Vol 9, No 2 (2023)

In recent years, the topic of infectious diseases has come to the fore in the modern medical agenda. The main reason for this was, of course, the COVID-19 pandemic, but it did not “cancel” (and in some places exacerbate) the problem of effectively combating many other infections, from influenza and SARS to various forms of hepatitis. In this regard, in the proposed issue of "Therapy" we have tried to cover various thematic aspects related to infectious diseases as widely as possible.

Human lungs perform critical functions in gas exchange and are a large and complex but vulnerable mucosal surface that interacts with a variety of microorganisms in the environment. Pulmonary cells, including type II pneumocytes and ciliated airway epithelial cells, are the main targets of SARS-CoV-2 infection in the lungs.

The vast majority of coronaviruses, including SARS-CoV-2, are characterized by the involvement of the digestive system. The virus infects the epithelial cells of the gastrointestinal tract (GIT), causing lesions of varying severity. However, fever, intoxication, respiratory symptoms, dominating the clinical picture, push gastrointestinal manifestations into the background, which may be the reason for the loss of the «golden hour” in this group of patients, when pathogenetic mechanisms can still be stopped and the severe course of the disease can be prevented.

Purpose of the work: to study the complications of the novel coronavirus infection from the GIT in patients in the acute period of COVID-19 damage and in the post-COVID period.

Material and methods. An analysis of the world literature was carried out using the TripDataBase search system, which allowed us to study, analyze and structure the described assumptions about the pathogenetic mechanisms of gastrointestinal lesions in COVID-19, as well as analyze and structure clinical, including endoscopic, materials provided by institutions health care in Moscow and Saint Petersburg, who were directly involved in the fight against the COVID-19 pandemic.

Results. The ability of the SARS-CoV-2 virus to directly infect enterocytes, the use by patients and healthcare workers of justified or unreasonably massive antibiotic therapy, anticoagulants, NSAIDs, targeted therapy, proton pump inhibitors against the background of gerontological problems and directly related comorbidity during the period treatment of a new coronavirus infection created an incredible, previously unseen, mix of problems, which was directly reflected in the gastrointestinal tract lesions identified during endoscopic examination of patients in the COVID/post-COVID period and made it necessary to introduce new terms in endoscopic semiotics.

Conclusion. The presented data confirm that the new coronavirus infection COVID-19 is an extremely complex, «insidious» pathology, which has both a direct damaging effect and the ability to trigger mechanisms of a latent, previously unmanifested pathology, which is sometimes systemic in nature.

The problem of the combined development and interconnection of ARVI and influenza-related parasitic systems occupies more and more space in the theory and practice of epidemic research. Occurrence of the upper respiratory tract pathologies caused by seasonal mixed circulation of influenza viruses and other acute respiratory viral infections in humans is of great concern now. Use of interferon inducers as antiviral and immunomodulating agents is an important approach to the treatment of acute respiratory viral infections.

Aim and methods of the research. Estimation of the incidence of acute respiratory viral infections and grippe in Saint Petersburg and the Kaliningrad region, as well as an estimation of vaccination as a factor influencing a self-regulating epidemic process was performed within the framework of this study. Use of an interferon inducer with various methods of administration in patients with diagnoses «ARVI» and «influenza» of moderate severity with an uncomplicated clinical course was studied.

Results and conclusion. Active co-circulation of numerous ARVI pathogens (influenza viruses, adenoviruses, parainfluenza viruses, metopneumovirus, bocavirus, coronavirus, etc.) was fixed. Such a large number and heterogeneity of ARVI pathogens requires the use of medicines that actively affect the entire group of viruses. The type of reported morbidity associated with respiratory viruses is very diverse and has undergone a pronounced transformation in recent years. At the same time, active vaccination against influenza leads to changes in the course of the annual epidemic seasons for influenza and ARVI. A promising interferon inducer has been identified; it increases the body’s resistance to infectious effects and can be successfully used to treat viral respiratory infections.

Today, about 30 infectious diseases can be prevented by vaccination. Successful vaccination of the population can prevent at least 2-3 million deaths per year from various infections. Unfortunately, to date, anti-epidemic measures throughout the world have led to the complete elimination of only one infectious disease - smallpox. At the same time, the incidence and mortality from infectious diseases remains at a fairly high level, and WHO has compiled a list of 9 infections that cannot be prevented by vaccination today, and the development of vaccines for the prevention of these diseases is one of the priorities of public health. The WHO also believes that vaccine development must move faster as the world prepares for the emergence of a new pandemic of yet unknown disease, «Disease X». In this regard, the production of new vaccines presents enormous challenges in terms of studying the target pathogens for future vaccine candidates, as well as achieving the desired results to prevent the development of epidemics and pandemics.

Atrophic gastritis is defined as the loss of gastric glands, with or without metaplasia, in a setting of chronic inflammation caused by autoimmunity or due to Helicobacter pylori infection. Gastrointestinal manifestations of the disease are nonspecific. The destruction of parietal cells in the stomach determines the decrease or cessation of hydrochloric acid secretion. Under conditions of hypochlorhydria, the absorption of micronutrients is disturbed, which leads to the formation of iron and vitamin B₁₂ deficiency anemia. All patients with atrophic gastritis should be screened for Helicobacter pylori infection. In the case of a negative result, the diagnosis of autoimmune gastritis is necessary. Regardless of the etiology, the diagnosis of atrophic gastritis must be confirmed morphologically with the definition of the stage of the process. Severe atrophy (stage III/IV according to the OLGA system) is a risk factor for the development of gastric adenocarcinoma. Another consequence of atrophy in autoimmune gastritis is the formation of a neuroendocrine tumor. Possible clinical outcomes determine the need for long-term and regular endoscopic and morphological follow-up. Autoimmune gastritis is often combined with other autoimmune diseases, among which thyroid diseases are the most common. The article presents a clinical observation of severe autoimmune atrophic gastritis in a young woman. The main manifestations of the disease were iron, vitamin B12-deficiency anemia and diffuse goiter with thyrotoxicosis, the trigger for the formation of which was a SARS-CoV2 infection. The clinical situation is discussed by hematologist, endocrinologist and gastroenterologist.

Still’s disease in adults (ADS) is a rare systemic autoinflammatory disease. Fever, arthralgia, rash, and neutrophilic leukocytosis are dominating in its clinical picture. These indexes let doctors to suspect infectious diseases, sepsis and prescribe antibiotic therapy, which is ineffective. Article presents a case of a disease that debuted with high fever, shortness of breath, severe weakness and myalgia. Female patient was diagnosed according to the present symptoms, laboratory signs, taking into account the criteria of Yamaguchi M. et al. and by excluding infectious and autoimmune diseases, malignant neoplasms. Treatment with corticosteroids resulted in complete clinical remission.

Treatment of acute gouty arthritis involves the use of anti-inflammatory medicines (NSAIDs, glucocorticosteroids, colchicine), but their use in comorbid patients may be limited by contraindications or associated with risk of significant adverse effects. The second part of the article discusses the features of drug therapy for gouty attacks in patients with the most common diseases and clinical conditions.

On March 11, 2023 in Moscow, leading experts in the field of therapy, infectious diseases, otorhinolaryngology, virology and clinical pharmacology discussed current approaches to the treatment of acute respiratory viral infections and influenza within the Expert Council.

Novel coronavirus infection has led to high morbidity and mortality throughout the whole world. There are several genovariants of the SARS-CoV-2 virus, including Delta (B.1.617.2) and Omicron (B.1.1.529). Delta variant is associated with more severe course of infection, while Omicron resulted in a significant increase in the total number of infected individuals. Upper respiratory tract damage symptoms and fever remain the most common symptoms of COVID-19, but extrapulmonary complications affecting the cardiovascular, central nervous system, and gastrointestinal tract may also develop. Proactive treatment before the full symptom complex of life-threatening conditions (pneumonia, ARDS, sepsis) develops is a major challenge in COVID-19 control. Prescribing of medicines that can reduce the production of key factors of the hyperinflammatory response in COVID-19, in particular cytokines interleukin 6 and interleukin 8, could be considered to be a promising direction in pathogenetic therapy of the disease.

Musculoskeletal pathology is one of the main medical and social problems in modern healthcare and are the most common cause of chronic pain. Osteoarthritis (OA) and periarticular soft tissues pathologies are prominent examples of this group of diseases. The main goals of their treatment include reducing pain, improving the functional condition and preventing the development of joint deformity, improving the quality of life of patients, as well as minimizing the side effects of pharmacotherapy. Local therapy with the use of hyaluronic acid is considered to be a promising direction in therapeutic interventions for these diseases. Numerous meta-analyses have shown that hyaluronic acid is well tolerated and has a full therapeutic effect (pain reduction, improved joint function) comparatively with placebo and other remedies. Currently, new data are appearing on the use of hyaluronic acid in case of periarticular tissues pathologies, which indicates the need for a more in-depth study of this method of therapy. Current review discusses modern aspects of the local application of hyaluronic acid in osteoarthritis and periarticular soft tissues pathologies.

Normally, earwax is removed spontaneously during movements of the temporomandibular joint, however, under certain conditions, so-called sulfur plugs can form, which are a common reason for patients to seek medical help. One of the effective methods of removing sulfur plugs is cerumenolysis. The article presents the results of an observational study involving 60 patients, performed in 2022 at the Department of otorhinolaryngology of A.I. Yevdokimov Moscow State University of Medicine and Dentistry. The purpose of this study was to evaluate the clinical effectiveness of the use of the cerumenolytic A-Cerumen Plus in the presence of sulfur plugs and after their removal as a means of prevention. The results indicate that A-Cerumen Plus is effective in patients with sulfur plugs and can be used both in both dissolving sulfur plugs and preventing their re-formation.

Functional constipation is a very common problem that naturally accompanies a sedentary lifestyle and unhealthy eating habits of a modern person. Currently, it is increasingly disturbing not only the elderly, but also young people. Background motivations for such violations could be developed even in early childhood. «Habitual» constipation is a constant physical discomfort, psycho-emotional disorders, general decrease life quality and work productivity. Among the typical consequences of systematic stool retention are also hemorrhoids, anal fissures, rectal prolapse, diverticulosis and inflammatory bowel disease, increased risk of colorectal cancer, etc. When it is not possible to normalize the rhythm of defecation and the consistency of the stool by making changes in habitual lifestyle and diet, there becomes obvious a need for the use of laxatives. But they do not always meet the expectations of the patient, and their long-term use often leads to the development of addiction and undesirable effects. This can be avoided by using the possibilities of balneotherapy as an alternative to medicaments.

On March 25, 2023, the XVIII All-Russian Scientific and Practical Conference of Young Therapists on Topical Issues of Internal Pathology "Zavadsky Readings" took place in Rostov-on-Don. It was dedicated to the memory of a student of Academician I.P. Pavlov, a prominent representative of the Russian and one of the founders of the Rostov regional therapeutic school, Professor Igor Vladimirovich Zavadsky.

On March 28, 2023, the III All-Russian meeting of student scientific circles (SSC) "The use of genetically engineered biological preparations in the treatment of internal diseases" was held. The event was organized at the initiative of the section of young therapists of the Russian Scientific Medical Society of Therapists (RNMOT).