Vol 84, No 11 (2012)


Hepatitis C virus Genotype 3: that "simple", yet that "complex"

Batskikh S.N., Morozov S.V., Chulanov V.P., Pokrovskiĭ V.I.


The data on natural course of chronic viral hepatitis C infection (HCV) and the efficacy of antiviral treatment depending on virus genotype are summarized in the article. The significance of virus genotype in progression of liver febrosis and liver steatosis is discussed. It is pointed out that chronic HCV infection caused by genotype 3 is characterized by a more aggressive clinical course of disease and less favorable prognosis. Optimal approaches to the management of patients with genotype 3 of chronic HCV infection as well as perspectives of antiviral therapy in this group of patients are discussed in the article.
Terapevticheskii arkhiv. 2012;84(11):4-10
pages 4-10 views

Immunogenetic predictors of a rapid virologic response to antiviral therapy in patients with chronic hepatitis C

Iushchuk N.D., Znoĭko O.O., Balmasova I.P., Fedoseeva N.V., Shmeleva E.V., Dudina K.R., Klimova E.A., Petrova T.V., Trofimov D.I., Belyĭ P.A., Safiullina N.K., Pypkina E.V.


Aim. To determine the correlation between interleukin 28B (IL28B) gene polymorphism in patients with chronic hepatitis C (CHC), the presence or absence a rapid virologic response to antiviral therapy, and a number of immunological characteristics as a basis for a personalized approach to treating the patients. Subjects and methods. Seventeen CHC patients infected with hepatitis C virus genotype 1b were examined and underwent genetic testing for IL28B gene polymorphism for rs12979860 (CC, CT or TT genotypes) and rs8099917 (TT, TG or GG genotypes) using the modified method of adjacent samples, which revealed single nucleotide substitutions in the genes. Their immunological parameters were identified by a flow cytometry technique by taking into account whether a rapid virologic response had been achieved. Results. The key phenomena of a rapid virologic response in the representatives of different IL28B genotypes are the nonspecific proliferative activity of blood natural killer cells before treatment, as well as the count of regulatory T cells before and 4 weeks after therapy start. Conclusion. To predict the efficiency of antiviral therapy for CHC, it is desirable to supplement genetic studies with immunological data.
Terapevticheskii arkhiv. 2012;84(11):11-17
pages 11-17 views

Predictors of the inefficiency of combination treatment in patients with infiltrative pulmonary tuberculosis

Volchegorskiĭ I.A., Novoselov P.N., Dudarova T.P., Bolotov A.A.


Aim. To reveal the predictors of inefficiency of combination treatment in patients with infiltrative pulmonary tuberculosis (IPT). Subjects and methods. One hundred and three patients with new-onset IPT underwent a complex clinical, radiological, laboratory and psychological examination before treatment. The findings were compared with the results of combination treatment for IPT within a year after the initiation of therapy. Results. The standard treatment regimens was ascertained to cause no clinical recovery in 6.8% of the patients who were characterized by the baseline excretion of M. tuberculosis and sputum in 100% of cases, by the highest X-ray and clinical manifestations of IPT with simultaneously evolving leukocytosis, increased erythrocyte sedimentation rate (ESR), elevated serum ceruloplasmin and enzyme markers of cholestasis, depressive fatigability, weight loss, and a worsening quality of life because of pain. Discriminant analysis yielded an algorithm for predicting the inefficiency of standard treatment for IPT, which was based on the integrative evaluation of thoracic pain, ESR, circulating ceruloplasmin levels, γ-glutamyl transpeptidase and alkaline phosphatase activities in the serum. Conclusion. It has been demonstrated that the inefficiency of IPT therapy may be predicted from the data of a complex clinical, hematological, and biochemical examination of patients before therapy.
Terapevticheskii arkhiv. 2012;84(11):18-25
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Effectiveness of the hepatoprotective activity of reamberine, remaxol, and ademethionine and risk assessment in their use in patients with respiratory tuberculosis and drug-induced liver injury

Sukhanov D.S.


Aim. To comparatively evaluate the hepatoprotective activity of reamberine, remaxol, and exogenous ademethionine and a risk for unfavorable/favorable outcomes of their use in patients with liver injury during antituberculosis chemotherapy. Subjects and methods. One hundred and eighty patients with new-onset respiratory tuberculosis were examined and divided into 4 groups (45 patients in each group): Study Group 1 (SG1): patients who took reamberine; Study Group 2 (SG2): those who received remaxol; Study Group 3 (SG3): those who had ademethionine; and a Comparative Group (CG): those who received 5% glucose solution. The test drugs were intravenously administered in a dropwise manner once daily for 10 days. The laboratory hepatic injury severity index (LHISI) was estimated according to the method described by T.N. Kalachnyuk and the risk for a favorable/unfavorable outcome was assessed, by calculating the average cost of the used hepatotropic agents. Results. LHISI increased statistically significantly with the development of liver injury induced by antituberculosis agents. There was a statistically significant reduction in LHISI during therapy with the test hepatotropic agents versus glucose solution, the most pronounced activity being shown by remaxol. Relative risk (RR) and odds ratio (OR) assessments revealed the high likelihood of a favorable outcome (a reduction in LHISI) when each of the 3 test drugs versus glucose solution was administered; the highest RR and OR were also found in the use of remaxol. Estimation of costs and the number of patients to be treated (NPBT) in order to avoid a case of none LHLIS reduction could reveal the highest efficacy of remaxol. Conclusion. The test agents (reamberine, remaxol, and ademethionine) are effective in treating tuberculosis patients with drug-induced liver injury. The administration of remaxol demonstrated the highest positive effect (as estimated by LHISI) in terms of both RR and NPBT.
Terapevticheskii arkhiv. 2012;84(11):26-29
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Glomerular diseases in HIV-infected patients: Clinical and morphological evaluation

Iushchuk N.D., Gadzhikulieva M.M., Volgina G.V., Tomilina N.A.


Aim. To evaluate the clinical and morphological variants of kidney abnormalities in HIV-infected patients. Subjects and methods. Thirty HIV-infected patients (60% men and 40% women) aged 26 to 54 years (mean age 31.6±4.7 years) who had undergone diagnostic needle renal biopsy were examined. The indication for the biopsy was nephrotic syndrome (NS) (isolated or concurrent acute nephritic syndrome) and/or decreased renal function. The morphological study of biopsy specimens included light microscopy and immunofluorescence assay. Results. In the examined HIV-infected patients, the histological variants of kidney abnormalities presented with immune complex glomerulonephritis (ICGN) in 26 cases and with focal segmental glomerulosclerosis (FSGS) in 4 cases. The clinical manifestations of ICGN were as follows: NS (61.5%), acute nephritic syndrome (in more than one third of the patients) concurrent with hematuria, as well as mainly grades 2-3 arterial hypertension (AH) (12/14) and renal dysfunction. Immune complex glomerulopathies were marked by polymorphism in the renal morphological pattern with fluorescence during immunofluorescence microscopy in most cases of virtually all classes of immunoglobulins (IgA, IgM, IgG) and complement system fragments (С3, С1q). FSGS was clinically characterized by NS concurrent with AH, hematuria. The morphological subtypes of FSGS were exhibited by apical, perihilar, and nonspecific variants in 1, 1, and 2 cases, respectively. By the time the signs of renal dysfunction appeared, the HIV-infected patients with glomerulopathy were found to have a high viral load (HIV RNA >100 000 copies/ml) and low CD4 lymphocyte levels (≤200 in 1 µl). Conclusion. In our study, the morphological pattern of chronic glomerulonephritis showed a preponderance of immune complex nephropathies with the clinical manifestations of acute nephritic syndrome and/or NS concurrent with hematuria. High viremia and depressed immune system may be risk factors for nephropathy.
Terapevticheskii arkhiv. 2012;84(11):30-33
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Clinical presentation of "new" tick-borne borreliosis caused by Borrelia miyamotoi

Sarksian D.S., Platonov A.E., Karan' L.S., Malinin I.E., Khalitova L.I., Shakhov V.I., Dudarev M.V., Malinin O.V., Maleev V.V.


Aim. The objective of this study was to confirm the role of B. miyamotoi in the etiology of ITBB-WOEM in Udmurtia and to investigate in detail the clinical presentation of this "new" disease.Materials and methods. 50 adult patients with ITBB-WOEM treated in Republic Hospital for Infectious Diseases, Udmurtia, in 2010-2011 had PCR-confirmed infection by B. miyamotoi. The laboratory evidence of co-infection by other pathogens, including tick-borne encephalitis virus, B. burgdorferi sensu lato, A. phagocytophilum, E. chaffeensis, and E. muris, were absent. Results. All patients had a tick bite from 10 to 18 days before the acute disease onset. The main clinical signs were high fever, fatigue, headache, chill, and sweat. Clinical, biochemical, and instrumental investigations also showed the signs of functional impairment of various organs: the liver (in about half of the patients), kidney (in 10 patients), heart (6 patients), etc. In contrast, acute ITBB with erythema migrans was usually a localized infection without a pronounced intoxication syndrome and impairments of the organs. Conclusion. ITBB-WOEM caused by B. miyamotoi is a systemic disease that is clinically closer to relapsing fevers transmitted by argasid ticks than to Lyme borreliosis. The number of B. miyamotoi infections in Russia may be comparable with that of Lyme disease cases, so the investigations of epidemiology, clinical presentation and therapy of this "new" disease are urgently requested.
Terapevticheskii arkhiv. 2012;84(11):34-41
pages 34-41 views

Impact of a learning program on the psychological aspects of quality of life in patients with prosthetic heart valves

Gorbunova E.V., Gorshkova T.V., Romanova M.P., Makarov S.A.


Aim. To evaluate the impact of a learning program on quality of life indicators in patients with prosthetic heart valves (PHV).Subjects and methods. One hundred and twenty-two patients with PHV were examined. A study group consisted of 72 patients who were trained at PHV school; a control group comprised 50 untrained patients. The comparison groups were matched for age, gender, education level, the underlying disease that had been a cause of heart disease, and the type of PHV. The SF-36 questionnaire assessing quality of life was used to evaluate the effectiveness of the learning program. Results. At baseline, before cardiac surgery, the patients with PHV showed low physical and mental health indicators in both groups. At 6-month follow-up, the physical health component was increased by 23.8% in the control group and by 27.4% in the study group trained by the learning program (p<0.05). Analysis of the scores of each scale of the questionnaire yielded significant results in both groups after 6 months of cardiac surgery (p<0.05), which showed better quality of life. The comparison groups had significant differences only in the scores of the mental health component. Thus, following 6 months the mental health component was 24.1% higher in the learning program group than in the control one (p<0.05). Conclusion. The learning program for patients with PHV, which is based on the principle of continuity of the in- and outpatient management, contributes to better quality of life mainly due to an improvement in the mental health component.
Terapevticheskii arkhiv. 2012;84(11):42-46
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Impact of replacement therapy for subclinical hypothyroidism on cardiovascular risk markers in patients with type 2 diabetes mellitus

Kasatkina S.G., Panova T.N.


Aim. To study the time course changes in the parameters of endothelial dysfunction in patients with type 2 diabetes mellitus (DM) and subclinical hypothyroidism (SH) in the natural course of SH and during replacement therapy. Subjects and methods. All the examined patients were divided into 2 groups: 1) 67 patients received replacement therapy with euthyrox in a dose of 25 to 100 µg/day; 2) 60 patients were followed up. Results. At the moment of study inclusion, there was a close direct correlation between the levels of cholesterol and the aggregate intima-media thickness (IMT) (r=0.7) and between IMT and the levels of sICAM-1 (r=0.71) and sVCAM-1 (r=0.8). In the dynamics of the disease (following a year), the above correlations became weaker due to the performed treatment. A weak positive correlation was found between the aggregate IMT and the levels of sICAM-1 (r=0.2) and sVCAM-1 (r=0.3). Conclusion. In patients with type 2 DM, the presence of SH serves as an additional risk factor for endothelial dysfunction. Replacement therapy will be able to considerably retard the progression of the disease and to reduce the incidence of vascular events.
Terapevticheskii arkhiv. 2012;84(11):47-50
pages 47-50 views

Metabolic disturbances as a factor of the pathogenesis of hypertensive disease and its clinical outcomes

Kovalenko V.N., Talaeva T.V., Shumakov V.A., Bratus' V.V.


Aim. To identify and determine the mechanisms of an association between arterial hypertension (AH) and proatherogenic systemic metabolic disturbances in hypertensive disease (HD), as well as the possibility of eliminating these disturbances by antihypertensive therapy. Subjects and methods. Fifty-four patients with HD and 64 persons randomly selected from an unorganized urban population were examined. Systolic and diastolic blood pressure (BP), insulin sensitivity, the most important metabolic parameters of lipids, lipoproteins, and glucose, the degree of systemic inflammation and oxidative stress, and the rate of lipoprotein proatherogenic and immunogenic modification were determined. Results. All the patients with HD were found to have a regular concurrence of AH with systemic inflammation and activated free-radical reactions, metabolic abnormalities, such as atherogenic dyslipidemia, insulin resistance, atherogenic and immunogenic modified lipoproteins. Antihypertensive treatment failed to eliminate metabolic disturbances even when BP control was fully restored. Conclusion. AH and systemic metabolic disturbances in HD have a common pathogenetic basis and the treatment of hypertensive patients should provide the normalization of not only BP, but also inflammatory and oxidative status and systemic metabolism.
Terapevticheskii arkhiv. 2012;84(11):51-58
pages 51-58 views

A histological response to antiviral therapy for chronic hepatitis C in patients who failed to achieve a sustained virological response

Riumin A.M., Korochkina O.V.


The paper presents the results of combination antiviral therapy (AVT) in 2 patients with chronic hepatitis C (CHC) unresponsive to AVT. Both patients are classified as difficult to treat (genotype 1b, a high viral load, overweight). 1.5 years after the termination of a course of AVT, histological examination of biopsy specimens revealed a histological response in one patient and significant histological worsening in the other. The specific features of the development of a histological response to AVT and possible reasons for its lack are discussed by the example of the described patients.
Terapevticheskii arkhiv. 2012;84(11):59-60
pages 59-60 views

Long-term entecavir efficacy retention in the treatment of chronic hepatitis B with an outcome to hepatic cirrhosis caused by its resistant virus strain

Znoĭko O.O., Dudina K.R., Safiullina N.K., Karandashova I.V., Chulanov V.P.


The paper gives concise data on the efficacy of entecavir in the treatment of chronic hepatitis B caused by its resistant virus strain and describes a relevant clinical case.
Terapevticheskii arkhiv. 2012;84(11):61-63
pages 61-63 views

Problems in the diagnosis of ornithosis

Nafeev A.A., Savinova G.A., Rechnik V.N., Voloshina O.A., Vinogradova I.B.


The paper describes 3 cases of ornithosis that could be detected by clinical and laboratory studies using immunological assays. In one case, its diagnosis was made late when the infection occurred in a woman working in a travel agency in Cyprus. The two other cases having an occupational contact (pet shop workers) were observed to have its acute form. All the described cases showed lung involvement characterized by external respiratory failure, one of the most common manifestations of ornithosis (psittacosis). Among the practically used laboratory tests, the indirect hemagglutination reaction is an accessible and effective serological assay for the diagnosis of ornithosis.
Terapevticheskii arkhiv. 2012;84(11):64-65
pages 64-65 views

A case of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) in a patient with diffuse large B-cell lymphoma and chronic hepatitis B virus infection

Melikian A.L., Kovrigina A.M., Giliazitdinova E.A., Gitis M.K.


The paper describes a case of diffuse large B-cell lymphoma detected in a patient 13 months after sinus histiocytosis with massive lymphadenopathy (SHML) or Rosai-Dorfman disease (RDD) being diagnosed together with active hepatitis B virus infection. Analysis of their observations of patients with sinus histiocytosis and the data available in the literature allowed the authors to identify a few tens of cases with SHML associated with lymphomas. This case and previously described ones in the literature on the association of RDD and lymphomas may suggest with a high degree of probability that patients diagnosed as having RDD in evident lymphadenopathy and the non-typical clinical course of RDD may develop blood cancer.
Terapevticheskii arkhiv. 2012;84(11):66-70
pages 66-70 views

Successful treatment for Hodgkin's lymphoma in a female patient with Ph+ chronic myeloid leukemia

Sharkunov N.N., Moiseeva T.N., Zybunova E.E., Vinogradova O.I., Kravchenko S.K.


To treat patients with different concurrent cancers, including lympho- and myeloproliferative neoplasms, is a difficult task. The paper presents the experience in successfully treating lymphogranulomatosis occurring in a female patient with chronic myeloid leukemia (CML). A combination of the BEACOPP-14 polychemotherapy regimen and imatinib induced no severe complications. Grade 2 neutropenia requiring no use of granulocyte colony-stimulating factors is the only manifestation of hematological toxicity. Infectious complications were successfully eliminated by first-line antimicrobial therapy in the intercourse periods. Remission in lymphogranulomatosis was achieved by polychemotherapy. The authors conclude that the chosen therapy option is effective and relatively safe in treating patients with CML concurrent with lymphogranulomatosis.
Terapevticheskii arkhiv. 2012;84(11):71-74
pages 71-74 views

Telaprevir: New possibilities for antiviral treatment in patients with chronic hepatitis C

Nikitin I.G., Gogova L.M., Baĭkova I.E., Kisliakov V.A., Volynkina V.M.


The review considers the chemical structure, pharmacodynamics and pharmacokinetics of telaprevir, a new direct-acting antiviral agent, used to treat patients with chronic hepatitis C (CHC). The given data on Phase II and III clinical trials enable the authors to state the high efficacy of the drug in patients infected with hepatitis C virus type 1. The paper also provides data on the resistance of telaprevir and its drug interaction and denotes the place of the drug in the current antiviral treatment of patients with CHC.
Terapevticheskii arkhiv. 2012;84(11):75-80
pages 75-80 views

Current possibilities for treatment for hepatitis C virus-induced cryoglobulinemic vasculitis and B-cell lymphoma

Ignatova T.M., Mukhin N.A.


The paper presents a detailed review of the data available in the literature on the treatment of cryoglobulinemic vasculitis and some forms of B-cell non-Hodgkin lymphoma caused by hepatitis C virus. It shows treatment successes associated with the use of current combined antiviral therapy (interferon-α and ribavirin) and its combination with anti-CD20 monoclonal antibodies (rituximab). The combined therapy with rituximab and antiviral drugs allows a radical improvement of prognosis in nearly 50% of patients. Remaining treatment problems and new drug prospects are discussed.
Terapevticheskii arkhiv. 2012;84(11):81-88
pages 81-88 views

Postviral asthenia and fatigue syndrome in a therapist's practice

Simanenkov V.I., Poroshina E.G., Makienko V.V.


Asthenia serves as a symptom of many both organic and mental diseases. 16-64% of patients with this diagnosis visit a polyclinic therapist. Asthenia is an obligate symptom of a number of mental illnesses, including stress-related neurotic disorders, and somatoform disorders (panic attacks, generalized anxiety disorders, somatoform autonomic disorders, adjustment disorders), as well as nonpsychotic petit mal depressions. Patients with these disorders generally see therapists or general practitioners, rather than psychiatrists. The paper reflects the classification, differential diagnosis, and treatment of asthenia. A clinical case is described; its therapy is warranted.
Terapevticheskii arkhiv. 2012;84(11):89-93
pages 89-93 views

СРАР therapy for obstructive sleep apnea syndrome in patients with carbohydrate metabolic disturbances and type 2 diabetes mellitus

Oleĭnikov V.É., Sergatskaia N.V.


The review presents the data of clinical trials assessing the association between type 2 diabetes mellitus (DM) and obstructive sleep apnea syndrome (OSAS). The factors influencing the development of OSAS are analyzed in patients with DM; and disturbed sleep patterns are described in detail in patients with OSAS. The relationship of OSAS, diabetic autonomic neuropathy, and insulin resistance is analyzed. Whether CPAP therapy may be used to correct metabolic disturbances in patients with DM is considered.
Terapevticheskii arkhiv. 2012;84(11):94-98
pages 94-98 views

Consideration of the psychosomatic status as one of the conditions for effective treatment and controlled asthma

Fedoseev G.B., Trofimov V.I., Eliseeva M.V., Babkina O.I., Kriakunov K.N.


The lecture is dedicated to the idea of a role of psychosomatic disorders in the occurrence and development of asthma, on the diagnosis and treatment of the neuropsychic type of its course, and on possibilities for psychotherapeutic correction.
Terapevticheskii arkhiv. 2012;84(11):99-103
pages 99-103 views

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