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Vol 30, No 4 (2024)
- Year: 2024
- Published: 09.09.2024
- Articles: 10
- URL: https://medjrf.com/0869-2106/issue/view/8441
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Description:
Main topics of the issue:
- Abdominal adhesions
- Proton pump inhibitors and dementia
- Tonsillitis-associated arthropathies
Original Research Articles
Efficiency of balneotherapy with highly mineralized sodium chloride water in the treatment of knee osteoarthritis
Abstract
BACKGROUND: This analyzed the effectiveness of balneotherapy in patients with osteoarthritis of the knee joint.
AIM: This study aimed to examine the effectiveness of including baths with natural mineral sodium chloride water in the complex of sanatorium treatment and the effect of these baths on the dynamics of pain syndrome in patients with radiological II stage knee joint osteoarthritis.
METHODS: In the sanatorium “Chuvashiyakurort,” 59 patients received sanatorium treatment. They were divided into two groups: group 1 (main, n=35) received basic treatment and mineral baths, and group 2 (control, n=24) received therapeutic classes such as physical education, dry carbon dioxide baths, enteric oxygen therapy, halotherapy, massage according to indications, consultation to a clinical psychologist, or individual and (or) group psychotherapy. The pain syndrome was assessed using the visual analog scale, Leken scale, hоspital anxiеty and dеprеssiоn sсalе, and quality-of-life parameters.
RESULTS: During sanatorium treatment, the visual analog scale score for pain during movement syndrome decreased: in group 1, pain scores decreased by 39% of the initial level on day 10 (p <0.05) and by 60% on day 20 (p <0.05), whereas in group 2, it decreased by 21% on day 10 (p <0.05). The psychoemotional state of patients improved: by day 20 of treatment in group 1, signs of depression were leveled in 51% of women and 69% of men; in group 2, they decreased in a third of patients. The anxiety level decreased to normal in 60% of the patients in group 1 (p <0.05) and in more than half in group 2. Physical functioning improved by 40% (p <0.05) and general health by 35% (p <0.05). The greatest shifts were noted on the emotional and role functioning scales by 79% (p <0.05) and the mental health scale by 80% (p <0.05).
CONCLUSION: The use of baths with highly mineralized sodium chloride water demonstrated a positive effect in the form of pain reduction, which contributed to the improvement of the psychoemotional state and quality-of-life indicators.
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Clinical manifestations of scarlet fever in children in the megalopolis at the present stage
Abstract
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 (pmax↔ pmin), 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 5th had severe scarlet fever.
Every 8th–9th 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.
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Peculiarities of oral microbiota in patients with small and medium-sized dental defects and chronic periodontitis of moderate severity
Abstract
BACKGROUND: Chronic generalized periodontitis is one of the most common dental pathologies and causes difficulties in adopting rational treatment plan, since there are no biomarkers to qualitatively assess the possibility of developing periodontal inflammation or its pathomorphosis.
AIM: Study of peculiarities of oral microbiota in patients with acquired dentition defects under chronic generalised periodontitis of moderate severity.
MATERIALS AND METHODS: The study participants were 88 people (44 males, 44 females) with small/medium dental defects (10th International Classification of Diseases — K08.1), who were divided into two groups: the first — without clinical signs of periodontal inflammation (23 men, 21 women); the second — with chronic generalized periodontitis of moderate severity (K05.31) (24 men, 20 women). The condition of periodontal tissues and the intensity of dental caries damage were assessed using the decay/missing/filled index, papillary-marginal-alveolar index, communal periodontal index, determined degree of tooth mobility. Using microbiological methods, biomaterial from the mucous membrane of the prosthetic bed was studied and microbiota composition was determined. Identification and quantification of deoxyribonucleic acid of periodontal disease pathogens was carried out using polymerase chain reaction. Statistical analysis was performed using the Shapiro–Wilk test, Student’s t test, and χ2 test.
RESULTS: The average values of the decay/missing/filled index and the papillary-marginal-alveolar index in patients of the second group were 1.5 and 5.7 times higher, respectively, than in the first. Under chronic generalized periodontitis of moderate severity in the biomaterial statistically significantly more often were found Neisseria spp. (7.6 times; p=0.002), Candida spp. (1.9 times; p=0.035), Enterobacterales (16.2 times; p=0.001), Enterococcus spp. (5.0 times; p=0.03) and less often — Corynebacterium spp. (10.1 times; p=0.001) and Streptococcus salivarius (3.0 times; p=0.001). When patients had partial dentition defects, the identified microorganisms formed stable communities, the nature of the symbiotic relationships in which determined the clinical manifestations of inflammatory changes in the soft periodontal tissues.
CONCLUSION: Increased occurrence of Candida spp. and Enterobacterales in patients with acquired dentition defects and periodontal inflammation, formation of stable connections between them and antagonistic effect on oral cavity autochthonous is of interest for the development of targeted antimicrobial therapy in preparation for dental orthopedic treatment.
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Features of densitometric assessment of bone tissue parameters in the verification of osteoporotic changes in young men with Hodgkin’s lymphoma
Abstract
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.
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Reviews
Affective disorders accompanied by cognitive impairment in patients with a cardiac profile: prevalence, multimorbidity, and medical and social risk factors
Abstract
Clinical and medico-social issues of affective pathology combined with cognitive impairment in cardiac patients are a crucial problem in modern medicine. Studies have shown that 30–50% of patients with cardiovascular diseases suffer from depression and anxiety, and depressive disorders lead to disease complications and increase the mortality rate among cardiac patients. Studies based on the concept of multimorbidity show that depressive and anxiety disorders and cardiovascular diseases have common pathogenesis mechanisms: dysfunction of the hypothalamic-pituitary system, dyslipidemia, cytokine activation followed by impaired metabolism of biogenic amines, high degree and rate of platelet aggregation, and other humoral cellular mechanisms leading to dyscirculatory changes and damage to the white matter of the brain. Moreover, studies have shown an association between hypertension and chronic cerebrovascular insufficiency and increased risk of cognitive impairment. Cognitive dysfunctions in affective pathology are of great clinical and social importance; however, their initial manifestations in cardiac patients remain insufficiently diagnosed. This leads to missed opportunities for the prevention of cognitive deficits. The clinical manifestations and prognosis of multimorbid diseases are influenced by biomedical and psychosocial factors. Adverse psychosocial factors lead to clinical complications of diseases, reduce patients’ adherence to treatment, negatively affect lifestyle, disrupt social functioning, and lead to disability. Affective pathology significantly worsens social adaptation, the quality of life of patients, and the prognosis of cardiac disease and reduces adherence to treatment and does not induce a healthy lifestyle.
This review shows that it is critical to further develop the concept of multimorbidity aimed at finding common mechanisms of affective, cognitive, and cardiovascular pathology, and improving measures for the prevention and therapy of combined diseases. Full-text articles and fragments of monographs selected by keywords in the databases Scopus, Web of Science, MEDLINE, RSCI, eLIBRARY.RU, disserCat.ru, Psychiatrist, and ScienceDirect were used.
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Side effects and interactions with the use of rivaroxaban: Global pharmacovigilance data
Abstract
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.
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Adhesive disease of the abdominal cavity: etiomorphopathogenesis, clinic, diagnosis, treatment, and prevention at the present stage
Abstract
During surgery of the gastrointestinal tract, peritoneal adhesions are detected in 80–90% of cases, including in open surgical interventions, and abdominal adhesions occur in 70–90% of patients, with laparoscopic — in 24–35% of patients. The number of deaths from adhesive disease ranges from 14 to 52% and reaches 68% in patients aged >60 years with concomitant pathology.
The main etiological factors of adhesions are mechanical, chemical, physical, and infectious effects. The pathogenesis of adhesion formation includes three processes: inhibition of fibrinolytic and extracellular matrix degradation systems; inflammatory reaction with cytokine production, mainly transforming growth factor β1; and tissue hypoxia due to interruption of blood supply to mesothelial cells and submesothelial fibroblasts. Clinically, adhesive disease of the abdominal cavity is characterized by dyspeptic disorders in the early stages and is accompanied by intestinal obstruction in advanced cases. Adhesive disease treatment can be performed using conservative therapy or surgical intervention. To date, prevention is the most preferred method to impede the consequences of the development of adhesive disease.
Despite improvements in surgical techniques and the development of new approaches to treatment and diagnosis, adhesions remain an inevitable consequence of intra-abdominal operations. Understanding the pathogenesis of the formation of the adhesive process and adhesion and possibility of their transformation, especially at the cellular and molecular level, is beneficial for the development of more effective methods of treatment and prevention of adhesive disease of the abdominal cavity.
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The impact of proton pump inhibitors on the development of dementia in the elderly population
Abstract
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.
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Clinical significance of flash monitoring indicators in children with type 1 diabetes mellitus
Abstract
A basic principle of the treatment of type 1 diabetes mellitus, along with insulin therapy and diet therapy, is regular self-monitoring of glycemia. Glucose meters are often used for daily self-monitoring, and devices for continuous and flash monitoring of glycemia have been used in recent years.
This review discusses the clinical aspects of the application of a glycemic monitoring system with periodic scanning (flash monitoring). The principle of operating the system and the main parameters obtained when using this system are described: time in the target range, time above and below the target range and their sub-ranges, indicators of glycemic variability and glycemic control, their normative levels, and their practical significance and relationship with the clinical aspects of the course of diabetes mellitus and prognosis of chronic complications.
The results of major international and domestic studies on the effectiveness of the flash monitoring system in different age groups are presented. The advantages of the second generation of flash glycemia monitoring sensors and results of clinical studies of the accuracy of this monitoring system in children and adult patients with diabetes mellitus are presented.
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Topical issues of diagnosis and treatment of arthropathy associated with tonsillitis: a literature review
Abstract
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-19th 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.
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