The paper presents the results of a standard and complex treatment method using the peptide drug thymus thymalin in patients with COVID-19. One of the mechanisms of the immunomodulatory effect of thymalin is considered to be the ability of this peptide drug to influence the differentiation of human hematopoietic stem cells (HSCs). It was found that, as a result of standard treatment, patients in the control group showed a decrease in the concentration of the pro-inflammatory cytokine IL-6, C-reactive protein, D-dimer. The addition of thymalin to standard therapy accelerated the decline in both these indicators and the indicators of the T cell system. This has helped reduce the risk of blood clots in COVID-19 patients. The revealed properties of the thymus peptide preparation are the rationale for its inclusion in the complex treatment of coronavirus infection. Peptideswith potential biological activity against SARS-CoV-2 virus [29]. Note: Nitrogen atoms are shown in blue, oxygen atoms - in red, carbon atoms – in gray, hydrogen atoms – in white, and phosphorus atoms – in yellow

Читинская государственная медицинская академия 2 Инновационная клиника «Академия здоровья», Чита 3 Санкт-Петербургский институт биорегуляции и геронтологии

Иновационная клиника «Академия здоровья», Чита 3 Санкт-Петербургский институт биорегуляции и геронтологии

Osteoporosis is a condition in which the bones are thinner and more liable to fracture. It is commoner in women and in people over 50. It cannot be cured so the focus is on prevention, which means identifying and addressing risk factors such as obesity, low vitamin D, chronic inflammation and prolonged steroid medication. Chronic urticaria (hives, CU) is an inflammatory condition, so one might expect it to be linked with osteoporosis, but that has never been investigated. If people with CU are indeed more likely to develop osteoporosis, they could be advised about preventative measures. To study this, doctors from Israel identified 11,944 patients diagnosed with CU in a large medical database covering 4.5 million people. A potential difficulty was that people with CU are more likely to be female, obese and to have been treated with systemic steroids, all of which also increase the risk of osteoporosis. Therefore for each CU patient they studied 5 age- and sex-matched control patients (people of the same age and sex but without CU) and their analyses took into account other known risk factors for osteoporosis. During a 16 year period 8.7% of the patients with CU were diagnosed with osteoporosis compared with 6.8% of the controls. They concluded that CU is a small but significant additional risk factor for osteoporosis. An accompanying editorial cautions against basing conclusions on routine health records which may not have all the information required. Nonetheless, doctors treating chronic urticaria might bear in mind the risk of osteoporosis in their patients, and counsel accordingly.

Thirty apparently healthy elderly women and 72 women diagnosed with Hypertensive Heart Disease (HHD) participated in the study. The subjects with hypertension were divided into two groups: the first group (HHD-1) included women receiving medication; the second group (HHD-2) included women receiving medication and kinesiotherapy (three or four courses regularly during the past two to three years). In elderly women with a high blood pressure, the total number of lymphocytes and eosinophils was higher than in healthy women. The women with hypertension also had higher values of stroke volume (SV), left ventricular end diastolic volume (LVEDV), cardiac output (CO), left ventricular mass (LVDM), and left ventricular mass index (LVMI). In women with hypertension, the balance of velocity distribution in the arteries and microvasculature was shifted toward the fast interlayer processes. In women who exercised regularly, these changes were much smaller. In both healthy women and women with hypertension, there was an association between the total leukocyte count, individual types of leukocytes, the level of blood pressure, and hemodynamic parameters. The strongest relationships were observed between the number of eosinophils and the blood pressure.

骨质疏松是一种骨骼变薄和更易于骨折的疾病。它在女性和年龄大于 50 岁人中更常见。它不能被治愈,因此重点在于预防,即意味着发现和处理风险因素,如肥胖、维生素 D 摄入少、慢性炎症和长期使用类固醇药物。慢性荨麻疹(风团,CU)是一种炎症性疾病,因此有人预计它可能与骨质疏松有关,但从未有人调查。如果 CU 患者真的更可能发生骨质疏松,可以就预防措施为其提供建议。为此,来自以色列的医生们调查了来自一个涵盖 450 万人的大型医学数据库中的 11,944 名诊断为 CU 的患者。一个潜在困难是 CU 患者更多为女性、肥胖且曾接受过系统类固醇治疗,这些都会增加骨质疏松的风险。因此,对于每名 CU 患者,他们研究了 5 名年龄和性别匹配的对照患者(年龄和性别相同,但无 CU),且他们的分析考虑了骨质疏松的其他已知风险因素。在 16 年中,8.7% 的 CU 患者被诊断为骨质疏松,而对照组只有 6.8%。他们得出结论,CU 是骨质疏松虽小但重要的额外风险因素。一篇随附的社论警告说,不能基于可能并未包含所有需要信息的常规健康记录来得出结论。尽管如此,治疗慢性荨麻疹的医生可能需要认识到他们患者有发生骨质疏松的风险,并给予相应咨询。

BackgroundEmerging evidence suggests that chronic urticaria (CU) is associated with chronic, low-grade, inflammatory process. ObjectiveTo evaluate the association between CU and metabolic syndrome and its components in a large community-based medical database. MethodsA cross-sectional study of CU patients and matched controls was performed. CU was defined as eight urticaria diagnoses (with each two diagnoses registered within a period of 6 weeks) from 2002 to 2012. Data regarding the prevalence of metabolic syndrome, its components and possible complications were collected. ResultsThe study included 11 261 patients with CU and 67 216 controls. In a univariate analysis, CU was significantly associated with higher body mass index (BMI) and a higher prevalence of obesity, diabetes, hyperlipidaemia, hypertension, metabolic syndrome, chronic renal failure and gout. Multivariate analysis demonstrated a significant association between CU and metabolic syndrome (OR = 1.12, 95% CI 1.1-1.2, P < 0.001) and its components - obesity (OR = 1.2, 95% CI 1.1-1.3, P < 0.001), diabetes (OR = 1.08, 95% CI 1.01-1.15, P = 0.001), hyperlipidaemia (OR = 1.2, 95% CI 1.1-1.2, P < 0.001) and hypertension (OR = 1.1, 95% CI 1.1-1.2, P < 0.001). ConclusionsCU patients may have one or more undiagnosed components of metabolic syndrome despite their young age. Thus, appropriate targeted screening is advised.

Background Chronic urticaria (CU) carries many risk factors for osteoporosis, but data on the relationships between CU and osteoporosis are lacking. Objectives To evaluate the association between CU and osteoporosis in a large community-based study. Methods A nationwide observational longitudinal cohort study was conducted. CU was defined as four pairs of urticaria diagnoses; each pair was recorded within a period of 6 weeks and was registered by physicians in a primary-care setting. Patients with CU and their age- and sex- matched controls were followed for the incidence of osteoporosis and other laboratory data between 2002 and 2017. Data regarding systemic steroid exposure and other relevant risk factors for osteoporosis were obtained. Analyses of risk for osteoporosis were performed in Cox regression models adjusted for age, sex, exposure to systemic corticosteroids, obesity, smoking and hyper- and hypothyroid disease. Results The study included 11 944 patients with CU and 59 829 controls. During the study's observation period, 1035 (8 center dot 7%) patients with CU were diagnosed with osteoporosis, compared with 4046 (6 center dot 8%) controls. The adjusted multivariate analysis demonstrated that CU was significantly associated with a higher risk for osteoporosis (hazard ratio 1 center dot 23, 95% confidence interval 1 center dot 10-1 center dot 37, P < 0 center dot 001). Conclusions CU may impose a risk for osteoporosis. Appropriate targeted screening should be considered.

We report an unusual case of a patient with severe antihistamine resistant chronic spontaneous urticaria (CSU) without concomitant angio-oedema. The CSU showed an excellent response to omalizumab, but the patient developed attacks of angio-oedema after each omalizumab injection. A 26-year-old woman presented with a 7-month history of severe generalized urticaria without angio-oedema, which was unresponsive to antihistamine treatment (fexofenadine 180 mg) at higher than licensed doses (up to 720 mg/day). The patient’s weekly Urticaria Activity Score (UAS-7) was calculated as 32 during the first week of follow-up. Subcutaneous omalizumab 300 mg/month was started as an add-on treatment to fexofenadine 180 mg four times daily. Two days after the first omalizumab administration, the patient reported a dramatic improvement of her CSU, but she also reported an appearance of severe angio-oedema of her lips, face and eyelids for the first time, which disappeared in 3 days. The patient continued fexofenadine 180 mg four times daily for 7 additional days, and then reduced the dose to 180 mg once daily. During the 4 weeks after omalizumab administration, the patient experienced a dramatic improvement of her CSU, corresponding to an UAS-7 of 4–6. Nevertheless, after each subsequent dose of omalizumab she deveoped similar manifestations of angio-oedema on her face and lips, which resolved in 2–3 days. Six months later, the patient discontinued the omalizumab injections, but continued fexofenadine 180 mg twice daily. She had a severe relapse of urticaria, but without angio-oedema. The clinical worsening of her CSU continued during the subsequent 8 weeks of follow-up, even though she continued treatment with fexofenadine 180 mg four times daily (720 mg/day). At this point omalizumab was restarted, and fexofenadine 180 mg four times daily was continued. The day after omalizumab administration, severe angiooedema developed on the patient’s face, lips and eyelids, which resolved in 3 days. Nonetheless, there was a dramatic improvement in the weals and pruritus of CSU. The patient had normal blood levels of C1-INH, complement factor 4 and tryptase at baseline and during the described episodes of angio-oedema after omalizumabinjections. We considered that the patient had omalizumab related nonhistaminergic angio-oedema. Previously, antifibrinolytic agents have been shown to be an effective treatment in idiopathic nonhistaminergic angio-oedema, so she was given tranexamic acid 1 g three times daily for 7 days after each omalizumab injection. After two subsequent omalizumab injections under tranexamic acid therapy, the angio-oedema did not relapse. While chronic angio-oedema appears to be histaminergic in most cases, in 14% of patients it has nonhistaminergic features. The pathophysiology of nonhistaminergic AE is mostly speculative, and several biological mediators acting as triggers or enhancers of vascular permeability have been implicated. The ineffectiveness of high-dose antihistamines and the efficacy of tranexamic acid led us to consider that our patient’s angio-oedema after omalizumab administration might be mediated by bradykinin. Another major component of mast cell granules is heparin, which is released following IgE/antigen activation and possibly during anti-IgE therapy. We hypothesize that in our patient, AE may possibly have been mediated by omalizumab-induced mast cell heparin release and heparin-driven Factor XII activation, which triggered the cleavage of high molecular weight kininogen by kallikrein, thus releasing bradykinin. To our knowledge, this is the first reported case of omalizumab-induced angio-oedema successfully treated with tranexamic acid.

Aim. To reveal the role of a “youth protein” GDF11 in regulation of lipid metabolism and cardiovascular system work in essential hypertension (EH) in women taking antihypertension medications and regularly involved in moderate physical exercises (kinesitherapy).Material and methods. In all participants, the level of GDF11 was measured by immune enzyme assay, and levels of lipids; registration was done of blood pressure, echocardiography and circulation condition with a novel sensor of dynamic light scattering (mDLS).Results. In women with AH taking antihypertension medications, the level of GDF11 was lower more than 3 times. In EH patients the deviations found, in a shear flow velocity with significant increase of rapid velocity processes. Correlations found for GDF11 level with the age, blood pressure, condition of the heart work, hemodynamical and oscillatory indexes. In the EH group patients regularly doing exercises (kinesitherapy), the level of GDF11, blood pressure, lipid profile and all parameters of heart work and hemodynamics are close to normal.Conclusion. The “youth protein” CDF11 is a factor of prevention of AH. Kinesitherapy in EH patients normalizes GDF11, lipid profile, and significantly increases the work of cardiovascular system.

The human body interacts with the environment mainly through three major tissues: the lungs, skin, and gastrointestinal (GI) tract. In each one, an intensive nervous network is present, conjugated with abundant mast cells (MC). While MC-mediated disorders in airways and the skin are extensively discussed, MC-mediated disorders of the GI tract remain relatively uncommon. Since the GI tract is one of the three main environment-interacting tissues, it is reasonable that MC-mediated disorders of the GI may have the same weight and impact as asthma or chronic urticaria (CU). This article is protected by copyright. All rights reserved.

Chronic urticaria (CU) and atopic disorders such as atopic dermatitis (AD), allergic rhinoconjunctivitis (AR), and asthma are related to aberrant immune function. The relationship between atopic disorders and CU is controversial, mostly since epidemiological data are lacking. The aim of our study was to investigate the association between CU and asthma, AD, and AR using a database of Clalit Health Services (CHS) - the largest healthcare provider organization in Israel. This article is protected by copyright. All rights reserved.

Objective. To investigate the effect of the quantitative ratios of different types of white blood cells on the cardiovascular system in healthy individuals and patients with essential hypertension (EH). Materials and methods. The study was performed on 102 women suffering EH. The control group consisted of 30 healthy patients. Results. In women with EH, both non-engaged (EH-1) and regularly engaged in kinesitherapy (EH-2), compared with the control group, the total content of leukocytes was increased, as well as the ratios of NEUTR/EOS, LYM/EOS, LYM/BAS and EOS/BAS. In hypertensive patients increased stroke volume and end-diastolic left ventricular volume, cardiac output, increased mass and the index of left ventricular mass. In EH-1 patients group, the balance of velocity distribution in the microcirculatory bed changes to fast interlayer processes. In patients with EH-2, these changes are much less pronounced. In healthy women and patients with EH, significant relationships between leukocyte ratios and the level of systolic diastolic, mean, pulse pressure, cardiohemodynamics, hemodynamic indices were found. Conclusion. Regular practice of kinesitherapy brings the condition of cardiohemodynamics, hemodynamic indices, as well as the investigated correlations to the characteristic of healthy women. These data suggest an important role of the relationship of various leukocyte populations in the pathogenesis of EH.

Summary Selective immunoglobulin A (IgA) deficiency (IgAD) is the most common primary immunodeficiency in the western world. The aim of the study was to investigate the prevalence and clinical characteristics of Helicobacter pylori-infected dyspeptic patients with IgAD. Case samples were drawn from all subjects ≥ 12 years of age (n = 104729) who had undergone serum total IgA measurements during 2004–14 for any reason at Leumit Healthcare Services (Israel) and had serum total IgA < 0·07 g/l. The control group was comprised of a random sample of remaining patients with a case–control ratio of 10 controls for each case. The dyspeptic diseases were identified and retrieved from Leumit Health Care Services electronic database using specific ICD-9-CM diagnostic codes. The case group included 347 subjects and the control group 3470 subjects. There were no significant differences in the prevalence of patients with dyspepsia [84 (24·2%) versus 821 (23·6%) for cases and controls, respectively]. Additionally, there was no difference in a proportion of dyspeptic H. pylori-positive subjects [59 (17·1%) versus 524 (15·1%)] between the case and control groups. Only 59 (17%) among the 347 IgAD patients underwent gastroscopy. A significantly larger proportion of case subjects experienced several forms of gastritis [13 (61·9%) versus 38 (21·6%), P < 0·001), duodenal ulcers [seven (33·3%) versus 19 (10·8%); P = 0·01] and nodular lymphoid hyperplasia (NLH) [two (9·5%) versus none; P = 0·011]. IgAD is not associated with increased prevalence of H. pylori-associated dyspepsia; nevertheless, H. pylori-infected dyspeptic IgAD subjects experience more EGD-proved gastritis, duodenal ulcers and NLH.

Irritable bowel syndrome (IBS) is the most commonly diagnosed gastrointestinal condition manifested by chronic abdominal pain and altered bowel habits in the absence of any organic cause. While 10% - 20% of the population has IBS, only ≈ 25% of patients with IBS seek professional health care. Due to IBS multifactorial etiology, there is no single therapeutic option available with a satisfactory efficacy; therefore, patients frequently express a high level of frustration with their current therapies. We present a case of the 42 year-old woman with IBS, who was administered Omalizumab (a recombinant DNA-derived humanized IgG1 monoclonal antibody which specifically binds to free human immunoglobulin E (IgE) in the blood) doe to concomitant antihistamine resistant chronic spontaneous urticaria and experienced significant improvement in overall IBS symptoms. If our observation will be confirmed in prospective randomized studies, Omalizumab may turn out to be a useful pharmacological tool for this common disorder.

BACKGROUND:There is no currently no information regarding the role of α-defensins in the pathophysiology of atopic dermatitis (AD).AIM:To investigate levels of plasma α-defensins at exacerbation and remission of AD, and to assess their association with clinical severity of AD.METHODS:Patients with AD during exacerbation were recruited from the Dermatology department at the Chita Medical Academy (Chita, Russian Federation). SCORAD (SCORing Atopic Dermatitis), itch intensity, plasma concentrations of α-defensins, and serum total IgE, interleukin (IL)-1β, IL-8 and IL-10 levels were measured at study entry and after 4 months.RESULTS:In total, 82 patients with AD [35 (45.1%) female and 47 (54.9%) male patients, mean ± SD age 42.2 ± 11.5 years, range 15-40] and 30 healthy controls (HCs) were included. Mean objective SCORAD score was 48.8 ± 19.4 and 16.1 ± 8.3 during AD during exacerbation and remission, respectively (P < 0.01). Plasma α-defensin levels in patients with AD (1.41 ± 0.32 μg/L) were significantly higher than in HCs (0.91 ± 0.34 μg/L) (P < 0.001). Significant correlations were found between plasma α-defensin levels with objective SCORAD (r = 0.55, P < 0.001), itch severity (r = 0.25, P < 0.05) and serum IgE levels (r = 0.38, P < 0.001) during AD exacerbation. Serum concentrations of IL-1β, IL-4 and IL-8 were significantly higher and levels of IL-10 were lower at AD exacerbation in patients than in HCs, with a weak negative correlation between plasma α-defensin and serum IL-10 levels (r = -0.22; P < 0.05).CONCLUSION:During AD exacerbation, plasma α-defensin levels are elevated, and are positively correlated with AD clinical severity, itch intensity and serum IgE levels.

Background. Some patients with chronic spontaneous urticaria (CU) are resistant to conventional doses of antihistamine (AH) medications. Some research groups have reported an association between CU and Helicobacter pylori infection. Aim. To determine whether H.pylori eradication can reverse AH resistance in CU. Methods. We retrospectively reviewed cases of patients with CU, and recorded their Urticaria Activity Score (UAS) and results of a 13C-urea breath test (13C-UBT) for H.pylori infection. Patients without improvement in CU despite a full 8 weeks of AH treatment at four times the initial dose comprised the resistant CU group, while the patients who did respond comprised the responsive CU group. Patients with resistant CU and a positive 13C-UBT (n = 46) were offered a 14-day treatment with amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily and omeprazole 20 mg twice daily. The effect of H.pylori eradication on CU was evaluated by the UAS, measured at baseline and at 8, 16, and 28 weeks after triple therapy. Results. Of the 46 patients with resistant CU, 29 (63%) had a positive 13C-UBT result. Treatment eradicated H.pylori in 18 of the 29 patients (subgroup A), and 11 patients refused the triple therapy (subgroup B). The remaining 17 patients had a negative 13C-UBT result, (subgroup C). In subgroup A, baseline UAS reduced from 5.29 +/- 0.94 to 3.62 +/- 0.96 (P = 0.03) at week 8; to 1.43 +/- 0.41 (P < 0.001) at week 16, and to 1.17 +/- 0.32 (P = 0.04) at week 28. Five of the patients (27.8%) in this group were completely free of symptoms at week 28, whereas none of the untreated patients achieved complete remission. Conclusion. Some patients with resistant CU might benefit from H.pylori eradication.