Vol 9, No 7 (2023)

Currently, inflammatory bowel diseases with an autoimmune type of lesion (ulcerative colitis, Crohn’s disease) occupy a leading position among gastrointestinal tract (GIT) pathologies. Changes in the generic composition of the intestinal microbiota may be an early diagnostic sign of autoimmune inflammation.

The aim: to assess the biodiversity of the gut microbiota in patients with ulcerative colitis (UC).

Material and methods. 16s-RNA genetic sequencing (the main method for studying intestinal microbiota) was carried out on 40 persons – 20 patients with UC of varying severity (main group) and 20 somatically healthy individuals (control group). In all patients, the diagnosis of UC was previously verified accordingly to the results of colonoscopy and targeted biopsy followed by histological examination. The severity of the course of UC was identified by Mayo index. In addition, laboratory diagnostics was carried out. It contained the estimation of indexes of general and biochemical (CRP) blood tests in both study groups. The average age of examined patients was 42±3,5 years.

Results. When assessing laboratory parameters, patients with UC showed leukocytosis (11,4±0,68 g/l), as well as an increase in CRP (9,6±1,5 mg/l) comparatively to the control group. When interpreting Mayo index, most patients had an average severity of the underlying disease. As a result of sequencing of the intestinal microbiota in the main group, comparatively to the control one, a significant decrease in representatives of the normal intestinal microflora – the main producers of short-chain fatty acids, and an increase in bacteria of the pathogenic cluster and sulfate-reducing bacteria were revealed.

Conclusion. A significant decrease in normal microflora and an increase in the pathogenic cluster of bacteria in patients with UC were found. The obtained data can form the basis for improving the diagnosis of this pathology.

Despite the presence in clinical practice of various methods for hepatic fibrosis estimation, assessing the functional state of that organ remains a serious problem for specialists in various areas of clinical medicine.

The aim: to evaluate and compare the results of laboratory and instrumental research methods with a non-invasive ¹³C-methacetin analog test (¹³C-MDT) for liver function estimation.

Material and methods. During the study, in patients with chronic liver diseases (CLD) of various etiologies, indexes of clinical and biochemical blood tests, coagulograms were measured, also results of ¹³C-MDT were studied. Liver fibrosis was assessed according to current standards. 13C-MDT was performed to characterize the functional reserve of the liver, which was assessed by the rate and volume of substrate metabolism (¹³C-methacetin) in the cytochrome P450 1A2 system.

Results. During the study, threshold indexes for the level of platelets, INR, albumin as biochemical markers of liver damage were identified. The values of the cumulative dose of ¹³CO₂ for ¹³C-MDT in CKD have been identified, which allow predicting the risk of fibrosis

Conclusion. Differences identified in the results of clinical and laboratory research methods between groups can be used as differential diagnostic criteria for severe fibrosis and cirrhosis of liver. In the future, using the obtained data, it is planned to identify laboratory markers that can be used for early diagnosis of a pronounced stage of fibrosis. It is possible to use laboratory markers of fibrosis in combination with ¹³C-MDT for early diagnosis of severe fibrosis and cirrhosis of the liver.

Hyperuricemia is an independent risk factor for a wide range of internal organs’ diseases.

The aim: to examine the correlations between asymptomatic hyperuricemia (ASH) and chronic kidney disease (CKD), as well as the effect of drug urate-lowering therapy (ULT) at glomerular filtration rate (GFR) in patients with osteoarthritis (OA).

Material and methods. A retrospective cohort study including data of 1026 OA patients – 530 with BGU and 496 with normal serum uric acid (UA) values was performed. To determine the dynamics of eGFR indicators, its correlation with UA levels in the blood serum and medicamentous ULT, a cohort of patients was selected during a follow-up visit to the research center. A threshold of <360 μmol/L was fixed as target levels (TL) of serum UA. All patients received non-drug therapy aimed at ASH eliminating. Drug ULT was prescribed for persistently elevated UA level in the blood serum despite non-drug treatment, as well as for the presence of cardiovascular risk factors. Xanthine oxidase inhibitors (xOIs) – allopurinol or febuxostat – were used for ASH correction.

Results. In the group of patients with OA having elevated UA levels in the blood serum, arterial hypertension, type 2 diabetes mellitus and obesity were detected significantly more often. Moreover, the presence of ASH was associated with higher levels of glucose, total cholesterol and creatinine in blood serum. Signs of CKD, urolithiasis and chronic pyelonephritis were also significantly more often found in OA patients with ASH. It was fixed, that adjusted odds ratio (OR) for a decrease of eGFR <60 ml/min/1,73 m2 in OA patients while increasing UA level in blood serum per 1 mg/dL should be 1,5 (95% CI: 1,4–1,7). In patients with OA in combination with ASH, who reached the sUA level in the blood serum, regardless of the treatment method, there was a significant increase in eGFR after 3–9, 6–12 and 9–15 months of therapy, while in patients with persistent ASH at the same time intervals, a decrease in eGFR was observed. Moreover, achieving the target value of serum UA led to a significant reduction in the probability of CKD progression after 6–12 months (OR 0,087; 95% CI: 0,011–0,701). In the group of OA patients with ASH who received xOIs, after 6–12 and 9–15 months, a significant increase in eGFR was recorded comparatively with patients receiving non-medicamentous treatment. Along with it, the use of drug ULT significantly reduced the probability of CKD progression after 6–12 (OR 0,252; 95% CI: 0,078–0,815) and 9–15 months (OR 0,216; 95% CI: 0,057–0,822).

Conclusion. According to the data from «Saint Petersburg city register of patients with gout and asymptomatic hyperuricemia», an increase in the level of sUA in the blood serum in patients with OA who do not have signs of gout is associated with a higher prevalence of kidney diseases and the severity of their clinical course. In patients with OA and ASH, getting a CV level of sUA in blood serum, including the same obtained by means of medicamentous ULT, can have a positive effect at eGFR and slow down CKD stage progression. The development of interdisciplinary algorithms for the diagnosis and management of patients with hyperuricemia at the stage of its asymptomatic clinical course is an important strategic task, the solution of which can lead to a reduction of the incidence and intensity of renal pathology progression.

Patients with immunoinflammatory rheumatic diseases are forming the risk group for COVID-19 severe clinical course.

The aim: to study the peculiarities of clinical course and outcomes of a novel coronavirus infection (NCI) in patients with rheumatic diseases (RD).

Material and methods. From March 2020 to February 2022 in the study were included 293 patients (77 males and 216 females) with significant RD and a history of COVID-19: 193 patients with rheumatoid arthritis (RA), 46 with ankylosing spondylitis (AS), 38 with psoriatic arthritis (PsA), 16 – with systemic connective tissue disease (SCTD). Average age of patients was 61,32 [55,25; 69], duration of RD at the moment of NCI – 14,06 [8; 17,5] years.

Results. Asymptomatic COVID-19 clinical course was fixed in 92 (31,4%), mild in 121 (41,3%), moderate in 59 (20,1%), severe in 21 (7,16%) patients. 201 patient had pulmonary damage of varying severity: CT-1 – in 94 (52,1%), CT-2 – in 69 (26,0%), CT-3 – in 22 (11,1%), CT-4 – in 16 (10,7%) cases. The study revealed the significant influence of coronary artery disease (post-infarction cardiosclerosis) and CHF at the increase in the volume of lung damage, as well as paroxysmal atrial fibrillation at the development of pulmonary fibrosis in COVID-19 case. From 293 patients, 37,1% required hospitalization in an infectious diseases hospital; 4,43% of NCI cases resulted in death. An increased risk of an unfavorable course of COVID-19 was associated with female gender, the presence of comorbid conditions and excess body weight, and the degree of activity of the underlying disease before infection with NCI.

Conclusion. The course of COVID-19 in RD patients is heterogeneous. A more severe course (CT-3–4) was more common in patients with CTD and RA. The type of RD therapy did not affect the severity of NCI, with the exception of rituximab use. High activity of RD before NCI and concomitant cardiovascular pathology play a significant role in the development of an unfavorable outcome of COVID-19.

Cancer-associated thrombosis affects the course, progression, and mortality of oncologic patients. Prognostication of thromboembolism probability in patients with malignant neoplasms (MN) remains to be a quite complicated task. Previously, we published the first results of a study that identified the most significant predictors of the risk of venous thromboembolic complications (VTEC) in malignant neoplasms patients that fit the criteria of the Khorana scale, and proved the role of D-dimer and sP-selectin in the development of cancer-associated thrombosis. In continuation of the work, we performed a search for risk factors of pulmonary embolism (PE) development in MN patients from the moderate-risk VTEC group to find further management tactics for this category of patients.

The aim: to study laboratory markers of the risk of developing PE in patients with malignant neoplasms from the group of moderate risk of developing VTEC in order to improve VTEC prognostication.

Material and methods. A cohort study with a prospective cohort was performed. In the course of this study, the data of laboratory assessments were evaluated: D-dimer, sP-selectin and their combined use in outpatients with malignant neoplasms from the group of moderate risk of VTEC developing.

Results. The study revealed threshold levels of D-dimer and sP-selectin as predictors of the development of PE in patients with malignant neoplasms. With a combined excess of the threshold value of D-dimer (>1,73 μg/ml) and sP-selectin (>309,4 ng/ml), the incidence of PE in MN patients from the moderate risk group according to Khorana scale increases to 95,1% (px² <0,001; RR 2,72; CI: 2,14–3,46).

Conclusion. Obtained results allow us to improve patient stratification by including biomarkers in multivariate predictive models for personalized VTEC risk assessment, which will contribute to the decision to start anticoagulant therapy of MN patients from the moderate risk group according to the Khorana scale.

In diabetic patients, the upper gastrointestinal tract is often affected. This pathology not only worsens the quality of life of patients, but can also lead to serious complications. The clinic and the course of diseases of the upper digestive tract have its own characteristics in patients with type 1 and type 2 diabetes mellitus. Knowledge of these features will allow doctors to correctly assess the condition and treat these patients. The review presents literature data and the results of our own research on the course and treatment of diseases of the esophagus, stomach and small intestine in patients with diabetes mellitus. Many years of experience of the authors on this subject may be useful to endocrinologists, gastroenterologists and therapists.

Interdisciplinary approach is the «gold standard» for treating obesity, but requires the patient to regularly visit the doctor. Research work in recent years has convincingly demonstrated the perspectives of telemedicine technologies’ implementation, which include remote consultation, use of mobile applications, activity trackers, etc. Telemedicine consultations (TMC) have enormous potential in providing medical care to patients with overweight and obesity. Current review shows the successful experience of foreign colleagues in TMC use for the treatment of obesity, allowing us to compare the effectiveness of this method with the classical approach to the treatment of the disease. Examples of works where smart applications were used to obtain remote consultations with nutritionists are given, and specific tools used in weight loss programs are shown.

Brain stroke is one of the main causes of morbidity and mortality worldwide. It causes great damage not only to the health of the patient, but also to the economy as a whole. Recently, there has been an increase in the frequency of strokes in young and middle-aged patients with chronic immunoinflammatory diseases. The article presents a description of ischemic stroke clinical case caused by cerebral artery atherothrombosis in a male patient with Crohn’s disease who does not have traditional cardiovascular risk factors.

The review article summarizes information about the problem of exacerbations of chronic obstructive pulmonary disease (COPD). The consequences of exacerbations of COPD on the progression of the disease and the risks of complications from other organs and systems are considered. The current data on the significance of various microorganisms for the occurrence of exacerbations of COPD are summarized. The information about the influence of the malnutrition factor on the characteristics of the course of COPD in patients and the possibility of its correction is being updated. The review identifies unresolved issues and the importance of further research in the described direction.

Article is devoted to the aspect of acute bronchitis (AB), which is one of the most actual problems of modern pulmonology and therapy. Most often, the cause of its development is a viral infection, and the clinical picture depends on the type of pathogen. AB treatment is determined by the characteristics of the etiopathogenesis of the disease, while an important component of complex therapy are mucoactive drugs that allow to control cough by changing the quantity and characteristics of bronchial secretions. Particular attention in the review is paid to N-acetylcysteine (NAC), which has a unique variety of pharmacological properties. The mechanism of mucolytic action of NAC is based on reducing the viscosity of sputum during coughing, increasing efficiency of mucociliary clearance and reducing the adhesive properties of sputum, which, in turn, helps reduce inflammation in the bronchial mucosa. Along with this, according to the results of clinical studies presented in the article, NAC, due to the presence of antioxidant properties, has a positive effect at the severity of various viral infections.

In recent years, it has been proven that there is a certain pattern in the long-term course of atrial fibrillation (AF): from asymptomatic, short episodes of arrhythmia to a stable permanent form of the disease, which creates the prerequisites for the progression of chronic heart failure and significantly worsens the prognosis for patients. The duration of the existence of paroxysmal or persistent form of AF in different patients can vary in a wide range – from several months to decades – and is interconnected with the severity of underlying disease. Paroxysmal AF persists for many years in only a small part of patients. Slowing the progression of AF from paroxysmal to permanent form improves the prognosis of patients, therefore, the assessment of risk factors for the progression of arrhythmia and prescription the correct tactics for managing patients are urgent tasks of modern cardiology.

Cough is one of the common reasons for seeking medical help. In many cases, the occurrence of acute cough is associated with acute respiratory infections. Studying the mechanisms of cough development during respiratory infections allows us to competently approach the choice of antitussive pathogenetic therapy. The use of a combination drug consisting of 3 components – salbutamol, bromhexine and guaifenesin – provides a comprehensive effect in the treatment of cough. The components of this combination act synergistically, effectively suppressing cough by changing the rheology of bronchial secretions and suppressing bronchial hyperreactivity. At the same time, guaifenesin is able to further reduce the undesirable effects of the β2-adrenergic agonist salbutamol on the central nervous system. The combination of salbutamol, bromhexine and guaifenesin has pronounced mucolytic, mucokinetic and bronchodilator effects and can be considered as the drug of choice for cough syndrome with a bronchoobstructive component.