[Effectiveness of empirical Helicobacter pylori eradication therapy with furazolidone in Russia: results from the European Registry on Helicobacter pylori Management (Hp-EuReg)].

BACKGROUND: First-line therapy does not always provide a high level of Helicobacter pylori eradication due to the increase of H. pylori resistance to antibiotics; therefore, it remains necessary to identify the most effective rescue treatments. The purpose of this study was to evaluate the efficacy and safety of empirical H. pylori furazolidone-containing regimens. MATERIALS AND METHODS: Adult H. pylori infected patients empirically treated with furazolidone-containing eradication regimens were registered in an international, prospective, multicenter non-intervention European registry on H. pylori management (Hp-EuReg). Data were collected at AEG-REDCap e-CRF from 2013 to 2021 and the quality was reviewed. Modified intention-to-treat (mITT) effectiveness analyses were performed. RESULTS: Overall 106 patients received empirical furazolidone-containing therapy in Russia. Furazolidone was prescribed in a sequential scheme along with amoxicillin, clarithromycin and a proton pump inhibitor in 68 (64%) cases, triple regimens were prescribed in 28 (26%) patients and quadruple regimens in 10 (9.4%). Treatment duration of 7 days was assigned to 2 (1.9%) patients, 10-day eradication therapy in case of 80 (75%) and 14 days - in 24 (23%) patients. Furazolidone was mainly used in first- (79%) and second-line (21%) regimens. The methods used to diagnose H. pylori infection were: histology (81%), stool antigen test (64%), 13C-urea breath test (6.6%), and rapid urease test (1.9%). The mITT effectiveness of sequential therapy was 100%; 93% with the triple therapy and 75.5% with quadruple therapy. Compliance was reported in 98% of cases. Adverse events were revealed in 5.7% of patients, mostly nausea (3.8%). No serious adverse events were reported. CONCLUSION: Furazolidone containing eradication regimens appear to be an effective and safe empirical therapy in Russia.

[The social role of intergenerational sports: the formation of norms, citizenship and the value of a healthy lifestyle].

The article discusses issues reflecting the importance of intergenerational sports as an institution influencing the formation of social values, civic identity, health-saving attitudes, etc. The paper defines the main and specific functions of sport as a social institution. Based on the author's sociological research, the results are presented reflecting the attitude of participants of intergenerational sports groups to certain types of social impact that sports activities and events held in mixed age groups have.

[The characteristics of elderly citizen of perceiving communication effects of issues of formation of healthy life-style].

The article discusses results of communication effects of various information actors on elderly citizen stimulating healthy life-style. The purpose of the study was to establish characteristics of perception by elderly Russians communication effects targeting formation and maintenance of healthy life-style, to determine degree of significance of communication channels by which such measures can provide high degree of individual motivation. The contradiction was established. From one hand, life span increases due to achievements of science, medicine and technologies promoting decreasing diseases' mortality and improving health indicators.From the other hand, the need in larger volume of caring services at lesser number of professional personnel providing social care and medical personnel comes up. It is established that age principle is one of the basic ones in segmentation of health state. According it, population of elderly age consists of several main groups having different social characteristics concerning conditions of life, medical indications, consumer behavior and information perception. The elderly pre-retired, elderly relatives, early retired, socially active retired. It is concluded that communication impact on elderly citizens concerning formation of healthy lifestyle and promotion of health saving practices are to be implemented considering specifics of particular communication channels (both interpersonal and mass ones). It is recommended in planning and implementing socially-oriented marketing and educational campaign not only to segment target audiences of senior citizens, but to evaluate degree of significance of communication channels for each of them.

[European registry Helicobacter pylori (Hp-EuReg): how has clinical practice changed in Russia from 2013 to 2018 years].

The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: "Hp-EuReg") allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations. MATERIALS AND METHODS: A comparative analysis of the data entered in the register by the Russian research centers "Hp-EuReg", in the period from 2013 to 2018, was conducted. RESULTS AND DISCUSSION: Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period. CONCLUSION: In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy.

European Registry on the management of Helicobacter pylori infection (Hp-EuReg): analysis of 2360 patients receiving first-line therapy in Russia.

AIM: European Registry on the management of Helicobacter pylori infection («Hp-EuReg¼) - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations. MATERIALS AND METHODS: The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg¼ in 2013-2017, who were underwent 1st line eradication therapy. RESULTS: The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effec- tiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clar- ithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Eradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment. CONCLUSION: Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

[The rehabilitative treatment of the patients presenting with chronic obstructive pulmonary disease including the application of the manual handling methods]. / Vosstanovitel'noe lechenie patsientov s khronicheskoi obstruktivnoi bolezn'iu legkikh s vkliucheniem metodov manipuliatsionnogo vozdeistviia.

AIM: The objective of the present study was to identify the peculiar features and advantages of different methods for the mechanical impact on the thoracic tissues of the patients presenting with chronic obstructive pulmonary disease (COPD) and to develop specific indications for their clinical applications. MATERIAL AND METHODS: This randomized prospective comparative study included 137 patients with COPD. In accordance with the currently accepted classification (GOLD, 2013), all the patients had COPD of medium severity. The smoldering inflammatory process was diagnosed in 75 (54.7%) patients, grade I and II respiratory insufficiency in 80 (58.4%) and 57 (41.6%) patients, respectively. The external respiration function was evaluated by means of pneumotachometry techniques during the forced expiratory maneuver and by spirometry. The pulmonary hemodynamics and myocardial contractility of the right ventricle were studied with the use of rheopulmonography and central hemodynamics by tetrapolar thoracic rheography. The routine inflammatory and immune tests were employed. RESULTS: Investigations of the systemic circulation have demonstrated the prevalence of its hyperkinetic type (54,0%) over the hypokinetic and eukinetic ones (23,3% and 22,7% respectively). All the patients were divided into three group identical in terms of clinical and functional characteristics. The patients comprising group 1 (n=46) were prescribed the rehabilitative treatment in the form of classical chest massage, those of group 2 (n=47) were treated by means of intense massage of asymmetric chest zones, and the patients included in group 3 (n=44) underwent manual therapy. It was shown that intense massage produced the most pronounced beneficial effect. Classical massage also resulted in the reduction of the inflammatory manifestations but its effectiveness was significantly lower than that of the intense treatment (р<0,05-0,02). Manual therapy failed to cause any appreciable changes in the character and severity of the inflammatory process (р>0,5). CONCLUSION: The intense massage of asymmetric chest zones proved to provide the most efficient tool for the anti-inflammatory treatment of the patients presenting with chronic obstructive pulmonary disease in comparison with other known methods for the mechanical impact on the thoracic tissues. However, the application of this technique is limited in the patients with the hypokinetic type of systemic circulation and pulmonary hypertension. The most important advantage of chest massage by the conventional method is the possibility of its application for the treatment of the patients suffering from severe forms of COPD associated with pulmonary and systemic cardiohemodynamic disturbances with alveolar hypoxia. Manual therapy can be recommended in the first place to the patients with COPD in remission and the accompanying functional blockade of the vertebral segments.

[Lipid metabolism in patients with hematologic cancers]. / Lipidnyi obmen u bol'nykh onkogematologicheskimi zabolevaniiami.

It is considered that hypercholesterolemia is life-threatening and low cholesterol levels are a positive factor. However, taking into consideration the fact that cholesterol plays a key role in cell proliferation, it should be remembered that its low blood level may be linked to high cholesterol demands from neoplastic cells. The literature review analyzes the results of recent investigations of lipid metabolism in patients with hematologic cancers and their other types. All given investigations show a significant reduction in the serum levels of total cholesterol and high-density lipoproteins in patients with hematological disease at its onset. The data for other indicators of the lipid transport system are ambiguous. Such changes have been elucidated to be associated with the accumulation of cholesterol in the leukemia cells due to enhanced synthesis de novo, a more active absorption from circulation and blocked release of its surplus. If the disease runs a favorable course, lipid metabolic parameters become normalized and, in case of remission, correspond to those seen in healthy individuals. They continue to decline in patients with disease progression. This allows the consideration of cholesterol, its fractions, and apolipoproteins as biochemical prognostic markers in hematological cancer patients and as indicators for assessment of treatment results. In addition, there is evidence for the effect of chemotherapeutic agents on lipid metabolism. Recent attempts to elaborate new treatment strategies, by using the current knowledge on the role of lipid metabolism in cancers, are considered.

[European Registry on the management of Helicobacter pylori infection (Hp-EuReg protocol): The first results of Russian centers].

AIM: To assess the clinical practice of diagnosis and treatment in patients with Helicobacter pylori infection and to compare this practice with the international guidelines in the European Registry on the management of Helicobacter pylori infection, Hp-EuReg protocol), a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group. MATERIALs AND METHODS: The data of 813 patients infected with H. pylori and entered in the Hp-EuReg register by the Russian centers in 2013-2015 were analyzed. RESULTS: The most common methods for the primary diagnosis of H. pylori infection are histology (40.3%), rapid urease test (35.7%), and serology (17.2%). The duration of H. pylori eradication therapy was 7, 10, and 14 days in 18.0, 49.3, and 25.1%, respectively. To monitor the effectiveness of treatment, the investigators used a histological examination (34%), a urea breath test (27.3%), H. pylori stool antigen (22.8%), and a rapid urease test (16.3%). A serological test was carried out in 2.5% of the cases. No monitoring was done in 13.5% of the patients. The average eradication efficiency was 82.6%. If the therapy was ineffective, 80% of physicians did not intend to prescribe a new cycle of treatment. CONCLUSION: Significant differences were found between clinical practice and the current guidelines.

DIAGNOSTIC ALGORITHM FOR DIARRHEA.

Diarrhea refers to one of the most common syndromes encountered in practice therapist, general practitioner, pediatrician, gastroenterologist and infectious disease. The article describes the main diseases and conditions in which there is a clinical syndrome of diarrhea.

THE EFFECTIVENESS OF GOLIMUMAB IN SEVERE ULCERATIVE COLITIS WITH EXTRAINTESTINAL MANIFESTATIONS.

A clinical case of severe ulcerative colitis vvith extraintestinal manifestations, development of steroid dependence and inefficiency of basic therapy is presented. A good effect of therapy with golimumabis demonstrated.

MICROBIOCENOSIS IN INFLAMMATORY PROCESSES OF MARGINAL GUM AMONG CHILDREN.

INTRODUCTION: The development of gingivitis among children remains actual problem in modern dentistry due to high prevalence, disorders of dental-alveolar functions and development of parodontium diseases at the older age. The microorganisms occupying dental chamfer play the leading role in parodontium tissues damage. AIM: Research of microbial spectrum of dental chamfer and assessment of etiology significances of the revealed microorganisms in gingivitis among children of school age. MATERIALS AND METHODS: Bacteriological research of dental chamfer in 30 children of secondary school age with gingivitis of slight and severe level. Inoculations have been done on the chocolate agar incubated in air-locked containers with gas generators for anaerobic atmosphere "GENbag Anaer" and inoculations on bloody gemagar--with gas generators for microaerophiles "GENbag Microaer" (bioMerieux) within 24-48 hours. Infections were precipitated out on the Saburo medium. Identification of discharged cultures was carried out on the microbialogic evaluator "Vitek II Compact" (bioMerieux). RESULTS: Microflora of dental chamfer in the examined children has been presented by three groups of microorganisms: gram-positive cocci (63.3%), gram-negative nonfermentative bacteriums (63.3%) and yeast Candida fungus (30%). Among gram-postitive cocci representatives of normal microflora of oral cavity Streptococcus oralis (26.6%) were dominated. Neisseria (N. sicca, cinerea et animaloris) were dominated most often in the group of gram-negative nonfermentative bacteriums (23.3% of children), yeast Candida fungus have been presented by two kinds--C. dubliensis (at 20% of children) and C. albicans (at 10%). The mean content of all discharged microorganisms has compounded 5,7 Ig KOE that supposes their etiology role in development of marginal gum inflammation. CONCLUSIONS: Received results showed us some mechanisms of development of inflammatory diseases of parodontium tissues which will allow us to develop new approaches of treatment and gingivitis prevention among children of school age.

[THE USE OF COMBINATION ANTIVIRAL THERAPY IN LIVER CIRRHOSIS HCV ETIOLOGY].

Is a clinical example of combination antiviral therapy drugs interferon and ribavirin in the treatment of liver cirrhosis in chronic HCV infection, class A on Child-Pugh which made the transition of liver cirrhosis in the F1 fibrosis (the Metavir) and achieved sustained antiviral response (SVR).

[The condition of lipid metabolism in patients with newly diagnosed acute leukemia.]

The article presents comparative analysis of lipid metabolism in patients with acute leukemia depending on form of disease, age, occurrence of cardiovascular pathology and infectious complications. The study sampling included 148 patients with primarily diagnosed acute leukemia aged from 16 to 79 years (average age is 54 years). The control group consisted of 28 healthy volunteers aged from 26 to 75 years (average age is 49 years). The distribution by age in this group corresponded to distribution in group of patients (p>0.05, khi-square). It is established that under acute promyelocyte leukemia indicators of lipid metabolism are subjected to minimum alterations because only concentration of high density lipoproteins reliably decreased. In case of other forms of acute myeloid leukemia and acute lymphoblastic leukemia significant alterations of lipid specter of blood occur characterized by decreasing of content of cholesterol, high and low density lipoproteins and apolipoprotein A1.Also it was established that these alterations have no dependence on age of patients in contrast with healthy individuals having direct dependence of level of cholesterol and high and low density lipoproteins on age. The occurrence of concomitant cardiovascular pathology in patients with acute leukemia had no effect on indicators of lipid metabolism. The occurrence of infectious complications during period of manifestation of acute leukemia enhances shifts in indicators of lipid transport system in direction of decreasing of levels of cholesterol and high and low density lipoproteins.

[Bronchial spasm as extraesophageal manifestations of gastroesophageal reflux disease].

Gastroesophageal reflux disease is one of the common spread diseases. Its manifestations are diverse and include esophageal and extraesophageal manifestations. One of them is a so-called "respiratory mask". It is very difficult to cure it without realizing therapy of the main disease. A clinical case of a patient with bronchial asthma in combination with a hernia hiatal and GERD is described. Clinical effectiveness of surgical treatment is demonstrated clinically.

[The evaluation of sensitivity and specificity of technique of detection of C-reactive protein under diagnostic of infectious complications in patients with acute lymphoblastic leucosis receiving chemotherapy].

The C-reactive protein is a generally recognized marker of inflammation and bacterial infection. However, issue of diagnostic effectiveness of this indicator is still open-ended in case of patients with oncologic hematological diseases. The level of C-reactive protein can increase under neoplastic processes. On the contrary, the inhibition of immune response observed under cytoplastic therapy can decrease synthesis of this protein. The study was organized to establish levels of C-reactive protein as markers of infection in adult patients with acute lymphoblastic leucosis under application of chemotherapy and to evaluate their diagnostic effectiveness. The sampling included 34 patients with acute lymphoblastic leucosis all patients had infectious complications at various stages of treatment. The levels of C-reactive protein in groups of patients with localized infections (mucositis, abscess, pneumonia, etc.) or fever of unknown genesis had no statistical differences but were reliably higher in patients without infectious complications. The concentrations of C-reactive protein in patients with syndrome of systemic inflammatory response and sepsis had no differences. At the same time, level of C-reactive protein under systemic infection (syndrome of systemic inflammatory response, sepsis) was reliably higher than in case of localized infection. The diagnostically reliable levels of C-reactive protein were established as follows: lower than 11 mg/l--infectious complications are lacking; higher than 11 mg/l--availability of infectious process; higher than 82 mg/l--generalization of infection. The given levels are characterized by high diagnostic sensitivity (92% and 97% correspondingly) and specificity (97% and 97%) when patients receive therapy without application of L-asparaginase. At the stages of introduction of this preparation effecting protein synthesizing function of liver sensitivity of proposed criteria are decreased (69% and 55% correspondingly). However; due to high specificity (100% and 96%) their diagnostic effectiveness remains high.

[Eyes' symptoms of the digestive diseases].

Substantial part of the eye disease manifestations constitute general or systemic diseases. Accordingly, the dosage systemic therapy of these diseases can affect the condition of the eye. Changes of the vision and the appropriate advice ophthalmologist can help the gastroenterologist in the diagnosis and adequate treatment of the patient. The article discusses the possible changes in the organ of vision in diseases of the digestive system and a number of infectious diseases, as well as changes occurring under the influence of drug therapy of these diseases.

[The dynamics of biochemical blood indicators in patients with hemophilia and posttransfusion hepatitis receiving hepatotropic therapy].

The sample of 128 patients with hemophilia aged from 1 to 71 years (Me 32) was examined. The study established that 109 patients (85.2%) had hemophilia A and 19 patients (14.8%) had hemophilia B. In 77 adult patients (60%) markers of viruses of hepatitis C and B were detected and the signs of disorders of liver functions were established in 64% out of them. These signs included reliable increasing of levels of AST and ALT, total and conjugated bilirubin, urea and creatinine and absence of any clinical manifestations. The detected alterations served as a background for implementation of hepatotropic therapy with pharmaceutical Heptral. The ademetionin is the reactant of preparation. After two weeks of intravenous application of Heptal the tendency to normalization of content of bilirubin was established. The significant decrease of activity of aminotransferases was detected, nevertheless their levels still overridden physiological standard. This situation required to prescribe pharmaceutical and to continue treatment in out-patient conditions. The continuous repair of functional activity of hepatic cells requires further search of more effective schemes of therapy.

[C-reactive protein as a marker of the severity of an infectious process in acute myeloid leukemia patients with neutropenia].

AIM: To determine C-reactive protein (CRP) levels as diagnostic markers of infection in acute myeloid leukemia (AML) patients with neutropenia. SUBJECTS AND METHODS: Sixty-three AML patients (28 men and 35 women) aged 20 to 77 years (median 50 years) were examined. According to the French-American-British (FAB) classification, the types of AML were as follows: M0 (n = 3), M1 (n = 9), M2 (n = 35), M4 (n = 10), and M5 (n = 6). All the patients had chemotherapy-associated neutropenia (granulocytes, less than 0.5.10(9)/l). In different treatment steps, all the patients developed infectious complications (the study analyzed the data of 86 cases). RESULTS: In patients with localized infections (such as mucositis, abscess, pneumonia, etc.) or fever of unknown origin (FUO), the levels of CRP were not statistically significant different, but were significantly higher than in those without infectious complications. The concentrations of CRP did not differ in patients with systemic inflammatory response syndrome (SIRS) and in those with sepsis. At the same time, the level of CRP in systemic infection (SIRS, sepsis) was significantly higher than that in localized infection (p < 0.001). In patients with neutropenia, the median CRP levels were as follows: 7 mg/l (range 0-37; 95% reference interval (RI) 0 to 32) for those without infection 56 mg/l (range 13-104; 95% RI 17 to 104) for those with localized infection or FUO; and 168 mg/l (range 103-399; 95% RI 105 to 362) for those with systemic infection. CONCLUSION: CRP is a marker of the severity of an infectious process in AML patients with neutropenia. The increase of its level more than 32 mg/l serves a valid criterion for the presence of infection and more than 105 mg/l does for that of a systemic inflammatory response in these patients.

[Correction of indigestion in chronic biliary pancreatitis].

Chronic pancreatitis (CP) is one of the most urgent and investigated problems in gastroenterology. Despite the variety of the spectrum of etiologic, pathogenetic and provoking factors for CP, one of the leading causes of disease pathology is pathology of biliary tract. A key element in the treatment of CP is a correction of the digestive system, with biliary pancreatitis feature that distinguishes it from other forms of pancreatitis, is a combination of exocrine pancreatic insufficiency with chronic biliary insufficiency. The variety of biochemical and immunological effects of ursodeoxycholic acid (UDCA) can treat it with biliary pancreatitis as the drug of etiological, pathogenetic and substitution therapy. UDCA (Ursosan) in combination with modern mini-microspheroidal polyfermental drugs significantly improves the clinical efficacy of the correction of the digestive system in biliary pancreatitis.

[Drug safety in gastroenterology].

Drug safety is one of the priorities of modern medicine and pharmacy. In modern gastroenterology drug safety issues due to a number of reasons even more relevant than in other branches of medicine. The major areas of drug ensure patient safety in the practice of gastroenterologists, as well as other doctors, are: 1) direct involvement of practitioners in the system of pharmacovigilance, 2) used in the practice of clinical research and evidence-based medicine, 3) the use of the principles of rational pharmacotherapy.