ISSN (print): 2075-1753, ISSN (online): 2542-2170 Founder: Closed Joint Stock Company "Medical Publications" Editor-in-Chief: Prof. Victor V. Fomin, MD, Dr. Sci. (Medicine) Frequency / Access: 12 issues per year / Open Included in: White List (3rd level), Higher Attestation Commission List, RISC
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All the Copyright statements for authors are present in the standart Publishing Agreement (Public Offer) to Publish an Article in an Academic Periodical 'CONSILIUM MEDICUM'. READ the details online (tap to see in details) Publishing Agreement (Public Offer) to Publish an Article in an Academic Periodical 'CONSILIUM MEDICUM' The editorial board of the 'CONSILIUM MEDICUM' (ISSN 2075-1753 (Print), ISSN 2542-2170 (Online), mass media registration certificate ПИ № ФС77-63969 dated 18.12.2015, ЭЛ № ФС 77 - 69134 dated 24.03.2017) represented by editor-in-chief Victor V. 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Impact of MAFLD on quality of life and neuropsychological status in post-COVID patients: a cross-sectional analysis
Background. With the increasing prevalence of metabolic-associated fatty liver disease (MAFLD) among patients with metabolic syndrome, there is a growing incidence of neurocognitive decline, depression, and anxiety. Similar complaints are observed in post-COVID syndrome. This spectrum of disorders poses a significant socio-economic burden, substantially impacting quality of life and work capacity. Aim. To assess the quality of life, psycho-emotional, and cognitive status of patients with MAFLD who recovered from COVID-19-associated pneumonia (COVID-AP). Materials and methods. In a cross-sectional study utilizing telephone surveys, patients hospitalized for COVID-AP between December 2021 and January 2022 were evaluated for the need for subsequent hospitalization and any medical consultations after discharge; work capacity; memory impairments; stress levels; and quality of life using validated assessment scales. Results. A total of 71 patients were included in the final analysis: 17 patients with confirmed MAFLD and 54 controls. The groups were comparable by sex (p=0.55) and age (p=0.935). The MAFLD group demonstrated a higher frequency of impaired glucose tolerance (p<0.001) and a need for medication and/or dietary interventions to control blood sugar following COVID-AP (odds ratio – OR 6.22; p=0.015). Patients with MAFLD showed reduced quality of life due to difficulties in daily activities (OR 17.967; p<0.001), increased levels of anxiety and depression (OR 3.491; p=0.031), decreased health satisfaction (p=0.014); issues related to forgetfulness and memory (p=0.036), and short-term memory (p=0.013). MAFLD patients more frequently reported doubts about their ability to cope with personal problems (p=0.004) and dissatisfaction with their work capacity (p<0.001). Conclusion. MAFLD significantly impairs quality of life, increases the risk of psychological stress and depression, worsens memory and cognitive functions, and reduces work capacity. Integrated clinical approaches addressing both metabolic and post-COVID complications are necessary to improve overall patient outcomes.
Copyright (c) 2025 Turankova T.A., Verdiyan E.A., Novikova M.V., Brazhnikov A.I., Pavlov C.S. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
Metabolically associated fatty liver disease and cholelithiasis – depressing comorbidity in XXI century: A review
Metabolically associated fatty liver disease (MAFLD) is one of the most common liver diseases found in 25–30% of the adult population. Similarly, cholelithiasis is one of the most common pathologies of the biliary tract worldwide, which is diagnosed in 10–20% of the adult population. Cholesterol concretions are common components of the gastrointestinal tract, the pathogenesis of which is significantly influenced by metabolic factors such as dyslipidemia, obesity, insulin resistance and rapid weight loss. The review highlights the mechanisms of concretion formation in patients with MAFLD in terms of the effect of various components of the metabolic syndrome on impaired gallbladder motility and bile lithogenicity. Aspects of the progression of biliary pathology from Oddi sphincter dysfunction to the formation of chronic stone-free cholecystitis, sludge syndrome, and further to gallstone disease and postcholecystectomy syndrome, called biliary continuum, are noted. The mechanisms of concretion formation associated with the liver, intestinal microbiota, hyperinsulinemia, and insulin resistance are described. The nonspecific and systemic nature of the holinoblocking effect of neurotropic antispasmodics is noted, as a result of which their limited use in gastroenterology is noted. The opinion of experts is given on a more preferable strategy for prescribing antispasmodics with minimal systemic effects, in particular, the selective myotropic antispasmodic mebeverine hydrochloride (200 mg 2 times a day orally). The results demonstrating the effectiveness of Duspatalin in relieving pain associated with gallbladder and Oddi sphincter dysfunction, including after cholecystectomy, in patients with physico-chemical and clinically pronounced stages of cholelithiasis, as well as with biliary sludge, are presented. Special attention is paid to the treatment of the comorbid course of MAFLD and cholelithiasis. It is shown that in patients with MAFLD and biliary comorbidity (with sludge syndrome, formed concretions in the gallbladder), the approach of complex therapy with ademetionine (the original drug Heptral®) and mebeverine (the original drug Duspatalin®) seems extremely rational. Due to the complementary clinical effects, the use of this strategy improves liver function from the inside, the outflow of bile acids into the biliary tract, the outflow of bile, and the relief of cramps and pain.
Copyright (c) 2025 Akhmedov V.A. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
A clinical case of granulomatous interstitial nephritis in a young patient with nonspecific ulcerative colitis
The article describes a clinical case of granulomatous interstitial nephritis (GIN) in a 26-year-old woman with an ulcerative colitis (UC). The initial manifestation of inflammatory bowel disease (IBD) in the patient was severe abdominal bloating and pain appeared in 2018 on the background of stress. The clinical presentation was nonspecific, and irritable bowel syndrome was diagnosed. Probiotics were prescribed with minimal positive effect. Since January 2019, the patient has had frequent loose stools with mucus and streaks of blood and the diagnosis of irritable bowel syndrome have been changed to IBD. In March 2019, according to a colonoscopy with biopsy, a diagnosis of UC was established. Subsequently, it was repeatedly confirmed by colonoscopy and histological data. Treatment with 5-aminosalicylic acid (5-ASA) preparations has been prescribed. For the first time in January 2020, a slight increase in creatinine level was noticed. In August 2021, against the background of a recurrent course of UC, an increase in creatinine level by more than two times and a significant decrease in glomerular filtration rate were detected. Tubulointerstitial nephritis was diagnosed. Subsequently, a biopsy revealed a large interstitial granuloma consisting of epithelioid cells with an admixture of eosinophils and neutrophils. The diagnosis was clarified as GIN. The disease developed against the background of IBD–UC, which is atypical and necessitates ruling out other causes. During an exacerbation of UC, the patient was also diagnosed with high titers of Epstein–Barr virus. In this regard, EBV infection, as well as preparations of 5-ASA, can also be considered among the probable causes of the development of GIN. As treatment, the patient received three courses of intravenous pulse therapy with methylprednisolone, with a total dose of 9000 mg. The treatment proved effective, leading to a decrease in creatinine levels and proteinuria. Notably, the baseline therapy for UC with 5-ASA drugs was not discontinued during this period.
Copyright (c) 2025 Martynov A.Y., Latifatou Y., Ryabukhina N.D. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
The choice of treatment approach for mild and moderate ulcerative colitis: A review
Ulcerative colitis (UC) is a chronic immune-inflammatory disease of unknown etiology characterized by continuous non-granulomatous inflammation of the colon mucosa. Inflammation may be limited to the rectum but often extends to the proximal colon. Mild and moderate UC are diagnosed in most patients, especially in distal colon involvement. The goal of UC therapy is to achieve endoscopic remission. Clinical remission is an intermediate goal. Current Russian and international clinical guidelines recommend 5-aminosalicylic acid (mesalazine), an effective anti-inflammatory drug with the best safety profile among currently used classes of drugs, as first-line therapy for mild and moderate UC. The clinical efficacy of mesalazine depends on its concentration in the mucosa of the affected colon; therefore, rectal formulations are recommended for the treatment of distal UC. Suppositories are preferred for the treatment of ulcerative proctitis, as they deliver the highest concentration of the active substance to the rectum. If the inflammation spreads to the proximal colon, the optimal rectal formulations are microclysters or foam. Combination therapy with oral and rectal formulations of mesalazine is recommended for left-sided and total UC. Mesalazine granules deliver a higher concentration of mesalazine in the distal colon than tablets, so they are preferred in left-sided UC. The combination of mesalazine granules with suppositories can significantly improve treatment compliance. In case of insufficient response to mesalazine, it is recommended to add rectal budesonide. Compared to systemic glucocorticoids, it has high local anti-inflammatory activity and minimal side effects. This literature review presents current regimens and algorithms for the treatment of distal and total UC with oral and rectal formulations of mesalazine and rectal budesonide.
Copyright (c) 2025 Golovenko O.V., Loranskaia I.D., Osadchuk A.M. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
Silver–Russell syndrome: a literature review
Slow growth and growth retardation compared to age norms are a common reason for seeking specialized medical care from a pediatrician and pediatric endocrinologist. Anthropometric monitoring, including dynamic assessment of height and weight parameters, is the most important component of clinical examination in pediatrics, since it serves as an integral marker of somatic health and physical development of the child. The etiology of short stature is characterized by significant polymorphism, which necessitates a two-stage diagnostic algorithm: verification of the growth retardation itself and subsequent determination of its pathogenetic mechanisms. This condition can manifest itself in a wide range of pathological conditions, including somatotropic insufficiency. The list of nosologies associated with short stature includes: chromosomal abnormalities and genetic syndromes (Turner, Prader–Willi, Silver– Russell – SRS, Noonan syndromes), skeletal dysplasia of various origins; congenital and acquired metabolic disorders, intrauterine growth retardation, chronic somatic diseases; idiopathic forms (familial and non-familial variants), endocrine disorders. The presented review examines SRS from the perspective of a modern view of the problem of pathogenetic mechanisms, variants of clinical manifestations, as well as methods of diagnostic research and therapy. SRS is a rather rare genetic disease, the main manifestations of which are prenatal developmental delay, expressed in a deficiency of the newborn's body weight and length relative to gestational age, as well as postnatal hypotrophy, accompanied by various congenital anomalies caused by disorders of embryogenesis. Typical clinical signs of this syndrome include: relative macrocephaly at birth, triangular facial contour, disproportionate body type, clinodactyly, and the presence of areas of skin hyperpigmentation. Birth weight in children with SRS does not exceed 2500 g, height is less than 45 cm. One third of children with the syndrome are born prematurely, while the anthropometric indicators also do not correspond to the gestational age, which indicates a primordial nanism. Children have a decreased appetite and slow weight gain. The prognosis for SRS is generally favorable if the disease is diagnosed in time and adequate therapy is carried out. Most patients successfully adapt to society and develop intellectually within normal limits, despite short stature and specific appearance features.
Copyright (c) 2025 Antonova A.A., Sagitova G.R., Yamanova G.A., Yunusova M.T., Bekmurzaeva M.R., Gazueva A.S., Sereda V.M. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
Combination of non-alcoholic fatty liver disease and cholelithiasis: Pathophysiological and clinical relationships and specific features of therapy. A review
Non-alcoholic fatty liver disease (NAFLD) and cholelithiasis (CL) are widespread diseases worldwide. The combination of NAFLD and CL is a common clinical situation. CL and NAFLD have common risk factors and are closely associated with such concomitant diseases as obesity, dyslipidemia, and carbohydrate metabolism disorders. Numerous studies in different populations have shown that NAFLD is an independent risk factor for CL, and CL is an independent risk factor for NAFLD. Insulin resistance is now being considered as a key link between NAFLD and the development of cholesterol cholelithiasis. In addition, changes in the expression of transcription factors, including hepatic X-receptor, farnesoid X-receptor, and membrane bile acid receptors, play an important role. It leads to increased lipogenesis in the liver and to bile cholesterol supersaturation, contributing to the development of gallstones and fatty liver. An equally important role in the pathogenesis of both diseases is played by gallbladder dysfunction, which serves as an important link between the liver and the intestine within the hepatic-gallbladder-intestinal axis and supports the metabolic homeostasis of cholesterol, triglycerides, and bile acids. It is supported by evidence that cholecystectomy increases the risk of NAFLD, contributes to insulin resistance, and promotes fat accumulation in the liver. The choice of drug therapy in patients with a combination of NAFLD and CL is based on knowledge of the general pathophysiological processes typical of both diseases. Drugs should comply with the principles of multipurpose monotherapy, targeting as many therapeutic targets as possible, and their combination should potentiate each other’s pharmacological effects. The treatment of patients with a combination of NAFLD and CL is primarily based on weight loss through exercise and a Mediterranean diet, enhanced by psyllium-containing agents and butyric acid, a key mediator of the Mediterranean diet’s positive effects. The drug of choice in patients with a combination of NAFLD and CL is ursodeoxycholic acid, exerting a pathogenetic effect on both diseases.
Copyright (c) 2025 Topchii T.B., Ardatskaya M.D., Maslovskii L.V., Minushkin O.N. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
Association of the gut microbiome and metabolome with the dynamics of laboratory parameters in individuals with type 2 diabetes and obesity after bariatric surgery
Background. It is known that the gut microbial community has a significant impact on the health of the host organism. It has been shown that changes in the composition and metabolic potential of the microbiota occur in people with obesity and diabetes type 2 (T2D). However, the impact of the microbiota on metabolic changes after bariatric surgery remains unclear. Aim. To assess the influence of the gut microbiome composition on metabolic parameters in patients with obesity and T2D after bariatric surgery. Materials and methods. The study included patients with T2D and obesity, who were treated with bariatric surgery (gastric bypass). Before surgery, as well as 6 and 12 months after surgery, the anthropometric, laboratory parameters were measured, feces were collected for analysis of the intestinal microbiota. The microbiota composition was determined through sequencing of the 16S rRNA gene from stool samples. For a subset of patients, the stool metabolome was also studied. Results. After surgery, there was a significant positive trend in weight loss, glycemia, lipid spectrum parameters, and insulin resistance. However, patients did not achieve target levels of 25(OH) vitamin D and calcium. Taxa were identified whose abundance before surgery was associated with the dynamics of parathyroid hormone and vitamin D. The order Verrucomicrobiales was negatively associated with vitamin D dynamics, while the order Fusobacteriales, which includes hydrogen sulfide producers in the gut, was positively associated with the increase in parathyroid hormone. Interestingly, these bacteria were also elevated in patients with higher total cholesterol levels prior to intervention, whereas other H2S producers in the gut correlated with C-peptide levels. No significant associations between the metabolome and clinical parameters' were found; however, the correlation structure of microbiome and metabolome data in patients with obesity was examined. Conclusion. The study revealed an association between several intestinal microbiota species and metabolic parameters after bariatric interventions. These results are pilot and, if reproduced, may allow the prediction of the bariatric surgery effects on weight and glycemia based on the composition of the gut microbiota.
Copyright (c) 2025 Shestakova E.A., Klimenko N.S., Pokrovskaya E.V., Sineokaya M.S., Koshechkin S.I., Odintsova V.E., Shestakova M.V. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
Medical profile of a patient with obstructive sleep apnea
Background. Snoring and obstructive sleep apnea (OSA) are common problems that frequently bring patients to see an ENT physician. This study focuses on the structural characterization of patients with these complaints, analyzing the anatomical features of the upper airways that may predispose to the development of snoring and OSA. In the practice of otorhinolaryngologists, patients with snoring complaints constitute a significant proportion and require special attention due to the risk of developing a number of severe and life-threatening conditions, including during elective surgical interventions. Successful diagnosis and treatment of these conditions require a careful assessment of the anatomical features of the upper airways. The study considers such parameters as: comprehensive otorhinolaryngologic examination, determination of body mass index (BMI), analysis of general somatic pathology, analysis of cardio-respiratory sleep monitoring and other characteristics. Aim. To conduct a comprehensive analysis of the structure of patients with complaints of snoring and respiratory arrest during sleep in the clinical practice of an ENT doctor. Materials and methods. Thirty patients with complaints of snoring, daytime drowsiness, and sleep apnea were examined. A STOP-BANG questionnaire survey, BMI determination, analysis of general somatic pathology, comprehensive otorhinolaryngological examination, cardiorespiratory sleep monitoring, examination of a maxillofacial surgeon, allergist and therapist were conducted. Results. The mean age of the patients was 44±3 years. The predominance of men among the surveyed subjects was revealed – 90%, against 10% of women. According to the analysis of BMI pre-obesity was found in 13 patients, grade 1 obesity – in 5 patients, grade 2 obesity – in 4 patients, and grade 3 obesity – in 3 examined patients. Hypertension was found in 20% of patients, and pathology of the bronchopulmonary system was found in 10% of patients. Pathology of the maxillary system was detected in 4 (13.3%) patients. Among the diseases of ENT organs, 16% of the examined patients had chronic tonsillitis, 6.6% had hypertrophy of the pharyngeal tonsil. Every 3 patients had nasal septal deformity, chronic maxillary sinusitis in 3 (10%), allergic rhinitis in 6 (20%), vasomotor rhinitis in 8 (26%), and rhinosinusitis with nasal polyps – 3 (10%). History of operations on ENT organs: adenotomies – in 7 (23%) patients, uvulopalotoplasty – in 4 (13%) patients with an unsatisfactory result, injuries nose surgery was performed – in 9 (30%) patients, tonsillectomy – 5 (16%), septoplasty previously performed – 2 (6.6%). Survey: according to the STOP-BANG questionnaire, a low risk of OSA was found in 22% of patients, while an average risk and a high risk were detected equally in 39% of the examined patients. Respiratory monitoring during sleep revealed the following: 16.7% of patients had position-dependent snoring (associated with ENT pathology in 40% of cases), 60% had severe OSA (IGA 56±8/h), mainly due to obesity or hypertrophy of the palatine tonsils, which required CPAP therapy or surgical treatment, and the remaining patients had mild/moderate forms of apnea that were corrected using various treatment methods. Conclusion. The results obtained in this study demonstrate the widespread pathology of ENT organs and a high comorbid background in patients with complaints of snoring and confirm the relevance of assessing the state of the upper respiratory tract by a ENT doctor, and also emphasize the need for a comprehensive examination of this category of patients within the framework of a multidisciplinary team.
Copyright (c) 2025 Budkovaia M.A., Dakhadaeva P.M., Muzikin M.I., Burletova V.A., Samsonova K.O., Aslambekova A.A. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
Macrophages in the skin: role in physiological processes and in response to cosmetic procedures. A review
Macrophages are a heterogeneous population of immune cells derived primarily from bone marrow monocytes and embryonic yolk sac erythromyeloid progenitors, capable of altering their phenotype and functions depending on the microenvironment. This article presents a review of current knowledge on the origin, structure, and function of dermal macrophages, including historical data from the first observations by I.A.E. Goeze (1777), confirmed by W.F. von Gleichen-Russwurm, the term "Fresszellen" by K. Klaus, and the phagocytic theory of I.I. Mechnikov (1882–1884) to the M1/M2 dichotomy of Mills et al. (early 2000s). This paper summarizes literature data on the human monocyte-macrophage system in both normal and pathological conditions, taking into account the heterogeneity of classical monocytes as precursors of tissue macrophages, non-classical monocytes for endothelial homeostasis, intermediate and organ-specific macrophages (Langerhans cells in the epidermis, microglia in the central nervous system, and Kupffer cells in the liver). Data are presented on various macrophage phenotypes, from proinflammatory M1 with glycolytic metabolism and inducible nitric oxide synthase to reparative M2 with mitochondrial respiration and arginase-1, and their involvement in immune surveillance, skin protection, regeneration, angiogenesis, and tissue remodeling. The article presents an analysis of the role of macrophages in response to cosmetic procedures: ablative and non-ablative lasers 10600 and 1550 nm, microneedle RF, SMAS-lifting, injections of polylactic acid, calcium hydroxyapatite, the role of Langerhans cells in response to external stimuli of ultraviolet radiation, cosmetics, etc., the role of macrophages in the development of fibrosis M1-initiation, M2a-proliferation, M2c-resolution, SPP1+ with CXCL4 from platelets, PRP-hypothesis, regulation of the adipocyte population in dermal-associated adipose tissue dWAT, elimination of biomaterials. Attention is paid to resident dermal macrophages located perivascularly and perineurally in the papillary and reticular layers, their ability to proliferate in situ to maintain homeostasis, the synthesis of collagenase enzymes, elastase, hyaluronidase and cytokines that regulate the functions of dermal and epidermal cells.
Copyright (c) 2025 Kirsanova L.V., Araviiskaia E.R., Rybakova M.G., Sokolovskiy E.V., Bogatenkov A.I. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
Complex of amino acids, choline, and B-group vitamins for the improvement of early-stage metabolic dysfunction-associated steatotic liver disease (Translation to Russian)
Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the most common cause of chronic liver disease worldwide, affecting an estimated 25% of the global population. Up to 80% of individuals with hepatic steatosis remain asymptomatic and may show no biochemical abnormalities, meaning that MASLD is frequently silent until complications occur, which makes early diagnosis challenging. Lifestyle modification, including dietary changes, regular physical activity, and sustained weight reduction, is the cornerstone of MASLD management. At present, however, there is still no universally standardized pharmacological treatment for MASLD all over the world, and management continues to rely primarily on lifestyle modification. The amino acids and B-group vitamin complex is expected to be effective in treating the early stage of steatohepatosis and steatohepatitis, reducing aminotransferases levels and decreasing liver fat cell accumulation. This article is published in the journal Consilium Medicum in Russian with the permission of the copyright holders. The original article: Murane N, Sprudza KL, Ivanova J, Zalizko P. Complex of Amino Acids, Choline, and B-Group Vitamins for the Improvement of Early-Stage Metabolic Dysfunction-Associated Steatotic Liver Disease. Health. 2025;17:1252-71. DOI: 10.4236/health.2025.1710083 is distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0).
Copyright (c) 2025 Murane N., Sprudza K., Ivanova J., Zalizko P. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
A clinical case of HIV-associated non-Hodgkin's lymphoma of the kidney with pulmonary dissemination syndrome. Case report
The incidence of HIV infection continues to rise over the past several decades, causing serious concern among healthcare professionals. Human Immunodeficiency Virus (HIV) destroys the immune system, significantly reducing its protective functions and increasing the body's vulnerability to the development of oncological diseases. According to various authors, HIV-associated neoplasms tend to be more aggressive, and in most cases, the diagnosis is made at advanced stages, when the neoplasm has often spread to organs and systems distant from the primary site. A significant factor in this is the prolonged diagnosis of oncological diseases in HIV-infected patients, which is related to the complexity of interpreting research data and the similarity of the clinical picture of oncological processes with a range of other diseases and conditions associated with HIV. The reduction in CD4+ cell counts, the ineffectiveness of CD8+ cell responses, and the resulting immune dysregulation lead to a weakening of local immune surveillance. The functional activity of CD4+ cells is also crucial, as it influences tumor antigen recognition, the production of effective anti-tumor antibodies, and the response to oncogenic viral invasion – another pathogenetic factor contributing to the development of oncological diseases in the context of HIV. Likely, this contributes to early tumor dissemination even at initial disease stages, with pronounced involvement of extralymphatic organs and systems, due to the absence of barriers to hematogenous metastasis. Such early dissemination serves as additional evidence of significant impairments in anti-tumor immune control in HIV-infected individuals at all stages of malignant neoplasm development. Therefore, it is critically important for at-risk groups to maintain vigilance, undergo regular medical examinations, and promptly identify potential complications. This study presents a clinical case of a 30-year-old patient who developed non-Hodgkin's lymphoma and disseminated lung syndrome against the background of HIV infection. These data help to better understand the challenges of diagnosing and treating this combination of diseases and provide valuable information for improving medical care for patients with HIV.
Copyright (c) 2025 Tselishcheva L.I., Afanasiev E.I., Larionova E.A., Perevoshchikova A.D., Opolonskiy D.V. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
Assessment of the tolerability and efficacy of ProstOptima in combination therapy in patients with benign prostatic hyperplasia and mild-to-moderate lower urinary tract symptoms
Background. Benign prostatic hyperplasia (BPH) is one of the most common disorders in middle-aged and older men. In the past 10 years, there has been an upward trend in BPH incidence in younger subjects, emphasizing the need for more careful diagnosis by urologists and adequate pharmacotherapy to alleviate the lower urinary tract symptoms (LUTS) and prevent the need for surgical intervention. Recently, combination therapy (α1-blocker and phytotherapeutic agent) has been increasingly used in the management of LUTS due to its positive clinical outcomes and ability to enhance patient quality of life. Aim. To evaluate the clinical efficacy of the combination of ProstOptima and α1-blocker (tamsulosin) in the treatment of BPH-related mild to moderate LUTS. Materials and methods. The study included 76 males with BPH and mild-to-moderate LUTS. The patients were randomized into two groups of 38 subjects each. Group 1 (n=38) received standard therapy with tamsulosin 0.4 mg QD for 2 months, Group 2 (n=38) received combination therapy with tamsulosin 0.4 mg QD and ProstOptima 1 capsule QD with food. Therapy was continued for 2 months. Follow-up examinations were performed 1 and 2 months after the start of treatment. Results. After 2 months of treatment, combination therapy (tamsulosin + ProstOptima) showed a statistically significant superiority over monotherapy, with better trends in key indicators and a more pronounced improvement in the International Prostate Symptom Score (IPSS) and the Quality of Life (QoL) scale. Conclusion. Combination therapy with tamsulosin and ProstOptima demonstrated high efficacy and safety in the treatment of BPH-related LUTS, as evidenced by objective urodynamic parameters and quality-of-life questionnaire data.
Copyright (c) 2025 Al-Shukri A.S., Kolomiitseva M.R. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
Analysis of clinical risk factors for complications of periferal venous catheterization
Background. Peripheral venous catheterization (PVC) is one of the most frequently performed invasive procedures in hospital practice. It is widely used for administration of infusion solutions, medications, and blood products. Despite its relative simplicity and perceived safety, PVC is often accompanied by local complications that may worsen clinical outcomes and patient discomfort. Identification of clinical risk factors for complicated PVC remains an important task for improving the quality of vascular access and optimizing patient management strategies. Aim. To identify statistically significant clinical predictors of complicated peripheral venous catheterization and to assess their impact on the development of catheter-related complications. Materials and methods. The study included 167 cases of PVC performed in surgical and rehabilitation departments. Demographic and clinical characteristics were analyzed, including patient age, body mass index, history of previous PVC-related complications, vein visualization and palpation prior to puncture, catheter gauge, duration of catheter placement, and features of the catheterization technique. The frequency and structure of local complications were evaluated. Univariate logistic regression analysis was used with calculation of odds ratios (OR) and 95% confidence intervals. Results. Complications were identified in 66.5% of cases. The most common were pain at the catheter insertion site (25.2%), phlebitis (15.3%), extravasation (12.6%), hematoma (10.2%), and catheter obstruction (8.4%). Significant risk factors for complicated PVC included a history of complications (OR=15.6), small vein diameter (OR=5.38), absence of vein visualization or palpation prior to puncture (OR=3.40), catheter dwell time exceeding 48 hours (OR=3.12), BMI>28 (OR=4.00), and age over 18 years (OR=3.53). Conclusion. Several clinical parameters were identified as significant predictors of complications associated with PVC. Consideration of these factors enables early risk stratification, supports justified selection of vascular access techniques, and allows for individualized patient management. Implementation of a risk-based approach to PVC may contribute to reducing complication rates, improving procedural safety, and enhancing the overall quality of medical care.
Copyright (c) 2025 Arkhireeva L.Y., Midlenko O.V., Midlenko V.I., Arkhireeva A.A. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
Diagnostic features of pulmonary embolism in hospitalized patients with COVID-19
Aim. To determine the effectiveness of diagnosing venous thromboembolic complications in patients with novel coronavirus infection COVID-19 using validated VTE risk assessment scales and routine diagnostic methods such as D-dimer level testing and echocardiography. Materials and methods. A retrospective, cohort, single-center, controlled, observational study was conducted at the Egorov Central Clinical Medical and Sanitary Unit for patients with novel coronavirus infection in 2020–2021. The study included 1050 patients with a confirmed diagnosis of COVID-19. To establish the diagnosis, patients had to have a positive laboratory test result for SARS-CoV-2 RNA, performed by nucleic acid amplification (real-time polymerase chain reaction test). All patients underwent clinical examination, laboratory, and instrumental diagnostic methods in accordance with the versions of the Provisional Methodological Recommendations for the Prevention, Diagnosis, and Treatment of Novel Coronavirus Infection (COVID-19) of the Ministry of Health of Russia (versions 6–11) valid at the time of hospitalization. Results. Diagnosing venous thromboembolic complications in the context of novel coronavirus infection COVID-19 can be challenging, as the clinical manifestations of pulmonary embolism and severe coronavirus pneumonia can be similar. When using commonly accepted VTE risk assessment scales, effectiveness in terms of accuracy and completeness of prediction was noted only for the IMPROVEDD scale, while the Wells scale was the least accurate. Furthermore, both conditions can be accompanied by an increase in D-dimer levels and show signs of right ventricular dysfunction on transthoracic echocardiography. Conclusion. The diagnosis of pulmonary embolism in patients with novel coronavirus infection COVID-19 using standard algorithms can be difficult, suggesting the potential indispensability of initial computed tomography angiography of the lungs. Moreover, the obtained data demonstrate that performing reperfusion therapy for high-risk pulmonary embolism patients solely based on echocardiographic findings may be erroneous.
Copyright (c) 2025 Abramov D.V., Smolkina A.V., Menzorov M.V., Byrina A.V., Nikishina D.D. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0
In vitro equivalence assessment of rivaroxaban tablets
Background. Thrombotic conditions and complicationsa are among the leading causes of death and disability in high-income countries. The introduction of direct oral anticoagulants into clinical practice has expanded the possibilities of anticoagulant therapy. Having a broader spectrum of indications compared to other direct oral anticoagulants, rivaroxaban is also used to prevent atherothrombotic complications in patients with ischemic heart disease and peripheral artery disease. Rivaroxaban drugs are available as film-coated tablets in doses of 2.5 mg, 10 mg, 15 mg, and 20 mg. Currently, more than 45 generic versions of rivaroxaban are approved in Russia, which may differ in the source and particle size of the active pharmaceutical ingredient, as well as the excipient composition. Aim. To assess the in vitro equivalence of brand-name vs. several generics of rivaroxaban that are available on the Russian market using the equivalence dissolution test. Materials and methods. The study was performed on rivaroxaban film-coated tablets (2.5, 10, 15, and 20 mg): Xarelto® (Bayer AG, Germany) as the reference drug (D 0), and three randomly selected generic drugs (D 1, D 2, D 3). Dissolution kinetics were studied in hydrochloric acid solution, acetic, and phosphate buffer solutions, using an impeller mixer. The amount of dissolved drug was measured using high-performance liquid chromatography with ultraviolet detection. We used our own results along with data obtained from publicly available sources. Results. The dissolution kinetics profiles of the generic drugs were similar to that of the reference drug. The dissolution speed of rivaroxaban from D 1 was not different from that of the reference drug D 0, which may be due to the use of a similar micronized form of the active ingredient. The results obtained for D 2 do not allow for a direct comparison because of the use of different dissolution media (including surfactants) in the experiments. Conclusion. The use of a micronized active ingredient may give D 1 an advantage in the speed and completeness of dissolution, and predetermine high reproducibility of pharmacokinetic parameters in clinical use.
Copyright (c) 2025 Smekhova I.E., Okovityi S.V. Consilium Medicum https://creativecommons.org/licenses/by-nc-sa/4.0