Vol 18, No 3 (2016)


Preliminary results of the epidemic season 2015-2016. Influenza and SARS in the Russian Federation

Popova A.Y., Ezhlova E.B., Melnikova A.A., Frolova N.V., Mikheev V.N., Ryzhikov A.B.


In preparation for the epidemic rise in the incidence of influenza and SARS 2015-2016. Russian Federal Consumer Rights Protection and Human Health Control Service was organized and conducted complex of sanitary and anti-epidemic (preventive) measures, will prevent complications of the situation. The epidemic of SARS and influenza season 2015-2016. in the Russian Federation was characterized by a wide geographical distribution with the inclusion of the epidemic process of all age groups, the early involvement of the country's southern, moderate length regions, the dominance in the etiological structure of influenza A (H1N1) 2009, the absence of severe clinical forms of infection among vaccinated individuals.
Consilium Medicum. 2016;18(3):8-11
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Features of influenza in children possibility of modern management and prevention

Lobzin Y.V., Babachenko I.V., Vasiliev V.V., Uskov A.N.


The article presents epidemiological data describing the development of the epidemic of influenza A in January and February of 2016 in Russia and in Saint Petersburg. Showing rates of increase and decrease the incidence of influenza children weekly epidemiological season, as well as data hospitalization of sick children with influenza in Saint Petersburg hospitals. In the etiological structure decoded SARS specific weight of influenza A(H1N1)pdm09 reached 60%. The detailed description of the clinical course of influenza in children depends on the severity and its complications are described in detail. The features of the flow of influenza in young children, influenza A(H1N1)pdm09 children in the epidemiological season 2015-2016, clinical and laboratory differences of pandemic and seasonal influenza variants in children (based on observation in the clinic Research Institute of Children's Infections). Detailed description of modern approaches to the treatment and prevention of influenza in children.Coverage of children vaccination against influenza in Saint Petersburg amounted to 40%, despite the availability of vaccines of the city, which led to their intensive involvement with the development of the epidemic process of individual deaths, which was not observed in Russia during the 2009 pandemic.
Consilium Medicum. 2016;18(3):12-17
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A look at the effectiveness of the release of active antivirals in treatment of influenza and ARVI in the light of evidence-based medicine

Afanasyeva O.I., Esaulenko E.V.


The problem of treatment and prophylaxis of acute respiratory viral infections (ARVI) is interdisciplinary and covers medical, social and economic aspects. The high relevance of the problem is determined by the prevalence of infections themselves, high sensitivity to them patients of all age categories, a significant rate of complications and exacerbations of several chronic diseases, especially in patients at risk. The lack of specific methods of prevention and treatment of ARVI, its non-influenza etiology, limited range of drugs for antiviral therapy in this group of medicines determine the need for a thorough analysis of the efficacy and safety of existing drugs with the position of evidence-based medicine. Attention of authors was attracted by a group of innovative domestic antivirals, established on the basis of antibodies to interferon-g release in a human-active form. This work is carried out with the purpose of concentration and systematization of information on the results of the preclinical assessment of antiviral activity of Ergoferon, Anaferon Kids and Anaferon, as well as data from clinical studies of these drugs in acute respiratory viral infections in children and adults. It uses search-analytical method for processing information sources published in specialized medical journals and are freely available in printed and electronic form on the Internet. The work is a brief literature review, which presents evidence of antiviral activity of Ergoferon, Anaferon Kids and Anaferon, current understanding of the mechanism of action of drugs, based on the data of the complex scientific and experimental studies on the molecular level. Also, review the results of clinical trials, which, according to the authors, with a high degree of evidence demonstrating the therapeutic efficacy and Ergoferon, as well as Anaferon Kids in the treatment of ARVI. Proofs of comparability of treatment of the antiviral activity of these drugs with ostamyvirum during influenza treatment in children and adults.
Consilium Medicum. 2016;18(3):18-21
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Topical issues of epidemiology of community-acquired pneumonia in the Russian Federation in 2015

Popova A.Y., Ezhlova E.B., Demina Y.V., Omariev Z.M.


During the last 2 years in the Russian Federation observed decline in incidence of community-acquired pneumonia (CAP). In the structure of the adult population of patients with predominant, but the higher the intensity of the epidemic process observed among children. At the end of 2015 exceeded the national average incidence of CAP is registered in 45 regions of the country. Organized and carried out a series of measures to stabilize the situation. One of the problematic issues is the standardization of laboratory diagnostics in medical institutions.
Consilium Medicum. 2016;18(3):22-23
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Therapy of acute respiratory diseases with those operating under conditions of low intensity occupational hazards

Logvinenko I.I., Voevoda M.I.


Consistently high incidence of acute upper respiratory infections of multiple and unspecified localization, and significant economic losses induced by them dictate the need for the development of therapeutic and preventive measures against this pathology. The purpose of the study was to explore the therapeutic efficacy of the drug Kagocel and tolerance to it in the treatment of acute respiratory infections (ARI).Materials and methodology. Included in the observational study were 100 patients from 43 to 65 years of age, who received outpatient treatment with a confirmed diagnosis of ARI, whose working conditions featured low intensity occupational hazards, and who were taking Kagocel in combination with symptomatic therapy. The control group consisted of 50 patients of comparable age with an established diagnosis of acute respiratory disease receiving only symptomatic therapy on an outpatient basis. Evaluated were the efficacy of Kagocel and the tolerance to the drug. The results of observational studies were processed with the standard software package Statistica 8.0 (StatSoft, Inc., USA) using standard methods of comparative analysis and descriptive statistics.Results. The assessment of the treatment effectiveness revealed that the intoxication and catarrhal syndromes with patients taking Kagocel had been less pronounced already on day 3 of treatment, as compared to the group of patients receiving just symptomatic therapy. The analysis of additionally prescribed drugs showed that none of the patients in the main group was in need of being prescribed antimicrobial and mucolytic drugs, and the duration of taking symptomatic medications was 1.8±0.1 days. In the control group the average duration of receiving medications was 3.9±0.4 days (p<0.05), while 10.0 percent of the cases required administration of penicillins combined with mucolytics due to the complicated course of ARI. Also noted were good tolerance and lack of side effects in the course of treating ARI accompanied with the administration of Kagocel.Conclusions: 1. The results of the outpatient administration of the drug Kagocel in the treatment of ARI demonstrate high clinical efficiency of ARI therapy with Kagocel as the reference drug (as compared to symptomatic therapy). 2. Administration of Kagocel featured a more rapid relief of intoxication and catarrhal syndromes of the disease, resulting in the reduction in the need for symptomatic remedies and facilitating a quicker recovery (as compared to symptomatic therapeutic agents). 3. The inclusion of the drug Kagocel in the ARI treatment not only resulted in a more rapid control of the disease, but also prevented the development of complications. Patients of the main group taking Kagocel did not suffer from exacerbations of chronic bronchitis. 4. Kagocel proved to be tolerated well, and its use was not accompanied by complications or side effects.
Consilium Medicum. 2016;18(3):24-29
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Hepatopulmonary syndrome

Avdeev S.N.


Hepatopulmonary syndrome (HPS) is a frequent complication of terminal liver disease. The HPS is based on the development of pulmonary vascular dilatation in response to the increase in the concentration of circulating vasoactive substances. To diagnose with HPS, the triad of symptoms is required: liver disease and/or portal hypertension, pulmonary vascular dilatation, and hypoxemia. The main therapeutic measures in HPS are the oxygen therapy and orthotopic liver transplantation.
Consilium Medicum. 2016;18(3):30-35
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Diagnostic and pharmacological approaches to the management of patients with community-acquired pneumonia in the hospital

Belevskii A.S., Sinopalnikov A.I., Zaitsev A.A.


The publication addresses key issues of management of patients with community-acquired pneumonia in the hospital. Submitted by examination of the patient algorithm at the stage of a reception, the tactics of Antimicrobial Chemotherapy in patients hospitalized in the ward of a general, the volume survey of patients with severe pneumonia, entering the intensive care unit, antibiotic treatment of severe pneumonia, the algorithm of examination in the case of unresolved (slowly permitted) pneumonia.
Consilium Medicum. 2016;18(3):36-41
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The effectiveness of using the conjugated pneumococcal vaccine in patients with chronic obstructive pulmonary disease for 3 years

Ignatova G.L., Antonov V.N., Rodionova O.V.


The article presents the results of a study showing prospective clinical and cost-effectiveness of vaccination conjugated pneumococcal vaccine Prevenar 13, with a horizon of 3 years in patients with chronic obstructive pulmonary disease (COPD) compared with patients without vaccination.Material and Methods. The study included 496 male patients who were treated at the Regional Hospital №4 and the city pulmonology center of Chelyabinsk in 2012-2015. The average age of study patients was 61.30±6.92 years. All patients underwent a complete clinical and instrumental study. The degree of dyspnea was assessed by MRC scale. For vaccination the 13-valent pneumococcal conjugate vaccine (PCV13) Prevenar 13 was used.Results and conclusions. Over 3 years in vaccinated patients there was a significant reduction in exacerbations of COPD level 9.6 times decrease in the number of hospital admissions by 7.7 times, improved respiratory function indices were also noted. PCV13 minimizes pro-health system expenditure for the treatment of patients with COPD. These budget savings of 89% in 3 years after vaccination, reached 61.737 rubles per 1 patient.
Consilium Medicum. 2016;18(3):42-46
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Ultra-long-acting b2-agonists in the treatment of chronic obstructive pulmonary disease and bronchial asthma

Koutsenko M.A.


B2-Agonists are effective bronchodilators due primarily to their ability to relax airway smooth muscle. Short-acting b2- agonists provide rapid as-needed symptom relief and short-term prophylactic protection against bronchoconstriction induced by exercise or other stimuli. But it was very important to increase compliance of control regimen of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD) medication. The 12-hours duration showed compliance increasing due to twice administration per day. Creating ultra-long-acting b2-agonists having a rapid onset of effect and acceptable safety profile with once-daily dose administration, is an important strategy to improve adherence and is a regimen preferred by most patients, which may also lead to enhancement of compliance, and may have advantages leading to improved overall clinical outcomes due to long-term and stability bronchodilating effect.
Consilium Medicum. 2016;18(3):47-53
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Comparative evaluation of different treatment regimens of sarcoidosis: analysis of real clinical practice

Vizel A.A., Vizel I.Y.


We present the analysis of the prevalence of sarcoidosis in the Republic of Tatarstan and the comparison of different modes of therapy of this disease. All recommended therapies Sarcoidosis have a positive impact on patients.Loefgren syndrome had positive dynamics as during active therapy, both with and without. At the same time, any treatment options not less than one third of patients developed recurrences and exacerbations, or wanted to move to a more aggressive therapy than assigned initially.
Consilium Medicum. 2016;18(3):54-58
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The use of corticosteroids in exacerbations of chronic obstructive pulmonary disease

Karoli N.A., Rebrov A.P.


Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by a high mortality rate. Due to the ever-growing social and economic burden, considerable attention is paid to the optimal management of patients with COPD and related exacerbations. Currently glucocorticoid (GC) remains the standard treatment for COPD exacerbations, that is based on their documented efficacy in reducing the severity of bronchial, improving gas exchange (increased forced expiratory volume in 1 second and PaO2), as well as dyspnea, decreased hospital stays and the percentage relapse over the next 30 days. Oral GC preferred over parenteral, both in terms of cost and ease of use. Inhaled GC can be used in non-severe exacerbations of COPD as an alternative to systemic steroid until other studies will be obtained.Despite the absence of large randomized controlled studies, the available data support a shorter period of treatment GK than previously recommended by the 10-14-day course of therapy. In particular, the results of a recently published randomized, double-blind, placebo-controlled studies have shown that 5-day course of systemic GC showed no less effective than the traditional 14-day regimen. Given these data, it is likely many patients are unnecessarily exposed to the negative impact of a longer course of treatment GK.It should be noted that the application of the Civil Code in exacerbations of COPD, a number of issues still remain open. For example, there are no studies on the direct comparison of different modes of HA and their use in patients with varying severity of exacerbations of COPD.
Consilium Medicum. 2016;18(3):59-64
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Prevention of infectious losses: strategy and tactics vaccination of respiratory infections in chronic diseases

Kostinov M.P., Protasov A.D., Blagovidov D.A., Shmitko A.D., Tarasova A.A., Cherdantsev A.P., Khromova E.A., Kazharova S.V., Polishchuk V.B., Ryzhov A.A.


Presents international and national guidelines for influenza vaccination and pneumococcal infections in patients with chronic diseases of various organs and systems. It has been shown that vaccination against these infections is safe, clinically and immunologically effective. The preliminary results of research into new vaccines against Pseudomonas aeruginosa infections in patients with cystic fibrosis and revealed the mechanisms of the immune response to the conjugated pneumococcal vaccine in patients with chronic obstructive pulmonary disease. The results of the application of immunoenhancing subunit influenza vaccines in vaccination of immunocompromised patients, pregnant women, evaluated the immunogenicity and safety.
Consilium Medicum. 2016;18(3):65-69
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Virus-induced asthma: possible prevention and treatment

Nenasheva N.M.


Most patients suffering from bronchial asthma achieved disease control as a result of therapy with inhaled corticosteroids and b2-agonists, but these drugs may be ineffective in the treatment of virus-induced asthma exacerbations. Respiratory viral infections are the most common cause of broncho-obstructive syndrome in young children and the most frequent triggers of asthmatic exacerbations in children, adolescents and adults. This article discusses the relationship of respiratory viruses and allergens, causes of virus-induced asthma exacerbations, as well as the role of antileukotriene drugs in the treatment of asthma and prevention of virus-induced exacerbations.
Consilium Medicum. 2016;18(3):70-79
pages 70-79 views

Current approaches to diagnosis and treatment of acute inflammatory diseases of the pharynx (the results of a clinical trial)

Vishniakov V.V.


The article presents the results of a study on the diagnosis and treatment of acute inflammatory diseases of the pharynx. The data allow us to consider justified the use of modern rapid tests for the diagnosis of infections caused by b-hemolytic group A streptococci (BHSA) in acute inflammatory diseases of the throat. Clinical observations have shown high efficacy of the topical anti-inflammatory treatment tablets with flurbiprofen (Strepsils® Intensive) in acute tonsillopharyngitis. If results are positive rapid test for BHSA shown compulsory use of antibiotics. This tactic will reduce the excessive use of antibiotics.
Consilium Medicum. 2016;18(3):80-85
pages 80-85 views

Modern ideas about the treatment of tonsillopharyngitis

Kosiakov S.Y., Angotoeva I.B., Muldasheva A.A.


The article presents the results of the literature review for the study of the etiology, clinical features, approach to diagnosis and treatment of acute tonsillopharyngitis by domestic and foreign otolaryngologists.
Consilium Medicum. 2016;18(3):86-89
pages 86-89 views

Multicomponent approach to the treatment of acute inflammatory diseases of the pharynx

Karpishchenko S.A., Baranskaia S.V.


Acute inflammatory diseases of the throat are of great clinical and social importance, due to their high prevalence. Inadequate and untimely treatment approach often leads to a prolonged duration, recurrence, chronic process and the development of serious complications that threaten the life of the patient. Currently, the problem remains topical therapy of choice. Systematic etiotropic treatment should be strictly regulated by medical conditions. Topical therapy, which provides a service optimum dose of the active substance in the inflamed mucosa becomes important. Topical therapy has several advantages, including the ease and convenience of administration of the drug in the area of pathological changes, the rapid onset of therapeutic effect is minimal risk of systemic side effects. Topical administration preparations may be a combination of different drugs, thus providing a multicomponent treatment approach.
Consilium Medicum. 2016;18(3):90-93
pages 90-93 views

Actual aspects of prevention and treatment of rhinitis and sinusitis in children

Zakirova A.M., Faizullina R.A., Malanicheva T.G., Ziatdinova N.V., Rashitov L.F., Moroz T.B., Suleimanova Z.Y.


In the treatment of respiratory diseases of the upper respiratory tract a wide range of medicines is used. The aim of the study was to investigate the combined use of irrigation and elimination therapy and nasal decongestants in the prevention and treatment of rhinitis and sinusitis in 63 children aged 3 to 15 years.The study was conducted via open clinical comparative study evaluating the efficacy, safety and ease of use of drugs and SeptoAqua SeptaNazal® taking into account the views of parents of children with rhinitis and sinusitis.SeptoAqua drug was administered at a dose of 1-2 age-injection in each nostril once a day for 7 days, SeptaNazal® preparation - 1 injection in each nostril 3 times a day for 5 days. The study drugs and SeptoAqua SeptaNazal® demonstrated good tolerability, the absence of adverse drug reactions, ease of use, a high efficiency in the treatment of rhinitis and sinusitis in children.
Consilium Medicum. 2016;18(3):94-99
pages 94-99 views

The effectiveness of therapies perennial allergic rhinitis associated with fungi of the genus of Candida, in children

Malanicheva T.G., Ziatdinova N.V., Akhmadieva L.F.


The purpose of research was to study the features of mucosal immunity in children with perennial allergic rhinitis (PAR) associated with fungi of Candida genus, for the improvement of the disease therapies. The study of mucosal immunity in 30 children aged from 3 to 18 years with PAR associated with fungi of the genus of Candida, revealed a high level of atopic type of response rates (eosinophilia, nasal secretion, increase secretory immunoglobulin - sIg - E and IL-4) due to lower anti-infective protection indicators (levels of interferon γ and sIgA, inhibition of neutrophil migration into nasal cavity and their functional activity). Inclusion complex therapy KAP associated with fungi of the genus Candida, immunomodulator polioxydonium administered intranasally in doses based on age, leads to reduced activity of allergic inflammation in the mucous membrane of the nasal cavity, which is manifested decrease in the level of eosinophils, sIgE and interleukin-4 in nasal secretions, as well as an increase in activity rates of anti-protection in the mucosa of the nasal cavity, which manifests an increase in the level of interferon γ, sIgA and activation of the functional activity of neutrophils in nasal secretions.
Consilium Medicum. 2016;18(3):100-103
pages 100-103 views

Prospects for treatment of rhinitis and rhinosinusitis: a review of the drug Euphorbium compositum

Marianovskii A.A.


The article presents a review of clinical studies on the efficacy and safety of an intranasal spray Euphorbium compositum. Spray for nasal application is an alternative to conventional drugs used for the treatment of rhinitis and sinusitis, which has no characteristic of these drugs side effects and limitations. The better tolerability compared with xylometazoline can recommend Euphorbium compositum as a means for long-term treatment of chronic sinusitis.The complex mechanism of action of the drug provides its antiviral and anti-inflammatory activity.
Consilium Medicum. 2016;18(3):104-106
pages 104-106 views

Me‘nie`re's disease: epidemiology, etiology, diagnostics, management

Palchun V.T., Guseva A.L., Levina Y.V.


Ménière's disease is an inner ear disorder, characterized by recurrent attacks of vertigo associated with fluctuating hearing loss, tinnitus and a sense of fullness in the ear and a fluctuating hearing loss. In this paper we present a review on epidemiology and incidence of this disease, pathogenesis of endolymphatic hydrops and diagnostic tools, including pure tome audiometry, electrocochleography, dehydratation test, videonystagmography, caloric test, video head impulse test and vestibular evoked myogenic potentials. Different treatment options, such as salt reduction diet, betahistine, diuretics, steroids, gentamicin, vestibular rehabilitation, Meniett therapy, endolymphatic sac and duct surgery, vestibular nerve section and surgical ablation, are also discussed.
Consilium Medicum. 2016;18(3):107-116
pages 107-116 views

Optimization of medical treatment for patients with acute bacterial rhinosinusitis

Edzhe M.A., Ovchinnikov A.I., Khon E.M.


The paper summarizes data on the prevalence of acute bacterial rhinosinusitis, the basic units of etiopathogenesis, formulated the basic principles of modern antibiotic policy of acute bacterial sinusitis, substantiated indications for the use of amoxicillin/clavulanate in combination with bacterial lysate Broncho-munal®. In clinical use of combined scheme with equal efficiency was significantly fewer relapses in the long-term follow-up compared to the group, where Broncho-munal® wasn't used.
Consilium Medicum. 2016;18(3):117-120
pages 117-120 views

Resolution of the expert council The place of Momat Reno Advance (azelastine + mometasone) in the treatment of allergic rhinitis of medium/heavy severity in ambulatory practice of doctors, otorhinolaryngologists, allergists, internists and general practitioners

Berdnikova N.G., Blokhin B.M., Nenasheva N.M., Nosulya E.V., Ovchinnikov A.Y., Ryazantsev S.V., Sinopal'nikov A.I., Fedoskova T.G.


Целью лечения АР является полный контроль над симптомами. Согласно международным и российским рекомендациям добиться контроля при АР (интермиттирующем и персистирующем) среднетяжелой/тяжелой степени тяжести удается с помощью применения комбинированной терапии блокаторами Н1-рецепторов (местными или пероральными) и интраназальными кортикостероидами. С учетом высокой распространенности АР, ограниченной возможности приема пациентов врачами-специалистами, а также принимая во внимание тот факт, что пациенты, как правило, обращаются к врачу уже со среднетяжелыми/тяжелыми проявлениями заболевания, участники дискуссии были единодушны в том, что описанная ситуация требует единого подхода к диагностике АР, организации междисциплинарных образовательных программ для врачей с целью повышения уровня их осведомленности о данной патологии, а также современных путях диагностики и внедрения схем лечения АР.
Consilium Medicum. 2016;18(3):122-124
pages 122-124 views

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