Publications by authors named "Irina Efremova"

9 Publications

  • Page 1 of 1

Early viral versus late antibiotic-associated diarrhea in novel coronavirus infection.

Medicine (Baltimore) 2021 Oct;100(41):e27528

Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation.

Abstract: Diarrhea is one of the manifestations of the novel coronavirus disease (COVID-19), but it also develops as a complication of massive antibiotic therapy in this disease. This study aimed to compare these types of diarrhea.We included patients with COVID-19 in a cohort study and excluded patients with chronic diarrhea, laxative use, and those who died during the first day of hospitalization.There were 89 (9.3%), 161 (16.7%), and 731 (75.7%) patients with early viral, late antibiotic-associated, and without diarrhea, respectively. Late diarrhea lasted longer (6 [4-10] vs 5 [3-7] days, P < .001) and was more severe. Clostridioides difficile was found in 70.5% of tested patients with late diarrhea and in none with early diarrhea. Presence of late diarrhea was associated with an increased risk of death after 20 days of disease (P = .009; hazard ratio = 4.7). Patients with late diarrhea had a longer hospital stay and total disease duration, and a higher proportion of these patients required intensive care unit admission. Oral amoxicillin/clavulanate (odds ratio [OR] = 2.23), oral clarithromycin (OR = 3.79), and glucocorticoids (OR = 4.41) use was a risk factor for the development of late diarrhea, while ceftriaxone use (OR = 0.35) had a protective effect. Before the development of late diarrhea, decrease in C-reactive protein levels and increase in lymphocyte count stopped but the white blood cell and neutrophil count increased. An increase in neutrophils by >0.6 × 109 cells/L predicted the development of late diarrhea in the coming days (sensitivity 82.0%, specificity 70.8%, area under the curve = 0.791 [0.710-0.872]).Diarrhea in COVID-19 is heterogeneous, and different types of diarrhea require different management.
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http://dx.doi.org/10.1097/MD.0000000000027528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519250PMC
October 2021

Probiotics in hepatology: An update.

World J Hepatol 2021 Sep;13(9):1154-1166

Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow 119435, Russia.

The gut-liver axis plays an important role in the pathogenesis of various liver diseases. Probiotics are living bacteria that may be used to correct disorders of this axis. Notable progress has been made in the study of probiotic drugs for the treatment of various liver diseases in the last decade. It has been proven that probiotics are useful for hepatic encephalopathy, but their effects on other symptoms and syndromes of cirrhosis are poorly studied. Their effectiveness in the treatment of metabolic associated fatty liver disease has been shown both in experimental models and in clinical trials, but their effect on the prognosis of this disease has not been described. The beneficial effects of probiotics in alcoholic liver disease have been shown in many experimental studies, but there are very few clinical trials to support these findings. The effects of probiotics on the course of other liver diseases are either poorly studied (such as primary sclerosing cholangitis, chronic hepatitis B and C, and autoimmune hepatitis) or not studied at all (such as primary biliary cholangitis, hepatitis A and E, Wilson's disease, hemochromatosis, storage diseases, and vascular liver diseases). Thus, despite the progress in the study of probiotics in hepatology over the past decade, there are many unexplored and unclear questions surrounding this topic.
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http://dx.doi.org/10.4254/wjh.v13.i9.1154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473492PMC
September 2021

Interleukin 17 antagonist netakimab is effective and safe in the new coronavirus infection (COVID-19).

Eur Cytokine Netw 2021 Mar;32(1):8-14

Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Pogodinskaya str., 1, bld. 1, Moscow, 119435, Russian Federation.

Cytokine release syndrome is a serious complication of the new coronavirus infection (COVID-19). The aim of the study was to assess effectiveness and safety of the IL-17 antagonist nekatimab for its treatment. The retrospective study included COVID-19 patients with C-reactive protein levels >60 mg/L. Patients received either netakimab (group NET), IL-6 antagonist tocilizumab (group TOC) or no anti-cytokine treatment (group CON). Forty-four patients were enrolled in the NET group, 27 patients in the TOC group, and 47 patients in the CON group. Mortality was lower in the NET group than in TOC and CON groups (2.3% vs. 14.8% and 31.9%; p = 0.018 and p < 0.001). NET group patients required intensive care unit admission (6.8% vs. 25.9% and 46.3%; p = 0.025 and p < 0.001) and mechanical ventilation (4.6% vs. 22.2% and 31.9%; p = 0.022 and p = 0.002) less frequently than patients of the TOC and CON groups. After 7-10 days of anti-cytokine drug administration, a reduction in lung lesion volume (p = 0.016) and an increase in the proportion of patients who did not need oxygen support (p = 0.005) or stayed in prone position (p = 0.044) was observed in the NET group only group; C-reactive protein levels were the same in the TOC and NET groups (p = 0.136) and lower in the CON group (p < 0.001 and p = 0.005). IL-6 levels decreased in the NET group (p = 0.005) and did not change in the TOC group (p = 0.953). There was no difference in the incidence of side effects between groups. The IL-17 antagonist netakimab is effective and safe in the treatment of cytokine release syndrome in COVID-19.
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http://dx.doi.org/10.1684/ecn.2021.0463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491178PMC
March 2021

Gut dysbiosis is associated with poorer long-term prognosis in cirrhosis.

World J Hepatol 2021 May;13(5):557-570

Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow 119435, Russia.

Background: Gut dysbiosis is common in cirrhosis.

Aim: To study the influence of gut dysbiosis on prognosis in cirrhosis.

Methods: The case-control study included 48 in-patients with cirrhosis and 21 healthy controls. Stool microbiome was assessed using 16S ribosomal ribonucleic acid gene sequencing. We used modified dysbiosis ratio (MDR): [ (%) + (%)]/[ (%) + (%)]. Patients with MDR more the median made up the group with severe dysbiosis, others did the group with non-severe dysbiosis. The follow-up period was 4 years.

Results: The mortality rate of patients with severe dysbiosis was significantly higher than that of patients with non-severe dysbiosis (54.2% 12.5%; = 0.001). The presence of severe dysbiosis was independent risk factors for death [hazard ratio = 8.6 × (1.9-38.0); = 0.005]. The abundance of ( = 0.002), ( = 0.002), and ( = 0.025) was increased and the abundance of ( = 0.025) and ( = 0.045) was decreased in the deceased patients compared with the survivors. The deceased patients had a higher MDR value than the survivors [0.131 × (0.069-0.234) 0.034 × (0.009-0.096); = 0.004]. If we applied an MDR value of 0.14 as the cutoff point, then it predicted patient death within the next year with a sensitivity of 71.4% and a specificity of 82.9% [area under the curve = 0.767 × (0.559-0.974)]. MDR was higher in patients with cirrhosis than in health controls [0.064 × (0.017-0.131) 0.005 × (0.002-0.007); < 0.001], and in patients with decompensated cirrhosis than in patients with compensated cirrhosis [0.106 × (0.023-0.211) 0.033 × (0.012-0.074); = 0.031]. MDR correlated negatively with prothrombin ( = -0.295; = 0.042), cholinesterase ( = -0.466; = 0.014) and serum albumin ( = -0.449; = 0.001) level and positively with Child-Turcotte-Pugh scale value ( = 0.360; = 0.012).

Conclusion: Gut dysbiosis is associated with a poorer long-term prognosis in cirrhosis.
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http://dx.doi.org/10.4254/wjh.v13.i5.557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173342PMC
May 2021

Immune disorders and rheumatologic manifestations of viral hepatitis.

World J Gastroenterol 2021 May;27(18):2073-2089

Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow 119435, Russia.

Infection with hepatotropic viruses is not limited to the liver and can lead to the development of various immunological disorders (the formation of cryoglobulins, rheumatoid factor, antinuclear antibodies, autoantibodies specific for autoimmune hepatitis and primary biliary cholangitis, and others), which can manifest as glomerulonephritis, arthritis, uveitis, vasculitis (cryoglobulinemic vasculitis, polyarteritis nodosa, Henoch-Schonlein purpura, isolated cutaneous necrotizing vasculitis), and other rheumatologic disorders, and be a trigger for the subsequent development of autoimmune hepatitis and primary biliary cholangitis. A further study of the association between autoimmune liver diseases and hepatotropic virus infection would be useful to assess the results of treatment of these associated diseases with antiviral drugs. The relationship of these immune disorders and their manifestations with hepatotropic viruses is best studied for chronic hepatitis B and C. Only isolated cases of these associations are described for hepatitis A. These links are least studied, and are often controversial for hepatitis E, possibly due to their relatively rare diagnoses. Patients with uveitis, glomerulonephritis, arthritis, vasculitis, autoimmune liver diseases should be tested for biomarkers of viral hepatitis, and if present, these patients should be treated with antiviral drugs.
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http://dx.doi.org/10.3748/wjg.v27.i18.2073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117740PMC
May 2021

Tofacitinib reduces mortality in coronavirus disease 2019 Tofacitinib in COVID-19.

Pulm Pharmacol Ther 2021 08 21;69:102039. Epub 2021 May 21.

Sechenov University, Pogodinskaya str., 1, bld. 1, Moscow, 119435, Russian Federation.

Background And Aim: Cytokine release syndrome is a dangerous complication of the coronavirus disease 2019 (COVID-19). This study aimed to evaluate the efficacy and safety of tofacitinib in the management of this complication.

Methods: The retrospective study included COVID-19 patients with C-reactive protein (CRP) levels of 60-150 mg/L.

Results: Thirty-two patients who received tofacitinib (TOF group) and 30 patients who did not receive any anti-cytokine drugs (control [CON] group) were enrolled. Mortality and the incidence of admission to the intensive care unit were lower in the TOF group than in the CON group (16.6% vs. 40.0%, p = 0.009; and 15.6% vs. 50.0%, p = 0.004). There was a significant decrease in the volume of the affected part of the lungs (p = 0.022) and a significant increase in oxygen saturation (p = 0.012) in the TOF group than in the CON group 7-10 days after the beginning tofacitinib administration. CRP level was lower in the TOF group than in the CON group (7 [3-22] vs. 20 [5-52] mg/L; p = 0.048) 7-10 days after the start of the administration of tofacitinib. During this period, the number of patients requiring mechanical ventilation or those in the prone position increased in the CON group compared to those in the TOF group (26.7% vs. 0.0%, p = 0.002; 33.3% vs. 6.7%, p = 0.020). There was no significant difference in the development of secondary infections, liver or kidney injury, and cytopenia between the two groups.

Conclusion: Tofacitinib was effective and safe for managing the cytokine release syndrome in COVID-19. Randomized controlled double-blind trials with tofacitinib with and without the simultaneous use of glucocorticoids are required to confirm our findings.
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http://dx.doi.org/10.1016/j.pupt.2021.102039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137353PMC
August 2021

Production of the growth factors GM-CSF, G-CSF, and VEGF by human peripheral blood cells induced with metal complexes of human serum γ -globulin formed with copper or zinc ions.

Mediators Inflamm 2014 3;2014:518265. Epub 2014 Jul 3.

Laboratory of Cell to Cell Interactions, N.F. Gamaleya Research Institute of Epidemiology and Microbiology, Health Ministry of the Russian Federation, Gamaleya Street 18, Moscow 123098, Russia.

As it was established in our previous studies, the proteins of human serum γ-globulin fraction could interact with copper or zinc ions distributed in the periglobular space, form metal complexes, and become able to perform effector functions differing due to the conformational shifts from those mediated by them in native conformation of their Fc regions. In the present work we have evaluated ability of the γ-globulin metal complexes formed with copper or zinc ions in the conditions like to the physiological ones to induce production or to regulate induction in the culture of freshly isolated human peripheral blood cells (PBC) of granulocyte (G) and granulocyte-macrophage (GM) colony-stimulating factors (CSF) as well as of vascular endothelial growth factor (VEGF). The γ-globulin metal complexes formed with both copper and zinc ions were found to similarly reduce production of GM-CSF, G-CSF, and VEGF induced in normal human PBC cultures by the control γ-globulins or by copper and zinc ions used alone. In context of theory and practice of inflammation the properties of the γ-globulin metal complexes might impact the basic knowledge in search of novel approaches to anti-inflammatory drugs development.
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http://dx.doi.org/10.1155/2014/518265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101935PMC
April 2015

5-bromo-2,3-dihydro-4-methyl-3-nitrothiophene 1,1-dioxide.

Acta Crystallogr C 2003 Mar 28;59(Pt 3):o177-8. Epub 2003 Feb 28.

Department of Chemistry, University of Northern Iowa, Cedar Falls, IA 50614-0423, USA.

The title compound, C(5)H(6)BrNO(4)S, crystallizes in the centrosymmetric space group P2(1)/c. Three weak C-H.O hydrogen bonds dominate the packing of the molecules in the solid. These weak hydrogen bonds and a short intermolecular O...Br contact of 3.003 (2) A are discussed using a Mulliken population analysis.
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http://dx.doi.org/10.1107/s0108270103000842DOI Listing
March 2003

Enhancing Continuity of Care: Residency Training in an Integrated Inpatient--Partial Hospital Program.

Acad Psychiatry 2002 Mar;26(1):4-8

Dr. Kim and Dr. Efremova are Assistant Professors of Psychiatry at Robert Wood Johnson Medical School.

This paper describes a teaching/service model that integrates inpatient, partial hospital, and intensive outpatient treatment. In this model, individual multidisciplinary treatment teams retain responsibility for a patient's care for any or all of three levels of intensity of services accessed during an episode of illness. This teaching/service model allows residents to follow patients for an average of 2.5 weeks across an entire acute episode of care compared with the 7.3 days of the average inpatient stay at the inpatient facility. The opportunity to continue treatment in step-down settings over longer periods of time allows residents and medical students to develop a fuller understanding of their patients. The authors believe that this continuum-care service model more efficiently trains residents in multiple aspects of psychiatric practice and provides patients with better care than the traditional inpatient-care service model.
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http://dx.doi.org/10.1176/appi.ap.26.1.4DOI Listing
March 2002
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