Russian Family Doctor最新文献

{"title":"New coronavirus infection and elderly patients in primary care","authors":"K. V. Ovakimyan, O. Kuznetsova, E. Frolova, Ruzanna V. Ambartsumyan, V.S. Dranets, A. Litvinova","doi":"10.17816/rfd366923","DOIUrl":"https://doi.org/10.17816/rfd366923","url":null,"abstract":"BACKGROUND: The high incidence of COVID-19 has been a major challenge to health systems in virtually every country in the world during the pandemic. Under these conditions, the elderly were especially vulnerable and were at risk for an unfavorable course of the disease. The elderly were not only at higher risk of contracting COVID-19 and had a worse outcome, but they could also experience reduced access to care for existing chronic noncommunicable diseases and be lost to follow-up. \u0000АIM: The aim of the study was to identify risk factors for the development of a severe course of COVID-19 in patients aged 60 years and older who applied for outpatient care during various periods of increased incidence of COVID-19: from March 2020 to February 2022. \u0000MATERIALS AND METHODS: The study was performed on the basis of the Center for Family Medicine of the North-Western State Medical University named after I.I. Mechnikov. A retrospective cohort study is based on an analysis of outpatient records of patients enrolled in the framework of compulsory health insurance, who applied for medical care at Center for Family Medicine and underwent COVID-19 during various periods of increased incidence, namely: from 19.03.2020 to 30.06.2020 (1st period), from 01.10.2021 to 30.11.2021 (2nd period) and from 18.01.2022 to 28.02.2022 (3rd period). Elderly patients were defined as study participants aged 60 years or older. \u0000RESULTS: The study included 343 patients: 137 men (39.9%) and 206 women (60.1%). The number of participants aged 60 and over was 85 (24.8%). It was found that in elderly patients such non-specific symptoms of acute respiratory viral infection as nasal congestion, rhinorrhea, sore throat, increased body temperature up to 38 ℃ (р 0.05) began to occur significantly more often. The severity of COVID-19 in elderly patients is influenced by the SARS-CoV-2 variant: the incidence of pneumonia and the number of hospitalizations were significantly less during the 3rd period of increase in the incidence (р 0.05), and the likelihood of developing a severe course of the disease was increased in 33.4 times and 23.8 times in waves 1 and 2, respectively, in comparison with wave 3. \u0000CONCLUSIONS: Over time, nasal congestion, rhinorrhea, sore throat, and an increase in body temperature up to 38 ℃ became significantly more common (p 0.05). Polymerase chain reaction testing for COVID-19 should be performed in all patients with symptoms of acute respiratory disease, regardless of severity. Pneumonia and hospitalization were significantly less common during the 3rd period of increased incidence (p 0.05), and the probability of developing a severe course of the disease was increased by 33.4 and 23.8 times in the 1st and 2nd waves, respectively, in compared to the 3rd wave. The data obtained should be taken into account when predicting severe outcomes in outpatients, developing tactics for monitoring and managing such patients.","PeriodicalId":432054,"journal":{"name":"Russian Family Doctor","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133744280","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":"Study of the problems of ageism and assessment of attitudes towards age in the medical environment","authors":"M. Grigorovich, Elena Y. Vychugzhanina, Elizaveta M. Limonova, Karine D. Guloyan, Anastasia A. Podushkina, Irina A. Gvozdeva","doi":"10.17816/rfd321218","DOIUrl":"https://doi.org/10.17816/rfd321218","url":null,"abstract":"BACKGROUND: Ageism pervades all areas of life, including the areas of medical and social care. Gerontological ageism has a significant negative impact on indicators of physical, mental health, functional status and well-being of older people. In the conditions of an aging society, the study of the scale and characteristics of this problem in various spheres of life is very relevant. \u0000AIM: To assess the prevalence of stereotypes of attitudes towards older age among primary health care physicians, senior students of a medical university and directly elderly people. \u0000MATERIALS AND METHODS: In the period from 2018 to 2022, 538 people aged 20 to 75 were interviewed in 3 subgroups: 1) senior students of a medical university of medical specialties, 2) young and middle-aged primary health care doctors, 3) elderly people. \u0000RESULTS: It was revealed that the opinions about the problems in this age period in the elderly and the beliefs of doctors and medical students often do not coincide. \u0000CONCLUSIONS: When training medical personnel, it is necessary to form the correct attitude to age and skills of communicative competence with different age groups of patients.","PeriodicalId":432054,"journal":{"name":"Russian Family Doctor","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123791000","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 concept of pre-COPD: development and feasibility in primary health care","authors":"E. Andreeva, M. Pokhaznikova, A. Turusheva, V. Popov, O. Kuznetsova","doi":"10.17816/rfd283633","DOIUrl":"https://doi.org/10.17816/rfd283633","url":null,"abstract":"BACKGROUND: Chronic obstructive pulmonary disease is often not diagnosed as a preventable disease. The primary physician needs a diagnostic tool to detect chronic obstructive pulmonary disease at an early stage. \u0000AIM: To develop the concept of early detection of chronic obstructive pulmonary disease through a diagnostic tool that stratifies patients according to the risk of disease development. \u0000MATERIALS AND METHODS: Random sample of persons 3570 years from the lists provided by 15 polyclinics of Saint Petersburg and Arkhangelsk (cross-sectional study, n = 2388). Cohort prospective study (respondents with fixed or variable obstruction, n = 167). All respondents were asked about demographic data, smoking history, risk factors, and the presence of symptoms. Spirometry with a bronchodilator was performed for all participants. \u0000RESULTS: Fixed obstruction was found in 6.8% of the participants in the first phase; obstruction was associated with male sex, smoking status over 10 packs/years, age over 55 years, chronic cough and shortness of breath. Of the 65 members of the cohort with variable obstruction, 23.1% had a fixed obstruction after a year, the risk factors of which were a smoking status of more than 10 packs/years, a night cough and forced expiratory volume in 1 second less than lower limit of normal. \u0000CONCLUSIONS: Based on the results of the two phases of the study, a diagnostic tool was developed for the early detection of chronic obstructive pulmonary disease in the general population by identifying a group of people with preserved lung function and high-risk chronic obstructive pulmonary disease factors.","PeriodicalId":432054,"journal":{"name":"Russian Family Doctor","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127675482","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 case of arrhythmic equivalent of myocardial ischemia in the practice of family doctor","authors":"I. V. Yubrina, I. Moiseeva, L. Degtyareva","doi":"10.17816/rfd303084","DOIUrl":"https://doi.org/10.17816/rfd303084","url":null,"abstract":"In the practice of the family physician (general practitioner) there are patients with recurrent cardiac arrhythmia (most commonly ventricular extrasystoles) accompanying angina pectoris attacks associated with local myocardial ischemia and manifested by ST-segment depression or elevation on the electrocardiogram. At the same time, there are patients with ischemic heart disease who may have palpable or insensible episodes of cardiac arrhythmia without ST-segment displacement and typical retrosternal pain during exercise. This clinic requires a detailed approach to diagnosing the equivalent of myocardial ischemia, including, exercise tests and coronarography, especially if a diagnosis of ischemic heart disease has been confirmed before. \u0000The case of cardiac arrhythmia as an equivalent of angina pectoris in a 67-year-old male patient with a history of myocardial infarction with postinfarction angina pectoris is presented in the article. Stenting of the right coronary artery was performed twice during ischemic heart disease treatment. \u0000Knowledge of the signs of myocardial ischemia equivalents determined the tactics of patient management by a general practitioner already at the stage of interview of ischemic heart disease history. Examination and referral of the patient for coronarography contributed to timely angioplasty with stenting of the affected left circumflex coronary artery, which caused local myocardial ischemia and arrhythmia.","PeriodicalId":432054,"journal":{"name":"Russian Family Doctor","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123340348","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":"Analysis of the clinical course, complications and causes of mortality at the onset of the primary necrotizing systemic vasculitis","authors":"","doi":"10.17816/rfd115270","DOIUrl":"https://doi.org/10.17816/rfd115270","url":null,"abstract":"BACKGROUND: Primary necrotizing systemic vasculitis is a significant problem of practical healthcare due to a severe progressive clinical course and a high risk of complications, including life-threatening damage. \u0000AIM: To evaluate the features of the clinical course of primary necrotizing systemic vasculitis during the first 3 years of the disease. \u0000MATERIALS AND METHODS: The study included 232 patients with primary necrotizing systemic vasculitis, who were hospitalized in Saint Petersburg clinics from 2010 to 2018. The features of the clinical course, complications, causes of mortality during the first 3 years of the disease were assessed. \u0000RESULTS: The cohort of patients with рrimary necrotizing systemic vasculitis consisted of patients with granulomatosis with polyangiitis (n = 94), microscopic polyangiitis (n = 46), eosinophilic granulomatosis with polyangiitis (n = 69), polyarteritis nodosa (n = 23). The highest values of the Birmingham Vasculitis Activity Score index were noted among patients with granulomatosis with polyangiitis and microscopic polyangiitis (21.4 and 21.5 points, respectively). Patients with microscopic polyangiitis were significantly more likely to develop chronic kidney disease (C3aC5 stages) compared to other primary necrotizing systemic vasculitis (p 0.001). We established that the average value of the Vasculitis Damage Index after 36 months of the disease was highest in the group of patients with granulomatosis with polyangiitis (4.7 points) and significantly exceeded the corresponding indicator at the same period of the disease in the group of patients with microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis, polyarteritis nodosa (3.8, 2.7 and 3.1 points, respectively). \u0000CONCLUSIONS: The most unfavorable prognosis among primary necrotizing systemic vasculitis during the first 3 years of the disease was noted in patients with granulomatosis with polyangiitis, which is reflected in the high level of the Vasculitis Damage Index that shows the number of irreversible organ lesions.","PeriodicalId":432054,"journal":{"name":"Russian Family Doctor","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114950693","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 problem of toxoplasmosis in outpatient practice. Part I. Toxoplasmosis in immunocompromised patients","authors":"","doi":"10.17816/rfd296574","DOIUrl":"https://doi.org/10.17816/rfd296574","url":null,"abstract":"Toxoplasmosis remains one of the most common opportunistic infections in immunocompromised patients, primarily in people living with HIV. An increase in the number of requests for medical care by patients with HIV infection as the disease progresses determines the need for knowledge of outpatient therapists and general practitioners of decision-making algorithms for suspected toxoplasmosis in such patients. The main clinical manifestations of toxoplasmosis in patients with immunodeficiency states, the formulation of a preliminary diagnosis, and the routing algorithm are given.","PeriodicalId":432054,"journal":{"name":"Russian Family Doctor","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125400037","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":"Healthy aging and oral health","authors":"E. Frolova, A. Turusheva, V. Trezubov, R. Rozov, M. Kabanov, R. Gvetadze, S. Arutyunov","doi":"10.17816/rfd312945","DOIUrl":"https://doi.org/10.17816/rfd312945","url":null,"abstract":"Currently, much attention is paid to healthy aging and aspects affecting it, such as, for example, oral health. Oral health determines the social, physical and mental well-being of an elderly person. A large proportion of the dentists patients are elderly people with numerous concomitant chronic somatic diseases who regularly take numerous medications. Along with this, this category of people is characterized by specific dental symptoms and syndromes. The review analyzes geriatric syndromes associated with oral health problems. It is proposed to include questionnaires to identify dental problems in a comprehensive geriatric assessment.","PeriodicalId":432054,"journal":{"name":"Russian Family Doctor","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125457552","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 memory to S.L. Plavinsky","authors":"Olga Y. Kuznetsova","doi":"10.17816/rfd321184","DOIUrl":"https://doi.org/10.17816/rfd321184","url":null,"abstract":"The obituary is dedicated to the member of the editorial board of the Russian Family Doctor Journal Professor S.L. Plavinsky.","PeriodicalId":432054,"journal":{"name":"Russian Family Doctor","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128716953","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":"Modification of the course of post-COVID syndrome associated with reactivation of chronic persistent Epstein−Barr virus infection and chronic nasopharyngotonsillitis of mixed etiology","authors":"V. Neverov","doi":"10.17816/rfd217717","DOIUrl":"https://doi.org/10.17816/rfd217717","url":null,"abstract":"A wide range of symptoms that occur in patients with post-COVID syndrome can include both manifestations of the clinical consequences of COVID-19 and symptoms of an exacerbation of a chronic pathology that they had before the development of coronavirus infection. Correct assessment of clinical data can help determine the origin of the existing manifestations of the disease and build a plan for adequate diagnostic and therapeutic measures. \u0000In the article, on the example of a clinical case, a variant of the modified (exacerbation of chronic pathology) course of the post-COVID syndrome was analyzed. An example of modern laboratory diagnostics of reactivation of chronic persistent EpsteinBarr virus infection and exacerbation of chronic nasopharyngotonsillitis of mixed viral-bacterial-mycotic etiology, developed against the background of post-COVID syndrome, is given. The principles of therapy for this comorbid condition are presented and explained.","PeriodicalId":432054,"journal":{"name":"Russian Family Doctor","volume":"173 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125052104","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":"Prevalence of chronic obstructive pulmonary disease and its risk factors among residents of Saint Petersburg and Arkhangelsk (based on the RESPECT project)","authors":"E. Andreeva, M. Pokhaznikova, V. Popov, O. Kuznetsova","doi":"10.17816/rfd112584","DOIUrl":"https://doi.org/10.17816/rfd112584","url":null,"abstract":"BACKGROUND: The study of the true prevalence of chronic obstructive pulmonary disease remains a significant area of research, as there is still a large gap between the official record of detected cases of the disease and epidemiological data. \u0000AIM: To study the prevalence of chronic obstructive pulmonary disease and its risk factors in two cities in the North-West region of Russia. \u0000MATERIALS AND METHODS: A random sample of respondents (2121 residents of Saint Petersburg, 1012 residents of Arkhangelsk); 2974 received qualitative results of spirometry (including 2388 with a bronchodilator test). The questionnaire included demographic, socioeconomic indicators, and risk factors for chronic obstructive pulmonary disease. \u0000RESULTS: The average age (54.9 9.2 and 52.3 9.2 years) and the proportion of respondents with higher education (37.4% and 29.7%) were higher in Saint Petersburg (compared to Arkhangelsk, p 0.0001). The proportion of ever smokers (49.5% and 44.4 %, p = 0.008), as well as the prevalence of chronic obstructive pulmonary disease (7.6% and 5.4%, p = 0.044), were higher in Saint Petersburg. In Arkhangelsk, exposure to biomass fuel and occupational hazards were more often noted. The prevalence of chronic obstructive pulmonary disease was higher in smokers and increased with age; the prevalence of smoking and chronic obstructive pulmonary disease was higher in men. \u0000CONCLUSIONS: The analysis of chronic obstructive pulmonary disease risk factors allows us to better understand not only the prevalence but also the structure and significance of each risk factor in different populations, which will improve the early diagnosis of the disease.","PeriodicalId":432054,"journal":{"name":"Russian Family Doctor","volume":"105 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122187395","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}