Effectiveness of antimicrobial therapy for community-acquired pneumonia in real clinical practice

Background. Community-acquired pneumonia (CAP) remains one of the most common infectious diseases, occupying an important place in the structure of mortality worldwide.Aim. To evaluate the effectiveness of antimicrobial therapy for community-acquired pneumonia in hospitalized patients in real clinical practice.Materials and methods. A retrospective, observational study was conducted, which included 236 patients hospitalized for community-acquired pneumonia at the Regional Clinical Hospital in Ryazan in 2019. Based on these case histories, an analysis of the effectiveness of the initial empiric antimicrobial therapy was performed.Results. The initial empiric antimicrobial therapy in 73% of cases included administration of ceftriaxone, in 45% of cases – levofloxacin, in 14% of cases – azithromycin. It was found that initial antimicrobial therapy was effective in 58% of patients who did not require replacement for the antibiotic. A need for a change in the treatment regimen was significantly associated with an increase in the length of hospitalization (p < 0.001), heart rate upon admission (p = 0.032), myelocyte count in the complete blood count (p < 0.001), and urea and blood creatinine levels (p = 0.004 and p = 0.044, respectively). The selected antimicrobial therapy regimen was significantly associated with the expected treatment effectiveness (p = 0.039). The choice of levofloxacin in monotherapy or in combination with ceftriaxone was accompanied by a decrease in the relative risk of replacing the antimicrobial, compared with other treatment regimens (odds ratio (OR) = 0.86 (95% confidence interval (CI): 0.55–1.34) and OR = 0.57 (95% CI: 0.37–0.87), respectively).Conclusion. Empiric antimicrobial therapy for community-acquired pneumonia in real clinical practice complies with current recommendations, however, at the same time, its ineffectiveness persists. Respiratory fluoroquinolones are most effective in treating pneumonia in hospitalized patients.

“Golden Shot” in the Treatment and Diagnosis of Schizophrenia: Psychiatrists or Neuroscientists?

The available published data indicate that antagonism towards D2 receptors of dopamine is a «necessary condition» in the process of effective treatment of schizophrenia, but at the same time, this antagonism is insufficient to achieve a state of complete remission. These data serve as a powerful stimulus for the process of searching new treatments and synthesizing new drugs. The current status of the theory of neural networks demonstrates to the professional community that in order to effectively change the functioning of basic biological systems, a number of subtle changes in the central nervous system are required, which are possible with the use of certain substances. The influence of modulation of glutamate on these processes is currently a very «popular» direction both in neurobiology and in clinical psychiatry. At the same time, the role of the latter in the pathogenesis of a number of mental disorders remains unproven. In parallel with this direction, the mechanisms of serotonergic and cholinergic effects on the main components of the pathogenesis of mental disorders are being studied and used in the development of new antipsychotic drugs. Most antipsychotic drugs which belong to «new wave» exhibit an affinity for different types of receptors, which mediate the effect on several therapeutic targets. In practice, a large number of patients take certain drugs not only as monotherapy, but often combine them with other drugs. At the same time, the effectiveness of such therapeutical regimens is low. Therefore, in most modern protocols, monotherapy is still recommended. In recent years, there has been a growing body of research on pharmacotherapy augmentation strategies. The results of these studies demonstrate that augmentation preparations belonging to different pharmacological classes can be generally effective, not only in certain diseases, but also in certain types of patients. In attempts to create a model of «rational polypharmacy», it is very important to accurately define and target the therapy to «problematic symptoms», and it is also necessary to develop an optimal withdrawal strategy from the active therapy regimen. To date, the only existing «lifeline» is Clozapine, which, despite its many disadvantages, remains an effective therapeutic agent for resistant forms of schizophrenic spectrum disorders. New methods of drug synthesis, including «individual drug affinity» analysis and strategies based on the study of gene polymorphism, look promising in the context of antipsychotic drug development. It is unlikely that there will be a «golden shot» for the schizophrenic spectrum disorders in the coming decades, both in terms of diagnostics and treatment. There is a hope that some of the strategies currently being developed (polypharmacy, augmentation), along with new antipsychotic drugs entering the pharmaceutical market, will ultimately become the «shot» that the professional community, patients and their families are looking forward to.

The impact of Sofosbuvir/Velpatasvir/Voxilaprevir treatment on serum hyperglycemia in HCV infections: A Systematic Review

Review question / Objective: To assess the possible cause of events, the incidence of grade 3 hyperglycemia after treating Sofosbuvir/Velpatasvir/Voxilaprevir in HCV infections. Condition being studied: Sofosbuvir, velpatasvir, and voxilaprevir (SOF/VEL/VOX) is an effective, safe rescue therapy regimen for patients have previously been treated failure. Initiating Direct-Acting Antiviral (DAA) treatment for HCV infection with diabetes have experienced hypoglycemia, it could improve insulin resistance due to clean HCV. However, some studies shown that SOF/VEL/VOX has Grade 3 hyperglycemia adverse events. This finding contradicts that other DAAs studies. Information sources: Conducting a comprehensive literature search on the pubmed, Cochrane, clinicalkey, Embase, and MEDLINE electronic databases.

Giant Cell Myocarditis Following COVID-19 Successfully Treated by Immunosuppressive Therapy

In this case report, we present a 46-year-old lady who has developed a rapidly progressive heart failure after an episode of COVID-19. The pathologic examination of her endomyocardial biopsy specimens was compatible with GCM and she was successfully treated with a combined immunosuppressive therapy regimen.

Laboratory features of cardiovascular injury in COVID-19 and other acute respiratory viral infections

The article presents data from a study of specific cardiac markers in patients with acute respiratory viral infection (ARVI) or coronavirus disease 2019 (COVID-19). COVID-19 caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) is characterized by cardiovascular injury. However, with other ARVIs, the prevalence of heart involvement is also high and, according to the literature data, is about 20%. At the same time, laboratory characteristics of these lesions have significant differences in ARVI and COVID-19, which necessitates different approaches to therapy.Aim. To determine the most significant markers for the diagnosis of cardiovascular involvement in patients with COVID-19.Material and methods. A total of 60 patients were included in the study: main group (n=30), COVID-19 was laboratory confirmed; comparison group (n=30), other ARVI pathogens were verified. The groups were completely comparable in sex, age and severity of disease course. The average values of troponin, creatine kinase MB, N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer were compared in patients of both groups in the acute disease phase, corresponding from 1 to 8 days from the symptoms’ onset. Data analysis was performed using a two-sided independent samples t-test using SPSS Statistics version 23.Results. The higher levels of troponin-I and D-dimer were significantly more common in the main group. The mean value of creatine kinase MB did not exceed the upper limits of reference values. There were no significant differences in NTproBnP levels between the groups. At the same time, in both groups, its level significantly exceeded the age reference values.Conclusion. The most effective markers of cardiovascular complications in COVID-19 patients should be considered troponin-I, D-dimer and NT-proBNP. Early diagnosis and laboratory monitoring in dynamics is important for the timely detection of cardiac pathology and alteration of therapy regimen.

FEATURES OF THERAPY FOR PANIC DISORDER, ASSOCIATED WITH THE SARS-COV-2 PANDEMIC

Введение. В силу существенной схожести симптомов острого респираторного синдрома SARS-CoV-2 и панического расстройства (ПР), диагностика представляет значительные трудности. ПР имеют тенденцию развиваться хронически, с рецидивами на протяжении всей жизни. Цель работы: выявить особенности клинического проявления ПА/ПР на фоне COVID-19 и обосновать оптимальную схему терапии. Методы. Проведен анализ данных 86 пациентов, у которых диагностировано ПР при обращении на консультативный неврологический прием КФ UMC с мая 2020 г по май 2021 г. Скрининг панического расстройства проведен по Шкале тревоги Шихана (Sheehan Anxiety Rating Scale, ShARS). Результаты. Среди пациентов было 54 (62,8%) женщины и 32(37,2%) мужчины. По шкале ShARS тяжелым тревожное расстройство (80 баллов и выше) определено у 39 (45,3%), у остальных тревога (от 30 до 80 баллов) - клинически выраженная. Диагноз ПР у 21(24,4%) был диагностирован ранее заражения ковидной инфекцией. У остальных, выставлен впервые 26 (30,2%) пациентам, ранее не обращавшихся к неврологу и 39 (45,3%) пациентам, обращавшихся к неврологу с диагнозами соматоформная вегетативная дисфункция, сосудистая цефалгия, мигрень, обсессивно-компульсивное расстройство. Бронхиальная астма отмечалась в анамнезе в 13 (15,1%) случаях. Разновидности панических приступов были расценены как большие (развернутые) ПР (4 симптома и более) - у 55 (64%), в остальных случаях как симптоматически бедные. Особенность течения ПР на фоне SARS-CoV-2 определяется возникновением на фоне ипохондрических фобий. В то же время агорафобии и избегающего поведения, характерных для ПР, не отмечалось. Заключение. Использование бензодиазепинов для анксиолитических целей, противоастматических препаратов может быть контрпродуктивным в лечении тревожных расстройств. Ятрогенный риск наслаивается на возможную гипокалиемию, удлинение интервала QTc, артериальную гипертензию, вызванную COVID-19. Оценка результатов проведённого нейрофармакологического анализа и назначения препаратов анксиолитического действия Бифрен, в более тяжелых случаях ПР Прегабина показала клинический положительный эффект. Introduction. Due to the significant similarity between the symptoms of SARS-CoV-2 acute respiratory syndrome and panic disorder (PD), diagnosis presents significant difficulties. PD tend to develop chronically, with lifelong relapses. Purpose of the work: to identify the features of the clinical manifestation of PD in the presence of COVID-19 and to substantiate the optimal therapy regimen. Methods. We analyzed the data of 86 patients who were diagnosed with PD when they applied for a consultative neurological appointment CF UMC from May 2020 to May 2021. Panic disorder was screened according to the Sheehan Anxiety Rating Scale (ShARS). Results. Among the patients there were 54 (62.8%) women and 32 (37.2%) men. On the ShARS scale, severe anxiety disorder (80 points and higher) was identified in 39 (45.3%), in the rest anxiety (from 30 to 80 points) was clinically expressed. The diagnosis of PD in 21 (24.4%) was diagnosed earlier than contracting a covid infection. The rest were exposed for the first time to 26 (30.2%) patients who had not previously visited a neurologist and 39 (45.3%) patients who visited a neurologist with diagnoses of somatoform autonomic dysfunction, vascular cephalgia, migraine, obsessive-compulsive disorder. A history of bronchial asthma was observed in 13 (15.1%) cases. The types of panic attacks were regarded as large (extensive) PR (4 symptoms or more) - in 55 (64%), in other cases as symptomatically poor. The peculiarity of the course of PR against the background of SARS-CoV-2 is determined by the occurrence of hypochondriac phobias against the background. At the same time, agoraphobia and avoidant behavior characteristic of PD were not observed. Conclusion. The use of benzodiazepines for anxiolytic purposes, anti-asthma drugs may be counterproductive in the treatment of anxiety disorders. The iatrogenic risk is superimposed on possible hypokalemia, prolongation of the QTc interval, arterial hypertension caused by COVID-19. Evaluation of the results of the neuropharmacological analysis and the appointment of drugs with anxiolytic action Bifren, in more severe cases of Pregabin in PR showed a clinical positive effect.

Comparison of preoperative chemoradiation with radiation or chemotherapy alone in patients with non-metastatic, resectable retroperitoneal sarcoma

Aim: Optimal preoperative therapy regimen in the treatment of resectable retroperitoneal sarcoma (RPS) remains unclear. This study compares the impact of preoperative radiation, chemoradiation and chemotherapy on overall survival (OS) in RPS patients. Materials and Methods: The National Cancer Database (NCDB) was queried for patients with non-metastatic, resectable RPS (2006–15). The primary endpoint was OS, evaluated by Kaplan–Meier method, log-rank test, Cox multivariable analysis and propensity score matching. Results: A total of 1,253 patients met the inclusion criteria, with 210 patients (17%) receiving chemoradiation, 850 patients (68%) receiving radiation and 193 patients (15%) receiving chemotherapy. On Cox multivariable analysis, when compared to preoperative chemoradiation, preoperative radiation was not associated with improved OS (hazards ratio [HR] 0·98, 95% CI 0·76–1·25, p = 0·84), while preoperative chemotherapy was associated with worse OS (HR 1·64, 95% CI 1·24–2·18, p < 0·001). Similar findings were observed in 199 and 128 matched pairs for preoperative radiation and chemotherapy, respectively, when compared to preoperative chemoradiation. Findings: Our study suggested an OS benefit in using preoperative chemoradiation compared to chemotherapy alone, but OS outcomes were comparable between preoperative chemoradiation and radiation alone.

Efficacy of azoximer bromide in the treatment of hospitalized patients with moderate to severe community-acquired pneumonia

Introduction. The high incidence of community-acquired pneumonia and the high complication rates in the cases of severe pneumonia actualize the search for new pharmacotherapy tools to improve the effectiveness of standard patient management regimens. A high level of severe inflammatory response underlies the high risk for developing septic complications of pneumonia, along with impaired immune responses.The aim is to evaluate the efficacy of azoximer bromide introduction in the combination therapy regimen for hospitalized patients with moderate to severe community-acquired pneumonia.Materials and methods. A prospective, open label, parallel group, randomized study comparing the efficacy of azoximer bromide introduction in the combination therapy of hospitalized patients with moderate to severe community-acquired pneumonia was conducted at the premises of Federal Scientific and Clinical Center for Reanimatology and Rehabilitation. 30 patients were included in the study group and 37 patients in the comparator group. The baseline characteristics were comparable in both groups. Results. The azoximer bromide introduction in the combination therapy of patients with community-acquired pneumonia led to a statistically significant reduction in the duration of hospital stay (Me (LQ; HQ): 9 (8; 10) days for the study group and 13 (10; 14) days for the comparator group, (p = 0.000078), duration of ICU stay (Me (LQ; HQ) 2 days (1.5; 2.5) and 5 days (5.0; 6.0), respectively, (p = 0.00001), the duration of febrile fever 5 (± 0.6) days versus 10 (± 1.2) days (p = 0.0000), the incidence of acute respiratory failure (13.33% in group 1 versus 37.84% in group 2, p = 0.024) and septic shock (10% in group 1 versus 32.43% in group 2, p = 0.0285).Conclusions. The azoximer bromide introduction in the standard therapy regimen for patients with community-acquired pneumonia allowed to reduce the duration of hospital stay, the duration of ICU stay, the length of febrile fever, the incidence of septic shock and respiratory failure. The possible mechanisms of action may include a reduction of the severe inflammatory reactions and an optimization of the patient's immune response to the infectious process.

Kidney`s functional state assessment when using different regimens of intraoperative fluid therapy

The aim of the research. To study the kidneys functional state when using different regimens of intraoperative fluid therapy in high cardiac risk patients during abdominal surgery. Materials and methods. 142 patients who underwent abdominal surgical interventions mainly for oncoproctological diseases of the gastrointestinal tract, aged over 50 years old and with a history of stable coronary heart disease were divided into four groups depending on the way of intraoperative fluid therapy, which was performed according to two regimens: restrictive (R) and liberal (L). R1 (n=36) with rate of intraoperative fluid therapy 3–5 ml/ kg/ h, R2 (n=35) patients received 5–8 ml/kg/h during surgery, L1 (n=35) with intraoperative fluid rate of 8–11 ml/kg/h and L2 (n=36) – more than 11 ml/kg/h intraoperatively. The study of the functional state of the kidneys included the determination of such indicators as urea, creatinine, diuresis, the degree of AKI according to KDIGO in two stages of the study – before surgery and 18–24 hours after. Results. The greatest tendency to develop acute kidney injury was observed in R1 subgroup with a restrictive intraoperative fluid therapy regimen, and the smallest in L1 subgroup with a relatively liberal regimen. The R2 and L2 subgroups took an intermediate place in the number of renal complications. A high tendency to develop renal dysfunction in patients of R1 subgroup was associated with circulatory hypokinesia and a moderate decrease of renal perfusion. Conclusions. The study found that restriction of infusion in R1 subgroup contributed to the development of renal dysfunction in almost half of the patients. First of all it was associated with a decrease of GFR in conditions of circulatory hypokinesia, which is larger in R1 subgroup and amounted to about 35 %. The safest regimens of intraoperative fluid therapy in relation to renal function in the perioperative period were relatively liberal (subgroup L1) and relatively restrictive (subgroup R2), which provided the least number of complications in patients

Induction Chemotherapy Followed by Pleurectomy Decortication and Hyperthermic Intraoperative Chemotherapy (HITHOC) for Early-Stage Epitheliod Malignant Pleural Mesothelioma—A Prospective Report

Malignant pleural mesothelioma (MPM) is an aggressive disease with poor prognosis and the current treatment for early-stage MPM is based on a multimodality therapy regimen involving platinum-based chemotherapy preceding or following surgery. To enhance the cytoreductive role of surgery, some peri- or intra-operative intracavitary treatments have been developed, such as hyperthermic chemotherapy, but long-term results are weak. The aim of this study was to report the post-operative results and mid-term outcomes of our multimodal intention-to-treat pathway, including induction chemotherapy, followed by surgery and Hyperthermic Intraoperative THOracic Chemotherapy (HITHOC) in the treatment of early-stage epithelioid MPM. Since 2017, stage I or II epithelioid MPM patients have been inserted in a surgery-based multimodal approach comprising platinum-based induction chemotherapy, followed by pleurectomy and decortication (P/D) and HITHOC with cisplatin. The Kaplan–Meier method was used to estimate overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS). During the study period, n = 65 patients affected by MPM were evaluated by our institutional Multidisciplinary Tumour Board; n = 12 patients with stage I-II who had no progression after induction chemotherapy underwent P/D and HITHOC. Post-operative mortality was 0, and complications developed in n = 7 (58.3%) patients. The median estimated OS was 31 months with a 1-year and 3-year OS of 100% and 55%, respectively. The median PFS was 26 months with 92% of a 1-year PFS, whereas DFS was 19 months with a 1-year DFS rate of 83%. The multimodal treatment of early-stage epithelioid MPM, including induction chemotherapy followed by P/D and HITHOC, was well tolerated and feasible with promising mid-term oncological results.