Vol 82, No 3 (2010)

Editorial
Diffuse alveolar hemorrhage syndrome
Chuchalin A.G., Chuchalin A.G.
Abstract
The diffuse alveolar hemorrhage syndrome (DAHS) determines three symptoms: hemoptysis, dyspnea, and anemia. DAHS may occur in the presence of diverse etiological and clinical manifestations of diseases. The paper presents information on the diseases and states, in which DAHS develops in different forms, and data on morphological changes in the lung. It also describes the clinical signs of DAHS, the specific features of its different forms, the methods of laboratory and instrumental diagnosis, as well as methods of its treatment.
Terapevticheskii arkhiv. 2010;82(3):5-8
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Circulating leptin and the trophological status of patients with chronic obstructive pulmonary disease
Beloborodova E.I., Akimova L.A., Asanova A.V., Burkovskaya V.A., Kritskaya N.G., Beloborodova E.I., Akimova L.A., Asanova A.V., Burkovskaya V.A., Kritskaya N.G.
Abstract
Aim. To study the specific features of the nutritional status of patients with persistent chronic obstructive pulmonary disease (COPD) in relation to the hormone-regulating function of energy exchange in terms of leptin and to concurrently evaluate the functional status of fat and protein digestion and absorption and to measure body fat percentage. To assess the influence of these factors on the regulation of the serum concentration of leptin and its potential role in the development of trophological insufficiency in patients. Subjects and methods. In 93 patients with COPD (Stages I, II, and III in 22, 36, and 35 patients, respectively, the nutritional status was evaluated by somatometric methods. The concentration of leptin was measured by enzyme immunoassay using a test system (DSL, USA). Absorption was estimated by biochemical studies and by using radionuclides. Body fat content was determined, by measuring bioelectric impedance with an OmRon BF-302 apparatus (Japan). Results. Protein and fat absorption was decreased in patients with moderate and mainly severe COPD as compared with that in the control group and correlated with body weight deficit and lower body fat percentage. Decreased leptin levels were detected in Stages II-III COPD and correlated with the degree of the disease and reduced protein (r = 0.68 ± 0.02) and fat (r = 0.64 ± 0.18) absorption. Conclusion. Protein and fat absorption impairments correlating with body weight deficit in patients with COPD underline the significant role of this mechanism in the development of trophological insufficiency. In COPD patients with trophological insufficiency, the lower circulating leptin levels that correlate with impaired absorption of fatty acids and protein characterize the pathogenetic role of secondary malabsorption syndrome in leptin-mediated impairments of energy exchange mechanisms. Functional insufficiency of the hormone-regulating mechanism responsible for energy exchange in terms of leptin in patients with Stages II-III COPD gives warning of the insufficient stock of adipose tissue and its reduced energy reserve.
Terapevticheskii arkhiv. 2010;82(3):8-13
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Study of an association between chronic obstructive pulmonary diseases and types 1 and 2 diabetes
Kobylyanskiy V.I., Babadzhanova G.Y., Suntsov Y.N., Kobylyansky V.I., Babadzhanova G.Y., Suntsov Y.I.
Abstract
Aim. To study an association between multifactorial obstructive pulmonary disease (COPD) and asthma and types 1 and 2 diabetes (T1D and T2D). Subjects and methods. A multicenter study was conducted in two formed cohorts of patients with bronchopulmonary pathology (n = 616) and diabetes (n = 700). Random sampling, retrospective data collection, by applying a blind approach, as well as questioning and, if need be, diagnosis verification and an additional study were accomplished. Statistical methods were employed to make a cross assessment of the prevalence of the diseases in each cohort as compared to a control group in which population-based values were used. Results. In the cohort of patients with bronchopulmonary pathology, the prevalence of T2D was considerable in patients with COPD, it was 9.49%, which was greater than the control values (3.0; p < 0.01), more than 2.5 times higher (p < 0.05) than that in asthmatic patients in whom the prevalence was 3.64% and it did not differ from the control group. In COPD concurrent with T2D, the prevalence of diabetes was as high as 16.15% (p < 0.001). At the same time, the prevalence of bronchopulmonary pathology in the T2D cohort being 2.3% for COPD and 1.0% for asthma was lower than the population-based value (p < 0.05), 2.6% and 6.1%, respectively. It was contrastingly found that T1D was absent in the asthmatic patients and the prevalence of asthma (0.33%) was low in patients with asthma (p < 0.05). In parallel, an association between COPD and T1D could not be traced, by taking into account an age difference and other specific features of a pathological process in these patient groups. Conclusion. Unlike asthma, COPD, in combination with asthma in particular, is an essential risk factor for T2D. Asthma and T1D mutually exclude each other.
Terapevticheskii arkhiv. 2010;82(3):13-18
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Aortic stiffness in chronic obstructive pulmonary disease concurrent with coronary heart disease
Nevzorova V.A., Shekunova O.I., Brodskaya T.A., Nevzorova V.A., Shekunova O.I., Brodskaya T.A.
Abstract
Aim. To study aortic stiffness in patients with chronic obstructive pulmonary disease (COPD) concurrent with coronary heart disease (CHD). Subjects and methods. Twenty-eight patients with CHD-associated COPD, 27 patients with isolated COPD in remission (a comparison group), and 30 gender- and age-matched healthy volunteers (a control group) were examined. Aortic stiffness was assessed by noninvasive arteriography, by determining the aortic pulse wave velocity (APWV), augmentation index (AI), systolic and diastolic coronary cycle index area ratio, and left ventricular (LV) ejection fraction index. Results. Noninvasive arteriography showed that in COPD concurrent with CHD, aortic stiffness was much higher (there were increases in APWV, AI, and relative coronary perfusion indices) than in COPD only. At the same time, no significant differences were found in the coronary perfusion in COPD only and in that concurrent with CHD. In CHD-associated COPD, there was an inverse correlation between decreased SaO2 and increased APWV and a direct association between the lower values of external respiration function and the level of hypoxemia, the poorer conditions of coronary perfusion, and diminished LV myocardial contractility. Conclusion. In COPD concurrent with CHD, central arterial stiffness is drastically increased as compared to that in healthy individuals and patients with COPD alone. There are no differences in the values of coronary perfusion in isolated COPD and its association with CHD, suggesting that COPD is of its own value in the formation of a cardiovascular risk. The correlation between the major parameters of aortic stiffness and the level of hypoxemia, on the one hand, and decreased lung ventilation function, on the other, testify their great contribution to the increase in the stiffness of elastic-type vessel walls in CHD-associated COPD.
Terapevticheskii arkhiv. 2010;82(3):18-22
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Effect of the If channel blocker ivabradine on the parameters of external respiration function in patients with chronic obstructive pulmonary disease in its stable course period
Komlev A.D., Kuzyaev A.I., Laskin G.M., Kuzenkova V.E., Kolosova M.V., Komlev A.D., Kuzyaev A.I., Laskin G.M., Kuzenkova V.E., Kolosova M.V.
Abstract
Aim. To evaluate the effect of the If channel blocker ivabradine on bronchial patency and the volume parameters of external respiration function in patients with chronic obstructive pulmonary disease (COPD) in remission in order to determine whether the drug may be used in patients with coronary heart disease (CHD) concurrent with COPD. Subjects and methods. Heart rate, bronchial patency, and lung volume were studied by body plethysmography in 59 patients with COPD before and 14 days after administration of ivabradine in a daily dose of 10 mg. Results. The If channel blocker ivabradine that is a highly selective bradycardiac agent fails to affect the velocity and volume parameters of external respiration function, thus it may be used to treat CHD concurrent with COPD. Conclusion. The If channel blocker ivabradine exerts no effect on external respiration function parameters (bronchial patency, volume parameters) and it can find clinical use in the treatment of angina pectoris and chronic heart failure in patients with CHD concurrent with COPD.
Terapevticheskii arkhiv. 2010;82(3):23-25
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The specific features of respiratory support in patients with obstructive sleep apnoea syndrome concurrent with chronic obstructive pulmonary disease (crossing-syndrome)
Shoykhet Y.N., Markin A.V., Shoikhet Y.N., Markin A.V.
Abstract
Aim. To determine the specific features of respiratory support in patients with obstructive sleep apnoea syndrome (OSAS) concurrent with chronic obstructive pulmonary disease (COPD). Subjects and methods. Thirty-six patients with OSAS concurrent with COPD were examined. External respiration function, apnoea/hypopnoea index, and arterial gas composition were determined in all the patients. The efficiency of continuous positive airway pressure (CPAP) therapy was evaluated in all the patients with the crossing-syndrome (CS). Results. The prevalence of CS among the patients with OSAS was 18.8%. The CS patients' need for bilevel positive airway pressure (BiPAP) therapy was 27.8%. These patients and those treated with CPAP had at baseline a daytime hypercapnia level of 50.7 ± 1.8 and 42.0 ± 1.2 mm Hg (p = 0.005) and a nocturnal blood oxygen saturation level of 83.6 ± 1.3 and 88.8 ± 0.9% (p = 0.004), respectively. BiPAP therapy resulted in a 1.8-fold reduction in the desaturation index than did CPAP therapy. Conclusion. On choosing a respiratory support method in patients with OSAS, one should assess the presence of chronic lower airway obstruction, the degree and type of chronic respiratory failure, and the presence and magnitude of clinical, functional, and laboratory signs of alveolar hypoventilation. Bilevel lung ventilation is more effective in patients who have CS, daytime hypercapnia, and nocturnal hypoxemia uncorrected by CPAP therapy and who need high therapeutic pressure.
Terapevticheskii arkhiv. 2010;82(3):26-28
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Impact of mycolytic therapy on the production of active oxygen formS in the blood of patients with an exacerbation of chronic obstructive pulmonary disease
Farkhutdinov U.R., Farkhutdinov R.R., Petryakov V.V., Farkhutdinov S.U., Mirkhaydarov A.M., Farkhutdinov U.R., Farkhutdinov R.R., Petryakov V.V., Farkhutdinov S.U., Mirkhaidarov A.M.
Abstract
Aim. To study the production of active oxygen forms (AOF) in the blood of patients with an exacerbation of chronic obstructive pulmonary disease (COPD) and the effect of the mycolytic agent Ambroxol on this process. Subjects and methods. Fifty-two patients with an exacerbation of COPD were examined. The patients were divided into 2 groups: 1) a study group (n = 25) received conventional therapy (antibiotics, bronchodilators, glucocorticosteroids) and Ambroxol inhalation; 2) a control group (n = 27) had conventional therapy and placebo (saline) inhalation. The blood production of AOF was studied by luminol-dependent chemiluminescence (CL) assay. Results. The intensity of whole blood CL was increased in patients with COPD. Ambroxol therapy reduced blood AOF generation and improved clinical parameters. On the contrary, the high intensity of blood CL remained and a slowing trend in the symptoms of the disease was noted in the control group. Conclusion. The use of Ambroxol in COPD exacerbations corrected AOF production in the blood of the patients and enhanced the efficiency of their treatment.
Terapevticheskii arkhiv. 2010;82(3):29-32
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Results of evaluation of the efficiency of complex rehabilitation in chronic obstructive pulmonary disease and occupational bronchitis
Fedorova T.N., Glotov A.V., Demchenko V.G., Fedorova T.N., Glotov A.V., Demchenko V.G.
Abstract
Aim. To evaluate the efficiency of the rehabilitation in patients with obstructive pulmonary disease (COPD) and occupational bronchitis (OB) and the disabled due to these diseases, which was based on the authors' developed procedure and criteria for evaluating the efficiency of rehabilitative measures. Materials and methods. The efficiency of implementation of 55 individual rehabilitation programs (RP) elaborated by the Medicosocial Examination Bureau for the disabled due to COPD and OB was evaluated. Results. The authors have determined qualitative criteria for evaluating the efficiency of rehabilitation: the extent to which the recommended rehabilitation measures being implemented, the trend in the magnitude of various vital activity categories and social inadequacy and in the disability group on regular examination, the results of implementation of some parts of an individual RP, the conformity of the achieved results to the rehabilitation potential of a disabled patient. The evaluation procedure supposes a unified quantitative gradation of each criterion. Overall, rehabilitation is more effective in COPD than in OB. Conclusion. The developed criteria and procedures for evaluating the efficiency of rehabilitation in patients with COPD and OB show a great informative value and practical content richness, which permits one to make corrections into the rehabilitation process. Functional impairments, the degree of vital activity restrictions and social inadequacy, as well as the rehabilitation potential and rehabilitation prognosis are concomitantly evaluated, which allows minor changes to be assessed in the clinical, personality, and social status of a patient.
Terapevticheskii arkhiv. 2010;82(3):32-36
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Changes in plasma hemostatic parameters under intravascular laser irradiation of blood in patients with community-acquired pneumonia
Burduli N.M., Pilieva N.G., Burduli N.M., Piliyeva N.G.
Abstract
Aim. To study the time course of changes in the activity of the protein C system and other hemostatic parameters under intravascular laser irradiation of blood (ILIB) in patients with community-acquired pneumonia (CAP). Subjects and methods. One hundred and forty patients aged 17 to 62 years (mean 39.5 ± 8.4 years) with CAP were examined. A control group (n = 40) received conventional drug therapy; the study group (n = 100) had a course of ILIB in addition to conventional therapy. Results. Before treatment, the patients with CAP were observed to have a lower protein C system activity and the signs of hypercoagulation that were eliminated by ILIB. Conclusion. ILIB is an effective method in correcting hemocoagulative disorders in patients with CAP.
Terapevticheskii arkhiv. 2010;82(3):36-38
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The parameters of the blood prooxidant and antioxidant systems in bacterial and viral pneumonias
Nagoev B.S., Ivanova Z.O., Nagoyev B.S., Ivanova Z.O.
Abstract
Aim. To determine the level of malondialdehyde (MDA) in plasma and nitro blue tetrasolium in leukocytes as parameters of the blood prooxidant system and the activity of ceruloplasmin (CP) in serum and erythrocyte catalase as the parameters of antioxidant activity in bacterial and viral pneumonias. Subjects and methods. The blood prooxidant and antioxidant systems were studied in 177 patients with bacterial and viral pneumonia over time. Results. Heterodirectional changes were found in the parameters of the blood prooxidant and antioxidant systems in bacterial and viral pneumonias. There was a regular and significant increase in MDA levels, spontaneous HCT test, and erythrocyte catalase. At the same tine, CP activity depending on the etiology, stage, and degree of the disease was inhibited. Conclusion. Severe prolonged impairments in the activity of the prooxidant and antioxidant systems and changes in their parameters are indicative of the more severe course of the disease, the presence of complications and infectious-inflammatory concomitant diseases.
Terapevticheskii arkhiv. 2010;82(3):38-42
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Impact of insulin therapy on insulin resistance and a risk for coronary heart disease and cardiovascular death in patients with type 2 diabetes
Ametov A.S., Kochergina I.I., Ulanova K.A., Ametov A.S., Kochergina I.I., Ulanova K.A.
Abstract
Aim. To evaluate the impact of insulin therapy in combination with oral sugar-reducing drugs (OSRD) on metabolic control and a risk for coronary heart disease (CHD) and a 10-year cardiovascular death risk in patients with type 2 diabetes (T2D). Subjects and methods. Seventy-four patients (49 women and 25 men) aged 36-78 years (mean 56.28 ± 2.58 years) with a 9.34 ± 1.12-year history of T2D were examined. The investigators made a clinical examination, studied the parameters of carbohydrate metabolism: glycated hemoglobin (HbA1c), fasting (FG) and postprandial glycemia (PPG) (2 hours after meals) and lipid metabolism, insulin resistance, microalbuminuria (MAU), and combined therapy-induced blood pressure changes. The risk for CHD was estimated from the atherogenicity index, total cholesterol/high-density lipoproteins and low-density lipoproteins/high-density lipoproteins ratios, and SCORE index. Results. Long-term insulin therapy in combination with OSRD caused a significant improvement in carbohydrate metabolism (reductions in HbA1c by 216-23.2%, FG and PPG by 33.4-35.7%), positive lipid metabolic changes, a decrease in MAU by 0.12 ± 0.03 to 0.03 ± 0.01 g/l, with a fall of its detection rate from 73 to 27%; a considerable decline in IR from the HOMA and CARO indices (by 30-32%), as well as a significant reduction in the risk for CHD and 10-year cardiovascular death risk from the SCORE index (from 4 to 1.5-1.6%; p < 0.01). Conclusion. Combined therapy with long-acting insulin in combination with OSRD in patients with T2D resulted in metabolic improvement and a significant reduction in the risk for CHD and 10-year cardiovascular death risk.
Terapevticheskii arkhiv. 2010;82(3):42-46
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Study evaluating the impact of a combination of inotropic support and heart rate monitoring on prognosis and stabilization rate in patients with decompensated chronic heart failure (LEGION)
Arutyunov G.P., Arutyunov A.G., Volkova A.L., Arutyunov G.P., Arutyunov A.G., Volkova on behalf of the task group A.L.
Abstract
Aim. To evaluate the efficacy of ivabradine and levosimendan in patients with acute circulatory decompensation. Subjects and methods. The study enrolled 41 patients (20 men and 21 women) aged 61 ± 9 years, admitted for decompensated heart failure (NYHA functional class IV). Ejection fraction averaged 21.6%. In most patients, systolic blood pressure was below 105 mm Hg and heart rate (HR) was 100-115 beats/min. Central hemodynamics was measured using the strip tests. The patients' clinical status was rated applying the scale accepted in Russia. In addition to conventional therapy, Group 1 patients received levosimendan and ivabradine and Group 2 took dopamine after randomization. Results. A significantly more pronounced clinical improvement was noted in Group 1 patients at hours 48 and 72 of determination. There was a significantly more marked HR reduction in Group 1 at 24 and 72 hours of observation. By day 3 of observation, pulmonary wedge pressure was significantly lower in Group 1 than in Group 2. In the same control periods, the increase in coronary perfusion pressure was significantly obvious in Group 1. The drastically increased level of N-terminal fragment of the prohormone brain-type natriuretic peptide was significantly reduced in both groups, but more considerably in Group 1. Conclusion. In patients with decompensated heart failure on conventional therapy, the co-administration of levosimendan and ivabradine is more effective than the use of dopamine.
Terapevticheskii arkhiv. 2010;82(3):47-52
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Spontaneous HCV clearance: an association with gender, age, viral genotypes, infection transmission routes, and markers of HBV and HIV
Fedorchenko S.V., Martynovich T.L., Lyashok O.V., Karyuk Z.A., Yanchenko V.I., Fedorchenko S.V., Martynovich T.L., Lyashok O.V., Karyuk Z.A., Yanchenko V.I.
Abstract
Aim. To determine the rate of spontaneous recovery depending on gender, age, prior icteric hepatitis, infection transmission routes, HCV genotype, markers of HBV and HIV. Subjects and methods. A humoral immunity response to core antigen and nonstructural viral proteins was assessed in patients with HCV clearance and in a group of patients with chronic hepatitis C (CHC). Two hundred and thirty-eight anti-HCV positive patients were examined. Spontaneous viral clearance (SVC) was diagnosed in 27 (12.1%) patients; a false-positive anti-HCV reaction was seen in 15. The spontaneous recovery group comprised young patients with a female predominance: 66 versus 41.9% in the CHC group. Results. 25.2% of the examinees with SVC had a history of the icteric form of acute viral hepatitis. There were no significant differences between HCV genotype and disease outcome. The markers of retrospectively sustained HBV infection were more detectable in the spontaneous recovery group: anti-HBc 48.1% and anti-HBs 14.8%; these were 32.6 and 8.7%, respectively. HIV co-infection reduced the likelihood of recovery. The determination of antibodies to nonstructural viral proteins could state their rare identification in patients with spontaneous HCV clearance (anti-NS3 HCV, 100%; SVC, 42.3%; NS4 HBC, 95.5%; SVC, 30.8%; p < 0.0001). AntiNS5 was only in 15.4% of the recovered patients and in 89.8% of the patients with chronic infections (p < 0.0001). Conclusion. Rare detection of anti-NS5 may serve as an additional serological marker indicating to spontaneous HCV clearance in anti-HCV positive patients.
Terapevticheskii arkhiv. 2010;82(3):52-56
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A case of hemolytic-uremic syndrome with the development of catastrophic antiphospholipid syndrome: Diagnosis and clinical tactics
Dzhumabaeva B.T., Biryukova L.S., Tsvetaeva N.V., Sukhanova G.A., Vasil'ev S.A., Shavlokhov V.S., Karagyulyan S.R., Kaplanskaya I.B., Petrova V.I., Avdonin P.V., Dzhumabayeva B.T., Biryukova L.S., Tsvetayeva N.V., Sukhanova G.A., Vasilyev S.A., Shavlokhov V.S., Karagyulyan S.R., Kaplanskaya I.B., Petrova V.I., Avdonin P.V.
Abstract
The paper describes a case of practically simultaneous development of the hemolytic-uremic syndrome (HUS) and the catastrophic antiphospholipid syndrome (CAPS) complicated by mesenteric vessel thrombosis and small bowel necrosis. Multimodality treatment comprising volume plasmapheresis, fresh frozen plasma transfusion, hemodialysis, anticoagulant and disaggregant therapy could relieve thrombogenic events, such as pulmonary artery thromboembolism and intestinal necrosis.
Terapevticheskii arkhiv. 2010;82(3):56-60
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Bronchopulmonary lesions in chronic inflammatory bowel diseases
Mikhaylova Z.F., Lazebnik L.B., Parfenov A.I., Mikhailova Z.F., Lazebnik L.B., Parfenov A.I.
Abstract
The paper reviews the literature on bronchopulmonary lesion, one of the least studied systemic manifestations associated with inflammatory bowel diseases (IBD). Knowledge of the entire diversity of extraintestinal manifestations of IBD, including respiratory diseases, allows clinicians to optimize their diagnosis and treatment as the asymptomatic course of the latter may lead to the development of severe respiratory complications. The detection of bronchopulmonary pathology in its early period or during current therapy contributes to the objective assessment of the pattern of the disease, to the correction of treatment and improvement of disease prognosis.
Terapevticheskii arkhiv. 2010;82(3):61-64
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myocardial responses to ischemia
Borisenko V.G., Gubareva E.A., Kade A.K., Borisenko V.G., Gubareva E.A., Kade A.K.
Abstract
The paper details the types of a myocardial response to impaired blood flow, such as myocardial stunning, hibernation, ischemic preconditioning, warm-up phenomenon, ischemic postconditoning, remodeling, and infarction. According to the pathogenesis, the authors identify several types of myocardial dysfunction in transient ischemic attack - uptake, delivery; and a mixed one. It is concluded the myocardial response to damage depends on a combination of influencing factors, a number of pathophysiological processes starting in the acute phase of ischemia achieve its peak in the late period.
Terapevticheskii arkhiv. 2010;82(3):64-67
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Current methods for measuring the glomerular filtration rate in persons with normal weight and overweight
Novikova M.S., Kutyrina I.M., Shilov E.M., Novikova M.S., Kutyrina I.M., Shilov E.M.
Abstract
A steady increase in glomerular filtration rate is considered to be one of the first stages of renal lesion in essential hypertension, metabolic syndrome, and type 2 diabetes mellitus. The paper discusses methods for detection of hyperfiltration and gives their comparative characterization and indications for their use.
Terapevticheskii arkhiv. 2010;82(3):67-71
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Chronic yersiniasis as a therapeutic problem
Shestakova I.V., Yushchuk N.D., Shestakova I.V., Yushchuk N.D.
Abstract
Physicians of any specialty encounter the chronic course of yersiniasis, the clinical manifestations of which are polymorphic and similar to the symptoms of other diseases, including autoimmune ones. The long interval of an evolving pathological condition after the acute period of the disease leads to the fact that the clinical and laboratory manifestations of chronic yersiniasis are wrongly regarded as an independent nosological entities unassociated with the persistence of Yersinia. Dynamic blood tests for specific IgA to the Yersinia enterocolitica virulence factors that are an indirect sign of on-going pathogen persistence in the body are required to elaborate the tactics for the examination, treatment, and follow-up of patients.
Terapevticheskii arkhiv. 2010;82(3):71-76
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Kalendar' yubileynykh dat istorii terapii 2010 goda
- -.
Abstract
Terapevticheskii arkhiv. 2010;82(3):78-80
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