Terapevticheskii Arkhiv最新文献

Aim: Тo evaluate the quality of dispensary observation (DO) and treatment after myocardial infarction in accordance with the current DO-algoritm and clinical guidelines (CG).

Materials and methods: A questionnaire collection of data of the quality of DO and CG compliance was conducted in 28 regions of the Russian Federation (1241 questionnaires). The quality of DO was assessed according to a number of criteria, including the timing of establishing DO and issuing prescriptions for drugs, the specialty of the doctor performing DO, the frequency of DO-visits and adherence to the diagnostic algorithm, compliance with drug prescriptions current CG.

Results: Timely DO, cardiologist's follow up of patients discharged from the hospitall did not take place in all regions. The diagnostic algorithms of DO were generally followed, however, the drug therapy did not fully comply to CG, especially in beta-blockers and drugs that affect the renin-angiotensin system.

Conclusion: There is a need for further improvement of the DO of patients with myocardial infarction. The introduction, modernization of additional mechanisms that ensure the continuity and efficiency of the diagnostic, treatment process, and the optimization of drug treatment will improve the quality of outpatient cardiac care and DO.

Coronary heart disease (CHD) is one of the most common cardiovascular diseases and the most common cause of death in Russia. Primary diagnostics of CHD involves assessing the pre-test probability of CHD. Thereafter, myocardial ischemia should be verified by visualization technique: stress echocardiography or stress single-photon emission computed tomography of the myocardium. Myocardial revascularization improves the prognosis in patients with stable CHD who have three-vessel coronary disease or significant stenosis of the left main coronary artery. Outpatient monitoring and free provision of medications can significantly reduce mortality among patients with stable high-risk CHD.

The main causes of death in patients with heart failure (HF) are sudden cardiac death and decompensation of HF, especially with a low left ventricular ejection fraction. The prediction and prevention of risk factors for the development of these conditions are important goals both for guideline-directed medical therapy and for electrophysiological treatment methods. The article presents an overview of clinical studies devoted to the study of implantable cardioverter defibrillators in the prevention of sudden cardiac death, highlights the issues of monitoring the course of HF. Special attention is paid to multisensory monitoring in implantable devices equipped with a unique set of sensors for early diagnosis of the development of HF decompensation. It is expected that the practical use of such devices will reduce the number of exacerbations and hospitalizations for HF by detecting signs of threatening decompensation of blood circulation before the appearance of active symptoms, and as a result will reduce mortality in this category of patients.

Aim: Study the effectiveness of Cytoflavin in the medical rehabilitation of elderly and senile patients after pneumonia associated with a new coronavirus infection (COVID-19) at the outpatient stage.

Materials and methods: A prospective observational randomized study involving 66 patients (45 women and 21 men, average age 66.5±5.1 years) undergoing outpatient medical rehabilitation after pneumonia associated with COVID-19, divided into 2 groups, comparable in age and gender. A standardized comprehensive rehabilitation program was conducted in both groups. Patients of the main group were additionally prescribed Cytoflavin according to the standard regimen. Testing was carried out on scales reflecting the physical condition, degree of asthenization, psycho-emotional and cognitive status (Borg scale, 6-minute walk test, SHAS-scale, Multidimensional Fatigue Inventory, Mini-mental State Examination, Hospital Anxiety and Depression Scale) upon admission to outpatient treatment and upon discharge.

Results: Against the background of Cytoflavin therapy, positive dynamics was observed in patients of the main group in the form of a decrease in the values of SHAS-scale (86.5 [7.3] vs 56.3 [7.2]; p=0.00001), Multidimensional Fatigue Inventory (68.6 [14.7] vs 43.6 [12.8]; p=0.025); improvements in TSH (383.3 m [48.2] vs 550 m [32.5]; p=0.0248) and the Borg scale 4.5 [1.32] vs 2.2 [0.52]; p=0.038); the severity of cognitive impairment on the Mini-Mental State Examination decreased (26.05 [1.3] vs 28.47 [0.86]; p=0.0001); the emotional background improved - a decrease in the level of anxiety (10.7 [1.25] vs 5.6 [0.81]; p=0.0001) and depression (11.8 [1.48] vs 7.0 [1.24]; p=0.0001).

Conclusion: The standard course of Cytoflavin therapy in the medical rehabilitation of elderly and senile patients after pneumonia associated with COVID-19 significantly reduces the severity of cognitive impairment, fatigue and depressive disorders, improves indicators of the emotional and volitional sphere, increases exercise tolerance.

Aim: To evaluate the efficacy of the antiviral drug riamilovir (trade name - «Triazavirin^®») for the prevention of SARS-CoV-2 infection (COVID-19) and other acute respiratory viral infections in young people from organized groups.

Materials and methods: The study involved 386 individuals aged 18-22 years: 199 received riamilovir at a daily dose of 250 mg for 15 days, while 187 did not receive prophylactic drugs. For 30 days, disease occurrence was monitored among volunteers. In case of illness, the duration, severity of clinical manifestations, complications, and pathogen elimination dynamics were assessed via PCR from nasopharyngeal and oropharyngeal swabs.

Results: During riamilovir administration, a statistically significant reduction in cases of acute respiratory viral infections of non-coronavirus etiology was observed, with no COVID-19 cases reported, confirmed by the absence of SARS-CoV-2 RNA in this group. The shortest duration of acute respiratory viral infections was noted in patients taking the prophylactic drug.

Conclusion: Riamilovir (trade name - «Triazavirin^®») showed statistically significant prophylactic efficacy during its administration in an organized group. Its use decreased the frequency of detection of viral pathogens and resulted in milder acute respiratory disease, likely due to reduced viral load in individuals.

Atrial fibrillation (AF) and heart failure (HF) often accompany each other, as they share similar risk factors and pathophysiological mechanisms. AF in patients with HF is known to increase hospitalizations and worsen prognosis. A combination of AF and HF translates into high risks of thromboembolic complications, which renders anticoagulants an important aspect of therapy for these patients. Vitamin K antagonists make achieving the target level of anticoagulation challenging due to drug interactions and comorbidities. Direct oral anticoagulants (DOACs) are preferred medications owing to a more favorable risk-benefit ratio in this group of patients. At the same time, patients with HF often require a personalized approach when choosing an anticoagulant due to increased risks of thromboembolic complications and bleeding, as well as multiple comorbidities. The article presents the results of sub-analyses of key studies on the efficacy and safety of DOACs vs vitamin K antagonists in patients with HF and AF. It also explores DOACs use in patients with chronic kidney disease.

The article is devoted to a form of botulism that has been little studied in our country and is registered exclusively in infants. The fundamental difference between this form and the most common foodborne botulism is that infants become infected by ingestion of spores, followed by their germination, colonization of the intestines and production of botulinum toxin in situ, which leads to the development of life-threatening flaccid paralysis. Taking into account the peculiarities of pathogenesis, the clinical manifestations of infant botulism have some features, which are discussed by the authors. Particular attention is paid to the epidemiology and risk factors for the development of the disease. The article discusses in detail the issues of diagnosis and laboratory verification of the etiology of the disease. Current data on the treatment of infant botulism are presented.

Introduction: The article discusses topical issues of the use of conjugated 13-valent pneumococcal vaccine Prevenar®13 (PCV13) in patients with severe bronchial asthma (SBA), including those receiving targeted therapy with genetically engineered biological drugs (GEBD).

Aim: To study the effectiveness of vaccination against pneumococcal infection (PI) in patients with SBA.

Materials and methods: The study included 381 patients with SBA. The average age in the study groups was 45.5 (42.0; 52.5) years. All patients underwent clinical and instrumental studies, including spirography with bronchodilation test. After confirming the diagnosis of BA, the patients were divided into 2 observation groups. Group 1 (n=191) consisted of patients undergoing treatment with GEBD. Group 2 included patients with asthma receiving standard therapy, according to the 4th-5th stage according to the criteria of the Global Initiative for Asthma 2022 (Global Initiative for Asthma - GINA). The observation group consisted of 190 patients. In each group, there are subgroups of patients who have been vaccinated against PI and have not been vaccinated for various reasons. The following criteria were used as the main endpoints of observation for 12 months to assess the effectiveness: the number of pneumonia during the observation period, the number of exacerbations of asthma (severe, non-severe), the number of hospitalizations, the duration of exacerbations, the level of control according to the Asthma Control Questionnaire (ACQ5), functional indicators.

Results: The coverage of PI vaccination in patients with BA remains quite low, further organizational and methodological work is required to increase their involvement in vaccination. Immunization of PCV13 in patients with SBA at the 4th-5th stage of therapy reduces the risk of community-acquired pneumonia by at least 28.5%. PCV13 vaccination may be an additional effective tool for controlling the symptoms of SBA, including in patients undergoing treatment with GEBD. Vaccination allows to normalize the functional parameters of respiratory function in patients with SBA. PCV13 is well tolerated and does not cause any significant allergic reactions in patients with asthma.

Conclusion: PCV13 vaccination is an effective tool for reducing the risk of community-acquired pneumonia in patients with severe bronchial asthma, including those on targeted therapy with genetically engineered biological drugs.

Since the era of the widespread introduction of antibiotics into the human sphere of activity, the problem of antimicrobial resistance has become an urgent and very important topic around the world. Recently, coagulasonegative staphylococci (CoNS), which are representatives of opportunistic microorganisms of the microbiome of the skin and mucous membranes of healthy people, have made a certain contribution to its progression. For a long time, they did not pose a threat to patients, but in recent decades among microorganisms they have been seeded in more than two-thirds of patients with postoperative mediastinitis, catheter-associated infections, as well as from wounds of the neck vessels and the inguinal region separated by pacemaker beds. This paper discloses, using clinical examples, the significance of CoNS in the formation of systemic inflammatory response syndrome in patients with a burdened comorbid background (type II diabetes mellitus, grade 3 arterial hypertension). During the examination of patients, it was shown that skin defects are foci of persistent bacteremia of representatives of the CoNS group, which can cause the development of a systemic inflammatory infectious response with the formation of resistant strains of the opportunistic flora of the microbiome of the skin and mucous membranes. It has been shown that to determine the tactics of antibacterial therapy, a bacteriological study of all detected foci of infection in patients, screening of pathogens and their sensitivity to antibiotics, and especially in persons at risk, is necessary. This will increase the effectiveness of antibacterial therapy and reduce the possibility of forming resistant strains of pathogens.

Often ill people are, first of all, patients with recurrent infectious and inflammatory diseases of the upper respiratory tract (URT). They put a significant financial burden on the healthcare system. The leading etiological factors of recurrent inflammatory diseases of URT, in addition to pathogenic bacterial microflora, are viral agents (viruses of the viral respiratory infections group, herpes viruses). The chronic infection and recurrence of local inflammation is due to the persistence of resident bacterial and viral flora (including herpes viruses), and as a result, the insufficiency of the mucosal immune response. In order to optimize therapeutic and preventive measures for frequently ill adults and children, the most promising is the use of immunotherapy and immunoprophylaxis. The immunomodulator inosine pranobex, due to its unique combined (immunotropic and antiviral) properties, demonstrates effectiveness in the complex treatment of viral respiratory infections, including in combination with herpes viruses, and is successfully used to prevent frequent relapses of infectious and inflammatory diseases of the URT. The domestic analogue of inosine pranobex Normomed^® [JSC "Valenta Pharm"», ЛП-№(002470)-(РГ-RU), ЛП-№(005542)-(РГ-RU)], has a good safety and bioequivalence profile, and occupies a worthy field in the Russian pharmaceutical market among drugs recommended for the treatment of viral infections in adults and children.