Klinicheskaia Meditsina[JOURNAL]
Sun
200 papers
[Pathogenetically targeted method for conservative treatment of obesity and overweight correction].
Achkasov EE, Razina AO, Runenko SD
Klin Med (Mosk) · 2016 · PMID 30289215
This review of literature presents modern pathogenetic treatment options for obesity and overweight correction including the optimization of the motor function, nutrition education, drug therapy, surgical techniques and...
This review of literature presents modern pathogenetic treatment options for obesity and overweight correction including the optimization of the motor function, nutrition education, drug therapy, surgical techniques and psychotherapy. The need for a multidisciplinary approach to the development of combined treatment programs is underlined taking into account the multifactorial pathogenesis of obesity. A combination of optimal physical activity and diet therapy with active personal involvement in the process of recovery is accentuated among the priority areas of excess body weight correction, as well as the treatment and prevention of obesity. It is shown that the physical rehabilitation should focus on the individualization of the physical exertion, its adequate dosing and intensity control using heart rate monitors to ensure the safety and effectiveness of the training sessions. The article also presents data on the effectiveness of rational medical and other types of treatment of obesity when the adjustment of physical activities and nutrition is insufficient. In particular, the results of the world's largest observation program of safe weight loss for the treatment of patients with alimentary obesity held in Russia from 2012 to 2015 are described.
[The Principles of primary prophylaxis of bleeding from oesophagealvaricies in patients with liver cirrhosis].
Garbuzenko DV
Klin Med (Mosk) · 2016 · PMID 30289214
The principles of primary prevention of bleeding from esophageal varices in patients with liver cirrhosis are discussed with reference to the stage ofportal hypertension. The information was collectedfrom the PubMed data...
The principles of primary prevention of bleeding from esophageal varices in patients with liver cirrhosis are discussed with reference to the stage ofportal hypertension. The information was collectedfrom the PubMed database, Google Scholar retrieval system, Cochrane reviews, and lists of references from relevant publications for 1980-2015 using the key words «bleeding from esophageal varices», «prophylaxis», «portal hypertension». Inclusion criteria were confined to primary prophylaxis of bleeding from esophageal varices in patients with liver cirrhosis. The analysis showed that the drugs of choice for primary prophylaxis of bleeding from esophageal varices in patients with liver cirrhosis are non-selective beta-adrenoblockers, but their application is indicated only in case of clinicallyl significant portal hypertension in patients with large and mediumsize esophageal varices. When the use of these drugs is contraindicated, endoscopic ligation of esophageal varices can be recommended.
[Hypothyroidism and cardiovascular system].
Verbovoy AF, Sharonova Lyudmila A, Kosareva OV … +2 more , Verbovaya NI, Dolgikh YA
Klin Med (Mosk) · 2016 · PMID 30289213
The article presents data on the relationship between thyroid dysfunction and cardiovascular diseases. The role of dyslipidemia, adipokines (adiponectin, leptin, resistin), C-reactive protein, deficiency of vitamin D3 in...
The article presents data on the relationship between thyroid dysfunction and cardiovascular diseases. The role of dyslipidemia, adipokines (adiponectin, leptin, resistin), C-reactive protein, deficiency of vitamin D3 in the development of cardiovascular disease in hypothyroidism is discussed. The article describes characteristics of myocardial remodeling, its dysfunction and their correlation with risk factors of cardiovascular diseases in patients with hypothyroidism.
[Gastroesophageal reflux disease: current views and prospects].
Tsimmerman YS, Vologzhanina LG
Klin Med (Mosk) · 2016 · PMID 30289212
This review presents a detailed definition of gastroesophageal reflux disease (GERD) and data on its prevalence, etiological and pathogenetic factors. The clinical picture of the disease, its clinical “masks” and complic...
This review presents a detailed definition of gastroesophageal reflux disease (GERD) and data on its prevalence, etiological and pathogenetic factors. The clinical picture of the disease, its clinical “masks” and complications including Barrett’s oesophagus and oesophageal carcinoma are discussed. Various diagnostic methods, such as oesophagofibroscopy, targeted biopsy, morphological studies, multichannel 24 hr pH-metry, etc. are considered. Classifications of GERD is presented with special reference to the original clinico-pathogenetic classification developed by one of the authors. The effectiveness of modern methods of GERD pharmacotherapy and surgical treatment is discussed.
Medicinas argads, 2015.
Klin Med (Mosk) · 2016 · PMID 28957615
Abstract loading — click title to view on PubMed.
N.A. KURSHAKOV- THERAPIST, TEACHER, SOCIALACTIVIST (to the 130th anniversary of the birthday).
Knopov M, Taraiukha VK
Klin Med (Mosk) · 2016 · PMID 28957614
Abstract loading — click title to view on PubMed.
THE FIRST MINISTER OF HEALTH OF RUSSIA ACADEMICIAN GEORGII ERMOLAEVICH REIN.
Abashin VG, Dolgov GV, Jigkaev MA
Klin Med (Mosk) · 2016 · PMID 28957613
Abstract loading — click title to view on PubMed.
DELAYED REPERFUSION FOR SAVING VITAL MYOCARDIUM IN THE ACUTE PERIOD OF MYOCARDIAL INFARCTION WITH ELEVATION OF ST SEGMENT.
Gazarvan GG
Klin Med (Mosk) · 2016 · PMID 28957612
Reperfusion therupy in case of acule inl , voc'ardial infiction is especialli desirble within 12 hr cfierfirs/ clinical manifestalions as show in stidies with the use of thrombolytic therapy (TLT). Its efficiency for sav...
Reperfusion therupy in case of acule inl , voc'ardial infiction is especialli desirble within 12 hr cfierfirs/ clinical manifestalions as show in stidies with the use of thrombolytic therapy (TLT). Its efficiency for saving ischemic myocardum decreqses as the time from the onset of pain syndrome increasrs. Nevertheless, patients admitted to the clinic in the period deemed infavourable for TLT still preserve large part of vital myocardium even if in the risk zone. Delayed saving myocardum impossible by TLT can be ensured by transdermal coronary interventions. The depence of myocardial necrois on the duration of occlution of coronary artery is as well recognized as the necessity of early interventions. Transdermal coronary interventions can be perforned within days 2 or 3 after onset of acute myocarial infraction if it was impracticable in an earlier period.
CONFLICT OF INTERESTS AS A PROBLEM OF EVIDENCE-BASED MEDICINE.
Arpent'eva MP
Klin Med (Mosk) · 2016 · PMID 28957611
The role of ideology (principles) of evidence-based medicine in prophylaxis and correction of con?flict of interests in various spheres of medicine and socio-medical assistance is considered. Professional ethics formed i...
The role of ideology (principles) of evidence-based medicine in prophylaxis and correction of con?flict of interests in various spheres of medicine and socio-medical assistance is considered. Professional ethics formed in the course of education and undergoing modification under conditions of real practical work is a main sphere of medical and related edological practices associated with conflicts of interests. Of special importance are principles of bioethics based on the requiremnents of evidence- based medicine. The role of evidence-based medicine in prophylaxis and resolution of conflicts of interests is related to the training and re-training of specialists, prevention and correction of their professional degradation and deformation in the course ofpractical clinical work. Analysis of prima, y and secondary motives underlying occupational out. activities and their role in the formation of the conflict of interests was carried.
COMPARATIVE EFFICIENCY OF APPLICATION OF DIFFERENT THERAPEUTIC SCHEMES FOR POST-CONTACT PREVENTION OF HIV INFECTION IN HEALTH PROVIDERS.
Vorob'eva NN, Ivanova ES, Krasnoperova NN … +1 more , Okishev MA
Klin Med (Mosk) · 2016 · PMID 28957610
AIM: Comparative assessment of the efficiency of application of different therapeutic schemes for post-contact prevention (PCP) of HIV infection in health providers. METHODS: Medical personnel that had professional conta...
AIM: Comparative assessment of the efficiency of application of different therapeutic schemes for post-contact prevention (PCP) of HIV infection in health providers. METHODS: Medical personnel that had professional contacts with HIV-infected patients (n=44) were given medications for PCP. 19 of them (group 1) used phosphazide, 25 (group 2) combivir (lamivudine + zidovudine) in combination with kaletra for 4 weeks after the contact. Phosphazide (AZT Farma K.B., Russia) was used at a dose of 0.4 g twice daily, other medications in standard doses. The results were evaluated 4 weeks, 3, 6, and 12 months after PCP from the safety of the treatment and the absence of professional HIV infection. RESULTS: The medical personnel showed no signs of HIV infection throughout the entire period of observation. The safety of therapy was confirmed by the absence of myelohepatotoxic effect of the preparations. Combivir therapy caused a 1.8-fold rise in AST activity of within 4 weeks after onset of PCP (p<0,05). Phosphazide produced no such effect. CONCLUSION: The above results indicate that both schemes ofantiretroviral activity are 100% efficient as PCP of HIV infection, but phosphazide has an advantage of higher safety and better tolerability.
CHRONIC HEPATITIS WITH DOUBLE B/C INFECTION: VIROLOGICAL, CLINICAL, MORPHOLOGICAL CHARACTERISTICS.
Dudanova OP, Shubina ME, Belavina IA … +4 more , Elpaeva EA, Pisareva MM, Grudinin MP, Kiselev OI
Klin Med (Mosk) · 2016 · PMID 28957609
AIM: To estimate the r, virological and clinical characteristics of chronic viral hepatitis (CVH) with double B/C infection. MATERIALS AND METHODS: We examined 282 patients with CVH. Genomes of hepatitis B virus (HBV) an...
AIM: To estimate the r, virological and clinical characteristics of chronic viral hepatitis (CVH) with double B/C infection. MATERIALS AND METHODS: We examined 282 patients with CVH. Genomes of hepatitis B virus (HBV) and hepatitis C virus (HCV) were studied by PCR in blood and liver (AmpliSens HBV and Amplisens HCV Russia), nuclear proteins (HBcorAg HBV and NS3 HCV) were determined by immunohistochemical method (Novocastra, UK), HBVgenome was sequenced by the Sanger method using ABI prism BigDye Terminator v3.1 kits and ABIPRISM 3100 analyzer (AppliedBiosystems, USA). Indices of histological activity (HAI), fibrosis, and portal vein (PV) congestion index (CI) were calculated by formula CI=SBB/LB V where S is P V cross section area in cm2 and LB V - linear blood flow velocity in cm/s (Vivid Pro- 7 apparatus, USA). RESULTS: CVH with double B/C infection was diagnosed in 85 (30.1%) patients including 44.7% with viral genomes and proteins in the live; 42.4% with HCVviremia, and 12.9% with HBJV/HCVviremia. Maximum CVH activity was documented in patients with latent HBV/HCVviremia (ALT 157.2±59.2 U/, HAI 11.6±1.3,fibrosis 2.8±0.7, C1 0.059±0.005); it was minimal inpatients.without viremia (Alt 76.25±63.0 U/I, HAI 6.7+-0.6,fibrosis 1.7±0.5, CI 0.042±0.001;p <0.05). Patients with latent HBV infection had precore/ore and pres/s mutations in HBVgenome and cytoplasmic localization ofHBcorAg. CONCLUSION: Double B/C infection was diagnosed in 30.1% of the patients with CVH dominated by HCV Patients with latent HBVhadprecore/ore and pres/s mutations. The highest intensity of hepatic cellular inflamation,fibrosis, and PV congestion was associated with HBV/HCV viremia and the lowest with intrahepatic localization of both viruses.
EFFECT OF LEPTIN ON THE GALLBLADDER IN PATIENTS WITH METABOLIC SYNDROME.
Virstvuk NG, Senvutovich NR
Klin Med (Mosk) · 2016 · PMID 28957608
The study involved 58 patients with chronic noncalculous cholecystitis (CNC) divided into two groups. Group I included 30 CNC patients with metabolic syndrome (MS), group II 28 CNC patients without MS. The control group...
The study involved 58 patients with chronic noncalculous cholecystitis (CNC) divided into two groups. Group I included 30 CNC patients with metabolic syndrome (MS), group II 28 CNC patients without MS. The control group consisted of 2O healthy people. MS was diagnosed according to Internationial Diabetes Federation guidelines (2005). The following anthroponetric parameters were determined: body mass index (BMI), waist to hip ratio, blood lipid profile (total cholesterol, triglycerides, high density lipoproteins (HDL), and low density lipoproteins (LDL)). Leptin and insulin levels were measured using com- mercial ELISA kits <<Leptin ELISA>> and <<Insulin ELISA>> (DRG International, Inc., USA) respectively Insulin resistance in- dex HOMA -JR (Homeostasis Model Assessment of Insulin Resistance) was calculated. It was shown that leptin level in CNC patients with MS was 2.61 times that in healthy subjects (p <0.001) and 2.47 times higher than in CNC patients without MS (p <0.001). Signficant direct correlations between leptin blood levels and BMI, HOMA-IR index, triglycerides, and cholesterol were documented The relationships between blood levels of leptin and the thickness of the gallbladder (GB) wall, the amount of cholesterol crystals in bile, and decreased bile release rate from GB which suggests effect of leptin on the structural and finctional changes in GB.
ADVANTAGES OF REMOTE MONITORING THE ACTIVITY OF PATIENTS WITH AXIAL SPONDYLITIS (PROGRESS STUDY).
Gaidukova IZ, Akulova AI, Aparkina AV … +1 more , Rebrov AP
Klin Med (Mosk) · 2016 · PMID 28957607
UNLABELLED: To improve the quality of treatment of patients with spondyloarthrities based on analysis of adherence to therapy and its timely correction by regular remote monitoring the activity of the disease. MATERIALS...
UNLABELLED: To improve the quality of treatment of patients with spondyloarthrities based on analysis of adherence to therapy and its timely correction by regular remote monitoring the activity of the disease. MATERIALS AND METHODS: 46 patents with axial spondylitis (ankylosing spondylitis, non-radiographic spondylitis) were interviewed by phone once in 4 weeks for 18 months with a 3 month interval after 12 months. 96 patients underwent routine outpatient examination for the evaluation of the main parameters of the disease. RESULTS AND DISCUSSION: Arbitrarily examined patients with spondyloarthritis reported poor compliance with therapy and its low efficiency. During 18 months, 79% of the patients were recommended treatment with TNF-a inhibitors. Only 18.5% of them in the remote monitoring group failed to reach the BASDAI index S 4 whereas 73.9% of the patients examined remotely for 1 year had low activity of the disease or its partial remission. An increased period between two phone interviews from 1 to 3 months in 58.6% patients with low activity of the disease was associated with impaired adherence to therapy (decreased intake of the anti-inflammatory drug or its withdrawal) that did not lead to enhancement of activity during 3 months after the change in the treatment. CONCLUSION: Remote monitoring of activity of the disease (one phone interview every 4 weeks) allows to decrease it or reach remission in 73.9% of the patients with axial spondyloarthritis. The decrease in the frequency of telephone calls to one every 3 months results in the impairment of compliance with therapy but does not lead to increase of disease activity in the short run.
ATHEROSCLEROSIS OF ABDOMINAL AORTA IN A POPULATION OF THE NORTHERN PART OF EUROPEAN RUSSIA.
Fedotova EJ, Popov VA, Malyavsky LY … +1 more , Seyentsov VJ
Klin Med (Mosk) · 2016 · PMID 28957606
Atherosclerosis is a major challenge for public health services throughout the world. It is a systemic degenerative disease affecting all arterial basins and most fiequently occurring in men aged above 40 years. Multifoc...
Atherosclerosis is a major challenge for public health services throughout the world. It is a systemic degenerative disease affecting all arterial basins and most fiequently occurring in men aged above 40 years. Multifocal lesions are much more typical than isolated lesion of a single basin. Atherosclerosis is a frequent cause of impaired patency of visceral branches of abdominal aorta and is a chronic disorder of visceral circulation manifest as ischemia of abdominal organs. We studied native preparations of abdominal aortafrom residents of the northern part of European Russia using the WHO-recommended visual planimetric method. It was shown that 93.4% of the residents of this region aged above 50 years have abdominal aorta affected by atherosclerosis. Statistical analysis did not reveal signficant differences between the frequency of atherosclerotic lesions in men and women. Most of them had raised aortic lesions. Correlation analysis with the calculation ofpaired Pearson correlation coefficients demonstrated moderate correlation between atherosclerotic lesions of abdominal aorta and the stage of atheromatosis (r=0,42; p = 0,000).
PREDICTORS OF SUDDEN CARDIOVASCULAR DEATH IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CONNECTIVE TISSUE DYSPLASIA.
Syromyatnikova TN, Obikhova TV, Golovskoy Bv … +3 more , Berg MD, Khovaeva YB, Ermachkova LV
Klin Med (Mosk) · 2016 · PMID 28957605
Connective tissue dysplasia (CTD) occurs in 70% of the patients with obstructive bronchial pathology. It promotes the development of electrical instability of myocardium and life-threatening arrhythmias. We studied elect...
Connective tissue dysplasia (CTD) occurs in 70% of the patients with obstructive bronchial pathology. It promotes the development of electrical instability of myocardium and life-threatening arrhythmias. We studied electrocardiographic markers of myocardial instability in patients with chronic obstructive bronchial pathology and CTD markers. Such patients were shown to more frequently have ventricular and supraventricular arrhythmias, decreased circadian heart rate index and enhanced heart rhythm variability. Other findings included high frequency of such predictors of sudden cardiovascular death as prolonged and enhanced dispersion. of QT intervals, T-wave microalternation, late atrial and ventricular potentials. The arrhythmic activity and the occurrence of predictors of sudden cardiovascular death increased in the patients aged above 60 vears with obstructive bronchial Pathology and CTD.
RELATIONSHIP BETWEEN BLOOD ALDOSTERONE AND SOMATOMETRIC PARAMETERS IN PATIENTS WITH CHRONIC HEART FAILURE AND PRESERVED EJECTION FRACTION OF LEFT VENTRICLE.
Vatutin NT, Shevelok AN
Klin Med (Mosk) · 2016 · PMID 28957604
UNLABELLED: Blood aldosterone level is an independent predictor of aggravated prognosis in patients with cardiovascular disorders. Synthesis of this hormone and its activity can determine the amount of adipose tissue in...
UNLABELLED: Blood aldosterone level is an independent predictor of aggravated prognosis in patients with cardiovascular disorders. Synthesis of this hormone and its activity can determine the amount of adipose tissue in the body, but this dependence is poorly known in patients with chronic heart failure (CHF). AIM: To analyse the relationship between blood aldosterone level and somatometric parameters in patients with CHF and preserved ejection fraction of left ventricle (LV). MATERIALS AND METHODS: This prospective cohort study included 56 patients (38 men and 18 women, mean age 59.4±3.4yr) with CHF and preserved (>45%) ejection fraction of left ventricle. We determined BMI, waist (WC) and hip (HC) circumference, WC/HC ratio, and serum aldosterone level, its reference value being 40-160 pg/mI. RESULTS: The patients were divided into 2 groups based on results of laboratoiy studies. Group 1 included 34 patients with practically normal blood aldosterone level, group 2 comprised 22 patients with hyperaldosteronemia. Those in group 1 had significantly higher BMI, WC and WC/HC ratio. They more frequently presented with abdominal obesity. Aldosterone level positively correlated with WC (r=0.642), WC/HC ratio (r=0.785) and the length of the history of arterial hypertension (Ro=0.848). It negatively correlated with the age (r=-0.346, in all cases p <0.05. No significant correlation with BMI was documented (r=0.012, p=0.902). CONCLUSION: In patients with chronic heart failure and preserved ejection fraction of left ventricle, blood aldosterone level is closely related to somatometric parameters being directly proportional to WC and WC/HC but unrelated to BMI. Abdominal obesity is associated with increased risk of hvperaldosteronemia (relative risk 3.4. 95% CI 1.7-6.6).
THE CARDIOVASCULAR SYSTEM IN TYPE 2 DIABETES MELLITUS AND THYROID DISORDERS IN THE ABSENCE OF THYROID GLAND DYSFUNCTION.
Ballyizek MF, Ignat'eva Pa
Klin Med (Mosk) · 2016 · PMID 28957603
The state of the cardiovascular system was studied in patients with type 2 diabetes mellitus and thyroid disorders in the absence of thyroid gland dysfunction. 76.9% of the 302 patients with DM2 had thyroid pathology; in...
The state of the cardiovascular system was studied in patients with type 2 diabetes mellitus and thyroid disorders in the absence of thyroid gland dysfunction. 76.9% of the 302 patients with DM2 had thyroid pathology; in 23,8% it was not previously diagnosed. We compared euthyroid patients with DM2 without thy'ropathies and with diffuse-nodular changes largely in the form of difuse- multinodular non-toxic goiter and autoinnnune thyroiditis (AIT). It was demonstrated that enhanced frequency of thyroid disorders is related to DM2 duration and vascular complications. The predominant thyroid pathology in DM2 was diffuse-multinodular non-toxic goiter followed by autoimnune thvroiditis. Nodular forms in AIT without DM2 are rare whereas multinodularformns in the patients with DM2 and AIT occur much more fequently. Node formation is related to such DM2 complications as diabetic nephropathy, angiopathy, and retinopathy. The study showed that the frequency of both non-specific clinical changes characteristic of thyroid dysfunction and of specific cardiological manifestations in euthyroid patients with DM2 and thyroid pathology signficantly increases especially in the presence of AIT and anti-thyreoperoxidase antibodies, regardless the form of thyropathy. It may be due to imimuno-inflammatory cross talk between thyroid and myocardial tissues. Patients with DM2 and diffuse-nodular changes in the thyroid gland more frequently presented with dif ferent forms of atrial fibrillation and high-grade ventricular extrasystole than patients with AIT or DM2 without thyropathies. It is concluded that euthyroid patients with DM2 need their thyroid function to be regularly monitored. The development of examination algorithm is an object of further studies.
NEW POSSIBILITIES FOR THE TREATMENT OF ENTEROCOCCAL INFECTIOUS ENDOCARDITIS.
Tyurin VP, Gudynovich VG, Volkova VL … +5 more , Gvozdkov AL, Zharkov OB, Zhirova LG, Mezenova TV, Gusaim TA
Klin Med (Mosk) · 2016 · PMID 28957602
This study was designed to analyze results of daptomycin therapy in 7 patients with enterococcal infectious endocarditis caused by Enterococcus faecium in two of them. Mean duration of therapy was 36.7 days. 70% of the s...
This study was designed to analyze results of daptomycin therapy in 7 patients with enterococcal infectious endocarditis caused by Enterococcus faecium in two of them. Mean duration of therapy was 36.7 days. 70% of the strains proved resistant to gentamycin, 40% showed resistance to penicillin antibiotics, and 14.3% to vancomycin. Three patients suffered prosthetic valve endocarditis, six had elevated presepsin level (up to 768.8 pg/ml). 28,6% of the patients underwent valve prosthetic surgery. Hospital lethality was 14,3%. The effectiveness of ampicillin plus ceftriaxone treatment of gentanycin-resistant enterococci is discussed. Recommendation for the antibacterial treatment of enterococcal infectious endocarditis (ESC 2015) are provided.
COMMUNITY-ACQUIRED PNEUMONIA IN PREGNANCY.
Sinopal'nikov AL, Styrt EA
Klin Med (Mosk) · 2016 · PMID 28957601
Conmnnity-acquired pneumonia in pregnancy.
Conmnnity-acquired pneumonia in pregnancy.
VARIABILTY OF ARTERIAL PRESSURE AND RENAL FUNCTION.
Kravnchenko AY, Chernyklh AA, Budnevsky AT
Klin Med (Mosk) · 2016 · PMID 28957600
This review deals with variability of arterial pressure (VAP) as an advers factor contributing to the development andprogression of cardiovascular diseases and renal pathology. VAP has recently attracted much attention i...
This review deals with variability of arterial pressure (VAP) as an advers factor contributing to the development andprogression of cardiovascular diseases and renal pathology. VAP has recently attracted much attention in connection with results of ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) showing that VAP is a risk factor of stroke and other complications of arterial hypertension (A H). The relationship between VAP and renalfunction remains unexplored and is considered to be a vicious circle in which kidneys are both a cause of AH and its target organs. Evidently elucidation of the relationship between enhanced VAP and renal function is of primay importance.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe