Russian Family Doctor

The lecture is devoted to two infections controlled by specific means of prevention — measles and rubella, which still pose a danger both to the sphere of child and maternal health, and to healthcare in general.

The first part of the lecture is devoted to measles, one of the most contagious diseases, outbreaks of which can be successfully prevented through vaccination or, conversely, serve as an indicator of gaps in immunization programs and primary health care systems. The lecture covers modern aspects of etiopathogenesis, epidemiology, clinical picture, diagnosis, treatment and prevention of measles. In the context of an increase in the incidence of this infection in our country and a number of foreign countries in 2023, the information presented in the lecture may be useful for practitioners and, first of all, family doctors.

BACKGROUND: People with comorbidity have increased life expectancy in recent years. It affects clinical outcomes, including increased risk of death, which have not been well studied in patients with sarcopenia.

AIM: To study the frequency and structure of comorbidity and assess the contribution of sarcopenia in predicting the risk of death in people aged 65 years and older.

MATERIALS AND METHODS: The study included 230 people 65 years of age and older (70 men and 160 women, median age — 75 (68–79) years), who were consulted at a medical institution in St. Petersburg. Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia, 2nd revision (2018). Comorbidity and predicted risk of death were studied using the Charlson comorbidity index.

RESULTS: Iron deficiency anemia and chronic kidney disease C3a–С3b were detected more often (p < 0.001 and p = 0.031, respectively), and obesity less often (p < 0.001) in sarcopenic patients. In sarcopenic patients, comorbidity was severe [5 (4–6) points] and the risk of death from all causes was 8.89 (95% confidence interval 3.95–20.2) times higher compared with non-sarcopenic patients (p < 0.001).

CONCLUSIONS: The significance of comorbidity was revealed, and a high probability of risk of death with sarcopenia in the elderly was revealed. This makes it possible to carry out activities that will delay the onset of death to a later age.

BACKGROUND: Cardiovascular disease remains a major public health problem associated with high mortality. The development of these diseases is associated with many genetic and cardiovascular risk factors, so the study of a person’s genetic predisposition to the development of cardiovascular disease based on gene polymorphism remains actual. The aim of research was to study the combination of polymorphisms of the ADRB1 rs1801253, AGT rs4762, SOD2 rs4880 and CAT rs1001179 genes in healthy young people to assess individual genetic predisposition to the development of cardiovascular disease.

MATERIALS AND METHODS: The study involved 33 people aged 19 to 21 years who currently had no pathology of the cardiovascular system. DNA was isolated from oral epithelial cells. Genotyping of DNA samples was determined using real-time polymerase chain reaction.

RESULTS: Among those examined, 39.4% had one or two unfavorable alleles for the ADRB1, AGT genes, suggesting a genetic predisposition to the development of cardiovascular disease. Unfavorable alleles of the ADRB1 gene were more common compared to the AGT gene. Each of those examined at risk of developing cardiovascular disease had one or two alleles associated with a decrease in the functioning of enzymes of the antioxidant system. Of the 33 people, only four (12.1%) do not have an unfavorable allele for the SOD2 and CAT genes.

CONCLUSIONS: We believe that the determination of polymorphisms in genes for enzymes of the antioxidant system will be an important additional criterion for earlier and more active prevention of cardiovascular disease.

BACKGROUND: The thyroid gland plays an important role in our body, influencing almost all metabolic processes in the body throughout life. However, literature data on the effect of decreased thyroid function on mortality in older people is contradictory.

AIM: To evaluate the impact of thyroid-stimulating hormone levels on 5-year survival in older adults.

MATERIALS AND METHODS: This work was carried out on the basis of the second screening of the Crystal study of community-dwelling individuals 65+ (n = 383). Main study parameters: thyroid-stimulating hormone level, blood test, lipid profile, albumin, total protein, comprehensive geriatric assessment, 5 years of follow-up.

RESULTS: A thyroid-stimulating hormone level of 3.3–10.0 mIU/L was associated with a 44.6% reduced risk of all-cause mortality (hazard ratio 0.554; 95% confidence interval 0.307–0.999) at 5 years of follow-up, regardless of the presence of non-communicable diseases and geriatric status. A thyroid-stimulating hormone level more 10.0 mIU/L is not associated with an increased risk of mortality. The lower risk of mortality in patients with high thyroid-stimulating hormone levels may be due to a larger thigh muscle circumference. After adjustment for all covariates used and thyroid-stimulating hormone level, a 1 cm increase in thigh muscle circumference was associated with a 4.5% reduction in the risk of all-cause mortality (hazard ratio 0.955; 95% confidence interval 0.932–0.979).

CONCLUSIONS: The lowest risk of all cause-mortality mortality in persons aged 65 years and older is observed with a thyroid-stimulating hormone level of 3.3–10.0 mIU/L. Thyroid-stimulating hormone level more 10.0 mIU/L is not associated with an increased risk of all cause-mortality.

Gorham–Stout disease is an extremely rare skeletal disorder of unknown etiology manifested by multiple foci of osteolysis (“vanishing bone disease”) and lymphangiomatosis. Osteolysis can occur in any part of the skeleton (skull, facial skeleton, ribs, clavicula, spine, pelvic bones, bones of the upper and lower extremities). Approximately half of the patients develop pleural effusion, accompanied by respiratory abnormalities. We describe a case of Gorham-Stout disease with recurrent bilateral exudative pleuritis as a first and most prominent sign, while the bone lesions at the vertebral bodies, ribs and sternum proceeded without active complaints and were an accidental finding during chest computer tomography. Timely diagnosis of the disease depends on the awareness of doctors of various specialties and careful reading of imaging results.

The article is dedicated to the memory of Professor of the Department of Family Medicine, member of the editorial board of the journal “Russian Family Doctor”, Doctor of Medical Sciences, Professor E.V. Frolova, who became a mentor and supervisor for a nurse with higher education, citizen of Israel Claudia Konson.