The Effectiveness of Topical Drugs with a Personalized Approach in the Treatment of Chronic Dermatoses

At the present time, dermatologists’ arsenal has been significantly enriched with new highly effective drugs able to improve significantly the treatment of chronic immune-dependent dermatoses, in particular – atopic dermatitis and microbial eczema. The article discusses topical external agents for the treatment of patients with chronic dermatoses.

Modern Views on Ethyopathogenesis and Achalasia Treatment

Achalasia is a chronic neuromuscular disorder of esophagus with supposed autoimmunity, genetic disturbancies and viral infection. The disease is characterized by poor relaxation of lower esophageal sphincter and absent of body peristalsis. The inflammation, eosinophilic and lymphocytic infiltration may play role in loss of inhibitory ganglion in the myenteric plexus. High resolution manometry is a gold standard for diagnosis of achalasia, because it distinguish three types of disorder. The aim of treatment of achalasia is to reduce symptoms, such as dysphagia. The most effective modality of surgical treatment are Heller myotomy and peroral endoscopy myotomy. The pneumodilation is less preferable because of short-term effect and high rate of relapse. The relapse after surgical treatment can be present and correlates increase with the time after intervention

Features of Mental Sphere of Patients with Obesity Before and After Bariatric Surgery

The article discusses the spectrum of the mental disorders that are potentially possible in obese patients, when they seek metabolic surgery; the personal characteristics of this category of patients are examined in detail, as well as questions of the motive and the purpose of the operation in terms of the degree of awareness of the decision made

Hypolipidemic Therapy in Patients with Chronic Liver Diseases: What Should a Gastroenterologist Know

Dyslipidemia is one of the main risk factors for the development of cardiovascular diseases (CVD), which remain the leading cause of death worldwide. Lipid level control is the most effective strategy for the prevention of CVD and its complications (CVC). Statins are the first-line drugs of hypolipidemic therapy. Dyslipidemia is often found in patients with chronic liver diseases (CLD). From a clinical point of view, a number of CLD have an increased risk of CVD. Due to insufficient awareness of doctors about the possibilities of using statin and non-statin lipid-lowering therapy in patients with CLD, the possibility of treating CVD and reducing the risk of CVC in this category of patients is often missed. The purpose of the review is to study modern approaches to lipid-lowering therapy (statin and non-statin) in patients with CVD of various etiologies, including at the stage of liver cirrhosis (LC). Conclusion. CLD should not be considered as a contraindication to the use of statins and other lipid-lowering drugs. Pleiotropic effects of statins, in addition to hypolipidemic action, create new prospects for their use in patients with CLD. Hypolipidemic therapy is recommended for patients with CLD (including at the stage of compensated LC), if they have dyslipidemia and an increased risk of CVD. It is important to compare the benefits and risks of prescribing statins in patients with CLD

The Effect of the Cytoprotector Rebamipid on the Activity of Disaccharidases in Patients with Enteropathy with Impaired Membrane Digestion

ENMP (enteropathy with impaired membrane digestion) is a new nosological form of pathology of the small intestine, which is based on a decrease in the activity of small intestine carbohydraz. The clinical picture of ENMA is very similar to irritable bowel syndrome, but it differs in the etiotropic relationship of symptoms with intolerance to products containing a lot of fermentable oligo -, di- and monosaccharides and polyols. The basis of the treatment of this pathology is the FODMAP diet, but this therapy only allows you to reduce the load on the enzymatic transport complexes, and not restore them. A new direction in the treatment of patients with EMF is our proposed system for restoring the activity of enzymes of the small intestine mucosa under the influence of the cytoprotector rebamipid. The use of rebamipid in the complex therapy of INMP contributes to an increase in the activity of small intestine carbohydraz and a decrease in symptoms associated with intolerance to short-chain carbohydrates FODMAP. The persistent positive effect of the drug is observed gradually over 8 weeks in patients who received the drug at a dose of 300 mg/day. With this treatment regimen, patients have an improvement in the tolerability of carbohydrate-containing foods, a decrease in flatulence, pain syndrome, and a tendency to normalize the stool has also been noted.

Features of Providing Medical Care to Patients with IBD in the Context of a Pandemic of the New Coronavirus Infection COVID-19 in the Voronezh Region

In March 2020, an outbreak of a new coronavirus infection COVID-19 occurred in Russia. During a pandemic, patients do not always have the opportunity to receive full-time medical care. It became necessary to choose other methods of communication "doctor-patient" to solve the problems associated with the need to maintain the availability of medical care for patients with IBD. The progressive nature of the course of ulcerative colitis and Crohn's disease in some cases requires careful monitoring of the patient's condition. During a pandemic, doctors are advised to make wider use of the telemedicine resource. The article presents options for using distance counseling methods during the period of coronavirus restrictions

Non-Selective Beta-Blockers in Liver Cirrhosis: the Effect of the "Therapeutic Window" and Patient Survival

Objectives of the study: to analyze the survival rate of patients who received and did not receive various drugs of the class of non-selective beta-blockers (NSBB) while waiting for liver transplantation (LT) on the waiting list for liver transplantation (WLLT), depending on the presence or absence of a "therapeutic window" for the appointment of NSBB; to determine risk factors for death when prescribing various representatives of the NSBB class in patients with refractory ascites (RA). Material and methods. The retrospective case-control study was conducted. The "case" group included 278 adult patients with decompensated liver diseases of various etiologies included in the WLLT, who were treated with NSBB while waiting for LT. The "control" group consisted of 72 patients with decompensated liver diseases of various etiologies included in the WLLT, who did not receive NSBB therapy during the waiting period for LT. For the subsequent analysis, the group of patients receiving NSBB (n = 278) was divided into two subgroups: with the presence of a "therapeutic window" (n = 175), and without it (n = 103). The survival rate of patients was determined by the Kaplan - Mayer method. Predictors of mortality of patients receiving NSBB in the absence of a" therapeutic window "for NSBB were determined using the Cox proportional hazards model in the groups of patients with RA (n = 103) and non-RA (n = 175). Results. The survival rate of patients receiving NSBB in the presence of a" therapeutic window "for NSBB is significantly higher than in the group of patients receiving NSBB in WLLP while waiting for LT in the absence of a" therapeutic window " for NSBB (Log-Rank < 0.0001). The risk of death in patients with RA treated with NSBB was significantly higher than in patients with non-RA (HR = 2.285; CI 1.237 4.220; p = 0.008). The risk of death for patients treated with propranol was significantly different from carvedilol (HR = 2,152 and HR = 0.765; p = 0.042, respectively). Conclusion. The results of the study confirmed the hypothesis that there is a "therapeutic window" for NSBB when they are prescribed to patients with decompensated cirrhosis of the liver and included in the WLLP. The use of NSBB contributes to an increase in the mortality of patients with RA, regardless of the type of drug, in the case when the "closed therapeutic window" phase develops. In order to reduce the mortality of patients waiting for LT for several years due to acute organ deficiency, doctors who lead patients to WLLT should assess the risk and benefit of using NSBB

Role of Dietary Fiber in the Correction of Gut Microbiocenosis Disorders Against the Background of Antibacterial Therapy

Antibiotic-associated gut microbiocenosis disorders develop on average in every third patient in the form of both mild disorders and severe life-threatening conditions. The negative impact of antibacterial agents on the gut microbiota causes a decrease in the number and species diversity of microorganisms that produce butyric acid. Low concentrations of butyric acid can often induce inflammatory and atrophic processes of the gut mucosa, the water-electrolyte balance regulation disorders and, as a result, the gut motility and functions disorders. Long-term gut microbiocenosis disorders themselves can cause the development of the disease and in future, they become factors of its progression, thereby launching a whole cascade of new pathological processes. The article analyzes a representative clinical data published in authoritative international magazines from 1990 to 2020, indicating the effectiveness of the dietary fiber (DF) management for the correction of gut microbiocenosis disorders caused by antibacterial drugs intake. Partially hydrolyzed guar gum, registered in our country under the trade name “OptiFiber”, due to its effects such as the gut regulation, abdominal pain reduction, flatus and bloating reduction, increase the resident gut microflora amount and its metabolic activity, helps to restore and maintain of the gut eubiosis. Conclusion. “OptiFiber” can be administered for a long-term intake in order to increase the effectiveness of antibiotic therapy for various infectious diseases, as well as for the correction and prevention of gut microbiocenosis disorders associated with antibacterial drugs intake

Some Aspects of Differential Diagnosis and Treatment of Pain Syndrome in Chronic Pancreatitis

Abdominal pain syndrome is widespread in the population. Pain can be both organic and functional in nature. Pain cider in chronic pancreatitis is characterized by a variety of manifestations, it depends not only on the severity of inflammation, the presence and absence of complications, but as well on individual susceptibility. Due to the fact that abdominal pain in chronic pancreatitis is multicomponent, its treatment requires the careful and deliberate approach using a variety of techniques

Risk Factors and Hepatocellular Cancer Screening After Hepatitis C Virus Eradication

Hepatocellular cancer (HCC) usually develops against the background of chronic liver disease. Until recently, the most common etiology of HCC was infection with hepatitis C virus (HCV). The appearance of direct-acting antiviral drugs (DAAD) has become a big breakthrough in the treatment of HCV infection. A stable virological response can now be achieved in almost all treated patients, even in people at high risk of HCC, primarily with cirrhosis of the liver. At the same time, reports gradually began to accumulate about the continued risk of malignant transformation after successful therapy of DAAD. Simultaneously with the decrease in the burden of cirrhosis caused by HCV, the etiological role of non-alcoholic fatty liver disease (NAFLD) has sharply increased. Moreover, in a significant part of patients with NAFLD, HCC is formed at the pre-cirrhotic stage. These changes in the etiology and epidemiology of HCC suggest the revision of patient management tactics