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Резюме журнала «Доктор.Ру» за 2017 г. англ. версия

Doctor.Ru Neurology Psychiatry No. 1 (130), 2017

 

Chronic Cerebrovascular Disease

P. R. Kamchatnov, A. V. Chugunov

 

Objective of the Review: To summarize information about the clinical manifestations of cognitive impairment and approaches to treating it.

Key Points: Cognitive impairment caused by cerebrovascular disease is characterized by reduced speed of cognitive performance and information processing, with relatively milder disturbances of some higher mental functions (aphasia, agnosia, and apraxia). Diagnosis is based on confirmation of the vascular origin of the abnormalities, the identification of cognitive impairment syndrome and the assessment of its severity. Treatment of patients with chronic cerebrovascular disease accompanied by cognitive impairment includes management of cardiovascular risk factors and therapy with drugs that improve cerebral metabolism. One such medication is cytoflavin, which is a potent neuroprotective agent.

Conclusion: This paper provides information about the effectiveness of cytoflavin in treating patients with various forms of chronic cerebrovascular disease. It also focuses on the beneficial effects of this medication on cognitive function in this patient population.

Keywords: chronic cerebrovascular encephalopathy, chronic cerebral ischemia, asymptomatic cerebral infarction, cognitive impairment, cytoflavin.

 

Guillain-Barre Syndrome: Review of Clinical Cases

S. A. Berns, K. V. Zverev, P. A. Talyzin, M. F. Talyzina, A. S. Tektova, R. R. Kurganov

 

Purpose of the Paper: To describe clinical cases of Guillain-Barre syndrome (GBS) treated at the Neuroresuscitation Department, M. E. Zhadkevich City Clinical Hospital, Moscow City Department of Health.

Key Points: Between February and October 2015, five patients with GBS were treated and observed at the Neuroresuscitation and Neurology Departments, M. E. Zhadkevich City Clinical Hospital, Moscow Department of Healthcare. At the time of hospitalization, these patients had different admission diagnoses, including stroke (2 cases), vertebrobasilar insufficiency, lumbar dorsopathy with associated sensory disturbances, and Quincke's edema. Four out of these five patients had a prior infection. Four of the patients were discharged in moderately severe condition with persistent signs of quadriparesis. One patient died due to complications of the disease. During treatment, four patients required mechanical ventilation; four out of the five patients received intravenous immunoglobulin G.

Conclusion: Despite the relatively low prevalence of GBS, it is important to emphasize that specialists should remain alert to this condition. Special attention should be paid to young patients who are brought to the hospital with clinical signs of ascending paresis.

Keywords: Guillain-Barre syndrome, ascending paresis, peripheral nerves, quadriparesis, immunoglobulin G.

 

Motor and Nonmotor Fluctuations in Men and Women with Parkinson’s Disease

M. A. Bykanova, N. V. Zarubina, N. V. Pizova

 

Study Objective: To determine the frequency of motor and nonmotor fluctuations in men and women with Parkinson’s disease (PD), describe their specific features, and establish their effects on patients' quality of life.

Study Design: This was an open-label, prospective, cohort clinical study.

Materials and Methods: Forty-three men and 57 women with PD (stages 2.5–4.0) were examined in this study. The severity of clinical manifestations was assessed using the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr scale. Fluctuations were assessed using the nine-symptom questionnaire (Wearing-off Questionnaire [WOQ-9]), a patient self-assessment diary. Quality of life was assessed using the 39-item Parkinson's Disease Quality of Life Questionnaire and the second part of the European Quality of Life Questionnaire.

Study Results: The most commonly reported motor fluctuation was the “on-off” phenomenon, which was seen in 69.8% of the men and 73.7% of the women. Autonomic fluctuations were observed in 86.0% of the men and 93.0% of the women. There was a statistically significant greater frequency of certain autonomic disorders observed in women, than in men. Mental fluctuations were observed in 79.1% of the men and 75.4% of the women. There was a statistically significant greater frequency of apathy in men, than in women. Sensory fluctuations were reported in 55.8% of the men and 50.9% of the women, with pain being observed in women with statistically significant greater frequency.

Conclusion: In patients with PD, gender influences the predominance of certain nonmotor fluctuations.

Keywords: Parkinson’s disease, motor fluctuations, nonmotor fluctuations, quality of life, men, women.

 

Monitoring of Clinical and Neurophysiological Parameters in Diabetic Polyneuropathy Patients Receiving Metabolic Therapy

Yu. V. Karakulova, T. A. Filimonova

 

Study Objective: To study the effects of cocarnit on the electroneurophysiology of peripheral nerves in patients with diabetic polyneuropathy (DPN).

Materials and Methods: Twenty patients with DPN (mean age 58.2 ± 5.1) were examined. Clinical examination included review of patients' complaints and medical history, neurological examination using the Total Symptom Score, the Neurological Symptom Score, and the Neuropathy Disability Score, and lower-extremity electroneuromyography. Quality of life was assessed using the Medical Outcomes Study 36-Item Short Form Survey. All participants were given cocarnit 2 mL once a day as an intramuscular injection for nine days. Patients were examined on four visits: before treatment, and at one week, one month, and three months after it.

Study Results: In patients with DPN, treatment with cocarnit rapidly reduces intensity of neuropathic pain and degree of neurological deficits, and improves quality of life. A longer-term outcome is a statistically significant improvement in axonal electrophysiology.

Conclusion: Сocarnit administered as a course of treatments can be considered pathogenetically justified for patients with DPN. For best effect it should be started at an early stage, and several courses administered per year.

Keywords: diabetic polyneuropathy, neuropathic pain, electroneuromyographic examination, cocarnit.

 

Carpal Tunnel Syndrome in the Elderly

A. S. Gilveg, V. A. Parfenov

 

Objective of the Review: To describe the etiology, pathogenesis, risk factors, diagnosis and treatment of median-nerve neuropathy manifested as carpal tunnel syndrome (CTS) in the elderly.

Key Points: The pathogenesis of CTS is a combination of mechanical trauma, increased intra-tunnel pressure and ischemic injury to the median nerve inside the carpal tunnel. Because the median nerve is a mixed nerve, this syndrome manifests clinically as a combination of sensory, motor, and autonomic dysfunction in the area where it innervates the hand. CTS can be treated conservatively or surgically. Conservative treatment includes splinting, using orthoses, and injections of glucocorticoids into the carpal tunnel. Surgical treatment involves decompression and reduction of pressure on the median nerve by cutting the transverse carpal ligament. In addition, this paper describes a clinical case of CTS.

Conclusion: Carpal tunnel syndrome, the most common form of tunnel compression neuropathy, is seen primarily in the elderly. Despite having typical clinical manifestations and clear diagnostic criteria, CTS often goes undiagnosed because of low awareness among health professionals about this disorder. When diagnosed in a timely manner, CTS responds well to treatment (usually surgery).

Keywords: carpal tunnel syndrome, compression neuropathies, median-nerve neuropathy.

 

Autonomic Mechanisms Underlying Goal-Directed Activity in Healthy People and Epileptic Patients

R. A. Zorin, V. A. Zhdanov, M. M. Lapkin, N. A. Kulikova

 

Study Objective: To carry out a comparative analysis of autonomic mechanisms underlying goal-directed activity and changes in indirect measures of gas homeostasis in apparently healthy people and epileptic patients, in order to assess the effectiveness of the goal-directed activity being modelled and the adaptive potential of these groups of subjects.

Study Design: This was an experimental, comparative, randomized study.

Materials and Methods: Fifty-four apparently healthy people and 134 epileptic patients were examined. The study methods included analysis of heart rate variability, spirometry combined with basal metabolic measurements, capnography, statistical methods, and artificial neural network modelling.

Study Results: The Schulte-Gorbov tables scores showed that the groups of apparently healthy people and epileptic patients were heterogeneous; each group had subgroups of good and poor performers. The study showed that in epileptic patients poor performance was associated with a higher mean total number of seizures and a higher mean number of complex partial-onset seizures per month. In the epilepsy group, poor performers showed higher activity of stress-mediating systems and stronger relationships between cardiorespiratory mechanisms and the indirect measures of gas homeostasis. It was also shown that in this subgroup, these mechanisms and parameters had more influence on performance than in other subgroups.

Conclusion: In epileptic patients, reduced effectiveness is explained not only by inadequate performance but also by its increased physiological cost.

Keywords: epilepsy, autonomic mechanisms underlying activity, gas homeostasis, physiological cost of activity.

 

Comparing Anxiety Coping Strategies in the Elderly and Very Elderly

T. P. Kalinichenko, Yu. I. Polishchuk

 

Study Objective: To determine the role of age in the choice of coping strategies by elderly and very elderly patients with anxiety disorders and mixed anxiety and depressive disorders.

Study Design: This was a comparative study.

Materials and Methods: Non-selective examination was done of 214 elderly and very elderly people (158 patients with anxiety disorders or mixed anxiety and depressive disorders and 56 people without these problems). The study tools included the Taylor Manifest Anxiety Scale, which was used to assess anxiety levels, the Geriatric Depression Scale, the Mini-Mental State Examination, and a coping strategy questionnaire developed by E. Heim.

Study Results: The very elderly, to a statistically significant degree in comparison with the elderly, more frequently employ acceptance, a maladaptive cognition-related coping strategy, to control high levels of anxiety, and diversion, a relatively adaptive action-related coping strategy, for moderate levels of anxiety. Active avoidance, an action-related maladaptive coping response to high levels of anxiety, and seeking for attention and care, an action-related adaptive coping mode for low levels of anxiety, are significantly more frequently observed in the elderly than in the very elderly.

Conclusion: The choice of coping strategies for anxiety disorders and mixed anxiety and depressive disorders differs for the elderly in comparison with the very elderly. It is influenced by the type of coping strategy itself, its category and the severity of the disorders. The lack of cognition-related coping strategies in the elderly and very elderly is compensated by intact action-related patterns of coping with anxiety.

Keywords: advanced age, anxiety disorders, coping behavior.

 

An Assessment Scale for Anxiety Disorders in Dementia Patients

O. R. Smirnov

 

Study Objective: To develop and test an anxiety disorder scale (ADS) for use with elderly dementia patients.

Study Design: This was a sampling, observational, comparative, longitudinal study.

Materials and Methods: The study included 236 patients with Alzheimer-type, vascular or mixed dementia and accompanying anxiety disorders. Eighty-two men and 154 women, aged 53 to 100 (mean age 79.26 ± 7.49), took part in this experiment. Cognitive status was assessed with the Mini-Mental State Examination. Screening for non-cognitive impairment was done using the Neuropsychiatric Inventory. Screening for anxiety disorders used a panel of parameters based on the Hamilton Anxiety Scale (HAM-A), Rating Anxiety in Dementia scale and the Diagnostic and Statistical Manual of Mental Disorders IV diagnostic criteria for generalized anxiety disorder.

Study Results: The data obtained helped us to develop a psychometric tool for quantitative and qualitative assessment of complex anxiety disorders, which are commonly seen in elderly subacute dementia patients.

Conclusion: Our anxiety disorder scale assesses the severity of an anxiety disorder and the intensity of physical and mental symptoms of anxiety. It also helps in identifying the type of major anxiety syndrome, which, in turn, depends on the underlying condition and the form of any prior psychosis.

Keywords: dementia, anxiety, anxiety disorder scale.

 

Elderly Mentally Impaired Patients: Clinical and Social Preconditions for Living Alone

V. F. Druz, I. N. Oleinikova, R. I. Palayeva, Ye. Yu. Antokhin, V. G. Budza

 

Study Objective: To determine the role of age, household conditions, clinical, and psychosocial factors as prerequisites for mentally impaired elderly patients to live alone.

Study Design: This was a snapshot, cross-sectional study.

Materials and Methods: Two hundred thirty-five psychoneurological clinic patients aged 60 or older underwent clinical and psychosocial examinations.

Study Results: Patients were divided into two groups, based on whether or not they had had their own family in the past. Group 1 included patients who had been married; Group 2 was made up of patients who had never been married. Group 1 was larger and included younger patients; it was also more heterogeneous in terms of disease entities and syndromes. The study identified the following factors, predisposing a person to living alone: clinical factors, the combination of psychosocial factors with subclinical disease, specific age-related features, and poor household conditions.

Conclusion: Among the factors mentioned above, clinical entities were the most important (104 cases, 44.3%). Other significant factors included the combination of psychosocial factors and subclinical preconditions (70 cases, 29.7%), and specific age-related features (58 patients, 24.7%). Poor household conditions did not play a significant role (3 patients, 1.3%).

Keywords: clinical and social predispositions, living alone, mentally impaired patients, elderly.

 

Adamantane-based Medications

Kh. S. Sayadyan, V. M. Shklovsky

 

Objective of the Review: To describe the unusually wide range of effects of adamantane and its derivatives, which have a high potential for the development of new drugs, including medications for patients with neurological, psychiatric, and immunological disorders.

Key Points: Adamantane is a natural compound with the chemical formula C10H16, with the spatial arrangement of the carbon atoms similar to that of a diamond crystalline lattice. Its tertiary carbon atoms at the lattice points are capable of bonding various moieties. Adamantane derivatives have been used for developing unique medications that regulate cascading reactions involving calcium ions. This review describes the effects of memantine, an adamantane derivative, which is the most commonly used drug for cognitive impairments accompanying various disorders. It also discusses different aspects of developing an array of therapeutic compounds for use in psychoneurological practice.

Conclusion: Polymeric adamantane analogues have been patented as antiviral agents. Substituted amides of adamantane-carboxylic acid can be used as sleep aids. Antimalarial drugs are produced by introducing an adamantane moiety into 2-naphthoquinone. In addition, using memantine in combination with drugs targeting other neurotransmitter pathways may be a promising option. Adamantane remains one of the most valuable basic molecules for developing new medicines.

Keywords: adamantane, rimantadine, memantine, N-methyl-D-aspartate receptors.

 

Doctor.Ru Gastroenterology No. 2 (131), 2017

 

Treatment and Prevention of Cholelithiasis: Current Concepts

V. V. Tsukanov, Yu. L. Tonkikh, A. V. Vasyutin

 

Objective of the Review: To analyze methods used in the treatment and prevention of cholelithiasis.

Key Points: Laparoscopic cholecystectomy is generally considered the leading treatment option for symptomatic or complicated cholelithiasis. Ursodeoxycholic acid (UDCA) has proven effective in dissolving choleliths in patients with asymptomatic cholelithiasis and reducing gallbladder inflammation in people with symptomatic cholelithiasis.

Exercise, losing weight, and dietary changes are important ways to prevent cholelithiasis. Using UDCA as a preventive measure for cholelithiasis is reasonable in patients at risk for this disorder (those with rapid weight loss).

Conclusion: Optimal outcomes in patients with cholelithiasis are achieved through an appropriate combination of surgical, therapeutic, and preventive treatments.

Keywords:cholelithiasis, treatment, prevention, ursodeoxycholic acid.

 

Current Non-Invasive Methods for Diagnosing Liver Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease

V. A. Akhmedov, O. V. Gaus

 

Objective of the Review: To review the data in currently available literature in order to assess the applicability, diagnostic value, and effectiveness of non-invasive markers in the diagnosis of liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).

Key Points: Outcomes of NAFLD such as liver cirrhosis and hepatocellular carcinoma are currently among the top ten causes of premature death worldwide. Monitoring the course of NAFLD is one of the most important goals in modern hepatology.

The degree of liver fibrosis reliably indicates the progression of chronic hepatic disorders. Since the use of morphological tests in a broad clinical practice is limited for a number of objective reasons (invasive techniques, the need for highly qualified staff, risk of intraprocedural complications, and risk of false results), the possibility of using non-invasive diagnostic markers of liver fibrosis is a particularly urgent issue.

Conclusion: In patients with NAFLD, a panel of laboratory parameters combined with ultrasound elastography data can be used as reliable non-invasive markers of liver fibrosis.

Keywords:non-alcoholic fatty liver disease, non-invasive markers, liver fibrosis, ultrasound elastography, biopsy.

 

Autoimmune Hepatitis: How to Avoid Mistakes

Yu. G. Sandler, Ye. V. Vinnitskaya, L. N. Gendrikson, T. Yu. Khaimenova, D. L. Rotin, R. B. Gudkova

 

Objective of the Review: To summarize current literature on the diagnosis and treatment of autoimmune hepatitis (AIH).

Key Points: AIH is a clinical diagnosis. The following should be considered as diagnostic criteria for this condition: presence of autoimmune markers, hypergammaglobulinemia, and morphological signs of active hepatitis.

Timely diagnosis and immediate initiation of appropriate treatment reduce the risk of complications and death in patients with AIH. This paper also describes a retrospective clinical study, to help raise doctors’ awareness about AIH. This study demonstrates that patients, upon the first signs of liver disease, require thorough and comprehensive examination, and adequate and timely treatment with systemic and topical corticosteroids.

Conclusion: AIH is a chronic liver disease that progresses if not treated properly. Treatment must be started as early as possible, at the precirrhosis stage. When AIH has led to liver cirrhosis (LC), treatment should be given with caution, since it is difficult to assess its efficacy. LC is not always associated with hypergammaglobulinemia and is frequently accompanied by a modest increase in alanine aminotransferase and aspartate aminotransferase levels. Given the high risk of infectious complications, patients should be closely monitored throughout the treatment process. When treatment has no effect, liver transplant is indicated.

Keywords: autoimmune hepatitis, autoantibodies, liver biopsy, immunosuppressive therapy, corticosteroids, azathioprine, budesonide.

 

Enzyme Activity in the Small-Intestine Mucosa of Celiac Disease Patients on Gluten-Free Diet

O. V. Akhmadullina, E. A. Sabelnikova, N. I. Belostotsky, A. I. Parfenov, S. G. Khomeriki

 

Study Objective: To measure intestinal carbohydrase (glucoamylase, maltase, sucrase, and lactase) levels in celiac disease patients following a strict gluten-free diet (GFD).

Study Design: This was a prospective study.

Materials and Methods: Thirty-six patients with celiac disease, aged 18 to 74, were examined; all were strictly following GFD. Levels of intestinal carbohydrases (glucoamylase, sucrase, maltase, and lactase) were measured in mucosa biopsy samples using the Dahlqvist method with Trinder's modification.

Study Results: Deficiencies of lactase, maltase, sucrase, and glucoamylase were detected in 83.3%, 58.3%, 55.6%, and 69.4% of the patients, respectively; 41.7% of the patients were deficient in all of the enzymes under study. Histology of small-intestine mucosa showed that GFD had led to complete restoration of mucosal structure in only 19 of the 36 (52.8%) patients examined. Six of the 19 (31.6%) celiac disease patients with structurally normal small-intestine mucosa had low levels of all the carbohydrases studied.

Conclusion: Deficiency of the enzymes that break down carbohydrates is quite common among celiac disease patients who follow GFD, even in cases of complete mucosal restoration. Such deficits may lead to long-term persistence of clinical symptoms cased by factors other than dietary non-adherence.

Keywords: celiac disease, gluten-free diet, disaccharidase deficiency, lactase deficiency.

 

Effects of Transfusional Hemosiderosis on Liver and Heart in Patients with Myelodysplastic Syndrome

G. A. Dudina

 

Objective of the Paper: To demonstrate the effects of transfusional hemosiderosis on the development of liver fibrosis and heart failure in patients with myelodysplastic syndrome (MDS) and to describe current methods for diagnosing and effectively treating complications of transfusional hemosiderosis.

Key Points: RBC transfusions remain the only treatment for anemic syndrome in patients with MDS. Iron overload associated with chronic blood transfusions causes severe toxic effects. Excessive amounts of this microelement are primarily accumulated in the liver and myocardium. Free iron causes destruction (damage) of these organs, resulting in organ dysfunction.

Understanding the pathophysiological pathways underlying the effects of transfusional hemosiderosis on the development and progression of cardiovascular insufficiency and liver fibrosis significantly expands the current view of how to treat this patient population.

Conclusion: Timely assessment of the severity of iron overload allows action to prevent its toxic effects on the hepatobiliary and cardiovascular systems, through initiation of treatment with iron-chelating agents, which subsequently reduce the risk of fatal hepatic or cardiovascular events.

Keywords: myelodysplastic syndrome, transfusional hemosiderosis, liver fibrosis, cardiovascular insufficiency.

 

Specific Features of Matrix Metalloproteinase Level Changes in Pancreatic Disorders

L. V. Vinokurova, G. G. Varvanina, A. V. Smirnova, A. S. Gulyayev, D. S. Bordin, Ye. A. Dubtsova

 

Study Objective: To analyze changes in serum matrix metalloproteinase 2 (MMP 2) and 9 (MMP 9) and tissue inhibitor of matrix metalloproteinase 2 (TIMP-2) levels in patients with chronic pancreatitis (CP) or pancreatic cancer and to assess their potential value for detecting these disorders.

Study Design: This was a prospective, comparative study.

Materials and Methods: Patients were examined who had a carcinoma of the pancreatic head (n = 15), CP with postnecrotic pancreatic cysts (n = 23), or CP without cystic lesions (n = 37), as well as 13 people who had no pancreatic disorders (control group). MMP 2, MMP 9, and TIMP-2 levels were measured by immunosorbent assay in blood samples collected after fasting.

Study Results: The study showed a statistically significant increase in serum MMP 9 levels in patients with pancreatic carcinoma and those with a six-to-15-year history of CP without cystic lesions, compared to the control group. No statistically significant differences in MMP 2 levels were seen between the groups. Patients with CP and postnecrotic pancreatic cysts had meaningfully lower TIMP-2 concentrations than patients who had CP without cystic lesions.

Conclusion: Long-term CP is associated with increased risk for pancreatic carcinoma. MMP 9 levels can be used as an additional parameter in determining the individual prognosis in CP patients. Changes in MMP 9 levels are greatest in patients with a carcinoma of the pancreatic head. Evaluation of MMP and MMP inhibitor levels is an urgent and clinically significant issue because these parameters can be used as diagnostic and prognostic markers of pancreatic carcinoma and pancreatic inflammatory diseases.

Keywords: chronic pancreatitis, pancreas, matrix metalloproteinases.

 

Russian Consensus on Diagnosis and Treatment of Chronic Pancreatitis: Treating Abdominal Pain

I. Ye. Khatkov, I. V. Mayev, D. S. Bordin, Yu. A. Kucheryavyy, S. R. Abdulkhakov, S. A. Alekseyenko, E. I. Aliyeva, R. B. Alikhanov, I. G. Bakulin, A. Yu. Baranovskiy, Ye. V. Beloborodova, Ye. A. Belousova, I. M. Buriyev, Ye. V. Bystrovskaya, S. V. Vertyankin, L. V. Vinokurova, E. I. Galperin, A. V. Gorelov, V. B. Grinevich, M. V. Danilov, V. V. Darvin, Ye. A. Dubtsova, T. G. Dyuzheva, V. I. Yegorov, M. G. Yefanov, N. V. Zakharova, V. Ye. Zagaynov, V. T. Ivashkin, R. Ye. Izrailov, N. V. Korochanskaya, Ye. A. Korniyenko, V. L. Korobka, N. Yu. Kokhanenko, M. A. Livzan, I. D. Loranskaya, K. A. Nikolskaya, M. F. Osipenko, A. V. Okhlobystin, V. D. Pasechnikov, Ye. Yu. Plotnikova, S. I. Polyakova, O. A. Sablin, V. I. Simanenkov, N. I. Ursova, V. V. Tsvirkun, V. V. Tsukanov, A. V. Shabunin

 

Objective of the Paper: To describe key points of the Russian Consensus on Diagnosis and Treatment of Chronic Pancreatitis (CP), related to treating abdominal pain.

Key Points: Patients with CP require adequate treatment for abdominal pain. In cases of exacerbation, fasting is not mandatory. In patients with CP, pain rating scales should be used for quantitative grading of pain, including when assessing treatment efficacy. The WHO 3-step pain ladder can be used as a guideline for starting and discontinuing medication.

Decisions regarding the duration of treatment with pain medications may be individualized for patients with CP. If a chosen method is not sufficiently effective, the treatment strategy should be regularly reviewed for the addition of endoscopic or surgical interventions if necessary. Octreotide, pancreatic enzymes, montelukast, electroacupuncture, percutaneous nerve electrostimulation, and radiation therapy are not recommended for abdominal pain related to CP. Antispasmodics, proton-pump inhibitors, celiac plexus neurolysis, and thoracoscopic splanchnicectomy may be used for the management of CP-related pain, but evidence supporting the use of these methods is scant.

Conclusion: The Consensus on Diagnosis and Treatment of CP, initiated by the Russian Pancreatology Club, has collected up-to-date information about these issues using the Delphi method. These principles of treatment for abdominal pain, and the related voting results, help in optimizing patient management plans and educational programs for doctors.

Keywords: chronic pancreatitis, consensus, abdominal pain.

 

Gastroesophageal Reflux Disease in Obese Patients: Clinical, Functional, and Morphological Features

L. A. Zvenigorodskaya, S. G. Khomeriki, M. V. Shinkin

 

Study Objective: To study the clinical, functional, and morphological features of gastroesophageal reflux disease (GERD) in patients with abdominal obesity and in non-obese subjects, and evaluate approaches to treating GERD in obese patients.

Study Design: This was a comparative study.

Materials and Methods: Seventy-five patients with GERD and abdominal obesity (main group) and 56 non-obese patients with GERD (control group) were examined. The following data were assessed in all the patients: clinical data, X-ray, esophageal manometry and 24-hour pH monitoring, and esophagogastroduodenoscopy findings, as well as the results of histological examination of the esophageal mucosa.

Study Results: Patients in the main group had atypical GERD: heartburn was not the main complaint; the predominant clinical symptoms were those caused by disturbances in gastric and esophageal motility; and histological examination of the esophageal mucosa showed no dilation of intercellular spaces, expansion of the basal layer of the stratified squamous esophageal epithelium, or inflammatory infiltration of the lamina propria.

Given the specific features found in patients with abdominal obesity, GERD management for these patients should include weight loss and intake of prokinetic agents. In cases of alkaline reflux, ursodeoxycholic acid is justified. In cases of acid reflux, proton-pump inhibitors are the medications of choice.

Conclusion: In patients with abdominal obesity, the clinical manifestations and progression of GERD have several specific features, which should be considered when prescribing treatment.

Keywords: obesity, gastroesophageal reflux disease, motor disturbances, prokinetic agents.

 

Using Picoprep for Colonoscopy Preparation G. S. Tsaryova, K. Ye. Pchelintsev, A. A. Gladyshev, A. N. Shikhmetov

 

Study Objective: To assess the tolerability and efficacy of Picoprep for colonoscopy preparation.

Materials and Methods: In a 12-month period 1,372 colonoscopies were performed, of which 954 (69.5%) were done using Picoprep. Quality of colon cleansing was assessed during colonoscopy using the Chicago Bowel Preparation Scale, an internationally recognized scoring system with objective criteria. Tolerability of Picoprep was assessed by patients' subjective feelings.

Study Results: When Picoprep was used, quality of bowel preparation was excellent in 27.3% of the cases, good in 52.8%, fair in 19.7%, and poor in 0.2%. All patients who had previously used other medicines for bowel preparation reported that Picoprep had a good flavor and was well tolerated.

Conclusion: The efficacy of Picoprep is not inferior to other currently available polyethylene glycol-based bowel preparations, and Picoprep is superior to them in consumer qualities (tolerability).

Keywords: colonoscopy, bowel preparation, Picoprep.

 

Diagnostic Criteria for Serrated Lesions of the Colon

N. V. Ageykina, O. A. Kharlova, N. A. Oleynikova, P. G. Malkov, M. V. Knyazev, V. A. Duvansky

 

Objective of the Paper: To describe endoscopic and morphological criteria for diagnosing serrated lesions of the colon.

Key Points: The WHO Classification of tumors of the colon and rectum, published in 2010, first included a classification group of premalignant lesions—serrated lesions, further classified as hyperplastic polyps, sessile serrated adenomas/polyps, and traditional serrated adenomas.

Serrated lesions are considered to be potentially malignant. This paper describes the serrated carcinogenesis pathway. Because of their malignant potential, serrated lesions of the colon should be detected and removed in a timely fashion.

Conclusion: This paper describes the specific features of each type of serrated lesion, which can suggest the nature of the abnormality even during endoscopy. Practitioners, however, often face atypical situations, which present additional diagnostic challenges.

Keywords: colon polyp, serrated lesion, diagnosis, sessile serrated adenoma/polyp, hyperplastic polyp, morphology, endoscopy.

 

Tribenoside in Combination with Lidocaine for Topical Treatment of Hemorrhoids: Review of Clinical Studies

G. Yu. Knorring

 

Objective of the Review: To analyze the published data from studies designed to evaluate the efficacy and safety of tribenoside in combination with lidocaine (T/L) as a topical treatment for uncomplicated hemorrhoids.

Key Points: The T/L combination is used for topical treatment of hemorrhoids; it is available as suppositories or rectal cream. This combination has rapid and comprehensive effects on different hemorrhoid symptoms, providing significant therapeutic benefit. The efficacy and safety of T/L has been studied in numerous high-quality studies, most of which used reference groups whose members received conventional therapies for hemorrhoids.

Conclusion: Analysis of the published data shows that T/L is at least as effective as corticosteroid agents, and sometimes even more effective than either corticosteroids, or tribenoside or lidocaine used as monotherapy. This combination rapidly (within 10 to 30 minutes) relieved symptoms and was very well tolerated.

Keywords: tribenoside, lidocaine, hemorrhoids.

 

Assessment of Surgical Stress Parameters after Laparoscopic and Open Liver Resection

D. N. Panchenkov, G. B. Aleksanyan, N. K. Akhmatova, M. G. Yefanov, R. B. Alikhanov, Yu. V. Ivanov

 

Study Objective: Comparative analysis of surgical stress parameters after laparoscopic liver resection (LLR) and open liver resection (OLR).

Study Design: This was a randomized parallel-group study.

Materials and Methods: Forty chinchilla rabbits were operated on in the experimental stage, and 38 patients underwent surgery in the clinical stage. These animals and patients were divided into groups of those who had laparoscopic surgery (main groups) and those who had open surgery (control groups). In each group, minor (segmental [up to three segments] or atypical) or major (hemihepatectomy) liver resection was performed.

Blood samples were collected before surgery, at 6 and 24 hours post-surgery, and on day 7 post-surgery. The following parameters of innate immunity were evaluated: phagocytic, cytotoxic, and proliferative activity of WBC, WBC subpopulations, Toll-like receptors (TLR), heat shock proteins (HSP), and cytokines.

Study Results: In the experimental stage, phagocytic, cytotoxic, and proliferative activity was higher in the OLR group. In the clinical stage, both groups showed a gradual increase in WBC and WBC subpopulations up to their pre-surgery levels on day 7 after surgery. Cytokines and TLR levels suggested higher reactivity following major OLR. Expression of HSP was significantly higher after OLR than after LLR.

Conclusion: LLR has certain advantages over OLR as confirmed by laboratory and clinical measurements of innate immunity. Compared to LLR, open liver resection causes a more marked increase in parameters of immune response and a more significant activation of innate and acquired immunity effectors.

Keywords: liver resection, laparoscopy, immune response, surgical stress.

 

Doctor.Ru Gynecology Endocrinology No. 3 (132), 2017

 

The Research Center for Obstetrics, Gynecology and Perinatology: Yesterday, Today, and Tomorrow

G. T. Sukhikh, V. N. Serov, I. I. Baranov

 

This paper describes the history and development of the V. I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology, its current advances, and future prospects. The information presented shows that this Center is a unique institution with highly qualified worldrenowned scientists, where the many scientific, therapeutic, and educational events and programs contribute to maintaining reproductive health at the national level. The article also describes new and promising areas of the Center’s work, including fundamental research in reproductive medicine.

Keywords:V. I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology, obstetrics, gynecology, neonatology, reproductive health.

 

Citation format for this article:

Sukhikh G. T., Serov V. N., Baranov I. I. The Research Center for Obstetrics, Gynecology and Perinatology: Yesterday, Today, and Tomorrow.Doctor.Ru. 2017; 3(132): 6–10.

 

Next-Generation Sequencing Technologies As a Noninvasive Prenatal DNA Screening Method in Pregnant Women with Obstetric Disorders

G. T. Sukhikh, N. K. Tetruashvili, D. Yu. Trofimov, L. V. Kim, I. Yu. Barkov, Ye. S. Shubina, N. G. Parsadanyan, N. I. Fedorova, A. Yu. Goltsov, N. V. Alexandrova

 

Study Objective: To assess the efficacy of next-generation sequencing technologies as a method for noninvasive prenatal DNA screening for trisomy 21, 18, and 13 and sex chromosome trisomies in blood samples collected from pregnant women with poor obstetric history and complications in the current pregnancy.

Materials and Methods: Noninvasive prenatal DNA screening was performed using next-generation sequencing in 506 pregnant women at between weeks 11 and 17 of gestation.

Study Results: When next-generation sequencing techniques were used to evaluate fetal DNA in maternal blood, gender was correctly determined in all fetuses, and all cases of autosomal trisomy 21, 18, and 13, as well as Turner's syndrome, were correctly detected.

Conclusion: Noninvasive prenatal DNA screening is an accurate method for detecting fetal chromosomal aberrations (CA) starting in early pregnancy. It can identify CA in low-risk women and may be recommended as a highly effective prenatal screening technique.

Keywords: noninvasive prenatal DNA screening, aneuploidies, free deoxyribonucleic acid, pregnancy, screening, threatened abortion.

 

Citation format for this article:

Sukhikh G. T., Tetruashvili N. K., Trofimov D. Yu., Kim L. V., Barkov I. Yu., Shubina Ye. S., Parsadanyan N. G., Fedorova N. I., Goltsov A. Yu., Alexandrova N. V. Next-Generation Sequencing Technologies As a Noninvasive Prenatal DNA Screening Method in Pregnant Women with Obstetric Disorders. Doctor.Ru. 2017; 3(132): 11–15.

 

The Role of Molecular Genetic Factors in the Development of Uterine Scarring after Cesarean Section

N. Ye. Kan, V. L. Tyutyunnik, N. A. Lomova, A. Ye. Donnikov, N. V. Dolgushina

 

Study Objective: To identify molecular genetic factors associated with formation of an insecure uterine scar after cesarean section (CS).

Study Design: This was a one-stage, cross-sectional, case-control study.

Materials and Methods: Based on the results of morphological examination, 160 women were included in the study. Group 1 (main group) included 80 patients with insecure post-cesarean section scars (IS); Group 2 (control group) was made up of 80 patients with secure post-cesarean section scars (SS). Study methods included immunohistochemistry, molecular genetic techniques, and statistical analysis.

Study Results: In both groups, an intraoperative visual assessment of the scar area was performed during a repeat CS. Secure scars were not usually observed, or appeared as connective-tissue scars 3-5 mm wide. Insecure scars appeared as local or total thinning of the myometrium to less than 2 mm. Immunohistochemistry showed high expression of type III collagen in the scar tissue. Women with IS showed a trend towards lower levels of type IV collagen. Molecular genetic analysis showed statistically significant linkage disequilibrium between estrogen receptor (ESR)α gene polymorphisms -397 T>C (Pvull) [rs2234693] and -351 G>A (Xbal) [rs9340799]: D’ = 0.991 (0.95–1.00), LOD = 16.98. The most commonly identified haplotypes were TA (52.0%) and CG (33.1%). The CA haplotype was detected significantly more frequently in women with signs of inflammation in the scar tissue: 17.2% vs. 5.4% (p = 0.046).

Conclusion: ESR-α gene polymorphisms contribute to the disorganization of connective tissue either directly, by influencing its remodeling, or by regulating inflammation and repair. Hormone imbalance and ischemia play a key role in incomplete tissue repair after CS, which could be related to polymorphisms in ESR genes.

Keywords: cesarean section, uterine scar, collagen, estrogen receptorα gene polymorphisms.

 

Citation format for this article:

Kan N. Ye., Tyutyunnik V. L., Lomova N. A., Donnikov A. Ye., Dolgushina N. V. The Role of Molecular Genetic Factors in the Development of Uterine Scarring after Cesarean Section. Doctor.Ru. 2017; 3(132): 16–19.

 

Using Stem Cells to Improve Myometrial Scar Repair

O. G. Pekarev, I. V. Maiborodin, Ye. O. Pekareva, I. M. Pozdnyakov, Ye. S. Brega

 

Study Objective: To study changes in uterine tissue and uterine scars in rats and assess the chances of spontaneous labor after uterine horn ligation followed by injection of multipotent mesenchymal stromal cells (MMSC) into these areas, in order to demonstrate the theoretical possibility of improving uterine scar repair and reducing the frequency of cesarean section in patients who have undergone uterine surgery.

Materials and Methods: This study was designed to assess the chances of becoming pregnant and delivering offspring in 26 inbred Wag laboratory rats with a myometrial scar. Another part involved the examination of tissues after the use of MMSC transfected with theGFP gene in modeling of hydrometra. The control group was 46 rats who had undergone uterine horn ligation followed by injections of the same volume of culture medium without MMSC, and intact animals.

Study Results: After injection of MMSC into a myometrial scar, vessel formation occursde novo with the participation of the injected cells, resulting in an increased number of new vessels. Entire vascular walls, or elements thereof, were formed from MMSC. After an MMSC injection, deliveries occurred two estrus cycles earlier. Compared with the group of animals who were not treated using cell technologies, the percentage of female rats in the MMSC group who delivered offspring was higher (30.8% vs. 15.2%), as were the total and maximum numbers of pups (3.13 ± 2.23 vs. 1.92 ± 1.12 and 7 vs. 4, respectively). The number of deaths among rats treated with MMSC was lower: two cases (7.69%) versus six cases (13.04%) in the control group.

Conclusion: In rats with uterine scars, use of MMSC is associated with a clear trend towards more rapid repair of uterine tissue.

Keywords: uterine scar, hydrometra, bone-marrow multipotent mesenchymal stromal cells, angiogenesis.

 

Citation format for this article:

Pekarev O. G., Maiborodin I. V., Pekareva Ye. O., Pozdnyakov I. M., Brega Ye. S. Using Stem Cells to Improve Myometrial Scar Repair. Doctor.Ru. 2017; 3(132): 20–25.

 

Rare Combinations of Congenital Lung Malformations in Newborns: Diagnosis and Surgical Treatment

Ye. I. Dorofeyeva, Yu. L. Podurovskaya, V. V. Zubkov, M. I. Pykov, Ye. A. Filippova, Ye. A. Kulabukhova

 

Objective of the Paper: To analyze the authors' own experience of observing and treating patients with congenital lung malformations; to determine the frequency of associated (several anomalies within the respiratory system) and combined (several anomalies in different systems) congenital malformations; and to establish the grounds for diagnostic and surgical strategies.

Materials and Methods: The authors observed 113 newborns with congenital lung malformations—bronchopulmonary sequestration (BPS) and congenital cystic adenomatoid malformation (CCAM). They were hospitalized after birth and underwent basic clinical, instrumental, and laboratory examinations, plain chest X-ray, ultrasound examination, and magnetic resonance imaging (MRI) or computed tomography (CT). In one case a combination of imaging techniques was used.

Study Results: In 13 (11.7%) of the babies, rare combinations of malformations were detected. In three (2.7%) of the cases, combined malformations were detected by prenatal diagnosis: One baby had BPS combined with congenital diaphragmatic hernia (CDH), the second had BPS and a gastric duplication cyst, and the third had CCAM and congenital heart defect. In the other cases, prenatal diagnostic procedures helped to identify a number of signs of lung malformations. Subsequent examinations (CT or MRI) revealed the following associated or combined malformations: CCAM and BPS (five cases); CCAM and finger malformations (two cases); and CCAM affecting two lobes of the lung, CCAM and a heart defect, and CCAM and a gastric duplication cyst (one case of each). Three babies with CDH did not undergo additional examination due to the severity of their condition. All 13 patients were operated on; in 10 cases surgery was performed by thoracoscopy. The postoperative period was uncomplicated, long-term growth and development have not been affected.

Conclusion: Modern diagnostic techniques help in determining the nature and location of combined and associated lung malformations. Video-assisted thoracoscopic surgery is an effective and minimally invasive treatment option.

Keywords: newborns, congenital lung malformations, bronchopulmonary sequestration, congenital cystic adenomatoid malformation, surgical treatment.

 

Citation format for this article:

Dorofeyeva Ye. I., Podurovskaya Yu. L., Zubkov V. V., Pykov M. I., Filippova Ye. A., Kulabukhova Ye. A. Rare Combinations of Congenital Lung Malformations in Newborns: Diagnosis and Surgical Treatment. Doctor.Ru. 2017; 3(132): 26–30.

 

Analysis of Exhaled Breath Condensate As a Method for Differential Diagnosis of Respiratory Pathologies in Newborns

A. S. Kononikhin, A. Yu. Ryndin, K. Yu. Fedorchenko, A. A. Burov, O. V. Ionov, V. Ye. Frankevich, I. I. Ryumina

 

Study Objective: To compare the composition of exhaled breath condensate (EBC) in intubated newborns with congenital pneumonia and those with left-sided congenital diaphragmatic hernia (CDH), in order to identify specific proteomic and metabolic profiles of these pathologies.

Study Design: This was a comparative study.

Materials and Methods: The study included 24 intubated newborns, aged four to 20 days, 12 of whom had congenital pneumonia and the other 12 had left-sided CDH. Samples of EBC were analyzed by high-performance liquid chromatography/high-resolution tandem mass spectrometry.

Study Results: As part of this study, a device was designed for the collection of EBC samples from newborns on mechanical ventilation. Proteomes and metabolomes of EBC were identified in intubated infants with congenital pneumonia or left-sided CDH. No significant differences in the frequency of identification of cytokeratin-group peaks or their total normalized intensity were observed between the study groups. The analysis showed that infants with pneumonia had a broader diversity of immunoglobulins (Ig) (Cluster of Ig alpha-1 chain C region, Ig J chain, Cluster of Ig mu chain C region, and Ig kappa chain C region). Compared with the group with left-sided CDH, the group of pneumonia showed a higher total normalized peak intensity of Ig and a lower total normalized peak intensity of some other proteins (dermcidin, cystatin-A, and calmodulin-like protein 5). In EBC samples collected from newborns with congenital pneumonia, the peak intensity of leukotriene B4 and 5-hydroperoxyeicosatetraenoic acid was significantly higher (p<0.05), and the peak intensity of polyunsaturated phosphatidylcholine and polyunsaturated monoglyceride was, on the contrary, significantly lower (p<0.05) than in EBC samples collected from newborns with left-sided CDH.

Conclusion: A comparison of EBC composition in patients with infectious and non-infectious pathologies revealed a difference in the spectrum of peptides and lipid components studied. The study also showed that the EBC protein profile in babies with congenital pneumonia was consistent with published data on EBC protein composition in adult patients with community-acquired pneumonia. This suggests the possibility of identifying a disease-specific profile.

Keywords: exhaled breath condensate, high-performance liquid chromatography, mass spectrometry, newborns.

 

Citation format for this article:

Kononikhin A. S., Ryndin A. Yu., Fedorchenko K. Yu., Burov A. A., Ionov O. V., Frankevich V. Ye., Ryumina I. I. Analysis of Exhaled Breath Condensate As a Method for Differential Diagnosis of Respiratory Pathologies in Newborns. Doctor.Ru. 2017; 3(132): 31–36.

 

Modern Contraception and Women’s Quality of Life

V. N. Prilepskaya, P. R. Abakarova, Ye. L. Yarotskaya

 

In recent years, contraception has received special attention worldwide. Modern contraception may be regarded as an important factor in women’s quality of life. This article includes information about the efficacy of modern hormonal contraceptives used as therapeutic or preventive agents, as confirmed by the results of international and Russian studies.

Along with other scientific and practical advances, modern hormonal contraception offers a new level of quality of life for today’s women. It not only reduces the number of abortions and their complications, but also helps women maintain their reproductive health, stay young and beautiful, and even live longer. Therefore, the world's top scientists view the use of modern hormonal contraceptives as therapeutic or preventive agents for women who do not need contraception, as a new and advanced approach in obstetrics, gynecology, and reproductive medicine.

Keywords: contraception, hormones, quality of life, combination oral contraceptives, Belara.

 

Citation format for this article:

Prilepskaya V. N., Abakarova P. R., Yarotskaya Ye. L. Modern Contraception and Women’s Quality of Life. Doctor.Ru. 2017; 3(132): 37–42.

 

Endometriosis As a Risk Factor for Cardiovascular Disorders and Certain Malignancies

G. Ye. Chernukha, L. M. Ilyina, S. V. Pavlovich

 

Objective of the Review: To describe data suggesting that endometriosis is among the disorders affecting young women, which contribute to increased morbidity and mortality later in life.

Key Points: Endometriosis is associated with chronic systemic inflammation, elevated oxidative stress, and accumulation of atherogenic lipids that play a key role in endothelial dysfunction, atherogenesis, and an elevated risk of ischemic heart disease. A relationship was shown between endometriosis and an increased prevalence of certain types of cancer, which may be explained by some pathogenic pathways these conditions share.

Conclusion: Appropriate treatment of endometriosis in young women may prevent the development of cardiovascular disorders and some malignancies.

Keywords: endometriosis, chronic inflammation, ischemic heart disease, ovarian cancer, breast cancer, colorectal cancer.

 

Citation format for this article:

Chernukha G. Ye., Ilyina L. M., Pavlovich S. V. Endometriosis As a Risk Factor for Cardiovascular Disorders and Certain Malignancies.Doctor.Ru. 2017; 3(132): 43–48.

 

Multitarget Therapeutic Approach to Ovarian Cancer

G. T. Sukhikh, L. A. Ashrafyan, V. I. Kiselev, Ye. V. Gerfanova, O. I. Aleshikova, I. B. Antonova

 

Objective of the Paper: To improve the efficacy of standard combination treatment for ovarian cancer (OC) by adding multitarget medications containing indole-3-carbinol (I3C) with or without epigallocatechin-3-gallate (EGCG) to the background regimen.

Materials and Methods: The study included 284 patients who had been examined and treated for advanced (stage III) serous OC associated with ascites and/or pleuritis. Study participants were divided into five groups. In all groups, women received conventional combination treatment, including standard polychemotherapy (PCT) — TP, TC or DC regimens — and the most optimal surgical cytoreduction.

In groups 1, 2, and 3, patients also received 2 to 4 cycles of neoadjuvant chemotherapy (NACT) and prolonged treatment with I3C (Indinol Forto) alone (group 1, n = 46) or with EGCG (Promisan) (groups 2 and 3, n = 76 and n = 42, respectively), which was started well before surgery.

In group 3, NACT and subsequent surgery were followed by prolonged PCT.

Two control groups included patients with stage III serous OC associated with ascites. These patients did not receive I3C medications. In control group 1 (n = 40), patients received conventional treatment: surgical cytoreduction and 6 cycles of adjuvant chemotherapy (ACT). In control group 2 (n = 80), patients underwent NACT, surgery and 6 cycles of ACT.

Study Results: Addition of I3C with or without EGCG to NACT used for advanced serous OC significantly improves treatment outcomes and increases the chances to provide optimal relatively radical surgical treatment. Using I3C with or without EGCG as part of conventional combination treatment for serous OC makes relapses of ascites very unlikely; maintains tumor sensitivity for first-line chemotherapy in most patients; and allows for a wider use of repeat surgery, which expands the range of treatment options available for patients with relapsed OC. In addition to conventional treatment, most women without disease progression received I3C (17.4% in group 1), I3C and EGCG (19.7% in group 2) or a combination of these medications with prolonged PCT (21.4% in group 3). In control groups 1 and 2, the percentage of patients without disease progression was 5.0% and 2.5%, respectively. The median 5-year survival was 60 months in groups 1, 2, and 3 and 46 and 44 months in control groups 1 and 2, respectively.

Conclusion: When used together with conventional combination treatment for OC, I3C medications with or without EGCG helped improve the efficacy of conventional treatment, allowing for an increase in relapse-free and overall survival.

Keywords: ovarian cancer, tumor stem cell, inflammation, ascites, indole-3-carbinol, epigallocatechin-3-gallate.

 

Citation format for this article:

Sukhikh G. T., Ashrafyan L. A., Kiselev V. I., Gerfanova Ye. V., Aleshikova O. I., Antonova I. B. Multitarget Therapeutic Approach to Ovarian Cancer. Doctor.Ru. 2017; 3(132): 49–58.

 

Microbiota and Local Immunity of Vaginal Mucosa in Very Young Girls: Normal and Abnormal Parameters

Ye. V. Uvarova, Z. K. Batyrova, Z. Kh. Kumykova, A. Ye. Donnikov, O. V. Burmenskaya, L. S. Namazova-Baranova

 

Study Objective: To describe the microbiota and local immunity of the vaginal mucosa in very young girls with recurrent labial adhesions, acute bacterial vulvovaginitis, or atopic dermatitis, compared to age-matched healthy girls.

Materials and Methods: The study included 217 girls, aged one to 36 months: 68 with acute bacterial vulvovaginitis, 60 with recurrent labial adhesions, 27 with atopic dermatitis, and 62 healthy girls with no abnormalities in physical or sexual development (control group). Quantitative molecular genetic analysis was performed on epithelial scrapes of the vaginal vestibule and vaginal wall obtained from all participants, to assess microbial composition (using real-time polymerase chain reaction) and local immunity.

Study Results: The following groups of anaerobic microorganisms were the most commonly observed components of the bacterial microbiota in very young girls:Eubacterium spp., Prevotella bivia/Porphyromоnas spp., Megasphaera spp./Velionella spp./Dialister, and Peptostreptococcus spp. Girls with labial adhesions frequently (about 1.2 times more so than healthy girls) hadMobiluncus spp./Corynebacterium spp(100% vs. 83%; р = 0.018). In girls with acute vulvovaginitis, the Enterococcusand Gardnerella vaginalis genomes were found less frequently by factors of 2.6 (27.3% vs. 72.3%;р = 0.014) and 3.2 (18.2% vs. 59.6%; р = 0.033), respectively, than in the control group. TheLactobacillus spp./G. vaginalis ratio was elevated because of a greater percentage ofLactobacillus spp. genomes. In the group of girls with atopic dermatitis, theG. vaginalis and Lactobacillus spp. genomes were found less frequently by factors of 3.2 (р = 0.001) and 2.4 (р = 0.002), respectively, than in the control group. There were no significant differences, however, in the quantity of any the groups of microorganisms studied, between the groups of girls with different health problems.

In participants with recurrent labial adhesions the following changes were observed in local immunity of the vaginal mucosa: lower levels of both pro-inflammatory (IL-1β, IL-10, and IL-12α) and anti-inflammatory (IL-18) cytokines and lower expression of messenger ribonucleic acid (mRNA), transforming growth factorβ, and tumor necrosis factor α. Changes observed in samples taken from girls with vulvovaginitis included a 1.7 times higher expression of CD45 mRNA and an expression of IL-18 that was lower by a factor of 1.9 than in the control group. Girls with atopic dermatitis had lower expression of IL-8, IL-10, and CD45 mRNA than the age-matched healthy controls.

Conclusion: Recurrent labial adhesions in very young girls are not associated with acute inflammation of infectious origin. The qualitative composition of the microbiota of the vaginal mucosa in this age population changes over time, with shifts being observed in different groups of organisms. It is possible that the balance of vaginal microbiota in these girls is maintained by the presence of certain groups of microorganisms in very low quantities. Low quantities ofG. vaginalis also play an important regulatory role.

Keywords: early childhood, molecular genetic techniques, microbiota, local immunity, atopic dermatitis, labial adhesions, vulvovaginitis.

 

Citation format for this article:

Uvarova Ye. V., Batyrova Z. K., Kumykova Z. Kh., Donnikov A. Ye., Burmenskaya O. V., Namazova-Baranova L. S. Microbiota and Local Immunity of Vaginal Mucosa in Very Young Girls: Normal and Abnormal Parameters. Doctor.Ru. 2017; 3(132): 59–65.

 

Chronic Human Papillomavirus-associated Cervicitis: Diagnosis and Therapeutic Approaches

G. R. Bairamova, A. S. Amirkhanyan, I. I. Baranov, O. V. Burmenskaya, Ye. A. Kalinina, T. V. Priputnevich, M. Yu. Bobrov, Ye. S. Bunyaeva

 

Study Objective: To conduct a systematic analysis of data in recent publications on the diagnosis of and therapeutic approaches to chronic cervicitis (CC) associated with human papillomavirus (HPV), based on the results of physical examination, colposcopy, morphology, and molecular genetic analysis.

Key Points: Using clinical, morphological, and molecular genetic inflammation markers and information about identified HPV types allows for tailoring the management of HPV-associated CC. Diagnosis of CC primarily aims to detect the cause of inflammation. Treatment of all abnormalities should be individually tailored, depending on the etiology and severity of cervical disease.

Conclusion: Applying the described approach to treatment helps reduce the number of destructive interventions and provides a basis for conservative therapeutic choices for women of reproductive age.

Keywords: chronic cervicitis, human papillomavirus infection, liquid-based cytology, HPV testing, microribonucleic acid.

 

Citation format for this article:

Bairamova G. R., Amirkhanyan A. S., Baranov I. I., Burmenskaya O. V., Kalinina Ye. A., Priputnevich T. V., Bobrov M. Yu., Bunyaeva Ye. S. Chronic Human Papillomavirus-associated Cervicitis: Diagnosis and Therapeutic Approaches. Doctor.Ru. 2017; 3(132): 66–72.

 

Kisspeptin and Reproductive System

G. Ye. Chernukha, G. I. Tabeeva, D. V. Gusev, R. G. Shmakov

 

Kisspeptin plays an important role in the neuroendocrine regulation of gonadotropin-releasing hormone (GnRH) secretion. Kisspeptinergic neurons have been recognized as central regulators responsible for transmitting homeostatic information to GnRH-neurons.

This review describes the characteristics of kisspeptin and its receptors and the role of cotransmitters (neurokinin B and dynorphin) in the regulation of kisspeptin secretion. The authors also look at the relationships between energy homeostasis, stress, and the kisspeptinergic system in terms of regulation of the reproductive function. They provide evidence of the clinical significance of kisspeptin and its agonists and antagonists as components of new therapeutic approaches to treating various hormone-dependent reproductive disorders.

The ability of kisspeptin to potentiate secretion of GnRH has opened up a new direction of research in gynecological endocrinology and reproductive biology.

Keywords: kisspeptin, reproduction, leptin, stress, energy homeostasis.

 

Citation format for this article:

Chernukha G. Ye., Tabeeva G. I., Gusev D. V., Shmakov R. G. Kisspeptin and Reproductive System. Doctor.Ru. 2017; 3(132): 73–78.

 

 

Doctor.Ru Pediatrics with a special allergology section No. 4 (133), 2017

 

The Effects of Tobacco Smoking on Respiratory Function in Children and Adolescents

T. N. Kozhevnikova, I. V. Grivas, I. V. Pomogayev, V. S. Malyshev

 

Study Objective: To assess the prevalence of tobacco smoking in the Tula Region and to study smoking status and its effects on respiratory function in children and adolescents.

Study Design: This was an empirical study.

Materials and Methods:A survey by anonymous questionnaire was conducted among 1,192 schoolchildren, aged 8 to 17, selected by continuous sampling. The Fagerström test was used to assess nicotine dependence in the 160 children and adolescents who smoked. In both smoking and non-smoking schoolchildren, the concentration of carbon oxide (CO) in exhaled air was measured (n = 115) and the acoustic component of the work of breathing was determined (n = 61).

Study Results:By age 18, 32% of the girls and 40% of the boys had tried smoking, and more than 70% of these children became addicted to smoking after their first cigarette. The Fagerström test was performed in 160 smokers and showed that 16% of them were greatly or very greatly dependent on tobacco and 25% smoked more than one pack a day. The mean exhaled CO level of the smokers was 14.1± 1.8 ppm, and 12% of the smokers had levels greater than 20 ppm. Asthma was the most commonly reported disease among the smokers. Measurements of the low-frequency acoustic component of the work of breathing were double in smokers without asthma and five times as high for smokers with asthma, compared to age-matched subjects without bronchopulmonary disorders.

Conclusion: Comprehensive diagnostics, treatment and rehabilitation, aimed at restoring respiratory function, should be applied for prevention of chronic bronchopulmonary disorders in children and adolescents.

Keywords: tobacco smoking in adolescents, carbon oxide, airway phonography, assessment of smoking status using the Fagerström test.

 

Citation format for this article:

Kozhevnikova T. N., Grivas I. V., Pomogayev I. V., Malyshev V. S. The Effects of Tobacco Smoking on Respiratory Function in Children and Adolescents. Doctor.Ru. 2017; 4(133): 8–13.

 

Approaches to Treating Acute Respiratory Infections in Children

N. A. Geppe, I. A. Dronov, G. N. Bayandina

 

Objective of the Review:To inform pediatricians about the latest principles of medication management for acute respiratory infections (ARI) in children.

Key Points: Determining optimal approaches to treating ARI in children is one of the key goals of practical healthcare. Choosing the right cough medicines for patients with ARI remains an urgent issue. The authors look at the use of cough medicines in children with ARI and specific approaches to administering mucolytic agents.

Conclusion: Adequate treatment of pediatric ARI relieves symptoms, improves the patient's condition, and contributes to more rapid recovery.

Keywords: children, acute respiratory infections, cough, mucolytic agents, acetylcystein.

 

Citation format for this article:

Geppe N. A., Dronov I. A., Bayandina G. N. Approaches to Treating Acute Respiratory Infections in Children. Doctor.Ru. 2017; 4(133): 14–18.

 

The Efficacy of Essential Oil Inhalation in Children with Acute Respiratory Illnesses

Е. I. Danilova, O. Yu. Trusova, V. V. Sumenko, T. N. Ignatova,Е. V. Azarova

 

Study Objective:To assess the efficacy of essential oil inhalation, administered through the Dyshi inhalation patch as part of combination therapy for acute respiratory illnesses (ARI) in children.

Study Design:This was an open-label, randomized, controlled study.

Materials and Methods:The study’s participants were 80 children with ARI, aged 5 to 12, who were divided into two groups. Children in the main group (n = 40) wore the Dyshi inhalation patch in addition to the background therapy they were receiving. Children in the control group (n = 40) received background therapy alone. The efficacy of the therapeutic approaches was assessed by physical-examination data, measured on a 10-point visual analogue scale (VAS). Examination was performed on treatment days 1, 6, and 12.

Study Results:In the main group, a complete course of treatment led to greater improvement in symptoms than in the control group. After 12 days of treatment, the mean VAS scores for nasal congestion, rhinorrhea, and daytime cough in the main and control groups were 0.3 and 2.4, 0.4 and 2.1, and 0.4 and 1.1, respectively (р < 0.001 for all comparisons). Children using the Dyshi inhalation patch did not experience any side effects.

Conclusion:Combination therapy including background therapy and the Dyshi inhalation patch provides the greatest clinical benefit for children with acute respiratory infections. The Dyshi inhalation patch is safe and well tolerated by children.

Keywords: essential oils, children, acute respiratory illnesses.

 

Citation format for this article:

Danilova Е. I., Trusova O. Yu., Sumenko V. V., Ignatova T. N., AzarovaЕ. V. The Efficacy of Essential Oil Inhalation in Children with Acute Respiratory Illnesses.Doctor.Ru. 2017; 4(133): 19–24.

 

The Programming Effects of Complementary Feeding

Ye. F. Lukushkina, M. G. Medyantseva, I. N. Vlasova, V. V. Meshcheryakova,Е. G. Novopoltseva, A. A. Kamalova

 

Objective of the Review:To optimize feeding regimens for babies during the first year of life and describe modern approaches to the introduction of complementary feeding.

Key Points: Complementary feeding has long been discussed in terms of the timing and sequence of its introduction. Today, nutritional programming is being actively debated and researched. Complementary feeding is a potent programming factor. It has been demonstrated that the early introduction of complementary foods and high consumption of milk protein during the period of their introduction increase risk for obesity; that timely introduction of complementary foods may reduce risk for allergies; that neither breastfeeding (including when gluten is introduced), the age when gluten is introduced, nor the amount or type of gluten influences risk for celiac disease; and that iron deficiency at an early age has long-term negative effects. The timing of the introduction of complementary foods is also important for the development of eating behaviors.

Conclusion: Complementary feeding is currently regarded as a factor with long-term health effects in both childhood and adult life.

Keywords: complementary feeding, metabolic programming, long-term effects.

 

Citation format for this article:

Lukushkina Ye. F., Medyantseva M. G., Vlasova I. N., Meshcheryakova V. V., NovopoltsevaЕ. G., Kamalova A. A. The Programming Effects of Complementary Feeding. Doctor.Ru. 2017; 4(133): 25–29.

 

Effects of Maternal Autoantibodies on Development of the Fetal Nervous System

S. G. Tsakhilova, A. V. Khmelnitskaya, I. Ye. Gulin, A. A. Malsagova, A. M. Begizova

 

Study Objective:To detect maternal antibodies (auto-AB) and evaluate their role in development of the fetal nervous system.

Materials and Methods:Fifty children with autism-spectrum disorders were examined, as well as their mothers. The ELI-Neuro-Test, a specialized test kit, was used to measure serum levels of IgG auto-AB in all study participants.

Study Results:Eighty-eight percent of the children and 84.0% of the mothers had autism-specific shifts in serum reactivity profiles, manifested as altered levels of auto-AB against opiateμ-receptors and β-endorphin. Less frequently, changes in the immunoreactivity profiles of the autistic children were manifested by the presence of auto-AB against serotonin receptors (n = 16), axonal or myelin proteins (n = 14), S100 proteins (n = 27), and GFAP protein, a marker for gliosis (n = 13). The same changes were observed in their mothers.

Conclusion:Shifts in profiles of serum immunoreactivity may be predictors of elevated risk for impairment of the development of a baby's nervous system, beginningin utero. Detection of immune abnormalities in pregnant women is important for assessing the risk of babies developing somatic, endocrine or neurological disorders during the first months and years of life. Immunological abnormalities in women are reversible, and should be treated before pregnancy. The ELI-Neuro-Test can be an effective diagnostic tool for preventing congenital autism or reducing its incidence.

Keywords: pregnancy, autism, environmental factors, maternal immune disorders, autoantibodies.

 

Citation format for this article:

Tsakhilova S. G., Khmelnitskaya A. V., Gulin I. Ye., Malsagova A. A., Begizova A. M. Effects of Maternal Autoantibodies on Development of the Fetal Nervous System. Doctor.Ru. 2017; 4(133): 30–33.

 

Bronchopulmonary Dysplasia in Preterm Babies, an Urgent Issue

Е. B. Pavlinova, G. A. Sakhipova

 

Objective of the Review:To evaluate the respiratory systems of babies who have had bronchopulmonary dysplasia, in order to improve approaches to the diagnosis, treatment, and prevention of this disorder.

Key Points: Improvements in special care for preterm babies and the use of modern perinatal techniques and intensive therapy in the treatment of premature newborns have increased the frequency of bronchopulmonary dysplasia. The main causes of this disorder are lung immaturity, surfactant deficiency, and the effects of high concentrations of oxygen administered during mechanical ventilation.

Conclusion: Analysis of published scientific studies of bronchopulmonary dysplasia in newborns shows that this disorder has become a major problem and demonstrates the need for early diagnosis of bronchopulmonary dysplasia in babies.

Keywords: extremely low birth weight, premature births, respiratory distress syndrome, bronchopulmonary dysplasia.

 

Citation format for this article:

Pavlinova Е. B., Sakhipova G. A. Bronchopulmonary Dysplasia in Preterm Babies, an Urgent Issue. Doctor.Ru. 2017; 4(133): 34–38.

 

T. V. Zabolotskikh, A. S. Kireeva, S. V. Medvedeva, E. K. Gertsenberger, A. V. Lir, E. V. Nizovskaya

 

Objective of the Paper:To describe the clinical manifestations and particular features of the diagnosis and treatment of infantile hypophosphatasia (HPP).

Key Points: The paper describes two cases of babies observed and treated at the Amur Regional Children's Clinical Hospital. The first baby did not receive pathogenesis-based therapy because it did not exist at the time. The second baby received treatment with recombinant human alkaline phosphatase (asfotase alfa). The baby who did not receive pathogenesis-based therapy died of progressive respiratory and cardiovascular insufficiency at the age of 1 year and 4 months. At the time of writing, the second patient had been receiving asfotase alfa for 1 year and 9 months. The patient’s chronological age was 2.1 years. Her body weight was 8,350 g and her height was 76 cm. She started to bear weight on her legs. She had still speech difficulties and was able to pronounce only single words.

Conclusion: Before the advent of enzyme replacement therapy, children with HPP received symptomatic therapy, which was of little help. The outcome was disability or death. Today, timely administration of enzyme replacement therapy makes it possible to save patients' lives and improve their quality of life.

Keywords: hypophosphatasia, diagnosis, treatment, asfotase alfa, babies during the first year of life.

 

Citation format for this article:

Zabolotskikh T. V., Kireeva A. S., Medvedeva S. V., Gertsenberger E. K., Lir A. V., Nizovskaya E. V. Clinical Experience with Infantile Hypophosphatasia. Doctor.Ru. 2017; 4(133): 40–44.

 

 

Vitamin D Deficiency and Autoimmune Diseases

A. V. Vitebskaya, M. I. Tikhaya

 

Objective of the Review:To describe the role of vitamin D in the development of autoimmune diseases and its effects on the severity of these conditions.

Key Points:The main function of vitamin D is to regulate calcium and phosphorus metabolism. In 2016 the Global Consensus Recommendations on Prevention and Management of Nutritional Rickets were published, which included diagnostic criteria, based on 25OHD concentrations, for vitamin D deficiency and insufficiency, as well as treatment recommendations.

The discovery of vitamin D’s effects on immune reactions suggested that it might play a role in the pathogenesis of autoimmune diseases.

Current studies focus on the role of vitamin D in the development and progression of type 1 diabetes mellitus, multiple sclerosis, asthma, rheumatoid arthritis, and systemic lupus erythematosus.

Conclusion:Studies have shown a relationship between vitamin D levels and the severity of autoimmune disorders, but the effects of vitamin D supplementation on the course of these conditions have not been fully evaluated.

Keywords: vitamin D, calcitriol, rickets, autoimmune diseases.

 

Citation format for this article:

Vitebskaya A. V., Tikhaya M. I. Vitamin D Deficiency and Autoimmune Diseases. Doctor.Ru. 2017; 4(133): 45–48.

 

Juvenile Autoimmune Hepatitis as Part of Polyglandular Autoimmune Syndrome

Е. N. Tyurina, A. V. Gorelov, I. V. Sichinava, A. Ya. Shishov,Е. V. Borisova, M. I. Grammatopulo

 

Study Objective:To study the onset of autoimmune hepatitis (AIH) as part of polyglandular autoimmune syndrome (PAS) and as a separate disorder.

Design: This was a research project.

Materials and Methods:Twenty-five children (17 girls and eight boys, aged 4 to 15) were observed. Twenty-two of these children (Group 1) had only AIH, and three children (Group 2) had PAS with AIH as an early manifestation.

Study participants underwent physical examination, laboratory tests, and instrumental investigations, including complete blood count, blood chemistry, immunological blood tests, urinalysis, abdominal ultrasonography, esophagogastroduodenoscopy, and core liver biopsy. PAS was confirmed by genetic testing of blood samples.

Results: The severity of AIH was similar in patients who had it as a major early manifestation of PAS and those who had no other abnormalities. In most of the cases, AIH was progressive and resulted in liver cirrhosis relatively soon after onset, whether or not it was associated with autoimmune involvement of other organs and systems.

Conclusion:The infrequency of occurrence, challenging diagnosis, and severity of PAS, as well as high rates of AIH conversion to liver cirrhosis, including in PAS patients, underpin the necessity of improving the early diagnosis of autoimmune diseases. Practitioners should remember that the onset of PAS may manifest as AIH.

Keywords: autoimmune hepatitis, polyglandular autoimmune syndrome, children, clinical manifestations, diagnosis.

 

Citation format for this article:

Tyurina Е. N., Gorelov A. V., Sichinava I. V., Shishov A. Ya., BorisovaЕ. V., Grammatopulo M. I. Juvenile Autoimmune Hepatitis as Part of Polyglandular Autoimmune Syndrome. Doctor.Ru. 2017; 4(133): 49–53.

 

The Use of Coryzalia in Children with Acute Infectious or Persistent Allergic Rhinitis

N. A. Geppe, I. M. Farber, I. V. Ozyorskaya, U. S. Malyavina, V. S. Malyshev, D. G. Bukharov

 

Study Objective:To evaluate the safety, tolerability and comparative efficacy of Coryzalia orally dispersible tablets in children with acute infectious rhinitis or mild or moderate persistent allergic rhinitis.

Study Design:This was an open-label, observational study.

Materials and Methods:Seventy-four children, aged 3 to 15, were observed. The patients were divided into two groups. Group 1 consisted of 39 patients with acute rhinitis (ACR), and Group 2 of 35 patients with allergic rhinitis (ALR). Study methods included scoring the disease symptoms, rhinopharyngoscopy, evaluation of ciliary activity (saccharin test and brush biopsy), and such functional diagnostic techniques as computer-digitized airway phonography and rhinomanometry. Coryzalia was administered as monotherapy or in combination with either vasoconstrictive agents (in patients with ACR) or antihistamine agents (in patients with ALR).

Study Results:Coryzalia provided beneficial clinical effects in both groups. By the end of the treatment period (days 7 to 14), clinical symptoms completely resolved in 32 patients (82.1%) with ACR and 24 patients (68.6%) with ALR. Restoration of nasal patency was accompanied by an improvement in functional parameters.

Conclusion:When used to treat ACR and exacerbations of allergic rhinitis, Coryzalia enhances the clinical effects of other therapies; this is confirmed by instrumental examinations.

Keywords: Coryzalia, children, acute rhinitis, allergic rhinitis, airway phonography.

 

Citation format for this article:

Geppe N. A., Farber I. M., Ozyorskaya I. V., Malyavina U. S., Malyshev V. S., Bukharov D. G. The Use of Coryzalia in Children with Acute Infectious or Persistent Allergic Rhinitis. Doctor.Ru. 2017; 4(133): 54–60.

 

Cow’s Milk Protein Allergy: Diagnosis and Choice of Formula. Review of Clinical Guidelines

L. S. Namazova-Baranova, S. G. Makarova, G. A. Novik, E. A. Vishneva

 

Objective of the Paper: To inform a wide range of pediatricians and other specialists about current clinical guidelines on medical care for babies with cow’s milk protein allergy (CMPA).

Key points: Cow’s milk proteins (CMP) are the main clinically significant allergens affecting babies during the first year of life. Early initiation of appropriate treatment significantly improves the prognosis of children with CMPA and prevents the development of more severe allergic disorders later on. The diagnosis of CMPA is based on a careful and complete allergy history. When necessary, a diagnostic diet is administered, with the introduction for diagnostic purposes of a CMP-containing food. Levels of specific IgE antibodies to CMP, and their fractions, as well as skin test parameters, are used as supportive diagnostic markers in the detection of IgE-mediated CMPA and should be interpreted together with clinical data. Complete elimination of foods containing CMP, and of the milk of other animals, for at least 6 months (12 to 18 months in severe cases) is the only effective treatment for CMPA. Babies who are bottle-fed or receive mixed feeding should be given only extensively hydrolyzed milk protein formulas or amino acid-based formulas.

Conclusion: Management protocols provided in current clinical guidelines on CMPA in babies help to achieve successful treatment of this common disorder.

Keywords: babies, cow’s milk protein allergy, food allergy, extensively hydrolyzed milk protein formulas, amino acid-based formulas, milk-free diet.

 

Citation format for this article:

Namazova-Baranova L. S., Makarova S. G., Novik G. A., Vishneva E. A. Cow’s Milk Protein Allergy: Diagnosis and Choice of Formula.Review of Clinical Guidelines. Doctor.Ru. 2017; 4(133): 61–68.

 

 

Doctor.Ru Cardiology Internal Medicine No. 5 (134), 2017

 

YKL-40, a New Inflammation Marker, YKL-40 in Patients with Type 2 Diabetes Mellitus and Cardiovascular Disorders

Е. I. Churakova, A. T. Shubina, M. G. Bolotina, V. P. Masenko, Yu. A. Karpov

 

Study Objective: To evaluate YKL-40 levels in patients with cardiovascular disorders (CVD) with or without type 2 diabetes mellitus (DM).

Materials and Methods: The study involved 83 patients, aged 40 to 80, with hypertension and/or stable ischemic heart disease (IHD). Sixty of the patients also had type 2 DM and 23 patients did not have DM or impaired glucose tolerance. The following parameters were measured in all study participants: glycated hemoglobin (HbA1c), YKL-40, creatinine, and glomerular filtration rate (GFR).

Study Results: The study groups were similar in terms of age and GFR. HbA1c concentration was greater to a statistically significant degree in patients with type 2 DM. Thirteen patients (56.5%) in the control group had HbA1c > 5.7% (threshold value for prediabetes).

No statistically significant difference in YKL-40 levels was observed between the groups. In patients with type 2 DM, YKL-40 levels correlated with age (r = 0.49; p < 0.001), duration of type 2 DM (r = 0.36; p = 0.006), and reduced GFR (r = –0.42; p < 0.001).

Conclusion: YKL-40 levels did not differ in patients with CVD with and without type 2 DM. In patients with type 2 DM and CVD, YKL-40 levels correlate with diabetes duration, age, and GFR, and may be a sign of diabetic nephropathy. Renal impairment (microalbuminuria and reduced GFR) are recognized predictors of cardiovascular complications. Thus, the prognostic value of YKL-40 levels may be due to its association with renal function.

Keywords:ischemic heart disease, YKL-40, type 2 diabetes mellitus, nephropathy.

 

Citation format for this article:

Churakova Е. I., Shubina A. T., Bolotina M. G., Masenko V. P., Karpov Yu. A. YKL-40, a New Inflammation Marker, YKL-40 in Patients with Type 2 Diabetes Mellitus and Cardiovascular Disorders. Doctor.Ru. 2017; 5(134): 8–13.

 

The Use of Various Anticoagulants in Treating Non-ST Elevation Acute Coronary Syndrome: Data from the RECORD-3 Registry

V. V. Kashtalap, I. S. Bykova, O. L. Barbarash

 

Objective of the Paper: To assess current approaches to the use of anticoagulants in patients with non-ST elevation acute coronary syndrome (NST E-ACS) in the actual clinical practice of Russian inpatient institutions, based on data from the Russian RECORD-3 Registry.

Materials and Methods: The ACS RECORD-3 Registry was created using data obtained from 47 inpatient facilities in 37 Russian cities in March and April 2015. It includes data on 1,495 patients with NST E-ACS.

Study Results: Anticoagulants were administered in pre-hospital settings to only 521 patients (34.9%) with NST E-ACS. Most of them received unfractionated heparin as an intravenous bolus injection. Unfractionated heparin was given to 110 patients (7.4%) subcutaneously, which is not an accepted route of administration for this medication. Low-molecular-weight heparin (enoxaparin) was used in pre-hospital settings in only 15 patients (1.0%), and only six patients (0.4%) received fondaparinux.

Anticoagulants were administered to 1,199 patients (80.2%) with NST E-ACS on day 1 of hospitalization. Most of the patients continued to receive unfractionated heparin, which in 50% of the cases was administered as subcutaneous injections. The modern anticoagulants enoxaparin and fondaparinux were given to 10.8% and 10.7% of the patients, respectively.

During hospitalization, 1,093 patients (73%) with NST E-ACS continued to receive anticoagulants, of whom 613 (41%) received subcutaneous unfractionated heparin. Another 11.8% and 11.2% of the patients with NST E-ACS received enoxaparin and fondaparinux, respectively, as longterm anticoagulant treatment. The majority of the 505 patients with confirmed myocardial infarction received subcutaneous unfractionated heparin during hospitalization. The same medication and route were used in the 830 patients with a final diagnosis of unstable angina.

Conclusion: Insufficient use is made of medications in the treatment of NST E-ACS at the present time. The practice of early initiation and prolonged use of anticoagulant therapy during hospitalization continues, even after effective endovascular revascularization. The most commonly used anticoagulant is subcutaneous unfractionated heparin.

Keywords: acute coronary syndrome, RECORD-3, registry, anticoagulants, fondaparinux.

 

Citation format for this article:

Kashtalap V. V., Bykova I. S., Barbarash O. L. The Use of Various Anticoagulants in Treating Non-ST Elevation Acute Coronary Syndrome: Data from the RECORD-3 Registry. Doctor.Ru. 2017; 5(134): 14–19.

 

Issues of Cardiac Rehabilitation in Patients after Acute Coronary Syndrome: Data from the Complete Krasnodar Territory Registry

Е. D. Kosmacheva, S. V. Kruchinova, S. A. Raff, V. A. Porkhanov

 

Study Objective: To assess the need for rehabilitation in patients after acute coronary syndrome (ACS) and to evaluate the effects of rehabilitation on the efficacy of treatment and quality of life, using data from Krasnodar Territory complete registry of ACS patients.

Study Design: This was a prospective cohort study.

Materials and Methods: Of 4,837 patients included in the registry, 3,420 people had had a confirmed acute myocardial infarction, and 2,190 had undergone myocardial revascularization by percutaneous transluminal coronary angioplasty. This cohort was divided into groups. Group 1 (n = 532) included patients who had received only in-patient rehabilitation. Group 2 (n = 771) included patients who had received in-patient rehabilitation followed by rehabilitation at special health resorts for cardiac patients and subsequent treatment at outpatient clinics. Group 3 (n = 887) was made up of patients who had received treatment at outpatient clinics after in-patient rehabilitation.

Study Results: In Group 2, recurrent infarction and unstable angina were reported less frequently; mortality and the prevalence of depressionspectrum disorders were significantly lower; a statistically significantly greater number of patients gave up smoking; and treatment compliance was the best. Borg Scale scores showed that the anaerobic threshold was reached by 28.1%, 65.0%, and 41.9% of patients in Groups 1, 2, and 3, respectively, with the difference between Group 2 and Groups 1 and 3 being statistically significant.

Conclusion: Comprehensive cardiac rehabilitation is necessary for improving the progression of disease. It increases exercise tolerance, encourages patients to give up smoking, improves patients’ psychological well-being, reduces mortality and number of hospitalizations, and significantly increases quality of life.

Keywords: registry, acute coronary syndrome, cardiac rehabilitation.

 

Citation format for this article:

Kosmacheva Е. D., Kruchinova S. V., Raff S. A., Porkhanov V. A. Issues of Cardiac Rehabilitation in Patients after Acute Coronary Syndrome: Data from the Complete Krasnodar Territory Registry. Doctor.Ru. 2017; 5(134): 20–24.

 

Compliance with Recommendations for Management of Cardiovascular Risk

Е. V. Bolotova, I. M. Komissarova

 

Study Objective: To assess compliance with recommendations for management of modifiable cardiovascular risk factors (RF) in the rural population of Krasnodar Territory, in relationship to the prevention strategy employed.

Study Design: This was an open-label, randomized epidemiological study.

Materials and Methods: A sample was created from the rural population of Krasnodar Territory using the Kish method (2,189 people, of whom 54.0% were female and 46.0% male; mean age 47.7 ± 16.6) and examined during the study. Modified cardiovascular RF were evaluated using a unified questionnaire, which was part of the main questionnaire developed as a tool for routine and preventive check-ups. Compliance with preventive recommendations for management of modifiable cardiovascular RF and with medication therapy was assessed using the Morisky-Green questionnaire.

Study Results: Three years after preventive counselling, positive changes were observed in modifiable cardiovascular RF in this population of rural residents of Krasnodar Territory; percentage of patients compliant and insufficiently compliant with the recommendations increased by 23.9 and 7.6 points, respectively, while the number of non-compliant patients decreased by 31.5%. Among the compliant patients, the percentage of women was statistically significantly greater (58.5% vs. 38.0%; p = 0.000); in the groups of insufficiently compliant and non-compliant patients there were more men than women (33.6% vs. 23.1% and 28.3% vs. 18,4% respectively, p = 0.000 for both comparisons), which again was a statistically significant difference. The highest (35.6%) and lowest (2.2%) rates of compliance with preventive recommendations were seen among patients aged 56 to 65 and 18 to 25, respectively. Graduates of vocational secondary schools and universities were more compliant (54.9% and 53.6%, respectively).

Conclusion: The study showed that rural residents of Krasnodar Territory are insufficiently compliant with recommendations for managing cardiovascular RF and with medication therapy for hypertension. However, a positive trend towards improved compliance was observed. The highest compliance was achieved by those who received both thorough individual counselling and preventive group counselling.

Keywords: compliance, preventive counselling, rural population.

 

Citation format for this article:

Bolotova Е. V., Komissarova I. M. Compliance with Recommendations for Management of Cardiovascular Risk. Doctor.Ru. 2017; 5(134): 25–30.

 

Treatment of Cognitive Dysfunction in Patients with Ischemic Heart Disease Who Have Undergone Coronary Artery Bypass Grafting

M. M. Petrova, S. V. Prokopenko, O. V. Yeremina,Е. Yu. Mozheyko, D. S. Kaskayeva

 

Objective of the Paper: To carry out clinical validation of a method for the prevention of progression of cognitive impairment in patients with ischemic heart disease (IHD) who have undergone coronary artery bypass grafting (CABG).

Key Points: This paper describes the clinical case of a patient with IHD and moderate cognitive impairment who had undergone CABG. The patient was examined upon admission to the hospital, on day 13 after CABG, and at 12 months post-surgery. Beginning on day 3 post-surgery, his treatment was combined with a rehabilitation course using computerized stimulation programs (one 20-min session a day for 10 days).

Conclusion: In this case the computerized stimulation programs had positive effects. They prevented postoperative cognitive dysfunction and even improved cognitive function in some areas.

Keywords: ischemic heart disease, cognitive impairment, coronary artery bypass grafting, computerized stimulation programs.

 

Citation format for this article:

Petrova M. M., Prokopenko S. V., Yeremina O. V., MozheykoЕ. Yu., Kaskayeva D. S. Treatment of Cognitive Dysfunction in Patients with Ischemic Heart Disease Who Have Undergone Coronary Artery Bypass Grafting. Doctor.Ru. 2017; 5(134): 32–35.

 

Linkages between Compliance and Mental Status in Patients after Coronary Artery Bypass Graft Surgery

S. A. Pomeshkina, V. A. Bezzubova, A. V. Solodukhin, A. V. Seryi, N. Yu. Ardashova

 

Study Objective: To identify associations between types of internal picture of disease (IPD) and choices of coping strategy, and compliance with recommended treatment in patients after coronary artery bypass graft (CABG) surgery.

Study Design: This was an open-label, prospective study.

Materials and Methods: The study looked at 378 male patients who had scheduled CABG. Patients were examined five to seven days before CABG and six months after surgery. The following data were evaluated: patients' clinical state, hospital records, and office charts. IPD was

identified before CABG using a personality questionnaire developed by the Bekhterev Institute, and coping strategies were identified by a special tool for evaluating coping behaviors.

Study Results: Six months after CABG, patients showed incomplete compliance with doctors' recommendations. Compliant patients had demonstrated balanced or ergopathic attitudes to disease in the preoperative period. Moreover, compared to noncompliant patients, compliant subjects statistically more often had chosen effective coping strategies, such as "planful problem solving," "accepting responsibility," and "self-controlling." Analysis of correlations between types of IPD and coping strategies showed negative correlations between the balanced type of IPD and the "escape-avoidance" strategy (r = –0.3; p = 0.002) and between the ergopathic type of IPD and the "escape-avoidance" (r = –0.3; p = 0.006) and "distancing" strategies (r = –0.19; p = 0.001). A positive correlation was observed between the anxiety type of IPD and the "escape-avoidance" strategy (r = –0.31; p = 0.001).

Conclusion: Determining the type of attitude toward disease and the dominant coping response in patients who have scheduled CABG helps in identifying possible non-compliance problems in the postoperative period.

Keywords: coronary artery bypass grafting, coping strategies, internal picture of disease, compliance.

 

Citation format for this article:

Pomeshkina S. A., Bezzubova V. A., Solodukhin A. V., Sery A. V., Ardashova N. Yu. Linkages between Compliance and Mental Status in Patients after Coronary Artery Bypass Graft Surgery. Doctor.Ru. 2017; 5(134): 36–41.

 

A Decision Support System as a Component of a Patient-Centered Model of Cardiac Rehabilitation

N. P. Lyamina, Е. V. Kotelnikova

 

Study Objective: To obtain a users' assessment of the efficacy of a decision support system (DSS) as an organizational and functional component of a patient-centered model of rehabilitation for patients with ST elevation myocardial infarction (ST EMI).

Materials and Methods: This prospective study (six months of observation of 28 patients with ST EMI) used information and communications technologies, including a DSS and modern online communications tools. The efficacy of the DSS was assessed by testing 15 doctors, who used this system, and evaluating electronic Patient-Reported Outcomes (еPRO).

Study Results: Twelve doctors (80%) successfully created an electronic Patient Rehabilitation Chart, spending on average 11 ± 4 minutes to create one such form. The mean number of errors made by doctors when choosing cardiac rehabilitation (CR) measures was 4.8 ± 1.2. Data obtained from ePRO showed that 15 patients (53.6%) had a physiological response to their CR programs. For six patients (21.4%), who had a borderline response, the CR programs were adjusted through distance consultations. Seven patients (25.0%) with an abnormal response required changes in treatment. The final score reflecting a subjective assessment of the doctors’ satisfaction with the DSS was fairly high (9.5 ± 0.5).

Conclusion: This study demonstrated the high efficacy of a DSS for organizing home-based CR programs. The use of electronic reports, designed to involve patients in the treatment and rehabilitation process, helped in obtaining information about the safety of the CR programs and assessing the role of a DSS in making patient-centered decisions.

Keywords: decision support system, cardiac rehabilitation, patient-centered model, information and communications technologies.

 

Citation format for this article:

Lyamina N. P., Kotelnikova Е. V. A Decision Support System as a Component of a Patient-Centered Model of Cardiac Rehabilitation. Doctor.Ru. 2017; 5(134): 42–46.

 

Mucoactive Therapy for Acute Bronchitis: What Should General Practitioners Choose in Real Clinical Practice?

V. I. Kupayev, L. A. Shchelkunova, Yu. M. Gushchina, O. A. Kirgizova, N. V. Kashtanova

 

Study Objective: To compare treatment with a mucolytic agent with or withoutβ2-agonist in order to develop the most effective and safest therapeutic strategy for acute bronchitis.

Study Design: This was a prospective randomized study.

Materials and Methods: Eighty-two patients with viral acute bronchitis were examined, mean age 38.16 ± 12.8. Randomization by envelopes was carried out to divide participants into two groups: Group 1 comprised 44 people who received Jocet, a combination medication, and Group 2 was made up of 38 patients who were given ambroxol. The following data were analyzed: clinical observation data, information from cough diaries including a visual analogue scale, and peak flow measurements.

Study Results: Analysis of the study data showed that in the acute bronchitis patients in Group 1 the duration of productive cough was 2.7 days shorter than in Group 2: 10.26 ± 5.48 and 12.94 ± 6.61 days, respectively (р = 0.046). Cough duration was short in both groups, but by the end of the observation period, the number of coughing patients was two (4.5%) in Group 1 and eight (25.0%) in Group 2 (р < 0.025). The rate of reduction of cough intensity and frequency was 10.66 ± 3.79 days in Group 1 and 13.43 ± 2.83 days in Group 2 (р = 0.0012). No patients in either group had elevated blood pressure.

Conclusion: In most cases, the combination of a mucolytic agent and aβ2-agonist, which is superior to monotherapy with a mucolytic agent, may be recommended as pathogenesis-oriented and symptomatic treatment for acute bronchitis.

Keywords: acute bronchitis in adults, mucolytic therapy.

 

Citation format for this article:

Kupayev V. I., Shchelkunova L. A., Gushchina Yu. M., Kirgizova O. A., Kashtanova N. V. Mucoactive Therapy for Acute Bronchitis: What Should General Practitioners Choose in Real Clinical Practice? Doctor.Ru. 2017; 5(134): 47–50.

 

Management of Comorbid Osteoarthritis: Clinical Recommendations for General Practitioners

L. I. Alekseyeva, A. V. Naumov

These Guidelines were approved at the XI National Congress of General Internists (November 23–25, 2016)

 

Citation format for this article:

Alekseyeva L. I., Naumov A. V. Management of Comorbid Osteoarthritis: Clinical Recommendations for General Practitioners.Doctor.Ru. 2017; 5(134): 51–69.