Medical Almanac最新文献

{"title":"Dispanserization monitoring for HIV-infected patients in the Siberian Federal District in 2013–2017","authors":"Е. C. Довгополюк, Л. И. Левахина, А. Т. Тюменцев, О. А. Пасечник","doi":"10.21145/2499-9954-2019-3-44-48","DOIUrl":"https://doi.org/10.21145/2499-9954-2019-3-44-48","url":null,"abstract":"According to UNAIDS, 1.4 million people are living with HIV in Eastern Europe and Central Asia, 75% of them in Russia. International guidelines recommend regular clinical evaluation of HIV-infected patients, which is achieved through follow-up. Purpose of the study: to characterize the quality of follow-up observation of HIV patients in the Siberian Federal District for the five-year period from 2013 to 2017. Materials and methods. A retrospective descriptive-assessment epidemiological study for the period 2013–2017 was conducted in the Siberian Federal District, in which dispensary observation indicators were most affected by improving the epidemiological situation associated with the spread of HIV infection. Results. The HIV infection in the Siberian Federal District increased during the period under review by 62,4% and reached 1328,5 per 100 thousand population. The prevalence of HIV infection at the beginning of 2018 was 679.0 per 100 thousand population (with an average Russian indicator of 430,2). The SFO accounted for 20,7% of all HIV cases (n = 130 595), which were registered at specialized medical organizations in the Russian Federation. The coverage of HIVinfected patients with clinical observation reached the target value and amounted to 88,2%. The number of patients who were examined to determine the immune status and viral load increased almost 2 times. At the same time, the proportion of HIV-infected people receiving antiretroviral therapy was at the level of 39,8%, which is 4,2% lower than the target values. The proportion of patients surveyed for tuberculosis among those who underwent medical examination in 2017 remains at the level of 87,8%, which does not stabilize the incidence of tuberculosis infection. The number of HIV-infected patients with a diagnosis of active tuberculosis increased 1,4 times to 17 610 in 2017 (10,9% of the number of patients). Conclusion. In the context of the continuing increase in the incidence of HIV infection in the population and an increase in the number of patients in need of various types of medical care, additional measures are needed to improve the quality and effectiveness of follow-up observation of patients with HIV infection.","PeriodicalId":140928,"journal":{"name":"Medical Almanac","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133637510","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":"Life-threatening conditions in pericarditis of different etiologies: diagnosis and treatment","authors":"A. Kosonogov, S. Nemirova, V. I. Pozdishev, A. B. Nikolskiy, K. A. Kosonogov, A. D. Ribinckiy, M. Sidorov, S. V. Loginova","doi":"10.21145/5/2499-9954-2019-2-40-45","DOIUrl":"https://doi.org/10.21145/5/2499-9954-2019-2-40-45","url":null,"abstract":"Purpose of the study: to analyze the etiology, diagnostic criteria and results of treatment of life-threatening conditions in pericarditis of different etiologies (based on our clinic materials).Materials and methods. The study included cases of hospitalization of patients with a diagnosis of «Pericarditis» and ICD-10 codes for pericardial diseases for the period from 2009 to 2018. In the course of the work, the history and clinical picture of the disease, laboratory and radiation research methods were analyzed. All patients started treatment of the underlying disease and performed symptomatic therapy, including those aimed at restoring hemodynamics and normalizing water and electrolyte disorders, stopping inflammation and auto-aggression of the immune system. When signs of compression/cardiac tamponade were detected, pericardiocentesis was performed, according to indications, drainage/fenestration of the cardiac sac, pericardiotomy were performed. In the postoperative period was carried out antibacterial and symptomatic therapy.Results. Life-threatening diseases of the pericardium accounted for 32,03% of all patients treated in the hospital for pericarditis. The most frequently detected signs of a hemodynamically significant compression and cardiac tamponade, less often purulent and constrictive P. Isolated 25 patients underwent closed drainage with pericardiocentesis, in 1 case the drainage was supplemented with f ibrinolytic therapy. Sanitation of the cavity and fenestration of the pericardium were carried out in 11 patients, pericardiotomy with notched drainage in 2 patients, thoracotomy with pericardiectomy – 4. In the postoperative period, the symptoms of inflammation were reduced, the level of cardiac enzymes decreased, the electrolyte balance stabilized. Most patients noted a distinct regression of the symptoms of pericarditis and cardiac compression. Recurrent P was noted in 5 cases, deaths occurred in 4 cases (8,16%).Conclusion. Early verification of the diagnosis and timely decompression of the heart with fractional evacuation of the exudate or pericardectomy with respect to the sequence of release of the heart chambers from adhesions and adhesions against the background of complex therapy allows to achieve positive dynamics, and fenestration of the cardiac bag with the formation of a sufficiently sized opening during recurrent fluid accumulation or intrapericardial fibrin. development of severe complications of pericarditis even in patients with multiple concomitant diseases evanii and oncopathology.","PeriodicalId":140928,"journal":{"name":"Medical Almanac","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124549714","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":"Concept «quality of life» and method of its assessment in patients after surgical treatment of the aortal valve faults","authors":"A. Molchanov","doi":"10.21145/5/2499-9954-2019-2-45-50","DOIUrl":"https://doi.org/10.21145/5/2499-9954-2019-2-45-50","url":null,"abstract":"The review of the literature examines the study of the quality of life of patients in the older age group after cardiac surgery for heart disease. In recent years, the number of elderly people has increased significantly in many countries. As a result of this phenomenon, cardiologists and cardiac surgeons are increasingly confronted in their practice with elderly patients. There are features of the management of cardiac and cardiac surgical patients of advanced age, caused both by the specifics of the underlying disease and by concomitant diseases. With the emergence of new options for evaluating the effectiveness of various methods of surgical correction of heart disease in age patients, new questions arise that require evidentiary consideration and an optimal answer. Opinions of experts about the feasibility of surgical interventions in the elderly are often different. The urgency of the problem is due to the recent increase in the number of heart operations in the group of age-related patients. The study of the quality of life of patients in the postoperative period helps to determine the most rational and optimal method of surgical treatment, not only from the point of view of the cardiac surgeon, but also from the standpoint of assessing the patient himself. In addition, frequent postoperative complications and recurrences of diseases force specialists to focus on the quality of life of patients after surgery, which makes the problem extremely urgent.","PeriodicalId":140928,"journal":{"name":"Medical Almanac","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128246676","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":"Organizing a posthumous organ donation in the Nizhny Novgorod region: to the tenth anniversary of the Volga coordination center of organ and tissue donation","authors":"S. Romanov, G. Y. Smirnova, O. P. Abaeva","doi":"10.21145/2499-9954-2019-1-7-10","DOIUrl":"https://doi.org/10.21145/2499-9954-2019-1-7-10","url":null,"abstract":"The article is devoted to the problems of posthumous organ donation and is prepared for the decade of the Volga coordination center of organ and tissue donation. The article analyzes the system of interaction of participants in the organ donation program existing in the region and highlights its features. The authors emphasized that the effectiveness of the system of collaboration between the participants of organ donation existing in Nizhegorodskaya region is mainly determined by the activity of doctors’ donor bases. According to the results of the survey of doctors, the most significant factor determining their inclination to collaborate with the Center of organ donation is the direction by the administration of the medical organization (59,3±3,0%), while only 11,1±1,3%. The active work of the specialists of the organ donation center made it possible to successfully solve a whole range of issues of interdepartmental cooperation and ensure the systematic implementation of organ transplants. At the same time, there are numerous problems whose solution is to optimize the use of donor resources in the Nizhny Novgorod region and a number of neighboring regions.","PeriodicalId":140928,"journal":{"name":"Medical Almanac","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127993190","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":"Еxtracorporeal membrane oxygenation in the treatment of refractory myocardial failure after cardiac operations with cardiopulmonary bypass","authors":"E. V. Taranov, V. Pichugin, A. Medvedev, M. A. Zelenov","doi":"10.21145/2499-9954-2019-1-76-81","DOIUrl":"https://doi.org/10.21145/2499-9954-2019-1-76-81","url":null,"abstract":"Целью исследования явилась оценка эффективности применения процедуры экстракорпоральной мембранной оксигенации (ЭКМО) у пациентов с острой сердечной недостаточностью после операций на сердце с искусственным кровообращением. Материалы и методы. Вено-артериальная ЭКМО с целью лечения критической острой сердечной недостаточности была использована у 16 взрослых больных. Среди пациентов было 10 мужчин и 6 женщин, средний возраст которых составил 61,5±9,8 года. Показанием для начала ЭКМО во всех случаях послужила острая сердечная недостаточность при неэффективности медикаментозной терапии. У 5 (31,3%) пациентов ЭКМО была начата интраоперационно, у 5 (31,3%) пациентов ЭКМО была начата в ОРИТ спустя 12 часов от момента операции, у 6 (37,5%) пациентов – более чем 24 часа от момента операции. Для проведения анализа было выделено две группы: в первую группу (10 больных) вошли пациенты, которым на фоне проведения ЭКМО удалось добиться стабилизации состояния и процедура ЭКМО закончена; во вторую (6 больных) – пациенты, которые погибли во время проведения ЭКМО. Оценка эффективности проводилась на основании клинических, функциональных и биохимических критериев. Результаты. СИ достоверно возрастал (на 11,3%) через 12 часов после начала ЭКМО, а через 48 часов достигал нормального значения в 1-й группе, что сопровождалось достоверным ростом ФВ ЛЖ (до 47,3±,7,4%), снижением инотропного числа (до 11,9±7,8) и ростом доставки кислорода (до 775±36 мл/мин) при отсутствии положительной динамики данных показателей во второй группе. Выживаемость после процедуры составила 62,5%, количество выписанных пациентов – 37,5%. Заключение. Применение процедуры вено-артериального ЭКМО в комплексном лечении больных с критической острой сердечной недостаточностью после кардиохирургических вмешательств позволяет добиться удовлетворительных показателей выживаемости и выписки из стационара при развитии потенциально летального осложнения. Ключевые слова: острая сердечная недостаточность, экстракорпоральная мембранная оксигенация, операции на открытом сердце. Дата поступления 31.01.2019","PeriodicalId":140928,"journal":{"name":"Medical Almanac","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122859898","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":"Clinical masks of Non-Hodgkin's lymphoma (clinical case)","authors":"A. V. Solovyova, E. Shurpo, I. V. Vasin, O. Kodyakova, D. Rakita","doi":"10.21145/2499-9954-2019-1-52-55","DOIUrl":"https://doi.org/10.21145/2499-9954-2019-1-52-55","url":null,"abstract":"Clinical polymorphism of non-Hodgkin's lymphoma causes difficulties in early diagnosis. Particular difficulties arise when a patient with lymphoma has specific organ lesions. The article presents a clinical case of non-Hodgkin's lymphoma in a 66-year-old woman hospitalized in the gastroenterology department with symptoms of hepatocellular insufficiency, cytolysis, cholestasis, and hepatosplenomegaly. Patient had a history of thrombocytopenia during 4 years. At the time of this hospitalization viral, toxic and autoimmune causes of liver damage were excluded. The presence of thrombocytopenia, lymphadenopathy of intrathoracic lymph nodes, hepatosplenomegaly allowed to suspect the presence of lymphoproliferative disease. Despite ongoing symptomatic therapy, the patient died. Autopsy confirmed the presence of non-Hodgkin's lymphoma with specific infiltration of multiple internal organs: liver, spleen, kidneys, adrenal glands, myocardium, and valvular apparatus of the heart. Affection of the heart, as a rare manifestation of non-Hodgkin's lymphoma, imitated in our clinical case the sonographic picture of myxoma.","PeriodicalId":140928,"journal":{"name":"Medical Almanac","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132442755","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":"Acinetobacter spp.: regional features of epidemiology","authors":"М. А. Шмакова, Н. А. Ефремова, Анатолий Егорович Гончаров, А. П. Чмырь, Е. Б. Брусина","doi":"10.21145/2499-9954-2019-1-23-28","DOIUrl":"https://doi.org/10.21145/2499-9954-2019-1-23-28","url":null,"abstract":"Purpose of the study . Investigation of the epidemiological process features in healthcare settings. Materials and  methods . Here we carried out  a retrospective  epidemiological study  in Kemerovo  Region  including 143 768  patient outcomes between  2012 and 2018. Results and conclusions . Average annual incidence of Acinetobacter  spp. infection/colonization was  13,14  per 1000 patients  (95% CI [13,14–14,35])   with range between  7,76 (95% CI [7,13–8,02]) to 20,58  (95% CI [20,04–20,82]). We revealed a trend to decreasing incidence of Acinetobacter spp. infection/colonization (average  growth rate 54,9%, y = -2,0438x + 21,261, R² = 0,93), without any notable seasonality  and or repeating cycles. Case-control  study was then conducted among  patients  who  were  admitted  to  the  neurology  and  neurosurgery  units. Patients  with stroke  has 4,29-fold  higher risk of Acinetobacter  spp. infection/colonization  (CI = 2,19–8,78) as  compared  to  those without. The proportion of carbapenem  resistant Acinetobacter baumannii strains was 58% and raised 3-fold from 2012 to 2018. The RAPD-PCR  genotyping with amplification of the variable integron I fragment detected the circulation of two integron-positive A. baumannii clones in 2018 in these  units.","PeriodicalId":140928,"journal":{"name":"Medical Almanac","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121243303","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":"Surgical treatment of high-risk patients with severe ulcerative colitis","authors":"А. А. Янышев, А. В. Базаев, А. И. Абелевич, Е. Э. Бабушкина","doi":"10.21145/2499-9954-2019-1-60-62","DOIUrl":"https://doi.org/10.21145/2499-9954-2019-1-60-62","url":null,"abstract":"Introduction . Ulcerative colitis (UC) is an idiopathic autoimmune disease of the colon of unknown etiology, which is characterized by recurrent and intermittent inflammation with ulceration of the mucous  membrane. In severe course often, a life-threatening condition requires a multidisciplinary approach with the participation of a gastroenterologist and surgeon.  In approximately 25–30%  of patients  with UC, surgical treatment  plays a key role. The timing of the operation  depends  on the effectiveness  of conservative  therapy and definitely affect the overall outcome of treatment. Postponing surgery, especially in severe, «critical» patients, is associated with an increased risk of postoperative complications and mortality. Purpose of the study is to analyze the results of surgical treatment of patients with ulcerative colitis and undifferentiated severe colitis. Materials and methods . The data of 15 patients aged from 19 to 83 operated in the period from January 2013 to May 2017 about severe ulcerative colitis. Results . The majority of patients (11  patients) underwent surgery on a planned and urgent basis, and the main indications were the ineffectiveness of conservative treatment. Mainly performed radical operations of large volume, usually with the imposition of ileostomy. In the early postoperative period, two patients died, urgently operated for toxic dilation and perforation of the intestine. Conclusions . Timely implementation of radical surgery for severe ulcerative colitis can avoid severe intestinal complications. Compliance with the optimal volume and technique of interventions can improve immediate results; reduce the incidence of perioperative complications in high-risk patients.","PeriodicalId":140928,"journal":{"name":"Medical Almanac","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128526356","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":"Inhaled nitric oxide in the prevention of ischemic and reperfusion injuries of the heart during operations with cardiopulmonary bypass","authors":"V. Pichugin, I. R. Seyfetdinov, A. Medvedev, S. Domnin","doi":"10.21145/2499-9954-2019-1-81-87","DOIUrl":"https://doi.org/10.21145/2499-9954-2019-1-81-87","url":null,"abstract":"Currently, much attention is paid to the study  of the role of nitric oxide, as  a universal transmitter, in the development  of various  pathological conditions. NO  causes relaxation of vascular  smooth muscle,  is involved in protection from ischemic and reperfusion injuries, is a neurotransmitter, regulates  programmed cell death  and proliferation, plays an important role in the secretory  and reproductive system.  New data indicate that inhalation of nitric oxide leads to the formation of new compounds that can be transported  as thiol groups associated with protein in the blood, or act indirectly through nitrites and nitrates, the metabolites of which, as  has  been shown, increase over time during exposure  to inhalation NO. This fact explains the extrapulmonary effects  of inhaled nitric oxide. Experimental and clinical studies  have convincingly shown the effectiveness  of inhaled nitric oxide in the prevention and treatment of: ischemic and reperfusion injury to organs  and tissues,  shock,  damage  to the central nervous  system and kidneys. For cardiac surgery, the effect of pharmacological preconditioning of the myocardium, caused  by inhalation of nitric oxide, is of undoubted  interest. How exactly NO has  a protective effect on the heart is currently unknown, but it is possible  that  direct cGMP/PKG-mediated  and  cGMP-independent  effects  on  the  myocardium  with additional relaxation of smooth muscles,  inhibiting effects  on  platelets, anti-apoptotic,  anti-inflammatory and antioxidant effectors. The number of clinical studies on the protective effect on the heart of inhaled nitric oxide is currently extremely limited, although all the work carried out confirms its additional cardioprotective effect. Most of the work is devoted to the supply of gaseous nitric oxide to the oxygenator of the heart-lung machine and does  not consider other possible options for the implementation of its protective mechanism.","PeriodicalId":140928,"journal":{"name":"Medical Almanac","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130766100","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}