[Epithelial protective therapy in comorbid diseases. Practical Guidelines for Physicians].

This document was produced with the support of the National Medical Association for the Study of Comorbidities (NASС). In 2021 the first multidisciplinary National Consensus on the pathophysiological and clinical aspects of Increased Epithelial Permeability Syndrome was published. The proposed guidelines are developed on the basis of this Consensus, by the same team of experts. Twenty-eight Practical Guidelines for Physicians statements were adopted by the Expert Council using the "delphic" method. Such main groups of epithelial protective drugs as proton pump inhibitors, bismuth drugs and probiotics are discussed in these Guidelines from the positions of evidence-based medicine. The clinical and pharmacological characteristics of such a universal epithelial protector as rebamipide, acting at the preepithelial, epithelial and subepithelial levels, throughout gastrointestinal tract, are presented in detail.

[The use of the medicine Ophtalmoferon for the treatment of conjunctivitis in patients with HIV-infection and tuberculosis]. / Opyt primeneniya preparata Oftal'moferon pri kon"yunktivitakh, assotsiirovannykh s VICh-infektsiei i tuberkulezom.

PURPOSE: To assess the effectiveness of the medicine Ophtalmoferon (eye drops) in the treatment of conjunctivitis of mixed aetiology in patients with first-time tuberculosis (TB) and human immunodeficiency virus (HIV) infection, who have been treated at the Clinical Anti-tuberculosis Hospital No. 4. MATERIAL AND METHODS: The study included 60 patients (42 men and 18 women with mean age of 41.48±1.34 years), who had consulted the ophthalmologist for conjunctivitis. The patients were divided into two groups: the first group - main one (n=32) - received complex local therapy with the medicine Ophtalmoferon; the second group (n=28) - control one - did not receive Ophtalmoferon as a part of complex local treatment. The treatment involved assessment of the effectiveness, tolerability and safety of the examined medicine. RESULTS: Patient examinations were conducted on the first visit, then on the third, fifth and seventh day of treatment. On the third day of treatment as compared to the baseline the burning sensation and pain in the eyes were less severe; in the main group that received the medicine Ophtalmoferon (group 1) the number of patients describing these symptoms as mild (1 point) were 15.6% (pain) and 18.8% (burning), respectively (W=2.15; p=0.03). Severe lacrimation (3 points) remained in 5 (15.6%) patients. On the fifth day there were no main group patients with severe (3 points) or moderate (2 points) lacrimation. On the seventh day complete resolution of subjective symptoms was noted in 71.9% (group 1) and 42.9% (group 2) of patients (χ2=1.39; p=0.238), respectively. There was no lacrimation in 71.9% (group 1) and 35.7% (group 2) of patients (χ2=2.36; p=0.125), no eye redness was noted in 78.1% (group 1) and 28.6% (group 2) of patients (χ2=4.51; p=0.034), respectively. CONCLUSION: The use of the combined medicine Ophtalmoferon in the complex local treatment of conjunctivitis of mixed aetiology in patients with tuberculosis and HIV infection helps to achieve a rapid relief of subjective and objective symptoms with good tolerability of the medicine.

[Acute respiratory viral infections: Topical issues of diagnosis, prevention and treatment in therapeutic practice]. / Ostrye respiratornye virusnye infektsii: aktual'nye voprosy diagnostiki, profilaktiki i lecheniya v praktike terapevta.

AIM: to assess the efficacy and safety of the medication Grippferon with loratadine for the prevention of acute respiratory viral infections (ARVI) and influenza during the epidemics. MATERIAL AND METHODS: This study included 103 patients (67 men and 36 women) aged 18 to 52 years (mean age 35.3±3.2 years). During the first visit (september 2015), we collected patient history data on the average rate of ARVI and influenza for the past three years, the disease duration and its symptoms, presence of concomitant allergic pathologies (such as vasomotor rhinitis, hay fever and urticaria) and food allergies. Appropriate recommendations for the medication use were given to patients. During the second visit (may 2016), we collected follow-up cards and then analyzed the findings. RESULTS: 33 percent of the patients were fully compliant with the medication dosage regimen. In the first group (68 people with a history of one-two ARVI cases in the autumn-winter period for the past three years) the average number of ARVI cases in previous years was 1,53±0,23, by comparing with 0,69±0,16 (p<0.01) during the follow-up period, when medication Grippferon with loratadine was used. No ARVI cases were noted in 21 patients. In the second group (35 people with a history of three or more ARVI cases for the past three years) the average number of ARVI cases in previous years was 3,69±0,29, by comparing with 2,49±0,22 (p<0.05) during the follow-up period, when nasal ointment Grippferon with loratadine was applied. Two people reported that they did not have ARVI. We noted a positive ARVI symptoms dynamics in patients, who received treatment with the given medication. Specifically, a reduced duration of fever and intoxication periods as well as decreased catarrhal symptoms in the nasopharynx and oropharynx were observed. CONCLUSION: The results of our study allow us to consider a new combined medication Grippferon with loratadine (nasal ointment) as an effective and safe medication for the prevention and treatment of influenza and acute respiratory viral infections in the complex therapy in adult patients, including patients with allergic history.

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.

[CHANGES IN THE ORGANS AND TISSUES OF THE ORAL CAVITY WITH DIGESTIVE SYSTEM DISEASES].

A substantial part of the pathology of organs and tissues of the oral cavity make common manifestations or systemic diseases. Accordingly, the dosage systemic therapy of these diseases can affect the condition of the eye. Changes in organs and tissues of the oral cavity and the appropriate advice a dentist can help the gastroenterologist in the diagnosis and adequate treatment of the patient. The article discusses possible changes in the organs and tissues of the oral cavity in diseases of the digestive system, as well as changes occurring under the influence of drug therapy of these diseases.

[Change in the organ of vision in somatic diseases]. / Izmenenie organa zreniia pri somaticheskikh zabolevaniiakh.

The functional or morphological changes associated with systemic diseases make up the bulk of eye pathology. Accordingly, systemic drug therapy for these diseases can affect the eye. Changes of the organ of vision and appropriate ophthalmological advice can assist an internist to diagnose and adequately treat the patient. The article considers possible changes in the organ of vision in the presence of somatic diseases, as well as alterations resulting from drug therapy for these diseases.

[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 role of psycho-autonomic status and the serotonergic system in patients with gastroesophageal reflux disease].

OBJECTIVE: Identify the differences of the autonomic nervous system (ANS), serotonin levels, cognitive, behavioral and emotsinalnoy areas in groups of patients with reflux esophagitis (RE) and non-erosive reflux disease (NERD) and assess the impact on the disease. MATERIALS AND METHODS: The study included 71 patients rith gastroesophageal reflux disease (GERD), including 29 patients with ER, 42--NERD. Diagnosis was based on anamnesis, clinical research, fibrogastrocopy, pH-metry. Tested with a scale situational and personal anxiety Spielberg Hanina, diagnostic techniques and forms of aggression indicators A. Bass and A. Dark, the Toronto aleksitimicheskoy scale method for investigating the level of subjective control, clinical questionnaire for the identification and evaluation of neurotic states, personality questionnaire Bekhterevsky Institute, cardiointervalography, orthoklinostatik and cold test, determined the level of serotonin in the blood. RESULTS: Compared with the group of patients suffering from ER patients with NERD determined by the displacement in the direction of internality measure locus of control personality, and patients with ER, in contrast, had lower locus of control personality, a high level of situational anxiety, irritability, anxiety type of attitude to the situation of the disease associated with impaired autonomic software ANS activity. CONCLUSION: Patients with ER are more pronounced changes in cognitive-emotional sphere may have an impact on the course of disease and requiring psychological, medical correction.

[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.

[Anti-Coxsakie B viruses humoral immunity status in patients with pancreatic diseases]. / Sostoianie gumoral'nogo immuniteta k virusam Koksaki B pri zabolevaniiakh podzheludochnoi zhelezy.

Similar titers and incidence of antibodies to group-specific Coxsackie B virus antigen were detected in 137 patients with chronic pancreatitis and 127 patients with insulin-dependent diabetes mellitus (IDDM). Characteristic clinical features of chronic pancreatitis associated with the presence of antibodies to Coxsackie B virus in high titers were detected. HLA Cw2 antigen is significantly more incident in the phenotype of patients with chronic pancreatitis and IDDM and high titers of antibodies to Coxsackie B virus. These data confirm the possible contribution of Coxsackie B virus infection to the development of IDDM and suggest its contribution to development of chronic pancreatitis.

[Clinico-immunological variants of the course of chronic pancreatitis]. / Kliniko-immunologicheskie varianty techeniia khronicheskogo pankreatita.

AIM: To study relationships between clinical course of chronic pancreatitis (CP) and humoral immunity in CP patients. MATERIAL AND METHODS: Humoral immunity to structural and secretory pancreatic components and some phlogogenic factors of humoral and cellular origin as well as distribution of HLA antigens were studied in 115 CP patients. RESULTS: Two variants of CP course were identified: immunologically dependent and immunologically independent. These variants have typical clinical, laboratory, immunological and immunogenetic differences. CONCLUSION: Identification of immunologically dependent variant of CP has both fundamental and practical value as it enables more precise prognosis of the disease clinical course and differential approach to its treatment.

[Immune and nonimmune variants of acute pancreatitis]. / Immunnyi i neimmunnyi varianty ostrogo pankreatita.

The article gives an analysis of humoral immunity to structural and secretory components of the pancreas in acute pancreatitis. Based on the distinctions revealed the authors determined two variants of the disease--the immune and nonimmune variants which is of great significance in diagnostics and treatment of acute pancreatitis, for the administration of immunocorrecting medicines in particular.

[Humoral immunity and antigens of HLA system in acute pancreatitis]. / Sostoianie gumoral'nogo immuniteta i antigeny sistemy HLA pri ostrom pankreatite.

In the authors investigations patients with acute pancreatitis had antibodies to endogenic antigens: to o-DNA--in 58.5%, to d-DNA--in 53.7%, to n-DNA in 51.2%, to trypsin--in 42.7%, to insulin--in 28.1% and to the tissue antigen of the pancreas--in 19.5%. A rise of serum immunoglobulins' and circulating immune complexes' levels were established. Alterations of humoral immunity in connection with high frequency of antigens HLA A1, B8, B18 associated with disregulation among T- and B-links of immune system detected in patients with acute pancreatitis, represent genetic and humoral mechanisms which mediate the development of autoimmune reactions in this disease.

[Humoral immunity and the distribution of HLA antigens in patients with chronic pancreatitis]. / Gumoral'nyi immunitet i raspredelenie antigenov sistemy HLA u bol'nykh khronicheskim pankreatitom.

132 chronic pancreatitis patients were studied for humoral immunity components and HLA antigens distribution. Antibodies to pancreatic tissue, insulin, o-DNA, d-DNA, n-DNA, ds-RNA were recognized in 44.5, 21.8, 41.8, 29.1, 20.9, 19.1% of chronic pancreatitis patients, respectively. Most pronounced immunological shifts occurred in aggravation of the disease. HLA-antigen typing was indicative of more frequent incidence in chronic pancreatitis patients of antigens HLA A1, B8, B27, Cw1 and less frequent occurrence of antigens A2, Cw4. The results evidence nonuniform etiology and pathogenesis of chronic pancreatitis.