A practical case: features of the autoimmune insulin syndrome diagnosis

Autoimmune Insulin syndrome (AIS), also named Hirata disease, is a rare condition characterized by hypoglycemic episodes due to the presence of high titers of insulin autoantibodies (IAA). AIS is a form of immune-mediated hypoglycemia, which develops when a triggering factor (medication or a viral infection) acts on an underlying predisposing genetic background. The diagnosis of IAS is challenging, requiring a careful workup aimed at excluding other causes of hyperinsulinemic hypoglucemia. The article presents a case of Hirata disease diagnosing of a patient of the therapy department of the Multidisciplinary Medical Center of the Bank of Russia.Purpose: Determining of the features of the diagnosis of Autoimmune Insulin syndrome (Hirata disease)Materials and methods: the article presents a clinical case of the diagnosis of Autoimmune insulin syndrome (Hirata disease), focuses on the diagnostic significance of laboratory tests. The article is intended for general practitioners, endocrinologists, gastroenterologists.

Hypofractionated radiotherapy for nonmelanoma skin cancer during the COVID-19 pandemic: experience in 31 cases

As a result of the coronavirus disease 2019 (COVID-19) pandemic, radiation therapies have been modulated to reduce the risk of infection during outpatient activities and hypofractionated regimens or radiotherapy delay for nonmelanoma skin cancer (NMSC) were suggested. Hypofractionated radiotherapy not only may confer no disadvantage in regard to outcome when compared to a more protracted schedule but might also reduce the risk of infection. We report the experience of a dermatologic radiation therapy department concerning a group of patients with a diagnosis of NMSC selected for a radiation treatment plan aimed to minimize the number of their accesses to our department.

“A doctor and teacher from God and from birth”. To the 100th anniversary from the birth of Tatiana Igorevna Zavadskaya

«Each of us has a Master. The first teacher to teach us how to read and write, add numbers and solve problems. The school teachers who taught us to love the Motherland and life, make friends and cherish beauty. Life teachers who taught us the lessons of love and hate, good and evil. Apart from the number of teachers who gave us general knowledge of life, there are People who taught us the great art of healing, who gave us professional foundations, who revealed to us the secret mysteries of healing. Each of us will name dozens of such Teachers, who have invested reasonable and light in us, who have given us a piece of their soul. But among them there is the very main Teacher who was able to consider in you only the visible sprouts of knowledge, the inclinations of a future doctor, the ability to master the profession. The very main Teacher who gave you all his knowledge and experience, taught you the art of healing, which became the basis of your profession, the meaning of your whole life. Tatiana Igorevna Zavadskaya was such a teacher», — recalled one of her many students, Yuri Ivanovich Zudbinov.The article is dedicated to the 100th anniversary of the birth of Zavadskaya T.I. - Associate Professor of the Hospital Therapy Department of the Rostov State Medical Institute, an experienced clinician, an enthusiastic scientist, a talented teacher and an outstanding personality.

Community-acquired pneumonia in HIV patients

The objective: to study the frequency and nature of community-acquired pneumonia (CAP) in HIV patients.Subjects and methods: The continuous longitudinal retrospective study of all cases of respiratory diseases among HIV patients (n = 185), who received in-patient treatment in the therapy department.Results. CAP was diagnosed in 38.4% (n = 71) of patients and it was the most frequent respiratory disease among HIV patients. The median CD4 count in CAP made 197.5 cells/μL, 9.1% of patients received antiretroviral therapy before hospital admission. 74.7% of CAP patients (n = 53) had lesions disseminated to several lobes. Laboratory parameters revealed in severe CAP (leukocytosis > 12 × 109/L, leukopenia < 4.0 × 109/L and thrombocytopenia < 100 × 1012/L) were associated with the degree of immunodeficiency and did not depend on the infiltration dissemination (p > 0.05). Bacteremia in CAP was detected in 20.8% of patients and it was associated with the failure of standard empiric antibiotic therapy (p < 0.05). 9.9% of CAP patients (n = 7) were diagnosed with polymicrobial infection. Lethal outcomes of CAP were recorded in 5.6% of cases (n = 4), all with severe immunosuppression (the median of CD4 count was 5 cells/μL), 2 cases had bilateral subtotal CAP and 2 suffered from polymicrobial infection.

Some aspects of radiation protection in radionuclide therapy departments

The paper presents the data that allow calculate the attenuation factors in lead, tungsten and concrete of various thicknesses or the thickness of shielding made of these materials for a given attenuation factor for the spectra of gamma radiation of 131I and 177Lu radionuclides. Using these data the effectiveness of the protection of supporting equipment (portable containers, shielded syringes, etc.) and the possible doses of external radiation of medical personnel in the radionuclide therapy department were calculated. It is shown that there are short-term operations in the production process when a radiation source (container with a capsule with activity, syringe with activity), being near the body of a medical worker, creates a significant dose rate. For this reason the annual individual dose of external exposure of a medical worker can approach or exceed 1/3 of the dose limit. Calculation of the attenuation of 131I gamma radiation by stationary shield showed that the thickness of walls and floors made of concrete 200 – 400 mm will ensure that the permissible values of the dose rates of gamma radiation in the air do not exceed at annual turnover of activity in the radionuclide therapy department of ~ 3.3 · 1012 Bq.

On the formation of the center of tuberculosis infection in general medical units

The objective of the study: to analyze the frequency of admission of tuberculosis patients to general medical units, to describe medical and social parameters of patients – sources of tuberculous mycobacteria which form a nosocomial center of tuberculosis infection.Subjects and methods. The following sources of information were used: Reporting Form no. 8 on Active Cases of Tuberculosis, data from the Annual Reporting Form on Analysis of Infectious Diseases Carrying drawn up by City Center for Medical Prevention in Yekaterinburg, Register of Infectious Diseases (Form no. 060/y), and 74 documents of Medical File of the Patient Receiving In-Patient Treatment (Form no. 003/y) for tuberculosis patients admitted to a therapy department of the city hospital.Results. Despite the decreasing tuberculosis incidence among Yekaterinburg residents, there was no significant decrease in the frequency of hospital admissions of patients with this disease to general medical units. Of all tuberculosis patients admitted to general medical units, 40.0 ± 2.7% were admitted to therapy departments. Duration of stay in a therapy department of tuberculosis patients excreting tuberculous mycobacteria made more than 7 days for 70% of such cases before they were discharged. The destruction phase was diagnosed in 56.8 ± 5.8%, 13.5 ± 4.0% had massive bacterial excretion documented by sputum microscopy. The frequency of TB/HIV co-infection made 43.2 ± 5.8%.Conclusion. In a therapy department, there is a high risk of getting infected with tuberculosis infection among patients and personnel who are exposed to a tuberculosis case.