Репозиторий Университета

© 2019 American Academy of Allergy, Asthma  &  Immunology Background: Mepolizumab is an anti–IL-5 antibody approved for the treatment of severe eosinophilic asthma. However, the prevalence of patients with severe asthma eligible for mepolizumab remains unknown, especially among children. Objective: To determine, in a population of patients with severe asthma from a tertiary referral center, the proportion of patients with an eosinophilic phenotype who would be eligible for mepolizumab, when stratified for the age of onset of asthma, and the prevalence of phenotypic features that favor mepolizumab therapy. Methods: An extensive database of 245 adults and children referred for severe asthma was used. The prevalence of severe asthma was estimated by using the European Respiratory Society/American Thoracic Society criteria. Patients with an eosinophilic uncontrolled phenotype qualified for mepolizumab. Results: In our cohort, 216 (88%) had severe asthma. Based on blood eosinophils of either greater than or equal to 150 cells/μL or greater than or equal to 300 cells/μL, 61%/41% had an eosinophilic phenotype, while 49%/34% were eligible for mepolizumab therapy. A greater percentage of adults (60%/47% of adults with asthma onset in adulthood [AoA] and 48%/26% adults with childhood-onset asthma [<18 years, CoA]) were eligible compared with children (33%/24%), for eosinophil counts of ≥150 and ≥300 cells/μL, respectively; P < .05. Compared with adults, children had a similar number of exacerbations while having better lung function (P < .05). Among adults, those with AoA were older, were more likely to have nasal polyps (28% vs 5%; P < .05), and had higher blood eosinophil counts (272 vs 150 cells/μL; P < .05) compared with those with CoA, with no difference in lung function noted between the 2 groups. Subjects showing greater than or equal to 500 eosinophils/μL, a strong indicator for mepolizumab therapy, had more nasal polyps, higher inhaled steroid dose, lower lung function, and AoA predominance than did those with less than 500 eosinophils/μL (P < .05). Conclusions: A smaller percentage of children with severe asthma were eligible for mepolizumab compared with their adult peers. Severe AoA has distinct phenotypic features that favor treatment with mepolizumab, including greater eosinophilia and nasal polyposis, in contrast to CoA, which appears to have fewer features of type 2 mucosal inflammation.

© 2018 Stolichnaya Izdatelskaya Kompaniya. Синдром такоцубо - это остро развивающаяся и, как правило, обратимая дисфункция миокарда левого желудочка. Наиболее часто синдром такоцубо проявляется локальной гипокинезией апикальных сегментов миокарда левого желудочка в ответ на эмоциональные или физические триггеры. Синдром такоцубо составляет около 2% от всех госпитализаций с подозрением на острый коронарный синдром. Диагностика синдрома такоцубо остается затруднительной. Клиническая картина острой фазы синдрома такоцубо зачастую не отличима от симптомов острого коронарного синдрома с подъемом или без подъема сегмента ST. Заболевание также сопровождается повышением маркеров по- вреждения миокарда, которое, однако, отличается от такового у пациентов с инфарктом миокарда с подъемом сегмента ST. Наиболее рас- пространенными для постановки диагноза являются модифицированные критерии клиники Mayo. Патогенез заболевания также мало изучен и представлен различными теориями, в которых главную роль играют катехоламины и их воздействие на миокард. На основании описанных семейных случаев синдрома такоцубо нельзя исключить генетическую предрасположенность к развитию заболевания. Несмотря на обратимую дисфункцию миокарда, почти в половине случаев синдром такоцубо осложняется развитием острой сердечной недостаточности, а госпитальная летальность сопоставима с таковой при инфаркте миокарда с подъемом сегмента ST. Вопрос о лечении синдрома такоцубо на сегодняшний день малоизучен. Проспективных клинических исследований каких-либо препаратов не проводилось. Считается, что тактика ведения пациентов с синдромом такоцубо, госпитализированных с подозрением на острый коронарный синдром, должна соответ- ствовать протоколу ведения больных с инфарктом миокарда, пока острая коронарная патология не исключена. На сегодняшний день забо- левание требует дальнейшего изучения.

© 2018, ABV-Press Publishing House. Attention deficit hyperactivity disorder (ADHD) is the most common cause of behavioral disorders and learning difficulties in preschool and school-age children. Patients with ADHD are often diagnosed with concomitant diseases, which creates additional diagnostic and therapeutic challenges and leads to a more significant reduction in the quality of life. ADHD is often associated with epilepsy: ADHD manifestations are more common in individuals with epilepsy, and vice versa, patients with ADHD are more likely to have epilepsy. The estimated prevalence of ADHD in children is 7-9 %, whereas in children with epilepsy, it reaches 20-50 %. Epilepsy is also one of the most common diseases in children (affecting approximately 1 % of the pediatric population), which is often aggravated by concomitant diseases, including cognitive, behavioral and emotional disorders. Various factors, such as characteristics of epileptic process and lesions in particular portions of the brain, can underlie the development of ADHD in epilepsy. Epileptiform activity and adverse effects of antiepileptic drugs can also play an important etiological role. Some antiepileptic drugs (such as barbiturates) may cause symptoms similar to those in ADHD (in this case, inattentiveness and hyperactivity shall be considered as adverse events that can be reduced or eliminated after cessation of the drug) or exacerbate ADHD symptoms in patients with these disorders. Therefore, the drugs with no negative impact on concomitant diseases or with a positive therapeutic effect for both diseases are preferable in these cases. High prevalence of the ADHD/epilepsy combination leads to a greater reduction in the quality of life, suggesting high relevance of this problem and requiring a revision of therapeutic approaches.