Vol 87, No 1 (2015)


Prevention of noncommunicable diseases in a local therapist's practice: Content, problems, solution ways, and prospects

Boĭtsov S.A., Vylegzhanin S.V.


High-risk and secondary prevention strategies for noncommunicable diseases in primary health care are mainly implemented by local therapists. The large-scale clinical examination of an adult population (a high-risk strategy), which has been launched in the country since 2013 to solve the problems of detecting people with noncommunicable diseases and their risk factors and making a prevention counseling, is simultaneously a mechanism for the formation of a full therapeutic area passport to identify follow-up groups (a secondary prevention strategy). Currently, there is an obviously insufficient follow-up of inadequate quality. The reasons for this situation are a lack of regular training of local doctors in follow-up in addition to staff shortages. Medical teachers and professional communities working on the basis of common guidelines must be attracted to solve this problem. The actual introduction of a local therapist's efficient performance measures, the setting up of special structures in charge of primary care prevention in the health authorities, and the active involvement of medical prevention and health centers (for people at high risk in the absence of proven non-communicable diseases) in this process will be able to enhance the efficiency of a follow-up. Information technologies, including a tele-follow-up, are an important reserve in implementing the high-risk and secondary prevention strategies.
Terapevticheskii arkhiv. 2015;87(1):4-9
pages 4-9 views

Russian and regional performance indices of local therapists

Starodubov V.I., Ivanova M.A., Armashevskaia O.V., Bant'eva M.N.


Aim. To analyze the statistical indicators of a local therapist's performance in the Russian Federation and its districts in the 2008-2012 period. Materials and methods. The authors analyzed staffing and understaffing in the federal districts with respect to the Russian Federation, a doctor's actual function and its deviation ratio, staffing of local therapists, secondary employment coefficient, and the total number of physician visits with the ratio of the number of home/polyclinic ones. Results. The staffing of local therapists was steady-state in the country as a whole in the period analyzed. At the same time, there was a decline in staffing. The performance of doctors everywhere is greater than the recommended one since 2009. There was a reduction in the number of visits to local therapists in both the country as a whole and its regions, with more visits being made by rural dwellers. Conclusion. The current approach to the standards for the load and number of physicians should determine needs for specialists of this profile and become a major part to solve the problem of delivering available and high-quality primary outpatient care to the population of Russia.
Terapevticheskii arkhiv. 2015;87(1):10-13
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Gender differences in health awareness and attitudes as a subjective-objective health index in the population of Russia/Siberia (WHO MONICA-psychosocial program, HAPIEE project)

Gafarov V.V., Gromova E.A., Gagulin I.V., Gafarova A.V., Panov D.O.


Aim. To establish gender differences in health attitudes and awareness of risk factors for cardiovascular diseases in an open 25-64-year-old population of Russia/Siberia. Subjects and methods. A representative sample from the population of a Novosibirsk district was examined using the 1988 WHO MONICA-MOPSY (847 women and 739 men aged 25-64 years) and the 2003 HAPIEE (1074 women and 576 men aged 45-64 years) programs. The health awareness and attitudes questionnaire was used. Results. The number of persons who considered perfectly healthy was minimal (2%) in the open Siberian population aged 25-64 years. The view of health in the women proved to be more pessimistic than that in the men. The fact that two thirds of the population could fall ill with a serious disease in the coming 5-10 years was accepted. Mainly the men took the view that modern medicine might prevent heart disease. The men were regularly examined 2 to 3 times more often than the women. The latter versus the men were less frequently inclined to stop work if they felt not quite well on-site, with the difference being more marked in old age groups. The majority of the study participants considered preventive examination to be useful for health. At the same time only a small portion of the population itself undergoes examination. Conclusion. The changed socioeconomic situation in the country leads to the need to alter the established stereotypes of conscience and behavior of the population in health and to realize the need for personal responsibility for health.
Terapevticheskii arkhiv. 2015;87(1):14-26
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The frequency of potentially inappropriate medication use according to the Beers' criteria in elderly people at the therapy departments of a multidisciplinary hospital

Sychev D.A., Danilina K.S., Golovina O.V.


Aim. To analyze the frequency of potentially inappropriate medication use according to the Beers' criteria in elderly people at the therapy departments of a hospital. Subjects and methods. Case histories of 150 patients over 65 years of age (47 men and 103 women at the age of 79.0±15.5 years) treated at the therapy department of a multidisciplinary hospital were analyzed to estimate the frequency of potentially inappropriate medication use in elderly people according to the Beers' criteria in the 4-month period: from March to June 2013. Each treatment sheet was checked against the so-called Beers' list (supported by the American Geriatric Associated in 2012) to reveal the use of potentially inappropriate medications. Results. An average of 6.4±4.0 drugs was simultaneously used in the patients. In 61 (40.67%) patients, the treatment sheets showed 78 potentially inappropriate medications that should be avoided by the elderly. Twenty-one (14%) patients were noted to use 24 potentially inappropriate drugs that should be avoided by elderly patients with definite diseases and syndromes. Fifty (33.3%) patients were observed to have taken the drugs that should be used with great caution. Conclusion. The findings suggest that the elderly patients frequently receive potentially inappropriate medications; as a result their benefits can be overweighed by the risk.
Terapevticheskii arkhiv. 2015;87(1):27-30
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Identification of circulatory diseases and their risk during medical examination of an adult population: Methodological aspects

Kalinina A.M., Ipatov P.V., Kaminskaia A.K., Kushunina D.V.


Aim. To study the efficiency of a methodology for the active detection of coronary heart disease (CHD) and cerebrovascular diseases (CVD) during medical examination and to determine the need and possible ways of its improvement. Subjects and methods. The medical examinations of 19.4 million people (94.6% of all the citizens who had undergone medical examinations in all the regions of Russia in 2013) were analyzed and the methodological aspects of identification of the circulatory diseases (CDs) that were induced by coronary and cerebral vessel atherosclerosis and had common risk factors, primarily CHD and CVD, were assessed. Results. The medical examinations revealed 2,915,445 cases of CDs and their suspicions, during which its clinical diagnosis was established in 57.2%. The suspected disease requiring that its diagnosis should be further specified; off-medical examinations revealed hypertension in more than 770,000 cases, CHD in 232,000, and CVD in 146,000. The proportion of stable angina pectoris of all angina cases was much higher at a young age (25.6%) than at middle (15.6%) and elderly (11.3%) ages. Brachiocephalic artery stenoses were detected in almost 13,000 cases. According to the official health statistics, within the years preceding the introduction of large-scale medical examinations, there was a slight rise in new CD cases among the adult population of Russia, which was more significant in 2013 (according to the preliminary data) than in 2012. Conclusion. The methodology for the active detection of CDs through a two-step medical examination, which is used during a follow-up, makes it possible to substantially increase detection rates for CDs. There has been shown to be a need for the better quality and completeness of diagnostic examination in real practice.
Terapevticheskii arkhiv. 2015;87(1):31-37
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Refralon (niferidil) is a new class III antiarrhythmic agent for pharmacological cardioversion for persistent atrial fibrillation and atrial flutter

Maĭkov E.B., Iuricheva I.A., Mironov N.I., Sokolov S.F., Golitsyn S.P., Rozenshtraukh L.V., Chazov E.I.


Aim. To evaluate the efficacy and safety of refralon (niferidil), a new class III antiarrhythmic agent whose activity is related to the block of delayed rectifying potassium current and to the prolongation of atrial and ventricular action potential and refractory periods, when it is used as an agent for pharmacological cardioversion for atrial fibrillation (AF) and atrial flutter (AFL). Subjects and methods. The efficacy of the drug as 3 intravenous boluses of 10 µg/kg was evaluated in 134 patients (90 men; 57.8±11 years) with a mean AF duration of 3 (1.5; 6) months. Its effect was controlled by 24-hour Holter ECG monitoring. The criterion for its antiarrhythmic effect was 24-hour sinus rhythm (SR) recovery. Results. Niferidil restored SR in 47.7% of the patients with AF after administration of bolus 1, in 62% after bolus 2, and in 84.6% after bolus 3. SR was restored in all 100% patients with AFL. With the AF duration of less than 3 months, the efficacy of niferidil was 91.8%. There was nonsustained polymorphic ventricular tachycardia (VT) (torsade de pointes) in 1 (0.7%) patient and nonsustained monomorphic VT was stated in 5 (3.7%) patients. Conclusion. Pharmacological cardioversion with niferidil for persistent AF and VT may be regarded as a possible alternative to electrical cardioversion.
Terapevticheskii arkhiv. 2015;87(1):38-48
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Impact of bosentan therapy on stress-induced pulmonary hypertension in patients with systemic sclerosis

Volkov A.V., Kurmukov I.A., Iudkina N.N., Glukhova S.I., Nikolaeva E.V.


Aim. To describe hemodynamic and clinical changes in patients with elevated mean pulmonary artery pressure (MPAP) >30 mm Hg during exercise and the impact of bosentan therapy on stress-induced pulmonary hypertension (SIPH). Subjects and methods. The study included 19 patients with systemic sclerosis (SDS) in whom possible causes of pulmonary hypertension (PH) (lung and left heart injuries and thromboembolism) were excluded. All the patients underwent pulmonary artery catheterization at rest and during exercise. The hemodynamic (right atrial pressure (RAP), systolic and diastolic pressure, MPAP, pulmonary artery wedge pressure (PAWP), cardiac output (CO) by a thermodilution technique), clinical (demographic, immunological, and instrumental) parameters were analyzed and the risk of pulmonary arterial hypertension (PAH) was also calculated; 5 patients with SIPH received 16-week bosentan therapy according to the conventional regimen. Results. Ten of the 19 patients were at increased risk for PAH in accordance with the DETECT scale, but no signs of PH at resting catheterization were found in anybody. In 5 patients, MPAP, was in the range from 21 to 24 mm Hg; in 9 (47%) patients were found to have SIPH, a median MPAP of 35 (32; 41) mm Hg. Seven patients had no diagnostic changes during exercise; 3 patients could not perform an exercise test. There were correlations between MPAP and DETECT risk scores (p<0.05). The patients with SIPH had significantly higher levels of resting MPAP and exercise pulmonary vascular resistance (PVR) and PAWP. The calculated DETECT risk was significantly higher in the SIPH group. The level of uric acid was also higher in the SIPH group (p<0.05). There were no changes in NT-proBNP levels, telangiectasias and anti-centromere antibodies, and EchoCG and lung test results. During 16-week bosentan therapy, there was a significant decrease in MPAP and transpulmonary gradient during exercise, but PVR, MPAP/CO ratio and NT-proBNP levels tended to decrease. Conclusion. In the patients with SDS, SIPH may be a stage of pulmonary vasculopathy that precedes the development of clinical PAH. The use of current PAH-specific drugs used at the preclinical stage of the disease may substantially improve lifetime prognosis in patients with SDS-associated PAH.
Terapevticheskii arkhiv. 2015;87(1):49-56
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Prevalence of some modified cardiovascular risk factors among young students

Zvolinskaia E.I., Kimitsidi M.G., Aleksandrov A.A.


Aim. To estimate the prevalence of some modified cardiovascular risk factors (RFs) among the students of two Moscow higher education institutions to further test the technology of individual medical prevention counseling. Subjects and methods. A questionnaire survey was conducted among 1912 first-year students (boys and girls, mean age 17.7 years) from 2 Moscow higher education institutions to reveal physical activity levels, smoking status, alcohol abuse, and food addictions. Results. Almost one third of the students (mainly girls) lead a sedentary lifestyle. The mean age at onset of smoking is 14.8 years. At the moment, the smoking students are 22% (28% of boys and 18% of girls). 12.2% of the respondents have moderate and high nicotine dependence. Most smokers demonstrate low motivation to give up smoking. The mean age for alcohol consumption is 15.8 years. 60% of the students use alcohol. There are no great differences in the drinking of alcoholic beverages between the girls and boys. 18% of the study sample students eat irregularly. Nearly 50% of the students add salt to cooked foods. 17% of the students eat too much sugar; more than 50% take sugar- and fat-laden foods. 54% of the students use vegetables and fruits insufficiently. Conclusion. Among all the modified cardiovascular RFs, alcohol use and irrational nutrition are most common among the students. Smoking and low physical activity are also relevant problems although these indicators among the students of Moscow are lower than among those in other regions of the Russian Federation. The found patterns call for the increased attention of the administrations of higher education institutions.
Terapevticheskii arkhiv. 2015;87(1):57-63
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Clinicoeconomic effectiveness of using psychotherapy to treat patients with essential hypertension

Kalmataeva Z.A., Zholamanova A.A.


Aim. To assess the expediency of psychotherapy in patients with essential hypertension (EH) from clinical and economic standpoints. Subjects and methods. Seventy-five (37 men, 38 women) with grades 1-2 EH (blood pressure (BP) was 140/90 to 179/109 mm Hg) and the verified psychosomatic background of the disease) were examined and randomized into 2 groups (the mean age in Groups 1 and 2 was 48.5±3.69 and 47.5±4.2 years, respectively). All the patients received medical therapy using the same regimen; however, Group 1 patients had additionally psychotherapy. The decrease in BP and the average number of visits required to reach goal BP were estimated as a criterion for therapeutic effectiveness. A pharmacoeconomic analysis of antihypertensive therapy was made in each group. Results. The average cost for 24 weeks was 349.67 rbl per person in Group 1 and 435.9 rbl in Group 2, which was 19.78% cheaper. The costs of reductions in systolic BP (SBP) and diastolic BP (DBP) were also lower in Group 1 (-22.108 and -39.534 rbl, respectively). At the same time, goal BP was achieved more rapidly in Group 1 (in Groups 1 and 2, the reduction in SBP was 5.28 and 3.38 mm Hg weekly and that in DBP was 2.51 and 1.73 mm Hg weekly, respectively). This makes it possible to lower a physicians' load and to save timing budget (p>0.032). Conclusion. The treatment policy in Group 1 surpassed that in Group 2 in the rate of BP normalization and the number of required visits to a physician and showed significant economic benefits.
Terapevticheskii arkhiv. 2015;87(1):64-68
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Association of cognitive impairments with carbohydrate and lipid metabolic parameters in patients with type 2 diabetes mellitus to undergo coronary bypass surgery

Trubnikova O.A., Mamontova A.S., Tarasova I.V., Maleva O.V., Kuz'mina A.A., Barbarash O.L.


Aim. To comparatively analyze neuropsychological parameters in patients with coronary artery disease (CAD) depending on the presence of type 2 diabetes mellitus (DM) and to evaluate their relationship to carbohydrate and lipid metabolic parameters. Subjects and methods. Fifty-two male patients with type 2 DM (mean age 58.0±5.7 years) and 46 male patients without this condition (mean age 57.1±6.2 years) were examined. Besides standard clinical examination, neurophysiological testing and determinations of glycated hemoglobin (HbA1c) and insulin concentrations, QUICKI index, and blood lipid profile were made. Results. The patients with DM differed from those without DM in the lower speeds of sensorimotor reactions during neurodynamic testing and in worse attention values. In the patients with type 2 DM, the worse neuropsychological status was associated with the higher plasma concentrations of glucose, insulin, HbA1c, total cholesterol, low-density lipoproteins, and triglycerides and with the lower levels of high-density lipoproteins. These relationships were not observed in the patients without DM. Conclusion. The patients with CAD concurrent with DM had a worse neurophysiological status than those without DM. Only the DM group demonstrated a relationship between cognitive impairments and carbohydrate metabolic markers. Carbohydrate and lipid metabolic disturbances may be assumed to make a negative contribution to the development of cognitive impairments in patients with CAD concurrent with type 2 DM.
Terapevticheskii arkhiv. 2015;87(1):69-75
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Cardiovascular diseases in the population of industrial towns and environmental factors

Ibraeva L.K., Azhimetova G.N., Amanbekova A.U., Bakirova R.E.


Aim. To study the influence of environmental factors (EFs) on the development of cardiovascular diseases in the population of industrial towns of the Republic of Kazakhstan. Subjects and methods. The investigation covered an 18-59-year-old adult population who had been living in the urbanized areas of the Republic of Kazakhstan for at least 10 years, who worked in harmless conditions and were unregistered as having chronic diseases. At Stage 1, screening (a therapist's examination, blood general and immunological tests, and electrocardiography) was carried out for risk group persons who underwent in-depth clinical examination (blood biochemical test) at Stage 2. Results. Multivariate statistical analysis has revealed that the development of hypertension is associated with the high concentration of sulfur dioxide in atmospheric air, copper in dust sediments, and zinc in soil and that of coronary heart disease (CHD) is related to the high levels of nitrogen dioxide in atmospheric air and zinc in dust sediments. Conclusion. Based on pathogenetic and statistical data and information available in the literature, hypertension and CHD are referred to as the diseases that may result from the influence of EFs.
Terapevticheskii arkhiv. 2015;87(1):76-78
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Lung ultrasound for the diagnosis of pneumonia in pregnant women with blood system tumors

Galstian G.M., Novikov V.A., Troitskaia V.V., Bariakh E.A., Makhinia S.A., Parovichnikova E.N., Savchenko V.G.


Aim. To estimate the informative value of ultrasonography (USG) in the diagnosis of lung injuries in pregnant women with blood system tumors. Subjects and methods. Lung ultrasound was performed in 5 pregnant patients with blood cancers. The women's age was 29-38 years; gestational age was 14-33 weeks. Four women had different types of acute leukemia; one had primary mediastinal large B-cell lymphoma. All the women received chemotherapy for blood cancer. When there were signs of lung injury, USG was conducted, the results of which necessitated therapy or bronchoalveolar lavage (BAL). Results. Three patients developed acute respiratory failure; 2 of them required noninvasive ventilation. Based on the detection of consolidation with a dynamic air bronchogram and pleural effusion, the authors diagnosed bilateral pneumonia and alveolar-interstitial syndrome in 1 patient, right-sided pneumonia in 1, left-sided one in 1, and transfusion-related pulmonary edema in 1. Lung ultrasound did not verify the diagnosis of pneumonia in 1 patient. According to USG data, BAL procedures were performed in 2 patients; one of them was diagnosed as having Pneumocystis pneumonia; the other was found to have no pathogens in lavage fluid. Treatment resulted in clinical improvements and normalization of the lung ultrasound pattern in all the pregnant women. Later on, 4 women delivered via cesarean section done at 32-34 weeks' gestation and gave birth to healthy babies. One patient died from infectious complications after chemotherapy. Conclusion. Lung sound may be used to diagnose lung injury in pregnant women with blood cancers.
Terapevticheskii arkhiv. 2015;87(1):79-87
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Clinical efficacy of Аrbidol (umifenovir) in the therapy of influenza in adults: Preliminary results of the multicenter double-blind randomized placebo-controlled study ARBITR

Kiselev O.I., Maleev V.V., Deeva É.G., Leneva I.A., Sel'kova E.P., Osipova E.A., Obukhov A.A., Nadorov S.A., Kulikova E.V.


Aim. To evaluate the efficacy and safety of Аrbidol (umifenovir) in adult patients with influenza. Subjects and methods. The analysis of the preliminary results of the multicenter double-blind randomized placebo-controlled post-marketing study ARBITR was performed. A total of 293 adults aged 18 to 65 years with influenza or acute respiratory tract infection of no more than 36 hours' duration were enrolled in the study. Individuals were randomized into 2 treatment groups: oral umifenovir 200 mg four times daily for 5 days or placebo four times daily for 5 days. The efficacy endpoints were time to resolution of all symptoms, severity of symptoms and illness, durations of virus shedding. Results. The efficacy of umifenovir was evaluated in the group of 119 (40.6%) patients with influenza: 45 patients with laboratory-confirmed influenza and 74 patients whom diagnosis of influenza was made based on clinical and epidemiological data. Umifenovir had influence on the time to resolution of all symptoms. All symptoms were resolved within the first 60 hours after therapy initiation in 23.8% patients with laboratory-confirmed influenza in the umifenovir group and it was 5.7 times greater compared to placebo group (4.2%) (p<0.05). Severity of illness, catarrhal symptoms and intoxication was reduced with umifenovir compared to placebo, reducing of severity was most evidently observed within the first 2-3 days following the therapy initiation. Umifenovir had a significant effect on viral shedding. The proportion of patients still shedding influenza virus on day 4 was significantly reduced in the umifenovir group compared to placebo (25 vs 53%, respectively; p < 0.05). Conclusion. It was found that the effect of umifenovir in the treatment of influenza in adults is most pronounced in the acute stage of the disease and appears in the reduction of time to resolution of all symptoms of the disease, reducing the severity of symptoms of the disease and durations of virus shedding.
Terapevticheskii arkhiv. 2015;87(1):88-96
pages 88-96 views

Common variable hypogammaglobulinemia: The author's observation

Parfenov A.I., Krums L.M., Akhmadullina O.V., Shcherbakov P.L., Khomeriki S.G., Orlova N.V., Sabel'nikova E.A., Fadeeva N.A.


The paper gives a case history of a patient with common variable hypogammaglobulinemia (СVHGG). Its clinical picture was characterized by frequent inflammatory airway diseases, pansinusitis, and periodic rises in temperature up to febrile ones. The diagnosis was established on the basis of the decreased serum concentrations of immunoglobulins (IG) A, M, and G, the unusual small intestinal (SI) wall relief created by large lymphoid follicles, as well as the characteristic sign of CVHGG, namely, the lack of plasma cells in the lamina propria of the SI mucosa. Antibacterial therapy was noted to have a good effect that confirmed the leading role of excessive bacterial growth in the pathogenesis of chronic diarrhea and fever, which are the major clinical manifestations of CVHGG in this patient.
Terapevticheskii arkhiv. 2015;87(1):97-99
pages 97-99 views

Arterial hypertension: An expanding pathogenic continuum and therapeutic limitations

Kharchenko E.P.


The paper considers the role of the immune system, endoplasmic network stress, metabolic dysregulation, and epigenetic mechanisms in the pathogenesis of essential hypertension, as well as the limited possibilities of therapy with existing antihypertensive agents.
Terapevticheskii arkhiv. 2015;87(1):100-104
pages 100-104 views

Renal dysfunction in patients with myocardial infarction concurrent with type 2 diabetes mellitus

Evseeva M.V., Karetnikova V.N., Barbarash O.L.


Carbohydrate metabolic disturbances are an independent risk factor for not only the development, but also poor course of cardiovascular diseases, particularly those concurrent with renal dysfunction (RD). This factor acquires particular relevance due to the fact that the incidence of type 2 diabetes mellitus significantly continues to rise worldwide. The review considers the main mechanisms and common components of the pathogenesis of RD, as well as the constituents forming its basis in the presence of carbohydrate metabolic disturbances. Moreover, it highlights the timely detection of RD, a search for new biomarkers of prognostic value for cardiovascular events, and the early diagnosis of RD. The review unveils the present view of optimal diagnostic and management tactics for patients with myocardial infarction concurrent with background diseases.
Terapevticheskii arkhiv. 2015;87(1):105-108
pages 105-108 views

Specific features of neurological complications developing in patients with type 2 diabetes mellitus and metabolic syndrome: Possibility for correction and prevention

Shishkova V.N.


The prevalence of type 2 diabetes mellitus (DM) and preceding metabolic disturbances has reached epidemic proportions. Oxidative stress plays a significant role in the development of micro- and macrovascular complications in patients with DM. The accumulation of free radicals is responsible for the development of systemic and vascular inflammation, endothelial dysfunction, and hypercoagulable and ischemic states. Since vascular and nervous system damages do not level off even under adequate glycemic control, there is a need for complex pathogenetic treatment strategies. Antioxidant therapy using mexidol is one of the compulsory components of combination therapy for complications of DM.
Terapevticheskii arkhiv. 2015;87(1):109-114
pages 109-114 views

Significance of surfactant proteins in the diagnosis of therapeutic diseases

Koval'kova N.A., Ragino I.I., Logvinenko N.I., Merekina E.V., Voevoda M.I.


The lung provides not only respiration, but also the functioning of innate immunity mechanisms. The hydrophilic proteins SP-A and SP-D are responsible for the regulation of the latter. In the literature, there is evidence for elevated serum SP-A and SP-D levels in respiratory diseases accompanied by enhanced mucosal inflammation of the lung or its parenchymal injury and their association with age and cardiovascular diseases has been recently found. Studies of the efficiency of using SP-A and SP-D as specific markers for inflammatory lung diseases are presently worthwhile.
Terapevticheskii arkhiv. 2015;87(1):115-119
pages 115-119 views

An important stage in the development of field therapy (on the 70th anniversary of victory in the Great Patriotic War)

Knopov M.S., Taranukha V.K.


Much previous experience accumulated by physicians in various wars and local military conflicts provides strong evidence that it is necessary to set up a harmonious system to deliver therapeutic care during wartime, which is based on the unity of views on the origin, course, and treatment of pathological processes having regard to the specific conditions under which armed forces are involved in combat operations. This all has given rise to the new branch of therapy - field therapy. The Great Patriotic War was the most important stage in the development of Russian field therapy, which was characterized by the setting up of the effective and scientifically ground system to deliver therapeutic care to the wounded and patients, which was based on the tenets of a uniform field medical doctrine.
Terapevticheskii arkhiv. 2015;87(1):120-125
pages 120-125 views

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