Verification Of Diagnosis Research Articles

Modern methods of diagnostics of syncopal conditions in servicemen

The review article is devoted to modern methods of diagnosing syncope, which is becoming more and more common among young people every year. This article discusses the causes and mechanisms of syncope, as well as methods of diagnosing and differentiating it. Particular attention is paid to syncope that occurs as a result of orthostatic hypotension. Unfortunately, syncope has long been ignored by both doctors and patients. It is not uncommon for patients to ignore isolated episodes of loss of consciousness, explaining them by lifestyle features. A long absence of any diagnosis, and, as a consequence, treatment leads to the progression of the underlying disease that provokes this syncope. But the problem of diagnosing syncope depends not only on patients, but also on doctors. Due to the lack of a clear algorithm that allows for accurate diagnosis of syncope and differentiation, doctors’ diagnostic capabilities are limited. However, this is not the only problem, since the lack of special equipment in most medical institutions also affects the quality of syncope diagnostics. Tilt test is currently the gold standard in syncope diagnostics according to the 2018 European Society of Cardiology recommendations. The equipment is expensive, and the diagnostic ability of this method does not provide the desired results for diagnosis verification. Today, the attitude to this problem is changing and in 2023, the development of a plan of clinical recommendations of the Russian Society of Cardiology began, where syncope is highlighted in a separate chapter. Accurate diagnostics of syncope is needed not only to determine the underlying disease. In the clinical practice of a doctor, there are often cases of simulation of syncope by young people of draft age for personal purposes. It is practically impossible to clinically confirm the presence of syncope in the past at the moment (especially if it was a single episode of loss of consciousness). The lack of a clear algorithm significantly complicates the verification of the diagnosis. The purpose of writing this article was to study the most effective diagnostic methods that allow you to most accurately determine the cause of syncope.

The Importance of the Skin Syndrome in the Primary Diagnosis of Connective Tissue Diseases in Children: Case Report

Background. Timely verification of the clinical diagnosis of connective tissue diseases in children based on the onset of the earliest symptoms, including skin manifestations, and timely initiation of treatment can prevent the development of irreversible complications, increase the life expectancy of patients and its quality. The aim of the study. To analyze the nature of skin manifestations as a marker of the onset connective tissue disorders, such as systemic lupus erythematosus (SLE), localized scleroderma (morphea), juvenile dermatomyositis (JDM), juvenile polyarteritis nodosa (PAN), systemic juvenile idiopathic arthritis (SJIA), and the timing of the main clinical diagnosis from the moment of manifestation of connective tissue disorders. To clearly demonstrate the importance of skin syndrome in the timeliness of clinical diagnosis, a clinical case is presented. Methods. Analysis of medical records and prospective observation of 47 patients aged up to 17 years 11 months with an established diagnosis of connective tissue diseases and the presence of skin syndrome at the onset of the disease. Results. Among patients with SLE, only 20.0% of children had skin syndrome only in the form of butterfly rash, and other skin manifestations were noted in 80.0% of patients. The period from the onset of skin syndrome to diagnosis was 8.0 ± 2.1 months. In 57.2% of patients with morphea, skin syndrome was detected exclusively in the form of single or multiple elements, and in 42.8% there was a combination of a pathognomonic morphological element with alopecia and scleroderma. The average time to make a clinical diagnosis of morphea from the onset of the skin syndrome was 11.0 ± 1.9 months. In all patients with JDM, skin manifestations were characterized by polymorphism (papules and Gottron’s sign, heliotrope rash, palmar capillaritis, livedo reticularis, cheilitis). The diagnosis was made 14.0 ± 3.2 months from the onset of skin syndrome. In patients with documented PAN, skin manifestations debuted in the form of erythema, areas of necrosis, palmar capillaritis, livedo reticularis, and cheilitis. The period from the onset of skin syndrome to clinical diagnosis was 6.0 ± 2.4 months. Among patients with SJIA, skin syndrome was represented by a maculopapular rash associated with fever and its regression when body temperature normalized. The period until clinical diagnosis was made from the onset of the skin syndrome was 2.0 ± 1.1 months. Conclusion. In most cases, the skin syndrome in patients at the onset of the disease was characterized by polymorphism and diversity of elements with the involvement of the vascular component. At the same time, the time from the debut of connective tissue disease in the form of the appearance of skin syndrome to the clinical diagnosis varied in the range from 2 to 14 months.

Difficulties in diagnosing hereditary angioedema (HAE) with normal c1 inhibitor levels in a patient with a pathogenic mutation in the MEFV gene associated with familial Mediterranean fever

Hereditary angioedema (HAE) is an orphan disease that causes potentially life-threatening edema in various locations and remains serious problem in both pediatrics and adult clinical practice often disguised as various diseases. The HAE diagnosis with normal C1 inhibitor activity is particularly difficult. The purpose of this publication is to demonstrate unique clinical case of HAE with normal C1 inhibitor activity in young patient with a pathogenic mutation in the MEFV gene, which is associated with familial Mediterranean fever. Severe abdominal attacks in this patient have been regarded for a long time as a part of therapeutic pathology (gastroenteritis, gastritis, Familial Mediterranean fever), acute surgical and gynecological diseases, which led to late diagnosis verification. The HAE requires timely diagnosis, elimination of factors that provoke exacerbations and an immediate therapy administration, that significantly improves life quality of patients and helps prevent death.

Primary ciliary dyskinesia in children: clinical, laboratory-instrumental and genetic characteristics

Background. Primary ciliary dyskinesia (PCD) is an orphan disease, and diagnosis is difficult because there is no gold standard for diagnosis. Aim. Clinical, laboratory-instrumental, genetic characteristics of PCD in children. Materials and methods. From 2009 to 2024, 31 patients with a genetically confirmed diagnosis of PCD were observed as part of a multicenter, open-ended, descriptive pilot longitudinal study. Examination methods: clinical and anamnestic method; X-ray examination and computed tomography of the chest organs and paranasal sinuses, tracheobronchoscopy; sputum/aspirate cultures of the tracheobroncheal tree with determination of sensitivity to antibiotics; transmission electron microscopy, high-speed video microscopy of the ciliated epithelium, cytological examination of bronchoalveolar lavage; monitoring computer pulse oximetry, echocardiography, audiometry, spirometry with bronchodilator test. Results. Respiratory symptoms in the neonatal period have 80% of children with PCD, lateralization defects – 35%, congenital heart defects – 13%, bronchiectasis – 68%, purulent endobronchitis – 62%, year-round rhinitis – 84%, hearing loss, otitis – 65%. The average age of onset of symptoms was 1 [1; 1] weeks, and the verification of diagnosis was 6 [2,5; 8] years. The main pathogens of chronic respiratory infection with PCD are Haemophilus influenzae, Pseudomonas aeruginosa, Staphylococcus aureus. The most common cause of PCD was biallelic variants of the DNAH5 gene. Conclusion. The diagnosis of PCD should be based on the application of the maximum number of diagnostic tests.

Keratoconus: modern diagnostic approach

Keratoconus (KC) is an ectatic corneal disease, resulting in loss of visual functions in young population. Diagnosis of the disease at a moderate stage with a typical progressive clinical course is not particularly difficult, however, the diagnosis verification in a few cases is rather troublesome. This literature review systematizes modern conceptions to the KC diagnosis, outlines current approaches to patients examining and diagnostics results assessing.

Belimumab in the treatment of systemic lupus erythematosus with juvenile onset: Results of a single-center retrospective study

The treatment of systemic lupus erythematosus with juvenile onset (jSLE) remains a difficult task, taking into account the more aggressive course of the disease, requiring the appointment of various therapy regimens, including mainly a combination of high doses of glucocorticoids (GC) with immunosuppressive drugs, which on the one hand improves control by the course of the disease, but on the other hand leads to an increase in serious adverse effects from therapy. Modern therapy capabilities have improved significantly with the advent of the belimumab – first and alone registered biologics for children with SLE.The aim of the study – based on an open single-center retrospective study, to analyze the efficacy and safety of belimumab in children with SLE.Material and methods. The study included all patients with jSLE who were observed in the pediatric department of V.A. Na sonova Research Institute of Rheumatology and received at least 1 infusion of belimumab. Diagnosis of SLE based on 2012 SLICC (Systemic Lupus Erythematosus International Collaborating Clinics) criteria. The efficacy of therapy was evaluated among patients who received belimumab for 6 months or more, and safety in all who received at least 1 infusion.Results. The study included 31 patients, 24 girls/7 boys. The median (Me) age at onset of the disease was 12.6 [10.18; 13.5] years, the Me duration of the disease at the time of initiation of belimumab therapy was 2.15 [0.9; 4.4] years. The Me activity on the SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) at the time of diagnosis verification was 12 [9; 17.5], at the time of start of belimumab – 8 [6; 12], 35.5% patients had severe activity, 51.6% – moderate, 12.9% – mild activity. The dose of GC per os at start of belimumab was 15 [10; 21.25] mg/day, 32.26% of patients received a high dose of GC, 54.84% – moderate dose, 12.9% – low dose. 9 patients had SDI (Systemic Lupus International Collaborating Clinics Damage Index) ≥1, Me – 1 [1; 2]. After 6 months of therapy, the Me of disease activity according to SLEDAI was 4 [2; 6], the dose of GC per os was reduced to 10 [8.25; 17.5] mg/day. In 15 patients, a decrease in antiDNA was recorded (57.7% of those who initially had elevated values of antiDNA), in 9 the level of complement was normalized (50% of those who initially had hypocomplementemia). After 12 months of therapy, the Me of SLEDAI was 4 [2; 4] (p=0.034), the dose of GC per os was 5 [5; 8.125] mg/day (p=0.012). 5 patients completed therapy within 12 months or more: 1 patient – remission, 4 patients – secondary inefficiency. Belimumab treatment was well tolerated, with the exception of three cases of serious adverse reactions (9.7%): prolonged diarrheal syndrome (after the 1st infusion), Lyell’s syndrome (after the 2nd infusion), infusion reaction (during the 2nd infusion). During the therapy of belimumab, no new damage were recorded; in 2 patients there was a decrease in the SDI.Conclusion. Belimumab therapy in patients with jSLE demonstrated high efficacy with a decrease in the activity of the disease according to SLEDAI, normalization of antiDNA and complement, the possibility of a significant reduction the dose of GC, the absence of progression of the SDI with a good safety profile in the vast majority of patients.

Damage to the organ of hearing and upper respiratory tract in vasculitis associated with antineutrophil cytoplasmic antibodies

Antineutrophil cytoplasmic antibodies associated vasculitis (ANCA-AV) is a systemic necrotizing granulomatous vasculitis affecting mainly small-caliber vessels. ANCA-AV occupy a special place among systemic vasculitis, which is characterized by a highly active life-threatening course of the disease, requiring rapid differential diagnosis and aggressive immunosuppressive therapy. The ANCA-AV group consists of 3 nosologies: granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis. The “calling card” of ANCA-AV is the lesion of the upper respiratory tract, especially the ENT organs (70–100 % of patients). The nasal cavity and paranasal sinuses are the most common areas of lesion in the head and neck (85–100 %), whereas ear damage occurs in about 35% (range, 19–61 %) of cases. Lesion of the ENT organs is typical for the debut of ANCA-AV, which makes early diagnosis difficult, since diseases of the upper respiratory tract are extremely common in all age groups. Diagnosis verification occurs mainly at the stage of generalized involvement of many organs and systems, causing severe course with the development of pulmonary-cardiac and renal insufficiency, which lead to the death of the patient. The main ENT manifestations of ANCA-AV can be grouped into several groups: sinonasal, otological, tracheobronchial, oral cavity lesions and others. Pseudotumors are often found in ANCA-AV. They are characterized by the appearance of parapharyngeal, parotid, submandibular, paratracheal volumetric formations. As a rule, the appearance of tumor-like formations is observed at an early stage of the disease and is associated with the presence of antibodies to proteinase 3, systemic manifestations of vasculitis. Pseudotumor in the ENT region may be accompanied by secondary neuropathies of cranial nerves, destruction of bone tissue, which requires histological verification of the disease.

Detection of pulmonary tuberculosis in the republic of Tajikistan

Objective: To study the dynamics and main reasons for the significant detection of pulmonary tuberculosis with a negative sputum test result in the Republic of Tajikistan over the past 5 years. Material and methods: An analysis of the estimated data of the WHO, as well as official statistics on TB incidence using the National TB Data Registry for 2019-2023, was carried out. Definitions of clinically established cases of pulmonary TB are noted. Information is presented on the introduction of the express PCR method of bacteriological verification of TB diagnosis in all regions of the country. Results: Over the past 5 years (2019-2023), WHO estimates on TB incidence in the Republic of Tajikistan have significantly decreased, indicating improved accessibility of the population to specialized anti-TB services. At the same time, during the COVID period (2019-2020), the prognosis was more unfavorable due to deteriorating accessibility to medical and social services than in the post-COVID period (2021-2023). At the same time, official statistics on the detection of new TB cases indicate the opposite dynamics: during the COVID period, the number of TB patients sharply decreased from 5976 to 4299 cases that is, by 1677 cases (more than 28%) and began to gradually increase in subsequent years, but has not yet reached the pre-COVID level. At the same time, in proportion to the indicated data, the number of clinically established cases of pulmonary TB decreased during the COVID period from 1422 to 720 cases (2019-2021), that is, almost twofold, and in the following years (2022-2023) began to gradually increase, still not reaching the pre-COVID period. Conclusion: Thus, despite the active introduction of new innovative methods for verifying the diagnosis of TB and improving the population's access to diagnostic services, including molecular genetic methods for rapid diagnostics of both sensitive and drug-resistant forms of TB, the proportion of clinically established cases of pulmonary TB remains high (34% of all pulmonary forms of TB) and tends to increase.

Economic burden of pulmonary hypertension. Systematic review

Aim. A systematic review of studies on pulmonary hypertension (PH) cost estimates.Material and methods. A systematic literature search was performed for studies assessing the cost of PH published up to November 30, 2023. The search was carried out in the PubMed/MEDLINE, EMBACE databases for publications in English and in the RSCI database for articles in Russian according to inclusion and exclusion criteria.Results. The systematic review included 13 studies. The mean direct costs per patient with PH after verification of the diagnosis per month ranged from 2023 to 9915 USD, while the median from 1141,5 to 8144 USD. Indirect costs were assessed in only 3 following studies: in Spain and USA, the mean indirect costs were 214 and 1226 USD per patient per month, respectively, while in Russia the median was 65 USD. The mean direct costs per patient with PH per month before diagnosis verification ranged from 1017 to 9723 USD. Indirect costs before diagnosis verification were assessed in only 1 study (median $102 per patient per month). After PH verification, in general, there was an increase in treatment costs with a decrease in other direct costs.Conclusion. PH causes great socio-economic damage to society and healthcare system. A decrease in non-drug therapy costs after PH verification may indicate not only the clinical effectiveness of PH-specific therapy, but also its potential costeffectiveness with reduced costs.

A clinical case of acute polyneuropathy, with the onset of bilateral facial nerve palsy in an early childhood

BACKGROUND: The differential diagnosis of peripheral nervous system damage depends on a thorough collection of history, comprehensive assessment of clinical manifestations, and dynamic examination of the patient. This article describes a clinical case of acute polyneuropathy in a young child, which began with gastrointestinal symptoms and bilateral facial neuropathy. CLINICAL CASE DESCRIPTION: The article presents a case of a child with an atypical course of acute polyneuropathy, which began with bilateral facial neuropathy combined with gastrointestinal complaints and pain syndrome. Features of the clinical presentation of the disease required extended laboratory and instrumental testing. Protocols for instrumental verification of diagnosis included nerve conduction studies examining neural conduction and axonal excitability of the affected facial nerve and the healthy side. Additionally, the functional status of the peripheral nerves in the upper and lower limbs was assessed. Polyneuropathic alterations revealed through nerve conduction studies confirmed diagnostic lumbar puncture to determine the presence of neuroinfectious processes. Magnetic resonance imaging of the brain, brachial, and lumbosacral plexuses using intravenous contrast showed the nature and prevalence of a lesion. Based on the overall clinical, laboratory, and instrumental examination data of the patient, “acute inflammatory demyelinating polyneuropathy” was diagnosed; timely etiopathogenetic treatment was initiated. CONCLUSION: In children, the course of a neuroinfection may be atypical. Sometimes, when dissociating the clinical manifestations of the disease from the results of a standard laboratory and instrumental test, expert diagnostic techniques should be used for differential diagnosis purposes.

Clinical Case of a Foreign Body in the Soft Tissues surrounding the Knee Joint: to Help the Practitione

INTRODUCTION: The existence of foreign bodies in a human organism often creates difficulties in differential diagnosis and diagnosis verification. A clinical case of a 45-year-old female patient is presented. On examination, the patient complained of pain in the knee joints, restricted range of active movements, more on the left. Pain syndrome in the joints has been present for several years intensifying on exertion; a week before the current consultation, the patient fell down from her height on the left knee and felt a sharp enhancement of pain in it. X-ray of the left knee joint showed a fragmented foreign body in the surrounding soft tissues. The patient denied a history of trauma with a foreign body getting into the wound; she cannot give the data and mechanism of appearance of a foreign body in the soft tissues. CONCLUSION: The peculiarities of the given clinical case include the absence of data on the fact of entry of a foreign body, its prolonged presence in the soft tissues without significant clinical symptoms. A relative rarity of a foreign body in soft tissues, however, does not exclude it being a cause of pain syndrome, the primary care physicians should have diagnostic alertness. A thorough history taking and instrumental examinations are required to exclude, among other things, the presence of an X-ray negative foreign body. Not a single method of examination can be considered ideal for diagnosis of all types of foreign bodies.

Registry of patients with autoimmune liver diseases in St. Petersburg: clinical and epidemiological data

BACKGROUND: The problem of autoimmune liver diseases, which include autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis and their overlap syndromes is an urgent problem of modern medicine. This is associated with an increase in the incidence and prevalence of these nosologies in different regions of the world. Absence of an established etiological factor, prolonged asymptomatic or low-symptomatic course, lack of pathognomonic clinical picture, imperfect diagnostic criteria, insufficient awareness of physicians lead to late diagnosis of autoimmune liver diseases and, accordingly, untimely initiation of treatment, which often reduces its effectiveness, affecting the further prognosis and survival rate for this group of patients. Patients with autoimmune liver diseases require long-term, often lifelong therapy and dispensary observation. Epidemiological registries along with autoimmune liver diseases registries, including various nosologies of autoimmune liver diseases, form an important database on the incidence, clinical features, development and course of the disease, variants of therapy and response to therapy, presence of extrahepatic manifestations as well as allow analysis of all data in dynamics. AIM: To analize data on various nosologies of autoimmune liver diseases, demographics, clinical symptoms, timing of the first symptoms, timing of diagnosis, and the nature of extrahepatic manifestations. MATERIALS AND METHODS: This article presents data from the autoimmune liver diseases Register of the North-West Hepatology Centre (North-West Autoimmune Liver Diseases Register) of the North-Western State Medical University named after I.I. Mechnikov. RESULTS: The study obtained data on the nosological structure, demographic characteristics, timing of diagnosis verification, clinical symptoms and extrahepatic manifestations of autoimmune liver diseases. CONCLUSIONS: Establishing registers of autoimmune liver diseases, providing information about patients with these diseases, will help to assess the effectiveness of examination and treatment methods, factors affecting the course and prognosis of the disease. Analysis of the data obtained will help to develop screening programs, diagnostic algorithms and differential diagnostics of autoimmune liver diseases, which, in turn, will facilitate the diagnostic process, shorten the time of diagnosis, make it possible to start therapy earlier and, consequently, improve the prognosis and survival rate for this group of patients.

Прогностическое значение цитотоксических CD8-позитивных Т-лимфоцитов реактивного микроокружения опухоли при диффузной В-крупноклеточной лимфоме

AIM. To assess the prognostic value of cytotoxic CD8-positive Т-lymphocytes of the reactive tumor microenvironment in diffuse large B-cell lymphoma (DLBCL). MATERIALS & METHODS. The study enrolled 124 patients with newly diagnosed DLBCL. All patients received the standard R-CHOP first-line immunochemotherapy. Immunochemistry and morphometry were used to assess the relative count of CD8-positive Т-lymphocytes in the biopsy samples of lymph nodes or other tumor tissues. In each biopsy sample, 20 fields of view were analyzed to assess the mean relative count of CD8-positive Т-lymphocytes in the reactive tumor microenvironment. Т-cells were counted by double-blind technique. Patients were aged 23–80 years (median 59 years); there were 62 women and 62 men. RESULTS. Obtained by ROC-analysis, the threshold value of the CD8-positive Т-lymphocyte count in the reactive tumor microenvironment was 13 %. The subthreshold relative count of cytotoxic CD8-positive Т-lymphocytes (≤ 13 %) was associated with extranodal lesions in DLBCL patients as well as with the lack of complete response to the R-CHOP first-line therapy and worse progression-free (PFS) and overall survival (OS) rates. In the group with the above-threshold (> 13 %) count of CD8-positive Т-lymphocyte, the 5-year PFS was 60 % (median not reached), in the group with the subthreshold count it was 45.3 % (median 39 months; p = 0.036); the 5-year OS was 78.3 % (median not reached) and 45.3 % (median 40 months) in the groups with the above- and subthreshold CD8+ T-cell counts, respectively (p = 0.001). CONCLUSION. The results of the present study clearly indicate the need to assess the count of cytotoxic CD8-positive Т-lymphocytes of the reactive tumor microenvironment in DLBCL patients as early as on diagnosis verification. It is likely that this approach will allow clinicians to more accurately predict the course of DLBCL.

Diagnostic Efficacy of Trephine Biopsy and Core Biopsy of Bone and Soft Tissue Tumors

Verification of pathomorphological diagnosis is a key stage in selection of treatment tactics in patients with neoplasms. Understanding of the nature of pathological process is especially important in context of primary tumors of the bones, soft tissues and metastases as despite active development of diagnostic techniques, they do not allow to obtain full information on histological nature of the tissues, differentiation grade, as well as molecular and genetic characteristics of the tumor. These data are associated with selection of optimal treatment tactics at every stage and disease prognosis. The optimal approach to obtaining histological materials in tumor of the bones and soft tissues are radiologically guided (X-ray, computed tomography and magnetic resonance imaging) trephine biopsy or ultra-sound-guided core biopsy.Aim. To determine information value of trephine and core biopsies of neoplasms of the bones and soft tissues of various locations, identify mistakes during manipulation affecting results of morphological diagnosis.Materials and methods. Between 2015 and 2023 at the Russian Scientific Center of Roentgenoradiology, 788 patients aged 18–85 years (380 men, 408 women) underwent 602 trephine biopsies and 248 core biopsies (n = 850) of neo-plasms of the soft tissues and bones of various locations. Absence of informational value of morphological study required repeat trephine biopsies in 19 patients, core biopsies in 2 patients, open biopsies in 13 patients.Results. Informational value of trephine biopsy of the bones was 90.5 % (long bones – 96.8 %, flat bones – 91.6 %, spine bones – 82.1 %), core biopsy of the soft tissues 98.8 %. Sufficient amount of material for immunohistochemical testing was obtained in 89 % biopsies. Interventions in cases of bone neoplasms were performed using CT (computed tomography) navigation; for core biopsies of the soft tissues, ultrasound was used. Absence of informational value in trephine bio psies was caused by insufficient amount of material (48 (7.97 %) cases), retrieval of trephine biopsy from the area of tumor necrosis (4 (0.67 %) cases), incorrect selection of access (4 (0.67 %) cases) and needle type (1 (0.17 %) case).Conclusion. Results of analysis of trephine and core biopsy data of bone and soft tissue neoplasms showed high information value, which is supported by literature data. This allows to consider these methods of histological material retrieval the “golden standard” of bone and soft tissue tumor diagnosis.

Reasons for difficulties in the interpretation of thyroid scintigraphy results with 99mTc-pertechnetate in functional autonomy of thyroid nodules and Graves’ disease: a clinical case

Thyrotoxicosis is a condition caused by an excess of thyroid hormones, such as thyroxine (T4) and triiodothyronine (T3), in the body, leading to corresponding clinical manifestations. One of the main challenges in the differential diagnosis of various forms of thyrotoxicosis is the similarity in the clinical presentation of diseases. Therefore, the main tools for accurate diagnosis verification in the wide spectrum of thyrotoxicosis nosologies are the correct sequence of laboratory and instrumental investigations and subsequent interpretation of the obtained results. Only accurately established disease etiology will allow for the selection of the most appropriate and effective treatment for a particular patient, as well as the avoidance of unjustified risks of possible complications. In this article, we will discuss the main difficulties that may arise during the differential diagnosis of various forms of thyrotoxicosis, as well as address some key aspects of proper diagnosis.

ОЦЕНКА ИНТЕРЛЕЙКИНОВОГО ПРОФИЛЯ В НАЗАЛЬНЫХ СМЫВАХ У ДЕТЕЙ С АЛЛЕРГИЧЕСКИМ РИНИТОМ

Allergic rhinitis is one of the most urgent problems of allergology and immunology, since, despite the improvement of therapeutic and diagnostic approaches, the number of patients remains very significant. Allergic pathologies of various types occur in 25-30% of children. Allergic rhinitis is based on a multifactorial chronic inflammatory process of the nasal mucosa, which causes the presence of constant persistent inflammation and the progression of the disease, especially in childhood. Biological inflammatory mediators in nasal flushes help to determine the pathophysiological phenotypes of allergic rhinitis, which is of undoubted interest. The work carried out the determination of the level of cytokines: IL 1b, IL 4, IL 6, IL 10 and interferon gamma in nasal flushes in patients with allergic rhinitis, depending on the presence or absence of changes in the nasal mucosa based on rhinoscopy during diagnosis verification. Changes in the nasal mucosa directly depend on the production of cytokines, which form individual phenotypes of the disease. According to the results of the analysis, the data obtained are associated with the presence of persistent allergic inflammation, neurohumoral and anti-infectious, which make a significant contribution to the clinical manifestations of the disease. The study of the role and significance of the proliferation of major cytokines in the nasal secretion will help the practitioner in determining treatment tactics, duration of therapeutic and preventive measures and further marching of the patient.

Ayurvedic Management of Psoriasis

Plaque psoriasis, akin to Mandalakhushta in Ayurveda, presents as scaly lesions and persistent rashes, often resistant to therapy. While topical corticosteroids may provide temporary alleviation, they do not address the underlying causes of the condition. Top of Form A 24-year-old male student, with symptoms aligning with Mandalakhustha, exhibited redness, scaling, and itching across his limbs and trunk for a month. The assessment identified Vata and Kapha as the involved Doshas. Diagnosis verification through biopsies can be confirm for plaque psoriasis, leading to conventional Kushta treatment. Pre-operative therapies, such as Rukshana (dehydration therapy) and Snehapana (medicinal ghee consumption), were followed by Vamana (emetic therapy) and Virechana (purgative therapy). The treatment spanned a month, supplemented by the Sansarjana Karma diet. Combining Shaman and Shodhan Chikitsa within Panchkarma therapy, along with internal medicine, yielded satisfactory results in this study.

Features of treatment, hospitalization and working ability of newly diagnosed patients with pulmonary arterial hypertension before and after diagnosis verification

Features of treatment, hospitalization and working ability of newly diagnosed patients with pulmonary arterial hypertension before and after diagnosis verification

OPTIMIZATION OF TESTS FOR VERIFICATION OF A DIAGNOSIS MADE BY A GENERAL PRACTITIONER (GP)

Introduction: In a GP’s work, the fundamental problem is the accuracy of the diagnosis under time constraints, cost limitations on health care and medical standards. A GP selects the medical tests for verification of a hypothetical (preliminary) diagnosis made after an interview and physical examination. Optimization of such verification tests as urine, blood, ultrasound examination and simple X-ray examination in order to improve the diagnosis accuracy has been attempted in the paper. Diagnostic potential, cost and precision of tests have been accepted as optimization criteria. Methods: For a health problem, a set of preliminary diagnoses is given. The diagnostic potential of tests in verification of the diagnosis from this set is determined using the Analytic Hierarchy Process. Then for each of these diagnoses, a set of tests with sufficiently great total diagnostic potential and minimal cost is found using a binary linear programming problem. The precision of tests in verification of the diagnoses is estimated using medical expert intuition. Then the pairs (hypothetical diagnosis, test) with the greatest coefficient of test precision impact in verification of the hypothetical diagnosis are selected. Finally, the recommendations for improving precision of the selected tests are defined. Results: In the case study, a lumbar pain health problem is considered. Six preliminary diagnoses and four tests have been theoretically considered, i.e., no sample of patients. Two recommendations for the tests have been formulated. Discussion and Conclusions: A quantitative method for indicating week points of medical tests in order to improve diagnosis accuracy has been proposed. A limitation of the case study is the estimation of diagnostic potential of tests and their precision by one medical expert only.

An evidence-based algorithmic approach to osteoporosis etiology verification on the example of a clinical case

Background. The importance of timely detection of osteoporosis in patients is conditioned by its severe consequences such as osteoporotic fractures. The disease can be both primary and related to the existing other pathology or to the therapy being carried out, i.e. secondary. In young patients, in most cases, osteoporosis is secondary in nature. Diagnosis verification requires doctor’s perseverance and knowledge. Purpose – is to demonstrate an algorithm of finding a possible cause of the osteoporosis development in a young person on the example of a clinical case. Materials and Methods. The medical history of a 32-year-old man is presented. The man was consulted a doctor with complaints of long-lasting aching pain in the back, stiffness in the morning in the thoracic spine and pain during movement, and was diagnosed with a compression fracture of the spine on the background of a decrease in bone mineral density. Results. The article describes the step-by-step algorithm of making a diagnosis by gradually excluding primary osteoporosis and possible causes of the secondary nature of the disease. Information about the possible mechanisms of osteoporosis formation in the most common conditions included to the differential diagnosis is given in the article. The described diagnostic search algorithm can be used in the practice of a doctor of any specialty. Conclusions. Making a diagnosis of osteoporosis must include a differential diagnosis of its forms with the establishment of the ethiology of this pathology. In young patients, in most cases, osteoporosis has secondary nature and requires a mandatory search for its cause by gradually and methodically excluding conditions that can lead to a decrease in the mineral density of bone tissue, including genetic ones. In practice, there are cases of idiopathic osteoporosis, when the examination does not allow to clearly establish the reasons that led to a decrease in bone density. Such cases require the special attention of doctors, because the diagnosis of the main disease that led to the development of osteoporosis in the future can be detected. In this case along with antiresorptive drugs, therapy of the condition, which is the root cause of the development of osteoporosis, is prescribed, if possible. The specified combined therapy will contribute to increasing the effectiveness of treatment and shortening its duration.