Diagnostic Complex Research Articles

Ketamine-assisted psychotherapy in adolescents with multiple psychiatric diagnoses.

Ketamine-assisted psychotherapy is a promising new treatment for a variety of mental disorders of adolescence. There is currently an adolescent mental health crisis, with a high prevalence of disorders, diagnostic complexity, and many adolescents failing to respond to conventional treatments. While there is strong evidence for the use of ketamine in adults for a variety of treatment-refractory mental illnesses, research in adolescents is in its early stages. Ketamine-assisted psychotherapy (KAP) has been described in adults with promising results and here we present the first published cases of the use of KAP in adolescents. The four cases include adolescents aged 14-19 at the initiation of treatment, each with a variety of comorbid diagnoses including treatment-resistant depression, bipolar disorder, eating disorders, anxiety, panic, and trauma-related symptoms. They each initially received sublingual ketamine, followed by sessions with intramuscular ketamine. Their courses varied, but each had symptomatic and functional improvements, and the treatment was well-tolerated. Subjective patient reports are included. Rapid resolution of symptomatology and suffering often occurs within months as the result of the application of KAP to adolescent psychiatric care but is not inevitable. Family involvement in the treatment process appears to be essential to success. The development of this modality may have a singularly positive impact that will expand the psychiatric toolbox and its healing potency.

TREATMENT OF PURULOUS-INFLAMMATORY COMPLICATIONS OF INJURIES AND DISEASES OF PELVIC BONES

Summary. Purulent-inflammatory complications of fractures of pelvic bones represent up to currently one of the most difficult and little-studied sections of traumatology. Complexity anatomical structure and topographic relations of the pelvic region, deep location a significant part of the bones under the muscle mass create objective difficulties for surgical treatment of bone damage and later in the diagnosis of purulent processes. Osteomyelitis of the pelvis is accompanied by high mortality and is from 2.5 to 52% as in acute and in the chronic stage of the disease.
 Purpose: by analyzing clinical mistakes and the possibility of purulent-inflammatory complications during operative treatment and postoperative management of patients with fractures bones of the pelvis, as well as to determine methods of diagnosis, treatment and ways of prevention traumatic sacroiliitis.
 Materials and methods. In the period from 2017 to 2022 in the bone-purulent surgery department of Zaporizhzhia city clinical hospital №9 treated 9 patients with purulent processes in of the pelvic region, 6 (66.3%) of them were men, and 3 (33.4%) were women. With postoperative osteomyelitis, which occurred after osteosynthesis with plates of multiple pelvic bone fractures, 4 (44.5%) patients were treated. Conservative therapy with sacroiliitis, the cause of which was abortion, received by 2 (22.2%) women, 1 (11.1%) patient suffered from right-sided sacroiliitis since childhood and repeatedly operated, and 2 (22.2%) men were treated with cause of sacroiliitis, which occurred after slaughter of the sacroiliac joint area.
 Results. All patients who were treated in the bone-purulent surgery department for purulent-inflammatory processes of pelvic bones, recovered and were discharged for outpatient treatment. While treatment in the ward, patients received complex treatment, which included conservative therapy and surgical intervention. Despite the introduction of modern methods of treatment of osteomyelitis of the pelvis, a trend of steady growth in the number is noted exits of patients with disabilities, which is confirmed by world statistics.
 Conclusions. Lack of hard fixation of bone fragments by implants increases the risk of purulent complications in the postoperative period. Use of additional diagnostic methods and complex treatment, which includes radical purulent sanitation foci, creation of favorable conditions for tissue regeneration, prevention of relapses suppuration, targeted antibacterial therapy, correction of homeostasis indicators and increases the protective forces of the body during purulent processes of the bones and joints of the pelvis achieving positive results in 80.2% of patients.

Isavuconazole Breakthrough Disseminated *Fusarium fujikuroi* Infection in a Patient with Allogeneic Hematopoietic Stem Cell Transplant: Diagnostic and Therapeutic Challenges – A Case Report

# Introduction This case report illustrates the diagnostic challenges and complexities in the treatment of disseminated fusariosis. # Case An 18-year-old patient received a second allogeneic hematopoietic stem cell transplant (HSCT) 5 months after the first HSCT. Two days post-transplant, the patient presented neutropenic fever with diffuse multiple cutaneous papular lesions under isavuconazole prophylaxis. A diagnosis of disseminated fusariosis due to *Fusarium fujikoroi* was established. Antifungal therapy had to be adapted multiple times for efficacy and safety issues. Long-term combination therapy with posaconazole and terbinafine efficiently controlled the infection and was well tolerated. # Discussion This case report illustrates three major teaching points: (i) high clinical suspicion based on typical clinical and microbiologic findings is a key factor for the diagnosis of fusariosis; (ii) treatment is challenging due to variable antifungal agent minimal inhibitory concentrations (MICs); and (iii) long-term administration of voriconazole can be associated with multiple, less frequently seen adverse events. # Conclusion Typical skin lesions and positive blood cultures for molds should promptly rise suspicion of fusariosis. Amphotericin-B and voriconazole are the first-line agents for the treatment of fusariosis. Second-line agents such as posaconazole and terbinafine can be used.

Complex applying physical therapy and preformed physical factors in pregnant women with chronic pyelonephritis

The aim of the work is to evaluate the impact of physical therapy and preformed physical factors in pregnant women with chronic pyelonephritis on central hemodynamic indicators. Materials and methods. The dynamics of 134 pregnant women with chronic pyelonephritis (CP) in the remission stage, who underwent a complex sanatorium rehabilitation program, were examined. The main study group consisted of 79 pregnant women with chronic pyelonephritis. In this contingent of women, the sanatorium rehabilitation complex additionally included a course of intermittent normobaric hypoxytherapy (INH). The comparison group consisted of 55 pregnant women with CP, for whom the sanatorium rehabilitation complex did not include an INH course. The control group is represented by 37 somatically healthy women with a physiological course of pregnancy. All pregnant women were examined for central hemodynamic (CH) indicators using the computer diagnostic complex REOKOM (Kharkiv). Results. Pregnancy periods of 20–30 and 31–30 weeks in women with CP are characterized by a pathological load on central hemodynamics. At the same time, the application for the INH course in the sanatorium rehabilitation complex (the main group) allows for an increase in the compensatory capabilities of the pregnant woman with CH. Thus, in the period of pregnancy of 22–30 weeks in the main group, indicators of diastolic blood pressure and heart rate were probably lower than the control values (P < 0.001), which in this group is determined by values of peripheral resistance of blood vessels close to those of the control group (P > 0.05), regardless of the timing of the study. The study of CH and the comparison of different periods of gestation and between research groups indicate an inverse relationship between indicators that reflect the intensity of cardiohemodynamics and indicators of vascular resistance, as one of the final mechanisms of maintaining blood pressure at a physiological level, or its pathological increase in chronic pyelonephritis and preeclampsia Taking into account that the ratio of cardiac index indicators and total peripheral vascular resistance in all study groups was stable and directly dependent on the level of blood pressure, it is advisable to recommend for practical application in order to assess the state of CH of pregnant women with CP indicators of stroke or cardiac indices, which characterize the intensity cardiohemodynamics and do not depend on the anthropometric data of the pregnant woman. Conclusions. The application of physical therapy and preformed physical factors, namely, intermittent normobaric hypoxytherapy in pregnant women with chronic pyelonephritis in a complex program of sanatorium rehabilitation increases the compensatory capabilities of the cardiovascular system, which is confirmed by a significant decrease in the values of the total peripheral resistance against the background of an increase in the cardiac index.

IMPLEMENTATION OF CURRENT RECOMMENDATIONS FOR PULMONARY EMBOLISM THERAPY UNDER CONDITIONS OF ANTIPHOSPHOLIPID SYNDROME AND ECG DIGITALIZATION TO DIFFERENTIATE THIS PATHOLOGY AND ACUTE CORONARY SYNDROME (OBSERVATION FROM PRACTICE)

The work highlights the principles of a new approach to the management of patientswith pulmonary embolism against the background of antiphospholipid syndrome, takinginto account modern recommendations and the clinical case analysis. The expediencyof ECG digitalization using software- diagnostic complex «Smart ECG» at pulmonaryembolism, combined with antiphospholipid syndrome, to make differential diagnostics ofacute coronary syndrome, is substantiated.

S2k Guideline - Merkel cell carcinoma (MCC, neuroendocrine carcinoma of the skin) - Update 2022.

Merkel cell carcinoma (MCC, ICD-O M8247/3) is a rare, malignant, primary skin tumor with epithelial and neuroendocrine differentiation. The tumor cells share many morphologic, immunohistochemical, and ultrastructural features with cutaneous Merkel cells. Nevertheless, the cell of origin of MCC is unclear. MCC appears clinically as a reddish to purple spherical tumor with a smooth, shiny surface and a soft to turgid, elastic consistency, usually showing rapid growth. Spontaneous and often complete regressions of the tumor are observed. These likely immunologically-mediated regressions explain the cases in which only lymph node or distant metastases are found at the time of initial diagnosis and why the tumor responds very well to immunomodulatory therapies even at advanced stages. Due to its aggressiveness, the usually given indication for sentinel lymph node biopsy, the indication of adjuvant therapies to be evaluated, as well as the complexity of the necessary diagnostics, clinical management should already be determined by an interdisciplinary tumor board at the time of initial diagnosis.

Comorbid Obsessive-Compulsive Symptoms in Schizophrenia - Diagnostic and Treatment Challenges

Introduction The comorbidity between Schizophrenia and Obsessive-Compulsive Symptoms represents almost 25% of schizophrenic patients and it is believed that almost 12% match the diagnostic criteria for Obsessive-Compulsive Disorder. Some second-generation antipsychotics may worsen or even induce those symptoms, which makes the treatment of this patients a difficult challenge.ObjectivesTo assess the link between Schizophrenia and Obsessive-Compulsive Symptoms, to discuss the diagnostic challenges and treatment options. To present a clinical case report of a schizophrenic patient with Obsessive-Compulsive Symptoms, which improved with proper treatment.MethodsWe performed a non-systematic review of the existent literature with the keywords “Schizophrenia” and “Obsessive-Compulsive Symptoms”. Description of a clinical case report.ResultsWe present the case report of a male, 21 years old, single, diagnosed with Schizophrenia. In the past year, he was admitted twice in a psychiatric ward for persecutory and mystic delusions, which lead him to erratic behaviour. Since his adolescence he manifested repeated washing and compulsive cleaning associated with the fear of being contaminated with multiple diseases. Those compulsions worsened when he started being treated with antipsychotics. However, with therapeutic adjustments and with the introduction of an antidepressant we were able to control those symptoms.ConclusionsSome antipsychotics may induce or even aggravate Obsessive-Compulsive Symptoms in psychotic patients. It is of extreme relevance to differentiate those symptoms as comorbid in Schizophrenia or if they existed prior to the first positive symptoms, since they can be representative of an Obsessive-Compulsive Disorder. Understanding this diagnostic and treatment complexity enables us to be more familiar with the development of Obsessive-Compulsive Symptoms in schizophrenic patients.Disclosure of InterestNone Declared

АЛГОРИТМ ОКАЗАНИЯ МЕДИЦИНСКОЙ ПОМОЩИ ПАЦИЕНТАМ С ЗАБОЛЕВАНИЯМИ СЛИЗИСТОЙ ОБОЛОЧКИ РТА

The relevance of this work is due to the high prevalence of diseases of the oral mucosa, which have a chronic protracted nature. Underdiagnosis of patients at a dental appointment often leads to complications of various kinds. The aim of the work is to develop an algorithm for providing dental care to patients with diseases of the oral mucosa. 146 patients who applied for dental care took part in the examination. As a result of clinical examination and additional diagnostic methods, defects of the oral mucosa were detected in 19.8% of patients. The patients underwent a basic examination, the nature and intensity of pain on the Hossley-Bergman scale were determined, the area of erosive and ulcerative defects was calculated. Additional examination methods included electromyography and laser Doppler flowmetry. Electromyographic examination during the "bruxism" test made it possible to diagnose muscle hypertension, which is a predictor of the development of chronic injuries. Doppler flowmetry reflected the state and genesis of microcirculatory disorders of the oral mucosa. Thus, there is a decrease in the microcirculation parameter, the mean square deviation and the basal blood flow rate. Carrying out a full-fledged diagnostic complex allows both to identify the root causes of the development of pathologies, and to prescribe pathogenetic therapy taking into account the identified disorders. Timely diagnosis makes it possible to identify pathology at an early stage, which will prevent the development of a number of complications, such as the transition to a more severe form of the disease and malignancy of the decubital ulcer. Compliance by dentists with the algorithm of providing medical care to patients with diseases of the oral mucosa will allow timely identification and elimination of the etiological factor, timely restoration of the functions of the oral mucosa, normalize the functional state of the body.

Behçet's Disease Revealed by Budd-Chiari Syndrome, Neuro-Behçet's and Pulmonary Embolism

Behçet's disease is a vasculitis of the vessels affecting the arterial and venous territories whatever their calibers. It preferentially affects young subjects between 10 and 45 years old and also affects men and women. The history and physical examination are key steps in the diagnosis. We report the case of a 37-year-old patient with a history of repeated oral aphtosis for several months, chronic active smoker and former chronic alcoholic, in whom the revelation of Behçet's disease by the Budd-chiari syndrome, neuro-behçet and pulmonary embolism in the complication phase, this despite the multidisciplinary intervention, the vital prognosis was put into play. The revelation of Behçet's disease by multi-visceral complications justifies the diagnostic and management complexity, hence the importance of the contribution of imaging. These patients require early diagnosis of this polymorphic pathology and regular monitoring. Its manifestation by the Budd-Chiari syndrome is its seriousness due to its complications. Essentially all forms of liver disease are possible: fulminant, acute, subacute, chronic or an inaugural digestive hemorrhage by portal hypertension. The diagnostic delay in the complications phase, with multi-visceral involvement associating Budd-chiari syndrome, neuro-behçet and pulmonary embolism are the consequence of life-threatening.

Features of the epidemiological situation with acute urogenital gonococcal infection in the Perm Region for the period from 2010 to 2021

BACKGROUND: According to WHO, more than 60 million people get sick with gonococcal infection every year. Recently, there has been a decrease in the incidence of gonorrhea in Russia. However, in addition to Neisseria gonorrhoeae, other microorganisms may also cause acute urethritis. However, there is no record of morbidity for them.
 AIM: This study analyzes the epidemiological situation of the incidence of аcute genital gonococcal infection and urethral nonspecific inflammatory diseases in the Perm Region for the period 20102021.
 MATERIALS AND METHODS: A comparative retrospective analysis of the incidence of аcute genital gonococcal infection and urogenital tract nonspecific inflammatory diseases among patients of the Perm Region was performed using the annually published data of official statistics. The data on the incidence of genital tract nonspecific inflammatory diseases were obtained from outpatient patient records of three clinics in the city of Perm. Epidemiological and statistical information processing methods were used in the work, and the Pearson coefficient was used for correlation analysis.
 RESULTS: The long-term dynamics of the incidence of аcute genital gonococcal infection among the population of the Perm Region was characterized by a pronounced downward trend. However, in recent years, the number of genital tract infections in women and men has increased. The decrease in the incidence of аcute genital gonococcal infection is most likely due to changes in the properties of N. gonorrhoeae, causing significantly more difficult laboratory diagnoses and often leading to false negative results. In addition, the high polymorphism of cultural, morphological, and biochemical properties of conditionally pathogenic microorganisms further complicates the identification stage of the isolated strains.
 CONCLUSION: As a result, against the background of a decrease in the incidence of аcute genital gonococcal infection, an increase in the incidence of genital tract nonspecific inflammatory diseases was revealed. The peculiarities of the epidemic process of аcute genital gonococcal infection and urogenital tract and the complexity of laboratory diagnostics of these conditions cause their untimely detection.

ILSHIP: An interpretable and predictive model for hypothyroidism

Hypothyroidism is one of the common endocrine diseases, and its incidence is increasing year by year. Due to the insidious nature of this disease, it often leads to delayed treatment and even misdiagnosis. This paper proposes ILSHIP, an interpretable predictive model for hypothyroidism, to reduce its diagnostic complexity as well as improve the predictive performance and interpretability of existing models. First, the ILSHIP prediction model was built based on label encoding, missing value processing, feature selection, and data enhancement of the dataset. Second, the comprehensive performance of ILSHIP was compared with twelve existing related study models and eleven mainstream models, such as XGBoost and MLP. The experimental results showed that, based on the optimal hyperparameters the ILSHIP model can achieve 99.392%, 99.437%, 99.348%, 99.381%, and 99.960% in accuracy, recall, specificity, F1, and AUC, respectively. The accuracy of the ILSHIP model was about 0.7%–15.4% higher than the existing models. By introducing the SHAP framework into the ILSHIP model, important features affecting hypothyroidism such as thyroid stimulating hormone (TSH) and free thyroxine index (FTI) were also identified, and the influencing factors for different individuals were finally analyzed to provide a basis for medical personnel to monitor the condition.

Emerging Recombinant Oncolytic Poliovirus Therapies Against Malignant Glioma: A Review.

Glioblastoma multiforme (GBM) is a fourth-grade malignant glioma that continues to be the main contributor to primary malignant brain tumour-related death in humans. The most prevalent primary brain tumours are gliomas. The most dangerous of these neoplasms, GBM, has been shown to be one of the most lethal and refractory tumours. For those who have been diagnosed with GBM, the median time to progression, as determined by magnetic resonance imaging, is roughly six months, and the median survival is approximately one year. GBM is challenging to manage with old treatments like chemotherapy, tumour debulking, and radiation therapy. Treatment outcomes are poor, and due to this effect, the treatment is not up to the mark. GBMalso shows diagnostic complexity due to limitations in the use of specific targeted therapies. The treatment protocol followed currently has an entire focus on safe resection and radiotherapy. Protein synthesis is not tightly regulated physiologically in malignant cells, which promotes unchecked growth and proliferation. An innovative, experimental technique for treating cancer uses polioviruses that have been genetically altered to target a fascinating aberration of translation regulation in cancer. This approach enables precise and effective cancer cell targeting based on the convergence of numerous variables. Oncolytic viruses have revolutionised cancer treatment. However, their effectiveness in glioblastoma remains restricted, necessitating more improvement. Oncolytic poliovirus has shown great potential in the treatment of GBM. Factors like the blood-brain barrier, immunosuppressive tumour microenvironment (TME), and tumour heterogeneity make treatment for malignant gliomas ineffective. In this review, we have focused on oncolytic viruses, specifically oncolytic poliovirus, and we explore malignant glioma treatments. We have also discussed currently available conventional treatment options for malignant glioma and other brain tumours.

Predicting fetal growth retardation: mathematical modeling

Introduction. Annually, more than 13 million neonates are born with fetal growth retardation (FGR) worldwide. FGR increases prenatal mortality and morbidity. Due to no effective treatments for FGR are available, its prevention and prognosis are of extreme relevance.Aim: development of prognostic clinical and anamnestic mathematical model for assessing a risk of developing FGR during pregnancy.Materials and Methods. A prospective, controlled, open, continuous study was performed. The main group (1) included 75 patients who had FGR during pregnancy; the control group (2) consisted of 414 women with favorable pregnancy outcome. All subjects underwent examination, including collecting medical history, a complex of prenatal diagnostics in the first trimester of pregnancy – ultrasound, Doppler uterine arteries, serum level of pregnancy-associated plasma protein-A (PAPP-A), free beta-subunit of human chorionic gonadotropin (β-hCG), placental growth factor (PlGF), and non-invasive prenatal test (NIPT).Results. To determine the relative contribution of each individual trait to the formation of FGR risk and develop a prognostic index, a discriminant analysis was carried out, on the basis of which a prognostic F-index was developed. The formula for calculating the F-index includes the age of pregnant woman, obstetric history data, method of conception, recorded nicotine addiction in pregnancy, detected uterine fibroids, body mass index, biochemical parameters (PAPP-A, β-hCG, PlGF), nuchal translucency of the fetus, the pulsation index of the uterine artery, the level of the fetal fraction and fetal gender (determined during NIPT). The parameters of sensitivity and specificity of the FGR prognosis were 90.1 and 82.18 % respectively, the method effectiveness was 83.97 %.Conclusion. The method developed for predicting FGR can be used in clinical practice to form risk groups for FGR development and choose tactics for pregnancy management.

Acute myeloid leukemia: 2023 update on diagnosis, risk-stratification, and management.

Acute myeloid leukemia (AML) is a frequently fatal bone marrow stem cell cancer characterized by unbridled proliferation of malignant marrow stem cells with associated infection, anemia, and bleeding. An improved understanding of pathophysiology, improvements in measurement technology and at least 10 recently approved therapies have led to revamping the diagnostic, prognostic, and therapeutic landscape of AML. One updated and one new classification system were published in 2022, both emphasizing the integration of molecular analysis into daily practice. Differences between the International Consensus Classification and major revisions from the previous 2016 WHO system provide both challenges and opportunities for care and clinical research. The European Leukemia Net 2022 risk classification integrates knowledge from novel molecular findings and recent trial results, as well as emphasizing dynamic risk based on serial measurable residual disease assessment. However, how to leverage our burgeoning ability to measure a small number of potentially malignant myeloid cells into therapeutic decision making is controversial. The diagnostic and therapeutic complexity plus the availability of newly approved agents requires a nuanced therapeutic algorithm which should integrate patient goals of care, comorbidities, and disease characteristics including the specific mutational profile of the patient's AML. The framework we suggest only represents the beginning of the discussion.

Electrophysiological parameters of the HRV of animals with different vegetative status

Studies of the electrophysiological indicators of the VCR in the Cows of the Jersey breed with different levels of autonomic regulation were not previously carried out, and their normal values in the accessible literature are not described. Given the subtlety of the mechanisms of autonomic heart regulation, there is a need to expand the diagnosis of very common heart disease in animals. The purpose of research is to study the electrophysiological parameters of the variability of the heart rhythm in cattle to assess the possibility of including them in an integrated approach to the analysis of the functioning of the heart in animals. The 103 healthy cows of the Jersey breed studied. The dependence of the change in electrophysiological indicators of the variability of the heart rhythm on the vegetative status of the animal has been studied. To register cardio intervalograms, a computer complex electrophysiological laboratory “Conan - 4.5” was used. The recording was carried out in cattle in a calm state in a standing position. The electrophysiological indicators of the VCR were studied. In this regard, it is advisable to include the assessment of these parameters to include in the basic set of a complex of diagnostics of heart disease in cattle.

Follicular occlusion syndrome in the practice of a coloproctologist

BACKGROUND: Pilonidal disease is the 4th most common disease among inpatient coloproctological patients and surgery remains the gold standard of its treatment. However, patients with pilonidal disease often have combined conditions with other follicular occlusion diseases which are most often encountered by dermatologists in their practice. In most cases it is difficult to treat follicular occlusion syndrome with pilonidal disease within one specialty. We demonstrate the complexity of follicular occlusion diseases diagnostics in combination with pilonidal disease, systemize the diagnostic protocol for patient management and present the treatment strategy for coloproctologists.
 CLINICAL CASE DESCRIPTION: There was one case of patient with pilonidal disease combined with other conditions of follicular occlusion syndrome noted in the clinic of coloproctology and minimally invasive surgery. Surgery was the first step. There were no complications in the early postoperative period. After hospital discharge, the patient was consulted by a dermatologist, and local and systemic conservative therapy was prescribed for concomitant diseases, which resulted in a significant improvement. There have been no recent reports of recurrence.
 CONCLUSION: The treatment of follicular occlusion syndrome with pilonidal disease requires a multidisciplinary approach. At the same time the optimal treatment for pilonidal disease is radical excision of all altered tissues. In cases of such diseases as hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp treatment should be comprehensive and begin with a dermatologist consultation.

Neurological aspects of connective tissue dysplasia

Disturbances in the formation of connective tissue lead to significant pathological changes in both individual organs and tissues, and at the organismal level. The complexity of diagnostics is also connected with the fact that there is no single terminology, a single view of the diagnostic criteria, a single approach among doctors of different specialties. The prevalence of external phenotypic signs of connective dysplasia is quite high, which can lead to overdiagnosis. On the other hand, insufficient attention to the manifestations of dysplasia can lead to delayed diagnosis, which can cause adverse complications. The most studied are clinical manifestations in dysplastic changes in the cardiovascular system, musculoskeletal system. This article provides an overview of current data on changes in the nervous system. Sufficient attention was paid to the pathology of the nervous system in differentiated forms (Marfan syndrome, Ehlers-Danlos, etc.). Currently, the role of various vascular anomalies, aneurysms associated with undifferentiated forms of connective tissue dysplasia is widely discussed. Much attention is also paid to clinical manifestations of the autonomic nervous system: sympathicotonic manifestations predominate in connective tissue dysplasia. There is evidence of an association of headaches, musculoskeletal pain, and connective tissue dysplasia in both children and adults.

Респираторно-синцитиальная инфекция – современное состояние проблемы

The review shows the main current data concerning the etiology, epidemiology, pathogenesis, features of the clinical picture, diagnosis, treatment and prevention of respiratory syncytial virus (RSV). We studied the influence of respiratory syncytial virus (RSV) on the severity of the disease depending on age, concomitant pathology, genetic factors. Over the past decades, manifest forms of infection have become more frequent in the elderly, especially with weakened immunity with the development of severe forms of the disease with damage to the lower respiratory tract. During the systematization, the importance of epidemiological surveillance for RSV was determined. Data on the incidence of RSV on the territory of the subjects of Russian Federation with a high degree of probability cannot reflect the true picture, due to the lack of alertness of primary care doctors and specialists providing medical care in the inpatient departments. This is accompanied by the complexity of diagnostics and laboratory differential diagnosis with other respiratory infections. The problem is aggravated due to the lack of effective etiotropic therapy, as well as the availability of only passive immunization for children under two years of age from the means of specific prevention. Thus, these aspects raise a number of important issues for epidemiological and medical-preventive services. Keywords: bronchiolitis, pneumonia, respiratory syncytial infection, respiratory syncytial virus

ПРИСТРІЙ ФОРМУВАННЯ ПЕРЕВІРЯЮЧОГО ТЕСТУ ЦИФРОВОГО ТЕЗ РЛС 19Ж6

The general need to develop additional diagnostic equipment is that a fairly large number of complex technical objects are currently in use, which are morally but not physically obsolete, and therefore it is not possible to abandon their use today. Radar 19Ж6 belongs to such objects. The level of diagnostic support for this radar does not meet the requirements for modern models of radio electronic weapons (REW). The 19Ж6 was replaced by another radar with significantly improved diagnostic support. An automated diagnostic complex of the Diana series is used to diagnose and repair modern radar systems of domestic production. This complex is designed to diagnose and restore complex digital and digital-to-analog standard replacement elements. It is possible to adapt a modern diagnostic complex to diagnose outdated equipment, but within the limited funding, it is economically impractical. Accordingly, there is a task to develop modern means of diagnosing typical replacement elements of the 19Ж6 radar, which can be used to equip stations. Within the framework of the overall task, a number of partial tasks can be identified. One of these tasks is the development of a general methodology and a structural diagram of the device for determining the verification test for digital standard replacement elements (SRE) from the 19Ж6 radar. Thus, the article is devoted to the development of a block diagram of the device for forming a diagnostic test as a component of the device for monitoring the technical condition of digital SRE. The structure of the device is completely determined by the methodology of the test structure. The result of the diagnostic test is a decision on the operability or inoperability of the SRE. The need for such diagnostics stems from the fact that the built-in technical diagnostic system does not detect a single inoperable TES, but detects a group of suspected inoperable SRE. To separate the inoperable digital device, it is necessary to use additional equipment. The paper proposes to use an energy-static diagnostic method, the essence of which is that the value of the voltage on an additional resistance, which is measured in a steady-state operation mode, is used as a diagnostic parameter. The method of designing the verification test is the method of experimental evaluation of the length of the test sequence, and the sequence itself is a pseudo-random sequence of input influences.

Utility of chest imaging in the diagnosis and management of patients with visceral leishmaniasis: A systematic review.

Visceral leishmaniasis remains a deadly parasitic disease with diagnostic complexities. Currently, point-of-care chest imaging is gaining momentum in the diagnosis of infectious diseases. Respiratory symptoms are common in visceral leishmaniasis. Here we aimed to systematically synthesize the evidence on the utility of chest imaging on the diagnosis and management of patients with visceral leishmaniasis. We searched PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar databases for studies reporting chest imaging findings in patients with visceral leishmaniasis, published in English from database inception to November 2022. We used the Joanna Briggs Institute checklists to evaluate the risk of bias. The protocol of this systematic review was registered with the Open Science Framework: https://doi.org/10.17605/OSF.IO/XP24W. Of 1792 studies initially retrieved, 17 studies with 59 participants were included. Of the 59 patients, 51% (30) had respiratory symptoms and 20% (12) were human immunodeficiency virus co-infected. Chest X-ray, high-resolution computed tomography, and chest ultrasound findings were available for 95% (56), 93% (55), and 2% (1) of the patients, respectively. The most common findings were pleural effusion (20%; 12), reticular opacities (14%; 8), ground-glass opacities (12%; 7), and mediastinal lymphadenopathies (10%; 6). High-resolution computed tomography was more sensitive than chest X-ray and detected lesions that were lost on chest X-ray, 62% (37) versus 29% (17). In almost all cases, regression of the lesions was observed with treatment. Microscopy of pleural or lung biopsy detected amastigotes. Polymerase chain reaction yield was better in pleural and bronchoalveolar lavage fluids. A parasitological diagnosis from pleural and pericardial fluid was possible in AIDS patients. Overall, the risk of bias was low. Visceral leishmaniasis patients frequently had abnormal findings on high-resolution computed tomography. Chest ultrasound is a useful alternative in resource-limited settings to aid in diagnosis and subsequent treatment follow-up, especially when routine tests yield negative results despite clinical suspicion.