Vol 15, No 2 (2023)

The problem of chronic functional dizziness is highly relevant nowadays. In case of a great number of patients suffering from persistent postural-perceptual dizziness, lack of a unified understanding of the pathogenesis, diagnostic mistakes, and, as a result, improper treatment lead to a deterioration in the quality of life and disability.

The purpose of the review is to analyse and highlight the persistent postural-perceptual dizziness problem, to explore the currently existing pathogenetic concepts, methods of diagnosis and treatment of this group of patients.

Domestic and foreign scientific papers have been analysed using the largest world citation databases according to the following keywords: “psychogenic dizziness”, “chronic subjective dizziness”, “vestibular rehabilitation”, “stabilometry”, “persistent postural-perceptual dizziness”, “postural phobic instability”, “selective serotonin reuptake inhibitors”, “cognitive behavioral therapy”.

The data of 78 scientific works of the research subject are the basis of the review. The article presents a brief historical background, contemporary conceptions of pathogenesis, symptoms and clinical manifestations of persistent postural-perceptual dizziness. The particular attention is given to the diagnostic methods and treatment principles. Relevant questionnaires and diagnostic scales as well as the Barany Society criteria are also considered. A multidisciplinary approach to treatment which allows to achieve a lasting positive effect is described.

Segregation of persistent postural-perceptual dizziness into a separate nosological item, understanding of its pathogenesis, an integrated approach to diagnosis with assessment of structural, functional and mental disturbances, just like complex therapeutic strategies make а fully recovery possible.

BACKGROUND: Currently, there is no consensus and approved tactics for choosing the method of hernioplasty in the surgical treatment of patients of fertile age planning pregnancy with hernias of the anterior abdominal wall. The study is devoted to the comparative analysis of surgical treatment of these patients.

AIM: To determine the algorithm of surgical treatment of hernias of the anterior abdominal wall in the patients of fertile age planning pregnancy.

MATERIALS AND METHODS: The analysis of the treatment results of fertile age patients with hernias of the anterior abdominal wall in the period from 2010 to 2019 has been carried out. The inclusion criteria were as follows: patients of fertile age who underwent surgical treatment of hernias of the anterior abdominal wall, who did not have a relapse before pregnancy. Thus, 252 patients have been included in the study.

RESULTS: The surgical tactics and optimal timing of the operation in patients of fertile age with hernias of the anterior abdominal wall have been determined.

CONCLUSIONS: When planning surgical treatment of hernias of the anterior abdominal wall in patients of fertile age, it is necessary to clarify information about pregnancy planning. The most favorable period for planning pregnancy and childbirth is 3 years or more after hernioplasty. When planning a pregnancy in the next 1–2 years after surgical treatment of a ventral hernia, it is necessary to give preference to hernioplasty with local tissues, which has fewer complications in the long-term postoperative period as well as fewer relapses after childbirth compared with open prosthetic surgery. When planning a pregnancy 3 or more years after surgical treatment, preference should be given to prosthetic hernioplasty. When analyzing the results of treatment of the patients of fertile age with inguinal and femoral hernias, planning pregnancy, clinical experience has shown that there are no contraindications to performing laparoscopic transabdominal preperitoneal prosthetic hernioplasty.

BACKGROUND: Patients with rheumatoid arthritis have a high level of comorbidity, and their most common and socially significant conditions are cardiovascular diseases, which represent a major cause of mortality. Currently, there are no data on the differences in cardiovascular risk scales in patients with rheumatoid arthritis depending on the presence or absence of thrombocytosis.

AIM: To assess and compare cardiovascular risk according to conventional scales in patients with thrombocytosis and normal thrombocytes.

MATERIALS AND METHODS: The study involved 85 patients diagnosed with rheumatoid arthritis: 40 with thrombocytosis [including 25 (62,5%) women] and 45 with normal thrombocytes [including 29 (64,4%) women]. The following scales were used to assess risk of cardiovascular complications: Systematic COronary Risk Evaluation with adjustment factor 1.5 (mSCORE), Reynolds Risk Score (RRS), QRESEARCH Cardiovascular Risk Algorithm (QRISK3), Assessing Cardiovascular Risk to Scottish Intercollegiate Guidelines Network / SIGN to Assign Preventative Treatment (ASSIGN).

RESULTS: The obtained findings have demontrated that according to the mSCORE and RRS scales the patients of both groups had almost identical parameters; however, according to the ASSIGN and QRISK3 high risk of cardiovascular complications has been detected nearly twice as frequently in the patients with rheumatoid arthritis and thrombocytosis in comparison with those with normal level of thrombocytes. It is also worth noting that more frequent determination of high risk of cardiovascular complications by the QRISK3 was statistically significant.

CONCLUSIONS: The QRISK3 calculation has shown significantly higher prevalence of high-risk cardiovascular complications among the patients with platelet counts >450 ∙ 10⁹/l compared with those with platelet levels within the reference values. Thus, the QRISK3 scale can be considered as more informative for estimating risk of cardiovascular complications in rheumatoid arthritis.

BACKGROUND: It has been established that the prognosis of ischemic heart disease patients after myocardial revascularization depends on the presence of comorbid pathology, which includes, in addition to cardiovascular and non-cardiac, low physical activity as well as the patient’s social status and environmental barriers. The use of the international classification of functioning in this category of patients makes it possible to assess the severity of the impairment of the structures and functions of the organs and systems involved in the process as well as the role of social, personal and contextual environmental factors necessary for the implementation of a comprehensive rehabilitation program.

AIM: To study structural and functional changes in the cardiovascular system and other organs and systems of the body based on clinical and expert parameters and the International Classification of Functioning, Disabilities and Health, the need for social protection measures, the main directions of complex rehabilitation of patients with coronary heart disease after coronary artery bypass grafting.

MATERIALS AND METHODS: The study included 221 patients with severe coronary artery disease requiring myocardial revascularization. All the patients have been examined after coronary bypass surgery in the Bureau of Medical and Social Expertise in Saint Petersburg and recognized as disabled by the third group. The amount of surgical intervention in the patients was different; in most cases (55%) 3 coronary bypass grafts have been inserted. Comorbidity has been assessed according to the Charltson and Kaplan – Feinstein indices.

RESULTS: High frequency of comorbid pathology has been revealed; the most common are cardiovascular diseases, less common — lung diseases, the diseases of the musculoskeletal system, diabetes mellitus. The value of the Kaplan – Feinstein index was 10.08 ± 0.25; Charlson index — 6.50 ± 0.16. In addition to structural disorders of the cardiovascular system, moderate dysfunctions of the respiratory and digestive systems, and metabolism have been determined. Violations of the functions and structures of the body led to restrictions on the categories of life activity: the ability to self-service in 85.07%, independent movement in 81.90%, labor activity in 100%. Among the domains of the international classification of functioning that characterize activity and participation, problems with paid labor activity (100%), movement, housework, and recreation have been identified.

CONCLUSIONS: The study expands the understanding of the frequency of comorbid pathology of disabled people due to coronary artery disease, its impact on prognosis and the development and implementation of an individual rehabilitation program. The international classification of functioning allows to assess the severity of functional and structural changes, disability as well as to determine the need for social protection measures in patients with coronary artery disease.

The article presents a clinical case of an unclassifiable myeloproliferative neoplasm in a 65-year old patient. Platelet count is not a criteria for differential diagnosis of reactive and tumor processes. A typical course of the disease is associated with the persistence of symptoms of microcirculation disorder against the background of previous asymptomic thrombocytosis for several years. The diagnosis of an unclassifiable myeloproliferative neoplasm is established by a combination of clinical, laboratory, instrumental, molecular genetic and morphological methods of research.