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Vol 13, No 2 (2021)

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Reviews

Shared pathological mechanisms of systemic lupus erythematosus and affective disorders

Rukavishnikov G.V., Smirnova A.A., Neznanov N.G., Mazurov V.I., Mazo G.E.

Abstract

The high prevalence and variability of neurological and psychiatric symptoms in systemic lupus erythematosus has become the basis for emphasizing the special neuropsychiatric form of the disorder. Affective disorders (pathological changes in mood and anxiety) are the second most common neuropsychiatric manifestations in patients with systemic lupus erythematosus. However, the current nomenclature primarily focuses on the general clinical manifestations of affective disorders in neuropsychiatric form systemic lupus erythematosus, without evaluating the problems of their etiopathogenesis. Thereby, the aim of this review is the integration of information on the pathological mechanisms of depression and anxiety in patients with systemic lupus erythematosus. The available data on the biological aspects of the anxiety and depression in systemic lupus erythematosus indicate that the complex pathological models may be the best approach for studying, diagnosing, and treating comorbid pathology. The latter can be based on expanding the existing clinical categories, supplementing them with data on pathological mechanisms specific to particular sub-cohorts of patients. Such an approach can provide the specific and most effective preventive, diagnostic and therapeutic measures for each category of patients.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(2):5-14
pages 5-14 views

Modern principles of cardiovascular disease prevention

Bershtein L.L.

Abstract

Atherosclerotic cardiovascular disease is the leading cause of death in the world, primarily in low-and middle-income countries, including Russian Federation. According to WHO experts, the global atherosclerotic cardiovascular disease epidemic can be brought under control mainly by improving the cardiovascular prevention. This paper describes the modern principles of risk assessment in people without manifested atherosclerotic cardiovascular disease, as well as considers drug and non-drug methods of primary prevention.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(2):15-26
pages 15-26 views

Disorders of lipid metabolism in the liver in patients with chronic viral hepatitis

Tsvetkov V.V., Tokin I.I., Nikitina O.E., Lioznov D.A.

Abstract

The review article is devoted to the problem of lipid metabolism disorders in the liver in patients with chronic hepatitis B and chronic hepatitis C. The results of modern biological, epidemiological and clinical studies aimed at studying the causes and mechanisms of the formation of liver steatosis and steatohepatitis, their prevalence and influence on the course of infectious pathology are presented. Particular attention is paid to the generalization and systematization of the currently available data on the mechanisms of lipid metabolism disorders in the liver, mediated by the molecular structures of hepatitis B and C viruses. In conclusion, the need for timely diagnosis and treatment of pathological conditions caused by the development of lipid metabolism disorders in the liver is substantiated in order to increase the quality of medical care for patients with chronic hepatitis B and C.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(2):27-38
pages 27-38 views

Original researches

Impact of a new coronavirus infection on the clinical course of immunoinflammatory rheumatic diseases

Mazurov V.I., Belyaeva I.B., Sarantseva L.E., Chudinov A.L., Bashkinov R.A., Trofimov E.A., Smulskaya O.A., Inamova O.V., Petrova M.S., Melnikov E.S.

Abstract

BACKGROUND: The COVID-19 pandemic poses a particular threat to patients suffering from immunoinflammatory rheumatic diseases. New coronavirus infection has been found to be accompanied by the development of a wide range of extrapulmonary clinical and laboratory manifestations, which are characteristic of a number of immunoinflammatory rheumatic diseases.

AIM: To evaluate the features of the clinical course of immunoinflammatory rheumatic diseases in patients who underwent new coronavirus infection.

MATERIALS AND METHODS: The clinical course of immunoinflammatory rheumatic diseases was analyzed in 324 patients who underwent new coronavirus infection from March 2020 to February 2021 and were treated at the Clinical Rheumatology Hospital No. 25, Saint Petersburg, for exacerbation of the underlying disease.

RESULTS: Analysis showed that the risk factors for severe new coronavirus infection in patients with immunoinflammatory rheumatic diseases were: age over 60, comorbidities, use of prednisolone in a dose greater than 12,5 mg, and ESR values ≥40 mm/hour before the development of new coronavirus infection. There was no effect of immunosuppressive and biological therapy on the severity of the course of viral infection. There was no effect of immunosuppressive therapy and biological therapy on the severity of the course of viral infection in patients with immunoinflammatory rheumatic diseases. The development of the postinfectious syndrome was observed in 1/4 of patients, which was characterized by the formation of postinfectious arthritis in 3,6% of patients, transformation of undifferentiated arthritis into various rheumatic diseases in 49% of patients (more often into early rheumatoid arthritis), as well as exacerbation of the underlying disease in 83,4% of patients with an advanced stage of rheumatoid arthritis. In patients with mixed connective tissue disease, there was a significant increase in immunologic activity due to antinuclear factor (up to a maximum of 1:163 840). Clinical cases of the development of arthritis associated with viral infection and the debut of rheumatoid arthritis after an new coronavirus infection are presented.

CONCLUSIONS: New coronavirus infection in the cohort of patients with immunoinflammatory rheumatic diseases observed in the Clinical Rheumatology Hospital No. 25, Saint Petersburg, proceeded in the variant of medium severity in half of patients, initiated the development of lung lesions in 68,6% of patients, arthritis associated with viral infection in 3,6% of patients, immunoinflammatory rheumatic diseases which transformed from undifferentiated arthritis in 49% of cases and exacerbation of the main disease in an overwhelming number of patients. Patients with immunoinflammatory rheumatic diseases have a high risk of adverse outcome of new coronavirus infection, especially in cases of unstable course of the disease or exacerbation of this group of diseases.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(2):39-47
pages 39-47 views

Differentiated approach to radical surgical treatment of elderly patients with tumor diseases of the pancreatoduodenal zone

Sigua B.V., Zemlyanoy V.P., Gulyaev A.V., Tsikoridze M.Y., Zakharov E.A.

Abstract

BACKGROUND: In recent years, there has been a widespread increase in the incidence of tumors of the pancreatoduodenal zone, especially noticeable in the older age group. A decrease in the incidence of postoperative complications and mortality after pancreatoduodenal resection made it possible to expand the indications for surgical treatment of elderly and senile patients.

AIM: Improvement of the immediate results of pancreatoduodenal resection in the treatment of elderly and senile patients suffering from tumor diseases of the pancreatoduodenal zone.

MATERIALS AND METHODS: Pancreatoduodenal resection was performed in 61 elderly and senile patients with tumors of the pancreatoduodenal zone. The main group consisted of 32 patients, whose treatment was carried out in accordance with the developed algorithm for choosing a method for forming a pancreatodigestive anastomosis based on a scale for assessing the risk of developing pancreatic fistulas. The comparison group consisted of 29 patients in whom the method of forming a pancreatodigestive anastomosis was carried out in accordance with the preferences of the operator without taking into account the risk of developing a pancreatic fistula.

RESULTS: In the main group, compared with the control group, pylorus-saving interventions were performed significantly more often — 27 (84.4%) and 14 (48.3%) (p < 0.01). There was also a decrease in the frequency of performing pancreaticojejunostomy 16 (50%) and 22 (75.9%) (p < 0.05), due to the use of reservoir terminolateral pancreatojejunostomy 8 (25%) and 0, respectively (p < 0.01). Postoperative complications were observed in 14 (43.8%) of the study group and in 21 (72.4%) patients of the comparison group (p < 0.05). There was also a decrease in the incidence of postoperative pancreatic fistulas from 8 (27.6%) to 2 (6.2%) (p < 0.05) in the study group. Repeated surgery was required in 5 (15.6%) patients of the main group and 11 (37.9%) in the comparison group (p < 0.05). The lethal outcome was recorded in 3 (9.4%) patients of the main group and in 7 (24.1%) in the comparison group (p > 0.05).

CONCLUSIONS: The results of performing pancreatoduodenal resection in the treatment of elderly and senile patients can be comparable with the results of treatment of the general population. The use of the developed algorithm made it possible to reliably reduce the incidence of complications from 72.4 to 43.8% (p < 0.05), postoperative pancreatic fistulas from 27.6 to 6.2% (p < 0.05), as well as the frequency of repeated interventions. from 37.9 to 15.6 % (p < 0.05). In addition, a downward trend in mortality was achieved from 24.1% to 9.4%.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(2):49-56
pages 49-56 views

H. pylori eradication therapy: impact of gastric mucosa atrophy on transport of amoxicillin to H. pylori colonization area

Sablina A.O., Sablin O.A., Andreeva J.V., Rodionov G.G., Shantyr I.I., Ushal I.E., Samusenko I.A.

Abstract

AIM: The aim was to assess systemic transport of amoxicillin, the most common antibiotic in H. pylori eradication regimens to the gastric in atrophic gastritis.

MATERIALS AND METHODS: Systemic transport of amoxicillin to the gastric lumen of rats was evaluated in washes from the gastric mucosa in the model of atrophic gastritis after intravenous drug infusion. Transport of amoxicillin from bloodstream to the gastric lumen was also assessed in patients with atrophic and non-atrophic gastritis in aspirated via nasogastric probe gastric juice after oral drug administration. Amoxicillin concentration was measured in samples using liquid chromatography-mass spectrometry.

RESULTS: In rats with induced atrophic gastritis, hyperemia and acute erosions of the gastric mucosa, as well as microscopic signs of non-active chronic body gastritis and non-active antral atrophic gastritis were found. Amoxicillin concentration in washes from the gastric mucosa was significantly (p < 0.01) higher in rats of experimental group than in control group at all time points (30, 60, 120, 240 min after drug infusion). The lowest mean amoxicillin concentration in gastric juice was observed in patients with antral atrophy (p < 0.01). The maximum amoxicillin concentration in gastric secretion was found at the 180th min of aspiration in patients with atrophy of gastric mucosa, while in patients of the group of comparison it was found at 30-120th min of aspiration.

CONCLUSIONS: Acute gastric mucosa erosions enhance amoxicillin delivery to gastric lumen in rats. Atrophy of antral mucosa more than in the corpus is characterized by decreased amoxicillin transfer from systemic bloodstream to gastric lumen in patients after oral amoxicillin intake. The gastric mucosa atrophy should be taken into consideration while predicting the efficacy of H. pylori eradication therapy in patients with chronic gastritis.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(2):57-66
pages 57-66 views

New opportunities in the diagnosis of asthma with sensitization to Aspergillus spp.

Kozlova Y.I., Uchevatkina A.E., Filippova L.V., Aak O.V., Kuznetsov V.D., Frolova E.V., Vasilyeva N.V., Klimko N.N.

Abstract

BACKGROUND: Diagnosis of asthma with sensitization to Aspergillus spp. is becoming increasingly important due to the severe, uncontrolled course of the disease and the possibility of the formation of allergic bronchopulmonary aspergillosis.

AIM: To evaluate the possibility of using the basophil activation test using flow cytometry for the diagnosis of asthma with sensitization to Aspergillus spp.

MATERIALS AND METHODS: 118 patients with asthma were examined. The levels of total IgE and specific IgE to aeroallergens were determined in the blood serum by the enzyme immunoassay. Basophil activation was studied by flow cytometry using the Allergenicity kit (Cellular Analysis of Allergy, Beckman-Coulter, USA). The allergen Aspergillus fumigatus (Alcor Bio, Russia) was used to stimulate basophils.

RESULTS: The first group consisted of 57 patients with asthma without sensitization to Aspergillus spp. The second group included 36 patients with asthma with sensitization to Aspergillus spp. The third group consisted of 25 patients with allergic bronchopulmonary aspergillosis. The number of basophils activated by the Aspergillus fumigatus allergen in patients with asthma with sensitization to Aspergillus spp. and allergic bronchopulmonary aspergillosis was significantly higher than in the asthma group and amounted to 8.1 [5.2; 20.9]% and 84.6 [75.7; 94.0]%, respectively (p < 0.001). The stimulation index in the study groups ranged from 0.7 to 72.6. The optimal diagnostic point (cut off) for identifying patients with asthma with Aspergillus spp. sensitization there was an stimulation index value of more than 2.4, and for patients with allergic bronchopulmonary aspergillosis — 15.95. Among all patients with sensitization to Aspergillus spp. a positive correlation was established between the level of specific IgE to Aspergillus spp. and the percentage of basophils activated by the allergen Aspergillus fumigatus (r = 0.792, p < 0.001) and stimulation index (r = 0.796, p < 0.05).

CONCLUSIONS: The basophil activation test can be used as an additional diagnostic method for asthma with sensitization to Aspergillus spp. and allergic bronchopulmonary aspergillosis.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(2):67-76
pages 67-76 views

Case report

Paraneoplastic neurological syndrome in onset of Hodgkin lymphoma

Pavlyuchenko E.S., Mirsaitov A.A., Diakonova M.N., Karev E.A.

Abstract

Hodgkin lymphoma is a malignant disease with clonal proliferation of B-cells and high-level reactive inflammatory microenvironment. The main clinical sings are lymphadenopathy and toxic symptoms. Neurological symptoms as usual can be a result of compression or tumor infiltration of nervous structures. The primary damage of CNS occurs from 0,2% to 0,5% of all cases HL.

Paraneoplastic neurological syndrome is a group of rare (an average 1 case on 10000 patients) neurological disorders against the background of oncological process. The pathophysiologic mechanism is due to production of antibody which is both to tumor cells and nerve cells. These antibodies are called onconeural autoantibodies. The hallmark which make diagnostics harder is the fact that onconeural autoantibodies rare take place in patients with lymphomas unless anti-Tr and anti-mGluR1 in patients with limbic encephalitis or paraneoplastic cerebellar degeneration.

There are two case reports about patients with PNS in onset of Hodgkin lymphoma in article.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(2):77-82
pages 77-82 views

Experience of surgical treatment of a patient with fractures of both necks of the femur on the background of severe osteoporosis

Yamshchikov O.N., Emelyanov S.А., Mordovin S.A., Petrukhin A.N., Kolobova E.A., Voronin N.I.

Abstract

The article shows the observation of the successful treatment of a patient with alternate fractures of the femoral necks against the background of osteoporotic lesions of the bone skeleton, examination of the patient and osteosynthesis with 3 AO screws in the operating room. The presented clinical case demonstrates the feasibility of osteosynthesis in a patient with severe osteoporosis.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(2):83-88
pages 83-88 views

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