Doctor.Ru最新文献

{"title":"Long-term Consequences Short Bowel Syndrome in a 13-year-old Child","authors":"E. Yablokova, S.A. Zyuzina, E. Borisova","doi":"10.31550/1727-2378-2022-21-7-63-67","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-7-63-67","url":null,"abstract":"Objective of the Paper: to demonstrate the observation of the long-term consequences of postresection short bowel syndrome in a 13-year- old boy. Key Рoints. Short bowel syndrome (SBS) is characterized by a low absorption capacity of the small intestine as a result of extensive resections, which is manifested by malabsorption, malnutrition and digestive disorders. Observation of a 13-year-old child with a history of postresection short bowel syndrome 10 years after acquiring intestinal autonomy (independence from parenteral nutrition) illustrates the long-term consequences SBS: megaloblastic B12-deficient anemia with neurological symptoms, delayed physical development, persistent anastomositis. Conclusion. In children with a history of short bowel syndrome, after acquiring intestinal autonomy, some risks remain that significantly disrupt the patient's health. Such patients need long-term food insurance and supervision by a multidisciplinary team of specialists. Keywords: short bowl syndrome, small intestine resection, malabsorption, parenteral nutrition, chronic intestinal failure, intestinal autonomy, B12-deficient anemia.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85310079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of Formation and Evaluation of the Efficiency of Medical Overuse Headache Therapy","authors":"E.A. Guziy, A. E. Shagbazyan, N. Kovalchuk, G. Tabeeva","doi":"10.31550/1727-2378-2022-21-8-18-24","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-8-18-24","url":null,"abstract":"Study Objective: The aim of the study was to evaluate the patterns of medical overuse headache (MOH), the effectiveness of therapy, and to compare 2 subgroups of patients with chronic migraine, medical overuse of symptomatic analgesics: with MOH and without MOH. Study Design: prospective cohort study. Materials and Methods. The study included 20 patients aged 18 to 75 years with an established diagnosis of chronic migraine medical overuse of symptomatic analgesics. We’re planning to apply a headache diary, several scales about various characteristics of headaches, the psychological state of patients, scales on lifestyle and quality of life, somatic pathology. Study Results. All patients were recommended to cancel the “guilty” analgesic and limit the use of the drug with analgesic action from another group. For prophylaxis, metoprolol was used in 6 (30%) cases, topiramate — in 2 (10%) cases, amitriptyline — in 30%, venlafaxine in 30%. After 3 months from the start of therapy, patients noted the greatest reduction in the frequency and intensity of headache when taking amitriptyline at a dose of up to 50 mg, venlafaxine at a dose of up to 150 mg. At the time of withdrawal, “rebound” symptoms and withdrawal syndrome developed in 14 (70%) people. Detoxification therapy (dexamethasone 4–8 mg per 200 ml of saline and magnesia 10% 25 ml N10) was carried out in 12 (60%) patients. Over 3 months of follow-up, the occurrence of a headache attack decreased by 2 points on the intensity scale, duration — by an average of 6 hours, the number of days with a headache increased by an average of 3.4 days, the number of days with the use of pathogens per month — by 12.6 days. Conclusion. It is necessary to raise the awareness of therapists, neurologists about the causes, patterns, methods of treatment of МОН, as well as about the risk factors for its recurrence. Patient compliance can be improved by telephone interviews, face-to-face consultations 1–3 months after the start of preventive therapy. With the correct use of the prophylactic drug and following the recommendations to limit the overuse of symptomatic analgesics, after 3 months the patient's quality of life improves, the headache decreases in frequency and intensity, and cognitive functions improve. Keywords: chronic migraine, medical overuse headache, chronic headache, overuse, treatment.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80607604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for the Development of a Progressive Course of Atopic Dermatitis in Children and Adolescents","authors":"V. Soboleva, A. Kudryavtseva, O. Svitich, N. Geppe","doi":"10.31550/1727-2378-2022-21-7-41-44","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-7-41-44","url":null,"abstract":"Study Objective: To determine the risk factors for the development of a progressive course of atopic dermatitis (AD) in children and adolescents. Study Design: Observational prospective cross-sectional study. Materials and Methods. The study enrolled 89 outpatients with AD aged 2 months — 17 years. The diagnosis was verified based on Hanifin and Rajkа criteria (1980); skin disorders were assessed via SCORAD followed by statistical analysis. Family history, breastfeeding duration and symptoms manifestation were assessed. Study Results. Based on our results, compared to children with erythemato-squamous plaques with lichenization AD (ESPL) and lichenoid AD (L), children with erythemato-squamous plaques of AD (ESP) predominated (ESP vs. ESPL vs. L: 44 (50%) vs. 28 (31%) vs. 17 (19%) respectively (p < 0.05). Progressive AD was noticed in more than 50% (p < 0.05). SCORAD index was maximal in lichenoid AD (p < 0.05). Progressive AD is frequently accompanied with genetic predisposition on the mother’s side as well as early AD manifestation and shorter breastfeeding. Prolonged course of the disease influences the risks for lichenoid forms. Conclusion. Risks for progressive course of AD is higher in children with genetic predisposition on the mother’s side, duration of breastfeeding with regard to early AD manifestation. Basically, clinical symptoms of the atopic march were related to seasonal allergic rhinitis, less often with asthma. Кeywords: atopic dermatitis, severe cases, children, adolescents.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86605024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Cerebral Dysfunction in Cardiac Aortic Valve Replacement","authors":"N. V. Tsygan, A. V. Ryabtsev, R. V. Andreev, K. Sapozhnikov, A. Peleshok, M. Odinak, I. Litvinenko","doi":"10.31550/1727-2378-2022-21-4-53-59","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-4-53-59","url":null,"abstract":"Study Objective: To study the incidence and the structure of the postoperative cerebral dysfunction after open and endovascular aortic valve replacement surgery, and to identify the risk factors and the methods of prevention of postoperative cerebral dysfunction after the open aortic valve replacement surgery. Study Design: Prospective cohort study. Materials and Methods. The study involved 114 patients (92 men and 22 women) aged 67 [58; 76] years, who undergone elective aortic valve replacement surgery. All patients were divided into three groups: “open surgery” (n = 82), “cerebroprotection” (n = 16) and “X-ray surgery” (n = 16). In the “open surgery” and “cerebroprotection” groups, patients undergo open aortic valve replacement surgery with cardiopulmonary bypass, in the “X-ray surgery” group transcatheter aortic valve implantation is performed. In the “cerebroprotection” group patients additionally received the 1.5% solution of meglumine sodium succinate in the early postoperative period. Study Results. The postoperative cerebral dysfunction was diagnosed in 41.2% of patients, the incidence of the postoperative cerebral dysfunction did not differ in the study groups. In the group “cerebroprotection” there was a shorter duration of symptomatic delirium of the early postoperative period (p = 0.0441) compared with the group “open surgery”. We identified 18 risk factors for postoperative cerebral dysfunction and its clinical types and two cerebroprotective factors — a body mass index more than 25 kg/m2 and the use of the meglumine sodium succinate in the early postoperative period. Conclusion. Aortic valve replacement surgery is characterized by the high incidence of the postoperative cerebral dysfunction, further improvement of the methods of the perioperative cerebroprotection is required. Keywords: postoperative cerebral dysfunction, perioperative stroke, symptomatic delirium of the early postoperative period, postoperative cognitive dysfunction, perioperative cerebroprotection, aortic valve replacement.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88869600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alternative Methods of Therapy of Nausea and Vomiting of Pregnant Women","authors":"M. Zhelezova, R. Sharipova","doi":"10.31550/1727-2378-2022-21-5-25-30","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-5-25-30","url":null,"abstract":"Study Objective: Evaluation of the effectiveness of ginger extract in the treatment of nausea and vomiting light and moderate range of pregnant women. Study Design: Observational study. Materials and Methods. The research included 56 pregnant women with symptoms of nausea and vomiting: at the first visit they had complaints of nausea and/or vomiting being 6–16 weeks pregnant. The severity of nausea and vomiting was assessed on the Pregnancy- Unique Quantification of Emesis and Nausea scale before the start of therapy, on days 4 and 7 of treatment. The pregnant women were divided into two groups. The main group consisted of 28 women who took the dietary supplement Preginor, a comparison group — 28 patients who were given only recommendations for lifestyle and diet modification. Among 56 pregnant women who were studied, there 36 were with light symptoms of nausea and vomiting (18 women from the main group and 18 in the comparison group); 20 pregnant women had a moderate degree of nausea and vomiting (10 patients from the main group, 10 from the comparison group). Preginor contains a highly selective ginger root extract (67 mg) standardized to 5% gingerols, which corresponds to about 1 g of fresh ginger; vitamin B6 1.4 mg, magnesium lactate 112.5 mg. Study Results. Relief of symptoms of nausea and vomiting in pregnant women who took ginger was on average 48 hours faster compared to patients who received only recommendations for lifestyle and diet modification: after 3,3 (0,5) and 5,1 (1,2) days, respectively (t = –5,60, p = 0.000). With a moderate course of nausea and vomiting, taking ginger also helped to alleviate the condition in the majority of patients (80%). Conclusion. Preginor is an effective non-pharmacological remedy for the relief of symptoms of nausea and vomiting of pregnant women. It is advisable to recommend the dietary supplement Preginor for widespread introduction into clinical practice, raising the awareness of medical personnel and patients about its effectiveness and safety. Keywords: vomiting, nausea, hyperemesis gravidarum, ginger extract.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85601692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern Aspects of Diagnosis and Treatment of Refractory Gastroesophageal Reflux Disease","authors":"V. Tsukanov, A. Vasyutin, Yu. L. Tonkikh","doi":"10.31550/1727-2378-2022-21-6-35-40","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-6-35-40","url":null,"abstract":"Objective of the Review: To analyze current data on the diagnosis and treatment of refractory gastroesophageal reflux disease (GERD). Key points. Refractory GERD is diagnosed when there is insufficient response to proton pump inhibitors (PPIs) twice daily for 8 weeks with the presence of pathological gastroesophageal reflux. Possible mechanisms underlying PPI-refractory symptoms characteristic of GERD include persistence of pathological reflux, esophageal hypersensitivity to reflux, association of symptoms with other diseases, and functional nature of symptoms. To diagnose refractory GERD, a thorough analysis of symptoms, esophagogastroscopy with morphological examination, pH-impedancemetry and esophageal manometry are performed. Treatment includes dietary and lifestyle modifications to reduce body weight in obese patients, optimization of PPI prescribing, use of other drugs, and, if indicated, surgery. Conclusion. Diagnosing the reasons for the decrease in the effectiveness of PPIs in patients with GERD is a complex process that requires the use of modern endoscopic methods with the performance of a morphological study of the esophagus, pH-impedance testing and highresolution manometry to determine the nature of reflux, the relationship of reflux with symptoms of GERD and the differential diagnosis of various GERD syndromes. The choice of therapy for patients with refractory GERD is determined by the results of the examination and the final diagnosis. Keywords: refractory gastroesophageal reflux disease, proton pump inhibitors, diagnosis, treatment.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87668844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Aspects of the Management of SARS-CoV-2-caused Viral Pneumonia","authors":"V. Vechorko, D. Sychev, I. Kitsul, T. A. Chebotareva","doi":"10.31550/1727-2378-2022-21-2-46-50","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-2-46-50","url":null,"abstract":"Study Objective: To conduct a cost analysis of the management of patients with viral pneumonia caused by SARS-CoV-2, and to develop nosological models of patients in order to optimise medical fees. Study Design: Statistical and economic study. Material and Methods. We studied 50,539 completed hospitalisations of patients with viral pneumonia caused by SARS-CoV-2 during a period from March 2020 to March 2021 in Municipal Clinical Hospital No. 15 named after O.M. Filatov. Using an expert evaluation, we found out 5 nosological models of patients and calculated mean duration of hospitalisation, confidence intervals (95% CI), and fee parameters using actual costs (cost of one bed-day and completed therapy). Study Results. We managed to prove the hypothesis, according to which correctness of analysis of actual costs of therapy and precise prognosis depend on the differentiation of cases of SARS-CoV-2-caused viral pneumonia using nosological models of a patient, nosological forms, and disease severity. We developed nosological models of a patient; identified a range of cost of therapy; and calculated corresponding relative factors. Conclusion. The cost of management of patients with viral pneumonia caused by SARS-CoV-2 should be analysed and planned depending on nosological models grouped on the basis of common causation of the disease, presence or absence of complications (pneumonia), presence of comorbidities and surgeries, and condition of patients. The most expensive is the management of patients with COVID-19 and npneumonia and surgery. Keywords: cost of management, nosological model, SARS-CoV-2, viral pneumonia.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84155889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience in Laser Coagulation of Placentary Anastomoses in Selective Foetal Growth Retardation","authors":"N. V. Kosovtsova, T. V. Markova, Y. Pospelova, A. V. Yuminova, A.E. Aytov","doi":"10.31550/1727-2378-2022-21-5-43-46","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-5-43-46","url":null,"abstract":"Objective of the Paper: To describe the course and outcome of a pregnancy with monochorionic-diamniotic twins with marked selective foetal growth retardation (sFGR) after laser coagulation of placentary anastomoses. Key points. Fetoscopy-guided laser coagulation of placentary anastomoses at week 21–22 of gestation made it possible to prolong the pregnancy to the term and eliminate the risks of intrauterine foetal death, preterm delivery, and neurological complications in a larger foetus. Conclusion. In sFGR with umbilical artery blood flow type II or III (E. Grtacós), it is possible to use placentary anastomosis or umbilical vessels coagulation in a smaller foetus. Further studies are needed with unified diagnostic criteria and outcome analysis; and pregnancy management approach needs to be developed. Keywords: twin-to-twin transfusion syndrome, laser coagulation of placentary anastomoses, selective foetal growth retardation.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84682191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nimesulide: Advantages, Perspective Use During the Coronavirus Pandemic","authors":"M. Eliseev","doi":"10.31550/1727-2378-2022-21-2-80-83","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-2-80-83","url":null,"abstract":"Objective of the Review: To discuss the specific properties of Nimesulide and its use in COVID-19. Key Points. A significant advantage of Nimesulide is a very rapid analgesic effect, due to rapid and meal-independent absorption in the gastrointestinal tract, almost complete binding to blood albumin, equally rapid achievement of the maximum concentration both in synovial fluid and blood. Now we have some data on the promising use of Nimesulide for COVID-19 management. Conclusion. An idea that Nimesulide should be among the medicinal products undergoing assessment for the use for COVID-19 management, seems rather rational. Although it is not clear whether such studies will be conducted and what their outcome will be, selection of Nimesulide as one of the primary drugs for pain management and inflammation therapy both by medical professionals and patients is not by chance; it is completely informed and justified. Keywords: Nimesulide, nonsteroidal anti-inflammatory drugs, COVID-19.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78437136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Stage II Intraepithelial Neoplasia: Antivirals Efficacy","authors":"O. P. Vinogradova, N. Andreeva, O. Artemova, O. V. Epifanova","doi":"10.31550/1727-2378-2022-21-1-54-58","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-1-54-58","url":null,"abstract":"Study Objective: To assess the efficacy of an antiviral in the management of HPV-associated cervical stage II intraepithelial neoplasia (CIN II), using the analysis of the apoptotic marker levels and cytokine profile — caspase 3 and 9, interferon (INF) γ, interleukin (IL) 18. Study Design: Perspective study. Materials and Methods. We examined 126 women of reproductive age. The study included two groups: controls (40 relatively healthy fertile women without any cervical pathologies and HPV) and a group of 86 women with HPV-associated CIN II. All subjects underwent an examination; and their cytokine response and apoptotic marker level were assessed. All patients in CIN II group had the affect area excised. 43 post-excision women were followed up (sub-group A); other 43 subjects had surgery and an antiviral (sub-group B). The antiviral was administered subcutaneously once daily, 3 injections before and 3 injections after the excision. The primary efficacy criteria were absence of HPV or reduction in the viral load below significant values, and absence of pathology relapses after 6 and 12 months of the study. Study Results. In subjects with CIN II, pre-therapy caspase 3 and 9 levels were significantly higher vs controls; INF-γ was 1.8 times higher than in controls, and mean IL-18 concentration was considerably lower (p < 0.05 in both cases). In sub-groups A and B, caspase 3 and 9 concentration in 3 and 6 months after therapy also differed significantly from controls, and in 6 months, caspase 3 and 9 concentration in sub-group В was considerably lower than in sub-group А. Women in sub-groups А and В demonstrated statistically significant difference in cytokine profile: in both sub-groups, INF-γ concentration in 10 days increased, while in 12 months it almost reached its baseline value. IL-18 in sub-group B in 10 days and 12 months was significantly higher than in sub-group А. Conclusion. The results of the study demonstrate high HPV elimination and reduction in relapse probability after excision in patients with CIN II with the use of antivirals. Keywords: human papilloma virus, cervical intraepithelial neoplasia, caspase 3, caspase 9, apoptosis, cytokines, interleukin18, tumour necrosis factor α, interferon γ, cervical cancer, genetic typing, high risk of cancer.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76165513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}