Vol 8, No 7 (2022)

Ulcerative colitis (UC) and Crohn's disease (CD) often lead to the development of complications when the basic therapy is delayed. The delay in disease verification is up to 2 years for CD and up to 10 months for UC. Up to 25% of cases of inflammatory bowel disease (IBD) are diagnosed 2 years after the onset of symptoms. In recent years, methods for detecting IBD based on artificial networks have been created. They increase the accuracy of diagnosis and thereby improve the prognosis of patients. The aim of the study: to create a method for the diagnosis and differential diagnosis of IBD based on the analysis of the artificial networks of endoscopic images. Material and methods. The study included patients aged 18 years with colonic CD and UC after excluding intestinal infections, who had endoscopic exacerbation. The comparison group consisted of patients with visually unchanged colon mucosa. Patients underwent videocolonoscopy, during which the obtained digital images were filtered using a non-local mean filter and contrast improved by adaptive contrast-limited histogram equalization. We developed the artificial networks based on the VGG16 network: the first network determined the presence of mucosal changes, the second gave a conclusion about the type of IBD. The input element was digital images, and the output layer of the artificial network gave a conclusion about the presence of pathology and the type of IBD. Results. The artificial network detected pathology with an accuracy of 89,3% and differentiated IBD with an accuracy of 81,9%. The artificial network detected the norm with an accuracy of 88% and, in comparison with other classes, determined the UC better (90% accuracy), and also most well distinguished the CD class from other classes (92% accuracy). The overall accuracy was 84,6%. On the basis of the developed artificial network, the doctor's decision support system (DDSS) was created. Conclusion. The developed models showed moderate accuracy in the detection of IBD and high accuracy in the determination of UC and CD. The created DDSS can reduce the time of IBD verification and can be used as an additional tool in the practice of physicians.

Currently, there are few works devoted to a comprehensive assessment of the state of the liver in psoriatic arthritis. Aim: to assess liver abnormalities in patients with psoriatic arthritis. Material and methods. 88 patients with psoriatic arthritis were consecutively enrolled. Clinical history, biochemical and ultrasound investigations and liver elastography were assessed. Results. Liver stiffness was comparable in groups of patients with different degrees of activity, there was no significant correlation between liver stiffness with age, anthropometric data, duration of the disease, and biochemical parameters. Ultrasound signs of steatosis were noted in 32 (37%) patients. All psoriatic activity scores, the number of painful joints and acute phase reactants (ESR, CRP) were significantly higher in patients with steatosis. Liver enzymes were within the reference values in 89% of patients. The predominance of cardiovascular pathology was noted in the group of patients with steatosis, arterial hypertension was significantly more in the same group. Conclusion. Psoriatic arthritis is associated with a low incidence of liver disease, the common cause of liver abnormalities was non-alcoholic liver disease. Ultrasound liver steatosis in patients with psoriatic arthritis is associated with higher activity of the underlying disease and the predominance of comorbid cardiovascular pathology.

In spite of the fact that the most expressed manifestation of COVID-19 is severe pulmonary damage, it is shown by clinical observations that other organs are often affected too in that infection. This multi-organ pathology is caused by disorders in haemostasis and endothelial function. Since there are no medicaments that can directly inhibit the activity of SARS-CoV-2, the effort to mitigate its damaging effects by protecting the endothelium and preventing hemostasis disruption looks to be essential. We investigated the ability of sulodexide, which is a mixture of a fast heparin fraction (80%) and dermatan sulfate (20%), to have a therapeutic effect in COVID 19. Material and methods. 28 patients with moderate COVID-19 were engaged in a single-center, prospective, observational study. Patients in the control group (n=14) were treated using the therapy according to the Ministry of Healthcare recommendations, and patients in the experimental group (n=14) received daily intravenous injections of sulodexide (600 units) in addition to this therapy for ten days. Blood samples were obtained from the ulnar vein on admission and 10 days later and were examined by scanning electron microscopy. Results. Sulodexide significantly reduced the concentration of circulating endothelial cells. That indicated its ability to protect the endothelium from the damaging effects of the virus. It also prevented additional platelet activation and erythrocyte aggregation, which inhibited the normal passage of these cells through the capillaries. Conclusion. The results showed that sulodexide is able to prevent thrombosis and suppress vascular inflammation. This makes it to be a promising treatment remedy for COVID-19 patients, although a randomised trial on a large number of patients is needed to validate this conclusion.

In recent years, an increasing number of studies indicate that patients with inflammatory bowel diseases (IBD) have an increased risk of cardiovascular diseases (CVD). There are several potential links between chronic inflammatory processes associated with IBD and CVD risk, but understanding of their pathogenetic pathways remains unclear. Endothelial dysfunction, high levels of inflammatory mediators and homocysteine, and hypercoagulability condition are considered to be important pathogenetic components. There is a positive correlation between markers of endothelial dysfunction and IBD activity. The aim of the review is to present current data on the risks of cardiovascular diseases in IBD patients. The article discusses the features of etiology and pathogenesis of CVD, taking into account the role of inflammatory factors and the microcirculatory system, and considers age-related peculiarities of IBD and CVD combination.

Non-alcoholic fatty liver disease (NAFLD) is characterized by an ever-growing prevalence, high progression rates, and a wide spectrum of complications and comorbidities. Despite their high incidence and significant impact on the patients' quality of life, mental and neurological disorders associated with NAFLD, especially its precirrhotic stages, remain relatively poorly explored. This work provides a review of pathogenetic features and main types of central and peripheral nervous system disorders accompanying different stages of NAFLD.

The novel coronavirus infection COVID-19, in addition to acute respiratory syndromes, is characterized by a wide range of extrapulmonary manifestations. Damage or dysfunction of the hepatobiliary system can range from an asymptomatic increase in liver transaminases to severe liver and biliary tract damage with a fatal outcome. A clinical case of severe cholestatic lesions of the hepatobiliary system with COVID-19 in a patient without previous pathology is presented. The reasons for the development of damage to the hepatobiliary tract in this case can be considered direct damage to cholangiocytes by the SARS-CoV-2 virus, immune damage to cholangiocytes as a result of a cytokine storm, ischemic hepatitis, drug-induced hepatotoxicity of the drugs used (favipiravir, paracetamol, ceftriaxone, amoxiclav, methylprednisolone). Their combination led to changes in the bile ducts, severe cholestasis and death.

Wilson's disease belongs to the group of hereditary diseases for which pathogenetic therapy has been developed, which allows, with timely initiation of treatment, to avoid the severe consequences of excessive accumulation of copper in the body. However, due to the rarity of pathology, the variety of clinical manifestations and the low alertness of doctors, the diagnosis is established at the stage of irreversible changes, which significantly worsens the prognosis of patients. All this determines the relevance of summarizing and discussing current data on epidemiology, features of clinical manifestations, diagnosis and treatment of Wilson's disease.

Due to the development of the «increased release of cytokines» syndrome in moderate and severe forms of COVID-19, anti-inflammatory therapy (AIT) is currently considered as the leading direction in the pathogenetic treatment of these forms of the disease. The aim of the study: to compare the effectiveness of AIT with dexamethasone, olokizumab, tocilizumab, baricitinib in COVID-19. Material and methods. A retrospective analysis of 229 cases of severe and moderate course of COVID-19 at Hospital of War Veterans (Saint Petrsburg) was performed, in which AIT was performed with dexamethasone, olokizumab, baricitinib, and tocilizumab. Calculations with a certainty of 95% or more were taken as statistically significant (p <0,05). The Bonferroni correction was used as a method for controlling the group error probability (of the first kind). Results and conclusion. During the study, differences in the outcome of the disease during AIT were established in the groups, a comparative analysis of patient subgroups was performed depending on the drug used. It was found that patients with an unfavorable outcome of COVID-19 had a later appointment of AIT, they needed more O2 support by the time it started. The volume of lung tissue damage according to the results of CT examination should be compared with the results of laboratory data, among which the most significant are CRP and D-dimer. The use of tocilizumab had the most significant effect on the decrease in mortality in the group of patients studied, and the use of dexamethasone was slightly less significant. At the same time, the significance of the effect of baricitinib and olokizumab on the outcome of AIT was comparable.

Correction of asthenia symptoms is an urgent task of primary care physicians in their clinical practice. The multicenter randomized controlled trial TONUS, which took place in 26 cities of Russia in 2021, demonstrated the efficacy and safety of asthenia treatment with Mildronate (meldonium) in patients who were consulted by primary care physicians - general practitioners, cardiologists and neurologists. Material and methods. TONUS study was an observational study in two parallel branches, one of which, TONUS-1, is discussed in details in this article. Patients without chronic cardiovascular or cerebrovascular disease were included in that study. After randomization, Mildronat® 500 mg/day for 14 days was added to therapy in the main study group; in the control group, standard vitamin complex in prophylactic doses served as a comparison medicine. The dynamics of asthenia symptoms and efficacy of therapy were estimated by MFI-20 asthenia self-assessment scale, Schulte Table test and the General Clinical Impression (CGI) scale with assessment of the efficacy index. Results. By the end of oservation period, all groups and subgroups showed an improvement in patients' condition comparatively to the first visit. Clinically significant reduction in asthenic symptoms, as assessed by the MFI-20 scale, was fixed only in the main group of patients. In the control group subgroups, a significant reduction in MFI-20 scores was observed, mostly only by the 3rd visit, and was almost three times less expressed than in the main group subgroups. In both subgroups of patients receiving Mildronat®, there was a significant improvement in the characteristics of attention and workability according to the Schulte table test. According to the CGI-I scale, there was a significant increase in the percentage of participants with «significant» and «marked»clinical improvement in the main group already by the 7th day of therapy comparatively to the control group of patients. At the end of observation, the proportion of participants in the Mildronat® group whose clinical improvement was considered «significant» and «marked» by physicians was over 90%, whereas the control group had less than 41%. Conclusion. In the TONUS-1 study branch, patients receiving Mildronat® showed positive dynamics and regression of all major symptoms of asthenia comparatively to patients receiving multivitamins. No serious adverse events were noted in either group.

The role of obesity as a factor of atrial fibrillation (AF) is currently discussed nowadays. Several mechanisms of the influence of excessive body weight at AF development are described in the literature: the occurrence of arterial hypertension, insulin resistance, and dyslipidemia. The molecular mechanisms of AF in obese patients include systemic inflammation. Management tactics for obese patients with AF include 3 main directions - anticoagulant therapy in case of increased risk of thromboembolic complications, control of arrhythmia symptoms, treatment of comorbidities and correction of risk factors. There are two main strategies in the treatment of AF: rhythm control and ventricular rate control. Stabilizing treatment of AF paroxysms in obesity is differentiated according to the stability of haemodynamic parameters. In patients with stable haemodynamics, IC and class III medicaments are recommended for sinus rhythm restoration in AF paroxysms.

The review article presents current data on gastrointestinal lesions in patients with COVID-19. The symptoms of gastrointestinal lesions, violations of the functional parameters of the liver, microbiome, and intestines are described. The necessity of optimizing the diet with the inclusion of specialized health food products is substantiated. Detailed information about the existing specialized food products for dietary therapeutic and dietary preventive nutrition LEOVIT GASTRO is given. The data of clinical studies on the effectiveness, methods of administration and duration of use of these products in patients with COVID-19 with varying degrees of severity in hospital conditions and during the rehabilitation period are presented.