Vol 18, No 12 (2016)


Review of European guidelines on the prevention of cardiovascular diseases in clinical practice

Nebieridze D.V., Boytsov S.A.


A review of the new European Guidelines on cardiovascular prevention in clinical practice, in which, compared with the previous version more attention is paid to population-based approach, specific interventions and prevention efforts in women, young people and ethnic minorities. The review provides information on the assessment of cardiovascular risk; situations that affect the risk; methods of intervention both at the individual and population level. This emphasizes the role of not only public health, but also the state and public organizations. In the new recommendations, it is assumed that the mortality rate from cardiovascular diseases can be reduced by half due to a rather moderate reduction of risk factors. However, this requires more stringent laws and purposeful policy in respect of food, physical activity and smoking.
Consilium Medicum. 2016;18(12):8-12
pages 8-12 views

The questionnaire for the relatives of unexpectedly dead people of the workig age according to the GERMINA register

Linchak R.M., Nedbaykin A.M., Sementsova E.V., Yusova I.A., Strukova V.V., Kuzovlev A.N.


Objective - to survey relatives of suddenly deceased working age persons to clarify the medical history and the circumstances of death. Material and methods. We made a survey 26 first-line relatives (husband/wife, father/mother, brother/sister) of 106 died suddenly working age persons who lived in the Bryansk region and died suddenly in 2012. Standardized questionnaire included questions about the existence of a history of diseases, risk factors for their development, the death rate and clinical signs immediately preceding death. Results. According to the relatives survey the most frequent diseases and conditions of sudden died people were heart failure (46%), myocardial infarction (31%) and/or exertional angina (31%). The high frequency of such risk factors as smoking (81%), physical inactivity (69%), hypertension (65%) and alcohol abuse (42%) were identified. In half of the cases death occurred within 1 hour of the onset of symptoms, in the 17% - instantly, in 22% of the deceased's body was found by relatives within 12 hours from the moment when the dead have seen in a satisfactory condition. The most frequent symptoms immediately preceding death were chest pain (50%), feeling short of breath or dyspnea (44%) and disruption of the heart (44%). Conclusion. The survey of relatives suddenly deceased persons provides additional information about the medical history data and circumstances of the death. It was confirmed the leading role of ischemic heart disease and heart failure in nosological structure of sudden cardiac death rate of working-age population of the Bryansk region, the prevalence of risk factors for cardiovascular disease. Almost 70% of cases death occurs within one hour or in a flash that actualizes the importance of preventive measures, as well as timely and effective first aid.
Consilium Medicum. 2016;18(12):13-16
pages 13-16 views

Non-compact myocardium of the left ventricle: secondary prevention of thromboembolic complications

Myasnikov R.P., Kulikova O.V., Kharlap M.S., Koretskiy S.N., Andreenko E.Y., Mershina E.A., Sinitsyn V.E., Boytsov S.A.


The main clinical features of left ventricular (NCMLV) are non-compact myocardial heart failure (HF), arrhythmias and thromboembolic complications. Pronounced trabecular and deep inter-trabecular spaces typical of NC, can cause stagnation of blood flow and blood clots in the left ventricular cavity. This article deals with modern aspects of anticoagulant therapy in patients with NC, and describes a clinical case of a man of 54 years with a diagnosis of NCMLV. The patient was admitted with symptoms of severe heart failure and left ventricular thrombosis of multiple complicated with recurrent embolism in the systemic circulation. In the future, when the reduction of self-therapy, the patient suffered repeated thrombosis of the left ventricle with the development of thromboembolic events after popliteal artery and the left brachial artery. All patients with NCMLV as secondary prevention of thromboembolic complications of chronic administration of anticoagulants is recommended. In this case, should be considered for patients with NCMLV, which are also risk factors for thromboembolic events, such as atrial fibrillation or ventricular systolic dysfunction as a primary prevention of thromboembolism anticoagulant therapy.
Consilium Medicum. 2016;18(12):17-21
pages 17-21 views

Molecular genetic diagnosis of predisposition to the development of coronary heart disease: modern state of the problem

Meshkov A.N., Shcherbakova N.V.


Coronary heart disease (CHD) remains the leading cause of morbidity and mortality in the adult population of the Russian Federation. For this reason, detection and treatment of people at high risk for coronary heart disease are some of the important areas of preventive medicine. However, further development of preventive medicine in the XXI century., Seems to be impossible without the use of personal data on the patient's genetics. The contribution of heredity in the development of coronary heart disease, according to research carried out on mono - and dizygotic twins in the families of patients with coronary artery disease, ranges from 30 to 80%. Nevertheless the family history factor is completely ignored in the major risk stratification systems for coronary artery disease and its complications. Currently, molecular genetic diagnosis is recommended for the detection of monogenic forms of ischemic heart disease and monogenic diseases with a high risk of CHD, such as familial hypercholesterolemia, a hereditary deficiency of apolipoprotein C-II and others. At the same time, genetic testing polygenic CHD forms is not recommended because, despite revealing today a large number of genes and the SNP, associated with coronary artery disease, each individual genetic variant has little effect on the development of coronary heart disease, says a very small share of heredity in the development of the disease and thus has limited predictive value. One solution to improve the predictive value of genetic testing is to combine the information of several SNP in a single risk assessment system of the so-called genetic risk scale. In this review of the current information about the molecular and genetic basis of coronary heart disease and the possibility of genetic diagnosis of predisposition to its development.
Consilium Medicum. 2016;18(12):22-26
pages 22-26 views

Results of testing of an automated system for clinical examination and preventive medical examinations

Egorov V.A., Drozdova L.Y., Kalinina A.M.


In the structures of medical prevention in medical institutions (MPI) in several regions the software testing with the functions of automatic analysis of questionnaires to identify chronic non-communicable diseases (NCD) and risk factors (RF) of their development, and the self-view of the FF, identified by the results of questionnaires and surveys within phase I clinical examination was conducted. Automating these processes has significantly increased the establishment of NCD risk factors. Objective: To evaluate the effectiveness of the automation process of identifying, evaluating and accounting systems' RF and determine the indications for the methods of the II stage of clinical examination in accordance with the requirements of the order, approved by the order of Ministry of Health of Russia from February 3, 2015 №36an. Materials and methods. In the July-September 2015 period as part of the clinical examination of individual groups of the adult population on the basis of departments and medical prevention offices in three regions of the Central Federal District with the use of specially developed software, adapted to the current regulatory and procedural requirements made collection and statistical analysis of data. Analyzed the incidence of risk factors and other pathological conditions that increase the likelihood of developing NCD, as a result of the program and the routine processing of questionnaires and the survey results as part of Phase I clinical examination of the comparative analysis of the data reporting forms №131 (Tab. 4000) formed routinely and software. Results. When comparing the data reporting forms №131, created in hospitals on the basis of routine and interpretation software profiles, comparable results were obtained only in relation to the fact of detection of tobacco smoking - 12.6% for software analysis against 11.3% in the analysis, performed by doctors. Other risk factors and conditions, the diagnostic criteria are listed in Appendix №2 to the conduct of the clinical examination, a multiple often identified with software analysis, questionnaires and results of the survey, carried out under Phase I clinical examination. Programmatically RF malnutrition was established in 79.7% of cases vs 24.7% of cases, certain physicians; low physical activity - 30.8% vs 18.5%; family history in the whole group - in 23.5% vs 4.7%; the risk of harmful alcohol consumption - to 3.1% vs 0.5%; the risk of the use of narcotic and psychotropic substances without a doctor's prescription was detected in 1.0% vs 0.1%; Diagnostic criteria for elevated blood pressure levels have been established in 36.5% vs 13.5%; dyslipidemia - 36% vs 18.1%; hyperglycemia - in 4.2% vs 3.1%; overweight - at 54.8% vs 15.6%, of them 29.5% vs 16,8% established obesity. When calculating the absolute cardiovascular risk, performed by software, high and very high levels of risk found at 5.1 and 1%, respectively, the last check-up. Conclusion: the automation of the processes of identification, assessment and accounting of RF and other pathological conditions improves the quality of the clinical examination, reducing the likelihood of errors and the effect of subjective factors in evaluating the data.
Consilium Medicum. 2016;18(12):27-30
pages 27-30 views

Antihypertensive and target-organ protective effects of fixed-dose combinations of amlodipine/lisinopril and bisoprolol/hydrochlorothiazide

Ostroumova O.D., Kochetkov A.I.


Aim - to compare the effect of the fixed-dose combination (FDC) amlodipine/lisinopril (A/L) and bisoprolol/hydrochlorothiazide (B/H) on blood pressure (BP) and stiffness parameters of common carotid arteries (CCA). Methods. The study involved 60 patients with hypertension stage II, grade 1-2 (31 men, 29 women, mean age 53.6±0.8 years). All participants were randomized into two groups of 30 individuals each. Patients of the first group (16 men, mean age 52.7±1.1 years) received FDC A/L in the start dose of 5/10 mg, the second group patients (15 men, mean age of 54.6±1.0 years) - received FDC B/H in the start dose of 2.5/6.25 mg. Medications’ doses were titrated every 14 days to achieve a target BP below 140/90 mm Hg and after that the subsequent therapy in selected dose combination for 12 weeks was continued. At baseline and at the end of follow-up period ambulatory BP monitoring and triplex ultrasonic examination of the CCA were performed. Results. All 60 patients had the target values of office BP. During antihypertensive therapy significant (p<0.05) reduction in office systolic BP - SBP (-23.8±2.5 and -16.6±2.4 mm Hg, respectively), diastolic BP - DBP (-13.5±1.3 and -11.2±1.0 mmHg, respectively), pulse pressure - PP (-10.4±2.0 and -5.4±1.9 mm Hg, respectively) was revealed in groups A/L and B/H. In the A/L group compared with the B/H group it was significantly (p<0.05) greater reduction in SBP and PP. In the A/L and B/H groups a significant (p<0.001) reduction in the daytime SBP (-19.0±1.8 and -17.1±1.6 mm Hg, respectively), daytime DBP (-12.5±1.2 and -11.2±1.2 mm Hg, respectively), daytime PP (-6.5±1.2 and -6.0±1.0 mm Hg, respectively), as well as nighttime SBP (-19.9±1.8 and -18.3±2.0 mm Hg, respectively) and nighttime DBP (-14.4±1.9 and -17.3±1.9 mm Hg, respectively) was observed. As opposed to the B/H, the A/L was showed a significant (p<0.001) reduction in the nighttime PP (-5.1±1.2 mm Hg). At the end of the follow-upmore patients in A/L group had target values of nighttime SBP than in the B/H group (80% and 43.3%, respectively, p<0.01). Daytime SBP variability was significantly (p<0.05) decreased in both groups, and in the A/L group it was significantly (p<0.05) greater compared with B/H (-2.7±0.7 and -0.9±0.3 mm Hg, respectively). Also therapy with A/L, in contrast with B/H, have shown a significant (p<0.05) decrease in nighttime SBP variability (-1.2±0.5 mm Hg) and day - and nighttime DBP variability (-0.7±0.3 and -1.4±0.6 mm Hg, respectively). After 12 weeks of A/L treatment a significant (p<0.01) decrease in the value of the CCA stiffness index (-15.2±3.8%) and the Young's modulus (-25.5±6.0%) of the CCA and in the Peterson’s elastic modulus of the CCA (-19.2±6.0%) have been noticed, and there was a significant increase in the CCA cross-sectional compliance (30.3±7.5%) and the CCA distensibility coefficient (52.9±9.3%). There were no significant changes in the CCA stiffness parameters in the B/H group. Conclusion. In untreated patients with arterial hypertension aged 45 to 65 years 12-week therapy FDC A/L has greater antihypertensive efficacy compared with FDC B/H. FDC A/L, but not FDC B/H improved elastic properties of the CCA.
Consilium Medicum. 2016;18(12):31-39
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Stress-overcoming behaviour in patients with minor heart anomalies: is there an influence of sex?

Kodochigova A.I., Olenko E.S., Kirichuk V.F., Kurako M.M.


Objective: to determine and compare the features of stress overcoming behavior in young patients with minor heart anomalies (MHA) of varying severity based on their gender. Using techniques E.Heim (building stress overcoming behavior differentiated according to spheres) and test S.Subbotin (stress) were examined in 145 healthy men and women (mean age - 22.16±2.42 years) with syndrome of connective tissue dysplasia of heart assessed by Doppler echocardiography was efficient. All observed individuals were divided into 2 groups: basic (n=83) with minimal manifestations of the syndrome of connective tissue dysplasia of heart and the comparison group (n=62) with MHA moderate severity. It is shown that in individuals with MHA moderate levels of stress resistance and adaptability in cognitive, emotional and behavioral spheres of the stress overcoming behavior significantly lower than for those who have symptoms of MHA was less pronounced irrespective of gender (p<0.05).
Consilium Medicum. 2016;18(12):40-43
pages 40-43 views

Torasemide clinical pharmacology: pharmacokinetics and pharmacogenetics

Leonova M.V., Alimova E.E., Eremina Y.N.


The article discusses the issues of pharmacogenetics in hypertensive patients, the influence of pharmacogenetic polymorphisms of different genes in the efficacy and safety of loop diuretic torasemide. A review of the scientific evidence on the influence of genetic polymorphism of metabolizing enzyme CYP2C9 and anion transporter on the pharmacokinetics of the drug (hepatic and renal clearance) and the pharmacodynamics (pronounced diuretic and salureticheskim effects) are also discussed.
Consilium Medicum. 2016;18(12):44-48
pages 44-48 views

The efficacy of antiarrhythmic therapy in the early postoperative period of catheter isolation of the mouths of the pulmonary veins for the treatment of paroxysmal atrial fibrillation

Tarasov A.V., Davtyan K.V., Miller O.N., Shatakhtsyan V.S.


Goal. Explore a comprehensive approach in monitoring and drug monotherapy with the evaluation of its effectiveness and safety of the following antiarrhythmic drugs (AAD): IC class - propafenone, III class - sotalol and class IV - verapamil, compared with the control group without the AAD, for the prevention of recurrence of atrial fibrillation (AF) and atrial tachyarrhythmias in the postoperative catheter isolation of the mouths of the pulmonary veins (PV). Material and methods. PRMF study (Prevention of recurrence of atrial tachyarrhythmias in the postoperative catheter wellhead isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation) is a prospective, comparative, open, randomized with a control group. Included in the study of men and women aged 25 years and over who suffer from symptomatic paroxysmal AF without structural heart disease. 243 patients (after invasive treatment to achieve electrical isolation mouth LP, confirmed during the operation) were randomized by envelope into 4 groups and control group. No significant differences in baseline characteristics: age, sex, duration of AF, the basic or comorbidities, echocardiography parameters and concomitant therapy, there were no between-group. Patients were 365 days. Results. The following results were obtained in the PRMF study: in group 1 (verapamil) effectiveness after 1st surgery was 65.5% (n=40) in group 2 (propafenone) - 70.96% (n=44) in group 3 (sotalol) - 65% (n=39) and control group (no AAD) - 65% (n= 39), respectively. During 3 months of follow up in all groups was carried out by an average 11.52±10.905 cardioversions medication (n=243), an average of 0.839±1.44 electrical cardioversion and the average number of hospitalizations for 3 months follow-up was 0.654±0.74 cases. Conclusion. Antiarrhythmic therapy in the postoperative period of radiofrequency ablation (RFA), the mouth of the LP does not affect the outcome of invasive therapy and repeated surgical intervention. 22% of patients have clinical efficacy. From AAD study significantly influenced the clinical course of early postoperative period of RFA mouth LP - only propafenone, reducing the average number of electrical cardioversion, pharmacological cardioversions and the number of hospitalizations associated with recurrent arrhythmias. Sotalol significantly reduced the mean number of hospitalizations, without lowering medication and electrical cardioversion in the early postoperative period of invasive treatment of AF.
Consilium Medicum. 2016;18(12):49-54
pages 49-54 views

The value of dietary supplements in the prevention of cardiovascular disease

Pogozheva A.V.


The review presents data on the role of biologically active food additives (BAA) in non-pharmacological prevention of cardiovascular disease (CVD). It is shown that poor nutrition is a significant risk factor (RF) contrbuting to CVD. Optimization of the diet by incorporating it supplements should be considered as one of the directions of prevention of these diseases. The importance of dietary supplement sources of macronutrients (such as polyunsaturated fatty acids, especially omega-3 family, phospholipids, squalene, phytosterols, dietary fibers) in the correction of risk factors of CVD. Modern data on the recommended level of dietary intake of micronutrients - vitamins, macro - and trace elements that make up the vitamin-mineral complexes. From the standpoint of the theory of oxidative stress, chronic inflammation of the expediency of inclusion in the diet of people with cardiovascular RF supplements containing antioxidant ingredients direction and lipotropic action, sources of which are vitamin-like substances and minor bioactive components of food. It is concluded that the inclusion of dietary supplements containing cardioprotective components in the power of people with CVD risk factors will have a preventive effect without increasing the energy value of the diet.
Consilium Medicum. 2016;18(12):55-59
pages 55-59 views

Medico-pedagogical system rehabilitation of patients with aphasia by innovative techniques of restoration

Scherbakova M.M., Kotov S.V.


Designed is innovative approach for speech recovery in patients with aphasia. This approach is based on the current view on the course of disease and specific factors influencing rehabilitation of speech. Our methods have been tested in the clinic neurology for 10 years. The developed methods have enabled to improve rehabilitation efficiency of patients with aphasias.
Consilium Medicum. 2016;18(12):62-67
pages 62-67 views

Improving the efficiency of nootropic therapy

Shavlovskaya O.A.


Traditionally, for the treatment of cognitive deficits neurologists prescribed nootropics. In order to achieve greater effect, the combination of several drugs (nootrop + vitamin and mineral complex) with different mechanisms of action, exhibiting a synergy of action was rightfully chosen. Complexes of vitamins B and C, macro - and micronutrients (calcium, magnesium, zinc), as well as folic acid, are part of the vitamin-mineral complexes, have an activating effect, exerting a positive influence on cognitive function and symptoms such as fatigue, change emotional background of mood, increased sensitivity to stress and anxiety.
Consilium Medicum. 2016;18(12):68-72
pages 68-72 views

Comorbidity and polypharmacy: focus on cytoprotection

Shishkova V.N.


The article discusses the pathogenetic relationship of neurological complications of the most common vascular diseases, as well as an assessment of the possibility of an early screening of the data and state drug prevention. Discussed in detail are the protective and therapeutic mechanism of action meldonium applied for this category of patients.
Consilium Medicum. 2016;18(12):73-79
pages 73-79 views

Features of the pharmacological actions and the use of dipyridamole in the prevention and treatment of viral infections

Kareva E.N.


The review presents recent data on the molecular mechanisms of antiplatelet, vasodilatory, angioprotective, antifibrotic and immunomodulatory effects of dipyridamole. The data of national studies on testing the effectiveness and safety of dipyridamole (Curantyl) in the prevention of acute respiratory viral infections and in the treatment of recurrent stress-induced opportunistic infections, which have shown that dipyridamole is an effective drug complex action with a good safety profile and the ability to have a positive effect on vessels in metabolic disorders in patients with a history of history, enables effective prevention of acute respiratory viral infections in patients at high risk.
Consilium Medicum. 2016;18(12):80-87
pages 80-87 views

Carbon dioxide exchange violation: features of the pathogenesis and diagnosis

Shtabnitskiy V.A.


Respiratory failure is a frequent and relevant complication of many diseases of the respiratory system and the cardiovascular and nervous systems. Acute and chronic respiratory failure is one of the adverse factors, and usually indicates the limit of the forecast for life. The ability to recognize early signs of respiratory insufficiency allows preventive treatment of respiratory disorders. For the correct choice of treatment, it is important to know the basic mechanisms of respiratory nedostatochnosti.V article understands detailed pathogenesis of carbon dioxide metabolic disorders. A brief review of diagnostic methods hypercapnia and hypocapnia.
Consilium Medicum. 2016;18(12):88-91
pages 88-91 views

Controversial aspects of modern ideas about the problem of chronic tonsillitis

Kosyakov S.Y., Angotoeva I.B., Polyakov D.P., Muldasheva A.A.


The simple form of chronic tonsillitis (CT) is based on subjective symptoms not amenable to digital assessment, which leads to erroneous diagnoses and consequently the ineffectiveness of the treatment. This article analyzes the literature on the study of the etiology and treatment of CT with evidence-based medicine, and also describes the most commonly used classification of CT.
Consilium Medicum. 2016;18(12):92-95
pages 92-95 views

Crohn's disease: modern aspects of anticytokine therapy

Akhmedov V.A., Orlov I.N., Gaus O.V.


A review of literature on topical issues in the treatment of inflammatory bowel diseases, such as Crohn's disease. It is based on the results of randomized studies conducted in the last 10 years. Considered terms such as “escape effect” and its causes, the transition from one anticytokine drug to another with the ineffectiveness of the first and the presence of the answer to it.
Consilium Medicum. 2016;18(12):96-99
pages 96-99 views

Basic principles of therapeutic education of diabetic patients (clinical lecture)

Redkin Y.A.


The article presents the basic principles of therapeutic education of patients with diabetes mellitus; displayed the stage of "awareness" of his patient's disease; the substantiation of tactics of the doctor with the patient's learning, located at each of the stages of the relationship to the disease; presented the rules of formulating individualized learning goals for the patient; the general recommendations at the beginning of training the patient self-control rules.
Consilium Medicum. 2016;18(12):100-102
pages 100-102 views

Modern approaches to the definition, classification and diagnosis of diabetic polyneuropathy. Pathogenetic aspects of treatment

Guriva I.V., Onuchina Y.S.


Diabetic neuropathy (DPN) is the most common complication of diabetes mellitus (DM) and the most common form of all peripheral neuropathies in the world. All patients with diabetes, regardless of the presence or absence of specific complaints, it is necessary to carry out an annual screening for DPN. There are the typical and atypical DPN. The reference method for the study of nerve conduction is electroneuromyography, which helps to establish the cash flow in the early stages. With a view to the diagnosis of atypical lesion unmyelinated with DPN and weakly myelinated nerve fibers of small caliber used quantitative sensory testing temperature/pain sensitivity, skin biopsy study of thin fibers of corneal confocal microscopy. The pathogenetic treatment of DPN include α-lipoic acid, B vitamins (thiamine, cyanocobalamin, pyridoxine), gemoderivat; tricyclic antidepressants, serotonin reuptake inhibitors and noradrenaline or α-2-β-ligands: to alleviate neuropathic pain by use of adjuvant analgesics can be recommended. Vitamins B1, B6 and B12 constitute a group of so-called neurotropic vitamins to ensure the normal structure and function of nerve cells, preventing them from damage in diabetes. For the treatment of DPN used with good effect Neyromultivit which comprises a combination of essential vitamins in therapeutic dosages, namely 100 mg of thiamine hydrochloride (vitamin B1), pyridoxine hydrochloride 200 mg (vitamin B6) and 200 mg of cyanocobalamin (vitamin B12). When using Neyromultivita there is a restoration of sensitivity of different types of nerve fibers, as well as a decrease in symptoms.
Consilium Medicum. 2016;18(12):103-109
pages 103-109 views

Bacterial (septic) arthritis and prosthetic joint infection

Belov B.S., Makarov S.A., Bialik E.I.


Currently, the problem of bacterial arthritis (BA) and prosthetic joint infections seems to be very relevant. BA and prosthetic joint infections are the cause of 0.2-0.7% of all hospital admissions per year. The frequency of deaths in asthma has not changed significantly over the past 25 years and is 5-15%. The article presents modern data on etiology, pathogenesis, clinical presentation, diagnosis and treatment of these clinical entities.
Consilium Medicum. 2016;18(12):110-116
pages 110-116 views

Panniculita in rheumatological practice

Belov B.S., Egorova O.N., Savushkina N.M., Karpova Y.A., Radenska-Lopovok S.G.


Under panniculita the heterogeneous group of inflammatory diseases characterized by lesions of subcutaneous fat is understood. The variety of their forms and course options requires a careful examination of the patient for the purpose of verification of the diagnosis. The article presents a diagnostic algorithm, setting out the principles of differential diagnosis and treatment approaches to panniculita in modern rheumatology practice.
Consilium Medicum. 2016;18(12):117-122
pages 117-122 views

Extra-pulmonary TB and HIV

Kulchavenya E.V., Zhukova I.I.


We analyzed the structure of morbidity in cases of isolated extrapulmonary TB, depending on the HIV co-infection, as well as the structure of morbidity of extrapulmonary tuberculosis with concomitant tuberculosis at other sites, according to the Novosibirsk regional TB Dispensary for 2015. Isolated extrapulmonary tuberculosis was diagnosed in 95 patients. In general, with the same frequency the tuberculosis of bones and joints and central nervous system (CNS), - by 31.6% occurred. However, if the share of the central nervous system tuberculosis (CNST) among immunocompetent individuals had only 4.1%, and in HIV-infected patients, the figure was 60.9% among immunocompetent patients with osteo-articular tuberculosis (OAT) was more than 2 times. In third place is tuberculosis of peripheral lymph nodes - 14.7%. In urogenital tuberculosis in total accounted for only 13.9%. Combined forms of tuberculosis were detected in 97 patients, including HIV-infected patients was 56 (57.7%) patients. Primarily the pulmonary tuberculosis (PD) in 74 (76.3%) of 97 cases was diagnosed , and in 23 (23.7%) patients with the disease to manifest extrapulmonary tuberculosis. Among the combined forms PD+CNS and PD+OAT. Variously for tuberculosis of peripheral lymph nodes, depending on the presence of HIV infection shows two clinical observations.
Consilium Medicum. 2016;18(12):123-126
pages 123-126 views

European Society of Cardiology Congress 2016

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Новые данные обширной исследовательской программы и результаты исследований реальной клинической практики из разных стран вновь подтвердили высокую эффективность и благоприятный профиль безопасности ривароксабана (Ксарелто®) компании Bayer
Consilium Medicum. 2016;18(12):127-128
pages 127-128 views

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