Doctor.Ru最新文献

{"title":"Diabetes Mellitus Secondary to Chronic Pancreatitis: Aspects of Clinical Course and Management","authors":"A. Ametov, E. Pashkova, K. Amikishieva, V.R. Gadzhiev","doi":"10.31550/1727-2378-2023-22-4-59-63","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-4-59-63","url":null,"abstract":"Aim: To demonstrate a clinical case of a patient with diabetes mellitus secondary to chronic pancreatitis, who needs not only compensation for carbohydrate metabolism, but also correction of exocrine pancreatic insufficiency. Key points. The patient noted a significant improvement in well-being against the background of adequate hypoglycemic therapy (nighttime metformin, sodium-glucose co-transporter type 2 inhibitors and glucagon-like peptide-1 receptor agonist, basal insulin glargine) and enzyme-replacement therapy with pancreatin minimicrospheres at a dose of 50,000 IU on main meals and up to 25,000 ED at snacks. When evaluating the glycemic profile of continuous glucose monitoring showed stabilization of blood glucose at the target range. According to the results of laboratory tests, the patient showed not only normalization of carbohydrate metabolism, but also an initially reduced level of total protein, vitamins and minerals. Conclusion. Administration of drugs used to treat patients with type 2 diabetes mellitus for the management of patients with diabetes secondary to chronic pancreatitis is justified. At the same time, the addition of insulin is often necessary. For this group of patients, the enzyme replacement therapy of exocrine pancreatic insufficiency is as important for the correction of metabolic disorders as the usual hypoglycemic therapy. Keywords: pancreatogenic diabetes mellitus, chronic pancreatitis, exocrine pancreatic insufficiency.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76316334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Features of Mothers of Premature and Full-term Babies","authors":"M.A. Arustamyan, L. Avetisyan, A.О. Kotanyan, M.R. Ohanyan, M. Mardiyan, A. Chopikyan","doi":"10.31550/1727-2378-2023-22-3-56-60","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-3-56-60","url":null,"abstract":"Aim: To evaluate the psychological peculiarities of mothers of preterm and term birth infants, and their attitude to breastfeeding before and after childbirth. Design: Observational study. Materials and methods. The subjects of the research were a pregnant woman at 12-week gestation randomly selected from 5 maternity hospitals in Yerevan. 268 pregnant women were eligible for inclusion in this observational study and created a total group. After birth, mothers were divided into groups of full-term (n = 239) and premature (n = 29) babies. We analysed baseline demographics, health information of the mother, history of pregnancy and delivery, as well as health information of babies. We assessed the presence of depressive symptoms with a Beck Depression Inventory and situational and individual anxiety levels with the Spielberger State-Trait Anxiety Inventory. Results. Assessment of the psychological status demonstrated a high level of state anxiety: 26.7 ± 1.4 and 45.8 ± 1.5 points in mothers of full-term and premature babies, respectively; in mothers of premature babies, the value was significantly higher (р < 0.05). Personal anxiety was relatively inert, there were no significant differences between the groups (p > 0.05). Depressive symptoms were also more pronounced in preterm mothers (moderate depression) than in term birth mothers (mild mood disturbance): 22.5 ± 0.8 points vs. 11.4 ± 0.9 points (p < 0.01). The majority of women (68.3%) who had preterm delivery had a high level of state anxiety (р < 0.01 vs. mothers of full-term babies). Women who were ready to breastfeed longer after the baby is born had more marked signs of depression. In mothers full-term and premature babies, the attitude to breastfeeding before delivery demonstrated direct correlation with the level of depression on Beck depression inventory (r = 0.75, p = 0.02 and r = 0.68, p < 0.01, respectively). The degree of state anxiety in mothers of premature babies correlated with hospitalisation duration (r = 0.9, p = 0.008). Conclusions. Mothers of preterm infants need psychological care based on high level of situational anxiety and depressive symptoms. Breastfeeding is a good biological tool for improved interaction of the mother with her baby; it boosts psychological comfort and reduces anxiety and depression. Keywords: preterm birth, anxiety, depression, mother-infant interaction.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75418897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Possible Use of Disposable Nappies for the Prevention of Diaper Dermatitis in Newborns and Babies Under 2 Years of Age","authors":"N. I. Zakharova, N. D. Odinaeva, A.S. Gryzunova, M. Shvedova","doi":"10.31550/1727-2378-2023-22-3-76-80","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-3-76-80","url":null,"abstract":"Aim: To assess the possibility of using Tanoshi nappies and pants for the prevention of diaper dermatitis, their safety and tolerability by newborns and babies under 2 years of age. Design. Prospective cohort study. Materials and methods. The study included 50 children with the weight 2 to 28 kg under 2 years of age without any signs of skin diseases, including nappy (pants) area. Proposed items were used for 14 days subject to timely change 4–7 times daily after bowel movement and during hygienic procedures 1–2 times daily. Skin was visually assessed by a children’s doctor on day 1, day 7, and day 14 of the study (M. Odio skin assessment tool). Results. On day 1, day 7, and day 14, all children had 0 points for their skin assessment of waist, buttocks, genitals, anal region, inguinal fold (M. Odio skin assessment tool). Assessment of the skin in the nappy and pants area after 14 days of use did not show any signs of dryness, irritation, oedema, and erosions from the contact with a nappy. Conclusion. All 50 newborns and babies under 2 years of age who used disposable Tanoshi nappies and pants in the real clinical practice over 2 weeks did not show any signs of diaper dermatitis. It proves that the nappies are safe and well tolerated by children under 2 years of age with proper skin care. Tanoshi nappies and pants can be recommended for children under 2 years of age who do not have any skin conditions and diseases. Keywords: diaper dermatitis, newborns, children under 2 years of age, nappies.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89900975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Assessment of the Quality of Life and the Level of Anxiety and Depression in Patients with Ulcerative Colitis","authors":"E. Bolotova, K. Yumukyan, A. Dudnikova","doi":"10.31550/1727-2378-2023-22-2-51-56","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-2-51-56","url":null,"abstract":"Aim: To assess the quality of life, the level of anxiety and depression in patients with ulcerative colitis (UC) depending on disease active/inactive status. Design: comparative prospective study. Materials and methods. In 2018–2020, a clinical study was conducted in Prof. S. V. Ochapovskiy Regional Clinical Hospital No. 1, which enrolled 218 patients: 178 patients with UC (139 patients with active disease and 39 patients with inactive disease) and 40 healthy volunteers (control group). In addition to routine examinations and faecal inflammatory markers, all patients underwent a quality-of-life assessment using The Short Form-36 (SF-36) and Inflammatory Bowel Disease Questionnaire (IBDQ), Clinical Activity Index (CAI), anxiety and depression evaluation using the Hospital Anxiety and Depression (HADS) scale. Results. The lowest mean values for SF-36 and the strongest correlations with CAI were observed in UC patients for the following domains: viability scale, overall health and emotional functioning (р < 0.05). Significant differences were recorded for IBDQ in mean values and correlations between the points on the scale and CAI for all domains (р = 0.0001). The strongest correlations were observed for the overall points and the “intestinal factor” domain (р = 0.0001). Lower mean values for SF-36 were in patients with chronic diseases not related to UC; for IBDQ, the situation was opposite — patients with extraintestinal UC signs had lower mean values. We found a correlation between HADS and CAI points which shows severity of an UC episode (r = 0.560; р = 0.01). Conclusions. The results demonstrate the importance of evaluation of the quality of life of patients with UC using both specific and nonspecific questionnaires, since they complement each other and allow personalising therapeutic approaches for patients with UC. Keywords: ulcerative colitis; inflammatory bowel diseases; quality of life; anxiety; depression.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90552270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risks of Venous Thromboembolic Events and the Great Obstetric Syndromes","authors":"V. Dolgushina, E. G. Syundyukova, V. Chulkov, K.A. Unigovskaya","doi":"10.31550/1727-2378-2023-22-1-33-39","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-1-33-39","url":null,"abstract":"Aim: Based on the study of the history, course of pregnancy and childbirth, to assess the risks of venous thromboembolic events among women with major obstetric syndromes. Design: Retrospective cohort study using the continuum sampling method. Materials and methods. 200 birth histories were analyzed: group 1 — 55 women with great obstetric syndromes, group 2 — 145 pregnant without them. The history of women, pregnancy outcomes were studied, and an analysis of the risks of venous thromboembolic complications was carried out. Results. Anamnestic risk factors for major obstetric syndromes were a family history aggravated by early thromboembolic events (RR = 3,13; 95% CI: 1,34–7,30), unemployed status (RR = 1,73; 95% CI: 1,32–2,65), preeclampsia in the past (RR = 23,46; 95% CI: 1,28–428,80), first pregnancy (RR = 1,63; 95% CI: 1,04–2,55), chronic arterial hypertension (RR = 8,45; 95% CI: 1,76–40,66). There was a significant increase in the risk of venous thromboembolic complications in patients of group 1 during pregnancy (1 (1–2) points; p < 0.001) and in the postpartum period (3 (1–4) points; p < 0.001). Conclusion. Prognostic markers of great obstetric syndromes were aggravated family and personal obstetric anamnesis, parity, low social status, chronic arterial hypertension. A significant increase in the risk of venous thromboembolic complications in pregnant women and puerperas with major obstetric syndromes was revealed. Keywords: great obstetric syndromes, preeclampsia, risk factors, venous thromboembolic complications.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80896278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumococcal Immunization in Young Children with Chronic Heart Failure","authors":"M. Kurdup, A. Fisenko, I. Davydova, A. A. Zhuzhula, N. Alyabieva, E. Basargina","doi":"10.31550/1727-2378-2023-22-3-15-21","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-3-15-21","url":null,"abstract":"Aim: To determine the coverage, efficacy and tolerability of pneumococcal vaccination in young children with cardiovascular disease associated with chronic heart failure. Design: Retro- and prospective randomized comparative study. Materials and methods. The study included 250 patients at the age of 2 months to 5 years with confirmed chronic cardiac failure caused by cardiomyopathy or congenital heart disorder. Within the scope of a specialised laboratory and instrumental examination, all children underwent an assessment of specific immunoglobulin (Ig) levels to the most common pneumococcal serotypes (1-5, 6B, 7F, 8, 9N, 9V, 10A, 11A,12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, 33F) using VaccZyme Anti-PCP IgG test system. During consultations and vaccination schedule development, pneumococcal vaccination coverage and the reasons for long-term medical exemptions or refusals were analysed. Provided the primary disease was stable, there were no contraindications and a parent gave their consent, patients were vaccinated with 13-valent pneumococcal conjugate vaccine (PCV13). Results. When questioning the parents of patients, it was revealed that before admission to the department, only 97 (38.8%) patients received at least 1 dose of pneumococcal vaccine, while the remaining 153 (61.2%) were not vaccinated. During hospitalization, 65 (42.5%) of 153 unvaccinated patients under 5 years of age who had not received a single pneumococcal vaccine received the first dose (V1) of PCV13; of 97 children vaccinated, 20 (20.6%) received a second dose, 18 (18.6%) — pneumococcal booster. There was a significant difference in the levels of antibodies to Streptococcus pneumoniae between the group of patients who received a full course of immunization according to age and the group of unvaccinated children: 108.1 ± 58.4 vs. 12.14 ± 7.8 mg/l (p < 0.05). In children with an incomplete course of vaccination, the levels of specific IgG to pneumococcal serotypes were lower. In groups of children who received only one dose of the vaccine in the first or second year of life, they amounted to 42.2 ± 11.7 and 40.2 ± 16.2 mg/l, respectively. Children who received at least two doses of vaccine without revaccination (starting before 12 months) had a relatively higher level of 68.2 ± 6.3 mg/L. But, despite a clear trend, there was no significant difference between these groups in our study. In the post-vaccination period, no serious complications were recorded in the examined children. Conclusion. Vaccination against pneumococcal infection in children with chronic heart failure is effective, safe and should be carried out as close as possible to the schedule of the national vaccination calendar, with a limited set of contraindications. Keywords: vaccination, 13-valent pneumococcal conjugate vaccine, immunoglobulin G, chronic heart failure.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82352314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Anti-Inflammatory Therapy Options for Bronchiolitis Obliterans in Children","authors":"N. Potapova, A. Markovskaya","doi":"10.31550/1727-2378-2023-22-3-40-44","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-3-40-44","url":null,"abstract":"Aim: To present the relevant information on the new approaches to the management of obliterating bronchiolitis in children, based on the data generated by foreign researchers. Key Points. Obliterating bronchiolitis is a non-reversible chronic obstructive lung disease associated with respiratory insufficiency, significant deterioration in the quality of life, and steady signs of disability. Despite the fact that this topic is of high interest, the management of patients and efficient therapy algorithms are a burning issue. A risk of side effects from systemic corticosteroids necessitates the search for alternative therapies. This overview presents information on a combined use of inhaled corticosteroids, azithromycin, monteleukast, and N-acetylcysteine. Conclusion. Further development of alternative therapies for chronic obliterating bronchiolitis can help in achieving efficient control of this disease. Keywords: obliterating bronchiolitis, therapy, children.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80213591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Problems with the Diagnostics of Postural Orthostatic Tachycardia Syndrome. Case Studies","authors":"Yu.R. Gvozdeva, E. Kantimirova, D. Dmitrenko","doi":"10.31550/1727-2378-2023-22-2-26-31","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-2-26-31","url":null,"abstract":"Objective of the Review: To demonstrate the complexity in diagnosing postural orthostatic tachycardia syndrome. Key Points. Clinical manifestations of postural orthostatic tachycardia syndrome vary and can have a clinical phenotype that is similar to a number of neurological and somatic conditions. Conclusion. The case studies presented demonstrate the significance of diagnostic manoeuvres in differentiating this syndrome from other types of impairment of consciousness. An active test in standing position which is easy to conduct can be a diagnostic prompt, if it is verified with a history of typical chronic orthostatic intolerability, postural heart acceleration, and a variety of accompanying complaints. Keywords: postural orthostatic tachycardia syndrome, loss of consciousness, diagnostics.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89815018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Use of Etanercept in a Child with Еnthesitis-Аssociated Аrthritis","authors":"A. V. Aksenov, Е.А. Ivanovskaya","doi":"10.31550/1727-2378-2023-22-3-89-91","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-3-89-91","url":null,"abstract":"Aim: demonstration of a clinical case of the successful use of etanercept in a child with еnthesitis-аssociated аrthritis. Key points. Еnthesitis-аssociated аrthritis is one of the clinical variants of juvenile idiopathic arthritis. The initial therapy of еnthesitis-аssociated аrthritis includes nonsteroidal anti-inflammatory drugs (NSAIDs) and non-biological disease-modifying drugs, the ineffectiveness of which is an indication for the appointment of genetically engineered drugs, in particular, the inhibitor of tumor necrosis factor-α etanercept. Conclusion. Currently, for the treatment of еnthesitis-аssociated аrthritis, if the use of NSAIDs and non-biological disease-modifying drugs is ineffective, genetically engineered drugs should be prescribed, in particular etanercept, which allows to achieve drug remission. Keywords: еnthesitis-аssociated аrthritis, etanercept, children.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73560449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal Outcomes in the Discordance of the Physical Development of Monochorionic Twins","authors":"M. Pavlichenko, N. V. Kosovtsova, Y. Pospelova, T. V. Markova","doi":"10.31550/1727-2378-2023-22-1-68-75","DOIUrl":"https://doi.org/10.31550/1727-2378-2023-22-1-68-75","url":null,"abstract":"Aim: To compare perinatal outcomes in the group of monochorionic discordant twins, depending on the complications of the antenatal period. Design: Cohort retrospective study. Materials and methods. 104 pairs of discordant monochorionic twins were examined: 44 pairs with feto-fetal transfusion syndrome (TTTS) and 60 pairs with signs of selective fetal growth retardation (SSFGR). Results. In the TFFT + CVDGR group, cervical insufficiency was more common (p = 0.004), delivery before 32 weeks of gestation (OR = 4.84; 95% CI: 1.78–13.18) and there was a higher risk of extremely severe discordance (≥ 50%) (p = 0.018): OR = 4.12; 95% CI: 1.2–14.6. Severe asphyxia was recorded more often in children who underwent TTTS — 34 (38.6%) patients versus 26 (21.7%) newborns of the SSFGR group: OR = 2.36; 95% CI: 1.28–4.36, p = 0.006. An inverse correlation was determined between gestational age and the degree of discordance in the SSFGR group. Conclusion. Differences in perinatal outcomes in monochorionic diamniotic twins with discordant physical development were revealed depending on the type of specific complication of intrauterine development. Keywords: growth discordance, feto-fetal transfusion syndrome, selective fetal growth retardation syndrome","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85743248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}