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1.
Artigo em Russo | MEDLINE | ID: mdl-34714008

RESUMO

There are no literature data on brainstem arachnoid cysts in humans. OBJECTIVE: To describe the clinical case of brainstem (pontomesencephalic) arachnoid cyst and to analyze classification, pathogenesis, differential diagnosis and treatment of this pathology considering literature data and own experience. MATERIAL AND METHODS: A 29-year-old patient with pontomesencephalic arachnoid cyst is reported. The disease manifested in childhood with a headache aggravated by bending and pushing. Later, syncope, vegetative-visceral paroxysms, mild oculomotor disturbances, transient paresthesia and numbness of the left half of the face occurred. Headaches became significantly more severe and resulted nausea and vomiting. Magnetic resonance imaging (MRI) revealed a two-chambered arachnoid cyst. A smaller chamber was localized in interpeduncular cistern, a larger one - in brainstem. RESULTS AND DISCUSSION: Differential diagnosis included cystic glioma and Virchow-Robin space enlargement. Fenestration of the cyst wall within interpeduncular cistern was performed via right-sided pterional approach. The diagnosis was verified by histological examination. The follow-up period was 14 months. We observed postoperative cyst reduction confirmed by MR data and regression of all symptoms except for minimal signs of medial longitudinal fasciculus dysfunction. CONCLUSION: Correct surgical approach for brainstem arachnoid cyst complicated by progressive neurological deterioration is confirmed by postoperative regression of cyst and symptoms.


Assuntos
Cistos Aracnóideos , Adulto , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/cirurgia , Diagnóstico Diferencial , Humanos , Hipestesia , Imageamento por Ressonância Magnética
2.
Environ Geochem Health ; 43(12): 5099-5118, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34117609

RESUMO

The effect of pollution of Albicluvisols/Retisols, Calcaric Leptosols, Luvic Phaeozems, Greyzamic Phaeozems and Folic Fluvisols with oil (Solovatovsky oil field, Perm region) added in amounts of 1, 2, 3 and 5 g oil/kg of soil on the organisms was studied in a model laboratory experiment. Oil addition showed phytotoxic effects on root length in Triticum aestivum L., Lepidium sativum L., Picea obovata Ledeb. and Pinus sylvestris L. in all soils. However, oil contamination of Calcaric Leptosols and Greyzamic Phaeozems led to growth stimulation in Picea obovata seedlings. A remarkable shift in the diversity and number of colony-forming units of heterotrophic and oil-oxidizing bacteria was detected in all soil types. The maximum decrease in biodiversity (45%) was noted for heterotrophic bacteria in Luvic Phaeozems. Aqueous extracts from all oil-contaminated soils had a toxic effect on Chlorella vulgaris Beijer, causing an increase in biomass by more than 30%, but did not show acute toxicity on Daphnia magna Straus. Oil addition in the range of 1-3 g oil/kg soil posed no environmental risk to human health. However, oil addition at 5 g oil/kg of soil led to an increase in the level of carcinogenic risk to children to the threshold values of acceptable risk and ranged from 0.95 × 10-4 for Greyzamic Phaeozems and Folic Fluvisols to 1.098 × 10-4 for Luvic Phaeozems. Our results suggest that the reaction of test organisms to oil pollution depends on the soil type, and their complex application makes it possible to identify the most sensitive factor and assess the dangerous level of pollution.

3.
Artigo em Russo | MEDLINE | ID: mdl-33580757

RESUMO

OBJECTIVE: Systematization of data on the incidence and risk of sleep disorders in patients with functional dyspepsia (FD). MATERIAL AND METHODS: Studies were searched in the electronic databases MEDLINE/PubMed, EMBASE, Cochrane until October 2020. Publications with detailed descriptive statistics (sample size, number of patients with sleep disorders) were selected for the final analysis, allowing the resulting data to be included in the meta-analysis. RESULTS: The final analysis included 10 studies with 7739 people (2354 patients with FD, 5385 controls). The generalized incidence of sleep disturbances in patients with FD was 53.23% (95% CI: 37.738-68.419). There was significant heterogeneity between the results (p<0.0001; I2=98.05%). An association was found between FD and sleep disorders (OR 2.884; 95% CI 2.518-3.304; I2=28.35%) compared with controls. In patients with epigastric pain syndrome (EPS), the generalized incidence of sleep disorders was 40.6% (95% CI 34.267-47.181; I2=0%), with postprandial distress syndrome (PDS) - 51.82% (95% CI 26.479-76.666; I2=94.76%), and at the intersection of EPS and PDS - 51.67% (95% CI 23.497-79.270; I2=95.34%). CONCLUSION: The meta-analysis has demonstrated that sleep disorders are often associated with FD and are observed in about every second patient with this functional gastrointestinal disease. Further research is needed to investigate possible causal relationships between sleep disorders and FD.


Assuntos
Dispepsia , Transtornos do Sono-Vigília , Dor Abdominal , Dispepsia/epidemiologia , Humanos , Período Pós-Prandial , Prevalência , Transtornos do Sono-Vigília/epidemiologia
4.
Ter Arkh ; 92(8): 4-11, 2020 Sep 03.
Artigo em Russo | MEDLINE | ID: mdl-33346454

RESUMO

The novel coronavirus infection COVID-19 in most cases manifests with respiratory symptoms and fever, however, some patients may have cardiovascular and gastroenterological manifestations. A feature of the clinical syndrome of COVID-19 is the development of pronounced immunopathological reactions and disorders of hemostasis, leading to the development of a wide range of cardiovascular complications. The course of COVID-19 may be complicated by the development of acute myocardial infarction, venous and arterial thrombosis and thromboembolism in various vascular pools, the development of acute myocardial damage and myocarditis. Among the gastroenterological manifestations, diarrhea, nausea or vomiting, as well as abdominal pain, are most often detected. These symptoms may precede the appearance of respiratory signs of the disease, and in some cases come to the fore in the clinical picture of the disease. In addition, in some patients there are laboratory signs of liver injury (increased serum transaminases). The exact pathogenesis of the above disorders continues to be studied.


Assuntos
COVID-19 , Infecções por Coronavirus , Trombose , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Diarreia , Humanos , SARS-CoV-2
5.
Ter Arkh ; 92(8): 24-28, 2020 Sep 03.
Artigo em Russo | MEDLINE | ID: mdl-33346458

RESUMO

AIM: Determine the primary antibiotic resistance of Helicobacter pylori (H. pylori) strains isolated from patients living in the European part of the Russian Federation. MATERIALS AND METHODS: As part of a clinical laboratory study, from 2015 to 2018, 27 gastrobiopsy samples obtained from H. pylori-infected patients were analyzed. H. pylori infection was verified using a rapid urease test or a 13C-urea breath test. The values of the minimum inhibitory concentration (MIC) of antibiotics were determined by the diffusion method using E-test strips (BioMerieux, France) according to the recommendations of the manufacturer. The sensitivity of the isolates was determined for 6 antibacterial drugs (amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, rifampicin). RESULTS: According to the data obtained, resistance to amoxicillin was 0%, clarithromycin 11.1%, metronidazole 59.3%, levofloxacin 3.7%, tetracycline 0%, and rifampicin 14.8%. Dual resistance to clarithromycin and metronidazole was recorded in two isolates (7.4%). CONCLUSION: Thus, the first results of the evaluation of H. pylori antibiotic resistance in the European part of the Russian Federation indicate a low resistance of the microorganism to clarithromycin and quite high to metronidazole.


Assuntos
Infecções por Helicobacter , Helicobacter pylori , Amoxicilina , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Claritromicina/farmacologia , Farmacorresistência Bacteriana , Resistência Microbiana a Medicamentos , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Humanos , Levofloxacino , Testes de Sensibilidade Microbiana , Federação Russa
6.
Artigo em Russo | MEDLINE | ID: mdl-32759926

RESUMO

Modern achievements in endoscopic technologies ensure extending the indications for endoscopic transnasal approach in skull base surgery. Knowledge on topographic anatomy of craniovertebral junction is a prerequisite for surgical interventions in this area. Transnasal endoscopic surgery of craniovertebral junction is a relatively new field. Therefore, this manuscript and similar anatomical studies are extremely important for neurosurgeons.


Assuntos
Endoscopia , Procedimentos Neurocirúrgicos
7.
Artigo em Russo | MEDLINE | ID: mdl-32649815

RESUMO

RATIONALE: When removing the meningiomas of the sellar region, there is always a risk of visual impairment for various reasons, in particular, as a result of traction damage to the optic nerve. Decompression of the optic canal increases nerve mobility during tumor manipulation. In cases of meningioma growing into the canal, its decompression often seems necessary. AIM: Evaluation of the effectiveness and risks of performing decompression of the optic canal. MATERIALS AND METHODS: The study included patients with meningiomas of the parasellar location, who underwent surgical treatment at the Burdenko Neurosurgical Center for the period from 2001 to 2017. They were divided into two groups - main and control. The main group consisted of 129 patients who underwent decompression of the optic nerve canals when the tumor was removed. The tumor matrix in this group was most often located in the region of the tuberum sellae, supradiaphragmally, in the region of the anterior clinoid process and the optic canal. In 31 cases, decompression was bilateral - during one operation and using one access in 27 patients; in 4 cases, the decompression of the second canal was delayed for 1.5-3 months after the first operation. 160 decompressions were performed by the intradural and 7 - by extradural methods. During intradural decompression, the roof of the optic canal was resected, and during extradural decompression, the lateral wall of the canal was trephined. The control group consisted of 308 patients who did not undergo canal decompression when the tumor was removed. It included meningiomas with a predominant location of the matrix in the area of the tuberclum and diaphragm of the sella. Tumors in both groups were removed according to the same principles (matrix coagulation, mainly the gradual removal of the tumor, the use of ultrasonic aspirator, a situational decision on the radicality of the operation, etc.). The main difference between operations in these two groups was only canal related algorithms (with or without its trepanation), as well as the probable prevalence of significant lateral tumor growth in cases with canal trepanation. Visual functions in the «primary¼ group were evaluated before and after operations with trepanation of the canal depending on various factors - the initial state of vision and the radicality of the tumor excision, including removal from the canal. The differences in the postoperative dynamics of vision in the main and control groups were studied. The primary data processing was carried out using the program MSExcel. Secondary statistical processing was carried out using the program Statistica. To assess the statistical significance of differences in the results obtained in the compared patient groups, the Chi-square test was used, and in the case of small groups - the exact Fisher test was applied. RESULTS: In the main group postoperative vision improvement of varying degrees on the side of trepanation was registered in 36.9% (59 out of 160) cases, no vision changes were found in 36.9% (59 out of 160), and in 26,2% (42 out of 160) the eyesight deteriorated. If preserving vision is attributed to a satisfactory result, then in general the results of these operations should be considered good. A comparative study of the results of removal of meningiomas with trepanation of the canals (main group) or without it (control group) was carried out among patients with the most critical vision situation (visual acuity 0.1 and below, up to only light perception). These groups are comparable in the number of observations - 62 and 73 respectively. The predominance of cases with improved vision in the main group compared with the control group (50.0% versus 38.36%) and a lower incidence of vision impairment (22.58% versus 34.25%) were found. However, the revealed differences are statistically unreliable and make it possible for us to talk only about the trend. The complications associated with trepanation of the canal include mechanical damage to the nerve by the drill. In our series of observations, there was only 1 case of abrasion of the nerve surface with the burr, which did not lead to a significant visual impairment. With the intradural method of trepanation in the area of the medial wall of the canal, the sphenoid sinus may open (in our series, in 34 cases out of 160 trepanations). Immediately closure of these defects was performed by various auto- and allomaterials in various combinations (pericranium, fascia, muscle fragment, hemostatic materials, and fibrin-thrombin glue). A true complication - CSF rhinorrhea liquorrhea developed in only one case, which required transnasal plastic surgery of the CSF fistula using a mucoperiostal flap. CONCLUSIONS: 1. Trepanation of the optic canal in cases of meningiomas of parasellar localization is a relatively safe procedure in the hands of a trained neurosurgeon and does not worsen the results of operations compared with the excision of the same tumors without trepanation of the canal. 2. The literature data and the results of our study make it possible to consider the decompression of the optic canal as an optional, but in many cases, useful option that facilitates the transcranial removal of some meningiomas of the sellar region.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Descompressão Cirúrgica , Humanos , Procedimentos Neurocirúrgicos , Nervo Óptico/diagnóstico por imagem , Estudos Retrospectivos , Base do Crânio/cirurgia , Osso Esfenoide/cirurgia , Resultado do Tratamento
8.
Ter Arkh ; 92(1): 30-35, 2020 Jan 15.
Artigo em Russo | MEDLINE | ID: mdl-32598660

RESUMO

AIM: The goal is to evaluate the effectiveness of pancreatic enzyme replacement therapy (PERT) using microencapsulated pancreatin preparations for the correction of nutritional status in patients with chronic pancreatitis (CP) and associated exocrine pancreatic insufficiency (EPI). MATERIALS AND METHODS: The study included 58 patients with CP who were divided into two groups depending on the results of a laboratory assessment of indicators of nutritional status: group I (n=30) consisted of patients with CP and signs of EPI (according to low elastase test values) without deviations in nutritional status; Group II (n=28) consisted of patients with CP with a EPI and an abnormal nutritional status. In both groups, patients during the entire observation period (8-12 months) received PERT using microencapsulated pancreatin preparations at a dose adjusted for the severity of permanent residence permit. Before and after the PERT course, the dynamics of anthropometric [body weight, body mass index (BMI)] and laboratory indicators of nutritional status (total protein, albumin, vitamins D and B12, transferrin, iron and magnesium) were evaluated. RESULTS: After the completion of PERT, a significant tendency towards an increase in BMI in patients was noted in both groups. In group I, this indicator increased from 21.45 [95% confidence interval (CI) 19.80-23.92] kg/m2 to 22.15 (95% CI 20.31-23.86) kg/m2, and in II group - from 19.22 (95% CI 18.33-21.99) kg/m2 to 22.0 (95% CI 19.97-24.08) kg/m2. At the same time, the duration of PERT (months) significantly correlated with the dynamics of the patient's body weight (r=0.4679; 95% CI 0.2384-0.6479, p=0.0002). When assessing laboratory markers of nutritional status after PERT, a general tendency was found to increase the levels of total protein, albumin, vitamin D, magnesium, transferrin, and iron in both groups, however, statistically significant differences in the dynamics were observed mainly in group II patients. So, the level of total protein in group II increased from 69.05 (95% CI 65.6717-70.9000) g/l to 72.8 (95% CI 71.1358-74.9000) g/l, vitamin D - from 10.6 (95% CI 32.8397-38.9603) ng/ml to 17.1 (95% CI 12.0166-23.6232) ng/ml, magnesium - from 0.72 ( 95% CI 0.6892-0.7825) mmol/L to 0.795 (95% CI 0.7692-0.8800) mmol/L, and transferrin from 2.91 (95% CI 2.1800-3.3656 ) g/l to 2.92 (95% CI 2.4000-3.5200) g/l. CONCLUSION: A prospective observational study demonstrated the effectiveness of PERT using microencapsulated pancreatin preparations in the correction of nutritional status in patients with CP.


Assuntos
Insuficiência Pancreática Exócrina/tratamento farmacológico , Pancreatite Crônica/tratamento farmacológico , Terapia de Reposição de Enzimas , Humanos , Estado Nutricional , Pancreatina/uso terapêutico
9.
Ter Arkh ; 92(2): 24-28, 2020 Apr 27.
Artigo em Russo | MEDLINE | ID: mdl-32598714

RESUMO

AIM: Assessment of the diagnostic accuracy of predictive indexes of liver fibrosis for the identification of severe fibrosis and cirrhosis (F3F4) in patients with chronic hepatitis C (CHC). MATERIALS AND METHODS: The retrospective design study included 127 patients with chronic hepatitis C (mean age 44.511.1 years). To assess the degree of liver fibrosis, all patients underwent transient elastography using a Fibroscan (EchoSens, France) and predictive indexes of liver fibrosis were calculated (APRI, FIB-4, discriminant Bonacini score). Transient elastography was considered as a reference method for assessing the degree of liver fibrosis for subsequent comparison of results with predictive fibrosis indixes. RESULTS: The sensitivity of the APRI index for the identification of severe fibrosis and cirrhosis of the liver (F3F4) was 79%, and specificity was 69%. The FIB-4 index showed greater specificity (86%), but less sensitivity (68%). The sensitivity of the discriminant Bonacini scale was 81%, and the specificity was 77%. The positive predictive value of the APRI index, FIB-4 and the Bonacini scale for the identification of severe fibrosis and cirrhosis of the liver (F3F4) in patients with chronic hepatitis C was 66; 78 and 72% respectively, and negative predictive value 82; 78 and 84% respectively. CONCLUSION: The results of this study indicate the relatively high diagnostic accuracy of a number of predictive indexes for evaluating liver fibrosis (APRI, FIB-4, discriminant Bonachini scale) in identifying severe fibrosis and cirrhosis of the liver (F3F4) in patients with chronic hepatitis C.


Assuntos
Hepatite B Crônica , Hepatite C Crônica , Adulto , Aspartato Aminotransferases , Biomarcadores , Biópsia , Humanos , Fígado , Cirrose Hepática , Contagem de Plaquetas , Curva ROC , Estudos Retrospectivos
10.
Artigo em Russo | MEDLINE | ID: mdl-32207743

RESUMO

Brain metastases of various types of cancer are diagnosed in 8-10% of all cancer patients. In the world literature, only 30 cases of cancer metastasis to the pituitary adenoma are described. This article presents yet another observation of a patient with breast cancer metastasis into the hormone-inactive pituitary adenoma at the Burdenko neurosurgical center, Russia The patient underwent endoscopic endonasal transsphenoid removal of the neoplasm. During microscopy and immunohistochemical studies of the biopsy, two types of tissue (pituitary adenoma and cancer metastasis) with different Ki-67 treated surgically (1% and over 40%) were found.


Assuntos
Adenoma/cirurgia , Neoplasias da Mama , Neoplasias Hipofisárias/cirurgia , Humanos , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Federação Russa
11.
Ter Arkh ; 92(12): 43-47, 2020 Dec 15.
Artigo em Russo | MEDLINE | ID: mdl-33720572

RESUMO

AIM: Systematization of data on the prevalence of sarcopenia in patients with chronic pancreatitis (CP). MATERIALS AND METHODS: MEDLINE/PubMed, EMBASE, Cochrane, the Russian Science Citation Index (RSCI) through June 2020 were searched to identify studies evaluating the prevalence of sarcopenia in CP. Additionally, a search for relevant abstracts was carried out in the electronic databases of the conferences of the European Pancreatic Club (EPC), the International Association of Pancreatology (IAP) and the European Congress of Radiology (ECR). For the final analysis, publications were selected that used validated muscle mass assessment tests with detailed descriptive statistics to enable the resulting data to be included in the meta-analysis. RESULTS: The final analysis included 7 studies involving 604 patients with CP. The pooled prevalence of sarcopenia in patients with CP was 42.09% (95% confidence interval CI 27.84557.055). There was significant heterogeneity between the results (p0.0001; I2=90.81%). When studies with a total sample of less than 50 patients were excluded from the meta-analysis, the overall prevalence of sarcopenia in patients with CP was 22.24% (95% CI 15.47529.847). CONCLUSION: The present meta-analysis demonstrated that sarcopenia is a common complication of CP and is observed in about 2 out of 5 patients with this inflammatory disease of the pancreas. Given the high incidence of adverse outcomes associated with sarcopenia, it is necessary to promptly diagnose this pathological condition in patients with CP.


Assuntos
Pancreatite Crônica , Sarcopenia , Humanos , Pancreatite Crônica/complicações , Pancreatite Crônica/epidemiologia , Prevalência , Federação Russa , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia , Sarcopenia/etiologia
12.
Ter Arkh ; 92(12): 53-58, 2020 Dec 15.
Artigo em Russo | MEDLINE | ID: mdl-33720574

RESUMO

AIM: Systematization of data on the frequency of detection of the syndrome of bacterial overgrowth in the small intestine (SIBO) in patients with functional dyspepsia (FD). MATERIALS AND METHODS: MEDLINE/PubMed, EMBASE, Cochrane, Google Scholar, the Russian Science Citation Index (RSCI) through July 2020 were searched to identify studies evaluating the prevalence of SIBO in FD. In addition, a search for relevant abstracts was carried out in the electronic databases of the United European Gastroenterology Week (UEG), American College of Gastroenterology (ACG), International Conference on Nutrition and Food (ICNF). For the final analysis, publications were selected that used validated tests for the assessment of SIBO (hydrogen breath test using glucose or lactulose) with detailed descriptive statistics, allowing the resulting data to be included in the meta-analysis. RESULTS: The final analysis included 7 studies with 1248 patients with FD. Overall pooled prevalence of SIBO in patients with FD was 34.73% (95% CI 24.80745.383). There was significant heterogeneity between the results (p0.0001; I2=89.91%). When excluded from the meta-analysis of a study in which the incidence of SIBO was studied in patients with refractory FD, the pooled prevalence was 38.98% (95% CI 28.96449.490). CONCLUSION: This meta-analysis has demonstrated that SIBO is often associated with FD and is observed in about every third patient with this functional gastrointestinal tract disease.


Assuntos
Infecções Bacterianas , Dispepsia , Síndrome do Intestino Irritável , Testes Respiratórios , Dispepsia/diagnóstico , Dispepsia/epidemiologia , Humanos , Lactulose , Prevalência , Federação Russa
13.
Ter Arkh ; 92(12): 97-104, 2020 Dec 15.
Artigo em Russo | MEDLINE | ID: mdl-33720581

RESUMO

Rebamipide is a cytoprotective drug that has been used in practical gastroenterology for 30 years. This article summarizes the main results of the most relevant clinical studies of rebamipide in diseases of various parts of the gastrointestinal tract, including the esophagus, stomach, small and large intestine.


Assuntos
Gastroenterologia , Infecções por Helicobacter , Helicobacter pylori , Quinolonas , Alanina/análogos & derivados , Humanos
14.
Ter Arkh ; 92(12): 105-119, 2020 Dec 15.
Artigo em Russo | MEDLINE | ID: mdl-33720582

RESUMO

This manuscript summarizes consensus reached by the International Anorectal Physiology Working Group (IAPWG) for the performance, terminology used, and interpretation of anorectal function testing including anorectal manometry (focused on high-resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed. Aim to provide information about methods of diagnosis and new classification of functional anorectal disorders to a wide range of specialists general practitioners, therapists, gastroenterologists, coloproctologists all who face the manifestations of these diseases in everyday practice and determine the diagnostic and therapeutic algorithm. Current paper provides agreed statements of IAPWG Consensus and comments (in italics) of Russian experts on real-world practice, mainly on methodology of examination. These comments in no way intended to detract from the provisions agreed by the international group of experts. We hope that these comments will help to improve the quality of examination based on the systematization of local experience with the use of the methods discussed and the results obtained. Key recommendations: the International Anorectal Physiology Working Group protocol for the performance of anorectal function testing recommends a standardized sequence of maneuvers to test rectoanal reflexes, anal tone and contractility, rectoanal coordination, and rectal sensation. Major findings not seen in healthy controls defined by the classification are as follows: rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity, and hypersensitivity. Minor and inconclusive findings that can be present in health and require additional information prior to diagnosis include anal hypertension and dyssynergia.


Assuntos
Canal Anal , Reto , Consenso , Humanos , Manometria , Federação Russa
15.
Ter Arkh ; 92(11): 24-30, 2020 Dec 26.
Artigo em Russo | MEDLINE | ID: mdl-33720600

RESUMO

AIM: Systematization of data on antibiotic resistance of Helicobacter pylori in Russia over the past 10 years. METHODS: A search for studies were carried out in electronic databases MEDLINE/PubMed, EMBASE, Cochrane, Russian Science Citation Index. We analyzed the papers published over the past 10 years (2011 to 2020). In the final analysis, publications were selected from periodical peer-reviewed foreign and Russian publications, in which validated tests for assessing the microorganism resistance were used with detailed descriptive statistics, which allows the obtained data to be included in the meta-analysis. RESULTS: The final analysis included 11 studies (808 isolates). H. pylori resistance to clarithromycin was 10.39% (95% confidence interval CI 7.10314.219), metronidazole 33.95% (95% CI 15.32955.639), amoxicillin 1.35% (95% CI 0.281 3.202), levofloxacin 20.0% (95% CI 12.63728.574), tetracycline 0.98% (95% CI 0.3532.163). Double clarithromycin-metronidazole resistance was reported in 2.7% (95% CI 1.1364.345). CONCLUSION: This meta-analysis is the first analytical work that allows objectifying the current structure of H. pylori antibiotic resistance in the Russian Federation. The data obtained in the analysis of publications over the past 10 years indicate a low resistance of the microorganism to clarithromycin (less than the regulated threshold of 15%), which allows us to consider the triple regimen of eradication therapy as a first-line therapy in our country.


Assuntos
Infecções por Helicobacter , Helicobacter pylori , Amoxicilina/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Farmacorresistência Bacteriana , Quimioterapia Combinada , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Humanos , Levofloxacino/uso terapêutico , Testes de Sensibilidade Microbiana , Federação Russa/epidemiologia
16.
Ter Arkh ; 91(8): 4-11, 2019 Aug 15.
Artigo em Russo | MEDLINE | ID: mdl-32598747

RESUMO

Gastroesophageal reflux disease (GERD) is characterized by high morbidity and a significant decrease in the quality of life of patients, and is a major risk factor for esophageal adenocarcinoma. Nowadays, antisecretory therapy with proton pump inhibitors (PPI) is the "gold standard" of conservative treatment of GERD, but in some cases this therapy is unsuccessful. According to various studies, the prevalence of refractory GERD can reach 30-40%. The latest scientific data in the field of genetics and pathophysiology of GERD demonstrate that a disruption of the barrier function of the esophageal mucosa and an increase of its permeability can be the leading causes of refractoriness. Thus, the optimal therapy for patients with GERD should not only suppress the secretion of hydrochloric acid, but also restore the barrier function of the mucous membrane, providing an esophagoprotective effect. To achieve these goals, Alfasoxx was developed, which consists of a mixture of low molecular weight hyaluronic acid and low molecular weight chondroitin sulfate dissolved in a bioadhesive carrier (poloxamer 407). The clinical efficacy of this product has been confirmed by three prospective, randomized, placebo - controlled trials. Alfasoxx has a healing and restorative effect towards the esophageal epithelium and due to high ability for bioadhesion provides long - term protection of the mucous membrane of the esophagus. Combination therapy for GERD with the use of PPI and an esophagoprotector offers new perspectives for the treatment of patients with GERD.


Assuntos
Refluxo Gastroesofágico , Inibidores da Bomba de Prótons , Qualidade de Vida , Refluxo Gastroesofágico/tratamento farmacológico , Humanos , Estudos Prospectivos , Inibidores da Bomba de Prótons/uso terapêutico
17.
Ter Arkh ; 91(8): 28-33, 2019 Aug 15.
Artigo em Russo | MEDLINE | ID: mdl-32598751

RESUMO

AIM: Evaluation of the efficacy and safety of quadrupletherapy without bismuth (concomitant therapy) in patients with Helicobacter pylori - associated gastric ulcer and duodenal ulcer in the framework of a comparative research in the population of patients in Russia. MATERIALS AND METHODS: A prospective randomized trial was conducted, which included 210 patients with H. pylori - associated gastric/duodenal ulcer without complications. During the process of randomization, the patients were divided into three equal groups (n=70) depending on the prescribed 10-day scheme of eradication therapy (ET): the first group received the classic triple scheme (Omeprazole 20 mg 2 times a day, Amoxicillin 1000 mg 2 times a day and Clarithromycin 500 mg 2 times a day); the second group received quadruple therapy with bismuth drugs (Omeprazole 20 mg 2 times a day, Tetracycline 500 mg 4 times a day, Metronidazole 500 mg 3 times a day, Bismuth subcitrate potassium 120 mg 4 times a day); the third group received quadruple therapy without bismuth - concomitant therapy (Omeprazole 20 mg 2 times a day, Amoxicillin 1000 mg 2 times a day, Clarithromycin 500 mg 2 times a day and Metronidazole 500 mg 2 times a day). Diagnostics of H. pylori infection during screening and control of eradication was carried out via the fast urease biopsy sample test and urea breath test system. Control of the effectiveness of ET of the microorganism was carried out not earlier than 4 weeks after the end of the treatment. During the course of therapy, the frequency of development of side effects was assessed using a special questionnaire. RESULTS AND DISCUSSION: The effectiveness of triple therapy was 72.8% (ITT; 95% CI of 62.17-83.54) and 78,4% (PP; 95% CI 68.19-88.72); quadruple therapy with the preparation of bismuth - 80.0% (ITT; 95% CI 70.39-89.6) and 84,8% (PP; 95% CI, 75.96-93.73); quadruple therapy without bismuth - concomitant therapy - 84.2% (ITT; 95% CI 75.54-93.02) and 92.1% (PP; 95% CI 85.43-98.94). Quadruple therapy without bismuth was reliably more effective than the classical triple therapy in the PP selection (p=0.044883). Statistical analysis showed a tendency to poorer effectiveness of ET in patients who had previously used antibiotic therapy (OR 0.4317; 95% CI 0.1776-1.049), and in individuals with a rapid metabolism genotype - CYP2C19*1/*1 (OR 0.12; 95% CI 0.005848-2.4624). The frequency of development of side effects during the use of triple therapy was 18.5% (95% CI of 9.23-27.91), when using quadruple therapy with bismuth - 20.0% (95% CI 10.39-29.6), and with the use of quadruple therapy without bismuth - concomitant therapy - 24.2% (95% CI 13.98-34.58). CONCLUSION: This prospective randomized study demonstrated the high efficiency of quadruple therapy without bismuth (concomitant therapy) in the framework of eradication of H. pylori infection in Russia.


Assuntos
Amoxicilina , Bismuto , Úlcera Duodenal , Infecções por Helicobacter , Helicobacter pylori , Úlcera Gástrica , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Bismuto/uso terapêutico , Quimioterapia Combinada , Infecções por Helicobacter/complicações , Infecções por Helicobacter/tratamento farmacológico , Humanos , Estudos Prospectivos , Federação Russa , Úlcera Gástrica/tratamento farmacológico
18.
Ter Arkh ; 91(8): 34-40, 2019 Aug 15.
Artigo em Russo | MEDLINE | ID: mdl-32598752

RESUMO

AIM: To evaluate an association of genetic polymorphisms CYP2C19, MDR1, and IL-1ß on the eradication rate by 10-day modified therapy in patients with H. pylori - associated diseases. MATERIALS AND METHODS: In this study was conducted a prospective, randomized trial, included 89 patients with H. pylori - associated diseases. They were divided into 2 groups depending on therapy: clarithromycin 500 mg, b.i.d., amoxicillin 1000 mg, b.i.d., bismuth subcitrate 240 mg, b.i.d. rabeprazole 20 mg or 40 mg, b.i.d. for 10 days. All subjects underwent pharmacogenetic testing of CYP2C19, MDR1, and IL-1ß. RESULTS AND DISCUSSION: Per - protocol (PP) eradication rates in group with rabeprazole 40 mg were 97.6% (41/42; 95% CI 87.7-99.6), in group with rabeprazole 20 mg were 82.1% (32/39; 95% CI 67.3-91.0). Intention - to - treat analysis in group with rabeprazole 40 mg eradication rates were 89.1% (41/46; 95% CI 77.0-95.3), in group with standard dose rabeprazole - 74.4% (32/43; 95% CI 59.8-85.1). No significant differences in eradication rates between the groups of ultrarapid, rapid, normal and intermediate CYP2C19 metabolizers (PP: 93.5%/90.3%/84.6% respectively; χ2=0.87, p=0.65). Eradication rates in group with IL-1ß CC genotype there was no difference among the IL-1ß CT and TT genotype groups (PP: 92.9%/85.7%/94.7% respectively; χ2=1.34; p=0.51). The cure rate among MDR1 TT genotype was significantly lower than among subjects in the MDR1 CC/CT genotype groups (PP: 76.2% vs 96.3%: χ2=5.04; p=0.025; OR=8.13). CONCLUSION: Ten - day modified triple therapy with high dose rabeprazole significantly high eradication rates in patients with H. pylori - associated diseases. Independent factor for treatment failure is MDR1 CC/CT genotype status.


Assuntos
Hidrocarboneto de Aril Hidroxilases , Citocromo P-450 CYP2C19 , Infecções por Helicobacter , Helicobacter pylori , Polimorfismo Genético , Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Amoxicilina/uso terapêutico , Antibacterianos , Claritromicina/uso terapêutico , Citocromo P-450 CYP2C19/genética , Quimioterapia Combinada , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/genética , Humanos , Estudos Prospectivos , Inibidores da Bomba de Prótons/uso terapêutico
19.
Ter Arkh ; 91(8): 118-126, 2019 Aug 15.
Artigo em Russo | MEDLINE | ID: mdl-32598763

RESUMO

In the article the problem of the combined use of clopidogrel and various proton pump inhibitors (PPIs) in terms of cardiovascular complications risk and stent thrombosis is considered. The results of meta - analyses and a systematic reviews affecting this issue are represented in detail. The inter - drug interactions mechanisms of various PPIs with clopidogrel based on the characteristics of the metabolism in the liver cytochromes system are discussed. The authors conducted a search, systematization and analysis of studies regarding the association between cardiovascular risk and combined use of individual medications from PPI class with clopidogrel, and these results are presented in the review. Currently available data do not allow to answer the question about the differences between individual PPIs in their impact on the risk of adverse cardiovascular events due to the small number of such studies, design heterogeneity, differences in the inclusion criteria and end points as well as in the rate of administration of individual PPIs.


Assuntos
Doenças Cardiovasculares , Clopidogrel , Interações Medicamentosas , Inibidores da Agregação Plaquetária , Inibidores da Bomba de Prótons , Doenças Cardiovasculares/induzido quimicamente , Clopidogrel/efeitos adversos , Quimioterapia Combinada , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Inibidores da Bomba de Prótons/efeitos adversos , Ticlopidina , Resultado do Tratamento
20.
Artigo em Russo | MEDLINE | ID: mdl-29927421

RESUMO

Until recently, tumors of the clival region and ventral posterior cranial fossa were considered hard-to-reach and often inoperable via standard transcranial approaches. The introduction of minimally invasive methods combined with the endoscopic technique into neurosurgical practice has enabled removal of hard-to-reach tumors, including midline tumors of the ventral posterior cranial fossa. OBJECTIVE: To improve and introduce the extended endoscopic endonasal posterior (transclival) approach into clinical practice and to analyze the results of its application in surgical treatment of midline skull base tumors extending into the ventral posterior cranial fossa. MATERIAL AND METHODS: During the period from 2008 to the present, we have operated 127 patients with various skull base tumors located in the clival region and ventral posterior cranial fossa (60 males and 67 females); the patients' age was 3 to 74 years. The distribution of tumors by histology was as follows: 96 (75.6%) chordomas, 9 (7.1%) pituitary adenomas, 8 (6.3%) meningiomas, 3 (2.33%) cholesteatomas, 2 (1.6%) craniopharyngiomas, 3 (2.33%) fibrotic dysplasia, and 6 (4.7%) other tumors (giant cell tumor, glioma of the neurohypophysis, osteoma, plasmacytoma, carcinoid tumors, chondroma). The tumor size was as follows: 36 (28.35%) giant (more than 60 mm) tumors, 71 (55.9%) large (35-59 mm) tumors, 19 (14.96%) medium (21-35 mm) tumors, and 1 (0.79%) small (less than 20 mm) tumor. Intraoperative monitoring of the cranial nerves was performed (20 cranial nerves were identified) in 10 cases. RESULTS: The extent of chordoma resection was as follows: total removal - 63 (65.62%) cases, subtotal removal - 23 (23.96%) cases, and partial removal - 10 (10.42%) cases. Pituitary adenomas were resected totally in 6 cases, subtotally in 1 case, and partially in 2 cases. Meningioma was removed subtotally in 4 cases, partially in 3 cases, and less than 50% in 1 case. Other tumors (cholesteatoma, craniopharyngioma, fibrous dysplasia, giant cell tumor, glioma of the neurohypophysis, osteoma, plasmacytoma, carcinoid tumors, chondroma) were removed totally in 7 cases and subtotally in 7 cases. Postoperative cerebrospinal fluid leakage occurred in 9 (7.2%) cases, and meningitis developed in 12 (9.4%) cases. Oculomotor disorders occurred in 17 (13.4%) patients; in 10 of these patients, the disorders regressed within 4 to 38 days after surgery; in 7 patients the oculomotor disorders did not regress. A lethal outcome occurred in 2 (1.57%) cases. CONCLUSION: The extended endoscopic endonasal posterior (transclival) approach, being minimally invasive, enables removal of various midline skull base tumors with/without involvement of the clivus with high radicalness, low risk of postoperative complications, and low lethality. Until recently, these tumors were considered almost inoperable.


Assuntos
Cordoma , Fossa Craniana Posterior , Neoplasias da Base do Crânio , Endoscopia , Feminino , Humanos , Masculino , Resultado do Tratamento
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