THE PREDICTORS OF PNEUMONIA IN PATIENTS WITH ACUTE VASCULAR DISEASES

Study Objective. To assess predictors of pneumonia in patients with acute myocardial infarction and acute ischemic stroke. Study Design: A retrospective analysis.Materials and methods. We reviewed archive data of 140 autopsy reports and medical histories of patients died from cardiovascular events to determine the frequency of pneumonia. The statistical analysis was used to derterman the connection between gender, age, duration of hospitalization, use of mechanical ventilation, central venous catheterization, presence of diabetes and COPD with the rate of pneumonia.Results and discussion. The study included 140 patients, of whom 84 (60,0%) with stroke in ischemic type 33 (23,6%) with stroke hemorrhagic type, and 23 (16.4%) with acute myocardial infarction. We examined the relationship of pneumonia with age, sex, duration of hospital stay, ventilator use, central venous catheterization, presence of diabetes and COPD. The average age of patients with pneumonia was 77±9 years, and without pneumonia 75±12 years. The average duration of hospitalization of the patients who died with pneumonia, was 13 (7,25; 25) days, and without pneumonia 3 (1; 10, and 25). Pneumonia developed in 39 (72,2%) males and 57 (66,3%) women. COPD was diagnosed in 98 (70%) patients. 19 patients (13,6%) patients have diabetes mellitus of the second type. CV catheterization was performed in 108 (77.1%) of the patient. In 83 (59.3%) patients during hospital treatment were on a artificial ventilation.Conclusion. The incidence of pneumonia increases depending on the duration of hospitalization, age, use of artificial ventilation. Gender, diabetes and COPD, central venous catheterization are not associated with the risk of pneumonia

Объективизация оценки качества труда и материального стимулирования медицинского персонала в стационаре

We propose and substantiate criteria of objective assessment of quality of work of medical staff in a hospital facility in order to restrict a length of inpatient treatment, to improve work of a doctor and a whole department and to achieve adequate material stimulation and appropriate wages. The criteria consider economic, medical and social aspects, allow computerized analysis of a doctor's and a department work, systematic analysis on clinical conferences and disclosure of factors worsening the quality of inpatients treatment.В статье предложены и обоснованы критерии объективной оценки качества работы медицинского персонала стационарного лечебно-профилактического отделения с целью сокращения сроков стационарного лечения, улучшения работы конкретного врача и отделения в целом, а также с целью оптимизации адекватного материального стимулирования и соответствующей качеству работы оплаты труда. Критерии учитывают экономические и медико-социальные аспекты и позволяют производить компьютерный анализ деятельности конкретного врача и отделения, при систематическом анализе на врачебных конференциях выявлять факторы, отрицательно влияющие на качество стационарного лечения больных

Саркоидоз: федеральные клинические рекомендации по диагностике и лечению

Sarcoidosis is a multi-organ granulomatosis  of unknown  origin. Modern  diagnostic methods  allow detecting  this disease at an early stage. The absence of specific markers requires a comprehensive  approach  to diagnosis based on comparison  of radiation,  clinical, morphological  and functional data. The course of sarcoidosis without damage to the respiratory system presents significant difficulties. It is extremely important  to understand the time and means of starting Sarcoidosis’s treatment to avoid the early initiation  of hormones  and cytostatics and, on the other hand,  to timely respond to progression and threatening  conditions.  Methods. Clinical recommendations are based on the analysis of Russian and English publications of the latest sarcoidosis research. The target audience of these clinical guidelines are therapists, general practitioners, pulmonologists, TB doctors, rheumatologists,  dermatologists,  radiation diagnosticians,  immunologists,  and clinical pharmacologists.  Each thesis-recommendation for diagnosis and treatment is evaluated on an 1 to 5 scale of levels of evidence and an A, B, C scale of the grades of recommendations. The clinical guidelines also contain comments and explanations for the theses-recommendations, diagnostic algorithms, treatment strategies, reference materials on the use of recommended drugs. Conclusion. Current information  on epidemiology, clinical manifestations,  diagnosis and management  strategies for patients with sarcoidosis are covered in the presented clinical guidelines. Approved by the decision of the Scientific and Practical Council of the Ministry of Health of the Russian Federation (2022).Саркоидоз является полиорганным гранулематозом неизвестной природы. При помощи  современных методов диагностики это заболевание возможно выявить на ранних стадиях. Для установления диагноза на основании сопоставления лучевых, клинических, морфологических и функциональных данных при отсутствии специфических маркеров требуется комплексный поход. Варианты течения саркоидоза без поражения органов дыхания представляют  значительные трудности. Во избежание  раннего  назначения гормонов  и цитостатических препаратов и, наоборот, в целях своевременного реагирования на прогрессирование и угрожающие состояния крайне актуально понимание времени  и средств  начала  лечения  саркоидоза.  Методы. Клинические рекомендации созданы  на основании анализа данных последних исследований саркоидоза, опубликованных на русском и английском языках. Каждый  тезис-рекомендация по проведению диагностических и лечебных мероприятий оценивается по шкалам оценки  уровня достоверности доказательств (1–5)  и убедительности  рекомендаций (по категориям  А, В, С). Клинические рекомендации содержат также комментарии и разъяснения к указанным тезисам-рекомендациям, алгоритмы  по диагностике, тактике терапии,  справочные материалы по использованию рекомендуемых препаратов. Целевой  аудиторией  данных  клинических рекомендаций являются  терапевты,  врачи  общей  практики,  пульмонологи, фтизиатры,  ревматологи,  дерматологи,   специалисты  лучевой  диагностики,  иммунологи, клинические  фармакологи.  Заключение. По данным представленных клинических рекомендаций освещаются современные сведения об эпидемиологии, клинических проявлениях,  диагностике и тактике  ведения  пациентов с саркоидозом. Одобрены  решением Научно-практического совета  Министерства здравоохранения Российской Федерации (2022)

EFFECTS OF LONG-TERM CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY (CPAP) ON EPICARDIAL FAT THICKNESS AND ARTERIAL STIFFNESS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND HYPERTENSION

Background: obstructive sleep apnea (OSA) is associated with high prevalence of arterial hypertension (AH), obesity, violation of carbohydrate metabolism and dyslipidemia. However, the effects of CPAP therapy to improve epicardial fat thickness of the OSA patient with AH the are poorly understood and poorly studied.Study objective: the aim of the study was to investigate 12-month effects of CPAP therapy with auto-adaptation to inhalation and exhalation of the OSA patient with AH and metabolic disorders (A-Flex therapy) on epicardial fat thickness (EFT).Methods: to the prospective single-center study were included 310 patients with OSA and AH (273 male, 45,3 ± 10,4 yr.) with apnea-hypopnea index (AHI) >5 events /hour. The night polygraphy study (PG) was performed to calculate AHI, oxygen desaturation index (ODI), mean nocturnal saturation (SpO 2 ) by the rules of American Academy of Sleep Medicine (AASM). The calculation of the epicardial fat thickness (EFT), the size and volume of the heart cavities, left ventricular mass index (LVMI) were performed by two-dimensional echocardiography. Endothelial functionof blood vessels determined by finger test was measured according to peripheral arterial tone (PAT). The reactive hyperemia index (RHI) and augmentation index (AI) was calculated. Optimal level of A-Flex therapy was adjusted at home. AHI, the level of air leakage, average pressure and compliance to CPAP treatment were established in accordance with international requirements.Results: after 3 months of A-Flex therapy we found a significant decrease of HOMA-IR -1,09 (95% Cl from -1,74 to -0,96; P=0,021), decrease AI -10.8% (95% Cl from -13,70 to -4.6; P=0,001), decrease EFT -1,26 mm (95% Cl from -2,2 to -0,95; P=0,001) in mild OSA patients. After 6 months of A-Flex therapy we found a significant decrease of HOMAIR -2,81 (95% Cl from -3,74 to -1,46; P=0,001), decrease AI -15.6 % (95% Cl from -17,23 to -11,75; P=0,001), decrease EFT -2,15mm (95% Cl from -3,2 to -1,5; P=0,001) in moderate OSA patients. After 12 months of A-Flex therapy we found a significant decrease of HOMA-IR -4,22 (95% Cl from -5,36 to -2,35; P=0,001), decrease AI -21,05 % (95% Cl from -26,5 to -17,4; P=0,001), decrease EFT -4,0 mm (95% Cl from-5,8 to -2,7; P=0,001) in severe OSA patients.Conclusions: The 12-month A-Flex therapy in moderate and severe OSA patients with AH has a significant therapeutic effect of stabilization systolic and diastolic blood pressure, level of blood lipids and epicardial fat thickness, level of endothelial dysfunction. The 12-month A-Flex therapy has to able to reduce the risks of cardiovascular events in moderate and severe OSA patients with acute metabolic manifestations

Rational antihypertensive therapy in patients with obstructive sleep apnea

Background. The relationship between obstructive sleep apnea (OSA) and hypertension (AH) is well known. In numerous studies it was found that obstructive sleep apnea was an independent predictor of the development of resistant AH (RAH), and the severity of apnea was directly correlated with the severity of RAH with the exception of the such confounders as age, obesity, sex.The purpose of this publication is to present a new strategy and modern approaches of drug and non-drug therapy of resistant hypertension in patients with OAS with the possibility of their implementation in real clinical practice.Conclusion. Currently, for a practitioner, the therapy of the patient with OSA and RAH is a serious clinical problem. A new rational therapeutic strategy for the treatment of such patients includes a combination of three-component drug therapy and non-drug continuous positive air pressure therapy (CPAP therapy). A reasonable duration of CPAP therapy should exceed 12 weeks. The proposed strategy for the treatment of patients with OAS+RAH has the highest efficiency of achieving blood pressure levels and significantly reduces the risks of fatal cardiovascular events