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Vol 26, No 2 (2022)

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Etiotropic therapy of the new coronavirus infection. Expectations and realities. Part 2

Kuznetsova O.Y.


Part 2 of the review includes an analysis of the literature data related to the etiotropic therapy of a new coronavirus infection using drugs from the group of monoclonal antibodies and viral protease inhibitors. The difficulty of choosing a drug for the treatment of a new coronavirus infection caused by the Omicron strain due to the high degree of mutation is emphasized. The mechanism of action of the combined drug Paxlovid, consisting of nirmatrelvir and ritonavir, is described, data on its high efficacy and safety obtained in randomized multicenter placebo-controlled trials are presented. Attention is drawn to the World Health Organization recommendations on the use of this drug in people at high risk of a severe course of a new coronavirus infection and the need for early diagnosis of clinical symptoms for the timely appointment of etiotropic therapy.


Russian Family Doctor. 2022;26(2):7-12
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Original studies

Comparative analysis of risk factors for hip fracture in patients of different nationalities living in Kazakhstan

Issayeva S.M., Lesnyak O.M., Issayeva B.G., Dilmanova D.S., Bissembay M.A., Burakhanova G.A.


BACKGROUND: Osteoporosis is a multifactorial systemic skeletal disease characterized by a decrease in bone strength leading to an increased risk of fractures. Hip fracture is a serious complication of osteoporosis. It is expected in Kazakhstan by 2050 the annual number of hip fracture will increase by 140% compared to 2015 data and will amount to 28,048 cases. There are differences in the incidence of fractures and low bone mineral density in different ethnic groups. However, low bone mineral density is only one of many risk factors for osteoporotic fractures.

AIM: To study the risk factors of osteoporosis and related osteoporotic fractures in patients with hip fracture living in Kazakhstan.

MATERIALS AND METHODS: The case-control study included 98 patients with hip fracture of Kazakh (main group, n = 49) and other nationalities (control group, n = 49). In the registration card, risk factors for osteoporosis and osteoporotic fractures from the Fracture Risk Assessment (FRAX) model were distinguished, and the Find cases Assess Confirm Severity algorithm (2019) was used to diagnose sarcopenia. Statistical analysis was carried out using the Statistics 26 (IBM SPSS, США).

RESULTS: The groups were comparable in terms of gender, disability, fracture location and functional activity, surgical treatment. An increase in cases of hip fracture at an older age was found in the main group than in the control group (р = 0.035).

There were no differences in the groups for clinical risk factors for osteoporotic fractures (body weight, height, history of fractures, family history of fractures, medication, comorbidity), except for smoking (lower in Kazakhs than in the other group) (р = 0.033). Differences in 10-year probability of major osteoporotic fracture and hip fracture between groups (р = 0.34 and р = 0.74) were not found. The proportion of patients who entered the intervention threshold and at low risk did not differ in the groups (р = 0.623).

The average SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) score was lower among Kazakhs (р = 0.011), there is a difference between the groups when walking (р = 0.044), climbing stairs (р = 0.003). A decrease of grip strength was noted in the main group (р = 0.008), especially in men (р = 0.011), but low grip strength (р < 0.001) and signs of sarcopenia (р < 0.001) were determined only by age, not nationality.

CONCLUSIONS: The Fracture Risk Assessment (FRAX) model and intervention threshold can be applied to all residents of Kazakhstan.

Russian Family Doctor. 2022;26(2):13-22
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Beta-blockers in elderly patients: neuroprotective effect or risk of cognitive decline?

Bogdanova T.A., Turusheva A.V.


BACKGROUND: Due to the fact that the number of elderly people with cognitive disorders is steadily increasing worldwide, there is an increased interest in studying the effects of drugs of different pharmacological groups on cognitive function.

For many years, beta-blockers have been one of the main groups in the therapy of cardiovascular diseases. The effect of beta-blockers on cognitive function has been studied for a long time, and there is different, sometimes contradictory data on this issue.

AIM: To evaluate the incidence of cognitive impairment in elderly and to determine the associations between cognitive impairment and the beta-blockers use.

MATERIALS AND METHODS: Cross-sectional study included all patients aged 60 years and older who attended the ambulance care from 24.10.2019 to 15.12.2019 at the polyclinic No. 78 in Saint Petersburg.

Measurements: the Montreal cognitive assessment (MoCA) test, the 15-item Geriatric Depression Scale. Data collection included a full medical history, a medication review and questionnaire.

RESULTS: The prevalence of cognitive impairment among the study participants was 71.1% (n = 138). Сognitive impairment was associated with high blood pressure and a history of stroke (p < 0.05). Beta-blockers use was associated with decreased in total MoCA score, fluency (p = 0.0115), thinking (p = 0.0012), and memory (p = 0.0040). The identified association remained statistically significant after adjusting for gender, age, high blood pressure, a history of stroke, level of education, and decreased emotional background with odds ratio 2.245 (95% confidence interval 1.156–4.358) for the fluency test and coefficient of regression −0.781 (95% confidence interval [−1,233]–[−0,328]) for delayed memory.

CONCLUSIONS: Memory impairment (coefficient of regression −0.781, 95% confidence interval −1.233 to −0.328) and decreased fluency (odds ratio 2.245; 95% confidence interval 1.156–4.358) were observed in the study in the outpatient elderly patient population taking beta-blockers. The beta-blockers may lead to memory impairment. When choosing hypotensive therapy, all possible effects of beta-blockers should be considered, including the effect on cognitive status.

Russian Family Doctor. 2022;26(2):23-30
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Case report

A case of bronchial asthma in a patient with long-term cough

Yubrina I.V., Bozhkov I.A., Degtyareva L.N., Karostik D.V.


BACKGROUND: The regulatory documents determining the phthisiatric care for population do not provide diagnostics and treatment of comorbid somatic pathology with tuberculosis in tuberculosis dispansery. If patients with diagnosed tuberculosis or suspected tuberculosis need therapeutic specialists’ consultation, they have to be referred to the district polyclinic working in the medical insurance system. So, timeliness of diagnostics and chronic diseases management decreases. The course of tuberculosis becomes more complicated and lengthened. At the same time tuberculosis specificities are not taken in to account complicating comorbid pathology. For effective diagnostics and treatment tuberculosis and comorbid pathology the special algorithms of patient management were develop in Tuberculosis Dispensary No. 5.

AIM: To describe the clinical case of bronchial asthma in a 35 year old female patient as an example of effective interdisciplinary communication between general practitioner, phthisiatrician and specialists of therapeutic profile.

MATERIALS AND METHODS: Patients with suspected tuberculosis are comprehensively examined by the phthisiatrician and therapeutic profile specialists according to special developed algorithms of diagnostic search at Tuberculosis Dispensary No. 5.

RESULTS: The patient with long-term cough was comprehensively examined. Within a short time tuberculosis was excluded, bronchial asthma was diagnosed. The effective treatment of asthma and a plan of further patient flow-up in the district polyclinic was recommended.

CONCLUSIONS: An experience of the interdisciplinary communication phthisiatricians and specialists of therapeutic profile who have entered the department of medical-social care and rehabilitation demonstrated the relevance and appropriateness in diagnostics of tuberculosis and concomitant chronic uninfection diseases, that let minimize risks of cross adverse effects and choose the optimal tactics of patient management.

Russian Family Doctor. 2022;26(2):31-38
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Association of visual, hearing and olfactory impairments with survival and quality of life of elderly people

Frolova E.V.


The review is devoted to the analysis of publications on the problems of sensory disorders in elderly and senile people. Sensory disorders, which include violations of tactile sensitivity, hearing, smell, taste, visual impairment, are widespread in old age, and are associated with unfavorable aging options. These disorders are associated with other geriatric syndromes, affect the quality of life, morbidity and mortality in the elderly and senile age. The author reviews publications on hearing, vision and olfaction disorders.

Russian Family Doctor. 2022;26(2):39-45
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