Vol 88, No 4 (2016)

Aim. To estimate the value of video capsule endoscopy (VCE) in the diagnosis of small intestine (SI) diseases. Subjects and methods. A total of 134 patients, including 72 (53.7%) women and 62 (46.3%) men whose mean age was 41.48±9.33 years. Group 1 included 73 patients who were examined using an algorithm for the diagnosis of SI diseases, 61 patients underwent VCE by the referrals handed in other healthcare facilities. Results. In the patients of Group 1, pathological SI changes were revealed by VCE by almost 4 times more frequently than in those of Group 2. VCE provides a possibility of establishing the sources of bleeding, Crohn’s disease, and other inflammatory diseases, which are inaccessible to other diagnostic methods. SI arteriovenous malformations, polyps, and diverticula, parasitic infections, and nonsteroidal anti-inflammatory drug-associated enteropathy may be causes of obscure SI bleeding and anemia. In celiac disease, VCE may estimate the extent of SI mucosal atrophy and reveal its disintegration as erosions and ulcers, which are inherent in its refractory form. Conclusion. VCE is a highly informative method for examining the SI, but, in view of the specific features of its performance and the high cost of hardware, VCE is recommended to be performed in accordance with the proposed diagnostic algorithm.

Aim. To study the electrocardiographic characteristics of secondary atrial septal defect (ASD) depending on its size. Subjects and methods. A total of 80 patients (32 men and 48 women; mean age 23.5±2.7 years) with this defect were examined and divided into three groups according to its size relative to body surface area. Results. The degree of electrocardiographic changes in secondary ASD depended on its size: a significant positive correlation was established between defect size and P wave amplitude (r=0.8; p<0.005), as well as its duration (r=0.5; p<0.001). A positive correlation was noted between defect size and R wave amplitude in lead V1 (r=0.6; p<0.04), that and S wave amplitude in lead V5 (r=0.3; p<0.02); between the size of the defect and the degree of an increase in the total index RV1+SV5,V6 (r=0.7; p<0.02); and that and the degree of electrical heart axis (EHA) deviation to the right (r=0.3; p<0.03). Conclusion. The degree of electrocardiographic changes in secondary ASD depends on its size. Giant defects are characterized by a frequent EHA deviation to the right, pronounced signs of right ventricular hypertrophy, and a higher prevalence of right bundle branch block.

Aim. To estimate the possibility of using arterial wall stiffness (AWS) parameters as predictors for carotid artery atherosclerotic plaques (CAAPs) in patients with abdominal obesity (AO). Subjects and methods. A total of 132 patients (72% men; mean age, 45.0±5.3 years) with normal blood pressure (BP) and AO, and no cardiovascular diseases (CVD) at a SCORE risk of <5% were examined. The investigators analyzed lipid composition of blood, its levels of glucose, uric acid, and creatinine, by calculating glomerular filtration rate and performed 24-hour BP monitoring, by estimating AWS parameters, and triplex scanning of the brachiocephalic arteries. Results. CAAPs were detected in 20 (15.2%) patients. A subgroup of persons with an aortic pulse wave velocity (PWV) of ≥75th percentile (8.0 m/sec for persons aged 31—45 years; 8.3 m/sec for those aged 46—55 years) showed higher rates of carotid atherosclerosis (CA) (44.1% versus 15.2%; p<0.01). The predictors of CAAPs were aortic PWV, average daily aortic systolic BP, and the blood levels of glucose on an empty stomach and uric acid. Conclusion. The analysis of AWS parameters in patients with AO and no CVD at a low SCORE risk may become a potential tool to estimate the likelihood of CAAPs. When the aortic PWV equal or greater than 8.0 m/sec for persons aged 31—45 years and 8.3 m/sec for those aged 46—55 years, CA screening is appropriate for possible further risk reclassification.

Aim. To comparatively assess formulas for estimating glomerular filtration rate (GFR) in the prediction of poor outcomes in patients with type 2 diabetes mellitus (DM) within one year after myocardial infarction (MI). Subjects and methods. The investigators examined 89 patients with ST-segment elevation myocardial infarction (STEMI) within 24 hours after the onset of clinical symptoms of the disease. All the patients underwent standard laboratory and instrumental tests. GFR was calculated using the Modified of Diet in Renal Diseases (MDRD) formulas in terms of serum creatinine levels, the Hoek equation: GFR [ml/min/1.73 m2] = (80.35/cystatin C [mg/l]) — 4.3 (CKD-EPI), as well as from cystatin C levels, and the creatinine clearance rate was determined using the Cockcroft and Gault formula (ml/min). During a year after STEMI, the investigators recorded cardiovascular events (CVEs), such as death, recurrent MI, progressive angina pectoris, emergency coronary revascularization, and decompensated chronic heart failure (CHF). The examinees were divided into two groups: 1) 70 (78.6%) patients with MI and no DM; 2) 19 (21.3%) patients with MI and DM. Results. Comparative analysis revealed a tendency towards a difference in the detection rate of GFR <60 ml/min/1.73 m2 calculated using the Hoek formula from cystatin C levels: 42.1% in Group 2 and 21.4% in Group 1 (р=0.067). There were no great differences in the GFR estimated using other formulas. Logistic regression analysis was carried out to determine the most sensitive formula for estimating GFR to assess the risk of CVEs in the patients within a year after MI concurrent with and without type 2 DM. A univariate analysis showed that GFR calculations using the CKD-EPI (odds ratio (OR), 13.5; p=0.046) and MDRD (OR, 6.5; р=0.040) formulas and creatinine clearance estimation (OR, 2.4; p=0.025) were most sensitive in selecting MI patients without DM and with poor outcomes. This analysis revealed that GFR estimates using the Hoek formula from cystatin C levels (OR, 6.15; p=0.018) were most sensitive for patients with MI concurrent with type 2 DM. In both models, multivariate analysis included none of the analyzed indicators. Conclusion. To estimate cardiovascular risk in the long-term post-infarction period, the CKD-EPI formula in the patients without type 2 DM and the Hoek formula from cystatin C levels were noted to be of the greatest prognostic value in patients with DM.

Aim. To study the genealogy of adult patients with primary immunodeficiencies (PID) and to analyze its data in the relatives of these patients. Subjects and methods. A genealogical analysis was carried out in 74 adult patients with PID and 200 adults without this condition, by examining groups of signs in the relatives in at least 4 generations, the genealogical markers were an atypical infectious and inflammatory process; allergic diseases; autoimmune diseases; the presence of relatives with cancers; cases of reproductive dysfunction; deaths from infectious diseases and/or cancers in children; and congenital malformations. The percentage of relatives with the above genealogical markers of the total number of the relatives in 4 generations was used as an indicator. The analysis applied nonparametric methods, such as quartile analysis, Spearman’s correlation coefficient, and Mann-Whitney test to verify the statistical significance of differences between the independent groups. Multifactor prediction models were based on the decision theory (Wald-Bayesian analysis) and classification trees. At Stage 1, the investigators made a univariate analysis, the data of which were used to perform a correlation analysis of the indicators. Multifactor prediction models were based on the decision theory (Wald—Bayesian analysis) and classification trees. Results. The genealogical markers were identified and analyzed using different statistical methods and conclusions were made on prognostically significant indicators. Conclusion. The findings may be recommended for practical use in order to enhance the efficiency of work with patients having various immunopathological syndromes.

Aim. To make a differential diagnosis of true and functional iron deficiency (ID) in anemia of chronic diseases (ACD). Subjects and methods. A total of 540 patients (785 investigations) and 311 healthy individuals (a control group) were examined. Among them, there were 118 cancer patients admitted for surgical treatment and 226 for chemotherapy (CT), 56 blood cancer patients, 86 with breast diseases without anemia, and 54 workers of the institute with the signs of ID. An enzyme immunoassay was used to determine the plasma levels of ferritin (FR), soluble transferrin receptor (sTFR), and endogenous erythropoietin (EPO). Results. 183 cancer patients did not receive specific treatment, 161 had different cycles of CT. In true ID, anemia was microcytic (average red blood cell size, <80.0 fl) and hypochromic (mean corpuscular hemoglobin concentration, <27.0 pg) with low FR levels (less than 20 ng/ml) and high sTFR concentrations (more than 4.0 µg/ml). The EPO level corresponded to the degree of anemia and was 4—5-fold the normal values. In ACDs, 292 (55%) patients had normocytic normochromic anemia with high FR levels (more than 100 ng/ml), the level of sTFR was low and that of EPO did not correspond to the degree of anemia in 74% of the patients. Functional ID was detected in 108 (37%) cancer patients in the presence of ACD. Despite high FR levels and low sTFR, anemia in Hodgkin’s and non-Hodgkin’s lymphomas was hypochromic microcytic, which may be considered as severe functional ID in ACD. Conclusion. In addition to a clinical blood test, the pharmacokinetic parameters (FR, sRFR, and EPO) should be determined for the differential diagnosis of true and functional ID.

Aim. To evaluate the efficiency and safety of two eradication therapy (ET) regimens for Helicobacter pylori infection in patients with concomitant chronic hepatitis C (CHC) in relation to the stage of liver fibrosis (LF). Subjects and methods. A prospective clinical trial was conducted in parallel groups. Group 1 included 50 HCV-negative patients with H. pylori-associated peptic ulcer of the stomach or duodenum; Group 2 consisted of 50 HCV-positive patients with H. pylori-associated peptic ulcer of the stomach or duodenum concurrent with CHC. Each group was divided in 2 subgroups according to the used triple ET (a proton pump inhibitor (PPI) in a standard dose + amoxicillin 1000 mg twice daily + clarithromycin 500 mg twice daily for 10 days) or sequential therapy (PPI in a standard dose + amoxicillin 1000 mg twice daily within the first 5 days and then PPI in a standard dose + clarithromycin 500 mg twice daily + metronidazole 500 mg twice daily for the next 5 days). LF was assessed using indirect elastometry. The efficiency of ET was evaluated by a breath test (after 4 weeks) and an analysis depending on intention-to-treat (ITT) and per-protocol (PP) treatments. A patients recorded adverse events in specially developed diaries. Results. The efficiency of ET was 74% (ITT) and 80.4% (PP) in Group 1 and 76 (ITT) and 79.1% (PP) in Group 2. Both groups displayed a tendency towards an 11.9—12.4% increase in the efficiency of the sequential therapy versus the classical triple (PP) one. The rate of totally found side effects was 20% in Group 1 and 28% in Group 2. During sequential therapy, the rate of side effects was lower than that during the classical one. The efficiency of ET did not significantly depend on the stage of LF. Only the presence of concomitant type 2 diabetes mellitus and the use of macrolides (12 months before treatment) significantly lowered the efficiency of ET (OR 0,21; 95% CI 0,06—0,69, p=0,0102 and OR 0,27 95% CI 0,08—0,9, p=0,0342). LF regardless of its magnitude significantly determined the risk of adverse events during ET (OR 3,33 95% CI 1,19—9,31, p=0,0217). A group at the highest risk of adverse events included patients with liver cirrhosis (OR 4,87; 95% CI 1,01—23,5, p=0,0492). Conclusion. It is appropriate to prescribe a sequential ET regimen as more effective and safe for patients with concomitant CHC during therapy for H. pylori infection-associated diseases. LF increases the risk of adverse events during ET.

Rebamipide is a cytoprotесtive drug that stimulates the generation of endogenous prostaglandins in the gastric and small intestinal mucosa and accelerates the healing of erosions and ulcers caused by Helicobacter pylori infection and NSAID administration. The major properties of rebamipide include stimulation of prostaglandins and synthesis of muсus glycoproteins, inhibition of reactive oxygen species, inflammatory cytokines, and chemokines, and suppression of neutrophil activation. This paper shows the ability of rebamipide to enhance the efficiency of therapy for Helicobacter pylori-induced infection, to reduce inflammation, including that after infection eradication, to accelerate ulcer healing, and to prevent the progression of preneoplastic lesions.

This paper reviews the latest federal guidelines published in 2015. Emphasis is placed on the etiology and pathogenesis of uncomplicated lower urinary tract infection (uLUTI). There are data of the last Russian Darmis-2011 study of urinary tract infection pathogens and their resistance to essential antibiotics. The paper reveals the causes of persistence of uropathogenic Escherichia coli, the main pathogen of uLUTI, and shows the occurrence of intracellular bacterial communities in the superficial layer of the bladder mucosa, which are characteristic of recurrent cystitis. There are justified treatment and prevention regimens using both first-line and alternative drugs for uLUTI and recurrent iLUTI.

The review provides information on the molecular genetic mechanisms for the development gestational diabetes mellitus (GDM). It gives data on the genetic identity of GDM and type 2 diabetes mellitus and considers a role of some adipokines and incretin hormones in the development of GDM. There is evidence for the role of magnesium and vitamin D deficiencies in the pathogenesis of gestational carbohydrate metabolic disturbances.