Therapy

There is a large amount of data concerning the mutual negative influence of bronchial asthma (BA) and obesity. At the same time, data on the peculiarities of the multimorbid course of BA and osteoarthritis (OA) are currently limited.

The aim: to study the influence of OA at clinical course of bronchial asthma in combination with obesity, as well as physical activity (PA) and quality of life (QL) in this group of patients.

Material and methods. The study included 137 patients with bronchial asthma (73.7% female, 26.3% male patients). Median age was 54 years [47; 60]. The participants were divided into two groups: 1st – persons with BA without OA (n = 46), 2nd – with BA and OA (n = 91). All patients underwent radiography of knee and hip joints, spirometry, assessment of the Lequesne algofunctional index, determination of interleukin 4 (IL-4), IL-6, tumor necrosis factor-alpha (TNF-α), blood leptin level, oxidant-antioxidant status. PA was assessed using ODA23+ and IPAQ questionnaires, QL – using AQLQ questionnaire.

Results. Formed groups differed by BA control level (p = 0.0000), also by the main spirometric indexes: forced expiratory volume in 1 second (FEV1; p = 0.0000), forced vital capacity (FVC; p = 0.0108), FEV1/ FVC (p = 0.0055). In the group of patients with BA and OA, there were significantly more patients with obesity and uncontrolled BA. A positive correlation was found between the stage of OA and the level of IL-4, IL-6, leptin, general oxidative status, and a negative correlation – with FEV1 and FVC. BMI indicators also had a positive correlation with concentrations of IL-4, IL-6, leptin, general oxidative status, and a negative correlation with FEV1 and FVC. In the group of patients with BA and OA, there were fixed lower indexes of life quality (through all AQLQ scales) and physical activity according to the results of ODA23+ questionnaire (p = 0.0000), general physical activity according to IPAQ (p = 0.0000) and energy expenditure ≥ 3 MET (p = 0.0000).

Conclusion. The combination of BA, obesity and OA is a little-studied multimorbidity, which, however, is widespread and negatively affects the control of BA, severity of OA, and the prognosis of these pathologies. The results of the presented study indicate a negative influence of OA at physical activity and life quality of patients with bronchial asthma.

Currently, there are very few studies on the frequency and nature of food sensitization in cases of isolated bronchial asthma (BA) and BA in combination with H. pylori-associated chronic gastritis (Hp-ACG).

The aim: to estimate the frequency and nature of food sensitization in patients with isolated BA and BA in combination with Hp-ACG.

Material and methods. 85 patients with bronchial asthma (BA) were divided into two groups: 1st group (main) – patients with BA in combination with Hp-ACG (n = 50), 2nd – patients with isolated BA (n = 35). All the participants of the research underwent clinical, laboratory, instrumental and allergological examination.

Results. In patients with isolated BA and BA in combination with Hp-ACG, very high and high levels of specific IgE and IgG to various food allergens (cow’s milk, pork, beef, chicken, cod, wheat, buckwheat, oatmeal) were identified. The most clinically significant food sensitization was observed in patients with severe uncontrolled BA in combination with Hp-ACG.

Conclusion. Food sensitization is a characteristic feature in patients with isolated BA and BA in combination with Hp-ACG. In case of severe persistent clinical course, frequent BA exacerbations, lack of the control over disease, it is necessary to check the level of total IgE and specific food IgE and IgG to study the nature and frequency of food sensitization and also for performing rational pharmacotherapy for patients with both isolated BA and in the case of comorbidity of BA with Hp-AHG.

Determining the prognosis in patients with a wide range of atherosclerosis clinical manifestations is quite difficult and requires integral parameters, which may include the same as skin autofluorescence (SAF) parameter.

The aim: to establish the prognostic significance of non-invasively determined SAF as a factor of cardiovascular complications and mortality.

Material and methods. Prospective study included 122 male patients hospitalized with peripheral arterial disease (PAD) and 31 male patients with acute coronary syndrome diagnosis. Clinical, anthropometric, biochemical, as well as instrumental parameters of heart and blood vessels were studied using methods of ultrasound investigation. To determine SAF, we used an original device developed by the authors. Control group consisted of 35 practically healthy male patients. The prospective part of the study was performed for up to 1043 days (average 736 days).

Results. SAF values did not differ in the main study groups, but were significantly higher than those in the control group (p < 0.001). SAF positively and significantly correlated with scores on the scale of clinical prognostic signs with chronic arterial insufficiency, the fact of previous operations on the arteries of lower extremities and Syntax coronary stenosis index. During observation period, 7 deaths and at least one hospitalization for cardiovascular reasons in 58 patients took place. Use of logistic and Cox regression methods in the group of PAD patients made it possible to establish that hospitalization or mortality was associated with SAF and plasma glucose, and also with the presence of chronic heart failure above functional class 1. The parameters of the constructed ROC-curve were as following: AUC = 0.73 (sensitivity 71%, specificity 68%). The use of a combined group of patients with coronary heart disease (n = 139) as a test sample was characterized by acceptable model quality: AUC = 0.75.

Conclusion. SAF parameter reflects the processes of remodeling of the cardiovascular system and can be used as an integral independent predictor of complications in patients with different clinical forms of atherosclerosis.

Antihistamine drugs have been used in the treatment of allergic diseases for over 70 years. The first H₁-antihistamines of the 2nd generation were synthesized in 1980s. These medicines in therapeutic doses are selectively interacting with H1-histamine receptors, they are well tolerated, have virtually no sedative effect, their duration of action is 24 hours. According to clinical recommendations, currently it is non-sedating 2nd generation antihistamine remedies that are considered to be drugs of choice for the treatment of allergic diseases, in particular allergic rhinitis and conjunctivitis. According to clinical studies and real clinical practice, one of the most studied drugs in this group is cetirizine, the experience of clinical use of which is more than 30 years. Article summarizes the available data on the efficacy and safety of this drug in patients with seasonal and year-round rhinitis and conjunctivitis.

Asthenia often occurs both among people who are not going to the doctor, and patients from general medical network and psychiatric institutions. Asthenic symptoms are observed at all stages of the course of coronavirus infection, as well as in the structure of long-lasting post-Covid syndrome. One of the well-proven antiasthenic remedies today is sulbutiamine (Enerion). Peculiarities of chemical structure and mechanisms of action allow it to penetrate the blood-brain barrier and influence the central components of pathogenesis of asthenia having various origins in different age groups of patients. Antiasthenic effect of the drug occurs quickly, is characterized by procognitive, anti-anxiety, vegetostabilizing effects and is not accompanied by hyperstimulation, excessive sedation, or other significant adverse effects. Currently, Enerion could be considered as an optimal antiasthenic remedy in a wide range of patients.

Any antibacterial pharmacotherapy is characterized by a certain profile of efficacy and safety. At the same time, some antibiotics, and vancomycin in particular, have a high degree of toxicity, and therefore their use is associated with a high risk of developing various adverse reactions. This, in turn, requires extremely strict adherence to the principles of rational antibiotic therapy, clear indications for prescribing the drug, and a careful assessment of the dynamics of the patient’s clinical status. The aim of the article is to describe a clinical case of the development of linear IgA-dependent bullous dermatosis while taking vancomycin in a patient from the “vulnerable” group. Improving doctors’ competence concerning antibacterial therapy complications, including rare ones, in our opinion, will make it possible to timely adjust the tactics of managing “difficult” patients in order to increase its safety.

The article describes a case of detection of a clinical sign of kidney cancer during an outpatient examination of 55-year-old patient with suspected acute respiratory viral infection, which turned out to be a manifestation of synchronous kidney cancer with metastasis to the pancreas. During a physical examination in the left hypochondrium, the doctor discovered a dense formation up to 10 cm in size, painless by palpation. According to the results of computed tomography of abdominal organs and retroperitoneal space with contrast enhancement, a retroperitoneal formation on the left and a formation of the pancreas tail were identified. Subsequently, in the hospital, the patient underwent left nephradrenalectomy, right kidney resection, and pancreatic resection with splenectomy. Current observation emphasizes the importance of regular preventive examinations and medical screenings, as well as the importance of performing an objective physical examination of the patient at every visit to the doctor in order to identify signs of malignant neoplasm as early as possible.

Some authors consider allergic rhinitis as an independent risk factor for obstructive sleep apnea development. The main mechanisms of such a comorbidity are considered to be an increase in airway resistance and decrease of pharynx diameter as a result of nasal mucosa swelling and difficulty in nasal breathing. Proinflammatory mediators playing an important role in the pathogenesis of allergic rhinitis, such as histamine, leukotrienes, proinflammatory interleukins, can contribute to the progression of obstructive sleep apnea syndrome. The article presents currently available data on the pathogenesis of the comorbidity of allergic rhinitis and obstructive sleep apnea and the possibilities of treatment for patients with such kind of pathology.

Article discusses the causes of cough, briefly introducing their classification, diagnostic algorithms, differential diagnosis and treatment. A clinical case of managing a patient with rhinosinusitis and exacerbation of chronic bronchitis is described.

At the Council of experts, held in January 2024 under the auspices of RSMSIM, the aspect of using innovative technologies and the prospects for complex treatment of comorbid conditions in therapist’s practice was considered. Treatment of chronic cerebral ischemia and cognitive impairment (CI) of mild to moderate severity in comorbid patients is recognized to be one of the most actual problems of modern medicine. When correcting iron deficiency anemia, it is preferable to use choline alfoscerate and iron protein succinylate as first-line medicines. In routine practice, we often meet complaints of CI in both elderly, young and middle-aged patients. At the same time, it is advisable to actively search for CI among high-risk patients. Treatment of CI should be carried out in accordance with generally accepted recommendations for management of patients with diseases that lay as their cause. It is also advisable to optimize lifestyle, timely correction of vascular risk factors and neuroprotective therapy with drugs that affect the general pathophysiological mechanisms of CI.

Excessive inflammatory response taking place during respiratory tract infections, including COVID-19, influenza and other seasonal acute respiratory viral infections (ARVI), is a critical factor of endogenous damage of the organism and a key target for therapeutic interventions in patients with these diseases. In 2022, innovative drug Aterixen^® (ХС221GI), with the ability to block/ prevent virus-induced release of pro-inflammatory cytokines and chemokines, was approved for the treatment of mild forms of COVID-19 in Russia. In 2023, indications for use of the drug were expanded to include influenza and other seasonal ARVI. Current narrative review analyzes the results of recently published two randomized placebo-controlled clinical trials and one observational study of Aterixen^® in patients with COVID-19, as well as one randomized placebo-controlled trial in patients with influenza and ARVI. The presented data indicate that Aterixen^® blocks universal chains in the pathogenesis of viral respiratory diseases of different etiologies and has a positive effect on their clinically significant outcomes. That allows to formulate convincing recommendations for the use of this medicine in the complex therapy of COVID-19, influenza and other seasonal ARVIs.

Gastrointestinal bleeding (GIB) is a serious complication of antithrombotic therapy. According to the data of Russian single-center prospective register of long-term antithrombotic therapy REGATA, a significant proportion of patients with stable coronary heart disease receiving antiplatelet agents and patients with atrial fibrillation using oral anticoagulants have concomitant pathologies of the gastrointestinal tract (GIT) and a high risk of GIB. At the same time, the frequency of prescribing gastroprotectors is insufficient for effective prevention of bleeding. Moreover, taking proton pump inhibitors (PPIs) alone did not fully reduce the risk of GIB arising. In accordance with the “Expert consensus on reducing the risk of gastrointestinal bleeding in patients receiving oral anticoagulants”, experts recommend prescribing PPIs in combination with rebamipide to protect the mucous membrane throughout all gastrointestinal tract. At the same time, unlike PPIs, the duration of use of which should be limited due to the risk of serious adverse events, rebamipide for the purpose of gastroprotection could be used indefinitely.