bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of сepeginterferon alfa-2b in the rteatment of chronic hepatitis c in outpatients.
Authors: Mamonov Alexander V. , Mamonov R. A.
Published: November 2020

The features of the application of pegylated interferon - Сepeginterferon alfa2b (cepeg-IFN) on the results of treatment of 20 patients with chronic hepatitis C in outpatient practice. The analysis of the clinical, biochemical, virological data and transient liver elastometry on the background of antiviral therapy with cepeg-IFN. Based on these data is justified is not the worst in comparison with foreign analogues the efficacy and safety of the original domestic product for the treatment of patients with chronic hepatitis C, not previously treated with antiviral therapy, without a high degree of fibrosis or cirrhosis. Demonstrated clinical example of treatment failure associated with infection with a recombinant virus 2k1b and proposes an approach to the diagnosis of this variant infection
Complex evaluation of endothelial dysfuncion markers for prediction of
outcomes in coronary surgery.
Authors: Mikheev Sergei L. , Mandel I. A. , Podoksenov Yu. K. , Svirko Yu. S. , Sukhodolo I. V. , Andreev S. L. , Aleksandrova E. A. , Pryakhin A. S. , Gusakova A. M. , Kozlov B. N. , Shipulin V. M.
Published: November 2020

Objective: to evaluate the dynamics of endothelial dysfunction markers during coronary artery bypass grafting (CABG) and to estimate their significance as predictors of postoperative complications in coronary surgery. Methods. The study included 30 patients scheduled for coronary artery bypass surgery (CABG) with cardiopulmonary bypass. We determined the concentration of endothelial dysfunction markers is blood plasma, including endothelin-1 (ET-1) and nitric oxide metabolites: total content (NOx.total), nitrite (NO2-) and nitrate (NO3-) before the surgery, at the end of the surgery and 24 hours postoperatively. Results. 5 patients (16,7%) demonstrated the complicated course of postoperative period (group I). In this group there was a significantly higher level of ET-1 in all three control points: before the surgery, at the end of the surgery and 24 hours postoperatively (p = 0,012; p = 0,010; p = 0,015) comparing to group II (uncomplicated course). Concentration of NO3- at the end of the surgery was substantially lower than in group II - 3,98 (1,96-5,82) and 10,53 (7,39-14,15) µmol/l, accordingly (p = 0,041). Concentration of NO2- before the surgery was about the same in both groups, but at the end of the surgery concentration of NO2- was significantly lower in group I comparing to group II - 0,34 (0,18-0,53) and 1,12 (0,85-1,40) µmol/l, accordingly, p = 0,001. Conclusion. High level of ET-1 at all stages of the surgery, as well as decline of NO2- and NO3- levels by the end of the surgery may be regarded as predictors of complicated course of postoperative period in CABG patients. Overproduction of ET-1 and imbalance of NO production during CABG may facilitate microcirculatory dysfunction and multiple organ failure.
The results of a comparative study effectiveness of therapy with nebivolol and sotalol in patients with ventricular arrhythmias.
Authors: Tregubov V. G. , Shubitidze Iosif Z. , Kanorskii S. G. , Pokrovsky V. M.
Published: November 2020

Aim. Compare the effectiveness of nebivolol and sotalol in patients ventricular arrhythmias (VA) given its impact on the regulatory adaptive status (RAS). Material and methods. 60 patients with VA of grade I-IV based on the В.Lown grading system, I-II groups based on J.T. Bigger grading system against the background of essential hypertension and/or coronary heart disease took part in the research, they were randomized into two groups for treatment with nebivolol (6,5 ± 2,1 mg/day) and sotalol (166,7 ± 49,4 mg/day). As part of combination therapy, patients were administered lisinopril (13,7 ± 4,5 mg/day and 14,0 ± 4,6 mg/day), acetylsalicylic acid when required (92,9 ± 18,2 mg/day and 95,5 ± 15,1 mg/day), atorvastatin (16,5 ± 4,7 mg/day and 15,7 ± 5,1 mg/day) in addition to nebivolol and sotalol, respectively. Initially and 6 months after therapy, the following was done: quantitative assessment of RAS (by cardio-respiratory synchronism test), echocardiography, triplex scanning of common carotid arteries, treadmill test, six-minute walk test, all-day monitoring of blood pressure and electrocardiogram, subjective assessment of quality of life. Results. Both drug regimens comparably improved structural and functional condition of the heart, increased controlled arterial hypertension, effectively suppressed ventricular arrhythmia, improved the quality of life. Nebivolol positively affected the RAS and increased exercise tolerance more. Conclusion. In patients with VA against the background of essential hypertension and/or coronary heart disease as part of combination therapy the use of nebivolol may be preferable to sotalol due to its positive impact on the RAS.
Contrast-induced acute kidney injury in a planned endovascular interventions on the
coronary arteries.
Authors: Vershinina Elena O. , Repin A. N.
Published: November 2020

Was performed a retrospective analysis of the frequency of contrast-induced acute kidney injury (CI-AKI) after the elective endovascular interventions on the coronary arteries in patients with stable coronary heart disease (CAD). CI-AKI was found in 23 patients (15,5%). Patients with CI-AKI initially significantly more likely to suffer chronic kidney disease (CKD), had higher erythrocyte sedimentation rate (ESR) before coronary intervention, received a significantly larger dose of the contrast medium, determines the ratio of the volume of the entered contrast medium to the glomerular filtration rate (VC/GFR). Predictors of CI-AKI, associated with the characteristics of patients are history of CKD (OR = 9,2; 95% CI 2,89-29,25; p <0,001) and COPD (OR = 4,07; 95% CI 1,23-13,5; p = 0,015), increased ESR before PCI ≥11,5 mm/h (AUC = 0,677; 95% CI 0,539-0,815; p = 0,025). Predictors of CI-AKI, associated with the conduct of the PCI procedure, are the ratio VC/GFR≥3,25 (AUC=0,633; 95% CI 0,505-0,762; р=0,042) and complications of arterial puncture site (OR = 1,23; 95% CI 1,13-1,33, p = 0,025). According to the analysis of Kaplan-Meier probability of overall survival and survival without fatal cardiovascular events in 7 years after the index PCI was significantly higher in the group of patients without CI-AKI.
Comparison of efficiency of a new sucrosomal
peroral form of iron with intravenous ferrotherapy in the treatment of anemia in inflammatory bowel diseases.
Authors: Stuklov Nikolay I. , Knyazev O. V. , Parfenov A. I. , Basiladze I. G. , Pivnik A. V.
Published: November 2020

The article describes the role of iron deficiency in the development of anemia in inflammatory bowel diseases (IBD), existing approaches to treatment. The problems of insufficient effectiveness and poor tolerance of standard iron preparations are discussed, which is associated with the presence of malabsorption and chronic inflammation of the intestinal wall. The aim of the work was to determine the effectiveness of a standard approach to treatment with intravenous iron preparations in comparison with the new sucrsomal oral form of iron Sideral Forte in patients with anemia in IBD. The materials of the study included data from 57 patients with anemia and IBD. The results of examination of 28 patients and treatment of 29 patients with anemia and IBD were analyzed, of which 14 received Sideral Forte, 15 intravenous ferrotherapy. According to the results of the study, it is proved that in the IBD hypo-normochromic and micro-normocytic anemia is always associated with a violation of iron metabolism. The results of the application of these groups of iron preparations for 3 months showed a significant increase in the concentration of hemoglobin, serum iron, a more significant effect of the sucrsomal oral iron for normalization of the hemoglobin concentration.
A case of pulmonary Langerhans cell histiocytosis a rare lung disease.
Authors: Tsvetkova Olga A. , Abbdullaeva G. B. , Fominykh E. V.
Published: November 2020

The patient was admitted with a suspicion of hypersensitivity pneumonitis. Only histological examination and immunohistochemical analysis of the biopsy samples allowed to establish the correct diagnosis.
Dengue fever in Russia: problems of diagnostics
Authors: Nafeev Aleksandr A. , Il’mukhina L. V.
Published: November 2020

The authors report clinical and laboratory data concerning a case of hemorrhagic dengue fever introduced to Ul’yanovsk by a tourist who had spent holiday in Vietnam. The clinical picture of the disease is described along with results of clinical and laboratory analyses. The approaches to the evaluation of the patient's health status during the period ofprimary examination and medical care as well as the problems that arose after the final diagnosis was established are discussed.
Systemic lupus erythematosus with lupus-nephritis at advanced age (case report)
Authors: Kanevskaya Mariya Z. , Kuznetsova O. M.
Published: November 2020

We report a clinical case of SLE in a women affected at the age of 63 years who had recurrent nephrotic syndrome with the development of renal insufficiency at the onset and a good outcome of therapy with a large total dose cyclophosphamide.
The history of Department of Faculty Therapy, at the Voronezh higher education institution (on the occasion of the centenary anniversary of N.N. Burdenko Voronezh State Medical University)
Authors: Budnevsky A. V. , Provotorov V. M. , Filatova Yuliya I.
Published: November 2020

The article is devoted to the history of the Department of Faculty Therapy, N.N. Burdenko Voronezh State Medical University. The history of its creation is inextricably linked to the Derpth (Yurievsky) University that was transferred to Voronezh in 1918. While the Department of Faculty Therapy remained in Voronezh, it several times changed location making use of various city hospitals as its branches. It simultaneously expanded its activities by organizing courses of physical therapy, endocrinology, and other medical disciplines. The article focuses on the events pertaining to the formation and development of the Department of Faculty Therapy, main directions and achievements of its scientific work.
Diagnostic significance of plasma troponin and cardiomyocyte fatty acid-binding protein levels in acute
coronary syndrome
Authors: Titov V. N.
Published: November 2020

Blood serum content of fatty acid-binding (FABP) protein increases within 2-3 h after the onset of acute coronary syndrome and myocardial infarction (MI) and reaches the maximum 8.5 h after the initiation of cardiomyocyte death. FABP content considerably decreases by the end of at 24-h period due to excretion with urine, remaining elevated for subsequent 24 h. High clinical sensitivity and relatively high organ specificity are typical of FABP for 12 h after ACS. Within the early period of MI clinical specificity of FABP prevails over troponin in terms of concentration. Troponins display higher clinical sensitivity and diagnostic specificity during a 12-h period after ACS, prevailing for several days after MI. Simultaneous measuring of FABP and troponins (Tr) within the first 12 h increases the sensitivity of biochemical diagnostics by 30%. At later periods, simultaneous determination of FABP and Tr becomes unnecessary: FABP is excreted with urine and Tr level acquires predominant diagnostic significance. No relationship has been revealed between blood content of FABP and reperfusion according to electrocardiography data, probably due to rare measurements of this highly dynamic parameter. FABP test cannot be used in patients with circulatory disorders since its results are not adequate. The best option for differential diagnostics of ACS within the first 24 h would be a combined express immunochromatographic test which allows to measure blood FABP and Tr levels pending objective evaluation.
Trends in development of gi-safe anti-inflammatory drugs
Authors: Sulaieva O. N. , Wallace J. L.
Published: November 2020

Despite the introduction of anti-inflammatory drugs that selectively inhibit cyclo-oxygenase-2 (COX-2), and potent inhibitors of gastric acid secretion, the gastrointestinal adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) remain a significant clinical problem. Combined use of antisecretory drugs and COX-2 inhibitors is helpful to limit the damage in the proximal gastrointestinal tract (stomach and duodenum), but it increases the risk of injury of small intestine and colon. It was proven that proton pump inhibitors and H2 receptor antagonists significantly worsen NSAID-induced small intestinal damage and microbiota balance. Nowadays, there is no proven effective preventative or curative treatment for NSAID-induced enteropathy. The new strategy of gastrointestinal protection is based on the discovery of endogenous cytoprotective molecules such as hydrogen sulfide (H2S). H2S is a gaseous mediator that produces strong cytoprotective and antioxidant effect on the gastrointestinal tract. The role of H2S in promoting mucosal integrity, healing of tissue injury and resolution of inflammation has been well documented. In addition, H2S stimulates productions of other cytoprotective molecules including prostaglandins, carbon monoxide and nitric oxide. Nowadays, the new generation of H2S-releasing non-steroidal anti-inflammatory drugs is developed and tested in clinical trials. H2S-NSAIDs possess enhanced anti-inflammatory activity and high gastrointestinal safety.
The role of low-frequency piezothromboelastography in the comprehensive evaluation of hemostasis
in coronary bypass surgery with cardiopulmonary bypass
Authors: Fanaskova E. V. , Gruzdeva O. V. , Akbasheva O. E. , Tyutrin I. I. , Penskaya T. Yu. , Uchasova E. G. , Plotnikov G. P. , Krivoshapova K. E. , Barbarash O. L.
Published: November 2020

Aim. To monitor the hemostatic system during platelet concentrate transfusions using low-frequency piezothromboelastography in patients with coronary bypass surgery given aspirin therapy. Materials and Methods. The study involved 148 patients with coronary bypass surgery, with 76 ones undergoing intraoperative transfusion of platelet concentrate and 72 treated without transfusion. The control group consisted of 20 healthy individuals. In the perioperative period indicators of vascular-platelet, coagulation, anticoagulant and fibrinolytic components of hemostasis were evaluated by low-frequency pezotromboelastography using the ARP-01M "Mednord" hardware and software system (Russia). Results. It was shown that the antiplatelet effect of aspirin in the preoperative period was manifest as inhibition of the initial stage of blood coagulation accompanied by increased thrombin potential, the total gain of anticoagulant and fibrinolytic activity of the blood. Heart-lung bypass was accompanied by structural and chronometric anticoagulation, reduction of anticoagulation and increase of blood fibrinolytic activity. In the postoperative period, structural and chronometric anticoagulation was more pronounced in patients who did not undergo transfusion of platelet concentrate than in the group of patients with transfusion. Donor platelets further increased the blood hemostatic potential by neutralizing the antiplatelet effect of aspirin. Perioperative thrombohemorrhagic complications were absent in both groups. Conclusion. Low-frequency piezothromboelastography provides a tool for real-time monitoring the functional state of hemostasis system. Transfusion of platelet concentrate is not advisable given that the thrombin potential is preserved as confirmed by the results of low-frequency piezothromboelastography.
The use of daptomycin for the treatment of infectious endocarditis: results of a multicenter study
Authors: Shevchenko Yu. L. , Tyurin V. P. , Popov L. V. , Gudymovich V. G. , Pavlikova E. P. , Bayandin N. L. , Fedorova T. A. , Rusanov N. I. , Tazina S. Ya.
Published: November 2020

Analysis of the results of daptomycin antibiotic therapy and surgical treatment of 37 patients with infective endocarditis (IE) admitted to three Moscow hospitals during 2012 to 2016 is presented. Primary endocarditis was diagnosed in 32.4% of the cases. The secondary forms of the disease dominated by endocarditis following cardiac surgery (29.7%) including valve prosthetics and implantation of pacemaker/cardioverter-defibrillator (PM/CVD). Positive reaction in 2 or more blood cultures was observed in 73% of the patients with the prevalence of Staphylococcus aureus (27%). Vegetation at TT and emergency echocardiography was documented in 89.2% of the patients, fibrous ring or leaflet abscesses in 24.3%). All patients were treated with daptomycin at an average dose of 6,7 ± 0,7 mg/kg b w. The duration of therapy was 26,7 ± 9,8 days. Surgical treatment was given to 48.6% of the patients including PM/CVD replacement in 5.4%. Surgical mortality was absent. Hospital mortality amounted to 13.5%. The use of daptomycin in combination with surgical treatment can significantly improve the results of treatment of this serious disease.
Clinical features and results of laboratory and instrumental examination of
patients with nodular structures in the thyroid gland in real clinical practice
Authors: Berezkina I. S. , Saprina T. V. , Zima A. P. , Isaeva A. V. , Latypova V. N. , Vorozhtsova I. N. , Mukhamedov M. R. , Bazilevich L. R. , Popov O. S. , Luneva S. V. , Zav'jalova N. G.
Published: November 2020

The ever increasing incidence of thyroid cancer throughout the world poses the problem of differential diagnosis of thyroid nodules at various stages of their formation. Objective: to determine the most important clinical, laboratory and instrumental parameters of thyroid nodules for the assessment of their malignancy potential and to identify "defects" of clinical and instrumental examination of patients with nodular goiter in clinical practice. Materials and methods: we analyzed the data of general clinical research, hormonal profile, and thyroid ultrasound studies performed on the basis of various clinics in the city of Tomsk (41%), Endocrinology Department of the OGAUZ TOKB consultative and diagnostic polyclinic (28 %), and Cancer Research Institute (31%) for the period from 2012 to 2014. The patients were selected for surgery. Pre-operative data were compared with histological features of the nodules. Results: we analyzed «defects» of patient examination, statistical data on clinical and laboratory-instrumental parameters of thyroid nodules. Conclusion: «defects» of description of ultrasound data significantly reduce sensitivity of the method for predicting malignancy of thyroid nodules. The description of the material obtained by US-FNA alone, in the absence of the conclusion of medical cytologists, has no informative value. Low specificity of a cytological study (48.4%) and its high sensitivity (95.8%) suggests overdiagnosis of thyroid cancer.
Genderspecific features of antioxidant protection and efficacy of atorvastatin in patients with stable forms of coronary heart disease
Authors: Bondar K. Yu. , Belaya O. L. , Lazutina O. M. , Mikhailova I. S. , Smorkalova T. V. , Kuropteva Z. V. , Baider L. M.
Published: November 2020

The gender-specific features of cardiovascular diseases (CVD) are actively being discussed which puts on the agenda the development of a differentiated approach to the treatment of cardiac diseases in men and women. Аim. To assess the gender-specific features of the antioxidant status and antioxidative activity of atorvastatin in patients with stable forms of coronary heart disease (CHD) and dyslipidemia (DLP). Material and methods. The study included 102 patients with stable forms of CHD divided into 2 groups according to sex and 40 healthy individuals. The generally accepted methods were used to determine plasma lipids, products of their peroxidation (diene conjugates, DC) and the products reacting with 2-thiobarbituric acid (TBA-RP), the antioxidant enzymes glutathione peroxidase (GP) and superoxide dismutase (SOD) in erythrocytes; the activity of the ceruloplasmin/transferrin antioxidant system (AOA AOS CP/TF) in blood plasma was measured by electron paramagnetic resonance and the final metabolites of nitric oxide with the use of the Griss reagent. The endothelial function was studied by ultrasound with the assessment of endothelium-dependent vasodilatation as described by D. Celermajer et al. (1992). All parameters were evaluated before and 6 months after the onset of the treatment. Results. The men with CHD, unlike women, underwent a reduction of AOA AOS CP/TF by 10%, SOD by 12% and GP by 19% (p<0.05) as well as excessive accumulation of DC up to 9% and TBA-RP to 11% (p<0.05). The homocysteine level in men, was 1.5 times higher (p=0.01), and that of final nitric oxide metabolites 12% lower (p=0.03) than in women. Atorvastatin administered for 6 months as a component of combined cardiac therapy more significantly increased the activity of AOS CP/TF and endothelium-dependent vasodilatation in men than in women. Conclusion. CHD is associated with significant sex differences in processes of lipid peroxidation - antioxidant protection, metabolism of nitric oxide, found, dilatation and anti-oxidation effect of atorvastatin.
Stratification of the risk and severity of metabolic syndrome
in patients in need of therapeutic treatment
Authors: Pinkhasov B. B. , Lutov Yu. V. , Deev D. A. , Selyatitskaya V. G.
Published: November 2020

The purpose of the present study was to estimate the risk and severity of metabolic syndrome (MS) in 108 therapeutic profile patients of different age and gender. The method based on the numerical score of deviation of the main and additional components of MS from the standard values was used. It included the detection of insulin resistance and the waist to the hip circumference ratio as a criterion of abdominal obesity. The metabolic syndrome was diagnosed in 57.4% of patients, with its mild, moderately severe and very severe forms being documented in 35.5%, 29.0% and 35.5% of the cases respectively. Mild MS was occurred much more often in women than in men in whom moderately severe and very severe forms predominated. MS manifestations were totally absent only in 3 women. In the remaining patients, the low, moderate and high risk of development of MS was estimated at 25.6%, 32.5% and 41.9% respectively. In groups with different risk and severity of MS, the average age of men was lower than in women, the difference amounting to 10 years and more in the groups including patients with mild and moderately severe MS. The proposed method of the stratification allows the personalized approach to diagnosis and correction of metabolic disorders, determination of the necessary volume of medical aid, and taking decisions about the treatment of individual patients.
The efficiency of treatment of cryoglobulinemic vasculitis associated with hepatitis C virus: analysis of 60
cases
Authors: Ignatova T. M. , Kozlovskaya L. V. , Gordovskaya N. B. , Chernova O. A. , Milovanova S. Yu. , Novikov P. I. , Beketova T. V. , Nekrasova T. P. , Mukhin N. A.
Published: November 2020

Aim. To evaluate the results of immunosuppressive and/or antiviral treatment of patients with hepatitis C virus (HCV)-induced mixed cryoglobulinemic (MC) vasculitis. Material and methods. This prospective study included 60 patients (m/f - 23/49, age - 45,9±11,1) with HCV-MC vasculitis. The Birmingham vasculitis activity score (BVAS) was used before the treatment and during follow-up (3,5±4,1 years). The rate of clinical and immunological responses to the treatment, the frequency of relapses and the influence of different treatment approaches on the prognosis of the disease were evaluated. Logistic regression analysis was used to assess factors influencing the effectiveness of treatment. Results. 23 (38%) patients had liver cirrhosis. BVAS scores before treatment ranged from 2 to 36. 25 (41,6%) patients had BVAS≥15. 6 (10%) patients presented with B-cell non-Hodgkin lymphomas. The antiviral treatment resulted in the elimination of the virus in 48.0% of the cases, complete clinical and immunological responses were achieved in 68,0% and 32,0% respectively. It had an advantage over immunosuppressive therapy in terms of long-term results of the treatment. We established the superiority of anti-CD monoclonal antibodies (rituximab) over conventional immunosuppressive drugs: complete clinical response 73% vs 13% (p=0,001). Combined therapy (rituximab and antiviral treatment) was more effective in patients with severe vasculitis (BVAS≥15). A case of successful treatment using direct-acting antivirals (DAAs) is reported. Causes of MC-vasculitis relapses after achieving sustained viral response are discussed. Conclusion. Antiviral therapy is the treatment of choice in all patients with HCV- HCV-MC vasculitis. Preference should be given to highly effective and safe modern therapy regimens with the use of DAAs. The antiviral treatment of severe forms of vasculitis must be combined with rituximab therapy.
Difficulties of diagnostics and treatment of Wilson-Konovalov disease
Authors: Podzolkov V. I. , Pokrovskaya A. E.
Published: November 2020

The article focuses on the discussion of diagnostics and treatment of Wilson-Konovalov disease (WKD) a rare progressive hereditary condition resulting from anomalous copper release that leads to its excessive accumulation in the tissues and combined lesions of parenchymatous organs (in the first place, liver) and brain. It most frequently diagnosed at the age of 5-40 years in association with manifestations of liver damage and neuropsychiatric symptoms. Sometimes, the disease occurs in subjects aged above 60 years. WKD is characterized by a variety of clinical manifestations and multi-organ lesions responsible for pathological conditions of the cardiovascular, endocrine, locomotor, hematological, digestive systems and kidneys. The main target organs are liver and brain. A most serious problem is late diagnostic of WKD at the stages with irreversible changes and liver cirrhosis. A case of WKD is reported presenting a classical example of this condition that manifested itself at a young age at the stage of cirrhosis which excluded reversal of the pathological process and thereby accounted for the unfavourable prognosis. The difficulty of WKD therapy is discussed in relation to the risk of side effects of D-penicillamine, the drug of choice, for the management of WKD.
The treatment of mitral valve infectious
endocarditis caused by a foreign body in the pulmonary artery
Authors: Simonenko V. B. , Borisova I. A. , Dalinin V. V. , Novikov A. N. , Uymanova M. Yu.
Published: November 2020

A case of acquired heart valvular disease (mitral valve insufficiency) is reported as a result of infectious endocarditis caused by a foreign body in a branch of the pulmonary artery. Mitral valve replacement with the mechanical Carbomedics Standard 27 prosthesis was combined with the removal of the foreign body and revision of the aortic valve under artificial circulation and pharmacocryocardioplegia.
Contribution of Vladimir Kharitonovich Vasilenko and his disciples to the study of ulcer disease
Authors: Sheptulin Arkadiy A.
Published: November 2020

The article outlines the contribution of V.Kh. Vasilenko and his disciples to the study of ulcer disease including substantiation of its pathogenesis as a result of disbalance between the aggressive action of acidic and peptic factors and protective potential of gastric and duodenal mucosa based on the evaluation of their role in mucus production, epithelial cell regeneration, secretion of gastrointestinal peptides, and other processes. Special emphasis is laid on the differentiation between ulcer disease and symptomatic gastroduodenal ulcers as proposed by Vasilenko, his analysis of the clinical picture and diagnostics of ulcer disease depending on the patient’s age and sex, evaluation of therapeutic efficiency of antiulcer medicines. Recent literature data confirm Vasiolenko’s idea about different role of selected pathogenic factors in individual patients with ulcer disease.
Desynchronization of biological rhythms in response to environmental factors
Authors: Komarov F. I. , Rapoport S. I. , Breus Tamara K. , Chibisov S. M.
Published: November 2020

The temporal structure and dynamics of biological rhythms were formed in the course of evolution under the influence of environmental factors. Circadian rhythm as a central one in biological objects developed in response to daily luminosity and temperature rhythms related to rotation of the Earth. New causative factors that could be involved in this process and affect the entire spectrum of biological rhythms emerged with the advent of space research. The discovery of solar wind, interplanetary magnetic field, and Earth’s magnetosphere revealed similar periodicity of biological rhythms and magnetic factors which suggests possible participation of the latter in the formation of the former. Disturbances in magnetic rhythms may lead to desynchronization of biological processes by the adaptive stress mechanism as exemplified by circadian rhythm disorders in response to jetlag. This hypothesis forwarded by the authors in the 1990s was confirmed by further investigations including those reported by foreign researchers.
Assessment of life quality in the patients with duodenal ulcer treated by melatonin therapy of under conditions of European North
Authors: Nikiforova Nadezhda A. , Karapetyan T. A. , Dorshakova N. V.
Published: November 2020

Objective: to estimate the quality of life (QOL) in the patients with duodenal ulcers residing in the North European part of Russia and treated by melatonin therapy in addition to standard anti-ulcer therapy using the GSRS questionnaire. Materials and methods: the study involved 80 patients with uncomplicated duodenal ulcer in the acute stage randomized into 2 groups: group I (n= 40) given three-component treatment (omeprazole, clarithromycin, amoxicillin) with the addition of melatonin and group 2 (control, n=40) given the same therapy but without melatonin. Taking into account the peculiarities of photoperiodicity in the study region, group 1 was subdivided into subgroups A and B and group 2 into subgroups C and D (A and C- received treatment from March to August; and B and D-from September to February). The quality of life was assessed based on the Russian-language version of GSRS before and on day 14 after onset of therapy. The clinical picture of the disease in groups 1 and 2 before treatment was dominated by abdominal (AU) and reflux (RS) syndromes. On 14 after onset of therapy, life quality improved in both groups but to a lesser degree in group 2 than in group 1 due to significantly more pronounced abdominal pain and reflux syndrome as well as worse results of evaluation from GSRS. In all subgroups, the number of GSRS points on the whole and for each scale of the questionnaire decreased on the 14th day of therapy . However, subgroup C showed a higher prevalence of abdominal pain and reflux syndrome than subgroup A as well as poorer GSRS-based estimates. Subgroup B differed in a similar way from subgroup D. Conclusion: anti-ulcer therapy in combination with melatonin is more effective than without it especially if started in a period of growing daylight duration and its maximum.
Surgical treatment of a patient with coronary heart disease and
post-infarction left ventricular aneurism associated with aortic stenosis
Authors: Borisov I. A. , Dalinin Vadim V. , Krainyukov P. E. , Travin N. O.
Published: November 2020

The paper reports a case of successful surgical treatment of a patient with coronary heart disease and post-infarction left ventricular aneurism associated with aortic stenosis. The unique combination of these two conditions is discussed along with advantages of seamless aortic valve prostheses for the treatment of combined heart pathology.
Application of healthcare protocols for the patients with severe exacerbation of bronchial asthma based at a specialized clinic from the perspective of quality management
Authors: Demko I. V. , Sobko E. A. , Gordeeva Natal’ya V. , Kraposhina A. Yu. , Solov’eva I. A. , Chubarova S. V. , Ishchenko O. P. , Vtyurina S. S. , Novikova N. A. , Khendogina V. T.
Published: November 2020

The aim of this work was to determine the optimal strategy for the treatment of patients with severe exacerbation of bronchial asthma based at a specialized clinic from the perspective of quality management as a basis for a universal therapeutic scheme taking account of the social status of the patient and localization of the medical facility. The study included 100 patients with bronchial asthma (BA) admitted to the Allergic Department of Regional Clinical Hospital. Those of group 1 were given systemic glucocorticosteroids (SGCS) parenterally or inhalation glucocorticosteroids (IGCS) through a metered dose inhaler. Patients of group 2 received SGCS parenterally or IGCS through a nebulizer. Examination included determination of external respiratory function, pulse oximetry, and ECG. Both modalities improved the patients’ clinical conditions within the first 4 hours, with the use of bronchodilators and IGCS through the nebulizer in combination with SGCS producing the most pronounced effect on peak expiratory flow rate. The per patient cost of medication therapy in group 1 was 131.5 rubles/day compared with 199.7 rubles in group 2. The cost of the complete treatment course was 1577.44 and 1797.78 rubles respectively. However, the number of one bed-days spent in the hospital for patients of group 2 was smaller than in group 1 which accounted for the cost of the complete treatment course 27 573.60 and 37 431.64 rubles respectively (р=0,04). It is concluded that the optimal therapeutic modality for the patients with severe exacerbation of bronchial asthma includes the use of bronchodilators and IGCS through a nebulizer in combination with SGCS. It not only improves clinical and functional characteristics of the patients but also reduces their hospital stay and the total cost of the treatment.
Bitter taste threshold and bronchial obstruction in bronchial asthma
Authors: Mineev Valerii N. , Supranovich I. Yu. , Kuzikova A. A.
Published: November 2020

Aim. To compare bitter taste sensitivity to potassium chloride and parameters of bronchial patency in patients with bronchial asthma (BSA). Material and methods. The study involved 40 healthy volunteers, 82 patients with allergic asthma (ABA), 48 patients with non-allergic asthma (NABA). Spirometry was conducted. The method of Robert I.Henkin et al. (1963) was used to determine the threshold of taste sensitivity to the bitter taste (potassium chloride). Results. The bitter taste threshold was significantly higher in asthmatic patients, particularly in patients with allergic variant of the disease compared to healthy volunteers. Statistically significant inverse correlations were revealed between bitter taste threshold and those volume (VC: τ=-0,306; n=43, p<0,01) and speed parameters (FEV1: τ=-0,429; n=44, p<0,01; MEF50: τ=-0,419; n=43, p<0,01; MEF75: τ=-0,460; n=44, p<0,01) that were obtained after inhalation of β2-agonist (berotec). Moreover, negative correlation (τ=-0,221, n=56, p<0,01) was documented between bitter taste threshold and blood ionized calcium level. Non-allergic BA was characterized by significant negative correlation between bitter taste threshold and initial vital capacity. Conclusion. The above findings suggest that changes in bitter taste sensitivity and disorders of bronchial patency in allergic BA may have common pathogenetic mechanisms based in accordance with modern concepts on disturbances in signal transduction systems coupled to G-proteins.
Systemic endotoxemia in patients with chronic kidney disease.
Authors: Zulkarnaev Alexey B.
Published: November 2020

Endotoxin plays an important role in the pathogenesis of atherosclerosis, metabolic syndrome, and other processes contributing significantly to mortality in patients with chronic kidney disease. Developing on the background of systemic endotoxemia chronic inflammation, causing numerous violations of adaptive-compensatory mechanisms of homeostasis regulation. The main source of endogenous endotoxin is the gut microbiome. The severity of endotoxemia increases with the progression of chronic kidney disease. In patients on hemodialysis endotoxinemia also associated with the use of high permeable membranes. Of particular importance in this case is the formation of biofilm in the dialysis lines, water purification system and central venous catheters. Targeted prevention of complications associated with systemic endotoxemia may improve outcomes in patients with chronic kidney disease.
Controversial issues of gallbladder and sphincter Oddi disorders: analysis of Rome IV criteria (2016).
Authors: Sheptulin Arkadiy A. , Kardasheva S. S.
Published: November 2020

Functional disorders of biliary tract published in 2016 include functional gallbladder disorders, biliary sphincter Oddi and pancreatic sphincter Oddi disorders. One of the advantages of these criteria is recognition of the diagnosis of such functional disorders as the diagnosis of exclusion, the establishment of which requires the conduction of complex laboratory and instrumental investigations to detect the possible organic diseases. The disadvantages of these new criteria include the lack of development of noninvasive instrumental methods (especially ultrasound method), complexity, inaccessibility and insecurity of recommended diagnostic methods (particularly sphincter Oddi manometry), insufficient attention to the current opportunities of medical therapy.
Collagen role in the mechanisms of chronic wounds healing diabetic foot syndrome.
Authors: Silina Ekaterina V. , Stupin V. A. , Gabitov R. B.
Published: November 2020

The review of the world literature, is devoted to the role of collagen in the process of wound healing. The problems of epidemiology of chronic wounds and ulcers of various genesis, physiology and pathophysiology of wound healing phases are considered. The pathogeneticrole of different types of collagen, as well as the mechanisms of collagen, macrophage, fibroblasts, matrix metalloproteinases and other cytokines in healing ulcers are discussed. The prospects of development and use of medical products and preparations based on collagen in the treatment of patients with chronic wounds and ulcers are shown. The results of clinical studies on the effectiveness of collagen with preserved (native) and unsaved (fractionated) structure are presented. The advantages of using native collagen in the treatment of diabetic foot syndrome are demonstrated.
Melatonin in menopausal metabolic syndrome formation.
Authors: Bruhina E. V. , Mamontova A. G. , Usoltseva Elena N.
Published: November 2020

Women’s life has changed considerably during the last decades. Often it can be characterized by hypodynamia, high-energy, refined diet, disturbance of circadian rhythms (working in shifts, staying for a long time in front of the TV screen or computer). All these factors, as well as, hormonal changes, which are connected with reduction of women’s reproductive function, increase the risk of metabolic syndrome. Thus, search of new therapeutic agent is currently taking place. Such medicament should effect on all symptoms of metabolic syndrome, and at the same time should be well co-administered with other drugs. Probably, one of such drugs is melatonin. The literature search was held in Russian (elibrary, cyberleninka.ru) and international (pubmed, wiley online library) data bases for the last seven years. Free access to the full document was of top-priority. The choice was limited by two languages: Russian and English. The article contains information about the metabolic syndrome frequency in a population, and metabolic changes in women’s organism in post-menopause. The article focuses on the role of melatonin in the menopause metabolic syndrome formation. Mechanisms of the melatonin influence on all the metabolic syndrome components: obesity, arterial hypertension, blood lipids changes, and insulin resistance are studied. The correlation between the melatonin secretion decrease and the atherosclerosis and diabetes mellitus type II formation is observed. The article contains data about animal experiences and the melatonin use for its management in biological models. It is proved that melatonin has positive influence on metabolic syndrome symptoms in animal studies.
The
relationship of visceral obesity and cardio-ankle vascular index with impaired glucose metabolism according to the ESSE-RF study in West Siberian region.
Authors: Sumin Alexei N. , Bezdenezhnykh N. A. , Fedorova N. V. , Bezdenezhnykh A. V. , Indukaeva E. V. , Artamonova G. V.
Published: November 2020

Aim. To study the relationship of cardio-ankle vascular index (CAVI) and the factors of cardiovascular risk (including visceral obesity) with impaired glucose metabolism in a population sampling. Material and methods. Cross-sectional study was performed within the framework of multicentre epidemiological study ESSE-RF from March to October 2013. The study subject was a random population sampling of male and female adult population in the age of 25-64 years old in the Kemerovo region. Standard research protocol ESSE-RF is extended with additional research of peripheral arteries' stiffness at VaSeraVS-1000 apparatus (Fukuda Denshi, Japan) with automatic estimation of cardio-ankle vascular index. A sample of 1619 subjects was formed in several stages, 2 subjects with T1DM were excluded from it. The rest 1617 subjects were divided into three groups: group 1 - subjects with type 2 diabetes mellitus (T2DM) (n = 272), group 2 - subjects with pre-diabetes - impaired fasting glucose, impaired glucose tolerance or a combination of them (n = 44), group 3 - subjects without any confirmed impaired glucose metabolism (n = 1301). Results. This type 2 diabetes was diagnosed in 16.6% patients, pre-diabetes - in 2.7%. When comparing the clinical and medical history and laboratory characteristics to the following trend is noteworthy: patients with diabetes and prediabetes were comparable for most indicators, but significantly different from patients without disorders of carbohydrate metabolism. The prevalence of coronary heart disease, hypertension, obesity, stroke, kidney disease, dyslipidemia was higher among diabetic and pre-diabetic persons. The incidence of pathologic CAVI (> 9.0) was higher among patients with diabetes and prediabetes (15.9% and 16.8%) compared with those with normoglycaemia (9.0%, p < 0.001 for trend). In the total sample CAVI positively correlated with age (r = 0.526, р < 0.001), T2DM (r = 0.128, р < 0.001), pre-diabetes (r = 0.071, р = 0.002), waist circumference (r = 0.125, р < 0.001), visceral obesity (r = 0.097, р < 0.001), but not with BMI (r = 0.042, р = 0.132). According to the result of the regression analysis CAVI values were associated with the presence of diabetes (odds ratio (OR) 1.185 with an increase in the CAVI for each unit, 95% confidence interval (CI) 1.100-1.276; p < 0.001), and pre-diabetes (OR 1.179, 95% CI 1.008-1.380; p = 0.044). Visceral obesity was associated with T2DM (OR 2.893, 95% CI 2.093-3.999, р < 0.001) and pre-diabetes (OR 2.350, 95% CI 1.119-4.935, р < 0.001). Conclusion. Prediabetic and diabetic patients have similar prevalence of cardiovascular risk factors, including increased stiffness of arteries and visceral obesity. In a community sample of West Siberia increase in CAVI was associated with both type 2 diabetes and prediabetes.
Effect of proton pump inhibitors on cytochrome P450 2c19 activity in
patients with gastroesophageal reflux disease.
Authors: Rabotyagova Yuliya S. , Klyaritskaya I. L. , Modak Anil
Published: November 2020

Patients with gastroesophageal reflux disease (GERD) are routinely prescribed one of the six proton pump inhibitors (PPI). All of these PPI are inhibitors of CYP2C19 enzyme to varying degrees. The phenotype 13C-pantoprazole breath test (Ptz-BT) was used to identify patients who are poor metabolizers (PM) and the extent of phenoconversion of CYP2C19 enzyme activity caused by four PPI (omeprazole, esomprazole pantoprazole and rabeprazole) in 54 newly diagnosed GERD patients prior to initiating randomly selected PPI therapy and 30 days after PPI therapy. The phenoconversion after 30 days of PPI therapy in GERD patients was statistically significant (p = 0.001) with omeprazole/esomeprazole (n = 27) strong CYP2C19 inhibitors, while there was no change in CYP2C19 enzyme activity (p = 0.8) with pantoprazole/rabeprazole (n = 27), weak CYP2C19 inhibitors. The rapid, in vivo, and non-invasive phenotype Ptz-BT can evaluate CYP2C19 enzyme activity. More importantly, it can identify GERD patients with low CYP2C19 enzyme activity (PM), caused by PPI or other concomitant medications, who would benefit from dose adjustments to maintain efficacy and avoid toxicity. The existing CYP2C19 genotype tests cannot predict the phenotype nor can it detect phenoconversion due to nongenetic factors.
Severe pneumonia with anemic syndrome.
Authors: Arkhangelsky Dmitry A. , Butikov V. P. , Zakrevsky Yu. N. , Barachevsky Yu. E. , Shevchenko A. G. , Balakhnov D. O.
Published: November 2020

The question of determining the criteria for medical evacuation of patients with severe pneumonia from remote regions is still poorly understood. Presented a clinical case of successful evacuation of a patient with severe pneumonia with the presence of anemia. The aim of the study was to evaluate anemia as a prediction of the possible development of acute respiratory failure in patients with pneumonia. Statistically significant associations of increased respiratory index (РаО2/FiO2) with hemoglobin levels (r=0,689 p=0.001) and the number of blood erythrocytes (r=0,683 p=0,001).
The fatty acid composition of the
mitochondrial membranes of platelets in chronic obstructive pulmonary disease.
Authors: Denisenko Y. K. , Novgorodtseva T. P. , Vitkina T. I. , Antonyuk M. V. , Bocharova Nataliia V.
Published: November 2020

Objective: to study the composition of fatty acids (FA) and mitochondrial membrane potential (MMР) of blood cells in patients with chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD); to establish the role of the Mitochondrial dysfunction in the formation of respiratory diseases. Material and methods. The study involved 26 patients with chronic bronchitis, 27 - with mild COPD, 21 - with moderate COPD steady flow, 29 healthy people. MMР leukocytes was assessed by flow cytometry. The composition of the FA mitochondrial membranes was studied by gas-liquid chromatography. Results and discussion. With the worsening of the disease (moderate COPD) increases the number of white blood cells with reduced MMP, appears deficit of the saturated, monoenic (14: 0, 16: 0, 18: 0) and n-3 polyunsaturated fatty acids (18: 3n-3 20: 5n-3, 22: 5n-3, 22: 6n-3) in the membrane of the mitochondria. Identified imbalance in the composition of fatty acids verifies the changes in the physicochemical properties of subcellular membrane malfunction membrane transport systems, enzymes and receptors, processes of oxidative phosphorylation. Conclusion: The imbalance in the composition of the LCD mitochondrial membranes lead to the development of mitochondrial dysfunction and the formation of cell hypoxia.
Acquired inhibitory form of hemophilia.
Authors: Barlamov Pavel Nikolaevich , Vasilieva E. R. , Golubeva M. E. , Zelobov V. G. , Starikova O. S. , Shutylev A. A.
Published: November 2020

The article presents a brief review of the literature on the current understanding of the etiology, pathogenesis, clinic, diagnosis and treatment of the acquired form of hemophilia, as well as the clinical case of this pathology with successful treatment.