Cell technologies in the treatment of hip osteoarthritis

SummaryThe article is dedicated to the current state and prospects of cell technologies in the treatment of hip osteoarthritis. The material is based on the analysis of clinical trials on this topic submitted to international registry СlinicalTrials.gov. It has been founded 5 clinical trials relevant to the theme. Only one of these trials was completed with the results pub-lished. It has been stated that the use of cell technologies for the treatment of hip osteoarthritis is still in the stage of a pilot clinical experiment. Thus, it can not yet be the subject of any translation into common clinical practice. At the same time, there is a reason to expect in the upcoming years a serious progress in this direction. This is indicated by the fact that, as of March 1, 2020, the СlinicalTrials.govregistry lists 4 active clinical trials in which the usage of cell technologies in the treatment of hip osteoarthritis is tested. Some of these trials have been already recruiting patients or are ready to begin the recruitment.

Pulmonology service staff N orth­Western Federal District in 2015–2019

Introduction. Prior to detailed review of the North- West Federal District (NWFD) pulmonology service per- formance during the COVID-19 pandemic, it is especial- ly worthwhile to evaluate its human resourcing in the prepandemic period of 2015–2019, since the perfor- mance of pulmonology service largely depends on its staffing, moreover in conditions of restructuring and decreased number of pulmonology bedspace in hospi- tals. Мethods. In the course of the study, the authors have analysed human resourcing data for pulmonology profile within the state healthcare system in NWFD for the period of 2015–2019. The results were statistically processed and data analysis carried out using Micro- soft Office Excel and SPSS software. Results . In the state healthcare system medical institutions of the NWFD throughout 2015–2019, the number of regular pulm- onologists’ positions fluctuated unrhythmically. The number of pulmonologists (MDs) in NWFD grew 0.82% during the period of 2015–2019, for comparison, in the Russian Federation the growth for the same period was 32.08%. The number of operating pulmonology depart- ments remained practically the same, but the number of occupied positions constantly changed. Practically all the pulmonologists in the NWFD have a specialist certi- ficate, but the share of doctors with qualification grade remains insufficient, and is on the decrease. Statistical analysis demonstrated significant positive Pearson cor- relation between the number of pulmonologists and general respiratory incidence (0.74 р=0.04), mortality (0.756 р=0.003), and the number of occupied pulmo- nology bedspace (0.619 р=0.024). Conclusion. Today, pulmonology service human resourcing review is to be conducted taking into account respiratory morbidity and mortality and the need for pulmonology services among the general population. Currently, there is no sci- entifically justified regulatory framework for the deve- lopment of the pulmonology service in NWFD regions, while the work of such services depends very much on the regional budgets and medical services’ tariffs. The development and fast implementation of such compre- hensive measures as salaries’ increase, adequate social support, regular residential and non-residential courses of continuous medical education, professional networ- king, etc. will allow to maintain and holistically develop the human potential of the NWFD pulmonology service.

Criteria for assessing severity of oral lichen planus

Introduction. Oral lichen planus (OLP) is an autoim- mune disease of unknown etiology, manifested in vari- ous clinical forms. A correlation between intensity of OLP local manifestations and severity of general disturbances predisposing to altered oral mucosa have been poorly investigated. The aim of our study was to identify criteria for assessing OLP severity score. Methods. OLP patients and control subjects (not OLP) matched by hepatobiliary disease and type IIa dyslipidemia were examined. Samples collected during the study were as- sessed by way clinical examination, gas chromatographic analysis of serum free fatty acids (FFA), oral fluid, serum and fecal microbial marker analysis by gas chromatogra- phy/mass spectrometry, laser Doppler flowmetry of the oral mucosa, immunohistochemistry staining with an- ti-CD68 monoclonal antibody specific to apolipoprotein B-100-bearing macrophages. Results. It was found that OLP patients significantly differed from control subjects in the three FFA levels (lauric acid, eicosopentaenoic/ lauric and eicosopentaenoic/linoleic ratios), displayed four pathologic factors matching the altered level of mi- crobial markers. In addition, OLP patients were found to differ in oral mucosa blood filling both inside and outside lesions paralleled with oxidative changes immediately in oral mucosa highlighted as elevated amount of apo- lipoprotein B-100-bearing CD68-positive macrophages. Conclusion. OLP severity score is an integrate parameter which reflects oxidative changes and alterations in oral mucosa microhemocirculation primarily in serum free fat- ty acid composition, altered oral and gut microbiota as well as intensity score of clinical picture.

Experience of using heliox in the treatment of viral pneumonia in COVID-19

SummaryIntroduction. With the ongoing COVID-19 pandemic, finding new treatments is an extremely important issue. The effectiveness of heliox was previously demonstrated in the complex treatment of patients with various bron-chopulmonary pathologies. Therefore, this method has been recommended for the treatment of pneumonia associated with COVID-19. Purpose. To study the safety and efficacy of inhaled heliox therapy in the treatment of pneumonia in COVID-19. Materials and methods. A sing-le-center prospective study was carried out for the period from 01.12.2020 to 15.02.2021. The study included 91 pa-tients. The patients were divided into two groups: group 1 (using heliox) included 46 people, and group 2 (con-trol) — 45. Inhalations of a heated oxygen-helium mixture heliox (70% helium, 30% oxygen) were carried out using “Ingalit-B2-01” inhaler. Objective (saturation, O2 flow) and laboratory parameters (lactate dehydrogenase, C-reactive protein), as well as chest organs CT data were studied. Differences between groups were determined using the χ2 test, as well as the Mann–Whitney U-test. The p value <0.05 was considered significant. Results. In group 1, side effects developed in 5 (11.3%) patients. These patients refused to further participate in the study. Final number of patients in group 1 — 41. Among patients of group 1, there was a tendency towards a more rapid normalization of lactate dehydrogenase and C-reactive protein, as well as a decrease in oxygen dependence. In group 1, according to CT data, no progression of pneumonia was recorded. In group 2, progression was observed in 6 (13.3%) patients. The overall effectiveness of treatment among patients in group 1 was 100%, among patients in group 2 — 86.7%. The differences between the groups are statistically sig-nificant (p=0.02). Conclusion. The use of inhalations with a heated oxygen-helium mixture heliox (30% oxygen, 70% helium) has shown its effectiveness and safety in the treatment of viral pneumonia (CT1- 2) associated with COVID-19.

The effectiveness of the main course of chemotherapy for drug-resistant tuberculosis

SummaryThe article is devoted to the effectiveness of treatment of tuberculosis with MDR-TB and XDR-TB mycobacteria after the main course of chemotherapy. The treatment of tuberculosis with multiple and broad MD MBT is a com-plex and urgent task. Prescribing the latest generation of drugs (thioureidoiminomethylpyridinium perchlorate, bedaquiline, linezolid) in the complex composition of tu-berculosis therapy with MDR and XDR-MBT significantly increases the effectiveness of the main course of treat-ment, compared with the control group, respectively (85.0% and 65.8%). Мaterials and methods. The main course of chemotherapy was completed by 119 patients with pulmonary tuberculosis with drug-resistant patho-gen, who were diagnosed for the first time, treated in anti-tuberculosis hospitals in St. Petersburg and on an outpatient basis in St. Petersburg “Inter-district Petro-grad-Primorsky TB dispensary No 3”. Clinical, radiological, and laboratory data are presented. All patients were iden-tified with Mycobacterium tuberculosis with multiple and broad drug resistance MBT. The patients were divided into 2 groups: the main group (OG) — 40 people, received the latest generation drugs; 79 patients (KG) — received standard therapy without the inclusion of the latest gen-eration of drugs. Half of the patients in all age groups were identified during a preventive examination (50.4%), a third when applying for complaints (31.9%), and one — when examining for contact with a patient with tubercu-losis. Infiltrative tuberculosis was most often diagnosed in 75 (63.0%), disseminated tuberculosis was detected in 20 (16.8%), and fibrocavernous pulmonary tuberculo-sis — in 24 (20.2%). The decay phase was diagnosed in 88 (73.9%) patients. Three-quarters of the studied patients had 90 comorbidities (75.6%). Results and discussion. The groups are comparable in terms of clinical, radiologi-cal, and bacteriological parameters. By the fourth month of the therapy, the cessation of bacterial excretion was significantly more often determined in patients taking bedaquiline, thioureidoiminomethylpyridinium perchlo-rate, linezolid as part of HT, compared with the group not receiving the above drugs 47.5% and 35.4%, respectively, (p<0.05); by the end of the intensive phase of treatment, the cessation of bacterial excretion occurred in OG in 92.0%, KG — 57.0% (p<0.001). Conclusions. The inclu-sion of drugs thioureidoiminomethylpyridinium perchlo-rate, bedaquiline, linezolid in the complex chemotherapy of tuberculosis with multi-resistant tuberculosis increases the effectiveness of the main course of treatment com-pared to the KG.

Bisphosphonate treatment in the bone disorders in children: a systematic review

Summary Background: bisphosphonates use over three decades in a variety conditions in children. However, the evi-dence of its use is limited. Aims:systematic analysis of publications regarding the effectiveness and safety of bisphosphonates (BPs) in children. Methods. PubMed and eLIBRARY were searched for eligible articles of Rus-sian and foreign authors up to February 2021. According the PRISMA strategies, 35 studies (data of 2545 patients) were included into the analysis. Results. More than 80% patients suffered from nonbacterial osteomyelitis (NBO) and osteogenesis imperfecta (OI). BPs in children are effective for increasing the bone mineral density for decreased fracture incidence, to reduce bone pain, to re-lieve inflammation and to improve the quality of patients’ life. The most frequently adverse event was the first-dose effect, such as flu-like syndrome. In the age group under study, no severe adverse events characteristic of adults have been seen (mandibular necrosis). Conclusions. BPs are efficient and safe in children with OI, NBO and cere-bral palsy in order to restore the bone mineral density. Further research is required to strengthen the recom-mendations made, while the wider use of BPs require revision of current registration documents in accordance with global guidelines.

Atypical CT manifestations of pulmonary sarcoidosis

SummarySarcoidosis is a granulomatous disease of unknown etiol-ogy that affects different organs and tissues. Pulmonary, mediastinal, and intrathoracic lymph nodes involvement occur in about 90% of patients with sarcoidosis. Radio-logical manifestations of pulmonary sarcoidosis vary sig-nificantly. This article describes focal and reticulonodu-lar changes, as well as consolidation zones and fibroticchanges. Isolated reticular changes due to thickening of intra-, and interlobular septa occur in approximately 50% of sarcoid patients. However, this CT pattern pre-vails only in 15–20% of patients. As a rule, in 80% of sar-coid patients changes in lung parenchyma are combined with intrathoracic lymphadenopathy. In the majority of cases, these changes are bilateral. In 10–13% of patients, foci 89–12 mm in diameter are detected. These foci have a homogenous structure and a well-defined outline. They locate mainly along costal and interlobar pleura, in interlobular septa, and may resemble metastases. In 2.4–4% of patients, these small foci, typical for sarcoid-osis are absent, while the changes are presented by larger nodular masses (>2 cm in diameter) or by masses with fuzzy outlines. Often sarcoidosis mimicking interstitial pneumonia is manifested by the ground-glass opacity of spot-like shape. Abnormalities are located in the up-per lobes. This sign occurs in 16–83% of sarcoidotic pa-tients, mainly at the onset of the disease. It usually com-bines with focal changes in the lungs and intrathoracic lymphadenopathy. Cavitary forms of sarcoidosis are also described. Conclusion. There are multiple pulmonary sarcoidosis manifestations on CT, and they vary a lot. The former allows suspecting the diagnosis, which is later confirmed clinically, morphologically, or by lab meth-ods. Аtypical radiological forms of lung sarcoidosis often mimic other pulmonary diseases. These forms require in-vasive diagnostic methods including abdominal surgery.

Drugresistance of Mycobacterium tuberculosis from surgical material taken from patients with pulmonary tuberculosis

At present, with the improvement of epidemic indicators for tuberculosis, the number of patients with drug-resis- tant forms of tuberculosis is increasing, which compli- cates and increases the duration of treatment of suchpatients. The aim of the work is to study drug resistance of mycobacterium tuberculosis (MBT) obtained from sur- gical material. Methods. 74 patients with radical and di- agnostic operations on the chest organs were included into the study. All patients were examined by standard me thods: microscopy, molecular genetic methods, cul- turing on so lid and liquid nutrient media of sputum, and, in case of bronchoscopy, BALF. The diagnosis of tuber- culosis was confirmed morphologically in all patients by histological examination of the surgical material. When analyzing the results of DR MBT, it was found that among the newly diagnosed patients, more than half (59.3%) had multiple (44.6%; p<0.001) and extensive drug resistance (14.7%; p=0.003), while in 74.5% (n=35/47) before the op- eration MBT were not detected in sputum. The frequency of development of drug resistance to anti-tuberculosis drugs of the first and reserve lines, and the structure of drug resis tance depending on the group of dispensary registration are presented. Comparative analysis of MBT LS isolated from sputum before operations and from the operating material was conducted. The results of the study showed a high percentage of MBT drug resistance obtained in the operating material in patients with nega- tive MBT tests. More than half of patients who did not receive antibiotic therapy before surgery have MDR and XDR, which suggests a high regional primary drug resist- ance of Mycobacterium tuberculosis.

Actuality and problems of tuberculosis prevention in patients receiving gene-engineering biological therapy

The aims of the study were to analyse the results of tuberculosis prevention in S.М. Kirov Military Medical Academy patients receiving gene-engineered biologi-cal therapy, to evaluate the topicality of this work and to define existing problems. Methods. The study included 185 patients who were consulted by a phthisiatrician because of the gene-engineered biological therapy in the period of 2018–2019. Patients’ medical case histories were studied. Screening and monitoring of tuberculosis infection was carried out in accordance with the metho-dical recommendations of the Association of Rheuma-tologists of Russia. Results. Among persons, referred to the phthisiatrician consultancy due to biological therapy, patients from department internal medicine clinic pre-vailed (76.2%) with key diagnosis: ankylosing spondylitis (Bekhterev’s disease) — 41.6%, and rheumatoid arthri-tis — 21.1%. Among gene-engineered biologicals, Goli-mumab (44.3%) and Adalimumab (18.5%) were most of-ten used. For the analyzed period, none of those receiving gene-engineered biologicals, got sick with tuberculosis. This indicates the effectiveness of preventive measures. A single clinical case of active pulmonary tuberculosis, that was timely detected in a patient at the preliminary screening stage before the start of biological therapy, is demonstrated. The guidelines on this aspect of the tuber-culosis prevention are analyzed. The current organiza-tion problems in examination and checks, dispensary dynamic observation and chemoprophylaxis are noted and illustrated by a clinical example of a patient with an-kylosing spondylitis (Bekhterev’s disease) and signs of la-tent tuberculosis infection. Ways to solve these problems are suggested. Conclusion. Prevention of tuberculosis in patients receiving gene-engineered biological therapy is atopical task, with a need to update and improve its regu-latory and procedural guidelines.

Bronchial asthma incidence and mortality dynamics in adult population of the North-Western federal district

SummaryAim. Study the BA incidence and mortality dynamics in adult population of the North-West Federal District (SZFО) throughout 2010–2019, as well as compare these param-eters of SZFO subjects with other regions. Маterials and methods. Official data from statistical books of the Min-istry of Healthcare of the Russian Federation have been used, in particular adults’ presentation to the medical in-stitutions of the Russian Federation, Moscow and SZFO subjects with BA throughout 2010–2019, as well as BA deaths. Microsoft Excel and SPSS programmes were used to process statistical data. Results. Among the federal districts of the Russian Federation, the North-West was #3 in 2018 with primary BA incidence. Сomparative analysis of 2010–2019 data showed that both general BA inci-dence and newly diagnosed cases of BA among the adult population of SZFO may be assessed as not very high on a global scale. The BA incidence dynamics throughout the period under study had an ascending trend. Mortality due to bronchial asthma on the whole tend to de-crease, but there is a significant variability among various regions of SZFO. BA primary incidence is much higher in Nenets Autonomous District and Arkhangelsk Region (М=191.1±12.6 and 106.4±5.7, respectively), while gener-al incidence was much higher in Arkhangelsk and Pskov Regions, higher than the average levels over Russia and the incidence levels in the majority of SZFO subjects. BA general incidence had minimal levels in the adult popu-lation of SZFO in 2010 (934.6), and maximum ones — in 2019 (1233.1). The BA general incidence in all the regions showed pronounced ascending trend, except Saint Pe-tersburg where it was stable (Тпр.ср.=0.73%). The highest BA mortality level among SZFO population was noted in 2010 — 1.6 сases per 100,000 population, the lowest — in 2016 (0.5 сases). Сomparative analysis demonstrated that BA mortality level in 2017 in the overall population of Russia was 22.2% higher than among SZFO population. Conclusion. Higher bronchial asthma incidence among adult population of SZFO regions is due to commonly recognized factors that promote the development of this condition, including ecology, pollution (environment, air) and climate and geographic features, but also are con-nected with improvement in BA diagnostics, last but not least thanks to better quality of continuous education of pulmonology specialists