Objective To evaluate fenebrutinib, an oral and highly selective noncovalent inhibitor of Bruton's tyrosine kinase (BTK), in patients with active rheumatoid arthritis (RA). Methods Patients with RA and an inadequate response to methotrexate (MTX) (cohort 1; n = 480) were randomized to receive fenebrutinib (50 mg once daily, 150 mg once daily, or 200 mg twice daily), adalimumab (40 mg every other week), or placebo. Patients with RA and an inadequate response to tumor necrosis factor inhibitors (cohort 2; n = 98) received fenebrutinib (200 mg twice daily) or placebo. Both cohorts continued MTX therapy. Results In cohort 1, the percentages of patients in whom American College of Rheumatology 50% improvement criteria (ACR50) was achieved at week 12 were similar in the fenebrutinib 50 mg once daily and placebo groups, and were higher in the fenebrutinib 150 mg once daily group (28%) and 200 mg twice daily group (35%) than in the placebo group (15%) (P = 0.016 and P = 0.0003, respectively). Fenebrutinib 200 mg twice daily and adalimumab (36%) were comparable (P = 0.81). In cohort 2, ACR50 was achieved in more patients receiving fenebrutinib 200 mg twice daily (25%) than placebo (12%) (P = 0.072). The most common adverse events in the fenebrutinib groups included nausea, headache, anemia, and upper respiratory tract infections. Fenebrutinib had significant effects on myeloid and B cell biomarkers (CCL4 and rheumatoid factor). Fenebrutinib and adalimumab caused overlapping as well as distinct changes in B cell and myeloid biomarkers. Conclusion Fenebrutinib demonstrates efficacy comparable to adalimumab in patients with an inadequate response to MTX, and safety consistent with existing immunomodulatory therapies for RA. These data support targeting both B and myeloid cells via this novel mechanism for potential efficacy in the treatment of RA.

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Functional intestinal diseases are often accompanied by the development of anxiety and depressive disorders, which are an important medical and social issue. The aim of this study is to investigate the prevalence and severity of anxiety and depressive disorders in patients with functional intestinal disorders depending on gender. Materials and methods. The study included 165 patients divided into 6 groups depending on the phenotype of functional bowel disorder: group I (n = 27) involved patients with functional constipation; group II (n = 28) included patients with functional bloating; group III (n = 27) comprised patients with functional diarrhoea; group IV (n = 27) included patients with irritable bowel syndrome and constipation; group V (n = 27) involved patients with irritable bowel syndrome of mixed type; and group VI (n = 29) included patients with irritable bowel syndrome and diarrhoea. The presence of anxiety and depression was assessed using the Hospital Anxiety and Depression Scale. Results and discussion. The highest frequency and severity of anxiety disorder was registered in the group of patients with irritable bowel syndrome and diarrhoea, and the lowest level was found in patients with functional constipation, bloating and diarrhoea. Subclinical and clinical manifestations of depression were the most often observed in patients with different phenotypes of irritable bowel syndrome: in 13 (48.2%) patients with constipation, in 10 (37%) with mixed syndrome and in 8 (27.6%) with diarrhoea. The incidence of anxiety and depressive disorders was higher in women with irritable bowel syndrome. Our results confirm the importance of pain in the formation of anxiety and depressive disorders in IBS patients. Conclusion. Female patients with irritable bowel syndrome demonstrate the higher risk of anxiety and depressive disorders.

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The aim of the work is a comprehensive assessment of the teaching quality at the Department of Internal Medicine №1 of the Poltava State Medical University. The assessment of monitoring was an anonymous online survey of VI year education medical students that was trained at the modules “Current practice of internal medicine” and “Emergency conditions in the clinic of Internal Medicine” in the context of the COVID-19 pandemic. It was shown that, despite the greatest difficulty of the “Cardiology” and “Hematology” cycles, the overall assessment of the teaching availability for all cycles was 4,16±0,416 points and the value of any cycle was not lower than 4 (5-point system). Given the conditions of distance learning in connection with the COVID-19 pandemic caused by the coronavirus SARS-CoV-2 the average score of student satisfaction with the skills acquired was 3.59 ± 0.593. Students noted that the most difficult mastering practical skills were on the “Emergency” (16.14%) and “Cardiology” (15.18%) cycles. This indicates that any cases, situational tasks, demonstration videos can’t replace live communication with the patient, under the guidance of a teacher-mentor, work with modern equipment and simulators. These results reflect that students need bedside teaching activities on patients’ experiences with teacher-mentor. A targeted approach to teaching and evaluating the learning process encourages feedback from students to improve the quality of educational services. Thus, the data allow us to analyze the effectiveness of distance educational quality using anonymous questionnaires, to get feedback and respond to the identified shortcomings.