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Aim: To present the interim results of the work of the specialized Register of gluten-associated disorders, created at the North-West Center for the Treatment of Gluten-Associated Disorders (NWCT GAD) on the basis of the Department of Internal Medicine Propedeutics, Gastroenterology and Dietetics n.a. S.M. Ryss, the Mechnikov North-Western State Medical University.

Materials and methods: From November 2022 to January 2024, 120 patients were examined on the basis of the NWCT GAD, of which 60 patients met the requirements of the Register and were regarded as patients with gluten intolerance or a genetic predisposition to it.

Results: The average age of patients was 35.4 ± 12 years, women predominated - 56.7%. In the structure of nosological forms of GAD, the diagnosis of "celiac disease" was more common (55%). In 23 patients, the primary diagnosis of celiac disease was revised due to the lack of criteria for the disease due to erroneous interpretation of the results and insufficient examination. Gastrointestinal symptoms were observed in 74.2%, extraintestinal manifestations - in 85.5% of patients. Among the patients included in the Register, 31 (51.7%) person had already followed a gluten-free diet for more than 3 months, but in 29 persons various clinical manifestations were observed. There was comorbidity of gluten intolerance with functional diseases of the pancreatobiliary system (41.7%) and chronic gastritis (33.3%).

Conclusion: Thus, further work of the Register allows us to obtain new data on the course and prognosis of GAD, improve the diagnostic algorithm for certain forms of gluten intolerance with the formation of an observation plan and a version of the elimination protocol, which will affect the improvement of the quality of medical care and the quality of patients' life.

Aim: To evaluate the efficacy of combination therapy with rifaximin and Saccharomyces boulardii CNCM I-745 versus rifaximin monotherapy in patients with small intestinal bacterial overgrowth (SIBO) associated with long-term proton pump inhibitor (PPI) use.

Materials and methods: A prospective comparative study with two parallel groups was conducted. Eligible patients were those on continuous long-term PPI therapy (> 3 months) with confirmed SIBO. SIBO was diagnosed in all patients using a lactulose Hydrogen/Methane Breath Test (HMBT). Symptom severity was assessed using the validated "7 × 7" Questionnaire, and Quality of Life (QoL) was evaluated using the SF-36 Health Status Survey. Enrolled patients were randomized into two groups based on a 7-day treatment regimen: Group 1 received rifaximin (400 mg twice daily); Group 2 received rifaximin (400 mg twice daily) plus the probiotic Saccharomyces boulardii CNCM I-745 (Enterol® drug product, Biocodex, France; 500 mg twice daily). SIBO eradication was confirmed via repeat lactulose HMBT, and symptom severity/QoL were reassessed 4 weeks after treatment completion.

Results: 108 patients were enrolled (mean age 38.7 ± 8.9 years; 65.7% female). Mean PPI treatment duration at enrollment was 4.81 months (95% confidence interval 4.15-5.46). At 4-week follow-up, repeat lactulose HMBT showed SIBO persistence in 41.5% of Group 1 (n = 22/53) versus 21.8% in Group 2 (n = 12/55; p = 0.038). Statistically significant resolution of diarrhea was observed only in Group 2 (p = 0.033). The final median "7 × 7" Questionnaire score was significantly lower in Group 2 (p = 0.0010). Both groups showed significant trends toward QoL improvement on the SF-36 survey.

Conclusion: This prospective comparative study demonstrates that combination therapy with rifaximin and Saccharomyces boulardii CNCM I-745 appears more effective than rifaximin monotherapy for SIBO eradication, symptom regression, and QoL improvement in patients with PPI-associated SIBO.

Over the past decades, acid production in the stomach has been regulated mainly by proton pump inhibitors (PPIs). However, despite their widespread use and solid evidence base for efficacy, PPIs have pharmacokinetic and pharmacodynamic limitations, such as a slow onset of action, response variability (dependent on CYP2C19 polymorphisms), and the need for activation in an acidic environment. These restrictions underscore the need for innovative molecular approaches to inhibiting acid production, which led to the development of a fundamentally different mechanism of action - potassium-competitive acid blockers (P-CABs), first introduced into clinical practice in 2015. The mechanism of action of P-CABs is based on a reversible ionic interaction with hydrogen potassium adenosine triphosphatase (H⁺/K⁺ ATPase) in parietal cells of the stomach. Direct inhibition of the active enzyme enables more rapid and sustained control of gastric secretion, including nocturnal and postprandial acid production, making this class of drugs particularly relevant in the treatment of gastroesophageal reflux disease, peptic ulcers, and in the eradication of Helicobacter pylori. Recent meta-analyses demonstrate the clinical benefits of P-CABs over PPIs for these indications.

Idiopathic recurrent pericarditis is a rare pathology characterised by recurrent inflammation in the cardiac cavity. Treatment of recurrent pericarditis is The possibilities of using food products based on vegetable protein to correct nutritional patterns in alimentary-dependent diseases (ADDs) of the digestive system have not been sufficiently studied. The purpose of the review is to analyze the literature data to determine the possibilities of using vegetable protein products to correct nutritional patterns in the most common ADDs of the digestive system. We searched the PubMed/MEDLINE, EMBASE, Google Scholar, CyberLeninka, and Elibrary databases with keywords corresponding to the study goals. There were 314 studies identified; however, after excluding duplicate publications and analyzing relevant data, 66 papers were included. The analysis results showed a possible benefit from using vegetable protein, which may be of clinical importance in diseases such as metabolically associated fatty liver disease, gastroesophageal reflux disease, and irritable bowel syndrome. Data on the adequacy of diets with vegetable protein and possible adverse events during their use are presented. The technological and economic prospects of using products based on vegetable proteins to correct nutritional patterns in patients with ADDs of the digestive system are addressed.

Aim: To optimize the algorithm of diagnosis and treatment of patients with gastroesophageal reflux disease (GERD) with comorbid obesity based on a comprehensive analysis of the clinical and functional characteristics of the disease.

Materials and methods: The study included 150 patients who underwent esophagogastroduodenoscopy, 24-hour pH-measurement or 24-hour pH-impedancometry of the esophagus. A stratification was carried out basing on the presence of typical GERD complaints and body mass index (BMI). Group 1 consisted of 30 patients with GERD and normal body weight; group 2 - 60 patients with GERD who were overweight or obese; group 3 - 30 patients without GERD, but overweight or obese; control group - 30 people with normal body weight without GERD, but with similar complaints due to functional disorders of the esophagus.

Results: When comparing esophageal pH-impedancometry data, it was found that the volume clearance time did not differ between the groups of patients with normal body weight and overweight, but in obese people reflux with pH > 7 was recorded more often and for a longer time. The duration of chemical clearance (DCC) was increased in both groups, however, with overweight (BMI > 25 kg/m²), DCC was shorter, and with obesity (BMI > 30 kg/m²), it was longer than in people with normal body weight. At the same time, as body weight increases, the frequency of mixed (gastric and duodenal) reflux also rises up.

Conclusion: A comprehensive analysis of the characteristics of refluxate allows us to assess the course of the disease in more details, make assumptions about a unique combination of aggression factors for each patient, determine the severity of damage to the mucous membrane of the esophagus and, thanks to this, optimize approaches to therapy.

The article presents a clinical case of Fabry disease in a woman, characterized by multisystemic lesions, late onset and predominant clinical picture of heart failure. The features of this pathology are described in detail with an emphasis on instrumental studies of the cardiovascular system, and the progressive course of Fabry disease is analyzed. This clinical observation illustrates the importance of family screening and detailed anamnesis, shows the process of supervision of a patient with an orphan disease by a cardiologist of a regional hospital in real clinical practice, thereby increasing awareness of the Russian medical community about this pathology.

The particular focus of the modern scientific community and practical medicine is concentrated on patients with refractory arterial hypertension when appropriate lifestyle measures and treatment with optimal or best tolerated doses of 5 or more drugs with diuretic and mineralocorticoid receptor antagonist fail to lower office blood pressure to <140/90 mmHg. Inefficiency of recommended treatment methods requires new therapeutic approaches for these patients. The efficiency and mechanisms of extracorporeal treatment for blood pressure reduction in patients with malignant hypertension were first studied in the 1980s and 1990s. This clinical case study demonstrates the use of extracorporeal hemocorrection procedures as part of the complex treatment of patients with refractory arterial hypertension.

Background: Dysregulation of apoptosis in diffuse B-large cell lymphoma (DLBCL) contributes to increased tumor proliferation, as well as the formation of resistance to treatment. One of the most relevant areas of molecular research is the study of the mechanisms of programmed cell death - apoptosis. The AIF (Apoptosis Inducing Factor) protein participates in the regulation of the caspase-independent pathway of cell death and is a potential predictor of the course of DLBCL.

Aim: To evaluate the prognostic value of AIF expression in DLBCL.

Materials and methods: A retrospective study included 100 patients with newly diagnosed DLBCL. All patients received standard 1st line therapy according to the R-CHOP scheme. Using histological, immunohistochemical studies of lymph nodes and/or other organs involved in the pathological process were performed. A morphometric calculation of the data was carried out with the determination of the percentage of AIF-expressing tumor cells. The threshold level of expression of these proteins was calculated using by the ROC analysis (57%). Based on the threshold, patients were divided into groups with high (above threshold) and low (subthreshold) protein levels. The calculation of overall (OS) and progression-free (PFS) survival was performed using the Kaplan-Meier method with graphical construction of the corresponding curves, the levels of factors were compared using the log-rank test criterion. The independent influence of factors on the course of DLBCL was determined using multivariate Cox regression analysis.

Results: The subthreshold level of AIF was associated with low rates of OS and PFS of patients (34.9 and 48.8%, respectively). As a result of multivariate Cox analysis, it was found that the AIF protein is an independent prognostic marker for the course of DLBCL.

Conclusion: The subthreshold value of AIF expression is associated with low OS and PFS in patients.

Aim: To evaluate cognitive impairment in patients with chronic heart failure (CHF) and its impact on treatment adherence.

Materials and methods: The study included 120 hospitalized patients with CHF regardless of left ventricular ejection fraction aged from 20 to 79 years with different etiology of CHF. All patients underwent complex neuropsychological testing to determine the presence and severity of CH, psychoemotional status, as well as adherence to treatment and quality of life. After 6 months, the group of patients who came for a follow-up visit was re-evaluated for these indicators. The first group of patients was compared with the second group of patients who did not come for a follow-up visit after 6 months, although the conditions of the study were explained to all single patients.

Results: Out of 120 patients, 28 (23.3%) patients came for a follow-up visit, 3 (2.5%) patients died, the rest of the study participants [89 (74.2%) patients] - refused a face-to-face visit to the physician. On MoCA after 6 months, patients showed a higher mean score of 23.89±2.67 (p=0.003). Percentage-wise, 53.6% of patients showed improvement in cognitive functioning scores. Group 1 patients (n=28) demonstrated a medium relationship between treatment adherence on the Morisky-Green questionnaire and RBM-7 (r=-0.532) in contrast to group 2 patients (n=89) who demonstrated a weak relationship (r=-0.283).

Conclusion: The complex relationship between CHF and cognitive impairment emphasizes the need for a comprehensive approach to patient care. Patients who demonstrate high compliance and good subjective assessment of their cognitive functioning, although some cognitive functions are reduced, are the most motivated to comply with the doctor's recommendations and follow-up.

Nutrition and physical activity play a key role in the onset and progression of sarcopenic obesity (SO). Therefore, dietary interventions are essential in comprehensive programs to prevent and treat this condition. The classic approach to obesity diet therapy, which is to reduce the caloric value of the diet, is associated with a decrease in body weight due to both fat and fat-free components. In elderly patients with SO, a reduction in body weight impacts not only the muscle mass but also muscle function. A promising approach to diet therapy for this type of obesity is qualitative modification of the diet structure used for weight loss. The clinical role of specific components of diets, foods, and overall dietary patterns that are effective for CO treatment remains poorly understood. Sufficient intake of high-quality protein and branched-chain amino acids is known to stabilize and increase muscle mass, and recommended protein intakes in patients with SO of different ages continue to be discussed. It has been shown that in the elderly and senile age, the need for energy decreases; however, the need for protein increases. The role of ù-3 polyunsaturated fatty acids, vitamin D, calcium, and polyphenols in the treatment of SO may be due to their anti-inflammatory effect, as well as, possibly, activation of mitochondrial functions and regulation of myogenesis processes. Developing and using specialized foods containing proteins, branched-chain amino acids, and other key nutrients can improve the effectiveness of SO therapy. The review summarizes modern nutritional approaches to SO.