Vrach

Peer-review scientific and practical multidisciplinary journal

 

Editor-in-chief

  • Vasily M. Delyagin, MD, Professor

Publisher

  • Publishing House «Russkiy Vrach»

Founder

  • Ministry of Health of the Russian Federation

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

About

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.


Sections

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

Current Issue

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Vol 35, No 1 (2024)

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Full Issue

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Topical Subject

Asthma and pregnancy
Lavrova O., Petrova M.
Abstract

Features of the course and treatment of bronchial asthma during pregnancy have been the subject of close attention of researchers in recent decades. Physiological changes and the nature of treatment of bronchial asthma during pregnancy determine the degree of control of the disease, which, in turn, affects the incidence of complications of pregnancy and childbirth, and the health of the newborn. The presented literature review analyzes recent publications on this issue.

Vrach. 2024;35(1):5-10
pages 5-10 views
Role of the gut microbiota in aging and maintenance of active longevity. Part 1
Ratnikova A., Grudina M., Ratnikov V., Dikur O., Ashikhmin Y.
Abstract

The role of intestinal microbiota in aging and maintaining active longevity is considered. The first part of the article describes the characteristics of a healthy microbiome, its changes during aging, and the composition of the intestinal microbiome of centenarians. The importance of high microbiome biodiversity in maintaining active longevity is emphasized. The role of intestinal permeability and new biomakers that assess its condition (including zonulin) in maintaining health and in the development of intestinal dysbiosis is revealed. Separate groups of microorganisms that are associated with longevity have been identified (such as Verrucomicrobia, which includes Akkermansia), and the important role of the Bacteroidetes – Firmicutes ratio has been noted. The influence of age-associated changes in the microbiome on health, the connection between changes in the microbiome and physical activity, the possibility of using microbiome analysis to predict biological age, and the correlation of microbiome composition with biomarkers of health and disease are discussed.

Vrach. 2024;35(1):10-15
pages 10-15 views

For Diagnosis

Hematological indicators as predictors of atrial fibrillation after cardiac surgery
Tatarintseva Z., Kosmacheva E., Shyk A., Batchaeva A.
Abstract

Newly diagnosed postoperative atrial fibrillation (NDPAF) is one of the most common complications after cardiovascular surgery, provoking early and late complications, such as cardiovascular, thromboembolic complications, cerebral circulation disorders, prolonged hospital stay and repeated hospitalizations to the intensive care unit and hospital.

Objective. To identify biochemical and clinical predictors of NDPAF in patients who underwent open-heart surgery for any indication.

Materials and methods. The study included patients operated in the cardiac surgery department No.2 of the Research Institute – Prof. S.V. Ochapovsky Territorial Clinical Hospital One (Krasnodar) in the period from January 1, 2020 to January 1, 2021. During the analyzed period of time, open heart surgery was performed in 1503 patients, of whom 158 (10.5%) had NDPAF.

Results. Hematological/biochemical parameters include low levels of hemoglobin (<12.5 g/dl), hematocrit (<35%), erythrocytes (<4,2•1012/L), and high levels of lymphocytes (>3,0•109/L), bilirubin (20.5 mmol/L), creatinine (115 mmol/L), urea (8.3 mmol/L), aspartate aminotransferase (>35 U/L), alanine aminotransferase (>55 U/L), C-reactive protein (>5 mg/L) were associated with an increased frequency of NDPAF in single-factor analysis (p<0.05 for all comparisons).

Conclusion. Hematological indicators can predict the risk of atrial fibrillation before surgery. The study of risk factors for NDPAF will allow to effectively influence them, thereby preventing the possibility of arrhythmia and improving the prognosis for postoperative complications and survival.

Vrach. 2024;35(1):15-18
pages 15-18 views

Pharmacology

A comparative study of lappaconitine hydrobromide extended release and propafenone in patients with paroxysmal atrial fibrillation
Revishvili A., Golitsyn S., Aksentiev S., Amiraslanov A., Artyukhina E., Duplyakov D., Zubov E., Isaeva E., Loginova A., Malkina T., Miloserdov G., Rivin A., Teplykh S., Tsygankova I., Shvarts Y., Yuricheva Y., Kanorsky S., Sokolov S.
Abstract

A new dosage form of lappaconitine hydrobromide has been created – the long-acting drug Allaforte®, which has fewer side effects compared to the traditional dosage form (Allapinin®).

Objective. To evaluate the effectiveness, safety and tolerability of Allaforte® therapy in comparison with the drug Rytmonorm® in patients with paroxysmal atrial fibrillation (AF).

Material and methods. Patients who met the inclusion criteria and those who did not meet the non-inclusion criteria were randomized into 2 groups: 1st (n=50) – patients received Allaforte® 25 mg 3 times a day with an increase in dose to 50 mg 2 times a day when detected attack of AF; 2nd (n=50) – patients received Rytmonorm® 150 mg 3 times a day with an increase in dose to 300 mg 2 times a day if an attack of AF was detected.

Results. The average time from the first dose of the drug to the development of AF paroxysm in the 1st group (Allaforte®) was 98.877±6.022 days, in the 2nd group (Rytmonorm®) – 98.808±5.876 days, the average time from the first dose of the drug to the completion of the study – 105.740±5.032 and 103.732±5.353 days, respectively. The drugs Allaforte® and Rytmonorm® equally improved the quality of life of patients. A comparative analysis in groups according to the severity of adverse events and their cause-and-effect relationship with the drug did not show significant differences.

Conclusion. The study drugs showed comparable effectiveness in preventing attacks of AF with similar safety and tolerability.

Vrach. 2024;35(1):20-26
pages 20-26 views
Prospects of application of non-hormonal drug Femo-Klim in complex therapy of menopausal disorders of medium severity in patients with cancer in anamnesis
Vinogradova O., Biryuchkova O., Mikheeva S.
Abstract

Objective. To study the possibility of using Femo-Klim preparation in the treatment of menopausal disorders of medium severity in gynecologic oncologic patients.

Material and methods. Seventy-eight female patients with menopausal syndrome of moderate severity participated in the study. The patients were randomly divided into 2 groups: the main group (n=40) – patients received Femo-Klim preparation; the comparison group (n=38) – patients did not receive the examined preparation.

Results. After 6 months of the study the dynamics of menopausal manifestations in the main group amounted to -0.9, in the comparison group – -0.7, somatic manifestations – -0.55 and -0.15 respectively, psychoemotional manifestations – -0.8 and -0.5 respectively (p<0.05). The level of anxiety in the main group decreased by 60% compared to the comparison group. Bone mineral density increased by 2.6% in the main group and decreased by 1.4% in the comparison group (p<0.05).

Vrach. 2024;35(1):26-33
pages 26-33 views

From Practice

History of patients with new coronavirus infection and preterm birth
Chernaya E., Kutefa E., Kasparova A., Vasilkovskaya E., Chegus L., Semenchenko S.
Abstract

Purpose. To study the anamnesis of patients who have suffered a new coronavirus infection (NCI) and preterm birth (PB).

Material and methods. A retrospective study of the anamnesis of patients who underwent NCI in the second half of pregnancy and PB was carried out in the period from May 2020 to December 2021. The division into groups was carried out taking into account the timing of delivery: Group 1 (n=104) – term birth at 37 weeks of gestation and later; Group 2 (n=44) – PB from 22 to 36+6 weeks of gestation.

Results. The combination of diseases such as chronic bronchitis, maxillary sinusitis and bronchial asthma increased the risk of PB against the background of NCI by 3.4 times (95% confidence interval [CI] – 2.65–4.39). Among extragenital diseases, opisthorchiasis was detected 4.7 times more often in patients with PB (95% CI – 1.308–17.097). In group 2, compared with group 1, among pregnancy complications, moderate anemia was 6.5 times more likely to be observed (95% CI – 1.2–35.1). PB were due to the severe course of COVID pneumonia and its progression, the serious condition of the woman, which required the prescription of etiotropic therapy. In this regard, the probability of cesarean section in group 2 was 12.6 times higher (95% CI – 4.2–37.8) compared to group 1.

Vrach. 2024;35(1):34-39
pages 34-39 views
Modern ideas about the mechanisms of development of preeclampsia
Dudnikova A., Konchakova E., Bedikyan E., Ershova E., Agutenkov R.
Abstract

In recent years, the two-stage model of preeclampsia has been updated. The review examines modern ideas about the pathophysiology of preeclampsia. Particular attention is paid to studies of uterine artery remodeling, as well as the role of microRNAs in preeclampsia.

Vrach. 2024;35(1):40-43
pages 40-43 views
Epicardial fat ectopy in women with different estradiol levels
Zimina M., Dora S., Lygdenova I., Yusipova T., Butomo M., Volkova A., Khalimov Y.
Abstract

Objective. To establish the early risk factors of metabolic syndrome in women with decreased ovarian reserve, premature and early menopause; to estimate the thickness of epicardial fat and the levels of estradiol and anti-mullerian hormone (AMH) in women with early estrogen deficiency and in control subjects without estrogen deficiency, to evaluate the effect of estrogen replacement hormone therapy on epicardial fat thickness and the change of arterial pressure (BP) parameters.

Material and Methods. Group 1 (n=12) included patients with co-preserved menstrual cycle and AMH >1 ng/ml, Group 2 (n=10) included patients with preserved menstrual cycle and AMH <1 ng/ml, Group 3 (n=12) included patients with premature menopause, Group 4 (n=13) included patients with early menopause. The level of the studied parameters in blood serum was determined by immunochemiluminescence assay. Epicardial fat thickness was determined on VIVID E90 machine in 3 cardiac cycles with subsequent calculation of the mean value.

Results. An increase in epicardial fat thickness was detected in Groups 2–4 with low estradiol levels compared to group 1 (p=0.01). Patients with normal body mass index and with estrogen deficiency also show increased epicardial fat thickness.

Vrach. 2024;35(1):44-46
pages 44-46 views
Relationship between selenium and hematologic markers in overweight and anemic patients
Khabibulina M., Bazhenova O., Shamilov M.
Abstract

Anemia is a widespread polyethological disease, one of the possible causes of which is chronic inflammation. In addition, selenium deficiency is also often detected in patients with anemia. In the study, we studied the effect of selenium on iron status in young men with anemia and overweight (since obesity is often associated with chronic inflammation) and the expediency of its use in real clinical practice.

The obtained results of treatment of two groups of patients with anemia and overweight who received iron monotherapy and combined therapy with iron and selenium showed that biomarkers of iron status significantly improved with combined treatment with SELENBIO for women than with iron monotherapy (p<0.05).

The drug SELENBIO for women has a complex and versatile effect on the human body, has a restorative, immunomodulatory effect, and slows down the aging process due to its antioxidant effect at the cellular level. All components of the drug are physiologically close to the human body and do not disrupt the natural processes occurring in it. The drug SELENBIO for women is highly effective with low toxicity, has a wide range of effects, has a complex harmonizing effect on the body.

Vrach. 2024;35(1):46-50
pages 46-50 views
Influence of a comprehensive method of rehabilitation includes transcranial magnetic stimulation and balance therapy on the severity of neurological disorders, gate function and balance in patients with diabetic neuropathy
Marchenkova L., Semenova F., Chelmakin S., Fesyun A., Yurova O.
Abstract

Objective. To evaluate the effectiveness of a new method of rehabilitation of patients with diabetic polyneuropathy using balance therapy and transcranial magnetic stimulation against the background of a basic rehabilitation program to reduce neurological symptoms and improve the function of movement and balance.

Material and methods. The study sample consisted of 34 patients with type 2 diabetes mellitus and with a severe degree of diabetic neuropathy, distal sensorimotor form, from which 2 groups were formed by randomization: the main group (n=17) and the control group (n=17). Patients of the main group received a new rehabilitation method, including rhythmic transcranial magnetic stimulation, No. 10, balance therapy on a simulator with biofeedback, No. 10, whirlpool baths for the lower extremities, No. 10, physical therapy, No. 10, and massage of the lower extremities, No. 10. The rehabilitation method for the control group included magnetic therapy for the lower extremities, No. 10, whirlpool baths for the lower extremities, No. 10, physical therapy, No. 10, and massage of the lower extremities, No. 10.

Results. There were revealed a decrease in NSS scale values by 33.3% (from 6.0 [4.0; 7.0] to 4.0 [3.0; 6.0] points, p=0.029) and DN4 questionnaire scores – by 36.4% (from 5.5 [3.0; 7.0] to 3.5 [2.5.0; 5.0] points, p=0.034, p=0.045 in comparison with control), increase in walking speed by 10.7% (from 75.0 [59.0; 88.0] to 83.0 [68.0; 103.0] steps per minute, p = 0.047), decrease in time performing the “Up and go test” from 12.0 [7.0; 15.0] to 10.0 [5.0; 11.0] sec (p=0.039) and an increase in the time of maintaining balance in the “One leg standing test” with eyes closed on the right leg from 2.0 [1.0; 3.5] to 3.5 [1.5; 6.0] sec (p=0.041, p=0.022 compared with control) in patients of the main group, after completion of rehabilitation,. In the control group, there were no reliably significant changes in any of the studied indicators (p>0.05).

Conclusion. A new rehabilitation complex, including transcranial magnetic stimulation and balance therapy with biofeedback against the background of standard therapy, helps to significantly reduce the severity of symptoms of distal diabetic polyneuropathy, increase walking speed and improve static balance.

Vrach. 2024;35(1):52-55
pages 52-55 views
Sulodexide in clinical practice: possibilities and prospects of its use
Morozov A., Sergeev A., Boltik A., Aslakhanova E., Ispieva K.
Abstract

Objective: to analyze up-to-date information about the efficiency of using sulodexide n clinical practice. Current publication on the efficacy and safety of sulodexide, as well as information on the pathogenesis and clinical manifestations of chronic venous insufficiency, microvascular angina, venous thromboembolic events, and diabetes mellitus have been sought for and analyzed Most clinical trials show that sulodexide exerts anti-inflammatory, endothelium-protective, and pleotrophic effects, by confirming its potential efficacy in the treatment of cardiovascular diseases, in particular chronic vein diseases, microvascular anginas, and venous thromboembolic events. Sulodexide as an additional therapy is used to treat type 2 diabetes mellitus.

Vrach. 2024;35(1):55-58
pages 55-58 views
Use of novel oral anticoagulants in patients with atrial fibrillation
Skvortsov V., Levitan B., Razvalyaeva O.
Abstract

Atrial fibrillation (AF) is one of the most common arrhythmias, which results in disability and death in the patients. The mechanisms of systemic and local atrial activation of the coagulation system provoke the risk of stroke in the presence of even short AF episodes. Novel oral anticoagulants (NOACs), particularly rivaroxaban, have shown their efficacy in preventing stroke in patients with AF. The international ROCKET AF, XANTUS, PREFER, and RIVER studies have studied different aspects of anticoagulant therapy, on the basis of which, the use of rivaroroxaban has been approved for the prevention of ischemic stroke and systemic embolisms in patients with non-valvular AF; the efficacy and safety of the drug have been proven.

Vrach. 2024;35(1):59-62
pages 59-62 views
Features of vegetative adaptation to educational activities of primary school children
Lebedenko A., Ershova I., Levchin A., Rogovtsova A.
Abstract

Purpose. To study the functional state of the autonomic nervous system (ANS), which is involved in the formation of adaptation processes in schoolchildren with different physiological abilities.

Material and methods. Three groups of junior schoolchildren were examined: 1st – intellectually gifted children, selected based on the results of specialized scales and tests; 2nd – children with high sports/physical abilities; 3rd (control) – schoolchildren with good academic performance and sports/physical abilities. The functional state of the ANS of children was studied using cardiointervalography.

Results. The dynamics of the mode indicators, mode amplitude, variation range, and tension index of regulatory systems (IN) indicated that in group 1 the activity of the sympathetic influences of the ANS predominated, the ratio IN2/IN1 showed hypersympathicotonic reactivity. In group 2, the IN values corresponded to normotonic values. The majority of children in groups 2 and 3 had a normal type of autonomic response. The greatest increase in heart rate and systolic blood pressure during orthostasis was observed in group 1.

Conclusion. Multidirectional changes in systolic blood pressure and an increase in diastolic blood pressure of varying degrees of severity were established in children of the study groups, which indicates the heterogeneous nature of vascular reactions to orthostasis. The rhythmogram indicators in group 1 are characterized by the predominance of the activity of the sympathetic influences of the ANS. The identified imbalance in the functional activity of the ANS in children of the 1st group indicates the tension of adaptation processes.

Vrach. 2024;35(1):63-68
pages 63-68 views
The role of chronic systemic inflammation in the formation of functional disorders of the biliary tract
Grinevich V., Kravchuk Y., Seliverstov P., Ivanyuk E., Petrukov S., Bunenkova G., Rusinova O.
Abstract

Functional disorders of the biliary tract are included in the group of functional diseases of the digestive system, widespread everywhere, and represent a complex of clinical symptoms developing as a result of motor-tonic dysfunction of the gallbladder, bile ducts and sphincters. Their clinical manifestations are often quite diverse and non-specific. Therefore, the problem of verification, treatment and prevention of this pathology continues to be relevant. In our study, among 37 practically healthy volunteers, in 55% of cases, a functional disorder of the gallbladder of the hypomotor type was detected, correlations of indicators of the motor function of the gallbladder with markers of systemic inflammation were established.

Vrach. 2024;35(1):69-73
pages 69-73 views
Gripmax® Nose Child effectiveness in the upper respiratory tract infections treatment
Geppe N., Soboleva V., Sukhovjova O., Isaichkina Y., Tikhonova M., Alieva Y.
Abstract

Children are highly predisposed to the respiratory tract infections. Nowadays, attention unit has been focused on the effect of herbal therapy on respiratory tract infections treatment.

Objective. To assess Gripmax® Nose Child effectiveness in patients with rhinitis.

Materials and methods. The open multicentral observational study of safety and effectiveness of the biologically active additive Gripmax® Nose Child. Data collection was performed in various regions of Russia (March–September 2023) via medical records analysis by ambulatory doctors followed by making a special individual registration form. Symptoms were assessed initially (visit 1), after 2–3 days (telephone contact), after 6–7 days (visit 2), after 10–14 days (visit 3). Duration of herbal treatment varied from 7 to 14 days.

Results. Ambulatory medical records of 1073 children aged 3–18 with rhinitis received Gripmax® Nose Child and additional therapy if needed was analyzed. If Gripmax® Nose Child was added to complex therapy, general condition improved, nasal obstruction and secretion significantly reduced from day 2–3. Patients demonstrated statistically significant (p<0,0001) rhinitis symptoms decrease (redness, nasal obstruction and rhinorrhea decrease up to vanishing in 84% by visit 2 and in 99% by visit 3, and up to 96.5% of patients at the treatment course end.

Conclusion. Investigated herbal therapy including herbal components may be recommended as an effective for rhinitis therapy.

Vrach. 2024;35(1):75-80
pages 75-80 views

Health Care Service

Results of comparative analysis of health literacy among student youth of Aktobe city (Kazakhstan)
Berdesheva G., Khairullina E., Zhubaniyazova A., Amlaev K.
Abstract

Objective. To conduct a comparative analysis of the level of student health education, depending on the specialty and the course of study. To test the European questionnaire to determine the level of HL, adapted for Kazakhstan.

Materials and methods. In a single-stage cross-sectional study, 1st and 4th year students of the specialties «general medicine» (n=422) and «military medicine» (n=433) were interviewed.

Results. Differences in the level of HL of all respondents in different fields were revealed. Proposals have been developed to increase the level of water supply.

Vrach. 2024;35(1):80-86
pages 80-86 views

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