Introduction. The search for simple and informative markers for predicting positive outcomes in patients with liver cirrhosis (LC) does not affect its relevance.Aim. To study the possibility of using the “neutrophil to lymphocyte ratio” indicator as a predictor of development of LC complications and death.Materials and methods. For a retrospective clinical study, 225 case histories of patients with LC were selected from 2008 to 2018. Three groups were formed from them: group 1: patients with LC class A according to Child- Pugh (24n); Group 2: patients with LC class B and C according to Child- Pugh (201n); and group 3: healthy individuals (50n). A correlation analysis of the NLR indicator with the Child- Pugh and MELD scales was carried out. The prognostic value of NLR in the development of complications and death was analyzed.Results. Patients with LC had statistically significantly higher values of NLR compared to healthy individuals (p < 0.001). NLR had a statistically significant positive correlation with the Child- Pugh (p < 0.001) and MELD (p < 0.001) scales. NLR is a statistically significant predictor of the development of complications in patients with LC (p = 0.003). A NLR value > 2.3 had a sensitivity of 0.97 [95% CI: 0.92; 0.99] and specificity 0.19 [95% CI: 0.11; 0.29]. NLR statistically significantly correlated with the number of complications of LC (p<0.001) and served as a statistically significant predictor of death (p<0.001). A NLR value > 4.5 had a sensitivity of 0.24 [95% CI: 0.15; 0.36] and specificity 0.97 [95% CI: 0.92; 0.99].Conclusion. An NLR value of more than 2.3 increases the risk of complications in patients with LC, and an NLR value of more than 4.5 increases the risk of death.
{"title":"Prognostic value of the neutrophil to lymphocyte ratio in the clinical course of liver cirrhosis","authors":"M. R. Sarkarova, M. Maevskaya","doi":"10.21518/ms2024-187","DOIUrl":"https://doi.org/10.21518/ms2024-187","url":null,"abstract":"Introduction. The search for simple and informative markers for predicting positive outcomes in patients with liver cirrhosis (LC) does not affect its relevance.Aim. To study the possibility of using the “neutrophil to lymphocyte ratio” indicator as a predictor of development of LC complications and death.Materials and methods. For a retrospective clinical study, 225 case histories of patients with LC were selected from 2008 to 2018. Three groups were formed from them: group 1: patients with LC class A according to Child- Pugh (24n); Group 2: patients with LC class B and C according to Child- Pugh (201n); and group 3: healthy individuals (50n). A correlation analysis of the NLR indicator with the Child- Pugh and MELD scales was carried out. The prognostic value of NLR in the development of complications and death was analyzed.Results. Patients with LC had statistically significantly higher values of NLR compared to healthy individuals (p < 0.001). NLR had a statistically significant positive correlation with the Child- Pugh (p < 0.001) and MELD (p < 0.001) scales. NLR is a statistically significant predictor of the development of complications in patients with LC (p = 0.003). A NLR value > 2.3 had a sensitivity of 0.97 [95% CI: 0.92; 0.99] and specificity 0.19 [95% CI: 0.11; 0.29]. NLR statistically significantly correlated with the number of complications of LC (p<0.001) and served as a statistically significant predictor of death (p<0.001). A NLR value > 4.5 had a sensitivity of 0.24 [95% CI: 0.15; 0.36] and specificity 0.97 [95% CI: 0.92; 0.99].Conclusion. An NLR value of more than 2.3 increases the risk of complications in patients with LC, and an NLR value of more than 4.5 increases the risk of death.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":" 32","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141367884","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}
The review examines the epidemiology and risk factors of non-alcoholic fatty liver disease (NAFLD) for women. According to various sources, the global prevalence of NAFLD ranges from 20 to 40% of the adult population in the world. In Russia, 37.3% of polyclinic patients have NAFLD. NAFLD can occur at any age and has differences in prevalence and severity depending on ethnicity and gender. Over the past 10 years, there has been a trend towards an increase in the prevalence of NAFLD among women, as well as a sharper increase in mortality compared to men. Regardless of gender, prognostically significant risk factors for NAFLD include age, obesity, type 2 diabetes mellitus, insulin resistance, dyslipidemia. The clinical course and prognosis of NAFLD in women depends on age, reproductive stage and use of synthetic hormones. Premenopausal women have less pronounced liver fibrosis and a better life prognosis compared to postmenopausal men and women. The article describes the features of the course of NAFLD in the reproductive period, pre- and postmenopausal period, characterizes the effect of liver steatosis on the course and outcome of pregnancy, the perinatal condition of the mother and fetus. Thus, there are gender differences in the prevalence, risk factors, fibrosis, and clinical outcomes of NAFLD. The prevalence and severity of NAFLD in reproductive age is higher in men, but after menopause, there is an increase in this pathology in women, especially those with metabolic disorders. Liver steatosis can affect the course of pregnancy, labor and postpartum periods.
{"title":"Features of the course of non-alcoholic fatty liver disease in women at different age periods: literature review","authors":"I. Bulatova, T. P. Shevlyukova","doi":"10.21518/ms2024-112","DOIUrl":"https://doi.org/10.21518/ms2024-112","url":null,"abstract":"The review examines the epidemiology and risk factors of non-alcoholic fatty liver disease (NAFLD) for women. According to various sources, the global prevalence of NAFLD ranges from 20 to 40% of the adult population in the world. In Russia, 37.3% of polyclinic patients have NAFLD. NAFLD can occur at any age and has differences in prevalence and severity depending on ethnicity and gender. Over the past 10 years, there has been a trend towards an increase in the prevalence of NAFLD among women, as well as a sharper increase in mortality compared to men. Regardless of gender, prognostically significant risk factors for NAFLD include age, obesity, type 2 diabetes mellitus, insulin resistance, dyslipidemia. The clinical course and prognosis of NAFLD in women depends on age, reproductive stage and use of synthetic hormones. Premenopausal women have less pronounced liver fibrosis and a better life prognosis compared to postmenopausal men and women. The article describes the features of the course of NAFLD in the reproductive period, pre- and postmenopausal period, characterizes the effect of liver steatosis on the course and outcome of pregnancy, the perinatal condition of the mother and fetus. Thus, there are gender differences in the prevalence, risk factors, fibrosis, and clinical outcomes of NAFLD. The prevalence and severity of NAFLD in reproductive age is higher in men, but after menopause, there is an increase in this pathology in women, especially those with metabolic disorders. Liver steatosis can affect the course of pregnancy, labor and postpartum periods.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141366370","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}
D. Y. Konstantinov, L. L. Popova, S. Y. Vasilev, M. A. Popilov
Introduction. Violation of metabolic processes in the gastrointestinal tract in patients with chronic hepatitis C (HCV) leads to the accumulation of toxic metabolic products in the intestine, negatively affecting both the balance of the microbiota and the functional state of hepatocytes. The sorption of toxins released by opportunistic anaerobic bacteria contributes to the restoration of the population of bifidobacteria and lactobacilli, which has a beneficial effect on the functional state of the liver.Aim. To evaluate the clinical and laboratory efficacy and safety of Polysorb as part of complex pathogenetic therapy in patients with HCV with severe liver fibrosis.Materials and methods. The study included 62 patients with HCV in the stage of severe liver fibrosis (F3 according to METAVIR) of both sexes aged 18 to 65 years who were not receiving antiviral therapy. In the study group, pathogenetic therapy was supplemented with Polysorb. Clinical and laboratory parameters were evaluated before and after the course of treatment. The study of the intestinal microbiota was carried out by determining the concentration of volatile fatty acids (VFA) in the intestinal contents: acetic, propionic, butyric, the total content of isoC4 + isoC5 + isoC6 and the value of the anaerobic index by gas-liquid chromatography (chromatograph “Tsvet 100”, Russia).Results and discussion. Complex pathogenetic therapy of patients with HCV (F3), including the enterosorbent Polysorb, increases the effectiveness of treatment for clinical syndromes: right hypochondrium by 35.8%, asthenovegetative – by 13.6%, dyspeptic – from 8 to 22.5% (according to individual symptoms), cholestatic – by 8%, and also improves the biochemical parameters of liver function: p = 0.060; GGTP, p = 0.014 and it helps to stabilize the composition of the microbiota, increasing the total level of LVH (p < 0.05), mainly due to normalization of acetic acid values, improvement of the anaerobic index: before treatment -0.858 ± 0.152, after -0.601 ± 0.163 (p < 0.05).Conclusion. The inclusion of Polysorb in the pathogenetic therapy of patients with HCV (F3) helps to stabilize the composition of the microbiota, while no side effects or adverse events have been recorded.
{"title":"Clinical experience of using Polysorb in complex pathogenetic therapy of chronic hepatitis C with severe liver fibrosis","authors":"D. Y. Konstantinov, L. L. Popova, S. Y. Vasilev, M. A. Popilov","doi":"10.21518/ms2024-191","DOIUrl":"https://doi.org/10.21518/ms2024-191","url":null,"abstract":"Introduction. Violation of metabolic processes in the gastrointestinal tract in patients with chronic hepatitis C (HCV) leads to the accumulation of toxic metabolic products in the intestine, negatively affecting both the balance of the microbiota and the functional state of hepatocytes. The sorption of toxins released by opportunistic anaerobic bacteria contributes to the restoration of the population of bifidobacteria and lactobacilli, which has a beneficial effect on the functional state of the liver.Aim. To evaluate the clinical and laboratory efficacy and safety of Polysorb as part of complex pathogenetic therapy in patients with HCV with severe liver fibrosis.Materials and methods. The study included 62 patients with HCV in the stage of severe liver fibrosis (F3 according to METAVIR) of both sexes aged 18 to 65 years who were not receiving antiviral therapy. In the study group, pathogenetic therapy was supplemented with Polysorb. Clinical and laboratory parameters were evaluated before and after the course of treatment. The study of the intestinal microbiota was carried out by determining the concentration of volatile fatty acids (VFA) in the intestinal contents: acetic, propionic, butyric, the total content of isoC4 + isoC5 + isoC6 and the value of the anaerobic index by gas-liquid chromatography (chromatograph “Tsvet 100”, Russia).Results and discussion. Complex pathogenetic therapy of patients with HCV (F3), including the enterosorbent Polysorb, increases the effectiveness of treatment for clinical syndromes: right hypochondrium by 35.8%, asthenovegetative – by 13.6%, dyspeptic – from 8 to 22.5% (according to individual symptoms), cholestatic – by 8%, and also improves the biochemical parameters of liver function: p = 0.060; GGTP, p = 0.014 and it helps to stabilize the composition of the microbiota, increasing the total level of LVH (p < 0.05), mainly due to normalization of acetic acid values, improvement of the anaerobic index: before treatment -0.858 ± 0.152, after -0.601 ± 0.163 (p < 0.05).Conclusion. The inclusion of Polysorb in the pathogenetic therapy of patients with HCV (F3) helps to stabilize the composition of the microbiota, while no side effects or adverse events have been recorded.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":" 99","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141367926","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}
V. V. Skvortsov, E. Skvortsova, V. V. Kolomytsev, L. V. Goryunova
Alcoholic hepatitis is a progressive inflammatory-dystrophic lesion of the liver, the pathogenetic mechanism of which is based on alcoholic damage. Acute alcoholic hepatitis is defined primarily as an exacerbation of the chronic process of alcoholic liver disease. Two mechanisms are defined as the basis for the formation of alcohol-associated liver damage: primary (direct effect of ethanol on hepatocytes and oxidative stress provoked by it) and secondary (through changes in the gut-liver axis with dysbacteriosis and increased permeability of the intestinal wall). For the treatment of acute alcoholic hepatitis, mainly glucocorticosteroids are used, the action of which is directed at cytotoxic and inflammatory mechanisms of the pathogenesis of this disease. Also, phosphodiesterase inhibitors, broad-spectrum antibiotics (rifaximin), probiotics, prebiotics, synbiotics, enterosorbents and hepatoprotectors are actively used. Choosing a hepatoprotector that is effective and safe for patients is still a challenge. At the moment one of the most promising and optimal in terms of “price-quality” ratio drug from this group is a domestic drug from the group of combined hepatoprotectors – Remaxol (inosine + meglumine + methionine + nicotinamide + succinic acid). A clinical case of application of this drug in a patient diagnosed with acute alcoholic hepatitis combined with chronic alcoholic hepatopathy is presented. Not severe course (MELD: 16. Maddrey’s index: 14.04). Ademetionine was prescribed. On the background of the prescribed treatment slight improvements were noted, no significant changes in laboratory data were registered (MELD: 16, Maddrey index: 12.54). After replacement of the hepatoprotector by Remaxol, the following was observed: correction of the general condition, correction of the mental status, reduction of the severity of hepatosplenomegaly, normalization of laboratory parameters (MELD: 10. Maddrey’s index: 6.06). Based on the review of Russian and foreign literature, as well as personal experience in the use of Remaxol, we can conclude that this pharmacological agent contributes to a more favorable course of acute alcoholic hepatitis, a significant reduction in the risk of complications, as well as reducing the length of hospital stay and the cost of treatment.
{"title":"Acute alcoholic hepatitis – the role of modern hepatoprotectors","authors":"V. V. Skvortsov, E. Skvortsova, V. V. Kolomytsev, L. V. Goryunova","doi":"10.21518/ms2024-215","DOIUrl":"https://doi.org/10.21518/ms2024-215","url":null,"abstract":"Alcoholic hepatitis is a progressive inflammatory-dystrophic lesion of the liver, the pathogenetic mechanism of which is based on alcoholic damage. Acute alcoholic hepatitis is defined primarily as an exacerbation of the chronic process of alcoholic liver disease. Two mechanisms are defined as the basis for the formation of alcohol-associated liver damage: primary (direct effect of ethanol on hepatocytes and oxidative stress provoked by it) and secondary (through changes in the gut-liver axis with dysbacteriosis and increased permeability of the intestinal wall). For the treatment of acute alcoholic hepatitis, mainly glucocorticosteroids are used, the action of which is directed at cytotoxic and inflammatory mechanisms of the pathogenesis of this disease. Also, phosphodiesterase inhibitors, broad-spectrum antibiotics (rifaximin), probiotics, prebiotics, synbiotics, enterosorbents and hepatoprotectors are actively used. Choosing a hepatoprotector that is effective and safe for patients is still a challenge. At the moment one of the most promising and optimal in terms of “price-quality” ratio drug from this group is a domestic drug from the group of combined hepatoprotectors – Remaxol (inosine + meglumine + methionine + nicotinamide + succinic acid). A clinical case of application of this drug in a patient diagnosed with acute alcoholic hepatitis combined with chronic alcoholic hepatopathy is presented. Not severe course (MELD: 16. Maddrey’s index: 14.04). Ademetionine was prescribed. On the background of the prescribed treatment slight improvements were noted, no significant changes in laboratory data were registered (MELD: 16, Maddrey index: 12.54). After replacement of the hepatoprotector by Remaxol, the following was observed: correction of the general condition, correction of the mental status, reduction of the severity of hepatosplenomegaly, normalization of laboratory parameters (MELD: 10. Maddrey’s index: 6.06). Based on the review of Russian and foreign literature, as well as personal experience in the use of Remaxol, we can conclude that this pharmacological agent contributes to a more favorable course of acute alcoholic hepatitis, a significant reduction in the risk of complications, as well as reducing the length of hospital stay and the cost of treatment.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":" 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141367471","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}
Gilbert’s syndrome, also known as benign hyperbilirubinemia, was described more than 100 years ago. It has usually been considered a physiological abnormality characterized by a mild elevation of the systemic level of unconjugated bilirubin, in the absence of any underlying liver or overt RBC hemolysis. The molecular basis of Gilbert’s syndrome lies in the impairment of the conjugation of bilirubin with glucuronic acid in the hepatocytes, which is mediated by a specific hepatic enzyme named bilirubin-UDP-glucuronosyl transferase 1A1 that forms bilirubin diglucuronoside. Clearance of various xenobiotics, which are not substrates for glucuronosylation, is impaired in patients with Gilbert’s syndrome; their detailed list is provided in the article. Fatigue, asthenia, and various vaguely defined dyspeptic complaints attributed to Gilbert’s syndrome in the past are no longer considered a part of this condition, and proper evaluation of possible causes is required in these cases. Since the re-discovery of the potent antioxidant effects of bilirubin in the late 1980s, as well as the multiple intracellular signalling pathways affected by bilirubin, an ever-increasing body of evidence suggests that individuals with Gilbert’s syndrome may benefit from the mild hyperbilirubinemia and are actually protected from the development of a wide range of “diseases of civilization”, such as cardiovascular diseases, certain cancers, and autoimmune or neurodegenerative diseases. Gilbert’s syndrome is defined phenotypically, and therefore not according to predisposing genetic markers, as the elevation of serum unconjugated bilirubin concentration above the upper limit of normal, with no laboratory signs of hemolysis or liver damage. This review analyses the current state of medical knowledge given recent discoveries in this rapidly developing field, as well as their possible clinical significance, and provides a new perspective on this condition.
{"title":"“Dark and bright sides” of Gilbert’s syndrome","authors":"E. Y. Plotnikova, M. N. Sinkova, L. K. Isakov","doi":"10.21518/ms2024-212","DOIUrl":"https://doi.org/10.21518/ms2024-212","url":null,"abstract":"Gilbert’s syndrome, also known as benign hyperbilirubinemia, was described more than 100 years ago. It has usually been considered a physiological abnormality characterized by a mild elevation of the systemic level of unconjugated bilirubin, in the absence of any underlying liver or overt RBC hemolysis. The molecular basis of Gilbert’s syndrome lies in the impairment of the conjugation of bilirubin with glucuronic acid in the hepatocytes, which is mediated by a specific hepatic enzyme named bilirubin-UDP-glucuronosyl transferase 1A1 that forms bilirubin diglucuronoside. Clearance of various xenobiotics, which are not substrates for glucuronosylation, is impaired in patients with Gilbert’s syndrome; their detailed list is provided in the article. Fatigue, asthenia, and various vaguely defined dyspeptic complaints attributed to Gilbert’s syndrome in the past are no longer considered a part of this condition, and proper evaluation of possible causes is required in these cases. Since the re-discovery of the potent antioxidant effects of bilirubin in the late 1980s, as well as the multiple intracellular signalling pathways affected by bilirubin, an ever-increasing body of evidence suggests that individuals with Gilbert’s syndrome may benefit from the mild hyperbilirubinemia and are actually protected from the development of a wide range of “diseases of civilization”, such as cardiovascular diseases, certain cancers, and autoimmune or neurodegenerative diseases. Gilbert’s syndrome is defined phenotypically, and therefore not according to predisposing genetic markers, as the elevation of serum unconjugated bilirubin concentration above the upper limit of normal, with no laboratory signs of hemolysis or liver damage. This review analyses the current state of medical knowledge given recent discoveries in this rapidly developing field, as well as their possible clinical significance, and provides a new perspective on this condition.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":" 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141367287","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}
A. Korkmazov, M. A. Lengina, M. Korkmazov, N. V. Kornova
Introduction. The relevance of studying the possibility of using targeted therapy in the treatment of polypous rhinosinusitis in patients with comorbid bronchial asthma is due to the observed growth of the disease and the disclosure of new pathophysiological mechanisms of their development.Aim. Based on the generalization of research results and the analysis of our own clinical observations, to improve the effectiveness of treatment and the quality of life of patients with polypous rhinosinusitis with a history of severe bronchial asthma, using genetically engineered biological therapy.Materials and methods. The literature of the eLibrary databases is analyzed.RU RSCI, Medline, Scopus, Web of Science for the period 2011–2023. The inclusion of monoclonal antibodies in the treatment regimen for diseases that are difficult to treat with medication is based on the results of clinical studies and meta-analysis data. A study of the quality of life was conducted, according to the SF-36 Health Status Survey, 47 patients receiving targeted therapy with monoclonal antibodies in medical and preventive institutions of the megalopolis.Results. The assessment of the quality of life of patients with polypous rhinosinusitis and comorbid bronchial asthma confirmed the effectiveness of targeted therapy with monoclonal antibodies. According to the SP-36 questionnaire, before treatment, the low-est scores were on the Role-Physical Functioning scales – 51.5 points and General Health – 49.1 points, respectively. At the 2nd and 16th weeks of treatment, gradually increasing positive dynamics was noted on all scales and by the end of the 52nd week of monoclonal antibody use, values as close to normal as possible were recorded in the Social Functioning, Role Emotional, Mental Health scales and amounted to 97.7; 98,3 and 98.7 points. The effectiveness of the treatment was confirmed by two clinical cases.Conclusions. Knowledge of the immunological and pathogenetic mechanisms of the disease allows us to open up significant prospects for diagnosis and treatment. Recommendations and drug selection should be consistently followed within the framework of the clinical recommendations of the relevant diseases. Strict consideration of the development of short-term and long-term risks of the use of genetically engineered biological therapy is necessary.
{"title":"The effect of targeted therapy on the quality of life of patients with polypous rhinosinusitis and comorbid bronchial asthma","authors":"A. Korkmazov, M. A. Lengina, M. Korkmazov, N. V. Kornova","doi":"10.21518/ms2024-208","DOIUrl":"https://doi.org/10.21518/ms2024-208","url":null,"abstract":"Introduction. The relevance of studying the possibility of using targeted therapy in the treatment of polypous rhinosinusitis in patients with comorbid bronchial asthma is due to the observed growth of the disease and the disclosure of new pathophysiological mechanisms of their development.Aim. Based on the generalization of research results and the analysis of our own clinical observations, to improve the effectiveness of treatment and the quality of life of patients with polypous rhinosinusitis with a history of severe bronchial asthma, using genetically engineered biological therapy.Materials and methods. The literature of the eLibrary databases is analyzed.RU RSCI, Medline, Scopus, Web of Science for the period 2011–2023. The inclusion of monoclonal antibodies in the treatment regimen for diseases that are difficult to treat with medication is based on the results of clinical studies and meta-analysis data. A study of the quality of life was conducted, according to the SF-36 Health Status Survey, 47 patients receiving targeted therapy with monoclonal antibodies in medical and preventive institutions of the megalopolis.Results. The assessment of the quality of life of patients with polypous rhinosinusitis and comorbid bronchial asthma confirmed the effectiveness of targeted therapy with monoclonal antibodies. According to the SP-36 questionnaire, before treatment, the low-est scores were on the Role-Physical Functioning scales – 51.5 points and General Health – 49.1 points, respectively. At the 2nd and 16th weeks of treatment, gradually increasing positive dynamics was noted on all scales and by the end of the 52nd week of monoclonal antibody use, values as close to normal as possible were recorded in the Social Functioning, Role Emotional, Mental Health scales and amounted to 97.7; 98,3 and 98.7 points. The effectiveness of the treatment was confirmed by two clinical cases.Conclusions. Knowledge of the immunological and pathogenetic mechanisms of the disease allows us to open up significant prospects for diagnosis and treatment. Recommendations and drug selection should be consistently followed within the framework of the clinical recommendations of the relevant diseases. Strict consideration of the development of short-term and long-term risks of the use of genetically engineered biological therapy is necessary.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"8 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379360","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}
E. Lyubimova, E. Savlevich, A. V. Zurochka, E. S. Mitrofanova, O. Kurbacheva
Introduction. Chronic rhinosinusitis with nasal polyps (CRSwNP) pathogenesis is based on inadequate local immune response, additional SARS-CoV-2 infection can alter CRSwNP pathological process.Aim. To effect of COVID-19 on CRSwNP course in patients with different drug control degree.Materials and methods. 99 patients with bilateral CRSwNP (48 men, 51 women, 58.37 ± 14.43 years), were divided into 3 groups based on CRSwNP medical control degree for 5 years [17]. Group 1 (n = 34) – patients with mild CRSwNP received treatment according to treatment algorithm stages I and II. Group 2 (n = 32) – moderate severity CRSwNP, therapy corresponded to algorithm stage II or III. Group 3 (n = 33) – patients with severe CRSwNP received stage IV treatment 1 or more times. All data about vaccination against coronavirus infection and confirmed COVID-19 episodes with an analysis of its severity were recorded,Results. 63 people had COVID-19 (63.64%, 62.5 ± 13.1 years), of which 62.5% people were vaccinated before infection. COVID-19 was mild in 84.1% (54.70 ± 13.83 years), moderate COVID-19 – in 12.7% (63.1 ± 15.38 years), and severe – in 3.2% (age – 40 years). 36% people (62.5 ± 13.1 years) did not infected with coronavirus. In group 1 mild COVID-19 was observed in 35.29%, moderate severity – in 5.88%. In group 2 all patients who had COVID-19 (87.5%) had mild course. In group 3 39.39% patients had mild COVID-19, 18.18% had moderate COVID-19. Severe COVID-19 was observed in 2 people from this group.Conclusions. COVID-19 was mild in most cases in CRSwNP patients. In 84.1% patients were treated as outpatients. CRSwNP patients had frequent swabs to detect SARS-CoV-2 RNA due to complaints of hyposmia and raised coronavirus infection suspicion.
{"title":"Incidence of coronavirus disease (COVID-19) in patients with different degrees of chronic rhinosinusitis with nasal polyps","authors":"E. Lyubimova, E. Savlevich, A. V. Zurochka, E. S. Mitrofanova, O. Kurbacheva","doi":"10.21518/ms2024-094","DOIUrl":"https://doi.org/10.21518/ms2024-094","url":null,"abstract":"Introduction. Chronic rhinosinusitis with nasal polyps (CRSwNP) pathogenesis is based on inadequate local immune response, additional SARS-CoV-2 infection can alter CRSwNP pathological process.Aim. To effect of COVID-19 on CRSwNP course in patients with different drug control degree.Materials and methods. 99 patients with bilateral CRSwNP (48 men, 51 women, 58.37 ± 14.43 years), were divided into 3 groups based on CRSwNP medical control degree for 5 years [17]. Group 1 (n = 34) – patients with mild CRSwNP received treatment according to treatment algorithm stages I and II. Group 2 (n = 32) – moderate severity CRSwNP, therapy corresponded to algorithm stage II or III. Group 3 (n = 33) – patients with severe CRSwNP received stage IV treatment 1 or more times. All data about vaccination against coronavirus infection and confirmed COVID-19 episodes with an analysis of its severity were recorded,Results. 63 people had COVID-19 (63.64%, 62.5 ± 13.1 years), of which 62.5% people were vaccinated before infection. COVID-19 was mild in 84.1% (54.70 ± 13.83 years), moderate COVID-19 – in 12.7% (63.1 ± 15.38 years), and severe – in 3.2% (age – 40 years). 36% people (62.5 ± 13.1 years) did not infected with coronavirus. In group 1 mild COVID-19 was observed in 35.29%, moderate severity – in 5.88%. In group 2 all patients who had COVID-19 (87.5%) had mild course. In group 3 39.39% patients had mild COVID-19, 18.18% had moderate COVID-19. Severe COVID-19 was observed in 2 people from this group.Conclusions. COVID-19 was mild in most cases in CRSwNP patients. In 84.1% patients were treated as outpatients. CRSwNP patients had frequent swabs to detect SARS-CoV-2 RNA due to complaints of hyposmia and raised coronavirus infection suspicion.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141381459","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}
Introduction. Nowadays, a multifactorial model of the pathogenesis of NAFLD is recognized. It is interesting to study the contribution of changes in the composition of the intestinal microbiota and its metabolites in the development of the disease.Aim. To evaluate the contribution of research into the qualitative composition of the intestinal microbiota in relation to the risk of progression of NAFLD to reduce the loss of health- saving potential of the population.Materials and methods. An open comparative study of 83 mature-aged patients (56.6 years (46–63)) suffering from NAFLD was conducted. The levels of insulin, leptin, its receptor, adiponectin in blood serum, zonulin in feces were studied, and SCFA in feceswas determined. The analysis was carried out depending on the phenotypes of NAFLD: the degree of steatosis (1 – 40 patients, degree 2 – 18 and degree 3 – 25), the presence of NASH (43 patients), the presence of fibrosis (fibrosis was found in 35 patients). The degree of steatosis and fibrosis was assessed using elastometry. The results of the study were analyzed using the Microsoft Excel, STATISTICA 12.0 software package.Results. In patients with NAFLD, the absolute number of all SCFA in the feces was reduced. The anaerobic index was deviated towards sharply negative values (-0,711 (-0,576-(-0,830)). A high level of propionic acid was noted among the patients with fibrosis (p < 0.05). Anaerobic index, relative content of isoC4 + isoC5 + isoC6, relative content of butyric acid had a positive relationship with the St-index (rs = 0.254, rs = 0.269, rs = 0.240, p≤ 0.05). An increase in the relative amount of propionic acid was statistically significantly associated with a decrease of FLI (rs = -0.229, p ≤0.05). A positive correlation was found between the level of insulin and the absolute amount of butyric acid C4 (rs = 0.228, p ≤ 0.05). There was an inverse relationship of the absolute and relative amounts of isoC4+ isoC5 + isoC6 and Iso Cn/Cn with zonulin in the feces (rs = -0.231, p ≤ 0.05, rs = -0.380, p ≤ 0.05 and rs = -0.332, p ≤ 0.05, respectively).Conclusion. There is the anaerobic flora among the patients with NAFLD. Modification of the content of SCFA in feces may affect to the progression of NAFLD. The effect of SCFA on the development and progression of NAFLD may be mediated by the development of insulin and leptin resistance, as well as an integrity violation of the intestinal barrier.
{"title":"The role of short-chain fatty acids in the progression of non-alcoholic fatty liver disease","authors":"T. Krolevets, M. Livzan, M. I. Syrovenko","doi":"10.21518/ms2024-009","DOIUrl":"https://doi.org/10.21518/ms2024-009","url":null,"abstract":"Introduction. Nowadays, a multifactorial model of the pathogenesis of NAFLD is recognized. It is interesting to study the contribution of changes in the composition of the intestinal microbiota and its metabolites in the development of the disease.Aim. To evaluate the contribution of research into the qualitative composition of the intestinal microbiota in relation to the risk of progression of NAFLD to reduce the loss of health- saving potential of the population.Materials and methods. An open comparative study of 83 mature-aged patients (56.6 years (46–63)) suffering from NAFLD was conducted. The levels of insulin, leptin, its receptor, adiponectin in blood serum, zonulin in feces were studied, and SCFA in feceswas determined. The analysis was carried out depending on the phenotypes of NAFLD: the degree of steatosis (1 – 40 patients, degree 2 – 18 and degree 3 – 25), the presence of NASH (43 patients), the presence of fibrosis (fibrosis was found in 35 patients). The degree of steatosis and fibrosis was assessed using elastometry. The results of the study were analyzed using the Microsoft Excel, STATISTICA 12.0 software package.Results. In patients with NAFLD, the absolute number of all SCFA in the feces was reduced. The anaerobic index was deviated towards sharply negative values (-0,711 (-0,576-(-0,830)). A high level of propionic acid was noted among the patients with fibrosis (p < 0.05). Anaerobic index, relative content of isoC4 + isoC5 + isoC6, relative content of butyric acid had a positive relationship with the St-index (rs = 0.254, rs = 0.269, rs = 0.240, p≤ 0.05). An increase in the relative amount of propionic acid was statistically significantly associated with a decrease of FLI (rs = -0.229, p ≤0.05). A positive correlation was found between the level of insulin and the absolute amount of butyric acid C4 (rs = 0.228, p ≤ 0.05). There was an inverse relationship of the absolute and relative amounts of isoC4+ isoC5 + isoC6 and Iso Cn/Cn with zonulin in the feces (rs = -0.231, p ≤ 0.05, rs = -0.380, p ≤ 0.05 and rs = -0.332, p ≤ 0.05, respectively).Conclusion. There is the anaerobic flora among the patients with NAFLD. Modification of the content of SCFA in feces may affect to the progression of NAFLD. The effect of SCFA on the development and progression of NAFLD may be mediated by the development of insulin and leptin resistance, as well as an integrity violation of the intestinal barrier.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"320 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141381365","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}
A. Korkmazov, A. Solodovnik, N. V. Kornova, L. S. Krasheninnikova
Introduction. In pediatric otorhinolaryngological practice, chronic adenoiditis is one of the most common diseases and causes the search for additional and effective methods of treatment.Aim. To evaluate the clinical effectiveness of the use of aqueous solutions treated with low-frequency ultrasound with high specific energy and monochromatic light radiation in the complex therapy of chronic adenoiditis in children.Materials and methods. The number of participants in the study was 104 patients aged 4 to 15 years with a verified diagnosis of chronic adenoiditis and were divided into 3 groups depending on the treatment. A comparative analysis of the results obtained was carried out before the start of therapy (day 0) and on the 7th day after the treatment. The state of the nasopharynx was assessed using a flexible nasopharyngoscope, as well as the structure of the middle ear and auditory tube during acoustic impedancemetry.Results. The use of a course of treatment of low-frequency ultrasonic cavitation in combination with photochromotherapy made it possible to relieve the signs of chronic adenoiditis in 62% of cases (p < 0.001), reduce the number of patients with grade III adenoid hypertrophy by 54% (p = 0.035), and reduce by 2 times (p = 0.05) number of relapses of chronic adenoiditis. In the group of children using low-frequency ultrasonic cavitation, the positive effect of treatment was 3.3 times [CI 0.75; 14.6] higher compared to the control group, and in combination with photochromotherapy it was 3.6 times [CI 0.85; 15.5]. The absence of adenotomy was assessed as a positive effect.Conclusion. The data obtained showed that the inclusion of non-drug methods of physical influence (low-frequency ultrasonic cavitation both in monotherapy and in combination with photochromotherapy) in complex treatment can reduce the number of surgical interventions on the organs of the lymphopharyngeal ring – the pharyngeal tonsil.
{"title":"Chronic adenoiditis and its effect on the reactivity of the bronchopulmonary system, the possibility of non-drug correction","authors":"A. Korkmazov, A. Solodovnik, N. V. Kornova, L. S. Krasheninnikova","doi":"10.21518/ms2024-071","DOIUrl":"https://doi.org/10.21518/ms2024-071","url":null,"abstract":"Introduction. In pediatric otorhinolaryngological practice, chronic adenoiditis is one of the most common diseases and causes the search for additional and effective methods of treatment.Aim. To evaluate the clinical effectiveness of the use of aqueous solutions treated with low-frequency ultrasound with high specific energy and monochromatic light radiation in the complex therapy of chronic adenoiditis in children.Materials and methods. The number of participants in the study was 104 patients aged 4 to 15 years with a verified diagnosis of chronic adenoiditis and were divided into 3 groups depending on the treatment. A comparative analysis of the results obtained was carried out before the start of therapy (day 0) and on the 7th day after the treatment. The state of the nasopharynx was assessed using a flexible nasopharyngoscope, as well as the structure of the middle ear and auditory tube during acoustic impedancemetry.Results. The use of a course of treatment of low-frequency ultrasonic cavitation in combination with photochromotherapy made it possible to relieve the signs of chronic adenoiditis in 62% of cases (p < 0.001), reduce the number of patients with grade III adenoid hypertrophy by 54% (p = 0.035), and reduce by 2 times (p = 0.05) number of relapses of chronic adenoiditis. In the group of children using low-frequency ultrasonic cavitation, the positive effect of treatment was 3.3 times [CI 0.75; 14.6] higher compared to the control group, and in combination with photochromotherapy it was 3.6 times [CI 0.85; 15.5]. The absence of adenotomy was assessed as a positive effect.Conclusion. The data obtained showed that the inclusion of non-drug methods of physical influence (low-frequency ultrasonic cavitation both in monotherapy and in combination with photochromotherapy) in complex treatment can reduce the number of surgical interventions on the organs of the lymphopharyngeal ring – the pharyngeal tonsil.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"24 41","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379051","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}
Helicobacter pylori (H. Pylori), microaerophilic spiral-shaped Gram-negative bacteria which colonize the gastric mucosa of human population, is the leading causal factor in the development of a whole range of diseases of the gastroduodenal region (chronic gastritis, gastric and duodenal ulcer disease, MALT lymphoma and gastric adenocarcinoma). Since the discovery of H. pylori infection and the identification of its leading role in the development of a range of gastroenterological diseases, researchers have begun to actively study the potential trigger significance of this pathogen in the development of extragastric pathology. At the epidemiological level, H. pylori infection has been shown to be frequently associated with skin diseases such as rosacea, acne, chronic urticaria and psoriasis, although the clinical significance of these associations remains clouded. In fact, recent meta-analytic studies (2019–2024) demonstrate an increased risk of developing the above diseases in H. pylori-infected individuals with odds ratios ranging from 1.19 to 3.00. On the other hand, not all studies have showed that eradication therapy of this microorganism helps reduce the clinical severity of symptoms of skin diseases, which is hypothetically explained only by the trigger role of infection within the complex pathogenesis. In a modern light, such associations can be viewed in terms of pathogenetic findings through the implementation of the syndrome of increased epithelial permeability (SIEP). The chronic gastritis caused by H. pylori infection is believed to lead to increased permeability of the epithelial lining of the stomach, as well as the walls of the mucosal vessels and a higher exposure of bacterial and nutritional antigens in the systemic circulation, which can induce both local release of inflammatory mediators in tissues and systemic immunological reactions (autoimmune and inflammatory processes, formation of molecular mimicry-induced immune complexes and cross-reactive antibodies).
{"title":"Helicobacter pylori infection and dermatological diseases","authors":"D. A. Dudukchyan, D. K. Sarkisyan, D. N. Andreev","doi":"10.21518/ms2024-232","DOIUrl":"https://doi.org/10.21518/ms2024-232","url":null,"abstract":"Helicobacter pylori (H. Pylori), microaerophilic spiral-shaped Gram-negative bacteria which colonize the gastric mucosa of human population, is the leading causal factor in the development of a whole range of diseases of the gastroduodenal region (chronic gastritis, gastric and duodenal ulcer disease, MALT lymphoma and gastric adenocarcinoma). Since the discovery of H. pylori infection and the identification of its leading role in the development of a range of gastroenterological diseases, researchers have begun to actively study the potential trigger significance of this pathogen in the development of extragastric pathology. At the epidemiological level, H. pylori infection has been shown to be frequently associated with skin diseases such as rosacea, acne, chronic urticaria and psoriasis, although the clinical significance of these associations remains clouded. In fact, recent meta-analytic studies (2019–2024) demonstrate an increased risk of developing the above diseases in H. pylori-infected individuals with odds ratios ranging from 1.19 to 3.00. On the other hand, not all studies have showed that eradication therapy of this microorganism helps reduce the clinical severity of symptoms of skin diseases, which is hypothetically explained only by the trigger role of infection within the complex pathogenesis. In a modern light, such associations can be viewed in terms of pathogenetic findings through the implementation of the syndrome of increased epithelial permeability (SIEP). The chronic gastritis caused by H. pylori infection is believed to lead to increased permeability of the epithelial lining of the stomach, as well as the walls of the mucosal vessels and a higher exposure of bacterial and nutritional antigens in the systemic circulation, which can induce both local release of inflammatory mediators in tissues and systemic immunological reactions (autoimmune and inflammatory processes, formation of molecular mimicry-induced immune complexes and cross-reactive antibodies).","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"27 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379927","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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