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.

 

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    • Russian Science Citation Index (RSCI)
    • Core Collection (Science Citation Index Expanded)
  • PubMed/Medline
  • Index Medicus
  • Current Contents Connect
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Current Issue

Vol 93, No 3 (2021)

Cover Page

Full Issue

Передовая статья
COVID-19 and human security
Chuchalin A.G.
Abstract

The article was prepared after materials of the report at the 22.12.2020 International Scientific Forum “COVID-19 and Human Safety” in partnership with the World Academy of Arts and Science and the Rome Club on the virtual platform of the Faculty of Global Processes of the Federal State Budgetary Educational Institution of Higher Education “Lomonosov Moscow State University”.

Terapevticheskii arkhiv. 2021;93(3):253-254
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Оригинальные статьи
Change in the expression of gene transcription negative regulator SOCS1 in the patients with bronchial asthma and metabolic disorders
Sorokina L.N., Lim V.V., Mineev V.N., Nyoma M.A., Lalayeva T.M.
Abstract

Aim. Comprehensive study of the negative regulation components of cell signaling in the bronchial asthma (BA) patients with metabolic disorders.

Materials and methods. 113 people were examined: 63 patients with allergic BA (ABA), 50 patients with a non-allergic variant of the disease (NABA). SOCS1 mRNA expression was evaluated by reverse transcription PCR (RT-PCR). SOCS1 protein expression was investigated by immunoblotting. The determination of cytokine levels was carried out according to the standard protocol on a Bio-Plex flow fluorimeter.

Results. A significant and multidirectional change in the expression of SOCS1 mRNA was found at a body mass index >25 (greater than normal) in ABA and NABA. The positive correlations between SOCS1 mRNA expression and body mass index indicate the regulatory role of SOCS1 in leptin signaling. The spectra of correlations in ABA and NABA are different, it indicates the probable existence of specificity in the pathogenesis of these variants of the diseases.

Conclusion. The obtained data allow us to consider the complexity of regulation disorders occurring at different levels of cell signaling. The multifunctionality of the SOCS1 regulator provides complex control of cytokine signaling simultaneously in different signaling pathways in the BA with metabolic disorders.

Terapevticheskii arkhiv. 2021;93(3):255-259
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The role of occupational factors in the development and course of respiratory sarcoidosis
Palchikovа I.A., Denisovа O.A., Chernyavskaya G.M., Kalacheva T.P., Purlik I.L., Bolotova E.V.
Abstract

Aim. The aim of the study was to study the frequency of occurrence of exposure to harmful occupational factors in patients with sarcoidosis of the respiratory organs, depending on the course of the disease.

Materials and methods. An open prospective study included 121 patients with sarcoidosis of the respiratory system from the age of 21 to 66 years, from 2007–2019. The diagnosis was histologically confirmed in all patients. Patients underwent a set of laboratory and instrumental examinations, studied profane history. The presence of a history of contact with harmful and dangerous production factors was clarified. To determine the effect of a harmful production factor on the course of sarcoidosis, patients were divided into 2 clinical groups: the first group consisted of 85 (70.2%) patients with a favorable course of the disease, the second group included 36 (29.8%) patients with an unfavorable course sarcoidosis (standardization coefficient between groups 2.4:1).

Results and discussion. Among the examined patients of working age prevailed (87%). Patient groups were comparable by age, but statistically differed by gender (chi2=9.75, p=0.0018). Frequency analysis of the occurrence of harmful occupational factors in sarcoidosis of the respiratory organs showed that the most frequently encountered factors in all the studied groups were contact with chemical hazards.

Conclusion. The presence of contact with harmful production factors increases the risk of an unfavorable course of sarcoidosis by more than 2 times.

Terapevticheskii arkhiv. 2021;93(3):260-264
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Evaluation of respiratory parameters in patients with chronic obstructive lung disease during physical exercises
Abrosimov V.N., Ageeva K.A., Filippov E.V.
Abstract

Aim. To study the relationship between the indicators of dynamic capnography and pulse oximetry with the indicators of the 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD).

Materials and methods. 67 patients of both sexes were examined: 45 patients with COPD (age 60.0±2.74 years) and 25 patients of the control group (age 47.60±3.46 years). The study of the functional capabilities of the patient’s respiratory system was carried out before, during and after the 6MWT on the equipment LifeSense LS1-9R capnograph-pulse oximeter (MedAir AB).

Results and discussion. In the comparison group, the parameters of dyspnea at rest were higher than the control group (p<0.05), the spirometry indices were significantly lower (p<0.05). Shortness of breath as a reason for stopping/slowing down the pace during the 6MWT was noted by patients of both groups (p<0.05). When analyzing the PETCO2 trend graphs, periodic breathing (PВ) was revealed. In the group of patients with COPD, signs of PВ in the analysis of the PETCO2 trend were found in 80.95% (p<0.05). Regression analysis of Cox proportional risks of mortality in patients with COPD revealed the prognostic value of the following parameters of a comprehensive assessment of the patient: body mass index (BMI), BODE index, dyspnea index on the mMRS scale, Borg, forced expiratory volume in 1 second (FEV1), index Tiffno, signs of PВ, distance 6MWT, signs of PВ and desaturation during 6MWT. At the same time, the total contribution of these indicators to the risk of a lethal event was assessed (p=0.003).

Conclusion. When analyzing the correlation dependence, it was revealed that the presence of PВ was a prognostically unfavorable sign in patients with COPD. Predictors of an unfavorable course of COPD were BMI (<23.0 kg/m2), BODE index, dyspnea indices on the mMRS, Borg, FEV1 scales, Tiffno’s index, signs of PH, distance 6MST, signs of PD and desaturation during 6MST (reliability of the model coefficient p=0.003) in terms of forecast.

Terapevticheskii arkhiv. 2021;93(3):265-272
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Leukocyte indices of patients with bronchial asthma: informative significance of use
Zaripova T.N., Antipova I.I., Titskaya E.V.
Abstract

Aim. Determination of informativeness of leukocyte indices in patients with bronchial asthma, who have comorbid diseases in clinical remission of asthma.

Materials and methods. The work based on a single examination of 225 patients with bronchial asthma. Criteria for inclusion in the study are following: the presence of a verified diagnosis of bronchial asthma, the phase of clinical remission. The patients have been divided into 4 groups, taking into account the type of comorbid diseases: the 1 group (53 patients) – bronchial asthma was combined with lesions of the upper gastrointestinal tract; the 2 group (73 patients) – with allergic rhinitis; the 3 group (76 patients) – with hypertension; the 4 group (23 patients) – comparison group: the patients without comorbid pathology. According to the clinical blood analysis, 10 leukocyte indices were calculated for each group of patients and their values were analyzed taking into account the frequency and severity of deviations from the reference values. Mathematical processing of the material was carried out using the statistical software package SPSS13.0 for Windows.

Results. Using leukocyte indices, it has been revealed that even during the period of clinical remission, almost all examined patients with BA have endogenous intoxication, the severity of which increases in comorbid diseases. Intoxication was inflammatory in nature and, according to the data of leukocyte indices, was due to the presence of persistent inflammation (local and systemic) and during clinical remission. Violation of immunological reactivity has been revealed in most of the examined patients. The presence of correlation relationships of leukocyte indices with a number of biochemical and immunological indicators allows one to exclude the latter from the plan of examination of patients without reducing the quality of their examination: for example, in the conditions of polyclinics, small hospitals, and resorts. Eight leukocyte indices that are the most informative at BA have been selected.

Conclusion. Additional information about the condition of BA patients who have comorbid diseases during clinical remission can be used to develop programs for their comprehensive treatment and rehabilitation.

Terapevticheskii arkhiv. 2021;93(3):273-278
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The use of a new semi-quantitative rapid test for procalcitonin in the diagnosis of multisegmental community-acquired pneumonia
Bayramova S.S., Nikolayev K.Y., Tsygankova O.V.
Abstract

Aim. Evaluation of the possibilities of a new semi-quantitative rapid test for procalcitonin in the diagnosis of multisegmental community-acquired pneumonia.

Materials and methods. A one-stage comparative study involved 123 patients hospitalized in a hospital with a confirmed diagnosis of community-acquired pneumonia. The mean age of the patients was 49.5±21.0 (M±SD) years. On the first day of hospitalization, all patients underwent a general clinical examination, chest x-ray, and a plasma procalcitonin level was determined using a semi-quantitative rapid test.

Results. Indicators of a new semi-quantitative rapid test for procalcitonin of at least 2 ng/ml are directly related to laboratory and instrumental indicators reflecting the severity of community-acquired pneumonia, namely, the severity of respiratory failure (p=0.001), respiratory rate (p=0.001), and heart rate contractions (p=0.001), systolic blood pressure (p=0.025), oxygen saturation (p=0,001), erythrocyte sedimentation rate (p=0.021), fibrinogen (p=0.003) and high CRB-65 scores (p=0.001). They are also associated with multisegmental community-acquired pneumonia (÷2=4.7; p=0.030) and complications of this disease, such as hydrothorax (p=0.029) and death (÷2=22.1; p=0.001).

Conclusion. Using a new semi-quantitative rapid test for procalcitonin allows you to optimize the diagnosis of complications of community-acquired pneumonia and determine the high risk of multisegmental pneumonia.

Terapevticheskii arkhiv. 2021;93(3):279-282
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Influence of demographic characteristics on the clinical course and results of therapy in patients with precapillary pulmonary hypertension
Taran I.N., Valieva Z.S., Belevskaya A.A., Saidova M.A., Martynyuk T.V., Chazova I.E.
Abstract

Aim. To assess the clinical course of the disease and the features of the treatment goals achievement in patients with IPAH and inoperable CTEPH depending on gender and age at the time of diagnosis verification.

Materials and methods. The study included 88 patients with IPAH and 38 patients with inoperable CTEPH with a PAWP <12 mm Hg and the duration of PAH-specific therapy treatment more than 12 months. IPAH/CTEPH patients were divided into groups depending on age at the time of diagnosis verification: age <50 years (n=69)/ >50 years (n=57), and gender: 106 women/20 men.

Results. Patients with age >50 years at the time of diagnosis verification have significantly more severe functional class (WHO). In IPAH/CTEPH male patients a significant hemodynamic disorder also as significantly higher level of NT-proBNP at the time of diagnosis verification were observed. In men with IPAH/CTEPH and patients aged >50 years more pronounced deterioration of right ventricular systolic function was observed (ECHO). Patients with IPAH younger than 50 years were significantly more likely to achieve the treatment goals by the median 26.5 months of treatment compared to the patients aged >50 years (21% vs 6.45%). Men with IPAH/CTEPH were significantly more likely to have a high risk of death (90%) at baseline compared to the women (61%).

Conclusion. IPAH/inoperable CTEPH patients with male sex, as well as the age 50 years and older at the time of diagnosis verification, compared with younger ones, are associated with a less favorable course of the disease.

Terapevticheskii arkhiv. 2021;93(3):283-289
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Evaluation of the effectiveness of Riamilovir in the complex therapy of patients with COVID-19
Kasyanenko K.V., Kozlov K.V., Maltsev O.V., Lapikov I.I., Gordienko V.V., Sharabhanov V.V., Sorokin P.V., Zhdanov K.V.
Abstract

Aim. In this study we evaluated the effects of Riamilovir on SARS-CoV-2 viral shedding and on admission duration in patients with moderate COVID-19.

Materials and methods. We have used data from 69 health records of patients with moderate severe PCR confirmed SARS-CoV-2 infection. Control group included 34 patients treated with off-label riamilovir 1250 mg per day for 5 days (250 mg 5 times a day), comparison groups – 35 patients, who received ribavirin and umifenovir 800 mg a day for 5 days. The antiviral therapy was administered within 72 hours from the onset of the disease. The primary endpoints were elimination of virus in oropharyngeal and nasopharyngeal swabs on 7 day of admission and discharge from the hospital by 14 day.

Results. Patients assigned to riamilovir had significantly shorter time to clinical improvement as well as increased PCR negative rate by day 7.

Conclusion. Yearly administration of riamilovir as opposed to the umifenovir and ribavirin in therapy of moderate SARS-CoV-2 infection was associated with significant shorter time to clinical improvement by 14 day of hospitalization. PCR negative rate by 7 days of hospitalization is significantly more likely in riamilovir group.

Terapevticheskii arkhiv. 2021;93(3):290-294
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Клинические наблюдения
Methotrexate-induced lung damage in a patient with rheumatoid arthritis
Ponomareva L.A., Gurova D.V., Popova E.N., Chebotareva N.V., Bondarenko I.B., Moiseev S.V.
Abstract

We herein report a case of interstitial lung disease secondary to the use of methotrexate in a patient with rheumatoid arthritis. Differential diagnosis between pneumonitis caused by methotrexate in patients treated with basic methotrexate therapy and interstitial pulmonary disease associated with rheumatoid arthritis is based on the clinical examination and instrumental data. The main condition for favorable clinical outcome in all drug-induced lung disease is drug withdrawal, what was proven in our report.

Terapevticheskii arkhiv. 2021;93(3):295-299
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Обзоры
"Difficult" pneumonia
Zaicev A.A., Sinopalnikov A.I.
Abstract

The article considers the issues of therapeutic management of patients with so-called “difficult” pneumonia, particularly, patients with diagnosed syndrome slowly resolving / nonresolving pneumonia, who do not respond to the treatment. The reasons and significant risk factors potentially affecting the effectiveness of therapy are analyzed, the therapeutic tactics of managing patients with no “response to treatment” are considered, the list of necessary diagnostic methods and directions of antibiotic therapy is updated. The article analyses the tactics of managing patients with pneumonia during a pandemic caused by SARS-CoV-2 coronavirus. It also provides directions of diagnostics with priority discussion of biological markers of the inflammatory response as well as antimicrobial therapy strategy.

Terapevticheskii arkhiv. 2021;93(3):300-310
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Pulmonary embolism and diffuse alveolar bleeding: combination options and therapy features
Tret’yakov A.Y., Radenska-Lopovok S.G., Novikov P.I., Tret’yakova V.A., Zakharchenko S.P.
Abstract

The analysis of the mechanisms of the formation of a rare clinical combination of pulmonary embolism (PE) and diffuse alveolar hemorrhage (DAH), which are complications of systemic vasculitis associated with antibodies to the cytoplasm of neutrophils (primarily granulomatosis with polyangiitis), systemic lupus erythematosus and secondary antiphlogistic syndrome – primary antiphospholipid syndrome and Goodpasture’s syndrome. Taking into account the chronological sequence of the occurrence of PE and DAH, 3 variants of the onset of these potentially fatal additions to the underlying disease were considered: the anticipatory DAH development of PE, delayed from DAH PE and joint (within 24 hours) formation of PE and DAH. A review of single descriptions of such a combination of complications of granulomatosis with polyangiitis is carried out, criteria are indicated, a working classification of severity is given and, taking this into account, a modern program of therapy for DAH as an independent event and in combination with PE.

Terapevticheskii arkhiv. 2021;93(3):311-319
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Differential diagnosis of chylothorax in therapeutic practice
Makarova M.A., Baimakanova G.E., Krasovsky S.A.
Abstract

The article is devoted to the differential diagnosis of chylous pleural effusion. The spectrum of traumatic and non-traumatic causes of chylothorax is discussed in detail. Examples of necessary diagnostic measures are given for the accumulation of milky fluid in the pleural cavity in order to verify chylothorax.

Terapevticheskii arkhiv. 2021;93(3):320-326
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The pathophysiological role of adipokines in the development of bronchial asthma combined with obesity
Kytikova O.Y., Antonyuk M.V., Gvozdenko T.A., Novgorodtseva T.P.
Abstract

The combined course of bronchial asthma (BA) and obesity is one of the urgent medical and social problems that requires a comprehensive and careful study in connection with a decrease in the quality of life of such patients, an increase in the frequency, duration of hospitalization and a high economic burden for the state as a whole. The relationship between BA and obesity is now confirmed by numerous studies, at the same time, despite the variability of the proposed mechanisms of pathogenetic effects of obesity on asthma, metabolic aspects of the relationship of these diseases need further study. Adipose tissue hormones are responsible for the energy homeostasis of the body therefore, excessive accumulation of adipose tissue is accompanied by the development of an imbalance in metabolic processes in various organs and tissues. Due to the emergence of new scientific data on the role and function of adipokines in the body, metabolic effects of adipokines are considered in the focus of their pathophysiological association with obesity and asthma. This literary review highlights the current understanding of the role of metabolic effects of the most studied adipokines (resistin, retinol-binding protein, leptin and adiponectin) in the development of obesity and BA. Gender and age-dependent features of adipokine levels in BA and obesity are described. Data on the confirmed role of adiponectin and leptin in the progression of BA combined with obesity are presented. It has been shown that the role of resistin and retinol-binding protein in the development of BA combined with obesity has not been studied. It is demonstrated that further study of metabolic activity of adipokines in BA is an actual and perspective direction of researches which will allow to develop new diagnostic and therapeutic strategies in patients with BA with obesity.

Terapevticheskii arkhiv. 2021;93(3):327-332
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Idiopathic interstitial pneumonias
Ilkovich M.M., Novikova L.N.
Abstract

The article presents the evolution of views on one of the current problems of present pulmonology – idiopathic interstitial pneumonias. On the basis of many years of experience in diagnosis and treatment of patients of IIPs in the clinic of pulmonology of Interstitial and Orphan Lung Diseases Research Institute of Pavlov First Saint Petersburg State Medical University, the authors formulated a new understanding of this pathology and proposed to unite all IIPs under the term “idiopathic fibrosing pulmonary disease”. Using the concept of “idiopathic fibrosing pulmonary disease” will make it possible to substantively address the issues of early diagnosis, determine the criteria for the activity of the pathological process, and there by develop an evidence base for the adequate prescription of antifibrotic drugs and corticosteroids.

Terapevticheskii arkhiv. 2021;93(3):333-336
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Modern understanding of bronchial asthma with fixed airflow obstruction
Kraposhina A.Y., Sobko E.A., Demko I.V., Kacer A.B., Kazmerchuk O.V., Abramov Y.I.
Abstract

The review provides data on one of the phenotypes of severe bronchial asthma – it is asthma with fixed airway obstruction. According to data published today, there is no single pathway for the formation of fixed airway obstruction in patients with severe asthma. Increasing knowledge of the pathophysiology of fixed airway obstruction, as well as identifying the most significant risk factors, is essential for the successful treatment of such patients. In addition, the development of fixed obstruction is associated with a worse and sometimes fatal prognosis. Expanding the existing views is also necessary to overcome the difficulties of differential diagnosis between bronchial asthma with fixed airway obstruction and bronchial asthma in combination with COPD. All this will optimize the approach to the management of patients with bronchial asthma to prevent the formation of fixed airway obstruction.

Terapevticheskii arkhiv. 2021;93(3):337-342
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COVID-19 and the small intestine
Bakharev S.D., Baulo E.V., Bykova S.V., Dbar S.R., Parfenov A.I.
Abstract

The SARS-CoV-2 virus enters the body through the angiotensin-converting enzyme 2 (ACE-2), which is the entry point of the virus into the cell. The most dense fabric of ACE-2 is the lungs. The small intestine also contains large amounts of ACE-2 in the enterocyte membrane and is often involved in this process. Intestinal symptoms can appear at different stages of the disease. The review describes the mechanisms of interaction of SARS-CoV-2 with enterocytes, the fecal-oral route of infection, diagnosis and treatment of COVID-19 with intestinal symptoms.

Terapevticheskii arkhiv. 2021;93(3):343-347
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История медицины
On the 95th anniversary of the first description of right ventricular myocardial infarction
Chuchalin A.G., Bobkov E.V.
Abstract

An analysis of the publication of the outstanding Russian therapist and cardiologist D.D. Pletnev (1871–1941) is given in the article. In 1925, he published an article “On the issue of lifetime differential diagnosis of right and left coronary artery thrombosis” in the journal “Russian Clinics” in Russian and German languages. Timely diagnosis of right myocardial infarction determines the prognosis and treatment tactics of this disease, and the case itself has a priority for the Russian science. The authors emphasize the outstanding talent of D.D. Pletnev as a physician and scientist, whose name is associated with the emergence of one of the most brilliant therapeutic schools (A.L. Myasnikov, E.I. Chazov, etc.).

Terapevticheskii arkhiv. 2021;93(3):348-351
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