V. Naumova, E. Beltyukov, O. P. Kovtun, O. Smolenskaya, G. А. Bykova, E. S. Klyachina
Introduction. Severe asthma targeted therapy effectiveness depends on precise targeting of the selected drug to the key link in pathogenesis. Therefore, severe asthma phenotyping in real clinical practice is relevant.Aim. To determine main clinical and allergological characteristics of patients with severe asthma and to establish important phenotyping signs determined choice of a targeted drug for severe asthma treatment.Materials and methods. The prospective and retrospective study involved patients (n = 198) of the Sverdlovsk region registry receiving targeted therapy of severe asthma. Considering clinical and allergological picture, allergic, non-allergic eosinophilic and mixed severe asthma phenotypes were identified. Clinical and laboratory characteristics of phenotypes were described. A phenotyping algorithm was developed.Results. In the register of patients (n = 198) with severe asthma, non-allergic eosinophilic asthma was 46.5%, allergic – 34.8%, mixed – 18.7%. Significant signs for phenotyping were identified: age of asthma onset, proven allergy, Phadiatop ImmunoCAP level and blood eosinophils on baseline, concomitant allergic rhinitis, chronic rhinosinusitis with nasal polyps and hyper-sensitivity to NSAIDs. The main signs of allergic severe asthma determined: early onset, proven allergy and a positive result of Phadiatop ImmunoCAP (the probability of allergic phenotype increases with Phadiatop ≥ 1.53 PAU/l). Signs of non-allergic eosinophilic asthma were eosinophilia ≥ 150 cells/µl, absence of allergy, concomitant chronic rhinosinusitis with nasal polyps and hypersensitivity to NSAIDs, late onset (after 30 years). Signs were identified for mixed asthma: presence of proven allergy or latent sensitization in combination with high level of Phadiatop ImmunoCAP, late onset, eosinophilia ≥ 300 cells/µl, chronic rhinosinusitis with nasal polyps, hypersensitivity NSAIDs.Conclusions. The algorithm for severe asthma phenotyping based on the isolation of eosinophilia of allergic and non-allergic origin is proposed. Severe asthma phenotyping, which can be carried out in real clinical practice, should facilitate the selection of an initial targeted drug.
{"title":"Clinical and allergological characteristics of patients with severe bronchial asthma in the regional registry and phenotyping principles for the targeted therapy choice","authors":"V. Naumova, E. Beltyukov, O. P. Kovtun, O. Smolenskaya, G. А. Bykova, E. S. Klyachina","doi":"10.21518/ms2024-177","DOIUrl":"https://doi.org/10.21518/ms2024-177","url":null,"abstract":"Introduction. Severe asthma targeted therapy effectiveness depends on precise targeting of the selected drug to the key link in pathogenesis. Therefore, severe asthma phenotyping in real clinical practice is relevant.Aim. To determine main clinical and allergological characteristics of patients with severe asthma and to establish important phenotyping signs determined choice of a targeted drug for severe asthma treatment.Materials and methods. The prospective and retrospective study involved patients (n = 198) of the Sverdlovsk region registry receiving targeted therapy of severe asthma. Considering clinical and allergological picture, allergic, non-allergic eosinophilic and mixed severe asthma phenotypes were identified. Clinical and laboratory characteristics of phenotypes were described. A phenotyping algorithm was developed.Results. In the register of patients (n = 198) with severe asthma, non-allergic eosinophilic asthma was 46.5%, allergic – 34.8%, mixed – 18.7%. Significant signs for phenotyping were identified: age of asthma onset, proven allergy, Phadiatop ImmunoCAP level and blood eosinophils on baseline, concomitant allergic rhinitis, chronic rhinosinusitis with nasal polyps and hyper-sensitivity to NSAIDs. The main signs of allergic severe asthma determined: early onset, proven allergy and a positive result of Phadiatop ImmunoCAP (the probability of allergic phenotype increases with Phadiatop ≥ 1.53 PAU/l). Signs of non-allergic eosinophilic asthma were eosinophilia ≥ 150 cells/µl, absence of allergy, concomitant chronic rhinosinusitis with nasal polyps and hypersensitivity to NSAIDs, late onset (after 30 years). Signs were identified for mixed asthma: presence of proven allergy or latent sensitization in combination with high level of Phadiatop ImmunoCAP, late onset, eosinophilia ≥ 300 cells/µl, chronic rhinosinusitis with nasal polyps, hypersensitivity NSAIDs.Conclusions. The algorithm for severe asthma phenotyping based on the isolation of eosinophilia of allergic and non-allergic origin is proposed. Severe asthma phenotyping, which can be carried out in real clinical practice, should facilitate the selection of an initial targeted drug.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"71 s294","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376461","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}
O. O. Yanushevich, I. Maev, N. I. Krikheli, P. S. Sokolov, D. N. Andreev, M. Bychkova, E. G. Lobanova, M. Y. Starovoytova
Gastroesophageal reflux disease (GERD) is a common chronic disease leading to a spontaneous and regular retrograde flow of gastric and/or duodenal contents into the esophagus. Reflux of the gastric contents into the oral cavity refers to the extraesophageal presentation of the disease, which, in the absence of timely treatment, can result in erosion of dental hard tissue (EDHT) through repeated exposure of the dental tissue to acidic contents. EDHT are non-carious lesions of the dental hard tissues (mainly enamel, and in some cases dentin), induced by a chemical reaction involving acids, which results in demineralization processes. The incidence rates of EDHT in adult patients with GERD are 32.5–51.5%. The EDHT in GERD develops in stages. Initially, the gradual degradation of tooth pelicula happens when it gradually becomes decayed by repeated acidic attacks. The loss of the pelicula results in direct contact of hydrochloric acid refluxate with the enamel surface and initiation of its demineralization at pH < 5.5 with dissolution of hydroxyapatite crystals. Given the high prevalence of GERD in the population, it seems important to update an integrated approach to the treatment of such patients, which involves pharmacotherapy provided by the gastroenterologist, as well as prevention and minimally invasive treatment of presentations in the oral cavity by the dentist. Patients with EDHT due to GERD need to maintain individual oral hygiene (use mouth washes with a neutral pH level, avoid abrasive toothpastes), use remineralization therapy at home applying remogels (Tooth Mousse), and also be observed by a dentist as part of the follow-up care. Minimally invasive treatment by the dentist involves restorations using composite tooth filling materials and ceramic veneers. It is reasonable to empirically use proton pump inhibitors twice a day for 3 months for the direct treatment of GERD in patients with EDHT.
{"title":"Gastroesophageal reflux disease as a risk factor of dental hard tissues erosions","authors":"O. O. Yanushevich, I. Maev, N. I. Krikheli, P. S. Sokolov, D. N. Andreev, M. Bychkova, E. G. Lobanova, M. Y. Starovoytova","doi":"10.21518/ms2024-234","DOIUrl":"https://doi.org/10.21518/ms2024-234","url":null,"abstract":"Gastroesophageal reflux disease (GERD) is a common chronic disease leading to a spontaneous and regular retrograde flow of gastric and/or duodenal contents into the esophagus. Reflux of the gastric contents into the oral cavity refers to the extraesophageal presentation of the disease, which, in the absence of timely treatment, can result in erosion of dental hard tissue (EDHT) through repeated exposure of the dental tissue to acidic contents. EDHT are non-carious lesions of the dental hard tissues (mainly enamel, and in some cases dentin), induced by a chemical reaction involving acids, which results in demineralization processes. The incidence rates of EDHT in adult patients with GERD are 32.5–51.5%. The EDHT in GERD develops in stages. Initially, the gradual degradation of tooth pelicula happens when it gradually becomes decayed by repeated acidic attacks. The loss of the pelicula results in direct contact of hydrochloric acid refluxate with the enamel surface and initiation of its demineralization at pH < 5.5 with dissolution of hydroxyapatite crystals. Given the high prevalence of GERD in the population, it seems important to update an integrated approach to the treatment of such patients, which involves pharmacotherapy provided by the gastroenterologist, as well as prevention and minimally invasive treatment of presentations in the oral cavity by the dentist. Patients with EDHT due to GERD need to maintain individual oral hygiene (use mouth washes with a neutral pH level, avoid abrasive toothpastes), use remineralization therapy at home applying remogels (Tooth Mousse), and also be observed by a dentist as part of the follow-up care. Minimally invasive treatment by the dentist involves restorations using composite tooth filling materials and ceramic veneers. It is reasonable to empirically use proton pump inhibitors twice a day for 3 months for the direct treatment of GERD in patients with EDHT.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"9 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380248","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}
T. N. Nizhenko, E. V. Shikh, Zhanna M. Sizova, V. N. Drozdov, N. I. Lapidus, A. E. Pakhomova
Introduction. It is now well known that a proportion of patients with COVID-19 develop a pathological systemic inflammatory response with complications resulting in multiple organ failure. The severity and prognosis of the disease, as well as the effectiveness of the treatment provided should be assessed as early as possible. For this purpose, a number of laboratory markers are used, such as C-reactive protein (CRP), IL-6, fibrinogen, ferritin, and changes in these parameters serve as a basis for the disease prognosis.Aim. To evaluate the effectiveness of levilimab in outpatients with COVID-19 based on the analysis of changes in laboratory markers of blood inflammatory activity.Material and methods. A total of 120 patients with COVID-19 receiving standard therapy (ST) were included in the study. The patients were divided into 2 groups: the treatment group of patients who received 2 injections of levilimab, IL-6 receptor blocker, included 47 men and 29 women (average age 46.7 years); the control group, who only received CT, included 21 men and 23 women (average age 46.3 ± 2 years).Results. The treatment group demonstrated a faster normalization of laboratory markers of inflammatory activity. After 14 days of follow-up, the CRP levels in the treatment group decreased significantly by 18.9 (67%) (p < 0.05), and in the control group by 14.3 (46.9%) (p < 0.05). The IL-6 level significantly decreased in patients of the control group, but did not change in the levilimab group. The changes in fibrinogen levels showed that the group of patients, who received levilimab, had a significant decrease in fibrinogen by 35% from baseline (p < 0.05), in contrast to the control group, in which fibrinogen levels virtually did not change (3.8% decrease) (p < 0.05).Conclusion. Levilimab therapy carried out at onset of coronavirus infection results in a faster normalization of laboratory markers of inflammatory activity and helps prevent the severe course of COVID-19.
{"title":"The effect of levilimab on the clinical presentations and changes in inflammatory biomarkers in outpatients with mild to moderate COVID-19","authors":"T. N. Nizhenko, E. V. Shikh, Zhanna M. Sizova, V. N. Drozdov, N. I. Lapidus, A. E. Pakhomova","doi":"10.21518/ms2024-201","DOIUrl":"https://doi.org/10.21518/ms2024-201","url":null,"abstract":"Introduction. It is now well known that a proportion of patients with COVID-19 develop a pathological systemic inflammatory response with complications resulting in multiple organ failure. The severity and prognosis of the disease, as well as the effectiveness of the treatment provided should be assessed as early as possible. For this purpose, a number of laboratory markers are used, such as C-reactive protein (CRP), IL-6, fibrinogen, ferritin, and changes in these parameters serve as a basis for the disease prognosis.Aim. To evaluate the effectiveness of levilimab in outpatients with COVID-19 based on the analysis of changes in laboratory markers of blood inflammatory activity.Material and methods. A total of 120 patients with COVID-19 receiving standard therapy (ST) were included in the study. The patients were divided into 2 groups: the treatment group of patients who received 2 injections of levilimab, IL-6 receptor blocker, included 47 men and 29 women (average age 46.7 years); the control group, who only received CT, included 21 men and 23 women (average age 46.3 ± 2 years).Results. The treatment group demonstrated a faster normalization of laboratory markers of inflammatory activity. After 14 days of follow-up, the CRP levels in the treatment group decreased significantly by 18.9 (67%) (p < 0.05), and in the control group by 14.3 (46.9%) (p < 0.05). The IL-6 level significantly decreased in patients of the control group, but did not change in the levilimab group. The changes in fibrinogen levels showed that the group of patients, who received levilimab, had a significant decrease in fibrinogen by 35% from baseline (p < 0.05), in contrast to the control group, in which fibrinogen levels virtually did not change (3.8% decrease) (p < 0.05).Conclusion. Levilimab therapy carried out at onset of coronavirus infection results in a faster normalization of laboratory markers of inflammatory activity and helps prevent the severe course of COVID-19.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"354 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380862","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}
M. F. Petrukhnova, O. Voronkova, O. E. Buyanova, O. N. Antyufeeva, A. E. Kamalova, M. Kozhevnikova, I. Ilgisonis, Y. Belenkov
This article describes a case of lung cancer, the symptoms of which have long been regarded as manifestations of pneumonia; the stages of diagnostic search from the first symptoms of cancer to radical treatment are revealed. At the same time, the patient was diagnosed with monoclonal gammopathy of unknown significance, which at the stage of differential diagnosis suggested the development of synchronous cancer – lung cancer and the onset of multiple myeloma (MM). A number of literature sources were analyzed, according to the results of the analysis, it was found that at the moment six cases of the development of synchronous lung cancer and ММ have been described in the world, in most of which the age of patients was less than 70 years, which indicates a relatively early development of ММ. The issues of differential diagnosis of pneumonia and lung cancer are considered; the importance of early detection of malignant neoplasms (especially at the outpatient stage) is emphasized. It has been established that in some cases pneumonia can mask cancer, especially the detection of neoplasia after diagnosing pneumonia of the upper lobe localization. It has been suggested that the pathogenesis of lung cancer and ММ associated with intensive expression of CD38 may be common, and an example of a positive clinical effect on unresectable lung cancer with daratumumab is given (CD38-blocking monoclonal antibody used in MM therapy). At the same time, the revealed observation of the combined development of oncological diseases is very interesting, since in patients with different types of cancer, as a rule, each tumor tends to develop sequentially. However, our case was analyzed in comparison with literature data with cases of concomitant development of multiple myeloma and lung cancer simultaneously. At the same time, common genes and related pathogenesis of progression of two types of tumors were identified due to activation of the expression of the mitochondrial trans-2-enoyl-CoA reductase (MECR) concentrator gene.
{"title":"The importance of oncological alertness in the differential diagnosis of inflammatory changes in the lungsdetected as a result of differential diagnosis of pneumonia","authors":"M. F. Petrukhnova, O. Voronkova, O. E. Buyanova, O. N. Antyufeeva, A. E. Kamalova, M. Kozhevnikova, I. Ilgisonis, Y. Belenkov","doi":"10.21518/ms2024-077","DOIUrl":"https://doi.org/10.21518/ms2024-077","url":null,"abstract":"This article describes a case of lung cancer, the symptoms of which have long been regarded as manifestations of pneumonia; the stages of diagnostic search from the first symptoms of cancer to radical treatment are revealed. At the same time, the patient was diagnosed with monoclonal gammopathy of unknown significance, which at the stage of differential diagnosis suggested the development of synchronous cancer – lung cancer and the onset of multiple myeloma (MM). A number of literature sources were analyzed, according to the results of the analysis, it was found that at the moment six cases of the development of synchronous lung cancer and ММ have been described in the world, in most of which the age of patients was less than 70 years, which indicates a relatively early development of ММ. The issues of differential diagnosis of pneumonia and lung cancer are considered; the importance of early detection of malignant neoplasms (especially at the outpatient stage) is emphasized. It has been established that in some cases pneumonia can mask cancer, especially the detection of neoplasia after diagnosing pneumonia of the upper lobe localization. It has been suggested that the pathogenesis of lung cancer and ММ associated with intensive expression of CD38 may be common, and an example of a positive clinical effect on unresectable lung cancer with daratumumab is given (CD38-blocking monoclonal antibody used in MM therapy). At the same time, the revealed observation of the combined development of oncological diseases is very interesting, since in patients with different types of cancer, as a rule, each tumor tends to develop sequentially. However, our case was analyzed in comparison with literature data with cases of concomitant development of multiple myeloma and lung cancer simultaneously. At the same time, common genes and related pathogenesis of progression of two types of tumors were identified due to activation of the expression of the mitochondrial trans-2-enoyl-CoA reductase (MECR) concentrator gene.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"115 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376404","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}
I. Mukatova, A. S. Serikova, G. S. Nuralieva, S. N. Avdeev
Respiratory support for chronic respiratory failure in the last stages is widely used, most often in patients with end-stage COPD. It has been proven that the development of chronic hypercapnic respiratory failure is associated with an increasing in exacerbations, increased hospitalization rates, and an acceleration of the time before subsequent decompensation. Also hypercapnia isa determining factor in mortality. Effective treatment method of hypercapnic insufficiency is non-invasive ventilation. Long-term non-invasive ventilation improves daytime hypercapnia, quality of life, increases the period until the next severe exacerbation and survival of patients with COPD. Patients with COPD have different phenotypes and various comorbid diseases, which which may be challenging while choosing method of respiratory support and assessing the effectiveness of this treatment method. There is lack of data on long-term non-invasive respiratory support for patients with COPD after pneumonectomy in chronic period. Most of publications dedicated for early post-operative period after pneumonectomy. The purpose of this publication is to present a case of successful long-term non-invasive ventilation combined with oxygen therapy in a patient with COPD and bronchiectasis of a single lung. Stages of management of hypoxemic and subsequently developed hypercapnic chronic respiratory failure are reflected. We demonstrate experience of successful long-term ambulatory non-invasive ventilation in a patient with chronic hypercapnic respiratory failure as a result of COPD and pneumonectomy was demonstrated. Observation study showed feasibility of combined respiratory support in outpatient settings for patient with COPD of a single lung and a history of pneumonectomy.
{"title":"The effectiveness of long-term respiratory support in a patient after pneumonectomy","authors":"I. Mukatova, A. S. Serikova, G. S. Nuralieva, S. N. Avdeev","doi":"10.21518/ms2024-185","DOIUrl":"https://doi.org/10.21518/ms2024-185","url":null,"abstract":"Respiratory support for chronic respiratory failure in the last stages is widely used, most often in patients with end-stage COPD. It has been proven that the development of chronic hypercapnic respiratory failure is associated with an increasing in exacerbations, increased hospitalization rates, and an acceleration of the time before subsequent decompensation. Also hypercapnia isa determining factor in mortality. Effective treatment method of hypercapnic insufficiency is non-invasive ventilation. Long-term non-invasive ventilation improves daytime hypercapnia, quality of life, increases the period until the next severe exacerbation and survival of patients with COPD. Patients with COPD have different phenotypes and various comorbid diseases, which which may be challenging while choosing method of respiratory support and assessing the effectiveness of this treatment method. There is lack of data on long-term non-invasive respiratory support for patients with COPD after pneumonectomy in chronic period. Most of publications dedicated for early post-operative period after pneumonectomy. The purpose of this publication is to present a case of successful long-term non-invasive ventilation combined with oxygen therapy in a patient with COPD and bronchiectasis of a single lung. Stages of management of hypoxemic and subsequently developed hypercapnic chronic respiratory failure are reflected. We demonstrate experience of successful long-term ambulatory non-invasive ventilation in a patient with chronic hypercapnic respiratory failure as a result of COPD and pneumonectomy was demonstrated. Observation study showed feasibility of combined respiratory support in outpatient settings for patient with COPD of a single lung and a history of pneumonectomy.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"27 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379215","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. Naumova, E. Beltyukov, О. P. Kovtun, G. А. Bykova, V. I. Troshina, A. N. Mineeva
Introduction. There is insufficiency of direct comparative studies of genetically engineered biological drugs (GEBD) for severe bronchial asthma (SA) treatment in scientific databases.Aim. To compare omalizumab and dupilumab effectiveness in patients with allergic and mixed SA in real clinical practice.Materials and methods. The direct comparative study included SA patients with an allergic component from regional registry of Sverdlovsk region. The data of patients with allergic (n = 68) and mixed (n = 27) SA treated with omalizumab (n = 62) and dupilumab (n = 33) were analyzed. Therapy effectiveness was determined for 12 months in general group No. 1, allergic asthma group No. 2 and mixed asthma group No. 3 according to the following indicators: asthma control level (ACT), proportion of patients with uncontrolled asthma, need for systemic glucocorticosteroids (SGCS) and short‐acting beta agonists (SABA), basic therapy volume, asthma exacerbations number, emergency calls and hospitalizations, forced expiratory volume in the first second (FEV ), assessment of life quality (AQLQ and SNOT-22). Control evaluation visits were conducted before therapy start, after 4 and 12 months of biologics taking.Results. In general, during the 12 months of targeted therapy in patients receiving omalizumab statistically significant positive dynamics was observed in 12 of the 13 evaluated indicators; in patients receiving dupilumab – in 9 indicators. When analyzing such indicators as, ACT, taking SGCS, exacerbations of SA, FEV , statistically significant positive dynamics was revealed for all 4 indicators in patients receiving omalizumab in group No. 2 and in patients receiving dupilumab in group No. 3.Conclusions. Patients with allergic component of SA respond equally well to therapy with omalizumab and dupilumab. At the same time, a tendency towards the advantage of omalizumab in patients with allergic asthma, and dupilumab in patients with a mixed phenotype of the disease was revealed.
{"title":"Direct comparative study of anti-IgE and anti-IL4Rα therapy effectiveness in patients with severe allergic and mixed bronchial asthma","authors":"V. Naumova, E. Beltyukov, О. P. Kovtun, G. А. Bykova, V. I. Troshina, A. N. Mineeva","doi":"10.21518/ms2024-195","DOIUrl":"https://doi.org/10.21518/ms2024-195","url":null,"abstract":"Introduction. There is insufficiency of direct comparative studies of genetically engineered biological drugs (GEBD) for severe bronchial asthma (SA) treatment in scientific databases.Aim. To compare omalizumab and dupilumab effectiveness in patients with allergic and mixed SA in real clinical practice.Materials and methods. The direct comparative study included SA patients with an allergic component from regional registry of Sverdlovsk region. The data of patients with allergic (n = 68) and mixed (n = 27) SA treated with omalizumab (n = 62) and dupilumab (n = 33) were analyzed. Therapy effectiveness was determined for 12 months in general group No. 1, allergic asthma group No. 2 and mixed asthma group No. 3 according to the following indicators: asthma control level (ACT), proportion of patients with uncontrolled asthma, need for systemic glucocorticosteroids (SGCS) and short‐acting beta agonists (SABA), basic therapy volume, asthma exacerbations number, emergency calls and hospitalizations, forced expiratory volume in the first second (FEV ), assessment of life quality (AQLQ and SNOT-22). Control evaluation visits were conducted before therapy start, after 4 and 12 months of biologics taking.Results. In general, during the 12 months of targeted therapy in patients receiving omalizumab statistically significant positive dynamics was observed in 12 of the 13 evaluated indicators; in patients receiving dupilumab – in 9 indicators. When analyzing such indicators as, ACT, taking SGCS, exacerbations of SA, FEV , statistically significant positive dynamics was revealed for all 4 indicators in patients receiving omalizumab in group No. 2 and in patients receiving dupilumab in group No. 3.Conclusions. Patients with allergic component of SA respond equally well to therapy with omalizumab and dupilumab. At the same time, a tendency towards the advantage of omalizumab in patients with allergic asthma, and dupilumab in patients with a mixed phenotype of the disease was revealed.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"26 30","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379800","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, A. A. Eremenko, M. V. Vinogradova
Diseases of the hepatobiliary system today remain an urgent health problem worldwide. A significant percentage of gastroenterological patients are people suffering from cholestasis syndrome. In gastroenterology, there are a number of nosological forms accompanied by the development of cholestasis syndrome. This pathological condition has many etiological factors, but in general, the mechanisms of its formation for various reasons are largely similar. When working with this group of patients, it is necessary to take into account the peculiarities of the clinical picture, which may vary depending on the etiology of the cholestatic syndrome. The fact of the economic burden in this pathology is also important, because sometimes it is necessary to resort to high-tech examination methods and expensive laboratory screening to perform high-quality differential diagnosis. As for the treatment of cholestatic syndrome, at the moment there are many drugs with different mechanisms of action, the predominant part of which, according to randomized clinical trials and meta-analyses, has proven effectiveness. In this article, based on literature sources taken from foreign and domestic databases, the etiology and pathogenesis of the development of cholestasis syndrome, the clinical picture and approaches to the diagnosis of this condition are considered. When considering the treatment of cholestatic syndrome, this article focuses on therapy with ursodeoxycholic acid drugs, in particular Ecurochol. A clinical case is also considered on the example of a patient with cholestasis syndrome who was prescribed treatment with Ecurochol and who showed positive dynamics due to improvements in the ultrasound picture of the abdominal organs.
{"title":"Modern pharmacotherapy for cholestasis syndrome","authors":"V. V. Skvortsov, A. A. Eremenko, M. V. Vinogradova","doi":"10.21518/ms2024-106","DOIUrl":"https://doi.org/10.21518/ms2024-106","url":null,"abstract":"Diseases of the hepatobiliary system today remain an urgent health problem worldwide. A significant percentage of gastroenterological patients are people suffering from cholestasis syndrome. In gastroenterology, there are a number of nosological forms accompanied by the development of cholestasis syndrome. This pathological condition has many etiological factors, but in general, the mechanisms of its formation for various reasons are largely similar. When working with this group of patients, it is necessary to take into account the peculiarities of the clinical picture, which may vary depending on the etiology of the cholestatic syndrome. The fact of the economic burden in this pathology is also important, because sometimes it is necessary to resort to high-tech examination methods and expensive laboratory screening to perform high-quality differential diagnosis. As for the treatment of cholestatic syndrome, at the moment there are many drugs with different mechanisms of action, the predominant part of which, according to randomized clinical trials and meta-analyses, has proven effectiveness. In this article, based on literature sources taken from foreign and domestic databases, the etiology and pathogenesis of the development of cholestasis syndrome, the clinical picture and approaches to the diagnosis of this condition are considered. When considering the treatment of cholestatic syndrome, this article focuses on therapy with ursodeoxycholic acid drugs, in particular Ecurochol. A clinical case is also considered on the example of a patient with cholestasis syndrome who was prescribed treatment with Ecurochol and who showed positive dynamics due to improvements in the ultrasound picture of the abdominal organs.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"4 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380482","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}
P. E. Kolesnikov, A. A. Vizel, A. R. Abashev, L. V. Davydova
Introduction. The novel coronavirus disease (COVID-19) pandemic has presented challenges for health systems globally. However, as the number of COVID-19 survivors continue to increase, we get more and more evidence on the long-lasting symptoms after an acute infection. According to some studies, the total number of symptoms described can reach 200, but fatigue is considered the key presentation in such patients. The subjectivity of fatigue concept continues to be a significant obstacle to its study: the absence of validated assessment methods does not allow to adequately assess the prevalence and significance of fatigue in patients with lung injury induced by COVID-19.Aim. To assess the prevalence of fatigue syndrome in patients with lung injury induced by COVID-19 using a validated tool, the Fatigue Assessment Scale, and risk factors for the development of this condition.Materials and methods. Medical records of patients hospitalised for PCR-confirmed new coronavirus infection COVID-19 with lung lesions (n = 100), evaluated using the FAS scale, were retrospectively analysed. Statistical processing of the data was performed.Results. Objectively assessed fatigue was detected in 66% of patients. Statistically significant association between fatigue syndrome and obesity, severity of acute phase of infection, presence of comorbidities, Charlson comorbidity index was revealed.Conclusions. The use of objectification methods makes it possible to assess the prevalence and significance of fatigue syndrome in patients with COVID-19-induced lung lesions, to perform statistical analysis of possible risk factors for the development of this condition.
{"title":"Fatigue syndrome after COVID-19 infection: results of personal observations","authors":"P. E. Kolesnikov, A. A. Vizel, A. R. Abashev, L. V. Davydova","doi":"10.21518/ms2024-062","DOIUrl":"https://doi.org/10.21518/ms2024-062","url":null,"abstract":"Introduction. The novel coronavirus disease (COVID-19) pandemic has presented challenges for health systems globally. However, as the number of COVID-19 survivors continue to increase, we get more and more evidence on the long-lasting symptoms after an acute infection. According to some studies, the total number of symptoms described can reach 200, but fatigue is considered the key presentation in such patients. The subjectivity of fatigue concept continues to be a significant obstacle to its study: the absence of validated assessment methods does not allow to adequately assess the prevalence and significance of fatigue in patients with lung injury induced by COVID-19.Aim. To assess the prevalence of fatigue syndrome in patients with lung injury induced by COVID-19 using a validated tool, the Fatigue Assessment Scale, and risk factors for the development of this condition.Materials and methods. Medical records of patients hospitalised for PCR-confirmed new coronavirus infection COVID-19 with lung lesions (n = 100), evaluated using the FAS scale, were retrospectively analysed. Statistical processing of the data was performed.Results. Objectively assessed fatigue was detected in 66% of patients. Statistically significant association between fatigue syndrome and obesity, severity of acute phase of infection, presence of comorbidities, Charlson comorbidity index was revealed.Conclusions. The use of objectification methods makes it possible to assess the prevalence and significance of fatigue syndrome in patients with COVID-19-induced lung lesions, to perform statistical analysis of possible risk factors for the development of this condition.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"22 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380083","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}
S. N. Avdeev, S. Chikina, E. I. Kondrat’eva, S. A. Krasovskiy, I. V. Leshchenko, G. Ignatova, V. Antonov, A. A. Zaitsev, Z. Merzhoeva, I. Demko, L. M. Kudelya, M. F. Kinyaykin, R. Zulkarneev, L. V. Shulzhenko, I. N. Trofimenko, I. V. Zaikova-Khelimskaia
Resolution of the Council of ExpertsNovember 17, 2023Respiratory diseases (acute and chronic bronchitis, chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis (CF), bronchial asthma, etc.) are often accompanied by impaired mucus clearance. In this regard, mucoactive drugs are most commonly used for the treatment. Hypertonic saline plus high-molecular-weight hyaluronic acid is one of the affordable and effective agents that can help with thinning and removal of bronchial secretions. The effect of 3%, 6%, 7% hypertonic saline on the respiratory system is multifaceted: it stimulates the osmotic fluid flow, breaks bonds linking polymers in the sputum, reduces swelling in the mucous membranes, stimulates ciliary beat frequency, and reduces the neutrophilic inflammation severity. The molecular size of HA plays an important role in the effectiveness of inhalation therapy with hypertonic saline combined with hyaluronic acid (HA). External administration of high-molecular-weight hyaluronic acid inhibits neutrophil elastase and metalloproteinase, potentiates hydration of bronchial secretions and has anti-inflammatory properties. In addition to clinical studies, real-life clinical practice in patients with cystic fibrosis, bronchiectasis and acute bronchitis also demonstrated the effectiveness of hypertonic saline combined with high-molecular-weight hyaluronic acid. The rationale for the use of hypertonic saline was reflected in the international GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines in 2023. Therefore, due to high interest in the hypertonic saline combined with high-molecular-weight hyaluronic acid, it is important to expand the evidence base: to initiate a Russian multicenter study evaluating the effectiveness and safety of this combination in patients with chronic bronchitis and COPD in the Russian Federation. It will allow us to recommend hypertonic saline combined with high-molecular-weight hyaluronic acid to be included in the Russian clinical guidelines on treatment of chronic bronchitis and COPD as a mucoactive drug.
{"title":"Use of inhaled solution of hypertonic saline combined with high-molecular-weight hyaluronic acid in patients with lower respiratory tract diseases","authors":"S. N. Avdeev, S. Chikina, E. I. Kondrat’eva, S. A. Krasovskiy, I. V. Leshchenko, G. Ignatova, V. Antonov, A. A. Zaitsev, Z. Merzhoeva, I. Demko, L. M. Kudelya, M. F. Kinyaykin, R. Zulkarneev, L. V. Shulzhenko, I. N. Trofimenko, I. V. Zaikova-Khelimskaia","doi":"10.21518/ms2024-050","DOIUrl":"https://doi.org/10.21518/ms2024-050","url":null,"abstract":"Resolution of the Council of ExpertsNovember 17, 2023Respiratory diseases (acute and chronic bronchitis, chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis (CF), bronchial asthma, etc.) are often accompanied by impaired mucus clearance. In this regard, mucoactive drugs are most commonly used for the treatment. Hypertonic saline plus high-molecular-weight hyaluronic acid is one of the affordable and effective agents that can help with thinning and removal of bronchial secretions. The effect of 3%, 6%, 7% hypertonic saline on the respiratory system is multifaceted: it stimulates the osmotic fluid flow, breaks bonds linking polymers in the sputum, reduces swelling in the mucous membranes, stimulates ciliary beat frequency, and reduces the neutrophilic inflammation severity. The molecular size of HA plays an important role in the effectiveness of inhalation therapy with hypertonic saline combined with hyaluronic acid (HA). External administration of high-molecular-weight hyaluronic acid inhibits neutrophil elastase and metalloproteinase, potentiates hydration of bronchial secretions and has anti-inflammatory properties. In addition to clinical studies, real-life clinical practice in patients with cystic fibrosis, bronchiectasis and acute bronchitis also demonstrated the effectiveness of hypertonic saline combined with high-molecular-weight hyaluronic acid. The rationale for the use of hypertonic saline was reflected in the international GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines in 2023. Therefore, due to high interest in the hypertonic saline combined with high-molecular-weight hyaluronic acid, it is important to expand the evidence base: to initiate a Russian multicenter study evaluating the effectiveness and safety of this combination in patients with chronic bronchitis and COPD in the Russian Federation. It will allow us to recommend hypertonic saline combined with high-molecular-weight hyaluronic acid to be included in the Russian clinical guidelines on treatment of chronic bronchitis and COPD as a mucoactive drug.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"21 S37","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141377938","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}
Y. Belotserkovskaya, A. G. Romanovskikh, I. P. Smirnov
Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality worldwide. Successful treatment of patients with CAP is mainly determined by the correct choice of the place of treatment (outpatient or inpatient) and the correct initial empirical therapy, considering the predictable spectrum of potential pathogens of CAP. The article provides up-to-date data on the etiological structure of non-severe CAP. Most patients with CAP receive outpatient medical care, which is determined by their clinical status and a limited number of laboratory data for minimizing the risk of adverse outcomes in CAP. The absence of a microbiological diagnosis in a mild course of CAP does not lead to a decrease in the effectiveness of empirical antibacterial therapy in outpatient settings. The article highlights current clinical recommendations on the choice of empirical antibiotic therapy for CAP in outpatients. Amoxicillin is a semi-synthetic penicillin, which, including in combination with the beta-lactamase inhibitor clavulanic acid, is the most affordable and widely used penicillin in various countries. According to clinical recommendations, amoxicillin, including in combination with a β-lactamase inhibitor, is the drug of choice for the initial empirical therapy of most outpatients with CAP. The oral route is the most common and preferred for antibiotic delivery in mild CAP. Dispersible forms of tablets have certain advantages, including easier intake in patients with difficulty swallowing, such as the elderly, stroke patients, and children. The assessment of biological equivalence showed similar pharmacokinetic parameters of Amoxicillin and Amoxicillin in combination with clavulanic acid in the form of dispersible tablets and in the original form of film-coated tablets.
社区获得性肺炎（CAP）是全球发病率和死亡率的主要原因之一。能否成功治疗 CAP 患者，主要取决于治疗地点（门诊或住院）的正确选择，以及考虑到 CAP 潜在病原体的可预测范围而采取的正确的初始经验疗法。文章提供了有关非重症 CAP 病因结构的最新数据。大多数 CAP 患者接受的是门诊医疗护理，而门诊医疗护理是由患者的临床状态和有限的实验室数据决定的，以最大限度地降低 CAP 不良后果的风险。在门诊环境中，轻度 CAP 病程中缺乏微生物诊断并不会导致经验性抗菌治疗的效果下降。文章重点介绍了目前关于门诊患者选择经验性抗生素治疗 CAP 的临床建议。阿莫西林是一种半合成青霉素，包括与β-内酰胺酶抑制剂克拉维酸联用，是各国最经济实惠、使用最广泛的青霉素。根据临床建议，阿莫西林（包括与β-内酰胺酶抑制剂联用）是大多数 CAP 门诊患者初始经验性治疗的首选药物。口服途径是轻度 CAP 患者最常用和首选的抗生素给药途径。分散片具有一定的优势，包括便于老年人、中风患者和儿童等吞咽困难的患者服用。生物等效性评估显示，阿莫西林和阿莫西林与克拉维酸复方分散片的药代动力学参数与原始薄膜衣片相似。
{"title":"Community-acquired pneumonia in outpatients: topical issues of antibacterial therapy","authors":"Y. Belotserkovskaya, A. G. Romanovskikh, I. P. Smirnov","doi":"10.21518/ms2024-102","DOIUrl":"https://doi.org/10.21518/ms2024-102","url":null,"abstract":"Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality worldwide. Successful treatment of patients with CAP is mainly determined by the correct choice of the place of treatment (outpatient or inpatient) and the correct initial empirical therapy, considering the predictable spectrum of potential pathogens of CAP. The article provides up-to-date data on the etiological structure of non-severe CAP. Most patients with CAP receive outpatient medical care, which is determined by their clinical status and a limited number of laboratory data for minimizing the risk of adverse outcomes in CAP. The absence of a microbiological diagnosis in a mild course of CAP does not lead to a decrease in the effectiveness of empirical antibacterial therapy in outpatient settings. The article highlights current clinical recommendations on the choice of empirical antibiotic therapy for CAP in outpatients. Amoxicillin is a semi-synthetic penicillin, which, including in combination with the beta-lactamase inhibitor clavulanic acid, is the most affordable and widely used penicillin in various countries. According to clinical recommendations, amoxicillin, including in combination with a β-lactamase inhibitor, is the drug of choice for the initial empirical therapy of most outpatients with CAP. The oral route is the most common and preferred for antibiotic delivery in mild CAP. Dispersible forms of tablets have certain advantages, including easier intake in patients with difficulty swallowing, such as the elderly, stroke patients, and children. The assessment of biological equivalence showed similar pharmacokinetic parameters of Amoxicillin and Amoxicillin in combination with clavulanic acid in the form of dispersible tablets and in the original form of film-coated tablets.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141385076","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：