Terapevticheskii Arkhiv最新文献

{"title":"[Anticoagulant therapy for chronic heart disease atrial failure and fibrillation: a review].","authors":"M V Serova, Y S Sazonova, A S Derevinskaiia, A S Steklov, D A Andreev","doi":"10.26442/00403660.2024.11.203071","DOIUrl":"https://doi.org/10.26442/00403660.2024.11.203071","url":null,"abstract":"<p><p>Atrial fibrillation (AF) and heart failure (HF) often accompany each other, as they share similar risk factors and pathophysiological mechanisms. AF in patients with HF is known to increase hospitalizations and worsen prognosis. A combination of AF and HF translates into high risks of thromboembolic complications, which renders anticoagulants an important aspect of therapy for these patients. Vitamin K antagonists make achieving the target level of anticoagulation challenging due to drug interactions and comorbidities. Direct oral anticoagulants (DOACs) are preferred medications owing to a more favorable risk-benefit ratio in this group of patients. At the same time, patients with HF often require a personalized approach when choosing an anticoagulant due to increased risks of thromboembolic complications and bleeding, as well as multiple comorbidities. The article presents the results of sub-analyses of key studies on the efficacy and safety of DOACs vs vitamin K antagonists in patients with HF and AF. It also explores DOACs use in patients with chronic kidney disease.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"96 11","pages":"1083-1088"},"PeriodicalIF":0.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897827","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":"[Infant botulism: an underestimated problem. A review].","authors":"V A Malov, V V Maleev, V P Chulanov, D S Sarksyan","doi":"10.26442/00403660.2024.11.202999","DOIUrl":"https://doi.org/10.26442/00403660.2024.11.202999","url":null,"abstract":"<p><p>The article is devoted to a form of botulism that has been little studied in our country and is registered exclusively in infants. The fundamental difference between this form and the most common foodborne botulism is that infants become infected by ingestion of spores, followed by their germination, colonization of the intestines and production of botulinum toxin <i>in situ</i>, which leads to the development of life-threatening flaccid paralysis. Taking into account the peculiarities of pathogenesis, the clinical manifestations of infant botulism have some features, which are discussed by the authors. Particular attention is paid to the epidemiology and risk factors for the development of the disease. The article discusses in detail the issues of diagnosis and laboratory verification of the etiology of the disease. Current data on the treatment of infant botulism are presented.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"96 11","pages":"1069-1075"},"PeriodicalIF":0.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897899","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 effectiveness of vaccination against pneumococcal infection in patients with severe bronchial asthma].","authors":"G L Ignatova, S N Avdeev, V N Antonov, E V Blinova","doi":"10.26442/00403660.2024.11.203038","DOIUrl":"https://doi.org/10.26442/00403660.2024.11.203038","url":null,"abstract":"<p><strong>Introduction: </strong>The article discusses topical issues of the use of conjugated 13-valent pneumococcal vaccine Prevenar®13 (PCV13) in patients with severe bronchial asthma (SBA), including those receiving targeted therapy with genetically engineered biological drugs (GEBD).</p><p><strong>Aim: </strong>To study the effectiveness of vaccination against pneumococcal infection (PI) in patients with SBA.</p><p><strong>Materials and methods: </strong>The study included 381 patients with SBA. The average age in the study groups was 45.5 (42.0; 52.5) years. All patients underwent clinical and instrumental studies, including spirography with bronchodilation test. After confirming the diagnosis of BA, the patients were divided into 2 observation groups. Group 1 (<i>n</i>=191) consisted of patients undergoing treatment with GEBD. Group 2 included patients with asthma receiving standard therapy, according to the 4th-5th stage according to the criteria of the Global Initiative for Asthma 2022 (Global Initiative for Asthma - GINA). The observation group consisted of 190 patients. In each group, there are subgroups of patients who have been vaccinated against PI and have not been vaccinated for various reasons. The following criteria were used as the main endpoints of observation for 12 months to assess the effectiveness: the number of pneumonia during the observation period, the number of exacerbations of asthma (severe, non-severe), the number of hospitalizations, the duration of exacerbations, the level of control according to the Asthma Control Questionnaire (ACQ5), functional indicators.</p><p><strong>Results: </strong>The coverage of PI vaccination in patients with BA remains quite low, further organizational and methodological work is required to increase their involvement in vaccination. Immunization of PCV13 in patients with SBA at the 4th-5th stage of therapy reduces the risk of community-acquired pneumonia by at least 28.5%. PCV13 vaccination may be an additional effective tool for controlling the symptoms of SBA, including in patients undergoing treatment with GEBD. Vaccination allows to normalize the functional parameters of respiratory function in patients with SBA. PCV13 is well tolerated and does not cause any significant allergic reactions in patients with asthma.</p><p><strong>Conclusion: </strong>PCV13 vaccination is an effective tool for reducing the risk of community-acquired pneumonia in patients with severe bronchial asthma, including those on targeted therapy with genetically engineered biological drugs.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"96 11","pages":"1057-1062"},"PeriodicalIF":0.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897922","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":"[Coagulase-negative staphylococci as a significant fact of generalization of infection in persons with a burdened comorbid background].","authors":"V V Maleev, E N Lazareva, Z B Ponezheva, Y V Kuznetsova","doi":"10.26442/00403660.2024.11.202994","DOIUrl":"10.26442/00403660.2024.11.202994","url":null,"abstract":"<p><p>Since the era of the widespread introduction of antibiotics into the human sphere of activity, the problem of antimicrobial resistance has become an urgent and very important topic around the world. Recently, coagulasonegative staphylococci (CoNS), which are representatives of opportunistic microorganisms of the microbiome of the skin and mucous membranes of healthy people, have made a certain contribution to its progression. For a long time, they did not pose a threat to patients, but in recent decades among microorganisms they have been seeded in more than two-thirds of patients with postoperative mediastinitis, catheter-associated infections, as well as from wounds of the neck vessels and the inguinal region separated by pacemaker beds. This paper discloses, using clinical examples, the significance of CoNS in the formation of systemic inflammatory response syndrome in patients with a burdened comorbid background (type II diabetes mellitus, grade 3 arterial hypertension). During the examination of patients, it was shown that skin defects are foci of persistent bacteremia of representatives of the CoNS group, which can cause the development of a systemic inflammatory infectious response with the formation of resistant strains of the opportunistic flora of the microbiome of the skin and mucous membranes. It has been shown that to determine the tactics of antibacterial therapy, a bacteriological study of all detected foci of infection in patients, screening of pathogens and their sensitivity to antibiotics, and especially in persons at risk, is necessary. This will increase the effectiveness of antibacterial therapy and reduce the possibility of forming resistant strains of pathogens.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"96 11","pages":"1021-1027"},"PeriodicalIF":0.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897775","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":"[Issues of treatment and prevention of recurrent inflammatory diseases of the upper respiratory tract: An immunologist's view. A review].","authors":"A E Shul'zhenko, I N Zuikova, R V Shchubelko","doi":"10.26442/00403660.2024.11.203033","DOIUrl":"https://doi.org/10.26442/00403660.2024.11.203033","url":null,"abstract":"<p><p>Often ill people are, first of all, patients with recurrent infectious and inflammatory diseases of the upper respiratory tract (URT). They put a significant financial burden on the healthcare system. The leading etiological factors of recurrent inflammatory diseases of URT, in addition to pathogenic bacterial microflora, are viral agents (viruses of the viral respiratory infections group, herpes viruses). The chronic infection and recurrence of local inflammation is due to the persistence of resident bacterial and viral flora (including herpes viruses), and as a result, the insufficiency of the mucosal immune response. In order to optimize therapeutic and preventive measures for frequently ill adults and children, the most promising is the use of immunotherapy and immunoprophylaxis. The immunomodulator inosine pranobex, due to its unique combined (immunotropic and antiviral) properties, demonstrates effectiveness in the complex treatment of viral respiratory infections, including in combination with herpes viruses, and is successfully used to prevent frequent relapses of infectious and inflammatory diseases of the URT. The domestic analogue of inosine pranobex Normomed^® [JSC \"Valenta Pharm\"», ЛП-№(002470)-(РГ-RU), ЛП-№(005542)-(РГ-RU)], has a good safety and bioequivalence profile, and occupies a worthy field in the Russian pharmaceutical market among drugs recommended for the treatment of viral infections in adults and children.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"96 11","pages":"1076-1082"},"PeriodicalIF":0.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897900","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":"[Problems of poliomyelitis eradication].","authors":"O E Ivanova, Y M Mikhailova, L I Kozlovskaya, V V Maleev","doi":"10.26442/00403660.2024.11.202993","DOIUrl":"10.26442/00403660.2024.11.202993","url":null,"abstract":"<p><p>The article is devoted to the problems of implementation of the WHO Global Polio Eradication Initiative. The influence of the features of poliovirus infection and poliovirus vaccines on the course of the program, its successes and difficulties is considered, the issue of possibility of eradication this infection is discussed.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"96 11","pages":"1104-1109"},"PeriodicalIF":0.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897904","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":"[Hematologic indices as an available tool in the diagnosis of adverse course of COVID-19].","authors":"V I Podzolkov, E V Volchkova, A E Pokrovskaya, D D Vanina, T S Vargina, I D Hutkina, G I Ashirova","doi":"10.26442/00403660.2024.11.202996","DOIUrl":"https://doi.org/10.26442/00403660.2024.11.202996","url":null,"abstract":"<p><strong>Aim: </strong>To study the prognostic significance of hematologic indices: neutrophils/lymphocytes (N/L), platelets/lymphocytes (P/L) and lymphocytes/C-reactive protein (L/CRP) in relation to the complicated course of new coronavirus infection (COVID-19), as well as their correlation with COVID-19 course severity indices and endothelial dysfunction marker sVCAM-1.</p><p><strong>Materials and methods: </strong>103 patients with new coronavirus infection (COVID-19) were included in the study. Based on the data of multispiral computed tomography (CT) of the chest organs, all patients were divided into 3 groups: CT group 1 - 30 patients, CT group 2 - 62 patients and CT group 3 - 11 patients.</p><p><strong>Results: </strong>The values of N/L and P/L were significantly higher in patients of CT group 3 compared to patients of CT group 1 and CT group 2. L/CRP index, on the contrary, significantly decreased with increasing CT-degree of lung lesion. The concentration of endothelial dysfunction marker sVCAM-1 was significantly higher in patients of CT-3 and 2 groups compared to patients of CT-1 group - 272.7 [267.4; 342.6] ng/mL and 212.5 [90.3; 335.6] ng/mL vs 120.0 [75.3; 189.2] ng/mL. Significant correlations of the studied hematologic indices with clinical, laboratory and instrumental characteristics of COVID-19 severity were found. P/L and L/CRP indices were associated with sVCAM-1 concentration in blood (<i>r</i>=0.28 and -0.33 respectively; <i>p</i><0.05). The values of N/L>2.53 and L/CRP≤0.043 are predictors of the development of cytokine storm in the examined patients.</p><p><strong>Conclusion: </strong>Hematologic indices N/L, P/L and L/CRP are correlated with clinical, laboratory and instrumental characteristics of COVID-19 severity, presence of endothelial dysfunction (P/L and L/CRP) and allow predicting the development of cytokine storm (N/L and L/CRP).</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"96 11","pages":"1028-1034"},"PeriodicalIF":0.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897897","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":"[Adverse reactions in the treatment of patients with non-tuberculous lung mycobacterial pulmonary disease and the possibility of their solution].","authors":"E B Vladimirova, E I Shmelev, A S Zaytseva, S A Kasimtseva, E I Shchepikhin, T G Smirnova, N N Makaryants","doi":"10.26442/00403660.2024.11.202992","DOIUrl":"https://doi.org/10.26442/00403660.2024.11.202992","url":null,"abstract":"<p><strong>Aim: </strong>To study the adverse reactions that develop as a result of complex antibiotic therapy in patients with non-tuberculous lung mycobacterial (NTML) and to determine methods for their elimination without compromising the effectiveness of NTML treatment.</p><p><strong>Materials and methods: </strong>Examined 147 patients with confirmed NTML, for which they received treatment in accordance with the results of drug susceptibility of the pathogen. Before and during treatment, a study of clinical, biochemical blood tests, urinalysis, electrocardiogram, external respiration function, ultrasound of the abdominal organs and kidneys was performed.</p><p><strong>Results: </strong>Under the conditions of antimicrobial therapy (AMT) for non-tuberculous mycobacteriosis of the lungs, 41 (27.9%) patients developed adverse drug reaction (ADR). The most frequent adverse reactions were: allergic reactions in the form of urticaria, nausea, vomiting, arthralgia, nephro- and ototoxic reactions; 34 (82.9%) patients required treatment adjustment without discontinuation of AMT, and only in 7 (17.1%) cases, AMT was discontinued. A full course of multicomponent AMT was completed in 124 (84.4%) patients with NTML. An algorithm for monitoring therapy in NTML patients from the standpoint of preventing ADR has been developed. The categories of patients with potential risks of developing ADR under AMT were determined. Patients without the development of ADR had a positive radiological dynamics in 27.9% of cases, sputum conversion - in 42%. Patients with ADR had positive clinical dynamics in 39% of cases, radiological - in 31.7% of cases, sputum conversion - in 36.6% of cases.</p><p><strong>Conclusion: </strong>The incidence of ADR development remains high when complex AMT is administered to patients with NTML. The patient's comorbid background is the main risk factor for the development of ADR when prescribing multicomponent AMT. A multivariate analysis of the effectiveness of treatment in NTML patients showed comparable data among patients taking complex AMT and receiving only alternative therapies. The success of NTML treatment depends on a comprehensive personalized approach.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"96 11","pages":"1049-1055"},"PeriodicalIF":0.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897823","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":"[Prediction of the course of antibiotic-associated diarrhea caused by <i>Clostridioides difficile</i> based on clinical and laboratory characteristics of the disease].","authors":"K D Ermolenko, T V Potapova, K V Silav, K V Zhdanov, D A Lioznov, D A Gusev","doi":"10.26442/00403660.2024.11.203040","DOIUrl":"https://doi.org/10.26442/00403660.2024.11.203040","url":null,"abstract":"<p><strong>Background: </strong>The most severe complications of antibiotic use are clostridial infection (CDI) and pseudomembranous colitis (PMC). There is a need for further study of these conditions and identification of their triggers.</p><p><strong>Aim: </strong>To identify risk factors for severe forms of antibiotic-associated diarrhea caused by <i>Clostridioides difficile</i>.</p><p><strong>Materials and methods: </strong>A clinical and laboratory examination of 440 patients with CDI who were treated at Botkin Clinical Infectious Diseases Hospital was conducted. CDI was confirmed by detection of toxins A and B of <i>C. difficile</i> in feces using enzyme-linked immunosorbent assay and immunochromatography. Metronidazole (2 g/day, in patients without comorbid pathology) and vancomycin (0.5-2 g/day) were used as a starting drug for up to 14 days. Statistical processing of the obtained data was performed using the Statistica for Windows, v.10 (StatSoft, USA) program.</p><p><strong>Results: </strong>CDI was confirmed by enzyme-linked immunosorbent assay in 202 (45.91%) patients, immunochromatography - in 149 (33.86%), endoscopically - in 203 (46.14%). CDI was most frequently recorded in 2 age groups of patients: 18-30 years old - in 137 (31.14%); over 60 years old - in 205 (46.59%). CDI was characterized by a combination of colitic and intoxication syndromes. In 43 (9.77%) patients the disease resulted in death. The diagnosis of PMС was established in 61 (13.86%) people. The risks of developing PMC when prescribing antibacterial drugs decreased in the following order: fluoroquinolones, cephalosporins, macrolides, penicillins, nitrofurans and chloramphenicol. Probiotic drugs reduced the risk of developing PMC (relative risk 0.5 [0.3; 0.7]; <i>p</i>=0.002).</p><p><strong>Conclusion: </strong>PMC was characterized by a combination of diarrhea, intoxication and abdominal pain. The formation of PMC was preceded by courses of antibacterial drugs of the fluoroquinolone and cephalosporin groups, eradication therapy for <i>Helicobacter</i> infection, the use of high doses of glucocorticosteroids, as well as intestinal superinfection in patients with previous episodes of CDI.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"96 11","pages":"1042-1048"},"PeriodicalIF":0.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897903","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":"[Long-COVID, severe course, with congenital bronchiectasis, Williams-Campbell syndrome. Case report].","authors":"S A Pribylov, T A Maslova, V S Pribylov, K O Leonidova, N N Pribylova, A P Kuts","doi":"10.26442/00403660.2024.11.202997","DOIUrl":"https://doi.org/10.26442/00403660.2024.11.202997","url":null,"abstract":"<p><p>We present a clinical observation of an 18-year-old female patient with congenital bronchiectasis combined with congenital cystic degeneration of the upper lobes of both lungs, Williams-Campbell syndrome, long-COVID, severe course. The patient was treated in infectious disease department (three times), with subsequent transfer to pulmonology department of Kursk Regional Multi-Purpose Clinical Hospital from 31.01.2023 to 02.05.2023. The patient was going to have lung transplantation, registered in Shumakov Federal Research Center of Transplantology and Artificial Organs earlier. The patient was transported by air ambulance escorted by the resuscitation team to the Shumakov Federal Research Center of Transplantology and Artificial Organs on 02.05.2023 with negative PCR COVID-19 test. The literature data on the frequency of association of these diseases, clinical features, criteria for diagnosis and treatment, indications for lung transplantation are presented.</p>","PeriodicalId":22209,"journal":{"name":"Terapevticheskii Arkhiv","volume":"96 11","pages":"1089-1095"},"PeriodicalIF":0.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897902","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}