efficacy of the parenteral form of highly purified chondroitin sulfate in the mode of perioperative preparation for total knee arthroplasty. RMJ. 2022;7:7–16.

Summary:

The level of the N-terminal fragment of probrain natriuretic peptide as a new marker of gout severity

E.V. Schemeleva, E.A. Skorodumova, L.P. Pivovarova, O.B. Ariskina St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg

Aim: to evaluate the association of the N-terminal fragment of probrain natriuretic peptide (NT-proBNP) concentration level with the gout course and its comorbid conditions.

Patients and Methods: 55 patients with gout were examined as part of an observational single-center cohort study. The disease duration and progression were evaluated: the gout attack frequency during the last 12 months, the presence / absence of tophi. Anamnesis, concomitant pathology, and anthropometric data were studied. The levels of uric acid, creatinine in the blood, and glomerular filtration rate were calculated using the CKD-EPI equation. According to the results of the evaluation of NT-proBNP level, all patients were divided into 2 groups: group 1 (n=27) with normal levels of NT-proBNP (34.2±10.0 pg/mL), and group 2 (n=28) with elevated levels of NT-proBNP (1157.4±186.9 pg/mL). The groups were compared according to the estimated parameters.

Results: the average disease duration in group 2 was significantly higher (p=0.013) than in group 1: 10.6±1.7 years vs. 5.4±1.0 years. Adding that, there were more patients with tophaceous gout (60.7% and 11.1%, respectively, p<0.01) and more common disease exacerbations in the group 2: 38.4% of patients had 10 or more attacks per year, while in the group 1 52.1% of patients recorded from 1 up to 3 attacks in the same period. In general, comorbidity in group 2 was higher: more commonly (p<0.05) there was a history of coronary heart disease, myocardial infarction and atrial fibrillation. The average level of serum uric acid did not significantly differ in the two groups (p=0.714). At the same time, significant differences were revealed in the average creatinine level and glomerular filtration rate, which was lower (p=0.042) in group 2.

Conclusion: patients with gout and high level of NT-proBNP are generally characterized by a more severe disease course. In such patients, comorbidity is higher and kidney disease is more significant, which can also aggravate the course of gouty arthritis. A high level of NT-proBNP can be considered as a potential marker of an adverse gout course.

Keywords: gout, NT-proBNP, uric acid, comorbidity, gout severity marker.

For citation: Schemeleva E.V., Skorodumova E.A., Pivovarova L.P., Ariskina O.B. The level of the N-terminal fragment of probrain natriuretic peptide as a new marker of gout severity. RMJ. 2022;6:12–16.

Summary:

Open 6-month study on the efficacy of dose titration of allopurinol in patients with gout as part of the "treat to target" strategy

M.S. Eliseev, M.N. Chikina, O.V. Zhelyabina V.A. Nasonova Research Institute of Rheumatology, Moscow 

Aim: to determine the probability of achieving the target serum urate (SU) level in patients with gout when the allopurinol dose is escalated as part of the "treat to target" strategy.

Patients and Methods: the study included patients over 18 years old with a diagnosis of gout (n=78) and SU level >360 µmol/L, who do not use urate-lowering agents and have no contraindications to allopurinol intake. Allopurinol was prescribed to every patient at an initial dose of 100 mg/day, followed by an increase in the dose every 2–3 weeks per 100 mg/day until the target SU level is reached (<300 µmol/L in patients with tophaceous gout (n=33) and <360 µmol/L in other patients (n=45)). The maximum dose of allopurinol was 900 mg/day. In patients with an estimated glomerular filtration rate (eGFR) of 30–59 ml/min /1,73m² (n=9) — 300 mg/day. Laboratory tests included the determination of the level of SU, ALT, AST and creatinine at each visit. The GFR was calculated using the CKD-EPI equation. The primary endpoint was the achievement of the target SU level, the secondary endpoint was the therapy efficacy after 6 months fr om the study initiation and the effect of allopurinol therapy on indicators reflecting kidney and liver functions.

Results: during allopurinol dose titration, the target SU level was achieved in 67 (86%) patients. The study was completed by 71 patients, of whom 52 (73%) had SU levels remaining within the established standard values at the time of the final visit (after 6 months). In the 15 (22%) patients who reached the target SU level during the dose titration, the SU level exceeded the target values at the final visit. In 5 (56%) patients with eGFR within 30–60 mL/min/ 1,73 m² by the end of the study, the SU level corresponded to the target, in 6 (67%) patients there was an increase in eGFR to >60 mL/min/1,73 m². The average creatinine level in 71 patients after the end of the study decreased from 89.1±18.8 µmol/L to 83.4±15.5 µmol/L. Serum levels of AST and ALT did not reach twice the upper lim it of the norm in any patient, regardless of the allopurinol dose. In 3 cases, allopurinol was canceled: in 2 patients due to an allergic reaction (at the allopurinol dose of 100 and 300 mg/day) and in 1 patient due to a decrease in eGFR <30 mL/ min/1.73 m² (at the allopurinol dose 200 mg/day).

Conclusion: gradual dose escalation of allopurinol allows to achieve the target SU level in 86% of patients with gout. In 22%, the effect escapes, which determines the need for the follow-up of SU levels in patients with the achieved target SU level. The probability of allopurinol withdrawal due to the adverse events is low and does not depend on the drug dose.

Keywords: gout, uric acid, allopurinol, target level, titration, chronic kidney disease.

For citation: Eliseev M.S., Chikina M.N., Zhelyabina O.V. Open 6-month study on the efficacy of dose titration of allopurinol in patients with gout as part of the «treat to target» strategy. RMJ. 2022;6:17–22.

Summary:

Possibilities of chondroprotective therapy of osteoarthritis in terms of preserving kidney function

L.N. Eliseeva¹, S.V. Kartashova², O.I. Zhdamarova¹, N.Yu. Tikhomirova¹, A.Yu. Blednova^{1 1}Kuban State Medical University, Krasnodar

²Research Institute of the Regional Clinical Hospital No. 1, Krasnodar 

Aim: to analyze the patterns of changes in the renal filtration function in patients with pain syndrome during knee osteoarthritis (OA) using therapeutic and surgical methods for pain management.

Patients and Methods: the study included 193 patients with Kellgren–Lawrence grade II-IV knee OA (mean age 61.23±6.64 years) with clinically significant joint pain syndrome (6 or more points according to VAS) and comorbid conditions, which were divided into 4 groups depending on the treatment: endoprosthetic replacement, arthroscopy, NSAIDs intake or injection therapy courses with chondroitin sulfate. The comparison group consisted of patients with hypertension without joint pathology receiving standard antihypertensive therapy. The creatinine level and estimated glomerular filtration rate (eGFR) were retrospectively and prospectively determined in the beginning and in the end (after 1.5–2.5 years) of the study. eGFR trend was evaluated based on 1 month. Besides, the need for NSAIDs intake was assessed.

Results: multidirectional changes in eGFR were established with a tendency to decrease in the majority of patients taking NSAIDs as analgesics. At the same time, the pain relief through surgical intervention, even with a temporary withdraw to take NSAIDs or by repeated courses of therapy using the parenteral form of chondroitin sulfate, prevents a decrease in eGFR or restores it to normal values in most patients.

Conclusion: determination of the eGFR trend calculated for 1 month allows to unify the control indicator during the follow-up of patients in real clinical practice. Dynamic evaluation of eGFR can be considered as an effective way to control the safety of analgesic therapy in pain forms of OA.

Keywords: knee osteoarthritis, glomerular filtration rate, chondroitin sulfate, endoprosthetics, nonsteroidal anti-inflammatory drug.

For citation: Eliseeva L.N., Kartashova S.V., Zhdamarova O.I. et al. Possibilities of chondroprotective therapy of osteoarthritis in terms of preserving kidney function. RMJ. 2022;6:24–29.

Summary:

Interferon-α and patterns of systemic lupus erythematosus in patients with juvenile and adult disease onset

D.B. Aliyev¹, I.Z. Gaуdukova^{1,2 1}Clinical Rheumatological Hospital No. 25, St. Petersburg

²I.I. Mechnikov North-Western State Medical University, St. Petersburg 

Background: systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease of unknown etiology, characterized by hyperproduction of organ-specific autoantibodies to various structures of the cell nucleus with the development of inflammation-mediated immune cell alterations to tissues and internal organs. Interferon (IFN) plays an important role in the pathogenesis of SLE (IFN-α and IFN-β), the significance of which is being clarified in various clinical subtypes of SLE.

Aim: to assess the level of IFN-α and its association with the clinical and immunological patterns of SLE in adult patients with the disease onset in juvenile age (juvenile SLE, jSLE) and adulthood (adult SLE, aSLE).

Patients and Methods: the study was defined as non-interventional — the researchers did not change the treatment prescribed to patients by the attending physician. The study included 51 (57%) patients with jSLE and 32 (43%) patients with aSLE. The disease activity was assessed at the time of examination by calculating the SLEDAI-2K. The SLICC/ACR DI (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) was used to characterize the course and outcomes of SLE. Determination of the serum IFN-α level was carried out by enzyme immunoassay.

Results: the serum IFN-α level was higher in aSLE versus the value of jSLE: 16.19±16.4 pg/mL and 7.83±7.93 pg/mL, respectively (p=0.0006). In patients with IFN-α ≥ 20 pg/mL, SLE debuted significantly later in comparison with patients with normal IFN-α values: at 26.5±9.1 years and 19.9±10.73 years, respectively, p=0.02. Despite lower IFN-α level in jSLE, there were more exacerbations, as well as more non-biologic immunosuppressive therapy was prescribed (88% vs. 67.5%, p=0.01) and genetic-engineering biological therapy with rituximab (21.6% vs 2.6%, p=0.01) than in aSLE. There were severe exacerbations, which required high doses of glucocorticosteroids (GCS), and a more recurrent occurrence of panniculitis in patients with aSLE during an increased IFN-α level.

Conclusions: the IFN-α level in patients with aSLE exceeded the IFN-α level in patients with jSLE. An increased IFN-α level was associated with a late onset of SLE and a greater incidence of panniculitis. In the treatment of bio-naive active patients with aSLE onset, a high IFN-α level was associated with an increased need for GCS in each of the exacerbations, but not with an increase in the number of disease exacerbations.

Keywords: juvenile systemic lupus erythematosus, systemic lupus erythematosus, interferon, SLE, panniculitis, genetic-engineering biological therapy.

For citation: Aliyev D.B., Gaуdukova I.Z. Interferon-α and patterns of systemic lupus erythematosus in patients with juvenile and adult disease onset. RMJ. 2022;6:3–6.

Summary:

Analysis of adverse events when using genetically engineered biological drugs and targeted synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis

E.N. Koltsova¹, G.V. Lukina^1,2, E.I. Schmidt³, K.A. Lytkina⁴, E.V. Zhilyaev^{5,6,7 1}A.S. Loginov Moscow Clinical Research Center, Moscow

²V.A. Nasonova Research Institute of Rheumatology, Moscow

³City Clinical Hospital No. 1 named after N.I. Pirogov, Moscow

⁴City Clinical Hospital No. 4, Moscow

⁵European Medical Center, Moscow

⁶Russian Medical Academy of Continuous Professional Education, Moscow

⁷Pirogov Russian National Research Medical University, Moscow

Background: due to the expansion of the use of genetically engineered biological drugs (GEBDs) and targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs) in rheumatology and, in particular, in the treatment of rheumatoid arthritis (RA), the study of adverse events associated with their use in real clinical practice becomes an urgent task. The association between the used drugs and their side effects is also of interests.

Aim: to describe and analyze the adverse events observed in patients with RA during the treatment with GEBDs and tsDMARDs in real clinical practice.

Patients and Methods: the study included patients with RA from the Moscow Unified Arthritis Registry (MUAR) receiving treatment with biological drugs or tofacitinib. All patients met the EULAR/ACR (2010) criteria for RA. At each visit, the patient filled in questionnaires about significant medical events that had occurred since the previous visit, as well as about changes in drug therapy and non-drug medical interventions.

Results: the analysis included 1217 therapeutic events in 661 patients. The mean age of patients was 58.7±12.9 years. The average follow–up period was 5.3 years. 537 (81.2%) patients were seropositive. 8 GEBDs (adalimumab, etanercept, certolizumab pegol, infliximab, abatacept, tocilizumab, rituximab, golimumab) and tsDMARDs (tofacitinib) were used in the treatment. The most frequently detected side effects were infectious diseases, namely acute respiratory infections. Among serious infectious diseases were: abscess — 2 cases (0.60%), erysipelas — 1 case (0.30%), phlegmon — 2 cases (0.60%), and pneumonia — 9 (2.70%). The main adverse events that caused the drug withdrawal were infectious diseases, allergic reactions, drug-induced hepatitis, significant changes in blood parameters, stomatitis and etc.

Conclusion: the analysis shows that the side effects associated with GEBDs and tsDMARDs are a clinically significant problem. Infectious diseases remain the most serious and frequent among these adverse events.

Keywords: rheumatoid arthritis, genetically engineered biological drugs, selective immunosuppressants, biological therapy, adverse events, infectious complications.

For citation: Koltsova E.N., Lukina G.V., Schmidt E.I. et al. Analysis of adverse events when using genetically engineered biological drugs and targeted synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis. RMJ. 2022;6:30–35.

Summary:

Hyperinterferonemia in rheumatic diseases as a protection factor against viral infections

V.V. Vakhlevsky, V.V. Tyrenko, I.S. Svintsitskaya S.M. Kirov Military Medical Academy, St. Petersburg

The role of hyperinterferonemia in the pathogenesis of rheumatic diseases (RD) has been proven in many studies. However, to date there are no studies demonstrating the sanogenetic role of hyperinterferonemia as an antiviral protection factor in patients with RD. In this article, the authors consider the protective role of hyperinterferonemia in patients with RD in viral infections. Nowadays, in a number of large-scale studies organized by the Global Rheumatology Alliance (GRA) and the European Alliance of Associations for Rheumatology (EALAR), only the influence of certain factors and various medications on the course of a new coronavirus infection in patients with RD is stated with no explanations for the reasons for such an influence. This circumstance was the impetus for our study of the interferons (IFN) level as a factor of antiviral protection in patients with RD and the effect of anti-rheumatic drugs on the IFN level. The authors present and discuss th e preliminary results of their research, in which it was shown that the inhibition of IFN production in various anti-rheumatic drugs differs significantly.

Keywords: COVID-19, autoimmune diseases, interferon, cytokines, anti-rheumatic drugs, rheumatic diseases, viruses.

For citation: Vakhlevsky V.V., Tyrenko V.V., Svintsitskaya I.S. Hyperinterferonemia in rheumatic diseases as a protection factor against viral infections. RMJ. 2022;6:36–41.

Summary:

Articular syndrome in clinical practice

R.R. Akhunova, G.R. Akhunova Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education, Kazan 

Articular syndrome is a clinical set of symptoms, expressed by joint pain, morning stiffness, joint deformity, mobility restriction, and pathological changes in the ligaments. The most important diagnosis components for the disease underlying the patient’s existing articular syndrome are: a properly collected anamnesis, a medical examination, a complex of laboratory tests and radiation imaging methods. The article aims at helping the doctor in the early diagnosis of joint disease underlying the patient’s existing articular syndrome. The article also discusses the main elements of the articular syndrome, highlights the characteristic symptoms and key manifestations of common rheumatic diseases, based on the articular syndrome, and presents modern methods for the diagnosis of this syndrome. Timely assessment of the articular syndrome contributes to the formation of an appropriate program comprising laboratory and instrumental research methods for patients, allows to suspect rheumatic disease at an earlier stage and promptly refer patients to a rheumatologist. In turn, timely diagnosis of rheumatic disease and early indication of basic therapy by a rheumatologist to patients with articular syndrome will improve the life quality and prognosis of such patients.

Keywords: rheumatic diseases, articular syndrome, diagnostics, radiography, ultrasound, magnetic resonance imaging.

For citation: Akhunova R.R., Akhunova G.R. Articular syndrome in clinical practice. RMJ. 2022;6:42–45.

Summary:

A.A. Klimenko, A.A. Kondrashov 

Pirogov Russian National Research Medical University, Moscow 

Osteoarthritis (OA) is the most common joint disease and cause of limited physical activity and decreased life quality in adult patients. There is a tendency of the "age rejuvenation" of the OA onset. The disease can affect almost any joint and is characterized by pathological changes in cartilage, subchondral bone, synovial membrane, ligaments, muscles and periarticular adipose tissue, which causes the development of the main set of disease symptoms. Patients with OA have more comorbidities and are sedentary versus those without OA. A decrease in physical activity leads to an increase in mortality. The basis of OA treatment includes physical exercises, weight loss in combination with the use of basic OA therapy, the choice of which is based on the phenotype of the disease and comorbid conditions. The review is devoted to the basic OA therapy, in particular with symptomatic slow-acting drugs in osteoarthritis (SYSADOA). Diacerein is one of the drugs of the SY SADOA group that has not only a symptom- and structurally-modifying effect but also a good safety profile in patients with cardiovascular diseases, type 2 diabetes mellitus and metabolic syndrome. It is confirmed by a large number of clinical research results.

Keywords: osteoarthritis, comorbidity, symptomatic slow-acting drugs, nonsteroidal anti-inflammatory drugs, diacerein.

For citation: Klimenko A.A., Kondrashov A.A. Osteoarthritis: basic therapy peculiarities. RMJ. 2022;6:46–50.

Summary:

The contribution of micronutrients and vitamin C to the combination of glucosamine and chondroitin ensuring joint health in osteoarthritis

I.S. Dydykina¹, P.S. Kovalenko¹, A.A. Kovalenko², A.V. Aboleshina^{1 1}V.A. Nasonova Research Institute of Rheumatology, Moscow

²I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 

The article presents modern data on the biological role and clinical significance of glucosamine, chondroitin sulfate, vitamin C, methylsulfonylmethane and essential micronutrients in the composition of medicinal products and biologically active additives for the prevention and treatment of musculoskeletal system diseases, primarily osteoarthritis. Exogenous administration of vital micronutrients (zinc, boron, selenium, manganese, chromium and copper) helps to compensate their deficiency caused by age-related changes, enhances the immune system, regeneration and stabilization of tissue cells and organs, and slows down the aging process and joint destruction. Micronutrients are co-factors of many enzymes and are a part of proteins and hormones. They perform an antioxidant function, improve the metabolism of proteins, fats and carbohydrates, calcium, magnesium, fluorine, phosphorus and vitamin D, normalize the endocrine system function, electrolyte balance and etc. The combination of methylsulfonylmethane, micronutrients with chondroitin sulfate and glucosamine sulfate promotes the regeneration of cartilage matrix (proteoglycans, hyaluronic acid and collagen) and collagen synthesis. It also allows to maintain the normal state of cartilage tissue and chondrocyte activity, stimulate the biosynthesis, maintain normal viscosity of joint fluid, prevent cartilage destruction, improve joint mobility, reduce inflammation, pain and the need for NSAIDs.

Keywords: osteoarthritis, biologically active additives, treatment of osteoarthritis, chondroitin sulfate, glucosamine, vitamin C, methylsulfonylmethane, micronutrients.

For citation: Dydykina I.S., Kovalenko P.S., Kovalenko A.A., Aboleshina A.V. The contribution of micronutrients and vitamin C to the combination of glucosamine and chondroitin ensuring joint health in osteoarthritis. RMJ. 2022;6:52–56.

Summary:

Chronic recurrent multifocal osteomyelitis: what we know about?

V.I. Mazurov^1,2, I.Z. Gaydukova^1,2, E.P. Filonenko^{2 1}Clinical Rheumatological Hospital No. 25, St. Petersburg

²I.I. Mechnikov North-Western State Medical University, St. Petersburg 

Chronic recurrent multifocal osteomyelitis (CRMO), also known as chronic recurrent multifocal osteomyelitis (so-called "sterile" osteomyelitis) is an auto-inflammatory bone disease of unknown etiology, which is the most severe form of chronic non-bacterial osteomyelitis. The disease is characterized by mono- and multifocal lesions of long tubular bones and occurs mainly in childhood and adolescence but can also occur in adult patients. In the presence of multiple bone lesions of unclear etiology and skin manifestations such as acne, palmoplantar pustulosis, less common psoriasis, the disease is called SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis). The ambiguity of views about CRMO brings difficulties in understanding its clinical association with the group of immune inflammatory rheumatic diseases. The problem of CRMO requires a careful study of its pathogenesis, clinical course, complications and complex therapy. This article aims to familiarize physicians of therapeutic specialties with modern views about the pathogenetic mechanisms, clinical manifestations, differential diagnosis of CRMO, as well as the basic principles of its treatment, based on international consensus data due to the lack of national clinical guidelines for the treatment of CRMO. The need for the participation of a multidisciplinary team in the development of a treatment tactics concerning CNO was particularly noted.

Keywords: chronic recurrent multifocal osteomyelitis, chronic non-bacterial osteomyelitis, SAPHO syndrome, "sterile" osteomyelitis.

For citation: Mazurov V.I., Gaydukova I.Z., Filonenko E.P. Chronic recurrent multifocal osteomyelitis: what we know about? RMJ. 2022;6:57–61.

Summary:

Experience of using Febuxostat-SZ in a comorbid patient with gout and high cardiovascular risk

M.M. Toporkov, A.V. Koltsov, I.S. Svintsitskaya, V.V. Tyrenko S.M. Kirov Military Medical Academy, St. Petersburg 

Aim: to evaluate the efficacy and tolerability of the domestic drug, Febuxostat-SZ, in patients with gout and high cardiovascular risk.

Patients and Methods: a single-center clinical prospective study was conducted, which included 50 patients with gout in combination with hypertension. At the time of inclusion in the study, patients did not receive treatment for gout or received allopurinol at a dose of 200–300 mg, but did not reach the target values of serum urate level. The glomerular filtration rate (GFR) was >30 mL/min/1.73 m². All patients received Febuxostat-SZ 80 mg not in gouty arthritis (2 weeks after the relief of acute arthritis). At the beginning of the study and 6 months after the treatment, the following indicators and procedures were evaluated and performed: the clinical condition, laboratory parameters, GFR, instrumental studies (electrocardiography, echocardiography, daily ECG and BP as indicated, and ultrasound of the abdominal cavity and kidneys). All patients filled in the Russian Scale of Quantitative Assessment Adherence to Treatment (QAA-25), the SF-36 questionnaire, as well as the pain syndrome severity was assessed on a visual analog scale (VAS). Episodes of acute gouty arthritis and cardiovascular events were analyzed.

Results: the age of the patients included in the study was 58 [49; 63] years, the history of gout was 2 [2; 10] years. There was a positive trend of serum urate level from 514.7 [496; 551] to 270.6 [233; 306] µmol/L (p<0,0001). The creatinine level decreased from 100.2 [93.8; 112] to 98.7 [91.2; 108] µmol/L (p<0,03). At the same time, the tendency of GFR level did not show significant changes and amounted to 67.7 [62.1; 76.3] at the time of inclusion and 70.4 [64.4; 79.9] mL/min/ 1.73 m² after 6 months (p>0.05). During the study period, no adverse events, in particular cardiovascular, were registered. Positive trend was revealed in all aspects of the SF-36 questionnaire (p<0,01), with the exception of pain intensity, and the QAA-25 scale (p<0,0005).

Conclusion: the use of Febuxostat-SZ in patients with cardiovascular risks is not accompanied by additional cardiovascular risks.

Keywords: gout, cardiovascular risk, normouricemia, Febuxostat, adherence to treatment, quality of life.

For citation: Toporkov M.M., Koltsov A.V., Svintsitskaya I.S., Tyrenko V.V. Experience of using Febuxostat-SZ in a comorbid patient with gout and high cardiovascular risk. RMJ. 2022;6:62–65.

Summary:

Assessment of the D-dimer and C-reactive protein levels in patients with osteoarthritis who experienced COVID-19 during therapy with a parenteral form of chondroitin sulfate

L.V. Vasilyeva¹, E.F. Evstratova¹, E.P. Karpukhina¹, O.A. Shavlovskaya^{2 1}N.N. Burdenko Voronezh State Medical University, Voronezh

²International University of Rehabilitation Medicine, Moscow 

Background: the most common manifestation of the postcovid syndrome is pain syndromes of various localization, including from the musculoskeletal system. Postcovid syndrome affects at least 10% of people who had COVID-19. At the same time, 91% of COVID-19 patients had an increase in the D-dimer level, and 56.4–81.5% of patients (depending on the disease severity) had an increase in the C-reactive protein (CRP) level. Thus, it requires timely detection and preventive measures.

Aim: to evaluate the dynamics of the D-dimer and CRP levels (as part of an in-depth medical examination) in patients with osteoarthritis (OA) who experienced COVID-19 during therapy with a parenteral form of chondroitin sulfate (CS).

Patients and Methods: the study included 62 patients with Kellgren–Lawrence grade 1–2 of the knee OA with pain syndrome (5–6 points according to VAS) who had suffered COVID-19 for 3 months before inclusion in the study. Group 1 (n=32; mean age 64.9±3.3 years) received CS intramuscularly, a course of 25 injections on alternate days. Group 2 (n=30; mean age 59.7±5.3 years) received topical nonsteroidal anti-inflammatory drugs. The period of the follow-up was 50 days.

Results: at the end of the treatment course, statistically significant (p<0.05) changes in the pain syndrome severity according to VAS were revealed: in group 1, the positive trend of the indicator "pain at rest" was 60.4%, "pain on activity" — 62.5%; in group 2 — 40% and 42.6%, respectively. Within each group, there was a decrease in the D-dimer level (group 1 — by 69.6%, group 2 — by 26.6%) and CRP level (group 1 — by 52%, group 2 — by 17.5%).

Conclusion: CS, which has a disease-modifying anti-inflammatory effect, can be recommended for patients with grade I–II OA, post-COVID-19, and significantly elevated levels of inflammatory markers (D-dimer and CRP).

Keywords: COVID-19, SARS-CoV-2, post-Covid pain syndrome, osteoarthritis, D-dimer, C-reactive protein, chondroitin sulfate.

For citation: Vasilyeva L.V., Evstratova E.F., Karpukhina E.P., Shavlovskaya O.A. Assessment of the D-dimer and C-reactive protein levels in patients with osteoarthritis who experienced COVID-19 during therapy with a parenteral form of chondroitin sulfate. RMJ. 2022;6:66–70.

Summary:

Comorbidity of musculoskeletal disorders in patients of elderly groups

N.O. Khovasova, A.V. Naumov, O.N. Tkacheva, V.I. Ruzanova Pirogov Russian National Research Medical University, Moscow 

Background: comorbidity is the presence of two or more chronic diseases in one patient. In senile age, geriatric syndromes play an important role in the comorbidity structure. One of the common comorbidity models are the musculoskeletal disorders.

Aim: to assess the prevalence and structure of geriatric syndromes in patients with musculoskeletal comorbidity.

Patients and Methods: the study included 1003 patients (age 77.6±8.2 years, 79.9% female patients) who were hospitalized in the geriatric department. All patients had chronic diseases, the Charlson Comorbidity Index was 5.82±1.8 points. The complaints, anamnesis and general examination data from all patients were collected, as well as the presence of age-related diseases of the musculoskeletal system (MSS) and a comprehensive geriatric assessment (CGA) were evaluated. To assess the effect of falls on the geriatric state of patients with musculoskeletal disorders, the patients with osteoarthritis (OA) were isolated and divided into 2 groups depending on the falls: group 1 — with falls (n=350), group 2 — without falls (n=347).

Results: 823 (82.1%) patients had musculoskeletal disorders. 77 (9.4%) of patients were diagnosed with one musculoskeletal disorder, 460 (55.9%) — with a combination of two disorders, 286 (34.7%) — with three or more. All patients were diagnosed with geriatric syndromes: the most common among them were balance disorders (71.1%), functional decline (59.9%), polypragmasia (50.9%), sleep disorders (50.1%), vision deficiency (48.6%), fear of falling (48.2%), senile asthenia (48.1%) and falls (46.9%). To CGA showed that in patients with OA and falls, the results of tandem gait test, gait velocity, hand dynamometry in women, gait-stair-gower-chair score, timed up & go test, FRAX algorithm, and MMSE were significantly worse than in patients with OA and without falls.

Conclusion: Comorbidity in elderly patients is a heterogeneous condition, including chronic diseases and geriatric syndromes. One common type of comorbidity in the elderly is musculoskeletal comorbidity. Falls are a significant factor in the deterioration of mobility in patients with OA.

Keywords: comorbidity, musculoskeletal disorders, osteoarthritis, geriatric syndrome, falls, complex geriatric assessment.

For citation: Khovasova N.O., Naumov A.V., Tkacheva O.N., Ruzanova V.I. Comorbidity of musculoskeletal disorders in patients of elderly groups. RMJ. 2022;6:7–11.

Summary:

Osteonecrosis of the femoral head induced by a new coronavirus infection

I.B. Bashkova^1,2, I.V. Madyanov^1,3, A.S. Mikhailov^{2 1}Chuvash State University named after I.N. Ulyanov, Cheboksary

²Federal Center for Traumatology, Orthopedics and Arthroplasty, Cheboksary

³Chuvash Republic Postgraduate Doctors’ Training Institute, Cheboksary

Osteonecrosis (ON) is a severe disabling disease that commonly develops in persons of young working age and is associated with the death of bone cells in a certain area of bone tissue, usually provoked by a local circulationdisorder. ON commonly develops in the femoral head. The following customary factors that can provoke the ON progression of the femoral head include: traumatic hip injury, surgical interventions on the hip, hip dysplasia, immune inflammatory rheumatic diseases, various coagulopathies, hyperlipidemia, genetic abnormalities, chronic liver diseases, treatment with glucocorticoids (GC), radiation and polychemotherapy, alcohol abuse and etc. According to the literature, there are the following pathogenetic factors associated with COVID-19 and causing bone destruction: coagulopathy, endothelial dysfunction and endotheliitis, cytokine hyperproduction, activation of the complement system, thrombotic microangiopathy, hypoxia and a number of other mechanism s, including the direct viral damaging effect on the trabecular and cortical bone tissue. The article presents the own clinical case describing the development of ON after a new coronavirus infection. Thus, all persons who have undergone COVID-19, regardless of the severity and the GC use / absence of use, should be considered as vulnerable to the ON progression and be included in the risk group for this complication.

Keywords: avascular necrosis, osteonecrosis, coronavirus infection, COVID-19, long-term effects of COVID-19.

For citation: Bashkova I.B., Madyanov I.V., Mikhailov A.S. Osteonecrosis of the femoral head induced by a new coronavirus infection. RMJ. 2022;6:71–74.

Summary:

Goodpasture syndrome. Clinical case

I.M. Patrikeeva¹, Yu.A. Lushpaeva², A.Yu. Evenko¹, T.Yu. Malysheva¹, A.G. Bichenova^{3 1}Regional Clinical Hospital No. 1, Tyumen

²Tumen State Medical University, Tyumen

³Multiprofile Clinical Medical Center "Meditsinskii Gorod", Tyumen

Goodpasture syndrome is a disease associated with the formation of anti-glomerular basement membrane antibodies. It belongs to the rare immune complex organ-specific systemic vasculitis. The article presents the clinical case of Goodpasture syndrome in a 23-year-old female patient. The disease manifested with a clinical picture of fulminant course of glomerulonephritis and rapidly progressive azotemia, followed by the pathological process in the lungs in the form of hemorrhagic alveolitis and pulmonary hemorrhage. Laboratory confirmation of the disease was high titers of specific anti-glomerular basement membrane antibodies (anti-GBM antibodies). The point of the described clinical case is the fulminant course of Goodpasture syndrome, despite the conducted immunosuppressive therapy in combination with plasmapheresis, the development of hemorrhagic stroke, coma and the fatal outc ome of the patient. Morphological analysis of the autopsy material showed proliferative nephritis with a very high percentage of crescentic glomeruli and pulmonary vasculitis. The authors focus on the urgent need for revision and adaptation to routine clinical practice of interdisciplinary algorithms for the patient management with Goodpasture syndrome, for the elimination of terminological differences and the determination of the intervention threshold of a primary care physician and a specialist (nephrologist, pulmonologist, rheumatologist).

Keywords: Goodpasture syndrome, anti-glomerular basement membrane antibodies disease, anti-GMB disease, anti-GBM antibodies, crescentic glomerulonephritis, hemorrhagic alveolitis, plasmapheresis.

For citation: Patrikeeva I.M., Lushpaeva Yu.A., Evenko A.Yu. et al. Goodpasture syndrome. Clinical case. RMJ. 2022;6:75–79.

Summary:

Appendicitis and COVID-19: new challenges in a pandemic era

L.V. Feklisova¹, E.B. Olkhova^2,3, S.V. Nikolaeva⁴, E.V. Kanner⁴, I.S. Allakhverdiyev^{3 1}M.F. Vladimirskiy Moscow Regional Research and Clinical Institute, Moscow

²A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

³St. Vladimir Children’s City Clinical Hospital, Moscow

⁴Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer

Rights Protection and Human Well-Being, Moscow A variety of clinical symptoms caused by damage both to the respiratory system and other organs characterizes COVID-19. Difficulties in establishing the diagnosis of COVID-19 are explained by the absence of pathognomonic manifestations, including those of the respiratory tract. Difficulties in diagnosis increase in cases of this infection with abdominal pain syndrome, simulating acute appendicitis. The article presents literature data on the clinical picture of COVID-19 in gastrointestinal tract (GIT) disorder. The article also describes the pathogenetic patterns of COVID-19, which can explain the recorded changes and symptoms; evidence of direct damage to intestinal epithelial cells. Particular attention is paid to the possible additional role of microbiota changes in the diarrhea development in patients with COVID-19 (by reduction of colonization resistance, production decrease of beneficial microbial metabolites, and trigger of local immune restructuring).  A clinical case of a male patient with COVID-19 (detected during laboratory examination) is presented without respiratory failure and signs of respiratory disease with phlegmonous appendicitis, with mild course because of the timely and adequate treatment.

Keywords: coronavirus infection, COVID-19, children, appendicitis, acute abdominal syndrome.

For citation: Feklisova L.V., Olkhova E.B., Nikolaeva S.V. et al. Appendicitis and COVID-19: new challenges in a pandemic era. RMJ. 2022;5:12–16.

Summary:

Sustainable pharmacological relief of headache

E.G. Filatova 

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 

Tension-type headache (TTH) and migraine are the most common types of headache. They can have a significant impact on the ability to work and life quality. Sustainable pharmacological relief of these headache types is still an important task and involves not only the choice of an adequate mechanism of action and drug intensity, but also the assessment of individual factors concerning drug safety. It has been shown that the combination of ibuprofen with pitofenone and fenpiverinium bromide predominates in efficacy versus ibuprofen mono-preparations in the treatment of TTH. Using a drug with international nonproprietary names for pharmaceutical substances ibuprofen, pitofenone and fenpiverinium bromide in coated tablets reduces the risk of components’ direct effect on the gastric mucosa. The combined drug works well in irregular short-term use on demand, as it has an over-the-counter status and effectively relieves headache.

Keywords: tension-type headache, migraine, combination drug, headache relief, ibuprofen, pitofenone, fenpiverinium bromide.

For citation: Filatova E.G. Sustainable pharmacological relief of headache. RMJ. 2022;5:17–20.

Summary:

Genetic factors associated with the risk of hypertension in patients with COVID-19

V.I. Korchagin¹, K.O. Mironov¹, I.I. Gaponova¹, A.A. Ploskireva¹_, I.A. Demina², A.G. Komarova², V.G. Akimkin¹ 

¹Central Research Institute of Epidemiology of the Federal Service on Customers’ Rights Protection and Human Well-being Surveillance, Moscow

²S.P. Botkin City Clinical Hospital, Moscow Aim: to identify the pathogenetic and prognostic significance of gene polymorphisms for the course prognosis and risk assessment of COVID-19 complications in patients with hypertension.

Patients and Methods: 153 patients with COVID-19 were examined. The infectious disease occurred in 95 patients during hypertension, in the remaining 58 patients there was no hypertension. In the observed patients, diseases that could affect the hypertension course, as well as secondary hypertension, were excluded. All patients underwent a complete check-up, which included, in particular, the determination of single-nucleotide polymorphisms of the analyzed genes (rs1937506, rs662, rs5186, rs5918, rs1143623, rs1799983). A sampling of 360 population specimen studied before the SARS-CoV-2 pandemic at the same hospital was used as a population-based control group.

Results: rs1937506-A, rs662-G, rs1143623-C and rs1799983-T alleles were more common in the group of patients with hypertension. At the same time, the occurrence rate of the studied alleles in the group with SARS-CoV-2 was comparable to the general population, which indicated that inherited predisposition to hypertension was not a factor that increased the risk of COVID-19 disease, despite the pathogenetic patterns of SARS-CoV-2 and its interaction with the ACE2 receptor. It was found that the presence of the rs1937506-A allele in carriers of the AG and AA genotypes increased the risk of lower respiratory tract disorders in COVID–19, and the rs5186-C allele was possibly protective for carriers of the AS and CC genotypes. The risk of hyperprothrombinemia was reduced in carriers of the AA and AG genotypes (rs1937506 locus), while the risk of thrombosis was increased in carriers of the GG genotype.

Conclusion: conducting trials to identify certain genetic polymorphisms allows patients with hypertension to determine the risk groups for developing pneumonia in COVID-19, as well as those who need to monitor the parameters of the blood coagulation system after COVID-19.

Keywords: hypertension, genetic factors, genetic predisposition, SNP, SARS-CoV-2, COVID-19.

For citation: Korchagin V.I., Mironov K.O., Gaponova I.I. et al. Genetic factors associated with the risk of hypertension in patients with COVID-19. RMJ. 2022;5:2–6.

Summary:

Complex therapy of spondyloarthrosis during rehabilitation of patients with dorsopathies in the attack-free interval using step therapy with serial forms of chondroitin sulfate

A.N. Komarov 

National Center for the Development of Technologies for Social Support and Rehabilitation "Doverie", Moscow 

Aim: to study the efficacy and tolerability of the step therepy with Ambene®Bio, injectable chondroprotective agent, with subsequent crossover to Ambebe®Chondro, peroral form, in patients with acute spondyloarthrosis of various localization during complex treatment and rehabilitation and to evaluate the aftereffect.

Patients and Methods: a prospective single-center study included patients aged 40 to 65 years with acute spondyloarthrosis, mainly of cervical and lumbar localization. Depending on the treatment option, the patients were randomized into two groups. In the main group (n=23), the treatment regimen in addition to standard therapy (meloxicam 7.5 mg/day for 14 days; muscle relaxants if necessary) included Ambene^®Bio injections (10 injections, 2 ml, alternate-day). The control group received only standard therapy. All patients of both groups underwent medical rehabilitation for the back pain relief. The treatment course lasted 21 days. The Visual Analog Scale (VAS), the Oswestry Low Back Pain Disability Questionnaire, and the Clinical Global Impressions Scale were used to evaluate the condition trend. After the main treatment course main group received oral chondroitin form — Ambene^®Chondro.

Results: initially, the patients were comparable in age, gender, and pain severity according to the VAS. Positive statistically significant trend of the studied indicators was noted in each group. During treatment, the decrease in the VAS values of the main group averaged 82%, of the control group — 41%; in general, the indicator improved in 95.7% and 50% of patients, respectively. In the main group, the decrease in the condition score according to the Oswestry Low Back Pain Disability Questionnaire was 69% (41.6 points), in the control group — 24% (14.3 points). After 6 months of the follow-up, the absence of exacerbation was found in 98% of patients of the main group.

Conclusions: inclusion of Ambene^®Bio into the main treatment regimen for patients with spondyloarthrosis and subsequent therapy with Ambene^®Chondro as part of comprehensive rehabilitation and preventive therapy allow patients to revert to the active life much faster and prevent seasonal exacerbations of spondyloarthrosis.

Keywords: dorsopathy, spondyloarthrosis, back pain, life quality, medical and social rehabilitation, step therapy.

For citation: Komarov A.N. Complex therapy of spondyloarthrosis during rehabilitation of patients with dorsopathies in the attack-free interval using step therapy with serial forms of chondroitin sulfate. RMJ. 2022;5:21–24.

Summary:

Cell-free DNA and cardiovascular diseases

A.M. Aliyeva¹, N.V. Teplova1, V.A. Kislyakov¹, R.K. Valiev ², A.M. Rakhaev³, M.N. Saryev², E.T. Gasanova¹, I.G. Nikitin¹ 

¹Pirogov Russian National Research Medical University, Moscow

²A.S. Loginov Moscow Clinical Research Center, Moscow

³Main Bureau of Medical and Social Expertise in the Kabardino-Balkarian Republic of the Ministry of Labor and Social Protection of Russian Federation, Nalchik 

The measurement of biological markers has revolutionized the diagnosis and monitoring of the treatment efficacy of patients with heart disease. Currently, the most widely used biomarkers are natriuretic peptides and cardiac troponins. Many other markers have been identified, however, only a few of them were applied in real clinical practice. This review is devoted to cell-free DNA (cfDNA) and its role in cardiovascular pathology. Cell-free DNA is a fragmented double-stranded DNA that circulates freely in extracellular body fluids (plasma, serum, urine, cerebrospinal fluid and saliva). Under normal physiological conditions, cfDNA level increases during physical exertion and in the elderly patients. cfDNA has been found in extracellular fluids in the form of microbubbles, microparticles, apoptoti c bodies, exosomes, histone complexes and virtosomes. The following cfDNA indices were determined in healthy donors: 10 – 100 ng/mL (10³–10⁴ genome equivalents in 1 ml). High levels of cfDNA versus the control group indices clearly indicate the pathological process in the body. Clinical studies have shown an increase in cfDNA levels in various cardiovascular diseases. Of particular interest, there is a need to conduct further study concerning cfDNA role, as well as future clinical trials to determine the diagnostic and prognostic significance of this marker. 

Keywords: cfDNA, cell-free DNA, biomarkers, cardiovascular diseases, hypertension, myocardial infarction.

For citation: Aliyeva A.M., Teplova N.V., Kislyakov V.A. et al. Cell-free DNA and cardiovascular diseases. RMJ. 2022;5:26–29.

Summary:

E.Yu. Ebzeeva¹, V.A. De¹, L.I. Ni², E.V. Sokolova², A.V. Arablinskiy^1,3, O.D. Ostroumova^1,4 

¹Russian Medical Academy of Continuous Professional Education, Moscow

²Central Clinical Hospital "RZD-Meditsina", Moscow

³S.P. Botkin City Clinical Hospital, Moscow

⁴I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 

Chronic kidney disease (CKD) is a progressive renal damage, more common in the elderly, women, in patients with diabetes mellitus (DM) and / or hypertension (H). Currently, CKD is recognized as one of the leading causes of fatal outcome worldwide. Another medical and social problem is hypertension (H), which is the most important factor of cardiovascular risk worldwide and one of the main causes of the CKD occurrence. The high prevalence and comorbidity of CKD and H, as well as a dismal prognosis determine the need for effective prevention and treatment of these conditions. The use of nephroprotection methods in the treatment of patients with CKD can significantly improve the prognosis both in patients with risk factors of renal dysfunction and in patients with pre-existing renal dise ase. According to modern recommendations for the treatment of H, combination therapy with drugs of two groups (preferably in one tablet) is indicated for high-risk patients with H (including from the standpoint of nephroprotection). The article presents data confirming the efficacy of a fixed combination of an angiotensin-converting enzyme inhibitor and a dihydropyridine calcium channel blocker.

Keywords: chronic kidney disease, hypertension, antihypertensive drugs, fixed combination, ramipril, amlodipine.

For citation: Ebzeeva E.Yu., De V.A., Ni L.I. et al. Chronic kidney disease and hypertension: how to break the vicious circle? RMJ. 2022;5:30–34.

Summary:

Modern methods of hypophosphatasia treatment

A.V. Vitebskaya, A.L. Kungurtseva I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 

Hypophosphatasia (HPP) is an orphan inherited disease caused by a deficiency of tissue-nonspecific alkaline phosphatase (TNAP) due to mutation in the ALPL gene, manifested by rickets-like bone deformities, tooth loss, muscle weakness and febrile seizures. The severity of HPP is variable: depending on the age of manifestation, there are perinatal, infantile, child and adult forms. In previous years, the treatment was purely symptomatic. However, currently, there is the only method of pathogenetic therapy — asfotase alfa (AA) enzyme replacement therapy, which efficacy and safety have been proven in clinical studies. There are also alternative treatment methods including the use of teriparatide and monoclonal antibodies to sclerostin, preclinical studies of gene therapy are being conducted. Bisphosphonate therapy in HPP is contraindicate d. Treatment with AA may be recommended for patients with a confirmed diagnosis of HPP in the presence of skeletal manifestations and child onset. Individual indications have been developed for the administration of AA in the adult form of HPP. The efficacy of AA enzyme replacement therapy is assessed by improving the clinical and radiological manifestations of HPP. The follow-up of patients with HPP includes laboratory and instrumental studies to evaluate the efficacy of therapy and search for ectopic calcifications. A patient with HPP needs consultation by a multidisciplinary specialist.

Keywords: hypophosphatasia, alkaline phosphatase, asphotase alpha, replacement therapy, pathogenetic therapy, multidisciplinary approach.

For citation: Vitebskaya A.V., Kungurtseva A.L. Modern methods of hypophosphatasia treatment. RMJ. 2022;5:36–39.

Summary:

Lysosomal acid lipase deficiency in the practice of an infectious disease doctor: clinical cases

V.A. Greshnyakova¹, L.G. Goryacheva^1,2, N.Yu. Makarevskaya³ 

¹Children’s Scientific and Clinical Center for Infectious Diseases of the Federal Medical and Biological Agency, St. Petersburg

²St. Petersburg State Pediatric Medical University, St. Petersburg

³Krasnoyarsk Regional Clinical Center for Maternal and Child Welfare, Krasnoyarsk 

The article presents clinical cases of patients with lysosomal acid lipase deficiency (LALD), which occurred under the guise of herpetic pathology. The first case demonstrates a severe infantile-onset LALD diagnosed in a child with cytomegalovirus (CMV) infection. In the second case, a child with congenital CMV infection with liver damage who did not respond to standard therapy was diagnosed with concurrent orphan pathology — LALD in the form of cholesteryl ester storage disease (in children and adults). The prescription of pathogenetic enzyme replacement therapy contributed to the improvement of well-being, weight gain, reduced liver size, almost complete normalization of hepatic transaminase level. The third case shows a long-term diagnosis of LALD during persistent Epstein — Barr virus and CMV, distracting from the search for the source of liver damage. In all cases, the first specialist who encountered the disease manifestations, while the infectious disease specialist suspected the presence of hereditary pathology. The clinical cases described in the article emphasize the importance of raising the level of awareness concerning infectious diseases. The necessity of patient management with atypical course of infectious liver damage (especially in combination with atherogenic dyslipidemia) is clearly demonstrated for diagnosing the LALD.

Keywords: lysosomal acid lipase deficiency, orphan diseases, hepatitis, cytomegalovirus, dyslipidemia, cholesterol, triglycerides, hyperfermentemia.

For citation: Greshnyakova V.A., Goryacheva L.G., Makarevskaya N.Yu. Lysosomal acid lipase deficiency in the practice of an infectious disease doctor: clinical cases. RMJ. 2022;5:40–45.

Summary:

Intra-abdominal hypertension in the perioperative period during abdominal surgery in children

B.D. Babaev^1,2, Yu.Yu. Sokolov^1,2, G.V. Smirnov², I.V. Turishchev², Z.T. Kumalagova², Yu.A. Gvozdev² 

¹Russian Medical Academy of Continuous Professional Education, Moscow

²St. Vladimir Children’s City Clinical Hospital, Moscow 

The review is devoted to the problems of intra-abdominal hypertension and changes in intra-abdominal pressure (IAP) during abdominal surgery in children. The article discusses the historical aspects concerning the concepts formation of IAP, abdominal perfusion pressure, intra-abdominal hypertension, and abdominal compartment syndrome. It also indicates the pathophysiological mechanisms of the intra-abdominal hypertension effect on various systems. The current state of the problem, the discutability of physiological and pathophysiological indicators in children are described. Due to the lack of a unified approach to the pressure measuring, as well as specialized consumables, there is an insufficient number of studies on this topic in pediatric patients. The importance of perioperative control of abdominal perfusion pressure and its effect on outcomes in children who underwent a bdominal surgery is emphasized. The importance and expediency of in-depth study concerning the problem of intra-abdominal hypertension in children are justified by the use of the IAP index in adult patients who have undergone abdominal surgery as a predictor and a sign of severe complications. The article outlines the possible directions of further research in this area.

Keywords: intra-abdominal pressure, children, abdominal perfusion pressure, intra-abdominal hypertension, abdominal surgery, peritonitis.

For citation: Babaev B.D., Sokolov Yu.Yu., Smirnov G.V. et al. Intra-abdominal hypertension in the perioperative period during abdominal surgery in children. RMJ. 2022;5:46–48.

Summary:

Patterns of acute cerebrovascular accident in patients who suffered COVID-19, according to the COVID Center of the S.P. Botkin City Clinical Hospital

O.S. Levin^1,2, A.G. Komarova¹, A.A. Ploskireva³, N.M. Krivosheeva¹, K.O. Litovchenko^{1,2 1}S.P. Botkin City Clinical Hospital, Moscow

²Russian Medical Academy of Continuous Professional Education, Moscow

³Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow 

Background: ischemic stroke in the absence of risk factors of cardiovascular events, as well as without clinically visible symptoms of an infectious disease, may be the first clinical manifestation of a new coronavirus infection (COVID-19), which underlines the importance of evaluating all incoming patients with acute cerebrovascular accident (CVA) as potentially infected or suffering from COVID-19, which in turn causes organizational characteristics of medical care.

Aim: to determine the clinical patterns of the CVA during COVID-19.

Patients and Methods: during the work of the COVID center on the basis of the S.P. Botkin City Clinical Hospital from April 29 to July 7, 2020, 52 patients were concurrently cured who suffered both CVA and COVID-19. Of these, there were 36 women and 16 men.

Results: among patients with CVA and COVID-19, ischemic stroke was verified in 43 (82.7%) patients. In the structure of dead patients, hemorrhagic strokes in combination with COVID-19 accounted for 19.2%, and ischemic strokes — 80.8%. There was a multiple increase in the level of creatine phosphokinase (CPK) in the blood of dead patients versus the discharged patients. Liver failure can be used as an indicator to assess the prognosis of patients with COVID-19, and should be carefully monitored during hospitalization. Among the dead patients, mild severity of pneumonia according to CT (CT 0/1) was diagnosed in 16 (61.5%) patients. Hypertension (as a concomitant disease) was diagnosed in 92% of discharged patients and in 96.2% of dead patients. Diabetes mellitus was found in 19.2% of discharged patients, and in 96.2% of dead patients. Of the concomitant diseases in young and middle-aged patients, only hypertension was found, while diabetes mellitus, hear t arrhythmia and carotid artery stenosis were absent.

Conclusion: the high mortality rate in the combination of two diseases increases the relevance of studying this problem, and therefore, it is necessary to continue studying the causal relationship of the processes occurring in CVA during COVID-19. CVA can be an atypical symptom of COVID-19 and lead to fatal outcome in the absence of massive lung damage. This is most likely due to microthrombosis, atherosclerotic plaque destabilization due to COVID-19.

Keywords: COVID-19, stroke, predictors of mortality, predictors of adverse outcome.

For citation: Levin O.S., Komarova A.G., Ploskireva A.A. et al. Patterns of acute cerebrovascular accident in patients who suffered COVID-19, according to the COVID Center of the S.P. Botkin City Clinical Hospital. RMJ. 2022;5:7–11.

Summary:

Meloxicam effect on coagulogram parameters in patients with back pain after COVID-19

M.V. Putilina¹, N.I. Shabalina², D.V. Grishin³, O.V. Kurushina⁴

¹Pirogov Russian National Research Medical University, Moscow

²Central Clinical Hospital RZD-Medicine, Moscow

³City Clinical Hospital No. 15, Moscow

⁴Volgograd State Medical University, Volgograd

Background: musculoskeletal symptoms commonly develop or worsen in patients who had COVID-19. The occurrence of musculoskeletal pain after infection can probably be explained by the direct primary viral attack to the muscles and peripheral nerves, and secondary hypoxia, which enhances the processes of hypercoagulation and inflammation, as well as microcirculatory disorders with the microthrombosis development.

Aim: to study the meloxicam effect on coagulogram parameters in patients with back pain after COVID-19.

Patients and Methods: a retrospective study included 50 patients aged 35 to 50 years with a diagnosis of dorsopathy (lower back pain), who had suffered COVID-19 within 40 to 90 days before inclusion in the study. Pain syndrome therapy included the prescription of meloxicam, a solution for intramuscular administration of 10 mg/mL (intramuscularly, 1.5 ml once a day for 10 days). All patients were examined during the first visit (Visit 1) and 14 days after therapy (Visit 2). At each visit, the following indicators were assessed: neurological status and the pain severity on a visual analog scale (VAS). Laboratory tests were performed a day after Visits 1 and 2: complete blood count with platelet count, levels of inflammatory markers and coagulogram indicators.

Results: 10 days after therapy with meloxicam, a statistically significant reduction of pain syndrome according to VAS (p<0.001) was registered. During the treatment, there was a significant decrease in the ESR and C-reactive protein levels, normalization of platelet levels, as well as there was no effect on activated partial thromboplastin time (APTT), thromboplastin time (TT), prothrombin time in a statistically significant decrease in the D-dimer level (p<0.006). There were no adverse events during the meloxicam use.

Conclusion: meloxicam had no effect on coagulogram parameters in patients with back pain after COVID-19.

Keywords: meloxicam, COVID-19, dorsopathy, back pain, inflammatory markers, coagulogram, musculoskeletal symptoms.

For citation: Putilina M.V., Shabalina N.I., Grishin D.V., Kurushina O.V. Meloxicam effect on coagulogram parameters in patients with back pain after COVID-19. RMJ. 2022;4:11–14.

Summary:

Cognitive and asthenic disorders after COVID-19

V.V. Zakharov, D.O. Gromova, L.A. Edilgireeva, T.A. Sadullayeva

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

A new coronavirus infection commonly entails persistent neurological complications, among the most common of which are cognitive and asthenic symptoms. The article provides data on the occurrence and clinical patterns of cognitive and asthenic symptoms after COVID-19, their association with the infectious disease severity, clinical significance and impact on everyday life. The article also discusses the pathogenesis of cognitive, asthenic and other neurological COVID-19 complications, including the following: direct invasion of the cerebral substance by the SARS-CoV-2; immune and metabolic disorders; occurrence of cerebrovascular diseases as a result of COVID-19-induced endotheliitis; cerebral hypoxia; social isolation due to restrictive measures; decompensation of concomitant diseases. Adding that, there are highlighted issues of prevention and treatment of COVID-19-induced neurological complications, including cerebrovascular diseases. The effect of antiplatelet therapy (prescribed to the patients with cardiovascular diseases for the prevention of recurrent ischemic events) on the COVID-19 course and complications is analyzed. The article describes a clinical case of persistent and significant cognitive impairment in a young woman who suffered a relatively mild COVID-19.

Keywords: COVID-19, SARS-CoV-2, new coronavirus infection, post-covid syndrome, endotheliitis, cognitive impairment, asthenia, cerebrovascular diseases.

For citation: Zakharov V.V., Gromova D.O., Edilgireeva L.A., Sadullayeva T.A. Cognitive and asthenic disorders after COVID-19. RMJ. 2022;4:15–19.

Summary:

Parkinson’s disease patterns in neurodegeneration with brain iron accumulation

A.B. Buryak^1,2, A.G. Trufanov²

¹S.M. Kirov Military Medical Academy of the Ministry of Defense of Russia, St. Petersburg

²I.I. Mechnikov North-Western State Medical University, St. Petersburg

Aim: to evaluate the association of iron deposition in the structures of the extrapyramidal system with the clinical picture patterns in patients with various stages of Parkinson’s disease (PD).

Patients and Methods: the study included 92 patients with PD (42 patients with stage II according to the Hoehn and Yahr scale, and 50 patients with stage III according to the Hoehn and Yahr scale). All patients underwent comprehensive clinical and neuropsychological testing according to the following scales: Unified Parkinson’s Disease Rating Scale (UPDRS), Freezing of Gait Questionnaire (FOGQ), Gait and Balance Scale (GABS), Frontal Assessment Battery (FAB), Mini-Mental State Examination (MMSE), Beck’s Depression Inventory. Also, all patients underwent magnetic resonance imaging (MRI) of the head using the Magnetom Trio A Tim 3.0 Tesla magnetic resonance tomograph with a susceptibility weighted imaging (SWI). ROI: substantia nigra (SN), nucleus ruber (NR), putamen, pale globe (PG), head of the caudate nucleus (CN), dentate body (DB). During SWI, the signal strength from each studied area was manually measured.

Results: statistically significant differences were found in the UPDRS and its sections, FOGQ, GABS, MMSE and FAB, between patients with stage II and III PD according to the Hoehn and Yahr scale. Statistically significant differences in signal strength indicators from the right and left SNs, right and left putamens, left PG, right and left CNs were revealed among the studied groups. Correlation analysis results showed that iron deposition in the structures of the extrapyramidal system with the UPDRS and its sections results predominated in patients with stage II according to the Hoehn and Yahr scale; in patients with stage III — with the UPDRS III, FOGQ, GABS, MMSE, FAB and Beck’s Depression Inventory.

Conclusion: a gradual increase in the brain iron accumulation in the PD progression was revealed. Multiple associations of iron deposition in the structures of the extrapyramidal system with various patterns of the clinical picture were revealed in patients with both stages II and III according to the Hoehn and Yahr scale. The combined use of complex clinical and neuropsychological examination with MRI of the head in SWI mode allows to assess the role of iron in the PD pathogenesis, identify biomarkers of disease progression and the development of its motor and non-motor manifestations.

Keywords: Parkinson’s disease, iron deposition, ferroptosis, basal ganglia, susceptibility weighted imaging, magnetic resonance imaging.

For citation: Buryak A.B., Trufanov A.G. Parkinson’s disease patterns in neurodegeneration with brain iron accumulation. RMJ. 2022;4:2–6.

Summary:

Selective cyclooxygenase-2 inhibitors in patients with low back pain: focus on safety

P.R. Kamchatnov¹, S.B. Khanmurzayeva², A.V. Chugunov¹, N.B. Khanmurzayeva², E.S. Agabekova³

¹Pirogov Russian National Research Medical University, Moscow 

²Dagestan State Medical University, Makhachkala

³City Clinical Hospital, Makhachkala

Low back pain (LBP) is a widespread musculoskeletal pain syndrome associated with a decrease in the life quality of patients and significant treatment expenses. Osteoarthritis (OA) of the lumbar facet joints can be considered as one of the important causes of LBP development. Commonly, a variety of pathogenetic mechanisms and clinical manifestations of LBP complicate the drug selection. The article analyzes information concerning the possibility of using a selective cyclooxygenase type 2 (sCOX-2) inhibitor, etoricoxib, for the treatment of patients with LBP. The article also presents the randomized clinical trial results concerning the efficacy and safety of its use in patients with LBP. The possibility of using this drug in patients (requiring a certain treatment duration, in particular, in LBP, which has developed in the setting of the facet joint OA) is extremely important, since it is necessary not only to relieve acute pain syndrome but also to inhibit the inflammatory process. In some cases, long-term treatment is required in OA, since an excessively short treatment course may not provide sufficient antiinflammatory effect, representing one of the reasons for the early onset of subsequent exacerbation.

Keywords: low back pain, osteoarthritis, nonsteroidal anti-inflammatory drugs, cyclooxygenase inhibitors, etoricoxib, tolerability.

For citation: Kamchatnov P.R., Khanmurzayeva S.B., Chugunov A.V. et al. Selective cyclooxygenase-2 inhibitors in patients with low back pain: focus on safety. RMJ. 2022;4:20–25.

Summary:

Evidence-based efficacy and safety of vitamin B complex (thiamine, pyridoxine and cyanocobalamin) in combination with diclofenac sodium for the treatment of acute back pain

A.P. Rachin^1,2, M.N. Sharov³, S.A. Rachin^2,4, Yu.S. Prokofieva⁵, O.V. Filippova⁶

¹National Medical Research Center of Rehabilitation and Balneology, Moscow

²National association of experts in comorbid neurology, Moscow

³A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

⁴I.P. Pavlov First St. Petersburg State Medical University, St. Petersburg

⁵Research Center of Neurology, Moscow

⁶I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

Nowadays, back pain is considered a common problem, for the treatment of which non-pharmacological and pharmacological methods are used (with the inclusion of NSAIDs). However, at present, there is no ideal treatment method. The article discusses the possibilities of using adjuvant agents that can reduce the dose of NSAIDs or the treatment duration. The analgesic effect of thiamine, pyridoxine and cyanocobalamin in therapeutic doses, including in combination with NSAIDs, has been studied. The article also considers results of a systematic review and meta-analysis in the studies on the efficacy of diclofenac in combination with vitamin B versus diclofenac as monotherapy for the treatment of low back pain. It was shown that the most significant effect of combination therapy was a reduction in the treatment duration and a decrease in the pain intensity. The results of the pharmacoeconomical analysis concerning the use of the combined analgesic, Neurodiclovit, vers us available alternatives are also presented. An analysis of vitamin drug offers shows that an attempt to replace Neurodiclovit with a combination of diclofenac with vitamin B leads to problems with the choice of drugs and dosages, without providing significant economic benefits. In turn, a change in the doses of drugs may be accompanied by a change in the treatment efficacy and safety.

Keywords: thiamine, pyridoxine, cyanocobalamin, diclofenac, back pain, combined analgesic, pharmacoeconomical analysis.

For citation: Rachin A.P., Sharov M.N., Rachin S.A. et al. Evidence-based efficacy and safety of vitamin B complex (thiamine, pyridoxine and cyanocobalamin) in combination with diclofenac sodium for the treatment of acute back pain. RMJ. 2022;4:26–32.

Summary:

Cognitive disorders in patients after COVID-19

P.R. Kamchatnov¹, R.A. Cheremin², L.A. Skipetrova², B.A. Abusueva³, L.I. Pyshkina¹, S.A. Khanmurzayeva³

¹Pirogov Russian National Research Medical University, Moscow

²Center for Speech Disorders and Neurorehabilitation, Moscow

³Dagestan State Medical University, Makhachkala

Nowadays, doctors of all specialties in Russia and worldwide are dealing not only with a new coronavirus infection but also with the COVID-19 comorbidities, the so-called post-covid syndrome (PCS). PCS manifestations are diverse and characterized by symptoms from various body systems, and neurological disorders are particularly important: cognitive disorders, asthenic, vegetative, and anxiety disorders, leading to a decrease in the patients’ life quality and a slowdown in the recovery rate. The most significant neurological disorders are observed in patients over 50 years with initially concomitant cardiovascular pathology. The wide prevalence of PCS, its significant impact on the patients’ life requires the search for adequate therapeutic methods. Of undoubted interest is the use of peptide preparations with neuroprotective and neuropreparative effects. The authors present their data f rom the first experience of using the domestic drug, Cellex (pig brain polypeptides), to treat patients with small vessel disease and PCS with cognitive disorder. Therapy positive effect was noted as a decrease in the severity of cognitive disorder, anxiety and asthenic syndromes. Adding that, there was a good tolerability and the absence of severe side effects.

Keywords: COVID-19, post-covid syndrome, cognitive impairment, asthenic syndrome, small vessel disease, chronic cerebral ischemia, treatment.

For citation: Kamchatnov P.R., Cheremin R.A., Skipetrova L.A. et al. Cognitive disorders in patients after COVID-19. RMJ. 2022;4:33–37.

Summary:

Characteristics of facial neuropathy (Bell’s palsy) therapy in comorbid conditions

G.V. Alekseyevich¹, G.Yu. Alekseyevich^2,3, N.V. Isaeva^2,3

¹"Arnica" Family Clinic LLC, Krasnoyarsk

²Krasnoyarsk Regional Clinical Hospital, Krasnoyarsk

³Krasnoyarsk State Medical University named after Prof. Voino-Yasenetsky, Krasnoyarsk

The prevalence of facial neuropathy (FN) (Bell’s palsy, facial nerve palsy) ranges from 20 to 30 people per 100 thousand populations, and among mononeuropathies it ranks 2nd in incidence. In 75% of cases, FN is idiopathic. In 25%, FN is due to secondary causes. In some cases, FN is a component of Ramsay Hunt syndrome (multiple neuropathy of cranial nerves during ophthalmic zoster). The review examines modern approaches to the diagnosis and treatment of FN from the standpoint of evidence-based medicine. The authors draw attention on the fact that with an obvious picture of FN, it is necessary to conduct a thorough examination of the patient, since prosoparesis can be only one of the another life-threatening disease manifestations. In all cases of the idiopathic FN, hormonal therapy with the corticosteroid group should be prescribed. If a viral infection is suspected, antiviral drugs such as acyclovir should be added. The prescription of non-drug methods such as reflexology, physiotherapy, facial gymnastics did not show their benefit in the recovery rate, however, they did not cause deterioration in the condition. The efficacy of including anticholinesterase drugs, B vitamins, and electrotherapy in the therapy course is questionable. The use of these treatment methods can contribute to the development of complications.

Keywords: facial neuropathy, Bell’s palsy, facial nerve palsy, lagophthalmos, facial nerve, prosoparesis, complications.

For citation: Alekseyevich G.V., Alekseyevich G.Yu., Isaeva N.V. Characteristics of facial neuropathy (Bell’s palsy) therapy in comorbid conditions. RMJ. 2022;4:38–43.

Summary:

Thrombectomy in stroke

¹M.F. Vladimirskiy Moscow Regional Research and Clinical Institute, Moscow

²A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

Cerebrovascular accident (CVA) or stroke is the leading underlying condition of neurological disorder and ranks 4th among the causes of adult mortality. Thus, timely reperfusion therapy is an important method of effective care for patients with stroke. The administration of endovascular techniques in the treatment of patients with acute ischemic stroke in the form of mechanical thrombectomy and selective thrombolysis has opened a new era in modern neurology. The article describes two clinical cases with the successful use of mechanical thrombectomy in female patients older than 70 years with ischemic stroke. In both patients, mechanical thrombectomy using second-generation stent retrievers and aspiration techniques was performed urgently, within 6 hours from the onset of ischemic stroke due to the presence of contraindications to systemic thrombolysis. CT and MRI perfusions performed at the examination stage made it possible to clearly visualize the penumbra, which is larger than the infarct area. In both cases, the result of timely intervention was a regression of neurological symptoms, which confirms the efficacy of this treatment method and the feasability of its use in elderly and senile patients.

Keywords: cerebrovascular accident, st roke, atrial fibrillation, thromboextraction, thrombectomy, stent retriever, systemic thrombolytic therapy, penumbra.

For citation: Avdeeva V.E., Kotov A.S. Thrombectomy in stroke. RMJ. 2022;4:44–50.

Summary:

Possibilities of improving the efficacy of neuroprotective therapy in patients with acute and chronic cerebrovascular diseases, cognitive disorders and asthenic syndrome of various etiologies: Expert Committee resolution

On March 26, 2022, an Expert Committee was held in Moscow on the possibilities of improving the efficacy of neuroprotective therapy in patients with acute and chronic cerebrovascular diseases, cognitive disorders and asthenic syndrome of various etiologies. Much attention of experts was paid to the therapeutic possibilities of Brainmax®, which is an innovative national drug in the form of a fixed combination of two molecules: ethylmethylhydroxypyridine succinate and meldonium.

For citation: Danilov An.B., Danilov Al.B. Possibilities of improving the efficacy of neuroprotective therapy in patients with acute and chronic cerebrovascular diseases, cognitive disorders and asthenic syndrome of various etiologies: Expert Committee resolution. RMJ. 2022;4:51–54.

Summary:

Resorption of herniated intervertebral disc. Phenomenon of transient increase in size

A.M. Tkachev^1,2, A.V. Epifanov², E.S. Akarachkova³, A.V. Smirnova⁴, A.V. Ilyushin¹, I.E. Gordeeva^1,5

¹Tkachev Clinic, Volgograd

²Tkachev Epifanov Clinic, Moscow

³International Society "Stress under Control", Moscow

⁴Medical Institute named after Berezin Sergey, St. Petersburg

⁵Volgograd State Medical University, Volgograd

Background: conservative treatment of herniated intervertebral discs (HID) is commonly accompanied by a decrease in their size, which is called HID resorption. Currently, it has been revealed that a transient size increase can accompany the process of HID resorption. However, there is no data on this phenomenon frequency and its role in the resorption process.

Aim: to determine the frequency of pseudoprogression or transient size increase of HID and to determine its role in the process of HID resorption.

Patients and Methods: the study included 327 patients aged 43.2±9.4 years with herniated lumbar and cervical disc who underwent conservative physical therapy. Patients had a decrease in HID size by over 50%. All patients underwent from 3 to 9 MRI scans, depending on the rate of HID resorption. The follow-up period ranged from 1.5 to 18 months.

Results: in 285 (87.1%) patients, there was a transient size increase of the hernia tissue, which was accompanied by a signal amplification on T2-weighted pulse sequences in the period from 2 to 5 months (3.4±0.9 months) in 266 (81.3%) cases, after which a subsequent decrease in the HID size occurred. In 233 (71.2%) cases, there was an increase in the signal from HID. In 195 (59.6%) patients, partial restoration of the intervertebral disc height was noted. An improvement in vertebral column statics accompanied HID resorption in 85 (25.9%) patients.

Conclusion: a transient size increase of HID is a pseudoprogression phenomenon observed  during HID resorption. It can be a positive prognostic marker and should be considered as a presumable predictor of the HID resorption onset.

Keywords: herniated intervertebral disc, resorption, pseudoprogression, phenomenon of transient size increase.

For citation: Tkachev A.M., Epifanov A.V., Akarachkova E.S. et al. Resorption of herniated intervertebral disc. Phenomenon of transient increase in size. RMJ. 2022;4:7–10.

Summary:

A patient with functional biliary disorder. Specificity of therapeutic management

I.G. Pakhomova

V.A. Almazov National Medical Research Center, St. Petersburg

In recent years, the dramatic growth of functional gastrointestinal disorders (including biliary tract disorders) has been reported. Numerous factors (e.g., unhealthy diet, obesity, psychogenic factors, etc.) account for this phenomenon. In addition, diagnostic armamentarium has significantly improved. Functional biliary disorders include gallbladder and sphincter of Oddi dysfunction. This paper describes diagnostic approaches and management in a woman with functional gallbladder disorder. A complex algorithm involving changes in diet, lifestyle, and psychology is of crucial importance. Antispasmodics are among first-line medications. They target cystic duct sphincter in gallbladder dysfunction and sphincter of Oddi in its dysfunction. Therefore, medications with a selective effect on the biliary tract should be prescribed to achieve the maximum effect and minimize adverse reactions of functional biliary disorder treatment. Hymecromone, which provides a selective antispasmodic effect on the sphincter of Oddi and cystic duct, is considered one of these agents.

Keywords: functional biliary disorder, gallbladder dyskinesia, biliary pain, antispasmodics, hymecromone.

For citation: Pakhomova I.G. A patient with functional biliary disorder. Specificity of therapeutic management. RMJ. 2022;3:13–19.

Summary:

Understanding endothelial function and dysfunction: state-of-the-art (a review)

E.Yu. Yupatov¹, T.E. Kurmanbaev², Yu.L. Timoshkova²

¹Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education, Kazan

²S.M. Kirov Military Medical Academy, St. Petersburg

Tissue metabolism, which directly depends on blood flow velocity, is crucial for the normal functioning of human and animal organisms. Endothelial cells have an essential role in tissue respiration and metabolism. These cells are characterized by unique reparative activity extensively involved in angiogenesis throughout life. Various endothelial cells have metabolic properties that determine their functions during angiogenesis when stimulated with growth factors. Hypoxia is one of the principal stimulators of angiogenesis, thereby having a vital role in the pathogenesis of atherosclerosis and malignancies. Susceptibility to damaging factors accounts for endothelial dysfunction with increased vascular permeability, cytokine and adhesion molecule synthesis, generation of pro-thrombotic environment, and cell dedifferentiation. The result is organ dysfunction. Endothelial dysfunction is the critical element of many disorders, e.g., preeclampsia, atherosclerosis, and COVID-19 complications. This paper reviews current data on endothelial metabolism, involvement in angiogenesis, and the role of endothelial dysfunction in the COVID-19 pathogenesis.

Keywords: endothelium, angiogenesis, endothelial dysfunction, hypoxia, glycolysis, COVID-19.

For citation: Yupatov E.Yu., Kurmanbaev T.E., Timoshkova Yu.L. Understanding endothelial function and dysfunction: state-of-the-art (a review). RMJ. 2022;3:20–23.

Summary:

Myths and reality of statin therapy: answers to most pressing issues

I.V. Sergienko

National Medical Research Center of Cardiology, Moscow

Today, cardiovascular diseases (CVD) are the leading cause of mortality and disability worldwide. According to the WHO, mortality from CVD was 17.9 million (32% of all deaths worldwide) in 2019. According to the international and Russian guidelines, statins are the mainstay of medical treatment in high-risk patients and patients with established atherosclerotic CVD. Statins have numerous beneficial effects. However, in Russia and elsewhere, adherence to lipid-lowering therapy is low. These drugs receive unfounded criticism from the media and even some practitioners. The arguments against statin therapy include potential side effects. Since the efficacy and safety of these medications are clear, while the information on adverse effects is not mostly consistent with facts, we provide a scientific analysis of the efficacy and safety of lipid-lowering therapy, in particular, an original member of this class of drugs, atorvastatin.

Keywords: statins, cardiovascular diseases, hyperlipidemia, statin-associated muscle symptoms, cognitive disorders, safety.

For citation: Sergienko I.V. Myths and reality of statin therapy: answers to most pressing issues. RMJ. 2022;3:24–27.

Summary:

Analysis of the effect of long-term glycemic control on the course of subclinical diabetic neuropathy in type 2 diabetes

A.S. Fokina¹, A.V. Zilov¹, I.A. Strokov¹, T.A. Demura¹, Z.V. Surnina², V.V. Fadeev¹

¹I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

²Scientific Research Institute of Eye Diseases, Moscow

Background: distal symmetrical polyneuropathy (DSP) is the most common neurological complication of diabetes from the peripheral nervous system. DSP is a significant social medical issue due to a significant reduction in the duration and quality of life of patients with diabetes.

Aim: to assess the possibility of reversing the impairment of peripheral nerve fibers identified by up-to-date diagnostic techniques in patients with type 2 diabetes (T2D) and subclinical DSP in the setting of long-term (over 5 months) improvement of glycemic control.

Patients and Methods: electrophysiological, morphological, and morphometric parameters of peripheral nerve fibers in patients with T2D and subclinical DSP (n=40) were compared at baseline and after 5 months in the setting of the reduction and maintenance of target glycemia (HbA1c≤6.5%). Subclinical DSP was established by electroneuromyography. Punch crus skin b iopsy and immunohistochemistry of nerve fiber density (PGP 9.5 staining) were performed to assess thin nerve fibers and vascular supply of skin. Confocal laser scanning microscopy using the authors’ algorithm of data processing was performed to assess thin nerve fibers of the cornea.

Results: in patients with T2D and subclinical DSP, reduction and maintenance of target glycemia (HbA1c≤6.5%) over a 5-month period increased the sural sensory nerve action potential (р=0.010), significantly improved of skin flap morphology (p=0.025), increased the density of intradermal nerve fibers by 1.5 times (p=0.004) and the number of intradermal vessels per unit area (p=0.007), and decreased thin corneal nerve tortuosity (p≤0.05).

Conclusion: in T2D, a complex evaluation of the peripheral nervous system is needed in the early stages to detect subclinical DSP and avoid further complications. The improvement and maintenance glycemic control over a 5-month period resulted in reliable positive ch anges in small and, more importantly, large nerve fibers.

Keywords: type 2 diabetes, glycemic control, diabetic neuropathy, electroneuromyography, skin biopsy, confocal laser scanning microscopy.

For citation: Fokina A.S., Zilov A.V., Strokov I.A. et al. Analysis of the effect of long-term glycemic control on the course of subclinical diabetic neuropathy in type 2 diabetes. RMJ. 2022;3:28–33.

Summary:

Fluvoxamine capabilities in the therapy of COVID-19 and post-COVID syndrome

V.A. Petrov¹, M.L. Maximov^2–4, A.A. Zvegintseva³

¹A. Tsyb Medical Radiological Research Centre — Branch of the National Medical Research Radiological Centre, Obninsk

²Russian Medical Academy of Continuous Professional Education, Moscow

³Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education, Kazan

⁴Pirogov Russian National Research Medical University, Moscow

Amid a decrease in the COVID-19 incidence, the severity of its course and mortality, and the patient management with post-COVID syndrome remains relevant. Currently, the post-COVID symptoms include fatigue, pain (myalgia and arthralgia), reduced physical strength and endurance, performance capability, life quality, and daily activity. Common mental manifestations are anxiety disorders, depression, emotional stress, the development mechanism of which may be different: direct viral neurotropic effect, cytokine imbalance. The pharmacotherapy of post-COVID syndrome may include anti-inflammatory drugs, painkillers, psychopharmaceuticals, neurocytoprotectors, antiplatelet agents and anticoagulants, vitamins. Fluvoxamine, according to various trials, can be used not only during the early rehabilitation, providing a direct psychotropic effect but also as an antiviral drug for the treatment and prevention of severe COVID-19 course, which also has an anti-inflammatory, antiplatelet and immunomodulatory effect. The article determines the criteria that the patient must meet to start fluvoxamine therapy.

Keywords: new coronavirus infection, COVID-19, prevention, treatment, post-COVID syndrome, antidepressant, antiplatelet, anti-inflammatory effect, fluvoxamine, rehabilitation, pharmacotherapy, psychotropic effect.

For citation: Petrov V.A., Maximov M.L., Zvegintseva A.A. Fluvoxamine capabilities in the therapy of COVID-19 and post-COVID syndrome. RMJ. 2022;3:34–39.

Summary:

Clinical efficacy of "Nonphenic", a line of specialty foods for nutritional care in children, adults, and pregnant women with phenylketonuria: study results

N.A. Semenova¹, E.A. Shestopalova¹, G.V. Baydakova¹, T.P. Zhukova², S.Yu. Ratnikova², E.S. Zaytseva², L.R. Nurgalieva³, S.I. Kutsev¹

¹Research Center for Medical Genetics, Moscow, Russian Federation

²V.N. Gorodkov Ivanovo Research Institute for Maternity and Childhood, Ivanovo, Russian Federation

³Republican Medical Genetic Center, Ufa, Russian Federation

Background: phenylketonuria (PKU) was the first hereditary metabolic disease for which high diet efficacy preventing its symptoms was demonstrated. A low-protein diet and specialty foods lacking phenylalanine should be prescribed as early as possible to control plasma PKU levels. PKU treatment is challenging due to low adherence to the diet. New specialty foods were introduced to improve the quality of medical care for PKU.

Aim: to assess the efficacy of specialty foods for nutritional care in children, adults, and pregnant women with PKU.

Patients and Methods: open-label, multicenter, prospective approbation was performed in outpatient facilities. The study included 60 patients. Nine patients received "Nonphenic^®-13˝ designed for children under one year. Six patients received "Nonphenic^®-20˝ designed for children aged 1–3 years. Nineteen patients received "Nonphenic^®-40˝ designed for children aged 3–7 years. Eighteen patients received "Nonphenic^®-70˝ designed for children over seven years. Eight patients received "Nonphenic^®-75˝ designed for children over seven years, adults, and pregnant women. The treatment duration was 30±2 days. Clinical efficacy and safety were evaluated according to the Good Clinical Practice principles and based on clinical and laboratory findings.

Results: mean PKU levels reduced (significantly in patients who received "Nonphenic^®-70˝ and "Nonphenic^®-75˝) and were within safe ranges. Tyrosine levels were similar at the first and second visits and were within normal ranges. Parents and physicians were completely satisfied with the study products. Moreover, parents reported rapid adaptation to the novel food. No serious adverse events related to the study product which required treatment cancellation were reported during clinical approbation.

Conclusions: this study has demonstrated the clinical efficacy and safety of specialty foods for nutritional care in children, adults, and pregnant women with PKU.

Keywords: phenylketonuria, specialty foods for nutritional care, phenylalanine, diet therapy.

For citation: Semenova N.A., Shestopalova E.A., Baydakova G.V. et al. Clinical efficacy of ˝Nonphenic˝, a line of specialty foods for nutritional care in children, adults, and pregnant women with phenylketonuria: study results. RMJ. 2022;3:4–8.

Summary:

Therapy for osteoarthritis in undifferentiated connective tissue dysplasia

E.B. Klester, L.A. Plinokosova

Altay State Medical University, Barnaul

Aim: to assess the efficacy and tolerability of AMBENE^® Bio for knee osteoarthritis secondary to undifferentiated connective tissue dysplasia.

Patients and Methods: this study enrolled 150 women with established gonarthrosis (Kellgren–Lawrence grade 1–2) secondary to undifferentiated connective tissue dysplasia (median age 45.7 years, median disease duration 3.2 years) who received NSAIDs and AMBENE^® Bio. Monthly monitoring included physical examination, assessment using visual analogue scale (VAS) and self-assessment (WOMAC) over a 12-month period.

Results: after one month of treatment, pain severity at rest and movement-evoked pain severity measured by VAS decreased in 73.33% and 62% of women, respectively. The WOMAC score reduced from 27.57±6.35 to 6.12±1.35 (p<0.01). Six months after completion the first treatment course, pain severity increased, i.e., overall WOMAC score significantly increased to 17.32±2.12 (p<0.01). Repeated treatment course with AMBENE^® Bio reduced pain severity at rest and movement-evoked pain severity measured by VAS reduced in 88% and 74% of women. Overall WOMAC score reduced to 4.12±1.01 (p<0.01). Six months after re-treatment course with AMBENE^® Bio, pain at rest and movement-evoked pain reappeared only in 15.33% and 30% of women, respectively (measured by VAS). Overall WOMAC score was 8.14±1.78 (p<0,01).

Conclusion: AMBENE^® Bio reduces pain severity and need for NSAIDs. Re-treatment courses improve symptoms and prolong remission.

Keywords: undifferentiated connective tissue dysplasia, osteoarthritis, gonarthrosis, chondroprotectors, visual analogue scale, WOMAC, osteoarthritis treatment, non-steroidal anti-inflammatory drugs.

For citation: Klester E.B., Plinokosova L.A. Therapy for osteoarthritis in undifferentiated connective tissue dysplasia. RMJ. 2022;3:40–42.

Summary:

Osteoarthrosis of facet and costotransverse joints is the cause of chronic thoracic back pain

E.V. Yakovleva¹, A.N. Barinov²

¹I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

²JSC Group of companies Medsi, Moscow

Osteoarthrosis (or osteoarthritis) is one of the most common causes of reduced working capacity and quality of life. Disorders of facet and costotransverse joints is considered to be one of the leading causes of chronic thoracic and thoracic back pain. The authors describe their experience with diagnosing and treating chronic thoracic back pain in 52 patients aged 30–68 years. Facet and costotransverse joint syndrome as the leading cause of thoracic back pain was identified in 12 patients (23.07%). Patients were informed of a favorable prognosis, received recommendations on physical activity, and were prescribed non-steroidal anti-inflammatory drugs and myorelaxants. Within a month, the clinically significant analgesic effect of this therapy was achieved in 13 patients (25%). Thirty-nine patients (75%) proceeded to treatment using interventional techniques. This study has demonstrated that the interdisciplinary approach is most effective to manage chronic thoracic back pain.

Keywords: osteoarthrosis, osteoarthritis, facet syndrome, musculoskeletal pain, myofascial pain syndrome, interventional therapy, cognitive behavioral treatment, rehabilitation, etoricoxib.

Summary:

Post-stroke arthropathy: therapy experience using chondroprotective agents

E.A. Antipenko¹, D.V. Sedyshev², A.A. Sorokina²

¹Volga Research Medical University, Nizhny Novgorod

²Nizhni Novgorod Regional Clinical Hospital named after N.A.Semashko, Nizhny Novgorod

Aim: to evaluate the efficacy of AMBENE^®BIO use as part of complex rehabilitation of painful shoulder joint in post-stroke arthropathy.

Patients and Methods: 52 patients with painful arthropathy of the shoulder joint were included in the follow-up in the early period of ischemic stroke. All patients received a complex of rehabilitation actions conducted by a multidisciplinary rehabilitation team, including positioning, kinesiotherapy, physiotherapy, and occupational therapy. Adding that, they underwent basic therapy aimed at secondary prevention of stroke. Nonsteroidal anti-inflammatory drugs could not be used at this rehabilitation stage due to the contraindications. The main group (n=30) additionally received AMBENE^®BIO intramuscularly 10 times a day. The following parameters in the main group and the comparison group were evaluated: severity of pain syndrome by using a visual analog scale (VAS), the movement amplitude in the shoulder joint, and the achievement of rehabilitation goals on days 7, 14, and 21 of follow-up.

Results: statistically significant expansion of the passive range of motion in the shoulder joint was observed in both groups starting from day 7 of follow-up concerning shoulder abduction, and starting from day 14 concerning shoulder flexion and extension. However, the increase in positive tendency was more definite in the main group. The expansion of the passive range of motion in the shoulder joint led to an increase in the rehabilitation potential of patients. Thus, it allowed to achieve the specified rehabilitation goals related to the patient self-care.

Conclusion: the inclusion of AMBENE^®BIO in the rehabilitation complex in post-stroke arthropathy of the shoulder joint helps to reduce pain, expand the passive range of motion and increase the rehabilitation efficacy in this patient cohort.

Keywords: post-stroke arthropathy, painful shoulder syndrome, therapy with chondroprotective agents, post-stroke rehabilitation.

For citation: Antipenko E.A., Sedyshev D.V., Sorokina A.A. Post-stroke arthropathy: therapy experience using chondroprotective agents. RMJ. 2022;3:51–54.

Summary:

Social epidemiological pattern of scabies in gerontological patients

M.M. Tlish, T.G. Kuznetsova, Zh.Yu. Naatyzh, E.V. Erokhina

Kuban State Medical University, Krasnodar

Improving the quality and accessibility of preventive and rehabilitation care for elderly and senile patients is one of the primary goals of today’s healthcare. Limited self-care and mobility, multiple comorbidities, and social-economic volatility are relevant medical social factors predisposing to parasitic skin diseases in these age groups. In addition, age-related reduction in epidermal barrier reparation, immune dysfunction, and neurodegenerative disorders account for an atypical and severe course of infectious dermatoses, particularly in other somatic diseases. As a result, somatic comorbidities and dermatoses aggravate each other. This paper describes a scabies nidus in gerontological patients, addresses the epidemiological investigation results, and discusses significant aspects of scabies dissemination and course in these patients. Since scabies is currently a high-prevalent condition, the analysis of epidemiological locus and the areas of improving medical social care in elderly and senile patients are relevant for dermatology, gerontology, and related disciplines

Keywords: scabies, epidemiological focus, gerontological patients, interdisciplinary approach, medical social care, health care quality.

For citation: Tlish M.M., Kuznetsova T.G., Naatyzh Zh.Yu., Erokhina E.V. Social epidemiological pattern of scabies in gerontological patients. RMJ. 2022;3:55–58.

Summary:

Kindler syndrome: a rare type of inherited epidermolysis bullosa

K.M. Gadzhimuradova¹, O.V. Zhukova², M.N. Gadzhimuradov¹, S.N. Aliyeva³

¹Dagestan State Medical University, Makhachkala

²Moscow Research and Practical Center for Dermatovenereology and Cosmetology, Moscow

³Republican Dermatovenerologic Dispensary, Makhachkala

Kindler syndrome (KS) is a rare autosomal recessive inherited genodermatosis, which manifests as bullae on the skin and mucous membranes from birth. Pathognomonic symptom consists of a combination of photosensitivity, poikiloderma and skin atrophy with structural gum weakness. Diagnosis of KS is based on clinical data and a detailed family history. The article presents a clinical case of an 11-year-old male patient with KS, who suffers from the bullous elements in the oral area and nail deformities from infancy. Among the disease manifestations there are carious teeth, malocclusion, ankyloglossia, atrophic glossitis, skin photosensitivity, visual deterioration, dyspnea. Adding that, the patient family history and presented disease manifestations attracts attention. His father, uncle and grandmother suffer from inherited nail pathology — onychogryphosis, and his mother — severe skin photo sensitivity. It can be assumed that recessive carriage of this gene may manifest as onychogryphosis, as well as cutaneous itching in response to sun exposure. The patient management with KS provides for symptomatic treatment, the creation of a safe environment and regular follow-up by a dermatologist and related specialists.

Keywords: inherited epidermolysis bullosa, Kindler syndrome, family history, poikiloderma, recessive gene.

For citation: Gadzhimuradova K.M., Zhukova O.V., Gadzhimuradov M.N., Aliyeva S.N. Kindler syndrome: a rare type of inherited epidermolysis bullosa. RMJ. 2022;3:59–63.

Summary:

Steatohepatosis and steatohepatitis in overweight children: therapeutic methods

A.A. Zvyagin, N.Yu. Fateeva, T.V. Chubarov, O.A. Zhdanova

Voronezh State Medical University named after N.N. Burdenko, Voronezh

The article presents data on the treatment of non-alcoholic fatty liver disease (NAFLD), commonly presented in overweight children (up to 77%). This pathology is based on the lipid accumulation in hepatocytes and the cell death in the liver with progressive inflammation, apoptosis and fibrosis. NAFLD includes several forms: steatosis, steatohepatitis, fibrosis. Steatosis and steatohepatitis are reversible stages in complex therapy. Since these pathological conditions in most cases are associated with overweight or obesity, the treatment of children with this pathology includes both non-drug methods (lifestyle modification, diet therapy, physical activity) and the use of different pharmacological drugs, biologically active substances with antioxidant effects (omega-3, omega-6 fatty acids, α-tocopherol, docosahexagenoic acid, choline, astaxanthin). The best known drugs for non-alcoholic steatohepatosis and steatohepatitis are preparations with ursodeoxycholic acid (UDCA). These preparations can become a promising group to treat various NAFLD forms because of their hepatoprotective, choleretic, cholelitholytic, hypocholesterolemic effect in combination with diet therapy and physical activity.

Keywords: steatohepatosis, steatohepatitis, non-alcoholic fatty liver disease, children, ursodeoxycholic acid, treatment, children.

For citation: Zvyagin A.A., Fateeva N.Yu., Chubarov T.V., Zhdanova O.A. Steatohepatosis and steatohepatitis in overweight children: therapeutic methods. RMJ. 2022;3:–12.

Summary:

Structural and functional patterns of myocardial changes in the pathogenesis of diabetic cardiomyopathy in type 1 diabetes mellitus

A.E. Goldshmid, N.A. Balakshina, Yu.S. Eremina, I.V. Poluboyarinova, V.V. Fadeev

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

Cardiovascular diseases (CVD) are the main cause of fatal outcome in patients with type 1 diabetes mellitus (DM). The definition of diabetic cardiomyopathy includes structural and functional changes in the myocardium (in diabetes without manifestations of coronary heart disease (CHD) or hypertension), due to which it is difficult to isolate the diabetic cardiomyopathy. DM causes endothelial dysfunction and early atherosclerosis. At the same time, hyperglycemia does not affect the left ventricular ejection fraction, and the presence of hypertrophy is an optional sign for ventricular dysfunction. It is unclear whether diabetes affects myocardial function without late complications. DM leads to a decrease in myocardial glucose uptake and glucose oxidation. Due to this, it results in cardiovascular performance reduction, energy generation and loss of "metabolic fl exibility". Insulin resistance in DM is one of the pathogenesis links and may be an important therapeutic target. In patients with DM, the increased risk of CVD development is underestimated. There are also no tools for stratification and prevention of CVD.

Keywords: diabetes mellitus, cardiovascular diseases, ventricular dysfunction, diabetic cardiomyopathy, hyperglycemia, endothelial dysfunction, atherosclerosis.

For citation: Goldshmid A.E., Balakshina N.A., Eremina Yu.S. et al. Structural and functional patterns of myocardial changes in the pathogenesis of diabetic cardiomyopathy in type 1 diabetes mellitus. RMJ. 2022;1:15–19.

Summary:

Benefits in inhibition of sodium-glucose cotransporter-1 in clinical practice

E.S. Maloletkina, V.V. Fadeev

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are a relatively new class of drugs used for the treatment of type 2 diabetes mellitus (DM2). Using SGLT-2 inhibitors in clinical practice is of interest not only to endocrinologists but also to doctors of related specialties. The article presents a review of studies on the efficacy and safety of a drug from the SGLT-2 inhibitors group — canagliflozin. Canagliflozin has an additional double insulin-independent mechanism of action relative to other representatives of SGLT-2 inhibitors class. It is associated with the inhibition of not only SGLT-2 in the kidneys but also SGLT-1 in the intestine and kidneys, which can contribute to better control of glycemia level, including postprandial glucose. In clinical studies, canagliflozin has proven its efficacy in reducing the risk of adverse cardiovascular events, as we ll as the risks associated with heart failure in patients with DM2. The presented nephroprotective properties of canagliflozin formed the basis of a registered indication to reduce the risk of renal and cardiovascular outcomes in patients with DM2 and diabetic nephropathy. The favorable safety and tolerability profile of the drug allows its widespread use in patients with DM2.

Keywords: sodium-glucose cotransporter-2 inhibitors, diabetes mellitus, nephropathy, nephroprotection, cardiovascular events, heart failure.

For citation: Maloletkina E.S., Fadeev V.V. Benefits in inhibition of sodium-glucose cotransporter-1 in clinical practice. RMJ. 2022;1:20–25.

Summary:

Is there any correlation between thyroid cancer, microelements, obesity, and insulin resistance?

L.V. Kvitkova, A.S. Khalimova

Kemerovo State Medical University, Kemerovo

In recent years, the prevalence of thyroid nodules has been growing. The role of external factors provoking thyroid carcinogenesis (e.g., exposure of carcinogens and mutagens, oxidative stress, etc.) is established. The role of the abnormalities of microelement content in the human body, obesity, high insulin concentrations, and insulin resistance in inducing oncogenic signal pathways in thyroid cells is currently studied. This paper reviews the role of microelement imbalance, imbalanced nutrition, obesity, and insulin resistance in the development of thyroid cancer. Intake of food supplements containing microelements and elimination of microelement imbalance are assumed to prevent thyroid cancer, given their crucial role in thyroid carcinogenesis. However, these issues are to be clarified. The authors discuss the favorable effect of metformin on thyroid functions in patients with insulin resistance and hypothyroidism since metformin is known to protect from cancer by inhibiting proliferation and carcinogenesis and regulating cellular aging and apoptosis. Metformin provides both direct and indirect anticancer effects. Further studies on these medications are needed to clarify their therapeutic and preventive role in thyroid carcinogenesis.

Keywords: carcinogenesis, obesity, insulin resistance, abnormal microelement content, metformin.

For citation: Kvitkova L.V., Khalimova A.S. Is there any correlation between thyroid cancer, microelements, obesity, and insulin resistance? RMJ. 2022;1:26–30.

Summary:

Clinical relevance of histopathology in foot osteomyelitis in diabetic osteoarthropathy

E.P. Burleva¹, Yu.V. Babushkina², L.N. Zaytseva¹

¹Ural State Medical University, Yekaterinburg

²Sverdlovsk Regional Clinical Hospital No. 1, Yekaterinburg

Aim: to assess the clinical relevance of osteomyelitis histopathology in diabetic osteoarthropathy.

Patients and Methods: clinical data of 17 patients with osteomyelitis in diabetic osteoarthropathy and histological samples collected during surgical resection were studied. At baseline, all patients were divided into three groups. Group 1 included 12 patients with acute osteomyelitis or its flare-up. Group 2 included 2 patients with quiescent chronic osteomyelitis. Group 3 included 3 patients with diabetic osteoarthropathy and soft tissue infection. Middle and posterior portions of the foot were predominantly affected (n=16). Standard histopathology with H&E stain and van Gieson’s stain was performed. Semi-quantitative assessment of samples using the Histopathological Osteomyelitis Evaluation Score (HOES), its sensitivity, specificity, the positive and negative prognostic value was determined. Clinical diagnoses and morphological reports were compared.

Results: two groups of conditions were isolated based on histopathology, i.e., osteomyelitis in diabetic osteoarthropathy (n=14: chronic osteomyelitis, n=13, and acute osteomyelitis, n=1) and diabetic osteoarthropathy without osteomyelitis (n=3). A description of these processes was provided. Articular cartilage lesions (e.g., dystrophy, thinning, and cracks) were diabetic osteoarthropathy hallmarks. Osteonecrosis, bone remodeling, and fibrosis were typical for diabetic osteoarthropathy and osteomyelitis. Cellular infiltration with lymphocytes and polymorphonuclear leukocytes (characteristic of infections) was also seen at the inflammatory phase of diabetic osteoarthropathy. Significant neutrophil infiltration of the bone marrow was a relevant morphological criterion of acute osteomyelitis in diabetic osteoarthropathy (n=1). Meanwhile, no relevant criteria for chronic (even active) osteomyelitis were identified. HOES sensitivity was 68.4%, specificity 20%, positive prognostic value 64.7%, and negative prognostic value 11.8%.

Conclusion: given similar histopathology (particularly in chronic osteomyelitis), the histopathological report cannot be considered a single criterion to verify osteomyelitis in diabetic osteoarthropathy. Both histopathology and HOES should be used to assess retrospectively non-invasive diagnostic tools for diabetic osteoarthropathy and osteomy elitis in diabetic osteoarthropathy.

Keywords: diabetic osteoarthropathy, osteomyelitis, histopathology, morphological diagnosis, Histopathological Osteomyelitis Evaluation Score.

For citation: Burleva E.P., Babushkina Yu.V., Zaytseva L.N. Clinical relevance of histopathology in foot osteomyelitis in diabetic osteoarthropathy. RMJ. 2022;1:3–8.

Summary:

Methods for assessing the malignant potential of thyroid nodes

Yu.S. Solomadin, Yu.P. Sych, V.V. Fadeev

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

Thyroid cancer (TC) ranks first in prevalence among malignant neoplasms of the endocrine glands. It accounts for 0.5% in the total structure of oncological diseases and up to 5% among head and neck cancers. The main task of the specialist in identifying the thyroid node is to assess the prognosis of tumor mass using ultrasound, radionuclide and molecular genetic diagnostics. The combination of ultrasound, cytological and radiological characteristics of the node makes up its phenotypic image. Ultrasound is the method of choice in the diagnosis of thyroid nodes, which allows to determine the indications for a fine needle aspiration (FNA). According to the FNA results, the article gives a cytological conclusion in accordance with the Bethesda classification: the thyroid node is assigned to one of 6 categories. At the same time, the most difficult to assess the ris k of malignancy are Bethesda III and IV categories (follicular tumors). The risk of follicular tumor malignancy varies from 6% to 30%, which requires diagnostic hemithyroidectomy with histology of the biopsy specimen or the use of molecular genetic research methods (mutations in RAS/MAPK, BRAFV600E, TERT, and microRNA expression). MIBI scintigraphy (methoxyisobutylisonitrile, labeled with 99mTc-pertechnetate) is a promising test for the exclusion of malignancy in follicular tumors. This review is devoted to the methods concerning preoperative assessment of the malignancy of thyroid follicular tumors.

Keywords: thyroid, nodular goiter, TIRADS classification, scintigraphy, 99mTc-MIBI, review.

For citation: Solomadin Yu.S., Sych Yu.P., Fadeev V.V. Methods for assessing the malignant potential of thyroid nodes. RMJ. 2022;1:31–35.

Summary:

Hypophosphatasia: a family rare disease

E.S. Romanenko

South Ural State Medical University, Chelyabinsk

Hypophosphatasia (HPP) is a rare hereditary disease characterized by a very diverse clinical manifestations, which hinders a timely diagnosis. The article presents a description of a family HPP — two brothers of the same family had the disease manifested in childhood. The first clinical symptoms began to appear in the first year of life. Clinical manifestations were typical for HPP: rickets-like lower limb deformities, muscle weakness, poor exercise tolerance, early tooth loss. The symptoms of the disease were observed from various organs and systems, which significantly affected the physical health and patients quality of life. Despite the typical clinical manifestations, the diagnosis of HPP was established in the older brother at the age of 6 years. Difficulties in the diagnosis led to a delayed prescription of therapy. It is possible to suspect HPP on the basis of a combination of disease clinical signs and chara cteristic changes according to X-ray examination. For differential diagnosis, it is necessary to determine the activity of alkaline phosphatase. The diagnosis is confirmed by the detection of a mutation in the ALPL gene based on the results of a molecular genetics. Early diagnosis of HPP is essential for the timely prescription of enzyme replacement therapy with asphotase alpha.

Keywords: hypophosphatasia, alkaline phosphatase, ALPL gene, stridor, enzyme replacement therapy, asphotase alpha.

For citation: Romanenko E.S. Hypophosphatasia: a family rare disease. RMJ. 2022;1:36–40.

Summary:

Combined hypoglycemic agent impact on the multifactorial development of glycemia in type 2 diabetes mellitus

A.V. Zilov, A.S. Fokina, V.V. Fadeev

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

The review discusses the issues concerning pancreatic islet cell dysfunction, the interaction of α-, β- and Δ-cells, the role of drugs that potentiate the incretin effect and their ability to affect the insulin resistance. Alogliptin, a typical representative of the DPP-4 inhibitors, increases the sensitivity of β-cells to the stimulating effect of food, elevating insulin secretion and inhibiting glucagon secretion. Pioglitazone is currently the main agonist of PPAR γ receptors. Its activity is aimed at increasing insulin sensitivity of muscles, liver, and adipose tissue. In recent years, both drugs have been well studied in the treatment of type 2 diabetes mellitus (DM2) in cardiovascular safety trials, as well as in non-alcoholic fatty liver disease and other conditions. The combination of these drugs significantly reduced HbA1c and fasting glycemia levels versus monotherapy in various groups of patients under the following terms: previously not receiving hypoglycemic drugs, previously receiving metformin, previously receiving a combination of metformin + pioglitazone. The presence of a finished dosage form of alogliptin + pioglitazone is convenient for patients, as it increases compliance with the treatment. This is one of the therapy options if there is intolerance or contraindications to metformin, or the next-line therapy if the use of metformin is ineffective in patients with DM2.

Keywords: alogliptin, pioglitazone, incretin effect, co mbination therapy, finished dosage form, insulin resistance.

For citation: Zilov A.V., Fokina A.S., Fadeev V.V. Combined hypoglycemic agent impact on the multifactorial development of glycemia in type 2 diabetes mellitus. RMJ. 2022;1:41–45.

Summary:

Biosimilars of aspart and lispro analogues in the insulin pump

E.N. Saverskaya¹, T.E. Eltysheva², D.S. Karpov², M.P. Korobkina², P.G. Zaikin²

¹Moscow State University of Food Production, Moscow

²Pharm-Holding CJSC, St. Petersburg

Background: insulin biosimilars hold a firm place in the treatment of patients with diabetes mellitus who need insulin therapy. The requirements for conducting trial confirming the biosimilar bioequivalence at the preclinical and clinical stages are regulated, which improves the biosimilar quality. Of particular interest is the use of biosimilar insulin analogues in the insulin pump.

Aim: to assess the stability of the produced substances (insulin biosimilars) according to the following indicators: quantitative determination, impurity content, pH level, as well as the dosing accuracy, and the tendency to catheter occlusion when used in insulin pumps.

Patients and Methods: aspart (RinFast^®) and lispro (RinLis^®) biosimilars were studied using the following pumps: MiniMed^TM 640G, MiniMed Paradigm REAL-Time (with continuous glucose monitoring) and Accu-Chek^® Combo. Studies on the dosing accuracy and the tendency to catheter occlusion were conducted using gravimetric analysis for 72 hours. Quantitative content analysis of insulin, related impurities and those exceeding the molecular weight of lispro was conducted with liquid chromatography for 72 hours at five points.

Results: the study demonstrated the stability of the substances produced by such indicators as quantitative determination, impurity content and pH level. The dosing accuracy of the used insulin pumps with both drugs corresponded to the initial dosing accuracy stated by the manufacturer. During the test, there was no occlusion signal, i.e. there was no tendency to catheter occlusion for 72 hours, which is equal to the recommended interval for infusion line replacement.

Conclusion: the stability of substances proven in these studies allows the use of RinFast^® and RinLis^® in insulin pumps.

Keywords: biosimilars, lispro, aspart, pump, occlusion, flash monitoring, insulin therapy.

For citation: Saverskaya E.N., Eltysheva T.E., Karpov D.S. et al. Biosimilars of aspart and lispro analogues in the insulin pump. RMJ. 2022;1:9–14.

Summary:

Pathogenically important risk factors for the progression of newly diagnosed infiltrative pulmonary tuberculosis

O.Z. Basieva, Z.K. Dzhagaeva, N.V. Kobesov, B.M. Maliev

North Ossetia State Medical Academy, Vladikavkaz

Aim: to evaluate the role of certain pathogenic factors (i.e., endogenous intoxication, lipid peroxidation, and immune imbalance) in the progression of tuberculosis and the potential tools to manage them.

Patients and Methods: this prospective cohort study included 60 patients aged 25–60 years with newly diagnosed infiltrative pulmonary tuberculosis (TB). All participants were divided into two groups (30 patients each). Comparison group patients (18 women [60%], mean age 47.2±3.6 years) received standard anti-TB treatment. Study group patients (16 women [53.3%], mean age 44.7±3.25 years) additionally received Imunofan^® (arginil-α-aspartil-lysil-valil-tyrosil-arginine), an immunoregulatory peptide (two series of 10–15 injections, 50 mg IM). Changes in clinical presentations, radiological findings, CBC parameters, indicators of intoxication, lipid peroxidation, antioxidant system, and immune functions were evaluated. Examinations were performed one and three months after starting treatment.

Results: infiltrative pulmonary TB is associated with significant alterations in homeostasis, e.g., endogenous intoxication, activation of lipid peroxidation and phospholipase, inhibition of antioxidant activity, and immune imbalance. These are important factors of TB progression. In patients with limited lung damage, the intensity of these predictors was minimal compared to patients with advanced disease associated with more severe and persistent impairments. The efficacy of standard anti-TB treatment was inadequate (less significant improvement in lab tests and lung tissue infiltration) .

Conclusions: immunoregulatory peptide as a part of complex treatment of newly diag-nosed infiltrative pulmonary TB at early stages provides a focused and relatively fast effect on pathogenically important alterations of homeostasis. Imunofan^® improves infection course and helps eliminate the pathogen.

Keywords: tuberculosis, endotoxicosis, lipid peroxidation, phospholipase, antioxidant system, immunity.

For citation: Basieva O.Z., Dzhagaeva Z.K., Kobesov N.V., Maliev B.M. Pathogenically important risk factors for the progression of newly diagnosed infiltrative pulmonary tuberculosis. RMJ. 2022;2:11–15.

Summary:

The effect of using an extrafine combination of beclomethasone/formoterol at an early stage of COPD model formation

O.N. Titova¹, N.A. Kuzubova¹, E.S. Lebedeva¹, Т.N. Preobrazhenskaya²

¹I.P. Pavlov First Saint-Petersburg State Medical University, St. Petersburg

²S.M. Kirov Military Medical Academy, St. Petersburg

Aim: to evaluate the effect of an extrafine combination of the glucocorticosteroid beclomethasone and the long-acting β₂-adrenomimetic formoterol at an early formation stage of an experimental model of chronic obstructive pulmonary disease (COPD).

Patients and Methods: a COPD model was reproduced in rats using inhaled nitrogen dioxide 60-day exposure. Starting from the 16th day of exposure, the experimental group received daily inhalations of beclomethasone/formoterol, while the control group received a placebo. At the end of the 60-day exposure, the cellular composition and cytokine profile of bronchoalveolar lavage (BAL), the content of secretory IgA (SIgA) and surfactant proteins B and D (SP-B and SP-D) were determined. Histology of the lungs was performed.

Results: neutrophils, lymphocytes and proinflammatory mediators count significantly increased in the BAL of the control group. Pulmonary epithelium damage (areas of desquamation, dystrophy and atrophy, squamous metaplasia, goblet cell hyperplasia, the inverted ratio of the number of ciliated and g oblet cells, signs of pulmonary emphysema) was accompanied by a deterioration in its functional activity (SIgA, SP-B, SP-D). In the experimental group, the cellular and cytokine composition of BAL did not differ from the intact values. In the bronchial epithelium, there were no areas of exfoliated epithelial cells, denuded basement membrane, areas of dystrophy, atrophy, and squamous metaplasia. The ratio of ciliated and goblet cells corresponded to the norm (5:2). There were no signs of airway wall remodeling and emphysema. Secretory IgA and surfactant protein B and D count in BAL did not significantly differ from the values of the intact group.

Conclusion: the use of an extrafine combination of beclomethasone/formoterol (at the stage of initial structural damage to the respiratory tract caused by nitrogen dioxide poisoning) allowed to prevent excessive damage to the bronchoalveolar epithelium, significantly reduce the neutrophilic inflammation activity, preserve the immune func tion of the bronchial epithelium and prevent the morphofunctional picture formation of the COPD model (characteristic of animals that did not receive the treatment).

Keywords: COPD, beclomethasone/formoterol, extrafine combination, neutrophil, inflammation, small airway dysfunction, proinflammatory cytokines, surfactant proteins.

For citation: Titova O.N., Kuzubova N.A., Lebedeva E.S., Preobrazhenskaya Т.N. The effect of using an extrafine combination of  beclomethasone/formoterol at an early stage of COPD model formation. RMJ. 2022;2:16–20.

Summary:

The incidence of asthma in children of the Moscow region: epidemiological characteristics

T.A. Bokova^1,2, D.A. Kartashova¹, E.V. Troitskaya¹

¹M.F. Vladimirskiy Moscow Regional Research and Clinical Institute, Moscow

²Pirogov Russian National Research Medical University, Moscow

Aim: to study the prevalence of asthma (A) in children of the Moscow region and the distribution peculiarities of incidence indicators depending on the age, gender and area of residence.

Patients and Methods: a descriptive epidemiological study was performed using data from the annual report forms of Federal Statistical Monitoring No. 12 «Information on the number of diseases registered in patients living in the service area of a medical institution» concerning the child population (including 0 to 17 years) for 2020.

Results: diagnosis of A (J45.0–45.9) registered in 17,757 children, which was 1.2% of the total child population in the region. Boys — 67%, girls — 33%. The total incidence of A was 116.5 per 10,000 children in the Moscow region. The average age of children with A was 11.6±3.86 years. The age at the time of diagnosis was 9.6±4.06 years. Atopic asthma (J45.0) (80.2%) was registered more commonly, while unspecified (J45.9) (17.4%), mixed (J45.8) (2.1%) and non-allergic (J45.1) (0.3%) were less common. The highest incidence rates of A per 10,000 children were registered in the following cities: Dubna (161.5), Zhukovsky (145.4), Shchelkovo (135.2) and Klin (133.0); the smallest — in Naro-Fominsk (37.0), Solnechnogorsk (31.7) and Chekhov (31.8). Atopic A was registered more commonly (62–99%) in all regions. The highest percentage of unspecified A was in the following cities: Khimki (35.9%), Naro-Fominsk (27.7%), Domodedovo (26.9%), Pushkino (24.8%), Orekhovo-Zuyevo (21.0%); the smallest — in Zhukovsky (0.4%), Dubna (0.5%). The mixed and non-allergic forms of A were registered less commonly and not in all regions.

Conclusions: the indicators concerning the general incidence of A are characterized by heterogeneity and a significant spread, which, along with differences in the diagnosis frequency of various disease forms, can be explained both by the environmental characteristics of the area of residence and a possible problem of hypo- or overdiagnosis, which requires further study and clarification.

Keywords: bronchial asthma, children, incidence, prevalence, environmentally caused diseases, differential diagnosis.

For citation: Bokova T.A., Kartashova D.A., Troitskaya E.V. The incidence of asthma in children of the Moscow region: epidemiological characteristics. RMJ. 2022;2:2–5.

Summary:

Long-term oxygen therapy in the treatment of patients with respiratory failure due to congenital kyphoscoliosis

N.A. Kuzubova, O.N. Titova, D.B. Sklyarova, A.L. Alexandrov

I.P. Pavlov First St. Petersburg State Medical University, St. Petersburg

Background: chest wall distortion in kyphoscoliosis leads to severe restrictive disorders, alveolar hypoventilation and pulmonary gas exchange abnormalities. The role of long-term oxygen therapy (LTOT) in kyphoscoliosis has not been sufficiently studied.

Aim: to determine the effect of LTOT on the clinical course, pulmonary gas exchange parameters and hemodynamics in patients with congenital kyphoscoliosis complicated by chronic respiratory failure (CRF).

Patients and Methods: 30 patients with congenital kyphoscoliosis and CRF (mean age 55.62±6.9 years) were examined. The patients were divided into 2 groups: group 1 — 20 patients with hypoxemia (partial pressure of oxygen in arterial blood (PaO₂): 57.68±7.24 mm Hg) and hypercapnia (partial pressure of carbon dioxide in arterial blood (PaCO₂): 52.8±of 6.96 mm Hg) treated with LTOT for 16 h per day at a flow rate of 3 L/min; group 2 — 10 patients with hypoxemia (PaO₂: 55.92±6.67 mm Hg) and hypercapnia (PaCO₂: 51.2±7.21 mm Hg) who did not receive LTOT. Echocardiography, spirometry, arterial blood gas test were performed at intervals of 1 year. The number of hospitalizations during the year was estimated.

Results: initially, patients from both groups had significant restrictive disorders in the lungs, hypertrophy and right heart dilatation, an increase of pulmonary artery systolic pressure (PASP) to 46.35±7.64 mm Hg, right ventricular diastolic dysfunction. LTOT helped to reduce the dyspnea severity, improve gas exchange: PaO₂ was 72.68±7.24 mm Hg (p<0.05), PaCO₂ — 40.8±5.25 mm Hg (p<0.05). In group 1, there was a decrease of PASP — 39.15±5.33 mm Hg (versus baseline, р<0.05), a decrease in the size and improvement in the right ventricular diastolic dysfunction (versus group 2 indicators, p<0.05). The number of hospitalizations during LTOT has significantly decreased.

Conclusion: LTOT use in patients with kyphoscoliosis and CRF helps to reduce the dyspnea severity, reduce the hospitalizations number, improve pulmonary gas exchange and cardiopulmonary hemodynamics.

Keywords: kyphoscoliosis, hypoxemia, long-term oxygen therapy, pulmonary hypertension, diastolic dysfunction, right ventricle.

For citation: Kuzubova N.A., Titova O.N., Sklyarova D.B., Alexandrov A.L. Long-term oxygen therapy in the treatment of patients with respiratory failure due to congenital kyphoscoliosis. RMJ. 2022;2:21–24.

Summary:

The topical antibiotic therapy in ENT practice

T.Yu. Vladimirova¹, N.V. Volov²

¹Samara State Medical University, Samara 

²«Outpatient centre No.1», Samara

Aim: to evaluate the clinical efficacy of framycetin solution for intranasal use in the complex therapy of acute bacterial rhinosinusitis (moderate severity).

Patients and Methods: a prospective randomized controlled study included 80 patients (mean age 33.13±8.5 years) with acute bacterial rhinosinusitis. The study participants were randomly assigned to two groups of 40 people: main and control. Patients in both groups received standard therapy in accordance with current clinical guidelines. In the main group, in addition, topical antibacterial therapy with framycetin in the dosage form of a nasal spray 1.25% was prescribed. The effectiveness of the therapy was assessed on the basis of anterior rhinoscopy data (the severity of mucosal edema and the presence of discharge on a 10-point visual analogue scale, VAS), the results of the SNOT-22 questionnaire, and a 10-point VAS for determining the severity of the condition. The examination was carried out at the primary outp atient appointment with an otorhinolaryngologist and again after 5 and 10 days.

Results: during the study in both groups, a stable positive trend of complaints and clinical status was demonstrated, which persisted throughout the entire follow-up period. According to the results of the study, on the 5th day of therapy, the frequency of complaints, which were marked as the main ones by the majority of patients, in the main group was lower than in the control group, more than 2 times, and the severity of almost all the main symptoms in this group was 3 times less than in the control group. The complete absence of complaints after treatment in the main group was noted by 15% of the examined, in the control group — by 10%. At the same time, only in the control group remained 5% of patients who assessed their condition as severe. According to the data of anterior rhinoscopy, upon re-examination on the 5th day, the swelling of the nasal mucosa in the main group corresponded to 5.20 10.45 points versus 8.0±0.65 points in the control group, the presence of discharge – 7.10±0.45 points and 7,4±0,5 points, respectively, on the 10th day – 3.6±0.3 points and 4,7±0,52 points, 2.8±0.3 points and 3,6±0,6 points, respectively.

Conclusion: a drug based on framycetin spray has a positive effect on the dynamics of the course of acute bacterial rhinosinusitis, improves overall well-being by restoring nasal breathing, which indicates the expediency of its use in the complex therapy of acute bacterial rhinosinusitis.

Keywords: rhinosinusitis, difficulty in nasal breathing, topical therapy, framycetin, spray, quality of life.

For citation: Vladimirova T.Yu., Volov N.V. The topical antibiotic therapy in ENT practice. RMJ. 2022;2:25–30.

Summary:

Symptomatic treatment of nasal congestion: improving the efficacy and safety of topical therapy

M.R. Bogomilsky ¹, E.Yu. Radtsig¹, N.D. Pivneva²

¹Pirogov Russian National Research Medical University, Moscow

²Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow

Background: nasal congestion is one of the most common complaints in pediatric practice. To reduce the severity of the adverse events (nose burning sensation, dry nasal mucosa, etc.) after the use of topical decongestants (TDs) in acute rhinitis, it is proposed to additionally use products with regenerating, protective and moisturizing effects.

Aim: to evaluate the treatment efficacy and tolerability during uncomplicated acute rhinosinusitis with a combination of xylometazoline and a complex preparation based on hyaluronic acid, vitamin E and lemon essential oil (Olyfrin).

Patients and Methods: a prospective single-center continuous non-randomized comparative study included patients aged 3 to 18 years with symptoms of acute infectious rhinitis, who were randomly divided into 2 groups. In group 1, patients received TDs: nasal spray with xylometazoline and a complex preparation based on hyaluronic acid, vitamin E and lemon essential oil (in the form of a nasal spray); in group 2 — only xylometazoline TD. The duration of TD use for therapeutic purposes was 7 days. Group 1 continued to use the complex preparation from day 8 to day 30. The following actions were performed in each of the groups: complaints evaluation, a routine ENT examination on the day of inclusion in the study, on the 7th and 30th day from the treatment initiation, including recording the results (evaluated on a 10-point VAS scale) in the patient’s chart.

Results: on the 7th day from the treatment initiation, patients of both groups noted an improvement in their condition. However, only in group 1, the dry nasal mucosa, nasal crusting, and especially bloody boogers in the nasal cavity were statistically significantl y (p<0.05) less (in terms of detection frequency and severity) than in the group 2. Recurrent episodes of rhinitis from the 7th to the 30th day of treatment in the group 1 were recorded in 14 (35%) patients, in group 2 — 37 (93%) (p<0,001).

Conclusions: the use of preparations with protective, regenerating and antioxidant effect on the nasal mucosa in the treatment of acute rhinitis can significantly reduce the adverse evetns after TDs use and shorten the recovery period of the epithelium and nasal mucosa after the inflammatory process.

Keywords: acute rhinitis, decongestants, xylometazoline hyaluronic acid, tocopherol, dry nasal mucosa, relapse.

For citation: Bogomilsky M.R., Radtsig E.Yu., Pivneva N.D. Symptomatic treatment of nasal congestion: improving the efficacy and safety of topical therapy. RMJ. 2022;2:31–35.

Summary:

Modern aspects of larynx and trachea prosthesis after reconstructive surgery

E.A. Kirasirova^1,2, N.D. Oltarzhevskaya³, T.S. Khlystova³, M.I. Usova¹, N.V. Lafutkina¹, R.F. Mamedov¹, R.A. Rezakov¹, E.V. Kulabukhov², S.I. Tyutina¹, E.A. Egorova¹

¹Clinical Research Institute of Otorhinolaryngology named after L.I. Sverzhevsky, Moscow

²Pirogov Russian National Research Medical University, Moscow

³Coletex LLC, Moscow

Background: one of the significant stages concerning patient management after reconstructive surgeries of larynx and trachea is the formed airway lumen prosthesis.

Aim: to evaluate the efficacy of the developed sodium alginate hydrogel for the larynx and trachea prosthesis in the treatment of patients with chronic cicatricial stenosis of the larynx and trachea and bilateral laryngeal paralysis.

Patients and Methods: in 2018–2021, 51 patients were examined and treated in the Department of Reconstructive Surgery of Hollow Neck Organs. 30 patients of the main group had the laryngeal and tracheal lumen prosthesis in the intra- and postoperative period using the developed hydrogel tampon. 21 patients of the control group had an elastic or Merocel tampon inserted into the laryngeal-tracheal lumen according to the standard procedure. The article pre sents conducted endoscopic and cytological studies to evaluate the larynx and tracheal prosthesis results with proposed tampon.

Results: according to endoscopy in the main group, there were no inflammatory phenomena after tampon removal and the beginning of epithelialization in the mucous membrane of the larynx and trachea was already established 7 days after surgery. The cytology of inflammatory touch smears was noted up to 5 days. Starting from 6 to 7 days, an inflammatory-regenerative cytogram was noted. According to the results of further follow-up, there was no restenosis of the laryngeal and tracheal lumen. Adding that, implanted allogeneic structures were not rejected. The long-term results of surgical treatment were satisfactory: there were no complications in the postoperative period, repeated surgeries were not required. In the control group, inflammatory phenomena of the postoperative area were observed for 7–12 days after tampon removal. Epithelization of the wounded area began 8 days after surgery. The cytogram with inflammatory activity persisted for 5–10 days after tampon removal from the laryngeal and tracheal lumen. There were complications in 5 patients developed from 2 weeks to 2 months, 4 of them required repeated surgical interventions.

Conclusion: the obtained preliminary data indicated the prospects of intra- and postoperative use of a sodium alginate h ydrogel tampon for prosthesis of the laryngeal and tracheal lumen.

Keywords: larynx, trachea, cicatrical stenosis, prosthesis, reconstructive surgery, sodium alginate.

For citation: Kirasirova E.A., Oltarzhevskaya N.D., Khlystova T.S. et al. Modern aspects of larynx and trachea prosthesis after reconstructive surgery. RMJ. 2022;2:36–40.

Summary:

Choosing an optimal medical equipment for surgical interventions in the nasal cavity

S.A. Karpishchenko, M.A. Ryabova, M.Yu. Ulupov, N.A. Shumilova, E.K. Tikhomirova, G.V. Portnov

Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg

Modern rhinosurgery is characterized by the widespread introduction of minimally invasive endonasal endoscopic techniques using the latest technological solutions. Surgical manipulations in the nasal cavity must meet strict criteria of efficiency and safety. The development of native endoscopic, laser and electrical equipment has made it possible to conduct operations both in inpatient and outpatient conditions, which increases the requirements for comfort and painlessness of intervention. The possibility concerning simultaneous use of endoscopic techniques allows better visualization of the surgical site and reduces the risks of postoperative complications. It is no coincidence that various surgical methods in the nasal cavity (using laser and electronic radio-wave equipment) have become widespread. In this article, the most effective and safe surgical treatment methods for nasal cavity diseases  conducted with the help of laser and electrocautery are considered (the benefits of their use are also indicated). The author presents his experience of using laser and electrosurgical medical equipment in the treatment of chronic rhinitis, nasal synechiae, recurrent nosebleeds, vascular tumors of the nasal cavity. The importance of the correct exposure mode selection and strict compliance with the procedure regulations were emphasized, which reduces the risk of intra- and postoperative complications.

Keywords: rhinosurgery, laser, 0.97µm, 1.56 µm, 1.94 µm, electrocoagulation, electrocauter, monopolar, bipolar.

For citation: Karpishchenko S.A., Ryabova M.A., Ulupov M.Yu. et al. Choosing an optimal medical equipment for surgical interventions in the nasal cavity. RMJ. 2022;2:41–45.

Summary:

Nasal obstruction after coronavirus infection caused by the omicron strain (clinical case)

I.M. Kirichenko^1,2, Popadyuk V.I.¹, N.S. Kozlova²

¹Peoples’ Friendship University of Russia, Moscow

²ON CLINIC Arbat LLC, Moscow

The pandemic of the new coronavirus disease 2019 (COVID-19) preserves for over two years. During this period, according to the WHO statistics, over 260 million confirmed cases of COVID-19 have been registered, including more than five million deaths caused by COVID-19. The new SARS-CoV-2 Omicron virus is the most rapidly spreading variant that occurs in adults with SARS symptoms. Symptoms of ENT organ lesion, such as rhinorrhea, nasal obstruction, tickling sensation and sore throat, commonly come to the fore. In some cases, there can be an exacerbation of chronic ENT diseases, such as tonsillitis, sinusitis, otitis media. The transport function of the nasal mucosa and paranasal sinuses is disrupted. The combination of topical mucolytic therapy and light decongestants can improve drainage function and prevent the development of congested inflammation in the sinus, leading to nasal breathing improvement. The authors present their clinical case concerning exacerbation of chronic sinusitis after COVID-19 in a male patient with allergic rhinitis and structural changes in the nasal cavity.

Keywords: ARVI, COVID-19, omicron strain, mucolytic therapy, decongestant, sinusitis.

For citation: Kirichenko I.M., Popadyuk V.I., Kozlova N.S. Nasal obstruction after coronavirus infection caused by the omicron strain (clinical case). RMJ. 2022;2:46–49.

Summary:

Topical therapy of acute tonsillopharyngitis

S.A. Karpischenko, O.M. Kolesnikova

Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg

Sore throat and acute tonsillopharyngitis account for more than 2% and 5% of the causes of all outpatient seeking for primary care in adults and children, respectively. Bacterial infection can occur primarily or secondarily, as a result of the pathogenic microflora overlay during viral infection or by increasing the opportunistic microflora growth, in the ENT organs. Topical therapy is one of the key stages in the treatment of acute tonsillopharyngitis. The clinical recommendations recommend topical therapy in the form of rinses, orodispersible tablets and sprays. Topical therapy can be combined, including a stage of gargarism, which allows to mechanically wash off pathogens, formed plaque with pathogen accumulation and food particles (infection source of the already inflamed pharyngeal mucosa. When choosing antimicrobials for topical therapy, preference should be given to those with a low-resistance potential, as well as with a favorable safety profile. The authors cite a clinical case of a female patient with acute tonsillopharyngitis. The prescription of a topical antimicrobial agent (nitrofural) allowed to quickly alleviate the disease symptoms and prevent the use of a systemic antibacterial drug.

Keywords: acute tonsillopharyngitis, tonsillitis, antibiotic resistance, antibiotic therapy, nitrofural, clinical recommendations.

For citation: Karpischenko S.A., Kolesnikova O.M. Topical therapy of acute tonsillopharyngitis. RMJ. 2022;2:50–54.

Summary:

Patterns of the community-acquired pneumonia course associated with SARS-CoV-2 in children

N.A. Belykh¹, N.A. Anikeeva¹, A.Yu. Panferukhina¹, N.N. Fokicheva², S.A. Shilina², 

M.V. Faletrov², N.Yu. Fedoseeva², V.V. Mayboroda¹, V.V. Goryachev², O.A. Solovyova¹

¹Ryazan State Medical University, Ryazan

²City Clinical Hospital No. 11, Ryazan

Aim: to study the clinical and laboratory patterns of community-acquired pneumonia course associated with SARS-CoV-2 in children.

Patients and Methods: a study included 55 children (30 boys, 25 girls) hospitalized in City Clinical Hospital No. 11 (Ryazan) from April 2020 to March 2021 with an established diagnosis: COVID-19, community-acquired pneumonia.

Results: among the examined patients, there was a predominance of children over 12 years (61.8%). 32 (58.2%) patients had an intrafamilial transmission with laboratory-confirmed cases of COVID-19 in relatives. 17 (30.9%) patients had various comorbidities, mainly obesity, diseases of the cardiovascular and central nervous system. The main clinical manifestations in patients who underwent the follow-up were intoxication, respiratory tract lesions and gastrointestinal symptoms. In 63.6% of cases, lung damage corresponded to mild severity (CT-1). IgM antibodies to Mycoplasma pneumoniae were detected in 15 (27.3%) patients, and pathogens of different species (among which pneumococci were the dominant pathogens) were sown by bacteriologic culture technique when analyzing a throat swab in 29 (52.7%) children. At the same time, mixed mycoplasma pneumonia infection was registered in 6 (10.9%) cases. A direct correlation was revealed between the stage of lung dama ge and C-reactive protein level (r=0.31, p=0.019), ALT (r=0.30, p=0.05) and lactate dehydrogenase (r=0.27, p=0.05), as well as the presence of concomitant diseases (r=0.41, p=0.002). There was a positive trend in the condition of all patients during the ongoing therapy.

Conclusion: in SARS-CoV-2-associated pneumonia, concomitant respiratory infection of mycoplasma, pneumococcal and mixed (Mycoplasma pneumoniae) etiology was most commonly detected (16.4, 12.7 and 10.9%, respectively). A statistically significant positive correlation was found between the stage of lung damage and the presence of concomitant diseases, as well as a deviation from the norm of several laboratory parameters. In timely treatment, most patients had a favorable disease outcome.

Keywords: children, community-acquired pneumonia, new coronavirus infection, comorbid pathology, viral pneumonia, Mycoplasma pneumoniae, pneumococcal pneumonia.

Summary:

A randomized, open-label, multicentre, comparative study of therapeutic efficacy, safety, and tolerability of complex herbal drug BNO 1030 in the treatment of mild forms of COVID-19

V. Popovych¹, I. Koshel², Y. Haman³, V. Leschak³, O. Malofiichuk⁴, N. Kapustina⁴, I. Shevaga⁵, O. Shevaga⁵ , T. Kunytska¹

¹ Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine

²Institute of Postgraduate Education, National Medical University, Ivano-Frankivsk, Ukraine

³Uzhgorod National University, Uzhhorod, Ukraine

⁴Regional Clinical Hospital of Gerbachevsky, Ivano-Frankivsk, Ukraine

⁵Kamianets-Podilsky City Hospital, Kamianets-Podilsky, Ukraine

Background: COVID-19 is a high burden for medicine and society as still no specific therapy exists. Most patients depend on symptomatic treatment, comparable to that in common respiratory infection e.g. Many cases of COVID-19 show mild forms without need of hospitalization.

Aim: analyze the efficacy, safety, and tolerability of the herbal medicinal product BNO 1030 in mild cases of COVID-19 to offer an additional symptomatic relive.

Patients and Methods: the study was designed as an open label randomized, prospective, multicentred clinical trial. Out of 133 screened outpatients aged 18 to 70 with mild COVID-19 symptoms 120 patients were randomised (1:1) in 2 parallel groups. The main group received BNO 1030 (Tonsilgon^® N) in addition to symptomatic therapy (acetaminophen or ibuprofen). The control group got a symptomatic therapy only. The patients with laboratory proven COVID-19 were included for the final analyses: 47 — in the main group and 46 — in the control one. The evaluation criteria were dynamics of the symptoms: hyperthermia, myalgia, nasal congestion, nasal discharge, coughing, anosmia, rhinolalia, sore throat, duration of the use of antipyretics (clinically significant fever). These symptoms were assessed during the physician’s visit on a 4-point scale and self- assessed via ten-point visual analogue scale (VAS) daily in a patient’s diary. The primary endpoint was the decrease of the average score compared to the baseline defined as "therapeutic benefit" from the usage of BNO 1030.

Results: in the comparison of both groups over the treatment time, the main group (n=47) showed a greater decrease in the severity of symptoms, assessed by the doctor on a 4-point scale on V2 (4^th day) and V3 (14^th day) compared to those on V1, as well as a reduction of the antipyretics intake duration (p<0.05). Significant differences of the main group were obtained, too, based on the results of symptoms self-assessment by the patient. The "therapeutic benefit" from the use of BNO 1030 was 3 days. There is an increase in the number of recovered patients from 73.9–96.6 %, and a decrease in the number of hospitalized patients from 8.6–4.4 % in the main group, as compared to the data of the control group (p<0.05). All patients tolerated the herbal medicine well. 

Conclusions: BNO 1030 offers a safe and effective treatment benefit in patients with mild forms of diagnosed COVID-19 aged 18–70 in addition to symptomatic treatment with acetaminophen or NSAIDs. COVID-19 positive patients treated with Tonsilgon® N showed an earlier relive of symptoms when being treated with BNO 1030.

Keywords: Phytotherapy, BNO 1030, Tonsilgon, mild COVID-19, coronavirus infection.

For citation: Popovych V., Koshel I., Haman Y. et al. A randomized, open-label, multicentre, comparative study of therapeutic efficacy, safety, and tolerability of complex herbal drug BNO 1030 in the treatment of mild forms of COVID-19. RMJ. 2021;10:11–20.

Summary:

Respiratory co-infections: clinical presentations, treatment approaches

S.V. Nikolaeva¹, E.V. Kanner¹, I.D. Kanner², N.M, Lapkin³, A.V. Gorelov^1,4

¹Central Research Institute of Epidemiology of the Russian Federal Service 

for Supervision of Consumer Rights Protection and Human Well-Being, Moscow

²Lomonosov Moscow State University, Moscow

³Yaroslavl State Medical University, Yaroslavl

⁴I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

Acute respiratory infections (ARIs) are still an important issue. They rank fifth among infectious and parasitic diseases. In Russia, ARIs are included in diseases with the highest economic relevance. Currently, co-infection is of particular importance. This paper addresses hypotheses that explain the role of dysbiosis (associated with the increased count of pathobionts) in the development of inflammation and reduction in epithelial integrity favoring viral invasion into upper airway mucosa. Three scenarios of the interaction of respiratory pathogens between each other (i.e., synergy, antagonism, or indifference), which account for predominant clinical presentations and disease course in co-infection, are described. The paper also discusses some clinical features of flu and SARS-CoV-2-infection and highlights symptoms typical for both disorders, allowing for differential diagnosis. Challenges in treating viral infections of the respiratory tract are accounted for by unreasonably freq uent use of systemic antibiotics that result in poor prognosis, increased risk of adverse reactions, and a growing number of antibiotic-resistant microbial strains. Finally, the use of medications stimulating the production of interferons, the critical element of antiviral defense, is substantiated.

Keywords: respiratory infections, co-infections, pathobionts, flu, SARS-CoV-2, therapy.

For citation: Nikolaeva S.V., Kanner E.V., Kanner I.D. et al. Respiratory co-infections: clinical presentations, treatment approaches. RMJ. 2021;10:21–26.

Summary:

Proton pomp inhibitors: focus on a multimorbid patient

A.N. Kazyulin¹, T.S. Shindina², I.M. Shcherbenkov³, C.C. Arkhipova⁴

¹A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

²Polyclinics No. 5, Moscow

³Multidisciplinary Clinics "Center of Endosurgery and Lithotripsy", Moscow

⁴LLC "Universal", Moscow

This paper discusses the selection of a proton pump inhibitor (PPI) in multimorbid patients. In these patients, polypharmacy associated with high risks of cumulative adverse effects of drug interactions comes to the fore. The authors describe a woman with gastroesophageal reflux disease (GERD) and comorbid cardiovascular disease, metabolic syndrome, and diabetes. The diagnostic algorithm in the lack of therapeutic effect of PPIs is addressed. Polymorphism of genes encoding CYP2C19 and CYP3A4 isoenzymes is considered the cause of refractory GERD. Most likely, this woman belongs to so-called rapid metabolizers. Ineffective treatment is accounted for because metabolites of a prescribed PPI have shown no pharmacological activity. The authors uncover the mechanism of action of rabeprazole given cytochrome P450 gene polymorphisms, thereby preventing hydrochloric acid secretion effectively and making drug effects predictable. Clinical studies on drug interactions in multimorbid patients rec eiving rabeprazole are addressed. Rabeprazole is an effective and safe treatment modality in patients with GERD and comorbidities.

Keywords: rabeprazol, drug interactions, gastroesophageal reflux disease, polypharmacy, multimorbid patient, proton pomp inhibitors.

For citation: Kazyulin A.N., Shindina T.S., Shcherbenkov I.M., Arkhipova C.C. Proton pomp inhibitors: focus on a multimorbid patient. RMJ. 2021;10:27–30.

Summary:

Vaccination of herpes simplex virus: past to present — where are we? Literature review

E.V. Melekhina, E.Yu. Soldatova, A.D. Musica, Zh.B. Ponezheva

Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow

The recurrent course of herpes simplex virus type 1 and 2 is an urgent medical and social problem. Nowadays, there are not many direct antiviral drugs in the arsenal of doctors that have proven efficacy against herpes viruses. Treatment of patients with recurrent herpes viruses is difficult due to the pathogenesis peculiarities and the ability of immune evasion. The use of etiotropic therapy can lead to resistance occurrence. In the current situation, the use of specific vaccines is an important issue in the treatment and prevention of recurrent herpes viruses. The literature review is devoted to herpes vaccine therapy with the given detailed description of various vaccine types. Information about the vaccination efficacy in the recurrent course of the herpes virus is contradictory. Thus, the efficacy of some vaccines shown in preclinical studies has not been confirmed in clinical trials. Also, clinical efficacy has been demonstrated for other vaccines. Promising directions in the treatment of herpesvirus infections are the development of improved therapy regimens using vaccines, recombinant interferons, and probiotics, which allow to quickly prepare the patient for the vaccine therapy onset, as well as to lengthen the period of subsequent remission.

Keywords: herpes simplex virus, herpesvirus infection, vaccination, vaccine therapy, genital herpes, labial herpes, ocular herpes.

For citation: Melekhina E.V., Soldatova E.Yu., Musica A.D., Ponezheva Zh.B. Vaccination of herpes simplex virus: past to present — where are we? Literature review. RMJ. 2021;10:3–10.

Summary:

Сase of common eosinophilic infiltrates of the gastrointestinal tract

A.V. Kuzmina¹, N.V. Novozhilov¹, A.Yu. Trebushenkov¹, D.V. Bulanov¹, A.A. Zhambeev¹, E.V. Zhilyaev^1-3

¹European Medical Center, Moscow

²Pirogov Russian National Research Medical University, Moscow

³Russian Medical Academy of Continuous Professional Education, Moscow

Eosinophilic gastrointestinal disorders are a group of diseases characterized by dense eosinophilic tissue infiltration of various organs in the gastrointestinal tract, leading to morphological and functional disorders, such as eosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis and eosinophilic colitis. The article presents a clinical case of a 17-year-old male patient with a common eosinophilic disease involving the esophagus, stomach, small and large intestines. The disease was manifested by nausea, vomiting, diarrhea and significant eosinophilia. The diagnosis was confirmed by laboratory and morphological data. The disease course was complicated by cervical lymphadenitis with phlebitis and jugular vein thrombosis, which regressed during antibacterial and anticoagulant therapy. Disease regression was achieved during treatment with ketotifen and medium doses of glucocorticoid. Based on the literature data, the authors discussed modern approaches to the diagnosis and treatment of eosinophilic diseases. The peculiarity of the case was the uncommon process spreading from the gastroesophageal junction to the cecum,  as well as an uncommon complication in the form of left-sided supraclavicular lymphadenitis occurrence, complicated by subclavian vein thrombosis and internal jugular vein thrombosis.

Keywords: eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enterocolitis, lymphadenitis.

For citation: Kuzmina A.V., Novozhilov N.V., Trebushenkov A.Yu. et al. Сase of common eosinophilic infiltrates of the gastrointestinal tract. RMJ. 2021;10:31–35.

Summary:

Topical issues concerning the choice of basic therapy for osteoarthritis

L.N. Eliseeva, M.I. Bocharnikova, A.Yu. Blednova, O.A. Zhikhareva

Kuban State Medical University, Krasnodar

Aim: to retrospectively evaluate the efficacy and safety of diacerein in the treatment of patients with osteoarthritis.

Patients and Methods: the study involved 28 patients with gonarthrosis and 25 with grade 3–4 coxarthrosis included in the waiting list for total endoprosthesis replacement with an expected surgical intervention period of more than 3–4 months. Diacerein was prescribed at a dose of 50 mg once a day for the first 3–4 weeks, followed by an increase up to 50 mg 2 times a day. Analgesic efficacy was evaluated using a 100 mm visual analog scale (VAS). Safety was assessed by the presence of side effects (including from the gastrointestinal tract) and changes in laboratory parameters.

Results: the average age of patients with coxarthrosis was 62.2±3.4 years, patients with gonarthrosis — 60±4.6 years. The intensity of the pain syndrome, estimated by VAS in the initial state, was 68.3±11.3 mm in patients with coxarthrosis and 70.6±8.8 mm in patients with gonarthrosis. During therapy, the pain severity decreased to 56.0±10.2 and 42.1±9.3 mm, respectively. At the same time, the need for the use of nonsteroidal anti-inflammatory drugs (NSAIDs) decreased from 92.0 to 64.0 % in patients with coxarthrosis and 92.86 to 85.71 % in patients with gonarthrosis. No side effects of diacerein were detected during the pre- and postoperative follow-up. When assessing glycemic and creatinine control with glomerular filtration rate, no changes were found during therapy.

Conclusion: the inclusion of diacerein in complex therapy makes it possible to refuse NSAIDs intake or significantly reduce their dosages while maintaining analgesic and anti-inflammatory effects. The absence of significant side effects and adverse events ensures the safety of diacerein in patients with osteoarthritis and comorbid conditions.

Keywords: osteoarthritis, comorbidity, diabetes me llitus, diacerein, SYSADOA, chondroprotectors.

For citation: Eliseeva L.N., Bocharnikova M.I., Blednova A.Yu., Zhikhareva O.A. Topical issues concerning the choice of basic therapy for osteoarthritis. RMJ. 2021;10:36–40.

Summary:

Peripartum cardiomyopathy: pathogenesis, presentations, diagnosis, treatment, and prognosis

N.G. Veselovskaya^1,2, G.A. Chumakova^1,2, M.G. Nikolaeva^2,3, Gorbacheva², A.V. Ott²

¹Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo

²Altay State Medical University, Barnaul

³Altay Branch of the National Medical Research Center of Hematology, Barnaul

Peripartum cardiomyopathy (PPCM) is a myocardial disorder with left ventricular (LV) systolic dysfunction and clinical signs of heart failure that presents in late pregnancy through the first months after delivery in previously healthy women. An irreversible myocardial lesion with persistent LV failure and high-grade abnormal heart rhythm result in unfavorable outcomes in young women. Therefore, timely diagnosis and treatment for PPCM (that provides recovery in most cases) are essential.

In recent years, oxidative stress as a factor potentiating PPCM development has been studied. The pathogenic relevance of a 16-kDa N-terminal prolactin fragment that provides a toxic effect on myocardium and cardiomyocyte apoptosis is established. In addition, the placenta produces antiangiogenic factors during pregnancy, e.g., sol uble vascular endothelial growth factor receptor (sFlt-1). Its high concentrations provoke LV dysfunction during pregnancy. Some trials demonstrate the efficacy of pathogenic therapy with bromocriptine to improve myocardial contractility and disease outcome.

However, more studies on PPCM prevalence in various ethnic groups and regions, etiology, risk factors, optimal therapy (including bromocriptine), long-term outcomes, and treatment duration after LV functional recovery.

Keywords: peripartum cardiomyopathy, oxidative stress, heart failure, left ventricular dysfunction, cardiomyocytes, bromocriptine, pregnancy, prolactin, apoptosis.

For citation: Veselovskaya N.G., Chumakova G.A., Nikolaeva M.G. et al. Peripartum cardiomyopathy: pathogenesis, presentations, diagnosis, treatment, and prognosis. RMJ. 2021;10:44–48.

Summary:

Diabetic neuropathy: interdisciplinary problem in clinical practice

E.V. Ekusheva^1,2

¹Academy of Postgraduate Education of the Federal Scientific and Clinical Center of the Federal Medical Biological Agency of Russian Federation, Moscow

²Belgorod State University, Belgorod

Diabetic neuropathy is one of the most significant and common complications of diabetes mellitus (DM), leading to impairment, severe maladaptation, early disability and death. Diabetic neuropathy is a complex of polymorphic clinical and subclinical syndromes characterized by diffuse or focal lesion of the fibers in the peripheral and/or autonomous nervous system (as a result of metabolic, vascular and other disorders associated with DM) and has characteristic manifestations and course. The article discusses the clinical signs and variants of diabetic neuropathy course, and the issues of diagnosis and therapy of patients with this disease. To date, the only drug with proven efficacy for pathogenetic therapy of diabetic neuropathy is thioctic acid (α-lipoic acid), which serves as a powerful endogenous antioxidant and cofactor of the most important mitochondrial enzyme complexes involved in the oxidative metabolism processes. The article presents the review of studies, the results of which indicate the efficacy of thioctic acid, and also describes own clinical experience of thioctic acid use in patients with diabetic neuropathy. The importance of early diagnosis of diabetic neuropathy and timely complex therapy, including thioctic acid preparations, is emphasized, as it will significantly affect the severity and further progression of the pathological process in patient with DM.

Keywords: diabetes mellitus, diabetic neuropathy, diabetic polyneuropathy, neuropathic pain, α-lipoic acid, thioctic acid.

For citation: Ekusheva E.V. Diabetic neuropathy: interdisciplinary problem in clinical practice. RMJ. 2021;10:50–55.

Summary:

Genome editing and gene therapy methods in the treatment of human diseases

S.N. Ptitsina

All-Russian Institute of Scientific and Technical Information of the Russian Academy of Sciences, Moscow

This review is devoted to one of the urgent problems of modern biomedicine — gene therapy of hereditary human diseases using new genetic technologies (genome editing systems, ZFN and TALEN nucleases, CRISPR-Cas9). The information from the databases of All-Russian Institute of Scientific and Technical Information of the Russian Academy of Sciences, SCOPUS, PubMed for 2015–2020 is analyzed. It is concerned both the general issues description of the new biotechnologies and disease models development, the use of various vectors, delivery systems, genetic engineering methods, and the successful application of the above technologies in the treatment of specific diseases. The article presents examples of modeling and therapy of neuromuscular, oncological, immunological, hematological and neurodegenerative human diseases. It also discusses the ethical issues that inevitably arise when editing the human genome. The results of the publication analysis from databases (All-Russian Institute of Scientific and Technical Information of the Russian Academy of Sciences, SCOPUS, PubMed for 2015–2020) provide an opportunity to generate new scientific and information products on the problems of medical genetics. It is expected that the data obtained will be useful to both geneticists and clinicians.

Keywords: hereditary diseases, biomedicine, genetics, gene therapy, methods, genome editing, CRISPR-Cas9 system, biotechnologies, databases.

For citation: Ptitsina S.N. Genome editing and gene therapy methods in the treatment of human diseases. RMJ. 2021;10:57–62.

Summary:

Prospects for the use of low-level laser radiation in immunology

O.V. Mislavsky¹, Yu.V. Alekseev², T.G. Fedoskova¹, V.V. Smirnov¹, A.V. Ivanov³, S.R. Mashtakova^1,4

¹National Research Center Institute of Immunology of the Russian Federal Medical Biological Agency, Moscow

²Skobelkin State Scientific Center of Laser Medicine of the Federal Medical and Biological Agency, Moscow

³N.N. Blokhin National Medical Research Center of Oncology, Moscow

⁴Laboratory of the Center of Immunology and Reproduction, Moscow

The article presents modern concepts concerning biological action mechanisms of low-level laser radiation, as well as experimental animal models and modern cell culture studies showing the efficacy of using devices (with power from 30 mW to 250–400 mW) for low-level laser therapy. The article also gives examples of effective clinical use of this therapy type, which affects the immune system of animals and humans.

To reduce allergic inflammation (based on the considered modelled cases on animals), it can be considered to study sources with a wavelength of 660 nm, whereas to reduce inflammatory activity — with a wavelength of 810, 830 and 904 nm. Sources with a wavelength of 1264 to 1270 nm are promising for further study of their therapeutic effects on an allergic patient.

Keywords: low-level laser therapy, laser biomodulation, primary radiation acceptors, light-oxygen effect.

For citation: Mislavsky O.V., Alekseev Yu.V., Fedoskova T.G. et al. Prospects for the use of low-level laser radiation in immunology. RMJ. 2021;10:63–68.

Summary:

Lack of platelet response to the use of acetylsalicylic acid and clopidogrel in coronary heart disease after coronary revascularization. Is resistance to antiplatelet drugs reversible?

A.N. Maltseva^1,2, Yu.I. Grinshtein¹

¹Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk

²I.S. Berzon Krasnoyarsk Interregional City Hospital No. 20, Krasnoyarsk

Cardiovascular pathology has occupied leading positions in the structure of morbidity and mortality for many decades. At the present stage of cardiology development, increasingly greater attention is paid to primary and secondary prevention. As part of therapy aimed at preventing the occurrence of both primary and recurrent cardiovascular events, the key place is occupied by antiplatelet drugs. However, despite modern therapy, the possibility of coronary revascularization remains the risk of adverse cardiovascular events. There are various causes of recurrent thrombosis, myocardial infarction, strokes, etc. One of the reasons is resistance to antiplatelet drugs, in particular, to acetylsalicylic acid and clopidogrel. In order to prevent this phenomenon, it is necessary to understand the mechanisms of its development and the factors contributing to its occurrence. This  article discusses clinical, molecular and cellular, metabolic, genetic and other patterns that may be the cause of this phenomenon in patients with coronary heart disease, including after coronary revascularization. The data on the causes of resistance reversibility and the expected predictors, used to predict and prevent the occurrence of cardiovascular accidents are presented.

Keywords: resistance, acetylsalicylic acid, clopidogrel, coronary revascularization, platelets, coronary artery disease, coronary artery bypass graft.

For citation: Maltseva A.N., Grinshtein Yu.I. Lack of platelet response to the use of acetylsalicylic acid and clopidogrel in coronary heart disease after coronary revascularization. Is resistance to antiplatelet drugs reversible? RMJ. 2021;9:1–5.

Summary:

Key preventive approaches to gastrointestinal mucosal injury in cardiological patients

L.O. Minushkina

Central State Medical Academy, Moscow

This paper reviews the aspects of the safety of antithrombotic therapy in cardiological patients. The most common antithrombotic agent used in cardiology is acetylsalicylic acid (ASA). Gastrointestinal (GI) mucosal injury and GI bleedings are relatively common in these individuals. Primary tools to prevent complications, i.e., gastric acid secretion inhibitors and coated ASA, are described. According to current guidelines, proton pump inhibitors (PPIs) are the primary tools to prevent GI tract injury and GI bleedings. In general, PPIs are effective in preventing upper GI tract damage. Therefore, their long-term use is required in cardiological diseases. ASA containing antacid (buffered ASA which dissolves in the stomach) and enteric-coated ASA (which dissolves and is absorbed in the intestinal alkaline environment, thereby affecting drug bioavailability) are prescribed to protect GI mucosa. Pharmacokinetics and pharmacodynamics of  buffered and coated formulations are discussed.

Keywords: acetylsalicylic acid, gastrointestinal bleeding, gastrointestinal mucosa, dyspepsia, antithrombotic therapy, buffered formulations.

For citation: Minushkina L.O. Key preventive approaches to gastrointestinal mucosal injury in cardiological patients. RMJ. 2021;
9:12–16.

Summary:

Edema syndrome treatment in patients with chronic heart failure: obtained successes vs. remained problems 

N.V. Drobotya, V.V. Kaltykova, A.A. Pirozhenko

Rostov State Medical University, Rostov-on-Don

Chronic heart failure (CHF) remains one of the most acute problems of modern therapy and cardiology. Despite the successes achieved in the CHF treatment, the rate of patients with a low ejection fraction, and, as a consequence, with decompensation, remains quite high. In the foreground, they have the edema syndrome problem, which exacerbates cardio-hemodynamic disorders, dramatically reduces exercise tolerance and life quality. The main group of drugs used for edema syndrome treatment is diuretics. In recent years, preference is given to loop diuretics, which include the main representatives of this class — furosemide and torasemide. The study results on the comparison of their effects (TORIC, DUEL–CHF, etc.) demonstrated distinct torasemide advantages, which can not only reduce the CHF clinical manifestations but also positively affect the prognosis. The problem in the edema syndrome treatment remains an adequate dosage of the drug, which should ensure the achieve ment and maintenance of euvolemia condition of the patient. It is suggested that the dosage presence of torasemide 20 mg could contribute not only to improving its diuretic efficacy, but also CHF patient’s compliance.

Keywords: chronic heart failure, edema syndrome, euvolemia condition, loop diuretics, torasemide, Trigrim.

For citation: Drobotya N.V., Kaltykova V.V., Pirozhenko A.A. Edema syndrome treatment in patients with chronic heart failure: obtained successes vs. remained problems. RMJ. 2021;9:17–21.

Summary:

Effective blood pressure-lowering therapy: what to consider?

M.D. Smirnova¹, D.V. Nebieridze²

¹National Medical Research Center of Cardiology, Moscow

²National Medical Research Center of Therapy and Preventive Medicine, Moscow

Treatment for arterial hypertension (AH) implies a reduction of blood pressure and organ protection since organ involvement (e.g., left ventricular hypertrophy, microalbuminuria, etc.) significantly increases the risk of cardiovascular events. Damage of target organs is relatively common in AH, even at early stages. Numerous randomized clinical trials have demonstrated that monotherapy effectively reduces BP only in a few patients, while most patients require a combination of at least two medications to control BP. This review paper discusses the selection of optimal hypotensive drug combinations. Clinical trials demonstrate the advantages of combining an angiotensin-converting enzyme inhibitor (ramipril) and calcium channel blocker (amlodipine), particularly a fixed-dose combinati on of ramipril and amlodipine, in routine practice in various patient groups. This combination provides pleiotropic effects. The role of depression and anxiety as significant independent risk factors of cardiovascular events is discussed. The importance of smoking cessation, body weight control, and physical activity is highlighted.

Keywords: ramipril, amlodipine, fixed-dose combination, blood pressure-lowering treatment, organ protection.

For citation: Smirnova M.D., Nebieridze D.V. Effective blood pressure-lowering therapy: what to consider? RMJ. 2021;9:22–26.

Summary:

Nebivolol versus metoprolol: comparative evaluation of their effect on metabolic parameters and endothelial vasomotor function in patients with essential hypertension

A.A. Semenkin, L.A. Zhivilova, A.G. Nazarov, T.V. Pritykina, I.V. Druk, E.N. Loginova

Omsk State Medical University, Omsk

Aim: to compare the vascular and metabolic effects of monotherapy with metoprolol tartrate and nebivolol hydrochloride in the treatment of  patients with uncomplicated essential hypertension. 

Patients and Methods: the study included 50 patients treated with metoprolol (n=25) or nebivolol (n=25) for 3 months. The following parameters were monitored at baseline and at the end of the study: body mass index (BMI), waist circumference (WC), lipid spectrum, blood glucose, blood pressure (BP), endothelium-dependent (EDV) and endothelium-independent (EIDV) vasodilation of the brachial artery, determined by high-resolution ultrasound.

Results: the study protocol was completed by 19 patients from the metoprolol group and 18 patients from the nebivolol group. In both groups, a similar degree of reduction in BP and heart rate was achieved. The following vascular parameters significantly differ between groups with significant improvement of EDV and EIDV on nebivolol (p<0,05 for both parameters), tendency to decrease of EDV and significant decrease of EIDV (p<0,05) on metoprolol. Significant differences were also revealed in the BMI trend (no changes in the nebivolol group versus significant increase in the metoprolol group, p<0.05), WC (decreasing tendency in the nebivolol group and a significant increase in the metoprolol group, p<0,05), HDL cholesterol (a significant increase in the nebivolol group and a significant decrease in the metoprolol group, p<0.01) and blood glucose (a significant decrease in the nebivolol group and a significant increase in the metoprolol group, p<0,001). In th e combined group (n=37) during therapy, significant negative correlations were revealed between changes in EDV and WC, total cholesterol, LDL cholesterol and blood glucose.

Conclusion: thus, two selective beta-blockers, (metoprolol and nebivolol) have the opposite effect on metabolic and vascular parameters: negative effect — metoprolol, and positive effect — nebivolol, which can potentially cause a diverse prognosis of patients with hypertension during long-term therapy. There is an association between the endothelial and metabolic effects of the studied drugs. 

Keywords: essential hypertension, metoprolol, nebivolol, endothelial vasomotor function, metabolic disorders.

For citation: Semenkin A.A., Zhivilova L.A., Nazarov A.G. et al. Nebivolol versus metoprolol: comparative evaluation of their effect on metabolic parameters and endothelial vasomotor function in patients with essential hypertension. RMJ. 2021;9:26–30.

Summary:

Role of anxiety disorders in patients with cardiovascular pathology who experienced COVID-19

E.V. Filippov

Ryazan State Medical University, Ryazan

Circulatory system diseases (CSD) are one of the most common causes of fatal outcomes in the Russian Federation. The article presents a study overview that examined the association between anxiety and adverse outcomes (AO) (including cardiovascular outcomes and all-cause mortality) in patients. In a recent large meta-analysis, it was found that there may be an association of anxiety with various AO (cardiovascular mortality, stroke, heart failure). The author considers the pathogenetic mechanisms of AO in patients with anxiety, which are based on two components: biological and behavioral. The biological component depends on the severity of anxiety and depression. Besides, it is a trigger for the development of «new» negative emotions and chronic stress. The article also discusses the anxiety role in patients who experienced COVID-19, as well as autonomic disorders associated with the post-covid syndrome. The author present s his clinical case concerning the development of post-covid syndrome, accompanied by increased anxiety and vegetative symptoms, and describes its therapy in a patient who suffered from long-term arterial hypertension.

Keywords: anxiety, circulatory system diseases, postural orthostatic tachycardia syndrome, sinus tachycardia, COVID-19, mortality.

For citation: Filippov E.V. Role of anxiety disorders in patients with cardiovascular pathology who experienced COVID-19. RMJ. 2021;9:31–34.

Summary:

Takotsubo cardiomyopathy: a clinical case

D.D. Azizova, A.M. Aldabergenova, K.T. Zhumabai, G.B. Kanafina, Zh.R. Turgambayeva  

Astana Medical University, Nur-Sultan, Kazakhstan

Takotsubo cardiomyopathy belongs to the group of heterogeneous diseases. It is a primary acquired stress-induced syndrome resulting from dysfunction of myocardial mid- and apical segments in the setting of resting global left ventricular contractility or hyperkinesis of the basal segments. This cardiomyopathy occurs in 1–2% of all patients with acute coronary syndrome signs, mainly in postmenopausal women without significant atherosclerotic coronary artery lesions. Clinical manifestations are similar to the myocardial infarction symptoms, and therefore, diagnosis establishment is somewhat complicated. Medical treatment commonly includes standard therapy used for myocardial infarction and heart failure since Takotsubo cardiomyopathy is complicated by the occurrence of heart failure in almost half of cases. Therapy duration is 1 to 4 weeks, during which the contractile function of the heart restores in most cases. The prognosis is commonly favorable. The article presents a clinical case of a female patient with Takotsubo cardiomyopathy. This is the first recorded case on the territory of Kazakhstan. The clinical picture, stages of diagnosis and complications in diagnosis establishment are described.

Keywords: Takotsubo cardiomyopathy, apical segmental dysfunction, transient apical hypokinesis, apical ballooning syndrome, stress-induced cardiomyopathy.

For citation: Azizova D.D., Aldabergenova A.M., Zhumabai K.Т. et al. Takotsubo cardiomyopathy: a clinical case. RMJ. 2021;9:36–38.

Summary:

Original and reproduced medicinal products: are they comparable? Emphasis on moxonidine

A.P. Pereverzev

Russian Medical Academy of Continuous Professional Education, Moscow

Nowadays, life expectancy worldwide is growing and, according to the World Health Organization, the number of people over 60 will double by 2050. With increasing life expectancy, the number of patients with arterial hypertension increases, which leads to the need for antihypertensive drugs with moxonidine.

A medicinal product (MP) with a new active substance, which is the 1st registered and approved in clinical practice based on the preclinical and clinical study results confirming its quality, efficacy and safety, is called an original MP. After the expiration of the patent protection period, any pharmaceutical companies receive the right to manufacture and sell MPs equivalent to the original in terms of the qualitative and quantitative composition of active substances, as well as an equivalent dosage form (reproduced MPs, generics). To register the MP data, it is sufficient to conduct bioequivalence studies, i.e. confirmation of pharmacokinetic parameters comparable to the original MP in the same dosages and administration method. The article considers the differences between the original and reproduced MPs due to the difference in the composition of the excipients, using the example of moxonidine, and presents the potential mechanisms underlying them.

Keywords: bioequivalence, safety, excipients, reproduced medicinal products, moxonidine.

For citation: Pereverzev A.P. Original and reproduced medicinal products: are they comparable? Emphasis on moxonidine. RMJ. 2021;9:6–10.

Summary:

Experience of donor kidney transplantation in patients with end-stage chronic renal disease

S.S. Dunaevskaya^1,2, A.A. Kosik^1,2, E.V. Kartashkov²

¹Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk

²Federal Siberian Research Clinical Center of the Federal Medical and Biological Agency, Krasnoyarsk

Kidney transplantation, which provides a high life quality to patients with end-stage chronic renal disease, is recognized worldwide as one of the main achievements of modern medicine. The article presents our experience concerning the surgical treatment of 44 patients who underwent orthotopic renal transplantation for various indications from 2018 to 2020. Kidney transplantation from a deceased donor was performed in 39 (88.6%) patients, from a living donor — in 5 (11.4%) patients. There were the following indications for kidney transplantation: end-stage renal disease in the outcome of chronic glomerulonephritis — 28 (64%) patients, polycystic kidney disease — 9 (20%) patients, diabetic nephropathy — 4 (9%) patients, chronic pyelonephritis — 3 (7%) patients. Besides, the article presents an example of successful multistage treatment of a patient with  autosomal dominant polycystic kidney disease who underwent nephrectomy after kidney transplantation. The right-sided native nephrectomy was performed as planned, while the acute pyelonephritis served as an indication for the left-sided native nephrectomy. During the surgical exploration, attention was drawn to the large kidney size, which occupied the entire left half of the abdominal cavity.

Keywords: chronic renal disease, transplantation, donor kidney, autosomal dominant polycystic kidney disease, native kidney, acute pyelonephritis.

For citation: Dunaevskaya S.S., Kosik A.A., Kartashkov E.V. Experience of donor kidney transplantation in patients with end-stage chronic renal disease. RMJ. 2021;8:11–13.

Summary:

Possibilities of CT study in diagnostics of hemodynamic disorders

E.V. Shaidakov¹, A.B. Sannikov^2,3, V.M. Emelianenko³, M.A. Rachkov², L.N. Kryukova², A.E. Baranova²

¹N.P. Bekhtereva Institute of the Human Brain of the Russian Academy of Sciences, St. Petersburg

²Clinic of Innovative Diagnostics "Medica", Vladimir

³Pirogov Russian National Research Medical University, Moscow

Due to the possibility of solving a large number of technical problems, the method of computed tomography (CT) venography is widely used nowadays. However, it has not yet received clinical recognition in the diagnosis of chronic venous diseases. This article analyzes the results of studying the CT venography use, describing the methods of indirect and direct contrast CT venography. It also shows the possibilities of using contrast CT venography in the diagnosis of deep vein thrombosis and discusses the opportunities concerning the combined use of CT venography and CT angiopulmonography in the diagnosis of pulmonary embolism. Contrast-enhanced CT venography can become an indispensable tool in studying the patterns of the topographic and anatomical structure of the venous bed. Using the example of their research, the authors demonstrate the possibilities of direct CT venography of the lower extremities. The  need for more accurate topical diagnostics with 3D imaging of the lower extremity and pelvic venous system with CT venography is due to the growing interest of vascular and interventional surgeons in testing and more active administration of endovascular correction of venous blood flow in phlebological practice. The use of magnetic resonance imaging (MRI) and CT imaging will help to clarify the data of clinical anatomy, as well as to look differently at some of the main path-dependent hemodynamic links in the development of cardiovascular diseases in patients with venous diseases.

Keywords: computed tomography, computed tomography venography, magnetic resonance imaging, magnetic resonance venography, chronic venous diseases.

For citation: Shaidakov E.V., Sannikov A.B., Emelianenko V.M. et al. Possibilities of CT study in diagnostics of hemodynamic disorders. RMJ. 2021;8:14–24.

Summary:

The use of cyanobacteria of the genus Arthrospira in the wound healing

E.N. Prazdnikov, Z.A. Evsyukova

A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

The skin is the only external barrier to protect the body from harmful environmental effects, which makes it extremely vulnerable to various types of damage. In case of skin integrity violation, there is an urgent need for an effective healing method. However, despite the availability of a wide range of healing agents and significant achievements in the field of regenerative medicine, the problem of wound healing is still of concern to many specialists from various fields of medicine. It is because the result of the wound process is commonly the formation of an esthetically unacceptable scar or cicatricial deformity, which negatively affects the life quality of the patient. Among the variety of external agents used in different wound process phases, the extract of cyanobacterium spirulina (the unique cellular composition used at all stages of cutaneous wound healing, which is the subject of nume rous studies and developments) attracted attention. Also, the relative availability of cyanobacteria spirulina (compared with the high-tech process of artificial regenerants synthesis) makes it the subject of scientific research. This article presents some studies on the use of spirulina in wound healing.

Keywords: wound healing, regenerants, spirulina, cyanobacteria, wound process, antioxidants, regenerative process.

For citation: Prazdnikov E.N., Evsyukova Z.A. The use of cyanobacteria of the genus Arthrospira in the wound healing. RMJ. 2021;8:25–28.

Summary:

Bacterial biofilms in orthopedics: the problem and possible prospects for prevention

E.M. Gordina, S.A. Bozhkova

Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg

This review presents modern views on the formation of a chronic orthopedic infection associated with the biofilm formation of bacteria. The stages of biofilm formation, the phenotypes of bacterial cells existing in them, as well as their role in the pathogenesis of implant-associated infection are briefly considered. The biofilm state allows pathogens to be resistant to antibiotic treatment and to the effects of immune system factors due to structural and metabolic heterogeneity because of simultaneous coexistence of microbial cells in various states, combined with active synthesis of the intercellular matrix. Currently, there are several directions in the prevention of microbial adhesion and maturation of films on orthopedic implants. For preventive and therapeutic purposes in traumatology and orthopedics, in addition to systemic and local antibacterial drugs, materials can be used to create implants with certain physical and chemical properties of surfaces. The main action targets of anti-biofilm agents are given This review shows the results of the clinical use of silver and iodine for the prevention and treatment of infectious complications during orthopedic operations. It is concluded that, despite all the optimistic results, most of the applied methods are still to be studied and difficult to scale up to industry standards, which requires further research.

Keywords: biofilms, biofilm formation, periprosthetic joint infection, implant-associated infection, implants.

For citation: Gordina E.M., Bozhkova S.A. Bacterial biofilms in orthopedics: the problem and possible prospects for prevention.
RMJ. 2021;8:29–32.

Summary:

The efficacy of drug dosage adjustment of spray sildenafil in men with erectile dysfunction

A.V. Kuzmenko, V.V. Kuzmenko, T.A. Gyaurgiev

N.N. Burdenko Voronezh State Medical University, Voronezh

Background: phosphodiesterase-5 inhibitors are the main drugs for the treatment of erectile dysfunction (ED). Over the past few years, new dosage forms of these drugs have appeared on the pharmaceutical market, which potentially predominate over the conservative tablet form.

Aim: to evaluate the efficacy and safety of drug dosage adjustment of oral spray sildenafil in men with ED.

Patients and Methods: a prospective study included 60 patients aged 19 to 50 years with ED. At visit 1, all patients completed the International Index of Erectile Function (IIEF-5) questionnaire to assess the severity of ED, as well as the Hamilton Rating Scale for Depression (HRSD) to  identify psychoemotional disorders. All patients were prescribed oral spray sildenafil at an initial dose of 50 mg (4 taps) on-demand, but at least once a week. Therapy assessment was conducted at visits 2, 3 and 4 after 4, 8 and 16 weeks, respectively. It included an analysis of the average score trend according to the IIEF questionnaire, an assessment of the overall sexual satisfaction of patients and the control of adverse events.

Results: the majority (n=32) were men with moderate ED. Psychoemotional disorders corresponded to mild (n=17) and moderate (n=43)  severity. Therapy at the initial dosage was effective in 42 (70%) of 60 patients, but in 5 cases it was accompanied by the occurrence of mild and moderate adverse events that required a reduction in the drug dosage. In 18 (30%) patients, the desired effect after drug intake at an initial dosage of 50 mg was not achieved. Thus they had to individually increase the dosage. Due to the ability to flexible adjustment of drug dosage in increments of 12.5 mg (1 tap), 3 patients (5%) stopped at a dose of 37.5 mg, 4 (6.7%) — at a dose of 62.5 mg, 5 (8.3%) — at a dose of 87.5 mg, i.e. 12 patients (20%) took doses that are not available during sildenafil intake in tablet form. According to the results of the psychoemotional state assessment of patients, 7 (11.7%) of them retained signs of mild psychoemotional disorders, the remaining 53 (88.3%) men had no changes in their psychoemotional state.

Conclusion: the study results demonstrated the efficacy and safety of sildenafil use in the form of a spray to correct ED. The possibility of flexible adjustment of the drug dosage helps to increase therapy compliance and reduce the number of adverse events.

Keywords: erectile dysfunction, sildenafil, phosphodiesterase-5 inhibitors, spray.

For citation: Kuzmenko A.V., Kuzmenko V.V., Gyaurgiev T.A. The efficacy of drug dosage adjustment of spray sildenafil in men with erectile dysfunction. RMJ. 2021;8:3–6.

Summary:

Protocol of prevention and conservative treatment of persistent edema after rhinoplasty

Z.A. Evsyukova¹, A.V. Glushko^2,3

¹A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

²I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

³Institute of Plastic Surgery and Cosmetology, Moscow

Due to the high popularity and relative availability of surgical methods concerning appearance enhancement, rhinoplasty consistently occupies a leading position among all types of plastic surgery, remaining difficult to use in both technical and recovery terms. Commonly, edema after even gentle closed rhinoplasty with the use of modern surgical methods, including piezotome, persist not less than a year, provoking the fibrous tissue formation, which makes the patient and the surgeon decide on the need for repeated intervention. With the increase in the number of repeated interventions on the nasal tissues, the following question arises: how to avoid certain complications and ensure a predictable surgery result. Based on the 3-year experience of working with such patients, we have developed a proto col for the treatment of postoperative edema, which we actively use both on patients after primary rhinoplasty and after repeated surgeries. This protocol allows not only to stop edema, but also to prevent fibrous changes. It helps to avoid repeated surgical interventions and increase patient satisfaction with the surgery result.

Keywords: rhinoplasty recovery, rhinoplasty, treatment of surgical complications, postoperative edema, soft tissue edema, neodymium laser.

For citation: Evsyukova Z.A., Glushko A.V. Protocol of prevention and conservative treatment of persistent edema after rhinoplasty. RMJ. 2021;8:33–36.

Summary:

Treatment of extensive infected wounds after lower extremity revascularization

A.A. Fokin^1,2, A.V. Makarov^1,2

¹South Ural State Medical University, Chelyabinsk

²Chelyabinsk Regional Clinical Hospital, Chelyabinsk

Among the peripheral artery diseases, the most catastrophic course is characterized by chronic limb-threatening ischemia (CLTI). Successful reconstruction of the main blood flow in patients with CLTI is not a guarantee of a positive treatment result in general. The presence and prevalence of necrosis and the presence of wound infection are the factors determining the possibility of limb preservation. Prolonged hospital stays, the likelihood of getting the hospital flora resistant to many antibiotics, reduced tissue regeneration and numerous interventions are the factors that worsen wound healing in this category of patients. The addition of antibiotic-resistant flora is a significant risk factor for limb loss. The authors present their own experience of patient management with peripheral arterial disease of the lo wer extremities and ulcerative and necrotizing foot lesions. Patients underwent lower limb revascularization, necrectomy, and negative pressure wound therapy. The authors noted the positive effect of silver sulfadiazine use in wound therapy. The balanced patient management, combining active surgical treatment with topical effect on wound healing, allows preventing amputation.

Keywords: peripheral artery diseases, chronic limb-threatening ischemia, antibiotic resistance, revascularization, necrectomy, negative pressure wound therapy, silver sulfadiazine.

For citation: Fokin A.A., Makarov A.V. Treatment of extensive infected wounds after lower extremity revascularization. RMJ. 2021;8:38–40.

Summary:

Epidemiology of urolithiasis and pilot study results concerning the use of extracorporeal shock wave lithotripsy

I.V. Zubkov¹, V.Kh. Biteev¹, P.N. Korotaev², Yu.V. Goloviznin², Ya.A. Ivina², A.A. Shevchenko¹

¹Kirov State Medical University, Kirov

²Clinical Hospital «Russian Railways-Medicine of the city of Kirov», Kirov

Urolithiasis is a chronic systemic disease resulting from metabolic disorders and/or the influence of environmental factors, which is manifested by the stone formation in the upper urinary tract. Urolithiasis has a high tendency to relapse, despite the significant development of therapy technologies. There is also the possibility of a substantial increase in the risks of morbidity and disability in professional groups, for instance, in the group of railway workers. Given the peculiarities and severity of labor in railway transport, the detection of kidney stones in workers directly related to the train movement (engine drivers, assistant engine drivers, etc.) is the basis for their suspension from work. The authors presented their own experience of evaluating the efficacy and safety of extracorpor eal shock wave lithotripsy in the treatment of patients (railway workers diagnosed with urolithiasis). A total of 26 patients of both sexes aged 30 to 62 years were treated (mean age — 41 years). The most common were lesions of the upper calyx (34.6%) and single calculi (60–66.7%) with an average size of 4 mm. The surgery duration averaged 50 minutes, and the number of hospital bed days averaged 5. The patients share who had intraoperative and postoperative complications was 7.7% and 11.5%, respectively. Open clinical study results concerning the use of extracorporeal shock wave lithotripsy in the treatment of patients diagnosed with urolithiasis demonstrated a low level of complications and sufficient method efficacy.

Keywords: nephrolithiasis, urolithiasis, intraoperative complications, postoperative complications, extracorporeal shock wave lithotripsy, lithotripsy.

For citation: Zubkov I.V., Biteev V.Kh., Korotaev P.N. et al. Epidemiology of urolithiasis and pilot study results concerning the use of extracorporeal shock wave lithotripsy. RMJ. 2021;8:7–10.

Summary:

Disease activity and comorbidities in patients with systemic lupus erythematosus — what has changed in two decades?

I.Z. Gaydukova^1,2, V.I. Mazurov^1,2, O.V. Inamova^1,2, A.Yu. Fonturenko^1,2, D.B. Aliyev², Ya.A. Leineman¹, E.A. Kornilova¹, A.A. Shapovalov³, I.M. Nagirnyak³

¹I.I. Mechnikov North-Western State Medical University, St. Petersburg

²St. Petersburg Clinical Rheumatology Hospital No. 25, St. Petersburg

³TechLab LLC, St. Petersburg

Background: systemic lupus erythematosus (SLE) is a disease which medical and social significance is determined by a decrease in the life quality of patients and high mortality (due to the direct damaging disease action on the patient’s body), as well as an increase in the comorbidities incidence. It is currently unknown whether the introduction of new approaches to the SLE diagnosis and treatment of patients can significantly change the disease activity and the comorbidities incidence in this population.

Aim: to conduct a comparative analysis of disease activity and comorbidities structure in the patient cohort with SLE diagnosed from 2000 to 2009 and 2010 to 2019.

Patients and Methods: demographic, clinical, laboratory data and comorbid conditions of patients with SLE observed in the St. Petersburg Clinical Rheumatology Hospital No. 25 (whose diagnosis was verified in the periods from 01.01.2000 to 31.12.2009 («history» cohort) and from 01.01.2010 to 31.12.2019 («current» cohort)) were studied.

Results: despite the differences in approaches to the diagnosis, follow-up and treatment of patients with SLE, it was found that the main demographic, clinical, laboratory indicators, as well as the structure of comorbid conditions in both cohorts were comparable. The number of patients who have not achieved low disease activity or remission remained high (44.4% and 47.1% of patients in the «history» and «current» cohorts, respectively, had SLEDAI-2K > 4), as well as patients with changes in the vital organs functions and comorbidity. Non-steroidal remission was extremely rare, 76% of patients continued to take prednisolone in doses exceeding 7.5 mg/day.

Conclusion: the change in the patient management with SLE for two consecutive decades did not lead to a significant change in the disease activity indicators. The incidence of comorbidities in the indicated periods also did not undergo significant changes: the incidence of cardiovascular diseases and risk factors for their development still remains high. The results obtained indicate the need to search for new approaches to SLE treatment that can reduce glucocorticoids use while maintaining minimal disease activity.

Keywords: systemic lupus erythematosus, activity, comorbidities, treatment, glucocorticoids.

For citation: Gaydukova I.Z., Mazurov V.I., Inamova O.V. et al. Disease activity and comorbidities in patients with systemic lupus erythematosus — what has changed in two decades? RMJ. 2021;7:13–16.

Summary:

Anemia and left ventricular remodeling in patients with axial spondyloarthritis — is there any association?

K.N. Safarova¹, V.I. Makhina², A.P. Rebrov¹

¹Saratov State Medical University named after V.I. Razumovsky, Saratov

²Regional Clinical Hospital, Saratov

Aim: to evaluate the possible association between anemia occurrence and left ventricular (LV) remodelling in patients with axial spondyloarthritis (axSpA).

Patients and Methods: 92 patients with axSpA were examined: 65 (70.6%) men; age — 37 [31; 45] y.o.; axSpA duration — 16 [9; 21] years. BASDAI and ASDAS-CRP indices were calculated, as well as hemogram, erythrocyte sedimentation rate (ESR), ferrokinetic parameters, C-reactive protein (CRP) level were studied. All patients underwent transthoracic echocardiography (EchoCG). The following 4 groups of patients were formed depending on the anemia and/or hypertension presence: group 1 — patients without anemia and hypertension (n=25), group 2 — patients with anemia without hypertension (n=34), group 3 — patients with hypertension without anemia (n=22), group 4 — patients with anemia and hypertension (n=11). 

Results: the proportion of patients with normal LV g eometry according to EchoCG data tended to decrease in groups 3 and 4 versus groups 1 and 2 (50 and 46% vs. 80 and 73%, respectively; p=0.056). The incidence of various types of LV remodeling in groups: LV concentric remodelling — 12% of patients of group 1, 12% of group 2, 27% of group 3 and 18% of group 4; concentric LV hypertrophy — 4% of patients of group 1, 6% of group 2, 5% of group 3, in patients of group 4, this type of LV remodeling was absent; eccentric LV hypertrophy — 4% of patients of group 1, 9 % of group 2, 18% of group 3 and 36% of group 4 (p=0.165 for all).

Conclusion: the study did not show statistically significant differences in the incidence of LV remodeling in patients with axSpA, depending on the presence of anemia. However, the highest incidence of eccentric LV hypertrophy was recorded in patients with hypertension and anemia. The incidence of LV remodeling naturally increased in patients with a longer course of axSpA, which was characterized by the accumulation of traditional cardiovascular risk factors (primarily hypertension, obesity and dyslipidemia). In this regard, the fundamental strategy for modifying the risk of cardiovascular pathology occurrence and progression in patients with axSpA should be considered the inhibition of the systemic inflammation activity and the control of traditional cardiovascular risk factors.

Keywords: anemia, inflammation, axial spondyloarthritis, left ventricular remodeling, left ventricular hypertrophy.

For citation: Safarova K.N., Makhina V.I., Rebrov A.P. Anemia and left ventricular remodeling in patients with axial spondyloarthritis — is there any association? RMJ. 2021;7:18–23.

Summary:

The effect of asymptomatic hyperuricemia on comorbidities and the possibility of its correction

V.I. Mazurov^1,2, R.A. Bashkinov^1,2, I.Z. Gaidukova^1,2, A.Yu. Fonturenko^1,2

¹I.I. Mechnikov North-Western State Medical University, St. Petersburg

²Clinical Rheumatology Hospital No. 25, St. Petersburg

Uric acid (UA) is the end product of purine metabolism. An increase in its serum level is defined as hyperuricemia (HU). In the absence of gouty arthritis signs, HU is considered asymptomatic. In recent decades, there has been a worldwide tendency to increase the prevalence of HU, which, as it turned out, has a wide range of effects on the progression of a large variety of pathologies with a therapeutic profile. Experimental and clinical studies have proven a high association of HU with various comorbidities. There are direct pathogenetic associations concerning elevated UA level with the occurrence and progression of cardiovascular pathology, damage to the musculoskeletal system, kidney disease and metabolic syndrome, which indicates that asymptomatic HU (aHU) is becoming a general therapeutic problem. That is why the conditions for the initiation of urate-lowering therapy (UST) in aHU are presented in the regulatory doc uments of the Russian Medical Society for Arterial Hypertension (RMSAH), IDEA and many other medical communities. At the same time, the viewpoints of specialists of various profiles remain ambiguous regarding the prescription of oral therapy in aHU, which raises the question concerning the expediency of preparing an interdisciplinary consensus on the patient management with aHU and comorbidities.

Keywords: uric acid, asymptomatic hyperuricemia, comorbidities, urate-lowering therapy.

For citation: Mazurov V.I., Bashkinov R.A., Gaidukova I.Z., Fonturenko A.Yu. The effect of asymptomatic hyperuricemia on comorbidities and the possibility of its correction. RMJ. 2021;7:24–30.

Summary:

Clinical and laboratory markers of rheumatoid cachexia in rheumatoid arthritis

E.V. Papichev, B.V. Zavodovskii, L.E. Sivordova, Yu.R. Akhverdyan, Yu.V. Polyakova

Research Institute of Clinical and Experimental Rheumatology named after A.B. Zborovsky, Volgograd

Aim: to study the prevalence and clinical and laboratory characteristics of rheumatoid cachexia (RC) in patients with rheumatoid arthritis (RA), as well as to identify indicators, the determination of which can improve the RC detection.

Patients and Methods: 110 patients with RA were included in the retrospective study. All patients underwent a standard clinical and laboratory examination. Besides, laboratory methods were used to determine the highly sensitive C-reactive protein level, antibodies to cyclic citrullinated peptides (AB-CCP), bone metabolism indicators (CTX-I, P1NP, 25(OH)D), Urine CartiLaps / creatinine index. Using dual-energy x-ray absorptiometry (DEXA) with the Total Body program, the body composition was determined. RC was diagnosed when there was a decrease in the body mass index (BMI) of fat-free tissues below the 10th percentile and an increase in the BMI of adipose tissues above the 25th percentile.

Results: the study included subjects of working age (median 53.7 y.o.), mainly women with long-term disease duration (85.5% of patients had the advanced or late clinical stage of RA). The clinical profile of patients was dominated by rheumatoid factor (RF) positivity and AB-CCP, moderate disease activity, the presence of erosive arthritis, moderate limitation of physical activity. RC was diagnosed in 25 patients.

Statistically significant risk factors for the RC development is the RA duration and the presence of RF. The long disease duration increases the risk of developing this condition by 5.8%. Among RF-negative patients, RC was almost 10 times less common (OR 0.11, p=0.032). RA duration with the maximum total value of sensitivity and specificity for RC was 9.5 years (60% sensitivity and 38% specificity). In the group of patients with RC (n=20), the median cumulative dose of glucocorticoids (GC) was statistically higher than in the group without RC (n=68): 8,5 [6,2–17,5] g and 5.8 [3.6–13.7] g, respectively (Z=-1.98, p=0.047). Among the patients who continued receiving GC during the study, 16 were patients with RC with a median daily dose of GC of 5 [4–8] mg, and 61 — without RC, at a dose of GC of 8 [5–10] mg (Z=2.58, p=0.01).

Conclusion: it is advisable to determine the body composition in patients with an established diagnose of RA more than 10 years ago to detect RC. Alertness to this condition should be higher in the RF-positive form of arthritis and prolonged use of GC.

Keywords: rheumatoid arthritis, rheumatoid cachexia, rheumatoid factor, glucocorticoids.

For citation: Papichev E.V., Zavodovskii B.V., Sivordova L.E. et al. Clinical and laboratory markers of rheumatoid cachexia in rheumatoid arthritis. RMJ. 2021;7:3–6.

Summary:

Outlines of the patient profile with pain syndrome. Different approaches to therapy depending on the pain localization and the age of the patient

O.A. Shavlovskaya

International University of Rehabilitation Medicine, Moscow, Russian Federation

More than 90% of people are prone to pain syndromes. 15% to 25% of the adult population suffers from chronic pain. The prevalence of chronic pain in the elderly group can reach 86%. The article is aimed at the help of the doctor in choosing treatment tactics, focusing on the patient profile with a pain syndrome (considering the pain syndrome localization and the patient’s age). Neck pain (cervicalgia) in the setting of degenerative changes in the cervical vertebrae is observed in 25% of adults under 40 years, in 50% — after 40 years, in 85% — at the age of 60 years. Cervicalgia is commonly observed in women aged 40 years. The front-line therapy is nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with a muscle relaxant and various therapeutic exercises, as well as chondroitin sulfate (CS) preparations. As a rule, patients with low back pain (LBP) with or without muscular tonic syndrome are people over the age of 50, mainly women. Equally combinations of drugs are used to relieve pain: NSAIDs + muscle relaxant; NSAIDs + CS injections; less common, oral glucosamine sulfate (GS) monotherapy. Therapy of elderly people with pain syndrome should consider the patient’s age characteristics with comorbid somatic diseases, osteoarthritis (OA), involutional ch anges (sarcopenia), locomotive syndrome. Considering the latest recommendations of European and American researchers, the effect on pain in the elderly can be achieved by using CS and GS, which have proven anti-inflammatory activity and structural modifications.

Keywords: low back pain, osteoarthritis, nonsteroidal anti-inflammatory drugs, SYSADOA, chondroitin sulfate, Chondroguard, glucosamine sulfate, Sustaguard Artro.

For citation: Shavlovskaya O.A. Outlines of the patient profile with pain syndrome. Different approaches to therapy depending on the pain localization and the age of the patient. RMJ. 2021;7:32–38.

Summary:

Are there any benefits of combined analgesics compared to monotherapy?

I.S. Dydykina¹, E.V. Arutyunova², P.S. Kovalenko¹

¹Research Institute of Rheumatology named after V.A. Nasonova, Moscow

²Lomonosov Moscow State University, Moscow

Nowadays, it is known that inadequate pain management leads to a decrease in the life quality of patients, an extension of the recovery period and an increase in mortality. Thus, the rational choice and safe use of medicines in the treatment of pain and inflammation is one of the main tasks of a practicing physician. This article discusses the possibility of using a combination of paracetamol and diclofenac in the treatment of pain of various origins. The results of randomized controlled trials are presented, in which the efficacy and safety of this combination were studied in patients with musculoskeletal diseases, as well as after surgery, toothache, etc. Different mechanisms of action and administration localizations of paracetamol and diclofenac allow using a lower dose of drugs while maintaining or increasing their therapeutic effect. This approach is a promising strategy for maximizing the benefit-risk ratio in the pharmacother apy of pain, especially in comorbid and elderly patients. Various mechanisms of action and administration localizations of paracetamol and NSAIDs, in particular diclofenac, allow considering this combination appropriate and justified.

Keywords: pain, paracetamol, diclofenac, NSAIDs, comorbidity, pharmacotherapy of pain, combined analgesics.

For citation: Dydykina I.S., Arutyunova E.V., Kovalenko P.S. Are there any benefits of combined analgesics compared to monotherapy? RMJ. 2021;7:40–43.

Summary:

Etanercept and its biosimilar in the treatment of rheumatoid arthritis: efficacy and safety

N.V. Chichasova^1,2, A.M. Lila^1,2

¹Research Institute of Rheumatology named after V.A. Nasonova, Moscow

²Russian Medical Academy of Continuous Professional Education, Moscow

Nowadays, the main goal of rheumatoid arthritis treatment is to achieve remission, whereas the alternative goal is to achieve low disease activity for six months in every patient. The article presents data on the efficacy and safety of the original drug — etanercept — and its biosimilar Erelzi^®, registered in the Russian Federation. The data on the immunogenicity of genetically engineered biological drugs (GEBD) with an emphasis on the tumor necrosis factor-α (TNF-α) inhibitors are presented. The article indicates the benefits of etanercept over other TNF-α inhibitors associated with its low immunogenicity. Predictors of an increase in the odds ratio for achieving remission with etanercept treatment and the possibility of maintaining remission with a halving of etanercept dose were presented. As for etanercept biosimilar, data on the comparability of pharmacokinetics with the original drug were presented, as well as the results of a multicenter randomized double-blind 48-week study that showed comparability of efficacy and safety compared with the original etanercept. The data on the preservation of treatment efficacy and safety when switching from the original etanercept to this biosimilar were also presented. The introduction of GEBD biosimilars into clinical practice makes it possible to reduce the treatment cost (covering more patients) and increase the availability of optimal therapy for patients with rheumatic diseases. 

Keywords: etanercept, efficacy, safety, immunogenicity, biosimilar, rheumatoid arthritis.

For citation: Chichasova N.V., Lila A.M. Etanercept and its biosimilar in the treatment of rheumatoid arthritis: efficacy and safety. RMJ. 2021;7:44–49.

Summary:

Optimal urate-lowering therapy in patients with gout — modern version of the problem

V.V. Tsurko^1,2, M.A. Gromova¹

¹Pirogov Russian National Research Medical University, Moscow

²Russian Medical Academy of Continuous Professional Education, Moscow

Gout is the most common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues in the setting of hyperuricemia, characterized by painful acute pain leading to disability. The goal of long-term therapy is to reduce the level of serum uric acid (SUA), which helps to dissolve crystals and eliminate tophi, reduce the frequency of gout exacerbations and prevent progressive joint damage and comorbid pathology development. Despite the availability of national and international recommendations and the effective medications for gout treatment that have already been developed and applied in clinical practice, therapy results are commonly unsatisfactory. The reason for these drawbacks is commonly multifactorial, including the doc tor-patient interaction. Poor adherence to urate-lowering therapy (ULT) is a common and significant factor in adverse outcomes for patients. The article examines gaps in the gout treatment, discusses patient management, including treatment tactics for concomitant diseases, with the mandatory achievement of the SUA target level to improve adherence to oral therapy, which ultimately provides a controlled disease course and a favorable prognosis.

Keywords: gout, hyperuricemia, clinical recommendations, urate-lowering therapy, goal achievement, commitment.

For citation: Tsurko V.V., Gromova M.A. Optimal urate-lowering therapy in patients with gout — modern version of the problem. RMJ. 2021;7:50–54.

Summary:

Treatment of Felty syndrome: modern approaches

S.S. Spitsina^{1, 2}, I.A. Zborovskaya¹, A.S. Trofimenko¹, E.E. Mozgovaya¹, S.A. Bedina¹, M.A. Mamus¹

¹Research Institute of Clinical and Experimental Rheumatology named after A.B. Zborovsky, Volgograd

²Volgograd State Medical University, Volgograd

Felty syndrome is a rare (less than 1%) type of seropositive rheumatoid arthritis, in which neutropenia and splenomegaly occur. Clinical manifestations of Felty syndrome also include severe destructive joint damage, rheumatoid nodules, lymphadenopathy, hepatopathy, vasculitis, lower-extremity ulcers, skin pigmentation, etc. The causes of neutropenia are considered to be both a decrease in the granulopoiesis intensity and an increase in the peripheral destruction of granulocytes. Recurrent bacterial infections commonly develop due to severe neutropenia. This can cause an increase in the patients’ mortality, which requires special diagnostic caution due to the similarity of Felty syndrome manifestations with adverse events in the treatment of rheumatoid arthritis. Based on the up-to-date data, the treatment tactics of Felty syndrome has a number of features. Neutropenia ca n be effectively corrected with the help of some disease-modifying anti-rheumatic drugs, primarily methotrexate. Among genetically engineered biological drugs, encouraging results were achieved with the use of rituximab; for cases of severe neutropenia with recurrent infection, there is an experience in using granulocyte colony-stimulating factor. Splenectomy should be considered as a last measure in patients with Felty syndrome who do not respond to conservative treatment methods.

Keywords: rheumatoid arthritis, Felty syndrome, basic anti-inflammatory therapy, methotrexate, genetically engineered biological therapy, tumor necrosis factor α inhibitors, rituximab, granulocyte colony-stimulating factor, splenectomy.

For citation: Spitsina S.S., Zborovskaya I.A., Trofimenko A.S. et al. Treatment of Felty syndrome: modern approaches. RMJ. 2021;7:56–60.

Summary:

Phenylbutazone: non-selective NSAIDs in modern medical practice

I.S. Svintsitskaya, K.Yu. Volkov, S.G. Bologov

S.M. Kirov Military Medical Academy, St. Petersburg

Despite the long history of the use of non-steroidal anti-inflammatory drugs (NSAIDs) in clinical practice, research continues concerning the comparative evaluation of the efficacy and safety of various NSAIDs classes, taking into account their selectivity with respect to the effect on cyclooxygenase. The article is devoted to one of the most well-known and studied drugs — phenylbutazone. The review reflects some historical aspects of phenylbutazone use, it’s pharmacokinetic and pharmacodynamic patterns that cause a prolonged effect. The review also indicates the main adverse events and methods of their control. The expediency of using parenteral forms of NSAIDs (in particular phenylbutazone) in patients with acute pain, providing rapid onset of analgesic effect, is substantiated. It is noted that a balanced approach to phenylbutazone use can minimize the risk of severe toxic responses (primarily from the b one marrow), significantly limiting the drug use by specialists, including in outpatient practice. The article presents the study results confirming the efficacy and safety of phenylbutazone use in injectable form for the relief of acute pain syndrome associated with degenerative-dystrophic and rheumatic diseases of the musculoskeletal system.

Keywords: phenylbutazone, non-steroidal anti-inflammatory drugs, efficacy, safety, acute pain.

For citation: Svintsitskaya I.S., Volkov K.Yu., Bologov S.G. Phenylbutazone: non-selective NSAIDs in modern medical practice. RMJ. 2021;7:62–65.

Summary:

Uncommon fever as a specific form of generalized enterovirus infection during anti-B-cell therapy

A.V. Kuzmina¹, A.V. Loginov¹, A.A. Zhambeyev¹, P.A. Glazunov¹, E.V. Zhilyaev^1–

¹European Medical Center, Moscow

²Pirogov Russian National Research Medical University, Moscow

³Russian Medical Academy of Continuous Professional Education, Moscow

The advanced use of targeted immunosuppressive antitumor drugs is accompanied by an increase in the risk of rare opportunistic infections and in the incidence of unusual course of common infections. The article presents a clinical case of a severe enterovirus infection course with a specific clinical picture in a 38-year-old female patient suffering from B-cell lymphoma and receiving obinutuzumab. The methods of differential diagnosis used to detect enterovirus infection, as well as the ongoing treatment using human immunoglobulin, are described. The safety issues concerning the use of monoclonal antibodies directed against B-lymphocytes are also discussed. The clinical case presented in the article is of interest to doctors of various specialties, since it demonstrates the uncommon cause of fever of unknown origin, polymyositis and uncommon edematous syndrome, the possible m echanisms of which are also discussed by the authors. The description of the clinical case may be especially useful for doctors who follow-up patients during treatment with anti-B-cell drugs. The high significance of enterovirus infection in such patients is due to an unfavorable prognosis in the absence of specific treatment. Thus, timely diagnosis is crucial.

Keywords: B-cell lymphoma, obinutuzumab, enterovirus infection, differential diagnosis, edema, human immunoglobulin, monoclonal antibodies.

For citation: Kuzmina A.V., Loginov A.V., Zhambeyev A.A. et al. Uncommon fever as a specific form of generalized enterovirus infection during anti-B-cell therapy. RMJ. 2021;7:66–69.

Summary:

The effect of pneumococcal vaccination on the risk of infectious complications in patients with rheumatoid arthritis treated with targeted anti-inflammatory drugs (data from the Moscow Unified Arthritis Registry (MUAR))

E.V. Zhilyaev^1,2,3, G.V. Lukina^4,5, D.A. Murtazalieva⁴, E.N. Koltsova⁴, E.I. Shmidt⁶, K.A. Lytkina⁷, A.V. Shmit’ko⁸, D.A. Blagovidov⁸, M.P. Kostinov^8,9

¹CJSC European Medical Center, Moscow

²Russian Medical Academy of Continuous Professional Education, Moscow

³Pirogov Russian National Research Medical University, Moscow

⁴Moscow Clinical Scientific Center n.a. A.S. Loginov, Moscow

⁵Research Institute of Rheumatology named after V.A. Nasonova, Moscow

⁶City Clinical Hospital No. 1 named after N.I. Pirogov, Moscow

⁷City Clinical Hospital No. 4, Moscow

⁸І.І. Mechnikov Research Institute of Vaccines and Sera, Moscow

⁹I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

Background: pneumococcal vaccines — 23-valent pneumococcal polysaccharide vaccine (PPV23) and 13-valent pneumococcal conjugate vaccine (PCV13) are recommended for use in most patients with rheumatic diseases. However, data confirming the clinical efficacy of such vaccination is limited.

Aim: to evaluate the effect of vaccination with pneumococcal vaccines (PPV23 and PCV13) in patients with rheumatoid arthritis (RA) receiving genetically engineered biological drugs (GEBDs) and targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs) on the risk of developing infectious adverse events of various categories in real clinical practice.

Patients and methods: data analysis of the Moscow Unified Arthritis Registry (MUAR) for 2018–2020 was conducted. The patients with RA over 18 y.o. receiving GEBD or tsDMARDs were included. All infectious, respiratory infectious and serious infectious events were studied for the same period in vaccinated and unvaccinated patients.

Results: 832 patients were included in the analysis, of which 40 were vaccinated with PCV13, 35 — with PPV23. The follow-up was 319±198 days. A total of 237 infectious events were recorded, of which 201 were respiratory and 21 — serious. Acute respiratory infections prevailed among the events (70.0% of all infectious and 82.6% of respiratory infectious events). Survival curve comparison (log-rank test), as well as a comparison of the Cox proportional hazard regression, including adjusted for the most important risk factors for infectious events (age and smoking), revealed a significant reduction in the risk of any infectious events (p=0.012 and p=0.015, respectively) in patients immunized with PCV13, compared with unvaccinated. These patients also showed a statistically significant reduction in the risk of respiratory infections (p=0.009 and p=0.014, respectively). No significant effect of PPV23 vaccine on the risk of these events has been established. There w as no significant effect of any of the vaccines on the serious infectious event probability.

Conclusion: in this study, the clinical efficacy of PCV13 was demonstrated for the first time in patients with RA receiving therapy with tsDMARDs. The effect was achieved mainly by reducing the incidence of acute respiratory infections.

Keywords: rheumatoid arthritis, pneumococcal vaccine, pneumonia, targeted synthetic disease-modifying anti-rheumatic drugs, confounders, smoking, age.

For citation: Zhilyaev E.V., Lukina G.V., Murtazalieva D.A. et al. The effect of pneumococcal vaccination on the risk of infectious complications in patients with rheumatoid arthritis treated with targeted anti-inflammatory drugs (data from the Moscow Unified Arthritis Registry (MUAR)). RMJ. 2021;7:7–12.

Summary:

Spondyloarthritis: diagnostic challenges and possibilities of modern methods of high-tech medical care

V.V. Vakhlevsky, I.S. Svinitskaya, V.V. Tyrenko

S.M. Kirov Military Medical Academy, St. Petersburg

In the diagnosis of rheumatic diseases, detailed complaints, medical history, laboratory and instrumental research methods are crucial. The correctness of the treatment tactics and patient management depends on the timely diagnosis, which ensures retardation in the disease progression and allows achieving effective disease control in dynamics. The article describes a clinical case of lately diagnosed ankylosing spondylitis (AS) in a 34-year-old young patient with severe coxitis. The disease onset started with the pain occurrence in the left hip joint (HJ). For two years, the patient was under follow-up with a diagnosis of reactive arthritis of unspecified etiology with systemic manifestations. Despite the ongoing therapy (prednisolone, sulfasalazine), the articular syndrome progression was noted. After an additional examination, the diagnosis of high-activity AS (ASDAS_CRP — 3.03, BASDAI — 3.6), with non-axial (bilateral coxitis) manifestations, HLA-B27-positive was established criterion-wise. Complication: stage III bilateral coxarthrosis with a predominant lesion of the left HJ with severe pain syndrome. To achieve a rapid effect and reduce the disease progression, a TNF-α inhibitor was prescribed. As a result of treatment, disease low activity was achieved, which made it possible to successfully perform total left HJ replacement.

Keywords: ankylosing spondylitis, coxitis, coxarthrosis, hip replacement, genetically engineered biological therapy, TNF-α inhibitor, prednisolone.

For citation: Vakhlevsky V.V., Svinitskaya I.S., Tyrenko V.V. Spondyloarthritis: diagnostic challenges and possibilities of modern methods of high-tech medical care. RMJ. 2021;7:70–73.

Summary:

Two views on the problem of osteoarthritis and osteochondrosis: comparison of approaches to the therapy (post-release)

On November 8–10, 2021, the Xll Congress «Manage Pain» was held. The congress objectives were the following: to spread advanced knowledge on the problem of pain, improve the interaction between doctors of various specialties and international experience exchange in organizing care and therapy for patients suffering from various pain syndromes. The event was organized with the participation of the following organizations: World Institute of Pain (WIP), European Pain Federation (EFIC), Association for Interventional Pain Management (AIPM), Russian Headache Research Society (RHRS), etc.

The audience of the event included leading specialists in the field of neurology and psychiatry, therapists, doctors of family medicine, psychologists, anesthesiologists, surgeons, nutritionists, urologists, gastroenterologists, endocrinologists, gynecologists and doctors of other specialties whose professional activities were related to the study, diagnosis and treatment of pain syndromes.

On November 8, 2021, within the framework of the Congress, Promomed company held an interactive session dedicated to the therapy of patients with osteoarthritis and osteochondrosis. The symposium was co-chaired by Andrey B. Danilov (Doctor of Sciences (Medicine), Professor of the Department of Nervous Diseases of the I.M. Sechenov First Moscow State Medical University), and Alexander M. Lila (Doctor of Sciences (Medicine), Professor, Director of the V.A. Nasonova Research Institute of Rheumatology). The session featured presentations on the topics: «Individual approach to the treatment of patients with osteoarthritis», «Osteochondrosis: a new look at an old problem», «Clinical study results on the efficacy and safety of AMBENE^®Bio (COLIBRI)».

For citation: Danilov A.B., Lila A.M., Feklistov A.Yu. Two views on the problem of osteoarthritis and osteochondrosis: comparison of approaches to the therapy (post-release). RMJ. 2021;7:74–78.

Summary:

Integral hematological indices as a marker of the postresection liver failure

S.S. Dunaevskaya, K.V. Sachivko, A.A. Kosik, M.A. Berezhnaya, A.N. Narkevich

Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk

Background: acute liver failure is the most dangerous complication after liver resection, characterized by acute, rapidly developing a hepatic injury.

Aim: to determine the patterns of changes in the integral hematological indices (IHI), to assess their diagnostic value in patients with the development of postresection liver failure (PLF). 

Patients and Methods: the study included 54 patients, among them 32 (59%) women (the average age of patients was 59.5 [49.7; 66] years), who underwent segmental resection or hemihepatectomy for malignant and benign liver tumors. The patients were divided into two groups: group 1 (n=44) — consisted of patients who had not been diagnosed with PLF in the postoperative period, group 2 (n=10) — the postoperative period was complicated by the development of hepatic failure. In all patients at admission, as well as on the 3rd day after surgery, the indicators of the complete blood count with the calculation of the WBC count were studied, and the values of the leukocyte indices of cellular reactivity were determined.

Results: IHI comparative analysis in patients with different postoperative period revealed statistically significant differences in most of the base indicators. It was found that the leukocyte intoxication index by J.J. Kalf-Kalif, modified leukocyte intoxication index of B.A. Reis, modified leukocyte intoxication index of V.K. Ostrovsky and hematological intoxication index in the postoperative period in the group of patients with the liver failure significantly (p=0.005, p=0.041, p=0.041, p=0.001, respectively) differed from the indicators of patients without liver failure. An increase in these indices can serve as an early diagnostic criterion for PLF development.

Conclusion: the method of calculating IHI is a simple and cheap diagnostic method that can be used only with the results of the leukocyte formula. The determination of diagnostically significant indices in dynamics can be used as a prognostic and screening method for detecting PLF.

Keywords: liver failure, liver resection, diagnosis, screening, integral hematological indices, leukocyte index.

For citation: Dunaevskaya S.S., Sachivko K.V., Kosik A.A. et al. Integral hematological indices as a marker of the postresection liver failure. RMJ. 2021;6:101–104 (in Russ.).

Summary:

C-reactive protein in the assessment of patients with respiratory symptoms before and during the COVID-19 pandemic

E.A. Andreeva

Northern State Medical University, Arkhangelsk

The article is devoted to the role of C-reactive protein (CRP) in the diagnosis of respiratory diseases and patient management with respiratory symptoms. The article presents the clinical recommendations of the Russian professional communities, including CRP level determination in various respiratory diseases. CRP role as an indicator of bacterial infection, as well as critical levels and changes in the CRP concentration in the disease dynamics, are considered. The article also discusses point-of-care testing of CRP role as a «here and now» strategy that allows deciding on the prescription of antibacterial therapy at the time and place where medical care is provided. This approach minimizes unnecessary antibiotic therapy, especially in primary health care settings. The significance of CRP determining during the COVID-19 pandemic as an inflammatory marker in new coronavirus infection is consi dered. Indications for determining the CRP concentration in patients with COVID-19, proposed by international and Russian recommendations, including the current version of the Temporary Methodological Guidelines «Prevention, diagnosis and treatment of new coronavirus disease (COVID-19)», are presented. The article discusses the need to determine the CRP concentration to plan the patient management with respiratory infections in the near future, taking into account the current COVID-19 pandemic.

Keywords: C-reactive protein, point-of-care testing, respiratory infections, clinical recommendations, COVID-19, pneumonia, inflammatory markers, antibacterial therapy.

For citation: Andreeva E.A. C-reactive protein in the assessment of patients with respiratory symptoms before and during the COVID-19 pandemic. RMJ. 2021;6:14–17 (in Russ.).

Summary:

Patient with GERD after a new coronavirus infection. Rational pharmacotherapy in clinical case

I.G. Pakhomova

V.A. Almazov National Medical Research Center, Saint-Petersburg

In 2020, the global health system is facing a new coronavirus infection caused by SARS-CoV-2. Among many publications devoted to the features of the infection clinical manifestations and its treatment, there are works on the gastrointestinal (GI) manifestations of COVID-19. Information about post-COVID-19 manifestations from the GIT is rather scarce. At the same time, doctors are faced in clinical practice with a considerable proportion of patients with COVID-19 GI manifestations and adverse events on some drugs prescribed to the patients with SARS-CoV-2. Such patient management may present some difficulties since there are no available recommendations for their management. Gastroesophageal reflux disease (GERD) is one of the most common pathologies of the GIT. To date, possible links in the pathogenesis of GERD have been studied and described. Proton pump inhibitors (PPIs), prokinetics, esophagoprotec tion, etc. are effective in GERD treatment. It will be rational to combine them. However, among PPIs, rabeprazole has a dual mechanism of action: antisecretory and cytoprotective, which makes it possible to achieve a rapid and effective clinical and endoscopic response to therapy. This review provides information on the patient management with GERD after COVID-19 in the clinical case.

Keywords: gastroesophageal reflux disease, GERD, COVID-19, proton pump inhibitors, rabeprazole.

For citation: Pakhomova I.G. Patient with GERD after a new coronavirus infection. Rational pharmacotherapy in clinical case. RMJ. 2021;6:18–22 (in Russ.).

Summary:

The role of non-invasive ventilation in the complex therapy of patients with chronic obstructive pulmonary disease with hypercapnic
respiratory failure

N.A. Kuzubova¹, O.N. Titova¹, D.B. Sklyarova²

¹Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg

²Vvedenskaya City Clinical Hospital, Saint-Petersburg

Background: hypercapnia development in patients with chronic obstructive pulmonary disease (COPD) with chronic respiratory failure leads to a decrease in the efficacy of long-term oxygen therapy (LTOT), an increase in the number of exacerbations and an increased risk of fatal outcome.

Aim: to determine the role of non-invasive lung ventilation (NVL) in the complex respiratory therapy of COPD complicated by chronic hypercapnic respiratory failure (HRF).

Patients and Methods: a prospective study included 30 patients with severe COPD (group D) with chronic HRF during disease remission. There were 2 groups: group 1 (n=14) — patients with COPD and HRF (partial pressure of carbon dioxide (PaСО₂) of 54.7±7.2 mm Hg), receiving NIV and LTOT; group 2 (n=16) — patients with COPD and HRF (PaСО₂ 52,8±o6.96 mm Hg) who received only LTOT. Group 1 was prescribed with BiLevel NIV 3 hours a day on the daily basis and LTOT 16 hours a day, flow rate — 3 L/min. Group 2 received only LTOT in a similar mode. The mMRC (Modified Medical Research Council) Dyspnea Scale, exercise tolerance test (6-minute walk test), blood oxygen saturation, blood gas composition, the main pulmonary function parameters, and pulmonary artery systolic pressure (PASP) were evaluated. The studies were conducted three times: initially, after 2 weeks and after 12 months of therapy.

Results: during NIV and LTOT, there was a decrease in dyspnea severity in group 1 (p<0.05), an increase in exercise tolerance, a significant decrease in PaCO₂ (54.7±7.2 to 43.14±4.86 mm Hg, p<0.05) and an increase in PaO₂. NIV use throughout the year contributed to a decrease in the number of hospitalizations associated with severe COPD exacerbation (from 3.0±1.37 to 1.2±0.5, p<0,05).

Conclusion: NIV use in patients with COPD and HRF during LTOT contributed not only to improving the parameters of gas exchange, improving the clinical condition but also to reducing the number of exacerbations that require hospitalization. In patients receiving LTOT, it is necessary to monitor the gas exchange indicators for the timely detection of HRF and NIV prescription.

Keywords: chronic obstructive pulmonary disease, hypercapnia, hypoxemia, respiratory failure, long-term oxygen therapy, non-invasive ventilation.

For citation: Kuzubova N.A., Titova O.N., Sklyarova D.B. The role of non-invasive ventilation in the complex therapy of patients with chronic obstructive pulmonary disease with hypercapnic respiratory failure. RMJ. 2021;6:23–26 (in Russ.).

Summary:

Inosine pranobex experience in children with recurrent respiratory infections

E.V. Melekhina, A.D. Muzyka, Zh.B. Ponezheva, A.V. Gorelov

Central Research Institute of Epidemiology of the Russian Federal Service for Supervision 

of Consumer Rights Protection and Human Well-Being, Moscow

Aim: to evaluate the efficacy of various treatment regimens using inosine pranobex in children with monthly infections of the respiratory tract in the setting of herpesvirus infections (hvi) reactivation, including combined forms.

Patients and Methods: 91 children aged 3 to 17 years with monthly respiratory infections were examined on an outpatient basis during the previous 3 months of follow-up and laboratory-confirmed active forms of HVI, including concomitant forms in 41% of cases. Of these, 12 children were treated with inosine pranobex, 29 — inosine pranobex + recombinant interferon (IFN), 24 children — inosine pranobex + meglumine acridone acetate. The comparison group consisted of 26 children who underwent topical therapy of inflammatory changes in the oropharynx with herbal medicines. In total, befo re the therapy initiation, infection reactivation caused by human herpes virus 6A/B was determined in 85.8% of children, Epstein-Barr virus — 35.6%, cytomegalovirus infection — 7.5%, herpes simplex virus — 1–16%. Therapy clinical effect was evaluated 3 months after the end of therapy by the presence or absence of respiratory infection cases.

Results: in patients receiving inosine pranobex + meglumine acridonacetate, there was the most statistically significant decrease (p=0.016, according to the Student’s t-test) in the severity of the inflammatory changes in the posterior pharyngeal wall after therapy. In the group of patients receiving inosine pranobex + recombinant IFN, the most significant decrease in regional lymphadenopathy (p=0.036, according to the Mann–Whitney U-test) and hepatomegaly was determined during therapy (p=0.003, according to the Student’s t-test). The largest number of patients with a complete clinical effect over the next 3 months was demonstrated in the group receiving inosine pranobex and recombinant IFN. After the end of therapy, laboratory markers of HVI rea ctivation were manifested in 47% of children, while the rate of concomitant infections decreased from 41% to 8%. The complete clinical effect after the end of the study was recorded in 86% of patients treated with inosine pranobex + recombinant IFN, in 75% of patients in the inosine pranobex monotherapy group, and 63% of patients treated with inosine pranobex + meglumine acridonacetate. In the comparison group, acute respiratory infections were absent only in 8% of cases. The differences between the groups receiving therapy and the comparison group were statistically significant.

Conclusion: inosine pranobex has clinical and virological efficacy in the treatment of recurrent respiratory infections in children associated with HVI reactivation, including concomitant forms.

Keywords: children, recurrent respiratory infections, concomitant infections, herpesvirus infections.

For citation: Melekhina E.V., Muzyka A.D., Ponezheva Zh.B., Gorelov A.V. Inosine pranobex experience in children with recurrent respiratory infections. RMJ. 2021;6:27–32 (in Russ.).

Summary:

Pharmacoresistant epilepsy. Clinical lecture

A.S. Kotov, K.V. Firsov, E.A. Sandu

M.F. Vladimirskiy Moscow Regional Research and Clinical Institute, Moscow

The article analyzes the definition of the concept pharmacoresistant epilepsy (PRE). The social significance of this disease is noted. The article also gives a detailed description of various types of PRE (genetic traits, morphological substrates, clinical phenomena, some typical biomarkers). Further study prospects of these predictors for the early detection of persons with PRE, as well as the main diagnostic methods in patients with pharmacoresistant epilepsy, including non-invasive and minimally invasive procedures of pre-surgical diagnosis are described. The main surgical treatment methods (resective and functional) are given, the method and types of invasive and non-invasive brain stimulation are considered. There are the main types of therapeutic diets in patients with PRE, such as the classic ketogenic diet, medium-chain triglyceride ketogenic diet, the modified Atkins diet, low glycemic diet. Adding that, the article gives the basic principles of pharmacological therapy for PRE. It is particularly noted that in pharmacoresistance, it is necessary to take into account not only the impossibility of achieving a sustained remission of seizures but also the presence of significant adverse events that, even in achieved remission, can force the patient to refuse to take an antiepileptic drug.

Keywords: epilepsy, pharmacoresistance, predictors, diagnosis, treatment, electrical stimulation.

For citation: Kotov A.S., Firsov K.V., Sandu E.A. Pharmacoresistant epilepsy. Clinical lecture. RMJ. 2021;6:33–39 (in Russ.).

Summary:

COVID-19 vaccination of pregnant women: current information

A.L. Zaplatnikov¹, A.A. Girina²

¹Russian Medical Academy of Continuous Professional Education, Moscow

²Khanty-Mansiysk State Medical Academy, Khanty-Mansiysk

Pregnant women are at risk for severe COVID-19, preterm birth, and other adverse outcomes during pregnancy. Preliminary data indicate that COVID-19 vaccination during pregnancy protects from the severe course of COVID-19 and is not accompanied by an adverse effect on pregnancy and the fetus. However, conclusions about the safety and efficacy of pregnant women immunization against COVID-19 will be possible only after receiving all the results of ongoing studies.

Keywords: pandemic, COVID-19, new coronavirus infection, pregnant women, vaccination.

For citation: Zaplatnikov A.L., Girina A.A. COVID-19 vaccination of pregnant women: current information. RMJ. 2021;6:4–5 (in Russ.).

Summary:

An innovative program for the prevention of joint pain in high-risk patients in outpatient practice

M.A. Strakhov^1-3, A.A. Shishkin², V.A. Bondarenko², N.V. Zagorodniy^1,4, K.A. Egiazaryan², A.A. Akhpashev^3,4, T.G. Gaev³, N.V. Shavaleeva³, V.Yu. Levkov²

¹N.N. Priorov National Medical Research Center for Trauma & Orthopedics, Moscow

²Pirogov Russian National Research Medical University, Moscow

³Federal Scientific & Clinical Center of the Federal Medical Biological Agency, Moscow

⁴Russian University of Peoples’ Friendship, Moscow

This paper addresses the authors’ materials on the development of the evidence-based preventive algorithm for joint pain in high-risk patients. This algorithm provides a differentiated management approach and involves consistent use of non-pharmacological (therapeutic and preventive exercises) and pharmacological treatments depending on pain severity. A set of exercises is shaped depending on the patient’s age and physical performance and efficacy of exercises according to evidence-based medicine. After expert analysis of the type of gymnastics, only exercises improving motion amplitude, muscle strength, and coordination were selected. Moreover, a combination of gymnastics exercises can serve as both physical therapy and therapeutic and preventive instrument. Pharmacotherapy, the next step to manage joint pain, includes various non-steroidal anti-inflammatory drugs. The novelty of this project is the discussion of pain prevention in the light of evidence-based therapeutic and preventive gymnastics exercises and their integration into current international guidelines on pain management.

Keywords: pain, joint pain, therapeutic and preventive program, pain prevention, evidence-based medicine, nimesulide.

For citation: Strakhov M.A., Shishkin A.A., Bondarenko V.A. et al. An innovative program for the prevention of joint pain in high-risk patients in outpatient practice. RMJ. 2021;6:Р 40-47 (in Russ.).

Summary:

Safety issues in the treatment of patients with dorsalgia

P.R. Kamchatnov¹, A.V. Chugunov¹, Z.A. Ashalmagomedova², A.M. Shemshedinova²

¹Pirogov Russian National Research Medical University, Moscow

²Dagestan State Medical University, Makhachkala

Patient management with dorsalgia requires not only timely and reliable pain relief and rehabilitation measures but also compliance with the treatment safety. Unfortunately, the widespread use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of such patients is associated with a certain risk of adverse events. The review examines the main complications during NSAIDs use from the gastrointestinal tract, cardiovascular and hepatobiliary system, etc., assesses the risks of adverse events in patients with comorbid pathology, analyzes their occurrence causes and ways to overcome them. When choosing a drug for the treatment of patients with an existing disease of these organs, you should choose those with minimal risk of complications and use short courses of treatment. The article provides information on flurbiprofen, which has a number of benefits that allow this drug to be widely used in the treatment of patients with dorsalgia.

Keywords: dorsalgia, pain syndrome, nonsteroidal anti-inflammatory drugs, treatment, adverse events.

For citation: Kamchatnov P.R., Chugunov A.V., Ashalmagomedova Z.A., Shemshedinova A.M. Safety issues in the treatment of patients with dorsalgia. RMJ. 2021;6:48–52 (in Russ.).

Summary:

Regional aspects of vaccination in the era of the COVID-19 pandemics

А.V. Dmitriev¹, N.V. Fedina¹, R.A. Gudkov¹, V.I. Petrova¹, А.L. Zaplatnikov²

¹Ryazan State Medical University, Ryazan

²Russian Medical Academy of Continuous Professional Education, Moscow

Aim: to assess the coverage of children aged 0–18 years with vaccination in 2018–2020 in the Ryazan region and to perform a comparative analysis of monthly immunization plan as a part of the national calendar of prophylactic immunization of children aged 0–18 years in the first year of the COVID-19 pandemic.

Patients and Methods: monthly and annual formulations No. 6 “Data on children and adults vaccinated against infections” (from December 31, 2018, to December 31, 2020) as well as monthly and annual formulations No. 5 “Data on preventive vaccinations” (from January to December 2020) in the Ryazan region were analyzed. Anonymous in-person voluntary questioning of 60 out-patient pediatricians on the novel coronavirus infection was performed.

Results: the coverage with vaccination in the Ryazan region in 2018–2020 is a rather high being at least 95%. In the second quarter of 2020, a significant reduction in the coverage with all calendar prophylactic vaccinations was reported being in line with the recommendations on the temporary suspension of vaccination in April-May 2020. The removal of limitations of immunization in May 2020 provided a gradual increase in the coverage of children of the Ryazan region with vaccination and the recovery to standard ratios in June 2020.

Conclusion: the COVID-19 pandemics in 2020 compromised vaccination plans in April-May as a result of limitations and quarantine. However, the vaccination plan was fully implemented by the end of 2020. This can be accounted for by vaccine runner-up measures realized in the summer and autumn of 2020.

Keywords: pandemics, COVID-19, immunization, vaccination, national calendar of prophylactic immunization, immunization plan.

For citation: Dmitriev А.V., Fedina N.V., Gudkov R.A. et al. Regional aspects of vaccination in the era of the COVID-19 pandemics. RMJ. 2021;6:5–8 (in Russ.).

Summary:

Association of human herpesvirus 6 with chronic pelvic pain syndrome: a clinical case

V.P. Kovalyk¹, K.I. Yurlov², M.A. Gomberg³, A.N. Shuvalov², V.V. Malinovskaya², A.A. Kusch²

¹Federal Research and Clinical Center of the Federal Medical Biological Agency, Moscow

²National Research Center for Epidemiology and Microbiology named after Honorary Academician N.F. Gamaleya, Moscow

³Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow

In chronic prostatitis/chronic pelvic pain syndrome IIIA (CP/CPPS) there is an increased WBC count in the prostate gland secret, but the standard diagnostic search for microbial agents is commonly unsuccessful. During the introduction of molecular genetics into clinical practice, the number of studies on the role of viral agents in this disease began to increase. Human herpesvirus 6 (HHV-6) has a tropism to nerve cells, and therefore, their role in neurodegenerative diseases and pain syndromes is being studied. The uniqueness of this virus is the possibility of its embedding in the chromosome telomere and its congenital transmission. The article presents a clinical case of HHV-6 detection in urogenital samples in the presence of CP/CPPS in clinically significant titers. HHV-6 was the only probable etiological agent of this disease. The conducted antiviral therapy using a combination of a nucleoside analog (Valacyclovir) (1000 mg per day for 90 days and interferon α-2b drug with antioxidants in rectal suppositories of 3 million IU 2 times a day for 10 days, then 3 times a week for 3 weeks) showed a good clinical and virological effect.

Keywords: chronic prostatitis, chronic pelvic pain, herpesvirus 6, antiviral therapy.

For citation: Kovalyk V.P., Yurlov K.I., Gomberg M.A. et al. Association of human herpesvirus 6 with chronic pelvic pain syndrome: a clinical case. RMJ. 2021;6:53–55 (in Russ.).

Summary:

Asymptomatic hyperuricemia impact on the comorbid pathology course in patients with osteoarthritis and the possibility of its correction

V.I. Mazurov^1,2, I.Z. Gaidukova^1,2, R.A. Bashkinov^1,2, A.Yu. Fonturenko^1,2, M.S. Petrova^1,2, O.V. Inamova^1,2

¹I.I. Mechnikov North-Western State Medical University, Saint-Petersburg

²Clinical Rheumatology Hospital No. 25, Saint-Petersburg

Background: hyperuricemia is diagnosed when the level of serum uric acid (SUA) exceeds 360 µmol/L in women and 420 µmol/L in men. The importance of hyperuricemia in the development of comorbid conditions (in the absence of gouty arthritis), as well as the need for the use of urate-lowering therapy (ULT) in asymptomatic hyperuricemia (AHU), are the subject of discussion among specialists of the medical community.

Aim: to study the incidence and treatment patterns of comorbid conditions in patients with osteoarthritis and AHU.

Patients and Methods: data of patients with OA and AHU were analyzed on the basis of Saint-Petersburg City Registry of Patients with Gout and AHU data. Gender and age of patients, laboratory parameters, the presence of comorbid conditions and the drug therapy received were analyzed.

Results: the analysis included data of 400 patients with AHU. It was found that in AHU, the incidence of arterial hypertension, angina pectoris, acute myocardial infarction, deep vein thrombosis, pulmonary embolism, chronic heart failure, transient  ischemic attacks, cerebrovascular diseases, obesity, type 2 diabetes mellitus, peptic ulcer disease, chronic pyelonephritis and chronic kidney disease significantly (p<0.05) exceeds the population indicator. Only 36.75% of patients received allopurinol as the ULT. Improvement of the SUA level during treatment was achieved in 20.4% of patients. The main reasons for not achieving the SUA target levels were the prescription of deliberately low doses of the drug and the lack of their titration according to the SUA level during treatment.

Conclusion: AHU is a condition associated with metabolic syndrome, kidney disease, and cardiovascular disease. ULT, during which allopurinol (Milurit^®, EGIS) is commonly used as a registered drug for the «hyperuricemia» indication, may be one of the promising options for solving problems associated with AHU. It should be noted that the ULT prescription may not be sufficient without dose titration of the drug according to the SUA level and the absence of non-drug correction of cardiovascular risk factors.

Keywords: uric acid, asymptomatic hyperuricemia, comorbid conditions, urate-lowering therapy, allopurinol.

For citation: Mazurov V.I., Gaidukova I.Z., Bashkinov R.A. et al. Asymptomatic hyperuricemia impact on the comorbid pathology course in patients with osteoarthritis and the possibility of its correction. RMJ. 2021;6:56–62 (in Russ.).

Summary:

Efficacy and safety of phenylbutazone use intramuscularly in knee osteoarthritis

V.A. Nesterenko, A.E. Karateev, V.A. Zelenov, E.G. Zotkin

Research Institute of Rheumatology named after V.A. Nasonova, Moscow

Background: osteoarthritis (OA) is the most common disease among joint diseases. In OA, there is developing chronic pain that decreases the life quality of patients, leading to significant limitations in daily activities and disability. One of the leading treatment methods is the use of non-steroidal anti-inflammatory drugs (NSAIDs).

Aim: to evaluate the efficacy and safety of phenylbutazone intramuscular injections in knee OA.

Patients and Methods: 30 patients participated in the prospective study, including 21 (70%) women (the median age of all patients was 48 [35; 62] years) with a confirmed diagnosis of OA according to X-ray examination data and the presence of active synovitis according to ultrasound results. All patients received intramuscular injections of AMBENIUM^® parenteral 2 ml with an interval of 7 days. The efficacy criteria were the pain dynamics during movement (according to the 100 mm VAS) and functional status (according to the HAQ-DI and KOOS questionnaires), and the dynamics of ultrasound inflammatory indicators in the knee joint. The treatment results were assessed during 5 consecutive visits: before the start of the course, after the 2nd and 3rd administration (after 7±2 and 14±2 days), after 28±2 and 56±2 days after the start of the study.

Results: during treatment, there was a significant improvement in all indicators of pain and knee joint function. The average pain severity according to VAS at baseline and by the end of the follow-up was 40 [30; 60] and 20 [0; 30] mm (p=0.000008), respectively; the average values of the KOOS indicator were 59.6 [32.5; 73.6] and 72.7 [54.9; 87.4] points (p=0.009469), for HAQ-DI — 1.1 [0.88; 1.75] and 1.0 [0.84; 1.3] points (p=0.07). As a result of the treatment, the excess amount of fluid was preserved only in 30% of patients. There was a significant (p<0.05) decrease in the thickness of the synovial membrane and the amount of fluid in the bursa. No serious adverse events were observed.

Conclusion: injection therapy with AMBENIUM^® parenteral is an effective method of relieving pain in knee OA and is associated with a low risk of adverse events.

Keywords: osteoarthritis, knee joint, synovitis, pain, nonsteroidal anti-inflammatory drugs, phenylbutazone, parenteral administration.

For citation: Nesterenko V.A., Karateev A.E., Zelenov V.A., Zotkin E.G. Efficacy and safety of phenylbutazone use intramuscularly in knee osteoarthritis. RMJ. 2021;6:63–66 (in Russ.).

Summary:

Place and role of the parenteral form of chondroitin sulfate in the treatment of osteoarthritis: multidisciplinary Consensus

A.M. Lila^1,2, O.N. Tkacheva³, A.V. Naumov³, L.I. Alekseeva¹, A.Yu. Kochish⁴, Yu.V. Kotovskaya³, A.P. Rachin⁵, I.V. Sarvilina⁶

¹Research Institute of Rheumatology named after V.A. Nasonova, Moscow 

²Russian Medical Academy of Continuous Professional Education, Moscow

³Pirogov Russian National Research Medical University, Moscow

⁴Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden, Saint-Petersburg

⁵National Medical Research Center of Rehabilitation and Balneology, Moscow

⁶Medical Center «Novomedicina» LLC, Rostov-on-Don

The article presents the first Consensus on the place and role of the parenteral form of chondroitin sulfate (CS) in the treatment of osteoarthritis (OA). An increase in the medical and social burden of OA was noted worldwide. The evidence base analysis on the efficacy and safety of its use was carried out in patients with comorbid pathologies and secondary OA of large joints. The clinical sections of the consensus discuss the place of the CS parenteral form in modern clinical recommendations for the patient management with OA, as well as the possibilities of using CS at the stages of providing traumatological and rehabilitative medical care to patients with OA, and the role of CS in the treatment of OA. It has been shown that the CS parenteral form for intramuscular and intra-articular administration (Chondroguard^®) has a number of pharmaceutical and clinical benefits, and, therefore, can be recommended for initial use in exacerbations of chronic joint and back pain in OA, including in comorbid patients. It is recommended to include CS for intra-articular and intramuscular administration in the treatment regimen for secondary OA of large joints (post-traumatic and dysplastic OA) at the stages of providing traumatological and rehabilitative medical care.

Keywords: osteoarthritis, comorbidity, chondroitin sulfate, Chondroguard, asthenia, standardization, pharmaceutical substance, pharmaceutical analysis.

For citation: Lila A.M., Tkacheva O.N., Naumov A.V. et al. Place and role of the parenteral form of chondroitin sulfate in the treatment of osteoarthritis: multidisciplinary Consensus. RMJ. 2021;6:68–74 (in Russ.).

Summary:

Cardiovascular safety of nonsteroidal anti-inflammatory drugs

N.V. Chichasova^1,2, A.M. Lila^1,2

¹Research Institute of Rheumatology named after V.A. Nasonova, Moscow

²Russian Medical Academy of Continuous Professional Education, Moscow

The article is devoted to the problem of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) with an emphasis on their adverse events (AEs) in relation to the cardiovascular system. The association of these AEs to the mechanism of action of NSAIDs was discussed. It was indicated that for the AEs prevention, it is necessary to assess the risk factors for the development of complications associated with NSAIDs use. Factors of high and moderate cardiovascular risk were identified. The article discusses the interpretation complexity of the changes in the cardiovascular system due to the high incidence of comorbid conditions in the pathology of the musculoskeletal system, as well as the involvement of chronic inflammation in the genesis of atherosclerosis and, as a result, cardiovascular pathology development (or aggravation of the course). Data on the increase in the risk  of cardiovascular complications with dose increment of selective and non-selective NSAIDs were presented. It was noted that only very high doses of selective cyclooxygenase 2 (COX-2) inhibitors could be considered potentially dangerous in long-term continuous administration in groups with the risk of developing cardiovascular complications. The article also presents the data of a large-scale cohort study comparing cardiovascular risk during selective COX-2 inhibitors intake, according to which meloxicam has some superiority. The high safety of meloxicam was confirmed by the data of meta-analyses and systematic reviews, which showed that meloxicam did not worsen the course of arterial hypertension and coronary heart disease, did not aggravate edema, did not increase the incidence of myocardial infarction or thrombotic events. Meloxicam intake is associated with a slight increase in the combined risk of cardiovascular complications (risk ratio — 1.14, 95% confidence interval 1.04 d01.25), mainly its vascular component, without increasing myocardial and renal risk. It was noted that the simultaneous administration of meloxicam and acetylsalicylic acid to healthy volunteers did not affect the disaggregation effect of the latter.

Keywords: nonsteroidal anti-inflammatory drugs, NSAIDs, meloxicam, rofecoxib, celecoxib, non-selective NSAIDs, cardiovascular safety, risk, prevention.

For citation: Chichasova N.V., Lila A.M. Cardiovascular safety of nonsteroidal anti-inflammatory drugs. RMJ. 2021;6:75–80 (in Russ.).

Summary:

Cholestatic liver diseases: diagnostic and treatment algorithms

T.E. Polunina

A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

Over the past decade, significant progress has been made in understanding the molecular basis of bilification and the cholestasis pathophysiology. The article presents the goals of cholestasis therapy, which help to understand existing treatment methods and contribute to the development of new drugs for cholestatic liver diseases (CLD). This article also briefly summarizes the current concepts of bilification and cholestasis occurrence. Treatment of CLD is illustrated by the example of the most common chronic cholestatic liver disease — primary biliary cholangitis.

Keywords: bile, cholestasis, cholestatic liver diseases, primary biliary cholangitis, ursodeoxycholic acid.

For citation: Polunina T.E. Cholestatic liver diseases: diagnostic and treatment algorithms. RMJ. 2021;6:81–87 (in Russ.).

Summary:

Heterotopic gastric mucosa in the proximal esophagus: historical aspect and modern view

A.I. Dolgushina¹, A.O. Khikhlova^1,2, E.R. Olevskaya^1,2, O.V. Naumenko²

¹South Ural State Medical University, Chelyabinsk

²Chelyabinsk Regional Clinical Hospital, Chelyabinsk

According to the autopsy data, heterotopic gastric mucosa in the proximal esophagus (or inlet patch), which is an area of ectopic mucosa (characteristic of the stomach), is diagnosed more commonly than it is visualized endoscopically, and also is accompanied by clinical symptoms. The article is devoted to the etiology and pathogenesis of the inlet patch, as well as to the analysis concerning the prevalence of pathology and clinical manifestations. The article also presents modern clinical and pathological classification, which includes five individual groups based on the clinical, endoscopic and histological characteristics of the inlet patch. The literature data on the association of inlet patch in the upper esophagus with functional disorders of the gastrointestinal tract (GIT), Barrett’s esophagus, as well as its neoplastic transformation are considered. Special attention is paid to the diagnosis of the inlet patch based on a targeted examination of the cervical esophagus using modern endoscopic equipment. The article presents the principles of drug therapy and endoscopic tr eatment of symptomatic patients with the inlet patch. The review demonstrates the importance of clinicians’ awareness of this pathology and a multidisciplinary approach to patient management.

Keywords: heterotopia, gastric mucosa, upper third of the esophagus, inlet patch, esophagogastroduodenoscopy, radiofrequency ablation.

For citation: Dolgushina A.I., Khikhlova A.O., Olevskaya E.R., Naumenko O.V. Heterotopic gastric mucosa in the proximal esophagus: historical aspect and modern view. RMJ. 2021;6:87–92 (in Russ.).

Summary:

The pandemic of a new coronavirus infection in the Kabardino-Balkarian Republic. Regional experience

M.S. Shogenova^1,2, S.Kh. Khutueva¹, I.B. Tlupova¹, M.A. Akkieva¹, L.S. Shogenova²

¹Center of Allergology of the Ministry of Health of the KBR, Nalchik

²Kabardino-Balkarian State University named after H.M. Berbekov, Nalchik

Aim: to analyze various clinical indicators in patients with a new coronavirus infection and determine the main disease markers.

Patients and Methods: 55 case histories of patients diagnosed with new coronavirus infection (COVID-19) were analyzed. There were 5 groups: group 1 — mild course; group 2 —moderate course with lung damage up to 25% (according to CT); group 3 — moderate course with lung damage 25–50% (according to CT); group 4 — severe course; group 5 — extremely severe course. The examination included clinical and biochemical studies, coagulogram, determination of SARS-CoV-2 RNA by polymerase chain reaction (PCR), as well as IgM and IgG antibodies to the SARS-CoV-2 betacoronavirus nucleocapsid protein by enzyme immunoassay.

Results: it was found that in the COVID-19 clinical picture, the manifestations of gastroenterocolitis (13 patients, 23.6%) and cutaneous eruption (3 patients, 5.5%), along with intoxication syndrome, were significant. In patients depending on the severity of detected eritropeniya (3,51±0,1×10¹²/L in group 5), leukopenia (2,93±0,1×10⁹/L in group 5) and elevated ESR (46,14±2.0 mm/h in group 5), which has significant differences versus the groups 3 and 4. Acute-phase proteins — C-reactive protein (CRP), D-dimer, ferritin — had statistically significant differences (p<0.01) and increased in groups depending on the COVID-19 course, for instance, CRP increased more than 15 times. A direct correlation was established (r=0.68, p<0.01) between CRP level and COVID-19 course. A direct correlation was recorded between an increase in the level of CRP, interleukin-6 (IL-6) and COVID-19 course (r=0.56, p<0.05), which suggests that CRP and IL-6 are markers of COVID-19 severity.

Conclusion: thus, the study identified clinical COVID-19 masks —intestinal (23.6% of patients) and cutaneous (5.5% of patients). At the disease onset before the pneumonia occurrence, the PCR diagnosis of COVID-19 is more informative, which confirms the presence of 100% positive results of a PCR smear on SARS-CoV-2 RNA in group 1 and 100% negative results of a PCR smear on SARS-CoV-2 RNA in group 5.

Keywords: new coronavirus infection, COVID-19, D-dimer, ferritin, saturation, lung damage rate, clinical masks.

For citation: Shogenova M.S., Khutueva S.Kh., Tlupova I.B. et al. The pandemic of a new coronavirus infection in the Kabardino-Balkarian Republic. Regional experience. RMJ. 2021;6:9–13 (in Russ.).

Summary:

Potential role of the gut microbiota in the development of Alzheimer’s disease

G.R. Bikbavova, S.I. Lopata, M.B. Kidalov, V.A. Akhmedov

Omsk State Medical University, Omsk

Over the past 10 years, leading experts in the study of Alzheimer’s disease (AD) pathogenesis have suggested that immune-mediated systemic inflammatory responses may play a leading role in AD development. We have summarized the literature data on the potential impact of gut microbiota disorders on AD development. Publications from GoogleSchoolar and PubMed resources were used in this study. It is known that some gut microflora representatives produce gamma-aminobutyric acid (GABA), which has a neuroprotective function and can inhibit immune-inflammatory responses, as well as participate in the proliferation of neuronal precursor cells. The gut microbiota participates in the synthesis of serotonin, which plays a crucial role in the processes of learning, memory formation, and higher cognitive functions that are affected in AD. A low amount of intestinal Lactobacillus and Bifidobacterium reduces the amount of GABA and serotonin in the intestine and central nervous system, which can mediate the launch of a systemic inflammatory response cascade and impaired higher cognitive functions. Lactobacillus among the metabolic products produces 3- (3’-hydroxyphenyl) —propionic acid and 3-hydroxybenzoic acid, which can inhibit the assembly of β-amyloid from the protein precursor. Therefore, the maintenance of Lactobacillus physiological function can play a key role in AD prevention.

Keywords: Alzheimer’s disease, amyloid cascade, gut microbiota, microbiome, dysbiotic processes, antibiotic therapy, systemic inflammatory response syndrome.

For citation: Bikbavova G.R., Lopata S.I., Kidalov M.B., Akhmedov V.A. Potential role of the gut microbiota in the development of Alzheimer’s disease. RMJ. 2021;6:93–95 (in Russ.).

Summary:

Vitamin D deficiency and insufficiency, risk factors and its correction in the elderly patients

Yu.A. Safonova^1,2, N.V. Toroptsova²

¹I.I. Mechnikov North-Western State Medical University, Saint-Petersburg

²Research Institute of Rheumatology named after V.A. Nasonova, Moscow

Aim: to study the vitamin D level in elderly and senile patients, to identify factors that contribute to its decrease and to evaluate the efficacy of the replacement therapy.

Patients and Methods: a prospective cohort study conducted from 2016 to 2018 included 506 people aged 65 years and older (354 women and 152 men), whose median age was 74 [68; 78] years, who did not take vitamin D preparations 6 months before the start of the study. Patients were divided into three age groups: group 1 – 243 patients aged 65–74 years (48.0%), group 2 – 223 patients aged 75–84 years (44.1%), and group 3–40 patients aged 85 years and older (7.9%). All those included in the study underwent an anthropometric measurement and calculation of the body mass index (BMI). The level of physical activity was determined by the International Physical Activity Questionnaires (IPAQ). The content of 25-hydroxy vitamin D (25(ОН)D) was determined by immunochemiluminescence analysis. The study was conducted during a period of low insolation from September to May. The therapy efficacy was evaluated after 3 and 12 months among 202 patients who completed the study.

Results: deficiency and insufficiency of 25(ОН)D was detected in 86.4% of patients over 65 years of age. The risk of vitamin D deficiency increased with increasing age and reached 77.5% of people aged 85 years and older (p<0.01), and was also higher in persons with insufficient BMI (relative risk (RR) =1.39; 95% CI: 1.24–1.55; p<0.0001), in obese people (RR=1.23; 95% CI: 1.06–1.42; p=0.0057) and low physical activity (RR=1.37; 95% CI: 1.12–1.68; p=0.0021). All patients with hypovitaminosis D underwent its correction using cholecalciferol, which allowed to achieve an adequate level of 25(ОН)D in 91.3% of cases and maintain it for 12 months in 90.6% of patients with a maintaining dose of vitamin D.

Conclusion: a high incidence of hypovitaminosis D was revealed among the elderly and senile patients; its adequate correction allowed not only to normalize but also to maintain its optimal level.

Keywords: vitamin D deficiency, hypovitaminosis D, elderly age, correction of vitamin D level, cholecalciferol.

For citation: Safonova Yu.A., Toroptsova N.V. Vitamin D deficiency and insufficiency, risk factors and its correction in the elderly patients. RMJ. 2021;6:96–100 (in Russ.).