Guidance on COVID-19 Vaccination in Hidradenitis Suppurativa Patients: A Modified Delphi Consensus of Experts

<b><i>Introduction:</i></b> Hidradenitis suppurativa (HS) patients may be at increased risk of COVID-19 infection and complications from their medications and comorbidities. There is a lack of expert consensus on recommendations for the COVID-19 vaccine for HS patients. Herein, we aim to provide expert-driven consensus recommendations regarding COVID-19 vaccinations in HS patients. <b><i>Methods:</i></b> A modified Delphi consensus survey developed by a core committee of 7 dermatologist HS experts consisting of 4 demographic questions and 12 practice statements was distributed to the US HS Foundation-sponsored provider listserv. Participants were attending physician HS experts. Survey results were to be reviewed by the core group and revised and resubmitted until consensus (≥70% agreement) was achieved. <b><i>Results:</i></b> Among the 33 survey participants, there were 30 (87%) dermatologists, 1 general surgeon, 1 plastic surgeon, and 1 rheumatologist. Consensus for all 12 statements on vaccine counseling and HS treatment counseling was achieved after the first round. <b><i>Discussion/Conclusion:</i></b> For now, this consensus can serve as a resource for clinicians discussing COVID-19 vaccination with their HS patients. These recommendations will need to be updated as new evidence on COVID-19 emerges.

PROCEDURE FOR FORMING AN EFFECTIVE SELECTION PROCESS RATIONAL REHABILITATION MEASURES FOR TREATMENT GYNECOLOGICAL DISEASES

В статье рассматривается ряд методов интеллектуальной поддержки принятия решений в диагностике и лечении гинекологических заболеваний. При применении высоких медицинских технологий возрастает роль лечащего врача (ЛВ), который по-прежнему остается лицом, принимающим решение (ЛПР). Однако применение этих методов принятия решений должно увязываться с логикой деятельности ЛВ, быть доступно для практического использования, освобождать ЛВ от "рутинной" работы и способствовать целенаправленному и эффективному лечебно-диагностическому процессу. Процессы диагностики и лечения гинекологических заболеваний характеризуются большим числом переменных и определяются индивидуальными характеристиками пациенток, рядом неопределенности при выборе тактики лечения. Процедура математического описания процессов лечения состоит из выбора метода моделирования в условиях неоднородностей. Выбор тактики лечения сводится к поиску эффективных алгоритмов, индивидуализирующих особенности каждой больной в процессе лечения, и позволяет врачу на основе опыта и интуиции принимать адекватные решения в любой момент времени. Вот почему, прежде всего, при выборе рациональных реабилитационных мероприятий в условиях неполной априорной информации требуется интеллектуальная поддержка принимаемых решений ЛВ. Для интеллектуальной поддержки принимаемых решений применяются методы имитационного эксперимента, основанные на априорной информации лечащего врача и эксперта для организации и алгоритмизации диалогового режима в ускоренном и реальном масштабе времени. Рассматривается алгоритмическая процедура процессов лечения The article discusses a number of methods of intellectual support for decision-making in the diagnosis and treatment of gynecological diseases. With the use of high medical technologies, the role of the attending physician (PD) increases, who still remains a decision-maker (DM). However, the application of these decision-making methods should be linked to the logic of the drug's activity, be available for practical use, free the drug from "routine" work and contribute to a purposeful and effective treatment and diagnostic process. The processes of diagnosis and treatment of gynecological diseases are characterized by a large number of variables and are determined by the individual characteristics of patients, a number of uncertainties in the choice of treatment tactics. The procedure for the mathematical description of treatment processes consists of the choice of a modeling method under conditions of inhomogeneities. The choice of treatment tactics is reduced to the search for effective algorithms that individualize the characteristics of each patient in the treatment process, and allows the doctor, based on experience and intuition, to make adequate decisions at any time. That is why, first of all, when choosing rational rehabilitation measures in conditions of incomplete a priori information, intellectual support for the decisions made by the dispensary is required. For the intellectual support of the decisions made, the methods of the simulation experiment are used, based on the a priori information of the attending physician and the expert for the organization and algorithmization of the dialogue mode in accelerated and real time. An algorithmic procedure for treatment processes is considered

Generic drugs: benefit/risk ratio

The review discusses the interchangeability of medications, approaches to the registration of original and generic drugs, and types of their equivalence, as well as problems with generics in clinical practice. Results of pharmacoepidemiological studies, which have been widely carried out recently, speak of insufficient understanding of the impact of generics on remote outcomes of chronic diseases, including mortality. The longterm economic prospects of generic drug administration continue to remain unclear. Among the primary differences between generics and brandname drugs are the differences in active ingredient synthesis methods and the composition of adjuvants and additives. Comparative studies on the therapeutic equivalence of generics with their originals or between themselves are rarely conducted. They are often affected by methodological flaws, which cannot ensure their comparable efficacy and safety. In this regard, automatic replacement of drugs containing the same active ingredient should be avoided without the participation of the attending physician.

Medication Overuse Headache in a Patient with Myasthenia Gravis: a Case Report on Successful Intervention by an Acupuncturist

In this case of medication overuse headache in a patient with myasthenia gravis, an acupuncturist identified the use of an over-the-counter analgesic that was not revealed to the attending physician. This case highlights the potential role of an acupuncturist as part of the medical care team involved in headache management.

Complementary medicine in Germany: a multi-centre cross-sectional survey on the usage by and the needs of patients hospitalized in university medical centers

Background The results of recent surveys indicate that more than 50% of the German population has experience with complementary and alternative medicine (CAM) or uses CAM regularly. This study investigated the CAM usage and CAM-related needs of hospitalized patients at university medical centres in the state of Baden-Württemberg, Germany. Methods A multi-centre, paper-based, pseudonymous survey was carried out by the members of the Academic Centre for Complementary and Integrative Medicine. Patients of all ages, regardless of sex, diagnosis and treatment, who were hospitalized in the Department of Cardiology, Gastroenterology, Oncology, Gynaecology or Surgery at the university medical centres in Freiburg, Heidelberg, Tübingen and Ulm were eligible for inclusion. Results Of the 1275 eligible patients, 67% (n = 854) consented to participate in the survey. Forty-eight percent of the study participants stated that they were currently using CAM. The most frequently used therapies were exercise (63%), herbal medicine (54%) and dietary supplements (53%). Only 16% of the patients discussed CAM usage with their attending physician. Half of the patients (48%) were interested in CAM consultations. More than 80% of the patients desired reliable CAM information and stated that physicians should be better informed about CAM. Conclusions The frequency of CAM usage and the need for CAM counselling among hospitalized patients at university medical centres in Baden-Württemberg are high. To better meet patients’ needs, CAM research and physician education should be intensified. Trial registration German Clinical Trial register (DRKS00015445).

Hypogammaglobulinemia as a Predictive Factor of Postoperative Complications in Pediatric Cardiac Surgery

Hypogammaglobulinemia, developed as a result of cardiac surgery accompanied by cardiopulmonary bypass (CPB), may be caused by hemodilution, destruction of immunoglobulin, extravasation into the interstitial space related to systemic inflammation, and capillary leak syndrome. Therefore, to address this gap, we analyzed the characteristics of the infants who developed hypogammaglobulinemia after cardiac surgery and could benefit from Immunoglobulin supplementation. Methods: This is a retrospective study evaluating infants undergoing surgery for repair of congenital heart defects from October 1, 2019 to June 30th, 2020 in the neonatal unit of our institution. Due to its retrospective design, informed consent was not required. Patients were divided in two groups: Group 1 (IgG >= 340mg/dL) and Group 2 (IgG < 340mg/dL). The value cut point was defined taking into consideration p10 level of Immunoglobulin according to Fujimura. Results: From October 1, 2019 to June 30th, 2020, 62 children were born or admitted in our neonatal unit. Among them, 19 (30%) have their IgG dosed, according to attending physician decision. Among patients with hypogammaglobulinemia, Pseudomonas sp was present in 87.5% of blood stream and/or tracheal secretion cultures. Regarding survival analysis, mortality was not different between Group 1 and 2. Conclusion: Hypogammaglobulinemia has proved to be a predictor factor of postoperative complications in pediatric cardiac surgery. However, prospective trials are needed to determine the incidence of this problem, its real impact on survival, and the appropriate therapy.

Heterotropic pregnancy: a common masquerade than ever thought?

Heterotopic pregnancy, coexistence of living or dead intrauterine pregnancy, single or multiple, with extra-uterine pregnancy located in the oviduct, ovary, uterine cornua, cervix or rarely peritoneal cavity. Heterotropic pregnancy is relatively uncommon in spontaneous conception with 1 in 30,000 cases reported, the incidence of heterotopic pregnancy increases to 1 in 3900 when conception is enhanced with various assisted reproduction techniques (ART). It is an ectopic pregnancy coexisting with intrauterine pregnancy. But is the incidence of heterotropic pregnancy rising? A case was reported from our centre in 2018 by Ejikeme et al, and we have recorded another two cases in the period of one year. Ectopic pregnancy has been described as a great masquerader, which makes diagnosis and management of heterotropic pregnancy a dilemma to attending physician. We present a case of an unbooked 26 years old G4P3+0 who has no family history of multiple gestation and presented at gestational age of 8 weeks and 5 days with 2 days history of abdominal pain and vaginal bleeding and 2 hours history of loss of consciousness. She later had exploratory laparotomy with left salpingectomy and manual vacuum aspiration of Retained Products of Conception with good outcome. In conclusion, spontaneous heterotropic pregnancy is a rare occurrence, however with advent of artificial reproductive technology and increase incidence of pelvic inflammatory disease, the incidence could be higher than earlier suspected.

ANAMNESIS MORBI OF DOCTOR FREUD: PSYCHO-HISTORICAL ANALYSIS

Sigmund Freud is known as a creator of psychoanalysis, developmental theory and models of personality. Freud's personality, his life story invariably attracts scientists, researchers and practitioners. This article is devoted to the history of Freud's illness, which lasted for 16 years, from 1923 until his death in 1939. Freud suffered from cancer of the upper jaw on the right. An attending physician who performed many operations and prosthetics for Freud was oral surgeon Hans Pichler. Freud bravely endured suffering of the illness. Despite the pains and difficulties in functioning, he continued to work on scientific works and receive patient visits. On September 21, 1939, family doctor Max Schur, at Freud's request, performed euthanasia by injecting a lethal dose of morphine. Among the factors that influenced Freud's decision to be euthanized, the hypothesis of loss of the meaning of further suffering is considered. The concept of meaning is implicitly embedded in understanding of functioning of the Ego in structural model of personality developed by Freud.

73-year-old Female with Syncope and Motor Vehicle Collision

Introduction: Patients with traumatic injuries can be difficult to assess, and their evaluation often evolves in the emergency department (ED). We describe how an ED attending physician member developed a differential diagnosis for this presentation, arrived at a suspected diagnosis, and what test he proposed to prove his hypothesis. Case Presentation: This clinicopathological case presentation details the initial assessment and management of a 73-year-old female who presented to the ED following a motor vehicle collision precipitated by a syncopal episode. Conclusion: The final surprising diagnosis is then revealed.

A. D. Kaplan. First aid station in industrial plants. V. A. Obukh Institute for the Study of Occupational Diseases. Moscow, 1928 Publishing house of the Moszdravotdel

With the present rapid rate of growth of the industrialization of the country and the reconstruction of the socialist economy with its huge factories, factories, state and collective farms under construction, the question of first aid points becomes urgent. The appearance of this brochure in print should be hailed as the first experience of analyzing the problem of a first aid station in production from an organizational and surgical point of view. The author raises in detail and broadly the question of the approach of the attending physician to production, of the structure of the first aid station for the successful treatment of injuries and its prevention. Concerning the organizational form of the item, the author believes that this institution should not have medical functions, but only the provision of first aid, and should be organizationally individualized according to the characteristics of the injury rate of this enterprise. Due to the fact that it is not possible to get a sufficiently qualified specialist for such a point - a doctor, the standardization of first aid should be carefully developed: typification of stopping bleeding, handling a wound, burn, fracture, typing of dressings, etc. In addition, the responsibilities of the point should be immediate transportation of the victim to the nearest medical institution.