Outpatient Stage Research Articles

The use of antibacterial drugs in the treatment of coronavirus infection in children in real outpatient clinic practice

Introduction. In light of the available data on the unjustified use of antibiotics in children with acute respiratory viral infections, the frequency of prescribing antibacterial drugs to children with a new coronavirus infection in real clinical practice is of great practical and scientific interest.The aim of the study was to study the frequency of antibiotic therapy and identify factors that increase the risk of needing antibiotics in children with coronavirus infection at the outpatient stage.Materials and methods. A retrospective cross-sectional study was conducted on the basis of children's polyclinics in Samara from November 2021 to July 2022, which included a survey of parents and an analysis of outpatient records of 100 children who were under outpatient observation and treatment for COVID-19. An analysis was made of the frequency of prescribing antibiotics to them and potential factors predisposing to their prescribing to children with COVID-19. The obtained data were subjected to statistical processing using the IBM SPSS Statistics 25 program and a comparative analysis.Results. The frequency of use of antibiotic therapy according to the results of the study was 11 % and did not exceed the Russian average data (14.3 %). When analyzing the factors influencing the doctor's decision to prescribe an antibiotic to a child with coronavirus infection, the most important were a history of recurrent respiratory infections (children from the FIC group), as well as the presence of concomitant diseases and background conditions in children, primarily chronic bronchopulmonary diseases. and nervous system.Discussion. The prescription of antibiotics for children with a new coronavirus infection at the outpatient stage remains empirical due to the limitations of the use of laboratory and instrumental methods for additional examination of the child, which objectifies the likelihood of a secondary bacterial infection. Despite this, the frequency of antibiotic use according to the results of the study was 11 % and did not exceed the Russian average data (14.3 %), as well as the average frequency of antibiotic use for acute respiratory viral infections in children in the Russian Federation (21.5-23.3 %).

Late diagnostics of hereditary nephrogenic diabetes insipidus: clinical case

Diabetes insipidus belongs to the group of rare heterogeneous diseases, it can manifest at any age and is distinguished by a variety of etiological factors, pathogenetic mechanisms and clinical variants of the debut and course. A significant water-electrolyte imbalance in this type of diabetes is its "calling card". The article presents a description of a clinical case of a preschool patient with early verification and late diagnosis of hereditary nephrogenic diabetes insipidus as a result of the lack of alertness of primary care specialists. Low awareness of parents about the essence of the pathology, insufficient sanitary and cultural level of the family and, as a result, a low level of parental compliance create additional risks for achieving a long-term remission. This case reflects the importance of a thorough history taking, which makes it possible to suspect the hereditary nature of the disease from the first days of a child's life at the outpatient stage. Carrying out timely diagnostics both at the regional and federal levels for further development of treatment tactics, recommendations and a follow-up plan is a necessary step towards improving the patient's quality of life.

Syntropy of bronchial asthma and gastroesophageal reflux disease: pathogenetic features and possibilities of minimally invasive diagnostics at the outpatient stage

The review highlights the prevalence, pathogenesis and clinical manifestations of bronchial asthma (BA), comorbid with gastroesophageal reflux disease (GERD). Difficulties in diagnosing triggers of extraesophageal symptoms were noted. Based on a large number of clinical studies, the review assesses the possibilities of minimally invasive methods for detecting biomarkers of gastroesophageal reflux (GER) and duodenogastroesophageal reflux (DGER) in the oral fluid. With syntropy of GERD and BA, a significant role and relationship between the parameters of respiratory oxidative inflammation and impaired functions of external respiration was noted. To confirm the reflux origin of extraesophageal respiratory symptoms, it is important to use minimally invasive methods for detecting bilirubin and pepsin in the oral fluid, and to assess the activity of respiratory stress, the determination of its substrates in the blood. Further studies aimed at determining the normative concentrations of DGER substrates in the oral fluid and markers of oxidative respiratory inflammation in the blood will help improve the diagnosis and treatment of BA and GERD syntropy in outpatient practice.

Rheumatic diseases as a reason for emergency hospitalization

The study of pain in the projection of joints occurrence is an important medical and social task, the solution of which makes it possible to determine the amount of necessary forces and means for the organization of medical care for these patients. For the first time in Russian Federation on the basis of Saint-Petersburg Research Institute of Emergency Care named after I.I. Dzhanelidze the concept of providing medical care to patients with pain in the projection of joints was introduced into clinical practice. The study of the prevalence of pain in the projection of joints data, places and roles of rheumatological diseases (RD) allows to outline ways to optimize diagnostic and therapeutic algorithms, reducing the time of diseases diagnosis and optimizing the inpatient stage of treatment duration. An increase in the proportion of patients referred to the outpatient stage allows rational use of specialized beds in the hospital and gives a significant economic effect for the healthcare system. RD are the second most common cause of pain in the projection of joints. Its average percentage of patients referred for hospitalization was 2.69% of the total number of patients in the Saint-Petersburg Research Institute of Emergency Care named after I.I. Dzhanelidze. The structure of the incoming flow of patients with pain in the projection of joints was analyzed, the nosological structure of patients with RD was evaluated. Osteoarthritis, rheumatoid arthritis and gouty arthritis are the leading causes of pain in the projection of joints.

Financial toxicity of cancer treatment in India: towards closing the cancer care gap.

The rising economic burden of cancer on patients is an important determinant of access to treatment initiation and adherence in India. Several publicly financed health insurance (PFHI) schemes have been launched in India, with treatment for cancer as an explicit inclusion in the health benefit packages (HBPs). Although, financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and determinants among the Indian population. There is a need to determine the optimal strategy for clinicians and cancer care centers to address the issue of high costs of care in order to minimize the financial toxicity, promote access to high value care and reduce health disparities. A total of 12,148 cancer patients were recruited at seven purposively selected cancer centres in India, to assess the out-of-pocket expenditure (OOPE) and financial toxicity among cancer patients. Mean OOPE incurred for outpatient treatment and hospitalization, was estimated by cancer site, stage, type of treatment and socio-demographic characteristics. Economic impact of cancer care on household financial risk protection was assessed using standard indicators of catastrophic health expenditures (CHE) and impoverishment, along with the determinants using logistic regression. Mean direct OOPE per outpatient consultation and per episode of hospitalization was estimated as ₹8,053 (US$ 101) and ₹39,085 (US$ 492) respectively. Per patient annual direct OOPE incurred on cancer treatment was estimated as ₹331,177 (US$ 4,171). Diagnostics (36.4%) and medicines (45%) are major contributors of OOPE for outpatient treatment and hospitalization, respectively. The overall prevalence of CHE and impoverishment was higher among patients seeking outpatient treatment (80.4% and 67%, respectively) than hospitalization (29.8% and 17.2%, respectively). The odds of incurring CHE was 7.4 times higher among poorer patients [Adjusted Odds Ratio (AOR): 7.414] than richest. Enrolment in PM-JAY (CHE AOR = 0.426, and impoverishment AOR = 0.395) or a state sponsored scheme (CHE AOR = 0.304 and impoverishment AOR = 0.371) resulted in a significant reduction in CHE and impoverishment for an episode of hospitalization. The prevalence of CHE and impoverishment was significantly higher with hospitalization in private hospitals and longer duration of hospital stay (p < 0.001). The extent of CHE and impoverishment due to direct costs incurred on outpatient treatment increased from 83% to 99.7% and, 63.9% to 97.1% after considering both direct and indirect costs borne by the patient and caregivers, respectively. In case of hospitalization, the extent of CHE increased from 23.6% (direct cost) to 59.4% (direct+ indirect costs) and impoverishment increased from 14.1% (direct cost) to 27% due to both direct and indirect cost of cancer treatment. There is high economic burden on patients and their families due to cancer treatment. The increase in population and cancer services coverage of PFHI schemes, creating prepayment mechanisms like E-RUPI for outpatient diagnostic and staging services, and strengthening public hospitals can potentially reduce the financial burden among cancer patients in India. The disaggregated OOPE estimates could be useful input for future health technology analyses to determine cost-effective treatment strategies.

Laparoscopic correction of combined forms of genital prolapse

BACKGROUND: The significance of pelvic organ prolapse is determined by the absence of a downward trend in its frequency and severity and by the steadily high number of recurrences in every third woman who underwent surgery. According to most authors, surgical correction is the primary treatment for genital prolapse. Therefore, the search for an effective and safe surgical treatment of this pathology is important. Currently, various minimally invasive surgical interventions have been performed via laparoscopic access, which reduces the risk of tissue or adjacent organ damage, possible intraoperative bleeding, and potential complications.&#x0D; AIM: This study aimed to assess the efficiency and safety of laparoscopic techniques for the correction of genital prolapse.&#x0D; MATERIALS AND METHODS: The study included 12 patients with pelvic organ prolapse quantification system grades IIIV who underwent surgical correction using a combined laparoscopic approach. The inclusion criterion was the presence of prolapse, including recurrent forms. At the outpatient stage, the patients medical history was collected, and complaints, and degree of pelvic organ prolapse were assessed. Genital prolapse was diagnosed based on medical history, clinical data, and additional methods of examination.&#x0D; RESULTS: With this surgical intervention technique, intraoperative bleeding was avoided, the number of possible postoperative complications was reduced, and disease recurrence was prevented. The criteria for assessing the surgical intervention included improvement of the pelvic floor anatomy, elimination of symptoms, patients satisfaction with treatment results and quality of life, and reduced risk of recurrence of complications. Mesh-associated complications were excluded by avoiding contact of the synthetic implanted material with the vaginal mucosa.&#x0D; CONCLUSIONS: Through laparoscopic access, the length of hospital stay was reduced, and compared with abdominal access, a better cosmetic effect was achieved. A comprehensive system considering the assessment of the anatomical outcome, functional status of the pelvic floor, and patients quality of life may become the most objective tool to evaluate the success of surgical treatment of genital prolapse.

Efficiency and safety of Vortioxetine in the treatment of depressive disorders in cardiac patients

Importance of the problem. Diseases of the cardiovascular system are in the first place among the causes of death and disability in most industrialized countries, which is undoubtedly an urgent medical and social problem and causes significant economic damage. The prevalence of depressive disorders in modern society, according to WHO estimates, is quite high, and the causes of depressive disorders and methods for their correction in patients with various somatic diseases have been the subject of study by specialists around the world for many decades. The comorbidity of depressive disorders with cardiac pathology is beyond doubt, and the bidirectional relationship of these disorders significantly aggravates the condition of patients, worsens their quality of life and reduces adherence to treatment. The most important conditions for the use of antidepressants in cardiology practice are good tolerability, absence of toxic effect, minimal interaction with other drugs, and relative safety in case of overdose. Vortioxetine, being a modern multimodal antidepressant, demonstrates not only a sufficiently high antidepressant and anti-anxiety activity, but also has a procognitive effect, as well as minimal side effects and undesirable cross-interactions with other drugs, which is confirmed by international randomized placebo-controlled trials. The aim of this work was to evaluate the efficacy and safety of Vortioxetine in the treatment of concomitant depressive disorders in patients with coronary heart disease (CHD), angina pectoris 2-3 functional class (FC) (I 20.8 according to ICD-10), receiving complex therapy for the main (cardiological) diseases at the inpatient and outpatient stages of therapy. Materials and methods. The study included patients with a diagnosis of coronary artery disease, angina pectoris FC 2-3, hypertension 2-3, aged 45 to 66 years (mean age 57.1±1.1 years), receiving complex therapy for the underlying cardiac disease and Vortioxetine at a dose of 10-15 mg/day. within 8 weeks. Anxiety and depressive manifestations were assessed on the HADS scale, the level of cognitive impairment on the PDQ questionnaire, social functioning on the SF-36 questionnaire, the general clinical impression on the CGI-C scale, and the main indicators of the functioning of the cardiovascular system upon admission to the hospital, after 4 weeks of hospitalization. treatment and another 4 weeks after discharge during the period of outpatient observation.The result of the combined therapy of patients with cardiac pathology and concomitant depressive disorder (basic therapy for CVD and Vortioxetine) was not only an improvement in the cardiovascular system (decrease in heart rate, blood pressure, the frequency of anginal pain, an increase in exercise tolerance), but also the relief of depressive manifestations, which contributed to an increase in the adherence of cardiological patients to the implementation of medical recommendations, and, in turn, led to a decrease in the level of end points—mortality, hospitalization rates, progression of chronic heart failure and disability. Conclusions. Appointment of Vortioxetine to cardiac patients with concomitant depressive disorder of moderate severity is quite effective not only in terms of relief of painful manifestations of the CVS, but also leads to a reduction in anxiety-depressive disorders and an improvement in cognitive and social functioning. The good tolerability of the drug makes it possible to recommend it for the treatment of depressive disorders in cardiological patients in a hospital setting and in outpatient practice.

#3546 “SURPRISE QUESTION”: IS IT A USEFUL TOOL IN CKD STAGES 4 TO 5?

Abstract Background and Aims The “Surprise Question” (SQ) (“would you be surprised if this patient died in 6 months/one year?”) has proven to be an interesting prognostication tool in a range of settings. However, its reliability in non-dialysis-dependent CKD is still unclear. Our aim was to study the applicability of the SQ to an outpatient CKD-EPI stages 4 to 5 and correlate it with mortality. Method Observational, prospective and single center study. Baseline comorbid conditions, cause of CKD, degree of autonomy, literacy, social support and baseline laboratory values (i.e., serum creatinine/ estimated glomerular filtration rate, serum albumin and hemoglobin) were collected. Results A total of 269 patients completed the study, mean age 65 years old; 256 patients (85.3%) had hypertension and 124 (41.3%) had diabetes. The main causes of renal disease were diabetic kidney disease (n = 53; 17.7%), hypertension (n = 15; 5%) and IgA nephropathy (n = 11; 3.7%). The etiology of kidney disease was undetermined for 24 patients (8.0%). Average CKD-EPI was15.5±7.4 mL/min/1.73 m2. A total of 188 patients (63%) were independent for daily living activities and 68 (23%) were professionally active and 45 (48%) were accompanied by family members or caregivers in outpatient consultation to discuss and define the care of plan regarding end stage renal disease. Mean follow up time of the study was 365±254 days, and 27 (9%) patients died during this time period. Using the SQ, providers responded Yes and No for 162 (54%) and 92 (31%) patients, respectively. There were no differences in CKD-EPI stage, arterial hypertension, cerebrovascular disease and dyslipidemia. The No group was older (73±16 vs. 63±16, p&amp;lt;0.001) and had more diabetes (n = 46, 55%, p = 0.015). About 8 (30%) and 18 (67%) of Yes and No patients died, respectively (P&amp;lt;0.001). In the Cox-proportional hazard model adjusted to diabetes, the risk of all-cause mortality was significantly increased by around 5.700 times in patients with a No answer by the providers to the SQ (95%CI, 2.340-13.900; p&amp;lt;0.001) and around 1.045 times with increasing age (95%IC, 1.012-1.080; p = 0.007). The model of the SQ to have predictive capacity for occurrence of death had an area under the ROC curve of 0.684 (95%CI, 0.580-0.790; p = 0.002). Conclusion SQ proved to be a support tool in order to identify patients at high risk of death, who might not have a full benefit of starting dialysis. The choice around kidney replacement therapy is a shared decision-making process, in which competing risks and benefits must be considered. It is essential and urgent to identify means of support for patients, caregivers and health providers to provide and discuss personalized prognostic information.

Outpatient Practice of Lipid-Lowering Therapy Prescription (According to the ARGO-3 Study)

Aim. To study the frequency of prescriptions of various types of lipid-lowering therapy and their effectiveness in outpatient clinical practice based on the results of a questionnaire of primary care physicians.Material and methods. The study was performed in 2022 in 75 constituent entities of the Russian Federation with the participation of 1117 doctors working in outpatient clinics. Most of the doctors had work experience of 10-20 years or more. Doctors of polyclinics (therapists and cardiologists, etc.) before the start of the study received instructions, questionnaires for filling out, developed by the National Atherosclerosis Society. The frequency of prescriptions by primary care physicians of various types of lipid-lowering therapy and their effectiveness in terms of the frequency of achieving target levels of low-density lipoprotein cholesterol (LDL-C) was studied based on the results of a questionnaire.Results. Monotherapy with statins was prescribed in 55.2% of cases, free combination of rosuvastatin with ezetimibe – in 17.2%, single pill combination of rosuvastatin with ezetimibe – in 23.2%, combination therapy with PCSK9 inhibitors – in 4.1% of cases. Target levels of LDL-C ˂ 1.8 mmol/l and ˂ 1.4 mmol/l were achieved with statin monotherapy in 42.6% and 28.2% of cases, respectively, free combination of rosuvastatin with ezetimibe – in 61.7% and 39 .5%, a fixed combination of rosuvastatin with ezetimibe – in 67.8% and 48.5%, combination therapy with PCSK9 inhibitors – in 96.8% and 92.8% of cases.Conclusion. The single pill combination of rosuvastatin with ezetimibe is more effective in achieving target levels of LDL-C compared with statin monotherapy and therapy with free combination of statin with ezetimibe. Despite the fact that the target values of LDL-C when prescribing a combination with PCSK9 inhibitors were achieved in 96.8% and 92.8% of cases, they were used quite rarely at the outpatient stage of treatment in the Russian Federation.

Structural and functional state of postinfarction myocardium and vascular endothelial growth factor: is there a connection?

Purpose of the study. To reveal the relationship between the serum concentration of vascular endothelial growth factor and the structural and functional state of the myocardium in patients in the post-infarction period at the stage of rehabilitation.Materials and methods. We examined 94 patients at the outpatient stage of rehabilitation after ad hoc stenting 6 weeks after myocardial infarction, 10 healthy volunteers without somatic pathology. All participants in the study underwent standard transthoracic echocardiography with assessment of thickness of epicardial fat, assessment of the concentration of vascular endothelial growth factor (VEGF) in peripheral blood by ELISA.Results and discussion. VEGF values above the median values were associated with lower left ventricular ejection fraction and left ventricular fraction shortening, which indirectly may indicate a more pronounced expression of VEGF in patients with left ventricular systolic dysfunction. Assessing the parameters of LV diastolic dysfunction in groups with different levels of VEGF, no significant differences were found in patients after myocardial infarction. Correlation relationships between the content of VEGF and the thickness of epicardial adipose tissue were not found either among patients or in the control group.Conclusions. Elevated VEGF values in patients with coronary artery disease at the 6th week of rehabilitation were accompanied by left ventricle systolic dysfunction, in contrast to diastolic dysfunction. There was no direct correlation between the thickness of epicardial fat and the concentration of VEGF in the blood serum in patients with coronary artery disease.

Current approaches to the treatment of patients with dyslipidemia in the real practice in the outpatient stage

Aim To evaluate the frequency and structure of lipid-lowering therapy and of achieving the goal of low-density lipoprotein cholesterol (LDL-C) in patients with very high cardiovascular risk (CVR) who were monitored at the outpatient stage.Material and methods A retrospective snapshot analysis was performed by continuous sampling method for 136 medical records of outpatient patients (71 men, 65 women) aged 42 to 91 years [median, 68 years; 25th and 75th percentiles (59; 78)].Results 134 (98,53 %) patients took statins; 8 (5.88 %) patients took a combination of statin and ezetimibe; 2 (1.47 %) patients took proprotein convertase subtilisin/kexin type 9 enzyme inhibitors (PCSK9): 2 (1.47 %) patients took evolocumab and 1 (0.74%) of 2 PCSK9-treated patients took a combination of PCSK9 inhibitor and statin. Atorvastatin at a dose of 20 (20; 40) mg as recommended at the hospital was the most frequently prescribed statin. 5 (3.68%) patients achieved the goal LDL-C of ≤1.4 mmol/l.Conclusion Statins prevail in the structure of lipid-lowering therapy in patients with very high CVR. The frequency of combination therapy (statin/ezetimibe, 5.88%; PCSK9 inhibitor/statin, 0.74%) and PCSK9 inhibitors was noted to be low. Only 3.68% of patients achieved the goal LDL-C during the lipid-lowering treatment.

Changes in spinal alignment one month post abdominal surgery: A prospective cohort study.

Following abdominal surgery, many patients assume a bending or stooping posture to protect the surgical wound. Such postural changes are known to induce side effects, but the improvement and persistence of these effects are unknown. Therefore, the purpose of this study was to clarify the nature of postural changes in patients undergoing abdominal surgery. In this prospective cohort study, we enrolled 25 patients who underwent abdominal surgery from February 2019 to January 2020. Measurements were obtained during the preoperative, pre-discharge, and first outpatient stages. The sacral tilt, lumbar lordotic, thoracic kyphosis, and overall tilt angles were measured in the static standing position in a private room. Wound pain was measured using a Visual Analogue Scale. Repeated measures analysis of variance was applied to compare spine measurements for each measurement period, followed by the Bonferroni method for each level. Pearson's product-moment correlation coefficient was performed to examine the relationship between wound pain and spinal column angle. The lumbar kyphosis angle was lower before discharge (-7.2 ± 7.4°) compared to preoperatively (-11.1 ± 7.5°) (95% CI 0.76, 7.08; P < .01, η2 = 0.21). Regarding the overall tilt angle, the anterior tilt angle increased before discharge (3.4 ± 3.9°) compared to preoperatively (1.1 ± 4.1°) (95% CI 0.86, 3.78; P < .01, η2 = 0.33). No statistically significant correlation with pain was observed. Compared to the preoperative period, the patients had an anterior tilt, mainly due to lumbar spine changes, prior to discharge from the hospital. Changes in spinal alignment were not associated with wound pain.

Analysis of the accessibility of cancer patients to drug provision at the outpatient stage of treatment in the Russian Federation

Introduction. The outpatient stage of management of patients with malignant neoplasms does not have additional funding. Availability of patients to prescribed drugs on outpatient review of funds allocated by the Russian Federation for the purchase of drugs based upon budgets providing for benefits. In connection with the study of the problem of procurement of drugs for the treatment of patients with malignant neoplasms in outpatient treatment, an urgent task arises, the solution of which is the essence of the development of a study on the planning of drug treatment of patients. &#x0D; Purpose is to study the accessibility of patients with malignant neoplasms to drug provision at the outpatient stage of treatment in the Federal Districts of the Russian Federation.&#x0D; Material and methods. To study the availability of patients with malignant neoplasms, the supply of medicines for the treatment of patients with malignant neoplasms in 2019 and 2020 to hospitals purchased at the expense of the constituent entities of the Russian Federation and the federal budget in the Federal Districts was analyzed. We compared the funds spent between the subjects of the Russian Federation in terms of patients with a first diagnosis. To compare the provision of patients with drugs, we recalculated the amount of funds spent on the purchase of drugs per patient with a newly diagnosed oncological disease living in the Federal District.&#x0D; Results. Significant differences were found in the provision between the Federal Districts, reaching almost four times the size.&#x0D; Limitations. When studying the accessibility of patients with malignant neoplasms to drug provision at the outpatient stage of treatment, purchases of all Federal Districts of the Russian Federation at the expense of both the subjects of the Russian Federation and the federal budget were analyzed, which is a sufficient reference sample.&#x0D; Conclusion. A significant difference in the amount allocated per patient both from the funds of the regional and federal budgets, with the newly diagnosed malignant neoplasm in the Federal Districts creates unequal conditions for treating patients on an outpatient basis.

ФАКТОРЫ, ВЛИЯЮЩИЕ НА ПРИВЕРЖЕННОСТЬ И РАСПРОСТРАНЕННОСТЬ ГРУДНОГО ВСКАРМЛИВАНИЯ: РЕЗУЛЬТАТЫ ОНЛАЙН-ОПРОСА МАТЕРЕЙ В РОССИЙСКОЙ ФЕДЕРАЦИИ (ЧАСТЬ 2)

The purpose of the research was to identify the reasons for the insufficient prevalence of breastfeeding (BF), to determine the ways to increase the prevalence of BF in Russia based on the data obtained during an online survey of mothers of infants in the first 6 months of life, which was conducted in two stages in 2020-2022. 1981 mothers from different age groups living in Russian cities with population from 100 thousand to 1 million and more participated in the study. Factors influencing the prevalence of BF were studied during the research. The analysis of data concerning the socio-demographic status of mothers and their observation during pregnancy in the antenatal clinic was carried out. Results: it was found out that the prevalence of exclusive BF was statistically significantly negatively affected by the period of breastfeeding after childbirth (p=0.005), repeated supplementary feeding with an infant formula in the maternity hospital (p&lt;0.001), mother’s attitude to the fact of supplementing the infant with the formula (p=0.005): “calm” vs. “negative” (p&lt;0.001), mother’s impression of insufficient lactation during the stay in the maternity hospital (p&lt;0.001), lack of counseling of the mother about a possible temporary decrease in breast milk (BM) volume (p=0.022) as well as of the ways to increasing the BM volume (p&lt;0.001). The later discharge from the maternity hospital (on the 5th to 7th days vs. on the 3rd day, p=0.005) as well as the mother’s confidence in the need for breastfeeding upon discharge from the maternity hospital after the child had been supplemented with an infant formula (p&lt;0.001) also had negative impact. The main factor affecting the likelihood of breastfeeding at the outpatient stage was the absence of attempts by a local neonatologist/pediatric physician to returning the child to BF after supplementary feeding with an infant formula in the maternity hospital (p&lt;0.001). Conclusion: recommendations are given that can contribute to increasing the prevalence of BF in Russia taking into consideration the data obtained during the survey.

The importance of outpatient etiotropic therapy in patients hospitalized with COVID-19

The aim of the study was to evaluate the effect of antiviral therapy prescribed at the outpatient stage on the course and outcomes of COVID-19 in hospitalized patients. Materials and methods. The retrospective study included 182 hospitalized patients with COVID-19 of moderate severity who received various initial therapy in the period before hospitalization. In the main group (91 patients), therapy included antiviral drugs: favipiravir or umifenovir, in the comparison group (also 91 patients), the treatment regimens did not contain etiotropic drugs against SARS-CoV-2. The groups were comparable in age, gender and severity of the disease. All patients received antipyretic drugs (paracetamol), vitamin therapy, according to indications – local antiseptics, mucolytics, antiplatelet agents and antibacterial drugs. The effectiveness of treatment was evaluated on days 7 and 14. Results. The presence of the virus was significantly less frequently detected on day 7 – in 15.38% and on day 14 of the disease – in 2.20% among patients receiving antiviral therapy, 82.42% and 39.56%, respectively in the comparison group. The average duration of the disease was more than 5 days less – 8.28 ± 3.74 days. The proportion of patients with a deterioration in their clinical condition to 3-4 points was significantly higher in the group that did not receive antiviral drugs – 61.54%, and with the use of favipiravir or umifenovir – 2.2%. Conclusions: 1. Timely administration of antiviral therapy for COVID-19 at the outpatient stage prevents the increase in severity, the development of complications, promotes earlier elimination of the virus and shortens the duration of the disease during hospitalization of the patient. 2. The absence of antiviral therapy with moderate severity of COVID-19 at the outpatient stage significantly increases the risk of deterioration of the patient’s condition.

Dynamics of hemodynamic parameters and tone of the autonomic nervous system in the rehabilitation of patients with neurocirculatory dystonia

Purpose: to substantiate, develop and evaluate the effectiveness of a physical therapy program for young women with hypertensive neurocirculatory dystonia at the outpatient stage. Material &amp; Methods: under our supervision there were 28 women with a diagnosis of neurocirculatory dystonia of hypertonic type; they were randomly divided into two groups: main (14 patients) and control (14 patients); the average age of patients in the main group was 20,1±0,35 years, in the control group – 20,6±0,23 years. The course of physical therapy for patients of the main and control groups lasted for 5 months. The patients of the main group underwent rehabilitation measures according to the program of physical therapy, which included kinesiotherapy using therapeutic exercises based on dance aerobics in combination with regulated breathing exercises, taking into account the tone of the ANS and autogenic training, patients of the control group were engaged in the E.V. Doliger physical therapy program for patients with NCD. Results: the functional indicators of the cardiovascular and autonomic nervous system obtained during the primary study indicated the absence of economization of the work of the cardiovascular system, the presence of dysfunction of the autonomic nervous system in the direction of the predominance of the activity of the sympathetic department. After 5 months of using physical therapy programs, when re-examined, patients in both groups showed a decrease in heart rate and a decrease in blood pressure; stroke volume in the main group was within normal limits, in the control group, a decrease in stroke volume indicated a reduced myocardial contractility; the decrease in the minute volume of blood in the main group was due to a decrease in heart rate, in the control group – due to a decrease in heart rate and stroke volume. The value of the Kerdo index in the main group corresponded to the state of eutonia, in the control group – sympathicotonia. Conclusions: in the course of the study, we came to the conclusion that a physical therapy program was developed, which included kinesitherapy using therapeutic exercises based on dance aerobics in combination with regulated breathing exercises, taking into account the tone of the parasympathetic and sympathetic divisions of the autonomic nervous system and autogenic training, is effective and contributes to the normalization of hemodynamic parameters and the tone of the autonomic nervous system, which improves the quality of life of NCD patients. The conducted studies have confirmed the need for the use of physical therapy, including kinesitherapy using therapeutic exercises based on dance aerobics in combination with regulated breathing exercises, taking into account the tone of the ANS and autogenous training.

Outpatient management of patients with peripheral artery disease by cardiologists or surgeons: influence on the prognosis and prevalence of surgical interventions

Highlights. The study shows for the first time that during the three-year follow-up of patients with diseases of the arteries of the lower extremities in the observation groups of a general surgeon and a cardiologist, adverse events (myocardial infarction, stroke, amputation, disability) and deaths occurred more often in a surgeon than a cardiologist. The study proves the correctness and real benefit of such an approach with the involvement of a cardiologist to the outpatient stage of management of a complex cohort of patients with atherosclerosis of the vessels of the lower extremities.Aim. To study the effect the outpatient observation of patients with peripheral arteries disease (PAD) by cardiologists and surgeons has on timing and prevalence of reconstructive surgery and the prognosis of patients. Methods We analyzed the data on 585 PAD patients who underwent outpatient observation from 2010 to 2017, dividing them into 2 groups. The first group (131 patients) managed by an surgeon; the second (454 patients) managed by a cardiologist. Since the groups were not comparable in terms of the initial parameters, the comparability of patients in the groups (observation by a surgeon or by a cardiologist) was achieved using pseudorandomization. The follow-up period was three years; we assessed the incidence of deaths, adverse events, and the prevalence of reconstructive operations.Results. During a three-year follow-up the 1st group, compared with the 2nd, had more deaths in general (p&lt;0.001), death from cardiac causes (p = 0.045), from stroke (p&gt;&lt;0.001), as well as the total number of adverse events (p&gt;&lt;0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients. Conclusion Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries. Keywords Peripheral atherosclerosis • Outpatient follow-up • Optimal drug therapy • Reconstructive surgery&gt;˂ 0.001), death from cardiac causes (p = 0.045), from stroke (p˂ 0.001), as well as the total number of adverse events (p˂ 0.001) and disability (p = 0.065). Indications for reconstructive surgery on the lower extremities arteries (LEA), and operations frequency were comparatible in groups. Amputation history, taking diuretics, presence of rhythm disturbances, and management by a surgeon increased the risk of adverse outcomes. Management by a cardiologist, reconstructive LEA surgeries, female sex improved the prognosis of patients.Conclusion. Observation of PAD patients by a cardiologist contributes to a higher frequency of optimal drug therapy by patients and can reduce the number of adverse events in patients and improve their survival without affecting the timing and frequency of reconstructive LEA surgeries.

The role of the quality of therapeutic alliance between the doctor and relatives of a schizophrenia patient at the outpatient stage of treatment

This article presents an analysis of modern scientific data on the role of relatives of schizophrenia patients in the effectiveness of the treatment process at the outpatient stage. Data on the psychological types of attitudes of relatives of schizophrenia patients both to the disease itself and to the ongoing treatment, as well as data on the importance of using various psychotherapeutic methods to improve the effectiveness of the treatment process, are summarized.

Placenta previa: risk factors, maternal and perinatal outcomes

Introduction. Placenta previa (PP), especially invasive forms (placenta accreta spectrum PAS), is one of the leading causes of maternal and perinatal morbidity and mortality. The aim of the study is to study the features of the anamnesis, pregnancy and childbirth outcomes for the mother and fetus with placenta previa, and to identify the main risk factors for this pathology. Materials and methods. Retrospective cohort study by continuous sampling method: Group 1 – 64 patients with PP, 2 – 30 women with normal childbirth. The anamnesis of women and pregnancy outcomes were studied. Statistical calculations: Mann-Whitney criteria, χ2 Pearson, odds ratio indicator (OSH). Results. The probability of PP increases in a woman's history with cesarean section in anamnesis (OR 20.53 (7.2–58.53), p &lt; 0.001), premature birth (OR 4.29 (1.45–12.68), p = 0.04), abortion (OR 3.77 (2.32– 6.12), p = 0.004), including induced (OR 14.16 (4.95–40.53), p = 0.001) and spontaneous (OR 3.65 (2.01–6.62), p = 0.02), as well as somatic diseases (OR 6.17 (3.8–10.02), p &lt; 0.001), especially the presence of anemia (OR 19.84 (6.95–56.61), p &lt; 0.001), gastrointestinal diseases (OR 13.18 (4.6–37.75), p = 0.002), overweight/obesity (OR 6.23 (2.14–18.14), p = 0.015), varicose veins (OR 5.37 (1.84–15.72), p = 0.005). The threat of miscarriage (p = 0.012), placental disorders (p = 0.012), anemia (p = 0.026), genital infection (p = 0.023) were recorded more often in women with placenta previa. All women with PP were delivered by operation caesarean section, often prematurely (45.3 %; p &lt; 0.001), urgently (45.3 %, p &lt; 0.001) because of bleeding (37.5 %, p &lt; 0.001). The expansion of the volume of surgery was required in 37.5 % of cases, hemotransfusion – 50.0 %. Morphofunctional indicators of children from mothers with PP were significantly lower, and the frequency of asphyxia, respiratory distress syndrome, аrtificial lung ventilation was higher than in the control group. Discussion. PP and PASS are potentially dangerous pathologies for the life and health of women and children, which is confirmed by the results of this study. However, problems of diagnosis of this pathology were revealed at the outpatient stage. In addition to the well-known risk factors for abnormal placentation, associations of PP with a low socio-economic status of a woman and a number of somatic nosologies, such as obesity, anemia, gastrointestinal tract diseases, varicose veins, the influence of which is probably indirect. The association of abnormal placentation with excessive use of gestogens during pregnancy cannot be ruled out. Conclusions. The risk factors for PP were the presence of a history of cesarean section, abortions, premature birth, low socio-economic status, somatic pathology (overweight / obesity, anemia, gastrointestinal diseases, varicose veins). PP is associated with a high frequency of the threat of miscarriage, placental disorders, genital infection, premature birth, cesarean section operations, bleeding, decreased morphofunctional indicators of newborns, perinatal morbidity and mortality

Bedaquiline resistance in Mycobacterium tuberculosis during antimycobacterial therapy and its impact on clinical outcomes (clinical cases)

Aim. To analyze the nature of Bedaquiline (Bdq) resistance in Mycobacterium tuberculosis (MBT) during antimycobacterial therapy (AMBT) in patients with multidrug-resistant tuberculosis (MDR-TB), its impact on clinical outcomes and to detect risk factors for the Bdq drug resistance development on the example of own observed clinical cases. Materials and methods. 2 clinical cases of own observations of the Bdq resistance development in MBT during AMBT in patients with MDR-TB who were treated at the clinical base of the Department of Phthisiology and Pulmonology of Zaporizhzhia State Medical University – Pulmonary Tuberculosis Department No. 2 of the Communal Non-profit Organization “Zaporizhzhia Regional Phthisio-Pulmonology Clinical Treatment and Diagnostic Center” are presented. Results. The presented clinical cases confirm the literature data that the treatment effectiveness in patients with Rifampicin-resistant TB (RR-TB) and MDR-TB is associated with Bdq drug resistance. Regarding the reasons for the development of acquired Bdq drug resistance, the second clinical case, like the examples of other authors, demonstrates low adherence to treatment. There is no data in the literature about the lack of controlled treatment at the outpatient stage as a risk factor for Bdq drug resistance and negative clinical outcomes in patients with MDR-TB, which would complement the scientific experience in this problem. Conclusions. In both clinical cases, Bdq drug resistance was acquired (secondary), and had an impact on the clinical outcomes of tuberculosis treatment. The risk factors for Bdq drug resistance and negative clinical outcomes were lack of controlled treatment at the outpatient stage in the first case and low adherence to treatment in the second one.