R. V. Ryabokon, V. V. Tsukanov, V. Khorzhevskii, A. V. Vasyutin, J. L. Tonkikh
Introduction. There is a debate about the significance of intestinal metaplasia (IM) subtypes for the development of gastric cancer. Therefore, determining the indicators of cellular renewal in individuals with complete and incomplete IM is certainly a topical issue.Aim. To study the proliferative activity of epithelial cells of the gastric antrum in patients with Helicobacter pylori-positive antral atrophic gastritis depending on the subtype of IM.Materials and methods. The study included 20 people with chronic antral non-atrophic gastritis (CNG; group A), 20 patients with chronic antral atrophic gastritis (CAG) without IM (group B), 20 patients with CAG with complete IM (group C) and 20 people with CAG with incomplete IM (group D). The stage of chronic gastritis was assessed by the morphological method in accordance with the modified Sydney classification. Typing of IM foci in the gastric mucosa was performed using the PAS reaction. Proliferation activity was studied by the expression of nuclear protein Ki67 using immunohistochemistry.Results. The proliferation index in the foci of complete BM in group C was 5%, and in group D in the foci of incomplete BM the Ki67 expression index was significantly higher and was 39% (p < 0.001). Outside the foci of metaplasia, the proliferation index was 23.5% in group C and 19% in group D (p = 0.06).Conclusion. We have registered significantly higher proliferation indicators of gastric epithelial cells in foci with incomplete IM compared to foci with complete IM. Determination of proliferation indicators in foci of incomplete intestinal metaplasia may be a marker of an increased risk of developing gastric cancer.
导言。关于肠化生（IM）亚型对胃癌发展的重要意义存在争议。因此，确定完全性和不完全性肠化生患者的细胞更新指标无疑是一个热门话题。研究幽门螺杆菌阳性前胃萎缩性胃炎患者胃窦上皮细胞的增殖活性，具体取决于 IM 的亚型。研究包括 20 名慢性前胃非萎缩性胃炎（CNG；A 组）患者、20 名无 IM 的慢性前胃萎缩性胃炎（CAG）患者（B 组）、20 名完全 IM 的 CAG 患者（C 组）和 20 名不完全 IM 的 CAG 患者（D 组）。慢性胃炎的分期根据改良悉尼分类法的形态学方法进行评估。使用 PAS 反应对胃黏膜中的 IM 病灶进行分型。免疫组化法通过核蛋白 Ki67 的表达研究增殖活性。C 组完全基底细胞病灶的增殖指数为 5%，而 D 组不完全基底细胞病灶的 Ki67 表达指数明显更高，为 39% (p < 0.001)。在癌变灶外，C 组的增殖指数为 23.5%，D 组为 19%（P = 0.06）。我们发现不完全变性灶的胃上皮细胞增殖指数明显高于完全变性灶。不完全性肠化生病灶中增殖指标的测定可能是胃癌发病风险增加的一个标志。
{"title":"Epithelial cell proliferation index in patients with atrophic gastritis depending on the presence of complete or incomplete intestinal metaplasia in the gastric antrum","authors":"R. V. Ryabokon, V. V. Tsukanov, V. Khorzhevskii, A. V. Vasyutin, J. L. Tonkikh","doi":"10.21518/ms2024-199","DOIUrl":"https://doi.org/10.21518/ms2024-199","url":null,"abstract":"Introduction. There is a debate about the significance of intestinal metaplasia (IM) subtypes for the development of gastric cancer. Therefore, determining the indicators of cellular renewal in individuals with complete and incomplete IM is certainly a topical issue.Aim. To study the proliferative activity of epithelial cells of the gastric antrum in patients with Helicobacter pylori-positive antral atrophic gastritis depending on the subtype of IM.Materials and methods. The study included 20 people with chronic antral non-atrophic gastritis (CNG; group A), 20 patients with chronic antral atrophic gastritis (CAG) without IM (group B), 20 patients with CAG with complete IM (group C) and 20 people with CAG with incomplete IM (group D). The stage of chronic gastritis was assessed by the morphological method in accordance with the modified Sydney classification. Typing of IM foci in the gastric mucosa was performed using the PAS reaction. Proliferation activity was studied by the expression of nuclear protein Ki67 using immunohistochemistry.Results. The proliferation index in the foci of complete BM in group C was 5%, and in group D in the foci of incomplete BM the Ki67 expression index was significantly higher and was 39% (p < 0.001). Outside the foci of metaplasia, the proliferation index was 23.5% in group C and 19% in group D (p = 0.06).Conclusion. We have registered significantly higher proliferation indicators of gastric epithelial cells in foci with incomplete IM compared to foci with complete IM. Determination of proliferation indicators in foci of incomplete intestinal metaplasia may be a marker of an increased risk of developing gastric cancer.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"50 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141384234","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}
M. M. Fedorin, M. Livzan, O. V. Gaus, E. V. Pashkova
Due to increasing prevalence of functional diseases of the colon in obese patients, the mechanisms by which the intestinal microbiota affects the development of symptoms of irritable bowel syndrome (IBS) in the setting of metabolic activity of adipose tissue should be investigated. The quantitative and qualitative changes in the pool of synthesized short-chain fatty acids, which have a multidirectional impact on the colonic motility is one of the key mechanisms by which the intestinal microbiota affects the occurrence and features of the course of irritable bowel syndrome. But as regards the issue of whether individual short-chain fatty acids have an impact on the severity of abdominal pain and characteristics of colonic motility dysfunction, it remains a subject of discussions. The study of the mechanisms of impact of short-chain fatty acids on the development and progression of obesity deserves special attention. Increased serum and faecal short-chain fatty acid levels in obese patients can either be a result of changes in the intestinal microflora composition associated with special eating habits and lifestyle, or have an independent effect on the development of obesity in individuals due to intestinal microflora composition disorders that have been already developed. Due to special features of the course of irritable bowel syndrome associated with overweight and obesity, studying the intestinal microbiota composition and the short-chain fatty acids produced by it in this cohort of IBS patients is of particular interest. This publication has been prepared to describe and systematize the possible mechanisms of impact of short-chain fatty acids on the development of abdominal pain and impaired colonic motility in IBS patients with overweight and obesity. The literature search was conducted in the databases Embase, PubMed and Google Scholar using the keywords “irritable bowel syndrome”, “obesity”, “short-chain fatty acids”, “gut microbiota”.
由于肥胖患者结肠功能性疾病的发病率越来越高，因此应研究肠道微生物群在脂肪组织代谢活动的背景下影响肠易激综合征（IBS）症状发展的机制。合成的短链脂肪酸池在数量和质量上的变化对结肠运动有多方位的影响，这是肠道微生物群影响肠易激综合征的发生和病程特征的关键机制之一。但关于单个短链脂肪酸是否会对腹痛的严重程度和结肠运动功能障碍的特征产生影响的问题，仍是一个讨论的主题。短链脂肪酸对肥胖症发生和发展的影响机制研究值得特别关注。肥胖症患者血清和粪便中短链脂肪酸含量的增加，可能是与特殊饮食习惯和生活方式相关的肠道微生物菌群组成发生变化的结果，也可能是由于已经出现的肠道微生物菌群组成紊乱而对肥胖症的发展产生独立影响。由于肠易激综合征与超重和肥胖相关的病程特点，研究肠易激综合征患者的肠道微生物群组成及其产生的短链脂肪酸特别有意义。本出版物旨在描述和系统阐述短链脂肪酸对超重和肥胖肠易激综合征患者腹痛和结肠蠕动受损的可能影响机制。在 Embase、PubMed 和 Google Scholar 数据库中以 "肠易激综合征"、"肥胖"、"短链脂肪酸"、"肠道微生物群 "为关键词进行了文献检索。
{"title":"Potential role of short-chain fatty acids in irritable bowel syndrome in overweight and obese individuals","authors":"M. M. Fedorin, M. Livzan, O. V. Gaus, E. V. Pashkova","doi":"10.21518/ms2024-168","DOIUrl":"https://doi.org/10.21518/ms2024-168","url":null,"abstract":"Due to increasing prevalence of functional diseases of the colon in obese patients, the mechanisms by which the intestinal microbiota affects the development of symptoms of irritable bowel syndrome (IBS) in the setting of metabolic activity of adipose tissue should be investigated. The quantitative and qualitative changes in the pool of synthesized short-chain fatty acids, which have a multidirectional impact on the colonic motility is one of the key mechanisms by which the intestinal microbiota affects the occurrence and features of the course of irritable bowel syndrome. But as regards the issue of whether individual short-chain fatty acids have an impact on the severity of abdominal pain and characteristics of colonic motility dysfunction, it remains a subject of discussions. The study of the mechanisms of impact of short-chain fatty acids on the development and progression of obesity deserves special attention. Increased serum and faecal short-chain fatty acid levels in obese patients can either be a result of changes in the intestinal microflora composition associated with special eating habits and lifestyle, or have an independent effect on the development of obesity in individuals due to intestinal microflora composition disorders that have been already developed. Due to special features of the course of irritable bowel syndrome associated with overweight and obesity, studying the intestinal microbiota composition and the short-chain fatty acids produced by it in this cohort of IBS patients is of particular interest. This publication has been prepared to describe and systematize the possible mechanisms of impact of short-chain fatty acids on the development of abdominal pain and impaired colonic motility in IBS patients with overweight and obesity. The literature search was conducted in the databases Embase, PubMed and Google Scholar using the keywords “irritable bowel syndrome”, “obesity”, “short-chain fatty acids”, “gut microbiota”.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"323 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141386347","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}
S. N. Avdeev, V. Gaynitdinova, Z. Merzhoeva, G. S. Nuralieva, L. Y. Nikitina, Z. Berikkhanov
Severe asthma (SA) is a pressing problem in respiratory diseases and accounts for 3–10% of all asthma cases. It is increasingly recognized that SA consists of multiple heterogeneous phenotypes and their histopathology, especially in the distal airways and interstitium, remains poorly understood. Transbronchial biopsy with video imaging and histologic examination allow the detection of various changes, including cases associated with granulomatous inflammation in addition to eosinophilic infiltrates. In the presented clinical case of a patient with severe eosinophilic bronchial asthma in the absence of autoimmune diseases, transbronchial biopsy with further histologic examination of the biopsy specimen revealed eosinophilic granuloma in the form of polyp-like masses in the lung tissue and walls of small bronchi. The cellular composition of the granuloma was represented by macrophage elements, a cluster of lymphocytes with an admixture of eosinophils, individual plasma cells, fibroblasts and capillary vessels with clusters of eosinophils. The treatment (baseline and anti-IL5 therapy), in addition to achieving complete control of asthma symptoms, reduction of nasal congestion, reduction of blood eosinophils, FENO, led to the disappearance of polyposis eosinophilic formation in the bronchial mucosa. Such pathology is described in the literature as “asthmatic granulomatosis” and is of interest for further studies.
{"title":"A case of asthmatic granulomatosis","authors":"S. N. Avdeev, V. Gaynitdinova, Z. Merzhoeva, G. S. Nuralieva, L. Y. Nikitina, Z. Berikkhanov","doi":"10.21518/ms2024-027","DOIUrl":"https://doi.org/10.21518/ms2024-027","url":null,"abstract":"Severe asthma (SA) is a pressing problem in respiratory diseases and accounts for 3–10% of all asthma cases. It is increasingly recognized that SA consists of multiple heterogeneous phenotypes and their histopathology, especially in the distal airways and interstitium, remains poorly understood. Transbronchial biopsy with video imaging and histologic examination allow the detection of various changes, including cases associated with granulomatous inflammation in addition to eosinophilic infiltrates. In the presented clinical case of a patient with severe eosinophilic bronchial asthma in the absence of autoimmune diseases, transbronchial biopsy with further histologic examination of the biopsy specimen revealed eosinophilic granuloma in the form of polyp-like masses in the lung tissue and walls of small bronchi. The cellular composition of the granuloma was represented by macrophage elements, a cluster of lymphocytes with an admixture of eosinophils, individual plasma cells, fibroblasts and capillary vessels with clusters of eosinophils. The treatment (baseline and anti-IL5 therapy), in addition to achieving complete control of asthma symptoms, reduction of nasal congestion, reduction of blood eosinophils, FENO, led to the disappearance of polyposis eosinophilic formation in the bronchial mucosa. Such pathology is described in the literature as “asthmatic granulomatosis” and is of interest for further studies.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"333 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141386532","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}
Combinations of inhaled glucocorticosteroids (IHGC) and long-acting bronchodilator inhalers (LABA inhalers) have been widely used to treat chronic obstructive pulmonary disease (COPD) over the past two decades. Prescription of these drugs was based on large studies showing that this therapeutic regimen was more effective compared to placebo and monotherapy. The article presents a clinical case report of a patient with severe course of COPD and coronary heart disease (CHD). Up-to-date concepts of using dual bronchodilator therapy when switching from combinations of inhaled glucocorticosteroids and long-acting bronchodilator inhalers (IHGC/LABA) is discussed. A patient with COPD and coronary artery disease, atrial fibrillation while using IHGC/LABA had progressive respiratory failure, frequent exacerbations, and acute symptomatology. As there is evidence that the use of IHGC/LABA has a number of limitations in the combined course of COPD and cardiovascular diseases, first of all in coronary artery disease and arrhythmias, it was recommended to replace therapy with a combination of dual bronchodilators – a long-acting muscarinic antagonist (LAMA) and a long-acting β agonist (LABA). The therapy resulted in stabilization of the condition, reduction of clinical symptoms, and absence of cardiovascular complications. It has been concluded that the dual bronchodilator therapy with a combination of glycopyrronium bromide and indacaterol is prioritized in COPD, including COPD combined with cardiovascular pathology; no increase in cardiovascular events in patients with COPD combined with coronary artery disease is observed; Breezhaler inhaler is user-friendly for the patients and has advantages over other delivery devices.
{"title":"Clinical case of indacaterol / glycopyrronium bromide prescription in a patient with severe copd and concomitant pathology","authors":"G. I. Ignatova, V. Antonov, I. A. Zakharova","doi":"10.21518/ms2024-207","DOIUrl":"https://doi.org/10.21518/ms2024-207","url":null,"abstract":"Combinations of inhaled glucocorticosteroids (IHGC) and long-acting bronchodilator inhalers (LABA inhalers) have been widely used to treat chronic obstructive pulmonary disease (COPD) over the past two decades. Prescription of these drugs was based on large studies showing that this therapeutic regimen was more effective compared to placebo and monotherapy. The article presents a clinical case report of a patient with severe course of COPD and coronary heart disease (CHD). Up-to-date concepts of using dual bronchodilator therapy when switching from combinations of inhaled glucocorticosteroids and long-acting bronchodilator inhalers (IHGC/LABA) is discussed. A patient with COPD and coronary artery disease, atrial fibrillation while using IHGC/LABA had progressive respiratory failure, frequent exacerbations, and acute symptomatology. As there is evidence that the use of IHGC/LABA has a number of limitations in the combined course of COPD and cardiovascular diseases, first of all in coronary artery disease and arrhythmias, it was recommended to replace therapy with a combination of dual bronchodilators – a long-acting muscarinic antagonist (LAMA) and a long-acting β agonist (LABA). The therapy resulted in stabilization of the condition, reduction of clinical symptoms, and absence of cardiovascular complications. It has been concluded that the dual bronchodilator therapy with a combination of glycopyrronium bromide and indacaterol is prioritized in COPD, including COPD combined with cardiovascular pathology; no increase in cardiovascular events in patients with COPD combined with coronary artery disease is observed; Breezhaler inhaler is user-friendly for the patients and has advantages over other delivery devices.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141383173","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}
N. Trushenko, B. Lavginova, V. A. Stener, S. N. Avdeev
Bronchial asthma is one of the most common respiratory diseases, and follows a severe clinical course in 10% of patients. 70–80% of patients with severe asthma have signs of type 2 (T2) inflammation, which is clinically defined as an increase in blood and airways eosinophil counts. The emergence of genetically engineered biological drugs has made it possible to review the purpose of asthma therapy, that is, achieving remission instead of disease control, which includes managing the symptoms, absence of exacerbations, stabilization of functional parameters and normalization of biomarkers in the absence of therapy with systemic glucocorticoids. Clinical studies have shown that therapy with genetically engineered biological drugs can reduce the frequency of asthma exacerbations, decrease the need for maintenance therapy with systemic glucocorticoids, relieve symptoms, improve quality of life, which results in achieving a disease remission in 19.6–31.6% of patients. Predictors of suboptimal response to biological therapy were a high body mass index, admission to the intensive care unit and a history of severe asthma exacerbations, as well as initially more severe clinical manifestations of the disease. The most pronounced effect of omalizumab therapy was observed in patients with atopic severe asthma showing symptoms and exacerbations that are clinically associated with allergic sensitization confirmed by positive results of skin prick testing and (or) identification of serological allergen-specific IgE, elevated levels of T2 biomarkers. This publication presents the latest data on asthma remission: the concept, basic criteria, as well as the role of genetically engineered biological drugs in achieving a remission.
{"title":"The role of anti-IgE therapy in achieving remission of bronchial asthma","authors":"N. Trushenko, B. Lavginova, V. A. Stener, S. N. Avdeev","doi":"10.21518/ms2024-169","DOIUrl":"https://doi.org/10.21518/ms2024-169","url":null,"abstract":"Bronchial asthma is one of the most common respiratory diseases, and follows a severe clinical course in 10% of patients. 70–80% of patients with severe asthma have signs of type 2 (T2) inflammation, which is clinically defined as an increase in blood and airways eosinophil counts. The emergence of genetically engineered biological drugs has made it possible to review the purpose of asthma therapy, that is, achieving remission instead of disease control, which includes managing the symptoms, absence of exacerbations, stabilization of functional parameters and normalization of biomarkers in the absence of therapy with systemic glucocorticoids. Clinical studies have shown that therapy with genetically engineered biological drugs can reduce the frequency of asthma exacerbations, decrease the need for maintenance therapy with systemic glucocorticoids, relieve symptoms, improve quality of life, which results in achieving a disease remission in 19.6–31.6% of patients. Predictors of suboptimal response to biological therapy were a high body mass index, admission to the intensive care unit and a history of severe asthma exacerbations, as well as initially more severe clinical manifestations of the disease. The most pronounced effect of omalizumab therapy was observed in patients with atopic severe asthma showing symptoms and exacerbations that are clinically associated with allergic sensitization confirmed by positive results of skin prick testing and (or) identification of serological allergen-specific IgE, elevated levels of T2 biomarkers. This publication presents the latest data on asthma remission: the concept, basic criteria, as well as the role of genetically engineered biological drugs in achieving a remission.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141385370","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}
R. A. Bontsevich, A. A. Ryabchikova, T. I. Balamutova, O. Tsygankova, O. Kompaniets, G. Ketova, V. O. Bogdanova, G. A. Batisheva, V. A. Nevzorova, I. Martynenko, N. Chukhareva, S. P. Pakhomov, M. L. Maximov
Introduction. The most common extragenital pathology during pregnancy includes upper and lower respiratory tract infections (URTI and LRTI), which, if left untreated, leading to obstetric and perinatal pathology. It is relevant to conduct pharmacoepidemiological studies assessing the preferences of specialists regarding the treatment of pregnant women and attitudes towards vaccination in real clinical practice.Aim. To analyze approaches to pharmacotherapy of URTI and LRTI in pregnant women, evaluate the compliance of prescribed drugs with current clinical recommendations and treatment standards.Materials and methods. The study was conducted from 2018 to 2022 using an anonymous questionnaire method in seven regions of Russia.Results and discussion. A total of 227 physicians from seven regions of Russia were surveyed, with 66.8% being internal medicine doctors and 33.2% obstetrician-gynecologists. This study revealed that physicians’ knowledge regarding the rational use of antimicrobial drugs (AMD) in pregnant women is insufficient. Respondents showed better results in the use of AMD in the treatment of pneumonia, with 78.7% of surveys indicating correct tactics. The worst results were observed in answering the question about the appropriateness of prescribing AMD for URTI, tracheitis, and bronchitis (40.3% to 67.7% of respondents made incorrect choices). Overall, 57.7% of respondents understand the importance of vaccination among pregnant women.Conclusion. The results of the conducted study indicate that the choice of drugs for the therapy of URTI and LRTI, especially AMD, for outpatient treatment of pregnant women in some situations does not fully correspond to the current clinical recommendations in our country. Moreover, it is particularly concerning that some physicians prescribe drugs that are unsafe for pregnant women or lack the necessary evidence base or indications for use.
{"title":"Physicians’ knowledge and preferences regarding pharmacotherapy of pregnant women with respiratory tract infections: research PIKAP","authors":"R. A. Bontsevich, A. A. Ryabchikova, T. I. Balamutova, O. Tsygankova, O. Kompaniets, G. Ketova, V. O. Bogdanova, G. A. Batisheva, V. A. Nevzorova, I. Martynenko, N. Chukhareva, S. P. Pakhomov, M. L. Maximov","doi":"10.21518/ms2024-052","DOIUrl":"https://doi.org/10.21518/ms2024-052","url":null,"abstract":"Introduction. The most common extragenital pathology during pregnancy includes upper and lower respiratory tract infections (URTI and LRTI), which, if left untreated, leading to obstetric and perinatal pathology. It is relevant to conduct pharmacoepidemiological studies assessing the preferences of specialists regarding the treatment of pregnant women and attitudes towards vaccination in real clinical practice.Aim. To analyze approaches to pharmacotherapy of URTI and LRTI in pregnant women, evaluate the compliance of prescribed drugs with current clinical recommendations and treatment standards.Materials and methods. The study was conducted from 2018 to 2022 using an anonymous questionnaire method in seven regions of Russia.Results and discussion. A total of 227 physicians from seven regions of Russia were surveyed, with 66.8% being internal medicine doctors and 33.2% obstetrician-gynecologists. This study revealed that physicians’ knowledge regarding the rational use of antimicrobial drugs (AMD) in pregnant women is insufficient. Respondents showed better results in the use of AMD in the treatment of pneumonia, with 78.7% of surveys indicating correct tactics. The worst results were observed in answering the question about the appropriateness of prescribing AMD for URTI, tracheitis, and bronchitis (40.3% to 67.7% of respondents made incorrect choices). Overall, 57.7% of respondents understand the importance of vaccination among pregnant women.Conclusion. The results of the conducted study indicate that the choice of drugs for the therapy of URTI and LRTI, especially AMD, for outpatient treatment of pregnant women in some situations does not fully correspond to the current clinical recommendations in our country. Moreover, it is particularly concerning that some physicians prescribe drugs that are unsafe for pregnant women or lack the necessary evidence base or indications for use.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"58 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141384298","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}
Introduction. The 6 Minute Walk Test (6MWT) plays a key role in assessing functional exercise tolerance and prognosis for a wide range of chronic respiratory and cardiovascular diseases. In acute bronchopulmonary diseases, in particular COVID-19, there is practically no data on the possibilities of using 6MWT.Aim. To compare the results of a 6-minute walk test with clinical and laboratory parameters of patients hospitalized with new coronovirus infection.Materials and methods. The prospective, non-randomized comparative study sequentially enrolled 117 patients hospitalized with a confirmed diagnosis of COVID-19. Upon admission to the hospital, all patients performed 6MWT in accordance with international recommendations.Results. During the 6-minute trial, patients walked an average of 390 m (340.0; 420.0). In 96.6% of patients, there was a marked limitation of physical activity. Desaturation during the 6-minute test was registered in 25 (21.4%) patients. When conducting a correlation analysis, it was found that the result of the test with physical activity (the number of meters traveled) is associated with both initial and final SpO2, the presence of desaturation and the severity of dyspnea according to Borg, with the age of patients, the severity of the course of new coronovirus infection, laboratory signs of the activity of the inflammatory process upon admission. Relationships between the results of 6MWT (the number of meters covered and the % decrease in SpO2) and the duration of hospitalization, the maximum volume of lung damage according to CT data, the maximum severity of laboratory signs of inflammation (CRP, ferritin) during hospitalization, the need for oxygen therapy, the volume of anti-inflammatory therapy (doses of systemic glucocorticoids, pulse therapy with methylprednisolone). Patients with desaturation during exercise had a more severe course of the disease with a large amount of lung tissue damage, as well as higher laboratory indicators of the activity of the inflammatory process. It was also found that patients who desaturate during the exercise test more often required oxygen therapy during hospitalization, more often pulse therapy with methylprednisolone was performed.Conclusion. Patients with COVID-19 develop a decrease in physical performance, which is multifactorial. These include respiratory failure due to lung tissue damage, muscle weakness, nervous system damage (anxiety, depression), and systemic inflammation, which characterizes the severity of the infection and the associated immune response. The results of 6MWT may have a certain prognostic value in terms of the severity of the course of the disease, the severity of systemic inflammation, the need for oxygen therapy, and pulse therapy with glucocorticoids.
{"title":"6-minute walk test in patients hospitalized with COVID-19","authors":"T. V. Kanaeva, N. Karoli","doi":"10.21518/ms2024-209","DOIUrl":"https://doi.org/10.21518/ms2024-209","url":null,"abstract":"Introduction. The 6 Minute Walk Test (6MWT) plays a key role in assessing functional exercise tolerance and prognosis for a wide range of chronic respiratory and cardiovascular diseases. In acute bronchopulmonary diseases, in particular COVID-19, there is practically no data on the possibilities of using 6MWT.Aim. To compare the results of a 6-minute walk test with clinical and laboratory parameters of patients hospitalized with new coronovirus infection.Materials and methods. The prospective, non-randomized comparative study sequentially enrolled 117 patients hospitalized with a confirmed diagnosis of COVID-19. Upon admission to the hospital, all patients performed 6MWT in accordance with international recommendations.Results. During the 6-minute trial, patients walked an average of 390 m (340.0; 420.0). In 96.6% of patients, there was a marked limitation of physical activity. Desaturation during the 6-minute test was registered in 25 (21.4%) patients. When conducting a correlation analysis, it was found that the result of the test with physical activity (the number of meters traveled) is associated with both initial and final SpO2, the presence of desaturation and the severity of dyspnea according to Borg, with the age of patients, the severity of the course of new coronovirus infection, laboratory signs of the activity of the inflammatory process upon admission. Relationships between the results of 6MWT (the number of meters covered and the % decrease in SpO2) and the duration of hospitalization, the maximum volume of lung damage according to CT data, the maximum severity of laboratory signs of inflammation (CRP, ferritin) during hospitalization, the need for oxygen therapy, the volume of anti-inflammatory therapy (doses of systemic glucocorticoids, pulse therapy with methylprednisolone). Patients with desaturation during exercise had a more severe course of the disease with a large amount of lung tissue damage, as well as higher laboratory indicators of the activity of the inflammatory process. It was also found that patients who desaturate during the exercise test more often required oxygen therapy during hospitalization, more often pulse therapy with methylprednisolone was performed.Conclusion. Patients with COVID-19 develop a decrease in physical performance, which is multifactorial. These include respiratory failure due to lung tissue damage, muscle weakness, nervous system damage (anxiety, depression), and systemic inflammation, which characterizes the severity of the infection and the associated immune response. The results of 6MWT may have a certain prognostic value in terms of the severity of the course of the disease, the severity of systemic inflammation, the need for oxygen therapy, and pulse therapy with glucocorticoids.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"7 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141383701","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}
G. Nekludova, D. V. Fan, N. Trushenko, G. S. Nuralieva, Z. Berikkhanov, S. N. Avdeev
Introduction. Pneumonia is a frequent manifestation of coronavirus infection. COVID-associated pneumonia is a disease characterized by a non-standard course and a number of clinical phenomena that complicate timely diagnosis and treatment.Aim. To investigate the phenomenon of mute hypoxemia in COVID-associated pneumonia.Materials and methods. The study included 214 patients who were divided into 2 groups. The study group included patients with confirmed COVID-associated pneumonia, and the control group included patients with interstitial lung diseases (idiopathic pulmonary fibrosis, nonspecific interstitial pneumonia, hypersensitivity pneumonitis). The subjective condition of the patient, presence of concomitant pathology, high-resolution computed tomography data, arterial blood gas composition, and spirometry data were evaluated.Results. In patients with COVID-associated pneumonia, “silent hypoxemia” was encountered 1.3 times more frequently than in patients with non-COVID-associated pneumonia. When comparing patients with silent hypoxemia and hypoxemia with dyspnea in COVID-associated pneumonia, statistically significantly higher values of PaCO2 and lower values of respiratory rate are observed. Such patterns are not detected in non-COVID-associated pneumonia. In patients with silent hypoxemia in non-COVID-associated pneumonia, the respiratory rate is statistically significantly higher compared to patients with COVID-associated pneumonia. Univariate logistic regression analysis demonstrates that in patients with non-COVID-associated pneumonia, silent hypoxemia is associated with BMI increase (OR = 1.380 (95% CI: 1.058–1.801); p = 0.017).Conclusion. The phenomenon of “silent hypoxemia” may manifest not only in pulmonary impairments resulting from SARS-CoV-2 infection but notably in COVID-associated pneumonia, where the absence of patient-reported dyspnea is substantiated by the lack of tachypnea. Owing to the subtleties of “silent hypoxemia”, clinical presentations may exhibit delays, diverting attention from significant pulmonary compromise, which could subsequently precipitate the failure of compensatory mechanisms.
{"title":"Silent hypoxemia – A specific sign of COVID-associated pneumonia?","authors":"G. Nekludova, D. V. Fan, N. Trushenko, G. S. Nuralieva, Z. Berikkhanov, S. N. Avdeev","doi":"10.21518/ms2024-068","DOIUrl":"https://doi.org/10.21518/ms2024-068","url":null,"abstract":"Introduction. Pneumonia is a frequent manifestation of coronavirus infection. COVID-associated pneumonia is a disease characterized by a non-standard course and a number of clinical phenomena that complicate timely diagnosis and treatment.Aim. To investigate the phenomenon of mute hypoxemia in COVID-associated pneumonia.Materials and methods. The study included 214 patients who were divided into 2 groups. The study group included patients with confirmed COVID-associated pneumonia, and the control group included patients with interstitial lung diseases (idiopathic pulmonary fibrosis, nonspecific interstitial pneumonia, hypersensitivity pneumonitis). The subjective condition of the patient, presence of concomitant pathology, high-resolution computed tomography data, arterial blood gas composition, and spirometry data were evaluated.Results. In patients with COVID-associated pneumonia, “silent hypoxemia” was encountered 1.3 times more frequently than in patients with non-COVID-associated pneumonia. When comparing patients with silent hypoxemia and hypoxemia with dyspnea in COVID-associated pneumonia, statistically significantly higher values of PaCO2 and lower values of respiratory rate are observed. Such patterns are not detected in non-COVID-associated pneumonia. In patients with silent hypoxemia in non-COVID-associated pneumonia, the respiratory rate is statistically significantly higher compared to patients with COVID-associated pneumonia. Univariate logistic regression analysis demonstrates that in patients with non-COVID-associated pneumonia, silent hypoxemia is associated with BMI increase (OR = 1.380 (95% CI: 1.058–1.801); p = 0.017).Conclusion. The phenomenon of “silent hypoxemia” may manifest not only in pulmonary impairments resulting from SARS-CoV-2 infection but notably in COVID-associated pneumonia, where the absence of patient-reported dyspnea is substantiated by the lack of tachypnea. Owing to the subtleties of “silent hypoxemia”, clinical presentations may exhibit delays, diverting attention from significant pulmonary compromise, which could subsequently precipitate the failure of compensatory mechanisms.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"52 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141384116","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}
The inhalation way of drug delivery seems to be the most logical for respiratory diseases. However, the most important condition for the effectiveness of inhalation therapy in children and adolescents along with the correct choice of the active substance is the selection of the optimal device and adequate execution of the inspiratory maneuver. When prescribing therapy attention should be paid to the inhalation technique of a particular patient and also take into account the likelihood of side effects when using certain devices. The article provides data on factors affecting the pulmonary deposit of the drug, the internal resistance of various inhalers which have the greatest informativeness for choosing a device along with the assessment of the inspiratory flow rate developed by the patient. The most problematic aspects of drug delivery to the respiratory tract in children under 5 years of age and in patients with inadequate inhalation rate are analyzed. The principles of correct inhalation are discussed which are necessary to obtain an optimal respiratory fraction. It is known that the problem of synchronizing inhalation with the moment of receipt of the drug is the most important when using metered – dose aerosol inhalers. In children this problem can be solved by using a spacer or using nebulizers that convert the liquid form of the drug into an aerosol using compressor air. Individual selection of an inhaler depending on the abilities and preferences of the patient in some groups of patients can significantly increase the effectiveness of therapy without increasing the dose of medications. The article presents up-to-date data on digital inhaler systems and the possibilities of using electronic devices for monitoring and using the inhaler.
{"title":"Age-related features of the choice of inhalers in chilren and adolescents with bronchial asthma and other respiratory diseases","authors":"E. Furman, E. Khuzina","doi":"10.21518/ms2024-200","DOIUrl":"https://doi.org/10.21518/ms2024-200","url":null,"abstract":"The inhalation way of drug delivery seems to be the most logical for respiratory diseases. However, the most important condition for the effectiveness of inhalation therapy in children and adolescents along with the correct choice of the active substance is the selection of the optimal device and adequate execution of the inspiratory maneuver. When prescribing therapy attention should be paid to the inhalation technique of a particular patient and also take into account the likelihood of side effects when using certain devices. The article provides data on factors affecting the pulmonary deposit of the drug, the internal resistance of various inhalers which have the greatest informativeness for choosing a device along with the assessment of the inspiratory flow rate developed by the patient. The most problematic aspects of drug delivery to the respiratory tract in children under 5 years of age and in patients with inadequate inhalation rate are analyzed. The principles of correct inhalation are discussed which are necessary to obtain an optimal respiratory fraction. It is known that the problem of synchronizing inhalation with the moment of receipt of the drug is the most important when using metered – dose aerosol inhalers. In children this problem can be solved by using a spacer or using nebulizers that convert the liquid form of the drug into an aerosol using compressor air. Individual selection of an inhaler depending on the abilities and preferences of the patient in some groups of patients can significantly increase the effectiveness of therapy without increasing the dose of medications. The article presents up-to-date data on digital inhaler systems and the possibilities of using electronic devices for monitoring and using the inhaler.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"352 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141385813","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}
Chronic obstructive pulmonary disease is one of the common respiratory diseases characterized by chronic inflammation, increased airway resistance and exacerbations. Treatment of chronic obstructive pulmonary disease is aimed at reducing the severity of symptoms, preventing exacerbations and progression of the disease, which significantly affects the well-being of patients. Irregular administration of prescribed drugs, as well as incorrect inhalation technique affects the well-being of patients, worsens the quality of life, increases the risk of adverse outcome. Over the past few years, the possibilities of therapy have certainly expanded, primarily due to the emergence of new combination drugs containing 2 or 3 components in one inhaler. The use of a medicament containing all three components in a single delivery device contributes to improved adherence to treatment and reduces the possibility of errors in inhalation technique. Drugs with the possibility of single use per day improve the patient’s adherence to therapy. In our clinical case, a patient with severe COPD and eosinophilia > 300 cells/µL with the administration of a double fixed combination of bronchodilators during the year showed an improvement in the condition, but a high level of blood eosinophils and frequent exacerbations remained. A personalized approach to COPD therapy will reduce the number of exacerbations, slow down the decline in lung function, and improve the quality of life of patients. The triple combination provides an effective and convenient option for supportive treatment of COPD, primarily for those whose disease is not controlled by dual ICS/LABA or LABA/LABA therapy.
{"title":"Triple fixed drug combination in the treatment of patients with chronic obstructive pulmonary disease","authors":"I. V. Demko, E. Sobko, A. Y. Kraposhina","doi":"10.21518/ms2024-196","DOIUrl":"https://doi.org/10.21518/ms2024-196","url":null,"abstract":"Chronic obstructive pulmonary disease is one of the common respiratory diseases characterized by chronic inflammation, increased airway resistance and exacerbations. Treatment of chronic obstructive pulmonary disease is aimed at reducing the severity of symptoms, preventing exacerbations and progression of the disease, which significantly affects the well-being of patients. Irregular administration of prescribed drugs, as well as incorrect inhalation technique affects the well-being of patients, worsens the quality of life, increases the risk of adverse outcome. Over the past few years, the possibilities of therapy have certainly expanded, primarily due to the emergence of new combination drugs containing 2 or 3 components in one inhaler. The use of a medicament containing all three components in a single delivery device contributes to improved adherence to treatment and reduces the possibility of errors in inhalation technique. Drugs with the possibility of single use per day improve the patient’s adherence to therapy. In our clinical case, a patient with severe COPD and eosinophilia > 300 cells/µL with the administration of a double fixed combination of bronchodilators during the year showed an improvement in the condition, but a high level of blood eosinophils and frequent exacerbations remained. A personalized approach to COPD therapy will reduce the number of exacerbations, slow down the decline in lung function, and improve the quality of life of patients. The triple combination provides an effective and convenient option for supportive treatment of COPD, primarily for those whose disease is not controlled by dual ICS/LABA or LABA/LABA therapy.","PeriodicalId":18391,"journal":{"name":"Meditsinskiy sovet = Medical Council","volume":"48 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141384676","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：