Journal of Clinical Practice

Quarterly peer-review medical journal.

Editor-in-chief

Main handling editor

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About

The main idea of our journal is to provide description and analysis of clinical cases with severe, rare and difficult for diagnoses diseases, occurred in the clinics of Federal Medical-Biological Agency of Russia. Such clinical analysis is aimed to develop “clinical” type of thinking, always have been the characteristic feature of Russian/USSR medical school. The journal purpose is also to improve scientific discussions and cooperation between physicians of different specialties.

Revival of historical traditions in our journal is the one of the components of continuing education, which is especially important in “closed” territories, where doctors can`t regularly participate in clinical conferences. An important aspect is to provide a printed tribune for any doctor who has an interesting clinical observation and wish to share his experience with colleagues. That is why we named our journal "Clinical Practice" and address it, first of all, those skilled in applied medicine. Of course, we also publish the results of original researches, clinical guidelines, current reviews and medical news. The journal is multidisciplinary and we hope that it will be interesting to doctors of different specialties. The journal is published by means of the Federal Research and Clinical Center of FMBA of Russia. Placement of all materials, except for advertising, are free of charge to authors.

Types of accepted articles

  • reviews;
  • systematic reviews and meta-analysis;
  • original study articles;
  • case reports and series of cases;
  • letters to the editor;
  • hystorical articles 

The joutnal accept manuscripts in English and in Russian.

Publication, distribution and indexation

  • Russian and English full-text articles;
  • issues publish quarterly, 4 times per year;
  • no obligatory APC, Platinum Open Access
  • articles distribute under the Creative Commons Attribution-NonCommercial-NoDerivates 4.0 International License (CC BY-NC-ND 4.0).

Indexation

  • Russian Science Citation Index (elibrary.ru)
  • DOAJ
  • CrossRef
  • Dimensions
  • Google Scholar
  • WorldCat
  • Ulrich's Periodicals Directory
  • CyberLeninka

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Current Issue

Vol 14, No 2 (2023)

Original Study Articles

Efficacy of two-stage approach for interventional treatment of coexistent atrial fibrillation and typical atrial flutter for sinus rhythm maintenance in long-term: a prospective controlled clinical trial
Khamnagadaev I.A., Kovalev I.A., Bulavina I.A., Kokov M.L., Zotov A.S., Troitskiy A.V., Khamnagadaev I.I., Shkolnikova M.A., Kokov L.S.
Abstract

Background: Atrial fibrillation (AF) and coexistent typical atrial flutter (AFL) interventional treatment strategy remains unresolved in cardiology and cardiovascular surgery. Results of this approach remain suboptimal. There are several approaches to the interventional treatment of patients with coexistent AF and AFL: simultaneous pulmonary vein isolation (PVI) and cavotricuspid isthmus (CTI) radiofrequency catheter ablation (RFCA), PVI or CTI RFCA only and two-stage approach. To our knowledge, cumulative efficacy of two-stage approach has not been previously reported. The aim. This study aimed to evaluate the efficacy of two-stage approach for interventional treatment of coexistent AF and AFL for sinus rhythm maintenance in long-term. Methods: Patients (pts) (n=34) with AF and AFL aged 41–82 years (11 women) were divided into two groups (1:1): «One-stage Approach» (group 1; n=17): PVI+СTI RFСA and «Two-stage approach» (group 2; n=17): first stage — CTI RFCA (group 2.1); second stage — PVI in case of AF recurrence after RFCA (group 2.2). Primary endpoint (PEP) was defined as any recurrent atrial tachyarrhythmia at the end of follow-up; group 2 events have been considered after PVI. Secondary endpoint (SEP) — recurrent any atrial tachyarrhythmia in groups 1 and 2 after CTI RFCA in group 2. PEP and SEP were evaluated at the end of the «blind period» (3 months after procedure). Results: Registered recurrent atrial tachyarrhythmia in pts who reached PEP or SEP was AF. AFL has not been detected in any cases. PEP was noted in 8 (47.06%) pts in group 1 and 1 (5.88%) pts in group 2. Further, SEP was observed in 3 pts (17.65%) in group 1 and in 4 (23.53%) pts in group 2 (p=0.671). The probability of long-term maintenance of sinus rhythm was significantly higher in «Two-stage approach» than in «One-stage approach» (94.12% and 52.94%, respectively, p=0.001). Significant differences in procedure length and fluoroscopy time have been found. Those were longer in group 1 compared to group 2.1 (p <0.001) and in group 2.2 compared to group 2.1 (procedure duration — p <0.001; fluoroscopy time — p=0.013). No differences were noted in length of procedure and fluoroscopy time between groups 1 and 2.2 (p=0.374 and p=0.028, respectively). Conclusion: The «two-stage approach» for interventional treatment of coexistent AF and AFL results in better long-term arrhythmia-free survival than «one-stage approach» (94.12% and 52.94%, respectively, p=0.001). CTI RFCA alone in pts with coexistent AF and AFL cause 23.53% AF recurrence rate and associated with shorter procedure duration and fluoroscopy time compared to simultaneous PVI and CTI RFCA (p <0.001).

Journal of Clinical Practice. 2023;14(2):5-18
pages 5-18 views
Features of therapeutic tactics for the failure of gastrointestinal anastomosis in patients with morbid obesity after Roux-en-Y gastric bypass
Stankevich V.R., Smirnov A.V., Zlobin A.I., Panchenkov D.N., Danilina E.S., Ivanov Y.V.
Abstract

Background: Roux-en-Y gastric bypass is the main type of bariatric surgery. The most formidable and severe complication in morbid obesity patients after gastric bypass is gastrojejunostomy leak. Aim: to study the possibilities of improving treatment outcomes of obese patients during gastrojejunostomy leak after gastric bypass surgery using new minimally invasive methods. Methods: This retrospective cohort descriptive study included all patients with gastrojejunostomy leak after gastric bypass treated in the Department of Surgery of the Federal State Budgetary Institution Federal Scientific and Practical Center of the Federal Medical and Biological Agency of Russia in 2019–2022. In total, 445 gastric bypasses were performed during this period, and seven patients (1.6%) developed HEA failure in the postoperative period. Results: The results of treatment of gastroenteroanastomotic leaks during gastric bypass in patients with morbid obesity are presented. The early diagnosis of gastroenteroanastomosis failure in this category of patients was difficult. All doubts in the diagnosis of anastomotic failure should be completed by revision laparoscopy with intraoperative esophagogastroscopy. Minimally invasive techniques (surgical, endoscopic), drug therapy, and adequate nutritional support are crucial for managing patients with anastomotic leaks. Conclusion: The use of an endoscopic intraluminal vacuum aspiration system in the treatment of gastroenteroanastomotic insufficiency avoids the spread of inflammation in the abdominal cavity, accelerates the reparative process in the area of insufficiency, and, in most cases, avoids programmed sanitation, significantly improving the treatment results.

Journal of Clinical Practice. 2023;14(2):19-27
pages 19-27 views
Magnetic resonance imaging in the diagnosis of myocarditis in children
Fomina L.E., Yarmola I.I., Barskiy V.I., Anikin A.V., Uglova E.V.
Abstract

Background: There is a need for the systematization, generalization and analysis of the structural changes of the myocardium, occurring in patients with myocarditis. This disease is rare; therefore, structured information in the field of radiological diagnostics is still insufficient within national publications. Aim: The study purpose was to determine the significance and specificity of changes observed in cardiac magnetic resonance images in patients with myocarditis, and to compare the obtained results with the literature data. Methods: 7 patients, including children aged 4 and 6, with a verified diagnosis of myocarditis were retrospectively examined. Results: The analysis of the obtained images revealed the most common changes related to myocarditis, such as myocardial edema, impaired myocardial contractility, increased delayed accumulation of the contrast agent. The pathophysiological mechanisms of the found structural changes were analyzed and described. Conclusion: Magnetic resonance imaging is the most important non-invasive method for diagnosing myocarditis, which allows one to identify the lesion of the heart muscle, to assess the extent of its damage, to differentiate myocarditis from other diseases, as well as to assess the dynamics when evaluating the effectiveness of therapy.

Journal of Clinical Practice. 2023;14(2):28-35
pages 28-35 views
Lipoprotein (a) as a marker of hereditary lipid metabolism disorders in patients with early manifestation of coronary artery disease
Rogozhinа A.A., Ivanova O.N., Minushkinа L.O., Brazhnik V.A., Zubova E.A., Ivanovа L.A., Zateyshchikov D.A.
Abstract

Background: The clinical phenotype of familial hypercholesterolemia (FH) combined with the “classical” genetic defects of this disease increase the risk of coronary artery disease (CAD) in the case of a high level of lipoprotein (a) (Lp(a)). Aim: To assess the association of hereditary disorders of lipid metabolism with a high level of Lp(a) in the case of an early manifestation of CAD in the absence of the FH phenotype. Methods: We studied 81 patients with premature CAD (at the age up to 55 years in men and up to 60 years in women). Lp(a) was measured in the blood serum by the immunoturbidimetric method. We performed the molecular genetic testing, using massively parallel sequencing, which included the following panel of genes: ABCA1, ABCG1, ABCG5, ABCG8, ANGPTL3, APOA1, APOA2, APOA4, APOA5, APOB, APOC1, APOC2, APOC3, APOE, APOH, CETP, CH25H, CIDEC, CREB3L3, GPD1, GPIHBP1, LCAT, LDLR, LDLRAP1, LIPA, LIPC, LIPE, LIPG, LMF1, LPA, LPL, MTTP, MYLIP, NPC1, NPC1L1, NPC2, PCSK9, PLTP, PPP1R17, SAR1B, SCARB1, STAP1. Results: 24 (29.6%) patients had Lp(a) ≥ 30 mg/dl and were more likely to have a family history of CAD (70.8% vs 42.1%, p=0.05). In patients with a confirmed FH phenotype, there were no pathogenic variants associated with hereditary disorders of lipid metabolism. 4 patients with Lp(a) ≥30 mg/dl without a confirmed FH phenotype appeared to be carriers of pathogenic variants in the genes of lipid metabolism (LDLR p.Glu763Asp, ABCA1 p.Arg1128His, APOA5 p.His321Le), as well as of a not previously registered variant in the LIPE gene NM_005357.4:c. 2312T>C. Conclusions: Lp(a) can be an appropriate marker for revealing pathogenic variants in the genes of the lipid metabolism system in patients without the clinical FH phenotype with an early CAD manifestation.

Journal of Clinical Practice. 2023;14(2):36-43
pages 36-43 views
Mid-term results of the treatment of acute postero-lateral rotational instability of the elbow joint
Haj Hmaidi M.A., Lazko F.L., Prizov A.P., Zagorodniy N.V., Belyak E.A., Akhpashev A.A., Lazko M.F., Kuznetsov A.V., Strashinskiy G.A.
Abstract

Background: Dislocations of the forearm are rare injuries with the annual incidence of 6.1 cases per 100 000 population. Postero-lateral rotational instability is the most common complication after the conservative treatment of forearm dislocations. To restore the congruency and provide early movements in the elbow joint, the primary repair or reconstruction of the damaged ligaments of the elbow are required. Aim: to evaluate the clinical and functional results after the surgical repair of the elbow joint ligaments in acute postero-lateral rotational instability. Methods: The study was based on a retrospective analysis of a series of clinical cases, including 17 patients with acute postero-lateral rotational instability, among them 5 simple forearm dislocations, 9 fracture-dislocations of the forearm and 3 fractures of the radial head. Refixation of the lateral ulnar ligament was performed with anchor fixation or bone tunnels. The evaluation was performed using the clinical aspects (the «lateral pivot shift» test, the range of motion), according to the scale for the evaluation of the elbow joint functional condition (MEPS), Oxford scale of the elbow joint evaluation (OEC), the X-ray results were also estimated. Results: In all the cases the elbow joint stability had been achieved, according to the X-ray and clinical aspects. In 4 cases, additional plasty of the medial collateral ligament was needed and performed after the restoration of the lateral ligament complex. According to the MEPS scale, 58% of the achieved results were excellent, 35% were good and 5.8% were satisfactory. Conclusion: The restoration of the lateral ulnar collateral ligament complex is a safe and effective procedure, which restores the elbow joint stability and allows the patients to return to full physical activity and avoid the development of postero-lateral rotational joint instability.

Journal of Clinical Practice. 2023;14(2):44-53
pages 44-53 views

Reviews

Rehabilitation of spinal patients with diseases and injury of the cervical spine in the early and late postoperative period (analysis of russian and foreign recommendations)
Tolstaya S.I., Ivanova G.E., Durov O.V., Lavrov I.A., Baklaushev V.P., Belopasov V.V.
Abstract

Despite the success of modern conservative therapy of severe spinal instability, surgical methods still retain their importance in the treatment of this pathology, but even the most successful operation may be in vain without subsequent adequate rehabilitation. This report summarizes the features of rehabilitation of patients after surgery for injuries of the cervical spine using methods and means of physiofunctional treatment.

Journal of Clinical Practice. 2023;14(2):54-65
pages 54-65 views
Biomarkers for surgical sepsis. A review of foreign scientific and medical publications
Sсherbak S.G., Sarana A.M., Vologzhanin D.A., Golota A.S., Rud’ A.A., Kamilova T.A.
Abstract

remained unchanged for over a decade, and early recognition continues to be the most crucial factor in survival outcome. Early and accurate diagnosis of infection and organ dysfunction remains problematic, as evidenced by numerous interventional trials that have not resulted in improved outcomes. These failures are partly because of the belated intervention, when the patient developed multiple-organ failure and the therapeutic window of opportunity closed. The success of immunomodulatory and other therapeutic strategies, which is often achieved in preclinical models of sepsis, depends on their use in the early stages of sepsis development or even proactive action. Predicting the development of sepsis in surgical patients using laboratory analysis of plasma may be useful for doctors in the intensive care unit and resuscitation. Significant efforts are being made to develop biomarkers for the early stages of sepsis with high sensitivity and specificity. For early and accurate diagnosis, effective treatment of sepsis requires a deep understanding of the pathogenetic mechanisms. Dysregulation of the patient’s response to infection leading to sepsis and septic shock is studied using ohmic approaches: proteomics, transcriptomics, and metabolomics. Owing to the complexity and large volume of data sets, special data analysis tools, the so-called machine learning, become necessary.

Journal of Clinical Practice. 2023;14(2):66-78
pages 66-78 views
Possibilities of treatment by radiofrequency denervation in coxarthrosis of various stages
Gorokhov M.A., Zagorodniy N.V., Kuzmin V.I., Sharamko T.G.
Abstract

The scientific review presents the treatment of coxarthrosis of various stages by the radiofrequency denervations technique. Full-text articles were searched in open electronic databases PubMed, eLibrary, CyberLeninka for the maximum possible time interval for the time interval from 1990 to 2023. Fifteen scientific articles were selected, in which 302 patients were treated with 489 radiofrequency denervations of the hip joint. The authors provide information about the state of the problem with special attention to the characteristics of various denervation protocols and justification of the choice of target points for exposure from the standpoint of anatomy and innervation of the hip joint. RCD is a modern, interventional, and effective solution to the main symptom, which is pain, according to numerous studies. The introduction of targeted effects on the articular branches of the locking and femoral nerves by radiofrequency denervation into the work of a practitioner can increase the period of remission of exacerbation of coxarthrosis and shorten the period of disability with a high level of intervention safety for the patient. Conducting further research on the role of radiofrequency denervation in coxarthrosis is critical.

Journal of Clinical Practice. 2023;14(2):79-87
pages 79-87 views

Case reports

A rare complication after endoscopic neurolysis of the sciatic nerve: а clinical case
Belyak E.A., Paskhin D.L., Lazko F.L., Prizov A.P., Asratyan S.A., Zagorodniy N.V.
Abstract

Background: Еndoscopic neurolysis of the sciatic nerve has proven itself as a low traumatic and effective technique of treatment for deep gluteal pain syndrome and sciatic nerve neuropathy. Until now, there have been no publications dedicated to the parietal peritoneum damage after endoscopic sciatic nerve decompression. Clinical case description: A 70-year-old female patient with deep gluteal pain syndrome and sciatic nerve neuropathy on the right side and failure of a conservative treatment. According to the VAS scale, the severity of pain syndrome was 10 cm. The severity of the motor dysfunction, according to the BMRC scale, was 4 points. The severity of the sensitive dysfunction, according to the Seddon scale, was 3 points. The functional activity of the lower limb, according to the LEFS scale, was 48 points. The instrumental investigation of the sciatic nerve included MRI, ultrasound, and ENMG. Endoscopic sciatic nerve decompression was performed in the prone position with saline irrigation using the technique published before. After the surgery, an ultrasound study and a CT scan were performed, which determined the presence of a free fluid in the abdominal cavity, and edema of the right retroperitoneal space. The patient underwent laparoscopy, which revealed the area of the parietal peritoneum damage in the lower floor, with a free saline fluid detected in the abdominal cavity, which was evacuated. The patient was discharged from the hospital on the 10th day after the surgery. 6 months after the surgery, the functional activity of the lower extremity, according to the LEFS scale, was 52 points. Pain syndrome, according to the VAS scale, was 8 cm. The severity of the motor dysfunction, according to the BMRC scale, was 4 points. The severity of the sensitive dysfunction, according to the Seddon scale, was 3 points. The performed surgical endoscopic treatment was rendered ineffective. Conclusion: The method of endoscopic sciatic nerve decompression with saline pumping has a risk of the following complication: damaging the parietal peritoneum, saline penetration into the abdominal cavity, edema of the retroperitoneal space. To decrease the risk of this complication, it is necessary to observe the specific surgical conditions such as: controlled hypotension in a patient and a low pressure in the arthroscopic pump, the time of surgery not exceeding 1 hour, and the saline consumption not exceeding 10 liters. It is also crucial not to perform the dissection and neurolysis too proximal to the piriformis area.

Journal of Clinical Practice. 2023;14(2):88-95
pages 88-95 views
The use of quadrotherapy of chronic heart failure in cancer patients (case series)
Peresada A.K., Dupik N.V., Dundua D.P., Kedrova A.G., Korolev S.V., Chaikin R.S.
Abstract

Background: Chronic heart failure (CHF) for a patient with cancer is complex, as it complicates antitumor treatment. In some cases, severe CHF is a contraindication to the chemotherapy or surgical treatment. Despite significant progress in CHF treatment, some groups of drugs, particularly mineralocorticoid receptor inhibitors, angiotensin receptor-neprilysin inhibitors, and sodium-glucose co-transporter type 2 inhibitors, have not been studied related to cancer patients. Clinical case description: In this report, we introduce two clinical cases in which, because of the invaluable contribution of the cardio-oncological team, we have managed to solve complex problems of treating patients with CHF and cancer. In patient 1 with severe CHF, it was possible to achieve regression of systolic dysfunction, despite the progression of bladder cancer T4N1M0. In patient 2 with severe ischemic cardiopathy and CHF, owing to the timely administration of quadruple therapy, we managed to significantly improve the cardiac status and increase the LV EF that the patient underwent gastrectomy and cholecystectomy for cancer of the cardiac part of the stomach cT2N0M0 without complications. Conclusion: The above clinical cases demonstrate the possibilities of a team, multidisciplinary approach in the treatment of complex category of patients with CHF and active oncological disease. Modern therapy of cancer patients with severe heart failure allows successful antitumor treatment.

Journal of Clinical Practice. 2023;14(2):96-104
pages 96-104 views
Morphological and molecular genetic diagnosis of CADASIL: a rare clinical case
Golubinskaya E.P., Makalish T.P., Kalfa M.A., Ostapenko O.V., Savchuk E.A., Zyablitskaya E.Y., Maksimova Р.E.
Abstract

Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary autosomal dominant vascular injury of the brain. Currently, the clinical diagnosis of CADASIL is based on the following criteria: the onset of the condition at a relatively young age (40–50 years), recurrent lacunar infarcts, gradual progression of encephalopathy with the development of pseudobulbar syndrome and dementia, various emotional disorders, and autosomal dominant inheritance. Having a family history of relatives with similar symptoms. The diagnosis is verified on the basis of the results of the following studies: neuroimaging, instrumental, morphological, and laboratory. The presence of leukoaraiosis and multiple small bilateral infarctions in such anatomical structures as the basal ganglia and white matter of the cerebral hemispheres, visual tubercles and the pons, and brain stem during MRI diagnostics. Histologically, transmission electron microscopy reveals granular osmiophilic inclusions in the adventitial membrane of the blood vessels of the brain, and on the periphery — in the adventitia of the vessels of skeletal muscles and somatic nerves and in vascular biopsies of skin flaps. A mutation in the Notch3 gene determines the clinic of the disease and morphological changes in blood vessels and is detected by a molecular genetic method. The article presents a clinical case, which was a manifestation of this rare hereditary microangiopathy. Clinical case description: A 43-year-old patient was admitted to the Department of Neurology of the Republican Clinical Hospital in Simferopol for ischemic stroke in the basin of the left middle cerebral artery. According to the anamnesis, the patient suffered from migraine without aura from a young age and lacunar strokes; examination revealed a decrease in cognitive function, and MRI showed signs of microangiopathy of cerebral vessels. For final diagnosis, the patient underwent an intravital pathomorphological examination of the biopsy of the musculoskeletal flap; the results obtained made it possible to make a reliable diagnosis of CADASIL. Conclusion: Understanding and knowledge of such a rare pathology as CADASIL is crucial for the rapid recognition of a characteristic clinical picture for further appointment and interpretation of the results of morphological and molecular genetic diagnostics, making it possible to make the correct diagnosis and treatment.

Journal of Clinical Practice. 2023;14(2):105-111
pages 105-111 views
Autoimmune anti-NMDA receptor encephalitis on the background of COVID-19: a clinical case
Ulyanova O.V., Ermolenko N.A., Dudina A.A., Belinskaya V.V., Dutova T.I., Kulikov A.V., Golovina N.P., Kuleshova E.O., Kuslivaya A.V.
Abstract

Background: During the new COVID-19 coronavirus infection pandemic, a growing incidence of autoimmune encephalitis cases has been observed. One of the primary problems related to patients with this highly lethal pathology is its timely early diagnostics and prescription of an optimal individual course of immunotherapy. In a debut of anti-NMDA receptor (inotropic glutamate receptor, selectively binding N-methyl D-aspartate) encephalitis, mental disorders are observed, prompting the initial admission of such patients to a psychiatric hospital. Then, the clinical picture of the disease is characterized by a significant polymorphism. In such cases, it is not always possible to suspect an autoimmune lesion of the nervous system. Clinical case description: In this article, we present a clinical case of a female patient with serologically confirmed autoimmune encephalitis against the background of the new coronavirus infection (U07.1 according to ICD-10). The disease onset involved psychiatric symptoms; the patient was transferred to the Department of neurology of the VGK BSMP No. 1 Municipal Clinical Hospital of Emergency Care No.1 from the municipal psychiatric hospital, when generalized cerebral symptoms appeared. According to the diagnostic criteria, mental disorders and generalized epileptic seizures are the most significant signs in the verification of autoimmune encephalitis. Autoimmune encephalitis was suspected based on the developed neurological symptoms and generalized epileptic seizures and confirmed by the detected anti-NMDA antibodies in the blood serum. The anti-NMDA antibody analysis in the blood and cerebrospinal fluid is the most informative way of autoimmune encephalitis diagnosis. Conclusion: Autoimmune encephalitis requires vigilance of physicians of all specialties who may encounter this disease. Timely diagnostic procedures and prescription of pathogenetically justified treatment are of importance.

Journal of Clinical Practice. 2023;14(2):112-119
pages 112-119 views
A clinical case of drug-induced arterial hypertension caused by glycyrrhizic acid
Antropova O.N., Osipova I.V., Silkina S.B., Obrazcova L.A.
Abstract

Background: In clinical practice, drug-induced arterial hypertension (AH) often remains undiagnosed, since the identification of an ethical disease in this form of AH avoids the initiation of antihypertensive therapy. A critical part in the differential diagnosis of hypertension and planning of long-term strategies for managing a patient requires a thorough study of the properties of the drugs taken and the pathophysiological mechanisms that depend on the increase in high blood pressure against the background of taking one or another substance. Clinical case description: Assumption of pregnancy in a random 57-year-old Caucasian female patient with AH syndrome and history of AD crisis during the year. Against the background of two-component antihypertensive therapy, indapamide 2.5 mg + telmisartan 80 mg, increased blood pressure. From the anamnesis of life, it is noteworthy that the patient should keep records with a hepatologist; with a diagnosis of chronic viral hepatitis C with moderate activity, she takes Phosphogliv. Physical examination confirmed the presence of grade 2 hypertension; no signs of target organ detection were found. Laboratory and instrumental research showed cytolytic syndrome of minimal activity (AST, 74.8 U/l; ALT, 60.5 U/l), hypokalemia (K+ 2.1 mmol/l), unknown etiology, aldosterone within the normal range, metanephrine (80.4 pg/ml at a rate of <64 pg/ml), and normetanephrine (276 pg/ml at a rate of <176 pg/ml) in blood plasma are increased. MSCT of the kidneys and adrenal glands revealed no enlarged formations. Drug-induced arterial hypertension was clinically diagnosed. Concomitant diseases: Chronic viral hepatitis C, moderate activity. Varicose veins, venous infection of the extremities. Dynamics and outcome. After the abolition of glycyrrhizic acid, blood pressure and potassium levels in the blood plasma returned to normal, which is not recommended to take antihypertensive drugs. Conclusion: An exceptional clinical situation is a pronounced manifestation of a rare side effect of glycyrrhizic acid in the form of drug-induced hypertension.

Journal of Clinical Practice. 2023;14(2):120-124
pages 120-124 views


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