卷 27, 编号 14 (2020)

There is limited experience with the use of medicines to treat COVID-19 in women during pregnancy and breastfeeding. The use of a number of drugs during these periods is absolutely contraindicated. The use of other medications is possible with a balanced assessment of the relative risk and benefit. When using medicines, a pregnant and lactation women must follow the instructions for a specific drug.

Today, inflammatory processes of various etiology and localization are an acute problem for the clinician. Despite the wide arsenal of drugs used, inflammatory processes are still often accompanied by complications or transform into the chronic phase. The article considers the main problems caused by the lack of efficacy and restrictions in the use of non-steroidal anti-inflammatory drugs due to their side effects, discusses the role of the main components of the inflammatory process, as well as their relationship with complications and the appearance of chronic pain. The question of the lack of regulation of exclusively inflammatory mediators is raised. Separate groups of drugs with a proven inhibitory effect on pro-inflammatory factors of inflammation and the ability to activate the processes of resolving the inflammatory process are discussed, in particular, it is about bioregulatory drugs and their mechanisms of action.

Data on the effectiveness of biological therapy in psoriasis vulgaris are well presented in foreign and Russian scientific literature. However, data on generalized forms of the disease are much less. Data on erythrodermic and generalized pustular psoriasis are the least commonly found. The article analyzes articles and clinical guidelines for the management of patients with these severe forms of dermatosis and presents strategies that may help clinicians to determine the therapy for such patients. According to Pubmed, the use of biological drugs in erythrodermic and generalized psoriasis has been analyzed based on clinical reports, case series and uncontrolled open-label studies. A limited number of direct comparative studies or clinical studies on this topic have been identified. In more than half of the cases, data on infliximab are presented based on the described clinical examples. Other biological agents such as etanercept, ustekinumab, adalimumab have also been used in patients with these severe forms of psoriasis. Moreover, there were clinical cases with positive results of therapy in most situations. Secukinumab has been shown to be effective in generalized pustular and palmar-plantar pustular psoriasis in selected clinical trials, while the number of published clinical cases using secukinumab is still small. The availability of updated AAD-NPF international recommendations can be very useful for the validity of the use of these drugs in clinical practice.

Background. Cardiovascular diseases are global medical problem. In the development of acute coronary events, including acute coronary syndrome (ACS), oxidative stress with an increased release of matrix metalloproteinases-9 (MMP-9) plays a critical role. However, the dynamics of MMP-9 level under the influence of different doses of statins in patients with ACS requires clarification. Objective. Evaluation of the oxidative stress indicators and MMP-9 levels in patients with non-ST segment elevation ACS (NSTE-ACS) depending on treatment with different doses of atorvastatin. Methods. In the conditions of the Kuban State Medical University, 68 patients with NSTE-ACS (mean age - 55.6±3.6 years) were examined. Study design: case series. All patients underwent ECG, determination of the troponin I, MMP-9, malondialdehyde (MDA) and sulfhydryl groups (SH-groups) levels, as well as the blood plasma content of stable NO metabolite - NO2. Results. Compared with patients with stable angina and the control group, in patients with NSTE-ACS against the background of oxidative stress (according to the SH-groups, MDA, and blood plasma NO2 levels), an increased level of proteolytic and inflammatory activity was revealed, which was confirmed by high MMP-9 concentration. Therapy with atorvastatin was accompanied by minimization of oxidative inflammation and a decrease in MMP-9 levels. Conclusion. The therapeutic effect of atorvastatin was dose-dependent with the greatest positive anti-inflammatory and antioxidant effect at a dose of 60 mg/day for 4 weeks.

Background. In patients with chronic obstructive pulmonary disease (COPD), the most common comorbid disease is coronary artery heart disease (CAD), including acute coronary syndrome (ACS). Assessment of the severity of the clinical course of COPD and the ventilation function of the lungs plays an important role in the choice of drug therapy and in predicting the outcome of ACS. Objective. Assessment of the severity of the clinical course of COPD and impaired ventilation function depending on the outcomes of ACS, as well as to determination of their correlation with the blood troponin T(TNT) level. Methods. The study included 54 patients (29 men and 25 women) aged 49 to 72 years (65.2±7.3 years) hospitalized with a diagnosis of ACS and concomitant COPD. Taking into account the outcomes of ACS, patients were divided into two groups: group 1 - 30 patients with acute myocardial infarction (MI); group 2 - 24 patients with progressive unstable angina. All underwent spirometry and CAT-test (the chronic obstructive pulmonary disease assessment test), and also determination of the blood TNT level. Results. Compared to group 2, exacerbation of COPD during hospitalization was more frequent in group 1: 80.0% versus 41.7% (p=0.009). Also, in group 1, the TNT level in patients with exacerbation of COPD was higher than in patients without exacerbation: 0.927±0.289 and 0.592±0.149 ng/ml, respectively (p=0.005). The values of the forced expiratory volume in 1 second (FEV1) and the Tiffeneau index in the presence of exacerbation of COPD in the group 1were lower than in the group 2: on average by 17.7 (p=0.028) and 12.6% (p=0.01), respectively. The TNT level correlated inversely with FEV1 (p=0.014) and directly with the CAT-test score (p=0.003). Conclusion. It was revealed that severe clinical symptoms and severe airflow restriction during exacerbations of COPD in hospitalized patients with ACS are often associated with the development of acute MI and elevated blood troponin T levels.

Background. Treatment of patients with acute bacterial rhinosinusitis (ABR) is an urgent and unresolved problem: there is a widespread prevalence and increase in the resistance of pathogens due to irrational, repeated courses of antibiotic therapy, especially in cases of mild rhinosinusitis. In this regard, it seems relevant to study the possibilities of alternative treatment, without the use of antibiotics. Objective. Evaluation of the effectiveness of monotherapy with Sinuforte in the treatment of patients with mild acute rhinosinusitis. Methods. The study included 85 patients (49 women, 36 men) aged 18 to 56 years (mean age 34.5±6.2 years) with a diagnosis of mild ABR, confirmed by clinical and anamnestic data and laboratory and instrumental research methods. Depending on the tactics of treatment, the patients were randomized into 2 groups. In the main group, the treatment regimen included the use of Sinuforte, 1 dose (1.3 mg) once a day as an intranasal spray for 7 days. In the comparison group, patients used only irrigation of the nasal cavity in combination with decongestants for 7 days. The effectiveness of the treatment was assessed on 3rd and 7th days and was determined by the degree of decrease in subjective and objective symptoms of ABR according to a 10-point system using a visual analogue scale (VAS), mucociliary clearance rate (saccharin test) and dynamics of the X-ray pattern. Results. According to the results obtained, the severity of subjective and objective symptoms of ABR presented in points on the 7th day was significantly lower in the main group. The dynamics of a decrease in the radiographic signs of rhinosinusitis and an improvement in mucociliary clearance in the main group were similar, which was expressed in the achievement of statistical significance between the groups according to these indicators by the end of the study (p<0.05). Conclusion. The results of the study confirm the high efficacy and safety of monotherapy with Sinuforte in patients with mild ABR compared to the treatment regimen using topical decongestants and irrigation therapy. Such a tactic of treatment is characterized by the absence of undesirable effects and allow to avoid the appointment of antibacterial drugs.

Background. The aging of the population and the increase in the proportion of people in older age groups has become a worldwide trend. For doctors and health professionals, a significant increase in average life expectancy dictates the need to determine treatment tactics for patients of older age groups. Patient management strategy, prognosis for health and life, the need for outside help and care are determined by the identified geriatric syndromes. The occurrence of one geriatric syndrome increases the risk of other geriatric syndromes and, as a consequence, the development of frailty syndrome. Objective. Epidemiological evaluation of the prevalence of geriatric syndromes and age-related diseases in a geriatric hospital using a cross-sectional study. Methods. The study included all patients over 65 years old admitted to a hospital for war veterans, who gave informed consent to participate in the study. Research procedures included interviewing and evaluation of medical records. All participants underwent a comprehensive geriatric assessment (CGA), which included an interdisciplinary examination of physical status, mental health, social relations, satisfaction with the quality of life among the elderly using an individual participant registration card, which included a validated screening questionnaire «Age is not a hindrance» to identify the frailty syndrome. All patients underwent assessment using the Geriatric Depression Scale GDS-15, the Barthel Index for Activities of Daily Living, the Lowton IADL scale, the SPPB and the Mini-Cog tests. Results. The results of the study indicate a wide prevalence of frailty syndrome among patients of a geriatric hospital; it was diagnosed in all patients studied. The most common diseases included osteoarthrosis (100% in the male and female groups) and arterial hypertension (97% among men and 98% among women) in all age groups. Chronic heart failure and stable angina ranked second in prevalence. More than half of men aged 65 and over suffered from prostate diseases (62%). Conclusion. In this study, an analysis of the incidence of geriatric syndromes and age-associated diseases in a geriatric hospital was carried out for the first time in the Russian Federation. The analysis made it possible to state a high frequency of in patients of this category (in 100% of cases). The results of the study show that among all the patients studied with frailty syndrome, the worst results (more than half of the patients did not complete the task) were found in the cognitive sphere. The cardiovascular diseases such as arterial hypertension, stable angina, and chronic heart failure, were the most common diseases. Prostate diseases were common among men, with urinary incontinence - the most troubling among women. The majority of patients in both groups suffered from visual and hearing impairments. The prevalence of diseases and the incidence of syndromes increased with age.

Background. Skin diseases in HIV-infected patients are considered the most common pathology, while in patients without HIV infection, inflammatory dermatoses (IDs) contribute to a significant decrease in the quality of life, the indicators of which can serve as a recommendation for starting treatment. Objective. Assessment of the quality of life indicators of the “physical and mental health” in HIV-positive and HIV-negative patients with IDs. Methods. The 285 patients with IDs were followed-up, among them 150 (52.6%) were HIV-positive (89 (59.3%) patients received antiretroviral therapy [ART], 61 [40.7%] patients were without ART), and the comparison group included 135 (47.4%) patients. There were 83 (55.3%) men in the HIV-infected group, 76 (56.3%) - in the comparison group; there were 67 (44.7%) women among HIV-infected patients, in the comparison group - 59 (43.7%) women. The mean age in the both groups was 27.9 years (minimum - 23 years, maximum - 43). The mean duration of a confirmed diagnosis of inflammatory dermatosis (psoriasis, atopic dermatitis) was 8.2 years (minimum - 1.7 years, maximum - 14 years); in the group of HIV-infected patients, the diagnosis of ID was recorded no later than 7 months before HIV detection; patients in both groups received comparable topical and systemic therapy for dermatoses. The mean duration of HIV infection in patients was 3.8 years (minimum - 1.2 years, maximum - 7 years), the duration of ART averaged 1.8 years (minimum - 1.1 years, maximum - 4.2). Results. In HIV-infected patients with ID, there was a significant decrease in the median PH («physical health») and MH («mental health») of the quality of life compared to HIV-negative patients with ID; a more pronounced decrease in indicators was observed in patients who did not receive treatment for HIV infection. Conclusion. The presence of ID in HIV-positive patients can serve as indication for the urgent administreation of ART.

Background. Cavernous hemangioma of the ethmoidal labyrinth is a vascular malformation, and its removal can lead to intense bleeding from both the anterior and posterior ethmoidal arteries feeding it. In this regard, there are several methods of early surgical devascularization of the tumor, one of which is the transcaruncular approach with the imposition of titanium clips on the anterior and posterior ethmoid arteries, followed by transnasal endoscopic removal of the tumor. Description of the clinical case. The results of surgical treatment of a patient with cavernous hemangioma of the left ethmoidal labyrinth are presented. At the first stage, early devascularization of the tumor by clipping the anterior and posterior ethmoidal arteries through the transcaruncular endoscopic approach was performed, and at the second stage - transnasal endoscopic removal of the cavernous hemangioma. Results. Transorbital endoscopic clipping of ethmoidal arteries made it possible to significantly reduce the intensity of blood flow in the tumor tissue and to perform endoscopic transnasal tumor resection with minimal blood loss. Intraoperative blood loss was 100 ml. There were no complications. Conclusion. Transorbital endoscopic clipping of the anterior and posterior ethmoid arteries is an effective and safe method for early devascularization of cranio-orbital tumors. The technique is promising and requires further development.