Aim. A comparative review of the rabeprazole properties vs. other PPIs, its efficacy and safety in treatment for aciddependent diseases.Key points. Rabeprazole provides a rapid proton pump blockade in parietal cells due to its high dissociation constant (pKa). A lower rabeprazole metabolic dependence on cytochrome P-450 enzyme system renders its antisecretory effect predictable and reduces the risk of interactions with other drugs metabolised through this system. A faster antisecretory effect and higher acid-suppressive activity of rabeprazole determine its better clinical efficacy in treatment for such acid-dependent diseases as gastroesophageal reflux disease and peptic ulcer. This makes rabeprazole (Pariet) a preferred drug in course and maintenance therapies for acid-dependent diseases, as well as in H. pylori eradication.Conclusion. The rabeprazole properties of high acid suppression potential, persistent antisecretory effect from first day of therapy, non-enzymatic metabolism and pleiotropic action determine its high efficacy in treatment for a wide range of acid-dependent diseases at a minimal risk of drug interaction.

The persistent evolution of SARS-CoV-2 necessitates novel antiviral strategies. This study evaluated the anti-HIV prodrugs tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) for repurposing against SARS-CoV-2, assessing key pharmacological indices (CC₅₀, EC₅₀, cytostatic effect, and therapeutic window). In vitro screening in Vero E6 cells measured cytotoxicity (via CCK-8/MTT assays) and antiviral activity against Kazakh B.1 and Wuhan strains. TDF (50 µg/mL) reduced high viral loads (MOI 2) by ~2 log₁₀ (100% inhibition), with minimal cytotoxicity (≥75% viability). TAF achieved near-complete suppression (100% inhibition) at 50 µg/mL, exhibiting dose-dependent inhibition (68–100%) at lower viral loads (MOI 0.01). Both prodrugs showed enhanced antiviral activity with prolonged exposure (96 h). Synergy assessments demonstrated favourable combination indices (CI < 1). Electron microscopy confirmed virion integrity post-treatment. These findings highlight TDF and TAF as promising candidates against SARS-CoV-2, with particular potential for targeting lymphoid reservoirs—sites implicated in persistent viral reservoirs that may contribute to long COVID pathogenesis. Further clinical validation is warranted.

Toxoplasmosis is a parasitic infection that can present in various clinical forms, ranging from asymptomatic to severe neurological manifestations. The primary sources of infection include undercooked meat, unwashed produce and contact with cat faeces. Toxoplasmosis can lead to encephalitis, particularly in immunocompromised patients, and is often misdiagnosed as other neurological conditions such as multiple sclerosis (MS). We report the case of a 44-year-old male from Almaty, Kazakhstan, who presented with neurological symptoms including headaches, dizziness, diplopia, leg weakness and elevated blood pressure. The patient had a history of consuming undercooked meat, but no prior neurological conditions. Initial magnetic resonance imaging (MRI) revealed demyelinating lesions, leading to a diagnosis of MS. However, high levels of IgG antibodies against Toxoplasma gondii were detected, prompting further testing. A polymerase chain reaction test for toxoplasmosis was negative, but the patient was treated empirically with trimethoprim and sulfamethoxazole for six months. A follow-up MRI showed a significant reduction in brain lesions, and the patient’s symptoms improved.

Introduction. Among the persistent consequences of SARS-CoV-2 infection in children, Long COVID and Multisystem Inflammatory Syndrome in Children (MIS-C) have attracted the greatest clinical attention. Although both conditions develop after resolution of the acute illness, their underlying mechanisms and clinical courses differ significantly, which is critical for diagnosis and management. Objective. We set out to compare the epidemiological, clinical, immunological, and diagnostic profiles of Long COVID and MIS-C in pediatric patients, focusing particularly on biomarker patterns and their implications for optimal post-COVID follow-up. Materials and Methods. Cclinical records from pediatric wards and outpatient clinics across Kazakhstan (2020–2022) were reviewed and compareds with key international studies. Assessmentsincludred fatigue, neurocognitive, psycho-emotional, cardiovascular, and gastrointestinal symptoms. Laoratory analyses comprised RT-PCR cycle threshold (Ct) valueis, IgG serology, and measuremenst of CRP, ferritin, IL-6, D-dimer, and procalcitonin. Cas classification followedr WHO (2023) and CDC (2022) criteri.a. Results. Among children with Long COVID, fatigue (55%), cognitive difficulties (35%), and psycho-emotional symptoms (30%) were predominant. In contrast, MIS-C typically presented with fever (100%) and was characterized by gastrointestinal (80%) and cardiovascular (70%) involvement. Children in the acute phase exhibited low Ct values (≤25), indicating higher viral loads than suggested by their mild clinical presentation. IgG titers declined more rapidly in children than adults, indicating reduced humoral immunity durability. MIS-C cases demonstrated markedly elevated CRP, ferritin, IL-6, and D-dimer levels, consistent with a cytokine-driven inflammatory response. Conclusions. Despite distinct pathogeneses, both conditions arise from SARS-CoV-2-induced immune dysregulation. Long COVID manifests as a chronic, low-grade inflammatory state with significant neurocognitive and psycho-emotional effects, whereas MIS-C presents as an acute hyperinflammatory syndrome. Systematic biomarker monitoring and individualized vaccination strategies are essential for preventing severe outcomes and facilitating full recovery in pediatric patients. Длительный COVID и мультисистемный воспалительный синдром у детей (MIS-C) являются двумя основными постинфекционными осложнениями SARS-CoV-2, которые продолжают оказывать значительное влияние на здоровье детей во всем мире. Несмотря на то, что оба синдрома развиваются после острой фазы инфекции, они существенно различаются по патогенезу, клиническим проявлениям и долгосрочным последствиям. Цель исследования. Провести сравнительный анализ эпидемиологических, клинических, иммунологических и диагностических особенностей длительного COVID и MIS-C у детей с акцентом на профиль биомаркеров и значение для постковидного наблюдения. Материал и методы. Исследование основано на анализе клинических данных, собранных в педиатрических отделениях Казахстана в 2020–2022 годах, и сопоставлении их с результатами международных исследований. Клиническая оценка включала анализ проявлений усталости, когнитивных, психоэмоциональных, сердечно-сосудистых и желудочно-кишечных симптомов. Лабораторное исследование включало ПЦР-диагностику (пороговые значения Ct), серологическое определение IgG и оценку воспалительных биомаркеров (СРБ, ферритин, IL-6, D-димер, прокальцитонин). Интерпретация данных проводилась в соответствии с определениями ВОЗ (2023) и CDC (2022) для постковидных состояний и MIS-C. Результаты. У детей с длительным COVID преобладали усталость (55%), когнитивные нарушения (35%) и психоэмоциональные расстройства (30%), тогда как MIS-C характеризовался лихорадкой (100 %), желудочно-кишечными (80%) и сердечно-сосудистыми (70%) проявлениями. У детей выявлены низкие Ct-значения (≤ 25), что указывает на высокую вирусную нагрузку в острой фазе заболевания. Уровни антител IgG снижались быстрее, чем у взрослых, что указывает на менее устойчивый гуморальный иммунитет. При MIS-C отмечалось значительное повышение СРБ, ферритина, IL-6 и D-димера, что подтверждает цитокин-опосредованную гипервоспалительную реакцию. Выводы. Длительный COVID и MIS-C представляют собой различные, но перекрывающиеся постинфекционные состояния, связанные с иммунной дисрегуляцией....

Background: Duchenne muscular dystrophy (DMD) has, for the first time, several mutation-specific drugs in clinical use. Four exon-skipping antisense oligonucleotides and one adeno-associated virus (AAV) micro-dystrophin gene therapy carry US FDA approval, and one nonsense-readthrough agent (ataluren) holds a conditional European authorisation that has since been placed under review; ataluren has never been approved by the FDA. Regulatory approval, however, has not translated cleanly into demonstrable clinical benefit, and in resource-limited settings it has not translated into access at all. Methods: We compiled published efficacy estimates for each approved therapy: the EMBARK randomised trial for delandistrogene moxeparvovec (Elevidys), the STRIDE registry for ataluren, and the long-term extension studies of eteplirsen, golodirsen, viltolarsen and casimersen. We read these alongside mutation-spectrum and clinical data from a Kazakh DMD cohort (n = 34), one of the first Central Asian populations to be characterised systematically. Because these sources differ in design, population, endpoint and follow-up, the comparison is indirect and descriptive rather than pooled or statistical. On that basis we assembled three descriptive maps: biological versus clinical efficacy, eligibility versus access, and an order-of-magnitude estimate of cost per year of preserved ambulation. Results: Across the approved therapies, larger biological dystrophin restoration did not correspond to longer preservation of walking. We describe this as the absence of the expected positive association rather than as evidence of a negative one: the comparison rests on a small number of drugs whose values come from heterogeneous studies. We did not—and with these data could not—test it as a formal correlation. Ataluren, with roughly 2% dystrophin restoration, was associated with a longer reported delay in loss of ambulation than Elevidys, which restores 34–51% micro-dystrophin. In the Kazakh cohort, 26.5% of patients were biologically eligible for exon-skipping and 11.8% for ataluren, yet realistic access to any mutation-specific therapy was effectively zero as of April 2026. Our order-of-magnitude cost estimates ran from about $12,000 per additional year of ambulation for standard of care to about $1.3 million for AAV gene therapy, a hundredfold range that did not track clinical effect. Conclusions: We argue that the conventional priority ordering (gene therapy first, exon-skipping second, standard care as background) does not hold up when weighed against patient-relevant outcomes and cost, and may reasonably be inverted for resource-limited systems. This is our interpretation of an indirect comparison, not an evidence-based clinical recommendation. On that reading, the highest-value investments for Central Asia are early molecular diagnosis, universal access to glucocorticoids and specialised physiotherapy, and individual-import pathways for ataluren, while AAV gene therapy is, in our view, a lower near-term priority until its durability and safety data improve.

For a long period of 46 years since the discovery of the hepatitis D virus antigen by M. Rizzetto in 1977, chronic hepatitis D was considered in conjunction with chronic hepatitis B, classified as chronic hepatitis B with the delta agent. As a result, both viruses were treated with the same low-efficacy therapies, primarily interferon-based treatments, including pegylated interferon-α combined with nucleoside analogues, achieving virological response rates of only around 25 %. For the first time, chronic hepatitis D was recognized as a separate disease entity from chronic hepatitis B in the first Practical Guidelines of the European Association for the Study of the Liveron the management of chronic hepatitis D, published on August 30, 2023. National Russian guidelines on chronic hepatitis D were published earlier, in 2021. Objective: To present and analyze the first international guidelines on the management of chronic hepatitis D, and to familiarize clinicians with randomized clinical trials evaluating the use of the antiviral drug Bulevirtide in patients with chronic hepatitis D and liver cirrhosis over 10 years. Materials and Methods: A literature review was conducted using the Medline/PubMed, CyberLeninka, and eLibrary databases. Results. Unlike chronic hepatitis B or C, liver injury in chronic hepatitis D is more severe and aggressive, with a progressive course, rapid progression to liver cirrhosis with decompensation, and a higher risk of hepatocellular carcinoma. The global prevalence of chronic hepatitis D is heterogeneous due to population migration; according to two major meta-analyses, it is estimated to affect between 12 and 72 million people worldwide. The use of Bulevirtide since 2014 has marked the beginning of etiological treatment for patients with chronic hepatitis D and liver cirrhosis. Clinical trials have demonstrated the efficacy and safety of Bulevirtide as monotherapy, and even greater efficacy when combined with pegylated interferon-α for 48 weeks or longer. Conclusions. The EASL guidelines summarize the global experience in treating patients with chronic hepatitis D and liver cirrhosis using Bulevirtide. Between 2019 and 2022, Bulevirtide received regulatory approval in Russia and EU countries.