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Vol 34, No 2 (2023)
Topical Subject
Issues of tuberculosis detection in general medical practice
Abstract
Implementing the tasks to reduce the burden of tuberculosis (TB) in Russia while striving for the declared WHO indicators weighs primarily on the general medical network. The main condition for reducing the incidence and prevalence of TB is its timely diagnosis with a comprehensive examination of the patient. The issues of the interaction with the anti-tuberculosis service begin at the stage of screening activities among the population or examination of a patient with complaints in suspected TB. The paper presents main information from the existing guidelines on adult TB, which is necessary in general medical practice, and the reasons that reduce the effectiveness of anti-tuberculosis measures.
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Lecture
Skin microbiota analysis in a patient and its role in clinical practice
Abstract
The skin is structurally a complex barrier organ that forms an original dynamic ecosystem colonized by a wide range of bacteria, fungi, viruses, and mites. The skin microbiome plays an important role in maintaining homeostasis and the state of local immunity and affects pathogenic microorganisms and skin barrier function through bacterial enzyme production. The most frequent and common infectious skin lesions are pyoderma, atopic dermatitis, psoriasis, hidradenitis suppurativa, acne vulgaris, rosacea, seborrheic dermatitis, various mycoses, as well as bacterial and fungal folliculitis. A detailed study of the impact of homeostatic balance on the health of the skin plays an important role in the diagnosis and treatment of skin diseases. Further investigations and deciphering bacteria, fungi, and viruses colonizing the skin will contribute to more effective diagnosis and identification of associations between the microbiota and the occurrence of various diseases, as well as to the development of more effective methods for their treatment, which is of great importance in clinical practice.
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For Diagnosis
Distribution of allele and genotype frequencies for the IL5 rs2069812 polymorphism in occupational asthma according to its phenotype
Abstract
Molecular genotyping opens up fresh opportunities to search for a more targeted and personalized approach to treating occupational asthma (OA) and to developing an individual strategy for its prevention.
Objective. To determine genetic risk markers for OA under the influence of sensitizers, by assessing IL5 rs2069812 polymorphic variants.
Subjects and methods. The investigation enrolled 170 patients with different OA phenotypes. The patients were divided into groups according to the OA phenotype: 1) 42 patients with an allergic OA phenotype; 2) 36 patients with a non-allergic OA phenotype; 3) 58 patients with an OA + occupational chronic obstructive pulmonary disease (COPD) phenotype; 4) 34 patients with an OA + metabolic syndrome (MS) phenotype. A control group included 50 healthy individuals. IL5 rs2069812 polymorphisms were determined as part of the study of genetic predisposition to OA. Phenol chloroform extraction was used to isolate DNA from peripheral lymphocyte samples. Genotyping was done by real-time polymerase chain reaction with primers and probes designed using the PrimerQuest program (Integrated DNA Technologies, Inc., USA).
Results. The genetic markers for OA were found for the first time after exposure to sensitizers, IL5 rs2069812 polymorphic variants, which can recommend that this genetic marker should be identified during thorough periodic medical examinations in individuals with clinical, functional, and immunological changes upon occupational exposure to sensitizing and irritating substances.
Conclusion. The identified marker profiles of the genotypes of OA can optimize an approach to diagnosing, treating, and preventing this disease, and expanding the range of criteria for predicting its course. When a polymorphism in the IL5 gene is detected using a molecular genetic study, the patient needs to be registered for follow-up, repeated respiratory function tests once every six months, thorough periodic medical examinations in a specialized center of occupational pathology, by obligatorily attracting a pulmonologist, an allergist/immunologist, and an occupational pathologist, as well as extensive functional and immunological studies once every two years.
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Prognostic factors for immune reconstitution inflammatory syndrome in patients with HIV and tuberculosis during antiretroviral therapy
Abstract
Antiretroviral therapy (ARVT) promotes the growth of a CD4 lymphocyte subpopulation, which leads to the development of immune reconstitution inflammatory syndrome (IRIS) in a number of patients with late-stage HIV and tuberculosis (TB) coinfection. Early prognostic factors for IRIS should be identified to timely initiate pathogenetic therapy aimed at its relief and ARVT continuation.
Objective. To develop a method for the early diagnosis of IRIS in patients with HIV/TB coinfection during ARVT and to identify criteria for initiating pathogenetic therapy.
Subjects and methods. The investigation enrolled 200 patients with HIV/TB coinfection who were divided into 2 groups: 1) 100 patients who received antituberculosis therapy (ATBT) without ARVT; 2) 100 patients who had combination (ARVT + ATBT) treatment. A control group included 50 healthy volunteers. To determine the prognostic factors for IRIS, all the patients underwent studies of viral load, CD4 lymphocyte levels, plasma lipid profile, and a complete blood count with a differential blood count before and after 1 month of treatment.
Results. In Group 2, the signs of IRIS were detected in 30 (30%) patients; those were absent in 70 (70%) patients at 10-14 days after the start of combination (ARVT + ATBT) therapy. The level of stab neutrophils was significantly higher in patients with the signs of IRIS than in those without IRIS, despite the absence of a difference in viral load and CD4 lymphocyte levels (p>0.05). All the patients with HIV/TB coinfection showed changes in the indicators of the lipid spectrum. However, there were significant differences between the patients with and without IRIS only in the level of triglycerides (TG) (1.4±0.2 and 0.9±0.2 mmol/l, respectively; p<0.001). Timely detoxification therapy for patients with the signs of IRIS (manifestations of intoxication syndrome and elevated TG levels) resulted in the relief of this syndrome, which made it possible to continue ARVT.
Conclusion. The significant increase in the level of TG in patients with the signs of IRIS during ARVT + ATBT allows this indicator to be used as an early laboratory marker of the risk for IRIS to timely prescribe pathogenetic therapy and to continue ARVT, which is important in predicting the disease.
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Novelty in Medicine
Use of medical imaging techniques as part of the evidence for the presence of meningeal lymphatics
Abstract
The lymphatic system is an integral part of the microcirculatory bed, which structurally and functionally complements the venous bed. It ensures constancy in the internal environment of the human body and performs transport, barrier, lymphopoietic, and immune functions, playing an exceptional role in the metabolism and cleansing of the body’s cells and tissues from metabolic products.
The researchers assume that the meningeal lymphatic vessels (MLVs) may be involved in the process of cleansing the brain from metabolic products. Today, the problem of proving the existence of MLVs is a key one in understanding the anatomy and physiology of processes in the brain as a whole. Medical imaging techniques make it possible to prove the presence of MLVs. The paper analyzes the methods that are currently more frequently used to determine MLVs.
Experimental medical imaging techniques allow us to conduct researches, by confirming or ruling out the scientific theories put forward. These methods are further evidence-based medicine.
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Pharmacology
Gut microbiota and probiotics: from theory to practice
Abstract
Research in recent years has provided much information about the overall composition and function of the gut microbiota. It has been established that the microbiota contributes to maintaining the integrity of the mucosa, providing nutrients, protecting against pathogens, etc. In addition, the interaction between the microbiota and the mucosal immune system is crucial for the formation of adequate immunity. Thus, understanding the human microbiota can be directed towards better diagnosis and rational treatment of many human diseases. The use of probiotics in various nosological forms demonstrate encouraging results. Diseases of the gastroenterological profile and not only often require the appointment of probiotics. The main mechanisms underlying the beneficial effects of probiotics are considered from the standpoint of their pleiotropic action. The choice of multi-strain probiotic preparations is preferable and justified from the point of view of the synergy of its constituent microorganisms, which allows achieving the best effect. The latest generation of probiotics with an innovative protective double shell demonstrate high clinical efficacy due to the preservation of the viability of probiotic microorganisms in the gastrointestinal tract.
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Health Care Service
Comparative analysis of the use of maintenance therapy drugs in women in the process of radiotherapy after surgical treatment of endometrial cancer
Abstract
Aim. To carry out a comparative analysis of the cost of a "unit of effect" of emoxipin, ethoxidol and mexidol used to improve the quality of life of women receiving radiation therapy after surgical treatment of endometrial cancer.
Materials and methods. The pharmacoeconomic analysis was carried out in accordance with the Guidelines for Calculating Costs in Conducting Clinical and Economic Studies of Medicinal Products and included determining the position of the study and the list of costs, the time period for cost accounting and cost calculation. The results of the use of the studied drugs were evaluated according to the previously published dynamics of integrative indicators of QL according to the generic questionnaire SF-36 and the cancer-specific questionnaire for patients with endometrial cancer FACT-En. In the course of the analysis, a comparison was made of the direct costs (Cost, in rubles) for the purchase of each of the studied drugs with the consequences (Ef) of their course use. The result of the pharmacoeconomical analysis was expressed in the form of a cost-effectiveness coefficient (CER = Cost / Ef) per patient.
Results. As a result of the clinical and economic analysis, it was found that in most cases mexidol is characterized by the lowest cost-effectiveness ratio. This concerns the calculation of CER according to the dynamics of the integral indicator (TS) of the questionnaire for the functional assessment of endometrial cancer therapy (FACT-En) and the psychological component of health (MH) according to SF-36. The exception was the result of the calculation of "cost-effectiveness" according to the criterion of increasing PH – the physical component of health according to SF-36. In this situation, mexidol was inferior to ethoxidol in terms of pharmacoeconomic efficiency. In all cases, without exception, the most expensive was the use of emoxipin.
Conclusion. According to the pharmacoeconomic criterion "costs - effectiveness", the most expensive is the use of emoxipin, and the least expensive is the use of mexidol. In all cases, the "cost per unit effect" of emoxipin was 3-6 times higher than the corresponding indicators of mexidol and ethoxidol.
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From Practice
A retrospective analysis of the causes of an adverse outcome in COVID-19 and HIV coinfection in the stage of secondary diseases
Abstract
The increased incidence of COVID-19 and HIV coinfection and the changes in the structure of HIV infection mortality during the pandemic necessitate an analysis of the causes of adverse outcomes in co-infection.
Objective. To retrospectively analyze deaths in patients with COVID-19 and HIV coinfection in the stage of secondary diseases.
Subjects and methods. The investigation involved the medical records of 56 patients with laboratorily confirmed COVID-19 and HIV infection who were hospitalized in January to December 2021.
Results. A retrospective analysis of the medical reports showed that bilateral polysegmental pneumonia of mixed etiologies was the cause of death in the majority cases of COVID-19 and HIV coinfection in the stage of secondary diseases. Along with pneumonia, multiple opportunistic diseases and conditions, which aggravated the course of the underlying disease, were identified in these patients. Various somatic diseases are one of the reasons for the severe course of the coinfection.
Conclusion. Stage IVB HIV infection was diagnosed in the majority of deaths. Bilateral polysegmental pneumonia of mixed etiologies was the most common cause of death in patients with COVID-19 and HIV coinfection in the stage of secondary diseases.
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Assessment of clinical data and the species composition of pathogens in the upper respiratory tract of patients with COVID-19 and determination of sensitivity to essential etiotropic drugs
Abstract
Objective. To comparatively analyze the clinical and microbiological data of outpatients with COVID-19 who took a bacteriophage-based drug and who did not.
Subjects and methods. The investigation involved 42 outpatients with COVID-19 who were divided into two groups: a study group of 30 patients who received standard therapy for COVID-19, as well as an oral bacteriophage-based drug (15 ml thrice a day for 10 days); a control group of 12 patients who had only the standard COVID-19 therapy. After 10 days of therapy, the clinical manifestations of the disease were comparatively evaluated in the examined groups. A repeated study of the material for bacterial microflora to assess the eradication of the pathogenic microflora in the respiratory tract was conducted on day 21 after the start of therapy.
Results. Klebsiella pneumoniae (77%), Staphylococcus aureus (17%), and streptococci (Streptococcus agalactiae and Streptococcus pyogenes) (6%) were identified in the structure of bacterial pathogens in patients with COVID-19. Microbiological monitoring revealed multidrug-resistant K. pneumoniae in 50% of the patients; that sensitive to antibiotics in 26.7% of cases and that sensitive to a bacteriophage in 100%. The investigation results showed that the use of a polyvalent K. pneumoniae bacteriophage in patients with COVID-19 to prevent bacterial complications contributed to a significant (p < 0.001) elimination of K. pneumoniae. The pathogen isolation rate in the study group decreased significantly (p < 0.001). Thus, the use of phage therapy in combination with etiotropic therapy can be recommended to prevent bacterial complications in patients with COVID-19.
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Iron deficiency anemia in reproductive-aged women: options for treatment and prevention
Abstract
Objective. To assess the frequency of iron deficiency states among reproductive-aged women and to consider the features of their prevention.
Subjects and methods. The investigation enrolled 2401 reproductive-aged patients who came first to the Clinic of the Kuban State Medical University in 2019. The patients’ mean age was 36.71±6.32 years; the follow-up period was 36 months.
Results. Iron deficiency and iron deficiency anemia (IDA) were detected in 518 (21.6%) and 591 (15.9%) patients, respectively. At the same time, IDA was mild, moderate, and severe in 383 (15.9%); 202 (8.2%), and 6 (0.5%) patients, respectively. New-onset anemia was recorded in 70.3% of patients. A re-examination was carried out after 36 months, which involved 1917 patients (79.8% of the baseline patients). A total of 156 (8.1%) patients were diagnosed with mild and moderate (in 149 (7.7%) and 7 (0.3%) patients, respectively; latent iron deficiency was identified in 518 (21.6%) patients. At the same time, IDA was undetected in the patients who had followed the recommendations for prophylactic iron supplementation after reaching the target levels of serum hemoglobin and ferritin.
Conclusion. An integrated approach that includes the informing of a patient about iron deficiency consequences, etiotropic and pathogenetic treatment, preventive drug use recommendations, and dynamic monitoring, assist in overcoming iron deficiency in reproductive-aged women.
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Risks for obesity-associated diseases and conditions
Abstract
Alimentary-constitutional obesity is a chronic heterogeneous multifactorial disorder, the relevance of which can hardly be overestimated. The severe forms of this disorder are accompanied by specific complications, a high cardiometabolic risk, and obesity-related comorbidities.
Objective. To study obesity-associated diseases and conditions.
Subjects and methods. The investigation involved 426 overweight and obese patients. They underwent an examination that included historical data collection; physical examination for estimation of the severity of obesity and the grade of hypertension; abdominal ultrasound for diagnosis of hepatic steatosis or non-alcoholic fatty liver disease (NAFLD), and laboratory testing for a study of the parameters of carbohydrate and fat metabolisms and liver function.
Results. Patients with severe alimentary-constitutional obesity had a higher risk of comorbidity: the risk of hypertension was elevated by 3.5-fold, type 2 diabetes mellitus and impaired glucose tolerance by 5-fold, metabolic syndrome by 4-fold, and NAFLD by 5.5-fold.
Conclusion. Severe alimentary-constitutional obesity is a risk factor for comorbidity. At the same time, the solution of losing weight is a complex task to physicians of various specialties and consists of measures in both public health and patient commitment to a healthy lifestyle.
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Rehabilitation method using virtual reality technology and robotic mechanotherapy in patients with coxarthrisis after hip joint replacement operation
Abstract
Objective: to evaluate the impact of the rehabilitation with the inclusion of virtual reality technology and robotic mechanotherapy on the speed and biomechanics of walking in patients with coxarthrosis after hip arthroplasty.
Material and methods. The sample consisted of 40 patients aged 40–80 years after hip arthroplasty for coxarthrosis. Within 14 days, patients of the main group (n=20) received a new complex of physical therapy, including robotic mechanotherapy and training on a system with virtual reality technology, in the control group (n=20) – a standard rehabilitation complex.
Results. In the main group, a decrease in the level of pain according to VAS by 41.7% (p=0.023 compared with the baseline; p=0.047 compared with the control group), as well as an increase in walking speed (by 20.5%; p= 0.028) and a decrease in step width (by 8.2%; p=0.048). Also, in the main group, there was a decrease in the time to complete the "Get up and walk" test (by 15.4%; p=0.043) and an increase in walking speed according to the ten-meter test (by 23.9%; p=0.039). There were no significant changes in data in the control group (p>0.05).
Conclusion. A new rehabilitation complex, including methods of mechanotherapy and virtual reality, is recommended for the rehabilitation of patients with coxarthrosis after arthroplasty.
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Experimental modeling of mandibular defect and analysis of the functional efficiency of the jaw exoskeleton
Abstract
Modeling of jaw bone defects after bisphosphonate administration is presently an urgent task of oral surgery. Methods for virtual modeling of pathological processes and ways for their elimination are becoming increasingly popular in experimental studies. However, biomedical research with experimental animals, which is strictly regulated by law, does not lose its relevance. The choice of a model for our study has been based on the assumption that bisphosphonate-associated osteonecrosis and jaw defect in experimental animals are identical to human clinical presentations. In addition, this study considers the development of devices for correcting biomechanical problems and positioning the jaw bone fragments. Simulated subtotal mandibular defects are accompanied by restricted mouth opening, malnutrition and, as a result, inhibited habitual functional activity in the experimental animals. This has served as a guide for incorporating the simultaneous fixation of fragments with a multifunctional device, such as with the mandibular exoskeleton, into the protocol of surgical intervention. Positive changes in the early postoperative period have been characterized by restoration of the biomechanical balance of the dentition. The findings provide evidence that it is necessary to modernize the device and to test the exoskeleton in patients with subtotal mandibular defects.
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Use of synthetic peptides in the prevention of oral diseases
Abstract
Among the protective factors of mixed saliva, antimicrobial peptides have received much attention. They have broad-spectrum antibacterial and antifungal activities. Synthetic peptides are found in hygiene products, such as mouthwashes, sprays, and toothpastes. According to their manufacturers, the use of these products helps prevent oral bacterial infections.
Objective. To study the effect of toothpastes and mouth spray, which contain synthetic peptide complexes, on the physicochemical parameters of mixed saliva in order to substantiate their preventive antibacterial effect.
Material and methods. Mixed saliva from patients was examined before and after the use of the synthetic peptide-containing spray and toothpaste. The following salivary physicochemical parameters (pH, surface tension, and base buffer capacity) were measured.
Results. The peptide-containing spray and toothpaste caused changes in the oral fluid pH within the normal range, which assisted in maintaining oral homeostasis and in effectively exerting the functions of mixed saliva. When the spray or toothpaste was used, the base buffer capacity was slightly reduced, which suggested that the synthetic peptides were able to neutralize oral fluid acids and thereby to enhance the anti-inflammatory and antibacterial functions of mixed saliva. The surface tension of saliva was increased with the peptide-containing spray and that was decreased with the peptide-containing toothpaste. This effect indicated the active ability of the synthetic peptides to be absorbed into blood and to have a direct effect on cell metabolism at the site of lesion (when using the spray), as well as the ability of the complexes to integrate into the colloidal system of saliva, which enhanced its reparative and protective properties (when using the toothpaste).
Conclusion. The study shows an increase in the antibacterial effect of mixed saliva when using oral hygiene products containing peptides, which contributes to the prevention of risk factors for inflammatory diseases of the oral mucosa and periodontium.
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Anxiety-depressive disorders in the presence of moderate acne (a clinical case)
Abstract
The paper describes a clinical case of a 27-year-old female patient with an anxiety-depressive disorder that developed in the presence of moderate acne. The patient consulted a dermatologist about facial rashes that had been disturbing her since adolescence. Because of the cosmetic defect, the patient experienced depression, anxiety, and uneasiness and limited social contacts. Moderate acne was diagnosed using an objective examination and anamnestic data. An analysis of her mental status on the standard Hospital Anxiety and Depression Scale (HADS) revealed clinically significant anxiety and depression. The patient was prescribed topical treatment (with azelaic acid, adapalene); skin care was recommended. The immunomodulatory agent aminodihydrophthalazinedione sodium was given to correct stress in the presence of an anxiety-depressive state. The treatment was noted to improve the skin and to reduce the level of anxiety and stress according to the HADS. Thus, the psycho-emotional status of patients with moderate acne should be evaluated. The use of immunomodulatory drugs as part of combination therapy can normalize psycho-emotional disorders associated with skin rashes.
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Anxiety compulsive disorders in adolescents with headache. Correction and prevention
Abstract
The paper deals with the actual problem of modern medicine, namely, the analysis of the association of headache (HA) in adolescents with the presence and severity of anxiety compulsive disorders. It presents information on the prevalence, etiology, and clinical manifestations of primary HA in children and adolescents. The characteristics of the components (phobic anxiety and compulsiveness) of the psychoemotional status are given. The authors present the results of their own study showing that frequent episodes of HA are associated with the greater severity of compulsive disorders and phobic anxiety. They highlight approaches to correcting anxiety and preventing its negative impact on the occurrence of HA. The need for further researches in this direction is emphasized.
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The use of selenium-containing drugs in the prevention and treatment of complications in patients with COVID-19
Abstract
Objective. To study literature data reflecting the use of selenium (Se) and selenium-containing drugs in the complex prophylaxis and treatment of complications in patients with COVID-19.
Material and methods. Data analysis of 37 publications of scientists from Russian Federation, United States of America, People's Republic of China, Great Britain, India, France, Germany, Italy, Sweden, Canada, Brazil, United Arab Emirates, Saudi Arabia, Ireland, Holland, Greece, Australia, Poland, Pakistan, Sudan, Nepal was performed. The authors reflected on the epidemiology, diagnosis, pathogenesis, clinic, risk of acute respiratory distress syndrome, multiple organ failure, cardiovascular complications, mortality in patients with COVID-19, the importance of Se deficiency in the body and the preventive use of selenium-containing drugs in novel coronavirus infection.
Results. Low dietary Se intake was associated with the development of acute respiratory distress syndrome in men and women with COVID-19. Deficiencies were associated with increased risk of morbidity and mortality. Organic forms of Se had the best bioavailability. Se had antioxidant, anti-inflammatory, antithrombotic, antiviral, immunomodulatory effects in patients with COVID-19.
Conclusions. Thus, control and optimization of the selenium status in population of selenium-deficient areas with addition of Se-enriched food to the diet, as well as SELENBIO for women complex of Russian company "Parapharm" could be one of the directions of prevention and treatment of complications in patients with COVID-19.
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Evaluation of the effect of metabolic therapy on the state of blood vessels in estrogen deficiency and hypertension
Abstract
The article presents the results of duplex scanning of the common carotid arteries (CCA) and assessment of the structural and functional state of the vascular bed women with arterial hypertension (AH) with hypoestrogenemia. It was found that in patients with hypertension with a reduced level of estradiol, there is an expansion of the lumen of the CCA, a decrease in the speed of blood flow in the carotid arteries of a rectilinear course, without hemodynamically significant stenoses, which indicates structural and functional changes in the vascular wall. In the studied patients, in almost every third case, an inertial type of vasomotor reaction is detected before treatment, which indicates the contribution of dishormonosis to the progression of hypertension due to an increase in the stiffness of the vascular wall and the development of endothelial dysfunction. Combination therapy with BioDihydroquercetin and ACE inhibitor improves the structural and functional characteristics of the vascular wall of the CCA, has a positive effect on endothelial dysfunction, reduces the stiffness of the vascular wall of the arteries compared with patients taking ACE inhibitor monotherapy. The drug BioDihydroquercetin, produced with trade mark “Baikal Legend”, is a natural antioxidant, capillaroprotector, strengthens blood vessels, improves blood microcirculation, and is recommended to slow down the aging process of the body.
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Tuberculosis of the maxillofacial region and larynx
Abstract
Tuberculosis (TB) can infect all organs and systems of the body. Affection of the maxillofacial region and larynx by TB is a rare localization. However, it presents great difficulties in diagnosis. Current views on the pathogenesis, clinic, diagnosis and treatment of TB of the maxillofacial region and larynx are presented.
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