Kirov Military Medical Academy

This work outlines the clinical manifestations and main diagnostic approaches in carpal tunnel syndrome, as well as the rationale for selecting the diagnostic workup required to establish the diagnosis and determine treatment strategy. The work is based on information available in university and institutional libraries, as well as electronic scientific databases. This work aimed to review diagnostic methods for carpal tunnel syndrome described in international publications and to identify the most effective and priority diagnostic approaches for this condition. According to the analyzed sources, most authors identify a basic diagnostic workup that is required to confirm the final diagnosis and determine further management strategy for this tunnel neuropathy. This includes a comprehensive neurologic examination with provocation tests and electroneuromyography, as well as imaging modalities such as ultrasonography, computed tomography, and magnetic resonance imaging. Carpal tunnel syndrome remains one of the most common tunnel neuropathies, particularly among individuals who do a lot of computer work, such as information technology professionals who use a mouse and keyboard for long periods of time. This has contributed to an increase in occupational disorders associated with chronic compression of the median nerve within the carpal tunnel. Carpal tunnel syndrome has been a major concern for many years due to its latent and gradual onset. Early clinical manifestations may be mild or nonspecific, making timely diagnosis difficult. The diagnosis of carpal tunnel syndrome does not follow a strictly defined algorithm, and additional diagnostic tests are selected on a case-by-case basis depending on the clinical presentation identified during the assessment of complaints and medical history, as well as during the neurologic examination. All diagnostic methods may be used; however, their simultaneous application is not required. In the presence of a typical clinical presentation, the diagnosis may be established without the use of high-tech diagnostic modalities.

BAKGRAUND: Ensuring that patients with mental disorders have access to psychotropic medications remains a pressing issue in modern psychiatry, particularly in the context of accessibility, quality of pharmacotherapy, and the integration of a quality management system. In the Sverdlovsk region, significant shortcomings in the organization of preferential drug provision persist, requiring scientifically based solutions. AIM: To analyze the current state and prospects for the development of preferential drug provision for patients suffering from mental disorders in the Sverdlovsk Region, identify key problems, and propose ways to solve them. METHODS: A cross-sectional study was conducted using official data from the Department of Health of the Sverdlovsk Region, the Territorial Compulsory Medical Insurance Fund, the Social Insurance Fund, the Ministry of Health of the Russian Federation, as well as archival and current data from the Sverdlovsk Regional Clinical Psychiatric Hospital. The study used quality management system analysis, lean production principles, and pharmacoeconomic analysis of the psychotropic drug market (as of 2025). RESULTS: Key development areas have been identified: import substitution and stimulation of domestic production of psychotropic medications; implementation of digital technologies (telemedicine, reminder systems); creation of a unified patient database; advanced training of specialists; transition to a bio-psychosocial model. CONCLUSION: The provision of preferential drug treatment for psychotropic drugs in the Sverdlovsk region is facing a shortage of funding, a limited list of drugs, delays in deliveries, and an inefficient procurement policy. To improve efficiency, it is proposed to integrate digital solutions, implement lean production methods, expand the list of drugs, strengthen internal quality management system controls, and support the domestic pharmaceutical industry.

Objectives. To conduct a comparative analysis of existing approaches to defining the initial stages of cognitive decline and to propose a universal practical approach to their coding for development of diagnostic criteria. Materials and methods. A comparative analysis of available published data was performed, including Russian and foreign sources documented in the PubMed and eLibrary databases reflecting the issues of the definition, diagnosis, prevention, and treatment of the pre-dementia stages of cognitive deficit. Results. The article discusses various options for defining the pre-dementia stages of cognitive disorders. The analysis led to the proposal to use the universal term “initial signs of cognitive impairment” in everyday practice for coding the stage of cognitive impairment preceding moderate cognitive impairment (MoCI). The following diagnostic criteria are proposed: presence of complaints of decreased memory, attention, and mental activity in general, presented independently or during active survey; complaints recurring, recorded at least once a week and not depending on any obvious causes or external factors; extended neuropsychological examination showing deviations from normal parameters; presence of risk factors for the development of cognitive impairment; duration of existing complaints at least six months; patient concerned about status due to the feeling of worse cognitive activity as compared with other people of the same age; absence of criteria for MoCI. Conclusions. Early objective diagnostics of the initial stages of cognitive impairment is a complex task even for trained specialists who are knowledgeable in the problem, so there is a need to standardize and universalize the diagnostic criteria available at all stages of medical care. Comprehensive assessment of the characteristics of complaints and the circumstances of their occurrence, persistence, and recurrence is required. Objective evidence of the disorder should be standardized using a universal set of neuropsychological methods.

Mineralocorticoid receptors (MRs) play a significant role in the pathogenesis of a number of internal diseases, including heart failure, hypertension, and chronic kidney disease. Their excessive activation contributes to the development of inflammation, fibrosis, tissue remodeling, and the development of cardiovacular-kidney-metabolic syndrome. The effectiveness of MR antagonism in promoting cardiac and renal protection has been confirmed by large experimental and clinical studies. However, there are significant differences in pharmacological properties between steroidal and nonsteroidal MR antagonists. This article presents the characteristics of MR antagonists registered in the Russian Federation, including their clinical effects, safety profile, and indications for use. Particular attention is paid to the drug selection algorithm, taking into account individual patient characteristics and the balance of potential benefits and risks. The material is based on current European and Russian clinical guidelines and is intended for practical use by internists in the management of patients with cardiovascular and renal diseases.

Objective. To analyse the clinical features of posterior reversible encephalopathy syndrome. Design and methods. We carried out analysis and systematisation of national and international literature on the pathogenesis, clinical manifestations and treatment of posterior reversible encephalopathy. Results. The main risk factors, etiology and differential diagnosis of this syndrome are considered. A clinical case of posterior reversible encephalopathy manifested in a patient with hypertension is presented. Conclusions. Due to its rare occurrence, the information on the pathogenesis, clinical manifestations, differential diagnosis and treatment of posterior reversible encephalopathy remains scarce. Advancements in diagnostic methods, in particular magnetic resonance imaging, contribute to better detection and differentiation of this disease. Spontaneous regression of clinical manifestations of the disease is often observed, but irreversible cases can occur.