Vrach最新文献

{"title":"Evaluation of the radial endosonographic image of peripheral lung lesions for choosing the bronchobiopsies in the differential diagnosis of tuberculosis, mycobacteriosis and malignancy","authors":"A. Zaitseva, E. Krasnikova, L. Semenova, I. Sivokozov, N. Karpina, А. Ergeshov","doi":"10.29296/25877305-2023-05-01","DOIUrl":"https://doi.org/10.29296/25877305-2023-05-01","url":null,"abstract":"Objective. To evaluate endosonographic images (EGI) for different peripheral lung lesions (PPLs) genesis, to identify patterns of malignancy in the differential diagnosis of tuberculosis (TB), mycobacteriosis (NTM), malignancy neoplasm, to compare the main combinations of variants of the echo characteristics of lung lesions visualized during rEBUS navigation with the data of a comprehensive microbiological, cytological and morphological studies. Methods. A cohort retrospective study included 145 patients (81 women (mean age 44.94±0.24 years) and 64 men (mean age 47.91±0.24)), with newly diagnosed PPLs and with negative sputum TB tests, who underwent diagnostic navigational bronchoscopy (rEBUS) and surgical diagnostics, and EGI of PPLs was visualized with rEBUS. Depending on the final verification, were endosonographic images divided into 2 groups: the Neo group (n=63), whose biopsy (during bronchoscopic or surgical diagnosis) verified the malignancy PPls, and the TB+NTM group (n=82) – infectious PPLs caused by mycobacterial infection (73 cases – pulmonary TB, 9 cases – mycobacteriosis). Results. It was established that differences were statistically significant in shape, contour/border, and the presence of inclusions (linear arcs, zones of hypo-anechogenesis) between the comparison groups. If there are echoic features of malignancy PPLs on EGI with rEBUS (irregular shape (found in 60,3%), lobulated shape (in 17,4%), visualized but blurred contour (in 57.2%), fuzzy/poorly visualized contour (in 25.4%), heteroechoic structure, with “linear arcs” (49.2%) with an air bronchogram (in 36,5%)), tissue bronchobiopsy (brush and TBBL) are priority for cytological and histological examination. If there are echoic features of delimited infectious inflammation on EGI of PPLs in rEBUS (round or oval shape (found in 34.1% of cases), definite, closed contour (in 78.0%), homoechoic structure (29,3%), heteroechoic structure with zones of hypo-anechoicity (in 32.9%) with an air bronchogram (in 23.2%)), bronchobiopsy is a priority, allowing to cover the largest area of the lungs (BAL) for microbiological examination (microscopy, PCR-RT, culture) in combination with tissue biopsy (cytological examination). A classification has been created that includes 3 types of EGI to determine rational approaches to bronchobiopsy for the purpose of differential diagnosis of TB, mycobacteriosis and neoplasia. Conclusions. The use of EGI of PPLs assessment during bronchoscopy with rEBUS navigation determines rational approaches to the complex of navigational bronchobiopsies in the differential diagnosis of TB, mycobacteriosis and malignant processes.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"302 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141012426","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":"Ultrasonic vascular visual-exercise early diagnosis of arterial hypertension","authors":"V. Avkhimenko, A. Trivozhenko","doi":"10.29296/25877305-2024-03-04","DOIUrl":"https://doi.org/10.29296/25877305-2024-03-04","url":null,"abstract":"High level of prevalence of the arterial hypertension (AH) demands use of new technologies of early disease verification. Purpose. Develop a visual-exercise method of diagnostics of AH: bicycle-stressful doppler sonography of a renal-vascular blood-groove with assessment of the vascular motion status and definition of diagnostic criteria of disease. Materials and methods. The cohort (n=48) of healthy subjects and patients with AH I-II degree is surveyed. Bicycle-stressful research of renal-vascular reactivity included initial measurement and exercise monitoring of peak speed of a blood-groove (Vps) and the resistant index (RI) in renal artery (RA). Calculation the index of the pressor and high-speed relation (IPHSR) on a formula was carried out: IPHSR = Systolic BP/ Vps RA. Results. At peak bicycle-stressful test the VpsRA at patients with AH increased only 8% (2.8–11.0%) while at healthy volunteers – 27% (21.4–37.0%). Significantly differed IPHSR: at patients with AH it was measured 2.38–3.23 units (2.8 [2.650–2.892] units), and healthy volunteers 1.72–2.37 units (2.03 [1.91–2.16] units) (p=0,0001). The sensitivity of IPHSR was 91%, specificity – 88%, accuracy – 93%. The decrease of cortically kidney perfusion (increase in RI RA) in group of control was less expressed, than group of patients with AH: 8,6% (4.3–11.0) and 14.7% (9.7–23.2] respectively (r=0,0004). Conclusion. In the course of bicycle-exercise at patients with AH load the small growth of peak speed (25%), the IPHSR is highly sensitive (91%) and highly specific (88%) criterion of AH with differential border of 2,5 units.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"351 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402215","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":"REVIEW OF MODERN DEVICES FOR INHALATION THERAPY","authors":"E. Yakovleva, E. Borodulina","doi":"10.29296/25877305-2024-03-16","DOIUrl":"https://doi.org/10.29296/25877305-2024-03-16","url":null,"abstract":"Inhalation therapy is the introduction of a medicinal substance directly into the respiratory tract using special inhalers. To date, more than 200 devices for inhalation therapy have been developed. The purpose of the work is to review modern devices for inhalation therapy, to clarify their advantages and disadvantages. Interest in inhalation therapy can be explained by several reasons. Let's list them. First, you can inject the drug directly into the respiratory system. Secondly, the therapeutic effect comes quickly. Thirdly, the drug is almost not absorbed into the blood, so there are no systemic side effects. In addition, the patient can do inhalation independently at home. At the same time, inhalation therapy has several disadvantages. Sometimes it is difficult for the patient to understand how to use the inhaler. The doctor should show, explain and control inhalation. The particle size of the aerosol is very important, as is the patient's inspiratory flow rate.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"241 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402895","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":"Methods of correction of chronic heart failure in patients of older age groups against the background of depressive disorders","authors":"Yu. Antonenkov, O. Taranina, A. Chernov","doi":"10.29296/25877305-2024-03-12","DOIUrl":"https://doi.org/10.29296/25877305-2024-03-12","url":null,"abstract":"Chronic heart failure (CHF) is a common disease in patients of older age groups. Often these patients experience depressive disorders that affect the course of chronic diseases and their standard of living. Purpose. To study methods for increasing the effectiveness of treatment of CHF against the background of depressive disorders in patients of older age groups. Material and methods. The study involved 100 patients aged 60–87 years with functional class II–III CHF and mild to moderate depressive disorders. Patients were divided into groups depending on the therapy received: 1st (n=25) – standard therapy for CHF; 2nd (n=25) – standard therapy for CHF + antidepressant; 3rd (n=25) – standard therapy for CHF + phototherapy; 4th (n=25) – standard therapy for CHF + placebo. The effectiveness of CHF therapy was assessed after 3 and 6 weeks during clinical examination using a 6-minute walk test, ECG, echocardiography, and a clinical condition rating scale. To diagnose depressive disorders, the Geriatric Depression Scale, HADS, Beck scale, and consultations with a psychotherapist were used. Results. After 6 weeks of therapy, patients of all groups noted a decrease in shortness of breath and chest pain, and an increase in tolerance to physical activity. At the same time, the decrease in the level of anxiety and depression was most pronounced in groups 2 and 3 – in 84 and 100% of cases, respectively.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"263 1‐5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402709","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 ideas about concentric sclerosis Balo: a clinical case","authors":"G. Mnatsakanyan, A. Raevskaya, I. Vyshlova, S. Karpov","doi":"10.29296/25877305-2024-03-08","DOIUrl":"https://doi.org/10.29296/25877305-2024-03-08","url":null,"abstract":"Balo's concentric sclerosis (BCS) is a rare demyelinating disease of the central nervous system, characterized by concentric areas of demyelination alternating with areas of preserved myelin in the form of a pathognomonic pathomorphological substrate of varying degrees of severity in the form of «annual rings on a tree cut». The pathogenesis of BCS is diverse and complex, today there are several theories of its occurrence, among which hypoxic, vascular and closely related genetic, as well as a number of other theories are distinguished. The BCS clinic is variable, represented by both focal neurological manifestations and general cerebral symptoms. The diagnosis is based on the data of magnetic resonance imaging of the brain. The drugs of choice for BCS therapy are glucocorticosteroids (prednisolone or methylprednisolone).","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"30 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406351","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":"Evaluation of the effectiveness of immunoglobulins in treatment of infectious diseases","authors":"T. Igityan, O. Burgasova, L. Generalova","doi":"10.29296/25877305-2024-03-01","DOIUrl":"https://doi.org/10.29296/25877305-2024-03-01","url":null,"abstract":"Human Specific Hyperimmune Globulins (HIG) are dosage forms of the concentrated purified protein fraction of immunoglobulin G against a specific viral or bacterial antigen. Effective and safe methods of the antibody’s purification makes possible to consider HIG as a preventive and curative agent, for the viral infections, against which there is no specific preventive or antiviral therapy, as well as bacterial infectious diseases due to increasing resistance to antibacterial drugs, especially in persons with immunodeficiencies.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"69 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406434","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":"Treatment of a multimorphic form of vertebral infection (clinical case)","authors":"A. Yarikov, O. Perlmutter, A. Fraerman, A. Simonov","doi":"10.29296/25877305-2024-03-09","DOIUrl":"https://doi.org/10.29296/25877305-2024-03-09","url":null,"abstract":"A clinical case of surgical treatment of a patient with a multimorphic form of vertebral infection is presented (spinal epidural abscess, paraspinal abscess, subdural epiema, iliopsoitis, purulent meningitis, complicated by sepsis and bilateral pneumonia). The patient underwent three surgical interventions and underwent targeted antibacterial therapy.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"332 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402264","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":"STATINS IN THE TREATMENT OF PATIENTS WITH PERIPHERAL ARTERY DISEASES: STRATEGY AND TACTICS OF APPOINTMENT","authors":"E. Paranina, E. Krivoshchekov, P. Paranin","doi":"10.29296/25877305-2024-03-03","DOIUrl":"https://doi.org/10.29296/25877305-2024-03-03","url":null,"abstract":"The article presents a review of the literature on the relationship of peripheral artery diseases and cardiovascular complications. According to modern concepts, peripheral artery diseases are classified as markers of very high cardiovascular risk. The most important aspect of the therapy of patients in this category, in addition to correcting specific symptoms of vascular lesions of the lower extremities, is to reduce the risk of developing cardiovascular diseases and their prevention, and treatment of patients in this category should be carried out in accordance with the recommendations for secondary prevention of cardiovascular complications, the most important part of which is the control of serum lipids. Statins are the most widely used class of drugs for the correction of hypercholesterolemia, but the frequency of their appointment as a strategically important class of drugs to prevent the development of atherosclerotic cardiovascular complications in high- and very high-risk individuals in the Russian Federation, as in other countries, remains low. The basic principles of lipid-lowering therapy in patients with peripheral artery diseases are described: strategies, goals and issues of therapy control.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405361","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":"The role of granulocyte-macrophage colony-stimulating growth factor in inflammatory bowel diseases","authors":"V. Pershko, I. Yarovenko, A. Pershko","doi":"10.29296/25877305-2024-03-02","DOIUrl":"https://doi.org/10.29296/25877305-2024-03-02","url":null,"abstract":"Inflammatory bowel diseases, which include ulcerative colitis and Crohn's disease, are chronic immune-inflammatory diseases of the intestine that are increasing in prevalence and incidence worldwide. They are progressive, with the need for lifelong therapy, a high risk of surgical interventions and a decrease in the quality of life of patients. The results of clinical and population studies indicate that the possibilities of modern therapy for inflammatory bowel diseases have reached their maximum. Its effectiveness in achieving complete clinical and endoscopic remission, despite the use of genetically engineered biological drugs, is estimated at 35-40%, which is obviously insufficient. A possible solution to this problem could be the inclusion of granulocyte-macrophage colony-stimulating factors in treatment regimens for inflammatory bowel diseases in combination with glucocorticosteroids, cytostatics and biological therapy drugs. A review of a number of experimental and clinical studies that confirmed the clinical effectiveness of macrophage growth factors is the subject of this article.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"50 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400509","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":"VENOTONICS IN MODERN CLINICAL PRACTICE","authors":"А. Morozov, A. Sergeev, E. Askerov, E. Aslakhanova, K. Ispieva, E. Fisyuk, P. Polyakov","doi":"10.29296/25877305-2024-03-13","DOIUrl":"https://doi.org/10.29296/25877305-2024-03-13","url":null,"abstract":"Chronic venous diseases (CVD) are an extremely common pathology of the circulatory system. An important component of the treatment of CVD is the use of pharmaceuticals. Their tasks include reducing the specific symptoms of the disease, enhancing the effects of other methods of treating CVD, preventing further development and complications of the disease. The main means of pharmacotherapy of CVD are called venotonics or phlebotonics. The most studied and most commonly used form of venotonics are flavonoids, which reduce the permeability of capillaries, thereby having a beneficial effect on the vessels of the microcirculatory bed. The main indications for taking venotonics are specific symptoms of CVD: a feeling of heaviness, varying degrees of discomfort, pain, itching in the lower extremities, chronic swelling and trophic skin changes. This determines the active use of venoactive drugs in the treatment of various forms of CVD. Most clinical studies show that venotonics have decongestant, anti-inflammatory, antioxidant properties, and also maintain the tone of the venous wall. The main effect of venotonics is their ability to affect the state of blood vessels both at the macrocirculatory level and at the microcirculatory level. The wide effect of venotonics confirms the effectiveness of their use in modern clinical practice in the treatment of various forms of CVD.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"14 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140407741","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}