Vol 20, No 7 (2018)

Active introduction of programs for early diagnosis of prostate cancer, including the implementation of digital rectal examination, determination of prostate-specific antigen and transrectal ultrasound made it possible to identify the disease at an early stage and offer patients radical treatment. Currently, in addition to the standardized cancer diagnostic methods of prostate cancer, patients may be asked a lot of non-invasive diagnostic methods: the definition of the prostate health index, the PCA3 (Prostate Cancer gene 3), carrying out magnetic resonance imaging, various fusion technology, as well as varieties of prostate ultrasound (histoscanning, sonoelastography, etc.). The emergence of new non-invasive imaging techniques has shown considerable potential in diagnosing prostate cancer, choosing a method of treatment, planning the course of the operation and subsequently monitoring patients.

Objective - to evaluate clinical effectiveness of step-down and peroral therapy with levofloxacin in combined therapy for patients with bacterial prostatitis and comorbid gastrointestinal pathology. Study design - a simple open comparative retrospective non-randomized study. Materials and methods. The study included 116 patients with chronic bacterial prostatitis who attended “Andromed” clinic in the period fr om 2014 to 2017 years. For quantitative symptoms evaluation in assessment and for treatment effectiveness evaluation a questionnaire “Chronic prostatitis symptoms index” developed by National Institute of Health, USA was used. Safety was assessed on the basis of fixed adverse events. All patients received levofloxacin for 28 days: patients in step-down therapy group received levofloxacin 500 mg/d intravenously for 10-12 days with subsequent transition to peroral administration of 500 mg/d, Another group received levofloxacin 500 mg/d in peroral therapy for 28 days. Patients in both groups received adjunctive therapy and physiotherapy in accordance with existing guidelines. All study participants were examined a month after antibiotic therapy was finished. Results. According to clinical examination results no significant differences between two groups were found. Levofloxacin course resulted in pathogen eradication in 82% patients in step-down therapy group and in 81% patients in peroral therapy group wh ere patients received levofloxacin for 28 days. In none of the cases significant adverse events were observed in step-down and peroral therapy with levofloxacin. Conclusion. Levofloxacin is effective in patients with chronic bacterial prostatitis. It is reasonable to use step-down therapy in patients with comorbid gastrointestinal pathology.

The role of combined viral infection in the genesis of various cancers, such as breast cancer, cervical cancer, oropharyngeal localization of the tumor process is being actively discussed. The aim of the study was to identify possible morphological, immunohistochemical features of the bladder tumor against the background of a combined viral infection. 100 patients (72 men and 28 women) aged 38 to 90 years (mean age 65±10) with a diagnosis of bladder cancer were examined and treated. In addition, molecular genetic, serological methods for the diagnosis of viral infections (herpes type 1 and 2, cytomegalovirus - CMV, Epstein-Barr virus - EBV, human papillomavirus - HPV of high oncogenic risk), morphological and immunohistochemical studies were performed. The indicators of proliferative activity, factors of angiogenesis, growth factors depending on the degree of anaplasia and the stage of the process are analyzed. Results. The expression of EGFR in patients with the presence of viral DNA in tumor tissue correlated with the presence of HPV in the tumor (R=0.354, p=0.115), p63 (R=0.707, p=0.182), p53 (R=0.499, p=0.025), Ki67 (R=0.747, p=0.05) and also with the level of anti-EBV Ig-VCA (R=0.47, p=0.032). In patients with the presence of EBV in tumor tissue, expression of growth factors correlated with the level of anti-EBV Ig-VCA (R=0.577, p=0.049), the presence of coylocytosis (R=0.368, p=0.24) and intranuclear inclusions (R=0.485, p=0.11) as manifestations of HPV infection. In patients with no viral DNA there is a slight degree of cytopathic changes (2 points: 10.3% vs. 28.6%, p=0.046), whereas in the presence of viral DNA the degree of these changes is higher (3 points: 27.6% vs. 9.5% respectively, p=0.06). The same situation can be observed in the case of the presence of intra-nuclear inclusions (1 point: 10.7% vs. 28.6%, p=0.046; 2-3 points: 17.9% vs 9.5% and 11.9% respectively). High correlation links between proliferative activity and the presence of high oncogenic risk HPV in tumor tissue were obtained (R=0.706, p=0.05), koilocytosis and factors of angiogenesis (R=0.576, p=0.008) and markers of proliferation (R=0.408, p=0.316). Moderate correlations were found between the presence of intracardiac inclusions and the presence of EBV in tumor tissue (R=0.303, p=0.04), coilocytosis (R=0.411, p=0.005), focal hyperplasia (R=0.459, p=0.001), perivascular infiltration (R=0.335, p=0.023). The presence of CMV in tumor tissue was correlated with focal hyperplasia in the form of follicles (R=0.362, p=0.012), coilocytosis (R=0.32, p=0.028), the presence of leukocytes (R=0.439, p=0.012) and eosinophils (R=0.439, p=0.012). Conclusion. The signs of a combined viral infection are to be determined both in patients with the presence and absence of viral DNA in the tumor tissue. Correlation interrelations between morphological, molecular genetic, immunoenzyme indicators of presence of virus co-infection in patients with bladder cancer are determined. Increased proliferative activity, expression of apoptosis factors, growth factors in patients with the presence of viral DNA in tumor tissue indicates an unfavorable course of the tumor process

Multimorbidity (comorbidity) is a presence of two or more co-occurring chronic diseases in one patient that are pathogenically inter-related or simultaneous irrespective of disease activity. According to the World Health Organization analysis, between 2000 and 2050 years the percentage of people older than 60 years will double from 11% to 22%. The proportion of patients with comorbid chronic diseases will also increase. Apart from therapists, specialized doctors also face the problem of multimorbidity nowadays. The article discusses treatment of hyperactive bladder patients from the perspective of comorbidity and understanding of major diseases pathogenesis and pharmacologic agents pharmacokinetics.

Tadalafil is the first long acting phosphodiesterase 5 inhibitor that is used in erectile dysfunction treatment. The effectiveness of its use was shown in treatment of erectile dysfunction of various ethiology and severity. At the same time the medication has other therapeutic effects, therefore its use is recommended in patients with comorbid erectile dysfunction. As it is highly safe, tadalafil is the treatment of choice for many patients with erectile dysfunction.

Итоги обсуждения вопросов лечения гиперактивного мочевого пузыря (ГМП) и определения места препарата мирабегрон в лечении пациентов с ГМП. Председатель: профессор О.Б.Лоран. Участники: профессор М.И.Коган, профессор С.Х.Аль-Шукри, профессор Г.Р.Касян, доктор медицинских наук З.К.Гаджиева, профессор Г.Г.Кривобородов.

Until recently it was considered that urine of healthy people is sterile. However, with the use of new diagnostic methods it was demonstrated that microbiome with many various bacteria species is present in urinary bladder. Potential damage from bacteria in urinary bladder depends not only on their virulence but also on inflammatory response of the body. A protective effect of asymptomatic bacteriuria on urinary tract infections relapses was demonstrated. It was also established that some bacteria in the gut microbiome such as Oxalobacter formigenes protect from calcium oxalate stone formation. A fast increase in uropathogens antibiotic resistance is observed all over the world. The main reason for this is improper and sometimes unreasonable antibiotic use. It appears that instead of combating the pathogens it would be more useful to target the inflammatory body reaction and to preserve the protective bacterial flora. Due to its antiadhesive, antiinflammatory, spasmolytic, and antinociceptive effects the use of three herbs combination - centaury, lovage, and rosmary leaves, CLR (Canephron® N, Bionorica SE, Neumarkt, Germany) in the pilot study demonstrated excellent results in acute uncomplicated cystitis treatment. Also a phase 3 clinical study of CLR and fosfomycin trometamol use comparison has started. Gut microbiome assay in mice showed that even a single dose of fosfomycin as well as nitrofurantoin course result in substantive microbiome changes, whereas phytotherapy with CLR did not show any negative influence