Dynamic Monitoring Of Patients Research Articles

ORGANIZATION OF DISPENSARY OBSERVATION OF PATIENTS WITH PATHOLOGY OF THE MACULAR RETINA USING ARTIFICIAL INTELLIGENCE SYSTEMS

Background: Despite the mention in the provision of medical care for diseases of the organ of vision, adnexa and orbit about equipping the medical consultative and diagnostic department of the clinic with an optical coherence tomograph, dynamic monitoring of patients with retinal pathology after the start of treatment is most often carried out in a medical ophthalmological center, which reduces accessibility for patients with primary (first identified) morbidity requiring initiation of treatment. The required technology needs to be changed, intensified, incl. using artificial intelligence technologies.
 Aim: development of methodological foundations for organizational technology for dispensary observation of patients with pathology of the posterior segment of the eye using clinical decision support system (CDSS) based on artificial intelligence.
 Materials and methods: The assessment of the existing regulatory framework was carried out on the basis of an analysis of the Constitution of the Russian Federation, Federal laws, by-laws, and judicial practice. The creation of a methodology for a structured medical document describing an optical coherence tomography image was carried out using an expert method: a survey of 100 ophthalmologists with the appropriate level of education, incl. additional professional, engaged in the provision of medical services - specialized medical care (treatment) to patients with pathology of the posterior segment of the eye.
 Results: Using an expert method, 123 binary signs were selected and described to describe the structure of the macular region of the retina in normal and pathological conditions, of which 26 signs were identified that can be interpreted as predictors of worsening of the clinical course of the disease.
 Conclusion: The developed classifier made it possible to create and train a medical decision support system based on 60,000 medical images, which, as an information service, without making a diagnosis, can change the organization of the dynamic observation process: the formation of patient routing - a primary service using the developed CDSS; if there are signs of deterioration in the clinical picture - routing to a medical ophthalmological center to assess the dynamics, provide specialized services, incl. high-tech medical care.

Clinical Application of Serum Interleukin-6 Combined with Inflammatory Cytokines in the Dynamic Monitoring of Patients with Acute Cholecystitis.

To investigate the dynamic fluctuations of serum interleukin-6 (IL-6), procalcitonin (PCT), and neutrophil counts in individuals diagnosed with acute cholecystitis. Additionally, the research seeks to investigate the potential clinical significance of these biomarkers in the early stages of acute cholecystitis. This retrospective cohort study included one hundred patients with acute cholecystitis (60 with mild acute cholecystitis and 40 with severe cholecystitis) admitted to our hospital between January 2022 and December 2022 were included. The levels of various cytokines, PCT and neutrophils in serum on days 1, 3, 5, and 7 were dynamically detected. The difference in each indicator between the two groups was analysed, and the diagnostic value of each indicator for acute cholecystitis was evaluated using a receiver operating characteristic (ROC) curve. IL-6 and PCT levels and neutrophil counts were significantly higher in patients with moderate and severe cholecystitis than those in those with mild cholecystitis (P <0.01). The AUC values for the three indicators were all greater than 60%, and the AUC value for the joint diagnosis of the three indicators reached 90%. Serum interleukin-6 combined with PCT and neutrophil count is helpful to determine the degree of disease development in patients with acute cholecystitis. The advantage of dynamic monitoring of the three indicators is that the detection is simple and worthy of clinical promotion.

Modern aspects of identifying and managing pregnant women with preeclampsia

This article explores the importance of early detection and systematic monitoring of pregnant women with preeclampsia at the stage of consultation in the antenatal clinic, management of labor and the postpartum period. The authors, based on their experience working at City Clinical Hospital No. 52 in Moscow, consider the features of diagnosing this complication, methods for monitoring the condition of patients and effective pregnancy management strategies to prevent possible complications (such as eclampsia and HELLP syndrome). The main emphasis of the article is on the importance of prenatal screening, regular assessment of blood pressure, protein levels in the urine and other clinical indicators during observations at the prehospital stage and in the departments of the maternity hospital. The results and recommendations obtained provide valuable information for healthcare institutions and medical personnel monitoring and managing pregnant women at risk of developing preeclampsia. Preeclampsia is one of the most dangerous complications of pregnancy, which can lead to irreversible consequences for the mother and fetus. One of the key factors for success in the treatment of preeclampsia is early detection and dynamic monitoring of patients at all stages of pregnancy. This article presents aspects of identifying preeclampsia at the stage of antenatal clinic, maternity hospital and the role of midwives in this process.

Left ventricular diastolic dysfunction and transmitral blood flow parameters in patients after COVID-19

Background. People who previously had COVID-19 infection have an increased risk of developing cardiovascular diseases. Left ventricular diastolic dysfunction is an early marker of the development of cardiac pathology. Its early detection is important for the adequate therapy order and dynamic monitoring of patients. In this regard, it seems relevant to study the effect of a recent COVID-19 infection on the left ventricular diastolic function and transmitral blood flow parameters in apparently healthy individuals without clinical and instrumental signs of cardiovascular pathology. The aim of the study. To assess the changes in the diastolic and systolic function of the left ventricle, its anatomical parameters and transmitral blood flow parameters in two groups of apparently healthy individuals: those who had and those who had not COVID-19 infection. Materials and methods. Transthoracic echocardiography was performed according to the standard technique and its results were analyzed in 66 examined patients who were recognized as apparently healthy according to the results of regular comprehensive clinical and instrumental studies. The first group included 30 individuals who underwent an echocardiographic study before or during the COVID-19 pandemic, but did not have a coronavirus infection; the second group consisted of 36 people who recovered from COVID-19. The indicators of the presence of left ventricular diastolic dysfunction and the transmitral blood flow parameters were assessed. The study was approved at a meeting of the Medical Ethics Committee under the Ministry of Health of the Republic of Karelia and of Petrozavodsk State University (Minutes No. 47 of 01.11.2023). Results. The frequency of the left ventricular diastolic dysfunction did not differ in the first and second groups of patients. Statistically significant differences were recorded in the average flow deceleration time for both early and late filling of the left ventricle in people who had and did not have COVID-19 infection. A change in the phase structure of the transmitral blood flow may be an early manifestation of intracardiac hemodynamic disorders in people who have recovered from COVID-19.

Applying of magnetic resonance tomography for assessment of cardiac remodeling and risk stratification in patients with pulmonary arterial hypertension

Magnetic resonance imaging - is high precision method for diagnosing cardiovascular diseases. Simultaneously with the anatomy and function of the right ventricle, magnetic resonance imaging allows to assess the pulmonary circulation, which leads to the widespread use of this method in the diagnosis and dynamic monitoring of patients with pulmonary arterial hypertension. The article is devoted to the assessment of cardiac remodeling and risk stratification of this group of patients. Special attention is given to new prognostic parameters included in the scale for risk stratification of patients with pulmonary hypertension of the European Society of Cardiology/European Respiratory Society 2022.

Preliminary outcomes of the COVID-19 pandemic: a new chronic pain profile

In summing up the preliminary results of the COVID-19 pandemic that has not yet ended, modern research pays much attention to the so-called post-COVID syndrome, which includes the long-term consequences of the disease. In English, symptoms are reported as long COVID, post-acute COVID, or chronic post-COVID syndrome and are described as symptoms of fatigue, respiratory disorders, memory, and sleep problems. Symptoms such as muscle pain and decreased endurance when performing habitual physical exertion are mentioned much less often. Meanwhile, among the complaints of those who have been ill, this symptom is present quite often, reducing the quality of life and tolerability of normal physical exertion. This review aimed to provide an in-depth study of a new type of the chronic myofascial pain syndrome after COVID-19, i.e., the frequency of occurrence, causes of the development, and pathophysiology of chronic pain syndrome associated with COVID-19 and manifested as fibromyalgia of various localizations. To answer the questions posed, the authors searched for information in four electronic databases. The key search terms used were COVID-19, long COVID, and signs and symptoms of pain syndrome. A review of current literature data has shown that close study and dynamic monitoring of patients who had COVID-19 can contribute to further deciphering the pathophysiological mechanisms of the development of its long-term consequences and provide answers to questions on the prevention and treatment of chronic pain syndrome in this patient cohort.

ЦЕНТР ПРОФИЛАКТИКИ ОНМК: КАК ОРГАНИЗОВАНЫ, ПРИНЦИПЫ РАБОТЫ

In Russia, more than 450,000 cases of Stroke are registered annually, while the risk of recurrence is 10- 30% per year. Mortality from cerebrovascular diseases is on the 3rd place among all pathologies. The reduction of the risks of recurrent Stroke is realized through the opening of Stroke prevention centers, the objectives of which are to conduct a consultative reception, prescribe a complex of diagnostic and therapeutic measures and dynamic monitoring of patients in order to prevent the possibility of recurrent Stroke. The article describes the principles of operation and organization of these centers.

КЛИНИКО-ЛАБОРАТОРНЫЕ ПРЕДИКТОРЫ БЫСТРОГО ТИПА ПРОГРЕССИРОВАНИЯ БОЛЕЗНИ ПАРКИНСОНА

In Parkinson's disease (PD), several types of progression are conditionally distinguished. Determination of reliable criteria for identifying patients with a rapid type of PD progression in the early stages of the disease will allow us to begin the development of therapy aimed at inhibiting its development. The aim of the study was to determine the clinical and laboratory predictors of the rapid type of PD progression in the Belarusian cohort of patients. Patients with PD underwent a general somatic and neurological examination. Non-motor symptoms were assessed by completing the appropriate scales. Laboratory studies included the determination of antibodies to α-synuclein, the study of the levels of cortisol, IL-1β and IL-10, the calculation of the albumin coefficient (Qalb). Longitudinal study with three groups: 1) rapidly progressive type of PD, 2) slowly progressive, and 3) indeterminate. Candidate predictors were obtained by comparing clinical and laboratory parameters of patients with fast or slow types of PD progression. During dynamic monitoring of patients with an indeterminate type of progression, the sensitivity and specificity of predictors were determined. 113 people with PD: group 1 – 32 patients, group 2 – 26, group 3 – 55. Threshold values of indicators were obtained by comparing the clinical and laboratory characteristics of groups 1 and 2 by the Mann-Whitney method and then by ROC analysis to determine the probability of a fast type progression : Qalb less than 83.95, antibodies to α-synuclein in serum more than 4.11 ng/ml, MoCA less than 26 points. Depending on these indicators, patients of group 3 were divided into 2 subgroups: 3a) "possibly rapidly progressive" course (n = 21) and 3b) "possibly slowly progressive" course of PD (n = 34). In 16 (76%) patients from group 3a, the rapid type of progression was confirmed. In 28 (82%) patients from group 3b, a slow type of progression was confirmed. The obtained results testify to the high sensitivity and specificity of the indicators. Further research is needed to develop therapies that change the course of PD.

The probability of developing a tumor in the small intestine neocyst

In clinical practice and scientific literature, there is very little data on the occurrence of tumors in the urinary intestinal reservoirs in patients after radical cystectomy with cystoplasty. A characteristic feature of such tumors is a long latent period before the formation of a relapse from 4 to 32 years.The article describes a clinical case of a 1951 patient with a tumor of a small intestinal neocyst. From the patient’s history, there is a long-term hematuria (for 2 years) after radical cystectomy with ileocystoplasty. The intensity of hematuria increased to the formation of profuse with the development of severe anemia. During the examination according to magnetic resonance imaging, computed tomography, ultrasound and invasive diagnostic examinations, no tumor was detected. The patient underwent a diagnostic laparotomy, a tumor was found in the area of ureteral-reservoir anastomosis of the small intestine neocyst. Resection of the small intestine reservoir and ureteral transplantation was performed. The morphological picture of the removed tumor is urothelial cancer of moderate differentiation.Secondary tumors of the small intestinal urinary reservoirs are rare and have the structure of adenocarcinoma. The mechanisms of their occurrence have not been fully studied at the moment. Dynamic monitoring of patients after radical cystectomy and ileocystoplasty should be carried out in a specialized center.

Algorithms for the diagnosis and treatment of chronic tonsillitis

Introduction. Features of the course of chronic tonsillitis may vary depending on the age of the patient, his comorbid status and the severity of the disease. One of the characteristic manifestations of the disease are local signs of chronic tonsillitis and manifestations of a systemic inflammatory response. The article considers the issue of increasing the effectiveness of treatment of patients with chronic tonsillitis at the stage of clinical examination by using bioregulatory therapy drugs in complex conservative treatment. Aim. Evaluation of the effectiveness of bioregulatory therapy (Traumeel ® S) in the dynamic monitoring of patients with chronic tonsillitis. Materials and methods. A randomized controlled trial was conducted in patients with newly established and confirmed diagnosis of chronic tonsillitis, decompensated form. The severity of subjective and objective symptoms was assessed using a visual analogue scale, as well as pharyngoscopy data, supplemented by the results of ultrasound examination of the palatine tonsils. Results. In the group of patients who took bioregulatory therapy, positive dynamics was observed already on the 2 nd day and related to the reduction of bad breath and sore throat. Comparative analysis in the groups made it possible to note a more significant and faster dynamics in relation to changes in the palatine arches, elasticity of the palatine tonsils and the phenomena of retromaxillary regional lymphadenitis. The monitoring of the condition of the treated patients over the course of 6 months made it possible to identify more rare recurrences of chronic tonsillitis among patients in the complex treatment of which the bioregulatory medicine was used, the frequency of which was 2.8 times lower compared to the control group. Discussion. The conducted study showed that the use of bioregulatory therapy has a positive effect on the symptoms of the inflammatory process. This is confirmed by an improvement in the general condition of patients in dynamics, a decrease in pain according to visual analogue scale, and an objective assessment of changes in the structure of the palatine tonsils using ultrasonography. Conclusions. Вioregulatory therapy as of a complex application (oral and parenteral forms) increases the effectiveness of treatment in patients of the dispensary group with a newly diagnosed chronic tonsillitis, decompensated form. Drug can significantly reduce the duration of therapy and reduce the number of relapses after complete recovery within 6 months.

Features of treatment of chronic brain ischemia in young patients with arterial hypertension

Actuality: Increasing the frequency of hypertension among the young population is a socially significant problem. The insidiousness of hypertension in young people is that it has the character of a disease with few symptoms. Since hypertension plays one of the main roles in the pathogenesis of chronic disorders of cerebral blood circulation, including both arterial and venous systems, the search for pathogenetically determined medicinal approaches to the elimination of cerebrovascular disorders, especially at a young age, continues. The purpose of the study: to study the effectiveness, tolerability and safety of the combination of Flego and Cognitium in young patients with chronic cerebral ischemia (CMI) on the background of hypertension. Methods: clinical-neurological, psychodiagnostic (asthenic state scale (ASS), anxiety scores according to the Spielberger-Hanin scale and Beck depression scale, Montreal scale of cognitive function assessment (MoCA)), ultrasound examination, general scale of clinical impression, statistical. Results: 52 patients (28 men and 24 women) at a young age with AMI on the background of hypertension were examined. The median age of the examined patients was (37.7 ± 4.6) years; among them, 23 patients suffered from hypertension of the 1st century. and 29 patients with hypertension of the second stage. Patients were randomly divided into two groups - the first - 23 (44.2%) patients (received only hypotensive drugs), the second - 29 (55.8%) patients (in addition to the standard hypotensive therapy received a combination of Phlego and Cognitium). Dynamic monitoring of patients after 2 months of treatment did not show significant changes in the distribution structure of objective clinical and neurological symptoms. However, positive dynamics of indicators of cognitive functions and the psychoemotional state of the subjects were observed, as well as a statistically significant decrease in the blood flow rate in the direct sinus at the end of the 2-month course using the combination of Phlego and Cognitium (decreased from 36.27±2.84 cm/s to 25.65±1.47 cm/s.). Conclusions: The introduction of the combination of Phlego and Cognitium into the treatment of young patients with arterial hypertension and chronic brain ischemia had a positive effect on the subjective state, on indicators of asthenia, emotional and cognitive state of the patients. A significant positive effect was noted in the dynamics of venous blood flow indicators (speed of blood flow in the direct sinus). Such treatment was well tolerated by patients, had few side effects and was combined with other drugs

Indicators of lung function in children with chronic nonspecific lung diseases with pulmonary fibrosis

Introduction. The pathogenesis of most chronic nonspecific lung diseases (CNSLD) in children is based on a long-term inflammatory process, often leading to the formation of pulmonary fibrosis in the structurally altered tissue, which requires dynamic monitoring of patients, including the study of lung function.Aim. To assess the indicators of the lung function in children with chronic bronchopulmonary pathology accompanied by pulmonary fibrosis.Materials and methods. 84 children with CNSLD were examined. The main group consisted of 45 children with CNSLD with pulmonary fibrosis (bronchopulmonary dysplasia, congenital malformations of the lungs, chronic bronchitis, and post pneumonia fibrosis). The comparison group consisted of 39 children with CNSLD without pulmonary fibrosis. The average age of children in the study groups was 9,3±0,48 years. The patients underwent multispiral computed tomography of the lungs with a virtual bronchoscopy program and intravenous bolus contrast enhancement. Evaluation of lung function was carried out by spirometry.Results. In patients in remission, the average values of the ventilation capacity of the lungs in both groups were within the predicted values. However, in patients with fibrotic changes, pulmonary dysfunction was detected 2 times more often than in children with CNSLD without pulmonary fibrosis (35.5% and 15.4%, respectively, p&lt;0.05). Restrictive ventilation disorders were diagnosed only in the group of patients with pulmonary fibrosis. In children with pulmonary fibrosis, the risk of reduced ventilation capacity is significantly higher than in children with CNSLD without pulmonary fibrosis (OR=3.04, 95% CI 1.049–8.78).Conclusion. The data obtained can serve as a prerequisite for further development of predicting the nature of the course of the disease, identifying “risk groups” for the development of fibrotic changes for a personalized approach to the treatment and follow-up of patients with CNSLD.

The calling a doctor in: what an optimal model can be? (publications review).

The primary health care represent the most common segment of medical care in many countries and provides prevention and treatment of diseases, dynamic monitoring of patients with chronic diseases and medical rehabilitation. There is substantial shortage of health personnel to meet health needs all over the world, especially in primary health care. The COVID-19 pandemic exacerbated this problem. It changed workload in primary health care and demonstrated need for new organizational solutions to increase access to primary health care. One of the new transformations in general practice can be redistribution of medical work in primary health care. In this research, five options for organizational models of primary home care were identified. We used "performer (doctor / nurse)", "payment method for the home visit", "frequency of patient visits per week" as indices. There is lack of unified approach in the way how home visits are organized so optimal organizational model of primary home medical care is needed. This will increase access of most demanded type of medical care and ensure rational use of human resources at the primary health care level, especially during COVID-19 pandemic.

Analysis of the sensitivity and specificity of ultrasound elastometry of the liver in women with chronic hepatitis C

Introduction. Despite the success in the treatment of chronic hepatitis C (HCV), the incidence of HCV remains at a high level, and the assessment of the degree of liver fibrosis is relevant in all patients with HCV.The aim of the study was to conduct a comparative diagnosis of the stages of liver fibrosis in women with chronic hepatitis C according to ultrasound elastometry and biopsy.Materials and Methods. To achieve this goal, a comprehensive clinical, laboratory (including virological), instrumental examination of 93 patients with HCV of reproductive age was conducted.Results. When interpreting the results, it was found that ultrasound elastometry in women with chronic hepatitis C is comparable to the results of percutaneous puncture liver biopsy.Discussion. Chronic hepatitis causes significant economic damage to health systems. The main factor affecting the reduction of morbidity and the risk of complications is the early diagnosis of HCV infection and timely antiviral therapy. The main objective of therapy is to achieve a stable virological response (SVR), as well as to reduce the activity of inflammation and the stage of AF in patients with HCV. The isolated use of serum markers of fibrosis and ultrasound elastometry of the liver at the early stages of the disease is not informative enough, so it is advisable to use a combination of different techniques, and at the CP stage, a puncture biopsy can be safely replaced with ultrasound elastometry of the liver, especially for the purpose of dynamic monitoring of patients with HCV.Conclusion. According to the comparative ROC-analysis of the results of ultrasound elastography and puncture liver biopsy, the high sensitivity and specificity of these methods for diagnosing liver fibrosis was established. The comparability of ultrasound elastography of the liver with the results of puncture biopsy, in young women, increases with the progression of liver fibrosis, and can be used to determine its degree.

General practitioner’s tactics in the management of patients with stable angina

Ischemic heart disease (IHD) is one of the most common diseases of the cardiovascular system, which is based on a disorder of the trophism of the heart muscle against the background of pathological changes in the coronary vessels. The leading factor in changes in coronary vessels is stenosing atherosclerosis, which results in impaired blood flow. Risk factors include male gender, older age, a burdened familial history, as well as low physical activity, arterial hypertension, diabetes mellitus, and obesity. Ischemic heart disease is the leading cause of death, especially in developed countries, and the number one cause of medical visits related to heart and vascular problems. One of the most common manifestations of ischemic heart disease is angina pectoris. When pain sensations appear against the background of physical activity or emotional stress, it is called angina of effort, but if angina manifestations occur outside the period of physical and mental activity, we are speaking about resting angina pectoris. There are acute and chronic forms of ischemic heart disease, and while cardiologists and cardiac resuscitators usually deal with acute conditions, dynamic monitoring of patients after a myocardial infarction or with angina pectoris is a part of the responsibility of a general practitioner.

Ischemic heart disease (IHD) is one of the most common diseases of the cardiovascular system, which is based on a disorder of the trophism of the heart muscle against the background of pathological changes in the coronary vessels. The leading factor in changes in coronary vessels is stenosing atherosclerosis, which results in impaired blood flow. Risk factors include male gender,

In their practice, family doctors may encounter symptoms that require differential diagnosis between organic and functional disorders of the gastrointestinal tract and malignant neoplasms. The similarity of the clinical picture in some cases requires timely making the right decision about the tactics of examination, additional diagnostic measures and further referral to specialized medical institutions for treatment. One of these diseases that do not have specific clinical features at an early stage is gastric cancer, which is a malignant degeneration of the epithelium of the gastric mucosa. Symptoms of gastric cancer in its initial stages are limited to dyspeptic disorders, loss of appetite and unexpressed asthenia, which makes its manifestations similar to many diseases that affect the gastrointestinal tract — gastritis, peptic ulcer of the stomach and duodenum, adenomatous polyps of the gastric mucosa. The main diagnostic method that allows making the correct diagnosis is gastroscopy, which makes it possible not only to assess the condition of the mucosa, but also to take material for a biopsy with further histological examination of the tissue. Since the main treatment for gastric cancer is surgery, a correct and timely diagnosis plays a significant role in the further prognosis of the disease and the patient's quality of life.

РОЛЬ ІМУНОГІСТОХІМІЧНИХ МАРКЕРІВ ДЛЯ ПРОГНОЗУВАННЯ ВИНИКНЕННЯ РЕЦИДИВУ АБО СМЕРТІ У ПАЦІЄНТІВ З МЕДУЛЯРНИМ РАКОМ ЩИТОПОДІБНОЇ ЗАЛОЗИ

Introduction. Medullary thyroid cancer (MTC) belongs to a class of rare neuroendocrine aggressive tumors and arises from parafollicular cells (C-cells). An important modern problem is the development of ways to predict the recurrence of this disease. The aim of the study is to determine the role of immunohistochemical tumor markers of medullary thyroid cancer in predicting recurrence or death. Materials and methods. The analysis of the prospective study included 22 patients with MTC, 5 of whom have developed a recurrence and 4 have died at the end of the 10-year (120 months) follow-up period. Immunohistochemical examinations were performed using monoclonal antibodies of tumor markers calcitonin, chromogranin A, vimentin and Ki-67. Results. The discrepancy between the data of histological and immunohistochemical examinations in MTC is 12.0%, which indicates the hyperdiagnosis of this nosology and argues the importance of performing immunohistochemical examinations to verify the diagnosis. Patients who had a recurrence of MTC had significantly (p &lt;0.05) lower levels of calcitonin expression (5.00 [5.00; 5.00] points) compared with patients who did not relapse, where this figure was 6.00 [6.00; 7.00] points. In patients with MTC, an increase in calcitonin expression was significantly associated with an increase in chromogranin A expression (r = + 0.49, p = 0.02); a similar relationship was found for the proportions of immunopositive cells of these tumor markers: r = + 0.68, p = 0.001. At the same time, it was found that the increase in the level of calcitonin expression was apparently combined with the decrease in the level of Ki-67 expression (r = -0.52, p = 0.02). It was also found that the increase in the level of vimentin expression is combined with an increase in the expression (r = + 0.64, p = 0.001) and the proportion of immunopositive cells of chromogranin A (r = + 0.45, p = 0.038). Conclusions. Low levels of calcitonin expression are prognostically unfavorable markers for the recurrence of MTC. Specific tumor markers are important in the treatment process and for the dynamic monitoring of patients with MTC.

CORRELATION OF KINETIC THERAPY WITH IMAGING INVESTIGATION IN THE TREATMENT OF LUMBAR DISC HERNIATION

According to worldwide statistics, the incidence of diagnosed lumbar disc herniation (LDH) among the population is estimated at 15%. Lifestyle changes have led to an accelerated decrease in age for the above-mentioned pathology. In the early stages, a herniated disc may be asymptomatic, which may delay the diagnosis; therefore, the real number of LDH-affected population is considered to be at least double. The complications associated with a herniated disc can have repercussions on the quality of life and can culminate with irreversible spinal cord injuries and functional impotence. Early detection of the condition can prevent the patient’s functional degradation. Magnetic resonance imaging (MRI) is the main method to confirm suspected LDH, with a diagnostic accuracy of 97%. Through this research, we aim to highlight the importance of clinical imaging investigations (especially MRI), the stages of the rehabilitation programme for LDH patients and the close monitoring of their disease status. The study is conducted on a group of patients diagnosed with LDH and evaluated clinically, functionally and by imaging methods at the time of disease onset. The kinetic programme adapted for LDH recovery is addressed to both patients undergoing conservative treatment and patients undergoing surgery. Therapeutic progress is quantified through new functional clinical evaluations and imaging investigations. The dynamic monitoring of patients allows highlighting the quality/limitations of the kinetic programme. Therefore, we can conclude that imaging investigation is the starting point for establishing an accurate diagnosis and choosing the therapeutic protocol in LDH pathology.

ANALYSIS OF THE WORK OF THE POLYCLINIC IN THE CONDITIONS OF THE COVID-19 PANDEMIC

Abstract. In the context of a pandemic of coronavirus infection, the work of medical institutions, especially the activities of primary health care, remains very relevant. The article presents an analysis of the work of the level 3 polyclinic in the conditions of the COVID-19 pandemic, the implementation of anti-epidemic and preventive measures in comparison with previous years. The clinical and advisory department is a multidisciplinary polyclinic, which is a structural subdivision of the State Agrarian University of the Republic of Sakha (Yakutia) "Republican Hospital No. 1-National Center of Medicine". The analysis of statistical data for 2020 for 20 medical specialties was carried out, there were 51667 visits in total, including 26265 primary visits. The statistical analysis was carried out using the STATISTICA 13 program.3. In order to prevent the spread of infection, all patients passed a test for RNA (SARS-Cov-2, PCR) and the presence of Covid– 19 antibodies before planned hospitalization to exclude the active phase of the disease. During the pandemic, all necessary measures were taken to prevent the spread of a new coronavirus infection, including vaccination from COVID-19 employees to continue the continuous provision of planned medical care to the population of the republic. In addition to providing planned consultative and diagnostic assistance, the polyclinic provides: dynamic monitoring of patients with blood diseases, dispensary monitoring of patients after kidney and liver transplantation. To achieve the most accurate diagnosis and make the most effective decisions on therapeutic tactics, multidisciplinary techniques were conducted with the participation of doctors of many specialties under the supervision of one patient. During the pandemic, remote work using telemedicine has increased by 2 times. There is an increase in newly diagnosed malignant neoplasms: the first place is occupied by diseases of the gastrointestinal tract (cancer of the stomach, esophagus, liver, rectum), the second by blood diseases (lymphoproliferative diseases-leukemia, lymphoma, myeloma) and the third by respiratory diseases (lung cancer). The intradepartmental control of outpatient care and day hospital showed a high level of quality of the polyclinic's activities.

А rare tumor in the practice of oncoophthalmologist — is an oncocytoma of the lacrimal gland

Introduction. Oncocytoma is an epithelial tumor, characterized by a benign course and has a favorable prognosis. The description of this clinical case is due to the rare occurrence of lacrimal gland oncocytoma in clinical practice and a small number of publications in the literature.Methods. A case study of the lacrimal gland oncocytoma is presented in a young patient, followed up for a long time.Results. The presented clinical case demonstrates the need for morphological diagnosis of lacrimal gland formations, despite the benign nature of the tumor and the favorable course of the disease. Discussion. Analysis of a clinical example and a review of the literature clearly demonstrates the need for differential diagnosis of tumors of the lacrimal gland.Conclusion. It is necessary to include the described pathology in the differential diagnostics of any neoplasms of the lacrimal gland and orbit in order to prevent an unwarranted expansion of surgical intervention, with subsequent dynamic monitoring of patients with this pathology.