Vol 46, No 1 (2018)


What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day

Piccoli G.B., Alrukhaimi M., Liu Z., Zakharova E.V., Levin A.


Chronic Kidney Disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this review, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.

On behalf of the World Kidney Day Steering Committee.

Members of the World Kidney Day Steering Committee are: Ph. Kam Tao Li, G. Garcia-Garcia, M. Benghanem-Gharbi, K. Kalantar-Zadeh, C. Kernahan, L. Kumaraswami, G.B. Piccoli, G. Saadi, L. Fox, E. Zakharova, S. Andreoli.

Almanac of Clinical Medicine. 2018;46(1):2-15
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The role of hereditary colorectal cancer registries in identification of high risk patients and treatment improvement

Pikunov D.Y., Toboeva M.K., Tsukanov A.S.


Up to 10% of cases of sporadic colorectal cancer are considered to be related to hereditary genetic factors. The rates of colorectal cancer related to already identified genetic factors is about 5%. In the last decades, due to the development of comprehensive familial cancer registries and progress in genomics, clinical diagnostic criteria for specific hereditary syndromes have been proposed and multiple genes have been detected whose germ mutations increase the risk of neoplastic syndromes. Identification of individual patients and families with hereditary syndromes (familial adenomatous polyposis, Lynch syndrome, MYH-associated polyposis, hamartoma syndromes) may help to develop an effective strategy for monitoring and, as the results, for reduction of cancer incidence and improvement of survival. The aim of this literature review is to assess the influence of the registries of patients with hereditary types of colorectal cancer on its incidence and long-term treatment results.

Almanac of Clinical Medicine. 2018;46(1):16-22
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Global epidemiology of celiac disease

Bykova S.V., Parfenov A.I., Sabel'nikova E.A.


The review presents the data on the prevalence of celiac disease in various world regions. The numbers of patients with celiac disease continues to rise every year. According to some authors, this is to be related not only to improvement in diagnosis, but to other extrinsic factors, as well, that require additional studies. In the 1980s the prevalence of this disease was 1.05%, and by the beginning of 2000s, it amounted to 1.99%. In particular, from 1993 to 2002 in Britain its incidence increased from 6 to 13.3 per 100,000. Both raised awareness of doctors and conduction of epidemiological studies play a decisive role in the improvement of the diagnosis of celiac disease. The information cumulated up to now makes it possible to conclude that the highest diagnostic rates of celiac disease can be found in the risk groups. They include 1st and 2nd degree relatives of patients with celiac disease, patients with autoimmune disorders (type 1 diabetes mellitus, autoimmune thyroiditis); those with clinical signs of an intestinal disorder, such as chronic diarrhea, as well as patients with anemia, osteoporosis and high transaminase levels of unknown origin. According to the Finnish epidemiological study, the prevalence of celiac disease, depending on the risk group, may vary from 6.6 to 16.3%. The guidelines by the American College of Gastroenterology, British Society of Gastroenterology, North-American Society of Pediatric Gastroenterology, and the Russian Consensus on Diagnosis and Treatment of Celiac Disease in Adults and Children all recommend thorough examination of patients from the risk groups. Active diagnosis of celiac disease (screening) has been recognized as one of the approaches to primary prevention to autoimmune disorders and cancer.
Almanac of Clinical Medicine. 2018;46(1):23-31
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Prevalence of rheumatic diseases in Russia

Galushko E.A., Nasonov E.L.


Aim: To estimate the prevalence of the rheumatic diseases in an epidemiological study.

Materials and methods: During a  questionnaire survey among 76 162 adult individuals in 12 regions of the Russian Federation, those with complaints of joint pain and swelling were selected and a group (n = 4894) was formed at random for subsequent clinical assessment by rheumatologists to identify main rheumatic diseases. In all regions, the study was conducted according to the unified protocol, with the unified strategy of the population selection and the use of unified questionnaires. Diagnoses were made based on widely adopted classification criteria for rheumatic diseases.

Results: For the first time in Russia it was found that among adult Russian population, the life-time prevalence of joint pain (mostly knee and hip) was 39.5%, whereas that of joint swelling amounted to 26%. From those, arthralgias eventually disappear in 8% and arthritis, in 7%. Among all rheumatic clinical entities, knee and/or hip osteoarthritis ranks the first, with its prevalence calculated to all adult population of Russia above 18 years of age being 13%. The prevalence of rheumatoid arthritis was 0.61%, of ankylosing spondylitis, 0.1%, psoriatic arthritis, 0.37%, reactive arthritis, 0.42%, gout, 0.3%, and of systemic connective tissue disorders (systemic lupus erythematosus, systemic sclerosis, dermatomyositis/polymyositis, Sjogren's syndrome, systemic vasculitis, etc),  0.11%.

Conclusion: The true prevalence of the rheumatic diseases found in the epidemiological study was higher than the data of the official statistics as follows: 2.5-fold for rheumatoid arthritis, 5-fold for osteoarthritis, 3.5-fold for spondyloarthritis and 3-fold for systemic connective tissue disorders. The results obtained showed an underestimation of the rheumatic diseases and incomplete data in the country statistics. This might be related to low referral levels for medical care due to significant distances of the vast regional areas from the specialized centers, as well as with insufficient qualification of primary care physicians in the field of rheumatology. All together, this leads to inevitable and serious misdiagnoses and low registration of the rheumatic diseases.

Almanac of Clinical Medicine. 2018;46(1):32-39
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Prevalence of Helicobacter pylori among medical workers in Moscow and Kazan according to ¹³С-urease breath test

Bordin D.S., Plavnik R.G., Nevmerzhitskiy V.I., Butorova L.I., Abdulkhakov R.A., Abdulkhakov S.R., Voinovan I.N., Embutnieks I.V.


Rationale: The relevance of the problem is related to the lack of data on Helicobacter pylori (HP) prevalence in Russia, which is associated with the risk of peptic ulcer and gastric cancer, and also, on the other hand, to the non-adherence of the doctors to the existing expert guidelines on diagnosis of this infection and HP eradication therapy.

Aim: To assess the prevalence of HP among medical workers and their willingness to undergo eradication therapy.

Materials and methods: A total of 315 medical workers (61 men and 254 women) aged 18 to 76 years were examined, among them 221 in Moscow and 94 in Kazan. To assess the HP contamination rate, all participants performed a ¹³С-urease breath test with the “HELICARB” test kit according to the “four-point” technique. All participants were asked to complete the questionnaires to access the impact of social and occupational factors on the prevalence of HP.

Results: HP was identified in 54.9% of the examined subjects, including 45.9% of men and 57.1% of women. The prevalence of HP in Moscow was substantially lower (49.8%) than in Kazan (67%). The proportion of HP-positive subjects increased with age from 41.8% in those below 25 years of age to 76.9% in those above their 60s. 60.2% of married participants and 49% of the singles were HP-positive. Among doctors, HP prevalence rate was the largest in the endoscopy specialists (61.5%) and internists (60.9%). Only 61.4% of HP-positive medical workers expressed their willingness to undergo eradication therapy.

Conclusion: The study showed a high prevalence of HР in medical workers increasing with age. It is presumably related to hygiene habits and conditions during childhood of each generation; however, one cannot exclude their potential contamination during their occupational activities.
Almanac of Clinical Medicine. 2018;46(1):40-49
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Current epidemiological, molecular and genetic characteristics of enteric viral hepatitis in Russia

Esaulenko E.V., Sukhoruk A.A., Bushmanova A.D., Ingabire T., Ostankova Y.V.


Rationale: Enteric hepatitis including hepatitis A and hepatitis E are globally prevalent diseases with large social and economic burden. In some patient categories these may be lethal. Hepatitis A (HAV) and hepatitis E (HEV) viruses are heterogeneous and have high geographic variability.

Aim: To assess current epidemiological, molecular and genetic characteristics of enteric viral hepatitis in the Russian Federation.

Materials and methods: We analyzed the data of the State statistical reports on the incidence of infectious diseases in the Russian Federation and of the analytical tables. Also, genotype identification of the HAVs isolated from 31 patients living in St. Petersburg was performed with specific primers flanking VP1/2A region.

Results: In the last 20 years (from 1997 to 2017), the epidemic process of hepatitis A in the Russian Federation has been changing substantially, including first of all its intensity and age distribution of the patients. Unlike hepatitis A, the official registration of hepatitis E in the Russian Federation was initiated only in 2013. During the analyzed time period, the incidence of hepatitis E varied from 0.06 to 0.08⁰⁄₀₀₀₀, with non-significant trend towards its increase in 2017. It has been found that from 2013 to 2015, two sub-genotypes of the virus (1a and 1b) circulated in St. Petersburg, with prevailing genotype 1a. The local cases of hepatitis E were caused by HEV genotype 3, whereas the imported cases, by HEV genotype 1.

Conclusion: In the Russian Federation, there has been a  long-standing and stable trend toward decreased incidence of hepatitis A. However this has led to weakening of collective immunity, mainly among the adult population. In combination with poor levels of municipal infrastructures and services in some territories, this may lead to an increase of the hepatitis A incidence. Despite that Russia is a non-endemic region for hepatitis E, local cases of the disease are increasingly identified.

Almanac of Clinical Medicine. 2018;46(1):50-58
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Liver cirrhosis in the Moscow Region: figures and facts

Bogomolov P.O., Matsievich M.V., Bueverov A.O., Kokina K.Y., Voronkova N.V., Beznosenko V.D.


The majority of deaths related to complications of liver cirrhosis would have been preventable with timely diagnosis and proper treatment. However, absence of the population-based screening programs for hepatitis, an asymptomatic course of the majority of liver disorders, failures in the registration of etiologically confirmed cases of liver cirrhosis, low population awareness of its risks and of current diagnostic and management opportunities do impede the collection of reliable epidemiological data on the incidence and prevalence of liver disorders including their end-stages, and on the related mortality of the population; as a consequence, all these factors hinder a comprehensive assessment of the medical and social burden of hepatic disorders. Medical registries are the single system for their registration and follow-up. Analysis of data from the Moscow Regional Registry of patients with liver disease has shown that the leading cause of liver cirrhosis is HCV infection (66%), with alcoholic liver cirrhosis ranking second (16.1%). There is a trend towards higher proportions of liver cirrhosis as an outcome of HCV hepatitis among newly referred patients (7.2% in 2012 and 10.6% in 2016). HCV genotype characteristics determine the rates of the disease progression: in those with genotype 3, liver cirrhosis would occur at an earlier age (51.8% of patients aged from 26 to 45) than with genotype 1 (58.7% of patients aged from 46 to 65). In older patients, various comorbidities can contribute to the development of liver cirrhosis. Among patients with HBV infection, 4.9% have liver cirrhosis, and most of patients receive antiviral treatment with nucleoside/nucleotide analogues. The highest percentage of liver cirrhosis has been found in the patients with chronic D hepatitis (46/116, 39.7%). In 10.3% of the patients with chronic D hepatitis, the aggressive course of the disease leads to primary liver cancer. Thus, the necessity of the development of prevention measures and early detection of liver disorders, as well as modernization of the public healthcare system at all stages of medical care should be recognized as the short-term goals, in addition to the search for highly effective etiologic treatment and making it available within the state-financed programs.

Almanac of Clinical Medicine. 2018;46(1):59-67
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Survival analysis of patients with uveal melanoma after organ preserving and liquidation treatment

Grishina E.E., Lerner M.Y., Gemdzhian E.G.


Rationale: Uveal melanoma is the most common primary malignancy of the eye.

Aim: To evaluate survival in patients with uveal melanoma stratified according to the type of treatment and to identify factors significantly associated with their survival.

Materials and methods: The study was performed on the data extracted from medical files and follow-up forms of patients with uveal melanoma seen in the Ophthalmological Clinical Hospital of the Department of Healthcare, Moscow, from 1977 to 2012. Analysis of survival was used to assess the life longevity of patients with uveal melanoma. The analysis was censored at January 2013, when vital status (dead or alive) of all patients was assessed. The factors included into the study analysis, were those taken from the follow-up forms. The incidence of uveal melanoma in Moscow (2012) was 0.9 per 100,000 of the population, whereas its prevalence was 11.1 per 100,000.

Results: 698 patients with uveal melanoma were included into the study, among them 260 (37%) men (aged from 19 to 87 years, median age 60 years) and 438 (63%) women (aged from 18 to 93 years, median age 63 years); therefore, the proportion of women under the follow-up monitoring was by 26% higher than that of men. The liquidation treatment (mostly enucleation) was performed in 358 (51%) of the patients, whereas the organ preserving treatment in 340 (49%). At 5, 7, and 10 years of the follow-up, the disease-specific survival of patients with uveal melanoma after the organ preserving treatment (median survival has not been reached) and after the liquidation treatment (median, 88 months) were 89 ± 2, 83 ± 3, and 75 ± 4% versus 63 ± 3, 52 ± 4, and 47 ± 5%, respectively (р = 0.001). Overall survival and disease-specific survival of the patients after the liquidation treatment were significantly lower than in the patients after the organ-preserving treatment. According to multiple regression analysis, this was associated not with the type of treatment, but rather with higher initial grade of the disease (as the most significant factor) and with older age (> 65 years; the second significant factor). Both factors were significantly more prevalent (р = 0.05; chi-square test) among the patients who underwent the liquidation treatment.

Conclusion: The large size of the uveal melanoma, with its pre-equator location and extrascleral spread, as well as the age above 65 years can be considered as unfavorable prognostic factors.

Almanac of Clinical Medicine. 2018;46(1):68-75
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Multiplicity of comorbidities in patients with severe psoriasis

Batkaeva N.V., Korotaeva T.V., Batkaev E.A.


Rationale: Severe treatment-resistant psoriasis and comorbidities are on the rise.

Aim: To evaluate the prevalence of comorbidities in a  hospital-based cohort of patients with severe psoriases.

Materials and methods: We performed a  retrospective analysis of medical files of 890  patients with moderate-to-severe plaque psoriasis (PASI > 10) treated in a  hospital from 2010 to 2015 (men, 516 [58%], women, 374 [42%]; mean age 51.9 ± 11.6 years; mean PASI, 44.3 ± 7.8  scores).

Results: Comorbidities were found in 61% (543 / 890) of the patients with severe psoriasis, with cardiovascular disorders ranking first (59%, or 516 / 890) and gastrointestinal and hepatobiliary disorders ranking second (46,4%, or 413 / 890). Psoriatic arthritis was diagnosed in 34% (303 / 890) of the patients and other disorders of the musculoskeletal system unrelated to psoriasis in 19.8% (176 / 890). The proportion of diabetes was 15.4% (137 / 890).

Conclusion: Psoriasis has a high rate of comorbidities, in particular of cardiovascular disorders. It significantly deteriorates the course of psoriasis and its response to therapy, and in some cases may reduce the possibility of adequate anti-psoriatic treatment due to contraindications.
Almanac of Clinical Medicine. 2018;46(1):76-81
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Prevalence and characteristics of various types of lichen planus in the Moscow Region

Molochkova Y.V., Molochkov V.A., Grineva N.K.


Rationale: Lichen planus (LP) is an important problem for the healthcare due to its increasing prevalence, as well as typical, atypical and prone to malignization types of the disease that can be both severe and poorly responding to treatment. Accurate data on the prevalence of LP are lacking.

Aim: To assess the prevalence of various LP types in the patient population of the Moscow Region.

Materials and methods: We analyzed the results of examination of 338 patients with LP, who were getting standard treatment in the Department of Dermatovenereology and Dermato-oncology of the Moscow Regional Research and Clinical Institute (MONIKI) in 1999 to 2017.

Results: Among 338 LP patients, atypical LP of the skin was diagnosed in 81 (23.96%): hypertrophic type, in 31 (38.27%), pigmented, in 23 (28.4%), atrophic, in 11 (13.58%), follicular, in 8 (9.88%), lichen obtusus, in 3 (3.7%), bullous, in 1 (1.23%), erythematous, in 1 (1.23%), vulvovaginal-gingival syndrome, in 2 (2.47%), and Grinspan's syndrome, in 1 (1.23%). In 35 (43.21%) of patients, cutaneous LP was associated with atypical oral LP (OLP): in 17 (48.57%) of cases with hyperkeratotic, in 11 (31.43%), with erosive, and in 7 (20%), with exudative-hyperemic type. In 19 (23.46%) cases, atypical cutaneous LP was associated with LP of the genital mucosae, including in 12 (63.16%) cases with a typical reticular type, in 6 (31.58%), with atypical erosive, and in 1 (5.26%), with hypertrophic type. In 16 (4.73%) of the patients there was atypical OLP only; in 6 (37.5%) of them it had the exudative-hyperemic type, in 5 (31.25%), erosive, and in 5 (31.25%), hyperkeratotic. The most severe course of the dermatosis was observed for follicular, atrophic, hypertrophic types of cutaneous LP, vulvovaginal-gingival syndrome, and erosive OLP.

Conclusion: Atypical LP was diagnosed in 81 (23.96%) cases, and in 45 (55.6%) cases it was associated with the OLP. The latter in 35 (43.21%) of cases was characterized by atypical lesions of OLP, including 11 (31.43%) cases of obligate precancerous erosive LP, which necessitates that this patient category should be managed with high cancer vigilance.

Almanac of Clinical Medicine. 2018;46(1):82-87
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Analysis of the prostate cancer incidence and mortality as a basis to optimize medical care in the Moscow Region

Balkanov A.S., Bazaev V.V., Gurov A.N.


Background: Prostate cancer (PC) is one of the most commonly diagnosed tumors in the male population that makes relevant to study current trends of its incidence and related mortality.

Aim: To identify current trends in РС incidence and mortality in the Moscow Region.

Materials and methods: To analyze the PC incidence and mortality in the Moscow Region from 2011 to 2016, we used data extracted from the annual report forms of the federal statistic surveillance of the public healthcare and from the Moscow Regional Cancer Registry that contains regional information on newly diagnosed cancers.

Results: From 2011 to 2015, the number of PC cases in men living in the Moscow Region has increased by 38%, with an average annual growth of the incidence by 8.8%. In 2016, there was a 8.7% decline in the new PC cases (in total, 1765), compared to that in 2015. From 2011 to 2015, the incidence of PC has increased from 42.5 to 57.8 per 100,000, primarily due to its change in men above their 50 years of age. In 2016, the PC incidence went down to 52.2 per 100,000. The peak PC incidence in all years of the study was in the age group of 70 to 79 years. In 2016, there was a non-significant decrease in PC-related mortality to 16.6 per 100,000.

Conclusion: The results obtained can be used to optimize medical care for PC patients in the Moscow Region.

Almanac of Clinical Medicine. 2018;46(1):88-93
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