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Introduction: Hallucinations are serious symptoms that can lead to high levels of distress, functional impairment, and increased risk of suicide in both adults and children. However, their etiology and treatment remain unclear. Hallucinations and sensory processing difficulties (SPDs) are associated with various psychiatric disorders, including mood, anxiety, and post-traumatic stress disorder. This study aimed to investigate the potential association between hallucinations and SPDs in a pediatric population. Methods: We conducted a cross-sectional study with 335 children aged 6--18 years who visited the child psychiatry outpatient clinic at Osaka Metropolitan University Hospital between April 2020 and March 2023 and continued treatment for at least three months. After excluding those with intellectual disabilities or uncontrolled epilepsy, 304 participants were included in the analyses. The presence of hallucinations was assessed through interviews with the children and their parents. SPDs were evaluated using the Short Sensory Profile. Binomial logistic regression analysis was conducted to assess the association between hallucinations and SPDs, adjusting for age, sex, autism spectrum disorder, socioeconomic difficulties (low-income, single-parent households), and the presence of mood and anxiety disorders. Results: Hallucinations were present in 64 children (21%). Logistic regression analysis showed a significant positive association between SPDs and hallucinations, even after adjusting for age, sex, autism spectrum disorder, socioeconomic difficulties, and the presence of mood and anxiety disorders (odds ratio, 1.02; 95% CI, 1.008--1.036; p = 0.002). Conclusion: The results of this study suggest a potential association between hallucinations and SPDs in pediatric patients. Further prospective studies are needed to explore the causal relationship between these factors and determine whether interventions for SPDs can alleviate hallucinations in children. [ABSTRACT FROM AUTHOR]

Background: Despite the numerous advantages of the nursing process, nursing students often struggle with utilizing this model. Therefore, studies suggest innovative teaching methods to address this issue. Teaching based on real clinical cases is considered a collaborative learning method that enhances students' active learning for the development of critical thinking and problem-solving skills. In this method, students can acquire sufficient knowledge about patient care by accessing authentic information. Objective: The aim of the present study was to investigate the experiences of nursing students and faculty members regarding the implementation of nursing process educational workshops, based on real case studies. Design: A qualitative descriptive study. Participants: 9 Nursing students and 7 faculty members from the Isfahan School of Nursing and Midwifery who attended the workshops. Methods: This qualitative descriptive study was conducted from 2021 to 2023. Data was collected through semi-structured individual and focus group interviews using a qualitative content analysis approach for data analysis. Results: After analyzing the data, a theme titled "Breaking Taboos in the Nursing Process" was identified. This theme consists of four categories: "Strengthening the Cognitive Infrastructure for Accepting the Nursing Process," "Enhancing the Applicability of the Nursing Process," "Assisting in Positive Professional Identity," and "Facilitating a Self-Directed Learning Platform." Additionally, thirteen subcategories were obtained. Conclusion: The data obtained from the present study showed that conducting nursing process educational workshops, where real clinical cases are discussed, analyzed, and criticized, increases critical thinking, learning motivation, and understanding of the necessity and importance of implementing the nursing process. Therefore, it is recommended that instructors utilize this innovative and effective teaching method for instructing the nursing process. [ABSTRACT FROM AUTHOR]

Gastric adenocarcinomas are encountered exceptionally infrequently in cats. Some studies have claimed a predisposition in Siameses, while others affirm no relation to the breed. In veterinary literature, only few cases of feline gastric adenocarcinoma (FGA) are reported, which accounts for about 1% of all feline gastrointestinal adenocarcinomas. The present case report describes a clinical case of FGA. The clinical signs, blood morphology and biochemistry, ultrasound and histopathological findings are presented. This is the first report of FGA from Bulgaria. [ABSTRACT FROM AUTHOR]

Introduction Due to the constant increase in the number of primary and revision hip arthroplasties, the incidence of complications has been also increasing. Periprosthetic joint infection (PJI) is the most common and dangerous complication in joint arthroplasty, including PJI with cavitary defects of the acetabulum (Paprosky type 2C). The purpose of the work was to demonstrate successful results of managing acetabular defects in patients with periprosthetic infection at the stage of installing an articulating spacer. Materials and methods The patients underwent surgical management of cavitary defects of the acetabulum with allobone plastic material at the stage of installation of an articulating spacer impregnated with antibacterial drugs. A clinical and functional assessment of the effectiveness of treatment of patients with PJI of the hip joint, who underwent bone grafting of acetabular defects at the first stage of two-stage revision arthroplasty, was carried out. Remission of the infectious process was assessed according to the ICM 2013 (International Consensus Meeting), and the function of the affected limb was assessed according to the HHS (Harris Hip Score). Results At a 6-month follow-up after implantation, there were no clinical and laboratory manifestations of PJI and radiological signs of instability of the implant components. Bone grafting was evaluated to be satisfactory; the function of the affected joint restored to 80–90 to HHS points. Remission of the infectious process according to ICM was achieved. Discussion Clinical cases studied demonstrate a positive result of treatin PJI with plastic surgery of cavitary defects of the acetabular bottom at the stage of articulating spacer installation. Filling acetabular defects at the sanitizing stage (implantation of a spacer) subsequently provides improvement of primary fixation and osseointegration of the acetabular component when converting the spacer to a permanent implant. This is due to an increase in the contact area of the acetabular component with bone tissue (native bone and remodeled allobone material). Conclusion The treatment of the first clinical case improved joint function from 24 to 85 HHS points, and in the second from 27 to 76 HHS points. The use of defect filling techniques enabled to stop the infection and improve functional results.

A clinical case of a severe toxic lesion of the cornea in the form of an extensive ulcer in the only seeing eye (left) due to a prolonged use of the local anesthetic oxybuprocaine is presented. The patient (who had lost the object vision in the right eye after a penetrating injury of the eyeball) started using the drug for the first time on his own accord, without informing the attending physician, 2 months before referring himself to the Ufa Research Institute of Eye Diseases due to the development of recurrent keratoconjunctivitis, accompanied by severe pain. The patient combined oxybuprocaine instillations 4–6 times a day with the prescribed anti-inflammatory therapy, including local application of steroid drops. This led to the development of a corneal ulcer, complicated by a toxic allergic reaction. The fact of a long-term unauthorized use of oxybuprocaine was discovered in a confidential talk with the patient. Subsequent in-patient and long-term out-patient treatment involving reparative, anti-inflammatory, antibacterial and antiviral therapy, helped achieve gradual epithelialization of an extensive corneal defect resulting in vascularized opacification and an increase in visual acuity of the only seeing eye to 0.5 with correction. The case demonstrates the need to increase the awareness of ophthalmologists, who should not disregard possible corneotoxic lesions in their differential diagnosis. In addition, the patients should be informed about severe complications and their consequences associated with self-administration and prolonged use of local anesthetics.

Background. Mucopolysaccharidosis type I (MPS I) is an inherited disease caused by pathogenic variants in the IDUA gene, which encodes the lysosomal enzyme alpha-L-iduronidase. This clinical case demonstrates the importance of diagnosing rare diseases when patients have phenotypic features indicating hereditary pathology presence. Phenotype changes can be so-called “red flag” that helps specialists suspect and diagnose lysosomal storage diseases. Clinical case description. The patient was observed with delayed psychomotor development; she also had hepatomegaly and on auscultation of the heart there was a functional systolic murmur above the apex and in the Botkin–Erb point on heart auscultation. Coarse “garholoid” facial features attracted attention at external examination: large nose, wide sunken nose bridge, macroglossia, thick lips, synophrysis, scaphocephaly, wide chest, and flat-valgus feet. Echocardiography has revealed mitral valve insufficiency and hardened valve leaflets. Ophthalmologist examination: hypermetropic astigmatism. Psychiatrist examination: mental and speech development delay. Enzymatic diagnostics: significant decrease in alpha-Liduronidase activity. No further examinations were carried out due to the onset of the COVID-19 epidemic and parents' doubts about the diagnosis. The patient was readmitted to the hospital at the age of 6 years due to aggravation of her condition. A molecular genetic study has revealed two pathogenic variants in the IDUA gene. Diagnosis of MPS I was established according to the clinical data, results of biochemical and molecular genetic studies. Conclusion. This clinical case demonstrates the classic course of MPS I with typical phenotypic signs and lesions in various organs and systems. The presented case demonstrates the importance of professional vigilance among doctors of various specialties regarding orphan diseases.

Background. Myopia is a serious medical and social problem specifically due to the high risk of such complications as cataracts, myopic maculopathy, glaucoma, and retinal detachment. Children with connective tissue dysplasia (CTD) syndrome are most subjected to myopia. Prevention of myopia progression in children remains the only effective way to prevent myopic maculopathy. Significant progress in this field has been achieved via optical technologies developed on the basis of peripheral defocus theory. Clinical case description. Patient, 10 years old, with CTD, mild myopia of both eyes with rapid progression, myopic maculopathy, grade 1. Ophthalmic status: spheroequivalent refraction — right eye (–)1.5 diopters / left eye (–)1.75 diopters; vision acuity with monocular correction — 1.0. Fundoscopy: optic disc is pale pink, with clear borders, arteries and veins are well-proportioned, their courses and calibers are intact; choriocapillary layer attenuation in the macular and paramacular zones, “parquet fundus”; areas of pigment redistribution on peripheral retina; no atrophic foci detected; anterior-posterior axis of the right and left eyes — 26.2 and 26.3 mm, respectively. Optical coherence tomography (OCT) has revealed retinal thinning in the upper and nasal sectors in the right eye during the first assessment. The left eye has demonstrated losses of retinal thickness within the middle parafoveal zone and significant thinning in the upper segment. Optical therapy with HAL spectacle lenses (inducing volumetric myopic peripheral defocus) was assigned to control myopia to slow down the pathological axial growth of the child's eyes and to stabilize refraction. 4 months of wearing glasses with HAL lenses has led to the stabilization of dystrophic changes in retina, signs of improvement in several sectors by were observed on OCT. No negative changes were revealed in all parafoveal segments of the left eye. The child was recommended to continue wearing glasses with HAL lenses with dynamic follow-up every 3 months. Conclusion. CTD in children is associated with high risk of complications in case of myopia progression, moreover, retinal pathology can occur even with mild myopia. Optical therapy with HAL spectacle lenses is effective and safe first treatment of choice in the control of myopia in children with CTD, and opens new opportunities in prevention of progressive myopia disabling complications in children, whose treatment results were not previously sufficient.

Background. Alopecia areata is an autoimmune disease characterized by hair loss that develops with the involvement of CD8+ T-cells of the immune system and cytokines produced by T-helper 2 cells (Th2). Efficacy of alopecia areata management is limited. The one potentially effective variant for treatment of severe forms of alopecia areata complicated with atopic dermatitis (AD) is genetically engineered biologic drug dupilumab (interleukin 4 receptor antagonist that suppresses Th2 response). Clinical case description. 11 years old boy was admitted to the dermatology department with complaints on aggravation of AD and numerous hair loss foci. Dupilumab, 300 mg, was prescribed once every 4 weeks. Severity of erythematous papular rashes significantly decreased within 9 months, as well as irritation intensity. Complete restoration of hair growth was noted in areas of former alopecia areata foci. Conclusion. Dupilumab can be effective in the management of severe forms of alopecia areata in children with comorbid AD. Clinical studies on the efficacy and safety of such therapy are needed to confirm this hypothesis.

Background. Congenital duplication of small intestine is a complex disease in terms of early diagnosis due to the absence of specific clinical manifestations. Screening methods do not always help to reveal the lesion localization. Only special methods, such as contrastenhanced fluoroscopy, computed and magnetic resonance imaging, allow us to diagnosis gastrointestinal tract (GIT) malformation more precisely. Moreover, the lack of sufficient awareness about this pathology among primary care physicians also postpones diagnosis and, therefore, the timely correction of this congenital GIT malformation. Thus, our clinical case should help primary care physicians to increase alertness on congenital bowel anomaly. Clinical case description. This clinical case demonstrates that intestinal abnormality was suspected in utero at the first trimester of pregnancy according to ultrasound examination. Intestinal colics can be considered as the first clinical non-specific manifestation of congenital anomaly of small intestine in a child under the age of 1 year. Constipation, abdominal pain, and occasional pyretic fever were observed from the age of 2. Intestinal ultrasound has revealed changes, and radiological and magnetic resonance methods confirmed the presence of small intestine malformation. Conclusion. Screening ultrasound of an intrauterine child in the first trimester of pregnancy could force pediatricians to search congenital GIT anomalies despite its non-specific clinical signs. Imaging methods revealed the defect localization, while surgical intervention recovered it. It has prevented any possible complications and improved the patient’s quality of life.

The issue on the differential diagnosis of formations of purulent-inflammatory etiology and the choice of treatment method taking into account the visual picture does not lose its relevance. Ultrasound (US) is not less crucial than computed tomography (CT) for the primary diagnosis of spleen abscesses. This article presents clinical observations of patients with suspected spleen abscesses admitted to the emergency room of the Novosibirsk City Clinical Hospital No. 1 with emergency indications for 2017–2022. All patients underwent ultrasound with Philips Affiniti 70G, Mindray M9, and General Electric Logiq P6 devices. While performing ultrasound in In-mode, attention was paid to the main signs: localization (in the parenchyma, subcapsular), quantity, contours (wall thickness), the nature of the abscess contents, dimensions (volume calculated according to the formula for irregularly shaped formations, A × B × C × 0.52), the presence or absence of effusion in pockets the spleen. The formations were classified by volume into small (up to 50 ml), medium (50–100 ml) and large (more than 100 ml). The main ultrasound signs in the seroscale mode have been determined. The presented clinical observations illustrate the possibilities of ultrasound for deciding on the method of treatment: for primary diagnosis (including emergency), it was possible to determine the presence of formations of purulent- inflammatory etiology, to determine the localization, the main signs in which minimally invasive treatment was effective (formed abscess of "medium" volume). Surgical abdominal treatment was preferable in the presence of multiple abscesses (without a formed capsule) of small size.

COVID-19 is an infectious disease that can progress from carrier and mild symptoms of acute respiratory infections to bilateral pneumonia, severe respiratory failure, acute respiratory distress syndrome (ARDS), multiorgan failure, sepsis and shock. One of the predictors of severe course of infection is advanced age and comorbidities. In this work we considered a clinical case of COVID-19 patient S., 86 years old, who was admitted to the hospital, to the intensive care unit on the 10th day of the disease, in an extremely severe condition. A diagnosis of bilateral polisegmental pneumonia with 70% lung involvement caused by SARS-CoV-2 virus was made. In addition to antiviral therapy with remdesivir and symptomatic therapy, pathogenetic therapy with tocilizumab was applied. On admission, the patient had leukopenia, thrombocytopenia, elevated values of COE, urea, significant elevation of inflammatory markers CRP and D-dimer, as well as pCo2. During inpatient treatment, positive dynamics of the condition and laboratory parameters were observed. The patient was discharged in satisfactory condition, all laboratory parameters were normalised, except for a slight increase in CRP and pCO2 levels. Despite the age of the patient and the severity of COVID-19 course, the combined use of drugs with multidirectional action, including tocilizumab, may improve the outcome of the disease.

Background. Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases in children. It manifests during the first year of life in majority of cases. Early AD manifestation is a risk factor for the development of other atopic spectrum diseases in the future. Nowadays, the ability of the dupilumab, as a genetically engineered biologic drug (GEBD), to modify the disease course, to reduce the frequency of AD persistence and the possibility of multimorbid atopic phenotype development is widely discussed. Thus, dupilumab management in young children with early onset and severe course arouses specific interest. Clinical case description. This article demonstrates the experience of effective administration of GEBD dupilumab in 4-year old patient with severe AD and comorbid food allergies. Continuous therapy for 12 weeks allowed to recover disease’s skin manifestations. No adverse events were reported. Conclusion. Long-term continuous dupilumab administration in children aged from 6 months to 5 years has proven its efficacy and acceptable safety profile. The potential disease-modifying effect of dupilumab is especially significant for young and preschool children due to the high risk atopic multimorbidity developing during this period.

Abstract Background Despite the numerous advantages of the nursing process, nursing students often struggle with utilizing this model. Therefore, studies suggest innovative teaching methods to address this issue. Teaching based on real clinical cases is considered a collaborative learning method that enhances students’ active learning for the development of critical thinking and problem-solving skills. In this method, students can acquire sufficient knowledge about patient care by accessing authentic information. Objective The aim of the present study was to investigate the experiences of nursing students and faculty members regarding the implementation of nursing process educational workshops, based on real case studies. Design A qualitative descriptive study. Participants 9 Nursing students and 7 faculty members from the Isfahan School of Nursing and Midwifery who attended the workshops. Methods This qualitative descriptive study was conducted from 2021 to 2023. Data was collected through semi-structured individual and focus group interviews using a qualitative content analysis approach for data analysis. Results After analyzing the data, a theme titled “Breaking Taboos in the Nursing Process” was identified. This theme consists of four categories: “Strengthening the Cognitive Infrastructure for Accepting the Nursing Process,” “Enhancing the Applicability of the Nursing Process,” “Assisting in Positive Professional Identity,” and “Facilitating a Self-Directed Learning Platform.” Additionally, thirteen subcategories were obtained. Conclusion The data obtained from the present study showed that conducting nursing process educational workshops, where real clinical cases are discussed, analyzed, and criticized, increases critical thinking, learning motivation, and understanding of the necessity and importance of implementing the nursing process. Therefore, it is recommended that instructors utilize this innovative and effective teaching method for instructing the nursing process.

Gastric adenocarcinomas are encountered exceptionally infrequently in cats. Some studies have claimed a predisposition in Siameses, while others affirm no relation to the breed. In veterinary litera-ture, only few cases of feline gastric adenocarcinoma (FGA) are reported, which accounts for about 1% of all feline gastrointestinal adenocarcinomas. The present case report describes a clinical case of FGA. The clinical signs, blood morphology and biochemistry, ultrasound and histopathological findings are presented. This is the first report of FGA from Bulgaria.

Epilepsy is a multifactorial disease, the important role in the emergence and development of which is played by hereditary factors, exogenous causes, combined effects of the exogenous causes and congenital or acquired susceptibility. Perinatal (antenatal, natal, and early postnatal) damage to the central nervous system is a common etiological factor of epilepsy in children. The paper reports the clinical case of the patient having structural focal epilepsy with bilateral tonic seizures, cramps resulting from the non-traumatic intracranial hemorrhage.

BACKGROUND: Surgical treatment of cataract in patients with postkeratotomic corneal ectasia has various features. First, difficulties arise when calculating the optical strength of an intraocular lens and its cylindrical component and determining the location of the main axes of astigmatism for toric intraocular lens implantation. Additionally, not all modern keratotopography installations are able to accurately determine the refractive power of the cornea in such patients owing to pronounced irregular astigmatism and a large difference in keratometric parameters in the main meridians. CLINICAL CASES DESCRIPTION: Two clinical cases of surgical treatment of cataract in combination with postkeratotomic keratectasia are presented. Patients underwent a standard preoperative ophthalmological examination. TMS-4 Tomey keratotopograph was used to accurately determine the refractive power of the cornea. The optical power of toric intraocular lens were calculated using the Holladay 2 formula with amendments for radial keratotomy and the Johnson Johnson VISIC online calculator. SN6AT9 intraocular lens (Alcon) and a Tecnis ZCT800 toric intraocular lens (Johnson Johnson) were implanted in patients. The orientation of the position of the cylinder axis of toric intraocular lens was performed perpendicular to the most flattened meridian, corresponding to the position of the keratectasia zone, determined by the most expanded keratotomy scar. Before surgery, the best corrected visual acuity of patient M was OD=0.2, OS=0.4 and that of patient K was OD=0.4, OS=0.2. After surgery, the best corrected visual acuity of patient M was OD=0.8, OS=0.8 and that of patient K was OD=0.8, OS=0.7. CONCLUSION: This study aimed to familiarize practicing ophthalmologists, clinical residents, and postgraduates with a possible treatment option for cataracts by phacoemulsification with implantation of a toric intraocular lens in patients with postkeratotomic keratectasia. The resulting high visual acuity and subjective satisfaction of patients indicate the accuracy of chosen treatment tactics. A reliable visual guide for choosing the cylinder axis is the meridian of the greatest degree of keratectasia (cornea flattening), which is determined by the maximally expanded keratotomy scar position. The intraocular lens cylinder axis is oriented perpendicular to the keratectasia meridian. Ultrasound phacoemulsification of cataract with implantation of a toric intraocular lens is an effective method for correcting induced ametropia after radial keratotomy against the background of postkeratotomy keratectasia with high astigmatism.

Background. Ichthyosis follicularis with atrichia and photophobia (IFAP syndrome), type 2 is a rare hereditary disease from the group of syndromic forms of ichthyosis. It is clinically characterized by triad of non-inflammatory follicular ichthyosis, total or subtotal alopecia at birth or shortly after, and photophobia of different severity. There is no etiotropic therapy for IFAP syndrome, while symptomatic treatment (emollients, keratolytics, retinoids) is aimed on stabilizing the patient’s condition and maintaining the optimal quality of life. About 60 cases of IFAP syndrome have been described worldwide by 2023, and none in Russia.Clinical case description. The girl, 2 years 3 months old, had signs of xeroderma, follicular hyperkeratosis, photophobia with lacrimation, and alopecia. The diagnosis of “ichthyosis follicularis with atrichia and photophobia (IFAP syndrome), type 2, autosomal dominant” was established according to anamnesis, clinical signs, and results of whole-exome sequencing, followed by validation of the identified nucleotide variant chr17:17720597G>A, p.1669C>T (p.Arg557Cys NM_001005291.2) in exon 9 of the SREBF1 gene via direct automatic sequencing in the patient and both parents (not revealed in her parents).Conclusion. Molecular genetic testing is crucial to establish IFAP syndrome as clinical signs of the disease are similar to other dermatoses. However, physicians need to have clinical suspicion when identifying cases of follicular ichthyosis in combination with alopecia and photophobia at or shortly after birth to timely diagnose IFAP syndrome and thus prevent any treatment delays.

Insulinoma is one of the most common neuroendocrine tumors. As a result of endogenous organic hyperinsulinism, a hypoglycemic symptom complex develops, characterized by an attack of hunger, sweating, trembling, severe weakness and headache. To diagnose insulinoma and provide timely medical care during an attack of hypoglycemia, it is necessary to quickly and accurately measure blood glucose, not only in the laboratory, but also at home, which can be done using a glucometer. One of the most important aspects of measuring blood glucose, especially when severe hypoglycemia occurs, is the accuracy of the meter. Monitoring blood glucose during symptoms of hypoglycemia is possible with the help of an accurate, simple and convenient means of determining blood glucose, one of which is the Contour Plus One glucometer. Thanks to the improvement of technologies used in the Contour Plus One glucometer, the accuracy of blood glucose measurements increases, the procedure for glycemic control is simplified, which speeds up the provision of necessary medical care for hypoglycemia in patients with insulinoma. Accurate and rapid glucose control is necessary not only for diagnosing insulinoma, but also for self-monitoring of glycemia in patients with diabetes mellitus (DM). In addition to glycemic control, imaging studies that include computed tomography (CT), magnetic resonance imaging (MRI), transabdominal and endoscopic ultrasound, and molecular imaging methods are used to clarify the diagnosis of insulinoma. The radical treatment method is surgery, namely enucleation of the tumor or resection of part of the pancreas. In the vast majority of cases, surgery provides a complete cure. Conservative treatment tactics are considered when severe comorbidities and the patient's overall health status significantly exceed the risk of surgical intervention. The presented clinical observation demonstrates the classic clinical manifestations of insulinoma, the main laboratory and instrumental diagnostic methods: measuring blood glucose, including at home, using an accurate, simple and convenient glucometer Contour Plus One, fasting test, MRI, contrast-enhanced CT and immunohistochemical study. This clinical case of insulinoma is recommended for study by doctors of various specialties, primarily endocrinologists, oncologists and therapists.

Progress in instrumental diagnostics, as well as increased awareness among doctors about rare diseases, is steadily leading to an increased number of patients diagnosed with cardiac amyloidosis. Regardless of amyloid formation route, cardiac damage is the main cause of mortality in systemic amyloidosis. The article presents a unique clinical observation of hereditary transthyretin (ATTR) amyloidosis mixed phenotype detection during skeletal scintigraphy. In the patient with severe shortness of breath, based on the results of radiological research, an oncological process in the lungs was suspected. The patient underwent skeletal scintigraphy to exclude metastatic lesions, during which a scintigraphy pattern characteristic of ATTR amyloidosis (Grade 3) was revealed. Subsequently, the oncological diagnosis was removed. An independent disease of hematopoietic system was excluded, and mutation in TTR gene was additionally confirmed. This clinical case illustrates the possibility of making a diagnosis of cardiac amyloidosis without resorting to myocardial biopsy, when the patient still has slight limitations in physical activity (NYHA class II) and there is no late gadolinium enhancement on magnetic resonance imaging.

Aim. To describe a clinical case and analyze the challenges in diagnosing hypertrophic cardiomyopathy (HCM) in a patient with concomitant arterial hypertension (AH). Materials and methods. The article presents the clinical case of HCM in the patient with concomitant AH that was observed in an ambulatory setting in the Municipal Enterprise “Dnipropetrovsk Regional Clinical Center for Diagnostics and Treatment” of Dnipropetrovsk Regional Council. Results. A 66-year-old woman N., diagnosed by her family physician with coronary artery disease (CAD): stable angina FC II, grade 2 AH, chronic heart failure FC II NYHA, was referred to a cardiologist because of experiencing exertional dyspnea, chest pain, and uncontrolled blood pressure despite treatment compliance. Echocardiography identified concentric left ventricular hypertrophy with the left ventricular outflow tract (LVOT) obstruction (a mean gradient of 35 mmHg as per catheterization). Cardiac MRI confirmed the diagnosis and coronary angiography ruled out CAD. Adjustments to the treatment regimen, taking into account HCM with LVOT obstruction, effectively alleviated the patient’s symptoms and stabilized her blood pressure. Conclusions. It is especially important to follow the guidelines of AH management and perform echocardiography in all patients with high blood pressure, so as not to miss the signs of concomitant HCM, particularly with LVOT obstruction. In addition, in the case of HCM, it is necessary to timely detect, provide prevention and manage patients at risk for sudden cardiac death. Since HCM encompasses various diagnoses with different pathogenesis and distinct management, cardiac MRI, enzymatic or genetic testing may be needed according to guidelines. As HCM is a relatively common inherited cardiac disease, general practitioners could often encounter such patients in everyday clinical practice. Hence, they should have a certain suspicion of this diagnosis in persons with AH whose left ventricular mass meets the criteria for HCM.

Introduction Intrauterine devices (IUDs) are widely used worldwide. One of the rare but serious complications is uterine perforation and the penetration of an IUD through the uterine wall into the bladder. In this report, we present two cases of IUD removal from the bladder wall.Clinical case. Two patients were referred for recurrent episodes of dysuria. Medical imaging and cystoscopy revealed a foreign body in the bladder wall, which was confirmed to be an IUD that had been inserted into the uterine cavity several years prior and partially migrated into the bladder lumen. Both patients underwent successful transurethral surgery, with complete removal of the IUD without fragmentation.Discussion. The removal of the IUD through the bladder did not cause any complications, and the patients were discharged from the hospital after five days. The translation of the IUD is possible if there is partial or complete damage to the wall of the cervix, isthmus or uteral body during the installation of the device.Conclusion. Patients with an IUD in place and frequent episodes of acute cystitis should have a cystoscopy to rule out bladder perforation caused by the IUD. The removal of the IUD through the urethra using an cystoscope and forceps is a relatively simple procedure that does not usually cause any intraoperative, immediate or delayed postoperative complications.

Primary multiple malignancies (PMMs) are defined as two or more malignant tumors of various pathogenic origin detected simultaneously or sequentially in one patient. Despite the successes of modern medicine, the incidence of PMMs is steadily increasing. According to worldwide statistics, the incidence of PMMs in the oncological population has increased from 2.4 to 8.0 % over the course of the 20 year span. The number of patients with PMMs is also increasing in the Russian Federation. Total of 58,217 PMMs were detected for the first time in our country in 2021, which constitutes 10.0 % of all newly diagnosed malignant neoplasms. Two tumors are usually observed among patients with PMMs (in 84–100 % of patients), three tumors occur in 9.9–16.0 % of these patients, four in 1.62 %, and five or more occur in only 0.095 %.Currently, the pathogenesis of this condition has not yet been fully studied. There are hypotheses that endogenous, exogenous, hereditary, and therapeutic factors are involved in the occurrence of PMMs. Endogenous factors include immunologic status, endocrine factors, and hereditary predisposition. Exogenous factors are represented by lifestyle and environmental factors such as smoking and alcohol, low physical activity, as well as prolonged exposure to ultraviolet radiation and industrial pollution. Iatrogenic factors, including radiation therapy and chemotherapy, can also increase the risk of developing PMMs.This article represents a clinical case of a patient born in 1942, in whom, during 11 years of follow-up care, primary multiple synchronous metachronous cancers of 5 localizations and 4 histological types were verified and treated. The presented clinical case is interesting for a very rare number of neoplasms and a relatively high duration of follow-up period. The authors describe in detail each stage, the choice of diagnostic methods and the definition of treatment tactics with an assessment of the accuracy of clinical decision-making.

To date more than 774 million people worldwide were infected with the SARS-CoV-2 virus (data for February 2024), and approximately 7 million people have already died from COVID-19. Since the beginning of the COVID-19 pandemic, there have been many reports and studies on damage involvement of the SARS-CoV-2 virus not only the respiratory but cardiovascular system as well, including myocardial damage, endothelial dysfunction, acute coronary syndromes, arrhythmias, myocarditis, thromboembolism, heart failure, hypotension, cardiogenic shock and even cardiac arrest. In addition, symptomatic COVID-19 infection with a severe course is more common in comorbid patients with a history of hypertension, diabetes, obesity, cancer or chronic obstructive pulmonary disease. According to the latest literature data, the occurrence of myocarditis associated with a new coronavirus infection is more often observed in young males and is associated with a severe or even fatal prognosis, which determines the relevance of a detailed study of the pathogenetic mechanisms and therapeutic possibilities for myocardial damage prophylaxis, relieving the main disease symptoms and unfavorable prognosis prevention. To date, there are also studies indicating that acute myocarditis could be a complication not only of the infection itself, but even one of the severe post-vaccination against SARS-CoV-2complications. The purpose of this study is to research the lethal clinical case of acute infectious myocarditis complicated the course of a new coronavirus infection. A retrospective analysis of the patient’s medical history with the final diagnosis: acute coronaviral myocarditis against the background of non-compact left ventricle myocardium was carried out.

Introduction Acute hematogenous osteomyelitis can persist as chronic infection in pediatric patients due to delayed diagnosis and treatment. An extended bone defect of the limb caused by osteomyelitic destruction is a rare clinical scenario in pediatric surgery. Metaepiphyseal and articular involvement suggests specific and long-term treatment with a high risk of disability. The objective was to report a clinical case of a teenager who suffered chronic hematogenous osteomyelitis of the tibial bones and raise awareness of primary diagnosis and treatment. Material and methods A clinical case of a teenager treated for extensive destruction of the tibial bones caused by chronic hematogenous osteomyelitis is reported. Clinical and functional evaluation of the effectiveness was produced at the stages of treatment. Results A positive functional result was achieved due to staged surgical treatment including radical debridement of the chronic infection nidus followed by total ankle arthroplasty. Discussion Acute hematogenous osteomyelitis persisting as chronic infection could be caused either by a wait-and-see strategy when the patient first sought medical help or a long-term follow-up. There is no consensus on the use of reconstruction or replacement of large long bone defects extended to the joints caused by chronic infection. Staged treatment including total joint replacement with custom-made endoprosthesis can be one of the options. Conclusion Staged surgical treatment including radical debridement followed by delayed total joint replacement with custom-made endoprosthesis provided satisfactory functionality for the limb without signs of infectious and inflammatory activity at a follow-up period of more than a year.

Primary radical correction of tetralogy of Fallot (ToF) is an optimal surgical option; however, in some conditions, in particular with concomitant extracardiac pathology and hypoplasia of the pulmonary artery (PA) branches, this intervention is not possible. Obstruction and/or hypoplasia of the PA is one of the risk factors for primary radical correction of this congenital heart defect (CHD). In world practice, there are several methods of palliative approach for PA growth with the possibility of further radical correction. However, in some cases, palliative approaches do not give the desired result. In this regard, we present a clinical case of a successful hybrid bifurcation Y-stenting of the PA and radical correction of ToF.

Background. Thrombotic thrombocytopenic purpura is a rare blood disease characterized by increased thrombogenesis in the microcirculation. One of the most common triggers for the development of this disease is pregnancy. The article describes a case of pregnancy complicated by thrombotic thrombocytopenic purpura.Materials and methods. To assess the clinical case, we used a retrospective analysis of medical documentation: maternity case record, birth history, results of laboratory and instrumental research methods.Results. A 32-year-old patient was admitted to hospital at week 32 of gestation with manifestations of moderate preeclampsia, thrombocytopenia, and moderate anemia. Due to worsening of the condition, the delivery was performed by cesarean section. Subsequently, the mother’s condition did not improve: thrombocytopenia and hyperbilirubinemia progressed; the level of transaminases increased; ADAMTS13 activity was 8 %. Teleconferences were repeatedly held with experts from the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov (Moscow). Complex therapy including extracorporeal methods led to a positive result; the patient was discharged in satisfactory condition under the supervision of a hematologist and obstetrician-gynecologist.Conclusion. Thrombotic thrombocytopenic purpura treatment tactics have its own characteristics; it is necessary to diagnose this pathology in a timely manner to provide qualified medical care and to prevent maternal and perinatal losses.

Aim. To describe a clinical case and analyze the challenges in diagnosing hypertrophic cardiomyopathy (HCM) in a patient with concomitant arterial hypertension (AH). Materials and methods. The article presents the clinical case of HCM in the patient with concomitant AH that was observed in an ambulatory setting in the Municipal Enterprise “Dnipropetrovsk Regional Clinical Center for Diagnostics and Treatment” of Dnipropetrovsk Regional Council. Results. A 66-year-old woman N., diagnosed by her family physician with coronary artery disease (CAD): stable angina FC II, grade 2 AH, chronic heart failure FC II NYHA, was referred to a cardiologist because of experiencing exertional dyspnea, chest pain, and uncontrolled blood pressure despite treatment compliance. Echocardiography identified concentric left ventricular hypertrophy with the left ventricular outflow tract (LVOT) obstruction (a mean gradient of 35 mmHg as per catheterization). Cardiac MRI confirmed the diagnosis and coronary angiography ruled out CAD. Adjustments to the treatment regimen, taking into account HCM with LVOT obstruction, effectively alleviated the patient’s symptoms and stabilized her blood pressure. Conclusions. It is especially important to follow the guidelines of AH management and perform echocardiography in all patients with high blood pressure, so as not to miss the signs of concomitant HCM, particularly with LVOT obstruction. In addition, in the case of HCM, it is necessary to timely detect, provide prevention and manage patients at risk for sudden cardiac death. Since HCM encompasses various diagnoses with different pathogenesis and distinct management, cardiac MRI, enzymatic or genetic testing may be needed according to guidelines. As HCM is a relatively common inherited cardiac disease, general practitioners could often encounter such patients in everyday clinical practice. Hence, they should have a certain suspicion of this diagnosis in persons with AH whose left ventricular mass meets the criteria for HCM. [ABSTRACT FROM AUTHOR]

The most common cause of severe cognitive impairment in adults is Alzheimer's disease (AD). Depending on the age of onset, AD is divided into early (<65 years) and late (≥65 years) forms. Early-onset AD (EOAD) is significantly less common than late-onset AD, accounting for only about 5–10% of cases. However, its medical and social significance as a disease leading to loss of ability to work and legal capacity, as well as premature death in patients aged 40–64 years, is extremely high. Patients with EOAD, as compared with late-onset AD (LOAD), have a greater number of atypical clinical variants: 25% and 6–12.5%, respectively, which complicates the differential diagnosis of EOAD against other neurodegenerative diseases. Nonetheless, the typical amnestic variant predominates in both LOAD and EOAD. Also, patients with EOAD have characteristic neuroimaging features: brain MRI scans from patients with EOAD often have more severe parietal atrophy and less severe hippocampal atrophy than those from patients with LOAD. This report addresses the features of the clinical and neuroimaging picture in patients with EOAD. A clinical case of a patient with EOAD is presented. [ABSTRACT FROM AUTHOR]

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L'objectif de cet article est de préciser les spécificités de l'approche psychanalytique du traumatisme, à partir de l'étude d'un cas clinique unique. Là où les discours contemporains tendent à souligner le rôle des évènements vécus dans la survenue d'un tableau psychopathologique, nous chercherons à montrer comment la psychanalyse opère un décentrement vis-à-vis des modèles explicatifs déterministes et linéaires. Â partir du cas d'un patient psychotique d'une cinquantaine d'années ayant perdu la vue suite à une blessure par arme à feu, nous montrerons comment la psychanalyse propose de mettre l'accent non pas intrinsèquement sur l'évènement passé, mais sur la réponse singulière et toujours imprévisible du sujet, dans une perspective diachronique prenant en compte l'importance de la temporalité et de l'après-coup. Nous pourrons ainsi étudier comment chez ce patient, l'évènement traumatique est progressivement réintégré dans une construction subjective singulière, et nous tenterons d'appréhender les ressorts stabilisateurs de cette construction au prisme de l'hypothèse freudienne du délire comme « tentative de guérison ». La méthode que nous avons adoptée est celle de l'étude d'un cas unique, dans la mesure où elle est la seule à pouvoir rendre compte de la singularité de la réponse du sujet dans son caractère diachronique. Il s'agira en particulier d'assumer le style d'une écriture analytique du cas qui s'écarte de tout idéal d'objectivité scientifique, puisque la technique psychanalytique se caractérise par la place majeure accordée à la dimension transférentielle dans la cure, et engage de fait la subjectivité du thérapeute. Nous nous efforcerons ainsi de restituer l'histoire de ce patient dans son déploiement temporel, en relatant les éléments biographiques et anamnestique tels qu'ils sont apparus au travers de la rencontre clinique, en y intégrant également des éléments issus de la consultation d'archives des dossiers médicaux. Nous étudierons ensuite l'évolution de sa position subjective au prisme des développements freudiens et lacaniens sur la psychose. Une approche psychanalytique a permis de mettre en évidence que, chez ce patient, sa position d'objet d'un préjudice est antérieure à la survenue de son agression par arme à feu. Cet évènement sera ainsi dans un premier temps réintégré par le sujet dans le cadre de la logique du délire de persécution qui le précède. Néanmoins, la reconnaissance sociale de sa position de victime a pu induire chez lui un effet pacificateur, et il réinterprètera dans un second temps cet évènement à partir de la construction d'une position d'exception, par l'incarnation de la figure du « voyant », qui viendra jouer un rôle de nomination et conduira à l'apaisement significatif des angoisses de persécution. Au-delà de l'hypothèse d'une « déduction logique » de la mégalomanie à partir des idées délirantes de persécution en vigueur dans la psychiatrie classique, la théorie freudienne et lacanienne permettent de situer les ressorts de cette position d'exception relativement à l'économie libidinale du sujet. Nous proposerons de discuter des similitudes existant entre la position d'exception construite par ce patient et deux cas célèbres de la littérature psychanalytique : le Président Schreber, auteur des Mémoires d'un névropathe , et l'écrivain irlandais James Joyce. Il s'agira en particulier de montrer que la construction délirante de notre patient diffère de la logique du « pousse-à-la-femme » à l'œuvre chez Schreber, et qu'elle n'est pas analogue non plus à la production d'un sinthome borroméen. En effet, sa construction délirante (contrairement à l'œuvre produite par Joyce) ne permet pas de le réinscrire dans une forme de lien social. Néanmoins, le travail thérapeutique réalisé avec ce patient lors de sa dernière hospitalisation permet de préciser comment la relation transférentielle peut dans certains cas permettre au patient psychotique de se saisir du thérapeute comme d'un partenaire qui viendrait authentifier l'advenue d'une position d'énonciation, ainsi que la production d'une nomination par le travail du délire. La méthode du cas unique permet de mettre en évidence que l'approche psychanalytique du traumatisme opère un décentrement vis-à-vis de toute perspective tendant à faire de l'évènement traumatique le ressort causal du tableau psychopathologique. L'abord de l'histoire du patient dans sa globalité et sa complexité permet ainsi au contraire de mettre l'accent sur la réponse unique et imprévisible du sujet. La logique temporelle de l'après-coup freudien implique en effet de reconsidérer dans une perspective dynamique et diachronique la rencontre entre le sujet et l'évènement, en prenant en compte le déjà-là de la structure, l'histoire singulière du sujet, mais aussi les potentialités créatrices et imprévisibles de chacun – la relation thérapeutique pouvant apparaître comme une quatrième dimension lorsqu'elle vient offrir un support à cette création subjective et l'accompagne. The objective of this article is to clarify the specificities of the psychoanalytic approach to trauma, based on the study of a single clinical case. Whereas contemporary discourses tend to emphasize the role of lived events in the emergence of a psychopathological picture, we aim to demonstrate how psychoanalysis operates a shift in perspective vis-à-vis deterministic and linear explanatory models. Focusing on the case of a psychotic patient in his fifties who had lost his sight following a gunshot wound, we demonstrate how psychoanalysis invites us not to place the emphasis intrinsically on a past event. Rather, it suggests looking at the singular and unpredictable response of the subject as an individual, in a diachronic perspective that takes into account the importance of temporality and hindsight. In this way, I was able to study how this patient gradually integrated the traumatic event into a singular subjective construct. In turn, this allowed me to understand the stabilizing mechanisms of this construct, through the prism of the Freudian hypothesis of delusion as an "attempt at healing". The method I adopted is that of the single case study. This approach was chosen as it is the only one that can illustrate the singularity of the subject's response in its diachronic character. In particular, I deliberately chose the style of an analytical case study. This differs from the ideal of scientific objectivity insofar as the psychoanalytic technique is characterized by the importance given to the transferential dimension in the cure, and thus calls upon the subjectivity of the therapist. Thus, I endeavored to reconstruct the history of this patient in its diachronic unfolding, by recounting the biographical and anamnestic elements as they appeared during the clinical encounter. To support this further, I integrated elements from the archival consultation of medical records. I then studied the evolution of the patient's subjective position through the prism of Freudian and Lacanian theories on psychosis. A psychoanalytic approach made it possible to demonstrate that in this patient, his position as the object of an injury predated the occurrence of his wounding by firearm. This later event was thus initially reintegrated, by him, within the framework of the logic of the delusion of persecution that predated it. Nevertheless, the social recognition of his position as a victim may have induced in him a pacifying effect. He was able to reinterpret the event in the aftermath, based on the construct of a position of exception. In that position, he assumed the figure of the 'seer' who played the role of naming, leading to a significant appeasement of the persecution anxieties. Here I propose a discussion of the possible similarities between the position of exception constructed by this patient, and the cases of President Schreber and the writer James Joyce. In particular, my aim was to show that the delusional construction of my patient differed from the logic of the 'pousse-à-la-femme,' and that it was also not analogous to the production of a Borromean sinthome. This was because his delusional construct did not enable his re-inscription into any form of social bond. Nevertheless, the therapeutic work carried out with this patient during his last hospitalization made it possible to pinpoint how the transferential relationship can, in some cases, help the psychotic patient to make use of the therapist as a partner. Such a partner authenticates the advent of a position of enunciation, and the action of naming through the process of delusion. The single case method made it possible to demonstrate that the psychoanalytic approach to trauma offsets any tendency to make the traumatic event the causal root of the psychopathological picture. By looking at the patient's history in its entirety and its complexity, it was possible to emphasize the unique and unpredictable nature of the subject's response. The temporal logic of Freudian hindsight calls for a re-evaluation of the encounter between the subject and the event from a dynamic and diachronic perspective. Such a re-evaluation takes into account structures that are already in place, the singularity of the subject's history, as well as the unpredictable creative potential of each individual. In addition, the therapeutic relationship may form a fourth aspect, when it becomes a support and accompaniment to the subjective creation. [ABSTRACT FROM AUTHOR]

L'objectif de notre étude est d'explorer les mécanismes à l'œuvre dans les cas de passages à l'acte suicidaires en période de post-partum. Il s'agit ici de souligner l'importance de l'accompagnement pluridisciplinaire, tant psychologique, médical que social, dans la mise en place d'un maillage pluridisciplinaire autour des parents pendant et après la grossesse. Notre méthode consiste en une revue de la littérature sur les enjeux de l'accompagnement de femmes en ante- et post-partum, afin de prévenir ou d'accompagner la dépression du post-partum et les passages à l'acte pouvant en découler. Nous appuierons notre propos sur l'étude d'un cas clinique illustrant les points aveugles du système de soin. Les résultats de notre étude montrent que la dynamique suicidaire en post-partum est multifactorielle, prenant sa source en période anténatale et parfois bien en amont, mêlant des facteurs endogènes et exogènes pour des femmes confrontées aux attendus supposés de la société envers la jeune mère. Il est également à noter que l'accompagnement de la dépression du post-partum se fait de façon inégale sur les différents territoires, par manque de moyens effectifs ou structurels, laisse échapper certains sujets au maillage professionnel et mène parfois un passage à l'acte. Nous observons que l'accompagnement pluridisciplinaire des femmes suicidaires permet de limiter les risques d'aggravation de la symptomatologie et d'un passage à l'acte. Nous encourageons le travail conjoint entre les professionnels institutionnels et les professionnels libéraux du champ psychiatrique, médical et social, pour la constitution du maillage pluridisciplinaire indispensable à l'accompagnement de toute femme dans son devenir mère, il s'agit d'une question de santé publique. The aim of our study is to explore the mechanisms that come into play in cases of suicidal acts during the post-partum period. Our starting point is to emphasize the importance of multidisciplinary support – psychological, medical and social – in establishing a multifaceted network for parents during and after pregnancy. Additionally, the link between post-partum depression and suicidal behavior is discussed, as are the different types of risk factors. Our method consists of a review of the literature on the issues involved in supporting women in the ante- and post-partum periods, to prevent or support post-partum depression, and any resulting acts of aggression. These observations are then supported through the study of a clinical case illustrating the blind spots in the care system, which can leave certain subjects out in the cold. The clinical case illustrates the desire to have a child, the use of drugs during the perinatal period and the consequences of confinement in France during the post-partum period. The results of our study show that the post-partum suicidal trajectory is multifactorial, originating in the antepartum period, combining endogenous and exogenous factors, as well as society's supposed expectations of the mother-to-be. It should also be noted that support for mothers suffering from post-partum depression is often uneven in the different regions of the country, due to a lack of resources in terms of staff or structure, sometimes allowing the patient to slip through the net of care, leading her to act out. Information and training for professionals on the issue of the post-partum period and its possible repercussions on the mother's behavior are essential for better prevention and rapid treatment. Sometimes, depression is diagnosed during pregnancy, which facilitates treatment and speeds up contact with professionals to provide the best possible support for the mother during her perinatal period. We note, however, that multidisciplinary support for suicidal women helps limit the risk of the symptoms worsening and the risk of the patient acting on them. We emphasize and encourage concerted work and cooperation between institutional professionals and independent professionals in the psychiatric, medical, and social fields, to establish the multidisciplinary network needed to support all women, as they become mothers. Multidisciplinary support for mothers is essential during the perinatal period. Of course, we need to consider the importance of the health professional's work, but the family, spouse, and friends are also essential resources for the mother's well-being, and it is important to include them in this support network. [ABSTRACT FROM AUTHOR]

Spontaneous coronary artery dissection (SCAD) is defined as a spontaneous dissection of the coronary artery wall that occurs independently of atherosclerosis, percutaneous coronary intervention, or mechanical trauma. Its distinctive feature is high prevalence in young women. This condition is associated with pregnancy and hormonal changes. A number of risk factors have been identified, including vascular pathology (most commonly fibromuscular dysplasia), other hereditary connective tissue disorders, systemic inflammatory diseases, migraine, and thyroid diseases. Nevertheless, the precise mechanisms of the pathophysiological relationship remain to be elucidated, and risk factors cannot be identified in all patients, indicating the complex and incompletely understood nature of the disease. The present article presents a case series on the development of SCAD in women and a review of the predisposing factors for the disease.

The article describes a clinical case of ectopic pregnancy with localization in the liver. The patient Sh. was admitted to the gynecological department with pain in the lower abdomen and epigastrium. Clinical, laboratory and instrumental examinations were conducted in accordance with clinical recommendations. The examinations showed that human chorionic gonadotropin level was 17,440.85 mIU/ml. Pelvic ultrasound did not determine the fetal egg in the uterine cavity. However, free fluid in the pelvis (about 50 ml) was found. Repeated pelvic ultrasound revealed a paraovarial formation on the right, and free fluid in the pelvis. Laparoscopic surgery was performed, during which a fetal egg was found in the V segment of the liver. Liver resection and cholecystectomy were performed on an emergency basis. This case describes the importance of timely and correct diagnostics and determination of patient management tactics to prevent the development of life-threatening complications.

Background. Methylmalonic aciduria (MMA) is a rare disease from the group of hereditary metabolic diseases. The MMA clinical picture is polymorphic and meanwhile similar to other metabolic disorders. Determination of specific metabolites in biological fluids and molecular genetic testing are crucial to diagnose this disease. Timely diagnosis mainly determines the treatment efficacy and, therefore, the prognosis of MMA development. Clinical case description. Two siblings with MMA caused by methylmalonyl-CoA mutase deficiency (OMIM #251000) have shown duplication chr6-49459106-T-TA: NM_000255.4c.360dupT (p.Lys121fs) in homozygous state in exon 2 of the MMUT gene. The disease was diagnosed in the first child with underlying metabolic crisis that finally led to irreversible changes in organs and systems and lethal outcome. The diagnosis in the second child was established antenatally, thus, therapy was initiated from the first day of life. Favorable clinical course of the disease was observed during 5 months of follow-up. Conclusion. Timely MMA diagnosis (antenatal or during neonatal screening) is crucial for effective management and relatively favorable life prognosis for infants.

Background. Psoriasis and vitiligo are chronic, relatively common dermatological diseases. Meanwhile, their combination in children is rare. The combination of psoriasis and vitiligo in a child with Sotos syndrome has not been previously described. Clinical case description. The boy, 10 years old, was hospitalized with complaints (according to his mother) of rashes on the scalp, body, and limbs, with mild itching that was not related to the time of day. The pathological skin process was widespread. The patient was hyperactive, restless, emotionally labile, irritable. Complaints of rashes was mentioned firstly at the age of 7. Sotos syndrome was established at the age of 8 (variant c.6559C>T (p.Arg2187Ter) in 23 exon of the NSD1 gene (5q35.3), autosomal dominant type of inheritance (pathological allele de novo)). Psoriasis vulgaris was diagnosed with secondary vitiligo (localized form) at the age of 8.5 years. Symptomatic antipruritic and external pathogenetic therapy was performed in the hospital. Phototherapy was not prescribed due to the relative contradiction (small retrocerebral cyst) and the peculiarities of major disease (hyperactivity, restlessness) that complicated to place the child in the phototherapy booth. Positive dynamics was noted during the treatment (14 days): no itching, decrease of peeling severity, flattening and blanching of psoriatic rash elements to spots of post-inflammatory hypopigmentation. The lesion (focus of depigmentation) on the right knee joint skin remained unchanged. The patient was discharged to outpatient care. The prognosis for Sotos syndrome and skin lesions is favorable. Conclusion. The first medical observation of the child with Sotos syndrome burdened with psoriasis and vitiligo is presented. The pathogenetic correlation of these diseases is not clearly defined. Management of such cases requires the joint collaboration of dermatologists, geneticists and pediatricians.

Background. Proud syndrome is rare inherited disease with X-linked inheritance associated with mutations in the homeobox gene ARX. Typical clinical signs of this syndrome are severe mental retardation, intractable epilepsy, agenesis (dysgenesis) of corpus callosum. Less common features are genital abnormalities, microcephaly, facial dysmorphia, and skeletal malformations. Clinical case description. The article describes the clinical findings of Proud syndrome in girl A., admitted to Children’s City Clinical Hospital No. 1 in Nizhny Novgorod. The girl was born without asphyxia at term through natural vaginal delivery after the first uneventful pregnancy. Body weight at birth was 2600 g. The genealogical history is burdened by the presence of epilepsy in girl’s father relatives. There were no deviations in psychomotor skills development before disease onset. Hemi-convulsive seizures (switching sides) have appeared at the age of 6 months. These attacks had status course and were resistant to anticonvulsant therapy. Neuroimaging has revealed agenesis of corpus callosum. Regression of psychomotor development, new behavioral disorders (stereotypes and auto-aggression), hyperexcitability, and sleep disorders were observed in dynamics. The diagnosis of Proud syndrome was confirmed by identification of probably pathogenic mutation in the ARX gene (c.1111C>T, p. Arg 371*64). The features of anticonvulsant management were demonstrated in the patient. Conclusion. This clinical case presents typical clinical picture of Proud syndrome. The disease is non-curable. Such patients should be administered with syndromic therapy: constant anticonvulsant therapy, correction of behavioral disorders (classes with specialist on mental defects), neurologist, epileptologist, psychiatrist observations. Parental examination is crucial ARX mutation search in order to determine the prognosis for further child-bearing (parents refused to perform genetic study at the time of article writing).

Background. Neonatal thrombosis remains a complex and urgent challenge due to the presence of certain features of the hemostasis system in newborns and the variety of clinical signs. Management approaches are still under consideration, therapeutic experience of thrombolytic therapy (TLT) remains limited and requires benefit-risk assessment. Clinical case description. Clinical case of premature infant with multiple arterial thrombosis diagnosed on the 1st day of life is presented. Modern diagnostic features have allowed to establish the right diagnosis quickly and to start the treatment in time despite the similarities of clinical signs with congenital heart disease. Conclusion. TLT and heparin therapy have saved the child’s life, reversed ischemia, and preserved lower limbs from death. Doctors must perform dynamic monitoring during TLT to diagnose and correct hemorrhagic complications in timely manner.

Introduction. Methemoglobinemia is a rare condition characterized by an elevated level of methemoglobin in the blood, leading to chemical hypoxia. The most common symptom is central cyanosis refractory to oxygen therapy. Diagnosis of methemoglobinemia is difficult due to the nonspecific clinical presentation and lack of awareness. Accurate diagnosis requires a thorough medical history, differential diagnosis, and confirmation through laboratory investigations.The objective was to demonstrate the successful use of ascorbic acid in the management of acute secondary methemoglobinemia in an 11-year-old boy on prolonged metoclopramide therapy.Materials and methods. The retrospective analysis was conducted on the clinical course of acute secondary methemoglobinemia in the 11-year-old boy on prolonged metoclopramide therapy, necessitating oxygen therapy and parenteral administration of ascorbic acid solution. Special attention was given to the clinical presentation, characteristic changes in laboratory parameters, and the effectiveness of timely ascorbic acid therapy. Clinical and laboratory improvement was achieved within 24 hours of treatment initiation.Conclusion. Caution should be exercised when prescribing medications that can induce methemoglobinemia, taking into account dosage, duration, and frequency of use. Furthermore, careful attention should be given to the combination of metoclopramide with other drugs that may affect iron heme oxidation reactions.

Complications after the introduction of the tuberculosis vaccine develop extremely rarely. They become accidentally vaccinated infants with undiagnosed severe immunodeficiency. The article considers a clinical case of the course of disseminated BCG infection with multiple organ damage in congenital immunodeficiency in a 9-month-old boy. The disease manifested itself acutely, the child’s condition worsened within a week, and its outcome was the death of the baby. Primary immunodeficiency was confirmed by the results of a pathoanatomic examination. The discussion provides a classification of complications after the introduction of BCG vaccine, the algorithm of the doctor’s actions in case of a suspected complication after vaccination, and also describes the main signs of immunodeficiency.

The use of biological markers for Alzheimer's disease (AD) allows diagnosis at the stage of moderate cognitive impairment and atypical course of the disease. We present two clinical cases of patients with posterior cortical atrophy (PCA), characterized by progressive impairment of visual and spatial functions due to atrophy of the parietal and occipital lobes of the brain. A differential diagnosis was made between AD, corticobasal degeneration and other diseases in which PCA syndrome occurs. In the cases observed, the patients showed a significant decrease in the level of beta-amyloid in the cerebrospinal fluid, which allowed the diagnosis of AD to be made. Clinical manifestations, diagnosis and treatment of PCA syndrome are discussed. At present, the diagnosis of AD at the stage of moderate cognitive impairment and mild dementia is of practical importance, as anti-amyloid therapy can prevent the progression of AD.

Libman–Sachs endocarditis (nonbacterial thrombotic endocarditis, NBTE) may be one of the cardiac manifestations of systemic lupus erythematosus (SLE). It is characterized by the presence of sterile platelet thrombi on previously normal heart valves. The diagnosis of NBTE is difficult as it is often asymptomatic until complications such as systemic emboli or valvular dysfunction occur. Patients with Libman–Sachs endocarditis and SLE are treated with immunosuppressive and anticoagulant therapy and, if it is ineffective, surgical treatment.A clinical case of SLE and Libman–Sachs endocarditis is presented. The clinical manifestations, diagnostic methods and treatment of NBTE in SLE are discussed. The difficulties in differential diagnosis and selection of optimal treatment tactics faced by physicians are highlighted.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a disease that develops unrelated to intracoronary intervention, atherosclerosis, aortic dissection, or mechanical trauma and causes a false lumen (intramural hematoma) in the wall of the coronary artery (CA) with impaired blood flow in it and myocardial ischemia in the affected region of the CA. SCAD most often develops in young and middle-aged adults (aged ≤50 years); among women, it becomes the culprit in 24%–35% of cases of acute myocardial infarction (MI). SCAD is a risk factor for MI, and incorrect interpretation of the angiographic picture and intravascular imaging methods can lead to incorrect tactics of patient behavior. CLINICAL CASE DESCRIPTION: This article presents a clinical case of SCAD leading to the development of MI in a young woman with concomitant connective tissue dysplasia and hereditary thrombophilia. The angiographic disease course resembled focal atherosclerosis, and in the course of invasive management, complications had arisen, confirming the probable genesis of coronary artery obstruction. CONCLUSION: SCAD is a complex disease, with a sudden onset and an ambiguous prognosis. In most cases, SCAD develops in young women in the absence of cardiovascular factors. It is difficult to diagnose because its signs and symptoms are similar to more common diseases, mainly MI. SCAD can masquerade as focal stenosis on an angiogram, mimicking an atherosclerotic plaque. The «gold standard» for diagnosing SCAD is optical coherence tomography (OCT). OCT enables the visualization of the state of all coronary artery walls and elucidates the pathogenetic mechanisms of MI. If performing OCT is impossible after diagnostic coronary angiography in young patients in suspected cases, the likelihood of DST and SCAD risk must be assessed to avoid errors in choosing treatments. The technical accessibility of intracoronary imaging methods reduces the frequency of diagnostic and, consequently, treatment errors.

BACKGROUND: Lambert–Eaton myasthenic syndrome (G73.1 according to ICD-10) is a rare autoimmune disease associated with a presynaptic impairment of neuromuscular transmission due to the production of antibodies to voltage-gated calcium channels. The peculiarity of Lambert–Eaton myasthenic syndrome is manifested in a combination of increased muscle weakness and fatigue with the phenomenon of «working in» — an increase in the muscle strength against the background of muscle load after a short-term maximum contraction. Lambert-Eaton myasthenic syndrome is often associated with small cell lung cancer and very rarely develops with tumors of another localization. CLINICAL CASE DESCRIPTION: We observed an 80-year-old patient with complaints of weakness and pain in the hips, shoulders, pelvic region, and half-ptosis of the eyelids. For half-ptosis of the eyelids, a differential diagnosis was conducted with myasthenia gravis. Stimulation electromyography revealed the M-response increment, i.e. the phenomenon of “working in”, which is typical for this syndrome. The examination revealed papillary thyroid cancer, which was later treated surgically. CONCLUSION: This case illustrates Lambert–Eaton’s paraneoplastic myasthenic syndrome, a rare tumor form associated with thyroid cancer.

We present a case report describing the diagnosis and management of a patient who presents with a rare diagnosis of Menetrier’s disease. This condition poses a diagnostic challenge to clinicians due to its nonspecific clinical presentation and is oftentimes misdiagnosed for more common gastric disorders. Menetrier’s disease is characterized by gastric mucosal hypertrophy and subsequent protein loss, resulting in gastric symptoms and widespread edema. While the etiology remains unclear, notable associations have been observed with Helicobacter pylori infection and overexpression of transforming growth factor alpha. The management often involves supportive measures with medical and surgical interventions for refractory cases and when necessary. This report includes a comprehensive review of the literature on the clinical presentation, diagnostic approach, and management of this rare disease. By documenting such cases in the medical literature, we aim to enhance the clinician’s ability to recognize and manage this disorder, thereby preventing the development of more severe manifestations such as diabetes mellitus. Menetrier’s disease is a rare disorder that should be suspected in patients with upper gastrointestinal complaints and hypertrophied gastric mucosa. With a rather broad differential diagnosis consisting of Zollinger-Ellison syndrome, hypertrophic lymphocytic gastritis, hypertrophic hypersecretory gastropathy, gastric adenocarcinoma, gastric polyps, infections such as histoplasmosis and tuberculosis, autoimmune-like inflammatory conditions such as sarcoidosis, and more commonly, gastrointestinal disease, it is often overlooked in the diagnostic workup. Therefore, it is crucial for clinicians to conduct a thorough evaluation and maintain a high clinical suspicion when there is concurrent H.pylori infection and/or imaging findings suggestive of hypertrophied gastric mucosa to avoid missing this disease.

Bronchial asthma and chronic polypous rhinosinusitis are diseases associated with a T2-inflammatory immune response. These nosologies can be combined, creating the preconditions for a more severe course of multimorbidity, requiring the use of genetic engineering biological therapy. Dupilumab is a monoclonal antibody that can specifically bind to the alpha subunit of the interleukin-4 receptor and block the action of interleukins 4 and 13, which play a key role in the development of T2 inflammation. Numerous studies have demonstrated the high effectiveness of this medicament. The use of dupilumab in some cases may be accompanied by an increase in eosinophils in the blood. This article presents scientific base and our own experience in treating patients with dupilumab-associated eosinophilia, in addition we describe an algorithm for examining this group of patients for the purpose of timely diagnosis of diseases such as eosinophilic granulomatosis with polyangiitis, eosinophilic pneumonia, etc. It should be noted that in the most cases eosinophilia during targeted therapy with dupilumab is temporary and does not cause clinical manifestations.

Aim. The aim of the work is to draw attention to the symptoms associated with Tourette syndrome and to examine the association with comorbid diseases. Materials and methods. A review of the scientific literature on Tourette syndrome (TS) was conducted using the following Keywords “tics”, “Tourette syndrome”, “Tourette obsessive-compulsive disorder, TOCD”, “obsessive-compulsive disorder, OCD”, “attention deficit hyperactivity disorder, ADHD” using PubMed, MEDLINE, EMBASE as search engines. Taking into account studies conducted in the last 10 years, the abstracts of 275 articles were analyzed. Articles were selected for the study based on the criterion of their close relevance to the topic. The study results covered in 49 articles were examined in more detail. A description of a TOCD clinical case was prepared from primary medical documentation with parental informed consent. Results. The prevalence of TS is quite variable, depends on epidemiological research methods and ranges from 0.3 % to 1.0 % worldwide. Given the methodological limitations of most studies, the actual prevalence may be 10 times higher. TS is a progressive disease and is characterized by regular stages. Tourette syndrome-plus is distinguished, including autoaggressive actions besides the basic symptoms of OCD and ADHD. The etiology of TS is still being studied. In particular, the impact of environmental factors is considered: infection or inflammation, perinatal complications and chronic psychosocial stress in childhood. In 70–80 % of cases, TS is a hereditary disorder, making it one of the most heritable childhood-onset neuropsychiatric diseases. Various approaches have been applied to assess the genetic architecture of TS, including candidate gene studies, segregation analysis, linkage analysis, cytogenetics, copy number variants (CNV), rare variation studies, genome-wide association studies (GWAS), and whole exome sequencing (WES). Currently, there is no specific laboratory or genetic test for TS diagnosis. Pharmacological treatments are available but often ineffective; behavioral and surgical treatments are under development. The clinical case of TS in a 10-year-old boy is described with an onset at the age of 7 years following frequent infections, manifested as cephalocaudal motor tics and several vocal tics (coprolalia, echolalia) with a progression to obsessive-compulsive behavior (mysophobia, compulsive skin picking, self-hitting, self-biting, repetitive compulsions). The presented clinical case is of great interest from the viewpoint of somewhat belated diagnosis of TOCD syndrome, as well as indicates the need to continue the search for effective methods of diagnosis and treatment. Conclusions. The case of comorbid OCD and tic disorder is a unique endophenotype combining externalized disinhibited TS movements in parallel with internalized distress reminiscent of OCD. Clinicians should consider these features when choosing treatment methods.

Chromomycosis is a slowly occurring mycosis of subcutaneous adipose tissue and skin. Most often, cases of the disease are recorded in countries with a tropical and subtropical climate. In the Russian Federation, the disease occurs sporadically. Very rarely (2 cases out of 100) malignant transformation into squamous cell carcinoma occurs. The article presents a clinical case of chromomycosis. A description is given of a patient in whom squamous cell carcinoma was detected at the onset of the disease, which was the reason for treatment by oncologists. Six months later, the patient had a relapse in the area of the postoperative scar and a focus in the area of the right hand. Repeated biopsy with histological examination made it possible to establish the correct diagnosis. Interest in the above clinical case was caused by the detection of chromomycosis in a resident of the city of Saint Petersburg, who was not in endemic areas, was not engaged in agricultural work, and denied the primary injury. Our patient experienced a rapid malignancy of the focus, after surgical treatment, a recurrence of deep mycosis occurred. A good effect was obtained from systemic antimycotic therapy.

Collusion designates a specific type of transference-countertransference interaction between two or more persons, linked by an unconscious and shared unresolved issue, which they avoid on an intrapsychic level by externalizing it in the interpersonal space. To find a way to identify collusion and to delineate it from other transference-countertransference interactions. We conducted this study based on a case series approach. The study material consisted of audiotaped clinicians-centered supervisions with oncologists. The case series methodology involved the systematic examination of a purposive sample of supervisions, with the aim to understand how and why they differ from one another with respect to the relational dynamic between the physician and his/her patient. Four cases/supervisions were selected as they allowed to situate collusion on the spectrum of transference-countertransference interactions. We report on it by describing a countertransference reaction, two transference-countertransference interactions, and a collusion. The study reveals the challenges and pitfalls of research on collusion. The results allow to confirm the criteria of our working definition of collusion and to delineate collusion from other transference-countertransference interactions, which represents a first step for the empirical investigation of collusion. [ABSTRACT FROM AUTHOR]

L'autopsie psychologique s'est ajoutée au coffre à outils diagnostiques du médecin psychiatre depuis son invention aux États-Unis, vers la fin des années 1950. Nous nous interrogeons toutefois sur la validité scientifique de cette méthode. Pour ce faire, nous retraçons l'histoire de sa création, avant d'en souligner les failles méthodologiques et les défauts : nous soutenons, à l'instar d'autres critiques, 1) qu'il est impossible de diagnostiquer un trouble mental chez une personne décédée en interviewant des proches et des connaissances, 2) que la littérature scientifique soutenant la validité de la méthode ne démontre pas qu'il est possible de répondre au point 1 avec une rigueur scientifique minimale et 3) que l'association entre la dépression et le suicide est un artéfact introduit par les failles méthodologiques des études sur l'autopsie psychologique. Nous montrons finalement que son utilisation outrepasse aujourd'hui l'objectif visé par ses créateurs. Psychological autopsy has been added to the psychiatrist's diagnostic toolbox since his creation in the United States in the late 1950s. However, we wonder about the scientific validity of this method. Therefore, we trace the history of its creation, before pointing out the methodological flaws and defects: we maintain that 1) it is impossible to diagnose a mental disorder in a deceased person by interviewing relatives and acquaintances, 2) that the scientific literature supporting the validity of the method does not demonstrate that it is possible to respond scientifically to point 1 and 3) that the association between depression and suicide is an artifact introduced by the methodological flaws of the studies on psychological autopsy. We finally show that its use today exceeds the objective of its creators. [ABSTRACT FROM AUTHOR]

Il existe une grande confusion entre les termes multidisciplinarité, interdisciplinarité et transdisciplinarité. Les soins complexes, comme ceux que nous rencontrons en psychiatrie, ne peuvent être gérés de façon efficace par une seule personne. Exigeante, l'interdisciplinarité analyse et harmonise les liens entre les différentes disciplines. Elle éclaire les situations complexes et enrichit les réponses proposées. Elle améliore la qualité, propose une approche globale de la personne en mobilisant les connaissances des différentes disciplines tout en défragmentant et décloisonnant leurs savoirs. There is considerable confusion between the terms multidisciplinarity, interdisciplinarity and transdisciplinarity. Multidisciplinarity suggests a juxtaposition of knowledge. The various specialists in their disciplines complement each other and intervene alongside each other around a common subject. This produces points of view, which are superimposed, without bringing out any real added value. Interdisciplinarity requires interaction and interrelation. The pooling of knowledge requires a greater intertwining of disciplines, minimizing the differences between them while preserving their specificities and their foundations. A specialist's robust monodisciplinary expertise enriches the other members of the team, allowing for a more global, more systemic approach. Refusing to approach complex problems through the categorial prism of individual disciplines, transdisciplinarity seeks to integrate disciplines to go between, through and beyond disciplines by completely dissolving traditional boundaries. One of the particularities of complex holistic care, such as that in psychiatry, is that it cannot be managed effectively by a single person or a single discipline. Hyperspecialization results in a segmentation of the human being by no longer taking into account the entirety of the person treated. By analyzing and harmonizing the links between the different disciplines, interdisciplinarity sheds light on complex situations and enriches the responses offered. It improves quality, offers a global approach to the patient by mobilizing knowledge from different disciplines and by defragmenting and decompartmentalizing their knowledge. Interdisciplinarity is not self-evident and it cannot be likened to a simple mode of coordination where complementarity is valued. To meet this challenge, communication, coordination and clarification of roles by the team leader, whose leadership is recognized and valued, are essential. The medical literature recognizes a real added value of interdisciplinary approaches in complex medical situations. Eventually, it may be necessary to go a step further. Nevertheless, transdisciplinarity is of such complexity and requires such maturity of the teams, that we do not support it as the first step toward implementing a patient holistic approach. By way of conclusion, we propose the metaphors that Choi and Pak developed. Multidisciplinarity is in a way a mathematical equation of the "2 + 2 = 4" type or, more daringly, a "salad bowl", juxtaposition and addition of ingredients or skills. Interdisciplinarity is likened to an equation of the "2 + 2 = 5" type or a "melting pot", which postulates that the result, due to an effective and harmonious interaction, is greater than the sum of the parts. Finally, they compare transdisciplinarity using a "2 + 2 = yellow" equation with the culinary metaphor of the "cake" highlighting integration. [ABSTRACT FROM AUTHOR]