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COVID-19
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№6, 2021. Клинические рекомендации и алгоритмы для практикующих врачей. Гастроэнтерология

Pages 101-104. Интегральные гематологические индексы как маркер развития пострезекционной печеночной недостаточности. Дунаевская С.С., Сачивко К.В., Косик А.А., Бережная М.А., Наркевич А.Н.

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.).

Pages 14-17. С-реактивный белок в оценке пациентов с респираторными симптомами до и в период пандемии COVID-19. Андреева Е.А.

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.).

Pages 18-22. Пациент с ГЭРБ после перенесенной новой коронавирусной инфекции. Рациональная фармакотерапия на клиническом примере. Пахомова И.Г.

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.).

Pages 23-26. Роль неинвазивной вентиляции легких в комплексной терапии больных хронической обструктивной болезнью легких с гиперкапнической дыхательной недостаточностью. Кузубова Н.А., Титова О.Н., Склярова Д.Б.

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.).

Pages 27-32. Опыт применения препарата инозин пранобекс у детей с рецидивирующими респираторными инфекциями. Мелехина Е.В., Музыка А.Д., Понежева Ж.Б., Горелов А.В.

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.).

Pages 33-39. Фармакорезистентная эпилепсия. Клиническая лекция. Котов А.С., Фирсов К.В., Санду Е.А.

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.).



Pages 4-5. Вакцинация беременных против COVID-19: оперативная информация. Заплатников А.Л., Гирина А.А.

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.).



Pages 40-47. Разработка инновационной программы для профилактики суставного болевого синдрома у пациентов с высокими рисками его возникновения в амбулаторной практике. Страхов М.А., Шишкин А.А., Бондаренко В.А., Загородний Н.В., Егиазарян К.А., Ахпашев А.А., Гаев Т.Г., Шевалеева Н.В., Левков В.Ю.

Summary:

An innovative program for the prevention of joint pain in high-risk patients in outpatient practice

M.A. Strakhov1-3, A.A. Shishkin2, V.A. Bondarenko2, N.V. Zagorodniy1,4, K.A. Egiazaryan2, A.A. Akhpashev3,4, 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.).


Pages 48-52. Проблемы безопасности лечения пациентов с дорсалгией. Камчатнов П.Р., Чугунов А.В., Ашалмагомедова З.А., Шемшединова А.М.

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.).



Pages 5-8. Региональные аспекты вакцинопрофилактики в условиях пандемии новой коронавирусной инфекции COVID-19. Дмитриев А.В., Федина Н.В., Гудков Р.А., Петрова В.И., Заплатников А.Л.

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.).

Pages 53-55. Ассоциация вируса герпеса человека 6 типа с синдромом хронической тазовой боли: клиническое наблюдение. Ковалык В.П., Юрлов К.И., Гомберг М.А., Шувалов А.Н., Малиновская В.В., Кущ А.А.

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.).

Pages 56-62. Влияние бессимптомной гиперурикемии на течение коморбидной патологии у пациентов с остеоартритом и возможности ее коррекции. Мазуров В.И., Гайдукова И.З., Башкинов Р.А., Фонтуренко А.Ю., Петрова М.С., Инамова О.В.

Summary:

Asymptomatic hyperuricemia impact on the comorbid pathology course in patients with osteoarthritis and the possibility of its correction

V.I. Mazurov1,2, I.Z. Gaidukova1,2, R.A. Bashkinov1,2, A.Yu. Fonturenko1,2, M.S. Petrova1,2, O.V. Inamova1,2

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.).

Pages 63-66. Эффективность и безопасность использования фенилбутазона для внутримышечного введения при остеоартрите коленного сустава. Нестеренко В.А., Каратеев А.Е., Зеленов В.А., Зоткин Е.Г.

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.).



Pages 68-74. Место и роль парентеральной формы хондроитина сульфата в терапии остеоартрита: мультидисциплинарный Консенсус. Лила  А.М., Ткачева О.Н., Наумов  А.В., Алексеева Л.И., Кочиш А.Ю., Котовская Ю.В., Рачин А.П., Сарвилина И.В.

Summary:

Place and role of the parenteral form of chondroitin sulfate in the treatment of osteoarthritis: multidisciplinary Consensus

A.M. Lila1,2, 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.).

Pages 75-80. Кардиоваскулярная безопасность нестероидных противовоспалительных препаратов. Чичасова Н.В., Лила А.М.

Summary:

Cardiovascular safety of nonsteroidal anti-inflammatory drugs

N.V. Chichasova1,2, A.M. Lila1,2


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.).



Pages 81-87. Холестатические заболевания печени: алгоритмы диагностики и лечения. Полунина Т.Е.

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.).

Pages 87-92. Гетеротопия слизистой оболочки желудка в проксимальном отделе пищевода: исторический ракурс и современный взгляд. Долгушина А.И., Хихлова А.О., Олевская Е.Р., Науменко О.В.

Summary:

Heterotopic gastric mucosa in the proximal esophagus: historical aspect and modern view

A.I. Dolgushina1, A.O. Khikhlova1,2, E.R. Olevskaya1,2, 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.).

Pages 9-13. Пандемия новой коронавирусной инфекции в Кабардино-Балкарской Республике. Опыт региона. Шогенова М.С., Хутуева С.Х., Тлупова И.Б., Аккиева М.А., Шогенова Л.С.

Summary:

The pandemic of a new coronavirus infection in the Kabardino-Balkarian Republic. Regional experience

M.S. Shogenova1,2, 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.).



Pages 93-95. Потенциальная роль кишечной микробиоты в формировании болезни Альцгеймера. Бикбавова Г.Р., Лопата С.И., Кидалов М.Б., Ахмедов В.А.

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.).

Pages 96-100. Дефицит и недостаточность витамина D, факторы риска и его коррекция у людей пожилого возраста. Сафонова Ю.А., Торопцова Н.В.

Summary:

Vitamin D deficiency and insufficiency, risk factors and its correction in the elderly patients

Yu.A. Safonova1,2, 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.).





№5, 2021. Неврология

Pages 11-16. Оценка эффективности комплексного физиотерапевтического лечебного подхода, направленного на стимуляцию процесса резорбции грыж межпозвонковых дисков поясничного отдела позвоночника. Ткачев А.М., Епифанов А.В., Акарачкова Е.С., Смирнова А.В., Илюшин А.В., Гордеева И.Е.

Summary:

Efficacy of complex physiotherapeutic approach to stimulate the resorption of lumbar disc herniation

A.M. Tkachev1,2,3, A.V. Epifanov3, E.S. Akarachkova4, A.V. Smirnova1, A.V. Ilyushin3, I.E. Gordeeva5

1Sergey Berezin Medical Institution, St. Petersburg

2Tkachev’s Clinic, Volgograd

3Tkachev’s and Epifanov’s Clinic, Moscow

4International Society “Stress under Control”, Moscow

5Volgograd State Medical University, VolgogradAim: to assess the efficacy of treatment approaches aimed at stimulating the resorption of lumbar disc herniation (LDH) in the acute stage of LDH, Volgograd

Patients and Methods: 101 patients (50 women and 51 men) with acute leg pain (≥ 6 points by VAS scale) resulting from LDH were enrolled. Initial LDH size and its changes were measured by MRI. All patients received gabapentin (300–2400 mg daily, dose adjustment after 3 and 8 weeks. At baseline, all patients underwent 12 consecutive daily acupuncture and laser therapy (MLS M6, Beka, Russian Federation). 12 weeks after finishing physiotherapy, all patients underwent re-MRI. Further management strategy was based on MRI results and clinical presentation, i.e., to proceed to treatment (persistent pain or no pain but persistent LDH) or to stop treatment (the lack of pain and reduced LDH sizes). Patients who proceeded to treatment were prescribed with repeated complex physiotherapy. This protocol was followed until pain relief and LDH resorption.

Results: after the first, second, and third courses of physiotherapy, 26 patients (25.7%), 47 patients (46.5%), and 22 patients (21.8%), respectively, stopped the treatment. 6 patients (5.9%) required the fourth course of physiotherapy. The rate and level of LDH resorption were directly proportional to LDH size at baseline. The mean LDH resorption period was 4.4 months. In the first 12 weeks, mean gabapentin dose to relieve leg pain was 1320±50 mg daily. Patients who proceeded to treatment required, on average, 489±30 mg daily.

Conclusions: acute LDH treatment using complex physiotherapy (acupuncture and MLS laser therapy) plus gabapentin that maintains natural inflammation is an effective and safe strategy that reduces the size of LDH.

Keywords: disc herniation, spontaneous resorption, inflammation, gabapentin, acupuncture.

For citation: Tkachev A.M., Epifanov A.V., Akarachkova E.S. et al. Efficacy of complex physiotherapeutic approach to stimulate the resorption of lumbar disc herniation. RMJ. 2021;5:11–16.

Pages 17-22. Роль комплексного препарата витаминов группы В, уридина и холина в терапии хронического болевого синдрома у пациентов с падениями. Наумов  А.В., Мороз В.И., Маневич Т.М.

Summary:

Complex medication containing B vitamins, uridine, and choline for chronic pain management in patients who fall

A.V. Naumov, V.I. Moroz, T.M. Manevich

Russian Research Clinical Center for Gerontology, Pirogov Russian National Research Medical University, Moscow

Background: chronic pain in elderly patients is associated with the increased rate of falls. Drug effects on the functional status and autonomy are the key issue of pain management in elderly patients.

Aim: to assess the efficacy of a complex medication containing B vitamins, uridine, and choline for chronic pain management in patients who fall.

Patients and Methods: this study included 60 patients with chronic pain and falls. These patients were divided into two groups (30 patients each). Study group patients received complex treatment including standard therapies for chronic pain (i.e., gabapentin, cholecalciferol, diclofenac, and omeprazole) and B vitamins in combination with uridine and choline (one dragee daily). Control group patients received standard therapies for chronic pain only. After two months, pain severity measured by VAS and WOMAC sca les, physical functioning, the severity of neuropathic pain component, and the risk of falls were evaluated.

Results: pain reduction, as demonstrated by VAS and WOMAC scores was more significant in the study group compared to the controls. Moreover, the treatment resulted in more significant reduction of time for five rises from the chair and timed up and go test. More significant changes, as demonstrated by increased score of the Short Physical Performance Battery were also seen in the study group. Complex treatment for musculoskeletal pain resulted in a significant reduction in the risk of falling.

Conclusions: a medication containing B vitamins, uridine, and choline as a component of the complex treatment for musculoskeletal pain reduces pain severity, clinical manifestations of neuropathic pain, and the risk of falling in patients over 60 with chronic pain.

Keywords: chronic pain, musculoskeletal pain, falls, neuropathic pain, thermoesthesia.

For citation: Naumov A.V., Moroz V.I., Manevich T.M. Complex medication containing B vitamins, uridine, and choline for chronic pain management in patients who fall. RMJ. 2021;5:17–22.

Pages 2-5. Влияние цитиколина на когнитивные функции у пациентов, перенесших COVID-19. Зуева И.Б., Ким Ю.В., Суслова М.Ю.

Summary:

Citicoline effect on cognitive function in COVID-19 patients

I.B. Zueva1, Yu.V. Kim2, M.Yu. Suslova1

1Saint Petersburg Medico-Social Institute, Saint Petersburg

2Pavlov First Saint Petersburg State Medical University, Saint Petersburg


Background: there is growing evidence that coronaviruses can affect not only the lungs but also other organs and systems, in particular, the central nervous system. However, little is currently known about the coronavirus infection long-term effects on the brain and its consequences in terms of cognitive functioning.

Aim: to study the effect of citicoline therapy on the cognitive functions and emotional status of patients who experienced COVID-19.

Patients and methods: 48 subjects were included in the study. The main group consisted of patients who experienced COVID-19 (n=24, mean age 43.72±5.21 years), the control group — healthy subjects (n=24, mean age 44.18±5.32 years). Patients of the main group were randomized into two subgroups of 12 patients: subgroup A r eceived citicoline orally at a dose of 1000 mg/day (100 mg in 1 ml), subgroup B did not receive treatment. The study duration was 14 days. Neuropsychological test was performed initially and after the end of the study.

Results: the majority of patients who experienced COVID-19 reported the following: persistent fatigue — 24 (100%), poor sleep — 20 (83.3%), palpitations — 20 (83.3%), memory loss — 18 (75%). The main group of patients showed a decrease in the short-term memory index (6.45±1.14 and 8.97±1.51 points, p<0.05), the MMSE test result (27.26±2.10 and 29.81±2.93 points, p<0.05), encryption test (40.37±9.64 and 48.91 ± 9.86 seconds, p<0.05), and increase in the anxiety level (9.34±0,45 and 4.12±0.21 points, p<0.05) versus the control group. In the subgroup A, during citicoline therapy, there was an improvement in memory index (6.48±1.15 and 8.32±1.49 points, p<0.05; 6.53±1.18 and 7.34±1.25 points, respectively, p>0.05), general cognitive functions (27.51±2.13 and 28.89±2.41 points, p<0.05; 27.62±2.29 and 27.95±2.36 points, respectively, p>0.05), encryption test results (40.34±9.61 and 46.72±9.83 seconds, p <0.05; 41.56±9.62 and 42.28±9.75 seconds, respectively, p>0.05), improved sleeping (19.38±0.61 and 21.64±0.74 points, p<0.05; 19.20±0.58 and 19.82±0.63 points, respectively, p>0.05), a decrease in the anxiety level (9.27±0.47 and 7.14±0.31 points, p<0.05; 9,35±0.46 and 8.81±0.44 points, respectively, p>0.05) versus the subgroup B.

Conclusion: there was an improvement in cognitive functions in general, a decrease in anxiety level and normalization of sleep during citicoline treatment of patients who have suffered from COVID-19.

Keywords: cognitive disorders, memory, attention, anxiety, COVID-19, citicoline.

For citation: Zueva I.B., Kim Yu.V., Suslova M.Yu. Citicoline effect on cognitive function in COVID-19 patients. RMJ. 2021;5:2–6.



Pages 24-29. Особенности ведения пациентов с нейродегенеративными заболеваниями в условиях пандемии COVID-19. Пилипович А.А.

Summary:

Characteristics of patient management with neurodegenerative diseases during COVID-19 pandemic

A.A. Pilipovich

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

There is no evidence that neurodegenerative diseases, including Parkinson’s disease (PD), worsen the COVID-19 outcome. However, in the advanced PD stages, the risk of respiratory decompensation increases due to the motor and vegetative disorders. Patients with cognitive decline during pandemic have an increased risk of infection, as well as an increase in the severity of the underlying disease due to stress. The review presents patient management tactics in dementia and the doctor’s response to this behavior, as well as some additional methods that can help patients cope with stress. High-tech treatment methods that are used in the advanced PD stage do not have contraindications for coronavirus infection. Their use is recommended to continue even in the intensive care unit to ensure constant antiparkinsonian support, to avoid motor and non-motor complications in the akin etic crisis. An important task is to provide all patients with neurodegenerative diseases with conditions for communication with medical personnel, which can be achieved through telemedicine technologies that are actively developing in the context of a pandemic.

Keywords: neurodegenerative diseases, Parkinson’s disease, Alzheimer’s disease, dementia, COVID-19, SARS-CoV-2, amantadine.

For citation: Pilipovich A.A. Characteristics of patient management with neurodegenerative diseases during COVID-19 pandemic. RMJ. 2021;5:24–29.

Pages 30-34. Поражение периферической нервной системы при коронавирусной инфекции COVID-19. Камчатнов П.Р., Евзельман М.А., Чугунов А.В.

Summary:

Peripheral nervous system disorders in COVID-19 

P.R. Kamchatnov1, M.A. Evzelman2, A.V. Chugunov1

1Pirogov Russian National Research Medical University, Moscow 2Orel State University named after I.S. Turgenev, Orel

The high incidence of a new coronavirus infection (COVID-19), the variety of organs and body systems involved in the pathological process in this disease, and commonly severe course with disabling consequences have caused deep interest in this problem. A common lesion of the peripheral nervous system (PNS) was found in patients with COVID-19, which allowed to suggest the neurotropic nature of the SARS-CoV-2. The article presents information about PNS lesions in COVID-19 and discusses possible mechanisms of their development. Among others, it is suggested that immune disorders play a key role in the initiation and subsequent progression of changes in the PNS. Article provides information on the possible role of B vitamins metabolic disorders in the pathogenesis of PNS lesions in COVID-19 (including through the impact on various parts of the immune system) and on the association of vitamin B deficiency with a more severe disease course. The possibilities of these disorders’ correlation are discussed.

Keywords: COVID-19, neuropathy, Guillain-Barre syndrome, anosmia, dysgeusia, thiamine, pyridoxine, cyanocobalamin, treatment.

For citation: Kamchatnov P.R., Evzelman M.A., Chugunov A.V. Peripheral nervous system disorders in COVID-19. RMJ. 2021;5:30–34.







Pages 35-41. Аффективные нарушения у пациентов с церебральной микроангиопатией в период пандемии COVID-19. Воробьева О.В.

Summary:

Affective disorders in patients with cerebral microangiopathy during the COVID-19 pandemic

O.V. Vorobieva

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

The most common and least studied type of cerebrovascular pathology is cerebral microangiopathy (CMA). Patients with vascular risk factors (hypertension, diabetes, obesity, etc.) are more vulnerable to the SARS-CoV-2 virus since the concomitant endothelial dysfunction and antioxidant protection break-down increase the probability of infection and contribute to a more severe disease course. COVID-19 outcomes, in particular, are affected by the cerebral perfusion level. Thus, slowing the progression of cerebrovascular pathology is one of the most important protective measures. At the same time, even a mild COVID-19 course can worsen cerebral perfusion and exacerbate affective and cognitive symptoms. In patients with a silent form of CMA, SARS-CoV-2 infection may contribute to the clinical manifestation of symptoms. The article describes the etiopathogenetic CMA aspects and the affective disorders associated with CMA. It also notes the problems faced by patients with such disorders in the context of the COVID-19 pandemic. Methods for the complex therapy of affective disorders in patients with CMA during the COVID-19 pandemic are considered.

Keywords: cerebral m icroangiopathy, affective disorders, cognitive disorders, endothelial dysfunction, COVID-19.

For citation: Vorobieva O.V. Affective disorders in patients with cerebral microangiopathy during the COVID-19 pandemic. RMJ. 2021;5:35–41.

Pages 42-44. Транзиторная ишемическая атака: агрессивная лечебная стратегия. Широков Е.А.

Summary:

Transient ischemic attack: an aggressive treatment strategy

E.A. Shirokov

Branch of the S.M. Kirov Military Medical Academy, Moscow, Russian Federation

In recent decades, vascular catastrophes (stroke and myocardial infarction) are the leading causes of early death and permanent disability. The prevention of vascular catastrophes by modifying the classical cardiovascular risk factors is the key measure to address this issue. Transient ischemic attacks (TIAs) increase the risk of all vascular events. Diagnosing TIAs, clarifying the causes and mechanisms of the decompensation of cerebral blood circulation, and reasonable targeted treatment prevent severe complications in patients with high cardiovascular risk being a considerable preventive resource. This paper discusses the evolution of approaches that consider TIAs as a risk factor for vascular events in high-risk patients and the use of neuroimaging techniques that determine management strategy. The authors analyze the efficacy and safety of aggressive treatment approach implying the prescription of dual antithrombotic, antihypertensive, lipid-lowering therapies. The differences in the approaches to prescribe treatment according to the guidelines of the world leading cardiological societies are highlighted.

Keywords: transient ischemic attack, stroke, dual antiplatelet therapy, antihypertensive therapy, lipid-lowering therapy, statins, antiplatelet drugs.

For citation: Shirokov E.A. Transient ischemic attack: an aggressive treatment strategy. RMJ. 2021;5:42–44.



Pages 45-49. Хроническая ишемия мозга: взгляд из ХХI века. Захаров В.В., Слепцова К.Б., Мартынова О.О.

Summary:

Chronic cerebral ischemia: a view from the ХХI century

V.V. Zakharov, K.B. Sleptsova, O.O. Martynova

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

The article is devoted to one of the most common forms of chronic cerebral circulatory disorders — chronic cerebral ischemia (CCI), the risk factors of which are various diseases with small-caliber vascular lesions (microangiopathy): arterial hypertension, diabetes mellitus, cerebral amyloid angiopathy, less common — genetic vasculopathy, vasculitis, etc. The article also considers the main pathogenetic mechanisms of chronic progressive vascular cerebral damage: recurrent brain infarctions without stroke, microhemorrhages, focal and diffuse changes in the white matter (leukoareosis). The questions concerning the earliest and most common clinical manifestations of CCI — cognitive disorders, the peculiarity of which is the inability to concentrate, problems with control and visuospatial functions with relative memory preservation, are covered in detail. In addition to controlling the risk factors, treatment of patients with CII involves the prescription of pathogenetically based treatment aimed at the main mechanisms of brain damage and/or activation of the neurorestoration processes. The article presents the experience of using the neuroprotective and neurotrophic drug, Cellex®, in cerebral vascular diseases, and considers its effect on the severity of cognitive disorders.

Keywords: chronic cerebral ischemia, silent strokes, leukoareosis, microhemorrhages, vascular cognitive disorders, neuroprotection.

For citation: Zakharov V.V., Sleptsova K.B., Martynova O.O. Chronic cerebral ischemia: a view from the ХХI century. RMJ.
2021;5:45–
49.

Pages 50-54. Применение комбинированных лекарственных препаратов для лечения пациентов с острой дорсалгией. Чугунов А.В., Камчатнов П.Р.

Summary:

The use of combined drugs for the treatment of patients with acute dorsalgia

A.V. Chugunov, P.R. Kamchatnov

Pirogov Russian National Research Medical University, Moscow

Musculoskeletal pain syndromes, in particular dorsalgia, are a common cause of seeking medical care. Timely relief of acute dorsalgia reduces the risk of adverse events and prevents the formation of chronic pain syndrome. The review, based on data from randomized trials, meta-analyses, and systematic reviews, discusses the efficacy and safety of the most widely used NSAIDs and paracetamol for acute pain relief. Special emphasis is placed on adverse events, including those from the cardiovascular system, gastrointestinal tract, liver, the risk of which depends on the prescribed dose and regimen duration. The possibility and expediency of their combined use (including as part of a combined drug containing low doses of paracetamol and diclofenac, which complement each other’s effects) are separately considered. The results concerning the prescription of this combination, which demonstrated the tr eatment efficacy and safety, are presented.

Keywords: musculoskeletal pain, dorsalgia, treatment, diclofenac, panoxen, adverse events, tolerability, treatment.

For citation: Chugunov A.V., Kamchatnov P.R. The use of combined drugs for the treatment of patients with acute dorsalgia. RMJ. 2021;5:50–54.



Pages 55-58. Миастения гравис у ребенка (клиническое наблюдение). Вороширина К.А., Гранкин Е.В.

Summary:

Myasthenia gravis in children (clinical case)

K.A. Voroshirina, E.V. Grankin

Regional Children’s Clinical Hospital, Orenburg

Myasthenia gravis is an autoimmune disease accompanied by a neuromuscular transmission disorder. The clinical picture in this disease is represented by a transient or increasing weakness of the skeletal (striated) muscles of the face, trunk and limbs. The article describes a clinical case of a 13-year-old male patient with a generalized rapidly progressive form of myasthenia gravis. Presumably, in the setting of an acute respiratory infection, the patient developed generalized weakness, bulbar disorders with the flaccid tetraplegia development, respiratory arrest with a transfer to an artificial lung ventilation (ALV). A diagnostic search was conducted concerning inflammatory, infectious and neoplastic lesions of the spinal cord and brain, and other diseases characterized by the neuromuscular transmission disorder. According to the MRI results of the cervical spine, examination of the cerebrospinal fluid, electron euromyography, determination of acetylcholine receptor antibodies, no pathology was found. Treatment with the use of specific immunotherapy with high doses of human IgG, as well as cholinesterase inhibitors, provided positive dynamics in the form of spontaneous breathing restoration, regression of bulbar disorders, and an increase in the movement volume of the extremities. Neurological symptoms completely regressed during regular use of cholinesterase inhibitors. Since myasthenia gravis is characterized by clinical polymorphism of symptoms and the absence of specific changes according to the study results, the doctor needs to know the characteristics of the disease clinical course. It will timely allow to establish the correct diagnosis and prescribe effective treatment.

Keywords: myasthenia gravis, generalized weakness, bulbar disorders, acetylcholine receptor antibodies, cholinesterase inhibitors, immunosuppressive therapy.

For citation: Voroshirina K.A., Grankin E.V. Myasthenia gravis in children (clinical case). RMJ. 2021;5:55–58.

Pages 60-64. Синдром Гийена — Барре и COVID-19: клинические наблюдения. Бондарь С.А., Маслянский А.Л., Смирнова А.Ю., Новожилова М.А., Симаков К.В., Янишевский С.Н., Конради А.О.

Summary:

Guillain-Barré syndrome and COVID-19: clinical cases

S.A. Bondar, A.L. Maslyansky, A.Yu. Smirnova, M.A. Novozhilova, K.V. Simakov, S.N. Yanishevskiy, A.O. Konradi

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

Since the outbreak of the new coronavirus infection (COVID-19), which subsequently increased to the pandemic scale, the number of reports concerning disease neurological manifestations has increased. One of the rare among them is Guillain-Barré syndrome (GBS). It is necessary to accumulate data to determine the patterns of the SARS-CoV-2-induced GBS clinical course and clarify its pathogenesis, which is probably autoimmune. The article presents two clinical cases concerning the GBS development during typical COVID-19 manifestations in 58-year-old men. The interval from the COVID-19 onset to the GBS manifestation was 5 and 13 days, respectively. In described cases, GBS was more severe than GBS development during COVID-19: both patients required invasive ventilation, both developed sepsis and acute kidney injury, which led to the fatal outcome of one of them. Antibodies to gangliosides were detected in only one patient, but they could not be detected. The patterns of the manifestations, GBS diagnosis and treatment in the presented patients should contribute to additional research, including providing greater clarity in the disease pathogenesis.

Keywords: COVID-19, SARS-CoV-2, Gu illain-Barré syndrome, intravenous immunoglobulin, plasmapheresis, antibodies to gangliosides.

For citation: Bondar S.A., Maslyansky A.L., Smirnova A.Yu. et al. Guillain-Barré syndrome and COVID-19: clinical cases. RMJ. 2021;5:60–64.

Pages 7-10. Траектория когнитивных функций у пациентов пожилого и старческого возраста: результат участия в программе тренировок по скандинавской ходьбе и терапии витамином D. Зуева И.Б., Мальцева Е.В., Суслова М.Ю., Ким Ю.В.

Summary:

Trajectories of cognitive function in elderly and senile patients: the result of participation in the Nordic walking program and vitamin D therapy

I.B. Zueva1, E.V. Maltseva2, M.Yu. Suslova2, Yu.V. Kim3

1Saint-Petersburg Medico-Social Institute, Saint Petersburg

2LLC Care Home "Nevskaya Dubrovka", Leningrad region, Dubrovka town

3Pavlov First Saint Petersburg State Medical University, Saint Petersburg

Background: cognitive function and life quality decrease with age. In this regard, various programs are being developed that contribute to the preservation of cognitive functions. Moderately intensive physical activity with vitamin D is particularly promising, as levels of vitamin D decline in the elderly and senile age.

Aim: to study the impact of the Nordic walking (NW) program and vitamin D therapy (DeTriFerol, LLC "Grotex", Russia) on cognitive functions in patients of elderly and senile age.

Patients and Methods: 40 subjects were included in a randomized controlled open-label study. They were divided randomly into 2 groups of 20 patients. In group 1 (mean age of patients 78.32±5.41 years), patients underwent NW program and vitamin D therapy (DeTriFerol) at a dose of 4000 IU/day; in group 2, patients (mean age 79.25±5.38 years) received only vitamin D therapy at the same dosage. The duration of the program was 16 weeks. In all patients, vitamin D levels were determined and neuropsychological testing was performed initially and after the program was completed.

Results: there was a correlation between vitamin D level, response rate, attention (r=0.42, p<0.01), memory, information storage and reproduction (r=0.38, p<0.01). The association between the result of the MMSE test and vitamin D level was revealed (r=0.37, p<0.01). By the end of the follow-up period, groups 1 and 2 showed improvements in short-term memory (3.47±1.15 and 5.39±1.43; 3.58±1.18 and 4.35±1.28 points, respectively, p<0.05), MMSE test results (24.68±2.45 and 26.25±2.72; 24.71±2.31 and 25.37±2.52 points, respectively, p<0.05), and encryption (34.84±8.93 and 38.92±9.04; 34.51±8.67 and 36.17±9.01 seconds, respectively, p<0.05). In both groups, there was an improvement in sleep parameters and a decrease in the level of depression.

Conclusion: it was found that vitamin D level correlates with cognitive functions in general, as well as with indicators of attention and memory. Conducting the NW program during vitamin D therapy provides a more significant improvement in cognitive functions versus vitamin D monotherapy in elderly and senile patients.

Keywords: cognitive functions, depression, anxiety, Nordic walking, vitamin D, DeTriFerol.

For citation: Zueva I.B., Maltseva E.V., Suslova M.Yu., Kim Yu.V. Trajectories of cognitive function in elderly and senile patients: the result of participation in the Nordic walking program and vitamin D therapy. RMJ. 2021;5:7–10.



№4, 2021. Клинические рекомендации и алгоритмы для практикующих врачей

Pages 10-16. Современные взгляды на роль кишечной микробиоты в формировании патологии кишечника. Гаус О.В., Беляков Д.Г.

Summary:

Modern views on the gut microbiota role in intestinal pathology

O.V. Gaus, D.G. Belyakov

Omsk State Medical University, Omsk

Association between the gut microbiota and human health is generally recognized. The emergence of molecular and genetic diagnostic methods has made it possible to make revolutionary discoveries in the field of studying the gastrointestinal tract microbiome. The article describes the characteristics of gastrointestinal tract colonization, depending on the type of delivery and feeding features. The article also shows the diet role in the formation of the quantitative and qualitative composition of the gut microbiota. Current information on the microbiota role in the pathogenesis of functional and organic intestinal diseases (irritable bowel syndrome, inflammatory bowel diseases, colorectal cancer) is presented. Special attention is paid to the gut microbiota impact on the risk of development and the nature of the COVID-19 course, which is currently under the close attention of researchers worldwide. It is noted that dysbiotic changes with an increase in the relative number of co nditionally pathogenic bacteria and pathobionts (during a decrease in the useful representatives proportion of the commensal microbiota) persisted even after complete recovery of patients. Modern methods concerning correcting the gut microbiota composition with an emphasis on the use of prebiotics are also presented.

Keywords: gut microbiota, microbiome, irritable bowel syndrome, Crohn’s disease, ulcerative colitis, colorectal cancer, COVID-19, prebiotic, dietary fibers, OptiFibre.

For citation: Gaus O.V., Belyakov D.G. Modern views on the gut microbiota role in intestinal pathology. RMJ. 2021;4:10–16.




Pages 17-21. Исследование параметров иммунной системы при профилактике острых респираторных вирусных инфекций препаратом с противовирусной и иммунотропной активностью у здоровых добровольцев. Головачева Е.Г., Афанасьева О.И., Попова В.В., Краснов А.А., Левина А.В., Апрятина В.А., Петленко С.В.

Summary:

Study concerning immune system parameters in the prevention of acute respiratory viral infections using a drug with antiviral and immunotropic activity in healthy subjects

E.G. Golovacheva1, O.I. Afanasieva1, V.V. Popova2, A.A. Krasnov3, A.V. Levina4, V.A. Apryatina4, S.V. Petlenko5

1Smorodintsev Research Institute of Influenza, Saint Petersburg

2LLC MedFort, Saint Petersburg

3S.M. Kirov Military Medical Academy, Saint Petersburg

4JSC MBSPC CYTOMED, Saint Petersburg

5 S.N. Golikova Scientific and Clinical Center of Toxicology of the Federal Medical Biological Agency of Russian Federation, Saint Petersburg

Aim: to study the safety and immunotropic efficacy concerning long-term administration of various dosage forms (powder and syrup) of Cytovir®-3 with antiviral and immunotropic activity during non-specific immunoprophylaxis.

Patients and Methods: 40 subjects (average age 25.9±3.6 years) were examined who received the drug at a dose of 12 ml 3 times a day for 14 days. During screening, on the 7th and 17th days of the study, the following immunological parameters were evaluated: induced oxidative activity of granulocytes and monocytes in the blood; total interferon (IFN) titer count in the serum; production of virus-induced IFN-α and-β; serum IgA count; secretory IgA count in saliva; phagocytic and oxidative activity of granulocytes and monocytes of peripheral blood.

Results: a statistically significant increase in the number of subjects with high titers of virus-induced IFN-α and-β (1/160 and 1/320) was revealed during the drug administration. There was a significant increase in the median of stimulated oxidative activity of neutrophilic granulocytes: from 275 c.u. (at screening) up to 945.5 c.u. e. (by the 17th day; Cytovir®-3 powder) and from 282 c.u. up to 453 c.u. (Cytovir®-3, syrup).

Conclusions: Cytovir®-3 in two dosage forms within the declared indications for use (prevention and treatment of influenza and ARVI), has a positive effect on a number of parameters of innate immunological reactivity of the body. Long-term drug administration with a high safety profile allows for increasing the body’s immune resistance to infectious agents, especially during the epidemic period.

Keywords: nonspecific immunoprophylaxis, innate immunity, secretory IgA, granulocyte oxidative activity, virus-induced interferon-α and-β, phagocytosis.

For citation: Golovacheva E.G., Afanasieva O.I., Popova V.V. et al. Study concerning immune system parameters in the prevention of acute respiratory viral infections using a drug with antiviral and immunotropic activity in healthy subjects. RMJ. 2021;4:17–21.



Pages 22-25. Клинико-лабораторная характеристика COVID-19. Маннанова И.В., Семенов В.Т., Понежева Ж.Б., Макашова В.В., Гришаева А.А., Мелехина Е.В., Плоскирева А.А., Николаева С.В., Малеев В.В.

Summary:

Clinical and laboratory characteristics of COVID-19

I.V. Mannanova1, V.T. Semenov2, Zh.B. Ponezheva1, V.V. Makashova1, A.A. Grishaeva1, E.V. Melekhina1, A.A. Ploskireva1, S.V. Nikolaeva1, V.V. Maleev1

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

2Center for Restorative Medicine and Rehabilitation “Berozovaya Roscha”, Medical Unit of the Ministry of Internal Affairs of the Russian Federation, Moscow

Aim: to identify clinical and laboratory patterns of COVID-19 in hospitalized patients with mild and moderate severity.

Patients and Methods: the study included 227 patients with COVID-19 aged 18 to 93 years (average age of men — 48.0±2.8 years (158 (69.6%), women — 69 (30.4%)). In 151 patients (66.5%), the presence of SARS-Cov-2 virus was confirmed by polymerase chain reaction (PCR), and in 76 people (33.5%), the diagnosis was clinically and epidemiologically established in the presence of a negative PCR result. The examination of patients was conducted according to the temporary recommendations «Prevention, diagnosis and treatment of new coronavirus infection (COVID-19)».

Results: the disease clinical picture in most patients was characterized by the presence of bilateral viral pneumonia (in 185 patients (81.5%)), whereas in 37 patients (16.3%), the disease proceeded without lung damage in the ARVI form with involvement of the upper respiratory tract. Among patients with pneumonia, mild severity was recorded in 52 (80%) patients, and moderate — in 133 (20%) patients. Men in comparison to women were more likely to have symptoms of intoxication (50.6% vs. 28.2%) and dyspnea (28.2% vs. 10.1%). 73% of patients had different degrees of respiratory failure (RF), quarter of patients (26%) had no signs of RF. According to CT data, at the time of hospitalization, lung tissue damage of varying degrees was observed in 88% of patients. Dynamics of most patients showed a decrease in the lung damage degree, however, in 30% of cases there was no lung damage regression at the end of the hospitalization period.

Conclusion: the new coronavirus infection caused by SARS-Cov-2 is a systemic disease with multiple organ damage and requires further careful study of clinical and immunological patterns.

Keywords: coronavirus, COVID-19, SARS-Cov-2, pneumonia, respiratory failure, computed tomography.

For citation: Mannanova I.V., Semenov V.T., Ponezheva Zh.B. et al. Clinical and laboratory characteristics of COVID-19. RMJ. 2021;4:22–25.







Pages 26-30. Помогая пациенту, защити себя! Что нужно знать каждому педиатру (пострелиз). Габай П.Г., Радциг Е.Ю., Духанин А.С.

Summary:

Protect yourself when helping the patient! What every pediatrician needs to know? (post-release)

P.G. Gabai1, E.Yu. Radtsig2, A.S. Dukhanin2

1Federal Research and Clinical Center of the Federal Medical Biological Agency, Moscow

2Pirogov Russian National Research Medical University, Moscow

From March 5 to 7, 2021, Moscow hosted the XXIII Congress of Pediatricians of Russia with international participation "Actual Problems of Pediatrics" with the I Conference on Social Pediatrics. As part of the congress, the symposium "Protect yourself when helping the patient! What every pediatrician needs to know?" was held. P.G. Gabay (lawyer, senior lecturer of the Department of Public Health Organization, Academy of Postgraduate Education, Federal Research and Clinical Center of the Federal Medical Biological Agency) in his report discussed the legal aspects of the doctor’s work, including the problem of prescribing off-label medicinal products and the problem of obtaining informed voluntary consent. Professor E. Yu. Radtsig reviewed current evidence-based methods to the treatment of ENT diseases in children. Professor A.S. Dukhanin presented a report on the comparison of the original and reproduced framycetin-based products.

Keywords: off-label, topical antibiotic, framycetin, rhinopharyngitis, adenoiditis, sinusitis, original product, generic, otitis, rifamycin.

For citation: Gabai P.G., Radtsig E.Yu., Dukhanin A.S. Protect yourself when helping the patient! What every pediatrician needs to know? (post-release). RMJ. 2021;4:26–30.

Pages 31-34. Дефицит лизосомной кислой липазы — орфанное заболевание в практике педиатра. Бокова Т.А., Чибрина Е.В.

Summary:

Lysosomal acid lipase deficiency — orphan disease in the practice of pediatricians

T.A. Bokova1,2, E.V. Chibrina3

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

2Pirogov Russian National Research Medical University, Moscow

3Children’s Clinical Multidisciplinary Center of the Moscow Region, Mytishchi

This article presents a family clinical case of a rare lysosomal storage disease in autosomal recessive manner – lysosomal acid lipase deficiency (LALD). LALD is caused by mutations in the lysosomal acid lipase A (LIPA) gene encoding lysosomal acid lipase (LCL), an enzyme responsible for the hydrolysis of cholesterol esters and triglycerides that are delivered to lysosomes. As a result of a decrease or complete absence of LCL activity, cholesterol esters and triglycerides are not hydrolyzed and accumulate in the lysosomes of the body’s cells, including macrophages, endothelial cells, and hepatocytes. This can lead to accelerated development of atherosclerosis, liver failure, and untimely death. LALD has an extremely variable clinical picture and can occur without the presence of obvious clinical signs until the patient goes to the doctor with another pathology or as part of a routine medical examination. For instance, in our patients, the disease was  suspected upon admitting to the hospital with a diagnosis of acute obstructive bronchitis, when elevated liver enzymes, dyslipidemia and hepatomegaly were detected in both cases. Since LALD can be fatal even in patients with a long-term stable condition, it is important to identify patients with disease at an early stage and treat them appropriately with enzyme replacement therapy. LALD should be suspected in patients with dyslipidemia (low level of high-density lipoprotein cholesterol and high level of low-density lipoprotein cholesterol) in combination with elevated liver enzymes or hepatomegaly.

Keywords: lysosomal acid lipase deficiency, lysosomal acid lipase, orphan disease, storage disease, Wolman disease, cholesterol ester storage disease.

For citation: Bokova T.A., Chibrina E.V. Lysosomal acid lipase deficiency — orphan disease in the practice of pediatricians. RMJ. 2021;4:31–34.

Pages 35-39. Проблемы диагностики и лечения ботулизма у детей: клиническое наблюдение. Сабинина Т.С., Новиков Д.В., Федоров П.В., Багаев В.Г., Мелехина Е.В.

Summary:

Problems of diagnosis and treatment of botulism in children: clinical case

T.S. Sabinina1, D.V. Novikov1, P.V. Fedorov1, V.G. Bagaev2, E.V. Melekhina3

1Khimki Regional Hospital, Khimki

2Russian Medical Academy of Continuous Professional Education, Moscow

3Central Research Institute of Epidemiology of The Federal Service on Customers’ Rights Protection and Human Well-being Surveillance, Moscow

Botulism remains an urgent problem in the XXI century. Although the number of cases registered in the Russian Federation has decreased in recent years, practising physicians of various specialities continue to face this problem. It is known that the botulism outcome depends on the early diagnosis of disease and the immediate administration of serum. However, the amount of botulinum toxin in the patient’s body is a factor in determining the disease severity. The article presents the patient management of a 9-year-old patient with severe botulism in the intensive care unit, with a favourable outcome. The article also describes the clinical picture dynamics, the characteristics of pharmacological therapy and the tactics of decision-making about the need for an ALV. The difficulties concerning establishing a diagnosis at the disease onset and the importance of a careful analysis of the anamnestic data are noted. Special attention is paid to the importance of physical and psychological rehabilitation. It is concluded that intensive therapy of botulism should be comprehensive and conducted in hospitals that have experience of long-term ALV in children.

Keywords: botulism, children, treatment, intensive care, artificial lung ventilation.

For citation: Sabinina T.S., Novikov D.V., Fedorov P.V. et al. Problems of diagnosis and treatment of botulism in children: clinical case. RMJ. 2021;4:35–39.

Pages 4-9. Изучение гепатопротективной активности терпенсодержащего препарата на модели алкогольного повреждения печени. Выштакалюк А.Б., Парфенов А.А., Маганова Ф.И., Лацерус Л.А.

Summary:

Study of the hepatoprotective activity concerning the terpene-based product on a model of alcohol-related liver disease

A.B. Vyshtakalyuk1, A.A. Parfenov1, F.I. Maganova2, L.A. Latserus2


1A.E. Arbuzov Institute of Organic and Physical Chemistry, Subdivision of Kazan Scientific Center of the Russian Academy of Sciences, Kazan

2LLC "Initium-Pharm", Moscow


Aim: to study the possibility of using a terpene-based product as a hepatoprotector.

Patients and Methods: the experiment was conducted on 48 Wistar rats (male, average weight 323.5±6.5 g, age 2.5–3.0 months) divided into 8 groups of 6 animals. A model of ethanol-induced liver pathology was taken with long-term administration of 40% ethanol at a dose of 7 mL/kg for 4 weeks to study the hepatoprotective characteristics of the terpene-based dietary supplement, CardioOrganic® Omega-3. Starting from the 3rd week of the ethanol administration initiation, the animals were injected with the test substances (CardioOrganic® Omega-3, flaxseed oil in various concentrations, product based on milk thistle extract) per os, continuing to administer ethanol. Then, at the end of the ethanol administration, test substances were administered for another 3 days. At the end of administration of all substances, the animals were euthanized, and the liver and blood were taken for analysis. The general health condition was examined: dynamics of the animal body weight and biochemical parameters of the blood were evaluated, the mass coefficient and pathomorphological changes in the liver were determined.

Results: the terpene-containing product, CardioOrganic® Omega-3, as the product based on the milk thistle extract, contributed to: normalization (increase) of the ALT and GGT levels, sharply reduced versus the normal value as a result of alcohol exposure due to impaired functional activity of hepatocytes; a shift towards the norm (increase) of the De Ritis ratio; a decrease in the level of LDH and alkaline phosphatase; normalization of the ratio concerning direct and indirect bilirubin (increase in direct bilirubin and decrease in indirect bilirubin); normalization (lowering) of the total protein level and albumin and globulins ratio (increase in the albumin concentration and decrease in the globulins concentration). Besides, there was an improvement in the structural and morphological organization of the liver under the effect of the studied substances. There was a decrease in the signs of hydropic and granular dystrophy, hepatocyte necrosis, and fibrotic changes.

Conclusion: terpene-based product, CardioOrganic® Omega-3, exhibits hepatoprotective characteristics on the model of alcoholic liver disease in rats, which allows us to consider terpene-based compounds as promising hepatoprotectors.

Keywords: terpenoids, terpene-based drugs, hepatoprotector, alcohol-related liver disease, experiment.

For citation: Vyshtakalyuk A.B., Parfenov A.A., Maganova F.I., Latserus L.A. Study of the hepatoprotective activity concerning the terpene-based product on a model of alcohol-related liver disease. RMJ. 2021;4:4–9.

Pages 40-44. Растительный препарат на основе гексанового экстракта Serenoa repens у пациентов с симптомами нижних мочевыводящих путей. Кривобородов Г.Г., Тур Е.И.

Summary:

Herbal medicinal product based on the hexane extract of Serenoa repens in patients with lower urinary tract symptoms

G.G. Krivoborodov1, E.I. Tur2

1Pirogov Russian National Research Medical University, Moscow

2Santa Maria alle Scotte Hospital, Siena

Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are a widespread problem among elderly and senile men. Herbal medicinal products are an effective and safe treatment option for this disease. Among them, Serenoa repens hexane extract — Permixon, has the broadest evidence base of clinical efficacy. This literature review highlights the main research works on the study of Permixon use in patients with LUTS due to BPH, indicating the equal efficacy of Serenoa repens hexane extract and classic drugs used in the treatment of this disease — α-adrenoblockers and 5α-reductase inhibitors with a better safety profile of Permixon. The article presents modern studies that indicate the successful Permixon use both as monotherapy and in combination with drugs of other groups used in the treatment of LUTS. Despite the successful use of Serenoa repens extract, not all the data about it are so unambiguous. Nevertheless, it is concluded that for
a certain number of patients with LUTS, Permixon can serve as a means of monotherapy and represent itself as the first-line drug.

Keywords: lower urinary tract symptoms, herbal medicine, benign prostatic hyperplasia, Serenoa repens extract, tamsulosin, 5α-reductase inhibitors, α-adrenoblockers.

For citation: Krivoborodov G.G., Tur E.I. Herbal medicinal product based on the hexane extract of Serenoa repens in patients with lower urinary tract symptoms. RMJ. 2021;4:40–44.

Pages 44-47. Хроническая тазовая боль при аденомиозе. Методы лечения. Эседова А.Э., Меджидова А.М.

Summary:

Chronic pelvic pain with adenomyosis. Treatment methods

A.E. Esedova, A.M. Medzhidova

Dagestan State Medical University, Makhachkala

Background: the urgency of the problem concerning adenomyosis is caused not only by the severity of disease clinical manifestations but also by the diagnosis complexity at the onset stage, long-term and progressive course, persistent chronic pelvic pain, which reduces the life quality.

Aim: to increase the treatment efficacy of adenomyosis in patients with chronic pelvic pain syndrome.

Patients and Methods: a prospective comparative study was conducted with 150 female patients of reproductive age (from 24 to 38 years). 120 of them, who were treated, had primary or secondary infertility and adenomyosis, and complained of pain during periods of different severity. 30 healthy women planning pregnancy were under the follow-up (control group). Group 1 (n=60) underwent surgical treatment of adenomyosis, of which 30 women were followed up after surgery, and 30 received dienogest at a dose of 2 mg for 6 months. Group 2 (n=60) did not undergo surgery, 30 of them were under the follow-up, and the rest received dienogest at a dose of 2 mg for 6 months. The pain severity was assessed using a visual analog scale (VAS), as the size of the uterus and the uterine artery resistance index.

Results: during dienogest intake, the most significant reduction in the pain severity was achieved: 1.5 times after 3 months and almost 3 times after 6 months (p<0.05). A statistically significant (p<0.05) decrease in the uterine artery resistance index was observed only in the subgroups of patients receiving dienogest. Besides, it was found that hormonal treatment caused a decrease in the uterus size, which correlated with a  decrease in pain during periods.

Conclusion: treatment with dienogest at a dose of 2 mg may be the treatment of choice in patients with adenomyosis accompanied by severe pain syndrome.

Keywords: adenomyosis, chronic pelvic pain syndrome, dyspareunia, dienogest, dopplerometry.

For citation: Esedova A.E., Medzhidova A.M. Chronic pelvic pain with adenomyosis. Treatment methods. RMJ. 2021;4:44–47.

Pages 49-52. Работа в ночную смену и гипераммониемия у врачей. Плотникова Е.Ю., Воросова О.А., Баранова Е.Н., Карягина М.С., Краснов К.А., Синьков М.А.

Summary:

Night shift and hyperammonemia in doctors

E.Yu. Plotnikova1, O.A. Vorosova2, E.N. Baranova1,2, M.S. Karyagina2, K.A. Krasnov1,2, M.A. Sinkov3

1Kemerovo State Medical University, Kemerovo

2Kemerovo Clinical Emergency Hospital, Kemerovo

3Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo

Background: chronic circadian rhythm sleep disorder is associated with a variety of health risks, including sleep and gastrointestinal disorders, and cardiovascular diseases. Besides, lack of sleep and sleep disorders increase the incidence of dementia. Pathophysiological mechanisms of non-cirrhotic hyperammonemic encephalopathy are multifactorial and poorly understood.

Aim: to assess the degree of asthenia and cognitive impairment, ammonia level, and study the L-ornithine-L-aspartate (LOLA) effect in hyperammonemia in duty medical officers of the city emergency hospital.

Patients and Methods: 31 doctors of therapeutic and surgical profile aged from 22 to 45 years were under the follow-up. All doctors worked in the day shift and had 8–12-night shifts per month. Subjects in the clinical follow-up were examined for ammonia level before and after duty. After, they were asked to complete the Number Connecting Test and Subjective Scale of Asthenia. Eight doctors with the highest levels of ammonia during the next duty took 3 LOLA sachets. After the duty, these subjects were again examined the ammonia level in their blood and offered to complete tests in dynamics.

Results: initially, almost all doctors (n=31) had an increased level of ammonia in capillary blood to an average of 107.19±43.72 μg/dL and increased after the duty to an average of 133.81±69.60 μg/dL (p=0.047). Asthenia severity increased from 37.48±12.81 points to 47.16±15.33 points (p=0.0015). During LOLA intake (n=8), the ammonia level decreased from 181.00±57.7 µg/dL to 129.37±61.1 µg/dL (p=0.0000924). A slight increase in the asthenia severity was statistically insignificant (p=0.026).

Conclusion: we recommend that those medical officers who have increased working hours, night shift, fatigue and asthenia, should monitor the level of ammonia. Thus, if it increases, it shall be reduced to normal value with medication.

Keywords: night shift, asthenia, circadian rhythm disorder, dementia, hyperammonemia, L-ornithine-L-aspartate.

For citation: Plotnikova E.Yu., Vorosova O.A., Baranova E.N. et al. Night shift and hyperammonemia in doctors. RMJ. 2021;4:49–52.



Pages 54-58. Диагностический триумвират боли: от понимания — к действию. Баринов А.Н., Плужникова М.Н.

Summary:

Diagnostic triumvirate of pain: from understanding to action

A.N. Barinov1, M.N. Pluzhnikova2

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

2Institute of Higher Nervous Activity and Neurophysiology of RAS, Moscow

The article presents a new diagnostic concept of pain, assumming three basic types of pain syndromes: nociceptive, neuropathic and nociplastic. Medical risk factors of chronic pain are described. The article also covers in detail the questions concerning one of the most striking manifestations of social communication disorders in any pain syndromes — the pain catastrophizing. The modern approach to the treatment of pain syndromes implies the earliest possible prescription of drugs, regardless of their development etiological origin. Treatment patterns of each of the above pain types, involving the use of different drug groups aimed at different mechanisms of nociception and antinociception, are presented. Special attention is paid to individual methods of non-drug therapy, which can be used for any pain type. The article describes modern methods of short-term psychological interventions that  can improve the treatment efficacy: hypnotherapy and cognitive behavioral therapy. Understanding the pain syndrome type and the leading mechanisms of pain development in a particular patient allows to recommend individual therapy aimed at eliminating not only the symptoms, but also the underlying cause of the disease.

Keywords: nociceptive pain, neuropathic pain, nociplastic pain, catastrophizing, short-term psychological interventions, cognitive behavioral therapy, paracetamol, tramadol.

For citation: Barinov A.N., Pluzhnikova M.N. Diagnostic triumvirate of pain: from understanding to action. RMJ. 2021;4:54–58.

Pages 59-62. Случай успешного лечения мукормикоза околоносовых пазух перед аллогенной трансплантацией гемопоэтических стволовых клеток. Долгов О.И., Попова М.О., Карпищенко  С.А., Пинегина О.Н., Роднева Ю.А., Рогачева Ю.А., Маркова И.В., Залялов Ю.Р., Бондаренко С.Н., Афанасьев Б.В.

Summary:

Сase of successful treatment of mucormycosis of the paranasal sinuses before allogeneic hematopoietic stem cell transplantation

O.I. Dolgov1, M.O. Popova1, S.A. Karpishchenko1,2, O.N. Pinegina1, Yu.A. Rodneva1, Yu.A. Rogacheva1, I.V. Маркова1, Yu.R. Zalyalov1

S.N. Bondarenko1, B.V. Afanasiev1

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

2Saint Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint Petersburg

Hematopoietic stem cell transplantation (HSCT) is a modern method of treating hematological diseases. HSCT is accompanied by certain risks due to the cytostatic therapy side effects, agranulocytosis period, and impaired cellular and humoral immunity. The development of infectious complications during anticancer therapy prior to transplantation calls into question not only the achievement of the underlying disease remission, but also the possibility of subsequent HSCT.

The article describes a case of successful combined treatment of mucormycosis of the paranasal sinuses in a female patient with acute myeloid leukemia occurred during anticancer therapy, which was performed in order to achieve the underlying disease remission before allogeneic HSCT from unrelated donors. The article also considers disease clinical manifestations, tendency of the paranasal sinuses’ lesions, combination therapy and surgical intervention in conditions of cytostatic pancytopenia. X-ray and endoscopic images of nasal cavity mucormycosis lesions, as well as the results of microscopic examinatio n are presented. The authors conclude that with timely diagnosis, early drug therapy, appropriate preparation and surgical treatment, it is possible to achieve a favorable outcome in the treatment of rapidly progressive life-threatening complication — mucormycosis of the paranasal sinuses in the setting of cytostatic pancytopenia.

Keywords: mucormycosis, acute leukemia, antitumor chemotherapy, hematopoietic stem cell transplantation, endoscopic rhinosurgery, sinusitis.

For citation: Dolgov O.I., Popova M.O., Karpishchenko S.A. et al. Сase of successful treatment of mucormycosis of the paranasal sinuses before allogeneic hematopoietic stem cell transplantation. RMJ. 2021;4:59–62.

Pages 63-66. Актуальные вопросы использования осельтамивира при гриппе. Фесенко О.В.

Summary:

Topical issues concerning oseltamivir use in influenza

O.V. Fesenko

Russian Medical Academy of Continuous Professional Education, Moscow

The rapid spread of COVID-19 and the increasing number of severe cases have diverted medical attention from the problem of influenza and other acute respiratory viral infections. Influenza causes annual epidemics and periodic pandemics with high morbidity rate, due to the high population susceptibility to this infection. Every flu outbreak has serious health, social, and economic consequences. The most significant of the influenza virus group is the influenza A virus. In recent decades, a negative trend in the epidemic process is the increasing incidence of influenza B outbreaks. Since the late 1970s, intensive research has been conducted on the development of etiotropic drugs for influenza therapy. Representatives of the neuraminidase inhibitors class are considered by the WHO as effective treatments for influenza A and B. In recent years, the gold standard of etiotropic therapy and prevention is oseltamivir. The drug has a systemic effect, prevents the release of viral particles. Drug efficacy and safety for the treatment and prevention of influenza are confirmed by a large number of studies combined in several meta-analyses. The article deals with the issues of influenza epidemiology and characteristics of the current course, and analyzes the study results evaluating oseltamivir efficacy and safety.

Keywords: ARVI, influenza, influenza virus, neuraminidase, prevention, epidemic.

For citation: Fesenko O.V. Topical issues concerning oseltamivir use in influenza. RMJ. 2021;4:63–66.



Pages 68-73. Фармакогенетическое управление эффективностью и безопасностью ингибиторов протонных помп. Карева Е.Н.

Summary:

Pharmacogenetic management concerning efficacy and safety of proton-pump inhibitors

E.N. Kareva1,2


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

2Pirogov Russian National Research Medical University, Moscow


Proton-pump inhibitors (PPIs) are used to treat acid-related diseases. Despite the recognized PPIs efficacy and safety, some patients do not have an adequate response or develop adverse events related to treatment. The variability of patients’ response to medicinal products may be associated with different mechanisms, but commonly this is due to the variability of metabolic enzymes genotype (rapid and poor metabolizers), which affects the effective drug concentration in the blood. One of the main PPI metabolism enzymes is CYP2C19. Large epidemiological studies confirm the association between the PPIs concentration and CYP2C19 gene polymorphism, resulting in variations of efficacy and safety. The article presents data on the pharmacokinetics and pharmacodynamics of currently available PPIs with an assessment of cytochrome isoforms in their metabolism and the potential role of CYP2C19 genetic variation in the therapeutic PPIs efficacy. The article also shows current recommendations for dosage modification of omeprazole, lansoprazole, pantoprazole, and dexlansoprazole depending on the patient’s metabolic phenotype. There is no need in rabeprazole dosage modification due to the peculiarities of its metabolism. Genotype-based dosage promises to improve therapeutic outcomes and minimize adverse events.

Keywords: gene polymorphism, personalized medicine, omeprazole, lansoprazole, pantoprazole, rabeprazole, metabolizers, CYP2C19.

For citation: Kareva E.N. Pharmacogenetic management concerning efficacy and safety of proton-pump inhibitors. RMJ. 2021;4:68–73.




Pages 74-77. Эффективность, безопасность и приверженность лечению внутривенными бисфосфонатами при постменопаузальном остеопорозе. Беляева И.Б.

Summary:

Efficacy, safety, and adherence to intravenous bisphosphonate treatment in postmenopausal osteoporosis

I.B. Belyaeva

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

Postmenopausal osteoporosis is one of the most common clinical types of osteoporosis. The article presents the main stages of the osteoporosis pathogenesis, directly related to the formation of estrogen deficiency and bone remodeling disorder. Particular attention is paid to the efficacy and safety of bisphosphonates (BP) administration, which are the first-line drugs in the treatment of this pathology. The article also presents the ability of BP to inhibit pathological bone resorption and stimulate bone formation and highlights the data of international placebo-controlled and Russian follow-up studies, which indicate the high efficacy of ibandronic acid (IA). It was noted that the use of IA with intravenous administration of 3 mg once every 3 months leads to the restoration of bone metabolism, an increase in bone mineral density (BMD) and strength, and reduces the risk of vertebral and extravertebral fractures in high-risk patients. Analysis of the results concerning the dynamic follow-up of patients receiving IA indicates its aftereffect during the 12 months after the end of treatment for the preservation of the spine BMD. The benefit of ibandronate intravenous administration route is the possibility for patients with gastrointestinal pathology (esophageal ulcers, esophagitis), as well as a reduction in the frequency of use (once every 3 months), which increases adherence to therapy.

Keywords: postmenopausal osteoporosis, bisphosphonates, ibandronic acid, compliance, cardiovascul ar risk.

For citation: Belyaeva I.B. Efficacy, safety, and adherence to intravenous bisphosphonate treatment in postmenopausal osteoporosis. RMJ. 2021;4:74–77.



Pages 78-80. Повышение эффективности терапии хронических дерматозов. Русак Ю.Э., Горшкова А.В., Ефанова Е.Н.

Summary:

Improving the treatment efficacy of chronic dermatoses

Yu.E. Rusak, A.V. Gorshkova, E.N. Efanova

Surgut State University, Surgut

Aim: to increase the treatment efficacy of chronic dermatoses by including meldonium in complex therapy.

Patients and Methods: a prospective study was conducted, which included 40 patients: 24 of them women with atopic dermatitis (n=14), eczema (n=14) and psoriasis (n=12). The median age was 51.3 years. Concomitant pathology was observed in 20 patients, while the other
20 patients had a comorbid condition. Depending on the indicated treatment, the patients were divided into 2 groups of 20 subjects. Group 1 with comorbid diseases received standard treatment using antihistamines, external glucocorticosteroids for 4 weeks. Group 2 with concomitant pathology received similar treatment according to the standard regimen with meldonium addition at a dose of 500 mg/day for 4 weeks. The incidence of relapses, the duration of remission periods, the area of cutaneous lesions, and the values of the SpO2 index were evaluated. The patients were followed up for 12 months.

Results: initially, all patients were characterized by the predominance of parasympathetic nervous system regulation, which was manifested by severe itching, insomnia and decreased work ability. Treatment result with the inclusion of meldonium was a decrease in the cutaneous lesions area during the next exacerbation, an increase in the duration of the relapse-free period, a reduction in the exacerbation period
to 14 days, and an increase in blood oxygen saturation level (p<0.05) versus patients who received only standard therapy.

Conclusion: meldonium inclusion in the complex therapy of chronic dermatoses in the setting of comorbid and concomitant pathology increases the therapy efficacy, improves sleep and increases work ability.

Keywords: chronic dermatoses, atopic dermatitis, eczema, psoriasis, patients, meldonium, comorbid condition.

For citation: Rusak Yu.E., Gorshkova A.V., Efanova E.N. Improving the treatment efficacy of chronic dermatoses. RMJ. 2021;4:78–80.



№3, 2021. Болезни дыхательных путей. Оториноларингология

Pages 13-18. N-ацетилцистеин в комплексном лечении COVID-ассоциированной пневмонии. Авдеев С.Н., Гайнитдинова В.В., Мержоева З.М., Берикханов З.Г., Медведева И.В., Горбачева T.Л.

Summary:

N-acetylcysteine in the complex treatment of COVID-19 pneumonia

S.N. Avdeev1,2, V.V. Gainitdinova1, Z.M. Merzhoeva1, Z.G.-M. Berikhanov1, I.V. Medvedeva1, T.L. Gorbacheva1

1Sechenov University, Moscow

2Research Institute of Pulmonology of the Russian Federal Medical Biological Agency, Moscow

Background: the available data on the treatment results of a new coronavirus infection (COVID-19) using all medicinal products do not allow for making a firm conclusion about their efficacy or inefficacy. Therefore, their use is permissible by decision of the medical commission in accordance in the prescribed manner, if the potential benefit to the patient exceeds the risk of their use. Drug choice for COVID-19 treatment regimens is based on data on efficacy and safety, their mechanism of action, and potential interactions. Pharmacological activity of N-acetylcysteine (NAC) and its potential effect in inhibition the progression of COVID-19 make it a promising therapeutic agent in COVID-19.

Aim: to evaluate the efficacy of NAC in the comprehensive treatment of a moderate COVID-19 pneumonia.

Patients and Methods: the study included adult patients (n=46) with moderate COVID-19 pneumonia, grade 2 CT. The age of the patients was 57 (51; 71) years, BMI — 30 (27.1; 32.3) kg/m2, disease duration before hospitalization — 7 (6; 8) days, temperature at the time of hospitalization — 37.5 (37.1; 37.8) °C. Two study groups were randomly formed. The first group (n=22) received standard COVID-19 treatment. Patients of the second group (n=24) additionally received NAC 1200–1500 mg/day intravenously. NAC was prescribed simultaneously during the initiation of standard therapy.

Results: this study showed that the inclusion of NAC in the comprehensive treatment of moderate COVID-19 pneumonia led to a statistically significant increase in the oxygen saturation, oxygenation index, difference in delta increase of the oxygenation index, higher rate of decline in the volume of lung damage and inter-group difference in delta decline. There was also a statistically significantly more intense rate of a decrease in C-reactive protein levels than in the standard treatment group and a reduction of hospitalization duration in the group receiving NAC.

Conclusion: study results indicated the efficacy of NAC inclusion in the comprehensive treatment of moderate COVID-19 pneumonia.

Keywords: COVID-19 pneumonia, oxygenation index, lung damage volume, hospitalization duration, treatment, N-acetylcysteine.

For citation: Avdeev S.N., Gainitdinova V.V., Merzhoeva Z.M. et al. N-acetylcysteine in the complex treatment of COVID-19 pneumonia. RMJ. 2021;3:13–18.

Pages 19-23. Нетяжелая внебольничная пневмония. Зайцев А.А.

Summary:

Non-severe community-acquired pneumonia

A.A. Zaitsev

Main Military Clinical Hospital named after N.N. Burdenko, Moscow

According to the World Health Organization (WHO), pneumonia and influenza firmly hold the 3rd place in the list of the main reasons of fatal outcomes worldwide achieving more than 3 million deaths annually. Adding that, a new coronavirus infection (COVID-19) was also the cause of the death of 2.5 million people in a year. Both in pneumonia and COVID-19, the mortality rate among elderly patients, especially patients with comorbidities (for example, patients with COPD, diabetes mellitus, chronic heart failure, malignant neoplasms, etc.) significantly exceeded the mortality rate among young and middle-aged patients without concomitant diseases. This article presents current issues concerning diagnosis and treatment of community-acquired pneumonia from the standpoint of national recommendations. The most important sections relate to the issues of lung damage in the framework of influenza and coronavirus infection, as well as the possibilities of disease diagnosing and the role of biomarkers related to inflammation. A significant place is given to the choice of empirical antimicrobial therapy for non-severe community-acquired pneumonia. The problem of increase in the number of strains resistant to antibiotics was also discussed. The inappropriate use of antibiotics, such as macrolides, beta-lactam antibiotics, and quinolones, is a well-known predisposing factor for the formation of resistance to them, especially in pneumococci.

Keywords: community-acquired pneumonia, antimicrobial therapy, antibiotics, clinical recommendations, resistance, pneumococcus.

For citation: Zaitsev A.A. Non-severe community-acquired pneumonia. RMJ. 2021;3:19–23.

Pages 24-26. Современные тенденции в эпидемиологии туберкулеза и ВИЧ-инфекции в мире и в Российской Федерации. Афанасьев Е.И., Русских О.Е.

Summary:

Modern trends in the epidemiology of tuberculosis and HIV infection worldwide and in the Russian Federation

E.I. Afanasiev1, O.E. Russkikh1,2

1Izhevsk State Medical University, Izhevsk

2Republican Clinical Tuberculosis Hospital of the Ministry of Health of the Udmurt Republic, Izhevsk

The article provides a brief overview of the modern trends in the epidemiology of tuberculosis and HIV infection in the Russian Federation and worldwide, indicating the complex impact of this combined pathology. The main epidemiological tuberculosis indicators over the past 10 years have downward trend: tuberculosis incidence in the Russian Federation from 2009 to 2019 decreased by 50.1%, prevalence decreased by 53.3%, mortality rate decreased to 70.9% (up to 5.2 per 100 000 population, among which 18% of cases was associated with the AIDS development). Whereas, HIV infection retains its position: about 40 million people are infected worldwide (20.1% of whom did not know their HIV status), more than 1 million cases were registered in the Russian Federation at the beginning of 2019. In 2018, tuberculosis incidence among patients with HIV infection in Russia was 1764.3 per 100 000 HIV-infected patients, which is 58.6 times more than the average in the Russian Federation in patients without HIV infection. Thus, in recent years, there has been an increase in the number of patients with combined pathology of HIV infection and tuberculosis in the Russian Federation.

Keywords: tuberculosis, HIV infection, HIV-associated tuberculosis, incidence, mortality, prevalence, epidemiology, infectious disease.

For citation: Afanasiev E.I., Russkikh O.E. Modern trends in the epidemiology of tuberculosis and HIV infection worldwide and in the Russian Federation. RMJ. 2021;3:24–26.

Pages 27-30. Профилактика и лечение гриппа у взрослых. Игнатова Г.Л., Антонов В.Н.

Summary:

Prevention and treatment of influenza in adults

G.L. Ignatova, V.N. Antonov


South Ural State Medical University, Chelyabinsk


Annual seasonal influenza epidemics of varying severity led to significant morbidity and mortality worldwide. According to the World Health Organization, up to 646 thousand patients die from seasonal influenza every year worldwide. People get sick with the flu at any age, however, there are populations at increased risk.

This article is devoted to topical issues concerning diagnosis, treatment and prevention of influenza. The following data on risk factors for adverse outcomes and complications are presented: adults aged >65 years, pregnant women, people with certain chronic diseases, residents of nursing homes and other long-term care facilities, overweight patients, unvaccinated patients. The data on the vaccination efficacy at different age periods, as well as the recommended vaccines composition for the 2020/2021 season, are shown. In the treatment section, the main priority is given to the use of antiviral evidence-based drugs. The efficacy of domestic antiviral drug, Influcein, as well as its regimens, are considered.

Keywords: seasonal influenza, epidemic, influenza complications, antiviral drugs, vaccination.

For citation: Ignatova G.L., Antonov V.N. Prevention and treatment of influenza in adults. RMJ. 2021;3:27–30.



Pages 3-7. Патологическая анатомия поражения сосудов при гриппе и вирусно-бактериальной пневмонии. Двораковская И.В., Титова О.Н., Ариэль Б.М., Платонова И.С., Волчков В.А., Кузубова Н.А.

Summary:

Pathological anatomy of vascular lesions in influenza and viral-bacterial pneumonia

I.V. Dvorakovskaya1, O.N. Titova1, B.M. Ariel2, I.S. Platonova1, V.A. Volchkov3, N.A. Kuzubova1

1Research Institute of Pulmonology of the I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg

2St. Petersburg Research Institute of Phthisiopulmonology, Saint Petersburg

3St. Petersburg State University, Saint Petersburg

Aim: to evaluate the structural changes of vessels in influenza and viral-bacterial pneumonia, and their role in thanatogenesis.

Patients and Methods: 387 autopsy reports were analyzed in St. Petersburg hospitals in 2016, and clinical diagnoses were compared with anatomicopathological or forensic diagnoses to determine the underlying disease and its complications. Most of the deceased (64.3% of the total number) were male patients. Microscopic examination of lung preparations and other organs stained with hematoxylin and eosin, as well as immunohistochemistry of influenza A virus nucleoproteins expression in alveolocytes and macrophages were performed.

Results: presenile age plays a key role in thanatogenesis, since the maximum mortality was observed in the age group of 60–79 years (42.2%), while the minimum mortality — in the group of 20–39 years (11.9%). The main cause of fatal outcome was severe pneumonia, the exact etiology of which was not established, since bacterioscopic and bacteriological studies were not conducted. Microscopic examination revealed hemorrhagic and necrotic and deep fibrinous-ulcerative lesions of the tracheal and bronchial mucosa, as well as exudative necrotic processes in the pulmonary parenchyma, peribronchitis and acute destructive bronchiectasis. These were combined with dystrophic and necrobiotic changes in the vascular wall, its permeability disorder, hyperemia, stasis, thrombosis and hemorrhages characteristic of vasculitis. The severity degree of morphological manifestations concerning vascular pathology (as essential patterns of influenza and combined influenza bacterial infection) varied significantly depending on the disease duration and the severity of secondary bacterial infection.

Conclusions: the combination of inflammatory changes in the lungs with circulatory disorders in influenza and viral-bacterial pneumonia creates a detailed picture of the black lung. Bacterial flora activation by the type of autoinfection in the setting of depressed immunity in influenza, along with severe inflammation to vessels and pulmonary parenchyma, plays a leading role in thanatogenesis.

Keywords: influenza, pneumonia, autoinfection, bronchitis, alveolitis, vasculitis, circulatory disorders, underlying disease, complication, thanatogenesis.

For citation: Dvorakovskaya I.V., Titova O.N., Ariel B.M. et al. Pathological anatomy of vascular lesions in influenza and viral-bacterial pneumonia. RMJ. 2021;3:3–7.



Pages 30-33. Оценка слухового поведения ребенка раннего возраста (LittlEARS) после кохлеарной имплантации при глухоте различной этиологии. Кузовков В.Е., Сугарова С.Б., Лиленко А.С., Каляпин Д.Д., Луппов Д.С.

Summary:

LittlEARS behavioral assessment of hearing after cochlear implantation in infants and toddlers with deafness of various etiologies

V.E. Kuzovkov1, S.B. Sugarova2, A.S. Lilenko2, D.D. Kalyapin2, D.S. Luppov2

1S.M. Kirov Military Medical Academy, Saint Petersburg

2Saint Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint Petersburg

Background: since 2018, Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech has been conducting a study on the etiological spectrum of congenital deafness in candidates for cochlear implantation. One of the important criteria for evaluating the results of cochlear implantation is to identify the level of auditory and speech development of the child after receiving the first auditory experience.

Aim: to evaluate the results of auditory and speech development of infants and toddlers after cochlear implantation, taking into account the etiological profile of congenital deafness via Little Ears Auditory Questionnaire (LittlEARS) concerning behavioral assessment of hearing in infants and toddlers.

Patients and Methods: 100 children were examined who made up  3 study groups and 5 dropout patients: group I consisted of patients with non-syndromic genetic hearing loss (44 patients), group II — patients with syndromic hearing loss (14 patients), group III — patients with congenital cytomegalovirus infection (37 patients). LittlEARS was conducted twofold: 7 days after the initial fitting of the cochlear implant and 6 months later.

Results: during the first survey in group I, the average result was 7.07±0.37 points, in group II — 7.35±0.67 points, in group III — 7.03±0.54 points, the differences were not statistically significant (p=0.72). The total score was formed mainly due to responses to non-speech signals; the differences between the groups were not statistically significant (p=0.56). According to the second survey, the average result in group I was 17.77±0.71 points, in group II — 16.93±1.13 points, in group III — 13.78±1.21 points, the difference in results was statistically significant (p=0.011). The differences between the groups were due to the statistical difference in the number of points standing for speech signals (p=0.036).

Conclusion: at the first stage of the study, there were no significant differences in indicators of patients with various etiology of deafness. After 6 months, group III showed lower test scores versus children with genetic hearing disorders due to a lower increase in the average number of responses to speech stimuli, while maintaining the same ratio of responses to non-speech stimuli.

Keywords: cochlear implantation, aural rehabilitation, congenital deafness, genetic hearing loss, cytomegalovirus infection.

For citation: Kuzovkov V.E., Sugarova S.B., Lilenko A.S. et al. LittlEARS behavioral assessment of hearing after cochlear implantation in infants and toddlers with deafness of various etiologies. RMJ. 2021;3:30–33.



Pages 34-38. Современные подходы к диагностике и лечению острого риносинусита. Кириченко И.М., Козлова Н.С.

Summary:

Modern methods to the diagnosis and treatment of acute rhinosinusitis

I.M. Kirichenko1,2, N.S. Kozlova2

1Peoples’ Friendship University of Russia, Moscow

2ON CLINIC Arbat LLC, Moscow

Acute rhinosinusitis is quiet a common disease in most countries, which generally occurs in the setting of viral infections. In acute viral infection of the nasal cavity and paranasal sinuses, the ciliated epithelium loses its cilia and its ability to purify and protect. As a result, mucous membrane gets swelling and inflammation. Discharge congestion is an appropriate growing medium for bacteria, which leads to the occurrence of acute bacterial rhinosinusitis (ABRS). Prescribing antibiotics for mild to moderate ABRS is not justified and contributes to increased antibiotic resistance. The use of topical medication that reduces mucosal swelling and improve the outflow of inflammatory secretions from the nasal sinuses, helps to relieve the symptoms of inflammation and improve the patients’ condition. Sinuforte based on cyclamen europaeum extract causes reflex hypersecretion in the mucous membrane. Mucus secretion is improved due to the direct osmotic actio n of the drug components, as well as due to the stimulation of hypersecretion, in combination with decongestant effect, thereby facilitating nasal breathing and secretion evacuation from the sinuses. Studies conducted in Russia and abroad on the use of Sinuforte in acute rhinosinusitis have shown that the drug contributes to the symptoms’ resolution, reduces the time of disease progression and the need for antibiotics or increases their effect.

Keywords: mucosa, paranasal sinuses, acute rhinosinusitis, mucociliary clearance, antibiotic resistance.

For citation: Kirichenko I.M., Kozlova N.S. Modern methods to the diagnosis and treatment of acute rhinosinusitis. RMJ. 2021;3:34–38.



Pages 40-42. Местная терапия верхнечелюстных пазух после эндоназального удаления включений костной плотности. Карпищенко С.А., Болознева Е.В., Карпищенко Е.С.

Summary:

Topical therapy of the maxillary sinuses after endonasal removal of bone density inclusions

S.A. Karpishchenko1,2, E.V. Bolozneva1, E.S. Karpishchenko1

1Pavlov First Saint Petersburg State Medical University, Saint Petersburg

2Saint Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint Petersburg

The maxillary sinus is a pyramidal cavity in the maxilla that has various functions. In the sinus cavity, the pathological bone masses and human-induced ones are possible as a result of the sinus augmentation surgery. Alveolar ridge augmentation is performed in patients with a lack of bone height for the dental implant placement. As the surgery result, the maxillary sinus volume decreases, which does not affect the subjective and objective respiratory assessment of a patient. Osteoma is a benign tumor of bone tissue. The incidence of maxillary sinus osteomas among all paranasal sinus osteomas is only 2%. Commonly, osteomas do not manifest clinical symptoms, but are a random finding during radiation detection methods, such as cone-beam computed tomography, multi-section computed tomography, teleroentgenography, orthopantomography.

A clinical case of maxillary sinus osteoma surgica l removal by endoscopic transnasal approach under the navigation system control is shown. The mass is represented by a mixed osteoma. In the postoperative period, irrigation of the nasal cavity with saline solutions and treatment with a drug containing propylene glycol, dexpanthenol, hydroxyethylcellulose and octenidine dihydrochloride were used to prevent infectious and inflammatory complications.

Keywords: maxillary sinus, osteoma, bone grafting, sinus augmentation surgery, endoscopic surgery.

For citation: Karpishchenko S.A., Bolozneva E.V., Karpishchenko E.S. Topical therapy of the maxillary sinuses after endonasal removal of bone density inclusions. RMJ. 2021;3:40–42.

Pages 43-47. Алгоритм хирургического лечения пациента с тяжелой формой тотального полипозного полисинусита. Болознева Е.В., Карпищенко С.А., Павлов В.Е.

Summary:

Surgical treatment algorithm of a patient with severe form of total rhinosinusitis with nasal polyps

E.V. Bolozneva1, S.A. Karpishchenko1,2, V.E. Pavlov1

1Pavlov First Saint Petersburg State Medical University, Saint Petersburg

2Saint Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint Petersburg

Chronic pathology of the nose and paranasal sinuses is quite common, its proportion among all diseases increases every year. Chronic rhinosinusitis with nasal polyps and without polyps depends on the stage of the pathological process, the patient’s condition severity, and the damage to adjacent anatomical formations. Surgical treatment is recommended in cases of a widespread polyposis process (total or subtotal obstruction of the nasal cavity, filling two or more paranasal sinuses with polyps, blocking with a single polyp of the following areas: natural ostium, choana, nasal passage). A modern method of surgical treatment concerning paranasal sinus pathology is functional endoscopic sinus surgery. The article presents a clinical case of the compilation and application of the surgical treatment algorithm for a patient with total destructive rhinosinusitis with polyps. The severity of the patient’s condition was due to the presence of concomitant diseases: hypertension, grade 2 obesity, chronic bronchitis, chronic obstructive pulmonary disease. A correctly formulated algorithm of pre-examination in the preoperative period made it possible to identify changes in the paranasal sinuses and tracheobronchial tree signifi cant for surgical intervention and anesthetic support. Intraoperative monitoring was carried out using endoscopic techniques and electromagnetic navigation system, which allowed the patient to provide an adequate amount of surgery and prevent the possible risks of severe fatal bleeding.

Keywords: chronic rhinosinusitis with nasal polyps, destructive rhinosinusitis with polyps, endoscopic endonasal rhinosurgery, electromagnetic navigation system, endotracheal anesthesia.

For citation: Bolozneva E.V., Karpishchenko S.A., Pavlov V.E. Surgical treatment algorithm of a patient with severe form of total rhinosinusitis with nasal polyps. RMJ. 2021;3:43–47.



Pages 8-12. Алгоритм диагностики гастроэзофагеальной рефлюксной болезни при бронхиальной астме. Титова О.Н., Кузубова Н.А., Ковалева Л.Ф., Склярова Д.Б., Филиппов Д.И., Смирнов А.А.

Summary:

Algorithm for the diagnosis of gastroesophageal reflux disease in bronchial asthma

O.N. Titova1, N.A. Kuzubova1, L.F. Kovaleva1, D.B. Sklyarova2, D.I. Filippov3, A.A. Smirnov3

1Research Institute of Pulmonology of the I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg

2Vvedenskaya City Clinical Hospital, Saint Petersburg

3Research Institute for Surgery and Emergency Medicine of the I.P. Pavlov First Saint Petersburg State Medical University, Saint Petersburg

Aim: to develop an algorithm for the diagnosis of gastroesophageal reflux disease (GERD) in bronchial asthma (BA).

Patients and Methods: the study included 32 patients with a moderate to severely controlled and partially controlled BA course, observed at the Research Institute of Pulmonology of the I.P. Pavlov First Saint Petersburg State Medical University. All the patients received controller therapy according to the Federal Clinical Guidelines for the diagnosis and treatment of BA. The examination included the use of АСТ (Asthma Control Test), spirometry with a bronchodilator test, fibroesophagogastroduodenoscopy, consultation with a gastroenterologist, daily esophageal impedance pH monitoring, and Numerical Rating Scale for pain intensity.

Results: at the time of the examination, partial control over the BA symptoms was observed in 7 patients, the ACT score was 22.3±1.1 points. In this group of patients, the following association of respiratory manifestations was revealed — complaints concerning the respiratory organs (coughing, a feeling of "wheezing", non-productive habit cough, sternal pain, respiratory distress) in a horizontal position and the presence of GERD. The nature of reflux was determined, which was necessary for a differentiated approach to the prescription of anti-reflux therapy: acid reflux was detected in 1 patient, weakly acidic — in 2, mixed acid-base and severe reflux — in 3. Successful anti-reflux therapy allowed to reduce and completely eliminate the use of additional inhalations "on demand" of formoterol/budesonide by the end of 4 weeks.

Conclusion: the lack of possible BA control during the optimal controller therapy in some cases may be due to the presence of concomitant GERD. Timely diagnosis of GERD and its pharmacological correction contributes to achieving optimal BA control, reducing the doses of inhaled glucocorticosteroids and long-acting β2-agonists, as well as preventing the progression and possible complications of GERD.

Keywords: bronchial asthma, gastroesophageal reflux disease, reflux, respiratory symptoms, spirometry, daily esophageal impedance pH monitoring.

For citation: Titova O.N., Kuzubova N.A., Kovaleva L.F. et al. Algorithm for the diagnosis of gastroesophageal reflux disease in bronchial asthma. RMJ. 2021;3:8–12.



№2, 2021. Эндокринология

Pages 10-12. Косвенные способы оценки инсулинорезистентности при метаболическом синдроме. Мадянов И.В.

Summary:

Indirect methods for assessing insulin resistance in metabolic syndrome

I.V. Madyanov

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

Chuvash Republic Postgraduate Doctors’ Training Institute, Cheboksary

Aim: to study the possibility of using calculated indices based on the results of determining routine clinical laboratory parameters for assessing insulin resistance (IR) in metabolic syndrome (MS).

Patients and Methods: the study included 77 subjects with MS who met the criteria of the International Diabetes Federation (2005). The following parameters were measured in all subjects: height, body weight, waist circumference, and fasting blood levels of insulin, glucose, triglycerides (TG), and high-density lipoprotein cholesterol (HDL–C). On the basis of the studied parameters, the insulin-based and non-insulin-based IR indices were determined using generally accepted formulas. Insulin-based indices included the following: HOMA-IR, Caro, QUICKI; non-insulin-based included: TG/HDL–C, visceral obesity, lipid accumulation, triglyceride-glucose (TyG) and metabolic indices. Association between these indices was estimated using the Spearman’s rank correlation coefficient (rs).

Results: it was shown that all calculated non-insulin-based indices significantly weakly and moderately correlated with H OMA-IR index. 4 out of 5 of these indices (excluding the TyG index) were significantly associated with QUICKI index. However, none of the non-insulin-based indices showed a statistically significant association with Caro index. Non-insulin-based indices were paired with HOMA-IR index approximately equally (the range of rs fluctuations was 0.25–0.34). Based on the ratio of TG to HDL–C, the simplest by definition and calculation IR index had a moderate correlation coefficient with HOMA-IR index equal to 0.33 (p=0.005).

Conclusion: non-insulin-based IR indices calculated on the basis of routine clinical laboratory parameters cannot be fully used to assess IR in MS during the work of general practitioner. It is necessary to continue the search for other (more accurate) non-insulin-based methods for diagnosing IR in subjects with MS.

Keywords: metabolic syndrome, insulin resistance, IR indices, HOMA-IR, TG/HDL–C index.

For citation: Madyanov I.V. Indirect methods for assessing insulin resistance in metabolic syndrome. RMJ. 2021;2:10–12.

Pages 13-17. Различия в накоплении висцеральной и эпикардиальной жировой ткани у больных с ишемической болезнью сердца и без нее. Миклишанская С.В., Саидова М.А., Орловский А.А., Сычев А.В., Карлова Н.А., Мазур Н.А.

Summary:

Differences in the accumulation of visceral and epicardial adipose tissues in patients with and without coronary heart disease

S.V. Miklishanskaya1, M.A. Saidova1,2, A.A. Orlovskiy2, A.V. Sychev2, N.A. Karlova1, N.A. Mazur1

1Russian Medical Academy of Continuous Professional Education, Moscow

2Institute of Clinical Cardiology named after A.L. Myasnikov, Division of the National Medical Research Center of Cardiology, Moscow

Aim: to evaluate epicardial adipose tissue (EAT) thickness and the content of visceral adipose tissue (VAT), as well as their association with metabolic disorders in overweight and obese patients with coronary heart disease (CHD) versus patients without CHD.

Patients and Methods: 152 patients (66 women and 86 men) were examined. The height was measured using a metal stadiometer Rm-1 «Diakoms» (Russia). The measurement of weight, body mass index (BMI), percentage of total adipose tissue and VAT was carried out using Omron BF-508 body composition monitor (Japan). EAT thickness was estimated using a 2D-EchoCG.

Results: 93 patients with the leading pathology had CHD, 59 patients had no CHD, there were other cardiovascular diseases (hypertension, abnormal heart rhythm). When comparing groups with and without CHD, statistically significantly higher values of VAT and, respectively, EAT were found in patients with CHD on the basis of comparable BMI. VAT percentage was 14 [11; 18] % and 13 [10; 14.5] % in patients with and without CHD, respectively (p=0.025). EAT thickness was 7 [6; 9] mm and 6 [5; 8] mm in patients with and without CHD, respectively (p=0.017). Patients with CHD had significantly higher glucose levels (p=0.023) and lower HDL cholesterol levels (p<0.0001) versus patients without CHD. There were no statistically significant differences in triglyceride levels between the groups (p=0.107).

Conclusion: on the basis of comparable BMI level, the values of VAT and EAT were significantly higher in the group with CHD versus the group without CHD, which can be considered  as one of the reasons for the disease development. The higher content of VAT was combined with higher values of glucose and low values of HDL cholesterol in the group with CHD versus the group without CHD.

Keywords: bioelectrical impedance analysis, visceral adipose tissue, epicardial adipose tissue, coronary heart disease, hypertension.

For citation: Miklishanskaya S.V., Saidova M.A., Orlovskiy A.A. et al. Differences in the accumulation of visceral and epicardial adipose tissues in patients with and without coronary heart disease. RMJ. 2021;2:13–17.

Pages 18-25. Синдром повышенной креатинфосфокиназы плазмы как диагностическая дилемма. Евдокимова Н.Е., Цыганкова О.В., Латынцева Л.Д.

Summary:

Evaluation of plasma creatine phosphokinase as a diagnostic dilemma

N.E. Evdokimova1, O.V. Tsygankova1,2, L.D. Latyntseva1

1Institute of Internal and Preventive Medicine, the branch of the Federal Research Center "Institute of Cytology and Genetics of the Siberian Department of the Russian Academy of Sciences", Novosibirsk

2Novosibirsk State Medical University, Novosibirsk

The article analyzes the literature data and current recommendations of international expert communities on conditions accompanied by an increased level of total creatine phosphokinase (CPK) and its isoforms in plasma. Attention is paid not only to the most common causes (such as acute myocardial infarction, acute stroke, dermatomyositis/polymyositis, hypothyroidism, paraneoplastic syndrome) but also to other less common pathological conditions (intake of a number of medications, hypoparathyroidism, neuromuscular diseases, obstructive sleep apnea syndrome, etc.), that a doctor of any specialty may encounter. Besides, there are reference points given for the interpretation of the plasma CPK level and its isoforms, depending on laboratory methods of determination, racial and gender-age characteristics, and physical development of the patient. The possible causes of unreliable results in the CPK dete rmination are associated with the presence of type 1 and 2 macrocomplexes, as well as CPK-BB in the blood serum, the identification of which is possible during electrophoresis. Their detection can be a reflection of autoimmune and tumor processes. Adding that, the review presents an algorithm of actions for doctors in case of suspected statin-associated muscle symptoms and asymptomatic hyperCKemia based on the clinical recommendations.

Keywords: creatine phosphokinase, CPK, acute myocardial infarction, statin-associated muscle symptoms, muscular dystrophy, hypothyroidism, idiopathic inflammatory myopathies, paraneoplastic syndrome.

For citation: Evdokimova N.E., Tsygankova O.V., Latyntseva L.D. Evaluation of plasma creatine phosphokinase as a diagnostic dilemma. RMJ. 2021;2:18–25.

Pages 26-30. Ожирение и инсулинорезистентность: механизмы развития и пути коррекции. Барсуков И.А., Демина А.А.

Summary:

Obesity and insulin resistance: pathogenesis and ways of correction

I.A. Barsukov, A.A. Demina

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

Obesity is currently one of the major healthcare problems. Pathologies associated with obesity (insulin resistance, type 2 diabetes mellitus and cardiovascular diseases) have a significant impact not only on the patient but also on the healthcare system and society as a whole. Insulin resistance is the main pathogenetic mechanism for the development of type 2 diabetes mellitus and many other diseases that significantly affect society. Thus, it is extremely important to understand this condition pathogenesis. The article describes the primary risk factors and mechanisms for the development of insulin resistance: molecular mechanisms, inflammation, endoplasmic reticulum stress, mitochondrial dysfunction. The article also considers the main therapeutic principles concerning correction of this condition, including new drug classes. The accumulation of clinical experience and further research data will help to determine a more precise place of the new drug class in the treatment algorithms for carbohydrate metab olism disorders.

Keywords: diabetes mellitus, obesity, insulin resistance, molecular mechanisms, endoplasmic reticulum stress, mitochondrial dysfunction.

For citation: Barsukov I.A., Demina A.A. Obesity and insulin resistance: pathogenesis and ways of correction. RMJ. 2021;2:26–30.



Pages 3-8. Определение уровня кортизола в слюне, собранной в позднее вечернее время, в скрининге эндогенного гиперкортицизма. Тимкина Н.В., Цой У.А., Курицына Н.В., Литвиненко Е.В., Васильева Е.Ю., Гринева Е.Н.

Summary:

Late-night salivary cortisol as a screening of endogenous hypercortisolism

N.V. Timkina, U.A. Tsoy, N.V. Kuritsyna, E.V. Litvinenko, E.Yu. Vasileva, E.N. Grineva

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

Aim: to analyze the results concerning evaluation of late-night salivary cortisol (LNSC), performed by electrochemiluminescence (ECL) assay in patients with different body weight for the screening of Cushing’s syndrome, and to determine the optimal cut-off value of LNSC for detection of endogenous hypercortisolism (EHC).

Patients and Methods: the study included 100 patients with evaluated LNSC for the purpose of primary diagnosis of EHC. The reference value was 6.7 nmol/L. At least one test for the diagnosis of EHC was used to confirm the study results. The statistical analysis was performed using the IBM SPSS Statistics v. 23 package. LNCS threshold value was determined using receiver-operator characteristic (ROC) analysis, where EHC presence was selected as the dependent variable.

Results: among 100 patients, the diagnosis of EHC was established in 28 cases. The patients’ body m ass index did not differ: in patients with EHC, the median was 31 [27; 37], and in patients without EHC — 29.4 [26; 33], p=0.475. According to the ROC analysis for the diagnosis of EHC, the optimal LNCS cut-off value with a sensitivity of 93% and a specificity of 87% was 6.6 nmol/L. The area under the curve (AUC) was 0.944, р<0.001. The sensitivity/specificity for the values of 6.7 nmol/L and 6.85 nmol/L was 89.3% / 88% and 89% / 88%, respectively. The sensitivity for 9.4 nmol/L was 71%, whereas the specificity was 91.7%.

Conclusion: according to our data during ECL, the optimal cut-off value for LNSC was 6.6 nmol/L in the EHC screening. The threshold values, 6.7 nmol/L and 6.85 nmol/L, were not significantly inferior in sensitivity and specificity, and can also be used in the diagnosis of EHC.

Keywords: electrochemiluminescence assay, salivary cortisol, endogenous hypercortisolism, Cushing’s syndrome, sensitivity, specificity.

For citation: Timkina N.V., Tsoy U.A., Kuritsyna N.V. et al. Late-night salivary cortisol as a screening of endogenous hypercortisolism. RMJ. 2021;2:3–8.



Pages 31-36. Роль ингибиторов дипептидилпептидазы-4 в управлении сахарным диабетом 2 типа. Демидова Т.Ю., Скуридина Д.В.

Summary:

The role of dipeptidyl peptidase-4 inhibitors in the management of type 2 diabetes mellitus

T.Yu. Demidova, D.V. Skuridina


Pirogov Russian National Research Medical University, Moscow


Type 2 diabetes mellitus (DM2) is currently one of the major healthcare problems. Every year, the increasing morbidity rate, the development of late disabling complications from the cardiovascular and nervous systems, kidneys, and eyes significantly reduce the life expectancy and life quality of the population. They also put a huge burden on the healthcare system of all countries worldwide. As it is known, DM2 is a multifactorial disease. At present, a number of pharmacological agents have been developed affecting most of the pathogenetic factors for DM2 development, which increase the concentration of insulin in the blood (direct administration of insulin or its production stimulation), improve insulin sensitivity, delay the passage and absorption of carbohydrates from GIT, increase the excretion of glucose by the kidneys. Dipeptidyl peptidase-4 (DPP-4) inhibitors class or gliptins refers to agents with incretin activity. By inhibiting the DPP-4 enzyme in the patient’s blood, drugs of this class increase the biological activity of hormones — incretins (such as glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide), which increase insulin secretion and reduce glucagon production in response to food intake. Thus, by activating the incretin response, DPP-4 inhibitors affect one of the main DM2 pathogenetic links. This review examines the currently available data on the efficacy and safety of DPP-4 inhibitors in DM2 treatment and presents a new domestic drug of this class — Evogliptin.

Keywords: type 2 diabetes mellitus, glycated hemoglobin, glucagon-like peptide-1, glucose-dependent insulin secretion, dipeptidyl peptidase-4, dipeptidyl peptidase-4 inhibitors, incretins, antidiabetic medications.

Pages 37-41. Метформин: время расширять показания?. Вербовой А.Ф., Вербовая Н.И., Ломонова Т.В., Долгих Ю.А.

Summary:

Metformin: is it time to expand the indications?

A.F. Verbovoy, N.I. Verbovaya, T.V. Lomonova, Yu.A. Dolgikh

Samara State Medical University, Samara

Metformin is known as an antidiabetic drug since the middle of the last century. It is widely used in clinical practice concerning the treatment of carbohydrate metabolism disorders. The effect of this drug is due to its impact on insulin resistance, which is a key link in the type 2 diabetes mellitus pathogenesis. However, in the last two decades, there have begun to appear researches demonstrating its effect on many body systems. The article presents data concerning the possible expansion of indications for metformin prescription. Metformin has been shown to have a positive effect in Huntington’s disease and Alzheimer’s disease, and to improve cognitive function in stroke patients. The anti-inflammatory effect of this drug, its ability to protect blood vessels from inflammation and oxidative stress are described. Metformin also has a beneficial impact in cardiovascular pathology, has an anti-a therogenic mechanism of action, and reduces the risks of micro- and macrovascular complications of type 2 diabetes mellitus. Separately, metformin efficacy in various types of cancer should be noted. The article shows its ability to block the progression of various tumors. The question concerning the metformin impact on the aging process is discussed.

Keywords: metformin, biguanides, type 2 diabetes mellitus, Huntington’s disease, Alzheimer’s disease, inflammation, oxidative stress, cardiovascular system, microvascular complications, oncology, aging.

For citation: Verbovoy A.F., Verbovaya N.I., Lomonova T.V., Dolgikh Yu.A. Metformin: is it time to expand the indications? RMJ. 2021;2:37–41.

Pages 42-48. Гипофосфатазия. Обзор клинических случаев, опубликованных в РФ. Гуркина Е.Ю., Воинова В.Ю., Кузенкова Л.М., Соснина И.Б., Витебская А.В., Костик М.М., Шатохина Н.С., Черняк И.Ю., Храмова Е.Б., Романенко Е.С., Вяткина А.С., Абрукова А.В.

Summary:

Hypophosphatasia. Review of clinical cases published in the Russian Federation

E.Yu. Gurkina1, V.Yu. Voinova2, L.M. Kuzenkova3, I.B. Sosnina4, A.V. Vitebskaya5, M.M. Kostik6, N.S. Shatokhina7I.Yu. Chernyak7, E.B. Khramova8, E.S. Romanenko9, A.S. Vyatkina10, A.V. Abrukova11

1V.A. Almazov National Medical Research Center, Saint Petersburg

2Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow

3National Medical Research Center for Children’s Health, Moscow

4Children’s Consultative and Diagnostic Center, Saint Petersburg

5Clinical Institute of Child Health named after N.F. Filatov of the First Moscow State Medical University named after I.M. Sechenov (Sechenov University), Moscow

6Saint-Petersburg State Pediatric Medical University, Saint Petersburg

7Children’s Regional Clinical Hospital, Krasnodar

8Tumen State Medical University, Tumen

9South Ural State Medical University, Chelyabinsk

10Children’s Regional Clinical Hospital, Perm

11Presidential Perinatal Center, Cheboksary

Hypophosphatasia (HPP) is a rare polymorphic disease that has different clinical manifestations depending on the age during disease onset and its severity. A wide range of symptoms affects various organs and systems, such as the musculoskeletal system (bones, muscles, joints), respiratory system, nervous system and kidneys, which can have a significant impact on the patient’s physical health and life quality. The prevalence of severe HPP in the European population is known, however, it is difficult to assess the prevalence of milder HPP forms due to the significant heterogeneity of clinical manifestations and the lower frequency of diagnosis. The review provides a modern view concerning HPP etiology and pathogenesis, as well as discusses diagnostic criteria and treatment options. Data from published clinical cases of HPP are also presented. Thus, as of 2020, Russian medical literature described 16  cases of children with the diagnosis of hypophosphatasia. The analysis of clinical cases published in Russian medical scientific journals has shown recommendation expediency to assess the level of tissue-specific alkaline phosphatase in the presence of any bone pathology with rickets-like manifestations in the patient.

Keywords: hypophosphatasia, HPP, tissue-specific alkaline phosphatase, TNSALP, ALPL gene, asfotase alfa, rickets-like diseases.

For citation: Gurkina E.Yu., Voinova V.Yu., Kuzenkova L.M. et al. Hypophosphatasia. Review of clinical cases published in the Russian Federation. RMJ. 2021;2:42–48.





№1, 2021. Кардиология. Ангиология

Pages 10-16. Особенности терапии ишемической болезни сердца у пациентов с туберкулезом и хронической обструктивной болезнью легких. Викторова И.А., Багишева Н.В., Моисеева М.В., Мордык А.В., Ароян А.Р., Филипенко Г.В., Самсонов К.Ю., Стативка Е.А.

Summary:

Treatment for ischemic heart disease in patients with tuberculosis and chronic obstructive pulmonary disease

I.A. Viktorova1, N.V. Bagisheva1, M.V. Moiseeva1, A.V. Mordyk1, A.R. Aroyan1, G.V. Filipenko2, K.Yu. Samsonov2, E.A. Stativka3


1Omsk State Medical University, Omsk

2Clinical Anti-tuberculosis Dispensary, Omsk

3City Polyclinics No. 4, Omsk

Aim: to optimize the treatment for ischemic heart disease (IHD) in patients with pulmonary tuberculosis (PL) and chronic obstructive pulmonary disease (COPD).

Patients and Methods: this prospective comparative study included 68 patients with PL, COPD, and IHD aged 40–70 years (mean age 65.35±9.9 years). All patients were subdivided into four groups based on antianginal therapy. Group 1 patients received bisoprolol and amlodipine (B+A), group 2 patients received bisoprolol and Nitrosorbide (B+N), group 3 patients received bisoprolol and trimetazidine (B+T), and group 4 patients received verapamil and trimetazidine (V+T). All medications were titrated to achieve clinical effect and/or adverse effects. Clinical data, arterial oxygen saturation, and 24-hour Holter monitoring records were evaluated.

Results: the improvement after antianginal therapy was reported in all four groups, i.e., the reduction in weekly intake of nitroglycerin, an increase in the distance until retrosternal pain occurs, the improvement of arterial oxygen saturation, reduction in heart rate, and improvement of ST segment depression (by 24-hour Holter monitoring). The best effect was achieved when using V+T or B+T (if bisoprolol was well-tolerated). Six out of 51 patients (11.7%) who received bisoprolol were switched to V+T due to the increase of cough and dyspnea. In this group, antianginal parameters after treatment were similar to those of group B+T, while treatment tolerability was better. Adequate therapy for IHD in patients with PL and COPD contributed to the increase in the efficacy of anti-tuberculosis treatment and the reduction in time to a negative swab as the first step of curing for tuberculosis.

Conclusions: verapamil and trimetazidine are the most rational and effective modalities in terms of safety and antianginal effect.

Keywords: coronary heart disease, stable angina, chronic obstructive pulmonary disease, pulmonary tuberculosis, comorbidity.

For citation: Viktorova I.A., Bagisheva N.V., Moiseeva M.V. et al. Treatment for ischemic heart disease in patients with tuberculosis and chronic obstructive pulmonary disease. RMJ. 2021;1:10–16.

Pages 17-24. Индивидуальный подход к лечению пациентов с АГ и коморбидной патологией: роль блокаторов кальциевых каналов. Карпов Ю.А.

Summary:

Personalized treatment approach to hypertension in comorbid patients: calcium channel blockers

Yu.A. Karpov 

National Medical Research Center of Cardiology, Moscow


Blood pressure (BP) monitoring is the major tool to manage hypertension, one of the important and independent cardiovascular risk factors. According to current clinical guidelines, five classes of first-line antihypertensives (including calcium channel blockers/CCB) are recommended to control or maintain target BP. A rational combination of antihypertensives is much more effective in terms of BP lowering than increasing the dose of one drug. Meanwhile, monotherapy for hypertension is recommended in some patients (e.g., in patients with low-risk stage 1 hypertension and systolic BP < 150 mm Hg, high-risk patients with high-normal BP, frail or older patients). This paper reviews clinical studies on the efficacy and safety of CCB for hypertension. In most controlled studies demonstrating CCB efficacy in terms of prognosis, dihydropyridines (mainly amlodipine) were prescribed. The safety of CCB in comorbid patients is discussed.

Keywords: hypertension, comorbidity, amlodipine, calcium channel blockers, clinical g uidelines, dihydropyridines.

For citation: Karpov Yu.A. Personalized treatment approach to hypertension in comorbid patients: calcium channel blockers. RMJ. 2021;1:17–24.

Pages 25-28. Статины — длительность приема и снижение сердечно-сосудистого риска. Сергиенко И.В., Прус Ю.А.

Summary:

Statins: treatment duration and cardiovascular risk reduction 

I.V. Sergienko, Yu.A. Prus

National Medical Research Center of Cardiology, Moscow


Hyperlipidemia is one of the leading risk factors of cardiovascular diseases. According to European and Russian clinical guidelines, statins are the first-line therapies for hyperlipidemia. These agents have demonstrated their efficacy to reduce cardiovascular morbidity and mortality. Adequate lipid-lowering treatment inhibits the progression of atherosclerosis and, therefore, prevents cardiovascular disorders and disability and reduces the rate of re-hospitalizations for myocardial revascularization. However, treatment success largely depends on adherence. Atorvastatin is one of the most effective, well-studied, most prescribed, and most sold drugs of this class. This paper reviews clinical studies on the efficacy of atorvastatin. Many large-scale clinical trials (GREACE, TNT, MIRACL, AVERT etc.) have demonstrated the efficacy of original atorvastatin for the primary and secondary prevention of cardiovasc ular diseases. The use of atorvastatin in comorbid patients with diabetes, hypertension, chronic kidney disease, and stroke is addressed. The authors also discuss the studies on atorvastatin safety. Ample evidence suggests that original atorvastatin is safe and well tolerated at doses of 10–80 mg.

Keywords: statins, hyperlipidemia, cardiovascular diseases, cardiovascular risk.

For citation: Sergienko I.V., Prus Yu.A. Statins: treatment duration and cardiovascular risk reduction. RMJ. 2021;1:25–28.

Pages 29-33. Дигиталисная интоксикация: диагностика, лечебная тактика и профилактика. Дядык А.И., Куглер Т.Е., Здиховская И.И., Ракитская И.В.

Summary:

Digitalis intoxication: diagnosis, management strategy, and prevention

A.I. Dyadyk , T.E. Kugler, I.I. Zdikhovskaya, I.V. Rakitskaya


M. Gorkiy Donetsk National Medical University, Donetsk, DPR


Current guidelines recommend prescribing cardiac glycosides with caution. However, considering their pharmacological properties and narrow therapeutic index, the rate of incorrect use of cardiac glycosides in clinical practice is still high. Digitalis toxicity develops at various serum concentrations of digoxin (generally, at concentrations > 2.0 ng/ml). Preventive strategies for digitalis toxicity should be based on both serum digoxin concentrations and its risk factors. Optimal doses of cardiac glycosides should be selected based on patient’s age, comorbidities, renal functions, and drug interactions. A wide spectrum of cardiac and non-cardiac manifestations of digitalis toxicity significantly hampers its diagnosis. The most common symptoms are irregular heartbeat and conduction abnormalities, nausea, vomiting, weakness, dizziness, headache, psychic disorders, and vision loss. The management strategy for digitalis toxicity is based on the severity of clinical signs. Severe life-threatening arrhythmias are a reason to prescribe anti-digoxin antibodies (Fab-fragments), which are, unfortunately, not readily available in Russian clinical practice.

Keywords: cardiac glycosides, digoxin, adverse effects, digitalis toxicity, arrhythmia, Fab-fragments.

For citation: Dyadyk A.I., Kugler T.E., Zdikhovskaya I.I., Rakitskaya I.V. et al. Digitalis intoxication: diagnosis, management strategy, and prevention. RMJ. 2021;1:29–33.



Pages 34-42. МР-флебография в диагностике гемодинамических нарушений у пациентов с хроническими заболеваниями вен нижних конечностей. Шайдаков Е.В., Санников А.Б., Емельяненко В.М., Крюкова Л.Н., Баранова А.Е., Рачков М.А.

Summary:

MRI venography in the diagnosis of hemodynamic disorders in patients with chronic venous diseases of the lower extremities

E.V. Shaidakov1, A.B. Sannikov2,3, V.M. Emelianenko3, L.N. Kryuchkova2, A.E. Baranova2, M.A. Rachkov2

1N.P. Bechtereva Institute of the Human Brain of the Russian Academy of Sciences, Saint Petersburg

2Clinic of Innovative Diagnostics "Medica", Vladimir

3Pirogov Russian National Research Medical University, Moscow

The article presents the analysis concerning studies of venous circulation pathology in the inferior vena cava system using magnetic resonance imaging (MRI). Special attention is paid to the attempts to use this method in the diagnosis of chronic venous diseases (CVD) of the lower limbs with magnetic resonance venography (MRV). The gradual introduction of MRV methods in the diagnosis of deep vein thrombosis (DVT) of the lower limbs and venous thromboembolism (VTE) has been shown. Methods of non-contrast-enhanced MRV based on the effect of blood flow are divided into two groups: methods based on the amplitude of Time-of-Flight (TOF) and methods based on Phase Contrast (PC). The techniques of conducting non-contrast-enhanced MRV, which has again received intensive development in recent years, are described in detail. One of these methods was direct visualization of a blood clot using  fast pulse sequences: bSSFP, BBTI, DANTE. The latest studies on this method of diagnosing DVT of the lower limbs were published in 2019, and they showed the high diagnostic value of the method. Specificity and sensitivity are shown for all commonly used MRV methods. Conducting MRV in patients with CVD is a promising diagnostic task in phlebology.

Keywords: magnetic resonance imaging, magnetic resonance venography, computed tomography, CT venography, chronic venous diseases, deep vein thrombosis of the lower limbs, varicosity.

For citation: Shaidakov E.V., Sannikov A.B., Emelianenko V.M. et al. MRI venography in the diagnosis of hemodynamic disorders in patients with chronic venous diseases of the lower extremities. RMJ. 2021;1:34–42.



Pages 43-48. Методы снижения частоты контраст-индуцированного острого почечного повреждения после чрескожных коронарных вмешательств. Хильчук А.А., Абугов С.А., Щербак С.Г., Гладышев Д.В.

Summary:

Methods to reduce the rate of contrast-induced acute kidney injury after percutaneous coronary interventions

A.A. Khil’chuk1–3, S.A. Abugov2, S.G. Shcherbak3, D.V. Gladyshev1,3

1City Hospital No. 40, Saint Petersburg, Sestroretsk

2B.V. Petrovsky Russian Research Center of Surgery, Moscow

3Saint Petersburg State University, Saint Petersburg

Contrast-induced acute kidney injury (CI-AKI) is an iatrogenic injury of kidney parenchyma occurring after the administration of iodinated radiocontrast agent (RCA). The number of patients who receive high-technology cardiologic care increases annually, the consumption of RCA also increases. The result is a higher rate of CI-AKI after coronary angiography and percutaneous coronary interventions. CI-AKI increases the rate and number of cardiovascular complications, the length of in-hospital stay, and the need in renal replacement therapy and is also associated with a 5-fold increase in the hospital mortality rate. CI-AKI is more common in patients with chronic kidney disease. Preventive and treatment strategies for CI-AKI involve minimization of RCA via the reduction of its volume or the use of specific equipment (e.g., intravascular ultrasound or optical coherence tomography). Various additional  measures to reduce the risk of CI-AKI can be applied as well, i.e., radial approach, ischemic preconditioning, hemodynamic support in high-risk patients. The authors review the methods for CI-AKI prevention and analyze technical aspects to improve the quality of medical care in patients with high risk of CI-AKI after percutaneous coronary interventions.

Keywords: kidney injury, radiocontrast agents, prevention of kidney injury, percutaneous coronary intervention, coronary angiography.

For citation: Khil’chuk A.A., Abugov S.A., Shcherbak S.G., Gladyshev D.V. Methods to reduce the rate of contrast-induced acute kidney injury after percutaneous coronary interventions. RMJ. 2021;1:43–48.

Pages 5-9. Оценка гемодинамических параметров у больных, госпитализированных с декомпенсацией хронической сердечной недостаточности. Пырикова Н.В., Осипова И.В., Мозгунов Н.А.

Summary:

Hemodynamic parameters in patients admitted for decompensated chronic heart failure

N.V. Pyrikova1, I.V. Osipova1, N.A. Mozgunov2


1Altai State Medical University, Barnaul

2City Clinical Hospital No. 11, Barnaul

Aim: to assess hemodynamic parameters with respect to gender in patients with decompensated congestive heart failure (CHF).

Patients and Methods: this point-prevalence retrospective study included 297 case records of patients who were consistently admitted for decompensated CHF from July 2018 to July 2019.

Results: 92.3% of patients were diagnosed with hypertension, 58.6% with atrial fibrillation (AF), 33.7% with prior myocardial infarction, 31.6% with type 2 diabetes, 21.5% with angina pectoris, and 64.6% with kidney diseases (stage 3 or more advanced). More women than men (by 17.2%) were admitted, women were older than men by 5.3 years. 9.4% of patients were diagnosed with CHF class II, 70.4% with CHF class III, and 20.2% with CHF class IV. At admission, more than half of patients (52.8%) were diagnosed with hypertension stage I or more advanced (30.2% were diagnosed with hypertension stage III). In 81.6% patients with AF, heart rate was 110 rpm or more. Among patients with sinus rhythm, 29.3% have tachycardia. Left ventricular hypertrophy was diagnosed in 57.9%, preserved ejection fraction (EF) in 46.1%, mid-range EF in 33.3%, and reduced EF in 20.6%. At admission, optimal-to-high normal blood pressure (BP) was observed more commonly in men than in women (by 1 2.0%). Meanwhile, more women than men (by 11.5%) achieved target BP. At admission, more men with AF than women (by 14.5%) had tachycardia, while more women with AF than men (by 10.5%) had normal
heart rate.

Conclusions: our findings can be applied for planning of medical care for decompensated CHF to optimize the treatment for this condition.

Keywords: congestive heart failure, left ventricular ejection fraction, hemodynamics, blood pressure, atherosclerosis, atrial fibrillation.

For citation: Pyrikova N.V., Osipova I.V., Mozgunov N.A. Hemodynamic parameters in patients admitted for decompensated chronic heart failure. RMJ. 2021;1:5–9.



№13, 2020. Урология. Хирургия

Pages 10-12. Особенности лечения пациентов с мужским фактором бесплодия в условиях пандемии COVID-19. Кузьменко А.В., Кузьменко В.В., Гяургиев Т.А.

Summary:

Treatment characteristics of patients with male factor infertility in COVID-19

A.V. Kuzmenko, V.V. Kuzmenko, T.A. Gyaurgiev


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


Over the past 20 years, the male factor infertillity in marriage has increased from 30% to 50%. The causes of this condition can be various diseases and pathological processes, including those caused by viral infections, in particular SARS-CoV-2. The article discusses possible mechanisms of SARS-CoV-2 effect on the male reproductive system, including damage to testicular tissues due to the SARS-CoV-2 penetration into the cell by attaching the S protein to the angiotensin-converting enzyme-2, which may be present in testicular tissue cells. Besides, not only the virus itself, but also the therapy can negatively affect male reproductive function. The article justifies the use of antioxidants in the setting of a systemic inflammatory process accompanied by fever, which can increase oxidative stress and have a gonadotoxic effect. The study results confirming the efficacy of one of the most studied antioxidant complexes — AndroDoz® — are presented. It significantly improves the semen quality and can be recommended for male infertility due to oxidative stress.

Keywords: COVID-19, SARS-CoV-2, male infertility, blood-testis barrier, oxidative stress, antioxidants.

For citation: Kuzmenko A.V., Kuzmenko V.V., Gyaurgiev T.A. Treatment characteristics of patients with male factor infertility in COVID-19. RMJ. 2020;13:10–12.

Pages 14-18. Опыт лечения гиперактивного мочевого пузыря: клинические наблюдения. Салюков Р.В., Салюкова Ю.Р., Фролова М.В.

Summary:

Treatment experience of overactive bladder: clinical cases

R.V. Salyukov1,2, Yu.R. Salyukova3, M.V. Frolova4

1RUDN University, Moscow

2Rehabilitation Center for Disabled People «Preodolenie», Moscow

3Russian Scientific Center of Roentgenoradiology, Moscow

4Lomonosov Moscow State University, Moscow

Overactive bladder (OAB) is a common syndrome accompanied by a number of lower urinary tract symptoms. The first line of medical therapy for OAB is medicines belonging to the group of m-cholinolytics. Medicines of this group are not safe, as they can penetrate the blood-brain barrier and affect cognitive functions, which is especially important in light of the fact that OAB is more common in elderly patients. Fesoterodine is the only drug from m-cholinolytics group that is classified as class B according to the FORTA classification for safety and efficacy. The article presents descriptions of several clinical cases with OAB that differ in the etiology and course, comorbid background, gender and age of patients. In all cases it was possible to achieve a stable positive effect with fesoterodine. Fesoterodine can be used in patients with dysuric disorders after transurethral resection of the prostate, benign prostatic hyperplasia, in the inefficacy of another cholinolytic, and in idiopathic and neurogenic OAB. Autonomic dysreflexia may be a new promising indication for fesoterodine use, but this statement requires further research.

Keywords: fesoterodine, overactive bladder, benign prostatic hyperplasia, neurogenic lower urinary tract dysfunction, autonomic dysreflexia.

For citation: Salyukov R.V., Salyukova Yu.R., Frolova M.V. Treatment experience of overactive bladder: clinical cases. RMJ. 2020;13:14–18.




Pages 2-5. Персонализированная комплексная терапия больных с доброкачественной гиперплазией предстательной железы в сочетании с хроническим простатитом. Баранников И.И., Кузьменко А.В., Кузьменко В.В., Гяургиев Т.А.

Summary:

Individual complex therapy of patients with benign prostatic hyperplasia in combination with chronic prostatitis

I.I. Barannikov, A.V. Kuzmenko, V.V. Kuzmenko, T.A. Gyaurgiev

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

Aim: to evaluate the efficacy of complex treatment of patients with benign prostatic hyperplasia (BPH) in combination with chronic prostatitis (CP), taking into account individual patient chronobiological characteristics.

Patients and Methods: 60 patients with BPH and category II CP were examined. Patients were randomly divided into two groups of 30 people. In the comparison group (CG), patients received standard therapy (tamsulosin 0.4 mg once a day, levofloxacin 500 mg once a day) for 28 days. Patients of the main group (MG) received standard therapy in combination with physiatrics with SMART-PROST device in the chronorhythm acrophase. Micturition frequency, the number of night urinations, the average score on the I-PSS, QoL, NIH-CPSI scales, the maximum urinary flow rate, prostate volume and residual urine volume, and bacterioscopic and bacteriological examination of expressed prostatic secretions were evaluated. After the end of the therapy course, all patients underwent transurethral resection of the prostate and bacteriological examination of resected prostate tissue fragments. Complications incidence was evaluated over the next 6 months.

Results: statistically more significant positive trend (p<0.05) was registered for all indicators in the MG after 4 weeks. Bacteriological examination of expressed prostate secretions  revealed the following: bacteria were initially detected in all 60 (100%) patients, after 2 weeks — in 11 (36.7%) in the CG and in 10 (33.3%) in the MG, after 4 weeks — in no cases. In resected prostate fragments, the microorganism’s growth was detected in 5 (16.7%) patients in CG and in 1 (3.3%) in MG. During 6 months of follow-up, acute urinary retention was detected in 2 (6.7%) patients, leukocyturia — in 18 (60%), hematuria — in 5 (16.7%), bacteriuria — in 14 (46.7%), and in MG — in 1 (3,3%), 10 (33,3%), 2 (6,7%) and 7 (23.3%) patients, respectively.

Conclusion: complex therapy of patients with BPH and CP, taking into account their individual chronobiological characteristics, can improve the results of conservative and surgical treatment.

Keywords: chronic bacterial prostatitis, benign prostatic hyperplasia, transurethral resection of the prostate, chronotherapy, acrophase, chronorhythm, physiotherapy, SMART-PROST device.

For citation: Barannikov I.I., Kuzmenko A.V., Kuzmenko V.V., Gyaurgiev T.A. Individual complex therapy of patients with benign prostatic hyperplasia in combination with chronic prostatitis. RMJ. 2020;13:2–5.

Pages 20-22. Клинические эффекты и механизм действия препаратов в урологии: все ли мы знаем? (Пост-релиз).

Summary:

Clinical effects and mechanism of action concerning drugs in urology: do we know everything? (post-release)

On November 28, 2020, in Moscow, a breakout session was held on lower urinary tract symptoms, chronic prostatitis, and chronic pelvic pain syndrome in men within the framework of the XX Congress of the Russian Society of Urology. Among the speakers was Professor L.G. Spivak, who presented a report on the topic: “Clinical effects and mechanism of action concerning drugs in urology: do we know everything?»

One of the questions was devoted to the treatment methods of patients with dysuria and the possibilities of symptomatic therapy. The cytomedins role in the functioning of various organs and tissues was considered in relation to the problem of benign prostatic hyperplasia and chronic prostatitis. The place of organotherapy drugs in the treatment of these pathological conditions was determined.

Keywords: dysuria, chronic prostatitis, benign prostatic hyperplasia, neurohumoral regulation, cytokines, peptides.

For citation: Clinical effects and mechanism of action concerning drugs in urology: do we know everything? (post-release). RMJ. 2020;13:20–22.



Pages 24-27. Анализ эффективности вариантов локального использования гомеопатического препарата при дорсопатиях. Агасаров Л.Г.

Summary:

Analysis of the options effectiveness for topical use of homeopathic preparation in dorsopathies

L.G. Agasarov

Sechenov University, Moscow

Professional Reflexology Association, Moscow

National Medical Research Center of Rehabilitation and Balneology, Moscow

Aim: to evaluate the effectiveness of two options for the original administration of Zeel® T in dorsopathies.

Patients and Methods: 90 patients with acute lumbosacral dorsopathy underwent the follow-up. The examination program included neurological, psychological and electrophysiological (thermo- and rheography) analysis. Patients were divided into 3 groups, in which Zeel® T was prescribed along with conventional therapy. In the comparison group, the drug was administered intramuscularly, while in the two main groups — topically by pharmacopuncture (injections in the area of acupuncture points) or phonophoresis, respectively.

Results: the study noted the therapeutic validity of topical drug administration, including a distinct analgesic effect. Differences within the main groups concerned thermographic characteristics, with the predominance of pharmacopuncture in distal hypothermia reduction. Changes in rheogram indices were comparable. According to the catamnesis, the incidence of dorsopathy exacerbations did not exceed 27% outside of reliable intergroup differences. However, only in the main groups the increase in neurological symptoms was minor.

Conclusion: the established effectiveness of pharmacopuncture and phonophoresis can be explained by the combination of reflex and drug effects provided by these methods. At the same time, the known differences in the achieved effects, as well as the execution peculiarities, determine the choice of a specific method. Based on the above, we can recommend the use of different administration methods of Zeel® T depending on the existing conditions and therapy goals.

Keywords: dorsopathies, complex drugs, pharmacopuncture, phonophoresis, thermography, rheovasography.

For citation: Agasarov L.G. Analysis of the options effectiveness for topical use of homeopathic preparation in dorsopathies. RMJ. 2020;13:24–27.



Pages 28-32. Комплексное лечение постиммобилизационной тугоподвижности голеностопного сустава. Ершов В.Е., Кривова А.В., Захаров В.П.

Summary:

Complex treatment of ankle stiffness after immobilization

V.E. Ershov, A.V. Krivova, V.P. Zakharov

Tver State Medical University, Tver

Aim: to study the effect of bionic cross-linked hyaluronic acid on the rehabilitation of patients with ankle fractures and clinical manifestations of ankle stiffness after immobilization.

Patients and Methods: the study included 52 patients (mean age 43.9±13.1 years) with ankle fractures of varying degrees after immobilization, who did not undergo surgery. The average immobilization period of the ankle joint was 32.9±5.9 days. The follow-up was carried out for 21 days after the external fixation of the ankle fracture. Main group (n=23) received Flexotron® CROSS single dose into the ankle joint on the 1st day after immobilization. Control group (n=29) underwent a conventional rehabilitation course without intra-articular administration of hyaluronic acid derivatives.

Results: in the main group, the achievement of the optimal range of motions in the ankle joint (80% of the healthy joint motion range) was observed on average 5.9 days earlier than in the control group (p<0.05), which allowed patients to weight-bear on an injured body part. Improvement in segment function was accompanied by the pain reduction. VAS indicators on the 3rd day of follow-up in the main group were on average 1.9 points lower than in the control group (p<0.05). The achieved analgesic effect and the range of motions in the ankle joint in the main group were persisted throughout the entire follow-up period. No analgesics were taken by the main group, while in the control group, 7 (24%) patients took painkillers "on demand".

Conclusion: the follow-up results indicated a high efficiency of using the bionic cross-linked hyaluronic acid preparation in the complex treatment of contractures after immobilization.

Keywords: ankle fracture, hyaluronic acid, joint contracture, stiffness after immobilization.

For citation: Ershov V.E., Krivova A.V., Zakharov V.P. Complex treatment of ankle stiffness after immobilization. RMJ. 2020;13:28–32.



Pages 33-44. Возможности МРТ-исследований в визуализации сосудистого русла нижних конечностей. Шайдаков Е.В., Санников А.Б., Емельяненко В.М., Крюкова Л.Н., Баранова А.Е., Рачков М.А.

Summary:

Possibilities of MRI studies in visualization of the vascular bed of the lower extremities

E.V. Shaidakov1, A.B. Sannikov2,3, V.M. Emeliyanenko3, L.N. Kryukova2, A.E. Baranova2, M.A. Rachkov2

1N.P. Bekhtereva Institute of the Human Brain of the Russian Academy of Sciences, Saint-Petersburg

2Clinic of Innovative Diagnostics "Medica", Vladimir

3Pirogov Russian National Research Medical University, Moscow

This literature review analyzes the research data on the methodology of magnetic resonance imaging (MRI) in relation to the vascular system and the choice of optimal scan modes. Given that this material is designed primarily for vascular surgeons and phlebologists, the authors briefly describe the essence of the physical phenomena underlying the receipt of MRI images, without which it is not possible to conduct a careful analysis of the benefits and drawbacks of MR-аngiography (MRA) and the search for the optimal scan mode for MR-venography.

When describing the non-contrast and contrast MRA methods, attention is paid to the conservative methods of image processing in 2D mode using pulse sequences: spin-echo, multi-echo, turbo spin-echo, Fast Advanced Spin Echo (FASE), Gradient Echo and Inversion Recovery. Besides, emphasis is placed on the most modern solutions, including: multiplantar reformatting, maximum intensity projection, subvolume maximum intensity, surface rendering, volume rendering and virtual intraluminal endoscopy. In relation to all current methods of conducting MRA, specificity and informativeness are shown with a detailed analysis of benefits and drawbacks. The nuances of understanding the obtained angiographic image in T1 and T2 weighted images and the phenomena of "bright blood" and "dark blood" are shown.

Given that in the Russian literature there is almost no data concerning the MRI possibilities in the diagnosis of hemodynamic disorders in patients with vascular pathology, it seems that this material is relevant and will cause some interest from various specialists.

Of particular interest is the potential use of non-contrast and contrast MRA methods in the study of venous pathology of the lower extremities and pelvis, especially with regard to timely and accurate diagnosis of deep venous thrombosis and venous thromboembolism, which occupy a special position in the structure of patients with chronic venous disorders of the lower extremities.

Keywords: magnetic resonance imaging, magnetic resonance angiography, magnetic resonance venography, computed tomography, computed tomography venography, chronic venous diseases, diagnostics, deep vein thrombosis of the lower extremities, varicosity.

For citation: Shaidakov E.V., Sannikov A.B., Emeliyanenko V.M. et al. Possibilities of MRI studies in visualization of the vascular bed of the lower extremities. RMJ. 2020;13:33–44.

Pages 45-47. Хирургическое лечение пациентки с гигантской нейрофибромой промежности. Быстров С.А., Шестаков Е.В., Безбородов А.И., Лисин О.Е., Арустамян А.В., Семеная Е.В., Полетаева С.В., Каторкин С.Е.

Summary:

Surgical treatment of a patient with giant perineal neurofibroma

S.A. Bystrov, E.V. Shestakov, A.I. Bezborodov, O.E. Lisin, A.V. Arustamyan, E.V. Semenaya, S.V. Poletaeva, S.E. Katorkin

Samara State Medical University, Samara

The article describes the successful surgical treatment of a patient with neurofibromatosis type I and giant perineal neurofibroma, which hinder movements and interfere with hygiene procedures. The 60x30 cm tumor spread to the right gluteal and perianal areas, the right labia majora area, and the posterior surface of the right thigh, significantly deteriorating the patient’s life quality. The choice of surgical treatment tactics was determined by the huge tumor size. Intraoperatively, special attention was paid to perianal and perineal areas, where local flaps grafting was used to hide the defect. When removing abnormal tissues, it was necessary to avoid damage to the sphincter muscle fibers and thereby prevent the development of fecal incontinence. Blood components (fresh frozen plasma, red blood cell suspension) were transfused intraoperatively. Blood loss was 300 ml. In the early postoperative period (2 months  after the operation), a satisfactory condition of post-operative scars and a significant improvement in the life quality were noted. Healing by primary intention. Anal sphincter function is not impaired. The patient performs hygiene procedures without any difficulties.

Keywords: von Recklinghausen’s disease, peripheral neurofibromatosis, phacomatosis, myxoid neurofibroma, surgical treatment.

For citation: Bystrov S.A., Shestakov E.V., Bezborodov A.I. et al. Surgical treatment of a patient with giant perineal neurofibroma. RMJ. 2020;13:45–47.

Pages 6-9. Диагностика и лечение пациентов с инфертильностью, развившейся на фоне хронического простатита. Шевырин А.А.

Summary:

Diagnosis and treatment of patients with infertility that developed in the setting of chronic prostatitis

A.A. Shevyrin

Ivanovo State Medical Academy, Ivanovo

Background: male infertility is a clinical manifestation of many different pathological conditions. It is known that physical and chemical changes in the prostate gland that occur during inflammation lead to changes in the semen quality.

Aim: to evaluate the semen quality, the microbiology of sperm and prostatic secretions in patients with infertility and chronic prostatitis, as well as to compare the efficacy of various treatment regimens for this pathology.

Patients and Methods: the study included 50 men of fertility age from 18 to 36 years, suffering from infertility and having various manifestations of pathospermia that occurred in the setting of chronic prostatitis. In group I (n=25), patients received Actifert-Andro dietary supplement in addition to standard treatment for chronic prostatitis according to the standard regimen, in group II (n=25) — only standard drug therapy. The examination was perfor med using general, clinical, laboratory and ultrasound methods in accordance with generally accepted standards.

Results: after three months of treatment in group I, general indices of the semen condition (viscosity, colliquation time, color, admixtures), as well as its morphology and viability were normal almost in all patients. In 6 cases, there was unexpressed sperm agglutination and mild asthenozoospermia, there was no aggregation and MAR-test was negative. In group II, the presence of mucus in the ejaculate, a change in ejaculate pH, an increase in the semen viscosity and in its colliquation time were determined after the therapy course. Adding that, asthenozoospermia was more significant, in some cases — oligo-asthenoteratozoospermia, there were also cases of agglutination and semen aggregation, the MAR-test was weakly positive.

Conclusion: Actifert-Andro addition to the complex therapy of male infertility, developed in the setting of chronic prostatitis, can influe nce different spermatogenesis disorder links, which is especially important given polygenic nature of this disease.

Keywords: male infertility, chronic prostatitis, pathospermia, complex therapy, semen analysis, prostatic fluid.

For citation: Shevyrin A.A. Diagnosis and treatment of patients with infertility that developed in the setting of chronic prostatitis. RMJ. 2020;13:6–9.





№12, 2020. Клинические рекомендации и алгоритмы для практикующих врачей

Pages 14-16. Сложности дифференциальной диагностики сахарного диабета 2 типа в клинической практике. Ушанова Ф.О., Измайлова М.Я., Плахотняя В.М.

Summary:

Challenges in the differential diagnosis of type 2 diabetes in clinical practice

F.O. Ushanova, M.Ya. Izmailova, V.M. Plakhotnyaya

Pirogov Russian National Research Medical University, Moscow

This article addresses the differential diagnostic aspects of type 2 diabetes (T2D) in a younger patient. Diabetes is a group of metabolic conditions with a common feature, chronic hyperglycemia. T2D is a complex multietiological heterogeneous disease requiring personalized treatment approach. Meanwhile, the clinical portrait of a T2D patient has long ago gone beyond the conventional views of type 2 diabetes. Gradual and slow progression of clinical manifestations in younger patients requires differential diagnosis between type 1 diabetes (T1D), T2D, maturity-onset diabetes of the young (MODY), and latent autoimmune diabetes mellitus in adults (LADA). In these cases, the diagnosis should not rely on patient’s age and phenotypic features only. Patients with atypical manifestations of diabetes require modern diagnostic tests (i.e., immunochemistry and molecular genetic testing) which, h owever, are not always available in routine clinical practice. Nevertheless, glucose-lowering therapy should be promptly prescribed irrespective of the etiology of hyperglycemia since it is well-known that early adequate glycemic control reduces the risk of micro- and macrovascular complications.

Keywords: type 2 diabetes, type 1 diabetes, diagnosis, metformin, safety, efficacy.

For citation: Ushanova F.O., Izmailova M.Ya., Plakhotnyaya V.M. Challenges in the differential diagnosis of type 2 diabetes in clinical practice. RMJ. 2020;12:14–16.



Pages 17-22. Нарушения кишечного микробиоценоза: актуальные аспекты терминологии, клиники, профилактики. Голошубина В.В., Трухан Д.И., Багишева Н.В.

Summary:

Intestinal microbiocenosis disorder: current aspects of terminology, clinical picture and prevention

V.V. Goloshubina, D.I. Trukhan, N.V. Bagisheva

Omsk State Medical University, Omsk

Bacterial flora in the gastrointestinal tract (GI) has a topical and systemic effect not only on the digestive organs but also on the entire body. Numerous studies have proved the pathogenetic association of the intestinal biocenosis state not only with GI diseases but also with pathological processes of other body organs and systems. At the same time, quantitative and qualitative changes in the normal intestinal microflora commonly occur as a result of various adverse events in humans and the development of various pathological conditions. In this review, the current aspects of terminology and clinical picture of intestinal microbiocenosis disorders are considered. Probiotics, prebiotics and synbiotics occupy an important place in the combination therapy of intestinal microbiocenosis disorders and clinical manifestations, associated with them. The review examines the main mechanisms of probiotic-host interaction, probiotics possibl e effects, and the requirements for them. Probiotics, prebiotics and synbiotics are used as the first-line treatment in the prevention of intestinal microbiocenosis disorders and associated possible metabolic shifts.

Keywords: intestinal microbiocenosis, dysbiosis, dysbacteriosis, clinical picture, prevention, probiotic, prebiotic, synbiotic, Bifidobacterium lactis, inulin, cholecalciferol.

For citation: Goloshubina V.V., Trukhan D.I., Bagisheva N.V. Intestinal microbiocenosis disorder: current aspects of terminology, clinical picture and prevention. RMJ. 2020;12:17–22.

Pages 24-29. Роль пищевых волокон в коррекции нарушений микробиоты и поддержании иммунитета. Ардатская М.Д.

Summary:

Role of dietary fiber in correcting microbiota disorders and maintaining immunity

M.D. Ardatskaya

Central State Medical Academy of the Administrative Department of the President of the Russian Federation, Moscow

The article discusses the association between the microbiota and the functioning of individual organs, systems and the entire macroorganism. This interaction is realized at the level of low-molecular-weight metabolites of the intestinal microbiota that can activate, inhibit, modify the processes, functions, and reactions of various organs and systems of the human body. Violation of their qualitative or quantitative ratio is the occurrence and progression factor of many gastrointestinal, metabolic, cardiovascular, hematological, neuropsychiatric, autoimmune and other diseases. The presented volume of reliable clinical data indicates that the prebiotics use, in particular dietary fiber (DF), for the correction of intestinal microbiota disorders is a promising method in the treatment and prevention of various diseases. In turn, partially hydrolyzed guar (cyam opsis) DF (registered in the Russian Federation under the trade name OptiFiber) due to their effects (such as regulating the intestine, reducing abdominal pain, reducing flatus and bloating, increasing the resident intestinal microflora amount and its metabolic activity) helps restore and maintain intestinal eubiosis, normalize the consistency and frequency of stool, relieve symptoms of irritable bowel syndrome, and increase immunity to influenza. At the same time, OptiFiber does not have significant side effects and can be administered for a long-term period in order to supplement the nutrition with the necessary amount of DF.

Keywords: microbiota, short-chain fatty acids (SCFAs), intestinal microbiocenosis, dietary fiber, cyamopsis, immunity, influenza.

For citation: Ardatskaya M.D. Role of dietary fiber in correcting microbiota disorders and maintaining immunity. RMJ. 2020;12:24–29.

Pages 30-34. Выбор НПВП для лечения острой и хронической боли у пациентов с ревматоидным артритом на амбулаторно-поликлиническом этапе. Василюк В.Б., Фарапонова М.В., Сыраева Г.И.

Summary:

Selection of NSAIDs for the treatment of acute and chronic pain in patients with rheumatoid arthritis at the outpatient stage

V.B. Vasilyuk1,2, M.V. Faraponova1, G.I. Syraeva1,3

1Research Center EcoSafety LLC, Saint-Petersburg

2North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg

3Pavlov First Saint-Petersburg State Medical University, Saint-Petersburg

Background: one of the most common manifestations of rheumatoid arthritis (RA) is pain syndrome, which significantly worsens the life quality of patients. The standard of medical care for RA involves the oral administration of nonsteroidal anti-inflammatory drugs (NSAIDs).

Aim: comparative evaluation of analgesic effect AMBENIUM® parenteral (study drug, SD) and diclofenac sodium (reference drug, RD) in patients with acute low back pain.

Patients and Methods: an open-label comparative randomized study on the efficacy and safety of AMBENIUM® parenteral versus diclofenac sodium in relieving acute low back pain included 164 patients aged 18 to 72 years with pain intensity of more than 80 points on the visual analog scale (VAS).

Results: therapy with AMBENIUM® parenteral SD was no less effective than therapy with diclofenac sodium for relieving acute low back pain. In the group of patients who received the SD, the pain intensity index on the VAS scale 2 hours after drug administration was statistically significantly low (p=0.003) than in the group receiving RD, while the analgesic effect during SD administration occurred statistically significantly earlier (p=0.013). When evaluating the pain dynamics using the McGill Pain Questionnaire, the efficacy of AMBENIUM® parenteral has been shown starting from the 4th hour after administration, which indicated that SD was no less effective than RD in terms of pain dynamics (p<0.05).

Conclusion: based on the study results, AMBENIUM® parenteral was found to be sufficiently effective in patients with acute low back pain. The SD profile, as well as its risk-benefit ratio, were characterized as «favorable» versus other oral NSAIDs, in particular, with diclofenac sodium.

Keywords: rheumatoid arthritis, pain syndrome, low back pain, nonsteroidal anti-inflammatory drugs, parenteral, AMINIUM® parenteral.

For citation: Vasilyuk V.B., Faraponova M.V., Syraeva G.I. Selection of NSAIDs for the treatment of acute and chronic pain in patients with rheumatoid arthritis at the outpatient stage. RMJ. 2020;12:30–34.

Pages 36-48. Лекарственно-индуцированный дефицит электролитов. Часть 2. Лекарственно-индуцированная гипомагниемия. Остроумова О.Д., Кочетков А.И., Клепикова М.В.

Summary:

Drug-induced electrolyte disorder. Part 2. Drug-induced hypomagnesemia

O.D. Ostroumova1,2, A.I. Kochetkov1, M.V. Klepikova1

1Russian Medical Academy of Continuous Professional Education, Moscow

2Sechenov University, Moscow

Drug-induced hypomagnesemia is caused by a wide range of medications, including those widely used in clinical practice (diuretics, proton pump inhibitors, insulin preparations, aminoglycosides, antineoplastic drugs, drugs used in cardiology (digoxin) and pulmonology (beta-agonists, theophylline, glucocorticosteroids). The prevalence of drug-induced hypomagnesemia is not generally known, but can reach 90% among certain classes of medications. A special feature of magnesium is its small percent in the blood serum composition (only 0.3% of the total amount in the human body), while the largest percent is found in the intracellular compartment. This commonly makes it difficult for early diagnosis of hypomagnesemia, which increases the risk of dangerous clinical signs concerning magnesium deficiency occurrence. Diagnosis of this condition is based on the detection of low magnesium levels in the blood. Methods have also been developed for determining the intracellular and interstitial magnesium content in red blood cells, white blood cells, platelets, macrophages, muscle tissue, hair, nails, and teeth. Due to the frequent combination of hypomagnesemia (including drug-induced) with potassium deficiency, the rational treatment tactics for such patients is to simultaneously fill the lack of these cations. High efficiency and safety profile in hypomagnesemia treatment was  proved by the use of combined preparation of potassium and magnesium asparaginate, which allows for combined correction of electrolyte disorders in magnesium deficiency, and, according to the viewpoint of Russian experts, it is also the first-line drug in this clinical picture.

Keywords: hypomagnesemia, drug-induced hypomagnesemia, hypokalemia, adverse events, potassium and magnesium asparaginate.

For citation: Ostroumova O.D., Kochetkov A.I., Klepikova M.V. Drug-induced electrolyte disorder. Part 2. Drug-induced hypomagnesemia. RMJ. 2020;12:–48.

Pages 4-8. Клиническая и патофизиологическая роль липопротеина (а) в развитии атеросклероз-ассоциированных заболеваний. Цыганкова О.В., Бондарева К.И., Латынцева Л.Д., Старичкова А.А.

Summary:

Clinical and pathophysiological role of lipoprotein (a) in the development of diseases associated with atherosclerosis

O.V. Tsygankova1,2, K.I. Bondareva2, L.D. Latyntseva2, A.A. Starichkova3


1Novosibirsk State Medical University, Novosibirsk

2Institute of Internal and Preventive Medicine, the branch of the Federal Research Center "Institute of Cytology and Genetics of the Siberian Department of the Russian Academy of Sciences", Novosibirsk

3Federal Research Center of Fundamental and Translational Medicine, Novosibirsk

The article analyzes the literature data and clinical recommendations reflecting the role of lipoprotein (a) (Lp(a)) as a pro-atherogenic factor. The article shows the prevalence of a marked increase in this indicator. It also highlights the level of cardiovascular risk in such patients, which is comparable to that in hereditary heterozygous familial hypercholesterolemia. A review of available and developed medicines affecting Lp(a) was conducted. Along with this, we present our own clinical case of a female patient with a Lp(a) level of 440.25 nmol/l (with reference values up to 50 nmol/l) who experienced a transient ischemic attack at the age of 45 years in the setting of previously underdiagnosed arterial hypertension. Subsequently, the patient had preventable arterial hypertension, took combined antihypertensive therapy and rosuvastatin 10–20  mg/day on a regular basis with the target values achievement of low-density lipoprotein cholesterol. Despite this, at the age of 54, she experienced the onset of angina pectoris, and at the age of 56, magnetic resonance imaging of the brain in connection with cervicalgia revealed signs of an ischemic stroke of unknown duration in the right hemisphere. It shows the adverse contribution of Lp(a) high level to the pathogenesis of diseases associated with atherosclerosis.

Keywords: lipoprotein (a), dyslipidemia, diseases associated with atherosclerosis, high cardiovascular risk.

For citation: Tsygankova O.V., Bondareva K.I., Latyntseva L.D., Starichkova A.A. Clinical and pathophysiological role of lipoprotein (a) in the development of diseases associated with atherosclerosis. RMJ. 2020;12:4–8.

Pages 50-55. Исследование токсических и аллергенных свойств мелиттина, полученного из отечественного пчелиного яда. Федоскова Т.Г., Мартынов А.И., Пампура А.Н., Миславский О.В., Шабанов Д.В., Маштакова С.Р., Головкина Е.Д.

Summary:

Study of the toxic and allergenic properties of melittin obtained from honey bee venom

T.G. Fedoskova1, A.I. Martynov1, A.N. Pampura2, O.V. Mislavsky1, D.V. Shabanov1, S.R. Mashtakova1, E.D. Golovkina1

1State Research Center "Institute of Immunology" of the Federal Medical and Biological Agency, Moscow

2Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University, Moscow

Aim: to study the toxic and allergenic activity of melittin, the main component of bee venom, which makes up 35–50% of the venom total dry weight, using various diagnostic methods.

Patients and Methods: we used melittin from the bee venom of the company Sigma (USA) and melittin obtained from domestic raw bee venom (RBV). The toxic and allergenic activity of the studied peptide was studied on the model of various laboratory animals with different degrees of sensitivity. Specific IgE level was studied by the method of enzyme Immunoassay. The method of active cutaneous anaphylaxis was applied in order to study the melittin sensitizing properties.

Results: it was shown that the toxic effect of domestic melittin from RBV was not inferior to the foreign melittin. Laboratory animal model most sensitive to the melittin  toxic properties was found. The coincidence of the dose-dependent effect for acute toxicity was noted. The allergenic properties of the studied peptide were studied when administrating the least toxic doses of melittin (0.1 LD50).

Conclusion: the presence of pronounced toxic properties and weak allergenic properties of melittin indicate that it is not advisable to use melittin as part of antihistamines.

Keywords: insect sting allergy, honey bee, Apis mellifera, bee venom, melittin, toxic properties, allergenic properties.

For citation: Fedoskova T.G., Martynov A.I., Pampura A.N. et al. Study of the toxic and allergenic properties of melittin obtained from honey bee venom. RMJ. 2020;12:50–55.

Pages 56-60. Современные лечебно-диагностические инструменты оценки назальной функции и нарушений обоняния у пациентов с аллергическим ринитом. Алгоритм комплексной терапии. Чурюкина Э.В., Уханова О.П.

Summary:

Modern medical and diagnostic tools for assessing nasal function and olfactory disorders in patients with allergic rhinitis. Complex therapy algorithm

E.V. Churyukina1, O.P. Ukhanova2,3

1Rostov State Medical University, Rostov-on-Don

2Stavropol State Medical University, Stavropol

3Stavropol Regional Clinical Hospital, Stavropol

Additional diagnostic tests have become important not only in otorhinolaryngology, neurology, psychiatry, but also in allergology. This article is devoted to the evaluation of olfactory function in patients with nasal obstruction and severe allergic rhinitis. A comprehensive application of three available tools for assessing olfactory dysfunction and nasal congestion in patients was described for the first time in the routine practice of an allergist-immunologist before and after therapy of allergic rhinitis. These tools include: portable PNIF (Peak Nasal Inspiratory Flow measurement) meter, UPSIT (University of Pennsylvania Smell Identification Test — «Qualitative smell evaluation analysis» test), combined decongestant with second generation antihistamine (Frinosol). Accurate evaluation of olfactory functi on disorders among our patients is very important before and after conservative, disease modifying and surgical treatment methods. Combined use of the PNIF, UPSIT and Frinosol results, in addition to detecting quantitative evaluation concerning olfactory disorders, demonstrates the impact of nasal obstruction assessment procedures on clinical results, as well as the objective achievement in nasal respiratory function improvement during therapy.

Keywords: allergic rhinitis, nasal obstruction, anosmia, olfactory assessment, UPSIT, Peak Nasal Inspiratory Flow.

For citation: Churyukina E.V., Ukhanova O.P. Modern medical and diagnostic tools for assessing nasal function and olfactory disorders in patients with allergic rhinitis. Complex therapy algorithm. RMJ. 2020;12:56–60.

Pages 61-64. Корь у взрослых в период эпидемического неблагополучия. Ретроспективное исследование. Харченко Г.А., Кимирилова О.Г.

Summary:

Measles in adults during epidemic ill-being: retrospective study

G.A. Kharchenko, O.G. Kimirilova

Astrakhan State Medical University, Astrakhan

Background: тeasles is an anthroponous airborne infection with a high susceptibility in all age groups of the population. For 6 months of 2019, 3251 cases of measles were registered in 64 regions of Russia, which indicated a tense epidemic situation of measles.

Aim: to establish the clinical and epidemiological patterns of measles in adults in Astrakhan region (AR) during epidemic ill-being.

Patients and Methods: epidemiological data, main symptoms and incidence depending on the period and severity of the disease were analyzed in a retrospective study (this study included 382 patients with measles (aged 18 to 60 years) for the period from January 2013 to July 2019).

Results: it was found that 64 of 382 patients (17%) were not vaccinated against measles, 85 of 382 (22%) had no vaccination history, and 8 of 382 (2%) refused vaccination. Measles in adults of all age groups (vaccinated and unvaccinated) occurred typically with a predominance of moderate degree in 85% of patients. Koplik’s spots were detected in 32%, stage manifestation of maculopapular rash — in 100%, and pigmentation — in 81% of patients. Mild course of measles was observed in 208 (54%) patients. The causes of moderate course were bronchitis (in 64 patients (16%)) and pneumonia (in 12 patients (3%)). Exacerbation of concomitant somatic diseases was recorded in 98 (25%) patients. Preliminary diagnoses in 236 patients during the subclinical period of measles were the following: acute respiratory viral infection (ARVI) — in 78 (33%), measles — in 158 (67%); during the rash period (146 patients) — measles in 124 (85%), rubella — in 5 (3.4%), ARVI, toxic and allergic reaction — in 15 (10.3%), infectious mononucleosis — in 2 (1.3%) patients.

Conclusions: the populat ion with measles aged 18 to 29 years dominates in AR. The share of seronegative individuals in the indicator groups of AR population in 2013–2018 was from 15.7% to 23.8%. Registration of measles in adults (vaccinated and revaccinated) might be associated with a decrease in post-vaccination immunity. All this indicates the need for additional revaccination against measles.

Keywords: measles, adults, epidemiology, incidence, clinical picture, vaccination.

For citation: Kharchenko G.A., Kimirilova O.G. Measles in adults during epidemic ill-being: retrospective study. RMJ. 2020;12:61–64.

Pages 66-70. Эволюция острых респираторных вирусных инфекций сочетанной этиологии у детей. Николаева С.В., Хлыповка Ю.Н., Музыка А.Д., Усенко Д.В., Шабалина С.В., Медкова А.Ю., Горелов А.В., Понежева Ж.Б.

Summary:

Evolution of acute respiratory viral coinfections in children

S.V. Nikolaeva1, Yu.N. Khlypovka1,2, A.D. Muzyka1, D.V. Usenko1, S.V. Shabalina1, A.Yu. Medkova2, A.V. Gorelov1,3, Zh.B. Ponezheva1

1Central Research Institute of Epidemiology of the Russian Federal Service for Supervision 

 of Consumer Rights Protection and Human Well-Being, Moscow

2Central Clinical Hospital and Polyclinic, Moscow

3I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow

Aim: to analyze the changes in the etiology and clinical presentations of coexisted acute respiratory viral infections (ARVIs) in children over a 17-year period.

Patients and Methods: the comparative retrospective analysis of the etiology, population, and clinical presentations of ARVIs in children admitted to Moscow hospitals in 2002–2003 (group 1, n=130) and 2018–2019 (group 2, n=133) was performed. At admission, ARVI etiology was identified by polymerase chain reaction (oral or nasal smears and/or discharge, sputum) and enzyme immunoassay (antibodies to herpesvirus type 1, 2, and 6, cytomegalovirus, Epstein–Barr virus, Chlamydia, and Mycoplasma).

Results: children younger than 6 years predominated in both groups (84.7% and 88%, respectively, p>0.05). No gender differences were reported. In 2018–2019, the children were infected more evenly across the year, without clear seasonality. The increase in the percentage of the identified etiology of ARVIs (from 61.3% in 2002–2003 to 76.3% in 2018–2019) and the portion of ARVI coinfections (from 12.1% in 2002–2003 to 17.3% in 2018–2019) in children admitted to hospitals was revealed. Meanwhile, the percentage of children younger than 1 year reduced but the percentage of children aged 3–6 years visiting preschool facilities increased. Over the last years, the etiology of ARVI coinfections has changed from respiratory syncytial virus (53% of ARVI coinfections in 2002–2003) to rhinovirus (34.8% of ARVI coinfections in 2018–2019). The clinical presentations of ARVIs were characterized by acute onset, high temperature, and catarrhal syndrome. Temperature reaction tended to be more severe but of less duration in 2018–2019. The percentage of pneumonias reduced in 2018–2019 compared to 2002–2003. The result was less often prescription of antibacterial therapy in all groups of children. Additionally, reduced severity and duration of abnormal breath sounds revealed by auscultation was seen in 2018–2019.

Conclusions: our findings allow for a rational planning of preventive and/or therapeutic measures considering age-related characteristics of children, season, and the clinical features of ARVI coinfections.

Keywords: children, viral infections, ARVI, coinfections, prevention.

For citation: Nikolaeva S.V., Khlypovka Yu.N., Muzyka A.D. et al. Evolution of acute respiratory viral coinfections in children. RMJ. 2020;12:66–70.



Pages 72-76. Микробиом влагалищного биотопа: от нормы до патологии. Летяева О.И.

Summary:

Microbiome of the vaginal biotope: from norm to pathology

O.I. Letyaieva

South Ural State Medical University, Chelyabinsk

The literature review presents data on the modern view concerning the state of colonization resistance of the female reproductive system, etiology, sexually transmitted infections pathogenesis, and urogenital infections. The review also considers the role of Lactobacillus flora as the main protection factor of the genital tract from pathogens invasion. Potential risks of pathological processes development in the case of functional inferiority of lactobacilli were indicated. The role of microbial associations was discussed from the perspective of modern microbiology. Data on the significance of microbial associations of Chlamydia trachomatis spp. with anaerobic microorganisms in the initiation of inflammatory and neoplastic processes were presented. The issues of co-infections amongst genital mycoplasmas and Trichomonas vaginalis were considered. Modern views about biofilms formed by Gardnerella vaginalis were also reflected. New data on fungi participation of the Candida genus in maintaining the pathological process in the female reproductive system, especially the interaction of fungi with the vaginal epithelium were shown. The review also highlights the issues of immunological protection during infection with obligate and opportunistic microorganisms. According to current research data and current clinical recommendations, the possibility of combined drug (metronidazole and miconazole) rational use for topical treatment of mixed infections in women was shown.

Keywords: genital tract, microbial associations, Chlamydia trachomatis, Trichomonas vaginalis, urogenital infections, Gardnerella vaginalis, Candida, biofilm, miconazole, metronidazole.

For citation: Letyaieva O.I. Microbiome of the vaginal biotope: from norm to pathology. RMJ. 2020;12:72–76.

Pages 77-79. Роль микроРНК при злокачественных новообразованиях органов брюшной полости с явлениями перитонеального канцероматоза. Ганцев К.Ш., Кзыргалин Ш.Р., Ишмуратова К.Р.

Summary:

The role of miRNA in abdominal cancer with peritoneal carcinomatosis

K.Sh. Gantsev, Sh.R. Kzyrgalin, K.R. Ishmuratova

Bashkir State Medical University, Ufa

Late diagnosis of peritoneal carcinomatosis in abdominal cancer verified by noninvasive and invasive imaging techniques (i.e., positron emission tomography, computed tomography, magnetic resonance imaging, laparoscopy, laparotomy etc.) accounts for low survival of these patients. Low efficacy of early diagnostic tests and a lack of a common approach to treatment choice demonstrate that the mechanisms of the development and progression of abdominal cancer with peritoneal carcinomatosis are to be investigated.

Research of cancer molecular mechanisms is of particular importance over the last decade. Numerous studies support the involvement of microRNA (miRNA) in cancer development and progression. This article reviews current conception of miRNA role in the development of gastric and colorectal cancer and associated peritoneal carcinomatosis. The role of miRNA in cancer pathogenesis is described. Our findings demonstrate the impo rtance of studying molecular genetic hallmarks of tumor growth and potential use of miRNA as a diagnostic marker and predicting factor in abdominal cancer with peritoneal carcinomatosis.

Keywords: abdominal cancer, gastric cancer, colorectal cancer, peritoneal carcinomatosis, miRNA, diagnostic markers.

For citation: Gantsev K.Sh., Kzyrgalin Sh.R., Ishmuratova K.R. The role of miRNA in abdominal cancer with peritoneal carcinomatosis. RMJ. 2020;12:77–79.

Pages 9-13. Влияние генетических особенностей на максимальное потребление кислорода и систолическую функцию левого желудочка в норме и в реабилитационном периоде после острого инфаркта миокарда. Головенкин С.Е., Никулина С.Ю., Максимов В.Н., Орлова Ю.В., Пелипецкая Е.Ю.

Summary:

Genetic characteristics effect on maximum oxygen consumption and left ventricular systolic function in normal condition and rehabilitation period after acute myocardial infarction

S.E. Golovenkin1, S.Yu. Nikulina1, V.N. Maximov2, Yu.V. Orlova1, E.Yu. Pelipetskaya1

1Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk

2Institute of Internal and Preventive Medicine, the branch of the Federal Research Center «Institute of Cytology and Genetics of the Siberian Department of the Russian Academy of Sciences», Novosibirsk

Myocardial infarction (MI) is the most dangerous manifestation of coronary heart disease, commonly leading to fatal outcome. Competently conducted rehabilitation measures can reduce cardiovascular mortality by a quarter and increase patient recovery by 1.5 times. The modern patient rehabilitation system includes appropriate measures immediately after the patient is admitted to the intensive care unit and their continuation at the outpatient stage throughout the year. At the same time, rehabilitation measures sometimes give different efficacy with the same severity of MI and concomitant pathology. This suggests the patients’ genetic characteristics influence on rehabilitation measures effect. The efficacy of rehabilitation measures largely depends on the maximum oxygen consumption and restoration of left ventricular systolic function. The article discusses the study results concerning patients’ genetic characteristics and an increase in ma ximum oxygen consumption during physical training, and association between the patients’ genetic characteristics and left ventricle systolic function in cardiovascular disease. The revealed polymorphisms associated with maximum oxygen consumption and systolic function restoration can be the subject of study in patients undergoing rehabilitation after MI. These study results will make it possible to individualize the rehabilitation process, which will increase the effectiveness of the ongoing rehabilitation measures and will have a positive effect on the disease prognosis.

Keywords: myocardial infarction, genetics, rehabilitation, maximum oxygen consumption, adaptation to physical activity, restoration of left ventricular systolic function, single-nucleotide polymorphism, allele.

For citation: Golovenkin S.E., Nikulina S.Yu., Maximov V.N. et al. Genetic characteristics effect on maximum oxygen consumption and left ventricular systolic function in normal condition and rehabilitation period after acute myocardial infarction. RMJ. 2020;12:9–13.



№11, 2020. Клинические рекомендации и алгоритмы для практикующих врачей

Pages 14-18. Оксигенотерапия при сердечно-сосудистых заболеваниях и инфекции COVID-19. Ухолкина Г.Б.

Summary:

Oxygen therapy for cardiovascular diseases and COVID-19 infection

G.B. Ukholkina1,2

1City Clinical Hospital named after S.S. Yudin of the Moscow Health Department, Moscow

2Multidisciplinary Medical Center of the Central Bank of the Russian Federation, Moscow


The article discusses the pathophysiology of hypoxia, the mechanisms of its elimination with oxygen therapy, and the toxic effects of oxygen. It also highlights modern recommendations and algorithms for application in cardiovascular diseases, including in combination with bronchopulmonary pathology. Given the data of evidence-based medicine, controversial and unclear aspects of oxygen therapy and the possibility of negative consequences if used incorrectly are discussed. The world experience of using oxygen therapy for the new COVID-19, including additional methods for improving the oxygenation (prone position), is discussed, and the author also shares his personal experience in treating comorbid patients with COVID-19. The modern methods of inhalation oxygen therapy and indications for their use, including non-invasive ventilation, high-flow nasal oxygenation (a promising, but no t widely used technique in our country), various types of oxygen therapy with masks, devices for home oxygen therapy are described.

Keywords: oxygen therapy, hypoxemia, oxygen, blood oxygen saturation, saturation, acute respiratory distress syndrome, new coronavirus infection, COVID-19, inhalations, oxygen masks.

For citation: Ukholkina G.B. Oxygen therapy for cardiovascular diseases and COVID-19 infection. RMJ. 2020;11:14–18.



Pages 20-28. Лекарственно-индуцированный дефицит электролитов. Часть 1. Лекарственно-индуцированная гипокалиемия. Остроумова О.Д., Переверзев А.П., Клепикова М.В.

Summary:

Drug-induced electrolyte imbalance. Part 1. Drug-induced hypokalemia

O.D. Ostroumova, A.P. Pereversev, M.V. Klepikova

Russian Medical Academy of Continuous Professional Education, Moscow


The incidence of severe drug-induced hypokalemia in medical institutions is about 4.32–4.64 per 10,000 visits per year. Drug-induced hypokalemia is caused by many medications: diuretics, adrenoceptor agonists, drugs used for chemotherapy of malignant neoplasms, glucocorticosteroids, antibacterial drugs, etc. Polypragmasia, long-term use of certain medications and their use in high doses are also associated with an increased risk of drug-induced hypokalemia. Its clinical manifestations correspond to those of hypokalemia in general and include depression, paresthesia, lower limb muscle cramps, convulsions, hyporeflexia, muscle weakness, decreased myocardial contractile function, various heart rhythm disorders, nausea, vomiting, intestinal paresis, intestinal obstruction, muscle necrosis, etc. The most accurate and reliable method for diagnosing hypokalemia is to determine the potassium level in the blood serum. Potassium deficiency is also characterized by ECG changes. When the potassium level in the blood serum of 2.5–3.9 mmol/L, oral potassium supplementation is required during which the patient can be treated on an outpatient basis. When the potassium concentration in the blood serum <2.5 mmol/L, in-patient care is required — infusion therapy with subsequent switch to oral potassium su pplementation. The article presents the benefits of potassium and magnesium asparaginate in the treatment of hypokalemia, including drug-induced.

Keywords: adverse events, hypokalemia, drug-induced hypokalemia, potassium, potassium and magnesium asparaginate.

For citation: Ostroumova O.D., Pereversev A.P., Klepikova M.V. Drug-induced electrolyte imbalance. Part 1. Drug-induced hypokalemia.
RMJ. 2020;11:20–29.



Pages 30-34. Инсулинотерапия при сахарном диабете 2 типа у пациентов с морбидным ожирением: факторы эффективной компенсации нарушений углеводного обмена. Амосова М.В., Гурова О.Ю., Глинкина И.В., Малолеткина Е.С., Фадеев В.В.

Summary:

Insulin therapy for type 2 diabetes mellitus in patients with morbid obesity: factors for effective compensation of carbohydrate metabolism indicators

M.V. Amosova, O.Yu. Gurova, I.V. Glinkina, E.S. Maloletkina, V.V. Fadeev

Sechenov University, Moscow

Aim: to study the factors that determine the efficacy of insulin therapy in patients with type 2 diabetes mellitus (DM2) and morbid obesity (MO).

Patients and Methods: the study included 141 patients with DM2 and MO. 61 patients received GLP-1 receptor agonists in combination with basal insulin and Metformin (group 1), 40 patients received basal insulin in combination with sulfonylurea drug and metformin (group 2), and 40 patients received basal-bolus insulin therapy with metformin (group 3). Initially and after 24 weeks, all patients underwent clinical and laboratory examinations, as well as assessment of their cognitive status, eating behavior, life quality by questionnaires, and sleep quality by polysomnography.

Results: cognitive impairment was detected in 56.1% of patients with DM2 and MO. The presence and severity of cognitive decline significantly affected the effectiveness of hypoglycemic therapy: HbA1c dynamics after 24 weeks of therapy (95% confidence interval) in patients without cognitive impairment -1.1% (-0.9; -2.2), with pre-dementia states -0.6% (-0.5; -1.3), with dementia -0.6% (-0.2; -1.4) (p<0.001). 84.4% of patients were diagnosed with eating disorders, represented in 67% of cases by a combination of emotiogenic, external and restrictive types. During GLP-1 receptor agonists therapy, there was a tendency to improve the life quality, initially reduced in all patients. Obstructive sleep apnea was detected n 86.9% of patients, with a severe degree of this disorder — in 61.5% of patients.

Conclusion: it is advisable to assess the cognitive status, eating behavior, and sleep quality to choose hypoglycemic therapy individually for patients with DM2 and MO. The high prevalence of cognitive impairment among patients with DM2 and MO determines the priority of prescribing the simplest insulin therapy regimens.

Keywords: diabetes mellitus, morbid obesity, in sulin therapy, GLP-1 receptor agonists, cognitive impairment, obstructive sleep apnea, eating disorders, life quality.

For citation: Amosova M.V., Gurova O.Yu., Glinkina I.V. et al. Insulin therapy for type 2 diabetes mellitus in patients with morbid obesity: factors for effective compensation of carbohydrate metabolism indicators. RMJ. 2020;11:30–34.

Pages 35-38. Опыт лечения лекарственного поражения печени. Тарасова Л.В., Арямкина О.Л., Волкова Т.В.

Summary:

Experience in treating drug-induced liver injury

L.V. Tarasova1,2, O.L. Aryamkina1,3, T.V. Volkova1,3


1Surgut State University, Surgut

2Chuvash State University named after I.N. Ulyanov, Cheboksary

3Surgut Regional Clinical Hospital, Surgut


Drug-induced liver injury (DILI) is one of the main adverse events of pharmacotherapy. New medicines appearance on the pharmaceutical market, the increase in the number of DILI caused by herbal preparations and dietary supplements, as well as the market expansion for immunobiological preparations, make medicines as the most important etiological factors of liver injury. The choice of tactics for the patient management with DILI is determined by the course and severity of the disease, the characteristics of the use of potentially hepatotoxic preparation, and the individual characteristics of the patient. There are common links in the DILI pathogenesis, including hypoxia, de-energization (deficit of ATP production), damage to hepatocyte membranes and inhibition of antioxidant protection. Therefore, pathogenetic pharmacotherapy and prevention of liver injury are based on preparations with a mechanism of acti on aimed at eliminating one or more links in the pathogenesis. One of these preparations is Remaxol, which includes antihypoxants and antioxidants of metabolic type: natural metabolites, substrates and cofactors involved in energy metabolism. The article presents the result of using Remaxol in a patient with drug-induced hepatotoxicity. The use of Remaxol made it possible to achieve clinical and biochemical remission, preventing the development of severe liver injury, and helped to preserve the recommended therapy duration of the underlying disease.

Keywords: drug-induced liver injury, hepatotoxicity, adverse events of pharmacotherapy, antioxidant, antihypoxant.

For citation: Tarasova L.V., Aryamkina O.L., Volkova T.V. Experience in treating drug-induced liver injury. RMJ. 2020;11:35–38.



Pages 39-42. Влияние интерлейкина-17 на патогенез и риски развития сердечно-сосудистых заболеваний при спондилоартритах. Василенко Е.А., Мазуров В.И., Гайдукова И.З., Дадалова А.М., Королев М.А., Гайдукова Е.К.

Summary:

Interleukin-17 effect on the pathogenesis and risks of cardiovascular diseases in spondylarthritis

E.A. Vasilenko1, V.I. Mazurov1, I.Z. Gaidukova1, A.M. Dadalova1, M.A. Korolev2, E.K. Gaidukova3


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

2Research Institute of Clinical and Experimental Lymphology (NIIKEL), the branch of the Federal Research Center "Institute of Cytology and Genetics of the Siberian Department of the Russian Academy of Sciences", Novosibirsk

3Clinical Rheumatology Hospital No. 25, Saint-Petersburg


Background: the critical value of the IL-17 for the pathogenesis of spondyloarthritis (SpA) led to the emergence of new genetic engineering biological drugs that inhibit IL-17. At the same time, it is possible that IL-17 may have a certain value in modifying the risk of cardiovascular diseases in SpA.

Aim: to study the association of cardiovascular risks in patients with axial spondylitis (axial SpA) and genetic polymorphism responsible for IL-17 synthesis, assessed by various scales: Systematic COronary Risk Evaluation (SCORE), QRESEARCH Cardiovascular Risk Algorithm (QRISK3), Reynolds Risk Score (RRS).

Patients and Methods: 48 patients aged 25 to 69 years (74.6% men) were examined with confirmed axial SpA who met the ASAS (2009) criteria, including those with extra-skeletal lesions (psoriasis). Cardiovascular risks were assessed using the QRISK3, SCORE, and RRS scales. Genetic typing was performed according to IL17A-197 AG, IL17-F7 His/Arg, IL17F-11139 CG, and the concentration of highly sensitive C-reactive protein (hs-CRP) was determined.

Results: factor analysis revealed correlations between the risk of significant cardiovascular events, CRP level, and the carrier of various IL-17A and IL-17F alleles. The highest capacity and direct association with an increased risk of fatal cardiovascular outcomes was achieved in individuals homozygous for the AA IL-17A allele and heterozygous for the CG IL-17F allele. An inverse relationship was found in the presence of homozygous for the GG IL-17A and CC IL-17F alleles. In the course of the study, data were obtained on the presence of a direct association between an increase in cardiovascular risk and the CRP level.

Conclusion: increased cardiovascular risk in axial SpA may be associated with genetically determined altered secretion of IL-17 subtypes, which in the future may determine the validity of IL-17 blockade use in patients with axial SpA with a high cardiovascular risk.

Keywords: cardiovascular risk, axial spondyloarthritis, psoriatic arthritis, prevention of cardiovascular diseases, SCORE, QRISK, Reynolds Risk Score, interleukin-17.

For citation: Vasilenko E.A., Mazurov V.I., Gaidukova I.Z. et al. Interleukin-17 effect on the pathogenesis and risks of cardiovascular diseases in spondylarthritis. RMJ. 2020;11:39–42.



Pages 4-8. Особенности течения и факторы неблагоприятного прогноза коронавирусной инфекции COVID-19 у пациентов с иммуновоспалительными заболеваниями. Мазуров В.И., Гайдукова И.З., Бакулин И.Г., Инамова О.В., Фонтуренко А.Ю., Самигуллина Р.Р., Крылова А.И., Гайдукова Е.К.

Summary:

Patterns of COVID-19 infection course and factors of adverse prognosis in patients with immune-mediated inflammatory disease


V.I. Mazurov1,2, I.Z. Gaidukova1,2, I.G. Mazurov1, O.V. Inamova1,2, A.Yu. Fonturenko1, R.R. Samigullina1, A.I. Krylova2, E.K. Gaidukova2


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

2Clinical Rheumatological Hospital No. 25, Saint-Petersburg


Background: the new COVID-19 infection is a poorly studied problem of modern medicine and rheumatology.

Aim: to study the patterns of COVID-19 infection course in patients with immune-mediated inflammatory rheumatic diseases (RD) on the basis of clinical practice data.

Patients and Methods: the analysis of data concerning patients with confirmed immune-mediated inflammatory RD and COVID-19 infection (n=31: 9 men and 22 women) was conducted. Enrollment period: 15.03.2020–15.06.2020.

Results: severe COVID-19 was observed in 38.7% of patients with RD: 49% of them were hospitalized and 16% of patients died. All the deceased patients had pneumonia with 75–100% lung damage, alveolar-capillary block syndrome, acute respiratory distress syndrome and severe respiratory failure. 4 out of 5 deceased patients had macrophage activation syndrome (MAS), whereas, two of them h ad MAS in combination with sepsis. The adverse prognosis of COVID-19 was influenced not so much by the current RD activity as by pre-existing organ damage (end-stage renal disease, chronic heart failure, etc.). All the deceased patients were female. Most of the deceased patients had a pathology of obesity, hypertension, chronic kidney disease, and a history of thrombotic events. The presence of obesity of any degree more than three times increased the risk of an adverse prognosis with COVID-19 in patients with RD.

Conclusion: immune-mediated inflammatory RD are associated with an increase in mortality from total or subtotal COVID-associated pneumonia in combination with MAS and sepsis in the setting of pre-existing internal organ damage (a significant decline of kidney function, chronic heart failure, etc.) and with the presence of obesity and diabetes.

Keywords: immune-mediated inflammatory diseases, rheumatic diseases, new coronavirus infection, COVID-19, coronavirus , pneumonia, adverse prognosis.

For citation: Mazurov V.I., Gaidukova I.Z., Mazurov I.G. et al. Patterns of COVID-19 infection course and factors of adverse prognosis in patients with immune-mediated inflammatory disease. RMJ. 2020;11:4–8.

Pages 43-48. Магнитно-резонансная томография как дополнительный инструмент выбора терапии при лечении остеоартрита. Гайдукова И.З., Мазуров В.И., Инамова О.В.

Summary:

Magnetic resonance imaging as an additional tool for treatment tactics for osteoarthritis

I.Z. Gaidukova1,2, V.I. Mazurov1,2, O.V. Inamova1,2

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

2Clinical Rheumatology Hospital No. 25, Saint-Petersburg

Aim: to establish the association between the intensity of pain in knee osteoarthritis (OA) and inflammatory changes in the knee detected by MRI with an assessment of changes in dynamics during treatment with NSAIDs.

Patients and Methods: in 46 patients with knee OA (n=46) and pain not less than 4.0 (according to NRS), pain intensity and WOMAC index were measured at baseline and 3 months after NSAIDs treatment (±10 days). MRI of the knee was performed in T1 STIR sequence. During MRI, the following patterns were assessed: the presence of subchondral bone marrow edema (SBME), the number and size of its foci, and the presence of synovitis / tenosynovitis. MRI was repeated after 3 months ± 10 days in patients with inflammatory changes.

Results: initially, signs of inflammatory changes in the knee joints were observed in the majority of patients (72%) with knee OA and joint pain not less than 4.0 poi nts. 39 patients completed the study. 3 months after treatment with NSAIDs, there was a positive trend in all parameters of the WOMAC index — the total index decreased from 64.4±15.4 to 24.12±11.1 points (n=39, p<0.05). According to the results of repeated MRI, the number of patients with SBME significantly reduced, while the number of patients with synovitis and tenosynovitis decreased slightly. The reduction degree in the total WOMAC index and joint pain was greater in patients who initially had signs of subchondral bone inflammation, compared with patients who did not have SBME before the treatment (p<0.05 for all comparisons).

Conclusions: patients with knee OA and severe pain had inflammatory changes in the subchondral bone in 72% of cases according to MRI; synovitis occurred in 91.3% of cases. The presence of inflammatory foci (but not synovitis) in the subchondral bone was associated with an increase in pain in the knee joint and a good response to NSAIDs, the  effect of which was manifested both clinically (pain reduction) and visually (disappearance or decrease of osteitis in the subchondral bone).

Keywords: osteoarthritis, low-grade inflammation, joint pain, MRI-detected inflammation, non-steroidal anti-inflammatory drugs, NSAIDs.

For citation: Gaidukova I.Z., Mazurov V.I., Inamova O.V. Magnetic resonance imaging as an additional tool for treatment tactics for osteoarthritis. RMJ. 2020;11:43–48.



Pages 49-53. Влияние секукинумаба на развитие дисфункции миокарда у пациентов с анкилозирующим спондилитом. Фейсханова Л.И., Лапшина С.А.

Summary:

Secukinumab effect on the myocardial dysfunction development in patients with ankylosing spondylitis

L.I. Feiskhanova, S.A. Lapshina


Kazan State Medical University, Kazan


Background: in ankylosing spondylitis (AS), early subclinical changes in the myocardium mostly remain undiagnosed. The impact of genetic engineering biological therapy (GEBT) on these changes is also unclear.

Aim: to establish the association between the secukinumab intake and changes in systolic and diastolic functions of myocardium in patients with AS.

Patients and Methods: 69 patients with confirmed AS were examined: the first group included 33 patients (average age 38.8±4.74, 63.6% of men) who received the interleukin 17 (IL-17) inhibitor — secukinumab, the second group — 36 patients who did not receive GEBT (average age 42.5±11 years, 66.7% of men). The control group included 40 healthy subjects, comparable in gender and age. Patients underwent tissue doppler echocardiography, transthoracic echocardiogram, and determination of matrix metalloproteinase-9 (MMP-9) level in blood serum. Statistical processing  of results was performed using STATISTICA 10.0 software.

Results: there was significantly (p<0.01) higher left ventricular mass index and ejection fraction in patients with AS compared to the control group, although they were generally within normal range. Moreover, the indicators were the highest among patients who did not receive GEBT, diastolic dysfunction was diagnosed only in this group (in 38.9%). In the setting of the secukinumab therapy, there was an increase in the systolic function of the myocardium. Analysis of the MMP-9 level in the blood serum of patients with AS showed significant (p<0.001) differences with the control group. In the group of patients receiving secukinumab, the elevation of MMP-9 level was associated with a deterioration of right ventricular systolic function and left ventricular diastolic function.

Conclusion: AS is characterized by a high frequency of subclinical cardiovascular disease. Inhibition of IL-17 can reduce diastolic dysfunction, which is confirmed by an improvement in myocardial contrac tility during secukinumab therapy.

Keywords: ankylosing spondylitis, spondylarthritis, diastolic dysfunction, myocardial contractility, secukinumab, interleukin 17 inhibitor, matrix metalloproteinase, tissue doppler echocardiography.

For citation: Feiskhanova L.I., Lapshina S.A. Secukinumab effect on the myocardial dysfunction development in patients with ankylosing spondylitis. RMJ. 2020;11:49–53.

Pages 54-58. Сердечно-сосудистая безопасность повторных назначений эторикоксиба при подагрическом артрите. Гайдукова И.З., Мазуров В.И., Фонтуренко А.Ю., Башкинов Р.А., Петрова М.С., Инамова О.В., Шаповалов А.А., Нагирняк И.М.

Summary:

Cardiovascular safety profile of repeated etoricoxib courses in gout

I.Z. Gaidukova1,2, V.I. Mazurov1,2, A.Yu. Fonturenko1,2, R.A. Bashkinov1,2, M.S. Petrova1,2, O.V. Inamova1,2, A.A. Shapovalov3, I.M. Nagirnyak3


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

2Clinical Rheumatological Hospital No. 25, Saint-Petersburg

3TechLAB LLC, Saint-Petersburg


Background: non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat gout attacks in short courses. Repeated courses of NSAIDs are prescribed for chronic or recurrent gout, which leads to an increase in the total dose and duration of course, changing the safety profile of treatment.

Aim: to study the incidence of myocardial infarction (MI), arterial hypertension (AH), and chronic kidney disease (CKD) in patients with chronic or recurrent gout with repeated courses of etoricoxib (EC).

Patients and Methods: an analysis of the features of EC use in patients with gout was performed based on the data of the Saint Petersburg city register of gout and asymptomatic hyperuricemia from 2000 to 2019, formed on the basis of the GALENOS cloud electronic data storage system (Techlab LLC).

Results: the register included data of 1,725 patien ts with gout, of whom 315 people took EC and 118 had repeated courses (average age 57.1±7.9 years; 43 women). Age-and gender-matched patients with gout who received other NSAIDs in repeated courses (n=60) made up the control group. The follow-up period averaged 4.85±3.36 (1–17) years. The average duration of EC treatment was 24.9±15.2 (8–87) days, and other NSAIDs-37.1±9.8 (21–74) days (p<0.0001). The NSAID intake index (Dugados Functional Index) for EC was equal to 6.8%, for other NSAIDs — 10.2% (p<0.05). The average dosage of EC was 92.3±16.8 (60–120) mg/day. During follow-up, 7 (3.9%) patients were diagnosed with AH, 45 (25.3%) with CKD, and 2 (1.7%) patients had MI. The occurrence of cardiovascular diseases was more commonly detected in patients who alternated EC with other NSAIDs, versus patients who received EC or other NSAIDs without switching, and versus population indicators (p<0.05 for all comparisons).

Conclusion: the use of repeated EC courses of for the treatment of chronic or recurrent gout is not associated with an increase in the risk of MI, hypertension, or CKD, provided that EC is not switched to other NSAIDs, since in this case the shortest duration of administration and the total dose of NSAIDs are achieved.

Keywords: gout, chronic inflammation, cardiovascu lar safety profile, non-steroidal anti-inflammatory drugs, coxibs.

For citation: Gaidukova I.Z., Mazurov V.I., Fonturenko A.Yu. et al. Cardiovascular safety profile of repeated etoricoxib courses in gout. RMJ. 2020;11:54–58.



Pages 59-63. Особенности иммунного ответа у больных внебольничной пневмонией с сочетанной сердечно-сосудистой патологией. Титова О.Н., Кузубова Н.А., Александров А.Л., Перлей В.Е., Тихонова К.А.

Summary:

Immune response characteristics in patients with community-acquired pneumonia and comorbid cardiovascular pathology

O.N. Titova1, N.A. Kuzubova1, A.L. Alexandrov1, V.E. Perley1, K.A. Tikhonova2


1National Research Institute of Pulmonology of the Pavlov First Saint Petersburg State Medical University, Saint-Petersburg

2Vvedenskaya City Clinical Hospital, Saint-Petersburg

Aim: to identify the characteristics of the immune status in patients with community-acquired pneumonia (CAP) and comorbid cardiovascular pathology (CCP), and its effect on the clinical course, cardiopulmonary hemodynamics and disease prognosis.

Patients and Methods: 58 patients, were examined and divided into two groups. The first group included 43 patients with CAP (74%) who had clinically significant CCP (average age 62±10 years). The second group consisted of 15 patients with CAP (26%) without concomitant diseases, (average age 56±15 years).

Results: a lower hemoglobin level was determined in group 1 (117.04±6.05 g/l), lower values of serum IL-8 and IL-6 — 2 and 2.3 times, respectively, while the average IL-17 values were almost more than two times higher than in group 2. The presence of direct, strong, reliable associations between the increased value of IL-17 and the content of neutrophils and young forms of WBC (r=0.85, and r=0.91, respectively, p<0.05) was established. In group 1, there was a direct medium-strong association, between the level of serum IL-17 and the time to reach the maximum ejection rate in the right ventricular outflow tract (r=0.61, p<0.05), as well as a direct strong association with the diameter of the inferior vena cava (r=0.86, p<0.05).

Conclusion: the revealed correlation between IL-17, myeloperoxidase and echocardiographic parameters in these patients indicated that the increasing level of pro-inflammatory cytokine was not only due to the development of the inflammatory process but also to the presence of concomitant CCP . The dynamics of the serum IL-17 level in patients with CAP can serve as a prognostic criterion for the severity of the pathological process and the functional state of the cardiopulmonary circulation.

Keywords: community-acquired pneumonia, comorbid cardiovascular pathology, proinflammatory cytokines, interleukin, myeloperoxidase, cardiopulmonary hemodynamics.

For citation: Titova O.N., Kuzubova N.A., Alexandrov A.L. et al. Immune response characteristics in patients with community-acquired pneumonia and comorbid cardiovascular pathology. RMJ. 2020;11:59–63.



Pages 64-68. Клинико-лабораторные аспекты аллергии на укусы комарами у детей Московского региона. Рыбникова Е.А., Образцов И.В., Продеус А.П., Федоскова Т.Г.

Summary:

Clinical and laboratory aspects of mosquito bite allergy in children of the Moscow region

E.A. Rybnikova1,2, I.V. Obraztsov1, A.P. Prodeus1, T.G. Fedoskova2,3

1Children’s City Clinical Hospital No. 9 named after G.N. Speransky, Moscow

2Pirogov Russian National Research Medical University, Moscow,

3State Research Center “Institute of Immunology» of the Federal Medical and Biological Agency, Moscow

Aim: to provide clinical and laboratory characteristics for pediatric patients with mosquito bite allergy on the example of the population in Moscow, to determine the proportion of mosquito bite allergy in the general structure of allergic pathology in children and to determine the aggravating risk factors of its occurrence.

Patients and Methods: 1587 patients under 18 y.o. were examined. The presence of hypersensitivity manifestations, their clinical patterns, and allergy diagnostics data were evaluated based on the study in vitro. The first part of the study involved 705 children with a confirmed atopic diagnosis including a history of mosquito bite allergy (247 children in the main group) or without it (426 children in control group 1). In the second part of the study, the main group was compared with the control group 2, which consisted of 14 children without allergic pathology and atopic predisposition (conditionally healthy), who had a history of allergic symptoms to mosquito bites.

Results: children with confirmed allergic pathology had complaints about the occurrence of hyperergic reactions of varying severity to mosquito bites in 35% of cases. Children of preschool (66.7%) and junior school (16.7%) ages predominated. In 88.7% of them there were the manifestations of topical reactions. In 11.3% of cases, there was the development of mild to moderate systemic reactions. No severe systemic reactions were observed. Patients of the main group with insect-bite allergy  suffered from skin manifestations in the form of atopic dermatitis (22.7% and 13.3%, p<0.05) and recurrent urticaria (3.2% and 1.4%, p<0.05) more often than patients of control group 1. There was a correlation (Pearson correlation coefficient: η=0.71, p<0.05) between the incidence of allergic symptoms to mosquito bites and the presence of allergic dermatosis. 2.7% of children in the main group had cross-sensitization with fish and/or seafood allergens. In 3.6% of cases, the development of IgE-mediated allergy was noted.

Conclusion: aggravating factors for the development of mosquito bite allergy are the following: preschool age (4–7 years), the presence of allergic dermatoses, the presence of allergies to fish and/or seafood. It is necessary to further study the mechanisms of insect —bite allergy and search for new diagnostic tools.

Keywords: insect-bite allergy, children, mosquitoes, Skeeter syndrome, domestic allergy, food allergy, prevalence, cross-reactivity.

For citation: Rybnikova E.A., Obraztsov I.V., Prodeus A.P., Fedoskova T.G. Clinical and laboratory aspects of mosquito bite allergy in children of the Moscow region. RMJ. 2020;11:64–68.



Pages 69-74. Острый и рецидивирующий цистит. Что нам известно?. Ходырева Л.А., Зайцев А.В., Берников А.Н., Куприянов Ю.А., Строганов Р.В., Арефьева О.А.

Summary:

Acute and recurrent cystitis. What do we know?

L.A. Khodyreva1,2, A.V. Zaitsev1, A.N. Bernikov1, Yu.A. Kupriyanov1,2, R.V. Stroganov3, O.A. Arefieva2,3

1A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

2Research Institute for Healthcare and Medical Management of Moscow Healthcare Department, Moscow

3City Clinical Hospital named after S.I. Spasokukotsky, Moscow

The growing antibiotic resistance of urinary tract infection pathogens is an urgent problem worldwide. Rational use of antibacterial drugs and alternative non-antibacterial prevention of lower urinary tract infections are aimed at solving this problem. The article presents current data on the etiology, pathogenesis, diagnosis, treatment, and prevention of acute uncomplicated and recurrent lower urinary tract infection. The article also shows the results of clinical studies on the use of proanthocyanidins, D-mannose and vitamin D3 in the complex treatment and prevention of acute infectious and inflammatory process in the urinary bladder. According to the scientific literature, the mechanism of action of alternative drugs and their efficacy in reducing the frequency of relapses is demonstrated.

Keywords: urinary tract infection, urinary bladder, recurrent infection, postcoital prevention, proanthocyanidins, D-mannose, vitamin D3.

For citation: Khodyreva L.A., Zaitsev A.V., Bernikov A.N. et al. Acute and recurrent cystitis. What do we know? RMJ. 2020;11:69–74.

Pages 75-78. Бактериальный вагиноз. Возможные пути решения проблемы. Ильина И.Ю., Доброхотова Ю.Э.

Summary:

Bacterial vaginosis. Possible solutions to the problem

I.Yu. Ilina, Yu.E. Dobrokhotova

Pirogov Russian National Research Medical University, Moscow

The article is devoted to the problem of bacterial vaginosis (BV) which is the main cause of vaginal dysbiosis in women of the reproductive period. The article highlights the features of diagnosis and treatment. Due to the fact that in BV one has to deal with polymicrobial associations, the sheer fact of detecting opportunistic microflora is not informative in the diagnosis of vaginal infections. The ratio of lactobacilli and opportunistic microorganisms is of fundamental importance. Despite the existing treatment algorithms presented in the clinical guidelines and confirmed by many studies, there are still many unresolved issues. This is due to the variety of microorganisms, leading to the BV development, and difficulties in treatment. Special attention is paid to the possibility of using a combined drug for intravaginal administration containing metronidazole 100 mg and miconazole nitrate 100 mg (Ginocaps)  in outpatient gynecological practice. This combined drug is recommended for BV treatment in combination with metronidazole intake. Besides, this drug can be recommended for the treatment of co-infection and in the presence of pathological vaginal discharge in women, especially of a recurrent nature, as well as in the absence of diagnostics to determine the pathogen, since it is effective against anaerobes and yeast-like fungi of the Candida genus.

Keywords: bacterial vaginosis, pathological vaginal discharge, Amsel’s criteria, Nugent’s criteria, metronidazole, miconazole.

For citation: Ilina I.Yu., Dobrokhotova Yu.E. Bacterial vaginosis. Possible solutions to the problem. RMJ. 2020;11:76–78.



Pages 79-80. Разработка методики количественного определения дубильных веществ в корнях ревеня лекарственного. Семенюта К.Н., Куркин  В.А., Шмыгарева А.А., Саньков А.Н.

Summary:

Development of assay methods for tannins content in Rheum officinale B.

K.N. Semenyuta, V.A. Kurkin, A.A. Shmygareva, A.N. Sankov

Orenburg State Medical University, Orenburg

Rheum officinale B. is a medicinal plant widely used in the traditional medicine of the European Union, United Kingdom, Japan and China and is promising for use in national pharmacy. Rheum officinale B. and Rheum palmatum L. are closely related plant species that contain two dominant groups of biologically active substances — anthracene derivatives and tannins. The aim of the study was to determine the optimal conditions for extracting tannins from the Rheum officinale B. and develop an assay technique. The study objects were the roots of Rheum officinale B. Electronic spectra were measured using Unico 2800 UV spectrophotometer. Solutions UV spectra of water extracts from raw materials were studied. Catechin was used as a reference standard, which had a maximum absorption at a wavelength of 282±2 nm. Optimal conditions for extracting tannins from the Rheum officinale B.: extraction  solvent — water; raw material/extraction solvent ratio — 1:50; extraction time — 15 minutes in a boiling water bath. Assay method for tannins content in Rheum officinale B. by spectrophotometry on the basis of catechin at the analytical wavelength of 282±2 nm has been developed. The content of tannins in the Rheum officinale B. was 25.35%.

Keywords: Rheum palmatum L., Rheum officinale B., roots, tannins, catechin, standardization, spectrophotometry.

For citation: Semenyuta K.N., Kurkin V.A., Shmygareva A.A., Sankov A.N. Development of assay methods for tannins content in Rheum officinale B. RMJ. 2020;11:78–80.

Pages 9-13. Особенности течения пневмоний, вызванных SARS-CoV-2, у госпитализированных пациентов: опыт Санкт-Петербурга. Титова О.Н., Волчков В.А., Кузубова Н.А., Козырев А.Г., Черменский А.Г., Волчкова Е.В.

Summary:

Patterns of the pneumonia course caused by SARS-CoV-2 on inpatient basis: clinical experience in St. Petersburg

O.N. Titova1, V.A. Volchkov2, N.A. Kuzubova1, A.G. Kozyrev1, A.G. Chermenskii1, E.V. Volchkova3

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

2Saint-Petersburg State University, Saint Petersburg

3Saint-Petersburg State Pediatric Medical University, Saint Petersburg

Background: one of the typical manifestations of a new coronavirus infection (COVID-19) is pneumonia.

Aim: to evaluate the patterns of pneumonia course in patients with COVID-19 and analyze the results of treatment depending on its type.

Patients and Methods: the medical documents of hospitalized patients with pneumonia caused by SARS-CoV-2 (n=229) were studied. Three groups were formed: I group (n=86) — patients who were discharged with clinical improvement and were not observed in the intensive care unit (ICU); II group (n=55) — patients who were discharged but were in the ICU during treatment; III group (n=88) — cases with a fatal outcome.

Results: patients from group III were older compared to groups I and II (p<0.001), and suffered from at least one concomitant pathology, mainly cardiological or neuropsychiatric. Groups II and III compared to group I were characterized by a more pronounced decrease in oxygen saturation on the day of hospitalization (p<0.001), as well as by the increase in the neutrophil-lymphocyte ratio in peripheral blood (p<0.001), the rate of erythrocyte sedimentation (p=0.045 for I/II and p=0.019 for I/III) and C-reactive protein concentration (p<0.001). Subgroups that received or did not receive umifenovir significantly differed in relation to the need for artificial lung ventilation (ALV) (p=0.013) and the number of cases with fatal outcome (p=0.002). This was more the case for patients who needed treatment in ICU. The use of lopinavir/ritonavir in the subgroup of patients who required ALV was associated with a decrease in the number of fatal outcomes, p=0.044.

 Conclusions: the probability of a fatal outcome in patients with pneumonia caused by SARS-CoV-2 increased with ageing and underlying cardiological and neuropsychiatric pathology. Predictors of severe pneumonia were significant laboratory signs on the day of hospitalization. The downward trend towards mortality in the subgroups of patients with severe COVID-19 prescribed with lopinavir/ritonavir and umifenovir requires further study.

Keywords: COVID-19, SARS-CoV-2, pneumonia, severe course, oxygen saturation, neutrophil-lymphocyte ratio, erythrocyte sedimentation rate, C-reactive protein, lopinavir, ritonavir, umifenovir.

For citation: Titova O.N., Volchkov V.A., Kuzubova N.A. et al. Patterns of the pneumonia course caused by SARS-CoV-2 on inpatient basis: clinical experience in St. Petersburg. RMJ. 2020;11:9–13.



№10, 2020. Кардиология

Pages 12-16. Плейотропные эффекты азилсартана медоксомила у больных артериальной гипертензией и хронической обструктивной болезнью легких. Григорьева Н.Ю., Королёва М.Е., Конторщикова К.Н., Соловьева Д.В.

Summary:

Pleiotropic effects of azilsartan medoxomil in patients with arterial hypertension and chronic obstructive pulmonary disease

N.Yu. Grigorieva, M.E. Koroleva, K.N. Kontorschikova, D.V. Solovieva

Volga Research Medical University, Nizhny Novgorod

Aim: to compare the effect of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on endothelial function and lipid peroxidation (LP) in patients with arterial hypertension (AH) in combination with chronic obstructive pulmonary disease (COPD).

Patients and Methods: patients were divided into 2 groups (n=30 each). In the first group, patients received ARBs II (azilsartan medoxomil) at a dose of 40 mg/day, in the second group — ACE (fosinopril) at a dose of 20 mg/day. Ambulatory blood pressure monitoring was performed in all patients before and after 1 and 6 months from the start of treatment, as well as the mean pulmonary artery pressure (mPAP), endothelial function, and COPD indicators were studied.

Results: аfter 6 months of the study, all patients in group 1 managed to achieve the target blood pressure (BP) without increasing the dose of the drug. In group 2, BP was also normalized in all patients, but 5 patients had to increase the fosinopril dose to 40 mg/day. After 6 months, all patients had a statistically significant decrease in mPAP vs. the baseline (p<0.001); it was more significant in group 1 (p=0.01). After 6 months, endothelium-dependent vasodilation (EDV) in group 1 improved and amounted to 9.4±2.1% (p<0.001 vs. the baseline). In group 2, EDV significantly increased to 8.5±2.3 (p<0.001) by the end of treatment. The degree of differences in EVD between the azilsartan medoxomil and fosinopril groups was 3,7,5%. In group 1, there was more significant normalization of COPD products, as well as NO2 and NO3 indicators.

Conclusion: there was more significant improvement in COPD indicators, endothelial function, as well as a decrease in mPAP in patients with AH and COPD after 6 months of treatment with azilsartan medoxomil vs. fosinopril treatment, which suggests a more pronounced performance of pleiotropic effects of ARBs in this patient cohort.

Keywords: arterial hypertension, chronic obstructive pulmonary disease, endothelial dysfunction, lipid peroxidation, azilsartan medoxomil.

For citation: Grigorieva N.Yu., Koroleva M.E., Kontorschikova K.N., Solovieva D.V. Pleiotropic effects of azilsartan medoxomil in patients with arterial hypertension and chronic obstructive pulmonary disease. RMJ. 2020;10:12–16.

Pages 17-19. Роль матриксной металлопротеиназы 9 в ремоделировании миокарда левого желудочка. Шумаков Д.В., Зыбин Д.И., Попов М.А.

Summary:

Matrix metalloproteinase 9 in the left ventricular remodeling

D.V. Shumakov, D.I. Zybin, M.A. Popov

Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow

Nowadays, chronic heart failure after myocardial infarction (MI) develops approximately in one of four patients and has a high five-year mortality rate (more than 50%), despite modern conservative treatment regimens. That is why understanding the mechanisms of heart failure is extremely relevant. Matrix metalloproteinases are key enzymes involved in left ventricular remodeling. At the same time, an issue concerning the effect of metalloproteinases on the basal cardiomyocyte membranes remains incompletely resolved. It is the basal membranes that are the link between the extracellular matrix and cardiomyocytes, participating in the transmission of the force of contractions during systole. One of the most well-studied is matrix metalloproteinase 9 (MMP-9). A more comprehensive study of MMP-9, especially in relation to the type IV collagen destruction in the basal cardiomyocyte membranes, may  help to optimize the chronic heart failure treatment tactics after MI and to improve the prognosis for difficult-to-treat patients. This review is devoted to the study of the MMP-9 effect on left ventricular remodeling.

Keywords: matrix metalloproteinases, heart failure, type IV collagen, left ventricular remodeling, myocardial infarction.

For citation: Shumakov D.V., Zybin D.I., Popov M.A. Matrix metalloproteinase 9 in the left ventricular remodeling. RMJ. 2020;10:17–19.

Pages 2-7. Возможности применения никорандила у полиморбидных пациентов со стабильной стенокардией напряжения при неэффективности пролонгированных нитратов и противопоказаниях к реваскуляризации. Некрасов А.А., Тимощенко Е.С., Валикулова Ф.Ю., Ярославцева М.А., Новиков М.Ю., Некрасова Т.А., Дурыгина Е.М.

Summary:

Possibilities of using nicorandil in patients with multimorbidity and preserved angina of effort in the inefficacy of long-acting nitrates and contraindications to revascularization

A.A. Nekrasov1, E.S. Timoshenko2, F.Yu. Valikulova1, M.A. Yaroslavtseva2, M.Yu. Novikov2, T.A. Nekrasova1, E.M. Durygina1

1Volga Research Medical University, Nizhny Novgorod

2City Clinical Hospital No. 5, Nizhny Novgorod

Aim: to study the possibilities of using nicorandil in patients with multimorbidity with preserved functional class II–III angina of effort in the inefficacy of long-acting nitrates and contraindications to revascularization.

Patients and Methods: an open prospective study was conducted, which included 40 patients (average age 72.7±9.14 years) who had 3 or more severe chronic diseases (cardiovascular, oncological, etc.) with confirmed inefficacy of long-acting nitrates (a combination of complaints concerning chest pain at least 2 times a week with ischemic changes in the myocardium according to 24-Hour ECG Monitoring). The follow-up was performed during conventional therapy, including long-acting nitrates (7–10 days) after replacing them with nicorandil (Kordinik®, PIQ-PHARMA LLC, the Russian Federation) 10 mg 2 times a day (7–10 days) and after increasing its dose to 20 mg 2 times a day (4 weeks). Each patient kept a daily diary, where they recorded angina attacks, short-acting nitrates regimen, and adverse events. They were examined twice (at the beginning and end of the study) using the 24-Hour ECG Monitoring.

Results: during nicorandil therapy, there was a decrease in the number of angina attacks from 7.8±6.53 to 3.4±3.09 (p<0.0001) and the need for short-acting nitrates from 4.5±4.35 to 1.4±2.34 nitroglycerin tablets (p<0.0001). According to 24-Hour ECG Monitoring data, there was a decrease in the daily average number of myocardial ischemia episodes from 14.8±6.23 to 2.8±2.34 (p=0.0004) and their duration from 64.1±34.32 to 9.1±9.74 min (p=0.0003), in the absence of significant adverse events.

Conclusion: nicorandil is an effective and safe drug in patients with multimorbidity and preserved angina of effort with tolerance to long-acting nitrates and contraindications to revascularization. Nicorandil can be considered as the second-line drug for angina of effort in this patient cohort.

Keywords: nicorandil, angina of effort, patient with multimorbidity, nitrate inefficacy, revascularization.

For citation: Nekrasov A.A., Timoshenko E.S., Valikulova F.Yu. et al. Possibilities of using nicorandil in patients with multimorbidity and preserved angina of effort in the inefficacy of long-acting nitrates and contraindications to revascularization. RMJ. 2020;10:2–7.

Pages 20-24. Розувастатин как доступное средство для эффективной профилактики сердечно-сосудистых заболеваний. Колмакова Т.Е., Алексеева И.А., Ежов М.В.

Summary:

Rosuvastatin as an affordable medicine for effective prevention of cardiovascular diseases

T.E. Kolmakova, I.A. Alexeeva, M.V. Ezhov

National Medical Research Center of Cardiology, Moscow

According to the latest ESC (European Society of Cardiology) Guidelines on dyslipidemia management for the prevention of cardiovascular diseases, low-density lipoprotein (LDL) cholesterol is the only causative risk factor for the development of atherosclerosis complications. In everyday clinical practice, the target level of LDL cholesterol is rarely achieved, which is especially important for high-risk patients of cardiovascular complications. In comparison with other statins, rosuvastatin is already most effective in initial doses and has a better safety profile. Lower all-cause mortality has been shown in patients receiving rosuvastatin versus those treated with other statins. Besides, the significant effect of rosuvastatin was observed in patients with metabolic syndrome, type 2 diabetes mellitus; reduction in the risk of cardiovascular complications in patients with arterial hypertension was also noted. Thera py with rosuvastatin has shown the reduction of complications risk in patients without cardiovascular diseases but with a moderate risk of their occurrence.

Keywords: dyslipidemia, low-density lipoprotein cholesterol, rosuvastatin, efficacy, safety, generics.

For citation: Kolmakova T.E., Alexeeva I.A., Ezhov M.V. Rosuvastatin as an affordable medicine for effective prevention of cardiovascular diseases. RMJ. 2020;10:20–24.



Pages 25-28. Поздние осложнения чрескожных коронарных вмешательств. Шумаков Д.В., Шехян Г.Г., Зыбин Д.И., Ялымов А.А., Степина Е.В., Попов М.А.

Summary:

Late complications of percutaneous coronary interventions

D.V. Shumakov, G.G. Shekhyan, D.I. Zybin, A.A. Yalymov, E.V. Stepina, M.A. Popov

Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow

According to the World Health Organization, cardiovascular diseases occupy first place in the world as the causes of fatal outcomes. At present, percutaneous coronary intervention (PCI) is the standard treatment regimen of patients with atherosclerotic lesions of the coronary arteries. The introduction of second-drug-eluting stents (SDES) into clinical practice has increased the efficacy and safety of PCI by reducing the severity of inflammatory changes, as well as increasing the rate of regeneration and endothelization of the artery at the stent implantation site. However, the technique and technology of intervention itself prevent the complete regeneration of vascular structure and function and are associated with the risk of late stent dysfunction. Patients who have undergone PCI with SDES implantation remain at risk of late stenting complications (stent thrombosis, restenosis, neoa therosclerosis and bleeding), which are described in this review. Neoatherosclerosis plays an important role in the pathogenesis of acute coronary syndrome after stenting, as well as the recurrence of clinical symptoms after PCI. Advanced cardiac imaging and long-term dual antiplatelet therapy may be of fundamental importance for further understanding and treatment of this pathological process.

Keywords: coronary heart disease, percutaneous coronary intervention, drug-eluting stents, restenosis, stent thrombosis, bleeding.

For citation: Shumakov D.V., Shekhyan G.G., Zybin D.I. et al. Late complications of percutaneous coronary interventions. RMJ. 2020;10:25–28.



Pages 29-34. Замедление прогрессирования мультифокального атеросклероза у больной с первичной гиперхолестеринемией на фоне длительной (16 лет) гиполипидемической терапии. Сусеков А.В., Лугинова З.Г., Горнякова Н.Б., Балахонова Т.В.

Summary:

Retarding progression of multifocal atherosclerosis in a patient with primary hypercholesterolemia in the setting of long-term hypolipidemic therapy (for 16 years)

A.V. Susekov1, Z.G. Luginova2, N.B. Gornyakova3, T.V. Balakhonova4

1Russian Medical Academy of Continuous Professional Education, Moscow

2Republic Hospital No. 1 of the National Medical Center, Yakutsk

3National Medical Research Center of Cardiology, Moscow

4Sechenov University, Moscow

Increasing the level of apoB-containing lipoproteins in blood plasma is the most important modifiable risk factor for atherosclerosis and its complications. Primary hypercholesterolemia is characterized by an increase in low-density lipoprotein cholesterol (LDL-C) > 4.9 mmol/l and requires intensive statin treatment and/or combined lipid-lowering therapy in accordance with current guidelines. The article presents a clinical case of a 73-year-old female patient with primary polygenic hypercholesterolemia, coronary heart disease (CHD), carotid, coronary and peripheral artery atherosclerosis, who has received such treatment for the last 16 years. During this period, the level of LDL-C fluctuated in the range of 1.39–4.26 mmol/l; the treatment was well tolerated at the maximum intensity of therapy with original rosuvastatin and ezetimibe. Dynamic monitoring data by transcranial doppler ultrasound of car otid and peripheral arteries allowed to state the atherosclerosis stabilization. During the follow-up, it was possible to control the CHD course, as evidenced by clinical data and the results of treadmill tests series. Within 16 years of follow-up, planned stenting surgery was performed due to critical stenosis in the common carotid artery. There were no serious complications (heart attack, stroke, acute coronary syndrome).

Keywords: primary hypercholesterolemia, long-term follow-up, rosuvastatin, ezetimibe, atherosclerosis, stabilization.

For citation: Susekov A.V., Luginova Z.G., Gornyakova N.B., Balakhonova T.V. Retarding progression of multifocal atherosclerosis in a patient with primary hypercholesterolemia in the setting of long-term hypolipidemic therapy (for 16 years). RMJ. 2020;10:29–34.



Pages 35-39. Инфаркт миокарда у молодого мужчины со специфическими факторами риска ишемической болезни сердца, длительно занимавшегося бодибилдингом. Мартынов А.Ю., Диане М.Л., Байрамов С.

Summary:

Myocardial infarction in a young male patient with specific risk factors for coronary heart disease who was a bodybuilder for a long time

A.Yu. Martynov, M.L. Diane, S. Bayramov

Peoples’ Friendship University of Russia, Moscow

Most researchers of myocardial infarction note its gradual “rejuvenation”. The article presents a clinical case of a young male patient (28 y.o.), who was a bodybuilder for a long time and was admitted to the hospital with the acute myocardial infarction confirmed by electrocardiography data. Coronary angiography revealed an occlusion of the left anterior descending artery with thrombus formation in the proximal segment, which required repeated thromboextraction, angioplasty, and the installation of a drug-eluting stent. The case specificity was that the patient had only one classic risk factor for coronary heart disease — chronic stress. The Reeder’s test score was 1.71 (high level of psychoemotional stress). At the same time, there were specific modifiable risk factors for myocardial infarction — abuse of energy drinks for 8 years (up to 1.5 liters per day) and long-term use of anabolic steroids (methandrostenolone and testosterone tablets intramuscularly). The role of severe infection (which patient has suffered shortly before) that provoked activation of systemic inflammation factors and prothrombotic activity, as well as the violation of the training regime, was considered among the possible causes of myocardial infarction.

Keywords: myocardial infarction, young age, risk factor, bodybuilding, energy drinks, anabolic steroids, coronary angiography, acute ventricular aneurysm.

For citation: Martynov A.Yu., Diane M.L., Bayramov S. Myocardial infarction in a young male patient with specific risk factors for coronary heart disease who was a bodybuilder for a long time. RMJ. 2020;10:35–39.



Pages 7-11. Прогностическое значение лабораторных и структурно-функциональных аспектов ремоделирования сердечно-сосудистой системы у больных с хронической сердечной недостаточностью ишемического генеза. Алиева А.М., Алмазова И.И., Резник Е.В., Никитин И.Г.

Summary:

Prognostic value of laboratory parameters and structural and functional aspects of cardiac remodeling in patients with chronic heart failure of ischemic origin

A.M. Alieva1, I.I. Almazova2, E.V. Reznik1, I.G. Nikitin1

1Pirogov Russian National Research Medical University, Moscow

2Russian Medical Academy of Continuous Professional Education, Moscow

Aim: to determine the prognostic value of laboratory parameters and structural and functional aspects of cardiac remodeling in patients with chronic heart failure (CHF).

Patients and Methods: the study included 218 patients with coronary heart disease (CHD) and CHF (the average age of patients was 54.4±8.9 years). Upon admission to the hospital, a clinical examination was performed. After discharge, the follow-up of the patients was conducted every 6 months in the first 2 years, and then once a year for 5 years. The end point was considered to be cardiac death.

Results: 124 patients were available for the follow-up. Given 3 cases of sudden cardiovascular death, the cause of death in 25 patients was progressive heart failure (HF), including 22 who died from the acute decompensated heart failure. Three patients died from acute HF that developed in the early postoperative period after coronar y artery bypass grafting. Patients with cardiac death were older and had a longer CHD course. Among the dead patients, there were significantly more with severe HF, arterial hypertension of grade 2 or more, and postinfarction cardiosclerosis. The following risk factors significantly affected five-year survival: age 65; left ventricular ejection fraction (LVEF) — 45.5%; left ventricular end-systolic volume index (LV ESVI) — 81%; left atrial size — 4.45 cm; the number of sites with impaired contractility — 5; stenosis of the proximal third of the anterior interventricular branch — 72.5%, C-reactive protein (CRP) — 6.5 mg/l. The following biochemical parameters regarding cardiac death: creatinine levels ≥ 98.65 mmol/l; brain natriuretic peptide precursor (proBNP) ≥ 420.2 fmol/ml; CRP ≥ 6.5 mg/l; LDL cholesterol ≥ 4.33 mmol/l. The most effective regression analysis model included LVEF of 45.5% and serum CRP of 6.5 mg/l. LVEF of 45.5% had a sensitivity of 89 .7% and a specificity of 90.4%.

Conclusion: proBNP, CRP and LVEF showed a high prognostic significance regarding cardiac death.

Keywords: chronic heart failure, echocardiography, ejection fraction, brain natriuretic peptide precursor.

For citation: Alieva A.M., Almazova I.I., Reznik E.V., Nikitin I.G. Prognostic value of laboratory parameters and structural and functional aspects of cardiac remodeling in patients with chronic heart failure of ischemic origin. RMJ. 2020;10:7–11.



№9, 2020. Клинические рекомендации и алгоритмы для практикующих врачей

Pages 13-17. Взаимодействие антиэпилептических препаратов и противовирусных средств для лечения COVID-19: нужна ли коррекция противоэпилептической терапии?. Холин A.A., Заваденко Н.Н., Холина Е.A., Заваденко А.Н., Нестеровский Ю.Е.

Summary:

Drug-drug interaction of anti-epileptic drugs and antiviral agents for the treatment of COVID-19: is it necessary to correct antiepileptic therapy?

A.A. Kholin, N.N. Zavadenko, E.A. Kholina, A.N. Zavadenko, Yu.E. Nesterovskii


Pirogov Russian National Research Medical University, Moscow


Epilepsy is one of the most common neurological diseases observed in almost every 100th person; a new coronavirus infection (COVID-19) pandemic can not pass by this patient cohort. In conditions of infection, patients with epilepsy should continue the selected antiepileptic therapy. The authors analyze the world experience of evaluating the drug-drug interaction between various antiepileptic drugs (AEDs) and antiviral and antiparasitic agents used to treat infections caused by SARS-CoV-2 pathogen and recommendations for their compatibility. In this review, the summary table shows the interactions of most AEDs used with such drugs as atazanavir, darunavir/cobicistat, lopinavir/ritonavir, remdesivir, favipiravir, chloroquine, hydroxychloroquine, nitazoxanide, ribavarin, tocilizumab and oseltamivir. Of the broad-spectrum AEDs, levetiracetam therapy alone is the safest for the patient with epilepsy if there is a  need to treat a severe viral infection, such as COVID-19. It is not advisable to use a combination of vigabatrin with glucocorticoids due to the risk of SUDEP (Sudden Unexpected Death in Epilepsy). Such AEDs as vigabatrin, gabapentin, retigabine and pregabalin are also without adverse interactions with antiviral agents, but the range of their use is significantly limited.

Keywords: epilepsy, anti-epileptic drugs (AEDs), antiviral drugs, COVID-19.

For citation: Kholin A.A., Zavadenko N.N., Kholina E.A. et al. Drug-drug interaction of anti-epileptic drugs and antiviral agents for the treatment of COVID-19: is it necessary to correct antiepileptic therapy? RMJ. 2020;9:13–17.



Pages 18-22. «Коронавирусный синдром»: профилактика психотравмы, вызванной COVID-19. Соловьева Н.В., Макарова Е.В., Кичук И.В.

Summary:

“Сoronavirus syndromе”: prevention of phsychotrauma caused by COVID-19

N.V. Solovieva1, E.V. Makarova1,2, I.V. Kichuk3


1Personilized Psychiatry JSC, Moscow

2National Medical Research Center of Rehabilitation and Resort Medicine, Moscow

3Pirogov Russian National Research Medical University, Moscow


COVID-19 (COronaVIrus Disease 2019) is a new viral infection characterized by rapid spread, high mortality rate, significant social and economic consequences that destroy the usual way of life. Coronavirus syndrome is a mental disorder presenting itself a response to the COVID-19 pandemic. Presumably, the coronavirus syndrome will affect up to 10% of the population involved in the pandemic, mainly people who have been exposed to a combination of psychosocial and biological factors of stress vulnerability. The article discusses predisposing factors and clinical manifestations of coronavirus syndrome. The risk groups of developing coronavirus syndrome are medical workers who provide care to patients with COVID-19; patients who have suffered a severe disease form, lost relatives and friends, as well as those who have suffered extensive financial losses and lost their jobs. The authors consider treatment methods for coronavirus syndrome: psychotherapy (cognitive behavioural therapy with narrative and exposure methods) and pharmacotherapy, which should be aimed at relieving anxiety, restoring sleep, treating depression and other mental disorders. The a uthors also emphasize that timely psychotherapy and pharmacotherapy of the coronavirus syndrome is very important since it is assumed that this syndrome will reduce the work productivity of the population at a time when it will be extremely necessary for economic recovery.

Keywords: COVID-19, post-traumatic stress disorder, psychotherapy, pharmacotherapy, fabomotizol, anxiolytic.

For citation: Solovieva N.V., Makarova E.V., Kichuk I.V. “Coronavirus syndromе”: prevention of phsychotrauma caused by COVID-19. RMJ. 2020;9:18–22.

Pages 2-6. Коронавирусная болезнь COVID-19: неиспользованные возможности терапии. Громов А.А., Кручинина М.В., Рабко А.В.

Summary:

Coronavirus disease CIVID-19 - unused therapy opportunities

A.A. Gromov 1,2, M.V. Kruchinina 1, A.V. Rabko 1,2

Research Institute of Therapy and Preventive Medicine - a branch of the Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk

LLC Center for the prevention of thrombosis, Novosibirsk

High mortality and the enormous socio-economic consequences of the COVID-19 virus epidemic require the immediate development of effective treatment methods. The main complication of coronovirus infection, leading to the development of a fatal outcome, is pneumonia, respiratory and multiple organ failure, which develop in some patients with COVID-19 infection.

An analysis of the clinical, laboratory and pathoanatomical picture of the SARS-CoV-2 virus lesion according to the literature suggests that there are disturbances in the microcirculation and oxygen transportation, erythrocyte hemolysis, intraalveolar fibrinogenesis and microthrombogenesis in the pathogenesis of patients, which fits into the picture of chronic hemolytic microtrombovascular syndrome of second and second intravascular coagulation (chronic DIC).

The prevention of these processes, preventive and early therapy, the combined use of anticoagulants, antiplatelet agents of the erythrocyte series, membrane-stabilizing drugs and, possibly, mild thrombolytic drugs for outpatient use, according to the authors, can prevent the development of life-threatening complications and reduce mortality of patients COVID-19.

Early prophylactic therapy with anticoagulants, antiplatelet agents and membrane-stabilizing drugs, an early treatment regimen for pneumonia with outpatient thrombolytic drugs and anticoagulants are proposed. To prevent hemorrhagic complications, two schemes for identifying risk groups for hemorrhagic complications and the use of thrombolytic therapy in these patients in lower doses have been proposed.

Keywords: SARS-CoV-2, COVID-19, microthrombosis, microcirculatory disorders, anticoagulant therapy, antiplatelet agents, red blood cells

For citation: Gromov A.A., Kruchinina M.V., Rabko A.V. COVID-19: therapy possibilities in reserve. RMJ. 2020;9:2–6.




Pages 24-30. Применение препарата Тималин® при заболеваниях органов дыхания. Перспективы использования при COVID-19. Хавинсон В.Х., Кузник Б.И., Стуров В.Г., Гладкий П.А.

Summary:

Thymalin use for respiratory diseases. Application potential in COVID-19

V.Kh. Khavison1,2, B.I. Kuznik3, V.G. Sturov4, P.A. Gladkii4


1St. Petersburg Institute of Bioregulation and Gerontology, Saint-Petersburg 

2Pavlov Institute of Physiology of the Russian Academy of Sciences, Saint-Petersburg

3Chita State Medical Academy, Chita

4Novosibirsk State University, Novosibirsk


Thymalin® (thymus extract) is aimed at correction of cellular and humoral immunity and hemostasis system. This medication has a significant antioxidant effect, stimulates phagocytosis, regeneration processes and improves cellular metabolism processes. During experiment, it prevents the atherosclerosis development in animals on an atherogenic diet. This medication is a geroprotector that can increase animal life expectancy when administered systematically. The use of this drug in respiratory diseases (acute pneumonia, chronic obstructive bronchitis, a combination of obstructive chronic bronchitis with chronic pneumonia, lung abscess, bronchial asthma, and etc.) is accompanied by immunogram normalization, a decrease of the pro-inflammatory cytokines level, which should prevent the cytokine storm syndromes. At the same time, the state of the hemostatic system and inflammatory acute-phase proteins is normalized. When using Thymalin®, the frequency of complications, the process transition to a chronic form and the period of inpatient stay decreased. Great clinical results in respiratory diseases were obtained when Thymalin® was co-administered with heparin. We consider it promising to study Thymalin® efficacy and safety in the treatment of patients with COVID-19.

Keywords: thymus extract, Thymalin, heparin, immunity, hemostasis, inflammatory acute-phase proteins, pneumonia, respiratory distress syndrome, COVID-19.

For citation: Khavison V.Kh., Kuznik B.I., Sturov V.G., Gladkii P.A. Thymalin use for respiratory diseases. Application potential in COVID-19. RMJ. 2020;9:24–30.



Pages 32-38. О перспективах использования витамина D и других микронутриентов в профилактике и терапии COVID-19. Громова О.А., Торшин И.Ю., Малявская С.И., Лапочкина Н.П.

Summary:

About the prospects of using vitamin D and other micronutrients in the prevention and therapy of COVID-19

O.A. Gromova1,2, I.Yu. Torshin1,2, S.I. Malyavskaia3, N.P. Lapochkina4


1Computer Science and Control of the Russian Academy of Sciences, Moscow

2Lomonosov Moscow State University, Moscow

3Northern State Medical University, Arkhangelsk

4Ivanovo State Medical Academy, Ivanovo 

Vitamin D deficiency, which occurs in 80% of Russians, is associated with impaired functioning of the innate and acquired immunity and an increased risk of viral and bacterial diseases. In the setting of vitamin D deficiency, chronic inflammation develops in a patient of any age, which significantly reduces the body’s resistance to bacterial and viral diseases. Innate antiviral immune bolstering is the most important direction of the new COVID-19 prevention among the general population. Given the biological role of vitamin D in maintaining antiviral immunity and the significant prevalence of vitamin D deficiency, its compensation is a necessary component for the prevention of new COVID-19. This review presents the systematic analysis results of the texts of 20,600 publications on coronavirus infections, conducted by artificial intelligence methods based on the topological theory of recognition. There  are two main directions for improving the efficacy of COVID-19 therapy and prevention: reducing the effects of the so-called cytokine storm syndrome and compensating of the patient’s chronic comorbid pathologies. Vitamin D is essential for maintaining the levels and activity of interferon-dependent proteins involved in antiviral defense, reducing the effects of the cytokine storm syndrome and compensating of comorbid pathologies.

Keywords: COVID-19, RNA viruses, micronutrients, vitamin D, SARS-CoV-2, cytokine storm syndrome, immunity, prevention.

For citation: Gromova O.A., Torshin I.Yu., Malyavskaia S.I., Lapochkina N.P. About the prospects of using vitamin D and other micronutrients in the prevention and therapy of COVID-19. RMJ. 2020;9:32–38.

Pages 39-44. Липосомальный лактоферрин как потенциальное средство профилактики и лечения COVID-19. Санмигель Г.С., Кочергина Ю., Альборс А., Диаз Е., Ороваль М., Уэсо Г., Серрано Х.М.

Summary:

Liposomal Lactoferrin as Potential Preventative and Cure for COVID-19

Gabriel Serrano Sanmiguel1, I. Kochergina1, A. Albors2, E. Diaz3, M. Oroval3, G. Hueso3, J.M. Serrano3


1Dr. Serrano Dermatology Clinic, Valencia, Spain

2Medical Department of Sesderma Laboratories, Valencia, Spain

3Research Department of Sesderma Laboratories, Valencia, Spain

Aim: this study is aimed at evaluating the efficacy of bovine liposomal lactoferrin (LLF) for the treatment of COVID-19 on outpatient basis.

Patients and Methods: a prospective observational study was performed in 75 patients with typical symptoms of COVID-19 who tested positive to IgM/IgG rapid test. Patients were isolated and treated at home using remote systems, reviewed twice a day for 10 days, and followed up to 1 month. A liposomal bovine lactoferrin (LLF) nutritional syrup food supplement (32 mg of LF / 10 ml plus 12 mg of vitamin C) was administered orally in 4 to 6 doses per day for 10 days. In addition, a zinc solution was administered at the dose of 10 mg / 10 ml twice or three times a day. A control group of 12 patients who took only LLF was included. All family members in contact with patients (256 persons) were also treated with half of this dose.

Results: the most frequent symptoms in our patients were a very heavy sensation of tiredness or weakness (95%), alteration in the perception of smelling and taste (88%), cough (83%) and muscular pain (67%). Oral treatment with LLF and LLF + zinc solution allowed for significant improvement in 100% of patients within the first 4–5 days. Same treatment at lower dose prevented the disease in healthy persons directly related with the affected patients.

Conclusion: LF possess antiviral, immunomodulatory and anti-inflammatory effects which might be important for the treatment of COVID-19 infection. The authors concluded that there is a potential use of LLF for the prevention and treatment of COVID-19.

Keywords: COVID-19, liposomal bovine lactoferrin, viral infection, respiratory tract infection, prevention.

For citation: Serrano G., Kochergina I., Albors A. et al. Liposomal Lactoferrin as Potential Preventative and Cure for COVID-19. RMJ. 2020;9:39–44 (translation into Russian).

Pages 46-50. Новые возможности выбора ингаляционного устройства для пациентов с бронхиальной астмой и хронической обструктивной болезнью легких. Архипов В.В.

Summary:

New options for choosing an inhalation device for patients with asthma and chronic obstructive pulmonary disease

V.V. Arkhipov


Russian Medical Academy of Continuous Professional Education, Moscow


The variety of drug delivery for the treatment of asthma and chronic obstructive pulmonary disease (COPD) allows using the differentiated approach when choosing an inhaler for each patient. The review considers various types of inhalers and the characteristics of their use in clinical practice. Dry-powder inhalers are a good alternative for patients who are unable to accurately synchronize the activation of a pressurized metered dose inhaler (pMDI), however, most dry-powder inhalers require a relatively high-volume flow rate on inhalation, commonly at least 60 L/min. In clinical practice, it is not possible to measure the inspiratory flow rate in each patient. However, it is possible to distinguish the types of patients who commonly have insufficient inspiration flow rate. Thus, the efficacy of dry-powder inhalers decreases in children aged 6 to 11 years and elderly patients wit h COPD and asthma. In these patient cohorts, it may be more preferable to use Symbicort® Rapihaler — pMDI that contains the same active components as the widely used Symbicort® Turbuhaler®.

Keywords: chronic obstructive pulmonary disease, bronchial asthma, Symbicort, Turbuhaler, Rapihaler, dry-powder inhaler, pressurized metered dose inhaler.

For citation: Arkhipov V.V. New options for choosing an inhalation device for patients with asthma and chronic obstructive pulmonary disease. RMJ. 2020;9:46–50.

Pages 51-58. Ревматоидный артрит: роль врача общей практики в улучшении исходов заболевания. Чичасова Н.В., Лила  А.М., Верткин  А.Л.

Summary:

Rheumatoid arthritis: the role of a general practitioner in improving disease outcomes

N.V. Chichasova1,2, A.M. Lila1,2, A.L. Vertkin3

1Research Institute of Rheumatology named after V.A. Nasonova, Moscow

2Russian Medical Academy of Continuous Professional Education, Moscow

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

The article discusses the role of a primary care physician (therapist) in improving the immediate and long-term outcomes of rheumatoid arthritis (RA). 2010 Rheumatoid Arthritis Classification Criteria, created for early diagnosis of the disease are presented in this aticle. These classification criteria describe the RA pathogenetic stages from the phase of autoimmune disorders induction to the clinical stage. According to the National Guidelines on the RA stages diagnosis for general practitioners, there are simplified criteria for early RA diagnosis, in the presence of which the patient should immediately be referred to a rheumatologist. The RA onset variants and recommendations for the necessary laboratory and instrumental examination of a patient with detected arthritis are also given.  The European League Against Rheumatism presents the arthralgia definition suspected of developing RA, which directs the general practitioners to identify RA in patients at a very early (preclinical) stage. It also brings up the principles of RA therapy, the place of symptomatic and baseline therapy and the need for early prescription of adequate therapy to improve the diseases outcomes. At present, the possibilities of methotrexate as an anchor drug in the RA treatment are being discussed: the conditions necessary to achieve the maximum and long-term methotrexate effect by using the subcutaneous form of the drug and the role of the general practitioner in conducting controlled treatment of patients with RA. Recommendations for the prevention and treatment of adverse reactions during the methotrexate use, for screening during planning the prescription of genetically engineered biological drugs and Janus kinase inhibitors are presented. The article also discusses the infeasibility  concerning the unjustified discontinuation of baseline treatment.

Keywords: rheumatoid arthritis, diagnostics, treatment tactics, methotrexate, efficacy, safety.

For citation: Chichasova N.V., Lila A.M., Vertkin A.L. Rheumatoid arthritis: the role of a general practitioner in improving disease outcomes. RMJ. 2020;9:51–58.



Pages 59-64. Терапия железодефицитной анемии в гериатрической практике. Кропова О.Е., Шиндина Т.С., Максимов  М.Л., Галявич  А.С., Александрова Е.Б.

Summary:

Therapy of iron-deficiency anemia in geriatric practice

O.E. Kropova1, T.S. Shindina1, M.L. Maximov2,3, A.S. Galyavich4, E.B. Alexandrova1

1Outpatient Clinic No. 5, Moscow

2Kazan State Medical University, the branch of the Russian Medical Academy of Continuous Professional Education, Kazan

3Pirogov Russian National Research Medical University, Moscow

4Kazan State Medical University, Kazan 

The review examines the causes, pathogenesis, as well as issues of diagnosis and correction of iron-deficiency anemia (IDA) in gerontological practice. IDA may have the pluricausal origin in patients of elderly and senile age. Systemic hypoxia caused by anemia worsens the course of concomitant diseases and affects life expectancy. Anemia is an independent factor of adverse prognosis in patients with chronic heart failure (CHF), while up to 70% of anemia cases in patients with CHF are iron-deficient. When diagnosing IDA, it is necessary to focus on the hemoglobin concentration, state indicators of red blood cells and iron metabolism in the body. The article describes methods to the IDA treatment in elderly and senile patients, taking into account the pharmacokinetics and pharmacodynamics of bivalent and trivalent iron medications for oral and parenteral administration. It is necessary to give preference to medications based on the trivalent iron(III)-hydroxide polymalt ose complex for enteral administration to minimize the frequency of adverse reactions. If there is no response to therapy with oral medications, it is indicated to use modern non-dextran intravenous iron medications in case of rapid correlation of IDA or iron deficiency before surgery.

Keywords: iron metabolism, iron-deficiency anemia, bivalent iron, trivalent iron, gerontology, anemia treatment, rational pharmacotherapy, polypragmasia, chronic heart failure, pharmacotherapy safety.

For citation: Kropova O.E., Shindina T.S., Maximov M.L. et al. Therapy of iron-deficiency anemia in geriatric practice. RMJ. 2020;9:59–64.



Pages 65-70. Современные подходы к лечению острых и хронических болей у пациентов с заболеваниями опорно-двигательного аппарата: фокус на безопасность фармакотерапии. Чичасова Н.В., Лила А.М.

Summary:

Modern methods to the treatment of acute and chronic pain in patients with musculoskeletal disorders: the focus on the pharmacotherapy safety

N.V. Chichasova1,2, A.M. Lila1,2

1Research Institute of Rheumatology named after V.A. Nasonova, Moscow

2Russian Medical Academy of Continuous Professional Education, Moscow

All disorders of the musculoskeletal system are characterized by the development of chronic pain syndrome. The most common cause is the presence of chronic inflammation of the synovial membrane. The first-line means for the treatment of chronic joint pathology are commonly non-steroidal anti-inflammatory drugs (NSAIDs). They are also used to relieve acute pain. Nimesulide is the only NSAID belonging to the class of arylsulfonamides. This review discusses the possibility of using nimesulide in the treatment of chronic and acute pain in patients with musculoskeletal disorders. The authors analyze the results of foreign and national randomized and open comparative studies on the efficacy and safety of nimesulide in acute and chronic pain in patients with musculoskeletal disorders. Based on the presented data, the researchers conclude that nimesulide has a pronounced anti-inflam matory and analgesic effect with the high rate of its action, and good tolerability, including in patients with NSAID gastropathy, metabolic syndrome and hypertension. The use of nimesulide in the dosage form of gel for external use allows to reach a greater effect when combined with the tablet form. It does not worsen the therapy tolerability, which is especially important for comorbid patients.

Keywords: musculoskeletal disorders, nimesulide, Nise, pharmacodynamics, efficacy, tolerance, comorbidity.

For citation: Chichasova N.V., Lila A.M. Modern methods to the treatment of acute and chronic pain in patients with musculoskeletal disorders: the focus on the pharmacotherapy safety. RMJ. 2020;9:65–70.

Pages 7-12. Острые инфекционные заболевания у детей: превентивные меры и патогенетическая терапия (симпозиум в рамках VI конгресса Евро-Азиатского общества по инфекционным болезням).

Pages 71-76. Фармакотерапия, проверенная временем: от механизмов к клинической эффективности. Максимов М.Л., Малыхина А.И., Шикалева А.А.

Summary:

Time-proved pharmacotherapy: from mechanisms to clinical efficacy

M.L. Maximov1, A.I. Malykhina2, A.A. Shikaleva1

1Kazan State Medical University, the branch of the Russian Medical Academy of Continuous Professional Education, Kazan

2Center of Endosurgery and Lithotripsy (CELT) JSC, Moscow

This review article, based on the significant number of sources, describes the full range of pharmacological effects, the mechanism and aspects of the clinical use of the original national Dimephosphon® (INN: dimethyloxobuthylphosphonilmethylate). Vasoactive and antihypoxic, neuroprotective and cerebroprotective, as well as antioxidant effects of this drug are considered. The article also notes the ability of this non-anticholinesterase organophosphorus compound to normalize cerebrovascular reactivity, reduce vascular tone, improve arterial elasticity, normalize regional blood flow and oxygen-dependent energy metabolism in the structures of the central nervous system. Adding that, this drug can optimize intracellular metabolism of the brain, prevent the reaction of lipid peroxidation and implement the antiacidotic effect by virtue of the intensification of the renal and pulmonary regulation mechanisms of the acid-base state body condition (as one of the most important and strictly stabilized parameters of homeostasis). Dimephosphon® increases organ blood flow and tissue metabolism, and also leads to a decrease in the content of lactic and pyruvic acids in brain tissues. At present, there is a large clinical use of dimethyloxobuthylphosphonilmethylate in acute disorders of cerebral blood flow, postoperative and posttraumatic cerebral disorders, Meniere’s disease and autonomic dysfunction, as well as in cerebrospinal injury.

Keywords: dimephosphone, neuroprotector, cerebroprotector, antioxidant, antihypoxant, vasoprotector, blood flow, vascular tone, metabolism, acid-base condition.

For citation: Maximov M.L., Malykhina A.I., Shikaleva A.A. Time-proved pharmacotherapy: from mechanisms to clinical efficacy. RMJ. 2020;9:71–76.

Pages 77-80. Разработка состава, методики получения и стандартизация лекарственного растительного препарата «Марены красильной сироп». Рыбалко М.В., Куркин  В.А., Шмыгарева А.А., Саньков А.Н.

Summary:

Rubia tinctorum L. syrup — composition development, techniques and standardization of medicinal plant preparation

M.V. Rybalko, V.A. Kurkin, A.A. Shmygareva, A.N. Sankov


Orenburg State Medical University, Orenburg

The aim of the study was to develop composition, techniques and standardization of medicinal plant preparation – Rubia tinctorum L. syrup. The study objects were rhizomes and roots of Rubia tinctorum L. Electronic spectra were measured using Unico 2800 UV spectrophotometer and Vilitek VBS ultrasonic bath. The study compared four extraction methods: maceration, percolation, repercolation, and fractional maceration using ultrasound. The method of fractional maceration with ultrasound proved to be the most effective extraction method for Rubia tinctorum L. raw materials.  For syrup preparation, a spissum extract of Rubia tinctorum L. was used. It was obtained by evaporation of water extraction and sugar syrup (made according to the compendial procedure). The following composition of Rubia tinctorum L. syrup has been developed: spissum extract of Rubia tinctorum L. — 3.5 g; 96.6% alcoh ol — 7.0 g; sugar syrup — 32.25 g. The result of the study was the development of methods for the assay of the anthracene derivatives content on the basis of ruberitrinic acid in the Rubia tinctorum L. spissum extract and syrup by spectrophotometry. The content of anthracene derivatives in the spissum extract of Rubia tinctorum L. was 8.7%±0.002 %, in the syrup — 0.75±0.002 %. During the study, the authors selected a method aimed at obtaining an extract for the manufacturing of Rubia tinctorum L. syrup by fractional maceration with ultrasound. The composition of Rubia tinctorum L. syrup was justified and methods for assay of anthracene derivatives content in the Rubia tinctorum L. spissum extract and syrup on the basis of ruberitrinic acid using spectrophotometry were developed. 

Keywords: Rubia tinctorum L., Rubia tinctorum L., rhizomes and roots, anthracene derivatives, ruberitrinic acid, spectrophotometry, spissum extract, syrup.

For citation: Rybalko M.V., Kurkin V.A., Shmygareva A.A., Sankov A.N. Rubia tinctorum L. syrup — composition development, techniques and standardization of medicinal plant preparation. RMJ. 2020;9:77–80.





№8, 2020. Неврология

Pages 12-15. Применение системной тромболитической терапии при остром ишемическом инсульте в практике врача-невролога: эффективность, безопасность, факторы, ограничивающие использование метода. Голдин А.Л.

Summary:

Systemic thrombolytic therapy for patients with acute ischemic stroke in the practice of a neurologist: efficacy, safety and factors limiting the use of the method

A.L. Goldin

Regional Vascular Center of the City Hospital No. 1, Sevastopol

Ischemic stroke (IS) is an acute medical and social problem. Thrombolytic therapy (TT) with alteplase is still not used on the common basis, given its important role in improving the medical care system for preventing stroke (as the most effective and safe method), according to the Ministry of Health of the Russian Federation.

The article discusses the possibilities concerning the practical application of systemic TT at the Vascular Center, provides data on the method effectiveness in patients diagnosed with IS, pays attention to the factors limiting the use of the TT method, and evaluates the efficacy of thrombolytic procedures in various gender and age groups. Cited data confirm the conclusions of national and foreign researchers concerning high safety and efficacy of systemic thrombolysis with alteplase, and assess the method of system TT in the modern practice of a neurologis t as an important and potent tool for emergency care of patients with acute IS. However, there is a number of objectively justified factors limiting its use that indicate the relevant problem of finding optimal ways to treat patients with acute IS.

Keywords: ischemic stroke, therapeutic window, thrombolytic therapy, thrombolysis, fibrinolytic, alteplase.

For citation: Goldin A.L. Systemic thrombolytic therapy for patients with acute ischemic stroke in the practice of a neurologist: efficacy, safety and factors limiting the use of the method. RMJ. 2020;8:12–15.



Pages 16-22. Трудный выбор НПВП для терапии боли у мультиморбидных пациентов. Акарачкова Е.С., Артеменко А.Р., Беляев А.А., Блинов Д.В., Бугорский Е.В., Кадырова Л.Р., Керимова К.С., Климов Л.В., Котова О.В., Лебедева Д.И., Орлова А.С., Ткачев А.М., Царева Е.В., Яковлев О.Н.

Summary:

Difficult choice of therapy with NSAIDs to relieve pain in multimorbid patients

E.S. Akarachkova1, A.R. Artemenko2, A.A. Belyaev3, D.V. Blinov4, E.V. Bugorkii5, L.R. Kadyrova6, K.S. Kerimova7, L.V. Klimov8, O.V. Kotova1,9, D.I. Lebedeva10, A.S. Orlova2, A.M. Tkachev11, E.V. Tsareva12, O.N. Yakovlev13

1International Society of Stress “Stress Under Control”, Moscow

2Sechenov University, Moscow

3Research Institute of Emergency Medicine named after N.V. Sklifosovsky, Moscow

4IPSOM LLC, Moscow

5Almatek LLC, Moscow region, Pavlovskaya Sloboda

6Kazan State Medical University, the branch of the Russian Medical Academy of Continuous Professional Education, Kazan

7Charitable Endowment “Podsolnukh”, Moscow

8Scientific and Practical Center of Pediatric Psychoneurology, Moscow

9National Medical Research Center of Cardiology, Moscow

10Tumen State Medical University, Tumen

11Diagnostic and Treatment Center of the Medical Institute named after Berezin Sergey (LDC MIBS-Volgograd LLC), Volgograd

12Unison LLC, Moscow

13Psychotherapeutic Outpatient Clinic Median, Trier, Germany

For a primary care physician, NSAIDs are convenient and effective agents for the treatment of pathologies in musculoskeletal system structures. The article presents the essentials when choosing NSAIDs for non-specific low back pain. The probability of an isolated risk in individual organ systems (gastrointestinal tract, cardiovascular system, liver, kidneys) and the combined risks when using NSAIDs is discussed. At present, many researchers stand for a more thorough study of NSAIDs to predict the potential risks of somatic adverse events. This is especially true of new medicines, the clinical profile of which does not allow to substantiate their complete safety. Against this background, special attention should be paid to Movalis® (meloxicam) — a drug with favourable spectrum of efficacy and safety, which is especially important  in patients with comorbid pathology and/or receiving combined therapy. For more than 20 years, Movalis in approved doses (7.5 mg/day or 15 mg/day) has been successfully used in the treatment of pain syndromes. Thanks to the “favourable history” and extensive experience in clinical practice, Movalis remains a priority in combined treatment and is considered as the “golden mean” of NSAID therapy.

Keywords: meloxicam, NSAIDs, polypragmasia, safety, combined risk, comorbid diseases, multimorbid patient, quality of life.

For citation: Akarachkova E.S., Artemenko A.R., Belyaev A.A. et al. Difficult choice of therapy with NSAIDs to relieve pain in multimorbid patients. RMJ. 2020;8:16–22.

Pages 2-4. Международные рекомендации по ведению пациентов с эпилепсией в условиях пандемии COVID-19 (по материалам ILAE). Холин A.A., Заваденко Н.Н., Холина Е.A.

Summary:

International guidelines for the patient management with epilepsy in the context of the COVID-19 pandemic (based on ILAE materials)

A.A. Kholin, N.N. Zavadenko, E.A. Kholina

Pirogov Russian National Research Medical University, Moscow

The conditions of the COVID-19 pandemic raise difficult questions for both patients with epilepsy and the doctors who treat them. The International League Against Epilepsy (ILAE) has developed new content and published a number of daily recommendations for specialists concerning patient management with epilepsy in the current conditions.

The risk of COVID-19 infection among patients with epilepsy, as well as other patients, is increased with disorders of the immune system and chronic diseases. It is necessary to ensure the regular provision of antiepileptic drugs (AED) to each patient. Since high body temperature and infection are triggers of epileptic seizures, patients with poorly controlled seizures may be more vulnerable to them during COVID-19 infection. Fatigue, sleep disturbances, and appetite disorders may be accompanied by a decrease in the administration of regular AED and an increase in the ri sk of epileptic seizures.

Keywords: epilepsy, recommendations, coronavirus, COVID-19, ILAE, the International League Against Epilepsy.

For citation: Kholin A.A., Zavadenko N.N., Kholina E.A. International guidelines for the patient management with epilepsy in the context of the COVID-19 pandemic (based on ILAE materials). RMJ. 2020;8:2–4.



Pages 23-29. Тревожные расстройства в практике педиатра и детского невролога. Заваденко Н.Н.

Summary:

Anxiety disorders in the practice of pediatrician and pediatric neurologist

N.N. Zavadenko

Pirogov Russian National Research Medical University, Moscow

Anxiety disorders (ADs) are one of the most common reasons for consulting doctors and occurring conditions in the clinical practice of pediatrician and pediatric neurologist. ADs are a group of syndromes concerning emotional disorders that are characterized by intense and long-term anxiety, subjective feelings of psychic tension and harm, states of being apprehensive, as well as the occurrence of an uncommon strong fear (irrational and not corresponding to the content of the situations or objects that cause it). Excessive anxiety causes children to experience significant disruptions and limitations in their lives: it becomes difficult for them to participate in normal activities at their age, attend school, cope with everyday school activities and homework, communicate and make friends. Signs of ADs vary significantly from patient to patient, depending on their age and type of ADs, and change over time  as they grow older. The GABAergic, noradrenergic, and serotonergic systems are considered key in relation to the ADs pathophysiology and the action mechanisms of anxiolytic agents. It is assumed that further study of the ADs neurobiological mechanisms, including the use of functional neuroimaging methods, will clarify the fundamental mechanisms of anxiety, the role of dysfunctions in various brain areas, and justify rational techniques to the therapy of ADs.

Keywords: anxiety disorder, children, teenagers, neurosis, physic tension, fear, phobia, emotions.

For citation: Zavadenko N.N. Anxiety disorders in the practice of pediatrician and pediatric neurologist. RMJ. 2020;8:23–29.

Pages 30-36. Боль, падения, ограничение двигательной активности и недостаточность питания как взаимосвязанные факторы риска инвалидизации лиц пожилого возраста: возможности коррекции. Колоколов О.В., Салина Е.А., Колоколова А.М.

Summary:

Pain, fallings, motor activity limitation and malnutrition as interrelated risk factors for disability in the elderly: ways for correction

O.V. Kolokolov, E.A. Salina, A.M. Kolokolova

Saratov State Medical University named after V.I. Razumovsky, Saratov

The article discusses the current risk factors and causes of disability in the elderly in the view of neurologists. Among disabilities are sensory disorders, spinal pain, depression, fallings, diabetes, dementia and osteoarthritis. The presence of one chronic disease mustn’t always limit the elderly life activity, while multimorbidity commonly leads to a significant decrease in life quality and an increase in the risk of fatal outcome. The authors focus on pain, fallings, motor activity limitation and malnutrition, which can become mutually aggravating problems. Malnutrition in the elderly can be aggravated by the presence of nervous system diseases and cause a decrease in muscle and bone mass, as well as the occurrence of motor activity limitation. It is important that the successful elimination of one of these factors reduces the risk of patient disability. The a rticle emphasizes the role of timely diagnosis and rational integrated approach in the treatment of multimorbid conditions, in particular the need for a combination of NSAIDs and B vitamins. Special attention is paid to the possibilities of relieving pain in elderly patients, the need to choose medicines with a high level of safety and multimodality.

Keywords: chronic pain, fallings, motor activity limitation, malnutrition, risk factors, elderly age, complex treatment.

For citation: Kolokolov O.V., Salina E.A., Kolokolova A.M. Pain, fallings, motor activity limitation and malnutrition as interrelated risk factors for disability in the elderly: ways for correction. RMJ. 2020;8:30–36.

Pages 37-40. Спондилит как осложнение перенесенного уросепсиса и инфекционного эндокардита (клиническое наблюдение). Третьякова Н.А., Суханин В.С., Вдовушкина Т.А.

Summary:

Spondylitis as a complication of urosepsis and infective endocarditis (case report)

N.A. Tretyakova, V.S. Sukhanin, T.A. Vdovushkina

Samara City Hospital No. 4, Samara

Spondylitis is an inflammatory destructive disease of the spine and its structural components. The urgency of the problem concerning diagnosis of this severe disease is due to the increase in the incidence of this pathology. Diagnosis of spondylitis is difficult, commonly occurs with a significant delay after the first disease signs, despite the availability of modern techniques of neuroimaging. The article describes a clinical case in which a patient experienced back pain in the setting of urosepsis, and the condition was subsequently complicated by the infective endocarditis occurrence. Despite the ongoing antibiotic therapy, the patient still had back pain, there was a neurologic deficit in the form of paraparesis. The diagnosis of spondylitis was established belatedly, 3 months after the disease onset.

The described clinical case showed insufficient alertness of doctors concerning this disease, which led to the late d iagnosis and prescription of pathogenetic treatment, therefore determining the disease outcome. In conclusion, it should be highlighted that protracted back pain in the elderly patient, not relieved by analgesics, combined with fever, as well as with the history of urosepsis and infective endocarditis, are the reasons for repeated spinal neuroimaging.

Keywords: spondylitis, infective endocarditis, urosepsis, spine CT, non-specific inflammatory disease of the spine, diagnostics.

For citation: Tretyakova N.A., Sukhanin V.S., Vdovushkina T.A. Spondylitis as a complication of urosepsis and infective endocarditis (case report). RMJ. 2020;8:37–40.



Pages 5-7. Особенности обновленной классификации эпилептического приступа и эпилепсии. Котов А.С., Фирсов К.В.

Summary:

Updated classification characteristics of seizures and epilepsy

A.S. Kotov, K.V. Firsov

Moscow Regional Clinical Research Institute named after M.F. Vladimirsky, Moscow

At present, the main classifications in Epileptology are ICD-10 and ILAE 2017. The ICD-10 does not meet the general scientific requirements for classification of epilepsy. This is due to several reasons: there is an intersection of concepts; the sum of the classification parts does not equal the generic concept volume; division into subclasses is not continuous; there are no classification bases, instead of which the non-operational terms «other», «special», «specified», «unspecified» are introduced. For a doctor, classification should be primarily practical. He should receive specific algorithms for diagnosis and treatment by using it. For a practitioner, it is necessary to classify epileptic seizures, forms of epilepsy, and epileptic syndromes. In turn, various specific grounds are highlighted in them, such as etiology, localization, and pathways of pathologic al activity. It leads to the establishment of detailed diagnosis, based on which the treatment algorithm is built. In some approximation, ILAE classification of 2017 is built on this principle. This classification of epilepsy is three-level (seizures type, epilepsy type, epileptic syndrome). The ideal way is to make a diagnosis at all levels and determine the etiology of epilepsy. Existing ILAE classifications are the result of a compromise obtained from various scientific and practical vectors. They do not meet the classical requirements for classification, but at the moment of Epileptology development, give the medical practitioner space to manoeuvre, and sometimes retreat.

Keywords: epilepsy, seizure, classification, terminology, ILAE 2017, ICD-10, syndrome, diagnosis, convulsions.

For citation: Kotov A.S., Firsov K.V. Updated classification characteristics of seizures and epilepsy. RMJ. 2020;8:5–7.



Pages 8-12. Магний в лечении и профилактике цереброваскулярных заболеваний. Акарачкова Е.С.

Summary:

Magnesium in the treatment and prevention of cerebrovascular diseases

E.S. Akarachkova

International Society of Stress “Stress Under Control”, Moscow

At present, there is mounting evidence concerning the magnesium role in determining the level of the cell potential, which is extremely important in the pathogenesis of stroke, as well as in the survival and recovery processes of brain cells. The energy donor in cellular processes is adenosine triphosphate (ATP) in the form of Mg2+-ATP complex. In acute and chronic brain ischemia, Mg2+ deficiency underlies cell hypoxia, which leads to their subsequent death. If there is much concern about life and death of the patient, severe micronutrient deficiency requires a massive correction of magnesium homeostasis. This is an integral component of resuscitation in neurology, cardiology, and obstetrics. But even in the routine practice of a neurologist, there are commonly patients with chronic cerebrovascular pathology accompanied by magnesium deficiency. This determines the need for the use of magnesium-containing agents with neuroprotective and neurotrophic properties in the treatment and prevention of cerebrovascular diseases. Magnesium sulfate is an essential part of therapy at the pre-hospital stage and during the acute phase of stroke, providing the brain with potentially protective agents and creating the basis for further neuroprotective therapy. Subsequently, the inclusion of magnesium  orotate in the comprehensive treatment and stroke prevention allows achieving persistent positive clinical results.

Keywords: neuroplasticity, neuroprotection, neurogenesis, apoptosis, excitotoxicity, ATP, NMDA receptors, cerebrovascular diseases, arterial hypertension, stroke, chronic brain ischemia, calcium, magnesium, magnesium deficiency, magnesium sulfate, magnesium orotate.

For citation: Akarachkova E.S. Magnesium in the treatment and prevention of cerebrovascular diseases. RMJ. 2020;8:8–12.



№7, 2020. Ревматология

Pages 14-18. От знания механизма действия — к принятию решения о выборе подхода к профилактике и лечению остеоартрита. Дыдыкина И.С., Нурбаева К.C., Коваленко П.С., Коваленко А.А., Зоткин Е.Г.

Summary:

From knowing the mechanism of action to choosing a method for the prevention and treatment of osteoarthritis

I.S. Dydykina1, K.S. Nurbaieva1, P.S. Kovalenko1, A.A. Kovalenko2, E.G. Zotkin1

1Research Institute of Rheumatology named after V.A. Nasonova, Moscow

2Sechenov University, Moscow

The article discusses the idea concerning the action mechanism of a drug substance allowing to successfully apply it in the clinical practice. This article also considers that the clinical practice is the main indicator and feasibility proof concerning the use of the drug substance. The long-term use experience of this drug allows to clarify its mechanism of action and interaction with other drugs, obtain and systematize late results or rare adverse events, and expand the indications or contraindications for certain groups of patients. Attention is drawn to the fact that many diseases, primarily osteoarthritis, have “become younger”, while the share of the elderly is steadily growing. The use of traditional analgesics and NSAIDs in elderly patients is limited or contraindicated in cases of high risk of cardiovascular complications, chronic kidney disease, and stomach ulcers. This category of patients may be prescribed  with topical therapy and/or alternative means leading to pain relief (disease-modifying antirheumatic drugs — DMARDs). It is important to expand the arsenal of means for the prevention and treatment of osteoarthritis with proven efficacy and safety. The article considers the mechanism of action, evidence data on the efficacy and safety of UC-II Undenatured Type 2 Collagen® (Sustaflex®), and the possibility of its use in patients with osteoarthritis.

Keywords: musculoskeletal disorders, osteoarthritis, pain treatment, gonarthritis, UC-II Undenatured Type 2 Collagen, Sustaflex.

For citation: Dydykina I.S., Nurbaieva K.S., Kovalenko P.S. et al. From knowing the mechanism of action to choosing a method for the prevention and treatment of osteoarthritis. RMJ. 2020;7:14–18.



Pages 19-24. Роль неомыляемых соединений авокадо/сои в лечении остеоартрита (реферат).

Summary:

Avocado/Soybean Unsaponifiables in the treatment of osteoarthritis (report)

This narrative review of the literature covers the mechanisms of action of avocado/soybean unsaponifiable mixture (ASU-E, Piascledine 300 from Laboratoires Expanscience) in patients with osteoarthritis (OA). The search was performed in Pubmed and Scopus between January 1981 and December 2016. Keywords used were (Cartilage OR Bone OR Synovium) AND Avocado AND Soybean. 32 articles out-off 35 found have been considered. Only research articles published in English and French have been taken into account. The review has included eleven in vitro and animal studies investigating the biological effects of ASU-E. ASU-E stimulated proteoglycans synthesis in chondrocytes cultures and counteracted the effects of interleukin-1 on metalloproteases and inflammatory mediators. Some of these effects were associated with inhibition of nuclear factor-κB nuclear translocation and stimulation of transforming growth factor synthesis. ASU-E also positively modulated the altered phenotype of OA subchondral bone osteoblasts and reduced the production of collagenases by synovial cells. Thus, ASU-E has positive effects on the metabolic changes of synovium, subchondral bone and cartilage which are the main tissues involved in the pathophysiology of OA. These findings contribute to explain the beneficial effects of ASU-E in clinical trials.

Keywords: cartilage, bone, synovium, osteoarthritis, avocado, soybean.

For citation: Avocado/Soybean Unsaponifiables in the treatment of osteoarthritis (report). RMJ. 2020;7:19–24.



Pages 2-8. Обновленные рекомендации по ведению пациентов с остеоартритом суставов кистей. Лила А.М., Алексеева Л.И., Таскина Е.А., Кашеварова Н.Г.

Summary:

Updated recommendations for the patient management with hand osteoarthritis

A.M. Lila1,2, L.I. Alekseeva1, E.A. Taskina1, N.G. Kashevarova1

1Research Institute of Rheumatology named after V.A. Nasonova, Moscow

2Russian Medical Academy of Continuous Professional Education, Moscow

Osteoarthritis (OA) is a joint disease characterized by cellular stress and degradation of the extracellular matrix resulting from macro/micro-injuries that activate pathological adaptive restorative responses, including pro-inflammatory pathways of the immune system. Hand OA is one of the most common localizations, and it is the second after knee OA in the prevalance. The article presents the classification of hand OA and provides data on the disease prevalence. The authors have reviewed in detail the current recommendations of the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) for the diagnosis and treatment of hand OA. The article also discusses in detail the issues of drug therapy of hand OA, in particular, the possibility of using chondroitin sulfate. Clinical study results show that the use of chondroitin sulfate in patient s with OA (including hand OA) contributes to a significant decrease in the pain severity, slow disease progression, improve joints function and comorbid diseases course, and can reduce the need for NSAIDs.

Keywords: Osteoarthritis, hand osteoarthritis, clinical recommendations, SYSADOA, chondroitin sulfate, Structum.

For citation: Lila A.M., Alekseeva L.I., Taskina E.A., Kashevarova N.G. Updated recommendations for the patient management with hand osteoarthritis. RMJ. 2020;7:2–8.

Pages 24-27. Волчаночноподобные дерматологические «маски» анапластической крупноклеточной лимфомы кожи. Башкова И.Б., Мадянов И.В.

Summary:

Lupus-like dermatological “masks” of cutaneous anaplastic large-cell lymphoma

I.B. Bashkova1,2, I.V. Madyanov1,3

1I.N. Ulianov Chuvash State University, Cheboksary

2Federal Center for Traumatology, Orthopedics and Arthroplasty, Cheboksary

3“The Postgraduate Doctors’ Training Institute”, Cheboksary

The systemic lupus erythematosus (SLE) is characterized by a wide range of clinical manifestations, which dictates the need for thorough differential diagnosis of SLE with other diseases. A special place in this case is occupied by skin lesions peculiar to SLE. Sometimes cutaneous lupus-like changes can mask the onset of other diseases, including oncohematological ones. The article gives an example of such a case.

A 40-year-old female patient whose dermatologist suspected SLE was referred to a rheumatologist. From medical history, it was known that 6 months ago during rest in camping site she caught a cold. A month later, mucopurulent discharge from the nasal passages occurred. Later, painless ulcers appeared in the nasal and oral cavity. Subsequently, right mammary gland swelling with diffuse induration and skin redness, similar to erysipelas, occurred. There was a moderate increase in the antero-cervical and axillary lymph nodes. The patient was referred for consultation to an oncologist-mammologist, who rejected the diagnosis of breast cancer based on ultrasound and mammography results and referred the patient to a dermatologist for consultation. After the research, the dermatologist suspected the onset of SLE on the basis of bilateral lesions in breast tissue, cutaneous erythema on the trunk, mild cutaneous hyperemia on the cheeks, increase in peripheral regional lym ph nodes, ulcers of the mucous membranes in the oral and nasal cavity, hair loss, weight loss during the disease by 7 kg. The immunological tests recommended by the rheumatologist did not confirm SLE in the female patient, which was the reason for conducting a breast biopsy. The combination of histological and immunohistochemical data obtained during the study of the biopsy material made it possible to diagnose primary anaplastic large-cell lymphoma with breast tissue lesions in the patient. In general, it took 6 months from the first visit to the doctors to establish a precise diagnosis.

Keywords: systemic lupus erythematosus, cutaneous and mucosal lesions, breast cancer, anaplastic large-cell lymphoma, diagnostic errors.

For citation: Bashkova I.B., Madyanov I.V. Lupus-like dermatological “masks” of cutaneous anaplastic large-cell lymphoma. RMJ. 2020;7:24–27.



Pages 28-32. Болезнь Стилла взрослых, моноциклическая форма (клинический разбор). Волков К.Ю., Свинцицкая И.С., Андрияненко А.О., Топорков М.М., Аганов Д.С., Белогуров А.Р., Клюев С.А.

Summary:

Monocyclic form of adult-onset Still’s disease (case report)

K.Yu. Volkov, I.S. Svintsitskaya, A.O. Andriyanenko, M.M. Toporkov, D.S. Aganov, A.R. Belogurov, S.A. Klyuiev

S.M. Kirov Military Medical Academy, Saint-Petersburg

Adult-onset Still’s disease (AOSD) is an autoinflammatory disease classified by ICD-10 as other rheumatoid arthritis (M06.1). The incidence of AOSD in the world is 0.16 per 100 thousand annually. The etiology of this disease is unknown. There are following main AOSD forms: self-limiting (monocyclic), intermittent (polycyclic) and chronic articular. Patterns of clinical diagnosis are concerned with the absence of pathognomonic symptoms, as well as of rheumatoid factor and cyclic citrullinated peptide antibodies in the blood serum and synovial fluid. Thus, the diagnosis of AOSD is an exclusion diagnosis.

This paper describes a clinical case of AOSD progression in a male patient aged 20 years. The key problems and principles of differential diagnosis are considered in detail. The authors note that AOSD is a nosology difficult to diagnose, occurring under the mask of infectious intoxication syndrome with febrile fever and catarrhal manifestations in the upper respiratory tract. Differential diagnosis and determination of the fever genesis requires a large amount of laboratory and instrumental studies. The patient was diagnosed with AOSD after performing several studies that made it possible to exclude a number of diseases and on the basis of M. Yamaguchi (1992) 5 classification criteria, 2 of which were major (temperature rise more than 39 °C for at least 1 week; WBC more than 10.0×106/L; neutrophilosis more than 80%), and 3 minor (sore throat, lymphadenopathy and splenomegaly, increased ALT and AST).

The authors demonstrated the efficacy of combination therapy with high doses of glucocorticosteroids (pulse methylprednisolone therapy with the switch to oral administration of 1 mg/kg/day) and methotrexate in the AOSD treatment. It was suggested that virus carriage (Epstein — Barr virus , cytomegalovirus, herpes viruses)in this patient might have triggered an auto-inflammatory process. The authors also noted that with correct and timely diagnosis, the monocyclic form is well amenable to therapy with the common achievement of persistent remission.

Keywords: fever of unknown origin, adult-onset Still’s disease, auto-inflammatory process, autoimmune pathology, neutrophilosis, hyperferritinemia, methylprednisolone, methotrexate.

For citation: Volkov K.Yu., Svintsitskaya I.S., Andriyanenko A.O. et al. Monocyclic form of adult-onset Still’s disease (case report). RMJ. 2020;7:28–32.



Pages 33-38. Воспалительная теория старения, возраст-ассоциированные заболевания и остеоартрит. Зоткин Е.Г., Дыдыкина И.С., Лила А.М.

Summary:

Inflammaging, age-related diseases and osteoarthritis

E.G. Zotkin, I.S. Dydykina, A.M. Lila

Research Institute of Rheumatology named after V.A. Nasonova, Moscow

As life expectancy and the proportion of elderly people in the general population increase, understanding how aging contributes to chronic diseases development is becoming a public health priority. This article discusses current views on the mechanisms of aging, including the inflammaging hypothesis by Claudio Franceschi in 2000, according to which the aging of many organisms, including human, is accompanied by an increase in inflammatory markers level in the blood, cells and tissues. The authors consider in detail the risk factors and causes of inflammaging: cytokine hypothesis, free radical hypothesis, genetic predisposition, cellular aging, autophagy, visceral obesity, age-related changes in the microbiota and intestinal permeability. Aging is one of the most significant risk factors for osteoarthritis. The major treatment tactics for osteoarthritis is combination therapy (medication and non-medication), aimed at suppressing both the systemic and topical inflammatory process. From  this point of view, the method for the treatment of osteoarthritis based on the principles of bioregulatory system medicine can be quite justified. Bioregulatory medicine is based on the idea of the human body as a multi-stage and multi-level regulatory network, an integral property of which is self-regulation.

Keywords: life expectancy, inflammaging, osteoarthritis, bioregulatory medicine, multimorbidity, Traumeel C, Zeel T.

For citation: Zotkin E.G., Dydykina I.S., Lila A.M. Inflammaging, age-related diseases and osteoarthritis. RMJ. 2020;7:33–38.



Pages 39-42. По следам исследования CARES: сердечно-сосудистая безопасность фебуксостата. Елисеев М.С., Новикова А.М.

Summary:

CARES study: cardiovascular safety of febuxostat

M.S. Eliseev, A.M. Novikova

Research Institute of Rheumatology named after V.A. Nasonova, Moscow

CARES (Gout and Cardiovascular Morbidities) study, data of which were published in 2018, served as the basis for adjustment the basic recommendations of the American College of Rheumatology (ACR) for the treatment of gout due to the fact that the incidence of cardiovascular mortality was significantly higher in the group receiving febuxostat (4.3%) versus the allopurinol group (3.2%) (p = 0.03). However, it is not possible to categorically accept the results of the study, given the number of serious methodological discrepancies, such as cancellation of the drug therapy in more than 50% of patients, termination of follow-up in 45% of patients, the initially prevailing number of patients with cardiovascular pathology in the febuxostat group, dosage inadequacy of medications taken, lack of information about the incidence and duration of arthritis and data on the use of non-steroidal anti-in flammatory drugs. Taking into account the described drawbacks and new researches results, the association of febuxostat administration with a high risk of cardiovascular mortality is premature and requires comparative studies without these drawbacks, including in patients with asymptomatic hyperuricemia, since in this case, it is possible to use placebo-control.

Keywords: cardiovascular diseases, febuxostat, allopurinol, hyperuricemia.

For citation: Eliseev M.S., Novikova A.M. CARES study: cardiovascular safety of febuxostat. RMJ. 2020;7:39–42.

Pages 44-48. Антикоагулянтные и антиагрегантные эффекты хондроитина сульфата. Торшин И.Ю., Лила А.М., Громова О.А., Лиманова О.А., Иванова М.И., Рудаков К.В.

Summary:

Anticoagulant and antiplatelet effects of chondroitin sulfate

I.Yu. Torshin1,2, A.M. Lila3, O.A. Gromova1,2, O.A. Limanova2,4, M.I. Ivanova1,2, K.V. Rudakov1,2

1Computer Science and Control of the Russian Academy of Sciences, Moscow

2Lomonosov Moscow State University, Moscow

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

4Ivanovo State Medical Academy, Ivanovo

Molecules of chondroitin sulphate (CHS), from which the gel-based proteoglycans of connective tissue are synthesized, are important for the restoration of cartilage and have a marked anti-inflammatory effect. Osteoarthritis (OA) is accompanied by chronic inflammation and, therefore, refers to diseases with an increased risk of thrombosis. Systematic analysis results of experimental and clinical studies presented in this paper indicate the prospects for the use of standardized CHS extracts to achieve anticoagulant and antiplatelet effects. Anticoagulant CHS mechanisms are implemented by inhibiting the activation of coagulation factor X, antiaggregant mechanisms — by activating the CD44 receptor, which leads to inactivation of NF-kB signalling cascades of platelets. Thus, the use of chondroprotectors based on CHS in patients with OA can be considered simultaneously as a means of cardioprophylaxis, as the an ticoagulant and antiplatelet effects of standardized CHS contribute to reducing the thromboembolic risk. Polypragmasia may be observed in patients with OA and comorbid diseases, due to the need for prescription of various anti-inflammatory, antithrombotic and chondroprotective agents. The use of CHS-based chondroprotective agents a with a high pharmaceutical standardization is pathogenetically substantiated to avoid adverse events in the treatment of patients with OA receiving antithrombotic therapy or NSAIDs. 

Keywords: chondroitin sulfate, heparins, systems biology, chondroprotector.

For citation: Torshin I.Yu., Lila A.M., Gromova O.A. et al. Anticoagulant and antiplatelet effects of chondroitin sulfate. RMJ. 2020;7:44–48.



Pages 9-13. Ультразвуковая диагностика в ревматологии: возможности и перспективы. Волков К.Ю., Свинцицкая И.С., Тыренко В.В., Платонова А.В., Хайрутдинов В.Р., Демьяненко Н.Ю., Бологов С.Г.

Summary:

Ultrasonic diagnostic in rheumatology: capabilities and prospects

K.Yu. Volkov, I.S. Svinitskaya, V.V. Tyrenko, A.V. Platonova, V.R. Khairutdinov, N.Yu. Demyanenko, S.G. Bologov

S.M. Kirov Military Medical Academy, Saint Petersburg

Nowadays, ultrasound is one of the most informative methods of imaging examination. Given its portability, accessibility, speed of execution, relatively low cost and almost complete absence of contraindications, ultrasound is an effective method not only for diagnosis but also for evaluating the quality of treatment. This method is highly informative in visualizing tendons and ligamentous apparatus, hyaline cartilage, cortical bone and para-articular soft tissues, which greatly expands the diagnostic and treatment capabilities of a rheumatologist and allows to monitor the treatment efficacy. This article discusses the possibility of using ultrasound in the diagnosis of a number of rheumatological diseases, such as rheumatoid arthritis, osteoarthritis, spondyloarthritis, gout and tendon lesions in hypercholesterolaemia. The possibilities of using sonoelastography (a method that allows determining the elasticity o f soft tissue structures) in the diagnosis of rheumatic diseases are also considered. According to the authors, sonoelastography may soon become substantially established in clinical practice as a first-line diagnostic method for detecting biomechanical changes in tendons, muscles, ligamentous apparatus, as well as evaluating the treatment efficacy. Ultrasound of the musculoskeletal system significantly increases the diagnostic and therapeutic capabilities of the clinician.

Keywords: rheumatological diseases, ultrasound of the musculoskeletal system, osteoarthritis, spondylarthritis, rheumatoid arthritis, gout, sonoelastography.

For citation: Volkov K.Yu., Svinitskaya I.S., Tyrenko V.V. et al. Ultrasonic diagnostic in rheumatology: capabilities and prospects. RMJ. 2020;7:9–13.



№6, 2020. Клинические рекомендации и алгоритмы для практикующих врачей

Pages 10-14. Эффекты и механизм действия таурина как лекарственного средства (реферат).

Summary:

Effects and Mechanisms of Taurine as a Therapeutic Agent (report)

Taurine is a β-amino acid found in most cells with diverse cytoprotective activity. In some species, taurine is an essential nutrient but in man it is considered a semi-essential nutrient, although cells lacking taurine show major pathology. These findings have spurred interest in the potential use of taurine as a therapeutic agent. The discovery that taurine is an effective therapy against congestive heart failure (CHF) led to the study of taurine as a therapeutic agent against other disease conditions. Today, taurine has been approved for the treatment of CHF in Japan and shows promise in the treatment of several other diseases. The present review summarizes studies supporting a role of taurine in the treatment of cardiovascular disease (CHF, hypertension, atherosclerosis, ischemic reperfusion injury, arrhythmia) and metabolic diseases (mitochondrial diseases — MELAS, diabetes mellitus and obesity). The review covers both experimental studi es on animal models and clinical trials, and addresses the functions of taurine (regulation of antioxidation, energy metabolism, gene expression, ER stress, quality control and calcium homeostasis) underlying its therapeutic actions.

Keywords: taurine, cytoprotection, antioxidation, cardiovascular diseases, metabolic diseases.

For citation: Effects and Mechanisms of Taurine as a Therapeutic Agent (report). RMJ. 2020;6:10–14.

Pages 15-19. Клинические рекомендации в свете нового законодательства. Казаков А.С., Зырянов С.К., Ушкалова Е.А.

Summary:

Clinical practice guidelines in the light of novel legislation

A.S. Kazakov, S.K. Zyryanov, E.A. Ushkalova

Peoples Friendship University of Russia, Moscow

For general practitioners, clinical practice guidelines are a framework to assist decision-making being summarized guides of actions. These guides are based on the results of clinical studies on efficacy and safety of medical procedures which significantly improve the quality of health care. Non-compliance with practice guidelines is one of the leading causes of ineffective treatment for various disorders. Started from January 1, 2019, medical care in Russian Federation is organized and provided according to the procedures for providing medical care approved by authorized federal executive body and mandatory for all health-care institutions. These procedures are based on clinical practice guidelines and health-care standards approved by authorized federal executive body. Professional medical non-profit organizations should develop and approve clinical practice guidelines for diseases and conditions approved by the Minist ry of Health by December 31, 2021. Started from January 1, 2022, every health-care institution should follow clinical practice guidelines as the basis for providing health care and create conditions for ensuring compliance of health care with the criteria for assessing health care quality.

Keywords: clinical practice guidelines, health-care standards, health care quality, Federal law, scientific practical Council, professional medical non-profit organizations.

For citation: Kazakov A.S., Zyryanov S.K., Ushkalova E.A. Clinical practice guidelines in the light of novel legislation. RMJ. 2020;6:15–19.



Pages 2-9. Нестероидные противовоспалительные препараты — собрание клонов или содружество ярких индивидуальностей? Взгляд клинического фармаколога. Прохорович Е.А.

Summary:

Nonsteroidal anti-inflammatory drugs: ensemble of clones or bright individuals? A clinical pharmacologist’s view

E.A. Prokhorovich

A.I. Evdokimov Moscow University of Medicine and Dentistry, Moscow

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed medicines. The choice of NSAIDs is made based on patient’s characteristics and risk factors for drug therapy complications. For patients who regularly receive NSAIDs, monitoring is required to di-agnose adverse drug reactions early. Ibuprofen is considered gold standard of analgesia. Ibu-profen is also the safest non-selective NSAID in terms of NSAID gastropathy. Combination of ibuprofen and paracetamol provides greater analgesia as compared with individual components and combination drugs containing codeine. Paracetamol has a central analgesic effect and does not induce NSAID gastropathy. The risk of cardiovascular complications is low as well. Paracetamol is slowly dissolved in alkaline solutions but quickly in acidic solutions (and ibuprofen vice versa). As a result, when taking separately, these drugs are  absorbed in various divisions of gastrointestinal tract, i.e., stomach (paracetamol) and intestine (ibuprofen). Modern technologies of capsule membranes optimize dissolution and provide rapid simultaneous release of ibuprofen and paracetamol when taking perorally.

Keywords: NSAID, risk factors, drug reactions, ibuprofen, paracetamol, Nurofen, capsule membrane.

For citation: Prokhorovich E.A. Nonsteroidal anti-inflammatory drugs: ensemble of clones or bright individuals? A clinical pharmacologist’s view. RMJ. 2020;6:2–9.



Pages 20-22. COVID-19 и дети. Заплатников А.Л., Свинцицкая В.И.

Summary:

OVID-19 and children

A.L. Zaplatnikov, V.I. Svintsitskaya

Russian Medical Academy of Continuous Professional Education, Moscow

On March 11, 2020, the World Health Organization announced that the COVID-19 (Coronavirus disease 2019) outbreak can be characterized as a pandemic. This paper reviews epidemiological and clinical laboratory features of novel coronavirus infection in children. It was demonstrated that children generally present with mild symptoms. Most children are asymptomatic or mildly symptomatic. Laboratory tests demonstrate that severe lymphopenia is very rare in children. In addition, children have better COVID-19 outcomes. Clinical laboratory specifics of COVID-19 in children is probably accounted for by a number of factors including age-related characteristics of immune response (in particular, innate immunity), more healthy respiratory system (since children do not suffer exposure to smoke or respiratory infections), and age-related specifics of angiotensin-converting enzyme 2 functioning (which is employed by coronavirus as a receptor for cellular entry). The authors highlight that these are children being asymptomatic or mildly symptomatic  who are important in COVID-19 transmission to prolong pandemic.

Keywords: children, novel coronavirus infection, infants, pandemic, COVID-19.

For citation: Zaplatnikov A.L., Svintsitskaya V.I. COVID-19 and children. RMJ. 2020;6:20–22.

Pages 23-27. Профилактика и лечение острых респираторных инфекций в педиатрической практике — фокус на применение эфирных масел. Николаева С.В., Шушакова Е.К., Хлыповка Ю.Н.

Summary:

The efficacy of essential oil composition for the prevention and treatment of acute respiratory infections

S.V. Nikolaeva1, E.K. Shushakova1, Yu.N. Khlypovka1,2

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

2Central Clinical Hospital and Polyclinic, Moscow

Acute respiratory infections (ARIs) are an important global public health issue due to health damage and economic burden. According to the World Health Organization (WHO), eve-ry person experiences 2 to 4 ARI episodes each year. In Russia, ARIs are the leading causes of infection-related morbidity. In 2018, 30,883,968 cases of ARIs were registered. Among them, 22,085,400 patients (71.5%) were children under 17 years. This paper discusses advantages and disadvantages of various preventive measures and treatment for ARIs in children. In recent decades, passive inhalations of essential oils has become increasingly important and has been widely applied to manage and/or prevent diseases. In vitro study demonstrates viricidal effect of natural essential oils of composition substance on influenza virus, rhinovirus, and respiratory syncytial virus. This paper addresses the results of clinical studies on th e efficacy of composition substance containing essential oils for the prevention and treatment of acute upper respiratory infections in children. Synergetic activity of this composition substance which makes essential oils more efficient in clinical settings was demonstrated.

Keywords: frequently ill children, ARI, rhinovirus, respiratory syncytial virus, influenza virus, essential oils, passive inhalations, prevention, Dyshi.

For citation: Nikolaeva S.V., Shushakova E.K., Khlypovka Yu.N. The efficacy of essential oil composition for the prevention and treatment of acute respira-tory infections. RMJ. 2020;6:23–27.



Pages 28-33. Экофуцин® – первый препарат для эрадикации грибов рода Candida с эффектом стимуляции роста лактобацилл у беременных женщин. Кузьмин В.Н., Богданова М.Н.

Summary:

Ecofucin® is the first drug to eradicate Candida spp. and to improve Lactobacillus growth in pregnant women

V.N. Kuzmin, M.N. Bogdanova 

A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow

Aim: to assess the efficacy and safety of Ecofucin® (International Nonproprietary Name [INN]: natamycin; additional component: lactulose) vaginal suppositories as compared with monocomponent drug containing natamycin based on the time to achieve clinical and microbiological remission of acute vaginal/vulvovaginal candidiasis in pregnant women.

Patients and Methods: pregnant women aged 18–45 (18 to 31 weeks of pregnancy) with acute vaginal/vulvovaginal candidiasis symptoms were enrolled in the study. Ecofucin® or monocomponent natamycin was prescribed. Both drugs were applied intravaginally once daily for 6 days. Primary efficacy endpoint was the time to achieve clinical remission and secondary efficacy endpoint was the number of women who achieved remission without recurrence. Lab examination of vaginal discharge was performed before and after treatment. Adverse reactions were r eported to assess the safety of both drugs.

Results: in the study group, more women achieved clinical and microbiological remission. Time to achieve remission was, on average, less than in the control group. In addition, some clinical signs (itching, burning) improved faster in the study group. Moreover, these women were characterized by less recurrences due to the increased Lactobacillus count (by 100 times as compared with the baseline). In women who received Ecofucin® Lactobacillus count in cervical canal discharge increased, on average, by 50 times (up to 100 times) while in women who received monocomponent drug this parameter increased by 2.5 times only (p < 0.001). No adverse reactions were reported in either of the groups.

Conclusions: our findings clearly demonstrate more effective eradication of Candida spp. and more rapid improvement of clinical signs of vaginal/vulvovaginal candidiasis in more study group women who applied Ecofucin®. In women who recieved Ecofucin®, an increase in the content of lactobacilli in the vagina up to 100 times was noted, which contributed to a decrease in the frequency of recurrence of the disease.

Keywords: Ecofucin, natamycin, lactulose, vaginal/vulvovaginal candidiasis, Candida, Lactobacillus.

For citation: Kuzmin V.N., Bogdanova M.N. Ecofucin® is the first drug to eradicate Candida spp. and to improve Lactobacillus growth in pregnant women. RMJ. 2020;6:28–33.

Pages 34-37. Ишемическая болезнь сердца и миома тела матки: клиническое наблюдение пациентки с сочетанной патологией. Шарафутдинов Б.М., Антропова Е.Ю., Абдульянов И.В., Рыжкин С.А., Газиев Э.А., Мазитова М.И.

Summary:

Coronary heart disease and uterine fibroids: case history

B.M. Sharafutdinov1,2, E.Yu. Antropova1, I.V. Abdul’yanov1, S.A. Ryzhkin1,3, E.A. Gaziev1, M.I. Mazitova1

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

2Kazan (Volga Region) Federal University, Kazan

3Kazan State Medical University, Kazan

Currently, 15% to 17% of adult Russian population suffer from coronary heart disease (CHD). In women older than 30 years, CHD is diagnosed in 30% of cases. Uterine fibroids rank second in incidence among gynecological disorders (20–40%). However, no data on uterine fibroids/CHD association are available from published sources. This paper describes case history of CHD and uterine fibroids. Considering a tendency to prescribe antiaggregant and anticoagulant therapies for cardiovascular disorders more often, there is an increased risk of hemorrhages including abnormal uterine bleeding. Endovascular image-guided interventions verify the diagnosis and provide full picture of the nature andseverity of the disease. This case history demonstrates that a first-step percutaneous coronary intervention and a second-step X-ray guided uterine artery embolization is a good and fast treatment for both conditions. Approved international guidelines for the management of CHD/uterine fibroid association are lacking, therefore, randomized multicenter clinical trials are required to produce optimal treatment strategy for these patients.

Keywords: coronary heart disease, uterine fibroids, antiaggregant therapy, anticoagulant therapy, abnormal uterine bleeding.

For citation: Sharafutdinov B.M., Antropova E.Yu., Abdul’yanov I.V. et al. Coronary heart disease and uterine fibroids: case history. RMJ. 2020;6:34–37.

Pages 38-39. Алгоритм выбора тонометров в различных клинических ситуациях. Трошина А.А.

Pages 40-44. Когнитивные нарушения у пациентов среднего возраста с артериальной гипертензией. Остроумова О.Д.

Summary:

Cognitive dysfunction in middle-aged patients with arterial hypertension

O.D. Ostroumova

Russian Medical Academy of Continuous Professional Education, Moscow

Brain is the most vulnerable target for arterial hypertension, therefore, early detection of subclinical brain damage by cognitive testing is of particular importance since MRI is an expensive screening tool. A study was performed to assess cognitive functions in middle-aged persons with uncomplicated essential arterial hypertension stage 1–2. It was demonstrated that just two tests are sensitive to vascular cognitive dysfunction, i.e., MoCA (Montreal Cognitive Assessment) and TNT (Trail Making Test). Despite middle age of these patients (50.5% were diagnosed with arterial hypertension for the first time), white matter damage was identified (by MRI) in 53.7% of them as compared with 9.7% of controls. High systolic blood pressure in middle age correlates with higher risk of cognitive dysfunction in older age. Antihypertensives reduces dementia risk and improves cognitive functions. Moreover, calcium channel blockers (CCBs) demonstrate cerebroprotective class effect. Angiotensin-converting-enzyme inhibitors which penetrate blood-brain barrier can also improve cognitive functions. Considering that most patients with arterial hypertension require fixed-dose combinations (FDCs) from the very beginning of treatment, FDCs of CCBs and second component providing cerebroprotection are of particular interest. Significant improvement of thinking and attention were revealed after 6 months of the treatment with FDC of amlodipine and lisinopril (Ekvator®).

Keywords: arterial hypertension, cognitive functions, middle age, subclinical brain damage, Montreal Cognitive Assessment score, Trail Making Test, fixed-dose combination.

For citation: Ostroumova O.D. Cognitive dysfunction in middle-aged patients with arterial hypertension. RMJ. 2020;6:40–44.



Pages 45-48. Возможности коррекции функциональных расстройств желудочно-кишечного тракта у пациентов с тревожными расстройствами. Голованова Е.В.

Summary:

Treatment modalities for functional gastrointestinal disorders in patients with anxiety disorders

E.V. Golovanova

A.I. Evdokimov Moscow University of Medicine & Dentistry, Moscow

Management of functional gastrointestinal (GI) disorders is a complex task. In many patients, treatment efficacy is insufficient. Underestimation of the severity of psychological and emotional disorders and a need for their management is one of the causes of ineffective treatment. Functional GI disorders are associated with reduced activity of stress-limiting systems, in particular, decreased levels of γ-aminobutyric acid (GABA) and GABAergic system activity. Under these circumstances, stress-realizing system prevails thus providing the conditions for the development of biologically negative stress (distress) and, later, persistent diseases (i.e., anxiety, depression etc.). This accounts for a set of symptoms associated with functional GI disorders, i.e., irritability, nervousness, trembling, muscle tension, tension headache, hyperhidrosis, palpitation, dizziness coupled with epigastric discomfort and dyspeptic symptoms. Therefore, compensating GABA deficiency will correct inhibiting systems of the central nervous system. Aminophenylbutyric acid, phenyl derivative of GABA, compensates GABA deficiency. This paper describes two case histories of prescribing Anvifen® (aminophenylbutyric acid) for functional GI disorders.

Keywords: functional disorder, irritable bowel syndrome, GABA, aminophenylbutyric acid, anxiety, Anvifen.

For citation: Golovanova E.V. Treatment modalities for functional gastrointestinal disorders in patients with anxiety disorders. RMJ. 2020;6:45–48.





№5, 2020. Оториноларингология

Pages 13-16. Клиническое течение хронического тонзиллита у пациентов с IgA-нефропатией. Карпищенко С.А., Колесникова О.М., Легкова Ю.В.

Summary:

Clinical course of chronic tonsillitis in patients with IgA nephropathy

S.A. Karpischenko1,2, O.M. Kolesnikova1, Yu.V. Legkova1

1Pavlov First Saint Petersburg State Medical University, Saint Petersburg

2Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint Petersburg

Chronic tonsillitis (CT) is one of the most common pathologies in otorhinolaryngological practice, characterized by the presence of focal chronic infection in the palatine tonsils. According to the WHO, there are about 100 diseases that can be associated with CT, one of which is IgA nephropathy.

Aim: to evaluate the CT clinical course in patients with IgA nephropathy.

Patients and Methods: 111 patients with CT (46 women and 65 men; average age — 34.5±9.3 years) underwent the study. Complaints, medical history data, and pharyngoscopy images were analyzed according to the developed rating scales from 0 to 3 or from 0 to 1.

Results: the majority of patients (44%) rarely noted a sore throat and did not observe the discharge of tonsilloliths (66% of patients); foul smell and bad breath disturbed only 0.5% of patients. Body temperature rarely rose to subfebrile numbers (42%) or did not rise at all (41%), but patients commonly complained of fatigue (almost 80%). In medical history, this group of patients rarely noted common angina (less than 1%) or sore throat (6.6%), whereas, regional lymph nodes growth was observed in 42% of cases, pain or joint ache — in 47%. Topical complications of angina were detected in only 1 patient in the form of paratonsi llar abscess. Most patients were not treated for CT (80%) and in 62% of cases, patients did not notice changes in urine during the period of sore throat. During pharyngoscopy images evaluation, hypertrophy of the palatine tonsils rarely exceeded the first degree, tonsilloliths discharge was also minimal, most patients had hyperemia of the faucial pillars and cicatricial changes between the tonsillar capsule and surrounding tissues.

Conclusion: CT in IgA-nephropathy is characterized by a subclinical picture and scant history data, which makes it difficult to provide treatment tactics. Timely and early diagnosis of CT, especially form free from angina, leads to the prevention of complications from various organs and systems.

Keywords: chronic tonsillitis, IgA nephropathy, tonsillogenic reactions, form free from angina, tonsillectomy.

For citation: Karpischenko S.A., Kolesnikova O.M., Legkova Yu.V. Clinical course of chronic tonsillitis in patients with IgA nephropathy. RMJ. 2020;5:13–16.

Pages 17-20. Аллергический ринит, осложненный гипертрофией слизистой оболочки полости носа: результаты пилотного обсервационного исследования. Крюков А.И., Бондарева Г.П., Нгуен Т.Ф.

Summary:

Allergic rhinitis complicated by hypertrophy of the nasal mucosa: results of a pilot observational study

A.I. Kryukov1,3, G.P. Bondareva2, T.Ph.T. Nguyen3,4

1L.I. Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow

2State Research Center “Institute of Immunology» of the Federal Medical and Biological Agency, Moscow

3Pirogov Russian National Research Medical University, Moscow

4Thai Nguyen National General Hospital, Vietnam

During a long-term course of allergic rhinitis (AR), various complications can develop, including hypertrophy of the nasal mucosa (HNM). Although AR is commonly considered as a not serious disease, it significantly affects the life quality (LQ) of patients. LQ depends on the severity of AR signs.

Aim: to evaluate the severity of symptoms in patients suffering from AR, with and without HNM.

Patients and Methods: the present pilot observational study was conducted in the ENT Department at the Thai Nguyen National General Hospital (Vietnam) with patients of urban and rural areas. 64 patients with AR were included in the study: 45 of them had AR with HNM (group 1) and 19 — AR without HNM (group 2). The Nasal Obstruction Symptom Evaluation (NOSE) scale and the subjective rating scale were used in this paper.

Results: the average age of group 1 patients was 46.15±20.54 years, and the average disease duration was 5.2±1.1 years (both indicators were higher than in group 2 patients). High incidence and severity of symptoms were revealed in patients having AR with HN M: nasal congestion and rhinorrhea were observed in 45 (100%), olfactory impairment was in 14 (31.11%) patients versus 68.42%, 63.16%, and 0% in group 2, respectively. The total score was significantly higher in group 1 for all 3 symptoms (p=0.008). There was a high incidence of comorbidities revealed in patients with AR and HNM. Also, there was a positive correlation between the incidence of AR and life in urban areas (r=0.864, p=0.0012), the incidence of the HNM complication was higher in patients with AR in urban areas (p=0.0032).

Conclusion: HNM develops during a long-term course of AR, leading to a higher frequency and degree of complaints in patients, whereas, the more vulnerable group are those living in urban areas.

Keywords: allergic rhinitis, hypertrophy of the nasal mucosa, nasal difficulty breathing, life quality, subjective rating scale, Nasal Obstruction Symptom Evaluation scale.

For citation: Kryukov A.I., Bondareva G.P., Nguyen T.Ph.T. Allergic rhinitis complicated by hypertrophy of the nasal mucosa: results of a pilot observational study. RMJ. 2020;5:17–20.

Pages 2-2. Слово редактора. Карпищенко С.А.

Pages 21-25. Клинические рекомендации: что нужно знать практикующему врачу. Андреева И.В., Стецюк О.У., Егорова О.А.

Summary:

Clinical guidelines: what the practitioner should know?

I.V. Andreeva, O.U. Stetsyuk, O.A. Egorova

Smolensk State Medical University, Smolensk

Clinical guidelines (CG) are documents, systematically developed to help practitioners make decisions to provide appropriate medical care in a specific clinical event. It is the CG that should serve as the main guide for each doctor in his clinical practice from January 1, 2022. In the light of the new legislation, no more than one CG can be approved and confirmed for each disease or condition in adults and children, respectively. Strengthening the CG role should be considered as a strategy aimed at improving medical care quality. CG implementation should have a positive impact on both everyday clinical practice and the procedure for evaluating the medical care quality, as well as provide a justification for economic calculations of health care costs. Also, it will allow providing all patients with an identical amount of medical care, regardless of the attending doctor and the area of residence. For doctors, CG should be a t ool to help them make decisions about patient management since an evidence-based approach provides the clinician with information about the most effective methods of diagnosis, prevention, and treatment.

Keywords: clinical guidelines, acute bacterial rhinosinusitis, amoxicillin, clavulanic acid, antibiotic therapy, antibiotic resistance

For citation: Andreeva I.V., Stetsyuk O.U., Egorova O.A. Clinical guidelines: what the practitioner should know?. RMJ. 2020;5:21–25.

Pages 26-30. Топическая антимикробная терапия инфекционно-воспалительных заболеваний носа и околоносовых пазух. Карпищенко С.А., Кривопалов А.А., Еремин С.А., Шамкина П.А., Чуфистова А.В.

Summary:

Topical antimicrobial therapy for infectious and inflammatory diseases of the nose and paranasal sinuses

S.A. Karpischenko1, A.A. Krivopalov1, S.A. Eremin1, P.A. Shamkina1, A.V. Chufistova2

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

2North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg

Aim: to study the characteristics of sputtering and distribution of framycetin solutions (used for topical antibacterial therapy of infectious and inflammatory diseases in the nose and paranasal sinuses) in the infectious focus.

Patients and Methods: the study involved healthy volunteers. The following 2 medicinal products with different spraying device were chosen: TRAMICENT® (Solopharm, Saint Petersburg) and ISOFRA® (Laboratoires BOUCHARA-RECORDATI, France). High-speed photography and video recording methods were used in contrast lighting conditions for a comparative analysis of aerosol formation during spraying, and 70–120 ms and 180–190 ms after the start of spraying. To assess the distribution of framycetin solutions in the nasal cavity of the subjects, an imaging method was used with the qualitative criteria assessment using video endoscopy with photo and video fixation.

Results: the duration of TRAMICENT® (Solopharm, Saint Petersburg) spray phase was stable due to the automatic sprayer mechanism and is 11–12 ms. The duration of ISOFRA® (Laboratoires BOUCHARA-RECORDATI, France) spray phase varied significantly (from 32
to 47 ms) and directly depended on the fingers movement performing the spraying and the effort applied to the bottle. The cloud of TRAMICENT® (Solopharm, Saint Petersburg) was visualized more compactly and retained saturation longer, while the cloud of ISOFRA® (Laboratoires BOUCHARA-RECORDATI, France) was less saturated and occupied a larger area. The lifetime of aerosols in TRAMICENT® (Solopharm, Saint Petersburg) was 230–278 ms (average 253 ms), which was significantly longer versus that of ISOFRA® (Laboratoires BOUCHARA-RECORDATI, France) (122–220 ms), the average time was 166 ms. Spraying TRAMICENT® (Solopharm, Saint Petersburg) promotes the entry of the antibacterial drug framycetin into the middle nasal passage, along the mucous membrane of the nasopharynx walls with the spread to the pharyngeal mouth of the Eustachian tube.

Conclusion: TRAMICENT® (Solopharm, Saint Petersburg) in the experimental study demonstrated a high quality of aerosol spraying and distribution in the nasal cavity.

Keywords: otorhinolaryngology, spray, topical therapy, spraying and distribution of solutions, framycetin.

For citation: Karpischenko S.A., Krivopalov A.A., Eremin S.A. et al. Topical antimicrobial therapy for infectious and inflammatory diseases of the nose and paranasal sinuses. RMJ. 2020;5:26–30.



Pages 3-8. Стационарные слуховые вызванные потенциалы в клинической практике. Савельева Е.Е., Туфатулин Г.Ш., Савельев Е.С.

Summary:

Auditory evoked potentials on an inpatient basis in clinical practice

E.E. Savelieva1, G.Sh. Tufatulin2,3, E.S. Saveliev1

1Bashkir State Medical University, Ufa

2Children’s City Center of Surdology, Saint Petersburg

3North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg

Aim: to determine the association between psychoacoustic auditory thresholds and hearing thresholds obtained using the registration method of auditory steady-state response (ASSR).

Patients and Methods: ASSR registration during intra-earphone stimulation was performed in 76 children (152 ears) with sensorineural hearing loss (average age — 2.68±0.16 years) during physiological sleep. Stimuli modulated in amplitude and frequency (ASSR MM) were used, modulation frequency was 90 Hz. Chirp stimulus was used in 40 children. ASSR during stimulation in the auditory field was registered in 2 adults (25 and 30 years old) and 2 children (4 and 8 years old) with normal hearing. The study was conducted in an anechoic chamber. The modulation frequency was 40 Hz. Thresholds obtained using psychoacoustic methods and ASSR were compared.

Results: the ASSR MM thresholds most closely reached the psychoacoustic auditory thresholds with a marked degree of hearing loss  and deafness; in the I–III degrees of hearing loss, the difference between thresholds of the ASSR MM and psychoacoustic tests was increased. The average difference was at 500 Hz — 18.03 dB, at 1000 Hz — 15.46 dB, at 2000 Hz — 12.71 dB, at 4000 Hz —13.96 dB (rs=0.73–0.79). When using the Chirp stimulus, the average difference between thresholds of ASSR and psychoacoustic tests was at 500 Hz — 8.94 dB, at 1000 Hz — 7.88 dB, at 2000 Hz — 5.63 dB, at 4000 Hz — 6.77 dB (rs=0.85–0.88). Depending on the frequency, the difference between behavioral and electrophysiological thresholds in the auditory field varied from 0 dB to 35 dB, there was a correlation from rs=0.75 to rs=0.95 (p<0.05) in adults, and from rs=0.55 to rs=0.95 (p<0.05) in children. The maximum difference between behavioural and ASSR thresholds in the auditory field was observed at 500 Hz (average value — 15.6 dB), and the minimum — at 2 and 4 kHz (average values of 8 dB and 7 dB, respectively).

Conclusion: ASSR method allows to determine hearing thresholds that have a high correlation degree with behavioural thresholds. Thus, the preferred type is Chirp stimulus. Providing stimulus in the auditory field opens up potential opportunities for evaluating the effectiveness of the auditory prosthetics.

Keywords: hearing loss, hearing diagnostics, ASSR, auditory prosthetics effectiveness.

For citation: Savelieva E.E., Tufatulin G.Sh., Saveliev E.S. Auditory evoked potentials on an inpatient basis in clinical practice. RMJ. 2020;5:3–8.

Pages 32-36. Применение местных антимикробных средств в комплексном лечении патологии верхних дыхательных путей. Крюков А.И., Царапкин Г.Ю., Товмасян А.С., Горовая Е.В., Вершинина Е.А.

Summary:

dministration of topical antimicrobial agents in the complex treatment of upper respiratory tract pathology

A.I. Kryukov1,2, G.Yu. Tsarapkin1, A.S. Tovmasyan1, E.V. Gorovaya1, E.A. Vershinina3

1Research Clinical Institute of Otorinolaringology named after L.I. Sverzhevsky, Moscow

2Pirogov Russian National Research Medical University, Moscow

3Sechenov University, Moscow

Aim: to study the efficacy and safety of silver proteinate in the form of a tablet for solution for topical administration (Sialor®) as an antiseptic drug in the complex treatment of acute rhinitis, nasopharyngitis and sinusitis.

Patients and Methods: the study included 56 patients (average age — 36±4 years) diagnosed with an acute rhinitis, nasopharyngitis, acute catarrhal sinusitis. Patients were divided into 2 equal groups: group I — 28 patients with acute rhinitis and nasopharyngitis; group II — 28 patients with acute sinusitis. Patients of each group were divided into 2 subgroups — control and main groups of 14 people each, depending on the drug selection for conservative therapy. In group I, both subgroups received irrigation therapy and decongestants. Besides, the main subgroup was prescribed with silver proteinate. In group II, both subgroups received irrigation therapy, decongestants and antibacterial therapy; the main subgroup was also prescribed with silver proteinate. In both groups, patients received silver proteinate for 7 days. The severity of inflammation in the nasal cavity was assessed during anterior rhinoscopy followed by nasal endoscopy prior to and within
10 days after the therapy initiation. Patients also self-assessed the severity of symptoms. Adverse events were registered for safety evaluation.

Results: during the treatment of both groups, there was a decrease in the severity of objective and subjective disease signs, which was more significant when silver proteinate was added to the therapy. In the main subgroups of both groups, there was a faster resolution of topical inflammatory manifestations. No adverse events were registered.

Conclusion: topical effect of silver proteinate significantly reduces topical inflammatory manifestations of acute rhinitis, nasopharyngitis and sinusitis. Administration of silver proteinate is well tolerated by patients.

Keywords: silver proteinate, acute rhinitis, nasopharyngitis, acute sinusitis, maxillary sinusitis, Sialor.

For citation: Kryukov A.I., Tsarapkin G.Yu., Tovmasyan A.S. et al. Administration of topical antimicrobial agents in the complex treatment of upper respiratory tract pathology. RMJ. 2020;5:32–42.

Pages 38-42. Лазерные технологии в ринохирургии. Рябова М.А., Улупов М.Ю., Шумилова Н.А., Тихомирова Е.К.

Summary:

Laser technologies in rhinosurgery

M.A. Ryabova, M.Yu. Ulupov, N.A. Shumilova, E.K. Tikhomirova

Pavlov First Saint Petersburg State Medical University, Saint Petersburg

Aim: to develop an algorithm for selecting the laser radiation wavelength, parameters and methods of exposure in rhinosurgery.

Patients and Methods: 250 surgeries performed using semiconductor lasers with wavelengths of 0.81 µm, 0.98 µm and 1.47 µm were analyzed: 52 cases — laser coagulation of inferior nasal turbinates, 21 cases — incision of nasal synechiae, 10 cases — coagulation of blood vessels in the nasal cavity, 175 cases — nasal polypectomy. The parameters of laser exposure were selected on the basis of previous experimental studies on biological effects of laser radiation with wavelengths of 0.81, 0.98 and 1.47 µm on various types of tissue.

Results: upon nasal polypectomy, the predominance of laser contact exposure with the wavelength of 1.47 µm over lasers radiation of the hemoglobin absorption spectrum was found due to less pronounced thermal damage to the surrounding tissues and more significant hemostatic properties. Incision of nasal synechiae with the laser radiation of the water absorption spectrum demonstrated more pronounced hemostatic properties and led to the formation of less significant reactive postoperative inflammatory events, including in patients with dystrophic changes in the nasal mucosa. Nasal tamponade was not required in any case; the re-epithelization period of the mucous membrane was from 2 to 4 weeks. Upon laser coagulation of inferior nasal turbinates with wavelengths of 0.81, 0.98 and 1.47 µm, the postoperative period was mild in all patients; intense nosebleed was observed in one patient receiving anticoagulants due to incorrect selection of laser exposure parameters. Laser coagulation of blood vessels in the nasal septum was effective when exposed on the capillary network. The method of stopping nosebleed from vessels of more than 1 mm in diameter using a laser did not have the necessary hemostatic properties.

Conclusion: velocity, power of laser exposure and the total amount of transmitted energy are crucial parameters in rhinosurgery. The mode of laser radiation exposure should be selected taking into account the localization of the irradiated zone in the nasal cavity, the presence of target chromophores for the spectrum of the laser radiation device.

Keywords: laser surgery, polyps, vasomotor rhinitis, synechiae.

For citation: Ryabova M.A., Ulupov M.Yu., Shumilova N.A., Tikhomirova E.K. Laser technologies in rhinosurgery. RMJ. 2020;5:38–42.

Pages 9-12. Опыт хирургического лечения врожденных аномалий развития уха, сочетанных с врожденной холестеатомой височной кости: клинические наблюдения. Аникин И.А., Хамгушкеева Н.Н., Князев А.Д.

Summary:

Experience in the surgical treatment of congenital ear malformations combined with congenital cholesteatoma of the temporal bone:
clinical cases

I.A. Anikin, N.N. Khamgushkeieva, A.D. Knyazev

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

Patients with congenital external ear malformations have an increased risk of congenital cholesteatoma of the temporal bone. The most common variant of acquired external auditory canal cholesteatoma is formed as a result of elimination processes disorder of the desquamated epidermis through the stenosis site. Congenital cholesteatoma of the temporal bone combined with the congenital malformation of the external and middle ear is an extremely rare pathology. This article describes two clinical cases: in the first case, the patient had external auditory canal atresia, and the congenital cholesteatoma was located medial to the bony atretic plate; in the second case, the congenital cholesteatoma was located in the tympanic cavity behind the intact tympanic membrane, moreover, the patient had microtia and multiple malformations of the middle ear. The article also describes the sp ecificities of diagnostics and surgical treatment of these patients. Presented clinical cases are focused on the cholesteatoma asymptomatic pathogenesis and its course in children with congenital malformations of the external and middle ear. Additional mandatory instrumental imaging methods is required to this group of patientsto exclude congenital cholesteatoma, and surgical treatment should be conducted as soon as possible, regardless of the child’s age.

Keywords: cholesteatoma, congenital cholesteatoma, congenital external auditory canal atresia, temporal bone, surgical tactics.

For citation: Anikin I.A., Khamgushkeieva N.N., Knyazev A.D. Experience in the surgical treatment of congenital ear malformations combined with congenital cholesteatoma of the temporal bone: clinical cases. RMJ. 2020;5:9–12.



№4, 2020. Болезни дыхательных путей

Pages 11-15. Взаимосвязь показателей системного воспаления и клеточного состава индуцированной мокроты при сочетании бронхиальной астмы и хронической обструктивной болезни легких. Демко И.В., Собко Е.А., Чубарова С.В., Кублик Е.С., Минеева Е.С., Эйдемиллер Н.С.

Summary:

Association between indicators concerning systemic inflammation and cellular composition of induced sputum in bronchial asthma and chronic obstructive pulmonary disease

I.V. Demko1,2, E.A. Sobko1,2 S.V. Chubarova1, E.S. Kublik1, E.S. Mineieva1, N.S. Eidenmiller2

1Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk

2Regional Clinical Hospital, Krasnoyarsk

Aim: to study the indicators of systemic inflammation in the peripheral blood and topical inflammation in the respiratory tract. Adding that, to identify their possible relationships with clinical and functional parameters in patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD).

Patients and Methods: the present study included 144 patients. Group 1 consisted of patients with severe allergic BA (n=32), group 2 — patients with BA and COPD (n=38), group 3 — patients with GOLD 3 COPD (n=34). Control group (n=40) included healthy volunteers. A general clinical study, pulmonary function test, determination of IL-8, IL-1β, IL-10 and myeloperoxidase in peripheral blood, exhaled nitric oxide test, and cellular composition analysis of induced sputum were performed.

Results: an imbalance of pro-inflammatory (IL-1β, IL-8) and anti-inflammatory (IL-10) cytokines in the peripheral blood were recorded in BA, COPD and their combination. In BA with COPD, an increase in exhaled NO level and the myeloperoxidase presence in peripheral blood were observed, which was interconnected with the severity of bronchial obstruction. Upon analyzing the cellular composition of induced sputum, it was noted that eosinophilic inflammation type prevailed in isolated severe BA, whereas in COPD (GOLD 3), the neutrophilic biological phenotype was more common, and in BA with COPD, a mixed inflammation type was registered in 51% of cases, in 29% — inflammation with low count of granulocytes, in 11% — eosinophilic, and only in 9% of patients — neutrophilic biological phenotype of inflammation.

Conclusion: the combination of BA and COPD is characterized by a more severe course, low rates of pulmonary function test, pulmonary hyperinflation, an imbalance of pro-inflammatory and an ti-inflammatory cytokines, and the initiation of oxidative and nitrotyrosine stress. The cellular composition of induced sputum indicates the eosinophilic inflammation type in asthma, the neutrophilic type in COPD, and the mixed type in most patients with BA and COPD.

Keywords: bronchial asthma, chronic obstructive pulmonary disease, myeloperoxidase, cytokines, induced sputum, nitric oxide.

For citation: Demko I.V., Sobko E.A., Chubarova S.V. et al. Association between indicators concerning systemic inflammation and cellular composition of induced sputum in bronchial asthma and chronic obstructive pulmonary disease. RMJ. 2020;4:11–15.



Pages 16-18. Особенности вентиляционной функции легких у студентов при лекарственно-индуцированной головной боли и табачной аддикции. Садретдинова Л.Д., Деревянко Х.П.

Summary:

Characteristics of pulmonary ventilation function in students with medication-overuse headache and tobacco addiction

L.D. Sadretdinova, Kh.P. Derevyanko

Bashkir State Medical University, Ufa

Aim: to evaluate the pulmonary ventilation function in students at reproductive age suffering from medication-overuse headache (MOH) and tobacco addiction.

Patients and Methods: the study included 95 smokers studying at the university with a history of chronic headache (48 female and 47 male subjects). All patients underwent spirometry with the evaluation of standard parameters. Surveys were conducted using special questionnaires.

Results: spirometric parameters revealed early signs of obstructive disorders in young smokers: the values of the forced expiratory volume in 1 second and forced vital capacity (FVC) were higher in young smokers, however, peak expiratory flow rate (PEFR) and the maximum expiratory flow of 25% and 50% FVC were much lower than in healthy subjects, indicating the reduction in PEFR. Students with MOH commonly took monocomponent analgesics and, to a lesser extent, combined analgesics and triptan s. Half of the students were aware of the consequences concerning uncontrolled use of painkillers, and continued to increase the dose of the drug. Women were less likely to visit doctors than men when headaches became more frequent, but men were more likely to the uncontrolled use of painkillers than women. In 57% of cases, male subjects used the drug again in the absence of the painkiller effect after 30 minutes.

Conclusion: spirometric parameters help to identify early signs of bronchial obstructive disorders in young male smokers and predict the development of severe diseases due to tobacco smoking. It is necessary to improve the awareness of young people about the smoking impact on the formation of chronic pain, the danger of increasing doses during self-medication or the excessive use of taking prescribed medications, which will allow avoiding the number of disability days in the future.

Keywords: secondary headache, excessive use of medications, tobacco smoking, pulmon ary function.

For citation: Sadretdinova L.D., Derevyanko Kh.P. Characteristics of pulmonary ventilation function in students with medication-overuse headache and tobacco addiction. RMJ. 2020;4:16–18.

Pages 19-23. Практические рекомендации по ведению пациентов с нетяжелой внебольничной пневмонией. Зайцев А.А., Синопальников А.И.

Summary:

Practical guidelines for the patient management with non-severe community-acquired pneumonia

A.A. Zaitsev1, A.I. Sinopalnikov2

1Main Military Clinical Hospital named after N.N. Burdenko, Moscow

2Russian Medical Academy of Continuous Professional Education, Moscow

Community-acquired pneumonia (CAP) is one of the most urgent problems of modern medicine due to its high incidence and mortality. The article discusses the role of various pathogens — bacteria and viruses, including COVID-19 — in the development of CAP. The authors consider the issues of CAP diagnosis, discuss the role of prognostic scales and biomarkers of inflammation, such as C-reactive protein and procalcitonin. Approaches to treatment of patients with CAP are described in detail. When planning the tactics of antimicrobial CAP chemotherapy, the doctor should take into account the clinical and epidemiological situation, the regional situation concerning antibiotic resistance, the presence of risk factors and patient compliance, as well as evaluate the drug safety in a specific clinical event. The article presents algorithms for drug selection to conduct empirical antimicrobial therapy of non-severe CAP on outpatient and inpatient basis. The authors consider in detail the criteria for the antimicrobial chemotherapy efficacy, which will allow the practitioner to adjust the patient management tactics in a timely manner, if necessary, and at the same time to avoid unjustified changes in the treatment regimen (after 24 hours from the beginning), not accompanied by positive effects, but leading only to the formation of antibiotic-resistant strains and of adverse events.

Keywords: community-acquired pneumonia, COVID-19, acute respiratory failure, acute respiratory distress syndrome, antimicrobial therapy, clinical guidelines, amoxicillin , clavulanate.

For citation: Zaitsev A.A., Sinopalnikov A.I. Practical guidelines for the patient management with non-severe community-acquired pneumonia. RMJ. 2020;4:19–23.

Pages 2-7. Топическая антибактериальная терапия острого риносинусита. Рязанцев С.В., Кривопалов А.А., Еремин С.А., Захарова Г.П., Шабалин В.В., Шамкина П.А., Чуфистова А.В.

Summary:

Topical antibacterial therapy for acute rhinosinusitis

S.V. Ryazansev1, A.A. Krivopalov1, S.A. Eremin1, G.P. Zakharova1, V.V. Shabalin1, P.A. Shamkina1, A.V. Chufistova2

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

2North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg

Aim: to study the clinical efficacy, tolerability and safety of framycetin in combination therapy of acute rhinosinusitis.

Patients and Methods: 30 patients aged 18 to 68 years were diagnosed with acute rhinosinusitis of moderate degree. The patients included in the study were randomized into 2 groups (n = 15 each). In the main group, topical antibacterial therapy for acute rhinosinusitis was conducted with TRAMICENT® nasal spray (international nonproprietary name (INN): framycetin, Solopharm, Saint-Petersburg). IZOFRA® (INN: framycetin, Laboratoires BOUCHARA-RECORDATI, France) was used in the control group. In both groups, patients also received standard therapy for rhinosinusitis (antibiotic therapy, nasal lavage with isotonic saline solutions, symptomatic therapy). The study included 3 visits to an ENT-specialist with an interval between visits of 5–7 days. The treatment effect was evaluated by comparing statistical scores of symptom severity based on patient diaries and clinical follow-up protocols. The ciliary beat frequency was assessed using biomicroscopy before and by 5–7 days from the treatment initiation.

Results: there was a good tolerance of framycetin drugs for topical therapy. No adverse events were registered. Comparative intergroup assessment of local topical antibacterial therapy efficacy with framycetin solution revealed the most marked and statistically significant dynamics of motor activity recovery in the ciliated epithelium in the main  group in which framycetin was of local production. In both groups, there was a significant decrease in the symptoms severity according to clinical follow-up and patient diaries. In the main group receiving locally produced framycetin, the symptoms relief was statistically significantly more marked than in the control group.

Conclusion: the obtained results allow recommending TRAMICENT® (framycetin, Solopharm, Saint-Petersburg) — a spray for topical administration, dosed for use in otorhinolaryngological practice for the treatment of rhinosinusitis as part of combined therapy.

Keywords: otorhinolaryngology, acute rhinosinusitis, spray, ciliated epithelium, topical therapy, framycetin, Tramicent.

For citation: Ryazansev S.V., Krivopalov A.A., Eremin S.A. et al. Topical antibacterial therapy for acute rhinosinusitis. RMJ. 2020;4:2–7.



Pages 24-28. Активация регенеративного потенциала легочной ткани при тяжелой внебольничной пневмонии. Титова О.Н., Кузубова Н.А., Лебедева Е.С., Волчкова Е.В.

Summary:

Regeneration potential activation of lung tissue in severe community-acquired pneumonia

O.N. Titova, N.A. Kuzubova, E.S. Lebedeva, E.V. Volchkova

National Research Institute of Pulmonology of the Pavlov First Saint Petersburg State Medical University, Saint Petersburg

Community-acquired pneumonia is one of the most common acute infectious diseases in the world, occurring on an outpatient basis or diagnosed in the first two days of hospitalization. It is characterized by variability in clinical manifestations and a high rate of fatal outcomes, especially among the elderly, infants and patients with comorbidities. The mortality rate caused by community-acquired pneumonia in Russia is from 1% to 30%.

The review presents an analysis of scientific publications over the last five years devoted to the search for fundamentally new treatment methods of community-acquired pneumonia based on the regenerative therapy principles. The results of experimental studies performed on models of bacterial and viral pneumonia, aimed at stimulating the regenerative potential of the alveolar epithelium, which is most suscepti ble to infectious damage, are discussed. The regenerative potential of the alveolar epithelium is crucial for survival after severe pneumonia and lung functions recovery. Various ways of activating the main progenitor cells of the epithelium — type II alveolocytes — and reprogramming the signaling systems involved in launching the epithelial-mesenchymal regenerative cascade are proposed. It is necessary to further study the association of simultaneously occurring inflammatory and regenerative processes and establish factors allowing to regulate the intensity of these processes in order to form a favorable microenvironment for regeneration.

Keywords: community-acquired pneumonia, infection, influenza virus, regeneration, alveolar epithelium, alveolocyte, inflammation.

For citation: Titova O.N., Kuzubova N.A., Lebedeva E.S., Volchkova E.V. Regeneration potential activation of lung tissue in severe community-acquired pneumonia. RMJ. 2020;4:24–28.



Pages 29-33. Аминокислотный гомеостаз в реализации адаптивных реакций у животных с различной устойчивостью к туберкулезной инфекции (экспериментальное исследование). Сабадаш Е.В., Скорняков С.Н., Медвинский И.Д., Павлов В.А., Степанов Н.Н.

Summary:

Amino acid homeostasis during the implementation of adaptive responses in animals with various resistance to tuberculosis infection (experimental study)

E.V. Sabadash1,2, S.N. Skornyakov1,2, I.D. Medvinskii1,2, V.A. Pavlov1, N.N. Stepanov2

1Ural Research Institute of Phthisiopulmonology, the branch of the National Medical Research Center of Physiopulmonology and Infectious Diseases, Yekaterinburg

2Ural State Medical University, Yekaterinburg

Aim: to study typical responses of amino acid homeostasis under damaging effects of various genesis.

Patients and Methods: the experimental study was conducted on laboratory animals — rats and guinea pigs. The choice of two experimental tuberculosis models was due to different resistance to this infection. Three effects were studied: 1) infection with Mycobacterium tuberculosis (MBT); 2) infection with MBT in combination with subsequent endotracheal administration of polycyclic aromatic hydrocarbons sood-adsorbed in the form of an oil solution of coal tar (CT); 3) infection with MBT in combination with acute blood loss. Animals of the experimental groups were infected with the MBT archival strain H3RV: guinea pigs — at a dose of 0.001 g in the inguinal fold, rats — at a dose of 0.1 g in the tail vein. Two control groups included intact guinea pigs and rats. All animals were tested for amino acids and glutathione.

Results and Discussion: the resistance of guinea pigs and rats to tuberculosis and other damage-specific effects depends on man y factors. We have shown that these factors include specific patterns of amino acid (AA) metabolism associated with the biosynthesis of glutathione and taurine, manifested in two variants of metabolic types in the studied animals. The first variant is typical for rats due to the initially high content of taurine and glutathione (hereinafter, conditionally substrate-metabolic); the second variant is typical for guinea pigs due to significantly lower content of taurine and intensive glutathione oxidation (functional-metabolic-redistributive). The patterns of these variants determine the difference of protective and compensatory mechanisms when exposed to various damaging factors. Thus, the substrate-metabolic variant is characterized by high resistance to bacterial infections and toxic effects, while the functional-metabolic-redistributive variant is characterized by very low resistance to infectious effects given resistance to mutagenic factors and acute blood loss. Obtained re sults can serve as a basis for developing methods to improve the treatment efficacy targeted at tuberculosis in humans.

Keywords: experimental tuberculosis, amino acids, taurine, glutathione,treatment of tuberculosis.

For citation: Sabadash E.V., Skornyakov S.N., Medvinskii I.D. et al. Amino acid homeostasis during the implementation of adaptive responses in animals with various resistance to tuberculosis infection (experimental study). RMJ. 2020;4:29–33.



Pages 34-36. Синехиальная обструкция полости носа как проявление гранулематоза с полиангиитом: клиническое наблюдение. Верещагина О.Е., Карпищенко С.А., Теплова Е.О.

Summary:

Synechiae of the nasal cavity as a manifestation of granulomatosis with polyangiitis: clinical case

O.E. Vereshchagina1, S.A. Karpishchenko1,2, E.O. Teplova1

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

2Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint-Petersburg

Granulomatosis with polyangiitis (formerly called Wegener’s) is an idiopathic systemic necrotic granulomatous polyangiitis, which is clinically manifested by lesions of the organs’ triad: the upper respiratory tract (ears, nose and throat), lungs and kidneys. Early diagnosis of this disease directly affects the damage severity to target organs and disability of patients. To date, immunosuppressive therapy allows to control the symptoms, so we can discuss a chronic relapsing course of this disease. ENT specialists are directly involved in the primary diagnosis of granulomatosis with polyangiitis since the disease manifestation in the head and neck areas occurs in 95% of cases. Commonly, pathognomonic changes affect the sinonasal region, which is manifested by recurrent sinusitis, abundant cortical formation in the nasal cavity, and the development of a saddle nose deform ity. Also, given the area of the head and neck, common events arise from the middle and inner ear, subglottic laryngostenosis. The role of the otorhinolaryngologist in the further follow-up of patients with diagnosed granulomatosis is important for controlling the disease signs and improving the life quality of patients. This article describes the manifestations of Wegener’s granulomatosis in the upper respiratory tract using a clinical case.

Keywords: Wegener’s granulomatosis, granulomatous with polyangiitis, upper respiratory tract, immunosuppressive therapy.

For citation: Vereshchagina O.E., Karpishchenko S.A., Teplova E.O. Synechiae of the nasal cavity as a manifestation of granulomatosis with polyangiitis: clinical case. RMJ. 2020;4:34–36.

Pages 37-42. Особенности проявлений бронхолегочного синдрома у пациента с дисплазией соединительной ткани и врожденной дисфункцией коры надпочечников (клиническое наблюдение). Тетенева А.В., Беспалова И.Д., Сердюков Н.А., Бодрова Т.Н., Саприна Т.В., Жогина Т.В., Ларченко В.В., Тетенев К.Ф., Дубаков А.В., Потапов К.В., Мезикова Е.А.

Summary:

Patterns of bronchopulmonary dysplasia manifestations in a patient with connective tissue dysplasia and congenital adrenal hyperplasia (clinical case)

A.V. Teteneva1, I.D. Bespalova1, N.A. Serdyukov2, T.N. Bodrova1, T.V. Saprina1, T.V. Zhogina1, V.V. Larchenko1, K.F. Tetenev1, A.V. Dubakov1, K.V. Potapov1, E.A. Mezikova1

1Siberian State Medical University, Tomsk

2Regional Military Medical Commission, Military Commissariat of the Tomsk Region, Tomsk

Joint consensus of medical specialists (pulmonologists, endocrinologists and radiologists) must be reached for an additional detailed study concerning manifestations of bronchopulmonary dysplasia (BPD) and endocrine disorders during the disease onset in patients with connective tissue dysplasia (CTD) and malnutrition (MN).

This clinical case reflects the patterns of BPD manifestations in a patient with CTD and congenital adrenal hyperplasia (CAH). Given the additional detailed examination, the following diagnosis was verified: CTD, severe degree, unclassifiable phenotype; BPD, severe pulmonary hyperinflation (residual volume/total lung capacity — 195%) in combination with hyperventilation (respiratory minute volume — 132%); grade I restrictive lung diseases . Grade I respiratory failure (clinically). Endocrine disorders: congenital adrenal hyperplasia, virile form. Subclinical hypothyroidism. Malnutrition, severe degree (BMI=14.6). The presented clinical case emphasizes the necessity of paying special attention to patients with severe forms of CTD and MN during a medical examination for eligibility for military service. Besides, a detailed assessment of the bronchopulmonary system state should be included in the examination plan and one should send patients to specialized endocrinological departments to assess the endocrine system function.

Keywords: bronchopulmonary dysplasia, connective tissue dysplasia, malnutrition, congenital adrenal hyperplasia.

For citation: Teteneva A.V., Bespalova I.D., Serdyukov N.A. et al. Patterns of bronchopulmonary dysplasia manifestations in a patient with connective tissue dysplasia and congenital adrenal hyperplasia (clinical case). RMJ. 2020;4:37–42.

Pages 7-10. Несоответствия терапии острой респираторной патологии у детей на амбулаторном этапе клиническим рекомендациям. Ермакова М.К.

Summary:

Treatment non-compliance with clinical guidelines concerning acute respiratory pathology in children on an outpatient basis

M.K. Ermakova

Izhevsk State Medical University, Izhevsk

Aim: to analyze the outpatient management compliance with clinical guidelines concerning children with acute respiratory diseases and community-acquired pneumonia.

Patients and Methods: given the outpatient medical records, prescribed treatment compliance with clinical guidelines and justification of prescribing antibacterial drugs in 225 cases of respiratory diseases in children treated on an outpatient basis were analyzed. These were children with acute rhinopharyngitis (n=100), acute bronchitis (n=59), acute tonsillitis (n=40), acute otitis media (n=17), acute sinusitis (n=9). We also analyzed the management concerning 478 cases of community-acquired pneumonia in children.

Results: several inconsistencies with the clinical guidelines associated with children management with acute respiratory pathology on the outpatient basis were identified. Otoscopy was not conducted in acute respiratory viral infections as well as rapid strep test for tonsillitis in children. Oxygen saturation was not measured. Unjustified prescriptions of antibacterial drugs were revealed in 43.5% cases of acute respiratory pathology. In rhinopharyngitis and acute bronchitis, antibacterial drugs were substantially prescribed in 46.0% and 66.1% of cases, respectively, due to persistent febrile fever for more than three days, inflammatory changes in the blood (WBC more than 15×109/l) and left shift in the leukocyte formula, as well as persistent dry paroxysmal cough and suspected atypical flora. The first-line antibacterial drug is incorrectly selected in cases when cephalosporins are prescribed instead of aminopenicillins. Commonly, antibacterial drugs are prescribed in doses lower than recommended. Antibacterial therapy duration for tonsillitis, rhinosinusitis and diseases caused by atypical flora is less than 10 days. In 55.0% of cases, there is an unjustified hospitalization of children with uncomplicated community-acquired pneumonia of moderate severity.

Conclusion: identified inconsistencies in the children management with acute respiratory pathology on the outpatient basis indicate that it is necessary to conduct training workshops on this problem.

Keywords: children, antibacterial therapy, acute respiratory infections, acute tonsillopharyngitis, acute otitis media, acute rhinosinusitis, acute tracheobronchitis, community-acquired pneumonia, outpatient basis, clinical guidelines.

For citation: Ermakova M.K. Treatment non-compliance with clinical guidelines concerning acute respiratory pathology in children on an outpatient basis. RMJ. 2020;4:7–10.



№3, 2020. Кардиология

Pages 14-17. Возможности современной антигипертензивной терапии в лечении артериальной гипертензии у больных с хронической обструктивной болезнью легких. Григорьева Н.Ю., Королева М.Е., Кузякина Е.С.

Summary:

Possibilities of modern antihypertensive therapy in the treatment of arterial hypertension in patients with chronic obstructive pulmonary disease

N.Yu. Grigorieva, M.E. Koroleva, E.S. Kuzyakina

Privolzhsky Research Medical University, Nizhny Novgorod

City Clinical Hospital No. 5, Nizhny Novgorod

Based on the latest national and foreign literature data, the current state of the problem concerning arterial hypertension (AH) treatment in patients with chronic obstructive pulmonary disease (COPD) is presented. AH is the most common comorbid pathology in patients with COPD. Emphasis is placed on the importance of studying different types of blood pressure variability and evaluating its dynamics under the exposure of modern antihypertensive therapy. Excessive activity of the renin-angiotensin-aldosterone system in patients with AH and COPD confirms the need for specific therapeutic effect, given the positive effect of antihypertensive drugs (AHD) on this system. Angiotensin converting enzyme inhibitors, in particular, fosinopril, have such properties. This article shows the association between blood pressure variability and the severity of fosi nopril pleiotropic effects, in particular its effect on endothelial function and pulmonary artery pressure, as well as the fosinopril predominance over other AHD in the treatment of AH in patients with COPD. The authors present the results of their own observations.

Keywords: arterial hypertension, chronic obstructive pulmonary disease, blood pressure variability, endothelial function, fosinopril.

For citation: Grigorieva N.Yu., Koroleva M.E., Kuzyakina E.S. Possibilities of modern antihypertensive therapy in the treatment of arterial hypertension in patients with chronic obstructive pulmonary disease. RMJ. 2020;3:14–17.

Pages 18-20. Полиморфизм генов MTHFR, GP1BA, FGA при тромбоэмболии легочной артерии. Крючкова Н.М., Федорова Т.Е., Чернова А.А., Никулина С.Ю.

Summary:

Polymorphism of MTHFR, GP1BA, FGA genes in pulmonary embolism

N.M. Kryuchkova1, T.E. Fedorova2, A.A. Chernova2, S.Yu. Nikulina2

1Krasnoyarsk Trans-Regional Clinical Hospital No. 20 named after I.S. Berzon, Krasnoyarsk

2Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk

Venous thromboembolism, which includes pulmonary embolism (PE), is the third most common cardiovascular disease after coronary heart disease and stroke of cardiovascular morbidity, which causes a large number of fatal outcomes in both inpatient and outpatient patients. Acquired and genetic factors play the important role in the PE pathogenesis. This article reflects a scientific literature review using OMIM and PubMed databases for the last 20 years concerning the glycoprotein Ib alpha (GP1BA) gene, which is located on the surface of the platelet membrane and acts as a receptor for von Willebrand factor; the gene responsible for encoding the fibrinogen alpha (FGA) polypeptide, as well as the gene encoding methylenetetrahydrofolate reductase (MTHFR). MTHFR catalyzes the conversion of 5.10-methylenetetrahydrofolate to 5-methylenetetrahydrofolate, necessary for the re-methylation of homocysteine to methionine. These genes mechanisms of action, their structure and proteins functioning encoded by them were analyzed. The article also presents data from published studies that indicate the role of these genes in the pathogenesis of not only venous thromboembolism, but also other cardiovascular diseases. Several studies have demonstrated the association of these genes with the PE occurrence.

Keywords: gene, glycoprotein Ib alpha, methylenetetrahydrofolate reductase, fibrinogen alpha, GP1BA, FGA, MTHFR, multifactorial disease, venous thromboembolism, pulmonary embolism.

For citation: Kryuchkova N.M., Fedorova T.E., Chernova A.A., Nikulina S.Yu. Polymorphism of MTHFR, GP1BA, FGA genes in pulmonary embolism. RMJ. 2020;3:18–20.

Pages 22-26. Тактика ведения пациентов с внезапным подъемом артериального давления. Гапонова Н.И., Абдрахманов В.Р.

Summary:

Patient management tactics during sudden high blood pressure

N.I. Gaponova, V.R. Abdrakhmanov

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

The article discusses the captopril efficacy in the treatment of patients with sudden high blood pressure (BP). Sudden high BP remains the most common reason for calling an emergency. A marked high BP without affecting target organs may be accompanied by subjective symptoms that reduce the patients’ life quality and ability to work (“individually significant acute high BP”). Antihypertensive therapy in acute high BP without affecting the target organs should be performed on an outpatient basis with oral medications. Fast-acting medications with an optimal duration of action should be chosen. The angiotensin-converting enzyme inhibitor captopril (Capoten) fully meets the requirements for medications aimed at relief of an individually significant acute high BP. The drug has a favorable safety profile, which allows to prescribe it for patients with comorbidity, includi ng chronic heart failure, heart rhythm disorders and elderly age. Fast action (achieved by sublingual administration) and good safety profile allow it to be considered the front-line drug, including as self-treatment and mutual aid to patients with a sudden high BP.

Keywords: sudden high blood pressure, emergency, antihypertensive therapy, angiotensin-converting enzyme inhibitor, captopril.

For citation: Gaponova N.I., Abdrakhmanov V.R. Patient management tactics during sudden high blood pressure. RMJ. 2020;3:22–26.

Pages 27-30. Подходы к рациональному выбору продолжительности и компонентов двойной антитромбоцитарной терапии у пациентов с острым коронарным синдромом и высоким риском кровотечений. Седых Д.Ю., Велиева Р.М., Кашталап В.В.

Summary:

Methods for the rational choice of duration and components of dual antiplatelet therapy in patients with acute coronary syndrome at high risk of bleeding

D.Yu. Sedykh, R.M. Velieva, V.V. Kashtalap

Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo

A special place in the prevention of recurrent ischemic events belongs to antiplatelet agents, the major task of which is to prevent the formation of platelet thrombi on the surface of unstable atherosclerotic plaques. To date, antiplatelet drugs are widely available in the pharmaceutical market in Russia and worldwide. Their effect is implemented through various pathogenetic mechanisms in patients with coronary heart disease. In real clinical practice, the physician needs to sel ect the most relevant antiplatelet drug fr om the available set, which is characterized by a potent disaggregant effect that does not require laboratory control; upon this, the drug should not increase the risk of adverse drug interactions, being convenient to use. The article presents arguments in favor of dual antiplatelet therapy with clopidogrel for a patient with hospital bleeding during myocardial infarction. The a rticle also shows study results indicating a higher safety of dual antiplatelet therapy in the composition of clopidogrel and acetylsalicylic acid while maintaining high efficiency.

Keywords: myocardial infarction, percutaneous coronary intervention, bleeding, dual antiplatelet therapy, clopidogrel.

For citation: Sedykh D.Yu., Velieva R.M., Kashtalap V.V. Methods for the rational choice of duration and components of dual antiplatelet therapy in patients with acute coronary syndrome at high risk of bleeding. RMJ. 2020;3:27–30.



Pages 3-6. Роль антагонистов альдостерона в лечении сердечно-сосудистых заболеваний. Мареев В.Ю.

Summary:

Aldosterone antagonists for cardiovascular disorders

V.Yu. Mareev1,2

1Faculty of Fundamental Medicine, M.V. Lomonosov Moscow State University, Moscow

2Medical Research and Educational Center, M.V. Lomonosov Moscow State University, Moscow

We interviewed Professor V. Yu. Mareev, and asked him important questions about aldosterone antagonist use in clinical practice. Prof. Mareev is one of the leading experts in cardiology. The role of aldosterone and renin-angiotensin-aldosterone system hyperactivation in the development and progression of cardiovascular disorders is discussed. A group of patients who require mineralocorticoid receptor antagonists is specified. Treatment for resistant arterial hypertension and chronic heart failure is highlighted. Evidence base and clinical studies on spironolactone, aldosterone antagonist, are addressed.

Keywords: aldosterone antagonist, mineralocorticoid receptor antagonists, resistant arterial hypertension, chronic heart failure, spironolactone, Verospiron.

For citation: Mareev V.Yu. Aldosterone antagonists for cardiovascular disorders. RMJ. 2020;3:3–6.



Pages 32-38. Хроническая обструктивная болезнь легких и артериальная гипертензия: существуют ли особенности ведения пациентов?. Адашева Т.В., Саморукова Е.И., Долбин С.С., Ли В.В., Задионченко В.С., Высоцкая Н.В.

Summary:

Chronic obstructive pulmonary disease and arterial hypertension: are there any specific patterns of patient management?

T.V. Adasheva1, E.I. Samorukova1, S.S. Dolbin2, V.V. Li1, V.S. Zadionchenko1, N.V. Vysotskaya1

1A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow

2Central Clinic of the Federal Security Service of the Russian Federation, Moscow

Arterial hypertension (AH) is the most common comorbid condition in chronic obstructive pulmonary disease (COPD). It is known that hypertension incidence is more than 50% in patients with COPD. As hypertension, COPD and lung function impairment are independently associated with an increased risk of cardiovascular events. According to a number of studies, reduced lung function (reduced forced expiratory volume in 1 second) is a strong risk factor for cardiovascular mortality just as the main cardiovascular risk factors.

The article discusses the pathophysiological patterns of AH in patients with COPD. Also, the article considers the general mechanisms of vascular damage progression in AH and COPD. Modern treatment tactics of AH and therapy characteristics in patients with COPD are described. All classes of antihypertensive drugs are analyzed — their exposure on the pathog enetic mechanisms of AH in COPD, possible negative respiratory effects and drug interactions. The use of combined therapy and individual approach is justified.

Keywords: arterial hypertension, chronic obstructive pulmonary disease, antihypertensive therapy, fixed drug combinations.

For citation: Adasheva T.V., Samorukova E.I., Dolbin S.S. et al. Chronic obstructive pulmonary disease and arterial hypertensionn: are there any specific patterns of patient management? RMJ. 2020;3:32–38.

Pages 39-43. Геморрагический васкулит на фоне активного гепатита В в периоде рубцевания инфаркта миокарда: клиническое наблюдение. Филимонова О.Г.

Summary:

Hemorrhagic vasculitis during active hepatitis B in the period of myocardial scarring: clinical case

O.G. Filimonova

Kirov State Medical University, Kirov

Every doctor in its practice can face with signs of petechiae on the lower extremities, mucous membrane hemorrhages, joint syndrome and abdominal pain in patients who had experienced the upper respiratory tract infection, tonsillitis or influenza. The cause of abdominal pain, flatulence, bowel disorders, nausea and vomiting (sometimes with blood admixture) are bleedings in the intestinal wall. These signs are characteristic of hemorrhagic vasculitis (HV). This disease onset in elderly in the presence of serious comorbid pathology does not always allow to initially establish the correct diagnosis. In the presented clinical case, the combination of hepatitis B and viral hepatitis B, as well as vasculitis onset during small focal myocardial scarring caused difficulties in the differential diagnosis. Fever and a discernible abdominal pain syndrome were absent, however, arthralgias, characteristic rash and swelling of the lower ex tremities were observed. Clinical signs of HV were mistaken for symptoms of decompensated chronic heart failure. In this regard, the therapy was ineffective, the kidney failure progressed according to glomerulonephritis type. Correctly established diagnosis made it possible to start pathogenetic therapy with glucocorticoids and get a positive dynamics of clinical manifestations.

Keywords: hemorrhagic vasculitis, petechiae, joint syndrome, abdominal pain, viral hepatitis B, myocardial infarction, chronic heart failure, kidney failure, glucocorticoids.

For citation: Filimonova O.G. Hemorrhagic vasculitis during active hepatitis B in the period of myocardial scarring: clinical case. RMJ. 2020;3:39–43.

Pages 44-47. Функциональное состояние сердечно-сосудистой системы у пациентов с хроническими лейкозами: результаты ретроспективного исследования. Ганцева Х.Х., Явгильдина А.М., Садретдинова Л.Д.

Summary:

Functional state of the cardiovascular system in patients with chronic leukemia: retrospective study results

Kh.Kh. Gantseva, A.M. Yavgildina, L.D. Sadretdinova

Bashkir State Medical University, Ufa

A retrospective analysis of the cardiovascular system (CVS) functional state in patients with chronic leukemia (CL) was conducted at the Hematology Center in Ufa, the Republic of Bashkortostan.

Aim: to evaluate the CVS functional changes in CL to identify characteristic disorders that require preventive therapy reducing the risk of disease progression.

Patients and Methods: the study involved 86 patients (20 patients were in the control group, 34 patients — with chronic lymphocytic leukemia (CLL), and 32 patients — with chronic myeloid leukemia (CML)). Age of patients ranged from 18 to 60 years; established diagnosis — CL. Clinically unstable patients with concomitant diseases were excluded from the study. All patients underwent the clinical status assessment, instrumental diagnostics (electrocardiography (ECG), Holter monitor (HM), echocardiography (ECHO-CG)). Also, evaluation of h eart rate variability and vegetative tonus was performed.

Results: the main clinical symptoms at admission were signs of general intoxication and weight loss. On the part of CVS, the most common complaints were chest pain of varying duration, intensity and nature, shortness of breath during physical exercise, and palpitation. According to ECG data, sinus tachycardia, signs of left ventricular hypertrophy and bundle branch block were most commonly registered. HM was more informative in identifying signs of CVS disorder than the ECG. Initial indicators of heart rate variability in patients with hemoblastosis were reduced in both groups. According to the ECHO-CG data, there were signs of an increase in the left ventricle size and volume, reduced contractility and its dilation. In patients with CLL, sympathicotonia dominated, in patients with CML — eutonia.

Conclusion: CL, having a systemic nature, affect the CVS functional state. Multicomponent therapy of CL causes the manifestation of adverse events, including cardiotoxic, in a significant part of patients which is why joint patient management by hematologist and therapist is very important.

Keywords: hemoblastosis, chronic lymphocytic leukemia, chronic myeloid leukemia, cardiovascular system, heart rate variability, functional research methods, heart rhythm disorders.

For citation: Gantseva Kh.Kh., Yavgildina A.M., Sadretdinova L.D. Functional state of the cardiovascular system in patients with chronic leukemia: retrospective study results. RMJ. 2020;3:44–47.



Pages 8-12. О рекомендуемом потреблении и обеспеченности населения калием и магнием. Погожева А.В., Коденцова В.М.

Summary:

About recommended consumption and provision of population with potassium and magnesium

A.V. Pogozheva1,2, V.M. Kodentsova1

1Federal Research Centre of Nutrition, Biotechnology and Food Safety, Moscow

2Sechenov University, Moscow

The article presents data on food products as sources of potassium and magnesium, causes and consequences of their insufficient intake with the diet. Diagnostic criteria and clinical manifestations concerning the lack of these micronutrients are considered, as well as the high prevalence of their insufficiency among the Russian population. The article also describes the protective role of adequate consumption of potassium and magnesium in the prevention and treatment of the following diseases: arterial hypertension, cardiovascular diseases, type 2 diabetes mellitus. The increase in the physiological need and recommended daily intake values of potassium and magnesium to 3500 mg and 420 mg is justified. Ways to increase magnesium intake include eating food with a high magnesium content, eliminating dietary components that reduce absorption, and using specialized food enriched with potassium and magnesium. The article discusses the selection  criteria and benefits of using drugs simultaneously containing potassium and magnesium to improve the population mineral status.

Keywords: potassium, magnesium, deficiency, provision, risk factors.

For citation: Pogozheva A.V., Kodentsova V.M. About recommended consumption and provision of population with potassium and magnesium. RMJ. 2020;3:8–12.





№2, 2020. Педиатрия

Pages 11-14. Изучение взаимосвязи показателей качества жизни и клинических характеристик при болезни Крона у детей. Тагирова А.Р., Сичинава И.В., Ивардава М.И.

Summary:

Association between the quality of life and clinical features of Crohn’s disease

A.R. Tagirova1, I.V. Sichinava1, M.I. Ivardava2

1Sechenov University, Moscow

2National Medical Research Center for Children’s Health, Moscow

Background: currently, mechanisms underlying the association between the quality of life (QoL) of children with Crohn’s disease and Crohn’s disease activity index remain elusive.

Aim: to assess QoL of children with Crohn’s disease depending on its clinical course.

Patients and Methods: 23 children with Crohn’s disease (15 boys and 8 girls, mean age 13.8±1.4 years) were examined. Pediatric Crohn’s disease activity index (PCDAI) was compared to QoL measured by PedsQL 4.0 Generic Core Scales. Follow-upwas 1 year.

Results: both parent-reported and child-reported QoL levels measured by all scales (28.6 [22.3; 38.1] and 32.0 [27.2; 48.1], respectively) were significantly lower as compared with healthy children (100). Child-reported QoL (58.6 [41.0; 67.3], p<0.001) and parent-reported QoL (60.3 [47.4; 71.2], p=0.006) were higher after the treatment as compared with baseline scores having been associated with reduced disease activity, i.e., PCDAI decreased from 71.4 [54.7; 86.2] to 28.1 [17.5; 40.4], p=0.023). Correlation analysis revealed significant negative correlations between the clinical course of Crohn’ disease (i.e., PCDAI score, disease duration, and extraintestinal manifestations) and QoL scores (physical activity, mood, schooling).

Conclusions: when examining children with Crohn’s disease, pediatrician should assess the quality of life and ask parents about physical activity of their children, school achievements and attendance. Health-related QoL monitoring is required when examining and managing children with Crohn’s disease since they report on significantly reduced QoL as compared with healthy age-matched children. Concern for QoL of children with Crohn’s disease improve treatment efficacy and outcomes.

Keywords: inflammatory bowel disorder, Crohn’s disease, quality of life, disease activity, extraintestinal manifestations, physical activity.

For citation: Tagirova A.R., Sichinava I.V., Ivardava M.I. Association between the quality of life and clinical features of Crohn’s disease. RMJ. 2020;2:11–14.

Pages 15-18. Слагаемые успеха терапии различных вариантов поражений кожи в практике врача. Пикуза О.И., Закиров А.М., Пикуза А.В., Закирова А.М., Максимов М.Л.

Summary:

Success factors for therapy of various skin disorders in physician’s practice

O.I. Pikuza1, A.M. Zakirov2, A.V. Pikuza1, A.M. Zakirova1, M.L. Maksimov3,4

1Kazan State Medical University, Kazan

2City Clnical Hospital No. 7, Kazan

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

4Pirogov Russian National Research Medical University, Moscow

Aim: to study the efficacy and safety of the following: combined topical antibacterial drug containing neomycin and bacitracin for wound detersion from pus and necrotic tissues; reparative processes course; the velocity of wound healing in the treatment of the skin and soft tissue infections.

Patients and Methods: the study involved 105 patients aged 16–77 years with various nosological forms of inflammatory lesions in the soft tissues. These patients were divided into 2 groups: 57 patients (the main group) were prescribed with various combined antibacterial drug forms containing neomycin and bacitracin (Baneocin®) (powder and ointment), which was distantly applied 3 times a day during dressings; 48 patients (the control group) received the traditional therapy.

Results: as a result of the study, there was a positive effect on reparative processesof the combined topical antibacterial drug containing neomycin and bacitracin. In 67.5% of cases, its efficacy was regarded as excellent and in 31.8% as good. The share of patients cured by day 7 in the main group was 77.2%, in the control group — 52.2% (p<0.01). A significant process resolution was revealed (p<0.05) when evaluating individual signs. When analyzing the dynamics of the clinical signs, a statistically significant relief of pain/burning, soft-tissue edema, and topical hyperthermia/hyperemia was revealed in patients of the main group. In patients with a severe infection process during complex treatment, the resolution of the inflammatory process and foci epithelialization was achieved by the 14th day  of therapy (therapy duration with the drug did not exceed 7 days).

Conclusion: given the conducted study, it can be argued about the high clinical efficacy of the combined topical antibiotic containing neomycin and bacitracin in the treatment of infected wounds of various localizations, which makes it possible to recommend this product for widespread use in everyday clinical practice.

Keywords: inflammatory skin and soft tissue lesions, treatment of infected wounds, bacitracin, neomycin, topical combined antibacterial drug.

For citation: Pikuza O.I., Zakirov A.M., Pikuza A.V. et al. Success factors for therapy of various skin disorders in physician’s practice.
RMJ. 2020;2:15–18.

Pages 19-22. Клинические особенности рубцового процесса в области ахиллова сухожилия у детей. Филиппова О.В., Говоров А.В., Афоничев К.А., Прощенко Я.Н.

Summary:

Clinical patterns of scarring process in the Achilles tendon of pediatric patients

O.V. Filippova, A.V. Govorov, K.A. Afonichev, Ya.N. Proschenko

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery, Pushkin

Aim: to study the characteristic patterns of the cicatricial process in Achilles tendon and ankle joint in pediatric patients.

Patients and Methods: clinical evaluation of scar tissue in the Achilles tendon was performed in 24 patients using the Vancouver scale. Besides, history data, patient complaints, and trophic disturbances in scar tissue were taken into account.

Results: the main causes of cicatricial deformities in the Achilles tendon are burns and mechanical injuries. The most common complaints are: scar tension when walking, scar trauma when wearing shoes, itching, especially in trophic disturbances. Analysis of anamnestic data showed that even after 2–5 years after the skin restoration, the quality of scar tissue in the Achilles tendon in 58.3% of cases corresponds to 10–13 points, which is regarded as the most unfavorable scar. The maximum number of points was noted for elasticity and scar thickness, which in 58.3% of cases exceeded 5 mm. In 41.6% of cases, trophic disturbances were detected on the scar tissue, which were represented by fissure, erosions and trophic ulcers with sluggish epithelization and common recurrence. Such ulcers do not tend to the self-healing since the resulting local inflammatory process contributes to the strengthening of fibrosis.

Conclusions: scar tissue formation in the Achilles tendon is prolonged with the marked tendency to hypertrophy; a significant functional and mechanical load on the segment against the background of the most unfavorable condition of scar tissue (10 or more points on the Vancouver scale) leads to the signs of recurrent trophic disturbances in the form of erosions and ulcers in 41.6% of cases. Children with scars in the Achilles tendon should be under regular medical supervision, especially during the period of intensive growth, since preventive and timely surgical treatment will allow preventing secondary shortening of the Achilles tendon and contracture occurrence in the ankle joint.

Keywords: scars, scar deformities, scar tissue, post-burn scars, Achilles tendon, Vancouver scale.

For citation: Filippova O.V., Govorov A.V., Afonichev K.A., Proschenko Ya.N. Clinical patterns of scarring process in the Achilles tendon of pediatric patients. RMJ. 2020;2:19–22.

Pages 2-6. Алгоритм диагностики и тактика лечения витамин-К-дефицитной коагулопатии у детей грудного возраста. Заплатников А.Л., Османов И.М., Бражникова О.В., Шеин В.Н., Майкова И.Д., Никитин В.В., Медоев С.Б., Ефимов М.С., Горев В.В., Дементьев А.А., Чабаидзе Ж.Л., Потанина Ю.В., Ашурова Б.А., Королева А.С., Трофимов А.А., Милованов А.В., Гаевый О.В., Шабля В.В., Волохин А.Ю., Петрушко С.И., Кузнецова О.А., Воробьева А.С., Радченко Е.Р., Гончарова Л.В., Гавеля Н.В., Лобань Н.В., Короид Н.В., Дубовец Н.Ф., Белоус Ю.Ю.

Summary:

Algorithm for diagnosis and treatment of сoagulopathy caused by vitamin K deficiency in infants

A.L. Zaplatnikov1,2, I.M. Osmanov2, O.V. Brazhnikova1,2, V.N. Shein2, I.D. Maykova2, V.V. Nikitin2, S.B. Medoev2, M.S. Efimov1, V.V. Gorev1, A.A. Dementiev1, Zh.L. Chabaidze1, Yu.V. Potanina2, B.A. Ashurova2, A.S. Koroleva2, A.A. Trofimov2, A.V. Milovanov2, O.V. Gaevyi1,2, V.V. Shablya2, A.Yu. Volokhin2, S.I. Petrushko2, O.A. Kuznetsova2, A.S. Vorobiova2, E.R. Radchenko2, L.V. Goncharova2, N.V. Gavelya2,
N.V. Loban’2, N.V. Koroid2, N.F. Dubovets2, Yu.Yu. Belous2

1Russian Medical Academy of Continuous Professional Education, Moscow

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

Newborns and young infants are at particular risk of hemorrhagic disorders. Of particular concern is the potentially high level of serious complications arising from pathological changes in hemostasis. The absence of specific manifestations in hemorrhagic syndrome, a variety of etiological factors and certain difficulties in conducting hemostasis research and interpreting its results concerning patients of this age category determine the template method to the therapy choice in many cases. Commonly, it leads to insufficient therapy efficacy and is accompanied by polypragmasia.

Given the analysis of modern literature data and our clinical studies, we have highlighted the clinical and laboratory patterns of coagulopathy caused by vitamin K deficiency in young infants (late hemorrhagic disease of newborns). Special attention is paid to the causes of vitamin K deficiency in children at the post-neonatal period. The importance of detecting early hemorrhagic manifestations preceding the signs of intracranial hemorrhages is noted. The algorithm of diagnostics and treatment tactics of coagulopathy caused by vitamin K deficiency is presented. It was shown that the high efficiency of the presented therapeutic measures was possible only with early diagnosis and timely treatment.

Keywords: vitamin K, coagulopathy caused by vitamin K deficiency, children, late hemorrhagic disease of newborns.

For citation: Zaplatnikov A.L., Osmanov I.M., Brazhnikova O.V. et al. Algorithm for diagnosis and treatment of сoagulopathy caused by vitamin K deficiency in infants. RMJ. 2020;2:2–6.

Pages 24-27. Паразитозы как коморбидное состояние у детей с аллергическими заболеваниями. Файзуллина Р.М., Санникова А.В., Гафурова Р.Р.

Summary:

Parasitic diseases are comorbidities in children with allergic disorders

R.M. Fayzullina, A.V. Sannikova, R.R. Gafurova

Bashkir State Medical University, Ufa

Background: currently, high occurrence of allergic disorders as well as parasitic infections in children is reported. Parasitic diseases and allergic disorders which have common pathogenic mechanisms are comorbid conditions. Therefore, when assessing clinical course and the severity of allergic disorders in children, potential potentiating effects of parasitic invasions should be considered.

Aim: to determine the rate of parasitosis and their effect on the clinical course of allergic disorders in children.

Patients and Methods: 262 children with allergic disorders (i.e., atopic dermatitis, allergic rhinitis, asthma, urticaria) were enrolled. All children underwent complex parasitic examination, i.e., the levels of specific IgA, IgM, and IgG, circulating immune complexes against parasitic antigens were measured (by ELISA), helminth eggs and/or G. lamblia cysts were identified by standard microsco py. Clinical manifestations of allergic disorders (clinical course, severity, prevalence, control) in children were evaluated depending on the presence of parasitosis.

Results: parasitic infections were diagnosed in 42.7% of children with allergic disorders. The most common parasitic invasions were lambliasis (65.2%), ascariasis (19.6%), opisthorchiasis (9.8%), and toxocariasis (0.9%). The rate of lambliasis was significantly higher in children with atopic dermatitis, allergic rhinitis, and asthma as well as in children younger than 12 years. Helminth infections were more common in children with urticaria. Mild and moderate controllable (p=0.0012) and uncontrollable (p=0.038) persistent asthma, moderate persistent allergic rhinitis (p=0.004), and moderate-to-severe atopic dermatitis (p=0.002) were more common in children with parasitosis.

Conclusion: high probability of comorbid parasitic invasions should be considered when assessing the severity of allergic disorders in children and treatment efficacy as well as controlling risk factors.

Keywords: comorbidity, children, allergic disorders, parasitosis, rate, severity, level  of control.

For citation: Fayzullina R.M., Sannikova A.V., Gafurova R.R. Parasitic diseases are comorbidities in children with allergic disorders.
RMJ. 2020;2:24–27.



Pages 28-32. Значение омега-3 полиненасыщенных жирных кислот для детей. Николаева С.В., Усенко Д.В., Шушакова Е.К., Савватеева О.А., Горелов А.В.

Summary:

Omega-3 polyunsaturated fatty acids value for children

S.V. Nikolaieva1, D.V. Usenko1, E.K. Shushakova1, O.A. Savvateieva2, A.V. Gorelov1,2

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

2Sechenov University, Moscow

Polyunsaturated fatty acids (PUFAs), which include omega-3 fatty acids (omega-3 PUFAs) are essential for the normal functioning of the body. The importance of omega-3 PUFAs for the human body is because they are the key structural components of all cell membranes, forming the basis of their phospholipid layer and affecting their flow property. This allows to maintain adequate functioning of enzymes embedded in the membrane in the active state, the correct conformation of cell receptors and, as a result, to implement the biological effects of omega-3 PUFAs: immunoregulatory, hypocholesterolemic, hypotriglyceridemic, antiatherogenic, anti-thrombogenic, vasodilating (hypotensive), anti-inflammatory, antiarrhythmic, cardioprotective. The main sources of omega-3 PUFAs are flaxseed oil and cold-water fish oil. However, due to the specificity of nutrition sources, there is i nsufficient consumption of omega-3 PUFAs with food. The use of the additional omega-3 PUFAs is considered promising.

Keywords: immunity, unsaturated fatty acids, omega-3 fatty acids, child development, fish oil.

For citation: Nikolaieva S.V., Usenko D.V., Shushakova E.K. et al. Omega-3 polyunsaturated fatty acids value for children. RMJ. 2020;2:28–32.

Pages 33-36. Лечение хронического риносинусита: фактические данные. Николаева С.В., Усенко Д.В., Горелов А.В.

Summary: Chronic rhinosinusitis treatment: actual data
S.V. Nikolaieva1, D.V. Usenko1, A.V. Gorelov1,2

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

Chronic rhinosinusitis (CR) is one of the most common upper respiratory tract infections. CR is a serious health problem, harming the patients’ life quality due to the deterioration of their well-being and restrictions on daily activity. At present, it has been proven that normally there are various bacteria in healthy sinuses. A decrease in bacterial diversity correlates with the CR severity. The presence and percentage of these microorganisms may be affected by previous antibiotic therapy, vaccination, presence/absence of normal microbiota that can affect the pathogenic microorganisms growth, and inflammatory process localization (supramaxillary, ethmoidal, or frontal sinuses). Special attention has recently been paid to the ability of microorganisms to form biofilms. In patients with CR, the presence of biofilms provokes a more severe and prolonged disease course. Currently, CR treatment includes medication (mainly antibiotics, irrigation therapy with saline solutions or corticosteroids) and surgical treatment. At the same time, there are no guaranteed methods aimed at achieving stable remission or recovery of the patient. It is advisable to limit the use of antibacterial therapy in favor of effective therapy methods targeted at CR that affect biofilms, since it is the biofilms that cause the main pathogenic bacteria persistence, reducing the medicamental sanitation efficacy of the infection focus in CR.

Keywords: chronic rhinosinusitis, nasal cavity, microorganisms, biofilms, medication, hypersaline solution.
For citation: Nikolaieva S.V., Usenko D.V., Gorelov A.V. Chronic rhinosinusitis treatment: actual data. RMJ. 2020;2:33–36.

Pages 37-39. Дистонии-плюс dyt12: трудности диагностики в раннем периоде заболевания. Шишкина Е.В., Базилевская Т.Н., Белкина А.Б., Андреева А.А., Алыева Л.П., Парамонова А.И., Прожкевич М.О., Маисеенко Д.А.

Summary:

Dystonia-plus DYT12: difficulties in diagnosis of an early disease onset

E.V. Shishkina1, T.N. Bazilevskaia2, A.B. Belkina2, A.A. Andreeva2, L.P. Alyieva2, A.I. Paramonova1, M.O. Prozhkevich1, D.A. Maiseenko1

1Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk

2Krasnoyarsk Trans-Regional Children’s Clinical Hospital No. 1, Krasnoyarsk

Dystonia is a group of diseases of various etiology. To date, there is an etiological classification dividing all dystonia into primary (idiopathic) and secondary variants.

This article presents our own clinical experience concerning follow-up and establishing the final diagnosis in a patient with one of the genetically determined dystonia-plus course variants in the form of early dystonia parkinsonism onset (DYT12) with manifestation in the early puberty period. It is an autosomal dominant disease with a genetically proven ATR1A3 gene mutation. The distinctive patterns of this disease from the classic dystonia view are described in detail. In this dystonia type, there are patterns of the first disease signs that resemble neuroinfection manifestations. Commonly, the trigger of such an event can serve as various infectious processes. The article describes in detail the first clinical manifestations in the somatic and neurological status and further signs transformation over the disease course, data from additional instrumental examinations such as brain imaging, electromyography. Based on these examinations, the authors were able t o initially suspect this disease and later confirm it during molecular genetic examination (target genetic panel for neurodegenerative diseases).

Keywords: diagnosis, clinical manifestations, early signs, DYT12, dystonia-plus, pediatric practice.

For citation: Shishkina E.V., Bazilevskaia T.N., Belkina A.B. et al. Dystonia-plus DYT1: difficulties in diagnosis of an early disease onset.
RMJ. 2020;2:37–39.

Pages 7-10. Эффективность пробиотиков в лечении неалкогольной жировой болезни печени у детей с ожирением. Павловская Е.В., Строкова Т.В., Багаева М.Э., Зубович А.И., Таран Н.Н.

Summary:

Probiotics efficacy in the treatment of non-alcoholic fatty liver disease in children with obesity

E.V. Pavlovskaya, T.V. Strokova, M.E. Bagaieva, A.I. Zubovich, N.N. Taran

Federal Research Centre of Nutrition, Biotechnology and Food Safety, Moscow

Aim: to evaluate the probiotics efficacy in the complex treatment of non-alcoholic fatty liver disease (NAFLD) in children and adolescents with obesity.

Patients and Methods: the study included 33 patients with obesity at the average age of 13 [11–15] years. Complex therapy included a low-calorie diet and individual physical activity for 14 days. Patients were divided into 2 groups: children of group 1 (n=20) received an additional complex multi-probiotic drug in the age-specific dosage, group 2 (n=13) was the control. All children were examined for indicators of carbohydrate and lipid metabolism, and abdominal ultrasound was performed. Comparative dynamics of anthropometric data, alanine aminotransferase (ALT), aspartate aminotransferase (AST), carbohydrate and lipid metabolism were evaluated. The follow-up duration after discharge from the hospital was 12–24 months. Children of  group 1 were recommended to continue taking probiotic in the course regimen for 14 days 4 times a year.

Results: during the period of inpatient treatment, children in both groups had statistically significant decreases in anthropometric indicators (body weight, body mass index (BMI), BMI Z-score), total cholesterol, and low-and high-density lipoproteins. ALT level also decreased in group 1 (p=0.025). At the beginning of follow-up in group 1, NAFLD was diagnosed in 12 children (60%), and non-alcoholic steatohepatitis (NASH) in 5 children (25%). In group 2, NAFLD and NASH were detected in 6 (46.2%) and 1 (7.7%) patients, respectively. Over the follow-up period, there was an increase in the absolute values of body weight (p=0.009) and body height (p=0.001), but the BMI Z-score (p=0.02) decreased in children of group 1. In group 2, the median body height increased in catamnesis (p=0.009). When evaluating the dynamics of biochemical parameters during the follow-up of children in group 1, a decrease in ALT and AST was revealed (p=0.013 and p=0.001, respectively), and in  group 2 — a decrease in serum triglycerides (p=0.04). In the catamnesis of group 1, NAFLD was detected in 11 children (55%), NASH — in 1 child (5%). In group 2, NAFLD and NASH were diagnosed in 8 (61.5%) and 3 (23.1%) children, respectively. Intergroup differences in the NAFLD and NASH incidence, as well as its dynamics in the catamnesis within the group, did not reach the level of statistical significance.

Conclusion: the use of the complex probiotic in the treatment of children with obesity is accompanied by a tendency to decrease the NAFLD and NASH incidence. Further researches are needed on probiotics efficacy in the treatment of NAFLD in children with obesity.

Keywords: obesity, children, probiotics, non-alcoholic fatty liver disease, steatohepatitis.

For citation: Pavlovskaya E.V., Strokova T.V., Bagaieva M.E. et al. Probiotics efficacy in the treatment of non-alcoholic fatty liver disease in children with obesity. RMJ. 2020;2:7–10.



№1, 2020. Эндокринология

Pages 10-13. Повторный набор массы тела, артериальная гипертензия и синдром обструктивного апноэ сна у пациентов молодого возраста с ожирением после бариатрических вмешательств. Волкова А.Р., Семикова Г.В., Волкова Е.В., Мозгунова В.С.

Summary:

Weight regain, hypertension and obstructive sleep apnea in young obese patients after bariatric interventions

A.R. Volkova, G.V. Semikova, E.V. Volkova, V.S. Mozgunova

Pavlov First Saint Petersburg State Medical University

Bariatric surgery is the most effective method of treating morbid obesity, however, some patients experience weight regain (WR) in the postoperative period, the clinical significance of which is not fully understood.

Aim: to determine the rate of clinically significant WR in young obese patients after bariatric interventions based on the dynamics of obesity-associated conditions.

Patients and Methods: the study included 98 patients (67 women, 31 men) under 45 and with grade II and III obesity who underwent bariatric surgery. Initially, body weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and diagnostic criteria for obstructive sleep apnea (OSA) were determined. The dynamics of body weight, blood pressure (BP), and OSA symptoms were evaluated in 6, 12, 18, 24, 30, and 36 months after the surgery. Also, for each patient, the onset of n adir point (postoperative minimum body weight) and the time of its achievement were retrospectively evaluated with WR calculation.

Results: in 62.8% of patients, hypertension of various severity was detected. Among obese patients who underwent bariatric surgery, men had a significantly higher BMI, hypertension and OSA were more common. In 49.2% of patients in 12 months after bariatric surgery, the target BP values were reached; no association was found between the patients’ gender and a decrease in SBP and DBP. Clinically significant WR more than 15% in 36 months after bariatric surgery was detected in 62.4% of patients younger than 45 years. WR of more than 15% was associated with a significant increase in SBP and DBP.

Conclusion: determining predictors of weight regain and predicting the outcomes of bariatric interventions in patients with severe obesity promising tasks of modern medicine.

Keywords: obesity, bariatric surgery, weight regain, obstructive sleep  apnea, hypertension.

For citation: Volkova A.R., Semikova G.V., Volkova E.V., Mozgunova V.S. Weight regain, hypertension and obstructive sleep apnea in young obese patients after bariatric interventions. RMJ. 2020;1:10–13.



Pages 14-19. Диабетическая полинейропатия: чего мы достигли в понимании проблемы?. Бирюкова Е.В., Ганненкова Е.С., Соловьева И.В.

Summary:

Diabetic polyneuropathy: achievements in understanding the problem

E.V. Biryukova, E.S. Gannenkova, I.V. Solovieva

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

Diabetes mellitus (DM) is one of the common causes of polyneuropathy, which reduces the ability to work, affects life quality, and can lead to disability. Disease duration and the lack of targeted glycemia control are the leading risk factors causing damage to the nervous system. The most common and well-known form of diabetic polyneuropathy is distal neuropathy. The development of this DM complication is based on a complex of interrelated pathological mechanisms. The damaging effect of hyperglycemia comes through a cascade of glucose metabolism pathological pathways. In recent years, there has been growing interest in the problem of vitamin B12 deficiency (cyanocobalamin) in polyneuropathies of various origins, since this vitamin plays an important role in the functioning of the nervous system. Among the neurotropic effects of vitamin B12, the most significant are the abilities to restore the myelin sheath structure, accelerate nerve regeneration and reduce neuropathic pain. Data review on the problem of vitamin B12 deficiency, which may be associated with the use of certain medications, is presented. Commonly, the development of cobalamin deficiency is observed in patients with type 2 DM receiving metformin for more than 5–10 years. The authors consider the possibilities of pathogenetic therapy in diabetic neuropathy associated with the use of Neuromultivit.

Keywords: diabetes mellitus, polyneuropathy, hyperglycemia, B12 deficiency, B vitamins, transketolase, Neuromultivit.

For citation: Biryukova E.V., Gannenkova E.S., Solovieva I.V. Diabetic polyneuropathy: achievements in understanding the problem. RMJ. 2020;1:14–19.



Pages 19-22. Иммуногенность инсулинов: клинические проявления и ее значимость. Мосикян А.А., Исаева Ю.Е.

Summary:

Insulin immunogenicity: clinical manifestations and its significance

A.A. Mosikyan1, Yu.E. Isaieva2

1Almazov National Medical Research Centre, Saint-Petersburg, Russia

2Pavlov First Saint Petersburg State Medical University, Russia

Biotechnological drugs (BTD) are substances of a protein nature, which can cause an immune response development (antibodies formation to the drug in response to its administration). The most common pathophysiological mechanism underlying the immune response is the BTD binding with antibodies without neutralizing activity changing its pharmacokinetic properties, in more rare cases — BTD neutralization with neutralizing antibodies. Much less common, the immune response is associated with the activation of Fc receptors and complement, the launch of the cytokine cascade and the cross-reactivity development of antibodies with endogenous proteins structurally similar to BTD. The reaction type is due to the molecule structure and BTD mechanism of action. In particular, insulin medications can not activate Fc receptors and complement and are not able to launch the cytokine cascade. However , during therapy with insulin medications, antibodies to insulin form in a significant number of patients, including neutralizing antibodies, although this rarely leads to clinical outcomes.

This review provides data on the possible clinical outcomes concerning immune response development, as well as its clinically significant incidence and antibodies formation without clinically significant manifestations during therapy with insulin medications, both original and biosimilar.

Keywords: insulin, biosimilars, immunogenicity, immune response, antibodies.

For citation: Mosikyan A.A., Isaieva Yu.E. Insulin immunogenicity: clinical manifestations and its significance. RMJ. 2020;1:19–22.

Pages 2-2. Слово редактора. Бабенко А.Ю.

Summary:

                                                              



Pages 23-28. Роль эндоканнабиноидной системы в развитии ожирения. Дударева В.А., Шикалева А.А., Максимов М.Л., Дядикова И.Г., Вовк В.О., Филимонова И.М.

Summary:

The role of the endocannabinoid system in obesity pathogenesis

V.A. Dudareva1, A.A. Shikaleva2, M.L. Maximov2, I.G. Dyadikova1, V.O. Vovk3, I.M. Filimonova2

1Rostov State Medical University, Rostov-on-Don

2Kazan State Medical University, the branch of the Russian Medical Academy of Continuous Professional Education

3Rostov Regional Clinical Hospital, Rostov-on-Don

The processes of human eating behavior have complex regulation, one of the links of which is the endocannabinoid system. Currently, the endocannabinoid system, as well as the substances that affect it are actively studied, since it can be involved in many physiological and cognitive processes. The article describes the types of cannabinoids, cannabinoid receptors and their localization, also endocannabinoid system functions and its role in the obesity pathogenesis. A promising method in the treatment of obesity is the use of Dietressa — a drug based on technologically processed affinity-purified antibodies (ultra-high dilutions) to type 1 cannabinoid receptors (anti-CB1). Possible mechanisms of its action are described. Preclinical studies have shown its ability to lead to weight loss in mice during a high-calorie diet. Toxicological studies have proven the drug safety and its lack of narcogenic potential. In clinical studies, it was shown that the use of this drug led to a statistically significant weight loss in patients with grade I obesity versus placebo (p<0.05).

Keywords: obesity, metabolic syndrome, treatment of obesity, diet, endocannabinoid system, cannabinoids, cannabinoid receptors, Dietressa.

For citation: Dudareva V.A., Shikaleva A.A., Maximov M.L. et al. The role of the endocannabinoid system in obesity pathogenesis. RMJ. 2020;1:23–28.

Pages 29-34. Cпособы коррекции недостаточности витамина D у населения. Коденцова В.М., Рисник Д.В.

Summary:

Ways to correct vitamin D deficiency in population

V.M. Kodentsova1, D.V. Risnik2

1Federal Research Centre of Nutrition, Biotechnology and Food Safety, Russian Federation

2Lomonosov Moscow State University, Russian Federation

Vitamin D is essential for the functioning of all organs and systems. Its deficiency is a risk factor for many extra-skeletal diseases. Vitamin D deficiency or inadequate level is detected in 60–92% of adults examined. A higher daily intake of this vitamin is necessary to achieve an adequate level of this vitamin in the blood. Thus, there was a need to increase the recommended daily intake of calciferol for adults up to 15 µg, for elderly — up to 20 µg. An effective way to eliminate nutritional deficiency is mandatory vitamin D fortification of food products (milk, butter, bread). Due to the lack of a sufficient enriched products number, Russians should take additional doses of this vitamin, however, the doses should not be excessively high. Vitamin D, depending on the dose and excipients, can be registered as a drug or dietary supplement. Its efficacy does not depend on the marketing auth orization form, dose, but  efficacy  depends on administration type and duration, initial vitamin D  sufficiency, as well as the sufficiency with other vitamins involved in the vitamin D metabolism.

Keywords: vitamin D, vitamin D deficiency, food products enriched with vitamin D, vitamin D pharmacological forms, efficacy.

For citation: Kodentsova V.M., Risnik D.V. Ways to correct vitamin D deficiency in population. RMJ. 2020;1:29–34.



Pages 3-6. Маркеры фиброза у пациентов с сахарным диабетом 2 типа и очень высоким риском сердечно-сосудистых заболеваний: результаты проспективного исследования. Лебедев Д.А., Бабенко А.Ю.

Summary:

Markers of fibrosis in patients with type 2 diabetes mellitus and cardiovascular high-risk patients: prospective study results

D.A. Lebedev, A.Yu. Babenko

Institute of Endocrinology, Almazov National Medical Research Centre, Saint-Petersburg

Cardiovascular diseases are the main cause of death in patients with type 2 diabetes mellitus (DM2). An important pathogenesis component of cardiovascular diseases in DM2 is the signs of fibrotic changes in the myocardium and vascular wall. At present, the role of various biomarkers involved in these processes is being actively studied.

Aim: to evaluate the dynamics of fibrosis biomarkers during empagliflozin therapy in cardiovascular high-risk patients with DM2.

Patients and Methods: the study included 30 patients with DM2 who received 10 mg of empagliflozin for 24 weeks. Laboratory tests and Echo-CG were conducted prior to treatment and after 24 weeks of empagliflozin therapy. To evaluate the initial values of fibrosis biomarkers, the study included 13 patients without diabetes, but with 3 cardiovascular risk factors (hypertension, obesity, dyslipidemia).

Results: the average age of the patients was 53 years (47–65), the HbA1c level at the study enrollment was 8.7% (7.9–9.2), the body mass index (BMI) was 33.9 kg/m2 (31.8–35.7), and the median DM2 duration was 6.6 (2.4–9.3) years. Comparison of the initial values of fibrosis biomarkers in the group with DM2 with the biomarkers values in the group without DM2: MMP-9580 ng/ml (390–1100) vs 350.0 ng/ml (270.0–720.0), p=0.01; galectin-38.9 ng/ml (7.5–10.3) vs 5.2 ng/ml (3.5–6.9), p=0.03; P1CP — 130.1 ng/ml (99.3–190.2) vs 90.3 ng/ml (70.1–99.8), p=0.009; therefore, concentrations described above were significantly higher in the group with DM2. There were no significant differences between galectin-3, ST-2, and MMP-9 concentrations prior to treatment and after 24 weeks of therapy. There was a significant decrease in the P1CP concentration after 24 weeks of treatment versus the initial values — 102.6 ng/ml (87.1–160.2) and 130.1 ng/ml (99.3–190.2), respectively; p=0.02.

Conclusion: patients with DM2 have significantly higher concentrations of fibrosis biomarkers versus patients without DM2, but with 3 cardiovascular risk factors (hypertension, obesity, dyslipidemia). Empagliflozin therapy for 24 weeks does not lead to significant changes in fibrosis biomarkers, except for a decrease in the concentration of procollagen type I carboxy-terminal propeptide.

Keywords: type 2 diabetes mellitus, fibrosis markers, empagliflozin, cardiovascular risks.

For citation: Lebedev D.A., Babenko A.Yu. Markers of fibrosis in patients with type 2 diabetes mellitus and cardiovascular high-risk patients: prospective study results. RMJ. 2020;1:3–6.



Pages 35-38. Актуальные маркеры ранних нарушений углеводного обмена. Гордиенко А.В., Федорова А.С., Сердюков Д.Ю.

Summary:

Current markers during the onset of carbohydrate metabolism disorders

A.V. Gordienko, A.S. Fedorova, D.Yu. Serdyukov

Kirov Military Medical Academy, Saint Petersburg

For several decades, there has been a increase in the prevalence of dysglycemia and type 2 diabetes mellitus (DM2) in patients with verified cardiovascular diseases. The number of patients with chronic hyperglycemia is doubling every decade, whereas with DM2 — up to 95% of all new cases. This fact explains the priority of primary prevention of DM and the risk of cardiovascular complications. Identification of markers concerning carbohydrate metabolism early disorders remains extremely relevant today. At present, commonly used indicators (e.g. pre-diabetes impaired fasting glycemia (IFG) and impaired glucose tolerance (IGT)) do not solve the issue of effective diagnosis concerning carbohydrate metabolism disorders, which actualizes the search for new markers. Results of large-scale research studies suggest that the reason is associated with glycemia increase after 1 hour or with the so-called one -hour (early) postprandial hyperglycemia (EPH), determined after the initiation of the oral glucose tolerance test (OGTT) at plasma glucose level ≥ 8.6 mmol/l (155 mg/dl).

Keywords: one-hour postprandial hyperglycemia, prediabetes, oral glucose tolerance test, risk marker, cardiovascular diseases, type 2 diabetes mellitus.

For citation: Gordienko A.V., Fedorova A.S., Serdyukov D.Yu. Current markers during the onset of carbohydrate metabolism disorders. RMJ. 2020;1:35–38.



Pages 40-42. Гипогликемия: распространенность и факторы риска у пациентов с сахарным диабетом 2 типа в условиях стационарного лечения. Беляева Н.Г.

Summary:

Hypoglycemia: prevalence and risk factors in hospitalized patients with type 2 diabetes mellitus

N.G. Belyaeva

Volga Research Medical University, Nizhny Novgorod

Hypoglycemia is one of the most common complications in patients with diabetes mellitus DM2. Its incidence is more common than the adverse events associated with hyperglycemia, especially among elderly patients with long-term diabetes, suffering from comorbidities. The following main causes of hypoglycemia in hospitalized patients are: reducing the quantity and/or caloric intake in the perioperative period or due to the patient condition; inconsistency of short-acting insulin dosage to the food intake quantity by the patient; changes in regimen or rapid cessation of enteral or parenteral nutrition; ignorance of hypoglycemia signs or patient’s inability to report his signs. The lack of knowledge in healthcare personnel on hypoglycemic signs, suddenness of signs concerning starvation in a particular patient, delay in the communication between healthcare personnel and doctors, lack of data fr om the doctor in occurrence of hypoglycemic episode, tasks manifold to relieve the hypoglycemic episode and their necessity to be performed simultaneously, the absence of coordinated actions in relation to the patient such as feeding, glycemic control and insulin administration — all this leads to the development of hypoglycemia and its complications. Multidisciplinary treatment targeted at the patient can help identify patients at risk, prevent this complication from occurring, and help optimize the treatment of hypoglycemia.

Keywords: hypoglycemia, type 2 diabetes mellitus, risk factors, insulin therapy, glucose, glycemia, prognosis, treatment intensification, mortality.

For citation: Belyaeva N.G. Hypoglycemia: prevalence and risk factors in hospitalized patients with type 2 diabetes mellitus. RMJ. 2020;1:40–42.

Pages 43-48. Принципы комплексной реабилитации пациентов с переломами на фоне остеопороза. Марченкова Л.А., Макарова Е.В.

Summary:

Principles of comprehensive rehabilitation of patients with fractures during osteoporosis

L.A. Marchenkova, E.V. Makarova

National Medical Research Center of Rehabilitation and Balneology, Moscow

Rehabilitation of patients with fractures during osteoporosis is based on the following principles: early onset upon achieving an adequate level of analgesia, continuity, consistency, complexity, validity, as well as individual approach and duration until positive dynamics are maintained. Upon rehabilitation of patients with fractures during osteoporosis, various means of physical therapy are used, the effectiveness and safety of which are discussed by the authors. Given the risks of physical activity, any rehabilitation protocols should be conducted for patients with osteoporosis receiving individually selected therapy. The main method to reduce the risk of fractures in patients with osteoporosis is antiresorptive therapy, for which bisphosphonates are widely used. Drugs of this group can accumulate in the bone tissue (especially in the areas of resorption), remain in it for a long time and for m strong chelate complexes with calcium ions in the hydroxyapatite crystals, which contributes to the long-term preservation of the therapy clinical effect. Bisphosphonates efficacy for fracture prevention in patients with osteoporosis has been confirmed in several clinical studies reviewed in this article.

Keywords: osteoporosis, rehabilitation, antiresorptive therapy, prevention, zoledronic acid, ibandronate.

For citation: Marchenkova L.A., Makarova E.V. Principles of comprehensive rehabilitation of patients with fractures during osteoporosis. RMJ. 2020;1:43–48.



Pages 6-9. Различные способы определения гормона роста в раннем послеоперационном периоде для прогнозирования ремиссии акромегалии после транссфеноидальной аденомэктомии. Циберкин А.И., Цой У.А., Черебилло В.Ю., Курицына Н.В., Пальцев А.А., Полежаев А.В., Гринева Е.Н.

Summary:

Various methods for determining somatotropic hormone in the early postoperative period to predict acromegaly remission after transsphenoidal adenomectomy

A.I. Tsiberkin, U.A. Tsoi, V.Yu. Cherebillo, N.V. Kuritsyna, A.A. Paltsev, A.V. Polezhaev, E.N. Grineva

Almazov National Medical Research Centre, Saint-Petersburg

Aim: to study the information value of determining the somatotropic hormone (STH) basal level 24 hours after surgery and its level in the oral glucose tolerance test (OGTT) 14 days after surgery to predict the outcomes of acromegaly surgery.

Patients and Methods: 39 patients with newly diagnosed acromegaly underwent a single-center cohort prospective surveillance study. Pituitary microadenoma was detected in 8 patients, macroadenoma — in 31 patients. All patients underwent a transsphenoidal adenomectomy (TSA) performed by a single neurosurgeon. 24 hours after the operation, the STH basal level in the blood was determined. Two weeks after the TSA, the OGTT was conducted to determine the STH level. The surgical treatment efficacy of acromegaly was evaluated after 12 months. The values of STH and insulin-like growth factor-1 (IGF-1) (that meet the Acromegaly Consensus Group criteria of 2010) were taken under the biochemical remission of acromegaly.

Results: 12 months after surgery, 18 of 39 patients achieved acromegaly remission. Basal STH level 24 hours after TSA <1.30 ng/ml was associated with acromegaly remission with sensitivity of 93.7% (95% CI 81.1–98.3%) and specificity of 83.5% (95% CI 60.1–93.8%). The minimum STH level in OGTT <1.0 ng/ml 14 days after TSA was associated with the subsequent development of acromegaly remission with sensitivity of 85.7% (95% CI 60.1–97.5%) and specificity of 80.0% (95% CI 54.8–92.9%).

Conclusion: STH level in the early postoperative period can be used to predict the TSA outcomes. Low basal STH level 24 hours after surgery is a better predictor of achieving acromegaly remission than STH levels inhibition in the OGTT by 14th day after TSA. The data obtained can be taken into account when making a decision about the patient’s management after TSA. It is necessary to confirm the identified results in further studies with a longer duration and numbe r of observations.

Keywords: somatotropic hormone, acromegaly, IGF-1, acromegaly remission, transsphenoidal adenomectomy, neuroendocrinology.

For citation: Tsiberkin A.I., Tsoi U.A., Cherebillo V.Yu. et al. Various methods for determining somatotropic hormone in the early postoperative period to predict acromegaly remission after transsphenoidal adenomectomy. RMJ. 2020;1:6–9.





№12, 2019. Клинические рекомендации и алгоритмы для практикующих врачей

Pages 14-16. XIV Национальный конгресс терапевтов. Новые возможности снижения сердечно-сосудистого риска в РФ (пострелиз).

Summary:

November 21, 2019, Symposium on «Innovations in reduction of cardiovascular risk­ in the Russian Federation» was organized by the pharmaceutical company «EGIS-RUS» in Moscow within the XIV National Congress of Therapists. The Symposium discussed the ­issues of improving the lipid-lowering therapy efficacy in cardiovascular diseases and the benefits of the combined medicinal products. The chairman of the Symposium was M.V.  Ezhov – MD, PhD, Chief Researcher at the Department of Atherosclerosis Issues, Research Institute of Clinical Cardiology named after A.L. Myasnikov at the National Medical Research Center of Cardiology, Chairman of the Russian National Society of Atherosclerosis.



Pages 18-21. XIV Национальный конгресс терапевтов. Гиперурикемия — эволюция значимости в популяции больных с сердечно-сосудистым риском (пострелиз).

Summary:

November 20, 2019, Symposium on “Hyperuricemia – significance evolution in a cohort of patients with cardiovascular risk” was held in Moscow within the XIV National Congress of Therapists, which discussed: 1) hyperuricemia issue as a risk factor for hypertension; 2) the algorithm of action in elevated level of uric acid; 3) regulatory documents. The Symposium co-chairmen were A.I. Martynov (MD, PhD, Professor, member of the Academy of Sciences, Chairman of the Russian National Medical Society of Therapists; Moscow) and K. Narkevich (MD, PhD, Professor; Poland).

Pages 22-24. Влияние различных видов сахароснижающей терапии на концентрацию бета-гидроксибутирата у пациентов с сахарным диабетом 2 типа. Лебедев Д.А., Колчанова Я.А., Бабенко А.Ю.

Summary:

Impact of different hypoglycemic therapy types on the concentration of beta-hydroxybutyrate in patients with type 2 diabetes mellitus

D.A. Lebedev, Ya.A. Kolchanova, A.Yu. Babenko

Almazov National Medical Research Center, Saint Petersburg

Aim: to evaluate the dynamics of beta-hydroxybutyrate level in the blood during therapy with sodium-glucose cotransporter-2 inhibitors (SGLT-2) in comparison with therapy with dipeptidyl peptidase-4 inhibitors (DPP-4).

Patients and Methods: the study included 46 patients with type 2 diabetes mellitus with poor glycemic control during monotherapy with metformin (who had never received therapy with SGLT-2 or DPP-4 inhibitors). 21 patients of the study group received dapagliflozin 10 mg/day for 3 months, whereas 25 patients of the control group received vildagliptin 100 mg/day. The concentration of HbA1c and biochemical parameters (creatinine, urea in serum and urine, lipid spectrum) of beta-hydroxybutyrate in serum were evaluated.

Results: in the study group there was a significant decrease in the HbA1c concentration from 8.8 ± 0.7% to 7.4 ± 0.5% (p=0.005), and fasting plasma glucose — from 9.3 mmol/l ± 2.9 mmol/l to 7.3 mmol/l ± 1.2 mmol/l (p=0.007). Also, there was a decrease in body weight by 2.4 ± 1.9 kg after 3 months. In the control group, there was a less pronounced decrease in the HbA1c concentration and fasting plasma glucose (8.5 ± 0.8% to 7.9 ± 0.5% (p=0.01) and 8.9 mmol/l ± 2.5 mmol/l to 7.8 mmol/l ± 1.4 mmol/l (p=0.009), respectively); there was no change in body weight. In the study group, the concentration of beta-hydroxybutyrate after 3 months of treatment was significantly higher than in the control group (0.24 ±0.13 vs 0.17 ± 0.05, p=0.006). None of the patients had clinical symptoms such as nausea, vomiting, shortness of breath, fatigue or confused mental state.

Conclusion: there were no statistically significant correlations between increased beta-hydroxybutyrate concentration and patient age, diabetes duration, GFR level, and HbA1c change. Further studies are needed to identify patients prone to DKA development at the beginning of therapy with SGLT-2 inhibitors.

Keywords: hypoglycemic therapy, sodium-glucose cotransporter-2 inhibitors, dipeptidyl peptidase-4 inhibitors, hyperketonemia, beta-hydroxybutyrate, euglycemic diabetic ketoacidosis.

For citation: Lebedev D.A., Kolchanova Ya.A., Babenko A.Yu. Impact of different hypoglycemic therapy types on the concentration of beta-hydroxybutyrate in patients with type 2 diabetes mellitus. RMJ. 2019;12:22–24.



Pages 25-28. Гистиоцитоз из клеток Лангерганса в эндокринологической практике. Клиническое наблюдение. Демидова Т.Ю., Грицкевич Е.Ю., Волкова Е.В.

Summary:

Clinical case of Langerhans cell histiocytosis in endocrinological practice

T.Yu. Demidova, Ye.Yu. Gritskevich, Ye.V. Volkova

Pirogov Russian National Research Medical University, Moscow

The article describes a clinical case of a rare disease — Langerhans cells histiocytosis, formerly histiocytosis X, which etiology is unknown. The main mechanisms of disease progression are a clonal proliferation of pathological Langerhans cells and abnormal regulation of immune system cells interaction in lesions. Cell infiltration has polymorphic nature and contains lymphocytes, eosinophils, monocytes, macrophages alongside pathological Langerhans cells. Langerhans cells histiocytosis pathogenesis combines patterns of neoplasm and reactive process. The peak incidence is in early childhood. The disease clinical picture varies from localized forms with the benign course and spontaneous recovery to disseminated forms with a rapidly progressive course and fatal outcome. Pathological process can involve any organs and systems in different combinations: skeleton, skin, lymph nodes, outer ear, liver, spleen, bone marrow, lungs, endocrine glands, central nervous system, gastrointes tinal tract, thymus. The peculiarity of this clinical case is the disease manifestation in adulthood with endocrinopathy: development of diabetes insipidus, hyperprolactinemia, amenorrhea.

Keywords: Langerhans cells histiocytosis, diabetes insipidus, hyperprolactinemia, autoimmune thyroiditis, amenorrhea.

For citation: Demidova T.Yu., Gritskevich Ye.Yu., Volkova Ye.V. Clinical case of Langerhans cell histiocytosis in endocrinological practice.
RMJ. 2019;12:25–28.



Pages 29-32. Манифестная форма первичного гиперпаратиреоза. Клиническое наблюдение. Демидова Т.Ю., Кишкович Ю.С.

Summary:

Symptomatic primary hyperparathyroidism. Clinical case

T.Yu. Demidova, Yu.S. Kishkovich

Pirogov Russian National Research Medical University, Moscow

Symptomatic primary hyperparathyroidism is a severe disease, sometimes difficult to diagnose, since the study of total and ionized calcium level is not included in the screening standards nowadays. Commonly, the diagnosis is established already in the presence of bone and visceral lesions, such as calcification of heart muscle and valves, nephrolithiasis, cholelithiasis, gastric and duodenal ulcers, visual acuity reduction, as well as osteopenia and osteoporosis pathogenesis. Timely diagnosis, instrumental confirmation, and additional examination of systems and organs will prevent possible severe complications, including heart failure, chronic renal failure, and low-energy fractures. Diagnosis of the symptomatic primary hyperparathyroidism using laboratory data with elevated levels of calcium and parathyroid hormone is not difficult. However, it is not always possible to verify the localization of hormo ne-producing parathyroid adenoma. The article presents the case of the patient with primary hyperparathyroidism with visceral manifestations, confirmed by laboratory study following the clinical recommendations algorithms, but instrumental diagnosis, in this case, required an additional examination to clarify the parathyroid adenoma localization. Further follow-up of the patient and conservative treatment methods are discussed.

Keywords: primary hyperparathyroidism, symptomatic, hypercalcemia, hypophosphatemia, parathyroid hormone, nephrolithiasis.

For citation: Demidova T.Yu., Kishkovich Yu.S. Symptomatic primary hyperparathyroidism. Clinical case. RMJ. 2019;12:29–32.



Pages 33-35. Применение в ревматологической практике Международной классификации функционирования, ограничения жизнедеятельности и здоровья. Ахунова Р.Р., Ахунова Г.Р.

Summary:

International Classification of Functioning, Disability and Health application in rheumatology practice

R.R. Akhunova, G.R. Akhunova

Medical Academy of Continuing Professional Education, Kazan

Rheumatological diseases are characterized by their constantly increasing prevalence, steady progression, early disability and a decrease in the life quality. The theoretical basis for determining the modern tactics of complex therapy and further medical rehabilitation of patients with the rheumatological profile is the International Classification of Functioning, Disability and Health (ICF), which classifies the patient’s health fr om biological, personal, social points of view. This classification application makes it possible to formulate a rehabilitation diagnosis with the multidisciplinary team participation to describe all the components of health and related real problems that lim it the functioning. ICF is strongly recommended for international use in clinical practice, as it allows providing a multidisciplinary, patient-centered and individual approach to the patient and giving a full picture of the body functioning taking into account the clinical situation, env ironmental and personal factors. However, according to available foreign and Russian literature data, there are not enough works devoted to the ICF application in rheumatological patients. At the same time, the use of an ICF basic set of for rheumatological patients will allow developing a comprehensive program of therapy and rehabilitation, distribute tasks to medical specialists and evaluate the results of work with the patient.

Keywords: rheumatological diseases, medical rehabilitation, International Classification of Functioning, Disability and Health, ICF.

For citation: Akhunova R.R., Akhunova G.R. International Classification of Functioning, Disability and Health application in rheumatology practice. RMJ. 2019;12:33–35.

Pages 37-40. Лечение больных анкилозирующим спондилитом — данные реальной клинической практики. Мазуров В.И., Василенко Е.А., Трофимов Е.А., Дадалова А.М., Самигуллина Р.Р., Гайдукова И.З.

Summary:

Treatment of patients with ankylosing spondilitis — real clinical practice

V.I. Mazurova, E.A. Vasilenko, E.A. Trofimov, A.M. Dadalova, R.R. Samigullina, I.Z. Gaydukova

North-western State Medical University named after I.I. Mechnikov, Saint Petersburg

Aim: to determine the efficacy and safety of therapy with golimumab in patients with active radipgraphic axial spondyloarthritis (r-AxSpA).

Patients and Methods: the article presents the results of the Monitoring program on activity, functional state and comorbidity in patients with AxSpA of the North-Western Federal district (LADOGA). The statistical assay included 40 patients with r-AxSpA of high activity and receiving therapy with golimumab at a dosage of 50 mg once a month for 24 weeks. BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDAS (Ankylosing Spondylitis Disease Activity Score) indices were used to determine the disease activity, the overall assessment of the patient’s health on a visual-analogue scale (VAS); the BASFI index (Bath Ankylosing Spondylitis Functional Index) was used to assess the functional state. 

Results: the ASDAS index decreased to 1.63±0.66 units 6 months after the beginning of therapy with golimumab. Low disease activ ity (ASDAS<1.3) was achieved in 12 patients (30%). Average activity (ASDAS 1.3–2.1) preserved in 16 patients. There was a decrease in the disease activity in this group: initially, ASDAS was 2.6±0.63, and after 6 months from the beginning of therapy — 1.78±0.31. High disease activity (ASDAS>2.1) persisted in 10 patients (25%). There was a less effective result in patients in whom golimumab is the second or third GEBD (ASDAS at the beginning of therapy — 2.85±0.87, after 6 months — 1.84±0.34). If golimumab was the first GEBD, then ASDAS at the beginning of therapy was 3.1±1.1, and after 24 weeks — 1.46±0.2.

Conclusion: in case of NSAIDs ineffectiveness or intolerance, which are the first-line agents in therapy for patients with AxSpA, the alternative way is the TNFα inhibitors. Patients who have not experienced the effect of other TNFα inhibitors can be recommended therapy with golimumab.

Keywords: radiographic axial spondyloarthritis, therapy, NSAIDs, TNFα inhibitors, golimumab.

For citation: Mazurova V.I., Vasilenko E.A., Trofimov E.A. et al. Treatment of patients with ankylosing spondilitis — real clinical practice. RMJ. 2019;12:37–40.



Pages 4-7. Рекомендации Европейского кардиологического общества по дислипидемиям 2019 года: новое для практикующего врача. Кашталап В.В., Ершова А.И., Мешков А.Н., Барбараш О.Л.

Summary:

2019 Dyslipidemia Guidelines from the European Society of Cardiology: news for the medical practitioner

V.V. Kashtalap1,2, A.I. Ershova3, A.N. Meshkov3, O.L. Barbarash1,2

1Kemerovo State Medical University

2Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo

3National Medical Research Center for Preventive Medicine, Moscow

The article presents an original analysis of 2019 Dyslipidemia Guidelines for patient management from the European Society of Cardiology and the European Atherosclerosis Society. Clinical studies have demonstrated therapeutic efficacy with monoclonal antibodies targeting PCSK9 in reducing low-density lipoprotein cholesterol (LDL-C) levels above levels achieved with intensive statin therapy, which led to a significant reduction in cardiovascular events (CVE) in patients with atherosclerotic cardiovascular diseases (CVD), including acute coronary syndrome. From the standpoint of clinical significance for medical practitioners, the authors focused on new data on risk assessment, therapy goals and medications aimed at correcting dyslipidemia markers and reducing the risk of adverse CVE. The promising treatment tactics are specified for achieving more stringent (vs. previous versions) recommendations and goals of therapy. 2019 Dyslipidemia Guidelines for patient management contain a nu mber of new provisions aimed at further reducing the CVD burden in European countries. Strict implementation of the main provisions in new recommendations is a necessary condition that will reduce the CVD incidence and mortality in the Russian Federation, which is a strategic task of national health care.

Keywords: clinical recommendations, dyslipidemia, risk, statins, rosuvastatin.

For citation: Kashtalap V.V., Ershova A.I., Meshkov A.N., Barbarash O.L. 2019 Dyslipidemia Guidelines from the European Society of Cardiology: news for the medical practitioner. RMJ. 2019;12:4–7.



Pages 41-43. Пчелиный яд на службе у человека. Елисеева Л.Н., Басте З.А., Бочарникова М.И., Тихомирова Н.Ю., Будашова Т.М.

Summary:

Bee venom on duty

L.N. Eliseeva1, Z.A. Baste1, M.I. Bocharnikova1, N.Yu. Tikhomirova1, T.M. Budashova2

1Kuban State Medical University, Krasnodar

2Research Institute — Regional Clinical Hospital № 1 named after S.V. Ochapovsky, Krasnodar

In world medical practice, much attention is paid to the use of natural agents for the treatment of various conditions. One of the multifunctional influence methods on the human body is the use of natural poisons, in particular, bee venom. The article reviews the literature on this topic, describes the known mechanisms of action in individual bee venom components on various pathological processes, indications and limitations in the apitherapy use. The data confirming the antiseptic effects of bee venom, its effect on the nerve impulses transmission, effects associated with the possible development of hemolytic and allergic manifestations were analyzed. Particular attention is paid to the safest methods of using the topical drug Apisarthron® in the treatment of musculoskeletal system diseases, neurological pathology, and in sports medicine. Descriptions of additional drug components (methyl salicylate and allyl isothiocyanate) wi th topical calefacient, anti-inflammatory and analgesic effects were presented. It has been shown that the combined use of bee venom with anti-inflammatory substances can improve local blood flow in tissues, eliminate muscle cramp phenomena, and reduce pain in major joints. Limitations and contraindications to the use of a combined preparation based on bee venom for topical use were clearly described.

Keywords: bee venom, methyl salicylate, allyl isothiocyanate, combined preparation based on bee venom for topical use.

For citation: Eliseeva L.N., Baste Z.A., Bocharnikova M.I. et al. Bee venom on duty. RMJ. 2019;12:41–43.

Pages 44-50. Анемия в практике врача-терапевта: новый взгляд на старую проблему. Ларина В.Н.

Summary:

Anaemia in the clinical practice: a new look at an old problem

V.N. Larina

Pirogov Russian National Research Medical University, Moscow

The general practitioner usually has to deal with comorbid diseases in patients. Anaemia and iron deficiency commonly cause congestive heart failure (CHF) in the elderly. Iron deficiency in combination with anaemia and individually can worsen the course of CHF and diseases underlying its development, reduce the life quality, physical activity of patients and increase the risk of adverse events. Fundamentally important is to conduct iron deficiency screening in all patients with CHF, especially during the first occurrence, and laboratory studies are crucial when diagnosing iron deficiency anaemia. To date, there is no unequivocal evidence for the treatment of elderly patients with CHF and anaemia. Therefore, it is necessary to identify and correct the causes of iron deficiency in patients with CHF, prescribe neuromodulators in recommended doses, in particular, the main groups of drugs (angiotensin-converting enzyme inhibitors and angiotensin I I receptor antagonists, β-blockers, mineralocorticoid receptor antagonists) and a reasonable approach to the treatment of the edema syndrome.

Keywords: anaemia, iron deficiency, congestive heart failure, iron supplements, treatment.

For citation: Larina V.N. Anaemia in the clinical practice: a new look at an old problem. RMJ. 2019;12:44–50.

Pages 51-56. Гендерные и возрастные особенности статуса витамина D (25(ОН)D) в России. Желтикова Т.М., Денисов Д.Г., Мокроносова М.А.

Summary:

Gender and age-related characteristics of vitamin D (25(ОН)D) in Russia

T.M. Zheltikova1, D.G. Denisov2, M.A. Mokronosova1

1Scientific Research Institute of Vaccines and Serums named after I.I. Mechnikov, Moscow

2OOO “NPF HELIX (Research and Production Company HELIX), Saint Petersburg

Aim: to assess gender and age-related characteristics of vitamin D among the population of the Russian Federation.

Patients and Methods: the study was conducted from September 2014 to June 2018. 104321 (one hundred four thousand three hundred twenty one) serums of patients from 105 cities of the Russian Federation were analyzed. Of them female: 80738, which was 77.4% and male — 23583 (22.6%). An electrochemiluminescence was conducted to determine the calcidiol 25(ОН)D concentration in serum. The analysis was carried out on an automatic analyzer Cobas 6000 (Switzerland).

Results: calcidiol concentration was significantly higher than normal and reached 60.45±2.1 ng/ml only in the infant group under 12 months. In children over 1 year of age, 25(ОН)D values in serum significantly decreased, but remained within the normal range, and averaged 40.79±0.79 ng/ml. In all other age groups, the calcidiol concentration was below the specified norm. The patients with calcidiol concentration of less than 30 ng/ml among children under 1 year — 13.9% — were most rarely detected. At the age of 1 to 3 years, the detection rate of patients with 25(ОН)D deficiency in the blood increased by 2.5 times and reached 34.6%. Among patients aged 8 to 14 years and 15 to 20 years, 25(ОН)D deficiency was reported in 76.0% and 79.9%, respectively.Calcidiol average concentration in the female and male serum statistically significantly differed only in the critical age group from 18 to 35 years and in women, it was higher, althoughit did not exceed 27.15±0.35 ng/ml.

Conclusion: the study results indicate that both the concentration and the detection rate of 25(ОН)D deficiency of in serum depended on the patient age and in some age groups — on gender.

Keywords: vitamin D, calcidiol (25(OH)D), gender and age-related characteristics of vitamin D.

For citation: Zheltikova T.M., Denisov D.G., Mokronosova M.A. Gender and age-related characteristics of vitamin D (25(ОН)D) in Russia.
RMJ. 2019;12:51–56.

Pages 57-60. Современные подходы к оптимизации лекарственной терапии острой респираторной инфекции у детей. Каннер Е.В., Николаева С.В., Хлыповка Ю.Н., Лапкин Н.М., Каннер И.Д.

Summary:

Modern methods for therapy optimization in acute respiratory infection in children

E.V. Kanner1, S.V. Nikolaeva1, Yu.N. Chlypovka1,2, N.M. Lapkin3, I.D. Kanner4

1Central Research Institute of Epidemiology, Moscow

2Central Clinical Hospital, Moscow

3Yaroslavl State Medical University

4Lomonosov Moscow State University

Acute respiratory infection (ARI) in children remains a major problem in Pediatrics, primarily due to its prevalence and incidence. It is advisable to use medicinal products aimed at reducing the disease duration and its course alleviation in each clinical case and each patient with ARI or influenza. The article considers the therapy possibilities of ARI in children, which still occupy a leading position in the structure of infectious pediatric pathology. The main etiological ARI factor is viruses. The authors present the leading clinical signs of ARI: body temperature rise, headache, pharyngeal hyperemia, runny nose, cough, conjunctivitis, regional lymph nodes enlargement. Commonly, the traditional clinical picture is accompanied by signs of digestive disorder in the form of abdominal pain, dyspepsia and diarrhea. The treatment of patients with ARI (which should be comprehensive and include antiviral drugs where necessary) is presented. However, children have age restrictions on the use of antiviral drugs, commonly due to possible toxic effects. In this case, it is advisable to use a complex homeopathic preparation Oscillococcinum®, the clinical efficacy and safety of which has been proven in numerous Russian and foreign studies.

Keywords: acute respiratory infections, children, viruses, concurrent infection.

For citation: Kanner E.V., Nikolaeva S.V., Chlypovka Yu.N. et al. Modern methods for therapy optimization in acute respiratory infection in children. RMJ. 2019;12:57–60.



Pages 62-68. Комплексное лечение никотиновой зависимости: возможности повышения эффективности. Антонов Н.С., Сахарова  Г.М.

Summary:

Complex treatment of nicotine addiction: performance improvements

N.S. Antonov1,2, G.M. Sakharova1,2

1Federal Research Institute for Health Organization and Informatics, Moscow

2Central Research Institute of Tuberculosis, Moscow

Tobacco use leads to the development of nicotine addiction. This addiction is characterized by the development of withdrawal syndrome during smoking cessation period. The main and most common manifestations of smoking cessation are symptoms of anxiety disorders. Besides, smokers have an increased risk of certain anxiety disorders, whereas smokers with anxiety disorders have more severe withdrawal symptoms during smoking cessation than smokers without anxiety disorders. Withdrawal syndrome exacerbation during smoking cessation is also observed in people with socially caused anxiety disorders. In this regard, anxiolytics use in the complex treatment of nicotine addiction significantly increases the smoking cessation effectiveness. Modern agent Fabomotizole has a pronounced anxiolytic effect, does not cause addiction and withdrawal syndrome after therapy discontinuation, and does not have the negative adverse events ch aracteristic of antidepressants and benzodiazepine anxiolytics. The therapeutic effect of Fabomotizole is manifested not only in the alleviation of existing anxiety-depressive symptoms, but also in the preventive effect focused on withdrawal syndrome during smoking cessation, which increases the effectiveness of treatment. In the article, the authors summarized their own experience using Fabomotizole in clinical practice.

Keywords: nicotine addiction, anxiety disorders, withdrawal symptoms in smocking cessation, treating nicotine addiction, treatment in smoking cessation, anxiolytics, Fabomotizole.

For citation: Antonov N.S., Sakharova G.M. Complex treatment of nicotine addiction: performance improvements. RMJ. 2019;12:62–68.



Pages 69-72. Эрозивно-язвенные гастродуоденопатии у пациентов с атеросклерозом артерий нижних конечностей. Долгушина А.И., Селянина А.А., Кузнецова А.С., Барышников А.А., Алипанахов М.Р., Молчанова А.Р.

Summary:

Erosive and ulcerative gastroduodenopathy in patients with lower extremity vascular disease

A.I. Dolgushina1, A.A. Selyanina1, A.S. Kuznetsova1, A.A. Baryshnikov2, M.R. Alipakhanov2, A.R. Molchanova1

1South Ural State Medical University, Chelyabinsk

2Chelyabinsk Regional Clinical Hospital

Patients with lower extremity vascular disease (LEVD) have risk factors of erosive and ulcerative gastroduodenopathy. Currently, there are few studies on the incidence and structure of digestive diseases in patients with LEVD.

Aim: to assess the incidence and clinical and endoscopic characteristics of erosive and ulcerative gastroduodenopathy in patients with different severity of LEVD.

Patients and Methods: the study involved 60 patients with IIA-IV stage LEVD according to Fontaine (I-III grade according to Rutherford): group I — 26 patients without chronic lower limb ischemia (CLLI), group II — 34 patients with CLLI, among them 41 (68.3%) men and 19 (31.7%) women. The median age of patients was 67.0 (61.0–74.8) years. All patients underwent multislice computed tomoangiography (MSCT-AG) of visceral branches in the abdominal aorta and lower limb arteries, esophagogastroduodenoscopy (EGDS), punch biopsy of the antral mucosa and the stomach body with the subsequent morphological examination.

Results: diseases of the upper gastrointestinal tract (GIT) were detected in 53 (88.3%) patients with LEVD, among them erosive and ulcerative lesions of the upper GIT — in 34 (64.2%). Statistically significant differences in the upper GIT diseases incidence were revealed between patients of groups I and II: in patients without CLLI, this parameter was 20 (77.0%), in the presence of CLLI — 33 (97%), p=0.017. Erosions, gastric ulcers and duodenal bulb ulcers were significantly more common in 75.8% of patients with CLLI, and in 45% of patients without CLLI (p=0.024).

Conclusion: in patients with LEVD, erosive and ulcerative lesions in the gastroduodenal area were revealed in 64.2%, which were more common in patients with CLLI. At the same time, disease clinical manifestations in the upper GIT occurred only in 48.3% of patients.

Keywords: peripheral arterial disease, chronic lower limb ischemia, gastroduodenopathy, erosive and ulcerative gastroduodenopathy, lower extremity vascular disease, chronic atrophic gastritis, chronic nonatrophic gastritis, mesenteric ischemia.

For citation: Dolgushina A.I., Selyanina A.A., Kuznetsova A.S. et al. Erosive and ulcerative gastroduodenopathy in patients with lower extremity vascular disease. RMJ. 2019;12:69–72.



Pages 74-78. Возможности снижения риска НПВП-гастропатии у больных остеоартритом. Дроздов В.Н., Ших  Е.В., Лазарева  Н.Б.

Summary:

Possibilities of reducing the NSAID gastropathy risk in patients with osteoarthritis

V.N. Drozdov, E.V. Shikh, N.B. Lazareva

Sechenov University, Moscow

Osteoarthritis (OA) is a degenerative joint disease that primarily affects the articular cartilage. In OA, patients experience pain almost constantly, as the disease is based on inflammation. NSAIDs are one of the most commonly used classes of drugs in OA because they have anti-inflammatory and analgesic effects. However, with undeniable analgesic efficacy, NSAIDS have pronounced adverse events, including those in the gastrointestinal tract. It seems logical to prescribe complex anti-inflammatory therapy, which affects the disease pathogenesis, leads to a decrease in the pain component, as well as levels the adverse events in the gastric mucosa caused by the NSAIDs use. In this regard, it is worth noting the drug Alflutop, which has: many years of administration experience; proven clinical efficacy, confirmed in practice (both in reducing inflammation and pain component); patient-oriented pharmacological economical par t, which manifests itself in the subsequent reduction of the NSAIDs need; potential gastroprotective effect, confirmed in preclinical and clinical studies. All these arguments allow recommending Alflutop as a first-line drug from the SYSADOA group in patients with OA, especially those taking NSAIDs.

Keywords: osteoarthritis, NSAIDs, gastropathy, defect, ulcer, gastroprotection, preclinical study, laboratory animals, placebo-controlled clinical study.

For citation: Drozdov V.N., Shikh E.V., Lazareva N.B. Possibilities of reducing the NSAID gastropathy risk in patients with osteoarthritis. RMJ. 2019;12:74–78.

Pages 79-84. XIV Национальный конгресс терапевтов. Персонализированная терапия кислотозависимых заболеваний ЖКТ (пострелиз).

Summary:

November 21, 2019, Symposium on “Personalized therapy of acid-dependent gastrointestinal diseases” was held within the XIV National Congress of Therapists. The meeting was opened by the Chairman Leonid B. Lazebnik (MD, PhD, Professor of the Department of Outpatient Therapy, Faculty of General Medicine at the A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Chairman of the Russian Scientific Society of Gastroenterologists; Moscow) making the report on “Adherence improvement to the treatment — key factor in the success of H. pylori eradication therapy”.



Pages 8-13. Особенности клинико-функциональных изменений у больных с ХСН ишемического генеза в сочетании с ХОБЛ. Евдокимов В.В., Евдокимова А.Г., Ющук Е.Н.

Summary:

Characteristics of clinical and functional changes in patients with ischemic CHF with concomitant COPD

V.V. Evdokimov, A.G. Evdokimova, E.N. Yuschuk

Yevdokimov Moscow State University of Medicine and Dentistry

Chronic heart failure (CHF) in patients with IHD is commonly combined with chronic obstructive pulmonary disease (COPD), while the clinical and functional characteristics of this comorbid condition formation are insufficiently studied.

Aim: to assess comparatively the clinical and structural-functional parameters of the heart, respiratory function condition in patients with ischemic CHF of II–III FC in the absence and combination with moderate and severe COPD.

Patients and Methods: the study included patients aged 50–75 years with a left ventricular ejection fraction ≤45% (according to Simpson). The first group consisted of 87 patients with ischemic CHF, and the second — 385 patients with ischemic CHF with concomitant COPD. Initially, clinical picture, echocardiography, Ambulatory Blood Pressure Monitoring with simultaneous ECG recording, the study of respiratory function, and life quality were evaluated with several scales in all patients. Physical exercise tolerance was studied with a 6-minute walk test (6MWT).

Results: patients with CHF with concomitant COPD had a more severe disease course: high mean CHF FC; average dyspnea grade; reduced physical exercise tolerance during 6MWT; greater number of patients with increased daily-average blood pressure and daily-average HR ≥90 per minute; elevated incidence and duration of painless myocardial ischemia (PLMI). There was an increase in LV volume, its spherification, hypertrophy of unchanged areas, increased myocardial mass and myocardial stress, the presence of LV and pancreas diastolic dysfunction (DD), decreased LVEF, significant pulmonary hypertension, and obstructive and restrictive spirometric patterns.

Conclusion: in the group with CHF and concomitant COPD, there are associated overburdened factors leading to the pathogenesis and progression of structural-functional disorders of left and right heart with the formation of LVDD, RVDD, pulmonary hypertension, obstructive and restrictive spirometric patterns of respiratory function, and life quality impairment. Thus, they need appropriate medical therapy.

Keywords: chronic heart failure, ischemic heart disease, chronic obstructive pulmonary disease, comorbidity.

For citation: Evdokimov V.V., Evdokimova A.G., Yuschuk E.N. Characteristics of clinical and functional changes in patients with ischemic CHF with concomitant COPD. RMJ. 2019;12:8–13.



Pages 85-88. Влияние полиморфизма гена PNPLA3 на течение неалкогольной жировой болезни печени. Райхельсон К.Л., Ковязина В.П., Сидоренко Д.В., Назаров В.Д., Лапин С.В., Эмануэль В.Л., Марченко Н.В., Пальгова Л.К., Кондрашина Э.А., Барановский А.Ю.

Summary:

PNPLA3 gene polymorphism impact on the nonalcoholic fatty liver disease course

K.L. Raikhelson1, V.P. Kovyazina1, D.V. Sidorenko2, V.D. Nazarov2, S.V. Lapin2, V.L. Emanuel2, N.V. Marchenko1, L.K. Palgova1,
E.A. Kondrashina1, A. Yu. Baranovsky1

1Saint Petersburg State University

2Pavlov First St. Petersburg State Medical University

Aim: to assess the PNPLA3 I148M gene polymorphism impact on the nonalcoholic fatty liver disease (NAFLD) course in St. Petersburg residents.

Patients and Methods: the study included 60 patients (women — 31, men — 29) aged 29 to 83 years with an established diagnosis of NAFLD. Standard laboratory and instrumental studies were performed, as well as an assessment of hepatic structural changes using transient elastography with controlled attenuation parameter (CAP). The PNPLA3 I148M (rs738409 C>G) gene polymorphism was determined in saliva samples of patients by real-time PCR.

Results: the PNPLA3 homozygous genotype mutation (group 1) was detected in 8 people (13.3%), heterozygous genotype (group 2) — in 29 people (48.3%), no mutation (group 3) — in 23 people (38.3%). There were no statistically significant differences between the study groups in assessing the main parameters of the metabolic syndrome. Elevated alanine aminotransferase (ALT) level was more common in the presence of pathological I148M allele (PNPLA3 gene) (p<0.05). Homozygotes had a higher ALT level vs. carriers of the heterozygous genotype mutation and without it (p<0.05). The average CAP in group 1 was 321±30.8 dB/m, in group 2–295.8±37.5 dB/m, in group 3–287.5±22.5 dB/m. Thus, in the PNPLA3 homozygous genotype mutation, higher rates of hepatic steatosis were revealed vs. patients without the mutation (p<0.05).

Conclusion: in patients (from St. Petersburg) with NAFLD, the PNPLA3 gene polymorphism leads to a more aggressive disease course, manifested by the laboratory cytolysis syndrome and severe hepatic steatosis pathogenesis, especially with the homozygous mutation. Further study of large patient cohorts and different populations will clarify these data and possibly develop screening methods that allow timely detection of high-risk patients of adverse NAFLD course.

Keywords: PNPLA3 gene, nonalcoholic fatty liver disease, fibrosis, steatosis.

For citation: Raikhelson K.L., Kovyazina V.P., Sidorenko D.V. et al. PNPLA gene polymorphism impact on the nonalcoholic fatty liver disease course. RMJ. 2019;12:85–88.



Pages 89-96. Эволюция терапии пробиотиками в клинике внутренних болезней. Казюлин А.Н., Гончаренко А.Ю., Павлеева Е.Е., Калягин И.Е.

Summary:

Probiotic therapy evolution in the clinical practice of internal medicine

A.N. Kazyulin, A.Yu. Goncharenko, E.E. Pavleyeva, I.E. Kalyagin

Moscow State University of Medicine and Dentistry

The article is devoted to the microbiota role in the human body. It has been alleged that the microbiota normal condition is accepted as one of the human health indicators. The article describes the following: diseases associated with intestinal microbiocenosis disorders, the causes of its violation; the history of the term “probiotics”; the clinical effects of their use. The necessity of microbiocenosis adequate correction and maintenance as a preventive and therapeutic measure with agents of probiotic activity is proved. The requirements for modern probiotics, following which served as the causal evolution of their types, are listed in detail. Probiotics characteristics of four generations with the causal data on the insufficient clinical efficiency of first-generation agents are given. The article presents distinctive characteristics of the fourth-generation  agents with a unique revolutionary double layer-coated system (developed and registered by Cell Biotech), using an example of a probiotic produced with this technique, registered in the Russian Federation under the trade name Neobiotic Lactobalance®. Also, the experimental and randomized clinical trials data confirming the probiotics effectiveness and their high potential for the treatment of various diseases, both in the monotherapy and as part of complex treatment, are presented. From the standpoint of evidence-based medicine, there is a necessity of further clinical studies to determine all possible clinical effects of probiotics concerning various nosology.

Keywords: microbiota, intestinal microbiocenosis disorder, probiotics, modern requirements, double-coated probiotics, clinical effects.

For citation: Kazyulin A.N., Goncharenko A.Yu., Pavleyeva E.E., Kalyagin I.E. Probiotic therapy evolution in the clinical practice of internal medicine. RMJ. 2019;12:89–96.



№11, 2019. Урология. Хирургия

Pages 12-14. Применение м-холинолитиков у больных после трансуретральной резекции простаты. Кузьменко А.В., Кузьменко В.В., Гяургиев Т.А.

Summary:

M-cholinoblockers after transurethral resection of the prostate

A.V. Kuzmenko, V.V. Kuzmenko, T.A. Gyaurgiev

Burdenko Voronezh State Medical University

Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms (LUTS) in elderly men. More than 30% of men older than 80 years require surgery which, however, do not completely relieve LUTS.

Aim: to assess the efficacy of M-cholinoblockers for BPH with LUTS persisting after transurethral resection of the prostate (TURP).

Patients and Methods: 60 patients with BPH who underwent TURP were enrolled in the study. The patients were subdivided into two groups (30 patients each). Group 1 patients received anti-inflammatory treatment for 10 days and were followed-up for 1 month. Group 2 patients were prescribed with anti-inflammatory treatment and fesoterodine for 1 month. Treatment efficacy was evaluated at day 3–5 after TURP (urinary catheter removal), in 1 month (day 30), 3 months (90 days), and 6 months (180 days) by completing voiding diary, I-PSS score, QOL score, uroflowmetry (peak urine flow rate, Qmax), adverse effect number, and acute urinary retention.

Results: at baseline, urination frequency was 12.6 and 12.7, urinary urgency 9.2 and 9.0, nocturia 5.2 and 5.3 daily in group 1 and group 2, respectively. Mean I-PSS score was 19.8 and 19.7, Qmax 6.5 ml/sec and 6.7 ml/sec, respectively. Fesoterodine prescribed in group 2 has provided significant (p < 0.05) positive outcomes by day 30 as demonstrated by more effective dysuria relief and increase in Qmax due to the increased effective bladder capacity. Quality of life has also improved as demonstrated by QOL score.

Conclusions: M-cholinoblockers (i.e., fesoterodine) in combination with classic therapy for LUTS after TURP are recommended. Our findings demonstrate that long-term use of these agents effectively and safely improves irritative symptoms.

Keywords: benign prostatic hyperplasia, transurethral resection, fesoterodine, lower urinar y tract symptoms, overactive bladder.

For citation: Kuzmenko A.V., Kuzmenko V.V., Gyaurgiev T.A. M-cholinoblockers after transurethral resection of the prostate. RMJ. 2019;11:12–14.

Pages 15-20. Возможности купирования симптомов нижних мочевых путей. Клинические наблюдения. Амдий Р.Э.

Summary:

Modalities for lower urinary tract symptom relief: clinical experience

R.E. Amdiy

Pavlov First St. Petersburg State Medical University

Disorders provoking lower urinary tract symptoms (LUTS) are a common issue of clinical urology. The paper reviews pharmacological properties and clinical experience with Serenoa repens fruit extract. Studies on the clinical efficacy of hexanic extract of Serenoa repens (including several meta-analyses) are addressed. These data are illustrated by the clinical examples on the use of this drug for LUTS and benign prostatic hyperplasia. Reducing prostatic inflammation is the key mechanism of symptom relief.

Drugs containing Serenoa repens are commonly prescribed for LUTS. However, the composition of various extracts of Serenoa repens can vary greatly. Hexanic lipidosterolic extract contains the highest levels of free fatty acids, the major biologically active compound of Serenoa repens fruits. It was demonstrated that hexanic extract of Serenoa repens fruits is more effective than placebo in terms of improving symptoms and the quality of life in patients with LUTS, reducing nocturia rate, and increasing maximum urine flow rate. Therefore, hexanic extract of Serenoa repens fruits can be widely applied in daily clinical practice for LUTS.

Keywords: lower urinary tract symptoms, benign prostatic hyperplasia, chronic prostatic inflammation, hexanic extract of Serenoa repens fruits.

For citation: Amdiy R.E. Modalities for lower urinary tract symptom relief: clinical experience. RMJ. 2019;11:15–20.

Pages 2-6. Роль окислительного стресса в патогенезе кальций-оксалатного уролитиаза. Камалов А.А., Охоботов Д.А., Низов А.Н., Стригунов А.А., Афанасьевская Е.В.

Summary:

The role of oxidative stress in the pathogenesis of calcium oxalate urolithiasis

A.A. Kamalov, D.A. Okhobotov, A.N. Nizov, A.A. Strigunov, E.V. Afanas’evskaya

Lomonosov Moscow State University

Dramatic technological progress has provided urologists with a myriad of surgical techniques for urolithiasis. Urinary stone removal is, however, symptomatic treatment since it does not address the immediate cause of stone formation. Free radical stress is one of the pathogenic factors of calcium oxalate urolithiasis. Increased levels of reactive oxygen species resulting from oxidative stress leads to renal tubule damage and over-secretion of calcium ions in Henle’s loop.

Aim: to assess the effect of biologically active ingredient complex in terms of reducing free radical load in the area of Randall’s plaque formation and its potential use for metaphylaxis of urolithiasis.

Patients and Methods: antioxidant activity of bioactive substance complex containing natural plant components (i.e., anthraquinones, resveratrol, glycyrrhizinic acid, salidrosides, and icariin — Rubia tinctorum root extract, Orthosiphon is staminei leaf extract, Epimedium extract, Rhodíola rósea root extract, Glycyrrhiza glabra root extract, and Ginkgo biloba leaf extract) was measured by chemiluminescence using Lum-1200 chemiluminometer (DISoft, Russian Federation). Antioxidant activity of bioactive substance complex was evaluated by resveratrol activity. The levels of potential urolithiasis markers (i.e., bikunin and osteopontin) were measured several times at various steps. Stone formation activity was measured by lithos-test.

Results: antioxidant activity of bioactive substance complex was 23.66±1.18 μmole (in trolox units). Biologically active ingredient complex containing anthraquinones, resveratrol, glycyrrhizinic acid, salidrosides, and icariin has reduced stone formation activity measured by lithos-test (decrease to minimum values in 42 out of 45 patients, р < 0.05).

Conclusion: antioxidant activity of bioactive substance complex containing natural plant components bioactive food additive potentially compensates free radical load thus preventing calcium oxalate urolithiasis.

Keywords: urolithiasis; recurrent urolithiasis; bioactive substance complex containing anthraquinones, resveratrol, glycyrrhizinic acid, salidrosides, and icariin; antioxidant activity; oxidative stress.

For citation: Kamalov A.A., Okhobotov D.A., Nizov A.N. et al. The role of oxidative stress in the pathogenesis of calcium oxalate urolithiasis. RMJ. 2019;11:2–6.



Pages 21-26. Инфекции мочевыводящих путей. Современная тактика врача-уролога. Зайцев А.В., Ширяев А.А., Ким Ю.А., Сазонова Н.А., Прилепская Е.А., Васильев А.О., Пушкарь Д.Ю.

Summary:

Urinary tract infections: current management strategy

A.V. Zaytsev, A.A. Shiryaev, Yu.A. Kim, N.A. Sazonova, E.A. Prilepskaya, A.O. Vasil’ev, D.Yu. Pushkar’

Evdokimov Moscow State University of Medicine and Dentistry

Urinary tract infections (UTIs) are among the most common disorders. High recurrence rate and antimicrobial resistance in urinary tract pathogens significantly increase economic burden of these infections. UTIs are an important cause of morbidity in children, elderly men, and women of all ages. Frequent recurrences, pyelonephritis, kidney disorders in children, and preterm birth are the most common complications. Increasing number of mutations in bacterial genome results in the generation of more aggressive strains. Considering the selection of resistant strains, rational use of antimicrobial drugs and searching for alternative therapy are of primary importance. The rate of the synthesis of novel antibacterial and antimicrobial agents is much less than the rate of the development of antimicrobial resistance. Adequate and rational drug prescription is a challenge in current clinical practice. Physician s should follow basic principles and recommendations on UTI diagnosis and treatment algorithms. These measures will significantly reduce the growth of antimicrobial resistance in urinary tract pathogens.

Keywords: urinary tract infections, antimicrobial resistance, treatment, rational pharmacotherapy.

For citation: Zaytsev A.V., Shiryaev A.A., Kim Yu.A. et al. Urinary tract infections: current management strategy. RMJ. 2019;11:21–26.

Pages 26-28. ХХ-тестикулярная форма нарушения формирования пола: редкая форма мужского бесплодия. Клиническое наблюдение. Прокопьев Я.В., Антропова Е.Ю., Мазитова М.И., Ключаров И.В.

Summary:

XX testicular disorder of sex development: rare variant of male infertility (case history)

Ya.V. Prokop’ev1, E.Yu. Antropova1, M.I. Mazitova1, I.V. Klyucharov2

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

2Kazan Federal University

In various regions of Russia, 8% to 17.2% of couples are infertile. Most disorders of sex development and abnormal sexual development, severe reproductive disorders, idiopathic male and female infertility, and recurrent miscarriage result from genetic factors. Disorders of sex development are characterized by clinical biochemical manifestations of the discrepancy between genetic, gonadal, and phenotypic sex. The paper addresses case history which describes this disorder to emphasize the importance of karyotyping when managing idiopathic male infertility.

Genetic consulting is one of the prior methods in the reproductive medicine. It is of special importance in idiopathic male infertility since its results may help verify the diagnosis, determine the prognosis, and prescribe early adequate treatment. Daily practice demonstrates that in the lack of karyotyping men having idiopathic male infertility generally undergo numerous unsuccessful examinations and receive unnecessary invasive procedures and inadequate treatment.

Keywords: idiopathic male infertility, disorders of sex development, genetic testing.

For citation: Prokop’ev Ya.V., Antropova E.Yu., Mazitova M.I., Klyucharov I.V. XX testicular disorder of sex development: rare variant of male infertility (case history). RMJ. 2019;11:26–28.



Pages 31-34. Особенности иммунологических нарушений у пациентов старших возрастных групп при благоприятном течении тяжелого острого панкреатита. Дунаевская С.С., Деулина В.В., Казакова О.В.

Summary:

Immune abnormalities in elderly patients with favorable course of severe acute pancreatitis

S.S. Dunaevskaya1, V.V. Deulina1, O.V. Kazakova2

1Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University

2Krasnoyarsk Interdistrict Clinical Hospital No. 7

Severe acute pancreatitis is an important issue of emergency surgery. The course of the disease depends on many factors including patient’s age.

Aim: to identify the signatures of immune status in patients with favorable course of severe acute pancreatitis depending on patient’s age.

Patients and Methods: group 1 included 35 young and middle-aged adults (according to WHO classification), median age was 39.8 years [27.3; 56.4]. Group 2 included 35 older and senile adults, median age was 67.5 years [62.4; 73.9]. Immune status was assessed at admission, at days 1, 5, and 7, and at discharge. Controls were 20 healthy young and middle-aged adults (according to WHO classification). Statistical analysis was performed using Mann-Whitney U test considering non-normal distribution (Shapiro-Wilk test).

Results: at admission, more significant immune changes were revealed in older adults as compared with young and middle-aged adults. Most important changes were detected for cellular immunity and phagocytosis. In group 2, immune parameters improved by day 7 while in group 1 these parameters improved by day 5.

Conc lusions: even in favorable course of severe acute pancreatitis, older patients are characterized by more significant immune abnormalities affecting primarily cellular immunity and phagocytosis. The lack of complete normalization of immune parameters demonstrate the need for immune correction.

Keywords: acute pancreatitis, immunity, old and senile age, hallmarks of disease course.

For citation: Dunaevskaya S.S., Deulina V.V., Kazakova O.V. Immune abnormalities in elderly patients with favorable course of severe acute pancreatitis. RMJ. 2019;11:31–34.

Pages 35-37. Особенности структуры паховых и подколенных лимфатических узлов и возможности их исследования у больных посттромбофлебитической болезнью нижних конечностей. Яровенко Г.В.

Summary:

Structure patterns of inguinal and popliteal lymph nodes and study possibility in patients with postphlebitic syndrome of the lower extremities

G.V. Yarovenko

Samara State Medical University

Aim: to justify the examination methods application for patients with PPS of the lower extremities at the stage of occlusion and recanalization, and to confirm their diagnostic significance.

Patients and Methods: 70 patients underwent the study and were separated into 2 groups. Of these, 51 were women and 19 — men. The median age was 43±1.4 years. Group 1 included patients with PPS of the lower extremities at the stage of occlusion (22 subjects), group 2 — patients with PPS of the lower extremities an the stage of recanalization (48 subjects). The ultrasound method was used to determine the linear dimensions of the lymph node and the layer size, and the thermal imaging method was used to study the IR patterns in the similar lymph nodes projection.

Results: lymph nodes objectification was carried out from a point defined below the inguinal ligament by 5–8 cm along the Ken line. Linear dimensions of inguinal lymph nodes in patients with PPS of the lower extremities at the occlusion stage were: length — 23.5±0.14 mm, width — 11.2±0.13 mm, cortical layer 0.75±0.07 mm, paracortical layer — 2.6±0.07 mm, and medullary layer — 3.5±0.05 mm. For patients with PPS of the lower extremities at the recanalization stage, the same dimensions corresponded to: length — 28.5±0.14 mm, width — 8.9±0.08 mm, cortical layer 0.51±0.09 mm, paracortical layer — 2.9±0.07 mm, and medullary layer — 4.9±0.04 mm.

In patients with PPS of the lower extremities at the occlusion stage, the IR level in the inguinal lymph nodes region on the right was 39.14±0.28 °C and on the left — 39.61±0.28 °C. In patients with PPS of the lower extremities at the recanalization stage, the thermoprofile in the inguinal region on the right was fixed at 38.81±0.22 °C and on the left — 39.31±0.17 °C.

Conclusion: presented data confirm the hyperthermia presence in the inguinal lymph nodes region in patients of both groups with their structural changes in PPS at the recanalization stage.

Keywords: postphlebitic disease, ultrasound, thermography.

For citation: Yarovenko G.V. Structure patterns of inguinal and popliteal lymph nodes and study possibility in patients with postphlebitic syndrome of the lower extremities. RMJ. 2019;11:35–37.

Pages 38-43. Эффективность межфасциальных блокад поперечного пространства живота в комплексной анестезии в плановой лапароскопической хирургии. Арыкан Н.Г., Шестопалов А.Е., Митичкин А.Е., Варнавин О.А., Чевокин А.Ю., Васин В.С., Фокина М.Н.

Summary:

The efficacy of intrafascial transversus abdominis plane block for complex anesthesia in laparoscopic surgery

N.G. Arykan1, A.E. Shestopalov2, A.E. Mitichkin1, O.A. Varnavin1, A. Yu. Chevokin1, V.S. Vasin1, M.N. Fokina1

1Inozemtsev City Clinical Hospital, Moscow

2Russian Medical Academy of Continuous Vocational Education, Moscow

Aim: to assess the efficacy and safety of 0.5% ropivacaine for ultrasound-guided transversus abdominis plane block (TAP block) in laparoscopic surgery in multidisciplinary hospital.

Patients and Methods: 88 patients who underwent bilateral laparoscopic hernia repair were enrolled in this randomized study. The patients were subdivided into two groups (n=44) depending on the type of anesthesia. Mean age of the control and study group was 55.77±14.74 years and 51.61±14.61 years, respectively. In the control group, the surgery was performed under inhalation anesthesia. In the study group, the surgery was performed under inhalation anesthesia with ultrasound-guided TAP block using 20 ml of 0.5% ropivacaine bilaterally. The efficacy and safety in both groups were assessed by the need in narcotic analgetics, i.e., the severity of pain syndrome after extubation, 2 and 4 hours after the surgery. The severity of pain syndrome was evaluated using visual analogue scale (VAS). The safety of TAP block was assessed by comparing the changes in hemodynamic parameters and the incidence of post-op nausea and vomiting (PONV) in both groups.

Results: the need in intra- and postoperative narcotic analgetics was significantly lower in the study group as compared with the control group. Heart rate after extubation in the study group was significantly lower as compared with the control group (p < 0.0001) thus demonstrating effective TAP block and the lack of significant pain syndrome. Pain severity assessed by VAS 2 and 4 hours after the surgery was significantly lower (p < 0.0001) as compared with the control group. PONV in both groups was similar.

Conclusions: bilateral TAP block using 20 ml of 0.5% ropivacaine for bilateral laparoscopic hernia repair is an effective and safe procedure.

Keywords: laparoscopy, anesthesia, anesthetic procedure, ropivacaine, TAP block, ERAS, PONV, ultasound-guided.

For citation: Arykan N.G., Shestopalov A.E., Mitichkin A.E. et al. The efficacy of intrafascial transversus abdominis plane block for complex anesthesia in laparoscopic surgery. RMJ. 2019;11:38–43.

Pages 44-48. Комплексное лечение трофических язв и ран у больных с синдромом диабетической стопы. Ступин В.А., Мантурова Н.Е., Горюнов С.В., Привиденцев А.И., Алиев С.Р.

Summary:

Complex treatment for trophic ulcers and wounds in patients with diabetic foot

V.A. Stupin1, N.Ye. Manturova1, S.V. Goryunov1,2, A.I. Prividentsev1,2, S.R. Aliyev1,3

1Pirogov Russian National Research Medical University, Moscow

2City Clinical Hospital No. 15, Moscow

3Outpatient Clinic No. 180, Moscow

Aim: to assess the efficacy of topical treatment with silver sulfathiazole for wounds and ulcers in patients with diabetic foot before reconstructive plastic surgery.

Patients and Methods: 120 patients aged 15–84 years (mean age 55.6±3.8 years, 63.3% female and 36.7% male) were enrolled in the study. These patients were characterized by the favorable course of diabetic foot (as a result of complex treatment) associated with the development of anatomical and functional defects (stages 2 and 3 of wound healing). 58 patients (48.3%) who received silver sulfathiazole as monotherapy were included in the study group. 62 patients (51.7%) who received water-based antibacterial and antiseptic ointments were included in the control group. A 2–3-mm layer of silver sulfathiazole was applied on the wound or ulcer surface under the occlusive dressing once daily. Microcirculation and the severity of its disorders were assessed in a total of 120 patients. 52 patients (43.3%) with neuroischemic diabetic foot have undergone reconstructive vascular surgery. In particular, revascularization with balloon angioplasty was performed in 37  patients (30.8%) and vascular stenting in 10 patients (8.3%). Pharmacotherapy for critical ischemia was prescribed in 5 patients (4.2%).

Results: in the study group, wound and ulcer cleaning and inflammatory type of the cytogram were revealed at day 4.8±0.8 and granulations at day 9.6±0.9. In the control group, inflammatory type of the cytogram was revealed at day 7.5±0.6 and granulations at day 13.4±1.4.

Conclusions: topical administration of silver sulfathiazole in the complex treatment for diabetic foot has reduced the time to wound and ulcer plasty as well as the terms of the recovery of limb supportive function.

Keywords: diabetic foot, wounds and ulcers, complex treatment, reconstructive plastic surgery, silver sulfathiazole.

For citation: Stupin V.A., Manturova N.Ye., Goryunov S.V. et al. Complex treatment for trophic ulcers and wounds in patients with diabetic foot. RMJ. 2019;11:44–48.



Pages 8-11. Возможности литолитической терапии цитратными препаратами у больных с мочекаменной болезнью. Неймарк А.И., Неймарк Б.А., Ноздрачев Н.А., Давыдов А.В., Каблова И.В.

Summary:

Therapeutic modalities for litholysis using citrate drugs in patients with urolithiasis

A.I. Neymark, B.A. Neymark, N.A. Nozdrachev, A.V. Davydov, I.V. Kablova

Altai State Medical University, Barnaul

Aim: to assess the efficacy and safety of complex citrate-containing drug in patients with urolithiasis.

Patients and Methods: patients with the stones in the upper third of the ureter or ureteropelvic junction stones were enrolled in the study. All patients underwent ureteric stenting and received anti-inflammatory treatment course. 30 patients were included in the study group while 27 patients comprised the control group. Study group patients additionally received citrate-containing drug (potassium bicarbonate + citric acid + sodium citrate) for 4 weeks, initial dosage was 3 g daily (this dosage was adjusted based on the urinary pH). 28 days after ureteric stenting, all patients underwent extracorporeal shock wave lithotripsy, and the drainage was removed.

Results: in the study group, blood levels of uric acid significantly reduced while no significant changes in this parameter were revealed in the control group. Signi ficant decrease in the sizes of the stones (from 1.7 cm to 0.7 cm) was demonstrated in the study group by the second visit. Moreover, in 5 patients, the stones were completely dissolved by the second visit. As a result, we managed to avoid extracorporeal shock wave lithotripsy. In the control group, standard treatment did not result in the decrease in the sizes of the stones by the second visit. Therefore, the sizes of the stones were significantly greater after extracorporeal shock wave lithotripsy as compared with the study group. No allergic reactions in both groups were reported.

Conclusions: complex citrate-containing drug can be used for kidney-stone therapy both to dissolve the stones completely as well as to prepare for extracorporeal shock wave lithotripsy. This drug is characterized by high safety which is important for kidney-stone therapy.

Keywords: urolithiasis, extracorporeal shock wave lithotripsy, citrate therapy, complex citrate-containing drug.

For citation: Neymark A.I., Neymark B.A., Nozdrachev N.A. et al. Therapeutic modalities for litholysis using citrate drugs in patients with urolithiasis. RMJ. 2019;11:8–11.



№10, 2019. Инфекционные болезни

Pages 12-16. Системный воспалительный ответ у больных ВИЧ-инфекцией и возможности его коррекции. Матузкова А.Н., Пшеничная Н.Ю., Алешукина А.В., Рындич А.А., Суладзе А.Г., Досягаева Л.И., Буравлев А.Ю., Твердохлебова Т.И., Журавлев А.С.

Summary:

Systemic inflammatory response in HIV-infected patients and modalities for its correction

A.N. Matuzkova1, N.Y. Pshenichnaya2,3, A.V. Aleshukina1, A.A. Ryndich1, A.G. Su-ladze1, L.I. Dosyagaeva1, A.Y. Buravlev1, T.I. Tverdokhlebova1, A.S. Zhuravlev3

1Rostov Research Institute of Microbiology and Parasitology

2Central Research Institution of Epidemiology, Moscow

3Research Institute for Phthisiopulmonology, National Medical Research Center of Tuberculosis and Infectious Diseases, Moscow

4Sechenov University, Moscow

Aim: to assess systemic inflammatory status in HIV-infected patients who receive antiretroviral therapy (ART) and modalities for its correction using immune-correcting agents.

Patients and Methods: 100 HIV-infected patients receiving ART were enrolled in the study. All patients were allocated into two groups (50 patients each) using random sampling technique. In group 1, sublingual sodium aminodihydroftalazindion (2 tablets twice a day for 10 days, then 2 tablets twice every other day for 10 days) was prescribed in addition to the standard ART. Treatment efficacy was evaluated by the changes in the concentration of lipopolysaccharide binding protein (LBP), TNF-α, IL-1β, IL-6, IL-8, IL-10, IFN-γ, and IFN-α measured using ELISA. Lymphocyte phenotyping was performed using flow cytometry. Statistical analysis was performed using SPSS Statistics Base v. 22.0 software.

Results: in most HIV-infected patients, anti-endotoxin protection is activated. In HIV infection, cytokine profile is characterized by pro-inflammatory shift, i.e., significantly elevated concentrations of IL-1β, TNF-α, IL-6, IL-8, IFN-α, and IFN-γ as compared with the control group. Moreover, in HIV infection, the percentage of CD4+ T cells (RA+) is reduced while the percentage of CD4+ memory T cells (RO+) is increased. In both groups, changes in CD8+ T cell were revealed, i.e., CD38+ cells and HLA-DR+ cells as well as CD38+HLA-DR+ cells were significantly increased as compared with healthy persons (p<0.05). ART reduces T cell activation but do not normalizes it. Addition of sodium aminodihydroftalazindion to the standard ART results in more rapid decrease in blood concentration of LBP, IL-6, IL-8, and IFN-α as well as the percentage of activated cytotoxic CD38+HLA-DR+ T cells (p<0.05).

Conclusions: sodium aminodihydroftalazindion treatment course reduces the activity of systemic inflammatory reaction and increases the efficacy and tolerability of ART.

Keywords: activation of the immune system, HIV, antiretroviral therapy, anti-endotoxin protection, cytokines, immunomodulation, aminodihydrophthalasindione sodium, Galavit.

For citation: Matuzkova A.N., Pshenichnaya N.Y., Aleshukina A.V. et al. Systemic inflammatory response in HIV-infected patients and modalities for its correction. RMJ. 2019;10:12–16.

Pages 17-21. Место инфекции, вызванной вирусом герпеса человека 6А/В, в детской популяции. Мелехина Е.В., Николаева С.В., Солдатова Е.Ю., Музыка А.Д., Горелов А.В.

Summary:

Human herpesvirus 6 variant A/B infections in child population

E.V. Melehina1, S.V. Nikolaeva1, E.Ju. Soldatova1, A.D.Muzyka1, A.V. Gorelov1,2

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

2Sechenov University, Moscow 

Herpes simplex virus (HSV) infections are among important pediatric issues due to their high prevalence, multiple transmission routes, and non-specific clinical signs. The latter makes the diagnosis of these infections more difficult and results in late treatment or, conversely, inadequate medication use (polypragmasia). In addition, infections with herpes viruses often determine the morbidity of other infections and affect immune status.

Aim: to assess the prevalence of human herpesvirus 6 (HHV-6) variant A/B infections in children.

Patients and Methods: 1,633 children aged 1–16 years were enrolled in the study. Of them, 567 children were admitted to hospital with clinical signs of acute respiratory infections, 958 children have monthly acute respiratory infections, and 108 children were healthy controls. All children underwent complex examination including direct diagnostic tests (ELISA) to identify the causative agent. Statistical analysis was performed using STATISTICA 6 software.

Results: we have demonstrated that HSV infection markers are identified with the similar rate in children aged 1–16 years, i.e., in 96% of children with clinical signs of acute respiratory infections, 91% of children with recurrent respiratory infections, and 91% of healthy children. HHV-6A and HHV-6B were the most common causative agents for HSV infections, i.e., their laboratory markers were identified in approx. 70% of the children. The proportion of active infections caused by HHV-6A and HHV-6B was 30%. They occurred mostly in association with HSV infections caused by other types of herpes viruses.

Conclusions: in child population, infections caused by HHV-6A and HHV-6B are the most common among HSV infections. However, active infections account for less than 30%. Our study has demonstrated that HSV diagnosis is required in children to prescribe early adequate etiological treatment.

Keywords: human herpesvirus 6 variant A/B, herpes simplex virus, children, meglumine acridоnacetate.

For citation: Melehina E.V., Nikolaeva S.V., Soldatova E.Ju. et al. Human herpesvirus 6 variant A/B infections in child population.
RMJ. 2019;10:17–21.

Pages 22-25. Комплексный подход к терапии острых тонзиллофарингитов у детей старше 1 года. Мелехина Е.В., Музыка А.Д., Плоскирева А.А., Сидельникова Э.С., Погорелова О.О., Горелов А.В.

Summary:

Complex treatment approach to acute tonsillopharyngitis in children over a year

E.V. Melekhina1, A.D. Muzyka1, A.A. Ploskireva1, E.S. Sidel’nikova1, O.O. Pogorelova1, A.V. Gorelov1,2

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

2Sechenov University, Moscow 

Acute infections affecting adenoids, and tonsils are common in pediatric practice. Inappropriate antibiotic prescribing is not unusual.

Aim: to assess the efficacy of complex homeopathic medication (Meditonsin®) for non-streptococcal tonsillitis and/or pharyngitis in children over a year.

Patients and Methods: the study included children with verified acute respiratory infections affecting upper respiratory tract without any signs of bacterial infection by the time of the enrollment who received outpatient treatment. Inclusion criteria were age 1 to 16 years, verified diagnosis of acute respiratory infection, complaints of sore throat, negative express-test for group A β-hemolytic streptococcus, and less than 48 hours of illness onset. Study group included 25 children over a year (mean age 6.94±1.1 years), 16 (64%) were boys and 9 (36%) were girls. Control group included 26 children over a year (mean age 7.33±1.0 years), 11 (42%) were boys and 15 (58%) were girls.

Results: complex homeopathic medication Meditonsin® for non-streptococcal tonsillopharyngitis in children over a year significantly accelerated the relief of intoxication symptoms and complaints of sore throat, cough, nasal congestion, and nasal discharge. Pediatricians reported on the significant improvement of oropharyngeal signs, reduced oropharyngeal inflammation and tonsil deposits on days 1, 4, and 7 after starting treatment. This homeopathic agent resulted in the rapid relief of tonsillopharyngitis symptoms and did not provoke bacterial complications. Six children of the control group required additional antibacterial treatment. No adverse side effects were reported.

Conclusions: it is rational to use complex homeopathic medication Meditonsin® in children over a year for outpatient treatment when therapy should be prescribed based on clinical signs of disease only.

Keywords: tonsillitis, pharyngitis, tonsillopharyngitis, children, complex homeopathic medication, Meditonsin.

For citation: Melekhina E.V., Muzyka A.D., Ploskireva A.A. et al. Complex treatment approach to acute tonsillopharyngitis in children over a year. RMJ. 2019;10:22–25.



Pages 26-31. Профилактика нарушений биоценоза у детей с острыми респираторными инфекциями, получающих антибактериальную терапию. Горелов А.В., Мелехина Е.В., Сидельникова Э.С.

Summary:

Prevention of biocenosis imbalance in children with acute upper respiratory tract infection receiving antibacterial treatment

A.V. Gorelov1,2, E.V. Melekhina1, E.S. Sidel’nikova1

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

2Sechenov University, Moscow

Aim: to assess protective properties of a multi-strain probiotic in children over 3 years with acute upper respiratory tract infection (URTI) who receive antimicrobial therapy (AMT).

Patients and Methods: the rate and severity of gastrointestinal adverse events as well changes in gut microbiocenosis (microbiota) were evaluated by 16S RNA gene sequencing in 67 children with URTI aged 3–7 years who received antibacterial treatment due to infectious complications. Study group included 35 children who received antibiotics and multi-strain probiotic Bac-Set® Forte (during antibacterial treatment 7±2 days and for 14 days after the treatment). Control group included 32 children who received antibiotics only. The frequency and characteristics of stool were assessed using Bristol stool chart at admission, by the end of AMT, and 21±2 days after starting antibacterial treatment.

Results: more frequent stool was reported in 20% of study group children and 87.5% of control group children by the end of AMT and in 5% and 28%, respectively, in 21±2 days after starting antibacterial treatment. No significant changes in stool consistency were reported in the study group while moderate diarrhea was reported in the control group. After antibacterial treatment, more significant gut microbiota α-diversity was observed in the study group as compared with the control group. No adverse side effects were reported in the study group.

Conclusions: multi-strain probiotic reduces gastrointestinal adverse event rate and negative effects of antibacterial treatment on microbiome. Considering these aspects as well as good tolerability, Bac-Set® Forte can be recommended for broad application in pediatrics to prevent gastrointestinal adverse events and microbiome imbalance in children who receive antibiotics.

Keywords: microbiome, probiotics, acute respiratory viral infections, antibiotic-associated diarrhea, prophylaxis.

For citation: Gorelov A.V., Melekhina E.V.,  Sidel’nikova E.S. Prevention of biocenosis imbalance in children with acute upper respiratory tract infection receiving antibacterial treatment. RMJ. 2019;10:–31.

Pages 3-3. Слово редактора. Горелов А.В.

Pages 31-35. Роль короткоцепочечных жирных кислот в патогенезе острых кишечных инфекций и постинфекционных синдромов. Тлюстангелова Р.К., Долинный С.В., Пшеничная Н.Ю.

Summary:

The role of short-chain fatty acids in the pathogenesis of acute intestinal infections and post-infectious syndromes

R.K. Tlyustangelova1, S.V. Dolinnyy1, N.Yu. Pshenichnaya2,3

1Adygea Republican Clinical Infectious Hospital, Maykop

2Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow

3National Medical Research Center for Phthisiopulmonology and Infectious Diseases, Moscow

Acute intestinal infections is one of the major causes of gastrointestinal disorders, i.e., post-infectious irritable bowel syndrome and associated metabolic syndrome in impaired microbiocenosis. The paper analyzes the effect of exometabolites of gut microbiota both on normal and pathological processes in acute intestinal infections. The role of short-chain fatty acids (SCFAs) in the inflammatory response in intestinal infections as well as their effect on the course and outcomes of acute intestinal infections, post-infectious irritable bowel syndrome, and metabolic syndrome are discussed. This is of crucial importance for the diagnosis, more rapid and long-term remission of acute intestinal infections, prediction, and early treatment of dysbiosis during the period of convalescence. The paper reviews recent domestic and foreign studies published over the last 20 years on metabolic processes involved in the pathogenesis of acute intestinal infections. Pathogenes is of post-infectious irritable bowel syndrome and metabolic syndrome in impaired gut microflora after infectious intestinal disorders is addressed. The importance of gut microbiota metabolites (i.e., SCFAs) for normal functioning of gastrointestinal tract and organism in whole is highlighted.

Keywords: microflora, dysbiosis, short-chain fatty acids, intoxication, dehydration, acute intestinal infections.

For citation: Tlyustangelova R.K., Dolinnyy S.V., Pshenichnaya N.Yu. The role of short-chain fatty acids in the pathogenesis of acute intestinal infections and post-infectious syndromes. RMJ. 2019;10:31–35.



Pages 36-41. Клинические формы вирусной инфекции Эпштейна — Барр. Понежева Ж.Б., Гришаева А.А., Попова Т.И.

Summary:

Clinical variants of Epstein — Barr virus infection

Zh.B. Ponezheva1, A.A. Grishaeva1,2, T.I. Popova2

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

2Infectious Clinical Hospital No. 2, Moscow

The importance of Epstein — Barr virus (EBV) infection is accounted for by its high occurrence, specific tropism to immune cells, difficulties in early and differential diagnosis, specificities of the clinical course, and the lack of specific preventive measures and effective etiological treatment.

Considering the diversity of clinical variants of EBV infection, high risk of complications, and the development of immunodeficiency of various severity (these factors are responsible for the outcomes), early diagnosis and adequate management strategy are of great importance. Detailed and careful study of EBV immunopathogenesis is required to determine prognostic criteria, to reveal immunological abnormalities and immunogenetic factors of the predisposition to EBV-associated complications, and to optimize the treatment.

Treatment for any EBV variant should be complex and consider cli nical manifestations, disease severity and stage. However, it could be difficult to implement these principles in practice. Early diagnosis, correct and individual (and then personalized) etiological and pathogenic treatment approaches are the key to successfully treating EBV infection. This paper addresses current views on immunopathogenesis, diagnosis, and treatment for EBV infection depending on its stage and clinical variants. Clinical examples of acute and chronic EBV infections are discussed.

Keywords: Epstein — Barr virus, chronic Epstein — Barr virus infection, clinical variants, differential diagnosis, etiological treatment, pathogenic treatment, complications, clinical examples.

For citation: Ponezheva Zh.B., Grishaeva A.A., Popova T.I. Clinical variants of Epstein — Barr virus infection. RMJ. 2019;10:36–41.

Pages 4-7. Современные аспекты нарушений сосудисто-тромбоцитарного звена гемостаза у больных корью. Малеев В.В., Лазарева Е.Н., Астрина О.С., Алешина Н.И., Цветкова Н.А., Вдовина Е.Т., Наврузова Л.Н.

Summary:

Abnormalities of vascular and platelet responses in measles: state-of-the-art

V.V. Maleev1, E.N. Lazareva1, O.S. Astrina1, N.I. Aleshina1, Tsvetkova2, E.T. Vdovina2, L.N. Navruzova2

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

2Infectious Clinical Hospital No. 2, Moscow

We report our findings on vascular and platelet responses as the stages of hemostasis in measles to address current aspects of measles pathogenesis.

Aim: to determine the importance of vascular and platelet response abnormalities in measles.

Patients and Methods: clinical laboratory tests were performed in 40 patients aged 36.9 ± 9.2 years with measles (the diagnosis was verified by ELISA) and 20 healthy volunteers. ADP-induced platelet aggregation and the degree of aggregation were assessed using AP-2110 aggregometer (Solar, Russian Federation). The activity of von Willebrand factor was evaluated using LA 230 aggregometer (BIOLA, Russian Federation) and von Willebrand test system (RENAM, Russian Federation). D-dimers were analyzed using Sysmex CS5100 coagulation analyzer and D-Dimer INNOVANCE test system (Siemens, Germany).

Results: confluent maculopapular rash was detected in 100% and petechial rash in 3.3%. Complete blood count has revealed elevated band neutrophil  count (13.4±2.4%) and normal white blood cells (6.5±0.2×109/L) in 97.1%. Thrombocytopenia (97×109/L) but normal MPV and PDW were identified in 66.7%. Mean degrees of platelet aggregation demonstrate their increased functional activity. However, the degree of platelet aggregation was reduced to, on average, 30.4% in a quarter of patients. Second wave aggregation was revealed in 73.6%. Significant increase in the activity of von Willebrand factor (up to 157.8±7.58%) was detected in 100% and increase in D-dimer levels in 75%.

Conclusions: currently, measles is characterized by significant vascular damage which enhances regenerative processes mediated by platelets and results in platelet hyperaggregation. However, hypoaggregation revealed in some patients indicate potential hemorrhagic syndrome affecting the severity and the outcomes of measles.

Keywords: measles, hemostasis, aggregation, endothelium.

For citation: Maleev V.V., Lazareva E.N., Astrina O.S. et al. Abnormalities of vascular and platelet responses in measles: state-of-the-art. RMJ. 2019;10:4–7.

Pages 42-45. Острые респираторные инфекции у детей: оптимизация тактики терапии. Николаева С.В., Хлыповка Ю.Н., Горелов А.В.

Summary:

Acute respiratory infections in children: optimizing treatment strategy

S.V. Nikolaeva1, Yu.N. Khlypovka1,2, A.V. Gorelov2,3

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

2Central Clinical Hospital and Polyclinic, Moscow

3Sechenov University, Moscow

Acute respiratory infections (ARIs) still rank first among infectious diseases in children. Viruses are the most common causative agents of ARIs. Clinical symptoms of ARIs are similar, i.e., fever, headache, hyperemic pharynx, rhinitis, cough, conjunctivitis, and enlarged regional lymph nodes. Treatment for ARIs should be complex and include, if needed, antivirals. Current-ly, identification of a specific virus is not a standard procedure in routine clinical practice. Some symptoms of ARIs can be significant thus requiring additional drugs. Treatment for ARIs should include antivirals (etiological therapy), pathogenic and symptomatic therapy, medications to boost antiviral and antibacterial immune response, and antibiotics (if bacterial complications occur). Considering that ARIs are common disorders, drugs which reduce ARI duration and time to recover working capacity are socially important. However, not all antivirals can be used in children due to their potential toxicity. In these cases, recombinant interferon alfa-2b in combination with highly active antioxidants vitamins E and C is recommended. Numerous studies have demonstrated clinical efficacy and safety of this agent.

Keywords: acute respiratory infections, viruses, children, recombinant interferon alfa-2b.

For citation: Nikolaeva S.V., Khlypovka Yu.N., Gorelov A.V. Acute respiratory infections in children: optimizing treatment strategy. RMJ. 2019;10:42–45.

Pages 46-49. Эффективность применения макролидов в лечении больных урогенитальными инфекциями. Кузьменко А.В., Кузьменко В.В., Гяургиев Т.А.

Summary:

The efficacy of macrolides for urogenital infections

A.V. Kuz’menko, V.V. Kuz’menko, T.A. Gyaurgiev

Burdenko Voronezh State Medical University

Currently, non-gonococcal microbes become the leading causative agents of sexually transmitted infections. It was demonstrated that these microbes provoke non-specific urethritis and pelvic inflammatory disorders.

and safety of roxithromycin for non-gonococcal urethritis in men were published Many authors report on the significant increase in the occurrence of inflammatory pelvic disorders associated with Mycoplasma hominis and Ureaplasma spp. in recent years. In men, the most common causative agents of non-gonococcal urethritis are Chlamydia trachomatis (23–55%), Ureaplasma urealyticum (20–40%), Mycoplasma genitalium (12–25%), Trichomonas vaginalis (2–5%). Moreover, mixed infections are commonly diagnosed in patients with non-specific urethritis.

Considering the growing role of intracellular bacterial pathogens in pelvic inflammatory disorders in women and non-gonococcal urethritis in men, macrolides gain significance in the treatment for these infections. Among macrolides, the most popular agent is roxithromycin. In recent years, a number of studies on the clinical efficacy. These studies have demonstrated that this drug is an effective and safe therapy for non-gonococcal urethritis and pelvic inflammatory disorders.

Keywords: sexually transmitted infections, urogenital infections, sexually transmitted infections, vaginitis, sexually transmitted infections, macrolides, roxithromycin.

For citation: Kuz’menko A.V., Kuz’menko V.V., Gyaurgiev T.A. The efficacy of macrolides for urogenital infections. RMJ. 2019;10:46–49.

Pages 50-52. Реактивация хронического гепатита В после отмены терапии. Макашова В.В., Омарова Х.Г.

Summary:

Chronic hepatitis B reactivation after treatment discontinuation

V.V. Makashova1,2, Kh.G. Omarova1

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

2Infectious Clinical Hospital No. 2, Moscow

The last decades have witnessed dramatic progress both in the diagnosis and development of novel drugs for chronic hepatitis B, in particular, nucleoside analogues. However, many aspects are still challenging, i.e., treatment duration, the risk of resistance in long-term treatment, criteria for drug discontinuation without any risk of chronic hepatitis B reactivation, the effect on the prevention of liver cirrhosis and hepatocellular carcinoma etc.

The paper addresses case history of chronic hepatitis B without delta agent, phase 2 (HbeAg+), characterized by high biochemical marker levels, high viral load, and liver fibrosis stage 2. This woman has received nucleoside analogue for 10 years. Liver enzyme levels have returned to normal quickly and were stable. However, after discontinuing the treatment, hepatitis B reactivation has occurred. The patient was prescribed with tenofovir. ALT has re turned to normal levels, viral load has reduced by 2 logs (to 1.45×104 IU/ml) and was stable.

This case history demonstrates that patients should not discontinue the treatment with nucleoside analogues to prevent disease progression and its transformation to liver cirrhosis and hepatocellular carcinoma. Identification of markers to assess the possibility of nucleoside analogue discontinuation and the development of novel drugs targeting viral DNA are still important.

Keywords: chronic hepatitis B, treatment, nucleoside analogues, hepatitis B reactivation.

For citation: Makashova V.V., Omarova Kh.G. Chronic hepatitis B reactivation after treatment discontinuation. RMJ. 2019;10:50–52.

Pages 52-55. Функциональные и морфологические изменения сердца при менингококковой инфекции у детей. Быков М.В., Лазарев В.В., Солдатова И.А., Мурзина О.Б., Захарова И.В., Великанова Е.Н., Чернышов Д.В., Серова В.В., Николаева С.В., Руженцова Т.А., Горелов А.В.

Summary:

Changes in cardiac functions and morphology in meningococcal infection in children

M.V. Bykov1,2, V.V. Lazarev1, I.A. Soldatova3, O.B. Murzina3, I.V. Zakharova3, E.N. Velikanova3, D.V. Chernyshov3, V.V. Serova3, S.V. Nikolaeva2, T.A. Ruzhentsova2,4, A.V. Gorelov2,5

1Pirogov Russian National Research Medical University, Moscow

2Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow

3Infectious Clinical Hospital No. 2, Moscow

4Medical University “REAVIZ”, Moscow

5Sechenov University, Moscow

Aim: to assess the effect of meningococcal infection on heart morphology and functions.

Patients and Methods: morphological and functional changes of cardiovascular system were assessed in 18 children aged 7 months to 13 years with meningococcal infection by transthoracic echocardiography. Interventricular septal wall thickness and structure at systole and diastole, left ventricle posterior wall thickness and structure, valve dimensions, parameters of central hemodynamics (i.e., left ventricle end-diastolic diameter, left ventricle end-systolic diameter, left ventricular ejection fraction, stroke volume, and cardiac output), and the ratio of stroke volume to body weight (ml/kg) were measured. The measurements were performed twice, i.e., at admission (within the first 2 or 3 days) and before discharge.

Results: at baseline, the parameters of central hemodynamics were within normal limits in all patients. In 15 children, these parameters have increased. Ejection fraction, stroke volume, and the ratio of stroke volume to body weight have increased while cardiac output have demonstrated no significant changes due to the baseline compensatory tachycardia. Hypertrophy of interventricul ar septum and left ventricle posterior wall with heterogeneous myocardial echogenicity was revealed in 14 patients and 9 patients, respectively. At baseline, 12 patients were diagnosed with mitral valve thickening to 4.7–6.6 mm.

Conclusions: typical changes of heart morphology in acute meningococcal infection demonstrate the presence of cardiodepressive component which accounts for specific infectious toxic cardiomyopathy and reduced myocardial contractility. Reduced ratio of stroke volume to body weight (less than 1 ml/kg) should be considered as a sign of cardiac decompensation and threatened heart failure which require intensive care.

Keywords: children, cardiomyopathy, meningococcal infection, echocardiography.

For citation: Bykov M.V., Lazarev V.V., Soldatova I.A. et al. Changes in cardiac functions and morphology in meningococcal infection in children. RMJ. 2019;10:52–55.



Pages 7-11. Роль метаболических и иммунологических нарушений в прогрессировании хронического гепатита С. Патлусов Е.П., Понежева Ж.Б., Маннанова И.В.

Summary:

The role of metabolic and immunological abnormalities in the progression of chronic hepatitis C

E.P. Patlusov1,2, Zh.B. Ponezheva3, I.V. Mannanova3

1Military Clinical Hospital of the National Guard Troops of Russian Federation No. 5, Ekaterinburg

2Ural State Medical University, Ekaterinburg

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

Aim: to assess the effect of metabolic and immune abnormalities on the course of chronic hepatitis C.

Patients and Methods: 250 patients with chronic hepatitis C older than 18 years without prior antiviral treatment were enrolled in the study. All patients provided informed consent for medical examinations and treatment. Exclusion criteria were alcoholism, inherited liver diseases, pregnancy, mixed hepatitis and coinfections, and examination/treatment refusal. Subpopulations of peripheral blood lymphocytes were assessed by flow cytometry. In addition to the standard panel of immune status, the levels of circulating lymphocytes were measured. Instrumental tests (i.e., abdominal ultrasound, liver fibroelastometry, and liver biopsy to assess the degree of hepatic steatosis) were performed. The degree of liver fatty degenerat ion was evaluated using CRN scoring system (2005) by hepatocyte fat content (in %).

Results: non-alcoholic fatty liver disease was diagnosed in 55.4% of patients with hepatic steatosis of various degrees. In 16.7% of patients, chronic hepatitis C was associated with metabolic disorders and type 2 diabetes characterized by high biochemical activity and significant dyslipidemia. Moderate direct correlation between the degree of hepatic steatosis and the stage of hepatic fibrosis was established. Progressive hepatic fibrosis in chronic hepatitis C was associated with higher rate of fatty degeneration, in particular, in patients with stage 3 (F3) and 4 (F4) fibrosis (89.3% of patients). Significant increase in the levels of circulating lymphocytes expressing IFN-α/β (CD118+) and IFN-γ (CD119+) is typical of advanced liver fibrosis (F4).

Conclusions: the levels of CD118+ and CD119+ can be used as additional immunological markers of the prediction of advanced liver fibrosis in chronic hepatitis C. Metabolic abnormalities significantly aggravate the course of chronic hepatitis C. These abnormalities are more significantly associated with the progression of fibrosis stage thus requiring personalized approach to determine management strategy.

Keywords: chronic hepatitis C, hepatic steatosis, liver fibrosis, non-alcoholic fatty liver disease.

For citation: Patlusov E.P., Zh.B. Ponezheva, Mannanova I.V. The role of metabolic and immunological abnormalities in the progression of chronic hepatitis C. RMJ. 2019;10:7–11.





№9, 2019. Болевой синдром

Pages 11-16. Цереброваскулярные заболевания и головная боль. Екушева Е.В.

Summary:

Cerebrovascular diseases and cephalalgia

Ye.V. Yekusheva

Federal Scientific Clinical Center of the Federal Medical Biological Academy, Moscow

Cerebrovascular diseases (CVDs) and cephalalgia (CA) are common causes of patients seeking medical care. CVDs are one of the most socially significant problem in the modern world due to the wide prevalence, high mortality and disability incidences. Among all the existing options for pain syndrome, CA takes one of the leading positions: about 90% of the population experienced a headache at least once in a lifetime, and in 25–40% of cases, it was chronic. Commonly, patients with CVDs and complaints of CA visit general practitioners, primary care physicians and neurologists, whose main task is to establish the correct diagnosis and assign an effective treatment. These comorbid disorders are in the area of special attention of different medical specialists. The most effective and strategically significant management tactics of this comorbid patient category is considered to be a comprehensive and multidisciplinary  approach, including therapy with drugs with proven efficacy, safety and a wide therapeutic spectrum. The article presents clinical pictures in patients with complaints of CA and chronic cerebrovascular ischaemia diagnosis and describes the management tactics of such patients.

Keywords: cerebrovascular diseases, cerebrovascular accident, chronic cerebrovascular ischaemia, cephalalgia, Vasobral.

For citation: Yekusheva Ye.V. Cerebrovascular diseases and cephalalgia. RMJ. 2019;9:11–16.

Pages 16-19. Дифференциальная диагностика лицевых болей. Раянова Г.Ш., Ахмадеева Л.Р.

Summary:

Differential diagnosis of facial pain

G.Sh. Rayanova1, L.R. Akhmadeeva2

1Clinic of Neurology and Pediatrics LLC, Ufa

2Bashkir State Medical University, Ufa

The review describes the main types of facial pain and clinical diagnosis principles, taking into account the pathophysiological patterns. According to the terminology of the International Association for the Study of Pain (IASP), facial or orofacial pain (prosopalgia) is pain or other unpleasant sensations localized on the anterior surface of the head above the cervicus area to the otic area outwards and superciliary ridge upwards. Due to the morphological structure complexity of the face, orofacial pain has different pathophysiological patterns. The main thing in facial pain diagnostics is a careful history taking. Paraclinical diagnostic methods are not major and in most cases do not reveal organic brain lesions. Neuroimaging methods can be recommended to differentiate a specific cause (tumour, multiple sclerosis, et c.), in the case of increased pain syndrome, prosopalgia changing nature, as well as in the absence of a positive therapeutic effect. Taking into account the numerous data on the prosopalgia comorbidity with heterogeneous mental pathology for the diagnosis and treatment of facial pain, a multidisciplinary approach should be recommended with mandatory consultation with a dentist, neurologist, neurosurgeon, otolaryngologist, ophthalmologist, psychiatrist or psychotherapist.

Keywords: facial pain, prosopalgia, orofacial pain, trigeminal neuralgia, non odontogenic pain syndromes.

For citation: Rayanova G.Sh., Akhmadeeva L.R. Differential diagnosis of facial pain. RMJ. 2019;9:16–19.



Pages 20-24. Невралгия тройничного нерва, ассоциированная с менингиомами задней черепной ямки: стратегия успешного хирургического лечения. Шиманский В.Н., Карнаухов В.В., Таняшин С.В., Пошатаев В.К., Гаспарян С.С., Шевченко К.В., Колычева М.В., Абдурахимов Ф.Д., Рыбаков В.А., Донской А.Д., Тохчуков Ш.Х.

Summary:

Trigeminal neuralgia associated with posterior cranial fossa meningiomas: successful surgical treatment tactics

V.N. Shimanskiy, V.V. Karnaukhov, S.V. Tanyashin, V.K. Poshataev, S.S. Gasparyan, K.V. Shevchenko, M.V. Kolycheva, F.D. Abdurakhimov, V.A. Rybakov, A.D. Donskoy, Sh.Kh. Tokhchukov

N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow

Aim: to improve the treatment quality in patients with trigeminal neuralgia associated with tumours of the posterior cranial fossa.

Patients and Methods: from 2012 to 2017 50 patients were operated on the posterior cranial fossa meningiomas associated with trigeminal neuralgia (43 women and 7 men, median age — 60 years). Depending on the localization, the following tumors were presented: petroclival meningiomas (19 patients — 38%), petrous apex meningiomas (16 patients — 32%), posterior petrous meningiomas (12 patients — 24%) and multiple meningiomas (3 patients — 6%). Three types of neurovascular conflicts were identified intraoperatively. The trigeminal nerve was compressed by a tumour in its fusion area with the brain stem in 35 (70%) cases, by the displaced arterial vessel — in 11 (22%) cases, and in 4 (8%) cases, there was a simultaneous trigeminal nerve displacement by the tumour and its artery compression. All patients underwent surgical tumour removal, microvascular decompression was performed in 30% of cases.

Results: during the surgical intervention, the tumour was rem oved completely in 34 patients, almost completely — in 6 patients and partially — in 10 patients. In the vast majority of cases (92%), patients had a complete intense pain syndrome regression after surgery. Partial pain relief was observed in 4 (8%) patients, of which 2 patients had type I trigeminal nerve compression intraoperatively, and 2 patients — type II. Complete tumour removal was performed to all patients with partial regression of pain syndrome. Intraoperative edema of the  posterior cranial fossa structures developed in 1 (2%) patient and nasal liquorrhea — in 2 (4%) patients.

Conclusion: trigeminal neuralgia can be caused by compression of the trigeminal nerve near to REZ (root exit zone) by the tumour at its fusion area with the brain stem or tumour and arterial vessel located in this area. Vascular decompression should be added to surgical intervention.

Keywords: skull base meningioma, petroclival meningioma, trigeminal neuralgia, vascular decompression of trigeminal nerve.

For citation: Shimanskiy V.N., Karnaukhov V.V., Tanyashin S.V. et al. Trigeminal neuralgia associated with posterior cranial fossa meningiomas: successful surgical treatment tactics. RMJ. 2019;9:20–24.



Pages 25-28. Лечение пациентов с мигренью без ауры и головной болью напряжения в условиях реальной клинической практики комбинированными препаратами. Корешкина М.И.

Summary:

Treatment of migraine patients without aura and tension type headache in real clinical practice using combined preparations containing ibuprofen and paracetamol

M.I. Koreshkina

AVA-PETER Ltd., St. Petersburg

Aim: to collect and evaluate the data on the effectiveness of relieving migraines without aura and tension type headache (TTH) using Brustan® (1 tablet contains 400 mg of ibuprofen and 325 mg of paracetamol), as well as to assess the safety of this drug in the prospective observational program (hereinafter — Program).

Patients and Methods: the Program, which lasted 4 weeks, involved patients aged 18–50 years (27 women, 3 men) with migraine without aura (n=27) and TTH (n=3) of mild or moderate intensity, who suffered no more than eight attacks per month. If a headache occurs, the patient will write in the diary, estimates the headache intensity on a visual analog scale (VAS), then take 1 tablet of the drug Brustan® per os, and after 10 minutes records changes on pain intensity (also according to VAS) in the diary insert. The following indices were evaluated: average number of headache attacks before and after treatment, the average decrease in pain intensity according to VAS for 10 minutes after taking the drug, as well as patient satisfaction with the treatment. Also, serious adverse events development was recorded to assess safety.

Results: the median age was 41.07±9.85 years. The average number of headache attacks before treatment was 12.77±9.79. This figure decreased to 4.8±3.93 (p < 0.05) against the background of the test drug application. The average headache intensity prior to taking the drug Brustan® was 6,43±1.68 points, and 10 min after administration — 2.4±2.13 points (p < 0.05). Whereas 23 patients out of 30 (76,67%) were satisfied with the headache treatment with drug Brustan®. No serious adverse events were reported.

Conclusion: the drug Brustan® can be recommended as the first-line drug for headache relief in patients with migraine without aura and TTH in real clinical practice.

Keywords: headache treatment, migraine treatment, headache tablets, painkillers, Brustan, strong painkillers, ibuprofen, paracetamol, NSAIDs in headache, analgesic in headache, migraine without aura, tension type headache.

For citation: Koreshkina M.I. Treatment of migraine patients without aura and tension type headache in real clinical practice using combined preparations containing ibuprofen and paracetamol. RMJ. 2019;9:25–28.



Pages 28-32. Боль в спине у детей и подростков. Сергеев А.В., Екушева Е.В.

Summary:

Back pain in children and adolescents

A.V. Sergeev1, Ye.V. Yekusheva2

1Sechenov University, Moscow

2Federal Scientific Clinical Center of the Federal Medical Biological Academy, Moscow 

Most studies and clinical guidelines focus on back pain in adult patients. At the same time, current epidemiological data indicate a high prevalence of back pain among adolescents. The most common causes of back pain in children are benign musculoskeletal pain and injuries. Despite the high prevalence of musculoskeletal pain (about 50%), the following pain syndrome specific causes can be identified quite often: infectious spinal pathology, inflammatory spondyloarthropathy, osteoid osteoma, Scheuermann’s disease, spondylolysis and spondylolisthesis. As a rule, no additional examinations are required in case of musculoskeletal pain. Additional examinations (laboratory diagnostics and visualization) are required if there are signs of a specific pain aetiology, the so-called “danger signa ls” or “red flags” described in this article. The basis for the treatment and prevention of musculoskeletal pain is the use of various exercises methods with training the motor control, maintaining daily activity, and also adjusting the risk factors for a particular patient. Pharmacological treatment of back pain in pediatric patients is used for the shortest possible period. The optimal approach is the use of agents with high efficiency and a low development spectrum of adverse events.

Keywords: back pain, children, adolescents, musculoskeletal pain, myofascial pain syndrome.

For citation: Sergeev A.V., Yekusheva Ye.V. Back pain in children and adolescents. RMJ. 2019;9:28–32.



Pages 3-3. Слово редактора. Екушева Е.В.

Pages 33-39. Боли в спине и остеопороз. Исайкин А.И., Исайкина О.Ю.

Summary:

Back pain and osteoporosis

A.I. Isaykin1, O.Yu. Isaykina2

1Sechenov University, Moscow

2National Medical Research Center for Preventive Medicine, Moscow

Lumbar pain is one of the most common problems in presenile age. The ageing process is accompanied by a change in the structure and a decrease in the functional activity of organs and tissues, including the osteoporosis development — a “silent disease”, asymptomatic until fractures appear. In a pilot study, we showed that osteoporosis alone is not the cause of chronic lumber pain in elderly patients. There were no significant differences in the following indicators: pain localization and intensity, the degree of anxiodepressive disorders, and the disability degree in patients with chronic lumbar pain syndrome suffering from osteoporosis and patients without diagnosed osteoporosis. Chronic lumbar pain treatment should include exercises, non-steroidal anti-inflammatory agents, and multimodal reha bilitation. Postmenopausal patients are advised to consume high protein and calcium-containing foods in combination with exercise due to the osteoporosis risk. Osteogenon (active component: ossein-hydroxyapatite compound) is a drug that affects bone mineralization and bone metabolism. The article presents the latest recommendations on therapeutic exercises, treatment methods and prevention of compression vertebral fractures in patients with osteoporosis.

Keywords: lumbar pain, osteoporosis, Osteogenon, multidisciplinary approach, therapeutic exercises.

For citation: Isaykin A.I., Isaykina O.Yu. Back pain and osteoporosis. RMJ. 2019;9:33–39.



Pages 4-10. Цервикокраниалгия: множество причин, одна проблема. Девликамова Ф.И., Хайбуллина Д.Х., Максимов Ю.Н., Губеев Б.Э.

Summary:

Cervicocranialgia: a multitude of reasons, but only one issue

F.I. Devlikamova1, D.Kh. Khaybullina1, Yu.N. Maximov1, B.E. Gubeyev1,2


1Russian Medical Academy of Continuing Professional Education, Kazan

2Republican Clinical Neurological Center, Kazan


Aim: to identify the functional disorders role of the spinal motion segment (SMS) in the cervical spine and significance clarification of each anatomical structure in the formation of the cervicogenic headache (CGH) clinical picture.

Patients and methods: the study included 110 patients (68 women, 42 men; the average age of all patients — 38.7 ±2.3 years) who complained of neck pain with irradiation to the head. All patients underwent the neurological and neuro-orthopaedic examination. CGH verification was conducted according to the CGH diagnostic criteria recommended by the International Headache Society.

Results: disease duration at the time of visit ranged from 20 days to 11 years. In 91 (82.7%) patients, the headache was unilateral. According to neuro-orthopaedic examination, movement restrictions in the cervical spine were diagnosed in all patients. In the vast majority of cases functional blocking had a concominant character: С0–СI and CI–CII; С0–СI, CI–CII and CVII–ThI, ThI–ThII; CIII–CIV, ThI–ThII–ThIII. In patients with changes in the upper cervical spine (С0–СI–СII), blocking was accompanied by visual and acoustic symptoms, dizziness, suboccipital muscles hypertonicity and the myofascial trigger zones (MTZ) development in the obliquus capitis inferior muscle and rectus capitis lateralis muscles, as well as in the sternocleidomastoid muscle. When blocking SMS CIII–CIV, the headache had a pronounced vegetative colour, accompanied by nausea and vomiting. Patients with lower cervical spine (CIII–CVII) blockage were diagnosed with MTZ in the splenius capitis muscle at the level of blocked SMS.

Conclusion: CGH is a heterogeneous group of headaches, one of the main causes of which is functional blocking of the SMS in the cervical spine. The CGH clinical picture depends on the level of the functional blocking site. SMS functional blocking in the cervical spine is accompanied by the MTZ development in the muscles of the neck and suboccipital region.

Keywords: cervicogenic headache, cervical spine, biomechanics, functional disorders, myofascial trigger zones, manual therapy.

For citation: Devlikamova F.I., Khaybullina D.Kh., Maximov Yu.N., Gubeyev B.E. Cervicocranialgia: a multitude of reasons, but only one issue. RMJ. 2019;9:4–10.



Pages 40-43. Стеноз поясничного канала. Исайкин А.И., Черненко О.А., Розен А.И.

Summary:

Lumbar spinal stenosis

A.I. Isaykin, O.A. Chernenko, A.I. Rosen

Sechenov University, Moscow

Lumbar spinal stenosis (LSS) is a narrowing of the central spinal canal (central stenosis) or lateral recess and intervertebral foramen (lateral stenosis). LSS is one of the most common causes of lumbar pain in the elderly. The clinical picture of this disease consists of local lumbar musculoskeletal pain and claudication — radicular symptoms that occur during walking. LSS diagnosis is most likely in elderly patients with claudication during walking and standing, regressed when leaning forward or sitting. The treatment tactics is determined by the clinical picture, rather than changes identified by imaging studies. The most significant diagnostic criterion is the walking distance. Therapeutic strategies for patients with LSS are not fully defined because there is insufficient evidence of different treatment options effectiveness. They usually begin with multidisciplinary conservative therapy, including lifestyle recommendations, psycholo gical techniques, exercise therapy, prescription of drugs (including NSAIDs), as well as epidural administration of glucocorticoids and local anaesthetics. If conservative therapy is ineffective, the possibility of neurosurgical intervention is discussed, sometimes in combination with the use of fixing systems. The application results of different neurosurgical intervention options are ambiguous.

Keywords: lumbar spinal stenosis, lumbosacral instability, stenosis surgical treatment with the imposition of the stabilizing systems.

For citation: Isaykin A.I., Chernenko O.A., Rosen A.I. Lumbar spinal stenosis. RMJ. 2019;9:40–43.



Pages 44-48. Коморбидный пациент с хроническим болевым синдромом. Екушева Е.В.

Summary:

Comorbid patient with chronic pain syndrome

E.V. Ekusheva

Federal Clinical Research Centre of the Federal Medical-Biological Agency, Moscow

Chronic pain syndrome is observed in more than 20% of the world population. The most common are chronic back pain, joint pain, headache and neuropathic pain. Currently, the most effective is considered to be a comprehensive multidisciplinary approach to the patients’ treatment with chronic pain, including pharmacological therapy with drugs of proven efficacy and various non-drug exposure methods. The issues of not only reducing the chronic pain syndrome intensity but also improving the functional activity and life quality, including patients with chronic neuropathic pain and concomitant comorbidity, remain relevant. In the treatment of this patient category, an adequate and long-lasting result is not always achieved, which necessitates the search for more effective and safe means for the pain syndrome treatment. The use of physiologically active pyrimidine nu cleotides acting on peripheral nerves and promoting their physiological regeneration in pathological conditions, along with neutropic components (choline and vitamins from group B), is one of the promising areas. The proven clinical efficacy and safety of the combined biologically active adjuvants in-take make it possible to successfully apply Neurospan and Neurospan Forte (the complex is characterized by a triple content of uridine monophosphate, the presence of choline and neutrotropic vitamins in the composition) in the complex therapy of patients with chronic pain syndrome and concomitant comorbidity.

Keywords: pain syndrome, chronic pain, neuropathic pain, pyrimidine nucleotides, uridine monophosphate, uridine, B vitamins, Neurospan Forte.

For citation: Ekusheva E.V. Comorbid patient with chronic pain syndrome. RMJ. 2019;9:44–48.



Pages 50-54. Болевой синдром при болезни Фабри: семиотика, диагностика и лечение. Войтенков В.Б., Екушева Е.В.

Summary:

Pain syndrome in Fabry disease: semiotics, diagnostics and treatment

V.B. Voitenkov1,2, E.V. Ekusheva2

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

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

This literature data review deals with the information about semiotics, diagnostics approaches and treatment features of painful conditions in adults and children with Fabry disease. A painful syndrome is one of the most frequent and early manifestations of such disease, in which the neuropathic pain prevails. In the disease onset, there are common complaints about symmetrical pain in the fingertips, toes, soles, and other pain localizations. It has been shown that pain syndrome development significantly decreases the life quality of patients with Fabry disease. The fundamentally important and main treatment aspect of this disease is perhaps the earlier use of the agalsidasebeta drug-enzyme, which can significantly affect the further disease progression, the severity of pain and prevent the fatal cerebrovascular complications or renal failure development. All  of these complications also have a direct effect on the life expectancy of patients with Fabry disease. Besides, the article also discusses a wide range of symptomatic agents, in particular, non-steroidal anti-inflammatory drugs and therapeutic agents of other pharmacological groups, which are also used in pain syndrome in Fabry disease.

Keywords: Fabry disease, pain syndrome, neuropathic pain, agalsidasebeta, accumulation disease, gangliosidosis, Fabrazyme, replacement therapy.

For citation: Voitenkov V.B., Ekusheva E.V. Pain syndrome in Fabry disease: semiotics, diagnostics and treatment. RMJ. 2019;9:50–54.



Pages 56-60. Взаимоотношения боли и сна в клинической практике. Полуэктов М.Г., Шувахина Н.А., Ламкова И.А.

Summary:

Association of pain and sleep in clinical practice

M.G. Poluektov1, N.A. Shuvakhina2, I.A. Lamkova1

1Sechenov University, Moscow

2Peoples’ Friendship University of Russia, Moscow

Sleep is a natural analgesic condition, due to both the processes of relative deafferentation and the influence of neurotransmitters and hormones. An important role in the pain reduction during sleep is a conduct impairment at the thalamus level and orexin activity suppression (neuropeptide involved in the regulation processes of excitation, «sleep-wake» cycle), and melatonin secretion increase. Night sleep disorder is accompanied by an increase in the frequency of various pain syndromes occurrence, both due to a reduction in the overall duration and because of the sleep continuity deterioration. Correction of the common sleep disorder — chronic insomnia — is accompanied by both an improvement in sleep itself and a decrease in concomitant pain. This is shown concerning cognitive behavioral therapy (CBT) — the choice  method in chronic insomnia treatment. Some psychological mechanisms commonality of chronic pain syndromes and sleep disorders allows the use of a combined technique that affects both conditions. The pharmacological possibilities of improving sleep in chronic pain syndromes and combining CBT with pharmacotherapy are discussed. Combined techniques application both concerning the intervention direction and pharmacological and non-pharmacological approach combination is promising for improving sleep in pain syndromes and, as a result, for better pain management.

Keywords: sleep, insomnia, chronic pain, cognitive behavioral therapy.

For citation: Poluektov M.G., Shuvakhina N.A., Lamkova I.A. Association of pain and sleep in clinical practice. RMJ. 2019;9:56–60.

Pages 62-66. Ретроспективное наблюдательное исследование ДРАйВ (Действенная и Рациональная Анальгезия: Выбор). Каратеев А.Е., Погожева Е.Ю., Лила А.М., Амирджанова В.Н., Филатова Е.С.

Summary:

The Retrospective observational study ESAC (Effective and Sustainable Analgesia: Choice)

A.Е. Karateev, Ye.Yu. Pogozheva, A.M. Lila, V.N. Amirdzhanova, E.S. Filatova

V.A. Nasonova Research Institute of Rheumatology, Moscow

Diclofenac potassium sachet (DPS, Dialrapid) — a new analgesic agent intended for the rapid suppression of intense acute pain.

Aim: DPS efficacy and safety evaluation in patients with acute (less than 14 days) intense musculoskeletal pain in real clinical
practice.

Patients and Methods: 7300 histories analysis was conducted in which the information on results of the 3-day DPS administration in patients with osteoarthritis (OA) and/or nonspecific low back pain (NLBS) experiencing acute intense pain was presented. The severity of pain was assessed on the Numerical Pain Rating Scale (NPRS), where 0 points corresponded to the pain absence, and 10 points — unbearable pain. The study included patients with pain intensity NLT 7 points according to the NPRS. The study group was represented by 57.5% women and 42.5% men, average age — 51.96 ±14.72 years. DPS was prescribed 50 mg 3 times a day. Pain dynamics, general health condition and functional disorders, as well as the number and characteristics of adverse events (AE) were assessed by NPRS.

Results: the number of patients with improvement ≥50%, 20% — 50% and <20% related to pain intensity was 58.7%, 33.2% and 8.0%, respectively; in relation to general health condition —55 .9%, 32.5% and 11.9%, respectively; in relation to functional disorders — 51.3%, 33.6% and 15.0%, respectively. The pain reduction probability ≥50% was lower in subjects older than 65 years — odds ratio (OR) 0.865 (95% confidence interval, CI 0.773–0.968), p=0.012; with a body mass index ≥30 kg/m2— OR 0.738 (95% CI 0.656–0.830), p<0.001; diagnosed with OA — OR 0.713 (95% CI 0.648–0.785), p<0.001. Gastralgia and dyspepsia were observed in 12.1% of patients, arterial hypertension — in 5.9%, and edema — in 0.9%. No serious AE were reported.

Conclusion: DPS is an effective and fairly safe agent for acute intense musculoskeletal pain.

Keywords: NSAIDs, osteoarthritis, nonspecific low back pain, analgesic drug therapy, diclofenac potassium sachet, efficacy, safety.

For citation: Karateev A.Е., Pogozheva Ye.Yu., Lila A.M. et al. The Retrospective observational study ESAC (Effective and Sustainable Analgesia: Choice). RMJ. 2019;9:62–66.



Pages 67-72. Ацетил-L-карнитин при болевой форме периферической нейропатии: систематический обзор (реферат).

Summary:

Acetyl-L-carnitine in painful peripheral neuropathy: a systematic review

Acetyl-L-carnitine (ALC) has shown a neuroprotective effect in patients with peripheral neuropathies of different etiologies. Preclinical studies demonstrated a central anti-nociceptive action, both in neuropathic and nociceptive pain models. The present review aims to provide the knowledge on the efficacy of ALC in patients with painful peripheral neuropathy, based on the evidence. Authors searched PubMed, Embase and the Cochrane Database of Systematic Reviews for relevant papers, including those issued before April 2018. Two authors independently selected studies for inclusion and data extraction: only trials including patients with a diagnosis of peripheral neuropathy and involving at least 10 patients were considered for the purposes of this review. Fourteen clinical trials were revised, to provide the level of evidence for neuropathy. To assess the global efficacy of ALC in painful peripheral neuropathy, a meta-analysis of four randomized controlled trials (RCT) was performed. Mean difference in pain reduction as measured on a 10-cm VAS. Four RCT tested ALC in patients with neuropathy secondary to diabetes and to antiretroviral therapy for HIV. Compared to placebo, ALC produced a significant pain reduction equal to 20.2% (95% CI: 8.3%-32.1%, P<0.0001) with respect to baseline. Clinical trials also showed beneficial effects on nerve conduction parameters and nerve fiber regeneration, with
a good safety profile. These data indicate that ALC provides an effective and safe treatment in patients with painful peripheral neuropathy.
We recommend further studies to assess the optimal dose and duration of the therapeutic effect (also after treatment withdrawal).

Keywords: neuropathic pain, peripheral neuropathy, treatment, neuroprotective function, epigenetic mechanism, Acetyl-L-carnitine, Carnicetine.

For citation:  Acetyl-L-carnitine in painful peripheral neuropathy: a systematic review. RMJ. 2019;9:67–72.



№6, 2019. Онкология

Pages 10-14. Аналоги соматостатина в лечении нейроэндокринных опухолей. Моргунов Л.Ю.

Summary:

Somatostatin analogs in neuroendocrine tumors treatment

L.Yu. Morgunov

Russian University of Peoples’ Friendship, Moscow

Functioning and non-functioning neuroendocrine tumors diagnosis and treatment is a difficult task. In recent decades, the neuroendocrine tumors incidence has been steadily increasing. Despite the fact that the only radical treatment method for these neoplasms remains surgical, tumors are commonly diagnosed at the metastasis stage, when only palliative care is possible. The task of treating patients with this pathology is to eliminate the tumor itself and suppress the symptom-complex caused by carcinoid syndrome, which itself can cause patient death. Tumor growth inhibition and hormonal expression suppression by somatostatin analogs (in particular, octreotide) can significantly extend the life and improve its quality in patients. In the patient’s treatment with neuroendocrine tumors, a drug with proven effectiveness that can suppress the carcinoid syndrome clinical symptomatology remains octreotide, which  also has antiproliferative activity. Sustained-release octreotide (Octreotide-depo) has great usability for patients. The article provides a literature review, studies and clinical cases in which the higher doses introduction of the drug in a number of conditions is considered, as well as rare diseases in which sustained-release octreotide can be effectively used.

Keywords: sustained-release octreotide, somatostatin analogs, neuroendocrine tumors, carcinoid syndrome, metastases.

For citation: Morgunov L.Yu. Somatostatin analogs in neuroendocrine tumors treatment. RMJ. 2019;6:10–14.

Pages 16-22. Современные возможности остеомодифицирующей терапии при метастазах в кости. Снеговой А.В., Кононенко И.Б.

Summary:

Modern possibilities of modified osteotherapy in bone metastases

A.V. Snegovoy, I.B. Kononenko


N.N. Blokhin National Medical Research Center of Oncology, Moscow


Bone metastasis is one of the most frequent manifestations of a common malignant process. Many tumours, especially breast, prostate, lung cancer and multiple myeloma are characterized by a high incidence of bone structures (up to 70–80%) and clinical complications. Intense pain syndrome, hypercalcemia, spinal cord compression, pathological fractures, the need for X-ray and surgical therapy (united by one common name — sceletal-related events (SRE)) can occur even with single metastases.

A multidisciplinary approach is used in treatment of patients with bone metastases. However, specific antitumor therapy and modified osteo-agents (MOA) are presented as the basis. Drugs capable of suppressing bone resorption include bisphosphonates, the most active of which is zoledronic acid. In addition to the inhibitory effect on bone resorption, zoledronic acid has antitumor properties that ensure the dr ug effectiveness for bone metastases. Another drug belonging to the MOA group is denosumab. It is a fully human monoclonal antibody with high affinity and specificity to the human RANK ligand (RANKL).

Keywords: bone metastases, modified osteo-agents (MOA), bisphosphonates, bone resorption markers, bone formation markers, zoledronic acid.

For citation: Snegovoy A.V., Kononenko I.B. Modern possibilities of modified osteotherapy in bone metastases. RMJ. 2019;6:16–22.



Pages 2-2. Слово редактора. Черкашин М.А.

Pages 23-30. Таргетное действие глюкозамина сульфата в рамках комплексной противоопухолевой терапии. Торшин И.Ю., Громова О.А., Лила А.М., Назаренко А.Г., Романов И.С., Федотова Л.Э., Калачева А.Г., Гоголева И.В.

Summary:

Glucosamine sulfate targeted effect in the combination cancer therapy

I.Yu. Torshin1,2, O.A. Gromova1,2, A.M. Lila3, A.G. Назаренко4, I.S. Romanov5, L.E. Fedotova1,2, A.G. Kalacheva1,2, I.V. Gogoleva1,2


1Federal Research Center “Informatics and Management” of the Russian Academy of Sciences, Moscow

2Big Data Storage and Analysis Center of the Lomonosov Moscow State University

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

4Burdenko National Medical Research Center for Neurosurgery, Moscow

5N.N. Blokhin National Medical Research Center of Oncology, Moscow


Glucosamine sulfate (GS), used in the treatment of joints diseases, contributes to the pro-inflammatory transcription factor NF-κB inhibition.

Aim: to study the GS potential effects on human kinome (the sum of all kinase enzymes).

Patients and Methods: a dose-dependent chemokine analysis of GS effect on 297 kinase enzymes activity was carried out using the analysis theory methods of labeled graphs and the topological analysis theory of poorly formalized recognition problems. To implement chemokine modeling, chemographs theories, chemoinformatic and chemoreactomy analysis methods were used.

Results: kinom experiments results in the Proteomics DB database are presented in tables, in the columns of which human kinases are shown, and in rows — the corresponding molecules, the activity of which was studied relative to the examined kinases set. The table shows the changes in the kinases activity when exposed to the MGS molecule. Each such “chemokine experiment table” corresponds to (1) a method for determining the kinase activity and (2) an acting mo lecules fixed concentration (1, 3, 10, 100, 1000 nmol / l, etc.).

GS can inhibit the 31 human kinases activity with inhibition constant values (EC50) in the submicromolar range. Kinases (MAP3K3, PDPK1, IKBKE) activity suppression corresponds to alternative inhibiting NF-κB ways by means of GS. Inhibiting the activity of cyclin-dependent kinases (CDK4, CDK6 and others), GS inhibits hyperproliferative processes, and the CHEK1, Src and PRKCD kinases inhibition stimulates tumor cells apoptosis. Dose-dependent changes in the levels of proinflammatory cytokine TNF-α and anti-inflammatory interleukin-10 under the GS influence were obtained, confirming the chemokine analysis results.

Conclusion: established profile inhibition of glucosamine sulfate kinases is advisable as part of the combined antitumor therapy for leukemia, breast cancer, colon cancer, melanoma, non-small cell lung cancer. This kinase sampling inhibition also contributes to the reduction of excessive angiogenesis, overcoming metastasis and tolerance to chemotherapy.

Keywords: human kinom, antiproliferative effect, glucosamine sulfate, Sustaguard artro.

For citation: Torshin I.Yu., Gromova O.A., Lila A.M. et al. Glucosamine sulfate targeted effect in the combination cancer therapy. RMJ. 2019;6:23–30.



Pages 3-9. Трепан-биопсии солидных опухолей под контролем компьютерной и магнитно-резонансной томографии. Черкашин М.А., Пучков Д.Д., Реут Е.А., Федоров А.В., Никитина Н.В., Куплевацкая Д.И., Куплевацкий В.И., Березина Н.А.

Summary:

Trephine biopsy of solid tumours under the CT and MRI control

M.A. Cherkashin, , D.D. Puchkov, E.A. Reut, A.V. Fedorov, N.V. Nikitina, D.I. Kuplevatskaya, V.I. Kuplevatsky, N.A. Berezina


Diagnostic and Treatment Center of the Medical Institute named after Berezin Sergey, Saint Petersburg


Histological diagnosis verification allows solving many problems that arise in the daily clinical work of an oncologist. The choice of special treatment regimes, the possibility of using targeted and immunotherapy, the need to change the chemotherapy line — these are just some of the questions that cannot be answered without histological material sufficient for immunohistochemical and molecular genetic studies. The gentlest method for the patient to collect tumor tissue is percutaneous trephine biopsy.

Aim: to develop and implement standard approaches to performing percutaneous biopsies of solid tumours.

Patients and Methods: in 2016–2018, at the Oncology Clinic of the Medical Institute named after Berezin Sergey, 280 percutaneous trephine biopsies (TB) of tumours were performed in different localizations: mediastinum, lung, pancreas, kidney, liver,  prostate, mamma, bone metastases and extraorgan tumours. TB was performed under the multispiral computed tomography (MSCT), ultrasound, and magnetic resonance imaging (MRI) control. In 11 cases, cognitive fusions of CT + PET-CT and CT + MRI were used. The intervention involved a number of stages: 1) native scanning and marking of needle input coordinates; 2) setting the needle mark and rescanning; 3) injection of the coaxial needle and control scanning; 4) injection of the biopsy needle with the coaxial unit and sampling the required number of tissue columns; 5) removal of the coaxial needle and scanning to assess possible complications.

Results: the success rate of primary pathomorphological verification was 92%. Complications developed in 7 cases (2.5%): intraperitoneal haemorrhage developed in 1 patient that required laparotomy; 2 patients had haemorrhages that did not require any surgical intervention; pneumothorax developed in 4 patients as a result of transthoracic biopsies, however, thoracostomy and oxygen therapy during the day were required only in one case.

Conclusion: 1. Percutaneous trephine biopsy of the mass lesions is a technically simple and relatively safe method to obtain sufficient material for pathomorphological examination. 2. The technology of combining images (CT + PET-CT, CT + MRI) allows accurately planning the intervention. 3. Freehand technique and step-by-step manipulation execution with constant CT-control allow safe biopsy even in cases of small size and complex tumor localization.

Ke ywords: solid tumors, percutaneous trephine biopsy, CT-navigation, MR-navigation.

For citation: Cherkashin M.A., Puchkov D.D., Reut E.A. et al. Trephine biopsy of solid tumours under the CT and MRI control. RMJ. 2019;6:3–9.



Pages 31-36. Оценка психоэмоционального состояния родителей детей с онкологическими заболеваниями. Никифорова Е.М., Воробьев Н.А., Мартынова Н.И., Антипин Д.А.

Summary:

Psychoemotional state evaluation in parents of children with oncology diseases being treated at the Proton Beam Therapy Center

E.M. Nikiforova1, N.A. Vorobiev1–3, N.I. Martynova1, D.A. Antipin1

1Diagnostic and Treatment Center of the Medical Institute named after Berezin Sergey, Saint Petersburg

2St. Petersburg State University

3North-western State Medical University named after I.I. Mechnikov, Saint Petersburg

The article presents the study results of the psychoemotional state in parents of children with oncology diseases. They were obtained using a questionnaire of parents. We have developed a questionnaire that allows obtaining information about the parent’s need for support, about what helps the parent cope with the disease and treatment of the child, about the parent’s attitudes regarding explaining the disease and treatment to the child, and about changes in the relationship between the parent and the child during the disease and treatment. Data were obtained that allowed reflecting the picture of the parent state as a crisis, associated with increased anxiety, emotional and physical fatigue, exposure to numerous stress factors, and a great need for support. The feelings experienced  by the parents correspond to the situation of loss and feeling grief, while the parent of the sick child can be “stuck” at any one stage. Behavioral reactions of parents depend on the attitudes and their personal characteristics, can help or hinder the establishment of trusting relationships with the child, and reduce anxiety. The importance of providing psychological assistance to parents to restore their resources is emphasized.

Keywords: life-threatening disease, psychoemotional state, active position, denial, depression, psychological support, proton beam therapy.

For citation: Nikiforova E.M., Vorobiev N.A., Martynova N.I., Antipin D.A. Psychoemotional state evaluation in parents of children with oncology diseases being treated at the Proton Beam Therapy Center. RMJ. 2019;6:31–36.



Pages 37-44. Стратегия сопроводительной нутриционно-метаболической терапии больных колоректальным раком. Костюченко Л.Н., Костюченко М.В., Кузьмина Т.Н., Лычкова А.Э.

Summary:

Accompanying nutrient-metabolic therapy tactics for patients with colorectal cancer

L.N. Kostyuchenko1, M.V. Kostyuchenko2, T.N. Kuzmina1, A.E. Lychkova1

1Loginov Moscow Clinical Scientific Center, Moscow

2Pirogov Russian National Research Medical University, Moscow

Accompanying nutritional supplementation (NS) is necessary for the prevention of metabolic complications and their correction, including within the detoxification alimentation. The search for new areas of accompanying nutritional therapy in the complex treatment of colorectal cancer (CRC) is relevant.

Aim: to determine the effectiveness of balanced infusion solution added to the accompanying NS regimen in CRC.

Patients and methods: 57 patients with CRC metastases in the liver, subjected to surgical or combined treatment, were randomly divided into groups: 30 patients received detoxification NS and balanced solution infusions with hepatoprotective action — Remaxol® (main group), whereas 27 patients received detoxification NS (control group). The following parameters were assessed: nutritional risk according to NRI; hematological intoxication indices; nutritional deficiency according to the criteria of a well-known alimentary-volemic diagnosis (AVD); hepatological parameters (total protein, albumin, bilirubin, ALT, LDH) according to generally accepted methods; intestinal involvement in detoxification by plasma citrulline level and intestinal microbiota activity (according to the volatile fatty acids content in coprofiltrate). In addition, urea and blood creatinine content were studied, as well as blood electrolyte composition, condition severity according to APACHE II, and life quality of according to ECOG. The groups were comparable in the nutritional risk degree and intoxication syndrome severity. Besides, data processing on factorial analysis and the variation statistics method using the Student’s crite rion was performed.

Results: the relationship between homeostasis indices violations and endotoxicosis development in patients with CRC at the stages T3 — T4, as well as the best detoxification dynamics when using the detoxification nutrition and Remaxol infusion regimen in comparison with detoxification nutrition were revealed.

Conclusion: to remove toxicants, it is advisable to add the well-known detoxification methods with nutritional compounds with detoxifying components — hepatoprotectors. Remaxol® is an effective medicine in the structure of detoxification programs for the alimentation of patients with CRC.

Keywords: detoxification nutrition, hepatoprotectors, Remaxol, nutritional supplementation.

For citation: Kostyuchenko L.N., Kostyuchenko M.V., Kuzmina T.N., Lychkova A.E. Accompanying nutrient-metabolic therapy tactics for patients with colorectal cancer. RMJ. 2019;6:37–44.



Pages 45-52. Злокачественные опухоли яичников у беременных. Доброхотова Ю.Э., Паяниди Ю.Г., Боровкова Е.И., Морозова К.В., Нагайцева Е.А., Арутюнян А.М.

Summary:

Malignant ovarian tumors in pregnant women

Yu.E. Dobrokhotova, Yu.G. Payanidi, E.I. Borovkova, K.V. Morozova, E.A. Nagaytseva, A.M. Arutyunyan


Pirogov Russian National Research Medical University, Moscow


The article presents the data systematic analysis results, available in the modern literature concerning the pregnant women management with ovarian cancer (OC). Diagnosis difficulties are associated with physiological gestational processes. All cases of mass lesions manifestation in the ovaries require thorough dynamic observation, additional survey techniques (in particular, MRI performance), and in some cases — surgical treatment. Surgical staging followed by chemotherapy is indicated for pregnant women with OC. In cases of advanced OC, chemotherapy may be the only treatment option to maintain pregnancy. Chemotherapy is not indicated for pregnant women with non-epithelial ovarian tumors of the early stages. In far-advanced stages of OC, chemotherapy is carried out in the same way as in non-pregnant women. In OC and pregnancy, obstetric complications can be caused not only by the underlying disease  but also by complications caused by surgical treatment and chemotherapy. The article presents the clinical cases of pregnant women management with OC.

Keywords: malignant ovarian tumors, pregnancy, cyst torsion, chemotherapy, cytoreductive surgery.

For citation: Dobrokhotova Yu.E., Payanidi Yu.G., Borovkova E.I. et al. Malignant ovarian tumors in pregnant women. RMJ. 2019;6:45–52.



Pages 53-56. Исходы беременности женщин, излеченных от злокачественных опухолей в детстве. Курочкина Д.Н., Кулева С.А.

Summary:

Pregnancy outcomes of female childhood cancer survivors

D.N. Kurochkina1, S.A. Kuleva2

1 St. Petersburg Clinical Scientific and Practical Center of Specialized Medical Care (Oncological), St. Petersburg

2 National Medical Research Center of Oncology named after N.N. Petrov, St. Petersburg

The article provides an analysis of literature about pregnancy outcomes in female childhood cancer survivors. Thanks to modern advances in the therapy of malignant tumors in children, the majority of patients reach reproductive age. In women cured of childhood malignant tumors, the risks of complications of pregnancy and childbirth, miscarriage in early pregnancy, intrauterine growth retardation and fetal development, gestational diabetes, hypertension, preterm labor, anemia, uterine rupture during labor, significantly increase. For children born from such mothers, lower birth weight, higher incidence of congenital malformations, higher incidence of stillbirths are characteristic. In order to timely detect abnormalities during pregnancy and fetal development abnormalities, careful monitoring of pregnant women who underwent treatment for malignant tumors in childhood is necessary. They require increased attention during the planning and management of their pregnancy and labor, and the ir born children must be carefully examined for the presence of stigma of disembryogenesis and malformations. A special group consists of children with a family «cancer» history, which should be observed from birth to old age with a frequency of once a year.

Keywords: pregnancy, malignant tumors, children, fertility.

For citation: Kurochkina D.N., Kuleva S.A. Pregnancy outcomes of female childhood cancer survivors. RMJ. 2019;6:53–56.





№8(II), 2019. Ангиология. Гемостаз

Pages 103-107. Эндоваскулярные методы лечения синдрома тазового венозного полнокровия. Гаврилов С.Г., Красавин Г.В.

Summary:

Endovascular treatment of pelvic congestion syndrome

S.G. Gavrilov, G.V. Krasavin

Pirogov Russian National Research Medical University, Moscow

The article is devoted to the current literature data study on the possibilities of various endovascular interventions in the treatment of pelvic congestion syndrome (PCS), pelvic vein incompetence. The review provides information on the epidemiology and socio-economic problem significance of timely and adequate PCS treatment, modern embolizing agents and stents. Also, indications and contraindications for endovascular interventions in patients with various pathologies of the pelvic veins are formulated. The results of gonadal vein embolization with various devices (spirals, occluders, sclerosing agents) in the treatment of patients with PCS were subjected to thorough analysis. The questions of the feasibility and effectiveness in performing left renal and common iliac veins endovascular stenting in patients with a combination of «nutcracker», May-Thurner syndromes and PCS are considered. The literatur e data indicate that in some cases, venous outflow correction along the left common iliac vein is an effective and safe way to treat PCS and relieve pelvic pain. The analysis results of modern literature indicate the important unresolved issues presence in the endovascular treatment methods application of PCS, the need for a differentiated approach to choosing a treatment method, and the use of hybrid surgical interventions.

Keywords: pelvic congestion syndrome, chronic pelvic pain, pelvic vein incompetence, endovascular stenting, endovascular embolization.

For citation: Gavrilov S.G., Krasavin G.V. Endovascular treatment of pelvic congestion syndrome. RMJ. 2019;8(II):103–107.



Pages 108-112. Формирование крупных «белых тромбов» в нижней полой вене и правом предсердии у пилота ближнемагистральных самолетов. Цоколов А.В., Ильин И.Б., Крылов В.А., Трофимец А.И., Колесова И.А., Каленицкая А.О.

Summary:

Large white thrombi formation in the inferior vena cava and right atrium in a pilot of short-haul aircraft

A.B. Tsokolov, I.B. Ilyin, V.A. Krylov, A.I. Trofimets, I.A. Kolesova, A.O. Kalenitskaya

Naval Clinical Hospital 1409, Kaliningrad

The article presents the first documented case of an acutely formed large mobile white thrombus in the vena cava inferior (VCI) system, with moving elements in the right atrium (RA) in a pilot of turboprop aircraft. After conducted thrombolysis with EchoCG and MRI studies, lysis of mobile structures was recorded (in fact, it was defragmentation with massive thromboembolism of pulmonary artery), and the sudden patient lethal outcome on the 4th day after thrombolysis. In this case, the hereditary (or — acquired) thrombophilic component of the thrombosis process cannot be excluded, including as a result of the antiphospholipid syndrome, hyperhomocysteinemia. The latter should be considered as predisposing factors that are commonly realized under the external factors influence (vibration, hypodynamia, hypothermia, hypovolemia) in the hypercoagulative syndrome form. Without excluding the thrombophili a likelihood, it is possible to assume that long-term hirudotherapy, which occurred in the patient, could provoke the appearance of loose white thrombi in the VCI system and RA (so-called hirudin-induced thrombocytopathy), and influence the outcome of the disease, taking into account information about their formation mechanisms.

Keywords: thromboembolism of pulmonary artery, hirudin, flight, echocardiography, heparin-induced thrombocytopathy, hypercoagulable syndrome, risk factors, white thrombi, thrombolysis, thrombosis.

For citation: Tsokolov A.B., Ilyin I.B., Krylov V.A. et al. Large white thrombi formation in the inferior vena cava and right atrium in a pilot of short-haul aircraft. RMJ. 2019;8(II):108–112.



Pages 75-75. Слово редактора. Кузнецов М.Р.

Pages 76-79. Тактические и лечебные действия при постпункционных ложных аневризмах бедренных артерий у пациентов с острым инфарктом миокарда. Фокин А.А., Киреев К.А.

Summary:

Tactical and therapeutic actions in postpuncture femoral artery pseudoaneurysms in patients with acute myocardial infarction

A.A. Fokin1,2, K.A. Kireev1,3

1South Ural State Medical University, Chelyabinsk

2Cardiovascular Surgery Center of the Russian Railways Road Clinical Hospital, Chelyabinsk

3Center for X-ray Endovascular Diagnostic and Treatment Methods of the Russian Railways Road Clinical Hospital, Chelyabinsk

Aim: to compare puncture complications in femoral arterial access (FAA) with hemostasis using special devices and radial arterial access (RAA) during percutaneous coronary interventions (PCI) in acute myocardial infarction. Also, to create an algorithm for tactical and therapeutic actions in case of postpuncture femoral artery pseudoaneurysms (FAPA).

Patients and Methods: during 2014–2016, 1333 PCI were performed in acute myocardial infarction. Since 2016, FAA has been used only when the radial arteries are inaccessible for puncture or endovascular instrumentation. Application frequency of FAA and RAA: 2014 — 100% and 0%; 2015 — 66.7% and 36.3%; 2016 — 18% and 82%, respectively. During the history analysis, 2 groups were identified: group 1 — FAA application with special hemostasis devices — 746 (56.0%);  group 2 — RAA — 587 (44%).

Results: when comparing RAA and FAA, statistically significant differences were registered (p<0.05) in the following conditions: pseudoaneurysm — 7 (1.2%) and 26 (3.5%) of observations (p=0.007); operated pseudoaneurysm — 1 (0.2%) and 8 (1.1%) of cases (p=0.046). The total number of operations, taking into account all topical complications, was 1 (0.2%) and 9 (1.2%) of cases (p=0.03).

Conclusion: taking into account the continuing need for FAA in urgent patients, the tactical and therapeutic actions algorithm in FAPA was developed, which allows increasing the efficiency and safety of endovascular interventions, as well as determining the risks with their minimization in the perioperative period.

Keywords: percutaneous coronary intervention, acute myocardial infarction, postpuncture pulsatile hematoma, femoral arterial access, radial arterial access, hemostasis device.

For citation: Fokin A.A., Kireev K.A. Tactical and therapeutic actions in postpuncture femoral artery pseudoaneurysms in patients with acute myocardial infarction. RMJ. 2019;8(II):76–79.

Pages 79-82. Лимфоцитарно-моноцитарный коэффициент как критерий диагностики и прогноза исхода реваскуляризирующих вмешательств у больных с синдромом критической ишемии нижних конечностей. Кательницкий И.И., Дарвин В.В., Зорькин А.А., Мазайшвили К.В.

Summary:

Lymphocytic-monocytic coefficient as a criterion of diagnostics and prognosis of the outcome of revascularizing interventions in patients with the syndrome of critical limb ischemia

I.I. Katelnitsky1, V.V. Darwin2, A.A. Zorkin2, K.V. Mazaishvili2

1Rostov State Medical University, Rostov-on-Don

2Surgut State University

Background: diagnosis of critical limb ischemia (CLI) and prediction of the results of revascularization is one of the unresolved issues of vascular surgery.

Aim: evaluate the diagnostic and prognostic significance of peripheral blood lymphocytes and monocytes, as well as their ratios (lymphocytic-monocytic coefficient (LMC)) in patients with CLI at an early stage after revascularizing interventions.

Patients and Methods: the prospective two-center study included 318 patients with obliterating diseases of the lower limbs arteries, who underwent various revascularizing interventions. The 1st group included 211 patients with signs of CLI, the 2nd group — 107 patients without signs of CLI. The groups were comparable in key parameters, including the nature of comorbidities, revascularizing interventions and drug therapy. The number of peripheral blood lymphocytes and monocytes was determined using an automatic blood analyzer. Integral LMC index was calculated as the ratio of lymphocytes to monocytes. To determine the diagnostic significance of the indices we compared the starting values between the 1st and 2nd groups. The prognostic significance in the evaluation of the outcome of revascularization was carried out by comparing the indices before the intervention an d in the 1–3 days postoperative period in the 1st group.

Results: for patients with CLI there was a statistically significant decrease in the absolute number of lymphocytes, the relative content of monocytes (p<0.05) and a low index of LMC (p<0.02), than for patients without CLI. Statistically significant differences between the groups with successful or unsuccessful revascularization were noted in terms of the absolute number of leukocytes, lymphocytes, relative monocyte content, as well as the LMC (p<0.02).

Conclusion: in the case of arterial occlusive diseases of the lower limbs, the absolute content of lymphocytes, LMC and the relative content of monocytes are additional laboratory criteria for the presence of CLI. Lymphopenia, relative monocytopenia and the value of the LMC less than 2.3 in the early postoperative period are associated with an unfavorable prognosis of arterial revascularization.

Keywords: critical limb ischemia, obliterating lower limbs diseases, diagnosis of critical ischemia, prediction of outcome of  arterial revascularization, lymphocytic/monocytic coefficient.

For citation: Katelnitsky I.I., Darwin V.V., Zorkin A.A., Mazaishvili K.V. Lymphocytic-monocytic coefficient as a criterion of diagnostics and prognosis of the outcome of revascularizing interventions in patients with the syndrome of critical limb ischemia. RMJ. 2019;8(II):79–82.



Pages 83-88. Гибридная тактика в лечении острого нарушения мезентериального кровообращения. Атаян А.А., Косенков А.Н., Кузнецов М.Р., Чернооков А.И., Иванова М.И., Хачатрян Э.О.

Summary:

Hybrid treatment tactics in acute mesenteric ishemia

A.A. Atayan1,2, A.N. Kosenkov1, M.R. Kuznetsov2,3, A.I. Chernookov4, M.I. Ivanova2, E.O. Khachatryan1

1Sechenov University, Moscow

2State Clinical Hospital № 29 named after N.E. Bauman, Moscow

3Pirogov Russian National Research Medical University, Moscow

4CJSC “Phlebology Center”, Moscow

Background: nowadays, acute mesenteric ischemia (AMI) is not a rare disease. Depending on the treatment tactics, mortality varies between 60–97%.

Aim: to study the possibility of using hybrid treatment tactics using endovascular revascularization of the superior mesenteric artery (SMA) and conventional surgical intervention in AMI.

Patients and Methods: AMI was treated in 52 patients. Average age of patients — 70.21±6.43 years. Patients underwent a hybrid treatment tactics using endovascular revascularization of SMA and conventional surgical intervention in AMI. After the endovascular intervention, all patients underwent a bowel resection with the necrotic area excision.

Results: there was an attempt to restore blood flow in SMA and its branches at all lesion levels using X-ray surgical methods, followed by bowel resection. It was noted that the higher the lesion of SMA, the larger the bowel area was involved and excised. Thus, the 1st SMA segment lesion was revealed in 5 patients with total necrosis; the 1st SMA segment lesion was revealed in 7 patients with a resection volume of more than 3 m, the 2nd segment — in 2. With resection of 2–3 m, the 1st segment lesion was revealed in 6 patients, in 9 patients — the 2nd SMA segment, in 3 patients — the 3rd SMA segment and/or branches. In the group with a resection volume of up to 2 m, the 1st SMA segment lesion in 4 patients, in 10 — the 2nd SMA segment, in 5 — the 3rd SMA segment and/or branches. Since intestinal necrosis begins with distal sites, it was possible to perform more limited resections that are not characteristic of proximal levels of SMA lesion.

Conclusion: the use of X-ray endovascular repair techniques made it possible to solve the mesenteric ischemia problem both in case of occlusion and SMA stenosis at the level of almost any segment and branch, unlike SMA revascularization conventional methods.

Keywords: acute mesenteric ischemia, superior mesenteric artery, diagnosis, treatment, hybrid surgery, resection.

For citation: Atayan A.A., Kosenkov A.N., Kuznetsov M.R. et al. Hybrid treatment tactics in acute mesenteric ishemia. RMJ. 2019;8(II):83–88.

Pages 90-93. Перемежающаяся хромота: от истории к современности. Виноградова Ю.А.

Summary:

Intermittent claudication: from history to modern era

Yu.A. Vinogradova

N.V. Sklifosovsky Research Institute of First Aid, Moscow

Chronic obliterating diseases of the lower limb arteries (CODLLA) are an urgent problem in vascular surgery, occupying one of the leading places in the incidence and disability of the population. The most common variant of chronic lower limb arterial insufficiency can be considered the stage of intermittent claudication, when, as a rule, the patient visits a doctor for the first time. Intermittent claudication is characterized as a syndrome that occurs in the setting of occlusal-stenotic processes in the lower limb arteries, subjectively manifested by pain, seizures during physical exertion, which are neutralized when it stops.

The article deals with the intermittent claudication syndrome history from the moment of its discovery to modern approaches in treatment. Patient treatment with peripheral atherosclerosis consists of measures aimed at stabilizing the atherosclerotic process and recovery (comm only, it is only about improving) of the limb arterial circulation. The basic principles of CODLLA conservative therapy are presented; the role of dosed physical activity is indicated, as well as the value of peripheral vasodilators (pentoxifylline, cilostazol) in the comprehensive treatment of intermittent claudication.

Keywords: chronic obliterating diseases of the lower limb arteries, intermittent claudication, claudication, peripheral artery disease, conservative therapy, pentoxifylline, cilostazol, Pletax.

For citation: Vinogradova Yu.A. Intermittent claudication: from history to modern era. RMJ. 2019;8(II):90–93.

Pages 94-97. Фармакотерапия хронических заболеваний вен. Что мы знаем об экстракте конского каштана?. Богачев В.Ю., Болдин Б.В., Кузнецов М.Р., Родионов С.В.

Summary:

Pharmacotherapy of chronic venous diseases What do we know about horse chestnut extract?

V.Yu. Bogachev, B.V. Boldin, M.R. Kuznetsov, S.V. Rodionov

Pirogov Russian National Research Medical University, Moscow

Chronic venous disease (CVD) of the lower extremities is the most common cardiovascular disease, occurring in more than half of the industrialized countries adult population. Veno-specific symptoms and syndromes significantly reduce the social activity of patients with CVD and their life quality. Nowadays, phlebotropic agents are considered as a mandatory component of complex treatment and rehabilitation of patients with CVD along with lifestyle modification and compression therapy. Horse chestnut extract and preparations from it have been used for a long time in clinical practice for wide indications, the most frequent of which are chronic vein diseases of the lower extremities. A combined venoactive drug Aescusan is registered in the Russian Federation, the active substances of which are horse chestnut extract and thiamine hydrochloride. Aescusan provides comprehensive phleboprotectiv e action including anti-edematous, anti-inflammatory and venotonic effects. The latter is due to improved transport of calcium ions into the slow channels of vessel wall smooth muscle cells. Aescusan anti-inflammatory effect can be explained by the blockade of the prostaglandin F2 release from the venous wall endothelium, antagonism with 5-hydroxytryptamine and histamine, as well as by a decrease in the tissue mucopolysaccharides catabolism. Decongestant drug effect is associated with an improvement in the endothelium function of the venous capillaries. Thus, Aescusan has a pluripotent effect on various pathogenetic CVD mechanisms. Good tolerability and administration convenience allow the widespread use of Aescusan in patients with various CVD forms and their complications.

Keywords: chronic venous disease, aescin, horse chestnut extract, thiamin, Aescusan.

For citation: Bogachev V.Yu., Boldin B.V., Kuznetsov M.R., Rodionov S.V. Pharmacotherapy of chronic venous diseases What do we know about horse chestnut extract? RMJ. 2019;8(II):94–97.

Pages 98-102. Эффективность перехода со стандартной антикоагулянтной терапии в лечении пациентов, перенесших тромбоз глубоких вен в системе нижней полой вены. Мельников М.А., Яровенко Г.В., Каторкин С.Е.

Summary:

Replacement effectiveness of standard anticoagulant therapy of patients with deep vein thrombosis in the inferior vena cava system

M.A. Melnikov, G.V. Yarovenko, S.E. Katorkin


Samara State Medical University


Aim: to evaluate the clinical effectiveness of standard anticoagulant therapy replacement to sulodexide in the treatment of patients experienced deep vein thrombosis (DVT) in the inferior vena cava system.

Patients and Methods: this study included 746 patients who underwent proximal DVT of the lower extremities, took standard anticoagulant therapy for 6 months, and then received acetylsalicylic acid (ASA) in a dosage of 100 mg (group 1) by randomization of 350 patients, whereas 389 patients took sulodexide in 500 dosage units daily for 6 months (group 2). To assess the effectiveness of the treatment, the following parameters were used: Villalta Score for Post-thrombotic Syndrome (PTS); Visual Analogue Scale (VAS) for pain measurement; Venous Clinical Severity Score (VCSS); circumference measurement of the limbs on the thigh and lower leg; lower extremities vein Color Doppler Imaging (CDI).

Results: 739 patients completed the stu dy. As a result of the conducted treatment, the convulsive syndrome in the calf muscles completely regressed in all patients of group 2. In group 1, 24.3% of patients complained of convulsive syndrome, and by the end of the sixth month of taking ASA, these complaints remained in 11.5% of patients (p=0.0861). There was a significant decrease in the complaints frequency of heaviness sensation and fatigue in the lower extremities under static loads in both groups from 26.3% to 9.4% (p=0.2414). The thigh circumference perimeter on the affected limb statistically significantly decreased only in group 2, in the middle tercile — from 53.7 cm to 51.1 cm (p<0.05), in the middle tercile of the lower leg — from 36.8 cm to 33.8 cm (p<0.05) and in the lower tercile of the lower leg — from 23.4 cm to 21.5 cm (p<0.05). According to VAS, there was a decrease in pain syndrome in the lower extremities in both groups: in group 1 — from 55.36±24.71 mm to 31.44±17.07 mm (p= 0.05), in group 2 — from 58.54±16.64 mm to 18.56±04 mm (p=0.0005). During the study of Villalta and VCSS questionnaires, the PTS severity of patients in group 1 was 13.5 points (PTS moderate severity), and in group 2 — 7.6 points (PTS mild severity). VCSS index decreased from 5.93±1.79 to 4.79±2.01 points in group 2–21% (p=0.0002). In group 1, the VCSS index decreased from 5.96±1.41 to 5.49±1.71 points —10.1% (p=0.04).

When studying the lower extremities vein CDI data, it was found that deep vein recanalization ranged from 12% to 25% after 6 months of standard anticoagulant therapy in patients of both groups. After 6 months of the study, deep vein recanalization ranged from 42% to 64% in group 1, and from 75% to 85% in group 2.

Conclusion: the sulodexide use in 500 dosage units daily for 6 months in patients with PTS of clinical classes C3-C6, according to CEAP,
is effective and pathogenetically justified.

Keywords: chronic vein disease, deep vein thrombosis, post-thromb otic syndrome, sulodexide, life quality.

For citation: Melnikov M.A., Yarovenko G.V., Katorkin S.E. Replacement effectiveness of standard anticoagulant therapy of patients with deep vein thrombosis in the inferior vena cava system. RMJ. 2019;8(II):98–102.





№7, 2019. Гастроэнтерология

Pages 11-14. НПВП-энтеропатия — перспективы профилактики и лечения. Карева Е.Н.

Summary:

NSAIDs-enteropathy — prevention and treatment aspects

E.N. Kareva1,2


1Sechenov First Moscow State Medical University

2Pirogov Russian National Research Medical University, Moscow

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used medicines worldwide, and their side effects number
is very large. In the first instance — NSAIDs-gastropathy, although, the NSAIDs use causes damage to the small intestine (NSAIDs-enteropathy) on the long-term basis in 50–70% of patients. This condition is characterized by the presence of the fecal blood, anemia of unknown etiology, abdominal symptoms, and phenomena of intestinal obstruction. Sometimes NSAIDs-enteropathy has serious consequences. NSAIDs cancellation is not always possible (for example, in chronic pain syndrome) and does not always lead to the NSAIDs-enteropathy cure. To date, not a single medicine with proven effectiveness to prevent this side effect has been proposed. Apparently, this is not fully explained by the mechanism of NSAIDs-enteropathy pathogenesis. The most promising  hypothesis is the participation of individual microflora representatives in the enteropathy development, so the intestinal flora modulation with probiotics can become a basic therapeutic strategy for the prevention and treatment of such damage. Role evaluation of lacto-and bifidobacteria individual strains in the NSAIDs-enteropathy development requires focused attention. Prospective randomized clinical trials conduction will assess probiotics effectiveness in the treatment and prevention of NSAIDs-enteropathy.

Keywords: NSAIDs-enteropathy, mechanisms of pathogenesis, microbiota, probiotics, Maxilac.

For citation: Kareva E.N. NSAIDs-enteropathy — prevention and treatment aspects. RMJ. 2019;7:11–14.



Pages 16-21. Опыт коррекции пищевого статуса у детей с детским церебральным параличом: клиническое наблюдение. Титова О.Н., Строкова Т.В., Таран Н.Н., Павловская Е.В., Матинян И.А.

Summary:

Experience of nutritional condition correction in children with infantile cerebral palsy: clinical review

O.N. Titova1, T.V. Strokova1,2, N.N. Taran1,2, E.V. Pavlovskaya1, I.A. Matinyan1,2


1Federal Research Center for Nutrition, Biotechnology and Food Safety, Moscow

2Pirogov Russian National Research Medical University, Moscow

Infantile cerebral palsy (ICP) is a group of stable disorders in the motor skills development and maintaining posture, leading to motor defects caused by non-progressive damage and/or developing brain anomaly in fetus or newborn baby. Patients with ICP are at the development risk of nutritional condition disorders, which are detected in average of half of children with this disease. Correct assessment of the nutritional condition with subsequent dietary correction can stabilize the biochemical parameters of macro-and micro-nutrients in blood serum, improve the health of the child by correcting the comorbidity manifestations, improve the rehabilitation measures effectiveness. When compiling a diet for a child with ICP, it is necessary to take into account age-related needs for nutrients and energy, the pathogenesis of the underlying disease and the nature of the comorbidity (constipations, gastrointestinal  food allergy, dysphagia, gastroesophageal reflux disease, etc.). This article illustrates the dietary correction experience of nutritional condition in patients with ICP. Due to the presence of nutritional insufficiency and food allergy, including cow’s milk protein, specialized elemental and semi-elemental enteric therapeutic mixtures were used for correction.

Keywords: infantile cerebral palsy, nutritional support, diet therapy, enteric nutrition, weight deficit, food allergy.

For citation: Titova O.N., Strokova T.V., Taran N.N. et al. Experience of nutritional condition correction in children with infantile cerebral palsy: clinical review. RMJ. 2019;7:16–21.



Pages 2-5. Индивидуализированный подход к обследованию пожилого пациента с гастроэзофагеальной рефлюксной болезнью. Денисова О.А., Ливзан М.А., Денисов А.П., Кун О.А.

Summary:

Personalized approach for examination of an elderly patient with gastroesophageal reflux disease

O.A. Denisova, M.A. Livzan, A.P. Denisov, O.A. Kun


Omsk State Medical University


Nowadays, general approaches to the diagnosis of gastroesophageal reflux disease (GERD) have not yet been developed, taking into account the age characteristics specificity of patient’s category, despite the high prevalence of this disease in the elderly patients.

Aim: to optimize the patient management tactics for elderly patients with GERD based on a personalized approach development to diagnosis.

Patients and Methods: an open cohort prospective controlled study included 120 patients with GERD, divided into two groups, identical in numerical structure. Treatment group: subjects aged 60–86 years (mean age 68,2±2,7 years). Control group: subjects aged 25–59 years (46,68±2,4 years).

Results: the frequency of heartburn decreased in patients older than 60 years (60.2%), compared to young people (77.3%; p < 0.05), during concurrent increasing of retrosternal pai n (44.2% and 7.1%, respectively; p < 0.001), dysphagia (16.8% and 3.9%; p <0.05) and cough (56.1% and 12.5%; p < 0.001) incidences. The more severe GERD state in elderly patients was due to a complex of various risk factors (smoking, male sex, overweight and obesity, duodenogastric reflux, hiatal hernia, regular use of nitrates, angiotensin-converting enzyme inhibitors). A direct correlation was found between age and the total time index pH <4 (rxy = 0.420, p <0.05), as well as the duration of the most prolonged reflux (rxy = 0.433, p <0.05). When conducting an alginate test, a positive specimen was determined in 78.2% of cases in elderly patients, and in 75.2% of cases in young and mature patients, which confirms the possibility of using alginate test as an early screening method in patients with GERD.

Conclusion: based on the data obtained, the personalized approach to the examination of patients with GERD was developed and introduced, taking into account age, somatic status, as well as the possible predictors’ presence that aggravate the pathological process course.

Keywords: gastroesophageal reflux disease (GERD), elderly patients, personalized approach, diagnosis, clinical features, alginate test.

For citation: Denisova O.A., Livzan M.A., Denisov A.P., Kun O.A. Personalized approach for examination of an elderly patient with gastroesophageal reflux disease. RMJ. 2019;7:2–5.

Pages 22-25. Цели нутритивной поддержки в предоперационном периоде. Арыкан Н.Г., Шестопалов А.Е., Митичкин А.Е., Варнавин О.А., Васин В.С., Лапин В.А., Каюпова Г.Ф.

Summary:

Nutritional support goals in the preoperative period

N.G. Arykan1, A.E. Shestopalov2, A.E.Mitichkin1, O.A Varnavin1, V.S. Vasin1, V.A. Lapin1, G.F. Kayupova1


1City Clinical Hospital named after F.I. Inozemtsev, Moscow

2Russian Medical Academy of Continuing Professional Education, Moscow


Nutritional deficiency is a subacute or chronic lack of nutrient substrates that leads to functioning disorders of systems and organs (cognitive impairment; immune response weakening; impaired muscle function, including respiratory), which affects the patient’s life quality and survival after surgery. According to the literature data, up to 61% of patients in surgical departments have nutritional deficiency already upon admission to the hospital. Nutritional deficiency in surgical patients is due to decreased appetite, dysphagia, disorders of digestion and nutrient absorption in gastrointestinal tract diseases, as well as due to socio-economic reasons. Nutritional deficiency in surgical patients is one of the factors determining the disease severity. A number of studies have shown that nutritional deficiency is a risk factor for complications and adverse outcomes in the postoperative period.  This article discusses the diagnosis of nutritional deficiency. The authors substantiate the need to include the patient nutritional condition assessment in the preoperative examination plan. The authors also consider modern methods of nutritional deficiency correction at the stage of preoperative preparation and discuss the nutritional support time frame.

Keywords: nutritional deficiency, nutritional support, nutritional condition, preoperative preparation, ERAS protocol, sip feeding, enteral nutrition, nutritional risk.

For citation: Arykan N.G., Shestopalov A.E., Mitichkin A.E. et al. Nutritional support goals in the preoperative period. RMJ. 2019;7:22–25.



Pages 26-29. Неалкогольная жировая болезнь печени в свете проблемы гепатитов невыясненной этиологии у детей и подростков. Рейзис А.Р.

Summary:

Non-alcoholic fatty liver disease — a new view of the hepatitis problem of unknown etiology in children and adolescents

A.R. Reyzis


Central Research Institute of Epidemiology, Moscow


Aim: to determine the place of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) among hepatitis of unknown etiology (HofUE) in children and adolescents.

Patients and Methods: 139 children aged 3 to 17 years with HofUE were examined. 26 children were diagnosed with NASH. Clinical, laboratory and instrumental examination of patients was carried out. NAFLD was diagnosed in accordance with Russian and International Clinical Guidelines.

Results: NAFLD frequency increased by 2.4 times between 2015 and 2017, compared to 2010–2014. Currently, NAFLD ranks 1st among the causes of liver damage in children with HofUE. All examined children had an increase in the liver size, detected during the check-up and confirmed by ultrasound. 

In children, NASH was associated with obesity of varying degrees only in 30.8% of cases, with overweight — in 57.7%. 11.5% of children were diagnosed with NASH at normal body weight. In NASH, total cholesterol level increase in the blood was revealed in 56% of cases, increased triglyceride level was noted in 76.9% of patients, and a decrease in high-density lipoproteins level — in 88.5% of chil dren. Metabolic syndrome was noted in 23% of cases (hypertension — in 19.3% of patients, impaired glucose tolerance — in 15.3% of children). Type 2 diabetes mellitus was not found in any child. All patients had an increase in ALT activity to 3–5 norms. The γ-glutamyltranspeptidase activity was within 1.5–3 norms in ¾ of patients.

Conclusion: NAFLD diagnosis, as an exclusion diagnosis, presupposes the existence of indicators such as for overweight or obesity, enlarged liver, and biochemical parameters change. Metabolic syndrome manifestations in most cases are absent in children suffering from NASH, and appear as the disease progresses in adulthood.

Keywords: non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, hepatitis of unknown etiology, metabolic syndrome, obesity, overweight, dyslipidemia.

For citation: Reyzis A.R. Non-alcoholic fatty liver disease — a new view of the hepatitis problem of unknown etiology in children and adolescents. RMJ. 2019;7:26–29.



Pages 30-33. Синдром раздраженного кишечника — взгляд врача-хирурга. Каторкин С.Е., Быстров С.А., Лисин О.Е., Безбородов А.И., Шестаков Е.В., Лисина А.А., Арустамян А.В., Лисин Д.Е.

Summary:

Irritable bowel syndrome: surgion’s view

S.E. Katorkin, S.A. Bystrov, O.E. Lisin, A.I. Bezborodov, V.E. Shestakov, A.A. Lisina, A.V. Arustamyan, D.E. Lisin

Samara State Medical University

Aim: to determine the rate of patients with abdominal pain syndrome and defecation disorder as manifestations of irritable bowel syndrome (IBS) in the total patients flow seeking emergency care in a surgical hospital on duty.

Patients and methods: a retrospective analysis of 240 patient’s case histories (18 to 40 years) who sought medical care in the emergency surgical hospital with complaints of abdominal pain and defecation disorder. During the follow-up examination, all patients were divided into 3 groups: group I — patients with surgical pathology, group II — patients with inflammatory bowel diseases, and group III — patients with IBS.

Results: unbearable abdominal pain was observed in 6.09% of group I, severe and moderate pain — in 39.13% and 48.7%, respectively. Mild pain was observed in 6.08% of patients. Diarrhea developed in 18.5% of patients, constipation — in 24.3%, alternation of d iarrhea and constipation — in 10%. Defecation disorders were absent in 47.2% of patients. In the group II, severe abdominal pain was observed in 24.5%, moderate pain — in 52.3%, and mild pain — in 23.2% of patients. Unbearable pain was not noted by any of the patients in this group. The major defecation disorder in this group was diarrhea (84.38%), 9.37% of patients had an alternation of constipation and diarrhea. Constipation developed in 6.25% of cases. Group III had no unbearable pain, however, 25.6% of patients had severe pain. Most of the subjects noted moderate pain intensity (48.2%). Mild pain was observed in 26.1% of patients. Constipation in this patient’s category was observed in 46.4% of cases, diarrhea — in 36.2%. Alternation of constipation and diarrhea was noted in 17.3% of patients.

Conclusion: a significant rate of patients who attended the emergency surgical hospital are patients with IBS. Knowledge of clinical IBS patterns allows referring  a patient to a gastroenterologist in a timely manner.

Keywords: irritable bowel syndrome, inflammatory bowel disease, ulcerative colitis, acute surgical pathology, differential diagnosis, diarrhea, constipation, abdominal syndrome.

For citation: Katorkin S.E., Bystrov S.A., Lisin O.E. et al. Irritable bowel syndrome: surgion’s view. RMJ. 2019;7:30–33.



Pages 34-38. Ремоделирование костной ткани у детей с печеночными формами гликогеновой болезни. Васильева Е.А., Строкова Т.В., Сурков А.Г., Багаева М.Э., Павловская Е.В., Зубович А.И., Прохорова И.В.

Summary:

Bone remodeling in children with hepatic forms of glycogen storage disease

E.A. Vasilieva1, T.V. Strokova1,2, A.G. Surkov1, M.E. Bagaeva1,2, E.V. Pavlovskaya1, A.I. Zubovich1, I.V. Prokhorova1


1Federal Research Center for Nutrition, Biotechnology and Food Safety, Moscow

2Pirogov Russian National Research Medical University, Moscow


Aim: to evaluate bone remodeling biomarkers in children with hepatic forms of glycogen storage disease (GSD).

Patients and Methods: the study included 72 children (aged 7 months to 16 years). Group 1 included 16 children with type I GSD, group 2 — 14 children with type III GSD, group 3 — 42 children with VI and IX types. Bone mineral density (BMD) of the lumbar spine was assessed in all children with a height of not less than 100 cm. Markers of bone tissue metabolism and osteoporosis and insulin-like growth factor-1 (IGF-1) level in the blood were determined in all patients.

Results: in 23 (51%) children aged 3 to 16 years, there was a decrease in BMD of varying severity: osteopenia was detected in 38% of patients and osteoporosis — in 6 (12%) children. The median BMD values, depending on the GSD type, did not significantly differ (p = 0.51). Osteopenia was registered in all GSD types, e xcept type Ia. The osteoporosis highest incidence was found in patients with type Ib GSD (42%). Children with reduced IGF-1 were more likely to have decreased BMD (p<0.05). The authors found IGF-1 correlation in the blood with osteocalcin and collagen C-terminal telopeptide, which confirmed the IGF-1 effect on the processes intensification of bone metabolism. This indicator can be used as an early marker of osteopenia and osteoporosis. In children with type Ib and type III GSD, a decrease in serum markers of bone tissue formation and resorption was registered. It was evidenced by a decrease in the level of osteocalcin and C-terminal telopeptide in the absence of significant differences in serum levels of type I procollagen N-terminal propeptide.

Conclusion: bone metabolism markers diagnosis in patients with GSD allows determining the process severity of bone resorption and the remodeling rate without instrumental examination.

Keywords: glycogen storage disease, bone remodeli ng, bone mineral density, BMD, osteoporosis, osteopenia, P1NP, osteocalcin, b-Crosslaps, IGF-1.

For citation: Vasilieva E.A., Strokova T.V., Surkov A.G. et al. Bone remodeling in children with hepatic forms of glycogen storage disease. RMJ. 2019;7:34–38.

Pages 39-40. III Гастро-Саммит в рамках XXVII Всероссийского конгресса «Человек и лекарство» (8–11 апреля 2019 г.).

Pages 6-10. Методы повышения эффективности эрадикационной терапии. Бикбавова Г.Р., Ахмедов В.А., Мухамеджанов Б.М.

Summary:

Improvement methods of eradication therapy effectiveness

G.R. Bikbavova, V.A. Akhmedov, B.M. Mukhamedzhanov

Omsk State Medical University

Currently, an eradication therapy conducting is a crucial way of stomach malignant tumors prevention in patients having a history with signs of chronic gastritis, gastric and duodenal ulcer, as well as other diseases associated with Helicobacter pylori. The article deals with the aspects of this causative agent resistance to various antibiotics used in eradication therapy regimens around the globe. Based on the latest data, the main rules that will contribute to the eradication therapy effectiveness are presented: application of proton pump inhibitors large doses; sensitivity determination to the antibacterial drug, if it was used previously; shift of the previously used eradication therapy regimen. It was noted that the most optimal regimen is quadruple therapy with bismuth in regions with high resistance to antibacterial drugs or after unsuccessful triple regimen application with clarithromycin/levofloxacin, as well as in patients  having in history the data on the macrolides and quinolones use. The triple regimen with clarithromycin is recommended in patients with a low resistance to this drug (<15%), while treatment duration should be increased up to 14 days. The sequential regimen application is currently not actively recommended.

Keywords: eradication therapy, Helicobacter pylori, antibiotic resistance, effectiveness improvement.

For citation: Bikbavova G.R., Akhmedov V.A., Mukhamedzhanov B.M. Improvement methods of eradication therapy effectiveness. RMJ. 2019;7:6–10.





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