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.

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.

Preliminary results of an adaptive randomized open-label controlled study on the efficacy and safety of enisamium iodide for outpatient treatment of the COVID-19 infection

Aim: to assess the efficacy and safety of enisamium iodide (film-coated tablets, 250 mg) for outpatient treatment of moderate-to-severe COVID-19 infection. Patients and Methods: this adaptive, randomized, open-label controlled study on the efficacy and safety of enisamium iodide enrolled 194 patients. The study group included 97 patients, and the comparison group included 97 patients. Comparison group patients received standard therapy. Study group patients received orally 500 mg of enisamium iodide three times daily for seven days. In addition, pathogenic and symptomatic treatment was prescribed. The first component of the primary endpoint was composite efficiency parameter. The second component of the primary endpoint was the proportion of patients with respiratory failure. Registration of deaths, adverse events and serious adverse events was carried out by standard methods. Results: cohort enrollment into part 1 of the study and treatment of all patients were completed. The mean time of the relief of major COVID-19 symptoms (primary combination endpoint) and differences between the study and comparison groups (8 days and 9 days, respectively, p=0.028) were revealed. The rate of respiratory failure in the study group and comparison group was: 4 (4,12%) versus 8 (8,25%) cases respectively. In addition, the effect of this drug on mortality in the groups was compared (one death in the study group and five deaths in the comparison group). The statistical reliability of these differences will be determined during part 2 of this study that started in September 2021. Conclusions: the efficacy and safety of enisamium iodide (film-coated tablets, 250 mg) for the COVID-19 were evaluated. A significant reduction in the time to clinical recovery (by one day) was reported in patients who received enisamium iodide. In addition, the rate of severe respiratory failure and associated mortality also tends to reduce after therapy that includes enisamium iodide. KEYWORDS: enisamium iodide, antivirals, etiopathogenic treatment, SARS-CoV-2, COVID-19, viral lung damage, pneumonia, randomized controlled study, adaptive study, open-label study. FOR CITATION: N.Yu. Pshenichnaya, Zhdanov K.V. Preliminary results of an adaptive randomized open-label controlled study on the efficacy and safety of enisamium iodide for outpatient treatment of the COVID-19 infection. Russian Medical Inquiry. 2021;5(11):705–711 (in Russ.). DOI: 10.32364/2587-6821-2021-5-11-705-711.

Principles of complementary food introduction in atopic dermatitis

Atopic dermatitis (AD) is one of the most common inflammatory skin disorders. In most patients, AD is a starting point for developing other atopic diseases, e.g., food allergy, allergic diseases of the gastrointestinal tract, allergic rhinitis, and asthma known under the umbrella of "atopic march". In addition to genetic predisposition, various environmental factors are essential for the development of this dermatosis. In young children, food is the most relevant factor. This paper discusses principles of the selection of complementary food, techniques, and terms of its introduction. Prolonging of breastfeeding, the adequate introduction of complementary food, and personified nutrition program prevent the atopic march. The authors highlight that there is no special diet for atopic dermatitis. Meanwhile, food should be safe, low allergy, and balanced to provide a child with essential macro-and micronutrients. In addition, the paper addresses the utility and validity of an elimination diet which should be prescribed only in established food sensitization and used under the control o f a specialist. KEYWORDS: atopic dermatitis, atopic march, infancy, early childhood, nutrition, complementary foods, prevention. FOR CITATION: Botkina A.S., Dubrovskaya M.I. Principles of complementary food introduction in atopic dermatitis. Russian Medical Inquiry. 2021;5(6):421–426 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-421-426.

Efficacy of combined therapy in patients with erosive gastroesophageal reflux disease

Aim: to evaluate the efficacy and safety of combined therapy with a proton pump inhibitor (PPI) and an esophagoprotector to relieve the symptoms of reflux esophagitis, improve the life quality of patients and achieve faster and complete disease remission. Patients and Methods: a randomized study included 60 patients, including 33 men (mean age 40.96±13.44 years) and 27 women (mean age 48.29±12.69 years) with a duration of gastroesophageal reflux disease (GERD) of 21.85±15.48 months and C/D stage of reflux esophagitis. Depending on the prescribed treatment, the patients were divided into 2 groups of 30 subjects. Patients of the main group received complex therapy: PPI pantoprazole 40 mg once per day and esophagoprotector based on hyaluronic acid, chondroitin sulfate and poloxamer 407. In the comparison group, only pantoprazole was prescribed at the same dosage. The duration of the treatment course in both groups was 4 weeks. Before and after treatment, the presence and severity of complaints were assessed on the Likert scale, life quality according to the SF-36 questionnaire and endoscopic examination data. Results: after the end of the therapy course, a statistically significant decrease in the severity of epigastric burning, regurgitation, substernal pain, gaseous eructation, odynophagia and dysphagia was found both in the main group (in all cases p<0.05, Wilcoxon Matched Pairs Test) and the comparison group (in all cases p<0,05, Wilcoxon Matched Pairs Test). The use of combination therapy made it possible to achieve a more significant improvement in the life quality of patients in all indicators versus PPI monotherapy. In addition, 3 (10%) patients of the main group achieved endoscopic remission, while there were no such patients in the comparison group. The use of esophagoprotector in addition to PPI made it possible to reach the primary and secondary endpoints significantly more commonly versus during monotherapy. Conclusion: the obtained data indicate the high efficiency and safety of PPI therapy in combination with esophagoprotector for relieving the disease symptoms and improving the life quality of patients, faster and complete remission of reflux esophagitis by additional restoration of the esophageal mucosa resistance. Esophagoprotector as a component of complex therapy together with PPI allows achieving clinical and endoscopic disease remission in patients with erosive esophagitis in shorter terms. KEYWORDS: gastroesophageal reflux disease, esophageal mucosa resistance, esophagoprotection, proton pump inhibitor, quality of life. FOR CITATION: Matoshina I.V., Livzan M.A., Fedorin M.M., Lapteva I.V. Efficacy of combined therapy in patients with erosive gastroesophageal reflux disease. Russian Medical Inquiry. 2021;5(6):366–372 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-366-372.

Cardiac risk stratification in patients with non-alcoholic fatty liver disease and cholelithiasis

Aim: to increase the efficacy of patient management, to assess the risk of developing cardiovascular diseases (CVD) with the fatal outcome for 10 years in patients with comorbid cholelithiasis (C) and non-alcoholic fatty liver disease (NAFLD). Patients and Methods: 183 patients with NAFLD participated in an open comparative study. The main group (n=88) consisted of subjects with comorbid NAFLD and C, of which 53 patients have a history of cholecystectomy (CE). The comparison group consisted of patients with NAFLD only (n=95). The risk of CVD with fatal outcome in the comorbid course of NAFLD and C was assessed according to the SCORE 2019 scale for regions with an increased risk. A scale of relative total CVD risk was used for people under 40 years of age. Results: the detection rate of CHD, is positively correlated with comorbid course of NAFLD and C (25% — in the main group, and 9.47% — in the comparison group, χ2=7.83, p<0,01, rs=0,207, R<0.01), and the correlation increases among people with CE (rs=0,258, R<0,01). In the comparison group, prediabetes was significantly more commonly detected (χ2=8.24, p<0.01, r s=-0.212, p<0,01). Patients after CE had a higher level of LDL cholesterol (rs=0.228, p≤0.01). Patients with NAFLD are characterized by hyperleptinemia and leptin resistance along with insulin resistance. Patients after CE have the highest level of leptin (p<0.001). Subjects with a comorbid course of NAFLD, C and CE in the history have a significantly higher risk of CVD with the fatal outcome for 10 years (43.4%) (χ2=9.4140, p<0,01). A correlation of mean level between CE and high CVD risk was revealed (r=-0,4341, p≤0.01). Conclusion: the factors causing the comorbid course of NAFLD and C are also concerning the CVD progression. Stratification of patients by CVD risk groups and metabolic status can become an indispensable tool in the clinicians’ arsenal. KEYWORDS: cardiovascular risk, non-alcoholic fatty liver disease, cholelithiasis, cholecystectomy. FOR CITATION: Krolevets T.S., Livzan M.A., Cherkashchenko N.A. et al. Cardiac risk stratification in patients with non-alcoholic fatty liver disease and cholelithiasis. Russian Medical Inquiry. 2021;5(6):377–384 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-377-384.

Gastrointestinal stromal tumor of the stomach (clinical case)

Gastrointestinal stromal tumors (GIST) are the most common malignant submucosal neoplasms of the gastrointestinal tract, with predominant localization in the stomach and small intestine. The disease pattern is the absence of specific clinical signs, at least a third of cases are detected during examinations or surgical interventions for other diseases or at an autopsy. The examination algorithm of patients with suspected GIST includes endoscopic and radiation diagnostic methods, including a number of high-tech and expensive techniques, such as endoscopic ultrasonography, computed tomography, immunohistochemical and molecular genetic methods for studying biopsy material. Only conducting a full set of examinations will allow timely diagnosis and choosing the optimal treatment tactics for the disease with a high risk of malignancy. The authors present their own clinical case of a patient, female, with GIST, which is of considerable interest to clinicians. The above clinical case represents a typical clinical and morphological picture of GIST. The disease onset occurred in a patient over the age of 60 years and proceeded under the guise of organic dyspepsia. In this case, the use of expensive high-tech techniques allowed to verify the diagnosis of GIST and refer the patient to surgical treatment. KEYWORDS: gastrointestinal stromal tumor, stomach tumor, endoscopic ultrasonography, immunohistochemistry, differential diagnosis. FOR CITATION: Skvortsova T.E., Oganezova I.A., Medvedeva O.I. et al. Gastrointestinal stromal tumor of the stomach (clinical case). Russian Medical Inquiry. 2021;5(6):433–437 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-433-437.

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.