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Diagnosis of bacteriologically unconfirmed pulmonary tuberculosis (literature review) 细菌学未确诊肺结核的诊断(文献复习)
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-7-387-392
T. Tyulkova, T. Lugovkina, D. M. Kutuzova, N. Khabibullina
The authors analyzed 31 scientific publications, which highlighted modern methods to the diagnosis of bacteriologically unconfirmed pulmonary tuberculosis (PTB). In the article, such clinical cases are classified into two groups due to the absence of the tuberculosis causative agent. This approach can serve as a justification for choosing optimal and appropriate additional methods and techniques for diagnosing bacteriologically unconfirmed PTB. Given the fact that bacterial excretion is determined by traditional microbiological methods (microscopic and cultural) in sputum, the literature review presents data on additional measures for obtaining biological material for the etiological diagnosis of tuberculosis, using molecular genetic methods for detecting Mycobacterium tuberculosis DNA. Besides, the article shows the diagnostic significance of immunological and serological tests for the tuberculosis diagnosis, as well as modern methods to the X-ray results interpretation, using mathematical methods that evaluate the dynamic X-ray imaging. A special place in the bacteriologically unconfirmed PTB diagnosis is occupied by the description of biopsy material using artificial intelligence. That is, the integration of medicine and information technology achievements allows us having a source of additional information that should help the doctor diagnose tuberculosis in difficult clinical cases. KEYWORDS: tuberculosis, oligobacillar forms of tuberculosis, sputum smear-negative tuberculosis, diagnosis, bacteriologically unconfirmed, diagnostic material, immunological methods, radiation methods, mathematical methods. FOR CITATION: Tyulkova T.E., Lugovkina T.K., Kutuzova D.M., Khabibullina N.F. Diagnosis of bacteriologically unconfirmed pulmonary tuberculosis (literature review). Russian Medical Inquiry. 2022;6(7):387–392 (in Russ.). DOI: 10.32364/2587-6821-2022-6-7-387-392.
作者分析了31篇科学出版物,这些出版物强调了诊断细菌学上未确诊的肺结核(PTB)的现代方法。在这篇文章中,这类临床病例被分为两组,因为没有结核病原体。这种方法可以作为选择最佳和适当的附加方法和技术来诊断细菌学上未证实的肺结核的理由。鉴于细菌排泄是通过传统的微生物学方法(显微镜和培养)在痰液中确定的,文献综述提出了利用分子遗传学方法检测结核分枝杆菌DNA来获得用于结核病病原学诊断的生物材料的其他措施的数据。此外,本文还介绍了免疫学和血清学检查对结核病诊断的诊断意义,以及现代方法对x线结果的解释,用数学方法评价x线动态成像。在细菌学上未确诊的肺结核诊断中,使用人工智能对活检材料的描述占据了一个特殊的位置。也就是说,医学和信息技术成果的结合使我们能够获得额外的信息来源,帮助医生在困难的临床病例中诊断结核病。关键词:结核病,少杆菌型结核病,痰涂片阴性结核病,诊断,细菌学未确诊,诊断材料,免疫学方法,放射方法,数学方法。引用本文:Tyulkova t.e., Lugovkina t.k., Kutuzova d.m., Khabibullina N.F.细菌学未确诊肺结核的诊断(文献综述)。俄罗斯医学调查。2022;6(7):387-392(俄文)。DOI: 10.32364 / 2587-6821-2022-6-7-387-392。
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引用次数: 0
Diagnostic errors in botulism 肉毒杆菌中毒的诊断错误
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-11-667-670
I. Sergeeva, Sh.Kh. Rakhimi
Botulism is a rare but serious condition characterized by long hospitalization and high lethality and therefore is considered an important problem of modern infectiology. Multiple diagnostic errors frequently occur in botulism, though the disease has highly distinctive clinical signs.The authors reviewed 27 patient medical records from 1992–2006: 15 records of the patients hospitalized with different preliminary diagnoses and later established diagnosis "botulism" and 12 records of the patients with initially diagnosed botulism which was not confirmed. The article highlights epidemiological and clinical criteria of botulism. While generating a differential diagnosis, it is necessary to recognize that botulism has different clinical manifestations, and that the disease severity may vary from mild to serious. Preventive measures for botulism play an important role and are aimed at enhancing the public awareness of the storage and consumption of mushroom, fish, and meat cans and products. KEYWORDS: botulism, botulinum toxin, Clostridium botulinum, early diagnosis, differential diagnosis, diagnostic errors. FOR CITATION: Sergeeva I.V., Rakhimi Sh.Kh. Diagnostic errors in botulism. Russian Medical Inquiry. 2022;6(11):667–670 (in Russ.). DOI: 10.32364/2587-6821-2022-6-11-667-670.
肉毒杆菌中毒是一种罕见但严重的疾病,其特点是长期住院和高致死率,因此被认为是现代感染学的一个重要问题。虽然肉毒杆菌中毒具有非常独特的临床症状,但经常发生多种诊断错误。作者回顾了1992-2006年27例患者的医疗记录,其中15例为初步诊断不同但后来确诊为“肉毒中毒”的住院患者,12例为初步诊断为肉毒中毒但未确诊的住院患者。文章强调了肉毒杆菌中毒的流行病学和临床标准。在进行鉴别诊断时,有必要认识到肉毒杆菌中毒具有不同的临床表现,并且疾病的严重程度可能从轻微到严重不等。预防肉毒杆菌中毒的措施发挥着重要作用,旨在提高公众对蘑菇、鱼和肉罐头及其制品的储存和消费的认识。关键词:肉毒杆菌中毒,肉毒杆菌毒素,肉毒梭菌,早期诊断,鉴别诊断,诊断错误。引文:Sergeeva i.v., Rakhimi Sh.Kh。肉毒杆菌中毒的诊断错误。俄罗斯医学调查。2022;6(11):667-670(俄文)。DOI: 10.32364 / 2587-6821-2022-6-11-667-670。
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引用次数: 0
Asymptomatic hyperuricemia and radiographic progression of rheumatoid arthritis 无症状高尿酸血症和类风湿关节炎的影像学进展
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-8-470-479
A.Yu. Tsinserling, V. Mazurov, I. Gaydukova, M. Petrova, O. Inamova, R. Bashkinov, N. Gonchar
Background: clinical and radiological studies on this issue remain unknown, despite the existing pathomorphological prerequisites, indicating the mutually potentiative effect of hyperuricemia (HU) on the radiographic progression (RP) in rheumatoid arthritis (RA). Aim: to study the association between the HU, the activity of RA, RP and the possibilities of their correction. Patients and Methods: among 967 patients included in the St. Petersburg City Register of HU from January 2011 to October 2021, 232 patients with RA and HU (uric acid (UA) level > 360 μmol/L) were selected, for which 232 patients of the comparison group with RA without HU were selected by random selection from the same register. A comparison of the demographic characteristics of patients (gender, age), their clinical, laboratory and radiological patterns and the ongoing treatment was conducted. Results: patients with RA and HU and without HU were comparable in age, gender, activity, disease course and the received baseline therapy. In patients with RA and HU, there was a higher (p=0.03) increase in the joint space narrowing (JSN) value of the feet. In patients with RA and HU, RP in all evaluated parameters (p<0,001) exceeded RP in patients with RA without HU. The article reveales direct correlations in the JSN of the feet and hands with the UA level, UA clearance, UA daily excretion, daily protein loss, as well as blood glucose and cholesterol levels, despite the well-known risk factors for the RA progression (age, disease duration, positivity according to RF and CCPA, elevated ESR and CRP level). Patients with HU and RP only reached the target UA levels in 27% of cases when treated with allopurinol, while patients without RP reached the target level in 80% of cases. Conclusion: HU in patients with RA is associated with RP, which indicates the need for its timely detection and correction. KEYWORDS: rheumatoid arthritis, asymptomatic hyperuricemia, radiographic progression, urate-lowering therapy, allopurinol. FOR CITATION: Tsinserling A.Yu., Mazurov V.I., Gaydukova I.Z. et al. Asymptomatic hyperuricemia and radiographic progression of rheumatoid arthritis. Russian Medical Inquiry. 2022;6(8):470–479 (in Russ.). DOI: 10.32364/2587-6821-2022-6-8-470-479.
背景:尽管已有病理形态学上的先决条件,但关于这一问题的临床和影像学研究仍然未知,表明高尿酸血症(HU)对类风湿关节炎(RA)放射学进展(RP)的相互潜在影响。目的:探讨HU与RA、RP活性的关系及其矫正的可能性。患者和方法:选取2011年1月至2021年10月在圣彼得堡市HU登记簿中登记的967例患者,其中RA合并HU(尿酸(UA)水平> 360 μmol/L)患者232例,其中RA合并HU对照组232例,随机从同一登记簿中抽取。对患者的人口学特征(性别、年龄)、临床、实验室和放射学模式以及正在进行的治疗进行比较。结果:RA和HU患者与未HU患者在年龄、性别、活动度、病程和接受基线治疗方面具有可比性。RA和HU患者足部关节间隙狭窄(JSN)值增高(p=0.03)。在有RA和HU的患者中,所有评估参数的RP (p< 0.001)都超过无HU的RA患者的RP。本文揭示了足部和手部JSN与UA水平、UA清除率、UA每日排泄、每日蛋白质损失以及血糖和胆固醇水平的直接相关性,尽管众所周知的RA进展危险因素(年龄、病程、RF和CCPA阳性、ESR和CRP水平升高)。在接受别嘌呤醇治疗的情况下,只有27%的HU和RP患者达到了目标UA水平,而没有RP的患者达到目标水平的比例为80%。结论:RA患者HU与RP相关,需及时发现并纠正。关键词:类风湿性关节炎,无症状高尿酸血症,影像学进展,降尿酸治疗,别嘌呤醇。引证:Tsinserling A.Yu。,马祖罗夫V.I.,盖杜科娃I.Z.等。无症状高尿酸血症和类风湿关节炎的影像学进展。俄罗斯医学调查。2022;6(8):470-479(俄文)。DOI: 10.32364 / 2587-6821-2022-6-8-470-479。
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引用次数: 0
Evaluating the efficiency of a five-minute cognitive test for the use in non-demented patients with cognitive declines (a pilot study) 评估五分钟认知测试在认知能力下降的非痴呆患者中的有效性(一项初步研究)
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-10-551-555
K.P. Tuzhikov, V. Voitenkov, E. Ekusheva
Background: the Five-Minute Cognitive Test (FCT) was designed in 2019 by the Chinese scientists to capture deficits in five domains of cognitive abilities, including episodic memory, language fluency, time orientation, visuospatial function, and executive function. Aim: to evaluate the efficiency of the Russian FCT version for identifying cognitive impairments (CI) in non-demented patients. Patients and Methods: according to the international requirements and standards, the FCT was translated and adapted and then evaluated in a focus group of non-demented patients (n=62, 60–75 years old) followed by the assessment of its psychometric properties. The FCT results were compared with the MMSE and Montreal Cognitive Assessment (MOCA) scores in two patient groups: the treatment group (n=30) consisting of patients with moderate CI, before after the cognitive rehabilitation course, and the comparison group, consisting of 32 individuals with normal cognitive functions. In addition, the correlation of the hippocampal volume with FCT/MMSE scores was assessed. Results: the average time to complete FCT was 5–6 min. The sensitivity and specificity of PCT for CI screening was 80.6% and 84.11%, respectively. As demonstrated by the study findings, FCT’s diagnostic performance was not inferior to that of other tests used for detecting CI. The neurovisualization data showed that there was a positive correlation between the hippocampal volume and the FCT/MMSE scores. Conclusion: the preliminary results suggest that the Russian FCT version is acceptable and promising for the use in clinical practice as a relevant screening test for identifying CI. KEYWORDS: mild cognitive impairments, moderate cognitive impairments, Alzheimer’s disease, brief cognitive test. FOR CITATION: Tuzhikov K.P., Voitenkov V.B., Ekusheva E.V. Evaluating the efficiency of a five-minute cognitive test for the use in non- demented patients with cognitive declines (a pilot study). Russian Medical Inquiry. 2022;6(10):551–555 (in Russ.). DOI: 10.32364/2587- 6821-2022-6-10-551-555
背景:五分钟认知测试(FCT)是由中国科学家于2019年设计的,旨在捕捉五个认知能力领域的缺陷,包括情景记忆、语言流畅性、时间取向、视觉空间功能和执行功能。目的:评价俄语FCT版本在识别非痴呆患者认知障碍(CI)方面的有效性。患者和方法:根据国际要求和标准,对FCT进行翻译和改编,然后在非痴呆患者(n=62, 60-75岁)的焦点小组中进行评估,随后评估其心理测量学特性。将FCT结果与两组患者的MMSE和蒙特利尔认知评估(MOCA)评分进行比较:治疗组(n=30)由中度CI患者组成,认知康复课程前后,对照组(n= 32)由认知功能正常的个体组成。此外,评估海马体积与FCT/MMSE评分的相关性。结果:完成FCT的平均时间为5-6 min, PCT对CI筛查的敏感性为80.6%,特异性为84.11%。研究结果表明,FCT的诊断性能并不逊于用于检测CI的其他测试。神经可视化数据显示海马体积与FCT/MMSE评分呈正相关。结论:初步结果表明,俄罗斯FCT版本是可接受的,有望在临床实践中作为识别CI的相关筛查试验。关键词:轻度认知障碍,中度认知障碍,阿尔茨海默病,简短认知测试引文:Tuzhikov K.P, Voitenkov V.B, Ekusheva E.V.评估五分钟认知测试对认知能力下降的非痴呆患者的有效性(一项试点研究)。俄罗斯医学调查。2022;6(10):551-555(俄文)。Doi: 10.32364/2587- 6821-2022-6-10-551-555
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引用次数: 0
Hypothyroidism is an interdisciplinary problem 甲状腺功能减退是一个跨学科的问题
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-9-509-515
A. Verbovoy, Y. Dolgikh, N. I. Verbovaya
Hypothyroidism is one of the most prevalent endocrine disorders, second only to diabetes. Hypothyroidism diagnosis can be difficult in view of its varied and non-specific symptoms. The reason is that thyroid hormones affect virtually every organ system in the body. At the same time, the severity of thyroid hormone deficiency may vary and does not always correlate with the changes in laboratory testing results. Clinical presentation of patients with hypothyroidism may include multiple symptoms and, as a result, it can be difficult to diagnose this disorder, especially in elderly and polymorbid individuals. In some patients, the prevailing symptoms indicate that only a particular system is affected. Thus, there are diseases known as the "masks" of hypothyroidism, and this review is focused on their clinical manifestations. Conditions that may be running under the "mask" of hypothyroidism include diastolic hypertension, dyslipidemia, hydropericardium, chronic constipation, biliary lithiasis, polyarthritis, alopecia, onycholysis, depression, dysfunctional uterine bleeding, infertility, anemia, etc. Due to a variety of clinical signs and symptoms, a patient with hypothyroidism may get an appointment with any medical specialist or receive a follow-up care provided in parallel by multiple specialists. Physicians should be aware of potential hypothyroidism and specific effects of the underactive thyroid on patient’s organs and systems. It is necessary to obtain a thorough medical history about comorbidities which would help to figure out that hypothyroidism is the cause of co-occurring conditions. KEYWORDS: autoimmune thyroiditis, hypothyroidism, subclinical hypothyroidism, euthyroidism, dyslipidemia, cardiovascular diseases, arterial hypertension FOR CITATION: Verbovoy A.F., Dolgikh Yu.A., Verbovaya N.I. Hypothyroidism is an interdisciplinary problem. Russian Medical Inquiry. 2022;6(9):509–515 (in Russ.). DOI: 10.32364/2587-6821-2022-6-9-509-515.
甲状腺功能减退是最常见的内分泌疾病之一,发病率仅次于糖尿病。甲状腺功能减退症的诊断是困难的,因为它的各种各样的和非特异性的症状。原因是甲状腺激素几乎影响身体的每个器官系统。同时,甲状腺激素缺乏的严重程度可能有所不同,并不总是与实验室检测结果的变化相关。甲状腺功能减退症患者的临床表现可能包括多种症状,因此,这种疾病很难诊断,特别是在老年人和多病个体中。在一些患者中,普遍的症状表明只有一个特定的系统受到影响。因此,有一些疾病被称为甲状腺功能减退的“面具”,本文就其临床表现进行综述。可能在甲状腺功能减退的“面具”下运行的病症包括舒张性高血压、血脂异常、心包积液、慢性便秘、胆结石、多发性关节炎、脱发、骨髓炎、抑郁症、功能失调性子宫出血、不孕症、贫血等。由于各种临床体征和症状,甲状腺功能减退患者可以预约任何医学专家或接受多名专家并行提供的随访治疗。医生应该意识到潜在的甲状腺功能减退和甲状腺功能减退对患者器官和系统的特殊影响。有必要获得有关合并症的全面病史,这将有助于确定甲状腺功能减退是合并症的原因。关键词:自身免疫性甲状腺炎、甲状腺功能减退、亚临床甲状腺功能减退、甲状腺功能亢进、血脂异常、心血管疾病、动脉高血压甲状腺功能减退症是一个跨学科的问题。俄罗斯医学调查。2022;6(9):509-515(俄文)。DOI: 10.32364 / 2587-6821-2022-6-9-509-515。
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引用次数: 2
Interferon profile of the mucosal immunity in women with papillomavirus infection 乳头瘤病毒感染妇女粘膜免疫的干扰素谱分析
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-2-67-71
E. Markelova, M. S. Tulupova, T. Nevezhkina, L. S. Matyushkina, M. Chernikova, S. Knysh
Papillomaviruses are a group of DNA viruses belonging to the Papillomavirida family. These viruses provoke pathological conditions manifesting with inflammation, exophytic masses, carcinogenesis, reproductive and perinatal disorders. Immune status is an essential factor de-termining the severity and duration of inflammatory diseases, the course of latent viral infections, including papillomavirus infection (PVI). The human immune system prevents the persistence, reactivation, and development of PVI clinical presentations. The cellular immune response is realized under the control of interferons (IFNs). Today, no complex studies on type 1, 2, or 3 IFNs in the cervical mucus of women with PVI associated with herpesvirus and chlamydia infec-tions are available. Aim: to compare IFN profile of mucosal immunity in women with PVI associated with herpesvirus and chlamydia infections. Patients and Methods: this study enrolled 149 women aged 25–44. Women were divided into four groups. Group 1 included women with PVI only (n=21). Group 2 included women with PVI and herpesvirus infection (n=47). Group 3 included women with PVI and chlamydia infec-tions (n=39). Group 4 included controls (n=30). Complex outpatient clinical laboratory examina-tion included clinical functional, biochemical, and immunological tests to detail pathophysiolog-ical mechanisms of urogenital PVIs. IFN (IFN-β, IFN-γ, IFN-λ1/IL-29, IFN-λ3/IL-28B) levels in the cervical mucus were measured by ELISA. Results: in all groups, IFN-λ3 and IFN-γ deficiencies were detected. In PVI, IFN-γ deficiency prevailed. In PVI associated with herpesvirus infection, IFN-λ3 deficiency prevailed. In PVI associated with chlamydia infection, a severe IFN-β deficiency was revealed. Conclusion: these patterns demonstrate a relevant role of the interferon arm of the im-mune response in the pathogenesis of isolated PVI and PVI associated with herpesvirus and chlamydia infections. These alterations in mucosal immunity support the prescription of immu-notherapy for these infections. KEYWORDS: human papillomavirus, herpesvirus infection, chlamydia infection, interferons, immune system, cervical mucus, mucosal immunity. FOR CITATION: Markelova E.V., Tulupova M.S., Nevezhkina T.A. et al. Interferon profile of the mucosal immunity in women with papillomavirus infection. Russian Medical Inquiry. 2022;6(2):67–71 (in Russ.). DOI: 10.32364/2587-6821-2022-6-2-67-71.
乳头瘤病毒是一组属于乳头瘤病毒科的DNA病毒。这些病毒引起的病理状况表现为炎症、外生性肿块、致癌、生殖和围产期疾病。免疫状态是决定炎症性疾病的严重程度和持续时间,潜伏病毒感染的过程,包括乳头瘤病毒感染(PVI)的重要因素。人体免疫系统阻止PVI临床表现的持续、再激活和发展。细胞免疫应答是在干扰素(ifn)的控制下实现的。目前,对于与疱疹病毒和衣原体感染相关的PVI患者宫颈粘液中1型、2型或3型ifn的复杂研究尚无。目的:比较与疱疹病毒和衣原体感染相关的PVI妇女粘膜免疫的IFN谱。患者和方法:本研究招募了149名年龄在25-44岁之间的女性。女性被分成四组。第1组仅包括患有PVI的女性(n=21)。第2组包括伴有PVI和疱疹病毒感染的女性(n=47)。第3组包括合并PVI和衣原体感染的女性(n=39)。第4组包括对照组(n=30)。复杂的门诊临床实验室检查包括临床功能、生化和免疫学检查,以详细了解泌尿生殖器PVIs的病理生理机制。ELISA法检测宫颈黏液中IFN (IFN-β、IFN-γ、IFN-λ1/IL-29、IFN-λ3/IL-28B)水平。结果:各组均检测到IFN-λ3和IFN-γ缺乏。在PVI中,IFN-γ缺乏普遍存在。在与疱疹病毒感染相关的PVI中,IFN-λ3缺乏普遍存在。在衣原体感染相关的PVI中,发现严重的IFN-β缺乏。结论:这些模式表明免疫-免疫反应的干扰素臂在分离的PVI和与疱疹病毒和衣原体感染相关的PVI发病机制中的相关作用。这些粘膜免疫的改变支持了针对这些感染的免疫治疗处方。关键词:人乳头瘤病毒,疱疹病毒感染,衣原体感染,干扰素,免疫系统,宫颈粘液,粘膜免疫。引用本文:Markelova e.v., Tulupova m.s., Nevezhkina T.A.等。乳头瘤病毒感染妇女粘膜免疫的干扰素谱分析。俄罗斯医学调查。2022;6(2):67-71(俄文)。DOI: 10.32364 / 2587-6821-2022-6-2-67-71。
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引用次数: 0
Rational approach to the treatment of otitis externa 外耳炎的合理治疗方法
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-7-404-410
A. V. Gurov, A. V. Muzhichkova
In recent years, there has been an increased number of calls to ENT specialists concerning otitis externa. These conditions are characterized by antibiotic resistance of key pathogens, as well as the presence of significant pain symptoms. In 60–98% of cases, inflammation in the external auditory canal has a bacterial etiology. Pseudomonas aeruginosa occupies a leading place in the microbial landscape — up to 78% on average, while Staphylococcus aureus is sown only in 9–27% of cases. Rational therapy of otitis externa is one of the urgent problems of otorhinolaryngology, despite the large variety of treatment methods. It is necessary to use complex therapy of external otitis, including a direct effect on the etiological factor, as well as pain relief. In the vast majority of cases, the frontline empirical therapy of otitis externa should be topical antimicrobial agents. The following combined drug is successfully used for the treatment of otitis externa: ear drops containing a combined antibiotic (aminoglycoside neomycin + cyclic polypeptide polymyxin B + topical anesthetic lidocaine). Early therapy of otitis externa with a combined antibiotic is the key to a fast and reliable clinical result. KEYWORDS: otitis externa, bacterial otitis, ear drops, combined antibiotic, aminoglycoside, cyclic polypeptide, topical anesthetics, neomycin, polymyxin B, lidocaine. FOR CITATION: Gurov A.V., Muzhichkova A.V. Rational approach to the treatment of otitis externa. Russian Medical Inquiry. 2022;6(7):404– 410 (in Russ.). DOI: 10.32364/2587-6821-2022-6-7-404-410.
近年来,有越来越多的电话呼叫耳鼻喉专科有关外耳炎。这些疾病的特点是主要病原体的抗生素耐药性,以及存在明显的疼痛症状。在60-98%的病例中,外耳道炎症是由细菌引起的。铜绿假单胞菌在微生物景观中占据主导地位-平均高达78%,而金黄色葡萄球菌仅在9-27%的病例中播种。尽管外耳炎的治疗方法多种多样,但合理治疗外耳炎仍是耳鼻喉科亟待解决的问题之一。外耳炎的综合治疗是必要的,包括对病因的直接影响,以及疼痛的缓解。在绝大多数情况下,外耳炎的一线经验性治疗应该是外用抗菌药物。以下联合药物成功用于治疗外耳炎:含联合抗生素(氨基糖苷新霉素+环多肽多粘菌素B +表面麻醉剂利多卡因)的滴耳液。早期联合应用抗生素治疗外耳炎是获得快速、可靠临床结果的关键。关键词:外耳炎、细菌性中耳炎、滴耳液、联合抗生素、氨基糖苷、环多肽、表面麻醉剂、新霉素、多粘菌素B、利多卡因。引用本文:Gurov A.V., Muzhichkova A.V.外耳炎的合理治疗方法。俄罗斯医学调查。2022;6(7):404 - 410(俄文)。DOI: 10.32364 / 2587-6821-2022-6-7-404-410。
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引用次数: 1
Disorders of endothelium-dependent vasodilation in patients with microvascular angina 微血管心绞痛患者内皮依赖性血管舒张功能紊乱
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-8-427-432
I. Leonova, O. Zakharova, S. Boldueva
Background: disorders of both endothelium-dependent and endothelium-independent vasodilation play a role in the pathogenesis of microvascular angina (MVA), the contribution of which may be different. Aim: to study the processes of endothelium-dependent vasodilation (EDV) in patients with primary MVA. Patients and Methods: an open prospective study included 60 patients (mean age 57.3±6.4 years) with MVA, confirmed clinical picture (chest pain), coronary angiography data (the absence of coronary artery stenosis), positive stress test (pain syndrome and/or ST segment depression by ≥2 mm by treadmill exercise stress test), positron emission tomography (PET) myocardial perfusion imaging (MPI) with tests (cold pressor test and with adenosine). Patients with diseases that can lead to secondary microvascular dysfunction were not included in the study. To evaluate the processes of EDV, all patients underwent the following evaluations: peripheral arterial tonometry (PAT), assessment of circulating endothelial cells (CEC), high-sensitivity C-reactive protein (hsCRP), endothelin-1 (ET-1), total antioxidant status. Adding that, the results of a cold pressor test during PET were analyzed. Results: the majority of the examined patients were women — 81.7%. Most of the female patients included in the study (93.9%) were postmenopausal. In all patients with MVA, according to the data of PET MPI with cold pressor test, signs of EDV disorder were detected as a decrease in coronary blood flow through the three coronary arteries. During PET, the index of reactive hyperemia was reduced (<1,67) in all examined patients and amounted to 1.43±0.15. According to the results of laboratory studies, there was an increase in the level of ET-1 and CEC — 3,335 [1,545; 3,952] fmol/L and 14±8 cells/3×105 leukocytes, respectively. The CRP level was 4,44 [1.02; 4.45] mg/L. The total antioxidant capacity was reduced in 53 (88%) patients, the average values of the indicator were 289,03±52,14 μmol/L. Conclusion: according to laboratory and instrumental studies, signs of endothelial dysfunction, namely disorders of EDV, were revealed in all examined patients with primary MVA. KEYWORDS: microvascular angina, peripheral arterial tonometry, endothelium-dependent vasodilation, positron emission tomography. FOR CITATION: Leonova I.A., Zakharova O.V., Boldueva S.A. Disorders of endothelium-dependent vasodilation in patients with microvascular angina. Russian Medical Inquiry. 2022;6(8):427–432 (in Russ.). DOI: 10.32364/2587-6821-2022-6-8-427-432.
背景:内皮依赖性和内皮非依赖性血管舒张障碍在微血管心绞痛(MVA)的发病机制中都有作用,但其作用可能不同。目的:探讨原发性MVA患者内皮依赖性血管舒张(EDV)的发生过程。患者和方法:一项开放的前瞻性研究,包括60例MVA患者(平均年龄57.3±6.4岁),确诊临床表现(胸痛),冠状动脉造影数据(无冠状动脉狭窄),阳性应激试验(疼痛综合征和/或跑步机运动应激试验ST段下降≥2mm),正电子发射断层扫描(PET)心肌灌注成像(MPI)试验(冷压试验和腺苷)。可导致继发性微血管功能障碍的疾病患者不包括在研究中。为了评估EDV的过程,所有患者都进行了以下评估:外周动脉血压(PAT)、循环内皮细胞(CEC)、高敏c反应蛋白(hsCRP)、内皮素-1 (ET-1)、总抗氧化状态评估。此外,还分析了PET期间冷压试验的结果。结果:检查患者以女性居多,占81.7%。纳入研究的大多数女性患者(93.9%)为绝经后患者。在所有MVA患者中,根据PET MPI与冷压试验的数据,EDV障碍的迹象是通过三条冠状动脉的冠状动脉血流量减少。PET期间,所有检查患者的反应性充血指数均降低(<1,67),为1.43±0.15。根据实验室研究结果,ET-1和CEC的水平增加了3335 [1545;3,952] fmol/L和14±8个细胞/3×105白细胞。CRP水平分别为4.44 [1.02;4.45 mg / L。总抗氧化能力降低53例(88%),指标平均值分别为289、03±52、14 μmol/L。结论:根据实验室和仪器研究,所有检查的原发性MVA患者均出现内皮功能障碍的迹象,即EDV紊乱。关键词:微血管心绞痛,外周动脉血压计,内皮依赖性血管舒张,正电子发射断层扫描。引用本文:Leonova i.a., Zakharova o.v., Boldueva S.A.内皮依赖性血管舒张在微血管心绞痛患者中的作用。俄罗斯医学调查。2022;6(8):427-432(俄文)。DOI: 10.32364 / 2587-6821-2022-6-8-427-432。
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引用次数: 1
The etiology and clinical characteristics of bacterial intestinal infections in adult patients in the Republic of Adygeya Adygeya共和国成人肠道细菌感染的病因学和临床特点
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-11-608-611
R. Tlyustangelova, N. Pshenichnaya, S.S. Khaidarov
Aim: To assess the structure of acute intestinal infections (AIIs) over the period of 2017–2021 and characterize the etiology and clinical course of bacterial AIIs in adult patients in the Republic of Adygeya. Patients and Methods: this retrospective cohort study used the following resources: 1) official statistical reports on viral and bacterial AIIs over the period of 2017–2021 in the Republic of Adygeya to assess trends in the morbidity rates and 2) medical records of 50 patients with bacterial AIIs who received treatment in 2020–2021 in the Adygeya Republican Infectious Diseases Hospital to identify clinical and laboratory findings associated with the bacterial causes of diarrhea. A complete blood cell count, biochemistry blood test, stool analysis and stool culture test were performed in the studied patients. First, the stool samples were inoculated onto an enrichment medium, and then elective nutrient media were used for the detection of pathogens. Results: over the last five years, 4,474 AII cases were reported in the Republic, and in 3,317 (74.14%) of them the etiology was not determined. In 2017–2019, bowel infections of viral etiology prevailed in the structure of AIIs. In 2020 and 2021, amid a significant decline in AII morbidity rates, the percentage of viral and bacterial AIIs was similar: 7.14% and 7.71% in 2020 and 1.11% and 3.05% in 2021, respectively. The median age of patients with verified AIIs of bacterial etiology was 34.5 years, most of the patients were females. Salmonellosis caused by Salmonella entеritidis constituted the highest percentage of bacterial AIIs. Most of the patients had moderate illnesses with enterocolitis symptoms and prevailing secretory diarrhea. Conclusion: over the last five years, 4,474 AII cases were reported in the Republic of Adygeya, and in most patients the etiology was not determined. In 2020 and 2021, amid a significant decline in AII morbidity rates, the percentage of viral and bacterial AIIs was similar. Salmonellosis was dominating in the structure of AIIs (moderate illnesses with enterocolitis symptoms and prevailing secretory diarrhea). Biochemistry tests are necessary for patients with bacterial AIIs to identify pathogenetic mechanisms implicated in the development of post- infectious disease syndrome and gastrointestinal diseases. KEYWORDS: acute intestinal infections, bacterial intestinal infections, etiology, post-infectious disease syndrome, irritable bowel syndrome, gastrointestinal diseases. FOR CITATION: Tlyustangelova R.K., Pshenichnaya N.Yu., Khaidarov S.S. The etiology and clinical characteristics of bacterial intestinal infections in adult patients in the Republic of Adygeya. Russian Medical Inquiry. 2022;6(11):608–611 (in Russ.). DOI: 10.32364/2587-6821- 2022-6-11-608-611.
目的:评估2017-2021年期间Adygeya共和国成年患者急性肠道感染(AIIs)的结构,并表征细菌性AIIs的病因学和临床病程。患者和方法:本回顾性队列研究使用了以下资源:1)2017-2021年Adygeya共和国病毒性和细菌性急性呼吸道感染的官方统计报告,以评估发病率的趋势;2)2020-2021年在Adygeya共和国传染病医院接受治疗的50例细菌性急性呼吸道感染患者的医疗记录,以确定与细菌性腹泻相关的临床和实验室发现。对患者进行全血细胞计数、血液生化检查、粪便分析和粪便培养试验。首先将粪便样本接种到富集培养基上,然后选择营养培养基进行病原体检测。结果:近5年来,我国共报告了4474例AII病例,其中3317例(74.14%)病因不明。2017-2019年,肠道病毒感染在aii结构中占主导地位。2020年和2021年,在AII发病率显著下降的情况下,病毒性和细菌性AII的比例相似,2020年分别为7.14%和7.71%,2021年分别为1.11%和3.05%。确诊细菌性aii患者的中位年龄为34.5岁,以女性居多。肠炎沙门氏菌引起的沙门氏菌病占细菌性人工感染的比例最高。多数患者病情中度,以肠结肠炎症状为主,以分泌性腹泻为主。结论:在过去五年中,Adygeya共和国报告了4,474例AII病例,大多数患者的病因尚未确定。2020年和2021年,在AII发病率显著下降的情况下,病毒性和细菌性AII的比例相似。沙门氏菌病在aii的结构中占主导地位(以肠结肠炎症状和普遍的分泌性腹泻为症状的中度疾病)。细菌性aii患者需要进行生物化学检查,以确定感染后疾病综合征和胃肠道疾病的发病机制。关键词:急性肠道感染、肠道细菌感染、病因学、感染后疾病综合征、肠易激综合征、胃肠道疾病引用本文:Tlyustangelova r.k., Pshenichnaya N.Yu。Adygeya共和国成年患者肠道细菌感染的病因学和临床特征。俄罗斯医学调查。2022;6(11):608-611(俄文)。Doi: 10.32364/2587-6821- 2022-6-11-608-611。
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引用次数: 0
Clinical study of the URSosan Forte in patients with non-alcoholic fatty liver disease and cholelithiasis (KURS study) URSosan Forte治疗非酒精性脂肪肝合并胆石症的临床研究(KURS研究)
Pub Date : 2022-01-01 DOI: 10.32364/2587-6821-2022-6-5-213-220
I. Pirogova, I.V. Ufimtseva
Aim: to evaluate the effect of ursodeoxycholic acid (UDCA) on hepatic fibrosis and steatosis, dyslipidemia, carbohydrate metabolism, and litholysis of cholesterol gallstones in patients with a combination of non-alcoholic fatty liver disease (NAFLD) and gallstone disease (GD). Patients and Methods: a prospective monocenter study was conducted, which included patients with NAFLD and GD at the age of 19 to 65 years. The diagnosis was established on the basis of clinical, laboratory, ultrasound and radiological data. The nature and incidence of comorbid pathology were assessed. The degree of hepatic fibrosis and steatosis was determined according to the abdominal MSCT and serum tests of liver fibrosis (FIB 4, APRI) and hepatic steatosis (FLI), as well as liver elastography. All patients received UDCA at a dose of 15 mg/kg for 6 months. Results: 85 patients were included in the study, 59 (70%) of them were female, the mean age was 49.3±9 years. Gallstones of low density (up to 75 HU) were detected in 45 (52%) patients who made up the group 1, of high density (75–120 HU) — in 40 (48%) patients included in the group 2. 42 (49%) patients had comorbidity. In group 2, comorbid pathology was significantly more common and the degree of hepatic steatosis and fibrosis was higher. During treatment with UDCA, the positive trend in group 1 was expressed in a significant decrease in the gallstone density and size, normalization of liver density, cytolysis and cholestasis indicators, improvement of carbohydrate metabolism, and regression of hepatic steatosis according to MSCT and elastography. In group 2, there was a decrease in bile density and gallstone size according to MSCT, as well as a positive trend of lipidogram, HOMA-IR index, hepatic density and steatosis according to MSCT and elastography.Conclusion: the use of UDCA in patients with NAFLD and GD as pathogenetic therapy has a positive effect on hepatic fibrosis and steatosis, dyslipidemia, carbohydrate metabolism, and provides litholysis of cholesterol stones, mainly with a density of less than 75 HU. KEYWORDS: comorbidity, non-alcoholic fatty liver disease, cholelithiasis, cholesterol stones, litholysis, hepatic steatosis. FOR CITATION: Pirogova I.Yu., Ufimtseva I.V. Clinical study of the URSosan Forte in patients with non-alcoholic fatty liver disease and cholelithiasis (KURS study). Russian Medical Inquiry. 2022;6(5):213–220 (in Russ.). DOI: 10.32364/2587-6821-2022-6-5-213-220.
目的:评价熊去氧胆酸(UDCA)对合并非酒精性脂肪性肝病(NAFLD)和胆结石病(GD)患者肝纤维化和脂肪变性、血脂异常、碳水化合物代谢和胆固醇结石溶解的影响。患者和方法:进行了一项前瞻性单中心研究,纳入了年龄在19至65岁的NAFLD和GD患者。诊断依据临床、实验室、超声和放射学资料。评估共病病理的性质和发生率。根据腹部MSCT、血清肝纤维化(FIB 4、APRI)、肝脂肪变性(FLI)及肝弹性图确定肝纤维化和脂肪变性程度。所有患者均以15mg /kg的剂量接受UDCA治疗,疗程6个月。结果:85例患者纳入研究,其中女性59例(70%),平均年龄49.3±9岁。1组45例(52%)患者检测到低密度(75 HU)胆结石,2组40例(48%)患者检测到高密度(75 - 120 HU)胆结石。42例(49%)患者有合并症。2组共病病理更常见,肝脂肪变性和纤维化程度更高。在UDCA治疗期间,MSCT和弹性成像显示,1组患者的阳性趋势表现为胆结石密度和大小明显下降,肝密度、细胞溶解和胆汁淤积指标正常化,碳水化合物代谢改善,肝脂肪变性消退。2组MSCT显示胆密度和胆结石大小下降,MSCT和弹性图显示脂质图、HOMA-IR指数、肝脏密度和脂肪变性呈阳性趋势。结论:UDCA用于NAFLD和GD患者的病理治疗对肝纤维化和脂肪变性、血脂异常、碳水化合物代谢有积极作用,并提供胆固醇结石的溶解,主要以密度小于75 HU的结石为主。关键词:合并症、非酒精性脂肪性肝病、胆石症、胆固醇结石、溶石、肝脂肪变性。引证:Pirogova I.Yu。URSosan Forte在非酒精性脂肪肝合并胆石症患者中的临床研究(KURS研究)。俄罗斯医学调查。2022;6(5):213-220(俄文)。DOI: 10.32364 / 2587-6821-2022-6-5-213-220。
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引用次数: 0
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Russian Medical Inquiry
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