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New coronavirus infection in patients with chronic non-communicable diseases in primary care 初级保健中慢性非传染性疾病患者的新型冠状病毒感染
Pub Date : 2023-01-18 DOI: 10.17816/rfd114966
O. Kuznetsova, E. Frolova, K. V. Ovakimyan, Ruzanna V. Ambartsumyan, V.S. Dranets, A. Litvinova
BACKGROUND: The pandemic of a new coronavirus infection, which began in the Chinese city of Wuhan in December 2019, has spread to more than 200 countries and territories. There are a number of studies, the results of which indicate that deaths are mainly registered among the middle-aged and elderly population with chronic non-communicable diseases. Most of these studies are based on the study of cases of COVID-19 with severe course or in hospitalized patients. At the same time, a greater number of patients, including those with chronic non-communicable diseases, carry COVID-19 to a mild degree and remain under the supervision of primary care physicians. AIM: To identify risk factors for the development of severe COVID-19 in patients with chronic non-communicable diseases who sought outpatient care during various periods of increased incidence of new coronavirus infection from March 2020 to February 2022. MATERIALS AND METHODS: The study was carried out on the basis of the Family Medicine Center of North-Western State Medical University named after I.I. Mechnikov, which provides primary health care to the population attached under compulsory health insurance. The design of the study was published earlier. A retrospective cohort study was conducted based on the analysis of outpatient records of patients who sought medical care at the Family Medicine Center during various periods of increased incidence of COVID-19: from 19.03.2020 to 30.06.2020 (group 1), from 1.10.2021 to 30.11.2021 (group 2) and from 18.01.2022 to 28.02.2022 (group 3). RESULTS: 343 patients were included in the study: 137 men (39.9%) and 206 women (60.1%). The number of patients with at least one chronic non-communicable disease was 232 (67.9%). It was found that the severity of COVID-19 is not affected by the presence of one or more chronic non-communicable diseases of mild severity in the patient. At the same time, grade II obesity and grade III hypertension are independent factors that significantly increase the risk of developing severe COVID-19 by 13.4 and 5.4 times, respectively (p 0.05). It should be noted that the combination of these diseases significantly increased the likelihood of developing severe COVID-19 by 11.9 times (p 0.05). CONCLUSIONS: Regardless of the period of morbidity, the clinical manifestations of COVID-19 in patients with chronic non-communicable diseases have their own characteristics: weakness, sweating, dry and wet cough are significantly more common (p 0.05). With each subsequent wave of increase in the incidence of COVID-19 in patients with chronic non-communicable diseases, there is a significant tendency to decrease the frequency of severe and very severe course of the disease, pneumonia and hospitalization, as in patients without chronic non-communicable diseases. It was found that the severity of the COVID-19 course is not affected by the presence of mild chronic non-communicable diseases in the patient. At the same time, grade II and highe
背景:2019年12月在中国武汉市开始的新型冠状病毒感染大流行已蔓延到200多个国家和地区。有一些研究结果表明,登记的死亡主要发生在患有慢性非传染性疾病的中老年人口中。这些研究大多基于对重症COVID-19病例或住院患者的研究。与此同时,包括慢性非传染性疾病患者在内的更多患者轻度感染COVID-19,并仍在初级保健医生的监护下。目的:确定在2020年3月至2022年2月新型冠状病毒感染发病率增加的不同时期就诊的慢性非传染性疾病患者发生严重COVID-19的危险因素。材料和方法:该研究是在西北州立医科大学以I.I. Mechnikov命名的家庭医学中心的基础上进行的,该中心为强制性健康保险所附的人口提供初级卫生保健。这项研究的设计早前已经公布。通过对2020年3月19日至2020年3月6日(第1组)、2021年10月1日至2021年11月30日(第2组)、2022年1月18日至2022年2月28日(第3组)就诊于家庭医学中心的患者门诊记录进行回顾性队列研究。结果:共纳入343例患者,其中男性137例(39.9%),女性206例(60.1%)。至少患有一种慢性非传染性疾病的患者人数为232人(67.9%)。结果发现,COVID-19的严重程度不受患者存在一种或多种轻度慢性非传染性疾病的影响。与此同时,II级肥胖和III级高血压是导致重症COVID-19发生风险分别显著增加13.4倍和5.4倍的独立因素(p 0.05)。值得注意的是,这些疾病的合并使发生严重COVID-19的可能性显著增加11.9倍(p < 0.05)。结论:无论发病时间如何,慢性非传染性疾病患者的COVID-19临床表现均有其自身特点:虚弱、多汗、干湿咳明显较常见(p < 0.05)。随着慢性非传染性疾病患者中COVID-19发病率随后的每一波上升,与没有慢性非传染性疾病的患者一样,严重和极严重病程、肺炎和住院的频率有显著下降的趋势。结果发现,患者是否患有轻度慢性非传染性疾病并不影响COVID-19病程的严重程度。与此同时,II级及以上肥胖或III级高血压是使发生严重COVID-19的风险分别显著增加11.9倍和5.4倍的独立因素(p 0.05)。这些疾病的合并使发生严重COVID-19的概率显著增加13.4倍(p < 0.05)。
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引用次数: 0
Modern principles of etiotropic therapy for chronic hepatitis B and C 慢性乙型和丙型肝炎致病因治疗的现代原则
Pub Date : 2023-01-18 DOI: 10.17816/rfd112383
N. I. Kuznetsov, I. Moiseeva
The review includes an analysis of literature data on the etiotropic therapy of chronic viral hepatitis B and C. In this review, we focused on the efficacy and safety of drugs that have been included in international and Russian guidelines for etiotropic therapy of chronic viral hepatitis B and C. The analysis of the feasibility of using antiviral drugs in real clinical practice was carried out, based on research data on the study of the mechanisms of action, efficacy and possible side effects of these drugs.
本综述包括对致病因治疗慢性乙型肝炎和丙型肝炎的文献资料进行分析。在本综述中,我们重点对国际和俄罗斯的致病因治疗慢性乙型肝炎和丙型肝炎指南中已纳入的药物的疗效和安全性进行了分析。这些药物的功效和可能的副作用。
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引用次数: 0
Impact of malnutrition and its correction on mortality in older adults 营养不良对老年人死亡率的影响及其纠正
Pub Date : 2023-01-18 DOI: 10.17816/rfd115271
A. Turusheva
BACKGROUND: Malnutrition is associated with decreased levels of physical function, cognitive decline, and an increased risk of all-cause mortality, making it important to identify risk factors for malnutrition, especially in old age. AIM: To identify factors associated with an increase and decrease in the risk of developing malnutrition, as well as to assess the impact of malnutrition and its correction on mortality in older adults. MATERIALS AND METHODS: A prospective cohort study of a random sample of 611 people aged 65 years and older. Mini Nutritional Assessment, Geriatric Depression Scale, Mini-Mental State Examination, dynamometry, Barthel Index, chronic noncommunicable diseases, clinical blood count, C-reactive protein. 2 examinations, 9 years of total follow-up. RESULTS: Risk factors for deterioration in nutritional status are decrease in emotional status (odds ratio 5.439; 95% confidence interval 2.79410.588), progression of autonomy decline (odds ratio 2.428; 95% confidence interval 1.3424.393), low physical function (odds ratio 2.877; 95% confidence interval 1.5775.250). A high level of physical function reduces the risk of malnutrition by 64.1%. Malnutrition increases the risk of five-year mortality by 2.7 times. A normal nutritional status reduces the risk of nine-year mortality by 50.2%. Improve nutrition status leads to a lower risk of mortality. CONCLUSIONS: The main factors in the deterioration of nutritional status are a decrease in emotional status, loss of autonomy and a low level of physical function. Early detection of older adults with malnutrition and its correction can reduce the risk of mortality.
背景:营养不良与身体功能水平下降、认知能力下降和全因死亡风险增加有关,因此确定营养不良的危险因素非常重要,尤其是在老年人中。目的:确定与营养不良风险增加和减少相关的因素,并评估营养不良及其纠正对老年人死亡率的影响。材料和方法:一项前瞻性队列研究,随机抽样611名65岁及以上的人。迷你营养评估、老年抑郁量表、迷你精神状态检查、动力测量、Barthel指数、慢性非传染性疾病、临床血球计数、c反应蛋白。2次检查,总随访9年。结果:营养状况恶化的危险因素为情绪状态下降(优势比5.439;95%可信区间2.79410.588)、自主性下降的进展(优势比2.428;95%可信区间1.3424.393),身体机能低下(优势比2.877;95%置信区间为1.5775.250)。高水平的身体机能可将营养不良的风险降低64.1%。营养不良使5年死亡率增加2.7倍。正常的营养状况可使9年死亡率降低50.2%。改善营养状况可降低死亡风险。结论:营养状况恶化的主要因素是情绪状态下降、自主性丧失和身体机能水平低下。早期发现老年人营养不良并加以纠正,可降低死亡风险。
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引用次数: 0
Results of the All-Russian Conference with international participation “Science and Practice. Why does a family physician need clinical recommendations?” 国际参与的全俄会议成果“科学与实践”。为什么家庭医生需要临床建议?”
Pub Date : 2023-01-18 DOI: 10.17816/rfd112414
O. Kuznetsova, I. Moiseeva
The article provides information about the All-Russian Conference with international participation Science and Practice. Why does a family doctor need clinical recommendations?, dedicated to the 25th anniversary of the founding of the scientific and practical journal Russian Family Doctor. The event took place on-line in St. Petersburg on October 20, 2022. The article summarizes the content of the reports in which the main principles of creating clinical guidelines, the problems of providing medical care to elderly patients with cognitive impairments in the light of updated clinical guidelines, the planning of scientific research aimed at studying the course of a new coronavirus infection, the problems of providing medical care to elderly people with arterial hypertension, and the choice of pain relief were considered. in comorbid patients, a strategy for detecting chronic obstructive disease in the primary health care setting, the main provisions of the latest clinical guidelines for the management of patients with bronchial asthma issues of predicting fractures in patients with osteoporosis in the framework of international projects, problems of managing comorbid patients with anemic syndrome, features of managing patients with gastroesophageal reflux disease on an outpatient basis, taking into account clinical recommendations.
文章介绍了国际参与的全俄会议的情况。为什么家庭医生需要临床建议?,以纪念科学实用杂志《俄罗斯家庭医生》创刊25周年。该活动于2022年10月20日在圣彼得堡在线举行。文章总结了报告的内容,包括制定临床指南的主要原则、根据更新的临床指南为老年认知障碍患者提供医疗服务的问题、以研究新型冠状病毒感染过程为目的的科学研究规划、为老年高血压患者提供医疗服务的问题以及缓解疼痛的选择。在合并症患者中,在初级卫生保健环境中发现慢性阻塞性疾病的战略,支气管哮喘患者管理最新临床指南的主要规定,在国际项目框架内预测骨质疏松患者骨折的问题,管理贫血综合征合并症患者的问题,门诊管理胃食管反流病患者的特点,考虑到临床建议。
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引用次数: 0
The results of the internship of a postgraduate student from Uzbekistan on the basis of the North-Western State Medical University named after I.I. Mechnikov in the framework of interuniversity cooperation 在校际合作框架内,一名乌兹别克斯坦研究生在以梅奇尼科夫命名的西北国立医科大学实习的结果
Pub Date : 2023-01-18 DOI: 10.17816/rfd112168
Shakhnoza A. Khasanova, B. M. Tajiev, Shakhnoza R. Abzalova
The article is devoted to the results of the internship of a postgraduate student of the Tashkent Pediatric Medical Institute at the I.I. Mechnikov Northwestern State Medical University within the framework of the inter-university cooperation program dedicated to the development of research in the field of infectious diseases and the exchange of experience in the field of medical care for a new coronavirus infection. The purpose of the internship of a postgraduate student of the Department of Infectious Diseases, Pediatric Infectious Diseases, Phthisiology and Pulmonology Sh.A. Khasanova was studying the specifics of providing care to patients with a new coronavirus infection in St. Petersburg. The program included a visit to the departments of Infectious Diseases, family Medicine, epidemiology, and disinfection, as well as a presentation at the All-Russian Conference with international participation Science and Practice. Why does a family doctor need clinical recommendations?, dedicated to the 25th anniversary of the scientific and practical journal Russian Family Doctor. The report highlighted the Uzbek experience of implementing measures to combat the new coronavirus infection and demonstrated their effectiveness. As part of the internship, the graduate student got acquainted with the peculiarities of providing inpatient and outpatient care to patients with COVID-19, including in-depth medical examination and the operation of the system of statistical registration of patients with a new coronavirus infection in the federal register, as well as the organization of epidemiological control in different periods of the pandemic of a new coronavirus infection. The main result of the internship was the creation of a basis for effective and long-term cooperation between Russian and Uzbek universities in the field of scientific research and training of personnel for national health systems in the field of infectious diseases.
这篇文章是在致力于发展传染病领域研究和交流新型冠状病毒感染医疗保健领域经验的校际合作计划框架内,在梅奇尼科夫西北国立医科大学塔什干儿科医学研究所的一名研究生实习的结果。我校感染性疾病、儿科感染性疾病、细菌学与肺内科研究生实习目的:哈萨诺瓦正在研究在圣彼得堡为新型冠状病毒感染患者提供护理的细节。该计划包括访问传染病、家庭医学、流行病学和消毒部门,并在国际参与的全俄科学与实践会议上发表演讲。为什么家庭医生需要临床建议?,以纪念科学实用杂志《俄罗斯家庭医生》创刊25周年。报告重点介绍了乌兹别克斯坦采取措施抗击新型冠状病毒感染的经验,并展示了这些措施的有效性。作为实习的一部分,该研究生了解了为COVID-19患者提供住院和门诊服务的特点,包括深入的医学检查和在联邦登记册中对新型冠状病毒感染患者的统计登记系统的操作,以及在新型冠状病毒感染大流行的不同时期组织流行病学控制。实习的主要结果是为俄罗斯和乌兹别克斯坦大学在传染病领域的科学研究和国家卫生系统人员培训领域的有效和长期合作奠定了基础。
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引用次数: 0
Basics of professional communication in general practice 一般实践中专业沟通的基础知识
Pub Date : 2022-11-10 DOI: 10.17816/rfd108376
L. Degtyareva
Knowledge and skills in the field of professional communication are necessary for the doctor to form a trusting relationship with the patient. The right approach to counseling based on this knowledge is important to ensure quality medical care. The consultation has two main tasks: to find out the essence of the problem that led the patient to the doctor, and to find possible solutions to this problem. At the same time, a combination of openness and structuring of the process is important. The lecture examines the Calgary-Cambridge model of counseling, its structure and features of each stage. The structure of the consultation in accordance with this model includes five stages the beginning of the consultation, the collection of information, inspection, explanation and planning, and the completion of the reception. Each stage has certain tasks, starting with establishing contact at the beginning of the consultation, and ending with summing up at the end of the reception. The principles and conditions of effective counseling include the availability of sufficient time; availability of consultation; respect for the personality of each patient and goodwill; confidentiality; provision of information in a language understandable to the patient; respect for the patients ability to make decisions. Communication with a patient in the conditions of primary health care is a long and multifaceted process, but the result of such communication often depends on the successful conduct of counseling by a doctor.
专业沟通领域的知识和技能是医生与病人建立信任关系所必需的。基于这些知识的正确咨询方法对于确保高质量的医疗服务非常重要。会诊有两个主要任务:找出导致病人去看医生的问题的本质,并找到解决这个问题的可能方法。同时,过程的开放性和结构化相结合也很重要。讲座探讨了卡尔加里-剑桥咨询模式,其结构和每个阶段的特点。按照这种模式,咨询的结构包括咨询开始、信息收集、考察、解释和规划、完成接待五个阶段。每个阶段都有一定的任务,从咨询开始时建立联系开始,到接待结束时进行总结。有效咨询的原则和条件包括:有充足的时间;提供咨询;尊重每位病人的人格和善意;保密制度;以患者可理解的语言提供信息;尊重病人的决定权。在初级保健条件下与病人的沟通是一个长期和多方面的过程,但这种沟通的结果往往取决于医生是否成功地进行咨询。
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引用次数: 0
A family case of giardiasis manifested as allergic urticaria in the joint practice of a family doctor and a pediatrician 一个家庭病例的贾第虫病表现为过敏性荨麻疹在家庭医生和儿科医生的联合实践
Pub Date : 2022-11-10 DOI: 10.17816/rfd96145
Maria O. Mokhika Estepa, I. Vasilenko, I. Moiseeva
To date, giardiasis remains an urgent disease in the practice of family doctors, internists and pediatricians. Family cases of giardiasis are quite common. If one case of giardiasis is detected in the family, it is necessary to examine all family members. Currently, giardiasis remains relevant, especially in pediatrics. The difficulty of detecting giardiasis in children is primarily due to the fact that its manifestations are often disguised as various clinical variants of gastroenterological pathology (functional disorders of the gastrointestinal tract, syndrome of excessive growth of microflora in the small intestine, malabsorption syndrome) and often occur with the clinic of allergic diseases recurrent urticaria, atopic dermatitis, gastrointestinal forms of food allergies and others forms. The article presents a clinical case of familial giardiasis, in which the primary diagnosis of the disease in a child caused the greatest difficulty due to its allergic manifestations by the type of severe urticaria in the presence of possible allergens at home, which led to a long diagnosis and two emergency hospitalizations in childrens hospitals, where despite the examination and treatment, the correct diagnosis was not suspected timely. Differential diagnosis at the first stages of patient management was carried out between allergic urticaria, infectious mononucleosis and streptococcal infection, the possibility of giardiasis was not considered. Difficulties in diagnosis led to the appointment of systemic glucocorticosteroids and unjustified antibacterial therapy. Indirectly, prolonged diagnosis and untimely start of treatment led to a decrease in motivation for examination and treatment of the patients parents due to distrust of doctors.
迄今为止,在家庭医生、内科医生和儿科医生的实践中,贾第虫病仍然是一种紧迫的疾病。贾第虫病的家庭病例很常见。如果在家庭中发现一个贾第虫病病例,有必要对所有家庭成员进行检查。目前,贾第虫病仍然具有相关性,特别是在儿科。贾第虫病在儿童中检测的困难主要是由于其表现往往被伪装成各种胃肠病的临床变异(胃肠道功能障碍、小肠微生物群过度生长综合征、吸收不良综合征),并且经常与临床变应性疾病一起发生:复发性荨麻疹、特应性皮炎、胃肠道形式的食物过敏和其他形式。本文介绍了一例家族性贾第虫病的临床病例,其中一名儿童的疾病的初步诊断造成了最大的困难,因为其过敏表现是在家中可能存在过敏原的情况下出现的严重荨麻疹类型,这导致了长时间的诊断和两次儿童医院的紧急住院,尽管进行了检查和治疗,但没有及时怀疑正确的诊断。在患者管理的第一阶段对变应性荨麻疹、传染性单核细胞增多症和链球菌感染进行鉴别诊断,未考虑贾第虫病的可能性。诊断困难导致全身性糖皮质激素治疗和不合理的抗菌治疗。间接地,诊断时间过长,治疗开始不及时,导致患者家长对医生的不信任而降低了检查和治疗的积极性。
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引用次数: 0
Reactivation of chronic brucellosis infection after COVID-19 (case report) COVID-19后慢性布鲁氏菌感染的再激活(病例报告)
Pub Date : 2022-11-10 DOI: 10.17816/rfd108303
Yu Khaidarova, O. Lesnyak, Gaukhar Kurmanova, Anarkul B. Kulembaeva
It has been proven that the SARS-CoV-2 virus, interacting with persistent latent pathogens in the human body, including those living in the ecosystems of the intestine, mouth and lungs, causes dysregulation of the immune system and can contribute to the reactivation of these pathogens. The authors of the article suggested this pathogenic virus can play the role of a superantigen and trigger the phenomenon of polyclonal activation of lymphocytes, due to which various clones of lymphocytes may be activated, thereby giving impetus to the reactivation of a chronic persistent infection. This article describes a clinical case of a patient who had previously undergone an effectively treated form of chronic brucellosis in history, with signs of reactivation of brucellosis infection detected after infection with the SARS-CoV-2 virus, confirmed by clinical laboratory and instrumental studies.
已经证明,SARS-CoV-2病毒与人体内持续潜伏的病原体(包括生活在肠道、口腔和肺部生态系统中的病原体)相互作用,导致免疫系统失调,并可能导致这些病原体的重新激活。这篇文章的作者认为,这种致病性病毒可以发挥超抗原的作用,引发淋巴细胞的多克隆激活现象,由于这种现象,各种淋巴细胞克隆可能被激活,从而推动慢性持续性感染的再激活。本文描述了一例临床病例,该患者既往经历过一种有效治疗的慢性布鲁氏菌病,在感染SARS-CoV-2病毒后发现布鲁氏菌感染重新激活的迹象,经临床实验室和仪器研究证实。
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引用次数: 0
Features of clinical manifestations, diagnosis, treatment and prevention of COVID-19 coronavirus infection in children 儿童COVID-19冠状病毒感染的临床表现、诊断、治疗和预防特点
Pub Date : 2022-11-10 DOI: 10.17816/rfd109302
I. Melnikova
Worldwide spread of COVID-19 coronavirus infection SARS-CoV-2 also affected the child population. Now, a sufficient number of studies have been described in adult patients, and only limited data are available with an analysis of the clinical course of the disease in pediatric patients infected with SARS-CoV-2. Currently, SARS-CoV-2 has spread around the world as a variant of omicron. The article is a lecture on the features of the clinical picture, diagnosis, treatment, and prevention of coronavirus infection in children, taking into account the latest domestic and foreign articles. The purpose of the lecture is to improve the knowledge of family doctors and pediatricians in the study of clinical features, course, diagnosis, therapy, prevention, and long-term consequences of a coronavirus infection. The lecture presents the etiology and epidemiology of coronavirus infection. The clinical picture of the omicron strain is described. The assessment of the clinical picture of the disease is presented based on the working criteria of the severity of the disease. The diagnosis of coronavirus infection is presented in detail. The algorithm for treating children with coronavirus infection is presented according to the latest recommendations of the Ministry of Health of the Russian Federation. The emphasis is on prevention and elimination of dehydration. Vaccine prophylaxis during the pandemic is considered.
COVID-19冠状病毒感染SARS-CoV-2在全球范围内的传播也影响了儿童群体。现在,已经有足够数量的研究描述了成人患者,并且只有有限的数据可以用于分析感染SARS-CoV-2的儿科患者的临床病程。目前,SARS-CoV-2已作为omicron的变种在世界各地传播。本文结合国内外最新文章,对儿童冠状病毒感染的临床表现、诊断、治疗、预防等方面的特点进行了介绍。讲座的目的是提高家庭医生和儿科医生对冠状病毒感染的临床特征、过程、诊断、治疗、预防和长期后果的认识。讲座介绍冠状病毒感染的病原学和流行病学。描述了组粒菌株的临床表现。该疾病的临床表现的评估是基于疾病严重程度的工作标准提出的。详细介绍了冠状病毒感染的诊断。根据俄罗斯联邦卫生部的最新建议,提出了治疗冠状病毒感染儿童的算法。重点是预防和消除脱水。考虑大流行期间的疫苗预防。
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引用次数: 0
Issues of the management of geriatric patients with valvular heart disease 老年瓣膜性心脏病患者的管理问题
Pub Date : 2022-11-10 DOI: 10.17816/rfd110814
E. Frolova, O. Y. Pankratova
The present article describes a clinical case as an example of compiled treatment of a geriatric comorbid patient with aortic stenosis. The case mentioned in this article enhances and underlines the meaning of multidisciplinary approach in the treatment of such patients according to the contemporary and actual standpoints of geriatrics. Elderly patients are often reported to have comorbidities including valvular heart diseases which might be regarded as one of the most significant reasons for functional activity decrease and lower quality of life of an elderly patient. Meanwhile, it is necessary to admit that functional resources of some patients are very high. It must be taken into consideration when choosing the disease management.
本文描述了一个临床病例作为一个例子汇编治疗老年合并症患者主动脉瓣狭窄。在这篇文章中提到的情况下,加强和强调多学科方法的意义,在治疗这类患者根据当代和实际的老年病的立场。老年患者常伴有包括心瓣膜病在内的合并症,这可能被认为是老年患者功能活动下降和生活质量下降的最重要原因之一。同时,必须承认一些患者的功能资源是非常高的。在选择疾病管理方案时必须考虑到这一点。
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引用次数: 0
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Russian Family Doctor
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