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Prevalence of polymorphism of АDRВ1, AGT, SOD2, CAT genes and their combinations to assess the risk of developing cardiovascular disease 评估АDRВ1、AGT、SOD2、CAT 基因及其组合的多态性,以评估罹患心血管疾病的风险
Pub Date : 2024-03-31 DOI: 10.17816/rfd624814
N. Golovanova, I. Astratenkova, I. Lukyanova, Aleksandra V. Basanko
BACKGROUND: Cardiovascular disease remains a major public health problem associated with high mortality. The development of these diseases is associated with many genetic and cardiovascular risk factors, so the study of a person’s genetic predisposition to the development of cardiovascular disease based on gene polymorphism remains actual. The aim of research was to study the combination of polymorphisms of the ADRB1 rs1801253, AGT rs4762, SOD2 rs4880 and CAT rs1001179 genes in healthy young people to assess individual genetic predisposition to the development of cardiovascular disease. MATERIALS AND METHODS: The study involved 33 people aged 19 to 21 years who currently had no pathology of the cardiovascular system. DNA was isolated from oral epithelial cells. Genotyping of DNA samples was determined using real-time polymerase chain reaction. RESULTS: Among those examined, 39.4% had one or two unfavorable alleles for the ADRB1, AGT genes, suggesting a genetic predisposition to the development of cardiovascular disease. Unfavorable alleles of the ADRB1 gene were more common compared to the AGT gene. Each of those examined at risk of developing cardiovascular disease had one or two alleles associated with a decrease in the functioning of enzymes of the antioxidant system. Of the 33 people, only four (12.1%) do not have an unfavorable allele for the SOD2 and CAT genes. CONCLUSIONS: We believe that the determination of polymorphisms in genes for enzymes of the antioxidant system will be an important additional criterion for earlier and more active prevention of cardiovascular disease.
背景:心血管疾病仍然是一个与高死亡率相关的重大公共卫生问题。这些疾病的发生与许多遗传因素和心血管风险因素有关,因此根据基因多态性研究一个人发生心血管疾病的遗传易感性仍然是现实的。本研究旨在研究健康年轻人的 ADRB1 rs1801253、AGT rs4762、SOD2 rs4880 和 CAT rs1001179 基因的多态性组合,以评估心血管疾病发病的个体遗传易感性。材料与方法:研究涉及 33 名年龄在 19 至 21 岁之间、目前没有心血管系统病变的人。从口腔上皮细胞中分离出 DNA。使用实时聚合酶链反应对 DNA 样本进行基因分型。结果:在受检者中,39.4% 的人有一个或两个 ADRB1、AGT 基因的不利等位基因,这表明他们有患心血管疾病的遗传倾向。与 AGT 基因相比,ADRB1 基因的不利等位基因更为常见。在接受检查的心血管疾病高危人群中,每个人都有一个或两个等位基因与抗氧化系统酶的功能下降有关。在 33 人中,只有 4 人(12.1%)没有 SOD2 和 CAT 基因的不利等位基因。结论:我们相信,确定抗氧化系统酶基因的多态性将成为更早、更积极地预防心血管疾病的另一个重要标准。
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引用次数: 0
Measles and rubella are two controlled airborne infections: etiopathogenesis, epidemiology, clinical picture, diagnosis, treatment and prevention. Part 1. Measles 麻疹和风疹是两种可控的空气传播传染病:发病机制、流行病学、临床表现、诊断、治疗和预防。第 1 部分。麻疹
Pub Date : 2024-03-31 DOI: 10.17816/rfd624422
Vladimir A. Neverov, G. I. Kirpichnikova, Vsevolod M. Antonov, G. Startseva, Margarita V. Klur
The lecture is devoted to two infections controlled by specific means of prevention — measles and rubella, which still pose a danger both to the sphere of child and maternal health, and to healthcare in general. The first part of the lecture is devoted to measles, one of the most contagious diseases, outbreaks of which can be successfully prevented through vaccination or, conversely, serve as an indicator of gaps in immunization programs and primary health care systems. The lecture covers modern aspects of etiopathogenesis, epidemiology, clinical picture, diagnosis, treatment and prevention of measles. In the context of an increase in the incidence of this infection in our country and a number of foreign countries in 2023, the information presented in the lecture may be useful for practitioners and, first of all, family doctors.
本讲座主要介绍两种通过特殊预防手段控制的传染病--麻疹和风疹,这两种传染病仍然对儿童和孕产妇健康领域以及整个医疗保健领域构成威胁。讲座的第一部分专门讨论麻疹,麻疹是传染性最强的疾病之一,它的爆发可以通过接种疫苗来成功预防,反之,也可以作为免疫计划和初级卫生保健系统存在缺陷的指标。讲座内容包括麻疹的病原学、流行病学、临床表现、诊断、治疗和预防等现代方面。2023 年,麻疹在我国和一些外国的发病率将有所上升,在此背景下,讲座中介绍的信息可能对从业人员,首先是家庭医生有用。
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引用次数: 0
The impact of sarcopenia and comorbidity on the predicted risk of death in the elderly 肌肉疏松症和合并症对预测老年人死亡风险的影响
Pub Date : 2024-03-31 DOI: 10.17816/rfd625689
Y. A. Safonova
BACKGROUND: People with comorbidity have increased life expectancy in recent years. It affects clinical outcomes, including increased risk of death, which have not been well studied in patients with sarcopenia. AIM: To study the frequency and structure of comorbidity and assess the contribution of sarcopenia in predicting the risk of death in people aged 65 years and older. MATERIALS AND METHODS: The study included 230 people 65 years of age and older (70 men and 160 women, median age — 75 (68–79) years), who were consulted at a medical institution in St. Petersburg. Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia, 2nd revision (2018). Comorbidity and predicted risk of death were studied using the Charlson comorbidity index. RESULTS: Iron deficiency anemia and chronic kidney disease C3a–С3b were detected more often (p 0.001 and p = 0.031, respectively), and obesity less often (p 0.001) in sarcopenic patients. In sarcopenic patients, comorbidity was severe [5 (4–6) points] and the risk of death from all causes was 8.89 (95% confidence interval 3.95–20.2) times higher compared with non-sarcopenic patients (p 0.001). CONCLUSIONS: The significance of comorbidity was revealed, and a high probability of risk of death with sarcopenia in the elderly was revealed. This makes it possible to carry out activities that will delay the onset of death to a later age.
背景:近年来,合并症患者的预期寿命有所延长。合并症会影响临床结果,包括增加死亡风险,但对肌肉疏松症患者合并症的研究还不够深入。目的:研究合并症的频率和结构,并评估肌肉疏松症在预测 65 岁及以上人群死亡风险中的作用。材料与方法:研究对象包括在圣彼得堡一家医疗机构就诊的 230 名 65 岁及以上老年人(男性 70 人,女性 160 人,年龄中位数为 75(68-79)岁)。根据欧洲肌肉疏松症工作组第二次修订版(2018 年)的标准诊断肌肉疏松症。使用查尔森合并症指数对合并症和预测死亡风险进行了研究。结果:在肌肉疏松症患者中,缺铁性贫血和慢性肾脏病 C3a-С3b 的检出率较高(分别为 p 0.001 和 p = 0.031),而肥胖的检出率较低(p 0.001)。在肌肉疏松患者中,合并症严重[5(4-6)分],与非肌肉疏松患者相比,死于各种原因的风险高出 8.89 倍(95% 置信区间为 3.95-20.2)(P 0.001)。结论:研究揭示了合并症的重要性,并发现老年人患肌肉疏松症的死亡风险概率很高。因此,有可能开展一些活动,将死亡时间推迟到晚年。
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引用次数: 0
The memory to the teacher, Doctor of Medical Sciences, Professor E.V. Frolova 缅怀恩师、医学博士 E.V. 弗罗洛娃教授
Pub Date : 2024-03-31 DOI: 10.17816/rfd625455
C. Konson
The article is dedicated to the memory of Professor of the Department of Family Medicine, member of the editorial board of the journal “Russian Family Doctor”, Doctor of Medical Sciences, Professor E.V. Frolova, who became a mentor and supervisor for a nurse with higher education, citizen of Israel Claudia Konson.
谨以此文纪念全科医学系教授、《俄罗斯家庭医生》杂志编委会成员、医学博士 E.V. 弗罗洛娃教授,她是受过高等教育的护士、以色列公民克劳迪娅-孔森的导师。
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引用次数: 0
Prevalence of smoking and consumption of nicotine-containing products among students of medical and technical universities (PROTECT) 医科大学和技术大学学生吸烟和消费含尼古丁产品的普遍程度(PROTECT)
Pub Date : 2024-03-31 DOI: 10.17816/rfd626281
M. Pokhaznikova, O. Y. Kuznetsova, K. V. Ovakimyan, Rosa R. Fatkieva, Anna Yu. Goryaeva, Elena A. Andreeva, Aleksandr E. Sychev, Aleksandra S. Bogacheva, Irina V. Budnikova, Inna L. Samodova, E. R. Nemtsova, A. Litvinova, Daria S. Mamonkina, Maria S. Skornyakova
BACKGROUND: The article presents data of the study “Prevalence of smoking and consumption of nicotine-containing products among students of medical and technical universities” (PROTEСT), carried out in 2023 at North-Western State Medical University named after I.I. Mechnikov and Saint Petersburg Electrotechnical University (LETI) named after V.I. Ulyanov (Lenin). AIM: To study the prevalence and patterns of consumption of tobacco and nicotine-containing products, attitudes to smoking behaviour. MATERIALS AND METHODS: A cross-sectional study of a random sample of student groups included 1105 respondents. RESULTS: The average age of respondents was 20.7 ± 2.0 years, 44.3% were men. 6.8% of participants smoked cigarettes; more often men than women (9.4 vs. 4.7%, p 0.01). The prevalence of nicotine-containing products consumption was 15.7%. There were no differences by gender (men 15.7% and women 15.8%). The use of a combination of cigarettes and nicotine-containing products was noted by 6.6% of students, which led to increase the tobacco smokers number to 13.4%; and the number of people consuming nicotine-containing products to 22.4%. The main reason for starting smoking/consuming nicotine-containing products was the example of friends (in 35.8 and 34% of cases). The reason for the start of smoking and consuming nicotine-containing products were problems in school and family among 21.1% of women and 6.6% of men (p 0.05), and nicotine-containing products by 16.0% of women and 5.7% of men (p 0.05). The majority of consumers of cigarettes and nicotine-containing products combination (38.4%) use them in a 20/80 ratio. Among the respondents, the proportion of smoking relatives is 40.3%, friends — 66.2%, classmates/dormitory neighbors — 71.9%. CONCLUSIONS: A reduction in tobacco smoking and an increase in the proportion of people using nicotine-containing products and their combination with tobacco, as well as the absence of gender differences in nicotine-containing products consumption, indicates a change in the smoking behavior of students and increases the risk of developing nicotine addiction and harmful health consequences. Differences in the motivation for starting smoking/using nicotine-containing product among men and women requires more detailed study.
背景:文章介绍了2023年在以伊-伊-梅契尼科夫命名的西北国立医科大学和以弗-伊-乌里扬诺夫(列宁)命名的圣彼得堡电工技术大学开展的 "医科大学和技术大学学生吸烟和消费含尼古丁产品情况"(PROTEСT)研究的数据。目的:研究烟草和含尼古丁产品消费的普遍性和模式,以及对吸烟行为的态度。材料和方法:对学生群体进行随机抽样的横断面研究,包括 1105 名受访者。结果:受访者的平均年龄为(20.7 ± 2.0)岁,44.3%为男性。6.8%的受访者吸烟,男性多于女性(9.4% 对 4.7%,P 0.01)。消费含尼古丁产品的比例为 15.7%。没有性别差异(男性为 15.7%,女性为 15.8%)。有 6.6% 的学生同时使用香烟和含尼古丁产品,这使得吸烟人数增加到 13.4%,而消费含尼古丁产品的人数增加到 22.4%。开始吸烟/消费含尼古丁产品的主要原因是朋友的言传身教(分别占 35.8%和 34%)。21.1%的女性和 6.6%的男性开始吸烟和消费含尼古丁产品的原因是学校和家庭问题(P 0.05),16.0%的女性和 5.7%的男性开始吸烟和消费含尼古丁产品的原因是学校和家庭问题(P 0.05)。大多数香烟和含尼古丁产品的消费者(38.4%)以 20/80 的比例混合使用。在受访者中,吸烟的亲戚占 40.3%,朋友占 66.2%,同学/宿舍邻居占 71.9%。结论吸烟人数的减少、使用含尼古丁产品及其与烟草混合使用的人数比例的增加,以及含尼古丁产品消费没有性别差异,表明学生的吸烟行为发生了变化,并增加了尼古丁成瘾和有害健康后果的风险。男女开始吸烟/使用含尼古丁产品的动机差异需要更详细的研究。
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引用次数: 0
Thyroid paradox in older age 老年甲状腺悖论
Pub Date : 2024-03-31 DOI: 10.17816/rfd627477
A. Turusheva, Ksenia S. Popova, Daria S. Kinder
BACKGROUND: The thyroid gland plays an important role in our body, influencing almost all metabolic processes in the body throughout life. However, literature data on the effect of decreased thyroid function on mortality in older people is contradictory. AIM: To evaluate the impact of thyroid-stimulating hormone levels on 5-year survival in older adults. MATERIALS AND METHODS: This work was carried out on the basis of the second screening of the Crystal study of community-dwelling individuals 65+ (n = 383). Main study parameters: thyroid-stimulating hormone level, blood test, lipid profile, albumin, total protein, comprehensive geriatric assessment, 5 years of follow-up. RESULTS: A thyroid-stimulating hormone level of 3.3–10.0 mIU/L was associated with a 44.6% reduced risk of all-cause mortality (hazard ratio 0.554; 95% confidence interval 0.307–0.999) at 5 years of follow-up, regardless of the presence of non-communicable diseases and geriatric status. A thyroid-stimulating hormone level more 10.0 mIU/L is not associated with an increased risk of mortality. The lower risk of mortality in patients with high thyroid-stimulating hormone levels may be due to a larger thigh muscle circumference. After adjustment for all covariates used and thyroid-stimulating hormone level, a 1 cm increase in thigh muscle circumference was associated with a 4.5% reduction in the risk of all-cause mortality (hazard ratio 0.955; 95% confidence interval 0.932–0.979). CONCLUSIONS: The lowest risk of all cause-mortality mortality in persons aged 65 years and older is observed with a thyroid-stimulating hormone level of 3.3–10.0 mIU/L. Thyroid-stimulating hormone level more 10.0 mIU/L is not associated with an increased risk of all cause-mortality.
背景:甲状腺在人体内发挥着重要作用,影响着人一生中几乎所有的新陈代谢过程。然而,有关甲状腺功能下降对老年人死亡率影响的文献数据却相互矛盾。目的:评估促甲状腺激素水平对老年人 5 年生存率的影响。材料和方法:这项工作是在对 65 岁以上社区居民(n = 383)进行的 Crystal 研究第二次筛查的基础上开展的。主要研究参数:促甲状腺激素水平、验血、血脂、白蛋白、总蛋白、老年综合评估、5 年随访。结果:促甲状腺激素水平为 3.3-10.0 mIU/L 与随访 5 年后全因死亡风险降低 44.6% 相关(危险比为 0.554;95% 置信区间为 0.307-0.999),与是否存在非传染性疾病和老年病状况无关。促甲状腺激素水平高于 10.0 mIU/L 与死亡风险增加无关。促甲状腺激素水平高的患者死亡风险较低,这可能是由于他们的大腿肌肉周长较大。在对所有协变量和促甲状腺激素水平进行调整后,大腿肌肉周长每增加1厘米,全因死亡风险就会降低4.5%(危险比为0.955;95%置信区间为0.932-0.979)。结论:在促甲状腺激素水平为 3.3-10.0 mIU/L 的人群中,65 岁及以上人群的全因死亡风险最低。促甲状腺激素水平高于 10.0 mIU/L 与全因死亡率风险增加无关。
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引用次数: 0
Lesions of the heart and parenchymatous organs in patients with COVID-19 and other acute respiratory infections COVID-19 和其他急性呼吸道感染患者的心脏和实质器官病变
Pub Date : 2024-01-19 DOI: 10.17816/rfd622794
Roman A. Khokhlov, Margarita V. Yarmonova, Lyudmila V. Tribuntseva
Based on available literature, this study aimed to critically assess the effect of SARS-CoV-2 and other respiratory viruses on the heart and parenchymatous internal organs, identify their common and distinctive features, assess the frequency of cytokine storm and “post-infection” syndrome, and identify risk factors for severe systemic reaction and damage to internal organs, particularly the heart. In the databases of MEDLINE/PubMed, eLibrary, Web of Science, CyberLeninka, and Openmedcom.ru, primary information (full-text and abstract databases) in English and Russian was searched using selected keywords from 2003 to 2023. Acute respiratory viral infection pathogens can cause not only respiratory but also cardinal, gastroenterological, neurological, and other complications. Acute respiratory viral infections have many similarities in their effects on parenchymal organs. The emergence of new viruses requires in-depth study, and it is important to consider both the distinctive features of the clinical picture of viral infections and the general patterns of influence on internal organs. In the medium term, patients who have COVID-19 may have complex heart damage in the form of a decrease in ventricular ejection fraction, appearance of pericardial effusion, and development of various types of focal myocardial lesions. The combined nature of damage to the heart and parenchymal organs is influenced by background diseases, nature of the course of viral infection, and features of therapy. The features of lesions of parenchymal organs and the heart after acute respiratory viral infection require further study, including their effect on the development of late complications.
本研究以现有文献为基础,旨在严格评估 SARS-CoV-2 和其他呼吸道病毒对心脏和实质性内脏器官的影响,确定其共同和显著特点,评估细胞因子风暴和 "感染后 "综合征的频率,并确定严重全身反应和内脏器官(尤其是心脏)损伤的危险因素。在 MEDLINE/PubMed、eLibrary、Web of Science、CyberLeninka 和 Openmedcom.ru 等数据库中,使用选定的关键词搜索了 2003 年至 2023 年的英文和俄文主要信息(全文和摘要数据库)。急性呼吸道病毒感染病原体不仅可引起呼吸道并发症,还可引起心脏、肠胃、神经及其他并发症。急性呼吸道病毒感染对实质器官的影响有许多相似之处。新病毒的出现需要深入研究,重要的是既要考虑病毒感染临床表现的显著特征,又要考虑对内脏器官影响的一般模式。从中期来看,COVID-19 患者可能会出现复杂的心脏损害,表现为心室射血分数下降、心包积液和各种类型的局灶性心肌病变。心脏和实质器官损伤的综合性质受背景疾病、病毒感染过程的性质和治疗特点的影响。急性呼吸道病毒感染后实质器官和心脏的病变特征需要进一步研究,包括其对后期并发症发展的影响。
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引用次数: 0
Creation of a model for training the communication skills of medical specialists 创建医学专家沟通技能培训模式
Pub Date : 2024-01-19 DOI: 10.17816/rfd607409
L. Shubina, Z. Lopatin
BACKGROUND: Effective interaction between medical workers and patients is not only a service function but also influences compliance with the implementation of recommendations for the prevention and treatment of diseases. The communicative competence of healthcare professionals affects treatment effectiveness and the success of health-preserving measures. AIM: To examine the problems associated with the formation of communicative competence and determine the fundamental principles of the model of communicative skills of a medical worker. MATERIALS AND METHODS: A literature review of 32 domestic and 54 foreign publications on teaching communication in medicine was performed. The work of an expert focus group within the framework of a strategic session on communication skills “A coordinated approach to teaching communication skills in medicine” was analyzed. RESULTS: During the work of the focus group, experts reviewed and specified the main shortcomings in the work of medical personnel in ensuring communication with the patient. In the second part of the focus group work, based on communication defects, four blocks of skills were developed to avoid communication errors. Because of a review of literature data and a generalization of the results of the work of experts, a prototype model of the communication skills of a medical worker was proposed. CONCLUSIONS: Existing models of medical communication must adapt to national characteristics based on research and joint discussions. The authors propose using fundamental principles of the model of communication skills of a medical worker in educational programs of higher and additional professional education, as outlined in this article.
背景:医务工作者与患者之间的有效互动不仅是一种服务功能,而且会影响到对疾病预防和治疗建议的执行情况。医护人员的沟通能力影响着治疗效果和健康保护措施的成败。目的:研究与沟通能力形成相关的问题,确定医务工作者沟通能力模型的基本原则。材料与方法:对 32 篇关于医学沟通教学的国内文献和 54 篇国外文献进行了综述。在 "医学沟通技能教学的协调方法 "沟通技能战略会议框架内,对专家焦点小组的工作进行了分析。结果:在焦点小组的工作中,专家们回顾并明确了医务人员在确保与病人沟通方面的主要不足。在焦点小组工作的第二部分,根据沟通缺陷,制定了避免沟通错误的四项技能。通过查阅文献资料和归纳专家的工作成果,提出了医务工作者沟通技巧的原型模型。结论:现有的医疗沟通模式必须在研究和共同讨论的基础上适应各国的特点。作者建议在高等和其他专业教育的教学计划中使用医务工作者沟通技巧模型的基本原则,正如本文所概述的那样。
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引用次数: 0
Artificial intelligence in medical practice 医疗实践中的人工智能
Pub Date : 2024-01-19 DOI: 10.17816/rfd601816
T. S. Fil
With state support, artificial intelligence is being intensively introduced into the healthcare sector. This review provides general information about artificial intelligence and its place in the healthcare system. A part of the lecture is devoted to the Moscow experiment on the use of computer vision in real clinical practice and the experience of the Kirov region on the use of artificial intelligence in the medical examination of the population. The lecture will be interesting to doctors and students to expand their general understanding of artificial intelligence and the possibility of its application in practical healthcare.
在国家的支持下,人工智能正被大力引入医疗保健领域。本综述提供了有关人工智能及其在医疗系统中的地位的一般信息。讲座的一部分专门介绍了莫斯科在实际临床实践中使用计算机视觉的实验,以及基洛夫地区在人口体检中使用人工智能的经验。讲座将使医生和学生对人工智能及其在实际医疗保健中应用的可能性有更多的了解。
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引用次数: 0
Clinical case of benralizumab use in severe eosinophilic bronchial asthma in the Republic of Dagestan 达吉斯坦共和国严重嗜酸性粒细胞支气管哮喘患者使用苯拉利珠单抗的临床病例
Pub Date : 2024-01-19 DOI: 10.17816/rfd569352
Seypula Sh. Ахмедханов, Saida G. Gadzhiyeva, Albina T. Beybalayeva, Z. Saidova
This article presents the results of the examination, observation, and treatment of a patient with severe persistent bronchial asthma with an eosinophilic phenotype who received benralizumab (Fazenra) in a complex treatment. Benralizumab is indicated for patients with severe bronchial asthma with an eosinophilic phenotype in adult patients as an additional maintenance therapy, in which the use of glucocorticosteroids does not achieve control over the symptoms of the disease. With complex therapy, the inclusion of benralizumab led to positive dynamics of both clinical symptoms and indicators of respiratory function, which allowed us to reduce the volume of therapy with corticosteroids and achieve disease control. The above case is of interest to both pulmonologists and therapists.
本文介绍了一名嗜酸性粒细胞表型的重症持续性支气管哮喘患者接受苯拉利珠单抗(Fazenra)复合治疗后的检查、观察和治疗结果。Benralizumab 适用于成年嗜酸性粒细胞表型的重症支气管哮喘患者,在使用糖皮质激素无法控制疾病症状的情况下,可作为一种额外的维持疗法。在复合疗法中,加入苯拉利珠单抗后,临床症状和呼吸功能指标都出现了积极的动态变化,这使我们能够减少糖皮质激素的治疗量,实现疾病控制。肺科医生和治疗师都对上述病例很感兴趣。
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引用次数: 0
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Russian Family Doctor
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