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Eliseeva T.I.,Institute of Federal Security Service of Russian Federation | Knyazeva E.V.,Nizhny Novgorod State Medical Academy | Geppe N.A.,Moscow State University | Balabolkin I.I.,Russian Academy of Medical Sciences
Sovremennye Tehnologii v Medicine | Year: 2013

The aim of the investigation was to assess the relationship of ACQ-5 and ACT-C indices and spirographic parameters in children with bronchial asthma (BA), reveal confidential intervals of these parameters typical for different levels of BA control. The BA levels were determined according to these questionnaires. Materials and Methods. We examined 130 patients aged from 5 to 11 years with primarily atopic BA and different control level of the disease. In addition to routine examination, all children underwent the tests to determine BA control level using Asthma control questionnaire - 5 (ACQ-5) and Childhood Asthma control test (ACT-C). Spirographic examination was performed using Master-Screen Pneumo (Jaeger, Germany). Bronchial hyperresponsiveness was studied in tests with physical load (veloergometer Kettler AX1). The test with bronchial spasmolytic was used in children with exacerbation of the disease. Results. According to ACQ-5, 90 children had complete control of the disease symptoms (ACQ-5<0.75 scores), 17 children - partial control (0.751.5 scores). According to ACT-C, in the same children, 95 children had controlled BA course (ACT-C≥20 scores), 35 patients - lack of control (ACT-C≥19). The correlation between ACQ-5 and ACT-C was -0.62, when pandlt;0.00001. The control level assessment according to ACQ-5 showed the average values of forced expiratory volume in 1 s (FEV1) in patients with complete BA control to be 98.99±10.56%, with partial control - 91.53±10.94%, with no control - 72.56±7.17%, pandlt;0.00001. The correlation between ACQ-5 and FEV1 was -0.7, when pandlt;0.00001. The control level estimated by ACT-C showed the average values of FEV1 in patients with the achieved BA control to be 95.78±12.38%, with the lack of control - 85.99±17.08%; p=0.0007. The correlation between ACT-C and FEV1 was 0.37, when pandlt;0.00001. We assessed the intensity of bronchial responsiveness estimated by the tests with physical load or with bronchial spasmolytics (taking into consideration initial clinical status and spirogram findings) in 40 patients. As BA control level decreased, there was found the bronchial responsiveness rising. The correlation between ACQ-5 and the intensity of bronchial responsiveness was -0.55, when p=0.0001, that exceeded the correlation relationship between ACT-C and this parameter (R=0.33; p=0.03). Conclusion. When diagnosing BA control level, one should take into consideration that spirographic parameters, as well as the intensity of bronchial responsiveness in the conditions of modern pharmacotherapy, demonstrate closer correlation with ACQ-5 indices compared to ACT-C.


Eliseeva T.I.,Institute of Federal Security Service of Russian Federation | Geppe N.A.,Moscow State University | Balabolkin I.I.,Russian Academy of Medical Sciences
Sovremennye Tehnologii v Medicine | Year: 2012

The aim of the investigation is to estimate the association of bronchial asthma control level indices according to Asthma Control Questionnaire (ACQ) with indices of peak expiratory flow (PEF) and forced expiratory volume 1-second (FEV1) measured simultaneously with the interviewing. Materials and Methods. There were examined 127 children and teenagers aged 5-17 years with atopic asthma of various levels of asthma control. Apart from standard clinical (including anthropometry), functional, immunologic, allergological examinations, all children underwent questionnaire survey according to ACQ, PEF measurement using peak-flowmetry, and the measurement of basic spirographic indices. Results. There was revealed the correlation relationship between ACQ test indices (in points), for one part, and PEF and FEV1 (in percentage of adequate values) measured in the daytime, for the other part. The correlation coefficient between ACQ and FEV1 was -0.65, p=0.00001, that is higher than the coefficient between ACQ and PEF (r=-0.39; p=0.00001). To estimate the potential contribution of data of functional parameters in the diagnostics of asthma control there was performed discriminative analysis. A part of correctly classified cases relying on functional parameters was 53% for PEF and 66% for FEV1, i.e. the classification of bronchial asthma control level with the assistance of FEV1 monitoring has advantages as compared to PEF measurements.


Eliseeva T.I.,Institute of Federal Security Service of Russian Federation | Knyazeva E.V.,Nizhny Novgorod State Medical Academy | Bochkova Y.S.,Nizhny Novgorod State Medical Academy | Kononova S.V.,Nizhny Novgorod State Medical Academy | And 2 more authors.
Sovremennye Tehnologii v Medicine | Year: 2013

The task of bronchial asthma (BA) treatment is the control of the symptoms and the course of the disease implemented through baseline anti-inflammatory therapy. There is the necessity for objective estimation of control level using pathogenically supported techniques including the assessment of key pathophysiological features of asthma - bronchial hyperresponsiveness (BHR) and/or inflammation. The aim of the investigation was to develop a method of control assessment objectivization based on the analysis of spirographic parameters and their change in BHR tests. Materials and Methods. We examined 134 patients aged from 5 to 16 years with atopic BA. In addition to standard examination, we determined BA control level using ACQ-5, spirographic parameters (Master-Screen Pneumo; Germany). BHR was studied in exercise tests - pedaling 60 rpm, the stress load being 1 W/kg within 10 minutes on bicycle ergometer Kettler AX1. If initial spirogram parameters were below conditional standard, BHR was determined in a test using bronchodilator. The changes of forced expiratory volume 1-second (FEV1) under the above mentioned stimuli (exercise, bronchodilators) were statistically processed in one amount of data, and FEV1 changed under bronchodilator were taken with the sign opposite to that of the obtained result (multiplying by -1). The data were presented as M{cyrillic}±SD, where M{cyrillic} - mean, SD - standard deviation. Results. Correlation coefficient in this sampling was the following: between ACQ-5 and FEV1 values R=-0.66, p<0.00001, between ACQ-5 values and BHR intensity R=-0.59, p<0.00001. FEV1 application enables to verify correctly BA control level in 64.93% of patients (coincidence with clinical verification of control level), BHR determination enables to verify control level in 60.47% of patients, and integrated use of these parameters increases the level of correct control diagnosis up to 78.29%. When the patients are grouped according to control level (complete control patients and patients with partial control level and lack of control), a part of verified cases using FEV1 increases up to 77.78%, using BHR test with indirect stimuli - up to 74.81%, using integrated assessment of these parameters - up to 86.67%. Based on the determined regularities we developed a computer program to objectivize control level in BA patients using the analysis of initial spirographic data results and their variability in tests with bronchodilators or indirect stimuli. The program enables to assess objectively a control level in particular patients engaging pathologically significant BA markers under real-life clinical setting.


Eliseeva T.I.,Institute of Federal Security Service of Russian Federation | Balabolkin I.I.,Russian Academy of Sciences
Sovremennye Tehnologii v Medicine | Year: 2016

More than 7% of population suffer from drug allergy. Cases of heavy life-threatening allergic reactions are well known. In this review current considerations of mechanisms of drug immune hypersensitivity development are presented, the main clinical forms and methods of diagnosing drug allergy are described. Drug allergy is diagnosed with specific in vivo tests (skin prick test, intradermal test, patch test, provocation tests) and in vitro tests (determination of specific IgE to medications, test for basophil activation, reactions of leucocyte blast transformation, quantitative determination of cytokines and other proteins, e.g. granzyme and tryptase in peripheral blood). However, not all of these methods are available in real clinical practice, the list of commercial kits for diagnosis of drug allergy is limited. Therefore, it is especially important in patient management to rely on history-taking and general clinical examination data, to consider the available information on association of drug allergy and infections caused by viruses of herpes-group, especially in children population, on hereditary predisposition to some kinds of drug allergy. © 2016, Nizhny Novgorod State Medical Academy. All rights reserved.


Komissarova E.S.,Nizhny Novgorod State Medical Academy | Belyaeva N.G.,Nizhny Novgorod State Medical Academy | Tezyaeva S.A.,Institute of Federal Security Service of Russian Federation | Strongin L.G.,Nizhny Novgorod State Medical Academy
Sovremennye Tehnologii v Medicine | Year: 2013

The aim of the investigation was to assess the efficiency of intensive insulin therapy in surgical patients with type 2 diabetes mellitus (DM 2) in intensive care unit in relation to the effect on postoperative clinical progression and 90-day survival of patients. Materials and Methods. The study included 89 patients hospitalized in intensive care unit for various surgical pathologies, with DM 2 in past medical history. On admission the patients were divided into 4 groups in a random manner. First 72 h target glycemia range for groups 1 and 2 was glucose level of 6.5-8.5 mmol/L, and for groups 3 and 4 - 8.6-11.0 mmol/L. Continuous insulin infusion was chosen for the treatment of groups 1 and 3 for the same period, the patients of groups 2 and 4 were given divided insulin injections. The severity of all patients was studied first 24 h and 72 h after inpatient treatment according to APACHE II, SAPS II. Conclusion. In ICU patients suffering from type 2 DM with various surgical pathology, target glycemic levels of 6.5-8.5 and 8.6-11.0 within the frame of one insulin therapy method are not associated with the differences in relation to the severity and outcome of the main pathology. Glycemic control in target range of 6.5-11.0 mmol/L by intravenous insulin infusion has the advantage over divided insulin subcutaneous injections regarding the severity and outcome of the main pathology.

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