Case History Research Articles

Diagnostic utility of selected faecal biochemical parameters in the determination of acute diarrhoea and associated defecation stooling characteristics in dogs: An observational study.

Diarrhoea, which is a clinical manifestation of various illnesses, is frequently observed in dogs. Regrettably, many dog owners find it difficult to provide comprehensive case histories, primarily because of limited interaction with their canine companions. This study aimed to evaluate the potential of faecal biochemical analytes in detecting and characterizing acute diarrhoea in dogs. Sixty-two domestic dogs were selected using the proportionate stratified sample technique. A structured questionnaire was used to collect demographic and clinical data. Faecal stool specimens from the dogs were obtained using the colon flush technique. The specimens were taken through biochemical analysis to determine urea, creatinine, total bilirubin, total cholesterol, triglycerides, gamma-glutamyl transferase and uric acid levels. Results showed a significant association between the diarrhoea status of the participants and their age, weight, breed, body size, source of last diet, period of inappetence, and other gastrointestinal signs (p < 0.050, respectively). Dogs that had not eaten in at least three days were five times more likely (p < 0.05) to have diarrhoea. Furthermore, miniature breeds were about six times more likely to develop diarrhoea (p < 0.05). Of the seven selected biochemical parameters, total faecal cholesterol was the most predictive index in diagnosing acute diarrhoea in dogs, with a likelihood ratio of 6.5, and it was the most accurate in predicting defecation stooling frequency and texture. In summary, in situations of inadequate case histories, measuring total faecal cholesterol could assist veterinarians in detecting diarrhoea and predicting its faecal stooling texture and frequency in dogs.

Frenectomy management for Ankyloglossia in a 1-Year-old patient under general anesthesia: A case report

Introduction: Ankyloglossia is defined as a congenital disorder that alters tongue mobility and function. It is listed as one of the possible reasons behind breastfeeding issues. The WHO currently recommends mothers to breastfeed exclusively up to 6 months of age, emphasizing the importance of promptly identifying any breastfeeding obstacles and determining the root cause of the problems as the primary focus. The purpose of writing this article is to describe a frenectomy as a surgical procedure that addresses ankyloglossia by excising the lingual frenulum with general anesthesia. Case History: A 1-year-old male patient presented at Dr. Saiful Anwar Regional General Hospital with complaints of difficulty in breastfeeding and consuming complementary foods, as well as prolonged pain experienced by the mother during breastfeeding. The patient had no history of systemic diseases such as heart disease or blood disorders, and there were no known allergies to food or medications. The patient was uncooperative (Frankl scale number 1). After analyzing the ankyloglossia, the choice of frenectomy with general anesthesia was chosen to treat this case. Discussion: Dental examinations and treatments for uncooperative 1-year-old children can be challenging in regular dental offices. Effective behavioral management, such as general anesthesia (GA), is required for safe and efficient treatment. GA involves a multidisciplinary team to oversee the procedure stages, allowing for one-visit treatment, reduced anxiety, and a safer, less painful dental experience. Conclusion: Frenectomy procedure under GA has been performed as an option to facilitate restorative therapy, improve nutritional intake, and quality of life.

Healthy Placemaking in the Public Space in Sana'a City: A Case Study (The Main Square of Qaa Al-Olfi)

The public space with its components (streets and public parks) occupied an important place in the history of urban design and community health, as they are the determinants and resilient elements of health within cities. Modern concepts and design methods have been developed in response to urban health pandemics, including the creation of a healthy placemaking that achieves the health of the population within the urban context; Due to the lack of applications by principles healthy placemaking in streets and public parks in Sanaa, it has negatively impacted the daily health activities of residents, The research problem is that Sanaa's streets and public parks do not have any urban design to promote the health of Yemenis in the face of the pandemics; he study object is to create guided design models for the streets and public park in the study area, which simulate the applications of healthy placemaking to help planners provide solutions to face the spread of diseases and pandemics in urban areas, The importance of this research comes in the form of the first Yemeni urban study that deals exclusively with the issue of healthy placemaking in the streets and public parks during of urban health pandemics. The research followed the descriptive inductive approach in studying the theoretical concepts and the practical approach in creating design models the applications of the health placemaking during health pandemics on the study area.

DYNAMICS OF CORONAVIRUS INFECTION COVID-19 AND SOCIAL CHARACTERISTICS OF PATIENTS WITH TUBERCULOSIS AND HIV-ASSOCIATED TUBERCULOSIS

The aim of the research. Assessment of the influence of social factors on the course and outcome of a new coronavirus infection COVID-19 in patients with tuberculosis and HIV-associated tuberculosis.Materials and methods. A retrospective analysis of 103 case histories of patients in 2 study groups: HIVassociated TB/COVID-19 (n=45) and TB/COVID-19 (n=58) is presented.Results. The mean age of patients with a combination of HIV-associated tuberculosis and COVID-19 infection (42,8 ± 7,2 years) is significantly lower than patients with tuberculosis and COVID-19 infection (51,3 ± 13 years). Bad habits, including drug addiction (62,2% and 3,4% in the groups, respectively) and alcoholism (93,3% and 67,2% in the groups, respectively) were associated with HIV infection. Hepatitis C (77,8% and 15,5% in the groups, respectively), refusal of further inpatient treatment (84,4% and 25,9% in the groups, respectively), stay in correctional labor institutions (ITU) (53,3% and 27,6% in the groups, respectively) were significantly more common in HIV-infected patients. Such social factors as disability, lack of work, place of residence, degree of education, living with or without relatives, marital status, housing characteristics did not affect the dynamics and outcome of the disease in general. The form and phase of the course of tuberculosis were associated with HIV infection. Type 2 diabetes mellitus was associated with the absence of HIV infection (0% and 17.2% in the groups, respectively). The severity of the course of COVID-19, the outcome of the disease at the end of inpatient treatment did not depend on the presence of HIV infection.Conclusion. No direct relationship between HIV infection and social factors associated with it with the severity of tuberculosis and the new coronavirus infection COVID-19 has been established.

Sir William Osler (1849-1919) and neurology in his time.

Sir William Osler, physician in Montreal, in Pennsylvania, at Johns Hopkins and in England, promoted clinical medicine and its interpretation through clinical and pathological observation. He was a keen bibliophile and medical historian. He taught at the bedside and wrote a textbook that was a standard work in his time and for several decades after he died. As a generalist he practised the emerging speciality of neurology and knew many of the early clinicians in that field. The neurology of his time and his contributions to the subject are explored here.

THE CHALLENGING SCENARIO OF DYSPNEA IN THE ELDERLY: DUE MORE TO CONGESTION OR INFLAMMATION?

Abstract Introduction Elderly patients hospitalized due to acute heart failure often have a concomitant acute lung disease. Establishing the role of each disease in a clinical picture of acute cardiopulmonary syndrome can be challenging. A common thread of these diseases is inflammation; a hyperinflammatory response determines more serious symptoms and a worse prognosis. Purpose We evaluated the effectiveness of a treatment with dexamethasone in patients with acute cardiopulmonary syndrome and strong inflammatory response. Materials and Methods We evaluated 302 consecutive HFPEF (heart failure with preserved ejection fraction) patients ≥80 years of age, with concomitant symptoms attributable to acute bronchitis, pneumonia, or COPD exacerbation, hospitalized due to worsening dyspnoea, with an NT–proBNP ≥3,000 pg/ml, and a finding X–ray of lung congestion with or without a consolidation. Reactive C Protein (CRP) was measured. Patients with SARS–CoV–2, indication to corticosteroids for other clinical conditions or need for mechanical ventilation were excluded. The 112 patients with CRP&amp;gt;20 mg/dl were randomized into 2 groups: 56 patients were treated open–label with dexamethasone at a dose of 8 mg iv/day for a maximun of ten days, in addition to the usual therapies, while the same number of patients were treated with the usual therapy. In both groups antibiotics were administered based on procalcitonin guided protocl. Clinical recovery time, length of hospitalization, in–hospital mortality, need for a new hospitalization and mortality at one month were evaluated. Results The mean age of patients was 89±5 years in the dexamethasone group and 88±5 in the usual therapy group. The results are shown in Table 1. Patients treated with dexamethasone experienced a faster clinical recovery and a shorter length of hospitalization. No significant differences were found regarding either in–hospital mortality or need for rehospitalization and mortality at 30 days. Notably, PCT guided treatment led to an average reduction in duration of antibiotic therapy from 8 to 5 days. Conclusions Very elderly patients with acute cardiopulmonary syndrome and hyperinflammatory state have a favorable response to dexamethasone therapy added to the usual therapy in terms of clinical improvement and length of hospitalization. Our case history is small to evaluate a possible improvement in mortality. These findings need to be consolidated from double–blind randomized controlled trials.

Thrivers and Survivors during Study Abroad: The Individual Cases of Japanese Learners of English

Whilst study abroad (SA) periods hold much promise for foreign language development, increasing research suggests sojourners’ experiences are unique, and language development does not always follow a linear trajectory. For some learners, SA has little impact on their language performance despite the affordances of L2 immersion (the Survivors). Other learners maximise the potential of SA, and this has a positive impact on their language development (the Thrivers). This paper examines the selected cases of four Japanese learners of English and their request language performance during a 10-month SA in the UK. Changes in pragmatic knowledge (based on appropriateness ratings) were documented at three equidistant time points. Language contact profile data also provided quantitative insights into the learners’ extracurricular language use and qualitative personal reflections. The selected cases illustrate two learners surviving the SA experience, showing minimal change in their request performance. The other two learners thrived during SA, showing accelerated performance in terms of lexical variation at the production level. This paper reports on the case histories of these learners to better understand these unique experiences and pragmatic discrepancies. Suggestions for how learners might be more pragmatically successful during SA are also offered.

Retrospective evaluation of the effectiveness and safety of UVB-311 in atopic dermatitis

BACKGROUND: Atopic dermatitis is a widespread skin disease based on immune and genetic mechanisms of chronic inflammation formation. The disease most often develops in early childhood, has a frequent recurrent course, age-related clinical features. In this regard, the disease is characterized by a wide variety of treatment methods, the effectiveness of which varies and is a highly debated topic at the present time. AIM: to retrospectively evaluate the efficacy and safety of standard local and systemic therapy of atopic dermatitis in combination with UVB 311 nm. MATERIALS AND METHODS: 100 case histories of patients with atopic dermatitis of varying severity who were in the clinic of skin and venereal diseases in the period from 2022 to 2023 were analyzed. Of these, 50 patients received combined systemic and topical therapy with UVB 311 nm (the first group), and 50 patients received only standard topical and systemic therapy (the second group). Systemic and topical therapy of atopic dermatitis included, according to clinical recommendations, corticosteroids, calcineurin inhibitors, antihistamines. RESULTS: As a result of combined therapy with UVB 311 nm, patients showed a decrease in the SCORAD index by 1.7 times after 1 month of therapy, by 8 times after 2 months, and by 30 times after 6 months. In the second group, the SCORAD index decreased 1.2 times after 1 month from the start of therapy (p=0.0004), 3 times after 2 months (p=0.0001), 20 times after 6 months (p=0.003). Side effects in the first group were detected only in 5 (10%) patients: 2 (4%) patients had skin burning, 2 (4%) had skin itching, 1 (2%) patient had photodermatitis in the form of erythema of the skin. These adverse reactions were of a short-term nature and quickly passed if the recommendations were followed without canceling the procedures. CONCLUSION: UVB 311 nm therapy for atopic dermatitis has a higher therapeutic effect, is well tolerated, has minimal early side effects, and leads to clinical remission faster than standard systemic and local therapy.

Implementation of Internet of Things for Condition-Based Maintenance in Elevator Systems: An Analytical Case Study

Implementation of Internet of Things for Condition-Based Maintenance in Elevator Systems: An Analytical Case Study

Liquefaction ground deformations and cascading coastal flood hazard in the 2023 Kahramanmaraş earthquake sequence

The 2023 Kahramanmaraş earthquake sequence produced extensive liquefaction-induced ground deformations and ongoing flooding along the shoreline of the Mediterranean port city of İskenderun, Türkiye. This study compiles field observations and analyses from cross-disciplinary perspectives to investigate whether earthquake-induced liquefaction was a significant factor for increasing the flood hazard in İskenderun. Geotechnical reconnaissance observations following the earthquakes included seaward lateral spreading, settlement beneath buildings, and failures of coastal infrastructure. Three presented lateral spreading case histories indicate consistent ground deformation patterns with areas of reclaimed land. Persistent scatterer interferometry (PSI) measurements from synthetic aperture radar (SAR) imagery identify a noticeably greater rate of pre- and post-earthquake subsidence within the İskenderun coastal and urban areas relative to the surrounding regions. The PSI measurements also indicate subsidence rates accelerated following the earthquakes and were typically highest near the observed liquefaction manifestations. These evaluations suggest that while the liquefaction of coastal reclaimed fill caused significant ground deformations in the shoreline area, ongoing subsidence of İskenderun and other factors likely also exacerbated the flood hazard. Insights from this work suggest the importance of evaluating multi-hazard liquefaction and flood consequences for enhancing the resilience of coastal cities.

Dynamic stress analysis of rock joints under railway loading

The proper estimation of stresses generated by the passage of a train is fundamentally important to the serviceability and longevity of railways, and yet very limited knowledge is available where the track substructure is built on a jointed rock mass. The present study introduces an analytical solution for estimating the ground stresses arising from moving wheel loads, causing a change in the three-dimensional stress state in the track formation, in relation to the stress variation with depth and along the longitudinal track section – that is, the direction of train passage. Based on 21 case histories, an array of field measurements and numerical simulations covering a wide range of freight tonnage, train speeds and different formation conditions were considered to validate the proposed analytical solution. The proposed methodology (analytical solution) was then applied to a jointed rock subgrade to determine the normal and shear stresses acting along a specific discontinuity plane. The main analytical outcome demonstrates that the orthogonal vertical and shear stresses present different and phase-shifted history plots for homogeneous ground conditions with principal stresses rotation. However, conversely for a jointed subgrade, the normal and shear stresses along the discontinuity have the same history plot pattern and are in phase. As a practical guide, the results from this study would help to define which cyclic loads should be applied in laboratory tests to simulate realistic traffic patterns of trains travelling over a jointed rock subgrade.

СОВРЕМЕННАЯ ТАКТИКА ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ БОЛЬНЫХ С ВАРИКОЗНОЙ БОЛЕЗНЬЮ НИЖНИХ КОНЕЧНОСТЕЙ

Varicose veins are a very popular disease. It is observed in 10–15% of men and 20–35% of women and is often accompanied by long-term incapacity and subsequent disability of the patient. That’s why it’s not surprising that endovenosus laser ablation therapy (EVLT) is replacing surgery as the main treatment for varicose veins. Currently, laser radiation with wavelengths in the λ range from 0.45 to 2 is used for EVLT. A positive treatment result was achieved at all wavelengths that were used. The resulting differences in clinical applications in terms of pain levels, complications, and postoperative healing were rates largely subjective, leading to controversy regarding the choice of the most effective method. This was facilitated by the evolution of interpretations of the processes occurring during EVLT, which, from the authors’ point of view, is useful for their understanding. Endovasal methods have been proven to be cost-effective and safe and can be performed under local anesthesia on an outpatient basis. To date, this technique has become quite widespread in vascular surgery. This paper provides a review of the literature on the prevalence and pathophysiology of varicose veins of the lower extremities, the achievements of endovasal methods of treating varicose veins of the lower extremities, and studied modern methods of surgical correction of varicose veins. We analyzed and described the main issues related to endovenous techniques for obliterating varicose veins. Conducted on 20 case histories of patients with venous insufficiency of the lower extremities, operated on at the CHU “KB “RZD-Medicine” named after. N.A. Semashko” comparative analysis of modern surgical methods for the treatment of varicose veins of the lower extremities. The operation was performed on one lower limb in 18 patients, and on two lower limbs in 2 people. All patients underwent endovasal laser coagulation (EVLC) in combination with miniphlebectomy. The disadvantages and advantages of the modern surgical method of treating venous insufficiency of the lower extremities (EVL) have been identified.

What predicts response to sertraline for people with depression in primary care? a secondary data analysis of moderators in the PANDA trial

Purpose Antidepressants are a first-line treatment for depression, yet many patients do not respond. There is a need to understand which patients have greater treatment response but there is little research on patient characteristics that moderate the effectiveness of antidepressants. This study examined potential moderators of response to antidepressant treatment. Methods The PANDA trial investigated the clinical effectiveness of sertraline (n = 326) compared with placebo (n = 329) in primary care patients with depressive symptoms. We investigated 11 potential moderators of treatment effect (age, employment, suicidal ideation, marital status, financial difficulty, education, social support, family history of depression, life events, health and past antidepressant use). Using multiple linear regression, we investigated the appropriate interaction term for each of these potential moderators with treatment as allocated. Results Family history of depression was the only variable with weak evidence of effect modification (p-value for interaction = 0.048), such that those with no family history of depression may have greater benefit from antidepressant treatment. We found no evidence of effect modification (p-value for interactions≥0.29) by any of the other ten variables. Conclusion Evidence for treatment moderators was extremely limited, supporting an approach of continuing discuss antidepressant treatment with all patients presenting with moderate to severe depressive symptoms.

Exploring Risk Factors for Adverse Reactions in Children with an Acute Psychotic Episode Using the Global Trigger Tool: Does Age Matter?

Aim: To establish significant risk factors for the development of adverse drug effects (ADEs) in children and adolescents with an acute psychotic episode taking antipsychotics. Materials and Methods: The research team randomly selected 15 patient records each month for 3 years (2016-2018). Overall, 450 patient records were included (223 boys and 227 girls, mean age was 14.52 ± 2.21 years). Adverse effects were identified using the standard algorithm of the Global Trigger Tool method. A "trigger" is an indication that an adverse reaction is likely to occur, e.g., an antihistamine prescription on a prescribing list. When a trigger was detected, the case history was studied in further detail to confirm the occurrence of ADEs. We divided patients into two groups: the "children" group (under 12 years old) and the "adolescents" group (13 years and older). Data were analyzed using the statistical package IBM SPSS Statistics 23.0. Results: Of the 450 patient records, 402 (89.3%) had at least one trigger detected. In total, 126 case histories contained evidence of ADE (28%). The total number of ADEs per 1000 patient days was 5.39 and the number of ADEs per 100 admissions was 32.0. Among adolescents, two or more triggers per patient were significantly more frequently identified (61.3% vs. 44.6%; p = 0.001). ADEs were rare in "Children" compared with "Adolescents" (13.8% vs. 30.4%; p = 0.006). The logistic regression analysis confirmed high predictive role of "Adolescence" (odds ratio [OR] = 2.58; 95% confidence interval [CI] 1.22-5.4; p = 0.013), "Polypharmacy" (OR = 1.96; 95% CI 1.23-3.1; p = 0.004), and "First-life hospitalization" (OR = 2.17; 95% CI 1.34-3.48; p = 0.001) for ADE fact in patient records. Conclusion: We found that significant risk factors for ADEs to antipsychotics in patients with acute psychotic episode were adolescence (13 years and older), polypharmacy, and first-life hospitalization. The fact that children (i.e., younger than 13 years of age) are less likely to experience ADEs was not associated with high-risk drugs or higher doses in our study.

Ulcerative stomatitis associated with yellow bristle grass in New Zealand dairy cows

ABSTRACT Case history A line of 25 cull cows were all found to have ulcerative lesions of the tongue at post-mortem inspection in a New Zealand slaughter plant. A further 9 of 10 cows inspected at the farm of origin had similar oral lesions. There were no other clinical signs or indicators of ill-health observed at ante-mortem inspection in the abattoir or on the farm. The cows had been fed baleage for 3 weeks prior to slaughter, made from pasture in paddocks heavily contaminated with yellow bristle grass (Setaria pumila). Clinical findings There was extensive and deep transverse linear ulceration in the lingual fossa immediately rostral to the torus linguae. At histological examination, full-thickness ulceration of the stratified squamous epithelium was observed with a bed of disorganised collagenous tissue and extensive mixed inflammatory infiltrate extending into the sub-epithelial connective tissue and skeletal muscle. Barbed plant fragments were embedded in both the superficial and deeper areas of inflammation. Detailed examination of the baleage also found that yellow bristle grass seedheads were present. Diagnosis Based on the presence of barbed plant material in the tongue and yellow bristle grass seeds in the baleage, a diagnosis of ulcerative stomatitis associated with yellow bristle grass was made. Clinical relevance Clinicians should be aware of the potential for hay or baleage contaminated with yellow bristle grass to cause oral lesions in cattle.

Auditory processing disorder: an online survey of hearing healthcare professionals’ knowledge and practices

Objective To investigate (1) the current level of awareness and knowledge on Auditory Processing Disorder (APD) among Audiologists and other hearing healthcare professionals; (2) current practices in screening, diagnosis, and management of APD in children and adults across the UK; (3) professional’s acceptance of APD assessment and diagnosis. Design An online survey was disseminated through the British Academy of Audiology and ENT UK. Study sample A total of 191 hearing healthcare professionals responded to the survey. Results Overall, while 63% of the respondents considered themselves to be adequately informed about APD, only 4% viewed themselves as very informed on the topic. Fewer than half of the respondents report screening (31%), diagnosing (14%), or managing (36%) cases of APD. For screening APD, professionals most commonly use auditory processing tests in adults and take case histories in children, whereas routine audiological procedures are the primary method for diagnosing APD in both adults and children. Although modifying the listening environment is a widely recommended management strategy for APD, half of the respondents indicated that a diagnosis of APD has no implications for patient management. Conclusions There is a critical need to promote APD-related training to ensure they can provide appropriate referrals and management.

Anaesthesia-related morbidity associated with recumbent, low-field magnetic resonance imaging of horses

ABSTRACT Case history: Medical records from 2009 to 2021 from a private equine referral hospital in Rochester, NH, USA were analysed for cases that underwent general anaesthesia for low-field MRI of the distal limb. These were used to determine peri-anaesthetic morbidity and mortality. Clinical findings and outcome: Two hundred and forty-three anaesthetic episodes were recorded in horses undergoing low-field MRI. The peri-anaesthetic complication rate prior to discharge was 6.2% (15/243). No patients experienced a fatal complication. Ninety two of the 243 patients had multiple sites imaged, 90/243 received pre-anaesthetic dantrolene, 134/243 received intra-anaesthetic dobutamine, and 15/243 were positioned in dorsal recumbency. Complications included: abdominal discomfort (“colic”; 9/243), myopathy (4/243), hyphaema (1/243) and carpal fracture (1/243). At the time of discharge, 14/15 complications had resolved. Of 135 horses for which data were available 55 became hypotensive during the procedure (lowest mean arterial pressure < 65 mmHg). Median body weight was 553 (min 363, max 771) kg. Horses were anaesthetised for a median of 150 (min 45, max 210) minutes. There was no evidence of an association between higher body weight (p = 0.051) or longer duration of anaesthesia (p = 0.421) and development of an anaesthetic complication. For categorical variables (dantrolene administration pre-anaesthesia, dobutamine administration during anaesthesia, hypotension (mean < 65 mmHg) during anaesthesia, dorsal vs. lateral recumbency, and imaging of single vs. multiple sites), the 95% CI for the OR included 1, indicating a lack of effect of the variable on the odds of complication. Clinical relevance: The cases included in this series suggest that low-field MRI under general anaesthesia is a viable option for diagnostic imaging in otherwise healthy horses. Complications occur, but most resolve before discharge.

Tofacitinib as a means of optimizing the treatment of rheumatoid arthritis at the outpatient stage (clinical cases)

Two clinical cases of tofacitinib use in the management of rheumatoid arthritis (RA) patients by a rheumatologist at the outpatient stage within the framework of the “Treatment to Target” strategy are presented. The first clinical case describes the case history of a female patient (age 48 years, RA duration 20 years), which demonstrates the difficulties in selecting pathogenetic therapy for late-stage RA. Consecutively prescribed four synthetic baseline anti-inflammatory drugs (methotrexate, sulfasalazine, cyclophosphamide, leflunomide) and two genetically engineered biological drugs (infliximab, rituximab) failed to achieve remission of the disease in the patient. Decrease in disease activity was noted after connection of the third biological drug – etanercept, treatment with which had to be interrupted due to pregnancy planning. The return to the combined treatment after childbirth did not lead to repeated “success”. A positive result was achieved 12 weeks after tofacitinib at a dose of 10 mg/day, which provided a decrease in RA activity to moderate and complete withdrawal of glucocorticoids. Given the incomplete clinical effect, tofacitinib dose was increased to 20 mg/day by the outpatient rheumatologist, which resulted in achieving low RA activity persisting for 5 years. The second case demonstrates the effectiveness of tofacitinib inclusion in the RA treatment regimen as a “second-line” drug. A patient (age 46 years, RA duration 10 years) with long-term drug (methotrexate 25 mg/week) clinical and laboratory remission of RA after an upper respiratory tract infection developed an exacerbation of the disease. Despite three-component therapy with baseline anti-inflammatory drugs, the patient had persistence of high RA activity, which led to the revision of pathogenetic therapy – tofacitinib at a dose of 10 mg/day with clinical effect of the drug after 4 weeks. The achieved clinical and laboratory remission of the disease has been maintained for two years. In outpatient practice tofacitinib can be an effective tool for optimizing RA treatment.

The analysis of medical prescriptions for patients with duodenal ulcer in hospital setting

The analysis of medical prescriptions for patients with duodenal ulcer in hospital setting

Diabetic bladder dysfunction.

More than 4.3 million people in the UK have been diagnosed with diabetes and there are thought to be a further 850 000 people living with diabetes who have not yet been diagnosed (Diabetes UK, 2024). Around half of all adults who have diabetes experience bladder dysfunction. It is one of the most common complications of diabetes, yet there is little in the medical literature and it is often unrecognised and poorly treated (Wittig et al, 2019). This article uses a case history approach to examine how diabetes can affect the bladder.