Doctors Of Various Specialties Research Articles

ANTI-VEGF THERAPY FOR DIABETIC RETINOPATHY

Diabetic retinopathy is one of the most severe complications of diabetes mellitus, requiring the participation of doctors of various specialties: endocrinologists, diabetologists, therapists, cardiologists, surgeons, anesthesiologists and others.The task of an ophthalmologist is to identify pathological changes in the eye associated with diabetes mellitus and prescribe appropriate treatment.There are three main methods for treating diabetic retinopathy: laser coagulation of the retina;intravitreal injections of anti-VEGF and glucocorticoids;vitreoretinal surgery.This literature review examines the use of vascular endothelial growth factor inhibitors in the treatment of diabetic retinopathy. In particular, it discusses the most relevant drugs, the most important studies on the therapy of DR and diabetic macular edema, as well as a post hoc analysis of these studies. In addition, the role of these drugs in the therapy of refractory DME is discussed.

Knowledge, Attitude, and Practice (KAP) and Perceptions of DFU and Foot Care among Doctors of Various Specialties in Western Maharashtra, India

Knowledge, Attitude, and Practice (KAP) and Perceptions of DFU and Foot Care among Doctors of Various Specialties in Western Maharashtra, India

Modern concepts of chronic fatigue syndrome: diagnosis and differential diagnosis with other variants of asthenic syndrome

Chronic fatigue is one of the most common syndromes in the clinical practice of medical doctors of various specialties. However, issues of criteria for distinguishing chronic fatigue from physiological fatigue, differential diagnosis of reactive asthenia, secondary fatigue syndrome and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as a distinct nosological form can be challenging for physicians. The provision of care to patients with ME/CFS is negatively impacted by the lack of accurate and up-to-date knowledge about the disease among healthcare professionals. Even if doctors are compassionate, they often do not know how to make a diagnosis or what can be done to improve the well-being of patients. Currently, this problem is especially relevant due to the increased risk of developing ME/CFS after suffering from a new coronavirus infection, COVID-19. This article presents a modern approach to the diagnosis of ME/CFS, set out in consensus recommendations that were developed in 2021 independently by groups of experts on the diagnosis and treatment of this disease in European countries and the USA, and taking into account the recommendations of domestic specialists.

Pregnancy as an important risk factor for the progression of diabetic retinopathy

Diabetic retinopathy, also defined as diabetic eye disease is one of the main causes of eye complications and blindless in the world therefore leads to irreversible vision disorder and vision loss. A pregnant women as a patient is always a real challenge for doctors of various specialties. During this period, numerous systemic changes occur, such as increased blood pressure in the third trimester, increased blood volume insulin resistance with worsening glycemic control and excessive coagulation. The above complication may be reflected in the image of the fundus of the eye. Pregnancy may induce retinal disease such as diabetic retinopathy. This review article presents the incidence, pathogenesis and risk factors associated with diabetic retinopathy during pregnancy. More over in the following paper discussed management of diabetic retinopathy in pregnancy and guidelines are recommended based on the achievable evidence.

Anesthetic management of laparoscopically assisted fetoscopic surgery to correct spina bifida

Introduction. The growing incidence of intrauterine pathology in the fetus at the present stage dictates the need to develop and improve intrauterine surgical correction of defects in the fetus. Myelomeningocele (SPINA BIFIDA) is the most common and severe neural tube defect in the fetus, the severity of the neurological deficit is determined by the level of location and extent of the anomaly. By uniting doctors of various specialties (obstetricians-gynecologists, neonatologists, surgeons, anesthesiologists-resuscitators), the Clinic of the St. Petersburg State Pediatric Medical University effectively introduces methods of prenatal surgery.The objective was to demonstrate by clinical example the experience of successful fetoscopic correction of myeloneningocele to reduce maternal risks and injuries, to reduce risks aimed at protecting the tissues of the spinal cord of the fetus, as well as to reduce the need for postpartum correction of the defect in the fetus, to improve prognosis and risks of subsequent disability.Materials and methods. The article presents the first successful experience of minimally invasive laparoscopic correction of myelomeningocele in the fetus with the participation of the multidisciplinary team and the features of anesthesiological support of the method.Conclusion. Laparoscopic access, together with the optimal choice of anesthetic management in fetal surgery, allows not only to successfully correct the defect in myelomeningocele in the fetus, but also to significantly minimize and reduce the risks of injury to the mother, and also reduces the need for postpartum surgical treatment and reduce disability. Accumulation and improvement of experience, a multidisciplinary approach is the key to successful correction of intrauterine fetal pathology.

Mucopolysaccharidosis Type I (Hurler – Scheie Syndrome): Case Report

Background. Mucopolysaccharidosis type I (MPS I) is an inherited disease caused by pathogenic variants in the IDUA gene, which encodes the lysosomal enzyme alpha-L-iduronidase. This clinical case demonstrates the importance of diagnosing rare diseases when patients have phenotypic features indicating hereditary pathology presence. Phenotype changes can be so-called “red flag” that helps specialists suspect and diagnose lysosomal storage diseases. Clinical case description. The patient was observed with delayed psychomotor development; she also had hepatomegaly and on auscultation of the heart there was a functional systolic murmur above the apex and in the Botkin–Erb point on heart auscultation. Coarse “garholoid” facial features attracted attention at external examination: large nose, wide sunken nose bridge, macroglossia, thick lips, synophrysis, scaphocephaly, wide chest, and flat-valgus feet. Echocardiography has revealed mitral valve insufficiency and hardened valve leaflets. Ophthalmologist examination: hypermetropic astigmatism. Psychiatrist examination: mental and speech development delay. Enzymatic diagnostics: significant decrease in alpha-Liduronidase activity. No further examinations were carried out due to the onset of the COVID-19 epidemic and parents' doubts about the diagnosis. The patient was readmitted to the hospital at the age of 6 years due to aggravation of her condition. A molecular genetic study has revealed two pathogenic variants in the IDUA gene. Diagnosis of MPS I was established according to the clinical data, results of biochemical and molecular genetic studies. Conclusion. This clinical case demonstrates the classic course of MPS I with typical phenotypic signs and lesions in various organs and systems. The presented case demonstrates the importance of professional vigilance among doctors of various specialties regarding orphan diseases.

Features of the Use of Communication Skills by Doctors of Various Specialties

Doctors of various specialties, depending on their professional activities, use specific professional communication skills more often in the doctor-patient model. The list of communication skills used by doctors of different specialties differs. A study was conducted at Tver State Medical University aimed at studying the peculiarities of the use of communication skills by internists, surgeons and obstetricians-gynecologists of the outpatient polyclinic level.

Ukrainian guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis

Introduction. Glucocorticoid-induced osteoporosis (GIOP) is a bone metabolic disease that develops as a result of glucocorticoid (GC) use, is one of the most frequent causes of secondary osteoporosis, leads to an increase in the risk of low-energy fractures, disability and mortality of GC users. Despite the few stu­dies conducted in Ukraine on the epidemiology and treatment of GIOP, there have been no national recommendations for its ma­nagement until now, which has become the background for their creation. The purpose was to develop national guidelines for the diagnosis, prevention, and treatment of GIOP based on the analytical analysis of modern literary sources to improve the awareness of the medical community of Ukraine, improve management, and reduce the socio-economic burden of the disease. Materials and ­methods. A group of 18 experts, leading Ukrainian scientists in various fields, was created to develop the guideline. An analysis of current literary sources on epidemiology, risk factors, diagnosis, prevention and treatment of GIOP, and monitoring of the effectiveness and safety of its treatment was carried out. Evidence was synthesized ­using the GRADE system, and a critical assessment of the quality of the recommendations was carried out using the AGREE II tool. ­Results. The guideline consists of 12 provisions on screening, diagnosis, prevention, and treatment of GIOP. The authors emphasized the need to increase the awareness of the medical community of Ukraine regarding the problem, as well as patients regarding the possible side effects of GC. They presented the features of the clinical assessment of the osteoporotic fracture risk in GC users, as well as modern and available in Ukraine methods of diagnosis and treatment of GIOP. Conclusion. The first Ukrainian guideline for screening, diagnosis, prevention, and treatment of GIOP is an important national tool for its management, which is recommended by the Board of the Ukrainian Association of Osteoporosis for use in practical health care by doctors of various specialties.

Epidemiological features and psychoneurological consequences of infection of people with the Nipah virus

The lecture outlines modern ideas about the etiology, features of the epidemic process, mechanisms of damage to the human body, clinical manifestations, diagnosis, treatment and prevention of infection caused by the Nipah virus. Particular attention is paid to the characteristics of individual outbreaks of the infectious process in various geographical regions of the world, early and long-term psychopathological, neurological and cognitive consequences due to human infection with the Nipah virus. The risk factors for the emergence and rapid spread of infection with a very high mortality rate, reaching 100%, are emphasized, which determines the high pandemic potential and hidden threats to human society. Recommendations are outlined for the prevention of transmission of infection caused by the Nipah virus at all levels: from animals to humans, from humans to humans, in medical institutions, which, in the absence of effective vaccine prevention and specific antiviral treatment, are the basis for containing the spread of the infectious process. In this regard, measures taken and planned to provide patients and contact persons with adequate medical and psychological care, features of the development and implementation of effective anti-epidemic, clinical diagnostic algorithms, timely and high-quality social and hygienic monitoring of environmental objects against the backdrop of increasing biological threats from outside, and within the country will minimize the risks of biological threats. The lecture is intended for doctors of various specialties, including infectious disease specialists, epidemiologists, general practitioners, neurologists, psychiatrists, laboratory diagnosticians, radiologists etc.

STATINS IN DISEASES OF THE PERIPHERAL ARTERIES: ARE THE CLINICAL RECOMMENDATIONS BEING FOLLOWED?

Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis and is associated with high mortality due to cardiovascular events. Since lipid-lowering therapy has proven effective in the treatment of patients with PAD, current clinical guidelines regulate statin treatment for all patients with PAD. However, in real clinical practice, the administration of statins in this category of patients is clearly insufficient. The purpose of this study was to study compliance with current clinical recommendations on the frequency of statin prescribing in various regimens among patients with PAD who sought medical help in a specialized hospital. It has been shown that in real clinical practice, the administration of statins does not comply with current clinical recommendations, and the desired low-density lipoproteins targets are not achieved in a significant number of patients. It is necessary to raise awareness among doctors of various specialties about the need for early diagnosis and treatment of PAD in accordance with clinical recommendations, especially in the absence of coronary heart disease and other atherosclerosis-associated diseases. When diagnosed with PAD, the patient should start taking statins in the most tolerable doses with the most effective drugs

Systemic amyloidosis in a patient with acute heart failure

Aim. To describe a clinical case of transthyretin amyloidosis, the first manifestation of which was an episode of acute heart failure.Materials and methods. Patient V., 58 years old, was taken to the intensive care unit for patients with myocardial infarction V.P. Demikhov State Clinical Hospital with a preliminary diagnosis: acute coronary syndrome without ST segment elevation, pulmonary edema. It is known from the anamnesis that the patient was disturbed for 3 months by a pronounced dry cough, hoarseness of voice, weakness with minor physical exertion.Results. The complexity of the diagnosis of postmortem diagnosis of systemic amyloidosis was explained by the absence of any clinical manifestations that made it possible to suspect a deadly disease before hospitalization for pulmonary edema. This clinical case demonstrates the rapid development of symptoms of systemic amyloidosis. From the moment of the first symptoms (persistent dry cough, hoarseness of voice) to death as a result of heart failure, about 3 months have passed. The addition of peripheral polyneuropathy to the clinical picture made it possible to suspect a systemic disease.Conclusion. This clinical case proves the relevance and importance of timely diagnosis of amyloidosis, as well as the need to raise awareness of doctors of various specialties about this disease.

Features of overtime work payment by medical organizations

The problem of rationing the volume of labor activity is one of the urgent for medical workers. Questions regarding the duration of working hours for doctors of various specialties cause difficulties for both the workers themselves and for economists and accountants. One of the greatest difficulties from the point of view of domestic labor and tax legislation is caused by the aspects of registration and accounting in the calculation and reporting documentation of work performed in excess of the normal number of working hours, which is very common in the field of medicine — it is impossible to accurately schedule the time of work of medical personnel with each patient. This article discusses the specifics of recording and processing overtime work in the healthcare sector in compliance with accounting requirements and principles. In accordance with Article 99 of the Labor Code of the Russian Federation, key legal norms, organizational aspects, and methods of registration of overtime hours worked by employees of medical organizations are outlined and analyzed. On specific theoretical provisions and practical examples, the authors explore the processes of personnel and accounting for overtime work and specifics, proposing possible ways to regulate the process of accounting and tariffication of employees in accordance with the accounting policy of medical organizations.

Examples of surgical treatment of pulmonary echinococosis in adults and children

ABSTRACT. The article presents a modern view of the diagnosis and treatment of pulmonary echinococcosis. The etiology, pathogenesis, clinical picture, ways of diagnosis and available methods of treatment of this pathology are highlighted. The purpose of the work was to acquaint doctors of various specialties with clinical cases of pulmonary echinococcosis. Two clinical cases of pulmonary echinococcosis became the object of the work. The first clinical example concerned a 17-year-old boy who had a typical course of echinococcosis and who underwent left lower lobectomy. The second clinical example concerned a young woman in whom pulmonary echinococcosis had an atypical course and was diagnosed only intraoperatively. It was concluded that the most effective method of treatment of echinococcal lung cysts is surgical operation. The volume of surgical intervention depends on many factors and is decided individually in each specific case. In the postoperative period, preventive anthelmintic therapy is mandatory.

Russian eligibility criteria prescribing menopausal hormonal hormones therapy for patients with cardiovascular and metabolic diseases. Consensus document of the Russian Cardiological Society, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Association of Phlebologists of Russia

Menopausal symptoms can disrupt the life course of women at the peak of their career and family life. Currently, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormonal therapy is the fear of doctors who are afraid of doing more harm to patients than good. Caution is especially important when it comes to women with underlying health conditions. Moreover, it should be recognized that there is a lack of high-quality research regarding the safety of MHT for major chronic non-infectious diseases and common comorbid conditions. The presented consensus document analyzed all currently available data obtained from clinical trials of various designs and created a set of criteria for the acceptability of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, doctors of various specialties who advise women in menopause will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real practice.

«ДОРОЖНАЯ КАРТА» БИОМАРКЕРОВ ПРИ ЕСТЕСТВЕННОМ ТЕЧЕНИИ HBV-ИНФЕКЦИИ

Background. Hepatitis B virus (HBV) causes both acute and chronic infection that can be asymptomatic or mild, occur as severe or fulminant hepatitis. Testing for HBV markers and establishing a diagnosis of hepatitis B are a key component affecting the epidemic process and allowing people with CHB to receive effective care to prevent or slow down progressive liver damage. Objective. To present a diagnostic «road map» of HBV biomarkers for doctors of various specialties involved in the diagnosis, treatment, screening and prevention of HBV infection. Material and methods. An electronic search was carried out on PubMed, UpToDate, Scopus, Web of Science, elibrary, CDC, ECDC, WHO/WHO using key words. In accordance with the specified search criteria and the purpose of the study; the titles, abstracts and full texts of scientific articles were studied, that is fully reflected in the list of references. Results. There have been provided a description of CHB natural history, its well-known diagnostic markers and new serological opportunities for medical monitoring, such as nuclear antigen (HBcrAg), pregenomic RNA (pgRNA) as well as quantitative determination of antibodies - qAnti-HBc. The diagnostic and prognostic effectiveness of “classical” and “new” biomarkers when used together opens up new opportunities for solving epidemiological or clinical problems. Conclusions. The unavailability of new tests in the form of commercial diagnostic kits complicates the use of some of them, at least that of HBcrAg, pgRNA, qAnti-HBc, which are on the “waiting list” for implementation.

Melanoma in Pregnancy-Diagnosis, Treatment, and Consequences for Fetal Development and the Maintenance of Pregnancy.

Cutaneous malignant melanoma is one of the most common neoplasms among pregnancy-associated cancers (PACs). Risk factors include excessive exposure to ultraviolet radiation, the presence of benign and dysplastic nevi, and a patient or family history of melanoma. Self-examination and careful inspection of nevi are crucial, especially in the context of their progression over time. Physiological changes that occur during pregnancy, such as the darkening and enlargement of the nevi, delay the diagnosis of CMM. In the fetus, metastases are very rare, and if they do occur, they concern the placenta or fetal tissues. The choice of treatment is influenced by the cancer stage, symptoms, the time of termination of pregnancy, and the patient's decision. Essential procedures which are safe for the fetus are diagnostic biopsy, ultrasound, and the therapeutic excision of the lesion and the affected lymph nodes. Other imaging methods can be used with a safe radiation dose limit of 100 mGy. Immunotherapy and targeted treatments must be carefully considered, because of their possible adverse effects on the fetus. An interdisciplinary approach to the problem of melanoma during pregnancy is necessary, involving doctors of various specialties.

The importance of the Association for Interventional Pain Treatment (AIPT) in the training of an outpatient neurosurgeon

One of the main goals of the Association for Interventional Pain Treatment (AIPT) is to expand the range of pain interventions and disseminate these skills among doctors of various specialties, incl. and neurosurgeons. The article describes the activities of AIPT and evaluates its significance in the training of outpatient neurosurgeons.

DIFFERENTIAL DIAGNOSIS OF TUBERCULOSIS AND NON-SPECIFIC PULMONARY INFILTRATS (Lecture)

Following the reformation of healthcare system and the dissolution of the specialty "Phthisiology," the extensive anti-tuberculosis efforts in Ukraine now fall under the purview of family doctors and specialists across various fields. According to the Law of Ukraine “On Overcoming Tuberculosis in Ukraine”, enacted on 14.07.2023 under No. 3269-IX, Paragraph 4 (Article 4), individuals afflicted with tuberculosis or latent tuberculosis infection are entitled to specialized medical care. This includes the treatment of all forms of tuberculosis and associated conditions across a spectrum of healthcare institutions. Compliance with this legal mandate necessitates that doctors of various specialties possess not only proficiency in contemporary tuberculosis treatment methods, which will be facilitated by the regional tuberculosis control center, but also competence in diagnosing tuberculosis in its various presentations. When health issues arise, patients typically seek assistance first from primary care specialists. The “Pulmonary infiltrate syndrome” is an X-ray syndrome characterized by the presence of shadows in the lungs exceeding 1 cm in diameter. There are numerous causes for such changes in the lungs. Given that the lungs are the most common site for tuberculosis, particularly in the form of infiltrative shadows, which may signify not only tuberculosis but also pneumonia, tumors, lung infarction, eosinophilic infiltrate, and other conditions, the question of their differential diagnosis becomes quite relevant. The increasing frequency and subtle clinical presentation of the “Pulmonary infiltrate syndrome” necessitate proficiency in the clinical aspects and diagnosis of its most common manifestations. The key differential diagnostic features that distinguish infiltrative pulmonary tuberculosis from other nonspecific infiltrates include contact with a tuberculosis patient or a history of tuberculosis, often subacute onset, heterogeneous infiltrative shadow in 1, 2, or 6 segments with a connection to the lung root, moderate leukocytosis, lymphopenia, elevated ESR, presence of acid-fast bacilli in sputum or bronchial lavage, specific endobronchitis, positive response to antitubercular therapy, and lack of improvement with other nonspecific treatment methods.

Gastroesophageal reflux disease in nurse practice

Gastroesophageal reflux disease (GERD) is characterized by a large number of clinical manifestations, including asymptomatic and extraesophageal manifestations, so the interest in this nosology of doctors of various specialties is huge. Gastroesophageal reflux disease is considered by modern gastroenterologists as one of the most urgent problems of diseases of the digestive tract. The prevalence of GERD in Western Europe is 10–20%, in Russia – 22,7%, and in Moscow – 23,6% [1]. Studies show that the incidence of this pathology is steadily increasing (annual increase of about 5%). The importance of gastroesophageal reflux disease is determined by its clinical significance, in particular, the possibility of the existence of so-called extraesophageal manifestations, as well as the lack of effectiveness of existing methods of treatment. All this causes close attention of gastroenterologists to the study of pathophysiological and clinical problems of gastroesophageal reflux disease.

Assessing the awareness of doctors of various specialties in the treatment of osteoporosis

Objective: to assess the degree of doctors’ awareness on the prevention, diagnosis and treatment of patients with osteoporosis.Material and methods. The study was conducted using the Yandex Forms service through an original anonymous questionnaire comprising 16 questions concerning personal characteristics (specialty, work experience, category, and academic degree), as well as the degree of awareness in the prevention, diagnosis and treatment of osteoporosis. The questions about the treatment of the disease were compiled based on Russian and foreign clinical guidelines.Results. Knowledge of the causes and symptoms of osteoporosis was relatively high, but further findings from the survey on prevention, diagnosis and treatment revealed a lack of awareness among physicians in this area. Only 13.7% of respondents identified the potential use of the promising FRAX tool in osteoporosis diagnosing, and only 25% correctly selected first-line medications for treating the disease.Conclusion. The study revealed that doctors lack sufficient knowledge regarding the prevention, diagnosis, and drug therapy for osteoporosis. In our view, this finding underscores the need for a more comprehensive approach to this issue within the context of continuing medical education. The therapy effectiveness and patients’ complience directly depend on the communication between physicians and pharmacists. Therefore, it becomes essential to consider enhancing their collaboration in osteoporosis prevention and management.