The risk of offspring mood and anxiety disorders in the context of prenatal maternal somatic diseases: a systematic review and meta-analysis

Aims The importance of prenatal maternal somatic diseases for offspring mood and anxiety disorders may be overlooked or undervalued. We conducted the first systematic review and meta-analysis assessing the risk of offspring mood and anxiety disorders in the context of prenatal maternal somatic diseases. Methods We screened articles indexed in Embase (including Embase, MEDLINE, PubMed-not-MEDLINE), PsycARTICLES and PsycINFO databases up to August 2021. 21 studies were included. We examined the overall associations between prenatal maternal somatic diseases and offspring mood/anxiety disorders. Analyses were stratified according to maternal somatic diseases and follow-up duration. Results We observed an increased risk of mood and anxiety disorders in the context of prenatal maternal somatic diseases [relative risk (RR) = 1.26; 95% confidence interval (CI) 1.15–1.37, RR = 1.31; 95% CI 1.24–1.38]; maternal obesity(RR = 1.92; 95% CI 1.72–2.11), hypertensive disorders (RR = 1.49; 95% CI 1.11–1.86) and infertility (RR = 1.26, 95% CI 1.14–1.39) were risk factors for mood disorders; maternal polycystic ovary syndrome (RR = 1.61; 95% CI 1.42–1.80), severe obesity (RR = 1.56; 95% CI 1.44–1.68) and moderate obesity (RR = 1.36; 95% CI 1.28–1.44) were risk factors for anxiety disorders. Prenatal maternal somatic diseases increased the risk of mood disorders in childhood and adulthood (RR = 1.71; 95% CI 1.34–2.09/RR = 1.19; 95% CI 1.09–1.30), as well as the risk of anxiety disorders in adulthood (RR = 1.33; 95% CI 1.26–1.41). Conclusion The results indicate that prenatal maternal somatic diseases are associated with offspring mood and anxiety disorders, and that the associations may be long-lasting.

How to live an elderly woman with prolapse of the genitals?

Несмотря на значительное развитие современной медицины, проблема пролапса органов малого таза не теряет своей актуальности и по сей день. Симптомокомплекс, который возникает при изменении анатомии тазового дна и органов малого таза, существенно ухудшает качество жизни пациенток. Это обстоятельство особенно важно учитывать у женщин старшей возрастной группы. Безусловно, повышенного внимания требуют все пациентки, страдающие пролапсом тазовых органов, который может быть диагностирован в различных возрастных категориях. Однако особую обеспокоенность вызывает состояние пациенток именно постменопаузального периода. Это обусловлено тем, что в старшем возрасте происходят значительные изменения в организме женщины, которые выступают провоцирующими или усугубляющими факторами в развитии пролапса тазовых органов. Одним из основных аспектов у таких пациенток является состояние гипоэстрогении. Кроме того, в старшем возрасте встречается большое количество других соматических заболеваний, которые оказывают существенное влияние на прогрессирование патологического процесса. Также необходимо учитывать, что современная женщина практически треть своей жизни проводит в постменопаузальном периоде. Поэтому перед врачами стоит серьезная задача по достижению должного качества жизни возрастных пациенток. В настоящее время причины, приводящие к развитию пролапса, известны, однако окончательного ответа относительно этиологии данного заболевания до сих пор нет. Это обстоятельство диктует необходимость дальнейшего глубокого и детального изучения проблемы пролапса, а также поиска более совершенных диагностических и лечебных методик. Внедрение в клиническую практику новых методов и подходов будет способствовать своевременной диагностике заболевания и адекватному лечению, что существенно повлияет на состояние здоровья пациенток постменопаузального периода и позволит начать жить полноценной жизнью. In spite of the significant development of modern medicine, the problem of pelvic organ prolapse does not lose its actuality nowadays. Complex of symptoms that occurs when the anatomy of the pelvic floor and pelvic organs changes greatly decrease the quality of patients lives. This circumstance is especially important to take into account in older women. Certainly increased attention is required by all patients suffering from pelvic organ prolapse, which can be diagnosed in different age categories. However, the condition of postmenopausal patients is of particular concern. This is due to the fact that at an older age, significant changes occur in a woman's body, which act as provoking or aggravating factors in the development of pelvic organ prolapse. One of the main aspects of such patients is the state of hypoestrogenism. Besides, at an older age there are a large number of other extra genital pathology somatic diseases that influence significantly on the progression of the pathological process. It is also necessary to take into account that a modern woman spends almost a third of her life in the postmenopausal period. That is why doctors face a serious challenge to achieve the proper quality of life of age-related patients. Nowadays the causes leading to the development of prolapse are known, but there is still no definitive answer regarding the etiology of this disease. This circumstance dictates the necessity for further in-depth and detailed studying the problem of prolapse, as well as the search for more advanced diagnostic and therapeutic techniques. The introduction of new methods and approaches into clinical practice will contribute to the timely diagnosis of the disease and adequate treatment, which will significantly affect the health of postmenopausal patients and will allow them to start living a full life.

ALCOHOL ABUSE AS AN UNDERESTIMATED CAUSE OF NON-TRAUMATIC OSTEONECROSIS OF THE FEMORAL HEAD (DESCRIPTION OF CLINICAL CASES)

Osteonecrosis of the femoral head is a severe degenerative-dystrophic disease, which is characterized by the destruction of the bone substance in the head in the most vulnerable (loaded) parts. Due to a rapid progression in the absence of proper surgical treatment, osteonecrosis of the femoral head, as a rule, results in disability. There is a wide range of causes that cause the development of osteonecrosis. According to the authors, alcohol abuse should be attributed to the underestimated causal factors of this pathology. The article presents two clinical observations which convincingly demonstrate the role of alcohol abuse as a cause of osteonecrosis. In a 44-year-old man prolonged alcohol abuse led to a progressive (within a year) advance of osteonecrosis in the heads of both femurs, and in a 26-year-old woman, along with a short-term intake of glucocorticoids, it contributed to the formation of multifocal non-traumatic osteonecrosis with damage to the pelvic, right knee, shoulder joints. The authors explain underestimated role of alcohol abuse as a causal factor of osteonecrosis as follows. Firstly, patients, as a rule, try not to display their addiction, and therefore, unlike other predictors of developing femoral bone osteonecrosis (injuries, serious somatic diseases, taking glucocorticoids), this fact is not reflected in medical documentation. Secondly, patients with idiopathic forms of osteonecrosis often do not have an "assigned" doctor who could dynamically follow up the patient and, consequently, monitor more carefully his condition and risk factors for osteonecrosis. When consulting such a patient, a subspecialist, as a rule, sets himself the task first of all to exclude "his disease", which makes the patient vulnerable in terms of finding out the causes of osteonecrosis. These clinical cases demonstrate the need to take into account alcohol abuse as a significant causal factor in the development of osteonecrosis.

IMPACT OF PSYCHOLOGICAL FACTORS ON INTEGRAL CHARACTERISTIC OF HEALTH. PROSPECTIVE POPULATION STUDY OF WORKERS IN DANGEROUS PROFESSIONS

Aim. To assess the social status and methods of psychological protection of the individual in a number of organized populations in several typical regions (5 cities of Russia), as well as to compare the identified psychological characteristics with traditional risk factors (FR) and chronic non-communicable diseases in a prospective population study. Material and methods. In 2010 - 2011, in five cities of Russia (Nizhny Novgorod, Veliky Novgorod, Vologda, Nalchik, Omsk), screening was conducted on full (representative) samples from organized populations (at least 500 people in each, with a response to the survey from 80 to 90%). A total of 2,227 people were examined: 1,336 women and 891 men aged 25-75 years. In 2012-2014, a prospective (through 3 years) population study in the cities of Nizhny Novgorod, Nalchik, Veliky Novgorod and Omsk. Screening of the same organized population was conducted in 1202 people (response-64.7%). The questionnaires for assessment of social-economic status, somatic and psychological health, life style index or psychological defense mechanisms, pathogen reflection, psychotism scale, hospital scale of anxiety and depression, international stress scale, as well as the moral potential of person were methods of screening. Results. It was exposed that among the mechanisms of psychological defenses primitive ones dominated, especially projection, replacement, denial and suppression; the pathogen reflection style was formed in the most of the respondents. In process of mathematic analysis we used the method of «simple cross-tabulation» for join all negative mechanisms of psychological defense. It gives us the possibility to show their significant connection with the most somatic diseases in the personal history (р<0,001). Conclusion. Psychological parameters significant dominate over physiological signs in their impact on the health. Thus it demands necessity to take into account the psychological status in the health improving process.

The Psychological Services Role in the Psychodiagnostics and Psychocorrection of Psychosomatic Patients in the Psychoemotional Situation

The article discusses the emotional state disorders that occur in patients with psychosomatic illnesses, their role in the severity of the disease and its negative consequences. It is noted that various somatic diseases such as cardiovascular disease, diabetes mellitus, gastrointestinal diseases are often manifested by emotional state disorders and conversely, in these diseases emotional sphere disorders prevent complete recovery from the disease. These cases require the organization of psychological care in the clinic of psychosomatic diseases and the implementation of all psychoprophylactic and corrective measures.

Systemic diseases and their association with open-angle glaucoma in the population of Stockholm

Objective We aimed to study open-angle glaucoma in association with somatic comorbidities in the total population of adults in Region Stockholm. Methods The study population included all living persons aged 19 years and above who resided in Stockholm County, Sweden, on 1 January 2017 (N = 1 703 675). Subjects with specified diseases were identified with data from all registered consultations and hospital stays during 2008–2019. As outcome, the risk of being associated with a diagnosis of open-angle glaucoma was identified during 2012–2018. Analyses were performed by gender, controlling for age and socio-economic status. Age-adjusted odds ratios (ORs) with 95% confidence intervals (95% CI) for women and men with open-angle glaucoma, using individuals without this as referents, were calculated. Socio-economic status was assessed based on the neighbourhood the subjects lived in. Results In total, 16,299 cases of open-angle glaucoma were identified during 2012–2018, 9204 women and 7095 men. Higher fully adjusted OR (95% CI) for risk of being associated with open-angle glaucoma was for women and men with diabetes 1.138 (1.074–1.207) and 1.216 (1.148–1.289), cancer 1.175 (1.120–1.233) and 1.106 (1.048–1.166), hypertension 1.372 (1.306–1.440) and 1.243 (1.179–1.311); and for women with thyroid diseases 1.086 (1.030–1.146), chronic lung diseases 1.153 (1.093–1.216), and inflammatory arthropathies 1.132 (1.006–1.275). Higher glaucoma incidence was observed in individuals residing in high socio-economic status neighbourhoods. Conclusion The risk of glaucoma is increased in some somatic diseases, especially in individuals with diabetes, hypertension and cancer; and in higher socio-economic neighbourhoods as compared to lower socio-economic neighbourhoods.

Modern approach to the diagnosis and treatment of thrombocytopenia

Normally, the number of platelets in a healthy adult is in the range of 150-320 x 10⁹. A condition in which their number falls below 150x10⁹ is called thrombocytopenia. It can be both associated with a violation of the process of platelet formation in the bone marrow (in particular, with aplastic anemia, hemoblastosis, thrombocytopenic purpura), and be a concomitant pathology, for example, be a consequence of drug treatment of a number of somatic diseases. In the pathogenesis of thrombocytopenia, three main directions are distinguished: a decrease in platelet production, an acceleration of their decay and a violation of the distribution of the platelet pool with their sequestration in the spleen. Most often, drug thrombocytopenia develops against the background of the use of cytostatics, chloramphenicol, antithyroid drugs, NSAIDs. The decrease in the number of platelets can also be influenced by the regular use of alcohol, some infectious diseases, and immunodeficiency states. The main clinical manifestation of thrombocytopenia is hemorrhagic syndrome, proceeding as petechial rashes or ecchymosis, however, in some cases, clinical manifestations may be absent, and then the diagnosis is made on the basis of a clinical blood test. Treatment of thrombocytopenia is carried out taking into account the etiological factor that caused it.

The viral myocarditis with cardiac аrrhythmia as complication of COVID-19 in the practice of family doctor of the tuberculosis dispensary

BACKGROUND: About 70% of TB dispensary patients have chronic somatic diseases which not only prevent effective treatment of TB but also take progressive course themselves. AIMS: To timely detect and treat acute and chronic somatic disease combined with TB. MATERIALS AND METHODS: since 2020 the algorithm of patient complex investigation by specialists of therapeutic profile was developed in the Tuberculosis Dispensary No. 5, among them the general practitioner was the coordinator of the patients medical route. This became especially relevant during the COVID-19 pandemic. RESULTS: In accordance with the developed algorithms of diagnostic search the patient was comprehensively examined. There were no signs of tuberculosis were in him, however the general practitioner involving to specialists team could diagnose signs of complex cardiac arrhythmia the probable cause which was a new coronavirus infection that he had had six weeks before. CONCLUSIONS: The organization of a new form of medical service for phthisiatric patients allowed general practitioner to reveal serious cardiac pathology directly at the TB dispensary, to refer the patient for consultation to the cardiologist-arrhythmologist, to follow the patient and perform recommended cardiologic treatment simultaneously with measures or medical supervision over persons contacting with tuberculosis.

The role of Helicobacter pylori in complex human comorbidity

One of the main features of modern medicine is the fact that most somatic diseases lose their mononosological character, acquiring the status of comorbidity. Comorbidity has become a separate research area in various specialties of medicine and is currently being formalized into a system of knowledge about the patterns of combination of diseases. With regard to infectious pathology, the term "comorbidity" is rarely mentioned. In the conventional sense, comorbidity is understood as a combination of two or more diseases in a patient at the same time.In our opinion, the term "comorbidity" can be applied from the standpoint of the simultaneous combination of somatic and infectious diseases, but with a certain addition. In particular, it can be used in relation to somatic pathology with simultaneous combination with both monoinfection and polyetiologic. This is "complex comorbidity", which should be understood as "a complex pathological condition of a person, characterized by a simultaneous or sequential combination of psychosomatic and infectious pathology. It can take place when one or more infectious diseases are combined in combination with psychosomatic nosologies consisting of one or more units. "Over the past decade, a significant number of works have appeared on the role of H. pylori in the etiology and pathogenesis of a large number of somatic diseases. H. pylori plays in the development of many diseases - both associated with the stomach and determining the damage to other organs and systems. The clinical significance of this infection is determined by its leading role in the formation of chronic gastritis, gastric ulcer and duodenal ulcer, MALT lymphoma, and gastric adenocarcinoma. There is good evidence for the association of H. pylori infection with idiopathic iron deficiency anemia and idiopathic thrombocytopenic purpura. The clinical aspects of H. pylori infection are heterogeneous and include a wide range of pathologies, the evidence base for which at both the pathogenetic and clinical levels continues to expand.