Kidneys and covid-19

For citation: Kidneys and COVID-19. Interview with N.F. Frolova. Consilium Medicum. 2021; 23 (1): 7–10. DOI: 10.26442/20751753.2021.1.200781

Endoscopic stenting of refractory benign esophageal strictures (review)

Despite the fact that the overwhelming majority of benign esophageal strictures, although long-term, but effectively stop with the help of endoscopic recanalization, 10% of them recur. Such strictures are a major problem in thoracic surgery. Disabled surgical methods of treatment are associated with a sufficiently high mortality rate and do not guarantee the formation of new anastomotic strictures. Esophageal stenting against the background of a limited endoscopic arsenal of methods for recanalization of benign strictures is the last option. A lot of different models of esophageal stents with their own individual characteristics and features have appeared since the introduction of the first stents in clinical practice. All were investigated in an attempt to identify the optimal stent type and design for the treatment of refractory benign strictures. The review is devoted to the current state of stenting in recurrent benign esophageal stenosis. The review reflects the efficacy and disadvantages of various types of stents and their comparison with a focus on new biodegradable stents used in the treatment of benign esophageal strictures.

Biomarkers of acute kidney disease. potential application in practice

Acute kidney injury (AKI) is a common clinical syndrome. Its variety of presentation explains the absence of “kidney troponin”. Many research projects of new biomarkers are ongoing now. The enormous number of biomarkers has been identified already. It makes difficult to choose the correct test and dictates the importance of the fastest and most accurate introduction of AKI biomarkers into clinical practice. The integration of appropriately selected biomarkers in routine clinical practice for high-risk patients of AKI is very important. Currently, serum creatinine (sCr) and urine output are used to define AKI in accordance with the definition of KDIGO (Kidney Disease: Improving Global Outcomes), which have a number of significant limitations for practitioners, including the inability to diagnose AKI before serum creatinine levels increase. Practitioners need systematic information about the latest AKI markers and possible situations, when and for which patient groups they can be used. This is the main goal of our review. Keywords: acute kidney injury, biomarkers, NGAL, TIMP-2, IGFBP7, cystatin C, markers, injury, kidney stress For citation: Schelkanovtseva ES, Mironova OIu, Fomin VV. Biomarkers of acute kidney disease. Potential application in practice. Consilium Medicum. 2021; 23 (1): 15–19. DOI: 10.26442/20751753.2021.1.200729

A patient with lacrimation at an otorhinolaryngologist consultation

Lacrimation is one of the most common symptoms in ophthalmic practice. Most patients first visit an ophthalmologist, but the otorhinolaryngologist also plays an important role in determining the etiology of the disease and in the choice of management for such patients. This review presents a literature search that addresses the diagnosis and treatment of patients with epiphora. Identifying the cause of lacrimation is the main factor in making the correct diagnosis and choosing the optimal treatment method. Endonasal dacryocystorhinostomy is of particular importance. The multidisciplinary approach of the ophthalmologist and otorhinolaryngologist allows for the success of the epiphora treatment.

Tactics of managing patients with primarily detected nasopharyngeal neoplasm. Case reports

In 5% of cases in the nasopharynx of an adult can be found a neoplasm with benign or malignant nature. Clinical manifestations of such pathology are next: persistent dysfunction of the auditory tubes, nasalness and postnasal drip syndrome. Endoscopy of the nasopharynx, computed tomography of the sinuses and magnetic resonance imaging of the head are the main diagnostic criteria for detecting neoplasms in this area. The tactics of treatment depends on the dysplasia type of the pathological process and varies from endoscopic one-stage resection to chemoradiation treatment. Using the example of two clinical cases, we will consider an algorithm for diagnosis and treatment the patients.

Screening method for diagnosis of pharyngolaryngeal reflux

Pharyngolaryngeal reflux (PLR) can cause the upper respiratory tract pathology. To diagnose PLR based on complaints is rather difficult, due to the absence of typical manifestations of reflux syndrome in some cases of the disease. The use of daily impedance pH monitoring of the esophagus is not always possible due to the invasiveness and unavailability of the method. The aim of the study was to develop an affordable non-invasive method for diagnosing PLR. The study group consisted of 48 patients with PLR proven by the results of impedance pH-monitoring. The control group consisted of 20 healthy patients. The “Pharyngolaryngeal reflux index” questionnaire was developed based on the analysis of patient complaints. The questionnaire was assessed using ROC analysis. Patients who scored 5.5 points according to the results of the questionnaire with a probability of 93.2% have PLR. Thus, a method for the diagnosis of PLR has been developed, including the simultaneous comparison of the laryngoscopic signs of PLR with the highest diagnostic sensitivity (hyperemia, edema, maceration of the interarytenoid mucosa) and “Pharyngolaryngeal reflux index” questionnaire results, which allows diagnosing of PLR.

Diabetic nephropathy: what should cardiologist remember

Prevalence of diabetes mellitus (DM) progressively increases around the world. Diabetic nephropathy (DN) is significant reason of end-stage renal disease and it is associated with high risk of cardiovascular disease and mortality. Necessity of expensive renal replacement therapy for patients with prominent vascular diabetic complications and end-stage renal disease has significant socio-economic impact. DM, as a one of leading causes of kidney diseases, competes for stricted resources of public health. Renal replacement therapy in patients with DM does not solve the whole problem, because survival of such patients is low, comparing with another kidney diseases, first of all because of cardiovascular diseases. Good control of glycaemia, blood pressure and cholesterol level and prescription of renin-angiotensin-aldosterone system inhibitors and statins decrease cardiovascular risk and slow down DN progression, as it was shown in many clinical trials. So patients with DM and DN should receive complex therapy for risk reduction of kidney disease and cardiovascular disorders progression. Keywords: diabetes mellitus type 2, diabetic nephropathy, nephroprotection, cardioprotection, SGLT-2 inhibitors, GLP-1 agonists, renin-angiotensin-aldosterone system For citation: Trubitsyna NP, Zaitseva NV, Severinа AS. Diabetic nephropathy: what should cardiologist remember. Consilium Medicum. 2021; 23 (1): 20–24. DOI: 10.26442/20751753.2021.1.200712

The relevance of prescribing triple neurohormonal blockade in real clinical practice: the role of mineralocorticoid receptor antagonists

In the article is outlined the main concepts use of the mineralocorticoids receptors antagonists in the treatment of congestive heart failure and systolic dysfunction after acute myocardial infarction. Claimed the pivotal role of eplerenone in the long-term treatment strategy due to decrease of mortality and improving the clinical outcomes.

Ectopic pregnancy as a complication after assisted reproductive techniques. Case report

Ectopic pregnancy (EP) is a rare and severe complication of assisted reproductive techniques (ART). A specific feature of EP after ART is a high frequency of rare atypical forms of EP, the absence of a specific clinical picture and a high probability of recurrent EP, which makes certain difficulties in terms of diagnosis. Interstitial pregnancies occur in 1–6% of all ectopic pregnancies and in 7.3% cases of EB which were the results of in vitro fertilization programs (IVF). The anatomical features of the blood supply in the intramural segment of the fallopian tube provide favorable conditions for the progression of pregnancy on the average up to 10 weeks of gestation, simulating the intra-uterine pregnancy. Chorionic villi, growing into the thickness of the myometrium, create a high risk of profuse intra-abdominal bleeding. The article presents a clinical case of a rare form of ectopic pregnancy in the interstitial segment of the fallopian tube after IVF. The patient had previously undergone a bilateral salpingectomy by tubal pregnancies. This clinical example shows the meaning of precise diagnosis and timely provision of highly qualified specialized medical care.

Properties and safety of combined dietary supplement Uronext in complex treatment of acute (recrudescence of chronic) cystitis in women with bacterial vaginosis

Aim. To analyze modern approaches to the conservative therapy of acute (exacerbation of chronic) cystitis in women in combination with bacterial vaginosis. To emphasize the importance of Esherichia coli as the main causative agent of urinary tract infection (UTI) due to the presence of virulence factors that not only affect the affinity of the pathogen to the urothelium, but also hinder the development of an immune response. To emphasize the importance of bacterial vaginosis as a factor contributing to the development and maintenance of acute cystitis in women. To substantiate the need for a differential approach to the appointment of antimicrobial drugs in patients with UTI and bacterial vaginosis, as well as the use of safe natural medicines in the complex therapy of UTI. Materials and methods. The properties and safety of the biologically active additive Uronext (NPO Petrovax Pharm, LLC, Russia) were studied in women with complex, together with medications, treatment of acute (exacerbations of chronic) cystitis against the background of bacterial vaginosis. A post-marketing comparative study was conducted in parallel groups. The study lasted for 4 months and included 60 patients aged 18 to 65 years (average age 39.4 years). Results. The severity of differential symptoms of acute cystitis was significantly lower in the study group compared with the control group – the frequency of the evaluation mode in the study group was significantly higher than in the control group: 29 and 22 respectively (p<0.01). In both groups, there was a significant improvement in the quality of life of patients (ACSS score) after treatment (the median value and the mode of the sum of points in the control group decreased from 7 to 3; p<0.01, in the study group – from 7 to 1; p<0.01). The quality of life of patients in the study group after treatment was significantly higher than in the control group (p<0.01). It is important to note that the frequency of relapses after treatment was significantly lower in the study group compared to the control group (31.6 and 13.3% respectively; p<0.01). Conclusion. Modern dietary supplements as part of the complex therapy of lower urinary tract infection provide a significant reduction in the severity of differentiated symptoms of acute cystitis, as well as a significant improvement in the quality of life of patients.