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Vol 25, No 4 (2021)

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Evaluation of early non-cognitive markers of dementia

Jogerst G.J.


Population aging is inextricably linked to an increase in the prevalence of dementia, which are one of the main causes of loss of autonomy in old age. However, early detection of cognitive decline is critical to proactively implementing interventions to slow the progression of cognitive decline and maintain the ability to live independently of outside help. Therefore, early detection of cognitive decline is one of the primary tasks of the general practitioner.

The aim of the lecture is to present a low gait speed, frailty, neuropsychiatric symptoms, sleep disorders and hearing loss as biomarkers of high risk to development of dementia risk and suggest ways measuring these risk factors in primary health care.

Russian Family Doctor. 2021;25(4):7-14
pages 7-14 views

Original studies

Problems of spirometry in the framework of the second stage of medical examination of the adult population

Kuznetsova O.Y., Chentsov D.V., Drovnina S.P., Ovakimyan K.V.


BACKGROUND: Spirometry is a method of studying the function of external respiration, which is widely used for the diagnosis of various bronchial obstructive diseases. This diagnostic method was included in the list of studies required for the second stage of medical examination of the adult population for the purpose of additional examination and clarification of the diagnosis. The correct organization of the study increases its effectiveness: it affects the quality of the conduct, on the result of which early diagnosis and timely appointment of treatment depends on the detection of bronchopulmonary disease.

AIM: To evaluate the organization of spirometry during the second stage of medical examination in real practice in outpatient medical organizations.

MATERIALS AND METHODS: The study involved 9 polyclinics selected randomly from the list of polyclinics and polyclinic departments in St. Petersburg, which participated in the medical examination of the adult population in 2020 (n = 97). The evaluation of the process of conducting a spirometric study, as well as the analysis of the dispensary records of patients who underwent spirometry, were carried out according to pre-developed checklists.

RESULTS: Among the medical organizations that took part in the study (n = 9), only in one polyclinic the prevention department was equipped with a spirometer. Employees of only four polyclinics (50%) had a certificate of training in spirometry or functional diagnostics. As part of the second stage of medical examination of the adult population, 251 spirometric studies were conducted, although there should have been much more, since the smoking factor in these polyclinics was established in 10,829 people according to the reporting form 131 “Information on the medical examination of certain groups of the adult population for 2020”.

CONCLUSIONS: The results obtained indicate a low efficiency of the organization of the spirometry procedure.

Russian Family Doctor. 2021;25(4):15-22
pages 15-22 views

Features of geriatric status of patients during the pandemic COVID-19

Bogdanova T.A.


BACKGROUND: In older patients, the new coronavirus infection may present with atypical symptoms such as delirium, dizziness, and unusual fatigue. At the same time, restriction of movement and fear of infection during the COVID-19 pandemic affect decreased physical activity and increased frequency of anxiety, depression and sleep disorders. Due to these symptoms and conditions are significant falls risk factors, the risk of falls and the frequency of falls in older adults is expected to increase in the near future.

AIM: To identify the new cases of COVID-19 infection in patients 65 and older and to determine the incidence and risk factors of falls in patients who have had COVID-19.

MATERIALS AND METHODS: The study involved 86 patients territorially attached to the Family Medicine Center of the North-Western State Medical University named after I.I. Mechnikov. All patients who took part in the study had COVID-19 infection. 48 of them (available at the time of the study) were interviewed in order to establish falls risk factors and cases of falls. The control group consisted of 58 patients who had not had COVID-19 infection. Analysis of the outpatient records of all study participants, screening of frailty, questionnaires, assessment of emotional status, and detection of sleep disorders were performed.

RESULTS: The frequency of neurological symptoms increased in COVID-19 infected patients: dizziness (p < 0.05), unsteady gait (p < 0.05), impaired or lost sense of smell (anosmia) and loss of taste (dysgeusia) (p < 0.05), sleep disorders, symptoms of depression and anxiety. The proportion of patients with decreased body weight was significantly higher after the disease (p = 0.0127). Patients in the control group also had a high frequency of complaints of memory and attention disorders, decreased vision, symptoms of anxiety and depression, and difficulty moving around. The incidence of frailty symptoms in the control group was 63.1% (n = 53). Patients who have not been infected with COVID-19 were significantly more likely to report imbalanced walking 60.3% (n = 35) than patients who had COVID-19 infection 37.5% (n = 18) (p = 0.002). One-third of COVID-19 survivors had elevated plasma glucose levels for the first time, 3.4% had worsened diabetes, and 5.8% of participants were rehospitalized within 3 months of illness.

CONCLUSIONS: The study demonstrated a high incidence of neurological symptoms in participants who had COVID-19: dizziness, unstable gait, sleep disorders, symptoms of depression and anxiety, and weight loss complaints. Patients who had not had COVID-19 infection showed a high frequency of complaints of memory and attention impairment, decreased vision, symptoms of anxiety and depression, and imbalanced walking. The syndromes and symptoms identified in both groups were risk factors for falls and the risk of developing a fear of falling.

Russian Family Doctor. 2021;25(4):23-30
pages 23-30 views

Case report

Outpatient treatment of patients with COVID-19: Normative documents and/or clinical thinking

Vasiliev V.V., Romanova E.S., Startseva G.Y., Kuznetsov N.I.


The legal framework for the provision of medical care, its evaluation and control of quality in Russia requires the attending physician to strictly comply with the provisions of regulatory documents. At the same time, clinical practice shows that the recommended algorithms for the provision of care do not allow in all situations to provide medical care of adequate quality. Analysis of the clinical example shows that in the era of the COVID-19 pandemic, in addition to compliance with the established rules, a thorough assessment of a specific clinical situation in the dynamics of development is necessary and timely correction of treatment and diagnostic measures, including those in excess of the established requirements, are required. The methods of remote monitoring of the patient’s condition need to be improved, since in their current form they do not provide an objective assessment of the patient’s condition. Face-to-face examinations of patients with COVID-19 receiving medical care at home should be carried out at least every 72 hours, regardless of the result of the remote assessment. The absence of the effect of therapy within three days may be an indication for transferring the patient to a higher level of medical care.

Russian Family Doctor. 2021;25(4):31-36
pages 31-36 views


Results of the all-russian conference with international participation “The place and role of a general practitioner in a changing world”

Kuznetsova O.Y., Degtyareva L.N., Moiseeva I.E.


The article provides information about the All-Russian conference with international participation “The place and role of a general practitioner in a changing world”, dedicated to the 25th anniversary of the founding of the Department of Family Medicine, which took place in a part-time format in St. Petersburg on October 5-6, 2021. The problems of organizing of primary health care, modern approaches to the training of general practitioners, tactics of providing medical care for cardiovascular diseases, issues of respiratory medicine, problems of osteoporosis, epidemiological and clinical aspects of providing care to patients during a pandemic of a new coronavirus infection were considered. The main provisions of the reports included in the conference program are presented.

Russian Family Doctor. 2021;25(4):37-46
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In memory of Academician I.N. Denisov


We are sorry to inform you that on November 17, 2021, Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Sciences, Chairman of the Editorial Board of our Journal Igor Nikolaevich Denisov passed away. His name is associated with a whole era of domestic medicine and the history of our country.

Russian Family Doctor. 2021;25(4):47-47
pages 47-47 views

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