V. V. Naumova, Е. К. Beltyukov, О. P. Kovtun, G. А. Bykova, О. G. Smolenskaya, A. A. Shtanova, D. A. Stepina
Introduction. Biologics for severe asthma (SA) treatment are widely used in real clinical practice. But there are very few direct comparative studies at the moment. Aim. To compare mepolizumab and dupilumab effectiveness in patients with non-allergic eosinophilic SA in real clinical practice using regional register of Sverdlovsk region. Materials and methods. The data of patients with non-allergic eosinophilic SA treated with dupilumab (n = 23) and mepolizumab (n = 19) were analyzed. Therapy effectiveness was determined according to BARS and patients’ proportion who achieved asthma remission, dynamics of ACT, AQLQ, FEV 1 , blood eosinophils, frequency of short-acting bronchodilators use and systemic glucocorticosteroids (SGCS) demand, frequency of asthma exacerbations and hospitalizations. Results. Within 12 months of targeted therapy a good response to biologics according to BARS in 77.8% of patients on dupilumab and in 82.4% of patients on mepolizumab (p = 1.000) was revealed. Remission of SA (without FEV 1 ) was achieved in 62.5% of patients in dupilumab group and in 68.8% of patients in mepolizumab group (p = 1.000). Remission of SA (with FEV 1 ) was achieved in 43.8% of patients on dupilumab and in 56.2% of patients on mepolizumab (p = 0.724). There were statistically significant improvements for all separately analyzed indicators in each observation group. Statistically significant differences after a year of therapy between groups were recorded in terms of eosinophil levels (p < 0.001) and nasal symptoms assessed using the SNOT-22 questionnaire (p = 0.048) in favour of mepolizumab. Conclusions. Patients with non-allergic eosinophilic SA have good response to both dupilumab and mepolizumab. The drugs equally improve disease control, life quality, reduce the need for relievers and SGCS, show a similar safety level.
{"title":"Direct comparative study of the effectiveness of mepolizumab and dupilumab in patients with severe non-allergic eosinophilic asthma","authors":"V. V. Naumova, Е. К. Beltyukov, О. P. Kovtun, G. А. Bykova, О. G. Smolenskaya, A. A. Shtanova, D. A. Stepina","doi":"10.21518/ms2023-308","DOIUrl":"https://doi.org/10.21518/ms2023-308","url":null,"abstract":"Introduction. Biologics for severe asthma (SA) treatment are widely used in real clinical practice. But there are very few direct comparative studies at the moment. Aim. To compare mepolizumab and dupilumab effectiveness in patients with non-allergic eosinophilic SA in real clinical practice using regional register of Sverdlovsk region. Materials and methods. The data of patients with non-allergic eosinophilic SA treated with dupilumab (n = 23) and mepolizumab (n = 19) were analyzed. Therapy effectiveness was determined according to BARS and patients’ proportion who achieved asthma remission, dynamics of ACT, AQLQ, FEV 1 , blood eosinophils, frequency of short-acting bronchodilators use and systemic glucocorticosteroids (SGCS) demand, frequency of asthma exacerbations and hospitalizations. Results. Within 12 months of targeted therapy a good response to biologics according to BARS in 77.8% of patients on dupilumab and in 82.4% of patients on mepolizumab (p = 1.000) was revealed. Remission of SA (without FEV 1 ) was achieved in 62.5% of patients in dupilumab group and in 68.8% of patients in mepolizumab group (p = 1.000). Remission of SA (with FEV 1 ) was achieved in 43.8% of patients on dupilumab and in 56.2% of patients on mepolizumab (p = 0.724). There were statistically significant improvements for all separately analyzed indicators in each observation group. Statistically significant differences after a year of therapy between groups were recorded in terms of eosinophil levels (p < 0.001) and nasal symptoms assessed using the SNOT-22 questionnaire (p = 0.048) in favour of mepolizumab. Conclusions. Patients with non-allergic eosinophilic SA have good response to both dupilumab and mepolizumab. The drugs equally improve disease control, life quality, reduce the need for relievers and SGCS, show a similar safety level.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135476656","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}
Non-calculous cholecystitis is a form of cholecystitis caused by dysfunction or hypokinesis of the gallbladder. The polyetiology and multiplicity of the pathogenesis of this disease requires different approaches to its correction. In this situation, phytopreparations containing components of origin provide special attention in combination with the main therapy. Curcumin has a strong protective effect against cholestasis through farnesoid X receptors, resulting in a release of bile acid homeostasis and counteracting inflammatory inflammation and as a manifestation of cholestasis. Several studies show that curcumin requires a contraction of the gallbladder. Despite the presence of many useful properties, the widespread use of curcumin in medical practice was limited by its limited bioavailability. Forms with increased bioavailability have been synthesized, such as kavacarcumin. The use of artichoke leaf extract in gastroenterology is based on its strong antidyspeptic effect, mediated by choleretic activity. As study show, the choleretic effect of the artichoke was more pronounced than that of the reference drug. In the description, there is no direct effect of chamomile phytocomponents on the state of bile compatibility and the function of bile outflow, however, an indirect effect on its work is possible. The results make chamomile flower extract a good addition to therapy. Thus, due to the occurrence of synergistic components, the complex is found in individuals, in patients with chronic diseases of the biliary tract, with functional disorders, the period of treatment in long-term complex therapy, with the prevention of exacerbation and prolongation of remission, as well as in healthy individuals for the prevention of these diseases.
{"title":"The role of phytocomponents in the complex therapy of chronic non-calculous cholecystitis","authors":"V. V. Skvortsov, E. A. Malyakina, G. I. Malyakin","doi":"10.21518/ms2023-394","DOIUrl":"https://doi.org/10.21518/ms2023-394","url":null,"abstract":"Non-calculous cholecystitis is a form of cholecystitis caused by dysfunction or hypokinesis of the gallbladder. The polyetiology and multiplicity of the pathogenesis of this disease requires different approaches to its correction. In this situation, phytopreparations containing components of origin provide special attention in combination with the main therapy. Curcumin has a strong protective effect against cholestasis through farnesoid X receptors, resulting in a release of bile acid homeostasis and counteracting inflammatory inflammation and as a manifestation of cholestasis. Several studies show that curcumin requires a contraction of the gallbladder. Despite the presence of many useful properties, the widespread use of curcumin in medical practice was limited by its limited bioavailability. Forms with increased bioavailability have been synthesized, such as kavacarcumin. The use of artichoke leaf extract in gastroenterology is based on its strong antidyspeptic effect, mediated by choleretic activity. As study show, the choleretic effect of the artichoke was more pronounced than that of the reference drug. In the description, there is no direct effect of chamomile phytocomponents on the state of bile compatibility and the function of bile outflow, however, an indirect effect on its work is possible. The results make chamomile flower extract a good addition to therapy. Thus, due to the occurrence of synergistic components, the complex is found in individuals, in patients with chronic diseases of the biliary tract, with functional disorders, the period of treatment in long-term complex therapy, with the prevention of exacerbation and prolongation of remission, as well as in healthy individuals for the prevention of these diseases.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775196","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. L. Brovin, D. V. Kuleshova, O. F. Dementeva, K. N. Malikov, D. A. Dolgushev, V. P. Sereda
Infective endocarditis (IE) is an infectious and inflammatory disease of the endocardium that is associated with a high incidence of complications and mortality. Elderly patients are the most vulnerable age group for the IE. Infective endocarditis caused by E. coli is a rare disease due to both bacteria life-cycle and human immune system protection. Nevertheless, recent years the incidence of IE associated with E. coli has been increasing in the group of elderly patients. It seems important to reassess the indications for antibiotic prophylaxis in certain categories of patients (including the elderly patients with an unobvious but increased risk of IE). This clinical case demonstrates a native valve endocarditis caused by E. coli developed after bowel preparation with osmotic laxatives and endoscopic procedure in an 85 year-old male without significant chronic diseases. Despite the fact that the patient did not belong to the category of increased risk of IE, he had the predisposing conditions for the development of IE (weaked immune system, bacteremia, heart valve sclerosis), that realized in the active manifest disease. Treatment with antibiotics led to an improvement in the patient’s condition and regression of infectious vegetations on the valve. Repeat blood cultures were negative. When planning endoscopic procedure for patients at risks (elderly person, weakened immune system, minimal aortic valve lesions), antibacterial prophylaxis should be considered. Additional research is required to develop clear algorithms for antibacterial prophylaxis.
{"title":"Infective endocarditis of the aortic valve in an 85-year-old man due to translocation of the intestinal flora","authors":"D. L. Brovin, D. V. Kuleshova, O. F. Dementeva, K. N. Malikov, D. A. Dolgushev, V. P. Sereda","doi":"10.21518/ms2023-390","DOIUrl":"https://doi.org/10.21518/ms2023-390","url":null,"abstract":"Infective endocarditis (IE) is an infectious and inflammatory disease of the endocardium that is associated with a high incidence of complications and mortality. Elderly patients are the most vulnerable age group for the IE. Infective endocarditis caused by E. coli is a rare disease due to both bacteria life-cycle and human immune system protection. Nevertheless, recent years the incidence of IE associated with E. coli has been increasing in the group of elderly patients. It seems important to reassess the indications for antibiotic prophylaxis in certain categories of patients (including the elderly patients with an unobvious but increased risk of IE). This clinical case demonstrates a native valve endocarditis caused by E. coli developed after bowel preparation with osmotic laxatives and endoscopic procedure in an 85 year-old male without significant chronic diseases. Despite the fact that the patient did not belong to the category of increased risk of IE, he had the predisposing conditions for the development of IE (weaked immune system, bacteremia, heart valve sclerosis), that realized in the active manifest disease. Treatment with antibiotics led to an improvement in the patient’s condition and regression of infectious vegetations on the valve. Repeat blood cultures were negative. When planning endoscopic procedure for patients at risks (elderly person, weakened immune system, minimal aortic valve lesions), antibacterial prophylaxis should be considered. Additional research is required to develop clear algorithms for antibacterial prophylaxis.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775200","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}
L. V. Tarasova, N. Yu. Kucherova, Yu. V. Tsyganova
Inflammatory bowel disease (IBD) is a chronic, relapsing, systemic and immune-mediated conditiondis that frequently involve extraintestinal manifestations. Latest studies showed increased risk of cardiovascular complications, which is the main cause of death in developed countries, in chronic inflammatory disorders, especially during IBD relapses. IBD patients are at increased risk of conditions such as early atherosclerosis, ischaemic heart disease, myocardial infarction, stroke, venous thrombosis, heart failure, аtrial fibrillation. Hypotheses for the mechanism underlying the association of IBD and atherosclerotic cardiovascular diseases include adverse effects of both the IBD itself (chronic inflammation, еndothelium dysfunction, dyslipidemia, thrombocytosis, gut microbiome dysfunction) and its treatment. The predominant role in atherogenesis is currently assigned to disruption of the endothelium. Endothelium plays an important role in physiologic regulation of vascular tone, cell adhesion, migration and resistance to thrombosis. Also, its dysfunction is associated with increased risk of atherosclerosis development. Early multifocal atherosclerosis is a serious complication of ulcerative colitis and can occur in young people without traditional cardiovascular risk factors. Untimely diagnosis, lack of pathogenetic treatment, correction of basic anti-inflammatory therapy and comprehensive consideration of a problem of high cardiovascular risk can lead to acute myocardial infarction and stroke and disability of a patient of working age. The authors present a case report of multifocal atherosclerosis complicated by acute coronary syndrome in a young man with ulcerative colitis, who required a radical revision of the therapy.
{"title":"A clinical case of early multifocal atherosclerosis complicated by acute coronary syndrome in a young man with ulcerative colitis","authors":"L. V. Tarasova, N. Yu. Kucherova, Yu. V. Tsyganova","doi":"10.21518/ms2023-306","DOIUrl":"https://doi.org/10.21518/ms2023-306","url":null,"abstract":"Inflammatory bowel disease (IBD) is a chronic, relapsing, systemic and immune-mediated conditiondis that frequently involve extraintestinal manifestations. Latest studies showed increased risk of cardiovascular complications, which is the main cause of death in developed countries, in chronic inflammatory disorders, especially during IBD relapses. IBD patients are at increased risk of conditions such as early atherosclerosis, ischaemic heart disease, myocardial infarction, stroke, venous thrombosis, heart failure, аtrial fibrillation. Hypotheses for the mechanism underlying the association of IBD and atherosclerotic cardiovascular diseases include adverse effects of both the IBD itself (chronic inflammation, еndothelium dysfunction, dyslipidemia, thrombocytosis, gut microbiome dysfunction) and its treatment. The predominant role in atherogenesis is currently assigned to disruption of the endothelium. Endothelium plays an important role in physiologic regulation of vascular tone, cell adhesion, migration and resistance to thrombosis. Also, its dysfunction is associated with increased risk of atherosclerosis development. Early multifocal atherosclerosis is a serious complication of ulcerative colitis and can occur in young people without traditional cardiovascular risk factors. Untimely diagnosis, lack of pathogenetic treatment, correction of basic anti-inflammatory therapy and comprehensive consideration of a problem of high cardiovascular risk can lead to acute myocardial infarction and stroke and disability of a patient of working age. The authors present a case report of multifocal atherosclerosis complicated by acute coronary syndrome in a young man with ulcerative colitis, who required a radical revision of the therapy.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775062","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. V. Tishkina, V. S. Shemenkova, E. V. Konstantinova
Chronic kidney disease is kidney damage that persists for three months or more due to the action of various etiological factors, the anatomical basis of which is the process of replacement of normal anatomical structures with fibrosis, leading to its dysfunction. This nosology is quite common in the modern world; it can progress and lead to disability of patients and a decrease in their quality of life. The mortality rate for this disease also remains high. About 3/4 of patients with this pathology have a terminal stage of the process, which is characterized by the development of protein-energy deficiency (due to uremia, malnutrition, acidosis and persistent inflammatory process), which significantly worsens the prognosis. Currently, the available literature contains a small number of works devoted to this problem, therefore an important part of the management of patients with chronic kidney disease (especially those on hemodialysis) is the assessment and correction of nutritional status. In this article, the authors highlight aspects of the development of protein-energy malnutrition, its possible methods of diagnosis and correction. Electrolyte disturbances, especially hyperkalemia and hyperphosphatemia, are also common complications of chronic kidney disease. Correction of these conditions, in turn, can lead to the development of deficiency of vitamins and other microelements. According to studies presented in the literature, nutritional status is one of the main factors determining the survival and degree of rehabilitation of patients on renal replacement therapy, as well as the effectiveness of dialysis treatment. Thus, a clinician’s knowledge of the nutritional status of this group of patients can improve their prognosis and quality of life.
{"title":"Characteristics of nutritional status in patients with chronic kidney disease","authors":"S. V. Tishkina, V. S. Shemenkova, E. V. Konstantinova","doi":"10.21518/ms2023-392","DOIUrl":"https://doi.org/10.21518/ms2023-392","url":null,"abstract":"Chronic kidney disease is kidney damage that persists for three months or more due to the action of various etiological factors, the anatomical basis of which is the process of replacement of normal anatomical structures with fibrosis, leading to its dysfunction. This nosology is quite common in the modern world; it can progress and lead to disability of patients and a decrease in their quality of life. The mortality rate for this disease also remains high. About 3/4 of patients with this pathology have a terminal stage of the process, which is characterized by the development of protein-energy deficiency (due to uremia, malnutrition, acidosis and persistent inflammatory process), which significantly worsens the prognosis. Currently, the available literature contains a small number of works devoted to this problem, therefore an important part of the management of patients with chronic kidney disease (especially those on hemodialysis) is the assessment and correction of nutritional status. In this article, the authors highlight aspects of the development of protein-energy malnutrition, its possible methods of diagnosis and correction. Electrolyte disturbances, especially hyperkalemia and hyperphosphatemia, are also common complications of chronic kidney disease. Correction of these conditions, in turn, can lead to the development of deficiency of vitamins and other microelements. According to studies presented in the literature, nutritional status is one of the main factors determining the survival and degree of rehabilitation of patients on renal replacement therapy, as well as the effectiveness of dialysis treatment. Thus, a clinician’s knowledge of the nutritional status of this group of patients can improve their prognosis and quality of life.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775197","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}
Yu. F. Shumskaya, A. P. Gonchar, M. G. Mnatsakanyan, I. A. Blokhin, R. V. Reshetnikov, Yu. A. Vasilev
Introduction . A high prevalence of decreased liver density has been shown among patients with COVID-19, but there are no convincing data on the cause of this phenomenon. It is still debatable whether decreased liver attenuation is an independent risk factor for the severe course of COVID-19. Aim . Assessment the prognostic value of liver attenuation on CT scan in patients with COVID-19. Materials and methods . Retrospective cohort study. Data of COVID-19 outpatients were analyzed. Inclusion criteria: two chest CT scans, alanine aminotransferase (ALT), aspartate aminotransferase (AST) blood values, polymerase chain reaction to verify SARS-CoV-2. Four comparison groups were assigned according to the severity of lung lesions. Liver attenuation was analyzed by automatic segmentation, with values less than 40 HU being considered pathologic. Results . Data from 499 patients was included. No correlation between ALT and AST and changes in liver attenuation was found. Groups differed in age and liver attenuation on both CT scans. On follow-up CT, low liver density was seen in males (odds ratio (OR) 2.79 (95% CI 1.42–5.47), p-value = 0.003) and in patients with a baseline reduced liver density (OR 60.59 (95% CI 30.51–120.33), p-value < 0.001). Age over 60 years was associated with the development of lung lesions (OR 1.04 (95% CI 1.02–1.06) for extent of lung injury < 25%, OR 1.08 (95% CI 1.05–1.11) for 25–50%, OR 1.1 (95% CI 1.06–1.15) for 25–50%, p-value < 0.001). Low liver attenuation on the primary CT scan increased the odds of severe lung injury (OR 6.9 (95% CI 2.06–23.07), p-value = 0.002). Conclusion . In COVID-19, patients with low liver attenuation are more likely to develop severe lung damage.
介绍。在新冠肺炎患者中，肝脏密度降低的发生率很高，但没有令人信服的数据说明这种现象的原因。肝衰减降低是否是COVID-19严重病程的独立危险因素仍存在争议。的目标。CT扫描肝脏衰减对COVID-19患者预后的价值评价。材料和方法。回顾性队列研究。对COVID-19门诊患者数据进行分析。纳入标准:两次胸部CT扫描，谷丙转氨酶(ALT)、天冬氨酸转氨酶(AST)血值，聚合酶链反应验证SARS-CoV-2。根据肺病变的严重程度分为4个对照组。通过自动分割分析肝脏衰减，值小于40 HU被认为是病理的。结果。纳入了499例患者的数据。ALT、AST与肝脏衰减变化无相关性。两组CT扫描的年龄和肝脏衰减程度不同。在随访CT中，男性低肝密度(优势比(OR) 2.79 (95% CI 1.42-5.47)， p值= 0.003)和基线肝密度降低的患者(OR 60.59 (95% CI 30.51-120.33)， p值<0.001)。年龄超过60岁与肺损伤的发展相关(OR 1.04 (95% CI 1.02-1.06);25%， 25-50% OR 1.08 (95% CI 1.05-1.11)， 25-50% OR 1.1 (95% CI 1.06-1.15)。0.001)。原发性CT低肝衰减增加严重肺损伤的几率(OR 6.9 (95% CI 2.06-23.07)， p值= 0.002)。结论。在COVID-19中，肝衰减低的患者更容易发生严重的肺损伤。
{"title":"Influence of liver attenuation on the severity of course COVID-19: a retrospective cohort study","authors":"Yu. F. Shumskaya, A. P. Gonchar, M. G. Mnatsakanyan, I. A. Blokhin, R. V. Reshetnikov, Yu. A. Vasilev","doi":"10.21518/ms2023-389","DOIUrl":"https://doi.org/10.21518/ms2023-389","url":null,"abstract":"Introduction . A high prevalence of decreased liver density has been shown among patients with COVID-19, but there are no convincing data on the cause of this phenomenon. It is still debatable whether decreased liver attenuation is an independent risk factor for the severe course of COVID-19. Aim . Assessment the prognostic value of liver attenuation on CT scan in patients with COVID-19. Materials and methods . Retrospective cohort study. Data of COVID-19 outpatients were analyzed. Inclusion criteria: two chest CT scans, alanine aminotransferase (ALT), aspartate aminotransferase (AST) blood values, polymerase chain reaction to verify SARS-CoV-2. Four comparison groups were assigned according to the severity of lung lesions. Liver attenuation was analyzed by automatic segmentation, with values less than 40 HU being considered pathologic. Results . Data from 499 patients was included. No correlation between ALT and AST and changes in liver attenuation was found. Groups differed in age and liver attenuation on both CT scans. On follow-up CT, low liver density was seen in males (odds ratio (OR) 2.79 (95% CI 1.42–5.47), p-value = 0.003) and in patients with a baseline reduced liver density (OR 60.59 (95% CI 30.51–120.33), p-value < 0.001). Age over 60 years was associated with the development of lung lesions (OR 1.04 (95% CI 1.02–1.06) for extent of lung injury < 25%, OR 1.08 (95% CI 1.05–1.11) for 25–50%, OR 1.1 (95% CI 1.06–1.15) for 25–50%, p-value < 0.001). Low liver attenuation on the primary CT scan increased the odds of severe lung injury (OR 6.9 (95% CI 2.06–23.07), p-value = 0.002). Conclusion . In COVID-19, patients with low liver attenuation are more likely to develop severe lung damage.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775063","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 number of patients complaining of indigestion is increasing every year. Made a significant contribution to this the COVID-19 pandemic, which has been going on for almost 3 years, led to this, the drugs used to treat the infection and its complications have a negative effect on the gastrointestinal tract, not to mention the most damaging effect of the virus. Against the backdrop of an increasing number of patients with indigestion as a result of COVID-19, it is important not to forget about other diseases that do not lie on the surface and do not always have typical manifestations. A relatively young disease, but increasingly common among patients with diarrhea, is microscopic colitis (MC). This article presents a clinical case of microscopic colitis of incomplete collagen type in combination with lactase deficiency. MC is a chronic inflammatory bowel disease of unknown etiology, characterized by chronic watery diarrhea, the absence of macroscopic signs of colon damage in the presence of specific pathomorphological changes. Based on the histological result, two main forms are distinguished: collagenous and lymphocytic colitis. According to the latest data presented in the European guidelines, the overall prevalence of MC is 119.4 cases per 100 thousand people, and the incidence is 11.4 cases per 100 thousand population per year. The progressive increase in the incidence, and even the prevalence of MC over patients with inflammatory bowel disease (IBD) in some countries in the group over 60 years of age, has led to an increase in clinical interest in this problem, improvement of diagnostic methods and revision of clinical guidelines in February 2021. Given the increase in the incidence of MC, the difficult diagnostic search for this diagnosis, age variation, and the description of clinical cases that differ from the average portraits of a “typical patient” with microscopic colitis are of clinical interest.
{"title":"Microscopic colitis of incomplete collagen type in combination with lactase deficiency","authors":"E. A. Volchkova, K. S. Legkova, M. D. Ardatskaya","doi":"10.21518/ms2023-387","DOIUrl":"https://doi.org/10.21518/ms2023-387","url":null,"abstract":"The number of patients complaining of indigestion is increasing every year. Made a significant contribution to this the COVID-19 pandemic, which has been going on for almost 3 years, led to this, the drugs used to treat the infection and its complications have a negative effect on the gastrointestinal tract, not to mention the most damaging effect of the virus. Against the backdrop of an increasing number of patients with indigestion as a result of COVID-19, it is important not to forget about other diseases that do not lie on the surface and do not always have typical manifestations. A relatively young disease, but increasingly common among patients with diarrhea, is microscopic colitis (MC). This article presents a clinical case of microscopic colitis of incomplete collagen type in combination with lactase deficiency. MC is a chronic inflammatory bowel disease of unknown etiology, characterized by chronic watery diarrhea, the absence of macroscopic signs of colon damage in the presence of specific pathomorphological changes. Based on the histological result, two main forms are distinguished: collagenous and lymphocytic colitis. According to the latest data presented in the European guidelines, the overall prevalence of MC is 119.4 cases per 100 thousand people, and the incidence is 11.4 cases per 100 thousand population per year. The progressive increase in the incidence, and even the prevalence of MC over patients with inflammatory bowel disease (IBD) in some countries in the group over 60 years of age, has led to an increase in clinical interest in this problem, improvement of diagnostic methods and revision of clinical guidelines in February 2021. Given the increase in the incidence of MC, the difficult diagnostic search for this diagnosis, age variation, and the description of clinical cases that differ from the average portraits of a “typical patient” with microscopic colitis are of clinical interest.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775053","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. V. Kruchinina, M. V. Parulikova, A. V. Belkovets, K. Yu. Nikolaev, A. K. Ovsyannikova
Introduction . Alcoholic steatosis, which is a reversible condition, is currently considered a significant risk factor for the progression of diffuse liver pathology, therefore understanding of its mechanisms at the molecular level is essential. Aim . To study the features of the fatty acid profile of erythrocyte membranes in patients with fatty liver disease of alcoholic origin for possible use of fatty acids (FAs) as biomarkers and potential therapeutic targets. Materials and methods . A total of 31 men with alcoholic fatty liver disease (AFLD) (average age of 45.1 ± 17.1 years) and 28 men of comparable age without AFLD and symptomatic pathology of internal organs were examined. The FA composition and levels of erythrocyte membranes (ER) were studied using Agilent 7000B (USA) triple quadrupole gas chromatography/mass spectrometry. Results and discussion . A higher level of a range of saturated FAs (lauric, margaric, pentadecane), monounsaturated FAs (MUFAs), which are additional factors for the progression of AFLD (palmitoleic, total monounsaturated acids), n-6/n-3 polyun-saturated FAs ratio (PUFAs), alpha-linolenic FA was detected in patients with AFL vs the control group (p = 0.00002–0.05). In contrast, the levels of arachidic and docosahexaenoic acids, total eicosapentaenoic and docosahexaenoic n-3 PUFAs, and total n-3 PUFAs were lower in patients with AFLD than in healthy men (p = 0.003–0.01), which is associated with increased ethanol induced adipose tissue lipolysis via PDE3B-AMPK axis. The use of FAs panel (C16:1;9, sum MUFA, n-6/n-3 PUFA, C22:6n3, C20:0) to distinguish patients with AFLD from healthy ones ensured high levels of sensitivity (79%), and specificity (81%) (AUC 0.808). Multidirectional associations of FA levels in erythrocyte membranes with each other and liver tests and lipid profile results were revealed. Conclusion . Thus, the features of erythrocytes membrane FAs in patients with AFLD and the potential to use them as biomarkers for differentiation of people with AFLD from healthy individuals have been identified.
{"title":"Features of the fatty acid profile of erythrocyte membranes in patients with fatty liver disease of alcoholic genesis","authors":"M. V. Kruchinina, M. V. Parulikova, A. V. Belkovets, K. Yu. Nikolaev, A. K. Ovsyannikova","doi":"10.21518/ms2023-391","DOIUrl":"https://doi.org/10.21518/ms2023-391","url":null,"abstract":"Introduction . Alcoholic steatosis, which is a reversible condition, is currently considered a significant risk factor for the progression of diffuse liver pathology, therefore understanding of its mechanisms at the molecular level is essential. Aim . To study the features of the fatty acid profile of erythrocyte membranes in patients with fatty liver disease of alcoholic origin for possible use of fatty acids (FAs) as biomarkers and potential therapeutic targets. Materials and methods . A total of 31 men with alcoholic fatty liver disease (AFLD) (average age of 45.1 ± 17.1 years) and 28 men of comparable age without AFLD and symptomatic pathology of internal organs were examined. The FA composition and levels of erythrocyte membranes (ER) were studied using Agilent 7000B (USA) triple quadrupole gas chromatography/mass spectrometry. Results and discussion . A higher level of a range of saturated FAs (lauric, margaric, pentadecane), monounsaturated FAs (MUFAs), which are additional factors for the progression of AFLD (palmitoleic, total monounsaturated acids), n-6/n-3 polyun-saturated FAs ratio (PUFAs), alpha-linolenic FA was detected in patients with AFL vs the control group (p = 0.00002–0.05). In contrast, the levels of arachidic and docosahexaenoic acids, total eicosapentaenoic and docosahexaenoic n-3 PUFAs, and total n-3 PUFAs were lower in patients with AFLD than in healthy men (p = 0.003–0.01), which is associated with increased ethanol induced adipose tissue lipolysis via PDE3B-AMPK axis. The use of FAs panel (C16:1;9, sum MUFA, n-6/n-3 PUFA, C22:6n3, C20:0) to distinguish patients with AFLD from healthy ones ensured high levels of sensitivity (79%), and specificity (81%) (AUC 0.808). Multidirectional associations of FA levels in erythrocyte membranes with each other and liver tests and lipid profile results were revealed. Conclusion . Thus, the features of erythrocytes membrane FAs in patients with AFLD and the potential to use them as biomarkers for differentiation of people with AFLD from healthy individuals have been identified.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775199","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 paper highlights the issues of antibiotic-associated diarrhea (AAD) of mild severity in the treatment of surgical patients, its epidemiology, etiology, features of the clinical picture and approaches to therapy. The mild course of AAD includes diarrhea without signs of intoxication, leukocytosis and fever. Stool disorder in patients receiving antibiotics who are in a surgical hospital is an urgent medical problem, since this pathology prolongs the time of hospitalization, increases economic costs, reduces the quality of life and can even be the cause of the patient’s death. According to various authors, AAD develops in 40% of people receiving antibacterial therapy. A clinical example of the management of a patient with AAD and injury of the musculoskeletal system is considered in detail.The abolition of antibiotics is not a method of solving this problem, since the severity of the patient’s injuries requires further surgical treatment and prevention of purulent-septic complications. The key point in the treatment of mild AAD will be the appointment of probiotic drugs, which have an effect on the pathogenetic links of AAD. Probiotics are microorganisms that have been known since ancient times and are purposefully used for health improvement and longevity. One of the first probiotic drugs used before the era of the discovery of antibiotics can be considered Mechnikov curdled milk with unique medicinal properties. Prescribing probiotic therapy from the first day of taking antibiotics, without waiting for the results of laboratory examination, will significantly reduce the prevalence of clinical manifestations of both clostridial diarrhea and idiopathic AAD.
{"title":"Approaches to the management of surgical patients with antibiotic-associated mild diarrhea","authors":"D. V. Egorov, Yu. A. Lazareva, P. V. Seliverstov","doi":"10.21518/ms2023-385","DOIUrl":"https://doi.org/10.21518/ms2023-385","url":null,"abstract":"The paper highlights the issues of antibiotic-associated diarrhea (AAD) of mild severity in the treatment of surgical patients, its epidemiology, etiology, features of the clinical picture and approaches to therapy. The mild course of AAD includes diarrhea without signs of intoxication, leukocytosis and fever. Stool disorder in patients receiving antibiotics who are in a surgical hospital is an urgent medical problem, since this pathology prolongs the time of hospitalization, increases economic costs, reduces the quality of life and can even be the cause of the patient’s death. According to various authors, AAD develops in 40% of people receiving antibacterial therapy. A clinical example of the management of a patient with AAD and injury of the musculoskeletal system is considered in detail.The abolition of antibiotics is not a method of solving this problem, since the severity of the patient’s injuries requires further surgical treatment and prevention of purulent-septic complications. The key point in the treatment of mild AAD will be the appointment of probiotic drugs, which have an effect on the pathogenetic links of AAD. Probiotics are microorganisms that have been known since ancient times and are purposefully used for health improvement and longevity. One of the first probiotic drugs used before the era of the discovery of antibiotics can be considered Mechnikov curdled milk with unique medicinal properties. Prescribing probiotic therapy from the first day of taking antibiotics, without waiting for the results of laboratory examination, will significantly reduce the prevalence of clinical manifestations of both clostridial diarrhea and idiopathic AAD.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775054","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. A. Shipovskaya, I. V. Kurbatova, N. A. Larina, O. P. Dudanova
Introduction . Insulin resistance (IR) is a key mechanism in the development of non-alcoholic fatty liver disease (NAFLD). To identify IR, various indices have been proposed, but their comparative diagnostic significance is not sufficiently covered. Aim . To conduct a comparative analysis of the diagnostic role of the triglyceride-glucose index (TyG Index or TGI) and HOMA-IR in different forms of NAFLD – hepatic steatosis (SP) and steatohepatitis (SH). Materials and methods . 194 patients with NAFLD were examined: 56 (28.9%) LS and 138 (71.1%) SH. TGI, HOMA-IR, fragments of cytokeratin-18 (FCK-18), tumor necrosis factor alpha (TNF-α), fibrosis index – NAFLD fibrosis index (NFS), traditional liver tests were determined. Results . TGI was increased in 43 (76.8%) patients with LS and its average level was 9.0 ± 0.4, it positively correlated with obesity, dyslipidemia, HOMA-IR, hepatocellular damage and negatively with albumin levels. HOMA-IR was elevated in 33 (58.9%) patients with SH, its level was 3.58 ± 1.7, it positively correlated with BMI, TGI and ESR. In SH, the level of TGI was increased in 125 (90.6%) patients, its level was 9.2 ± 0.6, it positively correlated with waist circumference, dyslipidemia, ALT, and negatively with albumin levels. HOMA-IR in SH increased in 111 (80.4%) patients, its level was 4.78 ± 1.8, it positively correlated with indicators of abdominal obesity, ALT, ESR, FCK-18 and NFS. Conclusion . An increase in TGI was detected in NAFLD more often – in 86.6% of patients than an increase in HOMA-IR – in 74.2% (p > 0.05). Both indices increased more often in SH than in LS. TGI indirectly reflected the degree of protein metabolism disturbance and the level of hepatic cell necrosis, while HOMA-IR reflected the level of hepatocyte apoptosis, inflammation, and liver fibrosis in SH.
{"title":"Comparative characteristics of the triglyceride-glucose index and the homeostatic index of insulin resistance in various forms of non-alcoholic fatty liver disease","authors":"A. A. Shipovskaya, I. V. Kurbatova, N. A. Larina, O. P. Dudanova","doi":"10.21518/ms2023-378","DOIUrl":"https://doi.org/10.21518/ms2023-378","url":null,"abstract":"Introduction . Insulin resistance (IR) is a key mechanism in the development of non-alcoholic fatty liver disease (NAFLD). To identify IR, various indices have been proposed, but their comparative diagnostic significance is not sufficiently covered. Aim . To conduct a comparative analysis of the diagnostic role of the triglyceride-glucose index (TyG Index or TGI) and HOMA-IR in different forms of NAFLD – hepatic steatosis (SP) and steatohepatitis (SH). Materials and methods . 194 patients with NAFLD were examined: 56 (28.9%) LS and 138 (71.1%) SH. TGI, HOMA-IR, fragments of cytokeratin-18 (FCK-18), tumor necrosis factor alpha (TNF-α), fibrosis index – NAFLD fibrosis index (NFS), traditional liver tests were determined. Results . TGI was increased in 43 (76.8%) patients with LS and its average level was 9.0 ± 0.4, it positively correlated with obesity, dyslipidemia, HOMA-IR, hepatocellular damage and negatively with albumin levels. HOMA-IR was elevated in 33 (58.9%) patients with SH, its level was 3.58 ± 1.7, it positively correlated with BMI, TGI and ESR. In SH, the level of TGI was increased in 125 (90.6%) patients, its level was 9.2 ± 0.6, it positively correlated with waist circumference, dyslipidemia, ALT, and negatively with albumin levels. HOMA-IR in SH increased in 111 (80.4%) patients, its level was 4.78 ± 1.8, it positively correlated with indicators of abdominal obesity, ALT, ESR, FCK-18 and NFS. Conclusion . An increase in TGI was detected in NAFLD more often – in 86.6% of patients than an increase in HOMA-IR – in 74.2% (p > 0.05). Both indices increased more often in SH than in LS. TGI indirectly reflected the degree of protein metabolism disturbance and the level of hepatic cell necrosis, while HOMA-IR reflected the level of hepatocyte apoptosis, inflammation, and liver fibrosis in SH.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775059","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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