Vol 25, No 3 (2024): ОПУБЛИКОВАН 30.10.2024

Articles

Assessment of the state of antibiotic resistance and the structure of prescriptions of antibacterial drugs for pyelonephritis in pregnant women

Dronova J.M., Batishcheva G.A., Arzhanykh Y.V., Prokudina J.A., Perova N.N.

Abstract

Pyelonephritis is the most common infectious and inflammatory disease in pregnant women, and is one of the most common causes of severe complications and deaths on the part of the mother and fetus. A retrospective analysis of 150 case histories of pregnant women with pyelonephritis who were hospitalized showed that the most common pathogens were E.coli (45,7%-55,6%), Kl.pneumoniae (7,8%-17,1%), E. faecalis (10,4%-14,2%). Pyelonephritis with urolithiasis had a more severe clinical course and Kl.pneumoniae was significantly more often detected (p<0,05). E.сoli, Kl.pneumoniae demonstrated a high level of antibiotic resistance to ampicillin and cephalosporins of the III, IV generations with preserved sensitivity to carbapenems and inhibitor-protected cephalosporins. In most cases the initial antibacterial therapy (cephalosporins of the third generation, inhibitor-protected penicillins) was empirical and took into account the timing of gestation and the severity of the disease. In 2020-2021years reserve drugs (carbapenems and inhibitor-protected cephalosporins) were used in 16,4% of cases, which was due to the spread of resistant strains of gram-negative bacteria. In order to prevent further growth of antibiotic resistance, it is necessary to conduct regular microbiological monitoring, more actively use the strategy of stratification of patients according to the risk of resistant pathogens, and widely use methods of rapid diagnosis of bacterial pathogens with an assessment of sensitivity to antibiotics.

Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2024;25(3):5-13
pages 5-13 views

Analysis of the pharmaceutical market of hypolypidemic drugs and real practice of statin prescription in patients with acs

Dubrovsky A.A., Goncharova N.Y., Batishcheva G.A., Nasonov E.S., Posohova A.A.

Abstract

Introduction. Achieving the target level of lipid metabolism to prevent cardiovascular events remains the most significant trend in the pharmacotherapy of cardiac patients. In this regard, it seems relevant to study real clinical practice of statin prescription with simultaneous analysis of clinical findings on achieving target LDL levels and pharmacoeconomic parameters of lipid-lowering drug consumption in the pharmacy market fraction. The aim of the study is to investigate the real practice of statin prescription in patients admitted with ACS, followed by an analysis of the pharmaceutical market for lipid-lowering drugs. Materials and methods. The research is a retrospective study that involves medical records of 60 patients admitted to VGKB No. 3 in 2023, who were diagnosed “acute myocardial infarction”. A sales pattern of lipid-lowering drugs in the Russian Federation in 2023 was analysed based on the data received from the analytical agency “IQVIA”. Results. According to medical documentation, acute myocardial infarction (AMI) was diagnosed for the first time in 73.1% of patients (n=42), repeated AMI was detected in 26.9% of patients (n=18). Among patients with recurrent AMI who were to take statins as secondary prevention, only one patient had the recommended LDL level. Only 3 patients (4.5%) received high-dose therapy with lipid-lowering drugs during hospitalisation; 65.7% of patients (n=44) received atorvastatin, dosage 40 mg, 26.9% (n=18) received atorvastatin, dosage 20 mg, 3% (n=2) received atorvastatin, dosage 10 mg. On discharge, most patients were recommended to take atorvastatin, dosage 40 mg, this accounted for 80.5% (n=54); in 15% of cases patients were recommended to take atorvastatin, dosage 80 mg, in 5% of cases, patients were discharged on low-dose therapy and were prescribed 10 mg atorvastatin per day. The analysis of the pharmaceutical market demonstrated that monocomponent drugs containing atorvastatin and rosuvastatin (58.3% and 34.4%) were the most sold in 2023. Notably, dosage forms 10 and 20 mg (35.3% and 47.7%) prevailed in the sales pattern of atorvastatin,  dosage forms 10 mg prevailed in the sales pattern of rosuvastatin. The dynamics of statin sales in 2021-2023 showed slight fluctuations in the sales structure with a predominance of low-dose forms of drug production, which reflect a general trend towards insufficient realisation of the statin potential to achieve LDL targets.  

Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2024;25(3):14-21
pages 14-21 views

Pharmacoepidemiological analysis of the efficacy and safety of sodium deoxyribonucleate with iron complex in a patient population: a retrospective non-interventional study

Kashaeva O.V., Klimovich A.E., Krasnorutskaya O.N., Zhilin A.E., Podrezov N.P.

Abstract

The article is devoted to the analysis of the results of a retrospective non-interventional post-registration study of the safety and effectiveness of sodium deoxyribonucleate iron complex (Ferrovir®, solution for intramuscular administration of 15 mg/ml). The study included all medical records of patients, which indicated the prescription and assessed the course of therapy with medicinal product. The study was conducted only in age groups 18 years and older. The safety and effectiveness of medicinal product was assessed for approved indications in special groups of patients (patients over 65 years of age, patients with liver and kidney diseases, patients with other diseases) as part of pharmacovigilance. Based on the results of the study, measures were developed aimed at minimizing the risks of adverse reactions in patients.

Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2024;25(3):22-31
pages 22-31 views

Внутренние болезни

Assessment of severity of painful symptoms in patients with chronic heart failure requiring palliative care

Shevtsova V.I., Pashkova A.A., Krasnorutskaya O.N.

Abstract

The aim of the study was to study the severity of painful symptoms in patients with chronic heart failure who need palliative care.

Materials and methods: 298 people participated in the study. The patients were divided into 5 groups depending on body weight and the presence of sarcopenia. A 10-point Edmont scale was used to assess the severity of painful symptoms.

Results: The results of the first stage of the study showed that the painful symptoms in patients with CHF are moderate severity.

The study revealed statistically significant differences in the studied signs in groups of patients with different body composition. It has been shown that fatigue, drowsiness, shortness of breath, impaired appetite, depression and deterioration are more pronounced in patients of the first group - with reduced body weight and sarcopenia, as well as in patients of the fourth group (with sarcopenic obesity).

Conclusion: Patients with CHF represent a large pool of applicants for palliative care, and studying the structure of symptoms that reduce their quality of life will improve the quality of care provided to them.

Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2024;25(3):32-36
pages 32-36 views

FEATURES OF GASTRINOMA DIAGNOSIS AT THE OUTPATIENT STAGE: A CLINICAL CASE

Chizhkov P.A., Lagutina S.N., Kalaev V.N., Larina A.V.

Abstract

The article describes a clinical case demonstrating the importance of timely diagnosis of gastroenterological pathology by primary care physicians at the outpatient stage, as well as the correct routing of the patient for further treatment and dynamic observation. The diagnostic stage of a neuroendocrine tumor - gastrinoma of atypical localization without clinical manifestations by a general practitioner (family medicine) at the BHI VGKP № 1 using anamnestic data, laboratory and instrumental examination methods is demonstrated.

Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2024;25(3):37-41
pages 37-41 views

Analysis of the incidence of hypertension in the elderly and their clinical examination in the Voronezh region based on long-term medical and statistical information

Gafanovich E.Y., Lvovich A.I., Choporov O.N.

Abstract

Arterial hypertension is one of the most common diseases of the cardiovascular system. The proportion of people suffering from this disease among people over working age is significantly increasing. In this regard, the purpose of the study is to analyze the incidence of elderly people with diseases characterized by high blood pressure, to identify the disease during medical examination and primary medical examinations, taking into account the long-term dynamics and short-term forecasts, to develop recommendations for health authorities to improve the effectiveness of medical care for this population. In the course of the study, statistical data for the Voronezh region for the period m 2013 to 2022. at the same time, data were analyzed both for the entire group of diseases under study, and for individual nosologies included in it. A detailed analysis of the obtained time series was carried out with the calculation of indicators of basic growth and chain growth rates. Based on the exponential smoothing method (Holt model), short-term forecasts for the period up to 2025 were made for all analyzed indicators. Correlation relationships between the analyzed indicators were assessed. Priority coefficients and a reverse priority model are proposed for making decisions when allocating resources. The results obtained can be used by health authorities at the regional level in planning measures to improve the effectiveness of medical care for people over working age suffering from arterial hypertension.

Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2024;25(3):42-54
pages 42-54 views

Педиатрия

Clinical characteristics of disorders in connective tissue dysplasia in children

Ledneva V.S., Bavykina I.A., Pertseva M.V., Ivannikova A.S.

Abstract

Connective tissue dysplasia is a widespread pathology that has a systemic effect on the body, aggravates the course of chronic diseases. Determination of risk groups by means of screening studies is an alternative for timely diagnosis of the condition. We conducted a screening assessment of the clinical picture of connective tissue dysplasia in children in the Voronezh region with the participation of 92 primary school children aged 6-11 years (42 boys, 50 girls), average age Me = 8.6 [8.1; 9.4] without an established diagnosis of connective tissue dysplasia using a questionnaire from parents. Physical development disorders were manifested by a disharmonious type with underweight in 14.1% (n = 13) of children (parents also noted signs of asthenic physique in children). Every third parent surveyed noted joint hypermobility in their child (33.7%), spinal curvature (scaliosis) - 31.4%, flat feet - 30.4% of respondents, irregular teething / other dental pathology - 27.2% of patients. Frequent dislocations and fractures in the anamnesis were diagnosed in 9.7% of children, the presence of hernias - 3.2%. Frequent and protracted infections in children were established in 23.9% and a tendency to nosebleeds in 20.6% of patients included in the study. Sleep disturbance and emotional lability are experienced by 25% of children, the presence of obsessive movements and enuresis were noted by 9.7% and 1%, respectively. 28.2% were diagnosed with a tendency to rash and 26% with hyperextensibility of the skin, decreased visual acuity and heart murmurs in 17.4% and 19.6%, respectively. In 33.7%, complaints were familial. The study showed that signs of CTD are quite common in the pediatric population, they need to be assessed in a timely manner and taken into account for correction and therapy.

Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2024;25(3):55-59
pages 55-59 views

The influence of perinatal factors on the nature of feeding newborns

Berdnikov A.A.

Abstract

Breastfeeding has long been recognized as the standard in the nutrition of children in the first year of life. Many programs have been developed to support natural feeding and lactation. However, there are a number of factors that can influence the nature of breastfeeding, including a burdened maternal history, intranatal complications and gestation period at birth. The article provides an analysis of perinatal factors that can potentially affect the time of the first application to the breast and the further type of nutrition. The study involved 115 children, of which 35 patients were born at 33-36 weeks gestation and 80 full-term newborns (37-42 weeks gestation). The data of medical documentation were studied and the anamnesis of mothers was collected. As a result, 17.4% (n=20) of children in the total cohort of subjects exclusively breastfed, more than half (67.8%) are committed to mixed feeding (n=78), 14.8% (n=17) received adapted formula milk (AMC) during enteral nutrition. Gestational age is inversely proportional to the time of application to the breast (p=0.016). The weakness of labor and premature detachment of the normally located placenta have a statistically significant negative effect on the time of application to the breast (p < 0.05). The features of the prenatal history between the groups of children were revealed, but none of the indicators had an effect on the nature of feeding in the perinatal period (p>0.05).

Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2024;25(3):60-64
pages 60-64 views

FEATURES OF OXIDATIVE STRESS AND THE ANTIOXIDANT SYSTEM IN INFLAMMATORY BOWEL DISEASES IN CHILDREN. LITERATURE REVIEW.

Vagin M.S., Fedulova E.N., Khavkin A.I.

Abstract

Inflammatory bowel diseases (IBD) are chronic, relapsing diseases of unclear etiolo-gy with multifaceted clinical manifestations, including extraintestinal ones. These include Crohn's disease (CD) and ulcerative colitis (UC). IBD in children has a number of features, which include difficulties in diagnosis and a more aggressive course. These differences re-quire researchers and clinicians to search for new methods of diagnostic and therapeutic approaches that are based on specific links in pathogenesis. This paper presents a literature review of studies indicating the critical role of imbalance of oxidative stress and the antiox-idant system in the formation of chronic inflammation in IBD, and the differences in this pathogenesis in CD and UC.

Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2024;25(3):65-72
pages 65-72 views

Пульмонология

ANALYSIS OF MAST CELLS REPRESENTATION IN THE LUNGS OF COVID-19 PATIENTS WITH RESPIRATORY SUPPORT AND ACID-BASE STATUS DISORDERS.

Budnevsky A.V., Ovsyannikov E.S., Savushkina I.A., Shishkina V.V., Alekseeva N.H., Perveyeva I.M., Vostrikova K.V.

Abstract

New coronavirus infection COVID-19 is characterized by the development of diffuse alveolar damage, often accompanied by the development of respiratory failure and acid-base imbalance. Mast cells (MCs) are of interest due to their involvement in the mechanisms of COVID-19 lung damage. The aim of the study was to determine the features of the representation and degranulation activity of chymase- and tryptase- positive MCs in the lungs of COVID-19 patients, including respiratory support and in conditions of acid-base imbalance. Materials and methods. The study included 55 patients died because of COVID-19 and 30 controls. The need for respiratory support was analyzed, and acid-base status was determined. Microslides of autopsy lung material were made with immunohistochemical staining to detect tryptase and chymase. A comparative analysis of MCs representation between groups and a correlation analysis with clinical and laboratory parameters were performed. Results. Significantly higher total content of tryptase-positive MCs (p=0.033) and a lower content of single degranulating tryptase-positive MCs, fragments and chymase-positive MCs (p < 0.001, p < 0.001 and p=0.013, respectively) were detected in the lungs of patients with COVID-19. The duration of non-invasive mechanical ventilation (NIV) correlated with the content of single tryptase-positive MCs and fragments (p=0.005, r=-0.371 and p=0.046, r=0.270). In a group of patients (n=12), the acid-base balance indicators were determined, and a tendency towards the development of respiratory acidosis was noted. As pH decreased, the content of single tryptase-positive MCs decreased (r=0.565, p=0.015) and the proportion of fragments (r=-0.605, p=0.008) increased. The PaCO2 level correlated with the content of single non-degranulating (r=-0.573; p=0.041), and lactate with the content of co-adjacent degranulating chymase-positive MCs (r=0.736; p=0.006). Conclusion. In patients with COVID-19, the content of tryptase-positive MCs is increased, but their degranulation activity is reduced. Representation of chymase-positive MCs is reduced in COVID-19 patients. A decrease in the content of single non-degranulating tryptase-positive MCs and an increase in the proportion of their fragments were established with increasing duration of NIV and the emergence of the need for invasive ventilation, reflecting the dynamics of the degranulation process. Increased degranulation of tryptase- and chymase-positive MCs was detected during the development of respiratory acidosis.

Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2024;25(3):73-79
pages 73-79 views

Клиническая и лабораторная диагностика

Immunometabolic activity of azithromycin in new coronavirus infection

Kostenko S.M., Tulinova I.A., Muha Т.A., Dushkina N.V., Kostenko D.S.

Abstract

Azithromycin, a representative of the macrolide family of antibiotics, has a bacteriostatic effect mainly against Gram-positive bacteria. In addition to its bacteriostatic action, it also has immunomodulatory properties. It inhibits the production of pro-inflammatory cytokines (IL-1β, IL-5, IL-6, IL-17, IL-18, tumor necrosis factor-α and chemokines), increases the release of anti-inflammatory cytokine IL-10, converts macrophages into an alternatively activated anti-inflammatory M2-like phenotype, reduces the number of neutrophils and inhibits them functions, inhibits the activation of CD4+ T cells. Azithromycin inhibits the replication of rhinovirus, Zika virus, SARS-CoV-2 virus, and influenza. The pathogenesis of the development of a new coronavirus infection is based on various dysregulatory mechanisms (decreased production of interferons, increased production of proinflammatory cytokines, inhibition of innate and adaptive immunity). The study investigated the effect of azithromycin on metabolic and immunological responses in patients with COVID-19. The study included 78 people hospitalized with a new coronavirus infection of moderate course. The first group consisted of patients who did not receive antibiotics at the outpatient stage of treatment, the second group received azithromycin. Azithromycin has been found to have multiple immunometabolic effects.

Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2024;25(3):80-87
pages 80-87 views

Modern indicators of the general blood test in the differential diagnosis of anemia

Dugusheva V.A., Kotova J.A., Pashkov M.V., Тюркин I.A.

Abstract

Anemia is one of the most common medical problems of this millennium. The article presents an analysis of current data on the importance of a general blood test in the differential diagnosis of anemia. The article examines laboratory tests for anemia and suggests a rational approach to determining the type of anemia. The possibilities of modern hematology analyzers are presented. Such indicators are considered, Macro; Micro; with the help of which it is possible to assess the type of anemia with the severity of anisocytosis. HYPO-He indicators; Hyperhy allows to differentiate anemia by the concentration of hemoglobin in the erythrocyte, determining the percentage of altered erythrocytes. If there are identical changes in the classical indicators of the general blood test such as MCV, MCH, additional modern indicators help to diagnose significant changes necessary for further correct diagnosis and therapy of the identified anemia syndrome.

Medical Scientific Bulletin of Central Chernozemye (Naučno-medicinskij vestnik Centralʹnogo Černozemʹâ). 2024;25(3):88-91
pages 88-91 views

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