Doctors Of Various Specialties Research Articles

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.

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.

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.

Levonorgestrel as part of menopausal hormone therapy: effects and clinical possibilities

Female hypogonadism, as a result of natural or induced shutdown of ovarian function, is a multifaceted problem. A variety of clinical manifestations motivates women to consult doctors of various specialties and solve health problems without focusing on the underlying cause. The financial and economic component of the problem due to a violation of the quality of life of women and a sharp decrease in their ability to work requires the inclusion of the most effective method of treatment. There are a number of MHT regimens and combinations that allow differentiated selection of the drug, taking into account the woman’s health status and her concomitant diseases. The range of biological effects and risks depends on the type and dose of the hormonal drug, duration of use, route of administration, and time of initiation of MHT. As a component of MHT, bioidentical estrogens and gestagens are used, different in their vector of influence, pharmacodynamic and pharmacokinetic profile. The article is devoted to cyclic biphasic MHT using a combination of 17β-estradiol (2 mg) and levonorgestrel (0.15 mg). The experience of using the drug will be presented in the form of a review and our own clinical cases from everyday medical practice.

Современные представления о патогенезе гестационного сахарного диабета

Aim. Gestational diabetes mellitus (GDM) is by far the most common type of metabolic disorder in pregnant women, the consequences of which are significant for doctors of various specialties. Features of the course of GDM determine a whole range of completely new problems associated with the health of newborns. This was influenced, on the one hand, by the obesity pandemic, which provoked an exponential increase in the incidence of GDM, and insulin resistance, responsible for the earlier onset of GDM, and on the other hand, by the introduction into clinical practice of clear unified diagnostic criteria adopted by major international medical associations. As the prevalence of GDM continues to increase, the development of new prognostic and diagnostic tests for this pregnancy-associated condition is of great importance to improve outcomes for both mothers and children. Purpose. To study modern ideas about the pathogenesis of GDM. Material and methods. To write this review, a search was carried out for domestic and foreign publications in Russian and international search systems (PubMed, eLibrary, etc.) over the past 9 years. The review included articles from the peer-reviewed literature. Results. The review presents data on various mechanisms of GDM occurrence. Conclusion. Thus, GDM is a growing public health problem associated with rising obesity. To minimize complications for mother and baby, early diagnosis is essential. However, ideal screening for GDM has not yet been developed. The studies discussed in this review highlight the seriousness of GDM, including identifying and managing risk factors, accurately diagnosing and treating the disease to prevent associated complications.

Secondary recurrent syphilis in a patient with HIV infection. Clinical case

Relevance. HIV infection is a chronic sexually transmitted infectious disease. Given the single route of transmission, quite often HIV-infected patients develop a syphilitic infection. At the same time, syphilis against the background of HIV infection has its own clinical characteristics. It is important for doctors of various specialties to know these features.Description of the case. A clinical case of secondary syphilis and early neurosyphilis in a 52-year-old patient with HIV infection is presented.Discussion. Patients with HIV infection are characterized by unusual clinical manifestations of syphilis in the form of its malignity, atypical, severe course with the development of various complications. In the article, the authors describe atypical manifestations of papular syphilide of the palms and soles. The effectiveness of specific treatment has been shown.Conclusions. Doctors’ knowledge of the clinical features of syphilis against the background of HIV infection will allow them to avoid diagnostic errors leading to late treatment and the development of complications.

Children’s heart and prematurity: a current view of the problem

Improved survival of children born with low, extremely low and very low body weight in modern conditions due to increased nursing capabilities, optimization of treatment and increased efficiency of resuscitation measures has led to the need for greater understanding of the importance of assessing the cardiovascular system’s state beyond the neonatal period. With approximately 10% of infants worldwide being born preterm, there is an increasing need for further research into optimal regimens, lifestyle and clinical interventions that can benefit and modify cardiovascular morphology and function in this growing population. Modern theoretical postulates on the physiology and pathophysiology of the child’s heart include ideas about the key process of cardiac biomechanics — diastole, during which the earliest disturbances, that precede the formation of systolic dysfunction, occur. Assessment of the pumping properties of the left ventricle in systole and diastole is a fundamental methodological technique for an in-depth understanding of the pathophysiological mechanisms of cardiovascular system’s emerging diseases, their early diagnosis and assessment of the complex therapy’s effectiveness. However, despite the widespread use of standard echocardiography to assess systolic and diastolic function, its traditional parameters have limitations in terms of diagnostic accuracy and effectiveness in practice. Expanding knowledge about new pathogenetic mechanisms of the cardiac dysfunction formation in conditions of prematurity at the current stage of cardiology development using the “trace spot” technology (two-dimensional speckle tracking echocardiography) will be very useful for scientists studying the mechanics formation of the child’s heart after premature birth, and for doctors of various specialties in early diagnosis of heart diseases.

Gorham–Stout disease started with recurrent bilateral exudative pleuritis: case description and literature review

Gorham–Stout disease is an extremely rare skeletal disorder of unknown etiology manifested by multiple foci of osteolysis (“vanishing bone disease”) and lymphangiomatosis. Osteolysis can occur in any part of the skeleton (skull, facial skeleton, ribs, clavicula, spine, pelvic bones, bones of the upper and lower extremities). Approximately half of the patients develop pleural effusion, accompanied by respiratory abnormalities. We describe a case of Gorham-Stout disease with recurrent bilateral exudative pleuritis as a first and most prominent sign, while the bone lesions at the vertebral bodies, ribs and sternum proceeded without active complaints and were an accidental finding during chest computer tomography. Timely diagnosis of the disease depends on the awareness of doctors of various specialties and careful reading of imaging results.

BORRELIAL LYMPHOCYTOMA IN A CHILD. CLINICAL CASE

Lyme borreliosis is a multisystem infectious disease caused by bacteria of the Borrelia burgdorferi sensu lato complex.The course of the disease is characterized by three stages: early localized, early disseminated and late disseminated. One of the rare forms of the early disseminated stage of Lyme disease in children is lymphocytoma.We present a clinical case of borrelial lymphocytoma caused by a combination of three types of Borrelia (Borrelia afzelii, Borrelia burgdorferi, Borrelia garinii) in a 6-year-old girl. The disease manifested as multiple migratory erythema on the child's face, mistaken for allergic dermatitis. According to the parents, the child had no history of tick bites. The diagnosis was confirmed by the ELISA method and immunoblot analysis. The patient was prescribed a 21-day course of doxycycline at 50 mg twice daily. Three weeks after the initiation of antibiotic therapy, complete regression of the lymphocytoma was observed. The purpose of the study is to draw the attention of doctors of various specialties to rare forms of Lyme borreliosis against the background of the absence of a verified fact of tick bite.Material and methods. Confirmation of the diagnosis by ELISA and immunoblot analysis.Research results. A clinical case of borrelial lymphocytoma caused by a combination of three Borrelia species (Borrelia afzelii, Borrelia burgdorferi, Borrelia garinii) in a 6-year-old girl is presented. The disease manifested as multiple migratory erythema in the area of the child's face, which was mistaken for allergic dermatitis. According to the parents, the child had no history of a tick bite. The diagnosis was confirmed by ELISA and immunoblot analysis. The patient was prescribed doxycycline treatment for 21 days at 50 mg twice a day. Three weeks after the start of antibiotic therapy, a complete regression of the lymphocytoma was observed.Conclusions. Doctors of various specialties have difficulties in diagnosing Lyme disease in its various stages, especially in children with a heavy allergic history. With the presented clinical case, we want to emphasize the importance of early and timely diagnosis of Lyme borreliosis, in particular, in the absence of an episode of tick bite in the anamnesis.

INDICATORS OF THE QUALITATIVE AND QUANTITATIVE COMPOSITION OF THE GUT COMMENSAL MICROBIOTA AS BIOMARKERS OF HOMEOSTASIS (Part 1)

In recent years, practical medicine has faced a surge of information highlighting the emergence of new microbes in the human body's microbiota, leading to challenges in interpreting laboratory test results. This study aims to equip medical professionals, including doctors of various specialties, medical students, and interns, with a comprehensive understanding of the current knowledge on the human gastrointestinal microbial profile. Our analysis included 53 articles from international literature sources indexed in PubMed, Scopus, and Google Scholar databases. These articles were identified through an electronic search. The composition of the human microbiome is shaped by alterations in environmental conditions, living environments, diet, climate, genetics, and various other factors. Following birth, the pivotal role in microbiome formation involves the vertical, horizontal, and mixed transfer of microorganisms. Navigating the diversity of resident microbiota can be challenging, leading scientists to suggest biomarkers such as diversity indices, enterotypes, and established ratios at typical taxonomic levels (genus, species) for convenience. In clinical practice, these indicators serve as indirect markers of microflora properties that model health or disease. To understand the distribution of species within types, ecologists introduced concepts like α-, β-, and γ-diversity, grounded in different mathematical models. These indicators are also employed to assess the human body microbiota. The division into enterotypes was proposed by scientists on the basis that the phylogenetic (species) composition of each category determines its own functional feature, which is likely to be related to long-term eating habits. Conclusion. Scientists endeavor to assess the intricate microbiome system and its substantial impact on the human body, as well as the adverse effects of dysbiosis, employing mathematical models applied in microbiology.

Hypercalcemia with the development of chronic kidney disease, nephrolithiasis after intramuscular injection of oil solutions

One of the rare causes of PTH-independent hypercalcemia can be anabolic oil solution, injected intramuscularly by bodybuilders, along with anabolic hormones, in order to make the muscles more prominent. Here is the clinical report of a 43-year-old patient who used Synthol oil solution at the age of 25–30 years is presented. He had long-term undiagnosed hypercalcemia that manifested with nephrolithiasis and progressing chronic kidney disease (CKD). For the first time hypercalcemia was diagnosed at the age of 37, but left omitted. In 2023 (43 years) the laboratory findings sowed extremely high calcium level (4.26 mmol/l) with decreased PTH and CKD C4. Malignancy hypercalcemia was excluded. With this case, the rare cause of hypercalcemia has been proven – intramuscular oil injection resulting in nephrolithiasis, nephrocalcinosis and CKD. Treatment with glucocorticoids has demonstrated positive effect, similar to the ones of granulomatous diseases and hypercalcemia. The mechanisms of PTH-independent hypercalcemia development and differential diagnosis are currently being discussed. The presented clinical case of a rare cause of hypercalcemia may be useful for doctors of various specialties: endocrinologists, therapists, urologists, dermatologists, etc.

The many faces of a cough in a child: Issues of differential diagnosis and treatment

Studying the causes of cough, which is one of the most common respiratory symptoms when seeking medical help, remains a pressing problem for doctors of various specialties. Due to the growing interest in herbal remedies, in the current study we aimed to analyze the effectiveness of marshmallow root in the treatment of cough. We conducted a systematic search in modern scientific literature in electronic databases PubMed, EMBASE, Cochrane Library, Wiley, PubFacts, Springer Link platform, scientific publishing house Elsevier, CyberLeninka. An analysis of 80 full-text reviews on the use of herbal medicine in the treatment of cough showed higher quality of life scores, lower rates of adverse events and less severe cough. The authors also provide evidence that herbal therapy successfully complements traditional treatment methods, providing longer periods of remission for chronic cough. Although coughing is a protective reflex responsible for clearing secretions and foreign bodies from the airways, it can be an unpleasant symptom that causes discomfort in patients. The use of preparations based on root extract of Althaea officinalis L leads to the formation of a protective film, which promotes faster regeneration of the damaged mucous membrane of the respiratory tract caused by a dry cough. The mucous membrane of the respiratory tract is a highly vascularized tissue. In this regard, anti-inflammatory phytochemicals that improve lesion repair, such as local neovascularization, are critical to promote healing. The herbal medicinal product containing the active component marshmallow root extract fully meets safety requirements and can be successfully used in patients with acute and chronic respiratory diseases.

Postmenopausal osteoporosis — an interdisciplinary problem of modern

Postmenopausal osteoporosis is an important interdisciplinary problem of modern medicine. The presented lecture highlights modern approaches to the diagnosis, prognosis and treatment of this pathology. The leading role in the detection of osteoporotic changes is played by radiation diagnostic methods that determine the level of bone mineral density - the equivalent of bone mass. In order to study metabolic disorders of bone tissue, laboratory methods are used that evaluate the activity of bone synthesis and resorption. When predicting osteoporotic fractures, the FRAX model is widely used, which determines the likelihood of fractures in the next 10 years, based on the presence of risk factors. Given the multifactorial nature of the formation of osteoporotic changes, an integrated approach to the treatment of this disease is necessary. According to the recommendations of the European Society of Endocrinology, bisphosphonates should be considered as first-line therapy. Denosumab, romosozumab, teriparatide can be used as second-line drugs. In addition, given the leading role of hypoestrogenism in the development of postmenopausal osteoporosis, the use of menopausal hormone therapy preparations occupies an important place in the prevention and treatment of osteoporotic changes. An important aspect that determines the effectiveness of the treatment of patients with postmenopausal osteoporosis is the need for interaction between doctors of various specialties, including gynecologists, endocrinologists, rheumatologists, traumatologists, doctors of radiation and laboratory diagnostics.

Vascular and renal calcification as a consequence of high-dose calcium and vitamin D drugs

Calcium-containing drugs occupy an important place in the list of anti-osteoporotic agents. Their consumption, often in combination with high doses of vitamin D, has increased significantly over the last couple of decades. Cases of uncontrolled intake of the macronutrient have become more frequent. Aggressive advertising of high-dose calcium supplements with calciferol of foreign production on television played its role in this. Nowadays doctors of various specialties have to face more and more often the consequences of using such preparations. The article describes the mechanism of calcium deposits formation in vessels and kidneys against the background of calcium supplementation. The results of large-scale studies proving the close relationship between high intake of calcium and vitamin D with calcification of vessels, development of cardiovascular diseases and nephrolithiasis are presented. Doubts are raised about the validity and necessity of high-dose calcium supplements in the treatment of skeletal diseases. The possibilities of successful therapy of postmenopausal osteoporosis without the use of such agents are presented on the example of the preparation Osteo-Vit D3, which does not contain calcium and high doses of calciferol, but increases the mineral density of bone tissue and reduces the volume of calcificates in blood vessels and kidneys.

STRUCTURE OF DIZZINESS SYNDROME IN OUTPATIENT PRACTICE

Dizziness is one of the most common complaints among patients seeking help from doctors of various specialties, especially a neurologist [2]. Every year, at least 6 million patients with dizziness seek medical help, and the number of patients with dizziness increases every year [4,5]. About half of patients with dizziness are people of working age. Dizziness is detected in 2.5% of the population aged 25 to 44 years, in 8.3% over the age of 65 years and in 18.2-39% over 80 years [6].