No 82 (2020)

Assessment of impact of work experience impact on antihypertensive drugs treatment structure was performed by questioning 104 doctors of outpatient services in Voronezh region. 58 people There were 58 general practitioners - (55.8%), 37 people werephysicians therapists (35.6%), 4 cardiologists (3.8%), and 5 persons did not indicate their specialty (4.8%). The first group included 49 doctors with an experience of up to 15 years (average experience of 6.2 ± 4.7 years), the second group - 45 doctors with an experience of more than 15 years (average experience of 27.5 ± 7.8 years), 10 doctors did not indicate their work experience. Most of the doctors prescribed fixed combinations of the drugs, most frequently ACE inhibitor and diuretic - 71.9%, ACE inhibitor and calcium antagonist (CA) - 46.2%, angiotensin receptor blocker (ARB) and diuretic - 36.4%. First group Ddoctors in the first group chose ACE inhibitors in 95.9% of cases, β-beta-adrenoblockers (BAB) and diuretics in 91.8%, less often ARBs - 89.7%, CA - 85.7% and imidazoline receptor agonists (IRA) - 61.2%. Second group Ddoctors with experience of more than 15 years prescribed ACE inhibitors for 93.3% of the patients; diuretics and CA were often used - 91.1%, BAB and ARB - in 88.8% and 80.0% of the cases respectively; IRA were prescribed less frequently - in 48.8% (p> 0.05). The choice of antihypertensive drugs by the outpatient doctors in Voronezh region did not depend on their work experience. The therapy was consistent with the current clinical guidelines with preference to the fixed combinations of the drugs.

The analysis of the values of diastolic blood pressure in comorbid patients older than working age, suffering from hypertension. The study involved 19 elderly and senile patients. According to the results of the questionnaire "Age is not a hindrance", three groups of patients were identified. The first group included 5 (26%) "strong" patients, average age 71.0±7.9 years, who applied for an appointment with a district therapist. 8 (43%) patients with psychasthenia and 6 (31%) patients with senile asthenia syndrome formed the second and third groups, respectively. The average age of patients in the second group was 74.0±8.54 years, and in the third group-74.4±8.53 years. The values of diastolic blood pressure (DBP) in patients of the first, second and third groups on the background of antihypertensive therapy were 80.6±13.7 mm Hg, 80.0±9.69 mm Hg and 88.4±11.2 mm Hg, respectively. Patients in all study groups did not reach the target DBP level.

Chronic obstructive pulmonary disease (COPD) is characterized by comorbidity. Obesity is one of the comorbidity in COPD. Obesity, in turn, causes the liver metabolic damage, such us non-alcoholic fatty liver disease (NAFLD) with a decrease of detoxification function, the conversion of toxic ammonia to urea and the development of hyperammonemia. The aim of the study is to identify hyperammonemia in patients with COPD and obesity, to analyze the degree of its effect on disease course and the quality of life.

The article presents the data from an original study to improve urological treatment of upper urinary tract obstruction in patients with urolithiasis, urological and gynecological oncological diseases. For this purpose, a comparative analysis of three alternative methods for drainage of the upper urinary tract was performed: internal stenting of the ureter, catheterization of the ureter, percutaneous puncture nephrostomy. The most informative signs responsible for the advantage of each of these methods in a specific clinical situation were statistically evaluated. On the basis of the confirmed logical and statistical relationships of informative signs and variants of clinical cases of obstruction, a system of information and analytical support has been developed, which facilitates the procedure for the primary selection of the drainage method in a specific clinical situation and ergonomizes the selection process itself. The results obtained have a high level of statistical significance, which allows them to be recommended for consideration for further use in the practice of urology and healthcare organization.

The analysis of the prevalence of non-Dement cognitive disorders in elderly and senile patients during outpatient admission was carried out. 40 patients aged 62 to 89 years participated in the study. For dementia screening, a Mini-cog test was used to identify non-dementia cognitive disorders - a short scale for assessing mental status (CSOPS). In the group of patients with a score of less than 3 on the Min-cog test, cognitive impairment was absent in 6% of cases. Pre-Dement impairment of cognitive functions, mild and moderate dementia were detected in 24%, 41% and 29% of respondents, respectively. In the second group of patients with a score on the Mini-cog test ≥3, pre-Dement changes in cognitive functions, mild and moderate dementia were detected in 52%, 17% and 22%, respectively. Cognitive impairment was absent in 9% of respondents in the group with a high probability of dementia.

Adherence to anticoagulant therapy in patients with atrial fibrillation (AF) was studied in this study. Used a questionnaire Moriscos-green. Patients who participated in the study were divided into 2 groups, taking into account the result on the CHA2DS2-VASc scale: with a risk of stroke < 2 points and ≥ 2 points. The number of patients in the first and second groups was 4 and 24 patients, respectively, with an average age of 55.2±6.18 years and 70.5±9.5 years, respectively. Adherence to treatment of patients with AF in the first group was insufficient (2.2±0.95 points). Patients with AF in the second group had no adherence to treatment (1.4±1.06 points). As the most common reason for low adherence to antithrombotic therapy, AF patients cited inattentive attitude to medication hours and forgetfulness. Thus, it is necessary to inform the patient about antithrombotic therapy and convince them of the need to strictly follow the doctor's recommendations.

The article presents the results of a retrospective analysis of the schemes of antibacterial therapy for nosocomial infections prescribed by surgical doctors. This analysis is based on the results of a study conducted in the period from 2000 to 2003 in the city of Dnepropetrovsk by one of the authors [1].

Obesity is a common problem throughout the world; the number of obese patients is expected to continue to increase. Obesity is of particular importance for patients with bronchial asthma, since obese asthmatics were found to have a greater number of asthma symptoms, more frequent and severe exacerbations, as well as a decrease in response to glucocorticosteroid treatment and a decrease in the quality of life. In turn, obesity negatively affects the quality of life of patients. The aim of the study was to study the characteristics of the quality of life in patients with bronchial asthma and obesity in comparison with patients with normal and overweight on the basis of a specific questionnaire "Quality of life in patients with bronchial asthma."

The pathogenesis of rheumatoid arthritis (RA) is described, including the significance of IL-1, IL-6, IL-17, the CD40R / CD40L system, metalloproteinases, TNF-alpha. Activation of the humoral response is the basis for the development of the autoimmune process. Levels of IL-6, IL-17, CD40L and MMP-3 clearly reflect the degree of activity of the inflammatory process, and is also an important addition to the main diagnostic markers of PAT. New approaches to predicting the course of rheumatoid arthritis in children and juvenile rheumatoid arthritis in children are also described. Thus, in RA it is possible to have a wide spectrum of organ-specific and organ-specific autoantibodies, accompanied by damage to a number of organs and systems, however, the mechanism and specific aspects of the relationship between organ damage and the nature of autoantibodies need further clarification.

The article analyzes the clinical effectiveness of the course of pulmonary rehabilitation for the prevention of exacerbations of COPD. The study included 92 patients diagnosed with COPD (GOLD 2), group D without exacerbation, "phenotype with frequent exacerbations", who received standard medical treatment for the underlying disease. A significantly higher clinical efficacy of pulmonary rehabilitation against the background of standard therapy was demonstrated, consisting in a significant reduction in the number of exacerbations and hospitalizations, positive dynamics of the severity of clinical symptoms of COPD, a significantly more pronounced decrease in the level of systemic biomarkers, increased tolerance to physical activity, and improved quality of life of patients. The results were evaluated after 12 months, using the computer program "Management system of the therapeutic and diagnostic process in patients with bronchial asthma and chronic obstructive pulmonary disease (Pulmosys)".

The article analyzes the clinical effectiveness of influenza vaccination and the use of erdostein in COPD patients in order to prevent exacerbations of the disease. The study included 86 patients diagnosed with COPD (GOLD 2), group D without exacerbation, "phenotype with frequent exacerbations". All patients were divided into two groups: group 1 received individually selected drug therapy for the underlying disease in accordance with GOLD (2019), group 2 included patients who were vaccinated against influenza and prescribed erdostein against the background of standard drug therapy. The number of exacerbations and hospitalizations, the severity of clinical symptoms of COPD, the level of systemic biomarkers, tolerance to physical activity, and the quality of life of patients for 12 months were evaluated using the computer program "Management system for the treatment and diagnostic process in patients with bronchial asthma and chronic obstructive pulmonary disease (Pulmosys)".

As part of the multi-center study "KNOCAP "(full name of the project "the assessment of students' and physicians' knowledge of community-acquired pneumonia basics») according to the assessment of students ' knowledge and preferences, a two-stage questionnaire was conducted for 85 students of the V-VI courses of the medical Institute OF NRU "BelSU" in 2017-2018, and in 2018-2019 academic years. When answering most of the questions in the questionnaire on EAP pharmacotherapy, there was a statistically significant increase in the level of knowledge of students, which indicates the undeniable benefits of conducting educational activities. The smallest increase in the number of correct answers was noted in the question of choosing the main criterion for the cancellation of antimicrobial therapy (AMT); the largest - regarding the pharmacotherapy of VP in the absence of risk factors.tactics.