Vol 24, No 1 (2024)

Aim – to study the changes in peripheral blood parameters and immune status in patients with mixed infection and to assess the risks of developing pulmonary fibrosis.

Material and methods. We examined 25 patients aged 23 to 72 years with co-infection in the acute phase of the disease, who were hospitalized at the infectious diseases hospital based in the OrSMU research center. The markers of cellular immunity, percentage of phagocytic cells and phagocytic index, the level of immunoglobulins of classes A, M, G, and cytokines were registered in all examined patients.

Results. The suppression of cellular immunity parameters, primarily the T-immune system, was revealed in elderly patients with co-infection, along with patients with an isolated course of COVID-19. In young and middle-aged patients, we found multidirectional changes in cellular immunity parameters during influenza and COVID-19 co-infection. An increase in IL-6 and TGF-β in the early stages of the disease was registered in patients with an isolated course of COVID-19 infection.

Conclusion. The changes in the immunity during co-infection are not pronounced enough for the development of lungs fibrous in the acute period of the disease. The possibility of detecting influenza viruses in patients with COVID-19 may change the strategy of treatment and suppression of cytokine storm reactions in critically ill patients.

Aim – to diagnose the state of nasal mucosa regeneration in rhinological patients in the postoperative period.

Material and methods. The study included examination of 206 patients after septoplasty with vasotomy of the inferior turbinates for a deviated nasal septum and vasomotor rhinitis. The patients were divided into 5 groups depending on the prescribed local regeneration-correcting treatment. All patients underwent cytological examination to assess destructive changes in the epithelium according to the method of L.A. Matveeva. The patients were monitored before surgery, on the 5th, 10th, 21st, 30th, 42nd and 60th days of the postoperative period.

Results. On the 5-10th day of the postoperative period, the destructive processes predominated in the rhinocytograms, and cell destruction indices were increased. Starting from the 21st day, the signs of proliferation were recorded, and the inflammatory reaction was decreasing. In the groups whose treatment regimens included reparants, the rhinocytograms showed a more rapid decrease in cell destruction indices and a full restoration of cellular representation. A more pronounced reparative effect was detected in a solution of sodium deoxyribonuclease and dexpanthenol.

Conclusion. In 2 months of the postoperative period, the rhinological patients represented the signs of impaired reparative regeneration. The local treatment for restoring the nasal mucosa in the postoperative period stimulated cytoprotective, anti-inflammatory, earlier and more complete regenerative effects.

Aim – to study the features of local production of IL-4, IL-6, IL-8, IL-10 in middle age and old age persons with chronic rhinosinusitis.

Material and methods. The study included patients aged 45 to 90 years with a confirmed diagnosis of "chronic rhinosinusitis" in the acute stage, who gave written informed consent to the study. The scope of the laboratory examination included determination of the cytokines IL-4, IL-6, IL-8, IL-10 concentration in nasal secretions by enzyme immunoassay.

Results. The maximum level of IL-4 was registered in younger persons with chronic rhinosinusitis (45–59 years old) compared with older persons. In our study, the maximum content of IL-6 occurred in a group of patients aged 75–90 years, while the cytokine level significantly exceeded IL-6 in a group of healthy age-related patients, which indicates a more pronounced inflammatory reaction in patients of the oldest group with chronic rhinosinusitis. Cytokine levels above 600 pg/ml were found mainly in patients with chronic rhinosinusitis. Patients of group 4 had high IL-10 values going beyond the range of the comparison groups.

Conclusion. The maximum level of macrophage-monocytic cytokines (IL-6 and IL-8) and anti-inflammatory IL-10 was determined in nasal lavage fluid in patients with chronic rhinosinusitis aged 75–90 years, the highest detectable values of IL-4 were characteristic of patients aged 45–59 years.

Aim – to evaluate the efficacy and safety of femto laser assisted phacoemulsification in coexistent cataract and glaucoma in combination with non-penetrating deep sclerectomy (NPDS) in long-term follow-up.

Material and methods. The results of surgical treatment of concurrent cataract and glaucoma were analyzed retrospectively. The patients were divided into groups according to the method of surgical intervention: group 1 – phacoemulsification with NPDS and implantation of the Xenoplast drainage (49 eyes, 43 patients); group 2 – femto laser assisted phacoemulsification with NPDS and Xenoplast drainage implantation (27 eyes, 23 patients).

Results. Before surgery, the average values of corneal-compensated intraocular pressure (IOP cc), pressure equated to Goldman pressure (IOP g) and corneal hysteresis (CH) in group 1 were 27.9±9.9 mm Hg, 27.7±8.9 mm Hg, 7.0±3.0 mm Hg.; in group 2 – 25.9±8.4 mm Hg, 24.7±7.7 mm Hg, 7.7±2.1 mm Hg, respectively. Five years after the surgical treatment, the average values of IOP cc, IOP g and CH in the 1st group were 17.1±3.8 mm Hg, 14.5±2.8 mm Hg, 8.5±2.6 mm Hg; in the 2nd group – 15.1±3.3 mm Hg, 15.3±4.7 mm Hg, 8.3±1.0 mm Hg, respectively. Normalization of IOP parameters and biomechanical properties of the corneoscleral membrane was noted in both groups, which persisted throughout the entire period of observation in the long-term postoperative period.

Conclusion. Combined phacoemulsification with femto laser assistance and non NPDS with Xenoplast drainage implantation is an effective and safe way to improve visual functions and normalize IOP with subsequent stabilization of the glaucoma process in the late postoperative period.

Aim – to clarify the clinical symptoms of COVID-19 in patients with the new coronavirus infection.

Material and methods. A total of 156 patients undergoing treatment in COVID-hospitals were included in the study. The patients were examined for the prevalence of COVID-19 clinical symptoms, COVID-19 clinical manifestations in the oral cavity and concomitant diseases.

Results. In the structure of general symptoms, the complaints of hyperthermia, general weakness and cough (more often dry) played a leading role. These symptoms were noted in the overwhelming majority of the examined patients. Two-thirds of patients reported body pain. The leading symptoms were also anosmia (in 68.6% of cases) and sweating (64.1%). More than half of the patients complained of shortness of breath (60.2%), difficulty in nasal breathing (55.1%), a feeling of tickling (58.3%) and pain (60.2%) in the throat. Among dental pathology, the loss of taste (57.5%) and hyposalivation (38.5%) were most common in patients. Bleeding gums were detected in 22.4% of the examined patients, which was most likely due to violations of the rheological properties of blood and changes in the hemodynamic provision of the parodontium during COVID-19.

Conclusion. The hemostasis disorders characteristic of the new COVID-19 infection certainly influenced the dental status, further destroying periodontal tissues. However, clinical manifestations of pathological effects might not occur immediately, but in the form of long-term complications. In this regard, it is necessary to dynamically monitor the patients who have undergone COVID-19.

Aim – to study the consumption patterns for antihypertensives in the population of individual regions of the Russian Federation (using the example of Moscow and St. Petersburg).

Material and methods. The raw data was collected using the following methods: content analysis, structural, comparative, logical, systemic, predictive, retrospective, graphic and marketing analysis. The results were normalized and processed using methods of mathematical statistics. The research focused on statistics for the range of antihypertensive drugs sold in the retail sector of the pharmaceutical market in Moscow and St. Petersburg.

Results. Moscow and St. Petersburg presented a wide range of drugs sold for treatment of arterial hypertension. Single active ingredient drugs predominated in the sales structure of both regions (Moscow – 90.08%; St. Petersburg – 85.64%). The consumption leaders among single active ingredient drugs were: ACE inhibitors (26.62%) in Moscow, and β-blockers (25.67%) in St. Petersburg. Among the fixed-dose combination drugs, the ACE inhibitors in combination with diuretics were leading in both regions, accounting for 3.54% and 5.15% in the structure of sales in Moscow and St. Petersburg, respectively. The most popular single active ingredient drugs and fixed-dose combination drugs for treating hypertension were rated. Several correlations were identified using mathematical and statistical analysis.

Conclusion. We have identified the most consumed classes of antihypertensives and INNs. We have described the relationship between the sales volumes of drugs prescribed for arterial hypertension (packages), the population size and the incidence of CSD in the studied regions.

Aim – to assess pharmacological and economic aspects of drug provision for patients with diabetes mellitus in the Novosibirsk region at federal and regional levels for the period of 2019–2021.

Material and methods. An array of data on drug provision for diabetic patients in the Novosibirsk region for the period of 2019–2021 was collected and subjected to analysis. The research process used a systematic approach with the following methods: logical analysis, content analysis, ABC analysis, XYZ analysis.

Results. For the period of 2019–2021, the burden on the regional drug provision system for diabetic patients had been steadily increasing. At the same time, the share of costs for drug provision for diabetic patients at the federal level continued to grow, despite the reducing number of covered prescriptions. Potentially, it could be explained by the constant increase in the average cost of a prescription. The ABC/XYZ inventory analysis of the consumed drugs and medical devices showed an increasing need for additional (non-hypoglycemic) medicines for the treatment of complications and concomitant diseases in diabetic patients. A greater increase in prescriptions of additional medicines and their funding was observed at the regional level in the period of 2019–2021.

Aim – to develop a method for isolation and determination of sertraline in biological fluids.

Material and methods. For the study we used "Zoloft" drug ("Pfizer", USA). The study equipment and substances: liquid chromatograph Shimadzu LC-20 Prominence (Japan) with detector SPD-M20A, gas chromatograph Agilent Technologies (USA) 7890 A / 5977 MSD, (program MassHunter GC-MS ), waters vacuum unit and cartridges for solid-phase extraction Oasis HLB; papain enzymes (MedFloran, Russia); trypsin, chymotrypsin, hyaluronidase (Lidaza) (Samson-Med LLC, Russia); test strips from different manufacturers under trade names: "Be sure", "NarcoCHEC", "FACTOR-MED". Urine samples were obtained after administration of the drug to laboratory animals – guinea pigs. The base of sertraline from a solution of its salt was isolated by liquid-liquid extraction (LLE) with organic solvents and their mixtures at pH = 10, 11 and 12 (pKa sertraline 9.48). Obtaining data on the effectiveness of blood sample preparation methods (liquid-liquid extraction, solid-phase extraction and enzymatic hydrolysis) for sertraline was carried out on enriched model samples of donor blood according to the method proposed by Cheger.

Results. Cross-positive urine test results were obtained with immunochromatographic test strips for derivatives of e 1,4-benzodiazepine and synthetic cannabimimetics ("spice"). The study with 1 mg/ml solution of sertraline gave a negative result. Desmethylsertraline, a major metabolite, was detected in the urine, a peak with a retention time of about 12.75 min, the peak of the original substance during the synthesis of sertraline – sertralinimine and the peak of the native sertraline with a retention time of about 12.65 min. A method for detecting sertraline by HPLC has been developed.

Conclusion. The use of the enzymatic blood hydrolysis with trypsin allows for increasing the degree of extraction by 1.5 times when compared with liquid-liquid extraction with chloroform, and by 2 times when compared with solid-phase extraction.

Aim – to assess the selectivity and metrological characteristics of the spectrophotometric method for procaine determination in combination drugs using a solid-phase extraction sorbent based on hypromellose.

Material and methods. The solid-phase extraction sorbent was obtained with hypromellose and ethyl cyanoacrylate; the procaine hydrochloride and sodium hydroxide formed the active centers. The sorbent was prepared using a standard method. The sorption capacity of the obtained sorbent samples for procaine was 10.2 ± 1.0 µg/g. For the study, we selected the combination drugs containing procaine and its salts, such as "Menovazin", "Sulfocamphocaine", and "Otolorin". The eluate optical density was registered using a SF-56 spectrophotometer (OKB SPECTR LLC) at an analytical wavelength of 292 nm in a cuvette with an optical layer thickness of 1 cm. The reference solution was a 0.1 M hydrochloric acid solution. To calculate the procaine content in the eluates, a calibration graph (dependence of eluate optical density on procaine concentration) was plotted in the concentration range of 1–20 mcg/ml. To evaluate the selectivity (specificity) of sample preparation in chromatographic separation of the combination drugs, the absorption spectra were registered in the wavelength range of 200–400 nm for eluates obtained using purified water and a 0.1 M hydrochloric acid solution. The procaine and benzocaine were identified in the eluate by the presence of absorption maxima at wavelengths of 222 and 286 nm for benzocaine, and 228 and 292 nm for procaine. For statistical processing of the experimental results and determination of metrological characteristics of the analysis method, we followed the GPM.1.1.0013 "Statistical processing of results of physical, physicochemical, and chemical tests".

Results. We have demonstrated the selectivity of the spectrophotometric determination of procaine in certain combination drugs using a solid-phase extraction sorbent based on hypromellose. The selective binding of the analyzed substance with active centers in the sorbent and stepwise elution with purified water and a 0.1 M hydrochloric acid solution during solid-phase extraction eliminated the interfering effect of drug components during the UV-spectrophotometry of procaine. The use of a hypromellose based sorbent improved the metrological characteristics and reduced the systematic error of the quantitative determination method by an average of 14.4%. The proposed methodological approach using a selective sorbent might be recommended as the quality control for combination drugs containing procaine and its salts.