«ВИТАМИНЫ ИНТЕЛЛЕКТА»

.(Педиатрическая фармакология. – 2007;4(4):114-115)

NATURAL MEDICATIONS AS AN ALTERNATIVE WAY TO TREAT THE PAIN SYNDROME IN RHEUMATOLOGY

Nonsteroid anti-inflammatory medications are the basis of pharmacotherapy for the pain syndrome, which is accounted for their anti-inflammatory, analgesic and febrifuge effects. The existing data on the dangers experienced during the prolonged application of the nonsteroid anti-inflammatory medications determines the necessity to look for the new medications with the similar pharmacodynamic effects. An alternative way to treat patients, suffering from chronic pain syndrome, might be plant extracts, in particular, zinaxin made of ginger and galangal in compliance with lipocap technology, which has anti-inflammatory, anesthetic and chondroprotective effects.Key words: children, pain syndrome, rheumatic diseases.</strong

NATURAL MEDICATIONS AS AN ALTERNATIVE WAY TO TREAT THE PAIN SYNDROME IN RHEUMATOLOGY

Nonsteroid anti-inflammatory medications are the basis of pharmacotherapy for the pain syndrome, which is accounted for their anti-inflammatory, analgesic and febrifuge effects. The existing data on the dangers experienced during the prolonged application of the nonsteroid anti-inflammatory medications determines the necessity to look for the new medications with the similar pharmacodynamic effects. An alternative way to treat patients, suffering from chronic pain syndrome, might be plant extracts, in particular, zinaxin made of ginger and galangal in compliance with lipocap technology, which has anti-inflammatory, anesthetic and chondroprotective effects.Key words: children, pain syndrome, rheumatic diseases

Clinical and experimental rationale for using phenylephrine with hypromellose for the treatment of extra accommodation strain in patients with myopia

M.V. Makhova1, E.V. Shikh2, V.V. Strakhov1, D.S. Blinov3,4, G.K. Poluosmak2, E.V. Semeleva5, E.V. Blinova2,4 1Yaroslavl State Medical University, Yaroslavl, Russian Federation 2I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation 3Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation 4National Research Nuclear University MEPhI, Moscow, Russian Federation 5N.P. Ogarev National Research Mordovia State University, Saransk, Russian Federation Aim: to perform a comparative analysis of the clinical efficacy of 2.5% phenylephrine with and without hypromellose for the treatment of extra accommodation strain in schoolchildren with myopia and to perform an experimental evaluation of the pharmacological effective of active ingredient of the finished dosage form (FDF) of preparations containing 2.5% phenylephrine with and without excipients. Patients and Methods: this clinical study enrolled 122 schoolchildren, 11–17 years old, with extra accommodation strain of various severity. The children were split into two groups. The group 1 patients received Irifrin® BK, containing 2.5% phenylephrine with hypromellose, one eye drop at the bedtime during 30 days, and the group 2 patients — Preparation A (2.5% phenylephrine without hypromellose) according to the same dosage regimen. The accommodative function was evaluated using the Speedy-i accommodation analyzer, and the coefficients of accommodation response before and 30 days after the treatment were determined. The experimental study was carried out in 40 sexually mature male rabbits of the Soviet Chinchilla breed to evaluate the development and duration of mydriatic effect and to measure the concentration of active ingredient — phenylephrine with hypromellose, as an excipient (Irifrin® and Irifrin® BK), phenylephrine without hypromellose (Preparation A) and phenylephrine with sodium hyaluronate as an excipient (Preparation B) in the aqueous humor within the eye anterior chamber using high-performance gas-liquid chromatography with tandem mass spectrometric detection. Results: the drug therapy of extra accommodation strain comprising 2.5% phenylephrine hydrochloride solution with hypromellose as an excipient (Irifrin® BK) demonstrated a decrease in severity of extra accommodation strain after 30 days of treatment. At the same time, Preparation B did not demonstrate its efficacy. In the experimental study, Irifrin® and Irifrin® BK were superior to Preparations A and B (without hypromellose as an excipient) as regards the peak mydriatic effect and the time required to reach maximal mydriasis. The peak phenylephrine concentrations in the aqueous humor within the eye anterior chamber were reached five minutes after instilling 1 drop of 2.5% phenylephrine with hypromellose solutions. These peaks were significantly higher than those observed after instilling Preparations A and B — phenylephrine in the same concentration but without hypromellose. Conclusion: the addition of hypromellose as an excipient to FDF of 2.5% phenylephrine solution helps to optimize pharmacodynamics and pharmacokinetics of the active ingredient by accelerating its inflow in the aqueous humor within the eye anterior chamber, increasing the topical bioavailability, and extending the exposure interval. It is likely that the above factors have underpinned the efficacy of Irifrin® and Irifrin® BK drugs used for the treatment of extra accommodation strain. The same results were obtained in this study comparing the clinical efficacy of 2.5% phenylephrine solution with hypromellose and its preparations without hypromellose used for the treatment of schoolchildren with extra accommodation strain amid myopia, as proven by the significant improvement of the accommodation indices during the treatment. Keywords: extra accommodation strain, mydriatic effect, peak concentration, rabbit, myopia, phenylephrine, hypromellose. For citation: Makhova M.V., Shikh E.V., Strakhov V.V. et al. Clinical and experimental rationale for using phenylephrine with hypromellose for the treatment of extra accommodation strain in patients with myopia. Russian Journal of Clinical Ophthalmology. 2023;23(1):33–38 (in Russ.). DOI: 10.32364/2311-7729-2023-23-1-33-38. </p

Влияние ингибиторов ангиотензиновых рецепторов и неприлизина на аортальную ригидность у пациентов с сердечной недостаточностью и сниженной фракцией выброса

Background. Compared with enalapril, sacubitril/valsartan reduces mortality from cardiovascular diseases and the number of hospitalizations for heart failure in patients with heart failure and reduced ejection fraction (HFrEF). These benefits may be related to effects on hemodynamics and cardiac remodeling. The aim of the study is to determine the effect of sacubitril/valsartan on aortic stiffness and cardiac remodeling compared with enalapril in HFrEF. Materials and methods. In this long-term outpatient study, 100 patients with HFrEF received sacubitril/valsartan or enalapril. The primary endpoint was the change in arterial impedance (aortic stiffness characteristic) over a 12-month follow-up. Secondary endpoints included changes in N-terminal cerebral natriuretic propeptide (NT-proBNP), ejection fraction, left atrial volume index, E/e index, left ventricular end-systolic and end-diastolic volumes; left ventricular-arterial index (Ea/Ees). Results. During 12 months of follow-up, 100 patients showed significant differences between the groups with respect to changes in arterial impedance, which decreased from 224.0 to 207.9 dynes s/ cm5 in the sacubitrile/valsartan group and increased from 213.5 to 214.1 dyne s/cm5 in the enalapril group (difference between groups: 9.3 dynes s/ cm5; 95% CI: from 16.9 to 12.8 dynes s/cm5; p = 0.69). Also, there were intergroup differences in the change in left ventricular ejection fraction and Ea/Ees index. NT-proBNP level, left ventricular end-diastolic and systolic volume index, left atrial volume index, E/e index were reduced in the sacubitril/valsartan group. Conclusions. Treatment with sacubitril/valsartan compared with enalapril resulted in a significant reduction in aortic stiffness in HFrEF.Обоснование. По сравнению с эналаприлом сакубитрил/валсартан снижает смертность от сердечно-сосудистых заболеваний и количество госпитализаций при сердечной недостаточности у пациентов с сердечной недостаточностью и сниженной фракцией выброса. Эти преимущества могут быть связаны с влиянием на гемодинамику и ремоделирование сердца. Цель исследования определить, какое влияние оказывает сакубитрил/валсартан на ригидность аорты и ремоделирование сердца по сравнению с эналаприлом при сердечной недостаточности со сниженной фракцией выброса. Методы. В данном длительном исследовании в амбулаторно-поликлинических условиях 100 пациентов с сердечной недостаточностью со сниженной фракцией выброса получали сакубитрил/валсартан или эналаприл. Первичной конечной точкой было изменение артериального импеданса (характеристики ригидности аорты) в течение 12-месячного наблюдения. Вторичные конечные точки включали изменения N-терминального мозгового натрийуретического пропептида (NT-проBNP), фракции выброса, индекса объема левого предсердия, индекса E/e, индексов конечного систолического и конечного диастолического объемов левого желудочка, индекса левожелудочково-артериального сопряжения (Ea/Ees). Результаты. В течение 12 мес наблюдения у 100 пациентов выявлены существенные различия между группами в отношении изменений артериального импеданса, который снизился с 224,0 до 207,9 дин с/см5 в группе сакубитрил/валсартана и увеличился с 213,5 до 214,1 дин с/см5 в группе эналаприла (разница между группами: 9,3 дин с/см5; 95%-й ДИ: от 16,9 до 12,8 дин с/см5; p = 0,69). Также наблюдались межгрупповые различия в изменении фракции выброса левого желудочка и индекса Ea/Ees. Уровень NT-проBNP, индекс конечного диастолического и систолического объемов левого желудочка, индекс объема левого предсердия, индекс E/e были снижены в группе сакубитрил/валсартана. Заключение. Лечение сакубитрил/валсартаном по сравнению с эналаприлом привело к значительному снижению ригидности аорты при сердечной недостаточности со сниженной фракцией выброса

Этиология бактериальных инфекций, связанных с оказанием медицинской помощи, и антибиотикорезистентность основных возбудителей у пациентов, госпитализированных с COVID-19: ретроспективный анализ

Background. One of the complications in patients hospitalized with COVID-19 is a secondary bacterial infection. Its frequency can reach 15%, which makes it important to determine the etiology and antimicrobial resistance of the key pathogens responsible for the development of this pathology, in order to further improve the practice of prescribing and increase the effectiveness of antimicrobial chemotherapy. Aims to assess the etiological structure and antibiotic resistance of the main pathogens of SBIs to improve the practice of antibiotic prescription. Methods. This retrospective study reviewed medical records of the patients hospitalized with COVID-19 in the Moscow city hospital No. 4 between April 28 and November 1, 2020. Demographic, clinical outcomes, etiology, and antimicrobial resistance data of the SBIs were collected. Outcomes were also compared between patients who were classified as severe and critical on admission. Results. Among 3180 patients hospitalized with COVID-19, 220 (6.9%) patients had acquired SBIs, and 50.0% of cases were fatal. The mean age was 72.7 13.07 years. A higher mortality rate was observed in the group of critical patients (63%). 560 strains of bacteria isolated from the SBIs (58.8% isolated from lungs, 21% from urine and 20.2% from blood). 330 strains (58.9%) were Gram-negative bacteria. 109 patients had infections with mixed bacteria. 45 of them (20.5% of the total number of patients included in the study) had 2 pathogens, and 64 patients (29.1%) 3 or more strains. The top three bacteria of SBIs were A. baumannii (23.6%; 132/560), K. pneumoniae (22.9%; 128/560), and S. epidermidis (10.4%; 58/560). The isolation rates of carbapenem-resistant A. baumannii were 97%. Cefoperazone/sulbactam was the most active antibiotic against this pathogen with 62.1% sensitivity. Among K. pneumoniae strains, the level of resistance to carbapenems was 77.4% to meropenem and 54% to imipenem. The proportion of resistant strains to tigecycline and to colistin was 4 and 2.3% respectively. Meticillin resistance was present in 38.5% of S. aureus. 50% of E. faecium strains were vancomycin-resistant. Conclusions. Gram-negative bacteria, especially A. baumannii and K. pneumoniae, were the main pathogens, and the resistance rates of the major isolated bacteria were generally high, which indicates that more accurate use of antibacterial agents is necessary for SBIs in patients hospitalized with COVID-19.Обоснование. Одним из осложнений у пациентов, госпитализированных с COVID-19, является инфекция, связанная с оказанием медицинской помощи (ИСМП). Ее частота может достигать 15%, что обусловливает важность определения ее этиологии и антимикробной резистентности ключевых патогенов, ответственных за развитие данной патологии, для дальнейшего совершенствования практики назначения и повышения эффективности противомикробной химиотерапии. Цель исследования оценить этиологическую структуру ИСМП и антибиотикорезистентность основных возбудителей ИСМП с целью совершенствования практики назначения антибиотиков. Методы. В этом ретроспективном исследовании были проанализированы медицинские карты пациентов, госпитализированных с COVID-19 в ГКБ № 4 г. Москвы в период с 28 апреля по 1 ноября 2020 г. Получены демографические показатели, данные по клиническим исходам, а также установлена этиологическая структура ИСМП и устойчивость к противомикробным препаратам основных возбудителей ИСМП. Варианты клинических исходов также сравнивались между пациентами в тяжелом и критическом состоянии. Результаты. Из 3180 пациентов, госпитализированных с COVID-19, у 220 (6,9%) была зафиксирована нозокомиальная бактериальная инфекция, в 50,0% случаев с летальным исходом. Средний возраст пациентов составил 72,7 13,07 года. Более высокий уровень летальности наблюдался в группе пациентов в критическом состоянии (63%). За время исследования было выделено 560 штаммов бактерий (58,8% из легких, 21% из мочи и 20,2% из крови). 330 штаммов (58,9%) были грамотрицательными бактериями. У 109 пациентов определялась микст-инфекции. 45 из них (20,5% от общего числа пациентов) имели 2 патогена, а 64 (29,1%) пациента 3 и более микроорганизмов. Ведущими возбудителями ИСМП были A. baumannii (23,6%; 132/560), K. pneumoniae (22,9%; 128/560) и S. epidermidis (10,4%; 58/560). Частота выделения карбапенем-резистентных штаммов A. baumannii составила 97%. Цефоперазон/сульбактам был наиболее активным антибиотиком в отношении данного патогена с чувствительностью 62,1%. Среди штаммов K. pneumoniae уровень резистентности к карбапенемам составил 77,4% к меропенему и 54% к имипенему. Доля штаммов, резистентных к тигециклину и колистину, составила 4 и 2,3% соответственно. Уровень выявления метициллин-резистентных штаммов S. aureus составил 38,5%. 50% штаммов E. faecium были устойчивы к ванкомицину. Выводы. Среди выделенных бактериальных патогенов у пациентов, госпитализированных с COVID-19, преобладали грамотрицательные бактерии, в частности A. baumannii и K. pneumoniae. Показатели резистентности основных выделенных бактерий были высокими, что указывает на необходимость более точного использования антибактериальных средств для лечения нозокомиальных бактериальных инфекций у пациентов, госпитализированных с COVID-19

Russian language as a factor of soft power in cross-cultural communication: Overcoming the crisis

The relevance of the work is determined by the need for a theoretical understanding of the problem of cultural interaction in the modern world. The process of globalization, which is underway, leads to the expansion of interrelationships and interdependencies of different peoples, including the problem of learning the specifics of cultures in the context of building an efficient local and global dialog based on the soft power policy. The purpose of the article is to analyze the crisis of the soft power policy in the spread of the Russian language as the most important tool of ethnic self-preservation. The methodological basis of the study consists of theoretical methods: the synthesis method is applied to study the problematic area of interaction between language and culture, in particular when considering the soft power policy. The combination of descriptive, comparative, and historical methods, as well as methods of classification and analytical reading, contributed to the formation of the author’s understanding of the problem. The article presents the author’s study of the soft power policy in the Russian education system. It discusses the signs of a crisis in the implementation of the soft power policy that has manifested themselves, on the one hand, through the changes of the main state documents regulating the education process, and on the other hand, the real results of the Russian language study are revealed. Upon analysis, the authors have identified and formulated a number of contradictions in the practice of the Russian language teaching in terms of the soft power policy application and also have come to the conclusion that, to overcome the crisis in the Russian language teaching, some viable options should be taken into account such as strong intellectual potential, experience and traditions of the national school. © 2019, Slovenska Vzdelavacia Obstaravacia. All rights reserved

Expert Council: promising areas of systemic enzyme therapy in gynecology

Yu.E. Dobrokhotova1, A.A. Khryanin2, E.V. Shikh3, L.Yu. Karakhalis4, I.M. Ordiyants5, E.A. Kogan1, A.V. Yakimova2, I.N. Korotkikh6, N.I. Kokhno7 1Pirogov Russian National Research Medical University, Moscow, Russian Federation 2Novosibirsk State Medical University, Novosibirsk, Russian Federation 3I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation 4Russian University of Peoples' Friendship, Moscow, Russian Federation 5Kuban State Medical University, Krasnodar, Russian Federation 6N.N. Burdenko Voronezh State Medical University, Voronezh, Russian Federation 7LLC “Center of Reproduction and Genetics”, Moscow, Russian Federation The interdisciplinary scientific and practical conference «Expert Council: promising areas of systemic enzyme therapy (SET) in gynecology» under the auspices of the National Association of Obstetricians-Gynecologists and Reproductologists "Women's Health" was held in Moscow on December 02, 2022. The conference brought together specialists from multiple Russian regions. The development of effective treatment algorithms for infection-caused inflammatory diseases in the practices of obstetricians and gynecologists remains relevant in view of the continuous growth of antimicrobial resistance underpinned both by the irrational use of antibiotics and the biofilm-forming ability of infectious agents. The speakers shared their experience of using systemic enzyme therapy (SET) in the combination treatment of inflammatory diseases in obstetric and gynecological practice, as well as in the prevention of fibrous and adhesive complications of pelvic inflammatory diseases (PID) and gynecologic surgeries. It was pointed out that systemic enzyme therapy should be recognized as a justified component of the combination PID treatment which helps to reduce the duration and severity of symptoms due to its proven immunomodulatory, fibrinolytic and antiplatelet effects. The use of SET drugs reduces the duration of all stages of reparative regeneration along with tamping down the inflammatory response. The Expert Council Resolution provides recommendations on using SET in gynecology. Keywords: proteolytic enzymes, pelvic inflammatory diseases, endometritis, adhesions, antibiotic resistance, systemic enzyme therapy. For citation: Dobrokhotova Yu.E., Khryanin A.A., Shikh E.V. et al. Expert Council: promising areas of systemic enzyme therapy in gynecology. Russian Journal of Woman and Child Health. 2023;6(2):149–156 (in Russ.). DOI: 10.32364/2618-8430-2023-6-2-149-156. </p