A non-interventional prospective cohort study was conducted on adult patients with cystic fibrosis, who received mucolytic therapy with 7% NaCl solution combined with 0.1% hyaluronic acid (medical product Hyaneb) and 7% NaCl solution for 4 and 8 weeks. Materials and methods: A total of 24 CF patients over 18 years old were enrolled in the study. A comparative analysis of respiratory function, therapy satisfaction, efficacy and safety of treatment was conducted following 4 weeks of therapy in 7% NaCl Solution Group (n = 12) and MP Hyaneb Group (n = 12), and the dynamics of these parameters was assessed against the background of the use of MP Hyaneb for 8 weeks (n = 12). Results: At week 4 of treatment, a significantly smaller number of patients complained of nasal congestion, ears and or accumulation of mucus in the throat and chest, irritation of the throat and unpleasant taste in the MP Hyaneb Group. No significant differences in the onset and increase in the intensity of cough were achieved. No significant differences between the groups in terms of spirometry parameters were identified. Findings: MP Hyaneb showed the best tolerability compared to 7% NaCl solution in adult patients with cystic fibrosis. The use of MP Hyaneb reduces the frequency and severity of irritation of the pharyngeal mucosa, cough and nasal congestion following administration for one month.
Introduction. Acute infectious rhinitis refers to the frequent causes of discharge therapy with nasal decongestants. The aim to analyze the clinical features of unloading therapy of acute infectious rhinitis with 0.1 % xylometazoline according to the materials of the research centers of Novosibirsk and Yekaterinburg. Materials and methods. In the research centers of Novosibirsk and Yekaterinburg, patients with acute infectious rhinitis were observed. Intranasal therapy in the study groups (group 1) and in the comparison groups (group 2) was carried out with 0.1 % xylometazoline spray for 7 days. Group 2 additionally received silver preparation intranasally. The need for decongestant and the state of mucociliary transport (MCT) were evaluated. Results and discussion. Initially, patients with normal MCT rate at 1 visit in Novosibirsk accounted for 20.8 % in group 1 and 34.78 % in group 2; in Yekaterinburg – 29.17 % of patients in group 1 and 25% of patients in group 2. In the study groups, 54.2 % of patients in Novosibirsk and 100 % in Yekaterinburg used decongestant on day 5; in the comparison groups – 41.7% in Novosibirsk; 83.3% of patients in Yekaterinburg. On day 5, the volumetric air flow velocity was determined to be more than 900 cm ³ /s in all patients. Decongestant was used for more than 7 days by 40.35 % of patients in the first groups and 12.45 % of patients in the second groups. Inhibition of MCT on the 14 th day of follow-up, detected in two research centers, amounted to 5.26 % of patients.
Conclusions. On the 5th day of unloading therapy, nasal breathing is objectively free. Intranasal antiseptic therapy reduces the probability of using decongestant for more than 7 days by 27.9 %. Inhibition of MCT when using 0.1 % xylometazoline should be attributed to frequent reactions.
Introduction. New coronavirus infection (COVID-19) contributes to the aggravation of respiratory symptoms in patients with COPD, including affecting the intensity and nature of cough. Hypertonic solution (HS) has a positive effect on the rheological properties of sputum and mucociliary clearance. However, there are no studies in the available literature on the use of HS in patients who have undergone COVID-19.
Goal. To evaluate the effect of the combination of 7% hypertonic saline and 0.1% natrii hyaluronas on the intensity and productive nature of cough in patients with COPD who have undergone a new coronavirus infection and the safety of its use in this cohort of patients.
Materials and methods. 50 patients with severe COPD in remission who suffered a new coronavirus infection were examined. The rehabilitation stage of treatment was carried out in the conditions of the pulmonology department. From the moment of receiving the last negative PCR result for SARS-CoV-2 to admission to the hospital for rehabilitation, it took from 2 to 3 weeks. The duration of follow-up of patients was 10 days. The patients were divided into two groups: group 1 (n = 25) – patients who received combination of 7% hypertonic saline and 0.1% natrii hyaluronas 7% by inhalation through a nebulizer; group 2 (n = 25) – patients who did not receive combination of 7% hypertonic saline and 0.1% natrii hyaluronas. The severity of cough was assessed (cough severity scale; shortness of breath, cough and sputum scale), clinical and biochemical blood tests, ECG, spirometry.
Results. In patients treated with combination of 7% hypertonic saline and 0.1% natrii hyaluronas, a significant decrease in the severity of cough, the amount of sputum was revealed. The tendency to reduce shortness of breath and improve the quality of life is determined. No serious adverse events were detected when using the drug.
Conclusions. The use of the combination of 7% hypertonic saline and 0.1% natrii hyaluronas in patients with COPD who have suffered a new coronavirus infection at the rehabilitation stage leads to a decrease in the intensity of cough and improved sputum discharge, which helps to reduce the severity of shortness of breath and improve the quality of life. The use of the drug is safe and does not lead to clinically significant adverse events.
Вопрос о том, что определяет здоровье человека - генетика или образ жизни и питание, не теряет своей актуальности. До недавнего времени Всемирная организация здравоохранения рекомендовала придерживаться позиции, согласно которой будущее здоровье ребенка на 20% определяет наследственность и на 80% - условия окружающей среды, образ жизни и питание. Эта тема подробно обсуждалась на конференции «Актуальные вопросы питания в педиатрии», проходившей в рамках V Московского городского съезда педиатров в октябре 2019 года.
Introduction. Trifluridine/Tipiracil (FTD/TPI) is a new chemotherapeutic drug approved in more than 60 countries for use in patients with metastatic colorectal cancer who have registered progression or intolerance to treatment with fluoropyrimidines, oxaliplatin and irinotecan, anti-VEGRand anti-EGFR-targeted agents. This study evaluated for the first time the effectiveness and tolerability of FTD/TPI therapy in the Russian patient population.
Mat erials and methods. A confirmatory open-label single-arm non-randomized trial was conducted in 2 clinical centres in Russia. The main criteria for inclusion were: conduction of at least the 2nd line of standard systemic therapy for metastatic colon adenocarcinoma. The primary efficacy criteria were: 2-month progression-free survival; secondary – median progressionfree survival, disease control frequency, safety assessment, overall survival. Research number: NCT03274882.
Results. A total of 26 patients were included in the study; the median age was 60.5 years (30 to 78); 19 (73%) women; and 4 patients with ECOG 0 and 22 – with ECOG 1. All patients were previously treated with the inclusion of oxaliplatin, irinotecan, fluoropyrimidines, 21 (81%) – bevacizumab, 6 (23%) – anti-EGFR antibodies, and 2 (7.7%) – regorafenib. The median for treatment courses was 4 (1–21), 11 (42.3%) patients were treated for 6 months or more. The two-month progression-free survival rate was 52% with a median progreesion-free survival rate of 4 months (95% CI 1.8–7.4 months). The median of total survival rate was 11 months (95% CI 5,2–16,8 months). Disease control was achieved in 60%. Neutropenia, nausea, vomiting, anemia, weakness prevailed among undesirable events associated with treatment (≥5 patients). The majority of complications were of the 1st–2nd degree. Among the undesirable events of the 3rd–4th degree, neutropenia was more common, while in 3 patients febrile neutropenia of the 3rd degree was registered.
Conclusions. In the Russian population of patients with colorectal chemorefractory cancer, the drug FTD/TPI (TAS-102) shows efficacy and tolerability comparable to the RECOURSE registration study.
Introduction . Adenoid hypertrophy (pharyngeal tonsil hypertrophy) is considered as one of the most common diseases of the ENT organs.
Aim . To study the polymorphism of the IL-10 gene (interleukin 10) and infections caused by human herpesvirus 6 (HHV6), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in children with AH.
Materials and methods . The study included 106 children with adenoid hypertrophy and 38 healthy children aged 2 to 11 years. All children with adenoid hypertrophy were divided into three subgroups depending on the size of the pharyngeal tonsil. Viruses were determined by real-time quantitative polymerase chain reaction (PCR).
Results . In patients with AH, HHV6 was detected more often than in CMV and EBV. Among the three subgroups of children with HGM, HHV6 and EBV infections prevailed in children with the maximum degree of pharyngeal tonsil hypertrophy. The frequency of the GG genotype was higher in the control group of children. Significantly higher frequencies of the G allele and GG and GA genotypes for IL-10 rs1800896 were found in the subgroup of children with the smallest size of the pharyngeal tonsil compared to other subgroups.
Discussions . The frequencies of HHV-6 and CMV in the control group are significantly different. HHV-6 was the most frequently detected virus in patients with HGM compared with CMV and EBV. The frequency of the GG genotype was in the control group of children. A significantly higher frequency of the G allele and GG genotypes was found in the first subgroup of children compared to the second and exclusive subgroups. We found a lower frequency of the G allele and GG and GA genotypes in a significant subgroup of children compared to the second subgroup. Previous studies show a significant increase in the frequency of the A allele and the AA and IL-10 genotypes (rs1800896-1082G/A) in patients resistant to HHV-6 and CMV infections compared to those infected.
Conclusions . The presence of HHV-6 and CMV infections contributes to the development of pharyngeal tonsil hypertrophy, and HHV-6 and EBV may contribute to the size of the pharyngeal tonsil.
Introduction. In the cases of neurosurgery failure in acromegaly treatment, drug therapy with somatostatin analogues (SSA) octreotide or lanreotide is indicated. The effectiveness of SSA is limited by the presence of resistance, there is an opinion that in some cases it can be overcome by replacing one drug with another.
Aim. Own experience analysis of transferring acromegaly patients from therapy with long-acting octreotide to lanreotide autogel 120 mg.
Materials and methods. The case histories of acromegaly patients who were recommended to replace long-acting octreotide therapy with lanreotide therapy 120 mg were analyzed. GH and insulin-like growth factor-1 (IGF-1) dynamics was evaluated at least 6 months after the replacement of the drug. The target value for GH was considered to be less than 2.5 micrograms/l, for IGF-1 – an excess of no more than 30% of the upper normal limit.
Results. 24 patients were transferred to lanreotide therapy 120 mg. Of the 19 patients with insufficient reduction of GH and IGF-1 on prolonged-acting octreotide therapy at a dose of 40 mg every 28 days (OCT40) the prescription of lanreotide 120 mg every 28 days (LAN120) led to the target values of both GH and IGF-1 in 4 (21%) cases. These patients had no more than a twofold excess of IGF-1, and the level of GH was less than 2.5 mcg/l on the background of OCT 40 therapy. In 6 (32%) patients, IGF-1 levels normalized or decreased, but GH remained outside the target values. In 9 (47%) cases, the replacement of the SSA did not lead to a significant positive dynamics in the levels of GH and IGF-1. The effects of lanreotide therapy 120 mg in another five patients initially treated with octreotide 20 mg are also described.
Conclusions. Replacement of OCT4 with LAN120 may be effective in some patients with acromegaly. A slight increase in the level of IGF-1 together with the target values of GH before replacing the SSA may be the predictor of success.
In the present article, the authors provide detailed material on the 13-year observation of a patient with such a rare disease as Whipple’s disease. Pathophysiological aspects, in particular changes in immunity within the framework of this nosology, clinical picture are also described in detail, and the emphasis is placed on the interrelation of certain symptoms, their intensification and regression. Taking into account the absence of clear recommendations for the management of such patients, the article considers various options of therapeutic schemes, and also reflects the own results of treatment.
The personalization of therapy is one of the innovative approaches gaining an increasingly strong foothold in modern medicine, implying an individual approach to each patient, taking into account the individual characteristics of the patient and the specific clinical case. This same standpoint of personified therapy should be used to plan rational analgesic therapy, the most important component of managing patients with the most common and socially significant diseases, with conditions that have a significant impact on the patient’s quality of life and worsen the course of concomitant diseases. The Meeting of Experts of different specialties such as rheumatologists, neurologists, cardiologists and clinical pharmacologists considered the key aspects of the prescription of NSAIDs, the most widely used class of painkillers, including those used for the relief of musculoskeletal pain. It was noted that when choosing NSAIDs, the practitioner should take into account the diagnosis, the planned duration of analgesic therapy, the intensity of pain, medical history data, the presence of comorbid diseases and risk factors for drug complications. There are different types of NSAIDs, some of which are most useful for urgent acute pain therapy (eg, ketoprofen), while others are most suitable for long-term pain management in chronic diseases (eg, etoricoxib). In any case, the practitioner should take into account the priority of patient safety and pay the utmost attention to the prevention of NSAIDassociated complications, and also keep in mind the duration of the specific drug administration permitted by the patient information leaflet. It was also noted that the launch of a new generic etoricoxib (Kostarox®) expands the possibilities of analgesic therapy for the Russian practitioners.
Personalized therapy is starting to play an increasing role in modern approaches to the treatment of oncological diseases. The previously existing uniform standard for each malignant disease is expanded with new options and treatment possibilities, depending on each specific clinical situation. That increases the effectiveness of therapy and helps to control the disease. A separate niche in the individual approach to anti-tumor treatment is occupied by targeted therapy of malignancies. There are a lot of mutations that can lead to the emergence of malignant neoplasms. So of all that multitude of choices the individual approach to a patient helps to select the mutations that are most likely to be found in a given patient. The research in the area of the c-MET mutation has allowed it to occupy its niche as a therapeutic target. The identification of this mutation is not included in the routine set of analyses performed for a patient with diagnosed lung adenocarcinoma. But expanding the panel of molecular testing would increase the detectability of this mutation and, as a result, improve the quality of treatment for this category of patients. This clinical case describes the experience of treatment of an elderly patient with lung adenocarcinoma, in whose tumor tissue a MET mutation was detected.
Purpose of the study: to determine the clinical significance of Zn deficiency based on the 14-year prospective study of children with different levels of zinc at birth. Patients and methods. Pregnant women and their newborns (n = 316) were screened for serum Zn levels. A total of 146 motherchild pairs were followed-up during the year, of which 102 children were followed-up for up to 14 years. Results. The study showed that the prevalence of zinc deficiency in the women followed-up was as follows: 77% in pregnant women, 80% in newborns. 94% of children with Zn deficiency at birth demonstrated zinc deficiency even at school age. There is a correlation between the serum Zn level in children and their mothers both during the newborn period and at school age (r = 0.38), with p <0.05. the period of newborns, and at school age (r = 0.38), with p <0.05. The 1-year-children with zinc deficiency, in comparison with infants with sufficient zinc levels are more often diagnosed with rickets 86,2% and 45,1%, anemia 37,9% and 17,7%, dystrophy 27,5% and 13,8 %, as well as atopic dermatitis 65.5% and 29.4%, allergic reactions 24.1% and 15.7%, at school age they were diagnosed with a pathology of the musculoskeletal system (79% and 52%, respectively), gastrointestinal tract (61% and 41%), nervous systems (54% and 30%) and skin (66% and 45%) with p <0.05. The decrease in resistance of the body was identified 2 times more often in zinc-deficient children. The conclusion. Zinc is important at all stages of a person’s life, therefore the analysis of zinc availability should be carried out not only in pregnant and nursing mothers, children of early age, but also among risk groups for the deficiency of this microelement.
Vitamin sufficiency in children can be estimated by the different values of their consumption in autumn-winter and spring-summer seasons. The paper presents the results of a study assessing the prevalence of vitamin deficiency among children of various ages depending on the season. The study included children and adolescents aged from 3 to 14 years (n = 2587, 51% boys) in various regions of Russia. As a result, significant seasonal differences were found in vitamin sufficiency in children aged 3–14 years. Analysis of clusters of parameter interactions demonstrated a relationship between seasonal differences in sufficiency of vitamins B6, E, A, B2 and the risk of various pathologies in all age groups of children. Finally, the presence of seasonal variations in vitamin sufficiency in children was confirmed. This should be taken into account when prescribing vitamin and mineral complexes to children.
Lymphatic malformations are benign neoplasms that form as a result of impaired formation of embryonic lymphatic sacs during embryogenesis. Lymphangiomas and lymphgemangiomas (visceral forms) rarely develop in the intra-abdomen, such localization does not exceed 8–15% of all observed lymphangiomas in children. Among the visceral forms are more common the forms that involve intestines, mesentery, spleen, omentum, liver in the pathological process, less often - the lymphatic vessels and lymph nodes of the mediastinum, and retroperitoneal tissue. The clinical presentation of lymphatic malformations is multivaried and depends on their localization, the patient age, and the development of complications. In case of complications, the clinic manifestation of “acute abdomen” requires emergency surgical intervention, during which the diagnosis and scope of surgical treatment are specified. a 14-year-old boy was admitted to the department of infectious diseases with complaints of fever, weakness, abdominal pain, sore throat and loose stools. Previously, the patient had complaints of abdominal pain for a year; ultrasound examination of the abdominal cavity was performed repeatedly, in which no pathological changes were detected. The patient underwent laparoscopic appendectomy; During the revision of the abdominal cavity, a space-occupying lesion emerging from the mesentery of the ascending colon and twisted around the vascular pedicle by 3 turns was revealed. Education removed. Histological and immunohistochemical examination confirmed the diagnosis of lymphatic-venous malformation. No signs of malignancy of lymphatic malformations are described in the literature. However, though lymphatic malformations are benign in nature, they tend to have an infiltrative growth pattern, often relapse, and sometimes become infected. The available literature doesn’t provide a proper description and analysis of the results of treatment of intra-abdominal lymphatic malformations using endovideo technologies. Transabdominal access provides the best exposure of the complete surgical field, freedom of movement and clarity of anatomical landmarks. The main advantages over open abdominal surgery are minimal trauma to the anterior abdominal wall and rapid rehabilitation of patients.
The article contains information about life and professional activity of one of the founders of Russian pediatrics, age-dependent morphology and biochemistry, school hygiene – Professor N.P. Gundobin, his contribution to clinical, scientific and social pediatrics. N.P. Gundobin’s views on child examination and treatment, regularities of growth and development of children and their significance, prevention of diseases are presented.
Psoriasis is a chronic immune-mediated inflammatory disease in which the pathological process quite often involves the nail apparatus. Psoriatic onychodystrophy is considered a serious psychological and social problem, as nail lesions are not only a cosmetic defect, they can also complicate daily activities, including employment, ability to work and generally impair the quality of life of patients. In addition, numerous studies and clinical practice show that nail lesions in psoriasis are also associated with a more severe course of the skin process, and are rather torpid to therapy. Moreover, psoriatic onychodystrophy is considered as a form of enthesitis, which is in fact an important predictor of the development of psoriatic arthritis. Various topical, systemic and physiotherapeutic options have been recommended in the therapy of psoriasis with nail plate damage, but the effectiveness of these therapeutic methods is in most cases insufficient and the search for highly effective treatment is of great clinical importance at present. Taking into consideration the critical importance of interleukin (IL)-17 in the pathogenesis of psoriasis, its inhibitors allow to achieve a stable remission of cutaneous and joint processes, thus, it is promising in the therapy of psoriatic onychodystrophy. The article presents the literature data on epidemiology, clinical picture of nail changes in psoriasis, the review of effective pathogenetic methods of psoriatic onychodystrophy therapy and personal clinical observations of patients with severe psoriasis with nail plate damage treated with Russian interleukin 17A inhibitor – Netakimab. These observations allow to draw a conclusion about high efficacy of netakimab in the therapy of patients with psoriasis including the presence of such hardtop-treat localizations as nail lesions.
Currently, psoriasis occupies a leading position in the structure of chronic recurrent dermatological diseases. The modern view on the etiopathogenesis of psoriasis allows us to consider this disease as a systemic, genetically determined, immune-mediated process, which manifests itself not only in the form of damage to the skin, but also leads to the development of various comorbid conditions (lesion of the musculoskeletal system, cardiovascular system, excretory system , metabolic disorders, etc.). This fact radically changes the approach to the treatment of patients with psoriasis, to the selection of a systemic drug. The main points in the management of patients with psoriasis, especially of moderate and severe course: interdisciplinary examination of the patient, prevention of the development of comorbid conditions and irreversible (sometimes disabling) changes in internal organs and systems, timely administration of systemic therapy. The article presents modern aspects of the etiopathogenesis of psoriatic disease, the advantages of genetically engineered biological therapy, and a clinical case of treating a patient with severe psoriasis. A 48-old-patient E. who had been suffering from extensive psoriasis vulgaris for 16 years, which manifested after pregnancy and childbirth, was proscribed the systemic therapy. In July 2022, the patient reported oedema that developed in the lower extremities and face while taking methotrexate, and was examined by a nephrologist. Microalbuminuria nephropathy was diagnosed, which served as a reason for adjusting the systemic therapy for psoriasis. The patient had to be switched to the genetically engineered biological therapy. After 3 subcutaneous injections of netakimab at a dose of 120 mg/week, psoriasis went into a steady-state showing the trend towards a regressing stage. The psoriasis severity index scores decreased by the end of the initiating course of therapy.
The history of the use of fermented, easily digestible products in the treatment and for prolonging life began long before their basis was called probiotics. Recipes for fermenting milk from various animals, endowing it with healing properties, have a long history. The first descriptions of fermentation of milk for making sour milk drinks and cheese are documented in the sacred writings of Indians and date back to about 2000 B.C. The first attempts to explain the secrets of sour milk began only in the second half of the XIX century and are associated with the works of outstanding scientists of the time - Louis Pasteur, Henri Tissier, I.I. Mechnikov, Stamen Grigorov and others. Today, in the usual sense, probiotics are living microorganisms that benefit the host when administered in adequate quantities. It is quite obvious that belonging of a probiotic strain to different species and types of bacteria determines a different set of immunological and non-immunological effects, as well as a number of specific, unique qualities. Lactobacillus reuteri is one of the most well-studied species with respect to both efficacy and safety. The beneficial health effects of L. reuteri strains (DSM 17938, ATCC PTA 6475, ATCC PTA 52899) have been confirmed in more than 200 clinical trials with the participation of about 18,000 people of all ages. The article most fully describes the effects of L. reuteri DSM 17938, the use of which is not limited to the well-known means of prevention and treatment of infantile colic.
The review is devoted to the analysis of data on the effects of Lactobacillus reuteri DSM 17938, confirmed in clinical trials. Thanks to their antimicrobial activity, L. reuteri is able to inhibit colonization by pathogenic microorganisms and restore the composition of compensatory intestinal microbiota. Another study showed a positive protective effect of intestinal microbiota when administered L. reuteri simultaneously with antibiotics. In addition, L. reuteri supports the immune system of the human body. For example, some strains of L. reuteri may reduce the production of pro-inflammatory cytokines while stimulating the development and proliferation of regulatory T-lymphocytes. Adding L. reuteri to the diet may be attractive in terms of preventing the development of inflammatory bowel disease. The results of a recent meta-analysis confirmed the efficacy of L. reuteri in the treatment of infantile colic. Further research is aimed at finding evidence of the efficacy of L. reuteri use in children who are artificially fed, with infant colic and in children born by caesarean section.
Vasomotor symptoms, including hot flashes (HF), are the most common symptoms of the menopause, which require the hormone replacement therapy with estrogens and/or progestogens. Recent international clinical guidelines recognize the need to use the lowest effective doses of hormone therapy. Drospirenone (DRSP) in combination with 17β-Estradiol (E) is used as hormone therapy (HT) to relieve the postmenopausal symptoms and prevent osteoporosis. The objective of this review is to perform a meta-analysis of the studies evaluating the efficacy and safety of low-dose E2 and DRSP for the treatment of vasomotor symptoms of menopausal syndrome, as well as assessing the state of the endometrium in postmenopausal women. The review presents data from the largest randomized controlled trials that evaluated the lowest effective dose of the E2/DRSP combination, the safety of this dose for endometrium, idetified features of its pharmacokinetics and pharmacodynamics, depending on various factors. The first randomized trial showed that 0.25 mg/E2 DRSP 0.5 mg combination is the lowest effective dose for the relief of HF in postmenopausal women. The efficacy of low doses of DRSP/E2 correlated with E2 and DRSP exposure in serum, while smoking adversely affected the effectiveness of treatment. Evaluation of the risk of endometrial hyperplasia and bleeding peculiarities on the background of DRSP reception 0.25 mg/E2 0.5 mg for 12 months did not reveal hyperplasia or atypia of the endometrium, which confirmed the safety profile of the DRSP 0.25 mg/E2 0.5 mg combination. Thus, 0.25 mg/E2 0.5 mg DRPP is the lowest effective dose for relieving HF, which does not significantly affect the endometrial state. DRSP 0.25 mg/E2 0.5 mg reverses vasomotor manifestations of menopausal syndrome, reduces the frequency and severity of genitourinary syndrome symptoms, which, in turn, improves the patients’ quality of life.
Vasomotor symptoms are the most common symptoms of menopause, requiring treatment with estrogen and/or progestogen. Recent international guidelines recognize the need to use the lowest effective dose of hormone replacement therapy. Drospirenone (DR) in combination with 17β-estradiol (E2) is used as hormone therapy (HT) for relief the symptoms and prevention of postmenopausal osteoporosis.
The review presents data of 2 large randomized controlled studies that evaluated the lowest effective dose combination DRSP/ E2, the safety of this dose for endometrium, identified features of its pharmacodynamics and pharmacokinetics, depending on various factors. The minimum effective dose for the relief of hot flushes without causing any significant impact on the endometrium is DRSP of 0,25 mg/E2 of 0,5 mg. According to the results of the pharmacokinetic study a correlation between effectiveness of low dose DRSP/E2 with DRSP and E2 exposure levels was showed, and smoking reduces the effectiveness of hormonal therapy. This drug not only copes with moderate to severe hot flushes, but also reduces the incidence of symptoms of vulvovaginal atrophy, improving quality of life.
Objective: study of effectiveness and safety of indication of a combination 17β-estradiol/drospirenon in patients with various manifestations of the climacteric syndrome and risk of the metabolic syndrome development.Materials and methods. Results of two-year therapy of climacteric syndrome by 17β-estradiol/drospirenon drug in 21 patient in post-menopause.Results. As a result of two-year administration of the 17β-estradiol/drospirenon drug in patients with a risk of metabolic syndrome development a significant reduction of Kuppermann index was observed as well as improvement of the skin and mucous tunic state. No negative effect of the drug on lipid exchange values and homeostasis parameters, arterial pressure value, growth of myomatous nodules and thickness of endometrium.Conclusions. A combination of 17β-estradiol/drospirenon is effective and safe in therapy of climacteric disturbances and might be a drug of choice for patients with a risk of metabolic syndrome development.
Introduction . Improving the nutrition of schoolchildren and introducing a culture of nutrition with a national component is one of the priority strategic tasks of improving the health of the population. Aim . Study the frequency of consumption of foods with high nutritional value by schoolchildren living in the Republic of Sakha (Yakutia). Materials and methods. According to the developed questionnaire, a survey of 932 parents (legal representatives) of children aged 7–18 was conducted. Statistical processing of the obtained data was carried out using the Excel program using Student’s t-test and Pearson’s χ2 method. Results and discussion . Children living in Yakutia are characterized by a higher frequency of meat consumption, but less consumption of milk and sour-milk drinks, cottage cheese, fish compared to children in the Arctic zone and the Russian Federation as a whole. At least once a week, 31% of local and 30% of alien children consume fish. Despite the presence of meat in the diet, especially of the local population, 40–60% of children consume sausages more than 3 times a week. 70–90% of children consume fruits several times a week and 65–80% vegetables. The number of children consuming sour-milk drinks has increased, and 60–70% of children use them in their diet, whereas previously only 50% consumed them. 10–15% of children of both ethnic groups do not consume milk and sour-milk drinks, cottage cheese – 50–60% of local and 40% of aliens. Both local and alien children began to use national products more often in their diet. Conclusion. In recent years, thanks to complex measures, the food diversity of the diets of schoolchildren living in the Republic of Sakha (Yakutia) has significantly improved, characterized by the inclusion of local traditional products in the diet of both the local and the alien population.
The monosomy 18p-syndrome refers to an extremely rare disorder (1:50,000 live-born infants). Congenital hypopituitarism is one of the manifestations of this syndrome in 13% of cases. The rarity of this pathology causes difficulties in the early detection of congenital hypopituitarism due to lack of awareness among paediatricians and neonatologists. The article presents a clinical case of congenital hypopituitarism in a girl with monosomy 18p-syndrome, which manifested itself after birth in the form of cholestasis and hypoglycaemia.
Introduction . One of the characteristic manifestations of COVID-19 is a disorder of smell, which, according to the literature, occurs in 61.2% - 85.6% of patients with COVID-19. The article discusses the problems of post-viral dysosmia in COVID-19 convalescents. Purpose of the study. Evaluation of olfactory disorders in patients after coronavirus infection and the possibility of obtaining additional benefits from prescribing bioregulatory medicine drugs.
Materials and methods . The assessment of the severity of olfactory disorders in patients, taking into account the age according to self-assessment data using a visual analogue scale, as well as an objective assessment of odor identification using the Sniffin ‘Sticks Screening 12 Test. The possibility of increasing the efficiency of recovery of olfactory disorders by prescribing complex preparations of bioregulatory therapy (main group) was studied.
Results . The percentage of persons who fully restored the olfactory function in the main group was 56.5%, while in the patients of the control group only in 6.6%. Faster (on the 7 th day) dynamics of identification testing using SST-12 in patients taking complex preparations of bioregulation therapy was noted. On the 3rd day of therapy, there was a significant decrease in anxiety in patients treated with bioregulatory drugs.
Discussion . The conducted study objectively confirmed that the olfactory disorder is present in the vast majority of patients with ARS. The appointment of bioregulatory therapy contributes to the early restoration of the olfactory function.
Conclusions . Based on the results of this study, it can be concluded that it is advisable to use bioregulatory drugs.
Introduction . COVID-19 increases the risk of ischemic stroke (IS), but the impact of COVID-19 on the recovery period of IS remains poorly understood.
The aim of the study – to identify patterns and features of the course and manifestations of the early and late stages of the recovery period after ischemic stroke associated with COVID-19.
Materials and methods . The combined retro-prospective study included 81 patients. Patients were divided into three groups: 1) development of stroke followed by outcome in ischemic stroke (IS) associated with COVID-19 (n = 21); 2) COVID-19 infection without stroke (n = 40); 3) development of stroke without COVID-19 (n = 20). All subjects were interviewed by telephone within 12 months from the date of discharge from the hospital. In patients with stroke, the severity of stroke (NIHSS scale), functional status (Rankine scale), and daily activity level (Bartel scale) were studied. All subjects were interviewed by telephone within 12 months from the moment of discharge from the hospital, the following were assessed: complaints, general condition of patients, the patient’s level of activity and ability to self-care, emotional status and the presence of anxiety and depressive disorders. The following were retrospectively assessed: stroke severity, functional status, volume of lung lesions according to MSCT, the presence of cardiovascular diseases, indicators of general and biochemical blood tests, changes in blood levels of cytokines IL-6, IL-8, IL-10, TNF-α.
Results . The highest mortality at the post-hospital stage (only 67 and 47% of the total number of deaths) was in patients who had an ischemic stroke associated with COVID-19; half of them were registered in the first 3 months; by the end of the 6th month, this figure was 79%. Deaths in patients with IS due to COVID-19 occur 6 months earlier than in the group of patients with stroke without COVID-19. The leading causes of fatal outcomes in patients with IS due to COVID-19 in the first 3 months were acute myocardial infarction and repeated strokes. A high frequency of unfavorable rehabilitation prognoses and deaths both in the acute period of the disease and at the post-hospital stage was observed in patients with high comorbidity with forms of pathology of the circulatory system.
Conclusion . Patients who have had an ischemic stroke associated with COVID-19, in the first 3 months of the post-hospital period, are at an increased risk of developing thrombotic complications and death and require special attention of outpatient doctors in this period after discharge from the hospital.
Introduction . For many years, one of the problems in medicine that attracted the attention of specialists from different areas of medicine was herpes virus infection. There are many reasons for this, including the often persistent nature of the course, a wide variety of clinical manifestations and routes of transmission, and many target organs of this infection. The disease can proceed in different ways, it has both asymptomatic, mild and rather severe course. For otorhinolaryngologists, Epstein-Barr virus (EBV), cytomegalovirus (CMV) and herpes virus 6 (HHV-6) are the most relevant and important in the context of the treated site of the pathological process. Since the end of 2020, humanity has faced a new, previously unexplored viral infection – a new coronavirus infection. And just like the previously studied herpes virus infection, COVID-19 has a large number of clinical manifestations and affects a huge number of organs and organ systems.
Aim . To determine the types of interplay between COVID-19 and herpesviruses (EBV, CMV, HHV-6) in children of different ages with abnormalities of the lymphoid ring of pharynx.
Materials and methods . In the course of the study, a comprehensive examination was carried out and the results of examination of children with pathology of the lymphoid ring of the pharynx who had herpes virus infection and COVID-19 were analyzed.
Results . The results of the study obtained in the course of the work are consistent with the data that the virus carrier. The presence of an infectious agent triggers the production of macrophages and leads to clonal selection of T and B cells. Further, lymphocytes are transformed into lymphoblasts, which are capable of division and their transformation into plasma and B-memory cells occurs. As a result of this process, hypertrophy of the lymphoid tissue occurs and its reactive activity increases. (persistent herpesvirus infection) is one of the important causes of lymphoid proliferation in children. The combination of antigenic load and immaturity of the immune system in children is accompanied by an increase in the activity of lymphoid tissue and its compensatory activity.
Conclusions . Past mild and asymptomatic COVID-19 can contribute to the reactivation of lymphotropic herpesviruses, first of all EBV, in 55-65% of children of preschool and school age.
Introduction. Pregnant women may be at increased risk for severe COVID-19 illness. Pregnant women are more likely to be hospitalized at ICU, needed the mechanical ventilation compared to nonpregnant women of childbearing age. Building on the experience of the effective use of the exogenous surfactant for influenza A/H1N1 treatment of pregnant women with COVID-19, the surfactant therapy has also been included in the treatment.
The objective. To evaluate the effectiveness of surfactant therapy in the integrated treatment of severe COVID-19 pneumonia of pregnant women and postpartum women.
Materials and methods. The study included 135 pregnant and postpartum women with severe COVID-19 pneumonia. All of them received antiviral, anticoagulant, anticytokine and anti-inflammatory therapy. 68 patients (main group) with an initially more severe course of the disease and a greater degree of lung damage (p = 0.026) received inhalations with Surfactant-BL, 67 patients (control group) did not receive the surfactant therapy. Patients received Surfactant-BL through a mesh-nebulizer at a dose of 75 mg 2 times a day for 3–5 days.
Result . Patients of the main group showed decreasing risks of requiring the noninvasive ventilation (27.9% vs. 52.2%, р = 0.014) and artificial lung ventilation (2.9% vs. 11.9%, p = 0.047), the length of stay in the intensive care unit (ICU) was reduced (10.6 vs. 13.1 inpatient days, р = 0.045). Сomplications such as pneumomediastinum and pneumothorax occurred less frequently in the surfactant therapy group (24.2% vs. 52.4%, p = 0.037) with a high extent of lung damage (CT-3–4). With early surfactant therapy in the standard oxygen therapy stage or high-flow oxygenation, gas exchange indicators were restored faster, thus avoiding mechanical ventilation and has reduced the duration of intensive care (р = 0.004) and prevented deaths.
Conclusion . The use of surfactant therapy for pneumonia associated with COVID-19 in pregnant and postpartum women against the background of ongoing complex therapy helps to prevent further lung damage, reduce the mechanical ventilation risk and improve oxygenation earlier, especially with early start of surfactant therapy.
The developing resistance of microorganisms to the effects of antibacterial drugs creates difficulties in the treatment of purulent diseases. This is especially reasonable in the pandemic of a new coronavirus infection (COVID-19). The aggressive effect of new strains of the virus on the mucous membrane of the nasal cavity and nasopharynx contributes to the occurrence of complications such as acute purulent otitis media and exacerbation of chronic purulent otitis, both during coronavirus infection and in the postcovid period. Even before the start of the pandemic, antibiotic resistance was already one of the big problems in most countries of the world, this was due to the frequent unjustified appointment of systemic antibacterial agents for viral infection, as well as uncontrolled self-medication of the population with all available drugs. Due to the fear of people getting sick with COVID-19 and disagreements among doctors in treatment tactics, the use of systemic antibiotics and hormonal drugs increased already in the first months of the pandemic. In the future, the unjustifiability of this tactic was proved, but many doctors continued to prescribe several systemic antibacterial drugs to patients with uncomplicated viral infection. Under the current conditions, when there is evidence of bacterial infection, it is rational to use local antibacterial drugs, which allows you to quickly reach high concentrations in the focus of inflammation and avoid side effects of systemic antibiotics. Among the existing means in the complex therapy of perforated otitis, a special place belongs to the preparations of the group of quinoxaline derivatives, which include hydroxymethylquinoxalindioxide (Dioxidine). The advantage of the drug is its effectiveness against resistant microorganisms, as well as stimulation of marginal tissue regeneration. This property is especially important in the treatment of perforated otitis media.
Introduction. Modern algorithms for the diagnosis and treatment of allergic rhinitis (AR) recommend a stepwise approach for managing symptoms of the disease. A part of patients with AR have symptoms that indicate to the past COVID-19 followed by significant impairment of the olfactory function. The article places special emphasis on the intranasal glucocorticosteroid option of treatment to manage nasal and general symptoms in persistent AR.
The aim of the study is to evaluate the efficacy of mometasone furoate in patients with a confirmed diagnosis of persistent AR, olfactory disorders, and past COVID-19 infection.
Materials and methods. A total of 72 patients with persistent AR were included in the randomized controlled prospective study. All patients had a history of olfactory dysfunction with varied severity, which persisted after COVID-19 infection.
Results. Measuring the severity of nasal and general symptoms on Day 15 of treatment showed a positive outcome in both groups: the patients of the main group experienced changes, to a greater extent, in nasal congestion, rhinorrhea, olfactory disorders, the
patients of the control group generally demonstrated a reduction in nasal congestion, rhinorrhea, itching and sneezing, and improvement of sleep. The final measuring of the severity of complaints on Day 30 of treatment showed that patients of the main group managed to cure the olfactory disorders (0.9 points on the VAS), nasal congestion (0.4 points on the VAS), rhinorrhea and itching (0.2 points on the VAS). Sleep disorders continued to disturb patients in both groups, its improvements in the main group were statistically insignificant.
Conclusions. The complaints of nasal congestion, impaired olfactory function and sleep disorders were noted to prevail in patients with persistent form of AR after COVID-19. The followed measuring of the olfactory function using the SST-12 screening test showed that all patients had anosmia. It has been confirmed that the use of mometasone furoate in the treatment of persistent AR in patients with severe olfactory dysfunction after COVID-19 would be appropriate.
Doctors of various specialties face orofacial and facial pain in their practice: dentists, maxillofacial surgeons, neurologists, neurosurgeons, otorhinolaryngologists, therapists, general practitioners, traumatologists, ophthalmologists, psychotherapists, physiotherapists, aesthetic medicine doctors, anesthesiologists, plastic surgeons and other specialists. The novel coronavirus infection (COVID-19) pandemic, spread by the SARS-CoV-2 virus, has become a challenge for all medical specialties and health care systems around the world. The respiratory system is the dominant target of SARS-CoV-2. The oral mucosa is also highly susceptible to SARS-CoV-2 infection, due to the wide distribution of angiotensin-converting enzyme type II receptors in the oral cavity. We searched the literature for the period from the beginning of the pandemic until August 22, 2022, on the study of the association of orofacial pain with a new coronavirus infection COVID-19 in the electronic search engines PubMed and Scopus. Analysis of the found sources indicates an increase in the frequency of various types of orofacial pain associated with 1) violation of dentoalveolar and related structures during the COVID-19 pandemic; 2) temporomandibular disorders; 3) with damage or disease of the cranial nerves; and 4) like manifestations of primary headache. This growth is due both directly to the infection caused by SARS-CoV-2, its complications, and to a complex of biopsychosocial factors directly related to the pandemic. In the second part of the article, as part of the review, the possibility of using nimesulide for the treatment of orofacial and facial pain during the COVID-19 pandemic is discussed. The choice of nimesulide is supported by 1) the likely coadjuvant effect of nimesulide in the treatment of COVID-19; 2) positive experience with the use of nimesulide in the treatment of facial and orofacial pain in the period preceding the COVID-19 pandemic; 3) the safety of using nimesulide in comorbid patients, who are the main risk group for the development and severe course of COVID-19.
The review examines the clinical and epidemiological links between COVID-19 and pneumonia. At the same time, both general patterns linking viral respiratory infections and bacterial infections of the lower respiratory tract are discussed, as well as recent data relating directly to COVID-19. The clinical aspects of secondary infections, the peculiarities of their etiology, course and outcomes are analyzed separately. The publication provides a short essay on the history of the development of vaccines against pneumococcal infection. The current vaccines against pneumococcal infection are described, their brief characteristics and individual characteristics are given, their clinical and immunological advantages and disadvantages are analyzed. The data on the effectiveness of vaccine prophylaxis using pneumococcal vaccine are presented. The specific and nonspecific effects of vaccine prophylaxis both at the population level and at the level of an individual organism as a whole and in particular when using vaccines against pneumococci are considered separately. Data on the putative biochemical and molecular mechanisms of these effects are presented. Based on the data presented, the need for the use of pneumococcal vaccines in the prevention of the spread of the SARS-Cov2 virus, the prevention of complications of COVID-19 and the rehabilitation of patients who have undergone this infection is substantiated. When considering the role of pneumococcal vaccines in the rehabilitation of patients who have undergone COVID-19, their potential is analyzed both in accelerating the restoration of the normal functioning of the immune system and in the prevention of superinfections. The ways of further research in this direction are outlined, which include the development of protocols for certain groups of patients with concomitant diseases and immuno-compromised contingents. In this direction, the role of a thorough and comprehensive study of the immunological and clinical indicators of this category of persons is emphasized.
On April 27, 2020, COVID-19 pandemic affected more than 2,5 million of people in more than 200 countries and caused 185 000 deaths. Healthcare systems have come under enormous stress. In COVID-19 pandemic oncological patients face two serious challenges: the risk of severe infectious disease course and the risk of malignant tumor progression. Forced correction of existing oncological standards of care is based on expert and professional community opinions, and daily gaining experience. The issue resumes the data on COVID-19 influence on liver function among the patients with chronic liver diseases and hepatocellular carcinoma. The guidance on HCC management in COVID-19 pandemic are provided. More than 1,5 million of people suffers from the liver pathology caused by chronic virus hepatitis, alcohol consumption, nonalcoholic fatty liver disease. Mild COVID-19 is often followed by transient liver function disorder which do not need specific treatment. Severe COVID-19 lids to the increase of aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT), to the decrease of serum albumin in most cases. Regarding the HCC treatment preference should be given to telemedicine, limitation of contacts in health-care facilities, outpatient treatment, including oral medication (tyrosine kinase inhibitors), and if possible delay of invasive procedures with the help of bridge-therapy and active monitoring. Selecting the patients for surgery, ablation or transarterial chemoembolization (TACE) patients with minimal risk of decompensation, with maximum treatment benefit (on the base of prognostic scales), with lack of comorbid should be preferred. Selective and super selective TACE with drug-eluting beads or radioembolization should be used to reduce the risk of immunosuppression and postembolic syndrome. Live organ transplantation should be considered to be postponed. Targeted therapy could be a temporarily alternative to invasive procedures.
Introduction . The COVD-19 pandemic caused by the SARS-CoV-2 continues from March 2020. The virus primarily affects the respiratory system. Moreover, there is new data about the various organ damage caused by COVID-19 such as heart, skin, kidney and central nervous system. That’s why it is necessary to investigate the neurological features of the COVID-19. The aim of the study . To investigate the effect of COVID-19 on the cognitive functions of hospitalized patients. Materials and methods. the PCR-positive patients hospitalized at the University Clinical Hospital No. 3 had been included in the study since March 2020 for May 2021. Thorax CT scan, physical and neurological examination, the biochemical blood test was provided for all patients. The neuropsychological examination was made by: MoCA, TMTA, TMTB, and emotional condition was tested by HADS. Results . 33 patients (21 (64.6%) women) were included; the median age was 73.0 [67.0; 76.0]. The average MoCA value was 22.64 points, median: 24.00 points [20.00; 25.00], median TMTA execution speed: 68 seconds [49.00; 84.00], TMTB: 194 seconds [153; 245.75]. HADS (depression) median: 7.0 [5.00; 9.00], for HADS (anxiety) median: 8.0 [4.00; 10.00]. A link between the olfactory disorders and low MoCA results (p = 0.015) was found according to the regression analysis. Moreover, the patient’s age, lung damage degree had a negative impact on the duration of TMTB (p = 0.001 and p = 0.049). The propensity score matching was made to confirm that the olfactory disturbances, regardless of other factors, are associated with a lower MoCA result (p = 0.012). Conclusion . The potential mechanisms, modality, defect duration and pharmacological response of cognitive disorders have a great interest. That’s why it is necessary to conduct clinical and experimental studies on patients, pathomorphological material and animal models.
In the article, the authors provided the overview of the results of international clinical studies and recent papers, as well as their own experience with the use of an enzyme mucolytic – dornase alpha in the treatment of cystic fibrosis and other chronic bronchitis affected by mucostasis. The dornase alfa has been shown to have two more non-mucolytic effects, the most important of them is anti-inflammatory one. It is the anti-inflammatory effect that plays an important role in patients with cystic fibrosis, when chronic bacterial inflammation and destruction of lung tissue take place in the pathogenesis of the disease. Dornase alpha counteracts neutrophil elastase, reducing its concentration in sputum. The authors emphasize on the fact that the same inflammatory reactions occur in covid infection and that it is dornase alfa that acts with an anti-inflammatory effect in ordinary patients, as well as in cystic fibrosis. The authors share their own experience and bring three clinical examples that demonstrate not only good tolerability and safety, but also the clinical efficacy of dornase alfa (Tigerase): in a young child when a diagnosis was established, in a teenager with a successful transition to a biosimilar after a long-term administration, and in a teenager with mucoviscidosis, who successfully managed a covid infection during therapy with this drug. The authors emphasize that dornaza alfa is now the main component of the background therapy of patients with mucoviscidosis, and its representative Tigerase may be successfully used in variously-aged children.
One of the most likely and serious complications of the novel coronavirus infection (COVID-19) is pneumofibrosis, which can negatively affect the duration and quality of life of patients who have suffered from this disease. The appearance of fibrotic changes in COVID-19 is due to a number of pathological processes that occur in the lungs after the pathogen, the SARS- CoV-2 virus, enters there. First of all, an inflammatory response is triggered, which is mediated by macrophages and granulocytes, due to which the synthesis of pro-inflammatory cytokines, incl. IL-1, TNF, which are potent inducers of hyaluronic acid synthetase. There is a decrease in the content of fibrinolysis activators in the pulmonary endothelium, which contributes to the accumulation of fibrin in the vessels of the lungs. Fibrin can escape into the interstitial space and cause the formation of sclerosing alveolitis. The increasing defeat of pneumocytes favors the release of fibrin into the lumen of the alveoli, which causes the formation of hyaline membranes. The regulation of the fibrotic process involves immunocompetent cells, primarily CD4 + T-lymphocytes, which are capable of producing cytokines, chemokines and growth factors, and these, in turn, stimulate the proliferation and differentiation of fibroblasts, as well as their production of collagen. The more severe forms of infectious process can lead to the greater risk of developing fibrotic changes. Risk factors are a large area of lung damage, the use of artificial pulmonary ventilation, ARDS, fibrosis in anamnesis. An additional role in the pathomorphogenesis of pneumofibrosis is played by smoking, external inhalation effects (inhalation of organic and inorganic dust), gastroesophageal reflux, type II diabetes mellitus, genetic factors (familial idiopathic pulmonary fibrosis). The pathogenetic features of COVID-19 require administration of anti-fibrotic treatment. Bovhyaluronidazum azoximerum, a drug that is a conjugate of the proteolytic enzyme hyaluronidase, is considered as an antifibrotic agent. The treatment regimens with this drug recommended in the period of convalescence for patients who have undergone COVID-19 are given.
Patients with COVID-19 may develop various neurological disorders of the central and peripheral nervous systems. It is known that diabetes mellitus (DM) type 1 or 2, cardiovascular diseases, obesity, old age and old age, male gender are risk factors for a severe course and complications of COVID-19. Currently, the COVID-19 pandemic is ongoing, and patients with the listed risk factors are recommended to follow a regime of social restriction or self-isolation. Outpatient treatment is most appropriate for this category of patients. Patients with diabetes who have undergone COVID-19 are at risk of developing or progressing diabetic polyneuropathy (DPN). It seems relevant to develop the principles of effective treatment of patients with DM and DPN in outpatient settings. Glycemic level correction, diet, weight normalization, therapy of combined cardiovascular diseases, an increase of physical activity, sleep normalization, maintenance of normal psychological state are the main principles of treatment of patients with DM and DPN in COVID-19 pandemic conditions. Pathogenetic therapy of DPN continues to be discussed, in our country the preparations of B vitamins, alpha-lipoic acid are widely used. B-group vitamin preparations can be used in the form of tablets or solutions for intramuscular injections. The effectiveness of B vitamins (B1, B6, B12) in the treatment of a severe course of COVID- 19, prevention of complications of COVID-19, especially in elderly patients and with diabetes is discussed.
Introduction. The use of remdesivir in patients with the new coronavirus infection COVID-19 is known to improve the prognosis of the disease. But there is not enough data on efficacy and safety of remdesivir use in patients from Russia. Aim. To evaluate the efficacy and safety of remdesivir in patients with COVID-19. Materials and methods. A comparative prospective study was conducted in two parallel groups. The study enrolled 300 patients diagnosed with COVID-19 (grade 1–3 severe pneumonia according to CT scan), who were divided into two groups (n = 150 in each) according to the prescription of remdesivir. Treatment efficacy was assessed by recording cases of disease progression and adverse outcomes. The safety of therapy was assessed by hepatotoxicity and nephrotoxicity. Results. Patients receiving remdesivir were significantly less likely to be transferred to the intensive care unit (OR 0.3884, 95% CI: 0.1645–0.9175) and to be on artificial ventilation (OR 0.3830, 95% CI: 0.1539–0.9527). Treatment with remdesivir had no significant effect on mortality (OR 0.4932, 95% CI: 0.08897–2.7346) and complications (OR 0.4391, 95% CI: 0.1623–1.1879), including acute respiratory distress syndrome (OR 0.3919, 95% CI: 0.07483–2.0524). The duration of hospitalization was significantly shorter in group 1 patients – 12.2533 days (95% CI: 11.4101–13.0966) compared to group 2 – 14.5267 days (95% CI: 13.5125–15.5408). Hepatotoxicity with remdesivir (OR 1.5376, 95% CI: 0.8035–2.9426), nephrotoxicity (OR 1.6338, 95% CI: 0.522–5.1141) were noted, but no statistically significant difference was found (p > 0.05). Conclusions. The addition of remdesivir to the basic regimen of patients with new coronavirus infection COVID-19 improved the course of the disease, reducing the risks of patients being transferred to the intensive care unit and of receiving artificial ventilation.
The COVID-19 pandemic was announced in 2020, and many professional medical societies had to review their algorithms for the management of high-risk patients. In addition to risk factors such as overweight, age over 65 years, cardiovascular disease, diabetes mellitus, and bronchial asthma, other chronic diseases should also be emphasized, taking into account possible immunosuppressive therapy. This publication presents two clinical cases of COVID-19 infection in patients with multiple sclerosis treated with ocrelizumab. During the course of the disease, both patients developed a cytokine storm and were treated with IL-6 blockers. Both cases ended with recovery and a subsequent return to anti-B-cell therapy. Given the mechanism of action of ocrelizumab, there are higher risks of infectious complications, including with COVID-19, but mortality is not higher than the population average. The information published to date may serve as a reason to consider the use of extended dosing intervals to minimize the possible risks of COVID-19 infection, which are probably highest in the first months after infusion.
The article notes features of the last epidemic season (2020-2021) in the form of extremely low activity of influenza viruses with SARS-CoV-2 remaining dominant in the etiological structure of acute respiratory viral infections. Presented own data indicating the heterogeneity of SARS-CoV-2 (Alpha, Delta, B.1.1.317, B.1.1.397, B.1.1.523) isolated from hospitalized patients was noted. An increase in the etiological role of bocavirus, alpha-coronavirus and metapneumovirus with a decrease in the frequency of parainfluenza viruses, adenoviruses, rhinoviruses and respiratory syncytial virus was established. An unusual shift of the period of maximum activity of respiratory syncytial virus to the 20th week was noted. Attention is paid to the need during the ongoing pandemic COVID-19 to fully immunize children as part of the National Immunization Calendar, also emphasized the role of mandatory annual vaccination against influenza. It is noted that the maximum protective effect of immunoprophylaxis of influenza acute and recurrent respiratory infections can be achieved with a combination of vaccination with bacterial lysates. The article presents a review of the literature and our data demonstrating the safety, good tolerability, and high clinical and immunological efficiency of polyvalent mechanical bacterial lysate for the prevention of acute and recurrent respiratory infections in children. It is shown that the use of polyvalent mechanical bacterial lysate during the prevaccination period makes it possible to substantially reduce the frequency of intercurrent infections, which reduces the number of temporary medical withdrawals and increases the coverage of vaccinations against influenza in organized groups to 85.1%. The role of trained immunity as one of the possible mechanisms providing nonspecific immunoprophylaxis during influenza vaccination and the use of bacterial lysates is discussed.
The article presents a comparative retrospective analysis of clinical, laboratory data and outcomes in 39 patients with severe COVID-19 complicated by acute respiratory distress syndrome, who received high-flow oxygen therapy. Of which, 19 patients additionally received 75 mg of inhaled surfactant BL twice daily for 5 days using a nebulizer. As a result, mortality rate in the group of patients receiving surfactant was 10.5%, while in the standard therapy group — 50%; the number of patients transferred to the mechanical ventilation was 21% and 70%, respectively. As the patients receiving the surfactant were injected with COVID-19 hyperimmune convalescent plasma and monoclonal antibodies to interleukin-6 receptors more often than those from the control group, we recalculated the results regardless of these patients. However, a significant difference between the mechanical ventilation rate (2.5 times less often in the surfactant group) and mortality rate (3.5 times less in the surfactant group) was observed. The duration of hospitalization and stay at the intensive care unit was not significantly different between patients with and without surfactant treatment. Inhalation therapy with surfactant BL was well tolerated even by patients with chronic obstructive pulmonary disease. In no case did therapy have to be stopped due to side effects, the most common of which was coughing during inhalation. This retrospective analysis shows that the prescription of an inhaled surfactant prior to transferring patients to mechanical ventilation can prevent the progression of respiratory failure, put down mechanical ventilation, and improve survival.
Arterial hypertension was one of the most common comorbidities associated with a high risk of death in hospitalized patients with COVID-19. Patients with hypertension are routinely and according to standards treated with angiotensinconverting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARB) II. ACE inhibitors or ARB II are included in fixed combinations of antihypertensive drugs recommended for patients with uncomplicated hypertension, as well as when combined with various comorbidities. During the COVID-19 pandemic, there were suggestions about the potential for a negative effect of drugs of these classes on the course and outcomes of a new coronavirus infection. There was a need for a quick response from the most reputable medical organizations to the question of the use of ACE inhibitors and ARB II during the COVID-19 pandemic. The expert position was soon published despite the lack of evidence from randomized clinical trials. Was there any reason for concern about the treatment of ACE inhibitors and ARB II for COVID-19? What are the relationships between the renin-angiotensin-aldosterone system (RAAS) and COVID-19? Is there any new data from clinical trials that can confirm or deny the previously presented position of professional societies regarding the use of RAAS blockers in COVID-19? What is the role of the difference in the mechanism of action of an ACE inhibitor and ARB II in COVID-19? Is it possible that RAAS blockers will be helpful in treating COVID-19? Will the tactics of hypertension pharmacotherapy change in the near future? In this review article, modern concepts on this problem are discussed and answers to the listed questions reflecting the achieved level of knowledge are formulated.
The main manifestations of COVID-19 are primarily interstitial pneumonia and respiratory failure. No less than 20% of patients have variable skin rashes, which try to be interpreted as markers and predictors of the peculiarities of the course of coronavirus infection. In addition, hair loss is a characteristic manifestation of COVID-19, and the salivary follicles are regarded as a target for SARS-CoV-2. The most common variants of alopecia in patients with a new coronavirus infection or vaccine-induced alopecia are acute telogenic, nondescript, and androgenetic alopecia. This review provides information on the most common variants of hair loss in patients with SARS-CoV-2 infection, the features of their manifestations, and possible mechanisms of development. Acute telogenic hair loss is the most common variant of SARS-CoV-2-induced alopecia, is characteristic of patients with subacute course of COVID-19 and can be combined with trichodynia, anosmia and aguvia, which are markers of nervous syste damage. Given the variability in the time of onset after infection, a heterogeneous pathogenesis of alopecia can be assumed. Nested alopecia after COVID-19 is often a relapse of the disease, its severity and frequency do not correlate with the severity of the infectious disease, and its prevalence in women indicates the importance of hormonal factors in its development. Androgenetic alopecia may be a predictor of high risk of infection, severe course, and recurrence of COVID-19. The first two variants of alopecia may be associated with COVID-19 vaccination, and the latter is a predictor of inadequate immune response to vaccine administration. The mechanisms of the damaging effects of SARS-CoV-2 on hair follicles have not been fully deciphered and are most likely complex, with different leading links in different types of hair loss. Deciphering these mechanisms may provide prerequisites for understanding the mechanisms of COVID-19 damage to other tissues and organs.
Introduction. In 2020, most doctors were at the frontlines in the fight against the novel coronavirus infection (COVID-19). In the process of searching for effective etiotropic drugs, news came in that type I interferons had been successfully used for the treatment of COVID-19. Choosing the optimal COVID-19 treatment strategy is of pivotal importance for vulnerable populations such as children.
Objective of the study. To show our own experience in providing medical care to children with COVID-19 and present the results of a comparative study of the efficacy and safety of interferon alfa-2b drugs combined with highly active antioxidants in the complex COVID-19 therapy in children.
Materials and methods. A comparative study of the efficacy and safety of interferon alfa-2b drugs combined with highly active antioxidants in the complex COVID-19 therapy in children was conducted. The study included children with a laboratoryconfirmed diagnosis of COVID-19 aged 1 – 17 years (n = 85). In the treatment group (n = 45), children received interferon alfa-2b drugs such as VIFERON® rectal suppositories and VIFERON® gel for topical administration according to the dosage regimen and standard therapy. In the control group (n = 40), children only received standard therapy in accordance with the recommendations of the Ministry of Health of Russia.
Results and discussion. 3,696 patients, including 3,507 children, received medical care in the City Children’s Hospital No. 1 in Kazan since April 2020. The share of laboratory-confirmed COVID-19 cases among admitted children was 21% (n = 736), of which 85 were enrolled in the study to assess the efficacy of complex therapy with interferon alpha-2b drugs combined with highly active antioxidants. The interferon alfa-2b therapy of COVID-19 children reduced the duration of the key clinical symptoms of the disease by 1.5-4 days and the virus elimination time by 6 days.
Conclusions. The use of interferon alfa-2b VIFERON® rectal suppositories and VIFERON® gel for topical administration according to the dose regimen in combination with the standard therapy in COVID-19 children contributed to faster elimination of clinical symptoms of the disease and virus elimination compared to the standard therapy.
The review presents modern views on the role of probiotics in the treatment and prevention of complications of the novel coronavirus COVID-19 infection. This infection can be complicated, for example, by the development of diarrhea after the use of antibacterial drugs in case of secondary bacterial infection, extrapulmonary viral infections, viremia, and the so-called «cytokine storm». The emphasis has been placed on such potentially beneficial effects of probiotics as а prevention of antibioticassociated diarrhea, prevention of intestinal damage induced directly by viral replication, prevention of leaky gut syndrome and immunomodulation in case of coronavirus COVID-19 infection. It has been shown that the use of probiotics alongside antibiotic therapy significantly reduces the risk of developing antibiotic-associated diarrhea, including such a severe variant as pseudomembranous colitis. The use of a probiotic during a viral respiratory disease reduces the risk of a severe disease course due to the positive modulation of inflammation and direct antiviral effects. Selected data showed the positive effect of probiotics on the tight junction stability of the intestine, which potentially protects against viremia and the penetration of immunogenic molecules into the internal environment of the body. In order to address the challenges adequately, a probiotic should meet certain requirements in terms of product quality, safety, evidence of efficacy, composition and understanding of the strains. The article presents data on the successful use of a multi-strain immuno-probiotic as an example demonstrating the therapeutic potential of modern multi-strain probiotics as a nonspecific immunomodulatory agent for the prevention of acute respiratory diseases.
The disease caused by the new coronavirus COVID-19 is considered by the world community as an emergency of internationalimportance. Along with the huge social importance, the COVID-19 pandemic has highlighted a number of principally new clinical and fundamental problems of immunopathology of human diseases. This problem is extremely urgent for patients suffering from immune-inflammatory rheumatic diseases (IIRD) due to their higher exposure to infectious complications. Achieving and maintaining control over the activity of IIRD plays an important role in reducing the incidence of comorbid infections in these patients. It has been shown that patients with IIRD undergoing active anti-rheumatic therapy are most likely not characterized by increased risk of respiratory or other life-threatening complications within COVID-19 compared to the general population. Given the need for continued monitoring of patients receiving these therapy, unjustified “prophylactic” cancellation should nevertheless be avoided, thereby increasing the risk of relapse of major IIRD. The article also discusses the issues related to the use of basic anti-rheumatic drugs in COVID-19. Currently there is no evidence to support the therapeutic and prophylactic efficacy of chloroquine or hydroxychloroquine in COVID-19. Tocilizumab can be considered as “lifesaving therapy” for patients with acute respiratory distress syndrome in COVID-19, if other treatments have failed or are unavailable. The use of baricitinib in hospitalized pneumonia patients as part of COVID-19 should be considered with extreme caution. The need for further research to assess the potential role of baricitinib for these patients is highlighted. In the absence of a COVID-19 vaccine in a continuing pandemic, vaccination against influenza and pneumococcal infection should be strongly recommended to the absolute majority of patients with IIRD. This is associated with a high risk of fatal respiratory infection in rheumatological patients, especially given the high respiratory tract involvement in COVID-19.
The novel coronavirus disease (COVID-19) pandemic has become a strength test for the national healthcare systems and medical professional communities. The pandemic gave a revealing insight into the provision of resuscitation care, a shortage of personnel and protective equipment, and the lack of effective drugs to treat a novel, poorly studied infection. Objective. To identify the attitude towards immunoprophylaxis in general and against the coronavirus infection (COVID-19) in particular among medical students and pediatricians and to assess the dynamics of compliance to vaccination in these groups. Materials and methods. The survey was conducted among the 5-6-year students of the medical and pediatric faculties of the Ryazan State Medical University (RSMU) of the Ministry of Health of Russia in 2017 and 2021, the groups of students included 250 and 225 people, respectively. The children’s polyclinic pediatrician groups included 45 and 60 people in 2017 and 2021, respectively. The survey was conducted anonymously, face-to-face, and without compulsion. The identical questionnaires asked students 13 questions and pediatricians 10 questions with suggested response options. Results and discussion. The percentage of students who correctly named the number of vaccine preventable diseases in the National Immunisation Schedule has significantly decreased; the number of students who were not aware of the availability of the chickenpox vaccine has increased by 1.9 times. In 2021, the number of students giving priority to domestic vaccines decreased by 2.3 times, and the number of those choosing imported drugs as better and safer ones has increased by 1.5 times. In 2021, the number of senior students who were vaccinated against influenza doubled as compared to 2017. At the same time, the students agreed to recommend their patients to be vaccinated against influenza 1.4 times more often. During the 2021 pediatrician survey, the number of respondents, who preferred imported vaccines as better and safer ones, increased by 4 times, and the number of domestic vaccine advocates decreased by 1.8 times. In addition, the number of pediatricians who did not decide on this issue has increased by 9.8 times. Сonclusion. The results of the survey showed that there is still a lack of compliance to vaccine prophylaxis in certain groups of the professional medical community. The student cohort showed a decrease in knowledge and confidence in the vaccine prophylaxis. Among practitioners, there has been a positive trend towards an increase in the percentage of pediatricians, who considered it expedient to vaccinate children with chronic pathology.
Introduction. Acute rhinosinusitis accounts for 40 % to 60 % of the morbidity in the structure of ENT pathology. COVID-19 pathogen, similarly to other respiratory viruses, can cause acute rhinosinusitis, which is the most relevant at the present time due to the ongoing pandemic. Viral etiology accounts for 90–98 % of all cases of acute rhinosinusitis. Accordingly, the choice of treatment tactics with antibacterial drugs in a number of cases is unreasonable and leads to the growth of antibiotic resistance. Local antiseptics containing sodium hypochlorite with a high safety profile that do not cause pathogen resistance are used to increase the effectiveness of therapy for acute rhinosinusitis. Objective. To evaluate the effectiveness of nasal spray containing sodium hypochlorite on the duration of the course of exacerbation and severity of acute rhinosinusitis during the epidemiological season. Materials and methods. The study involved 50 patients who were divided into 3 groups: 10 patients (group 1) with acute viral rhinosinusitis (therapy: sodium hypochlorite + decongestants); 20 patients (group 2) with acute bacterial rhinosinusitis (therapy: sodium hypochlorite + systemic antibacterial therapy); 20 patients (group 3) with acute bacterial rhinosinusitis (therapy: nasal lavage with isotonic sea salt solution + systemic antibacterial therapy). Results and discussion. Pathogen eradication – the absence of the original pathogen at the locus of the inflammatory process during dynamic microbiological examination – was found in 14 (35 %) clinical cases: in Group 2 (sodium hypochlorite) – 10 (25 %) and in Group 3 (nasal irrigation with isotonic sea water solution) – 4 (10 %). Conclusions. The results of microbiological studies showed effective antimicrobial properties of sodium hypochlorite when applied to the inflamed mucous membranes, expressed in a statistically significant reduction of bacterial semination of the nasal cavity epithelium.
Restrictions on the cancer care in an epidemic are observed in the most countries of the world. The first small publications gave information of the increased susceptibility of cancer patients to a new infection which led to the postpone of elective surgery, initiation of adjuvant therapy, and the transfer of specialist consultations to telemedicine. The cases of infections of medical personnel, as well as the reassignment of clinical units and clinics that previously assisted cancer patients to the treatment of patients with COVID-19, also contributed. This article presents the experience of treating viral infections in cancer patients from different countries. On the example of colon cancer, treatment approaches are considered that, in conditions of increased epidemic danger, will allow our patients to provide effective antitumor treatment. We recommend to use short course of radiotherapy with chemotherapy in patients with locally-advanced rectal tumors; short course of adjuvant chemotherapy in stage 3 colon cancer; rational decisions for choosing regimen in 1st and subsequent lines of systemic therapy in patients with metastatic disease.