Presence Of Concomitant Diseases Research Articles

Інсиденталома надниркової залози: що це таке? Частина 1

Огляд літератури та власні роздуми автора присвячені питанням виявлення різних форм патології, які, будучи часто доброякісними, могли б існувати тривалий час, якщо не все життя. Автором пропонується визначення терміна. Інсиденталома надниркової залози— це збірна робоча категорія (група), що містить різні форми патології надниркової залози, переважно неопластичні, доброякісні або злоякісні, з ознаками гормональної активності або без них, а також утворення запального, інфекційного, паразитарного походження, наслідки травм, аномалії розвитку, які випадково виявляються при обстеженні хворих із приводу позанаднирникових захворювань. Розглядаються епідеміологічні аспекти інсиденталом надниркової залози. В основному це пухлини коркової або мозкової речовини надниркових залоз, пухлиноподібні утворення (кіста, запальна пухлина, гематома). Інсиденталоми наднирників випадково виявляються при обстеженні осіб із захворюваннями шлунково-кишкового тракту, заочеревинного простору, нирок, хребта, грудної клітки, малого таза. Іншим джерелом виявлення інсиденталом наднирників є системні дані автопсії та рідко— операції на органах черевної порожнини. Поширеність інсиденталом наднирників досягає 2–6%. Найбільш об’єктивні дані можуть бути отримані за матеріалами автопсії. Частота прижиттєво виявлених інсиденталом надниркових залоз залежить від типу використовуваних візуалізуючих методик дослідження (ультразвукової, комп’ютерної томографії, магнітно-резонансної томографії), віку, характеру обстежуваних контингентів осіб, наявності супутніх захворювань (артеріальна гіпертензія, цукровий діабет та ін.), кваліфікації дослідника. Нещодавно опубліковані клінічні настанови, які пропонують діагностичний та терапевтичний алгоритм, що може допомогти в клінічній практиці, однак низка аспектів цієї проблеми все ще залишаються дискусійними і потребують подальших досліджень.

Drug-induced hypersomnia

Daytime somnolence may be a symptom of different somatic, neurological and psychiatric diseases and develop due to abuse and/or discontinuation of various medications. Drug- induced hypersomnia (DIH) is defined as hypersomnolence caused by the intake of multiple drugs. DIH is one of the most frequently reported effects and/or side effects of drugs. DIH prevalence varies widely and can be as high as 75% in patients receiving specific medications. DIH risk factors include elderly and senile age, impaired drug metabolism, serum drug concentration, method and frequency of drug administration, single and daily doses of drugs, etc., as in many other drug- induced diseases and syndromes. DIH can occur both due to sedative agents administration and withdrawal of psychostimulants and other activating psychotropic medications. Most often, the development of DIH is associated with the use of levodopa-carbidopa, antipsychotics, antidepressants. The pathogenesis of DIH is complex and multifactorial and is associated with the mechanism of action of individual drugs and the presence of concomitant diseases. The article discusses the risk assessment of DIH development due to various medications, diagnosis and management tactics of patients with DIH.

The value of ultrasound in the multivariate assessment complications of permanent vascular access for hemodialysis

Background. The maximum duration of vascular access for hemodialysis functioning rarely exceeds 4 years. The main tool for diagnosing access dysfunction is duplex ultrasound. Dynamic ultrasound examination of vascular access is not included in the standard examination of patient undergoing hemodialysis in Russia.Objective. To study the structure of complications and changes in hemodynamics in the vascular access for hemodialysis and to determine the risk factors contributing to its development.Design and methods. Ultrasound, clinical and laboratory examination was performed in 550 patients undergoing program hemodialysis, 517 (94.0 %) of them had arteriovenous fistula, 33 (6.0 %) patients had arteriovenous graft.Results. Vascular access complications occurred in 26.7 % (147 patients), there was no significant difference in the detection rate of thrombosis (26.5 %), stenosis (23.8 %), and aneurysm (21.1 %). A combination of two complications was observed in 20.4 %, the steal syndrome — in 8.2 %. A correlation was established between the presence of significant stenosis, aneurysm of the outflow vein and the development of thrombosis, between the presence of concomitant diseases of the peripheral arteries and the development of steal syndrome and stenosis of the inflow artery and the anastomosis zone.Conclusion. Duplex ultrasound allows to diagnose complications of vascular access for hemodialysis and determine its causes.

FEATURES OF THE QUALITY OF LIFE OF PATIENTS WITH RESPIRATORY DISEASES AND THEIR DYNAMICS DURING STATIONARY TREATMENT

This article is devoted to the features of the formation of chronic bronchopulmonary pathology and the effectiveness of treatment of patients are significantly influenced by such unfavorable factors as the state of the environment, working conditions, living conditions, late access to medical care, the presence of concomitant diseases, etc. The dependence between the features of the formation of chronic respiratory diseases, risk factors and the quality of life of urban residents was revealed. The functioning scales presented in the program allowed us to identify the features of the social and hygienic functioning of patients. The most important thing in the treatment of patients with respiratory diseases is to increase the level of medical awareness and medical activity. The obtained data can be used to develop recommendations for the detection of early chronic obstructive pulmonary diseases

Thromboembolic Adverse Drug Reactions in Janus Kinase (JAK) Inhibitors: Does the Inhibitor Specificity Play a Role?

Recent advances in immunology enabled the characterization of several signal transmitting pathways responsible for proper cytokine and chemokine signaling. Among them, Janus kinases (JAKs) are essential components of receptor activation systems. The discovery of JAK kinases enabled the synthesis of JAK kinase inhibitors (JAKi or Jakinibs), which have proven to be efficacious in the treatment of hematologic malignancies and several rheumatological disorders and continue to be investigated in many clinical indications. Blocking multiple cytokines belonging to several cytokine families with a single small molecule may, however, create a potential risk for the patients. Recently, a higher risk of thromboembolic complications, namely, deep vein thrombosis and pulmonary embolism, has been recognized as the main concern during treatment with Jakinibs. At present, it is not entirely clear whether this increased risk is related to direct cytokine blockade, the presence of concomitant diseases in treated patients or other unknown circumstances that work together to increase the risk of this side effect. In this review, we discuss data on the risk of thromboembolic side effects, with special emphasis on the mechanism that may be responsible for this increased risk. Many indirect data indicate that higher thromboembolic risk may be related to the specificity of JAK inhibitor action, such that preferentially blocking one signaling pathway upsets the balance between pro and anti-thrombotic activities.

Selective screening of patients with associated somatic diseases as a method of early detection of acromegaly

BackgraundBackgraund: Acromegaly is a multi-organ disabling disease, the effectiveness of treatment of which directly depends on timely diagnosis. Latent course and delayed diagnosis increase the exposure of pathological hypersecretion of growth hormone and insulin-like growth factor-1, contributing to the development of irreversible systemic and metabolic changes in the body that negatively affect survival.AimsAims: The aim of the study was to clinically test a comprehensive diagnostic approach using selective screening to detect cases of acromegaly in patients with combined somatic diseases.Materials and methodsMaterials and methods: The diagnostic search algorithm included a 2-stage questionnaire, expert assessment of the clinical status, laboratory and instrumental examination. The inpatient examination included the use of additional laboratory and instrumental methods and expert evaluation of the results obtained by filling out a doctor’s questionnaire. When the score was higher than 18 points, a more specific examination was performed: double determination of the insulin-like growth factor-1 level, oral glucose tolerance test with determination of the nadir of growth hormone value, and MRI of the brain with contrast enhancement. The diagnosis of acromegaly was made on the basis of personal data, expert assessment of the clinical status, results of laboratory and instrumental examinations.ResultsResults: A survey of 1249 patients with combined systemic and metabolic disorders conducted using the point system allowed us to suspect acromegaly in 367 patients (29.4%), who were offered further examination. The majority of patients were previously seen by specialists for diabetes mellitus (79.3%) or thyroid pathology (10%). In the result of inpatient ­examination of 329 patients, 35 (10.6%) patients showed an increase in the blood level of IGF-I. In 19 patients, a persistent increase in the level of IGF-I was combined with the absence of GH suppression of less than 0.4 ng/ml against the background of glucose load. During MRI in 9 patients, pituitary adenoma was detected (in 2 — microadenoma and 7 — ­macroadenoma).ConclusionsConclusions: As a result of the study, among the group of 1249 patients (mean age 58±13 years) with the presence of concomitant diseases, 9 newly identified patients with acromegaly were found who were prescribed adequate treatment. The introduction of selective screening technology into the practice of an endocrinologist will improve the effectiveness of diagnostic search for patients with acromegaly, more accurately assess the prevalence of the disease in Russia and the need for specialized medical care.

J-shaped sternotomy in aortic valve repair and ascending aorta replacement. Short-term results

Objective: to evaluate the short-term outcomes of surgical treatment of aortic valve and ascending aorta defects performed through mini-sternotomy using normothermic cardiopulmonary bypass and hyperkalemic cardioplegia via Calafiori technique from May 8, 2019 to May 14, 2020. Materials and methods . The study enrolled 80 patients with isolated aortic valve disease and combined pathology of the aortic root and ascending aorta. It lasted from May 8, 2019 to May 14, 2020. The patients were divided into two groups: Group 1 included 30 patients in whom the upper median J-shaped sternotomy was applied as an access, while Group 2 consisted of 50 patients in whom standard median sternotomy was used as an access. The patients consisted of 43 (53.7%) males and 37 (46.3%) females; the average age was 55.1 ± 11.6 years. All patients were examined before surgery. It revealed no statistically significant differences between the two groups. Results. Group 2 had a 30-day mortality of 2% (n = 1) due to the development of acute heart failure against the background of heart rhythm disturbances. One patient in this group had a late mortality due to acute cerebrovascular accident occurring a month after discharge, which corresponded to 2% (n = 1). There were no deaths in Group 1. In Group 1, there were two conversions (6.7%) to longitudinal median sternotomy. In the first case, it was not possible to restore heart rhythm through repeated defibrillator discharges from mini-sternotomy access due to the presence of an adhesive process in the pericardial cavity. In the second case, ligation of the right internal thoracic artery was required after sternal wire sutures. Artificial ventilation (AV) lasted for 170.9 ± 70.2 minutes in Group 1 and 358.2 ± 169.5 minutes in Group 2. Cardiac activity was independently restored in 23 patients (77%) in Group 1, and in 12 (24%) in Group 2 (p < 0.001). Intraoperative blood loss was 400 ± 150 mL and 850 ± 150 mL (p < 0.05) in Group 1 and Group 2, respectively. In the early postoperative period, it was 200 ± 150 mL in Group 1 and 350 ± 150 mL in Group 2. The length of stay at the intensive care unit and the duration of intensive therapy did not exceed 1 day in both groups. In the early postoperative period, 4 patients in Group 1 (13%) and 27 patients in Group 2 (54%) needed inotropic support (p < 0.001). The need for painkillers and non-steroidal anti-inflammatory drugs was within 3–4 days in Group 1 and 8–10 days in Group 2. In-hospital postoperative period varied from 10 to 16 days in both groups, depending on the severity of the initial condition, presence of concomitant diseases and the need to select an adequate anticoagulant dose. The patients were discharged in satisfactory condition under the supervision of a cardiologist at their homes. There were no inflammatory complications in the access area in both groups during their in-hospital stay. Among the complications in the mid-term postoperative period, two months after discharge, mediastinitis was observed in Group 2. The patient was re-hospitalized, after a course of antibiotic therapy which resolved the mediastinitis; sternal osteosynthesis was performed. Conclusion . Based on the study, it has been shown that this technique reduces the duration of mechanical ventilation, ensures early extubation, decreases blood loss, and, accordingly, ensures the use of replacement therapy, chest stability and a better cosmetic effect. It should be noted that there was no mortality and sternal complications in the patient group with a minimally invasive approach.

Chronic heart failure and adherence to medication: methods for assessing adherence to therapy and unresolved issues

The review of the literature examines the General problems of treatment of chronic heart failure, among which special attention is paid to the problem of adherence. This problem remains one of the most urgent and difficult to solve in medicine, because it directly affects the effectiveness of treatment and the outcome of the disease. The article considers the commitment of both doctors to comply with clinical recommendations and patients to prescribed therapy. Some of the reasons that explain the lack of adherence to treatment (such as gender, age, institution where the patient is observed, and others) are described. It is also described that comorbidity is an aggravating factor in the treatment of chronic heart failure. It is described that comorbidity is an aggravating factor in the treatment of chronic heart failure. The presence of concomitant diseases increases the number of medications taken, which exacerbates the problem of adherence to medication therapy. It is noted that medical registry is the ideal model for studying adherence in clinical practice. The main Russian registers included of patients with chronic heart failure are considered. It is noted that in none of them a full assessment of patients’ adherence to therapy was carried out. In the largest foreign chronic heart failure registers, the assessment of commitment is also given insufficient attention. Separate clinical trials are described, including randomized trials, specifically studying various aspects of the problem of adherence and its impact on the course of the disease. Special attention is paid to the methods of assessing adherence in these studies. It is noted that there is no “gold standard” for its evaluation, and existing methods (such as Chips, determining the concentration of the drug in the blood, counting prescription forms and others) are unacceptable for real clinical practice. This indicates the need and prospects for further work on assessing adherence to therapy in patients with chronic heart failure.

Monitoring of indications for hospitalization of patients in round-the-clock hospitals of anti-tuberculosis facilities of the Department of Health of the city of Moscow

The article presents the results of five-year (2014–2019) monitoring data analysis of indications for hospitalization of adult patients to in-patients’ tuberculosis hospitals in Moscow. The structure of the collected information, created on the basis of the developed guidelines, is presented. From 1 to 15 indications were notified for each hospitalization. It has been shown that the majority of patients were hospitalized on the basis of groups of indications associated with the tuberculosis process and / or the need for a diagnostic examination (91.2%). These groups of indications were registered in 73.7% and 28,0% respectively. Also, 48.2% of hospitalizations were associated with the presence of concomitant diseases and conditions requiring hospital treatment and / or seriously aggravating the course of tuberculosis, and 32.8% – with epidemiological and social factors. These four groups were analyzed for their various indications, such as the presence of bacterial excretion and lung cavern, a widespread tuberculosis process, the need to use special treatment methods or individual selection of chemotherapy regimens, the presence of different concomitant diseases and various social factors, such as living with children under 14 years of age, old age, etc. Separately, a comparative analysis of indications was carried out depending on the presence of HIV coinfection, which showed that these patients more often have indications associated with a widespread tuberculosis process, the need for individual selection of therapy, drug addiction, bad treatment adherence, and belonging to homeless people. Periodic monitoring of indications for hospitalization is a necessary measure that allows you to obtain information necessary to optimize the quantitative and qualitative structure of the bed fund of antituberculosis medical organizations.

До питання класифікації уражень шкіри, асоційованих із гострою респіраторною хворобою COVID-19

The objective. To systematize the clinical manifestations of skin lesions associated with COVID-19 and to propose the classification of these disorders. Materials and methods. The literature data describing skin lesions associated with COVID-19 and the results of observation of 31 patients with skin lesions and coronavirus infection were summarized. In the postcovid period patients with skin diseases were admitted to the hospital. They were divided into two groups: first – patients who did not suffer from skin diseases earlier; the second – patients with exacerbation of chronic dermatoses. All patients were examined by standard clinical and laboratory methods. Results. The proposed classification makes it possible to separately distinguish lesions caused precisely by COVID-19 and exacerbation of chronic dermatoses against the background of coronavirus infection, as well as as a result of the treatment of this disease (first of all, this consider to systemic corticosteroids, which are known to affect the course of psoriasis: cause the development of common forms that are resistant to other methods of therapy), which leads to their severe course. Photos of own observations are presented. This classification will improve the quality of diagnosis of COVID-19, especially in asymptomatic or low-symptomatic forms of the disease, and will also help prevent a number of complications associated with both the treatment of patients with coronavirus infection and the presence of concomitant diseases, in particular chronic dermatoses. Conclusions. The proposed classification, on the one hand, expands the possibilities of timely diagnosis of COVID-19, especially in asymptomatic or low-symptomatic forms of the disease, and also directs the doctor to the need to prevent a number of complications associated with both the treatment of patients and the presence of concomitant diseases, in particular chronic dermatoses.

Social factors of the formation of a low level of quality of life parameters in patients with chronic obstructive pulmonary disease and bronchial asthma

Aim: Study of social factors of the formation of a low level of quality of life parameters in patients with chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA). Material and methods: Researching of screening survey was carried out in the pulmonary department. 140 patients with chronic obstructive pulmonary disease and 314 patients with bronchial asthma were questioned. The average age of patients with chronic obstructive pulmonary disease was 53.6 ± 0.74 years, in patients with bronchial asthma it was 46.3 ± 0.61 years. Quality of life was determined using the Seattle questionnaire, which included 29 questions assessing physical condition, emotional state, professional fitness and satisfaction with treatment. Result: The results of the study identified the criteria of social factors that determine the increased risk of a low level of QOL parameters, which is determined for both COPD and BA patients. A high degree of low level of physical condition for patients with COPD and asthma are determined by factors: gender, with a deficit in body weight (IC 30), with the length of the disease, villagers employed in agricultural production (collective farmers), living in poor living conditions, in families of more than 5 people, or single, with a smoking experience of more than 20–30 years, with the presence of concomitant diseases and observed by therapists at the place of residence.

Clinical and Nutritional Follow-up of Cats with Chronic Kidney Disease Fed with a Renal Prescription Diet

Background: The use of prescription diets for cats with chronic kidney disease (CKD) is one of the main management approach of this disease in cats, and is considered a renoprotective strategy that may promote increased survival and/or improve quality of life, according to the stage of CKD. Besides that, nutritional assessment is important to monitor the maintenance of quality of life of the patients and their response to disease, especially those with chronic conditions. The aim of this study was to follow the clinical and nutritional status of cats with chronic kidney disease (CKD) IRIS stages II, III and IV fed with a renal prescription diet, followed for 12 months. Materials, Methods & Results: Patients were fed exclusively with a dry renal prescription diet and medications for the management of CKD were prescribed when needed. Exclusion criteria were cats that already received a renal prescription diet or medications for the treatment of CKD. Cats were evaluated every 2 months, considering body weight (BW), body condition score (BCS), muscle mass score (MMS), clinical and laboratory parameters. In all assessments, a complete blood count and biochemistry were performed by conventional methods with the patient fasted for 12 h. In addition, urinalysis, urinary protein:creatinine ratio (UPC) and urine culture were performed from a urine sample collected by cystocentesis. The quantitative variables were tested for their stability on consecutive assessments using the non-parametric Friedman test, and did not present significant variation during follow-up, except for systolic blood pressure (SBP). Eight cats with a diagnosis of CKD were included in the study and 6 of them remained in the same CKD stage during follow-up. On cat died due to an unrelated CKD cause. Regarding nutritional assessment, 5 of 7 cats maintained BW during the 12 months. Of these, 4 also maintained MMS and BCS. Three of 7 cats presented a decrease in MMS, 2 of which presented also a decreased BW and one maintained BW.Discussion: IRIS staging results combined with Friedman’s analysis demonstrated that the diet and the clinical management were effective in the non-progression of CKD in this study. As renal injury is not expected to be reversed in CKD, the maintenance of cats in the same IRIS stages and the minimum variation of the parameters is considered a positive result in this study. Hypertensive cats started on antihypertensive therapy during the study, achieving adequate control of SBP in most cases, what can justify the variation of this clinical parameter over the 12 months. Hyperphosphatemia was a frequent alteration, included stage II cats, and presented a positive response to nutritional and medical therapy. Despite CKD staging progression was not observed in most cats using serum creatinine as a single parameter, some cats presented BW and MMS reduction, which may have influenced this result. Weight loss and muscle wasting may have occurred by several reasons, including periods of hyporexia, presence of concomitant diseases, aging process or reduced protein content on renal prescription diets. This study enhances the importance of the association of clinical and nutritional management in the maintenance of cats with CKD. We suggest that other studies are done during longer periods of time and with a larger sample to support the results found. We also suggest new studies to evaluate the protein requirements for cats with CKD.

ЭПИДЕМИОЛОГИЯ, ФАКТОРЫ РИСКА, ДИАГНОСТИКА И ПРОФИЛАКТИКА ТРОМБОЗА ГЛУБОКИХ ВЕН ПРИ ПЕРЕЛОМАХ ДЛИННЫХ КОСТЕЙ НИЖНИХ КОНЕЧНОСТЕЙ

A literature review presents a data concerning the incidence and risk factors for development of venous thromboembolic complications (VTEC), as well as their diagnosis and prevention in long bones fractures of the lower extremities (LBFLE). Literature data show that, despite the widespread implementation of preventive measures in case of LBFLE, it is not always possible to completely avoid VTEC. The main risk factors for their development are the injuries’ severity, the location and nature of the extremity bone fracture, the duration of immobilization, the amount of surgery performed for bone fragments stabilization, as well as age and the presence of concomitant diseases. In the diagnosis of thrombotic process, laboratory and radiation research methods play an essential role, and according to data they has varying degrees of sensitivity and specificity. However, to date, none of them has absolute diagnostic accuracy. Complex thrombosis prophylaxis significantly reduces the risk of VTEC development, however, the choice of the type and dosage of anticoagulants, as well as the duration of their use, remain controversial, and some authors recommend different approaches in this issue. In addition, the diagnostic criteria and therapeutic tactics for embologenic floating thrombi remain open for discussion. In this regard, the conduct of large randomized scientific studies aimed at early diagnosis, prevention and treatment of VTEC using modern diagnostic tests and new generation anticoagulants is relevant and allows to minimize the risk of disability and death.

Irritable bowel syndrome, urolithiasis and role of microbiota in their comorbidity

Urolithiasis (UL) is a polyetiological disease that depends on climate, age, diet, infections, and the presence of concomitant diseases. The major risk factors for UL include inflammatory and functional bowel disease. The aim was analysis of changes in the bowel microbiota in patients with UL combined with Irritable Bowel Syndrome (IBS), as well as the effect of microbiome correction on the recurrence rates of oxalate UL in these patients. Material and Methods: We selected 320 patients with UL with oxalate stones and concomitant IBS. Small Intestinal Bacterial Overgrowth (SIBO) was assessed in all patients and microbiome analisis was performed. Patients has 3 year observation period. A breath test for SIBO was performed every 6 months. The determination of various taxa of fecal microbiota was carried out. Patients with UL+IBS were randomly divided into 2 groups. Group I involved 120 patients who were prescribed with rifaximin. Group II-control, involved 200 patients. Results: Initially, in patients with UL+IBS, the incidence of SIBO detection was 65%. The study of microbiome phylotypes has found the significant decrease in Firmicutes as well as Akkermansia muciniphila in patients with IBS-related oxalate UL. After 6 months SIBO in patients of Group I was positive in 54 (46.6%) patients, but following 3 years 15 (12.9%) patients. In Group II, following 6 months there were 123 (63.7%) patients with SIBO, following 3 years 149 (77.2%) patients. And after 3 years we found a significant decrease in the relative risk of recurrence of UL to 0.608 in Group I. Conclusions: Patients with UL have symptoms of IBS in 19.5% of cases. SIBO was diagnosed by 5.2 times more often in UL combined with IBS. Repeated courses of rifaximin, every 6 months, in patients with SIBO and persistent symptoms of IBS were accompanied by a significant decrease in recurrences of UL

Экономические аспекты лечения COVID-19 в условиях стационара

In April 2020 in order to prevent the spread of the new coronavirus infection COVID-19 on the territory of the Russian Federation, strict quarantine measures were introduced. In the shortest possible time, a large number of general hospitals were repurposed into COVID hospitals, recommendations were issued on the management of patients with a new coronavirus infection based on the existing global experience. The limited resources of the healthcare system in a pandemic require research into the pharmacoeconomic aspects of COVID-19. In the course of the study, a continuous retrospective analysis of the case histories of 6255 patients admitted to the Central Clinical Hospital RZD-Medicine was carried out. During the study period, 22% of patients received biological therapy. The average mortality rate of patients on biological therapy is 11.6%. An individual selection of the therapeutic dose of low molecular weight heparins was carried out, which showed high clinical efficacy. The developed methods were assessed from the perspective of pharmacoeconomics. The increase in the degree of damage to the lung tissue in patients with COVID-19, as well as the presence of concomitant diseases, entails an increase in the cost of treatment. Biotherapy can reduce the cost of treating patients with CT-4 by 16% by reducing the length of stay in the intensive care unit, the need for mechanical ventilation and reducing mortality. © 2021 Infectious Diseases: News, Opinions, Training. All rights reserved.

Clinical Traits of SARS-CoV-2 Infection

Aim. Analysis of clinical manifestations, laboratory and instrumental examination data in SARS-CoV-2 patients with taking into account the disease severity and outcome.Materials and methods. The study included 92 patients with confirmed coronavirus infection, including 15 lethal cases, hospitalised at the Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology of the Sechenov University in April 2020. The analysis included demographic data, the presence of concomitant diseases, chest computed tomography (CT) results, laboratory tests (including SARS-CoV-2-diagnostic PCR, general and metabolic blood panels, coagulogram) and the duration of disease.Results. Patients infected with SARS-CoV-2 usually exhibit lymphopenia (p ≤ 0.001), leucocytosis, the elevated neutrophils (p ≤ 0.05), neutrophil-lymphocyte ratio (p ≤0,05), C-reactive protein (p ≤ 0.05), ferritin (p ≤ 0.05), D-dimer (p ≤ 0.05) and fibrinogen (p ≤ 0.05), altered prothrombin time (p ≤ 0.05) and INR (p ≤ 0.05). In a critical coronavirus infection, the pulmonary lesion exceeds 50% (corresponds to CT3 — CT4). The risk of critical SARS-CoV-2 infection increases with elder age (p ≤ 0.001), associates with the male gender and presence of concomitant diseases, such as obesity (p < 0.01), diabetes mellitus (p < 0.001), hypertension (p ≤ 0.001), CHD (p ≤ 0.001) and atrial fibrillation (p <0.05).Conclusion. The risk of severe and adverse coronavirus infection is significantly higher in elder comorbid patients.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ СТРУКТУРЫ СОМАТИЧЕСКОЙ ПАТОЛОГИИ У БОЛЬНЫХ МИОМОЙ И РАКОМ ТЕЛА МАТКИ

Objective: to conduct a comparative analysis of the structure of somatic pathology in patients with myoma and cancer of the uterine body. Materials and methods: 522 women were examined, including 40 gynecologically healthy (group 1), 314 patients suffering from uterine myoma (group 2), 168 patients with malignant neoplasms of the uterine body (group 3). All patients, in addition to General clinical, histological and instrumental diagnostic methods, were calculated the Charlson comorbidity index, which determines the presence of concomitant diseases and the prognosis of mortality. Results. A comprehensive assessment of concomitant pathology in patients with group 3 showed that the leading positions among all patients in frequency are occupied by arterial hypertension - 72%, coronary heart disease - 28,6%, obesity - 27,9%, endocrinopathy - 25,6%, gastropathy - 23,1%, pathology of the hepatobiliary system - 20,8%. When analyzing somatic pathology in patients with uterine myoma, it was found that arterial hypertension is most common - 23,6% (3,5 times less often than in group 3), anemia - 26,8% (3.8 times more often than in group 3), endocrinopathy - 10,8% (2,4 times less often than in group 3), gastrotopathy - 15% (0,8 times less often than in group 3), pathology of the hepatobiliary system - 15,2% (0,7 times less than with group 3). At the same time, comorbidity has its own characteristics depending on the main pathology and the age of the patients. Thus, the total number of extragenital pathology in women with group 3 was 73% compared to 27,4% in patients with uterine myoma. The Charlson comorbidity index for group 3 was 1,78 overall, and 0,35 for group 2, which is 5 times lower. Conclusion. The range of somatic conditions in patients with benign and malignant uterine tumors is very wide. The age Association is obvious. The leading positions in the two compared groups are occupied by cardiovascular diseases. The total number of extragenital pathology in women with group 3 is 2,7 times higher, and the comorbidity index is 5 times higher, compared to those in patients with uterine myoma.

10-year mortality in women after hip fractures

The aim was to study the indexes of short- and long-term mortality in women after hip fractures (HF).Material and methods. In a retrospective study, the data of 146 women with HF aged 50 years and older (mean age (Me [25Q-75Q]): 77.7 [68.1-81.9] years old) hospitalized in 2005-2007 were analyzed. Life outcome data were collected three times (in 2015, 2016 and 2017) by the researchers by telephone contact with patients or their relatives. The analysis was carried out depending on age, type of fracture, the presence of concomitant diseases. The average follow-up period was 144.0 [131.5-152.5] months for surviving patients and 20.2 [6.7-55.0] months for deceased.Results. At the end of investigation 94 women (64.4% among all 146 patients) died, 52 survived. The average age at the time of death for the deceased (84.5 [76.9-91.3] years), did not differ from the indexes of survivors at the end of the study (82.0 [72.9-86.8] years). Hospital mortality rates were 1.6 %, 6-month, 1-, 5- and 10-year mortality, respectively – 12.7 %, 23.0 %, 43.7 % and 54.0%.Conclusions. Survival rates in women did not differ depending on fracture type, and were significantly higher (p < 0.01) in the patients older than 70 years compared with younger patients.

An Overview of the Application of Systems Biology in an Understanding of Chronic Rhinosinusitis (CRS) Development.

Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses. It is defined as the presence of a minimum of two out of four main symptoms such as hyposmia, facial pain, nasal blockage, and discharge, which last for 8–12 weeks. CRS significantly impairs a patient’s quality of life. It needs special treatment mainly focusing on preventing local infection/inflammation with corticosteroid sprays or improving sinus drainage using nasal saline irrigation. When other treatments fail, endoscopic sinus surgery is considered an effective option. According to the state-of-the-art knowledge of CRS, there is more evidence suggesting that it is more of an inflammatory disease than an infectious one. This condition is also treated as a multifactorial inflammatory disorder as it may be triggered by various factors, such as bacterial or fungal infections, airborne irritants, defects in innate immunity, or the presence of concomitant diseases. Due to the incomplete understanding of the pathological processes of CRS, there is a continuous search for new indicators that are directly related to the pathogenesis of this disease—e.g., in the field of systems biology. The studies adopting systems biology search for possible factors responsible for the disease at genetic, transcriptomic, proteomic, and metabolomic levels. The analyses of the changes in the genome, transcriptome, proteome, and metabolome may reveal the dysfunctional pathways of inflammatory regulation and provide a clear insight into the pathogenesis of this disease. Therefore, in the present paper, we have summarized the state-of-the-art knowledge of the application of systems biology in the pathology and development of CRS.

Pharmacotherapy of allergic rhinitis

The clinical picture of allergic rhinitis includes sneezing, nasal discharge, impaired nasal breathing, and itching of the nose and roof of mouth. Depending on the duration of symptoms, allergic rhinitis is divided into intermittent and persistent forms, and depending on the severity of symptoms, it can be mild, moderate, and severe. Treatment for allergic rhinitis includes elimination of allergic contacts, allergen-specific immunotherapy, and pharmacotherapy. The choice of a treatment regimen is determined by the severity of symptoms, age of a patient and presence of concomitant diseases. The work is aimed to review the most common pharmaceuticals to treat allergic rhinitis. Saline solutions are used as monotherapy when symptoms are mild, or before use of other topical drugs to clean mucous membranes before their application. Intranasal glucocorticosteroids can be used as monotherapy, if symptoms have different levels of severity, and supplemented with other drugs, in case they are not efficient. Intranasal glucocorticosteroids do not have a systemic effect due to minimal bioavailability. The patients with moderate/severe allergic rhinitis are recommended to use them jointly with second generation antihstamines, intranasal cromones, intranasal antihistamines and leukotriene receptor antagonists. The significant side effect of antihistamines, especially of the first generation, are sedative effects on the central nervous system. The side effects of leukotriene receptor antagonists are neuropsychological disorders. Intranasal cromones have a high safety profile, which makes them popular in paediatric practice. However, the dosage regimen up to 3–4 times a day reduces patient adherence to treatment. Decongestants are not indicated as monotherapy for allergic rhinitis but can be used in combination with other drugs in short courses, taking into account the possible side effects.