Svetlana A. Konchina

Background: Acute heart failure (AHF) is one of the leading causes of admissions to the emergency department (ED). There is a need to develop an easy-to-use score that can be used in the ED to risk-stratify patients with AHF and in hospitalization decisions regarding cardiac wards or intensive care units (ICUs). Methods: A retrospective observational study was conducted at a city hospital. The data from the presentation of AHF patients at the ED were collected. The combined primary endpoint included death from any cause during hospitalization or transfer to an intensive care unit (ICU) for using inotropes/vasopressors. Feature selection was performed using artificial intelligence. Results: From August 2020 to August 2021, 908 patients were enrolled (mean age: 71.6 ± 13 years; 500 (55.1%) men). We found significant predictors of in-hospital mortality and ICU transfers for inotrope/vasopressor use and built two models to assess the need for ICU admission of patients from the ED. The first model included SpO₂ < 90%, QTc duration, prior diabetes mellitus and HF diagnosis, serum chloride concentration, respiratory rate and atrial fibrillation on admission, blood urea nitrogen (BUN) levels, and any implanted devices. The second model included left ventricular end-diastolic size, systolic blood pressure, pulse blood pressure, BUN levels, right atrium size, serum chloride, sodium and uric acid concentrations, prior loop diuretic use, and pulmonary artery systolic blood pressure. Conclusions: We developed two models that demonstrated a high negative predictive value, which allowed us to distinguish patients with low risk and determine patients who can be hospitalized and sent from the ED to the floor. These easy-to-use models can be used at the ED.

Background. Food allergy is a serious, life-threatening condition that negatively impacts the quality of life of patients and their families, especially among children. In Europe, approximately 7 million people suffer from food allergy, while in Russia, the prevalence varies from 5% to 30%. Accurate diagnosis and treatment of food allergy are crucial to preventing complications and improving quality of life. Primary diagnostic methods include medical history, laboratory tests, and elimination diets, though each has its limitations. Globally, oral food challenges are considered the "gold standard" for food allergy diagnosis. It helps to establish a precise connection between the allergen and the reaction, reducing anxiety for patients and their families. Objective. To evaluate the feasibility of using oral food challenges as a diagnostic method for food allergies in children. Materials and methods. This single-center, prospective, interventional, non-randomized, uncontrolled study is being conducted from January 1, 2022, to December 31, 2024, at the G. N. Speransky Children’s Hospital No. 9 in Moscow. Children aged 6 months to 17 years, suspected of having an immediate allergic reaction to cow's milk protein and/or egg protein by a doctor or legal guardian, were invited to participate. The study involves using an open food challenge for diagnosing food allergies. An open food challenge involves consuming increasing amounts of the suspected allergen (milk, egg, etc.) in its natural form under medical supervision. To determine the necessity of a provocation test, a consultation is conducted, including a physical examination, medical history, and allergy testing (specific IgE blood tests, component diagnostics for milk and egg, and a prick test with the native allergen). Additionally, during the consultation, questionnaires on anxiety and quality of life were completed. Our patient selection and test procedure algorithm is an adapted version of existing protocols from international allergology organizations. Conclusions. Preliminary results indicate that the provocation test is a safe diagnostic method when following a strict patient selection and test procedure algorithm. Notably, parents of children undergoing these tests exhibit high anxiety levels. We plan to continue this study and assess personal and situational anxiety levels over time post oral food challenges.

Follicular occlusion syndrome consists of several conditions that share similar pathophysiology involving infundibular follicular occlusion and secondary inflammatory cascade. This syndrome includes hidradenitis suppurativa, dissecting cellulitis of the scalp, acne conglobata and pilonidal sinus. They can develop independently or as a component of a syndrome in different combinations. We are the first to present a clinical case of follicular occlusion tetrad and intermediate therapy outcome with tumor necrosis factor inhibitors. We also provide a full and updated review of the literature on the etiology and pathogenesis, diagnosis and treatment of similar syndromic conditions. Currently, there is no reliable algorithm of treatment for patients with follicular occlusion syndrome, which underlines the importance of further studies. The presented clinical case confirms the need for timely administration of genetically-engineered biological drugs to patients with diseases of the follicular occlusion group (before sinus tract formation).