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AIM: To assess the risk of severe adverse events (AEs) within 6 months after treatment with biological agents in patients with rheumatic diseases (RD)/MATERIAL AND METHODS: The 6-month open-label trial included 107 patients with rheumatoid arthritis, antineutrophil cytoplasmic antibody-associated vasculitides, systemic lupus erythematosus, and other RDs who received genetically engineered biological agents (GEBAs), primarily rituximab (n=66) and infliximab (n=31)/RESULTS: The majority of patients were noted to have improvements, including complete and partial remission in 62 (57.9%) and 42 (39.3%), respectively. There were mild or moderate AEs in 22 (20.6%) of the 107 patients, severe AEs in 6 (5.6%): grade IV neutropenia in 2 patients (after the use of rituximab), severe infusion reactions in 2 (after the administration of infliximab and rituximab), and systemic infections in 2 (fatal nocardial sepsis after rituximab treatment and unspecified sepsis after infliximab treatment)/CONCLUSION: The rate of serious AEs, mainly infusion AEs and infections during treatment with infliximab, rituximab, and other GEBAs proved to be relatively low in patients with different RDs. At the same time, the use of biological agents could lower RD activity in the presence of severe visceral injuries refractory to conventional immunosuppressive therapy. more...

There has been a substantial expansion in the possibilities of current therapy for rheumatic diseases (RD) primarily due to the use of genetically engineered biological agents (GEBA). Objective: to evaluate the short-term efficacy and safety of GEBA in patients with different RD. Subjects and methods. The trial included all RD patients receiving GEBA: rituximab (RTM), infliximab (INF), adalimumab, etanercept, tocilizumab, abatacept in 2009-2012. Therapeutic efficiency and safety were evaluated 6 months later. The effect of GEBA was determined as “remission”, “improvement”, and “no response”, by using the parameters peculiar to specific diseases (such as BVAS, DAS28, BASDAI). Results. The trial enrolled 107 patients (49 men and 58 women; mean age 41.5 years) with rheumatoid arthritis (n=34), ANCA-associated vasculitis (n = 34), systemic lupus erythematosus (n=16), cryoglobulinemic vasculitis (n=11), ankylosing spondyloarthritis (n = 8), systemic vasculitis with large artery involvement (n=6), and other RD. All the cases showed severe systemic autoimmune disease refractory to standard immunosuppressive therapy. RTM (n=66) and INF (n = 31) were most frequently used. The high rate of RTM prescription was due to the fact that this drug was given to all patients with ANCA-associated vasculitis, systemic lupus erythematosus, and cryoglobulinemic vasculitis who totaled more than half of the patients included into the trial. The vast majority of them received GEBA for the first time. After the treatment, there was remission in 62 (57.9%) and improvement in 42 (39.3%) cases. Mild or moderate adverse reactions were observed in 22 (20.6%) patients and severe ones were seen in 6 (5.6%). Conclusion. GEBA therapy ensures a significant improvement in a substantial proportion of patients with different RD refractory to standard immunosuppressive therapy. more...

Objective: to study the incidence rates of angina, myocardial infarction (MI), stroke, and the frequency of endovascular interventions in patients with systemic vasculitides, and the incidence rate of atherosclerosis according to autopsy data. Subjects and methods. Three hundred and twenty-one patients with systemic vasculitides: Wegener's granulomatosis (n = 138), Takayasu's arteritis (n = 79), polyarteritis nodosum (n = 55), and Churg-Strauss syndrome (n = 49) were examined; 55 autopsies were analyzed in patients with the above diseases. Results. Fifty-one (15.6%) of the 321 patients were diagnosed as having cardiovascular diseases (CVD): angina pectoris (7.1%) and MI (3.1%) and endovascular interventions (0.9%). The risk of cardiovascular events was found to be associated with traditional risk factors, such as male gender and age. Arterial hypertension, hypercholesterolaemia, and increased serum creatinine were more frequently detected in the CVD group that showed no significant differences from the non-CVD group. According to autopsy results, atherosclerosis was identified in the patients with Wegener's granulomatosis (52%), Takayasu's arteritis (50%), polyarteritis nodosum (52.6%), and Churg-Strauss syndrome (57.1%). Conclusion. CVD and atherosclerosis are common in systemic vasculitides, which requires the traditional risk factors of atherosclerosis to be actively corrected. more...

Russian and foreign data on development of atherosclerosis in patients with primary vasculitis are analysed. The discussion covers the role of risk factors, features of pathogenesis of atherosclerosis in primary vasculitis, diagnostic and therapeutic methods in this disease. more...

Subject. Reduction of threats to economic security based on the construction of multifactorial statistical models that quantify the impact of factors on the level of economic crime, in particular, on the scale of material damage from economic crime. Purposes. Adaptation and application of statistical methodology for complex quantitative assessment of threats to economic security, multifactor modeling of patterns and trends of economic crime. Methods. Applied methods of multidimensional classification - cluster analysis, correlation and regression, trend models and forecasting. Results. Statistical modeling was carried out in the context of clusters formed during the study, reflecting the specification of their regions based on the application of statistical methodology for the typologization of the regions of the Russian Federation and the construction of multifactorial statistical models that quantitatively describe the impact of factors on the level of economic crime (the scale of material damage from economic crime). Conclusions. The results of the conducted research can be used in information and analytical work and activities of departments of internal affairs bodies, public administration bodies to develop directions for reducing economic security risks from criminalization factors. The obtained substantiation of the significance of the factors provides the basis for their inclusion in the dynamic regression model, according to which it is advisable to create short-term forecasts of the crime level of an economic orientation. more...

the article discusses the features of financial management of media industry companies. The media industry requires deep planning, effective financing, compliance with the rules of interaction with customers using the main digital ERP functions. At the same time, it is necessary to take into account the separation of operational and business functions, flexible change of business planning taking into account modern realities, for example, quantum computing, which will contribute to more efficient financial management in the media industry. more...

The article defines that the social functioning of communication technologies forms the media environment (media space) of a digital society. Organizations that are at high levels of digital maturity are significantly more likely than organizations with lower maturity to achieve high net income and annual revenue growth. Based on the analysis, ten key competencies that are critical for the management of the media industry are identified. more...

The authors describe a clinical case of the rare tumor — skin leiomyoma in a 54-year-old patient. The authors describe clinical manifestations, differential diagnosis and pathomorphological picture of the disease. more...

Aim.Assessment of the diagnostic accuracy of predictive indexes of liver fibrosis for the identification of severe fibrosis and cirrhosis (F3F4) in patients with chronic hepatitis C (CHC). Materials and methods.The retrospective design study included 127 patients with chronic hepatitis C (mean age 44.511.1 years). To assess the degree of liver fibrosis, all patients underwent transient elastography using a Fibroscan (EchoSens, France) and predictive indexes of liver fibrosis were calculated (APRI, FIB-4, discriminant Bonacini score). Transient elastography was considered as a reference method for assessing the degree of liver fibrosis for subsequent comparison of results with predictive fibrosis indixes. Results.The sensitivity of the APRI index for the identification of severe fibrosis and cirrhosis of the liver (F3F4) was 79%, and specificity was 69%. The FIB-4 index showed greater specificity (86%), but less sensitivity (68%). The sensitivity of the discriminant Bonacini scale was 81%, and the specificity was 77%. The positive predictive value of the APRI index, FIB-4 and the Bonacini scale for the identification of severe fibrosis and cirrhosis of the liver (F3F4) in patients with chronic hepatitis C was 66; 78 and 72% respectively, and negative predictive value 82; 78 and 84% respectively. Conclusion.The results of this study indicate the relatively high diagnostic accuracy of a number of predictive indexes for evaluating liver fibrosis (APRI, FIB-4, discriminant Bonachini scale) in identifying severe fibrosis and cirrhosis of the liver (F3F4) in patients with chronic hepatitis C. more...

Gastroesophageal reflux disease (GERD) is one of the most common pathologies in modern clinical practice. Laryngopharyngeal reflux (LPR) is considered to be an extraesophageal manifestation of GERD and is characterized by retrograde ingestion of gastric content into the larynx and pharynx, leading to recurrent otolaryngological symptoms. Classical manifestations of LPR are hoarseness, perspiration, dryness and feeling of lump in the throat, coughing. There is no «gold standard» for the diagnosis of LPR. At the same time, several instrumental methods are used in clinical practice to verify the diagnosis: laryngoscopy and EGDS are the most common, and in some cases - 24-hour pH-metry and impedancemetry. In the case of an established diagnosis of LPR, it is recommended to use a standard dosage of PPI twice a day for 3–6 months. more...

In the present article, the authors provide detailed material on the 13-year observation of a patient with such a rare disease as Whipple’s disease. Pathophysiological aspects, in particular changes in immunity within the framework of this nosology, clinical picture are also described in detail, and the emphasis is placed on the interrelation of certain symptoms, their intensification and regression. Taking into account the absence of clear recommendations for the management of such patients, the article considers various options of therapeutic schemes, and also reflects the own results of treatment. more...

The article describes a clinical case of alopecia mucinosa, manifested in hair loss on the scalp. The diagnosis was confirmed on the basis of histological examination. Clinical, anamnestic and laboratory data allowed to establish the correct diagnosis. more...

Cell-mediated immunity parameters were studied in 26 patients (13 males, 13 females) aged 46 years (range: 39-51 years) with fistular type of chronic posttraumatic osteomyelitis of the humerus during the course of surgical treatment with the Ilizarov monofocal transosseous osteosynthesis. The study time-points were pre-surgery period and the following treatment stages: days 3, 7, 21 after osteosynthesis and day 1 after removal of the device. An obligatory criterion of inclusion was absence of postoperative complications and infection recurrence at least a year after removal of the apparatus. Control group were 30 healthy volunteers in the similar age (15 males, 15 females). Carriers of HCV, HIV, HBsAg and persons with concomitant somatic pathology that could affect the results of immunological study were not included. The study of subpopulation composition of the peripheral blood lymphocytes was carried out using laser flow cytometry. The parameters of cell-mediated immunity in patients with a fistular type of chronic posttraumatic osteomyelitis of the humerus were characterized by mild lymphopenia, increase in the number of cells of early and late activation of T lymphocytes (CD3+CD25+, CD3+HLA-DR+). Physiological response of the immune system to debridement of the purulent foci and transosseous osteosynthesis was normalization of the number of activated T-lymphocytes at the final stage of surgical treatment. In general, the dynamic changes of immunological indices were in favor of persistent arrest of the infection process and were confirmed by clinical observations. more...

Non-alcoholic fatty liver disease (NAFLD) becomes gradually the most frequent liver disease in the world. Expert teams in the USA, Western Europe, and Russia give pride of place within the NAFLD treatment regime to lifestyle modification including the optimization of physical activity, diet and, as a consequence, the BMI reduction. However, it is often difficult for the practitioner to motivate the patients to change their lifestyle and eating habits. Due to this, it is extremely important to use a pharmacologic therapy aimed at weight loss, reducing insulin resistance and repopulating the severely damaged liver parenchyma. By now ursodeoxycholic acid drugs (Ursosan) have been proved to be highly effective in treating NAFLD in clinical practice, having a significant impact on several pathogenetic mechanisms of this disease. more...