Vol 29, No 13 (2022)

Comorbid patients during the novel coronavirus infection (COVID-19) pandemic are the most vulnerable group of the population, in which the risk of adverse outcomes is especially high. The global clinical experience gained during the pandemic in managing patients with COVID-19 indicates the relevance of not only the prevention and management of comorbid patients with COVID-19, but also the importance of curating this category of patients in the rehabilitation period, especially in the post-COVID-syndrome. The first part of the review focuses on the management of comorbid patients with arterial hypertension during a pandemic, considers the relationship between hyperuricemia and COVID-19, and discusses the use of indapamide and nitrendipine in comorbid patients with arterial hypertension. The second part of the review discusses the potential of nutraceuticals in the development of chronic fatigue syndrome as part of the post-COVID-syndrome. It is noted that recommendations on the use of nutraceuticals for non-specific prevention of COVID-19 remain relevant even after recovery, since re-infection with SARS-CoV-2, in particular, with its new strains, is possible. In conclusion, it is noted that the problem of managing comorbid patients in the context of the COVID-19 pandemic is not limited only to the optimal management of comorbid conditions before the development of the disease and in patients with COVID-19, but should be supplemented by the optimal management of comorbid conditions in patients in the rehabilitation period, in particular when development of post-COVID-syndrome, taking into account the preventive (prophylactic) features of drugs and drug safety.

Circadian rhythm disorders, desynchronosis in all its manifestations, including its diagnostics are of interest to scientists in the field of sports medicine, as well as directly to athletes and the entire coaching staff of national teams. This literature review presents domestic and foreign scientific approaches to the study of the basic principles of the work of circadian rhythms in humans, the mechanisms of development and symptoms of desynchronosis, the problems of controlling circadian rhythms in athletes using modern somnological and digital technologies. The use of fitness trackers in athletes and the analysis of the information received is a promising and convenient method requiring attention for further comprehensive study.

Chronic localized scleroderma is a rare disease of the skin and subcutaneous tissue with an unknown etiology and pathogenesis, characterized by a variety of clinical variants. Pathological changes occur in the form of three consecutive stages of erythema or edema, induration and the formation of sclerosis and/or atrophy; however, such staging is not observed in all cases. Localized scleroderma covers a wide range of clinical variants, from solitary skin lesions with minimal discomfort to severe subtypes such as generalized or linear scleroderma. Research on development of a modern classification, clarification of the pathogenesis of the disease and effective methods of therapy is ongoing. Topical glucocorticosteroids are the first-line treatment for localized scleroderma. Ultraviolet A1 (UVA1) phototherapy is used to treat patients with advanced lesions.

Despite the fact that antipsychotic drugs have been known for a long time, the problem of finding new effective drugs really remains relevant. This article summarizes recent advances and failures in clinical trials for new antipsychotics. The Food and Drug Administration recently approved two new antipsychotic drugs USA (FDA). The combination form of olanzapine and samidorphan is intended to mitigate the side effects associated with the use of olanzapine. Another drug is lumateperone, which has the potential to treat patients with severe metabolic side effects. The efficacy and safety of the combined use of xanomeline and trospium in patients with schizophrenia are currently being studied. New indications of existing drugs for the treatment of schizophrenia are also considered.

Background. Currently, quite a lot of patients with osteoarthritis (OA) have a history of arterial hypertension (AH). This phenomenon makes it necessary to analyze the effect of AH on the clinical parameters of patients with OA. Objective. Evaluation of the dependence of clinical parameters in patients with OA on the presence of AH. Methods. 30 patients with a reliable diagnosis of OA, divided into 2 groups - with the presence of AH (n=17) and without increased blood pressure (n=13) - were examined. The mean age of the patients was 66.6±6.9, the duration of the disease was 7.9±5.8 years. Anthropometric parameters, anamnestic data, joint pain according to the visual analogue scale (VAS), and the presence of concomitant diseases were assessed. The analysis of the health status of patients with OA was carried out using the EQ-5D questionnaire. Results. AH was diagnosed in 56.7% of patients with OA. The study groups did not differ in age significantly. In the group of patients with AH, the duration of the OA was longer (10.1±6.7) than in the group without it (5.4±2.6) (P<0.05). In patients with OA, a significant relationship between taking chondroprotectors and an increase in blood pressure was found (P=0.024). In the group of patients with OA without AH, significantly more patients had a more favorable variant of the articular syndrome, stage I of the disease (P=0.009). Pain according to VAS did not differ statistically, moderate intensity of pain prevailed. According to the results of the EQ-5D questionnaire, the level of quality of life (physical and mental health) was significantly lower in patients with AH than in the control group by all parameters. Conclusion. Patients with OA and elevated blood pressure have worse clinical and functional parameters than those without arterial hypertension. Quality of life indicators in patients with OA and AH are significantly lower than in patients with OA without AH.

Background. The growing aging of the population creates the need for research to assess the tactics and effectiveness of providing care to patients of older age groups, the dynamics of prescribed therapy at all stages of myocardial infarction (MI) and in the late postinfarction period. Objective. Evaluation of the drug therapy in elderly patients with MI as part of an observational study. Methods. A retrospective-prospective observational study (follow-up period - 12 months) included 92 patients with myocardial infarction aged 75 to 93 years. Primary end point: in-hospital death at 3 months and 1 year. Secondary end points: hospitalization, bleeding, stroke, acute coronary syndrome, decompensation of chronic heart failure, the proportion of patients continuing to take cardiac drugs at 3 and 12 months. Results. Most patients had a set of different risk factors and concomitant cardiovascular diseases, however, the frequency of prescribing cardiac drugs did not correspond to them before the present MI (43.5% took the renin-angiotensin system (RAAS) inhibitors, 33.7% -в-blockers (BB), 30.4% - statins, and 46.7% - antiplatelet agents). The rate of coronary revascularization was 30.4%. During hospitalization, the proportion of patients receiving RAAS inhibitors increased to 76% (P=0.000), BB - up to 88% (P=0.000), diuretics - up to 51.1% (P=0.000), mineralocorticoid receptor antagonists - up to 15.2 %, statins - up to 100% (P=0.000), antiplatelet agents - up to 98.9% (P=0.000). The use of STOPP/START criteria revealed that 31.5% of patients were prescribed potentially non-recommended drugs, and 40.2% had a potential omission in prescribing drugs. Three months after MI, there was a decrease in the proportion of patients taking life-saving drugs, and this trend continued until the end of the year. 12 months after inclusion in the study, 16.3% of patients died. The main complications, including fatal ones, were associated with repeated ischemic events (29.3% of cases) or bleeding (4.3%). Conclusion. Frequent prescription of potentially non-recommended drugs can cause adverse reactions, and insufficient use of vital drugs, which is especially noticeable in the post-infarction period, increases the risk of adverse clinical outcomes for elderly patients with myocardial infarction.

Background. The problem of sialorrhea treatment in amyotrophic lateral sclerosis remains relevant due to the fact that the symptom significantly worsens the quality of life of patients, is not always immediately treatable, requires selection of therapy and is dangerous -saliva aspiration can cause pneumonia, which is fatal in 50% of cases. Clinical trials for treatments for sialorrhea are few. In the present work, an attempt to study the effect of the entire spectrum of possible drugs for the treatment of this symptom in amyotrophic lateral sclerosis (ALS) was made for the first time. Objective. Comparative assessment of the efficacy and safety of the use of various pharmacological forms of anticholinergic drugs and botulinum therapy in the treatment of sialorrhea in ALS. Methods. 70 ALS patients with bulbar disorders and sialorrhea (30 men, 40 women, age from 39 to 74 years, mean age 55±10.9 years, 55 bulbar onsets, 15 spinal onsets) were examined and consistently included in various therapeutic groups. Efficacy and safety of botulinum therapy (Dysport 250 IU in combination with amitriptyline 25 mg and Dysport 500 IU) and various pharmacological forms of anticholinergics (drops of atropine sulfate alone and in combination with a solution of ipratropium bromide 0.25 mg/ml, amitriptyline 25 mg at night separately and in combination with atropine and ipratropium bromide, Scopoderm patch, hyoscine butylbromide - Buscopan 40 mg/day) were evaluated. An objective assessment was carried out by saliva gravimetry before, 3 days (for Dysport) and 3 months after treatment for all drugs in parallel with the assessment of cognitive functions (Montreal Scale) and emotional-volitional disorders (FTD - Frontotemporal Dysfunction Scale). Results. Anticholinergic cocktail of atropine, ipratropium bromide and amitriptyline did not significantly affect sialorrhea (2.09±1.3 and 1.24±0.84 ml/5 min; P=0.083), but significantly and reversibly worsened cognitive functions (23.1±2.4, 18.1±1.4 and 21±2.1 points; P<0.05), whereas, when administered separately, these drugs did not have a significant effect on either sialorrhea or cognitive functions, as well as the selective peripheral anticholinergic hyoscine butylbromide (1.79±1.26 and 0.87±0.57 ml/5 min; P=0.061). Scopoderm patch effectively reduced sialorrhea (2.14±1.2 and 0.63±0.25 ml/5 min; P=0.03), but reversibly worsened cognitive functions (25.9±1.9, 17.3±2.1 and23.3±1.9points, P=0.03). The combination of Dysport 250 U and amitriptyline 25 mg effectively reduced sialorrhea (2.45±1.39 and 1.19±0.99 ml/5 min; P=0.048) and did not affect cognitive functions, while not adversely affecting the speech of patients. At the same time, an effective decrease in sialorrhea with Dysport at a dose of 500 IU (2.69±0.76 and 1.37±0.42 ml/5 min; P=0.02) was accompanied by an acceleration of the onset of anarthria in ALS patients with dysarthria (82±22 and 36±6 days; P=0.019), however, in ALS patients with anarthria, it was absolutely effective and safe.

Background. It is commonly known that elevated blood serum uric acid (UA) levels is the cause of a number of chronic diseases, such as gout, as well as osteoarthritis and uric acid nephritis. As a rule, prolonged hyperuricemia is accompanied by severe skin manifestations, such as pruritus, erythema, and hypersensitivity. However, the use of drugs to correct hyperuricemia, obviously, does not solve this problem. However, as known, a number of plant extracts effectively enhance the UA clearance, helping to reduce its concentration in blood serum and tissues. Objective. Evaluation of the effectiveness of the herbal composition on the blood serum UA level in patients with initially elevated UA levels. Methods. The study involved patients with elevated serum UA levels (more than 350 pmol/l in women and 415 pmol/l in men). A total of 109 patients aged 45-65 years were examined, including 47 men (Group 1) and 62 women (Group 2). Patients kept a routine diet during the study. A plant composition consisting of micronized leaves of meadowsweet (Filipindula ulmbria) and white birch (Bitula), as well as aspen bark (Pupulus tremula), was used per os at a dose of 500 mg for 30 days. Results. Taking this herbal composition for a month made it possible to significantly reduce the UA level both in men and women. Characteristically, this effect persisted 1 month after the end of treatment. Simultaneously with the decrease in UA level, there were positive significant changes in triglyceride and blood sugar levels in patients with initial hypertriglyceridemia and hyperglycemia. Almost 90% of patients indicated the disappearance of such manifestations as itching, erythema and hypersensitivity, 55% - a decrease in the size of tophi. The effect was observed regardless of the location and extent of skin changes. Conclusion. A plant composition based on meadowsweet (Filipindula ulmbria), white birch (Bitula) and aspen (Pуpulus tremula) can be recommended for use as a component of functional nutrition or as an independent herbal preparation in patients with elevated UA levels, metabolic syndrome and gout.

Background. The introduction of chemicals into various types of industry, everyday life, crop production and science provides a background for the development of methemoglobinemia. As a preparation capable of restoring cell metabolism under conditions of hypoxia, we offer the blood substitute rheoambrasol with antihypoxic, antioxidant and detoxification efficacy, developed at the Republican Specialized Scientific and Practical Medical Center for Hematology of the Ministry of Health of the Republic of Uzbekistan. Objective. Evaluation of the effect of rheoambrasol on the indicators of endogenous intoxication in nitrite-induced methemoglobinemia. Methods. Toxic methemoglobinemia in rats was created by daily administration of sodium nitrite at a dose of 50 mg/kg for 30 days. During the setting of the model of methemoglobinemia, the methemoglobin (metHb) level was determined one hour after the administration of sodium nitrite, on the 3rd, 15th and 30th days. On the 30th day after the reproduction of methemoglobinemia, rats were treated with blood substitutes at a dose of 10 ml/kg for 5 days: new blood substitute rheoambrasol in the experimental group and rheopolyglucin in the comparison group. Indicators of endogenous intoxication were determined during the experiment. Results. The study showed that the use of rheoambrasol effectively reduces the metHb level and restores the indicators of endogenous intoxication in experimental methemoglobinemia to the initial values. Compared with the results after the use of rheopolyglucin, one hour after the administration of the new blood substitute rheoambrasol, the sorption capacity of erythrocytes (SCE) was lower by 28.9% (p<0.05), plasma middle molecules (MMpl) - by 29.0% (p<0.05), plasma oligopeptides (OPpl) - by 20.6% (p<0.05), middle molecules (MMer) - by 22.5% (p<0.01), erythrocyte oligopeptides (OPer) - by 25.5% (p<0.01), plasma toxemia index(TIpl) - by 43.6% (p<0,01), erythrocyte toxemia index (Tier) - by 41.8% (p<0.01), intoxication index (II) - by 42.8% (p<0.01), MMpl/MMer - by 8.4% (p<0.05). Conclusions. The new blood substitute rheoambrasol restores metHb level in long-term nitrite-induced methemoglobinemia. Reoambrasol has a pronounced detoxification effect, which manifested itself in a decrease in endogenous intoxication with prolonged nitrite-induced methemoglobinemia and indicators of endogenous intoxication were restored almost to the initial level.

The prevalence of speech disorders in stroke patients reaches 15-50%. The speech process is provided by the cortical-subcortical dominant neural system surrounding the lateral sulcus in the dominant hemisphere. Focal changes in this neural network cause characteristic syndromes of speech disorders. The development of strategies aimed at improving the effectiveness of the treatment of post-stroke speech disorders is extremely important in achieving partial or complete functional independence of patients, restoring the quality of life, returning to work, and also in preventing subsequent cognitive decline. The main goal of the pharmacological treatment of post-stroke aphasia includes the stimulation of neuroplasticity processes by modulating the activity of neurotransmitter systems. The use of memantine in combination with the available neurorehabilitation techniques can increase the effectiveness of the treatment of post-stroke aphasia, reduce the number of patients disabled due to speech disorders, improve their quality of life and long-term prognosis.

Recently, indisputable evidence that it is really possible to change the long-term outcomes of rheumatoid arthritis (RA) only at the debut stage of the disease has been obtained. Therefore, the early stage of RA, which is a major medical and social problem, attracts the greatest attention of researchers around the world. The Treat to target (T2T) strategy currently remains the most relevant approach for previously untreated patients with early RA. Early therapy with methotrexate in combination with glucocorticosteroids serves as the basis for T2T. It is emphasized that, despite the potential advantages in efficacy and tolerability, new treatments for RA may be less safe and much more expensive.

Background. Myofascial pain syndrome (MPS) is the most common pathology in the structure of musculoskeletal pain and accounts for 85-90%. The development of MPS is associated with overstrain and microtraumatization of the muscles, followed by the development of the inflammatory process, the release of excess acetylcholine, which promotes muscle contraction. In addition, hyperplasia of connective tissue fibers occurs, the number of nociceptors in muscle fascia increases, local blood flow is disturbed, which ultimately leads to ischemia of muscle tissue areas, increased muscle tone, shortening of muscle fibers, and pain syndrome. Description of the clinical case. The article presents a clinical case illustrating the effectiveness of an integrated approach in the treatment of a patient with MPS. The clinical manifestations of MPS, approaches to diagnosis and methods of treatment are discussed. Conclusion. The possibilities of muscle relaxants (tolperisone) in correcting muscle spasm and reducing pain in myofascial syndrome have been demonstrated.

Background. In recent years, metabolic or cytoprotective agents have been actively studied, which can increase the efficiency of oxygen utilization by the myocardium under ischemia without affecting hemodynamic parameters. The trimetazidine is most studied in this group of drugs, which is reflected in the clinical guidelines for the treatment of coronary pathology and heart failure. The frequent combination of coronary artery disease (CAD) with comorbid pathology makes it relevant to study the use of trimetazidine in such patients. Description of the clinical case. The 57-year-old man had been suffering from coronary artery disease, arterial hypertension, type 2 diabetes mellitus, and gout for a long time. In 2009, CAD was verified and coronary artery bypass grafting was performed. The reason for contacting a cardiologist was the deterioration of health in the form of shortness of breath that occurs with severe physical exertion against the background of drug therapy. Echocardiography revealed concentric left ventricle hypertrophy and 1 degree left ventricle diastolic dysfunction without increasing filling pressure with normal ejection fraction. Stress echocardiography with treadmill test verified painless myocardial ischemia. Against the background of 3-month combined anti-ischemic therapy, which included bisoprolol and trimetazidine, clinical improvement and an anti-ischemic effect were noted according to repeated stress echocardiography. Conclusion. Thus, the use of trimetazidine in the complex therapy of coronary artery disease in the presence of comorbid cardiovascular pathology and metabolic disorders can both help potentiate the antianginal effect and have a positive effect on the course of heart failure.