EFFICACY OF INFLIXIMAB IN PATIENT WITH UNFAVORABLE CLINICAL COURSE OF JUVENILE RHEUMATOID ARTHRITIS

The article presents a case report of aggressive rapidly progressive severe polyarticular juvenile rheumatoid arthritis (JRA) resistant to standard immunosuppressive treatment. Patient with extra-early (up to 6 months) arthritis was successfully treated with genetically engineered biological agent infliximab. Pain decreased significantly after first injection of a drug, the second injection resulted in decrease of laboratory activity, third one completely stopped exudative lesion of joints, morning stiffness, and restored functional activity of a child. Thus, after 6 months the disease was transferred to inactive phase, motions of joints restored, there was no need in nonsteroid anti-inflammatory drugs. Cardiovascular symptoms stopped as well. The case report showed high efficacy of tumor necrotizing factor _ blocker infliximab in patients with aggressive clinical course and markers of unfavorable prognosis at very early stages of JRA before irreversible lesions of joints happen.Key words: children, early juvenile rheumatoid arthritis, infliximab, treatment.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3): 157–165

CLINICAL SIGNS AND PATHOMORPHOLOGICAL PICTURE OF HYPOXIC INTRAVENTRICULAR HEMORRHAGE IN NEWBORNS

(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(2):124-125)<br /

EXPERIENCE OF DESOXIRIBONUCLEATE SODIUM IMMUNOMODULATOR APPLICATION IN TREATMENT FOR REACTIVE ARTHRITIS OF CHLAMYDIA AETIOLOGY AMONG CHILDREN

Researchers compared efficacy of the conventional therapy (oilment with non steriod anti-inflammatory medication, diclofena sodium and azithromycin) among children with reactive arthritis of Chlamydia etiology and treatment with introduction of gluccosaminilmuramildi peptide and desoxiribonucleate sodium immunomodulators. The article shows that application of immunomodulators in combination with the conventional therapy provided for the decrease of the articular syndrome intensity, reduced the need of the patients in local corticosteroids and conduced to the reduction of the lab process activity indices. Further more, they noticed reduced recurrence of the antibodies to Chlamydias and their titers in the blood serum, while general intensity of the antiinflammatory effects from the combined therapy, which included glucosaminilmuramildipeptide and desoxiribonucleate sodium immunomodulators along with the antibiotic, proved to be comparable.Key words: children, reactive arthritis, chlamydia infection, immunomodulators

Post-COVID syndrome in children and adolescents: a literature review and clinical case

L.A. Balykova, M.V. Shirmankina, D.O. Vladimirov, E.I. Naumenko, E.S. Samoshkina, R.A. Chernyshova N.P. Ogarev Mordovia State University, Saransk, Russian Federation Post-COVID-19 syndrome is an important challenge for modern medicine, requiring the involvement of different health professionals. This multidisciplinary approach is underpinned by the variety of clinical manifestations and the need for comprehensive rehabilitation of patients, including children and adolescents. The review highlights clinical manifestations of post-COVID-19 syndrome. Currently, a symptom management approach has been established for improving post-COVID-19 conditions. Also, appropriate lifestyle changes, such as adequate rest and sleep hygiene, may be useful. Rehabilitation interventions for post-COVID-19 syndrome may include physiotherapy exercises and various psychotherapy techniques. Since mitochondrial dysfunction, energy supply deficit, oxidative stress, endothelial dysfunction, and immune dysregulation profoundly impact the pathogenesis of post-COVID-19 syndrome, the use of L-carnitine which plays a crucial role in energy production, is consider ed as a promising method in the management of such patients. L-carnitine may have cardioprotective, anabolic and neuroprotective effects. The authors present a case report of post-COVID-19 condition in their own patient, a 4-year-old boy who survived multisystem inflammatory syndrome. As a result of combination therapy, including L-carnitine, the patient’s sense of well-being significantly improved: he had no complaints, the muscle weakness and asthenization became less pronounced, and his spirits rose. The described clinical case illustrated the effectiveness of using L-carnitine in the combined therapy of post-COVID-19 syndrome in children. Keywords: COVID-19, post-COVID syndrome, multisystem inflammatory syndrome, L-carnitine, children, rehabilitation, asthenization, anxiety disorder. For citation: Balykova L.A., Shirmankina M.V., Vladimirov D.O. et al. Post-COVID syndrome in children and adolescents: a literature review and clinical case. Russian Journal of Woman and Child Health. 2022;5(4):366–372 (in Russ.). DOI: 10.32364/2618-8430-2022-5-4-366-372. <br

STUDY OF LONG-TERM CLINICAL AND PATHOGENETIC EFFECTS OF FAVIPIRAVIR-BASED ANTI-VIRAL DRUG IN PATIENTS WITH METABOLIC SYNDROME IN POST-COVID PERIOD [ИЗУЧЕНИЕ ОТДАЛЕННЫХ КЛИНИКО-ПАТОГЕНЕТИЧЕСКИХ ЭФФЕКТОВ ПРОТИВОВИРУСНОГО ЛЕКАРСТВЕННОГО ПРЕПАРАТА НА ОСНОВЕ ФАВИПИРАВИРА В ПОСТКОВИДНОМ ПЕРИОДЕ У ПАЦИЕНТОВ С МЕТАБОЛИЧЕСКИМ СИНДРОМОМ]

The article presents modern scientific data on long-term clinical and pathogenetic effects of the antiviral drug Areplivir (Favipiravir) in patients with metabolic syndrome in the post-COVID period. The aim of the article is to study long-term cytokine-mediated (IL-6/sIL6r and LIF/sLIFr) pathogenetic effects of the favipiravir (Areplivir®) based drug on the incidence of complications in patients with metabolic syndrome in the post-COVID period. Material and methods. With the approval of the local ethics committee at the N.P. Ogarevs Mordovia State University (Protocol No. 5 dated May 17, 2020) “An open prospective comparative study of the Areplivir® (Favipiravir) drug effectiveness in reducing the risk of complications in the post-COVID period in patients with metabolic syndrome” in the Republic of Mordovia was carried out. The study included 190 metabolic syndrome patients who received the outpatient treatment for COVID-19 at Saransk polyclinics from February 2021 to March 2021. The case of COVID-19 was diagnosed in accordance with the current Temporary Guidelines for the prevention, diagnosis and treatment of the new coronavirus infection. Results. The analysis of the metabolic syndrome patients' follow-up within 1 year after undergoing COVID-19, revealed significant differences in the incidence of complications depending on the intake of the favipiravir based drug. The patients who were administrated with favipiravir at the early stage of infection, were characterized by lower serum levels of four members of the interleukin 6 family - IL-6 (IL-6, sIL6r and LIF, sLIFr) 10, 30 and 180 days after a clinical and laboratory recovery (p<0.001). The average statistical changes in the IL-6/sIL6r system of the group administrated with favipiravir, were 90%, and they were higher than in the group not administrated with antiviral drugs. In the group of the patients administrated with favipiravir, there was a significant (p<0.001) positive dynamic of the sLIFr indicator, while in the comparison group, there was an increase in this indicator. A protective effect of the early favipiravir use was characterized by a decrease in the frequency of cardiovascular complications, a 2.66-fold decrease in the risk of a stroke and the ACS in the post-COVID period. Conclusion. The areplivir therapy in the acute period of coronavirus infection made it possible to timely reduce the viral load. It helps to correct the pro-inflammatory vector of the immune response at the post-COVID stage and, accordingly, reduces the risk of progression of atherosclerosis, transient cerebrovascular accidents with a cognitive decline, an endothelial dysfunction, and can be considered a secondary prevention of life-threatening cardiovascular complications. © 2022 Volgograd State Medical University, Pyatigorsk Medical and Pharmaceutical Institute. All rights reserved

EFFECTIVENESS AND SAFETY OF FAVIPIRAVIR INFUSION IN PATIENTS HOSPITALIZED WITH COVID-19 [ЭФФЕКТИВНОСТЬ И БЕЗОПАСНОСТЬ ИНФУЗИОННОГО ВВЕДЕНИЯ ФАВИПИРАВИРА У ПАЦИЕНТОВ, ГОСПИТАЛИЗИРОВАННЫХ С COVID-19]

Research in the development of new therapeutic agents with a wide spectrum of the antiviral activity and a low ability to develop resistance remains the main dimension in combating the global threat to public health. The need for a parenteral form of favipiravir was dictated by the necessity to increase the efficacy of therapy in COVID-19 inpatients. This dosage form has expanded the possibilities of drug therapy in the inpatients, for whom a therapeutic effect acceleration and a high safety profile of the drugs used are especially important. The aim of the article is the evaluation of the efficacy and safety of a medicinal product containing favipiravir for the parenteral administration against the background of pathogenetic and symptomatic therapy, in comparison with standard therapy in hospitalized COVID-19 patients. Materials and methods. An open, randomized, multicenter comparative study was conducted in 6 research centers in the Russian Federation to evaluate the efficacy and safety of favipiravir, a lyophilisate for the preparation of a concentrate for the infusion solution administrated to the patients hospitalized with COVID-19. Screening procedures and randomization were completed in 217 patients, 209 of which had completed the study in accordance with the protocol. Results. Between the study groups, statistically significant differences have been found out, making it possible to consider the hypothesis of the drug Areplivir (favipiravir) superiority for the parenteral administration over the standard therapy, which included favipiravir (p. o.) and remdesivir. A comparative analysis has shown that a course of therapy with the parenteral favipiravir drug leads to a significant improvement in the condition of patients with COVID-19, significant benefits in terms of the speed and frequency of improvement in the clinical status of patients, as well as a reduction in the hospital stay length. It has been proven that therapy with a drug containing favipiravir for the parenteral administration does not adversely affect the parameters of clinical and biochemical blood tests, urinalysis, coagulograms, vital signs and ECG, which indicates the therapy safety. The study drug is characterized by a high safety profile and tolerability. Conclusion. The versatility and resistance to mutations of RNA-dependent RNA polymerase make it possible to consider it as the main target for combating the most common RNA viruses that cause ARVI, that determines the need further studies of favipiravir to expand the range of its indications. © 2022 Volgograd State Medical University, Pyatigorsk Medical and Pharmaceutical Institute. All rights reserved