Terapevticheskii arkhiv

Exosomes are extracellular membrane vesicles with a diameter of 30–150 nm secreted by various cell types into the extracellular environment and regulating many vital physiological processes, including signaling, immune activation, proliferation, differentiation, and apoptosis. Numerous studies conducted in recent years have demonstrated the key role of exosomes in the development of various gastrointestinal diseases, including cancer, allowing them to be considered as potentially promising diagnostic biomarkers. Furthermore, due to their inherent biocompatibility, ability to overcome biological barriers, low toxicity, and immunogenicity, exosomes can be used for targeted drug delivery in the treatment of patients with gastrointestinal diseases. This review article systematizes and presents information on exosomes, their functions, extraction and detection methods, and examines the main exosomal markers, which demonstrate significant potential for the diagnosis and treatment of various gastrointestinal diseases.

Aim. To compare surgical and conservative treatment outcomes in patients with severe and fulminant ulcerative colitis (UC), pseudomembranous colitis (PMC), and ischemic colitis (IC) and to identify predictors of surgical intervention.

Materials and methods. A retrospective cohort study was conducted between 2015 and 2024 and included 308 patients with severe and fulminant UC, PMC, and IC. Surgical treatment was performed in 108 patients, while 200 received conservative therapy. Clinical and demographic data, endoscopic and imaging findings, complications, and outcomes were analyzed. Predictors of surgical intervention were identified using binary logistic regression with calculation of odds ratios (ORs) and 95% confidence intervals (CIs). Model discrimination was assessed using ROC analysis.

Results. Surgically treated patients were younger (p=0.025) and more frequently had a rapidly progressive disease course (OR 2.85, 95% CI 1.65–4.92; p<0.001). Endoscopic predictors of surgery included mucosal contact bleeding (OR 1.99, p=0.020) and ulcerative defects (OR 1.97; p=0.012). Among complications, colonic bleeding (OR 6.33; p<0.001) and colonic dilation (OR 3.67; p=0.013) were significantly associated with surgical intervention. The predictive model demonstrated satisfactory discrimination (AUC 0.700; p<0.001) with high sensitivity (92.9%) and moderate specificity (33.7%).

Conclusion. Key predictors of surgical intervention in patients with severe UC, PMC, and IC include rapidly progressive disease course, mucosal contact bleeding, ulcerative defects, colonic bleeding, and colonic dilation.

Aim. To evaluate the efficacy, safety and impact on gastrointestinal symptoms of Helicobacter pylori eradication therapy with a ready-to-use set of tablets and capsules [omeprazole 20 mg × 2, clarithromycin 500 mg × 2, amoxicillin 500 mg × 4] (Pylobact^® AM) in duodenal ulcer patients within the framework of an observational program.

Materials and methods. 912 H. pylori-positive patients were included (404 men and 508 women, average age – 43.8 years (43.82±11.39; 18–64 years). Symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire; patients assessed treatment satisfaction, and physicians assessed treatment efficacy and tolerability using a five-point Likert scale. The efficacy of H. pylori eradication was assessed using the results of the ¹³C-urea breath test, H. pylori antigen stool test, or a rapid urea test with biopsies of the gastric body and antrum obtained during upper endoscopy. A total of 870 patients completed the observational program: 538 patients in the standard triple therapy group (PAM group) and 332 patients in the group enhanced with a bismuth preparation, rebamipide, and/or a probiotic (PAMplus group). A subgroup of patients received triple therapy with bismuth and the synbiotic complex of Floriose with probiotic strains Lactobacillus acidophilus La-14, Lactobacillus rhamnosus Lr-32, Bifidobacterium lactis Bl-04, inulin and B vitamins.

Results. H. pylori eradication rates in the PAM, PAMplus, and PAM+Bi+F (ITT) groups were 90.6, 97.03, and 96.82%, respectively. Treatment significantly reduced GSRS abdominal pain scores. Physicians rated the treatment efficacy and tolerability as "very good" or "good" at the end of the program in 93.3% of patients. Patients rated 93.68% as completely or mostly satisfied with the treatment.

Conclusion. The effectiveness of H. pylori eradication with a ready-to-use set of capsules and tablets for standard triple therapy is ensured by high patient compliance. The combination of standard triple therapy with bismuth, probiotics, and/or rebamipide increases treatment efficacy.

Aim. To evaluate the structure of cardiovascular pharmacotherapy prescribed during the preoperative period including antihypertensive, antiarrhythmic, antianginal, lipid-lowering, and antiplatelet drugs and to analyze its compliance with clinical indications in patients scheduled for elective orthopedic interventions on the major joints of the lower extremities.

Materials and methods. This prospective, single-center cohort study included 1,733 patients. In all patients, a detailed medical history was obtained, an additional physical examination including blood pressure measurement was performed, and previously prescribed cardiovascular therapy was analyzed.

Results. The study population included 617 (35.6%) males and 1116 (64.4%) females with mean age 64.7±10.4 years. The majority (90.5%) patients were overweight, and 77.6% of patients had hypertension and other cardiovascular diseases; in 142 (10.5%) patients, no antihypertensive therapy had been prescribed prior to hospitalization, while in 295 (21.9%) patients, target blood pressure levels were not achieved despite previously prescribed therapy. Furthermore, 262 (15.1%) individuals were regularly taking various anticoagulants, and 534 (30.9%) were taking antiplatelet agents; of the latter group, 342 (19.7%) patients had no indications for such treatment.

Conclusion. The patient population undergoing total hip arthroplasty and total knee arthroplasty is characterized by a high prevalence of cardiovascular diseases; however, in a subset of these patients, antihypertensive therapy is suboptimal, and many patients with hypercholesterolemia do not receive statins despite clear indications. On the other hand, many patients take antiplatelet agents without appropriate indications – a situation that underscores the need to raise awareness among both patients and healthcare professionals.

Background. Identifying the character, frequency, and intensity of cough is crucial in clinical practice, aiding in differential diagnosis, influencing treatment choices. «CoughScan» is a software with an embedded neural network model designed to assess cough frequency in real-time for diagnostic and monitoring purposes.

Aim. To obtain additional data on the efficacy and safety of Rengalin® in the treatment of cough in adults with acute respiratory viral infections (ARVI) using both traditional and new intelligent technologies.

Materials and methods. An observational study was conducted involving 60 patients with ARVI, receiving Rengalin® for cough management. Outpatient patients were divided into 2 groups: the main group (n=40) received Rengalin® for 7 days, while the control group (n=20) received no cough medication. The severity of symptoms of ARVI and cough was assessed with Cough severity scale (CSS), «CoughScan», Bronchitis Severity Scale (BSS).

Results. The cough severity score on CSS decreased by 2.9 points in the Rengalin® group and by 1.5 points in the control group (p=0.0004). The average BSS score reduced by 1.3 units with Rengalin® and by 0.2 units in controls (p=0.0001). The mean duration of cough during treatment was 5.7±0.2 days versus 7.2±0.4 days without treatment (p=0.0178). Monitoring of daily cough intensity with «CoughScan» also showed a statistically significant advantage in the Rengalin® group (p<0.0001). A non-inferiority test based on the area under the curve (AUC) over 7 days indicated comparable results between «CoughScan» and the CSS, with differences within 10%.

Conclusion. «CoughScan» is a convenient and reliable tool for assessing cough dynamics in outpatient settings. Its data are comparable to the Cough severity scale regarding treatment efficacy, with antitussive activity of Rengalin® evident from the early days of therapy.

Invasive lobular breast carcinoma is characterized by infiltrative growth and a tendency toward atypical metastasis, including to the gastrointestinal tract, where metastases are often diffusely infiltrative, complicating their visualization and potentially leading to diagnostic errors. This paper presents a clinical case of a 55-year-old female patient with long-standing (approximately 20 years) abdominal pain syndrome. Based on imaging studies and elevated fecal calprotectin levels, this pain syndrome was interpreted as Crohn's disease, despite the lack of response to standard therapy. One year after confirmation of invasive lobular breast cancer (luminal A subtype, T1N1M0), the patient continued to experience abdominal symptoms until the development of dynamic intestinal obstruction, which required surgical intervention. Histological and immunohistochemical examination of the resected intestinal segment confirmed metastatic involvement of the small and large intestines. This case demonstrates a rare variant of lobular breast cancer metastasis to the intestine, which had been masquerading as Crohn's disease for a long time. It highlights the need for oncological vigilance in patients with abdominal symptoms and a history of cancer, as well as the crucial role of immunohistochemistry in verifying the diagnosis.

This article analyzes materials on the history of Russian medical societies, identifying four periods in their history. The first few voluntary associations dedicated to the development of medical science and the advanced training of physicians emerged in 1804, following the establishment of imperial universities empowered to establish societies. The second period begins in the 1860s, following the simplification of the procedure for approving the charters of public organizations. It is characterized by an explosive growth in the number of medical societies, some of which (the Russian Society for the Protection of Public Health, the Pirogov Society) played a significant role in the development of Russian medicine, reaching the national level in their activities. The third period begins after the Bolsheviks came to power; highly specialized societies focused exclusively on developing the science and practice of their disciplines. The fourth period begins in the 1990s, following the collapse of the USSR and the introduction of evidence-based medicine principles into all areas of healthcare. The number of medical societies grows, and they acquire new functions, such as the development of medical care standards and clinical guidelines.