Лечение бронхиальной обструкции у больных туберкулезом легких

.

Совершенствование лечения бронхиальной обструкции у больных туберкулезом легких

An assessment of the efficacy of bronchodilating therapy, which had been committed at the Federal programme for COPD patients management, was performed in lung tuberculosis patients with accompanying bronchial obstruction. Distinct advantages of modern inhaled therapy to traditional one were found. This led to significant reduction in respiratory signs and improvement in bronchial passability parameters. The data obtained allow these principles to be recommended for widespread use.Проведена оценка эффективности принципов бронхорасширяющей терапии, изложенной в Федеральной программе для больных ХОБЛ, при их применении у больных туберкулезом легких, протекающим с явлениями бронхиальной обструкции. Установлены отчетливые преимущества принципов современной ингаляционной терапии перед традиционными, что вело к значительному уменьшению респираторной симптоматики и улучшению показателей бронхиальной проходимости. Полученные данные позволяют рекомендовать широкое применение этих принципов в практике

Дифференциальная диагностика изменений в легких у пациентки с рецидивирующим течением папилломатоза гортани

Clinical observation of multi-cavity lung cancer in a patient with chronic recurrent laryngeal papillomatosis in a 23-year-old patient who underwent annual surgical treatment (papillomatous laser removal) is presented. Pulmonary cavities have been detected and differential diagnosis has been carried out at the annual fluorographic examination. The tactics of surgical intervention is due to the rare occurrence of this pathology, the lack of clinical manifestations and the peculiarities of the radiological picture.Представлено клиническое наблюдение многополостной формы рака легкого у 23-летней пациентки с хронически текущей формой папилломатоза гортани рецидивирующего течения, у которой ежегодно проводилось оперативное лечение заболевания (лазерное удаление папиллом). При ежегодном флюорографическом обследовании выявлены полостные образования в легких, проведена дифференциальная диагностика. Тактика хирургического вмешательства обусловлена редкой встречаемостью подобной патологии, отсутствием клинических проявлений и особенностями рентгенологической картины

Clinical case of multiple tumor-like eruptions in the practice of a Dermatovenerologist

A 26-year-old patient with multiple tumor-like formations attended by moderate itching, consulted a dermatologist. The presented clinical case demonstrates a late diagnostics of a relatively rare disease - type I neurofibromatosis (Recklinghausen disease).На консультацию к дерматовенерологу обратился пациент 26 лет с распространенным кожным процессом, представленным множественными опухолевидными образованиями, сопровождающимися умеренным зудом. Представленный клинический случай демонстрирует позднюю диагностику относительно редкого заболевания - нейрофиброматоза I типа (болезни Реклингхаузена)

Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group

<p>Abstract</p> <p>Background</p> <p>Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Several recent publications have noted an increasing trend in incidence over time. The international PPH collaboration was convened to explore the observed trends and to set out actions to address the factors identified.</p> <p>Methods</p> <p>We reviewed available data sources on the incidence of PPH over time in Australia, Belgium, Canada, France, the United Kingdom and the USA. Where information was available, the incidence of PPH was stratified by cause.</p> <p>Results</p> <p>We observed an increasing trend in PPH, using heterogeneous definitions, in Australia, Canada, the UK and the USA. The observed increase in PPH in Australia, Canada and the USA was limited solely to immediate/atonic PPH. We noted increasing rates of severe adverse outcomes due to hemorrhage in Australia, Canada, the UK and the USA.</p> <p>Conclusion</p> <p><it>Key Recommendations</it></p> <p indent="1">1. Future revisions of the International Classification of Diseases should include separate codes for atonic PPH and PPH immediately following childbirth that is due to other causes. Also, additional codes are required for placenta accreta/percreta/increta.</p> <p indent="1">2. Definitions of PPH should be unified; further research is required to investigate how definitions are applied in practice to the coding of data.</p> <p indent="1">3. Additional improvement in the collection of data concerning PPH is required, specifically including a measure of severity.</p> <p indent="1">4. Further research is required to determine whether an increased rate of reported PPH is also observed in other countries, and to further investigate potential risk factors including increased duration of labor, obesity and changes in second and third stage management practice.</p> <p indent="1">5. Training should be provided to all staff involved in maternity care concerning assessment of blood loss and the monitoring of women after childbirth. This is key to reducing the severity of PPH and preventing any adverse outcomes.</p> <p indent="1">6. Clinicians should be more vigilant given the possibility that the frequency and severity of PPH has in fact increased. This applies particularly to small hospitals with relatively few deliveries where management protocols may not be defined adequately and drugs or equipment may not be on hand to deal with unexpected severe PPH.</p

Craniectomy for Malignant Cerebral Infarction: Prevalence and Outcomes in US Hospitals

Randomized trials have demonstrated the efficacy of craniectomy for the treatment of malignant cerebral edema following ischemic stroke. We sought to determine the prevalence and outcomes related to this by using a national database.Patient discharges with ischemic stroke as the primary diagnosis undergoing craniectomy were queried from the US Nationwide Inpatient Sample from 1999 to 2008. A subpopulation of patients was identified that underwent thrombolysis. Two primary end points were examined: in-hospital mortality and discharge to home/routine care. To facilitate interpretations, adjusted prevalence was calculated from the overall prevalence and two age-specific logistic regression models. The predictive margin was then generated using a multivariate logistic regression model to estimate the probability of in-hospital mortality after adjustment for admission type, admission source, length of stay, total hospital charges, chronic comorbidities, and medical complications.After excluding 71,996 patients with the diagnosis of intracranial hemorrhage and posterior intracranial circulation occlusion, we identified 4,248,955 adult hospitalizations with ischemic stroke as a primary diagnosis. The estimated rates of hospitalizations in craniectomy per 10,000 hospitalizations with ischemic stroke increased from 3.9 in 1999-2000 to 14.46 in 2007-2008 (p for linear trend<0.001). Patients 60+ years of age had in-hospital mortality of 44% while the 18-59 year old group was found to be 24% (p = 0.14). Outcomes were comparable if recombinant tissue plasminogen activator had been administered.Craniectomy is being increasingly performed for malignant cerebral edema following large territory cerebral ischemia. We suspect that the increase in the annual incidence of DC for malignant cerebral edema is directly related to the expanding collection of evidence in randomized trials that the operation is efficacious when performed in the correct patient population. In hospital mortality is high for all patients undergoing this procedure

Nodular skin lesions on the face and upper extremities: clinical and pathomorphological diagnostics (case in clinical practice)

Data of the etiology, pathogenesis and clinical picture of a rare dermatosis from the group of mucinosis are presented. The description is given of the typical clinical manifestations of scleromyxedema (Arndt-Gottron Syndrome) at 61-year-old patient who applied for consultation to the doctor - dermatologist. The diagnosis was confirmed by pathomorphological examination of the biopsy of the affected skin.Представлены данные об этиологии, патогенезе и клинической картине редкого дерматоза из группы муцинозов. Приведено описание типичных клинических проявлений склеромикседемы Ардта-Готтрона у 61-летнего больного, обратившегося на консультацию к врачу - дерматовенерологу. Диагноз подтвержден патоморфологическим исследованием биоптата пораженной кожи

Maternal common mental disorders and infant development in Ethiopia : the P-MaMiE Birth Cohort

Background: Chronicity and severity of early exposure to maternal common mental disorders (CMD) has been associated with poorer infant development in high-income countries. In low- and middle-income countries (LAMICs), perinatal CMD is inconsistently associated with infant development, but the impact of severity and persistence has not been examined. Methods: A nested population-based cohort of 258 pregnant women was identified from the Perinatal Maternal Mental Disorder in Ethiopia (P-MaMiE) study, and 194 (75.2%) were successfully followed up until the infants were 12 months of age. Maternal CMD was measured in pregnancy and at two and 12 months postnatal using the WHO Self-Reporting Questionnaire, validated for use in this setting. Infant outcomes were evaluated using the Bayley Scales of Infant Development. Results: Antenatal maternal CMD symptoms were associated with poorer infant motor development ( β ^ -0.20; 95% CI: -0.37 to -0.03), but this became non-significant after adjusting for confounders. Postnatal CMD symptoms were not associated with any domain of infant development. There was evidence of a dose-response relationship between the number of time-points at which the mother had high levels of CMD symptoms (SRQ ≥ 6) and impaired infant motor development ( β ^ = -0.80; 95%CI -2.24, 0.65 for ante- or postnatal CMD only, β ^ = -4.19; 95%CI -8.60, 0.21 for ante- and postnatal CMD, compared to no CMD; test-for-trend χ213.08(1), p < 0.001). Although this association became non-significant in the fully adjusted model, the β ^ coefficients were unchanged indicating that the relationship was not confounded. In multivariable analyses, lower socio-economic status and lower infant weight-for-age were associated with significantly lower scores on both motor and cognitive developmental scales. Maternal experience of physical violence was significantly associated with impaired cognitive development. Conclusions: The study supports the hypothesis that it is the accumulation of risk exposures across time rather than early exposure to maternal CMD per se that is more likely to affect child development. Further investigation of the impact of chronicity of maternal CMD upon child development in LAMICs is indicated. In the Ethiopian setting, poverty, interpersonal violence and infant undernutrition should be targets for interventions to reduce the loss of child developmental potential.Peer Reviewe