卷 91, 编号 11 (2019)
- 年: 2019
- 文章: 21
- URL: https://journals.rcsi.science/0040-3660/issue/view/1917
Editorial
Chronic hepatitis B and C as stigma: Is the problem relevant for Russian society?
摘要
Chronic hepatitis B and C (CHB and CHC) are a serious medical and social problem of the world community. Aim: to study the problem of stigmatization and attitudes to patients with CHB and CHC among adolescents and adults. Materials and methods. An anonymous survey was conducted in 120 residents of the Kirov region. Of these, 94 adults (aged 18 to 76 years; average age 39.3±11.5 years) of different specialties except medical (group 1) and 26 adolescents aged 16-17 years (average age 16.5±0.5 years), high school students (group 2). The original questionnaire included 16 questions divided into 3 blocks. Block 1 contained questions about the socio - demographic status of the Respondent, block 2 and block 3 included questions on the epidemiology of HCV and HBV infection and on the treatment of patients with CHC and CHB respectively. Results. In the course of work the majority of respondents (50-65.4%) from both groups revealed a negative attitude towards patients with CHB and CHC (to a lesser extent pronounced against close relatives and friends of CHC patients), manifested by a desire to exclude casual contact and refusal to live in the same room with the patient CHB/CHC, no desire of sharing your child/brother in the same kindergarten group patients with CHB/CHC child. Fear of Contracting HBV/HCV infection has been linked to poor knowledge of the factors and pathways of transmission of these diseases. In a few cases, adolescents and adults showed an extreme degree of destructive attitude, which was expressed in the adoption of discriminatory measures against this category of patients - dismissal from work and expulsion from school/University. Conclusion. The results indicate that there is a problem of stigmatization of patients with CHB and CHC in society, both in children and adults, which requires systematic work on health education.
Terapevticheskii arkhiv. 2019;91(11):4-9
4-9
Features of hemorrhagic fever with renal syndrome with diabetes mellitus
摘要
Aim. Diabetes mellitus (DM) is known to be a risk factor in adverse outcomes and complications in many infectious diseases. In the combination of hemorrhagic fever with renal syndrome (HFRS) and DM there are mutually exclusive pathogenetic States - hyperosmolarity, characteristic of DM is layered on the reduction of osmotic blood pressure in HFRS. Under these conditions, the effect of one disease (DM) on the clinical manifestations of another (HFRS) is not obvious. The aim of the work is to find out the clinical features during hfps in patients with DM. Materials and methods. The study is based on the results of the retrospective studies "case - control" - studied the information contained in medical records of patient (form 003/u), who suffered HFRS in 2006-2018. The Selection of cards produced randomly. In the end, there were formed two groups: the first - 981 patient who suffered HFRS and had no signs of diabetes; the second, 33 patients who suffered HFRS on the background of previously existing (28 people), or the first identified (5) diabetes. Results. With a combination of HFRS and DM, a mild course of the disease is 2.5 times more common, there are no severe forms. Among this group of patients, complications are almost 10 times less common, less likely to develop infectious - toxic shock, acute kidney damage (class F by RIFLE), pulmonary edema. The combination of DM and HFRS is manifested by less high and prolonged fever, less high levels of urea and creatinine in the blood. Conclusion. HFRS in combination with DM is easier, apparently, high osmolarity of the blood is a stabilizing factor during the disease.
Terapevticheskii arkhiv. 2019;91(11):10-15
10-15
Difficulties and mistakes in the diagnosis of abdominal tuberculosis in the practice of the general practitioner
摘要
The relevance of the research is determined by the growth of cases of abdominal tuberculosis (AT), which is difficult to diagnose. Aim. Identify clinical features and possibilities of timely AT diagnosis. Materials and methods. Medical reports of 116 AT patients. The results of clinical, microbiological, immunological, radiological, endoscopic and morphological studies were analyzed. The results. AT proceeded under the mask of ulcerative colitis and Crohn's disease (26.3%), alcoholic and biliary hepatitis (11.8%), lymphoproliferative and oncological diseases (61.8%), often generalized against the background of HIV-infection. The duration of the diagnostic search for disease verification exceeded 3 months due to incorrect (erroneous) interpretation of intoxication (26.3%) and radiological pattern in the lungs (23.7%), non - application and late application of laparoscopy (39.5%). Conclusion. When diagnosing AT, it is necessary to consider the peculiarities of its clinic and to conduct timely laparoscopy.
Terapevticheskii arkhiv. 2019;91(11):16-19
16-19
Risk Factors for diarrhea associated with Clostridium difficile in patients at a clinical hospital
摘要
Aim: to identify risk factors for Clostridium difficile infection in patients of a therapeutic clinic in a multidisciplinary hospital. Materials and methods. A retrospective analysis of 110 case histories of patients who were hospitalized in therapeutic departments in the Municipal Autonomous Institution “City Clinical Hospital No. 40” in Yekaterinburg (MAU City Clinical Hospital No. 40) in 2014-2015 was conducted, in which antibiotic therapy has developed diarrhea. According to the results of the study of coprofiltrate on Clostridium difficile (CD), patients were divided into 2 groups: 60 patients with a positive result and 50 patients with a negative result. Results. The proportion of patients with CD infection in the structure of patients of the therapeutic profile of the MAU GKB No.40 for 2014-2015 amounted to 0.42%. Predictors of the risk of developing diarrhea associated with CD infection in patients are: age over 65 years (OS 4.33, 95% CI 1.15-16.20, p=0.028), Charlson comorbidity index more than 2 points (OS 3.05, 95% CI 1.29-7.23, p=0.016), the presence of anemia (OR 2.32, 95% CI 1.07-5.02, p=0.048), chronic dialysis in patients with chronic renal insufficiency (CRF) (OR 8.64, 95% CI 1.05-70.81, p=0.020), patients staying in hospital for more than 5 days (OR 3.50, 95% CI 1.57-7.75, p=0.003) and hospitalization of patients in the intensive care unit (ICU) lasting more than 1 day (OS 9.80, 95% CI 1.20-79.47, p=0.011), the use of proton pump inhibitors (PPIs) (OR 2.82, 95% CI 1.12-7.11, p=0.041), antibiotic therapy more than 10 days (OS 39.62, 95% CI 10.85-144.71, p<0.001), more than 1 course of antibacterial therapy (ABT) (OS 2.85, 95% CI 1.20-6.76, p=0.026), the use of ceftriaxone (OR 3.33, 95% CI 1.45-7.63, p=0.006). Logistic regression analysis showed a connection between the use of 3rd generation cephalosporins (OR 6.55, 95% CI 1.18-36.40, p=0.03) and ABT duration (OR 1.89, 95% CI 1.50-2.38, p<0.001) with a risk of developing diarrhea associated with CD. Conclusions. The use of cephalosporins of the 3rd generation and long - term antibacterial therapy are independent risk factors for the development of diarrhea associated with Clostridium difficile in patients of the therapeutic clinic of a multidisciplinary hospital.
Terapevticheskii arkhiv. 2019;91(11):20-25
20-25
Non - tuberculous mycobacteriosis of the lungs - diagnostic possibilities in the practice of the pulmonologist
摘要
Aim of the study. Show the possibilities of diagnosing non - tuberculous mycobacteriosis of the lungs (NTML) in the practice of the pulmonologist. Materials and methods. A survey of 90 patients with a confirmed diagnosis of non - tuberculous mycobacteriosis of the lungs (NTML) was presented. The diagnosis of pulmonary mycobacteriosis was established in accordance with the criteria proposed in 2007 by the American Thoracic Society and the American Society of Infectious Diseases (ATS/IDRS). Among the patients, 55 (61.1%) women prevailed, the average age was 51.2±15.3 years. Patients were evaluated complaints, the presence of concomitant diseases of the lungs, was carried out computed tomography of the chest high - resolution (HRCT), a culture study of sputum, in the absence of sputum or a single determination of the NTM culture in it, a study was conducted on materials of bronchoalveolar washout (ALS/BAL), or lung biopsies. Statistical processing of the research results was performed using descriptive statistics using Microsoft® Excel for Windows xp® on a personal computer. Results and conclusion. As a result of the study, it was revealed that before the diagnosis of NTML was established, 66.7% of patients were long observed for chronic lung diseases (chronic obstructive pulmonary disease, chronic bronchitis), and in 55.6% of cases (50 people) were registered with a phthisiologist about pulmonary tuberculosis. According to the CT scan of OGK, dissemination was determined in 66.7% of cases, in 48.9% - bronchiectasis, single or multiple destruction cavities - 46.7% of cases. In 72.2% of cases, non - tuberculous mycobacteria (NTM) were found in sputum, in 33.3% - in ALS and in 22.2% of NTMs were found in the surgical material. In 14.4% of cases, only surgery allowed to establish the diagnosis of mycobacteriosis.
Terapevticheskii arkhiv. 2019;91(11):26-31
26-31
The value of mucosal small intestine microbiota in digestion and absorption disorders in metabolic syndrome
摘要
Aim. To evaluate the qualitative and quantitative composition of the parietal microbiota of the small intestine (SI) and its significance in the disturbance of the digestive and absorption functions of the small intestine in metabolic syndrome (MS). Materials and methods. 67 patients with metabolic syndrome were examined. In addition to clinical data, a comprehensive study of the digestive and absorption function of SI was carried out using exercise tests with carbohydrates. The compositional characteristics of mucosal SI microbiota in MS patients were determined by gas chromatography mass spectrometry. The relationship of enteric disorders with changes in small intestinal microbiocenosis was assessed by correlation analysis. Results. The majority (82.9%) of patients with metabolic syndrome showed clinical local and general signs of small intestinal lesions. Violations of all stages of the hydrolysis - resorption process were revealed against the background of changes in the quantitative and qualitative composition of the parietal microbiota of the small intestine. In patients with MS, excessive bacterial growth is observed in the small intestine mainly due to conditionally pathogenic microbiota strains, and, in comparison with the control group, there is a significant increase in the growth of aerobes, microscopic fungi and viruses. The relationship between the severity of excess bacterial growth and impaired digestion and absorption in the small intestine in MS. Conclusion. The results of our research suggest that the identified changes in the functional state of SI in combination with a violation of mucosal enteral microbiocenosis are an important link in the complex pathogenesis of the MS.
Terapevticheskii arkhiv. 2019;91(11):32-37
32-37
Listeriosis of the Central nervous system
摘要
Object. To study the main causes of severe course and high mortality in patients with nervous form of listeriosis. Materials and methods. The analysis of the course of Listeria meningoencephalitis (LM) in 36 patients aged from 9 to 85 years, who were treated in the Infectious clinical hospital No. 2 DZM (IKB No. 2 DZM). Along with standard examination methods, blood and cerebrospinal fluid (CSF) polymerase chain reaction tests were performed to identify Listeria monocytogenes. The sensitivity of the pathogen to antibiotics was determined by serial dilutions on the WalkAway 96 Plus device of Siemens, USA. Results. LM in 84% of cases developed in patients with disorders in the immune system, in particular, with infection with the human immunodeficiency virus - in 25% of cases. The clinical picture of the disease, changes in CSF were not typical for bacterial purulent meningitis of another etiology. It is noted that LM is characterized by early involvement of the substance and ventricles of the brain in the process. Conclusion. Severe course and high mortality are due to atypical picture of the disease, late diagnosis, low bioavailability of the pathogen for antibiotics (intracellular persistence of the pathogen) and frequent resistance to them. The mortality from the nervous form of listeriosis was 33.3%.
Terapevticheskii arkhiv. 2019;91(11):38-44
38-44
Activity an enzyme 5`-nucleotidase in patients with chronic hepatitis C
摘要
Aim of the study. To determine the activity of enzyme 5`-nucleotidase depending on the of disseminated intravascular coagulation syndrome phases and duration of infection period in patients with chronic hepatitis C. Materials and methods. 166 patients (92 men, 74 women) with chronic hepatitis C were under observation. Conditionally, all patients were devided into 3 groups, based on the number of Tr, according to the phases of hemostasis: I group - hypercoagulation with number Tr>350×109/l; II - transient phase - Tr from 350 to 200×109/l and III - hypocoagulation - Tr <200×109/l which included patients with liver cirrhosis of A class according to Child-Pugh. Enzyme 5`-nucleotidase was determined using Camdell method (1962) in modification of D.M. Zubairov and I.A. Andrushko (1987). Results. Activity of 5`-nucleotidase in phases of hypocoagulation in patients with liver cirrhosis of A class according Child-Pugh were higher than transient phase - and hypercoagulation correspondignly by 29%, p=0.000; 32%, p=0.001 and 5%, p=0.000; 8%, p=0.022. Reverse side of correlation dependence of activity of 5`-nucleotidase on the Tr level in patients in phase multidirectional shifts (r=-496646, p<0.05), and in condition of hypocoagulation (r=-0.591818, p<0.05). Level of 5`-nucleotidase was significantly higher in patients with a period of desease 11-15 and 16-25 years in comparison with a period up to 5 years respectfully by 29.1%, p=0.032; 63.2%, p=0.000. Reliable difference in activity of 5`-nucleotidase was observed between 6-10 years and 16-25 years of illness by 43.5%, p=0.005. Conclusion. In the natural course of chronic hepatitis C increase of 5`-nucleotidase is typical, especially expressed in the phase of hypocoagulation. Level of enzyme 5`-nucleotidase activity depends on the terms of infection with hepatitis C virus.
Terapevticheskii arkhiv. 2019;91(11):45-48
45-48
Analysis of the impact of vaccination of pneumococcal infection in patients with chronic obstructive pulmonary disease in combination with diabetes
摘要
Aim. The article presents data on the evaluation of the clinical efficacy of using a conjugated pneumococcal vaccine in patients with COPD in combination with 2-type diabetes during a 3-year follow - up period. Materials and methods. The study included 309 patients with an isolated course of COPD and in combination with diabetes. The main parameters for evaluating the effectiveness were: the dynamics of clinical symptoms - shortness of breath on the mMRC scale, CAT test, FEV1, the number of exacerbations, hospitalizations, the number of pneumonia, the state of carbohydrate metabolism (HbA1c) and the lipid profile. For vaccine prevention 13-valent conjugated pneumococcal vaccine Prevenar-13 was used. Results and conclusions. The use of PСV13 helps to reduce the severity of respiratory symptoms, reduce the number and duration of exacerbations of COPD, reduce the number of pneumonia. Both in isolated course of COPD and in combination with diabetes. Vaccination PCV13 in patients with comorbid course contributes to the compensation of carbohydrate metabolism and improve the lipid profile.
Terapevticheskii arkhiv. 2019;91(11):49-54
49-54
Features of dermatological pathology on the background of HIV-infection
摘要
Over the past decade, there has been an increasing number of patients infected with HIV. The disease gradually leads to a pronounced immunodeficiency and death. In the vast majority of patients, polymorbidity phenomena are noted, which leads to the need for a differentiated interdisciplinary approach to their management. The knowledge of dermatologists of other dermatological aspects of HIV-infection by dermatologists and doctors will allow timely early detection of HIV-infected patients and avoid diagnostic errors. A clinical follow - up was carried out which showed issues of diagnostics while examining patients with HIV infection in outpatient practice.
Terapevticheskii arkhiv. 2019;91(11):55-59
55-59
Human babesiosis: clinical cases in the european part of the Russian Federation
摘要
The article describes four clinical observations of patients with babesiosis detected in the European part of the Russian Federation, two of whom were under the direct supervision of the authors. The analysis of epidemiological data, clinical picture, results of laboratory studies in the dynamics of the disease. Differential diagnosis and treatment are discussed.
Terapevticheskii arkhiv. 2019;91(11):60-65
60-65
A clinical case of visceral toxocariasis as a cause of eosinophilic polyserositis
摘要
The aim of the present report is to describe a clinical case of toxocariasis. 37-year - old man was admitted to Pirogov Municipal Clinical Hospital No.1 in Moscow. He was presented with intense generalized abdominal pain. Three months before the described hospitalization, the patient had acute bronchitis, then pneumonia. During the examination there were found hyperthermia, ascites, shortness of breath, sweating, hypereosinophilia. Patient lost 8 kilos over the last 6 months. There were arisen many hypotheses, however, after a more detailed survey about patient’s life it turned out that he travelled a lot. So that the parasitosis became the main conjecture, which later was confirmed by serological tests.
Terapevticheskii arkhiv. 2019;91(11):66-71
66-71
Helminths detection with video capsule endoscopy
摘要
The article describes clinical observations of helminthiasis detection in 18 of 208 patients during video capsule endoscopy (VCE). Indications for the appointment of VCE were complex clinical situations associated with the search for inflammatory diseases of the small intestine and sources of small intestine bleeding. Because of the high cost of VCE the diagnosis of parasitic diseases should be based on laboratory techniques in clinical practice. Only in case of anemia of unknown etiology VCE demonstrates high efficiency.
Terapevticheskii arkhiv. 2019;91(11):72-74
72-74
Complexity of the therapy of P. falciparum - malaria in the Russian Federation
摘要
The article presents a clinical case of malaria in a 29-year - old man without immunodeficiency, complicated by the development of infectious - toxic shock, anemia, kidney damage. The brief literature review discusses the complexity of etiotropic therapy, the problem of pathogen resistance to antimalarial drugs, pathogenetic mechanisms that contribute to the formation of shock, anemia and kidney damage in tropical malaria.
Terapevticheskii arkhiv. 2019;91(11):75-80
75-80
Cardiovascular syphilis (current state of the problem and analysis of own observations)
摘要
A description of two cases of cardiovascular syphilis is presented. The introduction discusses the relevance of visceral syphilis. The literary review is constructed in a chronological format and reflects the stages of studying the problem of cardiovascular syphilis. It emphasizes that cardiovascular syphilis is currently a rare pathology and internists are more likely to encounter it. Verification of the pathology of the cardiovascular system, including aortic aneurysm, during the early stages of syphilis (early latent) does not exclude the option of combined pathology. Early forms of syphilis in patients with diseases of the cardiovascular system should be considered a factor that complicates diagnosis. Such patients should be carefully examined to determine the cause of the disease. Rationale for the diagnosis of cardiovascular syphilis requires a comprehensive assessment of the results of clinical, laboratory and instrumental examination of the patient. A preliminary diagnosis of the specific etiology of an aortic aneurysm should be based on the following criteria: 1) relatively young age of patients with socially inappropriate sexual behavior; 2) sudden onset and rapid progression of the main signs of the disease. All patients with newly diagnosed aortic aneurysm at the outpatient stage should perform a serological examination. The diagnosis of cardiovascular syphilis, namely a syphilitic mesaortitis, can be established or confirmed by an autopsy.
Terapevticheskii arkhiv. 2019;91(11):81-85
81-85
Treatment of chronic viral hepatitis C with direct acting antiviral agent: review
摘要
HCV infection treatment regimens are viewed from positions of HCV life cycle and replication, effects of NS3/4A protease inhibitors and NS5A/NS5B inhibitors on HCV strain replication. Evolution of HCV treatment regimens from its discovery to modern DAA agents had led to substantial progress although drug resistance poses a new issue to be addressed.
Terapevticheskii arkhiv. 2019;91(11):86-89
86-89
Immunological aspects of tuberculosis pathogenesis
摘要
The morphological aspects of TB pathogenesis are well described in the publications. Much is also known about the main stages of development and formation of specific adaptive immunity. However, from our point of view, not enough attention is being paid to the involvement of the immune system in the pathogenesis of clinically relevant TB abnormalities, as well as various forms of the disease. Nevertheless, there is no doubt that the variety of clinical manifestations of any disease associated with the penetration of a foreign agent into the body, and Mycobacterium tuberculosis (MTB) in particular, is due to the collective interaction of the infectious agent and the individual response of the macroorganism to this infectious agent. The mosaic of such interactions usually imposes its own adjustments on the development of different forms of the process, its speed and direction, as well as the outcomes. Certainly, the response of a macroorganism to MTB is an integral part of pathogenesis and consists of many general components including the responses associated with the mechanisms of natural and acquired immunity. Intensity of these reactions depends on the characteristics of an agent (MTB) and a macroorganism. For the development of TB disease, massiveness of TB infection, dose and duration of MTB exposure to the human body, as well as virulence of MTB and the level of body's protection during the exposure play a very important role. TB pathogenesis is somewhat different in primary MTB infection and re - infection. With primary infection, 88-90% of individuals do not have clinical manifestations, and only the tuberculin skin test conversion signals the onset of infection. In some cases, without any use of anti-TB drugs limited abnormalities may result in spontaneous cure with the minimal residual changes in the lungs, intrathoracic lymph nodes and tissues of other organs, often in the form of calcifications and limited areas of fibrosis in more advanced cases. Only 10-12% of newly infected individuals develop TB with severe clinical manifestations requiring TB therapy. The absence of clinical manifestations of primary TB infection can be explained by a high level of natural resistance of the human body to tuberculosis, and sometimes can be an effect of acquired protection due to BCG vaccination. This review attempts to discuss the role of immune mechanisms in the pathogenesis both at the beginning of disease development, and in the process of its various manifestations. Issues of genetically determined resistance or susceptibility to TB are not being covered in detail in this manuscript.
Terapevticheskii arkhiv. 2019;91(11):90-97
90-97
Virus specific antibody - based remedies for the urgent prevention and treatment of Ebola virus disease
摘要
The Ebola virus (member of Ebolavirus genus Filoviridae family) is the etiologic agent of extremely hazard human disease with high mortality rates (up to 90%). The most important components of spectrum of therapeutics for special prophylactic and current of disease, caused by Ebola virus, are prepares, based on virus specific antibodies (convalescent’s plasma, geterologic immunoglobulins, monoclonal antibodies. The use of different class therapeutics, based on virus specific antibodies, the possible improvements of its composition and strategy of its application for special prophylactic and current of disease, caused by Ebola virus, are considered in this review.
Terapevticheskii arkhiv. 2019;91(11):98-104
98-104
Review of current and future directions of antiviral therapy of influenza and acute respiratory viral infections in Russia
摘要
Aim: to determine the perspectives for the use of drugs with combined antiviral, anti - inflammatory and immunomodulatory activity on the basis of medical studies of existing antiviral drugs for the treatment of influenza and acute respiratory viral infections in Russia. Materials and methods. A brief review of the antiviral drugs used in Russia for the treatment of influenza and acute respiratory viral infections was conducted on the basis of 37 articles published in Scopus, Web of Science (WoS), and RSCI databases in the period from 1997 to 2018. Results. Resistance to neuraminidase inhibitors (oseltamivir, zanamivir), is slowly developing due to the mutations of the neuraminidase gene H275Y and Q136K. Most influenza A viruses remain resistant to adamantane antivirals. Repeated use of immunomodulators with indirect antiviral action leads to a hyporeactivity of the immune system and, subsequently, to a decrease in their effectiveness. Positive clinical and laboratory data in clinical trials were obtained using Enisamium iodide, a drug with combined action - direct antiviral, and immunomodulatory. Conclusion. According to the WHO strategy, the results of the review demonstrate the need for continued research of medications with combined antiviral and pathogenetic effects on the infectious process caused by influenza and acute respiratory viral infections.
Terapevticheskii arkhiv. 2019;91(11):105-109
105-109
Antiviral therapy of chronic hepatitis C: 30 years success story
摘要
Exactly 30 years ago, hepatitis C virus was identified. Over the years, tremendous success has been achieved in the treatment of hepatitis C, which is currently considered to be an almost completely curable disease. The review presents the main stages in the development of hepatitis C antiviral therapy, the efficacy of various treatment regimens. The greatest progress in treatment was noted over the past 5 years when drugs with direct antiviral action appeared and began to be widely used, including in Russia, which ensure the elimination of the virus in 90-95% of cases.
Terapevticheskii arkhiv. 2019;91(11):110-115
110-115
Prinzmetal angina. Questions of pathogenesis, clinic, diagnosis and treatment
摘要
Current problems of Prinzmetal angina (vasospastic angina, variant angina) considers in this review. Attention is drawn to early diagnosis, which should be comprehensive, taking into account possible atypical courses and the development of complications. The important role of electrocardiographic monitoring (including using implantable recorders) is highlighted. It is emphasized that patients with cardiac arrhythmias, syncope are at high risk of developing sudden cardiac death. In this category of patients, it is recommended to timely determine the indications for implantation of a cardioverter - defibrillator. Authors consider the prospects of using new methods of treatment of angina pectoris.
Terapevticheskii arkhiv. 2019;91(11):116-123
116-123