The problem of iatrogenesis inevitably dictates the need for not only an exhaustive definition (which in principle is impossible), but also classification with a division into different species. The article deals with the main types of iatrogenia, the classification of iatrogenic proposed by I.A. Kassirsky, E.M. Tareev, S.Ya. Doletsky, A.V. Smolyannikov, V.V. Nekatchalov, and others, which are based on various principles and approaches. Given the expanded interpretation of iatrogenic and the need for a multidisciplinary approach to this problem among iatrogenic events, it is suggested to distinguish the following types of iatrogenic: psychogenic, hospital, therapeutic and preventive, iatrogenic diagnostic studies. Particular attention is paid in the article to psychogenic iatrogenia, which often arises in the process of communication between a doctor and patients. They consider not only iatrogenia, «having a starting point for the behavior of a doctor», but also iatrogenia, caused by certain traits of the patient’s character (insecurity, propensity to anxiety fears, increased attention to the slightest changes in health, emotional vulnerability, etc.), predetermining inadequate reactions to any Medical information. Of no small importance in the development of psychogenic iatrogenia is the quality of the medical documentation issued by the doctor to the patient (extracts from the case histories, advisory opinions, descriptions of research results, recommendations, etc.). In this case, it is necessary to avoid formulations that, without proper explanation, may be inadequately perceived by the patient and alert him or her. To the sources of psychogenic iatrogenic, some authors also refer to improperly conducted medical education, the publication of contentious, nonscientific results that do not meet the requirements of evidence-based medicine, although the doctor may not directly participate in this. The author of the article encourages colleagues to pay more attention to the process of communication with the patient, the preparation of documentation in the process of patient management, to remember that psychogenic iatrogenia can have negative consequences for the patient, and can be a source of violation of the relationship between the doctor and the patient.

 

Information on etiology, epidemiology and clinical manifestations of acute liver failure is systemized. The review provides statistics on the frequency of its occurrence in different nosological manifestations, describes the most frequent developed complications and the main approaches to therapy. Aim: to raise awareness of acute liver failure among physicians.

 

It is well known that the inflammatory process in rheumatoid arthritis (RA) is mediated by free radicals. Antioxidant vitamins can neutralize oxidative cell damage, so they suggested alleviate symptoms and prevent progression of RA. This article provides an overview of a current literature about clinical role of the antioxidant vitamins in patients with RA. In general, only a few clinical trials focused on this issue, and just a high dose vitamin E supplementation demonstrated moderate clinical efficacy in RA. On the other hand, convincing evidence exist that Mediterranean diet, rich in antioxidants, may reduce inflammatory activity, increase physical functioning and improve general well-being. In conclusion, patients with RA should follow antioxidant-rich diet (grains, fruits, vegetables) rather than take vitamin supplementation.

 

The goal — a scientific evaluation of the effectiveness and safety of NHS in the treatment of experimental drug-resistant tuberculosis. Materials and methods. Used silver nanoparticles obtained by an electrochemical method. With a size of 5-60 nm, 120-270 kontsentratsiey- 1 mcm² and the size of the stabilizer shell — 2-5 nm. 750 crops studied Inhibitory activity of the silver nanoparticles in an isolated form and as part of a nanocomposite with chemotherapy in concentrations of 5; 25 and 50 mcg/ml. Defines the minimum inhibitory concentration of bactericidal nanoparticles composed of a nanocomposite with isoniazid. To evaluate the morphometry M.tuberculosis used atomic force microscopy. Toxicology nanopreparations studied 83 non-linear white mice and 146 white rats. Chemotherapeutic Activity nanopreparations determined on an experimental model of tuberculosis in 65 white male mice imbrednoy line BALB/c. Infectivity dose amount 5х106 colony forming units injected into the sinus venosus animal eyes. Isoniazid, nanoparticles and nanocomposite began administered 14 days after infection by intramuscular injection daily. Treatment efficacy was determined by comparing the evaluation criteria in the experimental and control groups of animals. Evaluated the following indicators: survival index, body mass index and weight of target organ, lesions index, index smear and inoculation of affected organs. Conducted pathological examination. Results. When using isoniazid, which had resistant pathogens, with silver nanoparticles full and significant inhibition of the growth of the M.tuberculosis observed in 49,2% of cases. When the concentration of the nanoparticles 5 mcg/ml in the composite bactericidal activity reached 91,3%. The minimum inhibitory concentration of silver nanoperticles in combination with isoniazid was 2,5 mcg/ml, the minimum bactericidal — 5 mcg /ml. There have been changes in the M.tuberculosis morphometry under the influence of the nanocomposite according to atomic force microscopy. In the studied doses of isolated silver nanoparticles do not affect the basic biometrics, laboratory and functional parameters of the animals, and do not increase the toxicological parameters of isoniazid. All criteria studied the effectiveness of treatment of experimental tuberculosis had significantly priority performance using nanocomposite. Pathological studies have confirmed these results. Conclusions. Of the study provides a scientific rationale for the effectiveness of the experimental use of silver nanoparticles in treatment of drug-resistant tuberculosis. The most effective dose of silver nanoparticles in the composite in the treatment of experimental tuberculosis is 25 mcg / kg.

Objective: to clarify the dynamics of quality of life and psycho-autonomic profi le of patients with hypertension in combination with metabolic syndrome, with the use of interval normobaric hypoxic training. Materials and methods: examined 104 patients with essential hypertension stage I — III, 1 — 3 degrees on the background of metabolic syndrome, the average age 48,29±2.23 years. The observation group (54 patients) received a course of interval normobaric hypoxic training on the background of pharmaco- and diet therapy. The comparison group (50 patients) received drug therapy and diet therapy. Quality of life was assessed by SF-36 questionnaire (Russian version), psychological status scale CESD depression, vegetative disorders — according to the “Questionnaire to identify signs of vegetative changes Wayne”. The studied parameters were determined at baseline, after 1 and 6 months from initiation of therapy. Results: the dynamic monitoring of the surveyed showed positive changes in the clinical picture of the disease in both groups in the normalization of blood pressure, reduction of body mass index, more pronounced in patients of the observation group. The application course of interval normobaric hypoxic training provided signifi cantly earlier and more pronounced dynamics of quality of life, reducing the severity of depressive and vegetative disorders in patients. Conclusion: the course of interval normobaric hypoxic training in patients with essential hypertension and metabolic syndrome on the background of drug treatment provides the positive dynamics of quality of life, psychological and vegetative indices, exceeding the effi ciency of isolated pharmacological treatment. The estimation of these parameters can serve as an additional criterion in assessing the therapeutic effect of antihypertensive treatment.

 

The modern concepts about possible relationship between congestive heart failure and osteoporosis are described in the article. The results of bone mineral density and bone metabolism evaluation in very elderly patients with congestive heart failure (CHF) are presented. Bone mineral density was significantly lower in CHF-patients compared to control group (age-matched patients with similar main diseases — coronary artery disease and arterial hypertension). Largest differences were observed in proximal femur (р=0.01). Greater differences in BMD were detected in female patients (p=0.002). The reduced osteoblast function was observed in CHF-patients; mean osteocalcin level was 1.23 ng/ml in the CHF-group and 4.16 ng/ml — in the control group (p=0.03). Also increase of Beta-Cross laps (bone resorption marker) was registered in CHF-patients (p=0.003 vs control group). The significant negative correlation between tumor necrosis factor-a concentration and bone mineral density (especially in proximal femur) was detected (p=0.03). TNF-a levels were higher in CHF-patients than in the control group (p=0.04). In addition, bone mineral density values were lower in patients with low leptin level than in those with normal and high leptin concentrations (p=0.006). Noteworthy that low leptin values were detected in CHF-patients only.

 

The aim. To study the frequency and possible causes of the bacterial overgrowth syndrome in patients with cholelithiasis. Materials and methods. The study involved 76 patients with cholelithiasis. Used the results of endoscopic and radiologic studies in addition to general clinical data. The bacterial overgrowth syndrome determined using the hydrogen breath test with lactulose on LaktofaN2 coater AMA (St. Petersburg). Colonic microflora was assessed by seeding feces on different selective media. Results. In 86,8% of patients with cholelithiasis identified the bacterial overgrowth syndrome, accompanied by numerous clinical manifestations, such as bloating, diarrhea, pain and discomfort in the right iliac region, general weakness and fatigue, loss of weight. In most cases (73,6% patients) the bacterial overgrowth syndrome arose against the background of failure ileocecal closing apparatus (75% of patients with prestone stage of cholelithiasis and 82,1% of patients with stone stages of cholelithiasis). In 94,7% of patients had colonic dysbiosis, which promotes cecoileal reflux, thus causing the development of the bacterial overgrowth syndrome. Scarce dysbiosis (decrease of Bifidobacteria, Lactic acid bacteria, Escherichia coli) was more pronounced in patients with stage II and III of cholelithiasis, pathogenic dysbiosis (the presence of opportunistic pathogens) — in patients with stage I of cholelithiasis. In 55,3% of cases the bacterial overgrowth syndrome was due to both ileocecal failure and impaired colonic microflora. In 26,4% of patients the bacterial overgrowth was stored function of the ileocecal valve. Conclusion. In most cases development of the bacterial overgrowth syndrome is due to the insufficiency of the ileocecal obturator apparatus and colonic dysbiosis.

Study objective. To assess the peculiarities of hospitalization of patients with AF in combination with CHD in the departments of the general therapeutic profile of a multidisciplinary hospital, the frequency of complications of various forms of AF, to analyze anticoagulant (AC) and antiplatelet (AP) therapy in prehospital (PreH), hospital and post-hospital (PostH) stages of treatment based on the register. Material and methods. 502 patients were included in the prospective hospital registry RECVASA AF-Kursk, 480 of which with the diagnosis of AF in combination with ischemic heart disease were hospitalized in the therapeutical departments of Kursk Emergency Hospital during the period from 01.06.2013 to 31.05.2014. 2-3 years after the referral hospitalization, information about the drugs taken was collected after telephone or face-to-face contact with survived patients (n = 293), as well as their relatives, treating doctors. Results. The study included 261 women and 219 men, with an average age of 70.4 ± 10.3 years. The greatest number of patients with AF was treated in the departments of cardiology and therapy. In all departments, patients with a permanent AF prevailed, with the exception of cardiology, where the proportion of patients with persistent AF was the greatest. The share of stroke and MI was 39.4% and 29.8%, respectively. The cases of emergent hospitalizations recorded 56.8%, 28.6% of them — because of the AF. Among patients with different forms of AF, there were no differences in the frequency of emergent hospitalizations (p>0.05). The polyclinic directed 38% of patients, 41% of AF (p = 0.007). In all cases, the main cause of the hospitalization was cardiovascular disease (CVD). In patients with AF and IHD, prognostically significant AC therapy at the outpatient stage was assigned in 5.3%. By the time of discharge from hospital, the frequency of application of AC increased to 26.5% (p = 0.0001); Among patients with a permanent AF, AC are used significantly more often — in 30% of cases, in comparison with other forms of AF. At the PH stage, there remains a low share of AC (20%). At the same time in 20% of the PreH stage, 74.2% at the time of discharge and 64.5% of the cases at the PostH stage, instead of AC, AP were unreasonably prescribed. Conclusion. According to the prospective registry RECVASA AF-Kursk patients with AF in combination with IHD are hospitalized in the hospital, mainly because of CVD, half of them for emergent indications. Stroke and MI in this category of patients reaches a third of cases. There is a low frequency of prescribing ACat all stages of treatment (5.3% in PreH, 26.5% at discharge and 20.2% in PostH stages), unjustifiably replaced with AP therapy. At the hospital and PostH stages, significantly more frequent use of both AC and AP is observed in comparison with the PreH stage.

The article describes the clinical case of the first revealed vera polycythemia in a 67-year-old man admitted to a hospital in the hematological department of the Republican Clinical Hospital named after. G.G. Kuvatov, Ufa, about the restenosis of the superficial femoral artery. On admission, the patient’s main complaints were pain in the left leg, shortness of breath with physical exertion, headache, unstable blood pressure, numbness of hands, fatigue, general weakness. In addition, the patient was troubled by severe itching. When entering the objective status of the patient, attention was drawn to the hyperemia of the face and neck, injection of sclera, acrocyanosis, cyanotic shade of the oral mucosa, amputation stump of the lower left third of the thigh, necrotic area on the skin of the distal part of the middle finger of the right leg. After receiving laboratory and clinical data, as well as on the basis of patient complaints, a history of the disease and a clinical picture, the final clinical diagnosis was established: the vera polycythemia II B stage. Against the background of ongoing therapy, the patient noted improvement in general condition, stabilization of blood pressure, reduction of pain in the right leg, reduction of dyspnea, itching of the skin, improvement of sensitivity in the hands. According to laboratory data, positive dynamics was also revealed. This clinical observation emphasizes the need for timely diagnosis and continuous monitoring of the treatment of vera polycythemia with the help of clinical and laboratory-instrumental research methods, which is a prerequisite for correct prognosis of the course of the disease and for achieving maximum effectiveness of the therapy.

 

Background. Scurvy is very rarely seen in modern conditions. Material and Methods. We observed a case of scurvy that occurred as a result of prolonged malnutrition in a previously healthy 50-year-old man with low income. Results. The disease was manifested by severe weakness, edema of the legs, gingivitis and spontaneous hemorrhagic eruptions on the legs, which were initially regarded as hemorrhagic vasculitis. The confluent character of hemorrhagic eruptions, their predominant localization along the posterior surface of the legs, the presence of perifollicular hemorrhages, pathognomonic for scurvy, gingivitis, complete absence of ascorbic acid consumption for several months, as well as concomitant alimentary dystrophy and multivitamin deficiency, allowed us to suspect scurvy in the patient. The rapid effect of vitamin C treatment has confirmed this diagnosis. Conclusions. The differential diagnosis of spontaneous hemorrhagic eruptions and purpura in patients with prolonged malnutrition should include scurvy, a disease almost forgotten in modern conditions.

 

Data on the frequency, nature, risk factors and diagnosis of infectious complications (IC) in patients with cardioimplanted electronic devices (CED) — artificial rhythm drivers, cardiodefibrillators, devices for cardiosynchronizing therapy — often prognostically unfavorable, accompanied by high mortality, are given in the article. The data of a large-scale retrospective analysis of 200 219 patients with CED are given during the 3-year period after implantation. It was noted that among persons with IC there was a higher mortality rate compared to patients without signs of infection. In the analysis of cases of IC, the main risk factors for their development are identified, including. Presence of concomitant pathology. This article discusses the basic types of microorganisms were isolated from patients with the presence of IC, IC clinical symptoms, provides a diagnostic algorithm for suspected IC. A feature of the clinical case presented in the article is a relatively early development of IC with damage to the valve structures (tricuspid valve) — the first symptoms of bacterial damage appeared 6 months after the operation. Usually infectious endocarditis in patients with CED was verified at various times after implantation — from 1 to 72 months, and in most cases not earlier than 3 months later. The main clinical manifestations of the disease were recurrent fever, which is why the patient was repeatedly hospitalized for several months in various medical institutions. In each hospital, the patient management tactics were different and did not meet the accepted standards of diagnostic search in a febrile patient with CED. Only with the third hospitalization of the patient (November 2015) during the transthoracic echocardiography were revealed vegetations on the valves of the tricuspid valve. The given clinical observation testifies not only to the difficulties of diagnosing IE in patients with the presence of CED, but also about the inevitable mistakes in maintaining this category of patients when the standards for diagnosis and treatment of IE are not complied with. The authors emphasize that in the course of diagnostic search, and later in the development of treatment tactics, it is necessary to follow the ESC Guidelines for the management of infective endocarditis in 2015.