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Vol 25, No 1 (2021)

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COVID-19 lung damage: Diagnostics and treatment at the primary health care

Pokhaznikova M.A.


The lecture is devoted to lung damage in new coronavirus infection. The description of the pathogenetic mechanisms of lung damage is given. The characteristics of the morphological changes in the lungs with severe disease and their characteristics are given. Provides information on instrumental and laboratory diagnosis of lung lesions in COVID-19. Particular attention is paid to highlighting controversial and complex issues of managing patients with lung damage in COVID-19 in outpatient practice. In particular, controversial issues of terminology for defining lung damage, the complexity of differentiating viral lung damage and other causes, the complexity of diagnosing bacterial superinfection and its treatment. Aspects of patient management important for primary care physician are highlighted: current treatment regimens for COVID-19 patients with lung damage, the timing of the control X-ray examination. It provides information on the most common mistakes encountered in the management of patients with COVID-19 (over-prescribing radiation methods, over-prescribing antibacterial medications).

Russian Family Doctor. 2021;25(1):7-17
pages 7-17 views

Basic principles of management of patients with diabetes mellitus type 2 in outpatient practice. Part 1. Diagnostics

Degtyareva L.N.


Worldwide, there is a high rate of growth in the incidence of diabetes mellitus. In the Russian Federation, the prevalence of diabetes is also high. According to some data, the number of patients with this disease in the Russian Federation can reach at least 9 million people (about 6% of the population).

The most dangerous consequences of the global epidemic of diabetes mellitus are the development of its systemic vascular complications-nephropathy, retinopathy, lesions of the main vessels of the heart, brain, and arteries of the lower extremities.

To prevent the development of complications of diabetes mellitus, its timely diagnosis is extremely important. Primary care physicians play a key role in early detection of diabetes.

In this lecture, the risk factors for the development of diabetes mellitus, prevention of this disease, diagnostic approaches that allow timely detection of diabetes mellitus and start its treatment are considered. Diagnostic criteria for various disorders of the glycemic profile are presented. The role of glycated hemoglobin as a diagnostic criterion for diabetes mellitus is noted.

Russian Family Doctor. 2021;25(1):19-25
pages 19-25 views

Original studies

Features of the clinical course of a new coronavirus infection in students who were observed in the observator in the first and second wave of morbidity increasing

Kuznetsova O.Y., Lubimova A.V., Ovakimyan K.V., Frolova O.I., Zamyatina O.S., Durkin S.O.


INTRODUCTION: The sudden appearance of a new coronavirus infection in the world has posed difficult challenges for science to determine the main clinical manifestations of this disease, as well as to approve standards for diagnosis, treatment and prevention. Research of the symptoms of mild COVID-19 is continuing. The data obtained in such studies are particularly relevant for primary care physicians.

THE AIM: To evaluate the features of the clinical course of COVID-19 among students of the North-Western State Medical University named after I.I. Mechnikov, placed in the observatory, during the first and second waves of rising morbidity.

MATERIALS AND METHODS: The study was conducted on the basis of the observatory of the NWSMU named after I.I. Mechnikov in two stages: in the period from 21.04.2020 to 31.08.2020 (the first wave) and from 16.09.2020 to 31.12.2020 (the second wave). Demographic, epidemiological, and clinical-anamnestic data were recorded in all participants of the study.

RESULTS: The study involved 309 people: 39.8% men (n = 123) and 58.9% women (n = 182). The average age of the respondents was 21.5 ± 2.6 years. The number of participants in the first and second waves was 113 and 196 people, respectively. The average age of participants with COVID-19 in the first wave was 1.5 years less and was 21.2 ± 2.5 years (р < 0.001). There was a significant increase in the frequency of the following symptoms: dry cough, loss of smell, headache, general weakness, increased body temperature to 38.0 °С, nasal congestion (р < 0.05) in students who were monitored in the second wave of increased incidence of COVID-19 compared to the first. The frequency of symptoms such as chest congestion, lower back pain, and fever above 38.0 °С significantly decreased (р < 0.05). There was a significant decrease in the incidence of viral pneumonia in patients who were observed during the second wave, compared with the data obtained during the first wave (р < 0.001).

Russian Family Doctor. 2021;25(1):27-33
pages 27-33 views

The prevalence of frailty, measured with different diagnostic tools, and autonomy decline: Results of the Crystal study

Turusheva A.V., Frolova E.V., Bogdanova T.A.


INTRODUCTION: Frailty prevalence differs across different population depending on the models used to assess, age, economic situation, social status, and the proportion of men and women in the study. The diagnostic value of different models of frailty varies from population to population.

OBJECTIVES: To assess the prevalence of frailty using 4 different diagnostic models and their sensitivity for identifying persons with autonomy decline.

MATERIAL AND METHODS: A random sample of 611 people aged 65 and over. Models used: the Age is not a blocking factor model, the SOF Frailty Index, the Groningen Frailty Indicator, L. Fried model. Covariates: nutritional status, anemia, functional status, depression, dementia, chronic diseases, grip strength, physical function.

RESULTS: The prevalence of the Frailty Phenotype ranged from 16.6 to 20.4% and the Frailty Index was 32.6%. Frailty, regardless of the used models was associated with an increase in the prevalence of the geriatric syndromes: urinary incontinence, hearing and vision loss, physical decline, malnutrition and the risk of malnutrition, low cognitive functions and autonomy decline (p < 0.05). The negative predictive value (NPV) of the Age is not a blocking factor model, the SOF Frailty Index, the Groningen Frailty Indicator for identifying individuals with autonomy decline was 86–90%.

CONCLUSION: The prevalence of frailty depended on the operational definition and varied from 16.6 to 32.6%. The Age is not a blocking factor model, the SOF Frailty Index, the Groningen Frailty Indicator, L. Fried model can be used as screening tools to identify older patient with autonomy decline. Regardless of the model used, frailty is closely associated with an increase in the prevalence of major geriatric syndromes.

Russian Family Doctor. 2021;25(1):35-43
pages 35-43 views

Theory and practice

Heuristics and medical errors. Part 2: How to make better medical decisions

Graber M.A.


This publication is a continuation of the article published in the 4th issue of the journal Russian family doctor for 2020 “Heuristics, language and medical errors”, which described the ways of making medical decisions that can lead to errors in patient management tactics, in particular “affect of heuristics / visceral bias”, “attribution error”, “frame of reference”, “availability bias”, “one-word-one-meaning-fallacy”. This article discusses additional sources of diagnostic error, including “diagnosis momentum”, “confirmation bias”, “representativeness”, and “premature closure” also the conflict that arises from diagnostic uncertainty is discussed. All errors in the tactics and the diagnostic process are illustrated by clinical cases from the personal practice of the author of the article.

Russian Family Doctor. 2021;25(1):45-52
pages 45-52 views

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