Vol 11, No 8 (2025)

Standard approaches to treating excess body weight, including lifestyle modification (LM), do not always achieve comprehensive treatment goals, that makes it necessary to search for pharmacological agents capable of exerting a beneficial effect on metabolic processes.

The aim: to comparatively evaluate three therapeutic strategies efficacy (combination of therapy with ethylmethylhydroxypyridine succinate (Mexidol FORTE 250) + LM; monotherapy with Mexidol FORTE 250; and LM only) in terms of changes in anthropometric and body composition parameters.

Material and methods. 74 overweight female patients (mean age 33.2 ± 0.82 years), randomized into three groups depending on the used treatment strategy were involved in the study. Anthropometric and bioimpedance measurements were assessed at baseline and after a 3-month follow-up.

Results. Patients receiving Mexidol FORTE 250 (in combination with LM or as monotherapy) demonstrated a statistically significantly greater reduction in body weight and total fat mass comparatively to the control group receiving only LM (p <0.001). Combination therapy demonstrated the greatest effect in reducing visceral fat, significantly outperforming monotherapy (p = 0.0136). Monotherapy with Mexidol FORTE 250 demonstrated a significant advantage in preserving lean muscle mass comparatively to using LM alone (p = 0.0014).

Conclusion. Combination therapy with Mexidol FORTE 250 and LM is an optimal strategy for reducing visceral adiposity. Monotherapy with that drug demonstrates a significant protective effect on muscle tissue. Obtained data prove the need for larger studies to confirm the identified effects.

The efficacy of bronchial asthma (BA) treatment directly depends on the continuity and adequacy of drug therapy. Delayed or ineffective asthma treatment is a key factor contributing to a decrease in quality of life, worsening clinical picture, disability, and adverse outcomes.

The aim: to examine the opinions of BA patients regarding the availability of subsidized medication provision in outpatient conditions in Stavropol region.

Material and methods. A survey of respondents was performed using a specially developed questionnaire, followed by mathematical processing of the data. A total of 306 patients with BA, undergoing follow-up care at outpatient clinics in Stavropol, were interviewed using a specially developed questionnaire consisting of 25 questions.

Results. The survey revealed that 77.45% of respondents use subsidized anti-asthma medications. The main reasons for difficult obtaining subsidized medications included distance from home to pharmacies, long lines at outpatient clinics, frequent out-of-stocks, incorrectly written prescriptions, and limited expiration dates. Only 14.6% of patients experienced no difficulties obtaining subsidized medications. Foreign-made medications were preferred by 11.4% of respondents, the manufacturer was unimportant for 60.8%, and 27.8% preferred Russian-made medications.

Conclusion. The survey results show that the problem of medication provision for patients with BA in Stavropol region is an actual one, although it faces certain challenges. In bronchial asthma therapy prescribed for study patients, subsidized medications for symptom relief are dominating, while the majority of respondents do not receive combination basic anti-inflammatory therapy, which may lead to inadequate disease control.

Of great interest is Not only the study of the functional state of duodenum (DU), but also the search for pathogenetically reasoned treatment regimens for chronic duodenal insufficiency (CDI) that improve hydrolysis processes in the duodenum are of great interest nowadays.

The aim: to determine the efficacy of complex treatment for CDI patients with impaired duodenal parietal digestion.

Material and methods. The study included 110 patients with CDI stratified by disease stage (1–3) using machine learning. In patients with stages 1–2 CDI, intestinal duodenal mucosal carbohydrase activity was measured using a modified A. Dahlquist method. Duodenal intestinal alkaline phosphatase (ALP) isoform activity was also measured. Then patients with stage 1 CDI (n = 55) were prescribed mebeverine, rebamipide, and Lactobacillus plantarum DR7; patients with stage 2 CDI (n = 40) were prescribed itopride, rebamipide, and Lactobacillus plantarum DR7. Digestive function of duodenum was estimated before and after the treatment course.

Results. A study of the activity of parietal enzymes in duodenal mucosa in all patients with chronic duodenal failure revealed a decrease in the baseline levels of carbohydrases and alkaline phosphatase in duodenal contents comparatively to the control group (50 apparently healthy individuals). After comprehensive treatment, participants with stages 1 and 2 chronic duodenal insufficiency had restoration of parietal carbohydrase activity and intestinal alkaline phosphatase isoform.

Conclusion. Using of comprehensive personalized therapy in patients with chronic duodenal insufficiency allowed to restore the parietal digestion disorders in duodenum.

Acute insomnia (synonym: sleep loss) is a sleep disorder characterized by impaired initiation and/or maintenance of sleep by itself, the development of excessive daytime sleepiness syndrome, loss of daytime activity stimuli. It’s duration is limited to a period ranging from 1–2 weeks to 3 months. Despite existing options for pharmacological and non-pharmacological treatment, acute insomnia in patients with chronic obstructive pulmonary disease remains a serious clinical problem. Current review analyzes data from systematic meta-analyses and randomized clinical trials that expand our understanding of the mechanisms underlying acute insomnia development, as well as the data of new risk-modifying strategies and effective treatment for sleep disorders in patients with chronic obstructive pulmonary disease in real clinical practice.

The incidence of drug-induced diseases increases every year. The number of cases of off-label drug use is growing too. Current article presents a clinical observation of a bodybuilder with hereditary thrombophilia. It describes in detail the effects of testosterone medications on various organs and systems (cardiovascular, hematopoiesis, kidneys, prostate, hemostasis), analyzing side effects using a specific example. Mechanisms of renal damage associated with a high-protein diet are discussed. This clinical case illustrates the challenges of managing patients with drug-induced diseases, emphasizing the importance of awareness by physicians about systemic effects of testosterone-containing medications and high-protein diet.

Schnitzler syndrome (SS) is a rare autoinflammatory disease first described in 1972. Currently, 748 cases of this syndrome are known worldwide. Main symptoms of this syndrome are urticarial rash (persistent urticaria), monoclonal IgM gammopathy, and signs of systemic inflammation: recurrent fever, joint and bone pain, leukocytosis, elevated C-reactive protein levels, and also typical bone remodeling (osteosclerosis). Some cases of SS may be associated with a somatic mutation p.L265P in MYD88 gene, which is often observed in B-cell diseases that increase the risk of lymphoproliferative disorders. 749th case of SS described in this article is characterized by the presence of most diagnostic criteria of the disease, as well as a characteristic genetic mutation. Patient’s disease was diagnosed 5 years after its onset and raised reasonable suspicions of a lymphoproliferative process with PIgM kappa secretion (22% lymphocytosis + p.L265P mutations in MYD88 gene with an allelic load of 3.4%), accompanied by manifestations of SS. Long-term use of glucocorticosteroids by a patient could have a negative influence at the expression of specific markers during immunophenotyping of hemoblastosis, complicating their detection.

According to current clinical guidelines for treatment of patients with acute respiratory infections, the administration of antiviral drugs for etiotropic treatment is most appropriate within the first 2–3 days from the onset of clinical manifestations of the infection. However, in real-life clinical practice, patients often seek medical attention significantly later than this period. This article presents clinical examples of the effective use of the antiviral drug enisamium iodide in patients with respiratory viral infection in case of their late health encounter.

High prevalence of the combination of allergic bronchial asthma (BA) and allergic rhinitis (AR) allows us to consider the latter to be an independent risk factor for the development of BA. In patients with comorbid BA and AR with uncontrolled AR, the frequency of asthma attacks, emergency care applications, unscheduled visits to the doctor, hospitalizations, and the need for systemic glucocorticosteroids are increasing. Uncontrolled clinical course of BA in this category of patients is observed 4–5 times more often than in patients without concomitant AR. Intranasal glucocorticosteroids are the first-line drugs in patients with moderate to severe course of AR, especially with severe nasal obstruction. Mometasone furoate is one of the most studied drugs in that class. High efficacy and safety of mometasone furoate, proven in a large number of studies, including in patients with a combination of AR and bronchial asthma, justify its choice for basic therapy of AR in comorbid patients.

Osteoarthritis (OA) is a heterogeneous disease including various phenotypes and endotypes. OA metabolic phenotype is further subdivided into four endotypes, the development of which is associated with adipokine-mediated inflammation (1), lipotoxicity (2), exposure to advanced glycation end products (3), and mitochondrial dysfunction (4). These forms are associated with different biochemical mechanisms of disease development. Effective treatment of OA requires a personalized approach. Hyaluronic acid medicines play an important role in the treatment of this disease due to their ability to viscosupplement within a month of administration and anti-inflammatory activity lasting up to 6 months. The choice of a specific medicine largely depends on molecular weight of the active component. The advantage of combination hyaluronic acid medicines with different molecular weights (Flexotron® Ultra, Flexotron® Ultra M) for the metabolic phenotype of OA lays in their simultaneous action on mechanical damage of cartilage and relief of the inflammatory component of the disease.

Influenza is one of the most common diseases and one of the most frequent reasons for visiting primary care physician. The choice of treatment strategy for a patient with influenza depends on a number of factors, such as age, clinical form, nature and severity of infection, presence and type of complications and comorbidities, and the timing of seeking medical care. Basis for successful treatment is the earliest possible detection of the disease and administration of medications that directly target the pathogen. Current article summarizes information on the clinical pharmacology of direct-acting antiviral drugs recommended for the treatment and prevention of influenza in adults.

Non-alcoholic fatty liver disease (NAFLD) is an actual problem for medical community due to its high prevalence, association with other metabolically associated diseases, and asymptomatic early stages, which can contribute to the subsequent development of serious complications. To date, the choice of effective hepatoprotective therapy for NAFLD remains to be an open question.

The aim: to evaluate the efficacy of Ursosan (ursodeoxycholic acid) and its role in correcting metabolic disorders as a part of the comprehensive treatment of NAFLD patients.

Material and methods. We analyzed the treatment of 53 patients with NAFLD, who were focusing on a low-calorie diet and balanced physical activity. They were randomized by gender and age and divided into two groups based on the treatment regimen. Subjects in Group 1, in addition to non-pharmacological treatment methods, received Ursosan at a dose of 12 mg/kg/day for 6 months. Group 2 (the comparison group) consisted of patients who received only non-medicamentous treatment. All the participants were assessed dynamically (at baseline and after 6 months of treatment) for biochemical parameters of lipid, carbohydrate, and purine metabolism, as well as liver fat fraction (%), according to the data of abdominal magnetic resonance imaging.

Results. Patients with NAFLD, who received Ursosan as a part of combination therapy, had a significant improvement in lipid, carbohydrate, and purine metabolism. Total cholesterol levels after a 6-month course of the therapy decreased from 6.6 to 5.3 mmol/L (p = 0.001), triglycerides – from 1.9 to 1.6 mmol/L (p = 0.01), glucose – from 5.5 to 5.0 mmol/L (p = 0.06), uric acid – from 386 to 334 mmol/L (p = 0.001). Participants in Group 1 also showed a significant decrease in liver fat fraction relatively to the baseline level – from 12.25 to 6.0% (p = 0.002).

Conclusion. SVET study demonstrated that using Ursosan in the treatment of NAFLD not only reduces fatty liver damage but also improves metabolic profile of the patients.