Adequate Therapy Research Articles

Study of thyroid functions in transfusion dependent thalassemia patients of pediatric age group with reference to serum ferritin level in a tertiary care centre

Hypothyroidism is one of the most common endocrine complication in transfusion dependent thalassemia patients. Its prevalence and severity is variable and the natural history is poorly described. The frequency of hypothyroidism in Beta Thalassemia Major (BTM) children ranges from 6 to 30%. To determine the levels of serum TSH and FT4 in patients with transfusion-dependent thalassemia (TDT), as well as their relationship to the degree of iron excess indicated by serum ferritin levels. This observational descriptive study was undertaken on 200 patients (5 to15 yrs of age) in the department of Pediatrics in SCB Medical College, Cuttack, Odisha, India from to after obtaining clearance from institutional ethical committee. Out of total 200 TDT children, 141(70.50%) were euthyroid and 59(29.50%) were hypothyroid. Among hypothyroid children, 9(4.5%) had overt hypothyroidism and 50(25%) children had subclinical hypothyroidism. In children <10 years of age group there was a positive correlation between serum ferritin and rise in serum TSH (p < 0.05, r= .553). The rise in serum ferritin was statistically not significant with fall in serum FT4 (p < 0.05, r= .122). In children >10 years of age group, there was positive correlation between serum TSH and serum ferritin (p < 0.05,r=.845). There was an inverse relation between rise in serum ferritin and fall in serum FT4 (p < 0.05, r= -.406). Hypothyroidism was associated in significant number of transfusion dependent thalassemia patients. Adequate iron chelation therapy to keep serum ferritin level within normal limit and early detection of hypothyroidism preferably below 10 years of age will prevent hypothyroidism and its complications in transfusion dependent thalassemia.

Instruments for anxiety analysis and the utility of its assessment in oral surgical interventions under local anesthesia in patients undergoing four operative procedures

Introduction: Fear of intervention in the oral cavity is declared as dental fear and is defined as a specific form of anxiety. The reaction to oral-surgical intervention will also depend on the feeling the patient acquires about the operator, but the positive experience also plays an important role.Aim: The aim is to evaluate differences between the sexes and the influence of experience from a previous oral surgical intervention on a similar subsequent intervention.Material and methods: In the research, anxiety was assessed using Corah's Dental Anxiety Scale (DASR) and Spielberger's State-Trait Anxiety Inventory (X1 and X2). The study included adult patients of both sexes with an indication for surgical extraction of impacted third permanent molars. Preoperative and postoperative anxiety was assessed: 1st measurement (day of examination) - DASR, and STAI (X1 and X2); 2nd measurement (immediately before the intervention) – STAI (X1 and X2); 3rd measurement (day after the intervention) – STAI (X1 and X2).Results: Preoperatively determined high levels of general, immediate, and dental anxiety decreased before the surgical procedure itself and were significantly reduced in the postoperative period. The downward trend continued in line with the positive experience. Women had higher anxiety scores than men for all monitored parameters. The use of the STAI scales to assess anxiety by dental practitioners is on par with other well-known anxiety assessment instruments, such as the DASR. Conclusion: In order to increase patient satisfaction and to prevent possible complications in such oral-surgical procedures, it would be useful to consider adequate therapy for high anxiety.

The State of Hemodynamics of Retinal Vessels in Primary Open-angle Glaucoma in Patients With Type 2 Diabetes Mellitus

Objective: to study the features of linear blood flow rate with central artery and retinal vein calibration in patients with POGC and type 2 diabetes. Examined 220 eyes (110 patients) with type 2 diabetes and 40 eyes (20 patients) with PAH without diabetes. The average age — 58 years old — 0,35. In addition to the common methods of research were: ophthalmoscopy with Goldman lens, binocular ophthalmoscope (Schepevsa), and lens Volk-90,0D (USA), gonioscopy with lenses (Krasnova, Goldman), tonometry by Maccov, NIidek (Japan) pneumototometry NT-2000, simplified tonography for Nesterov, OCT optical nerve disc and yellow spot Carl Zeiss Cirrus, HD OCT Model 4000/5000 Germany), OCT retinal vessels with calibre meter (Cirrus HD-Octiss Ultrasonic), Carl Ultrasonic (ISS) Central artery vessels and retinal veins (UZ — expert class system Sono Scapesq), ultrasound of the eyes. The data are processed statistically. In patients with PSA with SD 2 type of LSC reduction in the CAC at the initial and advanced stages up to 12.5 0.66 cm/s and 11 0.46 cm/s, with blood flow slowing in the CNS-LCC vessels 8.0.5 cm/s and 9.0 0.52 cm/s. In addition, the vascular calibre of the CAC increased to 91.5 0.67 μm and 93.5 0.65 μm at the initial and advanced stages of glaucoma, and the vascular size of the CAC was reduced to -97.6 0.19 μm at 75% and 93.5 0.9 μm at 50%, respectively, and expanded to 141.5 0.7%,7%. Revealed microcirculatory disorders in retinal vessels at POGC with type 2 diabetes allow recommending patients to conduct adequate therapy.

Changes in rheological parameters of blood, microcirculation, and accumulation of antibiotic in the focus of acute inflammation of patients with maxillofacial phlegmon

BACKGROUND: Despite the modern development of dentistry, the frequency of purulent inflammatory diseases of complicated caries tends to increase. Up to 60%–70% of patients had odontogenic phlegmon in maxillofacial hospitals. With the spread of the process to the neck and mediastinum, mortality reaches 60%, and with the generalization of infection leading to septic shock, it increases to 90%. This study aimed to examine the state of rheological parameters and blood microcirculation in cases of acute purulent inflammation in patients with maxillofacial phlegmon based on blood viscosity, analysis of the microcirculatory bed according to laser Doppler flowmetry, and concentration of the antibiotics in the blood. This study will allow us to analyze pathophysiological changes and coordinate adequate drug therapy.
 AIM: To examine the state and rheological properties of blood in the microcirculation and antibiotic concentration in cases acute purulent inflammation in patients with maxillofacial phlegmon to improve the effectiveness of treatment.
 MATERIALS AND METHODS: The study enrolled 20 patients. Their age ranged from 28 to 62 years, and there were 13 (65%) men and 7 (35%) women. The average body weight of the patients in the study group was 79–95 kg. All patients under endotracheal anesthesia underwent phlegmon dissection. During the operation and treatment, microcirculation, blood viscosity, and laser Doppler flowmetry were evaluated, and the antibiotic concentration in the inflammation area was assessed.
 RESULTS: The results of the study of 20 patients were analyzed. As a result of studying the rheological parameters of blood obtained from the peripheral vein in patients with phlegmon of the maxillofacial region of various localization, changes in blood viscosity towards thickening compared with normal values were revealed.
 CONCLUSION: With acute purulent inflammation of the maxillofacial region, pathophysiological changes occur in the microcirculatory bed, which must be considered when prescribing adequate antibacterial therapy.

Community-acquired pneumonia. Current treatment regimens in pediatric practice

At the moment, an increase in the incidence of community-acquired pneumonia is quite an urgent problem. Its solution is based on the use of adequate antibacterial therapy, which will help significantly reduce the spread of the disease among children included in the risk group.
 Goal: Conducting a comprehensive assessment of etiological therapy tactics for community-acquired bacterial pneumonia in children and determining their compliance with modern clinical recommendations.
 Materials and methods: The study was conducted on the basis of the Voronezh Childrens Clinical Hospital of the Voronezh State Medical University named after N.N. Burdenko. A retrospective analysis of 18 case histories of patients aged 3 to 14 years who were treated from October 2021 to March 2022 with a diagnosis of community-acquired pneumonia of moderate severity was carried out.
 Results: During the analysis of the medical histories of children diagnosed with community-acquired pneumonia, it was found that the diagnosis of the patients condition was complete and sufficient in each of the cases considered, with the exception of the absence of sputum in terms of bacteriological examination, because the treatment was more empirical in nature, directed against the frequently detected pathogen determining the formation of this nosological form S. rpeimopiae.
 Conclusion: As a result of a comprehensive assessment of the tactics of etiological therapy of community-acquired bacterial pneumonia in children, it was revealed that effective antibiotic therapy was chosen for all patients in accordance with the severity of the disease and instructions for the use of antibacterial drugs, which led to the gradual elimination of clinical symptoms of community-acquired pneumonia.

Carbapenemase Detection and Identification: Which method should be Chosen?

Carbapenemase production constitutes the key mechanism of resistance to carbapenems. Rapid detection or confirmation of the involvement of carbapenemase-producing bacteria (CPB) in infections is crucial for adequate antibiotic therapy and infection control, particularly during epidemics or for surveillance purposes. The Ambler classification proposes four classes of carbapenemases: classes A, B, C, and D. Carbapenemases A, C, and D are called serine carbapenemases because they use serine in their active site to catalyze the hydrolysis of carbapenems. Class B carbapenemases are metallo-beta-lactamases (MBLs) that use a cation (Zn2+) to hydrolyze the beta-lactam ring. Biochemical, chromogenic, immunochromatographic, mass spectrometric, and molecular methods have both advantages and limitations for carbapenemase detection. Although there is no single method that meets all specifications of an ideal test, it is important to explore methods to identify the most suitable ones. Thus, according to the research articles reported in this review and the criteria (cost, turnaround time, sensitivity, specificity, expertise needs, target carbapenemases), chromogenic tests such as ChromID CARBA SMART and CHROMagar™ mSuperCARBA™ would be the best candidates for the rapid and effective detection of carbapenemase-producing bacteria in developing countries. Moreover, Carba NP, SUPERCARBA and Carbapenem Inactivation Method (CIM) could also be considered good carbapenemase-detecting methods. WGS may be reserved for large-scale funded studies of carbapenemase-producing bacteria.

Management of Crush Injury’s Complications Using Hyperbaric Oxygen Therapy: Case Series

Abstract: Crush injury occurs due to an external trauma mechanism that directly affects the skin, muscle, and bone tissue. Crush injuries can involve several parts of the body at the same time. When accompanied by handling, wound healing in crush injury can be long-term, so that it can affect the function of the patient. Various complications that can occur ranging from secondary infection, necrosis, recurrent bleeding, to compartment syndrome. We reported serial cases of crush injury with various clinical presentations and complications, varying in the age range of 16-65 years. All four patients were given multiple managements, such as open reduction external fixation and extensive debridement. There were complications such as secondary infection and delay in the wound healing process in patients who did not on time for follow-up. The four patients received additional treatment in the form of wound dressings hyperbaric oxygen therapy (HBOT) with 5-10 90-minute sessions under 2.4 ATA pressure for 10 consecutive days. Follow-up was carried out again within a period of one month to compare the wound condition before and after HBOT. The clinical condition was getting better, marked by the formation of granulation tissue. The state of hyperoxia in HBOT accelerated the inflammatory process and angiogenesis during the wound healing process characterized by the eradication of bacteria in the wound tissue and accelerated neovascularization formation. In conclusion, adequate therapy, wound dressing, and patient compliance affect patient outcome. Moreover, the addition of hyperbaric oxygen therapy has shown to accelerate the wound healing process and restore the patient's limb function. Keywords: crush injury; hyperbaric oxygen therapy; oxygen; wound healing

RISK CLASSIFICATION FOR SUDDEN CARDIAC DEATH IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY BASED ON MACHINE LEARNING ALGORITHMS

Hypertrophic cardiomyopathy is one of the most prominent cardiovascular diseases, with almost 1 in 500 people suffering from it. It is of great importance for this disease to be detected in a timely manner, so that patients can be provided with an adequate therapy. This is also important for monitoring the future development of the disease so that those patients under a high risk of sudden cardiac death can be provided with lifesaving implantable cardioverter-defibrillators. Regression models were created for the purpose of this paper using the random forest regression algorithm to monitor the future states of patients based on their previously known parameters. Regression models were built by maximizing R2 score for important patient parameters. The training of classification models was done using the random forest and extreme gradient boosted trees algorithms for the purposes of risk prediction. The classification models achieved 96% and 99% F1 score over the high-risk class respectively and 99% prediction accuracy overall.

Corticosteroids in sepsis and community-acquired pneumonia.

Sepsis and septic shock, which are often caused by pneumonia, impact millions of people every year. Despite adequate antibiotic therapy, mortality remains high, up to 45% in septic shock, which is characterized by an inappropriate, excessive immune response of the host. Moreover, critical illness-related corticosteroid insufficiency often coexists. Against this background, several trials and meta-analyses evaluated corticosteroid therapy as adjuvant therapy with heterogeneous results. Indeed, before 2000, high-dosage, short courses of corticosteroid treatment resulted in no benefit on mortality and ahigher rate of adverse events. After 2000, thanks to adeeper understanding of the pathophysiology, low-dosage with longer courses of treatment were tested. With this regimen, afaster decrease in inflammation and faster resolution of shock, with alow rate of mild adverse events, was demonstrated although no clear effect on mortality was shown. To date, guidelines on sepsis and septic shock and guidelines on severe community-acquired pneumonia suggest corticosteroid use in selected patients. Furthermore, by utilizing latent class analysis, phenotypes of sepsis patients who benefit the most from corticosteroid treatment were recently identified. Future research should be guided by aprecision medicine approach to identify adequate dosage and duration of corticosteroid treatment for appropriate patients. This article is freely available.

Importance of biopsy in the diagnostic assessment of chronic wounds-position paper of the Initiative Chronische Wunden (ICW)e. V.

Diagnostic assessment of chronic wounds is essential for the initiation of causal therapeutic treatment. For diagnostic classification of the wound genesis, it may be necessary to take atissue sample for histological and/or microbiological processing. If there is clinical suspicion of aspecific cause of the wound such as aneoplasm, an inflammatory dermatosis or apathogen-induced wound, atissue sample for further diagnosis is required immediately. If the ulceration does not respond sufficiently to adequate causal therapy, atissue sample for further evaluation is recommended after 12weeks. The choice of the correct sampling technique, further storage, transport and processing are just as decisive for areliable result as the specific question for the diagnostic laboratory.

УСПЕШНОЕ ПРИМЕНЕНИЕ МЕТОДА ПОЛИМИКСИНОВОЙ СОРБЦИИ ЭНДОТОКСИНА В КОМПЛЕКСНОЙ ТЕРАПИИ ПАЦИЕНТКИ С ГРАМОТРИЦАТЕЛЬНЫМ СЕПСИСОМ ПРИ ПОЗДНЕМ ИНФИЦИРОВАННОМ ВЫКИДЫШЕ

Abstract. Introduction. Sepsis is one of the most serious problems of modern obstetrics, accounting for 11% of the overall structure of maternal mortality. One of the main initial causes of sepsis is endotoxin having diverse biological effects. Moreover, during sepsis development, endotoxin directly or indirectly leads to irreversible and often life-incompatible damage to organs. Columns for direct hemoperfusion with polymyxin B are used for extracorporeal endotoxin removal. Aim: Reviewing the literature on using columns with polymyxin B in sepsis treatment and describing our own clinical observation of maternal sepsis. Materials and Methods. Review of publications in electronic resources, such as PubMed, eLibrary, EMBASE, and Google Scholar. This article presents a clinical case of successful sepsis treatment during late infected miscarriage in a young patient. Results and Discussion. Currently published systematic reviews and meta- analyses prove the reduction of mortality in patients with sepsis/septic shock. A 39-year-old patient was admitted with signs of chorioamnionitis and incipient miscarriage at 20-21 weeks of pregnancy. After the delivery of a dead fetus, the picture of sepsis and septic shock developed. Removal of the uterus as the primary source of infection did not improve the woman’s condition. Positive changes were only observed after having applied the polymyxin sorption of endotoxin. This new advanced technology in medicine, thanks to the timely use, correct dose, and duration of hemoperfusion with polymyxin B, made it possible to remove bacterial endotoxins safely and effectively from the blood, which led to the successful sepsis therapy. Conclusions. Thanks to the coordinated actions of a multidisciplinary team of highly qualified specialists and the timely administration of adequate therapy, it was possible to save the patient’s life, thus preventing her from maternal mortality.

Addressing Antimicrobial Resistance (AMR) on Dairy Farms: A One Health Case Study from Punjab, India

Abstract This case study explores the antimicrobial usage (AMU) practices on Punjab’s dairy farms, aiming to address the challenge of antimicrobial resistance (AMR) through collaborative efforts. It uncovers diverse AMU practices contributing to misuse, particularly on farm management-related diseases, such as mastitis, reproductive disorders, diarrhoeal diseases, and blood parasite infections. Some animal farms displayed high AMU levels of ‘critical importance’ category antibiotics, as per the World Health Organization. Additionally, some farmers exhibited inadequate knowledge and understanding of the importance of completing adequate antimicrobial therapy courses. The key risk factors for incorrect AMU include lack of awareness among the informal animal health service providers (without formal education/qualification), over-the-counter access of antibiotics, self-treatment practices by the farmers, and limited understanding of AMR’s public health implications. The study undertook a series of initiatives to combat AMR, including subject awareness workshops, biosecurity awareness activities comprising proper disposal of farm waste, and workshops for veterinarians, para-veterinarians, and farmers, sensitizing about AMR’s adverse consequences. Recommendations include enhancing access to qualified veterinarians, discouraging reliance on unauthorized practitioners, enhancing diagnostic capabilities, and providing technical support for disease prevention. Establishing AMU and AMR surveillance systems is essential for informed decision-making. Collaborative efforts are vital to raise awareness, promote responsible AMU, and ensure animal and public health security. These joint actions among dairy chain stakeholders are imperative to combat AMR and foster sustainable dairy production while protecting animal and human health. Information © The Authors 2023

Memantine Therapy as an Augmentation in Treatmentresistant Depression: A Case Report

Abstract Evidence suggests that treatment-resistant depression (TRD), defined as the occurrence of an insufficient clinical response after adequate antidepressant therapy among patients diagnosed with major depression, is one of the most important public health problems and is associated with significant disability and psychosocial impairment. Here we present a case of depression resistance to the treatment of a 22-year-old man and the effects of Memantine augmentation. The first symptoms of depression appeared in January 2019, and pharmacotherapeutic treatment began in March of the same year. He was in a bad mood, sad, hopeless, tense, lacked energy, lost interest, and decreased libido. During his twoyear pharmacotherapeutic therapy, he took SSRIs, SNRIs, TeCAs, SARIs, atypical antipsychotics with antidepressant effects, such as aripiprazole and cariprazine. Since the patient still did not have adequate therapeutic response and new drugs were available, the choice fell on Memantine after researching several databases and collecting the data listed at the beginning of the article. The initial dose was 5 mg daily and was gradually increased by 5 mg each week to a maximum of 20 mg. After 2 weeks at a stable dose, the patient reported feeling a little better. Significant improvement in symptoms was observed in the MADRS score, which was then applied to assess the effects of augmentation. After four weeks of therapy, he entered remission which is still ongoing.

Detection of volatile organic compounds in headspace of Klebsiella pneumoniae and Klebsiella oxytoca colonies

IntroductionEarly diagnosis of infections and sepsis is essential as adequate therapy improves the outcome. Unfortunately, current diagnostics are invasive and time-consuming, making diagnosis difficult, especially in neonatology. Novel non-invasive analytical methods might be suitable to detect an infection at an early stage and might even allow identification of the pathogen. Our aim is to identify specific profiles of volatile organic compounds (VOCs) of bacterial species.MethodsUsing multicapillary column-coupled ion mobility spectrometry (MCC/IMS), we performed headspace measurements of bacterial cultures from skin and anal swabs of premature infants obtained during weekly screening for bacterial colonization according to KRINKO. We analyzed 25 Klebsiella pneumoniae (KP) cultures on MacConkey (MC) agar plates, 25 Klebsiella oxytoca (KO) cultures on MC agar and 25 bare MC agar plates as a control group.ResultsUsing MCC/IMS, we identified a total of 159 VOC peaks. 85 peaks allowed discriminating KP and bare MC agar plates, and 51 peaks comparing KO and bare MC agar plates and 6 peaks between KP and KO (significance level of p < 0.05 after Bonferroni post hoc analysis), respectively. Peaks P51 (n-Decane) and P158 (Phenylethyl Alcohol), showed the best sensitivity/specificity/ positive predictive value/negative predictive value of 99.9% each (p < 0.001) for KP. P158 showed the best sensitivity/specificity/positive predictive value/negative predictive value of 99.9% each (p < 0.001) for KO. Comparing KP and KO, best differentiation was enabled using peaks P72, P97 and P16 with sensitivity/specificity/positive predictive value/negative predictive value of 76.0%, 84.0%, 82.6%, 77.8%, respectively (p < 0.05).DiscussionWe developed a method for the analysis of VOC profiles of bacteria. Using MCC/IMS, we demonstrated that VOCs derived from bacteria are clearly distinguishable from a bare agar plate. Characteristic peaks obtained by MCC/IMS are particularly suitable for the species-specific identification and differentiation of KP and KO. Thus, MCC/IMS might be a useful tool for in vitro diagnostics. Future studies must clarify whether similar patterns of VOCs can be detected in vivo in patients that are colonized or infected with KP or KO to enable rapid and accurate diagnosis of bacterial colonization.

Non-alcoholic steatohepatitis

Steatohepatitis is a common non-infectious inflammatory disease of the liver, ranking 3rd or 4th in the structure of chronic progressive lesions of the organ. The prevalence of non-alcoholic forms of the disease in the population reaches 11–25 %. In obese patients, the pathology occurs 7 times more often than in those with normal weight. Alcoholic steatohepatitis is diagnosed in 20–30 % of patients with chronic alcoholism. The pathology occurs in all age groups, but is mainly detected after 45–50 years. The relevance of timely diagnosis of steatohepatitis is associated with a high probability of liver cirrhosis, which, in the absence of adequate therapy, develops in 45–55 % of patients

Morphological changes in hematopoietic parameters in COVID-19 and their prognostic significance

The types of morphological changes in the complete blood count, along with other laboratory parameters, can help establish the severity of the condition and provide the prognostic value in determining the survival of a patient with COVID-19. Peripheral blood smear (PBS) examination is a routine and simple procedure that can be performed at any medical institution. However, data on morphological changes in PBS during COVID-19 are still insufficient. Therefore, it is relevant to identify the features and patterns of these changes, taking into account the severity of the clinical presentation of COVID-19, and establish their prognostic significance. The aim. To review the literature on the presence of morphological changes in hematopoietic parameters in the case of SARS-CoV-2 infection with respect to the disease course.Results and Conclusions. Morphological changes in at least one blood cell lineage were observed in all cases of SARS-CoV-2 infection. The most common are nuclear and cytoplasmic disorders of neutrophils, such as hypogranulation and hypo/hypersegmentation of neutrophil nuclei, often with toxogenic stippling. Typical changes in lymphocyte morphology include monocytoid, lymphoplasmacytoid, granular, and atypical cells with nucleoli. Prognostically unfavorable morphological signs in the PBS include giant neutrophils and their toxic granulation, plasmacytization of lymphocytes, and a dynamic decrease in granular and abnormal lymphocytes and monocytes. A low count of lymphocytes and their subpopulations is associated with a severe clinical presentation and an unfavorable outcome of COVID-19 disease, which suggests the feasibility of their immunophenotypic evaluation and monitoring. The detection and serial monitoring of inflammatory monocytes using flow cytometry may be valuable in predicting the course and choosing adequate therapy for SARS-CoV-2 infection. Additionally, an increase in the red cell distribution width was also shown to have prognostic importance.

Croup in children in the period of the COVID-19 pandemic

Croup syndrome remains one of the most common diseases in children, while being a life-threatening condition for the patient. Materials and methods. The paper presents the clinical and epidemiological features of croup in 79 children aged 0 months. up to 5 years of age hospitalized during the COVID-19 pandemic from January to September 2022. Results. In the age structure of patients, children of the first year of life predominated. The clinical picture of croup against the background of COVID-19 was usually characterized by an acute onset, febrile fever with the addition of symptoms of stenosing laryngotracheitis on the second and third days from the onset of the disease. The appointment of timely and adequate therapy at all stages of care is the key to a favorable outcome of croup in children.

Antisense oligonucleotides: a novel Frontier in pharmacological strategy.

Antisense oligonucleotides (ASOs) are short single stranded synthetic RNA or DNA molecules, whereas double-stranded RNA nucleotide sequences are called small interfering RNA (siRNA). ASOs bind to complementary nucleic acid sequences impacting the associated functions of the targeted nucleic acids. They represent an emerging class of drugs that, through a revolutionary mechanism of action, aim to directly regulate disease-causing genes and their variants, providing an alternative tool to traditional "protein-specific" therapies. The majority of the ASOs are designed to treat orphan genetic disorders that in most of the cases are seriously disabling and still lacking an adequate therapy. In order to translate ASOs into clinical success, constant technological advances have been instrumental in overcoming several pharmacological, toxicological and formulation limitations. Accordingly, chemical structures have been recently implemented and new bio-conjugation and nanocarriers formulation strategies explored. The aim of this work is to offer an overview of the antisense technology with a comparative analysis of the oligonucleotides approved by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA).

The Risk of Developing of Malnutrition and the Principles of Correction of Nutritional Status Disorders in Children with Cystic Fibrosis

Cystic fibrosis is a severe hereditary disease with polysystemic manifestations and progressive course. Malnutrition in cystic fibrosis occurs as a result of exocrine insufficiency of the pancreas, an increase in energy losses in chronic inflammation in the bronchopulmonary system, manifested by increased stress on the respiratory system. The presented literature review highlights the modern principles of prevention and correction of malnutrition in children with cystic fibrosis, identifies the most promising methods for further development that correct nutritional status disorders. The review has shown that an active approach to nutrition at any age, the use of aggressive methods of nutritional support against the background of enzyme replacement therapy, timely and adequate therapy of respiratory tract pathology lead to an improvement in the indicators of nutritional status in cystic fibrosis. The most promising is the further development of targeted therapy, which allows, as a result of exposure to the etiopathogenetic mechanisms of the disease, to reduce the frequency and severity of bronchopulmonary exacerbations, partially restore the exocrine function of the pancreas, which is manifested in patients with cystic fibrosis by an increase in body weight and mass-growth index.

Biomarkers of Progressive Fibrosing Interstitial Lung Diseases

Despite adequate therapy, interstitial lung diseases (ILD) can cause progressive scarring of lung tissue. This type of ILD is known as progressive fibrosing ILD (PF­-ILD). The challenge in diagnosing PF-­ILD lies in the lack of uniformly accepted criteria for a progressive fibrosing phenotype. Most authors use criteria based on clinical features and assessment of functional imaging and radiological findings over time. However, forced vital capacity (FVC) measurement is limited by its variability, and the follow­up lasts 1­2 years. The above diagnostic challenges prevent from prescribing early adequate therapy in patients with progressive ILD, indicting the need to search for new biomarkers of the progressive fibrosing phenotype. We review the most studied and informative biomarkers of fibrosis progression in patients with ILD.