Modern Guidelines Research Articles

Healthy intestinal colonization in children: strong immunity

The article presents actual data on the composition and functions of the intestinal microbiota, and examines the mechanisms of the microbiota effect on the macroorganism’s health state. The necessity and possibility of correction of microbiota are shown by the analysis of the composition and evaluation of the functions of the intestinal microbiota, and the mechanisms of the symbiotic relationship «microflora macroorganism» and the causes leading to the development of intestinal dysbiosis. The main groups of preparations (probiotics, prebiotics, synbiotics) used for correction of intestinal microbiocenosis are presented by taking into account the modern guidelines.

The Effects of Hepatitis C Infection and Treatment on All-cause Mortality Among People Living With Human Immunodeficiency Virus.

Persons living with human immunodeficiency virus (HIV; PLwH) are commonly co-infected with hepatitis C virus (HCV). Most co-infected individuals can achieve a sustained HCV virologic response after treatment with direct-acting antivirals (DAA). However, the effect of HCV co-infection and DAA treatment on mortality after initiating antiretroviral therapy (ART) is unknown for PLwH. We analyzed data from the Women's Interagency HIV Study and the Multicenter AIDS Cohort Study. Participants included those who had prevalent HIV or seroconverted during follow-up; all were antiretroviral-naive and acquired immunodeficiency syndrome (AIDS)-free prior to their first visit after 1 October 1994. The follow-up lasted 10 years or until 30 September 2015. We used parametric g-computation to estimate the effects of HCV infection and DAA treatment on mortality had participants initiated ART at study entry. Of the 3056 eligible participants, 58% were female and 18% had HCV. The estimated 10-year all-cause mortality risk in the scenario in which no PLwH had HCV was 10.4% (95% confidence interval [CI] 6.0-18.0%). The 10-year mortality risk difference for HCV infection was 4.3% (95% CI 0.4-8.9%) and the risk ratio was 1.4 (95% CI 1.0-1.9). The risk difference for DAA treatment was -3.8% (95% CI -9.2-0.9%) and the risk ratio was 0.8 (95% CI 0.6-1.1). HCV co-infection remains an important risk factor for mortality among PLwH after initiating ART according to modern guidelines, and DAAs are effective at reducing mortality in this population. HCV prevention and treatment interventions should be prioritized to reduce mortality among PLwH.

Practical use of modern guidelines for the diagnosis and treatment of exocrine pancreatic insufficiency in patients with chronic pancreatitis

The article presents a review of current European and Russian guidelines on diagnostics and treatment of exocrine pancreatic insufficiency in patients with chronic pancreatitis. Results of our own comparative study on treatment of 55 chronic pancreatitis patients with low and adequate doses of pancreatic enzyme replacement therapy (PERT) confirm the need for usage of recommended doses of modern micronized polyenzyme drugs since it improves both clinical manifestation and nutritional status in such patients unlike the lower doses. Our research findings show that the optimal criterium for PERT efficacy assessment is the normalization of antropometric and biochemical nutritional markers.

Особливості залучення студентів до наукової діяльності у вищих медичних навчальних закладах

In higher medical education institutions, students should be aware of the fact that all experiments are related to human life and, therefore, must be carefully performed and tested. We have found that students with a greater interest are involved in performing research tasks if they are conducted in medical institutions or contain modern medical terms and guidelines. From experience we note that in order to increase the efficiency of learning the learning material, and consequently, increasing interest in the subject (in particular, chemistry) in classes, it is necessary to use different didactic tools, techniques, forms and principles of learning. For example, chemistry teachers use advanced training, algorithms, presentations, use of video tutorials, work with a workbook, and homework assignments of varying degrees of difficulty. We note that increasing interest in the discipline develops the need for students to deeply study the subject, to understand its significance in future professional activities. In our opinion, one of the effective forms of work is the use of working notebooks on a printed basis. The analysis of the conducted survey, control of knowledge and skills of the students of the Cherkasy Medical Academy, makes it possible to draw conclusions. The effectiveness of the learning material (on chemistry) is increased by almost 22%. The desire to deepen knowledge and engage in research in chemistry is growing by 15%. Consequently, the use of the above methods and forms of work increases the attraction of students to research. Initially, this occurs at different stages during the training, and further, it is a desire to conduct research in future professional activities. That contributes to the development of the medical sector and the prestige of the profession. Keywords: research activity of medical students, professional competence, teacher's functions, workbooks, stages of engagement in research work.

A patient with сoronary artery disease and multifocal atherosclerosis. How to optimize the prognosis?

The review article summarized the positions of experts on the clinical and prognostic significance of multifocal atherosclerosis in patients with different forms of coronary heart disease and the impact of this phenomenon on overall cardiovascular risk based on the foreign and domestic studies, the guidelines of the European and North American Cardiological and Surgical Associations. It also presents the review of the modern clinical guidelines for antithrombotic therapy in patients with peripheral atherosclerosis. The review presents prospects for the optimization of antithrombotic therapy based on a recent clinical study.

Main Approaches to Assessing the Quality of Drug Therapy in Cardiology

A competent choice of drug therapy in a specific clinical situation is a difficult and important task that a practical doctor must regularly solve in everyday practice, and the consequences of errors in this decision can be quite serious. Therefore, evaluation of the quality of the prescribed therapy is extremely important.In the treatment of cardiovascular diseases, medicines that have a proven effect on the outcomes of the disease, primarily on mortality rates (so-called "life-saving drugs") acquire special significance. There are several classes of such drugs, and in different situations, their positive impact on the prognosis of the disease may be different. On the other hand, one should remember the so-called "drug-related problems" (DRP), which include contraindications to the prescription of certain drugs in a particular patient, the possibility of developing side effects of drug therapy, aggravated by polypharmacy, inter-drug interaction, improper dosage of drugs, etc.In this publication, an attempt is made to identify the main components by which the quality of the prescribed therapy can be evaluated in the treatment of cardiovascular diseases: compliance of prescriptions with official instructions for preparations, modern clinical guidelines, adequate selection of a specific drug within the class, drug formulation, salt of the drug, evaluation of important safety parameters and efficacy of the prescribed drug. In addition, a review of the methods and scales of the composite evaluation of the quality of drug therapy developed to date has been conducted, as well as attempts to improve them and create new ones that continue to the present day. Nevertheless, none of the currently known methods for assessing the quality of therapy is not universal or devoid of shortcomings.Most likely, a universal method of assessing the quality of the prescribed treatment may not exist. In its most general form, it can be said that treatment should be based on modern evidence-based medicine, which is usually reflected in the clinical guidelines, without contradicting the official instruction on the use of the drug, considering the presence of concomitant diseases, that are often the reasons of contraindications to prescribing those or other medicines.

Методы оценки биологической эффективности применения синтетических половых феромонов фитофагов

Evaluation of biological effectiveness of synthetic sex pheromones of grape moth (Lobesia botrana Den.S 1,8-20,8 %) application was considerably lower than that in the control(54,6-67,5 %: 71,6-92,6 %). Modern evaluation guidelines for biological effectiveness of these promising methods of plant protection are proposed. As pheromones are highly species-specific, are applied at very few numbers and, being volatile, do not remain on the treated territory, they can be recommended for the use as ecologically safe, alternative to chemical method assuring control of phytophages population.

Modern aspects of the treatment of irritable bowel syndrome

The diagnostic algorithm of IBS includes a careful analysis of symptoms in accordance with the requirements of the Rome IV criteria consensus, the use of laboratory and instrumental methods. The IBS therapy is primarily aimed at arresting the prevailing clinical symptoms and is regulated by the modern clinical guidelines. Trimebutin demonstrates high efficacy in the management of pain syndrome and motor control in patients with IBS in comparison with placebo.

Goal-directed use of balanced solutions for laparoscopic surgery in obese patients

Modern guidelines for infusion therapy in laparoscopic surgery of patients with obesity are ambiguous due to insufficient number of clinical researches. The aim of our work was to evaluate the effect of goal-directed infusion therapy with balanced solutions on hemodynamics, electrolyte balance, renal function and incidence of perioperative complications of laparoscopic surgery in obese patients. Materials and methods. The study included 54 obese patients (BMI >30 kg/m 2 ) who were performed laparoscopic surgery in case of the diaphragmatic hernia, colon tumors, postoperative ventral hernia and morbid obesity. In the group A (n = 26) goal-directed infusion therapy by balanced solutions Gelaspan and Sterofundin (B. Braun, Germany) was used. Impedance measuring technology using the monitor Utas 300 (Ukraine) was used to determine the target stroke volume (SV). In the group B (n = 28) infusion therapy was performed by unbalanced solutions (6 % HES and 0.9 % NaCl), focusing on fluid deficiency according to changes in blood pressure (BP), heart rate (HR), and diuresis. The incidence of hypotension and total volume of infusion therapy (TVIT) were evaluated intraoperatively, changes in BP and HR were compared. After surgery diuresis, blood Na + , K + , Cl – and creatinine concentrations, diuretic use frequency and incidence of cardiac, respiratory, hemorrhagic and infectious complications were controlled. Statistical analysis was performed using the Statistica for Windows software version 6.0. Results. The incidence of hypotension in the group B was almost 2 times more than in the group A (P 0.05). Intraoperative TVIT in the group B was 23 % higher due to crystalloid, and diuresis intensity was twice less than in the group A (P < 0.05). Concentrations of electrolytes and creatinine blood level did not change significantly in the study groups. After surgery in the group B 25 % of patients were prescribed diuretic and in the group A diuretic was not prescribed in any case (P < 0.05). In-hospital mortality in both groups was zero, no serious complications were observed. Conclusions. Goal-directed infusion therapy with balanced solutions in laparoscopic surgery in obese patients halved the incidence of intraoperative hemodynamic instability, reduces the volume loading of crystalloids by 23 % during surgery and provides adequate perioperative diuresis without additional stimulation.

Long-term HIV/AIDS survivors: Patients living with HIV infection retained in care for over 20 years. What have we learned?

Individuals diagnosed with HIV before 1996 had poor prognoses. Few HIV care centers can track patients continuously from the 1980s to present. We determined the sociodemographic, clinical, and health care utilization characteristics of patients diagnosed and followed for >20 years (i.e. long-term HIV/AIDS survivors) to understand what factors contributed to survival. All HIV-positive patients diagnosed before 1996 were categorized as active, moved/lost, or died as of 1 January 2016. Baseline sociodemographic, clinical characteristics, antiretroviral therapy (ART) usage, retention, HIV care costs, and health status were analyzed. Of 876 patients, 49.5% died, 30.3% moved or left, 20.3% remained active in care for a median of 23.4 years. At diagnosis, continuously-followed patients were younger with a higher CD4 cell count, attended regular clinic visits at higher frequencies, and had received more ART than patients who moved or died. As of 1 January 2016, their median age was 57 years (interquartile range 53-62), 15% were aged >65 years, median CD4 cell count was 591 cells/mm3 (475-863) with 68% >500 cells/mm3. Sixty-two percent remained employed. The total cost of HIV care was $32,251,030 (Cdn$); median cost per patient per year $15,418 ($13,697-$18,392). Individuals diagnosed prior to 1996 benefited from early diagnosis and engagement to care, regular follow-ups, and timely initiation of ART, strongly supporting the modern guidelines of care.

Pathogenetic treatment of non-specific back pain

Back pain is one of the most common reason for all physician visits, which makes the problem of rational therapy especially urgent. Non-specific dorsalgia is the most common in clinical practice, that is subdivided into acute, sub-acute or chronic. Modern guidelines for the treatment of acute and chronic non-specific back pain offer primarily the use of non-drug methods – cognitive-behavioural therapy and therapeutic gymnastics, and if they are ineffective – rational pharmacotherapy, taking into account the comorbid pathology in patients. Non-steroidal anti-inflammatory drugs, in particular Dexalgin, are the drugs of choice for the management of pain syndrome.

Allogeneic Hematopoietic Cell Transplantation for Chronic Granulomatous Disease: Controversies and State of the Art.

Chronic granulomatous disease (CGD) is a congenital disorder characterized by recurrent life-threatening bacterial and fungal infections and development of severe inflammation secondary to a congenital defect in 1 of the 5 phagocyte oxidase (phox) subunits of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex. Hematopoietic cell transplant (HCT) is a curative treatment for patients with CGD that provides donor neutrophils with functional NADPH and superoxide anion production. Many characteristics of CGD, including preexisting infection and inflammation and the potential for cure with mixed-donor chimerism, influence the transplant approach and patient outcome. Because of the dangers of short-term death, graft-versus-host disease, and late effects from chemotherapy, HCT historically has been reserved for patients with high-risk disease and a matched donor. However, as advances in CGD and HCT treatments have evolved, recommendations on transplant eligibility also must be amended, but the development of modern guidelines has proven difficult. In this review, we provide an overview of HCT in patients with CGD, including the debate over HCT indications in them, the unique aspects of CGD that can complicate HCT, and a summary of transplant outcomes.

MODERN THERAPEUTIC APPROACHES CORRECTION OF FUNCTIONAL CONSTIPATIONSIN INFANTS

Summary: One of the common complaints of parents of infants is constipation. At the present time, based on the evidence, specialists (pediatricians, pediatric gastroenterologists, nutritional specialists) have developed modern guidelines for managing children with functional constipation. The article discusses about etiology, pathogenesis and assessment of the condition and therapy of functional constipation in babies. As a symptomatic correction of functional constipation, experience is given and recommendations for the use of the rectal preparation Microlax®.

OUTPATIENT REGISTRY OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION (PROFILE-IM): DATA ON PREHOSPITAL THERAPY IN COMPARISON WITH THE LIS-3 REGISTRY

Aim. To study the quality of prehospital therapy in patients with a history of acute coronary syndrome/acute myocardial infarction (ACS/AMI), and included in 2 registers: LIS-3 and PROFILE-IM. Material and methods . Data on therapy before the reference ACS in the hospital register LIS-3 (Lyubertsy town, 01.11.2013-31.07.2015) and in the AMI outpatient registry PROFILE-IM (Moscow city polyclinic N9) were compared. Anonymized data from the case histories (320 patients from the LIS-3 registry) and outpatient charts (160 patients from the PROFILE-IM register) were analyzed. Results . Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers before AMI in patients from PROFILE-MI were prescribed significantly more often than in the LIS-3 registry (49.4% vs 39.4%, respectively, p<0.05), as well as calcium channel blockers – 6.7% vs 5.3%, respectively (p<0.05). The frequency of prescription of statins, antiplatelet agents and anticoagulants before reference AMI in patients of both registers did not differ significantly. Assessment of adherence to treatment was performed in the PROFILE-IM registry. 56 (35.0%) patients did not take medication. Among cases with pharmacotherapy only 41 (39.4%) patients had regular taking, and 24 (23.1%) took medication in worsening health, 39 (37.5%) had only short medication courses. Similar data were revealed in patients already having ischemic heart disease. Conclusion . Primary and secondary drug prevention of AMI in both registries did not meet modern clinical guidelines. This was especially true for patients with already established ischemic heart disease and to the greatest extent, according to both registries, refers to drugs from the statin group.

On the effect of weld defects on the fatigue strength of beam welded butt joints

Modern guidelines concerning the fatigue strength of welded components are often based on the nominal stress concept. These guidelines are valid for fusion welded steels but do not distinguish between different welding processes. However, different welding processes can lead to significant differences in the resulting weld geometry. This is particular true for arc welded components in comparison to beam welded components. Furthermore, it is well known, that the geometry of welded joints effects the fatigue strength severely. Therefore, it can be expected that beam welds behave differently to arc welds in fatigue tests. In this study, electron beam and laser beam welded samples of different thicknesses made from fine-grained steels were tested in fatigue tests under a constant amplitude loading. In order to assess the effects of weld defects on the fatigue strength, samples with defined weld defects (e.g. axial misalignment) were included in the study as well. The weld geometry of each sample was measured and evaluated according to the quality groups in ISO 13919-1. Additional numerical notch stress calculations were performed. Finally, a correlation between the quality groups according to ISO 13919-1 and the nominal cyclic stress at 2*106 load cycles with a survival probability of 97,5% was proposed. This correlation allows users of beam welding processes to predict the fatigue strength of components under the condition that certain quality levels according to ISO 13919-1 are met.

Требования к антигипертензивной терапии у больных сахарным диабетом и хронической болезнью почек: взгляд с позиций новых европейских рекомендаций 2018 г.

Требования к антигипертензивной терапии у больных сахарным диабетом и хронической болезнью почек: взгляд с позиций новых европейских рекомендаций 2018 г.

Effects of short-term fasting on gut-associated lymphoid tissue and intestinal morphology in mice

Summary Background & aims Modern management guidelines for surgical patients recommend that the fasting period before surgery be as short as possible. This study aimed to examine the influences of 24-h fasting, with and without water, on intestinal morphology, mucosal IgA levels and gut-associated lymphoid tissue (GALT) cells as a center of systemic mucosal immunity in mice. Methods Male Institute of Cancer Research mice (6-week-old, n = 24) were divided into three groups: ad libitum chow and water (Control), 24-h fasting without water (Fasted − water), and 24-h fasting with ad libitum water (Fasted + water). The Fasted + water group was used to examine possible influences of dehydration on the parameters measured. After a 24-h fasting, nasal and bronchoalveolar lavage were done under anesthesia. Then, the mice were killed by cardiac puncture. The whole small intestine was harvested and intestinal washing was obtained by lavage. Jejunal and ileal morphologies were evaluated by HE however, significant decreases were observed in IEL and LPL numbers in the Fasted − water and Fasted + water groups as compared to the Control. Conclusions Regardless of water supply, 24 h of fasting causes gut atrophy, with marked GALT lymphocyte losses in the IE space and LP.

Overview of Cardiac Rehabilitation Evidence, Benefits and Utilisation

Historically, the main objective of cardiac rehabilitation (CR) as an exercise-based programme was to restore or improve patients’ regular physical activity after a cardiac event. Since then CR has evolved into a comprehensive secondary prevention programme, the objectives of CR, and indications and contraindications for its use have also developed in sophistication. Current CR programmes are designed to stabilise or even reverse the progression of heart disease by controlling all modifiable risk factors. They are also concerned with improving patients’ quality of life by restoring their wellbeing. All this should be achieved with the maximum safety levels to patients. The first part of this review details on how CR evolved from a simple exercise programme to a comprehensive secondary prevention programme in the past few decades. The second part sets an example of modern CR provision, pathway and guidelines in a top leading country in this field, the UK.

Experience of modern skin care series Atopic® using in atopic dermatitis children

Atopic dermatitis - chronic allergic skin inflammatory disease with genetic predisposition, dysbalance of immune response, dysfunction of an epidermal barrier and influence of various exogenous and endogenous factors. Epidermal barrier dysfunction leads to rising of permeability of a skin for allergens, microbs and nonspecific stimuli, as well as to sensitivity to various external influences. Clinically these implications are shown by skin xerosis symptoms therefore. According to modern clinical guidelines, the moisturizing agents, so called emollients, have to be used at all disease stages. Own data on use of modern skin care series Atopic® in complex therapy of atopic dermatitis patients are presented in the article.

FUNCTIONAL CONSTIPATION IN INFANTS: THE MODERN STATE OF PROBLEMS ON THE BASIS OF EVIDENCE

One of the common complaints of parents of infants is constipation. At the present time, based on the evidence, specialists (pediatricians, pediatric gastroenterologists, nutritional specialists) have developed modern guidelines for managing children with functional constipation. Data on the classification, diagnosis and treatment of this condition in infants are included in the standard of the new IV Rome criteria for functional gastrointestinal disorders in children (San Diego, May 22, 2016). The article discusses the assessment of the condition, diagnosis and therapy of functional constipation in children under 6 months. As a symptomatic correction of proctogenic and mixed constipation, experience is given and recommendations for the use of the rectal preparation Microlax®