Russian Family Doctor

BACKGROUND: The rural population of the Russian Federation is underrepresented in osteoporosis studies.

AIM: The aim of the study was to evaluate the prevalence of osteoporosis in rural women of the Urals aged ≥ 50 years.

METHODS: A cluster comprehensive observational study was conducted in 2240 residents of a rural settlement in the Urals. Osteoporosis rates were based on fracture data obtained using a FRAX algorithm and dual-energy X-ray absorptiometry (DXA).

RESULTS: A history of fragility fractures was reported in 15% of the study subjects. An additional 4.4% of patients were diagnosed with osteoporosis using DXA. When other clinical data and FRAX scores were analyzed in subjects who declined DXA, the osteoporosis rates in the study population reached 21.2% and showed an increase with age.

CONCLUSION: The prevalence of osteoporosis in rural women aged ≥ 50 years was 21.2%, and osteoporosis rates increased with age, reaching 38.7% in subjects aged ≥ 85 years. FRAX has been shown to be effective in identifying women at intermediate and high risk of fracture in rural areas, in combination with diagnostic and therapeutic intervention thresholds specific to Russia. Low awareness of osteoporosis in patients with fragility fractures requires a coordinated primary care approach, including osteoporosis education programs for rural populations. Clinical decision making for osteoporosis therapy in 11% of rural women was based on a highly specific intervention threshold calculated using FRAX without consideration of DXA data.

BACKGROUND: Respiratory, neurological and other outcomes of bronchopulmonary dysplasia in infants are well documented. However, the incidence and severity of cardiovascular abnormalities require further research.

AIM: The aim of the study was to establish cardiovascular risk criteria in infants with bronchopulmonary dysplasia and develop a mathematical model to predict cardiovascular abnormalities.

METHODS: A total of 1931 perinatal discharge records were analyzed. The final analysis included 274 source records. The main group was divided into two subgroups: 91 infants with cardiovascular abnormalities and 46 infants without cardiovascular abnormalities. The analysis included 225 parameters of perinatal history, laboratory and functional diagnostic tests. Discriminant and correlation analyses were performed using SPSS for statistical data processing.

RESULTS: Cardiovascular abnormalities were found in 66.4% of infants with bronchopulmonary dysplasia at 3 months of age and were represented by morphological changes such as functional patent foramen ovale, patent ductus arteriosus, and prolonged exposure to these conditions. Circulatory failure, transient pulmonary hypertension and combinations of cardiovascular abnormalities were reported.

Nine significant cardiovascular risk factors were identified, such as patent ductus arteriosus, gestational age ≤ 32 weeks, use of two doses of surfactant, time of prenatal care enrollment, duration of mechanical ventilation and oxygen dependence > 28 days, grade III–IV cerebral ischemia, severe retinopathy, body weight < 1 kg.

A formula was developed to predict a low, moderate, or high cardiovascular risk (98%).

CONCLUSION: In infants with bronchopulmonary dysplasia at 3 months of age, estimated individual cardiovascular risk helps differentiate the approach to preventing heart and blood vessel damage.

BACKGROUND: Before the age of social digitalization, the internationalization of higher education was a fragmented process, involving only some areas of the academic environment. Over the last 50 years, as a result of the changes caused by globalization, the international status of a university has become a factor that influences all the processes of a university, as well as the global and national rankings of universities. The Russian Federation has been and continues to be an attractive destination for foreign students. As the number of these students increases, educational ecosystems should adapt to their needs in order to successfully integrate them into the student community, increase their motivation to learn, and create the conditions for better academic performance. Educational ecosystems should be sensitive to the sociocultural adjustment of foreign students.

AIM: The aim of the study was to determine the ways to improve the quality of education for foreign students at the North-Western Medical University named after I.I. Mechnikov.

METHODS: The university ecosystem and key processes in the education and life of foreign students were evaluated. The design of the study is based on the authors’ hypothesis that first-year students taking their first midterm assessment experience and manifest a state of culture shock that negatively affects their academic performance. To test this hypothesis, a validated tool for assessing sociocultural adjustment, the Sociocultural Adaptation Scale, was used in 106 foreign students enrolled in an English-language general medicine program. Survey results were compared with U-curve parameters from Oberg’s culture shock model.

RESULTS: Analysis of the survey results suggested that the students were smoothly integrated into the new university everyday and educational ecosystem, as indicated by result imposition on the U-curve of the culture shock model. The survey did not show the predicted sharp drop in the culture shock curve in the fourth month in the host country.

CONCLUSION: The authors stated that the U-curve hypothesis is no longer justified today due to the creation and active maintenance of a sustainable educational ecosystem at the university, which makes it possible to create conditions for the successful socio-cultural adjustment of foreign students.

Non-specific aortoarteritis in children is considered a rare disease, which is one of the reasons for its delayed diagnosis and treatment, leading to early disability and life-threatening complications, including death. Despite the active development of new diagnostic technologies and the widespread introduction of vascular ultrasound, there is still a trend toward late diagnosis of this disease. This is due to the non-specific nature of the symptoms, the ambiguous clinical picture and the delayed development of the characteristic symptoms of pulse absence and hypertension from the onset of the first symptoms.

The aim of the paper was to raise awareness among general practitioners and other non-rheumatologic specialists about the difficulties in detecting non-specific aortoarteritis in children and adolescents, its late diagnosis and consequent treatment failure, which significantly worsens the quality of life and prognosis of patients.

A retrospective analysis was performed using the medical records of children and adolescents (n = 17) under 17 years of age with non-specific aortoarteritis (Takayasu arteritis) who were evaluated and treated at the Scientific Center of Pediatrics and Pediatric Surgery in Almaty, Kazakhstan, from 2010 to February 2024. The study included 4 (23.5%) boys and 13 (76.5%) girls in a 1:4 ratio. The incidence of non-specific aortoarteritis in boys was mainly observed in early childhood, preschool and primary school age, whereas more than half of the girls showed the peak incidence in adolescence. Most of the affected children lived in rural areas, 12 (70.6%), and 5 (29.4%) children lived in urban areas. In terms of ethnicity, 15 (88.2%) patients were Kazakh, 1 (5.9%) patient was Uyghur (a 3-year-old female patient), and 1 (5.9%) patient was Russian (a 5-month-old patient).

The acute phase of non-specific aortoarteritis is characterized by nonspecific signs of systemic inflammation, leading to misdiagnosis such as acute respiratory viral infection or other infectious diseases, myocarditis, erythema nodosum, etc. When diagnosing non-specific aortoarteritis, general practitioners and non-rheumatologic specialists are guided by pulse absence in the radial arteries. However, in types III and IV of non-specific aortoarteritis, the subclavian arteries from the aortic arch are not affected. Pulses in the radial arteries are preserved. Non-specific aortoarteritis continues to be diagnosed late, leading to treatment failure, early childhood disability and poor prognosis.

This article presents a case report and a review of sources about hypophosphatemic osteomalacia, a rare adverse effect of chronic hepatitis B treatment with tenofovir disoproxil fumarate. Hypophosphatemic osteomalacia is caused by partial or complete Fanconi syndrome or reduced renal function due to acute or chronic damage to the proximal renal tubules. This case report describes manifestations such as multiple skeletal fractures, including rib and vertebral fractures, left acetabular and sacral fractures, bone and joint pain, signs of neuropathy, and severe muscle weakness. However, bone mineral density remained normal. There was also evidence of osteonecrosis of the talus, scaphoid, and medial cuneiform. Differential diagnoses included vitamin D deficiency, diabetic nephropathy and neuropathy, cancer, and hematologic disorders. The diagnosis was suspected by a decrease in blood phosphate levels and tubular reabsorption of phosphate, and by elevated levels of fibroblast growth factor 23. Discontinuation of tenofovir resulted in rapid clinical improvement and normalization of mineral metabolism, including estimated tubular phosphorus reabsorption and ratio of maximum rate of renal tubular reabsorption of phosphate to glomerular filtration rate.