卷 28, 编号 2 (2024)

The lecture is devoted to two infections controlled by specific means of prevention — measles and rubella, which still pose a danger both to the sphere of child and maternal health, and to healthcare in general.

The second part of the lecture is devoted to rubella, which, despite its benign course in most cases, currently poses a serious problem for global health due to its ubiquity and high incidence of severe intrauterine lesions of the fetus. Despite significant advances in the field of diagnosis and immunoprophylaxis of rubella, it is still found in economically developed countries with confirmed elimination of the disease. Therefore, to prevent the return of this infection to our country, where its elimination was achieved by 2018, maximum coverage of the population with vaccinations against rubella is still necessary in all its regions.

The lecture covers modern aspects of the etiopathogenesis, epidemiology, clinical picture, diagnosis, treatment and prevention of rubella. This information, given the increasing incidence of rubella, even in countries with confirmed elimination of the disease, may be useful for general practitioners, primarily family doctors.

Rheumatoid arthritis is a chronic inflammatory disease caused by genetic and environmental factors. Smoking is the one of the most important external risk factors for development rheumatoid arthritis, severity, rapid disease progression and an unsatisfactory response to treatment. This findings determines the importance of studying smoking among patients with rheumatoid arthritis to identify barriers to smoking cessation and factors contributing to tobacco cessation, as well as to develop specific smoking cessation programs.

BACKGROUND: The possibility of mutual aggravation of post-tuberculosis and post-COVID respiratory pathologies requires additional consideration.

AIM: To study some subjective breathing parameters at patients with post-tuberculosis pulmonary residual changes after a new coronavirus infection recovering.

MATERIALS AND METHODS: The study included two groups: the main group — 14 patients with cured pulmonary tuberculosis, who had recovered from a new coronavirus infection, a comparison group — 52 patients with post-tuberculosis changes non-sick new coronavirus infection who were admitted to the tuberculosis sanatorium “Glukhovskaya” in 2020–2021. The severity of shortness of breath using the Modified Medical Research Council (mMRC) and Borg scales was assessed upon admission to the sanatorium and a month later.

Results: The mMRC scale was 1.5 ± 1.4 and 2.1 ± 0.2 and the Borg scale was 1.5 ± 1.4 and 2.9 ± 0.2 before treatment respectively in the main group and the comparison group. According to the mMRC scale initially 14.3 and 11.5% of patients with pulmonary tuberculosis and the comparison group did not complain of shortness of breath and 50% of pulmonary tuberculosis patients and 42.4% of the comparison group defined it as severe. After a month there were 3 or 4 points on the mMRC scale among pulmonary tuberculosis patients. In the comparison group 3-point shortness of breath decreased by 11.2 times most often indicated shortness of breath with 2 score. According to the Borg scale dyspnea was initially assessed as 3 points at 71.5% pulmonary tuberculosis patients. In the comparison group 67.3% patients had grade 3 dyspnea and 11.5% noted 4–6 grade shortness of breath. After a month the proportion of patients with mild shortness of breath at the pulmonary tuberculosis and comparison groups increased by 4.5 and 3.3 times, respectively, and the frequency of 3-grade shortness of breath decreased by 5 and 3.9 times.

CONCLUSIONS: Major post-tuberculosis changes, smoking and chronic obstructive pulmonary disease determine the severity of breathing discomfort to a greater extent than the experience of new coronavirus infection but rehabilitation treatment are leveled out these differences. It is advisable to study the state of the respiratory system at patients cured of pulmonary tuberculosis.

BACKGROUND: Despite significant progress in the search for treatable additional features affecting multicomponent control of bronchial asthma, there is currently a paucity of research studies with a comprehensive assessment of the impact of obesity and multimorbidity on quality of life in patients with bronchial asthma.

AIM: To assess the effect of personalizing features (obesity and multimorbidity) on the quality of life of patients with different levels of asthma control.

MATERIALS AND METHODS: Patients with asthma (n = 237) were divided into 3 groups depending on BMI. Multimorbid pathology was analyzed by Cumulative Illness Rating Scale (CIRS), asthma control — Asthma Control Questionnaire-5 (ACQ-5), quality of life — Asthma Quality of Life Questionnaire with Standardized Activities [AQLQ(S)], anxiety and depression — Hospital Anxiety and Depression Scale (HADS). Statistical analysis: Microsoft Excel, Statistica 12.0, Statgraphics XVIII.

RESULTS: Patients with obesity and asthma had more comorbidities (p < 0.05). Quality of life in patients with high and normal body weight depended on the level of control and the number of diseases (p < 0.05), with getting worse disease control these differences became insignificant. In the group with obesity, activity limitation (p = 0.0150) and overall quality of life (p < 0.005) increased significantly with increasing number of diseases. Anxiety levels increased with increasing number of illnesses (p < 0.0001). Quality of life of patients according to AQLQ(S) has inverse correlation with BMI (r = −0.5135), age (r = −0.2034) with CIRS scores (r = −0.4905) with anxiety (r = −0.5078) and depression (r = −0.4820) level.

CONCLUSIONS: Body weight, level of asthma control, depression and anxiety, and the number of comorbid multimorbid conditions affect the quality of life of patients with asthma. Obesity makes a significant negative contribution to worsening asthma control and patients’ quality of life, in this group patients have the highest level of multimorbidity and they have a prevalence of anxiety. To improve asthma control, patients need a complex examination including assessment of quality of life, depression and anxiety, and comorbidities in order to develop personalization of therapeutic approaches to patient management.

The textbook “Outpatient Therapy,” prepared by a team of authors under the guidance of professors O.Yu. Kuznetsova and E.V. Frolova, allows you to implement a competent approach to training the future primary health care doctors. The textbook complies with the Federal State Educational Standard of Higher Education. The book is written at a high scientific and methodological level, it is distinguished by a holistic approach to the coverage of the training material and the focus on the formation of both universal and general professional, and specialized professional competencies in the future doctor. The textbook is intended for students of medical faculties and can be used as the main educational literature in the discipline “Outpatient Therapy”.

The editorial board regret that in the published version of “Gorham–Stout disease started with recurrent bilateral exudative pleuritis: case description and literature review” institution (place of work) of the authors North-Western State Medical University named after I.I. Mechnikov was indicated incorrectly.

The authors’ institutions are:

• Olga M. Lesnyak — North Western State Medical University named after I.I. Mechnikov, Clinical Rheumatological Hospital No. 25, Saint Petersburg;
• Vadim G. Pischik — Saint Petersburg State University, City Clinical Oncological Clinic, Saint Petersburg;
• Olga N. Tkach — Clinical Rheumatological Hospital No. 25, Saint Petersburg;
• Elena S. Kunitsina — Clinical Rheumatological Hospital No. 25, Saint Petersburg.

The editorial board is confident that the error could not significantly affect the perception of the work and the interpretation of information by readers. The error has been corrected online, the file of the article and the issue have been updated.