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Vol 31, No 3 (2020)

Articles

OBESITY: A MODERN VIEW ON THE PROBLEM

Amlaev K.R., Blinkova L.N., Dakhkilgova K.T.

Abstract

Obesity is one of the most important problems of current health care; the number of obese people is increasing annually. The authors present the epidemiology, etiology, pathogenesis of this disease; special attention is paid to the hormonal functions of adipose tissue and to adipokines produced by the latter. Modifiable and non-modifiable risk factors for this disease are considered separately. The paper highlights an association between obesity and comorbidities (circulatory system diseases, cancer, diabetes mellitus, non-alcoholic fatty liver disease, sleep apnea syndrome, and infertility). It describes the impact of the gut microflora on the development of this disease. Obesity-diagnosing methods and nondrug and drug therapies in patients with obesity are considered.
Vrach. 2020;31(3):3-10
pages 3-10 views

OSTEOPOROSIS IN THE PRACTICE OF A VERTEBROLOGIST

Yarikov A.V., Denisov A.A., Masevnin S.V., Perlmutter O.A., Smirnov I.I., Dokish M.Y., Lipatov K.S., Sosnin A.G.

Abstract

According to the WHO, osteoporosis (OP) ranks fourth among the factors that influence longevity and quality of life in people. The paper gives the risk factors, etiology, classification, and clinical picture of OP. Particular attention is paid to its diagnostic methods. Indications for OP treatment and criteria for its efficiency are also presented. Drug (vitamin D and calcium supple-ments, prolia, and calcitonin) and non-drug treatments are described in detail. The major surgical treatments, such as vertebroplasty and kyphoplasty, are considered.
Vrach. 2020;31(3):11-18
pages 11-18 views

COMPLICATIONS AFTER TREATMENT OF PATIENTS WITH GYNECOLOGICAL CANCER: HEMATOLOGICAL AND IMMUNE ASPECTS

Vlasina A.Y., Idrisova L.E., Solopova A.G., Blbulyan T.A.

Abstract

The purpose of the review: to demonstrate the relevance of studying the complications of patients with gynecological cancer after treatment; to highlight the most common disorders of the immune and blood-forming systems after radiation and/ or chemotherapy, and the possibility of their correction. Malignant neoplasms of the reproductive system occupy a leading position in the structure of morbidity and mortality of the female population. both in Russia and around the world. The successes of recent decades in the diagnosis and treatment have significantly improved the survival of patients with gynecological cancer. However, modern medicine seeks not only to extend, but also to ensure the maximum quality of the further life of patients. Treatment of patients with gynecological cancer is often associated with a large number of complications. Recently, many studies have been conducted on this issue, but many aspects remain unexplored and not understood by practitioners. This review is devoted to the mechanisms of some hematological and immunological disorders resulting from the aggressive effects of radiotherapy and chemotherapy, as well as to the complex or combined treatment of women with ovarian tumors and cervical cancer. Timely diagnosis of complications after treatment is important for patientswithgynecological cancer. It is necessary to remember the possibility of developing hematological, immune and infectious disorders and to correct them. This will improve survival and quality of life of women.
Vrach. 2020;31(3):18-21
pages 18-21 views

ELEVATED CARDIAC SPECIFIC TROPONIN CONCENTRATION IN THE ABSENCE OF MYOCARDIAL INFARCTION. PART 1

Chaulin A.M., Karslyan L.S., Aleksandrov A.G., Duplyakov I.V.

Abstract

Elevated cardiac troponin concentrations are observed in various clinical situations without acute coronary syndrome, and therefore physicians often find it difficult to interpret positive troponin levels. The emergence of high-sensitivity analyses has led to the accelerated diagnosis of myocardial infarction - rapid (1- and 3-hour) diagnostic algorithms; however, additional problems have appeared due to low specificity. The review describes the reasons for the elevated concentration of cardiac troponins without myocardial infarction. The mechanisms for elevation of cardiac troponins and their diagnostic value in various nosological entities are discussed. Part 1 of the paper considers the mechanisms for elevation of troponins and their diagnostic value in diseases having the clinical symptoms similar to those of myocardial infarction, which frequently causes diagnostic errors. These include pulmonary embolism, myocarditis, and Takotsubo syndrome.
Vrach. 2020;31(3):22-27
pages 22-27 views

A COMORBID PATIENT: RHEUMATOID ARTHRITIS AND HYPERTENSION

Bazina I.B., Kozyrev O.A., Pavlova M.V., Krechikova D.G., Mizyova E.A., Pak D.Y., Petrunina N.E.

Abstract

Pathology of the cardiovascular system occupies the leading place in the structure of comorbid diseases. According to the data available in the literature, hypertension is noted in 60% of patients with rheumatoid arthritis (RA); however, the relationship between RA activity and blood pressure levels has been insufficiently studied. The paper discusses the features of the course of hypertension in patients with RA, as well as the relationship between autoimmune inflammation and hypertension.
Vrach. 2020;31(3):28-32
pages 28-32 views

A NEW APPROACH TO THE POSSIBILITY OF RADIONUCLIDE DIAGNOSIS OF THE STRUCTURAL AND FUNCTIONAL STATE OF THE KIDNEY AND URINARY TRACT

Berdichevsky B.A., Suflanov A.A., Berdichevsky V.B., Pavlova I.V., Barashln D.A., Romanova A.V., Rasulov F.R., Zagorchlk E.V.

Abstract

The possibilities of positron emission and computed tomography are being investigated in the study of the structural and functional state of the kidney and urinary tract.
Vrach. 2020;31(3):33-34
pages 33-34 views

BISOPROLOL-INDUCED CHANGES IN THE SPECTRAL CHARACTERISTICS OF HEART RATE VARIABILITY IN PATIENTS WITH ATRIAL FIBRILLATION: A CLINICAL CASE

Popova E.P., Bogova O.T., Puzin S.N., Sychev D.A., Fisenko V.P.

Abstract

Spectral analysis of heart rate variability (HRV) can judge the autonomic regulation of myocardial chronotropic function. Medicines can significantly change the spectral HRVs, suggesting that there is a change in cardiac autonomic regulation during drug therapy. Objective. To investigate the effect of the β-blocker bisoprolol on the spectral parameters of HRV in patients with atrial fibrillation (AF). Subjects and methods. The spectral parameters of HRV were investigated in patients with both newly diagnosed AF and its 6-month to 8-year history, who were treated with oral bisoprolol 2.5-5.0 mg. The total power of the HRV spectrum and the fluctuation power of very low frequencies (VLF), low frequencies (LF), and high frequencies (HF) were calculated. Results. The proportion of slow fluctuations (LF) in the newly-diagnosed AF group was shown to be twice lower than that in the long-term AF group, and the proportion of fast fluctuations (HF) was twice higher. This suggests that a major role in the regulation of chronotropic cardiac function is played by the vagus nerve in bisoprol-treated patients with newly diagnosed AF and by the sympathetic nervous system in patients with long-term AF, Conclusion. Drug therapy for AF changes the spectral parameters of HRV and cardiac autonomic regulation. Selecting drug therapy in terms of the clinical type of AF in an individual and a patients autonomic status makes it possible to enhance therapeutic effectiveness.
Vrach. 2020;31(3):35-38
pages 35-38 views

THROMBOCYTOSIS IN A THERAPIST’S PRACTICE

Mikhailova Z.D., Cherepanova V.V., Babaev R.K., Klimkin P.F.

Abstract

A hospital or polyclinic therapist constantly investigates the causes of pathological conditions inter alia thrombosis or bleeding. The pathomorphism of diseases and the possibility of their atypical clinical picture prompt the physician to continuously improve his/her qualification, including that in allied fields.
Vrach. 2020;31(3):38-43
pages 38-43 views

BIOCHEMICAL PARAMETERS IN THE DRUG TREATMENT OF PATIENTS WITH CHRONIC HEART FAILURE

Mingalimova I.M., Baleeva L.V., Galeeva Z.M., Galyavich A.S.

Abstract

The mainstay of drug treatment in patients with chronic heart failure (CHF) is angiotensin-converting enzyme inhibitors, β-blockers, and mineral corticoid receptor antagonists, and, in edematous syndrome, diuretics. There is a drug treatment-induced change in number of biochemical blood parameters, such as plasma electrolytes, hormones, and catecholamines. The time course of biochemical blood changes induced by drug treatment in patients with CHF is important for the efficiency of the treatment and the control of its safety. The aim of the study was to investigate the impact of traditional inpatient drug treatment on a number of biochemical parameters in patients with obvious CHF.
Vrach. 2020;31(3):43-46
pages 43-46 views

THE NEW QUESTIONNAIRE «THERAPY ADHERENCE FACTOR SCALE»

Isakov V.A., Kholkina A.A., Zinkevich E.R.

Abstract

High compliance is considered as one of the most important conditions for the efficiency of treatment. Confirmation of this can be seen by practitioners when using inpatients on an example; compensation for symptoms or recovery of the patient can be fully achieved by the healthcare staffs monitoring of medical prescriptions under these conditions. Timely and adequate determination of the level of patient compliance will help to develop an effective treatment strategy for the period when the patient leaves the healthcare facility and is face-to-face with his/her diseases, which is especially important for patients with chronic diseases. Despite a certain abundance of indirect methods for diagnosing adherence to treatment, there are currently no methods for assessing factors influencing compliance. The designed questionnaire «Therapy adherence factor scale» used in patients who had undergone emergency intervention into the coronary arteries demonstrated satisfactory psychometric characteristics. Its use will assist investigators and practitioners to determine the factors that influence treatment adherence.
Vrach. 2020;31(3):46-50
pages 46-50 views

URBANIZATION AS A FACTOR FOR REPRODUCTIVE HEALTH DISORDERS (IN CASE OF THE INDIGENOUS MINORITY PEOPLES KHANTY AND MANSI)

Chegus L.A., Solovyeva A.V.

Abstract

Women’s reproductive health in Russia has deteriorated significantly over the past 30 years. There has been an increase in the incidence of civilization diseases, such as abnormal uterine bleeding and, consequently, iron deficiency anemia, endometriosis, hyperplastic processes (uterine fibroids, etc.), as well as pregnancy complications; perinatal outcomes have worsened. Changes in the traditional ways of indigenous minority peoples in the North (Khanty and Mansi), urbanization, occupational changes, etc. adversely affect reproductive health
Vrach. 2020;31(3):51-55
pages 51-55 views

COMBINATION TREATMENT FOR DELAYED UNION AND PSEUDOARTHROSIS OF THE NAVICULAR BONE

Tikhonenko A.A., Fedulicheva E.V., Tikhonenko A.

Abstract

The authors analyze the results of combination treatment for the navicular bone with the combined osteotropic drug Osteomed and those of the use of external fixators. Scaphoid union was achieved in 96% of cases. Positive results are confirmed by the data of Disabilities of Arm, Shoulder, and Hand (DASH) and Mayo Wrist Score scales, which allows one to recommend the proposed method for wide clinical use.
Vrach. 2020;31(3):56-60
pages 56-60 views

FEATURES OF PRIMARY TOTAL HIP ARTHROPLASTY IN PATIENTS WITH OBESITY

I L., Lychagin A.V., Gritsyuk A.A., Smetanin S.M.

Abstract

The authors conducted a retrospective study of 1885 patients who had undergone primary total hip arthroplasty. The patients with normal body weight were 63.9%; varying obesity was present in 36.1% (39.4% of women and 31.7% of men). In the obese patients, the treatment results were lower, and the number of complications was 2-3 times greater than that in normal weight patients, which requires their preparation for postoperative treatment of obesity.
Vrach. 2020;31(3):60-64
pages 60-64 views

CLINICAL DIFFICULTIES IN THE DIAGNOSIS OF PRADER-WILLI SYNDROME

Paramonova Y.A., Khalturina Y.V., Khruleva N.S., Khrulev A.E., Lyubavina N.A.

Abstract

The paper discusses Prader-Willi syndrome (PWS), a rare form of genetically determined obesity. Due to the low prevalence of the disease (the population frequency is 1:10000-1:20,000), the clinical experience of specialists is insufficient, which often leads to untimely diagnosis. The essence of genetic abnormalities resulting in this pathology is disclosed; the clinical picture of the disease is described; diagnostic criteria that allow reliable diagnosis to be made even before genetic analysis are presented. A clinical case of delayed diagnosis is given as an illustration.
Vrach. 2020;31(3):65-68
pages 65-68 views

EVALUATION OF THE EFFICIENCY OF METABOLIC THERAPY IN ELDERLY PATIENTS WITH CARBOHYDRATE METABOLISM DISORDERS AFTER ISCHEMIC STROKE

Shishkova V.N., Remennik A.Y., Kerimova E.I., Sayutina E.V., Kapustina L.A.

Abstract

The objective of this open-label randomized controlled study was to investigate the time course of changes in the parameters of carbohydrate and lipid metabolisms and in the concentration of N-terminal pro b-type natriuretic peptide (NT-proBNP), a marker for heart failure, in elderly patients who had experienced primary or secondary ischemic stroke treated with Mildronate 1000 mg/day added to the standard therapy cycle. Subjects and methods. The investigation enrolled 60 patients aged 60 to 90 years who had experienced a primary or secondary ischemic stroke in 2019. All the patients selected for this investigation were randomized into two groups. In Group 1 (n=30), the standard therapy was added by Mildronate as 500-mg capsules twice daily for 12 weeks; in Group 2 (n=30) Mildronate was not used. All the included patients underwent a double study of blood biochemical parameters: glucose, cholesterol, LDL-cholesterol, HLD-cholesterol, triglycerides, ALT, AST, creatinine, high-sensitivity C-reactive protein (hs-CRP), NT-proBNP, glycated hemoglobin (HbA1c) at the beginning and completion of the treatment cycle. The follow-up period was 12 weeks. All the patients included in the study received therapy that included secondary prevention of stroke and correction using antihypertensive, lipid-lowering, antiplatelet, anticoagulant, and hypoglycemic therapies for all currently existing concomitant diseases. Results. Group 1, in which Mildronate 1000 mg per day was added to the therapy for 12 weeks, showed a significant decrease in the parameters: glucose, glycated hemoglobin, triglycerides, ALT, AST and brain natriuretic peptide. The levels of cholesterol, LDL-cholesterol, atherogenic index, CRP, and creatinine decreased in Group 1, and, on the contrary, the concentration of HDL-cholesterol increased; however, these changes did not reach statistical significance at the end of the follow-up. In the control group, no significant changes were found in the biochemical parameters under study. Conclusion. This open-label randomized controlled study has led to the conclusion that Mildronate can have a positive effect on the parameters of carbohydrate and lipid metabolisms and improve myocardial and hepatic functions in elderly patients after a primary or secondary ischemic stroke.
Vrach. 2020;31(3):69-75
pages 69-75 views

STAPLE-FREE AND STANDARD BARIATRIC GASTRIC BYPASS SURGERY: A CLINICAL AND ECONOMIC ANALYSIS

Ospanov O.B., Eleuov G.A., Mukantaev T.E., Vychuzhanin D.V., Khasenova A.Z., Sinyakin S.Y.

Abstract

The paper presents a clinical and economic analysis of the outcomes of staple-free band-divided and standard single-anastomotic bariatric gastric bypass surgery using endoscopic staplers. A cost minimization analysis has established that among the two compared methods having the same clinical efficiency, the staple-free procedure is much cheaper and accordingly more economical for practical application.
Vrach. 2020;31(3):76-80
pages 76-80 views

THIRTY YEARS OF EXPERIENCE WITH PEPTIDE THYMOMIMETICS IN THE PREVENTION AND TREATMENT OF ACUTE RESPIRATORY VIRAL DISEASES AND INFLUENZA

Trofimova S.V., Trofimov A.V., Semenova E.D.

Abstract

The paper presents the results of 30-year clinical use of peptide thymomimetics to prevent and treat acute respiratory viral infections and influenza. The findings suggest that the peptide thymomimetics have a high clinical effect and show promise for use during an epidemic.
Vrach. 2020;31(3):81-82
pages 81-82 views

EARLY MANIFESTATIONS OF PRIMARY KNEE OSTEOARTHROSIS: IMMUNOLOGICAL ASPECTS

Belova S.V., Gladkova E.V., Zubavlenko R.A., Ulyanov V.Y.

Abstract

Objective: to evaluate immunological changes in patients with primary knee osteoarthrosos (OA) at an early stage of its development. Subjects and methods. The patients underwent clinical, instrumental (ultrasonography, X-ray, and magnetic resonance imaging of the knee joints), and laboratory examination that involved the assessment of cartilage tissue metabolism, activity of an inflammatory response, and the immune system. Results. The patients showed increases in the serum concentration of cartilage oligomeric matrix protein and in the production of the proinflammatory cytokines interleukin (IL-1ß, tumor necrosis factor-а, and IL-6), as well as changes in the qualitative and quantitative composition of peripheral blood lymphocyte subpopulations (T and B lymphocytes, natural killer cells). Conclusion. The study of the immunological aspects of primary knee OA at an early stage of its development showed the activation of proinflammatory cytokines along with a certain change in the cellular component of immunity, which determines an autoimmune response that creates conditions for the development of an inflammatory process that entails degenerative and dystrophic phenomena in the joint tissues. This is confirmed by the elevated serum level of cartilage oligomeric matrix protein. The results of the study can be useful for the objective assessment of these patients’ condition and for the prescription of immunomodulatory and chondroprotective drugs just at an early stage of the disease.
Vrach. 2020;31(3):84-87
pages 84-87 views

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