Terapevticheskii arkhiv

 

About

The journal Therapeutic archive (ISSN key title is "Terapevticheskiy arkhiv") was founded by the prominent Russian therapists M.P. Konchalovsky and G.F. Lang in 1923. Then its editors-in-chief were Professors V.N. Vinogradov and A.G. Gukasyan. Since 1972, E.I. Chazov, Academician of the Russian Academy of Sciences, has been heading the editorial board of the journal.

Over 90 years, there have been more than 1000 issues where the authors and editorial staff have done their best for readers to keep abreast of current advances in medical science and practice and for physicians to master the advanced principles of recognition and treatment of a wide spectrum of visceral diseases.

The papers published in the journal (editorials, original articles, lectures, reviews, etc.) cover both current scientific achievements and practical experience in diagnosing, treating, and preventing visceral diseases. The authors of publications are not only Russian, but also foreign scientists and physicians. All papers are peer-reviewed by highly qualified Russian specialists.

The journal is published monthly. Traditionally, each issue has predominantly certain thematic areas covering individual therapy specializations. Every year, one of the issues is devoted to related problems in practical medicine (allergology and immunology, neurology and psychiatry, obstetrics, oncology, etc.). This all draws the attention of the reading public to the journal.

 

Editor-in-Chief

Irina Chazova
MD, PhD, Professor, Academician of the Russian academy of Sciences
ORCID: http://orcid.org/0000-0002-1576-4877

 

Publications

Monthly issues publish in print and online in Open Access under the Creative Commons NC-ND 4.0 International Licensee.

 

Indexation

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    • Russian Science Citation Index (RSCI)
    • Core Collection (Science Citation Index Expanded)
  • PubMed/Medline
  • Index Medicus
  • Current Contents Connect
  • BIOSIS Previews
  • Scopus/EMBASE
  • Ulrich’s Periodicals Directory
  • Google Scholar
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Current Issue

Vol 93, No 1 (2021)

Cover Page

Full Issue

Editorial
Modern content and improvement of high cardiovascular risk strategy in reducing mortality from cardiovascular diseases
Boytsov S.A., Drapkina O.M.
Abstract

The article describes the modern content of the high-risk strategy, which, along with the population strategy, forms the basis of a set of measures to reduce mortality from cardiovascular diseases. The high cardiovascular risk strategy is carried out at the individual level in outpatient structures as a part of primary and secondary prevention of cardiovascular diseases, and is also implemented in hospitals when performing elective surgical procedures, including high-tech interventions. Improving this strategy within the framework of primary health care involves the development of a system of high-risk offices, telemedicine consulting, remote monitoring of physiological parameters on the basis of a regional medical information system, and in the future, on the basis of a uniform vertically integrated medical information system. The development of the high-risk strategy as a part of inpatient practice occurs through the further replication of high technologies and the implementation of new types of them.

Terapevticheskii arkhiv. 2021;93(1):4-6
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Original articles
Problems of insufficient control of target blood pressure levels in the outpatient practice
Larina V.N., Fedorova E.V., Mikhailusova M.P., Golovko M.G.
Abstract

Aim. Assessment of the frequency of reaching the target level of blood pressure (BP) and the factors affecting it in outpatients with arterial hypertension (AH).

Materials and methods. An open, one-stage, comparative study involving 64 patients with hypertension and 47 without hypertension at the age of 40 to 59 years. All patients underwent physical examination, assessment of cardiovascular risk (CVR), 24-hour blood pressure monitoring (ABPM), echocardiography (ECHOCG), color duplex scanning of brachiocephalic arteries.

Results. Patients with hypertension and comparison groups were comparable in age, sex, smoking, history of myocardial infarction. 1st degree of hypertension was present in 26.6%, 2nd – in 40.6%, 3rd – in 12.5% of patients. Obesity was detected in 24.3% of patients and all patients with obesity had AH. The SCORE score in individuals with hypertension was 4.9±4.5; in the comparison group, 2.3±2.6 (p<0.001). Non-stenosing atherosclerosis was present in 54.8% and 88%, p=0.020, and atherosclerotic plaque in the vascular lumen was present in 45.3% and 12% of patients with and without hypertension, respectively (p<0.001). 68.8% were constantly treated, and the target BP was reached in 31.3% of patients with hypertension. Male gender (OR 1.68; 95% CI 1.68–28.49; p=0.007), obesity (OR 4.78; 95% CI 1.14–20.29; p=0.033), concomitant pathology (OR 3.09; 95% CI 1.02–9.37; p=0.046) were negative, and dyslipidemia (OR 0.10; 95% CI 0.01–0.84; p=0.033) was positive, affecting the achievement of the target level of blood pressure.

Conclusion. The target level of blood pressure was achieved in 31.3% of outpatients with hypertension, mainly in women. Among patients who did not reach the target level of blood pressure, men, individuals with high SSR and obesity predominated. Concomitant pathology and obesity are negative, and dyslipidemia was positively associated with the achievement of the target level of blood pressure, which must be taken into account when developing measures for prevention and treatment.

Terapevticheskii arkhiv. 2021;93(1):7-14
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Hepatocellular damage and inflammation in various forms of alcoholic liver disease
Rodina A.S., Shubina M.E., Kurbatova I.V., Topchieva L.V., Dudanova O.P.
Abstract

Aim. The aim of the study was to evaluate hepatocellular damage and immune inflammation in various forms of alcoholic liver disease (ALD).

Materials and methods. 104 patients with ALD were examined: 15 (14.4%) with liver steatosis (LS), 19 (18.3%) with steatohepatitis and 70 (67.3%) with liver cirrhosis (LC); men 50 (48.1%), women 54 (51.9%); age – 45.7±8.4 years. Traditional clinical, laboratory, instrumental studies were performed, the levels of fragments of cytokeratin-18 (FCK-18), cytokines – IL-1â, TNF-á, IL-4, IL-6, IL-8 were determined by ELISA. The control group consisted of 39 healthy individuals: men – 20 (51.2%), women – 19 (48.7%), age – 48.5±8.3 years.

Results. In LS, an increase in the level of FCK-18 was noted with normal aminotransferase activity, the content of TNF-á, IL-6, IL-1â, IL-8 increased and the level of IL-4 decreased compared to those in healthy individuals. In steatohepatitis, a triple increase in aminotransferases and FCK-18 was observed compared with LS, as well as an increase in the level of inflammatory mediators, to a greater extent – IL-6, to a lesser extent – IL-8, TNF-á, a decrease in IL-4, IL-1â remained at the same level. In LC, there was a further increase in FCK-18, significantly more pronounced than an increase in AST, and the increase in cytokines continued – to the same extent, the levels of IL-6 and IL-8, to a lesser extent – IL-1â and TNF-á, and the level of IL-4.

Conclusion. With the progression of ALD from LS to steatohepatitis, hepatic cell damage was carried out by equally pronounced processes of hepatocyte necrosis and apoptosis, with the development of cirrhosis of the liver, parenchyma damage occurred mainly due to hepatocyte apoptosis. The immuno-inflammatory process progressively increased from the stage of LS to LC with IL-6 and IL-8 undergoing the greatest dynamics. FCK-18 can serve as a non-invasive marker of hepatic cell damage, and IL-6 and IL-8 – markers of immune inflammation in ALD.

Terapevticheskii arkhiv. 2021;93(1):15-19
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Telomere length as a biomarker of the risk of cardiovascular complications in patients with coronary heart disease
Doroshchuk N.A., Lankin V.Z., Tikhaze A.K., Kheimets G.I., Doroshсhuk A.D., Smirnova M.D., Chazova I.E.
Abstract

Aim. To study the effect of oxidative stress and telomere length in the chromosomes of blood leukocytes in patients with coronary heart disease (CHD) on the development of cardiovascular complications.

Materials and methods. In 119 patients with CHD, the level of oxidatively modified low-density lipoproteins (ox-LDL) in blood plasma and the length of telomeres in nuclear blood cells were determined during the examination. After 5 years, a telephone survey of patients (or their relatives) was conducted to obtain data on the presence of cardiovascular complications. Telomere length was determined using quantitative real-time PCR, and the level of ox-LDL was determined by immunochemical method.

Results. It was found that reducing the length of telomeres in patients with CHD increases the risk of subsequent development of cardiovascular complications. A strong negative correlation was found between the level of ox-LDL and telomere length in the group of examined CHD patients who had cardiovascular complications after 5 years.

Conclusion. CHD patients with short telomere length and high levels of ox-LDL have an increased risk of cardiovascular complications during 5 years.

Terapevticheskii arkhiv. 2021;93(1):20-24
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Prevalence of ischemic heart disease depending on factors of psychoemotional stress among men of mature age (epidemiological study)
Akimova E.V., Akimov M.Y., Kayumova M.M., Gafarov V.V.
Abstract

Aim. To establish associations of the prevalence of ischemic heart disease (IHD) and factors of psychoemotional stress in men of the open urban population in the age group 45–64 years after two decades of life.

Materials and methods. A cross-sectional epidemiological study using a model of the city of Tyumen was conducted on a representative sample of the population among males of mature age (45–64 years). Based on standard epidemiological methods, IHD was established according to strict epidemiological criteria – «definite» IHD. The study of the factors of psycho-emotional stress (depression, hostility, life exhaustion) was carried out according to the algorithms of the World Health Organization program «MONICA-psychosocial». When calculating the odds ratio for the development of IHD, a low level of psycho-emotional stress factors was regarded as the absence of a sign, a combination of medium and high levels as a presence.

Results. The prevalence of ischemic heart disease in the open population (on the model of Tyumen) according to strict epidemiological criteria in men aged 45–54 years was 8.2%, at the age of 55–64 years – 19.2%, a predominance of painless form of ischemic heart disease was revealed. According to the levels of factors of psychoemotional stress in mature men, mainly the average level of depression and life exhaustion, a high level of hostility were established. In men of an open population (on the model of Tyumen), depending on the psychoemotional stress, a high risk of developing a certain coronary heart disease was established in the age categories 45–54 and 55–64 years old – in the presence of depression, at the age of 55–64 years – in the presence of hostility or life exhaustion.

Conclusion. Consequently, the data obtained indicate the importance of further studying the factors of psychoemotional stress in men of mature age in Siberian populations, their relationships with conventional risk factors for coronary artery disease, as well as the advisability of preventive measures aimed at weakening the influence of not only conventional risk factors, but also factors of psycho-emotional stress. among the Russian population.

Terapevticheskii arkhiv. 2021;93(1):25-29
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Blood pressure telemonitoring and remote counseling in uncontrolled hypertension
Ionov M.V., Zhukova O.V., Zvartau N.E., Konradi A.O.
Abstract

Telehealth is a useful adjunct in hypertension (HTN) management. Despite obvious short-term clinical benefit, long-term social impact and cost-effectiveness have not been fully investigated.

Aim. Predictive modeling of long-term clinical and social outcomes and the cost-effectiveness analysis of blood pressure (BP) telemonitoring and remote counseling (BPTM) in patients with HTN.

Materials and methods. A Markov cohort-based (1000 patients in each study arm) model was developed and adopted a 10-year time horizon with 12-month time cycles. Cost and outcome data collected from the three-month study of 240 patients (160 in BPTM group and 80 controls, 48 y.o.). All patients started at a non-complicated HTN “well” state with a certain possibility of disease progression in a number of health states over a discrete time period. BPTM was compared with usual care in terms of 10-year healthcare costs, quality adjusted life years (QALY) using a Ministry of Health of Russian Federation perspective.

Results. In the long-term run when compared with usual care BPTM was more effective in terms mortality (67 versus 91 patients lost and 9.6 versus 9.71 life years gained) and costs (cost of illness 102 508 000 RUR versus 145 237 700 RUR). Taking quality of life measures into account, the effect of BPTM was also more pronounced (8.31 versus 7.82 QALYs gained). The resultant incremental cost-utility ratio for BPTM was 275 178.98 RUR/1 QALY gained/1 patient (134 837.70 RUR/0.49 QALY/1 patient).

Conclusion. According to the results of predictive modeling, implementation of BPTM into clinical practice is likely lead to reduced cardiovascular morbidity and mortality in a cost-effective way.

Terapevticheskii arkhiv. 2021;93(1):30-40
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Features of genetic manifestations in patients with abdominal obesity during atrial fibrillation in combination with arterial hypertension
Hidirova L.D., Yakhontov D.A., Maksimov V.N.
Abstract

Aim. To study the significance of the rs1378942 polymorphisms of the CSK gene and rs2200733 (chromosome 4q25) in the progression of AF in men with AH and AO.

Materials and methods. In an observational cohort study, 116 men aged 45–65 years were followed. Of these, 57 patients with AF, AH and AO and a control group including 59 patients with AF, AH and without AO. Testing of polymorphism rs1378942 of the CSK gene and rs2200733 of chromosome 4q25 using polymerase chain reaction with restriction fragment length polymorphism. All statistical calculations were performed using the Rstudio program (version 0.99.879 – ©2009–2016 RStudio, Inc., USA).

Results. The average age of all studied patients was 53.3±7.1 years. When dividing patients with AF and AH into groups based on the presence/absence of AO, it turned out that in the subgroups of carriers of different genotypes of the rs1378942 polymorphism of the CSK gene there are significant differences in BMI: in the group with BMI, there is an increase in the indicator in the series of CC, AC, AA genotypes. The highest BMI value in carriers of the CC genotype (p<0.03) was in the group with AO. In the subgroups of carriers of different rs2200733 genotypes of chromosome 4q25, CC has the highest BMI (p<0.05). It was proved that in the group with AO, the progression of AF occurred 2.57 times more often than in the group without AO (p<0.003).

Conclusion. In men with AF and AH, single nucleotide polymorphisms rs1378942 of the CSK gene and rs2200733 of chromosome 4q25 are associated with BMI. The heterozygous genotype AC rs1378942 in the CSK gene is significantly more common in patients, regardless of the presence of AO. In the group with AO, the progression of AF occurred 2.57 times more often than in the group without AO.

Terapevticheskii arkhiv. 2021;93(1):41-43
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Dynamics of adreneractivity after transfer of myocardial infarction: annual observation
Rebrova T.Y., Muslimova E.F., Alexandrenko V.A., Afanasiev S.A., Garganeeva A.A., Maksimov I.V.
Abstract

Aim. To study the change in the β-adrenergic reactivity of red blood cell membranes in patients during the first year after acute myocardial infarction.

Materials and methods. The study included 25 patients with acute myocardial infarction (AMI) who signed informed consent to participate in the study. The erythrocyte membrane β-adrenoreactivity index (β-ARM) was determined in venous blood samples upon admission to the intensive care unit, one day after admission, 6 and 12 months after the index MI was transferred using the BETA-ARM-AGAT reagent kit (Agat-Med, Russia).

Results. According to the results of dynamics assessment of β-APM during the first day, patients included in the study were divided into 2 groups. Group 1 (n=14) included patients who had an increase in β-APM in the first day, and group 2 (n=21) included patients in whom β-ARM either did not change or decreased. At the time of admission to the hospital in the formed groups, there were no differences in the β-APM index and clinical and anamnestic characteristics. A day after hospitalization, the value of β-APM in group 1 significantly exceeded the same indicator in group 2 (p=0.02). At the periods of 6 and 12 months, the β-APM indices in the groups did not differ. In the 2nd group of patients, the progression of chronic heart failure to one or more functional classes (NYHA) was significantly more often compared with the 1st group.

Conclusion. The study showed that on the first day in patients with AMI, both an increase and a decrease in the activity of the sympathoadrenal system are possible with a further leveling of these differences over the next year. For a group of patients with decreased activity of sympathoadrenal system on the first day, a more unfavorable course of heart failure in the post-infarction period is characteristic.

Terapevticheskii arkhiv. 2021;93(1):44-48
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Refractory and resistant hypertension in patients with type 2 diabetes mellitus: differences in metabolic profile and endothelial function
Falkovskaya A.Y., Mordovin V.F., Pekarskiy S.E., Ripp T.M., Manukyan M.A., Lichikaki V.A., Zyubanova I.V., Sitkova E.S., Gusakova A.M., Ryabova T.R.
Abstract

Aim. To determine the prevalence of refractory hypertension (RfH) in patients with and without type 2 diabetes mellitus (DM), as well as to evaluate whether diabetic patients with RfH significant differ from those with uncontrolled resistant hypertension (RH) in clinical phenotype, metabolic profile and endothelial function.

Materials and methods. The study included 193 patients with RH: RH 74 patients with diabetes and 119 patients without DM. Uncontrolled RH and RfH were defined by the presence of uncontrolled blood pressure – BP (≥140 and/or 90 mm Hg) despite the use of >3 but <5 antihypertensive drugs (for RH) and ≥5 antihypertensive drugs, including a mineralocorticoid receptor antagonist (for RfH). Clinical examination, lab tests were performed. Flow-mediated dilation (FMD) and vasoreactivity of middle cerebral artery (MCA) using both breath-holding and hyperventilation test were measured by high-resolution ultrasound.

Results. The prevalence of refractory hypertension in patients with and without DM was similar (30% vs 28%, respectively). No differences in BP levels, data of echocardiography and clinical phenotype were found between the diabetic groups, but value of HOMA index, plasma resistin level and postprandial glycaemia were higher in patients with RfH. FMD and MCA reactivity to the breath-holding test were worse in patients with RfH, and they had a more pronounced vasoconstrictor response of MCA to the hyperventilation test compared to patients with RH.

Conclusion. The prevalence of RfH is the same in patients with and without diabetes. Diabetic patients with refractory hypertension have a more unfavorable metabolic profile and greater impairment of endothelial function than patients with uncontrolled resistant hypertension.

Terapevticheskii arkhiv. 2021;93(1):49-58
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Analysis of the causes of repeat stenosis of the coronary arteries after elective stenting in patients with stable angina pectoris
Filatova A.Y., Osokina A.K., Potekhina A.V., Romasov I.V., Kotkina T.I., Shchinova A.M., Noeva E.A., Arefieva T.I., Barabanova E.A., Merkulov E.V., Samko A.N., Provatorov S.I.
Abstract

Aim. Coronary stenting is the evidence-based treatment approach of stable angina. The objective was to determine the incidence of restenosis or atherosclerosis progression which led to the need for coronary angiography according to a single center registry data.

Materials and methods. The procedure and clinical data of 3732 (2897 males) consecutive stable coronary artery disease patients undergoing coronary stenting, over five years between March 2010 and September 2014, were subject of this study. Over the next 4 years, 1487 (1173 males) patients were re-evaluated due to angina reoccurrence. 699 patients demonstrated the indications for coronary angiography.

Results. The restenosis of the previously stented segment was detected in 84 (12%) cases, the progression of coronary atherosclerosis – in 306 (44%), the combination of restenosis and atherosclerosis progression in 63 (9%), and the absence of these complications in 245 (35%) cases. The progression of coronary atherosclerosis was the leading indication for the repeat angiography and revascularization (44 and 58%, respectively); p<0.05. The basal level of hsCRP≥2 mg/l had a prognostic significance for the development of combined event (the restenosis and atherosclerosis progression): AUC 0.65 (0.50–0.75), OR 3.0 (1.1–7.9), p<0.05.

Conclusion. The progression of coronary atherosclerosis was the leading indication for the repeat angiography and repeat revascularization during 2 years after coronary stenting. The hsCRP level ≥2 mg/l at baseline had a prognostic significance for the development of restenosis in previously stented segment and coronary atherosclerosis progression.

Terapevticheskii arkhiv. 2021;93(1):59-65
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Reviews
Inflammatory diseases of the pancreas: what new do we know about the mechanisms of their development in the 21st century?
Akhmedov V.A., Gaus O.V.
Abstract

Inflammatory diseases of the pancreas can range from acute to acute recurrent and chronic pancreatitis. With the improvement of laboratory diagnostics in the 21st century, the mechanisms of the pro-inflammatory and anti-inflammatory role of tight junctions, in particular the transmembrane proteins occludin, claudine and JAMs, cytoplasmic Zo-proteins, and adherens junctions, in particular α-catenin, β-catenin, E-cadherin, selectins and ICAMs in the pathogenesis of acute and chronic pancreatitis have become more clear. The study of genetic factors in the development of acute and chronic pancreatitis showed the role of mutations in the genes SPINK1 N34S, PRSS1, CEL-HYB in the progression of the disease.

Terapevticheskii arkhiv. 2021;93(1):66-70
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The asymptomatic microhematuria in the physician’s practice
Drapkina O.M., Samorodskaya I.V., Larina V.N.
Abstract

The review article presents data on: a) definition of microhematuria and diagnosis; b) prevalence estimation and causes of the asymptomatic microscopic hematuria; c) diagnostic approaches for the first time identified of microhematuria; d) follow-up monitoring of patients with asymptomatic hematuria; e) feasibility of medical screening for microhematuria. The analysis includes recommendations of Russian and foreign urological associations, the results of cohort and observational studies, previous study reviews. The identification of 3 or more red blood cells during microscopic examination should be considered microhematuria. There is no uniform examination algorithm for all patients. The basic principle is an individual diagnostic tactic, taking into account the anamnesis, age, concomitant diseases and risk factors. The purpose of a comprehensive examination is to exclude life-threatening conditions (malignant neoplasms and/or glomerular kidney damage). In some cases, after research, the cause of microhematuria remains unclear and monitoring is required. Routine screening of the population in order to detect microhematuria is currently not justified.

Terapevticheskii arkhiv. 2021;93(1):71-78
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Current understanding of the role of age-related hypogonadism in the development of cardiovascular diseases
Lebedeva N.B., Hoffman V.V.
Abstract

The literature review presents novel data on the prevalence of age-related hypogonadism and its relationship with aging, its impact on the circulatory system and cardiovascular diseases. This review summarizes the methods for diagnosing age-related hypogonadism, its association with traditional cardiovascular risk factors such as dyslipidemia, insulin resistance and diabetes mellitus, obesity, arterial hypertension. The mechanisms of the possible direct effect of testosterone on endothelium and vascular tone, the role of hormone replacement therapy as a way of preventing cardiovascular diseases are discussed.

Terapevticheskii arkhiv. 2021;93(1):79-83
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Calcification and atherosclerosis of the coronary arteries
Kashtanova E.V., Polonskaya Y.V., Ragino Y.I.
Abstract

Calcification is a very common phenomenon in the coronary arteries, which is part of the atherosclerotic process, and the degree of calcification can predict clinical outcomes in patients at high risk of coronary events. Both the degree of calcification and the patterns of its distribution are of prognostic importance, but the relationship of coronary artery calcification with atherosclerotic plaque instability is extremely complex and not fully understood. This article is devoted to the study of calcification markers and their influence on the development of atherosclerotic foci.

Terapevticheskii arkhiv. 2021;93(1):84-86
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Cardio-ankle vascular index (CAVI) in diagnostics, risk and severity evaluation of magistral vessels lesion in patients with cardio-vascular diseases and type 2 diabetes
Verner V.A., Mel’nik M.V., Knjazeva S.A.
Abstract

Assesment of arterial stiffness – the substantional prognostic factor for evaluating complications of cardiovascular diseases (CVD) in patients with atherosclerosis, hypertension and type 2 diabetes, may be performed using different parameters, including cardio-ankle vascular index (CAVI). The main purpose of this review is to analyze data from studies where CAVI is used to test the arterial wall stiffness in magistral vessels. CAVI measurement is non-invasive and performed by portable devices which makes it comfortable for ambulatory use in patients who come for a check-up and also in those who already are hospitalized. It does not require any special knowledge from investigator and the test lasts a couple of minutes long. CAVI does not depend on blood pressure changes and is more specific in structural changes of arterial wall assessment than brachial-ankle pulse wave velocity (baPWV). CAVI shows considerable correlation with markers of CVD like atherosclerotic plaques in vessels, diastolic disfunction of left ventricle and angina pectoris. CAVI may be used for early monitoring and assessing the lesions of target organs in patients with atherosclerosis, chronic hypertension and type 2 diabetes. Establishing CAVI as a standart parameter in assessing patients who are at risk of CVD can help to improve complications prevention, reduce mortality and prolong their lifespan.

Terapevticheskii arkhiv. 2021;93(1):87-93
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Characteristics of arterial hypertension clinical course in patients with obesity and anxiety-depressive disorders
Vasyuk Y.A., Dovzhenko T.V., Dubrovskaya T.I., Nesterova E.A., Shupenina E.Y.
Abstract

This article covers an important subject – clinical course of arterial hypertension in patients with metabolic abnormalities with obesity and anxiety-depressive disorders. Relevance of this topic is defined with high incidence of each aforementioned conditions and their influence on quality of life and social functioning of patients. Review of literature covers subjects of comorbidity and multimorbidity. Relevant data are presented which are focusing on complex management of arterial hypertension co-existing with obesity and anxiety-depressive disorders.

Terapevticheskii arkhiv. 2021;93(1):94-99
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Gallbladder polyps: modern approaches to diagnostics and treatment
Onuchina E.V.
Abstract

Gallbladder polyps are an elevation of the mucous membrane that protrudes into the lumen of the gallbladder cavity. Their prevalence in the general population varies from 0.3 to 13.8%. According to the modern classification, polyps of the gallbladder are divided into benign non-tumor, «benign» tumor and malignant tumor polyps. A review of modern literature presents cohort and randomized controlled trials, including those summarized in meta-analyzes and systematic reviews, suggesting that the dominant form of polypoid formations of the gallbladder are cholesterol pseudo-polyps with no malignant potential associated with impaired cholesterol metabolism, often combined with gallbladder cholesterosis, metabolic syndrome and cardiovascular morbidity. Evidence is building up on the effectiveness of ursodeoxycholic acid for controlling components of the metabolic syndrome and cardiovascular risks. Ursodeoxycholic acid preparations may become promising for the management of cholesterol polyps.

Terapevticheskii arkhiv. 2021;93(1):100-107
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BCG, muramylpeptides, trained immunity (part II): a low molecular weight alternative to multicomponent bacterial immunostimulants for prevention of respiratory infections during a pandemic
Kalyuzhin O.V., Andronova T.M., Karaulov A.V.
Abstract

During a pandemic, nonspecific immunoprophylaxis of SARS-CoV-2 infection and other acute respiratory infections (ARI), which can worsen the course of COVID-19, is increasingly in demand in addition to specific immunization. BCG vaccine appears to be one of the candidate immunostimulants in this regard. At the same time, other microbe-derived preparations capable of inducing a state of trained immunity deserve attention. BCG and other bacterial immunostimulatory agents containing a large number of biologically active subunits have long been considered as objects of search for promising pharmacological substances. The review analyzes the linkages between BCG, mycobacterial adjuvants, bacterial lysates, trained immunity, muramylpeptides (MPs) and NOD2 receptors in light of the choice of a low molecular weight alternative to multicomponent bacterial immunostimulants for ARI prevention during the COVID-19 pandemic. The search for key molecules by which bacteria stimulate innate and adaptive immune responses proceeds in a spiral. On different loops of this spiral, MPs have repeatedly reproduced the nonspecific effects of multicomponent bacterial adjuvants, vaccines and immunostimulants. MPs and peptidoglycans containing MPs determine the adjuvant properties of the cell walls of mycobacteria and their peptide-glycolipid fraction (wax D). MPs were able to replace Mycobacterium tuberculosis in complete Freund’s adjuvant. MPs determine the NOD2-dependent ability of BCG to induce trained immunity. Probably, MPs provide NOD2-mediated long-term prophylactic action of bacterial lysates. All of the above has prompted revisiting the previously obtained evidence of the efficacy of glucosaminylmuramyl dipeptide (GMDP) as a NOD2 agonist in treatment/prevention of respiratory infections. We speculate here that MPs, in particular GMDP, at rational dosing regimens will be able to reproduce many aspects of the nonspecific effects of BCG and multicomponent bacterial immunostimulants in preventing ARI during the COVID-19 pandemic and in the post-pandemic period.

Terapevticheskii arkhiv. 2021;93(1):108-113
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Pharmacotherapy for acute respiratory infections caused by influenza viruses: current possibilities
Zyryanov S.K., Butranova O.I., Gaidai D.S., Kryshen K.L.
Abstract

Routinely the influenza virus significantly contributes to the formation of the annual incidence of acute respiratory infections, with a peak in winter season. The high level of mutagenic potential of influenza viruses is a standard factor determining the complexity of the rational choice of pharmacotherapy. The upcoming epidemiological season 2020–2021 brings additional challenges for health care practitioners mediated by the widespread prevalence in the human population of a new infection caused by the SARS-CoV-2 virus affecting the respiratory system among many organs and systems. An adequate choice of pharmacotherapy tools should be based on high efficiency and safety of drugs, with a possible reduction in such negative factors as polypharmacy. This review includes comparative pharmacological characteristics of drugs with activity against RNA viruses, along with parameters of their clinical efficacy.

Terapevticheskii arkhiv. 2021;93(1):114-124
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