Klinicheskaia Meditsina[JOURNAL]
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200 papers
[The clinical course of atrial fibrillation in patients with coronary heart disease].
Podzolkov VI, Tarzimanova AI, Gataulin RG
Klin Med (Mosk) · 2016 · PMID 30289675
UNLABELLED: The modern medical literature practically does not contain clinical publications reporting studies of factors responsible for progression of atrial fibrillation (AF) in patients with coronary heart disease (C...
UNLABELLED: The modern medical literature practically does not contain clinical publications reporting studies of factors responsible for progression of atrial fibrillation (AF) in patients with coronary heart disease (CHD). It accounts for the importance of investigations into evolution of the clinical course of AF in such patients. AIM: To elucidate evolution of the clinical course of AF in patients with CHD in a long-term prospective study. MATERIALS AND METHODS: The study included. 112 patient aged 57-74 (mean 67.44±3.3) years with CHD and paroxysmal form of AF carried outfrom 2011 to 2015. Evolution of the clinical course of AF was evaluated based on the number of arrhythmic attacks during the last 3 months. The appearance of prolonged persistent AF episodes or permanent AF was regarded as progression of arrhythmia. RESULTS: During the 4 year study, 64 (57,2%) patients (group 1) did not experiencea rise in the frequency and duration of AF attacks. Progression of arrhythmia was documented in 48 (42,8%) of the 112 (100%) patients (group 2). These patients more frequently had the history of myocardial infarction and chronic heart failure than patients of group 1. The latter had the mean values of left ventricular (LV) ejection fraction 61,23±6,24%, i.e. significantly higher than 48,47±8,4% in group 2.47 and 28 % of the patients in group 2and 1 respectively suffered mitral regurgitation (p<0,05). Patients of group 2 had significantly more akineticzones. Intake of nitroglycerin in group 1 resulted in positive dynamics of local LV contractility that did not change in patients of group 2. CONCLUSION: 42,8% of the patients with CHD and paroxysmal form of AF experienced progression of arrhythmia into a persistent or permanent form. Predictors of AF progression in patients with CHD are the history of myocardial infarction, chronic heart failure, mitral regurgitation, and irreversible changes in local myocardial LV contraction.
[THE HISTORY OF DEPARTMENT OF FACULTY THERAPY, AT THE VORONEZH HIGHER EDUCATION INSTITUTION (ON THE OCCASION OF THE CENTENARY ANNIVERSARY OF N.N. BURDENKO VORONEZH STATE MEDICAL UNIVERSITY)].
Budnevsky AV, Provotorov VM, Filatova YI
Klin Med (Mosk) · 2017 · PMID 30311765
The article is devoted to the history of the Department of Faculty Therapy, N.N. Burdenko Voronezh State Medical University. The history of its creation is inextricably linked to the Derpth (Yurievsky) University that wa...
The article is devoted to the history of the Department of Faculty Therapy, N.N. Burdenko Voronezh State Medical University. The history of its creation is inextricably linked to the Derpth (Yurievsky) University that was transferred to Voronezh in 1918. While the Department of Faculty Therapy remained in Voronezh, it several times changed location making use of various city hospitals as its branches. It simultaneously expanded its activities by organizing courses of physical therapy, endocrinology, and other medical disciplines. The article focuses on the events pertaining to the formation and development of the Department of Faculty Therapy, main directions and achievements of its scientific work.
[KYOTO CONSENSUS - THE NEW ETIOLOGICAL CLASSIFICATION OF CHRONIC GASTRITIS AND ITS DISCUSSION].
Tsimmerman YS, Zakharova YA
Klin Med (Mosk) · 2017 · PMID 30311764
The main provisions and headings of the new etiological classification of chronic gastritis are discussed in the context of recent data on the true role of Helicobacter pylori infection in the development of this patholo...
The main provisions and headings of the new etiological classification of chronic gastritis are discussed in the context of recent data on the true role of Helicobacter pylori infection in the development of this pathology. The methods and results of the authors ’ investigations into gastric microflora are presented along with information about the frequency of detection of its different forms, concentration of microbial forms in gastric mucosa, their pathogenic properties including urease activity, and possible contribution to chronic gastritis etiology. The possibility of alcoholic and chemical chronic gastritis is discussed along with the role of these conditions in the development of stomach cancer. Special emphasis is laid on the disagreement between the adopted consensuses and principles of evidence-based medicine.
[PITUITARY ADENOMA APOPLEXY].
Tereshchenko IV
Klin Med (Mosk) · 2017 · PMID 30311763
We present 3 cases of pituitary adenoma apoplexy in young women (one microadenoma and two macroadenomas). The possible risk factors, clinical presentation and outcome of pituitary apoplexy are discussed. Diagnostic error...
We present 3 cases of pituitary adenoma apoplexy in young women (one microadenoma and two macroadenomas). The possible risk factors, clinical presentation and outcome of pituitary apoplexy are discussed. Diagnostic errors as regards pituitary adenoma apoplexy are analyzed.
[A CASE OF FAMILIAL PULMONARY AND HEPATIC ECHINOCOCCOSIS)].
Tsvetkova OA, Voronkova OO, Ovchinnikova DV
Klin Med (Mosk) · 2017 · PMID 30311762
Echinococcus granulosus still remains a widespread disease. Moreover, there is a large number of patients in whom it is diagnosed rather late because its clinical presentation can be unspecific and symptoms vary. We repo...
Echinococcus granulosus still remains a widespread disease. Moreover, there is a large number of patients in whom it is diagnosed rather late because its clinical presentation can be unspecific and symptoms vary. We report a familial case of the disease. Its specific feature was the onset with the bilateral pulmonary process and late involvement of the liver. This excluded other pulmonary diseases, such as pneumonia, tuberculosis or cancer.
[SYSTEMIC LUPUS ERYTHEMATOSUS WITH LUPUS NEPHRITIS IN THE ELDERLY (CLINICAL OBSERVATION)].
Kanevskaya MZ, Kuznetsova OM
Klin Med (Mosk) · 2017 · PMID 30311761
We report a clinical case of SLE in a women affected at the age of 63 years who had recurrent nephrotic syndrome with the development of renal insufficiency at the onset and a good outcome of therapy with a large total d...
We report a clinical case of SLE in a women affected at the age of 63 years who had recurrent nephrotic syndrome with the development of renal insufficiency at the onset and a good outcome of therapy with a large total dose cyclophosphamide.
[TYPICAL ERRORS IN THERAPY OF GASTROESOPHAGEAL REFLUX DISEASE].
Chikunova MV, Khlynov IB, Khromtsova DV
Klin Med (Mosk) · 2017 · PMID 30311760
AIM: To analyze compliance of doctors with the clinical guidelines for the management of patients with gastroesophageal reflux disease (GERD) under outpatient clinic conditions. MATERIAL AND METHODS: An anonymous questio...
AIM: To analyze compliance of doctors with the clinical guidelines for the management of patients with gastroesophageal reflux disease (GERD) under outpatient clinic conditions. MATERIAL AND METHODS: An anonymous questionnaire study involving 104 general practitioners was undertaken. The questionnaires included items concerning lifestyle modifications, the use of proton pump inhibitors (PPI), dosage and time of their administration, combined therapy and endoscopic control. RESULTS: The analysis of the filled questionnaires demonstrated that 15,6% of the doctors always discuss the necessity changing lifestyle with GERD patients, 75% of the doctors discuss it but occasionally, and 9,4% never hold such discussions. 56,7% of the doctors begin treatment from double doses of proton pump inhibitors regardless of the endoscopic stage of esophagus damage. The mode of PPI administration is at variance with that recommended by the instruction in 61,5% of the cases. The basic course of erosive esophagitis treatment lasts 4, 2, and 8 weeks in 45,2%, 9,6%, and 45,2% of the cases. Treatment of GERD starts from combined therapy in 14,4% of the cases. Monotherapy with PPI is inefficient in 85,6% of the cases. Endoscopic control of erosive esophagitis is practiced by 51,9% of the doctors, 48,1% of the respondents recommend this diagnostic procedure only in the absence of clinical effect. CONCLUSION: Our analysis revealed typical mistakes in the treatment of patients with GERD, demonstrated the importance of expert control and support of training physicians, and introduction of modern quality standards into the practical management of patients with this pathology.
[CARDIOVASCULAR DISEASES: EVALUATION OF PERSISTING DISORDERS IN THE BLOOD CIRCULATION SYSTEM AND DISABILITY, CRITERIA FOR SEVERITY OF INVALIDISM].
Shurgaya MA
Klin Med (Mosk) · 2017 · PMID 30311757
A most important indicator of population health, its social and economic wellbeing is premature disability. 10.3 mln people had to retire from their jobs due to disability during the ten-year period from 2005 to 2014. Th...
A most important indicator of population health, its social and economic wellbeing is premature disability. 10.3 mln people had to retire from their jobs due to disability during the ten-year period from 2005 to 2014. The number of elderly subjects among them was twice that of the younger ones, with the leading cause of disability being blood circulation disorders (61,9%). At the same time, the fraction of old subjects in the group of invalids suffering from coronary heart disease and idiopathic hypertension accounted for only 58,9% and 40,9% respectively. The quantitative evaluation of persistent dysfunction of the cardiovascular system related to circulatory disturbances included in ICD class IX and to those referred to other classes is based mainly on an assessment of the following clinical and functional manifestations: pain syndrome (cardialgia or angina); hypertensive syndrome; pulmonary hypertension; arrhythmia; syncope. Other aspects of pathological process are taken into consideration, such as its form and severity, presence and frequency of exacerbations, magnitude, involvement of target organs, complications. The gerontological slant of disabling cardiovascular pathology accounts for its social significance (idiopathic hypertension, coronary heart disease, chronic heart failure) which requires the adequate solution of the problem of healthcare provisions taking account of the current demographic situation and increased life expectancy within the older population suffering from a number of chronic diseases.
[DENGUE FEVER IN RUSSIA: PROBLEMS OF DIAGNOSTICS].
Nafeev AA, Il'mukhina LV
Klin Med (Mosk) · 2017 · PMID 30311755
The authors report clinical and laboratory data concerning a case of hemorrhagic dengue fever introduced to Ul’yanovsk by a tourist who had spent holiday in Vietnam. The clinical picture of the disease is described along...
The authors report clinical and laboratory data concerning a case of hemorrhagic dengue fever introduced to Ul’yanovsk by a tourist who had spent holiday in Vietnam. The clinical picture of the disease is described along with results of clinical and laboratory analyses. The approaches to the evaluation of the patient's health status during the period of primary examination and medical care as well as the problems that arose after the final diagnosis was established are discussed.
[EVALUATION OF BODY MASS INDICES AND ARTERIAL PRESSURE AS CARDIOVASCULAR RISK FACTORS IN THE ADULT POPULATION OF THE CITY OF VORONEZH].
Kryuchkova AV, Seminina NM, Kondusova YV … +2 more , Poletaeva IA, Knyazeva AM
Klin Med (Mosk) · 2017 · PMID 30303672
AIM: To determine body mass index (BMI) and blood pressure (BP) of the Voronezh city adult population. MATERIALS AND METHODS: 1108 residents of Voronezh city at the age from 20 to 75 years were examined in 2015 including...
AIM: To determine body mass index (BMI) and blood pressure (BP) of the Voronezh city adult population. MATERIALS AND METHODS: 1108 residents of Voronezh city at the age from 20 to 75 years were examined in 2015 including measurement of their height, body mass, arterial pressure, and BMI calculation. Medical histories were analyzed to reveal arterial hypertension in the preceding period in the following age groups: 20-29, 30-39, 40-49, 50-59, 60-75 yr and the entire study group (20-75 yr). RESULTS: The mean BMI of the residents of Voronezh was 28.5 (23.8; 33.1) kg/m. The highest values were found between 40 and 59 years. BMI in women under 40 was lower than in men of the same age. The education level affected the prevalence of obesity in that people with secondary vocational education were more likely to be obese than those given higher education. At the age of 40, the incidence of hypertension among women was lower than among men of the same age, it more frequently occurred at the age of 60-75 years. Both age and BMI were related to the level of blood pressure: higher BMI and blood pressure were recorded at an older age. The prevalence of hypertension also increased with age. CONCLUSION: Obesity was detected in 29.7% of the Voronezh population recruited to the study. The prevalence of obesity among young adults (20-29 years) iproved lower than in the middle and old age groups. 30.9% of the residents suffered from AH.
[MODERN CLINICAL EPIDEMIOLOGICAL CHARACTERISTIC OF LUPUS ERYTHEMATOSUS BASED ON THE DATA OF REGIONAL REGISTRY].
Shaduro DV, Beloglazov VA, Petrov AV … +1 more , Aliev KA
Klin Med (Mosk) · 2017 · PMID 30303671
Systemic lupus erythematosus (SLE) is a severe rheumatic disease characterized by polysymptomatic clinical picture. At the present stage, there are no updated epidemiological data due to the low prevalence of the disease...
Systemic lupus erythematosus (SLE) is a severe rheumatic disease characterized by polysymptomatic clinical picture. At the present stage, there are no updated epidemiological data due to the low prevalence of the disease. The aim of the study was to examine the current clinical and epidemiological characteristics of patients with systemic lupus erythematosus based on the information contained in the territorial register, analysis of occurrence and symptoms at the early stage of the disease. This study demonstrated the epidemiological and clinical characteristics of SLE from the analysis of 107 cases during the period from 2011 to 2013 and retrospective analysis of the cases for 1980-2013. The epidemiological situation was evaluated based on extensive and intensive indicators using statistical software license. The current SLE prevalence was estimated at 5,59 per 100 000 population in 2013, the incidence between 1994 and 2003 at 0,29 per 100 000 population and between 2004 and 2013 at 0,49, with the peak in 2010 up to 1,35 per 100 000 population. The average absolute growth and growth rate of SLE in the first decade was 0,05% and 0,24%, in the second decade 0,001% and 0,006% respectively, with the female to male ratio being 9:1, mean age of the patients 37,62±11,65 years), and ethnic composition of 87 Slavs and 15 Crimean Tatars. The most common symptoms at the early (polyarthritis, fever, dermatitis) and advanced (polyarthritis, Raynaud's syndrome, carditis, myalgia) stages differed from those specified by American College of Rheumatology (1997). The difference between early and late symptoms of SLE was documented . Based on the data obtained, the division of the disease into clinical subtypes (phenotypes) is proposed.
[MELATONIN: THE POSSIBILITY TO ANALYSE THE MARKER OF AGE-RELATED PATHOLOGY IN THE BUCCAL EPITHELIUM AND URINE].
Konovalov SS, Polyakova VO, Drobintseva AO … +3 more , Kvetnoy IM, Kvetnaia TV, Linkova NS
Klin Med (Mosk) · 2017 · PMID 30303666
Extrapineal and pineal melatonin is the marker of the aging rate of organism making it possible to characterize functional condition of the neuro-immuno-endocrine system. In this article we have used the new method for n...
Extrapineal and pineal melatonin is the marker of the aging rate of organism making it possible to characterize functional condition of the neuro-immuno-endocrine system. In this article we have used the new method for non-invasive diagnostics of melatonin expression in buccal epithelium and determination of the main melatonin metabolite 6-hydroxymelatonin sulfate (6-HMS) in urine of elderly people. Normal, impaired and enhanced melatonin expression was documented in 20.5%, 43.2% and 36.30% of the patients respectively. Such comprehensive melatonin and 6-COMT studies can be recommended for elderly patients with oncological, neurodegenerative, cardiovascular diseases, and ageing macular dystrophy. Moreover, melatonin expression analysis in buccal cells can be used for integral investigation of biorhythms in elderly people.
[DIFFERENTIAL APPROACH TO THE EVALUATION OF RIGHT VENTRICULAR SYSTOLIC FUNCTION BY PULSED WAVE DOPPLER ULTRASOUND].
Mirzoyan ES, Nelasov NY, Babaev MV … +2 more , Volkov GP, Shumarin KA
Klin Med (Mosk) · 2017 · PMID 30303665
A method for diagnostics of systolic function of the right ventricle of the heart in patients with cardiovascular disease is proposed. Its application expands possibilities for detecting disorders of the discharge RV fun...
A method for diagnostics of systolic function of the right ventricle of the heart in patients with cardiovascular disease is proposed. Its application expands possibilities for detecting disorders of the discharge RV function using a conventional pulsed wave Doppler ultrasonography.
[THE INFLUENCE OF DEFICIT OF ENDOGENOUS NEUROPEPTIDES ON THE CLINICAL COURSE OF CORONARY HEART DISEASE].
Dontsov AV
Klin Med (Mosk) · 2017 · PMID 30303664
The study is aimed at elucidating the relationship between the blood b-endorphin level in patients with coronary heart disease (CHD) with metabolic syndrome (MS) and cardiovascular risk factors and evaluating the possibi...
The study is aimed at elucidating the relationship between the blood b-endorphin level in patients with coronary heart disease (CHD) with metabolic syndrome (MS) and cardiovascular risk factors and evaluating the possibility to correct them by dalargin therapy. The study included 123 patients (61 men and 62 women) at the mean age 57.6±5,2 years randomized into 2 groups. The patients of group 1 (n=63) were given the standard treatment, those of group 2 (n=60) additionally received 2 mg/day of dalargin for 10 days (3 courses during 3 months). The group of comparison (n=84) contained 84 CHD patients without MS. Biochemical and immunological characteristics were measured by immuno enzyme and immunochemiluminescent assays before and 3 months after treatment. The study revealed inverse correlation between b-endorphin levels and those of leptin, insulin, cortisol, TNF-a, IL-6, oxidized LDLP, triglycerides (TG), and HDLP cholesterol. Standard therapy resulted in a 6.5% reduction of insulin level, 9,4% , 6,1%, and 17,4% reduction of TNF-a , IL-6, TG levels respectively; it increased the HDLP cholesterol level by 10,3% (p<0,05 for all values) but did not change other parameters of interest. Dalargin therapy caused a 32,6% and 17,4%, rise in the b-endorphin and HDLP cholesterol levels but decreased leptin, insulin, cortisol, TNF-a, IL-6, LDLP, and tG levels by 36,1%, 22,4%, 23,9%, 55%, 56,3%, 14% and 27,2% respectively (p<0,001). It is concluded that the decrease of the blood b-endorphin level in the patients with coronary heart disease and metabolic syndrome is associated with enhanced blood atherogenicity, hyperinsulinemia, hypercortisolemia, activation of pro-inflammatory cytokines and lipid peroxidation. Supplementation of conventional therapy with dalargin results in the increased b-endorphin level, enhanced anti-atherogenic effect, reduced activity of pro-inflammatory cytokines and lipid peroxidation, reduction of leptin, insulin and cortisol levels.
[INTESTINAL MICROBIOTA: ITS ROLE IN PATHOGENESIS OF ARTERIAL HYPERTENSION].
Aitbaev KA, Murkamilov IE
Klin Med (Mosk) · 2017 · PMID 30303663
The review presents data on the relationship of intestinal microbiota and the development of arterial hypertension. Mechanisms through which intestinal dysbiosis may contribute to the development of this disease are revi...
The review presents data on the relationship of intestinal microbiota and the development of arterial hypertension. Mechanisms through which intestinal dysbiosis may contribute to the development of this disease are reviewed. Results of studies on modulation of intestinal microbiota in patients with arterial hypertension with the use of probiotics and antibiotics are presented. It is concluded that the development of innovative dietary strategies ensuring restoration of the balance in the intestinal microbiota will allow to effectively control and treat arterial hypertension.
[SUBCLINICAL HYPOTHYROIDISM].
Dolgikh YA, Verbovoy AF, Sharonova LA
Klin Med (Mosk) · 2017 · PMID 30303662
Subclinical hypothyroidism is a rather common disorder of the thyroid gland. Despite the fact that subclinical hypothyroidism has no clear-cut clinical picture, this condition is associated with changes in various organs...
Subclinical hypothyroidism is a rather common disorder of the thyroid gland. Despite the fact that subclinical hypothyroidism has no clear-cut clinical picture, this condition is associated with changes in various organs and systems, moreover, it is a risk factor of cardiovascular diseases. The article summarizes the available data on subclinical hypothyroidism, principles of its diagnostics and treatment.
[ZIKA FEVER: CLINICAL, EPIDEMIOLOGICAL, LABORATORY, AND DIAGNOSTIC ASPECTS].
Zhdanov KV, Zakharenko SM, Kovalenko AN … +3 more , Semenov AV, Kozlov SS, Fisun AY
Klin Med (Mosk) · 2017 · PMID 30303661
The authors overview data on the prevalence of Zika fever with reference to biological properties of the causative agent, epidemiological process, pathogenesis, and clinical symptoms of the disease. Special attention is...
The authors overview data on the prevalence of Zika fever with reference to biological properties of the causative agent, epidemiological process, pathogenesis, and clinical symptoms of the disease. Special attention is given to the identification of the virus in pregnant women, microcephaly in the babies born by Zika-infected women, algorithm of laboratory diagnostics, and measures needed to prevent and control mosquitoes that spread viruses.
[ACUTE HEPATIC LESION ASSOCIATED WITH MYOCARDIAL INFARCTION: CLINICAL SIGNIFICANCE AND MODERN DIAGNOSTICS].
Il'ina AS, Borovkova NY, Spassky AA … +1 more , Borovkov NN
Klin Med (Mosk) · 2017 · PMID 30303654
This review of the literature is devoted to the problem of acute kidney injury (AKI) in patients with acute myocardial infarction (MI). We discuss the occurrence of AKI in patients with MI, mechanisms of its development...
This review of the literature is devoted to the problem of acute kidney injury (AKI) in patients with acute myocardial infarction (MI). We discuss the occurrence of AKI in patients with MI, mechanisms of its development and modern diagnostic methods. The article examines biomarkers of kidney injury that may be useful for early diagnostics of AKI.
[INFLAMMATION AND HEMOCOAGULATION].
Bokarev IN
Klin Med (Mosk) · 2017 · PMID 30303653
Problems of inflammation are extensively studied all over the world. Its mechanisms are known to involve hundreds of factors. The blood coagulation system is a major component of each living organism. This article was de...
Problems of inflammation are extensively studied all over the world. Its mechanisms are known to involve hundreds of factors. The blood coagulation system is a major component of each living organism. This article was designed to analyze the relationship between inflammation and hemocoagulation and discuss definition of the term “low-grade inflammation” with reference to the blood coagulation system.
[MODERN APPROACH TO THERAPY OF PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS].
Tsvetkova OA, Voronkova OO, Buyanova OE
Klin Med (Mosk) · 2017 · PMID 30303652
A case of the treatment of a patients with idiopathic pulmonary fibrosis with pirfenidone and nintedanib is reported with reference to the role of these medications in therapy of his condition in the context of modern th...
A case of the treatment of a patients with idiopathic pulmonary fibrosis with pirfenidone and nintedanib is reported with reference to the role of these medications in therapy of his condition in the context of modern theory of its pathogenesis.
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