The use of phytopreparations in the treatment of bronchopulmonary diseases: evidence base and practical experience

Respiratory diseases take the lead in the infectious pathology pattern of various organs and systems and are the most common. Acute bronchitis is inflammation of the bronchi due to a viral infection and is characterized by a persistent cough that can be productive or dry. The authors consider the use of herbal preparations as an effective symptomatic product for the treatment of cough of various origins. Medicinal herbs are widely used in medicine due to many useful properties and do not have any serious side effects. Ivy leaf (Hedera helix) extract preparations are common cough medicines available over the counter that are approved by the European Medicines Agency (EMA). Ivy (Hedera helix) leaves contain various biologically active components, but saponins are the main substance. Saponins are natural compounds that have a variety of biological effects. According to literature data, the action of saponins is determined not only by their bronchodilator and mucolytic properties: among additional therapeutic options of saponins are high anti-inflammatory activity, as well as antimicrobial, antifungal and antiviral effects. The article shows the potential for use of ivy saponins as carriers of pharmaceutical substances, which can significantly reduce the effective doses of certain drugs. Preparations containing ivy leaf extract are safe and approved for use even in new-borns. Also, herbal preparations with antiviral, immunomodulatory and anti-inflammatory potential become the object of study as a new strategy for treating COVID-19

Overview of Epizootological and Epidemiological Situation on Brucellosis in the Russian Federation in 2017 and Prognosis for 2018

Analysis of brucellosis morbidity rates in humans and animals across the Russian Federation in 2017 is presented. Epidemic situation on the infection is characterized as unstable, the incidence and number of people with brucellosis are reduced in reference to the average long-term indicators by more than 20 %, against the background of epizootic situation aggravation as regards brucellosis of farm animals. There are cases of group outbreaks of brucellosis in the Stavropol Territory, Lipetsk and Penza Regions. According to the Federal Service for Veterinary and Phytosanitary Surveillance, analysis of the cumulative epizootic state of the population of epidemically significant species of cattle and small cattle in 2017 defines the risk of brucellosis in the Russian Federation as “high.” In 2018, the unstable epidemic situation on brucellosis will remain; there is high probability of outbreaks with cluster human incidence, including in the territory that is free from brucellosis. Predicted for 2018 morbidity rates on brucellosis in humans will be below the level of the average long-term morbidity and may be within the range of 330–360 cases

ДОСТАВКА ПРЕПАРАТОВ В ЛЕГКИЕ: ПРОБЛЕМНЫЕ АСПЕКТЫ

Drug delivery to the lungs: issues of concernДоставка препаратов в легкие: проблемные аспект

Psychoemotional status of gynecological patients and develop pain in the postoperative period

An observational prospective 'longitudinal' cohort study was conducted in patients of the gynecological contingent on the basis at the Municipal Budgetary Institution 'Central City Clinical Hospital №1 of Oktyabrsky District* of Ekaterinburg. The severity of preoperative anxiety and depression, the level of pain during the first three days of the postoperative period, the time of postoperative recovery of patients, the overall satisfaction with the quality of postoperative analgesia were evaluated, the complications of the perioperative period were analyzed.Проведено обсервационное проспективное «продольное» когортное исследование у пациентов гинекологического контингента на базе МБУ «ЦГКБ №1 Октябрьского района» г. Екатеринбурга. Оценена выраженность дооперационной тревоги и депрессии, уровень боли в течение первых трех суток послеоперационного периода, время послеоперационного восстановления пациенток, общая удовлетворенность качеством послеоперационного обезболивания, проанализированы осложнения периоперационного периода

Features of Toxic Nephropathy Development during Antibiotic Therapy

Antibacterials can have nephrotoxic effects because medicinal products of this class are primarily excreted by the kidneys. The aim of the study was to analyse literature data on the mechanisms, risk factors and specific features of toxic nephropathy development during antibiotic therapy. The article considers mechanisms of development of acute interstitial nephritis, acute tubular necrosis, crystal deposits in the tubules, proximal or distal tubulopathy with electrolyte abnormalities during the use of antibiotics. Nephrotoxicity was shown to be most often associated with the use of aminoglycosides, beta-lactams, and vancomycin. The authors analysed the dependence of nephrotoxicity on antibacterial agent lipophilicity and drug-drug interactions. The main risk factors for developing nephropathy are older age; male sex; black race; hypovolemia; arterial hypotension; angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, non-steroidal anti-inflammatory drugs or their combinations; and individual genetic characteristics. Nephrotoxicity is associated with genetic characteristics of the systems responsible for metabolism and excretion of antibacterial products: cytochrome P450 isoenzymes, P-glycoprotein, multidrug resistance protein (MRP), multidrug and toxin extrusion (MATE), breast cancer resistance protein (BCRP), and organic anion transporters. Severe generalised infections change pharmacokinetic parameters of antibacterial products. This should be taken into account when prescribing the hydrophilic antibiotics that are excreted by tubular secretion and reabsorbed in the renal tubules. The study demonstrated the effectiveness of the method comprising a combination of dose adjustment based on therapeutic drug monitoring results and renal function monitoring for improving the safety of antibiotic therapy

STUDYING DEVELOPMENT OF POST-VACCINAL CELLULAR IMMUNITY AGAINST BRUCELLOSIS BY MEANS OF LYMPHOCYTE <i>IN VITRO</i> TESTS USING AN EXPERIMENTAL ANTIGENIC COMPLEX

Regulatory framework and methodological approaches to evaluation of immunological effects of vaccination against brucellosis are not established, and the degree of immunological post-vaccinal rearrangement is not yet developed. Due to leading role of cellular immunity in formation of immune protection against brucellosis, evaluation the cellular response in response to antigenic stimulation may be considered the most informative and objective approach to analysis of immune changes in the body during vaccination. In order to develop the most diagnostically informative methods for design of antigen-stimulation cell tests in vitro, a careful selection of a stimulating agent (antigen) is required, which should have a sufficient activating potential, thus providing specificity of reaction under in vitro conditions. The aim of the present study is to study the in vitro specific activity of a protein-polysaccharide antigenic complex from the Brucella abortus 19 BA strain (BrAg), and an opportunity of its application in order to assess the formation of post-vaccinal cellular immunity against brucellosis.The study was performed with white laboratory mice (n = 50) immunized with the Brucella abortus 19 BA strain. The control group (n = 50) consisted of laboratory mice that received a sterile saline solution in a volume of 0.5 ml. Blood samples were taken from immunized and control animals before vaccination, and 7, 14, 21, and 30 days after immunization. By means of flow cytometry, the activation molecules CD25, CD69, MHC II and CD95, expressed on T lymphocytes (CD3+CD69+, CD3+CD25+, CD3+CD95+, CD3+MHC+) were determined. To observe the development of immunity, the intensity of expression of T lymphocyte activation markers was calculated using the stimulation quotient. BrAg was used for specific in vitro stimulation of T lymphocytes. The liquid brucellosis allergen (brucellin) was used as an antigen for comparison, when studying opportunity of BrAg usage for assessing the postvaccinal immunity development.The following results were obtained: BrAg has pronounced specific activity, it did not cause non-specific in vitro reactions (activation) of T lymphocytes, thus enabling its application as a test antigen when evaluating development of adaptive vaccine immunity against brucella.Experimental testing of brucellosis antigen for carrying out the in vitro antigen-stimulated cellular reactions, aiming for evaluation of post-vaccinal immunity development against brucellosis, showed that the usage of BrAg promotes increase in diagnostic sensitivity of cellular reactions under in vitro experimental conditions. The applied experimental antigen is a quite promising tool for development of laboratory algorithms for brucellosis diagnostics, and assessment of actual vaccination efficiency in cohorts previously vaccinated against brucellosis

Comparative analysis of pain levels, preoperative anxiety, depression and laboratory parameters during uterine surgery

Purpose of the study was to determine the factors influencing the development of uncontrolled pain syndrome in patients who underwent uterine surgery.Цель исследования – установить факторы, влияющие на развитие неконтролируемого болевого синдрома у пациенток, перенесших операции на матке

Experience of Using Therapeutic Drug Monitoring to Control the Safety of Vancomycin in Intensive Care Unit Patients with Sepsis

Vancomycin is prescribed to patients in serious condition with infections caused by Gram-positive microorganisms; however, if the therapeutic plasma concentration of the medicinal product is exceeded, it can have a nephrotoxic effect.The aim of the study was to demonstrate the possibility of using therapeutic drug monitoring (TDM) to reduce the risk of developing nephropathy in intensive care unit patients with sepsis.Materials and methods: the study comprised a retrospective analysis of four clinical cases of patients with sepsis admitted to intensive care units of I.V. Davydovsky City Clinical Hospital in 2021 and treated with vancomycin. TDM of vancomycin plasma levels was performed by reverse-phase high-performance liquid chromatography with mass spectrometric detection.Results: using the four cases of septic patients, the study demonstrated that vancomycin at adequate case-specific doses may result in plasma concentrations beyond the therapeutic range. TDM of vancomycin concentrations helped to prevent further deterioration of renal dysfunction in one septic patient having developed acute kidney injury and to control the achievement of therapeutic vancomycin concentrations or timely adjust the dose to that effect in the other three cases.Conclusions: a timely correction of vancomycin dosing with plasma TDM allows for achieving high antimicrobial efficacy in patients with sepsis and minimising the nephrotoxic effect of the medicinal product. Studies of the feasibility of using TDM as a treatment personalisation tool for patients in serious condition will continue in the future

Analysis of Epizootiological-Epidemiological Situation on Brucellosis in the Russian Federation in 2018 and Forecast for 2019

Presented is the analysis of brucellosis incidence among humans and animals in the Russian Federation in 2018. Epizootiological situation in the regions of developed animal husbandry remains reasonably tense. In 2018, as in previous years, the foci of bovine cattle and small ruminant brucellosis were registered in the North Caucasian, Southern Federal Districts, Volga and Siberian Federal Districts, the share of which made up to more than 90% of all registered in Russia potentially hazardous as regards brucellosis areas and cases of the disease in animals. Against the background of long-term unfavorable epizootic condition, the incidence of brucellosis over the past three years was, on average, 14 % lower than the average long-term indicators. The greatest number of cases (94.1 % of the overall Russian incidence) is registered in the administrative subjects of the North Caucasus Federal District, Southern Federal District and Siberian Federal District, which have the maximum levels of brucellosis incidence in cattle (88.9 %) and small ruminants (95 %). In 2019, persistence of epidemiological problems in regard to brucellosis in the subjects of the North Caucasus Federal District (primarily the Republic of Dagestan, Stavropol Territory), the Southern Federal District (the Republic of Kalmykia, Volgograd and Astrakhan Regions), and the Siberian Federal District (the Tuva Republic, the Omsk and Tyumen Regions) is predicted. The number of human cases of brucellosis may be within the range of 290–310 cases (intensive incidence rate per 100 thousand population – 0.21)

Особенности развития токсической нефропатии при проведении антибиотикотерапии

Antibacterials can have nephrotoxic effects because medicinal products of this class are primarily excreted by the kidneys. The aim of the study was to analyse literature data on the mechanisms, risk factors and specific features of toxic nephropathy development during antibiotic therapy. The article considers mechanisms of development of acute interstitial nephritis, acute tubular necrosis, crystal deposits in the tubules, proximal or distal tubulopathy with electrolyte abnormalities during the use of antibiotics. Nephrotoxicity was shown to be most often associated with the use of aminoglycosides, beta-lactams, and vancomycin. The authors analysed the dependence of nephrotoxicity on antibacterial agent lipophilicity and drug-drug interactions. The main risk factors for developing nephropathy are older age; male sex; black race; hypovolemia; arterial hypotension; angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, non-steroidal anti-inflammatory drugs or their combinations; and individual genetic characteristics. Nephrotoxicity is associated with genetic characteristics of the systems responsible for metabolism and excretion of antibacterial products: cytochrome P450 isoenzymes, P-glycoprotein, multidrug resistance protein (MRP), multidrug and toxin extrusion (MATE), breast cancer resistance protein (BCRP), and organic anion transporters. Severe generalised infections change pharmacokinetic parameters of antibacterial products. This should be taken into account when prescribing the hydrophilic antibiotics that are excreted by tubular secretion and reabsorbed in the renal tubules. The study demonstrated the effectiveness of the method comprising a combination of dose adjustment based on therapeutic drug monitoring results and renal function monitoring for improving the safety of antibiotic therapy.Антибактериальные препараты могут оказывать нефротоксическое действие, поскольку препараты этой группы преимущественно элиминируются почками. Цель работы — анализ данных литературы о механизмах, факторах риска и особенностях развития токсической нефропатии при проведении антибиотикотерапии. Рассмотрены механизмы развития острого интерстициального нефрита, острого некроза канальцев, отложения кристаллов внутри канальцев, проксимальной или дистальной тубулопатии с аномалиями расходования электролитов на фоне применения антибиотиков. Показано, что нефротоксичность наиболее часто ассоциирована с применением аминогликозидных, бета-лактамных антибактериальных средств, ванкомицина. Проанализирована зависимость нефротоксичности от липофильности антибактериальных препаратов и межлекарственного взаимодействия. Определено, что основными факторами риска развития нефропатии являются пожилой возраст, мужской пол, негроидная раса, гиповолемия, артериальная гипотензия, прием ингибиторов ангиотензинпревращающего фермента, блокаторов рецепторов ангиотензина II, нестероидных противовоспалительных препаратов или их комбинации, индивидуальные генетические особенности. Отмечена связь нефротоксичности и генетических особенностей систем метаболизма и выведения антибактериальных средств: изоферментов цитохрома P450, Р-гликопротеина, белков семейства множественной лекарственной резистентности MRP (multidrug resistance-associated protein) и MATE (multidrug and toxin extrusion protein), белка резистентности рака молочной железы BCRP (breast cancer resistance protein). Тяжелая генерализованная инфекция изменяет фармакокинетические параметры антибактериальных лекарственных средств, что следует учитывать при назначении гидрофильных антибиотиков, которые выводятся путем канальцевой секреции и реабсорбируются в почечных канальцах. Показано, что коррекция дозирования антибактериальных лекарственных препаратов на основе результатов терапевтического лекарственного мониторинга в совокупности с контролем функции почек является эффективным методом повышения безопасности антибиотикотерапии