Prevalence of chronic HCV infection in patients with type 2 diabetes mellitus in Russia

BACKGROUND: The poor outcomes of chronic hepatitis C (CHC) and type 2 diabetes determine the socio-economic significance of the combined pathology since they lead to premature death. The proportion of patients with type 2 diabetes with markers of viral hepatitis (VH) in the Russian Federation is not known, which does not allow us to estimate the burden for the state of this medical problem.OBJECTIVE: Assessment of the prevalence of concomitant pathology, HCV infection and type 2 diabetes, as well as the proportion of severe liver damage in its structure, according to the analysis of the primary medical records of four Moscow hospitals.MATERIALS AND METHODS: A retrospective analysis of the medical records of patients with HCV infection and diabetes mellitus, who admitted at different periods to four hospitals in Moscow, was carried out, as well as a total examination for the presence of anti-HCV in the blood of all patients with diabetes who were admitted within a certain period to the endocrinology department of a multidisciplinary hospital. Additionally, to determine the proportion of patients with liver cirrhosis (LC), an additional examination of patients with this combined pathology was carried out in accordance with the standards for the diagnosis of hepatitis C.RESULTS: In total, according to data from 4 hospitals in Moscow, over a certain period, 2% (105/5298) of diabetes patients with anti-HCV in their blood were identified. Sex ratio for men: women = 54 (51%): 51 (49%). Patients aged 50–69 years prevailed — 70% (74/105). Seroprevalence of HCV in cohorts of patients with type 2 diabetes according to the analysis in 3 health facilities: 0.9% (20/2196), 1.9% (8/432), 1.9% (28/1500). A significant drawback was revealed that did not allow assessing the true seroprevalence of HCV: not all patients were hospitalized with the results of a VH test, and not all of them were assigned an examination for VH markers if it was not performed before hospitalization. The proportion of type 2 diabetes patients with anti-HCV in the blood according to the results of total screening (3.7%; 16/432) became comparable to the proportion of type 2 diabetes patients among patients with CHC admitted to an infectious hospital (4.2%; 49 / 1170). The proportion of patients with LC according to the analysis of the medical records of the infectious hospital is 65% (32/49), in the group of endocrinological patients with additional examination it is 18% (13/71).CONCLUSION: For the first time in the Russian Federation, data were obtained on the prevalence of HCV infection in combination with type 2 diabetes. The results of the study indicate the need to develop effective screening programs to detect active HCV infection in the group of patients with diabetes, as well as patients among them with severe hepatic fibrosis for the timely conduct of highly effective antiviral therapy, which will prevent poor outcomes in a separate perspective

Облитерирующий бронхиолит при ревматоидном артрите (клиническое наблюдение)

Obliterative (constrictive) bronchiolitis (OB) is a rare disease characterized by destruction of the bronchiolar epithelium and subsequent progressive airway obstruction. OB is most common in rheumatoid arthritis (RA) compared to other systemic rheumatic diseases. Clinical manifestations of OB are found mainly with a long duration of RA and the absence of adequate therapy for articular manifestations. We present a clinical observation, demonstrating the distal respiratory tract involvement in a patient with RA during the first year of the disease, which is observed in no more than 10–20% of cases. The nonspecificity of respiratory symptoms on the background of immunosuppressive therapy led to a diverse differential diagnostic spectrum of pulmonary pathology. For timely diagnosis and optimization of therapeutic approaches, clinical suspicion for respiratory lesions in patients with RA and interdisciplinary cooperation are necessary.Облитерирующий (констриктивный) бронхиолит (ОБ) – редкое заболевание, характеризующееся разрушением бронхиолярного эпителия и последующей прогрессирующей обструкцией дыхательных путей. ОБ чаще всего встречается при ревматоидном артрите (РА) по сравнению с другими системными ревматическими заболеваниями. Клинические проявления OБ обнаруживаются в основном при большой длительности РА и отсутствии адекватной терапии суставных проявлений. Представлено клиническое наблюдение, демонстрирующее поражение дистальных отделов респираторного тракта у пациентки с РА в течение первого года заболевания, что отмечается не более чем в 10–20% случаев. Неспецифичность респираторных симптомов на фоне иммуносупрессивной терапии обусловила разнообразный дифференциально-диагностический спектр легочной патологии. Для своевременной диагностики и оптимизации терапевтической тактики необходимы клиническая настороженность в отношении поражения органов дыхания у больных РА и междисциплинарное сотрудничество

Eosinophilic granulomatosis with polyangiitis in comorbidpatient: is the immunological diagnostics always unambiguous

Eosinophilic granulomatosis with polyangiitis (EGPA), previously called Churg—Strauss syndrome, represents a rare form of ANCA-associated necrotising vasculitis which affects small vessels. This disease is characterized by typical combination of immunological disturbances, hypereosinophilia, severe bronchial asthma, transient pulmonary infiltrates, and kidney injury which is less frequent than in other forms of necrotising vasculitis.Verification of the diagnosis is often hampered by comorbidities, such as chronic obstructive pulmonary disease (COPD) in the patients with long-term smoking history and occupational hazards.In this article, we report a clinical case of EGPA in elderly patient with preceding COPD which caused diagnostic difficulties for this eosinophilic syndrome. Clinical pattern at the beginning of disease was presented by moderate inspiratory dyspnea and cough with small amounts of mucus sputum, which appeared after longterm exposure to chlorine-containing substances. COPD diagnosis in this patient was based on clinical pattern, long smoking experience, and occupational hazards. However, persistence of the symptoms during the ongoing therapy, as well as multidirectional dynamics of transient pulmonary infiltrates found on repeated CT-scans, prompted us to intensify diagnostic search for a systemic disease. Clinical, laboratory and instrumental signs of bronchial asthma were revealed, as well as hypereosinophilia and sensory polyneuropathy, which, if combined with CT-scan data, allowed us to prove the EGPA diagnosis.This case shows that, despite great value of immune diagnostics, with negative blood tests for ANCA, it is necessary to detect mutually complicating comorbid pathology. EGPA was considered the basic diagnosis, and COPD as accompanying disorder, taking into account such reasons as an unfavorable prognosis for EGPA and the need for long-term chemotherapy with systemic corticosteroids and monoclonal antibodies. ANCA-negative testing in the patient, absence of severe kidney and skin lesions allows to suggest better clinical prognosis in this patient

Long-Term Monitoring of Liver Fibrosis and Steatosis in Patients with Chronic Hepatitis C after Achieving a Sustained Virologic Response to Antiviral Therapy

Aim: to analyze the dynamics of fibrosis and steatosis of the liver according to fibroelastometry in patients with chronic hep-atitis C (CHC) after ≥ 6 months from transient elastometry (TE) achieving a sustained virologic response (SVR) to antiviral therapy.Materials and methods. At baseline, a prospective observational study included 628 CHC patients with known stage of liver fibrosis (F) before AVT, some of whom were phased out due to non-compliance with the inclusion criteria. The final analysis included 297 patients who had transient elastometry (TE) data with CAP™ technology on the severity of liver fibrosis (± steatosis) before treatment and after ≥ 6 months after reaching SVR (67 % – interferonfree regimens of therapy). Median follow-up from the moment SVR was confirmed was 3 years [2; 6].Results. At the end of the study, the average age of patients was 49 ± 12 years, of which 53 % were men. In the long-term period after reaching SVR, regression of liver fibrosis was diagnosed in 80 % of cases (including in patients with cirrhosis), and the progression of fibrosis was in 3 % of patient. At the same time, regression of liver steatosis was detected only in 31 % of the patient, worsening of the results was in 23 % (26 % of them had the appearance of steatosis (S) of the liver of 1–3 degrees in persons with no fatty liver before the start of AVT). In the group of patients with liver steatosis, the proportion of men was significantly higher (p = 0.004). Clinically significant stages of fibrosis F3–F4 were significantly more often recorded in patients with hepatic steatosis, both before treatment (46 % S1–S3 and 22 % S0, p < 0.001) and after ≥ 6 months after reaching SVR (19 % S1–S3 and 9 % S0, p = 0.023).Conclusion. In patients with chronic hepatitis C with SVR achieved in the long term, despite a significant regression of liver fibrosis, a high prevalence of hepatic steatosis remains. The data obtained indicate the feasibility of routine diagnosis of both fibrosis and steatosis of the liver in the management of patients with chronic HCV infection before and after successful antiviral therapy

Особенности течения остеопороза у пациентов с хронической обструктивной болезнью легких

The aim of this study was to analyze the course of osteoporosis in elderly females with pulmonary diseases. Methods. The study involved females with postmenopausal osteoporosis who did not receive regular treatment with oral steroids. All patients underwent spirometry before and after inhalation of a bronchodilator, bone densitometry with assessment of bone mineral density (BMD) and T-score at the proximal thigh, the lumbal spine and the one third distal forearm. FRAX risk assessment score was also used. Results. We examined 79 patients (mean age, 66.9 ± 1.7 years). Female patients with chronic obstructive pulmonary disease (COPD) had significantly more frequent forearm fractures, significantly lower FEV1, BMD at the forearm, and T-score at the forearm compared to patients with asthma and patients without obstructive pulmonary diseases. Conclusions.COPD contributes to more severe course of postmenopausal osteoporosis.Актуальность проблемы обусловлена высокой частотой развития остеопороза (ОП) у больных хронической обструктивной болезнью легких (ХОБЛ) на фоне неуклонного роста заболеваемости. Материалы и методы. С целью выявления особенностей течения ОП при ХОБЛ в женской популяции обследованы пациентки (n = 79; средний возраст 66,9 ± 1,7 года) с диагностированным постменопаузальным ОП, не принимавшие стероидные гормоны. Результаты и обсуждение. У пациенток с ХОБЛ выявлены достоверно более низкие значения показателей объема форсированного выдоха за 1-ю секунду, минеральной плотности костной ткани предплечья (лучевой кости), Т-критерия предплечья на фоне достоверно более частых переломов предплечья по сравнению с больными бронхиальной астмой и пациентками без бронхообструктивной патологии. Заключение. Наличие ХОБЛ способствует утяжелению течения постменопаузального ОП

О-RADS and ADNEX MR scoring system: standardization of assessment and modern approaches to stratification of ovarian malignancy risks

This article reviews the studies published over the recent 10 years about diagnostic imaging of ovarian lesions (OL). We discuss the current classification systems considering the imaging criteria and the risks of malignancy as well as the ways of optimizing the treatment of patients. There are a number of methods of evaluation and interpretation of diagnostic data obtained using ultrasound as a first line method for OL visualization. To report the results, there is a unified terminology system O-RADS (Ovarian-Adnexal Reporting and Data System) developed specifically for ultrasound examinations. In 2013, the ADNEX MR (adnexal lesions magnetic resonance imaging) scoring system (AMRSS) was developed to standardize magnetic resonance data. That system combines the analysis of both basic-anatomical and functional MR-images and allows one to classify ovarian tumors by the risk of malignancy. Although O-RADS and AMRSS are based on different diagnostic modalities, they complement each other for the diagnostic purpose. In this review, we analyze correlations between the results obtained with these two methods; we also address the possibility of using the above methods in combination in order to pursue a more comprehensive approach to diagnosis of ovarian cancer

Relapse-Free Survival and PD-L1 Expression in First High- and Low-Grade Relapsed Luminal, Basal and Double-Negative P53-Mutant Non-Muscular Invasive Bladder Cancer Depending on Previous Chemo- and Immunotherapy

The goal of this study was to assess how PD-L1 expression in tissue specimens of patients with main molecular subtypes of NMIBC (luminal, basal and double-negative p53-mutant) associates with relapsed-free survival in dependence on the tumor grade and prior treatment of primary bladder cancer. PD-L1 expressions on the membrane of neoplastic and CD8+ immune cells were assessed in tumor specimens (n = 240) of primary and relapsed luminal, basal and double-negative p53-mutant NMIBC. Association between relapse-free survival and PD-L1 expression was estimated for high-and low-grade relapsed NMIBC according to previous treatment and their molecular profile, using the Kaplan–Meier method, and assessed by using the log-rank test. Potential confounders were adjusted by Cox regression models. In a group of patients who underwent only TUR without intravesical therapy, there were significant differences in relapse time between high-and low-grade tumors in basal and luminal molecular subtypes; for basal relapsed carcinoma, RFS was shorter in cases where tumors were less malignant. Both intravesical mitomycin and Bacillus Calmette–Guerin (BCG) therapy significantly extended the time of recurrence of low-grade luminal and basal bladder malignancies with no intergroup differences in double-negative NMIBC. PD-L1 expression status was associated with RFS for luminal relapsed NMIBCs in the group without previous frontline intervention, and with RFS in the group of patients with luminal relapsed bladder cancer previously utilized BCG. Obtained results may be considered as a promising approach for further clinical implementation. © 2020 by the authors. Licensee MDPI, Basel, Switzerland

Treatment efficacy of chronic myeloid leukemia with imatinib in clinical practice

Imatinib (IM) treatment efficacy in 116 chronic myeloid leukemia (CML) patients in different studies was analyzed. Patient group was non‑selective with prospective enrollment. The study was based on real‑time patient’s register allows to treatment quality control due to clinical results. Cytogenetic response (CO), hematological data, and overall survival (OS) were used as criteria for the therapy efficacy. After 12 month of treatment in 46.4 % of CML patients in early chronic phase complete CO (CCO) was obtained, in 33.3 % — in the late chronic phase, and in 13.3 % — in accelerated phase. Deficit of daily imatinib dose and intervals in treatment schedule were made a negative influence on CO quality. The median of OS was 120 months.</p