Репозиторий Университета

Chronic obstructive pulmonary disease (COPD) is one of the main causes of disease and death incidences worldwide. Different organs and systems are involved in COPD activating tissue hypoxia. It affects especially tissue functioning with the high level of intensity of metabolic processes, and the nervous system suffers first. Neuroimaging studies show white and grey matter damage and cerebral atrophy, which may clinically manifest themselves in different neurological symptoms depended on vascular system lesions, and cognitive and affective impairments. Despite of its potential importance, encephalopathy in COPD remains a little-studied concomitant pathology. Application of cytoprotective drugs is pathogenetically justified in this case and must be included in COPD complex therapy. In particular, the inclusion of mexicor in the treatment of patients with chronic pulmonary heart increases the efficacy of treatment of the main and associated diseases (chronic cerebral ischemia, cardiac insufficiency and arrhythmia).

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. A special place among liver diseases is occupied by various tumors and tumor-like lesions. In recent years in clinical practice the possibilities of correct diagnosis have increased significantly as a result of the introduction of advanced diagnostic equipment and wide usage of various contrast agents at studies of the abdominal cavity using the ultrasound method (US), multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). In addition, the differential diagnosis of benign and malignant lesions has been simplified even when the size of the lesions is less than 1 cm. This scientific review describes the capabilities of the "routine" method of the liver diagnostics – US, as well as the latest techniques that are being introduced into the modern practice such as: US with intravenous contrast enhancement, US elastography and perfusion CT and MRI. The advantages of each method are presented as well as the limitations of their use in clinical practice.

The tendency to anxiety is a characteristic feature of alcohol abusers, and anxiety can be a symptom of alcohol withdrawal as well as comorbid disorder. The frequent comorbidity of alcohol use disorders and anxiety is due to a number of reasons including general hereditary predisposition, mutual conditioning and similar pathogenesis. Pharmacological therapy of anxiety disorders in alcohol-dependent patients is carried out on the basis of general principles of anxiety treatment and involves the use of benzodiazepines, antidepressants and, in some cases, antipsychotics as second-line medicines.

© 2018, Media Sphera Publishing Group. All rights reserved. The main cause of reflectory cough is neurogenic hyperventilation. The clinical signs of reflectory cough include its dry and back-breaking character, the gradual increase and abrupt beginning, impossibility to stop the coughing fit, and the feeling of shortness of breath. The triggers of a coughing attack can be a deep breath, a talk, physical and/or psycho-emotional stress, fatigue, and other sensations. The typical laryngological signs of the condition in question include the broad glottal aperture (up to 20 mm and more in contrast to its normal maximum width of 15 mm) and the spasm of the vocal cords in response to inspiration. The clinic of Diseases of Ear, Throat and Nose affiliated with I.M. Sechenov First Moscow State Medical University has gained the extensive experience with the treatment of more than 500 patients presenting with reflectory cough. All these patients received the combined treatment including 10 procedures for intracutaneous novocaine blockade of the Zakhar’in- Geda zones in the larynx in the combination with auricular reflexotherapy and respiratory gymnastics intended to eliminate hyperventilation and sedative medications and myorelaxants to remove the pathologically enhanced muscle tone as well as calcium-containing preparations if indicated.

© 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. 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 resvered. The article presents a clinical case of vaginal hysterectomy in the absence of genital prolapse in a patient with adenomyosis and anaemia, who before surgery complaint of discomfort in the vagina after local treatment with metronidazole medications. Before and after surgery vaginal lavage with a solution of benzydamine hydrochloride (Tantum® Rosa) was performed. Symptoms of discomfort were alleviated within the first 24 hours of the postoperative period. A marked anaesthetic effect of the drug was noted. No adverse effects were recorded. The conclusion is made of the appropriateness of using Tantum® Rosa in the postoperative period after vaginal hysterectomies.

© 2018, Dynasty Publishing House. All rights reserved. At present the incidence rates of urogenital chlamydiosis maintain the leading positions among sexually transmitted infections. Special attention to this infection is conditioned by a high risk for development of complications on the part of the reproductive system in both women and men. The ability of Chlamydia to affect various tissues accounts for a broad spectrum of clinical manifestations of urogenital pathologies: urethritis, vulvovaginitis, cervicitis, endometritis, salpingitis, epididymitis, prostatitis, proctitis, and also extragenital forms of disease. Taking into account a possibility of transition of Chlamydia infection into a latent stage with subsequent development of a chronic persisting course, early and adequate management of infection is of considerable importance. Etiotropic therapy of Chlamydia infection employs antibacterial drugs capable of penetrating into cells. Tetracycline antibiotics are the most effective drugs of choice administered as part of complex therapy. Minolexin is a tetracycline antibiotic that demonstrates the best effectiveness in the fight against infectious agents affecting the urogenital tract. The article presents the author’s clinical experience of using minolexin for management of urogenital chlamydiosis in 60 patients.

© 2018, Media Sphera Publishing Group. All rights reserved. Antidepressants are among the most commonly prescribed drugs due to their effectivenes in treating depression and anxiety disorders. One of the reasons for early discontinuation of taking antidepressants are side-effects. Agomelatine is a relatively novel antidepressant with high efficacy and good tolerance. Clinical effects of agomelatine include a reduction in symptoms of depression, anti-anxiety and hypnotic effects, as well as the rapid elimination of anhedonia, which determines high adherence to therapy, restoration of normal social functioning, and complete remission of disease.

© 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.

© 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 Authors. This article presents the results of studies devoted to assessing the survival of students' knowledge, regardless of their basic training. The study was conducted based on two groups of specialists, recertified under the program "Pharmacy management and economics" at the Pharmacy Department of Sechenov First Moscow State Medical University. Some of the specialists of the experimental groups had been previously trained at the Pharmacy Department of Sechenov First Moscow State Medical University in 2012-2013 using a new devel-oped didactic tool named "Activity Book". According to the results obtained, the skills acquired by the specialists trained using on "Activity Book" in 2012-2013, were characterized by higher "survivability".

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The paediatric patient is considered to be a child. However, when it comes to communication with a patient, his consent, implementation of appointments, then the party of interaction is supposed to be an adult. In this regard, the paediatric patient is represented by a child-adult alliance, which allows us to speak of a 'complex patient'. At the same time, his personal agency (the ability to independently formulate a complaint, accept appointments and achieve compliance) changes with the age of a child, coming to him from an adult. This determines the efficacy of screening as well as the main tactics of interaction between the doctor and the patient, explanation, and compliance. Based on the theory of periodization of the personality development, answers are given to the questions: who, a child or an adult, formulates a complaint, who accepts the explanation and who is the subject to compliance? It has been shown that in early childhood (up to 3 years) the patient's subjectivity in the formulation of a complaint and a picture of the disease, the perception of prescriptions and adherence to compliance is provided by the parent. During the pre-school (3-7 years) and primary school (7-11 years) periods, the picture is mosaic: the doctor compares the opinion of the parent and his child to get a picture of the disease, he gives prescriptions to the parent and/or to the child, so both of them can be a subject to compliance. And only in adolescence (12-17 years) a child can be almost a completely independent subject in all aspects of interaction in the doctor-patient system.

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.

Decision-making process is often complex, responsible and not always reflected in surgical protocol. Some surgeons usually prefer standard finishing of procedure; others talk about individual approach but they have some preferences; the third ones analyze all possible perioperative factors (pre- and intraoperative data) and seek to justify differentiated approach. Some aspects of these processes are discussed in this report.

© 2018, © 2018 Informa UK Limited, trading as Taylor  &  Francis Group. Background: Antiphospholipid antibodies (aPL) have a multifaceted effect on the hemostatic system, damaging all its protective links. Aim: To study the effect of APA on outcomes of assisted reproductive technologies (ART). Study design: We examined 267 women with infertility, who planned pregnancy using ART. They included 178 women with IVF failure (I group) and 89 women with pregnancy after the IVF program (II group). The comparison group consisted of 80 pregnant women after IVF (male factor); a control group included 80 pregnant women with physiological pregnancy. Results of study demonstrated a high frequency of aPL circulation in a group of women with IVF failures. Overall, the proportion of aPL among all 267 women who planned pregnancy with ART was 32.6%. Elevated levels of aPL in the structure of causes of IVF failures (group I) were observed in 42.1% of them. Among women whose pregnancy occurred with ART (II group) the rate of APA was 19.1%. In the comparison group, in 6.3% of cases, aPL circulation was observed. In the control group, the rate was 3.4%. Conclusion: Considering the high percentage of aPL circulation in the case of IVF failures, authors think that high titers of aPL are a temporary contraindication for IVF. Patients with a history of aPL circulation are required to receive anticoagulant therapy from the first days of the hormonal protocol. The drug of choice is a group of low molecular weight heparins (LMWH). An individual approach is extremely important with the possible identification of causes of IVF failures and selective therapy, which leads to a significant improvement in the outcomes of the IVF program.

© 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, Dynasty Publishing House. All rights reserved. A clinical observation of the patient (26 years) is presented, for whom prolene (a non-absorbable monofilament suture material with a perfectly smooth surface) was used for the recovery of the wound in the uterus during Caesarean section. Numerous prolene sutures were hanging free in the uterine cavity and performed a peculiar function of intrauterine contraceptive. After excision of sutures by the resectoscope loop, fertility was restored.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To study the effectiveness, safety and tolerance of Viferon® (human recombinant interferon alpha-2b with antioxidants vitamins Е and С) as compared with standard therapy in complex treatment of mixed female urogenital infections during pregnancy and the effect of Viferon® on the formation of immunity in ontogenesis and during the early adaptation period of newborns. Patients and methods. The study included 70 women aged 18 to 40 years with mixed urogenital infections. The treatment group included 36 patients, who received etiotropic antimicrobial and antiviral therapy, underwent correction of immune status disorders and restoration of vaginal colonisation resistance. Along with standard therapy, patients of the treatment group received Viferon®, suppositories 500 000 IU, according to the schedule: 1 suppository 2 times/day every day for 10 days, then 1 suppository 2 times/day for 9 days with a 3-day interval. Aftre that, Viferon®, suppositories 150 000 IU 1 suppository 2 times daily every day for 5 days every 4 weeks until delivery. The control group comprised 34 patients who received standard therapy without interferon correction. All patients received standard therapy appropriate for their disease. Results. Among the patients receiving Viferon®, the development of placental insufficiency was recorded by 2 times more rarely. In the treatment group (Viferon®), fetal growth restriction (IUGR) was diagnosed only in 8.3%. In the control group, IUGR was found in 22% (OR + 2.65). In the treatment group, the incidence of fetal CMV infection was reduced by 16 timesd anf of herpesvirus infection type 2 – by 10 times. In the group of patients who did not use Viferon®, the share of newborns with CNS lesions amounted to 18.4%, whereas in the treatment group it approached 6.5% (OR –2.83). Inclusion of Viferon® in complex therapy resulted in a lower incidence of infectious lesions of the skin and mucous membranes of the newborn infants (amniotic fluid infection syndrome) by 5.8 times. Colclusion. The use of Viferon® (human recombinant interferon alpha-2b with antioxidants vitamins Е and С) suppositories in complex therapy in pregnant women with infection promotes a faster elimination of viruses, a significant decrease of the signs of threatened miscarriage, premature labour, risk for developing PI and IUGR, associated with inflammatory process (p < 0.05).

AIM: To evaluate the results of selective approach for splenic flexure mobilization (SFM) after total mesorectal excision with low colorectal anastomoses. MATERIAL AND METHODS: Clinical data were obtained from the multicenter RCT database comparing ileostomy and colostomy in patients with rectal cancer who underwent total mesorectal excision from 2012 to 2017. Our clinic policy is performing paraaortic lymph node dissection with 'low' inferior mesenteric artery ligation, left colic artery preservation and use of sigmoid colon for colorectal anastomosis. SFM was used only in cases of inability to apply above-mentioned procedure (selective approach for SFM). RESULTS: SFM was performed in 15 (13%) out of 115 patients. The most frequent reasons for SFM were sigmoid colon diverticulosis, impaired blood supply or inadequate length of sigmoid colon. There were no differences in intraoperative and postoperative complications between TME without SFM and TME with SFM. CONCLUSION: Selective SFM in TME followed by advanced paraaortic lymph node dissection and left colic artery preservation is safe and may be considered as a viable option to routine SFM in rectal cancer surgery.