Pathomorphosis of Vascular Dementia with Psychotic Symptoms

Objective: To study the pathomorphosis of vascular dementia over the past 30 years. The study of the pathomorphosis of mental disorders makes significant adjustments to the criteria for diagnosis and nosography. Dementia has also undergone pathomorphosis over the years. Materials and Methods: The research was carried out in the Psychiatric Hospitalsin Azerbaijan. A retrospective analysis was carried out for the period 1990-1999, which were compared with a similar contingent during 2010-2020. Results: The number of hospitalized patients with vascular dementia has increased over the past 10 years, which means both an increase in the incidence of the disease and an increase in symptoms requiring psychiatric treatment. Conclusions: Pathomorphosis has also manifested itself in sex. Thus, the number of female patients has increased in the last 10 years. As a result of the disease, there is a positive trend, a decrease in mortality.

The 2020 “Padua Criteria” for Diagnosis and Phenotype Characterization of Arrhythmogenic Cardiomyopathy in Clinical Practice

Arrhythmogenic Cardiomyopathy (ACM) is a heredo-familial cardiac disease characterized by fibro-fatty myocardial replacement and increased risk of sudden cardiac death. The diagnosis of ACM can be challenging due to the lack of a single gold-standard test: for this reason, it is required to satisfy a combination of multiple criteria from different categories including ventricular morpho-functional abnormalities, repolarization and depolarization ECG changes, ventricular arrhythmias, tissue characterization findings and positive family history/molecular genetics. The first diagnostic criteria were published by an International Task Force (ITF) of experts in 1994 and revised in 2010 with the aim to increase sensitivity for early diagnosis. Limitations of the 2010 ITF criteria include the absence of specific criteria for left ventricle (LV) involvement and the limited role of cardiac magnetic resonance (CMR) as the use of the late gadolinium enhancement technique for tissue characterization was not considered. In 2020, new diagnostic criteria (“the Padua criteria”) were proposed. The traditional organization in six categories of major/minor criteria was maintained. The criteria for identifying the right ventricular involvement were modified and a specific set of criteria for identifying LV involvement was created. Depending on the combination of criteria for right and LV involvement, a diagnosis of classic (right dominant) ACM, biventricular ACM or left-dominant ACM is then made. The article reviews the rationale of the Padua criteria, summarizes the main modifications compared to the previous 2010 ITF criteria and provides three examples of the application of the Padua criteria in clinical practice.

Microvascular Angina: Diagnosis and Management

Recognition of suspected ischaemia with no obstructive coronary artery disease – termed INOCA – has increased over the past decades, with a key contributor being microvascular angina. Patients with microvascular angina are at higher risk for major adverse cardiac events including MI, stroke, heart failure with preserved ejection fraction and death but to date there are no clear evidence-based guidelines for diagnosis and treatment. Recently, the Coronary Vasomotion Disorders International Study Group proposed standardised criteria for diagnosis of microvascular angina using invasive and non-invasive approaches. The management strategy for remains empirical, largely due to the lack of high-level-evidence-based guidelines and clinical trials. In this review, the authors will illustrate the updated approach to diagnosis of microvascular angina and address evidence-based pharmacological and non-pharmacological treatments for patients with the condition.

Perspectives of physical medicine and rehabilitation specialists and rheumatologists towards fibromyalgia syndrome in Turkey

Objective: Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread, unexplained pain in the muscles, including the head, neck, and sides of the hips, and fatigue. We aimed to evaluate the familiarity of physical medicine and rehabilitation and rheumatology physicians with fibromyalgia syndrome (FMS) in Turkey by means of a survey and to determine if these physician groups followed the 1990 FMS diagnostic criteria and 2010 FMS classification criteria for diagnosis. Material and Methods: The survey questions consisted of two parts; the first part consisted of 10 questions about demographics and professional experience, as well as the number of patients who had been diagnosed, treated, and followed up with in the prior 3 months by physicians. The second part consisted of 15 questions about perspectives on the 1990 FMS diagnostic criteria and 2010 FMS classification criteria. Results: One hundred and seventy one physicians participated in this survey. The majority of physicians 105 (99.1%) from physical medicine and rehabilitation and 59 (90.8%) rheumatologists could diagnose FMS. The rate of diagnosis and the rate of follow-up for FMS patients were significantly higher with physical medicine and rehabilitation specialists than with rheumatologists (p= 0.013 and p = 0.000; respectively) and were statistically significant. Conclusion: Differences in the awareness and descriptions of as well as approaches to FMS by physical medicine rehabilitation physicians and rheumatologists were examined in this study.

Discordant diagnostic criteria for pneumonia in COPD trials: a review

Inhaled corticosteroids (ICS) have a class effect of increasing pneumonia risk in patients with COPD. However, pneumonia incidence varies widely across clinical trials of ICS use in COPD. This review clarifies methodological differences in defining and recording pneumonia events in these trials and discusses factors that could contribute to the varying pneumonia incidence. Literature searches and screening yielded 40 relevant references for inclusion. Methods used to capture pneumonia events in these studies included investigator-reported pneumonia adverse events, standardised list of signs or symptoms, radiographic confirmation of suspected cases and/or confirmation by an independent clinical end-point committee. In general, more stringent pneumonia diagnosis criteria led to lower reported pneumonia incidence rates. In addition, studies varied in design and population characteristics, including exacerbation history and lung function, factors that probably contribute to the varying pneumonia incidence. As such, cross-trial comparisons are problematic. A minimal set of standardised criteria for diagnosis and reporting of pneumonia should be used in COPD studies, as well as reporting of patients’ pneumonia history at baseline, to allow comparison of pneumonia rates between trials. Currently, within-trial comparison of ICS-containing versus non-ICS-containing treatments is the appropriate method to assess the influence of ICS on pneumonia incidence.

Evaluación participativa del programa de educación continua en detección temprana del cáncer de mama

Los programas de educación continua en detección temprana del cáncer son una herramienta útil y necesaria en la adquisición de conocimientos, competencias y habilidades requeridas por los profesionales de la salud. En Colombia existen falencias en la formación de profesionales en estas áreas, derivando en la falta de estandarización de técnicas y procedimientos, e inadecuada unificación de criterios de abordaje diagnóstico y terapéutico de los pacientes. El estudio buscó evaluar el programa de educación continua en detección temprana del cáncer de mama implementado por el Instituto Nacional de Cancerología entre 2016-2018. Se realizó un estudio con metodología mixta concurrente, con diseño analítico descriptivo, a partir de un análisis documental, entrevistas semiestructuradas, análisis de las encuestas de satisfacción, y de los exámenes pre y pos de las capacitaciones realizadas. Se realizó un muestreo no probabilístico y a conveniencia, la población seleccionada fueron los sujetos involucrados (profesionales capacitados, capacitadores, creadores), entre los años 2016 a 2018. Dentro de los resultados se encontró, que el nivel de satisfacción con el curso fue del 97.5%; resaltando la metodología basada en el aprendizaje activo, la educación por competencias, la pertinencia de los temas abordados, la utilización de modelos anatómicos en silicona y la experticia de los capacitadores. Se encontraron diferencias estadísticamente significativas posterior a la intervención educativa (V=439; p=0.001). Quedaron en evidencia barreras de tipo económico, administrativo y de divulgación; además, se sugiere implementar el curso de manera sistemática, aumentando la cobertura, divulgación y tiempo de capacitación, ofreciendo prácticas con pacientes. Concluyendo que, la implementación de programas de educación continua en profesionales de la salud son una herramienta útil y necesaria en la adquisición de competencias básicas en detección temprana del cáncer y debe contar con una estructura definida, organizada y en concordancia con los programas y políticas públicas del país. Continuing education programs in early detection of cancer are a useful and necessary tool for the acquisition of knowledge, competencies, and skills required by health professionals. In Colombia, there are shortcomings in the training of professionals in these areas, resulting in a lack of standardization of techniques and procedures, and inadequate unification of criteria for diagnosis and therapeutic patient management. This study sought to evaluate the continuing education program in early detection of breast cancer implemented by the National Cancer Institute of Colombia between 2016 and 2018. A concurrent mixed methodology study was conducted, with descriptive analytical design, based on a documentary analysis, semi-structured interviews, analysis of satisfaction surveys, and pretest and posttest exams. A non-probability convenience sampling was performed; the selected population consisted of subjects involved in the program (trained professionals, trainers, creators) between 2016 and 2018. Among the results, the level of satisfaction with the course was found to be 97.5%, highlighting the methodology based on active learning, competency-based education, the relevance of the topics addressed, the use of anatomical silicone models, and the expertise of trainers. Statistically significant differences were found after the educational intervention (V=439; p=0.001). Economic, administrative, and dissemination barriers were evidenced. In addition, it was suggested to implement the course in a systematic way, increasing its coverage, dissemination, and training time, as well as to offer internships with patients. The study concludes that the implementation of continuing education programs among health professionals are a useful and necessary tool for the acquisition of basic skills in early cancer detection and must have a defined and organized structure in accordance with existing programs and public policies in the country.

Types of vaginal microbiomes in PCOS affected females

To evaluate and analyze the microbiomes component of the vagina in females with polycystic ovarian syndrome PCOS, and compare it with that of healthy females. A case- control study included 120 participants, 60 had been diagnosed as having PCOS according to the Rotterdam Criteria for diagnosis of PCOS and the other 60 are healthy females visiting the outpatient private clinics in Hay Aljameaa/ Al-Harthya in Baghdad from October 2020 till march 2021 for different medical problems, statistical analysis was done by using the SPSS computer application for statistical analysis. Both study groups had L. crispatus in their vagina, while for L. jensonii 93.33% of control group have this microbiota while only 66.66% of PCOS group have it, L. gasseri presents in the vagina of 80% of controls and only 38.33% of PCOS. S. aureus in 41.66% of PCOS group and only 3.33% of control group, S. epidermidis presents in 25% of PCOS females while it not presents in control group. Str. Pyogenes presents in 36.67% of PCOS group and absent in control group (p< 0.0001), Str. Agalactiae presents in 26.67% of PCOS group and 1.67% of control group. Bacteroides presents in 30% of PCOS cases and only in 1.67% of controls (p< 0.0001). For other types of vaginal microbiota e.g. Gardnerella vaginalis we found that it presents in high percentage of PCOS group 66.67% and absent in females of control group, Prevotella spp presents in 55% of PCOS group and only 3.33% of control group, Mobiluncus spp and Fusobacterium spp were absent in both study groups. For candida species, C. albicans presents in 30% and 6.67% of vagina of PCOS and control group respectively. There is large diversity in the vaginal microbiota with disruption to normal flora in PCOS affected patients so We need further studies to evaluate the relationship between the microbiota and different PCOS symptoms.

Establishment of accurate criteria for diagnosis of the time since death in forensic medical practice

Over the course of technological development, it is recommended to use more and more new modern methods to assess the time since death. However, most of them have practical limitations or show insufficient results that could ensure the most accurate assessment of the time since death in forensic medical practice. Aim of the work. To review modern scientific articles on the problem of establishing the time since death, to identify the most promising areas of work that can potentially be used in the daily work of practitioners. Conclusions. The analysis of scientific literature shows the relevance of the search and development of new modern methods of assessment of time since death, which could provide scientific validity, specificity and objectivity of the expert opinion.

Precipitating Factors of Psoriasis in North Indian Population

Aim: This study aims to study precipitating factors of psoriasis in the north Indian population.Material & Method:Two hundred twenty-eight psoriasis patients regardless of age, sex, religion,occupation, attending the skin, and V.D. outpatients Department, B.R.D. Medical College, Gorakhpurfor were taken because of the subject of this study. The bulk of patients belonged to the Eastern U.P.and adjoining areas of Bihar and Nepal. The clinical criteria for diagnosis of psoriasis were thepresence of Erythematous and papulosquamous lesions with loosely adherent silvery-white scales.The auspitz's sign was demonstrated all told the cases. The detailed clinical history and examinationwere recorded. Each patient was categorized into mild to severe psoriasis. Result: The maximumpercentage of cases was aggravated by weather (winter), 55.26%, next to that was trauma 27.19%, and least after infections 4.35%. The summer and spring seasons showed an improved effecton the condition of psoriasis. Alcohol, smoking, and mental stress found no relation with psoriasis.In most cases, where the infection was associated with the disease, it had been aggravated only inchildren, and young adults and lesions were of guttate type. Pregnancy had no effect in 25.43% ofcases, while the disease was improved in 3.50% of patients and worsen in 4.35% of cases.Conclusion: Psoriasis is positively correlated with the winter season and negatively associated withSummer and Spring.