Russian Family Doctor

Preconception counseling is an important step in planning a pregnancy. It improves women’s reproductive health and increases the likelihood of a successful pregnancy. This article provides a detailed overview of the key issues to discuss with a primary care physician before trying to conceive, including plans to have children, current physical health status (such as chronic diseases and medication use), mental health status, and genetic status. Preconception counseling should include a timely medical examination to identify and address potential risks for future children. Special attention should be given to the preconception management of chronic diseases, such as diabetes mellitus and epilepsy. The article emphasized the important roles of psychological support and genetic counseling to minimize risks and prevent possible complications. In addition, the article discusses preventive measures such as infection screening, vaccinations, and lifestyle changes, including efforts to combat obesity and bad habits. These efforts should create optimal conditions for conception and healthy pregnancy. Therefore, preconception counseling is crucial to maintain women’s reproductive health and ensure the safety of expectant mothers and their children.

BACKGROUND: Dairy products are a key source of calcium for children and adolescents. Calcium is essential for achieving peak bone mass, which largely determines bone health in old age. In recent years, there have been no large studies conducted in Russia that have evaluated dietary calcium intake.

AIM: The study aimed to evaluate dietary calcium intake in schoolchildren aged 7–17 years.

METHODS: A questionnaire was developed to evaluate dairy product consumption as part of a comprehensive survey of 1,361 students in grades 2–11 in two secondary schools in Yaroslavl and Kostroma (Russia).

RESULTS: The mean calcium intake was 1,271.91 ± 779.7 mg/day, which decreased significantly with age. Physiological calcium intake was compared with reference values established in Russia. The percentage of children receiving an adequate amount of calcium decreased with age, ranging from 57.7% of students in grades 2–4, to 40.3% of students in grades 5–9, and 35.0% of students in grades 10–11. The percentage of children receiving 50%–99% of the daily calcium requirement increased from 33.1% of students in grades 2–4 to 44.4% and 48.0% of students in grades 5–9 and 10–11, respectively. The percentage of children receiving less than 50% of the daily calcium requirement also increased, from 9.2% to 15.3% and 17.0%, respectively.

CONCLUSION: The obtained data demonstrate high prevalence of inadequate dietary calcium intake, especially in adolescents.

BACKGROUND: The pressing task of the healthcare system is to provide high-quality medical care, including outpatient care, to patients with chronic non-communicable diseases. The progression of these diseases depends on the quality of medical care. Defects can complicate diagnosis, treatment, and prognosis.

AIM: The study aimed to evaluate the quality of primary healthcare for patients with chronic, non-communicable diseases.

METHODS: This was a cross-sectional study that included an analysis of a random sample of 288 outpatient medical records (n = 288). The study used quality criteria specified in the clinical guidelines on hypertension, type 2 diabetes mellitus, asthma, chronic obstructive pulmonary disease, and stable ischemic heart disease. The study also used parameters regulated by Order of the Ministry of Health of the Russian Federation dated March 15, 2022 No. 168н (168n) On Approval of the Procedure for Outpatient Follow-Up of Adults. This order regulates parameters such as the availability of data on complaints, smoking status, examinations, laboratory testing, investigations, diagnoses, and data on influenza and pneumococcal infection vaccinations.

RESULTS: Complaints were obtained in 6.6%–11.7% of patients. The smoking status was reported in 75.5%–90.2% of cases. A complete physical examination was performed on all patients with stable ischemic heart disease (100%) and none of the patients with type 2 diabetes mellitus (0%). Patients with hypertension had the fewest referrals for laboratory tests (4.9%), whereas patients with asthma had the most referrals (88.7%). Only 54.7% and 56.7% of patients with asthma or chronic obstructive pulmonary disease, respectively, were referred for complete investigations. The diagnoses corresponded to clinical guidelines in 75.9% of patients with diabetes mellitus and only in 10.0% of patients with chronic obstructive pulmonary disease. Vaccinations against influenza and pneumococcal infection were recommended for 21.5% and 14.9% of patients, respectively. An analysis of the quality of medical care for patients with chronic non-communicable diseases during outpatient follow-up revealed issues that could affect disease progression, as well as the identification of complications and suitable treatments.

CONCLUSION: The patient management did not fully comply with the clinical guidelines and Order of the Ministry of Health of the Russian Federation dated March 15, 2022 No. 168н (168n). Further research is needed to understand why outpatient follow-up is inadequate and how to improve it.

BACKGROUND: Hyperphosphatemia is defined as fasting phosphorus levels higher than 1.45 mmol/L. Although it is often asymptomatic, it can cause adverse effects, including hypocalcemia, decreased calcitriol levels, secondary hyperparathyroidism, ectopic calcification, hemodynamic disorders, and increased morbidity and mortality. Therefore, it is crucial to promptly identify and treat the underlying causes of hyperphosphatemia. Hyperphosphatemia is typically associated with renal failure. Less common causes include hypoparathyroidism; burn injury; metabolic and respiratory acidosis; rhabdomyolysis; tumor lysis syndrome; acromegaly; and excessive intake of phosphorus from food or medication.

AIM: The study aimed to identify the possible causes of an asymptomatic increase in blood phosphorus levels in young healthy adults.

METHODS: Laboratory tests were performed in young healthy men and women aged 18 to 35 years.

RESULTS: Despite preserved renal function, asymptomatic hyperphosphatemia was diagnosed in 12 (9.9%) participants. A significant association was found between hyperphosphatemia and the use of electronic nicotine delivery systems and heated tobacco products (p = 0.0002).

CONCLUSION: More research is needed on the effects of electronic nicotine delivery systems and heated tobacco products on human health, especially calcium and phosphorus metabolism.

BACKGROUND: Frailty is associated with the dysfunction of various organs and systems. According to Russian publications, it is often identified through outpatient screening. However, the clinical guidelines for frailty were revised in 2024. The diagnosis algorithm was significantly simplified, eliminating the need for pre-frailty identification and assessment of functional, mental, and emotional disorders prior to a comprehensive geriatric assessment. Therefore, it is necessary to determine whether the updated diagnostic algorithm changed the rates of frailty and associated geriatric syndromes.

AIM: The study aimed to evaluate frailty rates in patients aged 60 years and older using the 2020 and 2024 diagnostic criteria, as well as determine the association between the rates of frailty and geriatric syndrome.

METHODS: This cross-sectional, single-center study included aged male and female patients. Frailty was diagnosed using the 2020 and 2024 criteria. A comprehensive geriatric assessment was then conducted using questionnaires and scales. The DK-50 digital hand dynamometer (Russia) was used to assess muscle strength.

RESULTS: The study included 462 patients (77 male and 385 female). The median age was 76 (62–83) years. No significant differences in frailty rates based on the 2020 and 2024 criteria, were found in the general aged population (25.7% and 29.9%, respectively; p = 0.164), nor in different age groups of men and women (p > 0.05). In addition, pre-frailty that was not identified using the 2024 criteria was present in 60.4% of patients. Of these, the Short Physical Performance Battery showed decreased mobility in 36.9% of patients, and the Mini-Cog test suspected cognitive impairment in 10.7% of patients. Among patients with frailty, muscle strength (p < 0.0027) and physical performance (p < 0.0015) were 3.9 and 8.9 times lower, respectively, using the 2020 criteria. Skeletal muscle function less than 2 times lower, using the 2024 criteria.

CONCLUSION: The frailty rates showed no difference by sex or age, using the 2020 and 2024 criteria. Screening for frailty using the 2024 criteria, revealed that 36.9% of patients previously identified as pre-frail were underdiagnosed for functional disorders related to decreased mobility, which significantly increased the risk of frailty.

BACKGROUND: A physician’s views on overweight and obesity can affect their attitude toward patients with these conditions, as well as their willingness to recommend weight loss and choice of treatment options they consider effective.

AIM: The study aimed to evaluate the effects of a personal history of weight gain and loss on attitudes toward overweight and obese individuals among sixth-year medical students.

METHODS: This cross-sectional study included sixth-year medical students who provided written informed consent. The main study parameters included sex, age, personal history of weight loss or gain, family history of being overweight, and scores on the Antifat Attitudes questionnaire and Body Parts Satisfaction Scale.

RESULTS: The study showed that people with higher body mass indexes were more dissatisfied with their bodies. Body satisfaction levels were also influenced by factors such as the number of previously used weight-loss strategies and a history of being bullied for being overweight or obese. People with a family history of being overweight, who were bullied because of their weight, and who are currently dissatisfied with their body image are less likely to dislike overweight or obese people and to exercise. Male participants and participants who follow a diet tend to dislike overweight and obese people, blaming them for their conditions.

CONCLUSION: A participant’s personal history of weight gain and loss, as well as their own body image, significantly affects their attitude toward overweight and obese individuals.

Botulism is an extremely dangerous infection caused by consuming food containing the botulinum toxin. It is classified as a foodborne toxic infection. Although botulism is relatively rare, it remains a significant health concern because it is difficult to diagnose, often resulting in late diagnoses and frequent fatal outcomes. Paresis and paralysis of smooth and skeletal muscles during botulinum toxin exposure often confuse healthcare professionals, leading to misdiagnosis and incorrect treatment.

The article presents a case report of botulism in a female patient who was admitted to the intensive care unit (ICU) at the Botkin Clinical Infectious Diseases Hospital in 2024. The report clearly illustrates the clinical and laboratory challenges of diagnosing and treating this disease.

The clinical presentation of botulism is similar to that of various infectious and non-infectious diseases. This underscores the importance of raising awareness and organizing health education initiatives, especially in primary outpatient settings, to encourage medical specialists to remain vigilant about botulism. It is crucial to educate the population systematically about the dangers of consuming improperly produced or stored canned foods in order to significantly reduce rates of botulism.