Vol 30, No 9/10 (2023)

The article discusses the current possibilities of therapeutic nutrition for children with acute intestinal infections. The authors outline the fundamental approaches to diet therapy, the regimen and nature of nutrition depending on the age of the patient, the pathogenetic mechanism of the development of the disease and the severity of its clinical manifestations. Particular attention is paid to probiotic products that can have a positive effect on the body of a child with acute intestinal infection, both in the acute period and at the rehabilitation stage.

Ulcerative colitis (UC) is a chronic non-specific inflammatory bowel disease that involves the rectum and spreads proximally. According to the extent of the process, proctitis, left-sided and total UC are distinguished, while the distal forms of the disease account for more than half of all detected cases. Mesalazines, the main component of which is 5-aminosalicylic acid (5-ASA), are the drugs of choice for mild-to-moderate forms of the disease. For the implementation of the therapeutic effect of 5-ASA, direct contact with the mucous membrane of the colon or rectum is required, and without appropriate protection, 5-ASA is completely absorbed in the upper gastrointestinal tract. Therefore, when choosing therapy for patients with distal forms of UC, local forms of preparations, such as rectal suppositories, suspension or foam with mesalazine, are optimal. Rectal suppositories are effective for mild-to-moderate proctitis, they are proven to be superior in effectiveness to local forms of glucocorticosteroids. In a more widespread inflammatory process, a rectal suspension with 5-ASA is used, which can reach the right flexure of the colon and have a therapeutic effect. In case of violation of the reservoir capacity of the rectum, for example, with severe inflammation, rectal foam with mesalazine will be an alternative. Due to the fact that 5-ASA preparations are effective and safe, therapy for distal forms of UC begins with their administration; in case of inefficiency or intolerance, it is possible to replace them with topical glucocorticosteroids. With a more widespread inflammatory process, combined therapy with systemic and local aminosalicylates is recommended, which contributes to a faster achievement of remission and its maintenance for a longer period.

The review presents the current problems of the combination of a new coronavirus infection COVID-19 and circulatory diseases. The results of studies on the indicated problem, the complexity of patient management, the combination of viral infection and concomitant pathology of the cardiovascular system are discussed. Data on the features of antiviral therapy in combination with cardiovascular drugs were analyzed. Assessment of the quality of life of patients after coronavirus infection using the Russian version of the “Medical Outcomes Study – Short Forms” questionnaire, will make it possible to clarify the tactics of medical and social rehabilitation of patients in this group.

Plasminogen activator inhibitor-1 (PAI-1) is the main physiological inhibitor of the fibrinolytic system in vivo. The results of modern studies do not allow to form an unambiguous opinion about the degree of influence of the PAI-1 level and its polymorphism (4G/5G, 4G/4G) on the incidence of thrombotic events in the arterial bed. In this regard, the purpose of this review was to compile a general characterization of the properties of PAI-1, as well as to establish the role of its polymorphism in the development of thrombosis, depending on individual physiological and ethnic factors, as well as promising directions in its further study.

To date, the COVID-19 pandemic remains one of the biggest public health challenges in recent memory. At the moment, more than 600 million people around the world have become its victims. SARS-CoV-2 is characterized by multiple organ damage, but the lungs and heart are most involved in the pathological process. Elevated levels of cardiospecific enzymes are common in patients with COVID-19 infection and indicate myocardial damage. Possible mechanisms of myocardial injury include: 1) renin-angiotensin-aldosterone system dysfunction, 2) direct viral damage to the heart, 3) hyperinflammation and «cytokine storm», 4) endothelial dysfunction, hypercoagulation and development of coronary microvascular thrombosis, 5) hypoxemia and hypoxia, due to both respiratory failure and destabilization of coronary plaques and/or mismatch of supply and demand, leading to ischemia/myocardial infarction. The presence of cardiac pathology in patients with COVID-19 has become one of the most significant predictors of an unfavorable prognosis and made it necessary to single out patients with cardiovascular diseases as a separate risk group. In total, cardiac pathology (heart failure) accounts for approximately 40% of all deaths in patients with COVID-19. In the presence of cardiovascular diseases, lethality was more marked in elderly and senile patients, which is associated with a greater prevalence of cardiac pathology, functional disorders of the immune system, as well as with more frequent cardiotoxicity against the background of reduced metabolism during etiotropic therapy for coronavirus infection.

Background. Despite the obvious progress in the diagnosis and treatment of cardiovascular diseases, ST-segment elevation myocardial infarction (STEMI) still occupies a leading position in the structure of mortality and disability in the adult population. Thrombotic complications after percutaneous coronary intervention (PCI) in STEMI may develop despite standard antiplatelet therapy. Genetically determined (GD) causes are one of the main ones. Identification of GD factors in patients with STEMI seems to be important, because may allow timely adjustment of antiplatelet therapy and reduce the likelihood of adverse cardiovascular effects in the perioperative period of PCI.

Objective. Determination of the effect of GD on clinical and laboratory parameters and outcomes in STEMI.

Methods. The study included 46 patients (13 women, 33 men) aged 35 to 83 years, mean age 61.7 years, with STEMI, who underwent PCI in the territory of the infarct-associated artery (IAA). Depending on the presence of GD factors, patients were divided into 2 groups: group I – with the presence of GD factors, group II – with the absence of GD factors. Group I consisted of 21 patients (4 women, 17 men) aged 56.6±2.56 years. Group II consisted of 25 patients (9 women, 16 men) aged 66.0±2.58 years. The study design included laboratory tests (traditional coagulogram, thromboelastometry, aggregometry, pharmacogenetic testing), instrumental studies (ECG, echocardiography) on the 1st, 3rd and 6th days after the patient admission. The following pharmacogenetic markers were determined for all patients: CYP2C19*17, CYP2C19*2, CYP2C19*3, SLCO1B1, CYP3A5*3. The course of the disease and its outcomes were assessed.

Results. There were no intergroup differences in coagulation parameters. The groups did not differ in the severity of coronary injury, according to echocardiography at the time of patient admission and before discharge from the hospital. The duration of hospitalization in group I was 11.1±0.37 days, in group II – 11.0±0.35 days. The duration of stay in the intensive care unit, in the hospital in the groups was the same. A significant relationship was found between the presence of GD factors and the formation of left ventricular (LV) aneurysm, which formed in 19% of patients in group I. In group II, LV aneurysms did not form in any of the cases.

Conclusion. GD factors to P2Y12 receptor antagonists were detected in 46% of patients with STEMI. The presence of GD may be associated with the impossibility of intraoperative achievement of complete restoration of coronary blood flow in the IAA during PCI, as well as with the development of LV aneurysm in the postoperative period.

Cardiac rhythm disturbances are among the most common syndromes in the clinic of internal medicine. The development of arrhythmias is almost always accompanied by a deterioration in the quality of life, and the development of ventricular cardiac arrhythmias increases the risk of a poor prognosis. Propafenone deserves special attention among the many modern antiarrhythmics as one of the most effective and safe drugs. The pharmacodynamics of propafenone allows it to be used as a loading dose when taken orally and used for the relief of paroxysms of atrial fibrillation and a wide range of supraventricular cardiac arrhythmias in outpatient settings by patients independently. To maintain sinus rhythm in patients without severe structural pathology of the heart, both with supraventricular rhythm disturbances and with ventricular extrasystole, propafenone can be used for a long time, without interruptions.

Background. Inflammation, oxidative stress, and an imbalance between proteases and protease inhibitors are recognized pathophysiological features of chronic obstructive pulmonary disease (COPD).

Objective. Determination of the serum levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in patients with COPD and evaluation of their association with the severity of COPD symptoms.

Methods. In a cohort study, serum MMP-9 and TIMP-1 levels, the ratio of MMP-9/TIMP-1 in the peripheral blood of COPD patients and in the control group, as well as their relationship with pulmonary function were determined. Spirometry, symptom severity scale (mMRC and CAT), and history of exacerbations were assessed.

Results. COPD patients (n=96) had significantly higher serum MMP-9 and TIMP-1 levels, higher MMP-9/TIMP-1 ratio than controls (n=40) (P ≤0.001). MMP-9 and MMP-9/TIMP-1 ratio were negatively correlated with FVC, FEV1, FEV1/FVC (P<0.05). COPD GOLD-3-4 patients had higher MMP-9 levels and a greater MMP-9/TIMP-1 ratio compared to COPD GOLD-1-2 patients (P≤0.001).

Conclusion. In patients with COPD, serum MMP-9 and TIMP-1 levels and the MMP-9/TIMP-1 ratio were elevated. In patients with COPD, there was an imbalance between MMP-9 and TIMP-1 in favor of fibrosis, which generally indicates the importance of the MMP-9/TIMP-1 ratio as a potential biomarker for the diagnosis and severity of COPD.

This work was aimed to the comparative assessment of the activity of free-radical lipid oxidation in the body of tuberculosis patients and healthy volunteers. The study involved 76 patients with drug-susceptible and drug-resistant pulmonary tuberculosis (mean age 42.97±15.38 years) and 40 relatively healthy volunteers (mean age 42.45±11.56 years). Venous blood samples were used for the study. Malondialdehyde concentration was determined in blood serum (Costa et al. [2006]); the activity of enzymes of the glutathione system – glutathione peroxidase (Paglia et al., [1967]), glutathione-S-transferase (Habig et al. [1974]), glutathione reductase (Mannervik et al. [1978]) and the concentration of reduced glutathione (Tietze et al. [1969]) – was determined in erythrocyte hemolysate According to the results of our study, in the body of patients with tuberculosis, there is an increase in the intensity of free-radical oxidation against the background of a decrease in antioxidant protection. The intensity of free-radical lipid oxidation and the indices of the glutathione system among patients with drug-sensitive and drug-resistant pulmonary tuberculosis did not differ significantly.

Background: The role of comorbid infections (CI) in rheumatology is still great. Increasingly active use of genetically engineered biological agents (GEBA) and glucocorticosteroids (GCS) exacerbates the existing immunodeficiency.

Objective. Assessment of the the frequency, structure and risk factors for CI in rheumatic diseases.

Methods. A retrospective analysis of the case histories of patients who were hospitalized at the Rheumatology Department of the Republican Hospital named after A.I. V.A. Baranov (Petrozavodsk) in 2018–2022 was performed. All infections that had clinical or laboratory manifestations were taken into account. Statistical analysis of the results obtained was carried out using the Statistica 13.3. Differences were considered statistically significant at p<0.05.

Results: Patients with rheumatoid arthritis [RA] predominated among hospitalized patients (≈40%). From 53 to 80% of patients with RA received GEBA therapy. In the group of patients with RA who received GEBA, viral infections of the respiratory tract predominated. In the group of patients treated with traditional disease-modifying anti-rheumatic drugs (DMARDs), bacterial infections of various localizations had a greater proportion. The relationship between the development of CI and RA activity (p=0.005), as well as GCS therapy at a dose of 7.5 mg/day and more prednisolone equivalent was statistically significant (p=0.016).

Conclusion: The number of CIs in RA was 49.09% of the total number of infections in rheumatic diseases over 5 years; their structure differed depending on the type of DMARD therapy. The identified risk factors for CI included RA activity (P=0.005) and GCS therapy at a dose of 7.5 mg/day and more prednisolone equivalent (P=0.016).

Background. Asthenic syndrome (AS) occurs in the practice of doctors of all specialties, and its frequency and prevalence tend to steadily increase, especially among young and middle-aged population groups. Therapy for AS should be carried out in accordance with the etiological factors and the main clinical manifestations; however, the correction of asthenic manifestations continues to be a complex medical problem.

Objective. Evaluation of the clinical effectiveness and safety of using the phenylpiracetam (Actitropil) in patients with AS.

Methods. An open, observational, prospective, non-comparative, non-randomized study included 50 patients aged 18 to 30 years (mean age 24.7±5.4 years), with clinical manifestations of reactive asthenia lasting from 3 to 6 months. Patients received Actitropil at a dose of 200 mg/day. The duration of therapy was 30 days, the total follow-up period was 60 days.

Results. The results of the study showed the high effectiveness and safety of Actitropil in the treatment of AS. During therapy, by the end of the 1st month of treatment, the severity of AS significantly decreased according to the MFI-20 (from 76.0±5.5 to 58.0±6.2 points; P<0.05) and WAM scales, and psychoemotional state has improved (total HADS score decreased from 16.1±4.7 to 12.2±3.9; P<0.05) as well as and sleep (dynamics on the Spiegel scale from 16.9±2.1 to 20.9 ±2.1; P<0.05). The drug was well tolerated and had no side effects.

Conclusion. Actitropil at a dose of 200 mg/day for a month can be recommended for the treatment of AS, in particular for the correction of clinical manifestations of reactive asthenia in young people as monotherapy.

The review article describes the general characteristics and classification of benzodiazepines, methods of quantitative determination and their area of nitended usage. The effects of benzodiazepines on γ-aminobutyric acid receptors and safety issues are discussed. Information on the pharmacology, metabolism and pharmacogenetics of benzodiazepines is provided. Screening and quantitative methods for determining benzodiazepines, including extraction methods, are presented. In a comparative aspect, the main methods for the quantitative determination of benzodiazepines, enzyme immunoassay and high-performance liquid chromatography with mass spectrometry, are described.

The article presents a literature review on the problem of the use of narcotic analgesics as pharmacological doping by athletes. To date, medical universities have introduced a new general professional competence in the educational program of the academic discipline «Pharmacology» – the ability to counteract the use of doping in sports and the fight against it, which is necessary in their future professional activities. This competence aims to improve the level of anti-doping education of medical students. The article focuses on the pharmacological analysis of the list of illicit drugs on the basis of regulatory documentation, which contributes to the formation of the legal culture of students on the issue of illicit trafficking in doping drugs. The review focuses on the motives for the use of narcotic analgesics by athletes as doping in accordance with the mechanism of action, pharmacodynamics. Side effects of the use of narcotic analgesics have been noted. The information obtained is necessary for students to form anti-doping knowledge, which will contribute to the conduct of sanitary and educational work.

The article focuses on the prevalence and pathogenesis of chronic urticaria, especially spontaneous. Research in these areas has led to significant progress in terms of recommendations for the treatment of pathology. New CIA (Collegium Internationale Allergologicum) data show that the prevalence of chronic urticaria is geographically heterogeneous, high in all age groups, especially in young and middle-aged patients, and there is an upward trend in incidence. Chronic urticaria disrupts performance capability, leads to a deterioration in the quality of life of patients. Several recent studies have clarified and characterized two endotypes of chronic spontaneous urticaria: autoimmune (or autoallergic) type I, driven by IgE to autoallergens, and type IIb, which is caused by autoantibodies targeting mast cells. The aim of studying the pathogenesis of chronic urticaria is development of recommendations for medical practitioners to facilitate and accelerate the diagnosis of chronic urticaria, to be able to control the disease and maintain long-term remission.

Background. After synthetic sling surgery, “de novo” urination disorders often occur, which requires correction. Pollakiuria, urgency and urge urinary incontinence, in various combinations, may require symptomatic therapy for a period of 1–2 months.

Objective. Evaluation of the effectiveness of correction of urinary disorders after trocar synthetic sling (TSS) surgery in the early postoperative period against the background of combination therapy with M-anticholinergic and alpha1-blocker.

Methods. We followed-up 140 women (mean age 55.5 years) who underwent surgical interventions using the Danilov-Volnykh method due to existing stress urinary incontinence. The urodynamic situation was monitored using a non-invasive method of in-home 2–3-day uroflowmetric monitoring. Correction of urinary disorders was carried out by prescribing combination therapy with an M-anticholinergic (Spasmex, Trospium chloride) at a dosage of 15 mg 2 times a day and the alpha1-adrenergic blocker Doxazosin, at a dosage of 1–4 mg with titration. The duration of therapy was 12 weeks.

Results. It was found that both minimum capacities and average volumes increased during therapy. Combination therapy with administration of an alpha1-blocker in this regard looks more attractive, since it will neutralize the decrease in detrusor contractility and, according to the neurophysiological model, improve the clinical picture of urinary disorders. Combination therapy prescribed for a period of up to 3 months had a positive effect.

Conclusion. The occurrence of “de novo” urinary disorders in the early postoperative period is successfully verified using uroflowmetric monitoring, and combination therapy with M-anticholinergic (Spasmex) and alpha1-blocker can successfully and quickly eliminate the resulting urinary disorders.

Background. Ischemic stroke is one of the leading causes of disability in men of working age. Stroke risk factors have gender and age characteristics. Compared with such common risk factors as arterial hypertension, dyslipidemia, atrial fibrillation, diabetes mellitus, etc., the problem of age-related acquired androgen deficiency in patients with stroke has not been studied enough.

Objective. Identification of the prevalence of acquired androgen deficiency and metabolic syndrome as significant risk factors for stroke in men.

Methods. A total of 154 patients (men, mean age – 51.5+7.5 years) with hemispheric ischemic stroke were followed-up. Clinical assessment was carried out using the National Institutes of Health Stroke Scales (NIHSS), modified Rankin Scale, standard international questionnaire “Aging Male Screening”, Beck Depression Inventory; neuroimaging, laboratory and instrumental methods studies were used to confirm the pathogenetic variant of stroke. Statistical analysis was carried out using the “IBM SPSS Statistics version 19” software package, MS Excel 2019 software (Microsoft) and GraphPad InStat3.1 program

Results. At the time of onset of ischemic stroke, clinical symptoms of androgen deficiency according to the AMS questionnaire were observed in almost all examined patients. Moreover, men with moderate (25%) and severe (57.6%) clinical symptoms of acquired androgen deficiency predominated. In the control group of non-stroke men, clinical symptoms of androgen deficiency according to the AMS questionnaire were identified in less than ¼ of the subjects, and symptoms of mild deficiency predominated. Androgen deficiency was detected using laboratory testsin 66.3% of patients. At the same time, with increasing severity of clinical symptoms of androgen deficiency according to the AMS questionnaire, the percentage of laboratory confirmation of the syndrome increased. It should be noted that androgen deficiency in patients with diabetes mellitus was 2 times more common than in patients without diabetes (50%versus 26%).

Conclusion. The results of the study show that androgen deficiency in middle-aged men is included in the structure of the metabolic syndrome along with such components as arterial hypertension, impaired glucose tolerance, dyslipidemia, obesity, which in turn are leading risk factors for ischemic stroke.