Репозиторий Университета

© 2018, Media Sphera Publishing Group. All rights reserved. This publication was designed to report the experience gained by the Department of ear, nose and throat diseases at I.M. Sechenov First Moscow State Medical University in the matters concerning professional medical education in the framework of the clinical residency. The main factors that contribute to the adequate shaping of the future ENT-doctor are considered. These include the continuity of generations and conservation of the traditions in the combination with the development of the leading areas of scientific, clinical and educational work.

© 2018, Media Sphera Publishing Group. All rights reserved. The article presents a clinical case that reflects the difficulties of postoperative management of patients after the removal of the jugular glomus tumor.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To specify the frequency and species composition of vaginal bacterial carriage in pregnant women at the term of gestation 35–37 wks. Patients and methods. We examined 800 pregnant women, who were followed-up on an outpatient basis at terms of gestation 35–37 wks. Cultural examination of the content of the posterior vaginal fornix was performed. Species identification of microorganisms was performed by the method of direct protein profiling with the help of MALDI-TOF mass spectrometry, FLEX series, Bruker Daltonic GmbH, Germany. Results. The growth of flora was obtained in 761 patients (95%). Bacterial vaginosis (n = 71), Candida vulvovaginitis (n = 83) were diagnosed in 154 patients (19%). Lactobacillus spp. were found in 80% (n = 637) of examined women, of them in 161 (20%) in monoculture. Bacterial carriage was diagnosed in 55.8% of cases. The prevalence of Enterococcus faecalis, Escherichia coli, Streptococcus agalactiae, Staphylococcus epidermidis and Staphylococcus haemoliticus was noted. They were much more rarely detected in monoculture: E. faecalis (1%), S. agalactiae (0.1%), S. epidermidis (0.1%), Candida albicans (0.1%). In 39 (5%) patients, no growth of flora was found. In 17 patients we found extended-spectrum B-lactamase-producing bacteria: E. coli (n = 15), Klebsiella pneumoniae (n = 2). Conclusion. Taking into account a high prevalence of vaginal bacterial carriage in pregnant women in the 3rd trimester, it might be expedient to consider inclusion of microbiological examination of vaginal discharge in the basic spectrum of antenatal observation and screening examination of pregnant in the Russian Federation.

© 2018, Dynasty Publishing House. All rights reserved. The objective. A comparative study of the dose uniformity, dose reproducibility, imprint areas on a planar simulation model as indicators of dispersion of spray-aerosol pharmaceutical forms of various trademarks for treatment of diseases of the mouth cavity and throat. Materials and methods. As objects of study we selected 10 drugs manufactured in the «aerosol» and «spray» forms. Test for dose uniformity was performed in accordance with articles of the State Pharmacopoeia of the Russian Federation «Aerosols and sprays», comparison of dose reproducibility was performed by comparing average dose mass dispersions according to Fisher. The test for the width of dispersion was performed by imprints obtained of a single release of drugs on filter paper with Dragendorff’s reagent and plates for thin-layer chromatography. Results. All metered-dose sprays successfully passed the test for dose mass uniformity. The test for dose mass reproducibility showed a high enough stability of dosage in all the examined drugs: the percentage error of the average dose mass was at the level 1–3%. The test for dispersion width performed on planar simulation models showed significant differences in the character of drug dispersion. For comparing the width of dispersion we calculated imprint areas from a single-dose release on PSM, which permitted to determine drugs with wide and fine dispersion as the most effective with respect to the way of drug delivery to the focus of inflammation – on the mucous membranes of the throat and mouth cavity. Conclusion. The optimal combination of the examined spray characteristics was found in the spray Tantum® Verde, which permits to recommend it as a drug of choice in paediatrics for local therapy of inflammatory diseases of the throat in children beginning from the age of 3 years.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To determine vitamin D status in children with rheumatic disease who live on the territory of Russia. Patients and methods. A pilot study was conducted that included 52 children (35 girls and 17 boys) aged 5 to 17 years (11.88 ± 0.48 years), among them 29 children with systemic connective tissue disorders (SCTD) and 23 children with juvenile idiopathic arthritis (JIA). All patients underwent complex clinical-laboratory and instrumental examination in order to confirm the diagnosis and assess the patients’ health. Vitamin D status was assessed by 25(ОН)D serum levels using the method of chemiluminescence immunoassay. Results. Sufficient levels of 25(ОН)D (>30 ng/l) were found only in 5 (9.5%) children, vitamin D insufficiency (25(ОН)D 21–30 ng/l) was observed in 6 (11.5%) children, deficiency (25(ОН) <20 ng/l) in 41 (79.0%) children, among them in 7 (13.4%) it was severe (25(OH)D <10 ng/l), in spite of a long-term intake of low-doses of cholecalciferol (100–400 U/day) by 40 (76.9%) patients. Average levels of 25(ОН)D in patients with SCTD were significantly higher than in patients with JIA (20.86 ± 2.15 ng/l vs. 14.98 ± 0.91 ng/l, p = 0.0151), deficiency was more rarely found in these patients (69.0% vs. 91.3%), which was to a certain degree conditioned by more intensive vitamin D therapy. Conclusion. Insufficiency/deficiency of vitamin D is noted in an overwhelming majority of children with RD. Standard therapy with low doses of cholecalciferon offered to patients with RD is not sufficient for obtaining optimal 25(ОН)D levels and needs correction.

© 2018, Dynasty Publishing House. All rights reserved. A clinical case of a giant vulvar tumor in a puerperal of 38 years is presented. Tumor removal was performed using thermal ligation.

© 2018 Media Sphera Publishing Group.All rights reserved.  Contribution of diseases of the circulatory system to total mortality of the population remains high. Therefore it is necessary to study factors with most substantial impact on regional morbidity and mortality for elaboration of targeted programs of preventive measures aimed at definite population groups. Purpose of this study was to perform analysis of differences of mortality from cardiovascular diseases (VVD) of Moscow region inhabitants of various gender and age. Materials and methods. Data on 2016 mortality of Federal Service of State Statistics (Rosstat) and territorial service of state statistics of the Moscow Region were used in this analysis. Analysis was conducted for men and women divided in age groups ≤50, 50-59, 60-69, and ≥50 years. Diseases were classified in accordance with 10 th Revision of International Statistical Classification of Diseases (ICD10). Results. Population of the Moscow Region territory on January 1, 2016, amounted 7 318 647 (men 46.2, women 53.8%, persons of working age 58.9%). Contribution in the mortality structure of chronic ischemic heart disease (IHD) and cerebro-vascular diseases in women was greater than in men (80 vs. 68%, respectively, р<0.0001). Contribution of acute IHD, IHD unrelated heart diseases, and vascular diseases in men was significantly greater than in women (30 vs. 18%, respectively, р<0.0001). In the age group over working age mortality indexes were substantially higher compared with those in working age. In men these indexes became 10-20 times while in women - 30-130 times higher. Conclusion. Despite positive dynamics of mortality from diseases of the circulatory system (45.3% lowering from 2008 to 2016) it is necessary to strengthen efforts directed to correction risk factors of IHD and implementation of timely diagnostics and correction of IHD unrelated diseases.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Most patients with arterial hypertension (AH) for successful long-term blood pressure (BP) control require combination of antihypertensive drugs acting on various target organs. Accumulated experience shows that about 30% of patients require combination therapy with 3 drugs from different pharmacological classes. Efficacy of BP control in real clinical practice with the use of various doses of perindopril, indapamide, and amlodipine as components of taken once-daily triple fixed combination was assessed in the 3-months prospective observational open-label PETRA study. In this study data of office BP measurements and 24-hour ambulatory BP monitoring (ABPM) were obtained from 11209 ambulatory patients (47.6% women) with AH. Initial mean office BP (BPmoff) was 156.58±16.10/91.56±9.33 mm Hg, AH duration - 9.48±7.19 years. After switching to triple fixed dose combination of perindopril, indapamide, and amlodipine BPmoff decreased by 24.81±15.47/11.41±9.90 mm Hg (p<0.0001). Doses of perindopril, indapamide, and amlodipine in combination at the final visit were 5/1.25/5, 10/2.5/5, and 10/2.5/10 mg. 24-hour ambulatory BP monitoring (ABPM) was carried out in 76 patients. Mean 24-hour BP lowed from mean 155.51±17.43/85.28±11.48 down to 134.63±12.51/77.83±8.99 mm Hg (p<0.0001). Clinically relevant improvement of a number of parameters of metabolism occurred after 3 months of the study (in particular, lowering of levels of total and low-density lipoprotein cholesterol [-8.6 and - 11.4%, respectively], triglycerides [-12,1%], fasting blood glucose [-6.6%]). Thus, results of the PETRA study confirmed 24-hour long antihypertensive efficacy of triple fixed dose combination of perindopril, indapamide, and amlodipine. This drug combination can present novel possibility in treatment of patients with AH who have not achieved target BP values on preceding dual combination therapy and fully corresponds with the single pill concept for formation of adherence to therapy.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. In this article we present a clinical case of a quick recovery and restoration of pulmonary function after withdrawal of amiodarone in a patient with drug-associated acute lung injury induced by intake of amiodarone for two months.

© 2018 American Leather Chemists Association. All rights reserved. Classification, mechanism of action, features of pharmacodynamics and pharmacokinetics, and indications for use of chondroprotectors (drugs promoting the regeneration of cartilage tissue) are presented. Comparative analysis of experimental and clinical studies of main representatives of this group of drug has been performed.

For the purpose of studying the possibility of labor functions development for public health and healthcare during training in the educational organizations the comparative analysis of provisions of the professional standard with the materials stated in textbooks and national manuals of the corresponding profile was carried out. It was found that in the development of Federal state educational standards of higher education in dentistry (specialization level), updating educational methodological publications on dentistry and public health, the formation of a unified database of evaluation tools for accreditation of specialists and obtaining or confirming qualification categories, it is necessary to take into account the content of labor functions of the professional standard in each discipline.

© 2018 Cardiovascular Therapy and Prevention. The article discusses the role of telmisartan in the treatment of arterial hypertension in patients with metabolic syndrome. Telmisartan is second-generation type 1 angiotensin II receptor blocker, which has unique pleiotropic effects due to partial affinity for receptors that activate the proliferation of subtype γ peroxisomes (PPARγ) located in adipose tissue. The interrelation of metaflamation, a specific chronic inflammatory process with pathogenetic mechanisms of development of cardiovascular diseases, including arterial hypertension, is also described in study. The role of the adiponectin peptide is considered, which synthesis is stimulated by partial PPARγ receptor agonists (as mentioned above - telmisartan). It has a positive effect on fat and carbohydrate metabolism, as well as cardioprotective properties. The conclusion contains the results of numerous randomized studies and meta-analyzes confirming the high efficacy of telmisartan in the treatment of arterial hypertension in patients with morbid obesity.

© 2018 Cardiovascular Therapy and Prevention. Modern appropriate treatment of hypertension involves the use of combination antihypertensive therapy. According to updated version of European Society of Cardiology 2018 guidelines, renin-angiotensinaldosterone system blockers must be used as first-line drugs, including in combination with hydrochlorothiazide. This article presents the algorithms for the management of patients with uncomplicated and asymptomatic (with target lesions) arterial hypertension. It also described the management of patients with concomitant cardiovascular, cerebrovascular, renal pathology and diabetes mellitus, and use of fixed combination of candesartan and hydrochlorothiazide. The article presents research data that confirmed not only the high antihypertensive efficacy of this combination, but also demonstrated its neutral metabolic profile, organ-protective effects, the ability to use in patients with chronic kidney disease, chronic heart failure, prior stroke, as well as high tolerability and treatment adherence.

© 2018 Authors. The authors substantiate the need to develop a scientific and methodical approach to modernizing business processes of a pharmacy using information technologies. IK FARM LLC pharmacy has been chosen as a model object of the study. The IDEF0 (Integrated Definition Function Modeling) method adopted as a state standard in the US and recommendations of the State Standard of Russia R 50.1.028-2001 have been used for the analysis, systematization and reorganization of business processes. The article offers methodology for optimizing the pharmacy's activities, which includes the building of two models for managing business processes - before and after modernization (AS-IS and AS-WILL). The structure of the AS-WILL model includes new functions: "Plan the pharmacy's activities" (set the goals and objectives of the organization, plan target sales for the next period) and "Monitor the pharmacy's activities" (control the compliance with the rules of drugs' storage and layout, sanitary regime, and rules of property operation). The complex automation of the pharmacy's trading activities ensures these functions through the Magister software. Estimated efficiency of business processes' modernization based on the net present value has indicated that automation of processes will increase net unreduced profit.

© 2018 Media Sphera Publishing Group. All rights reserved. Aim. To perform a comparative analysis of anemia of chronic disease (ACD) and iron-deficiency anemia (IDA) in late middle-aged and elderly patients with chronic heart failure (CHF) by ferrokinetic parameters, inflammation indexes, and their associations. Materials and methods. 65 patients with ischemic heart disease were evaluated, including 35 patients with CHF and ACD, 10 patients with CHF and IDA, and 20 patients without CHF, ACD, and IDA (control group, CG). Results. Patients with CHF and IDA had true iron deficiency whereas 54% of patients with CHF and ACD had functional iron deficiency, and 46% of patients had no iron deficiency. Levels of acute phase proteins, ferritin and hepcidin, C-reactive protein (CRP), and interIeukin-6 (IL-6) were highly sig-nificantly different in patients with CHF and ACD and patients with CHF and IDA; positive and significant correlations were found for levels of IL-6 and ferritin, IL-6 and CRP, and CRP and hepcidin. In patients with CHF and IDA, levels of acute phase proteins, ferritin and hepcidin, CRP, and IL-6 were low and correlations of IL-6 with ferritin, IL-6 with CRP, and CRP with hepcidin were non-significant. Concentrations of erythropoietin were significantly higher in patients with CHF and ACD and patients with CHF and IDA compared to the control group; however, significant differences between them were absent.

© 2018 Copyright A. Hubail et al. Lupus pernio (LP) is a chronic non-life threatining type of cutaneous sarcoidosis that can be related to chronic fibrotic sarcoidosis, hyperglobulinemia and hypercalcemia. The aim of this case report is to evaluate the clinical and demographic features of cutaneous sarcoidosis mainly presenting with a rare manifestation of LP. In this paper we report a case of systemic sarcoidosis presenting with LP and a review of the available literature. LP is a rare presentation with infiltrated erythematoviolaceous plaques affecting the nose. We address the main management approach, and possible association with an underlying systemic sarcoidosis. LP is a rare but chronic manifestation of systemic sarcoidosis that needs to be treated in order to prevent cosmetic defects and psychological effects. It is important to recognize such a condition early in order to avoid a delay in treatment and worsening of the condition, both physically and psychologically. Further research regarding the diagnostic approach and management is required to understand this condition thoroughly. n-

© Russian Journal of Cardiology. Renin-angiotensin-aldosterone axis activation is an important mechanism of hypertension and its cardiovascular and renal complications. Angiotensin receptor blockers are considered among the first-choice antihypertensive drugs in Russia, European countries, and the USA. In addition to antihypertensive action, these drugs positively influence several components of the cardiovascular continuum and can be used for individualized management of high cardiovascular risk patients. The paper discusses the benefits of angiotensin receptor blockers use in patients with cardiovascular comorbidities. The paper includes a clinical case scenario revealing antihypertensive efficacy of telmisartan as an initial agent in a patient with high risk of cardiovascular events.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To study the effect of сavinton comforte (CC) on the severity of cognitive impairment and motor awkwardness in patients with chronic brain ischemia (HIGM). Material and methods. There were 30 patients (8 men, 22 women) aged 50—65 years (61.6±4.9 years on average) with AHU with cognitive impairment. We used tests of MINI-Cog, Munsterberg, TMT), ADL). QC appointed 10 mg 3 times a day for 3 months. Results. Against the background of therapy, the improvement of constructive praxis and short-term memory, an increase in the speed of visual search and visual-motor function, an increase in the level of selectivity of attention, an improvement in the reproduction of visual images and perception, an increase in the speed of the motor task (drawing strokes). Conclusion. The obtained data can testify about the improvement of indicators of function of a small motility of brushes on the background of improvement of cognitive functions.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To study the efficacy of various methods of non-drug therapy of diseases manifested by vertigo and dizziness in neurological practice. Material and methods. Referral and final diagnoses were compared after neurovestibular examination of 599 patients (177 men and 422 women), aged 25 to 79 years (mean age 55 years), with various causes of vertigo. Patients underwent vestibular rehabilitation, trainings on the stabiloplatform with biological feedback (biofeedback), repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV). Severity of dizziness on a Visual analogue scale of dizziness (VAS-d) and balance on stabilography before and after a course of vestibular rehabilitation was analyzed. Results. Before neurovestibular examination, the diagnoses of vertebrobasilar insufficiency (44%), hypertensive or atherosclerotic encephalopathy (35%), cervical spondyloarthrosis (8%), autonomic dystonia (11%)) are often considered mistakenly as the causes of vertigo and dizziness. After neurovestibular examination, the diagnoses were as follows: BPPV (39%), phobic postural vertigo (29%), Ménière’s disease (14%), vestibular neuritis (11%), multisensory dizziness in elderly (5%). The effectiveness of repositioning maneuvers in BPPV was 90,2% after the first session and 100% after the second session. After a course of vestibular exercises and trainings on the stabiloplatform with biofeedback, there was the marked improvement in indicators of stabilography and VAS-d in patients with vestibular neuritis, Meniere’s disease, phobic postural vertigo (p<0.05). Vestibular rehabilitation was most effective if started within the first month after vestibular neuritis. There was the high efficacy of complex rehabilitation, including vestibular exercises and trainings on stabilographic platform with biofeedback, in patients with Meniere’s disease. In the rehabilitation of patients with phobic postural vertigo, better results were achieved when vestibular exercises were combined with trainings on stabilographic platform with biofeedback and psychotherapy. Conclusion. The results demonstrated the low accuracy of diagnosis of diseases manifested by vertigo and dizziness and high efficacy of non-drug therapy in most cases, especially BPPV, vestibular neuritis, Meniere’s disease, postural phobic vertigo.

© 2018, Dynasty Publishing House. All rights reserved. The article analyzes a favourable outcome of multiple pregnancy achieved after using assisted reproductive technologies and donor egg in a patient with recurrent pregnancy loss and combined thrombophilia.