Genitourinary menopausal syndrome is still a widespread problem that significantly affects the quality of life in postmenopause. The cause of this state is hypoestrogenism that is associated with menopause and the following change in the vaginal microflora due to the elimination of lactobacilli. The disturbance of the vulval and vaginal microflora provides risks for the invasion of pathogenic microorganisms, and the deficiency of sex hormones is associated with atrophy of the epithelium of the urogenital tract. An analysis of published clinical studies using a combination of L. acidophilus and 0.03 mg estriol (Gynoflor® E) in postmenopausal women with vulvovaginal atrophy, breast cancer survivors, in postmenopausal women with breast cancer on aromatase inhibitors was performed. Treatment with a combination of L. acidophilus and 0.03 mg of estriol (Gynoflor® E) can be evaluated as safe without risk of endometrial effects or other systemic effects. Local estrogen therapy in postmenopausal women can restore the vaginal epithelium, and a useful lactobacillus flora is needed to prevent urogenital infections. Local application of estriol is preferable, as it causes a local proliferative response and has no stimulating effect on the endometrium. This method of therapy may also be considered for hormone-sensitive women with breast cancer on aromatase inhibitors. However, today, there are not enough clinically validated studies proving the absolute safety of this treatment method among breast cancer women. The effect of this therapy is achieved due to the synergistic action of estriol and lactobacilli.
{"title":"Current trends in the prevention and treatment of genitourinary menopausal syndrome","authors":"I. A. Apolikhina, L. A. Tarnaeva","doi":"10.21518/ms2023-294","DOIUrl":"https://doi.org/10.21518/ms2023-294","url":null,"abstract":"Genitourinary menopausal syndrome is still a widespread problem that significantly affects the quality of life in postmenopause. The cause of this state is hypoestrogenism that is associated with menopause and the following change in the vaginal microflora due to the elimination of lactobacilli. The disturbance of the vulval and vaginal microflora provides risks for the invasion of pathogenic microorganisms, and the deficiency of sex hormones is associated with atrophy of the epithelium of the urogenital tract. An analysis of published clinical studies using a combination of L. acidophilus and 0.03 mg estriol (Gynoflor® E) in postmenopausal women with vulvovaginal atrophy, breast cancer survivors, in postmenopausal women with breast cancer on aromatase inhibitors was performed. Treatment with a combination of L. acidophilus and 0.03 mg of estriol (Gynoflor® E) can be evaluated as safe without risk of endometrial effects or other systemic effects. Local estrogen therapy in postmenopausal women can restore the vaginal epithelium, and a useful lactobacillus flora is needed to prevent urogenital infections. Local application of estriol is preferable, as it causes a local proliferative response and has no stimulating effect on the endometrium. This method of therapy may also be considered for hormone-sensitive women with breast cancer on aromatase inhibitors. However, today, there are not enough clinically validated studies proving the absolute safety of this treatment method among breast cancer women. The effect of this therapy is achieved due to the synergistic action of estriol and lactobacilli.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135619816","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}
I. A. Shafieva, S. V. Bulgakova, A. V. Shafieva, D. P. Kurmayev
Introduction . Non-steroidal anti-inflammatory drugs (NSAIDs) are currently the mainstay of the management for relieving pain syndrome in osteoarthritis (OA). NSAIDs are characterized by an individual reaction to medication, as well as a quite high frequency of gastrointestinal side effects. The issue of the disadvantages and advantages of a particular group of NSAIDs is still open. Aim . To evaluate the safety and efficacy of Meloxicam at a dose of 15 mg/day as compared with Nimesulide and placebo in postmenopausal women with an inflammatory phenotype of OA. Results and discussion . The frequency of all adverse events was comparable among the group of patients receiving meloxicam (40.0%), and lower than in the nimesulide group (48.0%), but higher than in the placebo group. A decrease in pain syndrome was observed as early as at 2 weeks of treatment in the group of patients receiving meloxicam. A significant decrease in WOMAC scores (overall result, pain syndrome, stiffness, function) was observed in the group of patients receiving meloxicam, and in the group of patients receiving nimesulide, after 3 weeks of treatment. meloxicam and nimesulide demonstrated high efficacy at 3 weeks compared with the initial VAS scores. The placebo group showed no efficacy. Conclusion . The frequency of all adverse events was lower while taking meloxicam as compared to nimesulide. Our results substantiate the concept to prescribe meloxicam at a dose 15 mg once daily for the treatment of pain and stiffness in post-menopausal women with OA.
{"title":"Evaluation of the efficacy and safety of various non-steroidal anti-inflammatory drugs in postmenopausal women with an inflammatory phenotype of osteoarthritis","authors":"I. A. Shafieva, S. V. Bulgakova, A. V. Shafieva, D. P. Kurmayev","doi":"10.21518/ms2023-281","DOIUrl":"https://doi.org/10.21518/ms2023-281","url":null,"abstract":"Introduction . Non-steroidal anti-inflammatory drugs (NSAIDs) are currently the mainstay of the management for relieving pain syndrome in osteoarthritis (OA). NSAIDs are characterized by an individual reaction to medication, as well as a quite high frequency of gastrointestinal side effects. The issue of the disadvantages and advantages of a particular group of NSAIDs is still open. Aim . To evaluate the safety and efficacy of Meloxicam at a dose of 15 mg/day as compared with Nimesulide and placebo in postmenopausal women with an inflammatory phenotype of OA. Results and discussion . The frequency of all adverse events was comparable among the group of patients receiving meloxicam (40.0%), and lower than in the nimesulide group (48.0%), but higher than in the placebo group. A decrease in pain syndrome was observed as early as at 2 weeks of treatment in the group of patients receiving meloxicam. A significant decrease in WOMAC scores (overall result, pain syndrome, stiffness, function) was observed in the group of patients receiving meloxicam, and in the group of patients receiving nimesulide, after 3 weeks of treatment. meloxicam and nimesulide demonstrated high efficacy at 3 weeks compared with the initial VAS scores. The placebo group showed no efficacy. Conclusion . The frequency of all adverse events was lower while taking meloxicam as compared to nimesulide. Our results substantiate the concept to prescribe meloxicam at a dose 15 mg once daily for the treatment of pain and stiffness in post-menopausal women with OA.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135619818","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 presence of coexisting chronic non-infectious diseases is associated with reduced quality of life and increased risk of early disability and mortality. The coexistence of two or more diseases in a patient is defined by the term polymorbidity. Currently, there is an increase in polymorbid pathology not only among elderly patients, but also among young and middle-aged people, which entails significant health care costs and has a negative impact on the economy of the country as a whole. Therefore, the problem of polymorbidity and the management of such patients in real clinical practice is urgent and key in the field of public health. According to major foreign and domestic studies, the most common polymorbidity phenotype is the cardiometabolic phenotype. Taking into account the fact that in our country almost every second patient with arterial hypertension has metabolic disorders and, therefore, polymorbid pathology, approaches to the management of such patients should be personalized already from the beginning of drug therapy. In this regard, this review reviews some key pathophysiological mechanisms of the relationship between arterial hypertension and metabolic disturbances occurring in patients with the cardiometabolic phenotype of polymorbidity, presents features of antihypertensive therapy in such patients, in particular, describes in more detail the class of beta-blockers with pathogenetic validity of use in this case. Also, a review of the available clinical trial data concerning the effects of the highly selective beta-adrenoblocker bisoprolol in patients with arterial hypertension is presented, emphasizing its effect on metabolic status and its importance for comprehensive clinical management.
{"title":"Features of management of patients with cardiometabolic polymorbidity phenotype: focus on the efficacy and safety of bisoprolol","authors":"O. A. Polyakova, O. D. Ostroumova","doi":"10.21518/ms2023-220","DOIUrl":"https://doi.org/10.21518/ms2023-220","url":null,"abstract":"The presence of coexisting chronic non-infectious diseases is associated with reduced quality of life and increased risk of early disability and mortality. The coexistence of two or more diseases in a patient is defined by the term polymorbidity. Currently, there is an increase in polymorbid pathology not only among elderly patients, but also among young and middle-aged people, which entails significant health care costs and has a negative impact on the economy of the country as a whole. Therefore, the problem of polymorbidity and the management of such patients in real clinical practice is urgent and key in the field of public health. According to major foreign and domestic studies, the most common polymorbidity phenotype is the cardiometabolic phenotype. Taking into account the fact that in our country almost every second patient with arterial hypertension has metabolic disorders and, therefore, polymorbid pathology, approaches to the management of such patients should be personalized already from the beginning of drug therapy. In this regard, this review reviews some key pathophysiological mechanisms of the relationship between arterial hypertension and metabolic disturbances occurring in patients with the cardiometabolic phenotype of polymorbidity, presents features of antihypertensive therapy in such patients, in particular, describes in more detail the class of beta-blockers with pathogenetic validity of use in this case. Also, a review of the available clinical trial data concerning the effects of the highly selective beta-adrenoblocker bisoprolol in patients with arterial hypertension is presented, emphasizing its effect on metabolic status and its importance for comprehensive clinical management.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135620270","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. B. Berezhanskaya, A. A. Afonin, A. A. Lebedenko, N. N. Vostrykh, D. I. Sozaeva, L. V. Kravchenko, N. N. Popova
Introduction. High incidence and great social significance of attention deficit hyperactivity disorder (ADHD) in preschool children determines the search and development of new options for their rehabilitation. Aim. To analyse the patient outcomes of the most up-to-date treatment and rehabilitation complex (biofeedback, sensory integration, psychological and speech, physiotherapeutic effects) and the possibility of its widespread practical application for the rehabilitation of preschool children with ADHD. Materials and methods. A total of 63 children (33 boys and 30 girls) aged 5–8 years were included in the prospective study. Patients were divided into two groups: Group I – 34 children aged 5 years – 5 years 11 months, 29 days with ADHD, and Group II – 29 children aged 6 years – 6 years 11 months, 29 days with ADHD. The follow-up period for each patient was 15 months. The children were examined by a neurologist, rehabilitation therapist, neuropsychologist, and speech pathologist with an assessment of active attention measures using the B. Bourdon scale for children of Group I and the Toulouse-Pieron scale (adapted by L.A. Yasyukova) for children of Group 2. Parents were surveyed and questioned using special questionnaires. Results. Before initiation of treatment, all children were diagnosed with active attention disorders of isolated (26.5 and 23.8%) and mixed (73.5 and 62.5%) nature in Groups I and II, respectively. After the rehabilitation activities complex was provided, a significant decrease in not only isolated, but also mixed attention disorders in children with ADHD was detected in both groups. Evaluation of electroencephalograms after the rehabilitation activities complex showed a decrease of theta power and an increase of low beta frequency power in 18.7% of children of Group I and in 16.2% of children of Group II, which indicated an improvement in neurodynamic functions and sufficient cognitive potential in that cohort of children. Conclusion. Early start and prolonged use of the proposed rehabilitation complex will enhance learning ability and prevent school and social maladjustment of children with ADHD.
{"title":"Comprehensive rehabilitation of preschool children with attention deficit hyperactivity disorder","authors":"S. B. Berezhanskaya, A. A. Afonin, A. A. Lebedenko, N. N. Vostrykh, D. I. Sozaeva, L. V. Kravchenko, N. N. Popova","doi":"10.21518/ms2023-291","DOIUrl":"https://doi.org/10.21518/ms2023-291","url":null,"abstract":"Introduction. High incidence and great social significance of attention deficit hyperactivity disorder (ADHD) in preschool children determines the search and development of new options for their rehabilitation. Aim. To analyse the patient outcomes of the most up-to-date treatment and rehabilitation complex (biofeedback, sensory integration, psychological and speech, physiotherapeutic effects) and the possibility of its widespread practical application for the rehabilitation of preschool children with ADHD. Materials and methods. A total of 63 children (33 boys and 30 girls) aged 5–8 years were included in the prospective study. Patients were divided into two groups: Group I – 34 children aged 5 years – 5 years 11 months, 29 days with ADHD, and Group II – 29 children aged 6 years – 6 years 11 months, 29 days with ADHD. The follow-up period for each patient was 15 months. The children were examined by a neurologist, rehabilitation therapist, neuropsychologist, and speech pathologist with an assessment of active attention measures using the B. Bourdon scale for children of Group I and the Toulouse-Pieron scale (adapted by L.A. Yasyukova) for children of Group 2. Parents were surveyed and questioned using special questionnaires. Results. Before initiation of treatment, all children were diagnosed with active attention disorders of isolated (26.5 and 23.8%) and mixed (73.5 and 62.5%) nature in Groups I and II, respectively. After the rehabilitation activities complex was provided, a significant decrease in not only isolated, but also mixed attention disorders in children with ADHD was detected in both groups. Evaluation of electroencephalograms after the rehabilitation activities complex showed a decrease of theta power and an increase of low beta frequency power in 18.7% of children of Group I and in 16.2% of children of Group II, which indicated an improvement in neurodynamic functions and sufficient cognitive potential in that cohort of children. Conclusion. Early start and prolonged use of the proposed rehabilitation complex will enhance learning ability and prevent school and social maladjustment of children with ADHD.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136013628","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. A. Kharitonov, Yu. V. Rudakov, V. V. Salukhov, N. I. Voloshin
Pulmonary surfactant is an important structure of the lungs, providing basic vital functions: reducing alveolar surface tension and facilitating breathing, preventing collapse of the airways and ensuring their patency, protection against infections and pathological environmental factors. Although disturbances of surfactant homeostasis are usually considered in the context of respiratory distress syndrome in preterm infants, it has been established that many lung diseases in adults are accompanied by significant disturbances of surfactant homeostasis. However, preclinical and clinical studies of bronchopulmonary pathology too often overlook the potential role of changes in the qualitative or quantitative composition of pulmonary surfactant in the pathogenesis and development of disease symptoms. In many lung diseases, whether these disturbances in homeostasis are cause or effect remains contravertial field. This review will examine current data on the composition, main functions of pulmonary surfactant and the role of its dysfunction in the pathogenesis of the most frequently encountered bronchopulmonary diseases in the practice of pulmonologists, therapists and rehabilitation specialists, in particular, such as acute respiratory distress syndrome in adults, including associated with a new coronavirus infection, pneumonia of various etiologies and their consequences, bronchial asthma, chronic obstructive pulmonary disease. The review presents the current best practices of replacement therapy with exogenous surfactant preparations and the prospects for pharmacological modulation of surfactant homeostasis disorders in the above nosological forms.
{"title":"Role of surfactant in the pathogenesis of bronchopulmonary pathology","authors":"M. A. Kharitonov, Yu. V. Rudakov, V. V. Salukhov, N. I. Voloshin","doi":"10.21518/ms2023-340","DOIUrl":"https://doi.org/10.21518/ms2023-340","url":null,"abstract":"Pulmonary surfactant is an important structure of the lungs, providing basic vital functions: reducing alveolar surface tension and facilitating breathing, preventing collapse of the airways and ensuring their patency, protection against infections and pathological environmental factors. Although disturbances of surfactant homeostasis are usually considered in the context of respiratory distress syndrome in preterm infants, it has been established that many lung diseases in adults are accompanied by significant disturbances of surfactant homeostasis. However, preclinical and clinical studies of bronchopulmonary pathology too often overlook the potential role of changes in the qualitative or quantitative composition of pulmonary surfactant in the pathogenesis and development of disease symptoms. In many lung diseases, whether these disturbances in homeostasis are cause or effect remains contravertial field. This review will examine current data on the composition, main functions of pulmonary surfactant and the role of its dysfunction in the pathogenesis of the most frequently encountered bronchopulmonary diseases in the practice of pulmonologists, therapists and rehabilitation specialists, in particular, such as acute respiratory distress syndrome in adults, including associated with a new coronavirus infection, pneumonia of various etiologies and their consequences, bronchial asthma, chronic obstructive pulmonary disease. The review presents the current best practices of replacement therapy with exogenous surfactant preparations and the prospects for pharmacological modulation of surfactant homeostasis disorders in the above nosological forms.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135967875","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 article is devoted to the results of the subanalysis published after release of the AUGUSTUS trial. The most important conclusion of the parent trial is the evidence that weekly aspirin therapy is sufficient to prevent thrombotic complications in the majority of patients with AF and ACS, as well as those undergoing elective PCI, and that aspirin therapy can be extended up to 1 month after PCI only in a part of patients with additional risk factors for ischemic events and a low risk of bleeding. Four years have passed since the publication of the AUGUSTUS trial results, and all subsequent subanalyses of the trial confirmed its results. The safety and efficacy advantages of apixaban over warfarin were shown to be independent of renal function and consistent with the overall trial results. The advantages of apixaban and the association of aspirin with bleeding were similar in both stroke and non-stroke patients with AF and were dose-independent when a dose was reduced to 2.5 mg twice in accordance with the reduction criteria. The advantages of apixaban over warfarin lasted regardless of time spent in the therapeutic range in the warfarin group. The advantages of apixaban over warfarin and the association of long-term intake of aspirin with bleeding rates persisted in patients with high and low baseline risk of bleeding and stroke. All subanalyses of the AUGUSTUS trial confirmed the efficacy and safety of apixaban, as well as the option to discontinue aspirin at the outpatient stage in the majority of patients with AF, who underwent elective PCI or ACS.
{"title":"Apixaban in patients with atrial fibrillation and acute coronary syndrome in elective percutaneous coronary intervention: what did the subanalysis of the AUGUSTUS trial add to our understanding?","authors":"E. P. Panchenko","doi":"10.21518/ms2023-286","DOIUrl":"https://doi.org/10.21518/ms2023-286","url":null,"abstract":"The article is devoted to the results of the subanalysis published after release of the AUGUSTUS trial. The most important conclusion of the parent trial is the evidence that weekly aspirin therapy is sufficient to prevent thrombotic complications in the majority of patients with AF and ACS, as well as those undergoing elective PCI, and that aspirin therapy can be extended up to 1 month after PCI only in a part of patients with additional risk factors for ischemic events and a low risk of bleeding. Four years have passed since the publication of the AUGUSTUS trial results, and all subsequent subanalyses of the trial confirmed its results. The safety and efficacy advantages of apixaban over warfarin were shown to be independent of renal function and consistent with the overall trial results. The advantages of apixaban and the association of aspirin with bleeding were similar in both stroke and non-stroke patients with AF and were dose-independent when a dose was reduced to 2.5 mg twice in accordance with the reduction criteria. The advantages of apixaban over warfarin lasted regardless of time spent in the therapeutic range in the warfarin group. The advantages of apixaban over warfarin and the association of long-term intake of aspirin with bleeding rates persisted in patients with high and low baseline risk of bleeding and stroke. All subanalyses of the AUGUSTUS trial confirmed the efficacy and safety of apixaban, as well as the option to discontinue aspirin at the outpatient stage in the majority of patients with AF, who underwent elective PCI or ACS.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135696039","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. N. Shishkova, V. A. Shishkov, D. B. Ustarbekova
Introduction. Next to neurodegenerative disorders, cardiovascular diseases are now the most common cause of cognitive impairment. The combination of factors such as older age and chronic heart failure is a corner-stone of a greater risk for developing vascular cognitive impairment. Aim. To study the relationship between the parameters of the left ventricular ejection fraction and the concentration of NT-proBNP with the results of neuropsychological testing in patients with chronic heart failure in old age. Materials and methods. The study included 200 elderly patients with CHF II–III FC. The neuropsychological examination included tests: tracking, Schulte tables, verbal associations, the Montreal Cognitive Function Assessment Scale (МоСА test). Laboratory tests included determination of the concentration of NT-proBNP in serum. Results. During neuropsychological testing, reduced indicators were obtained: during the MOS test in patients with left ventricular ejection fraction (LVEF) values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 7230 [3325; 8830] pg/ml; in the Schulte test, an increase in execution time was noted in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 2900 [700; 7500] pg/ml; in the tracking test – an increase in time in part A in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 5385 [2125; 8675] pg/ml and part B in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 6947 [3325; 9310] pg/ml, in the verbal association test – in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 2090 [608; 7126] pg/ml. Correlation analysis showed the presence of a significant relationship between LVEF indicators, the concentration of NT-proBNP and the results of neuropsychological testing (p < 0.001), while, according to the Rea&Parker classification, the connection was assessed as relatively strong and medium strength. Conclusion. The cognitive impairments identified in this study in elderly patients with chronic heart failure were characterized by a decrease in concentration, memory, executive functions and the overall integrative index of cognitive functions. These disorders were significantly associated with a decrease in the left ventricular ejection fraction and a high concentration of NT-proBNP.
{"title":"Marker associations of chronic heart failure severity and cognitive dysfunction in elderly patients","authors":"V. N. Shishkova, V. A. Shishkov, D. B. Ustarbekova","doi":"10.21518/ms2023-331","DOIUrl":"https://doi.org/10.21518/ms2023-331","url":null,"abstract":"Introduction. Next to neurodegenerative disorders, cardiovascular diseases are now the most common cause of cognitive impairment. The combination of factors such as older age and chronic heart failure is a corner-stone of a greater risk for developing vascular cognitive impairment. Aim. To study the relationship between the parameters of the left ventricular ejection fraction and the concentration of NT-proBNP with the results of neuropsychological testing in patients with chronic heart failure in old age. Materials and methods. The study included 200 elderly patients with CHF II–III FC. The neuropsychological examination included tests: tracking, Schulte tables, verbal associations, the Montreal Cognitive Function Assessment Scale (МоСА test). Laboratory tests included determination of the concentration of NT-proBNP in serum. Results. During neuropsychological testing, reduced indicators were obtained: during the MOS test in patients with left ventricular ejection fraction (LVEF) values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 7230 [3325; 8830] pg/ml; in the Schulte test, an increase in execution time was noted in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 2900 [700; 7500] pg/ml; in the tracking test – an increase in time in part A in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 5385 [2125; 8675] pg/ml and part B in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 6947 [3325; 9310] pg/ml, in the verbal association test – in patients with LVEF values < 40% and ≥ 40% and < 50% and with a concentration of NT-proBNP 2090 [608; 7126] pg/ml. Correlation analysis showed the presence of a significant relationship between LVEF indicators, the concentration of NT-proBNP and the results of neuropsychological testing (p < 0.001), while, according to the Rea&Parker classification, the connection was assessed as relatively strong and medium strength. Conclusion. The cognitive impairments identified in this study in elderly patients with chronic heart failure were characterized by a decrease in concentration, memory, executive functions and the overall integrative index of cognitive functions. These disorders were significantly associated with a decrease in the left ventricular ejection fraction and a high concentration of NT-proBNP.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135199394","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. P. Tereshchenko, N. N. Potekaev, A. G. Gadzhigoroeva, O. V. Zhukova, O. N. Andreenko
Introduction . Atopic dermatitis (AD) is among a comorbid conditions in alopecia areata (AA), that influence the risk of development, severity of AA and the immunologic profile of the perifollicular inflammatory process. Narrowband UVB-311 nm, which has been successfully used in AD, is considered as a treatment for AA with limited efficacy, but may contribute to AA regression when combined with other therapies. The anti-inflammatory effect combined with the relative safety make it relevant to study the possibility of using this method in the treatment of AA in children. Aim . To evaluate the efficacy of NB-UVB 311 nm in the complex therapy of pediatric patients with coexisting diseases: AA and AD. Materials and methods . We conducted an open cohort comparative study with 49 patients 5–12 years old (mean age 7.4 ± 0.38 y.o.) with different clinical forms of AA. Group 1 included 22 patients with concomitant AD, group 2 consisted of 27 patients without AD. All patients received standard therapy of AA with topical glucocorticosteroids; patients of the first group also received a course of total NB-UVB 311 nm for the treatment of AD. The response to treatment was evaluated after 3 months and was considered as positive when hair regrowth was more than 30%. Results . In group 1 there was a significant predominance of patients who responded to treatment (77%) compared to group 2 – 48% (OR 3.7; CI [1.05;12.8] p = 0.045); the mean percentage value of SALT index in group 1 decreased by 46% from baseline values, in group 2 – by 26.6%; when comparing the groups by the percentage of alopecia regression p = 0.027. Conclusions . Combined treatment of AA including NB-UVB 311 nm, contributes to the tendency to more intensive hair regrowth. NB-UVB 311 nm can be considered as an additional option in the treatment of AA, associated with AD.
{"title":"Efficacy of therapy with 311nm narrow-band UVB 311nm in the treatment of patients with alopecia areata associated with atopic dermatitis","authors":"G. P. Tereshchenko, N. N. Potekaev, A. G. Gadzhigoroeva, O. V. Zhukova, O. N. Andreenko","doi":"10.21518/ms2023-271","DOIUrl":"https://doi.org/10.21518/ms2023-271","url":null,"abstract":"Introduction . Atopic dermatitis (AD) is among a comorbid conditions in alopecia areata (AA), that influence the risk of development, severity of AA and the immunologic profile of the perifollicular inflammatory process. Narrowband UVB-311 nm, which has been successfully used in AD, is considered as a treatment for AA with limited efficacy, but may contribute to AA regression when combined with other therapies. The anti-inflammatory effect combined with the relative safety make it relevant to study the possibility of using this method in the treatment of AA in children. Aim . To evaluate the efficacy of NB-UVB 311 nm in the complex therapy of pediatric patients with coexisting diseases: AA and AD. Materials and methods . We conducted an open cohort comparative study with 49 patients 5–12 years old (mean age 7.4 ± 0.38 y.o.) with different clinical forms of AA. Group 1 included 22 patients with concomitant AD, group 2 consisted of 27 patients without AD. All patients received standard therapy of AA with topical glucocorticosteroids; patients of the first group also received a course of total NB-UVB 311 nm for the treatment of AD. The response to treatment was evaluated after 3 months and was considered as positive when hair regrowth was more than 30%. Results . In group 1 there was a significant predominance of patients who responded to treatment (77%) compared to group 2 – 48% (OR 3.7; CI [1.05;12.8] p = 0.045); the mean percentage value of SALT index in group 1 decreased by 46% from baseline values, in group 2 – by 26.6%; when comparing the groups by the percentage of alopecia regression p = 0.027. Conclusions . Combined treatment of AA including NB-UVB 311 nm, contributes to the tendency to more intensive hair regrowth. NB-UVB 311 nm can be considered as an additional option in the treatment of AA, associated with AD.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135425299","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. N. Bulanov, A. A. Kazakov, I. V. Khamaganova, P. O. Kazakova, S. V. Potapova
Patients with rare diseases, particularly skin conditions, can be particularly problematic for doctors of intensive care units. The present study shows the features of the course of sepsis in bullous pemphigoid in terms of clinical case management. A 66-year-old patient with polymorbid pathology was admitted for scheduled hospitalization to the Endocrinology Department with a diagnosis of non-insulin-dependent diabetes mellitus with multiple complications, and examined. She complained of pain in the small of the back and abdomen irradiating to the inguinal region, and increased oedema of the lower extremities. A few hours after admission to the Endocrinology Department, she was transferred to the intensive care unit due to the deterioration of her condition. Analysis of the severity and prognosis assessment of her condition was performed: 9 scores according to SOFA, 20 scores according to APACHE II. The patient underwent clinical, laboratory (biochemical, immunological, bacteriological, cancer markers, blood gases), instrumental methods of examination (Doppler ultrasonography of the lower extremity veins, brain MRI, chest MRI, lumbar puncture). A skin biopsy for morphological study was taken. The analysis of test results showed a critical condition of the patient with a high risk of death, which was prognostically dangerous. Bullous pemphigoid diagnosis was established by morphological and immunological assays. The patient was prescribed therapy with due account for her polymorbidities: prednisolone 80 mg orally, antibiotic therapy, later on she was transferred to the mechanical ventilation. A session of substitutive renal therapy CVVHD using the Prismaflex system was performed. After treatment, improvement was observed. Over the 3-month follow-up care, the patient's condition has been stabilised. It is critical for doctors of various specialties to identify signs of bullous pemphigoid in a timely manner, assess the risk of developing sepsis and take appropriate therapeutic measures in case of secondary infection, as the polymorbidity of pathological conditions can lead to death.
{"title":"Clinical case of the sepsis development in a patient with bullous pemphigoid","authors":"M. N. Bulanov, A. A. Kazakov, I. V. Khamaganova, P. O. Kazakova, S. V. Potapova","doi":"10.21518/ms2023-272","DOIUrl":"https://doi.org/10.21518/ms2023-272","url":null,"abstract":"Patients with rare diseases, particularly skin conditions, can be particularly problematic for doctors of intensive care units. The present study shows the features of the course of sepsis in bullous pemphigoid in terms of clinical case management. A 66-year-old patient with polymorbid pathology was admitted for scheduled hospitalization to the Endocrinology Department with a diagnosis of non-insulin-dependent diabetes mellitus with multiple complications, and examined. She complained of pain in the small of the back and abdomen irradiating to the inguinal region, and increased oedema of the lower extremities. A few hours after admission to the Endocrinology Department, she was transferred to the intensive care unit due to the deterioration of her condition. Analysis of the severity and prognosis assessment of her condition was performed: 9 scores according to SOFA, 20 scores according to APACHE II. The patient underwent clinical, laboratory (biochemical, immunological, bacteriological, cancer markers, blood gases), instrumental methods of examination (Doppler ultrasonography of the lower extremity veins, brain MRI, chest MRI, lumbar puncture). A skin biopsy for morphological study was taken. The analysis of test results showed a critical condition of the patient with a high risk of death, which was prognostically dangerous. Bullous pemphigoid diagnosis was established by morphological and immunological assays. The patient was prescribed therapy with due account for her polymorbidities: prednisolone 80 mg orally, antibiotic therapy, later on she was transferred to the mechanical ventilation. A session of substitutive renal therapy CVVHD using the Prismaflex system was performed. After treatment, improvement was observed. Over the 3-month follow-up care, the patient's condition has been stabilised. It is critical for doctors of various specialties to identify signs of bullous pemphigoid in a timely manner, assess the risk of developing sepsis and take appropriate therapeutic measures in case of secondary infection, as the polymorbidity of pathological conditions can lead to death.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135425048","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. V. Mezentsev, E. V. Denisova, V. V. Sobolev, I. M. Korsunskaya
Alarmins are a group of immune activating proteins/peptides that initiate an inflammatory process by interacting with immune cells. The alarmins are biosynthesized as a result of cell injury, often due to proteolysis of native proteins. Most often, the alarmins are released into the extracellular matrix as a result of infection, burn or trauma. Several studies have been conducted recently to determine the role of alarmins in the pathogenesis of autoimmune diseases. This work was aimed to assess the clinical potential of alarmins and characterize their role in the pathogenesis of psoriasis. The proposed review analysed 6 groups of alarmins with increased expression in the skin of patients with psoriasis: defensins, CAMP/LL-37, amphoterin/HMGB1, interleukin-1 (IL-1)-like cytokine family members (IL1 and -33) with alarmin properties, heat shock proteins, and proteins of the S100 family. The presented work also discusses the therapeutic potential of alarmins: the possibility to use them as the drug therapy target, as well as to establish diagnosis and monitor the progress of psoriasis. The further experimental studies are supposed to pay considerable attention to alarmin receptors, as well as members involved in the signalling pathways they initiated. These work findings help to obtain biologically active compounds that will be able to specifically and effectively inhibit the physiological effects of alarmins, as well as control the inflammatory process they induced. It seems certain that the use of alarmin antagonists in clinical practice will prove useful in the treatment of both psoriasis and other chronic autoimmune diseases, especially in cases where the most commonly used therapies are not effective enough.
{"title":"The role of alarmins in the pathogenesis of psoriasis","authors":"A. V. Mezentsev, E. V. Denisova, V. V. Sobolev, I. M. Korsunskaya","doi":"10.21518/ms2023-276","DOIUrl":"https://doi.org/10.21518/ms2023-276","url":null,"abstract":"Alarmins are a group of immune activating proteins/peptides that initiate an inflammatory process by interacting with immune cells. The alarmins are biosynthesized as a result of cell injury, often due to proteolysis of native proteins. Most often, the alarmins are released into the extracellular matrix as a result of infection, burn or trauma. Several studies have been conducted recently to determine the role of alarmins in the pathogenesis of autoimmune diseases. This work was aimed to assess the clinical potential of alarmins and characterize their role in the pathogenesis of psoriasis. The proposed review analysed 6 groups of alarmins with increased expression in the skin of patients with psoriasis: defensins, CAMP/LL-37, amphoterin/HMGB1, interleukin-1 (IL-1)-like cytokine family members (IL1 and -33) with alarmin properties, heat shock proteins, and proteins of the S100 family. The presented work also discusses the therapeutic potential of alarmins: the possibility to use them as the drug therapy target, as well as to establish diagnosis and monitor the progress of psoriasis. The further experimental studies are supposed to pay considerable attention to alarmin receptors, as well as members involved in the signalling pathways they initiated. These work findings help to obtain biologically active compounds that will be able to specifically and effectively inhibit the physiological effects of alarmins, as well as control the inflammatory process they induced. It seems certain that the use of alarmin antagonists in clinical practice will prove useful in the treatment of both psoriasis and other chronic autoimmune diseases, especially in cases where the most commonly used therapies are not effective enough.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135425301","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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