Volume 10, Nº 7 (2024)

High mortality rates among COVID-19 patients hospitalized in 2020–2022, especially among patients over 60 years of age, make necessary the early diagnosis of COVID-19 and assessment of complications and death risk in order to provide timely treatment and supply preventive measures implementation to avoid adverse outcomes of the disease.

The aim: to develop a prognostic model using artificial intelligence (machine learning) to predict adverse outcomes in elderly patients hospitalized with COVID-19 at the initial stage of the disease.

Material and methods. A single-center retrospective cohort study of 263 patients hospitalized with COVID-19 from March 2020 to December 2022 was performed. Multiple logistic regression was used to build a forecasting model.

Results. During the process of multivariate analysis, 23 most important indexes associated with a fatal outcome were identified from 200 different indexes obtained in COVID-19 patients aged 60 years and older. These 23 indexes later were subsequently included in the model for predicting an unfavorable outcome: age, clinical and instrumental examination data (thermometry, pulse oximetry and respiratory rate counting) taking into account polymorbidity (the presence of certain chronic diseases) and anamnestic data (previous anti-COVID vaccination, therapy carried out at the outpatient stage). During the study, a predictive model for assessing the threat of an unfavorable outcome of COVID-19 was developed. The accuracy of the suggested method at the development stage was 80.4 [76.2; 84.6] %, sensitivity – 79.2 [72.6; 84.8] %, specificity – 81.7 [76.4; 87.4] % and ROC-AUC – 88.3 [84.7; 91.5] %. At the testing stage, similar indexes were as following: accuracy – 71.7 [60.4; 81.1] %, sensitivity – 70.6 [50.0; 88.2] %, specificity – 72.2 [59.0; 83.9] %, ROC-AUC – 78.9 [67.0; 88.8] %.

Conclusion. A model for predicting the risk of an adverse outcome of COVID-19 arising in hospitalized patients of older age groups has been developed and tested. It demonstrates high specificity and has undoubted practical value.

Probiotic cocktails are a complex of pro-, meta- and prebiotics in a liquid nutrient solution, which can play role of a substrate for maintaining the metabolic activity of normobiota.

The aim: to estimate the dynamics of a number of somatopsychic status indexes and parameters of intestinal microbial-tissue barrier in convalescents with mild forms of COVID-19 taking a course of functional products in the form of biococktails.

Material and methods. Open observational study was performed in 2021–2023. 150 individuals aged 20–55 years with mild forms of COVID-19 were observed. The main group received a course of biococktails for 28 ± 2 days. Parameters of subjective well-being and asthenia manifestations were studied using the Giessen questionnaire of psychosomatic complaints, FSS asthenia severity assessment scales and MFI- 20 subjective asthenia assessment. Laboratory stage of the research included a study of the level and spectrum of short-chain fatty acids (SCFA) in stool. Permeability of the intestinal epithelial barrier was estimated by studying the dynamics of the alpha-1-antitrypsin (AAT) level in stool.

Results. In the main group, a significant decrease in the parameters of somatopsychic manifestations on the scales of “rheumatic factor” (p = 0.000003), “exhaustion” and “stomach complaints” (p = 0.000024), “heart complaints” (p = 0.001124), “pressure complaints” (p = 0.0000001), the sum of points of all scales on the FSS questionnaire (p = 0.000019), as well as the values of the subscales “general asthenia” and “physical asthenia” (p = 0.002) on the MFI-20 took place. In the comparison group, there was no significant dynamics of similar indexes. The initial study of SCFA in stool showed that initially in both groups there was a decrease in the absolute content of all types of acids. The level of AAT in stool in the dynamics of the study was two times lower than the initial level (16.544 ± 1.047, 8.078 ± 3.944, p = 0.041).

Conclusion. A positive influence of biococktails at the dynamics of the parameters of somatopsychic status and microbiocenosis in COVID-19 convalescents was found, which contributed to the restoration of their subjective well-being and functional activity.

Combination of acute respiratory viral infection (ARVI) and allergy is characterized by a complex interaction and mutual influence of two pathological processes.

The aim: to find clinical and immunological peculiarities of seasonal ARVI in patients with concomitant allergic rhinitis (AR) in the remission stage, to determine the efficacy of various drug therapy options in such kind of patients.

Material and methods. 88 patients with uncomplicated ARVI were involved in the study. Group 1 included 32 persons with ARVI and seasonal AR who received recombinant interferon alpha-2b (IFN- α-2b) with antioxidants (VIFERON^®). The same treatment regimen was received by the 2nd group of 29 patients with ARVI without allergy. Group 3 included 27 persons with ARVI without allergy who used umifenovir. The control group consisted of 30 conditionally healthy individuals.

Results. Concentration of IFN-α in the blood serum and the proportion of cells expressing CD118+ among peripheral blood lymphocytes in patients with ARVI + AR before treatment significantly exceeded this index in conditionally healthy patients. In patients with ARVI without allergy, the level of induced IFN-α production was significantly higher than in conditionally healthy patients and patients with ARVI and AR. After treatment, in both groups, concentration of serum and induced IFN-α decreased to the conditional norm, there was a tendency for increasing the levels of CD118+ and CD119+.

Conclusion. In the early stages of ARVI development, patients with AR in remission were found to have a decreased ability of blood cells to produce IFN types I and II in response to stimulation comparatively to patients without allergy. Comparison of the clinical efficacy of two treatment options in patients with ARVI revealed that the combination of nasal and rectal forms of recombinant IFN-α-2b with antioxidants (VIFERON^®) is more effective than use of umifenovir in stopping clinical manifestations of ARVI in the presence of almost identical virological efficacy.

Chronic systemic inflammation (SI) in chronic obstructive pulmonary disease (COPD) is accompanied by reactivity of endothelial cells and connective tissue elements. An important aspect of practical medicine is the correlation of SI and endothelial dysfunction (ED) biomarkers with phenotype of the disease.

The aim: to evaluate the diagnostic value of SI and ED markers in the formation of COPD phenotypes.

Material and methods. 78 COPD patients (73% male and 27% female) were examined. The median age of the participants was 61 (95% confidence interval: 58.9–62.4) years. Classification criterion was the phenotype of the disease: group 1 – 40 patients having COPD with a bronchitis phenotype, group 2 – 38 patients with an emphysematous phenotype, the control group – 18 practically healthy individuals. To assess the severity of SI and ED, the level of fibrinogen, C-reactive protein, tumor necrosis factor-alpha (TNF-α), soluble form of intercellular adhesion molecule-1 (sICAM-1) in the blood serum, the concentration of human platelet-derived growth factor AA in saliva, vascular endothelial adhesion molecule type 1 in the blood serum, Willebrand factor related antigen were determined.

Results. The development of COPD is characterized by SI, ED, and hemostatic stress regardless of the disease phenotype. The threshold value of the TNF-α level for the formation of the bronchitis phenotype was ≥ 12 pg/ml, the ICAM-1 level for emphysematous phenotype formation was ≥ 234.5 pg/ ml. The activity indexes of TNF-α and sICAM-1 are a more specific marker of the severity of SI and ED. An increase in the activity of vascular endothelial adhesion molecule type 1 and human platelet-derived growth factor AA in patients with COPD can be used as a diagnostic marker for the development of ED.

Conclusion. Diagnostic significance of TNF-α and ICAM-1 biomarkers for differentiating between bronchitis and emphysematous phenotypes of COPD is confirmed.

The main aim of orthognathic operations is to restore dental occlusion, oral functions and facial proportions, and from the point of view of long-term prognosis – to improve life quality of patients.

The aim: to compare life quality of patients underwent orthognathic surgery, taking into account their drug therapy adherence.

Material and methods. 29 patients (14 men and 15 women) aged 26 to 32 years after bilateral sagittal plane osteotomy were involved in the study. Experimental psychological study included the use of SF-36 (36-item short-form health survey) and OHIP-14 (Oral Health Impact Profile-14) questionnaires. All participants were prescribed meldonium 500 mg 3 times a day in the postoperative period (day 15). The course of treatment was 45 days. In the process of studying treatment efficacy, two groups were formed: group 1 – 16 patients with high adherence to treatment, group 2 – 13 patients with low adherence to treatment. The control points for estimation were 14th, 30th and 60th days after orthognathic correction.

Results. Experience in assessing adherence to therapy in patients who underwent orthognathic surgery showed that the use of meldonium in this case is quite effective method. On the 60th day of the postoperative period, the study participants showed positive dynamics in life quality status according to SF-36 scale, expressed in a significant improvement in physical and emotional condition, daily functioning, general health, and vitality. The total score on the OHIP-14 scale was 7.1 points and corresponded to a slight decrease in dental health (within 7–15 points).

Conclusion. Meldonium can be used in the complex treatment of patients after orthognathic surgery. High adherence to meldonium treatment is associated with positive dynamics of quality of life and dental health of patients who have undergone bilateral sagittal split osteotomy.

Considering the necessity for secondary brain stroke prevention in patients with atrial fibrillation, it is important to comparatively evaluate the efficacy and safety of various oral anticoagulants used for this purpose.

The aim: to compare the clinical efficacy and safety of the main strategies used for secondary prevention of ischemic brain stroke based on published data from real clinical practice.

Material and methods. PubMed (MEDLINE), Scopus, and eLibrary data bases were searched using key words that included drug names or generic names of anticoagulant drugs and words describing indications for their use for secondary prevention in stroke patients.

Results and conclusion. During initial literature search 12,992 results from Pubmed, Scopus, and eLibrary were obtained. Eighteen studies were included in the systematic review. In most studies comparing apixaban with warfarin, warfarin was associated with a lower risk of stroke and systemic embolic complications, as well as major bleeding, especially intracranial hemorrhage and gastrointestinal bleeding. Apixaban is associated with little difference in the incidence of stroke and any thromboembolic events in real-world clinical practice compared with other direct oral anticoagulants and warfarin. Analyzed research works demonstrated a better safety profile for apixaban comparatively with warfarin, dabigatran etexilate, or rivaroxaban.

Chronic kidney disease (CKD) is a global health problem due to its high economic costs and its impact on increasing cardiovascular morbidity. Asymptomatic clinical course of CKD leads to extrapolation of the prevalence of end-stage renal failure to CKD prevalence in general. In order to study the incidence of this disease throughout the world, the authors searched for scientific publications in the PubMed, Scopus, and eLibrary databases. They analyzed 32 literary sources, where various aspects of the identified topic were discussed. Current review demonstrates the high relevance and social significance of the problem of CKD in all countries of the world due to its high frequency (from 6.86 to 34.3% in different countries), low level of detection in the early stages, evident comorbidity and complexity of preventive measures performing. Determining the current prevalence of CKD is necessary to allocate health care resources for the prevention, early diagnosis and treatment of CKD.

Article presents a clinical case of mixed malaria infection caused by Plasmodium falciparum and Plasmodium ovale. Due to the pathogenic properties of the causative agent of tropical malaria and the delay in the starting of medicamentous treatment, the patient developed complications such as cerebral edema (cerebral form of tropical malaria) and multiple organ failure in 7 days after the onset of clinical signs. After 3 weeks of his recovery and discharge from the hospital, he was hospitalized with fever syndrome in the infectious diseases hospital. During the second hospitalization, he was diagnosed with ovale malaria. Current clinical case illustrates the possibility of developing a mixed infection with different incubation periods of pathogens. It is necessary to remember the resistance to antimalarial therapy of the second pathogen, which was in the incubation period at the time of treatment. Clinical observation also demonstrates the objective difficulties of timely diagnosis of malaria at the outpatient stage. Late initiation of treatment led to the development of severe life-threatening complications, which confirms the need for a thorough diagnostic search in patients with fever, careful study of the epidemiological history.

Incidence of acute respiratory viral infections (ARVI) is rapidly increasing and often accompanied by the development of complications and an increase of the number of hospitalizations. Virus-induced inflammation is characterized by contamination of endothelial cells with the development of their pathological activation, as well as increased production of cytokines, which causes structural tissue damage and accelerates viral spreading. To counteract this, XC221GI medicine with selective antichemokine action was developed. It prevents the development of hyperinflammatory immune response, reduces the viral load and leads to acceleration of ARVI resolving and to improved prognosis in the whole. The prescription of this drug does not require molecular diagnostics of a specific virus due to the similarity of immune-mediated inflammatory pathways during infection with various pathogens, and the mechanism of action does not limit its use in combination with traditional antiviral drugs, which allows us to consider XC221GI as a drug of choice in patients with ARVI.