Differential diagnosis of neuropathic pain

Neuropathic pain is an acute or chronic pain caused by damage to or dysfunction of the peripheral and/or central nervous system. Neuropathic pain is a direct sequel of damage to or disease of the somatosensory nervous system. The paper presents the definition, international diagnostic criteria, clinical and diagnostic features, and causes of neuropathic pain syndrome, differences between nociceptive and neuropathic pain, the classification of major neuropathic pain syndromes, and the DN4 questionnaire to identify neuropathic pain. It shows a substantial clinical and pathophysiological similarity of neuropathic pain and fibromyalgia and gives preliminary diagnostic criteria for fibromyalgia. The differential diagnosis of neuropathic, nociceptive, and psychogenic pain and the determination of the level of damage to the nervous system and a leading pathogenetic mechanism of neuropathic pain syndrome require not only meticulous clinical examination of the sensory sphere, but also neurophysiological examination including electroneuromyography, somatosensory evoked potential recording, quantitative sensory testing, and, in a number of cases, neuroimaging (magnetic resonance imaging) or morphological (intraepidermal nerve fiber density examination) verification of injury somatosensory afferents

COMPLEXITY OF EARLY DIAGNOSIS AND TREATMENT OF RHEUMATIC DISEASES

This article presents a review of the scientific literature on the early diagnosis and treatment of rheumatic diseases. Separate issues of early arthritis, which due to the paucity of clinical symptoms, often incorrectly considered doctors. Describes the diagnostic difficulties with rheumatic heart disease, systemic lupus erythematosus, Behcet's disease, ankylosing spondylitis, it focuses on the diagnosis of gout

DISTRIBUTION MODEL AND ACCRUED STIMULATING ALLOWANCES IN A MEDICAL ORGANIZATION WITH A HEALTH CENTER IN ITS STRUCTURE

This publication contains the universal model of the distribution of incentive bonuses in the medical organization, by the example of the structure containing a health center. Prepared algorithm of individual incentive bonuses presents the requirements for formulating criteria, and a form of the final protocol, painted traffic scheme documents is developed

Efficacy of olocizumab in treatment of COVID-19 patients

Background. Production of pro-inflammatory cytokines including interleukin 6 (IL-6) is activated in COVID-19. Using olokizumab which inhibits IL-6 production in treatment of COVID-19 is pathogenetically justified.The aim. To study in real clinical practice the efficacy and safety of using the IL-6inhibitor (olokizumab) in treatment of patients with confirmed COVID-19 pneumonia.Materials and methods. The first group included 41 hospitalized patients with confirmed COVID-19 pneumonia having complex therapy including olokizumab. The control group consisted of 66 patients with confirmed COVID-19 pneumonia who did not have therapy with IL-6 inhibitor. We analyzed clinical (volume of lung involvement, respiratory failure degree, body mass index) and laboratory data (levels of T-troponin, lactate, procalcitonin, natriuretic peptide, C-reactive protein, fibrinogen, D-dimer, ferritin, erythrocyte sedimentation rate, glomerular filtration rate).Results. The groups did not differ in gender, age, body mass index of patients, volume of lung tissue injury, and duration of hospitalization (p > 0.05). Respiratory failure of 2–3rd degree was more common in patients of the first group (χ2 = 6.3; p = 0.010). The initial levels of C-reactive protein (50.9 [34.2; 76.2] and 32.2 [9.9; 69.1] mg/L respectively; p = 0.009) and fibrinogen (6.0 [5.3; 6.7] and 5.2 [4.3; 6.2] g/l respectively; p = 0.005) in patients having therapy including olokizumab were significantly higher than in the control group. The levels of erythrocyte sedimentation rate, fibrinogen and ferritin, D-dimer, detected upon admission of patients to the hospital, didn’t have statistically significant differences. At discharge, the erythrocyte sedimentation rate in patients receiving olokizumab was statistically significantly lower (9.0 [5.5; 14.5] and 13.0 [7.0; 27.0] mm/h; p = 0.018).Conclusions. Using olokizumab in the treatment patient with COVID-19 pneumonia has demonstrated a positive effect on clinical and laboratory parameters (erythrocyte sedimentation rate, fibrinogen level) in patients with pronounced inflammatory changes and respiratory impairment

Kaposi's sarcoma associated with Wegener’s granulomatosi

A case of Kaposi's sarcoma development in a pt with Wegener's granulomatosis during immunosupres- sive treatment with cyclophosphane and prednisolone

Изменилось ли клиническо е течение подагры в последнее время?

Gout is a severe metabolic disease with a wide range of comorbidities. The specific features of gout should be evaluated to optimize medical control over the disease.Objective: to study clinical trends for gout in Irkutsk over time (2007–2016).Patients and methods. Examinations were made in two patient groups: Group 1 (n=467) during 2007 and Group 2 (n=252) during 2016. The groups were matched for gender, age, and mean disease duration.Results. There was an increase in the prevalence of gout among able-bodied patients, in the rate of late gout diagnosis, and in the cases of chronic tophaceous gout and concomitant diseases. The number of patients continuously taking allopurinol reduced.Conclusion. The reasons for negative clinical trends for gout can be late diagnosis and insufficient medical supervision.Подагра – тяжелое метаболическое заболевание с широким спектром коморбидности. Оценка особенностей течения подагры необходима для оптимизации врачебного контроля за заболеванием.Цель исследования – изучение динамики особенностей клинического течения подагры в Иркутске за 2007–2016 гг.Пациенты и методы. Обследовано две группы больных: 1-я группа (n=467) – в течение 2007 г., 2-я группа (n=252) – в течение 2016 г. Группы были сопоставимы по полу, возрасту и средней длительности заболевания.Результаты. Выявлено увеличение распространенности подагры среди больных трудоспособного возраста, частоты поздней диагностики подагры, а также случаев хронической тофусной подагры и сопутствующих заболеваний. Уменьшилось количество больных, постоянно принимающих аллопуринол.Выводы. Причинами негативных тенденций в динамике клинической картины подагры могут являться поздняя диагностика заболевания и недостаточный врачебный контроль

Первичная медико-санитарная помощь больным подагрой

Gout is a systemic tophaceous disease that is becoming more and more prevalent. If untreated or poorly managed, gout can result in disability. The possible reason for inadequate gout control may be that the primary care physicians are unaware of diagnostic criteria and clinical guidelines for the management of these patients and diagnostic errors. Objective: to estimate the level of gout knowledge in primary care physicians. Subjects and methods. Fifty Irkutsk local therapists were questioned. A specially developed anonymous questionnaire included items on sex, age, work experience, and the principles of gout diagnosis and treatment. Results. Only 42% of the therapists know that the gold standard for diagnosis of gout is identification of monosodium urate crystals by polarizing microscopy. Only 6% of the therapists use the Wallace classification criteria for the early diagnosis of gout. 56 % of the physicians consider it possible to prescribe allopurinol in the acute period of the disease 26% think that allopurinol intake can be stopped after normouricemia is achieved; 10% of the physicians do not prescribe allopurinol for gout patients. These widespread errors lead to worsening arthritis and a negative attitude of patients towards allopurinol treatment in future. Conclusion. The findings suggest that the level of gout knowledge should be increased in primary care physicians.Подагра — системное тофусное заболевание, которое становится все более распространенным. Неправильное лечение подагры может привести к инвалидизации. Возможными причинами недостаточного контроля за течением подагры могут быть незнание врачами первичного звена диагностических критериев и клинических рекомендаций по ведению таких пациентов, а также диагностические ошибки. Цель исследования — оценить уровень знаний о подагре у врачей первичного звена здравоохранения. Материал и методы. Проведено анкетирование 50 участковых терапевтов Иркутска. Специально разработанная анонимная анкета включала в себя вопросы о поле, возрасте, опыте работы и принципах диагностики и лечения подагры. Результаты исследования. Только 42% терапевтов знают, что «золотым стандартом» диагностики подагры является выявление кристаллов моноурата натрия (МУН) методом поляризационной микроскопии. Классификационными критериями Wallace, разработанными для ранней диагностики подагры, пользуются лишь 6% терапевтов. 56% врачей считают возможным назначение аллопуринола в острый период болезни, 26% полагают, что прием аллопуринола можно прекратить после достижения нормоурикемии, 10% врачей не назначают больным подагрой аллопуринол. Эти распространенные ошибки ведут к утяжелению артрита и негативному отношению больных к лечению аллопуринолом в дальнейшем. Заключение. Полученные данные свидетельствуют о необходимости повышения уровня знаний о подагре у врачей первичного звена

Rare cases in herniology: The contents of the hernia – part of the liver, metastatic carcinoma, a foreign body

Surgical treatment of patients with postoperative ventral hernias is one of the most pressing problems in herniology. Verification of the diagnosis of postoperative ventral hernia is usually not difficult. At the same time, there may be difficulties in diagnosis associated with determining the true size of the hernia orifices, the contents of the hernial sac. These moments are  determined by various factors: the location of the hernia on the anterior abdominal wall, the age, sex of the patient, as well as anamnesis of hernia and the volume of surgery previously performed. One of the very rare situations in external abdominal hernias is the situation when the content of  the hernial sac is the part of the parenchymal organ, the tumor process, as well as foreign bodies. The study presents the observation materials of three patients admitted for diagnosis and treatment to the surgical hospital clinics of Irkutsk State Medical University. When examined and treated, it was found that in one case the content of the hernia sac included a part of the left lobe of the liver, in another observation, the inguinal hernia sac contained metastatic carcinoma, in the third case – a foreign body was found. All patients underwent surgery (hernioplasty, hernioplasty). Diagnosis of hernia of the anterior abdominal wall was confirmed. A literary search was made for rare clinical examples in herniology. In the world literature, there are only eight observations when the content of the hernia sac was a part of the lobe of the liver; the presence of metastatic carcinoma and a free foreign body we found as single observations described by known specialists in herniology

Postoperative complications of endoscopic methods of treatment of urolithiasis

In article we say about data of the retrospective analysis of the complications arising after performance of a percutaneous nefrolitotripsiya are given.В статье даны данные ретроспективного анализа осложнений, возникающих после выполнения перкутанной нефролитотрипсии