Saratov JOURNAL of Medical and Scientific Research

Internal Diseases

Norm and disease. Monomorbidity, comorbidity and methodology for their diagnostics

Year: 2018, volume 14 Issue: №2 Pages: 209-216
Heading: Internal Diseases Article type: Review
Authors: Kats Y.A., Parkhoniuk E.V., Skriptsova S.A.
Organization: Saratov State Medical University
Summary:

The absence of a single classification and generally accepted terminology of comorbidity leads to a different understanding of the issues of diagnosis of comorbidity. Comorbidity is a complex system in which the patient is both an integral object and part of this system, which includes diseases complexes. As it is known, the success of solving diagnostic problems, especially in the presence of comorbidity ultimately determines the consistency and validity of the findings, and, consequently, the effectiveness of the diagnosis as a whole. Previously, we proposed an integrative method which, preserving the system approach and the method of comparison, suggests using the sum of data from genetic, constitutional, immunological, anthropological and other types of examination to obtain the most complete representation not only of the nature of the disease, but, first of all, the patient himself. Proceeding from the foregoing, the present review focuses not only on the features of compiling a "patient diagnosis" in the presence of comorbidity but also on the sequence in which the pathological conditions should be considered and reflected in the main diagnosis in the presence of several active processes.

AttachmentSize
2018_2_209-216.pdf258.36 KB

Clinical case of favourable outcome at a patient with eosinophilic granulomatosis with polyangiitis complicated by severe heart disease

Year: 2018, volume 14 Issue: №2 Pages: 207-209
Heading: Internal Diseases Article type: Case report
Authors: Alexandrova O.L., Skryabina E.N., Nikitina N.M., Romanova I.A., Alexandrova N.L.
Organization: Saratov State Medical University
Summary:

The aim of the article is to present a clinical case of rapid generalization of eosinophilic granulomatosis with polyangiitis. The course of disease with multiple organ lesions and the heart being affected the most is described. Remission is achieved by combined therapy with corticosteroids and cyclophosphamide.

AttachmentSize
2018_2_207-209.pdf260.16 KB

Irritable bowel syndrome: epidemiological and pathogenetic aspects

Year: 2018, volume 14 Issue: №1 Pages: 53-60
Heading: Internal Diseases Article type: Review
Authors: Tikhonova Т.А., Kozlova I.V.
Organization: Saratov State Medical University
Summary:

The literature review focuses on some epidemiological aspects, molecular-genetic predictors of irritable bowel syndrome formation, the role of psychosocial and infectious factors, low-grade inflammation, imbalance between neu-rotransmitters and cytokines, as well as changes in the intestinal microbiome in the development of irritable bowel syndrome.

AttachmentSize
2018_1_053-060.pdf308.55 KB

Prediction of heart remodeling in patients with bronchial asthma

Year: 2018, volume 14 Issue: №1 Pages: 49-52
Heading: Internal Diseases Article type: Original article
Authors: Ryabova A.Yu., Shapovalova T.G., Shashina M.M., Lekareva L.I., Kudishina M.M.
Organization: Saratov State Medical University
Summary:

The aim of the study was to identify cardiac remodeling in bronchial asthma (BA), to construct a mathematical model for its prediction to optimize diagnosis. Material and Methods. Atotal of 283 patients with asthma who underwent a comprehensive examination including general clinical, immuno-enzymatic (determination of the N-terminal fraction of the brain natriuretic propeptide, activity of the angiotensin-converting enzyme) and instrumental methods: ECG, ECHO, daily Holter monitoring of ECG, FVD. Results. The analysis of the obtained results showed that in patients with asthma, structural, geometric changes of the myocardium of the right and left ventricles were noted, increasing as the disease became more severe. The activation of local neurohormonal systems, primarily myocardial is no less important. An analysis of the relationship between the concentration of natriuretic peptide and the end-diastolic size of the right ventricle in BA patients revealed a moderate correlation relationship. There was a weak correlation between the right ventricular end-diastolic size, the right ventricular frontal wall thickness and the ACE level. The analysis of the relationship between the above dimensions of the right ventricle and the index of the balance of the autonomic nervous system was reliable. Conclusion. Thus, the development of cardiac remodeling in AD patients occurs against the background of the hyperactivation of neurohumoral systems, including sympathoadrenal, renin-angiotensin-aldosterone and the system of natriuretic peptides.

AttachmentSize
2018_1_049-052.pdf260.04 KB

Comparative evaluation of autonomic regulation of circulation in patients undergone coronary artery bypass grafting or correction of acquired valvular heart disease

Year: 2018, volume 14 Issue: №1 Pages: 45-49
Heading: Internal Diseases Article type: Short message
Authors: Kiselev A.R., Vulf K.A., Shvartz V.A., Karavaev A.S., Borovkova E.l., Bockeria O.L.
Organization: Bakulev Center of Cardiovascular Surgery, Saratov State Medical University n.a. V.I. Razumovsky Research Institute of Cardiology, Saratov state university
Summary:

The aim of the research was to study the peculiarities of vegetative regulation of blood circulation in cardiac surgery patients who underwent coronary artery bypass grafting (CABG) or correction of acquired valvular heart disease (CAVHD). Material and Methods. In this study we included 42 patients (12 women; 63 (57; 67) years), who underwent CABG, and 36 patients (16 women; 58 (47; 65) years) who underwent CAVHD. The synchronous 15 minutes records of electrocardiogram and photoplethysmogram (PPG) were performed in all patients before and after surgery. Time domain and frequency domain measures of heart rate variability (HRV) and index of synchronization between low-frequency (LF) oscillations in HRV and PPG (index S) were analyzed. Results. Most studied autonomic indices did not have statistically significant differences between patients with CABG and CAVHD in the study stages, except for heart rate, which was higher in patients before CAVHD (p=0,013). Conclusion. The values of HRV and index S do not depend on the difference in the clinical status and the features of performed cardiac surgical interventions between patients with CABG and CAVHD.

AttachmentSize
2018_1_045-049.pdf271.3 KB

Features of the clinical course of gastroesophageal reflux disease associated with obesity

Year: 2018, volume 14 Issue: №1 Pages: 42-45
Heading: Internal Diseases Article type: Original article
Authors: Andreeva E.l.
Organization: Stavropol State Medical University
Summary:

The research goal is to reveal the features of clinical manifestations of gastroesophageal reflux disease (GERD) in obesity. Material and Methods. A survey and anthropometric study of 51 patients suffering from GERD and obesity aged 30 to 60 years were conducted. The average age of the patients was 42.3±2.11 years. Patients were divided into groups according to the BMI score. The control group consisted of patients suffering from GERD without obesity. Results. The main complaint of the patients of the control group was heartburn, while the patients of the main group had complaints of dyspeptic nature. With an increase in BMI, there was an increase in the incidence of complaints, in addition, complaints of an extra-esophageal nature associated with the direct effect of acidic gastric contents on the pharyngeal mucosa were detected. This regularity is explained in the article by pathogenetic mechanisms of GERD development. In patients suffering from GERD without obesity, the development of the disease is caused by a change in the motor activity of the esophagus due to a decrease in the tone of the lower esophageal sphincter, and in patients with co-pathology the main role is given to increased intragastric pressure, which leads to disruption of the sphincter. Conclusion. Thus, the clinical picture of combination of GERD and obesity differs atypical for GERD current, the main features of which are the predominance of dyspeptic complaints, motor-evacuation disorders, and the presence of extraesophageal complaints.

AttachmentSize
2018_1_042-045.pdf414.26 KB

Pulmonary lymphangioleiomyomatosis (case report)

Year: 2017, volume 13 Issue: №4 Pages: 828-833
Heading: Internal Diseases Article type: Case report
Authors: Shashina M.M., Shapovalova T.G., Kazimirova N.E., Ryabova A.Y., Arkhangelskaya Е.Е., Lifanova D.V., Chernyshkova M.A.
Organization: Saratov State Medical University, Saratov Clinical Hospital № 8
Summary:

This article presents a clinical observation of a patient with a proven diffuse-nodular form of lymphangioleiomyomatosis of the lungs. Features of the course of the process against the background of pathogenetic therapy which included sirolimus and progesterone have been considered. It is necessary to raise awareness of doctors about the disease that facilitates timely diagnosis and treatment.

AttachmentSize
2017_04_828-833.pdf2.43 MB

A rare case of Loeffler endocarditis associated with eosinophilic granuloma-tosis with polyangiitis

Year: 2017, volume 13 Issue: №4 Pages: 823-828
Heading: Internal Diseases Article type: Case report
Authors: Skryabina E.N., Safonova V.N., Agareva Т.А.
Organization: Saratov State Medical University
Summary:

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease that affects small and medium-sized blood vessels of different organs, characterized by asthma, prominent peripheral blood eosinophilia. Cardiac involvement was reported in 20-50% and it is the major cause of mortality. A case of EGPA in a 43-year-old female, who had endocarditis, associated with thrombus formation in left ventricle, thromboembolic syndrome and recurrent stroke has been reported. The described case has showed that it is of crucial importance to perform the full cardiac imaging even in asymptomatic patients with suspected EGPA. The early identification of cardiac involvement may lead to better prognosis.

AttachmentSize
2017_04_823-828.pdf1.29 MB

A clinical case of fast progression of amyloidosis of kidneys in rheumatoid arthritis

Year: 2017, volume 13 Issue: №4 Pages: 821-823
Heading: Internal Diseases Article type: Case report
Authors: Romanova I.A., Magdeeva N.A., Nikitina N.M.
Organization: Saratov State Medical University
Summary:

The article presents clinical case of unfavorable outcome of amyloidosis of kidneys in a patient with rheumatoid arthritis. The absence of basic treatment and persistent activity of disease leads to fast progression of nephrotic stage of secondary amyloidosis in a young woman.

AttachmentSize
2017_04_821-823.pdf553.81 KB

Platelet indices as markers of platelet turnover and aggregation: pathophysiological interpretation, clinical impact, perspectives in research

Year: 2017, volume 13 Issue: №4 Pages: 813-820
Heading: Internal Diseases Article type: Review
Authors: Malinova L.I., Furman N.V., Dolotovskaya P.V., Puchinyan N.F., Kiselev A.R.
Organization: Saratov State Medical University n.a. V.I. Razumovsky Research Institute of Cardiology
Summary:

The purpose of the review is to characterize existing in open access bibliographical databases such as eLibrary and PubMed evidence on clinical impact of morphometric platelet indices as markers of platelet aggregation ability and turnover as a methodology and theoretical framework of further investigation. Studies results were pooled from open access bibliographic databases (eLibrary, and PubMed) according to modified PRISMA algorithm. Relevant studies were identified by systematic searches of the original studies published during the last 10 years in the Russian and English languages. Results of 96 original studies in accordance with inclusion criteria were published during the last 10 years in scientific journals indexed in eLibrary, and PubMed. The majority of publications (64.58%) consist of evidence pro diagnostic and prognostic significance of platelet indices. Studies demonstrating the significance of platelet indices as possible risk markers of thrombotic events in cardiovascular patients were predominating among "pro" publications. In 15.63% published results contradict concept of platelet indices usefulness as diagnostic and prognostic markers in clinical practice. Morphometric platelet indices can be considered as useful diagnostic and prognostic markers of thrombotic events in cardiovascular patients. Existing gaps in evidence suggest the need of further investigations.

AttachmentSize
2017_04_813-820.pdf482.16 KB