Vol 20, No 11 (2018)
Articles
Potential of effective topic monotherapy in patients with acute tonsillopharyngitis
Abstract
Despite the wide arsenal of available drugs for systemic and local therapy acute tonsillopharyngitis still remains the most common cause of outpatient treatment, not only to otolaryngologists, but also to general practitioners and pediatricians during the seasonal burden of acute respiratory tract infectious diseases. Systemic antibioticotherapy in cases of acute bacterial tonsillopharyngitis should be prescribed according to strict indications, in case of viral tonsillopharyngitis, as a rule, only adequate local therapy is required. The main purpose of topical treatment is pain relief, which significantly reduces the quality of life of a patient with acute tonsillopharyngitis. The monotherapy of topical nonsteroidal anti-inflammatory drugs combines both pathogenetic and symptomatic treatment. Currently, there are many different ways of delivering topical drugs to relieve sore throat. The using of a spray allows to achieve the longest contact of the drug with the affected mucous membrane of the pharynx.
Consilium Medicum. 2018;20(11):8-12
8-12
Role of fluticasone propionate in modern treatment of allergic rhinitis
Abstract
Allergic rhinitis is a common disease that greatly affect a quality of life and can contribute to the development of concomitant pathology of the upper airway tract. The main aim of the treatment is reducing or riddance of symptoms, prevention of acute conditions and complications. Appropriate treatment should allow patients to keep their normal pattern of life. Intranasal corticosteroids is the first-line treatment considering allergic rhinitis. According to multitude investigations fluticasone propionate proved its effectiveness in a control of the symptoms of allergic rhinitis along with low incidence of side effects.
Consilium Medicum. 2018;20(11):13-16
13-16
Mucocele of ethmoidal labyrinth as complicatioin of transethmoidal orbital decompression. Clinical case
Abstract
The mucocele of paranasal sinuses is quite seldom found pathology which is followed by appreciable damages of a mucosa, a bone tissue with possible intracranial and intraorbital complications. We represent a clinical case of a mucocele of the ethmoidal labyrinth as a complication after the transetmoidal endoscopic decompression of an orbit (TEDO) made concerning an endocrine ophthalmopathy. The postoperative diplopia which arises, according to different authors, in 6-38% of cases belongs to the most frequent complications of TEDO. Cases of emergence of the rinosinusit after the decompression of an orbit in 4-11% of cases and isolated cases of a liquorrhea from area of a clinoid sinus are also described. The feature of our clinical case is that it is the only case of a complication of iatrogenic character after an endoscopic transetmoidalny orbitotomy registered in our clinic.
Consilium Medicum. 2018;20(11):17-19
17-19
Opportunities of Tonsilgon® N use in complex treatment of chronic tonsillitis
Abstract
The article covers modern problems of chronic tonsillitis (CT) diagnostics and treatment. The authors discuss the background for chronic inflammation focus formation in tonsils, etiology and pathogenesis of CT, and the role of group A b-hemolytic streptococcus in development of local and systemic concomitant diseases. CT classification by Preobrazhenskiy-Palchun is presented as well as differential diagnosis criteria for different CT forms. The basic CT treatment methods including conservative therapy and sanitation intervention are also discussed. The article presents the study of Tonsilgon® N effectiveness and safety in CT treatment that assessed dynamics of main clinical symptoms. Authors conclude that the medication has high clinical effectiveness and good safety profile, they recommend it to be used in combined CT treatment.
Consilium Medicum. 2018;20(11):20-24
20-24
25-29
New opportunities of the treatment of inflammatory diseases of the pharynx
Abstract
One of the main complaints that caused patients to visit an otolaryngologist is sore throat. This problem is widespread, and therefore socially and clinically significant. There are many reasons of the sour throat, one of the key is inflammatory diseases of the pharynx, such as acute and chronic pharyngitis. A variety of drugs is used for the treatment of this kind of pathology. In most cases, the drugs of choice are nonsteroidal anti-inflammatory drugs, the main properties of them are analgesic and anti-inflammatory.
Consilium Medicum. 2018;20(11):30-32
30-32
Principles of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (literature review)
Abstract
He purpose of this review is to analyze current literature data on the approaches and realization principles for pulmonary rehabilitation (PR) in the treatment program for patients with chronic obstructive pulmonary disease (COPD). Currently, PR represents anevidence-based COPD treatment method that significantly improves the course of the disease. Enrollment of all the COPD patients in the PR programs has been shown to be reasonable. Based on a large number of studies it is emphasized that the greatest effect of PR is achieved using programs that include all four main types of intervention: exercise training, nutritional status correction, education and psychosocial rehabilitation. Different principles of organization of PR programs are reviewed and necessity of individual approach to the PR programs based on illness behavior types is shown in this article.
Consilium Medicum. 2018;20(11):33-39
33-39
Systemic inflammatory markers as predictors of cardiac complications in patients with comorbid course of chronic obstructive pulmonary disease and ischemic heart disease
Abstract
The characteristics of comorbid chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) still remain very important. The systemic inflammation, leading to the major clinical and functional manifestations, plays a very important role in the genesis of this disease. The main attention is paid to preventive vaccination due to the important role of Streptococcus pneumonia in developing the relapse of COPD. The aim of the study is to examine the impact of 13-valent pneumococcal conjugate vaccine (PСV13) on the clinical and functional features of systemic inflammation in patients with COPD and IHD. Materials and methods. The study included 36 vaccinated patients with COPD and IHD and 42 non-vaccinated patients with COPD and IHD. We have analyzed the number of relapses of COPD and IHD, major adverse cardiac events, the number of admissions to hospital and of pneumonia cases and functional parameters. We have been monitoring the inflammatory markers, such as C-reactive protein (CRP), fibrinogen and procalcitonin. Results. The vaccine PСV13 allows achieving statistically significant reduction of the basic indicators of inflammation (such as CRP and fibrinogen: 12 and 20%, respectively) within a year of observation. The significant systemic inflammatory indicators show significant clinical manifestations of relapse of COPD and IHD. One year after receiving vaccination the patients will have not only statistically significant reduction of CRP and fibrinogen, but also will show statistically significant reduction of adverse cardiac events (4.3 times) and the number of admissions to hospital (2.6 times). Even more indicative results can be seen in the example of reducing relapses of COPD (9 times), the number of admissions to hospital (7.4 times) and pneumonia cases (6 times). Conclusions: 1. Such indicators of systemic inflammation as CRP and fibrinogen can play a role of predictors of adverse cardiac events in patients with comorbid course of COPD and IHD. 2. The dynamic monitoring of procalcitonin can be used as an additional highly informative method of assessing the probability of bacterial infection and the effectiveness of applied therapy. 3. The vaccine PKV13 allows reducing the level of systemic inflammation after 1 year of the application.
Consilium Medicum. 2018;20(11):40-4
40-4
Vserossiyskaya neinterventsionnaya retrospektivnaya nablyudatel'naya programma izucheniya primeneniya Rengalina v ambulatornom lechenii kashlya (REAL)
Consilium Medicum. 2018;20(11):45-45
45-45
Changes in markers of liver damage in the treatment of patients with pulmonary tuberculosis with multiple drug resistance of the Mycobacterium tuberculosis
Abstract
Aim. The study of the frequency and severity of hepatotoxic reactions to antituberculosis drugs in a comparative aspect when initially 4th regimens were used and initially 1 and then 4th chemotherapy regimens in new detected patients with multi-drug-resistant (MDR) tuberculosis. Material and methods. We studied 261 new cases of MDR tuberculosis. Patients were divided into 2 groups. The first group included 164 patients. The resistance of Mycobacterium tuberculosis to rifampicin in these patients determined by using the GeneXpert MTB/RIF method. Treatment of this group of patients was initially conducted according to the 4th regimen of chemotherapy (pyrazinamide, kanamycin/amikacin/capreomycin, fluoroquinolones, cycloserine/terizidone, protionamide, para-aminosalicylic acid). The second group included 97 patients who, before receiving data on MDR Mycobacterium tuberculosis by sputum culture method (2-3 months of treatment), were treated according to the 1st standard chemotherapy regimen (isoniazid, rifampicin, pyrazinamide, ethambutol/streptomycin), followed by correction of treatment with re-registration for 4th regimen. Results and conclusion. It was found that hepatotoxic reactions in patients without initial liver function abnormalities in the appointment of 4 regimens of chemotherapy occurred in 31.3% of cases, when initially treated by 1st regimen, followed by correction for 4th regimen in 87.8% of cases (p<0.001). In the course of treatment, signs of liver damage in patients who initially received 4th regimen of chemotherapy were more likely to occur in the first 2 months of treatment, whereas in patients treated initially with 1st regimen followed by correction for 4th regimens - during the first 4 months. In the overwhelming majority of cases, hepatotoxic reactions were of mild severity, both groups. At the same time, severe hepatotoxic reactions were more frequent in patients of the second group.
Consilium Medicum. 2018;20(11):46-51
46-51
Opportunities of modern mesh nebulizers use
Abstract
Optimization of medical care for patients with various diseases of upper and lower respiratory tracts includes not only new medication development but also use of focal delivery methods. At present nebulizer therapy has with good reason become an essential component of treatment for most acute and chronic respiratory diseases. A conceptually new gear - a vibrating membrane is used in new-generation nebulizers (mesh nebulizers), that substantially increases effectiveness and comfort of inhalation process. The article discusses opportunities of modern mesh nebulizer use by the example of one of the latest models - Nebzmart (Glenmark Pharmaceuticals Ltd).
Consilium Medicum. 2018;20(11):52-54
52-54
Difficulties in diagnostics of eosinophil granulomatosis with polyangiitis (Churg-Strauss syndrome)
Abstract
Eosinophilic granulomatosis with polyangiitis (previously designated as Churg-Strauss syndrome) is an eosinophilic granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small and medium-caliber vessels, combined with asthma and eosinophilia.A brief review of the literature on the problem of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) and an analysis of one’s own observation demonstrating the difficulties of diagnosing this clinical condition are presented.
Consilium Medicum. 2018;20(11):55-60
55-60
The relationship of JAK/STAT and MAPK/SAPK signaling pathways, NF-kB and content in the mononuclear cells of whole blood thioredoxins in the post-clinical stage of community-acquired pneumonia
Abstract
The study discusses the relationship between the content of mononuclear cells in peripheral blood (MNC) of the MAPK/SAPK and JAK/STAT-signaling pathways, nuclear transcription factor NF-kB, and thioredoxin reductase. The content and level of phosphorylation of signal transducers and transcription activators STAT3, STAT5A, STAT6, nuclear transcription factor NF-kB (IkBa), stress-activated protein kinases JNK, ERK, mitogen-activated protein kinase p38, the level of nuclear transcription factor NF-kB subunit p65 were determined by enzyme immunoassay in MNCs. The results of the study indicate that the stage of reconvalescence of VP is characterized by a deficiency of antioxidant protection, manifested by a decrease in the concentration of antioxidants by 6.7% (p=0.051), despite the existing increase in the level of MNC thioredoxin reductase by 16.3% (p=0.028). This fact indicates the need for correction of the state of AOSIS in patients who have undergone EAP. The analysis revealed a significant relationship between the level of TR and STAT5A, as well as the content of P65 and STAT6, characterized by a positive correlation with these factors.
Consilium Medicum. 2018;20(11):61-65
61-65