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Volume 30, Nº 14 (2023)
- Ano: 2023
- Artigos: 24
- URL: https://journals.eco-vector.com/2073-4034/issue/view/8454
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News of Medicine
News of medicine
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Pediatria
Rimantadine in combination with sodium alginate as a means of treatment and prevention of acute respiratory viral infections of various etiologies in infants and preschool children
Resumo
Background. The annual seasonal rise in the incidence of acute respiratory viral infections (ARVI) begins in September with maximum incidence rate among infants and preschool children. In November-December, influenza begins to dominate, first in the form of local outbreaks, and then an epidemic rise in incidence of varying intensity. In the fall of 2021, against the backdrop of the ongoing incidence of COVID-19, influenza viruses returned to epidemic circulation both in the world and in Russia, causing in 2022 –2023 increase in influenza activity, first caused mainly by the influenza A(H1N1)pdm09 virus, and then by influenza B.
Objective. Summarizing the results of evaluation of the therapeutic and preventive efficacy of rimantadine + sodium alginate for ARVI of various etiologies in infants and preschool children.
Methods. The therapeutic efficacy of rimantadine + sodium alginate was studied in 808 children hospitalized on days 1–2 of acute respiratory viral infection with a proven etiology of the disease. The latter was established by detecting pathogen antigens in material from the nasal passages and nasopharynx of patients using the polymerase chain reaction or immunofluorescence express method, followed (after 2–3 days and before discharge) by determining their persistence or the appearance of new pathogens, as well as serologically in paired blood sera: in complement fixation reactions, hemagglutination inhibition and enzyme immunoassay with a wide range of antigens. The preventive effectiveness of the drug was studied during 6 outbreaks of ARVI in 269 children from 3 orphanages: 134 children received the drug, 135 were included in the comparison group.
Conclusion. Clinical and epidemiological observations have shown that the polymer drug, consisted of a complex derivative of rimantadine and modified sodium alginate from seaweed in sugar syrup, has statistically significantly proven therapeutic and preventive efficacy in ARVI of any etiology in children aged 1–7 years.
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Possibility of using a combination of interferon alpha-2b and a complex immunoglobulin drug for infectious diseases in children
Resumo
Combination of interferon alpha-2b and a complex immunoglobulin preparation containing antibodies to a wide range of infections. The use of the drug in acute infectious diseases in addition to standard therapy accelerates the recovery of patients. Prophylactic use of a combination of interferon alfa-2b and a complex immunoglobulin preparation at the stage of clinical remission reduces the frequency and duration of symptoms in frequently ill children.
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Bronchiolitis in children: a series of clinical examples
Resumo
The article is devoted to a pressing pediatric problem – the development of bronchiolitis in childhood. The study presents a series of clinical observations describing the clinical heterogeneity of bronchiolitis in terms of age, taking into account the variability of clinical symptoms, etiological factors and therapy. During the observation, clinical and laboratory differences in the course of acute bronchiolitis in children depending on age were determined. In the younger age group, the clinical picture was characterized by a pronounced intoxication syndrome, a moderate or severe course of the disease, a long hospital stay (14.3±4.2 days), and the inclusion of systemic glucocorticosteroids in the treatment complex. Among the etiologically significant factors, the RS virus and rhinovirus dominated.
In the older age group, disease was characterized by the absent of intoxication syndrome, with mild respiratory failure, and the duration of hospitalization was 7.2±2.4 days. According to computed tomography data, typical manifestations of acute bronchiolitis were observed in the form of areas of “ground glass”, areas of mosaic oligemia with centrilobular nodules (sign of “tree in bud”), and when assessing the respiratory function, an obstructive-restrictive type of disorders was determined.
The course of bronchiolitis obliterans in the examined patient was favorable with rare exacerbations of the bronchopulmonary process, no progression of respiratory failure, and maintenance of normal growth rates and physical development.
Interstitial lymphocytic lung disease in the form of follicular bronchiolitis was diagnosed in one child with primary immunodeficiency ataxia-telangiectasia (Louis-Bar syndrome).
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Gastroenterology/hepatology
Disturbances of the gut microbiota and their correction in patients with oxalate nephrolithiasis
Resumo
The complex of microorganisms found in the intestine (gut microbiota) influences the pathogenesis of a number of diseases. There are theories that gastrointestinal diseases increase the risk of development and recurrence of urolithiasis. Current evidence presented in this article demonstrates a link between gut microbiota, particularly Oxalobacter formigenes, and the formation of oxalate kidney stones. The connection between inflammatory bowel diseases and the use of antimicrobial drugs with oxalate homeostasis is shown, and ways of correcting the gut microbiota in patients with urolithiasis using diet therapy, probiotics, and fecal microbiota transplantation are analyzed. The article presents research results demonstrating that correction of the gut microbiota can be a therapeutic goal and may become an important component of the complex treatment of nephrolithiasis.
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Antibiotic-associated diarrhea: potentials for the use of synbiotics
Resumo
Gastrointestinal disorders are the most common adverse drug reactions that occur during antibiotic therapy, often with the development of antibiotic-associated diarrhea (AAD). Antibiotics are believed to be the direct cause of one in four cases of drug-induced diarrhea. The first part of the review briefly provides basic information about the etiology, pathogenesis and clinical forms of AAD. The second part discusses the issues of normalization of intestinal microbiocenosis as an important aspect of the treatment and prevention of AAD. The effectiveness of probiotic strains increases when used together with prebiotics. The properties and capabilities of probiotic strains Bifidumbacterium lactis B l-04; Lactobacillus acidophilus La-14, Lactobacillus rhamnosus Lr-32, andtheir combination with the prebiotic inulin and B vitamins are discussed. The results of clinical studies of the synbiotic Floriosis, demonstrating its effectiveness and safety in restoring a balanced intestinal microbiota are presented.
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Upper gastrointestinal involvement in Crohn’s disease
Resumo
Manifestations of inflammatory bowel disease in the upper gastrointestinal tract are often hidden behind the classic symptoms of ileal and colon lesions and are observed in only 0.5–4% of adult patients. However, due to the improvement of endoscopic methods and the more frequent use of esophagogastroduodenoscopy with biopsy, both asymptomatic and clinically significant manifestations of the esophageal, gastric and duodenal lesions are increasingly being detected. The diagnosis of inflammatory bowel disease affecting the upper gastrointestinal tract should ideally be based on a combination of clinical history, endoscopic and histological findings. Although endoscopic changes such as aphthoid or longitudinal ulcers and a bamboo-joint-like appearance are suggestive of Crohn’s disease, histologic examination increases the sensitivity of the diagnosis because histologic changes may be present in endoscopically normal mucosa. Conversely, in many cases the histological findings are nonspecific and knowledge of the clinical history is essential to making an accurate diagnosis. This article discusses the most important clinical, endoscopic and histological features of Crohn’s disease affecting the esophagus, stomach and duodenum.
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Features of the use of genetic engineering biological drugs in the treatment of patients with Crohn’s disease
Resumo
Background. Genetically engineered biological drugs (GEBDs) have now become the drugs of choice for the treatment of inflammatory bowel diseases (IBD) and have been successfully used since their discovery. This is due to their ability to effectively influence both the IBD pathogenetic mechanisms and symptoms. For the effective and safe use of biological drugs, it is necessary to comply with the indications and rules for their use, and irrational prescription and use of biological drugs can lead to side effects.
Description of a series of clinical cases. The article presents a clinical case of a complicated course of Crohn’s disease (CD) in a young patient, reflects the features of diagnosis and course, and treatment tactics for CD. The problem of loss of response to biological therapy and management features are revealed.
Conclusion. The ability to provide timely and high-tech medical care using modern physical therapy makes it possible to avoid the development of surgical complications for a long time and slow down the progression of IBD.
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Cardiology
Therapeutic horizons of indirect oral anticoagulants
Resumo
The review article is devoted to summarizing the data on the use of indirect oral anticoagulants (IOACs). A broad therapeutic platform for preventing thrombotic complications using drugs of this group is shown. The prospects for the use of IOACs in patients with new coronavirus infection are indicated. A promising domestic drug of this group has been named, which, among well-known competitors such as rivaroxaban, apixaban, edoxaban and betrixaban, shows one of the lowest concentrations required to double prothrombin time, which researchers associate with tight binding between the ligand-drug and the amino acids Gly216 and Gly218 target protein.
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On the issue of improving the safety of antithrombotic therapy in patients with atrial fibrillation and coronary heart disease receiving antithrombotic therapy
Resumo
Today, the burden of atrial fibrillation (AF) and coronary heart disease (CHD) increases with increasing life expectancy. For patients with a combination of these diseases, in certain clinical situations, combination therapy with anticoagulant and antiplatelet drugs is indicated, which increases the risk of adverse events and complications, in particular gastrointestinal bleeding (GIB). To reduce the risk of complications from the gastrointestinal tract, it is recommended to identify modifiable and non-modifiable risk factors, as well as prescribe gastroprotective therapy to protect the mucous membrane of the gastrointestinal tract. Considering the peculiarities of the mechanism of action, pharmacokinetics and pharmacodynamics, the gastroprotective drug rebamipide has both high safety and significant effectiveness due to multiple pleiotropic actions (changes in the structure of tight junctions of mucosal enterocytes, stimulation of mucin formation, acceleration of cell regeneration, etc.). In real clinical practice, according to our studies, a significant number of patients did not have gastroprotective therapy or only monotherapy with proton pump inhibitors (PPIs), which indicates the need to increase the awareness of practicing physicians about methods of reducing the risk of gastrointestinal complications in patients with AF and CHD. In summary, prevention of gastrointestinal and gastrointestinal mucosal damage is critical for long-term antithrombotic therapy in cardiac patients.
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Analysis of the structure of comorbidities and pharmacotherapy in patients with a combination of atrial fibrillation and coronary heart disease
Resumo
Background. Atrial fibrillation (AF) and coronary heart disease (CHD) mutually worsen the course and prognosis of each other, especially in the presence of a history of previous myocardial infarction. Such a combination of diseases is more common in elderly and senile patients, which requires special control of pharmacotherapy due to the high prevalence of polypharmacia.
Objective. Analysis of the structure of comorbidities and compliance of prescribed pharmacotherapy with STOPP/START criteria in hospitalized patients ≥65 years old with a combination of AF and CHD, depending on the presence of previous myocardial infarction. Methods. We conducted a retrospective analysis of the medical histories of 342 patients ≥65 years old with a combination of AF and CHD who were treated in the cardiology department of a multidisciplinary hospital in Moscow, and divided them into groups: group 1 – 214 patients, median age 85 (78–90) years without history of previous myocardial infarction and a group 2 – 128 patients, median age 85.5 (78–90) years with a history of previous myocardial infarction. The comparative analysis of the structure of multimorbidity and pharmacotherapy according to STOP/START criteria was carried out.
RESULTS. In the second group, the score on the CHA2DS2-VASc (p<0.001), the value of the Charlson comorbidity index (p<0.001), and the number of maximally prescribed drugs at the same time (p=0.002) were significantly higher. Among the comorbidities in patients with a history of previous myocardial infarction, there were chronic heart failure of functional class IV according to the New York Heart Association (NYHA) classification (p=0.006), type 2 diabetes mellitus (p=0.005), stage 3b chronic kidney disease (p=0.019) more common. START criteria were more common than STOPP criteria, and we also found two START criteria with significant differences in frequency between groups.
Conclusions. The data obtained requires more careful selection of medicines in elderly patients. STOPP/START criteria can be recommended to use to select the optimal treatment strategy.
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Analysis of the frequency of CYP2C9, AGTR1, AGT, ACE, CYP11B2 gene Polymorphisms occurrence in patients with newly diagnosed 1–2 degree arterial hypertension
Resumo
Background. The lack of clinical effectiveness of pharmacotherapy for arterial hypertension (AH) may be associated with interindividual genetic variability. The most relevant is the identification of genetic polymorphisms in the genes of key factors regulating the cardiovascular system associated with the functioning of the renin-angiotensin-aldosterone system (RAAS): genes encoding angiotensin-converting enzyme (ACE), angiotensinogen, receptors for angiotensin II type 1, aldosterone synthetase, and also in the gene for the enzyme CYP2C9, one of the main enzymes in the metabolism of angiotensin II receptor blockers (ARBs).
Objective. Determination of the frequency of occurrence of polymorphic variants of the CYP2C9*2 (Arg144Cys) and CYP2C9*3 (Ile359Leu), AGTR1 (A1166C), AGT (M235T), ACE (I/D polymorphism), CYP11B2 (C-344T) genes and combinations of risk alleles in patients with newly diagnosed 1–2 degree AH followed-up in a Moscow clinic.
Methods. The study included 179 patients with newly diagnosed 1-2 degree AH, 141 (78.8%) women and 38 (21.2%) men aged 32 to 69 years (mean age – 58.2± 6.4 years). In patients with newly diagnosed 1–2 degree AH, permanently residing in Moscow, allelic variants of the CYP2C9*2 (Arg144Cys) and CYP2C9*3 (Ile359Leu), AGTR1 (A1166C), AGT (M235T), ACE (I/D polymorphism), CYP11B2 (C-344T) genes were analyzed using molecular genetic analysis.
Results: The frequency distribution of genotypes for the CYP2C9*2 gene was as follows: genotype *1*1 was determined in 141 (78.8%) patients, heterozygous genotype for the risk allele *1*2 in 34 (19%), homozygous *2* 2 – in 4 (2.2%) patients. The distribution of genotypes for the CYP2C9*3 genetic polymorphism was as follows: genotype *1*1 was detected in 146 (81.6%) patients, heterozygous for the nonfunctional allele *1*3 – in 33 (18.4%) patients; patients homozygous for the risk allele of the CYP2C9*3 gene were not identified. The distribution of patient genotypes according to the genetic polymorphism A1166C of the AGTR1 gene is as follows: the AA genotype was determined in 85 (47.5%) patients, the AC genotype in 80 (44.7%) patients, the CC genotype in 14 (7.8%). As a result of molecular genetic analysis of single nucleotide M235T polymorphism of the AGT gene, the following distribution of genotypes was obtained: 36 (20.1%) patients were carriers of the CC genotype, the CT genotype was determined in 98 (54.7%) patients, and the TT genotype was determined in 45 ( 25.1%). According to the data obtained, the carrier frequency of the risk allele D for the I/D polymorphism of the ACE gene was 48.3%, while 45 (25.1%) patients were homozygous for this allele and carriers of the DD genotype, and heterozygous representatives of the ID genotype – 83 (46.4%) patients. The frequency distribution of genotypes for the polymorphism of the aldosterone synthetase gene CYP11B2 (C-344T) was obtained as follows: the CC genotype was determined in 38 (21.2%) patients, the CT genotype in 90 (50.3%) patients and the TT genotype in 51 (28.5%).
Conclusion. There were no statistically significant deviations in the observed frequency of genotypes from the theoretical one determined by the Hardy–Weinberg equilibrium, which indicates this group of patients is in genetic equilibrium and the possibility of extrapolating the study results to the population. In 16.2% of this sample of patients, a combination of risk alleles was determined for all genes studied affecting the pharmacodynamics of RAAS inhibitors, key factors in the regulation of the cardiovascular system. In 6.1% of patients in this sample, carriers of risk alleles for CYP29*2 and pharmacodynamic genes AGT, ACE, CYP11B2 were determined, 4.5% of patients were carriers of risk alleles for CYP2C9*3 and pharmacodynamic genes AGTR1, AGT, ACE, CYP11B2.
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Bempedoic acid – a new drug in lipid-lowering therapy
Resumo
The clinical significance of lipid-lowering therapy in reducing the risk of atherosclerotic cardiovascular disease (CVD) and mortality has been proven. However, the achievement of target levels of cholesterol and its fractions in real practice is not ensured, there are problems with the tolerability of standard drugs (statins), often the use of additional lipid-lowering agents (ezetimibe, PCSK9 inhibitors) is required. In February 2020, the FDA approved a new drug, bempedoic acid (BA), recommended in the US and the European Union (EU) as an adjuvant to maximally tolerated statin therapy to lower low-density lipoprotein cholesterol in patients with atherosclerotic CVD and familial hypercholesterolemia, as well as in cases of intolerance or contraindications to the use of statins or in combination with ezetinib. The article presents data on the mechanism of action and clinical pharmacology of the drug, the results of 2nd and 3rd phase clinical trials (a series of CLEAR studies) to assess the safety and lipid-lowering efficacy in different categories of patients and modern meta-analyzes, as well as the results of a recent large study CLEAR Outcomes to assess major cardiovascular outcomes with BA. The place of BA in lipid-lowering therapy in patients with atherosclerotic CVD is also discussed.
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Clinical case of complete atrioventricular block complicated by Morgagni-Adams-Stokes syndrome at the prehospital stage
Resumo
Background. The study of this clinical case is necessary in order to increase the knowledge of emergency medical service (EMS) field personnel in dealing with patients with extreme bradycardia due to the lack of a developed algorithm for action in such cases. The use of available medications (eg, atropine) should be a deliberate manipulation, taking into account the option of atrioventricular block. This will allow to develop a personalized approach already at the prehospital stage and reduce the risk of life-threatening complications.
Description of a clinical case. When a 72-year-old woman lost consciousness at home, a general paramedic team was called and arrived within 4 minutes. The patient underwent several chest compressions and an electrocardiogram (ECG) was recorded: atrial contraction rate ~100 per minute, complete absence of ventricular electrical activity for ~5.8 seconds. Measures: artificial ventilation, chest compressions, catheterization of a peripheral vein and administration of atropine 1 mg/ml – 2 ml, aminophylline 2.4% – 10 ml. Preliminary diagnosis: 3rd degree atrioventricular block, Morgagni-Adams-Stokes syndrome. To correct hypoxic encephalopathy, 250 mg of ethylmethylhydroxypyridine succinate was administered intravenously. Before transportation, the patient’s condition worsened: ventricular contraction rate (VFR) was 23–25 per minute, blood pressure was 70 and 40 mmHg. ECG: atrial flutter. A infusion of dopamine 40 mg/ml, 6 μg/kg per minute was started. It was possible to restore sinus rhythm with a heart rate of 100 per minute and stabilize hemodynamic parameters.
Conclusion. To improve the quality of emergency medical care provided to the population, it is necessary to constantly improve the qualifications of EMS field personnel. The administration of atropine should not only be formally indicated, but also a deliberate manipulation. It is necessary to create clinical guidelines to regulate the general approach to emergency care.
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Endovascular treatment of a patient with chronic abdominal ischemia syndrome: a clinical case
Resumo
Chronic abdominal ischemia syndrome (CAIS) is most often manifested by postprandial abdominal pain, weight loss and dyspeptic symptoms (diarrhea/constipation, flatulence). Due to the fact that such manifestations are characteristic of many diseases of the gastrointestinal tract, and the data of laboratory and instrumental methods during routine examination are nonspecific, this leads to a late diagnosis of CAI. An important role in the timely diagnosis of this pathology is given to such examination methods as Doppler ultrasound, multislice computed tomography, magnetic resonance imaging and/or angiography of the abdominal aorta and its branches. The etiological factors in the development of CAIS are different, but one should think about atherosclerotic genesis if the patient has the above complaints, the absence of the effect of the therapy, and the presence of risk factors for the development of atherosclerosis or already existing atherosclerotic lesions of other circulation systems. In the last decade, endovascular methods have become more often used in the treatment of such patients, but the lack of criteria for the implementation or contraindications to the use of this technique, the features of management in the postoperative period make it difficult to use them in routine practice.
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Pulmonology/ENT/ARVI
Modern ideas about the combination of bronchial asthma and chronic obstructive pulmonary disease
Resumo
The term «asthma-chronic obstructive pulmonary disease overlap (ACO)» is a heterogeneous condition with airflow limitation, which is not completely reversible, and also has clinical and inflammatory signs of both asthma and COPD. The study was aimed to the analysis of the material on this topic. An analytical method was used to study the diagnosis, clinical manifestations and approaches to treatment of patients with a combination of asthma and COPD over the past 10 years (2013–2023) using the following databases: PubMed, Wiley, EMBASE database, Cochrane Library.
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Evaluation of the effectiveness of the new anti-tuberculosis drug thiozonide in patients with pulmonary tuberculosis with multiand extensive drug resistance of Mycobacterium tuberculosis
Resumo
Objective. Evaluation of the effectiveness of the drug tiozonide included in a comprehensive treatment regimen for patients diagnosed with multidrug-resistant (MDR-TB) or extensive drug-resistant (XDR-TB) pulmonary tuberculosis.
Methods. Evaluation of the safety and efficacy of tiozonide in 160 patients diagnosed with MDR-TB or XDR-TB who were treated as inpatients or outpatients in a multicenter clinical trial, against standard antituberculosis chemotherapy in patients diagnosed with multidrug-resistant or extensive drug-resistant pulmonary tuberculosis. As the main criterion for the effectiveness of combination treatment of patients with MDR and XDR tuberculosis using various doses of the drug thiozonide compared with placebo, the dynamics of the quantitative content of Mycobacterium tuberculosis (MBT) in the sputum of patients, determined by bacterioscopic and bacteriological methods, was assessed.
Results. Analysis of the results of bacterioscopic studies showed a significant decrease in bacterial excretion in patients during long-term treatment in the tiozonide treatment groups. It was most pronounced when taking 400 mg and amounted to 93% at the 10th visit (84th day of treatment) compared to the baseline indicator. Analysis of the results of bacteriological studies, as well as sputum bacterioscopy, showed a significant increase in the rate of decline in bacteriological test indicators in patients taking thiozonide. This reduction was most pronounced in the 400 mg group and amounted to 2 points or 95% at the last 10th visit compared to the pre-treatment value of 2.1 points. Treatment in this group resulted in the absence of MBT in the sputum of most patients.
Conclusion. The results of the evaluation of the effectiveness of the drug thiozonide in the complex therapy of patients with MDRand XDR-TB demonstrated that the use of thiozonide in doses of 400 and 600 mg ensured the achievement of a complex primary endpoint compared with placebo in relation to the dynamics of MBT content in sputum according to the bacterioscopic and bacteriological methods. The data obtained allow to justify the sample size and treatment regimen for the third phase study of the drug thiozonide.
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Dynamics of antibiotic resistance in the surgical departments of a multidisciplinary hospital using the example of the Republican Hospital n.a. V.A. Baranov
Resumo
Background. The problem of antibiotic resistance is one of the most pressing public health problems. Antibiotic resistance monitoring is necessary at all levels (global, national, local).
Objective. Assessment of the etiological structure and dynamics of antibiotic resistance of nosocomial pathogens in the leading multidisciplinary institution of the Republic of Karelia (Republican Hospital n.a. V.A. Baranov, Petrozavodsk) for 2019–2022.
Methods. All microbiological studies performed in 2019 and from June 2021 to June 2022 were analyzed. A summary of the data, statistical grouping, followed by a tabular and graphical presentation of the information obtained are presented.
Results. The largest number of cultures was performed in the intensive care unit № 1 (ICU-1), sputum tests predominated. The main pathogens were Acinetobacter baumannii (A. baumannii) (30.82% in 2019 and 30.71% in 2021-2022), Klebsiella pneumoniae (K. pneumoniae) (29.45 and 35.71%) and Pseudomonas aeruginosa (P. aeruginosa) (17.12 and 16.43%). The microflora was resistant to most antibiotics. In the surgical department, wound discharge was examined more often; K. pneumoniae predominated (33.77 and 36.17%). In the neurosurgical department – cultures of wound discharge (26.72 and 31.53%), sputum (28.44 and 29.73%) and urine (36.20 and 26.42%) were examined. The following microorganisms were isolated from wound discharge in 2019: K. pneumoniae (31.25%), sensitive to meropenem and amikacin in all cases, Enterococcus spp. (25%), in all cases sensitive only to vancomycin and linezolid, Staphylococcus aureus (S. aureus) (18.75%), in all cases sensitive to cefoxitin. Wound discharge in 2021–2022: S. aureus (45.16%), 50% sensitive to cefoxitin, K. pneumoniae (16.13%, of which 20% of strains are sensitive to cefotaxime, cefepime, ciprofloxacin, 60% – to meropenem, 40% – to amikacin). K. pneumoniae (40 and 45.45%), P. aeruginosa (20 and 10%) and A. baumannii (16.67 and 15.15%) predominated as the causative agent of lower respiratory tract infection in the neurosurgical department in both periods.
Conclusion. In surgical departments, gram-negative microflora dominated as causative agents of nosocomial infections. A significant decrease in the sensitivity of all types of pathogens to antimicrobial drugs was revealed.
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Neurology
Personalized approach to the rehabilitation of patients with degenerative dystrophic disk disease and clinical manifestations in the form of poor posture and pain syndrome
Resumo
Background. The article analyzes the results of various types of treatment of 86 patients with dorsopathy, advanced osteochondrosis, complicated by scoliotic deformity and instability of the spinal motion segment, manifested by pain and poor posture in the period 2016–2000.
Objective. Improvement of technology and increase the effectiveness of rehabilitation of patients with degenerative dystrophic disk disease (DDDD) (justification, development, clinical implementation and evaluation of the effectiveness of differentiated programs for medical rehabilitation of patients with DDDD).
Methods. The group included 86 patients, 43 (50%) men and 43 (50%) women; the mean age and duration of the disease were 44.5 and 5 years, respectively. 3 treatment regimens were used in the treatment of patients: 1) medication, including intramuscular injections of non-steroidal anti-inflammatory drugs, B vitamins, centrally acting muscle relaxants for 10–14 days 25 (29.1%) patients; 2) a course of manual therapy and corporal acupuncture, consisting of 5 sessions conducted over 10–18 days – 11 (12.8%) patients; 3) a course of manual therapy and auricular acupuncture, consisting of 5 sessions conducted over 10–18 days – 25 (29.1%) patients. 25 (29.1%) patients did not receive treatment for various reasons. Pharmacotherapy was not used in regimens 2 and 3.
Results. The condition of the patients in the group without treatment showed no dynamics; when using treatment regimen 1, the dynamics of the summary assessment of the condition significantly improved; when using schemes 2 and 3, the dynamics of the summary assessment of the patients’ condition significantly improved.
Conclusion. Based on the data obtained, it can be conclude dthat for the treatment of patients with advanced osteochondrosis complicated by scoliotic deformity and instability of the SMS, manifested by pain and poor posture, the most effective courses are manual therapy and acupuncture, both corporal and auricular, which allows to relieve not only pain syndrome, but also reliably level out postural disorders.
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Dermatology/allergology
Experience with the use of various forms of zinc pyrithione for seborrheic dermatitis
Resumo
Seborrheic dermatitis (SD) is a common multifactorial chronic recurrent inflammatory skin disease that occurs in children and adults, characterized by the formation of erythematous-squamous or papulosquamous rashes in areas with a high concentration of sebaceous glands. The pathogenesis of the disease is not fully understood, but it is assumed that it is associated with hypercolonization of the skin by opportunistic Malassezia yeast, a pronounced immune response to an increase in the fungal population, and genetic predisposition. Chronicity of the process and acute relapses have a significant impact on the quality of life of patients. It is possible to treat acute forms of SD and prolong stable remission with the drug zinc pyrithione. In the current retrospective study, the drug was used in 76 patients who were divided into 3 groups taking into account the clinical symptoms of the process. Depending on clinical symptom, patients were prescribed various dosage forms of zinc pyrithione: shampoo, cream, aerosol. The results of the therapy were assessed 2 weeks after the start of using the drug. The data obtained during the study confirm the literature that it is possible to achieve a pronounced improvement in the process and remission already on the 10–14th day.
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Seborrheic dermatitis. association of MCM6 lactase gene polymorphism and seborrheic dermatitis by the example of a clinical case
Resumo
Seborrheic dermatitis (SD) is a chronic, relapsing skin disease manifested by inflammation and desquamation in areas where sebaceous glands accumulate. SD is characterized by changes in the qualitative composition and quantity of sebum produced, disruption of the epidermal barrier, and a defective immune response to skin colonization by Malassezia spp. It is important to note that SD is a multifactorial disease. By understanding the genetics of the disease, personal approach to selecting an individual treatment plan based on its key aspects of development and course can be made, thereby increasing the patient’s quality of life and minimizing drug exposure. The genetics of SD and other inflammatory diseases with a chronic relapsing course have not been sufficiently studied and are currently of particular interest to scientists. The materials presented in this review suggest that one of the reasons for the development of SD in adults may be carriage of the genotype C/C variant of the nucleotide sequence at position -13910 of the MCM6 gene (rs4988235). However, there are no studies that show a direct association of SD with the rs4988235 C/C genotype of the MCM6 gene. The article shows a direct association between chronic relapsing SD in a patient with poor response to standard treatment methods with the C/C genotype of the nucleotide sequence of the MCM6 gene at position -13910. To confirm the connection between the variant of the C/C nucleotide sequence at position -13910 of the gene and SD, additional studies of patients with a newly diagnosed SD are required. A clinical case of a patient with a prolonged course of SD, with a minimal response to standard therapy against the background of a variant of the C/C nucleotide sequence at position -13910 of the MSM6 gene (rs4988235), who achieved stable remission of the disease with nutritional correction is described.
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Oncology
Clinical experience with the use of combination drug therapy in the first line treatment of metastatic non-small cell lung cancer
Resumo
Background. Lung cancer occupies a leading place in the structure of morbidity and mortality from cancer in Russia and in the world. Non-small cell lung cancer (NSCLC) accounts for about 85% of cases among all lung malignancies; 42.2% of lung cancer cases in Russia were detected at the most advanced stage IV. Today, the optimal first-line treatment for patients with stage IV NSCLC without driver mutations, regardless of the level of PD-L1 expression, includes combination treatment regimens, representing by various combinations of chemotherapy, immune checkpoint inhibitors, and antiangiogenic therapy for the non-squamous histotype.
Description of a clinical case. A patient born in 1965 was under medical supervision with peripheral cancer of the upper lobe of the right lung, T1N0M0, stage I at the time of diagnosis, with relapse in the form of metastases in the supraclavicular, subclavian and bronchopulmonary lymph nodes 5 years after the atypical resection and subsequent rethoracotomy with upper lobectomy. Tumor control in the form of complete regression of lesions after three courses of combination therapy using an immune checkpoint inhibitor, cytotoxic drugs and an angiogenesis inhibitor with progression-free survival of more than a year was achieved. Tolerability of treatment was satisfactory.
Conclusion. The use of a combination with atezolizumab in patients with EGFR and ALK negative stage IV NSCLC who have not previously received therapy for advanced disease can significantly improve patient survival.
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Data in the treatment of colon cancer from real clinical practice in Tashkent, Uzbekistan
Resumo
Background. Colon cancer (CC) is the 2nd leading cause of cancer death and the 3rd most common cancer diagnosed worldwide. The proportion of CC in Uzbekistan accounts for 6.7%. In the overall structure of cancer incidence, CC ranks 5th, in the structure of mortality – 4th place, almost 25 thousand new cases and more than 14 thousand deaths from CC are registered annually. Five-year OS is 34–35%. Statistical information is the basis for developing and monitoring the results of anti-cancer interventions.
Objective. Evaluation of the state of oncological care for patients with CC at the Tashkent City Branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology.
Methods. According to retroand prospective analysis, from 2015 to 2022, 250 patients with RTC received treatment at the Tashkent City Branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology. Of these, 61 (24%) patients had stage II, 117 (47%) had stage III, and 72 (29%) had stage IV CC. The mean age was 59.2±9.9 years. Damage to the left parts of the intestine predominated (72.8 versus 37.2%), regardless of the stage. Histologically adenocarcinoma – in 97% of casea. Of the 250 patients, 31 (12.4%) received complex treatment, 138 (55.2%) received combined treatment, 81 (32.4%) received conservative treatment. Surgical treatment was performed in 145 (58%) patients, colostomy in 16 (6.4%), surgical treatment and colostomy in 25 (10%), 64 (25.6%) patients were treated without surgery. Radiation therapy was performed in 30 (12%) cases preor postoperatively, 20 (8%) versus 10 (4%) cases, respectively. 26 (10%) patients received targeted therapy. Chemotherapy was administered in 248 (99%) cases. Of these: neoadjuvant – in 39 (15.6%), postoperative – 91 (36.4%), perioperative – 40 (16%=), palliative – 78 (31.2%).
Results. In the structure of morbidity and mortality in the Republic of Uzbekistan, the CC ranks 5th and 4th, respectively. During the follow-up period (mean 26.4±16.0 months, range 1 to 75 months, median 24.2 months), mortality was 145 (58.0%) cases, progression rate was 220 (88.0%). Upstaging worsened OS and progression-free survival (PFS). 2-year OS for stages II, III, and IV was 69.7% (median, 36.9 months), 63.2% (median, 28.4 months), and 21.9% (median, 16.9 months); P=0.000001, respectively. The 2-year PFS for stages II, III, and IV was 52.8% (median, 25.0 months), 30.3% (median, 18.9 months), and 3% (median, 9.5 months); P=0.00001, respectively.
Conclusion. Analysis of statistical information showed that CC is one of the leading pathologies in the structure of cancer morbidity and mortality in Uzbekistan. There has been a steady increase in morbidity and mortality from CC. Taking into account the advanced stage at the initial detection of the tumor, the issues of diagnosing cancer in the early stages remain relevant, and treatment of cancer requires compliance with international standards for the treatment of this pathology.
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The role of cyclin-dependent kinase inhibitors in adjuvant therapy of breast cancer
Resumo
Hormone receptor positive (HR+)/HER2-negative breast cancer (BC) is the most common subtype of breast cancer, accounting for approximately 70% of all breast cancer cases. Hormone therapy (tamoxifen) has been the basis of systemic treatment for such tumors since the 1980s. Further research began to focus on other endocrine therapeutic approaches, in particular, the return to ovarian ablation or conservative ovarian suppression in premenopausal women, as well as the use of aromatase inhibitors in postmenopausal women. Further administration of 3rd-line endocrinotherapy with fulvestrant in patients with advanced breast cancer improved progressive-free and overall survival. Overcoming endocrine resistance in the progression of the disease has become the basis of a new generation of endocrine therapy for progress in the therapy of hormone-receptor positive (HR+)/HER2-negative breast cancer. It turned out that cyclin-dependent kinases (CDK 4/6) are crucial for the progression of the cell cycle, and are an effective target in the treatment of breast cancer at various stages.
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