Vol 76, No 6 (2021)

Background. Drug treatment of non-alcoholic fatty and alcoholic liver disease remains an urgent, unsolved problem. Due to the commonality of many pathogenetic mechanisms and predictors of progression, a universal approach to the search for a therapeutic agent can be considered.

Aims — pooled analysis of the results of two multicenter, randomized, double-blind, placebo-controlled studies of a fixed combination of glycyrrhizic acid and essential phospholipids in two dosage forms to study its efficacy and safety in non-alcoholic fatty and alcoholic liver disease, in the presence and absence of predictors of disease progression.

Methods. The pooled analysis included 180 patients with non-alcoholic fatty liver disease (Gepard study) and 120 patients with alcoholic liver disease (Jaguar study). Patients of the main group received a fixed combination of 5.0 g intravenous jet 3 times a week for the first 2 weeks; then — 2 capsules 3 times a day for the next 10 weeks. Patients in the control group received placebo according to the same scheme. The total duration of treatment was 12 weeks in the Gepard study (1 course of stepwise therapy) and 24 weeks in the Jaguar study (2 courses of stepwise therapy). A comparative analysis of the efficacy and safety of a fixed combination and a placebo was carried out, in the presence and absence of predictors of progression, separately for each nosology and in a mixed sample.

Results. In patients with non-alcoholic fatty and alcoholic liver disease who received the fixed combination, in contrast to the placebo group, there was a statistically more significant decrease in the level of biochemical markers of inflammation — alanine aminotransferase, aspartate aminotransferase, adiponectin, and the value of the AktiTest index. There was no negative trend in the NAFLD fibrosis score; more significant positive dynamics of FibroTest is shown. Predictors of disease progression — hyperglycemia, hyperlipidemia, age did not have a negative impact on the results in the study group. The efficacy of the study drug was noted in patients with non-alcoholic fatty liver disease and normal body weight; data were obtained indicating its possible effectiveness with a high activity of the inflammatory process associated with alcoholic liver damage. The frequency of adverse events in the study and control groups was comparable.

Conclusions. Based on a generalized analysis of the results of two studies, promising directions for the study and use of a fixed combination of glycyrrhizic acid and essential phospholipids were identified: non-alcoholic fatty liver disease without obesity, alcoholic steatohepatitis of high activity (as an adjuvant); steatohepatitis of non-alcoholic and alcoholic etiology, combined with hyperglycemia and hyperlipidemia.

Background. Androgenic alopecia (AGA) is the most common form of pathological hair loss with multiple micronutrient disorders involvedin its occurrence and development.

Aim—to evaluatethe effectiveness of personalized treatment of micronutrient deficiencies in patients with early stages of AGA and conservative therapy using a vasodilator drug minoxidil based on evidence-based medicine.

Methods. A total 48 patients with stages I–IV of AGA (according to the Norwood–Hamilton scale) were recruited to experimental prospective clinical study evaluating the effectiveness of pharmaceutical forms of trace elements and vitamins. The primary diagnosis of micronutrient deficiency was carried out by comparing laboratory parameters of patients with AGA and 25 healthy volunteers. After that, conservative treatment with 5% topical minoxidilin AGA patients was enriched with 2-month personalized systemic supplementation of pharmaceutical forms of trace elements and vitamins. At the end of the study, the correspondence between changes in trace elements and vitamins content in the plasma and the trichogram parameters before and after conservative therapy was assessed.

Results. The majority (96%) of the examined patients with AGA were characterized by mono- or polynutrient deficiencies. Personalized correction made it possible to restore the content of Se, Mg, Fe and vitamin E to the baseline levels and to achieve a significant increase in Zn, vitamin D and folic acid plasma content. The relationship between changes in the level of micronutrients and trichogram parameters was recorded only for Se (decrease in anagen hairs: r = –0.43; p = 0.037; decrease in hair density: r = –0.45; p = 0.028) and folic acid (an increase in anagen hairs: r = 0.41; p = 0.024); the positive effect of vitamin E on hair density was also detected.

Conclusion. The results of the study allow to recommend a personalized treatment of folic acid and vitamin E deficiencies, with possible refusal to use the Se-containing drugs in conservative therapy of patients with the early stages of AGA.

Background. Taking into account the special medical and social significance of oncological diseases, as well as taking into account that patients suffering from neoplasms are a special risk group for developing complications of coronavirus infection, it seems relevant to study the impact of the COVID-19 pandemic on the level of morbidity and hospital lethality of patients with neoplasms.

Aims — to study the trends of morbidity and hospital lethality due to neoplasms in the Russian Federation before and during the pandemic of the new coronavirus infection COVID-19.

Methods. The indicators of primary and general morbidity, hospital lethality from neoplasms of the adult population were calculated on the basis of federal statistical observation data contained in reporting forms No. 12 and No. 14 of all subjects of the Russian Federation for 2015–2020.

Results. During the period from 2015 to 2019, an increase in the general (by 14.8%) and primary (by 4.8%) incidence of neoplasms was noted in the Russian Federation. In 2020, compared with 2019, on the contrary, the indicators of general (by 5.0%) and primary (by 17.4%) incidence of neoplasms decreased. Hospital lethality due to neoplasms also increased during 2015–2019, in total it increased by 19.2%, in one year (2020) hospital lethality increased by 6.6%. A similar situation has developed in all federal districts and most regions of the country.

Conclusions. The decline in the incidence of neoplasms in 2020, with their previous continuous growth, reflects the difficult situation that has developed during the pandemic of a new coronavirus infection in the healthcare of the Russian Federation. The increase in hospital lethality from neoplasms indicates a more severe course of coronavirus infection in adult patients with malignant neoplasms and a more frequent development of fatal complications in them.

The transition to personalized, predictive, preventive and participatory medicine, due, among other things, to the achievements of fundamental science, digitalization and the development of information and communication technologies, naturally demanded changes in children’s health care. New organizational, methodological and technological changes that have taken place to ensure a highly dynamic, adapted, and, at the same time, permanent provision of the medical process — anywhere and at any time, have led to the need for specialists of a new formation — a pluriexpert team ready to work in new conditions: how to participate in research in fundamental science, and to the introduction of innovative methods in clinical practice, medical and social support and the educational process. In these conditions, the strategic goal set for pediatrics — to analyze absolutely all aspects of health: somatic, neuropsychic, emotional and psycho-social, in the process of growth and development of a child from conception/birth to adolescence / adulthood — was implemented in a new direction of clinical and fundamental medicine — developmental pediatrics and child health programming. 7P-pediatrics: Programming the development and health of the child, Preventive, Predictive, Personalized, Participatory, Polyprofessional (Pluriexpert), Progressive — medicine for children, in which the results of scientific work based on fundamental data and ideas of neurosciences about progressive development and modern methodology of educational support of the entire medical process are fully translated into a clinical practice.

Background. COVID-19 outbreak resulted in an increased psychological and physical pressure on healthcare professionals worldwide. Doctors treating COVID-19 patients have turned out to be at higher risk of depression, anxiety, psychosomatic disorders. The data about the influence of the pandemic on psychological health of Russian doctors is still missing.

Aims — to evaluate a psychological status of Russian doctors during COVID-19 pandemic.

Methods. This cross-sectional online-study was conducted among 133 doctors of different specialties aged 25–70 (mean age 43.6 ± 9.9), 112 (84.2%) of the them were females. We assessed the work conditions of the respondents during pandemic, the presence of psychosomatic disorders, depression and anxiety levels by HADS scale.

Results. Almost two thirds (82; 61.7%) of the respondents reported an increased workload during the pandemic, 54.1% of them work more than 40 hours per week. The income has risen only in 25.6% of the doctors. Most of the respondents announced a manifestation of one or more psychosomatic disorders during the pandemic. The most frequent complaint was insomnia found in 72 (54.1%) of the doctors. Clinical anxiety was confirmed in 30 (22.6%), clinical depression in 15 (11.3%), moderate anxiety in 22 (16.5%), moderate depression in 31 (23.3%), both clinical anxiety and depression in 6% of the participants.

Conclusions. During the pandemic Russian doctors continue to work under physical and psychological pressure and provide medical care even if they have clinical depression and anxiety that influences on patient’s and doctor’s wellbeing. There’s still a lack of psychological assistance to doctors and of other methods to prevent professional burn-out.

The review presents the recent data on assumed risk factors for the development of ANCA-associated vasculitis (AAV), among which environmental factors, such as climatic, chemical, etc., are of particular interest of researchers. Controversial opinions of various authors on the role of individual causative agents of infectious diseases in the development of AAV are analyzed. The review pays special attention to scientific data on the influence of variants of the structure of genes encoding various components of the immune system on the development of the pathogenetic process of AAV. Up-to-date information on the association of single-nucleotide polymorphisms (SNPs) with the course, risk of development and the likelihood of AAV recurrence is indicated, the most associated of which are genes encoding proteins of the main histocompatibility complex (HLA), a toll-like receptors (TLR`s), as well as an inhibitor of serine proteinases-alpha-antitrypsin (AAT). The analysis of scientific publications describing the molecular mechanism of the development of a pathological focus that forms the conditions for the synthesis of PR3–ANCA and MPO–ANCA complexes characteristic of AAV has been carried out. The data of a number of foreign studies on the relationship of individual SNPs associated with the features of the course of granulomatosis with polyangiitis, microscopic polyangiitis, as well as eosinophilic granulomatosis with polyangiitis are presented and summarized. The review presents current AAV treatment regimens and promising directions for the development of medical care for patients.

The most effective means of combating the COVID-19 pandemic s the formation of herd immunity, with the formation of an immune population to infection. Vaccination rates are continuously increasing. In early February 2021, WHO announced that the number of people vaccinated against the disease for the first time exceeded the number of infected. In early June 2021 the vaccinated number exceeded 2 billion which is more than 12 times the total number infected for the entire duration of the pandemic. The high rate of vaccination leads to the formulation of a number of questions concerning the effectiveness of vaccines currently used for mass immunization the level of herd immunity, necessary to stop the spread of the disease, the actual duration of the vaccination carried out, long-term prospects of the platforms, used in the creation of vaccines. The purpose of this paper is to substantiate reasoned answers to the questions posed.

December 10, 2021 marks the 90th anniversary of the birth and 65 years of the scientific activity of Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor Felix Ivanovich Ershov. F.I. Ershov is a prominent scientist-virologist, popularizer of science, known in our country and abroad, one of the leading experts on the problem of interferon and its inducers. Staff members of the National Research Center for Epidemiology and Microbiology named after Honorary Academician N.F. Gamaleya, friends, colleagues and students sincerely congratulate Felix Ivanovich Ershov on his anniversary and wish him new creative successes, health, long and happy years of life!