Early signs of myocardial dysfunction in patients with rheumatoid arthritis and ankylosing spondylitis

The objective of the study – identify early preclinical signs of myocardial dysfunction in patients with rheumatoid arthritis and ankylosing spondylitis.Material and methods. We examined 142 people with verified rheumatic diseases. All patients were divided into 2 groups. The first group consisted of patients with rheumatoid arthritis – 95 people. The second group – patients with ankylosing spondylitis – 47 people. The control group included 70 practically healthy individuals. In addition to standard diagnostic tests, all patients underwent tissue dopplerography of the heart using the GE Vivid E9 ultrasound device using the two-dimensional deformation technique (speckle tracking) to assess the deformation and rate of myocardial deformation, as well as determining the level of matrix metalloproteinase-9 in the blood serum.Results. Among patients with rheumatoid arthritis, diastolic dysfunction of both the left ventricle and both ventricles was more common than in the control group. The same pattern was observed in the group with ankylosing spondylitis. The calculation of the relative risk showed that the presence of rheumatoid arthritis in 4,42 times increases the risk of diastolic dysfunction of the left ventricle in comparison with practically healthy people (CI 1,6–12,2). In individuals with rheumatoid arthritis also results in a deterioration of systolic function of both ventricles. The level of matrix metalloproteinase metalloproteinase-9 was highest and most often increased in patients with ankylosing spondylitis. Among patients with rheumatoid arthritis, the average level of metalloproteinase-9 was low, but the incidence was higher than in the control group. The obtained results indicate that in these rheumatic diseases there is a marked degradation of the extracellular matrix components.Conclusion. Patients with rheumatoid arthritis and ankylosing spondylitis are characterized by a deterioration in the diastolic function of the left ventricle or both ventricles simultaneously, which is accompanied by an increase in the level of metalloproteinase-9

Evaluation of Small Intestinal Permeability in Patients with Overlap Syndrome (Autoimmune Hepatitis/Primary Biliary Cholangitis)

Аim: to evaluate the state of small intestine permeability by the “double sugar test” in patients with overlap syndrome (autoimmune hepatitis / primary biliary cholangitis (AIH / PBC)).Materials and methods. Prospectively, 56 people were included in the study. Of these, 26 were diagnosed with AIH/PBC, 30 were in the control group. The diagnosis was made in accordance with the current recommendations. The average age of patients was 49.7 ± 13.8 years, healthy volunteers — 48.6 ± 9.2 years. The determination of the permeability of the small intestine was carried out by a “double sugar test” (the ratio of lactulose/mannitol in urine), using the method of high-performance liquid chromatography — mass spectrometry.Results. In patients with AIH/PBC, an increase in intestinal permeability was found — 0.20 [0.09; 0.30] (p < 0.001) compared with the control group 0.01 [0.01; 0.02]. We divided patients at the stage of liver damage. An increased small intestinal permeability was revealed: hepatitis stage — 0.19 [0.13; 0.30] (p < 0.001), liver cirrhosis stage — 0.18 [0.09; 0.30] (p < 0.05) compared with the control group. In the early stages of disease (1 month from the onset of the disease) had an increased lactulose/mannitol ratio — 0.13 [0.05; 0.26] (p < 0.001) compared to the control group. In the presence of portal hypertension (PH), small intestinal permeability was increased — 0.18 [0.09; 0.30] (p < 0.001) compared with the control group.Conclusions. An increase in small bowel permeability was found in patients with overlapping syndrome. All patients had increased intestinal permeability (regardless of the presence of extrahepatic manifestations)

Course of COVID-19 in Patients with Inflammatory Bowel Disease: Regional Experience

Aim: to study the course of COVID-19 in patients with inflammatory bowel diseases (IBD) using the example of the region of the Republic of Tatarstan.Material and methods. The study included 101 patients diagnosed with IBD and COVID-19, who were observed in two infectious diseases hospitals in Kazan (Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan and City Clinical Hospital No. 7) and on an outpatient basis from April 2020 to March 2022. All patients underwent physical examination, laboratory and instrumental diagnostic methods, including a PCR test for SARSCoV-2. Chest computed tomography was performed in patients with clinical signs of moderate to severe COVID-19.Results. Ulcerative colitis (UC) was diagnosed in 60 (59.4 %) patients, Crohn's disease (CD) — in 41 (40.6 %) patients. The mean age of the patients was 41.0 ± 14.7 years, of which 59 (58.4 %) were men and 42 (41.6 %) were women. A comparative analysis of patients with and without IBD and CT-verified lung disease was carried out. It was found that the development of viral pneumonia was influenced by age over 55 years (39.2 ± 9.7 vs. 46.3 ± 10.6, p < 0.05), increased Body Mass Index (BMI) (23.1 ± 5.35 vs. 30.25 ± 6.17, p < 0.05), hypertension (6 (8.3 %) vs. 8 (27.6 %), p < 0.05), diabetes mellitus (2 (2.7 %) vs. 5 (17.2 %), p < 0.05), the use of corticosteroids in the treatment of IBD (8 (11.1 %) vs. 10 (34.5 %), p < 0.05). In a comparative analysis of patients with IBD and COVID-19 from the SECURE-IBD database and own data, it was found that the average age of patients was comparable (42.7 vs 41.0). At the same time, in our group of male patients, there were slightly more people with DM, increased BMI, and an active course of IBD. The proportion of hospitalized patients was higher. In our cohort, there were fewer patients receiving biological therapy, but more patients on 5-aminosalicylic acid (5-ASA) and systemic corticosteroids. At the same time, lethal outcomes were comparable.Conclusion. In patients with IBD, the development of viral pneumonia was influenced by known risk factors for COVID-19: age over 55 years (p < 0.05, odds ratio (OR) 3.153), increased BMI (p < 0.05, OR 1.667), hypertension  (p < 0.05, OR 2.724), diabetes (p < 0.05, OR 1.489), as well as the use of systemic corticosteroids (p < 0.05, OR 1.5)

COVID-19-ассоциированный ангиит: обзор литературы и описание клинического случая

The article systematizes information about various dermatological signs of a novel coronavirus infection – COVID-19. Special attention is paid to the phenomenon of COVID-19-associated angiitis. A clinical case of acroischemia associated with COVID-19 is described: on the 34th day after the onset of infection, a patient developed skin cyanosis of the distal parts of the fingers, which resolved spontaneously after a few days. The need for further research on the skin manifestations of COVID-19 and the development of an effective strategy for managing patients, as well as monitoring the condition of convalescents, is emphasized.В статье систематизированы сведения о различных дерматологических признаках новой коронавирусной инфекции – COVID-19. Особое внимание уделено феномену COVID-19-ассоциированного ангиита. Описан клинический случай акроишемии, связанной с COVID-19: у пациента на 34-й день после дебюта инфекции развился цианоз кожи дистальных отделов пальцев кистей, разрешившийся самостоятельно через несколько дней. Подчеркивается необходимость дальнейших исследований кожных проявлений COVID-19 и разработки эффективной стратегии ведения пациентов, а также мониторинга состояния реконвалесцентов

Септальный панникулит как проявление COVID-19: собственные данные

Objective: to study the clinical and laboratory features of erythema nodosum (EN) in a cohort of patients with COVID-19 referred to a rheumatological center.Patients and methods. During 2020–2021 years 21 patients (18 women and 3 men, mean age 43.2±11.4 years) with EN and polyarthralgia/arthritis were examined. Depending on the time of EN and articular syndrome associated with COVID-19 development, patients were divided into three groups: 1) up to 4 weeks – acute COVID (symptoms potentially associated with infection); 2) from 4 to 12 weeks – ongoing symptomatic COVID and 3) more than 12 weeks – post-COVID syndrome (persistent symptoms not associated with an alternative diagnosis). All patients underwent a comprehensive clinical, laboratory and instrumental examination, including ultrasound of the joints and chest computed tomography (CT), as well as pathomorphological examination of skin and subcutaneous adipose tissue from the site of the node (in 9 cases). Results and discussion. Based on the anamnesis data, COVID-19 in the study cohort had mild (in 13 patients) and moderate (in 8) severity. Two patients (21 years old and 23 years old) with mild severity of the disease noted red painful (45 mm on the visual analogue scale of pain) nodes on the legs and polyarthralgia for the first time on the 2nd – 3rd day from respiratory symptoms onset. In 9 (52.3%) patients, mainly with a mild course, similar skin changes were detected 24.5±7.6 days after active COVID-19 relieve, i.e. during the period of ongoing symptomatic COVID. In 8 (38%) patients, including 6 with moderate severity of the disease, the appearance of nodes was noted after 85.6±12.3 days, which corresponded to the post-COVID syndrome.At the time of examination, complaints of skin rashes and joint pain were reported in 100 and 71.4% of patients, respectively. 67% of patients had shortness of breath, weakness, cough, sweating and myalgia. Subfebrile fever had 5 (24%) patients, mainly with ongoing symptomatic COVID (3 patients). In the overwhelming majority of cases (86%), EN was located on the anterior and lateral surfaces of shins, less often on the posterior and medial surfaces. It is noteworthy that the affection of more than 50% of the surface of the lower and upper extremities was associated with the number of nodes (p<0.02), the level of CRP (p<0.03) and the presence of post-COVID syndrome (p<0.2). Fifteen (71.4%) patients had arthralgias, mainly of ankle (80%) and knee (53.3%) joints.Laboratory abnormalities included: median ESR was 34 [12; 49] mm/h, CRP level – 9 [2; 32] mg/l. The results of the polymerase chain reaction for SARS-CoV-2 were negative in all patients. In 100% of cases IgG antibodies to SARS-CoV-2 were detected and in 52.3% – IgM antibodies. On chest CT 5% lung affection was detected in 43% of patients, 5–25% lesion in 57.1% of patients, 8 (38%) of whom were with post-COVID syndrome. Pathomorphological examination of the nodes showed signs of septal panniculitis.Conclusion. When EN, associated with SARS-CoV-2 appears it is important to suspect a post-infectious manifestation in time, based on the clinical picture of the disease and to determine the scope of further examination and adequate treatment.Цель исследования – изучить клинические и лабораторные особенности узловатой эритемы (УЭ) в когорте больных COVID-19, направленных в ревматологический центр.Пациенты и методы. В течение 2020–2021 гг. исследован 21 пациент (18 женщин и 3 мужчины, средний возраст 43,2±11,4 года) с УЭ и полиартралгиями/артритами. В зависимости от времени развития УЭ и суставного синдрома, ассоциированных с COVID-19, пациенты были разделены на три группы: 1) до 4 нед – острый COVID (симптомы, потенциально связанные с инфекцией); 2) от 4 до 12 нед – продолжающийся симптоматический COVID и 3) более 12 нед – постковидный синдром (сохраняющиеся стойкие симптомы, не связанные с альтернативным диагнозом). Всем пациентам проводили комплексное клинико-лабораторное и инструментальное обследование, включая УЗИ суставов и компьютерную томографию (КТ) органов грудной клетки, а также (в 9 случаях) патоморфологическое исследование биоптатов кожи и подкожной жировой клетчатки из области узла.Результаты и обсуждение. На основании данных анамнеза СOVID-19 в исследуемой когорте имел легкую (у 13 пациентов) и среднюю (у 8) степень тяжести. Двое больных (21 года и 23 лет) с легкой степенью тяжести заболевания на 2-е – 3-и сутки развития респираторного симптома впервые отметили красные болезненные (45 мм по визуальной аналоговой шкале) узлы на голенях и полиартралгии. У 9 (52,3%) пациентов, преимущественно с легким течением, аналогичные изменения кожи выявлены через 24,5±7,6 сут после купирования активного СOVID-19, т. е. в период продолжающегося симптоматического COVID. У 8 (38%) пациентов, в том числе у 6 со средней степенью тяжести болезни, узлы возникали через 85,6±12,3 сут, что соответствовало постковидному синдрому.На момент осмотра жалобы на кожные высыпания и боль в суставах предъявляли 100 и 71,4% пациентов соответственно. Одышка, слабость, кашель, потливость и миалгии беспокоили 67% больных. Повышение температуры тела до субфебрильной наблюдалось у 5 (24%) пациентов, преимущественно при продолжающемся симптоматическом COVID (3 больных). В подавляющем большинстве случаев (86%) УЭ располагалась на передней и латеральной поверхностях голеней, реже – на задней и медиальной поверхностях. Примечательно, что поражение более 50% поверхности нижних и верхних конечностей ассоциировалось с количеством узлов (р<0,02), уровнем СРБ (р<0,03) и постковидным синдромом (р<0,2). У 15 (71,4%) больных имелись признаки артралгий, преимущественно голеностопных (80%) и коленных (53,3%) суставов.При лабораторном исследовании медиана СОЭ составила 34 [12; 49] мм/ч, уровня СРБ – 9 [2; 32] мг/л. Результаты полимеразной цепной реакции на SARS-CoV-2 были негативными у всех пациентов. В 100% случаев выявлены антитела IgG и в 52,3% – IgM к вирусу SARS-CoV-2. При КТ органов грудной клетки 5% поражения легких определялось у 43% больных, от 5 до 25% – у 57,1%, из них у 8 (38%) больных с постковидным синдромом. При патоморфологическом исследовании узлов отмечены признаки септального панникулита.Заключение. При развитии УЭ, ассоциированной с SARS-CoV-2, важно вовремя заподозрить постинфекционное проявление на основании клинической картины заболевания и определить объем дальнейшего обследования и адекватное лечение

L.L. Fofanof: 140th anniversary of his birth. Contribution to science

The article is dedicated to Professor L.L. Fofanof’s scientific activity. He headed the faculty therapeutic clinic of Kazan Imperial University in 1915-1920. Being a student L.L. Fofanov was interested in pathological anatomy and physiology. His dissertation «To physiology of n. depressoris» was dedicated to studying the vasomotor center. During his visit in Germany he worked a lot. In Charite together with Professor His he studied gout and its treatment with Radium emanation. In Halle clinic under Professor Schmidt’s supervision he studied assimilation of starch in normal and pathological digestion. L.L. Fofanov also made a contribution to tuberculosis treatment: with professor V.F. Orlovskiy he studied treatment of tuberculosis with simulated pneumothorax. In his research professor L.L. Fofanov paid great attention to the issues of pathogenesis and pathogenetic substantiation of the clinical manifestation and treatment. During the World War I and Civil War he fought against typhus epidemies: he saw patients, gave lectures, studied the features of myocardial involvement. He died in 1920 from typhus

Thirteen-Year Follow-Up of a Patient with Liver Cirrhosis Resulting from the Overlap Syndrome of Autoimmune Hepatitis and Primary Biliary Cholangitis: Severe COVID-19 and Liver Transplantation

Aim: to present the difficulties of long-term management of a patient with liver cirrhosis in the outcome of overlap syndrome (autoimmune hepatitis and primary biliary cholangitis) who suffered from severe COVID-19 infection.Key points. The diagnosis of liver cirrhosis as an outcome of overlap syndrome (autoimmune hepatitis and primary biliary cholangitis) was established at the patient’s age of 33 years. At the age of 40, the patient became pregnant for the first time, the pregnancy proceeded well, and a cesarean section was performed at 36 weeks. At the age of 45, the patient suffered a severe new coronavirus infection, followed by decompensation of liver cirrhosis, which required liver transplantation 4 months after COVID-19, followed by a favorable postoperative course.Conclusion. This clinical case demonstrates the successful onset and outcome of pregnancy in a patient with liver cirrhosis in the outcome of overlap syndrome (autoimmune hepatitis and primary biliary cholangitis). The pronounced activity of the disease after severe new coronavirus infection required liver transplantation with successful outcome

To the 50th anniversary of hematology service of the Republic of Tatarstan

The article presents an overview of the development of hematology service in the Republic of Tatarstan. The well-known scientist Nikolay Konstantinovich Goryaev (1875-1943), who worked in Kazan for a long time, began to develop this direction and after passing an internship in Germany proposed an improved device for calculating the blood elements known throughout the world. Adherents of Professor Goryaev continued research in the field of hematology, a blood transfusion station was organized. Professor S.I. Sherman proposed new methods of diagnosis and treatment of B12 deficiency anemia. Professor Sh.I. Ratner studied the changes in the blood picture in diseases of the abdominal cavity. The first 15 specialized hematological beds were opened in 1968 in the hospital named “Old Clinic”. The physician who treated such patients was Rakhil Sholomovna Dashevskaya, PhD. At present, hematology service is provided by three hospitals in Kazan, hematological and therapeutical beds in Naberezhnye Chelny and Nizhnekamsk, outpatient hematology service in Zelenodolsk. In recent years, the introduction of stem cell therapy has begun, and modern combined methods of chemotherapy have been introduced