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No 34 (2023): The Review (3)
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6-10 314
Abstract

Ulcerative colitis is a chronic autoimmune disease characterized by inflammation of colonic mucous layer. Patients affected with ulcerative colitis are often subjected to immunosuppressive therapy that makes them susceptible to opportunistic infections. This article presents clinical case of moderate-to-severe ulcerative colitis, complicated by cytomegalovirus infection. We demonstrated the necessity of the inclusion of cytomegalovirus infection into the differential diagnostic algorithm of ulcerative colitis relapse using molecular methods of diagnosis. Also, we justified the choice of specific antiviral therapy and first line biological therapy in a bionaive steroid-dependent, refractory to thiopurines patient. The choice of ustekinumab as therapeutic armamentarium showed to be safe and effective in attainment and maintenance of persistent clinical, laboratory and endoscopic remission in a patient affected with ulcerative colitis with intestinal reactivation of cytomegalovirus infection.

10-15 275
Abstract

The COVID‑19 pandemic, first reported in late 2019, despite ending in May 2023, continues to have a devastating impact on global health with significant associated morbidity and mortality rates. Liver injury is a common feature in patients with COVID‑19 and ranges from mild and temporary elevation of liver enzymes to severe liver damage and even acute liver failure. The purpose of this review is to present data on the prevalence, pathophysiological mechanisms, clinical manifestations, diagnosis, course features, complications, and treatment options for liver damage in patients with SARS-CoV‑2. Several pathophysiological mechanisms are responsible for liver damage in COVID‑19, including the direct cytotoxic effect of the virus, cytokine storm, hypoxia and ischemia of the organ, and drug hepatotoxicity. Patients with underlying chronic liver disease (CLD) (liver cirrhosis, non-alcoholic fatty liver disease, alcohol-related liver disease, hepatocellular carcinoma, etc.) may have greater risk to develop both severe COVID‑19 and further liver deterioration. Some COVID‑19 patients experience post-covid syndrome, also known as post-acute COVID‑19, long-term COVID‑19 or long COVID‑19. The most common manifestations of post-covid syndrome in patients with liver pathology, both developed directly in connection with SARS-Cov‑2 infection, and in people with pre-existing CLD, include the phenomena of astheno-vegetative syndrome, as well as clinical and biochemical signs of moderate cytolysis and cholestasis syndrome.

16-19 256
Abstract

Relevance. Inflammatory bowel diseases can cause a lag in physical development and a decrease in the nutritional status of children. Therapy with glucocorticosteroids can aggravate the process of formation of the body and reduce the mineralization of bone tissue.

Materials and methods. The study included 24 children aged 5 to 17 years with inflammatory bowel diseases, of which 19 patients did not use glucocorticosteroids in therapy – group 1, and group 2–5 children on hormone therapy. The groups did not differ statistically significantly in age and gender composition. In order to assess the level of physical development, an assessment of anthropometric indicators was carried out using the ANTHRO Plus program. Bone mineral density was assessed by densitometry. Statistical processing was carried out using Statistica 6.0 statistical programs and descriptive statistics methods. To compare independent groups of small volume, the method was used Mann-Whitney

Results. The evaluation of length, body weight and body mass index was carried out, as a result, it was found that the majority of patients who participated in the study had an average level of physical development in the population, no statistically significant differences were found by any criterion (p > 0.05). When assessing the BMD in children with IBD who did not use hormone therapy in the treatment of diseases, it was found that the Z-Score level within the reference values was observed in 57.9% (n = 11) children, 1 (5.3%) child has below –2.49 and in 36.8% (n = 7) the Z-Score level was determined in the range from –1.00 SD to –2.49 SD. More than half of the patients in group 2 had no changes in BMD (60%; n = 3), the Z-Score value in 1 (20%) patient corresponded to the level of osteopenia and in 1 (20%) child – osteoporosis. No differences were found between the groups and depending on physical development, gender or age (p > 0.05).

Conclusions. It was found that children, regardless of the use of hormone therapy they have similar indicators in the levels of physical development and bone mineralization. The importance of monitoring the studied indicators for the timely prevention of changes is noted.

20-23 638
Abstract

Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the digestive tract from the mouth to the anus. Oral lesions in oral Crohn's disease are the most common extraintestinal manifestations of this disease and may reflect various pathogenic diseases. They can cause specific granulomatous inflammation in the oral mucosa, may be caused by malabsorption in patients, and also with side effects of CD drug therapy. In CD, several extraintestinal manifestations can also occur at the same time, and the appearance of one of them increases the likelihood of developing another. Use of private sector services. Also, in this article there are cases of development of Crohn's disease with recurrent aphthous stomatitis.

24-28 303
Abstract

The article presents the results of a study of the frequency of diarrheal syndrome in patients with COVID‑19. The pathogenesis of diarrhea and its differences from other acute respiratory infections are considered in detail, including on a clinical example.

Objective. To study the frequency of registration, features and results of pathogenetic therapy for diarrhea in patients with confirmed COVID‑19.

Materials and methods. 286 case histories of male and female patients aged 18–96 years old who received outpatient treatment from June 2020 to February 2021 in connection with the confirmed diagnosis of COVID‑19 were analyzed.

Results. Diarrhea was noted in 72 (25.0%) patients. In 4 (1.4%) patients, it was the only symptom of COVID‑19, in 15 (20.8%) – manifesting, followed by the addition and increase of catarrhal symptoms and manifestations of intoxication. In most cases (in 53 patients – 73.6%), diarrheal syndrome appeared simultaneously with other complaints or somewhat later.

Conclusions. 1). According to the study, COVID‑19 in 25% of patients is accompanied by diarrhea, in most cases of a watery nature. 2). Different pathogenesis of diarrheal syndrome is possible in patients with COVID‑19. 3). The use of rehydration solutions with additional components, cytomucoprotective and probiotic therapy can reduce the period of diarrhea in patients with COVID‑19 to 1–3 days and prevents adverse effects.

29-32 298
Abstract

According to the Ministry of Health of the Russian Federation (2022) 12–13% of cases of COVID‑19 were registered among children. Currently, COVID‑19 is considered as a systemic disease characterized by both respiratory and extrapulmonary symptoms, including dermatological manifestations. According to a number of foreign authors, the frequency of skin manifestations in COVID‑19 in children ranges from 0.2% to 20.4% of cases. The literature presents a few cases of exanthema in children, characterized by livedo, spotted-papular, urticar, papulo-vesicular elements, which determines the relevance of this problem. The clinical case of coronavirus infection in a child demonstrated by us against the background of dermatological manifestations is associated with the reactivation of EBV infection, which is quite rare in the practice of a pediatrician, thereby may cause certain difficulties in conducting differential diagnosis with a number of other diseases.

33-38 302
Abstract

Objective. To study the vulnerability of a group of drug users to the HIV/COVID‑19 syndemic.

Methods and materials. We used data from personalized registration of patients with HIV infection in the Moscow region, which were ill with covid‑19 in 2020–2021.

Results. Alcohol and drug addiction are an additional factor that makes the course of COVID‑19 more severe in patients with HIV infection. The reasons for this additional influence, both in the vulnerability of this group due to behavioral risks, and in psychosocial problems affecting adherence to HIV treatment, and this factor does not allow achieving the immunological and virological effectiveness of antiretroviral therapy.

Conclusions. The article presents data showing that people living with HIV/AIDS, suffering from alcohol and drug addiction, are more vulnerable to COVID‑19 in terms of severity and mortality from the disease.

39-43 415
Abstract

The aim of the study was to identify indicators of cytokine and free radical periodontal status of patients with moderate severity of periodontitis that occurred after a new coronavirus infection 1–3 monthes ago. IL‑1ß, IL‑6, IL‑10, IL‑17A, nitrate-nitrite concentration, antioxidant activity, matrix metalloproteinase MMP‑8 in gingival fluid samples were studied. A significant increase in the local level of IL‑6, matrix methylproteinase‑8 and nitrate-nitrites was found in patients with periodontitis after a new coronavirus infection compared with the indicators of patients with periodontal diseases of the same severity, who have not had covid (p < 0.05). Patients with periodontitis after undergoing new coronavirus infection to develop comprehensive methods of therapy and prevention of complications.

44-46 287
Abstract

A review of modern Russian and foreign, predominantly English-language, literature on bacterial meningitis and complications resulting from its outcome was carried out. Publications not older than 5 years published in specialized medical journals and manuals were taken into account. The review includes studies in which participants had a verified diagnosis of bacterial meningitis according to modern clinical and laboratory criteria, and were under 18 years of age at the time of the disease. Eligible observational study designs for our review included case-control observational descriptive and analytic studies and cohort studies. Studies were excluded in which participants suffered from any somatic pathologies that could affect the results or provoke complications as a result of neuroinfection. The review also included data from the Russian Reference Center for Monitoring Bacterial Meningitis for 2019.

47-50 224
Abstract

The purpose of the study. The aim of the study was to evaluate the effectiveness of antiviral therapy in urogenital infection caused by the herpes simplex virus in combination with human papillomavirus (HSV‑1, -2 and HPV) in couples with impaired reproductive function.

Materials and methods. The study included 149 married couples with complaints about the absence or pathological course of pregnancy with termination in the first trimester. Urogenital infection caused by the herpes simplex virus was detected in 80 couples. A combination with human papillomavirus was detected in 36 cases. The effectiveness of antiviral therapy was evaluated.

Results. After the first course of treatment with the use of an antiherpetic drug in 80 couples who had manifestations of active herpes infection, pregnancy and the birth of a healthy child were registered in 44 cases (55%). Combination therapy with acyclovir or valacyclovir and inosine pranobex was required, which led to a positive dynamic of indicators in case of a combined infection. The onset and normal course of pregnancy were registered after treatment in 33% of couples in this group.

Conclusions. A possible cause of reproductive dysfunction with the absence or termination of pregnancy in the early stages may be a urogenital infection caused by HSV types 1, 2. In most cases, antiviral therapy promotes the birth of a healthy child. The ineffectiveness of therapy may be associated with the simultaneous presence of two or more infectious significant agents. For the treatment of couples who have an active persistence of HSV‑1, -2 in combination with HPV, the appointment of inosine pranobex in combination with acyclovir or valacyclovir is recommended.

51-56 166
Abstract

Relevance. The quality of dermatological care in the treatment of acne in adolescents is under-researched. Therefore, it is relevant to analyze the problems that negatively affect the quality of care for adolescents suffering from acne.

Target. To identify problems in the quality of dermatological care in relation to the treatment of acne in adolescents.

Materials and methods. 20 literature sources over the past 6 years have been found. Standard methods of literature analysis (induction, synthesis and comparison of the presented information) were used.

Results. The following have not been sufficiently studied: the psychological aspect of the influence of acne and its treatment on the condition of a teenager; anti-relapse effect of retinoids depending on their dose and course duration; mechanisms of acne formation in adolescents. Information about the possibility of chronic disease and/or relapse of acne in adolescents is fragmentary. Maintenance therapy in adolescents to minimize the side effects of acne treatment has practically not been developed. Problems with compliance of adolescents undergoing treatment for acne are fragmentarily studied.

Conclusions. Problems in the development of individualized acne treatment algorithms for adolescents have been identified. At the same time, adolescents are at risk of developing acne and require a special approach in the treatment of acne due to their unstable psyche and the importance of young citizens as a valuable asset of the state.

57-62 295
Abstract

The article discusses the common pathogenetic mechanisms of the development of osteoporosis and joint diseases. The concept of doctor of medical sciences (habil.), professor V.I. Strukov is presented about the influence of osteoporotic bone cavities on the development of degenerative processes in cartilage tissue. A new approach to the treatment of diseases of the musculoskeletal system using drugs of gonadotropic and osteoimmunological action of the Osteomed group is presented.

63-66 390
Abstract

Hepatitis C is an urgent global health problem. The high prevalence of infection among the population leads to the involvement of women of reproductive age in the epidemic process. In order to study the prevalence of specific markers of hepatitis C virus in pregnant women and to assess the risk of intrauterine infection of the fetus, an epidemiologic analysis was conducted using information collections of statistical and analytical materials of Rospotrebnadzor, blood serum samples of pregnant and postpartum women (n = 28394) at admission to obstetric institutions for the period 2018–2022 were examined. According to statistical reporting, the average annual prevalence of anti-HCV prevalence in pregnant women was 1.7% (95% CI: 1.5–1.9%). Women aged 40–49 years were found to be most actively involved in the epidemic process (4.3% [95% CI: 3.3–5.6%]). Among anti-HCV-positive samples, HCV RNA was detected in 47.0% (95% CI: 41.7–52.9%) of cases, the prevalence of current infection confirmed by HCV RNA detection in pregnant women was 0.9% (95% CI: 0.8–1.0%). The pattern of HCV genotypes in pregnant women was as follows: subtype 1b was detected in 34.9% (95% CI: 25.6–45.7%) of cases, subtype 3a in 42.2% (95% DI: 32.1–52.9%), minor subtype 1a was 9.6% (95% CI: 5.0–17.9%) and genotype 2 was 7.0% (95% CI: 3.4–14.9%). Samples containing two genotypes simultaneously (1a/1b, 1b/3a) were 3.6% (95% CI: 1.2–10.1%) and non-genotyped samples were 2.4% (95% CI: 0.7–4.1%). The results of the assessment of the significance of risk factors for perinatal transmission of hepatitis C virus show a high degree of influence on vertical transmission of HCV RNA in the presence of active infection in the mother (RR = 6.4; [95% CI: 0.9–44.6%]: p < 0.05), no statistical significance of HCV genotypic affiliation (p > 0.05) and maternal viral load level (R = 0.00009; p > 0.05). The obtained data argue the necessity of screening examinations for molecular genetic markers of hepatitis C virus in women planning pregnancy in order to conduct antiviral therapy and, as a consequence, to reduce the risk of perinatal infection of children.



ISSN 2078-5631 (Print)
ISSN 2949-2807 (Online)