Vol 27, No 2 (2021)

Cover Page

Full Issue

Health care organization and public health

Peculiarities of outpatient care for COVID-19 patients using telemedicine technologies

Tyazhelnikov A.A., Polunina N.V., Kostenko E.V., Polunin V.S.

Abstract

BACKGROUND: The use of telemedicine in providing outpatient care for COVID-19 patients is an integral part of the most intensively developing and promising areas of national health care.

AIM: This study aims to demonstrate the efficiency of using telemedicine technologies in outpatient care for COVID-19 patients.

MATERIALS AND METHODS: This study is the retrospective analysis of remote consultations for 57,256 patients with COVID-19 from April 1, 2020, to May 24, 2020.

RESULTS AND DISCUSSION: The results of human resource analyses, the physician workloads, and the categories of observed patient categories are presented. The majority of patients were asymptomatic (45%), a mild form of the disease was observed in 4534 (34%) patients, and moderate cases were observed in 2800 (21%) patients. Concomitant pathology was observed in 60.0% of patients. The capacity of the telemedicine center was 52.8 patients for one physician per shift.

CONCLUSIONS: The telemedicine structure of the center, which regulates the interactions of physicians with patients and other healthcare facilities, has enabled the appropriate use of human resources to ensure that therapeutic, diagnostic, and epidemiological activities are adequate and timely in outpatient settings.

Medical Journal of the Russian Federation. 2021;27(2):107-114
pages 107-114 views

Preparation for decannulation of children with the consequences of cervical vertebrospinal cord injuries in surgical hospitals

Novoselova I.N., Ponina I.V., Machalov V.A., Valiullina S.A.

Abstract

BACKGROUND: Approximately 40 million people worldwide suffer from vertebrospinal cord injuries every year. According to different authors, children account for 1% to 5% of those injured. The relevance of developing a protocol for preparing children with vertebrospinal cord injuries for decannulation is due to the frequency of respiratory disorders and the peculiarities of the mechanism of their occurrence in patients with cervical spinal cord injuries, the lack of clear recommendations on preparing the patient for decannulation, and early comprehensive rehabilitation measures that contribute to restoring or compensating respiratory, muscular function, and the need for a unique approach to performing rehabilitation measures that consider the age of the child.

AIM: This study aims to develop a preparation protocol and an algorithm for decannulation of children with cervical vertebrospinal cord injuries and assess the efficiency of early rehabilitative measures in the preparation process.

MATERIALS AND METHODS: This study included 74 children with vertebrospinal cord injuries admitted to the Emergency Children’s Surgery and Traumatology Research Institute from 2014 to 2019. The patients were divided into two groups depending on the time of admission. Group 1 consisted of children admitted to the institute in the acute and early periods of vertebrospinal cord injuries. Group 2 included children in the intermediate and recovery periods. All patients were prepared for spontaneous breathing according to the protocol.

RESULTS AND DISCUSSION: Group 1 patients with C2–C4 vertebrospinal cord injury levels were decannulated on days 110–140 after the injury. One child was diagnosed with an overgrowth of granulations over the tracheostomy tube, which required medical correction followed by successful decannulation. Group 1 patients with C5–C8 vertebrospinal cord injury levels were decannulated on days 15–41 after the injury. All Group 1 patients underwent early rehabilitation measures, which began immediately after stabilizing vital functions.

On days 97–110 after the injury, 12 patients of Group 2 with С5–С8 vertebrospinal cord injury levels were decannulated. In contrast to Group 1 patients with the same injuries, Group 2 patients did not undergo early rehabilitation measures in primary inpatient settings. Therefore, they required much more time to adapt to spontaneous breathing.

CONCLUSIONS: Compliance with the proposed protocol allows determining the patient’s readiness for decannulation, reduces the risk of potential complications that may arise due to the untimely removal of the tracheostomy tube, increases the effectiveness of rehabilitation measures in this patient category, and reduces the length of the hospital stay. The preparation algorithm for decannulation may serve as a practical guide for specialists involved in treating and rehabilitating children with vertebrospinal cord injuries.

Medical Journal of the Russian Federation. 2021;27(2):115-126
pages 115-126 views

Clinical medicine

Results of active remote cardiac monitoring of oncohematological patients

Emelina E.I., Gendlin G.E., Nikitin I.G.

Abstract

BACKGROUND: Despite their targeted effects, targeted drug therapies also lead to adverse events, including various cardiac effects.

AIM: This study aims to determine the possibility of treating cardiovascular diseases underlying or occurring as a side effect of ibrutinib treatment without blocking targeted therapy for chronic lymphocytic leukemia (CLL).

MATERIALS AND METHODS: From 2016 to the present, we have examined and followed 217 patients with CLL who were continuously treated with ibrutinib targeted therapy for five years. The study included patients with CLL, aged 32 to 91 years [median age of 66.0 (32.0–91.0) years], including 136 men aged 66.0 (32.0–91.0) years and 81 women aged 65.0 (39.0–83.0) years. All patients underwent electrocardiography, echocardiography, 24-hour electrocardiographic Holter monitoring, 24-hour blood pressure monitoring, assessment of comorbidities using the Charlson Index, and screening for fragility using the G8 questionnaire.

RESULTS: Active cardiac monitoring, including continuous remote monitoring of cardioprotective therapy intake and efficiency, allows oncohematological patients to achieve higher overall survival rates. The long-term monitoring group included a statistically significant number of patients with atrial fibrillation and/or arterial hypertension and patients who receive dual and triple antithrombotic therapy. This group included patients with CLL and more severe cardiac status than other patients, who were regularly observed by a cardiologist.

CONCLUSIONS: Widespread introduction of the techniques for continuous remote monitoring of the oncological patient’s condition into clinical practice will improve the patients’ quality of life and increase their life expectancy.

Medical Journal of the Russian Federation. 2021;27(2):127-138
pages 127-138 views

Laparoscopic plasty of giant diaphragmatic hernia using a biocarbonic implant

Rozenfel’d I.I.

Abstract

This article discusses the results of a prospective randomized study of laparoscopic plasty of giant hiatal hernias with a hernial defect area of 10–20 cm2. A total of 92 patients underwent surgery from 2014 to 2020. The patients were divided into two study groups. Group 1 included 46 patients who underwent laparoscopic plasty of the esophageal hiatus by posterior cruroraphy. Group 2 consisted of 46 patients who underwent laparoscopic plasty of the esophageal hiatus using a two-layer Ultrapro (Ethicon) mesh biocarbonic implant according to the developed technique.

Medical Journal of the Russian Federation. 2021;27(2):139-144
pages 139-144 views

Clinical pharmacology and pharmaceuticals

Some aspects of pharmacological support with antidysrhythmic drugs

Archipov V.V., Bolsunovskaya Y.R.

Abstract

A high level of morbidity and mortality from cardiovascular diseases remains prevalent in the Russian Federation, despite a decreasing trend that emerged in recent years. Rhythm and conduction disorders play an essential role in the thanatogenesis of cardiovascular pathology, which determines the medical and social significance of their pharmacotherapy. This is indicated by the stable demand for antidysrhythmic drugs from both the state and the population. This is evidenced by high levels of public procurements and retail sales of “drugs for the treatment of cardiovascular diseases,” since patients take this drug group for a long time and often permanently. Our marketing analysis of the antidysrhythmic drugs market used current open data from the State Register of Medicines and the State Register of Maximum Selling Prices and available analytical data. It showed that from 54.5% (metoprolol drugs) to 100% (procainamide drugs) of the market share is occupied by generic drugs made in Russia. The presented analysis confirms the assumption of a significant increase in the share of generic drugs in public procurements. This is associated with the implementation of the drug safety program for vital and essential drugs and the optimization of costs by the state. A priority of the state drug policy in Russia is to monitor the effectiveness and safety throughout its entire life cycle. Moreover, particular importance should be given to the issue of interchangeability, which is regulated by Federal Law No. 1360 dated September 5, 2020, “On the Procedure for Determining the Interchangeability of Medicines for Medical Use.” The annual increase in the share of generic domestic antidysrhythmic drugs on the market poses the problem of selecting the most efficient and safe approach to pharmacotherapy for practicing specialists. The solution may be to develop and implement open automated information systems for the safety profiles of the original and generic antidysrhythmic drugs.

Medical Journal of the Russian Federation. 2021;27(2):145-152
pages 145-152 views

Reviews

Open-chest or transcatheter aortic valve implantation?

Chernyavsky M.A., Strelkov D.A., Zubarev D.D., Prokhorikhin A.A., Susanin N.V., Kazantsev A.N.

Abstract

This literature review focuses on the choice of treatment strategies in patients with aortic stenosis. The main surgical techniques for this condition are presented. The rationale for the efficiency of transcatheter aortic valve implantation is provided. The results of studies comparing the outcomes of surgical and endovascular correction of aortic stenosis are analyzed. Particular attention is paid to the treatment choices in patients with aortic stenosis and a history of coronary artery bypass grafting. Conclusions on the perspectives of transcatheter aortic valve implantation in this cohort of patients are reached.

Medical Journal of the Russian Federation. 2021;27(2):153-162
pages 153-162 views

Use of modern spinal braces in the treatment of idiopathic scoliosis

Shavyrin I.A., Kolesov S.V., Levkov V.Y., Lobov A.N., Polyaev B.A.

Abstract

This review presents an analysis of scientific papers on the conservative treatment of idiopathic scoliosis with spinal braces.

Insufficient awareness of brace treatment for spinal deformities is often the reason for the negative attitude of orthopedists toward brace therapy and the conservative treatment of scoliosis in general.

In world practice, braces have been the primary and scientifically proven technique for conservative treatment of intermediate forms (grades II–III) of scoliosis in children and adolescents for over 50 years. Modern spinal braces are active orthopedic products that provide three-dimensional correction of the existing deformity and prevent the progression of scoliosis. The main goal of using braces is to eliminate the pathological displacement of the vertebrae, ribs, and pelvis to a physiological state by applying pressure to specific body areas and actively correcting the deformity. Using a brace is the only non-surgical method to treat scoliosis with scientifically proven efficiency. The poor results of using braces to treat scoliosis are primarily due to insufficient correction in the brace, non-compliance with the wearing time, and the lack of adjunctive therapy. The efficiency of brace therapy depends on three main factors that require the personal involvement of the patient: the time of wearing the corset per day, the degree of correction in the corset, and constant (daily) training of the back muscles. The results of recent multicenter studies confirm the efficiency of using braces to treat idiopathic adolescent scoliosis.

Medical Journal of the Russian Federation. 2021;27(2):163-174
pages 163-174 views

Antibiotic treatment failure

Alpatov S.P., Bogush N.V., Borozdenko D.A., Buyanova N.M., Ganshina I.V., Dibirova G.O., Dmitrieva N.B., Kalinina E.V., Kirillova A.V., Kiseleva N.M., Kukushkin G.V., Leonteva T.I., Maximov M.L., Markina E.V., Mileshina S.E., Tsitsuashvili M.D., Yurov D.E.

Abstract

This review presents information on cases of antibiotic failure (insufficient effect) in the global population over the past three years. We analyzed scientific papers, clinical trial data, and the WHO Program for International Drug Monitoring (VigiBase) data from 2018 to 2020. The values of global success and safety rates of antibacterial drugs for medical use are presented. The findings may be of practical interest to physicians, researchers, developers, and healthcare regulators.

Medical Journal of the Russian Federation. 2021;27(2):175-182
pages 175-182 views

Parkinson’s disease: epidemiology and pathogenesis

Borozdenko D.A., Bogorodova V.I., Kiseleva N.M., Negrebetsky V.V.

Abstract

This review presents data on the etiology, epidemiology, and pathogenesis of Parkinson’s disease from National Center for Biotechnology Information (NCBI), eLibrary, CyberLeninka, and from monographs and textbooks. The prevalence, classification, genetic variability, main pathogenetic links, and potential disease development mechanisms are described. Both classic Parkinson’s disease and variable manifestations of parkinsonism are considered. The factors that contribute to disease progression and inhibit its development are described. The main hypotheses of the pathogenetic mechanisms of Parkinson’s disease are presented. These are protein misfolding, mitochondrial dysfunction, impaired protein purification systems, neuroinflammation, and pathology of the gut-brain axis.

Medical Journal of the Russian Federation. 2021;27(2):183-194
pages 183-194 views

Practice case

A clinical case of the novel coronavirus (COVID-19) reinfection in a health care worker

Kovtyukh I.V., Gendlin G.E., Nikitin I.G., Kabirova E.V., Markina O.Y.

Abstract

The peculiarities of immune responses to a novel coronavirus infection (COVID-19) and the possibility of reinfection due to the variability of humoral immunity are currently under discussion. This article presents a case of COVID-19 reinfection in a health care worker.

Medical Journal of the Russian Federation. 2021;27(2):195-200
pages 195-200 views

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