Terapevticheskii Arkhiv最新文献

Aim: To identify risk factors for adverse drug reactions (ADRs) in patients co-infected with multidrug-resistant tuberculosis (MDR-TB), HIV and viral hepatitis C (HCV).

Materials and methods: The incidence, spectrum, association with medications, and outcomes of ADRs were studied in 132 patients with MDR-TB/HIV/HCV receiving antituberculosis and antiretroviral therapy. Statistical methods of data processing were used to identify predictors of ADRs development.

Results: The overall incidence of undesirable ADRs amounted to 67%, severe ADRs of 3-4 degrees - 12%. Hepatotoxic (31%), nephrotoxic (18%) and dyspeptic (16%) reactions took the leading place in the spectrum of undesirable ADRs. Among the outcomes of all undesirable ADRs, the vast majority of TB drugs were canceled (61%), and undesirable ADRs were managed only in 6% of cases. Pyrazinamide, para-aminosalicylic acid, injectable aminoglycosides had the most unfavorable safety profile in the studied cohort, which led to their final exclusion from chemotherapy regimens.

Conclusion: Independent predictors of any undesirable ADRs were kanamycin, pyrazinamide and para-aminosalicylic acid administration, severe reactions were hepatobiliary disorders, and drug withdrawal due to the development of undesirable ADRs were pyrazinamide and para-aminosalicylic acid administration. Bedaquiline, delamanid, moxifloxacin and ethambutol had the most favorable safety profile in the study cohort. The obtained data allow to form risk groups for the development of ADRs in patients with triple infection, to identify indications for enhanced monitoring and prescription of drug prophylaxis at the start of treatment.

The article's scope is to review the modern approaches to the treatment of acute respiratory viral infections and influenza in adults, including those go higher risk. Both the main mechanisms of action of the drugs and the evidence base of their use in various clinical situations, including the prevention of complications, are discussed. The main prospects for the development of this area are outlined, taking into account the characteristics of pathogens.

Dengue fever is the most common zoonotic infection with a transmissible mechanism of virus transmission in tropical and subtropical countries. In the first two decades of the 21st century, a significant increase in dengue fever cases was registered in more than 120 countries worldwide. The article presents a family imported case of dengue fever in a 34-year-old man and a 35-year-old woman who fell ill within 3 days after returning from Thailand (Phuket Island). In both cases, there was an acute onset of the disease with an increase in body temperature to (39-40°С), severe weakness, severe muscle and joint pain, severe headache, and loose stools once or twice. They were treated independently for acute respiratory infections. They sought medical help on the 4th and 5th days of their illness and were admitted to an infectious diseases hospital. The disease was accompanied by the development of posterior cervical and submandibular lymphadenitis, hepatomegaly, an uncommon spotty-papular rash on the skin of the trunk and arms, single point hemorrhages, severe thrombocytopenia and leukopenia. The woman was diagnosed with posterior cervical and submandibular lymphadenitis, and hepatosplenomegaly. On the 6th day of the disease, the woman was radiographically diagnosed with peribronchial edema of the interstitium. On the 7th day of the disease, the man developed a hydrocele on the right. Type 2 dengue virus was detected in blood, urine, and saliva by polymerase chain reaction in both patients. The man was discharged on the 20th day of his illness with asthenovegetative and dyspeptic symptoms that persisted for several weeks. The woman was discharged on the 17th day of her illness with residual asthenovegetative manifestations and secondary thrombocytopenia lasting several years.

Aim: To evaluate the efficacy and safety of levilimab (LVL) in patients with rheumatoid arthritis (RA) in real clinical practice.

Materials and methods: A retrospective observational study of 144 patients with RA and the need to adjust previously prescribed therapy against the background of an exacerbation of the disease, which took place at the Republican Clinical Hospital in Kazan. All patients included in the study were prescribed LVL (Ilsira). The activity of RA was assessed using Disease Activity Score 28 - DAS28-ESR/CRP indices. The assessment was performed before initiation of LVL therapy and at the end of follow-up.

Results: The analysis included 144 patients with RA (112 - women, 32 - men, average age - 55.1±12.3 years). The patients were divided into 3 groups, depending on the duration of follow-up. The first group (up to 4 weeks) - 33 (22.9%) patients, the second group (4-8 weeks) - 75 (52.1%), the third group (more than 8 weeks) - 36 (25%). The duration of follow-up described in the study did not exceed 12 weeks. The assessment was performed before initiation of LVL therapy and at the end of follow-up. In each of the groups, at the time of completion of the observation, there was a decrease in RA activity according to the DAS28-ESR/CRP indices by 6.1% (p=0.000162), 11.1% (p=0.00001) and 27% (p=0.0001) respectively, according to acute phase indicators - ESR by 39.6% (p=0.0001), 55.4% (p=0.0001) and 44.6% (p=0.000028) respectively, CRP decreased by 65.2% (p=0.000196), 71.5% (p=0.0001) and 58.6% (p=0.000707) respectively. At the end of the follow-up, the number of patients with high RA activity decreased by 65.8% (p=0.000022). Against the background of LVL therapy, the proportion of patients taking CS≥7.5 mg/day decreased by 31.4% (p=0.006). LVL's safety profile was assessed as favorable. The registered AE related to deviations in the reference values of laboratory parameters and corresponded to 1 or 2 degrees of severity according to CTCAE version 5.0. No serious AE were reported.

Conclusion: Levilimab has demonstrated high efficacy and a favorable safety profile for RA therapy.

The presented case demonstrates the development of glomerulonephritis associated with generalized salmonellosis. At the onset of the disease, a symptom complex mimicking systemic lupus erythematosus was noted. A kidney biopsy made it possible to make the correct diagnosis and choose the optimal treatment.

Background: Metabolomics studies in oncology provide a deeper understanding of the biochemical processes associated with tumor growth and the body's response to treatment. In patients with lymphoma, systemic metabolic changes remain poorly understood despite their high clinical significance.

Aim: To evaluate changes in the metabolomic profile of blood plasma in patients with lymphoma at various stages of polychemotherapy (PCT) and compare them to those of healthy volunteers.

Materials and methods: The study included 18 patients with lymphoma from whom blood was collected before treatment and after the first and third courses of PCT. The control group included 30 healthy volunteers. The analysis was performed by high-performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS) and included measurements of amino acids, tryptophan and arginine derivatives, and acylcarnitines. Statistical processing was performed using analysis of variance and principal component analysis.

Results: Prior to therapy, patients showed characteristic metabolic disorders: activation of the kynurenine pathway of tryptophan metabolism, a decrease in arginine, and an increase in its methylated derivatives, as well as shifts in the amino acid and acylcarnitine profiles. During PCT, partial normalization of these indicators was observed, especially for the serotonin-melatonin cascade and kynurenine metabolites.

Conclusion: Metabolomics analysis revealed characteristic biochemical changes in patients with lymphoma and their changes over time during treatment. The data obtained emphasize the potential of metabolomics as a tool for monitoring treatment effectiveness and patient condition in oncology.

The article presents the main stages of studying cryoglobulinemia and the associated clinical symptom complex as a manifestation of cryoglobulinemic vasculitis. Achievements in the study of hepatitis C virus are shown: the etiological role of the hepatitis C virus, pathogenesis, diagnosis. Variants of the course are considered, modern criteria for differential diagnosis, prognosis, choice of tactics and treatment methods are given.

Clinical and prognostic significance of cardio-renal syndrome in various infectious diseases are discussed. Incidence and prognosis, as well as pathogenesis of cardio-renal syndrome in patients with infectious diseases, admitted to ICU of infectious hospitals, as well as hemorrhagic fever with renal syndrome and in COVID-19 are reviewed.

Aim: Evaluation of the efficacy of Cytoflavin in the correction of mild cognitive disorders in patients with chronic brucellosis.

Materials and methods: A total of 40 patients with inactive forms of chronic brucellosis who sought medical care were examined, including 17 men (42.5%) and 23 women (57.5%), with an average age of 46.4±3.7 years. In Group 1 patients received intravenous infusions of Cytoflavin for 10 days as a neuroprotector, and in Group 2 - "active placebo" (100 ml of 0.9% sodium chloride solution).

Study design: open-label, randomized, comparative, random sampling.

Results: It has been established that inactive forms of chronic brucellosis are accompanied by damage to the nervous system with the development of mild (predementia) cognitive impairment and deterioration in quality of life. In the group of patients receiving Cytoflavin, there was a statistically significant decrease in the severity of neurological deficit, a significant increase in the total score of the MoCA test, and a statistically significant improvement in the indicators of both physical and psychological health components according to the scales of the SF-36 questionnaire. No side effects were recorded during the use of Cytoflavin in the patients of the study group, which indicates good tolerability of the drug.

Conclusion: The prescription of a course of infusion neuroprotective therapy with Cytoflavin contributes to a significant clinical improvement in patients with inactive chronic brucellosis with significant positive dynamics of cognitive functioning parameters assessed using MoCA testing and health indicators according to the SF-36 questionnaire.

Background: Despite the variety of antidiabetic therapies, many patients with type 2 diabetes (T2D) do not achieve optimal glycemic control. Therefore, there is a need to develop additional methods for managing T2D, including ones that regulate the gut microbiome.

Aim: To assess the effect of AntiAGE-Biom probiotic on metabolic parameters in T2D patients during 3 months of therapy.

Materials and methods: A randomized, double-blind, placebo-controlled, single-center study included patients with T2D with glycated hemoglobin - HbA_1c<7,5% on stable antidiabetic therapy. Patients were randomized into groups receiving AntiAGE-Biom and placebo. The primary endpoint was the change in HbA_1c from baseline, secondary endpoints included the dynamics in biochemical and anthropometric parameters, body composition, as well as HOMA-IR index.

Results: The study included 40 patients with T2D (n=20 in each group). There was a trend towards a decrease in HbA_1c in AntiAGE-Biom group, that did not reach statistical significance. The use of the probiotic improved the body composition after 3 months: reduced the percentage of fat in men and a subgroup of patients with an initial HbA_1c≥ 6.5%; also increased skeletal muscle mass and lean mass in the trunk segment in men (р<0,05).

Conclusion: AntiAGE-Biom probiotic helps to maintain metabolic control and significantly improve body composition in T2D patients with initial HbA_1c<7.5%.