Terapevticheskii Arkhiv最新文献

Localized light chain (AL) amyloidosis (amyloidoma) is a rare disease with unclear pathogenesis and undeveloped approaches to therapy. This article presents 3 clinical observations of localized AL amyloidosis with lesions of the respiratory tract, eyes, and soft tissues of the face. Tumor masses consisted of amyloid masses in which single monotypic plasma cells were "embedded". To verify the cell substrate, the method of chromogenic in situ hybridization with probes to immunoglobulin light chains was used. Amyloid typing was performed using FITC-labeled antibodies to kappa and lambda light chains after enzymatic treatment of paraffin sections with pronase. The absence of monoclonal secretion (in two cases) made it difficult to assess the efficacy of the therapy. Taking into account the prevalence and severity of vital organs damage, as well as the recurrent nature of the disease course, systemic combination therapy with targeted drugs was prescribed. Stabilization of the process in all patients was stated during one year of follow-up. Nevertheless, clonreducing therapy in localized AL amyloidosis is not considered as a standard option, its feasibility and efficacy requires further confirmation.

Aim: To assess biomarkers of T2-inflammation in patients with chronic obstructive pulmonary disease (COPD).

Materials and methods: We examined 173 adult outpatients (80% male, age 40-89 yrs) with COPD. Lung function tests were assessed by using the Spirograph 2120 (Vitalograph, UK). Blood eosinophils (Eos) were measured by automatic haemoanalyser. Atopic status was determined by serum specific immunoglobulin E to common inhalant allergens. Fractional exhaled nitric oxide (FeNO) was measured by a chemiluminescence analyzer (LR4100, Logan Research, Rochester, UK). Symptoms and quality of life were assessed by using Russian versions of St. George's Respiratory Questionnaire (SGRQ) and COPD Assessment Test. Statistical analyses were performed with Statistica ver. 10.0 (StatSoft, Inc., USA).

Results: The most frequent marker was blood Eos ≥150 cell/μl (36%), less often was elevated level FeNO≥20 ppb, allergy was rare (5%) and house dust mites were the common allergen. T2-associated diseases (allergic rhinitis, nasal polyposis, atopic dermatitis) were diagnosed in 7% patients.

Conclusion: Forty percent of patients with COPD without concomitant asthma have markers of T2-airway inflammation in a real clinical practice. The most frequent marker was blood Eos≥150 cell/μl that was associated with rate of COPD exacerbation. Frequency of concomitant T2-diseases (allergic rhinitis, nasal polyps, atopic dermatitis) was low.

Aim: To determine the frequency and prognostic significance of right ventricular-pulmonary artery (RV-PA) uncoupling, in the development of cardiovascular complications in patients with acute decompensation of chronic heart failure (ADCHF).

Materials and methods: The prospective single-center observational study included 171 patients with ADCHF. Tricuspid Annular Plane Systolic Excursion (TAPSE)/PA systolic pressure <0.36 mm/mmHg by 2D echocardiography was used as the indicator of the right ventricular-pulmonary artery RV-PA uncoupling.

Results: The incidence of RV-PA uncoupling in the general population of patients with ADCHF was 67.2% (n=129). Patients with RV-PA uncoupling had a more severe clinical status. RV-PA uncoupling was associated with male sex (odds ratio, OR 2.6, 95% CI 1.35-5.04; p=0.004), myocardial infarction (OR 2.06, 95% CI 1.04-4.09; p=0.037), and a history of cerebrovascular accident (OR 10.89, 95% CI 1.42-83.55; p=0.005). Echocardiography showed more pronounced deviations in the structural and functional parameters of the right and left heart compartments and a higher PA systolic pressure. In ischemic heart disease, the risk of RV-PA uncoupling increased 2.85 times (95% CI 0.99-8.23; p=0.053), and in diabetes mellitus, it increased 4.31 times (95% CI 1.19-15.56; p=0.026). With an increase in the diameter of the inferior vena cava per unit, the risk of RV-PA uncoupling increased 9.49 times (95% CI 2.17-41.40; p=0.003), and with an increase in the transverse size of the right atrium, it increased 2.83 times (95% CI 1.28-6.26; p=0.010). In patients with RV-PA uncoupling, higher liver density was identified using transient elastography and reduced active and reactive resistance using bioimpedance vector analysis, regardless of right ventricular dysfunction. The effect of the RV-PA uncoupling on the overall hospitalization rate and related to ADCHF was shown.

Conclusion: The high frequency, clinical association, and prognostic significance of RV-PA uncoupling support RV-PA assessment in patients with ADCHF.

Chronic bronchitis (CB) is one of the most commonly diagnosed non-communicable chronic diseases. At the same time, with such a high incidence of CB registered in the Russian Federation, this pathology requires a balanced approach to the interpretation of clinical and functional indicators and their differentiated approach. The main provisions of the new clinical recommendations on CB, which are reflected in the article, will be useful in the practical work of an internist.

Aim: To evaluate markers of bacterial infection and features of antibiotic therapy in patients hospitalized with exacerbation of chronic obstructive pulmonary disease (COPD) once and again during the year.

Materials and methods: Analysis of 423 medical records of inpatients hospitalized in the therapeutic department of a city hospital with exacerbation of COPD over 4 years. 276 cases were hospitalized once during the year (control group), 147 - hospitalized repeatedly (main group).

Results: In the control group 36.9% of patients complained of cough with purulent sputum, while in the main group - 25.2% (p<0.05). 31.5% of patients in the control group and 17% of the main group reported fever during hospitalization (p<0.05). A high level of CRP during hospitalization was observed in 62.8% of patients in the control group and 49.1% in the main group (p<0.05); 47.1% of patients in the control group and 28.6% of patients in the main group had an increased level of leukocytes in sputum. According to the results of bacteriological analysis of sputum, there were no differences in the inoculation of infectious agents in the groups. At the same time, in almost 90% of cases, patients in both groups were prescribed antibiotic therapy, and in some cases, the same antibiotic for 2 and 3 hospitalizations in a row. Patients of the main group had extremely severe obstructive disorders twice as often. The degree of respiratory failure in patients with repeated exacerbations increased by 2 times from the first to the third hospitalization. Arterial hypertension and chronic heart failure of the 2nd stage were more common in the main group.

Conclusion: The severity of obstructive disorders, the severity of the comorbidity, and the general condition of patients may have a more significant effect on the recurrence of severe exacerbations requiring repeated hospitalizations than bacterial infection. In this regard, in this group of patients, special attention should be paid to assessing the indications for prescribing antibiotic therapy, as well as optimizing its regimens.

Pulmonary health is a key aspect of modern medicine, covering all age groups, from neonatology to gerontology. The article addresses the impact of genetic factors, environment, and human lifestyle on the development of respiratory diseases. Particular attention is paid to the role of genetic predisposition, embryonic disorders, and external factors such as air pollutants and tobacco smoking in the development of chronic lung diseases. Data on the structural and functional development of the respiratory system, its age-related changes, and the risks associated with the involution of the lung tissue are presented. An interdisciplinary approach, including cooperation between pediatricians, therapists, and pulmonologists, is essential for the early diagnosis and effective treatment of respiratory diseases. Particular attention is paid to the impact of new scientific advances, including genomic research and artificial intelligence systems, on diagnosing and treating respiratory diseases.

Background: The incidence of venous thromboembolic complications (VTEC) in patients with inflammatory bowel diseases is approximately 3 times higher than in the general population and leads to a 2-fold increase in the risk of mortality. The risk of VTEC is the highest during the patient's hospital stay.

Aim: To compare the overall VTEC risk in inpatients with ulcerative colitis (UC) with and without VTEC primary prevention.

Materials and methods: In 2020, anticoagulant therapy was used for patients with UC in the case of acute venous thrombosis, and in 2022, primary thromboprophylaxis in patients with UC with moderate and high VTEC risk was based on the data obtained from the previous analysis of VTEC risk factors in inpatients with inflammatory bowel diseases. VTEC prophylaxis in UC patients was performed with a low molecular weight heparin (LMWH) - calcium nadroparin - at a dose of 0.3 mL (2850 IU anti-Xa) per day subcutaneously throughout the stay in the round-the-clock hospital.

Results: In 2020, venous thrombosis was diagnosed in 16 (1.8%) patients with UC, including venous thrombosis of the lower extremities in 3 (0.3%) patients, venous thrombosis of the upper extremities in 7 (0.8%), pulmonary embolism in 2 (0.2%), and combined thrombosis in 4 (0.5%). In 2022, venous thrombosis was diagnosed in 5 (0.5%) patients with UC, including venous thrombosis of the lower extremities in 1 (0.1%) patient, venous thrombosis of the upper extremities in 3 (0.3%), and pulmonary embolism in 1 (0.1%). Thus, primary prevention with an LMWH significantly reduces the risk of VTEC in hospitalized patients with UC (relative risk 0.285, 95% confidence interval 0.103-0.774; χ²=6.917; p=0.009).

Conclusion: Our results demonstrate that primary prevention with an LMWH significantly reduces the risk of VTEC in patients with UC hospitalized in a round-the-clock hospital.

Aim: To evaluate the efficacy and safety of the Russian biosimilar infliximab in patients with ulcerative colitis (UC).

Materials and methods: This is a retrospective study of stable patients with UC, who are followed up at the department of bowel pathology of Loginov Moscow Clinical Scientific Center and who underwent a non-medical switch from the original infliximab to its Russian biosimilar. The primary outcome is treatment continuation for 16 weeks after the switch. Secondary outcomes include the rate of loss of response, adverse events, and immunogenicity during the first 12 months after the switch.

Results: There was no significant difference in infliximab continuation between the biosimilar, switch and control groups. While the alternation group had the highest rate of loss of response and adverse events.

Conclusion: Non-medical switching from the original infliximab to its Russian biosimilar, as well as therapy with a biosimilar under one trade name, demonstrates similar clinical results compared to continuing to take the original molecule for the treatment of UC. The obtained data confirm the safety and efficacy of non-medical switching to infliximab in patients with UC.

Aim: To review the results of the open observational study Makhaon on the use of a fixed combination of glycyrrhizic acid (GA) and ursodeoxycholic acid (UDCA) (Phosphogliv Urso) for the treatment of abdominal pain, assessment of contractile function of the gallbladder and bile rheology in patients with stage I cholelithiasis.

Materials and methods: The study included 330 subjects, 44.5% males and 55.5% females. The study participants were 18-70 years old, with a mean age of 43.8±0.6 years. In 2021-2022, patients were treated in 14 clinical centers in 10 cities of the Russian Federation: Moscow, St. Petersburg, Stavropol, Volgograd, Perm, Samara, Ufa, Omsk, Novosibirsk, Tomsk. All patients received Phosphogliv Urso (UDCA 250 mg + sodium glycyrrhizinate 35 mg), 1 capsule 3 times daily with food for 6 months.

Results: Based on the clear improvement, therapy with a combination of GA and UDCA has demonstrated high efficacy and safety and appears to be optimal for the treatment of abdominal pain, improvement of the contractile function of the gallbladder, and physicochemical properties of bile in patients with stage I cholelithiasis.

Conclusion: Treating all variants of baseline changes in the bile rheology is an urgent task of modern biliology. Universal drugs for stage I cholelithiasis are UDCA and its fixed combination with GA.

Aim: To evaluate the associated effects of dynapenia and overweight in patients with ulcerative colitis (UC).

Materials and methods: Single-center observational cross-sectional case-control study. 80 patients with UC were divided into groups: 14 UC patients with dinapenia and overweight/obesity; UC and dinapenia patients with normal body weight/body weight deficiency (n=12); overweight/obese UC patients (n=24); UC patients with normal body weight/weight deficiency bodies (n=30). The protocol included: the study of nutrition, physical activity, the risk of nutritional insufficiency, measurement of body mass index, blood pressure, dynamometry, duplex scanning of extracranial vessels, determination of the insulin resistance index (HOMA-IR). The assessment of blood composition parameters included studies of blood lipid composition, C-reactive protein, TNF-α, glucose, insulin, C-peptide, leptin, adiponectin, leptin receptors. Zonulin has been studied in feces.

Statistical methods: median (Me), upper and lower quartiles (Q₂₅, Q₇₅); fraction and standard error of the fraction; Mann-Whitney criterion; Kruskal-Wallis criterion; Pearson's χ². To identify the statistical relationship, Spearman's correlation coefficient was calculated. Statistical indicators are calculated using Statistica 10.01.1011.

Results: Dinapenia in combination with obesity/overweight is observed in 17.5% of patients with UC, most of them patients with low physical activity. Dinapenic obesity is associated with metainflammation and increased permeability of the epithelial barrier, as evidenced by significantly higher rates of C-reactive protein, TNF-α, HOMA-IR and fecal zonulin. In patients with dinapenia in combination with overweight/obesity, higher leptin levels were determined, and the leptin receptors level was lower than in participants of other groups.

Conclusion: The mechanisms of dinapenia in overweight/obese UC patients include a synergistic effect of inflammation, insulin resistance and increased epithelial permeability.