Vol 29, No 3 (2025)

Atopic dermatitis is a multifactorial genetic inflammatory skin disorder, which is characterized by pruritus, a chronic relapsing course, and age-specific location and morphology of lesions. Atopic dermatitis is detected in 2%–3% of older individuals. In Russia, the incidence of atopic dermatitis is approximately 80 cases per 100,000 population. Males are affected three times more than females. Approximately 30% of patients with atopic dermatitis aged 60 years and older report no history of this condition, whereas 20% report episodes of the disease in childhood. New-onset atopic dermatitis in patients aged 60 years and older is diagnostically challenging. Pruritus is the most prevalent skin-related complaint in older patients, even without a history of atopy. In the United States, this debilitating symptom affects one-quarter of patients with atopic dermatitis over 65 years receiving outpatient treatment. Furthermore, this complaint is typical of other skin diseases and conditions, such as diabetes mellitus, malignant neoplasms, renal failure, hepatic disorders, thyroid disorders, polycythemia vera, side effects of systemic drugs, scabies, and xeroderma. Atopic dermatitis is relatively uncommon in older individuals; however, its prevalence is increasing, and managing such patients is challenging. This review examines various therapeutic options in older patients, including drug therapy.

BACKGROUND: Asthma is managed using clinical assessment of the patient's condition, questionnaires, and pulmonary function parameters. Respiratory sound monitoring is the most effective way to diagnose and manage nocturnal asthma. There is limited research into respiratory sound monitoring in asthma, and available studies primarily focus on pediatric patients.

AIM: This study aimed to assess the reliability of respiratory sound monitoring and changes in the severity of wheezing in patients with various levels of asthma control.

METHODS: The study included patients with various levels of asthma control. A Vitalograph ALPHA spirometer (England) was used for spirometry. The author’s technique was used for respiratory sound monitoring by electronic auscultation. The resulting audio files were computer-analyzed.

RESULTS: The study included 86 patients, who were divided into groups 1, 2, and 3 with well-controlled, partially controlled, and uncontrolled asthma, respectively. Wheezing episodes had a direct correlation with asthma control level and severity. In group 3, the mean incidence of nocturnal episodes was 3.3 ± 0.4 (p < 0.05). Monitoring revealed a strong correlation between the number of wheezing episodes and the level of asthma control (r = 0.74; p < 0.05). There was a moderate positive correlation between objective pulmonary function disorders and subjective symptoms (r = 0.39; p < 0.05). There was a weak positive correlation between the duration of wheezing episodes and the severity of pulmonary function disorders (r = 0.23; p < 0.05).

CONCLUSION: Continuous respiratory sound monitoring is a reliable tool for assessing changes in respiratory sounds in patients with asthma.

BACKGROUND: In Russia, no research has been conducted on the prevalence of smoking among physicians, the reasons why they start smoking, and their perception of smoking.

AIM: This study aimed to assess the prevalence of smoking in anesthesiologists and intensive care physicians and general practitioners in Saint Petersburg.

METHODS: This cross-sectional study included general practitioners (family physicians), and anesthesiologists and intensive care physicians. The primary study method was an anonymous online survey.

RESULTS: The study included 254 respondents aged 26 to 76 years (mean age: 41.7 ± 11.4 years). The proportion of males was 31.5%. Overall, 13.8% of respondents were daily smokers, 7.5% were occasional smokers, and 17.7% were quitters. The incidence of smoking was higher in males than females. The most common reason to start was smoking among friends. The second most common reason was smoking in the family (parents), as well as occupational or academic stress. Other reasons in males included military service and teenage angst. Anesthesiologists and intensive care physicians noted the positive aspects of smoking 34.2% more frequently than general practitioners. Even after quitting, anesthesiologists and intensive care physicians continued to believe that smoking is a good opportunity to take a break, have a rest, or meet new people.

CONCLUSION: The prevalence of smoking in general practitioners and anesthesiologists and intensive care physicians was 21.3%, which is lower than the national average in Russia. There were no significant differences in the prevalence of smoking between general practitioners and anesthesiologists and intensive care physicians. Factors that encourage smoking among physicians, such as stress and the need for short breaks during working hours, necessitate organizational measures at health facilities to promote positive behavioral changes and improve the health of physicians.

BACKGROUND: Smoking is one of the main environmental factors proven to worsen the progression of rheumatoid arthritis and reduce the effectiveness of its treatment. The relationship between smoking and rheumatoid arthritis characteristics and comorbidities has not been widely studied, and the views of Russian rheumatologists on this topic are unclear.

AIM: The study aimed to evaluate the smoking status of patients with rheumatoid arthritis and its association with disease presentation and comorbidities, as well as to explore views of Russian rheumatologists on smoking among these patients.

METHODS: This cross-sectional registry-based study employed a comparative analysis of the records of smokers and nonsmokers with rheumatoid arthritis from a rheumatology hospital registry. A survey of smokers with rheumatoid arthritis and an anonymous survey of rheumatologists were conducted.

RESULTS: Compared with non-smokers, smokers were more likely to have seropositive rheumatoid arthritis (p = 0.001) and higher disease activity (p = 0.0002). Positive associations were found between smoking and chronic obstructive pulmonary disease (p < 0.001), tuberculosis (p = 0.008), and peptic ulcer (p < 0.001). Patients with high rates of cardiovascular disease were more likely to quit smoking. Smoking was characterized by long-term, highly intensive patterns. Every fifth respondent (20%) reported being highly motivated to quit smoking, whereas 71% had made unsuccessful attempts. Although most rheumatologists are aware of the negative effects of smoking on rheumatoid arthritis, they are not trained to counsel patients who smoke.

CONCLUSION: The study supports the importance of developing and implementing smoking cessation programs for patients with rheumatoid arthritis.

Considering the aging population and the growing number of patients with polymorbidity, who are unable of self-care and require control and support, digital technologies with integrated data systems are crucial for comprehensive treatment and accessible high-quality primary care in the era of “remission society.”

We present a clinical case of an older female patient with polymorbidity and frailty as an example of optimized prospective detection and comprehensive management of patients requiring external assistance through information system-based digital integration of primary care with social support organizations. Validated STOPP/START criteria were used for the detection of unreasonably prescribed drug therapies, with the 7 Steps algorithm for therapy optimization. A personalized approach was used to select drug therapy, taking into account the polymorbidity and geriatric status. This included perindopril 5 mg in the morning, bisoprolol 2.5 mg in the morning, torasemide 5 mg in the morning, apixaban 5 mg in the morning and evening, and atorvastatin 20 mg in the evening, with an intermittent topical use of nonsteroidal anti-inflammatory drug-based ointments. The outcomes of comprehensive management were assessed after one year based on the geriatric and physical status, as well as treatment efficacy and tolerability.

The Home Health approach enabled to improve compliance and treatment outcomes, preserve performance status, and increase quality of life and satisfaction with medical care and social support.