Vol 92, No 11 (2020)

Full Issue

Editorial
Hepatitis C awareness among therapists and general practitioners. Survey results
Sineglazova A.V., Sineglazova A.V.
Abstract

Aim. In order to improve the diagnosis and treatment of chronic hepatitis C in the framework of this study was the awareness among general practitioner (GPs) and physicians in various districts of Chelyabinsk Oblast was assessed.

Materials and methods. A continuous study of hepatitis C virus (HCV) awareness among therapists and GPs was conducted within the framework of the regional research-to-practice conference Multidisciplinary Issues of Family Medicine on May 19, 2018. 78 questionnaires have been distributed. Thus, 78 therapists from different districts of Chelyabinsk Oblast took part in the study. For these purposes, a questionnaire of 12 questions developed by Olga I. Sagalova was used. The study involved 78 therapists from different districts of Chelyabinsk Oblast. 20.52% (n=16) of respondents were from the healthcare institutions (HCI) of urban districts of Chelyabinsk Oblast, 39.74% (n=31) were from the HCIs of municipal districts of Chelyabinsk Oblast, and 39.74% (n=31) from the HCIs of the city of Chelyabinsk.

Results. The survey revealed certain gaps in therapists’ awareness of the natural course of the disease, diagnosis, routing, the natural course of HCV infection, as well as its extrahepatic manifestations. The survey results indicate a lack of understanding among physicians and therapists of tactics for managing patients with HCV infection and emphasize the need to improve interdisciplinary interaction between infectious disease specialists, primary care doctors and doctors of other specialties including the development and implementation of an educational strategy for non-infectious disease doctors.

Conclusion. The results indicate the needs to increase the level of education among doctors in the diagnosis and management of patients with HCV in accordance with guidelines and to include screening for HCV infection in the guidelines for selected chronic non-communicable diseases as part of the initial examination.

Terapevticheskii arkhiv. 2020;92(11):5-12
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Original articles
Whooping cough in different periods of pregnancy
Popova O.P., Smetanina S.V., Antipyat N.A., Revazyan N.R., Skirda T.A.
Abstract

Aim. To study the clinical course, diagnosis of pertussis in pregnant women.

Materials and methods. Under observation were 25 pregnant women with whooping cough. The age structure was dominated by patients from 6 to 35 years old, amounting to 64%. At the time of hospitalization in 2 (8%) patients the gestation period corresponded to the first trimester, in 7 (28%) – II, in 9 (36%) – III. In 7 (28%) patients, the diagnosis of whooping cough was made during childbirth. The following methods were used to verify pertussis: bacteriological, PCR and serological (ELISA).

Results and discussion. Clinical analysis showed that pregnant women with pertussis who came to the hospital were admitted to hospital mainly in the late stages of the disease (at 4–5 week in 68.6% of cases). Pertussis infection in all cases was typical: in moderate form – 96%, mild – at 4%. In 64% of patients, whooping cough accompanied by other respiratory diseases, which were the main cause of development of bronchitis. The use of ELISA allowed to confirm the clinical diagnosis in 91.7% of patients.

Conclusion. The course of whooping cough in pregnant women is characterized by a typical symptom complex. To improve the verification of the diagnosis, it is advisable to use modern laboratory tests (PCR, ELISA).

Terapevticheskii arkhiv. 2020;92(11):13-16
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Risk factors for the early development of septic shock in patients with severe COVID-19
Glybochko P.V., Fomin V.V., Moiseev S.V., Avdeev S.N., Yavorovskiy A.G., Brovko M.Y., Umbetova K.T., Aliev V.A., Bulanova E.L., Bondarenko I.B., Volkova O.S., Gaynitdinova V.V., Gneusheva T.Y., Dubrovin K.V., Kapustina V.A., Kraeva V.V., Merzhoeva Z.M., Nuralieva G.S., Nogtev P.V., Panasyuk V.V., Politov M.E., Popov A.M., Popova E.N., Raspopina N.A., Royuk V.V., Sorokin Y.D., Trushenko N.V., Khalikova E.Y., Tsareva N.A., Chikina S.Y., Chichkova N.V., Akulkina L.A., Bulanov N.M., Ermolova L.A., Zykova A.S., Kitbalyan A.A., Moiseev A.S., Potapov P.P., Tao E.A., Sholomova V.I., Shchepalina A.A., Yakovleva A.A.
Abstract

Aim. In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19.

Materials and methods. We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure.

Results. We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.0±13.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.53–3.67; p<0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.76–2.70).

Conclusion. The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.

Terapevticheskii arkhiv. 2020;92(11):17-23
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Helicobacter pylori resistance in the Russian Federation: a meta-analysis of studies over the past 10 years
Andreev D.N., Maev I.V., Kucheryavyy Y.A.
Abstract

Aim. Systematization of data on antibiotic resistance of Helicobacter pylori in Russia over the past 10 years.

Methods. A search for studies were carried out in electronic databases MEDLINE/PubMed, EMBASE, Cochrane, Russian Science Citation Index. We analyzed the papers published over the past 10 years (2011 to 2020). In the final analysis, publications were selected from periodical peer-reviewed foreign and Russian publications, in which validated tests for assessing the microorganism resistance were used with detailed descriptive statistics, which allows the obtained data to be included in the meta-analysis.

Results. The final analysis included 11 studies (808 isolates). H. pylori resistance to clarithromycin was 10.39% (95% confidence interval – CI 7.103–14.219), metronidazole – 33.95% (95% CI 15.329–55.639), amoxicillin – 1.35% (95% CI 0.281– 3.202), levofloxacin – 20.0% (95% CI 12.637–28.574), tetracycline – 0.98% (95% CI 0.353–2.163). Double clarithromycin-metronidazole resistance was reported in 2.7% (95% CI 1.136–4.345).

Conclusion. This meta-analysis is the first analytical work that allows objectifying the current structure of H. pylori antibiotic resistance in the Russian Federation. The data obtained in the analysis of publications over the past 10 years indicate a low resistance of the microorganism to clarithromycin (less than the regulated threshold of 15%), which allows us to consider the triple regimen of eradication therapy as a first-line therapy in our country.

Terapevticheskii arkhiv. 2020;92(11):24-30
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Organizing the medical care for the COVID-19 patients in non-infectious Moscow hospital: reassignment experience
Nikitin I.G., Melekhov A.V., Sayfullin M.A., Agafonov S.S., Bedritskiy S.A., Vishninskiy A.A., Gultiaeva N.A., Guseynov E.R., Ermakov N.A., Zorin E.A., Koroleva I.V., Kudryavtsev D.V., Manevskiy A.P., Negovskiy A.A., Petrovichev V.S., Rudakov B.E., Ruleva A.I., Serebryakov A.B., Sitnikov A.R., Fedosova N.F., Khammad E.V., Avramov A.A., Agaeva A.I., Golubykh K.Y.
Abstract

Aim. To present the results of work of National Medical Research Center of Treatment and Rehabilitation, reassigned for COVID-19 patients’ treatment during pandemic. Run-up methodology, procedures and working process organization are detailed.

Materials and methods. 354 COVID-19 patients were treated from 13.04.2020 to 10.06.2020 [age 59 (4–70) years, 56% women, body mass index 28.5 (24.9–32.2) kg/m2]. Patients were admitted at 8 (6–11) day of sickness. In-hospital stay was 16 (14–20) days.

Results. NEWS scale at the day of admittance was 2 (1–4); 2 (1–3) in patients discharged alive and 6 (4–7) in died patients, p=0.0001. So prognostic accuracy of NEWS scale was confirmed as very well (area under ROC-curve = 0.819). 69 patients (19.5%) were treated at intensive care department for 7 (4–13) days. 13 patients died, 11 of them had COVID-19 as direct or indirect cause of death. Total in-hospital mortality was 3.67%, in-hospital mortality of COVID-19 patients – 3.1%. 17 healthcare workers (HCW), contacted with COVID-19 patients were infected (2.67%). 4 HCW, who had no direct contact with patients were also infected and 7 HCW were infected before the first patient was admitted. No one of them died.

Conclusion. Complex tasks of healthcare organization during COVID-19 pandemic can be solved quickly with acceptable quality, characterized by low levels of patients; mortality and HCW infection.

Terapevticheskii arkhiv. 2020;92(11):31-37
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Experience with 13-valent conjugated pneumococcal vaccine in HIV-infected patients
Zhestkov A.V., Zolotov M.O., Lyamin A.V., Borisova O.V., Chernova O.E., Limareva L.V., Ismatullin D.D.
Abstract

Aim. Evaluate the effect of PCV13 vaccination on the composition of the microflora of the upper respiratory tract and the immune system in HIV-infected patients.

Materials and methods. 100 patients with HIV-infection were included in the study. The patients underwent immunological examination and the collection of biomaterial from the posterior pharyngeal wall for microbiological examination. After obtaining the results of the examinations, PCV13 was intramuscularly administered. 7 days after the introduction of the vaccine, an assessment of adverse events was carried out, after 3 months, microbiological and immunological examinations were repeated.

Results. Immediately after the administration of PCV13, 5% of patients felt pain during the administration. Local reactions were reported in 6 patients. One participant showed a rise in temperature to 38.3°C over 2 days. Before vaccination, 16 strains of S. pneumoniae were seeded in patients. 3 months after the administration of PCV13, pneumococcus was isolated in 8 patients. 3 months after immunization, the median level of populations and subpopulations of lymphocytes became higher than the pre-vaccination.

Discussion. Our results show high risk of pneumococcal infections in HIV-positive patients. A tendency towards a decrease in the level of S. pneumoniae carriage was revealed 3 months after the administration of PCV13. The high level of enterobacteria carriage in HIV-positive patients is noteworthy. There is a pronounced positive effect from the use of PCV13 in HIV-positive patients on cellular factors of the immune system.

Conclusion. The use of PCV13 is a safe and effective method for the prevention of S. pneumoniae infections.

Terapevticheskii arkhiv. 2020;92(11):38-44
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Anti-viral activity of enisamium iodide against viruses of influenza and ARVI’s on different cell lines
Zarubaev V.V., Slita A.V., Sinegubova E.O., Muryleva A.A., Lavrentieva I.N.
Abstract

Influenza and ARVI represent the most numerous and dangerous group of causative agents of respiratory infections human.

Aim. Characterization of the antiviral properties of enisamium iodide against human respiratory viruses in in vitro experiments.

Materials and methods. In the course of experiments, the cytotoxic properties of enisamium iodide were studied against the cell lines Vero, MA-104, A549, L-41 and HEp-2. The antiviral activity of enisamium iodide was studied using virus yield reduction assay against influenza viruses, parainfluenza virus, respiratory syncytial virus, Coxsackie B3 and Coxsackie B4 viruses, as well as adenoviruses types 5 and 6.

Results. The most sensitive to the action of enisamium iodide was the human parainfluenza virus, whose activity decreased by 2.3 orders of magnitude under the action of the drug in A549 cells. Of the cell cultures used, enisamium iodide exhibited the maximum antiviral effect in human lung carcinoma cells A549, where, in its presence, the level of reproduction of adenoviruses of types 5 and 6, Coxsackie viruses B3 and B4, and human parainfluenza virus decreased by an order of magnitude or more. The antiviral activity of enisamium iodide was least manifested in Vero cells.

Conclusion. According to the results of in vitro experiments, enisamium iodide can be considered as an antiviral drug with a wide spectrum of activity against human respiratory viruses.

Terapevticheskii arkhiv. 2020;92(11):45-50
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Pathogenesis, diagnosis, prevention and treatment of disseminated intravascular coagulation syndrome in COVID-19 infection
Vorobyev P.A., Momot A.P., Krasnova L.S., Vorobiev A.P., Talipov A.K.
Abstract

Aim. Clinical characteristics of disseminated intravascular coagulation (DIC) in COVID-19 infection and assessment of the effectiveness of complex therapy for this syndrome at the stages of prevention and treatment of various complications.

Materials and methods. The study of publications was carried out through search engines on the Internet using keywords. To diagnose the infection, the COVID-19 program was used on the MeDiCase platform, which is publicly available on www.medicase.pro, which suggests a diagnosis with a sensitivity of 89.47%. The study included 85 patients with acute COVID-19 with mild to moderate disease, aged 11 to 81 years. The presence of the pathogen was confirmed immunologically in 12% of patients; in other cases, the diagnosis was based on the results of an automated survey in the MeDiCase system. All patients, according to the MGNOT recommendations, were prescribed one of the oral direct anticoagulants - Eliquis at a dose of 5 mg 2 times a day, Ksarelto at a dose of 10 mg 2 times a day or Pradax at a dose of 110 mg 2 times a day for at least 2 weeks. All other drugs with antiviral, immunomodulatory effects, antibiotics were canceled.

Results. The presence of DIC is substantiated by the morphological picture of changes in organs and tissues, clinical (hematoma-petechial type of bleeding in combination with thromboembolic syndrome and the presence of thrombovasculitis) and laboratory changes: an increase in the level of soluble fibrin-monomer complexes, D-dimer, hyperfibrinogenaemia, less often - thrombocytopenia, violation of fibrinolytic activity. The phenomenon of consumption of clotting factors and profuse bleeding are rare. Direct anticoagulants, fresh frozen plasma transfusions and plasmapheresis are used in the treatment of disseminated intravascular coagulation. The paper presents its own positive results of early prescription at the outpatient stage of direct oral anticoagulants in prophylactic doses (no case of disease progression), individual cases of the use of fresh frozen plasma and plasapheresis.

Conclusion. DIC syndrome with the development of thrombovasculitis is the most important pathogenetic mechanism for the development of microthrombotic and hemorrhagic disorders in organs during infection with COVID-19, leading to dysfunction of the lungs, brain and other nerve tissues, kidneys, thromboembolic complications, etc. Many symptoms of the disease may be associated with a violation of the nervous regulation of the functions of organs and systems. Prevention of thrombovasculitis is effective already at the stage of the first manifestation of the disease with the outpatient use of direct anticoagulants (oral, low molecular weight heparins). In case of more severe manifestations (complications) of the disease, additional use of freshly frozen plasma and plasmapheresis is effective.

Terapevticheskii arkhiv. 2020;92(11):51-56
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Clinical notes
Viruso-bacterial pneumonia, complicated by lightness pulmonary bleeding with death
Chizhova O.Y., Ruslyakova I.A., Baculin I.G., Vinnichuk S.A., Sakharov V.I.
Abstract

Despite the significant achievements and successes of medical science, the incidence of influenza, its complications and socio-economic damage do not decrease, remaining at a high level. In the clinic of Mechnikov North-Western State Medical University from December 2018 to February 2019, from 89 hospitalized patients with pneumonia/acute bronchitis viral etiology was determined in 29 (32%). In 27 (97%) patients it was virus A (H1N1), in 2 cases – A (H3N2). 9 (31%) patients were sever and were hospitalized in intensive care unit. The case of severe viral pneumonia caused by A (H3N2) complicated by fulminant pulmonary hemorrhage with a lethal outcome is presented.

Terapevticheskii arkhiv. 2020;92(11):57-61
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Inguinal lymphadenitis due to invasion of Dirofilaria repens
Ermakova L.A., Nagorny S.A., Kornienko I.V., Kiosova J.V., Todorov S.S., Pshenichnaya N.Y.
Abstract

The paper presents the case of the right-sided inguinal inflammation of a lymph node as a result of invasion of Dirofilaria repens, the parasitic pathogen of subcutaneous dirofilariasis in animals of the canine family. The diagnosis was verified on the basis of the parallel application of morphological studies of cross sections of the nematode in histological samples and the molecular biological method – polymerase chain reaction of scrapings of histological material. The localization of this helminth inside the cavities of the human body is extremely rare. Only isolated cases of atypical localization of D. repens are described: in the organs of the chest, cervical lymphatic node in the spermatic cord and epididymis, which led to pseudotumor formations that needed to be differentiated with neoplastic processes. This case is of great interest to experts of various fields (surgeons, oncologists, infectious disease specialists and pathologists), primarily in the differential diagnosis of malignant neoplasms of the lymphatic system.

Terapevticheskii arkhiv. 2020;92(11):62-64
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Administration of the immunomodulatory drug aminodihydrophthalazinedione sodium for prevention of progression pneumonia induced COVID-19
Svistunov A.A., Makhnach G.K., Bunina D.V., Khorobrykh T.V., Volgin M.V., Agadzhanov V.G., Mishchenko N.P., Gandybina E.G.
Abstract

Aim – to determine the efficacy of drug aminodihydrophthalazinedione sodium (Galavit) for prevention of progression of the coronavirus infection pulmonary complications: acceleration of regression of pulmonary infiltrates and resolution of COVID-induced pneumonia. 22 patients with medium and severe COVID-induced pneumonia were included in the study. The study included 8 men and 14 women, the average age was 62.1±7.4 years. Patients with more than one adverse prognostic factor made 82%. Average volume of pulmonary tissue affection (computer tomography – CT-2, 25–50% of lung volume) was registered in 13 (59.1%) patients, significant volume (CT-3, 50–75% of lung volume), in 9 (40.9%) patients. All patients had progressive respiratory failure manifestations due to hypoxemia and related diseases. Aminodihydrophthalazinedione sodium was administered for 7–14 days from the beginning of disease, at the end of the course of standard complex therapy, in case of preservation of signs of intoxication, negative dynamics according to computer tomography data. Administration of aminodihydrophthalazinedione sodium had a positive effect on the dynamics of clinical scores. The progression of respiratory failure was halted and there was an increase in SpO2 values. According to the control computer tomography data the stabilization of the pulmonary parenchyma affection degree was noted, as well as reduction of the size of the compacted areas in the pulmonary tissue and formation of the picture of organising pneumonia that contributed to reduction of respiratory failure grade. The use of aminodihydrophthalazinedione sodium in complex therapy of COVID-induced pneumonia has a modulating effect on the immune system, prevents the progression of pulmonary tissue affection, promotes regression of infiltration foci, preventing the development of excessive pneumofibrosis and the progression of respiratory failure.

Terapevticheskii arkhiv. 2020;92(11):65-70
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Reviews
Opportunities for use the cascade model of medical care for people living with HIV
Pokrovskaya A.V., Pokrovskiy V.V., Akimkin V.G.
Abstract

The HIV cascade model can be used as an epidemiological surveillance tool and for assessing the quality of medical care for HIV-positive people. It is possible to use the model for the entire population of people living with HIV, in various socio-demographic groups, by region, years and other indicators. This article describes the features of a HIV cascade model depending on the goals for its use.

Terapevticheskii arkhiv. 2020;92(11):71-76
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Epidemiological and clinical aspects of diagnosis, treatment and prophylaxis of imported malaria cases in Russian Federation
Tokmalaev A.K., Baranova A.M., Maleev V.V.
Abstract

Actually one of the main tasks of health workers in the field of the tropical diseases prevention (malaria) is early detection of malaria imported cases and efficacious treatment. In order to prevent the re-establishment of local malaria transmission by Anopheles mosquitoes from imported malaria cases, and fatal cases of disease there is develop and implement the Case Management Protocol of malaria diagnosis and treatment (2014, 2019) based on long-term experience of epidemiologists and clinicians, taking into account recommendations of WHO (2013, 2015). In this article the main principles of diagnosis and treatment of different malaria species Plasmodium falciparumand Plasmodium vivax-malaria, prophylaxis measures of autochthonous cases from imported cases of the word endemic region are discussed.

Terapevticheskii arkhiv. 2020;92(11):77-81
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Risks of oncologic pathology in parasitosis at the present time
Omarova K.G., Aleshina N.I., Ponezhevа Z.B., Gorelov A.V., Maleev V.V., Akimkin V.G.
Abstract

An analysis of published literature data on the relationship of parasitic diseases and oncogenesis is carried out. Current knowledge about the association of parasitic infections and cancer formation has revealed several carcinogenic mechanisms, but the severity of the relationship between parasites and cancer formation (except for schistosome, opisthorchis and clonorchis) should be confirmed in future experimental and population studies.

Terapevticheskii arkhiv. 2020;92(11):82-85
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Current view on Blastocystis species: clinical forms, diagnosis and treatment
Maleev V.V., Tokmalaev A.K., Kozhevnikova G.M., Tsvetkova N.A., Polovinkina N.A., Golub V.P., Maksimova M.S., Barysheva I.V., Konnov V.V., Kharlamova T.V.
Abstract

The symptomatic form of Blastocystis spp. infection not only with mild diarrhea or dysentery-like syndrome, but also with the development of severe ulcerative necrotic lesions of the intestine. Meanwhile, the pathogenicity of these microorganisms should not be exaggerated, due to majority asymptomatic cases or infection transmission with minor impaired bowel function.

Terapevticheskii arkhiv. 2020;92(11):86-90
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Umifenovir and coronavirus infections: a review of research results and clinical practice
Leneva I.A., Pshenichnaya N.Y., Bulgakova V.A.
Abstract

Coronaviruses are known to cause acute respiratory infections. Antiviral therapy, including for COVID-19, is based on clinical practice, experimental data and trial results. The purpose of this review is to: provide and systematize actual preclinical data, clinical trials results and clinical practice for antiviral agent umifenovir (Arbidol). Databases Scopus, Web of Science, RSCI and medRxiv were used for publication searching from 2004. A meta-analysis of clinical trials results was performed. Umifenovir is antiviral agent, it belongs to fusion inhibitors, interacts with SARS-CoV-2 spike protein. Umifenovir the impede the trimerization of spike glycoprotein and inhibit host cell adhesion, at the level of the coronaviruses S-protein of interaction with ACE2 receptor. Preclinical studies in vitro and on animals show umifenovir activity against a number of coronaviruses, including SARS-CoV, MERS-CoV, SARS-CoV-2, and others. Umifenovir, in combination with other antiviral drugs, symptomatic or traditional medicine, was used in China to treat patients with COVID-19, resulting in reduced mortality, virus elimination, the frequency of more severe course and complications in middle severity. However, antiviral therapy for the treatment of severe patients, with ARDS, did not lead to improved outcomes. In comparative clinical studies, umifenovir showed similar effectiveness with other antiviral drugs, and lower frequency of adverse reactions. Therapy with umifenovir, led to an increase percentage of patients with negative results of PCR tests on days 7–14 (I2=69.8%, RR 0.48, 95% CI 0.19–0.76; p=0.001). The efficacy and safety of antivirals against SARS-CoV-2 still requires clinical investigation. Moderate forms of COVID-19 could be effectively treated by antivirals, but severe forms of COVID-19, characterized by pulmonary immunopathology, require different approaches to treatment.

Terapevticheskii arkhiv. 2020;92(11):91-97
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The role of vitamin D in seasonal acute respiratory viral infections and COVID-19
Pigarova E.A., Povalyaeva A.A., Dzeranova L.K., Rozhinskaya L.Y., Mokrysheva N.G.
Abstract

A link between vitamin D deficiency and susceptibility to infectious diseases was suggested over a hundred years ago. Epidemiological studies show a strong association between seasonal fluctuations in vitamin D levels and the incidence of various infectious diseases, including septic shock, acute respiratory infections, and influenza. Our understanding of vitamin D metabolism and its extra-skeletal functions has improved significantly over the past three decades, and the discovery that the vitamin D receptor and 1a-hydroxylase, an enzyme needed to convert vitamin D to its active form, is present in the cells of the immune system, revolutionized in this area. Recent studies have shown that vitamin D regulates the expression of specific endogenous antimicrobial peptides in immune cells, modulates the immune response and the course of autoimmune processes; these actions indicate the potential role of vitamin D in modulating the immune response to various infectious diseases. This publication reviews the literature on the effects of vitamin D on immunity, its potential in the prevention and treatment of viral diseases, with a particular focus on COVID-19.

Terapevticheskii arkhiv. 2020;92(11):98-105
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Urinary tract infections in patients with type 2 diabetes mellitus with pharmacological glucosuria
Sturov N.V., Popov S.V., Mamporia N.K., Mager A.A.
Abstract

Selective inhibitors of sodium-glucose cotransporter belong to a new class of drugs for the treatment of type 2 diabetes mellitus. The mechanism of their action is based on insulin-independent reduction of glucose reabsorption in the proximal renal tubules, which leads to stimulation of its excretion in the urine and, accordingly, to a decrease in the concentration of glucose in the blood plasma. Drugs of this group demonstrate effectiveness in the treatment of type 2 diabetes, but their use may be associated with an increased frequency of urinary tract infections. Pharmacological glucosuria, which leads to a decrease in the concentration of glucose in the blood, creates the preconditions for the occurrence of urinary tract infections. Urinary tract and genital infections are the most common adverse events associated with the use of sodium-glucose cotransporter inhibitors. In the presented literature review for 2016–2019, the relationship between urinary tract infections in patients with type 2 diabetes mellitus and therapy with sodium-glucose cotransporter inhibitors was analyzed.

Terapevticheskii arkhiv. 2020;92(11):106-109
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The problem of global development of antibiotic resistant nosocomial pathogens
Gabrielyan N.I., Sharapchenko S.О., Kisil О.V., Kormilitsina V.G., Drabkina I.V., Safonova Т.B., Petrukhina М.I., Saitgareev R.S., Zakharevich V.М.
Abstract

The problem of global expansion of multidrug-resistant nosocomial infections pathogens is under special attention at the moment. Antibiotic resistance increasing give us the limited treatment options. This problem is particularly acute for transplant clinics, because of patients need lifelong immunosuppressive therapy. From the one hand this ensures stable allograft functioning, but from the other – increases the risk of severe infectious complications in the postoperative period. The purpose of this article is analysis carbapenem resistance dynamics of Klebsiella spp., Acinetobacter spp., Pseudomonas spp. and Staphylococcus spp. isolated from the blood of recipients of donor organs from 2009 to 2019 in the Shumakov National Medical Research Center of Transplantology and Artificial Organs. A significant annual decrease of carbapenem-sensitive strains of Klebsiella spp. and Acinetobacter spp. are shown. The study of a distinctive pathogen resistance profile specific to each institution can help one in selecting an adequate antimicrobial strategy and is an effective predictive tool for controlling the growth of multidrug-resistant microorganisms.

Terapevticheskii arkhiv. 2020;92(11):110-116
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Lecture
Visceral leishmaniasis: a challenging diagnosis in internal medicine
Brovko M.I., Akulkina L.A., Potapov P.P., Sholomova V.I., Lebedeva M.V., Nekrasova T.P., Varshavskii V.A., Volchkova E.V., Rozina T.P., Nikulkina E.N., Karan L.S., Moiseev S.V., Fomin V.V.
Abstract

Leishmaniasis is a vector-born parasitic disease characterized by predominant cutaneous or visceral involvement with fever, hepatosplenomegaly and anemia. Leishmaniasis has relatively high prevalence in tropical and subtropical areas. Several sporadic and mostly imported cases are detected in Russian Federation. Nevertheless, some local incidents are noted in southern areas (Crimea, Dagestan). Lack of epidemiological alertness hampers confirmation of diagnosis and may lead to incorrect treatment. The article summarizes current state of knowledge in epidemiology, diagnostic approach and treatment of leishmaniasis. Particular clinical case is discussed.

 

Terapevticheskii arkhiv. 2020;92(11):117-121
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Meta-analysis
A network meta-analysis of the efficacy and safety of baloxavir marboxil versus neuraminidase inhibitors for the treatment of influenza in otherwise healthy patients
Taieb V., Ikeoka H., Ma F., Borkowska K., Aballea S., Tone K., Hirotsu N.
Abstract

Aim. Baloxavir marboxil (baloxavir) is the first cap-dependent endonuclease inhibitor being studied for the treatment of influenza in single oral dosing regimen. This network meta-analysis (NMA) evaluated the efficacy and safety of baloxavir compared to other antivirals for influenza in otherwise healthy patients.

Methods. A systematic literature review was performed on 14 November 2016 in Medline, Embase, CENTRAL, and ICHUSHI to identify randomized controlled trials assessing antivirals for influenza. A NMA including 22 trials was performed to compare the efficacy and safety of baloxavir with other antivirals.

Results. The time to alleviation of all symptoms was significantly shorter for baloxavir compared to zanamivir (difference in median time 19.96 h; 95% CrI [3.23, 39.07]). The time to cessation of viral shedding was significantly shorter for baloxavir than zanamivir and oseltamivir (47.00 h; 95% CrI [28.18, 73.86] and 56.03 h [33.74, 87.86], respectively). The mean decline in virus titer from baseline to 24 h was significantly greater for baloxavir than for the other drugs. Other differences in efficacy outcomes were not significant. No significant differences were found between baloxavir and the other antivirals for safety, except total drug-related adverse events where baloxavir demonstrated a decrease compared to oseltamivir and laninamivir.

Conclusion. The NMA suggests that baloxavir demonstrated better or similar efficacy results compared to other antivirals with a comparable safety profile. Baloxavir led to a significant decrease in viral titer versus zanamivir, oseltamivir and peramivir and decreased viral shedding versus zanamivir and oseltamivir.

Terapevticheskii arkhiv. 2020;92(11):122-131
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Obituary
In memory of academician V.I. Pokrovsky (04/01/1929 - 10/29/2020)
 
Abstract

In memory of academician V.I. Pokrovsky (04/01/1929 - 10/29/2020)

Terapevticheskii arkhiv. 2020;92(11):132-132
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