Aim. This work is aimed at studying the role of the small bowel bacterial overgrowth syndrome (SBBOS) in the pathogenesis of bronchial asthma (BA).Materials and methods. The study included 80 BA patients (45 and 35 patients allergic and non-allergic BA forms, respectively). Conventional laboratory and instrumental studies were conducted. SBBOS was confirmed by a hydrogen breath test with lactulose. Patients received conventional basal therapy with combined drugs (long-acting β2-adrenomimetics, and inhaled glucocorticoids). For SBBOS treatment, rifaximin (23 patients) or rifaximin followed by probiotic (B. bifidum, B. longum, B. infantis, L. rhamnosus) for 1 month (22 patients) was administered. Control studies were conducted on the 14th day and following 1 month of treatment.Results. A frequent combination of the small bowel bacterial overgrowth syndrome and bronchial asthma was revealed. 67 % and 43 % of the patients with the allergic form and non-allergic asthma form, respectively, are shown to suffer from SBBOS, p = 0.028. High levels of IgE (p < 0.01) and eosinophils in sputum (p < 0.001), combined with severe impairment of the function of external respiration (p < 0.01) in the case of SBBOS with allergic asthma reflect a more pronounced degree of sensitization of these patients. The correction of composition disorders of the intestinal microflora is accompanied by a statistically significant decrease in the immune response (p < 0.01) and improvement in the function of external respiration (p < 0.001).Conclusion. SBBOS is a significant factor, aggravating the course of bronchial asthma and playing an important role in the development and maintenance of sensitization of patients.
Aim. To explore the effectiveness of corticosteroids in patients with lung damage caused by SARS-CoV-2.Materials and methods. The retrospective study included patients with confirmed SARS-CoV-2 infection and lung damage diagnosed by computed tomography (CT), who was receiving low molecular weight heparin (LMWH). 56 patients included in Group 1 received dexamethasone 4–12 mg/day for 8–10 days after admission to the hospital. 30 patients included in Group 2 (control group) had no dexamethasone treatment. The laboratory and instrumental data obtained from the patients under admission and for the 8–10th day of the treatment were analyzed. Hospital mortality was evaluated by Kaplan — Meier method. To predict a lethal outcome, we have used the logistic regression method. Results. By the 8–10th day of hospitalization, only in the Group 1, there was a statistically significant decrease in the volume of lung tissue lesions by CT (p = 0.027), fibrinogen concentration (p = 0.001). A statistically significant decrease of the C-reactive protein concentration was noted for the both groups. Oxygen therapy was more often needed in Group 2 (26 patients — 87%) in opposite to Group 1 (36 patients — 64%) (p = 0.028). Hospital mortality was 3.6% in Group 1 and 13.3% in Group 2 (p = 0.177). There was a trend towards an increase in patient survival in Group 1 between 18 and 28 days of hospitalization (Mantel — Cox test, p = 0.095). Age (p = 0.012), percentage of CT lesions at the time of admission (p = 0.020) and assignment to the dexamethasone group (p = 0.080) were included in the logistic regression equation.Conclusion. For the patients with SARS-CoV-2 lung damage, treatment with dexamethasone 4–12 mg, started from the first day of hospitalization additionally to LMWH, contributes to positive CT dynamics on the 8–10th day and decreases hospital mortality.
Aim. Analysis of clinical manifestations, laboratory and instrumental examination data in SARS-CoV-2 patients with taking into account the disease severity and outcome.Materials and methods. The study included 92 patients with confirmed coronavirus infection, including 15 lethal cases, hospitalised at the Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology of the Sechenov University in April 2020. The analysis included demographic data, the presence of concomitant diseases, chest computed tomography (CT) results, laboratory tests (including SARS-CoV-2-diagnostic PCR, general and metabolic blood panels, coagulogram) and the duration of disease.Results. Patients infected with SARS-CoV-2 usually exhibit lymphopenia (p ≤ 0.001), leucocytosis, the elevated neutrophils (p ≤ 0.05), neutrophil-lymphocyte ratio (p ≤0,05), C-reactive protein (p ≤ 0.05), ferritin (p ≤ 0.05), D-dimer (p ≤ 0.05) and fibrinogen (p ≤ 0.05), altered prothrombin time (p ≤ 0.05) and INR (p ≤ 0.05). In a critical coronavirus infection, the pulmonary lesion exceeds 50% (corresponds to CT3 — CT4). The risk of critical SARS-CoV-2 infection increases with elder age (p ≤ 0.001), associates with the male gender and presence of concomitant diseases, such as obesity (p < 0.01), diabetes mellitus (p < 0.001), hypertension (p ≤ 0.001), CHD (p ≤ 0.001) and atrial fibrillation (p <0.05).Conclusion. The risk of severe and adverse coronavirus infection is significantly higher in elder comorbid patients.
Aim. To justify the need to include colorectal cancer (CRC) in the circle of differential diagnostic search for suspected irritable bowel syndrome (IBS).Background. In accordance with the latest Rome IV criteria for IBS, its diagnosis is mainly based on the assessment of clinical symptoms and objective examination data with a very limited list of additional studies. In this case, colonoscopy for suspected IBS is performed only in patients aged over 50 years old, provided a hereditary predisposition to CRC and the “alarm symptoms” are detected. It has been recently shown that CRC can proceed under the “mask” of IBS. However, colorectal and rectal tumours are often found in patients younger than 50 years old in the absence of hereditary predisposition to CRC and “anxiety symptoms”. This makes it necessary to conduct colonoscopy for all patients with suspected IBS.Conclusion. The list of diseases requiring differential diagnostics in patients with suspected IBS should always include CRC.
Aim. An efficacy assessment of steroid therapy in SARS-CoV-2 patients aged over 50 years with lung damage over 50 % (grade 3–4).Materials and methods. A retrospective study of 158 SARS-CoV-2 patients hospitalised in April—June 2020 was conducted under the inclusion criteria: age over 50 years, chest computed tomography (CT) for COVID-19-asso-ciated pneumonia, C-reactive protein (CRP) >50 mg/L, anticoagulant therapy, no contraindications to steroids, no biologic therapy. Cohort 1 patients (n = 96) received dexamethasone 4–12 mg/day, cohort 2 (n = 62) — a standard non-dexamethasone therapy.Results. Dexamethasone treatment associated with a significant alleviation of COVID-19-associated pneumonia in CT score (p = 0.001), reduced fibrinogen (p = 0.001), a trend to CRP reduction by day 8–10 and lower demand for oxygen therapy, including ventilatory support (p = 0.001). Mortality rate was 19.8 and 75.8 % in cohorts 1 and 2, respectively (p = 0.001).Conclusion. Dexamethasone therapy 4–12 mg/day in SARS-CoV-2 patients aged 50+ years with grade 3–4 CT changes receiving LMWH from start of hospitalisation significantly improved CT scores and reduced mortality.
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