Terapevticheskii arkhiv

Clinical and prognostic significance of cardio-renal syndrome in various infectious diseases are discussed. Incidence and prognosis, as well as pathogenesis of cardio-renal syndrome in patients with infectious diseases, admitted to ICU of infectious hospitals, as well as hemorrhagic fever with renal syndrome and in COVID-19 are reviewed.

Background. Metabolomics studies in oncology provide a deeper understanding of the biochemical processes associated with tumor growth and the body's response to treatment. In patients with lymphoma, systemic metabolic changes remain poorly understood despite their high clinical significance.

Aim. To evaluate changes in the metabolomic profile of blood plasma in patients with lymphoma at various stages of polychemotherapy (PCT) and compare them to those of healthy volunteers.

Materials and methods. The study included 18 patients with lymphoma from whom blood was collected before treatment and after the first and third courses of PCT. The control group included 30 healthy volunteers. The analysis was performed by high-performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS) and included measurements of amino acids, tryptophan and arginine derivatives, and acylcarnitines. Statistical processing was performed using analysis of variance and principal component analysis.

Results. Prior to therapy, patients showed characteristic metabolic disorders: activation of the kynurenine pathway of tryptophan metabolism, a decrease in arginine, and an increase in its methylated derivatives, as well as shifts in the amino acid and acylcarnitine profiles. During PCT, partial normalization of these indicators was observed, especially for the serotonin-melatonin cascade and kynurenine metabolites.

Conclusion. Metabolomics analysis revealed characteristic biochemical changes in patients with lymphoma and their changes over time during treatment. The data obtained emphasize the potential of metabolomics as a tool for monitoring treatment effectiveness and patient condition in oncology.

Aim. To evaluate the efficacy and safety of levilimab (LVL) in patients with rheumatoid arthritis (RA) in real clinical practice.

Materials and methods. A retrospective observational study of 144 patients with RA and the need to adjust previously prescribed therapy against the background of an exacerbation of the disease, which took place at the Republican Clinical Hospital in Kazan. All patients included in the study were prescribed LVL (Ilsira). The activity of RA was assessed using Disease Activity Score 28 – DAS28-ESR/CRP indices. The assessment was performed before initiation of LVL therapy and at the end of follow-up.

Results. The analysis included 144 patients with RA (112 – women, 32 – men, average age – 55.1±12.3 years). The patients were divided into 3 groups, depending on the duration of follow-up. The first group (up to 4 weeks) – 33 (22.9%) patients, the second group (4–8 weeks) – 75 (52.1%), the third group (more than 8 weeks) – 36 (25%). The duration of follow-up described in the study did not exceed 12 weeks. The assessment was performed before initiation of LVL therapy and at the end of follow-up. In each of the groups, at the time of completion of the observation, there was a decrease in RA activity according to the DAS28-ESR/CRP indices by 6.1% (p=0.000162), 11.1% (p=0.00001) and 27% (p=0.0001) respectively, according to acute phase indicators – ESR by 39.6% (p=0.0001), 55.4% (p=0.0001) and 44.6% (p=0.000028) respectively, CRP decreased by 65.2% (p=0.000196), 71.5% (p=0.0001) and 58.6% (p=0.000707) respectively. At the end of the follow-up, the number of patients with high RA activity decreased by 65.8% (p=0.000022). Against the background of LVL therapy, the proportion of patients taking CS≥7.5 mg/day decreased by 31.4% (p=0.006). LVL's safety profile was assessed as favorable. The registered AE related to deviations in the reference values of laboratory parameters and corresponded to 1 or 2 degrees of severity according to CTCAE version 5.0. No serious AE were reported.

Conclusion. Levilimab has demonstrated high efficacy and a favorable safety profile for RA therapy.

Dengue fever is the most common zoonotic infection with a transmissible mechanism of virus transmission in tropical and subtropical countries. In the first two decades of the 21st century, a significant increase in dengue fever cases was registered in more than 120 countries worldwide. The article presents a family imported case of dengue fever in a 34-year-old man and a 35-year-old woman who fell ill within 3 days after returning from Thailand (Phuket Island). In both cases, there was an acute onset of the disease with an increase in body temperature to (39–40°С), severe weakness, severe muscle and joint pain, severe headache, and loose stools once or twice. They were treated independently for acute respiratory infections. They sought medical help on the 4th and 5th days of their illness and were admitted to an infectious diseases hospital. The disease was accompanied by the development of posterior cervical and submandibular lymphadenitis, hepatomegaly, an uncommon spotty-papular rash on the skin of the trunk and arms, single point hemorrhages, severe thrombocytopenia and leukopenia. The woman was diagnosed with posterior cervical and submandibular lymphadenitis, and hepatosplenomegaly. On the 6th day of the disease, the woman was radiographically diagnosed with peribronchial edema of the interstitium. On the 7th day of the disease, the man developed a hydrocele on the right. Type 2 dengue virus was detected in blood, urine, and saliva by polymerase chain reaction in both patients. The man was discharged on the 20th day of his illness with asthenovegetative and dyspeptic symptoms that persisted for several weeks. The woman was discharged on the 17th day of her illness with residual asthenovegetative manifestations and secondary thrombocytopenia lasting several years.

The article’s scope is to review the modern approaches to the treatment of acute respiratory viral infections and influenza in adults, including those go higher risk. Both the main mechanisms of action of the drugs and the evidence base of their use in various clinical situations, including the prevention of complications, are discussed. The main prospects for the development of this area are outlined, taking into account the characteristics of pathogens.

The article presents the main stages of studying cryoglobulinemia and the associated clinical symptom complex as a manifestation of cryoglobulinemic vasculitis. Achievements in the study of hepatitis C virus are shown: the etiological role of the hepatitis C virus, pathogenesis, diagnosis. Variants of the course are considered, modern criteria for differential diagnosis, prognosis, choice of tactics and treatment methods are given.