Pub Date : 2022-01-01DOI: 10.31550/1727-2378-2022-21-2-51-55
A. Tokareva, N. Borovkova, Natalia Lineva, I. Polyakova
Study Objective: To define the predictive value of arterial stiffness parameters in the development of intradialytic hypertension (IDH) in patients undergoing long-term HD. Study Design: Prospective study. Material and Methods. The prospective study included 45 patients undergoing long-term HD. An IDH criterion was an increase in systolic blood pressure >10 mm Hg after the HD in more than 4 out of 6 sessions during the period preceding 24-hour blood pressure monitoring (24BPM). Arterial stiffness parameters were assessed using a Vasotens-24 BPLab software package (by Peter Telegin, Russia). We recorded the demographics of patients and physical examination results, lab test results, duration of HD, concomitant cardiovascular diseases, and medications taken. For data analysis we used Statistics 26 application package (IBM SPSS). Study Results. The mean age of patients was 51 [41; 61] years old; HD duration was 4.5 [1.1; 7.8] years. IDH was recorded in 20 patients; the multivariate correlation analysis showed that IDH was associated with the patients’ age (HR = 3.78; 95% CI 1.29–11.04), with the augmentation index AIx (HR = 7.75; 95% CI 2.65–22.7). Inverse correlation was observed between IDH development and reflection wave transmission time — RWTT100–60 (HR = 0.27; 95% CI 0.14–0.53), presence of diabetic nephropathy (HR = 0.34; 95% CI 0.094–1.251), residual diuresis (HR = 0.43; 95% CI 0.21–0.87), and albumin level (HR = 0.12; 95% CI 0.02–0.79). Inclusion of arterial stiffness parameters into the mathematical model increased its predictive ability from AUC = 0.886 to AUC = 0.978. Conclusion. In this study, AIx ≥ –6.5% and RWTT100–60 ≤ 134.5 m/s were associated with a higher frequency of IDH, which can be a sign of the leading role of progressive artery stiffness in the development of intradialytic cardiovascular complications. Keywords: hemodialysis, intradialytic hypertension, arterial stiffness.
研究目的:探讨动脉僵硬度参数对长期高血压患者血栓性高血压(IDH)发展的预测价值。研究设计:前瞻性研究。材料和方法。这项前瞻性研究包括45名长期患有HD的患者。IDH的标准是在24小时血压监测(24BPM)之前的6个疗程中有4个以上在HD后收缩压升高bb10mmhg。使用Vasotens-24 BPLab软件包(由Peter Telegin，俄罗斯)评估动脉硬度参数。我们记录了患者的人口统计数据、体格检查结果、实验室检查结果、HD病程、伴随心血管疾病和服用的药物。数据分析使用Statistics 26应用程序包(IBM SPSS)。研究的结果。患者平均年龄51岁[41岁;[61]岁;HD持续时间为4.5 [1.1;7.8)年。20例患者记录IDH;多因素相关分析显示，IDH与患者年龄相关(HR = 3.78;95% CI 1.29-11.04)，增强指数AIx (HR = 7.75;95% ci 2.65-22.7)。IDH发育与反射波透射时间RWTT100-60呈负相关(HR = 0.27;95% CI 0.14-0.53)，存在糖尿病肾病(HR = 0.34;95% CI 0.094-1.251)，残余利尿(HR = 0.43;95% CI 0.21-0.87)，白蛋白水平(HR = 0.12;95% ci 0.02-0.79)。将动脉刚度参数纳入数学模型后，其预测能力由AUC = 0.886提高到AUC = 0.978。结论。在本研究中，AIx≥-6.5%，RWTT100-60≤134.5 m/s与较高的IDH发生频率相关，这可能是进行性动脉僵硬在溶栓性心血管并发症发生中起主导作用的标志。关键词:血液透析，分析性高血压，动脉僵硬。
{"title":"Prediction Models of Intradialytic Hypertension: The Role of Arterial Stiffness Parameters","authors":"A. Tokareva, N. Borovkova, Natalia Lineva, I. Polyakova","doi":"10.31550/1727-2378-2022-21-2-51-55","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-2-51-55","url":null,"abstract":"Study Objective: To define the predictive value of arterial stiffness parameters in the development of intradialytic hypertension (IDH) in patients undergoing long-term HD. Study Design: Prospective study. Material and Methods. The prospective study included 45 patients undergoing long-term HD. An IDH criterion was an increase in systolic blood pressure >10 mm Hg after the HD in more than 4 out of 6 sessions during the period preceding 24-hour blood pressure monitoring (24BPM). Arterial stiffness parameters were assessed using a Vasotens-24 BPLab software package (by Peter Telegin, Russia). We recorded the demographics of patients and physical examination results, lab test results, duration of HD, concomitant cardiovascular diseases, and medications taken. For data analysis we used Statistics 26 application package (IBM SPSS). Study Results. The mean age of patients was 51 [41; 61] years old; HD duration was 4.5 [1.1; 7.8] years. IDH was recorded in 20 patients; the multivariate correlation analysis showed that IDH was associated with the patients’ age (HR = 3.78; 95% CI 1.29–11.04), with the augmentation index AIx (HR = 7.75; 95% CI 2.65–22.7). Inverse correlation was observed between IDH development and reflection wave transmission time — RWTT100–60 (HR = 0.27; 95% CI 0.14–0.53), presence of diabetic nephropathy (HR = 0.34; 95% CI 0.094–1.251), residual diuresis (HR = 0.43; 95% CI 0.21–0.87), and albumin level (HR = 0.12; 95% CI 0.02–0.79). Inclusion of arterial stiffness parameters into the mathematical model increased its predictive ability from AUC = 0.886 to AUC = 0.978. Conclusion. In this study, AIx ≥ –6.5% and RWTT100–60 ≤ 134.5 m/s were associated with a higher frequency of IDH, which can be a sign of the leading role of progressive artery stiffness in the development of intradialytic cardiovascular complications. Keywords: hemodialysis, intradialytic hypertension, arterial stiffness.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80120064","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}
Pub Date : 2022-01-01DOI: 10.31550/1727-2378-2022-21-2-15-17
D.F. Nurkhametova, E. Yudina, L. E. Ziganshina, D. Sychev
Objective of the Review: To describe the aims and objectives of the Cochrane Russia Center. Key points. Decision-making processes in health care are complex and include various components, involving multiple factors and actors at different levels. In such circumstances, the sources and availability of information are of particular importance. One of the goals of the Cochrane Collaboration, in particular the Cochrane Russia Center, which is based in the Russian Medical Academy of Continuing Professional Education (RMANPO), is to disseminate quality information on health issues. In response to the challenges faced by healthcare systems during the COVID-19 pandemic, the Global Commission on Evidence was established. Its work resulted in developing the Evidence Commission Report. This report providing a number of recommendations for all participants in decision-making at different levels, was translated into Russian by the staff of Cochrane Russia based in RMANPO. In addition, to increase the availability of quality information for both physicians and patients, Cochrane Russia translates summaries of Cochrane systematic reviews and training materials into Russian, develops and publishes information materials. Conclusion. Supporting clinical decision making by physicians is the main goal of Cochrane Russia's activities at RMANPO. Cochrane Russia is a link and source of quality evidence-based information for all Russian-speaking audiences. Keywords: Cochrane, Cochrane Russia, RMANPO, systematic review, evidence, evidence-based medicine, clinical decisions.
{"title":"The Role of Cochrane Russia in Clinical Decision Making by Physician","authors":"D.F. Nurkhametova, E. Yudina, L. E. Ziganshina, D. Sychev","doi":"10.31550/1727-2378-2022-21-2-15-17","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-2-15-17","url":null,"abstract":"Objective of the Review: To describe the aims and objectives of the Cochrane Russia Center. Key points. Decision-making processes in health care are complex and include various components, involving multiple factors and actors at different levels. In such circumstances, the sources and availability of information are of particular importance. One of the goals of the Cochrane Collaboration, in particular the Cochrane Russia Center, which is based in the Russian Medical Academy of Continuing Professional Education (RMANPO), is to disseminate quality information on health issues. In response to the challenges faced by healthcare systems during the COVID-19 pandemic, the Global Commission on Evidence was established. Its work resulted in developing the Evidence Commission Report. This report providing a number of recommendations for all participants in decision-making at different levels, was translated into Russian by the staff of Cochrane Russia based in RMANPO. In addition, to increase the availability of quality information for both physicians and patients, Cochrane Russia translates summaries of Cochrane systematic reviews and training materials into Russian, develops and publishes information materials. Conclusion. Supporting clinical decision making by physicians is the main goal of Cochrane Russia's activities at RMANPO. Cochrane Russia is a link and source of quality evidence-based information for all Russian-speaking audiences. Keywords: Cochrane, Cochrane Russia, RMANPO, systematic review, evidence, evidence-based medicine, clinical decisions.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74198502","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}
Pub Date : 2022-01-01DOI: 10.31550/1727-2378-2022-21-2-18-22
V. Tsukanov, M. A. Cherepnin, E. G. Gorchilova, A. Vasyutin, Yu. L. Tonkikh, A. Savchenko, A. Borisov
Study Objective: To study the clinical symptoms and prevalence of hepatic fibrosis in patients with chronic virus hepatitis C (CVHC), genotype 1, or Opisthorchis felineus invasion. Study Design: Cross-sectional comparative study of random groups of inpatient or outpatient patients. Material and Methods. We examined 297 patients with CVHC, genotype 1, and 214 patients with chronic opisthorchiasis. CVHC was diagnosed in accordance with the guidelines of the European Association for the Study of the Liver. Opisthorchiasis was diagnosed when eggs or mature parasites were found in duodenal content and/or faeces of the patient. Hepatic fibrosis was assessed with shear wave elastography using the METAVIR scale. Study Results. We have found differences in clinical symptoms: prevailing cytolytic syndrome (82.8% vs 9.8%; p < 0.001), hepatomegaly (20.9% vs 10.3%; p = 0.002), and stage F3-F4 hepatic fibrosis (METAVIR) (20.5% vs 8.4%; p < 0.001) in patients with CVHC and higher prevalence of cholestatic syndrome (14.5% vs 0.3%; p < 0.001), chronic cholecystitis (18.2% vs 8.8%; р = 0.002), gallstones (4.7% vs 0.7%; р = 0.008) in patients with opisthorchiasis. Conclusion. Highly significant is frequently diagnosed F2, F3 and F4 hepatic fibrosis (METAVIR) in patients with opisthorchiasis (20.5%). These evidences point out that O. felineus invasion is a hepatic pre-cancer condition. Taking into account the high prevalence of O. felineus invasion in some regions of Siberia, the available data show that opisthorchiasis is a relevant medical and social issue which must be addressed. Keywords: virus hepatitis С, Opisthorchis felineus, hepatic fibrosis.
研究目的:探讨基因1型、猫角胸菌侵袭型慢性病毒性丙型肝炎(CVHC)患者的临床症状及肝纤维化发生率。研究设计:对住院和门诊病人随机分组进行横断面比较研究。材料和方法。我们研究了297例基因型为1的CVHC患者和214例慢性蛇胸腺病患者。CVHC是根据欧洲肝脏研究协会的指导方针诊断的。当在患者的十二指肠内容物和/或粪便中发现虫卵或成熟寄生虫时，诊断为opisthorchasis。肝纤维化采用METAVIR分级的剪切波弹性成像进行评估。研究的结果。我们发现临床症状的差异:普遍存在的溶细胞综合征(82.8% vs 9.8%);P < 0.001)，肝肿大(20.9% vs 10.3%;p = 0.002)， F3-F4期肝纤维化(METAVIR) (20.5% vs 8.4%;p < 0.001)，且胆汁淤积综合征的患病率较高(14.5% vs 0.3%;P < 0.001)，慢性胆囊炎(18.2% vs 8.8%;= 0.002)，胆结石(4.7% vs 0.7%;0.008)。结论。高度显著的是常诊断为F2, F3和F4肝纤维化(METAVIR)的opisthorchasis患者(20.5%)。这些证据表明，猫科疟蚊入侵是一种肝脏癌前病变。考虑到西伯利亚某些地区猫伊蚊入侵的高流行率，现有数据表明，阿片吸虫病是一个必须解决的相关医疗和社会问题。关键词:病毒性肝炎С，猫腹绦虫，肝纤维化。
{"title":"Clinical Profile and Prevalence of Hepatic Fibrosis in Patients with Chronic Virus Hepatitis C or with Opisthorchis felineus Invasion","authors":"V. Tsukanov, M. A. Cherepnin, E. G. Gorchilova, A. Vasyutin, Yu. L. Tonkikh, A. Savchenko, A. Borisov","doi":"10.31550/1727-2378-2022-21-2-18-22","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-2-18-22","url":null,"abstract":"Study Objective: To study the clinical symptoms and prevalence of hepatic fibrosis in patients with chronic virus hepatitis C (CVHC), genotype 1, or Opisthorchis felineus invasion. Study Design: Cross-sectional comparative study of random groups of inpatient or outpatient patients. Material and Methods. We examined 297 patients with CVHC, genotype 1, and 214 patients with chronic opisthorchiasis. CVHC was diagnosed in accordance with the guidelines of the European Association for the Study of the Liver. Opisthorchiasis was diagnosed when eggs or mature parasites were found in duodenal content and/or faeces of the patient. Hepatic fibrosis was assessed with shear wave elastography using the METAVIR scale. Study Results. We have found differences in clinical symptoms: prevailing cytolytic syndrome (82.8% vs 9.8%; p < 0.001), hepatomegaly (20.9% vs 10.3%; p = 0.002), and stage F3-F4 hepatic fibrosis (METAVIR) (20.5% vs 8.4%; p < 0.001) in patients with CVHC and higher prevalence of cholestatic syndrome (14.5% vs 0.3%; p < 0.001), chronic cholecystitis (18.2% vs 8.8%; р = 0.002), gallstones (4.7% vs 0.7%; р = 0.008) in patients with opisthorchiasis. Conclusion. Highly significant is frequently diagnosed F2, F3 and F4 hepatic fibrosis (METAVIR) in patients with opisthorchiasis (20.5%). These evidences point out that O. felineus invasion is a hepatic pre-cancer condition. Taking into account the high prevalence of O. felineus invasion in some regions of Siberia, the available data show that opisthorchiasis is a relevant medical and social issue which must be addressed. Keywords: virus hepatitis С, Opisthorchis felineus, hepatic fibrosis.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86891800","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}
Pub Date : 2022-01-01DOI: 10.31550/1727-2378-2022-21-6-13-18
D. Gamayunov, A. Kalyagin, G. Sinkova, O. Ryzhkova, Y. Varavko
Objective of the Review: To consider the pathogenetic relationship of COVID-19 and chronic heart failure, the concept of “postcovid syndrome”, the peculiarities of management of this group of patients. Key points. Chronic heart failure is a predictor of an unfavorable outcome in patients with COVID-19. Angiotensin converting enzyme 2 is involved in the penetration of viral particles into the cell. Direct viral damage to cardiomyocytes is not excluded, cardiotoxic effects of antiviral therapy are possible. The consequences of COVID-19 are manifested by arrhythmia, myocarditis and pericarditis, cardiomyopathy. Corticosteroids can lead to decompensation of heart failure. The use of renin-angiotensin-aldosterone system inhibitors and β-blockers is associated with lower mortality. Conclusion. Chronic heart failure in combination with postcovid syndrome requires carefully developed patient management tactics and rehabilitation measures. Keywords: chronic heart failure, postcovid syndrome, COVID-19.
{"title":"Postcovid Syndrome and Chronic Heart Failure: Current Issues","authors":"D. Gamayunov, A. Kalyagin, G. Sinkova, O. Ryzhkova, Y. Varavko","doi":"10.31550/1727-2378-2022-21-6-13-18","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-6-13-18","url":null,"abstract":"Objective of the Review: To consider the pathogenetic relationship of COVID-19 and chronic heart failure, the concept of “postcovid syndrome”, the peculiarities of management of this group of patients. Key points. Chronic heart failure is a predictor of an unfavorable outcome in patients with COVID-19. Angiotensin converting enzyme 2 is involved in the penetration of viral particles into the cell. Direct viral damage to cardiomyocytes is not excluded, cardiotoxic effects of antiviral therapy are possible. The consequences of COVID-19 are manifested by arrhythmia, myocarditis and pericarditis, cardiomyopathy. Corticosteroids can lead to decompensation of heart failure. The use of renin-angiotensin-aldosterone system inhibitors and β-blockers is associated with lower mortality. Conclusion. Chronic heart failure in combination with postcovid syndrome requires carefully developed patient management tactics and rehabilitation measures. Keywords: chronic heart failure, postcovid syndrome, COVID-19.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80120228","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}
Pub Date : 2022-01-01DOI: 10.31550/1727-2378-2022-21-2-34-39
E. Bolotova, K. Yumukyan, A. Dudnikova
Objective of the Review: To analyse available contemporary references about possible pathological mechanisms of ulcerative colitis (UC). Key Points. There are data on high prognostic significance of genetic and demographic factors, characteristics of intestinal microbiota in UC development; and the absence of genetic differences in UC morbidity. Results of a number of studies demonstrate favourable impact for UC from some environmental factors, such as smoking, appendectomy and obesity. A significant component of UC and, thus, a useful marker of the disease activity/severity and a potentially attractive pharmacological target for UC management is neutrophils. Conclusion. Understanding the pathogenic mechanisms and assessment of risk factors allow expanding the comprehensive aid to patients with UC. Keywords: ulcerative colitis, inflamed intestine, microbiota, risk factors, neutrophils.
{"title":"Modern Idea of the Mechanisms of Development and Predictors of Ulcerative Colitis Severity","authors":"E. Bolotova, K. Yumukyan, A. Dudnikova","doi":"10.31550/1727-2378-2022-21-2-34-39","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-2-34-39","url":null,"abstract":"Objective of the Review: To analyse available contemporary references about possible pathological mechanisms of ulcerative colitis (UC). Key Points. There are data on high prognostic significance of genetic and demographic factors, characteristics of intestinal microbiota in UC development; and the absence of genetic differences in UC morbidity. Results of a number of studies demonstrate favourable impact for UC from some environmental factors, such as smoking, appendectomy and obesity. A significant component of UC and, thus, a useful marker of the disease activity/severity and a potentially attractive pharmacological target for UC management is neutrophils. Conclusion. Understanding the pathogenic mechanisms and assessment of risk factors allow expanding the comprehensive aid to patients with UC. Keywords: ulcerative colitis, inflamed intestine, microbiota, risk factors, neutrophils.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"128 11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79594594","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}
Pub Date : 2022-01-01DOI: 10.31550/1727-2378-2022-21-4-13-18
N. Kovalchuk, E.A. Guziy, G. Tabeeva
Study Objective: To study the characteristics and compliance of patients with bilious headache. Study Design: Observational сomparative clinical trial. Materials and Methods. We reviewed medical records of 184 patients treated for bilious headaches. The mean age was 42 ± 12 years old. Diagnosis of 82 (44.6%) patients combined bilious headache and drug-induced headaches (DIH). We examined the past history of bilious headaches, frequency of visits to the doctor, life-long use of medications to kill bilious headache, and preventive therapy. Also, we reviewed the factors impacting DIH development depending on prevalence of bilious headaches, comorbidities and medications used. 6 months after discharge from the hospital, participants took a survey on the efficiency of preventive management. We compared patients with and without DIH. Compliance of patients who started drug prevention was assessed using Morisky–Green questionnaire. Study Results. 125 (67.9%) patients had chronic bilious headache, while in 59 (32.1%) patients, bilious headaches were episodic. Patients with chronic bilious headaches included 66 (52.8%) persons with DIH and 59 (47.2%) did not have any bilious headaches, while among patients with episodic bilious headache the figures were 16 (27.1%) and 43 (72.9%), respectively. In chronic bilious headache group, the frequency of DIH was statistically higher (p = 0.001). The correlation analysis of the relation between the duration of the history of bilious headaches and past drug therapy did not demonstrate any significant correlation between the amount of drugs used (grouped by the active ingredient) and course of disease (ρ = 0.115, p = 0.12); however, when drugs are counted on their trade names, there is a statistically significant correlation (ρ = 0.149, p = 0.048). Also, statistically significant correlation is seen when reviewing the duration of disease depending on the presence of DIH (p = 0.001): a longer past history of bilious headaches is associated with DIH development. 22 out of 184 patients (12%) did not start prescribed therapy. According to Morisky–Green questionnaire results, 137 (84.6%) patients were highly compliant, 21 (13%) were inadequately compliant, and 4 (2.5%) were not compliant at all. Most highly compliant were patients on antidepressants (p = 0.024). Patients with combined chronic bilious headache and DIH were also more compliant with preventive therapy (p = 0.045); patients without DIH mentioned beneficial effect from the therapy more often (p = 0.047). Conclusion. A majority of patients were compliant with the therapy. We found out that 142 (78%) patients were familiar with preventive therapy; however, there was no statistically significant difference in compliance between such patients and naive subjects. Patients taking antidepressants and those without DIH are most compliant; they mentioned the beneficial effect of the preventive therapy more often, and this is a result not only of good compliance, but als
{"title":"Characteristics of Patients with Chronic Episodic Bilious Headache","authors":"N. Kovalchuk, E.A. Guziy, G. Tabeeva","doi":"10.31550/1727-2378-2022-21-4-13-18","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-4-13-18","url":null,"abstract":"Study Objective: To study the characteristics and compliance of patients with bilious headache. Study Design: Observational сomparative clinical trial. Materials and Methods. We reviewed medical records of 184 patients treated for bilious headaches. The mean age was 42 ± 12 years old. Diagnosis of 82 (44.6%) patients combined bilious headache and drug-induced headaches (DIH). We examined the past history of bilious headaches, frequency of visits to the doctor, life-long use of medications to kill bilious headache, and preventive therapy. Also, we reviewed the factors impacting DIH development depending on prevalence of bilious headaches, comorbidities and medications used. 6 months after discharge from the hospital, participants took a survey on the efficiency of preventive management. We compared patients with and without DIH. Compliance of patients who started drug prevention was assessed using Morisky–Green questionnaire. Study Results. 125 (67.9%) patients had chronic bilious headache, while in 59 (32.1%) patients, bilious headaches were episodic. Patients with chronic bilious headaches included 66 (52.8%) persons with DIH and 59 (47.2%) did not have any bilious headaches, while among patients with episodic bilious headache the figures were 16 (27.1%) and 43 (72.9%), respectively. In chronic bilious headache group, the frequency of DIH was statistically higher (p = 0.001). The correlation analysis of the relation between the duration of the history of bilious headaches and past drug therapy did not demonstrate any significant correlation between the amount of drugs used (grouped by the active ingredient) and course of disease (ρ = 0.115, p = 0.12); however, when drugs are counted on their trade names, there is a statistically significant correlation (ρ = 0.149, p = 0.048). Also, statistically significant correlation is seen when reviewing the duration of disease depending on the presence of DIH (p = 0.001): a longer past history of bilious headaches is associated with DIH development. 22 out of 184 patients (12%) did not start prescribed therapy. According to Morisky–Green questionnaire results, 137 (84.6%) patients were highly compliant, 21 (13%) were inadequately compliant, and 4 (2.5%) were not compliant at all. Most highly compliant were patients on antidepressants (p = 0.024). Patients with combined chronic bilious headache and DIH were also more compliant with preventive therapy (p = 0.045); patients without DIH mentioned beneficial effect from the therapy more often (p = 0.047). Conclusion. A majority of patients were compliant with the therapy. We found out that 142 (78%) patients were familiar with preventive therapy; however, there was no statistically significant difference in compliance between such patients and naive subjects. Patients taking antidepressants and those without DIH are most compliant; they mentioned the beneficial effect of the preventive therapy more often, and this is a result not only of good compliance, but als","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72907304","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}
Pub Date : 2022-01-01DOI: 10.31550/1727-2378-2022-21-8-44-51
E. Melnikova, S. N. Smirnova
Study Objective: To assess the possibilities of sanatorium-and-spa treatment in patients with neurotic, stress-associated and somatoform disorders taking into account the modern idea of their pathogenesis. Main part. According to various sources, at least 30% of patients who come to outpatient clinics have neurotic and/or somatoform disorders. Given the complex pathogenesis of these conditions, the rate of exacerbations and relapses, such patients should undergo a long-term comprehensive therapy aimed at elimination of etiological and pathogenic factors, together with the development of adequate adaptive reactions, including psychogenic reactions, increased physical and mental performance, and healthy lifestyle habits. The potential to reach the goal increases considerably with the use of sanatorium-and-spa treatment, the main methods of which include climatotherapy, hydrobalneotherapy, reflexotherapy, physical factors, biofeedback techniques, mental therapy, and exercise therapy. Conclusion. The efficiency of the comprehensive treatment of neurotic, stress-related and somatoform disorders using natural and artificial therapeutic factors is 60%. The knowledge of non-drug treatments of such conditions is essential not only for medical staff in sanatoria and spas, but also for outpatient medical professionals, since they are the primary referring individuals. Keywords: neurotic disorders, sanatorium-and-spa treatment, balneotherapy, physical activity.
{"title":"Treatment of Neurotic, Stress-Related and Somatoform Disorders in Sanatoria","authors":"E. Melnikova, S. N. Smirnova","doi":"10.31550/1727-2378-2022-21-8-44-51","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-8-44-51","url":null,"abstract":"Study Objective: To assess the possibilities of sanatorium-and-spa treatment in patients with neurotic, stress-associated and somatoform disorders taking into account the modern idea of their pathogenesis. Main part. According to various sources, at least 30% of patients who come to outpatient clinics have neurotic and/or somatoform disorders. Given the complex pathogenesis of these conditions, the rate of exacerbations and relapses, such patients should undergo a long-term comprehensive therapy aimed at elimination of etiological and pathogenic factors, together with the development of adequate adaptive reactions, including psychogenic reactions, increased physical and mental performance, and healthy lifestyle habits. The potential to reach the goal increases considerably with the use of sanatorium-and-spa treatment, the main methods of which include climatotherapy, hydrobalneotherapy, reflexotherapy, physical factors, biofeedback techniques, mental therapy, and exercise therapy. Conclusion. The efficiency of the comprehensive treatment of neurotic, stress-related and somatoform disorders using natural and artificial therapeutic factors is 60%. The knowledge of non-drug treatments of such conditions is essential not only for medical staff in sanatoria and spas, but also for outpatient medical professionals, since they are the primary referring individuals. Keywords: neurotic disorders, sanatorium-and-spa treatment, balneotherapy, physical activity.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75221258","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}
Pub Date : 2022-01-01DOI: 10.31550/1727-2378-2022-21-4-60-66
E. Grigorieva, O. V. Lisauskene
Study Objective: To track the dynamics of an organic personality disorder for 5 years after call-up. Study Design: Longitudinal study. Materials and Methods. The study had two stages. Stage one was the analysis of information on conscripts who were undergoing a medical examination and were condemned as unserviceable or partially suitable for conscription. We examined 52 conscripts with an organic personality disorder with the mean age of 19.02 ± 1.01 years old. We assessed their mental status, mental disorder intensity, and degree of social adaptation; also, an experimental psychological questionnaire for anamnestic study of conscripts and Conscript Questionnaire were completed. Stage two was a clinical and follow-up (for 5 years) examination of patients. A factorial analysis of results was performed in 2, 3, 4, 5 years after the first examination. Six subjects withdrew from stage two because their place of residence changed or because they did not want to further participate in the study. Study Results. The clinical presentation of the disorder was more complicated in more than 60% cases. The factorial analysis revealed the most stable rigid link, i. e., a combination of clinical symptoms to be targeted by the therapy in order to more drastically unravel the stable pathological system of disorder manifestations. The rigid link of the system passes all first factors in examinations conducted and characterises the highest proportion of cases vs. total variance: inclination to impulsive response with poor control over behaviour, uptown tastes, decreased social adaptation and close symptoms in the form of unstable inner emotional well-being or impaired affective volitional regulation. At year four of the study, a flexible link appears: addictions, e. g., alcohol and substance abuse, and unskilled labour. At year five, further aggravation of psychopathy-like state was observed. We have identified the flexible links of the system, which can be manipulated in order to attempt to gradually negate the stable pathological condition; the quality of manipulations is worse since elimination of one relation between symptoms brings about another one, but with a lower number of observations vs total variance. Conclusion. This study highlights the need in further observation, a more drastic interference (therapeutic, psychocorrective, social and rehabilitative) with conscripts who were condemned as unserviceable or partially suitable for conscription, in order to avoid a complicated mental pathology. Keywords: organic personality disorder, conscription, rigid link, flexible link, complicated psychopathologic pattern, drastic interference.
{"title":"Clinical Presentation Dynamics of an Organic Personality Disorder in Conscripts Who Are Condemned as Unserviceable or Partially Suitable for Conscription","authors":"E. Grigorieva, O. V. Lisauskene","doi":"10.31550/1727-2378-2022-21-4-60-66","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-4-60-66","url":null,"abstract":"Study Objective: To track the dynamics of an organic personality disorder for 5 years after call-up. Study Design: Longitudinal study. Materials and Methods. The study had two stages. Stage one was the analysis of information on conscripts who were undergoing a medical examination and were condemned as unserviceable or partially suitable for conscription. We examined 52 conscripts with an organic personality disorder with the mean age of 19.02 ± 1.01 years old. We assessed their mental status, mental disorder intensity, and degree of social adaptation; also, an experimental psychological questionnaire for anamnestic study of conscripts and Conscript Questionnaire were completed. Stage two was a clinical and follow-up (for 5 years) examination of patients. A factorial analysis of results was performed in 2, 3, 4, 5 years after the first examination. Six subjects withdrew from stage two because their place of residence changed or because they did not want to further participate in the study. Study Results. The clinical presentation of the disorder was more complicated in more than 60% cases. The factorial analysis revealed the most stable rigid link, i. e., a combination of clinical symptoms to be targeted by the therapy in order to more drastically unravel the stable pathological system of disorder manifestations. The rigid link of the system passes all first factors in examinations conducted and characterises the highest proportion of cases vs. total variance: inclination to impulsive response with poor control over behaviour, uptown tastes, decreased social adaptation and close symptoms in the form of unstable inner emotional well-being or impaired affective volitional regulation. At year four of the study, a flexible link appears: addictions, e. g., alcohol and substance abuse, and unskilled labour. At year five, further aggravation of psychopathy-like state was observed. We have identified the flexible links of the system, which can be manipulated in order to attempt to gradually negate the stable pathological condition; the quality of manipulations is worse since elimination of one relation between symptoms brings about another one, but with a lower number of observations vs total variance. Conclusion. This study highlights the need in further observation, a more drastic interference (therapeutic, psychocorrective, social and rehabilitative) with conscripts who were condemned as unserviceable or partially suitable for conscription, in order to avoid a complicated mental pathology. Keywords: organic personality disorder, conscription, rigid link, flexible link, complicated psychopathologic pattern, drastic interference.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"135 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75490440","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}
Pub Date : 2022-01-01DOI: 10.31550/1727-2378-2022-21-1-18-20
R. N. Marchenko, I. I. Kukarskaya
Study Objective: To assess the extent of blood loss and underlying factors in patients with placenta accreta, who underwent caesarean section, when various methods of haemostasis are used. Study Design: Perspective study. Materials and Methods. We performed a prospective multivariate analysis of 147 medical cards of pregnant women and new mothers, labour and delivery records for single pregnancies termination with labour or abrupt termination of pregnancy. All examined women were divided into three clinical groups. The key factor for division into groups was the type of surgery for postpartum haemorrhage because of placenta accreta. Group I included women (n = 106, mean age: 29.2 ± 2.9 years old), who underwent uterine artery embolisation; group II (n = 31, mean age: 32.2 ± 3.4 years old) had hysterectomy; and group III (n = 10, mean age: 31.6 ± 3.4 years old) underwent surgical haemostasis (uterine and ovarian vessels ligation, compression suture of uterus) without hysterectomy. Study Results. Minimal blood loss was recorded in patients who underwent uterine artery embolisation. The rate was 176.5% lower than in post-hysterectomy women and 96% lower than in patients who underwent surgical haemostasis (p < 0.05 in both cases). The highest blood loss rate was recorded in post-hysterectomy women, and the value was 41.1% higher than mean values for patients who underwent surgical haemostasis (p < 0.05). There is direct strong correlation between the number of deliveries and the rate of blood loss, where the overall number of deliveries was not more than two (R = 0.87, р < 0.05). However, for more than 3 deliveries, the correlation between the number of deliveries and the rate of blood loss was not statistically significant (R < 0.3, p > 0.05). The highest blood loss was recorded after 2 deliveries (p < 0.05). The group of patients who had 2 deliveries was the only examined group where the blood loss exceeded 2 L. The lowest blood loss rate was in first-time-mothers (less than 800 mL). Conclusion. Uterine artery embolisation is the most efficient surgical method to arrest bleeding. When assessing risk factors impacting the rate of blood loss, it is essential to pay attention to the number of previous pregnancies and deliveries, as well as a history of surgical termination of pregnancy (endometrectomy) and caesarean sections. Keywords: placenta accreta, uterine artery embolisation, haemostasis, hysterectomy.
{"title":"Placenta Accreta: Postpartum Haemorrhage Correction","authors":"R. N. Marchenko, I. I. Kukarskaya","doi":"10.31550/1727-2378-2022-21-1-18-20","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-1-18-20","url":null,"abstract":"Study Objective: To assess the extent of blood loss and underlying factors in patients with placenta accreta, who underwent caesarean section, when various methods of haemostasis are used. Study Design: Perspective study. Materials and Methods. We performed a prospective multivariate analysis of 147 medical cards of pregnant women and new mothers, labour and delivery records for single pregnancies termination with labour or abrupt termination of pregnancy. All examined women were divided into three clinical groups. The key factor for division into groups was the type of surgery for postpartum haemorrhage because of placenta accreta. Group I included women (n = 106, mean age: 29.2 ± 2.9 years old), who underwent uterine artery embolisation; group II (n = 31, mean age: 32.2 ± 3.4 years old) had hysterectomy; and group III (n = 10, mean age: 31.6 ± 3.4 years old) underwent surgical haemostasis (uterine and ovarian vessels ligation, compression suture of uterus) without hysterectomy. Study Results. Minimal blood loss was recorded in patients who underwent uterine artery embolisation. The rate was 176.5% lower than in post-hysterectomy women and 96% lower than in patients who underwent surgical haemostasis (p < 0.05 in both cases). The highest blood loss rate was recorded in post-hysterectomy women, and the value was 41.1% higher than mean values for patients who underwent surgical haemostasis (p < 0.05). There is direct strong correlation between the number of deliveries and the rate of blood loss, where the overall number of deliveries was not more than two (R = 0.87, р < 0.05). However, for more than 3 deliveries, the correlation between the number of deliveries and the rate of blood loss was not statistically significant (R < 0.3, p > 0.05). The highest blood loss was recorded after 2 deliveries (p < 0.05). The group of patients who had 2 deliveries was the only examined group where the blood loss exceeded 2 L. The lowest blood loss rate was in first-time-mothers (less than 800 mL). Conclusion. Uterine artery embolisation is the most efficient surgical method to arrest bleeding. When assessing risk factors impacting the rate of blood loss, it is essential to pay attention to the number of previous pregnancies and deliveries, as well as a history of surgical termination of pregnancy (endometrectomy) and caesarean sections. Keywords: placenta accreta, uterine artery embolisation, haemostasis, hysterectomy.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74087790","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}
Pub Date : 2022-01-01DOI: 10.31550/1727-2378-2022-21-8-60-65
M. Gilenko, V.Yu. Gulyaeva
Objective of the Review: To summarise the references related to the forensic psychiatry aspects of exogenous organic psychotic disorders. Key Points. The majority of acute exogenous organic psychotic disorders during a wrongdoing are more or less associated with the use of psychoactive substances (PAS). This literature overview discusses typical forensic psychotic conditions appearing in acute intoxication with PAS (short-term psychotic disorders, abnormal alcoholic intoxication, abnormal forms of alcoholic intoxication, PAS-induced psychosis) and psychosis associated with withdrawal. Key challenges in the diagnosis of these conditions, changes in approaches to their forensic psychiatric assessment and the modern idea of legally relevant skills of wrongdoers who committed an illegal act during an exogenous psychosis, are analysed here. Conclusion. The matter of acute exogenous psychoses which is a relevant issue for forensic and psychiatric examination, is discussed insufficiently in recent literature sources. Further studies are needed, and approaches to a forensic and psychiatric examination of legally relevant skills of wrongdoers should be developed. Keywords: organic psychotic disorder, exogenous psychosis, PAS-induced psychosis, forensic and psychiatric examination.
{"title":"Forensic Psychiatry Aspects of Exogenous Organic Psychotic Disorders","authors":"M. Gilenko, V.Yu. Gulyaeva","doi":"10.31550/1727-2378-2022-21-8-60-65","DOIUrl":"https://doi.org/10.31550/1727-2378-2022-21-8-60-65","url":null,"abstract":"Objective of the Review: To summarise the references related to the forensic psychiatry aspects of exogenous organic psychotic disorders. Key Points. The majority of acute exogenous organic psychotic disorders during a wrongdoing are more or less associated with the use of psychoactive substances (PAS). This literature overview discusses typical forensic psychotic conditions appearing in acute intoxication with PAS (short-term psychotic disorders, abnormal alcoholic intoxication, abnormal forms of alcoholic intoxication, PAS-induced psychosis) and psychosis associated with withdrawal. Key challenges in the diagnosis of these conditions, changes in approaches to their forensic psychiatric assessment and the modern idea of legally relevant skills of wrongdoers who committed an illegal act during an exogenous psychosis, are analysed here. Conclusion. The matter of acute exogenous psychoses which is a relevant issue for forensic and psychiatric examination, is discussed insufficiently in recent literature sources. Further studies are needed, and approaches to a forensic and psychiatric examination of legally relevant skills of wrongdoers should be developed. Keywords: organic psychotic disorder, exogenous psychosis, PAS-induced psychosis, forensic and psychiatric examination.","PeriodicalId":11479,"journal":{"name":"Doctor.Ru","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81976874","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}
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