Acquired hemophilia A (AHA) is a rare but life-threatening autoimmune disorder caused by the development of inhibitors against coagulation factor VIII. This article presents a clinical case of an 82-year-old female patient who was admitted with intracerebral hemorrhage and multiple spontaneous hematomas and was subsequently diagnosed with AHA. The diagnosis was confirmed by prolonged activated partial thromboplastin time (aPTT) and significantly decreased factor VIII activity level of 3.5%. The patient received hemostatic and immunosuppressive therapy with a positive clinical response. This case emphasizes the importance of early diagnosis and a personalized therapeutic approach, especially in elderly patients without a previous history of bleeding disorders. The observation illustrates the diagnostic challenges of AHA when masked by other clinical conditions and highlights the need for interdisciplinary collaboration among healthcare providers.
The article provides documentary information about the history of the creation of the first pharmacies in St. Petersburg, their location and connection to the districts of the city. Historical plans of St. Petersburg of the XVIII century are used.
The main reason for the severe and difficult to correct course of asthma is the remodeling of the respiratory tract. The purpose of the review is to summarize the main pathogenetic mechanisms of airway remodeling in asthma and to present the diagnostic capabilities of various methods. Results. The main patterns of development and progression of morphofunctional restructuring of the respiratory tract in asthma are presented. The involvement of immune cells and the role of angiogenesis in the remodeling of the respiratory tract are shown. Instrumental and laboratory diagnostic methods are considered. The diagnosis of airway remodeling faces a number of difficulties. Currently, there are no available non-invasive methods for assessing airway remodeling with high sensitivity and specificity. The lack of informative biomarkers available for airway remodeling limits clinical studies of this process. Understanding the pathogenetic mechanisms, timely diagnosis and treatment of airway remodeling is a promising strategy for preventing the onset and progression of asthma. Conclusion. The pathogenetic mechanisms and modern diagnostic methods of airway remodeling in asthma described and systematized in the review are intended to help in the search for new therapeutic targets for the prediction and treatment of the disease.
The objective of this study is to assess the efficacy of transcranial electrostimulation in the management of phantom pain syndrome. Material and methods. This study involved 117 male patients (mean age 36 ± 3.74 years) who experienced phantom pain syndrome following traumatic limb amputation. The participants were assigned to two groups. The control group consisted of patients receiving standard analgesic pharmacotherapy (n = 60). In the transcranial electrical stimulation group (n = 57), patients received the same pharmacotherapy and transcranial electrical stimulation, administered over 20 sessions, comprising two sessions per day – one in the morning (monopolar mode) and another in the evening (bipolar mode) – over a period of 10 days. To evaluate the intensity and characteristics of pain over time, a visual analog scale and clinical questionnaires DN4, PainDETECT, and LANSS were employed. Assessments were conducted on days 1, 10, and 17 of the study. Results and Discussion. The application of transcranial electrical stimulation was associated with a more pronounced and statistically significant reduction in the assessed parameters on the tenth day of the study compared to the control group. In contrast to the comparison group, pain intensity decreased to a complete absence or mild pain (1 to 3 points on the visual analog scale) in most patients. By day 17, the differences between the groups had somewhat smoothed out, but the transcranial electrical stimulation group retained a statistically significantly lower pain intensity on the visual analog scale. Сonclusion. The therapeutic application of transcranial electrostimulation in the management of phantom pain syndrome has been demonstrated to be associated with a marked improvement in the clinical manifestations of phantom pain syndrome. This finding offers a compelling rationale for the continued investigation of the effects of transcranial electrostimulation in this setting.
The article presents a clinical case of a rare iatrogenic complication associated with intramuscular or subcutaneous administration of drugs — drug embolism of soft tissues (Nicolaou syndrome). This complication occurred in a woman in labor on the second day after a cesarean section due to the injection of a non-steroidal anti-inflammatory drug for pain relief in the postoperative period. The clinical picture was characterized by the appearance of pain syndrome and swelling of the anterior surface of the right thigh (in the area of the drug injection). According to the ultrasound examination of the soft tissues of the right thigh, moderate thickening of the skin was visualized in the area of the affected tissue; at a depth of 26 mm from the skin surface in the thickness of the muscle — an area of high echogenicity measuring 48 × 5 mm; however, fluid accumulations, as well as cavity formations in the soft tissues were not detected. Against the background of antibacterial, anticoagulant therapy and drug analgesia, positive dynamics, a decrease in the severity of edema and intensity of pain syndrome were noted.
Research objective: to identify the main components of mental health of outpatient medical workers using questionnaires to develop ways to prevent burnout syndrome and to evaluate the effectiveness of rehabilitation measures. Material and methods. The study included 50 outpatient medical staff of a healthcare facility. The median age was 49.5 [44.2; 58.8] years. General clinical, laboratory and instrumental studies were used. According to the results of the Hospital Anxiety and Depression Scale questionnaire, after rehabilitation, the severity of symptoms of anxiety and depression in those examined decreased. Results. The study showed an improvement in the psychological component of the quality of life of medical staff after individual rehabilitation. According to the results of the Boyko questionnaire, the number of medical staff with an unformed exhaustion phase after rehabilitation increased by 40%, in the resistance phase, the number of doctors with a formed phase after rehabilitation significantly decreased from 46% to 16%. An unformed stress phase before rehabilitation was registered in 62%, and after in 90% of those examined. According to the results of the Hospital Anxiety and Depression Scale questionnaire, the severity of anxiety and depression symptoms in those examined decreased after rehabilitation. Conclusions. This study demonstrates the need to monitor health status and the importance of implementing individual rehabilitation programs for medical staff to reduce staff outflow and maintain the prestige of the medical profession.
The main milestones in the formation and development of proctology as an independent discipline in surgery are briefly covered. The merits of outstanding scientists in improving methods of treating proctological diseases for more than 200 years are noted. Little-known facts from the history of surgery for acute hemorrhoids are presented. The evolution of views from the origins to the present day in the treatment of acute hemorrhoids is analyzed. Throughout the 19th century, major scientific articles and monographs were published by both domestic and foreign authors, conferences and congresses were held on diseases of the rectum and anus, with a significant place devoted to the study of acute hemorrhoids, especially its surgical treatment. It is noted that the relevance of the topic has grown over the decades and attracted more and more researchers both in our country and abroad.
The aim of the study : to evaluate the state of the oxidative potential and antioxidant defense system in patients with psoriatic arthritis (PsA) associated with metabolic syndrome (MS). Material and methods . The study included 278 PsA patients (130 men, 148 women, average age 55.8 ± 6.95 years), of whom 208 had signs of MS, 70 did not. The control group consisted of 45 practically healthy individuals. Enzyme immunoassay was used to determine the total oxidative capacity of blood serum (TOC), total serum antioxidant activity (TAC), blood levels of oxidized LDL (LDL-ox), and superoxide dismutase (SOD). Results. In patients with PsA and MS, the value of TOC and the level of LDL-ox were 1.3 times higher than in patients without MS, and 1.3 and 2.7 times higher (respectively) than in healthy individuals (p < 0.001). In patients with MS, the blood TAC value and SOD level were significantly lower (1.7 and 2.3 times, respectively) than in patients without MS, and 2.7–3.9 times lower (respectively) relative to its value in the control group (p < 0.001). Conclusion . In patients with PsA and MS, higher TOC and LDL-ox values were found compared with patients without MS and healthy individuals, along with lower TAC and SOD values.
One of the key factors in the pathogenesis of eosinophilic esophagitis is the disruption of the epithelial barrier integrity, leading to deep penetration of environmental allergens into the esophageal mucosa. The causes of dilated intercellular spaces in eosinophilic esophagitis are recognized as inflammatory processes induced by type T2cytokines (IL-4, 5, 13), as well as a genetically determined impairment in the synthesis of tight junction proteins. At the same time, the contribution of pathological gastroesophageal refluxes to mucosal damage and increased permeability of the esophagus cannot be ruled out. Given the high prevalence of gastroesophageal reflux disease in the population, this may play an important role in the pathogenetic processes occurring in the esophageal wall of patients with eosinophilic esophagitis. Aim. To study the parameters of 24-hour pH-impedance monitoring in patients with eosinophilic esophagitis in order to assess the role of gastroesophageal refluxes in the pathogenesis of eosinophilic esophagitis and to determine treatment strategies for patients with eosinophilic esophagitis. Material and methods. 24-hour esophageal pH-impedance monitoring was performed on 57 patients aged 18 to 52 years with a previously confirmed diagnosis of "eosinophilic esophagitis," who provided signed voluntary informed consent. The study results were evaluated in comparison with pH-impedance monitoring data from patients with gastroesophageal reflux disease (60 individuals) and healthy volunteers (23 individuals). Results. Pathological gastroesophageal refluxes (primarily acidic) likely play a significant role in the pathogenesis of eosinophilic esophagitis, as they were detected in this study in 21.1% of patients with eosinophilic esophagitis. Routine pH-impedance monitoring is not indicated for eosinophilic esophagitis but may be used as an additional diagnostic method in patients when determining therapeutic strategy (prescribing antisecretory therapy or topical corticosteroids). Assessment of basal nocturnal impedance may be an important additional marker of inflammatory process activity in patients with EoE.
Superficial vein thrombosis (SVT) is a common clinical condition that carries with it significant risk of propagation of thrombus, recurrence, and, most concerning, subsequent venous thromboembolism (VTE). Conservative therapy with nonsteroidal antiinflammatory medication and heat does not prevent extension of thrombus or protect against recurrent or future VTE in patients with extensive SVT thrombotic segment of at least 5 cm in length. To prevent future thromboembolic events, anticoagulation has become the treatment of choice for extensive SVT. The aim of the review was to provide evidence-based, up-to-date information on the epidemiology, risk factors, diagnosis, and treatment of patients with SVT. A comprehensive literature search was conducted to identify all randomized controlled trials (RCTs) that addressed the epidemiology and treatment of SVT. RCT publications were identified using the MEDLINE database of English-language medical literature from 2002 to February 2025. The key search terms used were superficial vein thrombosis, treatment of superficial vein thrombosis, medical and surgical treatment of SVT. The search was performed using both single and combinations of terms.
The article presents materials of the consensus devoted on malabsorbtion syndrome (MS), published with the support of the United European Gastroenterology Association. In the Consensus are discussed such questions as Definition of SM, its Diagnostic Testing, Supportive Care of such patients.
Mesh prostheses are used for surgical treatment of postoperative ventral hernias, which becomes an additional risk factor for wound complications. Aim: to determine predictors of wound complications in patients with postoperative ventral hernias after implantation of mesh prostheses. Material and methods. A prospective study of 50 patients with postoperative ventral hernias who underwent mesh implantation was conducted. The patients were divided into two groups: the first group consisted of 39 patients (78%) without wound complications, and the second group consisted of 11 patients (22%) who developed wound complications. Preoperative and postoperative predictors of wound complications were assessed in all patients, as well as complete blood count, C-reactive protein, albumin, and ferritin levels before surgery and on the third postoperative day. Results. Preoperative predictors of wound complications, including age, comorbidities, and hernia size, were not statistically significant. Criteria such as operative time greater than 2 hours, drainage for more than 8 days, and daily wound exudation greater than 100 ml were significant. Among inflammation indicators, albumin and ferritin were statistically significant (p = 0,010). In the group with wound complications, albumin decreased to 35,4 ± 1,8 g/L, and ferritin increased to 357,7 ± 50,5 μg/L. Leukocyte, lymphocyte, neutrophil, monocyte, and C-reactive protein counts were not statistically significant. Conclusions. Thus, for the timely diagnosis of wound complications in patients with postoperative ventral hernias, it is possible to study albumin and ferritin as reliable markers of inflammation after alloplastic operations.
In 2025, it will be 120 years since the first successful full-fledged telemedicine communication. This article describes the main stages of telemedicine development. The first attempts to provide remote medical care are inextricably linked with the invention of the telegraph. Throughout the 20th century and the first quarter of the 21st century, telemedicine technologies have been progressively developing. The authors analyzed the general chronological dynamics of the distribution of scientific publications on telemedicine — a significant increase in publication activity occurred during the COVID-19 pandemic, which became an important stage in the development and transformation of this area of medical services. Using cluster analysis, a classification of areas in which telemedicine is actively used was carried out. Promising areas were identified, one of which is the combination of telemedicine with artificial intelligence. The active development of telemedicine is changing approaches to medical care and forming a new understanding of the relationship «doctor–patient», «doctor–doctor» and «patient–patient».
Background. Urolithiasis is a chronic multifactorial disease characterized by the formation of renal calculi of various salt compositions. Determination of the composition of salts that form calculi is necessary for adequate treatment and prevention of the transition of the stone formation process to the active stage. However, the possibility of determining stone-forming salts in the early stages of the disease (before stone formation) remains a problem for clinical practice. Purpose of the study : to prove the possibility of determining stone-forming salts of oxalate-calcium composition by examining urine using the systemic self-organization method (Lithos-system technology) in patients at the early (preclinical) stage of nephrolithiasis, as well as at the early stage of disease recurrence. Material and methods. Method of systemic self-organization of a urine drop (Lithossystem technology), method of X-ray spectral microanalysis. Results . In urine facies (structured films of dehydrated drops) of 57 patients, the systemic self-organization of urine method revealed an active process of stone formation, as indicated by multiple crystalline formations in the marginal (protein) zone of the facies. Microscopy of these crystalline formations in polarized light showed that they were crystallized structures of the fungus of the genus Candida spp. It is known that the main product of the vital activity of Candida spp. is oxalic acid. Electron probe study (X-ray spectral microanalysis method) showed that the chemical composition of crystalline formations in the protein zone of the facies was represented by calcium oxalate. Thus, the simultaneous presence of crystalline formations and Candida spp. structures in the protein zone of urine facies indicates the formation of oxalate-calcium stones. Conclusion . The method of systemic self-organization of urine can be used to diagnose the process of stone formation based on calcium oxalate in urolithiasis at all (including preclinical) stages of disease development in clinical diagnostic laboratories.
Hageman’s disease is a rare genetic disorder of the hemostasis system characterized by a congenital deficiency of blood coagulation factor XII. The frequency of the disease in the general population is unknown, as it is asymptomatic under normal conditions, but it is considered to be about 1 case per 1 million population. The aim of the work is to present a clinical case of successful surgical treatment of a patient with prostate adenoma, with severe congenital deficiency of plasma coagulation factor XII. The patient underwent a postpartum adenomectomy for benign prostatic hyperplasia. Open access made it possible to successfully remove prostate adenoma despite the presence of severe deficiency of blood coagulation factor XII. To correct coagulopathy and compensate for factor XII deficiency, a transfusion of freshly frozen plasma in a volume of 10 ml/kg body weight (870 ml) was performed on the day of surgery and tranexam 1000 mg was administered intravenously. Preoperative correction of factor XII deficiency in the form of transfusion of freshly frozen plasma allowed during surgery and in the early postoperative period to fully compensate for factor XII deficiency and normalize APTT, which ensured adequate intraoperative hemostasis, surgical blood loss of no more than 200 ml. Immediately after surgery, enoxaparin was prescribed 0.4 ml subcutaneously per day for 7 days to prevent thromboembolic complications. The use of low molecular weight heparin eliminated the threat of postoperative thromboembolic complications. The course of the long-term postoperative period is without any special features.
An aortopulmonary septal defect (APSD) is a rare congenital heart anomaly characterized by an abnormal communication between the ascending aorta and the pulmonary trunk in the presence of two distinct semilunar valves. Among septal defects, APSD is associated with the most rapid and unfavorable progression of pulmonary hypertension and Eisenmenger syndrome; in unoperated cases, mortality reaches up to 40% within the first year of life. We present a clinical case of a 49-year-old patient with congenital APSD complicated by Eisenmenger syndrome, who developed infective endocarditis of the pulmonary valve – an extremely rare combination not previously described in the literature.
The article presents historical information about the creation and activities of Communities of Sisters of Mercy in Crimea, as well as biographical data of doctors and nurses. Information is provided on the medical institutions (hospitals and infirmaries) of the ROCC, organized by the Crimean communities of sisters of Mercy to provide assistance during the First World War.
One of the results of the elevation of Professor V.F. Yasenetsky-Voino of Turkestan State University and Tashkent surgeon to the priesthood (1921) was the best achievements of 1921–1923 in his scientific activity compared with the results of the previous period. They became possible despite his appointment as a junior priest at the Cathedral of Tashkent, his hasty study of theology, and his weekly (Sunday) sermons to the parishioners, which required Valentin (Voino-Yasenetsky) to pay considerable attention to them. A new historical fact has been established about the selfless refusal of a professor-priest to participate in the XV Congress of Russian Surgeons (Petrograd, 1922) for spiritual reasons, where he was expected to present four original scientific reports. Despite his thorough preparation for the presentations, he was forced to cancel his research trip just days before the forum was scheduled to open. The reason for the refusal was explained by urgent commitments. One of them was related to the professor-priest’s personal participation in an anti-religious debate in Tashkent, where he made a speech in defense of Orthodoxy. Another obligation was to attend an extraordinary meeting of the clergy and laity in Tashkent, where Valentin Voino-Yasenetsky was expected to be elected as a candidate for ordination as a bishop. At the same time, both the debate and the meeting took place in Tashkent during the Petrograd Congress of Surgeons. The participation of the professor-priest confirmed the superiority of the spiritual aspect over secular duties. This feature later became an integral part of his professional activity. It testified not only to the unity of both aspects in the life and work of St. Luke (Voino-Yasenetsky), but also to the primacy of the spiritual principle.
The aim of the study was to improve the treatment results of patients after anterior non–tensioning hernioplasty using endoprostheses with a nafion coating. Material and methods. A prospective, non-randomized study involved 120 people divided into 2 groups. The main group (n = 60) consisted of patients operated on using a polypropylene endoprosthesis with a nafion coating. The control group (n = 60) consisted of patients with classical hernioplasty. For subgroups A, the operation was performed using the “in-lay” method. Subgroups B (n = 30) — posterior separation hernioplasty. All patients were examined in the standard volume. The follow-up period was 6 months. The number, nature, and timing of purulent complications and infiltrates, as well as the volume of lymphorrhea, were recorded. The SPSS 17.0 software was used for statistical data processing. Results. The use of nafion coating on endoprostheses used in hernia repair, regardless of their size, showed a statistically significant reduction in the number of complications. The use of modified endoprostheses in preperitoneal plastic surgery improves the results of its implementation, making them comparable to TAR plastic surgery. The use of a modified endoprosthesis in posterior separation hernioplasty significantly reduces the number of postoperative infiltrates and seromas in the surgical area compared with the use of a similar material in preperitoneal plastic surgery. There was no pathogenic microflora in the crops from the wound discharge in the main group. Conclusion. The use of a polypropylene endoprosthesis with a nafion coating in performing various posterior abdominal wall surgeries in patients with postoperative ventral hernias leads to a statistically significant decrease in the frequency of postoperative lymphorrhea and purulent-inflammatory complications.
