Репозиторий Университета

© 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, Media Sphera Publishing Group. All rights reserved. Objective. To study clinical characteristics of depression in women and men. Material and methods. One hundred and twenty women, aged from 18 to 65 years, and 67 age-matched men with the diagnosis of recurrent depressive disorder (RDD) (ICD-10 F33) were examined using a specially developed survey. Results. Differences in the clinical picture and course of RDD in women and men were found. RDD in women develops at an earlier age, the number of attacks is greater but remissions are longer. However, complete remission is achieved more frequently in men. Most typical effect in the structure of depression in women is anxiety whereas melancholy prevails in men. Daily mood fluctuations and suicidal thoughts are characteristic of women. Motor retardation and decreased motivation are more frequent in men. Ideas of self-blame, avoidance of contacts with other people, adynamia, persistent sense of fatigue are more common in women. Sleep disorders are equally common in men and women but falling asleep disturbance and lack of sleep feeling are more common in women. Somatic symptoms of depression are generally more common in men as well as concomitant diseases of cardiovascular, respiratory and genitourinary systems. Men are more likely to abuse alcohol and other psychoactive substances. Conclusion. The identified characteristics of depression in women and men allow more accurate diagnosis and treatment recommendations.

Prevalence, risk factors of primary pancreatic tuberculosis, clinical symptoms and data of instrumental and laboratory diagnosis are reviewed in the article. The authors emphasized the peculiarities of differential diagnosis with pancreatic malignancies and advisability of the most informative methods - endoscopy and fine-needle aspiration procedure.

© 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, 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.

© 2018 Pirogov Russian National Research Medical University. All rights reserved. Mathematical modeling of pharmacokinetic (PK) and pharmacodynamic (PD) parameters essential for establishing correct dosing regimens is an alternative to pharmacokinetic studies (PKS) adopted in the clinical setting. The aim of this work was to compare the values of PK parameters for vancomycin obtained in an actual PKS and through MM in postoperative patients with kidney injury. Our prospective study included 61 patients (47 males and 14 females aged 60.59 ± 12.23 years). During PKS, drug concentrations at steady state Сtrough and Cpeak were measured by high-performance liquid chromatography followed by the calculation of the area under the plasma concentration-time curve AUC24. For mathematical modeling, a single-compartment model was employed; PK parameters were estimated using R 3.4.0. The values of Ctrough measured 48 h after the onset of antibiotic therapy during PKS were significantly lower than those predicted by MM (р = 0.004). In a group of patients with acute kidney injury (AKI), AUC24 measured at the end of treatment was significantly higher than its value predicted by MM (р = 0.011). The probability of achieving the target AUC24 to MIC ratio of over 400 µg•h /ml is higher in the group of patients with Ctrough = 10–15 µg /ml. Our findings confirm that the use of MM in postoperative patients with renal dysfunction is limited and therapeutic drug monitoring should be used instead.

© 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved. Bolshaya Pirogovskaya ul. 2-4, Moscow, 119435 Russia Pericarditis is not enough researched and described in literature despite the emergence of a large quantity of up-to-date laboratory and instrumental methods of verification. The main problem is that pericarditis might be a sign of many infectious and non-infectious diseases. It is quite difficult to define the etiopathogenetic reason of process. The article presents a clinical observation of a 53 years old mail patient with paroxysms of atrial flutter, non-symptomatic febrile fever, arthralgia and signs of exudative pericarditis, which were manifested after the acute viral infection. The symptoms have been lasting for 8 months before the patient's hospitalization. In lab tests anemia, leucopenia, increase level of platelets and increase antinuclear antibody level were found. Several conceptions were considered: cancer with paraneoplastic syndrome, systemic disease, infectious process, myeloma, which were subsequently excluded. Due to the fact that pericardial effusion may often be associated with tuberculosis Diaskin test and T-SPOT were performed and they appeared to be positive. After several months of antituberculous treatment temperature normalized, atrial flutter episodes and arthralgia diminished. So empirically and laboratory tuberculous pericarditis with atypical manifestation was confirmed. The particularity of this observation is a nontypical clinical picture and the absence of a primary focus of infection. That is why the clinicians could not define the diagnosis rapidly.

© 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved. This article affects the problems of using NOAC in the most defenseless groups of patients with atrial fibrillation: those who have high bleeding and high thromboembolic risk and elderly. The focus is on comparison of effectiveness and safety of NOACs based on randomized clinical trials (RCT) and real-world data (RWD). The possible reasons for the different interpretation of the data of the RCT and the RWD are shown. Use of NOAC in reduced doses prescribing according to RCT and RWD are shown. Our own 13-month observation of patients 75 years and older with very high thromboembolic risk (CHA2DS2-VASc-4,5 points) on rivaroxaban therapy are presented. Good efficacy and safety of full and reduced doses of rivaroxaban were demonstrated: only 2 episodes of small bleedings and no large bleedings (ISTH criteria) were detected as well as no thromboembolic events. Thus, even difficult patients with AF and comorbidity may be safely and effectively treated with NOACs taking into consideration integrated approach and correction of modifiable risk factors.

© 2018 National Research University Higher School of Economics. All rights reserved. Thiamphenicol glycinate acetylcysteinate (TGA) is a combination of thiamphenicol, a broad-spectrum antibiotic, and mucolytic drug N-acetylcysteine. This article is a review of pharmacological, microbiological, and clinical effects of this combined drug. Inhaled TGA could be considered as a worthy alternative for oral mucolytics and oral antibiotics in treatment of upper and lower airway diseases, such as acute and chronic rhinosinusitis, otitis media, tonsillitis, acute bronchitis, and acute exacerbation of chronic bronchitis and chronic obstructive pulmonary disease, in children and adults.

© 2018 Vitebsk State Medical University. All rights reserved. Objective: To study the efficacy and to establish expedience of antibiotic treatment for diverticulitis. Methods: The retrospective analysis of 141 medical histories was made of patients with acute uncomplicated diverticulitis, who were treated during the period from 2013 to 2016 years. Antibiotics were prescribed to treat 85 (60.3%) patients (the main group), 56 (39.7%) patients (the control group) were not given antibacterial drugs. To assess the treatment effectiveness, a dynamic assessment of the clinical picture and laboratory indicators was performed. In the long-term period patients were questioned to determine the nature of the course and the occurrence of relapses of diverticulitis. Results: The duration of hospitalization of the main group patients was 10.8+3.2 days (M+o), control -11.2+2.6 days (M+o), p>0.05. During the treatment, disease progression was registered in none of the patients. In the main group the body temperature was normalized after 1.6 + 0.4 days, in the control group after 1.7+0.3 days, p>0.05. The level of leukocytes came back to normal in the main group at 2.7+0.8 days, in the control group at 2.9+0.7 days (p>0.05). Long-term results were evaluated in 82 (96.5%) of patients and 55 (98.2%) in the control group. Use of antibiotic treatment in diverticulitis had no effect in the remote period for redevelopment of complications (OR 1.19; CI 0.58-2.44), the need to seek medical care (OR 1.11; CI 0.52-2.34), need for hospitalization (OR 0.95, CI 0.3-2.96) and surgical treatment (OR 1.36, CI 0.34-7.69). Conclusions: The use of antibiotic treatment for diverticulitis does not affect the outcome of treatment and does not determine the further course of the disease. Taking into account the increasing resistance of microorganisms to antibiotics and the need to optimize costs with limited funding for health care, it is advisable to exclude the use of antibacterial drugs for the treatment of uncomplicated diverticulitis.

© 2018, Media Sphera Publishing Group. All rights reserved. The authors describe manifestations of chronic cerebral ischemia (CCI) and present the cases of a combination of primary headache and CCI. Management of patients with CCI and headache and the use of vazobral and its efficacy in treatment of such patients are discussed.

© 2018, Media Sphera Publishing Group. All rights reserved. Alzheimer’s disease and vascular dementia are two most common causes of dementia in late life. The combination of Alzheimer’s type dementia and vascular dementia is the third most common form of dementia, especially in the elderly. Most clinical forms of dementia are characterized by the presence of «overlap» symptoms of both neurodegenerative and vascular pathology, which makes it expedient to consider mixed dementia as a separate entity characterized by clinical presentations, course and the rate of progression of cognitive decline. Despite the lack of clinical guidelines for management of patients with mixed dementia, it seems appropriate to use strategies that have shown their effectiveness in various types of cognitive impairment.

© 2018 Media Sphera Publishing Group. All rights reserved. Development and use of new anticancer drugs has resulted in the improving of 5-year survival rates in patients with cancer. However, many of the modern chemotherapies are associated with cardiovascular toxicities that increases cardiovascular risk in cancer patients, including hypertension, heart failure, thrombosis and thromboembolism, cardiomyopathy, and arrhythmias. These side effects limitation restrict treatment options and farther perspectives. With increasing use of modern chemotherapies and prolongation of the cancer patients survival, the incidence of cardiovascular disease in this patient population will continue to increase. Accordingly,careful assessment and management of cardiovascular risk factors in cancer patients by oncologists and cardiologists working together is essential for optimal care.

© 2018 Media Sphera Publishing Group.All Rights Reserved. The goal is to present the possibilities of diagnosis verification, the features of the clinical picture of tuberculous pericarditis in the therapeutic clinic and the results of its treatment. Materials and methods. The paper presents clinical observation and a general analysis of 10 cases of tuberculous pericarditis in patients aged 31-79 (mean age 58.0 ± 15.1 years), 6 women and 4 men. Diagnostic puncture pericardium was performed on two patients, pleural puncture - on three Thoracoscopic biopsy of hilar lymph nodes and lung (n=1), pleura (n=1), supraclavicular lymph node biopsy (n=1). Dyskin test was carried out, as well as sputum examination, multispiral computed tomography, oncological search. Results. A 31-year-old patient with a massive effusion in the pericardial cavity, pleural lesion, arthritis of the left knee joint, whose results of the pericardial effusion and sputum were not diagnosed, tuberculosis was detected only with thoracoscopic biopsy of the lung and intrathoracic lymph nodes; the treatment via prednisolone and subtotal pericardectomy was performed. Among 10 patients with MSCT of the lung, changes were noted in general, but in only one case they were highly specific. Diaskin test is positive in 70%. In the study of punctata, bronchoalveolar flushing, Koch bacteria were not detected; at sputum in microscopy and biological sample BC was detected in two patients. The lymphocytic character of effusion in the pericardium / pleura is noted in 4 out of 5 cases. At a biopsy of lymphonoduses and a lung at 2 patients the picture of a granulomatous inflammation with a caseous necrosis. Pericarditis was predominantly large (from 2 cm and more) effusion, signs of constriction were noted in 50% of patients. Conclusion. Tuberculosis is one of the frequent causes of pericarditis in the Moscow therapeutic clinic. The most lymphocytic effusion with fibrin and the development of constriction. The negative results of all laboratory tests for tuberculosis do not exclude a diagnosis, It is necessary to use invasive morphological diagnostics, including thoracoscopic biopsy.

© 2018 Media Sphera Publishing Group. All rights reserved. Cardiovascular diseases (CVD) are the main cause of death worldwide. A broad study of the pathogenetic mechanisms of the CVD onset and progression has led to understanding of the importance of endothelial dysfunction (ED) in these processes. During recent years intensive work has been conducted in the direction of searching for markers of ED. Metabolomics is an intensively advancing approach to early diagnostics of diseases. Metabolomic analysis based on mass spectrometry allows to study complete metabolic profiles and their deviations resulting from changes in expression of genes and RNA, protein activity, or environmental factors. Metabolomic analysis has already demonstrated significant results in the solving of different scientific and clinical problems. It appears to be a promising method for detecting early biomarkers of CVD. Various aspects of application of metabolomic profiling in the field of cardiovascular diseases are discussed in this article.

© 2018 Stolichnaya Izdatelskaya Kompaniya. The metabolic syndrome is a highly prevalent condition associated with increased cardiovascular risk in the population. Microvasculature is the terminal part of the cardiovascular system which primarily reacts to the increased secretion of the pro inflammatory adipokines typical for the metabolic syndrome. Microcirculation and blood cell abnormalities are the leading mechanisms of cardiovascular events development in this condition. Prevalence of microcirculation abnormalities and red blood cell dysfunction in metabolic syndrome and their role in the increased blood viscosity and cardiovascular events development are covered by the paper. The microcirculation abnormalities with a special focus on red blood cell dysfunction (impaired aggregation, stiffness) seen in metabolic syndrome and associated conditions are discussed in detail. The impact of abnormal red blood cell deformability (secondary to cholesterol accumulation in the cellular membranes) on the hemorheological abnormalities is revealed. Abnormal red blood cell surface charge due to proinflammatory changes associated with insulin resistance in diabetes mellitus is highlighted. These abnormalities lead to increased red blood cell aggregation and plasma viscosity that are the essential components of cardiovascular events pathogenesis. Their timely diagnosis is crucial for effective cardiovascular prevention.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. This clinical observation emphasizes the importance of a clear interaction between radiologists and surgeons within the treatment of primary spontaneous pneumothorax. Materials and methods. Patient A, 15 years old, was admitted to the thoracic department of the Faculty Surgery Clinic of the Sechenov University with complaints of dry cough, constant pain, uncomfortable sensations and edema in the left chest half, dyspnoea within physical exercises. Results. Based on the patient's complaints, the history of the present disease, data of subjective and objective investigation methods, the patient was diagnosed with a spontaneous primary left-sided pneumothorax complicated by the growing intermuscular emphysema. Controled by X-ray, the patient's pleural cavity was drained with subsequent air aspiration. Conclusion. The observation confirms the high information value of radiology diagnostic methods: thoracic X-ray and computed tomography. These methods allowed checking the effectiveness of each treatment stage, to diagnose such complication of primary spontaneous pneumothorax-increasing intermuscular emphysema and timely performing adequate surgical treatment.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Mainly, intracoronary thrombosis is the cause of acute coronary syndrome. The structure of the atherosclerotic plaque plays an important role in the development of the mechanism of intracoronary thrombosis. Currently, there are various radiological methods for diagnosis of atherosclerotic plaques of the coronary arteries. The current review reveals the theme of "indirect" signs of instability of atherosclerotic plaques, their combinations and occurrence, detected by computed tomography. Retrospective studies have shown the feasibility of these signs of plaques in the assessment of the prognosis of acute coronary events. The review compares the results of computed tomography (CT) and intravascular ultrasound, which is the gold standard in the diagnosis of atherosclerotic plaque morphology.