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No 5 (2018)
- Year: 2018
- Articles: 18
- URL: https://journals.eco-vector.com/2412-4036/issue/view/6756
Articles
4-5
Andrey Aleksandrovich Spasskiy (to his 60th anniversary)
Therapy. 2018;(5):6-6
6-6
17th European congress of physicians: skills of managing complicated clinical situations and integrated patient-oriented approach
Abstract
С 30 августа по 1 сентября 2018 г. в Висбадене (Германия) состоялся 17 Европейский конгресс терапевтов, прошедший под девизом «Искусство разрешения сложных клинических ситуаций: интегрированный пациентоориентированный подход». Организатором форума выступила Европейская федерация внутренней медицины (EFIM), участие в нем приняли свыше 1200 специалистов из 70 стран Европы и других континентов.
Therapy. 2018;(5):8-10
8-10
The First Russian consensus on the quantitative assessment of the adherence to treatment (Approved by the XII National Congress of physicians - Moscow, 22-24 November 2017)
Therapy. 2018;(5):11-32
11-32
Modern capacities of the control of early carbohydrate metabolism disorders
Abstract
The prevalence of type 2 diabetes mellitus (DM2) and prediabetes in recent years has been steadily increasing. The increase in the number of patients with diabetes is a serious threat to the entire population and could be considered to be the one of the main medical and social problems of public health. Effective measures of primary prevention of diabetes is the most rational way to increase the life expectancy of patients and improve their quality of life. In recent years throughout the world have been taken measure to identify opportunities for preventing development and delaying the clinical manifestation of diabetes melitus2. Non-pharmacological and medication interventions used at the «pre-diabetes» stages, the most effective of which are 5-10% body weight reduction by correcting the diet, increasing physical activity and taking metformin, can significantly reduce the risk of the disease.
Therapy. 2018;(5):33-39
33-39
Causes of decompensation of 1 type diabetes mellitus in hospitalized to reanimation and intensive care department patients
Abstract
The results of retrospective analysis of case histories of patients with acute complications of type 1 diabetes (DM1) hospitalized in the intensive care unit are represented in the study. Material and methods. Patients were divided into groups depending on the causes of decompensation: 104 patients with a violation of lifestyle recommendations ; 53 - with errors of insulin therapy; 55 - with newly diagnosed CD1. Results. The attendance of the diabetes school was analyzed: among hospitalized patients, 44,8% of them do not visit it. Frequency of chronic complications was 81,6%. There were revealed correlations between diabetes school attendance and frequency of chronic complications of diabetes mellitus. Conclusions. The main reason of type 1 diabetes mellitus decompensation was determines as a lack of orientation of patients in their disease.
Therapy. 2018;(5):40-46
40-46
Estimation of practical value of physical symptoms of extremity ischemia in diabetes mellitus patients
Abstract
The aim of the research: to evaluate the diagnostic value of classical visual signs of extremity ischemia in patients with diabetes mellitus. Material and methods. 30 patients with diabetes were examined independently by two students and an experienced doctor. Visual signs of extremity ischemia were compared with data from ultrasound duplex scanning of lower extremity arteries (UZDS). Results. At UZD, atherosclerotic lesion is revealed in 30% of the extremities. The reproducibility of visual signs of ischemia was 44-92%, but the diagnostic accuracy was low (22-68%). Palpation of the pulse was characterized by high reproducibility (71-85%) and acceptable diagnostic accuracy (73-77%). The conclusion. In the studied population of patients with diabetes mellitus, the informative value of the «classic» signs of extremity ischemia was low. It is very helpful to take into account the obtained data in teaching guidances development. Palpation of the pulse on the feet demonstrated better information and reproducibility. Palpable pulse excludes severe stenosis in the basin of this artery, and non-palpable requires instrumental examination of blood flow.
Therapy. 2018;(5):47-53
47-53
Aspects of hypercorticism diagnostics and treatment in therapeutical practice
Abstract
Syndrome of hypercorticism (Cushing syndrome) unites together etiologically and pathogenetically different diseases, in which a prolonged chronic effect of excessive amounts of adrenal cortex hormones (primarily cortisol) at the organism takes place, regardless of the cause, which caused an increase of these hormones concentration in the blood. Endogenous hypercorticism is considered to be a relatively rare pathology with a incidence of 2-3 cases per million population per year. As a rule, the symptoms grow quite slowly, for several months or years, which significantly complicates the timely diagnosis of the disease, without which the progression of the syndrome inevitably leads to disabling complications. Therefore, this pathology is so actual in therapeutic practice.
Therapy. 2018;(5):54-60
54-60
News of clinical recommendations on diagnostics and treatment of subclinical hypothyroidism in pregnant women
Abstract
Diseases of the thyroid gland during pregnancy are a worldwide clinical problem. Since the publication by the American Thyroid Association (ATA) in 2011 the latest clinical guidelines for this pathology, many new clinical and scientific achievements in this field have been occurred. New published recommendations give clinicians, researchers, patients and representatives of the health care system contemporary ideas for of current management of female patients with thyroid disease during pregnancy and the postpartum period. Despite the fact that medical care must be individualized, these paradigms are optimal for use in medical practice in the management of patients with thyroid gland dysfunction.
Therapy. 2018;(5):61-65
61-65
Parameters of glycemic control and adherence to treatment in type 2 diabetes mellitus insulin-taking patients
Abstract
Aim of the research. To study the parameters of glycemic control, injection technique and adherence to treatment in patients with type 2 diabetes mellitus (DM2) receiving insulin therapy. Material and methods. 177 patients with DM2 receiving insulin therapy were examined. Participants in the study were divided into 3 groups: a basic-bolus scheme of insulin therapy, basal insulin therapy, and therapy with mix insulins. The parameters of glycemic control, daily doses of insulin were analyzed depending on the mode of insulin therapy. Statistical data were processed in the Statistica program. Results. Basal-bolus regime of insulin administration was used in 52% of patients, basal insulin therapy - in 21.5%, therapy with mix insulins - in 26.5%. Only 39% of study-involved participants achieved the target value of glycated hemoglobin <7.0%. Participants in the group of basal-bolus insulin therapy received a daily dose of insulin 3 times bigger (69.71 units) comparatively to participants in the basal insulin therapy group (24.89 units) (p = 0.0001). The use of a baseline bolus insulin regime did not improve control of carbohydrate metabolism in patients with diabetes mellitus - therefore there were fixed no significant differences between groups in the mean level of glycated hemoglobin, fasting glycaemia and postprandial. Only 2.8% of participants in the study used the correct insulin injection technique.
Therapy. 2018;(5):66-73
66-73
Place of atorvastatin in chronic obstructive pulmonary disease patients with no cardiovascular pathology
Abstract
Due to pleiotropic effects of statins, the spectrum of their therapeutic possibilities increases in multiple way. Theoretical data of the effect of statins on systemic inflammation and endothelial function make it possible to study the effects of their action at ventilation disorders in chronic obstructive pulmonary disease (COPD). Aim of the study. To study the effect of 6-month atorvastatin treatment at the lipid spectrum, the severity of subclinical inflammation, pulmonary respiratory function and endothelial function in patients with COPD and without cardiovascular diseases. Material and methods. Smoking men with COPD of the 2 nd stage (n = 83) on the phone of stable baseline bronchodilator therapy with no clinical manifestations of cardiovascular diseases, initially and after 6 months of treatment, were tested for respiratory function and diffusivity of the lungs, also for reactive hyperemia of the brachial artery. Also lipid profile, the concentration of interleukin-6 (IL) -6, IL-8, tumor necrosis factor α (TNF-α) and endothelin-1 (ET-1) in blood serum and cardiovascular risk were calculated on the SCORE scale. Results. After 6 months of observation, target cholesterol levels of low-density lipoprotein (LDL-C) cholesterol were achieved in all patients treated with atorvastatin at a dose of 20 mg, with a significant decrease in the cardiovascular risk score on the SCORE scale, a significant positive dynamics of volumes and diffusivity of the lungs according to the results of bodipletizmography, a significant increase in the volume of forced expiration in one second (FEV1); increased endothelium-dependent dilatation; a decrease in plasma concentrations of ET-1 and pro-inflammatory cytokines. Conclusions. In patients with II stage of COPD without cardiovascular disease, 6-month therapy with atorvastatin helps to improve lipidogram indexes, decrease the concentration of proinflammatory cytokines; it improves lung respiratory function parameters and parameters reflecting endothelial dysfunction.
Therapy. 2018;(5):74-82
74-82
The phenotype of knee joint osteoarthritis in 60 years old and more patients (results of the multicenter ULA study)
Abstract
The purpose of the study, registered as an observational program ULA and performed between October 2017 and March 2018 on the basis of outpatient clinics in Samara, Voronezh, Lipetsk and Nizhny Novgorod, was the study of the prevalence of concomitant diseases in patients with osteoarthritis (OA) of the knee joint over the age of 60 years. Material and methods. Inclusion / non-inclusion criteria were used in 499 patients (68.0 [65.0, 72.0] years old) in whom were evaluated clinical and demographic data, as well as information on taken medications. Results. According to the analysis of the results, we found that patients with OA over the age of 60 have many comorbidities, including cardiovascular, diabetes (34.3%), chronic kidney disease (36.3%), diabetic polyneuropathy (17.4% %), gastric ulcer (11.2%), chronic gastritis (18.8%), osteoporosis / osteopenia (10.2%), anemia (19.6%), Parkinson's disease (8.2%), glaucoma (10.8%), adenoma of the prostate (8.2%), also they are accepting a wide range of drugs. The highest percentage of drugs is in antihypertensive drugs (calcium channel blockers - 37.0%, ACEI - 40.7%, sartans - 38.3%), diuretics (35.0%), statins (43.0%), β -adrenoceptor blockers (16.2%), α-adrenoblockers (13.0%), sugar-reducing medicaments (25.9%). The level of pain in the knee joint according to the VAS consisted 55.5 ± 12.5 mm, in 31.3% of cases the pain was neuropathic, the average duration of the OA history was 7.0 ± 2.5 years. 92,5% of patients had a history of lower back pain. The conclusion. Obtained data allow to propose for discussion a degenerative-dystrophic phenotype of a patient with OA over 60 years old with a high prevalence of concomitant diseases and wide range of taken medicines in order to formulate a methodology by doctor for making a reasonable decision on the tactics of such patients' curation.
Therapy. 2018;(5):83-90
83-90
Metabolic disorders in case of androgen deprivation: the role of endocrinologist in the management of the case
Abstract
Androgen depriving therapy (ADT) is widely used around the world for the treatment of various stages of prostate cancer (PCa). It it considered to be a basis of medicamentous treatment of the first line of common hormone-sensitive prostate cancer. This therapy increases the overall and cancer-specific survivance of such patients, but has a number of side effects: it leads to metabolic disorders, endothelial dysfunction and, as a result, increases the risk of cardiovascular death. Such factors as the increase of life expectancy in the world, including Russia, the improvement of methods of diseases diagnosing, the growth of cancer incidence lead to an increase in the number of prostate cancer patients, which requires the improvement of treatment methods, evaluation of efficacy and safety of the therapy. Evaluation of the safety and effectiveness of hormone therapy, as well as the development of measures to reduce cardiovascular risks is one of the important tasks of modern medicine. The purpose of current review is to analyze the research work for these metabolic disorders, which demonstrates the possibility of these disorders’ correction in order to form an understanding of the role of the endocrinologist in management of the case.
Therapy. 2018;(5):91-95
91-95
Improving of treatment efficacy for target therapy-taking rheumatoid arthritis patients. Conclusions of Moscow uniform registry of arthritis (MERA)
Abstract
The data of the Moscow uniform register of arthrites (MERA) are analyzed. The analysis included patients (n = 554) with rheumatoid arthritis who received genetically engineered biological medicaments or tofacitinib at least for 6 months. During their checking visits, the information concerning the history of life, disease, therapy, and examination data was collected. The effectiveness of treatment was estimated by the achieved value of DAS-28. Under the conditions of a multifactor model, it was performed the search of significant independent predictors of the achieved activity (estimated by DAS28-ESR). It was found, that female sex, pain in the spine during the disease, age were associated with higher values of the studied activity index. A greater number of patient visits in the register and longer targeted therapy were associated with better treatment outcomes. According to the obtained results, the level of the achieved activity of the disease is significantly associated with used targeted drug (p = 0.03). However, there were no statistically significant differences between the different targeted drugs. There was no correlation between the achieved activity of the disease and the basic therapy that was used, and the use of glucocorticoids. Tactical approaches to treatment aimed at increasing its effectiveness are discussed in current article on the ground of abovementioned analysis of the MERA register data.
Therapy. 2018;(5):96-103
96-103
Peculiarities of cardiovascular risk estimation in rheumatoid arthritis patients
Abstract
Aim of the research. Estimation of clinical-diagnostical value of arterial rigidity (AR) disorders according to the data of daily monitoring in evaluation of the summary cardiovascular risk (CVR) in patients with rheumatic arthritis (RA). Material and methods. 74 females with firm RA were examined, their average age was 58,11 ± 6,45, average RA duration - 8 [4; 14] years. Comparison group was introduced by 30 females with essential arterial hypertension (AH), control group - by 22 practically healthy females (average age 54,13 ± 6,25 years). SCORE index was calculated for all examined persons, for RA patients was calculated SСОRЕ/ЕULАR, daily arterial pressure and AR monitoring was performed (BPlab, Russia). Results. According to SСОRЕ/ЕuLАR high CVR was fixed in 6,8% of RA patients with AH. Increase of PWVao was fixed in 80% RA patients with AH and without it. Increase of Aix75 was fixed in 44% RA and AH patients and in 25% females with RA and without AH, high risk of ischemic heart disease (according to ASI100) - in 10% RA patients with AH. Conclusion. Increase of AR in RA patients without AH comparatively with persons from control group let us to consider RA as an independent factor of arterial rigidity increase and could be used for estimation of CVR in RA patients. In patients with high activity of RA takes place the underestimation of CVR while using the generally accepted indexes, that could be proved by structural-functional left heart changes at echocardiography.
Therapy. 2018;(5):104-108
104-108
Medical errors: character, causes, consequences, ways of prevention
Abstract
Article considers a problem, actual for doctors of all specializations. Because of what reason mostly are medical errors occuring? Which of them are the most typical and common? What measures are needed to reduce their risk and improve the quality of medical care? Dear readers! We invite you to share your professional thoughts on that aspect. Write to us, and the most interesting opinions will be printed under the heading «Invite to discussion».
Therapy. 2018;(5):109-115
109-115
Clinical case of primary hyperparathyroidism
Abstract
Article contains the description of primary hyperparathyroidism clinical case - endocrine disease, characterizing by excessive parathyroid hormone secretion while upper-normal or increased blood calcium level due to parathyroid glands' primary pathology. Primary hyperparathyroidism is manifesting by multysymptomatic clinical picture involving various organs and systems in the pathological process, which leads to significant decrease in the quality of life, disability of patients, and an increased risk of premature death. The authors give short information about the multisymptomatic picture of primary hyperparathyroidism, also the methods of its diagnostics and treatment.
Therapy. 2018;(5):116-121
116-121
Case of primary antiphospholipid syndrome complicated by thrombotic kidney microangiopathy of with infective endocardite addition
Abstract
Antiphospholipid syndrome (AFS) is a symptom complex, which is manifested by thrombosis of vessels of different localization and caliber with obligatory presence of antiphospholipid antibodies in the blood. AFS is an acquired thrombophilic disease in which autoantibodies are produced not to the phospholipids of cell membranes per se, but to proteins interacting with phospholipids. This syndrome can affect several organ systems, so the problem of AFS is multidisciplinary. Clinical manifestations of AFS are quite nonspecific (thrombosis of different localization), therefore the diagnosis can be verified only by the presence of antiphospholipid antibodies. The presented clinical example illustrates the difficulties of diagnosing a disease that has occurred with the syndrome of renal failure and complicated by infective endocarditis.
Therapy. 2018;(5):122-127
122-127