Physicians Of Various Specialties Research Articles

A qualitative approach to assess the opinion of physicians about the challenges and prospects of pharmacogenomic testing implementation in clinical practice in Greece

BackgroundPharmacogenomics (PGx) constitutes an important part of personalized medicine and has several clinical applications. PGx role in clinical practice is known, however, it has not been widely adopted yet. In this study, we aim to investigate the perspectives of Greek physicians regarding the implementation of PGx testing in clinical practice and the key issues associated with it.MethodsFourteen interviews were conducted with physicians of various specialties for which PGx applications are available. A semi-structured interview guide was utilized based on the Consolidated Framework for Implementation Research (CFIR) context and the Diffusion of Innovation model. Transcripts were coded independently and compared by two members of the research team. Descriptive statistics were generated using Microsoft Excel.ResultsSix main themes emerged: awareness and use of PGx testing; source of information; key stakeholders of the PGx supply chain, their interactions and change agents; clinical benefit and significance of PGx testing; barriers and lack of reimbursement; and recommendations to boost the PGx adoption rate. Most respondents were aware of PGx applications, but only three had already recommended PGx testing. Peer-reviewed journals along with clinical guidelines were regarded as the most used source of information while stakeholders of the PGx supply chain were discussed. PGx was considered that promote patient-centered care, enhance medication clinical effectiveness, decrease the risk of side effects, and reduce healthcare costs. Lack of reimbursement, scarcity of resources, and high PGx cost were the foremost barriers affecting PGx adoption.ConclusionsIt was concluded that if case PGx testing is reimbursed and physicians’ training is reinforced, PGx implementation will be boosted and improved shortly.

The Review of Ophthalmic Symptoms in COVID-19.

The COVID-19 pandemic caused by SARS-CoV-2 had a significant impact on the health of the global human population, affecting almost every human organ, including the organ of vision. Research focus on understanding the pathophysiology, identifying symptoms and complications of the disease. Eye-related pathologies are important foci of research due to the potential for direct impact of the virus. Ophthalmologists around the world are reporting various symptoms of eye infections and ocular pathologies associated with SARS-CoV-2. The review of ophthalmic symptoms was conducted to help physicians of various specialties recognize possible ophthalmic manifestations of this viral disease. A literature review was conducted from January 2020 to July 2023 in the PubMed, MEDLINE, Science Direct, Scopus, Scielo and Google Scholar databases. The review of the literature showed that conjunctivitis is the most common ophthalmic symptom observed during the course of COVID-19 and can occur at any stage of the disease. Changes in the eye may result from the direct effect of the virus, immune response, prothrombotic states, comorbidities, and medications used. Symptoms related to the organ of vision can be divided into: changes affecting the protective apparatus of the eye, the anterior eye segment, the posterior eye segment, neuro-ophthalmic, and orbital changes. Ocular symptoms may suggest COVID-19 infection or appear several weeks after recovery. Following COVID-19 vaccinations, a diverse range of ophthalmic symptoms was observed in various locations and at different times, mirroring the ocular symptoms experienced throughout the course of the COVID-19 illness. It is important for physicians of all specialties to be aware of possible potential connections between eye diseases and SARS-CoV-2, in order to effectively diagnose and treat patients.

The Spectrum of Cutaneous Manifestations in Lupus Erythematosus: A Comprehensive Review.

Lupus erythematosus (LE) is an autoimmune inflammatory disease with complex etiology. LE may present as a systemic disorder affecting multiple organs or be limited solely to the skin. Cutaneous LE (CLE) manifests with a wide range of skin lesions divided into acute, subacute and chronic subtypes. Despite classic forms of CLE, such as malar rash or discoid LE, little-known variants may occur, for instance hypertrophic LE, chilblain LE and lupus panniculitis. There are also numerous non-specific manifestations including vascular abnormalities, alopecia, pigmentation and nail abnormalities or rheumatoid nodules. Particular cutaneous manifestations correlate with disease activity and thus have great diagnostic value. However, diversity of the clinical picture and resemblance to certain entities delay making an accurate diagnosis The aim of this review is to discuss the variety of cutaneous manifestations and indicate the clinical features of particular CLE types which facilitate differential diagnosis with other dermatoses. Although in diagnostically difficult cases histopathological examination plays a key role in the differential diagnosis of LE, quick and accurate diagnosis ensures adequate therapy implementation and high quality of life for patients. Cooperation between physicians of various specialties is therefore crucial in the management of patients with uncommon and photosensitive skin lesions.

The main principles of managing patients with Graves’ disease in clinical practice

BACKGROUND: Graves’ disease (GD) is a common cause of persistent thyrotoxicosis. In regions with adequate iodine intake, the incidence is 20–30 cases per 100,000 people. Modern treatment of GD includes antithyroid drugs, radioactive iodine therapy (RAI), and thyroidectomy. The choice of treatment strategy is based on the severity of thyrotoxicosis, the frequency of potential side effects, the availability of treatment options, and the likelihood of achieving sustained remission. Previous studies have demonstrated differences in approaches to diagnosis, treatment, and follow-up between countries and individual specialists.AIM: To conduct a survey on the current clinical practice of treating Graves’ disease in Russia.MATERIALS AND METHODS: An online survey was conducted among physicians in 2022-2023. The questions covered the principles of diagnosis, treatment, and dynamic observation of adult patients with Graves’ disease.RESULTS: The study involved 104 physicians of various specialties who treat patients with Graves’ disease. Approximately 99% of respondents chose the determination of thyroid-stimulating hormone receptor antibodies (TSHR-ab) to clarify the etiology of thyrotoxicosis, while only 60.6% of them chose thyroid scintigraphy. As the first-line treatment method, antithyroid drug therapy is chosen by 88.5%, while 13.5% of physicians use radioactive iodine therapy (RAI), and less than 1% of respondents refer patients to thyroidectomy. Thiamazole is most commonly used (99%), while propylthiouracil (PTU) is used in cases of allergy to thiamazole or during the first trimester of pregnancy. The «block-replace» scheme is preferred over the «block» scheme, with 72.1% compared to 28.8%, respectively. The majority of physicians (95.2%) initiate therapy with moderate doses of thiamazole (20–30 mg) and PTU (200–300 mg). Most physicians conduct dynamic monitoring of liver transaminase levels (57.7%) and complete blood count (78.8%). Conservative therapy is prescribed for a period of 12–18 months (88.5%) or up to 24 months (10.6%). Before discontinuing antithyroid drug therapy, 89.4% of respondents monitor thyroid hormone levels, 82.7% monitor TSHR-Ab levels, and 47.1% perform thyroid ultrasound. Repeat courses of conservative therapy are prescribed for up to 61.5% of respondents. Approximately 63.5% of surveyed physicians reported difficulties in referring patients for radical treatment due to a limited number of specialized institutions. Physicians cited patient unwillingness and the need to postpone pregnancy (81.6% and 24.3% respectively) as the main inhibitory factors for RAI. Thyroidectomy was associated with patient unwillingness (69.2%), as well as physician fear of laryngeal paralysis (48.1%) and postoperative hypoparathyroidism (49%).CONCLUSION: The results of the study demonstrated that physicians in their practice generally adhere to international recommendations for the treatment of Graves’ disease.

The main principles of managing patients with Graves’ disease in clinical practice

BACKGROUND: Graves’ disease (GD) is a common cause of persistent thyrotoxicosis. In regions with adequate iodine intake, the incidence is 20–30 cases per 100,000 people. Modern treatment of GD includes antithyroid drugs, radioactive iodine therapy (RAI), and thyroidectomy. The choice of treatment strategy is based on the severity of thyrotoxicosis, the frequency of potential side effects, the availability of treatment options, and the likelihood of achieving sustained remission. Previous studies have demonstrated differences in approaches to diagnosis, treatment, and follow-up between countries and individual specialists.AIM: To conduct a survey on the current clinical practice of treating Graves’ disease in Russia.MATERIALS AND METHODS: An online survey was conducted among physicians in 2022-2023. The questions covered the principles of diagnosis, treatment, and dynamic observation of adult patients with Graves’ disease.RESULTS: The study involved 104 physicians of various specialties who treat patients with Graves’ disease. Approximately 99% of respondents chose the determination of thyroid-stimulating hormone receptor antibodies (TSHR-ab) to clarify the etiology of thyrotoxicosis, while only 60.6% of them chose thyroid scintigraphy. As the first-line treatment method, antithyroid drug therapy is chosen by 88.5%, while 13.5% of physicians use radioactive iodine therapy (RAI), and less than 1% of respondents refer patients to thyroidectomy. Thiamazole is most commonly used (99%), while propylthiouracil (PTU) is used in cases of allergy to thiamazole or during the first trimester of pregnancy. The «block-replace» scheme is preferred over the «block» scheme, with 72.1% compared to 28.8%, respectively. The majority of physicians (95.2%) initiate therapy with moderate doses of thiamazole (20–30 mg) and PTU (200–300 mg). Most physicians conduct dynamic monitoring of liver transaminase levels (57.7%) and complete blood count (78.8%). Conservative therapy is prescribed for a period of 12–18 months (88.5%) or up to 24 months (10.6%). Before discontinuing antithyroid drug therapy, 89.4% of respondents monitor thyroid hormone levels, 82.7% monitor TSHR-Ab levels, and 47.1% perform thyroid ultrasound. Repeat courses of conservative therapy are prescribed for up to 61.5% of respondents. Approximately 63.5% of surveyed physicians reported difficulties in referring patients for radical treatment due to a limited number of specialized institutions. Physicians cited patient unwillingness and the need to postpone pregnancy (81.6% and 24.3% respectively) as the main inhibitory factors for RAI. Thyroidectomy was associated with patient unwillingness (69.2%), as well as physician fear of laryngeal paralysis (48.1%) and postoperative hypoparathyroidism (49%).CONCLUSION: The results of the study demonstrated that physicians in their practice generally adhere to international recommendations for the treatment of Graves’ disease.

ПРОТИВОМИКРОБНАЯ ТЕРАПИЯ ПРИ РИНОСИНУСОГЕННЫХ ОСЛОЖНЕНИЯХ: ВЗГЛЯД КЛИНИЧЕСКОГО ФАРМАКОЛОГА

Rhinosinusogenic orbital (RSOC) and intracranial complications (RSIC) remain relevant for physicians of various specialties due to high risks of unfavorable outcomes. The key to successful medical care of patients with complicated forms of nasal and paranasal sinus pathology is not only untimely diagnosis and surgical sanation of the primary focus of infection, but also properly selected systemic antimicrobial therapy (SPMT), the choice of which is based on local data on the structure of pathogens and their sensitivity to antibacterial drugs. As a result of retrospective analysis of medical records of 266 completed cases of complicated forms of rhinosinusitis in adult patients for the period from 2010 to 2023, the peculiarities of the course of RSOC and RSIC, the microbial landscape in this pathology, the nature and extent of SPMT were studied. It was revealed that in the structure of the complicated course of RSOC occupy the leading positions. Secondary meningitis prevailed among RSIC, accounting for (92.6%). Clearly expressed changes of inflammatory character on the part of the general blood analysis and integral hematologic indices were characteristic for RSIC and purulent-inflammatory complications of the eyes. Staphylococcus spp. prevailed in the structure of etiologic factors in RSOC, while polymorphism of the isolated microflora was observed in RSIC (Staphylococcus spp., Streptococcus spp., Enterobacterales, Acinetobacter spp., Enterococcus spp., anaerobes, Candida spp., Mucor spp). Analysis of antibiograms revealed that the most problematic in terms of the choice of SPMT were representatives of the order Enterobacterales, Acinetobacter spp., in some established ones - Enterococcus spp., among the pathogens of mycosis - Mucor spp. 3-generation cephalosporins prevailed in the structure of empirical SPMT, and to a lesser extent inhibitor-protected aminopenicillins. However, the severity of the patients' condition, especially in case of RSIC, the results of microbiologic examination dictated the need to switch to "observation" antibiotics (meropenem, cefepime). Timely diagnosis, clear tactics of medical care, including the choice of effective SPMT led to favorable outcomes in 98.8% of patients.

Awareness of somatisation disorder among Swedish physicians at emergency departments: a cross-sectional survey

BackgroundSomatisation is a highly prevalent psychiatric syndrome in both women and men, in which psychological distress is manifested in physical symptoms without a medical explanation. Many patients with somatisation disorder are high healthcare utilisers, particularly at emergency departments. Unnecessary investigations and diagnostic operations occur frequently, which cause both patient suffering and a significant burden on the healthcare system. Emergency department physicians’ awareness of somatisation and its manifestations has not previously been studied. This study aimed to investigate awareness about somatisation disorder among physicians working at emergency departments in western Sweden, and to explore differences between gender, specialty, and work experience.MethodsA web-based, cross-sectional survey consisting of six dichotomous questions about somatisation disorder was conducted, in December 2021 – January 2022, among licensed physicians of various specialties working at emergency departments in western Sweden. Descriptive analyses and comparative analyses were performed to investigate differences between gender, type of specialty, and years of practice. Data were analysed using chi2 tests and Fisher’s exact test.ResultsOf the 526 eligible physicians who received the survey, 241 responded; response rate 45.8%. The majority of the respondents (56.4%) were women, and most (35.3%) were specialised in obstetrics/gynaecology. Average years of work experience was 11.1 (SD 8.7) years. Although 71% of respondents were aware of the diagnosis, only 7% knew the diagnostic criteria and only 6% had ever diagnosed a patient with somatisation disorder. Female physicians were more aware of underlying factors than their male colleagues (55.7% vs. 38.2%; p = .010). Type of specialty or years of practice did not affect awareness.ConclusionsAwareness of somatisation disorder is low among physicians working at emergency departments in western Sweden. The findings suggest a need to increase awareness and knowledge and provide training in diagnosing the condition, to ensure correct decisions and optimal patient management. Clinical guidelines need to be developed to support diagnosis, investigation, and treatment, in Sweden as well as internationally.

A Breakthrough in the Treatment of Necrobiosis Lipoidica? Update on Treatment, Etiopathogenesis, Diagnosis, and Clinical Presentation.

Necrobiosis lipoidica (NL) is a rare granulomatous disease of a not fully understood etiopathogenesis. Classically, NL is associated with insulin-dependent diabetes mellitus. The disease often fails to respond to conventional treatments and adversely affects patients' quality of life. First-line medications are usually topical corticosteroids, but patients respond to them with varying degrees of success. Other options include tacrolimus, phototherapy, cyclosporine, fumaric acid esters, and biologics (adalimumab, etanercept, and infliximab). Our review aims to present new therapeutic approaches potentially effective in patients with refractory lesions, describe the presumed etiopathogenesis, and provide diagnostic guidance for clinicians. The review concludes that Janus kinase inhibitors and biologics such as ustekinumab and secukinumab can be used effectively in patients with recalcitrant NL. Another promising treatment option is tapinarof (an aryl hydrocarbon receptor agonist). However, studies on larger groups of patients are still needed to evaluate the effectiveness of different therapeutic options and to define consistent treatment regimens for NL. It is advisable to improve the awareness of physicians of various specialties regarding necrobiosis lipoidica as lesions diagnosed earlier usually have a better response to treatment.

Arc of Riolan revisited-proposal of a new classification system.

The arterial supply of the large colon is provided by the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). A particularly important area, especially in the field of colorectal surgery is the splenic flexure of the colon. There is a noticeable misunderstanding in the correct nomenclature of the major arterial anastomoses between SMA and IMA - Drummond's Marginal Artery (DMA), Arc of Riolan (AOR), and Moskovitz Artery (MA). The aim of this study is to organize the nomenclature and propose a new simplified one to facilitate communication between physicians of various specialties. Fourteen formalin-fixed cadavers (9 male, 5 female) accessible from the Chair of Anatomy of the Jagiellonian University Collegium Medicum were dissected to examine and describe the anatomical variations of anastomoses between SMA and IMA. The artery of Drummond was present in all 14 specimens maintaining the continuity of the vessel along its entire course. The Arc of Riolan was found in 7 out of 14 cadavers (50%). The artery of Moskovitz was not found. The average length measured between IMA and aortic bifurcation and between IMA and SMA was 51,00 mm and 84,68mm respectively. CONCLUSIONS: SMA and IMA anastomoses form an arterial network that is characterized by high variability and trail in surgically strategic areas. For this reason, simplifying the terminology and using unambiguous names of these vessels based on their trail and anatomical relationship with IMV are crucial for the proper planning and execution of surgical procedures performed on the colon.

Особенности преподавания гигиены в медицинском университете с учетом профильности и цифровизации

The issue of organizing the teaching of hygiene considering specialization of the medical university faculties is relevant in the context of digitalization. Proficiency in digital skill determines the modern professional physician’s competitiveness. The paper provides analysis of the use of digital technologies to study the relevant issues of hygiene. Educational process at the Department of General Hygiene of the Voronezh State Medical University is built on the principle of uniformity and consistency. Professional educational trajectory, including that on digital platforms, considers the teaching continuity, from fundamental theoretical subjects to clinical and specialized ones. Within the framework of educational process, issues of special hygiene, such as specifics of structure and use of medical institutions, features of professional activity of physicians of various specialties, are considered. Conventional methods to teach hygiene are supplemented with the differentially used innovative teaching techniques. The business game method is successfully used by the future clinicians to master the topic “Food Poisoning”. The method of creating educational videos for visual demonstration of laboratory work can be used in distant learning. The digital learning method demonstrates the possibility of using advanced digital devices and internet-based technologies in preventive medicine. It seems necessary to further improve the educational process at all the faculties as educational and professional standards, as well as the academic passport for Hygiene, are updated.

Drug-induced hyperprolactinemia: mechanism of development, features of diagnosis and treatment

One of the causes of non-tumor related hyperprolactinemia is taking a medications. Physicians of various specialties, such as cardiologists, gastroenterologists, endocrinologists, and neurologists, encounter hyperprolactinemia as a side effect of drug therapy in their practice, but it is most often observed in the practice of a psychiatrist when treating patients with psychotropic medications. Over the past few years, there has been an increase in the frequency of prescriptions of antidepressants and neuroleptics due to post-COVID-19 syndrome, anxiety and stress caused by the pandemic of a new coronavirus infection. There is also a predisposition to the development of hyperprolactinemia on the background of taking neuroleptics due to genetic features of patients. Currently, there is no established common algorithm for diagnosis and treatment of drug-induced hyperprolactinemia in the world. Based on a review of foreign and domestic literature, the article discusses in detail the mechanisms of development and various approaches to the correction of iatrogenic (drug-induced) hyperprolactinemia, assesses the prolactogenic activity of neuroleptics, and proposes algorithms for prolactin monitoring and correction of hyperprolactinemia using dopamine agonists. Often the tactics of management of such patients need to be discussed by a team of specialized physicians.

Russian Eligibility Criteria for Prescribing Menopausal Hormone Therapy to Patients With Cardiovascular and Metabolic Diseases. Consensus Document of RSC, RSOG, RAE, EUAT, RAP

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

Vestibular migraine: issues of diagnosis and optimization of therapy

Headache and dizziness are the two most common complaints with which patients turn to physicians of various specialties. A thorough examination often reveals a combination of these two symptoms. Currently, the term “vestibular migraine” (VM) is recognized by the worldwide community of otoneurologists and neurologists as the most appropriate for the combination of vestibular vertigo and migraine headaches. The difficulties in diagnosis and differential diagnosis are related to the lack of possibility to confirm the disease (and to detect) instrumentally and to the fact that the dizziness may be different in different VM episodes, even in one patient. The complexity of therapy is in the need to choose a relatively individualized treatment regimen and in the lack of an ideal vestibular suppressant (which quickly suppresses dizziness and has no significant side effects). In this context, finding the most effective drugs for emergency and elective treatment of patients with VM is undoubtedly important. For patients with VM, the use of the drug Arlevert (dimenhydrinate 40 mg + cinnarizine 20 mg) can be recommended for the relief of acute vestibular crisis at home, since the drug is highly effective and well tolerated. In addition, and most importantly, Arlevert has no known interactions with other medications used for migraine prevention.

A clinical case of a successful treatment of an interrupted ovarian pregnancy

A rare clinical case of successful treatment of an interrupted ovarian pregnancy (ОР), the incidence of which is 0.4– 1.3 % of all ectopic pregnancies (ЕР), is described. The exact etiopathogenetic mechanism of OP development is still unknown. The rupture of OP mainly occurs in the first trimester of pregnancy 91.0 %, in the second trimester it is 5.3 %, and in the third it’s 3.7 %. Untimely diagnosis of EP in the ovaries can be fatal with massive bleeding and is associated with the risk of ovariectomy with a subsequent decrease in fertility in patients of reproductive age. It is very difficult to diagnose OP. Differential diagnosis should be carried out with interrupted tubal pregnancy, rupture of the ovarian cyst, as well as with torsion of the ovarian cyst. The article presents the results of a pathomorphological study confirming the diagnosis and adequacy of the performed therapeutic measures. The algorithm of OP diagnosis, justification and decision- making on the method of patient’s management and treatment are shown. The presented clinical case will allow physicians of various specialties to know about this EP rare form, to suspect and successfully diagnose OP in the early stages of gestation, which will avoid severe, and sometimes life-threatening, complications or reduce their development.

Practical ultrasonography in hands of clinician

Point-of-Care Ultrasound is a complex of diagnostic ultrasound methods with ultrasound guided interventions. The main difference from the classical use of ultrasound is the use of ultrasound by doctors of various specialties (anesthesiologists, intensive care, surgeons, obstetriciansgynecologists, etc.) to answer diagnostic questions that arise from a clinician when working with patients. The article presents the Russian experience of successful implementation of the method of focused ultrasound-assisted examination (manipulation) in the clinical practice of physicians of various specialties on the example of several medical institutions of Buryatia Region.

ГЕПАТОСПЛЕНОМЕГАЛИЯ КАК ПРОЯВЛЕНИЕ РЕДКИХ (ОРФАННЫХ) ЗАБОЛЕВАНИЙ НА ПРИМЕРЕ БОЛЕЗНИ ГОШЕ

Hepatosplenomegaly occurs in many diseases. Physicians of various specialties often encounter it in their practice. It is the main clinical symptom in a number of rare (orphan) diseases and in Gaucher disease, in particular. A detailed description of this hereditary disease related to lysosomal storage diseases is presented in the Article as well as its modern diagnostic and treatment features. A clinical case of a six y/o pediatric patient with hepatosplenomegaly who was diagnosed with Gaucher disease type 1 based on a complex of laboratory and instrumental examination methods and prescribed with pathogenetic enzyme replacement therapy is observed.

Some aspects from the history of studying sarcoidosis

The word sarcoidosis comes from the Greek word “sarcoid”, meaning “having flesh or tissue”, and the Greek suffix “-osis”, meaning “condition”, referring to skin lesions on various parts of the body. Over the course of history, sarcoidosis has been consistently dealt with by physicians of various specialties. The palm of victory belongs to dermatologists, and further for quite a long period of time, phthisiatricians dealt with this problem, then pulmonologists, and, more recently, doctors of many other specialties. The term “Besnier-Boeck-Schaumann disease” was officially approved at the congress of dermatologists in Strasbourg in 1934. This name of the disease has been preserved to the present for a little less than 90 years. However, it should be noted that in recent years their names in the headlines and texts of articles are mentioned much less frequently. To our knowledge in the PubMed information registry, only one paper was published in 2022 on various clinical and experimental studies of sarcoidosis, which mentions the name of the disease as “BesnierBoeck-Schaumann disease”. For illustration, several presentations of own clinical and radiological observations are given, identical in their pathogenetic parameters, noticed and described for the first time by Besnier, Boeck, Schaumann and Löfgren. These presentations are formed using modern diagnostic technologies, which significantly expand the visualization possibilities of sarcoidosis variants and fully reveal the fullness of the symptom complexes that were noticed and described by the path-breakers of sarcoidosis.

Features of cerebral circulation in patients with chronic migraine

The relevance of differential diagnosis and treatment of primary and secondary headaches remains an important problem for physicians of various specialties. Migraine is a maladaptive disease, which necessitates further study of new pathogenetic mechanisms, symptomatic treatment improvement of migraine, as well as the development of more effective non-drug and drug methods for preventing migraine attacks. It is also important to determine the predictors of the chronic migraine development, which will prevent the episodic migraine transformation into a chronic form. The team of authors conducted a study to assess the degree of cerebral circulatory disorders in patients suffering from chronic migraine. The obtained results of the study made it possible to improve the diagnosis of both chronic and episodic migraine, to clarify the pathogenetic mechanisms of the formation of migraine attacks and the transformation possibility into chronic migraine. Practical recommendations have been developed to improve the effectiveness of ongoing symptomatic and preventive treatment, which improves patient’s quality of life. This article will be useful for doctors – neurologists, algologists, cephalgologists, GPs, doctors of functional and radiation diagnostics and doctors of other specialties, both for beginners and with experience

Influence of Religious Affiliations on Attitudes Toward Homosexuality Among Physicians: A Cross-Sectional Study From India.

Objective: To examine the attitudes among practicing physicians of various specialties toward homosexuality and its association with participants’ religious affiliations in India. Methods: A cross-sectional descriptive study was conducted among physicians about their attitudes toward homosexuality between December 2018 and January 2019. Participants completed a survey anonymously in hardcopy form or online. The survey was developed based on the Attitude Toward Homosexuality Scale for Indians (AHSI). A higher AHSI score indicates less homonegativity. It was modified by adding demographic details, career status, and personal experience with homosexual individuals. Results: The study results showed that among 106 respondents, 81 were men with a mean (SD) age of 32.2 (7.3) years. Of the participants, 40 (37.7%) were MBBS graduates with no specialization, while 34 (32.1%) and 32 (30.2%) respondents were from medical and surgical specialties, respectively. The majority of the respondents were Muslim (43.4%), followed by Hindu (35.8%), Christian (10.4%), those not conforming to any religion (5.7%), and other religions (4.7%). The mean ± SD total score on the AHSI was 69.6 ± 17.7, which was higher than the mean neutral score of 60. The AHSI total score was significantly higher among women (P < .001). The total AHSI score was highest among the no religion category followed by Hindus, with the lowest for biblical religions; the difference was statistically significant (P < .001). No significant difference was seen between Muslims and Christians. Conclusions: This study showed an overall positive attitude among the respondents toward homosexuality; however, those belonging to Abrahamic religions, especially Muslims, had more negative attitudes. The results highlight the need for antistigma campaigns and educational interventions targeting the physician population of India to reduce negative attitudes toward homosexuality and improve their knowledge of this topic.

Risks for obesity-associated diseases and conditions

Alimentary-constitutional obesity is a chronic heterogeneous multifactorial disorder, the relevance of which can hardly be overestimated. The severe forms of this disorder are accompanied by specific complications, a high cardiometabolic risk, and obesity-related comorbidities. Objective. To study obesity-associated diseases and conditions. Subjects and methods. The investigation involved 426 overweight and obese patients. They underwent an examination that included historical data collection; physical examination for estimation of the severity of obesity and the grade of hypertension; abdominal ultrasound for diagnosis of hepatic steatosis or non-alcoholic fatty liver disease (NAFLD), and laboratory testing for a study of the parameters of carbohydrate and fat metabolisms and liver function. Results. Patients with severe alimentary-constitutional obesity had a higher risk of comorbidity: the risk of hypertension was elevated by 3.5-fold, type 2 diabetes mellitus and impaired glucose tolerance by 5-fold, metabolic syndrome by 4-fold, and NAFLD by 5.5-fold. Conclusion. Severe alimentary-constitutional obesity is a risk factor for comorbidity. At the same time, the solution of losing weight is a complex task to physicians of various specialties and consists of measures in both public health and patient commitment to a healthy lifestyle.