Basic Principles Of Diagnosis Research Articles

Long-diagnosed primary adrenal insufficiency in the setting of Werlhof’s disease. A clinical case report

Chronic adrenal insufficiency is an endocrine disease caused by insufficient secretion of adrenal hormones due to dysfunction of one or more links of the hypothalamic-pituitary-adrenal axis. The highest prevalence has been documented in Scandinavian countries: 15–22 people per 100,000 population, while other European countries report 10 cases per 100,000 population. Autoimmune adrenalitis is the most common cause of primary adrenal insufficiency in adults, and it can be either alone (40 %) or a component of autoimmune polyglandular syndromes (60 %). The etiologic factors of primary adrenal insufficiency include tuberculosis or AIDS. These causes of adrenal cortical insufficiency are particularly relevant in Ukraine. The article describes a clinical case of a patient with both primary adrenal insufficiency and Werlhof’s disease. The prevalence of adrenal insufficiency and etiologic factors of primary adrenal insufficiency are highlighted. A detailed differential diagnosis of primary adrenal insufficiency with other diseases that could cause clinical symptoms such as hypoglycemic states, severe weight loss, hypotension, severe muscle weakness, hyponatremia, hyperkalemia is performed. The basic principles of diagnosis, treatment, and prognosis in primary adrenal insufficiency are discussed. Despite typical, specific manifestations of adrenal insufficiency, diagnosis in real clinical practice is difficult. Awareness and vigilance of doctors regarding the symptoms of adrenal insufficiency is necessary. Late detection of chronic adrenal insufficiency can lead to complications. Timely diagnosis and treatment of chronic adrenal insufficiency improves disease prognosis and quality of life.

Maastricht VI/Florence Consensus for the treatment of Helicobacter pylori infection: updated recommendations for cancer prevention opportunities

For many decades, one of the most relevant issues remains the effectiveness of treatment of diseases associated with Helicobacter pylori (H. pylori) infection, the main goal of which is the prevention of gastric cancer (GC). The basic principles of diagnosis and treatment of helicobacter infection from the standpoint of evidence‑based medicine formulated in the Maastricht Consensus series. The data is constantly updated and refined by experts based on dynamic research. The new Maastricht VI/Florence Consensus clarified a number of provisions that were previously under discussion. One of the main provisions is that infection with H. pylori always causes gastritis regardless of symptoms or complications. Helicobacter gastritis must be excluded before establishing a clinical diagnosis of functional dyspepsia. About 90% of stomach cancer cases are associated with H. pylori. It is the the main etiological factor of gastric adenocarcinoma, including proximal gastric cancer. Eradication of H. pylori provides an opportunity for cancer prevention at any age in adults, but its effectiveness decreases with age. Therefore, carrying out the timely and effective eradication allows preventing negative consequences in H. pylori — infected patients. In the modern algorithm of eradication therapy in accordance with the Maastricht VI/Florence consensus, preference has been given to quadruple therapy with the use of bismuth drugs. The value of triple therapy with clarithromycin has decreased. There is a rapid increase in the resistance of H. pylori to fluoroquinolones. Bismuth‑containing quadruple therapy with amoxicillin and tetracycline and triple therapy with rifabutin are among the final eradication protocols. Research is underway on new candidate molecules for inclusion in antihelicobacter therapy regimens. Further research will need to optimize new opportunities to improve eradication efficiency, particularly in non‑Asian populations. We hope that the publication of this important international consensus document will allow practicing doctors to use the knowledge of modern gastroenterology and increase the percentage of effective cancer prevention in Ukraine.

Combination treatmnet of breast cancer patients during the COVID-19 pandemic

The aim of the study was to analyze the most significant studies representing the basic principles of diagnosis and treatment of patients with breast cancer (BC) during the CO VID -19 pandemic.Material and Methods. The search for relevant sources was carried out in PubMed, Cochrane Library, Web of Science systems, publications for 2019–2020 were studied, 48 of which were used to write this review.Results. During the CO VID -19 pandemic, it is necessary to suspend screening examinations for a certain period of time; patients with early and metastatic breast cancer should be transferred to outpatient treatment in the LU s located in their place of residence. Examinations and consultations of patients undergoing hormone therapy should be postponed or carried out using telemedicine technologies. Treatment of breast cancer patients during a pandemic should be carried out according to clinical guidelines and protocols, but minimizing the number of visits to the hospitals.Conclusion. The pandemic of the novel coronavirus infection (CO VID -19) is a serious problem for healthcare and professionals around the world. All treatment decisions must be based on risks and benefits in the context of each stage of the pandemic, on an individual basis and taking into account the preferences of patients.

A view at postbariatric hypoglycemia by endocrinologist

The obesity epidemic has led to the growing number of bariatric operations and the expansion of indications for this operation as the most effective method of treatment, that’s why endocrinologists are increasingly faced the challenge of late complications, including postbariatric hypoglycemia. Postbariatric hypoglycemia is a rare but severe metabolic disorder that occurs months or years after upper gastrointestinal surgery. Postbariatric hypoglycemia can be accompanied by severe clinical symptoms and lead to disability and decreasing of the life’s quality. It is difficult to assess the prevalence of hypoglycemia after bariatric surgery due to the lack of clear diagnostic criteria, often a hidden clinical picture and ignorance of doctors and patients about this complication. Hypoglycemia in this case has postprandial and hyperinsulinemic nature. The mechanisms of development of this complication have recently been actively discussed. The exchange of incretins and dysregulation of insulin secretion are the subject of constant research in this area. Understanding the mechanisms of development of this condition makes it possible to develop optimal methods of diagnosis and treatment. The issues of pathophysiology, basic principles of diagnosis and treatment of post-bariatric hypoglycemia will be considered in this review.

Роль пробіотиків в оптимізації етіотропної терапії гострого бактеріального риносинуситу

Стаття присвячена одному з найпоширеніших лор-захворювань — риносинуситу, зокрема бактеріальної етіології. Наведені основні положення щодо діагностики та лікування цієї патології згідно із сучасними рекомендаціями (EP3OS, редакція 2012 року). Доведено, що антибактеріальна терапія практично всіма групами антибактеріальних препаратів, показаних при гострому бактеріальному риносинуситі, з частотою до 25 % випадків супроводжується розвитком ускладнень, найчастішим із яких є антибіотикоасоційована діарея. Для профілактики та лікування цього ускладнення рекомендується призначення пробіотиків (клас Іb, рівень доказовості А), зокрема Субаліну.

Atipical course of Crohn’s disease

The work outlines the causes of development, clinical manifestations and basic principles of diagnosis and treatment of Crohn’s disease. The authors give their own clinical observation: a case of an atypical course of this disease.

Basic principles of diagnosis and treatment of diseases as part of hyperandrogenic syndrome

Diseases (conditions) associated with excess production of androgens in the female body or an increase in the sensitivity of hormone-dependent organs to them are united by the concept of ‘hyperandrogenic syndrome’. Its variants range from isolated skin lesions and its derivatives to systemic diseases accompanied by a high risk of menstrual irregularities, infertility, metabolic disorders, cardiovascular pathology, and carcinogenesis. The management of patients with hyperandrogenism is carried out by gynecologists, endocrinologists, dermatologists, general practitioners, but in real life, interaction between representatives of certain medical specialties, unfortunately, is rarely observed. As a result, the treatment of patients with hyperandrogenism is sinning with polypharmacy, inappropriate prescribing and ignoring the current needs of women. The situation is aggravated by the fact that there are practically no drugs annotated for the treatment of external manifestations of hyperandrogenism, and the number of drugs that can have a multifaceted effect is small. One of the strategies that can reduce the drug load and solve several problems at once to compensate for androgen-dependent dermopathies and maintain health in patients with hyperandrogenism is the appointment of combined hormonal contraception. The determining factors in the choice of a hormonal contraceptive for women with hyperandrogenism should be the presence of the antiandrogenic effect of the progestin in the composition of the drug and the safety of long-term use of the drug.

Diagnostics and modern treatment of migraine: what can a general practitioner do?

The article focuses on the basic principles of diagnosis and treatment of migraine at the stage of primary health care. The diagnostic criteria of migraine, common diagnostic errors and alarming symptoms that are indications for instrumental investigations are given. The main treatment strategies of migraine are described: behavioral therapy, attack relief, and preventive therapy. Special attention is being paid to the treatment of a migraine attack, depending on its severity, including the features of the use of simple analgesics and triptans – specific drugs that have a pathogenetic antimigrenous effect. The principles of the use of tryptans that provide a high effect of relieving a migraine attack are being listed. The advantages of eletriptan as a last‑generation triptan, which is highly effective in relieving migraine attacks and is safer than other drugs in this class, are highlighted. Among the modern classes of drugs that have an evidence base in migraine prevention, those that can be successfully used by general practitioners are indicated.

Principles of treatment of late rectal radiation damage in cancer patients

Malignant neoplasms of the pelvic organs in the structure of cancer incidence make up about 30 % of the adult population of our country. The widespread use of radiation therapy, unfortunately, has also increased the frequency of radiation damage to the pelvic organs, which, as a rule, take a chronic course. Late radiation damage to the pelvic organs is a fairly common complication of radiation therapy for prostate cancer. According to various authors, the frequency of such iatrogenic pathological changes is up to 25 %. In fact, some patients who are cured of a malignant neoplasm acquire a new disease that significantly reduces the quality of life and requires treatment. During radiation therapy of prostate cancer, various anatomical formations can fall into the zone of radiation fields: the bladder, rectum, intra-pelvic tissue, neurovascular bundles and pelvic bones. It should be noted that isolated lesions of one organ are rare and in most cases they are combined. A special place in clinical practice is occupied by cases of local radiation injuries of the rectum, including severe complications of radiation and combined treatment associated with the formation of fistulas against the background of radiation-induced intra-pelvic fibrosis in the absence of a relapse of the underlying disease. In addition, this situation is associated with a violation of the psycho-emotional status of patients, a sharp decrease in the quality of life, difficulties in social adaptation in society and family, pain syndrome, and problems of medical rehabilitation. Unfortunately, conservative measures for such local radiation injuries are not always effective, and the results of surgical interventions are far from ambiguous and require careful study of patients, search for an algorithm of indications and acceptable standardization of surgical manipulations. This paper presents the basic principles of diagnosis, comprehensive treatment and rehabilitation of patients with late radiation rectitis, depending on the severity of the pathological process. Given the growth of malignant neoplasms of the pelvic organs, we can assume a relative increase in the number of patients with complications associated with radiation therapy, which require rehabilitation measures. Such patients come to the attention of oncologists, radiologists, coloproctologists, gastroenterologists and therapists, etc. Currently, our country lacks a network of specialized regional departments that deal with this problem, as well as treatment standards, clinical recommendations, and an algorithm for diagnostic and rehabilitation measures for local radiation injuries. In connection with the above, it became necessary to summarize the data of clinical studies based on their own experience.

Basic principles of diagnosis and treatment of viral pneumonia

Viral pneumonia is an acute inflammatory lesion of the lung tissue caused by viruses, which proceeds with a pronounced intoxication syndrome and is accompanied by respiratory disorders. Previously, viral pneumonia was called atypical; this term was used in all cases when the bacterial causative agent of the disease was not isolated, and immunity to antibiotic therapy was noted. The most common viral pneumonia occurs in early childhood, accounting for about 90 % of all cases of pneumonia. In the structure of the incidence of pneumonia among the adult population, bacterial pneumonia predominates, while viral pneumonia accounts for an average of 4 to 40 % of the total number of cases (moreover, most often people over 65 years old or patients with weakened immunity and severe concomitant pathology get ill). The incidence of viral pneumonia is in direct correlation with epidemiological outbreaks of acute respiratory viral infections — the maximum number of cases of the disease is observed in the autumn-winter period. In pulmonary practice, primary viral pneumonia is distinguished (interstitial, with a benign course, and hemorrhagic, malignant), as well as secondary (viral-bacterial pneumonia, which can be early and late).

Basic paradigms of antidepressants use in real clinical practice

The article is devoted to the basic principles of diagnosis and treatment of anxiety-depressive disorders. The indications, features of the use of antidepressants are considered separately on the example of drugs of the class of selective serotonin reuptake inhibitors. The advantages of Sertraline as the only dopamine-sparing’ antidepressant with a high degree of safety and a minimal risk of unwanted drug interactions are described.

SnakeBite wound with open volar proximal interphalangeal joint dislocation of little toe: An uncommon rural case

Snake-bite injuries are uncommon events but a significant number of cases are reported from rural areas. The basic principles of diagnosis and management of snake-bite injuries should be known to rural practitioners and prompt referral should be done in selected cases. The extremity bite may occasionally result in localized cellulitis and soft tissue infection that may complicate later into underlying bone invilement. Dislocation following the open wound in these setting is rare occurrence that needs proper knowledge for its diagnosis and management.

Multidisciplinary Consensus: Brachial Plexus Injuries. Basic Principles of Diagnostics and Treatment

Summary. Brachial plexus injuries is a severe and debilitating trauma characterized by gross impairment of upper extremity function. Mostly this is the trauma of young active people of working age, which often leads to significant loss of upper extremity function and disability of the patient. On October 10, 2019, at the XVIII Congress of Orthopedists Traumatologists of Ukraine held in Ivano-Frankivsk, a round table was held on the basic issues of diagnosis and treatment of patients with brachial plexus injuries, and a multidisciplinary consensus was adopted on the basic principles of diagnosis and treatment of brachial plexus injuries. During the round table, the issues of determining risk groups for brachial plexus injury (patients with polytrauma, road trafic accident, patients with injuries of the shoulder girdle area, dislocations of the shoulder, open lesions of the shoulder girdle and subclavian area, patients with atypical pain in the shoulder, patients that lost upper extremity function after surgery in the supraclavicular and subclavian area, neck, mastectomy, radiation therapy) and the protocol of clinical examination of patients (which must include the possibility of active movements in the joints of the upper limb and stabilization of the scapula; it is obligatory to determine the strength of the muscles of the affected limb in comparison with the healthy one, to determine sensitivity in the corresponding areas of autonomous innervation of the roots; also it is important to determine Horner syndrome) were discussed. Also, the place and time of additional diagnostics methods (emergency ultrasound and radiography, after 3 weeks – needle and stimulation electroneuromyography (ENMG), MRI of the brachial plexus or cervical spine, CT myelography) and an algorithm for the supervision of patients with a brachial plexus injury were adopted; the centers of brachial plexus surgery were specified. All this later formed the basis of multidisciplinary consensus.

Multidisciplinary Consensus: Complex Regional Pain Syndrome Type 1. Basic Principles of Diagnostics and Treatment

Summary. Complex Regional Pain Syndrome Type I (CRPS I) (G90.5) is a set of condi- tions accompanied by regional pain that is disproportionate in time and degree relative to the normal course of the post-traumatic period or other lesion, does not correspond to the zones of innervation of certain nerves or nerve roots and is usually manifested by sensory, motor, vasomotor, and/or trophic disorders in distal extremities. A multidisciplinary consensus on the basic principles of diagnosis and treatment of complex regional pain syndrome type 1 was adopted at a round table meeting at the XVIII Congress of Orthope- dists Traumatologists of Ukraine in Ivano-Frankivsk on October 10, 2019.Principles of diagnosis and treatment:1) Individual approach taking into account the leading pathogenetic mechanisms of the disease.2) Control over the total number of appointments.3) Using the Bruehl, Atkins or Veldman criteria to diagnose CRPS I.The treatment influence the following links of the pathogenesis of the disease or indi- vidual symptoms: a) inflammation – DMSO (compresses), corticosteroids (short course), b) pain – gabapentin or pregabalin, in case of low effect – antidepressants (in case of no effect – pain treatment by using subanesthetic doses of ketamine, narcotic analge- sics, implantation of neurostimulants or pumps for intrathecal drug administration or sympathetic blocks); c) central nervous system training (mirror therapy, imaging and behavioral therapy, etc.); d) reduction of fear of movements and pain; e) anti-edema and venotonic agents; f) vitamin C; g) activation of the affected limb with increase in range of movements, muscle strength and load tolerance (immobilization only accord- ing to strict indications); с) transcutaneous electrical stimulation of the nerves, ultra high frequency (UHF) in impulse mode and oligothermal dose; i) surgical interventions - surgical treatment is indicated for CRPS type II; for CRPS type I it is indicated in cases where such treatment is intended to eliminate the trigger for CRPS development with adequate multimodal anesthesia/analgesia.

OVERACTIVE BLADDER

In recent years, there has been a steady increase in patients visiting a specialist for what is known as overactive bladder syndrome. Due to the extremely negative impact of the disease on patients' quality of life, timely diagnosis and adequate treatment choices are of the utmost importance. The guidelines presented include a description of the etiology and pathogenesis, basic principles of diagnosis, and current methods of treatment for this category of patients.

Differential diagnosis of hydroxychloroquine-induced retinal damage

Coronavirus infection is currently en extremely relevant scientific topic due to the emergence of a new serotype that causes a condition identified as Severe Acute Respiratory Syndrome (SARS)-COV-2. Chloroquine and hydroxychloroquine have a long history of use against other infectious diseases, they are available and inexpensive, so the possibility of using them in vivo and in vitro to suppress the infectious agent was examined. Despite the noted therapeutic potential of these drugs, it was necessary to take into account the toxicological aspects that dictate the importance of rational use of 4-aminoquinoline derivatives. This review analyzes literature on the development patterns of hydroxychloroquine retinopathy, basic principles of diagnosis and differentiation of this condition from other types of retinal pathology.

Hematopoietic Stem Cell Transplantation for Severe Combined Immunodeficiency (SCID)

Severe Combined Immunodeficiencies (SCID) are a heterogeneous group of monogenetic diseases. We describe the typical clinical presentation of patients with SCID as well as basic principles in diagnosis and therapy by hematopoietic stem cell transplantation. Therapeutic strategies may differ between subtypes and the inherent reduced capacity or inablility to reject a graft have to be considered.

Maxillary and Palatal Fracture With Near-Avulsion of Bone Fragment-Case Report

Facial trauma can assume complex patterns closely related to the mechanisms of injury, often associating soft tissue injuries with bone fractures, sometimes with important functional and esthetic impact. The approach of such complex injuries must be individualized and basic principles of diagnosis, preoperative planning, wound care and postoperative management must be applied. We present a case of unusual orofacial trauma involving a complex fracture of the maxilla with associated soft tissue lacerations, involving the alveolar process, hard palate, maxillary sinus and nasal floor with near-avulsion of the fragment which was pediculated only by the anterior vestibular mucosa. The approach and surgical treatment of this case is presented along with a discussion of the management of this type of injuries.

Stable angina pectoris: choice of therapeutic tactics.

In everyday practice, the basic principles of diagnosis and treatment of stable ischemic heart disease, set out in the clinical recommendations, are often not observed. For successful treatment of angina, first of all, it is necessary to verify the diagnosis. The diagnosis of stable angina pectoris can be considered sufficiently justified, provided the characteristic chest pain and documentary evidence of transient myocardial ischemia by stress tests. The patient should be evaluated as a whole, taking into account all existing diseases, since concomitant diseases can directly or indirectly exacerbate the course of coronary heart disease, and sometimes be the main cause of angina. In such cases, treatment of concomitant diseases has a pronounced positive effect on the course of angina pectoris. It is advisable to assess the magnitude of the coronary reserve, the severity and prevalence of transient myocardial ischemia, its impact on hemodynamics and, based on the analysis of these indicators, to identify patients with high or low risk of myocardial infarction. Revascularization brings a clear prognostic benefit only in subgroups at high risk.

Результат лечения двусторонней перипротезной инфекции тазобедренных суставов

Introduction Infection is a devastating complication after joint arthroplasty. In most cases of purulent infection, surgeons are forced to perform revision of the artificial joint. This is caused by the ability of microorganisms to adhere on the implant surface. Periprosthetic infection is a heavy burden both for patients due to a significant level of the disease recurrence and for medical institutions because of high medical treatment costs. Methods The analysis of the treatment outcome in a female patient with bilateral periprosthetic hip infection was conducted. One- and two-stage revisions were performed. Results The treatment measures stopped the purulent inflammatory process (according to Delphi) and restored the functional state of both hip joints (HHS of 79 points on the left and 93 points on the right side). Discussion Treatment of periprosthetic infection is a complex clinical task, which requires a personalized and comprehensive approach that includes implementation of the basic principles of diagnosis and treatment of the disease, understanding of this pathology, and teamwork. One- and two-stage revisions provide a successful arrest of periprosthetic infection and functional restoration of the affected joint.