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Vol 31, No 8 (2020)

Articles

Diagnosis of COVID-19. Methods and problems of virus SARS-CoV-2 detection under pandemic conditions

Kudlay D.A., Shirobokov Y.E., Gladunova E.P., Borodulina E.A.

Abstract

As the COVID-19 pandemic continues and testing for SARS-CoV-2 becomes more readily available, there are new questions and concerns regarding this new virus. When to test? Who should be tested? How often? And what to do with the results obtained? What types of tests are currently available and under what circumstances they might be useful? Understanding the organization of testing at the local, regional, state, and national levels will optimize testing. The paper provides an overview of the available tests and how they can be useful in a rapidly changing and never-before-seen situation.
Vrach. 2020;31(8):5-10
pages 5-10 views

Problems in choosing treatment options

Samorodskaya I.V.

Abstract

The discussion article presents problems in the intuitive and science- and evidence-based application of treatment options. There are no clear criteria between these concepts, just as there are no clear criteria for evidence of the efficiency of treatment. Today, even in the best journals, there are problems with the reliability and correctness of the information placed. The intuitive and theoretically substantiated treatment searches (considered by the example of COVID-19) are quickly transformed into myths and misinformation, including the widespread use of off-label drugs and the misinterpretation of research results on prevention, diagnosis, and treatment methods.
Vrach. 2020;31(8):11-18
pages 11-18 views

Current ideas about stress

Amlaev K.R.

Abstract

Stress is one of the most important problems in modern healthcare, which is widespread in the world. The individual has regularly to deal with daily stress in the workplace and family, as well as with global problems of mankind, for example, with poverty, hunger, and terrorism. The consequence of stress is the development of posttraumatic stress disorders leading to mental and somatic diseases. This review describes the epidemiology of stress disorders and the theory of stress and discusses different types of stressors and their prevalence in society, the effect of stress on the individual’s mental and physical health and its relationship to the development of addictions. Non-drug methods and strategies for managing stress, its pharmacological treatment options, and possible ways to prevent stress disorders are considered separately. The results of studying the efficacy of venlafaxine in patients with coronary heart disease after stenting and aortocoronary bypass grafting are given.
Vrach. 2020;31(8):18-24
pages 18-24 views

Neonatal respiratory distress syndrome in extremely premature infants: epidemiology, pathogenesis, clinical presentations, and perinatal risk factors

Zavyalov O.V., Chabaidze Z.L., Dementyev A.A., Pasechnik I.N.

Abstract

The paper deals with the epidemiology, pathogenesis, and clinical manifestations of neonatal respiratory distress syndrome (NRDS) in extremely premature infants. Based on the study of current Russian and foreign literature sources, the authors give new evidence for the impact of parturient somatic and obstetric/ gynecological diseases on the occurrence of NRDS in extremely low-birth weight (ELBW) premature infants. Gestational age and ELBW are shown to be of great sociomedical significance for the severity and progression of NRDS within the first 168 hours of life in extremely premature infants. There is evidence that intrauterine infection and experienced asphyxia worsen the course of NRDS in the early neonatal period. The survival and perinatal outcomes of the extremely premature infants with NRDS are described
Vrach. 2020;31(8):24-31
pages 24-31 views

Hemophilia (from fatal outcome to outpatient management)

Delyagin V.M.

Abstract

Hemophilia is the most common form of severe hereditary bleeding. The prevalence of hemophilia among adolescents according to official statistics in Moscow is 12.2-16.0 per 100 thousand. Hemophilia B occurs 5 times less frequently than hemophilia A, hemophilia C -10 times less often. Taking into account the localization of the FVIII and FIX genes on the X chromosome and their recessiveness, clinically significant manifestation of hemophilia A and B is characteristic almost only of men. Mild forms of hemophilia are much more common in female carriers than is commonly thought. New female carriers often arise from old fathers (that is, old paternal sperm). Clinically, depending on the degree of clotting factor deficiency (severity of hemophilia), bleeding of varying intensity is possible, up to disabling and life-threatening. Modern replacement therapy with recombinant clotting factors, the appointment of recombinant clotting factors prevents bleeding, allows surgical interventions and ensures a sufficiently high quality of life.
Vrach. 2020;31(8):31-38
pages 31-38 views

Prediction and assessment of somatic risk factors affecting the course of pregnancy

Rimskaya B.A., Chudinov I.K., Samokhin V.Y., Murashko M.M., Vasilieva T.P., Vasiliev M.D., Melerzanov A.V.

Abstract

An important public health goal is to increase the number of successful births and to carry out a systemic approach aimed at reducing risk factors for pregnant women and women who have already given birth. This work is aimed at building a statistical model for assessing and forecasting risk factors for the following 5 years. By applying the linear regression method and time series analysis methods the presence of trends in the dynamics of the disease was determined with a high level of significance, the forecast with confidence intervals was built for the disorders such as varicose veins, diseases of the urinary system and respiratory system, as well as complications associated directly with an increased body mass index were considered. The obtained data has shown the need for the development of a monitoring system that will take into account the positive growth dynamics of mentioned risk factors.
Vrach. 2020;31(8):38-45
pages 38-45 views

Male reproductive health under the influence of a complex set of harmful occupational and environmental factors

Zaitsev V.A., Tsepkova G.A., Goverdovsky Y.B.

Abstract

Reduced spermatogenic function in men can result from exposure to harmful occupational and environmental factors, as well as in the presence of any other diseases. Occupational and environmental factors that negatively affect the reproductive health of men are presented.
Vrach. 2020;31(8):45-53
pages 45-53 views

Features of the course of community-acquired pneumonias in women of childbearing age

Lavrova O.V., Petrova M.A., Kulikov V.D., Kucheryavenko A.N.

Abstract

In recent years, the results of a number of studies have been published, suggesting the more severe course of community-acquired pneumonias in the gestation period. The data on the course of pneumonia in pregnant women during the COVID-19 pandemic are also extremely relevant. Objective: to compare the features of diagnosis, course, and treatment of community-acquired pneumonia in women of childbearing age in the presence and absence of pregnancy. Subjects and methods. Case histories were used to comparatively analyze the course and treatment of community-acquired pneumonia in women of childbearing age during pregnancy (n = 35) and non-gestation (n = 28). There are also data on the specific features of the course of COVID-19 during pregnancy. Results. Most (70%) pregnant women were hospitalized in the second trimester. During pregnancy, hospitalization was carried out in a significantly shorter time. On hospital admission, the number of patients with moderate disease was significantly higher, whereas saturation was significantly lower in the group of pregnant women; however, both groups showed mild symptoms represented by fever, cough that was mostly dry. The content of stab neutrophils was significantly higher in the group of pregnant patients. In both groups, initial antibacterial therapy was significantly more frequently performed with intravenous ceftriaxone than with other drugs. The duration of hospitalization did not differ in the groups and averaged 12 days. Conclusion. Based on the findings, the authors cannot conclude that there are substantial differences in the severity of the course and symptoms and in the duration of treatment for community-acquired pneumonia in pregnant women and women of childbearing age during the non-gestation period.
Vrach. 2020;31(8):54-57
pages 54-57 views

Treatment for neonatal respiratory distress syndrome in extremely low-birth weight premature infants: selection of respiratory support

Zavyalov O.V., Marenkov V.V., Dementyev A.A., Pasechnik I.N.

Abstract

The paper deals with the urgent problem of perinatology and neonatal resuscitation - the treatment of extremely premature infants with neonatal respiratory distress syndrome (NRDS). It discusses the epidemiology, survival, and perinatal outcomes in premature babies. NRDS is a severe respiratory disorder in premature babies due to immaturity of the lungs and primary surfactant deficiency. The paper shows the high sociomedical significance of the impact of gestational age and extremely low-birth weight on the severity and progression of respiratory failure in extremely premature infants. It presents the clinical manifestations and features of the diagnosis of NRDS. The Silverman-Andersen respiratory severity score is applied. The paper discusses the modern principles of and approaches to performing a starting and prolonged respiratory therapy as mechanical ventilation with biphasic positive airway pressure (BIPAP). The authors give their preliminary results of using non-invasive mechanical ventilation in the duoPAP mode, an analogue of BIPAP through nasal cannulas. They consider indications, contraindications, and predictors of effective use of duoPAP in a in extremely low-birth weight premature infant within the first hours and days.
Vrach. 2020;31(8):58-64
pages 58-64 views

Alagille syndrome

Gadzhimuradov M.N., Alieva M.G., Mamasheva G.D.

Abstract

Alagille syndrome (AS) is a rare multisystem autosomal dominant hereditary disease. It may be identified on the basis of a number of clinical signs: cholestasis, heart disease, skeletal abnormalities, typical facial appearance, and eyeball abnormalities. AS is accompanied by growth retardation and delayed physical development. Obvious hypoplasia of the intrahepatic bile ducts is noted; defects of the liver can cause its end-stage disease that needs transplantation. Most of fatal AS cases are due to cardiovascular diseases: injury of the pulmonary artery, its branches (more commonly stenosis) and valve; directly that of the heart (tetralogy of Fallot, ventricular and atrial septal defects, aortic stenosis and coarctation); cerebrovascular diseases (cerebral aneurysms, arteriopathy, dolichoectasia, moya-moya disease). Bone abnormalities are common in AS; these are butterfly vertebrae, vertebral fusion, hemivertebrae, intercostal joints, shortened fingers, a convex forehead, moderate hypertelorism with deep-set eyes, a saddle-shaped or straight nose with a flattened-convex tip and large ears. AS is also manifested by severe growth retardation, chronic exhaustion, and sometimes moderate mental retardation. Specific therapy for AS has not been developed. The paper describes clinical cases (an 11-year-old boy and his 5-year-old sister). The children complained of obvious itching, dry and tightened skin; AS was manifested by a complete set of the above clinical signs with delayed mental and physical development. Only a few years later, the specialists from regional and federal clinics of Russia diagnosed AS on the basis of a set of symptoms. The authors note that both patients have a number of clinical manifestations that may be signs of AS, such as talipes valgus; funnel-shaped deformation of the chest; ichthyosi form lesions of the axillary regions; watch-glass nails; thinning and brittle hair.
Vrach. 2020;31(8):64-69
pages 64-69 views

Osteomed Forte in the treatment of patients with ankle injuries

Romanov D.V., Polikarpochkin A.N., Polikarpochkina E.V.

Abstract

The paper presents the results of therapy for ankle injuries with various treatments: a traditional basic medical complex, as well as therapy using hyperbaric oxygenation, and course Osteomed Forte administration.
Vrach. 2020;31(8):70-74
pages 70-74 views

The use of Thymaline to correct immune status deviations in COVID-19 (rationale for the use of drug and clinical case)

Lukyanov S.A., Kuznik B.I., Khavinson V.K., Shapovalov K.G., Smolyakov Y.N., Tereshkov P.P., Shapovalov Y.K., Konnov V.S., Magen E.

Abstract

Data on violations of cellular and humoral immunity in severely patients with COVID-19, as well as the hemostatic system were summarized. It has been shown that patients with COVID-19 have leukocytopenia, lymphocytopenia, neutrophilia, as well as a violation of the ratio between individual subpopulations of T-lymphocytes. The content of pro-inflammatory cytokines increases significantly, which leads to the development of a «cytokine storm». At the same time, such patients develop endothelial dysfunction, hypercoagulation, accompanied by an increase in D-dimer with the subsequent development of microangiopathy (MAP), immunothrombosis, disseminated intravascular coagulation (DIC) and multiple organ failure. A case is given of the use of an immunocorrector thymalin in a patient with a severe course of COVID-19, which contributes to the elimination of disorders in the immune system (including «cytokine storm») and hemostasis.
Vrach. 2020;31(8):74-82
pages 74-82 views

The pattern of underlying, borderline, and pathological conditions in different schooling periods in children who started their education at different ages

Tepper E.A., Taranushenko T.E.

Abstract

A prospective cohort observational study was simultaneously conducted in several schools of Krasnoyarsk, by covering all children going to school at the beginning of this study. The total follow-up period was 10 years. The study included the results of the survey of 437 schoolchildren. The authors analyzed the pattern of the diseases at different schooling stages among the pupils according to the age at which they started their education.
Vrach. 2020;31(8):83-86
pages 83-86 views

Challenges in diagnostics of microscopic polyangiitis in day to day practice

Bazina I.B., Kozyrev O.A., Denisova T.P., Krechikova D.G., Astafyeva O.Y.

Abstract

Early diagnosis of microscopic polyangiitis is quite challenging for doctors of various specialties due to involvement of multiple organs and variety of clinical symptoms. Moreover, absence of classification criteria for this vasculitis also plays a significant role. A clinical case in female patient with late diagnosis of microscopic polyangiitis which was treated as flu, bronchitis and pneumonia is described in the article.
Vrach. 2020;31(8):87-88
pages 87-88 views

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