Peer-review scientific and practical multidisciplinary journal


  • Vasily M. Delyagin, MD, Professor


  • Publishing House «Russkiy Vrach»


  • Ministry of Health of the Russian Federation

  • The First Sechenov Moscow State Medical University under Ministry of Health of the Russian Federation


The journal’s story began over 100 years ago. At that point in time, the publication was subtitled “Daily paper devoted to all fields of medical studies, public and private hygiene, and medical living issues”. Professor, Manassein Vyacheslav Avksentyevich, who is a physician, scientist, public person, and sponsor of charity funds, was its editor and publisher. During 20 years (1880–1901) “Vrach” has been covering a broad range of issues related to public medicine, medical living, ethics, and education, and became of the the most readable Russian medical periodical. Since 1901, after death of Manassein, V.A., the journal has been published under title “Russky Vrach”, and in 1910 has been placed under censorship regime. In 1988, decision on publication renewal has been taken at the initiative of the academician, Chazov, E.I., at the I All-Union Medical Congress. First issue of the renewed journal was released in 1990.

As compared to traditional academic scientific publications, present journal has been published as a practical periodical and year by year has been approved as a reputable and reliable handbook of practicing physicians. Permanent headings “Lecture”, “Problem”, “From Experience”, “Pharmacology”, and etc. introduce new treatment technologies and methodologies, and modern medications, constantly replenishing arsenal of practical physicians and ensuring better guidance in developments of modern medicine.


  • Topical Subject
  • Lecture
  • Problem
  • For Diagnosis
  • Pharmacology
  • From Practice
  • Health Care Service
  • Physician’s Notebook

Current Issue

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Vol 34, No 8 (2023)

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Topical Subject

Bicuspid aortic valve: anatomy, physiopathology, clinical presentations
Delyagin W.M., Amir-Zade K.A.

The bicuspid aortic valve (AoV) (BAV) occurs in about 1% of the population, while the probability of its observation in first-degree relatives is 9-10%. Familial aortic aneurysm in BAV is inherited as an autosomal dominant disease with incomplete penetrance. BAV accompanies connective tissue dysplasia, congenital cardiovascular defects, aortic coarctation, Turner syndrome, etc., is frequently concurrent with cardiac arrhythmias, general somatic, and neuropsychiatric disorders. The basis of diagnosis is transthoracic echocardiography (EchoCG). If needed, transesophageal EchoCG, magnetic resonance imaging and/or computed tomography of the heart are performed. Persons with BAV, even without stenosis or valve insufficiency, are frequently recorded to have dilation of the ascending aorta and/or its root. Aortic dilation may occur many years after the detection of BAV, more often in valve insufficiency. Abnormal systolic blood flow through the BAV leads to regional aortic wall tension and promotes the development of aortopathy that is manifested as aortic aneurysm and dissection. Arthropathy develops in the presence of cystic media damage, activation of matrix metalloproteinases, and apoptosis. The aim of interdisciplinary management in patients with BAV is the prevention of circulatory disorders, the early detection of complications and the identification of a group of patients to be referred to cardiac surgeons. Taking into account the fact aortic aneurysm may develop late, therapeutic monitoring should be continued after surgical correction of valve abnormality. During a follow-up, BAV should be considered as a manifestation of the systemic process.

Vrach. 2023;34(8):5-11
pages 5-11 views
Targeted two-phase noninvasive mechanical ventilation in the neonatal intensive care unit: a follow-up assessment of respiratory tactics and perinatal outcomes in premature babies
Zavyalov O.V., Pasechnik I.N., Ignatko I.V., Babaev B.D.

The paper considers respiratory support strategies in neonatal intensive care practice. The paper describes the impact of noninvasive mechanical ventilation (NIMV) on oxygenation in premature babies. In order to improve the differentiated choice of targeted two-phase NIMV as a starting respiratory support, the authors have made a follow-up assessment of respiratory tactics and perinatal outcomes in premature babies of small gestational age. The data of the follow-up of 90 extremely low-birth weight babies, which was performed at 6 months of adjusted age, were compared with the comprehensive perinatal assessment criteria and with clinical, laboratory, and instrumental data obtained in the early neonatal period.

Vrach. 2023;34(8):11-16
pages 11-16 views
Topical issues of surgical treatment of cicatricial tracheal stenosis
Ivanyuk A.S., Kotiv B.N., Dzidzava I.I., Novikov V.N., Fufaev E.E., Barinov O.V., Yasuchenya D.A.

Advances in surgery make it possible to successfully treat seriously ill patients who are on prolonged artificial lung ventilation. As a result of a combination of ischemia, trauma and infection of the tracheal mucosa due to chronic inflammation, the normal structures of its wall are replaced by fibrous tissue, which is manifested by narrowing of the tracheal lumen with the development of progressive suffocation. Despite the studies conducted, the mechanism and timing of the formation of a chronic inflammatory reaction and a fibrous process in the affected area and peripheral bronchopulmonary structures in various variants of post-intubation tracheal complications are not sufficiently disclosed. One of the most important areas in tracheal surgery is ensuring the safety of operations in order to reduce the number of postoperative complications and mortality. This applies both to simultaneous radical operations and stage-by-stage interventions, as well as to new intra-light technologies. The advantage of cicatricial tracheal stenosis is the possibility of preserving the pathologically altered tracheal wall for the formation of the respiratory tract, unlike oncological practice. Further development of tracheal surgery directly depends on the introduction of preventive measures and analysis of adverse factors associated with an increased risk of complications. An integrated approach to the prevention, treatment and rehabilitation of patients with cicatricial tracheal stenosis allows us to develop personalized tactics aimed at improving the effectiveness of treatment and achieving full rehabilitation of each patient. We believe that the research conducted in this field of science is promising.

Vrach. 2023;34(8):16-22
pages 16-22 views


An integrated approach to cervical cancer prevention
Klinyshkova T.V., Frolova N.B.

Cervical cancer (CC) is the fourth most common cancer among women in the world. In the Russian Federation, the incidence of cervical cancer is in second position in the structure of genital cancers. The WHO Global Strategy to Accelerate the Elimination of CC as a Public Health Problem recommends an integrated approach to prevention and control of CC that combines vaccination, screening and treatment. A review and analysis of modern data on this problem over the past decade is presented. Scaling up HPV vaccination, increasing the level of cervical screening and coverage of the female population, developed post-screening management and timely treatment of precancer will reduce the incidence and mortality associated with cervical cancer.

Vrach. 2023;34(8):22-26
pages 22-26 views


Tuberculosis and diabetes mellitus: the current state of the problem
Komissarova O.G., Polushkina E.G., Abdullaev R.Y.

Certain successes have been achieved in the fight against tuberculosis (TB) in the Russian Federation in recent years. However, the current TB situation remains tense. A certain role in this has been played by the spread of nosological entities that also include diabetes mellitus (DM). The review presents data on the prevalence, the features of the course of TB and DM comorbidity, and the efficiency of its treatment.

Vrach. 2023;34(8):27-32
pages 27-32 views
Non-tuberculous mycobacterioses of the lungs: problems of diagnosis and treatment
Lyukshin D.V., Borodulina E.A., Vdovina D.V., Zaytseva O.A.

Infectious diseases caused by non-tuberculous mycobacteria (NTMB) are an important public health problem in most countries, increasing in recent years. The problem is both diagnosis, differential diagnosis with tuberculosis, and treatment. To study the data on NTMB, a review of scientific publications was carried out. Literature search was carried out using the RSCI, CyberLeninka, Scopus, Web of Science, MedLine, PubMed databases. To search for articles, such keywords as mycobacteriosis, non-tuberculous mycobacteria, HIV infection were used. Data on the prevalence of NTMB in different regions of the country were analyzed. The issues of diagnosis and treatment of mycobacteriosis are reflected.

Vrach. 2023;34(8):33-39
pages 33-39 views


The role of immunomodulatory therapy in the treatment of acute respiratory viral infections in patients with year-round allergic rhinitis
Trukhan D.I., Bagisheva N.V., Nesterova K.I., Mordyk A.V., Alekseenko V.A., Moiseeva M.V., Kalashnikova N.M., Neshcheretneva V.N.

Objective. To assess the effectiveness and safety of the combined medicine interferon alpha-2b + loratadine (Grippferon® with loratadine, nasal ointment) for the prevention and treatment of acute respiratory viral infections (ARVI) in patients with year-round allergic rhinitis.

Materials and Methods. A total of 154 patients were included in the study and divided into four groups: group 1A patients (n=37) received the combined medicine interferon alpha-2b + loratadine (Grippferon® with loratadine) 5 times a day for 7 days for the ARVI treatment; in group 2A (n=41) standard therapy was carried out in accordance with the clinical guidelines for the ARVI treatment in adult patients (2021). Group 1B (n=38) patients used the combined medicine interferon alpha-2b + loratadine once a day for 7 days for the ARVI prevention; in group 2B patients (n=38) ARVI prevention was not conducted. There were 75 (48.7%) men and 79 (51.3%) women, aged 22-45 years.

Results. During treatment with the combined medicine interferon alpha-2b + loratadine in group 1A patients there was a significant decrease in respiratory manifestations (such as nasal congestion, rhinorrhoea, sneezing) by comparing with group 2A patients. Rhinocytogram analysis results showed that the use of the combined medicine interferon alpha-2b + loratadine contributed to the reduction in the intensity and severity of inflammatory (leukocyte count) and allergic (eosinophils) responses. In group 1B patients, who received the medicine interferon alpha-2b + loratadine for the ARVI prevention, we noted that during three observation months 3 times less patients got acute respiratory infections by comparing with group 2B patients.

Conclusion. The received study results demonstrate that the use of topical medicine interferon alpha-2b + loratadine in patients with concomitant acute respiratory viral infections and year-round allergic rhinitis shortens the ARVI treatment period. The preventive use of the given medicine allows us to reduce the number of ARVI in patients with year-round allergic rhinitis.

Vrach. 2023;34(8):39-43
pages 39-43 views

Health Care Service

Studying the opinion of obstetric and gynecological patients on their communication with medical specialists
Amlaev K.R., Bakunts S.A., Kuzmina E.M., Khripunova A.A., Dakhkilgova K.T.

The paper presents the results of studying the communicative patterns that have developed in everyday obstetric and gynecological practice, as well as the patients’ ideas about them.

Objective. To study the opinion of obstetric and gynecological patients on their communication with medical specialists.

Subjects and methods. A total of 975 patients who were on inpatient treatment in obstetric and gynecological clinics were surveyed.

Results. For older respondents, the absence of tattoos and piercings, as well as the presence of a badge, are important in the appearance of a physician. Almost half of the respondents consider that the physician should comfort an upset patient by giving him the opportunity to vent his negative emotions. To get information on medical topics, most patients use social media; 27.6% are not absolutely interested in social media. 20% of the patients have the impression that the physician talks with him irritably or in a "negative" form; 67% of the patients would like to participate in decision-making with the physician regarding their health.

Conclusion. In order to increase the satisfaction of patients with their interaction with medical specialists, the physicians need to improve their communication skills, pay attention to their image and appearance, and to show empathy when communicating with patients.

Vrach. 2023;34(8):43-47
pages 43-47 views
Associations of depression with parameters of attitude to medical care in open urban population, gender aspect
Kayumova M.M., Bessonova M.I., Gafarov V.V., Gakova E.I., Akimov A.M., Lebedev E.V., Novoselov A.V., Petelina T.I., Akimova E.V.

Objective. To establish associations of a high level of depression with certain parameters of attitudes towards medical care in women in an open urban population.

Subjects and methods. A cross-sectional epidemiological study was conducted on a representative sample of women aged 25–64, formed from the electoral lists of citizens of the city of Tyumen in the amount of 1000 people, the response was 70.3%. The levels of depression and the attitude of the population to medical care were determined using the standard WHO MONICA-MOPSY questionnaire.

Results. About a third of women in the open urban population showed the presence of depression, over four age decades of life, a tendency was established for a decrease in the prevalence of D from its low level to an average and further to a high level, a tendency to an increase in the prevalence of D from the fourth to the sixth decade of life was noted. Half of the women in the open population, regardless of age, only with severe pain in the region of the heart would go to the doctor and trust specialized studies more, and only a third part would go to the doctor if there was any pain in the region of the heart and trust the examination of the doctor. One-fifth of the population was more guided by their well-being, and not by the doctor's opinion. In the presence of a high level of depression in women of the open population, associations with the parameters of attitude to medical care were established and the minimum activity in the prevention and treatment of CVD was determined.

Conclusion. Thus, the results of the study obtained on an open urban population, which identified the most vulnerable categories of women with a high level of depression, can serve as a scientific basis for the formation of comprehensive preventive programs to reduce the risks of developing CVD in female populations of medium urbanized cities of Western Siberia.

Vrach. 2023;34(8):48-53
pages 48-53 views

From Practice

Tooth enamel demineralization in children during treatment with aligners: impact of oral hygiene and oral fluid pH (a pilot study)
Zhdanova D.A., Admakin O.I., Morozova N.S., Grinin V.M., Kozlitina Y.A., Malanova O.A., Gordienko I.D., Rumyantseva T.V., Garibyan A.A., Bille D.S.

The use of removable and non-removable orthodontic equipment shifts the biochemical, microbiological, and immunological balance of the oral cavity, which contributes to the increase in the risk for tooth hard tissue carious lesions and for periodontal diseases.

Objective. To identify the relationship of the activity of the development of enamel demineralization on the initial level of hygiene in the patient and on the level of his oral fluid acidity.

Subjects and methods. The investigators evaluated the patient hygiene performance (PHP) index and the International Caries Detection and Assessment System (ICDAS) index and also measured the oral fluid pH in 6–12-year-old patients with a changeable occlusion who have undergone treatment with aligners. The patients were divided into 2 groups: a study group (n=25) who had received treatment with aligners and a control group (n=25) who had not received this treatment option.

Results. No statistically significant differences were found between the study and control groups in the probability of developing a carious lesion; however, the localization of enamel demineralization foci differed significantly in the groups, which needs further study.

Vrach. 2023;34(8):53-58
pages 53-58 views
Efficiency of application of virtual reality technologies and mechanotherapy with biofeedback in increasing tolerance to physical loads in patients with post-COVID disorders syndrome
Ansokova M.A., Marchenkova L.A., Vershinin A.A., Fesyun A.D., Yurova O.V.

Objective. To investigate the effectiveness of the use of mechanotherapy and virtual reality technologies in increasing physical endurance and eliminating dyspnea during the rehabilitation of patients with post-COVID disorders syndrome (PCDS).

Material and methods. The study included 120 patients who underwent a new coronavirus infection COVID-19, aged 40 to 70 years, with manifestations of PCDS. Patients of the main group (n=60) were assigned 10 sessions on a robotic simulator with biofeedback for training the muscles of the lower extremities, 10 sessions of interactive balance therapy and 10 sessions on an interactive rehabilitation system with virtual reality technology against the background of basic treatment. In the control group (n=60), patients received only basic treatment. The effectiveness of rehabilitation was assessed according to cardiopulmonary testing and the severity of dyspnea.

Results. According to cardiopulmonary testing after completion of rehabilitation in the main group, an increase in the maximum work performed by 12.9% (p=0.001 compared with the baseline, p=0.006 compared with the control) and oxygen consumption of the first ventilation threshold by 6.3% (p=0.022 and p=0.016, respectively), a decrease in diastolic blood pressure (BP) at rest by 5 mm Hg. Art. (p=0.044 and p=0.01, respectively) and at the peak of the load - by 7 mm Hg. Art. (p=0.003 and p=0.037, respectively). The level of systolic blood pressure at rest after completion of rehabilitation was 3 mm Hg. Art. lower than in control (p=0.02). In the main group, after rehabilitation, there was no severe and very severe dyspnea (0% in each case, p = 0.029 compared with the baseline), the proportion of people with moderate dyspnea decreased from 61.7% to 13.3% (p< 0.001) and increased the proportion of patients with no dyspnea (from 8.3% to 26.7%, p=0.009) or mild dyspnea (from 13.3% to 60.0%, p<0.001)

Conclusion. The use of virtual reality technologies and mechanotherapy in the framework of medical rehabilitation programs for patients who have undergone COVOD-19 contributes to an increase in exercise tolerance, a decrease in the severity of hypoxic syndrome, shortness of breath, and an improvement in cardiovascular performance in patients with PCDS.

Vrach. 2023;34(8):59-62
pages 59-62 views
Dystrophic changes of the spine in a patient with Kimmerle anomaly on the example of a clinical case
Kutsenko V.P., Kovaleva D.D., Postanogov R.A., Menshikova S.V.

Of all diseases of the musculoskeletal system, degenerative changes of the spinal column occupy the first place in frequency. Especially in recent years, cases of diagnosis of dystrophic changes in the vertebrae and intervertebral discs in children have become more frequent, which indicates the rejuvenation of this pathology, and, as a result, an increase in cases of disability of the young population.

The presence of congenital defects of the vertebral apparatus is important for the rate of progression of the disease. Such an innate feature is considered to be the Kimmerle anomaly. Several variants of the Kimmerle anomaly are known: 1) ossification is observed between the articular process of the atlas (C1) and its posterior arch; 2) the bone arch connects the articular process of the Atlas and its transverse process. Pathology can be unilateral or bilateral, and the bone arch may be complete or incomplete, then the bone bridge remains unclosed in the form of an arched outgrowth.

In the presence of connective tissue dysplasia at the same time, even in the most minimal manifestations, and Kimmerle anomaly, a more rapid development of denegerative changes of the cervical spine can be observed.

Vrach. 2023;34(8):63-67
pages 63-67 views
Hypertension therapy with Equator according to the genotype of the estrogen receptor gene
Khabibulina M.M., Shamilov M.D.

A cardiovascular disease is clinically heterogeneous with a differently pronounced genetic component that determines the predisposition or resistance of the patient to the development of many cardiovascular diseases (CVD). In women carrying the ESR1 gene, the risk of developing CVD is twice higher than that in the general population.

Objective. To study the impact of therapy with Equator (the angiotensin-converting enzyme inhibitor lisinopril + the third generation calcium channel blocker amlodipine) on blood pressure, left cardiac chamber remodeling, and silent myocardial ischemia (SMI) in female patients according to the genotype of the estrogen receptor gene.

Subjects and methods. The study involved 148 premenopausal women with hypertension and estrogen deficiency. All the patients underwent molecular genetic testing of the allelic estrogen receptor gene polymorphism ESR1–397 C>T. There was an association of the ESR1 – 397 CC genotype with the high risk of developing left ventricular hypertrophy (LVH) and SMI. The patients received treatment with one Equator tablet (at a dose of amlodipine, 5 mg, and lisinopril, 10 mg) once daily.

Results. Equator was shown to have a positive effect on central hemodynamic parameters in patients with a different ESR1 genotype. After 3 months of therapy, the patients with the heterozygous type CT tended to improve systolic and diastolic function of the left ventricle (LV), LVH. The highest effect was shown by the drug in the homozygous genotype CC group after 2 months of therapy as compared with the baseline levels: there was a significant decrease in the LV cavity, better LV contracting function, diastolic function LVH, SMI.

Vrach. 2023;34(8):68-74
pages 68-74 views
Possibility of using Femoklim in menopause women with cardiovascular pathologies
Dedov D.V., Denisova A.G., Moiseeva I.Y., Petrova E.V., Poluboyarinov P.A., Vikhrev D.V., Panina E.S., Fedorov A.V., Burmistrova S.S.

An analysis of Russian and foreign publications on the tactics of treating menopausal women with concomitant diseases of the cardiovascular system was carried out. The prospects for the use of drugs with phytoestrogens as an alternative therapy for menopausal manifestations are considered. The effectiveness and safety of the Russian drug Femoklim is evaluated in the context of providing a personalized approach to the treatment of patients in menopause, taking into account existing cardiovascular pathologies.

Vrach. 2023;34(8):75-78
pages 75-78 views
Skin ulcerative defects therapy in chronic venous insufficiency
Sakaniya L.R., Chekh A.S., Korsunskaya I.M.

Chronic venous insufficiency (CVI) is characterized by various symptoms and manifestations, including skin manifestations, among which venous eczema is the most common – about 44% of patients. The itching associated with eczema leads to scratching, which in turn increases the chances of secondary infections. In addition, venous ulceration of the lower extremities often develops in CVI, which can also be complicated by secondary infection, making the choice of therapy difficult. The treatment of venous eczema uses combined glucocorticosteroids, which relieve pruritus and infectious complications, as well as care products with a pronounced moisturizing effect. In the presence of ulcerative defects it is necessary to use means for cleansing of the wound surface and acceleration of epithelization processes.

Vrach. 2023;34(8):79-81
pages 79-81 views
A clinical case of morphea associated with Borrelia infection
Abo Khadeejeh M.B., Olenich I.V., Niewozinska Z.A., Korsunskaya I.M.

Scleroderma is an inflammatory disease that is evident as skin atrophy. The pathogenesis of scleroderma remains not completely understood. It is agreed that this disease arises from vascular changes, impaired fibroblast function, and immune dysfunction. The scientific literature also widely discusses an association between scleroderma and Borrelia infection. To date, there is no consensus regarding the mechanism of the influence of Lyme disease on the development of focal scleroderma. However, multiple cases of its occurrence after tick bites have been described.

The authors want to draw the attention of specialists to this problem, by presenting their own case from practice. A thorough history collection and examination of patients with focal scleroderma are necessary in order to detect Borrelia infection and, conversely, there is a need for the close monitoring of patients with Lyme disease for the timely initiation of therapy for focal scleroderma.

Vrach. 2023;34(8):81-84
pages 81-84 views

Physician’s Notebook

Digital telemedicine technologies in healthcare: impact on professional development, practice integration and data security
Brudyan G.S., Seliverstov P.V.

The article provides a detailed examination of the current role of digital health technologies (DHTs) in modern healthcare. Special attention is given to their impact on professional development of specialists, opportunities for integration into practice, and key issues related to patient data security. The benefits that DHTs can bring to the daily practice of dentists are analyzed, as well as the potential risks and challenges associated with their use. The article offers recommendations for the effective use of digital technologies, ensuring confidentiality and security of patient data, and emphasizes the importance of continuous education for professionals in the era of digitalization.

Vrach. 2023;34(8):85-88
pages 85-88 views

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