Vol 21, No 3 (2019)
Articles
Community-acquired pneumonia. Clinical recommendations. Yesterday, today and tomorrow. To the article (round-table discussion: physician, pulmonologist, clinical pharmacologist)
Abstract
Diagnostics and antimicrobial therapy of community-acquired pneumonia are discussed considering updated clinical recommendations. Diagnostic implications of clinical symptoms and radiologic investigation results are evaluated. Special attention is given to the choice of the first antimicrobial drug with regard to approximate etiological cause of pneumonia, disease severity, antibiotic resistance risk, and antimicrobial drug pharmacological properties. Evaluation of antimicrobial drug effectiveness and decision for future management tactics in case of its ineffectiveness as well as antimicrobial therapy duration are important practical aspects of patient management. Importance of present and future clinical recommendations for medical practitioners is emphasized.
Consilium Medicum. 2019;21(3):9-14
9-14
С-reactive protein in the diagnostics of communicative pneumonia
Abstract
The article provides an analysis of current information about the diagnostic value of the C-reactive protein in therapy and pulmonology in the context of the differential search for pathology of the respiratory system organs, as well as nosological forms that have common elements of clinical symptoms characteristic of community-acquired pneumonia. The history of discovery, main effects, biological significance and features of laboratory diagnosis of C-reactive protein content in blood are reflected. The results of studies on the use of C-reactive protein concentration as a biological marker of the occurrence of community-acquired pneumonia, its complications and severity, as well as the adequacy of the selected antibacterial therapy are critically disclosed.
Consilium Medicum. 2019;21(3):15-19
15-19
Pleural effusion
Abstract
Questions of differential diagnosis of syndrome-similar diseases in the medical literature is still not enough, but it is-the most difficult stage of medical practice. This article discusses the stages of diagnostic search in pleural effusion-a syndrome that sometimes confuses the most experienced Clinician. The frequency of this syndrome according to statistics is 300-320 cases per hundred thousand population. This is one of the most common pathologies in therapy, occurring in every tenth patient who turned to the doctor. If you suspect the presence of fluid in the pleural cavity, the doctor must first confirm the presence of fluid and determine its amount, then using the data of the clinical picture of the disease, the results of clinical, functional and laboratory research methods to build a differential diagnostic series and to identify the cause of this syndrome. The article consistently presents several simple and easily perceived diagnostic algorithms that demonstrate the optimal scheme of diagnostic actions of a doctor when diagnosing. The ability to correctly analyze the data of anamnesis, clinical and functional methods of examination and correctly interpret the results of the study of pleural fluid, allow in 90% of cases to correctly diagnose and prescribe effective treatment.
Consilium Medicum. 2019;21(3):21-26
21-26
Pneumocystis pneumonia in non-HIV patients
Abstract
The rates of pneumocystis pneumonia (PcP) are increasing in the HIV-negative susceptible population. Guidance for the diagnostic and treatment of PcP in patients with HIV, hematologic, and solid-organ transplant recipients is available Although for many other populations with immune disorders there remains an urgent need for recommendations. The main drug for treatment of PcP is trimethoprim/sulfamethoxazole. The possibilities of mycological diagnosis in routine clinical practice are very limited and require significant expansion. Outbreaks PcP in immunocompromised patients, likely caused by human-to-human spread, is highlighting the need for efficient infection control policies, sensitive diagnostic assays and Guidance for treatment in not-HIV patients.
Consilium Medicum. 2019;21(3):27-32
27-32
Analysis of lethal outcomes in patients with HIV/tuberculosis co-infection undergoing inpatient treatment in penitentiaries
Abstract
Aim. Of the study - to study the characteristics of the clinical picture in patients with tuberculosis/HIV co-infection, among those serving a sentence. Materials and methods. The retrospective analysis included persons suffering from tuberculosis on the background of HIV infection (51 people - group 1) and persons suffering from isolated tuberculosis (45 people - group 2) with an unfavorable outcome, held in the medical and correctional institution of the Udmurt Republic. The assessment of the significance of differences was carried out using Student's test using two-sided tests. Results. Patients with HIV-associated tuberculosis are characterized by acutely progressive forms (p<0.001) and a high frequency of recurrences of tuberculosis (p=0.043). The consequence of the rapid progression of the tuberculous process is the lower incidence of destructive forms (p=0.034), bacterial excretion (p<0.001) and drug resistance (p<0.001). In clinical and laboratory indices, more pronounced anemia (p<0.001), leukopenia (p<0.001), thrombocytopenia (p=0.024) were noted. Characteristic indicators reflecting high functional load and liver damage (p<0.001), as well as splenomegaly (p<0.001) and cardiac arrhythmias (p<0.001). Conclusion. Patients with HIV-associated tuberculosis are characterized by a more malignant course of the disease, requiring new treatment approaches. At the same time, a high level of controllability of treatment provides a higher survival rate among patients in penitentiary institutions.
Consilium Medicum. 2019;21(3):33-36
33-36
Diagnosis of pulmonary tuberculosis in XXI century: what has changed?
Abstract
This article discusses approaches to diagnosis of TB, have changed in the twenty-first century in the light of new knowledge and capacity. In the work of phthysiologists and general practitioners need to abandon previously prevailing simplified stereotypes of diagnosis of TB. Knowledge of trends in TB epidemiology, in particular, a high risk of developing it in HIV-infected and socio-maladjusted persons will help doctors of all specialties to better identify patients with TB. Widespread nontuberculous mycobacteriosis in the declining incidence and prevalence of TB and similar manifestations of these diseases require physicians to consider the possibility of an alternative diagnosis.
Consilium Medicum. 2019;21(3):37-40
37-40
Current trends in the treatment of bronchial asthma
Abstract
Bronchial asthma is a widespread disease of the respiratory system, has a significant impact on the quality of life of patients. The main objectives of the treatment of asthma is to achieve symptom control, prevent exacerbations and prevent the development of complications. The article describes approaches to the management of patients with severe asthma, the use of monoclonal antibodies in the treatment of asthma.
Consilium Medicum. 2019;21(3):41-44
41-44
Effectiveness and safety of bronchodilator use in chronic cardiac insufficiency of ischemic genesis comorbid with chronic obstructive pulmonary disease
Abstract
The article presents a brief literature review on the problem of cardiopulmonary comorbidity, namely, chronic heart failure (CHF) against ischemic heart disease (CHD) in combination with chronic obstructive pulmonary disease (COPD). The issues of epidemiology, the relationship of pathogenetic mechanisms in the development and progression of heart failure and COPD are considered. The questions of optimization of CHF and COPD treatment in the light of modern recommendations, controversial issues of safety and effectiveness of correction of bronchial obstructive syndrome are discussed. The results of our own study are presented in which 110 patients with chronic heart failure II-III FC with postinfarction cardiosclerosis (LVEF≤45%) and COPD 2-3 st. severity. It was shown that the inclusion of tiotropium and indacaterol both in mono and in combination in the complex therapy of CHF II-III FC ischemic genesis with COPD after 6 months of observation is safe and effective: the clinical state of patients improved, the quality of life improved significantly CHF, the degree of dyspnea, the frequency and duration of episodes of ischemia decreased. Improvement of parameters of intracardiac hemodynamics, a decrease in pulmonary hypertension, a positive effect on the bronchopulmonary system were noted.
Consilium Medicum. 2019;21(3):45-51
45-51
Сhanges in the organ of view, lucious sheets and skin in respiratory diseases
Abstract
In the lecture, possible changes from the side of the visual organ, the mucous membranes of the oral cavity and the skin with respiratory diseases are considered. These changes can be a direct manifestation of the disease, and in a number of clinical situations they are even an additional differential diagnostic criterion, and can also arise against the background of drug therapy of these diseases as a manifestation of drug disease.
Consilium Medicum. 2019;21(3):52-55
52-55
Additional possibilities of bioregulation products in correction of ENT-associated halitosis (bad smelling breath)
Abstract
Chronic tonsillitis is a very common disease, often occurs in patients with somatic pathology, such as enterocolitis against the background of lactase deficiency, diabetes, kidney disease. Chronic tonsillitis is accompanied by halitosis, and with comorbidities, this symptom may become dominant. With exacerbation of chronic tonsillitis, patients are forced to increase the drug load, which is due to concomitant somatic diseases. To prevent polypragmasy, doctors more often began to turn to modern means of bioregulatory therapy, providing detoxification and anti-inflammatory effects. Of the diseases of the internal organs, giving an unpleasant smell from the mouth, in the first place is diabetes. Treatment of diabetes, especially in the newly ill, takes a lot of time and effort, and a more rapid deposition of plaque and the formation of tartar in violation of microcirculation and deterioration of tissue supply, including in the oral cavity and pharynx, contributes to halitosis. The appearance of an unpleasant odor in diseases of the kidneys, liver, endocrine system, intestines in exhaled air, due to metabolites in the blood, is persistent and does not respond well to correction. In this regard, the search for detoxification drugs is relevant. Having studied the pharmacodynamic capabilities of the drug Engystol we paid attention to its ability to improve the condition of patients with viral infections, allergic reactions, restore metabolic processes in tissues, maintain general homeostasis. Unlike many drugs that have a toxic effect on the liver, this bioregulatory drug is safe.
Consilium Medicum. 2019;21(3):56-59
56-59
Differential diagnosis of maxilla and maxillary sinus cysts
Abstract
Even nowadays some difficulties in diagnostic of maxillary sinus cysts and maxillary cysts can appear. The most impartial kind of diagnostic of such pathology is computed tomography. However the proper diagnose can be get only by pathomorphological checkup. We represent a clinical cases.
Consilium Medicum. 2019;21(3):60-64
60-64
Allergic rhinitis - the actual problem of the XXI century
Abstract
Allergic rhinitis (AR) is one of the most common chronic diseases of the upper respiratory tract throughout the world. Despite advances in understanding the mechanisms of allergic inflammation, the symptoms of AR in most cases are not completely controlled by modern methods of treatment. AR is a precursor and a predisposing factor for the development of other respiratory diseases, one of which is bronchial asthma. Therefore, it is important to diagnose AR in time and select the most effective and modern drugs that will not only help control the course of AR, but also improve the quality of life of patients. Intranasal glucocorticosteroids are recommended as first-line therapy for patients with varying severity of AR. The experience of using intranasal fluticasone propionate in Russia and abroad testifies to the effectiveness of this drug in the treatment of various forms of AR, both as mono-therapy and in combination with antihistamines and decongestants.
Consilium Medicum. 2019;21(3):65-68
65-68
New aspects of allergic rhinitis treatment
Abstract
Allergic rhinitis is a worldwide disease, which occurred from 17% to 40% of the population in different countries. Allergic rhinitis affects negative on the quality of patient’s life and is often associated with asthma. Modern strategy for the treatment of allergic rhinitis based on three principles: the elimination of contact with the allergic agent, pharmacotherapy and immunotherapy. The second generation of the antihistamines drugs, as a representative of pharmacotherapy, are used at all stages of the allergic rhinitis treatment due to their high therapeutic efficacy and have not only anti-allergic, but also anti-inflammatory effect. In this article provides a comparative review of the effectiveness of second-generation antihistamines drugs among themselves and in comparison with antileukotriene medications. Although the availability of effective drugs for allergic rhinitis treatment, there is some kind of patients who had no effect from drugs. At the recent time, there are some searches for a new drugs and / or delivery methods for “known” drugs that would improve allergic rhinitis treatment. At first sight, intranasal using of drugs combines a good safety with high efficiency. However, after determining the molecular goal, one drug can affect a greater number of diseases or symptoms. From this point of view, it is preferable to use one systemic drug for stopping the variations of an allergic reaction.
Consilium Medicum. 2019;21(3):70-74
70-74
Allergic rhinitis from the perspective of an allergist
Abstract
Allergic rhinitis (AR) is the most common allergic disease. Rational drug therapy should be aimed at nonspecific suppression of the clinical symptoms of AR without taking into account the properties of the allergen. Histamine is the main mediator of allergic inflammation. Fexofenadine is an effective H1-antihistamine and a drug of choice for the treatment of all kinds of AR.
Consilium Medicum. 2019;21(3):75-78
75-78
Respiratory system condition in men working in polychlorinated hydrocarbons production: morphological and functional aspects
Abstract
Aim. To evaluate functional and morphological changes in respiratory system in patients with chronic exposure to polychlorinated hydrocarbons (PCH). Materials and methods. Group of 268 working men with chronic professional exposure to PCH were followed up for 5 years. Morphofunctional assessment of respiratory system was conducted with the use of bronchoscopy (with a bronchoscope FB-3C Olympus) and brush biopsy. Pulmonary ventilatory function was assessed using Custo-Vit diagnostic system with resistance measurements by the forced oscillation (Rfo) technique. Conclusion. Functional and morphological changes in respiratory system in men with chronic exposure to PCH resulted in development of catarral endobronchitis with transition to atrophic one.
Consilium Medicum. 2019;21(3):79-81
79-81