D. I. Trukhan, E. N. Degovtsov, V. V. Goloshubina, M. A. Popilov
Diarrhea is one of the most common syndromes encountered in the practice of a general practitioner, a general practitioner, a pediatrician at the stage of providing primary health care, as well as a gastroenterologist, an infectious disease specialist and a surgeon at the stage of providing specialized medical care. The first part of the review is devoted to the differential diagnosis of diarrhea, the main pathological conditions and nosological forms in which the development of diarrhea syndrome is possible in real clinical practice are considered. The second part of the review is devoted to a promising active method in gastroenterological practice-enterosorption. The main requirements for modern enterosorbents are met by the domestic enterosorbent based on silica (colloidal silicon dioxide) Polysorb® MP. Its properties are considered, data of comparative studies with other enterosorbents are given. The studies demonstrating the efficacy and safety of the use of enterosorbent Polysorb® MP in the complex therapy of infectious diarrhea in adult patients and in pediatric practice are presented. Diarrhea is one of the most common gastrointestinal symptoms in the new coronavirus infection COVID-19. A number of studies have noted the effectiveness of the use of colloidal silicon dioxide (Polysorb® MP) in the complex treatment of adults and children with COVID-19 and as part of the post-COVID syndrome. The use of Polysorb® MP helps to reduce the viral load in the intestine, reduce diarrhea and other clinical symptoms of gastrointestinal lesions in COVID-19. Availability of modern effective and safe enterosorbent Polysorb® MP in the arsenal of a doctor at the stage of providing primary health care will optimize drug therapy in patients with diarrhea syndrome and other comorbid somatic pathologies.
{"title":"Diarrhea syndrome: current aspects of differential diagnosis and treatment at the stage of primary health care","authors":"D. I. Trukhan, E. N. Degovtsov, V. V. Goloshubina, M. A. Popilov","doi":"10.21518/ms2023-284","DOIUrl":"https://doi.org/10.21518/ms2023-284","url":null,"abstract":"Diarrhea is one of the most common syndromes encountered in the practice of a general practitioner, a general practitioner, a pediatrician at the stage of providing primary health care, as well as a gastroenterologist, an infectious disease specialist and a surgeon at the stage of providing specialized medical care. The first part of the review is devoted to the differential diagnosis of diarrhea, the main pathological conditions and nosological forms in which the development of diarrhea syndrome is possible in real clinical practice are considered. The second part of the review is devoted to a promising active method in gastroenterological practice-enterosorption. The main requirements for modern enterosorbents are met by the domestic enterosorbent based on silica (colloidal silicon dioxide) Polysorb® MP. Its properties are considered, data of comparative studies with other enterosorbents are given. The studies demonstrating the efficacy and safety of the use of enterosorbent Polysorb® MP in the complex therapy of infectious diarrhea in adult patients and in pediatric practice are presented. Diarrhea is one of the most common gastrointestinal symptoms in the new coronavirus infection COVID-19. A number of studies have noted the effectiveness of the use of colloidal silicon dioxide (Polysorb® MP) in the complex treatment of adults and children with COVID-19 and as part of the post-COVID syndrome. The use of Polysorb® MP helps to reduce the viral load in the intestine, reduce diarrhea and other clinical symptoms of gastrointestinal lesions in COVID-19. Availability of modern effective and safe enterosorbent Polysorb® MP in the arsenal of a doctor at the stage of providing primary health care will optimize drug therapy in patients with diarrhea syndrome and other comorbid somatic pathologies.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"23 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775056","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 prevalence of non-alcoholic fatty liver disease (NAFLD) and metabolic associated liver disease (MAFLD) is growing world-wide. A new terminology (MAFLD) allows us not only to focus on the “metabolic” genesis of this pathology, but also to take into account other factors affecting damage to hepatocytes, such as alcohol consumption in low doses, viral and toxic hepatitis. Currently, obesity is a pathology, that is growing with MAFLD and causes of various non-communicable diseases. Most deaths in patients with NAFLD/MAFLD are caused, firstly, by adverse cardiovascular events, secondly, by malignant tumors of both the digestive organs (liver, intestine, esophagus, stomach and pancreas) and other localizations (kidney cancer in men, breast cancer in women) and, thirdly, by development of hepatic complications (cirrhosis, hepatocellular carcinoma – HCC). Because of the pandemic growth of MAFLD and its association with cardiovascular diseases and obesity, the question about properly clinical management of patients suffered from comorbid pathology to reduce the risks of deaths is timely and very relevant. This review has been prepared to systematize the available literature dates about association of NAFLD/MAFLD with the malignant tumors. A literature searches were conducted, modern epidemiological dates about the prevalence of NAFLD/MAFLD in the population and their complicated forms were presented. The risk of HCC formation both with and without cirrhosis in NAFLD was assessed. It was found that the severity of liver fibrosis can be useful predictor of the future risk of not only the adverse cardiovascular events, but also the malignant tumors in patients with NAFLD/MAFLD. Possible targets for treatment were discussed, the impact on which is useful for the treatment and prevention of progressive forms of the disease. One of the possible therapeutic molecules is essential phospholipids, which are currently included in the consent documents for the managment of patients with NAFLD.
{"title":"Non-alcoholic fatty liver disease and the risk of malignant tumors","authors":"M. A. Livzan, M. I. Syrovenko, T. S. Krolevets","doi":"10.21518/ms2023-355","DOIUrl":"https://doi.org/10.21518/ms2023-355","url":null,"abstract":"The prevalence of non-alcoholic fatty liver disease (NAFLD) and metabolic associated liver disease (MAFLD) is growing world-wide. A new terminology (MAFLD) allows us not only to focus on the “metabolic” genesis of this pathology, but also to take into account other factors affecting damage to hepatocytes, such as alcohol consumption in low doses, viral and toxic hepatitis. Currently, obesity is a pathology, that is growing with MAFLD and causes of various non-communicable diseases. Most deaths in patients with NAFLD/MAFLD are caused, firstly, by adverse cardiovascular events, secondly, by malignant tumors of both the digestive organs (liver, intestine, esophagus, stomach and pancreas) and other localizations (kidney cancer in men, breast cancer in women) and, thirdly, by development of hepatic complications (cirrhosis, hepatocellular carcinoma – HCC). Because of the pandemic growth of MAFLD and its association with cardiovascular diseases and obesity, the question about properly clinical management of patients suffered from comorbid pathology to reduce the risks of deaths is timely and very relevant. This review has been prepared to systematize the available literature dates about association of NAFLD/MAFLD with the malignant tumors. A literature searches were conducted, modern epidemiological dates about the prevalence of NAFLD/MAFLD in the population and their complicated forms were presented. The risk of HCC formation both with and without cirrhosis in NAFLD was assessed. It was found that the severity of liver fibrosis can be useful predictor of the future risk of not only the adverse cardiovascular events, but also the malignant tumors in patients with NAFLD/MAFLD. Possible targets for treatment were discussed, the impact on which is useful for the treatment and prevention of progressive forms of the disease. One of the possible therapeutic molecules is essential phospholipids, which are currently included in the consent documents for the managment of patients with NAFLD.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"24 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775201","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, V. V. Kolomytsev, L. V. Goryunova
Pain in the right hypochondrium is one of the most frequent complaints in patients with diseases of the biliary system. According to statistics, every tenth person experiences unpleasant sensations in the upper right abdomen after drinking alcohol, fatty, fried or salty food, as well as after psychoemotional and physical exertion. The most common of the pathologies of the biliary system is the sphincter of Oddi dysfunction (SOD). SOD is a clinical syndrome caused by a functional disorder of sphincter of Oddi (SO), which leads to the development of abdominal pain syndrome, increased activity of liver and / or pancreatic enzymes, dilatation of the common bile duct and the main pancreatic duct. One of the methods of treatment of SOD is drug therapy, accompanied by the following groups of drugs: antispasmodics, nitrates, choleretics, antidepressants, etc. At the same time, many medications show low efficacy against SOD, or cause pronounced side effects. At present, for the treatment of sphincter of Oddi dysfunction, the domestic drug from the group of myotropic antispasmodics, hymecromon, Holicron, has the optimal characteristics in terms of price-quality ratio in the Russian pharmacological market. The drug has a selective antispasmodic effect on SO, and also has a choleretic effect. Mechanism of antispasmodic action is an increase in the concentration of nitric oxide (II) and cyclic mononucleotides, which through a cascade of biochemical reactions leads to a decrease in the number of calcium ions in the cell and a decrease in the tone of smooth myocytes of SO and gallbladder. The drug is absorbed into the blood in a small amount, which excludes its systemic effect and determines the selectivity of the effect on the biliary system. According to the results of clinical testing and consideration of a specific clinical case, it can be concluded that the use of hymecromone (Holicron) reduces the severity of pain syndrome and reduces dyspepsia syndrome, good tolerability and absence of side effects that would require withdrawal of the drug are also recorded.
{"title":"Possibilities of modern pharmacotherapy in patients with dysfunction of the sphincter of Oddi","authors":"V. V. Skvortsov, V. V. Kolomytsev, L. V. Goryunova","doi":"10.21518/ms2023-344","DOIUrl":"https://doi.org/10.21518/ms2023-344","url":null,"abstract":"Pain in the right hypochondrium is one of the most frequent complaints in patients with diseases of the biliary system. According to statistics, every tenth person experiences unpleasant sensations in the upper right abdomen after drinking alcohol, fatty, fried or salty food, as well as after psychoemotional and physical exertion. The most common of the pathologies of the biliary system is the sphincter of Oddi dysfunction (SOD). SOD is a clinical syndrome caused by a functional disorder of sphincter of Oddi (SO), which leads to the development of abdominal pain syndrome, increased activity of liver and / or pancreatic enzymes, dilatation of the common bile duct and the main pancreatic duct. One of the methods of treatment of SOD is drug therapy, accompanied by the following groups of drugs: antispasmodics, nitrates, choleretics, antidepressants, etc. At the same time, many medications show low efficacy against SOD, or cause pronounced side effects. At present, for the treatment of sphincter of Oddi dysfunction, the domestic drug from the group of myotropic antispasmodics, hymecromon, Holicron, has the optimal characteristics in terms of price-quality ratio in the Russian pharmacological market. The drug has a selective antispasmodic effect on SO, and also has a choleretic effect. Mechanism of antispasmodic action is an increase in the concentration of nitric oxide (II) and cyclic mononucleotides, which through a cascade of biochemical reactions leads to a decrease in the number of calcium ions in the cell and a decrease in the tone of smooth myocytes of SO and gallbladder. The drug is absorbed into the blood in a small amount, which excludes its systemic effect and determines the selectivity of the effect on the biliary system. According to the results of clinical testing and consideration of a specific clinical case, it can be concluded that the use of hymecromone (Holicron) reduces the severity of pain syndrome and reduces dyspepsia syndrome, good tolerability and absence of side effects that would require withdrawal of the drug are also recorded.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"24 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775052","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. Yu. Serebrova, D. O. Kurguzova, L. M. Krasnykh, G. F. Vasilenko, E. Yu. Demchenkova, N. N. Eremenko, E. N. Kareva, A. B. Prokofiev
Among the defecating disorders with constipation or diarrhea, there is a group of major intestinal disorders defined by the Rome IV Diagnostic Criteria (2016): irritable bowel syndrome, functional constipation, functional diarrhea. The presence of several updates of the Rome criteria is due to the current lack of objective signs of the listed disorders while many options for describing subjective sensation by patients from different countries. It calls for their terminological multilingual standardization. Both constipation and diarrhea can be caused by a variety of exogenous and endogenous factors and have different pathogenetic mechanisms, but they cannot be identified properly using modern clinical and laboratory methods for functional intestinal disorders. However, the high prevalence of these syndromes, characterized by the presence of complaints that reduce patients’ quality of life, necessitates their correction. The drug choice for defecation disorders and abdominal pain is often limited by contradictions from international clinical guidelines and national regulations.Therefore, the Recommendations of the Russian Gastroenterological Association for the treatment of functional intestinal diseases contain many instructions on general therapeutic and dietary measures. The pain syndrome treatment is based on the spasmolytics. Among the laxatives that have long been used in the treatment of chronic constipation, sodium picosulfate has long been successfully used. This drug has high efficacy and safety profiles; the instructions for its medical use allow to prescribe it in patients suffered from irritable bowel syndrome with constipation. The use of sodium picosulfate for IBS is regulated by many clinical recommendations. However, this drug may be ineffective against abdominal pain. It is incorrect to assign the mission of pain relief to a laxative because of multifactorial pathogenesis of IBS pain with constipation or diarrhea and uncertainty of methods for its pharmacological control.
{"title":"Irritable bowel syndrome: modern ideas about pathology and the possibility of its correction","authors":"S. Yu. Serebrova, D. O. Kurguzova, L. M. Krasnykh, G. F. Vasilenko, E. Yu. Demchenkova, N. N. Eremenko, E. N. Kareva, A. B. Prokofiev","doi":"10.21518/ms2023-380","DOIUrl":"https://doi.org/10.21518/ms2023-380","url":null,"abstract":"Among the defecating disorders with constipation or diarrhea, there is a group of major intestinal disorders defined by the Rome IV Diagnostic Criteria (2016): irritable bowel syndrome, functional constipation, functional diarrhea. The presence of several updates of the Rome criteria is due to the current lack of objective signs of the listed disorders while many options for describing subjective sensation by patients from different countries. It calls for their terminological multilingual standardization. Both constipation and diarrhea can be caused by a variety of exogenous and endogenous factors and have different pathogenetic mechanisms, but they cannot be identified properly using modern clinical and laboratory methods for functional intestinal disorders. However, the high prevalence of these syndromes, characterized by the presence of complaints that reduce patients’ quality of life, necessitates their correction. The drug choice for defecation disorders and abdominal pain is often limited by contradictions from international clinical guidelines and national regulations.Therefore, the Recommendations of the Russian Gastroenterological Association for the treatment of functional intestinal diseases contain many instructions on general therapeutic and dietary measures. The pain syndrome treatment is based on the spasmolytics. Among the laxatives that have long been used in the treatment of chronic constipation, sodium picosulfate has long been successfully used. This drug has high efficacy and safety profiles; the instructions for its medical use allow to prescribe it in patients suffered from irritable bowel syndrome with constipation. The use of sodium picosulfate for IBS is regulated by many clinical recommendations. However, this drug may be ineffective against abdominal pain. It is incorrect to assign the mission of pain relief to a laxative because of multifactorial pathogenesis of IBS pain with constipation or diarrhea and uncertainty of methods for its pharmacological control.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135775055","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}
This review focuses on the most current information on the pathogenesis, diagnosis and treatment of sarcopenia and malnutrition in patients with liver disease. Sarcopenia and malnutrition are common complications of liver diseases. Liver cirrhosis, as a stage of the pathological process, serves as the main predisposing factor for the development of malnutrition and sarcopenia. The frequency of sarcopenia in liver cirrhosis is 30–50% and reaches 100% in decompensated patients. The main pathogenetic links are: impaired proteostasis of skeletal muscles, systemic inflammation and changes in gut microbiota. In recent years, enough data have been accumulated to consider these conditions as a prognostically unfavorable factor in patients with liver cirrhosis of various etiologies, affecting their quality of life and survival, as well as worsening the out-comes of transplantation. This dictates the necessity to define unified approaches to diagnostics and correction of these conditions. Currently, tests are used for diagnosis, which allow to assess muscle strength and function. Muscle mass is assessed using instrumental methods by measuring individual muscles and calculating skeletal muscle indices. In patients with liver cirrhosis and concomitant sarcopenia and malnutrition, nutritional and lifestyle modification strategies are applicable for correction in addition to therapy aimed at elimination of the etiologic factor. The aim of the review is to evaluate the problems of diagnosis and effective treatment of malnutrition and sarcopenia in patients with liver disease based on literature data. The article presents an overview of the main strategies for the approach, diagnosis and correction of these conditions.
{"title":"Sarcopenia and malnutrition in patients with liver diseases","authors":"A. S. Ostrovskaya, M. V. Maevskaya","doi":"10.21518/ms2023-374","DOIUrl":"https://doi.org/10.21518/ms2023-374","url":null,"abstract":"This review focuses on the most current information on the pathogenesis, diagnosis and treatment of sarcopenia and malnutrition in patients with liver disease. Sarcopenia and malnutrition are common complications of liver diseases. Liver cirrhosis, as a stage of the pathological process, serves as the main predisposing factor for the development of malnutrition and sarcopenia. The frequency of sarcopenia in liver cirrhosis is 30–50% and reaches 100% in decompensated patients. The main pathogenetic links are: impaired proteostasis of skeletal muscles, systemic inflammation and changes in gut microbiota. In recent years, enough data have been accumulated to consider these conditions as a prognostically unfavorable factor in patients with liver cirrhosis of various etiologies, affecting their quality of life and survival, as well as worsening the out-comes of transplantation. This dictates the necessity to define unified approaches to diagnostics and correction of these conditions. Currently, tests are used for diagnosis, which allow to assess muscle strength and function. Muscle mass is assessed using instrumental methods by measuring individual muscles and calculating skeletal muscle indices. In patients with liver cirrhosis and concomitant sarcopenia and malnutrition, nutritional and lifestyle modification strategies are applicable for correction in addition to therapy aimed at elimination of the etiologic factor. The aim of the review is to evaluate the problems of diagnosis and effective treatment of malnutrition and sarcopenia in patients with liver disease based on literature data. The article presents an overview of the main strategies for the approach, diagnosis and correction of these conditions.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"24 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135874178","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. S. Fedorinov, V. K. Lyadov, Sh. P. Abdullayev, A. A. Kachanova, R. N. Heydarov, I. A. Shashkov, V. M. Mikhailovich, S. A. Surzhikov, M. A. Lyadova, I. V. Sychev, V. N. Galkin, I. V. Poddubnaya, D. A. Sychev
Introdiction . Systemic chemotherapy (CT) based on oxaliplatin, 5-fluorouracil, capecitabine is the standard of treatment for advanced gastric, colorectal and rectal cancer, which is characterized by frequent development of severe adverse events (AEs). The results of translational studies in the Russian patient population are limited, it is necessary to study pharmacogenetic markers. Aim. To study the frequency of carrying allelic variants of DPYD, GSTP1, MTHFR, XPC, ERCC1, TYMS genes and their association with the development of AEs during palliative treatment with FOLFOX/XELOX. Materials and methods . A total of 166 patients (67 gastric cancer, 99 colorectal cancer) were included in the prospective observational study. All patients underwent pharmacogenetic testing by hybridization analysis on biological microarrays ( DPYD (rs2297595 and rs75017182), MTHFR (rs1801133), XPC (rs2228001), TYMS (rs11280056), ERCC1 (rs3212986)) and PCR ( GSTP1 (rs1695), ERCC1 (rs11615)) before starting CT. The genotype frequency distribution was analyzed between the groups of patients with and without the development of severe AEs. Results . AEs developed in 97.7% of patients, severe AEs accounting for 54.2%. According to the results of univariate analysis, TC genotype of DPYD gene rs2297595 OR = 3.0 (95% CI 1.2–7.3, p = 0.025), GG genotype of GSTP1 gene rs1695 OR = 2.9 (95% CI 1.02–8.6, p = 0.038) were associated with the development of severe neutropenia. In multivariate analysis TT genotype rs2297595 of the DPYD gene remained the only predictor of severe neutropenia (B ± SE = -1.103 ± 0.503; DI [-2.090; -0.116]; p = 0.028). Conclusions . The results of this study allowed us to identify possible markers of toxicity of FOLFOX/XELOX chemotherapy.
Introdiction。以奥沙利铂、5-氟尿嘧啶、卡培他滨为基础的全身化疗(CT)是晚期胃癌、结直肠癌的标准治疗方案，其特点是严重不良事件(ae)的频繁发生。俄罗斯患者群体的转化研究结果有限，有必要对药物遗传标记进行研究。的目标。研究FOLFOX/XELOX姑息治疗期间DPYD、GSTP1、MTHFR、XPC、ERCC1、TYMS基因等位变异的携带频率及其与ae发生的关系。材料和方法。前瞻性观察研究共纳入166例患者(胃癌67例，结直肠癌99例)。所有患者在开始CT前均通过生物微阵列(DPYD (rs2297595和rs75017182)、MTHFR (rs1801133)、XPC (rs2228001)、TYMS (rs11280056)、ERCC1 (rs3212986)和PCR (GSTP1 (rs1695)、ERCC1 (rs11615))的杂交分析进行药理学检测。分析发生和未发生严重ae患者的基因型频率分布。结果。97.7%的患者发生不良反应，严重不良反应占54.2%。单因素分析结果显示，DPYD基因rs2297595的TC基因型OR = 3.0 (95% CI 1.2 ~ 7.3, p = 0.025)， GSTP1基因rs1695的GG基因型OR = 2.9 (95% CI 1.02 ~ 8.6, p = 0.038)与严重中性粒细胞减少症的发生相关。在多变量分析中，DPYD基因的TT基因型rs2297595仍然是严重中性粒细胞减少症的唯一预测因子(B±SE = -1.103±0.503;DI (-2.090;-0.116);P = 0.028)。结论。这项研究的结果使我们能够确定FOLFOX/XELOX化疗毒性的可能标记物。
{"title":"Pharmacogenetic markers of toxicity of FOLFOX/XELOX chemotherapy in patients with gastrointestinal tumors: a prospective observational study","authors":"D. S. Fedorinov, V. K. Lyadov, Sh. P. Abdullayev, A. A. Kachanova, R. N. Heydarov, I. A. Shashkov, V. M. Mikhailovich, S. A. Surzhikov, M. A. Lyadova, I. V. Sychev, V. N. Galkin, I. V. Poddubnaya, D. A. Sychev","doi":"10.21518/ms2023-384","DOIUrl":"https://doi.org/10.21518/ms2023-384","url":null,"abstract":"Introdiction . Systemic chemotherapy (CT) based on oxaliplatin, 5-fluorouracil, capecitabine is the standard of treatment for advanced gastric, colorectal and rectal cancer, which is characterized by frequent development of severe adverse events (AEs). The results of translational studies in the Russian patient population are limited, it is necessary to study pharmacogenetic markers. Aim. To study the frequency of carrying allelic variants of DPYD, GSTP1, MTHFR, XPC, ERCC1, TYMS genes and their association with the development of AEs during palliative treatment with FOLFOX/XELOX. Materials and methods . A total of 166 patients (67 gastric cancer, 99 colorectal cancer) were included in the prospective observational study. All patients underwent pharmacogenetic testing by hybridization analysis on biological microarrays ( DPYD (rs2297595 and rs75017182), MTHFR (rs1801133), XPC (rs2228001), TYMS (rs11280056), ERCC1 (rs3212986)) and PCR ( GSTP1 (rs1695), ERCC1 (rs11615)) before starting CT. The genotype frequency distribution was analyzed between the groups of patients with and without the development of severe AEs. Results . AEs developed in 97.7% of patients, severe AEs accounting for 54.2%. According to the results of univariate analysis, TC genotype of DPYD gene rs2297595 OR = 3.0 (95% CI 1.2–7.3, p = 0.025), GG genotype of GSTP1 gene rs1695 OR = 2.9 (95% CI 1.02–8.6, p = 0.038) were associated with the development of severe neutropenia. In multivariate analysis TT genotype rs2297595 of the DPYD gene remained the only predictor of severe neutropenia (B ± SE = -1.103 ± 0.503; DI [-2.090; -0.116]; p = 0.028). Conclusions . The results of this study allowed us to identify possible markers of toxicity of FOLFOX/XELOX chemotherapy.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135975015","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}
Irritable bowel syndrome (IBS) is one of the most common diseases of the digestive tract. IBS negatively affects the quality of life and work ability of patients. It is generally accepted that IBS is an important medical and social problem associated with high financial costs both on the part of the patient and the public health system. The pathophysiology of the disease involves the participation of many factors (genetic, dietary, psychosocial, infectious) and the mechanisms of their implementation, including disruption of interaction along the functional “gut-brain axis”, visceral hypersensitivity, changes in motility, low-grade inflammation, increased permeability of the epithelial intestinal barrier, modulation of microbiota, changes in neurohumoral regulation and processes of central processing of peripheral stimuli. Research shows an important role for gut microbiota in the development of IBS. Modulation of the intestinal microbiota through diet, the use of pre- and probiotics or fecal microbiota transplantation is considered as a promising target for disease therapy. A reduction in the number of bacteria of the genus Bifidobacterium is described as a universal change in the microbiota in IBS, regardless of the clinical course and severity of the disease and the possibility of using different strains of Bifidobacterium in treatment regimens for the disease is of particular interest. This article provides a review of the literature on modern approaches to prescribing probiotics for IBS. Using our own clinical observations as an example, we demonstrated the effectiveness and safety of prolonged administration of the probiotic strain Bifidobacterium longum 35624® for up to 12 weeks.
{"title":"Modulation of microbiota as a target in the management of patients with irritable bowel syndrome","authors":"M. A. Livzan, O. V. Gaus","doi":"10.21518/ms2023-366","DOIUrl":"https://doi.org/10.21518/ms2023-366","url":null,"abstract":"Irritable bowel syndrome (IBS) is one of the most common diseases of the digestive tract. IBS negatively affects the quality of life and work ability of patients. It is generally accepted that IBS is an important medical and social problem associated with high financial costs both on the part of the patient and the public health system. The pathophysiology of the disease involves the participation of many factors (genetic, dietary, psychosocial, infectious) and the mechanisms of their implementation, including disruption of interaction along the functional “gut-brain axis”, visceral hypersensitivity, changes in motility, low-grade inflammation, increased permeability of the epithelial intestinal barrier, modulation of microbiota, changes in neurohumoral regulation and processes of central processing of peripheral stimuli. Research shows an important role for gut microbiota in the development of IBS. Modulation of the intestinal microbiota through diet, the use of pre- and probiotics or fecal microbiota transplantation is considered as a promising target for disease therapy. A reduction in the number of bacteria of the genus Bifidobacterium is described as a universal change in the microbiota in IBS, regardless of the clinical course and severity of the disease and the possibility of using different strains of Bifidobacterium in treatment regimens for the disease is of particular interest. This article provides a review of the literature on modern approaches to prescribing probiotics for IBS. Using our own clinical observations as an example, we demonstrated the effectiveness and safety of prolonged administration of the probiotic strain Bifidobacterium longum 35624® for up to 12 weeks.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"54 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135976138","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 review of current data on the management of patients with non-erosive reflux disease (NERD) was made. Diagnosis of gastroesophageal reflux disease (GERD) is based on symptom analysis, endoscopic evaluation of the esophageal mucosa, objective evidence of gastric contents reflux into the esophagus during pH-impedancemetry, and response to therapeutic intervention. Treatment for GERD should include weight loss if overweight, lifestyle modification, and dietary modification. Current consensus recommends starting NERD treatment with once-daily proton pump inhibitors (PPIs), but only 50% of patients with this pathology respond to such therapy. Incomplete response to PPIs is a reason to increase the dose of PPI and add Gaviscon to treatment to neutralize the post-prandial “acid pocket”. Gaviscon is especially effective in patients with postprandial or nocturnal symptoms and in those with hiatal hernia. The mechanism of action of Gaviscon is based on the formation of an alginate “raft” on the surface of the gastric contents, which neutralizes the acid and blocks its pathological effect to esophageal mucosa. A modern meta-analysis on the NERD treatment, which included 23 studies and 10,735 patients, showed the efficacy of Gaviscon monotherapy comparable to PPIs in treatment for 4 weeks. The combination of a PPI with Gaviscon offers the opportunity to optimize response to treatment in NERD patients with an incomplete response to PPIs monotherapy. The Russian Gastroenterological Association thinks that alginates can be used both as monotherapy for mild clinical variants of NERD and in complex treatment regimens for various GERD variants.
{"title":"Modern aspects of managing patients with non-erosive reflux disease","authors":"V. V. Tsukanov, A. V. Vasyutin, Ju. L. Tonkikh","doi":"10.21518/ms2023-218","DOIUrl":"https://doi.org/10.21518/ms2023-218","url":null,"abstract":"A review of current data on the management of patients with non-erosive reflux disease (NERD) was made. Diagnosis of gastroesophageal reflux disease (GERD) is based on symptom analysis, endoscopic evaluation of the esophageal mucosa, objective evidence of gastric contents reflux into the esophagus during pH-impedancemetry, and response to therapeutic intervention. Treatment for GERD should include weight loss if overweight, lifestyle modification, and dietary modification. Current consensus recommends starting NERD treatment with once-daily proton pump inhibitors (PPIs), but only 50% of patients with this pathology respond to such therapy. Incomplete response to PPIs is a reason to increase the dose of PPI and add Gaviscon to treatment to neutralize the post-prandial “acid pocket”. Gaviscon is especially effective in patients with postprandial or nocturnal symptoms and in those with hiatal hernia. The mechanism of action of Gaviscon is based on the formation of an alginate “raft” on the surface of the gastric contents, which neutralizes the acid and blocks its pathological effect to esophageal mucosa. A modern meta-analysis on the NERD treatment, which included 23 studies and 10,735 patients, showed the efficacy of Gaviscon monotherapy comparable to PPIs in treatment for 4 weeks. The combination of a PPI with Gaviscon offers the opportunity to optimize response to treatment in NERD patients with an incomplete response to PPIs monotherapy. The Russian Gastroenterological Association thinks that alginates can be used both as monotherapy for mild clinical variants of NERD and in complex treatment regimens for various GERD variants.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"54 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135976139","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. S. Nikitin, N. B. Guseva, A. A. Kartseva, M. V. Lepiseva, I. V. Lepiseva
Mesadenitis (mesenteric lymphadenitis, mesenteritis) is a common cause of acute abdominal pain syndrome in children. At the same time, the cause of acute mesadenitis is far from being established in all cases. Diagnosis of mesenteric lymphadenitis presents a certain problem. Differential diagnosis is always carried out with acute surgical diseases of the abdominal cavity, primarily with acute appendicitis. Special attention is paid to ultrasound examination in the diagnosis of mesadenitis. Given the absence of statistically proven diagnostic criteria for changes in abdominal lymph nodes in mesadenitis, it is relevant to determine their ultrasound characteristics. The article is presented in the form of a lecture for practicing pediatricians based on a literature review. The characteristics of mesentery lymph nodes in various pathological processes are collected from various sources. The features of ultrasound characteristics of mesenteric lymph nodes in normal and acute mesadenitis with herpes infection, coronavirus infection, tuberculosis, as well as features of lymph nodes with lymphogranuloma are presented. A table has been developed that indicates such characteristics as the shape, number of lymph nodes in the section, echogenicity, blood flow status, capsule, contour, as well as additional characteristics in some conditions (such as the tendency to form conglomerates or the presence of calcinates in the structure of lymph nodes in tuberculosis lesions). A detailed description of the lymph nodes makes it possible to conduct a preliminary differential diagnosis of mesadenitis using ultrasound, which makes it possible to determine the vector of further diagnostic search in children with acute abdominal syndrome, and then to select pathogenetically justified therapeutic tactics and preventive measures.
{"title":"A modern view on the differential diagnosis of ultrasound characteristics of lymph nodes in mesadenitis in children","authors":"S. S. Nikitin, N. B. Guseva, A. A. Kartseva, M. V. Lepiseva, I. V. Lepiseva","doi":"10.21518/ms2023-269","DOIUrl":"https://doi.org/10.21518/ms2023-269","url":null,"abstract":"Mesadenitis (mesenteric lymphadenitis, mesenteritis) is a common cause of acute abdominal pain syndrome in children. At the same time, the cause of acute mesadenitis is far from being established in all cases. Diagnosis of mesenteric lymphadenitis presents a certain problem. Differential diagnosis is always carried out with acute surgical diseases of the abdominal cavity, primarily with acute appendicitis. Special attention is paid to ultrasound examination in the diagnosis of mesadenitis. Given the absence of statistically proven diagnostic criteria for changes in abdominal lymph nodes in mesadenitis, it is relevant to determine their ultrasound characteristics. The article is presented in the form of a lecture for practicing pediatricians based on a literature review. The characteristics of mesentery lymph nodes in various pathological processes are collected from various sources. The features of ultrasound characteristics of mesenteric lymph nodes in normal and acute mesadenitis with herpes infection, coronavirus infection, tuberculosis, as well as features of lymph nodes with lymphogranuloma are presented. A table has been developed that indicates such characteristics as the shape, number of lymph nodes in the section, echogenicity, blood flow status, capsule, contour, as well as additional characteristics in some conditions (such as the tendency to form conglomerates or the presence of calcinates in the structure of lymph nodes in tuberculosis lesions). A detailed description of the lymph nodes makes it possible to conduct a preliminary differential diagnosis of mesadenitis using ultrasound, which makes it possible to determine the vector of further diagnostic search in children with acute abdominal syndrome, and then to select pathogenetically justified therapeutic tactics and preventive measures.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"55 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135975010","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}
G. R. Sagitova, I. V. Tkachev, O. V. Antonova, O. V. Davydova
Coarctation of the aorta is a congenital malformation characterized by the presence of narrowing of the aorta, which can be localized in any part of it. In this publication, we present a clinical case of coarctation of the aorta before and after surgical correction in a newborn. The child was admitted to the cardiosurgical hospital at the age of 6 days. Congenital heart disease of a low category of complexity was diagnosed prenatally. After birth, the condition is satisfactory. After 3 hours, the negative dynamics due to the clinic of respiratory failure. According to echocardiography – hypoplasia of the aortic arch, coarctation of the aorta? Open ductus arteriosus, ventricular septal defect. On the 3rd day of life, a diagnosis of congenital pneumonia was made and the child was transferred to a cardiosurgical hospital. Upon admission to the FCSSH in Astrakhan, the condition was regarded as severe, due to heart and respiratory failure. The child is examined. On echocardiography – Pronounced preductal form of coarctation of the aorta. Hypoplasia of the proximal arch and isthmus. Open ductus arteriosus. Ventricular septal defect. biventricular hypertrophy. Severe dilatation of the right chambers of the heart. Relative hypoplasia of the left ventricle. Tricuspid regurgitation. On the 7th day of life, surgical correction of the defect was performed plasty of the arch and isthmus of the aorta, plasty of the VSD. The early postoperative period proceeded with a clinic of moderate respiratory and heart failure. Against the background of the expansion of the volume of feeding, chylothorax was detected, drainage of the right pleural cavity was prescribed. Enteral feeding has been replaced by parenteral nutrition. The child was extubated on the 4th postoperative day. However, oxygen dependence was noted. The pleural drainage was removed on the 11th day after the operation. On the 12th day, the newborn was transferred from the intensive care unit. Discharged from the hospital on the 20th day after surgical treatment. After 4 months the child was examined in the hospital. The general condition was regarded as satisfactory. This clinical example shows the complexity of prenatal diagnosis of obstructive pathology of the aortic arch and the rapid manifestation of clinical manifestations after birth against the background of an unfavorable combination with a large septal defect.
{"title":"A clinical case of aortic coarctation in combination with a septal defect in a newborn child","authors":"G. R. Sagitova, I. V. Tkachev, O. V. Antonova, O. V. Davydova","doi":"10.21518/ms2023-254","DOIUrl":"https://doi.org/10.21518/ms2023-254","url":null,"abstract":"Coarctation of the aorta is a congenital malformation characterized by the presence of narrowing of the aorta, which can be localized in any part of it. In this publication, we present a clinical case of coarctation of the aorta before and after surgical correction in a newborn. The child was admitted to the cardiosurgical hospital at the age of 6 days. Congenital heart disease of a low category of complexity was diagnosed prenatally. After birth, the condition is satisfactory. After 3 hours, the negative dynamics due to the clinic of respiratory failure. According to echocardiography – hypoplasia of the aortic arch, coarctation of the aorta? Open ductus arteriosus, ventricular septal defect. On the 3rd day of life, a diagnosis of congenital pneumonia was made and the child was transferred to a cardiosurgical hospital. Upon admission to the FCSSH in Astrakhan, the condition was regarded as severe, due to heart and respiratory failure. The child is examined. On echocardiography – Pronounced preductal form of coarctation of the aorta. Hypoplasia of the proximal arch and isthmus. Open ductus arteriosus. Ventricular septal defect. biventricular hypertrophy. Severe dilatation of the right chambers of the heart. Relative hypoplasia of the left ventricle. Tricuspid regurgitation. On the 7th day of life, surgical correction of the defect was performed plasty of the arch and isthmus of the aorta, plasty of the VSD. The early postoperative period proceeded with a clinic of moderate respiratory and heart failure. Against the background of the expansion of the volume of feeding, chylothorax was detected, drainage of the right pleural cavity was prescribed. Enteral feeding has been replaced by parenteral nutrition. The child was extubated on the 4th postoperative day. However, oxygen dependence was noted. The pleural drainage was removed on the 11th day after the operation. On the 12th day, the newborn was transferred from the intensive care unit. Discharged from the hospital on the 20th day after surgical treatment. After 4 months the child was examined in the hospital. The general condition was regarded as satisfactory. This clinical example shows the complexity of prenatal diagnosis of obstructive pathology of the aortic arch and the rapid manifestation of clinical manifestations after birth against the background of an unfavorable combination with a large septal defect.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"55 3‐4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135975013","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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