Therapy

Nowadays, lots of data concerning the higher incidence of cardiovascular diseases (CVD) in patients with ulcerative colitis (UC) comparatively to the general population, despite the significantly lower incidence of traditional cardiovascular risk factors among them are collected. Existing methods for assessing CVD risk do not cover all aspects through which inflammatory bowel diseases (IBD) potentiate cardiovascular risk, therefore, a targeted study of the pathophysiological links between UC and CVD is necessary to improve methods for assessing the risk of cardiovascular events in this group of patients for their timely prevention.

The aim: to estimate the characteristics of the lipid profile and severity of arterial wall rigidity in UC patients.

Material and methods. A comparative analysis of the lipid profile and cardio-ankle index CAVI was performed in 120 patients with UC. All of them were kept for observation at the Republican Clinical Hospital of the Ministry of Healthcare of Chuvashia.

Results. Patients with UC had lower levels of total cholesterol, low-density and high-density lipoproteins, higher values of cardio-ankle index CAVI than in the control group, as well as a stronger correlation between the rate of increase of this index and age. A high correlation between the degree of excess of CAVI index and the duration and age of onset of the disease was found.

Conclusion. Patients with UC associated with long-term persistent chronic inflammation, have changes in the structure of the vascular wall and endothelium, which is confirmed by detected higher values of CAVI index. Also in this case, qualitative changes in the activity of lipoproteins are observed, which, in combination with the identified changes in lipid profile indexes, determines the presence in this group of patients of a special type of dyslipidemia with a specific combination of quantitative and qualitative indexes that determine its high atherogenicity.

The increase in the cohort of elderly people throughout the world leads to a revision of the approach to medical care provision, taking into account body involutional changes.

The aim: to assess the incidence of multimorbidity, geriatric syndromes and their correlations in patients who are taking medical care at an outpatient basis.

Material and methods. Open, cross-sectional study included 371 patients (61.7% females) aged 60–93 years, observed by a general practitioner in medical consulting room for patients of older age groups with multiple chronic diseases. Clinical and laboratory parameters were analyzed, screening for senile asthenia was performed using “Age is not a hindrance” questionnaire.

Results. The average age of studied patients was 73 (68; 80) years, most of them were elderly (58.8%) and female (61.7%) persons, having more than three (70.89%) diseases. The most common disease was arterial hypertension (95%). Diabetes mellitus and obesity had 42 and 39% of them, respectively. Geriatric syndromes occurred in 80.86% of patients: decreased hearing and vision (71%), sleep disturbances (56%) and movement disorders (48%), urinary incontinence (27%) and falls during the year (20%). Factors associated with frailty were osteoarthritis (odds ratio (OR) 2.56; 95% confidence interval (CI): 1.33–4.89; p = 0.005), myocardial infarction in anamnesis (OR 3.43; 95% CI: 1.78–6.62; p = 0.001), chronic kidney disease (OR 1.91; 95% CI: 1.00–3.65; p = 0.050), female gender (OR 4.23; 95% CI: 1.73–10.31; p = 0.002). The cut-off value for the age at which the likelihood of senile asthenia developing increases was 75.5 years (95% CI: 0.68–0.85).

Conclusion. Among outpatients aged 60 years and older, elderly female patients and persons with complex pathology are predominating. Arterial hypertension, diabetes mellitus and obesity are leading diseases in the structure of multimorbidity, hearing and vision loss, sleep disturbances and mobility problems are existing among geriatric syndromes. Chronic kidney disease, history of myocardial infarction, and osteoarthritis are associated with senile asthenia, especially in females, as well as at the age of 75.5 years and older, when the probability of senile asthenia developing is highest.

Asthenia is a common and at the same time alarming symptom of many chronic non-communicable diseases (CNCDs).

The aim: to estimate the efficacy of drug treatment of asthenia with Enerion (sulbutiamine) medicine in CNCDs patients in outpatient conditions.

Material and methods. An open prospective clinical study was performed. Screening for asthenia was made in 2373 outpatients with chronic NCDs, of which 847 persons (326 male and 521 female patients, mean age 60.6 ± 14.1 years) met the diagnostic criteria. A survey, collection of complaints and anamnesis, physical examination, and analysis of outpatient records of patients were carried out, on the basis of which CNCDs diagnosis was made. Using MFI-20 asthenia rating scale and FSS asthenia severity scale, subjective diagnosis of asthenia syndrome was established. All the participants were divided into 3 groups: 1st – 446 patients who did not receive anti-asthenic therapy and did not change their lifestyle; 2nd – 71 patients who changed only their lifestyle; 3rd – 330 patients who received Enerion 600 mg/day. within 4 weeks.

Results. In patients of the 3rd group, at the 1st screening of asthenia, a greater degree of severity was fixed on both scales in comparison with patients of the 1st and 2nd groups. Despite this, while taking sulbutiamine in group 3, there was a decrease and complete normalization of the total score by MFI-20 and FSS questionnaires. At the same time, the severity of asthenia in groups 1 and 2 also decreased, but did not reach norm level by MFI-20 assessment. Also, in the group of patients receiving sulbutiamine therapy, normalization of asthenia severity indexes was fixed for all its subtypes, and the total score for each of the MFI-20 subscales after a month of observation was significantly lower in comparison with both groups 1 and 2. There were no side effects associated with sulbutiamine during the study.

Conclusion. Our study is the first to demonstrate the positive effect of sulbutiamine (Enerion) on the symptoms of asthenia in a fairly large group of patients with CNCDs in outpatient practice. Active, targeted diagnosis of asthenic syndrome in patients with chronic NCDs by therapists will lead to the need to resolve the point concerning appropriateness of its pharmacotherapy, including the possibility of using sulbutiamine as a highly effective and safe medicine.

During the new coronavirus pandemic, alcohol abuse among adults has significantly increased. Lack of social activities and social support, isolation from society are among the influencing factors. Analyzing the impact of SARS-CoV-2 at the human body, it is worth to note that, in addition to damaging the respiratory system, the virus can also damage other organs and systems, including digestive system. Enhancing the aggressive effect of coronavirus at the human body, ethanol worsens clinical course and prognosis of the disease. For timely diagnosing of COVID-19, prescribing correct treatment tactics and preventing the development of complications in patients with alcoholic liver disease, the interaction of an entire team of specialists is required.

Medical statistics accepts respiratory system diseases to be the most common in the structure of morbidity in Russia; also they are leading in the number of cases of associated disability. Most of these diseases are acute respiratory viral infections (ARVI) and bronchitis. The causes and mechanisms of respiratory tract damage due to viral infections are varied and require the use of a wide range of medications. Using of mucoactive agents in these cases is justified by their most important characteristics. Thus, carbocisteine, in addition to its mucoregulatory, mucolytic activities and the ability to improve mucociliary transportation, also demonstrates anti-inflammatory, immunomodulatory and antioxidant properties, which determines its place in the treatment of acute respiratory viral infections and bronchitis. The article provides a review of studies on the efficacy of this mucoactive medicine and also outlines perspectives for its use in therapeutic practice.

Ulcerative colitis is characterized by the development of extraintestinal manifestations (EIM), which are predominantly damaging the gastrointestinal, musculoskeletal and cutaneous systems. The article presents a clinical case of ulcerative colitis female patient, who had debut of EIM in the form of axial spondyloarthritis, pyoderma gangrenosum and aphthous stomatitis arising after colectomy. The difficulties of diagnosing and managing such kind of patients are discussed.

Hepatocellular cancer (HCC) is a primary hepatic tumor starting from hepatocytes, is characterized by high aggressiveness and conditionally unfavorable prognosis, which makes the problem of its chemoprevention urgent. Despite the numerous drugs considered as chemopreventive agents, their use in clinical practice is limited by the small volume and unsystematic nature of evidence of their efficacy and safety. Current work considers well known metabolic and epigenetic mechanisms of action of ademetionine (S-adenosyl-L-methionine), which are laying in the basis of its chemopreventive and antitumor activity against HCC.

Obesity (OB) still retains a leading role in the development of associated clinical conditions in case of cardiovascular system pathology among the population of various age groups.

The aim: to study the prevalence of risk factors for obesity and excess body weight (EBW) development and assess the dynamics of these parameters in young individuals examined in 2005 and 2023.

Material and methods. Using questionnaires specially developed by the authors, the prevalence of overweight and obesity and risk factors for their occurrence were determined, taking into account the type of eating behavior of patients. Based on the analysis of their food diaries and self-observation, the diet and regularity of eating were estimated.

Results. Comparing data from 2005 and 2023, we found that students’ nutrition is still remaining irrational and irregular, although there are some positive trends (increase in fresh vegetables and fruits in the diet, protein foods for breakfast). In 2023, the number of first-year students with EBW and OB increased comparatively to 2005, when these diseases were not encountered at all among this cohort. This may indicate an increase in the number of cases of obesity among adolescents. The range of bad habits has also changed. In 2023, in general, 6 ± 1.5% of respondents smoke, but among people with EBW and OB, the same figure is 25%. The number of beer drinkers in general has also significantly decreased, and among people with EBW, not a single person consumed this drink in 2023. The prevalence of physical inactivity among students has decreased slightly over 18 years, but this difference is not significant. In students with EBW and OB, tonus of sympathetic nervous system and emotiogenic type of eating behavior are predominating, and their general well-being is worse.

Conclusion. Contemporary students (2023) are more objective concerning their body weight, less turn to restrictive diets without reason comparatively to students in 2005. At the same time, 87% of respondents in 2023 did not take any action to reduce body weight.

Migraine is a primary headache (PH), and it is the one of the leading causes of disability in the world. Currently, a division into episodic and chronic migraine is accepted, however, the boundary between these forms is arbitrary, and the presence of one or more comorbid diseases in a patient increases the risk of chronic episodic migraine and may reduce the efficacy of therapy. Tablet medications approved for the preventive treatment of migraine are nonspecific, poorly tolerated, and patient adherence to such kind of treatment is extremely low. Monoclonal antibodies to calcitonin gene-related peptide (CGRP) or its receptor (anti-CGRP mAb) have become the first targeted preventive therapy for migraine.

The aim: to determine the efficacy and safety of anti-CGRP mAb of erenumab in real clinical practice in patients with episodic and chronic migraine.

Material and methods. 76 patients diagnosed with diagnoses chronic and episodic migraine were included in the study according to the criteria of the International classification of headache disorders, 3rd revision. During 3 months all the participants were given erenumab 70 mg subcutaneously for every month. From the beginning and every month, a clinical interview, estimation of the headache diary, and completion of questionnaires for anxiety, depression, impact of headache on the quality of life, and sleep quality assessment were performed.

Results. In patients with both chronic and episodic migraine after 1 and 3 months of erenumab therapy, there was a significant reduction in the frequency of headaches in general, migraine headaches, days with analgesics, as well as positive changes in questionnaire data. Treatment-arising adverse events were of low prevalence.

Conclusion. Erenumab is an effective and safe drug when used in real clinical practice in patients with both episodic and chronic migraine, including multimorbid patients.