Terapevticheskii Arkhiv最新文献

{"title":"[Resolution of advisory board on issues in the diagnosis of asthma and COPD: current challenges and modern approaches to their resolution].","authors":"S N Avdeev, E A Shabanov, L M Kudelya, V D Fedotov, E A Demchuk, V V Tsoma, Y V Bogdanova, N D Ponomareva, O Y Pozdnyakova, I V Petryakov","doi":"10.26442/00403660.2024.08.202949","DOIUrl":"10.26442/00403660.2024.08.202949","url":null,"abstract":"<p><p>Diagnosis of asthma and chronic obstructive pulmonary disease (COPD) remains an actual problem in Russia. The lack of diagnostics and control of these diseases leads to serious consequences for public health and economic damage. Effective initiatives to improve the level of diagnosis and control of asthma and COPD include the organization of educational activities, instrumental methods of examination, the use of mobile offices for outreach work in remote communities and the introduction of medical information systems. The introduction of digital technologies into medical practice will help to improve the quality of medical care, increase the efficiency of medical centers, and ensure timely diagnosis and control of respiratory diseases. The introduction of modern approaches and methods in the diagnosis of asthma and COPD, active use of validated questionnaires and medical information systems will improve the quality of life of patients and reduce the risks of complications and exacerbations of diseases.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cytomegalovirus infection in gastroenterology].","authors":"I V Maev, K A Velikolug","doi":"10.26442/00403660.2024.08.202814","DOIUrl":"https://doi.org/10.26442/00403660.2024.08.202814","url":null,"abstract":"<p><strong>Aim: </strong>To highlight the relevance of gastrointestinal manifestations of cytomegalovirus infection (CMVI), to highlight the main risk factors for the development of this pathology, current trends in diagnosis and treatment.</p><p><strong>Key points: </strong>CMVI is one of the most common opportunistic diseases, characterized by a variety of manifestations from asymptomatic to severe generalized forms affecting internal organs and body systems. The prevalence of CMVI worldwide ranges from 20 to 95%. Particular attention is paid to timely diagnosis, treatment and prevention of CMVI. The \"gold standard\" in the diagnosis of digestive diseases associated with CMVI is immunohistochemical examination and detection of cytomegalovirus (CMV) DNA in tissues using the polymerase chain reaction (PCR). Of undoubted interest in the diagnosis of CMV is the detection of CMV DNA in stool using digital PCR. Compared to quantitative PCR, digital PCR has higher accuracy and sensitivity. As first-line therapy, the drugs of choice are ganciclovir and valganciclovir. Maribavir has been successfully used to treat patients with CMV infection refractory to one or more previous therapies. One of the promising directions in the treatment of cytomegalovirus colitis in patients with ulcerative colitis is fecal microbiota transplantation.</p><p><strong>Conclusion: </strong>Timely identification of risk factors for the development of CMV infection, the introduction of innovative methods and approaches in diagnosis, and the use of effective methods for treating diseases of the digestive system associated with CMV infection can improve the prognosis of the underlying disease and reduce the risk of developing urgent conditions in gastroenterology.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Barth syndrome in an adult patient: an overview of the problem and case report. A review].","authors":"M D Muksinova, Y F Osmolovskaya, I V Leontyeva, M A Galaeva, O V Stukalova, A G Beniashvili, A A Safiullina, I V Zhirov, S N Tereshchenko","doi":"10.26442/00403660.2024.08.202815","DOIUrl":"10.26442/00403660.2024.08.202815","url":null,"abstract":"<p><p>Barth syndrome is a rare genetic disease caused by abnormal cardiolipin metabolism, characterized by high mortality within 5 years of diagnosis due to heart failure and/or infectious complications. This article describes a clinical case of an adult patient with Barth syndrome. The peculiarities of the course of the disease are described, including the transformation of the hypertrophic type of cardiomyopathy into the hypokinetic type as the patient grew older. This article demonstrates the difficulty in selecting the optimal treatment of a patient with Barth syndrome in real clinical practice, in the absence of clearly prescribed recommendations and pathogenetic therapy.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comparative assessment of the clinical effectiveness of direct-acting antiviral drugs in outpatient patients with acute respiratory viral infections].","authors":"K V Kozlov, O V Maltsev, K V Kasyanenko, V S Sukachev, Y I Lyashenko, A A Kosuhina","doi":"10.26442/00403660.2024.08.202911","DOIUrl":"https://doi.org/10.26442/00403660.2024.08.202911","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the clinical effectiveness, safety and compare the incidence of hospitalization during treatment with antiviral drugs with a direct mechanism of action (riamilovir and umifenovir) in people with acute respiratory viral infections (ARVI) in an outpatient setting.</p><p><strong>Materials and methods: </strong>The study included 150 outpatients with ARVI aged 18-27 years: 50 patients received riamilovir 250 mg 3 times a day for 5 days, the second group included 50 patients who received umifenovir 200 mg 4 times a day for 5 days, 50 individuals received only pathogenetic treatment.</p><p><strong>Results: </strong>The use of direct-acting antiviral drugs was characterized by the least severity of pain and aches in the body, general weakness, and in the group of patients receiving riamilovir, the lowest severity of rhinitis, cough, and the lowest morning body temperature were recorded compared to other groups. In riamilovir group reduction in the duration of the disease was observed. The lowest frequency of ARVI pathogens detection was observed on the 6th day in riamilovir group. Outpatient treatment with riamilovir was accompanied by a minimal number of cases of the disease requiring hospitalization.</p><p><strong>Conclusion: </strong>The use of direct antiviral drugs contributes to the rapid relief of ARVI symptoms in patients receiving medical care on an outpatient basis. The antiviral drug riamilovir showed the most pronounced effectiveness (clinical and laboratory).</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Herbal extracts in hepatoprotection: antioxidant and immunomodulatory effects. A review].","authors":"E V Shikh, E D Khaytovich, D N Tsvetkov","doi":"10.26442/00403660.2024.08.202841","DOIUrl":"https://doi.org/10.26442/00403660.2024.08.202841","url":null,"abstract":"<p><p>The global market for herbal medicines is valued at $83 billion and continues to expand rapidly. Plant extracts, widely used due to their safety and minimal side effects, play a significant role in supporting liver function. The treatment of liver diseases, including hepatitis of various etiologies, alcoholic and non-alcoholic fatty liver disease, and cirrhosis, involves the use of effective hepatoprotective drugs. Plant extracts provide antioxidant and immunomodulatory pharmacological effects that contribute to the maintenance of liver function. The aim of this review was to analyze the mechanisms underlying the hepatoprotective effects of various herbal extracts included in the formulation of DIPANA^®, focusing on their antioxidant and immunomodulatory properties. Additionally, the review aimed to present clinical study results supporting their efficacy in treating of various liver diseases. The analysis was based on available literature data and clinical studies on the use of DIPANA^®. The reviewed herbal extracts and their combination (DIPANA^®) demonstrate efficacy in experimental models of liver damage and clinical studies involving patients with liver diseases, including alcoholic and non-alcoholic steatohepatitis, drug-induced liver injury, and functional disorders of the gallbladder. This drug exhibits hepatoprotective, choleretic, relaxing effects and is well-tolerated by patients.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Personalized diagnosis of patients with gastroesophageal reflux disease using 24-hour pH-impedance testing and high-resolution esophageal manometry].","authors":"I V Maev, G L Yurenev, E V Barkalova, M A Ovsepian, D N Andreev, R I Shaburov","doi":"10.26442/00403660.2024.08.202816","DOIUrl":"https://doi.org/10.26442/00403660.2024.08.202816","url":null,"abstract":"<p><strong>Aim: </strong>To determine the phenotypic variants of patients with symptoms of gastroesophageal reflux disease (GERD), non-erosive reflux disease (NERD), hypersensitive esophagus (HSE), functional heartburn (FH) using 24-hour pH-impedance testing and high-resolution esophageal manometry (HSEM).</p><p><strong>Materials and methods: </strong>Fifty-five treatment-native symptomatic patients with newly diagnosed GERD and 48 control group subjects (CG) were examined. The mean age of the subjects was 45.0 years (95% confidence interval [CI] 41.0-48.9). Patients were grouped based on typical symptoms (heartburn, belching, regurgitation, odynophagy, dysphagia), medical history, endoscopy results, and 24-hour pH-impedance testing. Patients with typical symptoms of GERD and Grade B, C, D erosive esophagitis (EE) according to the Los Angeles Classification (LA) based on endoscopy were excluded from the further study. All patients without changes in the esophageal mucosa on endoscopy or with LA grade A EE (presumably NERD) underwent 24-hour pH-impedance testing and HSEM without proton pump inhibitors. Acid exposure, acid reflux count, symptom association with reflux (with symptom index and symptom association with reflux), mean nocturnal impedance, and post-reflux swallow-induced peristaltic wave index were assessed. The structure (presence or absence of a hiatal hernia) and function (presence or absence of the lower esophageal sphincter hypotonia) of the esophagogastric junction, as well as the motor function of the thoracic esophagus, were assessed using HSEM. The results of the HSEM were interpreted according to the Chicago Classification, 3rd edition (2015).</p><p><strong>Results: </strong>The number of acid refluxes in patients with NERD was 71.0 (95% CI 58.4-83.7), in subjects with HSE - 38.5 (95% CI 28.3-49.0), with FH - 13.0 (95% CI 6.5-18.2), in CG - 16.5 (95% CI 9.0-21.0). The average nocturnal basal impedance was 1300 ohms (95% CI 1000-1986) in patients with NERD, 1725 ohms (95% CI 1338-2261) in patients with HSE, 2760 ohms (95% CI 2453-3499) in FH, 2515 ohms (95% CI 2283-2700) in CG. The index of post-reflux swallow-induced peristaltic wave in patients with NERD was 61% (95% CI 57-71), with HSE - 85% (95% CI 82-88), with FH - 71% (95% CI 64-78), in CG - 66% (95% CI 63-69). Hiatal hernia and/or hypotonia of the LES were more common in patients with NERD (23%) than in CG (13.3%). Ineffective motility was detected in 34% of patients with NERD, in 23% of subject with FH and in 66.7% of patients with HSE.</p><p><strong>Conclusion: </strong>The results support the hypothesis that patients with GERD symptoms represent a heterogeneous population. 24-hour pH-impedance testing and HSEM helps to differentiate endoscopically negative patients with GERD symptoms and patients with Grade A EE by LA to NERD, HSE and FH.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Diagnosis and management of patients with pheochromocytoma/paraganglioma: Consensus of experts of the Russian Medical Society for Arterial Hypertension and the Multidisciplinary Group for the Diagnosis and Treatment of Neuroendocrine Tumors].","authors":"N V Blinova, I A Ilovayskaya, N M Chikhladze, A Y Lugovskaya, T A Britvin, L E Gurevich, L N Nefedova, V E Shikina, I E Chazova","doi":"10.26442/00403660.2024.07.202779","DOIUrl":"https://doi.org/10.26442/00403660.2024.07.202779","url":null,"abstract":"<p><p>The understanding of the nature of catecholamine-secreting tumors has changed significantly in recent years, affecting terminology and classification. Phaeochromocytoma/paraganglioma (PCC/PG) is a rare neuroendocrine tumor from chromaffin tissue that produces and secretes catecholamines. The incidence of PCC/PG is relatively low, with 2-8 cases per 1 million population per year; among patients with arterial hypertension, their prevalence is 0.2-0.6%. However, delayed diagnosis of PCC/PG is associated with a high risk of cardiovascular complications and a high mortality rate. The consensus presents the clinical manifestations of the disease with an emphasis on the course of arterial hypertension as the most common symptom in PCC/PG; modern ideas about the features of diagnosis, aspects of preoperative preparation, treatment, and follow-up of patients with PCC/PG are considered.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[GDF-15 and the risk of bleeding in patients with stable CAD receiving multicomponent antithrombotic therapy: the results of the prospective REGATA register].","authors":"E N Krivosheeva, A L Komarov, E P Panchenko, M B Khakimova, E S Kropacheva, O A Pogorelova, T V Balakhonova, E V Titaeva, A B Dobrovolsky, D M Galyautdinov, E E Vlasova","doi":"10.26442/00403660.2024.07.202783","DOIUrl":"10.26442/00403660.2024.07.202783","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the prognostic value of GDF-15 in relation the development of bleeding and events in stable CAD patients, receiving combined antithrombotic therapy.</p><p><strong>Materials and methods: </strong>The data was obtained from the prospective registry REGATA, 343 CAD patients (249 males), median age 68 [IQR 62; 75] years) were enrolled. Patients with sinus rhythm and concomitant PAD received acetylsalicylic acid in combination with rivaroxaban 2.5 mg bid (31.8%) or clopidogrel (24.8%). Other 43.4% with concomitant atrial fibrillation (AF) received direct oral anticoagulants in combination with antiplatelet therapy after elective percutaneous coronary interventions. Median follow-up was 12 months [<i>IQR 9.0</i>; 18.0]. The safety end point was major and clinically relevant bleedings (type 2-5) according to the BARC classification. Plasma samples for GDF-15 identification were taken at the inclusion and analyzed using ELISA assay.</p><p><strong>Results: </strong>Frequency of BARC 2-5 bleedings was 16% (BARC 2 - 46; BARC 3 - 9; BARC 4-5 - 0), median GDF-15 level was 1185.0 pg/ml [850.0; 1680.0]. In patients with AF and concomitant MFA, the level of GDF-15 was significantly higher than in the subgroups of patients with only AF or MFA (<i>p</i>=0.0022). According to the quintile analysis, GDF-15 values in the top three quintiles of distribution (cut-off value >943 pg/ml) were associated with higher frequency of bleeding events: 23.2% versus 5.1%; <i>p</i>=0.0001. The multivariable logistic regression model demonstrated that bleeding events were independently associated with GDF-15 level>943 pg/ml (OR 2.65, 95% CI 1.11-6.30; <i>p</i>=0.0275), AF (OR 2.61, 95% CI 1.41-4.83; <i>p</i>=0.0023) and chronic kidney disease (OR 1.92, 95% CI 1.03-3.60; <i>p</i>=0.0401). Clinical factors determining the risk of bleeding events also determined a GDF-15 elevation.</p><p><strong>Conclusion: </strong>Assessment of GDF-15 level may improve bleeding risk stratification in CAD patients with concomitant AF and/or PAD receiving combined antithrombotic therapy.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Glucose metabolism disorders and hypoglycemic therapy in patients hospitalized for elective lower limb arthroplasty: a prospective, single-center, real-world study].","authors":"E A Okisheva, O Y Trushina, M M Mamaeva, E A Redyanova, A A Zhazhieva, I D Chasova, A S Panferov, M M Bogdanov, A V Lychagin, V V Fomin","doi":"10.26442/00403660.2024.07.202780","DOIUrl":"https://doi.org/10.26442/00403660.2024.07.202780","url":null,"abstract":"<p><strong>Aim: </strong>To assess the incidence of glucose metabolism disorders, administered hypoglycemic therapy and its effectiveness in a cohort of patients with previously diagnosed diabetes mellitus (DM) hospitalized for scheduled lower limb joint arthroplasty.</p><p><strong>Materials and methods: </strong>The study included 502 patients. Medical history, information about previously diagnosed DM and prescribed hypoglycemic therapy were collected in all patients according to medical documentation, as well as according to the patients' survey. Within the preoperative examination, the glucose level was measured, and in patients with previously diagnosed diabetes, measuremaent of the HbA_1c level was recommended.</p><p><strong>Results: </strong>The study population included 180 (35.9%) males and 322 females (64.1%). Among them, 99 (19.7%) patients had disorders of glucose metabolism [type 1 diabetes - 1 (0.2%) patient, type 2 diabetes - 90 (17.9%) patients, impaired glucose tolerance (IGT) - 8 (1.6%) patients]. In 8 patients, type 2 diabetes was newly diagnosed during the preoperative examination. HbA_1c was measured before hospitalization in 26 patients with diabetes, the mean level was 7.0±1.4%. Regarding the analysis of hypoglycemic therapy, almost half of the patients with DM - 47 (47.5%) - received metformin monotherapy, 8 patients with IGT and 8 patients with newly diagnosed DM did not receive any drug therapy. Target glycemic levels during therapy were achieved in 36 (36.4%) patients, and target HbA_1c levels were achieved in 21 patients.</p><p><strong>Conclusion: </strong>The cohort of patients hospitalized for elective lower limb joint arthroplasty is characterized by a relatively high incidence of glucose metabolism disorders, and in some patients, DM was newly diagnosed during the preoperative examination. Metformin is most often used as hypoglycemic therapy, and the target values of glycemia during treatment were achieved in less than half of the patients. The monitoring of the level of glycated hemoglobin is low and requires additional population analysis in order to determine the causes and optimize the strategy of patient management.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The last illness of I.S. Turgenev].","authors":"L I Dvoretsky","doi":"10.26442/00403660.2024.07.202787","DOIUrl":"https://doi.org/10.26442/00403660.2024.07.202787","url":null,"abstract":"<p><p>The article discusses the causes and course of the last illness of I.S. Turgenev. The writer was consulted by many famous French and Russian doctors who made various diagnoses and used various methods of treatment. The primary disease that caused Turgenev's death is myxosarcoma (one of the sarcoma variants), involving soft tissues and thoracic vertebrae. The article presents data and discusses alternative diagnostic versions about the nature of the disease and the causes of death of the great Russian writer.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}