Treatment of soft tissue injuries

Background: soft tissue injuries accompany the patient's life and make up the main number of visits to primary health care facilities. As a rule, contusions occur when falling or hitting hard objects and are inherently associated with pain. Aim: to determine the analgesic therapy efficacy for soft tissue injuries of the upper and lower extremities. Patients and Methods: a pilot prospective comparative study was conducted including 54 subjects aged 25–50 years (27 patients with shoulder contusion and 27 with hip contusion). Contusions in all patients were characterized by the formation of subcutaneous or intradermal hemorrhage and soft tissue edema without muscle damage. 8 groups were formed to assess the efficacy of the tablet and injection administration types of ketoprofen and diclofenac, depending on the location of the injury. The time of analgesic effect onset on the 1st day after the injury and the trend of pain severity were evaluated using a visual analog scale, as well as edema severity. Treatment and follow-up of patients were discontinued when a persistent analgesic effect was achieved and the function of the limb was restored. Results: the patients' median age was 44.7 years. The ratio of men and women was 1:1. A feature of the pain syndrome assessment during the initial treatment was that patients with a shoulder contusion rated pain 2-3 points higher than patients with a hip contusion. In the upper limb contusions, ketoprofen in tablets activated already at the 10th minute, in the lower limb contusions – at the 20th minute. The drug injectable form provided a pronounced analgesic effect already at the 5th minute. Both the tablet and injectable forms of ketoprofen demonstrated a benefit over diclofenac. By the 3rd-4th day, it was possible to achieve complete pain relief in all cases. Conclusion: this pilot study confirmed the efficacy and rapid onset of the ketoprofen analgesic effect in the treatment of soft tissue injuries. KEYWORDS: contusion, soft tissue, pain, analgesic therapy, ketoprofen, diclofenac. FOR CITATION: Zhukov D.V., Ustikova N.V., Prokhorenko V.M. Treatment of soft tissue injuries. Russian Medical Inquiry. 2021;5(3):145–149. DOI: 10.32364/2587-6821-2021-5-3-145-149.

Efficacy of personalized combined treatment for preventing postoperative complications in patients with benign prostatic hyperplasia and chronic prostatitis

Aim: to assess the efficacy of personalized combined treatment for preventing postoperative complications after transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and chronic prostatitis (CP) that involves complex physiotherapy using “SMART-PROST” device considering individual chronobiological characteristics. Patients and Methods: 60 patients with BPH and CP who were referred for TURP were examined. α-blockers and fluoroquinolones were prescribed for 28 days in the control group (n=30). Personalized complex therapy was additionally prescribed in the study group (n=30). Treatment efficacy was assessed at baseline (visit 1), after two weeks (visit 2), and after four weeks (visit 3). The severity of lower urinary tract symptoms, prostate volume and postvoid residual volume, and prostatic hemodynamics were evaluated. Additionally, expressed prostatic secretion bacterioscopy and culture and TURP specimen histology were performed. Results: significant differences (p<0.05) in all clinical laboratory tests and prostatic hemodynamics were demonstrated between the groups by the end of week 4. Histology of TURP specimens revealed more severe fibrosis and inflammatory infiltration in the control group. During a 6-month follow-up, acute urinary retention was detected in 2 patients (6.7%), leukocytes in the urine in 18 patients (60%), blood in the urine in 5 patients (16.7%), and bacteria in the urine in 14 patients (46.7%) of the control group. Meanwhile, acute urinary retention was detected in 1 patient (3.3%), leukocytes in the urine in 10 patients (33.3%), blood in the urine in 2 patients (6.7%), and bacteria in the urine in 7 patients (23.3%) of the study group. Conclusion: personalized combined therapy for BPH and CP reduced the severity of lower urinary tract symptoms and the signs of prostatic inflammation, improved prostatic hemodynamics, and increased the efficacy of antibacterial therapy as demonstrated by bacteriological tests. KEYWORDS: chronic prostatitis, benign prostatic hyperplasia, TURP, chronotherapy, personalized combined physiotherapy, TRUS, Doppler ultrasound, immunohistochemistry. FOR CITATION: Barannikov I.I., Kuzmenko A.V., Kuzmenko V.V., Gyayrgiev T.A. Efficacy of personalized combined treatment for preventing postoperative complications in patients with benign prostatic hyperplasia and chronic prostatitis. Russian Medical Inquiry. 2021;5(3):110– 117. DOI: 10.32364/2587-6821-2021-5-3-110-117.

Novel therapeutic modalities for children with spasticity

Background: early treatment using botulinum toxin type A (BTA) postpones or even prevents contractures and osteoarticular deformations and, therefore, surgical interventions in children with cerebral palsy (CP). Expansion of age groups and conditions to prescribe BTA is the primary trend of current studies. Aim: to assess the safety and efficacy of Relatox® in children aged 2–6 years with spastic CP. Patients and Methods: this simple blind randomized comparative study (2018–2019) enrolled 100 children aged 2–6 years with spastic CP. According to the study protocol, Relatox® (n=51) or reference preparation (n=49) was injected into spastic muscles. Each group included two subgroups (predominant involvement of the muscles of the upper or lower extremities). Topical and systemic reactions were evaluated immediately after injection. Over the follow-up (after 2, 4, 8, and 12 weeks after injections), muscle tonus using Modified Ashworth Scale (MAS) and pain severity using a 10-point visual analogue scale were assessed. Results: maximum total doses of botulinum toxin per injection session for both preparations were 60 to 200 units. The efficacy of both preparations was similar (p>0.05). Single self-limited mild and moderate topical and systemic adverse reactions typical for botulinum toxin were reported in both groups. Conclusions: the safety and efficacy of Relatox® are similar to these of reference preparation. Antispastic effect for muscles of the upper extremities was demonstrated, thereby allowing for expanding indications for Relatox®. Inclusion of the maximum number of spastic muscles in the protocol of injection session provided a full motor habilitation/rehabilitation of children. KEYWORDS: botulinum toxin type A, cerebral palsy, spasticity, efficacy, safety. FOR CITATION: Krasavina D.A., Ivanov Yu.I. Novel therapeutic modalities for children with spasticity. Russian Medical Inquiry. 2021;5(10):630–635 (in Russ.). DOI: 10.32364/2587-6821-2021-5-10-630-635.

Control of allergic rhinitis symptoms in adults in the Russian Federation: online survey results

Aim: subjective assessment by patients with allergic rhinitis (AR) of the efficacy in control of the main symptoms, seeking medical care for AR symptoms and general treatment methods. Patients and Methods: from April to August 2020, a study was conducted of 328 adult respondents (buyers of medicines for the AR treatment: antihistamines and/or intranasal corticosteroids), who voluntarily agreed to an online survey. 164 respondents purchased medicines based on the prescription or doctor recommendation, while other 164 chose medicines independently. Visual analog scale (VAS) was used to assess the severity of individual AR symptoms (nasal congestion, runny nose/nasal discharge, sneezing, itchy nose, cough), as well as eye and general symptoms (general malaise, drowsiness, headache). Results: 56% of respondents had persistent AR symptoms. Herewith, 60% of respondents suffered from seasonal AR, 40% — perennial AR. 52% of respondents had a mild AR form. However, the main triad of AR symptoms (nasal congestion, rhinorrhea and sneezing), despite the non-severe AR form in the absolute majority of respondents corresponded to moderate or severe severity (VAS>5) and indicated a lack of AR control. 31% of those surveyed experienced severe AR symptoms that disrupted daytime activity and sleep. The respondents were most concerned about nasal congestion, runny nose/rhinorrhea, and sneezing (the average VAS score was 7.3, 7.1, and 6.5, respectively). The frequency of visits to the doctor for AR was very low: 95% of respondents visited their doctor no more than once a year, while 48% of them — every few years. The first choice in therapy was antihistamines, regardless of the presence or absence of doctor’s recommendation. In second place were decongestants, in third — intranasal corticosteroids, which were more commonly purchased on the doctor’s recommendation. Conclusion: adult respondents with a suspected diagnosis of AR, despite uncontrolled and marked symptoms, underestimate their disease, rarely consult a doctor, and prefer to follow the recommendations of relatives and friends or pharmacists for treatment. The lack of AR control among adults in our country is obvious and requires the active participation of the medical and pharmaceutical community for salvation of such problem. KEYWORDS: allergic rhinitis, visual analog scale, control of allergic rhinitis symptoms, survey, therapy choice, severity of allergic rhinitis symptoms. FOR CITATION: Nenasheva N.M., Shilenkova V.V. Control of allergic rhinitis symptoms in adults in the Russian Federation: online survey results. Russian Medical Inquiry. 2021;5(1):25–31. DOI: 10.32364/2587-6821-2021-5-1-25-31.

Efficacy and safety of non-steroidal anti-inflammatory drugs for acute attack of gout

Gout is one of the most common forms of inflammatory arthritis. Medical care for gout includes non-steroidal anti-inflammatory drugs (NSAIDs). This paper reviews the efficacy and safety of NSAIDs prescribed for the acute attack of gout, in particular, AMBENIUM® parenteral. It was demonstrated that phenylbutazone is a powerful NSAID that provides significant analgesic and anti-inflammatory effects. Considering a broad spectrum of adverse reactions of NSAIDs, these agents should be prescribed and used under in-depth analysis of patient’s condition, comorbidities and the level of their decompensation, and potential drug interactions. In addition, optimal dosages and duration of NSAID treatment are of particular importance. The authors conclude that AMBENIUM® parenteral is an effective and safe therapeutic modality for gout. Its profile and risk/benefit ratio are regarded as “favorable” compared to other NSAIDs. KEYWORDS: gout, arthritis, pain, non-steroidal anti-inflammatory drugs, parenteral, efficacy, safety. FOR CITATION: Vasilyuk V.B., Syraeva G.I., Faraponova M.V. Efficacy and safety of non-steroidal anti-inflammatory drugs for acute attack of gout. Russian Medical Inquiry. 2021;5(2):96–101. DOI: 10.32364/2587-6821-2021-5-2-96-101.

Anticholinergic therapy of an overactive bladder: clinical practice aspects

The review presents data on the epidemiology, clinical course and modern methods to the treatment of overactive bladder. It also describes the pharmacological bases of anticholinergic drug use, which are first-line in the treatment of this disease. The pharmacological and clinical aspects of the new M-holinoblocker, fesoterodine, are considered. The drug belongs to the competitive blockers of M2-and M3-cholinergic receptors. The conducted studies have shown the high clinical efficacy of fesoterodine. Due to the low lipophilicity and large molecular weight, the drug’s ability to penetrate the blood-brain barrier is minimal, which causes a low frequency of adverse events from the central nervous system. The pharmacokinetic and pharmacodynamic properties of fesoterodine allow it to be prescribed to "vulnerable" groups of patients — the elderly, patients with CNS diseases and cognitive disorders. According to the FORTA system, fesoterodine is the only antimuscarinic drug classified in category B. The results of a multiple-criteria decision-making showed a favorable benefit-risk profile of fesoterodine, prescribed according to a flexible dosage regimen of 4 mg and 8 mg. Important benefits of fesoterodine are the convenience of intake, the possibility of dose titration, as well as the ratio of treatment costs and its efficacy. The practical issues of using fesoterodine in various clinical cases are considered. KEYWORDS: overactive bladder, anticholinergic therapy, fesoterodine, multiple-criteria decision-making, FORTA classification. FOR CITATION: Kuzmin I.V., Kuzmina S.V. Anticholinergic therapy of an overactive bladder: clinical practice aspects. Russian Medical Inquiry. 2021;5(5):273–279 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-273-279.

Secukinumab for non-radiographic axial spondyloarthritis

Since 2009, the concepts of axial spondyloarthritis (axSpA) and peripheral spondyloarthritis (pSpA) have been used, while the radiographic phenotype (r-axSpA) and the non-radiographic phenotype (nr-axSpA) are distinguished. Nowadays, the treatment of nr-axSpA is carried out in the same way as r-axSpA. At the same time, it is obvious that nr-axSpA is more heterogeneous than radiographic, which can determine the peculiarities of patient management tactics. The authors cited 2 clinical cases in which they demonstrated the possibility of achieving persistent drug-free remission at an early (less than 6 months from the first occurrence of disease signs) use of secukinumab in patients with nr-axSpA. The clinical, laboratory and radiological data of two patients meeting the criteria of the SpondyloArthritis International Society are presented in detail. The clinical cases described in this paper are of considerable interest to practitioners since they present the first experience of using this drug in patients with nr-axSpA outside the clinical studies. Also, they can become a part of the clinical experience that will form the basis for further nraxSpA study with the subsequent development of individual clinical recommendations for the treatment of this disease. KEYWORDS: axial spondyloarthritis, non-radiographic axial spondyloarthritis, secukinumab, early treatment, remission. FOR CITATION: Gaydukova I.Z., Mazurov V.I., Inamova O.V. Secukinumab for non-radiographic axial spondyloarthritis. Russian Medical Inquiry. 2021;5(5):294–300 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-294-300.

Blood exosomes as new biomarkers of infectious diseases

Extracellular vesicles are biological membrane objects having a size of less than 1000 nm, the main function of which is the transport of various biologically active molecules. They can also provide intercellular interactions and perform other biological functions. The review provides general information about extracellular vesicles, their varieties, morphological and microscopic features. The article gives various classifications of extracellular vesicles and considers pathogenetic features of the exosome interaction with viruses. Adding that the specific patterns of the introduction, interaction and identification of exosomes affected by viruses are determined on the example of a number of viruses. The possibility of extracellular vesicles to penetrate the blood-brain barrier, coordinating the immune system activity in response to the viral effects, is indicated. Exosome ability to mediate intercellular communication through innate and adaptive immune responses is discussed. The paper considers the prospects of using exosomes in the preventive diagnosis of infectious diseases, which will allow using exomes as the main diagnostic tool and determining the stage of infectious disease progression. The review provides information about the study of the exosome therapeutic possibilities. The authors have drawn conclusions about the importance of continuing the study of exosomes for use in the diagnosis and treatment of infectious diseases. KEYWORDS: viruses, extracellular vesicles, apoptotic bodies of exosomes, ectosomes, diagnosis, treatment. FOR CITATION: Ageykin A.V., Gorelov A.V., Usenko D.V., Melnikov V.L. Blood exosomes as new biomarkers of infectious diseases. Russian Medical Inquiry. 2021;5(11):744–748 (in Russ.). DOI: 10.32364/2587-6821-2021-5-11-744-748.

COVID-19 vaccination of pregnant women: state-of-the-art

Despite efforts made by the world community to battle the novel coronavirus infection, we are still unable to take complete control of virus spread. One of the causes of this issue is inadequate coverage of vaccination. Meanwhile, disease course in specific populations is associated with the risks of severe complications and lethal outcome. Infection of pregnant women is of particular concern. This paper addresses recent data on vaccination against the COVID-19 infection in pregnant women, including those with risk of severe disease course and unfavorable outcome. Monitoring the health of women infected with SARS-CoV-2 during gestation demonstrates unfavorable effects of the COVID-19 infection on the course and outcome of pregnancy. On the other hand, observational programs have demonstrated that vaccination has no effects on pregnancy course and perinatal outcomes. A view of the WHO and professional associations on the vaccination of pregnant women, particularly those from risk groups of severe COVID-19 course, is discussed. The importance of a personalized and balanced approach to COVID-19 vaccination of pregnant women involving the assessment of risks and benefits for the mother and child is emphasized. KEYWORDS: novel coronavirus infection, COVID-19, vaccination, immunization, pregnant women, risk group. FOR CITATION: Girina A.A., Zaplatnikov A.L., Svintsitskaya V.I., Izhogina S.D. COVID-19 vaccination of pregnant women: state-of-the-art. Russian Medical Inquiry. 2021;5(11):768–772 (in Russ.). DOI: 10.32364/2587-6821-2021-5-11-768-772.

Respiratory viral infections in children: modalities for pathogenic treatment

Respiratory viruses are the leading cause of pediatric morbidity and mortality worldwide. Rapid identification of a pathogen, epidemiological surveillance, description of symptoms, and the development of preventive and therapeutic measures are keystones to limit the spread of respiratory infections. Novel viruses with specific properties are regularly discovered. This paper addresses essential data on the most common viruses provoking acute respiratory infections, including whose in children and the pattern of their course. Conventionally, the most vital concern is flu. Influenza viruses provoke seasonal outbreaks, epidemics, and pandemics. Many studies demonstrate the role of rhinovirus C in the development of bronchiolitis and, subsequently, asthma. Severe acute respiratory syndrome-related coronavirus (SARS-CoV), Middle East respiratory syndrome-related coronavirus (MERS-CoV), and SARS-CoV-2 provoking COVID-19 were recently described. Knowledge of known and newly emerging viruses is crucial for timely adequate medical care. The authors discuss major therapeutic strategies for acute respiratory infections that provide a more favorable course of infectious inflammation irrespective of viral etiology. KEYWORDS: acute respiratory infections, influenza virus, rhinovirus, coronavirus, pneumonia, interferon. FOR CITATION: Nikolaeva S.V., Khlypovka Yu.N., Zavolozhin V.A. et al. Respiratory viral infections in children: modalities for pathogenic treatment. Russian Medical Inquiry. 2021;5(11):762–767 (in Russ.). DOI: 10.32364/2587-6821-2021-5-11-762-767.