Vol 24, No 4 (2023): Опубликован 29.12.2023

One of the most common infectious and inflammatory diseases faced by primary care professionals is acute tonsillitis. The correct etiological diagnosis of this disease determines the choice of an antibacterial drug and its rational use in a particular patient. During the information campaign, which took place from February to May 2023 in outpatient clinics in Voronezh, a two-stage voluntary anonymous survey of pediatricians and otolaryngologists was conducted. The results of the survey at the initial stage showed the need to increase the level of knowledge of primary care physicians on the rational use of antibacterial drugs in acute tonsillitis. The information campaign conducted in medical organizations included lectures, provision of visual materials to doctors, as well as rapid sets of tests for BGSA for testing in outpatient settings. Repeated questioning showed an increase in the level of knowledge of doctors on a number of issues of rational antibacterial therapy of acute tonsillitis, while understanding the seriousness of the problem of antibiotic resistance in modern conditions.

According to the literature, back pain ranks second in terms of the frequency of requests for medical help. Cytochrome P450 isoenzymes affect the biotransformation of nonsteroidal anti-inflammatory drugs (NSAIDs), which are prescribed for the treatment of pain syndrome. It is clinically important to study the effectiveness of NSAID administration depending on the activity of the 2C9 isoenzyme involved in their metabolism. 86 patients hospitalized with a diagnosis of dorosopathy and chronic pain syndrome were under observation. Pharmacotherapy included the use of NSAIDs in a stepwise therapy regimen (meloxicam 1.5 ml intramuscularly for 5 days, then orally 15 mg/ day) and a muscle relaxant (tolperisone orally 150 mg / day). An assessment of the polymorphism of CYP2C9 isoenzymes showed that among the examined individuals there were 19.8% of "slow" metabolizers.  80.2% of patients retained the activity of cytochrome P 450 enzymes.  Control of the subjective perception of pain using VAS showed a more pronounced reduction in pain syndrome when taking meloxicam for individuals with a gene characteristic of "slow" metabolizers.

Introduction. One of the possible ways to increase the effectiveness of therapy for a number of diseases is to control the pharmacokinetics of the used drugs.

Aim of the study: to test the pharmacokinetics of lisinopril in patients with controlled and uncontrolled arterial hypertension.

Materials and methods. A prospective, open-label, single-stage clinical study examined the pharmacokinetics of lisinopril in patients with controlled and uncontrolled arterial hypertension (AH). Fasting, as well as 2 hours after taking lisinopril, blood was drawn from patients in both groups and its concentration in the serum was analyzed by HPLC-MS/MS.

Results. A total of 183 patients were included in the study, 85 patients, in the controlled hypertension group 98 patients. The values of daytime systolic and diastolic pressure according to 24-hour blood pressure monitoring in the group of patients with uncontrolled hypertension were statistically higher than those of patients in the group with blood pressure control: 141 (134;151) mm Hg. versus 119 (112;124) mm Hg. (p=0.001) and 81 (71;90) mm Hg. versus 64 (60;72) mm Hg.

Only 48.2% of patients with uncontrolled and 45.1% with controlled hypertension had lisinopril concentrations within the therapeutic range. In 28.9% of patients with uncontrolled and in 19.7% of patients with controlled hypertension, the concentration of lisinopril was above the therapeutic range. On the other hand, 6.0% of patients with uncontrolled and 4.2% of patients with controlled hypertension had lisinopril concentrations below the therapeutic range.

Conclusion. Thus, studying the pharmacokinetics of drugs can be a useful tool for monitoring treatment adherence, as well as personalizing and improving the safety of hypertension therapy.

Based on the literature and the results of our own experimental and clinical studies, the ability of metabolic factors, such as cyclic nucleotides, to regulate immunological processes has been established. Using correlation analysis, the unity of immuno-metabolic mechanisms of pathology was established.

It has been established that hyperlipidemia developing in patients with chronic and infectious diseases causes inhibition of the processes of T cell proliferation, perversion of intracellular metabolism with impaired functioning. Correlation analysis showed that the studied indicators of blood antioxidant protection are in inverse interdependence with free radical oxidation products.

Objective. The aim of this research was to study changes in the physical development over time from the moment of diagnosis to 6.5 years after its completion in children with acute lymphoblastic leukemia (ALL).

Materials and Methods. A study of the medical histories of 38 patients with ALL, with an average age of 10.7±3.7 years (23 boys and 16 girls), was conducted. Physical development was assessed using the WHO ANTHROPlus program. Z-scores for height-for-age (HAZ) and body mass index-for-age (BAZ) were evaluated according to the WHO growth standards for children. Group comparisons were conducted using the Mann-Whitney U test. The results were presented as the mean and standard deviation (M±SD), as well as the median and interquartile range (Me [25; 75]).

Results. Before the start of intensive therapy (IT), the mean HAZ value was 0.52±0.96, and the mean BAZ value was 0.49±1.62. At the end of IT, there was a growth delay, with a mean HAZ value of -0.11±1.19 (p=0.018). An increase in body weight was observed, with a mean BAZ value of 1.08±1.35 (without significant significance). In the first two years after the completion of ALL therapy, children tended to have excess body weight and obesity 1.51±1.28 (p<0.001). All children achieved normal growth parameters after completing post-therapy follow-up.

Conclusion. During intensive ALL therapy, growth retardation and an increase in the proportion of children with excess body weight and obesity were observed. After completing specialized therapy, anthropometric indicators normalize, although there is a tendency for an increase in body weight relative to heigh

The article presents modern data on pathogenetic mechanisms of formation and clinical features of respiratory pathology diseases in children with connective tissue dysplasia. The morphofunctional state of the bronchopulmonary system in connective tissue dysplasia is determined by endopulmonary and extrapulmonary factors. The article highlights the influence of thoracophrenic syndrome on the course of diseases of the bronchopulmonary system. The necessity of timely detection by pediatricians of changes in the axial skeleton is emphasized, which will contribute to the rational treatment of respiratory diseases associated with connective tissue dysplasia. Correction of deformities of the axial skeleton in childhood will contribute to the rational therapy and rehabilitation of diseases of the respiratory system associated with connective tissue dysplasia.

Type 2 diabetes mellitus is a frequently diagnosed disease among pathologies of non-infectious origin, the confirmation of which in patients with ulcerative colitis negatively affects the severity of the course, leading to the development of complicated forms. Changes in the number of genus and species composition of the intestinal microflora can contribute to disruption of absorption processes with the active formation of insulin resistance. Target. Assessing the role of intestinal microbiota in the development of type 2 diabetes mellitus in patients with ulcerative colitis. Materials and methods. 16s-rRNA sequencing of the intestinal microbiota was carried out in 80 patients with type 2 diabetes mellitus and ulcerative colitis. An analysis of biochemical blood test parameters (glucose, glycated hemoglobin, lipid spectrum) was carried out. Statistical data processing was carried out using Statistics software. Results. Among the laboratory subjects studied, a significant increase in carbohydrate metabolism parameters was noted compared to the control group. Sequencing of the intestinal microbiota revealed an increase in representatives of bacteria involved in the development of metabolic disorders. Conclusion. The active influence of the intestinal microbiota and its metabolites, involved in the development of type 2 diabetes mellitus in patients with ulcerative colitis, contributes to the failure to achieve target glycemic values, which may be a new diagnostic sign.

Introduction. The treatment of patients with a combined course of bronchial asthma (BA) and gastroesophageal reflux disease (GERD) requires an individualized approach, taking into account clinical manifestations and common pathogenetic factors of the formation of the underlying and concomitant pathology.

Aim. To evaluate the effect of concomitant GERD on the parameters of function of external respiration (FER) in comorbid patients with asthma. To monitor the effectiveness of complex broncholytic therapy in patients with BA combined with GERD, based on spirometry and bodyplethysmography data.

Materials and methods. The study involved 130 patients, group I included 64 patients with a combination of BA and GERD, and group II – 66 patients with BA without concomitant GERD. The study of FER was carried out by methods of spirometry and bodyplethysmography. Broncholytic therapy of BA in group I patients was enhanced with an M-holinoblocker, group II patients received standard BA therapy.

Results. Initially, patients from group I had more pronounced obstructive changes and higher respiratory tract resistance compared with patients from group II. A control study of FER in patients with a combination of BA and GERD, conducted 1 month after the start of treatment, showed a statistically significant increase in indicators compared with initial values.

Conclusion. Enhancement of broncholytic therapy with M-holinoblocker in patients with a combination of BA and GERD showed a statistically significant improvement in bodyplethysmography in a control study, which indicates the expediency of including ipratropium bromide in complex therapy for the comorbid course of these diseases.