Рубрика: Медицина

Аннотация: (English) The subject of the present research is the specificity of the prehospital management of acute life-threatening conditions of diabetic ketoacidosis (DKA) and severe neuroglycopenia in patients with type 1 diabetes mellitus (T1DM) within the framework of the American emergency medical services (EMS) system. The clinical situation is analyzed wherein the provision of urgent care under conditions of information deficit and severe time constraints becomes a catalyst for severe iatrogenic complications. In focus are the cognitive biases of providers, the phenomenon of diagnostic obfuscation and systemic contradictions between the complex transcellular biochemistry of endocrine crises and the rigid architecture of field operational algorithms. The objective of the work consists in conducting a comprehensive, pathophysiologically substantiated critical analysis of the most common diagnostic and therapeutic errors committed by emergency medical crews. The research seeks to deconstruct the mechanisms of iatrogenesis occurrence to substantiate the necessity for the profound humanization and conceptual optimization of local EMS protocols. To realize the set objective, an integrative critical review design was applied, combining elements of the retrospective analysis of clinical guidelines and the assessment of epidemiological metrics. Leading medical repositories (PubMed, Cochrane Library, Scopus) served as the information base, encompassing specialized publications for the 2010-2024 period. The research synthesizes current consensuses of US associations (ADA, NAEMSP, ACEP) and representative data of the National Emergency Medical Services Information System (NEMSIS). The extracted data array was subjected to thematic content analysis with the stratification of identified deviations into three fundamental categories: diagnostic distortions, osmotic catastrophes of fluid resuscitation and pharmacotherapeutic incidents. The research results convincingly demonstrate that the high frequency of complications in patients with T1DM is a logical consequence of systemic algorithmic dissonance rather than the individual incompetence of medical professionals. To break the vicious cycle of iatrogenesis, the mandatory integration of expanded screening (POCT) into the basic triage protocol, the categorical rejection of the prehospital application of exogenous insulin and the transition to a restrictive, physiologically calibrated tactic of infusion therapy and the gentle alleviation of hypoglycemia (D10W) are critically necessary. The global transformation of prehospital endocrinology requires the abandonment of the rigid “cookbook medicine” concept in favor of adaptive guidelines returning to paramedics the right to scientifically substantiated clinical judgment.

Аннотация: (English) Massage therapy is widely used to relieve muscle tension and improve circulation, yet the physiological mechanisms responsible for these effects remain fragmented across disciplines. This study constructs a hierarchical model of how massage acts on muscle tissue, the vascular system, and the nervous system at different levels of biological organization. Through a systematic review of 20 peer-reviewed sources, including shear-wave elastography studies, Doppler ultrasound investigations, near-infrared spectroscopy measurements, and molecular-level biopsy analyses published between 1990 and 2024, the study identifies four distinct levels at which massage exerts its effects: the tissue level (viscoelastic deformation and fascial remodeling), the macrovascular level (venous return facilitation without significant arterial flow increase), the microcirculatory level (capillary perfusion enhancement and lymphatic drainage), and the neuroreflex level (spinal, brainstem, and cortical modulation of muscle tone). A notable finding is that massage does not increase arterial blood flow to muscles, as demonstrated by Shoemaker et al. [8] and confirmed by Wiltshire et al. [10], contradicting a widely held assumption. At the molecular level, Crane et al. [1] showed that massage attenuates NF-κB signaling and stimulates mitochondrial biogenesis via PGC-1α activation. The study proposes three original analytical frameworks: a three-stage temporal model of muscle relaxation based on shear-wave elastography data [4; 6; 7], a concept of differentiated vascular response synthesizing Doppler and near-infrared evidence [8–12], and a comparative effectiveness matrix evaluating six massage techniques across six physiological parameters.

Аннотация: (English) In the context of the global increase in diabetes mellitus, which by 2024 has affected 589 million people, ensuring the safety of aesthetic procedures becomes a priority task in podology and dermatology. The present study is devoted to the substantiation of standards for safe manicure in patients with endocrinological disorders who have a high risk of injury due to diabetic neuropathy and angiopathy. The aim of the work is a comparative analysis of the effectiveness and safety of dry and wet hardware technologies for nail plate treatment. The research methodology is based on a systematic literature review, analysis of ADA and IWGDF clinical guidelines, as well as a retrospective case study of the author’s practice. The results demonstrate that the use of wet spray technologies makes it possible to maintain the temperature in the treatment area below the protein coagulation threshold (<40°C) and reduces the concentration of respirable bioaerosol by 90%, which is critically important for the prevention of infectious complications. In conclusion, it is stated that there is a need to introduce hydro-burring as the most appropriate option for diabetic patients, excluding aggressive cuticle removal. The information contained in this article will be of interest to practicing podologists, nail service specialists, dermatologists, and endocrinologists seeking to improve patients’ quality of life.

Аннотация: (English) This article examines the impact of different diet types, plant‐based and Western, on the composition and functional state of the gut microbiota, its metabolites, and related immunometabolic processes. The relevance of this study is rooted in the key role of the microbiota as an “auxiliary organ” that synthesizes vitamins, regulates energy metabolism, and shapes immune tolerance through the production of short‐chain fatty acids (SCFAs), which account for a substantial portion of interindividual differences attributable specifically to diet. This work aims to systematically describe and quantitatively assess changes in taxonomy, metabolomes, and markers of barrier function and inflammation when switching to plant‐based versus Western dietary patterns, drawing on the latest metagenomic cohorts, intervention studies, and multi‐omic analyses. Methodologically, the study combines metagenomics (shotgun sequencing, 16S rRNA), gas chromatography-mass spectrometry of SCFAs, measurement of permeability and inflammation markers (CRP, IL‐6, TNF-α, zonulin, LBP), and multivariate statistical models. The novelty of this work lies in the integration of large‐scale population data with controlled intervention results, which not only confirmed a consistent increase in butyrate‐producing genera and SCFA levels on plant‐based diets but also traced in detail the molecular mechanisms of their anti‐inflammatory action via GPR41/43 receptors and histone deacetylase inhibition, while juxtaposing these effects against dysbiosis, endotoxemia, and chronic inflammation observed with Western‐type diets. This article will be valuable to dietitians, microbiologists, clinical researchers, and preventive medicine specialists interested in evidence‐based microbiota modulation through rational nutrition.