Vol 17, No 11 (2015)
Articles
Systemic inflammation and endothelial dysfunction in patients with chronic obstructive pulmonary disease in combination with hypertension: review of the literature and our own data
Abstract
The goal is to provide an overview of the literature on systemic inflammation and endothelial dysfunction in patients with chronic obstructive pulmonary disease (COPD) in combination with arterial hypertension (AH) and our own results.Materials and methods. A review of the 56 literature resources on the stated theme is presented. Our own study included 65 patients (50 men and 15 women), of mean age 65.5±8.5 years with COPD stages I-IV in a period of stability of the disease with hypertension 1, 2 and 3rd degree.Results. The state of systemic inflammation and endothelial dysfunction in patients with COPD combined with hypertension according to the literature and evaluated the results of our own research-level markers of inflammatory status and endothelial dysfunction in patients was examined. Revealed were high levels of the studied parameters (hsSRB, sICAM-1, endothelin-1 and SP-selectin) in patients with COPD associated with AH. During the correlation analysis, statistically significant feedbacks activity studied in the index markers forced expiratory volume in 1 second.Conclusion. In patients with COPD combined with hypertension high levels of markers of inflammation and endothelial dysfunction (hsSRB, sICAM-1, endothelin-1 and SP-selectin), which indicate the presence of an active systemic inflammation and endothelial dysfunction in these patients were revealed. In the work carried out it shows that as the deterioration of bronchial obstruction increases the intensity of the markers of inflammation and endothelial dysfunction.
Consilium Medicum. 2015;17(11):8-12
8-12
Community-acquired pneumonia: basic questions of tactics, diagnosis and treatment
Abstract
There were a lot of efforts during the last two decades to implement guidelines for the management of adult community-acquired pneumonia, but there has been a negative trend of morbidity and mortality from pneumonia in the last few years. This review aims to draw attention to the key issues of tactics of community-acquired pneumonia, which largely determine the success of treatment.
Consilium Medicum. 2015;17(11):13-19
13-19
Options for prevention of respiratory tract infection
Abstract
The article presents the results of studies showing prospective clinical and cost-effectiveness of vaccination for pneumococcal conjugate vaccine (PCV) Prevenar® 13 patients with lung disease for 2 years.Material and Methods: The study included a total of 115 male patients treated in Regional Clinical Hospital №4 pulmonology and urban center of the city of Chelyabinsk in 2012-2014. The average age of study patients was 62.09±9.22 years. All persons had a comprehensive clinical and instrumental examination. The degree of dyspnea was evaluated on the scale of the Medical Research Centre (Medical Research Consil Scale - MRC). Estimated was the frequency of hospitalization with acute exacerbations of chronic obstructive pulmonary disease (COPD), the number of pneumonia in 2 years. 13-valent PCV (PKV13) Prevenar® 13 was used for vaccination.Results and conclusions: the vaccinated patients with comorbidity had significant reduction in exacerbations of COPD 8 times and thereby reducing the number of admissions to 4 times in 2 years. The use of the vaccine PKV13 to minimize the costs of the health care system for the treatment of patients with COPD. This saves up to 64% of the budget year after vaccination and in 1.5 years - to 73.6%. At the same time the use of 23-valent pneumococcal polysaccharide vaccine was associated with a reduction in clinical efficacy over time, and the possible budget savings amounted to 55 and 47% next year andyears, respectively.
Consilium Medicum. 2015;17(11):20-24
20-24
Exacerbation of chronic obstructive pulmonary disease: the choice of empirical antibiotic therapy
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a dramatic influence on further COPD course and prognosis. The majority of COPD are associated with respiratory tract infection, with predominant etiology of respiratory viruses, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae , as well as Pseudomonas aeruginosa and Enterobacteriaceae in patients with severe and concomitant disease. Empiric antimicrobial treatment is based on exacerbation severity and patient's risk stratification, which refers to multi-resistant microbial agenda. Amoxicillin/clavulanate and respiratory quinolones appear to be an optimal choice for out-patients with moderate AECOPD.
Consilium Medicum. 2015;17(11):25-30
25-30
Features of airway microbiota in smoking patients: predictors of form factors-resistant microflora
Abstract
This article contains information about the effects of smoking on the state of human respiratory tract microflora. Respiratory infections in Russia are a significant problem and, although on a large amount of scientific data and practical advice, practical public health physicians each year have problems of diagnosis and treatment of bacterial infections of the respiratory tract. First of all, it is bacterial pneumonia, which requires the appointment of antibacterial therapy, the choice of which depends on the etiologic factor. Taking into account the data of the respiratory tract microflora in smokers, it is possible to optimize the assignment of antibacterial agents in the treatment of pneumonia, exacerbation of chronic obstructive pulmonary disease and other bacterial infections of the respiratory tract.
Consilium Medicum. 2015;17(11):31-34
31-34
Viral, bacterial respiratory infections, immunity and atibiotic therapy - what is common? View and recommendation of clinical immunologist and infectologist
Abstract
The paper reviews the current status of the problem of respiratory infections. It considers the main aspects and chatacteristics of viral and bacterial respiratory infections. Key data on their groups and risk factors, antibiotic microflora resistance, immunological aspects, benefits of amoxicillin-clavulanat are given in detail.
Consilium Medicum. 2015;17(11):35-41
35-41
Vospalenie v patogeneze infektsiy dykhatel'nykh putey LOR-organov: znachenie protivovospalitel'noy terapii
Abstract
Серьезной проблемой, влияющей на эффективность терапии и качество жизни больного, является чрезмерное назначение лекарственных средств - полипрагмазия. Каким образом можно решить возникающие сложности? С этой целью необходимо разобраться в патогенезе процесса, развивающегося при воспалительных заболеваниях органов дыхания, - воспаления.
Consilium Medicum. 2015;17(11):42-43
42-43
44-46
Mesto antileykotrienovykh preparatov v lechenii patsientov s tyazheloy astmoy
Abstract
Профессор Р.М.Файзуллина отметила большой прогресс, достигнутый усилиями ученых и практических врачей в вопросе терапии бронхиальной астмы (БА). Однако для самих пациентов зачастую гораздо большее значение имеет не столько степень тяжести заболевания, сколько контроль над его течением, отражающийся на качестве жизни больного БА. В клинической практике врачам приходится встречать пациентов с легкой степенью БА с тяжелыми приступами и, наоборот, длительное отсутствие приступов у больного с тяжелой степенью БА при правильно подобранном лечении, поэтому именно контроль заболевания приобретает такое важное значение для пациента.
Consilium Medicum. 2015;17(11):46-47
46-47
47-50
Terapiya infektsiy verkhnikh dykhatel'nykh putey i srednego ukha v pediatrii: kak ne dopustit' oshibok?
Abstract
Выступление Д.П.Полякова было посвящено разбору основных ошибок, возникающих при лечении инфекций верхних дыхательных путей (ВДП) и среднего уха у детей. К таким ошибкам, по словам докладчика, относят: полирагмазию, избыточное назначение антибактериальных препаратов (АБП), неадекватный выбор антибиотика, режима его дозирования, путей введения и т.п.
Consilium Medicum. 2015;17(11):51-52
51-52
Features of adult cystic fibrosis, according to the national register in 2013
Abstract
From the group of Russian researchers The article analyzes the characteristics of adult cystic fibrosis (CF), according to the National Register of 2013, which included 1968 patients (62% of the total estimated number of CF patients in the country) of the 74 regions of the Russian Federation. It demonstrated that adult CF occurrence is more "soft" mutation, a significant decrease in lung function, high frequency pulmonary and extrapulmonary complications, as well as the need for more multi-component therapy.
Consilium Medicum. 2015;17(11):53-59
53-59
Retsidiviruyushchie respiratornye infektsii u detey: vozmozhnosti personifitsirovannoy terapii
Abstract
Широкое применение во всем мире нашли препараты группы микробных иммуномодуляторов, оказывающих достаточно сложное влияние на иммунитет: бактериальные лизаты (Бронхомунал®, Имудон, ИРС 19), рибосомальные иммуномодуляторы (Рибомунил), синтетические аналоги мембранных фракций (Ликопид, Биостим). Действие бактериальных лизатов имеет определенное сходство с вакцинами: пациенту вводятся антигены возбудителя, в результате чего формируется иммунный ответ.
Consilium Medicum. 2015;17(11):52-52
52-52
60-63
Fenspiride: pharmacological possibilities in the treatmentof inflammatory diseases of the upper and lower respiratory tract
Abstract
Fenspiride refers to the group of anti-inflammatory medicines. By reducing the activity of phospholipase A2, fenspiride reduces the synthesis of prostaglandins, thromboxanes and leukotrienes - basic pro-inflammatory proteins, initiating the development of the vascular phase of inflammation. It prevents the tension of smooth muscle of the bronchi caused by the action of these agents. The accumulated experience of preclinical and clinical study demonstrates the efficacy and safety of using the drug in the treatment of acute and chronic inflammatory diseases of the upper and lower respiratory tract. To date, extensive experience exists in the clinical use of fenspiride in acute respiratory viral infections treatment, as well as in chronic obstructive pulmonary disease, sinusitis.
Consilium Medicum. 2015;17(11):64-69
64-69
Kashel' - obshcheterapevticheskaya problema
Abstract
6 октября 2015 г. в России стартовала комплексная программа, посвященная здоровью легких. Одним из важнейших этапов проекта является медико-социальная программа для врачей первичного звена по вопросам ранней диагностики, профилактики и лечения бронхолегочных патологий - «Кашель в центре внимания». Она направлена на повышение настороженности врачей в отношении тяжелых респираторных заболеваний, которые могут скрываться за обычным кашлем. Большое внимание данной проблеме было уделено и на прошедшем юбилейном XXV Национальном конгрессе по болезням органов дыхания. В рамках форума состоялся симпозиум с одноименным названием, на котором с докладами выступили ведущие специалисты: профессор Е.И.Шмелев, профессор А.А.Зайцев, доцент Н.П.Княжеская. Евгений Иванович Шмелев в своем выступлении отметил, что искусство врачевания при работе с кашляющим больным заключается в умении установить причину кашля, определить меру его вредности и форму лечебного воздействия на кашель.
Consilium Medicum. 2015;17(11):70-71
70-71
72-73
74-75
Patient with bronchial asthma: how to make a diagnosis and start a treatment? With respect to clinician doctors
Abstract
Bronchial asthma (BA) is wide-spread disease, being as a serious medical and social and economic problem. In spite of this fact, the quality of BA's diacrisis is extremely low. New version of Recommendation enacted by GINA 2014 (Global Initiative for Asthma) and also Russian Federal recommendation on diagnosis and treatment of BA is another step towards improving of medical tactics and achieving best results in care of patients suffered by BA. A key drug of BA's basic anti-inflammatory therapy is inhaled corticosteroids.
Consilium Medicum. 2015;17(11):76-81
76-81
Rationale for the antihistamine for the treatment of chronic urticaria and allergic rhinitis
Abstract
Antihistamines of II generation are selective H1-receptor antagonists and agents of the 1st-line treatment of chronic idiopathic urticaria and allergic rhinitis. In practice allergist-immunologist is often observed unfounded selecting antihistamine for the treatment of chronic idiopathic urticaria and allergic rhinitis, as well as the unjustified application of the scheme. In the article on the example of some well-known and influential post-marketing studies that formed the basis of international consensus documents and programs - ARIA (Allergic Rhinitis and its Impact on Asthma), GA(2)LEN (Global Allergy and Asthma European Network - a European network of Global allergy and asthma), - demonstrate the validity of the application of one of antihistamines II generation - desloratadine.
Consilium Medicum. 2015;17(11):82-86
82-86
Care of the nasal cavity in children with allergic rhinitis in the autumn-winter period
Abstract
Constant inhalation of dry air (including during the heating season), contributes to the dryness of the nasal mucosa, and nasal congestion manifests itself (often alternating), through itching, burning, formation of nasal crusts, reduced sense of smell. In addition to discomfort, dry nasal mucosa has negative effect on mucociliary transport (MCT) and, as a consequence, the filtration function - dust particles, bacteria and viruses contained in the air in the breathing process virtually unchecked fall into the trachea, bronchi and lungs. In turn, changes in the nasal mucosa, including increasing histamine production, in allergic rhinitis help reduce MCT. Vibrocil drug due to natural pH and isotonic not interfere with the function of ciliated epithelium of the mucosa. Normalization of the rheological properties of mucus, increased motor activity of cilia, activate the reparative processes in the cells of the nasal mucosa can be achieved by using the Otrivin sea spray. In severe dryness of the nasal mucosa, the tendency to form crusts, bleeding we can recommend the patients to use spray Vibrolor, that has more moisturizing and regenerative effects, thanks to its composition of dexpanthenol.
Consilium Medicum. 2015;17(11):87-89
87-89
Modern features of acute rhinosinusitis in children
Abstract
Currently, acute rhinosinusitis is very common among children. Thus 5-10% of cases of inflammation is the cause of bacterial infection. In the treatment of acute bacterial sinusitis in pediatric practice at the present stage it is necessary to use antibiotics, the purpose of which is eradication of the pathogen, the restoration of the state of the paranasal sinuses and the prevention of complications. Use of the drug Sumamed® is safe due to it being antibacterial drug macrolide and possessing broad spectrum of activity, improves the efficiency and reduce the duration of treatment.
Consilium Medicum. 2015;17(11):90-93
90-93
Harms and benefits of nasal decongestants: ways to decrease the risks
Abstract
Nasal decongestants are still one of the most frequently prescribed drugs in different pathology of the nose and the nearest anatomical regions. Despite of they high effectiveness there are many side effects (cito - and ciliotoxity, systemic sympathomimetic effects, reboud-effect, rhinitis medicamentosa). One of the ways to decrease the side effects is the use of combined medication included alpha-2-adrenomymetics and dexpanthenol. The paper is the review of clinical trails on the effectiveness of such a combined therapy and other methods to minimize the side effects of nasal decongestants.
Consilium Medicum. 2015;17(11):94-98
94-98
Unilateral deafness: solutions
Abstract
The aim of this research - the study of modern literature data on the prevalence, etiology, psycho-acoustic features of speech perception, sound localization in patients with single-sided deafness. Analyzed the effectiveness of modern methods of rehabilitation of this disease - such as hearing aids system CROS, bone conduction implants, cochlear implant. We carried out studies measuring speech intelligibility in quiet and in noise in 10 patients with unilateral deafness using the system implant bone conduction and CROS. The highest percentage of speech intelligibility in noisy environments (81%) and in silence (98%) was detected when using the audio processor implant bone conduction. The role of cochlear implantation in the rehabilitation of patients in this category. The use of hearing aids CROS, bone conduction implants proved improves sound reproduction from a deaf ear. Review of foreign literature has shown a significant improvement of sound localization in patients with cochlear implant in unilateral deafness, compared with the CROS system and the bone conduction implant.
Consilium Medicum. 2015;17(11):99-102
99-102
New opportunities therapy of inflammatory diseases of the pharynx
Abstract
Pain in the throat is one of the most frequent complaints of patients on the doctor. The etiopathogenesis of pharyngeal pain may be different, therefore the treatment of different patients may radically differ. One of the leading areas of treatment for these patients is topical treatment. This article provides a description of the combined drug - Septolete® total (benzydamine + cetylpyridinium chloride), used for the relief of the inflammatory process and eliminate pain in patients with diseases of the pharynx.
Consilium Medicum. 2015;17(11):103-107
103-107