Ta Gaydina

Currently, comprehensive medical care for combat veterans on the part of primary care doctors is an important problem. To improve the unified teaching strategy in medical universities for preparation of highly qualified specialists, the main questions of the training process of students studying the general medicine specialty are discussed. The article presents points of view of psychiatrists, psychologists, internal medicine doctors, ophthalmologists, dermatologists, and proposals on optimization of continuity of teaching how to manage patients with post-traumatic stress disorder and how to improve communication skills of future doctors during caring for patients with this acute emotional disorder. To improve preparedness of medical students to apply knowledge in clinical practice, the experts focus on the classical manifestations of post-traumatic stress disorder and psychosomatic disorders, teaching systemic approach to patients’ needs with focus on communication during outpatient appointments, discussion of combat stress target organs. During comprehensive discussion, the experts concluded that it is necessary to strengthen interactions between clinical and scientific departments of medical universities to study the role of stress in stepwise development of long-term consequences of stress-induced somatic pathology, to increase attention to details in communication between doctors and patients with post-traumatic stress disorder, to introduce problems of outpatient observation of combat veterans into the summer working practice of 5th year students training in general medicine. Regular updates of the training materials will help to better understand the problem of post-traumatic stress disorder and prepare graduates for performing qualified and rounded medical services to combat veterans.

Introduction: Langerhans cell histiocytosis (LCH) is a rare clonal myeloid disorder characterized by tissue infiltration with pathological antigen-presenting cells morphologically and phenotypically similar to Langerhans cells. Activating mutations in the MAPK/ERK signaling pathway play a key role in the pathogenesis of LCH. The aim of this study was to characterize the morphological and molecular features of the neoplastic process. Materials and Methods: This study presents a clinical case of a 34-year-old patient with a rare mixed form of LCH combined with Erdheim-Chester disease (ECD), involving multiple organs including kidneys, skin, bones, ENT organs, eyes, and the central nervous system. The patient also had diabetes insipidus, chronic external otitis, and presumptive hereditary forms of anemia and hemochromatosis. A comprehensive histopathological evaluation was performed, including histochemical, immunohistochemical, and immunofluorescent analyses, alongside molecular genetic testing using whole exome sequencing (WES) of blood and skin samples. The patient demonstrated a partial clinical and laboratory response to targeted therapy with trametinib and desmopressin. Results: Comparison of WES data from blood and skin revealed 71,953 shared variants consistent with likely germline changes, as well as 3,081 unique somatic variants in skin and 2,633 unique variants in blood. Low-level mosaic BRAF V600E mutation (VAF = 1%) was detected in the skin, alongside pathogenic germline variants in the STEAP3 (c.523-2A>T, NM_182915.3) and SLC40A1 (c.332T>A, p.Met111Lys, NM_014585.6) genes. Immunofluorescence analysis of the trephine biopsy revealed diverse cellular populations, including sparse tryptase-positive mast cells, which showed minimal contact with each other or other labeled cells. The populations of Vimentin⁺CD11b^–CD34⁺ and Vimentin⁺CD11b⁺CD34^– cells (excluding endothelial cells) accounted for median values of 0.68% and 7.78%, respectively, of the total Vimentin⁺ cells. Regarding CD68 and S100 expression, CD68⁺ cells predominated (median = 55.61%), S100⁺ cells constituted a median of 43.02%, whereas CD68⁺S100⁺ cells were the rarest (median = 2.174%), reflecting the transition of Langerhans cells to LCH cells, encompassing up to 4.81% of the cellular population. This hybrid microenvironment paralleled the patient’s systemic inflammatory activity (elevated acute-phase reactants), multi-organ involvement, and renal interstitial fibrosis/tubular atrophy with reduced kidney function, without serological or histological evidence of vasculitis. Conclusion: This case illustrates the histological heterogeneity and hybrid pathology of mixed histiocytosis, where canonical dendritic LCH cells coexist with macrophage-rich ECD-like stroma. An integrated approach involving a multidisciplinary clinical team, thorough molecular genetic testing, and the application of targeted therapy is essential for improving prognosis and quality of life in young patients.

Otitis externa is the most common diagnosis in the practice of an otorhinolaryngologist. Definitions of the term are not precise at the moment, and a universal generally accepted classification has not been developed. In a separate nosological group, otitis externa can be distinguished from the background of dermatological diseases. These patients need an interdisciplinary approach, joint supervision of otorhinolaryngologists and dermatovenerologists to increase the effectiveness of treatment and minimize the risks of chronic otitis. Severe complications of otitis externa are obstructive keratosis, fibrous atresia, and persistent conductive hearing loss. Diagnostic algorithms and therapeutic strategies for otitis externa should include the search and therapy of a background dermatological disease. At the moment, the tactics of managing patients suffering from otitis externa on the background of dermatological diseases continues to be developed.

Localized scleroderma is an autoimmune chronic connective tissue disease characterized by the appearance of foci of local inflammation in various areas of the skin, followed by the formation of sclerosis and/or atrophy of the skin and underlying tissues in them. Among systemic connective tissue diseases, scleroderma occupies the second place in terms of frequency, mainly female patients. The authors observed a severe comorbid patient S., 75 years old, who was hospitalized at the Federal Center of Brain Research and Neurotechnologies of the FMBA of Russia in the department of medical rehabilitation for patients with impaired central nervous system function № 1 from 02.11.2022 to 03.01.2022 with a diagnosis of the underlying disease: the consequences of an ischemic stroke in the basin of the left middle cerebral artery from 02.23.2021, cardioembolic pathogenetic variant. Right-sided hemiparesis. Complex motor aphasia. After consulting a dermatovenerologist, a diagnosis was added to the concomitant diseases: localized scleroderma. Limited plaque shape. Patient S. external treatment was carried out (fluticasone ointment 0.005 % applied to the affected areas of the skin 1 time a day in a thin layer for 4 weeks), upon discharge, a course of physiotherapy at the place of residence was recommended.

Early accurate detection of skin cancer is a growing global problem of health’s services throughout the world. Malignant skin formation can be suspected by using an anamnesis, visual inspection of the skin, and diffrent types of investigations in primary care settings. The dermatoscopic examination is necessary for exclusion or confirmation skin cancer, which is performed by a dermatovenerologist. The patient is referred futher to an oncologist in case the cancer cannot be excluded. Well-organized identification of patients with suspected skin cancer is accociated with favorable prognosis. However, in order to reduce the rates of high neglect for malignant skin tumors and optimize the routing of patients after visiting a primary care phisician, it is worth to pay attention to the following points: annual medical check-up examinations, especially among people of age is over than 40 years; a complete physical examination, including thorough history and full body skin examination by general practition as part of a clinical examination in a primary care settings; the use of mandatory dermoscopic examination by a dermatovenerologist for early diagnosis of skin cancer, and, if possible, dynamic skin mapping with artificial intelligence analysis; increasing the professional and communicative skills, especially needed in managing newly diagnosed skin cancer, since psychosocial factors influence the patient’s attitude towards his/her own health; maintaining continuity between general practitioners and dermatovenerologists to improve the quality of medical care; creation of “Healthy Skin” schools in clinics to increase the medical literacy of the population concerning the education regarding the danger of skin cancer, training in skin self-examination skills; using e-health technologies as an additional source of information.

Чесотка представляет собой инфекционное кожное заболевание, вызываемое специфичным для человека эктопаразитом Sarcoptes scabiei var. hominis. Несмотря на всестороннюю изученность чесотки, проблема ее своевременной диагностики у маломобильных пациентов с определенными неврологическими и когнитивными нарушениями остается актуальной во всем мире. Одновременное назначение большого количества лекарственных препаратов маломобильным пациентам может маскировать клинические проявления чесотки и ошибочно относить зуд к проявлениям кожных аллергических реакций или иных дерматозов. Авторы наблюдали пациента К., который находился в ФГБУ «ФЦМН» ФМБА России с 14.11.2022 по 15.11.2022. Клинический диагноз при поступлении: I69.3. Последствия инфаркта мозга. Основное заболевание: ранний восстановительный период ишемического инсульта в бассейне левой средней мозговой артерии от 09.08.2022, атеротромботический подтип по критериям TOAST. Правосторонний гемипарез. Грубая афазия. Нарушение функции тазовых органов. Шкала реабилитационной маршрутизации 5 баллов. Фоновые заболевания: гипертоническая болезнь III стадии 3 степени, контролируемая, риск сердечно-сосудистых осложнений — 4 (очень высокий). Целевое значение артериального давления менее 135/85 мм рт. ст. Окклюзия левой передней мозговой артерии, средней мозговой артерии. Токсико-аллергический дерматит (лекарственный) в фазе обострения. На основании комплекса клинических данных и лабораторного обнаружения возбудителя пациенту К. был поставлен диагноз: B86 — чесотка. Несмотря на то, что пациент находился под медицинским наблюдением на догоспитальном этапе, чесотка не была своевременно диагностирована. Поздняя диагностика чесотки ведет к распространению заболевания и поддержанию неблагоприятной эпидемиологической ситуации.

Due to the changes in the modern world, it is necessary to develop the domestic pharmaceutical industry, which is a task especially important in the context of implementation of the import substitution policy. The article classifies the main measures the state industrial policy has for the pharmaceutical industry; these measures cover informational and consulting aspects, research and technical parts, innovations and economic matters. Practical actions and their possible consequences are considered for each group of the industrial policy measures: encouragement of domestic consumption, regulation of imports, stimulation and support of exports, stimulation of technological development, public-private partnerships, support of the development of intersectoral territorial production complexes (clusters), direct state support of investment activities, tax incentives for investors.

ПАРАНЕОПЛАСТИЧЕСКИЙ СИНДРОМ ЛЕЗЕРА-ТРЕЛЯ (LESER-TRÉLAT): КЛИНИЧЕСКИЕ ПРОЯВЛЕНИЯ, ДИАГНОСТИКА И ЛЕЧЕНИЕ