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Fungal pneumonia is considered as one of the most serious forms of pneumonia, the number of which has recently increased despite the use of new antimycotic drugs in pulmonology. Specificity of pathogens and torpid current of pneumomycosis represent great difficulties for accurate diagnosis and delay the timely onset of therapy, exacerbating inflammatory changes. In this article we present a rare case of isolated infection of the lungs parenchyma with Candida albicans in the form of focal pneumonia of the right lung lower lobe complicated by a clotted pleurisy. Patient is eighteen-year-old young man who is currently finding in the army. Our attention was attracted the fact that he was hospitalized twice within the 4 months with the same diagnosis - fungal pneumonia. At the same time, the localization of the process was the same as in the previous hospitalization. In this article, we tried to understand the reasons of unsuccessful treatment of this pathology. And we came to the following conclusions that the reason of repeated hospitalization of this patient was the short stay in the hospital and the duration of the diagnostic tests. Bacteriological examination of sputum takes about 5-7 days on average, which led to untimely started treatment. A short period of hospitalization, regulated by the protocols of diagnosis and treatment, contributed to inadequate treatment of this pathology. Thus, today there is a definite demand for the development of rapid diagnostic tests of fungal pneumonia and new protocols for diagnosis and treatment, taking into account the duration of treatment for Candida infection.

Aim: To find out the factors of satisfaction with psychiatric help in inpatients with neurotic and depressive disorders depending on the moment of satisfaction evaluation and patients' treatment experience., Material and Methods: The sample included 266 first-time admission inpatients (satisfaction was evaluated at the moment of discharge) and 134 rehospitalized inpatients (satisfaction with previous treatment was evaluated at the moment of discharge; satisfaction with current treatment was evaluated at the moment of rehospitalization). The survey was performed using a questionnaire designed for this study. Statistical analysis was performed using multiple regression., Results and Conclusion: Satisfaction with nursing care was the key factor of satisfaction at the moment of discharge among both groups of inpatients (first-time admission and rehospitalization). Psychiatrist's empathy was the 2nd factor by importance. The structure of factors of medical service satisfaction of these 2 groups was different. General satisfaction with psychiatrist's work was the key factor of satisfaction with medical service during previous hospitalization while nursing care was twice less important. In whole, there were major differences in the structure of factors of medical service satisfaction during previous and current hospitalizations. The shift of importance from nursing care to psychiatrist's work and other differences in the structure of factors of satisfaction of rehospitalized patients with medical services can be explained by belonging of medical services to credible goods - patient is able to evaluate results of treatment only some period after discharge.

We studied impact of ethylmethylhydroxypyridine succinate n the course of chronic heart failure during 3 years follow-up after myocardial infarction. Dynamics of objective and subjective parameters was assessed in 100 patients; 48 patients received conventional therapy (control group) and 52 patients received conventional therapy plus ethylmethylhydroxypyridine succinate (main group). Addition of ethylmethylhydroxypyridine succinate resulted in decreases of rates of complications, mortality, and re-hospitalizations. Increases of myocardial contractile function, myocardial adaptation, as well as improvement of range of biochemical parameters were also observed. The latter changes were indicative of antioxidant, anti-inflammatory, anti-stress activities of Ethylmethylhydroxypyridine succinate. Moreover, antidepressant and antineurotic effects of complex therapy including ethylmethylhydroxypyridine succinate was confirmed.

Unlabelled: PURPOSE of this investigation was to study correlation between brain natriuretic peptide (BNP), extent of cardiac abnormalities, and six minute walk test (6-MWT) in order to asses diagnostic value of BNP in patients with trial fibrillation (F), heart failure (HF) and preserved systolic function., Material and Methods: Sixty five patients with history of hypertension, permanent F, and shortness of breath in absence of signs of congestive hemodynamics were included into this study., Results: Concentration of BNP in serum n the day of inclusion was significantly inversely related to results of 6-MWT, and positively related to left atrial dilation, to hospitalizations due to cardiovascular causes., Conclusion: Measurement of BNP concentration in patients with AF allows to diagnose HF at early stages and to predict cardiovascular complications.

The study was aimed to assess the efficacy and safety of treating coronary heart disease (CHD) patients complicated with COPD using the combination of tolerable doses of -blocker bisoprolol and inhibitor If-channel ivabradine, compared with bisoprolol alone. A total of 50 patients were included (88% men, mean age 62.8+/-7.2 years) with stable angina and clinical signs of bronchoobstruction (84% with COPD and 16% with bronchial asthma in remission phase). At the study start, all patients received bisoprolol, the dose of which was titrated until the clinical signs of intolerance (most common - bronchoobstruction) appeared or worsened. Average dose of bisoprolol at the time of forced titration stop was 6.3+/-2.2 mg/day, mean heart rate (HR) decreased from 82.1+/-8.4 to 72.2+/-8.5 bpm. Then, the patients were randomized into two groups: patients of the first group (n=25) continued to take bisoprolol in tolerable dose, and patients of the second group were added ivabradine (5-15 mg, mean dose 10.7+/- 3.1 mg/day). In contrast to the bisoprolol alone, combination therapy resulted in further decrease of HR to an average of 62.6+/-4.1 bpm over 6 month of follow-up. This was associated with additional decrease of the number of angina attacks (by 4.68+/-4.40 per week vs. 2.48+/-4.70, <0.05), nitrates consumption (by 206.0+/-153.6 mg/week vs. 95.6+/-134.2 mg/week, <0.01) and score of negative components of quality of life (by 5.16+/-3.3 vs. 2.24+/-4.5, <0.05), compared with the first group, respectively. In combination therapy group there was also the decrease of the inhaled broncholytics consumption (from 2.88+/-3.23 to 1.88+/-2.65 per week, <0.05), that was not evident in the first group. Average number of hospitalizations per 1 patient decreased over 6 months of follow-up, compared to the same period before the trial, in both groups, but more prominently in the combination therapy group (-0.31+/-0.55 vs. -0.56+/-0.76, accordingly, <0.1). Therefore, in the treatment of patients with CHD, stable angina and concomitant bronchoobsrtuctive manifestations, if not possible to administer -blockers in the adequate HR-reducing dose, the addition of ivabradine to the treatment could be the treatment of choice. The combination of tolerable doses of bisoprolol and ivabradine is s afe and allows to achieve adequate HR decrease. This is a ssociated with maximal antianginal effect, decrease in the need for broncholytic therapy, improvement of the quality of life and decrease of the number of hospitalizations, compared with the treatment with bisoprolol alone.

Aim of this study was to assess clinical and pharmacoeconomic effects of long term use of adrenoblockers in patients with ischemic heart disease (IHD) undergoing coronary artery bypass grafting. Patients with IHD (n=294) were included in open, prospective, randomized clinical trial. The follow up period was 3 years. It was noted that long term use of bisoprolol in comparison with atenolol and metoprolol was characterized by more pronounced increase of exercise tolerance, lower rate of angina recurrence and lower expenses for treatment of patients with IHD.

Patients with chronic heart failure (CHF) represent a group with high risk of repetitive hospitalizations. In order to assess frequency of repetitive hospitalizations and elucidate their risk factors we included in this study 962 patients with stage IIA-III and functional class II-IV CHF hospitalized in a multiprofile hospital once or repeatedly during 1 year. Rate of rehospitalizations during 1 year was 59%. The following factors of risk of rehospitalizations were revealed: admission because of progression of CHF, history of myocardial infarction, atrial fibrillation, systolic left ventricular dysfunction, hyperuricemia, and hyperglycemia.

The subjects of the study were 504 patients with bronchial asthma (BA) exacerbation, hospitalized in Saint Petersburg Hospital #32 in 1997 - 2004; the maintenance therapy in these patients was analyzed. Severe exacerbations were diagnosed in 256 (51%) of the patients, moderate--in 200 (40%), and mild--in 48 (9%). The study revealed that 78% of patients had been given instructions on their preventive anti-inflammatory therapy, informed about the doses of medications and the duration of the therapy. However, only 13% of the patients received anti-inflammatory therapy that was adequate to the severity of the illness, and only 32% of all the patients demonstrated correct technique of using meter dose inhalers. Correlations (p < 0.05) were established between these factors and poorer asthma control (R = -0.07) and the severity of the exacerbations (R = -0.41). Seventy-seven per cent of BA patients hospitalized for severe exacerbations either did not received inhaled glucocorticosteroids (IG) or received them irregularly, and only 8% of the patients received adequate anti-inflammatory therapy. The main causes of inadequate therapy were low compliance (46%) and poor level of patients' knowledge (22%). Unavailability of medications was reported only by 29% of the patients. The main cause of poor compliance was fear of corticosteroid therapy side effects; and the most common scenario of not following physician's recommendation was premature discontinuation of IG therapy. In conclusion, the rational way of the maintenance therapy optimization is correct choice of preventive anti-inflammatory medications and adequate inhalation delivery systems, patients' education, and overcoming of poor compliance at hospital stage. This is of particular importance in frequently hospitalized patients with BA.

Aim: To study a course of coronary heart disease (CHD) in patients with depressive disorders., Material and Methods: The trial included 77 CHD patients aged 39 to 68 years (mean age 54.9 +/- 0.9 years), 40 (51.9%) of them had myocardial infarction. All the examinees had effort angina of functional class II-IV by criteria of the Canadian Cardiology Association. All the patients have undergone standard clinical examination, stress tests, coronaroangiography (n = 30), assessment of the degree of vegetative dystonia and quality of life. The patients were divided into two groups depending on the depression degree., Results: CHD patients with manifest depression vs those with subclinical depression had a higher level of personality and reactive anxiety. They had neurotic and psychopathological personality alterations associated with more pronounced vegetative disorders. These patients suffered from more severe coronary atherosclerosis, more hospitalizations for the previous year, more myocardial infarctions, lower physical activity and quality of life., Conclusion: CHD patients with manifest depression have lower physical performance and quality of life though this is not confirmed at exercise tests.

Aim: To evaluate efficacy of use of technological charts (TC) in upgrading management and treatment safety in patients with atrial fibrillation (AF)., Material and Methods: Two groups of AF patients were compared: 196 patients treated before introduction of TC (group 1) and 431 patients managed according to TC technology (group 2)., Results: In group 2 treatment duration reduced from 26.1 to 18.5 days, rehospitalizations occurred by 6% less frequently, number of unexpected side effects fell 2.5-fold, the rate of varfarin prescription for prevention of thromboembolic complications rose from 18 to 64%, the patients were satisfied with the treatment in 97% vs past 79%., Conclusion: TC was a tool of treatment improvement and introduction of the latest clinical recommendations into clinical practice with reference to facilities and staff qualification of an individual hospital without additional financial input.

The authors made a statistical analysis of 1491 case histories in children aged 4-14 years treated for various psychotic disorders at a mental hospital in 1992-2001. The proportion of these children remained to be relatively stable and averaged 14.2% of the total number of inpatients. Throughout the 10-year follow-up, among children with psychoses, boys were prevalent: an average ratio of boys to girls being 3.4:1. In Saint Petersburg, there has been recently a steady reduction in the number of children with psychosis admitted to hospitals, the number patients treated in the outpatient setting being on the increase. At the same time the rates of rehospitalizations are also on the rise of patients mainly with severest psychoses. In the past 10 years, Saint Petersburg has been a town of a steady rise in the number of disabled individuals due to mental diseases among children with schizophrenia and dementia admitted to the hospital.

As high as 12.4% of children suffering from tuberculosis are readmitted, rural children are more frequently readmitted (18.0 versus 7.2%, p < 0.01), children having tuberculosis (10.9%) and nonspecific pathology (1.5%). Among the children readmitted for tuberculosis, 75.9% had exacerbations which provoke infectious diseases in 18.2%. In 72.7% of cases, the cause of readmission was premature discharge due to their parents' noncompliance.

557 case records of patients with late postoperative purulent complications (LPC), admitted to department of purulent infection during 10 years were studied (4% of total number of operated patients). The mean duration of hospitalization period of rehospitalized patients made up 14.2 bed days. Mortality rate was 0.4%. 70% of patients with LPC were people of working age. 3 groups of patients were singled out regarding the time after the operation until readmission: group 1 (38.5%) 1 month since the discharge of the patients; group 2 (31.5%) up to 12 months; group 3 (30%) more than 1 year after. In group 1 purulent infection of the wounds predominated, in group 2--infiltrates and mattery fistulas, in group 3--ligature-fistulas, infiltrates of abdominal cavity. LPC after appendectomy was observed in 53% of cases. Among complications purulent infection predominated (60%). 75.8% of patients with LPC needed surgery.

It is recommended to use the following indices for assessing the quality of hospital treatment: average hospital stay, the percent of repeated admissions with one and the same disease, the percent of discrepancy between clinical and postmortem diagnosis with subsequent expert evaluation of each case of death. The departments of surgery also find it necessary to take into account the frequency of postoperative complications, postoperative lethality and average hospital stay of operated patients. The well-founded complaints per 100 hospitalized patients can also be considered as indices.

The causes of repeated admissions of 35 patients with viral hepatitides were unraveled on the basis of studies of the serum markers HAV, HBV, HBsAg, anti-HBs, HBeAg, IgM-anti-HBc, anti-HBc, IgM-anti-HAV, anti-HAV, and anti-D. Mixed viral infections were diagnosed in 14 persons: 3 persons had superinfection with HAV associated with chronic HBsAg carriership, 6 had superinfection with HDV and 5 manifested superinfection with HAHB viruses. Reactivation of chronic hepatitis was diagnosed in 5 patients. The measurement of the activity of alanine aminotransferase in blood serum diluted 1:10 and of IgM-anti-HBc titers was shown to be of high differential diagnostic importance in the identification of relapses and reinfections. The effects of superinfections with HAV and HDV are under discussion.

Two-year-long examination of 183 schizophrenic patients with a lingering course of the disease receiving active rehabilitation in individualized conditions of an ordinary industry (the basic group) were carried out. The examinations have shown that prophylaxis of re-hospitalizations is effective, if the organizational structure of the industrial rehabilitation is well designed. The principal role in the re-hospitalization prophylaxis belongs to the schemes of observation and rehabilitation based on correct evaluation of the variants of remissions, polyexogenia and periods of the patients' adaptation to the environment. The forms and methods of the re-hospitalization prophylaxis offered have made it possible to reduce tow times the number of re-hospitalized patients, as compared with 110 patients of the control group.

In order to determine the criteria of the clinical prognosis at the initial and long-term stages of the disease, the author conducted a clinico-epidemiological study of 156 patients with at least 10-year history of slowly progressive schizophrenia who had fallen ill at the age of 10-20 years. The criteria of the clinical prognosis have been identified, both common and typical of the immediate and long-term stages of the disease. The age factor is a significant criterion of the prognosis of initial manifestations of the clinical picture in patients with slowly progressive schizophrenia. The use of the elaborated criteria of the clinical prognosis with regard to the range and time course of psychopathological manifestations at different stages of the disease will make it possible to conduct rehabilitative measures more effectively and adequately, which will contribute to increasing the number of patients having a socially useful employment.

Using clinico-epidemiological research methods, the authors have studied 260 schizophrenic patients in whom the disease was first manifested in the period when wide-scale combined rehabilitation programmes were under way. It has been demonstrated that the incidence of chronic schizophrenia shows no tendency to decrease despite the use of modern rehabilitation methods. Chronicity itself has become more variable in its manifestations; thus the population of "chronics" is mostly made up of young people. An analysis of the time-course of invalidization of schizophrenic patients in the first four years of the disease has indicated a clear-cut peak at the second year after the manifestation of the process. The findings obtained made it possible to describe a number of parameters of functioning of "chronic patients of a new type". It has been shown that these patients are young and characterized by a comparatively short duration of the disease, frequent rehospitalization, marked manifestations of social disadaptation in the presence of externally normal behaviour due to rapid incapsulation of the current symptomatology, formally intact familial ties and a high frequency of abnormal behavioural manifestations.

The causes of 1382 readmissions of 156 patients with traumatic epilepsy were studied with regard to the seasonal and pathogenic factors. It was established that readmissions of patients with traumatic epilepsy directly correlated with the spring and autumn seasons and 8 pathogenic factors (no maintenance therapy, psychogenias, dysphorias, intoxication with antiepileptic drugs, alcoholization, infectious diseases and inadequate rehabilitative measures). The data obtained will help neuropathologists and psychiatrists to time repeated prophylaxis of traumatic epilepsy under outpatient conditions.

A total of 256 schizophrenics were examined for the effect of different variables on the duration of their hospital stay over the entire period of the disease. An analysis was performed with the help of the rehabilitation automated information system, using formalized case reports. The duration of hospitalization was shown to depend not only on the clinical characteristics of the patient but also on his or her personality and socio-psychological characteristics both in the process of illness and in the premorbid state.