Vrach最新文献

{"title":"Telemedicine and information technology in healthcare. Experience and perspectives","authors":"E. Vdoushkina, E. Borodulina, L. Povalyaeva, K. Zhilinskaya, S. Zubakina, N. Bahmetyeva","doi":"10.29296/25877305-2024-02-13","DOIUrl":"https://doi.org/10.29296/25877305-2024-02-13","url":null,"abstract":"In modern conditions, telecommunication technologies (TMT), designated by the term “telemedicine,” are increasingly used to provide medical services at a distance. Purpose. To analyze the work of telemedicine consultations (TMK) during the COVID-19 pandemic. Material and methods. The experience of using TMT (telemedicine) in a city hospital, on the basis of which a “Covid hospital” was opened during the spread of COVID-19 from September 2020 to September 2021, is presented. Patients applied for TMK through call centers or the clinic’s registry. Results. The operating principles of telemedicine have been formed, the possibilities of outpatient patient management in a remote format, a minimum list of examinations at home, routing rules and indications for inpatient treatment have been determined. Based on the identification of key complaints and diagnostic criteria, a questionnaire was created that reduces consultation time. The experience gained allows us to make wider use of remote management technologies, TMK, medical consultations, to develop and implement monitoring technologies for monitoring patients at home to optimize the work of primary healthcare.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"150 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462554","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":"Lipid spectrum of cell membranes and blood plasma in adolescents with recurrent cephalgia associated with arterial hypertension. Methods of correction","authors":"Y. Kostyuchenko, T. Potupchik, L. Evert, E. Panicheva, Yu. Dubrovsk, N. Loseva","doi":"10.29296/10.29296/25877305-2024-02-08","DOIUrl":"https://doi.org/10.29296/10.29296/25877305-2024-02-08","url":null,"abstract":"Purpose. To study the characteristics of the content of neutral lipids and phospholipid fractions in the membranes of erythrocytes and blood plasma of adolescents with cephalalgia and arterial hypertension (AH). Materials and methods. Subject of the study – adolescents 12–17 years old (boys and girls) with cephalgia and the presence of AH (main group) and without AH (comparison group). Methods: questionnaires, laboratory, statistical. Examination program: verification of the clinical form of cephalgia (episodic, chronic); assessment of the presence of AH (using percentile tables, taking into account age, gender and height percentile); determination of the concentration of neutral lipids and phospholipid fractions in blood plasma and erythrocyte membranes using thin layer chromatography. Results. Of the 64 examined adolescents – patients of the pediatric department with recurrent cephalgia, the frequent (chronic) form of cephalgia was verified in 40 (62.5%) people, AH was diagnosed in 10 (25.0%) adolescents with chronic cephalgia and in 30 (75.0%) adolescents with this form of cephalalgia AH were not identified. Features of the lipid spectrum of adolescents with a chronic form of cephalgia associated with AH included a lower concentration of total lipids and triglycerides in erythrocyte membranes, higher values of the general phospholipids/free cholesterol ratio and a smaller number of statistically significant correlations. Conclusion. The features we identified in the lipid spectrum of erythrocyte membranes and blood plasma in adolescents with a frequent (chronic) form of cephalalgia associated with AH may indicate the presence in adolescents of initial minimal changes in the biochemical status of cell membranes at the stages of development of cardiovascular pathology – hypertension and coronary heart disease.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"130 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462320","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":"An integrated approach in the treatment of a patient with pulmonary tuberculosis and tracheobronchial tree with psychological support","authors":"N. Chumovatov, O. Komissarova, V. Streltsov, N. Chernykh","doi":"10.29296/25877305-2024-02-10","DOIUrl":"https://doi.org/10.29296/25877305-2024-02-10","url":null,"abstract":"One of the complications of the tuberculosis process is tuberculosis of the tracheobronchial tree, which tends to grow in recent years. Many studies indicate the incidence of bronchial tuberculosis from 10% to 40%, taking into account the level of diagnostic measures to detect tuberculosis and the availability of endoscopic services. An important problem in the treatment of tuberculosis is psychological problems in patients, including those with drug-resistant tuberculosis. In phthisiology, attention is drawn to the widespread history of stress in patients with tuberculosis and the complexity of psychological rehabilitation against the background of treatment. In relation to such patients, it is advisable to use a comprehensive medical and psychological approach, including specialized care based on the developed models of psychological rehabilitation. A large number of studies show that among patients with tuberculosis of the trachea and bronchi, young women, non-smokers with a high level of education and income are about 2 times more likely. An important problem is also unstable compliance and low stress tolerance in patients with neurotic personality organization, prone to actualization of maladaptive stereotypes of responding to the difficulties of the treatment process. This clinical example demonstrates the high efficiency of complex treatment of the tuberculosis process, which included anti-tuberculosis therapy, inhalation therapy, surgical treatment and psychological correction. Despite the late diagnosis of the tuberculosis process, relief of intoxication syndrome, cessation of bacte excretion and improvement of the clinical condition were achieved by 2 months of treatment. This approach in the complex treatment of the tuberculosis process is extremely important and relevant to achieve high treatment results.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"187 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462303","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 current research on microvascular angina","authors":"M. Khabibulina, O. Bazhenova, M. Shamilov","doi":"10.29296/25877305-2024-02-12","DOIUrl":"https://doi.org/10.29296/25877305-2024-02-12","url":null,"abstract":"Insufficient awareness of the etiology and pathogenesis of microvascular angina (MVA), as well as certain difficulties in diagnostic search, can lead to untimely or erroneous diagnosis. Objective. To generalize and systematize the available data on MVA and to raise awareness of doctors about modern diagnostic methods. Materials and methods. The selection of literature sources was carried out in the databases PubMed, GoogleScholar, Web of Science by keywords: coronary heart disease, microvascular angina, cardiac syndrome X for the period 2003-2023. Results and discussion. The article provides a general overview of the problem of MVA as an independent disease, provides various points of view on this problem, and identifies the difficulties of finding possible causes of its development. Special attention is paid to diagnostic algorithms and differential diagnostics. Conclusion. When working with patients with complaints of chest pain, it is important to remember about the features of MVA and conduct the necessary examination to exclude it.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"119 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462587","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":"A modern approach to surgical tactics in patients with residual post-tuberculosis changes of lungs","authors":"E. Krasnikova, R. Tarasov, A. Tikhonov, L. Lepekha, R. Amansakhedov, N. Karpina, M. Bagirov","doi":"10.29296/25877305-2024-02-01","DOIUrl":"https://doi.org/10.29296/25877305-2024-02-01","url":null,"abstract":"In patients with residual changes after the treatment of destructive forms of tuberculosis (TB), the risk of recurrence of the disease increases significantly. The study of the surgical material of patients with pulmonary TB as a result of the progression of residual post-tuberculosis changes a year or more after the completion of anti-tuberculosis therapy makes it possible to justify the need for surgery in this category of patients. Objective. To substantiate surgical tactics in patients with residual post-tuberculosis lung changes. Materials and methods. The analysis of 1121 adult patients who underwent surgery from 2015 to 2021 for etiologically verified pulmonary TB and completed anti-tuberculosis therapy more than a year before the operation. Of these, 176 patients were divided into two comparable groups: the main group included 37 patients in whom non-tuberculosis mycobacteria (NTMB) DNA was found in the surgical material, the comparison group included 139 patients in whom NTMB was not found in the surgical material. All patients underwent a comprehensive microbiological and morphological examination of the surgical material. Results. In the comparison group, in the majority of operated patients with microbiological screening of surgical material, the etiological diagnosis was positive: the most informative method for both destructive forms of pulmonary TB and forms without destruction was the real-time PCR method: in 82.0% and 87.2% of positive results, respectively, and luminescent microscopy, which allowed to identify acid-resistant Mycobacteria in 67.2% of cases with destructive forms of TB and in 73.1% – without lung destruction In the comparison group, in 19 (13.2%) patients, no evidence of TB was obtained by any screening method, but morphologic examination of surgical material showed the presence of TB inflammation with high activity in 11 (58.0%) and moderate activity in 8 (42.0%) patients. In the main group species identification of NTMB in the surgical material was obtained in the majority of cases, both in forms without destruction of lung tissue and in destructive forms – in 72.2 and 63.3% of patients, respectively, slow-growing NTMB prevailing. Fast-growing NTMB were detected in isolated cases. Morphological examination of the surgical material in a group of patients with NTMB revealed structural changes in the lungs that affected the air parenchyma and/or small airways in areas of the lungs free from TB foci, which should be taken into account when planning surgical intervention. Conclusion. Surgical treatment immediately after completion of the course of anti-tuberculosis therapy in case of formation of residual post-tuberculosis changes is the method of choice in the complex treatment of this category of patients.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"81 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462356","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":"Respiratory fluoroquinolones in the treatment of specific and non-specific lung diseases (literature review)","authors":"E. Yakovleva, E. Eremenko, E. Borodulina","doi":"10.29296/25877305-2024-02-04","DOIUrl":"https://doi.org/10.29296/25877305-2024-02-04","url":null,"abstract":"Фторхинолоны активно изучаются с 1980-х гг. и являются полностью синтетической группой антибиотиков, не имеющих прототипа в природе. \u0000Современная классификация фторхинолонов включает 4 поколения. Больший практический интерес представляют фторхинолоны III и IV поколения, воздействующие на респираторные патогены и грамотрицательную флору. \u0000Цель. Систематизировать накопленные к настоящему времени данные \u0000о значении фторхинолонов в лечении заболеваний легких. \u0000Материал и методы. Проведен системный поиск публикаций, в которых рассмотрены данные о значении фторхинолонов в лечении заболеваний легких. \u0000Результаты. По механизму действия фторхинолоны являются бактерицидными препаратами: ингибируя два жизненно важных фермента микробной клетки, ДНК-гиразу и топоизомеразу-4, фторхинолоны нарушают синтез ДНК, что приводит к гибели бактерий. Именно это свойство востребовано в поиске препаратов для лечения туберкулеза (ТБ) в период роста лекарственной устойчивости (ЛУ) микобактерий ТБ и отсутствия новых противотуберкулезных препаратов. Одновременно с получением данных эффективности «респираторных» фторхинолонов в лечении ТБ органов дыхания формировалось направление запрета их применения по широким показаниям при лечении заболеваний легких. В настоящее время обсуждается вопрос, связано ли широкое распространение множественной ЛУ ТБ с ранее проводимым лечением фторхинолонами у пациентов с заболеваниями легких без мероприятий по исключению ТБ. \u0000Заключение. Фторхинолоны – сильное и современное оружие в наших руках, требующее грамотного и вдумчивого подхода к практическому назначению.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"142 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462190","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 and functional features and quality of life in various phenotypes of occupational asthma","authors":"S. Babanov, L. L. S. L. Strizhakov, A. Baikova, A. Melentev, A. Agarkova, V. Lotkov","doi":"10.29296/25877305-2024-02-09","DOIUrl":"https://doi.org/10.29296/25877305-2024-02-09","url":null,"abstract":"Purpose. To study the characteristics of the content of neutral lipids and phospholipid fractions in the membranes of erythrocytes and blood plasma of adolescents with cephalalgia and arterial hypertension (AH). \u0000Materials and methods. Subject of the study – adolescents 12–17 years old (boys and girls) with cephalgia and the presence of AH (main group) and without AH (comparison group). Methods: questionnaires, laboratory, statistical. Examination program: verification of the clinical form of cephalgia (episodic, chronic); assessment of the presence of AH (using percentile tables, taking into account age, gender and height percentile); determination of the concentration of neutral lipids and phospholipid fractions in blood plasma and erythrocyte membranes using thin layer chromatography. \u0000Results. Of the 64 examined adolescents – patients of the pediatric department with recurrent cephalgia, the frequent (chronic) form of cephalgia was verified in 40 (62.5%) people, AH was diagnosed in 10 (25.0%) adolescents with chronic cephalgia and in 30 (75.0%) adolescents with this form of cephalalgia AH were not identified. Features of the lipid spectrum of adolescents with a chronic form of cephalgia associated with AH included a lower concentration of total lipids and triglycerides in erythrocyte membranes, higher values of the general phospholipids/free cholesterol ratio and a smaller number of statistically significant correlations. \u0000Conclusion. The features we identified in the lipid spectrum of erythrocyte membranes and blood plasma in adolescents with a frequent (chronic) form of cephalalgia associated with AH may indicate the presence in adolescents of initial minimal changes in the biochemical status of cell membranes at the stages of development of cardiovascular pathology – hypertension and coronary heart disease.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"35 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462616","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 SEVERITY OF VASCULAR INFLAMMATION AND ITS RELATIONSHIP WITH CLINICAL AND FUNCTIONAL FEATURES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CONCOMITANT CARDIOVASCULAR PATHOLOGY","authors":"T. Tayutina, N. Klimenko, D. Kudlay, L. Shovkun, N. Nikolenko","doi":"10.29296/0.29296/25877305-2024-02-05","DOIUrl":"https://doi.org/10.29296/0.29296/25877305-2024-02-05","url":null,"abstract":"The Russian Federation is one of the countries with a high prevalence of chronic obstructive pulmonary disease (COPD). In the last decade, the list of families of chemical regulators of vascular inflammation in COPD has been supplemented with information about growth factors, whose participation in the processes of regulation of vascular function seems significant. The study of the role of angiogenesis factors in patients with isolated COPD disease is insufficient at this stage and needs to be clarified. Objective. To study was to identify diagnostic and prognostic criteria for the severity of vascular inflammation and to assess its relationship with clinical and functional features in patients with COPD without concomitant cardiovascular pathology in comparison with the clinical phenotype of the disease. Material and methods. 96 patients with COPD were examined, the median age was 61 years. In addition to standard clinical, functional and laboratory research methods, the severity of vascular inflammation was assessed in all examined patients with the determination of quantitative indicators of human platelet growth AA factor and tumor necrosis factor-α (TNFα) by quantitative solid-phase enzyme immunoassay Results. In all patients with isolated COPD, regardless of the risk of developing the underlying disease, an increase in the level of platelet growth AA factor and TNFα was noted. The level of platelet growth AA factor and TNFα in patients with COPD, regardless of the risk of exacerbation, was correlated with the functional state of the lungs, clinical phenotype and severity of clinical manifestations of the disease. The value of platelet growth AA factor above 317 ng/ml in patients with COPD may be an early marker of endothelial dysfunction and a predictor of the development of hemostatic disorders and concomitant cardiovascular pathology.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"88 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462663","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":"Role of the gut microbiota in aging and maintenance of active longevity. Part 2","authors":"A. Ratnikova, Ya. Ashikhmin, V. Ratnikov, M. Grudina, O. Dikur","doi":"10.29296/25877305-2024-02-03","DOIUrl":"https://doi.org/10.29296/25877305-2024-02-03","url":null,"abstract":"The role of intestinal microbiota in aging and maintaining active longevity is considered. The second part examines the issues of DNA damage by metabolites of various bacteria, which increases the risk of cancer. The interactions between the microbiota and the immune system, the connection between dysbiosis and the aging of the immune system, indicating specific molecular mechanisms, are described in detail. Particular attention is paid to lymphocytes of the Th17 subpopulation. Changes in the microbiome that are observed in individuals with cardiovascular diseases (arterial hypertension, coronary heart disease, chronic heart failure) are shown. The role of trimethylamine oxide and new mechanisms of damage to the cardiovascular system associated with the migration of immune cells from Peyer's patches to atherosclerotic plaques is revealed. Ideas about the relationship between the microbiome and cognitive function are given. Changes in the microbiome against the background of increased physical activity are considered. The final part of the article presents microbiome interventions aimed at increasing life expectancy and quality of life. These include diet, the use of prebiotics, probiotics, synbiotics, and medications that affect the microbiota.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"69 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462013","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":"Vascular and renal calcification as a consequence of high-dose calcium and vitamin D drugs","authors":"V. Strukov, M. Sergeeva-Kondrachenko, A. Denisova, I. Moiseeva, O. Vinogradova, E. Panina, E. Petrova, N. Galkina, A. Pronkina, O. Gorina, D. Elistratov, S. Burmistrova, D. Agafonov","doi":"10.29296/25877305-2024-02-15","DOIUrl":"https://doi.org/10.29296/25877305-2024-02-15","url":null,"abstract":"Calcium-containing drugs occupy an important place in the list of anti-osteoporotic agents. Their consumption, often in combination with high doses of vitamin D, has increased significantly over the last couple of decades. Cases of uncontrolled intake of the macronutrient have become more frequent. Aggressive advertising of high-dose calcium supplements with calciferol of foreign production on television played its role in this. Nowadays doctors of various specialties have to face more and more often the consequences of using such preparations. The article describes the mechanism of calcium deposits formation in vessels and kidneys against the background of calcium supplementation. The results of large-scale studies proving the close relationship between high intake of calcium and vitamin D with calcification of vessels, development of cardiovascular diseases and nephrolithiasis are presented. Doubts are raised about the validity and necessity of high-dose calcium supplements in the treatment of skeletal diseases. The possibilities of successful therapy of postmenopausal osteoporosis without the use of such agents are presented on the example of the preparation Osteo-Vit D3, which does not contain calcium and high doses of calciferol, but increases the mineral density of bone tissue and reduces the volume of calcificates in blood vessels and kidneys.","PeriodicalId":23748,"journal":{"name":"Vrach","volume":"241 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462445","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}