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Idiopathic pulmonary fibrosis: state of the problem. Vizel A.A., Vizel I.Yu., Amirov N.B. P. 15
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Evidence-based approach to biological agents in rheumatoid arthritis. Data from Moscow common arthritis registry. Zhilyaev E.V., Me-
zenova T.V., Lukina G.V., Koltsova E.N., Schmidt E.I. P. 65
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Problem of tuberculous detection in pulmonologist’s practice. Borodulina E.A., Povalyaeva L.V., Borodulina E.V., Vdoushkina E.S.,
Borodulin B.E. P. 89
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REVIEWS
UDC 616.24-036.12-085.234(048.8)
DOI: 10.20969/VSKM.2017.10(1).7-14
ERMANNO PUXXEDU, pneumologist, assistant of professor of the Department of respiratory medicine, the Department of systems medicine, University of Rome Tor Vergata, Rome, Italy, University Hospital Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy, e-mail: ERMANNOPUX@libero.it
JOSUEL ORA, pneumologist, University hospital Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy, e-mail: josuel78@gmail.com
LUIGINO CALZETTA, D. Med. Sci., research worker of the laboratory of respiratory clinical pharmacology of the Department of systems medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy, e-mail: luigino.calzetta@uniroma2.it
MARIO CAZZOLA, honorary professor of respiratory medicine, the Department of systems medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy, e-mail: mario.cazzola@uniroma2.it
Abstract. Aim. The treatment of chronic obstructive pulmonary disease (COPD) is generally based on the assumption of drug combinations in which β2-agonists are commonly included. Ultra-LABAs were developed to induce a greater adherence to the treatment as a result of the simplification of treatment with the reduction of the daily dose to be taken. Material and methods. We analyzed the current literature data on β2-adrenergic agonists. The potential positioning of ultra-LABAs in the treatment of COPD and their cardiovascular safety is discussed according to the new information on the topics. Results and discussion. The novel fixed-dose combinations of ultra-LABAs with LAMAs and/or ICSs are examined, as well as the novel ultra-LABAs under clinical development and the ultra-LABAs in preclinical development. Conclusion. The huge interest in developing new ultra-LABAs has apparently declined progressively in recent times. Nevertheless, ultra-LABAs are considered a fundamental component of the combinations with other classes of drugs (LAMAs and ICSs) that are central for treating COPD and now are administered on oncedaily basis.
Key words: Cardiovascular safety; combination therapy; COPD; monotherapy; ultra-LABAs.
For reference: Puxxedu E, Ora J, Calzetta L, Cazzola M. Progress and prospects for long-acting β2-agonists in the treatment of COPD. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (1): 7—14. DOI: 10.20969/VSKM.2017.10(1).7-14.
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DOI: 10.20969/VSKM.2017.10(1).14-21
IDIOPATHIC PULMONARY FIBROSIS: STATE OF THE PROBLEM
VIZEL ALEXANDER A., D. Med. Sci., professor, Head of the Department of phthisiopulmonology of Kazan State Medical University, chief independent pulmonologist of the Ministry of Health of Republic of Tatarstan, Russia, 420012, Kazan, Butlerov str., 49, e-mail: lordara@inbox.ru
VIZEL IRINA YU., C. Med. Sci., assistant of professor of the Department of phthisiopulmonology of Kazan State Medical University, professor of Russian Academy of Natural History, Russia, 420012, Kazan, Butlerov str., 49, e-mail: tatpulmo@mail.ru
AMIROV NAIL B., D. Med. Sci., professor of the Department of general medical practice of Kazan State Medical University, аcademician of Russian Academy of Natural History, Russia, 420012, Kazan, Butlerov str., 49, e-mail: namirov@mail.ru
Abstract. Aim. Content analysis and review of the works devoted to the modern understanding of idiopathic pulmonary fibrosis and its treatment. Material and methods. Publications of national and foreign authors were reviewed. Results and discussion. Idiopathic pulmonary fibrosis is a special form of chronic progressive fibrosing interstitial pneumonia of unknown etiology that occurs predominantly in older people. It only affects lungs and it is associated with histological and/or X-ray pattern of usual interstitial pneumonia. Prediction flow of idiopathic pulmonary fibrosis is worse than in some cancers. Diagnosis of idiopathic pulmonary fibrosis is based on the result of the multidisciplinary conclusion of pulmonologist, radiologist and pathologist. The leading diagnostic criterion is a set of X-ray computer tomography data of high resolution, which are the changes in basal predominance or cortical parts of the lungs; diffuse reticular changes; «honeycomb lung» with traction bronchiectasis or without them and the absence of any signs that are contrary to this pathology. Functional assessment of the patients is based on the measurement of vital and diffusion capacity of the lungs. Surgical methods for the preparation of tissue samples are only recommended for non-compliance of the X-ray signs of idiopathic pulmonary fibrosis or if other diseases are suspected. Application of nintedaniba, pirfenidoza, sildenafil and N-acetylcysteine is being discussed in terms of existing medical methods. Conclusion. The new understanding of idiopathic pulmonary fibrosis is achieved at present. The new mechanisms of pathogenesis largely associated with the repeated damage and repair of the anomalous than inflammation were established. In the last decades there were clinical studies that gave hope for emergence of the medications that slow down lung fibrosis development and reduce mortality from this disease.
Key words: idiopathic pulmonary fibrosis, pathogenesis, diagnosis, treatment.
For reference: Vizel AA, Vizel IYu, Amirov NB. Idiopathic pulmonary fibrosis: state of the problem. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (1): 14—21. DOI: 10.20969/VSKM.2017.10(1).14-21.
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DOI: 10.20969/VSKM.2017.10(1).22-28
P2Y-RECEPTOR AGONISTS AND ANTAGONISTS IN MODERN CLINICAL PRACTICE
KALININA OLGA S., special pharmaceutical discipline teacher of Medical and Pharmaceutical College of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-950-318-23-23, e-mail: os_kalinina@bk.ru
ZIGANSHIN AYRAT U., D. Med. Sci., professor, Head of the Department of pharmacology of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8-987-297-88-64, e-mail: auziganshin@gmail.com
Abstract. Aim. To analyze the recent publications on the medications, which are P2Y-receptor agonists and antagonists in modern clinical practice. Material and methods. Current article is an analytical review of Russian and foreign literature. Results and discussion. P2 receptors are widely spread in different tissues and participate in a variety of physiological and pathological processes. A number of substances which are potential P2 receptor agonists or antagonists are synthesized and investigated. Some of them are introduced into clinical practice, which is an undoubted achievement of pharmacology. The article presents characteristics of the drugs affecting P2Y receptors as well as their advantages and disadvantages. Conclusion. Currently P2Y12-receptor antagonists are widely used in treatment of cardiovascular diseases. Research and development of new compounds, potential P2 receptors agonists and antagonists is being carried out. There is a high probability of occurrence and introduction of new drugs into clinical practice.
Key words: P2Y-receptor, antagonists, agonists, antiplatelet agents.
For reference: Kalinina OS, Ziganshin AU. P2Y-receptor agonists and antagonists in modern clinical practice. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (1): 22—28. DOI: 10.20969/VSKM.2017.10(1).22-28.
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UDC [616.98:579.873.21]-078(048.8)
DOI: 10.20969/VSKM.2017.10(1).29-35
LABORATORY DIAGNOSIS OF MYCOBACTERIOSIS
LYAMIN ARTEM V., C. Med. Sci., associate professor of the Department of general and clinical microbiology, immunology and allergology of Samara State Medical University, Russia, 443079, Samara, Gagarin str., 18, tel. +7-846-260-33-61, e-mail: avlyamin@rambler.ru
ZHESTKOV ALEXANDER V., D. Med. Sci., professor, Head of the Department of general and clinical microbiology, immunology and allergology of Samara State Medical University, Russia, 443079, Samara, Gagarin str., 18, tel. +7-846-260-33-61, e-mail: avzhestkov2015@yandex.ru
ISMATULLIN DANIR D., 6-year student of faculty of preventative medicine of Samara State Medical University, Russia, 443079, Samara, Gagarin str., 18, tel. +7-846-260-33-61, e-mail: danirhalitov@mail.ru
KOVALYOV ALEXANDER M., C. Biol. Sci., biologist of bacteriological laboratory of N.V. Postnikov Samara Region Clinical Tuberculosis Dispensary, Russia, 443068, Samara, Novo-Sadovaya str., 154, tel. +7-927-659-06-24, e-mail: alexferreiro@yandex.ru
Abstract. Mycobacteriosis unifies a group of diseases characterized by lesions of various organs with predominant localization in bronchopulmonary system. One of the etiological features is extremely high diversity of pathogens belonging to the group of nontuberculous mycobacteria (NTMB). Aim. Analysis of modern data on the diagnosis of mycobacteriosis and NTM identification. Material and methods. Review of publications of national and foreign authors. The article analyses the peculiarities of laboratory diagnosis of mycobacteriosis based on the NTMB allocation from biological material and evaluation of their clinical significance. Results and discussion. Analysis of the recent studies has illuminated a modern view on the underlying causes of the rise in mycobacteriosis incidence. The basic features of pre-analytical phase, methods of decontamination, microscopic examination as well as clinical material cultivation are presented. Current identification methods and their comparative characteristics are described. Conclusion. There are no approved guidelines for the diagnosis of mycobacteriosis in Russia. Variety of NTMB, in its turn, requires optimization of the algorithms for their isolation and identification. The results from foreign publications show contradictory aspects of laboratory diagnosis of mycobacteriosis and require further research in this direction.
Key words: mycobacteriosis, nontuberculous mycobacteria, laboratory diagnosis.
For reference: Lyamin AV, Zhestkov AV, Ismatullin DD, Kovalyov AM. Laboratory diagnosis of mycobacteriosis. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (1): 29—35. DOI: 10.20969/VSKM.2017.10(1).29-35.
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UDC [616.98:579.862.1]-057.36-084.47(048.8)
DOI: 10.20969/VSKM.2017.10(1).36-42
SHUBIN IGOR V., C. Med. Sci., Honored Doctor of the Russian Federation, Head of the Сlinical vaccinology laboratory of Scientific Research Institute of Pulmonology, 105077, Moscow, 11th Parkovaya str., 32, build. 4, chief therapist of Army Medical Department of Chief Command of Interior troops of the Ministry of Internal Affairs of Russia, 111250, Moscow, Krasnokazarmennaya str., 9a, e-mail: shubin-igor@mail.ru
Abstract. Pneumococcal disease is a serious problem in Russia and all around the world. It acquires special relevance in organized groups of servicemen due to a high people concentration and, consequently, large number of healthy pneumococci carriers in the team. Aim. Identification of the relevance of pneumococcal vaccination in organized servicemen groups. Material and methods. Analysis of publications and statistical data on the problem of pneumococcal disease in organized servicemen groups. Results and discussion. A number of adverse factors that accompany military service lead to a large number of non-invasive and invasive pneumococcal infection cases. They hereby cause harm for health. Complications of pneumococcal disease that are particularly difficult to occur, are often leading to death. In addition, the high incidence leads to high economic losses. Among various preventive measures carried out by the Command and troop medical service, the priority is given to vaccination. Conclusion. Vaccination against pneumococcus allows reducing the incidence of invasive and non-invasive pneumococcal infections several times in organized servicemen groups.
Key words: pneumococcus, pneumonia, vaccination, military personnel.
For reference: Shubin IV. The relevance of preventative vaccination against pneumococcal infection in organized groups of military personnel. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (1): 36—42. DOI: 10.20969/VSKM.2017.10(1).36-42.
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17. Gladinec IV, Ivashhenko AN, Rybin VV et al. O sovershenstvovanii profilaktiki ostryh boleznej organov dyhanija vo vnutrennih vojskah MVD Rossii [On improving the prevention of acute respiratory diseases in Internal Forces ofRussia]. Medicinskii vestnik MVD [Medical Bulletin MIA]. 2014; 2 (69): 29-34.
18. Zhogolev SD, Ogarkov PI, Zhogolev PD et al. Jepidemiologija i profilaktika vnebol’nichnyh pnevmonij u voennosluzhashhih
[Epidemiologiya and prevention of community-acquired pneumonia in the military]. Voenno — medicinskii zhurnal [Military Medical Journal]. 2013; 11: 55-60.
19. Sabanin JuV, Rihter VV, Rybin VV et al. Specificheskaja profilaktika vnebol’nichnoj pnevmonii vo vnutrennih vojskah MVD Rossii [Specific prevention of community-acquired pneumonia in the internal troops of the Russian Interior Ministry]. Voenno — medicinskii zhurnal [Military Medical Journal]. 2008; 10: 31-34.
20. Bajturov OR, Shubin IV. Nizkaja adaptacija voennosluzhashhih novogo popolnenija kak odin iz faktorov razvitija zabolevanij i simptomov, v chastnosti, dlitel’nogo subfebriliteta [Slow adaptation of servicemen of the new replenishment as one of the factors in the development of diseases and conditions, in particular, long subfebrile]. Medicinskii vestnik MVD [Medical Bulletin MIA]. 2014; LHVIII (1): 28-32.
21. Belevitin AB, Akimkin VG, Mosjagin VD et al. Organizacionno-jepidemiologicheskie aspekty profilaktiki vnebol’nichnoj pnevmonii v voinskih kollektivah [Organizational and epidemiological aspects of the prevention of community-acquired pneumonia in military units]. Voenno — medicinskii zhurnal [Military Medical Journal]. 2009; 9: 56-63.
22. O’Shea MK et al. Respiratory infections in the military. J R Army Med Corps. 2013; 159: 181–189.
23. Budul JuI. Mediko-jekonomicheskoe obosnovanie immunizacii voennosluzhashhih po prizyvu vnutrennih vojsk MVD Rossii vakcinoj «Pnevmo23» [Medico-economic assessment of immunization conscripts of internal troops of the Russian Interior Ministry vaccine «Pnevmo23»]. Aktual’nye problemy medicinskogo obespechenija vojsk (sil) na strategicheskih napravlenijah: sbornik tezisov dokladov Vsearmejskoj nauchno-prakticheskoj konferencii 22 nojabrja 2013 goda [Actual problems of medical support
of troops (forces) in strategic areas: abstracts of the All-Army scientific and practical conference November 22, 2013]. SPb: VMedA [Saint Petersburg: MMA]. 2013; 13-14.
ORGANIZATION OF HEALTHCARE
DOI: 10.20969/VSKM.2017.10(1).43-47
TOPICAL ISSUES OF PRIMARY HEALTH CARE INCIDENCE
BERSENEVA EVGENIA A., D. Med. Sci., Head of Higher and supplementary professional education department of N. Semashko National Research Institute of Public Health, Russia, 105064, Moscow, Vorontsovo Pole str., 12/1, build. 1, tel. +7-916-216-84-59, e-mail: eaberseneva@gmail.com
LALABEKOVA MARINA V., vice-principal on public relations and discipline of N. Pirogov Russian National Research Medical University, Russia, 117997, Moscow, Ostrovityanova str., 1, tel. + 7-903-295-66-81, e-mail: lalabekova_mv@rsmu.ru
CHERKASOV SERGEY N., D. Med. Sci., chief research worker of N. Semashko National Research Institute of Public Health, Russia, 105064, Moscow, Vorontsovo Pole str., 12/1, build. 1, tel. + 7-967-079-68-96, e-mail: cherkasovsn@nriph.ru
MESHKOV DMITRY O., D. Med. Sci., Head of scientific research coordination sector of N. Semashko National Research Institute of Public Health, Russia, 105064, Moscow, Vorontsovo Pole str., 12/1, build. 1, tel. + 7-985-179-10-83, e-mail: meshkovdo@nriph.ru
Abstract. Topical issues of primary health care volume territory planning in the Tver region of the Russian Federation are considered in the article. Aim. Study of territorial features of primary health care incidence in the Tver region of the Russian Federation. Material and methods. The research was conducted according to statistical accounting of primary health care incidence in the Tver region. The incidence was studied on 5 types of territories different in population structure as well as in medical care access and primary incidence levels. Results and discussion. Standard rates were developed for primary health care volume planning taking into account the features of the territory. Dependence of the incidence on age, gender, place of residence and primary incidence level was proved both for medical and pre-medical healthcare levels. Conclusion. On the basis of the results received, we find it possible to recommend using the standards in various territorial subjects of the Russian Federation.
Key words: primary health-care, territorial planning, standard rates of medical care volume.
For reference: Berseneva EA, Lalabekova MV, Meshkov DO, Cherkasov SN. Topical issues of primary health care incidence. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (1): 43—47. DOI: 10.20969/VSKM.2017.10(1).43-47
References
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5. Cherkasov SN, Kurnosikov MS, Sopova IL. Ispol’zovanie demograficheskogo analiza pri planirovanii ob#emov medicinskoj pomoshhi [Population analysis use when planning medical care amounts]. V sbornike: Jekologija I zdorov’e cheloveka na Severe sbornik nauchnyh trudov VI-go Kongressa s mezhdunarodnym uchastiem; Pod redakciej Petrova PG [In the collection: Ecology and health of the person in the north the collection of scientific works of the VI Congress with the international participation; Under Petrov P edition]. 2016: 601-605.
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8. Berseneva EA. Aktual’nye voprosy sozdania avtomatizirovannoy sistemy rascheta ob’emov pervichnoy medico-sanitarnoy pomoshhi v Tverskoy oblasty [Topical issues of tver region primary health care volumes calculation automated system creation]. Vestnik sovremennoy klinicheskoy mediciny [The Bulletin of Contemporary Clinical Medicine]. 2016; 9 (4): 15-20.
ORIGINAL RESEARCH
DOI: 10.20969/VSKM.2017.10(1).48-53
MINIMALLY INVASIVE TREATMENT OF PATIENTS WITH MASSIVE MULTIPLE CHOLEDOCHOLITHIASIS
ABRAMOVA ALISA G., graduate student of the Department of surgery of Yaroslavl State Medical University, Russia, 150023, Yaroslavl, Gagarin str., 12, tel. 8-920-655-67-96, e-mail: Aliceabramova@rambler.ru
KHOREV ALEXANDER N., D. Med. Sci., professor, Head of the Department of surgery of Yaroslavl State Medical University, Russia, 150023, Yaroslavl, Gagarin str., 12, tel. 8-902-330-51-11, e-mail: khorev48@mail.ru
KOZLOV SERGEY V., C. Med. Sci., associate professor of the Department of surgery of Yaroslavl State Medical University,
Russia, 150023, Yaroslavl, Gagarin str., 12, tel. 8-920-656-25-25, e-mail: SVKy@yandex.ru
PLJUTA ANDREY V., C. Med. Sci., associate professor of the Department of surgery of Yaroslavl State Medical University,
Russia, 150023, Yaroslavl, Gagarin str., 12, tel. 8-905-634-01-96
BLAGOV DMITRIY A., C. Med. Sci., associate professor of the Department of surgery of Yaroslavl State Medical University, Russia, 150023, Yaroslavl, Gagarin str., 12, tel. 8-903-825-76-83, e-mail: D-Blagov@yandex.ru
KLOKOV VADIM A., C. Med. Sci., assistant of professor of the Department of surgery of Yaroslavl State Medical University, Russia, 150023, Yaroslavl, Gagarin str., 12, tel. 8-903-691-07-37, e-mail: klokov-mail@yandex.ru
ABRAMOV GARIK S., surgeon of Clinical hospital №10, Russia, 150023, Yaroslavl, Gagarin str., 12, tel. 8-930-103-12-70,
e-mail: Garikabramov59@gmail.com
Abstract. Aim. To evaluate clinical effect of minimally invasive choledocholithiasis surgery. Material and methods. We conducted an analysis of minimally invasive surgical treatment of 198 massive multiple choledocholithiasis cases. The patients have been divided into 4 groups according to the surgical method: Group A — 68 patients with endoscopic papillosphincterotomy, lithotripsy, lithoextraction; Group B — 30 patients with mini laparotomy, choledochotomy, lithoextraction, mechanical dilation of the major duodenal papilla and internal drainage of the common bile duct; Group C — 46 patients with mini laparotomycholedochotomy, lithoextraction and choledochoduodenostomy; Group D — 54 patients with mini laparotomy, choledochotomy, lithoextraction and external drainage of the common bile duct by T-tube. Evaluation criteria: duration of analgesia and antibiotic treatment, intestinal paresis, normalization of bilirubin and leukocyte level, hospitalization, operative and postoperative complications. Results and discussion. We have found the biggest number of operative complications in group A. In 16 cases we used conversion to open surgery. Duration of analgesia, antibiotic treatment, normalization of white blood cells and bilirubin levels was significantly lower in groups B and D comparing to A and C. Minimal duration of intestinal paresis has been observed in the groups with mini laparotomy performed. In most cases postoperative complications were found in patients from groups A and C. Traumatic removal of drainage was not present in group B. Conclusion. Mini laparotomy access radically reduces duration of hospitalization. It also allows performing different manipulations on the common bile duct. Mechanical dilatation of the major duodenal papilla is less traumatic comparing to endoscopic papillosphincterotomy. Internal drainage of the common bile duct prevents the stricture of the common bile duct and of the major duodenal papilla. It can be easily removed.
Key words: choledocholithiasis, choledochotomy, mini laparotomy, internal drainage of the common bile duct, endoscopic papillosphincterotomy.
For references: Abramova AG, Khorev AN, Kozlov SV, Pljuta AV, Blagov DA, Klokov VA, Abramov GS. Minimally invasive treatment of patients with massive multiple choledocholithiasis. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (1): 48—53. DOI: 10.20969/VSKM.2017.10(1).48-53.
References
1. Razmahnin EV, Hyshiktuev BS, Lobanov SL. Kontaktnaja litotripsija pri lechenii holedoholitiaza [Contact lithotripsy in treatment of choledocholithiasis]. Hirurgija; Zhurnal imeni NI Pirogova [Surgery; Journal behalf of NI Pirogov]. 2014; 7: 34-37.
2. Boboev BD. Rezul’taty odnomomentnogo laparoskopicheskogo lechenija bol’nyh holecistoholedoholitiazom [Results of One-Step laparoscopic management of the cholecystocholedocholithiasis patients]. Analy hirurgicheskoj gepatologii [Annals of surgical hepatology]. 2012; 4 (17): 80-83.
3. Durleshter VM, Gabriel SA, Dynko VY et al. Jeffektivnost’ kompleksnogo primenenija maloinvazivnyh metodik v lechenii bol’nyh s holedoholitiazom [The efficiency of complex application minimally invasive methods in treatment of patients with choledocholithiasis]. Vestnik hirurgicheskoj gastrojenterologii [Bulletin Surgical Gastroenterology]. 2012; 4: 15-21.
4. Agadzhanov VG, Shulutko AM, Chanturija MO et al. Povrezhdenie magistral’nyh zhelchnyh protokov pri holecistjektomii iz mini-dostupa [Damage to the main bile duct during cholecystectomy from the minimal access]. Jendovideohirurgija zhelchnokamennoj bolezni segodnja: problemy i puti ih preodolenija: materialy vyezdnogo plenuma pravlenija ROJeH [Endovideosurgery cholelithiasis today: problems and ways to overcome them: materials of plenum of the ROEH]. 2012;
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DOI: 10.20969/VSKM.2017.10(1).53-59
EXPERT QUALITY ASSESSMENT PRIMARY HEALTH CARE TO THE POPULATION WITH ARTERIAL HYPERTENSION
АTSEL EVGENIA А., C. Med. Sci., associate professor of the Department of therapy, geriatrics and family medicine KSMA — Branch of the FSBEI АPE RMACPE MOH, Russia, 420012, Kazan, Mushtari str., 11, e-mail: atzel@mail.ru
FOMINA ANNA V., C. Farm. Sci., professor, Head of the Department of public health and health FSAEI HE PFUR, Russia, 117198, Moscow, Miclukho-Maclay str., 6, e-mail: anutyk74@mail.ru
Abstract. Aim — expert evaluation of the quality of primary care patients with hypertension. Material and methods. Spend peer review 347 cases of primary health care to patients with arterial hypertension in the conditions of organizational experiment, and 172 cases of primary health care to patients with arterial hypertension of the comparison group. Compared groups were comparable in terms of the basic characteristics of the analyzed diseases. Among patients with arterial hypertension accounted for the largest proportion of patients with stage III disease (53,0 and 52,3% respectively), and 4 risk of cardiovascular events (68,8 and 72,3% respectively). Results and discussion. As a result of the experiment in the study group showed a statistically significant reduction in defect rate in diagnosis (p<0,001), history-taking (p<0,001) describing objective status (p<0,001), laboratory and instrumental diagnosis (p<0,001), treatment (p<0,001), in addition to the use of drugs by the standards, but with polypharmacy and/or polytherapy (p>0,05). Conclusion. As a result of the carried-out expert assessment the statistical importance of efficiency of the made organizational experiment regarding realization in educational process of programs of professional development of doctors of primary link of health care concerning improvement of quality of diagnostics and treatment of diseases of the blood circulatory system was revealed.
Key words: quality of medical care, expert assessment, arterial hypertension.
For reference: Atsel EA, Fomina AV. Expert assessment of quality of rendering primary medical and sanitary help to the population with an arterial hypertension. The Bulletin of Contemporary Clinical Medicine. 2016; 10 (1): 53—59. DOI: 10.20969/VSKM.2017.10(1).53-59.
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DOI: 10.20969/VSKM.2017.10(1).65-70
ZHILYAEV EVGENY V., D. Med. Sci., professor of the Department of rheumatology of Russian Medical Academy of continuing professional education, acting chief doctor of CJSC «European Medical Center», Russia, 125993, Moscow, Barrikadnaya str., 2/1, tel. 8-499-252-21-04, e-mail: zhilyayevev@mail.ru
MEZENOVA TATIANA V., C. Med. Sci., associate professor of the Department of rheumatology of Russian Medical Academy of continuing professional education, Russia, 125993, Moscow, Barrikadnaya str., 2/1
LUKINA GALINA V., D. Med. Sci., professor of V.A. Nasonova Research Institute of Rheumatology, Head of the Moscow City Rheumatological Center, Russia, 115522, Moscow, Kashirskoe shosse, 34а
KOLTSOVA EKATERYNA N., Head of the organizational-methodical Division of Rheumatology Research Institute of the Organization of health and healthcare management, Russia, 115184, Moscow, Bolshaya Tatarskaya str., 30
SCHMIDT EUGENIJA I., C. Med. Sci., Head of the Department of rheumatology of N.I. Pirogov City Clinical Hospital № 1,
Russia, 117049, Moscow, Leninsky ave., 8
Abstract. The goal of the study is to identify the signs that allow to choose a biologic drug for a patient with rheumatoid arthritis to achieve minimal disease activity. Material and methods. The study includes 361 rheumatoid arthritis patients meeting the classification criteria of ACR (1987) or ACR/EULAR (2010) from the Moscow Arthritis Registry (MAR), who received a targeted disease modifying anti-rheumatic drug provided using funds from the regional or federal budget. In the process of enrollment through a survey, data were collected about clinical manifestations of the disease at the onset and subsequently. Upon enrollment and during every subsequent visit, activity was evaluated using DAS28(ESR). The search for choice predictors was conducted using a specially built multi-factor mathematical model with the achieved DAS28(ESR) value used as a dependent variable. A systematic search was conducted to identify parameters demonstrating, within the model, a significant interaction with the factor of the used biologic drug. Results and discussion. Smoking and the type of disease onset (acute or gradual), as well as tender and swollen elbow and shoulder joints at the onset of rheumatoid arthritis were identified as the most important factors for choice of drug. Smokers/ex-smokers demonstrated better results of the therapy with abatacept or rituximab and relatively poor results with TNFα inhibitors. In case of acute rheumatoid arthritis onset, better results were observed with abatacept. When complaints at the disease onset included tender, swollen elbow joints and swollen shoulder joints, better clinical-laboratory results were reported with abatacept and rituximab. Conclusion. Personalization of treatment with targeted drugs may be achieved by identifying clinical markers. The history of smoking and the clinical characteristic of disease onset are very important for the selection of an effective anti-cytokine medication.
Key words: rheumatoid arthritis, genetically engineered biological drugs, drug selection.
For reference: Zhilyaev EV, Mezenova TV, Lukina GV, Koltsova EN, Schmidt EI. Evidence-based approach to biological agents in rheumatoid arthritis. Data from Moscow common arthritis registry. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (1): 65—70. DOI: 10.20969/VSKM.2017.10(1).65-70.
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UDC 615.225.2:615.12:339.133.017(470.41-25)
DOI: 10.20969/VSKM.2017.10(1).71-78
CONSUMPTION OF CARDIO-VASCULAR MEDICATIONS PURCHASED FROM PRIVATE PHARMACY CHAIN BY POPULATION?
TUKHBATULLINA RUZALIA G., D. Pharm. Sci., professor of Russian Academy of Natural Science, Head of the Department of pharmaceutical technologies of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. +7-917-266-45-66, e-mail: Ruzaliyatuhbatullina@mail.ru
NAGAEVA ALINA R., Marketing Director of «RAN» Ltd, Russia, 420043, Kazan, Kalinin str., tel. +7-987-296-34-26, е-mail: nagaevaalina2011@yandex.ru
Abstract. Aim.To study the structure of consumption of medication used for cardio-vascular diseases treatment purchased from private pharmacy chain «Saulyk» Ltd, Kazan. Material and methods. Analysis of reports on performance indicators related to the purchase and marketing of medications used for cardio-vascular diseases treatment, of the pharmacy chain «Saulyk» Ltd was performed. The analysis was carried out using comparative, systemic, and economic methods and methodology of WHO — АТС/DDD for 2011-2013. Calculations included the data on the package number of medicines sold annually during the studied period (thousand units) in the private pharmacy chain «Saulyk» Ltd, as well as the amount of active ingredient in a pill, the number of pills and values of DDD according to the data taken from the WHO website. Results and discussion. The analysis of disposal of the medications used for cardio-vascular diseases treatment showed that ACE inhibitors are ranked first in the total number of packages sold during the studied period in the pharmacy № 6 of the «Saulyk» Ltd chain. Beta-blockers were ranked second being followed by calcium channel blockers, antiarrhythmic and other groups of medications. Conclusion. АТС/DDD methodology allows to calculate the medication consumption by population. It helps to improve the quality and availability of medications for the population due to the timely drug purchase during the first patient visit to the pharmacy. Carried out disposal analysis allows to guarantee availability of the necessary medicines.
Key words: anatomic/therapeutic/chemical classification, methodology АТС/DDD, prescribed daily dose, medicine consumption, cardio-vascular diseases.
For reference: Tukhbatullina RG, Nagaeva AR. Consumption of cardio-vascular medications purchased from private pharmacy chain by population. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (1): 71—78. DOI: 10.20969/VSKM.2017.10(1).71-78.
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DOI: 10.20969/VSKM.2017.10(1).78-82
THE PREVALENCE OF METABOLIC SYNDROME COMPONENTS IN METALLURGICAL ENTERPRISE WORKERS
CHIGISOVA ANTONINA N., junior research worker of the Laboratory of epidemiology of cardiovascular disease of Research Institute of cardiovascular diseases complex problems, Russia, 650002, Kemerovo, Sosnoviy ave., 6, tel. 8-960-916-40-93, e-mail: chigan@kemcardio.ru
OGARKOV MIKHAIL YU., D. Med. Sci., professor, Head of the Department of cardiology of Novokuznetsk State Physician’s Continuing Education Institute, Russia, 654095, Novokuznetsk, Stroitely ave., 5, Head of the Laboratory of epidemiology of cardiovascular disease of Research Institute of cardiovascular diseases complex problems, Russia, 650002, Kemerovo, Sosnoviy ave., 6, tel. 8-905-900-93-80, e-mail: ogarmu@kemcardio.ru
Abstract. Aim. The purpose of research is to investigate the prevalence of metabolic syndrome and its components in workers of metallurgical enterprise. Material and methods. A total of 1285 metallurgical plant workers were divided into 6 groups according to the nature of the work. Examination, survey (age, sex and risk factors), blood pressure and waist circumference measurement was performed. Blood biochemical parameters were determined for hyperglycemia and lipid metabolism disorders detection. Metabolic syndrome was diagnosed on the basis of results obtained. Statistical analysis was performed using the program Statistica 8.0. Results and discussion. The prevalence of metabolic syndrome among metallurgical plant workers was: abdominal obesity occurred in 40,47% of the employees, hypertension — in 45,53%, dyslipidemia — in 54,36%, hyperglycemia — in 14,37% of the persons. The workers were characterized by the low prevalence of metabolic syndrome (13,68%) compared to the unorganized ESSAY-RF population. Maximum prevalence of metabolic syndrome was found only in the group of female metallurgical equipment drivers (17,31%). Their work was characterized by the low level of physical activity and high levels of emotional stress. The most frequent clinical variant of metabolic syndrome is a combination of abdominal obesity with hypertension and dyslipidemia. Conclusion. Lower prevalence of metabolic syndrome was identified at the steel plant workers, while it was high for arterial hypertension (in women) and hypertriglyceridemia. The contribution of professional activities to the prevalence of metabolic syndrome is set only for female drivers of metallurgical machinery. The most frequent clinical variant of metabolic syndrome is a combination of abdominal obesity with hypertension and dyslipidemia.
Key words: metabolic syndrome, abdominal obesity, arterial hypertension.
For reference: Chigisova AN, Ogarkov MY. The prevalence of metabolic syndrome components in metallurgical enterprises workers. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (1): 78—82. DOI: 10.20969/VSKM.2017.10(1).78-82.
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HELP FOR PRACTITIONER
DOI: 10.20969/VSKM.2017.10(1).83-88
SOKOLOV ALEKSEY A., D. Med. Sci., professor of the Department of nephrology and efferent therapy of S.M. Kirov Military Medical Academy, executive director of the National Board of Experts on Rare Diseases, Russia, 194044, St. Petersburg, Akademik Lebedev str., 6, lit. J, e-mail: dr.sokolov@list.ru
ALEXANDROVA OKSANA YU., D. Med. Sci., professor of the Department of the principles of legislation in health care of I.M. Sechenov First Moscow State Medical University, Russia, 119991, Moscow, Trubetskaya str., 8, build. 2, e-mail: Aou18@mail.ru
KASHTALAP VASILIY V., D. Med. Sci., Head of the laboratory of pathophysiology of multifocal atherosclerosis of Research Institute of Cardiovascular Diseases Complex Problems, Russia, 650002, Kemerovo, Sosnoviy ave., 6, e-mail: v_kash@mail.ru
BARBARASH OLGA L., corresponding member of Russian Academy of Science, D. Med. Sci., professor, Director of Research Institute of Cardiovascular Diseases Complex Problems, Russia, 650002, Kemerovo, Sosnoviy ave., 6, e-mail: olb61@mail.ru
YEZHOV MARAT V., D. Med. Sci., professor, leading researcher of the Department of atherosclerosis of Russian Cardiology Research and Production Complex, president of the National Atherosclerosis Research Society, Russia, 121552, Moscow, 3rd Cherepkovskaya, 15a, e-mail: Marat_ezhov@mail.ru
Abstract. Cardiovascular diseases, including those caused by atherosclerosis and thrombosis, take a leading place in the structure of adult mortality of the population of economically developed countries. Aim. Guidelines are designed to demonstrate possible approaches to routing organization for the patients with hereditary atherogenic lipid disorders according to existing legal documents. Material and methods. The stages of care for this group of patients were considered in the recommendations. Results and discussion. Possible types of medical care, conditions of its provision and institutions, on the basis of which it can be performed, as well as the options of payment were considered for each stage. Detailed examination criterion was considered for the group of patients with suspected hereditary atherogenic lipid metabolism. Conclusion. The main statements of the guidelines on the organization of medical care to patients with hereditary atherogenic lipid disorders in the Russian regions presented are intended for health managers, head physicians, cardiologists, internists and other physicians.
Key words: patient routing, inherited atherogenic lipid disorders, procedures and types of medical care.
For reference: Sokolov AA, Alexandrova OYu, Kashtalap VV, Barbarash OL, Yezhov MV. Guidelines on the medical care organization to the patients with hereditary atherogenic lipid disorders in the Regions of Russia (Joint project of the national society for the research on atherosclerosis and non-profit partnership @The national council of experts on rare diseases@). The Bulletin of Contemporary Clinical Medicine. 2017; 10 (1): 83—88. DOI: 10.20969/VSKM.2017.10(1).
PRACTICAL EXPERIENCE
DOI: 10.20969/VSKM.2017.10(1).89-93
PROBLEM OF TUBERCULOUS DETECTION IN PULMONOLOGIST’S PRACTICE
BORODULINA ELENA A., D. Med. Sci, professor, Head of the Department of phthisiology and pulmonology of Samara State Medical University, Russia, 443099, Samara, Pionerskaya str., 48, tel. 8-846-332-57-35, e-mail: Borodulinbe@ yandex.ru
POVALYAEVA LYUDMILA V., C. Med. Sci, deputy Head physicion of Samara City Hospital № 4, associate professor of the Department of phthisiology and pulmonology of Samara State Medical University, Russia, 443056, Samara, Michurin str., 125, tel. 8-846-312-55-18
BORODULINA ELVIRA V., postgraduate student of the Department of public health and health management with economics course of Samara State Medical University, pulmonologist of Samara City Hospital № 4, Russia, 443056, Samara, Michurin str., 125, tel. +7-846-312-55-10
VDOUSHKINA ELIZAVETA S., postgraduate student of the Department of phthisiology and pulmonology of Samara State Medical University, pulmonologist of Samara City Hospital № 4, Russia, 443056, Samara, Michurin str., 125, tel.+7-846-312-55-10
BORODULIN BORIS E., D. Med. Sci, professor of the Department of phthisiology and pulmonology of Samara State Medical University, Russia, 443099, Samara, Pionerskaya str., 48
Abstract. Diagnosis of tuberculosis is an important problem in general health care. Pulmonologists deal with this problem more often. Aim. To indicate the importance of the problem of differential diagnosis at present using clinical case of pulmonary tuberculosis detection in patient with destructive pneumonia with a background of 3 month non-specific treatment (ABT broad-spectrum). Initial screening usually does not allow detecting tuberculosis. Respiratory fluoroquinolones and broad-spectrum antibiotics prescribed for pneumonia can often imply masking tuberculosis clinic. Material and methods. Clinical observation. Results and discussion. In the clinical example the infiltration has decreased turning into tuberculosis cavity formation as a result of long-term treatment in different hospitals. This case is considered to be an example of late untimely tuberculosis detection. Finger pointing does not help; a new approach to potential tuberculosis patient stratification is needed. Conclusion. Creating diagnostic departments and 0-B group medical follow-up extension will imply better diagnostics.
Key words: pneumonia, cavernous tuberculosis, diagnostics, diabetes, Diaskintest, radiography, CT, direct microscopic study for Mycobacterium tuberculosis
For reference: Bоrоdulinа EA, Povalyaeva LV, Borodulina EV, Vdoushkina ES, Borodulin BE. Problem of tuberculous detection in pulmonologist’s practice. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (1): 89—93. DOI: 10.20969/VSKM.2017.10(1).89-93.
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