[Treatment of toxic hepatitis in COVID-19 patients].

BACKGROUND: The article reflects the clinical significance of the early diagnosis of toxic hepatitis in patients who have undergone a new coronavirus infection with the determination of clinical and laboratory predictors of the response to therapy. A dynamic analysis of the effectiveness of toxic hepatitis therapy in patients of three experimental groups and a control group is presented. AIM: The aim of the present study is to increase the effectiveness of the treatment of toxic hepatitis in patients who have undergone COVID-19. MATERIALS AND METHODS: On the basis of the newly created infection centers of the Central Clinical Hospital "RZhD-Medicine" and Vishnevsky 3-rd Central Military Clinical Hospital 996 patients with COVID-19, who had clinical and laboratory signs of toxic liver damage (cytolytic and/or cholestatic syndromes) against the background of COVID-19 therapy. RESULTS: On the 14th day from the start of therapy in group 3, there was a significant decrease in the clinical manifestations of jaundice in 163 (72.8%) patients, on the 21st day of treatment, this symptom was stopped in all patients. In groups 1 and 2, the decrease in clinical manifestations of jaundice was significantly lower - 122 (55.2%) and 134 (58.8%); p<0.05. At the end of therapy, no manifestations of jaundice were observed in all experimental groups, while in the control group, symptom reduction was achieved only in 47 (14.5%) patients. CONCLUSION: The use of drugs with hepatoprotective effect in the form of monotherapy in groups 1 (UDCA) and 2 (ademethionine) showed a low therapeutic effect with positive dynamics of clinical and laboratory indicators of toxic hepatitis activity. The use of combined treatment in group 3 (UDCA and ademethionine) demonstrated the maximum therapeutic effect, pronounced positive dynamics in the form of normalization of clinical and laboratory indicators of toxic hepatitis activity.

[Diagnostics and treatment of non-alcoholic fatty liver disease with concomitant asthenic syndrome].

AIM: Analysis of the effectiveness of therapy for non-alcoholic fatty liver disease (NAFLD) with severe asthenic syndrome. MATERIALS AND METHODS: In the period from 2017 to 2019, on the basis of the gastroenterology center of the Vishnevsky 3-rd Central Military Clinical Hospital, 247 patients with NAFLD, including those at the stage of steatohepatitis, and severe asthenic syndrome were examined and treated. The main group included 124 patients, the control group 123 patients. All patients underwent complex laboratory and instrumental diagnostics and neuropsychological research using the subjective asthenia assessment scale (MFI-20). In both groups, domestic drugs were included in the therapy regimen: from the 1st to the 10th day, Heptrong solution 3 ml intramuscularly in the morning; from the 1st to the 60th day UDCA 250 mg orally, 3 capsules at bedtime, Omega-3 forte 1000 mg, 2 capsules in the morning with meals. In group I patients received additionally from the 1st to the 10th day intravenous drip Cytoflavin 10 ml + 0.9% NaCl solution 200 ml; pentoxifylline solution 5 ml + 0.9% NaCl solution 200 ml. Then, from the 11th to the 60th day, Cytoflavin inside, 2 tablets 2 times a day. Pentoxifylline inside 400 mg 1 tablet 3 times a day. All patients underwent neuropsychological examination using the subjective asthenia rating scale (MFI-20). RESULTS: The effectiveness of treatment in patients of both groups was assessed by clinical, laboratory data and neuropsychological studies. In the main group, a significant reduction in asthenic syndrome was achieved against the background of diagnosed NAFLD compared with the control group. CONCLUSION: The early inclusion of patients with NAFLD and severe asthenic syndrome in the treatment regimen, in addition to the basic therapy of Cytoflavin, achieved a significantly high therapeutic effect in the form of normalization of the main clinical, laboratory and instrumental parameters, as well as a significant reduction in the manifestations of asthenia.

[Evaluation of the efficiency of hepatoprotective monotherapy using succinic acid and methionine for nonalcoholic fatty liver disease at the stage of steatohepatitis].

AIM: To evaluate the efficiency of Remaxol monotherapy in patients with nonalcoholic fatty liver disease (NAFLD) at the stage of steatohepatitis (SH). MATERIALS AND METHODS: The treatment of 156 patients with NAFLD at the stage of SH was analyzed. A study group included 84 patients who had received intravenous Remaxol, 400 ml, dropwise at a rate of 40-60 drops per minute once daily in the morning for 10 days; a control group of 72 patients had been treated with the conventional scheme. RESULTS: During the treatment, the study group showed a rapider relief of the manifestations of asthenovegetative and dyspeptic syndromes and a reduction in the magnitude of biochemical manifestations of cytolytic and cholestatic syndromes than did the control group. CONCLUSION: Incorporation of Remaxol into the therapy regimen in patients with NAFLD at the stage of SH enhances the effectiveness of treatment.

[Diagnosis and treatment of metabolic syndrome combined with liver toxicity genesis in contract service officers].

In this paper is synthesized current and recent data on the problem of metabolic syndrome (MS) in combination with toxic liver injury (CCI). Statistical parameters of the last 15 years, the dynamics of alimentary-constitutional obesity (ABC) in patients from the officers contracted service of Defense Ministry of Russia are reflected. Two-year experience in the application of modern non-invasive methods of diagnosis of liver fibrosis with a reflection of its dynamics on the background of complex treatment of patients with MS in conjunction with the Chamber on the example of 57 patients is shown. Paid great attention to psychological and emotional adjustment of patients with ABC, given the complex survey design and treatment in violation of motivational and behavioral responses. High clinical efficiency of combination drug therapy of MS and CCI, the diagnostic value of modern non-invasive methods of diagnosis of hepatic fibrosis are reliably performed. Technique of elastography significantly improves the liver clinical evaluation of the effectiveness of the therapy, allows for early detect the presence of the initial degree of hepatic fibrosis, choose the optimal treatment regimen and to evaluate the results dynamically.

[An evaluation of acute effects of sulfur compounds for the human organism in natural gas fields emergencies (review)]. / Problema otsenki ostrogo vozdeistviia soedinenii sery na organizm cheloveka pri avariinykh situatsiiakh na mestorozhdeniiakh prirodnogo gaza (obzor).

A trend towards a growing number of emergency situations at industrial enterprises has been recently traced throughout the world. The main reasons of such phenomenon are: a comprehensive use of highly dangerous technologies and materials; large-scale violations of the operational rules and norms; and an inadmissibly high wear-and-tear of the main production funds in economic branches with extra risk. The world experience is indicative of a high degree of danger related with exploiting the natural-gas fields with a high content of sulfur compounds. The occurrence of emergency situations in the mentioned fields is accompanied by development of acute and sub-acute toxic effects in the workers and population. It necessitated, recently, an elaboration of a concept of a relative safety, in view of an unfavorable impact produced by chemical substances in emergencies, and an elaboration of methods applicable to the evaluation of emergency regulations.

[Hygienic assessment of ambient air pollution in rural localities in the area exposed to effluents of the Orenburg gas-field complex]. / Gigienicheskaia otsenka zagriazneniia atmosfernogo vozdukha sel'skikh naselennykh punktov v zone vliianiia vybrosa Orenburgskogo gazopromyslovogo upravleniia.

A complex analysis suggests that there has been an increase in airogenic load on the population living in an area exposed to gas waste from the Orenburg gas-field complex at the expense of nitrogen dioxide, which may be associated with its higher levels in the waste from 1058.3 tons/year in 1996 to 2084.89 tons/year in 2000 and with the maximum effluent of 2550.79 tons/year in 1999. The study has revealed that the rural locality with the greatest aerogenic load is the village of Dedurovka.