Vol 30, No 1/2 (2023)

The nutrition of a newborn child is one of the fundamental factors affecting his subsequent health, psychomotor development, and intellectual potential. At present, there is enough evidence-based research that indicates that mother’s milk, the composition of which cannot be completely replicated, is a unique product for feeding a newborn baby. As the child grows, breastfeeding must be supplemented with complementary foods that differ from breast milk and adapted milk formulas not only in composition, but also in consistency. The timing of the introduction and the sequence of complementary foods for a premature child have not been finally determined, and the heterogeneity of this group requires an individual approach to solving the problem of complementary feeding. This review focuses on studies that can be used to determine the principles of individual introduction of complementary feeding to a premature child, evaluate the effectiveness and avoid certain difficulties and complications.

The formation of mucus in the airways is the first line of defense against microbial agents, allergens, and foreign particles. However, excessive sputum production and difficulty in clearing the airways can lead to many respiratory diseases. Mucoactive substances are drugs that either change the properties of sputum or reduce its production. The article provides a brief overview of common mucoactive agents, as well as current data on the main therapeutic effects of ambroxol.

Constipation is a serious medical and social problem due to the widespread prevalence of this condition, a decrease in the quality of life and social activity of patients. For successful treatment of constipation, it is necessary to establish the causes leading to a violation of the stool in the patient. And this task is a priority for the doctor at the outpatient stage. A common gastroenterological pathology is functional constipation, for which no physiological, anatomical or iatrogenic origin can be identified. Constipation is a delicate problem, with the importance of «delicacy» being inversely proportional to the patient’s age. We conducted an express survey of 30 women aged 23 to 42 years, in which we asked them to rate on a five-point scale (1 – minimum, 5 – maximum) the convenience of using various forms of laxatives and their «delicacy» (lack of direct instructions for others if they have a constipation problem). Mineral water (4.8) and disposable filter bags (herbal tea – 4.0 points) received the highest average score. Next came tablets (3.3 points) and capsules (3.2 points). The least convenient respondents attributed drops (2.1 points) and powders for preparing a solution (1.9 points). The possibilities of natural mineral waters rich in magnesium sulfate in the treatment of constipation are considered. To date, three natural mineral waters rich in magnesium sulfate have been studied in randomized, double-blind, placebo-controlled clinical trials. Comparison of the effectiveness of the three studied mineral waters showed that Donat mineral water is more effective. The results of a randomized clinical trial of Donat Mg mineral water in the treatment of functional constipation, as well as the experience of its use in domestic studies demonstrating the effectiveness and safety of Donat Mg therapeutic mineral water in pediatric practice and in adult patients with functional constipation and other gastroenterological pathology.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, affecting about 25% of the general population and up to 70–90% of obese or diabetic patients. Due to the increasing frequency of cardiometabolic polymorbidity phenotype and the fact that, on the one hand, NAFLD patients often have concomitant cardiovascular pathology and, on the other hand, that patients with cardiovascular disease (CVD) are often diagnosed with concomitant NAFLD, the relationship of NAFLD with CVD is currently subject to active study. Common metabolic risk factors and pathogenetic mechanisms such as systemic inflammation, endothelial dysfunction, lipid and glucose metabolism disorders, and insulin resistance are considered as the main determinants of the relationship between NAFLD and CVD. The involvement of the latter in the development of these diseases suggests that NAFLD and CVD are comorbid conditions, aggravating the course of each other, and, accordingly, the adjustment of lifestyle, risk factors and treatment of NAFLD can reduce the risks of CVD. In this regard, the purpose of this review is to analyze the relationship between NAFLD and CVD, as well as to discuss therapeutic strategies, in particular, the prospects of ursodeoxycholic acid in patients with NAFLD and CVD.

The prevalence of gastroesophageal reflux disease (GERD) in the human population exceeds 20%. Proton pump inhibitors (PPIs) are the main group of drugs for the treatment of this disease. Nevertheless, according data provided, PPI-refractory form of GERD occurs in 28–54.1% of persons suffering from this disease. The results of studies indicate that PPIs are good at stopping typical reflux syndrome, but are often not effective in atypical and extraesophageal manifestations of the disease. The pathogenesis of PPI-refractory GERD is associated predominantly with non-acid refluxes and visceral hypersensitivity. Thus, the administration of alginic acid preparations can be an effective treatment for PPI-refractory GERD. This is due to the fact that alginates are able to bind pepsin and bile acids, limiting their diffusion and reducing the enzymatic activity of pepsin. We demonstrate a clinical case of a patient suffering from PPI-refractory form of GERD, the complete relief of symptoms of which became possible only after the addition of alginate to therapy with rabeprazole in a standard dose.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Over the past 20 years, the global burden of AF and its related complications has significantly increased both worldwide and in Russia. These trends are alarming and suggest that there is a need to reassess current approaches to the prevention and treatment of AF, as well as to explore new therapies. One promising direction in this topic is the study of the relationship between AF and anemia, since, on the one hand, anemia is common in patients with AF and, on the other hand, that anemia is associated with the risk of developing new cases of AF. Hemodynamic, metabolic, and inflammatory pathways, as well as pathways associated with micronutrient and vitamin deficiencies that affect erythropoiesis, are identified as the main mechanisms of the relationship between anemia and AF. In addition, given the increasing incidence of AF and the high prevalence of anemia in this patient population, it is critical for clinical practice to obtain answers not only to the questions of how AF and anemia are related, but also how anemia affects the course of the disease, including the risks of bleeding in AF patients taking anticoagulants, and which anticoagulant is preferable in safety profile in patients with AF and anemia. In this context, this review discusses the specifics of the relationship between AF and anemia in a comprehensive way and also considers a personalized approach to therapy in these patients.

Currently, atrial fibrillation (AF) is one of the most common arrhythmias in clinical practice. The prevalence of this heart rhythm disorder in the population exceeds 2%. Despite the fact that AF is not a life-threatening arrhythmia, it leads to an increased risk of thromboembo- lic complications (TEC). According to the latest recommendations for the treatment of AF, the tactics of managing patients should include three directions, which today are commonly called the ABC rule: A) prescribing anticoagulant therapy to patients with an increased risk of TEC; B) treatment of symptoms of arrhythmia, including a strategy to maintain or maintain sinus rhythm); C) treatment of the underlying disease. The most difficult task in the treatment of patients with paroxysmal or persistent forms of AF is considered to be long-term maintenance of the heart rate. This direction in the treatment of AF includes electrical or pharmacological cardioversion followed by long-term antiarrhythmic therapy or radiofrequency catheter ablation. Among the modern antiarrhythmic drugs (AAPs) used for medical cardioversion in AF, the most popular in Russia are amiodarone and propafenone. The choice of AAD is based on an assessment of the severity of the underlying heart disease and the likelihood of side effects with the introduction of a loading dose of the drug. Thus, antiarrhythmic therapy remains one of the important directions in the treatment of patients with AF. Early prescription of AAD and anticoagulant therapy at an increased risk of TEC, catheter ablation can not only improve the quality of life, but also the prognosis of patients with AF.

Background. A comparative assessment of the effect of therapy with angiotensin-converting enzyme inhibitors (lisinopril, fosinopril or zofenopril) on the structural and functional parameters of the heart and subjective parameters of quality of life (QoL) in patients with essential hypertension (AH) was carried out.

Methods. The study included 120 patients randomly divided into three groups. Patients with arterial hypertension and functional class I and II chronic heart failure with preserved left ventricular ejection fraction underwent echocardiography, 24-hour blood pressure monitoring, treadmill test, 6-minute walk test, determination of the blood plasma N-terminal precursor brain natriuretic peptide level, calculation of glomerular filtration rate, and subjective assessment of QoL using the Minnesota questionnaireat the beginning of therapy and after 24 weeks.

Results. Lisinopril, fosinopril and zofenopril showed comparable sufficient organoprotective, antihypertensive and neuromodulatory activity in hypertensive patients. Significant differences in influence ofthese drugs on exercise tolerance and subjective parameters of patients’ QoL were revealed.

Conclusion. Fosinopril, compared with lisinopril, increased exercise tolerance to a greater extent, improved the subjective parameters of QoL. Fosinopril increased exercise tolerance to a greater extent than zofenopril. Compared to lisinopril, zofenopril improved the subjective parameters of QoL to a greater extent.

The use of coronary angiography as a method for diagnosing coronary lesions in myocardial infarction (MI) in order to determine further management tactics has become widespread in recent years. In case of no significant atherosclerotic changes in the coronary arteries (CA) according to the coronary angiography in a patient with probable clinical and laboratory-instrumental signs of MI, it is necessary to conduct a thorough analysis of clinical and instrumental data in search of the true cause of the existing changes. For such clinical cases, the term myocardial infarction (MI) with non-obstructive coronary arterie (MINOCA) and an algorithm for further diagnostic search are proposed. Myocarditis often occurs under the guise of minoca, but the difficulties of differential diagnosis in practice are associated to the fact that the clinical course of myocarditis is very variable and nonspecific, and with an anginal-like pain syndrome, infarction-like changes in the electrocardiogram and an increase in the cardiospecific enzyme levels, the diagnosis of MI is established. The timely initiation of treatment, the determination of the volume of specialized care for both MI and myocarditis depends on the correct interpretation of complaints, the interpretation of symptoms and data from laboratory and instrumental tests. In addition, a correctly established diagnosis will avoid the prescription of drugs with action often associated with the development of serious complications. The article presents a clinical case of a patient with acute myocarditis, most likely of viral origin (unspecified), occurring under the guise of MINOCA.

The present review considers the possibilities of using nutraceuticals for the prevention, treatment and rehabilitation of patients with seasonal acute respiratory viral infections (ARVI) and influenza, as well as with a new coronavirus infection (NCVI). The first part of the review provides data on the potential of microelements (selenium and zinc) and vitamin C as adjuvant therapy in the complex treatment of patients with ARVI, including those with NCVI COVID-19. The second part of the review discusses the possibility of using selenium, zinc, vitamins A, E, C as a means for non-specific prevention of ARVI, as well as the possibility of their use at the stage of rehabilitation. Frequently ill adults are not uncommon in the practice of an internist and general practitioner. The data presented in the review make it possible to recommend determining the levels of selenium, zinc, vitamins A, C, E in this category of patients, and if their reduced level is detected, it is advisable to consider prescribing vitamin-mineral complexes in order to eliminate the deficiency of the main micronutrients.

Background. Occupational asthma (OA) is an urgent medical and social problem due to the prevalence, severity of the course, the complexity of diagnosis and choice of therapy, and high treatment costs. In the pathogenesis of occupational asthma as a multifactorial disease, several complex interrelated polymorphic genetic and biochemical systems are involved, and individual characteristics of the organism are also should be taken into account, so study and search for informative markers of various forms of OA are relevant. Molecular genotyping opens up new opportunities in the search for a more targeted and personalized approach to the treatment of OA, as well as in the development of an individual strategy for its prevention.

Objective. The study was aimed to the determination of the genetic markers of the risk of developing OA under the exposure to sensitizing substances by assessing TSLP (thymic stromal lymphopoietin) gene polymorphic rs1837253 variants.

Methods. The study was conducted with the participation of 170 patients with different OA phenotypes and 50 people in the control group: the group 1 (42 patients) – «occupational asthma, allergic form» phenotype; group 2 (36 patients) – «occupational asthma, non-allergic form» phenotype; group 3 (58 people) – «occupational asthma – occupational chronic obstructive pulmonary disease (COPD)» phenotype; group 4 (34 patients) – «occupational bronchial asthma – metabolic syndrome» phenotype, group 5 – control group (healthy) – 50 people. As part of the study of genetic predisposition to OA, TSLP genetic rs1837253 polymorphisms were determined. DNA samples were isolated from peripheral venous blood lymphocytes by phenol-chloroform extraction. Genotyping was performed by real-time polymerase chain reaction using primers and probes developed using the PrimerQuest program (Intergrated DNA Technologies, Inc.).

Results. For the first time, genetic markers of OA risk under exposure to sensitizing substances, TSLP gene polymorphic rs1837253 variants were identified, which makes it possible to recommend determining these genetic markers during regular medical examinations in persons working under exposure to sensitizing and irritating substances in the presence of clinical, functional, immunological changes.

Conclusion. The marker OA genotype profiles identified can optimize the approach to the diagnosis, treatment and prevention of this pathology, as well as expand the range of criteria for predicting the course of the disease.

During the global pandemic of the coronavirus infection COVID-19, the epidemiology of these viruses, as shown in the literature, has changed dramatically. In many countries, during normal peak seasons, there has been a significant decrease in the incidence of both influenza and other viral respiratory infections, primarily respiratory syncytial infection. The current situation calls for a revision of the traditional understanding that children are the main driver of seasonal upsurges in respiratory infections. The article summarizes lite-rature data demonstrating the role of the COVID-19 pandemic in changing the seasonality of respiratory viral infections – a decrease in the incidence during the period of anti-epidemic measures, followed by a sharp increase in the number of cases; shift of the peak of incidence to “atypical” months for the given hemisphere. Traditionally, the symptoms of acute respiratory viral infection (ARVI) are characterized by the development of fever-intoxication and catarrhal syndromes. The basis of the treatment of acute respiratory viral infections is non-specific etiotropic and symptomatic therapy recommended for specific symptoms. Since children in the vast majority of cases with ARVI develop such a worrying symptom for parents as fever, symptomatic treatment with the inclusion of paracetamol-based antipyretics is relevant.

Background. Acute otitis media (AOM) is much more common in children than in adults. Predisposing factors for the development of AOM are dysfunction of the auditory tube, formations that cause compression of the Eustachian tube or obstruction of its ostium; abnormal immune response. It was also revealed that laryngopharyngeal reflux (LPR) causes a violation of mucociliary transport.

Description of the clinical case. Patient S., 32 years old. She went to the clinic with complaints of pain in the right ear, congestion of the right ear for 1 week, fever up to 37ºС, without a runny nose, but the patient was worried about dripping down the back of the pharynx and sore throat. When searching for the causes of recurrence of AOM in an adult woman, taking into account the results of an objective examination of the ENT organs, there was a suspicion that she had LPR, which was confirmed by the results of the tests. Local treatment with the use of ear drops with lidocaine and phenazone, which stopped otalgia and inflammation due to the analgesic component and anti-inflammatory action, made it possible to avoid the appointment of systemic antibiotic therapy. Antireflux therapy and the elimination of the consequences of nonspecific inflammation of the nasopharyngeal mucosa around the tubal fold made it possible to avoid the recurrence of AOM in a patient suffering from LPR.

Conclusion. Although the exact causal relationship between LPR and AOM is still unclear and new clinical and experimental studies are needed to study it in both children and adults taking into account acid, weak acid and alkaline refluxes, this cause of eustachian tube dysfunction must be taken into account in adult patients.

Osteoarthritis is the most common joint disease in adults. Statistical data allow to talk about a constant increase in the number of patients suffering from this disease. Despite progress in understanding the pathogenesis of the disease, osteoarthritis remains an incurable pathology. Additional difficulties may arise in the presence of concomitant pathology in a patient, limiting the intake, in particular, of non-steroidal anti-inflammatory drugs. The article presents modern approaches to the treatment of osteoarthritis, as well as clinical observation of a patient with comorbid pathology and the use of a delayed-release drug for its treatment.

Stroke is the leading cause of disability and the second leading cause of death worldwide. The outcome of this condition is influenced by many factors, in particular the age of the patient and the presence of concomitant diseases. With the development of both pharmacological and mechanical thrombolysis, some progress in the treatment of patients with ischemic stroke has been made. Nevertheless, there is a significant need to develop drugs for neuroprotection in acute ischemic stroke in order to protect the brain from damage before and during the recanalization process, extend the “therapeutic window” for intervention, and further improve the functional outcome of the disease. The article discusses the problems in the development of neuroprotective strategies, the mechanisms underlying these strategies, and issues related to the search for new drugs.

Background. Age-associated facial skin changes are not only an aesthetic but also a social problem, especially for women. The key markers of skin aging include a decrease in regenerative potential, impaired barrier function, and loss of elasticity. With age, the proliferative and metabolic activity of dermal fibroblasts decreases, and structural and compositional remodeling of skin extracellular matrix proteins, primarily collagen, occurs. Human placenta hydrolyzate (HPH)-based peptide preparations are currently used for therapeutic purposes in various branches of medicine.

Objective. Comprehensive (clinical-instrumental, immunological, microbiological, immunohistochemical) evaluation of the effectiveness of the use of the HPH preparation for the correction of age-associated facial skin modifications.

Methods. The study included 25 women aged 39 to 59 years with signs of age-related facial skin changes. All women received five pharmacopuncture intramuscular injections of the drug Laennec into the projection of biologically active points of the face 2 ml per procedure 1 time in 5 days.

Results. After a course of five intramuscular injections of the HPH preparation into biologically active points of the face, a significant decrease in the depth of wrinkles in the paraorbital and perioral zones, the degree of deformation of the facial oval, an increase in skin hydration and bactericidal activity was noted. In the peripheral blood, a significant increase in the number of regulatory T-lymphocytes and monocytes was observed with a simultaneous increase in the activity and intensity of phagocytosis of the latter; the concentration of pro-inflammatory IL-6 and -8 decreased with a parallel increase in the IL-4 level. According to the mmunohistochemical analysis of the skin in the dermis, the bulk density of collagen-I and -III, laminin, FGF-2, TGF-β, VEGF, IL-1α, -6, -20 increased most significantly with a simultaneous decrease in PDGF and IL-8; there was an increase in the TGF-β, EGF levels and a decrease in IGF level in the epidermis.

Conclusion. Thus, the HPH preparation activates dermal fibroblasts, supports the renewal and trophism of epidermal cells, and restores the biomechanical and bactericidal properties of aging skin.

Background. Hemolytic-uremic syndrome (HUS) is one of the important causes of acute kidney injury (AKI) in children. An analysis of the literature data demonstrates the central role of endothelial dysfunction (ED) in numerous pathophysiological processes, including in kidney disease. This article discusses the ED indicators (endothelin-1 – ET-1 and nitric oxide – NO) in the blood serum of children with HUS.

Objective. Determination of the clinical diagnostic and prognostic value of ET-1 and NO in blood serum in children with HUS.

Methods. The 2-stage study was carried out. At the first stage of the study, a retrospective analysis of 89 case histories of children aged from 3 months to 17 years with a typical form of HUS (stec-HUS) was carried out. The second stage included a prospective study with participation of 31 children with stec-HUS.

Results. As a result of the determination of the blood serum ET-1 level in patients with stec-HUS in the prospective group, a significant increase in its level in the acute period of the disease and before discharge compared with the data of the control group was revealed (P<0.001); when examined a year later, high blood serum ET-1 level in convalescent children with HUS persisted, which indicates a persistent impairment of the vasomotor function of the vascular endothelium in children with HUS. The results of determination of blood serum NO level in children with stec-HUS, on the contrary, showed a decrease in NO level in the acute stage of the disease and before discharge compared with the control group (P<0.05). When examining convalescent children with-HUS 1 year after, an increase in the blood serum NO level was revealed.

Conclusion. The formation of chronic kidney disease (CKD) after stec-HUS and its progression was accompanied by a significant increase in the ET-1 level and a decrease in the NO level in all studied groups compared with the control group (P<0.05), which indicates a violation of the vasomotor function of the endothelium.

The prevalence of obesity in the world is becoming alarming. Along with aging of the population, pathology of bone metabolism is also a big and often hidden, problem. The detection of obesity and calcium metabolism disorders with bone tissue damage have long be recognized as mutually aggravating factors. In our country, according to scientific research, the vitamin D deficiency has become widespread due to geographical features and climatic conditions. It is more common in obese patients than in those with a normal mass body. The prevalence of osteoporosis among obese patients is not always more pronounced than among patients with normal weight. Apparently, there are some controversial features of the pathogenesis of osteoporosis and obesity. On the one hand, adipose tissue produces a variety of protective substrates, including estrogens, which improves the state of bone tissue. On the other hand, the effect of excess weight on bone mineral density has been established in the form of a higher risk of osteopenia and bone fractures in obese individuals. In our article, we observe the effect of obesity on the state of bone metabolism, vitamin D metabolism and deposition. Due to deposition of the cholecalciferol in adipose tissue, large doses and longer saturation courses are required to correct vitamin D deficiency in overweight patients. Therapy for osteoporosis in obesity has a number of features associated with significant marrow obesity and a static load on brittle bone. In the such case, it is preferable to use the antiresorptive drugs discussed in our article.

Background. The problem of the relationship between self-attitude and self-actualization of medical students is analyzed. For 1st-year students, the desire for the most complete identification and development of personal capabilities is carried out primarily by obtaining information about themselves and a favorable attitude towards themselves; for 4th -year students – by a positive attitude towards themselves, self-confidence and the ability to accept themselves as they really are on the basis of real and deep knowledge about themselves.

Objective. Determination of the dynamics of the relationship between self-attitude and self-actualization of medical students in the process of their education at the university.

Methods. The on-line study was carried out. Study included 530 students of medical universities in Russia, of which 320 were 1st-year students and 210 – 4th-year students. Two diagnostic methods were used: the CAT method (the Russian version of the POI (Personal Orientation Inventory) method, E. Shostrom) and the Self-Attitude Test (V.V. Stolin, S.R. Pantileev). The main research method was the cross-sectional method. Statistical methods included the Mann-Whitney U-test (for unconjugated samples) and the Spearman rank correlation method.

Results. Differences in terms of independence of values and judgments, the ability to express their thoughts and feelings spontaneously and directly, as well as in terms of self-interest and self-accusation were revealed between groups of 1st- and 4th-year medical students. Differences between groups are also manifested in the nature of the relationship between self-actualization and self-attitude of students.

Conclusion. In general, the results of the study indicate the development of the traits of a self-actualizing personality in future doctors in the process of their studies at the university; it was found, however, that many medical students are characterized by a decrease in sensitivity to problems and creativity, which can be attributable to both subjective and objective factors. The revealed dynamics of the relationship between self-attitude and self-actualization of medical students determines the feasibility of organizing special training sessions with students – future doctors, focused on helping them in self-development and self-actualization.