Vol 83, No 1 (2011)

Articles
Physician of an outpatient clinic: perfection of professional skills
Galkin V.A., Galkin V.A.
Abstract
The article presents a short history of development of outpatient therapy, basic principles of improvement of professional skills of outpatient clinic physicians, methods of VI grade students teaching at a therapeutic faculty.
Terapevticheskii arkhiv. 2011;83(1):5-7
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Coronary heart disease in Russia: incidence rate and treatment (according to epidemiological data)
Shal'nova S.A., Deev A.D., Shalnova S.A., Deev A.D.
Abstract
Monitoring of arterial hypertension on representative samples has shown that overall prevelance of coronary heart disease (CHD) in Russia is 13.5±0.1%, in men- 14.3±0.3%, in women - 13.0±0.2%. This is three times higher than in the United States where this figure in 2004 was 4.9%. CHD morbidity raises with age and in population over 70 years of age reaches in Russia 50%. Recently, treatment of CHD improved significantly, modern medication is applied more often though doses of drugs are often not optimal and specialized medical aid is not sufficient.
Terapevticheskii arkhiv. 2011;83(1):7-12
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Non-rheumatic myocarditis in practice of outpatient therapist and cardiologist
Bart B.Y., Benevskaya V.F., Brodskiy M.S., Bart B.Y., Benevskaya V.F., Brodsky M.S.
Abstract
Non-rheumatic myocarditis occurs in therapeutic and cardiological practice both at prehospital and hospital stages. Diagnosis of this myocarditis at early stages is difficult. The course and outcome of this disease and its present-day treatment are outlined to help clinical and cardiological practitioners.
Terapevticheskii arkhiv. 2011;83(1):12-17
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Algorithm of anxiodepressive disorders detection in patients with coronary heart disease in general clinical practice
Kozlova S.N., Shlyakhto E.V., Golubev A.V., Krylova Y.S., Neznanov N.G., Smirnov B.I., Kozlova S.N., Shlyakhto E.V., Golubev A.V., Krylova Y.S., Neznanov N.G., Smirnov B.I.
Abstract
Aim. To estimate a diagnostic algorithm for anxiodepressive disorders (ADD) in coronary patients in general therapeutic practice. Material and methods. A total of 163 coronary patients were examined using Seattle, Moriski and Green, Hospital questionnaires for anxiety and depression. Patients with clinical and subclinical anxiety and/or depression by Hospital testing responded to Hamilton anxiety and depression questionnaire. An analysis of clinical, anamnestic and socioeconomic parameters was made to create a multifactor model for ADD detection in coronary patients basing on the method of multiple logistic regression. Results. A model of ADD dependence Z = -3.446 [presence or absence of anxiety and/or depression in the past]-2.451[presence or absence of stress for a year] - 2.452 [drinking alcohol or rejection of alcohol] + 0.071 [the disease perception in percent from Seattle angina questionnaire]. In certain combination of responses (presence or absence of parameters) and digital result in 7 combinations the patients can be diagnosed to have ADD. Conclusion. The diagnostic algorithm proposed helps ADD detection in coronary patients in general therapeutic practice without participation of psychotherapists and medical psychologists.
Terapevticheskii arkhiv. 2011;83(1):17-21
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Physical exercise in combined outpatient rehabilitation of coronary patients with biliary dysfunction
Aronov D.M., Gulyaeva S.F., Shikhova E.V., Vedernikov V.A., Aronov D.M., Gulyaeva S.F., Shikhova E.V., Vedernikov V.A.
Abstract
Aim. To study prevalence of gastrointestinal symptoms (GIS) including gall-bladder dysfunction (GBD) in coronary patients after acute coronary event (ACE) and effects of early physical exercise (PE) of moderate intensity in coronary patients with GBD on efficacy of outpatient rehabilitation. Material and methods. A two-stage trial was conducted. Stage 1: 237 coronary patients responded to questionnaire detecting incidence of GIS including GBD 8 weeks after ACE. Stage 2: 85 coronary patients with verified GBD were examined for efficacy of rehabilitation. Of them, 43 patients entered PE group while 42 patients entered a control group. The latter received standard therapy without PE. The efficacy of the treatment was evaluated by clinical, device and biochemical findings at baseline and 12 months later. Results. Of 237 coronary patients 217 (91.7%) patients 2 months after ACE had symptoms of coronary insufficiency, 192 (81.3%) had GIS, 78.9% had GBD. Patients from PE group significantly improved exercise tolerance (bicycle exercise test reached 79.3±15 and 121.3±14.5 bt (p < 0.05), respectively. These patients demonstrated improvement of gall-bladder contraction, a decrease in the level of total cholesterol from 6.12±0.4 to 4.7±0.2 mmol/l (p < 0.05), of LDLP cholesterol from 3.85±0.21 to 2.86±0.32 mmol/l (p < 0.05), thioldisulphide coefficient from 13±0.3 to 2.7±0.4 (p < 0.01). The intergroup analysis 12 months after the study revealed significant differences in favor of the PE group. A weekly number of anginal attacks reduced from 5.1±1.5 to 1.3±1.4 (p < 0.01). Conclusion. The exercise program is rather effective and can be practiced outpatiently in coronary patients after ACE associated with GBD. It can be also used for secondary prophylaxis of cholestasis in coronary patients with biliary problems.
Terapevticheskii arkhiv. 2011;83(1):21-25
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Efficacy of balneotherapy in cholelithiasis
Gorbunov A.Y., Vakhrushev Y.M., Gorbunov A.Y., Vakhrushev Y.M.
Abstract
Aim. To assess therapeutic efficacy of mineral water Uvinskaya at a prestone stage of cholelithiasis. Material and methods. A total of 135 cholelithiasis patients entered the trial. Of them 57 patients had a prestone stage and 78 - stone stage of the disease. The stages were verified by clinical data, findings of dynamic hepatobiliscintygraphy, biochemical bile tests, anatomoemission spectroscopy with induction-bound plasma. Results. 57 patients at prestone stage of cholelithiasis received balneotherapy with mineral water Uvinskaya. The treatment relieved pain syndrome, dyspeptic symptoms, enhanced absorption-excretion function of the liver, prolonged the time of maximal gall-bladder filling, shortened radiopharmaceutical half-life in the gall-bladder, raised the level of trace elements (magnesium, iron, potassium) in the bile, improved gall-bladder contraction, lithogenic bile characteristics. Conclusion. Mineral water Uvinskaya has a positive effect in a physical-chemical stage of cholelithiasis.
Terapevticheskii arkhiv. 2011;83(1):25-28
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ECG dispersion mapping on CardioVisor-06 C in outpatient setting
Evstigneeva O.I., Safiulova I.A., Evstigneeva O.I., Safiulova I.A.
Abstract
Aim. To evaluate diagnostic potential of measurement of myocardial metabolism with ECG dispersion mapping based on low-amplitude (10-30 mcV) oscillations of the electrocardiographic signal in persons aged 30-80 in health and pathology. Material and methods. A total of 283 patients were examined. The input ECG signal was digitized isolating 15 successive complexes for 30-60 s with reference to results of the analysis of ECG signal low amplitude oscillation amplitude dispersions, the data were processed on the weak signal multiplication module, the surface map of electric fluctuations formed at output was projected on the surface of 3D anatomic model of the heart. Results. Age groups were the following: 30-40 years (n = 18, 6.4%), 41-50 years (n = 68, 24%), 51-60 years (n = 90, 31.8%), 61-70 years (n = 78, 27.6%), 71 and older (n = 29, 10.2%). According to the integral index of myocardial changes the patients were divided into 4 groups: group 1 (n = 182) - up to 15% (normal), group 2 (n = 83) - 16-30% (moderate changes), group 3 (n = 16, 5.6%) - 31-45% (marked changes), group 4 (n = 2) - over 45% (dramatic changes). The examination aimed at not only early detection of pathology in healthy able to work population, but also at drawing attention of this population to health protection programs. Conclusion. Myocardial metabolism disorders were detected in 64 patients, borderline conditions of the myocardium were detected in 86 patients. Almost 50% of able to work examinees aged 50 years and younger have borderline conditions, older patients have these conditions in 30-35%. Thus, older population pay more attention to their health.
Terapevticheskii arkhiv. 2011;83(1):29-32
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Osteoporosis: diagnosis, prevention and treatment in outpatient setting
Rubin M.P., Chechurin R.E., Rubin M.P., Chechurin R.E.
Abstract
Early diagnosis and adequate treatment are main components in prophylaxis of osteoporosis and ruptures. We examined 8578 postmenopausal and elderly women for osteoporosis. A total of 26084 examinations were made: x-ray absorptiometry, bone ultrasonometry, DEXA of low spine bones and proximal bone for mineral density led us to the conclusion that it is necessary to make regular prophylactic examinations of 45-50-year-old women in peri- and postmenopause with following monitoring on demand for detection of initial signs of systemic osteopenia.
Terapevticheskii arkhiv. 2011;83(1):32-38
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WHO programs "Acute Myocardial Infarction Register", MONICA: thirty years (1977-2006) of epidemiological studies of myocardial infarction in a high-risk population
Gafarov V.V., Gafarova A.V., Gafarov V.V., Gafarova A.V.
Abstract
Aim. To reveal 30 year (1977-2006) trends of myocardial infarction (MI) morbidity, lethality and mortality in population of the West Siberia megapolis (Novosibirsk). Material and Methods. WHO programs "Acute Myocardial Infarction Register (AMIR) and MONICA covered 3 districts of Novosibirsk. Results. MI morbidity in 25-64 year old population of Novosibirsk (high-risk population) in Russia is one of the highest in the world. MI morbidity was stable for 30 years excluding in 1988, 1994 and 1998 when it rose and in 2002-2004, 2006 when it lowered. Changes in mortality and lethality resemble changes in morbidity trend excluding 1977-1978 (fall) and 2002-2005 (rise). Prehospital mortality and lethality were much higher than those in hospital. Mortality and lethality in 1988, 1994, 1998 and 2002-2005 increased due to prehospital lethality and mortality, while it decreased in 1977-1978 due to hospital one. Reduction of mortality and lethality in stable MI morbidity shows improvement of medical care for MI patients, increased lethality and mortality in MI morbidity decline reflect deterioration of such care. Changes in behavioral and somatic factors of cardiovascular risk in population of Novosibirsk for 30 years were not observed while psychosocial risk factors gain a significant importance. By indirect indications, MI morbidity, mortality and lethality mark growing social stress in the population. MI mortality is 2-3 times higher than that of alcohol and is a basic factor of mortality increase in the population of Russia. Conclusion. MI morbidity, mortality and lethality are markers of social stress in population.
Terapevticheskii arkhiv. 2011;83(1):38-45
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Results of a multicenter trial "Epidemiology of Gastroesophageal Reflux Disease in Russia" (MEGRE)
Lazebnik L.B., Masharova A.A., Bordin D.S., Vasil'ev Y.V., Tkachenko E.I., Abdulkhakov R.A., Butov M.A., Eremina E.Y., Zinchuk L.I., Tsukanov V.V., Lazebnik L.B., Masharova A.A., Bordin D.S., Vasiliev Y.V., Tkachenko E.I., Abdulkhakov R.A., Butov M.A., Eremina E.Y., Zinchuk L.I., Tsukanov V.V.
Abstract
Aim. To assess prevalence of gastroesophageal reflux disease (GERD) in Russia in MEGRE trial in 6 cities of the Russian Federatiion (Kazan, Kemerovo, Krasnoyarsk, Ryazan, St-Petersburg, Saransk). Material and methods. Mayo Clinic questionnaire (USA) adapted for Russia was used to question 7812 people over 18 years of age from of random population sample. The symptoms (heartburn and regurgitation) were classified as frequent if they arose once a week and more often for the last 12 months, rare symptoms arose less often than once a week. The responders with frequent heartburn and/or regurgitation were regarded as persons with epidemiological quantitative criteria of GERD. Results. Heartburn occurred in 47.5% responders: frequent in 9%, rare in 38.5%. Regurgitation occurred in 42.9%: frequent in 7.6%, rare in 35.3%. GERD prevalence was 13.3% (city range 11.3-14.3%). Frequent GERD symptoms are associated with frequent gaseous eructation (24.3%), chronic cough (22.9%), chest pain (15.1%), dysphonia (11.4%.). To stop heartburn, 88% responders took antacids, 32% - blockers of histamine H2-receptors and only 23% - inhibitors of proton pump. Only 52.8% responders with frequent chest pain and 29.3% those with frequent hearburn visited a doctor. Conclusion. The population-based trial MEGRE conducted by international methodology in 6 cities of Russia demonstrated that GERD prevalence is 13.3%. Most of the patients pay little attention to the symptoms, do not seek medical advice and, therefore, receive no adequate treatment.
Terapevticheskii arkhiv. 2011;83(1):45-50
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Age-specific features of acute myeloid leukemia karyotype
Gritsaev S.V., Martynkevich I.S., Martynenko L.S., Ivanova M.P., Aksenova V.Y., Moskalenko M.V., Zapreeva I.M., Abdulkadyrov K.M., Gritsaev S.V., Martynkevich I.S., Martynenko L.S., Ivanova M.P., Aksenova V.Y., Moskalenko M.V., Zapreeva I.M., Abdulkadyrov K.M., Tiranova S.A.
Abstract
Aim. To study distribution of some karyotype variants among patients of different age with acute myeloid leukemia (AML). Material and methods. Distribution of balanced, normal, unbalanced, complex and monosomic karyotype among 244 patients with de novo AML in age groups 16-20, 21-30, 31-40, 41-50, 51-60, 61 and older was analysed. Results. There is difference in frequency of balanced and complex karyotype in patients under and over 60 years. Number of AML patients with balanced aberrations including favourable variants t(8;21), t(15;17) and inv(16) falls after 60 years of age (6.7% versus 15.0% in patients aged 16-20 years; p < 0.001), while a complex karyotype occurs more frequently in AML patients at the age of 61 and older (56.8% versus 2.7% in the group 16-20 years; p < 0.001). With age, more frequently detected is the most unfavourable monosomic karyotype with aberrations similar to those in myelodysplastic syndrome (57.1% in patients aged 16-60 years and in 80.0% in the group of 61 years of age and over). Conclusion. Age-specific karyotype features detected may be explained by different biological mechanisms involved in leukosogenesis in young and elderly AML patients.
Terapevticheskii arkhiv. 2011;83(1):51-55
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Trends in systemic inflammatory factors and aminoterminal brain natriuretic propeptide in the treatment of chronic heart failure
Egorova E.N., Kuz'mina M.I., Mazur V.V., Kalinkin M.N., Mazur E.S., Egorova E.N., Kuzmina M.I., Mazur V.V., Kalinkin M.N., Mazur E.S.
Abstract
Aim. To study trends in systemic inflammatory factors and aminoterminal brain natriuretic propeptide (NT-proBNP) in the blood of patients with stage IIA and IIB chronic heart failure (CHF) during therapy aimed at reducing venous congestion. Material and methods. The study enrolled 52 patients with postinfarction cardiosclerosis (PICS). Clinical, echocardiographic and laboratory studies were conducted. The levels of TNF-alpha, IL-6, IL-10 and C-reactive protein (CRP) were measured by enzyme immunoassay. The concentration of endotoxin (ET) was estimated by the end-point chromogenic LAL test, that of NT-proBNP - by immunochromotographic assay. Results. In the patients with CHF, clinical signs of pulmonary venous congestion are associated with a statistically significant increase in the blood levels of TNF-alpha and CRP, those of systemic venous congestion are related to a further rise in TNF-alpha levels and elevation of blood concentrations of NT-proBNP, ET and IL-10. Treatment-related reduction in pulmonary venous congection is associated with a decrease in the levels of TNF-alpha, CRP and IL-6; that in systemic venous congestion - with lower concentrations of NT-proBNP, TNF-alpha and ET. Conclusion. Specific changes in the levels of systemic inflammatory factors and NT-proBNP were found in patients with CHF in the presence of pulmonary and systemic venous congestion. Treatment aimed at elimination of the latter leads to reduction in the levels of systemic inflammatory factors and NT-proBNP.
Terapevticheskii arkhiv. 2011;83(1):56-59
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Apical hypertrophic cardiomyopathy associated with HCV infection
Fomin V.V., Nikulkina E.N., Sedov V.P., Girina S.S., Doletskiy A.A., Moiseev S.V., Fomin V.V., Nikulkina E.N., Sedov V.P., Girina S.S., Doletsky A.A., Moiseev S.V.
Abstract
A case is reported of a female patient with apical hypertrophic cardiomyopathy with negative chest T waves associated with HCV infection.
Terapevticheskii arkhiv. 2011;83(1):59-62
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Some problems of pathogenesis and clinical symptoms of atherosclerosis (coronary heart disease, hypertension) in the Far North
Tikhonov D.G., Nikolaev V.P., Sedalishchev V.I., Tikhonov D.G., Nikolaev V.P., Sedalischev V.I.
Abstract
Cardiovascular diseases now have a trend to greater prevalence in the direction from the South to the North. This trend is more pronounced in the North of Russia including Far East Federal Region. It is suggested that such trend is caused by different eating behavior responsible for increasing blood pressure in population from colder region, low temperature of the environment, chronic stress in conditions of the North. These risk factors aggravate standard risk factors which operate independently of the geographic region of living. Intensive industrial development of the North Far East regions of Russia demands introduction of effective measures of cardiovascular disease prophylaxis.
Terapevticheskii arkhiv. 2011;83(1):63-69
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Anticitrullin antibodies modern markers of rheumatoid arthritis
Shilkina N.P., Luzinova M.S., Vinogradov A.A., Shilkina N.P., Luzinova M.S., Vinogradov A.A.
Abstract
Modern diagnosis of rheumatoid arthritis (RA) is based on the ARA criteria with seropositivity detection by the rheumatoid factor (RF). In a clinically evident stage of the disease this factor is highly sensitive and specific (about 90%), but in early RA efficacy of this diagnosis is considerably less. RF-IgM phenotype has limitation: frequent detection of this factor in the absence of RA and unstability of RF-IgM phenotype. Therefore, it is necessary to search for new serological criteria of RA diagnosis at early stage of the disease. Proteins containing citrullin appear only in the course of posttranslation modification of arginin residues. This fact gave rise to an original, available for clinical practice method of enzyme immunoassay for detection of antibodies to cyclic citrullinized (ACCP) - filaggrin derivative with synthetic cyclic citrullinized peptide serves as antigenic substance. According to the results of different studies, ACCP specificity in early RA diagnosis is more than 80%, combination of ACCP with ESR, RF-IgM, CRP, morning stiffness - more than 90%. As specificity of combination of these autoantibodies is almost 100%, their simultaneous determination is indicated in patients with undifferentiated arthritis for specification of the diagnosis. ACCP and antibodies to modified citrullinized vimentin (AMCV) significantly correlate with RA activity, are prognostic factors of rapidly progressive course and can be used for the disease prognosis at its early stage. Present-day data on comparative specificity and sensitivity of ACCP and AMCV are not certain and need further study.
Terapevticheskii arkhiv. 2011;83(1):70-75
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Index of articles published in the journal Terapevticheski arkhiv in 2010
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Abstract
Terapevticheskii arkhiv. 2011;83(1):76-80
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