Etiopathogenetic Therapy Research Articles

Плацебо-контролируемое клиническое исследование эффективности D-маннозы Суперкомплекс в профилактике рецидивов ИМП.

Introduction. In recent years, the use of D-mannose as an alternative to antimicrobial agents has been widely discussed in the literature due to the fact that when applied topically, it reduces the ability of E. coli to bind to the urothelium. The aim of this study was to evaluate the change in the number of relapses during the observation period in patients who used «D-Mannose Supercomplex» as a metaphylaxis of cystitis in comparison with the control group, which received a placebo instead of this product. Materials and methods. A multicenter, randomized, double-blind, placebo-controlled, prospective clinical study was conducted to evaluate the efficacy and safety of a dietary supplement containing 2000 mg of D-mannose, 100 mg of cranberry extract, 80 mg of bearberry extract (8 mg of arbutin), and 30 mg of magnesium. Results. In animal models, the use of D-mannose led to a significant decrease in the bacterial load. The use of «D-Mannose Supercomplex» prolongs the relapse-free period in patients with RUTI after the end of antibacterial therapy. The duration of the relapse-free period correlates with the duration of D-mannose intake, which is consistent with modern concepts of the mechanism of action of the drug. The drug is well tolerated by patients. The number of adverse events (AE) in the «D-Mannose Supercomplex» and placebo groups was comparable. AE and allergic reactions associated, according to the researchers, with the use of the study drug, were not registered during the administration of the drug. Conclusions. The presented study data indicate that complex drugs containing D-mannose, cranberry extract, bearberry and magnesium (for example, «D-Mannose Supercomplex») can be considered from the standpoint of evidence-based medicine as a promising means of complex etiopathogenetic therapy for prolonging the relapse-free period in patients with exacerbation of recurrent urinary tract infection (RUTI).

Endocrinopathy due to proproteinkovertase 1/3 deficiency: primary enteropathy, diabetes insipidus, secondary hypothyroidism

Proprotein convertase 1/3 (PC1/3) deficiency is an autosomal recessive disease caused by rare mutations in the proprotein convertase subtilisin/kexin type 1 (PCSK 1)gene, associated with severe malabsorptive diarrhea, obesity and some endocrine abnormalities. Proprotein convertase 1/3 is acalcium-dependent serine endoprotease involved in the proteolytic processing of various prohormones (peptide hormones in enteroendocrine cells that are necessary for the absorption of nutrients and is also expressed in the arcuate and paraventricular nuclei of the hypothalamus, in the beta cells of the pancreas) in their bioactive forms. The onset of the disease in the neonatal period of life is characterized by aclinical picture of severe malabsorption diarrhea, accompanied by developmental delays, and requires long-term parenteral nutrition. As the disease progresses, additional endocrine abnormalities develop, including diabetes insipidus, growth hormone deficiency, primary hypogonadism, adrenal insufficiency, hypothyroidism, and obesity. We conducted aprospective observation of apatient with agenetic disease due to proprotein convertase 1/3 deficiency confirmed during follow-up. The patient was examined and treated at the State Novosibirsk Regional Clinical Hospital in Novosibirsk for 11 months, with repeated (3-fold) hospitalizations. Purpose: to demonstrate the features of the onset and course of the disease, as well as the difficulties in verifying the clinical diagnosis of an ultra-rare genetic disease from the category of endocrinopathies, the complexity of medical support and therapy. Apeculiarity of this case is the fact that the identified mutation in the gene was not previously registered in control Russian samples of the genetic mutation of proprotein convertase 1/3 deficiency, as well as apreviously undescribed variant of the nucleotide sequence in exon 4 of the PCSK1 gene in aheterozygous state and was not registered in control samples gnomAD and RUSeq. Proprotein convertase 1/3 deficiency is adisease that is amultidisciplinary problem, since etiopathogenetic therapy has not yet been developed. The disease has achronic course with constant relapses of intestinal syndrome, is difficult to manage with symptomatic treatments and, as it progresses, has ahigh risk of developing additional endocrinopathies and death. All of the above emphasizes the need for early diagnosis and selection of rational replacement and accompanying therapy to save the lives of patients.

Current state of research in the field of dosage forms containing viburnum (Review article)

The new age of studying the therapeutic and prophylactic properties and molecular mechanisms of action of herbal medicines that do not contain toxic and potent substances has opened up exciting prospects for their use for etiopathogenetic therapy. The results of numerous studies indicate that botanicals act as multi-target agents by modulating inflammatory, apoptotic, and other signaling pathways in multiple steps, highlighting the promising role of botanicals in achieving new and valuable effects. It should also be emphasized that one of the most important advantages and benefits of herbal medicine is the implementation of an individual approach to each patient. Early applied pathogenetic herbal medicine can stop the progression and chronicity of diseases. Viburnum is not last on the list of medicinal plant materials. Viburnum is an almost universal antibacterial agent of natural origin. Recipes with its use have found application in traditional medicine and received scientific recognition. Viburnum is a case where treatment can be not only effective, but also very tasty. It is used to prepare medicinal forms, delicious purees, compotes, tinctures, and kissels. Purpose of the work: to summarize the available literature data on dosage forms containing viburnum. Materials and methods. We conducted a literature review of scientific papers over the last 20 years in the resources of the PubMed and eLIBRARY search engines using the key words below. For this meta-analysis, we used articles containing the evidence base on the most current issues relating to medicinal forms of viburnum. Results. It has been established that the range of medicines from viburnum is limited to viburnum fruits, tincture, extract, glucose and fructose syrups, the Kalinaktiv syrup, and the Cardionorm syrup. Research is being conducted on the development of a gel with a wound-healing effect for use in dermatology, a cream for cosmetic purposes, and a liquid adjusted dosage form with an antipyretic effect (Kadilaeva Z.A. et al., 2023). Conclusion. The result of the research has been the establishment of prospects for expanding the range of medicinal products utilizing viburnum fruits.

Regional experience in monitoring children with cystic fibrosis on targeted therapy in the Republic of Tatarstan

In connection with the introduction of targeted therapy for cystic fibrosis (CF) into clinical practice, there is a need to study the clinical effectiveness of these drugs and to record their possible side effects in children.The aim was to present the regional experience of the Republic of Tatarstan in the use of etiopathogenetic therapy (ivacaftor + tezacaftor + elexacaftor) in 41 children diagnosed with CF.Methods. Before initiation of triple therapy, a comprehensive assessment of body functions was carried out. Monitoring of safety and effectiveness was carried out at 14 days, 1 month, 3 months, 6 months, and 12 months after from the start of therapy.Results. In the first 2 weeks from the start of therapy, 10 (27%) patients reported mild side effects in the form of increased cough, sputum, and rhinorrhea, 2 (5,4%) patients had skin rashes, and 3 (8,1%) patients had elevated blood aminotransferases. One child developed encephalopathy due to arterial hypertension several months after starting therapy.Conclusion. Monitoring of the safety of the therapy over 12 months in children with CF showed a satisfactory profile. The therapy was associated with an improvement in the body functions, nutritional status, and quality of life.

The role of Recombinant interleukin-2 in the treatment of patients with chronic hepatitis B.

Dysregulated immune response occurring in chronic hepatitis B prevents the virus elimination and contributes to progression of the infectious process. The aim of the study was to evaluate the effectiveness (biochemical, immunological, virological) of combination treatment with tenofovir and Recombinant interleukin-2 in chronic hepatitis B patients.
 Material and methods. A comparative analysis of the results from laboratory examination of chronic hepatitis B patients in two comparison groups, comparable in sex, age, stage of fibrosis, viral load, was carried out: group I (n = 27) received tenofovir, according to the accepted recommendations, and recombinant interleukin-2 (rIL-2), group II (n = 25) — tenofovir.
 Results. Before the onset of antiviral therapy all patients with chronic hepatitis B had increased hepatic transaminases, alkaline phosphatase and gammaglutamyl transpeptidase from 1.2 to 5 norms as well as dysregulated cellular immunity factors with significantly decreased absolute count of CD4+, CD8+, CD16+ and increased CD20+ lymphocytes. After 12 months of treatment, patients in observation groups showed normalized cytolysis and cholestasis with insignificant intergroup differences. The level of absolute count of CD4+, CD8+ T-cells and CD16+ lymphocytes in the I group increased (by 24.7%, 24.1%, 34.5%, respectively, all p 0.001 relative to the initial values), not observed in comparison group. The level of CD20+ lymphocytes in group 1 was decreased by 35.9%, and in group 2 — by 7.9% (pI–II 0.001). In group 1, the level of HBsAg after 12 months of treatment became lower by 52% (p 0.001).
 Conclusion. The conducted pilot study showed that the combination etiopathogenetic therapy of patients with chronic hepatitis B using tenofovir and rIL-2 improves liver functional state, restores the disturbed balance of immunocompetent cells: by increasing level of CD4+, CD8+ T-lymphocytes, CD16+ lymphocytes and reducing the count of CD20+ cells, and also allows to steadily reduce blood serum HBsAg level.

Перикардит – осложнение или проявление менингококковой инфекции, вызванной Neisseria meningitidis серогруппы W, у ребенка?

Meningococcal infection is one of the most insidious and dangerous infections (due to the risk of lethal outcome up to 80% when septic shock develops). The article presents a clinical observation of patient A. 4 years old, who had a generalized form of meningococcal infection (GFMI) caused by meningococcus of serogroup W. Despite targeted adequate etiopathogenetic therapy, heart damage developed, which was diagnosed late in the course of the disease (day 26 of the disease). The world literature describes cases of development of complications of GFMI in children caused by N. meningitidis serogroup W at late stages of the disease in the presence of targeted therapy and with CSF sanitation. All of the above necessitates a complex clinical and neurophysiological examination in the periods of early and late recuperation and an individual program of medical rehabilitation. It should be emphasized that if there is a suspicion of complications in the late recovery period, the prescription of complex pathogenetic therapy, including the use of non-steroidal anti-inflammatory drugs and drugs with antioxidant, antihypoxic and cytoprotective effect, such as cytoflavin, is shown to improve the outcome of the disease. Key words: meningococcal infection, children, N. meningitidis serogroup W, meningitis, pericarditis, cytoflavin, medical rehabilitation

Особенности течения нейроинфекций, вызванных парвовирусом В19 (на примере клинических случаев)

Parvovirus infection B19 is a pressing problem in pediatrics due to its widespread distribution and polymorphism of clinical manifestations. At present, the causes of damage to the nervous system during acute parvovirus B19 infection are not completely clear, although the virus is able to persist in neuroglial cells only in immunocompromised individuals and is not neurotropic. The article presents two clinical observations of neuroinfections caused by Parvovirus B19 infection. In one clinical case, severe damage to the brain substance with the development of convulsive syndrome was described. Timely administration of complex etiopathogenetic therapy contributed to a favorable outcome, despite the severity of the disease. A special feature of the second clinical case was the two-wave course of parvovirus infection B19 followed by the development of acute serous viral meningitis of combined etiology (parvovirus B19 + tick-borne encephalitis virus). In both cases, along with etiotropic treatment, a complex drug cytoflavin was used as pathogenetic therapy, which helps optimize the course of the disease and favorable outcomes. Key words: parvovirus B19, neuroinfections, encephalitis, meningitis, children, cytoflavin

Socioeconomic efficiency of neonatal screening for spinal muscular atrophy in the Russian Federation

Background. Spinal muscular atrophy (SMA) is a severe rare disease that has been widely discussed in recent years. Achievements in etiopathogenetic therapy and the social significance of the disease (child population, high mortality), the cost of treatment attracted the attention of the public and the goverment, which, among other things, led to the formation of a separate area with the creation of a fund to finance the treatment of patients with orphan diseases.Aim. To conduct an analysis of the socio-economic efficiency of mass neonatal screening for SMA in the Russian Federation.Materials and methods. A survey of patients (their parents) and doctors was conducted. The current clinical guidelines and the standard of medical care for children with SMA were studied. The cost of medicines is taken from the State Register of Maximum Selling Prices. If the drug is not included in the List of Vital Essential and Necessary Drugs, cost information from the procurement data is used.Results. The socioeconomic burden of SMA on identified patients was about 3,994,289,548 rubles per year prior to screening. The very introduction of mass neonatal screening will amount to about 679,224,000 rubles in year. At the same time, a disease detected in a timely manner due to neonatal screening and timely prescribed effective treatment can lead to a reduction in the cost of specialized and palliative care by 54,073,271 rubles, direct non-medical costs by 88,137,423 rubles, and indirect costs by 154,197,900 rubles per year, which together is more than 7 % of the calculated burden of SMA.Conclusion. The introduction of mass screening will lead to the fact that the number of annually detected patients will increase from current values to the actual value of the prevalence when registering patients with milder forms of SMA. The need for drug supply with drugs and medical care in general will increase. At the same time, children diagnosed with SMA will not die in the early years of life, their survival rate, life expectancy will increase, the quality of life will improve, infant mortality will decrease, which is the main task of neonatal screening and one of the goals of the National Healthcare Project.

Neuroinflammation Process as a Key Etiopathogenetic Factor in the Evolution of Autism Spectrum Disorders in Child Patients

Background: the prevalence of autism spectrum disorders (ASD) is increasing every year, however, diagnostic and therapeutic options are still limited. Aim: identification the patterns of the neuroinflammation process in the etiopathogenesis of ASD of child patients. Patients and methods: clinical, anamnestic and laboratory data of 85 child patients with a confirmed ASD diagnosis. Each patient was assessed for the level of neurospecific proteins (neuron-specific enolase (NSE), S100b protein), the indices of the “Neuro-immuno-test” panel (leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) activity, autoantibodies to S100b protein and myelin basic protein) in the blood before and after a standardized three-month-course of treatment. The reference interval of the laboratory was taken as normal values. The clinical picture was assessed according to the Childhood Autism Rating Scale (CARS). The correlation calculations were carried out in the MS Excel program. Results: in this work we describe the dynamics of the neuroinflammation process parameters in children with autism-like syndrome and psycho-speech development delay on the basis of complex anti-inflammatory therapy. The results of the research prove the increase in NSE and S100b protein quantity among 85% of patients before the treatment. More than 60% of patients had the increase of the parameters of the Neuro-test panel. The severity levels of symptoms among patients according to the scales used specified moderate and severe autism. The quantity of neurospecific proteins and immunological parameters correlated with CARS scale scores. Positive dynamics of clinical symptoms and studied parameters decrease were observed while therapy. The use of the parameters allows to evaluate objectively the severity levels of the patient’s immunomitochondrial status and shows a congruent change on the basis of etiopathogenetic therapy.

On the classification of cytomegalovirus infection in newborn children

Relevance: Cytomegalovirus (CMV) infection is the most common infection that is most commonly found in sick newborns and may be the leading cause of their morbidity and mortality. Current research and clinical observations confirm the likelihood of contracting CMV infection not only in the antenatal period but also in the perinatal and postnatal periods. The study aimed to comment on the current understanding of neonatal CMV infection, its clinical manifestations depending on the time of infection, perinatal outcomes, and long-term consequences to develop a functional classification of CMV infection in newborns. Materials and methods: A systematic review and analysis of the literature sources published by scientists in neonatology and perinatology, healthcare practitioners, and professional associations was carried out. Literature searches were conducted in PubMed, Embase, Scopus, and Euro-Peristat over the past decade by the study keywords. A total of 30 sources were included in the analysis. Results: Delayed sequelae, symptomatic and asymptomatic congenital and perinatal infections have been identified. A review shows that, to date, the incidence of asymptomatic congenital CMV infection has not been established. There is no systematization of the clinical manifestations and outcomes of congenital, perinatal, and postnatal CMV infection in newborns. Conclusion: Based on the literature review, we have developed a functional classification of CMV infection in newborns by the time of infection. Thus, CMV infection can be congenital, perinatal, or postnatal. The classification presents manifestations of symptomatic forms of CMV infection, perinatal and distant outcomes. However, there are no clear diagnostic criteria for asymptomatic forms of CMV infection. There is no clear rationale for etiopathogenetic therapy, prognostic and preventive criteria for various forms of CMV infection. All of the above tasks require further prospective cohort studies.

Функциональное состояние вегетативной нервной системы как предиктор состоятельности нейрогенных механизмов регуляции сосудистого тонуса при расстройствах кровообращения в вертебробазилярной системе

The article presents the results of assessing the functional state of the autonomic nervous system in patients with circulatory disorders in the vertebrobasilar system. It has been established that the addition of neuro-reflex diagnostic methods (dynamic segmental diagnostics and manual examination) improves the assessment of the functional state of the sympathetic nervous system and allows monitoring the effectiveness of etiopathogenetic therapy. The application of methods of reflexotherapy and biodynamic correction of the spine improves the functional state of the autonomic nervous system and enhances the effectiveness of treatment of patients with circulatory disorders in the vertebrobasilar system.

Clinical and genetic characteristics and an algorithm for the differential diagnosis of progressive muscular dystrophies that manifest after a period of normal motor development

Background. Progressive muscular dystrophies (PMD) are a group of genetically heterogeneous diseases that manifest in the age range from early childhood to adulthood. Depending on the predominant topography of the muscular lesion, there are: limb-girdle, distal, oculopharyngeal, facial-shoulder-scapular-peroneal variants of PMD.Aim. Creation of algorithms for the differential diagnosis of PMD with multiple topography of muscle lesions.Materials and methods. We observed 192 patients aged 1.5 to 66 years with PMD with a debut after a period of normal motor development. The diagnosis was established on the basis of genealogical analysis, neurological examination, assessment of non-muscular manifestations, results of instrumental, biochemical molecular genetic studies.Results. Four groups of patients were identified, differing in the topography of muscle damage and 19 genetic variants of PMD were diagnosed. An algorithm for diagnosing PMD that manifest after a period of normal motor development is proposed, which is based on the frequency of occurrence of individual genetic variants and their proportion in the analyzed sample, the presence of major mutations in causal genes, the features of phenotypic characteristics, the gender of the patient and the possibility of conducting etiopathogenetic therapy developed by for some genetic variants.Conclusion. The use of the proposed algorithm in clinical practice can significantly reduce the economic and time costs for confirmatory molecular genetic diagnosis, and promptly recommend etiopathogenetic therapy for some genetic variants of this group of diseases.

Окончательные результаты адаптивного рандомизированного открытого контролируемого исследования эффективности и безопасности энисамия йодида в терапии госпитализированных больных с COVID-19

Despite extensive vaccination as well as the introduction of new therapies for COVID-19, morbidity and mortality rates remain high worldwide, especially among the unvaccinated population and patients at risk. One possible strategy for improving the treatment of patients with COVID-19 could be to study the efficacy and safety of existing antiviral or immunomodulatory agents against SARS-CoV-2 and their impact on the course of the disease. Objective. To assess the efficacy and safety of enisamium iodide – Nobazit®, film-coated tablets, 250 mg (Avexima LLC, Russian Federation), for inpatient treatment of moderate coronavirus disease caused by the SARS-CoV-2 (COVID-19). Patients and methods. This was an open-label, multicentre, randomized study that enrolled 304 hospitalized patients with moderate COVID-19. Patients were divided into 2 groups: the enisamium iodide group (n = 151) included patients who received therapy according to the current version of the Interim Guidelines “Prevention, Diagnosis and Treatment of New Coronavirus Infection (COVID-19)” (IG) except for etiotropic drugs in combination with enisamium iodide (500 mg 3 times daily for 7 days); the routine therapy group (n = 153) included patients who received therapy according to IG, including etiotropic drugs. The primary efficacy endpoint (first component) was a composite of the median time (in days) from the initiation of treatment with study drug/routine therapy to sustained resolution of fever, reduction in respiratory rate to less than 22/min, and achievement of blood oxygen saturation (SpO2) more than 96%. The second component of the primary endpoint was the proportion of patients who developed respiratory failure. Secondary endpoints included all-cause mortality, duration of hospitalization, change in World Health Organization (WHO) 8-point scale score, median time to reduction in the severity of major symptoms (fever, cough, headache, myalgia, weakness). Efficacy endpoints were analysed in the intention-to-treat (ITT) and per protocol (PP) populations. Results. As follows from the analysis of the first component of the primary endpoint, the mean number of days from treatment initiation to sustained resolution of fever, normalization of the respiratory rate, and achievement of SpO2 was 8.8 in the enisamium iodide group and 10.6 in the control group (hazard ratio [HR] 0.738, p = 0.013 [97.62% CI: 0.581–0.937]). The proportion of patients who developed respiratory failure in both groups was comparable, indicating that enisamium iodide therapy does not lead to an increased risk of respiratory failure in patients with COVID-19. As for the secondary efficacy endpoints, no statistically significant differences between the groups were shown, except for the WHO 8-point scale score on days 14 and 28 in favour of the study drug (p = 0.024 and p = 0.042, respectively). In addition, there was a trend towards lower mortality in the study drug group than in the control group: 1 and 5 cases, respectively. The addition of enisamium iodide to standard therapy was not associated with a worsening in the treatment safety profile. Conclusion. The statistically significant superiority of the efficacy of adding Nobazit®, film-coated tablets, 250 mg (Avexima LLC, Russian Federation), to routine therapy over routine therapy alone in patients with moderate COVID-19 was proved. Consequently, it is reasonable to recommend the addition of Nobazit® to the standard treatment of patients with COVID-19 of moderate severity. Key words: enisamium iodide, antivirals, etiopathogenetic therapy, SARS-CoV-2, COVID-19, viral-induced lung damage, pneumonia, randomized controlled study, adaptive study, open-label study

Комбинированная терапия больных рецидивирующим циститом с применением комплекса природных антимикробных пептидов и цитокинов: первые результаты

Urinary tract infections (UTIs) remain an important problem in urology due to their high prevalence and tendency to relapse. The improvement of the treatment outcomes in chronic cystitis is still relevant.A total of 91 patients were included in prospective, multicenter, randomized, comparative, controlled study. They were randomized into three groups: in the comparison group 1 (n=32) basic therapy was administered for 5 days. In the comparison group 2 (n=28) basic therapy was combined with rectal suppositories Superlymph 25 IU once a day for 10 days. In the main group (n=31) basic therapy in combination with rectal suppositories Superlymph 10 IU once a day for 20 days were prescribed. The basic therapy included a combination of two antimicrobial drugs: fosfomycin trometamol 3.0 g at night once on the first day of therapy, and furazidin 100 mg three times a day after meals for 5 days. Pathogenetic treatment was not prescribed in comparison group 1, but administered for 10 days and 20 days in comparison group 2 and main group, respectively.After the completion of etiotropic therapy, a significant effect in all groups was shown. At the same time, at the 2nd visit, there was a significantly better results in patients who received Superlymph rectal suppositories, both at a dose of 10 U and at a dose of 25 U, without any differences between two schemes. The frequency and severity of cystitis symptoms at the end of etiopathogenetic therapy in the main group was less pronounced than in the comparison groups (p=0.0001), and a significant difference was found between comparison groups 1 and 2 (p=0.0001). The use of Superlymph significantly improved the parameters of microcirculation in the urethra, however, there was no difference between comparison group 2 and main group.Etiopathogenetic therapy, including Superlymph rectal suppositories at a dose of 10 IU and 25 IU in patients with chronic cystitis, can significantly improve the results of combination therapy. Analysis of the symptoms score of acute cystitis showed the superiority of longer-term use of Superlymph rectal suppositories at a reduced dosage (10 units). Peptide-cytokine therapy led to a significant improvement in local microcirculation in comparison group 2 and the main group.

Experience with the use of combination antithrombotic therapy in a patient with acute coronary syndrome and underlying severe coronavirus infection

The paper presents the experience of treating a patient with acute coronary syndrome without ST segment elevation and underlying severe novel coronavirus infection (COVID-19) complicated by polysegmental viral pneumonia and significant respiratory events. Emphasis has been placed on the use of antithrombotic therapy after endovascular treatment. A 56-year-old patient underwent respiratory support (non-invasive face mask lung ventilation followed by high-flow oxygenation), urgent diagnostic coronary angiography followed by percutaneous coronary intervention (balloon angioplasty and stenting of the right coronary artery and anterior interventricular artery). In addition to the etiopathogenetic therapy for coronavirus infection, the patient received combination antithrombotic therapy, including acetylsalicylic acid, prasugrel, FRaMon monoclonal antibodies (single exposure, intraoperatively), sodium enoxaparin. The therapy resulted in normalization of hemodynamic parameters, stable normothermia, absence of catarrhal events, improvement of exercise tolerance. A chest ultrasound imaging showed consolidation events, inflammatory markers significantly decreased, circulatory deficiency events were compensated, anginal pains did not recur. On the 20th day of hospitalization, the patient was discharged home with outpatient follow-up. The use of potent antiplatelet agents such as prasugrel or ticagrelor combined with IIb/IIIa receptor inhibitors and prolonged anticoagulant therapy can potentially improve the outcome of the disease in acute coronary syndrome with underlying severe coronavirus infection. In the presented clinical example, the use of aggressive approaches to the antithrombotic therapy did not lead to the development of significant hemorrhagic or other complications.

Проблема поліомієліту: загроза чи реальність?

The relevance of infectious pathology in children in modern conditions has acquired new significant features. We are talking about the measles epidemic (2017–2019), then the incidence and mortality caused by the Covid-19 virus (since 2020), and now (autumn 2021–January 2022) – an outbreak of polio in Ukraine. Already in January 2022, the second case of polio in a child from Ukraine was confirmed, so we have two outbreaks (Rivne and Zakarpattia regions), where the level of vaccination is the lowest in the country. And it is one of the lowest in the Zakarpattia region, and the tendency to further decrease has been observed for the last 2 years. It was found that the children were infected with the second type of poliovirus. This has greatly alarmed ukrainian and foreign experts, as the previous active campaign on global vaccination has reduced the number of polio cases in the world by 99% (for the period 1988-2021). The risk of polio in Ukraine is still high. These circumstances motivate to update the knowledge of doctors on diagnostic issues, differential diagnosis, to improve the quality of diagnosis. In the context of a decrease in the activity of the vaccine company, a high percentage of asymptomatic course and carriers of the polio virus, difficulties in differential diagnosis, and the absence of etiopathogenetic therapy, the threat of the spread of this dangerous infection among the child population with serious long-term consequences is obvious. The only step that can make a real difference is the introduction of active action to close the gap in routine immunization coverage for children. No conflict of interests was declared by the author. Key words: children, polio, diagnosis, differential diagnosis.

Изучение герпесвирусной инфекции в развитии острого оптического неврита неустановленной этиологии

Purpose. Study of the etiological significance of herpesvirus infection (HVI) in patients with acute optic neuritis (ON) of unknown etiology using clinical and laboratory monitoring. Material and methods. Clinical and laboratory studies were carried out over 10 years and were based on the results of etiological monitoring of 81 patients (85 eyes) with acute ON in the period from 2008 to 2018. Results. During a comprehensive examination of 81 patients with acute ON, various infectious pathogens were diagnosed in 75 people (95 %). HVI dominated in 87 % of cases. In the total population of examined patients with acute ON associated with HVI, herpes simplex virus-1 was more common, Epstein – Barr virus and cytomegalovirus were less common. Active current HVI in the general group of patients was diagnosed in 58 patients (84 %). At the same time, the predominance (80 %) of reactivation of chronic infection was noted, and even less often (4 %), primary acute BBVI was diagnosed. The remaining 11 patients (16 %) had chronic persistent BBVI. Conclusion. Based on the complex of serological markers in the reactions of enzyme immunoassay of blood serum, it was found that the frequency of herpes virus infection is 87 %. The results of the performed clinical and laboratory studies are of great practical importance for the verification of the etiological diagnosis and the choice of adequate etiopathogenetic therapy in patients with acute ON associated with HVI. Keywords: acute optic neuritis, herpes virus infection, laboratory monitoring, serological markers.

Clinical case of fibronectin glomerulopathy

Fibronectin glomerulopathy (FNGP) is an extremely rare glomerulopathy with an autosomal dominant pattern of inheritance. Sporadic cases of the disease are also described. Currently, several types of FN1 gene mutations are known that underlie conformational changes in the fibronectin molecule and lead to its deposition in the renal tissue. The clinical manifestations of FNGP may be very heterogeneous, but in most cases are characterized by proteinuria, microscopic hematuria, arterial hypertension, and long-term progressive renal failure. Renal biopsy is the main method for diagnosing the disease. Histologically, GFND is characterized by a lobular glomerular architecture with mesangial expansion and obliteration of capillary loops due to the accumulation of an acellular, periodic acid–Schiff positive, silver Jones-negative material. Immunofluorescence is usually negative. Electron microscopy shows finely granular or fibrillary mesangial and subendothelial electron-dense deposits. At higher magnifications, the fibrils have a diameter of 12-16 nm and are randomly arranged. Standard protocols for the etiopathogenetic therapy of FNGP are not currently developed. Improvement of clinical status and prognosis can be achieved by optimizing blood pressure and proteinuria control by renin–angiotensin–aldosterone system blockers. The recurrence risk of FNGP after renal transplantation remains uncertain due to the rare prevalence of the pathology. In this article, we report a 25-year-old man with nephrotic syndrome, which occurred after a previous upper respiratory tract infection. Histological changes specific to FNGP were found in the kidney biopsy. Genetic analysis was not performed. The absence of a family history of kidney disease suggests that this is a sporadic case of FNGP.

Pathophysiological aspects and complex diagnosis of sepsis-associated encephalopathy. Prospects for etiopathogenetic therapy

<h3></h3> Дисфункция центральной нервной системы при сепсисе проявляется в виде сепсис-ассоциированной энцефалопатии (САЭ) с различными уровнями неврологического дефицита, включая делирий и кому. Септическая энцефалопатия, будучи фактором риска длительно протекающих расстройств сознания и смертности, выделена в самостоятельный синдром, что предполагает необходимость дальнейшего изучения патогенеза для разработки диагностических подходов и прогноза. Патофизиологические механизмы развития септической энцефалопатии многообразны и недостаточно изучены. Методы лабораторной, лучевой и функциональной диагностики позволяют выявить неспецифические морфофункциональные и структурные изменения в центральной нервной системе, присущие острому церебральному повреждению. Лечебная тактика САЭ строится на этиопатогенетической терапии сепсиса, нормализации нейрональной метаболической активности и функционирования гематоэнцефалического барьера (ГЭБ), контроля нейровоспаления. Результаты экспериментальных работ демонстрируют перспективные направления исследований этого состояния.

Laboratory evaluation of the efficacy of Liastene application in complex therapy of multiresistant pulmonary tuberculosis

OBJECTIVE. Evaluating according to laboratory tests the effectiveness of Liasten in the treatment of patients with multidrug-resistant pulmonary tuberculosis (MDR-TB).&#x0D; MATERIALS AND METHODS. Evaluation of the effectiveness of etiotropic and etiopathogenetic therapy in 57 patients with MDR-TB was performed. According to the treatment schemes, patients were divided into groups. The control group (n=22) received individualized antimycobacterial therapy (AMBT) regimens. The experimental group (n=35) received AMBT in combination with Liasten. Evaluation of the effectiveness of treatment regimens was performed on the basis of indicators of general clinical blood tests, immunological and bacteriological studies.&#x0D; RESULTS AND DISCUSSION. In patients of the experimental group, compared with the control in 1.5 times more often found positive changes in the hemogram of blood and ESR (p&lt;0.05-0.001), the establishment of a dynamic balance between the pools of lymphocyte cells CD4+ and СD8+ (immunoregulatory index, p&lt;0.05), an increase in the number of phagocytosis active cells (phagocytic index, p&lt;0.05), the content of cationic lysosomal proteins of granulocyte leukocytes (p&lt;0.05), a 1.4-fold decrease in the cytochemical coefficient of neutrophils (p&lt;0.05), the number of proliferated under the action of PPD-L lymphocytes (p&lt;0.05), normalization of phagocytic counts and total redox activity of neutrophils (p&lt;0.05), increase in frequency and reduction of anesthesia was stated.&#x0D; CONCLUSIONS. Restoration of the body’s immune status, blood hemogram, increase in frequency and reduction of the time of decontamination were more active and occurred 1.5 times more often in patients receiving a complex combination of AMBT with Liasten.