Vol 24, No 12 (2022)


Algorithms for management of patients with severe A/H1N1 influenza: from diagnosis to respiratory support techniques. Guidelines

Avdeev S.N., Zaytsev A.A., Zhdanov K.V., Patsenko M.B., Chernov S.A., Stets V.V., Potekhin N.P., Sergoventsev A.A., Davydov D.V., Kryukov E.V., Chernetsov V.A.


In 2022, the incidence of swine (A/H1N1) influenza markedly increased. It causes acute lung injury similar to that caused by SARS-CoV-2. These practice guidelines focus on the management of patients with severe influenza: from the diagnostic algorithm to the specifics of therapy and the use of respiratory support techniques. The guidelines provide recommendations on the rational pharmacotherapy principles: antiviral, antibacterial, mucoactive, anticoagulant, and symptomatic. The need to avoid prescribing drugs that may worsen the condition of patients with A/H1N1 influenza that are effective in other viral lung diseases, including SARS-CoV-2, has been pointed out. A detailed review of the criteria for initiation and principles of respiratory support is given.

Consilium Medicum. 2022;24(12):843-850
pages 843-850 views

Updated the Maastricht VI/Florence Consensus recommendations for the treatment of Helicobacter pylori infection: A review

Pimanov S.I., Makarenko E.V.


The new Maastricht VI/Florence Consensus clarifies a number of provisions that were previously under discussion. It has been postulated that Helicobacter pylori infection always causes gastritis, regardless of symptoms or complications. Before making a convincing diagnosis of functional dyspepsia, it is necessary to exclude Helicobacter’s gastritis. Some provisions of the consensus, such as the “test and treat” tactic, require elements of a critical attitude, taking into account Russian regional conditions. About 90% of stomach cancers are due to H. pylori. Eradication of H. pylori makes it possible to prevent gastric cancer at any age in adulthood, but the effectiveness of such cancer prevention decreases with age. Bismuth quadruple therapy is preferred in the eradication therapy algorithm. Decreased value of triple treatment with clarithromycin. There is a rapid increase in H. pylori resistance to fluoroquinolones. Triple therapy with rifabutin is called the final eradication protocol.

Consilium Medicum. 2022;24(12):851-859
pages 851-859 views

Therapeutic efficacy evaluation of the reference drug ursodeoxycholic acid and its analogues in the biliary sludge dissolution: a meta-analysis

Kucheryavyy Y.A., Cheremushkin S.V.


Aim. To compare the therapeutic efficacy of the reference drug ursodoxycholic acid (UDCA) for Russian Federation (Ursofalk) and generic UDCA preparations of other manufacturers in the solution of biliary sludge (BS).

Materials and methods. The search for studies was carried out in the electronic databases MEDLINE/PubMed, EMBASE, Cochrane, Russian Science Citation Index (RSCI) until February 2022. Inclusion criteria for the meta-analysis were controlled trials, trials using the reference drug for RF – Ursofalk in one of the groups, diagnosis and subsequent assessment of the dynamics of resolution of BS according to transabdominal ultrasound, the absence of simultaneous use of other therapy that could affect therapeutic outcomes, a documented endpoint, which reflects the percentage of the total resolution of the BS in each of the compared groups.

Results. The final analysis included 6 studies involving 671 patients with BS (324 with Ursophalc, 347 with other UDCA). When using any UDCA preparations, the generalized frequency of BS dissolution within 3 months was 52.010% (95% confidence interval – CI 36.554–67.272; I2=94.07%), and after 6 months – 78.204% (95% CI 67.840–87.024; I2=86.90%). When using the RF reference drug Ursofalk, the generalized frequency of dissolution of BS during 3 months of therapy was 64.826% (95% CI 49.242–78.941; I2=87.53%), while when using other UDCA drugs it was 39.187% (95% CI 17.520–63.390; I2=95.24%). Ursofalk was more effective than other UDCA preparations (odds ratio – OR 3.183; 95% CI 1.495-6.777; I2=74.52%). A similar trend persisted when evaluating the effectiveness of a 6-month course of therapy (OR 4.614; 95% CI 2.881–7.388; I2=26.41%). Thus, the generalized frequency of dissolution of BS in the Ursofalk groups was 88.381% (95% CI 80.890–94.198; I2=64.98%), and for other UDCA drugs – 65.978% (95% CI 60.125–71.491; I2=43.22%).

Conclusion. This meta-analysis demonstrated that the reference drug UDCA for RF (Ursofalk) is more effective than generic UDCA drugs from other manufacturers in diluting BS.

Consilium Medicum. 2022;24(12):860-864
pages 860-864 views

Effect of obesity and sociodemographic factors on chronic pain: a cohort study in general practice

Morozova T.E., Vorob'eva O.V., Gertsog A.A.


Background. Obesity is a component of metabolic syndrome, a separate disease, and a predictor of most chronic diseases. In recent decades, increasing attention has been paid to the effect of obesity on chronic localized pain.

Aim. To determine the clinical characteristics of chronic localized pain depending on the body mass index and sociodemographic factors.

Materials and methods. The study enrolled 112 eligible patients, 37 (33%) males and 75 (67%) females aged 19 to 65 years, with a mean age of 40 [32; 40] years. Patients were divided into three groups depending on the body mass index. All patients underwent a comprehensive general clinical examination, including an assessment of the pain prevalence and duration, the number of exacerbations in the current year, the pain severity using the Numeric Pain Rating Scale (NPRS), and the number of pain descriptors.

Results. Obese patients experience more severe pain (p=0.004), are prone to prolonged (p=0.010) and frequent exacerbations (p=0.004), and use more lexical units to describe the pain (p=0.001). The main pain sites associated with obesity are the upper (p=0.023) and lower extremities (p=0.002). The overweight group falls between obese subjects and those with normal body weight and, by many parameters, is similar to the normal body weight group. It was noted that age worsens the pain; thus, with age, the number of exacerbations per year (p=0.006) and the duration of exacerbations (p=0.016) increase, and a direct correlation of age with the pain prevalence and the number of descriptors was revealed (r=0.271; p=0.004 and r=0.267; p=0.004, respectively). The most severe pain occurs in females. In contrast, physical activity reduces the number and duration of exacerbations and the prevalence of pain (p=0.004; p=0.048; p=0.015, respectively).

Conclusion. Obesity, older age, and female gender are associated with more severe chronic pain. Body weight loss in obese patients with pain, as well as lifestyle modification with increased physical activity, is an essential aspect of overall rehabilitation, although additional studies are needed to establish strategies for maintaining long-term effects.

Consilium Medicum. 2022;24(12):865-870
pages 865-870 views

The impact of sports on the normal functioning of the prostate gland: A review

Ershov A.V.


This article explores the relationship of physical activity to the normal functioning of the prostate gland. The biomechanism of hormonal activity during exercise was studied, and special attention was paid to the biomechanism of an actively working muscle and the release of myokines. The analysis of the relationship between myokines and the functioning of the prostate gland was carried out. It has been established that physical activity reduces the risk of developing prostate diseases and is an important method of prevention.

Consilium Medicum. 2022;24(12):871-875
pages 871-875 views

Stenosis of the trunk of the left coronary artery in idiopathic pulmonary hypertension. Case report

Ivanov S.N., Edemskiy A.G., Vasiltseva O.Y., Chernyavskiy A.M., Kalashnikova M.V., Seletskaya S.V.


The manuscript presents a clinical case of treatment of a patient with idiopathic pulmonary hypertension and a rare complication – left main coronary artery stenosis caused due to compression by the dilated pulmonary artery. This complication was clinically manifested by chest pain. The patient underwent percutaneous coronary angioplasty with stenting of the left main coronary artery and subsequent prescription of combined PAH-specific therapy. During the late follow-up examination in addition to clinical improvement and the absence of pain, 6-minute walking test distance increase, positive dynamics of echocardiography, right heart catheterization, as well as the laboratory marker of heart failure NT-proBNP were noted.

Consilium Medicum. 2022;24(12):876-881
pages 876-881 views

The role of interleukin-6 in the development of cardiovascular diseases: A review

Alieva A.M., Butenko A.V., Teplova N.V., Reznik E.V., Valiev R.K., Skripnichenko E.А., Sozykin A.V., Nikitin I.G.


Currently, the search and study of new biological markers that can provide early diagnosis of cardiovascular diseases, serve as a laboratory tool for assessing the effectiveness of treatment, or be used as prognostic markers and risk stratification criteria is ongoing. Our literature review indicates the potentially important diagnostic and prognostic value of assessing members of the interleukin-6 family. It is expected that further scientific and clinical studies will demonstrate the possibility of using members of the interleukin-6 family as an additional laboratory tool for the diagnosis, risk stratification and prediction of cardiovascular events in cardiac patients. It is necessary to evaluate in detail the possibilities of blockade of these interleukin-6 molecules in patients with cardiovascular diseases in vitro and in vivo.

Consilium Medicum. 2022;24(12):882-887
pages 882-887 views

Differential clinical signs of aphasia syndrome in acute and residual recovery periods. Directions of neurorehabilitation of patients with aphasia syndrome depending on the recovery period

Shcherbakova M.M.


Background. Speech and cognitive disorders of vascular genesis account for a significant percentage of the existing consequences of local disorders of cerebral circulation. Approximately 21–40% of stroke patients suffer from persistent aphasia, which gradually worsens the quality of life and rehabilitation results.

Aim. Improving the quality of neurorehabilitation of patients who have suffered a brain stroke.

Materials and methods. The analysis of differential clinical signs of aphasia syndrome in patients of neuro-intensive care and vascular neurological departments was carried out. The typical clinical symptoms of aphasia syndrome characteristic of ICU patients were identified, a rehabilitation direction was proposed that promotes rapid compensation of syndromes in the acute recovery period (up to 88% of cases). The clinical signs of aphasia syndrome at the late, residual recovery stage have been clarified. An effective method of neurorehabilitation of patients with aphasia syndrome in the late recovery period (significant positive dynamics up to 85% of cases) is proposed.

Results. Achieved high results in the reversibility of the aphasia syndrome, both at an early and late, residual, recovery stage.

Conslusion. Aphasia syndrome in acute and residual recovery periods has a certain specificity of its clinical manifestation. This factor must be taken into account: 1) when making speech diagnoses; 2) when planning rehabilitation programs. An effective rehabilitation technique for the aphasia syndrome involves a functional reorganization of mental processes, which allows speech thinking to either completely return or get as close as possible to its original state, regardless of the stage of recovery work.

Consilium Medicum. 2022;24(12):888-892
pages 888-892 views

Atopic diseases and oncopathology. What do they have in common? A review

Ustimenko V.I., Logvinenko N.I.


The increasing prevalence of cancer worldwide has influenced the interest of researchers to search for factors that may trigger oncogenesis in order to prevent and treat cancer. There is a burning question, can allergic diseases cause or prevent cancer? Numerous epidemiological studies have been conducted that have evaluated aspects of the relationship between allergic diseases and the occurrence of cancers of various localizations. The results of most of these studies are inconsistent, both in the nature of the course of the disease and in the variety of localizations of the occurrence of cancer. In this connection, two basic theories were suggested: the theory of immune surveillance and the theory of inflammation. This review analyzed current scientific work to estimate the incidence of neoplasms against the background of atopic diseases. The analysis of clinical studies shows inconsistent results of the association between allergic diseases and cancer. Several studies an inverse relationship between atopic diseases and cancer risk, which supports the theory of immune surveillance [brain tumor (glioma), pancreatic cancer, colorectal cancer, non-Hodgkin's lymphoma, and breast cancer, cancer of the mouth and throat, larynx]. At the same time, a number of studies note a positive association between atopic diseases and cancer, which confirms the theory of chronic inflammation (lung cancer and colorectal cancer combined with bronchial asthma). The lack of an unequivocal explanation testifies to the urgency of long-term prospective studies aimed at studying the risk factors of cancer in combination with atopic diseases with the subsequent development of risk scale for the purpose of patient stratification, screening, development of early detection programs and new approaches to the treatment of malignant neoplasms.

Consilium Medicum. 2022;24(12):894-898
pages 894-898 views

Interdisciplinary issues of clinical medicine

Anticoagulant therapy in a hemodialysis patient at high risk of thrombotic and hemorrhagic complications (case report)[ru]

Orudzheva S., Kudriavtsev A.N., Demidova V.S., Ushakov A.A., Magomedova S.D., Mitish V.A., Kuprin A.V., Bozh'eva E.I.



We present an attempt to preserve the knee joint in a patient on hemodialysis with stage IV lower extremity ischemia after acute popliteal artery thrombosis. Multifocal atherosclerosis and extended occlusion of the lower leg arteries precluded the technical possibility of revascularization. The patient refused the proposed hip-level amputation. An attempt was made to perform amputation at the calf level. Taking into account ischemic changes in the tissues of the foot and the lower third of the lower leg, therapy was required to improve microcirculation and the development of collaterals in the tissues of the upper third of the lower leg. Therapy with antithrombotic and vasoactive drugs was not effective, complicated by the condition of persistent hypocoagulation with an episode of bleeding. Femoral limb amputation was performed according to vital indications after hypocoagulation correction. The lack of reasonable recommendations for anticoagulant therapy in dialysis patients requires an individual approach to the selection of antithrombotic drugs and their doses, monitoring the state of blood coagulation using an integral method for assessing the hemostasis system – thromboelastography (TEG).

Consilium Medicum. 2022;24(12):

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies