Vol. 3 Issue 4 (2010)

Обложка журнала

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Editorial

The topic of the issue is sarcoidosis. A. Vizel P.5

Sarcoidosis and smoking: from publicatiom analysis to original investigation. I.Yu. Vizel, A.A. Vizel P.6

Pharmacogenetic testing after a simple DNA isolation method. P. Wijnen, O. Bekers, M. van Dieijen-Visser, M. Drent P.9

‘Drug’-induced pneumonitis associated with CYP and VKORC1 variants. P.A.H.M. Wijnen, O. Bekers, M. Drent P.15

Causes of lung hemorrhagy and hemoptysys in patients with pulmonary sarcoidosis. M.M. Ilkovich, O.P. Baranova, A.A. Speranskaja, V.P. Zolotnickaja, V.E. Perlej P.18

A case of sarcoidosis treatment with help of alternative methods. G.M. Kouklina, V.V. Romanov P.23

Antigen-induced interferon-γ in sarcoidosis, tuberculosis and non-specific inflammatory lung diseases. N.V. Makarova, S.E. Borisov, M.A. Vladimirskiy, T.N. Vlasik P.25

Sickness rate and dispensary examination potential of sarcoidosis in Omsk. D.V. Petrov, N.V. Ovsyannikov, S.M. Mazhbich, A.M. Kochetov P.29

Clinical significance of endothelial dysfunction patterns in progression of interstitial pulmonary diseases. E.N. Popova, A.B. Ponomarev, I.A. Popova, S.B. Bolevich P.33

FOR GENERAL PRACTITIONER

Obstructive sleep apnea syndrome. Definitoin, diagnostics, treatment. R.A. Galyavi P.38

Organizational matters of accounting and control when working with open sources of ionizing radiation in the radiological departament of the State health agencies Republican Clinical Hospital of the Ministry of Health Care of the Republic of Tatastan. I.I. Kamalov, E.V. Touisheva, L.F. Ziganshina, E.V. Begicheva, R.A. Bashirov P.43

BRIEF ARTICLES

The risk of sudden death and heart beats frequency. N.B. Amirov, E.V. Chоukhnin P.47

Habits of diagnostics and therapy of dysregulatory arrhythmias in women in postmenopause. O.V. Kashchenko, Yu.V. Kashchenko P.49

The comparative characteristic of treatments for thyroid eye disease. I.I. Kamalov, I.V. Gоulyaeva, R.R. Akhmadeyev P.51

ORIGINAL ARTICLES

Possibilities of rationalization of systemic antimicrobial therapy in a multi-field hospital. E.V. Paravina, A.V. Zhestkov, O.L. Kоulagin, E.A. Oskina P. 53

The effectiveness of early use of clarithromycin and azithromycin for patients having home pneumonia in ambultory terms. N.N. Zharov, E.K. Beltyukov P.57

Evaluation of a specific cellular immunity among TB sick children and teenagers. A.V. Mordik P.60

Diagnostic importance of N-terminal fragment of brain natriuretic peptide in patients with chronic heart failure of ischemic genesis. A.P. Rebrov, N.A. Kosheleva, N.A. Morosova, S.S. Shirocova, I.N. Agayeva P.65

CONGRESSES, CONFERENCES

Actual questions of diagnostics, clinic and treatment in general medical practice. III All-Russian conference of medico-sanitary units`doctors of MIA, TR doctors with the international participation in 15—16 october, Kazan. N.B. Amirov, A.A.Vizel, Z.M. Galeyeva, M.V. Potapova, L.F. Sabirov P. 70

Brief review of the activity of the «Bulletin of Contemporary Clinical Medicine» journal from the moment of foundation in 2008 and till december 2010 P. 78

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PDF downloadSarcoidosis and smoking: from publicatiom analysis to original investigation

I.Yu. Vizel, A.A. Vizel

Abstract. The analysis of the literature devoted to infuence of smoking on frequency of occurrence and severity of clinical manifestation of sarcoidosis is carried out. The retrospective analysis of 329 cases histologicaly proved sarcoidosis is made. It is established that among smokers sarcoidosis is found less often, smoking negatively infuences function of breath of these patients.

Keywords: sarcoidosis, smoking, spirometry.

 

Rerences

  1. Bradvik, I. Kinetics of lung clearance of 99mTc-DTPA in smoking patients with sarcoidosis compared to healthy smokers / I. Bradvik, P. Wollmer, E. Evander [et al.] // Respir. Med. — 2002. — Vol. 96, № 5. — P. 317—321.
  2. Carlens, C. Smoking, use of moist snuff, and risk of chronic infammatory diseases / C. Carlens, M.P. Hergens, J. Grunewald [et al.] // Am. J. Respir. Crit. Care Med. — 2010. — Vol. 181, № 11. — P. 1217—1222.
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  8. Prasse, A. Essential role of osteopontin in smoking-related interstitial lung diseases / A. Prasse, M. Stahl, G. Schulz [et al.] // Am. J. Pathol. — 2009. —Vol. 174, № 5. — P. 1683— 1691.
  9. Schildge, J. The infuence of smoking on clinical manifestation and composition of bronchoalveolar lavage in sarcoidosis / J. Schildge // Pneumologie. — 2003. — Vol. 57, № 10. — P. 585—590.
  10. Scott, D.A. Exploitation of the nicotinic anti-infammatory pathway for the treatment of epithelial infammatory diseases / D.A. Scott, M. Martin // World J. Gastroenterol. — 2006. — Vol. 12, № 46. — P. 745—749.
  11. Terasaki, H. Pulmonary sarcoidosis: comparison of fndings of inspiratory and expiratory high-resolution CT and pulmonary function tests between smokers and nonsmokers / H. Terasaki, K. Fujimoto, N.L. Mьller [et al.] // AJR. Am. J. Roentgenol. — 2005. — Vol. 185, № 2. — P. 333—338.
  12. Valeyre, D. Smoking and pulmonary sarcoidosis: effect of cigarette smoking on prevalence, clinical manifestations, alveolitis, and evolution of the disease / D. Valeyre, P. Soler, C. Clerici [et al.] // Thorax. — 1988. — Vol. 43, № 7. — P. 516—524.

 

PDF downloadPharmacogenetic testing after a simple DNA isolation method

P. Wijnen, O. Bekers, M. van Dieijen-Visser, M. Drent

Abstract. Several commercial DNA isolation kits are available for extracting genomic DNA from whole blood samples, but these procedures require certain consumption of hand and work time and are rather expensive. An alternative technique could be dried blood spot (DBS) sampling, with which DNA isolation is faster, cheaper and logistics are easier. We have developed a non-commercial DBS method and examined whether the quality and quantity of DNA, isolated from DBS and noninvasively obtained buccal swab (BS) samples, was satisfactory. DNA isolation from EDTA blood samples and blood spots on flter paper were compared after DNA isolation with a column method and two different DBS methods. BS samples were obtained by rubbing a sterile, dry cotton swab against the inside of the subject’s cheek. In addition, the quantity of the obtained DNA was measured and melting curve analyses of 5 cytochrome P450 and 3 ATP-binding cassette polymorphisms were performed with real-time PCR FRET assays to establish the quality of the obtained DNA from both the DBS and BS samples. In all cases the genotype results corresponded completely. Moreover, the derivative melting curves of the DNA samples obtained from the capillary blood and BS were comparable and highly reproducible. The mean DNA concentrations measured were 16,0 ng/μl (12,6—19,4 ng/μl) and 70,2 ng/μl (57,3—83,1 ng/μl), respectively, for DBS and BS samples (p<0,001). The DBS DNA isolation appears to be a useful alternative for the commercially available DNA isolation kits and an extremely useful method to discriminate between genotypes. This expands the possibilities of this quick and easy DNA isolation procedure. In particular, the noninvasive BS sampling method appeared to be a good alternative to invasive sampling methods.

Key words: dried blood spot and buсcal swab, sampling method DNA, genotype.

 

References

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  8. Costa, X. Simple method for alpha1-antitrypsin defciency screening by use of dried blood spot specimens / X. Costa, R. Jardi, F. Rodriguez [et al.] // Eur. Respir. J. — 2000. — Vol. 15. — Р. 1111—1115.
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  15. Wijnen, P.A. Role of cytochrome p450 polymorphisms in the development of pulmonary drug toxicity: a case-control study in the Netherlands / P.A. Wijnen, M. Drent, P.J. Nelemans [et al.] // Drug. Saf. — 2008. — Vol. 31. — Р. 1125—1134.

 

PDF download‘Drug’-induced pneumonitis associated with CYP and VKORC1 variants

P.A.H.M. Wijnen, O. Bekers, M. Drent

Abstract. The presence of CYP variant genotypes appears to be a substantial susceptibility risk factor in the development of drug-induced pulmonary adverse events. We hypothesized that in some patients these serious complications may be associated with the presence of variant alleles in combination with illicit drug use. We present two patients who developed a fu-like syndrome with diffuse interstitial infltrates after ‘drug’ abuse probably associated with the presence of cytochrome P450 (CYP) and vitamin K epoxide reductase complex 1 (VKORC1) allelic variants. Both cases were heterozygote for VKORC1 and possessed CYP polymorphisms (CYP2C19 *1/*2 and CYP2C9 *1/*3, respectively). In the described cases an association between the presence of CYP and VKORC1 allelic variants and interstitial lung damage caused by cocaine use was highly likely. Moreover, it highlights the increasing importance of introducing genetic testing into the work-up of patients with suspected ‘drug’-induced toxicity.

Key words: genotype, genetic testing, drugs, toxic reaction.

 

References

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  3. Gotway, M.B. Thoracic complications of illicit drug use: an organ system approach / M.B. Gotway, S.R. Marder, D.K. Hanks [et al.] // Radiographics. — 2002. — № 22 (Spec. No). — S. 119—135.
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  5. Wijnen, P.A. Role of cytochrome P450 polymorphisms in the development of pulmonary drug toxicity: a case-control study in the Netherlands / P.A. Wijnen, M. Drent, P.J. Nelemans [et al.] // Drug Saf. — 2008. — Vol. 31 (12). — Р. 1125—1134.
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  10. Wijnen, P.A. Variant VKORC1 and CYP2C9 Alleles in Pa­tients with Diffuse Alveolar Hemorrhage Caused by Oral Anticoagulants / P.A. Wijnen, C.F. Linssen, G.R. Haenen [et al.] // Mol. Diagn. Ther. — 2010. — Vol. 14(1). — Р. 23—30.

 

PDF downloadCauses of lung hemorrhagy and hemoptysys in patients with pulmonary sarcoidosis

M.M. Ilkovich, O.P. Baranova, A.A. Speranskaja, V.P. Zolotnickaja, V.E. Perlej

Abstract. The article deals with modern abilities of radiologic assessment (computed tomography-CT, high resolution computed tomography — HRCT, computed tomography with angiography, single photon emission computed tomography — SPECT) and fberoptic bronchoscopy of lung hemorrhage in 26 from 290 patients with pulmonary sarcoidosis, which were observed in Research Scientifc Institute of Pulmonology in last 5 years. The main causes of this severe complication were pulmonary embolism (15 patients, including trombosis «in situ» in 3 of them), rarely — atrophic bronchitis (n=3), traction bronchoectasis (n=2) and dry cavities (n=2). In single cases hemoptysis was observed in viral and bacterial infections in lung tissue (n=1), addition of tuberculosis (n=1) and lung cancer (n=1). The relapsing lung hemorrhage was observed in only one patient with pulmonary sarcoidosis of 4 stage complicated with micetome in fbrotic tissue.

Key words: pulmonary sarcoidosis, radiology, lung hemorrhagy and hemoptysis.

 

References

  1. Amosov, V.I. Mul'tispiral'naja komp'juternaja tomogra¬fija v klinikah medicinskogo universiteta / V.I. Amosov, A.A. Speranskaja, O.V. Lukina, E.I. Bobrov. — SPb.: JeLBI-SPb., 2009. — S. 234.
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  3. Prokop, M. Spiral'naja i mnogoslojnaja komp'juternaja tomografija: ucheb. posobie / M. Prokop, M. Galanski. — M.: MEDpress-inform, 2006. — T. 2. — S. 789.
  4. Trufanov, G.E. Rentgenovskaja komp'juternaja tomo¬grafija: rukovodstvo dlja vrachej / G.E. Trufanov, S.D. Rud'. — SPb.: OOO «Izdatel'stvo FOLIAT», 2008. — S. 1090.
  5. Tjurin, I.E. Komp'juternaja tomografija organov grudnoj polosti / I.E. Tjurin. — SPb.: JeLBI, 2003. — S. 543.
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PDF downloadA case of sarcoidosis treatment with help of alternative methods

G.M. Kouklina, V.V. Romanov

Abstract. The case of application of an alternative method of sarcoidosis treatment in case of impossibility of treatment
with systemic steroids is described.

Key words: sarcoidosis, alternative treatment.

 

References

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  2. Kreit, J.W. Hemoptysis / J.W. Kreit // Clinical Respiratory Medicine. — 2004. — Mosbiy. — P. 249—255.
  3. Lachkar, S. Aspergillosis and sarcoidosis / S. Lachkar, S. Dominique, L. Thiberville [et al.] // Rev. Mal. Respir. — 2007. — Vol. 24, № 8. — P. 943—953.
  4. Schreiber, J. Differential diagnosis of diffuse pulmonary haemorrhage / J. Schreiber, J. Knolle, R. Kachel, R. Schuck // Pneumologie. — 2006. — Vol. 60, № 6. — P. 347—354.

 

PDF downloadAntigen-induced interferon-γ in sarcoidosis, tuberculosis and non-specific inflammatory lung diseases

N.V. Makarova, S.E. Borisov, M.A. Vladimirskiy, T.N. Vlasik

Abstract. The serum concentration of IFN-γ after 24-hours incubation with PPD/ESAT-6 was estimated in patients with sarcoidosis (67), tuberculosis (60) and non-specifc lung infammation (44). The mean concentration (picogram/ ml) after PPD-incubation was signifcantly higher in tuberculosis (302,1±32,6; 95%CI 236,9—367,4) in comparison with sarcoidosis (66,7±16,8; 95%CI 33,2—100,2). After ESAT-6-incubation IFN-γ concentration in sarcoidosis was the lowest (9,2±2,98; 95%CI 3,3—15,2), in comparison with tuberculosis (92,8±16,7; 95%CI 59,3—126,3) and non-specifc lung infammation (95,2±29,4; 95%CI 35,9—154,4). The IFN-γ concentration level 70 picogram/ml (both PPD- and ESAT-6-induced) provides the diagnostic accuracy for sarcoidosis and tuberculosis differentiation 77,9%, sensitivity — 76,1%, specifcity — 80%. Odds ratio for sarcoidosis in patients with IFN-γ concentration level less then 70 picogram/ml is 12,8 (95%CI 5,1—32,8).

Key words: sarcoidosis, tuberculosis, non-specifc infammatory lung diseases, γ-interferon.

 

References

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  2. Solov'eva, I.P. Granulematoznoe vospalenie i granule-matoznye bolezni / I.P. Solov'eva // Patologija. — M.: Medicina, 2002. — S. 106—120.
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  4. Brock, I. Performance of whole blood IFN-gamma test for tuberculosis diagnosis based on PPD or specifc antigens ESAT-6 and CFP-10 / I. Brock, M.E. Munk, A. Kok-Jensen, P. Andersen // Int. J. Tuberc. Lung. Dis. — 2001. — Vol. 5. — P. 462—467.
  5. Ferrand, R.A. Interferon-gamma responses to ESAT-6 in tuberculosis patients early into and after anti-tuberculosis treatment / R.A. Ferrand, G.H. Bothamley, A. Whelan [et al.] // Int. J. Tuberc. Lung. Dis. — 2005. — Vol. 9 (9). — P. 1034— 1039.
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PDF downloadSickness rate and dispensary examination potential of sarcoidosis in Omsk

D.V. Petrov, N.V. Ovsyannikov, S.M. Mazhbich, A.M. Kochetov

Abstract. A simple retrospective study of epidemiology of sarcoidosis and the clinical examination of patients with sarcoidosis opportunities in pulmonology specialist service based on 227 case histories of patients with sarcoidosis treated in Omsk city Kabanov’s clinical hospital № 1. The incidence of sarcoidosis in the period from 2003 to 2010 increased 5-fold, from 4,08 to 18,9 per 100000 population. Women accounted for 73%, men 27%. The mean age 49,4±12,3 years. Stage I disease was noted in 10,6% of patients, II Stage — in 75,3%, III stage, in 9,3%, IV stage — in 4,8%. Relapse occurred in 15% of patients with 1—2 relapses occurring in 13,7% of patients and 3 or more recurrences in 1,3% of patients. Corticosteroids therapy was performed in all patients on individual schemes, taking into account the rate of regression of disease, also other methods of treatment were carried out in the complex. Thus, the morphological verifcation of diagnosis, clinical examination of patients with active sarcoidosis in pulmonology specialist service can streamline regimens to reduce the number of relapses.

Key words: sarcoidosis, corticosteroids, dispensary examination, epidemiology.

 

References

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  16. Prikaz ministra zdravoohranenija Rossijskoj Federacii ot 21 marta 2003 g. № 109 «O sovershenstvovanii protivo¬tuberkuleznyh meroprijatij v Rossijskoj Federacii».
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PDF downloadClinical significance of endothelial dysfunction patterns in progression of interstitial pulmonary diseases

E.N. Popova, A.B. Ponomarev, I.A. Popova, S.B. Bolevich

Abstract. Endothelium derived factors and neoangiogenesis (ET-1, VEGF) were evaluated in 96 patients with interstitial pulmonary diseases. Morphometry of infammation, fbrosis, angioneogenesis in lung tissue were performed. The comparisons between ET-1, VEGF levels and clinical course, HRCT scans, histology patterns showed correlations between endothelial dysfunction, HRCT fbrosis, honeycombing, morphological patterns of angiogenesis. All parameters correlated with activity and survival period of diseases. Elevation of ET-1 correlated with extrapulmonary localizations in sarcoidosis. Alterations in the endothelium derived factors and neoangiogenesis system may contribute to the pathogenesis of interstitial pulmonary diseases. The results of our study can be considered predictive of progressive course and complications in interstitial pulmonary diseases and organs involvments in sarcoidosis.

Key words: interstitial pulmonary diseases, sarcoidosis, endothelium derived factors, endothelin 1.

 

References

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  18. Nakayama, S. Comparison of BALF concentrations of ENA-78 and IP10 in patients with idiopathic pulmonary fbrosis and nonspecifc interstitial pneumonia / S. Nakayama, H. Mukae, H. Ishii [et al.] // Respir. Med. — 2005. —Vol. 99. — Р. 1145— 1151.
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  22. Stenmark, K.R. Hypoxia-Induced Pulmonary Vascular Remodeling. Cellular and Molecular Mechanisms / K.R. Sten-mark, K.A. Fagan, M.G. Frid // Circ. Res. — 2006. —Vol. 99. — Р. 675—691.
  23. The Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology. Guidelines on diagnosis and treatment of pulmonary arterial hypertension // European Heart Journal. — 2004. —Vol. 25. — Р. 2243—2278.
  24. Voelkel, N.F. Vascular endothelial growth factor in the lung / N.F. Voelkel, R.W. Vandivier, R.M. Tuber // Am. J. Physiol. Lung. Cell. Mol. Physiol. — 2006. —Vol. 290. — Р. L209 — L221.
  25. Walsh, D.A. Pathophysiological mechanisms of angiogenesis / D.A. Walsh // Adv. Clin. Chem. — 2007. —Vol. 44. — Р. 187— 221.
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FOR GENERAL PRACTITIONER

PDF downloadObstructive sleep apnea syndrome. Definitoin, diagnostics, treatment.

R.A. Galyavi

Abstract. For last decades the big urgency was got by a problem of disturbance of breath during a sleer. The most frequent implication of these disturbances — obstructive аpnea, registered in 5—10% of adult men [27]. Primary risk factors of obstructive sleep apnea syndrome (OSAS) — age, being a male and the family anamnesis. To the minor factors contributing to development of OSAS, adiposity, abusing alcohol, the smoking, a habitual snore, day drowsiness, small vital capacity of lungs concern. Accumulation of knowledge of the nature, character and mechanisms of OSAS at patients with various diseases, promoted working out of an effective method of OSAS treatment by means of creation of continuous positive pressure in respiratory tracts (Continuous Positive Airway Pressure — CPAP). However complexity of a problem and presence of various concomitant factors leave many questions concerning OSAS insuffciently studied.

Key words: obstructive sleep apnea syndrome, snore, CPAP-therapy, polysomnography.

 

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PDF downloadOrganizational matters of accounting and control when working with open sources of ionizing radiation in the radiological departament of the State health agencies Republican Clinical Hospital of the Ministry of Health Care of the Republic of Tatastan

I.I. Kamalov, E.V. Touisheva, L.F. Ziganshina, E.V. Begicheva, R.A. Bashirov

Abstract. Complex of measures designed and carried on at the Radiology Department of the State Health Care Institution Republican Clinical Hospital (RCH) of Ministry of Health Care of the Republic of Tatarstan for Control and Accounting of Radioactive Substances and Radioactive Waste during work with bare sources of ionizing radiation is directed towards provision of safe work, decrease of radiation exposure of the personnel and patients, ecological environmental protection in view of the requirements of Federal Laws on radiation and epidemiological population safety.

Key words: organization, control, radioactive substances, ionizing radiation.

 

References

  1. Federal'nyj zakon ot 30.03.1999 g. № 52-FZ «O sanitarno-jepidemiologicheskom blagopoluchii naselenija».
  2. Federal'nyj zakon ot 09.01.1996 g. № 3-FZ «O radiaci¬onnoj bezopasnosti naselenija».
  3. Normy radiacionnoj bezopasnosti NRB-2000.
  4. Osnovnye sanitarnye pravila obespechenija radiacion¬noj bezopasnosti OSPORB-99.
  5. «Gigienicheskie trebovanija po obespecheniju radiaci¬onnoj bezopasnosti pri provedenii radionuklidnoj diagnostiki s pomoshh'ju RFP». MU 2.6.1. 1892-04.
  6. «Osnovnye pravila ucheta radioaktivnyh veshhestv i radioaktivnyh othodov v organizacii NP-067-05».

 

BRIEF ARTICLES

PDF downloadThe risk of sudden death and heart beats frequency

N.B. Amirov, E.V. Chоukhnin

Abstract. To defne the indicators most fully correlating with SDNN that is especially important, for forecasting of sudden cardial death in the conditions of absence of possibilities to carry out the analysis of HRV parametres, for example, absence of the program for estimation HRV. We had been surveyed 262 persons on the device of daily monitoring of an electrocardiogram «DNK» with the program of variability of a rhythm of heart. We revealed, that the indicator «minimum daily HR», measured during a night dream, authentically correlates with change of daily allowance SDNN (r=-0,74). That is, increase of minimum HR more than 64±9,2 a minute, corresponds to SDNN decrease (60 — 100), being, on literary data, the adverse factor of sudden death.

Key words: SDNN, minimum HR.

 

References

  1. Fei, L. Heart rate variability and its relation to ventricular arrhythmias in congestive heart failure / L. Fei, P.J. Keeling, G.S. Gill // Br. Heart. J. — 1994. — Vol. 71. — Р. 322—328.
  2. Galmier, M. Depressed frеquency domain measures of heart rate variability as an independent predictor of sudden death in chronic heart failure / М. Galmier, J. Fourcade, Ch. Androdias // Eur. Heart. J. — 1999. — Vol. 20 (suppl.). — Р. 117.
  3. Kruger, C. Heart rate variability enhances the prognostic value of established parameters in patients with chronic heart failure / C. Kruger, Т. Lahm, C. Zugek // Eur. Heart. J. — 1999. — Vol. 20 (suppl.). — Р. 90.
  4. Nolan, J. Relationship between heart rate variability and mode of death in chronic heart failure: results of the UK-HEART study / J. Nolan, R. Andrews, P. Brooksby // Eur. Heart. J. — 1997. — Vol. 18 (suppl.). — Р. 577.
  5. Рathak, A. Approach of the autonomic nervous system in chronic heart failure: is QT dynamicity better than heart rate variability? / А. Рathak, J. Fourecade, А. Castel // Eur. Heart. J. — 2000. — Vol. 21 (suppl.). — Р. 331.
  6. Ponikovski, P. Depressed heart rate variability is an independent predictor of death in patients with chronic heart failure / Р. Ponikovski, S.D. Anker, T.P. Chua // Eur. Heart. J. — 1997. — Vol. 18 (suppl.). — Р. 577.
  7. Reunanen, A. Heart rate and mortality / A. Reunanen, J. Karjalainen, P. Ristola [et al.] // Eur. Heart. J. — 1997. — Vol. 18 (suppl.). — Р. 595.
  8. Tygesen, H. Heart rate variability measurements correlate with sympathetic nerve activity in congestive heart failure / Н. Tygesen, G. Eisenhofer, М. Elam // Eur. Heart J. — 1997. — Vol. 18 (suppl.). — Р. 592.

 

PDF downloadHabits of diagnostics and therapy of dysregulatory arrhythmias in women in postmenopause

O.V. Kashchenko, Yu.V. Kashchenko

Abstract. Cardioneurology — an integrated direction in the medicine main objective of which is brain research at certain diseases of heart. In the given article questions of diagnostics and therapy of dysregulatory arrhythmias in women in postmenopause as one of the private aspects in cardioneurology are discussed. Complexity of the given pathology isexplained by the variety of neurologic displays, and also absence of uniform approaches to therapy of the given conditions. The complex algorithm of diagnostics and therapy dysregulatory arrhythmias in women in postmenopause should be accessible to general practitioners in view of frequent appealability to them of the given patients.

Key words: dysregulatory arrhythmias, climacteric period, therapy, general practitioners.

 

References

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  2. Vejn, A.M. Vegetativnye rasstrojstva: klinika, diagno¬stika, lechenie / A.M. Vejn. — M.: Medicinskoe informa¬cionnoe agenstvo, 2000.
  3. Hsia, J. Resting heart rate as a low tech predictor of coronary events in women: prospective cohort study / J. Hsia, J.C. Larson, J.K. Ockene [et al.] // BMJ. — 2009. —№ 7.
  4. Smetnik, V.P. Rukovodstvo po klimakteriju / V.P. Smet-nik, V.I. Kulakova. — M.: Medicinskoe informacionnoe agentstvo, 2001 — 685 s.
  5. Balan, V.E. Vozmozhnosti korrekcii klimaktericheskih ras¬strojstv negormonal'nymi sredstvami / V.E. Balan, Ja.Z. Zaj-dieva // Lechashhij vrach. —2000. — № 5/6. — S. 24—27.
  6. Baevskij, R.M. Metodicheskie rekomendacii po analizu variabel'nosti serdechnogo ritma pri ispol'zovanii raz¬lichnyh jelektrokardiologicheskih sistem / R.M. Baevskij, G.G. Ivanov, L.V. Chirejkin // Vestnik aritmologii. — 2000. — № 4.

 

PDF downloadThe comparative characteristic of treatments for thyroid eye disease

I.I. Kamalov, I.V. Gоulyaeva, R.R. Akhmadeyev

Abstract. At the present stage the therapeutic approach to endocrinous ophthalmopathy includes drug, radiation (roentgenotherapy, radioiodinetherapy) therapies, their combination, which is more effective and operative therapy. The choice of therapy depends on the disease phase and its duration.

Key words: endocrinous ophthalmopathy, exophthalmos, roentgenotherapy of orbits.

 

References

  1. Klinicheskaja rentgenoradiologija: rukovodstvo: v 5 t. / pod red. G.A. Zedgenidze. — M.: Medicina, 1983—1985. — T. 5.
  2. Central'nyj nauchno-issledovatel'skij rentgeno-radiologicheskij institut MZ SSSR: metod. rekomenda¬cii po luchevoj terapii neopuholevyh zabolevanij. — L., 1989.
  3. Krassas, G.E. Sovremennye koncepcii diagnostiki i lechenija jendokrinnoj oftal'mopatii / G.E. Krassas, W.M. Wiersinga // Mezhdunarodnyj jendokrinologicheskij zhurnal. — 2007. — № 3 (9).
  4. Sviridenko, N.Ju. Jendokrinnaja oftal'mopatija: ot per¬vichnogo zvena do vysokih tehnologij / N.Ju. Sviridenko, M.B. Anciferov, I.M. Belovalova // Klinicheskaja i jeks¬perimental'naja tireoidologija. — 2008. — T. 4, № 1.
  5. Korytova, L.I. Rol' luchevoj terapii v kombinirovan¬nom lechenii zabolevanij organa zrenija / L.I. Korytova, V.N. Alekseev, N.V. Il'in, Ju.N. Vinogradova // Russkij medicinskij zhurnal. — 2002. — T. 3, № 4.
  6. Dreval', A.V. Vlijanie lechenija radioaktivnym jodom na techenie jendokrinnoj oftal'mopatii / A.V. Dreval', A.F. Cyb, O.A. Nechaeva [i dr.] // Klinicheskaja i jeksperi¬mental'naja tireoidologija. — 2007. — T. 3, № 3. 

 

ORIGINAL ARTICLES

PDF downloadPossibilities of rationalization of systemic antimicrobial therapy in a multi-field hospital

E.V. Paravina, A.V. Zhestkov, O.L. Kоulagin, E.A. Oskina

Abstract. The example of the usage of the methods of clinical-and-economic analysis, pharmacoepidemiological analysis
for the study of antimicrobial consumption in a multidisciplinary hospital is given. The results of software analysis and
fnancial medical expenses are presented.

Key words: pharmacotherapy, clinical-and-economic analysis, pharmacoepidemiology, DDD-analysis, drug
management.

 

References

  1. Petrov, V.I. Prikladnaja farmakojekonomika: ucheb. po¬sobie dlja vuzov / V.I. Petrov. — M.: GEOTAR-Media, 2005. — S. 336.
  2. Belousov, Ju.B. Klinicheskie i jekonomicheskie aspekty racional'nogo ispol'zovanija lekarstvennyh prepa¬ratov / Ju.B. Belousov, L.I. Ol'binskaja, A.V. Bykov // Klinicheskaja farmakologija i terapija. — 1997. — № 6. — S. 83—86.
  3. Strachunskij, L.S. Moksifloksacin: nastojashhee i budu¬shhee v stupenchatoj terapii / L.S. Strachunskij, A.V. Ve-selov, V.A. Krechikov // Klinicheskaja mikrobiologija i antimikrobnaja himioterapija. — 2003. — T. 5, № 1. — S. 19—31.
  4. Omel'janovskij, V.V. Antibiotiki v stacionare — pro¬blemy i puti reshenija / V.V. Omel'janovskij, Ju.V. Popova // Pediatrija. — 2001. — № 1. — S. 52—56.
  5. Reshed'ko, G.K. Sostojanie rezistentnosti k antiinfekci¬onnym preparatam v Rossii: prakt. rukovodstvo po anti-infekcionoj himioterapii / G.K. Reshed'ko, R.S. Kozlov; pod red. L.S. Strachunskogo, Ju.B. Belousova, S.N. Kozlo¬va. — Smolensk, 2007. — S. 49—51.
  6. Vorob'ev, P.A. Kliniko-jekonomicheskij analiz v medicin¬skoj organizacii: prakt. rukovodstvo dlja lic, prinimaju¬shhih reshenija / P.A. Vorob'ev // Problemy standartizacii v zdravoohranenii. — 2004. — № 7. — S. 82—114.

 

PDF downloadThe effectiveness of early use of clarithromycin and azithromycin for patients having home pneumonia in ambultory terms

N.N. Zharov, E.K. Beltyukov

Abstract. From 01.01 till 31.12.2007 in the town of Novouralsk there was research on the effectiveness of urgent use of azithromycin and clarithromycin of slow freeing (n=79) within the frst hour of the initial visit to the doctor in comparison with amoxicillin (n=80) in the later period for home pneumonia (HP) patients in ambulatory terms. In the group of patients of HP (n=79) as compared with patients (n=80) there was more rapid permission of pneumonic infltration by 6%, less duration of treatment by 10%, less number of days of temporary disability by 7% and less number of the hospitalized patients by 79%. Death rate in the town in the second half of 2007, when the patients of HP were urgently given macrolides became less by 67% than death rate in a frst half-year. Thus, urgent starting therapy of HP by the prolonged forms of azithromycin and at the clarithromycin beginning of treatment within the frst hour at the initial visit to the doctor is more effective than amoxicillin, given in the later period.

Key words: home pneumonia, azithromycin, clarithromycin, early treatment (use), death-rate.

 

References

  1. Kozlov, R.S. Antibiotikorezistentnost' Streptococcus pneumoniae v Rossii v 1999—2005 gg.: rezul'taty mnogo¬centrovyh prospektivnyh issledovanij PeGAS-1 i PeGAS-2 / R.S. Kozlov, O.V. Sivaja, K.V. Shpynev // Klini¬cheskaja mikrobiologija i antimikrobnaja himioterapija. — 2006. — T. 8, № 1. — S. 33—47.
  2. Sinopal'nikov, A.I. Vnebol'nichnye infekcii dyhatel'¬nyh putej: rukovodstvo dlja vrachej / A.I. Sinopal'nikov, R.S. Kozlov. — M.: Prem'er MT; Nash Gorod, 2007. — 352 s.
  3. Chuchalin, A.G. Vnebol'nichnaja pnevmonija u vzroslyh: prak¬ticheskie rekomendacii po diagnostike, lecheniju i pro¬filaktike / A.G. Chuchalin, A.I. Sinopal'nikov, L.S. Stra-
  4. chunskij // Klinicheskaja mikrobiologija i antimikrobnaja himioterapija. — 2006. — T. 8, № 1. — S. 54—86.
  5. Chuchalin, A.G. Racional'naja farmakoterapija zabole¬vanij organov dyhanija: rukovodstvo dlja praktikujushhih vrachej / A.G. Chuchalin, S.N. Avdeev, V.V. Arhipov, S.L. Ba-bak [i dr.]; pod obshh. red. A.G. Chuchalina. — M.: Litterra, 2004. — 874 s. — (Serija. Racional'naja farmakoterapija: rukovodstvo dlja praktikujushhih vrachej, t. 5).
  6. Chuchalin, A.G. Pul'monologija / A.G. Chuchalin. — M.: Belaja kniga, 2003.
  7. Jakovlev, S.V. Analiz adekvatnosti startovyh jempiriche¬skih rezhimov antibakterial'noj terapii pri tjazhelyh nozokomial'nyh infekcijah (issledovanie ASJeT) / S.V. Jakovlev, V.B. Beloborodov, S.V. Sidorenko [i dr.] // Klinicheskaja farmakologija i terapija. — 2006. — № 2. — S. 14—20.
  8. Jakovlev, V.P. Racional'naja antimikrobnaja farmakote¬rapija: rukovodstvo dlja praktikujushhih vrachej / V.P. Jakov¬lev, S.V. Jakovlev [i dr.]; pod obshhej red. V.P. Jakovleva, S.V. Jakovleva. — M.: Litterra, 2003. — 1008 s. — (Serija. Racional'naja farmakoterapija: rukovodstvo dlja prakti¬kujushhih vrachej, t. 2).

 

PDF downloadEvaluation of a specific cellular immunity among TB sick children and teenagers

A.V. Mordik

Abstract. In order to assess specifc cellular immunity were examined 111 of children and teenagers suffering from tuberculosis. The results of specifc immunological reactions revealed that no matter what age and diseases genesis having expressed the proliferation in modifed reaction of blast transformation of lymphocytes within tuberculin stimulation. Additionally, after tuberculin stimulation determined the high level of γINF mainly with tuberculosis of primary genesis. It was found out that the defnition of sensitization to tuberculin in the reaction braking migration leucocytes indirectly may indicate a disadvantaged course of tuberculosis process, in connection with the activation of the humoral link of immunity. Thus, the results of the study of a specifc cellular immunity are an additional criterion for diagnosis of tuberculosis in children and adolescents, as well as the assessment of the current forecast of the disease.

Key words: children, teenagers, tuberculosis, specifc immunity, diagnostics.

 

References

  1. Aksenova, V.A. Jepidemiologicheskaja situacija po tuber¬kulezu u detej v RF / V.A. Aksenova // Tuberkulez segodnja: materialy VIII Rossijskogo s#ezda ftiziatrov. — M., 2007. — S. 210.
  2. Efremova, S.N. Klinicheskaja znachimost' immunologi¬cheskih testov v ocenke aktivnosti tuberkuleza vnutri-grudnyh limfaticheskih uzlov u detej i jeffektivnost' lechenija: avtoref. dis. … kand. med. nauk / S.N. Efremo¬va. — SPb., 2007. — 21 s.
  3. Efremova, S.N. Ocenka urovnja specificheskoj sensibi¬lizacii organizma rebenka i drugih pokazatelej immuniteta u detej v period lechenija tuberkuleza vnutrigrudnyh limfaticheskih uzlov / S.N. Efremova, I.F. Dovgaljuk, I.Ja. Saharova // Problemy tuberkuleza i boleznej leg¬kih. — 2007. — № 12. — S. 22—26.
  4. Efremova, S.N. Pokazateli immunnogo statusa pri ocenke aktivnosti specificheskogo processa u inficirovannyh mikobakterijami tuberkuleza detej i bol'nyh tuberkule¬zom vnutrigrudnyh limfaticheskih uzlov / S.N. Efremova, I.F. Dovgaljuk, I.Ja. Saharova // Problemy tuberkuleza i boleznej legkih. — 2009. — № 1. — S. 48—51.
  5. Knoring, B.E. Harakter specificheskogo immunnogo otveta i produkcija citokinov mononuklearami krovi bol'nyh raznymi formami tuberkuleza legkih / B.E. Knoring, I.S. Frejdlin, A.S. Simbircev [i dr.] // Medicinskaja immunologija. — 2001. — T. 3, № 1. — S. 61—68.
  6. Knoring, B.E. Klinicheskaja immunologija / B.E. Knoring; pod red. Ju.N. Levasheva, Ju.M. Repina // Rukovodstvo po legochnomu i vnelegochnomu tuberkulezu. — SPb., 2006. — C. 115—136.
  7. Tjul'kova, T.E. Osobennosti funkcionirovanija immunnoj sistemy pri tuberkuleznoj infekcii / T.E. Tjul'kova, Ju.P. Chugaev, Je.A. Kashuba // Problemy tuberkuleza. — 2002. — № 11. — S. 48—55.
  8. Tjul'kova, T.E. Kliniko-immunologicheskaja harakteristika detej grupp riska po razvitiju lokal'nogo tuberkuleza: avtoref. dis. … kand. med. nauk / T.E. Tjul'kova. — Tju¬men', 2004. — 22 s.
  9. Tjul'kova, T.E. Izmenenija immunnoj sistemy detej star¬shej vozrastnoj gruppy pri pervichnyh i vtorichnyh for¬mah tuberkuleznoj infekcii / T.E. Tjul'kova, Ju.P. Chugaev, Je.A. Kashuba [i dr.] // Problemy tuberkuleza i boleznej legkih. — 2009. — № 1. — S. 51—55.
  10. Hasanova, R.R. Rol' citokinov v moduljacii subpopuljaci-onnogo sostava limfocitov krovi u bol'nyh tuberkulezom legkih / R. R. Hasanova, O.V. Voronkova, O.I. Urazova [i dr.] // Problemy tuberkuleza i boleznej legkih. — 2008. — № 3. — S. 31—35.
  11. Honkina, N.A. Osobennosti immuniteta u bol'nyh s raz¬lichnymi formami tuberkuleza legkih / N.A. Honkina, S.D. Nikonov, S.V. Shpilevskij [i dr.] // Problemy tuber¬kuleza. — 2000. — № 1. — S. 12—13.
  12. Dlugovitzky, D. Infuence of disease severity on nitrite and cytokine production by peripheral blood mononuclear cells (PBMC) from patients with pulmonary tuberculosis (TB) / Dlugovitzky [et al.] // Clin. Exp. Immunol. — 2000. — Vol. 122 (3). — P. 343—349.

 

PDF downloadDiagnostic importance of N-terminal fragment of brain natriuretic peptide in patients with chronic heart failure of ischemic genesis

A.P. Rebrov, N.A. Kosheleva, N.A. Morosova, S.S. Shirocova, I.N. Agayeva

Abstract. Purpose: assessment of NT-proBNP diagnostic importance in CHF patients of ischemic genesis. Methods: 69 CHF patients were included in the study. Inclusion criteria were CHF symptoms developed after Q-wave myocardial infarction and shown in ECG findings, and informed consent of the patients. NT-proBNP level was defined by enzyme immunoassay. Statistical processing of the data obtained was performed using software package STATISTICA 7,0. Results were considered statistically significant at p<0,05. Numerical data is presented in the form of Ме [10-90%] (mediana, 10-90 per cent). Results: NT-proBNP level in the study group was 120,0 [60; 470] pg/ml. Correlation analysis of NT-proBNP level and the studied clinical indices was carried out. Positive significant relation (р<0,05) was noted between NT-proBNP and the patients’ age (r=0,35), body mass index (BMI) (r=0,38), heart rate (HR) (r=0,50), CHF functional class (r=0,46), C-reactive protein (CRP) (r=0,55), left atrial end-systolic dimension (LAESD) (r=0,53), left ventricular end-systolic dimension (LVESD) (r=0,41), left ventricular end-diastolic dimension (LVEDD) (r=0,40), left ventricular end-systolic volume (LVESV) (r=0,39), left ventricular end-diastolic volume (LVEDV) (r=0,38), systolic pulmonary artery pressure (sPAP) (r=0,62), left ventricular myocardial mass index (LVMMI) (r=0,58). Negative significant relation (р<0,05) was noted between NT-proBNP and left ventricular ejection fraction (LVEF) (r=-0,54). According to mediana level the patients were divided into two groups: group I enrolled patients with NT-proBNP ≤ 120, pg/ml (35 patients), group II enrolled patients with NT-proBNP>120,0 pg/ml (34 patients). Patients in group II were significantly older (р=0,04), had a history of old myocardial infarctions (р=0,01), longer period of CF manifestations (р=0,04), more increased HR (р=0,003), higher CRP level (р=0,005). In group II in comparison with the group I the patients had more unfavorable events (р=0,03), CHF progression (р=0,03), recurrent myocardial infarctions (р=0,02), lethal outcomes (р=0,01).

Key words: chronic heart failure, NT-proBNP, unfavorable events.

 

References

  1. Fomin, I.V. Rasprostronennost' hronicheskoj serdech¬noj nedostatochnosti v evropejskoj chasti Rossijskoj Federacii / I.V. Fomin, Ju.N. Belenkov, V.Ju. Mareev, F.T. Ageev // Serdechnaja nedostatochnost'. — 2006. — № 3. — S. 112—115.
  2. Mareev, V.Ju. Nacional'nye rekomendacii VNOK i OSSN po diagnostike i lecheniju HSN (tretij peresmotr) / V.Ju. Mareev, F.T. Ageev, G.P. Arutjunov [i dr.] // Serdechnaja nedostatochnost'. — 2009. — № 2. — S. 64—106.
  3. Danieljan, M.O. Prognoz i lechenie hronicheskoj serdech¬noj nedostatochnosti (dannye 20-letnego nabljudenija): avtoref. dis. … kand. med. nauk / M.O. Danieljan. — M., 2001.
  4. Bold de, A.J. Rapid and potent natriuretic response intra venous injection of atrial extracts in rats / A.J. de Bold, H.B. Boerenstein, A.T. Veress, H.A. Sonneberg // Life Sci. — 1981. — Vol. 28 (1). — R. 89—94.
  5. Sudoh, T. A new natriuretic peptide in porcine brain / T. Sudoh, K. Kangawa, N. Minamino, H. Matsuo // Nature. — 1988. — Vol. 332 (6159). — R. 78—81.
  6. Suga, S. Receptor selectivity of natriuretic peptide family, atrial natriuretic peptide, brain natriuretic peptide and C-type natriuretic peptide / S. Suga, K. Nakao, K. Nosoda [et al.] // Endocrinology. — 1992. — Vol. 130 (1). — R. 229—239.
  7. Jaffe, A.S. Biomarkers in acute cardiac disease / A.S. Jaffe, L. Babuin, F.S. Apple // J. Am. Coll Cardiol. — 2006. — Vol. 48. — R. 1—11.
  8. Clerico, A. Diagnostic accuracy and prognostic relevance of the measurement of cardiacnatriuretic peptides: a review / A. Clerico, M. Emdin // Clin. Chem. — 2004. — Vol. 50. — R. 33—50.
  9. Weber, M. Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine / M. Weber, C. Hamm // Heart. — 2006. — Vol. 92. — R. 843—849.
  10. Guyatt, G.H. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure / G.H. Guyatt, M.J. Sullivan, P.J. Thompson [et al.] // Can. Med. Assoc. J. — 1985. — Vol. 132 (8). — R. 919—923.
  11. Hobbs, F.D.R. Reliability of N-terminal pro-brain natriuretic peptide in diagnosis of heart failure / F.D.R. Hobbs, R.C. Davis [et al.] // BMJ. — 2002. — Vol. 324. — R. 1498—1500.
  12. O`Hanton, R. The biologic variability of B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide in stable heart failure patients / R. O`Hanton, P. O`Shea, M. Ledwidge [et al.] // J. Card. Fail. — 2007. — Vol. 13(1). — R. 50—55.
  13. Galasko, G. What is the normal range for N-terminal pro-B-type natriuretic peptide? How well does this normal range screen for cardiovascular disease? / G. Galasko, A. Lahiri, S. Barnes [et al.] // Eur. Hart J. — 2005. — Vol. 26(2). — R. 2269—2276.
  14. McCord, J. Relationship between obesity and B-type natriuretic peptide levels / J. McCord, B.J. Mundy, M.P. Hudson [et al.] // Arch. Intern. Med. — 2004. — Vol. 164 (20). — R. 2247—2252.
  15. Galjavich, A.S. N-terminal'nyj pro-mozgovoj natrijure-ticheskij peptid i vyzhivaemost' bol'nyh hronicheskoj serdechnoj nedostatochnost'ju ishemicheskogo geneza / A.S. Galjavich, S.N. Merjasev, R.A. Galjavi [i dr.] // Serdechnaja nedostatochnost'. — 2009. —№ 4. — S. 188—191.
  16. Bramah, N. Singh Morbidity and Mortality in Cardiovascular Disorders: Impact of Reduced Heart Rate / N. Bramah // J. Cardiovasc. Pharmacol. Therapeut. — 2001. — Vol. 6(4). — R. 313—331.
  17. Belenkov, Ju.N. Vzaimosvjaz' urovnja provospalitel'nyh faktorov s vyrazhennost'ju serdechnoj nedostatochno¬sti pri ishemicheskoj bolezni serdca / Ju.N. Belenkov, S.N. Tatenkulova, V.Ju. Mareev [i dr.] // Serdechnaja nedo¬statochnost'. — 2009. — № 3. — S. 137—139.
  18. Ndrepepa, G. N-terminal probrain natriuretic peptide and C-reactive protein in stable coronary heart disease / G. Ndrepepa, A. Kastrati, S. Braun [et al.] // Am. J. Med. — 2006. — Vol. 119(4). — R. 355.
  19. Passotti, M. Echcardiographic correlates of plasma BNP in patients with chronic heart failure / M. Passotti, S. Ghio, R. Latini [et al.] // Eur. J. Echocardiogr. — 2006. — Vol. 7. — R. 535.
  20. Wang, T.J. Plasma natriuretic peptide levels and risk of C.V. events and death / T.J. Wang, M.G. Larson [et al.] // N. Engl. J. Med. — 2004. — Vol. 350. — R. 655—663.

 

CONGRESSES, CONFERENCES

PDF downloadActual questions of diagnostics, clinic and treatment in general medical practice. III All-Russian conference of medico-sanitary units`doctors of MIA, TR doctors with the international participation in 15—16 october, Kazan.

N.B. Amirov, A.A.Vizel, Z.M. Galeyeva, M.V. Potapova, L.F. Sabirov 

 

PDF downloadBrief review of the activity of the «Bulletin of Contemporary Clinical Medicine» journal from the moment of foundation in 2008 and till december 2010