Aim.Clinical guidelines for the management of adult patients suffering from drug-induced liver injuries (DILI) are intended for all medical specialists, who treat such patients in their clinical practice.Key findings.The presented recommendations contain information about the epidemiological data, terminology, diagnostic principles, classification, prognosis and management of patients with DILI. The recommendations list pharmacological agents that most commonly cause DILI, including its fatal cases. Dose-dependent and predictable (hepatotoxic), as well as dose-independent and unpredictable (idiosyncratic) DILI forms are described in detail, which information has a particular practical significance. The criteria and types of DILI are described in detail, with the most reliable diagnostic and prognostic scales and indices being provided. The pathogenesis and risk factors for the development of DILI are considered. The clinical and morphological forms (phenotypes) of DILI are described. The diseases that are included into the differential diagnosis of DILI, as well as the principles of its implementation, are given. The role and significance of various diagnostic methods for examining a patient with suspected DILI is described, with the liver biopsy role being discussed. Clinical situations, in which DILI can acquire a chronic course, are described. A section on the assessment of causal relationships in the diagnosis of DILI is presented; the practical value of using the CIOMS-RUCAM scale is shown. All possible therapeutic measures and pharmacological approaches to the treatment of patients with various DILI phenotypes are investigated in detail. A particular attention is paid to the use of glucocorticosteroids in the treatment of DILI.Conclusion.The presented clinical recommendations are important for improving the quality of medical care in the field of hepatology.
Приоритетным при инфекции, обусловленной коронавирусами, является своевременная диагностика таких ее проявлений, как вирусная пневмо-ния. Наряду с оценкой клинического статуса значимым является применение таких инструментальных методов визуализации, как компьютерная томография (КТ) и рентгенография легких. В оценке легочной паренхимы при вирусных пневмониях, в том числе и вызванных COVID-19, рентге-нография малоинформативна. Авторы предлагают тактику ранней инструментальной диагностики поражений легких и их функционального со-стояния при коронавирусной инфекции. Большей диагностической ценностью при вирусных интерстициальных пневмониях обладает КТ, которую авторы предлагают проводить в первую очередь. В условиях массового поступления пациентов и загруженности КТ предлагается проведение ультразвукового исследования легких как методики динамического наблюдения и скрининга с учетом свойственных ей ограничений. При необхо-димости объективизации функции легких целесообразно проводить спирометрию согласно установленным стандартам. Авторы отмечают, что для двусторонней интерстициальной вирусной пневмонии характерен рестриктивный паттерн изменений. В случае его выявления оцениваются также диффузионная способность и общая емкость легких. Ключевые слова: коронавирусная инфекция, COVID-19, инструментальная диагностика, компьютерная томография, спирометрия. Для цитирования: Войтенков В.Б., Марченко Н.В., Скрипченко Н.В. и др. Значение инструментальных методов в диагностике пневмонии при ко-ронавирусной инфекции. Педиатрия. Consilium Medicum. 2020; 1: 20–25. DOI: 10.26442/26586630.2020.1.200120
Introduction. The increase in serum transaminases (ALT and AST) and the persistence of their high values is associated with morbidity and mortality from liver diseases. Bicyclol has anti-inflammatory and antioxidant effects, which formed the basis for this study.Materials and methods. The study enrolled 51 patients (MELD < 19); hepatitis stage – 84.4%, cirrhosis – 15.6%. Treatment: Bicyclol 75 mg/day for 12 weeks. Criteria of efficacy: dynamics of ALT, AST, CRP; general well-being (D-FIS scale).Results. After 4 weeks of treatment the share of patients with ALT normalization was 50,9% (p < 0,001); with AST normalization – 62.7% (p < 0.001); after 12 weeks - 79,5% and 89,7% respectively (p < 0,001). CRP decreased statistically significantly after 2 and 4 weeks from the beginning of treatment. The D-FIS questionnaire was filled in by 36 patients at the beginning of the study, in 4 weeks - by 35 patients, in 12 weeks – by 32 patients. Median D-FIS decreased from 12 (8.2; 32.2) to 8 (5; 29) points (p < 0,001) after 4 weeks of treatment, after 12 weeks – to 6.5 (3; 28.5) points (p < 0.001). The CRP was positively correlated with the D-FIS value. Fibrosis (“Fibromax”, “Fibroscan”) was studied in 10 additional patients, the dose of Bicyclol was 150/75 mg/day during 6 months, the result was statistically significant (p < 0.001).Conclusion. Application of Bicyclol leads to reduction of fatigue, local and systemic inflammation, fibrosis in chronic diffuse liver diseases regardless of etiology.
This review includes information about epidemiological data, development feature, phenotypes, principles of classification, diagnosis, and prognosis for drug-induced liver injury (DILI). Actual clinical recommendations regarding management of the DILI arising in the chemotherapy of cancer discussed. Drugs that can influence on individual pathogenetic mechanisms of growth and symptoms DILI are considered. Clinical studies for the prophylaxis and treatment of DILI associated with anticancer chemotherapy analyzed in detail. The prevention and treatment regimens for DILI in patients receiving chemotherapy and immunotherapy various localizations of cancer given both in research and in practical recommendations.
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