卷 96, 编号 12 (2024): VARIO (РАЗНОЕ)

Gastric cancer (GC) is one of the top five cancer morbidity and mortality rates in the Russian Federation and worldwide. Currently, there is a decrease in gastric cancer incidence, which is associated with a decrease in the prevalence of Helicobacter pylori infection. However, due to changes in the population structure and increased life expectancy, the absolute number of gastric cancer cases and mortality are expected to increase. GC is a consequence of long-term chronic gastritis. At least 90% of gastric cancers are caused by H. pylori. Reducing the incidence and mortality from GC is achievable with a reasonable combination of 2 strategies: primary prevention based on the detection and eradication of H. pylori, and secondary prevention, which is based on endoscopic screening of early GC and the formation of high-risk groups for cancer development and their subsequent endoscopic observation.

Aim. To assess the acceptability of the screening questionnaire for the identification of patients with mild cognitive impairment (MCI) in general medical practice, to assess its psychometric validity and to determine the threshold value of the total score of the questionnaire.

Materials and methods. The study included outpatients of both sexes over the age of 18 years with a diagnosis of MCI according to ICD-10 F 06.7. The MoCA was used as a tool to validate the new questionnaire. The formulation of the seven items of the MCI 7 questionnaire was based on patients' complaints about those aspects of cognitive dysfunction that are found in MCI. The linguistic form of the questions was as close as possible to everyday speech, each question had to be answered either ”Yes” or ”No”.

Results. 99 patients (64 females) were included in the study, the mean age was 60±12.7 years, education calculated in years of study – 14.2±2 years, the average score for MoCA was 23.6±3.5 points. MoCA parameter met the criteria for possible MCI (total score lower than 26 score) in 65 patients. Filling out the questionnaire did not cause difficulties for patients and did not require the assistance of the staff. The consistency of the detection of MCI by MoCA and by the questionnaire of MCI 7 with the threshold value of the total score for MCI 7 equal to three reached 92% from the patients with MCI by MoCA. The questionnaire showed good internal consistency: a criterion Cronbach's alpha was 0.81.

Conclusion. The MCI 7 questionnaire can become useful screening instrument for detection of patients with suspected MCI in primary health care institutions.

Aim. To study the profile of cardiac biomarkers (NT-proBNP – N-terminal pro-brain natriuretic peptide, sST2 – soluble growth stimulation expressed gene 2, galectin-3, copeptin) in clusters of patients with chronic heart failure with preserved (CHFpEF) and mildly reduced (CHFmrEF) left ventricular (LV) ejection fraction (EF).

Materials and methods. The study included 135 patients with CHF and LV EF>40%. All patients signed informed consent.

Results. Patients in the study were of senior age – 76 [65; 82] years; 56% are women. The most common comorbid diseases were hypertension and ischemic heart disease, including previous AMI, CKD, obesity and AF. During the cluster analysis, 4 clusters were identified: 1 – “ischemic”, in which men aged 64 [57.5; 76.3] years old with coronary artery disease and previous myocardial infarction and COPD. 2 – “hypertensive”, represented by elderly women 80.0 [74.3; 85.5] years old with arterial hypertension. 3 – “maladaptive with multiple organ disorders” – represented by elderly women with AF, signs of pulmonary hypertension, lower LV EF (48 [43; 54]%) and CKD. 4 – “cardiometabolic” – included female patients aged 71 [60.0; 78.0] years old, with obesity and type 2 diabetes, CKD and AF. In patients of cluster 3 there were higher concentrations of NT-proBNP (1640 [746; 2218] pg/ml; p=0.0015), sST2 (25.2 [17.0; 54.5] ng/ml) and galectin-3 – 11.8 [9.5; 14.3] ng/ml and the highest one-year mortality rate – 33.3%.

Conclusion. Four distinct clusters of CHF with LV EF>40% patients were identified that differed in clinical characteristics, heart failure biomarkers and prognosis: ischemic, hypertensive, cardiometabolic and maladaptive with multiple organ dysfunction. These results confirm the heterogeneity of CHFpEF and CHFmrEF and create the prerequisites for the development of personalized approaches to therapy.

Background. Administration of antiplatelet therapy (APT) is the basis for the prevention of thrombotic complications after endovascular closure of patent foramen ovale (PFO). The 2018 European consensus document on the management of patients with PFO recommended long-term APT. Dual antiplatelet therapy was prescribed for 6 months followed by acetylsalicylic acid (ASC) monotherapy for up to 5 years. Subsequent clinical trials demonstrated a trend towards shorter APT due to the risk of ASC-associated bleeding. In 2022, the SCAI society recommended limiting the duration of APT to 5 months. However, the evidence base is insufficient.

Aim. To compare the efficacy and safety of shortened and prolonged APT regimens after endovascular closure of PFO.

Materials and methods. Data were searched for the period from January 2017 to May 2024. The primary endpoint was defined as the development of recurrent ischemic stroke (IS). The development of major bleeding was selected as the secondary endpoint. The combined endpoint (CEP) included all-cause death, IS, transient ischemic attack, peripheral thrombosis, myocardial infarction, and major bleeding.

Results. Eighty-nine sources were analyzed, of which 3 studies with a total sample of 1870 patients were included in the meta-analysis, which included 731 and 1139 patients with shortened and prolonged APT, respectively. Fatal outcome was recorded in 7 patients receiving abbreviated APT and 6 patients receiving prolonged APT. Patients in both groups had a comparable risk of mortality (RR 1.97; 95% CI 0.59–6.57; p=0.24; I²=29%). Similar results were obtained for the risk of TIA (RR 1.02; 95% CI 0.43 to 2.42; p=0.41; I²=0%), for the risk of IS (RR 1.01; 95% CI 0.41–2.49; p=0.59; I²=0%), and for minor bleeding (RR 0.81; 95% CI 0.49–1.34; p=0.24; I²=29%). CEP was achieved in 26 patients receiving abbreviated APT and 39 patients receiving prolonged APT; the risk of CEP did not significantly differ between combined endpoints (RR 1.04; 95% CI 0.63–1.72; p=0.15; I²=48%).

Discussion. The results of the meta-analysis showed that there was no statistical difference between abbreviated and prolonged APT in terms of efficacy and safety, which is consistent with previous clinical studies.

Conclusion. Abbreviated APT can be considered as the strategy of choice in patients at high risk of bleeding and in the absence of risk factors for thromboembolism. Conducting new studies will make it possible to accurately determine the duration of APT and develop clinical recommendations with a convincing evidence base.

Aim. To study the lipid-lowering and pleiotropic effects of statin monotherapy and combination with ezetimibe in patients in the postinfarction period, depending on the achievement of the target level of low-density lipoprotein cholesterol (LDL cholesterol) for 24 weeks.

Materials and methods. 114 patients with myocardial infarction were included. Treatment was started with statin monotherapy, with insufficient efficacy, ezetimibe was added. After 24 weeks, the 1st group included 38 people, the 2nd – 76 patients. On 7–10th days and 24 weeks later, the lipid profile, the N-terminal fragment of the precursor of the cerebral natriuretic peptide (NT-proBNP) were determined, speckle-tracking echocardiography, ultrasound examination of the carotid arteries (CA) with RF technology were performed.

Results. At week 24, the patients were divided depending on the achievement/non-achievement of the LDL cholesterol target. The highly effective therapy group (HET) included 52 patients, the insufficiently effective therapy group (IET) consisted of 62 people. The ratio of the chances of achieving LDL cholesterol with the addition of ezetimibe to a statin was 3.4 [1.8; 6.6] (p<0.001). In the HET group, by the 24th week, NT-proBNP decreased by 59.6% (p=0.045); in the IET group – by 52.2% (p=0.042). According to echocardiography data, after 24 weeks in the HET group, an increase in global constructive work GCW by 9.1% (p=0.036) and the global work index GWI by 8.2% (p=0.041) was revealed without dynamics of indicators in the comparison group. In the study of the CA, the thickness of the intima-media complex in the HET and IET groups regressed by 9.5% and 6.8% respectively (p<0.05). Only in the HET group did the common CA stiffness indicators improve.

Conclusion. The achievement of LDL cholesterol control on the background of combined lipid-lowering therapy in patients in the postinfarction period is characterized by the most pronounced organoprotective effect.

Aim. To evaluate the efficacy and tolerability of the combination of isatuximab, pomalidomide, dexamethasone (IsaPd) in the treatment of relapsed refractory multiple myeloma (RRMM) in a real clinical practice.

Materials and methods. The retrospective study included 60 patients (28 men and 32 women aged 39 to 81 years, median age 64 years) with refractory and relapsed forms of MM. All patients received isatuximab intravenously at a dose of 10 mg/kg (weekly during cycle 1 and once every 2 weeks in subsequent cycles), pomalidomide 4 mg orally once a day from day 1 to day 21 of the course, and dexamethasone weekly at a dose of 40 mg (if age <75 years) or 20 mg (if age ≥75 years). IsaPd courses of 28 days were administered until RRMM progression or unacceptable toxicity.

Results. The median follow-up was 17.3 months (range 2–34 months) and the median duration of response was 16.3 months (range 2–27 months). The overall response rate was 65.0%. Complete response was achieved in 5 patients (8.3%), very good partial response in 18 (30%), partial response in 16 (26.7%), minimal response in 5 (8.3%), stabilization in 3 (5%), and progression in 11 (18.3%). Median progression-free survival was 16.1 months (95% confidence interval 9.0–23.2 months), 12-month progression-free survival was 58.0%. Median overall survival was not reached, 12-month overall survival was 72.9%. The most common adverse events with this regimen were upper respiratory tract infections (32%) and neutropenia (35%).

Conclusion. The IsaPd combination demonstrates a favorable toxicity profile and high efficacy in patients with RRMM in the real clinical practice setting.

Aim. To evaluate the efficacy of oral administration of the original ademetionine (Geptral) at a dose of 1500 mg/s in patients with NAFLD at the steatosis stage and cognitive impairment within the framework of a prospective observational open non-comparative study in real clinical practice against the background of achieved lifestyle modification.

Materials and methods. Thirty patients with NAFLD and cognitive impairment were examined using routine methods examination. NAFLD was diagnosed in accordance with the clinical guidelines of the Ministry of Health of the Russian Federation. All patients met the criteria for MAFLD. Cognitive functions were assessed using the Montreal Cognitive Assessment Scale. After selection, patients were recommended dietary and physical activity modification in combination with oral administration of the original ademetionine at a dose of 1500 mg/day. The duration of the study was 6 months.

Results. Oral administration of the original ademetionine for 6 months against the background of lifestyle modification improved cognitive functions with an increase in the Montreal Cognitive Assessment Scale score from 19.1 (16.3–20.1) to 27.6 (25.1–29.0; p=0.001). In addition, the study found a decrease in the severity of steatosis according to the FLI index and quantitative ultrasound. Additionally, a decrease in the Fatigue Assessment Scale (FAS) scores from 34 [25–39] to 19 [16–27]; p=0.000002, and 10-year fatal and non-fatal cardiovascular risk according to the SCORE2 scale from 34 [15–44] to 9 [7–13]; p=0.000002, was revealed.

Conclusion. The original ademetionine as a multitarget drug for NAFLD may be useful in terms of improving cognitive functions, increasing adherence to lifestyle modification, and improving its quality and duration.

Aim. To evaluate the effectiveness of hepatoprotective support in patients with hemorrhagic fever with renal syndrome (HFRS) with cytolytic syndrome by using the combined drug Remaxol^®.

Materials and methods. 60 patients with HFRS were examined: 43 (71.7%) men, 17 (28.3%) women, the average age of patients was 41.4±2.3 years. The subjects were divided into 2 groups (30 people each). Study design: open, randomized, comparative.

Results. The analysis of the use of the drug Remaxol^® was carried out as a means of hepatotropic support for patients with HFRS with liver damage. When evaluating the dynamics of clinical and laboratory parameters characterizing liver functionality in 2 groups of patients receiving intravenous infusions of Remaxol^® (400.0 ml) or active placebo (400.0 ml 0.9% sodium chloride solution) for 10 days, it was shown that the use of Remaxol^® as a hepatoprotector in the complex treatment of patients HFRS with cytolysis syndrome contributes to the dynamic stabilization of biochemical parameters of liver function and normalization of its size.

Conclusion. The use of Remaxol^® as part of the complex pathogenetic therapy of patients with HFRS with liver damage makes it possible to accelerate the disappearance of cytolytic syndrome, as well as laboratory indicators of cholestasis. The good tolerability of Remaxol^® and the absence of significant side effects make it possible to recommend its wide use in this cohort of patients.

The review article describes the 30-year practice of using the cytoprotector rebamipide. The use of the drug in South Korea and Russia in various gastrointestinal disorders, including gastroesophageal reflux disease, functional and organic dyspepsia, chronic gastritis, gastric ulcer, including those associated with H. pylori, inflammatory bowel diseases, irritable bowel syndrome, and as a carcinopreventive agent has been demonstrated. Particular attention is paid to drug-induced conditions, given the uncontrolled use of non-steroidal anti-inflammatory drugs and the high prevalence of cardiovascular diseases, which requires the use of antithrombotic drugs with ulcerogenic action.

The article presents the results of studying the efficacy of netakimab (Efleira) in the complex treatment of patients with psoriasis, psoriatic arthritis, spondylitis and concomitant metabolic syndrome. The study included observations of clinical manifestations of diseases and changes after the use of netakimab. As a result of treatment, there was an improvement not only in clinical symptoms, but also in the metabolic syndrome parameters. In all 3 patients treated with netakimab, there was a decrease in the activity of sacroileitis, accompanied by weight loss, which indicates pleiotropic effect of this drug. The described clinical cases are of interest to rheumatologists, dermatologists, endocrinologists, therapists, general practitioners, and illustrate the successful use of netakimab as an interleukin-17 inhibitor.

According to WHO, extrapulmonary forms of tuberculosis (TB) account for 10–15% of the total number of tuberculosis cases worldwide. Crohn's disease (CD) and intestinal tuberculosis have similar clinical, endoscopic and morphological manifestations in many ways. In all cases, when detecting intestinal CD, it is necessary to exclude tuberculosis infection in biopsies using PCR diagnostics. The risk of developing various forms of TB increases with pathogenetic immunosuppressive therapy for inflammatory bowel diseases. A clinical case of a rare combination of the intestinal form of TB and CD is presented, reflecting the difficulty of diagnosing the two pathologies and the difficulty of choosing therapy when they are combined.