Vol 93, No 4 (2021)

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Full Issue

Nuclear medicine and molecular imaging in clinical practice: yesterday, today and tomorrow
Sergienko V.B., Ansheles A.A.

Over the past 40 years, nuclear medicine has grown to be the largest non-invasive diagnostic and therapeutic industry in the world, playing a pivotal role in various fields and disciplines of clinical practice and contributing to improved quality of life and patient prognosis. Over the first 20 years of the XXI century, the number of radionuclide procedures in the world has increased significantly, primarily due to innovations in radiopharmaceuticals, continuous improvement of the technical properties of equipment and the expansion of the boundaries of multimodal imaging. The review examines the historical and current trends in the development of nuclear medicine in the world and in Russia, including those related to radionuclide diagnostics, therapy and theranostics.

Terapevticheskii arkhiv. 2021;93(4):357-362
Original articles
Clinical and angiopulmonographic association in pulmonary embolism
Mazur E.S., Mazur V.V., Rabinovich R.M., Bachurina M.A.

Aim. To detect the effect of the feature of the pulmonary vascular obstruction on the clinical manifestations of pulmonary embolism (PE).

Materials and methods. The 127 patients with PE were included in this study. PE verified with multidetector computed tomography with pulmonary angiography. Among them were 57 patients with high-risk PE, and 39 patients with intermediate-risk PE and 31 patients with low-risk PE. The pulmonary artery obstruction index and the obstruction level were determined.

Results. The mean values of the pulmonary artery obstruction index in high and intermediate risk patients were 42.5%, and in low risk patients – 12.5% (p<0.001). The trunk or main branches obstruction was in 80.7% of high-risk PE patients, the main or lobar branches obstruction – in 92.3% of intermediate-risk patients and lobar or segmental branches obstruction – in 93.5% of low-risk patients. Pulmonary infarction was detected in 89.2% of patients with the segmental branches obstruction and with another level of obstruction – in 28.0% of patients only (p<0.001).

Conclusion. The hemodynamic disorder in pulmonary embolism associate with the pulmonary artery obstruction index of more than 30%. The development of obstructive shock is associated with the pulmonary artery trunk obstruction, and the development of pulmonary infarction associated with the segmental branches obstruction.

Terapevticheskii arkhiv. 2021;93(4):363-368
Peculiarities of sonoelastographic imaging of thyroid papillary cancer in presence of autoimmune thyroiditis
Khachatryan A.R., Vardanyan G.J., Avetisyan G.A., Chomoyan A.S., Baghdasaryan S.E., Porksheyan K.A.

Aim. To determine the features of visualization of papillar thyroid cancer (PTC) in presence of autoimmune thyroiditis (AIT) according to sonoelastography data.

Materials and methods. 155 patients were examined (75 – PTC, 30 – AIT, 20 – PTC in presence of AIT and 30 – with diffuse parenchymal changes) and 30 patients of the control group. Among patients with PTC 68 (90.7%) were represented by female (mean age 46.7±13.12 years) and 7 (9.3%) – by male (average age – 48.1±4.05 years) patients, PTC in presence of AIT – by 19 female (average age 46.9±16.98 years) and 1 male (22 years) patients. Ultrasound investigation was performed with devices Toshiba Aplio-400 and Toshiba Aplio-500 (Japan) by the standard method and using elastography. A surface transducer with a frequency of 10–14 MHz was used. An analysis of the thyroid ultrasound image was performed in correspondence with TI-RADS. For a qualitative assessment of the elastographic picture of thyroid foci, the Tsukuba–Ueno assessment visual standardized system was implemented.

Results. According to the TI-RADS scale, most nodular formations are assigned to category 4. With TPC with an unchanged thyroid gland, category 4 was determined in 52 patients (69.3%), and with PR in presence of AIT – 15 patients (75%). When determining the qualitative criteria for Tsukuba – Ueno, the majority of tumors were assigned to types 3b and 4: cancers in presence of AIT – 95% and cancers with no changes to thyroid gland – 81.3%. Sonoelastographic criteria for thyroid parenchyma with AIT with a high degree of confidence are significantly higher than in the control group (p<0.000). In a comparative analysis of thyroid sonoelastography in PTC with unchanged parenchyma and AIT, changes according to compression elastography are statistically unreliable. In shear wave elastography, sonoelastographic criteria for PTC are significantly higher in patients with AIT (p<0.02 when measured in kPa, p<0.01 when measured in m/s).

Conclusion. Sonoelastography data can be used as additional criteria in the differential diagnosis of focal thyroid formations.

Terapevticheskii arkhiv. 2021;93(4):369-375
Cardiovascular magnetic resonance in myocardial infarction with non-obstructive coronary arteries
Pershina E.S., Shchekochikhin D.Y., Shaginyan G.M., Shilova A.S., Sherashov A.V., Poltavskaya M.G., Isaeva S.K., Gilyarov M.Y., Svet A.V., Sinitsyn V.E.

Aim. To analyze diagnostic performance of cardiovascular magnetic resonance (CMR) in patients, presented with myocardial infarction with nonobstructed coronary arteries (MINOCA).

Materials ant methods. 46 consecutives patients presented with myocardial infarction without evidence of obstructive coronary disease on angiography between January, 1 2018 and October 1, 2019 were included in the study. All patients underwent CMR within 10 days after admission. MRI was performed on 1.5 T Magnetic Resonance Imaging (MRI) using comprehensive protocol (T2-images, Cine-CMR, late gadolinium enhancement (LGE)).

Results. CMR revealed myocardial infarction (MI) pattern in 14 patients (30.4%), myocarditis in 12 (26.1%), hypertrophic cardiomyopathy in 6 (13.1%). In 14 patients (30.4%) no LGE was observed. Notably in 2 patients without LGE features of takotsubo syndrome were noted. Mean age was significantly lower in patients with MI versus patient with non-ischemic causes of MINOCA (56.1±12.3 vs 64.6±12.8; p=0.04). ST elevation at admission frequency didn’t differ between MI and non-ischemic patients (35.7% vs 25.0%; p=0.76). However MI patients had significantly increased troponin level, 0.87 [0.22; 1.85] vs 0.22 [0.07; 0.38]; p=0.008. CMR allowed to establish the précised clinical diagnosis in 73.9% of the cases.

Conclusion. Clinical data doesn’t allow to differentiate ischemic or non-ischemic causes of MINOCA. However, CMR establish the correct diagnosis in most cases.

Terapevticheskii arkhiv. 2021;93(4):376-380
Familial left ventricular noncompaction: phenotypes and clinical course. Results of the multicenter registry
Kulikova O.V., Myasnikov R.P., Mershina E.A., Pilus P.S., Koretskiy S.N., Meshkov A.N., Kiseleva A.V., Kharlap M.S., Sinitsyn V.E., Sdvigova N.A., Gandaeva L.A., Barskiy V.I., Derevnina Y.V., Zharova O.P., Basargina E.N., Boytsov S.A., Drapkina O.M.

Aim. To analyze and demonstrate various phenotypes in patients with familial left ventricular noncompaction (LVNC).

Materials and methods. In 2013 was created a multicenter registry of LVNC patients. On its basis 30 families with a familial LVNC were selected.

Results. 30 LVNC families were selected from the register. From a total of 115 people (probands and relatives) in 71 (61.7%) LVNC was diagnosed (30 probands and 41 relatives with non-compact myocardial criteria). The most common type of remodeling in patients was the dilated type (DT) (n=30), the isolated LVNC with preserved ejection fraction (EF) was slightly less common (n=23), and the hypertrophic type (GT) was detected in 8 patients. 4 patients were diagnosed with the isolated LVNC with a reduced EF. 3 patients were with a combination of non-compact myocardium with congenital heart disease and with a combination of DT and GT (DT+GT). During the analysis of cases a combination of different phenotypes in the same family was observed. The largest number of families was diagnosed with a combination of DT and the isolated LVNC with preserved EF. The development of cardiovascular complications was associated with DT.

Conclusion. Family cases of LVNC had different types of myocardial remodeling and variants of clinical course. In one family a combination of different types of left ventricular remodeling is possible. DT is associated with the most severe clinical manifestations. The clinical picture of the isolated LVNC with preserved EF, is the most favorable, but in rare cases, serious clinical manifestations were observed.

Terapevticheskii arkhiv. 2021;93(4):381-388
Chromogranin A in diagnosis of pheochromocytoma (comparative analysis)
Yukina M.Y., Karpova P.L., Troshina E.A., Platonova N.M., Beltsevich D.G.

Aim. To study the prognostic value of determining Chromogranin A blood level in the diagnosis of PHEO.

Materials and methods. We conducted a comparative analytical study of 157 patients with suspected PHEO, statistical analysis of 24-hour urinary metanephrine and normetanephrine excretion test was performed, as well as a blood test for CrA, in groups that included patients without PHEO, with primary tumor or its recurrence, confirmed according to MSCT and/or scintigraphy with MIBG and/or the clonidine suppression test.

Results. The parameters of efficiency of these methods were calculated by groups and it was noted that the lowest sensitivity of the CrA determination method was observed in the group with recurrence of PHEO (43.8%), their exclusion from the entire sample didn’t change specificity of the method and it remained at a high level (85.45%), though sensitivity significantly increased up to 87.1%. Sensitivity of determining 24-hour urinary metanephrine excretion also increased significantly up to 96.8%, with 98.2% of specificity. The correlation between diameter of the tumor and its secretory activity was identified: small – with CrA level (rho 0.491) and strong – with total level of methylated catecholamines (rho 0.765). False positive results were more often observed in patients present with other neuroendocrine tumors (37.5%), as well as those taking proton-pump inhibitors (43.75%). The sensitivity and specificity of CrA determining method in the group of patients with methanephrins elevated within “gray zone” appeared to be 50 and 86.1%, respectively.

Conclusion. A blood test for CrA can be recommended as a confirmatory test for diagnosing PHEO in cases of questionable methylated catecholamines indicators or in cases of suspected relapse of PHEO. The use of the test as a first-line method is only possible if there is no possibility to study methylated catecholamines. When interpreting CrA level, it is necessary to take into account the conditions that may cause false-positive results.

Terapevticheskii arkhiv. 2021;93(4):389-396
Aortic stiffness and content of adipokines in the serum in persons of European and South Asian ethnic
Brodskaya T.A., Repina N.I., Nevzorova V.A., Plekhova N.G., Shumatov V.B.

Aim. To evaluate the cardiovascular risk (CVR) based on arterial stiffness and content of adipokines in young-aged persons of different ethnicity (European and South Asian).

Materials and methods. 290 persons of European (Slavic) and South Asian (Korean) ethnicity aged from 19 to 49 years with and without arterial hypertension (AH) were examined. Clinical, anthropometric, laboratory examinations were performed, levels of resistin and adiponectin of blood were assessed. Total CVR was assessed by SCORE scale, patients under the age of 40 years were assessed by relative risk scale. Aortic stiffness was examined by non-invasive arteriography.

Results. Patients of European ethnicity had higher blood pressure (BP), body mass index (BMI), waist circumference (WC), levels of resistin and adiponectin. Pulse wave velocity in the aorta (PWVA) did not differ significantly in ethnic groups. According to the SCORE scale in individuals of the European and South Asian races in general groups and groups with arterial hypertension a moderate absolute risk was determined, in individuals under 40 years of age a moderate relative risk was determined without a significant difference between the groups. However increased levels of PWVA (more than 10 m/s) were registered more often in Korean ethnicity (46.9% compared to Slavic ethnicity, 22.2%). Closer reliable correlations between the level of BP and BMI, WC, PWVA were revealed in Korean ethnicity. Ethnic differences in correlation of adipokines in blood and their dependence on anthropometric and hemodynamic characteristics were described.

Conclusion. The assessment of CVR according to traditional scales does not always accurately represent its real level. New information was obtained on the features of adipokine metabolism and its connections with early manifestations of vascular remodeling in young-aged depending on the race. Taking into account ethnic differences, we recommend in-depth diagnostics of CVR in South Asians. The data can be useful for the design of personalized programs for the diagnostics and assessment of CVR.

Terapevticheskii arkhiv. 2021;93(4):397-403
Analysis of the effectiveness of multiple myeloma treatment based on the clinical experience of European countries
Ptushkin V.V., Mueller M.

Aim. The main aim of this study was to model the effectiveness of multiple myeloma (MM) therapy using machine learning, which was based on the analysis of various methods of MM treatment, a number of prognostic factors and their results in the daily routine clinical practice of medical centers in European countries.

Materials and methods. The present study was retrospective, non-interventional, multicenter. A structured database of MM patients provided by the Oncology Information service (O.I.s.) was used for the study. Registration took place in medical institutions in eight countries: Austria, Belgium, Switzerland, Germany, Spain, France, Greece and Great Britain.

Results. In total, 57% of men and 43% of women were analyzed in the base of 6074 patients with MM. The median age was 71 years. The median follow-up time along the lines was 387 days. High-risk cytogenetics are represented in 15% of cases. The efficacy endpoint was the best response to each line of therapy, as measured by time to death (TTD) as an indirect indicator of overall survival and time to next treatment (TTNT) as an indirect indicator of progression-free survival. The median TTD and TTNT were 730 and 399 days respectively. After a multi-step selection process, characteristics with the greatest importance for the therapy prognosis were selected: age at the beginning of therapy, line of therapy, time after MM verification, ECOG (Eastern Cooperative Oncology Group), cytogenetic risk, transplant eligibible or not, TTNT after the previous line of therapy, therapy regimen.

Discussion. To continue the study it is necessary to analyze literature data and compare with real practice. Also analysis and comparison with Russian data on the treatment of patients with MM is required.

Conclusion. The analysis of the presented data provides a basis for modeling a tool for assessing the effectiveness of MM therapy (prognosis of TTD and TTNT) for each patient, based on a number of prognostic factors and the results of routine clinical practice in various medical centers in European countries.

Terapevticheskii arkhiv. 2021;93(4):404-414
Mobile application “Aterostop” for a comprehensive assessment of cardiovascular risk in patients in the Russian population
Sergienko I.V., Ansheles A.A., Boytsov S.A.

The article provides an overview of an innovative software product for a comprehensive assessment of cardiovascular risk in cardiac patients in the Russian Federation. Based on the new recommendations of the Russian National Atherosclerosis Society (2020), the Aterostop application allows to assess cardiovascular risk, determine the patient’s achievement of target levels of low-density lipoprotein cholesterol, and also provides recommendations for correcting lipid-lowering therapy. The calculator is implemented as a web browser version, as well as a mobile application for Android and iOS platforms.

Terapevticheskii arkhiv. 2021;93(4):415-420
Impact of summer heat waves on key parameters of oxidative stress in patients with coronary artery disease
Osyaeva M.K., Tikhaze A.K., Konovalova G.G., Heimets G.I., Martynyuk T.V., Lankin V.Z.

Aim. To assess the impact of summer heat waves on key parameters of oxidative stress in patients with coronary heart disease.

Materials and methods. We included 30 male patients aged 52±13 years with stable angina pectoris of II–III functional class with at least one coronary artery stenosis proved by angiography (ischemic group) in comparison with 10 male patients aged 48±7 years with no angiographic sings of significant coronary stenosis and without angina manifestation (non-ischemic group). The following parameters were studied: activity of superoxide dismutase (Cu,Zn-SOD), catalase (CAT), glutathione peroxidase (GSH-Px), the level of malondialdehyde (MDA) and MDA-modified low-density lipoproteins (MDA-LDL). The analysis of indicators was performed at normal average daily temperature (daytime temperature not higher than 20°С) and after a heat wave (daytime temperature above 27°C for more than 2 consecutive days).

Results. Our study revealed the decrease of CAT and GSH-Px activities with increased activity of Cu,Zn-SOD in both groups after the heat wave. At the same time we observed accumulation of MDA and increased MDA-LDL level in both groups. Initially ischemic patients showed significantly increased level of CAT and GSH-Px activity compared to the non-ischemic group, while it was no difference in activity of Cu,Zn-SOD and MDA and MDA-LDL level. We observed significant reduce of Cu,Zn-SOD activity in ischemic patients compared to non-ischemic group with no significant differences in all other studied parameters of oxidative stress after heat wave.

Conclusion. Changes in the key parameters of oxidative stress in patients with ischemic heart disease during summer heat waves are comparable to those in patients without ischemia, however significantly greater inhibition of GSH-Px activity and significantly lower increase in Cu,Zn-SOD activity was noted. These results may indicate misregulation of free radical processes in patients with ischemic heart decease

Terapevticheskii arkhiv. 2021;93(4):421-426
Liver and COVID-19: possible mechanisms of damage
Mnatsakanyan M.G., Pogromov A.P., Lishuta A.S., Fomin V.V., Volkova O.S., Tashchyan O.V., Kuprina I.V., Shumskaya Y.F.

The global epidemic of a new coronavirus infection caused by SARS-CoV-2 is a major threat to human health. In the clinical picture, along with acute respiratory distress syndrome, liver lesions are also noted. The following mechanisms are currently being considered: direct damaging effects of SARS-CoV-2, immuno-mediated inflammation, hypoxia, drug exposure, and reactivation of pre-existing liver disease. We studied 150 patients with COVID-pneumonia who are under inpatient treatment at the University Clinical Hospital No. 1 of Sechenov First Moscow State Medical University. Of these, the presence of SARS-CoV-2 RNA was confirmed by polymerase chain reaction in 84 (56.0%) patients. In 55 (36.7%) patients, an increase in serum aminotransferases was registered, mainly alanine aminotransferase max. up to 572 U/L and aspartate aminotransferase up to a max. of 232 U/L. The long-term consequences are unknown and require monitoring of these patients.

Terapevticheskii arkhiv. 2021;93(4):427-430
The role of a combined probiotic in the treatment of lactase deficiency
Ruchkina I.N., Fadeeva N.A.

Aim. To study the effectiveness of the combined probiotic Bifiform and the enzyme lactase in the treatment of secondary lactase deficiency (SLD).

Materials and methods. We examined 79 patients with SLD, isolated from the group of patients with post-infectious irritable bowel syndrome (IBS) with a predominance of diarrhea. The age of patients reached 27±3.5 years, women predominated by gender – 62%. Diagnosis of SLD was carried out in biopsies of the small intestine mucosa using a color rapid test. To diagnose small intestinal bacterial overgrowth (SIBO) all patients underwent lactulose breath test (LBT) during 2 hours by gas analyzer. All patients with lactase deficiency (LD) were divided into 2 groups: group 1 included 54/79 patients who received the combined probiotic Bifiform (1 capsule per day), group 2 was treated with the enzyme lactase [1 capsule (3450 ME) 3 times a day]. The effectiveness of therapy was evaluated by the dynamics of clinical symptoms, indicators of LBT and the detection of hypolactasia in biopsies of the small intestine mucosa twice, before and 2 weeks after treatment.

Results. In the group of patients with LD, as a result of 14-day therapy with the combined probiotic Bifiform, 85.2% showed positive clinical dynamics, the values of SIBO in the small intestine decreased from 58±14 to 21±9 ppm, p≤0.05, and the activity of the lactase enzyme was completely restored. In 14.8% of patients, LD was preserved against the background of persistent SIBO. In the second group of 25 patients, 84% of patients did not achieve a positive dynamics of the disease as a result of taking the lactase enzyme, and hypolactasia and changes in the lumen microflora of the small intestine were preserved after repeated examination of small intestine biopsies. Recovery of the activity of the lactase enzyme was observed in a small percentage of patients, which was 16%.

Conclusion. In 85.2% of patients, as a result of therapy with the combined probiotic Bifiform, the activity of the lactase enzyme was restored, due to the suppression of bacterial contamination in the lumen of the small intestine. Replacement therapy with the enzyme lactase only led to remission of LN in 14.2%, while in the majority – 85.8% – hypolactasia and SIBO remained. Pathogenetic therapy of LN in the adult population includes the appointment of a combined probiotic Bifiform 1 capsule 3 times a day, a course of at least 14 days. As a symptomatic therapy for LN, replacement therapy with the enzyme lactase can be prescribed.

Terapevticheskii arkhiv. 2021;93(4):431-434
Experience of the preventive use of the drug Riamilovir in the foci of coronavirus infection (COVID-19)
Sabitov A.U., Sorokin P.V., Dashutina S.Y.

Aim. The assessment of the effectiveness, safety and tolerance of the drug Riamilovir for emergency drug prevention in the foci of a new coronavirus infection (COVID-19).

Materials and methods. The trial included 113 persons aged 18 years and older who had level 1 contacts with patients with a new coronavirus infection (COVID-19), who had not previously been ill, with negative PCR results for COVID-19.

Results. The high effectiveness, safety and good tolerance of the preventive use of the drug Riamilovir for the period of 20 days of taking a prophylactic dose of 1 capsule (250 mg) per day in the foci of COVID-19 has been established.

Conclusion. The effectiveness and safety of the preventive use of the drug Riamilovir allow to recommend it for emergency drug prophylaxis in contact persons in the foci of a new coronavirus infection (COVID-19).

Terapevticheskii arkhiv. 2021;93(4):435-439
Features of antihypertensive therapy and real-world prescription of selective imidazoline receptor agonists in Russia vs other countries: STRAIGHT study data analysis
Konradi A.O., Zvartau N.E., Chazova I.E., Zhernakova J.V., Schutte A.E., Schlaich M.P.

Analysis of routine clinical practice of hypertensive patient management represents one of the important tools in the search for further ways to minimize hypertension-associated cardiovascular and renal adverse outcomes.

Aim. To compare the strategies for hypertension management and features of clinical use of I1-imidazoline receptor (I1-IR) agonists in the Russian Federation and other countries where the STRAIGHT (Selective imidazoline receptor agonists Treatment Recommendation and Action In Global management of HyperTension) study was conducted.

Materials and methods. It was a cross-sectional online study involving physicians of various specializations. The study was conducted from January 18 to July 1, 2019, in seven countries with a high rate of I1-IR agonist prescription, including Russia.

Results. A total of 125 (4.5%) responders filled out the survey in the Russian Federation, which was somewhat lower than in other countries (6.8%). The participants were mostly general practitioners (54.0%) and cardiologists (42.0%), while in other countries greater diversity was seen. Most Russian physicians (83.0%) seemed to rely on national clinical guidelines in their routine practice, while in other countries the US guidelines were more popular (66.0%). The majority of responders stated that they took into account the traditional risk factors of hypertension when initiating the therapy; every second responder noted if sleep apnea was present. Awareness of I1-IR agonists, their prescription rate and their preference were higher in Russia. The main reported benefits of I1-IR agonists were their efficacy, including in resistant hypertension, and their metabolic effects (in Russia). Most participants preferred I1-IR agonists as third-line therapy (65.0% in Russia vs 60.0% in other countries) and in combination with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blockers (ARB) (55.0% in Russia vs 54.0% in other countries). Compared to responders from other countries, Russian physicians prescribe I1-IR agonists as first-line (15.0% vs 5.0%) and second-line (48.0% vs 21.0%) therapy more often.

Conclusion. Russian physicians were the most aware of I1-IR agonists and tended to prescribe drugs of this class for hypertension management more often, and I1-IR agonist combination with ACEi was preferable compared to physician responders from other countries. Antihypertensive efficacy and metabolic effects were reported as the major benefits of I1-IR agonist therapy.

Terapevticheskii arkhiv. 2021;93(4):440-448
Peculiarities of Mild Asthma in Russia: the Results of SYGMA2 Study
Aisanov Z.R., Avdeev S.N., Arkhipov V.V., Belevsky A.S., Voznesenskiy N.A.

Aim. Patients with mild asthma may experience severe exacerbations. This analysis was conducted to investigate regional peculiarities of mild asthma population in Russia.

Materials and methods. The SYGMA2 is a double-blind multinational study involving adult patients with mild asthma (n=4176). We conducted an open-label descriptive analysis of the baseline characteristics of the Russian group (n=579) of SYGMA2 trial comparing to SYGMA2 population from other countries. The subanalysis was descriptive only, and no hypothesis were tested.

Results. The Russian population of patients with mild asthma was comparable to the rest of countries in terms of demographic characteristics, smoking status and duration of asthma. The spirometric parameters in the Russian group was slightly worse than in the other population. At the study entry 48% of Russian patients had symptom control on maintenance therapy, but 52% were uncontrolled on short-acting bronchodilators. While in other countries this ratio was inverse (55/45%). More patients with mild asthma in the Russian group had at least one severe exacerbation in the previous year (30.1% vs 20.7% in other countries).

Conclusion. We revealed a delayed prescription of controller therapy and overuse of short-acting bronchodilators in the Russian group of mild asthma patients, that may increase risk of asthma non-control and severe exacerbation.

Terapevticheskii arkhiv. 2021;93(4):449-455
Efficiency of application of sorbed probiotics in complex therapy of pneumonia caused by SARS-CoV-2. Part 1. Heating clinical displays period
Meskina E.R., Tselipanova E.E., Khadisova M.K., Galkina L.A., Stashko T.V.

Aim. To determine the clinical efficacy and safety of the sorbed probiotics Bifidobacterium bifidum 1 (5×108 KОЕ) and B. bifidum 1 (5×107 KОЕ) in combination with Lactobacillus plantarum 8P-А3 in the complex therapy of pneumonia caused by SARS-CoV-2 in adult patients without severe risk factors.

Materials and methods. An open, randomized prospective study included 100 patients (45 men, 55 women), aged 18 to 60 years without risk factors for severe COVID-19 with pneumonia confirmed by computed tomography, and an area of lung lesion no more than 75% (moderate forms). SARS-CoV-2 RNA in nasal and oropharyngeal swabs (RT-PCR) was detected in 72% of the participants, in the rest it was highly probable in terms of the aggregate parameters. Diagnostics of COVID-19 and its severity, the appointment of a standard examination and treatment were carried out in accordance with the Temporary Methodological Recommendations of the Ministry of Health of Russia, version 8 of 09.03.2020. This publication presents the results of using B. bifidum 1 (3 capsules twice a day for 10 days) during the peak of clinical manifestations (in a hospital).

Results. In those who received sorbed B. bifidum 1, by the 10th day of treatment, the frequency of weakness was 32% lower (RR 0.55 [95% CI 0.24–0.73], OR 0.25 [0.11–0.59]); hypoosmia/dysgeusia – by 22% (RR 0.42 [0.05–0.65], OR 0.40 [0.17–0.90]) and cough – by 24% (RR 0.39 [0.07–0.60], OR 0.38 [0.17–0.84]). B. bifidum 1 reduced the average duration of weakness by 3 days [1.1–4.9], hypoosmia/dysgeusia by 3.2 days [1.3–5.1], cough by 1.9 days [0.4–3,4], dyspnea – by 1.8 days [0.7–2.7], diarrhea – by 1.7 days [0.1–3.5]; reduced the risk of antibiotic-associated diarrhea by 20% (RR 0.77 [0.24–0.93], OR 0.18 [0.05–0.68]). Due to the deterioration of the condition and the increase in the symptoms of respiratory failure, additional treatment was required less often by 24% (p=0.005). After the end of the intervention, the frequency of virologic debridement, levels of CRP, leukocytes, lymphocytes, platelets and the degree of lung damage on computed tomography did not statistically differ in the compared groups. No side effects of B. bifidum 1 (5×108 KОЕ) have been identified.

Conclusion. The use of sorbed B. bifidum 1 (5×108 KОЕ) improved the well-being of patients without risk factors with moderate viral (SARS-CoV-2) pneumonia and reduced the duration of diarrheal syndrome in a short time. The safety profile of their use was high. More research is needed to clarify the anti-inflammatory effects of the sorbed probiotic.

Terapevticheskii arkhiv. 2021;93(4):456-464
Clinical notes
Tachicardia-induced cardiomyopathy. Case report
Atabegashvili M.R., Shchekochikhin D.Y., Gromyko G.A., Pershina E.S., Bogdanova A.A., Nesterov A.P., Shilova A.S., Gilyarov M.Y., Svet A.V.

The tachycardia-induced cardiomyopathy is a rare case of reversible heart failure and left ventricle disfunction. The diagnostic approach and treatment strategy are described in this article. Also the clinical case of heart failure compensation in the patient with left ventricle dilatation and atrial flutter after the reverse to sinus rhythm is after catheter ablation presented.

Terapevticheskii arkhiv. 2021;93(4):465-469
Сardiac myxoma: challenge in diagnostics. Case report
Fomin V.V., Kogan E.A., Morozova N.S., Chichkova N.V., Komarov R.N., Kurasov N.O., Dgengera N.A., Romanova V.I., Sedov A.V., Sarkisova N.D., Shelukha P.A.

Cardiac myxoma is the most common primary benign cardiac tumor (up to 50% of all primary cardiac neoplasms). The implementation of the modern imaging techniques into the clinical practice, particularly, 2D e–chocardiography, computed tomography and magnetic resonance tomography (MRI) results to the prompt diagnosis of the myxoma. However, the absence of specific clinical features, insufficient awareness of this condition among the physicians along with a rare prevalence, may lead to a misdiagnosis. This case report is notable for the relatively late diagnosis of a giant left atrial myxoma due to a number of circumstances but with successful surgical treatment.

Terapevticheskii arkhiv. 2021;93(4):470-477
Some features of the diagnostics of thrombophilia. Case report
Filev A.P., Portyannikova O.O.

Differential diagnosis of causes of the pulmonary embolism in patients can be associated with certain difficulties and requires the exclusion of a wide range of diseases. There is a description of a clinical case of pulmonary embolism caused by verified thrombophilia. Features of tactics of management and treatment of the patient according to modern views are given.

Terapevticheskii arkhiv. 2021;93(4):478-481
The periprocedural myocardial infarction and probability of the developing of the contrast-induced acute kidneys injury in clinical practice. Case report
Dmitrieva O.A., Mironova O.Y., Sivakova O.A., Denisova A.R., Solnceva T.D., Fomin V.V.

Nowadays, taking into account the number of elderly patients with sеveral associated diseases requiring percutaneous transluminal balloon coronary angioplasty (PTCA), the risk of the development of unwanted complications is also growing. In this article we present the clinical case, where the PTCA had complications with myocardial infarction of the 4a type without contrast-induced acute kidney injury (contrast-induced nephropathy).

Terapevticheskii arkhiv. 2021;93(4):482-486
AL-amyloidosis with cardiac involvement. Diagnostic capabilities of non-invasive methods
Gudkova A.Y., Lapekin S.V., Bezhanishvili T.G., Trukshina M.A., Davydova V.G., Krutikov A.N., Kulikov A.N., Streltsova A.A., Andreeva S.E., Grozov R.V., Poliakova A.A., Kostareva A.A., Salogub G.N., Shlyakhto E.V.

There are presented the literature data and a description of the clinical course of the disease in isolated/predominant cardiac amyloidosis. Amyloid cardiomyopathy is the most common phenocopy of hypertrophic cardiomyopathy. The modern possibilities of non-invasive diagnostics using osteoscintigraphy for the differential diagnosis between amyloid cardiomyopathy caused by AL- and transthyretin amyloidosis are described in detail.

Terapevticheskii arkhiv. 2021;93(4):487-496
The role of cardiac magnetic resonance imaging (cardiovascular magnetic resonance) in defining the prognosis of patients with acute ST-segment elevation myocardial infarction. Part 1. Indications and contraindications to cardiovascular magnetic resonance
Terenicheva M.A., Stukalova O.V., Shakhnovich R.M., Ternovoy S.K.

Recently, the role of cardiac magnetic resonance imaging (cardiovascular magnetic resonance) in the diagnosis of coronary artery disease and acute myocardial infarction has increased significantly. This method is defined as the “gold standard” for differentiation between ischemic vs non-ischemic and acute vs chronic myocardial injury. This part of the review summarizes the main methods of cardiovascular magnetic resonance, its safety, indications and contraindications.

Terapevticheskii arkhiv. 2021;93(4):497-501
Central hemodynamic monitoring in patients with cardiogenic shock
Syrkina A.G., Ryabov V.V.

Cardiogenic shock is the pathology most commonly encountered by intensive care physicians. Its frequency averages 4–10% in STEMI (ST-elevation myocardial infarction) patients and 2–4% in NONSTEMI (non-ST-elevation myocardial infarction) patients. Effective shock therapy is impossible without understanding the hemodynamic mechanisms of its occurrence. Many authors emphasize that cardiac output is the most important indicator of cardiac function, which necessitates its monitoring. Meanwhile, the cardiac output monitoring is associated with a number of difficulties, including those related to the technology of recording this function. In this article, the authors emphasize the importance of measuring central hemodynamic parameters in patients with predominantly cardiogenic shock. We have tried to structure the knowledge about different techniques of central hemodynamics monitoring, considered advantages and disadvantages of each of them. We believe that the data obtained by hemodynamic monitoring should be closely studied and used, because sometimes multidirectional mechanisms may be involved in the genesis of shock; therefore, therapy should be based on the data obtained in a particular patient.

Terapevticheskii arkhiv. 2021;93(4):502-508
Exocrine pancreas insufficiency: clinical significance and approaches to correction from evidence medicine
Maev I.V., Kucheryavyy Y.A., Andreev D.N.

Exocrine pancreatic insufficiency (EPI) is a common complication of both benign and malignant diseases of the pancreas, as well as a consequence of radical surgical operations on the pancreas and a whole range of other variable extra-pancreatic causes. In clinical practice in the adult population, most cases of EPI are associated with chronic pancreatitis, while in the pediatric population – with cystic fibrosis. The regression of the production of digestive enzymes in EPI mediates the development of the syndrome of maldigestion and malabsorption, leading to the progressive development of malnutrition, the importance of which is often underestimated by practitioners. At the same time, the development of nutritional deficiency is not just a complication of EPI, but also has an important effect on the course of the underlying causative disease, worsening the prognosis and quality of life of the patient, and is also a proven risk factor for osteoporosis and sarcopenia. To date, compensation for the absolute deficiency of pancreatic enzymes using enzyme replacement therapy is the only possible way to correct the EPI and prevent nutritional deficiency.

Terapevticheskii arkhiv. 2021;93(4):509-515
Mixed steatohepatitis: more questions than answers (part 2)
Raikhelson K.L., Kondrashina E.A., Pazenko E.V.

In this review, we discussed the epidemiological and pathogenetic aspects of mixed steatohepatitis (SH), developed due to non-alcoholic fatty liver disease, metabolic associated fatty liver disease, drug-induced liver injury. We discussed the mechanisms of the mutually aggravating influence of etiological factors. Drugs can cause steatosis and SH, as well as contribute to the progressive course of existing SH, primarily of metabolic origin. The issues of interaction of pathogenetic factors, peculiarities of diagnostics and perspectives of pathogenetic and symptomatic treatment are considered. Therapy of mixed SH is based on avoidance of hepatotoxic drugs and lifestyle modification, medications with demonstrated efficacy (such as ademetionine) in certain SH might be used.

Terapevticheskii arkhiv. 2021;93(4):516-520
Extraesophageal signs of gastroesophageal reflux disease: otorhinolaryngologist’s view
Radtsig E.Y., Konstantinov D.I.

The data on association between various pathologies of the ENT organs and gastroesophageal reflux disease (GERD) is analysed in the article. The variety of extraesophageal signs of GERD in children and adults is given, what is advisable to inform physicians of different specialties about the possibilities of antireflux therapy. These options are expanded with the emergence of a unique new drug, Alfasoxx. Its bioadhesive formula is based on hyaluronic acid and chondroitin sulphate thereby protecting the esophageal mucosa. Alfasoxx acts on the surface of the esophageal mucosa without penetrating into the systemic bloodstream and it also has a low allergenic potential, which has been confirmed by numerous studies. With its healing and repairing effect on erosive lesions of the esophageal epithelium, Alfasoxx in combination with proton pump inhibitors is more effective in achieving regression of clinical manifestations of the disease and improving patients’ quality of life (according to SF-36 questionnaire) compared to proton pump inhibitors monotherapy.

Terapevticheskii arkhiv. 2021;93(4):521-525
History of medicine
From palpation of the pulse to cuff-free methods: evolution of arterial pressure measurement methods
Solnceva T.D., Sivakova O.A., Chazova I.E.

The arterial pressure is an important physiological indicator. The review describes the different techniques of measurement of arterial pressure, their advantages and limitations. Moreover, it also represents a historical reference about the main stage of the development of clinical sphygmomanometrya that nowadays is a relevant method for measuring arterial pressure. The emergence and the development of devices for daily monitoring of arterial pressure and modern techniques for non-invasive arterial pressure measurement are described too.

Terapevticheskii arkhiv. 2021;93(4):526-531

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