Terapevticheskii arkhiv

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Monthly peer-review medical journal

 

Editor-in-Chief

Irina Chazova
MD, PhD, Professor, Academician of the Russian academy of Sciences
ORCID: 0000-0002-1576-4877

 

About

Therapeutic archive journal (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.

 

Publications

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


 

Indexation

  • Web of Science:
    • 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
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Current Issue

Vol 96, No 8 (2024): Вопросы лечения

Cover Page

Full Issue

Editorial

Cytomegalovirus infection in gastroenterology
Maev I.V., Velikolug K.A.
Abstract

Aim. To highlight the relevance of gastrointestinal manifestations of cytomegalovirus infection (CMVI), to highlight the main risk factors for the development of this pathology, current trends in diagnosis and treatment.

Key points. CMVI is one of the most common opportunistic diseases, characterized by a variety of manifestations from asymptomatic to severe generalized forms affecting internal organs and body systems. The prevalence of CMVI worldwide ranges from 20 to 95%. Particular attention is paid to timely diagnosis, treatment and prevention of CMVI. The “gold standard” in the diagnosis of digestive diseases associated with CMVI is immunohistochemical examination and detection of cytomegalovirus (CMV) DNA in tissues using the polymerase chain reaction (PCR). Of undoubted interest in the diagnosis of CMV is the detection of CMV DNA in stool using digital PCR. Compared to quantitative PCR, digital PCR has higher accuracy and sensitivity. As first-line therapy, the drugs of choice are ganciclovir and valganciclovir. Maribavir has been successfully used to treat patients with CMV infection refractory to one or more previous therapies. One of the promising directions in the treatment of cytomegalovirus colitis in patients with ulcerative colitis is fecal microbiota transplantation.

Conclusion. Timely identification of risk factors for the development of CMV infection, the introduction of innovative methods and approaches in diagnosis, and the use of effective methods for treating diseases of the digestive system associated with CMV infection can improve the prognosis of the underlying disease and reduce the risk of developing urgent conditions in gastroenterology.

Terapevticheskii arkhiv. 2024;96(8):723-731
pages 723-731 views

Original articles

Clinical, endoscopic, laboratory and immunomorphological parameters in predicting the occurrence of colorectal cancer in patients with diverticular disease of the colon
Svistunov A.А., Osadchuk M.A., Mironova E.D., Krylova I.S.
Abstract

Aim. To define the role of clinical, endoscopic, laboratory and immunomorphological parameters in predicting the occurrence and course of colorectal cancer (CRC) in patients with diverticular disease of the colon (DDC).

Materials and methods. One hundred and seventy five people with DDC were examined, divided into 3 groups: group 1 – 85 patients with DDC; group 2 – 45 with DDC in combination with adenomatous polyps (AP); 3rd group – 45 with DDC with established CRC (I or II stage). The control group consisted of 30 practically healthy people. Patients and healthy people were examined according to a single program: clinical, laboratory, instrumental data and immunomorphological research methods [use of primary antibodies to p53 (mAb clone DO-7 product no. PA0057, Leica Biosystems, Leica Bond III) and Ki-67 (Ab16667, Abcam, UK)].

Results. Among the main complaints in patients with DDC and CRC, constipation was more common than in patients with DDC and DDC with AP (p<0.05). In patients with DDC and colorectal neoplasia, a positive reaction to occult blood in the feces was more often verified, compared with the group with DDC (p<0.05). Higher levels of glucose and cholesterol in blood plasma, as well as body mass index were found in patients with DDC with AP and CRC, compared with the DDC group (p<0.05). A higher level of expression of Ki-67 and p53 was found in patients with DDC combined with AP and CRC, compared with patients with DDC without colorectal neoplasia (p<0.05). At the same time, in patients with DDC with CRC, the expression level of Ki-67 and p53 was higher than in patients with DDC with AP (p<0.05)

Conclusion. In patients with DDC combined with AP and CRC, higher levels of glucose, plasma cholesterol, as well as body mass index were observed compared to the group of patients with DDC alone (p<0.05). Of note, the results of the determination of Ki-67 and p53 in the mucous membrane of the colon should be considered important prognostic markers for the development of CRC in patients with DDC.

Terapevticheskii arkhiv. 2024;96(8):732-738
pages 732-738 views
The prevalence of mutations underlying development of Helicobacter pylori resistance to antibiotics in Kazan
Kupriyanova E.A., Abdulkhakov S.R., Ismagilova R.К., Safina D.D., Akhtereeva A.R., Galimova R.R., Safin A.G., Grigoryeva T.V., Abdulkhakov R.А.
Abstract

Background. One of the reasons for the decrease of Helicobacter pylori eradication effectiveness is its resistance to antibiotics.

Aim. To examine the prevalence of H. pylori point mutations responsible for clarithromycin and levofloxacin resistance among the patients with upper gastrointestinal (GI) tract disorders in Kazan.

Materials and methods. The study included 203 patients with symptoms of dyspepsia who underwent upper GI endoscopy at the University Hospital of Kazan Federal University (Kazan, Russia) in 2019–2021. DNA isolation from gastric antrum mucosal biopsies was performed using PureLink Genomic DNA Mini Kits (Thermo Fisher Scientific, USA). Polymerase chain reaction was performed using primers specific for the V-region of the 23S gene and the A subunit DNA gyrase encoding gyrA gene region. The sequencing of obtained DNA fragments was performed on 3730 DNA Analyzer. The sequences were searched for point mutations responsible for H. pylori resistance to clarithromycin (A2143G, A2142G and A2142C193 mutations) and levofloxacin (mutations of the gyrA gene).

Results. H. pylori was detected in 47.78% of biopsy specimens using polymerase chain reaction. The proportion of H. pylori strains with mutations leading to clarithromycin resistance was 17.53%. Amino acid substitutions in the gyrA gene were found in 12.37% of samples. In case of two H. pylori strains (2.06%), dual resistance to clarithromycin and levofloxacin was found.

Conclusion. So high incidence of mutations underlying the development of H. pylori resistance to clarithromycin and levofloxacin was observed among examined patients in Kazan.

Terapevticheskii arkhiv. 2024;96(8):739-743
pages 739-743 views
Detection of anticoagulant medication errors by triggers
Otdelenov V.A., Kleymenova E.B., Nigmatkulova M.D., Payushchik S.A., Dukhanina O.D., Yashina L.P., Sychev D.A.
Abstract

Background. Medication errors can cause preventable adverse events. For example, inappropriate use of anticoagulants (AC) can result in bleeding and thromboembolic complications. Detection and analysis of AC medication errors allow to reveal deficiencies in the safety systems in healthcare organizations.

Aim. The study was aimed to develop a method of systematic detection of anticoagulant medication errors for consequent audit, analysis and development of medication safety improvement measures.

Materials and methods. The study was conducted in the multidisciplinary hospital and included 4924 patients admitted from January 2019 to December 2021 who received AC. Three laboratory triggers (international normalized ratio ≥4, serum creatinine ≥133 μmol/l, and glomerulofiltration rate <30 ml/min/1.73 m2) helped to reveal 4304 cases. Their matching with patient’s data helped to develop combined triggers. Two clinical pharmacologists reviewed all cases identified by combined triggers for checking medication errors. The trigger was considered positive when anticoagulant medication error was detected in the history selected by combined trigger.

Results. Of the 4924 patients 253 (5.3%) were selected by combined triggers. Combined trigger allowed to reduce the amount of medical health records audit by 97.3%. Medication errors were detected in 137 patients. Positive predictive value of selected combined triggers varied from 0 to 63.9%. Aggregated positive predictive value of all combined triggers amounted to 54.2%. AC medication errors were detected in 2.8% patients.

Conclusion. Method of systematic detection of AC medication errors using combined triggers in all hospitalized patients receiving AC allowed to reveal typical medication errors for consequent analysis and elaboration of measures to reduce preventable patient harm in healthcare settings.

Terapevticheskii arkhiv. 2024;96(8):744-750
pages 744-750 views
Prevalence of gastroesophageal reflux disease in Russia: a meta-analysis of population-based studies
Andreev D.N., Maev I.V., Bordin D.S., Abdulkhakov S.R., Shaburov R.I., Sokolov P.S.
Abstract

Aim. To systematize data on the prevalence of gastroesophageal reflux disease (GERD) in the adult population of Russia.

Materials and methods. The search for studies was conducted in the electronic databases MEDLINE/PubMed, EMBASE, and RSCI (Russian Science Citation Index) from January 2000 to December 2022. The review included relevant publications in peer-reviewed periodicals in English or Russian, publications with data from cross-sectional epidemiological studies assessing the prevalence of GERD in the Russian population, studies on adult patients with GERD, and publications with detailed descriptive statistics that allow using the data in the meta-analysis.

Results. The final analysis included 6 studies involving 34,192 subjects. The overall prevalence of GERD (prevalence of heartburn ± regurgitation once a week or more frequently) in the analyzed studies was 25.605% (95% confidence interval [CI] 17.913–34.147). The analysis used a random effect model, as there was significant heterogeneity between the results in both groups (I2=99.63%; p<0.0001). The overall mean age of GERD patients in the study population was 48.14 (95% CI 32.25–4.03) years. The prevalence of GERD in the male population was 23.653% (95% CI 13.351–35.832) and 25.457% (95% CI 17.094–34.849) in females.

Conclusion. This meta-analysis demonstrated that GERD is a common esophageal disease in the Russian population, affecting approximately one in four country residents.

Terapevticheskii arkhiv. 2024;96(8):751-756
pages 751-756 views
Personalized diagnosis of patients with gastroesophageal reflux disease using 24-hour pH-impedance testing and high-resolution esophageal manometry
Maev I.V., Yurenev G.L., Barkalova E.V., Ovsepian M.A., Andreev D.N., Shaburov R.I.
Abstract

Aim. To determine the phenotypic variants of patients with symptoms of gastroesophageal reflux disease (GERD), non-erosive reflux disease (NERD), hypersensitive esophagus (HSE), functional heartburn (FH) using 24-hour pH-impedance testing and high-resolution esophageal manometry (HSEM).

Materials and methods. Fifty-five treatment-native symptomatic patients with newly diagnosed GERD and 48 control group subjects (CG) were examined. The mean age of the subjects was 45.0 years (95% confidence interval [CI] 41.0–48.9). Patients were grouped based on typical symptoms (heartburn, belching, regurgitation, odynophagy, dysphagia), medical history, endoscopy results, and 24-hour pH-impedance testing. Patients with typical symptoms of GERD and Grade B, C, D erosive esophagitis (EE) according to the Los Angeles Classification (LA) based on endoscopy were excluded from the further study. All patients without changes in the esophageal mucosa on endoscopy or with LA grade A EE (presumably NERD) underwent 24-hour pH-impedance testing and HSEM without proton pump inhibitors. Acid exposure, acid reflux count, symptom association with reflux (with symptom index and symptom association with reflux), mean nocturnal impedance, and post-reflux swallow-induced peristaltic wave index were assessed. The structure (presence or absence of a hiatal hernia) and function (presence or absence of the lower esophageal sphincter hypotonia) of the esophagogastric junction, as well as the motor function of the thoracic esophagus, were assessed using HSEM. The results of the HSEM were interpreted according to the Chicago Classification, 3rd edition (2015).

Results. The number of acid refluxes in patients with NERD was 71.0 (95% CI 58.4–83.7), in subjects with HSE – 38.5 (95% CI 28.3–49.0), with FH – 13.0 (95% CI 6.5–18.2), in CG – 16.5 (95% CI 9.0–21.0). The average nocturnal basal impedance was 1300 ohms (95% CI 1000–1986) in patients with NERD, 1725 ohms (95% CI 1338–2261) in patients with HSE, 2760 ohms (95% CI 2453–3499) in FH, 2515 ohms (95% CI 2283–2700) in CG. The index of post-reflux swallow-induced peristaltic wave in patients with NERD was 61% (95% CI 57–71), with HSE – 85% (95% CI 82–88), with FH – 71% (95% CI 64–78), in CG – 66% (95% CI 63–69). Hiatal hernia and/or hypotonia of the LES were more common in patients with NERD (23%) than in CG (13.3%). Ineffective motility was detected in 34% of patients with NERD, in 23% of subject with FH and in 66.7% of patients with HSE.

Conclusion. The results support the hypothesis that patients with GERD symptoms represent a heterogeneous population. 24-hour pH-impedance testing and HSEM helps to differentiate endoscopically negative patients with GERD symptoms and patients with Grade A EE by LA to NERD, HSE and FH.

Terapevticheskii arkhiv. 2024;96(8):757-763
pages 757-763 views
The relationship between diabetes mellitus and non-alcoholic fatty liver disease: a clinical and instrumental paired study
Sasunova A.N., Goncharov A.А., Gapparova K.M., Isakov V.A.
Abstract

Aim. To study the impact of type 2 diabetes mellitus (DM2) on the severity of liver steatosis and fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).

Materials and methods. To conduct a paired case-control study 2989 patients were examined at the Federal Research Center of Nutrition, Biotechnology and Food Safety. Pairs were matched by gender and age and distributed into groups: NAFLD + DM2+ (n=313), NAFLD + DM2- (n=313) and a control group of patients without NAFLD and without DM2 (n=313). The severity of liver steatosis was determined by measuring the controlled attenuation parameter. The severity of liver fibrosis was determined by measuring the liver stiffness measurement. Body composition of the patients was determined using bioimpedance measurements. Indicators of lipid and carbohydrate metabolism, and the serum activity of liver enzymes was determined by standard biochemical methods.

Results. In NAFLD + DM2+ group compared to NAFLD + DM2- group, and in NAFLDM + DM2-compared to the control group, weight, BMI, waist and hip circumference, waist-to-hip ratio were higher, while in all. In NAFLD + DM2+ and NAFLD + DM2- groups the volume of fat mass directly correlated with the level of blood triglycerides (r=0.21), HbA1с (r=0.32) and fasting blood glucose (r=0.35), and inversely correlated with high-density lipoproteins (r=-0.19). In NAFLD + DM2+ group versus NAFLD + DM2- group severe steatosis (S3, 78% versus 59.4%; p<0.001) and severe fibrosis (F4, 8% vs 2.6%; p<0.001) was more common; 70% of patients in the NAFLD + DM2- group had no liver fibrosis according to elastography (F0), while in the NAFLD + DM2+ group only 43.2% of patients had no liver fibrosis (p<0.0001).

Conclusion. When NAFLD is accompanied by DM2, there is an increase in total fat mass, the severity of steatosis and liver fibrosis, and an associated deterioration of lipid metabolism. More than half of these patients have various stages of liver fibrosis, which indicates the progressive nature of the disease.

Terapevticheskii arkhiv. 2024;96(8):764-770
pages 764-770 views
Clinical and economic analysis of the use of dapagliflozin in patients with chronic heart failure with reduced left ventricular ejection fraction in various subgroups of standard therapy in the Russian Federation
Nedogoda S.V., Zhuravleva M.V., Tereshchenko S.N., Salasyuk A.S., Zhirov I.V., Barykina I.N., Lutova V.O., Popova E.A.
Abstract

Aim. To evaluate the clinical and economic effectiveness of dapagliflozin in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction (HFrEF) in the Russian Federation in various subgroups of standard therapy for CHF.

Materials and methods. A clinical and economic analysis of the use of the drug dapagliflozin in addition to standard therapy was carried out in comparison with standard therapy in various subgroups of standard therapy for HFrEF using a modeling method. Cost calculations were carried out in a mathematical model adapted to the healthcare conditions of the Russian Federation by using Russian cost indicators and characteristics of the patient population.

Results. The present study demonstrates that the addition of dapagliflozin is beneficial in terms of clinical and cost-effectiveness, regardless of the initial regimen (angiotensin receptor-neprilysin inhibitors [ARNI] or angiotensin-converting enzyme inhibitors [ACEi]/angiotensin II receptor blockers [ARB]) of standard drug therapy for HFrEF and in all cases leads to an increase in life expectancy, a decrease in the number of hospitalizations and emergency visits due to CHF, as well as cardiovascular mortality. The obtained values of added value per additional year of life in all cases are significantly lower than the willingness-to-pay threshold, which indicates the clinical and economic effectiveness of the strategy of prescribing dapagliflozin as part of standard therapy for patients with HFrEF. In the case of adding dapagliflozin the values of the additional cost of an added year of life in the 3 considered standard therapy options (ARNI or ACEi/ARB, only ACEi/ARB and only ARNI) were 291,256, 279,571 and 338,374 rubles respectively. Thus, the scenario of using dapagliflozin with standard therapy, which included only ACEi/ARB, is characterized by the lowest additional cost and has the best clinical and economic characteristics. At the same time the scenario of use with standard therapy, which included only ARNI, is characterized by the highest value of the additional value of the added year of life.

Terapevticheskii arkhiv. 2024;96(8):771-779
pages 771-779 views
Possibilities of post-processing of multislice computed tomography results in non-invasive diagnosis of pancreatic fibrosis
Khatkov I.E., Lesko K.A., Dubtsova E.A., Khomeriki S.G., Karnaukhov N.S., Vinokurova L.V., Shurygina E.I., Makarenko N.V., Izrailov R.E., Savina I.V., Salimgereeva D.A., Kiriukova M.A., Bordin D.S.
Abstract

Aim. To evaluate the possibilities of post-processing of multidetector computed tomography (CT) results in the non-invasive diagnosis of pancreatic fibrosis (PF).

Materials and methods. The study included 165 patients aged 57.91±13.5 years who underwent preoperative CT during surgical treatment for chronic pancreatitis and pancreatic cancer from April 2022 to February 2024. The normalized contrast ratios of pancreatic tissue in the pancreatic (NCPP) and venous (NCVP) phases, as well as the contrast ratio (CR) were measured. Pathomorphological assessment of PF performed in tissues outside neoplasm or desmoplastic reaction by the Kloppel and Maillet scale.

Results. The values of post-processing CT results were compared in groups with different degrees of PF. Mean CR values were significantly higher (p=0.001) in patients with severe PF (CR 1.16±0.65 HU) than in patients with mild PF (CR 0.78±0.31 HU). CR value significant increase (p=0.03) was found in patients with signs of inflammatory changes in the pancreas tissue (CR 1.14±0.6 HU) than in those without them (CR 0.81±0.3 HU). There were no significant differences between the values of NCPP and NCVP, and the degree of PF.

Conclusion. The CR value increased in patients with severe degree of PF. There was a relationship between CR value increase and the radiological density of pancreatic tissue in non-contrast phase and presence of early signs of pancreatic inflammatory changes. Thus, there was a relationship between CT postprocessing results and morphological signs of PF, which can be used for pancreatic fibrosis non-invasive diagnosis and identification of additional signs of early chronic pancreatitis.

Terapevticheskii arkhiv. 2024;96(8):780-789
pages 780-789 views
The influence of comorbidities on treatment outcomes in patients with tuberculosis
Ivanova D.A., Belilovskiy E.M., Bogorodskaya E.M., Reshetnikov M.N., Plotkin D.V., Avdentova V.B.
Abstract

Aim. To study the association of comorbidities and treatment outcomes in tuberculosis (TB) patients.

Materials and methods. A retrospective study includes all TB patients aged 18 years and older registered for treatment in Moscow in period 2021 the end of the 3rd quarter of 2022 using data of regional epidemiological TB monitoring system, a total of 3039 patients. The frequency and spectrum of comorbidities, its impact on the risk of adverse treatment outcome (ATO) and mortality using univariate and regression analysis were assessed.

Results. Comorbidities were identified in 1528 (50.3%) patients (95% confidence interval – CI 48.5–52.1); HIV infection (18.0%), chronic nonspecific lung disease (9.6%) and cardiovascular disease (8.2%) were predominant. The presence of comorbid pathology increased the odds of uneffective treatment (odds ratio – OR 2.56, 95% CI 2.22–3.03) and death (OR 2.45, 95% СI 1.67–3.59). Independent risk factors for ATO were HIV infection (OR 4.10, 95% CI 3.36–5.10), substance use (OR 2.57, 95% CI 1.70–3.66), chronic nonspecific lung disease (OR 1.39, 95% CI 1.04–1.88), diabetes mellitus (OR 1.69, 95% CI 1.15–2.48), liver pathology (OR 2.10, 95% CI 1.46–3.03), mental illness (OR 2.01, 95% CI 1.32–3.06). The death rate was 13.4%; the most significant predictors of mortality were HIV infection (OR 3.89, 95% CI 2.42–6.22) and liver disease (OR 1.90, 95% CI 1.27–2.82). A comorbidome model was constructed to assess the importance of different comorbidities for patient prognosis.

Conclusion. The presence of comorbidity (predominantly HIV infection and liver disease) is a significant risk factor for ATO and mortality in TB patients, which should be taken into account when organizing and providing TB care to comorbid patients.

Terapevticheskii arkhiv. 2024;96(8):790-796
pages 790-796 views
Comparative assessment of the clinical effectiveness of direct-acting antiviral drugs in outpatient patients with acute respiratory viral infections
Kozlov K.V., Maltsev O.V., Kasyanenko K.V., Sukachev V.S., Lyashenko Y.I., Kosuhina A.A.
Abstract

Aim. To evaluate the clinical effectiveness, safety and compare the incidence of hospitalization during treatment with antiviral drugs with a direct mechanism of action (riamilovir and umifenovir) in people with acute respiratory viral infections (ARVI) in an outpatient setting.

Materials and methods. The study included 150 outpatients with ARVI aged 18–27 years: 50 patients received riamilovir 250 mg 3 times a day for 5 days, the second group included 50 patients who received umifenovir 200 mg 4 times a day for 5 days, 50 individuals received only pathogenetic treatment.

Results. The use of direct-acting antiviral drugs was characterized by the least severity of pain and aches in the body, general weakness, and in the group of patients receiving riamilovir, the lowest severity of rhinitis, cough, and the lowest morning body temperature were recorded compared to other groups. In riamilovir group reduction in the duration of the disease was observed. The lowest frequency of ARVI pathogens detection was observed on the 6th day in riamilovir group. Outpatient treatment with riamilovir was accompanied by a minimal number of cases of the disease requiring hospitalization.

Conclusion. The use of direct antiviral drugs contributes to the rapid relief of ARVI symptoms in patients receiving medical care on an outpatient basis. The antiviral drug riamilovir showed the most pronounced effectiveness (clinical and laboratory).

Terapevticheskii arkhiv. 2024;96(8):797-803
pages 797-803 views
Efficacy of rabeprazole for the treatment of gastroesophageal reflux disease in a 7-day non-interventional trial
Tsukanov V.V., Onuchina E.V., Vasyutin A.V., Dambaeva B.B., Tonkikh J.L., Pavlova N.V.
Abstract

Aim. To evaluate the efficacy of seven-day treatment with rabeprazole (Razo®) 20 mg once daily in patients with NERD and esophagitis based on monitoring the results of pH-impedancemetry of the stomach and esophagus and assessment of clinical symptoms.

Materials and methods. Thirty patients with typical GERD manifestations were examined. The study included patients who underwent pH-impedancemetry, endoscopic examination, and were prescribed treatment with rabeprazole at a dose of 20 mg once a day. Clinical monitoring was performed during three visits: before treatment, after 3 days, and after 7 days of treatment. Control pH-impedancemetry was performed after 7 days of therapy. The third visit was the endpoint of the study.

Results. After 7 days of treatment, the response rate for heartburn was 86.7% in the overall group of patients with GERD, 94.4% in those with NERD, and 75.0% in patients with esophagitis stage A and B. After 7 days of therapy with rabeprazole, we registered a significant decrease in the total number of refluxes (from 88 to 54; p<0.001), the number of acid refluxes (from 53 to 22; p<0.001), the DeMeester index (from 23.81 to 7.62; p<0.001), and AET (from 7.54 to 2.01; p<0.001) in the esophagus and an increase in the median daily pH (from 1.8 to 5.4; p<0.001) and the time with pH>4 in the stomach (from 2.57 hours and 10.7% up to 12.3 hours and 51.3%; p<0.001). 7-day therapy with rabeprazole was accompanied by a significant improvement in GERD patients in all parameters of quality of life. 100% of patients with GERD rated their satisfaction with therapy as “good” and “very good”.

Conclusion. As a result of 7-day therapy of patients with NERD and esophagitis with Razo® at a dose of 20 mg per day, an excellent clinical response was obtained, confirmed by a marked optimization of pH-impedancemetry parameters.

Terapevticheskii arkhiv. 2024;96(8):804-811
pages 804-811 views

Reviews

Barth syndrome in an adult patient: an overview of the problem and case report. A review
Muksinova M.D., Osmolovskaya Y.F., Leontyeva I.V., Galaeva M.A., Stukalova O.V., Beniashvili A.G., Safiullina A.A., Zhirov I.V., Tereshchenko S.N.
Abstract

Barth syndrome is a rare genetic disease caused by abnormal cardiolipin metabolism, characterized by high mortality within 5 years of diagnosis due to heart failure and/or infectious complications. This article describes a clinical case of an adult patient with Barth syndrome. The peculiarities of the course of the disease are described, including the transformation of the hypertrophic type of cardiomyopathy into the hypokinetic type as the patient grew older. This article demonstrates the difficulty in selecting the optimal treatment of a patient with Barth syndrome in real clinical practice, in the absence of clearly prescribed recommendations and pathogenetic therapy.

Terapevticheskii arkhiv. 2024;96(8):812-819
pages 812-819 views
Hyaluronic acid in the treatment of osteoarthritis: innovations in injection therapy. A review
Menshikova I.V.
Abstract

The review briefly presents modern understanding heterogeneity of osteoarthritis (OA) which is based on pathophysiological features of its variants. The concept of the phenotypes and endotypes of OA reflects these differences. In clinical recommendations description the emphasis on the place of hyaluronic acid is made. The mechanisms of action of sodium hyaluronate with different molecular mass are studied in detail. The results of foreign and Russian studies on efficacy and safety of different forms of hyaluronic acid are given. Personalized treatment of patients with different phenotypes of OA is shown by an example of a line of Flexotron series.

Terapevticheskii arkhiv. 2024;96(8):820-825
pages 820-825 views
Ferritin as a biomarker of aging: geroprotective peptides of standardized human placental hydrolysate. A review
Gromova O.A., Torshin I.I., Chuchalin A.G.
Abstract

Ferritin, an iron transport protein, is an acute phase protein of inflammation and oxidative stress (OS), a biomarker of cytolysis and ferroptosis. Inflammation, OS and iron overload are characteristic processes of the pathophysiology of aging. Human placental hydrolysates (HPHs) are promising hepatoprotective agents for anti-aging therapy. The goal of the team of authors was to systematize data on ferritin as a marker of aging and to identify peptides that counteract the aging pathophysiology, including through the regulation of iron and ferritin metabolism, in the HPH Laennec (manufactured by Japan Bioproducts). The results of basic and clinical studies confirm the above relationships and indicate that blood ferritin levels characterize the chronological and biological aging of the human body.

Terapevticheskii arkhiv. 2024;96(8):826-835
pages 826-835 views
Herbal extracts in hepatoprotection: antioxidant and immunomodulatory effects. A review
Shikh E.V., Khaytovich E.D., Tsvetkov D.N.
Abstract

The global market for herbal medicines is valued at $83 billion and continues to expand rapidly. Plant extracts, widely used due to their safety and minimal side effects, play a significant role in supporting liver function. The treatment of liver diseases, including hepatitis of various etiologies, alcoholic and non-alcoholic fatty liver disease, and cirrhosis, involves the use of effective hepatoprotective drugs. Plant extracts provide antioxidant and immunomodulatory pharmacological effects that contribute to the maintenance of liver function. The aim of this review was to analyze the mechanisms underlying the hepatoprotective effects of various herbal extracts included in the formulation of DIPANA®, focusing on their antioxidant and immunomodulatory properties. Additionally, the review aimed to present clinical study results supporting their efficacy in treating of various liver diseases. The analysis was based on available literature data and clinical studies on the use of DIPANA®. The reviewed herbal extracts and their combination (DIPANA®) demonstrate efficacy in experimental models of liver damage and clinical studies involving patients with liver diseases, including alcoholic and non-alcoholic steatohepatitis, drug-induced liver injury, and functional disorders of the gallbladder. This drug exhibits hepatoprotective, choleretic, relaxing effects and is well-tolerated by patients.

Terapevticheskii arkhiv. 2024;96(8):836-845
pages 836-845 views

Consensuns

Resolution of advisory board on issues in the diagnosis of asthma and COPD: current challenges and modern approaches to their resolution
Avdeev S.N., Shabanov E.A., Kudelya L.M., Fedotov V.D., Demchuk E.A., Tsoma V.V., Bogdanova Y.V., Ponomareva N.D., Pozdnyakova O.Y., Petryakov I.V.
Abstract

Diagnosis of asthma and chronic obstructive pulmonary disease (COPD) remains an actual problem in Russia. The lack of diagnostics and control of these diseases leads to serious consequences for public health and economic damage. Effective initiatives to improve the level of diagnosis and control of asthma and COPD include the organization of educational activities, instrumental methods of examination, the use of mobile offices for outreach work in remote communities and the introduction of medical information systems. The introduction of digital technologies into medical practice will help to improve the quality of medical care, increase the efficiency of medical centers, and ensure timely diagnosis and control of respiratory diseases. The introduction of modern approaches and methods in the diagnosis of asthma and COPD, active use of validated questionnaires and medical information systems will improve the quality of life of patients and reduce the risks of complications and exacerbations of diseases.

Terapevticheskii arkhiv. 2024;96(8):846-851
pages 846-851 views

History of medicine

On the institutionalization of Russian pulmonology: the second and third stages of its history
Borodulin V.I., Banzelyuk E.N., Topolyanskiy A.V.
Abstract

For the first time, the authors conducted a historical analysis of primary sources and identified 3 stages in the history of Russian pulmonology, naming 8 of its founders. The content is disclosed in two articles (the first one was published in No. 3 of our journal for 2024). This article tells about the second (pulmonology as an independent scientific and educational discipline within the clinic of internal diseases) and the third (as a new medical specialty) stages of the history of Russian pulmonology in the XX century.

Terapevticheskii arkhiv. 2024;96(8):852-855
pages 852-855 views


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