Vol 28, No 2 (2021)

There are theoretical prerequisites for the use of colchicine in the treatment of patients with COVID-19, and clinical studies are underway. To date, there is only limited published data indicating the potential efficacy of colchicine for COVID-19. These data do not yet allow to recommend it for general practice. When using colchicine, it is important to perform clinical and hematologic control and avoid drug interactions.

The development of autoimmune liver diseases (AILDs) is based on disorders in the functioning of the immune system, when autoantigens are perceived as foreign, which can lead to inflammation and destruction of liver tissue. Although the etiology of AILDs is not fully understood, it is most likely that a prerequisite for their development is the interaction of a number of genetic and environmental factors. There are certain haplotypes of human leukocyte antigen (HLA) that increase susceptibility to AILDs. At the same time, the simple presence of risk factors does not guarantee the onset of the disease, just as the presence of certain HLA haplotypes does not always lead to the development of AILDs; the etiopathogenetic relationships are much more complex. Epidemiological and molecular research data indicate that a number of pathogens (including viruses) may be responsible for the induction of AILDs. One of the mechanisms by which viruses can initiate and/or exacerbate AILDs is molecular mimicry, in which a foreign antigen has a common sequence or structural similarity to autoantigens. The review presents data indicating the probable role of hepatotropic viruses in the development of AILDs.

There is growing evidence that increased permeability of the epithelial barrier may be important in the pathogenesis of inflammatory bowel disease (IBD). This review examines the current understanding of the structure of the epithelial barrier and the molecular mechanisms underlying increased intestinal permeability. Particular attention is paid to the structural changes of the tight junctions (TJ) and adhesive junctions (AJ) of the colonic epithelial barrier in IBD patients.

Drug-induced autoimmune hepatitis (DIAIH) is an infrequent but serious complication of pharmacotherapy. It is one of the most severe variants of drug-induced liver damage with a potentially unfavorable prognosis in the natural course. However, if diagnosis and treatment are made in time, the symptoms of this disease completely disappear without relapse and cirrhosis is not formed. At the same time, there are certain difficulties in the diagnosis of DI AIH by practical health professionals due to the low level of awareness about this disease. The purpose of this research is to analyze and systematize data on drugs and on the pathophysiological mechanisms which can potentially lead to the development of DI AIH. Currently, the prevalence of the disease remains unknown, what is largely caused due to the individual reaction to the particular drug. Two types of factors may be important in the development of DI AIH. Those, which are directly related to the features of MP biotransformation in the body and those, which are associated with the individual profile. There are no pathognomonic diagnostic criteria for DIAIH, however, based on its similarity to idiopathic AIH, the most important criteria are: time of symptoms manifestation, rash, arthralgias and/or extrahepatic manifestations, hepatocellular character of increased serum enzyme levels, the presence of autoantibodies, increased levels of immunoglobulins, treatment with drugs that are associated with the DIAIH development, characteristic features of chronic hepatitis in a liver biopsy, rapid response to corticosteroid therapy and the disappearance of symptoms after discontinuation of drugs. The main thing in the treatment of AIH, as well as any DI, is the cancellation of the inducer drug. In some cases, this measure can lead to the disappearance of clinical symptoms and reduction of pathological changes in liver enzymes in the biochemical analysis of blood without additional corticosteroid therapy. In other cases, DIAIH requires prednisone therapy. If there is no effect from glucocorticoids, mofetil mycophenolate, calcineurin inhibitors (cyclosporine and tacrolimus) are considered as reserve drugs.

In this article, we have considered the main clinical, laboratory and instrumental features that allow us to suspect one of the rarest forms of chronic gastritis, autoimmune, in patients with dyspeptic syndrome, using clinical examples. Early and high-quality morphological examination of gastric mucosa biopsies in combination with serological diagnostics become key goals in the diagnostic algorithm for these patients. Progressive atrophy of the gastric mucosa is the context for the formation of neuroendocrine hyperplasia and neuroendocrine tumors of type 1 in patients with chronic inflammation of autoimmune genesis, which causes our increased interest in this problem.

Background. Hemangioma is the most common benign liver neoplasm. In most cases, it is an accidental finding when examining abdominal organs. As a rule, hemangiomas have their own pathognomonic pattern in each type of radiodiagnosis. Sometimes their diagnosis can be difficult. Single-photon emission computed tomography (SPECT) with labeled red blood cells is a fairly accurate, noninvasive, low-cost method for diagnosing this pathology. Objective. Evaluation of the effectiveness of the SPECT with labeled erythrocytes in the diagnosis of hepatic hemangiomas. Methods. The study involved 147 patients (mean age 58±13.9) who underwent SPECT study of the liver in the PET center of Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine in the period from 2011 to 2019. Results. According to the SPECT results, foci of RP hyperfixation described as hemangiomas were determined in 35% of cases; all these patients were diagnosed with hepatic hemangioma in 100% of cases. In 65% of patients, foci of increased accumulation of radiopharmaceuticals (RP) were not identified. Of these, metastatic liver damage was revealed in 40%, and hepatic atypical cysts or abscesses - in 28%. In the remaining 32% of patients, no RP hyperfixation foci were detected during the SPECT study, and based on 6-month follow-up, according to computed tomography or magnetic resonance imaging, diagnosis of hepatic hemangioma was made. Of these, in 67% of cases, the hemangioma size was <10 mm, and in 27% of cases the formations were close to blood vessels. In 6% of cases, atypical forms of hemangiomas were detected. Depending on the size of the formations, sensitivity and specificity indicators were calculated. As a result, the lowest sensitivity and specificity were determined with respect to formations of size <10 mm. The highest values were determined for formations with a size of >20 mm. Conclusion. The SPECT shows high specificity in the detection of hepatic hemangiomas. However, sensitivity varies depending on the size of the formations and their localizations. With size of the formations <10 mm or localization near blood vessels, the sensitivity of the method decreases.

Background. Currently, there is a need to develop new types of drugs for the treatment of patients with Crohn's disease (CD), which would make it possible to achieve rapid induction of clinical remission, reduce the risk of immunogenicity and other side effects, and reduce the number of side effects. Objective. Retrospective assessment of the efficacy and tolerability of therapy with ustekinumab (UST) in patients with moderate-to-severe CD in real clinical practice. Methods. To assess the efficacy and safety of UST, we included in the study 11 patients with CD who received an induction course of therapy with this drug starting from January 2020. There were 18.2% of men, 81.8% of women, mean age was 34,4±6.8 years, disease duration - 8.4±3.2 years. The vast majority of patients (90.9%) received immunosuppressants and glucocorticosteroids. All patients were previously treated with with genetically engineered biological drugs (GIBD). Results. After induction of UST, 10 patients during the first week showed a decrease in the Crohn's disease activity index (CDAI) by more than 100 points. In 6 (54.5%) patients at 6 weeks of therapy, clinical remission according to CDAI was noted, 4 (36.4%) patients achieved clinical response rates, and 1 (9.1%) patient did not show any positive dynamics. In 2 of 6 patients who achieved clinical remission by the 15th week from the start of the UST administration, there was an increase in the stool frequency with type 6 stool consistency according to the Bristol scale. In this regard, it was decided to reduce the intervals between repeated injections of UST from 12 to 8 weeks. After that, the clinical picture of the disease improved. After 12 weeks, clinical remission was achieved in 8 (72.7%) patients, the clinical response persisted in 2 (18.2%) CD patients. Most patients with clinical remission at 12 weeks have also achieved mucosal healing. At week 12, endoscopic examination was performed in 6 patients, 5 (45.4%) of them were diagnosed with endoscopic remission (SES-CD <,4). After 12 weeks, in all patients who responded to UST therapy, CDAI decreased on average from 425.0±49.3 to 128.6±110.6 points, and the Crohn's disease endoscopic activity index - from 7.8±2.4 to 3.2±1.2points. At the same time, the C-reactive protein level decreased on average from 35.1±34.3 to 6.6±3.8 mg/L. Fecal calprotectin level decreased on average from 1382.0±474.2 to 405.0±47.3 pg/g. At the 48th week of the study, 10 patients were examined, 7 (63.6%) of whom had endoscopic remission (SES-CD <,4) and complete healing of lesions of the intestinal mucosa. In 3 patients, complete clinical and endoscopic remission was not achieved, most of them previously received more than 3 GIBDs - 3 anti-TNF-а drugs registered in the Russian Federation for the treatment of CD, and an a4@7 integrin blocker. It should be noted that 10 (90.9%) patients who achieved clinical remission after the induction course of UST, maintained it by 48 weeks of follow-up by the time of completion of the analysis. Conclusion. This clinical observation of a small group of CD patients, as well as previous multicenter studies, demonstrated the high efficiency of UST in induction and maintenance therapy in a cohort of patients with moderate-to-severe CD resistant to disease-modifying agents and GIBD.

Background. The course of small hiatal hernia (SHH) is accompanied by persistent reflux syndrome and the need for long-term administration of drugs, which certainly has a negative effect on the psychoemotional sphere of patients and the sleep-wakefulness pattern. However, this issue has not been studied in detail for patients of this category. Objective. Evaluation of the features of reflux-associated dyssomnias and disorders in the emotional and personality sphere in patients with small hiatal hernias. Methods. Cross-sectional observational (analytic) study with participation of patients with SHH (I-II degrees) and reflux esophagitis (RE) was performed. Endoscopic and X-ray contrast studies of the stomach were performed to diagnose HH and the severity of RE. The emotional and personality sphere and sleep disorders in patients were assessed using the Mini-Mult, TATD questionnaires and the Yu.A. Alexandrovsky sleep disorder scale. Results. With the predominance of gastroesophageal reflux (GER), the dominance of hypochondriacal and depressive tendencies in the emotional sphere was revealed; in cases of duodenogastroesophageal reflux, signs of psychopathy and psychasthenia were dominated. In GER, harmonious and ergopathic types of attitude towards the disease prevailed, and in duodenogastroesophageal reflux (DER) - anxious, hypochondriac and neurasthenic types. Dyssomnia with predominant GER was observed in 76.2% of cases, with DGER - in 30.6%. Presomnic and intrasomnic disorders prevailed, which were more common in GER. The calculated indices of the severity of dyssomnia showed statistically significant differences for all types of sleep disorders, depending on the type of reflux into the esophagus, while the severity of ER did not show such differences. Conclusion. Depressive and hypochondriacal tendencies, anxious, hypochondriac and neurasthenic responses to the disease prevailed in the emotional-personality sphere in patients with SHH, regardless of the type of reflux and the severity of RE. Sleep disorders, regardless of the severity of ER, were characterized by mild to moderate presomnic and intrasomnic disorders, most pronounced when GER dominated.

Background. Wilson’s disease is a rare genetic disease accompanied by impaired copper excretion from the body and excessive accumulation of this micronutrient in tissues. The clinical picture of the disease is very variable, and may be the cause of late diagnosis. Early start of pathogenetic therapy promotes favorable prognosis, satisfactory quality of life of patients and, in some cases, disease regression. Description of the clinical case. Clinical case of Wilson’s disease in 17-year-old patient with pronounced extrahepatic manifestations, development of fulminant hepatic failure and death is presented. Modern criteria of diagnosis of Wilson’s disease are considered, stages of diagnostic search and difficulty in making final diagnosis are described. Conclusion. This case may be of practical interest to the clinicians, because, patients with Wilson’s disease are rarely observed in therapeutic practice, and at the time of their detection, irreversible changes in the liver and central nervous system may already develop. At the same time, timely diagnosis and pathogenetic therapy contribute to stabilizing the process and preserving the lives of patients.

Background. Hyperamilasemia is a laboratory sign, which in most cases serves as a marker of pancreatic diseases of an inflammatory, traumatic, and tumor nature. However, in some cases, the high activity of blood amylase is combined with the normal urine amylase level and is not accompanied by other symptoms. In such cases, there is a suggestion of macroamylasemia. The diagnosis of macroamylasemia is difficult due to the lack of a standardized algorithm, the complexity of its implementation, and discrepancies in the interpretation of laboratory tests. Series of clinical observations. Approaches to the differential diagnosis of various variants of hyperamilasemia are presented using clinical examples. The first clinical example (patient A.), describes the significance of the amylase level in the diagnosis of pancreatic disease. The second clinical observation (patient B.) is a case of long-term asymptomatic hyperamilasemia. After additional examination, type 1 macroamylasemia was diagnosed. The mechanisms of increasing the amylase level in various conditions are described. Conclusion. In patient A., hyperamilasemia was considered as an important diagnostic sign indicating the structural pathology of the pancreas. In patient B., the cause of hyperamilasemia was macroamylasemia - a non-life-threatening biochemical anomaly that requires a detailed examination, broad differential diagnosis, but does not require treatment. This information is important to prevent overdiagnosis of chronic pancreatitis.