Vol 20, No 3 (2018)
Articles
Diagnosis and differential diagnosis of disseminated lung lesions in patients with HIV infection (review)
Abstract
The purpose of the review is to analyze the current literature data on the diagnosis and differential diagnosis of disseminated lung processes in patients with HIV infection. Considered the most relevant diseases in patients with HIV infection with the syndrome of dissemination in the lungs, which develops in severe immunosuppression. Practicing phthisiologists, pulmonologists, therapists, infectious diseases specialists and doctors of other specialties should be aware of this pathology in order to timely suspect possible disseminated lung lesions in HIV-infected patients, conduct thorough clinical, radiological, laboratory and instrumental examinations, choose adequate further tactics of patient management.
Consilium Medicum. 2018;20(3):8-13
8-13
Disseminated tuberculosis in the late stages of HIV infection: diagnosis and course of generalized disseminated tuberculosis in combination with other secondary opportunistic diseases in a patient with HIV infection and drug dependence (clinical case)
Abstract
The article describes a clinical case of peculiarities of diagnosis, complex treatment and outcome of generalized disseminated tuberculosis in combination with other secondary opportunistic diseases in a patient at late stages of HIV infection suffering from drug dependence. The analysis of features of multimorbid condition of the patient IVC stage of HIV infection in the stage of progression, without antiretroviral therapy, with generalized disseminated tuberculosis in combination with fungal lesions of the skin. The features of this case was the prolonged use of intravenous drugs, chronic hepatitis C, polyadenopathy, encephalopathy, neuropathy and chronic bronchitis in the acute stage. The authors focus on the low motivation and non-commitment of the patient to complex treatment, which requires multidisciplinary supervision of doctors of various specialties, including a psychologist, a narcologist, a psychiatrist, a neurologist, a dermatologist, and consider the creation of specialized treatment and preventive institutions for this contingent of patients.
Consilium Medicum. 2018;20(3):14-20
14-20
Alcohol and lungs
Abstract
The review article presents the available information about the influence of alcohol on the respiratory system. Particular attention is paid to the mechanisms of damaging effects of alcohol, morphological changes in the lungs, describes the features of a number of respiratory diseases in persons who overuse alcohol. Recommendations on the formation of adequate diagnostic and treatment tactics are given.
Consilium Medicum. 2018;20(3):21-29
21-29
Idiopathic pulmonary fibrosis: from diagnosis to treatment
Abstract
Idiopathic pulmonary fibrosis (IPF) is a severe progressive disease with a rapidly (for several years) onset fatal outcome. The disease occurs in the second half of life, the number of patients increases. In 2011, an official agreement between The American thoracic society and the European respiratory society was published, presenting a modern classification of idiopathic interstitial pneumonia. An important characteristic of the course of the disease is the nature of its progression. Allocate at least 3 options (phenotype) of the IPF. A special place within the IPF is worsening. The Russian respiratory society has established National recommendations for the diagnosis and treatment of patients with IPF, taking into account international agreements, the register of patients with IPF.
Consilium Medicum. 2018;20(3):30-34
30-34
Patients with chronic obstructive pulmonary disease: analysis of actual clinical practice
Abstract
Chronic obstructive pulmonary disease (COPD) remains a disease whose global prevalence is not decreasing, and mortality is increasing. Over the past 10 years, the position of the global initiative GOLD classification and treatment COPD three times changed. The aim of the work is to assess the distribution of COPD patients according to different criteria, peculiarities of their treatment and adherence to treatment. Material and methods. 125 patients with COPD in hospital - 123 (98.4%) men and 2 (1.6%) women with an average age of 64.9±0.7 (8.2) years were examined. All patients underwent physical examination, a survey on standardized questionnaires CAT and mMRC and spirography. Results. According to GOLD 2007 classification, patients were distributed as follows: GOLD I - 6.4%, GOLD II - 29.6%, GOLD III - 43.2%, GOLD IV - 20.8%. According to the ABCD GOLD 2011 classification, 4% of patients were classified as type C and 96% as type D, and 3.2, 11.2, 0.8 and 84.8%, respectively, in ABCD GOLD 2017 redistribution. Such factors as hospitalization, changed the distribution of the patients according to groups ABCD. Among the respondents 93.6% received short - acting bronchodilators, 63.2% - long-acting bronchodilators, inhalation steroids with long-acting bronchodilators - 58.4%. 27,2% of patients were completely complementary, 72.8% of patients were well trained by the medical worker to correct use of the inhaler. Patients among all drugs preferred short-acting bronchodilators and dosing aerosol inhalers, would like to use them only on demand. The worst time of the day the majority of patients called morning. Conclusion. The study reflects the dynamism in the diagnosis and treatment of COPD, the change of priorities from clinical physiology to anamnetic data. Identified key areas that will improve the quality of treatment of patients with COPD in the studied region - the increased commitment of physicians national clinical guidelines and improving patient adherence to doctor's prescriptions.
Consilium Medicum. 2018;20(3):35-39
35-39
Therapy of bronchial asthma in children: inhaled corticosteroids vs. antagonists of leukotriene receptors (literature review)
Abstract
Bronchial asthma is one of the most common chronic diseases of childhood and more often manifests in early childhood. Despite the fact that to date, available findings about efficacy and safety of bronchial asthma pharmacotherapy in children are limited, available data allow us to recommend a step-wise approach in patients aged 5 years and younger, including administration of inhaled glucocorticosteroids and leukotriene receptor antagonists. In this article, authors discuss the pharmacodynamics and pharmacokinetics properties of these classes of drugs onthe example of budesonide and montelukast, and compare the efficacy and safety of their use in pediatric practice.
Consilium Medicum. 2018;20(3):40-44
40-44
Polymorphism of genes SOCS5 and EGFR with bronchial asthma
Abstract
The article presents the scientific literature review of the previous 20 years about gene - supressor of cytokine signaling SOCS5 and gene of epidermal growth factor receptor EGFR adapted from data pool of OMIM, PubMed. Were analised the mechanisms of the gene SOCS5 and gene EGFR, structure and functioning of proteins encoded by these genes. The results of published studies have confirmed the role of SOCS5 gene and EGFR in the pathology of the lungs and other system of organs. For example, some studies have shown аssociation of these genes with the development of asthma.
Consilium Medicum. 2018;20(3):45-47
45-47
Experience of the usage of Tonsilgon® N in the complex treatment of chronic tonsillitis with irrigations of palatine tonsils in adults
Abstract
A prospective, open-label, randomized comparative clinical trial of patients aged 18 to 46 years, who had chronic tonsillitis of simple and toxic allergic forms in remission phase, was performed. Objectives. This study was conducted to evaluate the effectiveness of the treatment of chronic tonsillitis by irrigation of palatine tonsils with antiseptic solution combined with herbal medicinal product (HMP) Tonsilgon® N intake and without it and to evaluate the prophylactic effect of HMP in the period after the course of irrigation. Patients and methods. All subjects were divided into two treatment arms: first treatment arm was treated with irrigation of palatine tonsils combined with Tonsilgon® N intake and second treatment arm was treated with irrigation of palatine tonsils only. Irrigations of palatine tonsils were performed by special ultrasound vacuum ENT-equipment "Tonzillor". Results. In the main group the positive dynamics was marked on 4±1 day of treatment, throat inflammation was fully resolved by 7±1 day of treatment and during following 60 days after end of treatment there were no relapses. Results of bacteriological analysis showed decrease of microbial contamination rate of palatine tonsils mucosa and reduction of subjects with pathogen or opportunistic bacterial strains. Conclusion. Herbal medicinal product Tonsilgon® N has anti-inflammatory, immunomodulating and antibacterial effects and can be successfully used in the complex treatment of chronic tonsillitis of simple and toxic-allergic form stage I.
Consilium Medicum. 2018;20(3):48-52
48-52
Chronic inflammatory diseases of the oropharynx complicated by Herpesviruses and Papillomaviruses infections
Abstract
Despite the large number of works devoted to the defeat of the pharynx Herpesviruses and Papillomaviruses infections currently not taken into account the role of herpesvirus and human papillomavirus infection as the etiological factors contributing to recurrence of inflammatory processes in the throat, therefore it remains unclear approach to treatment of patients with chronic inflammatory diseases of the oropharynx (CIDO) complicated by persistent of Herpesviruses and Papillomaviruses infections. The aim of the study was to improve the effectiveness of diagnosis and treatment of CIDO complicated by Herpesviruses and Papillomaviruses infections. Material and methods. All patients of the main group underwent General clinical examination, bacteriological examination, PCR-diagnosis in real time, cytolo-gical examination. After 6 months, the rate of recurrence of CIDO after the use of different treatment regimens was clinically assessed. Subjective evaluation of symptoms was carried out in accordance with the criteria of quality of life on two scales: visual analog scale of subjective evaluation of sore throat and visual analog scale of complex reduction of symptoms. Conclusion. Applying strict selection criteria based on objective data, we have identified a pool of patients with complaints and laringoscopiei a picture resembling those in the classic forms of chronic tonsillitis and chronic pharyngitis, which is the main etiological factor of the inflammation was chronic VI. The subjectivity of the signs characterizing the clinical picture, the low specificity of complaints and pharyngoscopy data can allow to combine these diseases on the basis of the leading etiological factor (chronic VI) and to regard the disease as viral tonsillopharyngitis. Based on the results of the study, a therapeutic and diagnostic algorithm for managing patients with CIDO and Herpesviruses and Papillomaviruses infections was developed.
Consilium Medicum. 2018;20(3):53-57
53-57
Acute rhinosinusitis: diagnosis and treatment
Abstract
The article presents the etiology, clinical performance and diagnostic criteria of acute rhinosinusitis. Differential diagnostics of acute rhinosinusitis of viral and bacterial etiology, as well as peculiarities of prescription of antibacterial and concomitant auxiliary therapy for this disease are considered.
Consilium Medicum. 2018;20(3):58-60
58-60
Cicatricial processes in the external auditory canal and methods of their correction
Abstract
In the literature review, the scar processes of the external auditory canal (EAC) are examined from the point of view of their formation, their surgical correction and conservative treatment. Various surgical techniques are presented that form an idea of the elimination of atresia of the EAC. Since resection of atretic tissue is associated with the risk of restenosis, various techniques for the plasticization of the EAC are presented, which reduce the possibility of restenosis. Despite the success of surgery, the percentage of relapses is still high, so we propose our own modification of the existing technique, which reduces the number of re-operations to 10%. Existing types of stenting materials of the EAC are considered. The use of stents allows you to keep the size of the EAC after surgery. The variants of conservative treatment are given: injectable glucocorticosteroids, growth factors, promising drugs, laserotherapy. Despite the achievements of modern medicine, the problem of repeated occurrence of atresia remains relevant and requires further development of integrated approaches in its treatment.
Consilium Medicum. 2018;20(3):61-66
61-66
The efficacy of a new antihistamine in the treatment of allergic rhinitis
Abstract
Allergic rhinitis (AR) does not refer to serious diseases, but significantly reduces the quality of patients' life, their ability to learn and work, causes sleeplessness. AR is aggravated by its close connection with bronchial asthma, acute and chronic rhinosinusitis, allergic conjunctivitis, exudative otitis media. In this regard, the goals of AR treatment are the control of symptoms and the prevention of complications. Oral antihistamines take the first place in therapy of AR. The article discusses such issues as etiology, pathogenesis and classification of AR, modern principles and approaches to the therapy. Particular attention is paid to the role of oral antihistamines and specially to the new drug bilastin. The results of clinical trials, real clinical practice and experience demonstrate high efficacy of bila-stin and good tolerance towards this drug in control of symptoms of AR.
Consilium Medicum. 2018;20(3):67-72
67-72
Fitting of speech processors using algorithms of the neural network system
Abstract
The results of the operation of cochlear implantation directly depend on the quality of the operation performed, the rehabilitation program and the setting of the cochlear implant system. For each patient, the maximum accuracy of these measures is important. But in case of making errors at any stage of cochlear implantation, the entire rehabilitation system as a whole will not be effective. Precise adjustment of the speech processor is very important for young children and complex groups of patients, and subjective data and diagnostic exercises with teachers can not give enough information to adjust the speech processor. In such cases, objective methods of hearing research are used. The fastest and automated method of objective research used in CI is the of a nervous response telemetry. The purpose of our study was to study the possibility of using neural networks for processing electrically induced action potential in patients with CI. Materials and methods. 120 patients were examined. The patients were divided into 2 groups: neural network training group and comparison group. Results. The data of the trained neural networks were analyzed and the network with the lowest error was chosen. The network structure consisted of three input neurons, three hidden neurons and one output neuron. The proportion of the correct forecast for this network was 99.2%. Conclusion. The application of the neural network expert system allows increasing the informative value of the telemetry of the neural response when tuning the CI; optimize speech processor settings for each patient; improve the efficiency of rehabilitation of patients after CI.
Consilium Medicum. 2018;20(3):73-76
73-76
Correction of postnasal drip in the context of bioregulatory medicine
Abstract
The article presents two case reports of correction of postnasal drip of various etiologies using bioregulatory medicine. Application bioregulatory drugs quickly and efficiently to influence the causes of postnasal drip and thereby neutralize its symptoms.
Consilium Medicum. 2018;20(3):77-79
77-79
Acquired pathology of the inner ear, as a factor complicating the surgical stage of cochlear implantation
Abstract
Cochlear implantation (CI) is an effective method for treating patients with a high degree of hearing loss and deafness as it provides direct electrical stimulation of the auditory nerve fibers, using an active implant electrode inserted into the cochlear duct of the cochlea. CI is a complex of measures that includes three main stages: selection of candidates, surgical stage of CI and postoperative auditory rehabilitation. The acquired pathology of the inner ear, accompanied by ossification of the labyrinth, has a significant effect on the surgical stage of CI.
Consilium Medicum. 2018;20(3):80-84
80-84
Evidence-based approach to the treatment of acute sinusitis
Abstract
Inflammatory diseases of the paranasal sinuses is the most common chronic pathology of ENT organs in all age groups. Among patients who were treated in ENT wards, from 15 to 36% are patients with diseases of the paranasal sinuses. In outpatient practice, the proportion of patients with sinusitis is approximately the same. Acute sinusitis is one of the most common diseases faced by primary health care doctors.
Consilium Medicum. 2018;20(3):85-89
85-89
Use of telemedicine in cochlear implantation
Abstract
Aim: To assess the potential of modern telemedicine in cochlear implantation. Patients and methods: 30 patients took part in the research on the program of patients support in remote regions (St. Petersburg-Krasnoyarsk). There were 30 teleconferences to determine the indications for CI, 18 streams of surgical operations, as well as remote fitting of the speech processors of the cochlear implants. The group consisting of 50 patients aged 0,7 to 48 years was formed for the research of intraoperative testing of a cochlear implant in our institute. Regardless of age and etiology of deafness, all patients were divided into 2 subgroups of 25 people, to compare the effectiveness of remote and local intraoperative testing. Results: The effectiveness of the stream of surgical operation and the intraoperative measurements (implant telemetry, registration of stapedial reflexes and telemetry of the auditory nerve responses) was highly appreciated, which as well as the results of remote fitting of speech processors, did not differ significantly from the "face to face" fitting. The assessment of the results of intraoperative testing demonstrated that if an audiologist have from 20 to 30 remote intraoperative sessions hi can save from 2.9 to 4.3 hours per week. Conclusion: Thus, using of modern telemedicine helps to increase the effectiveness of the high-tech medical care and raises the level of skills of specialists in the regions, leads to saving the regional budget, and in the federal centers, helps to organize the remote testing of intraoperative measurements.
Consilium Medicum. 2018;20(3):90-93
90-93
Problems of treatment of inflammatory diseases of the nose from the standpoint of evidence-based medicine
Abstract
The article deals with some issues of treatment of allergic rhinitis, acute and chronic rhinosinusitis, as well as therapeutic tactics of managing patients with polypous rhinosinusitis. The issues of empirical rational use of antibiotics in the treatment of acute and exacerbation of chronic rhinosinusitis are highlighted. The essential importance of the use of topical corticosteroids in the treatment of allergic rhinitis, acute and chronic rhinosinusitis is emphasized.
Consilium Medicum. 2018;20(3):94-100
94-100