Characteristics of mukoviscisidosis in the southern regions of Russia

Introduction. Cystic fibrosis (CF) is a  hereditary disease with genetic heterogeneity and clinical polymorphism. Expanding the range of knowledge about the characteristics of the course of the disease in different regions is important to achieve the goal of improving the quality and life expectancy.Purpose. Comparative analysis of the features of the course of CF in the subjects of the Southern Federal District, Stavropol Territory.Methods. Data from the National Register of Patients of the RF MV 2016 were used. Results: there are clinical and genetic features between the regions of the Southern Federal District and the Stavropol Territory of the North Caucasus Federal District and in general with the Russian Federation. Analysis of the data showed differences in indicators: the proportion of patients aged ≥ 18 is the lowest in the Republic of Crimea (14.9%), in the Rostov region the lowest average age of patients (9.0 ± 6.3), and the lowest age of diagnosis 2.2 ± 3.1 years. Late terms of diagnosis were revealed in the Stavropol Territory (4.0 ± 8.0 years), but here there is one of the highest average age of CF patients (14.1 ± 11.5), the proportion of adult patients (23.3%) and the lowest allelic frequency of F508del, which is determined by the high number of patients with a “soft” genotype. There is a high proportion of patients with an undetermined genotype. A low proportion of two identified genetic variants of the CFTR gene is registered in patients of the Republic of Crimea. A low frequency of Burkholderia cepacia complex and Achromobacter spp was revealed, and a high infection with non-tuberculous mycobacteria was revealed in the Rostov region. FEV1 in children and adults was lower in Rostov Region and Stavropol Territory. In all regions, there is a discrepancy between the seeding of flora and azithromycin therapy and the severity of the genotype with the use of pancreatic enzymes.Conclusions. Analysis of the data of the registry, which allows substantiating the need to study the regional characteristics of the course of CF in order to differentiate the planning of measures to improve the quality of medical care for patients with CF

Изучение эффективности, безопасности и оценка удовлетворенности ингаляционной терапией препаратом Тобрамицин-Гобби при синегнойной инфекции у детей с муковисцидозом

Study of efficacy, safety, and patient satisfaction with inhaled tobramycin (Tobramycin-Gobbi) in children with cystic fibrosis and pseudomonas infectionAim of the study was to assess efficacy and safety of Tobramycin-Gobbi in CF, as well as the patients’ satisfaction with the treatment.Methods. 35 children from 6 to 18 years with CF were enrolled in this non-interventional prospective cohort multicenter study. All children had P. aeruginosa in the respiratory tract (newly diagnosed, recurrent, or chronic infection). The children received inhalation treatment with Tobramycin-Gobbi in the following cycles: 28-day treatment/28-day break, for 6 months. The studied parameters included respiratory function, bacterial cultures of the respiratory tract with a bacterial count, growth and body weight, antibiotic therapy for the respiratory episodes. The children and parents filled in a questionnaire “Treatment satisfaction assessment” and assessed their state of health on the visual-analog scale before and after each treatment cycle.Results. P. aeruginosa was eradicated in 17.7% of cases (6 patients, including 2 newly diagnosed, 3 recurrent infections, and 1 chronic infection), reduced bacterial count, decreased number of courses of antibiotic therapy, improvement of FEV1. Adverse reactions were reported by one patient.Conclusion. The efficacy, safety, and tolerability of Tobramicine Gobbi were confirmed in the patients with newly diagnosed, recurrent, and chronic infection caused by P. aeruginosa.Антибактериальная терапия (АБТ) синегнойной инфекции при муковисцидозе (МВ) остается основным фактором, определяющим функцию легких и продолжительность жизни больных. Основным патогеном, который определяет степень тяжести течения МВ, продолжительность и качество жизни пациентов, является Pseudomonas aeruginosa.Целью исследования явилось изучение эффективности, безопасности и оценка удовлетворенности ингаляционной терапии препаратом Тобрамицин-Гобби при синегнойной инфекции у детей с МВ.Материалы и методы. В неинтервенционном проспективном когортном многоцентровом исследовании принимали участие дети (n = 35; возраст – 6–18 лет) с установленным диагнозом МВ, наличием синегнойной инфекции (первый высев, рецидивирующая и хроническая инфекция), наблюдавшиеся в 8 российских центрах МВ. В течение 6 мес. дети получали ингаляционную терапию указанным препаратом циклами по 28 дней ингаляций / 28 дней перерыв. Контролировались показатели респираторной функции, бактериальная флора дыхательных путей с оценкой степени обсемененности, показатели массы тела и роста, применяемая АБТ по поводу респиратор- ных эпизодов. Дети и их родители заполняли анкету пациента «Оценка удовлетворенности препаратом», при этом отмечалось самочувствие по визуальной аналоговой шкале до начала лечения и после каждого цикла приема препарата.Результаты. На фоне терапии в 6 (17,7 %) случаях (2 – с первичным высевом, 3 – с рецидивирующим, 1 – с хронической синегнойной инфекцией) выявлено отсутствие высева P. аeruginosa, уменьшение степени обсемененности, сокращение числа курсов АБТ, улучшение показателей объема форсированного выдоха за 1-ю секунду. Зарегистрированы нежелательные побочные реакции (n = 1).Заключение. Показана эффективность препарата Тобрамицин-Гобби при первичном высеве, интермиттирующей и хронической инфекции, вызванной P. аeruginosa, его безопасность и хорошая переносимость

Эффективность и безопасность биоаналогичного лекарственного препарата Тигераза® (дорназа альфа) при длительной симптоматической терапии пациентов с муковисцидозом: результаты клинического исследования III фазы

The article discusses the results of a phase III clinical trial to compare the pharmacokinetics, efficacy and safety of the biosimilar medicinal product Tigerase® (dornase alpha) (Generium JSC, Russia) and the reference medicinal product Pulmozyme® (F.Hoffmann-La Roche Ltd, Switzerland) with the purpose of establishing their comparability for symptomatic treatment of patients with cystic fibrosis (CF).Methods. The study included 100 patients aged 18 years and older with a confirmed diagnosis of CF, who were divided into two groups by stratified randomization in a ratio of 1 : 1 based on the initial level of FEV1 (40–60% or > 60–100% from due value). Tigerase® or Pulmozyme® were used in a dose of 2.5 mg daily, once a day in the form of inhalations using a jet nebulizer compressor for 24 weeks.Results and discussion: The analysis of the data regarding the primary efficacy endpoint – changes in FEV1 – showed that in both groups (FAS population (Full analyses set) and PP population (Per protocol)), similar changes in FEV1 were observed. The average value of changes in FEV1 after 24 weeks of treatment compared with the initial level in the FAS population was –1.3% ± 9.8 % (95% CI (–4.1; 1.6)) in Group I (Tigerase®) and –1.9% ± 10.0% (95% CI (–4.7; 1.0)) in Group II (Pulmozyme®). The point estimate for the intergroup difference in changes in FEV1 (Group I – Group II) was 0.6%. The calculated 95% CI for the difference in changes in FEV1 in the FAS population was (–3.3; 4.6%]. In both populations studied, the intergroup difference in changes in FEV1 did not exceed 6%. During long-term treatment of patients with CF, no statistically significant differences were found in terms of efficacy (changes in FEV1 and FVC; number of exacerbations of chronic pulmonary disease and the number of days before its development; change in body weight; quality of life) between medicinal products in both studied populations (FAS and PP).Conciusion. A safety analysis demonstrated the comparability of medicinal products in terms of the incidence of adverse events. The frequency of detection of antibodies to dornase alpha during the study was similar in the treatment groups; the formation of antibodies did not lead to a decrease in the efficacy and safety of therapy.В статье рассматриваются результаты сравнительного клинического исследования III фазы по изучению фармакокинетики, эффективности и безопасности биоаналогичного препарата Тигераза® (дорназа альфа) (АО «Генериум», Россия) и референтного препарата Пульмозим® (Ф.Хоффманн-Ля Рош Лтд., Швейцария) с целью установления их сопоставимости для симптоматической терапии пациентов с муковисцидозом (МВ).Материалы и методы. В исследование включены пациенты (n = 100) в возрасте 18 лет и старше с подтвержденным диагнозом МВ, которые методом стратифицированной рандомизации были распределены на 2 группы в соотношении 1 : 1 по исходному уровню объема форсированного выдоха за 1-ю секунду (ОФВ1) 40–60 или > 60–100%долж. Указанные препараты применялись в дозе 2,5 мг ежедневно 1 раз в сутки в виде ингаляций с помощью джет-небулайзера-компрессора в течение 24 нед.Результаты. По результатам анализа данных первичной конечной точки эффективности, изменения ОФВ1 показано, что у пациентов обеих групп лечения в популяции полного набора данных для анализа (включая данные всех рандомизированных пациентов) (Full analyses set – FAS) и популяции в соответствии с протоколом (все рандомизированные пациенты, завершившие исследование без нарушений протокола) (Per protocol – PP) наблюдались схожие изменения показателей ОФВ1. Среднее значение изменения показателей ОФВ1 через 24 нед. терапии по сравнению с исходным уровнем в FAS-популяции составило –1,3 ± 9,8% (95%-ный доверительный интервал (ДИ) – (–4,1; 1,6)) в 1-й группе (Тигераза®) и –1,9 ± 10,0% (95%-ный ДИ – (–4,7; 1,0)) – во 2-й (Пульмозим®). Точечная оценка для межгрупповой разности изменения ОФВ1 (1-я – 2-я группы) составила 0,6%. Рассчитанный 95%-ный ДИ для разности изменения ОФВ1 в FAS-популяции составил –3,3; 4,6%. В обеих изучаемых популяциях межгрупповая разность по изменению ОФВ1 не превышала 6%. При длительной терапии пациентов с МВ статистически значимых отличий по показателям эффективности (изменение ОФВ1 и форсированной жизненной емкости легких; число обострений хронического бронхолегочного процесса и число дней до его развития; изменение массы тела; качество жизни пациентов) между указанными препаратами в обеих изучаемых популяциях (FAS и PP) не выявлено. По результатам анализа безопасности продемонстрирована сопоставимость исследуемого или референтного препаратов по частоте развития нежелательных явлений. Частота выявления антител к препарату дорназа альфа в ходе исследования в группах лечения была сходной; образование антител не приводило к снижению эффективности и безопасности терапии.Заключение. На основании результатов проведенного клинического исследования доказано, что препарат Тигераза® (АО «Генериум», Россия) является биологическим аналогом препарата Пульмозим® (Ф.Хоффманн-Ля Рош Лтд., Швейцария)

EFFECT OF ANTIBACTERIAL PREPARATIONS ON VIBRIO CHOLERAE EL TOR BIOFILMS

Aim. Study the effect of antibacterial preparations on biofilms of Vibrio cholerae El Tor. Materials and methods. Sensitivity of V. cholerae El Tor (6 strains) to various concentrations of antibacterial preparations (doxycycline, tetracycline, levomycetin, rifampicin, gentamycin, ceftazidime) was determined (MD 4.2.2495-09). Transmission electron microscopy was used for visualization of the effect of preparations on biofilms. Results. The values of minimal inhibiting concentrations of antibacterial preparations against biofilms have increased by 5 - 100 times compared with plankton cultures. Certain smoothing of strands between the bacterial cell and substrate, alteration of vibrios’ form, reduction of electron density of the matrix with an increase of its transparency were observed during electron-microscopy of the effect of antibacterial preparations on the biofilm. Conclusion. Study of the effect of antibacterial preparations on biofilms could increase effectiveness of rational antibiotics therapy of infections by selection of preparations that disrupt functioning of microbial communities

Influence of COPD on the development of renal disease and identification of nature of kidney with specific markers

It is still not quite clear how chronic obstructive pulmonary disease (COPD) affects the urinary system. The investigation of renal disease as systemic manifestation of COPD is still relevant

EFFECTIVE TREATMENT OF PATIENTS WITH CHRONIC HEART FAILURE AND DEPRESSIVE DISORDERS WITH NOOTROPICS DRUG PANTOGAM ACTIV

We investigate the efficiency of the inclusion nootropic drug Pantogam Activ in the complex therapy of 82 patients with heart failure, ischemic heart diseases, anxiety and depressive disorders. It was shown that an 8-week treatment with Pantogam Activ in most patients is accompanied by a significant reduction of anxiety and depressive disorders, increase exercise tolerance, improved autonomic regulation of heart function and decrease the frequency of supraventricular and ventricular arrhythmias, which is accompanied by a marked improvement in the quality of life

B-CELL SUBPOPULATIONS OF PERIPHERAL BLOOD IN SYSTEMIC LUPUS ERYTHEMATOSUS

Distinct changes of B-cell subpopulations are observed in most systemic rheumatic diseases associated with polyclonal B cell hyperreactivity. Immunosuppressive and cytostatic therapy may also differentially influence B lymphocyte subsets in these. We studied subpopulations of B cells in systemic rheumatic patients along treatment with cytostatics. We analyzed B cell phenotypes in ninety-nine blood samples from the patients with systemic lupus erythematosus (SLE, n = 25), systemic sclerosis (n = 27), Sjogren’s syndrome (n = 47) in the course of their hospital treatment. Control group consisted of 49 healthy blood donors. Phenotyping of blood B-cell subpopulations was performed by means of flow cytometry (Beckman Coulter, USA). Naïve B-cell subpopulations in SLE patients who underwent cyclophosphan treatment, were underrepresented, if compared with normal control group, whereas plasmablast levels were increased irrespectively of medication mode. B cell population exhibits a natural heterogeneity, thus making it necessary to analyze distinct B cell subpopulations as independent functional units, when studying different rheumatic diseases. The levels of plasmablasts which are active antibody producers, remain high, despite immunosuppressive therapy performed in SLE. Thus, therapy targeted against certain B cell subsets, could be able to provide a more effective treatment for the patients with systemic rheumatic diseases

Spatial Visualization of Data on the Antibiotic Resistance of Vibrio cholerae Strains Isolated in Russia

Aim. The aim was to develop an integrated online and updated geographic information system (GIS) for the systematiza tion and analysis of information on V. cholerae El Tor antibiotic resistance.Material and methods. The method of serial dilutions in a dense nutrient medium (MUK 4.2.2495-09) was used to determine the sensitivity/resistance to 22 antibacterial preparations of V. cholerae O1 El Tor strains isolated from people and from aquatic environmental objects in Russia in 2005–2016. The development of the Internet version of the GIS was carried out using programming languages HTML, JavaScript and PHP and cartographic data obtained from the corporation Rostelecom (Russia) and the community OpenStreetMap.Results. A comparative analysis of the antibiotic resistance of the strains by regions of the Russian Federation and by isolation time showed an increase of strains resistant to streptomycin, ampicillin, rifampicin and furazolidone, the appearance of cultures resistant to nalidixic acid and ceftriaxone, reduced resistance to trimethoprim/sulfamethoxazole in 2012–2016 compared to 2005–2009. In the Stavropol Krai, the isolated V. cholerae O1 El Tor were characterized by resistance to furazolidone (33.3%) and trimethoprim/sulfamethoxazole (100%); in the Primorsky Krai — to ampicillin, streptomycin, rifampicin (7%), furazolidone (43%), trimethoprim/sulfamethoxazole (100%); in the Irkutsk region and Kalmykia, to ampicillin (8.3% and 11%), furazolidone and trimethoprim/sulfamethoxazole (11% and 89%).Conclusion. The GIS developed allows to collect and analyze information on the antibiotic resistance of V. cholerae O1 El Tor, and to select the strains for given properties

Assessment of Population Immunity to SARS-CoV-2 Virus in the Rostov Region

By August 2020, more than 850000 cases of new coronavirus infection (COVID-19) caused by SARSCoV-2 were confirmed in the Russian Federation, with the Rostov Region as one of the ten most affected regions in Russia. The spread of the disease is largely determined by the state of population immunity in a certain area. Our research focuses on specific humoral immune response and estimates the level of herd immunity to SARS-CoV-2 virus among the population of the Rostov Region.Materials and methods. The study involved 3,048 people; the volunteers participating in the study were divided into seven age groups. The content of antibodies to SARS-CoV-2 was determined applying ELISA using a kit for the analysis of human serum or blood plasma for the presence of specific IgG to the nucleocapsid of the SARS-CoV-2 virus, manufactured by the State Scientific Center of Applied Microbiology and Biotechnology (Obolensk) in accordance with the instructions for use.Results and discussion. The assessment of seroprevalence to SARS-CoV-2 in the Rostov Region showed that the proportion of people positive for IgG to the new coronavirus was 16.5 %, the range of seropositive individuals in the general population was between 13.9 % and 19.1 % (p<0.05). There were no significant gender differences in the degree of seroprevalence with a positive result registered in 16.6 % of women and 16.5 % of men. A high level of humoral immunity to SARS-CoV-2 was established in individuals aged 1–17 against the background of low incidence rates, which may indicate the dominance of asymptomatic forms of the disease in this age group. The highest level of seropositivity was found in preschool children (33.6 %), students (29.3 %), employees (17.3 %), and education professionals (15.3 %)