Pharmacology of Antispasmodic Drugs Used in Management of Irritable Bowel Syndrome

Objective of the Review: To describe and compare some pharmacodynamic and pharmacokinetic parameters of antispasmodic drugs used in complex management of irritable bowel syndrome (IBS) in the Russian Federation. Key Points. IBS is a chronic recurrent disease associated with abdominal pain and bowel disorders. The key factors of IBS pathogenesis include intestinal motility disorders and visceral hypersensitivity. Both processes are controlled by endocrine and neural systems. In a target cell, voltage-operated calcium channels mediate neuronal signals for unstriped muscles to contract and for glands to start secreting. Antispasmodic drugs are a group of products that have been used for IBS management for decades. The review describes contemporary idea of molecular mechanisms to control contraction of GIT muscle cells and a comparison of antispasmodic drugs used in complex therapy of IBS in the Russian Federation. Their key pharmacodynamic and pharmacokinetic characteristics are discussed. Conclusion. The fundamental difference of mebeverine (Duspatalin) is its ability to normalise bowel motility in patients with IBS without the need in complete motility suppression. Also, its inability to block muscarinic receptors and stimulate opioid receptors is another advantage in improving the quality of life of patients. Keywords: pharmacodynamics, pharmacokinetics, antispasmodic drugs, therapy of irritable bowel syndrome, mebeverine.

Hepatitis C Infections with Cryoglobulinemia: Features and Symptoms

Study Objective: To study the incidence of cryoglobulinemia (CGE) in chronic hepatitis C infection (hepatitis C infection) and to analyse the characteristics of chronic hepatitis C infection with CGE in Belarusian patients. Study Design: Open non-randomised observational study. Materials and Methods. The study included 773 patients with chronic hepatitis C infection (in Minsk). The patients had their anti-hepatitis C antibodies, chronic hepatitis C RNA and virus genotype measured; blood cryoglobulins identified; demographic and epidemiological data collected; and complete blood assay and biochemical blood assay performed. Study Results. 282 (36.5%) subjects had positive blood cryoglobulins test, while 491 (63.5%) patients had negative result. CGE and non-CGE groups had comparable sex, BMI and infection duration parameters. CGE patients had statistically more surgeries (р < 0.001), clinical syndromes (including asthenovegetative, arthralgic and dyspeptic syndromes, р < 0.001 in all cases), hepatic fibrosis F3 (р < 0.05), hepatic cirrhosis (р < 0.001), and extrahepatic diseases (EHDs); more often they had genotype 3 of hepatitis C infection (р < 0.05) and low replicative activity of the virus (р < 0.05). Conclusion. The incidence of CGE in the study population made 36.5%. CGE patients had more pronounced hepatic process chronization, frequenter EHDs, more genotype 3 cases, and lower replicative activity of the virus. Keywords: hepatitis С, hepatic cirrhosis, cryoglobulinemia, extrahepatic diseases.

Assessment of the Balance and Dizziness Objectification in Patients with Vestibular Bilous Headache

Study Objective: To study the balance in patients with vestibular bilious headache (BH) and possible use of a special comprehensive stabilometrical program for dizziness objectification in them. Study Design: open comparative study. Materials and Methods. The study included 188 patients. Group 1 were 94 patients with confirmed BH (according to the International Headache Classification). Group 2 were 94 patients with common migraine. The stabilometrical control group included 94 healthy subjects. The balance and dizziness objectification were assessed using a special comprehensive method comprising a set of stabilometrical tests. Study Results. The most marked changes in stabilometrical parameters were recorded in patients with BH. Primary frequency spectra of these patients were in a range of 0.3 Hz and above 2 Hz, showing the dysfunction of the postural system and vestibular component in particular. The rate of pressure centre deviation and statokinesigram area were increased in the patients from group 2 vs controls; however, statistically significant differences were noted only in opticokinetic test, sensory and vestibular, and closed-eye tandem results. Comparison of the two clinical groups demonstrates significant differences in basic stabilometrical parameters of all challenge tests. Visual control exclusion as well as substandard visual stimulation had significant impact on changes in the analysed parameters. Conclusion. The use of special stabilometrical tests (opticokinetic stimulation, sensory and vestibular and tandem tests) described in this article allows assessing the balance, quantifying vestibular dysfunction in patients with BH, and objectifying dizziness. Keywords: dizziness, balance, vestibular migraine, computer-aided stabilometry.

Modern Methods for Assessment of the Implantation Potential of Embryos in Assisted Reproductive Programs

Objective of the Review: To analyse the modern methods for assessment of the implantation potential of embryos in assisted reproductive programs. Key Points. We present the study results for selection of a most optimal embryo for transfer, using visual assessment of embryo quality, preimplantation genetic aneuploidy testing, analysis of metabolomic, proteomic, transcriptomic profiles of culture media and embryo blastocele. We have paid special attention to assessment of small non-coding RNA (sncRNA) in embryo culture medium. Conclusion. Due to the high sensitivity, objectivity and biomarker resistance to degradation, the most promising non-invasive method to assess the implantation potential of an embryo is analysis of the sncRNA profile in embryo culture media. Keywords: aneuploidy, pre-implantation genetic testing, small non-coding RNAs, proteomic analysis, metabolomic analysis.

Analysis of Risk Factors and Perinatal Mortality Structure in Pregnant Patients with Diabetes Mellitus

Study Objective: To analyse risk factors and perinatal mortality structure in patients with various types of diabetes mellitus (DM) over the last 30 years in specialised settings. Study Design: retrospective single-site cohort study. Materials and Methods. We have studied 42 medical records containing cases of perinatal death of foetus or newborn in 1988–2018 in patients with DM1 (n = 20), DM2 (n = 10), gestational DM (n = 12). Study Results. The most common complication in pregnancy was preeclampsia combined with chronic placental insufficiency (47.6%). The most common risk factors of perinatal death were inadequate glycemic control in 1st trimester (69.0%), absence of preconception preparations (66.7%), preconception overweight and obesity (42.8%), and chronic arterial hypertension (28.6%). There were 38.1% antenatal deaths, 16.7% intranatal deaths, and 45.2% cases of postnatal mortality. The major causes of perinatal foetal mortality in 26.2% cases were placental disorders, 16.7% were associated with foetus growth retardation, diabetic fetopathy and respiratory distress syndrome. Conclusion. DM during pregnancy was associated with a higher risk of perinatal death. Timely preconception preparation, BMI normalization and a consolidated approach to term and mode of delivery can reduce the risk of perinatal mortality in women with various types of DM. Keywords: diabetes mellitus, gestational diabetes mellitus, perinatal mortality, stillbirth, obesity, preeclampsia

Review of the Studies in the Use of Biofeedback Therapy in Rehabilitation and Physiatrics of Neurological Patients

Objective of the Review: To collect information, analyse and evaluate previous studies in the use of biofeedback in neurological patients. Key Points. Despite the wide practical application and a lot of available publications, the level of evidence of this method is low because of a small sample size and the challenges with biofeedback mechanism description. A review of various types of biocontrol, its mechanisms and developments shows that drug-free therapy using only patient’s resources (organic, psychological, emotional and volitional) can activate the mechanisms of neuroplasticity, which are poorly studied. Still, it does not prevent from using biocontrol for the therapy of patients and/or prevention of various diseases in healthy population. Conclusion. Biofeedback therapy has proven to be a safe, relatively efficient and easy-to-use method. However, organisation of a large-scale double blind randomized trial is one of the predominant directions in the future. Keywords: biofeedback, biocontrol, neurofeedback, biofeedback therapy.

Hemostasis in Infertile Patients Participating in Assisted Reproduction Programmes

Study Objective: To evaluate the impact of multifollicular ovarian stimulation in in vitro fertilisation (IVF) programmes on hemostasis. Study Design: perspective comparative study. Materials and Methods. The study included 68 patients divided into two groups: study group (n = 36) — infertile patients; control group (n = 32) — healthy non-pregnant women of reproductive age. The protocol with gonadotrophin releasing hormone antagonists was used for ovulation stimulation. Hemostasis system in study patients was evaluated in 2 weeks after embryos were transferred to uterus; in control group — on day 20–22 of menstrual period. For the study group, we evaluated clotting test parameters of hemostasis system, D-dimers (D-d) and fibrin monomer (FM). Study Results. We have not found statistically significant differences between hemostasis screening results of study groups. We have identified increase in pro-coagulatory properties of blood in the study group patients: increase in FM and D-d (р < 0.0001 in both cases). There is an association between study parameters and pregnancy (p < 0.001) and no association with obesity, age and infertility. Conclusion. In IVF programme, FM and D-d levels rise, evidencing hypercoagulation development. An increase in FM levels was even more significant and can be used as an early and specific fibrogenesis marker. Keywords: assisted reproductive technologies, fibrin monomer, D-dimer, hypercoagulation, venous thromboembolic events.

Anogenital Warts: A Modern Idea of the Problem

Objective of the Review: To expand the understanding of the possibilities of complex personalized therapy for anogenital warts (AW). Key Points. Human papilloma virus (HPV) is a widespread viral infection that causes genital precancer and cancer. Clinical manifestations of low-risk HPV can include anogenital warts, the therapy of which, despite the benign nature of the process, should be multicomponent, interdisciplinary and individualized. Conclusion. Numerous studies have proven the high clinical efficacy and safety of VIFERON® (Russia), which is actively used in various fields of medicine, including obstetrics and gynaecology. Currently, conservative management in combination with other surgical and non-surgical methods is fundamental for the treatment of patients with AWs. Keywords: anogenital warts, human papilloma virus, НPV, vulvar condylomata acuminata, cervical cancer.

Thyroid Disorders and COVID-19

Objective of the Review: To present the available information on the SARS-CoV-2 impact on thyroid gland (TG), impact from a thyroid pathology over COVID-19 morbidity and course, and management of patients with various thyroid pathologies and the novel coronavirus infection. Key Points. SARS-CoV-2 virus demonstrates exponential spread all over the globe and has caused a global pandemic of COVID-19 infection. Currently, the mechanism of non-pulmonary complications of SARS-CoV-2 and endocrine involvement is yet not clear. The impact from SARS-CoV-2 on TG can be a result of direct invasion of target cells by the virus or activation of immunise and inflammatory response.Changes in the pituitary-hypothalamic thyroid system can be caused by developing euthyroid pathology syndrome, glucocorticosteroid therapy, destructive thyroiditis. Manifestation of autoimmune thyroid disorders associated with COVID-19 cannot be ruled out. Conclusion. Currently there is no information on direct thyroid invasion by SARS-CoV-2; however the available results from trials and clinical observations demonstrate possible impact from coronavirus infections, in particular from SARS-CoV and SARS-CoV-2, on the pituitaryhypothalamic-thyroid system with development of various pathologies or a number of changes in thyroid hormone levels. Taking into account possible associations between thyroid dysfunction and prolonged hospitalisation, risk of deaths in hospital, and the association between thyrotoxicosis and atrial fibrillation and hypercoagulation, it is advisable to screen patients with severe COVID-19. Keywords: SARS-CoV-2, COVID-19, thyroid gland, nonsuppurative granulematous thyroiditis.

Visual Object Agnosia in Acute Ischemic Stroke: A First Neuroimaging Biomarker

Study Objective: To demonstrate the potential use of peripheral sulcus occipitotemporalis involvement as a first neuroimaging biomarker of visual object agnosia in acute ischemic stroke. Study Design: Retrospective study. Materials and Methods. We have examined 76 patients (52 males, 24 females) in peracute or acute hemisphetic (supratentorial) ischemic stroke. The age of participants was 66.5 ± 6.7 years. The examination involved neurological, neuropsychologic, neuroimaging and eye checks. Any disturbances of the visual object gnosis were diagnosed with the Object Decision test from the Birmingham Object Recognition Battery. According to brain CT and MRI results, all patients underwent assessment of their sulcus occipitotemporalis involvement. Study Results. Stroke-related visual object agnosia was diagnosed in 7 (9.2%) patients. Statistically significant correlation between foci localisation in the sulcus occipitotemporalis and visual object agnosia development (χ2 = 64.2; р < 0.001) has been demonstrated. The sensitivity of sulcus occipitotemporalis involvement as a biomarker of visual object agnosia in acute ischemic stroke was 85.7%, while the specificity was 100%. Conclusion. Sulcus occipitotemporalis involvement in acute ischemic stroke can be used as a neuroimaging biomarker of visual object agnosia. Keywords: visual agnosia, object agnosia, ischemic stroke, neuroimaging, sulcus occipitotemporalis.