Practice Of Internists Research Articles

Rhabdomyolysis as a cause of acute kidney injury in internist practice

Rhabdomyolysis as a cause of acute kidney injury in internist practice

Stress-related emotional disturbances in patients with cardiovascular diseases

Acute and chronic stress, as well as emotional disturbances as a consequence of stressful situations, are significant risk factors for the development and progression of some of acute and chronic non-communicable diseases, including cardiovascular diseases (CVD), among which the most common are arterial hypertension, chronic heart failure and atherosclerotic CVD. Specific emotional disturbances that arise after exposure to significant traumatic or stressful situations include acute and post-traumatic stress disorder. When a stress factor does not reach high intensity or significance, adjustment disorder may develop. Stress-related emotional disturbances significantly affect other CVD risk factors, reduce patients’ adherence to healthy lifestyle changes and drug therapy, deteriorate quality of life and increase the risk of disability. The urgency of identifying and managing post-stress emotional disturbances in the practice of internists is caused by high frequency of these disturbances in outpatient patients. It is especially important to manage and prevent these disturbances in patients with CVD due to increased number of adverse outcomes resulting from this combination. Treatment of emotional disturbances resulting from stressful situations includes both drug and non-drug methods. Antidepressants and benzo-diazepine anxiolytics are the main classes among the drugs used to treat post-stress emotional disorders. However, the prescription of these drugs requires taking into account a wide range of possible side effects, especially in patients with CVD. The choice of drugs with a favourable safety profile and a rapid onset of sedative and anti-anxiety effects is a key element in the modern effective patient management strategy. Tofisopam and buspirone are the most advanced of this group of drugs in therapeutic and cardiological practice.

New insight into the management of psychoemotional risk factors in patients with cardiovascular diseases in middle and young age

Affective spectrum disorders, such as depression and anxiety disorders, are important psychoemotional risk factors for the development and complicated course of many common chronic non-communicable diseases, including cardiovascular ones: arterial hypertension, coronary heart disease, chronic heart failure, atrial fibrillation, acute coronary syndrome, etc. A feature of this comorbidity is the significant impact of psychoemotional factors on the motivation and adherence of patients to a healthy lifestyle, as well as various drug treatment options, which involves an increased risk of complications and, as a consequence, increased healthcare costs. The topicality of the issues of screening and management of psychoemotional disorders in the internist practice arises from a variety of reasons. On the one hand, it is a high incidence of these disorders in patients with cardiovascular diseases, including young and middle-aged ones, which is associated with a deterioration in the quality of life and an increased risk of complications and adverse outcomes in the future. On the other hand, it is caused by insufficient level of awareness among doctors about new possibilities for the management of the psychoemotional state of such patients. This review presents data on the effectiveness and safety of therapy of psychoemotional disorders in patients with various CVDs with a drug containing D,L-hopanthenic acid (rat-hopanthenic acid) as an active substance of the nootranquilizer class, which has a wide range of clinical effects, including a beneficial effect not only on psychoemotional sphere, but also on cognitive functions. The prospects for prescribing a D,L-hopantenic acid drug to young and middle-aged patients with CVD, which reduces the drug burden on the patient and provides high quality of life for patients both in hospital and at subsequent stages of treatment, are discussed. The key point is availability of an option for prolonged use of D,L-hopanthenic acid drug without any risk of addiction, withdrawal syndrome or hyperstimulation, which is an important clinical aspect of drug therapy for patients with CVD, especially in young and middle age.

Psychosomatic causes of the gastrointestinal tract functional disorders: historical aspects and modern assessment

Psychosomatic disorders are becoming increasingly common among neurotic disorders in the practice of doctors of various profiles. The history of studying psychosomatic disorders goes back to the past, and even in ancient times, doctors paid attention to a special group of diseases, the cause of which was related to the mental state of the patient, while complaints were in the nature of somatic diseases. At the present stage, psychosomatic disorders prevail in the practice of internists, as well as obstetricians and gynecologists. Irritable bowel syndrome, as one of the psychosomatic disorders, currently attracts the attention of many researchers. The article presents the results of a study of pregnant women with irritable bowel syndrome and the peculiarities of their emotional response. The aim of the study was to identify the level of anxiety in pregnant women with IBS, depending on the IBS clinical form. The feeling of anxiety was revealed at an equally high level in all subjects in the experimental and control groups. Tension was more pronounced in the patients with diarrhea predominant irritable bowel syndrome, while depressive states were more often detected in the patients with IBS-D and less pronounced in the subjects with abdominal pain.

Коморбидность синдрома повышенной эпителиальной проницаемости

Syndrome of increased epithelial permeability is one of the most studied pathogenic syndromes in the 21st century. In the English literature, the term “the leaky gut syndrome” is widely used to refer to Syndrome of increased epithelial permeability. The participation of Syndrome of increased epithelial permeability in the development of diseases and pathological conditions of the gastrointestinal tract, as well as the pathology of other organs and systems, is widely discussed. In early 2021, the first multidisciplinary national consensus “Syndrome of increased epithelial permeability in clinical practice” was published, and in 2022, practical recommendations for physicians were published on one of the topical aspects of Syndrome of increased epithelial permeability – epithelial protective therapy. Of the epithelial protectors used in gastroenterology, only rebamipide has a universal positive effect on the barrier function of the gastrointestinal tract throughout its entire length and at three structural levels (preepithelial, epithelial, and subepithelial). As part of the review, experimental and clinical studies, systematic reviews on Syndrome of increased epithelial permeability and the use of rebamipide, published in domestic and foreign literature in 2022, were considered. Separately, the issues of the use of rebamipide in diseases of the cardiovascular system, its protective effect and the ability to level possible problems associated with drug therapy in terms of increasing its safety in the practice of internists (cardiologist and therapist) and surgeons (cardiac surgeon and vascular surgeon) are considered. The data presented in the review demonstrate the comorbidity of the Syndrome of increased epithelial permeability, which takes a certain part in the development of diseases not only of the digestive system, but also of non-gastroenterological diseases, in particular, the pathology of the cardiovascular system, which suggests the formation of new therapeutic strategies, the use of which will improve the clinical prognosis.

Warfarin hypersensitivity in the internist's practice: a case report

Anticoagulants are widely used in clinical practice to reduce the risk of cardiovascular events. However, there are associated clinical conditions that require coagulation system monitoring due to an increased risk of bleeding. In clinical practice, cases of warfarin hypersensitivity due to gene polymorphisms are known. Taking warfarin in such a situation is often manifested by massive bleeding that threatens the patient's life. Sixty seven-years-old female patient was admitted to the internal medicine department of Rostov State Medical University clinic in March 2022. The day before, she noted severe abdominal pain, loose bloody stool. An outpatient examination revealed an increase in international normalized ratio to 9,42, thrombin time >30 sec. There were no signs of primary gastrointestinal pathology. According to anamnesis, on January 21, 2022, the patient underwent mechanical aortic valve replacement, in connection with which warfarin was prescribed at a dose of 2,5 mg/day. After establishing hypocoagulation, warfarin was discontinued. A pharmacogenetic analysis was performed, which established the carriage of polymorphisms of cytochrome P450 system genes, the homozygous mutation 1075A>C (CYP2C9 (*3/*3)), and the heterozygous mutation of the vitamin K reductase gene VKORC1 G(-1639)A (VKORC1 GA). The individual dosage of warfarin was calculated according to International Warfarin Pharmacogenetics Consortium guidelines, which was 9 mg/week. After adjusting the dose of warfarin, the level of international normalized ratio decreased to 3,61, thrombin time to 13 sec. The patient was discharged with recommendations to follow an individual warfarin regimen and monitor coagulation parameters. The presence of hypersensitivity to warfarin is not a reason for its complete withdrawal in situations requiring longterm anticoagulation. In this regard, it is necessary for the doctor to be vigilant when prescribing warfarin to a patient, understanding the causes and methods for diagnosing hypersensitivity to warfarin, and timely correction of its dosage.

Internists’ ambivalence toward their role in health counseling and promotion: A qualitative study on the internists’ beliefs and attitudes

Crucial to its success is that physicians enhance their competence in Lifestyle Medicine and take on their role as Health Advocates in Health Counseling and Promotion (HC&P). However, studies on patients' views of lifestyle counseling in clinical practice demonstrate that many patients neither perceived a need to adopt a healthy lifestyle nor having had any discussion with their physician about their lifestyle. This study is part of a participatory action research project focusing on identifying areas of improvement for health promotion in the practice of internists. Within this project, we interviewed 28 internists from six different subspecialties of an academic medical center in the Netherlands. This study aims to gain insight into how internists understand their role in HC&P by a qualitative analysis of their beliefs and attitudes in the interview data. Participants claimed that promoting a healthy lifestyle is important. However, they also reflected a whole system of beliefs that led to an ambivalent attitude toward their role in HC&P. We demonstrate that little belief in the success of HC&P nurtured ambivalence about the internists' role and their tasks and responsibilities. Ambivalence appeared to be reinforced by beliefs about the ability and motivation of patients, the internists' motivational skills, and the patient-doctor relationship, and by barriers such as lack of time and collaboration with General Practitioners. When participants viewed HC&P as a part of their treatment and believed patients were motivated, they were less ambivalent about their role in HC&P. Based on our data we developed a conceptual framework that may inform the development of the competences of the Health Advocate role of internists in education and practice.

Clinical significance of bleeding scoring systems

Introduction. Bleeding scoring systems are used for predicting the risk of a specific primary outcome in a specific population.In this article, we present scoring systems frequently used in internist practice. Bleeding scoring systems for acute upper gastrointestinal bleeding. Are divided into clinical, endoscopic,and combined scoring systems, according to the type of variables included. Besides traditional systems (Rockall, Glasgow-Blatchford), we primarily present clinical scoring systems used for upper gastrointestinal bleeding. Bleeding scoring systems for patients with atrial fibrillation on anticoagulant therapy. We refer to the most significant scoring systems - ATRIA, HAS-BLED, and ORBIT. Since the prognostic performance of the existing scoring systems is less than satisfactory, medical organizations suggest they should be used for recognizing patients who deserve close monitoring during anticoagulant therapy. Bleeding scoring systems for patients with acute myocardial infarction treated with percutaneous coronary intervention. ACUITY-HORIZONS was proven to be superior to other scoring systems in predicting bleeding within 30 days in patients with a myocardial infarction treated with transradial percutaneous coronary intervention. Bleeding scoring systems for bleeding disorders. Scoring systems enable the detection of bleeding disorders before performing laboratory tests. Considering the frequency severity of symptoms, newer systems have been developed for the pediatric population and self-testing by modifying the original scoring system. Conclusion. Although medical organizations encourage the implementation of scoring systems in clinical practice, the development of newer and enhanced existing systems requires a comprehensive approach and critical analysis of the existing systems.

Priorities of mental and physical health problems in internist's practice

Priorities of mental and physical health problems in internist's practice

Intoxication syndrome in the practice of internist

Background. Intoxication syndrome (IS) is one of the most common syndromes in the medical practice, but its exact scientific outline has not yet been established. This is due to a variety of toxic factors, a large polymorphism of symptoms, and complex interactions between the processes of toxin production and detoxification.
 Objective. To describe the main features of IS and its treatment.
 Materials and methods. Analysis of literature sources on this issue.
 Results and discussion. The morphological basis of IS is the subcellular interaction between the toxin and the receptor. IS develops if the toxins’ entry or formation outweigh their elimination. Intoxications are divided into exogenous and endogenous. The diagnostic criteria for exogenous intoxications are the contact of the patient with the substance that caused the intoxication and the corresponding damage to the organs. Exogenous intoxications have a clear clinical picture, and the introduction of specific antidotes or antitoxins is the best treatment. In turn, endogenous IS is mediated by the accumulation of bacterial endotoxins, excess amounts of physiological metabolic products, biologically active substances and mediators. Natural ways of detoxification include metabolism, excretion and immune mechanisms. Infusion detoxification (IDT) with a significant load by crystalloids and multicomponent drugs is a mandatory treatment for both exogenous and endogenous IP. In most cases, the volume of infusion should be 25-35 ml/kg body weight. Requirements for the ideal drug for detoxification include hypervolemia, improving microcirculation and rheological properties of blood, correction of electrolyte disorders and disorders of acid-base balance, increase of diuresis and peristalsis. All these effects are typical for Reosorbilact (“Yuria-Pharm”). In general, the IDT program may include classical and balanced crystalloids (800-1500 ml), Reosorbilact (600-800 ml), specialized solutions (100-200 ml), and symptomatic drugs. The optimal duration of treatment with Reosorbilact is 7 days.
 Conclusions. 1. Exact scientific characteristics of IS are still missing. 2. IDT is the mandatory method of treatment of exogenous and endogenous IS. 3. Reosorbilact is the main component of IDT in any IP, as it affects the main links of the pathogenesis of the latter.

Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine

Point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. It has many uses in daily clinical practice, including improved diagnostic timeliness and accuracy, and providing information about a patient's prognosis and follow-up. It has been integrated into numerous specialities, but remains relatively undefined in internal medicine training programs. Ultrasonography is a useful tool in the standard clinical practice of internists in numerous clinical scenarios (Emergency Department, hospital ward, general and specific consultations, and home care). Although POCUS has been recently included in the European curriculum of internal medicine, there are differences between European internists in its use, ranging from not at all to well structured educational programs. The use of POCUS needs to be widespread in internal medicine departments, and to accomplish this we must encourage structured training. This document details the consensus-based recommendations by the European Federation of Internal Medicine (EFIM) Ultrasound working group. We establish POCUS core competencies and clinical settings for internists in a symptom-based approach. We also propose training requirements, providing a framework for training programs at a national level.

Scope of application of the ursodeoxycholic acid at gastroenterological pathology

The article presents modern concepts on the using of ursodeoxycholic acid in the clinical practice of internist. The presented review is focused on the effects of ursodeoxycholic acid, the current spectrum of it’s application in the treatment of the patients with gastroenterological pathology, in particular, gastroesophageal reflux disease, non-alcoholic fatty liver disease, autoimmune hepatobiliary processes, chronic hepatitis, intestinal dysbiosis. The literature review has covered the historical data on the release of ursodeoxycholic acid, the first studies on the results of this drug using, and listed the ursodeoxycholic acid effects and scope of application. The literature review presents data from the global studies of the ursodeoxychloric acid effects on patients with the above listed nosology. The efficacy of its preparation has been proved in terms of reduction of the clinical manifestations of intrahepatic cholestasis in pregnant women without side effects. The presented data showed the survival prolongation in patients with primary biliary cholangitis against the background of ursodeoxychloric acid administration. It has been emphasized that long-term use of ursodeoxycholic acid at viral hepatitis, along with etiotropic therapy, allowed to eliminate the clinical manifestations and to avoid the development of complications. It was demonstrated that ursodeoxycholic acid has protective properties against the damaging effect of bile acids on the esophagus walls at gastroesophageal reflux disease. The data have been presented on the UCDA positive effects on the lipid spectrum in patients with non-alcoholic fatty liver disease. The data illustrating the significant positive differences in the composition and function of the microbiome after prolonged use of ursodeoxycholic acid have been outlined.

Iatrogeniа in internist practice.

The article presents the history of the issue, the concept of iatrogenia, possible negative consequences of the interaction of the doctor and the patient in modern conditions. The main forms of iatrogenic (psychogenic, hospital, iatrogenic diagnostic procedures, medicinal, etc.) are given. An important place is occupied by implantation of iatrogenic (patients with artificial heart valves, cardio-implanted electronic devices, coronary stents, articular endoprostheses). The most vulnerable to the development of iatrogenic are elderly and senile patients. The interdisciplinarity of the iatrogenic problem and its educational significance for therapists, general practitioners, clinical pharmacologists, pathologists. Keywords: iatrogeniа, iatrogenic events, undesirable drug reactions, мedical error.

Positioning document on incorporating point-of-care ultrasound in Internal Medicine departments

This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine.

Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna

This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine.

Procedural Skills of a General Internist - Informed by the Front Line.

Procedural Skills of a General Internist - Informed by the Front Line.

Основные гепатологические синдромы в практике врача-интерниста

Основные гепатологические синдромы в практике врача-интерниста

Когнитивные нарушения и ноотропная терапия в практике терапевта и кардиолога

Когнитивные нарушения и ноотропная терапия в практике терапевта и кардиолога

The practice of internal medicine in Europe: organisation, clinical conditions and procedures

BackgroundCurrent information on the role of internists in the European countries is scarce. This report describes the results of a survey of the practice of internists in Europe. MethodsTwo online questionnaire-based surveys were carried out by the European Board of Internal Medicine, one on the practice of internists and the other on postgraduate training in internal medicine. The national internal medicine societies of all 30 member countries of the European Federation of Internal Medicine were invited to participate. The responses were reviewed by internal medicine trainees from the respective countries and summaries of the data were sent to the national societies for approval. Descriptive analysis of the data on the practice of internists was carried out. ResultsTwenty-seven countries (90%) completed the questionnaire and approved their datasets. In 8 European countries, most internists practised internal medicine alone and in 7 countries at least half of physicians practised internal medicine together with a subspecialty. Internal medicine was considered a hospital-based specialty in most countries. The majority of selected presenting problems and diagnoses were rated as commonly encountered in all countries. More variability between countries was observed in the performance of diagnostic and therapeutic procedures. ConclusionMany similarities exist in the practice of internal medicine between the European countries, while some differences are present that likely reflect the variable impact of subspecialisation. The results of the survey should prove valuable for the definition of specific competencies and development of a common curriculum for internal medicine at the European level.

Postgraduate education in internal medicine in Europe

BackgroundLimited information exists on the framework and content of postgraduate education in internal medicine in Europe. This report describes the results of a survey of postgraduate training in internal medicine in the European countries. MethodsTwo online questionnaire-based surveys were carried out by the European Board of Internal Medicine, one on the practice of internists and the other on postgraduate training in internal medicine. The national internal medicine societies of all 30 member countries of the European Federation of Internal Medicine were invited to participate. The responses were reviewed by internal medicine residents from the respective countries and summaries of the data were sent to the national societies for approval. Descriptive analysis of the data on postgraduate training in internal medicine was performed. ResultsTwenty-seven countries (90%) completed the questionnaire and approved their datasets. The length of training ranged from four to six years and was commonly five years. The majority of countries offered training in internal medicine and a subspecialty. A common trunk of internal medicine was frequently a component of subspecialty training programmes. Hospital inpatient service was the predominant setting used for training. A final certifying examination was in place in 14 countries. ConclusionAlthough some similarities exists, there appear to be significant differences in the organisation, content and governance of postgraduate training in internal medicine between the European countries. Our findings will prove invaluable for harmonisation of training and qualification in internal medicine in Europe.