THE ONSET OF ANCA-ASSOCIATED SYSTEMIC VASCULITIS MASKING RHEUMATOID ARTHRITIS

The paper describes a case of microscopic polyangiitis (MPA), the first clinical manifestation of which has been joint damage characterized chiefly by arthralgias. The overproduction of rheumatoid factor and anticyclic citrullinated peptide antibodies served as the basis for assuming rheumatoid arthritis (RA). Two years after disease onset, there were the first signs of glomerulonephritis (GN) that further progressed to severe kidney failure. MPA was diagnosed by a renal biopsy that revealed the morphological pattern of immunonegative GN with glomerular crescents. The diagnosis was verified by the presence of serum antineutrophil cytoplasmic antibodies (ANCA). There were no X-ray bone changes typical for RA at a 10-year follow-up. The paper discusses whether it is important to incorporate ANCA-associated systemic vasculitis into a diagnostic search in patients with early arthritis, particularly when the latter is concurrent with involvement of the kidney or other organs

The Use of Computed Tomography in the Diagnosis of Jejunal Diverticulosis Complicated by Diverticulitis and Intestinal Bleeding

The jejunal diverticulosis is rare and accounts for approximately 0.5–1 % of the general population. Diagnosis of the pathology is difficult even in the presence of symptomatic complications (perforation, abscess, peritonitis, sepsis, intestinal obstruction and bleeding), therefore, it is often overlooked or delayed, which requires high awareness and vigilance of physicians. Emergency surgical interventions are performed due to the lack of clear clinical symptoms and reliable radiological data in an average of 25 % of patients with complications of diverticulosis. In the presented case, multislice computed tomography (MSCT) with intravenous contrasting revealed multiple diverticula of the jejunum with reactively altered walls, infiltration of the adjacent cellular tissue and small gas inclusions, indicating diverticulum microperforation. Esophagogastroduodenoscopy (EGD) was performed which confirmed the jejunum bleeding, and was followed by laparotomy which confirmed multiple jejunal diverticula with microperforation and bleeding. Thus, timely MSCT in combination with EGD allowed to avoid complications of jejunal diverticulitis

КЛИНИКО-ЭПИДЕМИОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА КОРИ У ВЗРОСЛЫХ ЖИТЕЛЕЙ АЛТАЙСКОГО КРАЯ

The aim of the study is to determine the clinical and epidemiological features of measles in the Altai territory. Materials and methods: a retrospective analysis of 92 medical histories of inpatient patients with a confirmed diagnosis of «Measles» at the age of 17 to 54 years, who were treated in the Infectious Departments of City Hospitals № 5 and №11 in Barnaul in 2015–2018, was made. Results: the epidemic situation of measles in the Altai territory is characterized by an increase of morbidity rate in 2015, as well as isolated cases in 2017–2018. The peculiarity of the outbreak of the disease was in-hospital infection of patients upon admission to medical hospitals and late diagnosis of measles, as well as the importation of infection from adjacent territories (regions of Russia and the Republic of Kazakhstan), which is confirmed by genotyping of the virus in patients. The development of the disease in 23,9% of those,who were vaccinated, was routinely observed in the age group older than 30 years. In the clinical picture of measles at the present stage, along with the classical manifestations, in 15.2% of patients in the first days of the disease gastroenteritis was marked, in 40,2% of patients the signs of hepatitis (cytolysis syndrome) were observed. Conclusion: the prevalence among the patientspersons, older than 30 years, may indicate the extinction of post-vaccination immunity. Timely immunization against measles in adulthood (after 30 years), will increase the effectiveness of measures to implement the program of elimination of measles in the Altai territory. The development of gastroenteritis up to the 5 days of the disease (on average 2,5±0.9 days), hepatitis in the period of height of the disease (in 15,2% and 40,2% of patients, respectively), determined the erroneous diagnosis of «Enterovirus infection», pseudotuberculosis, etc. and deserved the attention of practitioners.Цель: определить клинико-эпидемиологические особенности кори у взрослых на территории Алтайского края. Материалы и методы: проведен ретроспективный анализ 92 медицинских карт стационарного больного пациентов с подтвержденным диагнозом «Корь» в возрасте от 17 до 54 лет, находившихся на лечении в инфекционных отделениях КГБУЗГБ № 5 и № 11 г. Барнаула в 2015–2018 гг. Результаты: эпидемическая ситуация по кори в Алтайском крае характеризуется подъемом заболеваемости в 2015 г., а также единичными случаями в 2017– 2018 гг. Эпидемиологическими особенностями явились завоз инфекции из сопредельных территорий и из-за рубежа (Республики Казахстан, Турции, Мальдивских островов), несвоевременное установление диагноза кори при поступлении в медицинское учреждение и, как следствие, внутрибольничное инфицирование. Завозной характер инфекции подтвержден генотипированием вируса у заболевших. Развитие заболевания у 23,9% вакцинированных в плановом порядке наблюдалось в возрастной группе старше 30 лет. В клинической картине кори на современном этапе, наряду с классическими проявлениями, у 15,2% пациентов в первые дни болезни отмечены явления гастроэнтерита, у 40,2% заболевших – признаки гепатита (синдром цитолиза). Заключение: преобладание среди больных лиц старше 30 лет может свидетельствовать об угасании постпрививочного иммунитета. Дополнительное проведение иммунизации против кори в зрелом возрасте (после 30 лет) повысит эффективность мероприятий по реализации программы элиминации кори на территории Алтайского края. Развитие синдрома гастроэнтерита до 5-го дня болезни (в среднем на 2,5±0,9 сутки), гепатита в периоде разгара (у 15,2% и 40,2% больных соответственно) определяло постановку ошибочного диагноза «Энтеровирусная инфекция», «Псевдотуберкулез» и т.д. и заслуживает внимания практикующих врачей

Антитела к рецептор-связывающему домену спайкового белка SARS-COV-2: связь с возрастом, пневмонией, длительностью периода после COVID-19

Despite the rapid accumulation of facts about the humoral immune response in COVID-19, there are still no evidencebased answers to questions about the factors influencing the level and duration of the detection period of antibodies to SARS-CoV-2 in the blood.Objective: To assess the prevalence, clinical and demographic associations of IgG antibodies to RBD of the SARSCoV-2 spike protein at different times after COVID-19.Materials and methods. Residents of the Altai region of Russia, Caucasians aged 20-93 years, who had COVID-19 from May 2020 to February 2021 (n = 314), took part in a onetime observational study. The level of antibodies in the blood was measured by enzyme-linked immunosorbent assay 1-14 months after the onset of the clinical manifestation of COVID-19.Results. Anti-RBD IgG antibodies of the SARS-CoV-2 spike protein were detected in 86.9% of the study participants. The dependence of the antibody titer on the duration of the period after COVID-19 was not revealed. The antibody titer was positively correlated with the complication of COVID-19 pneumonia and the volume of lung tissue lesions. The presence of pneumonia COVID-19 and the volume of lung tissue lesions are positively associated with age. Age positively correlated with antibody titer regardless of the pneumonia COVID-19 in the anamnesis.Conclusion. IgG antibodies to RBD of the SARS-CoV-2 spike protein are present in most of the COVID-19 patients. The titer of these antibodies in adults depends on age, complications of pneumonia COVID-19, and probably persists up to 14 months after the first symptoms of infection appear.Несмотря на быстрое накопление фактов о гуморальном иммунном ответе при COVID-19, пока нет доказательных ответов на вопросы о факторах, влияющих на уровень и длительность периода обнаружения антител к SARS-CoV-2 в крови.Цель: оценить распространенность наличия, клинические и демографические ассоциации антител IgG к RBD спайкового белка SARS-CoV-2 в разные сроки после COVID-19.Материалы и методы. В одномоментном обсервационном исследовании приняли участие жители Алтайского края России, европеоиды, в возрасте от 20 до 93 лет, переболевшие COVID-19 в период с мая 2020 г. по февраль 2021 г. (n=314). Уровень антител в крови измеряли через 1–14 месяцев от начала клинической манифестации COVID-19 методом иммуноферментного анализа.Результаты. Антитела IgG к RBD спайкового белка SARS-CoV-2 обнаружены у 86,9% участников исследования. Не выявлено зависимости титра антител от давности COVID-19. Титр антител положительно коррелировал с осложнением пневмонией COVID-19 и объемом поражений легочной ткани. Наличие пневмонии COVID-19 и объем поражений легочной ткани положительно связаны с возрастом. Возраст положительно коррелировал с титром антител независимо от наличия пневмонии COVID-19 в анамнезе.Заключение. Антитела IgG к RBD спайкового белка SARS-CoV-2 имеются у большей части переболевших COVID-19. Титр этих антител у взрослых зависит от возраста, осложнения пневмонией COVID-19 и может сохраняться до 14 месяцев после появления первых симптомов инфекции

INTERLEUKIN-23 IN PATIENTS WITH ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED SYSTEMIC VASCULITIDES: THE AUTHORS’ RESULTS AND A REVIEW OF LITERATURE

T helper type 17 (Th17) cell-mediated reactions can be implicated in the pathogenesis of antineutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitides (SV) (ANCA-SV). The relationship of clinical parameters to the serum levels of interleukin-23 (IL-23) that is involved in a Th17 response and the impact of therapy on this factor were studied in patients with ANCA-SV.Objective: to study serum IL-23 concentrations in patients having varying ANCA-SV activities and different induction treatment regimens as compared to healthy donors.Subjects and methods. Enzyme immunoassay was used to investigate IL-23 concentrations in 40 patients with ANCA-SV [median age, 44 years (20 to 65 years); female/male ratio, 1.11] and 8 healthy donors [median age, 47 years (21 to 66 years); female/male ratio, 1.67]. ANCA-SV was classified as granulomatosis with polyangiitis in 23 patients, as microscopic polyangiitis in 14, and as eosinophilic granulomatosis with polyangiitis in 3. Examinations were made in 26 patients with ANCA-SV in active stage and in 28 in remission (induced with rituximab in 22 of the 28 patients). The association was analyzed between IL-23 concentrations and disease activity, as well as clinical features of ANCA-SV.Results and discussion. Significantly elevated serum IL-23 concentrations were noted only in the untreated patients at the onset of ANCA-SV as compared to the healthy donors (median 41.9 and 13.1 pg/ml, respectively; p < 0.05). Both immunosuppressive and anti-B-cell therapy persistently decreased serum IL-23 concentrations (to 5.2–88 pg/ml).Conclusion. Further investigation of IL-23 and functionally related cytokines in ANCA-SV is promisin

LUNG INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS: WELL-KNOWN FACTS AND UNSOLVED ISSUES

<p class="MsoNormal"><span lang="EN-US">The review presents the data available in the literature on the clinical manifestation, diagnostic methods,  histological features, prognosis, and response to therapy of various lung injuries in systemic lupus erythematosus (SLE). The authors give their own data on the spectrum of pulmonary diseases in patients with SLE and describe a clinical case. </span></p

EXPERIENCE WITH EFFECTIVE COMBINED ANTI-B-CELL THERAPY WITH RITUXIMAB AND BELIMUMAB FOR REFRACTORY GRANULOMATOSIS WITH POLYANGIITIS (WEGENER'S) WITH SEVERE LUNG DAMAGE

Systemic vasculitis (SV) associated with antineutrophil cytoplasmic antibodies (ANCA) is characterized by severe multiple organ lesions with a poor prognosis. The successful introduction of standard therapy with cyclophosphamide (CP) and innovative anti-B-cell therapy with rituximab (RTM) for the treatment of ANCA SV gives no grounds to stop further searching for effective and safe therapy since about 10–15% of patients with ANCA SV are refractory to standard therapy with CP; after the latter, approximately 40% of patients develop recurrences, and granulomatous inflammation in the respiratory organs in granulomatosis with polyangiitis (GPA) can be resistant to RTM treatment, especially following its single cycle. There is increasing evidence that the efficiency of anti-B-cell therapy can be enhanced by adding belimumab (BLM). The paper describes a clinical case of effective sequential combined anti-B-cell therapy with BLM and RTM for remission induction in a female patient who has GPA with severe granulomatous lung injury refractory to previous therapy with CP (a total dose of 6.2 g) and a single cycle of therapy with RTM (a total dose of 2.6 g). BLM was used 12 months after RTM administration because there were no positive changes in lung injury. At 12 months after initiations of treatment with BLM (800 mg twice at a weekly interval, then 800 mg monthly), there was a substantial reduction in the lung parenchymal foci, as evidenced by multislice spiral computed tomography (MSCT); and the treatment was continued for another 6 months, thereafter discontinued due to the occurrence of ulcerative stomatitis. After its relief, RTM was again given at reduced dose cycles of 500 mg every 6 months; lung MSCT showed further improvement and remission achieved. BLM may be effective in treating the GPA patients who are refractory to CP and have an insufficient response to RMT treatment. Combined anti-B-cell therapy aimed at depleting SD20+ B-cells and at blocking BAFF may be a promising area for the treatment of patients with ANCA SV

Use of by-products of millet, amaranth and sorghum grains in bakery production

The use of additional gluten-free grain raw materials in the form of flour or secondary raw materials of cereal industry in the recipes of bakery products allows regulating the biotechnological processes of dough maturing and proofing, obtaining a finished product with new functional properties and high nutritional value. The purpose of the research is to justify experimentally the use of processed products of amaranth grain and sorghum for the production of bread of high quality and functionality. The methodological basis of the study is presented by a systematic analysis of the technology for the production of bakery products enriched with promising phyto-fortifiers. In accordance with the chosen methodology, the chemical composition is analyzed and the positive effect of the use of flour from millet grain, sorghum and amaranth seeds in the mixture with premium wheat flour on the quality of bread is experimentally justified. It was found that the introduction of these types of additional raw materials had a positive effect on the activation of baking yeast and the maturation of dough. In the production of bread from wheat flour of the highest grade, it is optimal to use these phyto-fortifiers in the amount of 3% by weight of the composite mixture

COMPARATIVE CLINICAL, LABORATORY, AND INSTRUMENTAL EVALUATION OF INTERSTITIAL LUNG CHANGES IN RHEUMATOID ARTHRITIS

Interstitial lung disease (ILD) is a common extra-articular manifestation of rheumatoid arthritis (RA). Objective: to study the associations of the data of high-resolution computed tomography (HRCT) and the esti- mate of diffusing lung capacity (DLC) with clinical and laboratory parameters in RA patients with and without ILD. Subjects and methods. 79 RA patients fulfilling the 1987 American College of Rheumatology criteria (61 women and 18 men) admitted to the Nasonova Research Institute of Rheumatology were included. Results. HRCT revealed signs of ILD in 58 (73%) cases. The patients with ILD were divided into three groups: 1) 18 (31%) patients with ground glass opacities; 2) 34 (58.6%) patients with fibrosis; 3) 6 (10.4%) patients with the honeycomb lung. Twenty-one (27%) patients with ILD were included in Group 4. In the ILD patients with ground glass opacities, the levels of anti-cyclic citrullinated peptide (ACCP) antibodies and rheumatoid factor (RF) were much above those in the patients without ILD (240 [166; 410.5], 480 [140; 850.5] and 73 [31; 101], 330,5 [118.5; 604.8], respectively). In the patients with ILD, the concentration of C-reactive protein (CRP) (46 [35; 91]) was higher than that in those without ILD (24 [18; 31]; p &lt; 0.05). In the ILD patients with ground glass opacities, DLC was considerably below that in those with ILD – 59.2±11.2 and 79.8±12.1% of the normal value, respectively (p &lt; 0.001). Conclusion. The associations found between ACCP antibodies and DLC, DAS28 and DLC may suggest that ACCP antibodies are implicated in the pathogenesis of ILD and the lung is involved in the immunoinflammatory process. The high percent of smokers detected in our investigation confirms the considerable role of smoking in the pathogene- sis of RA-associated ILD. In the RA patients with ILD, ground glass opacities must be an indicator of the activity of an immunopathological process in the lung