Vol 30, No 4 (2024)

BACKGROUND: According to the literature, an increase in severe forms of scarlet fever among children was noted in several countries in 2022–2023.

AIM: To identify the current clinical features of scarlet fever in children in a large metropolis in Russia.

MATERIALS AND METHODS: An observational descriptive retrospective continuous study of the clinical features of the course of scarlet fever in children was conducted based on patient case histories from 2020 to 2022.

Statistical processing was performed using methods for calculating extensive and intensive indicators (p₁ and p₂), errors of extensive indicators (m₁ and m₂), and standard deviations (p_max↔ p_min), considering the confidence interval (t) and confidence probability (P=95%).

The percentages were compared using Fisher’s exact criterion. The differences were considered significant at p <0.05.

RESULTS: The abolition of anti-epidemic restrictions on COVID-19 in 2022 led to an increase in the incidence of scarlet fever among children aged 0–18 years by 3.6 times compared to that in 2021 and to an increase in hospitalization in hospitals in Moscow. The number of hospitalized children with scarlet fever in 2022 increased by 18.0 times compared to that in 2020. Majority of those hospitalized (83.4%) were children of preschool and school age, including those aged 3–7 years (52.9%) and 7–15 years (39.3%), with an average severity of the disease of 93.6%.

Among the examined children, 53 (18.0%) had a history of COVID-19, and among this group of children, one in 5^th had severe scarlet fever.

Every 8^th–9^th patient (12.2%) had various complications, mainly of a septic nature, that occurred at week 1 of the disease; at week 2 and later, complications of infectious and allergic nature were observed.

Antibiotics of the cephalosporin (53.6%) and penicillin (46.4%) series were used to treat scarlet fever.

CONCLUSION: In modern conditions of the megalopolis, scarlet fever occurs with typical clinical characteristics. In most children, scarlet fever was characterized by a moderate course, and various complications were identified in 12.2% of children. It was noted that against the background of an increase in the number of hospitalized patients, the number of patients with severe scarlet fever decreases and the incidence of complications does not change (12.3–12.8%). Scarlet fever is 8.3 times more likely to occur in severe form in patients who have had COVID-19 than in those who did not have a history of COVID-19.

BACKGROUND: Factors such as genetic predisposition, lack of sex hormones, low physical activity, and smoking affect the development of osteoporosis in men. Moreover, in young men with Hodgkin’s lymphoma (LH), osteoporosis results from a complex interaction of various factors, including the influence of tumor cells, pathogenetic therapy, and a decrease in androgen concentration, which together leads to a change in bone composition and decrease in bone mineral density (BMD).

AIM: To determine the parameters of BMD in young men with LH and assess the risks of osteoporosis associated with pathogenetic therapy.

MATERIALS AND METHODS: The study included 26 men: 14 were diagnosed with Hodgkin’s lymphoma, and 12 were healthy males (control group). The patients underwent two absorption X-ray scans of bone tissue in the lumbar spine and femur. The following parameters were identified and studied: MPC, Z-criterion, and T-criterion.

RESULTS: BMD analysis showed a significant decrease in this indicator in the upper part of the femur and lumbar spine in patients with LH. Additionally, a decrease in the level of osteopenia or osteoporosis in the lumbar spine was observed in patients with LH. Furthermore, a decrease in the T-criterion level to osteopenia or osteoporosis was noted in the proximal part and neck of the femur in individuals with LH.

CONCLUSION: In young men who have undergone pathogenetic treatment of LH (e.g., cytostatics and glucocorticoids), a significant increase was found in the risk of osteoporosis and related complications. Densitometric examination showed a decrease in BMD and significant changes in the Z-criterion and T-criterion, indicating the development of osteopenia/osteoporosis in the proximal femur and femoral neck. The results demonstrate a high risk of fractures in these areas, which underscores the need for preventive measures.

This study aimed to review literature data on the side effects and interactions when using rivaroxaban according to global pharmacovigilance data as of March 23, 2022. The data obtained are based on the VigiLyze expert-level analytical system and the use of the international VigiBase database of the WHO International Drug Monitoring Program.

Data processing and storage were performed using Microsoft Excel. The authors provided a consolidated expert opinion based on professional experience in clinical and scientific work. The received data contained 112,654 individual case safety reports (ICSR) about cases of adverse reactions to drugs, particularly rivaroxaban. When processing the ICSR database, duplicates and reports containing incomplete information that were not comparable with the Medical Dictionary for Regulatory Activities were excluded.

After processing, 32,779 ICSRs were extracted according to the criteria, which accounted for 29.1% of the total number of all ICSRs. Basic data on ICSR were recorded from the USA, Germany, France, Great Britain, and Japan. Most often, adverse reactions were observed in patients aged >75 years (31.9%), followed by patients aged 65–74 (20.0%) and 45–64 (15.3%). By age, more adverse reactions were observed in male (46.0%) patients. Countries that have developed pharmacomonitoring system contributed significantly to the development of the ICSR of the adverse reactions of rivaroxaban, namely, USA (n=62,992; 55.3%), Germany (n=9912; 8.8%), France (n=6983; 6.2%), Great Britain (n=5632; 5.0%), and Japan (n=5294; 4.7%). Adverse reactions were reported by 57.8% of ICSRs from medical and pharmaceutical professionals, including doctors, pharmacists, pharmacists, and other healthcare professionals. Adverse reactions with rivaroxaban include hospitalizations or its prolongation (47.8%), deaths (12.4%), and gastrointestinal bleeding (14.1%). Serious adverse reactions were observed in 99.4% of the cases. Drugs that were used in parallel or were not discontinued during the prescription of rivaroxaban were acetylsalicylic acid, clopidogrel, warfarin, and enoxaparin sodium. The risks of side effects increase when rivaroxaban is combined with other drugs, which must be taken into account when writing prescriptions.

Dementia is characterized by progressive decline in cognitive functions and loss of motor skills and the ability to perform self-care tasks. The global increase in the number of dementia patients each year is attributed to longer life expectancy and aging populations. Currently, there is no standardized approach to dementia treatment; thus, primary prevention aimed at mitigating risk factors is a key focus of healthcare systems.

Some pharmacological agents have potential effects on patients’ cognitive functions, which should be considered during prescribing them.

Proton pump inhibitors (PPIs) are commonly prescribed for elderly patients prone to gastrointestinal diseases. The polymorbidity of this patient group warrants PPI prescription as gastroprotective therapy alongside other medications affecting gastric secretion (i.e., nonsteroidal anti-inflammatory drugs, anticoagulants, glucocorticoids).

There are several undesirable interactions between PPIs and other drugs: reduced absorption of antifungal agents and certain cardiac glycosides, alteration of metabolism, mutual enhancement or reduction of the pharmacological effects of PPIs and another prescribed drug against the background of the first, and increased mortality among patients taking PPIs and clopidogrel due to the possible reduction of its antiplatelet effect.

This study aimed to analyze and systematize data on the relationship between the use of PPIs and the development of dementia. The potential influence of PPIs on the cognitive functions of elderly and senile people were considered.

Analysis of the literature data showed that the risks of developing dementia vary across different patient cohorts depending on age, comorbidities, duration of medication use, vitamin B₁₂ levels, presence of apolipoprotein E alleles ε4, beta-amyloid concentration, and the ability of PPIs to inhibit the cholinergic enzyme. In prescribing PPIs to elderly patients, it is crucial to consider all risk factors and individual patient characteristics and conduct a thorough assessment of the risk/benefit ratio of the therapy.

Currently, chronic tonsillitis and its complications remain an urgent concern in modern otorhinolaryngology. The high probability of developing associated diseases, such as rheumatic heart disease, nonspecific arthritis, and glomerulonephritis, emphasizes the significance of this nosological unit in the practice of an otorhinolaryngologists and doctors of other specialties. Reactive arthritis is a critical complication of chronic tonsillitis.

Acute rheumatic fever was the most common disease associated with streptococcal tonsillitis, as well as reactive arthritis. Since 1959, patients with acute rheumatic fever have become less common, but cases of “aseptic” arthritis in patients with acute tonsillitis continued to be recorded. However, no other major criteria were established to confirm the diagnosis of acute rheumatic fever. This type of arthritis is called “post-streptococcal reactive arthritis.” Despite the fact that this disease has been known since mid-19^th century, information about its etiology and pathogenesis is limited. The main symptoms of post-streptococcal reactive arthritis are usually similar to the articular syndrome in classical reactive arthritis and are clinically manifested by acute asymmetric non-migrating polyarthritis. Laboratory diagnosis of post-streptococcal reactive arthritis, particularly the determination of titers of streptococcal antibodies, plays a crucial role in confirming the diagnosis. Differential diagnosis of post-streptococcal reactive arthritis with rheumatic diseases is critical. The main diagnostic laboratory markers of rheumatic diseases are antinuclear antibodies, rheumatoid factor, and antibodies to citrullinated proteins. Joint syndrome is often prevented in post-streptococcal reactive arthritis when nonsteroidal anti-inflammatory drugs are prescribed in combination with antibacterial drugs. If arthritis does not respond to long-term treatment with antibiotics and nonsteroidal anti-inflammatory drugs, a planned tonsillectomy is required to prevent the development of a chronic form of tonsillitis-associated arthritis, especially in patients with a history of recurrent chronic tonsillitis.

This study presents an analytical review of domestic and foreign publications on chronic tonsillitis complicated by reactive arthritis. The possible diagnostic methods warranted to confirm the diagnosis and exclude a wide range of arthritis of a different etiology are described.