Vol 24, No 3 (2020)

The article presents an overview of methods of treatment of coronavirus infection based on available data from recent clinical studies and methodological recommendations. Drugs recommended as pathogenetic therapy are considered. Data from clinical trials and expert opinions are analyzed.

Aim. To compare US, Russian and Indian primary care physicians’ attitudes, comfort and experiences providing palliative care.

Design. Cross sectional survey.

Settings. Iowa, USA; Leningrad Oblast, Russia; Mangalore, India.

Participants. Primary care physicians.

Methods. Chi-squared testing for dichotomous variables and t-tests for mean scores.

Results. 66 US, 81 Russian and 95 Indian physicians completed the survey. More US physicians preferred end of life care at home (83% v 56% Russian and 29% Indian) p < 0.001 and Indian physicians preferring hospitals (36% v 0% US and 1% Russian) p < 0.001. 94% percent of US physicians preferred patient make their own decisions, 57% of Russian sample preferred physicians as decision makers, and Indian physicians preferred family members to patients themselves (44%) p < 0.001. Patient should be informed (US vs Russia vs India) of terminal illness “Always” (74% vs 31% vs 33%) p < 0.001, “If Asked” (9% vs 64% vs 12%) p < 0.001 or “Physician’s Judgement” (15%, 5%, 54%) p < 0.001. US physicians reported higher comfort rates with managing symptoms at the end of life. In the last 6 months US physicians were more satisfied with provided care “Often or Always” (63% vs 36% Russian v 21% Indian) p < 0.001.

Conclusions. US sample was more concerned with patient autonomy and had more comfort and satisfaction in providing end of life care compared to Russian and Indian samples.

The article presents the results of research of theoretical knowledge and practical skills of general practitioners with more than 5 years of experience.

The aim of the study is to assess the level of proficiency in otoscopy by General practitioners using a simulator, depending on various socio-demographic characteristics.

Materials and methods. The study was conducted at the Department of family medicine of North-Western State Medical University named after I.I. Mechnikov. Doctors who agreed to participate in the project filled out a socio-demographic questionnaire, tests to test theoretical knowledge, for the level of proficiency in otoscopy, was evaluated using a checklist. Statistical analysis of the data was performed using the SPSS 22.0 program (SPSS Inc., Chicago, Illinois, USA). The study involved 24 General practitioners with more than 5 years of experience.

Results. Analysis of the results showed that 66.7% of General practitioners rated their skill in otoscopy as “satisfactory” or higher, but only 54.1% were able to correctly perform 70% of the actions according to the checklist.

Conclusions. 1. The level of theoretical knowledge in otoscopy among General practitioners with experience who took part in the study was quite low: 62.5% of respondents did not achieve satisfactory results. A low level of proficiency in otoscopy among General practitioners was also revealed when evaluating the performance of manipulation on the simulator — only 20.8% of doctors correctly performed 80% of the actions according to the checklist. 2. Independent assessment of the level of proficiency in otoscopy in General practitioners is not a predictor of the success of its demonstration on the simulator in accordance with the checklist. 3. The level of proficiency in otoscopy in the study group of General practitioners did not have a statistically significant relationship with the basic level of theoretical knowledge, work experience and regular otoscopy in everyday practice.

The article is devoted to the peculiarities of the clinical course of severe coronavirus infection in a 59-year-old woman at risk for comorbidities. Data on the pathogenesis of the severe form of COVID-19 are presented. Prognostic laboratory signs of an unfavorable outcome of coronavirus infection in people at risk are considered. The patient management tactics are described in accordance with the protocol for the treatment of new coronavirus infection. The assessment of patient management at the outpatient stage is given.

A new coronavirus infection in at-risk patients can quickly lead to a worsening of the condition, which is manifested by severe lung damage not only according to computed tomography data, but also by the clinical symptom of ARDS. The severity of the condition in this category of patients is due to severe viral aggression, the development of a cytokine storm. The use of the recommended protocol for the treatment of new coronavirus infection in patients at risk does not always give the expected positive result.

The case of asymptomatic 3^rd stage myxomatous degeneration of the mitral valve in a 42-year old male patient is presented. The patient was referred to Tuberculosis dispensary No. 5 for investigation of pathological findings revealed by fluorography during the coronavirus pandemic period. The patient was examined by TB specialists and the general practitioner in accordance with new interdisciplinary diagnostic algorithms primary involving the GP. As а result of the detailed investigation the patient was found to have previously undiagnosed consequences of pneumonia caused by COVID-19 and 3^rd stage myxomatous degeneration of the mitral valve.