Vol 22, No 11 (2020)


Antibacterial therapy for ENT diseases during the COVID-19 pandemic

Svistushkin V.M., Nikiforova G.N., Artamonova P.S.


In the structure of the pathology of the respiratory tract, including the ENT organs, the leading position is occupied by infectious and inflammatory diseases. Acute respiratory infections of the upper and lower respiratory tract account for 80-97% of all infectious diseases and in 20-30% of cases are the reason for patients of different ages to visit medical institutions. The primary cause of the development of inflammatory diseases of the ENT organs is most often viral agents, however, against the background of any viral infection, bacterial pathogens can be activated, which in some cases requires the appointment of appropriate systemic etiotropic therapy. An irrational approach to the choice of an antibacterial drug for the treatment of patients with infectious and inflammatory diseases of the respiratory tract leads to the growth and spread of antibiotic resistance, which today is a global health problem around the world. The emergence and significant expansion of a new coronavirus infection COVID-19 in the human population, the principles of treatment for which have not yet been clearly defined, entails frequent unjustified prescription of antibiotics, especially in mild cases of the disease, which also makes a certain contribution to the progression of resistance of microorganisms to drugs. Treatment of patients with respiratory infectious and inflammatory diseases, including etiotropic treatment, especially in the context of a pandemic of a new coronavirus infection, should comply with the clinical guidelines developed by the relevant national professional associations. Having an idea of the most probable bacterial pathogens of infectious diseases of the respiratory system, such as Streptococcus pneumoniae, Haemophilus influenzae and others, as well as considering their main protective factors, the professional medical community, including the National Association of Otorhinolaryngologists, recommend amoxicillin as the drug of choice for the treatment of patients with inflammatory and infectious diseases of the respiratory tract. If patients have risk factors for infection with antibiotic-resistant microorganisms, treatment is started with amoxicillin/clavulanate.
Consilium Medicum. 2020;22(11):10-15
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Differential diagnosis of acute tonsillopharyngitis

Guseva A.L., Levina L.V., Derbeneva M.L.


Acute tonsillopharyngitis (ATP) is one of the most common diseases that makes patients to search for primary medical care. In clinical practice, the differential diagnosis of streptococcal and viral pharyngitis is based on clinical manifestations along with express diagnostics. In pharyngitis caused by group A р-hemolytic streptococcus, febrile temperature, sore throat, plaque on the tonsils and lymphadenopathy in the anterior part of the neck are most characteristic signs and symptoms, while viral pharyngitis is typically associated with conjunctivitis, rhinitis, cough and diarrhea. In streptococcal pharyngitis, antibacterial therapy is indicated to prevent potential severe complications (including acute rheumatic fever and glomerulonephritis) while in viral pharyngitis -symptomatic treatment and plenty of drinking. In addition, ATP may be a symptom of infectious mononucleosis, acute retroviral syndrome in primary HIV infection and Kawasaki disease, pharyngeal diphtheria and hematological diseases. Purulent infections, including Lemierre's syndrome, Ludwig's angina, paratonsillitis, parapharyngitis, and retropharyngeal abscess, should also be considered in the differential diagnosis of ATP.
Consilium Medicum. 2020;22(11):16-20
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The choice of effective treatment for infectious and inflammatory diseases of the pharynx

Morozova S.V., Shchennikova E.S.


Sore throat is one of the most common patients' complaints at outpatient appointments in otorhinolaryngologists, general practitioners', and pediatrics' practice. Pain in tonsillopharyngitis is due to local factors, so local treatment plays an overwhelming role either for anti-inflammatory or painkilling effects. Nevertheless systemic antibacterial treatment is widespread during this pathology. But since this condition is usually caused by the viral infection, systemic antibiotic therapy should be prescribed strictly according to indications. Thereby, symptomatic treatment is the first line treatment that should be used in the patients with sore throat. Non-steroidal anti-inflammatory drugs are considered to be the most effective in that condition. According to the results of the number of studies, OKI is shown to be safe and effective against the symptoms of sore throat.
Consilium Medicum. 2020;22(11):21-24
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About treatment tactics for acute rhinosinusitis in adult patients, including pregnant women, during the period of accelerating antibiotic resistance

Ovchinnikov A.l., Miroshnichenko N.A., Nikolaeva Y.O.


Treatment of rhinosinusitis is still actual problem according to the reports of European Position Paper on Rhinosinusitis and Nasal Polyps 2020 and Centers for Disease Control and Prevention. A lot of scientific evidence suggests that herbal medicine may be helpful as an adjuvant or alternative treatment in patients with such diagnosis. Using herbal product Sinupret in therapy of diseases of upper respiratory tract is well-known, safe and effective. Concerning stated above at the Otorhinolaryngology department of Yevdokimov Moscow State University of Medicine and Dentistry observational study was carried out to evaluate efficacy and tolerability of Sinupret in complex therapy of rhinosinusitis. The study involved 52 patients of different sex and age, including 11 pregnant women. The assessment was made by several objective and subjective manifestations of the disease, as well as objective examination methods. As a result, herbal drug Sinupret have proven effective in acute rhinosinusitis.
Consilium Medicum. 2020;22(11):25-30
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Possibilities of therapy for patients with sensorineural hearing loss at the present stage

Svistushkin V.M., Ordyan A.B., Nikiforova G.N., Morozova S.V., Gergiev V.F.


Sensorineural hearing loss is one of the common diseases and it represents an urgent problem of otorhinolaryngology. The most complex and significant issues are acute and sudden sensorineural hearing loss. Every year, the number of patients suffering from this pathology is steadily growing. The increase in the number of cases of sensorineural hearing loss is associated with a number of socio-medical aspects of human life at the present stage - the growth of somatic and immune pathology, frequent stresses, high noise and vibration levels, regular use of headphones, environmental degradation and the influence of other adverse factors. The widespread use of audiometric research methods contributes to a more accurate diagnosis of impaired sound in patients of various age groups, which also affects the epidemiological data. In connection with the above, the study of modern treatment options for patients with sensorineural hearing loss is an urgent problem of clinical medicine.
Consilium Medicum. 2020;22(11):31-33
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Opportunities for acupuncture in treatment tinnitus

Morozova S.V., Shadyev T.H., Sinkov E.V., Malova E.V., Shibina L.M.


The article is devoted to an actual problem that family doctors, therapists, neurologists and otorhinolaryngologists frequent phenomenon in their practice - tinnitus. The definition of tinnitus is given. The division of ear noise into subjective and objective is considered. The prevalence of this pathology in different countries of Europe and North America is described. Reflects modern views on the etiology and pathophysiological mechanisms of the development of this pathology. The definition of acupuncture from the point of view of modern neurophysiology is given. Possibilities of various acupuncture techniques in the treatment of patients with ear noise are presented: corporal and auricular acupuncture, electropuncture. The experience of clinical application of these techniques by researchers in different countries in patients with tinnitus is described, including a comparison of the effectiveness of transauricular stimulation of the vagus nerve and electroauriculo-puncture. The results of a meta-analysis of publications on the use of various types of acupuncture in the treatment of patients with tinnitus for more than ten years are presented; the comparative assessment of the effectiveness of different acupuncture techniques in patients with tinnitus is presented.
Consilium Medicum. 2020;22(11):34-36
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Symptomatic therapy of acute respiratory viral infections with damage to the upper respiratory tract

Svistushkin V.M., Morozova S.V., Artamonova P.S.


Acute respiratory viral infections (ARVI) are an urgent problem for doctors of various specialties. Occupying a leading position in terms of accessibility to medical institutions, ARVI inflict significant economic damage due to the cost of drugs, as well as temporary disability of patients. The cause of ARVI can be the ingress of more than 200 different viral pathogens on the mucous membrane of the upper respiratory tract and, as a consequence, a decrease in its protective abilities with subsequent damage and the development of local and general inflammatory symptoms. The manifestations of acute respiratory viral infections are diverse, on the part of the ENT organs it is most often rhinorrhea, as well as discomfort, perspiration, sore throat, nasal congestion, decreased or loss of smell. For general intoxication syndrome in ARVI, severe headache, pain in muscles and joints, as well as general malaise and fever with an increase in body temperature of varying severity are characteristic. At the moment, there is no universal etiotropic drug for the treatment of acute respiratory viral infections, and therefore preference is given to symptomatic treatment. The use of symptomatic drugs is aimed at relieving such symptoms as pain of various localization and hyperthermia. The main drugs for such therapy are nonsteroidal anti-inflammatory drugs, which can be used as monotherapy and in combination therapy.
Consilium Medicum. 2020;22(11):37-42
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Patients with pulmonary arterial hypertension in the context

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Interview with S.N. Avdeev
Consilium Medicum. 2020;22(11):44-46
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Change in anti-SARS-CoV-2 IgG antibodies (COVID-19) among the population of the Russian Federation regions and in convalescents in dynamics

Smetanina S.V., Isaev A.N., Isaeva Y.O., Nurmukhametova E.A., Blokhina N.P., Nikolaev N.A., Ershov A.V.


Materials and methods. The article presents the results of laboratory tests for the presence of IgG antibodies to the SARS-CoV-2 coronavirus in 2112 patients living in 5 regions of the Russian Federation. In the main group of the study, 50 people were under dynamic observation for 6 months. Depending on the severity, the main group was divided into two subgroups: group I1 (n=25), represented by patients with moderate coronavirus infection, and group I2 (n=25), consisting of patients with a severe course of coronavirus infection. Blood sampling was carried out on the 14th day of illness (from the moment the first symptoms appeared) in the conditions of the procedure room of the Infectious Diseases Clinical Hospital №1, subsequent blood sampling (44 and 74 days, 3-6 months). Results. During a three-month observation of patients in the main group, there were no significant changes in the content of IgG antibodies to the SARS-CoV-2 coronavirus, and all fluctuations were characterized only by a trend. By the 4th month of observation, the decrease in antibody titer relative to the maximum level (as a rule, 14-44 days) was 43.3% in subgroup I,, and 37.6% in subgroup I2. By the 5th month, the level of IgG antibodies to the SARS-CoV-2 coronavirus in subgroup I, was 40.9% relative to the maximum value (on day 44), and in subgroup I2 - 35.0% relative to the maximum value (on day 14). After 6 months from the start of observation, the content of IgG antibodies to the SARS-CoV-2 coronavirus in both groups did not differ significantly from the control (p>0,05). Conclusion. We found that there were no significant changes in the level of IgG antibodies to the SARS-CoV-2 coronavirus from the 14th day of illness to the 3rd month of observation from the moment of the first symptoms of the disease. Starting from the 4th month of observation, the level of antibodies decreased in both groups by multiples in relation to the maximum values, decreasing by the 6th month of observation to the values of the control group.
Consilium Medicum. 2020;22(11):47-50
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Changes in markers of hematological, biochemical and coagulological blood tests with coronavirus COVID-19 infections

Abdullaev R.Y., Komissarova O.G.


This review provides new literature data on the features of changes in the indicators of clinical and biochemical analysis of blood, as well as hemostatic and fibrinolysis systems in patients with coronavirus infection COVID-19. It was shown that laboratory manifestations of COVID-19 have their own characteristics and are closely interrelated with the nature of the course of infection. In a clinical blood test, lymphopenia and thrombocytopenia are most common. Among the biochemical parameters of blood, an increase in the level of C-reactive protein and ferritin, as well as a decrease in the level of albumin, are more often detected. It should be noted that in 1/3 of severe patients with COVID-19 infection, the activity of liver enzymes, ALT and AST, increases. Among the indicators of hemostasis and fibrinolysis systems, an increase in the concentration of D-dimer in blood plasma is more often detected. The review also analyzes the possible causes of changes in some laboratory parameters with COVID-19.
Consilium Medicum. 2020;22(11):51-55
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Favipiravir as a potential countermeasure for COVID-19

Leonova M.V.


Favipiravir is a broad-spectrum antiviral agent, an analogue of purine nucleosides, licensed as an anti-influenza drug in Japan. Like other analogs of nucleosides, favipiravir acts as a prodrug, and undergoes an intracellular phosphoribosylation to be an active form, favipiravir ribofuranosyl-5'-triphosphate. The metabolite competitively inhibits the activity of RNA polymerase of RNA viruses and prevents virus replication by incorporating into the viral RNA, acting as a chain terminator. It possesses selective or virus-specific intracellular action and low cytotoxicity. Favipiravir inhibits viral RNA synthesis by terminating chain elongation, which reduces the likelihood of mutations and the emergence of resistant virus strains. Favipiravir causes a significant decrease in pro-inflammatory cytokines levels, which enhances the antiviral effect. Favipiravir demonstrated antiviral activity against a broad spectrum of RNA viruses, such as influenza A, B and C viruses, Ebola virus, Lassa virus, rabies, etc. In 2020, as part of screening testing of antiviral drugs, including favipiravir, it was shown in vitro antiviral activity against 2019-nCoV with better efficacy and selectivity compared to ribavirin. More than 10 clinical trials have been initiated to study the effectiveness of favipiravir for the treatment of mild to moderate COVID-19. A fixed loading and maintenance dose of 3200/1200 mg and 3600/1600 mg was used. The results showed a better clinical effect with earlier elimination of coronavirus, regression of computed tomographic changes and the need for mechanical ventilation in the favipiravir treatment groups compared with lopinavir/ritonavir, Arbidol and other drugs. In a Russian phase II/III clinical study of efficacy and safety of favipiravir (Avifavir) (1600/600 mg or 1800/800 mg 2 times a day) vs standard treatment in patients with moderate COVID-19, favipiravir showed virus clearance within 4 days in 62,5% of patients, safety and good tolerance. Favipiravir is included in the Russian guidelines for the treatment of COVID-19 and is the only approved oral medication for the treatment of moderate COVID-19 to date.
Consilium Medicum. 2020;22(11):56-60
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Case of cryptogenic organizing pneumonia

Belotserkovskaya Y.G., Tiurin I.E., Shvaiko S.N.


Cryptogenic organizing pneumonia is a diffuse lung disease characterized by excessive proliferation of granulomatous tissue in the small bronchi and alveoli and moderate interstitial inflammation. The diagnosis requires a multidisciplinary approach involving a pulmonologist, a radiologist and, in some cases, a morphologist. In most patients, cryptogenic organizing pneumonia is diagnosed on the basis of clinical symptoms, typical findings in computed tomography and cytology of the bronchoalveolar lavage fluid, after excluding the known causes of organizing pneumonia. Secondary confirmation of the diagnosis is a pronounced positive response to glucocorticosteroid therapy. The article presents a clinical case of a 58-year-old patient with progressive dyspnea and infiltrates in the lungs, which were initially interpreted as a manifestation of bilateral pneumonia. High-resolution computed tomography of the chest organs revealed a characteristic picture of "organizing pneumonia". Clinical and radiological changes regressed after glucocorticosteroid therapy.
Consilium Medicum. 2020;22(11):61-65
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Cough: from basics to pharmacotherapy

Zaitsev A.A., Okovity S.V.


The article considers current issues in the management of patients with cough. It provides a definition of cough, its clinical classification, analysis of main causes, a list of necessary diagnostic methods and directions of pharmacotherapy. A place is given for the differential diagnosis of various pathological conditions and diseases, the leading clinical sign of which is cough. The authors describe the characteristics of drugs for the treatment of cough, the principles of using mucoactive drugs, practical recommendations for rational pharmacotherapy of unproductive and productive cough.
Consilium Medicum. 2020;22(11):72-77
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Features of clinical manifestations and diagnostics of pulmonary tuberculosis and opportunistic lung infections combination in adult patients with advanced HIV infection and immunodeficiency

Mishina A.V., Mishin V.Y., Ergeshov A.E., Sobkin A.L., Romanov V.V., Kononets A.S.


Aim. To study the features of clinical manifestations and diagnostics of a combination of pulmonary tuberculosis (PTB) and opportunistic lung infections (OLI) in patients in advanced stage of HIV infection with immunodeficiency. Materials and methods. The study included 338 patients with newly diagnosed PTB with isolation of Mycobacterium tuberculosis, aged 25-60 years, having stage 4B and 5 HIV infection in a stage of progression, with no antiretroviral therapy, who were divided into 2 groups: 169 patients with a combination of PTB and OLI (main group) and 169 - with PTB (comparison group). All patients underwent clinical and laboratory, radiation and bronchological examination, as well as microbiological, immunological, molecular and genetic, cytological and histological examination of the diagnostic material from the respiratory tract, cerebrospinal and pleural fluid, blood, urine and feces in order to reveal OLI. Statistical analysis was carried out using Microsoft Office Excel 2010, data are presented as mean and standard deviation, the confidence interval. Results. It was found that tuberculosis in patients of the main group and the comparison group was generalized with multiple lesions and extrapulmonary phenomena, which include severe intoxication syndrome, bronchopulmonary lesions and symptoms of other organs and systems disorders. These made it difficult to differentiate between the PTB+OLI combination and PTB, and their diagnosis is possible only when M. tuberculosis and causative agents of other OLI are detected. If there is a combination of several lung diseases, chest computed tomography shows dissemination syndrome, adenopathy syndrome and lung pattern pathology syndrome, which looks like ground-glass opacity. In these cases, the PTB+OLI combination played not the least role, which together with direct lung lesions by HIV, made it impossible to differentiate these pathologies. The difference was possible only when M. tuberculosis and causative agents of other OLI were identified. Conclusion. With study data, an algorithm for the sequential etiological diagnosis of the PTB and OLI combination in patients with advanced stages of HIV infection with immunodeficiency was proposed.
Consilium Medicum. 2020;22(11):78-86
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Combination of pulmonary tuberculosis and interstitial lung disease in the same patient

Kuklina G.M., Shmelev E.I., Makar'iants N.N.


This article presents the issue of diagnosis of two coexisting lung diseases (pulmonary tuberculosis and interstitial lung disease) in a 53-year-old muscovite without chronic diseases. The hard way of diagnostic procedures, which had to go through, is shown: repeated bronchological examination, two videothoracoscopic lung biopsies.
Consilium Medicum. 2020;22(11):87-90
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Algorithms for the management of patients with a new coronavirus COVID-19 infection in a hospital. Guidelines

Zaitsev A.A., Chernov S.A., Stets V.V., Patsenko M.B., Kudriashov O.I., Chernetsov V.A., Kriukov E.V.


The guide is devoted to issues of practice on diagnosis and treatment of the new coronavirus COVID-19 infection. The purpose of creating this document was the need to develop a unified approach to providing care to patients with the new coronavirus COVID-19 infection in military hospitals in terms of the practical experience of hospital specialists, the requirements of national guidelines. The most important recommendations concern the issues of correct understanding of the disease, algorithms for actions of medical personnel and pharmacotherapy regimens for patients with coronavirus infection.
Consilium Medicum. 2020;22(11):91-97
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