ДИАГНОСТИКА, ДИФФЕРЕНЦИАЛЬНАЯ ДИАГНОСТИКА И ЛЕЧЕНИЕ БРОНХООБСТРУКТИВНОГО СИНДРОМА: МЕСТО КОМБИНИРОВАННЫХ ПРЕПАРАТОВ Β2-АГОНИСТОВ И ИНГАЛЯЦИОННЫХ ГЛЮКОКОРТИКОСТЕРОИДОВ

Diagnosis, differentiation and management of bronchial obstructive syndrome: a role of β2-agonists and inhaled steroids combined in a single inhalerДиагностика, дифференциальная диагностика и лечение бронхообструктивного синдрома: место комбинированных препаратов β2-агонистов и ингаляционных глюкокортикостероидо

Шестилетняя выживаемость больных с тяжелой дыхательной недостаточностью, получавших длительную кислородотерапию на дому

Long-term oxygen therapy (LTOT) improves survival of patients with chronic obstructive pulmonary disease (COPD) having severe respiratory failure and chronic hypoxemia. In our study 51 patients received LTOT at home via concentrators (34 males, the mean age, 65.5 ± 7.8 yrs; 17 females, the mean age, 62.8 ± 4.1 yrs). Of them, 37 (72.5 %) survived 6-year period and 14 died (13 males and 1 female). Causes of death were acute respiratory viral infection (in 1 patient), insult (in 1 patient), chronic heart and lung failure (in 12 patients). Survival of patients with chronic restrictive pulmonary diseases was not longer than 3 years. A control group included 45 COPD patients with severe respiratory failure not receiving LTOT (30 males, the mean age, 66.3 ± 8.5 yrs; 15 females, the mean age, 69.1 ± 4.6 yrs). Of them, 16 survived 6 years and 29 died (5 females, the mean age, 72.6 ± 3.6 yrs, 24 males, the mean age, 67.8 ± 5.2 yrs). So, LTOT at home improves survival of COPD patients with severe respiratory failure.Длительная кислородотерапия на дому (ДКТ) увеличивает выживаемость больных хронической обструктивной болезнью легких (ХОБЛ) с явлениями тяжелой дыхательной недостаточности и хронической гипоксемии. Курсы ДКТ на дому при помощи концентраторов кислорода получали 51 пациент (34 мужчины, средний возраст — 65,5 ± 7,8 лет; 17 женщин, средний возраст — 62,8 ± 4,1 года). В течение 6 лет выжили 37 (72,5 %) и умерли 14 пациентов (13 мужчин, 1 женщина). Причинами смерти были: острая респираторно вирусная инфекция (1), инсульт (1), нарастающие явления сердечно-легочной недостаточности (12). Выживаемость пациентов с заболеваниями легких, приводящими к реструктивным нарушениям функции внешнего дыхания, не превышала 3 лет. В контрольной группе пациентов наблюдались 45 больных ХОБЛ, не получавших ДКТ на дому (30 мужчин, средний возраст — 66,3 ± 8,5 лет; 15 женщин, средний возраст — 69,1 ± 4,6 года). В течение 6 лет умерли 29 пациентов, выжили 16 (35,5 %). Среди умерших были 5 женщин (средний возраст — 72,6 ± 3,6 года) и 24 мужчины (средний возраст — 67,8 ± 5,2 лет). Причинами смерти в контрольной группе были: инсульт (4), повторный инфаркт миокарда (4), нарастающие явления сердечнолегочной недостаточности (21). Заключение: ДКТ на дому увеличивает выживаемость больных ХОБЛ с явлениями тяжелой дыхательной недостаточности

Simulation of wavepacket tunneling of interacting identical particles

We demonstrate a new method of simulation of nonstationary quantum processes, considering the tunneling of two {\it interacting identical particles}, represented by wave packets. The used method of quantum molecular dynamics (WMD) is based on the Wigner representation of quantum mechanics. In the context of this method ensembles of classical trajectories are used to solve quantum Wigner-Liouville equation. These classical trajectories obey Hamilton-like equations, where the effective potential consists of the usual classical term and the quantum term, which depends on the Wigner function and its derivatives. The quantum term is calculated using local distribution of trajectories in phase space, therefore classical trajectories are not independent, contrary to classical molecular dynamics. The developed WMD method takes into account the influence of exchange and interaction between particles. The role of direct and exchange interactions in tunneling is analyzed. The tunneling times for interacting particles are calculated.Comment: 11 pages, 3 figure

TACTICS OF PRENATAL CARE OF A YOUNG PATIENT WITH INHERITED LONG QT SYNDROME AND IMPLANTED CARDIOVERTER-DEFIBRILLATOR

Ase report. This clinical case illustrates the example of prenatal care of a young woman with verified long QT syndrome (LQTS) type 2 with implanted cardioverter-defibrillator (ICD). In the course of pregnancy she had physiological sinus tachycardia, though the life-threatening ventricular arrhythmias and ICD shocks were not registered. On the 38th week of pregnancy the woman underwent the planned caesarean delivery (due to obstetrics indications) with live child. In the post-partum period she continued to experience recurrent VF episodes terminated after the adequate ICD shocks. Life-threatening arrhythmias were triggered by group PVC registered in the settings of persistent bradycardia. At the moment the number of the adequate ICD shocks reduced supported by betablocker therapy, the patient remains on continued standard monitoring. Discussion. Numerous cases of favourable course and even benefits in clinical and functional status during pregnancy in patients with LQTS are reported. This fact can be conditioned by the positive influence of physiological hemodynamical changes and hypersympathicotonia during pregnancy especially on the bradydependent arrhytmias. Conclusion. Pregnancy in patients with inherited LQTS and implanted ICDs is not always contraindicated and treatment tactics depends on certain clinical situation. Algorithms of pharmacological and shock therapy during pregnancy in women with ICD are corrected individually

Re-envisioning Addiction Treatment: A Six-Point Plan

This article is focused on improving the quality of addiction treatment. Based on observations that patients are leaving treatment too early and/or are continuing to use substances during their care, the authors propose six actions that could help reorient and revitalize this kind of clinical work: (1) conceptualize and treat addictive disorders within a psychiatric/mental health framework; (2) make the creation of a strong therapeutic alliance a core part of the healing process; (3) understand patients’ addictions and other problems using models based on multiple internal parts, voices, or modes; (4) make contingency management and the use of positive reinforcement systems a standard and central practice in all treatment settings; (5) envision long-term change and healing through the lens of identity theory; and (6) integrate the growing developments in recovery culture with formal treatment

Markers of myocardial injury and inflammation after radiofrequency ablation in children and adolescents

Aim. To assess the severity of myocardial damage and inflammation after radiofrequency ablation in children and adolescents using biochemical markers.Material and methods. The study included 58 children with tachyarrhythmias (Wolff-Parkinson-White (WPW) syndrome, WPW phenomenon, atrial tachycardia, paroxysmal atrioventricular reciprocating tachycardia, ventricular tachycardia) who underwent catheter ablation from July to October 2019. Before and after surgical treatment (after 2 hours and 5 days), the blood concentrations of myocardial damage and inflammation biomarkers (myoglobin, creatine phosphokinase-MB, interleukin-8, C-reactive protein, tumor necrosis factor alpha, metalloproteinase (MMP)-2, MMP-9, heart-type fatty acid binding protein). During the operation, catheter ablation parameters (power, temperature, application duration), the localization of arrhythmogenic focus and the type of ablation catheter were recorded. Their relationship with changes in the concentration of biochemical markers before and after intervention was studied.Results. Two hours after the operation, the concentrations of myoglobin, creatine phosphokinase-MB, MMP-9, heart-type fatty acid binding protein were increased several times (p<0,05). Changes in concentrations of interleukin-8, tumor necrosis factor alpha after the operation was not revealed. On the 5th day, elevated levels of cardiac markers returned to baseline values. MMP-9 level also decreased, but was higher than the preoperative level. Using Spearman’s correlation analysis, a direct relationship was revealed between the application duration and heart-type fatty acid binding protein level.Conclusion. Radiofrequency ablation is a safe method of treating arrhythmias in children and adolescents, since there is low volume of damaged myocardium. There was a slight increase in the level of biochemical markers after ablation (myoglobin, creatine phosphokinase-MB, fatty acid binding protein, MMP-9), incomparable with their rise in acute coronary syndrome, as well as the rapid decrease in the early postoperative period

Особенности клинического течения заболеваний органов дыхания у лиц, участвующих в ликвидации аварии Чернобыльской АЭС

The aerosol radiation damage of airways was registered among Chernobyl catastrophe liquidators. There are few scientific data of aerosol radiation damage of airways. 9 liquidators — males at the age of 33—43 — were examined in our institute. They worked in highly dusted atmosphere that caused the inhalation of radioactive dust. The chronic obstructive bronchitis was diagnosed in 4 cases and chronic bronchitis with purulent sputum- in 4 cases and bronchial asthma — in 1 case. All patients were healthy before 1986. The first symptoms of the disease were found in 3 cases when the patients worked on atomic station in 1986 and in 6 cases — 3—6 years later. The specific feature of the disease was torpide inflammatory process with progressive respiratory failure. The pulmonary function testing demonstrated the obstructive abnormalities and the reduction of diffusing lung capacity. The examination of BAL discovered- the macrophages with polygonal optically dense particles in their cytoplasm. X-ray spectral analysis showed the existence of Np, FR, Pm, Pa, Pu in these particles. Thus, we suppose that inhaled radionuclides may play a significant role in the genesis of respiratory abnormalities for this patients category.Авария на Чернобыльской АЭС явилась одной из самых крупных экологических катастроф в мире за последние десятилетия с поражением обширных территорий страны и населения, проживающего на них. Наряду с воздействием проникающей радиации возникло аэрозольное радионуклидное поражение органов дыхания у лиц, находящихся в зоне загрязнения окружающей среды и, особенно, у ликвидаторов аварии. В доступной литературе данные о клинике, диагностике и лечении патологии бронхолегочной системы при таком виде поражения практически отсутствуют. В НИИ Пульмонологии М3 РФ обследовано 9 мужчин в возрасте от 33 до 43 лет, участвующих в ликвидации последствий катастрофы на ЧАЭС в 1986 году. Выполняемые работы были связаны с высокой запыленностью воздуха, что обусловило преимущественно ингаляционный путь проникновения радионуклидов в организм. Средняя паспортизированная доза облучения составила 22 Р. У 4 больных выявлен хронический обструктивный бронхит, у 4 — хронический гнойно-обструктивный бронхит, у 1 — бронхиальная астма. Все пациенты до 1986 года были практически здоровы. Первые симптомы заболевания у 3 больных возникли во время работы на ЧАЭС, у 6 — в сроки от 3 до 6 лет спустя. Особенностью заболевания у всех больных являлся вялотекущий воспалительный процесс с нарастающими признаками дыхательной недостаточности. При обследовании выявлен обструктивный тип нарушения и снижения диффузионной способности легких. При исследовании клеточного состава БАЛ в цитоплазме большинства альвеолярных макрофагов зарегистрированы оптически плотные полигональные включения. При рентгеноспектральном анализе в составе этих включений у 5 больных обнаружены прометий, франций, протактиний, нептуний, плутоний. Таким образом, предполагается роль ингаляционных радионуклидов в генезе выявленной патологии органов дыхания

Preventing the Reintroduction of Malaria in Mauritius: A Programmatic and Financial Assessment

Sustaining elimination of malaria in areas with high receptivity and vulnerability will require effective strategies to prevent reestablishment of local transmission, yet there is a dearth of evidence about this phase. Mauritius offers a uniquely informative history, with elimination of local transmission in 1969, re-emergence in 1975, and second elimination in 1998. Towards this end, Mauritius's elimination and prevention of reintroduction (POR) programs were analyzed via a comprehensive review of literature and government documents, supplemented by program observation and interviews with policy makers and program personnel. The impact of the country's most costly intervention, a passenger screening program, was assessed quantitatively using simulation modeling