Innovations in primary health care

This review is devoted to a number of important innovations and their role in modern medical practice of a family practitioner. We have discussed benefits, restrictions and controversies related to their use. We have also reviewed the evidence base on the practical implementation of these innovations. This review is devoted to a number of important innovations and their role in modern medical practice of a family practitioner. We have discussed benefits, restrictions and controversies related to their use. We have also reviewed the evidence base on the practical implementation of these innovations.

Pulmonary inflammatory myofibroblastic tumor in a breast cancer patient, a rare presentation

Inflammatory myofibroblastic tumor (IMT), a benign and rare neoplasm, of mesenchymal origin, pseudoarcomatous, is responsible for about 0.7% of all neoplastic presentations in the pulmonary region, being the most frequent cause of pulmonary nodules in pediatric patients, approximately 50% of the presentations. Thus, the present study aims to report a rare case of IMT in the lung site in a 31-year-old patient undergoing treatment for breast cancer, according to a literary review, relating the data according to the clinical presentation. Due to scarce documentation in the medical literature, no cases were found similar to the one described in relation to the reported oncological primary condition of the patient, making the present case a clinical challenge in modern medical practice.

Cardiotoxic effects induced by the use of antimetabolites in the chemotherapy of oncological diseases

In modern medical practice, the treatment of cancer is one of the most pressing issues. Many of the drugs used in the treatment of cancer have a toxic effect on the cardiovascular system of patients. The main clinical manifestations of cardiotoxicity are ischemic heart damage, rhythm disturbances, thrombosis, angina, asymptomatic changes in the electrocardiogram, and others. Side effects can develop both during the treatment period and months after the end of the course of chemotherapy. This is especially important for patients with concomitant cardiac or vascular pathology, since the severity of developing side effects can lead to disability or death of cancer survivors. The article discusses the data on the frequency of detection of the negative effect of pyrimidine, purine and folic acid antagonists on the cardiovascular system of cancer patients, the mechanisms of cardiotoxic effects of drugs in such patients, the possibilities of preventing heart damage and correcting for already developed lesions. The aim of this work is to collect, compare and systematize the available disparate data on the cardiotoxic effects of antitumor drugs of the antimetabolite group. An important condition for saving and preserving the quality of life of cancer patients is the identification of cardiovascular pathologies at the stage of preparation for chemotherapy, which can be facilitated by the active cooperation of oncologists and cardiologists. The search for information was carried out on the bases of scientific medical publications (eLibrary.ru, PubMed) taking into account the clinical recommendations for the treatment of malignant neoplasms.

Urinary tract infections and vitamin D: prospects for use in prevention and treatment

Urinary tract infections are a common global problem among physicians of various specialties, including therapists, pediatricians, nephrologists and urologists. Today UTI is one of the leading bacterial infections in both adult and child populations. The main type of therapy and prevention of recurrent UTI is the use of drugs with an antibacterial effect (antibiotics, uroseptics). An urgent problem in modern medical practice is the increasing antibiotic resistance, which requires the development of new approaches to therapy and prevention, including UTI. In recent years, special attention has been paid to the study of vitamin D receptor (VDR) gene polymorphisms as a possible risk factor determining the predisposition to a number of infectious and noninfectious diseases. More than 200 polymorphisms of the VDR gene have been identified, four of which – FokI, BsmI, ApaI, and TaqI – are particularly common. Different VDR alleles can cause small changes in receptor function, which can affect resistance or susceptibility to a particular infection. The review presents data from modern studies demonstrating the relationship between vitamin D supply and development, the frequency of recurrence and the nature of the course of UTI. In one study, vitamin D has been shown to enhance the cathelicidin-mediated antibacterial action of bladder epithelial cells. It also demonstrated the currently known defense mechanisms of vitamin D against urinary tract infections, including its effect on components of the innate immune system.

Urachal adenocarcinoma: a rare clinical presentation

Urachal tumor is extremely rare, since it is responsible for about 0.01% of all neoplasms already repeated in the history of clinical oncology, with the adenocarcinoma subtype being the most prevalent. Thus, the present work aims to report a case of a 55-year-old patient diagnosed with urachal tumor, relating the clinical presentation of the case according to current literary data. It was possible to show that such a diagnosis, as well as the institution of a standard treatment, is still a clinical challenge in modern medical practice.

HOW TO CRITICALLY APPRAISE A RESEARCH PAPER?

Background: Critical appraisal of research paper is a fundamental skill in modern medical practice, which is skills-set and developed throughout the professional career. The professional experience facilitates this and through integration with clinical experience and patient preference, permits high quality evidence-based medicine practice in patient care. These skills to be mastered not only by academic medical professionals but also by the clinicians involved in clinical practice. Objective: To provide a simple and robust method for assessing the trustworthiness of a research paper and its value in clinical practice. Methodology: Through detailed literature search, All essential sections and subsection mandatory for a research paper were identified followed by the necessary steps or information required in each section or questions which may arise or needs to addressed were identified. The important questions or steps which are integral in assessing the reliability and validity of a research are gathered during critical review of a research paper. Results: Out of 128 full text articles, 49 full-text articles containing robust and pertinent information as per objective were short listed for review. Conclusion: Critical appraisal of a research paper or project is a fundamental skill in modern medical practice for assessing the worth of clinical research and in providing a guideline of its relevance to the profession.

ANALYSIS OF COMPLICATIONS INDUCED BY IODINE-BASED RADIOGRAPHIC CONTRAST MEDIA AND OF METHODS OF THEIR PREVENTION (A literature review)

The existence of modern medical practice is impossible without the use of radiological diagnostic methods. Due to the introduction of evidence-based medicine, most diagnoses need to be confirmed by imaging techniques, and some diseases require radiographic contrast media. Despite the medical and scientific breakthrough in these technologies, there are still risks of developing an individual body reaction to the contrast agent. In view of this, the purpose of the work was to substantiate the choice of iodine-containing radiographic contrast agents, to study the possible complications caused by these substances during the X-ray examination, and the methods of prevention of such conditions. To determine these key points, an analytical review of the literature was conducted. Analysis of iodine-containing radiographic contrast agents, which differ in their chemical structure and properties, showed the advantage of non-ionic radiographic contrast media over the ionized ones. The work considers hypersensitive reactions and thyroid dysfunctions caused by the introduction of iodine-containing contrast agents. The allergic reactions may occur occur regardless of the dose of the drug, immediately or after some time after the examination. Due to the fact that the average duration of radiographic examination is from a few minutes to an hour, the appearance a certain reaction to iodine-containing radiographic contrast agents in a patient may not be established in time. That is why, it important to monitor a patient in the radiology department for 30 minutes after the examination. When establishing an increased risk of hypersensitivity reactions, due to the collection of anamnesis, it is necessary to carry out premedication with glucocorticoids is recommended according to the scheme that is described in the literature and is used in the modern medical practice. The development of hyperthyroidism or hypothyroidism depends on the initial level of hormones and the correct operation of the response system. In the presence of anamnestic and laboratory risk factors that can cause the occurrence of these conditions (TSH, free T4, total T3 and Thyroid peroxidase antibodies), it is recommended to consult an endocrinologist and, based on his/her judgement, to carry out premedication with the control of the TSH levels according to the schemes presented in the literature review or, alternatively, to correct the existing pathological conditions before the examination.

Rudolf Virchow: Requiem for a Visionary

Rudolf Virchow's scientific legacy to mankind is invaluable. His holistic view of disease allowed him to develop detailed experimental models based on the precepts of cell biology, which is why he is considered the forerunner of modern pathology. Many of his observations were transferred to the clinical setting and are still valid today in different areas of internal medicine. This biographical sketch highlights his main contributions to modern medical practice on the basis of his profound social sensitivity, including the founding of the first German anthropological society.