Pharmateca

Background. The annual seasonal rise in the incidence of acute respiratory viral infections (ARVI) begins in September with maximum incidence rate among infants and preschool children. In November-December, influenza begins to dominate, first in the form of local outbreaks, and then an epidemic rise in incidence of varying intensity. In the fall of 2021, against the backdrop of the ongoing incidence of COVID-19, influenza viruses returned to epidemic circulation both in the world and in Russia, causing in 2022 –2023 increase in influenza activity, first caused mainly by the influenza A(H1N1)pdm09 virus, and then by influenza B.

Objective. Summarizing the results of evaluation of the therapeutic and preventive efficacy of rimantadine + sodium alginate for ARVI of various etiologies in infants and preschool children.

Methods. The therapeutic efficacy of rimantadine + sodium alginate was studied in 808 children hospitalized on days 1–2 of acute respiratory viral infection with a proven etiology of the disease. The latter was established by detecting pathogen antigens in material from the nasal passages and nasopharynx of patients using the polymerase chain reaction or immunofluorescence express method, followed (after 2–3 days and before discharge) by determining their persistence or the appearance of new pathogens, as well as serologically in paired blood sera: in complement fixation reactions, hemagglutination inhibition and enzyme immunoassay with a wide range of antigens. The preventive effectiveness of the drug was studied during 6 outbreaks of ARVI in 269 children from 3 orphanages: 134 children received the drug, 135 were included in the comparison group.

Conclusion. Clinical and epidemiological observations have shown that the polymer drug, consisted of a complex derivative of rimantadine and modified sodium alginate from seaweed in sugar syrup, has statistically significantly proven therapeutic and preventive efficacy in ARVI of any etiology in children aged 1–7 years.

The article is devoted to a pressing pediatric problem – the development of bronchiolitis in childhood. The study presents a series of clinical observations describing the clinical heterogeneity of bronchiolitis in terms of age, taking into account the variability of clinical symptoms, etiological factors and therapy. During the observation, clinical and laboratory differences in the course of acute bronchiolitis in children depending on age were determined. In the younger age group, the clinical picture was characterized by a pronounced intoxication syndrome, a moderate or severe course of the disease, a long hospital stay (14.3±4.2 days), and the inclusion of systemic glucocorticosteroids in the treatment complex. Among the etiologically significant factors, the RS virus and rhinovirus dominated.

In the older age group, disease was characterized by the absent of intoxication syndrome, with mild respiratory failure, and the duration of hospitalization was 7.2±2.4 days. According to computed tomography data, typical manifestations of acute bronchiolitis were observed in the form of areas of “ground glass”, areas of mosaic oligemia with centrilobular nodules (sign of “tree in bud”), and when assessing the respiratory function, an obstructive-restrictive type of disorders was determined.

The course of bronchiolitis obliterans in the examined patient was favorable with rare exacerbations of the bronchopulmonary process, no progression of respiratory failure, and maintenance of normal growth rates and physical development.

Interstitial lymphocytic lung disease in the form of follicular bronchiolitis was diagnosed in one child with primary immunodeficiency ataxia-telangiectasia (Louis-Bar syndrome).

The complex of microorganisms found in the intestine (gut microbiota) influences the pathogenesis of a number of diseases. There are theories that gastrointestinal diseases increase the risk of development and recurrence of urolithiasis. Current evidence presented in this article demonstrates a link between gut microbiota, particularly Oxalobacter formigenes, and the formation of oxalate kidney stones. The connection between inflammatory bowel diseases and the use of antimicrobial drugs with oxalate homeostasis is shown, and ways of correcting the gut microbiota in patients with urolithiasis using diet therapy, probiotics, and fecal microbiota transplantation are analyzed. The article presents research results demonstrating that correction of the gut microbiota can be a therapeutic goal and may become an important component of the complex treatment of nephrolithiasis.

Manifestations of inflammatory bowel disease in the upper gastrointestinal tract are often hidden behind the classic symptoms of ileal and colon lesions and are observed in only 0.5–4% of adult patients. However, due to the improvement of endoscopic methods and the more frequent use of esophagogastroduodenoscopy with biopsy, both asymptomatic and clinically significant manifestations of the esophageal, gastric and duodenal lesions are increasingly being detected. The diagnosis of inflammatory bowel disease affecting the upper gastrointestinal tract should ideally be based on a combination of clinical history, endoscopic and histological findings. Although endoscopic changes such as aphthoid or longitudinal ulcers and a bamboo-joint-like appearance are suggestive of Crohn’s disease, histologic examination increases the sensitivity of the diagnosis because histologic changes may be present in endoscopically normal mucosa. Conversely, in many cases the histological findings are nonspecific and knowledge of the clinical history is essential to making an accurate diagnosis. This article discusses the most important clinical, endoscopic and histological features of Crohn’s disease affecting the esophagus, stomach and duodenum.

The review article is devoted to summarizing the data on the use of indirect oral anticoagulants (IOACs). A broad therapeutic platform for preventing thrombotic complications using drugs of this group is shown. The prospects for the use of IOACs in patients with new coronavirus infection are indicated. A promising domestic drug of this group has been named, which, among well-known competitors such as rivaroxaban, apixaban, edoxaban and betrixaban, shows one of the lowest concentrations required to double prothrombin time, which researchers associate with tight binding between the ligand-drug and the amino acids Gly216 and Gly218 target protein.

Background. Atrial fibrillation (AF) and coronary heart disease (CHD) mutually worsen the course and prognosis of each other, especially in the presence of a history of previous myocardial infarction. Such a combination of diseases is more common in elderly and senile patients, which requires special control of pharmacotherapy due to the high prevalence of polypharmacia.

Objective. Analysis of the structure of comorbidities and compliance of prescribed pharmacotherapy with STOPP/START criteria in hospitalized patients ≥65 years old with a combination of AF and CHD, depending on the presence of previous myocardial infarction. Methods. We conducted a retrospective analysis of the medical histories of 342 patients ≥65 years old with a combination of AF and CHD who were treated in the cardiology department of a multidisciplinary hospital in Moscow, and divided them into groups: group 1 – 214 patients, median age 85 (78–90) years without history of previous myocardial infarction and a group 2 – 128 patients, median age 85.5 (78–90) years with a history of previous myocardial infarction. The comparative analysis of the structure of multimorbidity and pharmacotherapy according to STOP/START criteria was carried out.

RESULTS. In the second group, the score on the CHA2DS2-VASc (p<0.001), the value of the Charlson comorbidity index (p<0.001), and the number of maximally prescribed drugs at the same time (p=0.002) were significantly higher. Among the comorbidities in patients with a history of previous myocardial infarction, there were chronic heart failure of functional class IV according to the New York Heart Association (NYHA) classification (p=0.006), type 2 diabetes mellitus (p=0.005), stage 3b chronic kidney disease (p=0.019) more common. START criteria were more common than STOPP criteria, and we also found two START criteria with significant differences in frequency between groups.

Conclusions. The data obtained requires more careful selection of medicines in elderly patients. STOPP/START criteria can be recommended to use to select the optimal treatment strategy.

The clinical significance of lipid-lowering therapy in reducing the risk of atherosclerotic cardiovascular disease (CVD) and mortality has been proven. However, the achievement of target levels of cholesterol and its fractions in real practice is not ensured, there are problems with the tolerability of standard drugs (statins), often the use of additional lipid-lowering agents (ezetimibe, PCSK9 inhibitors) is required. In February 2020, the FDA approved a new drug, bempedoic acid (BA), recommended in the US and the European Union (EU) as an adjuvant to maximally tolerated statin therapy to lower low-density lipoprotein cholesterol in patients with atherosclerotic CVD and familial hypercholesterolemia, as well as in cases of intolerance or contraindications to the use of statins or in combination with ezetinib. The article presents data on the mechanism of action and clinical pharmacology of the drug, the results of 2nd and 3rd phase clinical trials (a series of CLEAR studies) to assess the safety and lipid-lowering efficacy in different categories of patients and modern meta-analyzes, as well as the results of a recent large study CLEAR Outcomes to assess major cardiovascular outcomes with BA. The place of BA in lipid-lowering therapy in patients with atherosclerotic CVD is also discussed.

Chronic abdominal ischemia syndrome (CAIS) is most often manifested by postprandial abdominal pain, weight loss and dyspeptic symptoms (diarrhea/constipation, flatulence). Due to the fact that such manifestations are characteristic of many diseases of the gastrointestinal tract, and the data of laboratory and instrumental methods during routine examination are nonspecific, this leads to a late diagnosis of CAI. An important role in the timely diagnosis of this pathology is given to such examination methods as Doppler ultrasound, multislice computed tomography, magnetic resonance imaging and/or angiography of the abdominal aorta and its branches. The etiological factors in the development of CAIS are different, but one should think about atherosclerotic genesis if the patient has the above complaints, the absence of the effect of the therapy, and the presence of risk factors for the development of atherosclerosis or already existing atherosclerotic lesions of other circulation systems. In the last decade, endovascular methods have become more often used in the treatment of such patients, but the lack of criteria for the implementation or contraindications to the use of this technique, the features of management in the postoperative period make it difficult to use them in routine practice.

The term «asthma-chronic obstructive pulmonary disease overlap (ACO)» is a heterogeneous condition with airflow limitation, which is not completely reversible, and also has clinical and inflammatory signs of both asthma and COPD. The study was aimed to the analysis of the material on this topic. An analytical method was used to study the diagnosis, clinical manifestations and approaches to treatment of patients with a combination of asthma and COPD over the past 10 years (2013–2023) using the following databases: PubMed, Wiley, EMBASE database, Cochrane Library.

Background. The problem of antibiotic resistance is one of the most pressing public health problems. Antibiotic resistance monitoring is necessary at all levels (global, national, local).

Objective. Assessment of the etiological structure and dynamics of antibiotic resistance of nosocomial pathogens in the leading multidisciplinary institution of the Republic of Karelia (Republican Hospital n.a. V.A. Baranov, Petrozavodsk) for 2019–2022.

Methods. All microbiological studies performed in 2019 and from June 2021 to June 2022 were analyzed. A summary of the data, statistical grouping, followed by a tabular and graphical presentation of the information obtained are presented.

Results. The largest number of cultures was performed in the intensive care unit № 1 (ICU-1), sputum tests predominated. The main pathogens were Acinetobacter baumannii (A. baumannii) (30.82% in 2019 and 30.71% in 2021-2022), Klebsiella pneumoniae (K. pneumoniae) (29.45 and 35.71%) and Pseudomonas aeruginosa (P. aeruginosa) (17.12 and 16.43%). The microflora was resistant to most antibiotics. In the surgical department, wound discharge was examined more often; K. pneumoniae predominated (33.77 and 36.17%). In the neurosurgical department – cultures of wound discharge (26.72 and 31.53%), sputum (28.44 and 29.73%) and urine (36.20 and 26.42%) were examined. The following microorganisms were isolated from wound discharge in 2019: K. pneumoniae (31.25%), sensitive to meropenem and amikacin in all cases, Enterococcus spp. (25%), in all cases sensitive only to vancomycin and linezolid, Staphylococcus aureus (S. aureus) (18.75%), in all cases sensitive to cefoxitin. Wound discharge in 2021–2022: S. aureus (45.16%), 50% sensitive to cefoxitin, K. pneumoniae (16.13%, of which 20% of strains are sensitive to cefotaxime, cefepime, ciprofloxacin, 60% – to meropenem, 40% – to amikacin). K. pneumoniae (40 and 45.45%), P. aeruginosa (20 and 10%) and A. baumannii (16.67 and 15.15%) predominated as the causative agent of lower respiratory tract infection in the neurosurgical department in both periods.

Conclusion. In surgical departments, gram-negative microflora dominated as causative agents of nosocomial infections. A significant decrease in the sensitivity of all types of pathogens to antimicrobial drugs was revealed.

Background. The article analyzes the results of various types of treatment of 86 patients with dorsopathy, advanced osteochondrosis, complicated by scoliotic deformity and instability of the spinal motion segment, manifested by pain and poor posture in the period 2016–2000.

Objective. Improvement of technology and increase the effectiveness of rehabilitation of patients with degenerative dystrophic disk disease (DDDD) (justification, development, clinical implementation and evaluation of the effectiveness of differentiated programs for medical rehabilitation of patients with DDDD).

Methods. The group included 86 patients, 43 (50%) men and 43 (50%) women; the mean age and duration of the disease were 44.5 and 5 years, respectively. 3 treatment regimens were used in the treatment of patients: 1) medication, including intramuscular injections of non-steroidal anti-inflammatory drugs, B vitamins, centrally acting muscle relaxants for 10–14 days 25 (29.1%) patients; 2) a course of manual therapy and corporal acupuncture, consisting of 5 sessions conducted over 10–18 days – 11 (12.8%) patients; 3) a course of manual therapy and auricular acupuncture, consisting of 5 sessions conducted over 10–18 days – 25 (29.1%) patients. 25 (29.1%) patients did not receive treatment for various reasons. Pharmacotherapy was not used in regimens 2 and 3.

Results. The condition of the patients in the group without treatment showed no dynamics; when using treatment regimen 1, the dynamics of the summary assessment of the condition significantly improved; when using schemes 2 and 3, the dynamics of the summary assessment of the patients’ condition significantly improved.

Conclusion. Based on the data obtained, it can be conclude dthat for the treatment of patients with advanced osteochondrosis complicated by scoliotic deformity and instability of the SMS, manifested by pain and poor posture, the most effective courses are manual therapy and acupuncture, both corporal and auricular, which allows to relieve not only pain syndrome, but also reliably level out postural disorders.

Seborrheic dermatitis (SD) is a common multifactorial chronic recurrent inflammatory skin disease that occurs in children and adults, characterized by the formation of erythematous-squamous or papulosquamous rashes in areas with a high concentration of sebaceous glands. The pathogenesis of the disease is not fully understood, but it is assumed that it is associated with hypercolonization of the skin by opportunistic Malassezia yeast, a pronounced immune response to an increase in the fungal population, and genetic predisposition. Chronicity of the process and acute relapses have a significant impact on the quality of life of patients. It is possible to treat acute forms of SD and prolong stable remission with the drug zinc pyrithione. In the current retrospective study, the drug was used in 76 patients who were divided into 3 groups taking into account the clinical symptoms of the process. Depending on clinical symptom, patients were prescribed various dosage forms of zinc pyrithione: shampoo, cream, aerosol. The results of the therapy were assessed 2 weeks after the start of using the drug. The data obtained during the study confirm the literature that it is possible to achieve a pronounced improvement in the process and remission already on the 10–14th day.

Background. Lung cancer occupies a leading place in the structure of morbidity and mortality from cancer in Russia and in the world. Non-small cell lung cancer (NSCLC) accounts for about 85% of cases among all lung malignancies; 42.2% of lung cancer cases in Russia were detected at the most advanced stage IV. Today, the optimal first-line treatment for patients with stage IV NSCLC without driver mutations, regardless of the level of PD-L1 expression, includes combination treatment regimens, representing by various combinations of chemotherapy, immune checkpoint inhibitors, and antiangiogenic therapy for the non-squamous histotype.

Description of a clinical case. A patient born in 1965 was under medical supervision with peripheral cancer of the upper lobe of the right lung, T1N0M0, stage I at the time of diagnosis, with relapse in the form of metastases in the supraclavicular, subclavian and bronchopulmonary lymph nodes 5 years after the atypical resection and subsequent rethoracotomy with upper lobectomy. Tumor control in the form of complete regression of lesions after three courses of combination therapy using an immune checkpoint inhibitor, cytotoxic drugs and an angiogenesis inhibitor with progression-free survival of more than a year was achieved. Tolerability of treatment was satisfactory.

Conclusion. The use of a combination with atezolizumab in patients with EGFR and ALK negative stage IV NSCLC who have not previously received therapy for advanced disease can significantly improve patient survival.

Hormone receptor positive (HR+)/HER2-negative breast cancer (BC) is the most common subtype of breast cancer, accounting for approximately 70% of all breast cancer cases. Hormone therapy (tamoxifen) has been the basis of systemic treatment for such tumors since the 1980s. Further research began to focus on other endocrine therapeutic approaches, in particular, the return to ovarian ablation or conservative ovarian suppression in premenopausal women, as well as the use of aromatase inhibitors in postmenopausal women. Further administration of 3rd-line endocrinotherapy with fulvestrant in patients with advanced breast cancer improved progressive-free and overall survival. Overcoming endocrine resistance in the progression of the disease has become the basis of a new generation of endocrine therapy for progress in the therapy of hormone-receptor positive (HR+)/HER2-negative breast cancer. It turned out that cyclin-dependent kinases (CDK 4/6) are crucial for the progression of the cell cycle, and are an effective target in the treatment of breast cancer at various stages.