Pub Date : 2023-01-20DOI: 10.17816/mechnikov116731
A. Zagrebneva, E. Simonova, Тatiana V. Mezenova, N. B. Burmistrova, Yuliya A. Gavrikova, Vladislav V. Dolgov, E. O. Morozova, Zh. M. Kodzeva, K. S. Sapogina, Anastasia A. Fomina
The growing demand for biological disease-modifying antirheumatic drugs (bDMARDs) and their high cost put a heavy burden on the healthcare budget, thereby limiting the availability of treatment for patients. The introduction of bDMARDs biosimilars into clinical practice has made it possible to expand the availability of therapy for a larger number of patients. Our analysis of the use of the biosimilar etanercept Erelzi in 103 patients with rheumatoid arthritis showed that the drug is highly effective in the treatment of rheumatoid arthritis. It can be used both in bionaive patients with the ineffectiveness of basic therapy, and in the case of medical switching from other biologics (including tumor necrosis factor alpha inhibitors (iTNF)) and targeted synthetic basic anti-inflammatory drugs (tsDMARDs), as well as when non-medical switching is necessary. The biosimilar of etanercept Erelzi has optimal cost of treatment course and the lowest cost-effectiveness value, which means that its use will not affect the budget and will make highly effective therapy available to more patients.
{"title":"Moscow experience of using etanercept biosimilar in patients with immune-inflammatory rheumatic diseases","authors":"A. Zagrebneva, E. Simonova, Тatiana V. Mezenova, N. B. Burmistrova, Yuliya A. Gavrikova, Vladislav V. Dolgov, E. O. Morozova, Zh. M. Kodzeva, K. S. Sapogina, Anastasia A. Fomina","doi":"10.17816/mechnikov116731","DOIUrl":"https://doi.org/10.17816/mechnikov116731","url":null,"abstract":"The growing demand for biological disease-modifying antirheumatic drugs (bDMARDs) and their high cost put a heavy burden on the healthcare budget, thereby limiting the availability of treatment for patients. The introduction of bDMARDs biosimilars into clinical practice has made it possible to expand the availability of therapy for a larger number of patients. Our analysis of the use of the biosimilar etanercept Erelzi in 103 patients with rheumatoid arthritis showed that the drug is highly effective in the treatment of rheumatoid arthritis. It can be used both in bionaive patients with the ineffectiveness of basic therapy, and in the case of medical switching from other biologics (including tumor necrosis factor alpha inhibitors (iTNF)) and targeted synthetic basic anti-inflammatory drugs (tsDMARDs), as well as when non-medical switching is necessary. The biosimilar of etanercept Erelzi has optimal cost of treatment course and the lowest cost-effectiveness value, which means that its use will not affect the budget and will make highly effective therapy available to more patients.","PeriodicalId":12949,"journal":{"name":"HERALD of North-Western State Medical University named after I.I. Mechnikov","volume":"109 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76370409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-20DOI: 10.17816/mechnikov111045
Denis S. Medvedev, N. Bakulina
BACKGROUND: De-escalation strategy of antimicrobial therapy demonstrates favorable short-term results: it lowers the mortality and reduces the cost of treatment. The long-term results of applying this strategy in the burn unit had not been studied previously. AIM: To compare the long-term results of the de-escalation approach to antimicrobial therapy on the microbial spectrum, resistance of the hospital microflora and consumption of antimicrobials in the burn unit. MATERIALS AND METHODS: The study comprises the data from the burn unit of the Severstal hospital for 2006, 2012 and 2021: statistical data on mortality and the average duration of hospital stay; microbiological data on spectrum and resistance of bacteria to antimicrobials. RESULTS: The use of the de-escalation strategy of antimicrobial therapy in the burn unit of the Healthcare Institution Severstal for 10 years has reduced mortality, length of stay, consumption of antimicrobials. De-escalation strategy has not significantly affect the spectrum of nosocomial microflora but has lowered the resistance of gram-positive microorganisms to antibiotics. There was a decrease in the drug resistance index for the main pathogens of infectious complications as a result of implementing the de-escalation strategy. CONCLUSIONS: The implementation a de-escalation strategy of antimicrobial therapy requires conducting periodic microbiological monitoring for early correction of starting antimicrobial regimens.
{"title":"Long term effects of de-escalation antimicrobial strategy in the burn unit","authors":"Denis S. Medvedev, N. Bakulina","doi":"10.17816/mechnikov111045","DOIUrl":"https://doi.org/10.17816/mechnikov111045","url":null,"abstract":"BACKGROUND: De-escalation strategy of antimicrobial therapy demonstrates favorable short-term results: it lowers the mortality and reduces the cost of treatment. The long-term results of applying this strategy in the burn unit had not been studied previously. \u0000AIM: To compare the long-term results of the de-escalation approach to antimicrobial therapy on the microbial spectrum, resistance of the hospital microflora and consumption of antimicrobials in the burn unit. \u0000MATERIALS AND METHODS: The study comprises the data from the burn unit of the Severstal hospital for 2006, 2012 and 2021: statistical data on mortality and the average duration of hospital stay; microbiological data on spectrum and resistance of bacteria to antimicrobials. \u0000RESULTS: The use of the de-escalation strategy of antimicrobial therapy in the burn unit of the Healthcare Institution Severstal for 10 years has reduced mortality, length of stay, consumption of antimicrobials. De-escalation strategy has not significantly affect the spectrum of nosocomial microflora but has lowered the resistance of gram-positive microorganisms to antibiotics. There was a decrease in the drug resistance index for the main pathogens of infectious complications as a result of implementing the de-escalation strategy. \u0000CONCLUSIONS: The implementation a de-escalation strategy of antimicrobial therapy requires conducting periodic microbiological monitoring for early correction of starting antimicrobial regimens.","PeriodicalId":12949,"journal":{"name":"HERALD of North-Western State Medical University named after I.I. Mechnikov","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81133593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-20DOI: 10.17816/mechnikov112004
A. A. Kurkov, B. Sigua, E. L. Lataria, D. V. Gurzhiy, Victoria E. Kvarku, A. Belyaeva, S. Vinnichuk, Abdul R. Abdulov, V. P. Zemlianoi
The incidence of neoplasms of the small intestine does not exceed 3% in the structure of all tumors of the gastrointestinal tract. Among them, the frequency of neuroendocrine tumors is about 30%. Due to the absence of pathognomonic symptoms, such tumors are usually detected at the stage of surgical complications such as intestinal obstruction or intestinal necrosis. In such a situation, the oncological process is already either locally widespread or generalized. Therefore, timely diagnosis of tumors should be based not only on the complaints and anamnesis, allowing to suspect the development of complications, but also on the use of modern imaging methods. A clinical case demonstrating the difficulties of timely diagnosis of a neuroendocrine tumor of the small intestine is presented.
{"title":"A case of successful treatment of a neuroendocrine tumor of the small intestine complicated by partial intestinal obstruction","authors":"A. A. Kurkov, B. Sigua, E. L. Lataria, D. V. Gurzhiy, Victoria E. Kvarku, A. Belyaeva, S. Vinnichuk, Abdul R. Abdulov, V. P. Zemlianoi","doi":"10.17816/mechnikov112004","DOIUrl":"https://doi.org/10.17816/mechnikov112004","url":null,"abstract":"The incidence of neoplasms of the small intestine does not exceed 3% in the structure of all tumors of the gastrointestinal tract. Among them, the frequency of neuroendocrine tumors is about 30%. Due to the absence of pathognomonic symptoms, such tumors are usually detected at the stage of surgical complications such as intestinal obstruction or intestinal necrosis. In such a situation, the oncological process is already either locally widespread or generalized. Therefore, timely diagnosis of tumors should be based not only on the complaints and anamnesis, allowing to suspect the development of complications, but also on the use of modern imaging methods. \u0000A clinical case demonstrating the difficulties of timely diagnosis of a neuroendocrine tumor of the small intestine is presented.","PeriodicalId":12949,"journal":{"name":"HERALD of North-Western State Medical University named after I.I. Mechnikov","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86161789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-20DOI: 10.17816/mechnikov112620
D. Enaldieva, R. V. Donskikh, P. Krivorotko, E. Imyanitov, E. Zhiltsova, A. Sokolenko, T. Tabagua, N. Amirov, R. Pesotsky, L. F. Shaikhelislamova, A. Emelyanov, V. Mortada, L. Gigolaeva, S. Yerechshenko, A. Komyakhov, K. Nikolaev, K. Zernov, Yana I. Bondarchuk, R. Paltuev, A. Bessonov, A. Artemyeva, V. Semiglazov, T. Semiglazova, V. Semiglazov, A. M. Belyaev
BACKGROUND: BRCA-associated triple-negative breast cancer does not only have a better overall survival rate, but also a longer recurrence-free period in compatison to patients with sporadic breast cancer. BRCA-associated triple-negative breast cancer shows high sensitivity to chemotherapeutic agents, but the benefit of systemic neoadjuvant therapy for patients with tumor size T1 in triple-negative breast cancer is unclear. AIM: The aim of the study is to determine the recurrence rate in the patients with BRCA-associated triple-negative breast cancer and to determine the recurrence rate for the group of patients with tumor size T1, depending on the initial treatment. MATERIALS AND METHODS: The study includes the data of 129 patients diagnosed with BRCA-associated triple-negative breast cancer treated in the period from 2010 to 2022 at the Department of Breast Tumors of the N.N. Petrov National Medical Research Center of Oncology. All the patients have been divided into two groups depending on the initial treatment. Group I included 93 (72.1%) patients whose treatment was started with systemic neoadjuvant therapy, group II, whose initial treatment involved surgery, included 36 (27.9%) patients. RESULTS: In group I, the number of recurrences was 22 (23.6%), and in group II 6 (16.6%). Depending on the pathomorphological response to systemic neoadjuvant therapy, the patients of group I have been separated: in the group of patients with a complete pathomorphological response, the number of relapses was 6 (13.3%), and in the group of patients with a partial pathomorphological response 16 (33.3%). A comparative analysis of 2 groups with tumor size T1 has shown that in group I the number of patients with tumor size T1 was 11 (11.8%) cases, and in group II 16 (44.4%). Subgroup comparative analysis in group I, taking into account tumor size T1, has shown that recurrence has not been observed when a complete pathomorphological response was achieved in 8 (17.7%) patients, and in the group with partial pathomorphological response in 3 (6.25%) patients with tumor size T1. A relapse has been observed in 1 (2%) case. With clinical tumor size T1 (n = 16), there was no recurrence in group II. CONCLUSIONS: Patients diagnosed with BRCA-associated triple-negative breast cancer remain at a high risk of recurrence at a later stage of the disease, but this does not apply to patients with a tumor size T1 since the difference in relapse-free survival [AP1] between patients, whose treatment was started with neoadjuvant systemic therapy and patients, whose initial treatment involved surgery % with a clinical tumor size T1, is not confirmed.
{"title":"Comparative analysis of the effectiveness of neoadjuvant systemic therapy and primary surgical treatment of patients with BRCA-associated triple-negative T1 breast cancer","authors":"D. Enaldieva, R. V. Donskikh, P. Krivorotko, E. Imyanitov, E. Zhiltsova, A. Sokolenko, T. Tabagua, N. Amirov, R. Pesotsky, L. F. Shaikhelislamova, A. Emelyanov, V. Mortada, L. Gigolaeva, S. Yerechshenko, A. Komyakhov, K. Nikolaev, K. Zernov, Yana I. Bondarchuk, R. Paltuev, A. Bessonov, A. Artemyeva, V. Semiglazov, T. Semiglazova, V. Semiglazov, A. M. Belyaev","doi":"10.17816/mechnikov112620","DOIUrl":"https://doi.org/10.17816/mechnikov112620","url":null,"abstract":"BACKGROUND: BRCA-associated triple-negative breast cancer does not only have a better overall survival rate, but also a longer recurrence-free period in compatison to patients with sporadic breast cancer. BRCA-associated triple-negative breast cancer shows high sensitivity to chemotherapeutic agents, but the benefit of systemic neoadjuvant therapy for patients with tumor size T1 in triple-negative breast cancer is unclear. \u0000AIM: The aim of the study is to determine the recurrence rate in the patients with BRCA-associated triple-negative breast cancer and to determine the recurrence rate for the group of patients with tumor size T1, depending on the initial treatment. \u0000MATERIALS AND METHODS: The study includes the data of 129 patients diagnosed with BRCA-associated triple-negative breast cancer treated in the period from 2010 to 2022 at the Department of Breast Tumors of the N.N. Petrov National Medical Research Center of Oncology. All the patients have been divided into two groups depending on the initial treatment. Group I included 93 (72.1%) patients whose treatment was started with systemic neoadjuvant therapy, group II, whose initial treatment involved surgery, included 36 (27.9%) patients. \u0000RESULTS: In group I, the number of recurrences was 22 (23.6%), and in group II 6 (16.6%). Depending on the pathomorphological response to systemic neoadjuvant therapy, the patients of group I have been separated: in the group of patients with a complete pathomorphological response, the number of relapses was 6 (13.3%), and in the group of patients with a partial pathomorphological response 16 (33.3%). A comparative analysis of 2 groups with tumor size T1 has shown that in group I the number of patients with tumor size T1 was 11 (11.8%) cases, and in group II 16 (44.4%). Subgroup comparative analysis in group I, taking into account tumor size T1, has shown that recurrence has not been observed when a complete pathomorphological response was achieved in 8 (17.7%) patients, and in the group with partial pathomorphological response in 3 (6.25%) patients with tumor size T1. A relapse has been observed in 1 (2%) case. With clinical tumor size T1 (n = 16), there was no recurrence in group II. \u0000CONCLUSIONS: Patients diagnosed with BRCA-associated triple-negative breast cancer remain at a high risk of recurrence at a later stage of the disease, but this does not apply to patients with a tumor size T1 since the difference in relapse-free survival [AP1] between patients, whose treatment was started with neoadjuvant systemic therapy and patients, whose initial treatment involved surgery % with a clinical tumor size T1, is not confirmed.","PeriodicalId":12949,"journal":{"name":"HERALD of North-Western State Medical University named after I.I. Mechnikov","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82737160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-16DOI: 10.17816/mechnikov106089
U. Mukhametov, S. Lyulin, D. Borzunov, I. Gareev
BACKGROUND: Today, growth factors, in particular bone morphogenetic proteins in the composition of osteoplastic materials, are widely used to accelerate bone tissue regeneration after injuries or diseases of the musculoskeletal system. There are various methods for evaluating the effectiveness of using these proteins, in particular, the methods for medical imaging and determining specific markers. Bone loss often occurs after trauma or injury, including surgery. Rapid impairment of bone formation and increased bone resorption, as reflected by biochemical markers of bone metabolism, may cause this bone loss. Therefore, the detection of these markers in patients after spinal fusion using bone morphogenetic proteins is important in assessing the effectiveness of this therapy at various stages of observation in the postoperative period. However, due to the widespread use of bone morphogenetic proteins, their therapeutic efficacy can increasingly be seen in everyday radiological practice. X-ray or computed tomography is usually used to assess the effectiveness of the surgical intervention. Magnetic resonance imaging may be a useful adjunct, however, postoperative magnetic resonance imaging analysis is vulnerable to hardware artifacts. Although there is extensive data in the literature on the outcomes of surgical interventions for spondylodesis using bone morphogenetic proteins, radiographic data and data on the detection of specific markers and their use are scarce. AIM: In this study, we will discuss the current knowledge about existing and possible methods for evaluating the effectiveness of the use of bone morphogenetic proteins in spondylodesis. MATERIALS AND METHODS: Using PubMed, Embase, the Cochrane Database, and Google Scholar, we conducted a comprehensive literature search demonstrating possible methods for evaluating the effectiveness of bone morphogenetic proteins in spondylodesis. RESULTS: This study presents various methods for determining the effectiveness of the use of bone morphogenetic proteins in spondylodesis. In addition, the results of preclinical and clinical studies, which analyzed the effectiveness of the use of bone morphogenetic proteins, have been analyzed. CONCLUSIONS: To identify the effectiveness of bone morphogenetic proteins in spondylodesis further preclinical and clinical studies are required.
{"title":"Methods for assessing the effectiveness of using bone morphogenetic proteins in spondylodesis","authors":"U. Mukhametov, S. Lyulin, D. Borzunov, I. Gareev","doi":"10.17816/mechnikov106089","DOIUrl":"https://doi.org/10.17816/mechnikov106089","url":null,"abstract":"BACKGROUND: Today, growth factors, in particular bone morphogenetic proteins in the composition of osteoplastic materials, are widely used to accelerate bone tissue regeneration after injuries or diseases of the musculoskeletal system. There are various methods for evaluating the effectiveness of using these proteins, in particular, the methods for medical imaging and determining specific markers. Bone loss often occurs after trauma or injury, including surgery. Rapid impairment of bone formation and increased bone resorption, as reflected by biochemical markers of bone metabolism, may cause this bone loss. Therefore, the detection of these markers in patients after spinal fusion using bone morphogenetic proteins is important in assessing the effectiveness of this therapy at various stages of observation in the postoperative period. However, due to the widespread use of bone morphogenetic proteins, their therapeutic efficacy can increasingly be seen in everyday radiological practice. X-ray or computed tomography is usually used to assess the effectiveness of the surgical intervention. Magnetic resonance imaging may be a useful adjunct, however, postoperative magnetic resonance imaging analysis is vulnerable to hardware artifacts. Although there is extensive data in the literature on the outcomes of surgical interventions for spondylodesis using bone morphogenetic proteins, radiographic data and data on the detection of specific markers and their use are scarce. \u0000AIM: In this study, we will discuss the current knowledge about existing and possible methods for evaluating the effectiveness of the use of bone morphogenetic proteins in spondylodesis. \u0000MATERIALS AND METHODS: Using PubMed, Embase, the Cochrane Database, and Google Scholar, we conducted a comprehensive literature search demonstrating possible methods for evaluating the effectiveness of bone morphogenetic proteins in spondylodesis. \u0000RESULTS: This study presents various methods for determining the effectiveness of the use of bone morphogenetic proteins in spondylodesis. In addition, the results of preclinical and clinical studies, which analyzed the effectiveness of the use of bone morphogenetic proteins, have been analyzed. \u0000CONCLUSIONS: To identify the effectiveness of bone morphogenetic proteins in spondylodesis further preclinical and clinical studies are required.","PeriodicalId":12949,"journal":{"name":"HERALD of North-Western State Medical University named after I.I. Mechnikov","volume":"505 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77833027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-16DOI: 10.17816/mechnikov110874
A. Elikov
BACKGROUND: The study of antioxidant protection state is important both for diagnosing the influence of forced hypodynamia on the main pathological process and development of the approaches to minimize these adverse manifestations. AIM: To study the state of antioxidant protection system in blood plasma and erythrocytes in the patients with tibia and femur fractures depending on the duration of immobilization. MATERIALS AND METHODS: The study involves biochemical examination of 20 patients with shin and hip fractures aged from 18 to 50 years, without a concomitant pathology, who underwent skeletal traction associated with prolonged restriction of motor activity. Blood sampling was performed on the 7th, 14th, 21st, 28th, and 35th days after injury. The main parameters of the antioxidant defense system in the blood plasma and erythrocytes have been studied. RESULTS: A stagewise shift of the studied parameters depending on the time of immobilization has been established. The maximum decrease in the antioxidant defense action has been noted on the 21th day, while relative stabilization of the indicators has been noted on the 35th day of the observation. CONCLUSIONS: The findings can be recommended to estimate the effect of forced limitation of motor activity on the posttraumatic process. The necessity of including vitamins with antioxidant action in the complex therapy of the patients of the corresponding profile has been proved.
{"title":"State of the antioxidant protection system in trauma patients during prolonged immobilization","authors":"A. Elikov","doi":"10.17816/mechnikov110874","DOIUrl":"https://doi.org/10.17816/mechnikov110874","url":null,"abstract":"BACKGROUND: The study of antioxidant protection state is important both for diagnosing the influence of forced hypodynamia on the main pathological process and development of the approaches to minimize these adverse manifestations. \u0000AIM: To study the state of antioxidant protection system in blood plasma and erythrocytes in the patients with tibia and femur fractures depending on the duration of immobilization. \u0000MATERIALS AND METHODS: The study involves biochemical examination of 20 patients with shin and hip fractures aged from 18 to 50 years, without a concomitant pathology, who underwent skeletal traction associated with prolonged restriction of motor activity. Blood sampling was performed on the 7th, 14th, 21st, 28th, and 35th days after injury. The main parameters of the antioxidant defense system in the blood plasma and erythrocytes have been studied. \u0000RESULTS: A stagewise shift of the studied parameters depending on the time of immobilization has been established. The maximum decrease in the antioxidant defense action has been noted on the 21th day, while relative stabilization of the indicators has been noted on the 35th day of the observation. \u0000CONCLUSIONS: The findings can be recommended to estimate the effect of forced limitation of motor activity on the posttraumatic process. The necessity of including vitamins with antioxidant action in the complex therapy of the patients of the corresponding profile has been proved.","PeriodicalId":12949,"journal":{"name":"HERALD of North-Western State Medical University named after I.I. Mechnikov","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76306202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-16DOI: 10.17816/mechnikov109536
I. Sukhomlinova, I. Bakulin, M. Kabanov
BACKGROUND: Anti-inflammatory therapy is a leading method of pathogenetic treatment of moderate and severe forms of COVID-19. The drugs used during anti-inflammatory therapy, in particular, dexamethasone, olokizumab, tocilizumab, and baricitinib, are still actually prescribed in off-label mode. Of course, their use is justified by the Russian and international clinical guidelines, practical experience, expert opinions. However, the opinion of an attending physician, based on the assessment of the risk/benefit ratio for each patient, is fundamental in determining a drug for anti-inflammatory therapy. Determination of clinical and laboratory predictors of anti-inflammatory therapy effectiveness in moderate and severe forms of COVID-19 will facilitate a decision-making process when identifying risk groups for developing an adverse outcome during anti-inflammatory therapy, as well as determining an optimal drug for an anti-inflammatory therapy, taking into account the identified criteria. AIM: To compare the effectiveness of preemptive anti-inflammatory therapy with anticytokine drugs (tocilizumab, olokizumab, baricitinib, dexamethasone) in the patients with moderate and severe COVID-19 to identify clinical, laboratory and instrumental predictors of anti-inflammatory therapy outcome. MATERIALS AND METHODS: A retrospective analysis of 229 cases of severe and moderate COVID-19 disease requiring various types of anti-inflammatory therapy at the Hospital of War Veterans, including the Lenexpo site. RESULTS: The study has identified the main (significantly affecting the outcome) and additional (significant) predictors of the effectiveness of anti-inflammatory therapy in moderate and severe forms of COVID-19. The main ones include: the level of oxygen support, the period from the onset of clinical manifestations, the level of C-reactive protein, D-dimer. The additional, but significant factors include: the amount of damage to the lung tissue according to the computed tomography data, the presence and degree of compensation of concomitant pathology, the presence of therapy for concomitant pathology, as well as the level of leukocytes and neutrophils in the clinical blood test. CONCLUSIONS: The presence of additional oxygen support is a leading predictor of the effectiveness of an anti-inflammatory therapy, and its administration as early as possible, if indicated, can significantly increase the chances of a favorable outcome for a patient with moderate to severe COVID-19. Important prognostic markers also include C-reactive protein and D-dimer. The presence of concomitant diseases in anamnesis, as well as the degree of lung damage according to computer tomography data, are significant factors; however, they should be compared with other clinical and laboratory data and the objective status of the patient in order to predict the outcome of an anti-inflammatory therapy.
{"title":"Clinical, laboratory and instrumental predictors of the effectiveness of anti-inflammatory therapy in COVID-19","authors":"I. Sukhomlinova, I. Bakulin, M. Kabanov","doi":"10.17816/mechnikov109536","DOIUrl":"https://doi.org/10.17816/mechnikov109536","url":null,"abstract":"BACKGROUND: Anti-inflammatory therapy is a leading method of pathogenetic treatment of moderate and severe forms of COVID-19. The drugs used during anti-inflammatory therapy, in particular, dexamethasone, olokizumab, tocilizumab, and baricitinib, are still actually prescribed in off-label mode. Of course, their use is justified by the Russian and international clinical guidelines, practical experience, expert opinions. However, the opinion of an attending physician, based on the assessment of the risk/benefit ratio for each patient, is fundamental in determining a drug for anti-inflammatory therapy. Determination of clinical and laboratory predictors of anti-inflammatory therapy effectiveness in moderate and severe forms of COVID-19 will facilitate a decision-making process when identifying risk groups for developing an adverse outcome during anti-inflammatory therapy, as well as determining an optimal drug for an anti-inflammatory therapy, taking into account the identified criteria. \u0000AIM: To compare the effectiveness of preemptive anti-inflammatory therapy with anticytokine drugs (tocilizumab, olokizumab, baricitinib, dexamethasone) in the patients with moderate and severe COVID-19 to identify clinical, laboratory and instrumental predictors of anti-inflammatory therapy outcome. \u0000MATERIALS AND METHODS: A retrospective analysis of 229 cases of severe and moderate COVID-19 disease requiring various types of anti-inflammatory therapy at the Hospital of War Veterans, including the Lenexpo site. \u0000RESULTS: The study has identified the main (significantly affecting the outcome) and additional (significant) predictors of the effectiveness of anti-inflammatory therapy in moderate and severe forms of COVID-19. The main ones include: the level of oxygen support, the period from the onset of clinical manifestations, the level of C-reactive protein, D-dimer. The additional, but significant factors include: the amount of damage to the lung tissue according to the computed tomography data, the presence and degree of compensation of concomitant pathology, the presence of therapy for concomitant pathology, as well as the level of leukocytes and neutrophils in the clinical blood test. \u0000CONCLUSIONS: The presence of additional oxygen support is a leading predictor of the effectiveness of an anti-inflammatory therapy, and its administration as early as possible, if indicated, can significantly increase the chances of a favorable outcome for a patient with moderate to severe COVID-19. Important prognostic markers also include C-reactive protein and D-dimer. The presence of concomitant diseases in anamnesis, as well as the degree of lung damage according to computer tomography data, are significant factors; however, they should be compared with other clinical and laboratory data and the objective status of the patient in order to predict the outcome of an anti-inflammatory therapy.","PeriodicalId":12949,"journal":{"name":"HERALD of North-Western State Medical University named after I.I. Mechnikov","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90436054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-16DOI: 10.17816/mechnikov108970
V. Mazurov, E. Nasonov, A. Lila, I. Gaydukova, O. Inamova, Natalia Yu. Leonchenkova
BACKGROUND: Decreasing new coronavirus infection-associated morbidity and mortality among patients with rheumatic diseases is one of the main goals of current rheumatology. Vaccination may be one of the ways to limit the incidence of new coronavirus infection in patients with rheumatic diseases. AIM: To evaluate the results of vaccination in the patients with rheumatic diseases against the new coronavirus infection according to the data from real clinical practice and a review of the literature. MATERIALS AND METHODS: 68 out of 556 literary medical sources and data from the St. Petersburg register of patients with rheumatic diseases as of September 1, 2021 (n = 16,263) have been analyzed. The data from the register have been compared with the population data on morbidity and mortality from a new coronavirus infection (data of the Ministry of Health of the Russian Federation). RESULTS: Despite the matched incidence rates of new coronavirus infection associated mortality and morbidity in rheumatological patients and population (morbidity 26.2 and 34.1% mortality 3.47 and 2.8%, respectively), the patients with rheumatic diseases demonstrate three times lower frequency of vaccination against new coronavirus infection (13.2% of patients versus 31.8% in the population, respectively). Vaccination is prescribed by rheumatologists in 8.2%; 75% of patients are self-vaccinated. Data analysis from 2,134 rheumatological patients vaccinated in 2021 have shown a decrease in the incidence of the new coronavirus infection to 0.25% compared to the incidence of unvaccinated patients (25.6%) in the absence of deaths among the vaccinated. There were no serious adverse reactions to vaccination among the vaccinated rheumatological patients; in 12% of the cases, pyrogenic post-vaccination reactions, arthralgias and myalgias have been noted. A prolonged pyrogenic reaction, myalgia, arthralgia, hypercreatinophosphataemia have been revealed in 11 patients, who recovered within 6 months. Exacerbations of the underlying rheumatic disease after vaccination has been revealed in 12% of the cases, all the exacerbations have been resolved with the use of standard tactics recommended by the Association of Russian Rheumatologists. The question of the timing and the necessity of revaccination, as well as the long-term efficacy and safety of vaccination, has not yet been resolved. Determining the level of antibodies to coronavirus infection can be a useful option in the formation of an individual vaccination plan for rheumatological patients in the present conditions. CONCLUSIONS: The register data show the efficacy and safety of vaccination against COVID-19 in rheumatological patients in the short term, including in relation to exacerbation of rheumatic disease, and justify the need to comply with epidemiological safety measures after vaccination.
{"title":"Problems associated with new coronavirus infection vaccination in patients with rheumatic diseases","authors":"V. Mazurov, E. Nasonov, A. Lila, I. Gaydukova, O. Inamova, Natalia Yu. Leonchenkova","doi":"10.17816/mechnikov108970","DOIUrl":"https://doi.org/10.17816/mechnikov108970","url":null,"abstract":"BACKGROUND: Decreasing new coronavirus infection-associated morbidity and mortality among patients with rheumatic diseases is one of the main goals of current rheumatology. Vaccination may be one of the ways to limit the incidence of new coronavirus infection in patients with rheumatic diseases. \u0000AIM: To evaluate the results of vaccination in the patients with rheumatic diseases against the new coronavirus infection according to the data from real clinical practice and a review of the literature. \u0000MATERIALS AND METHODS: 68 out of 556 literary medical sources and data from the St. Petersburg register of patients with rheumatic diseases as of September 1, 2021 (n = 16,263) have been analyzed. The data from the register have been compared with the population data on morbidity and mortality from a new coronavirus infection (data of the Ministry of Health of the Russian Federation). \u0000RESULTS: Despite the matched incidence rates of new coronavirus infection associated mortality and morbidity in rheumatological patients and population (morbidity 26.2 and 34.1% mortality 3.47 and 2.8%, respectively), the patients with rheumatic diseases demonstrate three times lower frequency of vaccination against new coronavirus infection (13.2% of patients versus 31.8% in the population, respectively). Vaccination is prescribed by rheumatologists in 8.2%; 75% of patients are self-vaccinated. Data analysis from 2,134 rheumatological patients vaccinated in 2021 have shown a decrease in the incidence of the new coronavirus infection to 0.25% compared to the incidence of unvaccinated patients (25.6%) in the absence of deaths among the vaccinated. There were no serious adverse reactions to vaccination among the vaccinated rheumatological patients; in 12% of the cases, pyrogenic post-vaccination reactions, arthralgias and myalgias have been noted. A prolonged pyrogenic reaction, myalgia, arthralgia, hypercreatinophosphataemia have been revealed in 11 patients, who recovered within 6 months. Exacerbations of the underlying rheumatic disease after vaccination has been revealed in 12% of the cases, all the exacerbations have been resolved with the use of standard tactics recommended by the Association of Russian Rheumatologists. \u0000The question of the timing and the necessity of revaccination, as well as the long-term efficacy and safety of vaccination, has not yet been resolved. Determining the level of antibodies to coronavirus infection can be a useful option in the formation of an individual vaccination plan for rheumatological patients in the present conditions. \u0000CONCLUSIONS: The register data show the efficacy and safety of vaccination against COVID-19 in rheumatological patients in the short term, including in relation to exacerbation of rheumatic disease, and justify the need to comply with epidemiological safety measures after vaccination.","PeriodicalId":12949,"journal":{"name":"HERALD of North-Western State Medical University named after I.I. Mechnikov","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78707157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-16DOI: 10.17816/mechnikov109061
B. Sigua, I. Kochanov, S. Boldueva, E. L. Latariya, D. V. Gurzhiy, Natalya A. Trostyanetskaya, Evgeny A. Zakharov, Anna V. Belyeva, N. S. Tretyakova, A. L. Efimov, Maria S. Emilyanova, V. Zemlyanoy
Patients with various forms of coronary artery disease often suffer from other comorbid conditions that affect the quality of life and make it difficult to select the optimal therapy. The most acute problem of comorbidity manifests itself in the need for surgical treatment, especially extensive surgical interventions. The key to successful surgical treatment in this category of patients is the work of a multidisciplinary team of specialists deciding on the operability, stages of surgical interventions, choice of methods revascularization and features of patient management in the postoperative period. The article presents a case of successful surgical treatment of the patient with unstable angina and gastric stump cancer, demonstrating the well-coordinated work of a multidisciplinary team of specialists.
{"title":"Combined surgical treatment of oncological patient with concomitant acute coronary syndrome with tumor lesions of the gastric stump in a multidisciplinary clinic","authors":"B. Sigua, I. Kochanov, S. Boldueva, E. L. Latariya, D. V. Gurzhiy, Natalya A. Trostyanetskaya, Evgeny A. Zakharov, Anna V. Belyeva, N. S. Tretyakova, A. L. Efimov, Maria S. Emilyanova, V. Zemlyanoy","doi":"10.17816/mechnikov109061","DOIUrl":"https://doi.org/10.17816/mechnikov109061","url":null,"abstract":"Patients with various forms of coronary artery disease often suffer from other comorbid conditions that affect the quality of life and make it difficult to select the optimal therapy. The most acute problem of comorbidity manifests itself in the need for surgical treatment, especially extensive surgical interventions. The key to successful surgical treatment in this category of patients is the work of a multidisciplinary team of specialists deciding on the operability, stages of surgical interventions, choice of methods revascularization and features of patient management in the postoperative period. The article presents a case of successful surgical treatment of the patient with unstable angina and gastric stump cancer, demonstrating the well-coordinated work of a multidisciplinary team of specialists.","PeriodicalId":12949,"journal":{"name":"HERALD of North-Western State Medical University named after I.I. Mechnikov","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72972542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-16DOI: 10.17816/mechnikov108652
A. Malinovskiy
There is a well established theory that an essential amino acid of threonine is incapable of transamination. According to this theory, in a diet of patients who suffer from nephropathy, including diabetic threonine, is not replaced by its ketoanalogue. However, transamination of threonine, in the human organism in particular, has been discovered by a number of researchers. This suggests that there is a possibility of replacing threonine by its nitrogen-free analogues in nutrition of patients with nephropathy. At the same time nitrogen-free analogues of all amino acids can be subject to oxidative decomposition subsequently not only up to the finishing products, but they can also form glucose or ketone bodies, or both. Depending on this, amino acids are divided into glucogenic only, ketogenic only or both at the same time. With reference to diabetes this becomes especially important as introduction of glucogenic amino acids and their nitrogen-free analogues has a positive effect, whereas that of ketogenic amino acids and their nitrogen-free analogues is inadmissible. This is caused by the fact that before being transformed into glucose, glucogenic amino acids are transformed into one or another component of Krebs cycle or into the pyruvic acid which is in balance with the components which stimulates oxydation of acetyl coenzyme A and, therefore, ketone bodies. Ketose with reference to diabetes can be caused by two reasons. While the main source of energy of a healthy person is carbohydrate, in case with diabetes fats perform the function being oxydized intensively, they form a great number of ketone bodies. The second reason is a decrease in the formation of oxaloacetic acid (Krebs cycle catalyst) from pyruvic acid due to a decrease in the formation of the latter from glucose and an increase in the use of the components of the Krebs cycle for gluconeogenesis. Ketose causes a sharp shift of pH value to more acidity as a result of accumulation of the acetoacetic acid and the -hydroxybutyric acid in blood and narcotic actions of the third ketonic body acetone. The reason for lethal outcome with reference to diabetes is diabetic coma caused by a sharp shift of pH value to more acidity, which disturbs the work of the ferments. Threonine has a strong glucogenic effect in the complete absence of a ketogenic effect on the human body. In this respect, nitrogen-free analogues of threonine do not differ from it.
{"title":"The possibility of replacing threonine by nitrogen-free analogues in a diet of patients with diabetic nephropathy: a biochemical aspect","authors":"A. Malinovskiy","doi":"10.17816/mechnikov108652","DOIUrl":"https://doi.org/10.17816/mechnikov108652","url":null,"abstract":"There is a well established theory that an essential amino acid of threonine is incapable of transamination. According to this theory, in a diet of patients who suffer from nephropathy, including diabetic threonine, is not replaced by its ketoanalogue. However, transamination of threonine, in the human organism in particular, has been discovered by a number of researchers. This suggests that there is a possibility of replacing threonine by its nitrogen-free analogues in nutrition of patients with nephropathy. At the same time nitrogen-free analogues of all amino acids can be subject to oxidative decomposition subsequently not only up to the finishing products, but they can also form glucose or ketone bodies, or both. Depending on this, amino acids are divided into glucogenic only, ketogenic only or both at the same time. \u0000With reference to diabetes this becomes especially important as introduction of glucogenic amino acids and their nitrogen-free analogues has a positive effect, whereas that of ketogenic amino acids and their nitrogen-free analogues is inadmissible. This is caused by the fact that before being transformed into glucose, glucogenic amino acids are transformed into one or another component of Krebs cycle or into the pyruvic acid which is in balance with the components which stimulates oxydation of acetyl coenzyme A and, therefore, ketone bodies. \u0000Ketose with reference to diabetes can be caused by two reasons. While the main source of energy of a healthy person is carbohydrate, in case with diabetes fats perform the function being oxydized intensively, they form a great number of ketone bodies. The second reason is a decrease in the formation of oxaloacetic acid (Krebs cycle catalyst) from pyruvic acid due to a decrease in the formation of the latter from glucose and an increase in the use of the components of the Krebs cycle for gluconeogenesis. \u0000Ketose causes a sharp shift of pH value to more acidity as a result of accumulation of the acetoacetic acid and the -hydroxybutyric acid in blood and narcotic actions of the third ketonic body acetone. The reason for lethal outcome with reference to diabetes is diabetic coma caused by a sharp shift of pH value to more acidity, which disturbs the work of the ferments. Threonine has a strong glucogenic effect in the complete absence of a ketogenic effect on the human body. In this respect, nitrogen-free analogues of threonine do not differ from it.","PeriodicalId":12949,"journal":{"name":"HERALD of North-Western State Medical University named after I.I. Mechnikov","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73996424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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