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# Diabetes Mellitus (DM) - Recommendations
## Recommendations
- HbA1c once every 6 months.
- Urinalysis and albuminuria test once a year.
- Blood biochemistry (BB): total cholesterol, LDL, triglycerides (TG), creatinine, GFR calculation, potassium, total protein, total bilirubin, ALT, AST, uric acid, glucose - once a year.
- ECG once a year.
- Consultation with a podotherapist (foot specialist), ophthalmologist and neurologist once a year.
- Blood test for hormones: TSH, free T4, anti-TPO antibodies.
- Nutrition: up to 6 meals a day, limiting easily digestible carbohydrates with a high glycemic index and animal fats (20 bread units).
- Dosed physical activity (walking) 150 minutes per week.
# Herpes Zoster (left buttock and thigh), moderate pain syndrome
## Examination plan
- Neurologist consultation.
## Treatment
- Diclopol 100 mg 1 time/day.
- Pregabalin 75 mg at night with subsequent dose titration until the analgesic effect is reached, not exceeding 600 mg per day, then gradual dose reduction to full withdrawal.
- Amitriptyline 25 mg per schedule.
- Physiotherapy (PT).
# Coxarthrosis (right stage 1-2, left stage 3-4); Aseptic Necrosis of the Left Femoral Head; Vertebrogenic Lumbalgia
Moderate pain syndrome, chronic course. Coxarthrosis right side stage 1-2, left side stage 3-4. Aseptic necrosis of the head of the left femur. Vertebrogenic lumbalgia, moderately expressed pain syndrome, chronic course.
## Examination plan
- Complete blood count (CBC), urinalysis, blood biochemistry (BB), PSA, ECG.
## Treatment
- Chondroprotector courses of 3 months: chondroitin 1200 mg per day; or Structum 500 mg 2 times/day for 3 months; or solution Mucosat 2.0 IM every other day, N15; or glucosamine 1.5 g per day (Dona 1 sachet per day for 3 months) - 2 times a year; or solution Alflutop 1.0 IM 1 time/day, N20.
- For pain: nimesulide 100 mg 2 times/day or meloxicam 15 mg per day; NSAID ointments topically 2-3 times/day for pain; exercise therapy (ET).
- Exercise therapy for the joints. Calcium-rich diet. Avoid overloading and overcooling.
- Aceclofenac (Aertal) 100 mg 2 times/day for pain, after meals, 10-14 days.
- Omeprazole 20 mg per day for the duration of NSAID use.
- Topically on painful areas: NSAID gels/ointments 2-3 times/day (ketoprofen, Naiz).
- Chondroprotectors as a long course, minimum 3 months, 2 times a year (Chondromed, Structum 500 mg x 2 times/day, or Donica (Dona) 1500 mg 1 time/day, or solution Chondroitin sulfate (Mucosat) 2.0 IM 1 time/day every other day, N30).
- Calcium and vitamin D3 preparations 500 mg/400 IU, 1 tablet 2 times/day for 3 months, 2 times a year.
- Pregabalin 75 mg: 1 capsule (days 1-2), 2 capsules (days 3-4), 3 capsules (days 5-14).
- Sirdalud 4 mg 1 tablet in the evening - 10 days.
- Xefocam 8 mg 1 tablet in the morning - 5 days, then Aertal 100 mg 1 tablet in the morning - 7 days.
- Detraven 1000 mg 1 tablet 3 times/day - 5 days.
- Given the persistence of the pain syndrome: Reneira 75 mg 1 capsule in the evening - 5 days, then 1 capsule 2 times/day - 10 days, with gradual withdrawal by reducing the intake to 1 capsule in the evening.
- Gabapentin 300 mg, 1 capsule 1 time a day (days 1-5), 2 times a day (days 6-10), 3 times a day (days 11-15), 4 times a day (days 16-21), with subsequent withdrawal.
# Acute Hemorrhagic Cystitis; Urolithiasis (in history)
## Examination plan
- Urinalysis and CBC to be repeated on 20.03.2023.
- Repeat urologist examination on 20.03.2023 at 13.00, room 433 (in 4 days).
## Treatment
- Fosfomycin 3 g, single dose at night.
- Furagin 100 mg, 1 tablet 3 times a day for 7 days.
- Canephron 2 dragees 3 times a day for 10 days.
- Kidney herbal teas (cornflower flowers, birch buds, bearberry, pol-pala) 3-4 times a day for 10 days.
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- Ibuprofen 1 tablet 2 times a day for 5 days.
- No-shpa 1 tablet 3 times a day for 7 days.
- Plentiful drinking regimen.
- Warmth on the bladder area.
# Primary Osteoarthritis (POA) of Hand Joints and Knees; Osteoporosis; Bilateral Carpal Tunnel Syndrome
## Diagnosis
- Primary osteoarthritis (POA), osteoarthritis of the hand joints stage 1, gonarthrosis stage 1. Functional insufficiency of joints (FNS) 1.
- Osteoporosis L1-L4 (T-score -3.8).
- Carpal tunnel syndrome on both sides.
## Examination plan
- Anti-CCP antibodies (to exclude rheumatoid arthritis).
## Treatment
- Therapeutic physical training (exercise therapy).
- Chondroprotector courses of 3 months, 2 times a year: Structum 500 mg 2 times/day for 3 months.
- Topically: ketoprofen gel + compresses with Dimexide on the hand joints.
- For pain: Naiz 1 tablet 2 times/day.
- Omeprazole 20 mg 30 minutes before breakfast.
- Vitamin D 50,000 IU per week.
- Calcium D3 Nycomed Forte 1 tablet 2 times/day.
- Alendronic acid 70 mg 1 tablet once a week.
# Arterial Hypertension (AH) - List of Investigations
## Investigations
- Blood pressure (BP) and heart rate (HR) profile.
- Complete blood count.
- Urinalysis.
- Blood biochemistry: determination of the concentration of glucose, urea, creatinine, cholesterol, potassium, sodium, calcium.
- GFR (by the Cockcroft-Gault formula).
- ECG.
- Echocardiography (Echo-CG).
- Ophthalmologist consultation.
# Chronic Helicobacter-associated Antral Gastritis; Unspecified Anemia
## Diagnosis
- Chronic Helicobacter-associated antral gastritis, mildly expressed, mildly active, with focal complete intestinal metaplasia grade 1 (+), with qualitative atrophy grade 1 (+), HP+ (06.02.2024).
- Eradication in history (2018; stool antigen test for H. pylori negative from 26.01.2024).
- Anemia, unspecified.
## Examination plan
- Control of eradication in 6-8 weeks: 13C urea breath test or stool antigen test for H. pylori (exclude antibiotics and PPIs (omeprazole, pantoprazole, etc.) for 2 weeks before the test).
- EGDS (esophagogastroduodenoscopy) with biopsy per OLGA, once in 3 years.
## Treatment
- Pantoprazole 40 mg 2 times/day for 14 days.
- Ulcavis (bismuth) (film-coated tablets, 120 mg) orally 120 mg 4 times a day, 30 minutes before meals; the last dose may be taken at night.
- Tetracycline (film-coated tablets, 100 mg) orally 500 mg 4 times a day for 14 days (prescription on the card).
- Metronidazole (tablets 250 mg) orally 500 mg 3 times a day, during or after meals, for 14 days.
- Alternative: omeprazole 20 mg, 1 capsule 2 times/day for 14 days, 30 minutes before meals; amoxicillin 1000 mg (without clavulanic acid), 1 tablet 2 times/day for 14 days; clarithromycin 500 mg, 1 tablet 2 times/day for 14 days.
# Spine Examination Findings and Dispensary Plan
## Objective findings
- The volume of active movements is limited in the lumbar spine, palpation of the paravertebral points (PVP) is painful, myofixation of the lumbar region, no tension symptoms.
- The volume of active movements is limited in the cervical spine, palpation of the paravertebral points is painful, myofixation of the neck region.
## Examination plan
- According to the Resolution of the Ministry of Health of the Republic of Belarus dated 16.12.2024, N173 "On the procedure for conducting dispensarization of the adult and child population".
## Recommendations
- Healthy lifestyle, work and rest regime, full healthy sleep, avoid overcooling, excessive physical and psychoemotional load, exercise therapy in a gentle regime according to the general strengthening method.
# Vertebrogenic Left-sided Lumboischialgia
Unstable mild pain syndrome.
## Dispensary observation group D1
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## Prescriptions
- Hygiene of postures and movements.
- Exclude work associated with prolonged stay in a forced position, lifting and carrying heavy objects, frequent bending of the trunk. Therapeutic physical training (exercise therapy) on a long-term basis.
- Chondroprotector courses 1-2 times a year, outpatient: Alflutop 1 ml IM 1 time a day, N20, or Mucosat 2 ml IM every other day for 1 month, then Chondrosamine 1 capsule 2 times a day for 2 months.
- With an increase in the pain syndrome - a short course of NSAIDs (Arcoxia 60 mg 1 tablet 1 time a day, or Aertal 100 mg 1 tablet 2 times a day, or Movalis 15 mg 1 tablet 1 time a day), together with muscle relaxants (Tizalud 4 mg 1 tablet 1 time a day, or tolperisone 150 mg 1 tablet 3 times a day - 10 days).
# Examination Findings: Oral Cavity, Pharynx and Lymph Nodes
Lips without cracks and ulcerations, no induration on palpation. Visible mucous membranes of the oral cavity and pharynx are clean, no plaque. Mucosa of the cheeks without plaque, unchanged. Mucosa of the floor of the mouth without visible changes and formations. Tongue moist, clean, without pathological plaque, cracks, ulcerations. Gum mucosa of normal color, without visible changes. Tonsils of normal structure, not enlarged, no plaque.
Peripheral lymph nodes: lymph nodes accessible to palpation (posterior cervical, anterior cervical, submandibular, parotid, supraclavicular, subclavian, axillary, ulnar) and inguinal are not enlarged, painless, mobile, not fused with the skin.
# Styloiditis (right)
## Diagnosis
- Styloiditis on the right.
## Dispensary observation group D1
## Prescriptions
- Diclopentil 1 tablet 2 times/day for 7 days, after meals.
- Omeprazole 20 mg 1 tablet 2 times/day for 10 days.
- Topically: Dimexide gel + Troxevasin gel + diclofenac gel 3 times/day.
- Elastic bandaging.
- Physiotherapy (PT): electrophoresis with novocaine, ultrasound therapy with Dimexide, N10.
- If conservative therapy is ineffective - decide on a blockade.
## Investigations
- X-ray of the right wrist joint in two projections.
# Allergy - Recommendations
- Hypoallergenic environment at home (remove carpets and other dust collectors, frequent wet cleaning, frequent airing, control of mold fungus, etc.).
- Hypoallergenic diet with limitation of obligate allergens (citrus fruits, chocolate, whole milk, chicken protein, coffee, exotic fruits, etc.).
# Bilateral Carpal Tunnel Syndrome; Vertebrogenic Cervicalgia
Carpal tunnel syndrome on both sides. Vertebrogenic cervicalgia, mild pain syndrome, exacerbation.
## Dispensary observation group D1
## Prescriptions
- 1. Avoid lifting heavy objects and prolonged stay in a forced position.
- 2. Neuromidin 20 mg, 1 tablet 3 times a day for 1-2 months.
- 3. B-group vitamins, 1 tablet 1 time/day (Milgamma, Borivit).
- 4. Trental 100 mg, 1 tablet 1 time a day after meals for 1 month.
- 5. With an increase in the pain syndrome - a short course of NSAIDs (Aertal 100 mg, 1 tablet 2 times a day for 5-7 days) together with omeprazole (20 mg, 1 capsule 2 times a day).
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# Acute Respiratory Infection (ARI) - Recommendations
- Gargle the throat with Furasol / Furacilin / chamomile 3-4 times a day.
- Irrigate with Phytospray / Hexaspray / Orasept up to 4 times a day.
- Septolete Total / Anzibel / Dequadol lozenges - dissolve up to 4 times a day.
- Plentiful warm drink, vitamin C 1000 mg per day, in a complex with B and D vitamins, zinc, selenium.
- At a temperature above 38.5: paracetamol / ibuprofen / Ibuklin.
# Varicose Veins of the Lower Limbs, C3sEpAsPr; Infected Wounds of the Right Shin
## Recommended
- Treatment by a surgeon at the polyclinic at the place of residence (dressings daily until the wounds heal) or in a surgical hospital.
- Surgical treatment of varicose veins is not indicated at present.
- Elastic compression (elastic bandaging, compression hosiery (knee-highs, stockings) of compression class 2).
- Venotonics (Detralex 1000 mg 1 tablet 1 time a day, or Venolek 600 mg 1 tablet 1 time a day, or Phlebodia 600 mg 1 tablet 1 time a day) in courses of 1 month, 2-3 times a year.
# Benign Prostatic Hyperplasia (clinically); Chronic Prostatitis, Exacerbation
## Examination plan
- CBC and urinalysis to be done on 08.09.2023; repeat urologist examination on 11.09.2023, room 433, at 17.50, to assess the dynamics of treatment.
## Treatment
- Ciprofloxacin 500 mg, 1 capsule 2 times a day for 7 days, after meals.
- Tamsulosin 1 capsule 1 time a day at night for 1 month.
- Pentoxifylline 100 mg, 1 tablet 3 times a day for 10 days.
- Indomethacin suppositories: 1 suppository 1 time a day for 6 days.
# Heel Spur (right)
## Diagnosis
- Heel spur on the right.
## Examination plan
- X-ray of the right heel region.
## Prescriptions
- 1. Naiz 100 mg, 1 tablet 2 times/day for 10 days.
- 2. Laser, 10 sessions, on the heel region.
- 3. Ketorol gel 3 times/day topically.
- 4. Wearing comfortable shoes, orthopedic insoles.
# Pregnancy 28-29 Weeks; Gestational Pyelonephritis; Asymptomatic Bacteriuria
Pregnancy 28-29 weeks. Gestational pyelonephritis, latent course. Asymptomatic bacteriuria.
## Examination plan
- Urine by Nechiporenko, quantitative [as written: "k-l"].
- Urine culture for flora and sensitivity to antibiotics.
## Treatment
- Observation by the general practitioner (GP) and the surgeon at the place of residence.
- Canephron 2 dragees 3 times/day for up to 1 month.
- Positional therapy.
- Plentiful warm drink 1.5 - 2 L/day.
- With ASYMPTOMATIC BACTERIURIA of 10^5 and above - antibiotic therapy according to the results of the urine culture (drug of choice: Cefpotek 200 mg 2 times/day for 10 days, or Megacef 500 mg 1 tablet 2 times/day for 10 days).
# Lifestyle in Coronary Heart Disease (CHD) and Arterial Hypertension (AH)
- 1. Follow a hypocholesterolemic diet: exclude the use of
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butter, pork, eggs, offal, high-fat dairy products; limit sweets, sweet drinks, red meat, easily digestible carbohydrates; give preference to whole-grain cereals; vegetables and fruits (3-5 servings a day), fish (mackerel, herring, tuna, salmon), fat-free fermented milk products, the use of olive and rapeseed oil, nuts (walnuts, almonds, hazelnuts), sesame, white meat (turkey, chicken). Regular physical activity; if 150 minutes of moderate-intensity activity per week is impossible - activity according to ability and state of health. Normalization of body weight until a BMI of 20-25 kg/m2 is reached, and a waist circumference of less than 80 cm in women. Refusal of alcoholic drinks in hepatotoxic doses and of tobacco in any form. Refusal of smoking in any form.
- 2. Control of BP and HR twice a day with keeping a diary. Target BP figures should be less than 140/90 mm Hg. Limit the use of table salt (less than 5 g/day).
- 3. Daily consumption of at least 200 g of vegetables and 200 g of fruit.
- 4. Weight reduction. BMI less than 25 (BMI = body weight (kg) / height^2 (m2)). Waist circumference in men should be less than 94 cm, in women less than 88 cm.
# J45.8 Mixed Asthma
- 1. Inhaled budesonide 200 mcg 2 times a day, 1 dose regularly, rinse the throat after use; if the effect is insufficient, double the dose. If poorly tolerated: formoterol/beclomethasone 60, 2 doses 2 times a day.
- 2. Prednisolone 5 mg, 3 tablets in the morning for 5-7 days.
- 3. Theophylline 200 mg at night for 10-15 days.
- Inhalation: Pulmovent Combi 1 ml + saline 4 ml for 10 days.
- Inhalation: fenoterol 2 doses during attacks.
# Minor Cardiac Anomalies (MARS); Frequent Ventricular Extrasystole; Vitamin D Insufficiency
## Diagnosis
- 2. Diagnosis: MARS (minor anomalies of the heart): patent foramen ovale (PFO)? atrial septal defect (ASD)? false chord of the left ventricle (LV).
- Frequent ventricular extrasystole with episodes of trigeminy (in history per Holter ECG monitoring 2021, 2022). Heart failure stage 0 (H0).
- Vitamin D insufficiency (14).
- Dyslipoproteinemia.
- Bacteriuria.
## Dispensary observation group D3
## Prescriptions
- 1. Refuse strong tea, coffee, caffeine-containing drinks ("Coca-Cola", "energy drinks") and alcoholic drinks.
- 2. Limit the influence of stress factors, avoid emotional overstrain. Use relaxation techniques and autogenic training (psychotherapy sessions, psychological counseling).
- 3. Exclude smoking.
- 4. Establish a daily routine, provide full sleep and rest (at least 8 h), reduce the time spent in conditions of electromagnetic radiation (mobile phone, computer, etc.).
- 5. Increase physical activity in a dosed manner in accordance with the capabilities of the body: do not allow overfatigue, tiredness; exclude excessive physical loads (lifting weights, weightlifting).
- 6. In the diet exclude chocolate, fried, spicy and too hot food; include foods rich in potassium and magnesium.
- Magne B6 (Magnefar B6, biopharm) 2 tablets at night for 1 month.
- Hawthorn, Potassium + Magnesium 0.5, 1 tablet 2 times a day for 2 weeks.
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- OMEGA 3 (fish oil) 1000 mg 2 times a day for 2 months.
- Vitamins - continue the intake.
# Medial Epicondylitis (right); Damage to the Biceps Tendon at the Right Elbow Joint
## Diagnosis
- Medial epicondylitis on the right. Damage to the biceps tendon at the right elbow joint.
## Examination plan
- X-ray of the elbow joint.
## Prescriptions
- Nimesil 100 mg, 1 sachet 2 times a day for 2 days, then aceclofenac 100 mg, 1 tablet 2 times a day for 10 days.
- Nolpaza 40, 1 tablet a day for 14 days.
- Naiz gel topically 3-5 times/day (up to 10 days) + sling (kerchief) bandage for 3 weeks.
- Cryotherapy 6 sessions, electrophoresis with lidocaine 6 sessions.
- Limitation of heavy physical loads for 1 month.
- Dimexide gel at night.
- Midocalm 150 mg, 1 tablet 2 times a day for 15 days.
# Medial Epicondylitis (left)
## Diagnosis
- Medial epicondylitis on the left.
## Examination plan
- X-ray of the elbow joint.
## Prescriptions
- Nimesil 100 mg, 1 sachet 2 times a day for 2 days, then aceclofenac 100 mg, 1 tablet 2 times a day for 10 days.
- Nolpaza 40, 1 tablet a day for 14 days.
- Indovazin gel topically 3-5 times/day (up to 10 days) + elastic bandaging.
- Limitation of heavy physical loads.
- Dimexide solution 1 teaspoon : 5 teaspoons of water, compresses for 1 hour 3 times a day for 2-3 weeks.
- Dimexide gel at night.
- Orthosis (wrist supports).
# Medial Epicondylitis of the Left Elbow Joint - Second Plan
## Examination plan
- Ultrasound (US) as scheduled.
- X-ray: registered (appointment recorded).
- Return after treatment to the traumatologist.
- Blood biochemistry, rheumatologist.
## Prescriptions
- Wearing a soft-fixation orthosis; remove at night.
- Celecoxib 200 mg, 1 tablet 2 times a day for 10 days [as written: "2р 2д"], then Diaflex 50 mg, 1 tablet 2 times a day for 10 days.
- Omez 20 mg, 1 tablet 1 time a day for the duration of NSAID intake.
- Naiz gel 2-3 times a day topically.
- Limit heavy physical loads.
- Cyclo 3 Fort, 1 tablet 2 times a day for 14 days.
# Lateral Epicondylitis (right)
## Diagnosis
- Lateral epicondylitis on the right.
## Examination plan
- (not specified in the source)
## Prescriptions
- Oxiten 20 mg, 1 tablet a day for 1 month.
- Naiz gel topically 3-5 times/day (up to 10 days) + elastic bandaging.
- Limitation of heavy physical loads.
- Compress with Dimexide solution for 5 minutes 2 times a day.
- Cryotherapy N5.
- Shock-wave therapy N10.
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- Wearing an orthosis (wrist supports).
# Trigeminal Neuralgia (left); Left Ankle Joint Swelling
Neuralgia of the left trigeminal nerve, persistent mildly expressed pain syndrome, protracted course.
## Treatment
- Artoxan IM 1 time/day for 3 days.
- Pregabalin 75 mg, 1 capsule x 1 time/day for 14 days.
- Vasonit 600 mg, 1/2 tablet x 2 times/day for 1 month.
- Arcoxia 90 mg, 1 tablet x 1 time/day for 7 days.
## Objective findings
- Left ankle joint is swollen, painful on palpation, movements are painful and limited.
# Pollinosis (rhino-conjunctival and bronchospastic? syndrome), Exacerbation
Pollinosis: rhino-conjunctival and bronchospastic? syndrome, exacerbation. Sensitization to tree pollen.
## Examination plan
- Spirometry (respiratory function test) with a bronchodilator test, sputum analysis, CBC, blood biochemistry.
## Treatment
- Avamys 2 sprays 1 time/day for a month.
- Nixar 20 mg, 1-2 tablets 1 time/day.
- Lecrolin eye drops, 2 drops 3-5 times/day.
- Dexamethasone 1 mg/ml, 5.0, 1-2 drops in both eyes for 7-10 days.
- Pulmovent Combi 0.5 mg/0.25 mg, 1.0 in 3 ml of saline, for 7-10 days.
- Beclomethasone 250 mcg, 1 dose 2 times/day, by inhalation.
# ARI / Viral Infection - General Treatment Recommendations
(Heading not shown in the source; this block follows the pollinosis plan.)
- Plentiful drink, vitamin C up to 1000 mg/day, zinc, vitamin D.
- For hyperthermia above 38.5: Ibuklin 1 tablet / ibuprofen 400 mg, paracetamol 500 mg.
- Antiviral drugs: Angrimax Neo 1 capsule 3 times a day for 5 days; Vitavirin 1 sachet 1 time a day for 7 days; Ingavirin 90 mg, 1 capsule 1 time a day for 7 days; Flustop 75 mg, 1 tablet 2 times a day for 5 days.
- Antibiotics: Augmentin (Amoxiclav) 1000 mg 2 times a day for 7 days; azithromycin 500 mg 1 time a day for 5 days; Megacef 500 mg 2 times a day.
- Pharyngospray / Hexaspray / Orasept / Ingalipt - irrigate the throat 3-5 times a day.
- For sore throat: Furasol - gargle 2-3 times a day; Grammidin - dissolve 3 times a day.
- For nasal congestion: Galazolin gel (xylometazoline) into the nose, 1 dose.
- Antihistamines: Allerway Express 5 mg, 1 tablet 1 time a day; Fenkarol 50 mg, 1 tablet 2 times a day; Cetrin 10 mg 1 time a day; loratadine 10 mg, 1 tablet 1 time a day.
- For wet cough: ACC 600 mg/day, ambroxol 30 mg, 1 tablet 3 times a day.
- For dry cough: Herbion with plantain, 10 ml 3-5 times a day.
- Nifuroxazide 200 mg 4 times/day, Smecta 1 sachet 3 times/day, Regidron / Normohydron 1 sachet per day, Linex 1 capsule 3 times/day.
- Drotaverine 40 mg, 2 tablets 3 times/day for pain; paracetamol 500 mg at a temperature above 38.5.
# Hemorrhoids
- Detralex 3 tablets per day (1 tablet in the morning, at midday and in the evening) for 4 days, then 2 tablets per day (1 tablet in the morning and in the evening) for the following 3 days, during meals.
- Natalsid 1 suppository 2 times/day.
- Nigepan 1 suppository 2 times/day.
- Baths with furacilin or chamomile.
# ARI. Acute Rhinopharyngolaryngitis
## Diagnosis
- ARI. Acute rhinopharyngolaryngitis.
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## Prescriptions
- Strict voice rest!
- Gentle diet.
- Augmentin 1000 mg, 1 tablet 2 times/day for 7-10 days.
- Phytospray - spray the throat 3-4 times/day.
- Alkaline inhalations (Borjomi, Minskaya-4) through the nose 2-3 times a day.
- Homeovox 2 tablets, dissolve every hour for 6 days.
- Cetrin (loratadine) 1 tablet in the evening for 10 days.
# ARI in Pregnant Women
- Paracetamol at a temperature of 38.5 and above; plentiful warm drink; Argento-kea Nanolar - irrigate the throat 3 times a day for 5 days; Aquamaris 1-2 sprays into each nasal passage several times a day (2-6 times a day).
# Non-erosive GERD; Gastric Erosions; Chronic Antral Gastritis; Overweight
## Diagnosis
- Non-erosive gastroesophageal reflux disease (GERD) with clinical manifestations of moderate severity.
- Gastric erosions (27.04.2023).
- Chronic antral gastritis, mildly expressed, inactive, with mild atrophy and focal mild incomplete intestinal metaplasia, HP- (04.05.2023).
- Excess body weight (BMI = 26.8 kg/m2).
## Examination plan
- (not specified in the source)
## Treatment
- Pantoprazole 40 mg, 1 tablet 2 times/day 30 minutes before meals - 4 weeks, then 1 tablet 1 time/day in the morning - 4 weeks.
- For heartburn: Pepsan 1 sachet 3 times/day before meals; Alginomax 2-4 tablets, chew 30 minutes after meals.
- Itomed 50 mg, 1 tablet 3 times/day for up to 4 weeks.
## Recommendations
- Diet, adherence to the meal regimen. Sleep with the head end raised by at least 15 cm. Choice of clothing: avoid wearing tight clothing and tight belts. Limitation of physical exercises associated with strain of the abdominal press and increased intra-abdominal pressure. Quit smoking!!! 3-4 meals a day. Exclude overeating. Do not

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# Day-Stay Unit Infusion Regimen (from 08.04.25)
(Heading in the source reads "in ODP from 08.04.25"; the abbreviation ODP is not expanded.)
- Sol. Dexamethasoni 4 mg - 2.0 + Sol. Analgini 50% - 2.0 + Sol. Euphyllini 2.4% - 5.0 + Sol. NaCl 0.9% - 100.0, IV drip, N5.
- Sol. Furosemidi 1% - 2.0, IV jet, N5.
# Coronary Heart Disease: Atherosclerotic Cardiosclerosis; Bradyarrhythmia; Arterial Hypertension
## Diagnosis
- CHD: atherosclerotic cardiosclerosis.
- Aortic valve insufficiency grade 1-2.
- Sinus bradycardia, frequent SV (supraventricular) extrasystole, paroxysm of unstable accelerated atrial rhythm, transient sinus arrest (max RR 3732 msec) per Holter ECG monitoring of 01.12.2023.
- Arterial hypertension grade 2, risk 4. Heart failure H1.
## Dispensary observation group
## Prescriptions
- Diet.
- Aspicard 75 mg, 1 tablet 1 time/day.
- Equapril 5/10 mg, 1/2-1 tablet 2 times/day under BP control.
- Preductal OD 80 mg, 1 tablet 1 time/day for 2 months, 2 times a year.
- Tiolin 200 mg, 1 tablet 3 times/day for 1 month, 2 times a year.
- Zelenin drops 20-30 drops at a heart rate below 50 per minute.
- Pacemaker implantation is not indicated at the time of examination, given the absence of clinically significant manifestations of bradysystole.
## Investigations
- Control Holter ECG monitoring in 2-3 months.
- Repeat examination.
# Gout (tophaceous); Possible Olecranon Bursitis
## Diagnosis
- Gout, gouty arthritis, tophaceous form, chronic intermittent course, exacerbation. Functional insufficiency of joints (FNS) 2.
- Bursitis of the elbow joint?
## Examination plan
- Surgeon consultation (bursitis of the elbow joint?).
## Treatment
- Diet N6, refusal of alcohol; continue febuxostat 80 mg per day.
- Arcoxia 120 mg, 1 tablet 1 time/day for 7 days.
- Colchicine 0.5 mg 2 times/day for 10 days, then 1 tablet 1 time/day for 1.5-2 months.
- Methylprednisolone 4 mg, 2 tablets in the morning, reducing the dose by 1/2 tablet every 5 days.
# Dry Eye Discomfort
- Tear substitutes with hyaluronic acid for a feeling of discomfort in both eyes, on a long-term basis (Optinol Intensive, Artelac, Hylo-Care).
# Herpes Zoster (Shingles)
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- Acyclovir 800 mg at 7:00, 11:00, 15:00, 19:00, 23:00.
- Nimesulide 100 mg 2 times/day.
- Loratadine 10 mg 1 time a day.
- Pregabalin 75 mg at night.
- Treat the eruptions with brilliant green.
# Urolithiasis - General Recommendations
- Plentiful drink 1.5 - 2 L/day, diet.
- Canephron 50 drops 3 times/day for 1 month and then in courses 2-3 times/year, or Cyston 2 tablets 2 times/day for 1-2 months in courses 2-3 times/year.
- Herbal uroseptics (pol-pala, bearberry, cowberry leaves) for 10 days of each month for up to 6 months.
# Relief of Hypertensive Crises
- With a sharp rise in BP: Captopril 50 mg, 1 tablet (no more than 3 tablets per day under BP control); or Moxonidine 0.4 mg, 1 tablet (no more than 2 tablets per day under BP control).
# Shoulder Pathology; Alopecia Areata; Erosive GERD; Hiatal Hernia; Gastritis; CHD
## Diagnosis
- Incomplete rupture of the supraspinatus tendon on the right. Tenosynovitis of the tendon of the long head of the biceps on the right.
- Alopecia areata.
- Erosive GERD with esophagitis grade A (26.05.22). Axial hernia of the esophageal opening of the diaphragm.
- Chronic mildly expressed inactive antral gastritis without atrophy and metaplasia. HP-.
- CHD: atherosclerotic cardiosclerosis. AH grade 2, risk 3. Heart failure H1.
## Examination plan
- Ultrasound of the right shoulder joint, surgeon consultation.
## Treatment
- Co-Amlessa 8/10/2.5, 1 time/day.
- Electrophoresis with lidocaine - 7 sessions; LMT - 7 sessions.
- Meloxicam 15 mg, 1 tablet in the evening for 2 weeks.
- Sirdalud 2 mg, 1 tablet 2 times/day for 5-10 days.
- Massage, exercise therapy.
# Contusion - Recommendations
- Physiotherapy (magnetotherapy, laser therapy, UHF) on the site of injury in the absence of contraindications; cold on the 1st day to the site of injury.
- Indovazin gel topically 2 times a day.
- Aceclofenac tablets 100 mg, 1 tablet x 2 times/day for pain, 7-10 days, with simultaneous intake of omeprazole capsules 20 mg, 1 tablet x 1 time/day.
# Reducing Cardiovascular Risk
- 1. Rational nutrition with limitation of animal fats,
@@ PAGE 11
easily digestible carbohydrates; in AH - limitation of fluid and salt.
- 2. Physical activity for more than 30 minutes a day.
- 3. Maintaining a normal weight (BMI not more than 25, waist circumference in men less than 94 cm).
- 4. Control of BP level, target figures not higher than 140/80.
- 5. Total cholesterol - from 3.1 to 5.2 mmol/L; HDL - more than 1.68 mmol/L in women and 1.42 mmol/L in men; LDL - less than 3.9 mmol/L; triglycerides - from 0.14 to 1.82 mmol/L.
- 6. Fasting glucose level less than 6.0 mmol/L.
- 7. Smoking cessation.
# Acute Mixed Conjunctivitis on the Background of ARI
## Diagnosis
- OU (both eyes): acute mixed conjunctivitis on the background of ARI.
## Treatment
- Miroseptin drops, 1 drop 4-5 times/day for 7 days in both eyes.
- Moxifloxacin drops, 1 drop 4 - times/day for 7 days in both eyes [number missing in the source].
- 3. Loratadine tablets, 1 tablet at night for 7 days orally.
- 4. Laferon drops, 1 drop 6-8 times/day for 10 days in both eyes.
- 5. From 13.01 add Dexamethasone drops, 1 drop 3 times/day for 5 days in both eyes.
- 6. Rinse the conjunctival cavity with furacilin solution.
# COPD Stage 4 with Multiple Cardiovascular Comorbidities
## Diagnosis
- COPD stage 4, emphysematous type, outside exacerbation. Respiratory failure (RF) stage 1.
- CHD: atherosclerotic and post-infarction (2017) cardiosclerosis, stenosing coronary sclerosis. CABG / mammary-coronary bypass (2017).
- AH stage 2, risk 4. Heart failure H2A (NYHA functional class III).
- Stenosing atherosclerosis of the brachiocephalic arteries. Subocclusion of the external carotid artery (ECA) on the right.
- Colloid cysts of both lobes of the thyroid gland.
- Adrenal mass, hormonally inactive.
- Chronic calculous cholecystitis in remission.
- Organic anxiety disorder, F06.4.
- OD - immature (cataract), OS - incipient cataract OU.
- Diffuse bilateral atrophic bronchitis stage 1-2.
## Examination plan
- Once a year: complete blood count, urinalysis, blood biochemistry: determination of the concentration of glucose, urea,
@@ PAGE 12
creatinine, cholesterol, potassium, sodium, calcium. GFR. BP self-monitoring. Electrocardiography. Echocardiography. Ophthalmologist consultation.
## Treatment
- Co-Amlessa 8/10/2.5 mg x 1 time/day, Rosulip 5 mg in the evening, ASA 75 mg in the evening, L-thyroxine 150 mcg in the morning.
- Course intake of expectorants (ACC 600 mg per day or ambroxol 30 mg 3 times/day).
- Tiotropium bromide (Spiriva Respimat) 2.5, 2 inhalations 1 time a day, permanently.
- Beta-2 agonists during suffocation attacks; nebulizer inhalations during suffocation attacks: Pulmovent Combi 1 ml + saline 3 ml.
- Seretide Multidisk metered-dose powder for inhalation 50 mcg/dose, 250 mcg/dose, 2 inhalations 2 times/day.
- Beclomethasone/formoterol 100/6 mcg, 2 inhalations 2 times a day, permanently.
- Breathing exercises.
# Palliative Care Home Visit - Patient 1 (Kartsev)
Kartsev. Examination: narcotics [unclear in source]. Body temperature 36.4 °C. BP 125/70 mm Hg. Pulse 68 per minute. Examination for scabies and pediculosis: not found.
## Complaints and condition
- Complaints of general weakness, pain in the epigastric region, pain in the area of the tumor formation, headache, mucous discharge with blood clots from the tracheostomy, periodic rise in BP.
- The patient lies in bed, does not move around the apartment, turns over independently. Care is provided by his wife. Does not speak, communicates in writing. Feeding is carried out through a gastrostomy, breathing through a tracheostomy.
- To relieve the pain syndrome he takes ketorolac 2.0 up to 2 times/day, analgin 2.0 1 time/day IM, diphenhydramine 1.0 1 time/day IM, papaverine 2.0 1 time/day IM; the analgesic effect is insufficient. Chronic pain syndrome on the NOSh scale (numeric rating scale) - 4 points.
- On examination: on the lateral surface of the right thigh there is a wound 5 cm by 10 cm, hyperemic, without discharge, covered with a crust; in the area of the chin on the right there is a tumor formation, hyperemic,
@@ PAGE 13
up to 3 cm, with insignificant recurrent bleeding.
## Examination plan
- The patient was offered hospitalization in the palliative care department of GGKB N4; the patient categorically refused. The possible consequences of refusing the above-mentioned types of medical interventions were explained to the patient and relatives in an accessible form. A written refusal was drawn up.
## Treatment
- Dynamic observation by the GP.
- Provision of palliative medical care in accordance with the order of the Ministry of Health of the Republic of Belarus N842 of 11.06.2024 "On the organization of palliative medical care for the adult population".
- Protective bed rest. Breathing exercises.
- Medical rehabilitation: exercise therapy sessions (strengthening the muscles of the lower limbs, massage of the limbs).
- Avoid overcooling and staying in one position for more than 2 hours. Follow the "5 pillows" rule when feeding. Control of the patient's body position: change the body position at least once every 2 hours, including at night, observing the order and the absence of restrictions for one or another position: low semi-sitting position, position on the side, position on the back. The low semi-sitting position should coincide with mealtime. At each movement, inspect the risk areas. Do not subject them to friction; position the patient in bed in a position that ensures comfortable stay, using devices to hold the body in an optimal position that reduces pressure on the skin and areas of bony prominences.
- Hygienic treatment of the wound with chlorhexidine 1 time/day, application of levomekol 1 time/day, application of a sterile dressing to the wound area.
- Prevention of pressure sores (anti-decubitus mattress), elimination of unevenness and folds on underwear and bed linen; use of underwear made of natural fabrics (preferably with seams outward); use of bed linen made of natural fabrics (preferably a fitted sheet for better tension on the mattress).
- BP and HR profile.
- Diet balanced in proteins, fats and carbohydrates, with limitation of easily digestible carbohydrates.
- Observance of a regimen of dosed physical activity.
- To relieve the pain syndrome, start intake: according to the scheme tramadol 50 mg, 1 tablet 2 times/day (8:00, 20:00), at the same time, at equal intervals.
- Evaluation of the analgesic effect on 10.07.2025.
- Analgin 2.0 1 time/day IM (22:00 if necessary).
- Diphenhydramine 1.0 1 time/day IM (22:00 if necessary).
- Papaverine 2.0 1 time/day IM (22:00 if necessary).
@@ PAGE 14
- Continue taking drugs for chronic diseases:
- Ramilong 10 mg, 1 tablet 1 time/day long-term (under BP control).
- Rosuvastatin 10 mg, 1 tablet 1 time/day long-term.
- Ferrum Lek 1 tablet 3 times/day (under CBC control).
- Folic acid 1 mg, 2 tablets 3 times/day.
- Omeprazole 20 mg 1 time/day in the morning, long-term.
- Gefal 1 tablespoon 30 minutes after meals, long-term.
# Palliative Care Home Visit - Patient 2 (Metastatic Lung Cancer)
Body temperature 35.8 °C. BP 100/60 mm Hg. Pulse 60 per minute. Examination for scabies and pediculosis: not found.
## Complaints and condition
- Contact with the patient is unavailable due to the deterioration of her general condition. According to relatives, she has not eaten for 4 days, drinks in small amounts, has been unavailable for contact for 4 days, swelling of the lower limbs, constantly with closed eyes, "tosses about in bed".
- The patient lies in bed, does not react to stimuli, sometimes opens her eyes. On examination: icteric skin, dark spots on the soles of the feet. Assessment of the chronic pain syndrome on the NOSh scale is impossible.
## Objective findings
- Condition of moderate severity.
- Skin icteric.
- Throat: did not open her mouth.
- Peripheral lymph nodes: peripheral lymph nodes accessible to palpation (posterior cervical, anterior cervical, submandibular, parotid) are not enlarged, painless, mobile, not fused with the skin.
- Mammary glands: no lumpiness, contour even. Skin icteric, no edema, erythema, peeling, ulcerations. Nipple anomalies: no inversion, retraction, crusts, no discharge.
- Lungs: breathing weakened, no wheezes.
- Edema of the lower limbs: yes.
- Heart sounds rhythmic, muffled.
- Cardiac murmur: none.
- Tapping (costovertebral) symptom negative on both sides.
- Abdomen enlarged in size.
- Stool into a diaper.
- Urination free, painless, into a diaper.
## Diagnosis
- Central glandular disease of LNDB [abbreviation unclear in source] with mts in NDLL [unclear in source], in the mediastinal lymph nodes, with ingrowth into the pericardium, T2a N2 M0, stage IIIA.
- Condition after VATS (video-assisted thoracoscopy) on the right: biopsy of bifurcation lymph nodes from 16/11/23.
- Condition after 2 courses of neoadjuvant polychemotherapy (PV).
@@ PAGE 15
- Progression (01.2024): mts in the mediastinal lymph nodes on the right, mts in the liver, mts in the spleen.
- Condition after 15 courses of targeted therapy (Alectinib at RNPC OMR named after N.N. Alexandrov from 22.01.2024 to the present). Mts in the bones of the skeleton, pathological fracture of the body of the L1 vertebra without stenosis of the spinal canal (04.25). Lumbalgia, persistent pronounced pain syndrome.
- Condition after stabilization by transpedicular fixation (TPF) at the Th12-L2 level with transplantation of autobone fragments with a cortical layer, 19.05.2025. Condition after 2 courses of targeted therapy (Alecensa).
- Progression (08.2025): new mts in the liver (subtotal lesion). Clinical group "46" [as written; probably 4b].
## Concomitant diagnosis
- Anemia of malignant neoplasm, moderate severity.
- CHD: atherosclerotic cardiosclerosis. Atherosclerosis of the aorta and coronary arteries. Fibrosis of the ring and cusps of the aortic valve without valve dysfunction, mitral valve with mitral regurgitation grade 1, regurgitation on the pulmonary artery grade 1. Paroxysmal form of atrial fibrillation, outside paroxysm.
- AH grade 2, risk 4. Heart failure H1.
- Fatty degeneration of the liver, liver cysts. Lipomatosis of the pancreas. Cysts of both kidneys.
## Treatment
- An emergency medical service (EMS) team was called.
# Allergic Contact Dermatitis; Allergic Rhinitis
Unspecified allergic contact dermatitis, widespread, recurrent course. Unspecified allergic rhinitis (sensitization to library dust?).
## Examination plan
- Evaluation of immune indicators: immunoglobulins A, M, G, E, phagocytosis, circulating immune complexes (CIC), CBC with leukocyte formula; biochemical indicators: CRP, RF, ASO; total protein, AST, ALT, GGT, glucose, total bilirubin; blood for thyroid hormones (exclude hypothyroidism).
- On a scheduled basis at the place of residence: blood for a food allergy panel (Helix N2810).
## Treatment
- Hypoallergenic environment at home (remove carpets and other dust collectors, frequent wet cleaning, frequent airing, control of mold fungus, etc.).
- Hypoallergenic diet with limitation of obligate allergens (citrus fruits, chocolate, whole milk, chicken protein, coffee, exotic fruits, etc.).
- Skin care: application of emollients 2-4 times a day (Dexpanthenol (Bepanthen), Oilatum, Locobase, Physiogel, Topicrem, Apteker (prescription N14,15), Farmakos "Atopic", etc., of your choice); use of special cosmetic products for washing and caring for dry skin. Daily shower for 10-15 minutes with water at 35-36 degrees, without rubbing the skin with washcloths; blot the skin after washing, do not rub. In winter use softening agents with a greasier composition
@@ PAGE 16
- Care cream Ezmitop 1 time/day on problem areas of the skin, long-term.
- On the foci of dermatitis: Advantan (Elocom, Lokond, Momederm) 1 time/day as a short course until subsidence; on foci with weeping (infection) Triderm or Triacutan 1 time/day; on the face and skin folds - hydrocortisone ointment 1 time/day + increase the application of emollients to 4-6 times a day.
- For itching: a second-generation antihistamine (desloratadine, loratadine, cetirizine, Nixar, etc.) 1-2 times/day after meals for up to 1 month. Glycine (Gromecin) 0.1, 2 tablets under the tongue before bedtime for 1 month. If ineffective - consultation with a dermatologist of GOKVD (correction of treatment).
- For nasal congestion: 1) "Shower" of the nasal passages with saline solutions using the "Aquamaris" device 2 times a day for 5-7-10 days. 2) Nasal spray with GCS (Nasonex, Avamys, Flixonase, Morezon, Moris, etc., of your choice), 1-2 doses 2 times/day for 5 days, then 1 time a day for 5-7-10 days, then "on demand" 1 time a day. 3) Orally: first-generation antihistamines (Fenkarol) 25 mg 2-3 times a day or second-generation (cetirizine, loratadine, desloratadine, Nixar, etc., of your choice) 1 tablet 1 time a day.
# Ankle Joint Osteoarthritis?; Hyperuricemia
## Diagnosis
- POA (primary osteoarthritis) of the ankle joint?
- Hyperuricemia.
## Examination plan
- X-ray of the ankle joint.
- Control of uric acid in 1 month.
## Treatment
- Diet N6; Milurit 100 mg 1 time/day.
- Normalization of body weight.
- Orthopedic insoles.
- For pain, topical NSAIDs 2-3 times/day.
# Gastric Erosions; Functional Dyspepsia; Chronic Constipation; Liver Cyst
## Diagnosis
- Gastric erosions (12.07.2025). Chronic antral gastritis, mildly expressed inactive, without atrophy and metaplasia, HP- (15.07.2025).
- Functional dyspepsia, mixed variant, with clinical manifestations of moderate severity.
- Chronic constipation of unspecified etiology, moderate severity.
- Liver cyst (per abdominal ultrasound of 15.01.2025, in S2 - 11*10 mm).
- Excess body weight (BMI = 27.4 kg/m2).
## Examination plan
- Colonoscopy (FCS) as scheduled under general anesthesia (due to adhesions in the history).
## Treatment
- Omeprazole 20 mg (or esomeprazole 20 mg), 1 tablet 2 times/day for up to 8 weeks.
@@ PAGE 17
- Itomed 50 mg, 1 tablet 3 times/day before meals for up to 4-8 weeks, or trimebutine 300 mg, 1 tablet 1-2 times/day for up to 4 weeks.
- Pepsan 1 sachet 30 minutes before meals, on demand.
# Invitation for Fluorography (RFO)
Invited to undergo VD [abbreviation unclear in source] and fluorography (RFO).
We inform you that you belong to the category of persons who have not undergone an X-ray fluorographic examination (hereinafter - RFO), live in a territory subject to periodic radiation control and are in a risk group for the development of lung diseases.
In this connection we explain that on the basis of the order of the Ministry of Health of the Republic of Belarus of 23 May 2012, N 622 on the approval of the "Clinical guidelines for the organization and conduct of anti-tuberculosis measures in outpatient healthcare organizations"; the resolution of the Ministry of Health of the Republic of Belarus N28 of 16.03.2010 "Instruction on the procedure for organizing the dispensary examination of citizens affected by the Chernobyl disaster and other radiation accidents" you must undergo RFO.
For the purpose of early detection of this lung pathology, we ask you to go to the State Healthcare Institution "Gomel Central City Polyclinic" for an X-ray fluorographic examination in room N139, from 8:00 to 13:15 and from 14:00 to 19:30 (bring your passport). If you underwent RFO in another healthcare institution, please provide the data on completion of this type of examination to your district general practitioner.
# CHD with Persistent Atrial Fibrillation
## Diagnosis
- CHD: atherosclerotic cardiosclerosis. Persistent form of atrial fibrillation (AF). Fibrosis of the aortic valve and mitral valve. Mitral valve insufficiency grade 1-2, tricuspid valve grade 2. Heart failure H1. AH grade 1, risk 3.
## Examination plan
- ECG on 13.03.2025.
- Transesophageal echocardiography on 13.03.2025 to check for thrombi in the left atrial appendages.
- Return on 13.03 after the examination for referral to the on-duty cardiology department for restoration of sinus rhythm.
# Tinnitus? Vertebrogenic Cervicocranialgia?
## Diagnosis
- Tinnitus? Vertebrogenic cervicocranialgia?
@@ PAGE 18
## Recommendations for examination
- MRI of the brain, vessels.
- Ophthalmologist (fundus).
- Ultrasound of the brachiocephalic arteries (BCA).
- X-ray in functional positions.
- Blood biochemistry (creatinine, urea, AST, ALT, bilirubin, cholesterol, TG, LDL, APV [unclear in source]), KA [unclear in source]).
- Repeat appointment with the results of the additional examination.
## Recommendations for treatment
- Betahistine (Polvertic, Betastaz, and others) 24 mg 2 times a day for 1 month.
- Cavinton (vinpocetine) 10 mg 3 times a day for 1 month.
- Lucetam 1200 mg 1 time a day in the morning for 1 month.
- Neuromultivit 1 tablet a day for 1 month.

# Chronic Kidney Disease (CKD) - Recommendations
## Diagnosis
- Ischemic nephropathy. CKD C3b (GFR 36.6 ml/min/1.73 m2 by the CKD-EPI formula). Secondary hyperuricemia.
## Recommendations
- Observation by the general practitioner and neurologist.
- Diet with limitation of animal protein to 0.8 g/kg of body weight per day, salt to 3 g/day, foods rich in purines; hypocholesterol diet.
- Avoid the use of nephrotoxic drugs (including NSAIDs, nephrotoxic antibiotics, X-ray contrast agents), overcooling, heavy physical load.
- Control of BP and HR.
@@ PAGE 19
- AH therapy under BP control to target values with the mandatory prescription of an ACE inhibitor or ARB for nephroprotection (under control of the potassium level): candesartan 8 mg, 1 tablet x 1 time/day in the morning under BP control.
- Cynara 400 mg, 1 tablet x 3 times/day for a month, in courses once a quarter.
- Intake of statins under control of ALT, AST, lipid profile.
- Adenuric 80 mg, 1/2 tablet 1 time a day under control of the uric acid level after 3-4 weeks.
- Aspicard 75 mg, 1 tablet in the evening.
- Kidney ultrasound once a year (provide the report).
- Control of urinalysis and blood biochemistry (total protein, urea, creatinine, uric acid, cholesterol, K, Na, Cl, Ca, P) once every 3 months.
# Gilbert Syndrome
- Genetic test for carriage of the UGT1A1*28 gene mutation.
# Balanoposthitis
- Balanoposthitis (IPP [as written; possibly sexually transmitted infections, unclear]).
- Doxycycline 100 mg, 1 tablet 2 times a day for 7 days after meals.
- Metronidazole 250 mg, 2 tablets 3 times a day for 5 days after meals.
- Baths with chamomile 2 times a day for 10 days, then immediately apply Triderm ointment 2 times a day for 10 days.
# Acute Prostatitis
## Diagnosis
- Acute prostatitis.
## Examination plan
- If treatment is ineffective - repeat urologist examination in 7-10 days.
## Treatment
- Doxycycline 100 mg, 1 tablet 2 times a day for 10 days after meals.
- Trichopol (metronidazole) 250 mg, 2 tablets 3 times a day for 7 days after meals.
- Vasonit 600 mg, 1 tablet 1 time a day for 20 days after meals.
- Diclofenac suppositories, 1 suppository 1 time a day for 10 days at night.
- Antioxycaps with Zn, 1 capsule 1 time a day for 1 month.
# Chronic Sluggish Conjunctivitis
## Treatment
- Levofloxacin 0.5% (or ciprofloxacin 0.3%), 1 drop 4-6 times/day for 7-10 days.
@@ PAGE 20
# Trigeminal Neuralgia (right); Vertebrogenic Lumbalgia
## Diagnosis
- Neuralgia of the trigeminal nerve on the right, moderate pain syndrome.
- Vertebrogenic lumbalgia, persistent moderate pain syndrome, outside exacerbation.
## Examination plan
- Ultrasound of the brachiocephalic arteries (BCA) on 22.09.2025, CT of the brain on 24.09.2025.
## Treatment plan
- Zeptol 200 mg, 1/2 tablet in the morning, 1 tablet in the evening; Xefocam 8 mg 1 time/day for 5 days.
# Prolonged Cough
## Examination
- Tests for Mycoplasma pneumoniae IgM and IgG.
- Chlamydophila IgM and IgG.
- Complete sputum analysis.
- FBS (fibrobronchoscopy).
- FEGDS (fibroesophagogastroduodenoscopy).
- Spirometry + bronchodilator test.
## Recommendations for treatment
- Iceland moss 2 g, 1 sachet to be brewed in 200 g of water and taken orally 1/3 of a glass 3 times a day for 4 weeks.
- Rational breathing (inhale through the nose and not through the mouth when talking).
- Breathing exercises with breath holding.
@@ PAGE 21
# ARI. Acute Laryngotracheitis; Dysphonia
## Diagnosis
- ARI. Acute laryngotracheitis. Dysphonia.
## Prescriptions
- Dexamethasone 2 ml IM for 5 days.
- Strict voice rest!
- Gentle diet.
- Cetrin (loratadine) in the evening for 7-10 days.
- Homeovox - dissolve 2 tablets every hour for 6 days.
- Gelomyrtol Forte, 1 capsule 4 times a day.
- Pelargo (Nanolar, Phytospray, pharyngospray) - spray the throat 3-4 times/day.
# Palliative Care Home Visit - Patient 3 (Artamoshina)
## Complaints and condition
- Complaints of general weakness, pain in the left hip joint, limited movement in the hip joint, pain in the right mammary gland radiating to the right arm, periodic rise in BP, insomnia, constipation.
- On examination: wounds on the right breast with serous-purulent discharge, the edges are swollen, hyperemic, painful on palpation; lumpiness is traced near the nipple; the wounds have purulent-bloody exudate, the bottom of the wound is deep, with pus, the edges of the wound are hyperemic and swollen.
- The patient sits on the bed, gets up and sits down independently, moves around the apartment with the help of a walker over a short distance. Care is provided by relatives. Does not expectorate sputum.
- To relieve the pain syndrome she takes ketorolac 10 mg, 1 tablet up to 2 times/day; the analgesic effect is sufficient. Chronic pain syndrome on the NOSh scale - 2 points.
## Objective findings
- Condition satisfactory.
- Skin of normal color.
- Throat pink, clean.
- Lips without cracks and ulcerations, no induration on palpation. Visible mucous membranes of the oral cavity and pharynx are clean, no plaque. Mucosa of the cheeks without plaque, unchanged. Mucosa of the floor of the mouth without visible changes and formations. Tongue moist, clean, without pathological plaque, cracks, ulcerations. Gum mucosa of normal color, without visible changes. Tonsils of normal structure, not enlarged, no plaque.
- Peripheral lymph nodes accessible to palpation (posterior cervical, anterior cervical, submandibular, parotid) are not enlarged, painless, mobile, not fused with the skin.
- Lungs: vesicular breathing, no wheezes.
- Edema of the lower limbs: none.
- Heart sounds rhythmic, muffled.
@@ PAGE 22
- Cardiac murmur: none.
- Tapping (costovertebral) symptom negative on both sides.
- Abdomen soft, painless.
- Stool formed.
- Urination free, painless.
## Examination plan
- (not specified in the source)
## Treatment
- Provision of palliative medical care in accordance with the order of the Ministry of Health of the Republic of Belarus N842 of 11.06.2024 "On the organization of palliative medical care for the adult population".
- Hygienic treatment of the wound with chlorhexidine 2 times/day, application of levomekol 2 times/day, application of a sterile dressing to the wound area. Wound dressing performed.
- To relieve the pain syndrome continue intake of ketorolac 10 mg, 1 tablet up to 2 times/day; Piralgin 1 tablet up to 2 times/day (if necessary).
- Omeprazole capsules 20 mg, 1 capsule 2 times/day 30 minutes before meals.
- Continue taking drugs for chronic diseases: lisinopril 20 mg, 1 tablet 2 times/day long-term (under BP control); nifedipine 10 mg, 1 tablet up to 3 times/day long-term; atorvastatin 20 mg, 1 tablet 1 time/day in the evening, long-term; Aspicard 75 mg, 1 tablet in the evening, long-term; lactulose syrup 1 tablespoon up to 3 times/day (if necessary); drinking regimen.
# Rheumatology Follow-up: Methotrexate Regimen
## Recommendations
- Dispensary examination by a rheumatologist 2 times a year.
- Viral hepatitis markers (HBsAg, a-HCV-tot) to be taken on an outpatient basis before starting Methotrexate.
- Examination by a rheumatologist in 1 month with control of CBC (+ESR) and blood biochemistry (CRP, RF, uric acid).
## Continue treatment
- Tab. Methotrexate 5 mg - scheme of intake: Week 1 - 1 tablet (5 mg) at 8.00. Week 2 and onward - 1 tablet (5 mg) at 8.00 and 1 tablet (5 mg) at 20.00, with control of CBC once a month, blood biochemistry once a month, liver ultrasound once in 6 months.
- Folic acid 1 tablet 1 time a day on the days when Methotrexate is not taken.
- Tab. Methylprednisolone 4 mg, 1 tablet in the morning at 8:00 and 1/2 tablet at 11:00 for 2 weeks, then
@@ PAGE 23
reduce the dose by 1/4 tablet every 7 days to 1 tablet in the morning. Dose correction at the appointment with the rheumatologist.
- Calcium D3 Nycomed Osteoforte, 1 tablet during dinner for 2 months, in courses 2 times a year.
- Chondroprotectors in courses 2 times a year - powder Chondromed Plus, 1 sachet 2 times a day for 3 months, or solution Chondromed 2.0 IM 1 time a day every other day, a course of 30 injections.
- With an increase in joint pain: tab. aceclofenac 100 mg, 1 tablet 2 times/day, or tab. meloxicam 15 mg, 1 tablet during dinner // topically ointments (Tareflex, Chondrocream Forte or ketoprofen [text cut off in the source]).
- Intake of gastroprotectors: omeprazole 20 mg, 1 capsule 30 minutes before meals.
- Sanitation of foci of infection. Meal regimen. Exercise therapy. The "school of the third age" was conducted.
- Healthy lifestyle. Avoid heavy physical loads and overcooling, hyperinsolation.
- Diet with limitation of alcohol, meat products (no more than 1-2 times a week, boiled), meat and fish broths, offal, canned food, tomatoes, fruit juices. Limitation of thiazide diuretics.
- Control of BP in dynamics.
# Neurological Examination Form (Fibromyalgia Work-up)
## Complaints
- Pain throughout the body, aching in character on movement, tingling in the legs, migrating pains.
- Examined for scabies and pediculosis: yes. Questioned for taeniasis: yes.
## Anamnesis
- Head injuries: none.
- Convulsive syndrome (single seizure, epilepsy): (not filled in).
- Acute cerebrovascular events (transient, stroke): (not filled in). Hereditary burden: (not filled in).
## Objective examination data
- Features of somatic status: BP 125/80 mm Hg. Pulse 68 beats/min.
- Neurological status: higher nervous activity - normal.
- Functions of the cranial nerves: normal.
- Tendon-periosteal reflexes: normal.
@@ PAGE 24
- Skin reflexes: normal.
- Motor sphere: volume of active movements - normal.
- Muscle strength and tone: normal.
- Superficial sensitivity: normal.
- Coordination: normal.
- Other detected deviations: (none entered).
# Fibromyalgia
## Diagnosis
- Fibromyalgia.
## Dispensary observation group D1
## Prescriptions
- Avoid stress.
- Daily physical activity.
- Full sleep.
- Work and rest regime.
- Nexetin 20 mg, 1 capsule in the morning for 1 week, then Duxet 30 mg, 1 capsule in the morning for 1 week, then Nexetin 20 mg, 2 capsules in the morning for 1 week, then Duxet 30 mg, 2 capsules in the morning.
- For pain: Nalgesin 550 mg, 1 tablet 1 time a day, not more than 2 times a week.
- Diaspora Magnesium 300 mg, 1 sachet in the evening; dissolve the contents of 1 sachet in 1/2 glass of fruit juice, tea or water, for 1 month.
# Chronic Prostatitis, Exacerbation (second plan)
## Examination plan
- Blood biochemistry (total protein, urea, creatinine), urinalysis, CBC.
- PSA in 10-14 days.
- Ultrasound of the kidneys, bladder with residual urine volume, prostate gland transabdominally or TRUS on a scheduled basis (drink 600-700 ml of water 1.5-2 h before the ultrasound).
## Treatment
- Observation by the GP, urologist at the place of residence.
- Tamsulosin (or Omnic 0.4 mg, 1 capsule 1 time/day in the morning or in the evening for 1 month (if poorly tolerated - Urorec 8 mg, 1 capsule 1 time/day).
- Ofloxacin 200 mg, 1 tablet 2 times/day after meals for 10 days (prescription).
- Ornidazole (Ornimed) 500 mg, 1 tablet 2 times/day after meals for 10 days (prescription).
- Rectal suppositories Vitaprost N10 (or Diclofenac 100 mg), 1 suppository rectally at night for 10 days.
- Nisit 0.1, 1 tablet 2 times/day after meals for 3-5 days.
- Afterwards - rectal suppositories Longidaza 3000 IU N10, 1 suppository rectally at night every other day.
- Vitamin E 400 mg, 1 capsule 1 time/day for 2 weeks.
@@ PAGE 25
# Rehabilitation Plan: Heel Spur, Lumboischialgia, Osteochondrosis
(The word "print" in the source marks template fields.)
## Clinical-functional diagnosis (ICD diagnosis [print])
- Heel "spur" of the right foot, exacerbation.
- Discogenic lumboischialgia on both sides, against the background of protrusions L4-L5, L5-S1 up to 4 mm, persistent moderate pain syndrome.
- Osteochondrosis of the C5-C6 segment, stage II.
- Bilateral coxarthrosis stage 1.
- Mild impairment of statodynamic functions.
- Paroxysmal tachycardia with narrow complexes: AVNRT (atrioventricular nodal reentrant tachycardia).
- Micro-cysts of the thyroid gland.
- Functional class: mild impairment of statodynamic functions. RP high KRG [unclear in source].
- Presence of disability: none.
- Examined for scabies, pediculosis; questioned for taeniasis.
## Rehabilitation plan
- 1. Diet [print]: Diet N15, balanced in proteins, fats, carbohydrates, with limitation of easily digestible carbohydrates, animal fats (20 bread units), salt (up to 5 g/day), control and reduction of weight (BMI 18.5-24.9 kg/m2).
- 2. Lifestyle [print]: healthy lifestyle.
- 3. Avoid [print]: crowds of people, overcooling, increased insolation, excessive physical and psychoemotional load, prolonged stay in a forced posture, frequent bending, lifting and carrying weights, running, jumping, deep squats, standing on the knees. Observe hygiene of postures and movements, work and rest regime, wakefulness and sleep. Ergonomics of the workspace.
- 4. Exercise therapy [print]: silicone heel pads constantly; exercise therapy to strengthen the back muscles, in a gentle regime (gradually increasing the volume of movements in the joints, strengthening the muscles). Training of small muscle groups. Daily morning hygienic gymnastics. Breathing exercises. Massage of the back muscles along the spine outside exacerbation; reflexology (IRT) after consultation with a reflexologist, N10. Recommended: swimming in the pool, yoga therapy outside exacerbation, Kuznetsov and Lyapko applicator, "prickly healer", for 15-20 minutes under the projection of painful zones. Corseting under loads. Exercise therapy for both feet daily. Self-massage of the feet with a hard foot massager daily, N10. Recommended: walking barefoot on medium-sized pebbles.
- 5. Medication treatment [print]: Meloxicam 15 mg, 1 tablet a day for 15-20 days; compress with Dimexide solution 1 teaspoon : 5 teaspoons of water for 1 hour 3 times a day; gabapentin per scheme; topically Naiz gel 3-5 times/day for 14 days.
- 6. Inpatient treatment [print]: according to indications.
- 7. Physiotherapeutic treatment [print]: ultrasound with
@@ PAGE 26
hydrocortisone, N7, alternating with novocaine electrophoresis on the lumbosacral spine, N10. Shock-wave therapy (SWT) N7 on the heel is recommended; in the State Healthcare Institution "Gomel Central City Polyclinic" the apparatus is out of order, so contact the medical center "Brak i semya", polyclinic N5, RNPC of Radiation Medicine and Human Ecology, GOKTB, medical center "7-ka". If the treatment is ineffective, decide with a traumatologist on a blockade with Diprospan.
# Chickenpox (Varicella)
- Plentiful drink.
- With hyperthermia above 38.5: Ibuklin 1 tablet / ibuprofen 400 mg, paracetamol 500 mg.
- Acyclovir 800 mg 5 times/day for 10-14 days / valacyclovir 500 mg, 2 tablets 3 times/day for 7-9 days.
- Treat the area of eruptions with brilliant green.
- Cetrin 10 mg at night for 7-10 days.
# Recommendations After Chemotherapy
- Diet with limitation of fatty, fried foods, smoked foods, marinades.
- Drinking regimen: about 1.5 liters of drinking water a day.
- Avoid places of mass gathering of people. Avoid heavy physical loads, do not visit the sauna or bath, do not sunbathe. With an increase in body temperature - a course of antibacterial / antifungal therapy (as prescribed by the doctor).
- Intake of hepatoprotectors: Heptral (Heptalnan) 2 capsules/day, or Essentiacaps or Essentiale 2 x 3 times a day, or Ursosan (Ursocaps) 3 capsules/day, or L-ornithine-aspartate (Hepa-Merz) 1 sachet 3 times/day; omeprazole 20 mg, 1 capsule _ times a day [number missing in source] for 7-10 days. Pancreatin (Mezim Forte, Creon tablets during meals; Geral 1 tablespoon 3 [text garbled in the source] before meals).
- For nausea: tab. metoclopramide 10 mg x 4 times/day or IM 2.0 ml x 3 times a day; tropisetron 5 mg/day; ondansetron; Emend.
- Prevention of stomatitis: rinse the oral cavity with a baking soda solution after each meal. In stomatitis, treat the oral cavity with chlorhexidine, Hexaspray, Lugol's solution, Metrogyl Denta.
- With frequent stool (4 or more times a day): tab. loperamide ("Operamid") 4 mg, then 2 mg after each act of defecation (but not more than 8 tablets a day), taken for 2 days; Smecta. With constipation - diet, Duphalac.
- Prebiotics: Linex.
- For pain syndrome - non-steroidal anti-inflammatory drugs (ketorolac, nimesulide, ibuprofen, diclofenac), drotaverine; selection of the optimal regimen and dosage of analgesic drugs at the place of residence.
# Chalazion of the Upper Eyelid
## Diagnosis
- OS (left eye) - chalazion of the upper eyelid.
## Treatment
- Tobradex, 1 drop according to the scheme
@@ PAGE 27
- Floxal ointment 2 times/day behind the lower eyelid and on the upper eyelid for 7 days.
- Compresses with sulfacyl sodium 4-5 times/day.
- Tear substitutes with hyaluronic acid, 1 drop 2-3 times/day.
# Multinodular Euthyroid Goiter
## Diagnosis
- Multinodular euthyroid goiter (node of the right lobe).
## Examination plan
- Thyroid ultrasound once a year, TSH, free T4, fine-needle aspiration biopsy (FNAB) of the thyroid in case of negative dynamics.
## Treatment
- Autumn-spring period: Antioxycaps with Se, Zn - alternate, 1 capsule 1 time/day, in courses.
# Deviated Nasal Septum; Chronic Rhinitis; Chronic Pharyngitis
## Diagnosis
- Deviated nasal septum (DNS). Chronic rhinitis. Chronic pharyngitis.
## Prescriptions
- Nasonex into the nose, 2 sprays 2 times/day for 2-3 weeks.
- Olizol into the nose, 2 drops 3 times a day for 2-3 weeks.
# Persistent Transaminasemia; Symptomatic Dyslipidemia
## Diagnosis
- Persistent transaminasemia of moderate degree. F0 by METAVIR. Symptomatic dyslipidemia.
## Examination plan
- Fluorography (RFO)!!! ECG, control of blood biochemistry (total, direct, indirect bilirubin, ALT, AST, GGTP, alkaline phosphatase).
- EGDS with biopsy per OLGA (the patient refused, as recorded).
## Treatment
- Balanced nutrition enriched with protein and fiber. Exclude from the diet bakery products, confectionery, sweets, carbonated drinks, energy drinks, alcohol. Include in the diet: greens, vegetables, all kinds of cabbage and lettuce, dark chocolate, instant coffee 1 serving a day. Meal frequency: 5 times a day.
- Sleep hygiene. Sufficient drinking regimen: 2.4 L of drinking water (do not count juices, teas, coffee, soups, etc.).
- Physical activity: daily walking at a moderate pace for 30-45 minutes; swimming, cardio training 2 times/week for 40-50 minutes.
- Hepatoprotective therapy: Ursofalk (Ureosan) 500 mg: 2 tablets 2 times/day after meals for 2 months; Legalon 140 mg, 1 tablet 3 times/day 10 minutes before meals for 1 month; Heptral 500 mg, 1 tablet 2 times/day after meals for 2 months; Thiazoline (Tiolin) solution 4 ml IM 1 time/day for 10 days; OMEGA max 2 capsules during breakfast 1 time/day for 3 months, break of 2 months.
- Maintaining the level of 25(OH)D3 above 30 ng/ml (preferably from 30 to 50 ng/ml).
- If necessary, add a vitamin D3 preparation in a daily dose of 1000
@@ PAGE 28
to 2000 IU. When a deficiency of 25(OH)D3 is detected, the prescription of cholecalciferol is indicated, in a dose of 6000 IU a day or 50,000 IU a week for 8 weeks until the level of 25(OH)D3 in the blood is above 30 ng/ml, with subsequent maintenance therapy of 1500-2000 IU/day.
# Vertebrogenic Cervicobrachialgia (right)
## Complaints
- Exacerbation of pain in the neck on the right, radiating to the shoulder girdle.
- Constant numbness of the right arm along the posterior surface (max forearm - hand).
- Weakness and clumsiness in the right arm.
## Anamnesis
- Fell ill for the first time about 2 weeks ago. Exacerbation after physical load.
## Examination data
- Ultrasound of the shoulder joints dated 22.04, 26 "cm" [as written; possibly "see"]. MRI of the cervical spine dated 01.05.26 "cm" [as written; possibly "see"].
## Diagnosis
- Vertebrogenic cervicobrachialgia on the right, muscular-tonic form, exacerbation, moderate pain syndrome.
## Recommendations for examination
- Ultrasound of the shoulder joints.
## Recommendations for treatment
- Hygiene of movements in the neck (avoid sharp and high-amplitude movements).
- Sleep on an orthopedic memory-foam pillow.
- Avoid heat procedures on the neck (ozokerite, mud, heating pad, hot bath).
- Midocalm 150 mg, 1 tablet 3 times a day for 20 days (prescription issued).
- Sirdalud 2 mg, 1/2 tablet in the morning (if well tolerated: no decrease in BP, no drowsiness) and 1 tablet at night (15-20 minutes before sleep) for 20 days (prescription issued) !
- Nalgesin Forte 550 mg 2 times a day for 10 days (after meals).
- Tebantin 300 mg, 2 capsules at night for 2-3 weeks (prescription issued).
- Artoxan 2 ml intramuscularly every other day, N3 more.
## Topically
- Kuznetsov, Lyapko applicator, "prickly healer".
- "Warming" ointments (Finalgon, Capsicam) 1-2 times a day on clean, dry skin.
## Physiotherapy
- SMT (sinusoidal modulated currents) on the cervical spine and right shoulder girdle, N10.
- Magnetotherapy (pulsed EMF, BIMP, MLT) on the cervical spine and right shoulder joint, N10.
- Massage of the cervical spine and collar zone (after pain decreases), N10.
- If ineffective - a course of paravertebral blockades in the cervical spine on the right, N4-5.
# Chronic Anal Fissure (epithelialization stage)
## Diagnosis
- Chronic anal fissure, epithelialization stage.
## Prescriptions
- Kegel exercises (as shown in the brochure).
- Fiber-enriched diet, follow the brochure (handed out).
- Detralex 1000 mg, 1 tablet 3 times/day for 3 days, then 1 tablet 2 times/day for 7 days, then 500 mg, 1 tablet 1 time/day for 3 months, in courses 2 times/year.
- Baths (warm!) with chamomile decoction 2 times/day for 2 weeks.
- Natalsid N10 (in the morning), 1 suppository 1 time/day for 15-20 days.
@@ PAGE 29
# Bell's Palsy (right facial nerve) with Multiple Comorbidities
## Diagnosis
- Secondary neuropathy of the right facial nerve (21.02.2024) with pronounced prosopareisis, Bell's palsy, subacute period.
- CHD: atherosclerotic cardiosclerosis, single SV extrasystole (per Holter ECG of 09.02.2022). Heart failure H1.
- Non-stenosing atherosclerosis of the brachiocephalic arteries.
- Hypothyroidism, state of medication subcompensation.
- Type 2 DM (HbA 6.49 from 15.02.2024).
- Uterine fibroids. Chronic atrophic gastritis. Diverticular disease of the colon (colonoscopy of 07.12.2019).
## Examination plan
- Neurologist consultation.
## Treatment plan
- Actovegin 5 ml IM N10; Polfilin 400 mg, 1 tablet 2 times/day N120; Neuromultivit, 1 tablet 2 times/day N60; Thiogamma 600 mg in the morning N60.
# Chronic Antral Gastritis with Atrophy and Intestinal Metaplasia; Constipation
## Diagnosis
- Chronic moderately expressed inactive antral gastritis with mild atrophy and focal complete intestinal metaplasia, HP-.
- Constipation.
## Recommendations for examination
- Colonoscopy (constipation) + anesthesia.
- CBC, urinalysis, blood biochemistry (ALT, AST, bilirubin, GGT, alkaline phosphatase, urea, creatinine, iron, ferritin, glucose).
- Coagulogram.
- ECG ("EKT" as written in the source).
- Rh factor, blood group.
## Recommendations for treatment
- Trimedat Forte 300 mg, 1 tablet 1-2 times a day 30 minutes before meals, for a month, 4 times a year.
- Lactulose 45-60 ml 1-2 times a day, 30 minutes before meals, lunch, dinner.
# Diffuse Telogen Hair Loss
## Examination plan
- 25(OH) vitamin D, ferritin, serum iron, glycosylated hemoglobin (HbA1C), blood biochemistry: total protein, vitamin B12, folic acid.
## Treatment
- Cream-peeling Bio Clean UP: rub into the damp scalp, leave for 5 min., 1 time a week.
- Nizoral shampoo: 3 times a week, for 2 min.; 1 hour before - Aisida balm for oily scalp.
- Diet.
@@ PAGE 30
# ENT Examination Form
## Complaints
- Dry cough, tickling in the throat, periodic hoarseness of the voice for more than 6 months.
- Examined for scabies and pediculosis. Questioned for taeniasis.
## Anamnesis
- Without an outpatient card.
## Objective examination data
- General condition: satisfactory. Body temperature __ °C, pulse __ per minute, BP __ mm Hg (values not entered).
- Nasal breathing: moderately difficult.
- Nasal cavity: discharge - none.
- Nasal cavity (mucosa): pale pink in color.
- Polyps: absent.
- Nasal turbinates: swollen.
- Nasal septum: deviated (moderately).
- Nasopharynx: no changes.
- Pharynx (mucosa): hyperemic.
- Tonsils (D, S): lax, plugs in the lacunae, anterior arches hyperemic, posterior wall of the pharynx lax, sputum.
- Lymph nodes: not palpable.
- Voice function: normal.
- Larynx, epiglottis: no changes.
- Mucosa moderately swollen, pink.
- Vocal folds gray; mucosa pink, vocal folds clean, whitish, mobile on phonation, symmetrical, no swelling.
- Ears: no changes.
- External ear (D, S): tenderness in the parotid region on the right.
- Auditory canal (D, S): no changes.
- Tympanic membrane: no changes (D, S).
- Hearing: whispered speech D 6 m, S 6 m; conversational speech D _ m, S _ m, D-S.
- Vestibular functions: (not entered).
- Manipulations performed: (not entered).
@@ PAGE 31
- Additional data: (not entered).
# Deviated Nasal Septum; Chronic Rhinitis; Chronic Tonsillitis
## Diagnosis
- Deviated nasal septum (DNS) on the right. Chronic mixed rhinitis. Chronic compensated tonsillitis.
## Prescriptions
- GP consultation.
- Furacilin solution - gargle the pharynx 3 times a day.
- Pelargo (Hexaspray) - irrigate the pharynx 3 times a day.
- Tonsilgon 2 dragees 3 times a day.
- Cetrin 1 tablet 1 time a day for 10 days.
- Methyluracil ointment into the nose 2 times a day for 10 days.
- Repeat examination if necessary.
# Bilateral Carpal Tunnel Syndrome (mild sensory disturbances)
## Diagnosis
- Carpal tunnel syndrome on both sides with mild sensory disturbances.
## Dispensary observation group D1
## Prescriptions
- Vasonit 1 time/day - 1 month.
- Neuromidin 20 mg - 3 times/day - 1 month.
- Detralex 1000 mg - 1 time/day - 1 month.

import re, os, matplotlib
from xml.sax.saxutils import escape
from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.lib.styles import ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT
from reportlab.pdfbase import pdfmetrics
from reportlab.pdfbase.ttfonts import TTFont
from reportlab.platypus import (BaseDocTemplate, PageTemplate, Frame, Paragraph, Spacer, Table, TableStyle,
                                PageBreak, KeepTogether, Flowable, NextPageTemplate)
from reportlab.platypus.tableofcontents import TableOfContents

fd = os.path.join(matplotlib.get_data_path(), 'fonts', 'ttf')
pdfmetrics.registerFont(TTFont('DV', os.path.join(fd, 'DejaVuSans.ttf')))
pdfmetrics.registerFont(TTFont('DV-B', os.path.join(fd, 'DejaVuSans-Bold.ttf')))
pdfmetrics.registerFont(TTFont('DV-I', os.path.join(fd, 'DejaVuSans-Oblique.ttf')))
from reportlab.pdfbase.pdfmetrics import registerFontFamily
registerFontFamily('DV', normal='DV', bold='DV-B', italic='DV-I', boldItalic='DV-B')

PAL = [('#0F8B8D', '#E0F4F4'), ('#E4572E', '#FDE9E3'), ('#4B3F9E', '#E9E6F7'), ('#F29E4C', '#FEF1E1'),
       ('#2E9E5B', '#E1F4E8'), ('#C2368D', '#F9E3F1'), ('#2F6FDE', '#E2ECFC'), ('#D4A017', '#FBF3D9')]
LABELCOL = [('diagnos', '#D64545'), ('plan', '#2F6FDE'), ('investigation', '#2F6FDE'), ('examination', '#2F6FDE'),
            ('treatment', '#2E9E5B'), ('prescription', '#2E9E5B'), ('recommend', '#F08A24'), ('dispensary', '#7B4FC9'),
            ('complaint', '#C2368D'), ('objective', '#0F8B8D'), ('anamnesis', '#0F8B8D'), ('topical', '#2E9E5B'),
            ('physio', '#2E9E5B'), ('concomitant', '#D64545'), ('continue', '#2E9E5B')]
def lcol(t):
    t = t.lower()
    for k, c in LABELCOL:
        if k in t: return colors.HexColor(c)
    return colors.HexColor('#0F8B8D')

# ---- parse
src = ''
for f in ['en_part1.txt', 'en_part2.txt', 'en_part3.txt']:
    src += open(f, encoding='utf-8').read().rstrip('\n') + '\n'
cards = []; page = 1
for line in src.split('\n'):
    if not line.strip(): continue
    if line.startswith('@@ PAGE'):
        page = int(line.split()[-1]); continue
    if line.startswith('## '):
        cards[-1]['items'].append(('label', line[3:].strip()))
    elif line.startswith('# '):
        cards.append({'title': line[2:].strip(), 'page': page, 'items': []})
    elif line.startswith('- '):
        cards[-1]['items'].append(('b', line[2:].strip(), page))
    else:
        cards[-1]['items'].append(('p', line.strip(), page))
print('cards', len(cards))

W, H = A4
S = lambda n, **k: ParagraphStyle(n, fontName=k.pop('fontName', 'DV'), **k)
body = S('body', fontSize=9.2, leading=13.2, spaceAfter=3)
bul = S('bul', fontSize=9.2, leading=13.2, leftIndent=14, bulletIndent=3, spaceAfter=2.5)
ttl = S('ttl', fontName='DV-B', fontSize=12.5, leading=16, textColor=colors.white)
lab = S('lab', fontName='DV-B', fontSize=8.8, leading=11, textColor=colors.white)
note = S('note', fontName='DV-I', fontSize=8.5, leading=12, textColor=colors.HexColor('#555555'), spaceAfter=3)
srcst = S('src', fontSize=7.5, leading=10, textColor=colors.white, alignment=2)
numst = S('num', fontName='DV-B', fontSize=13, leading=16, textColor=colors.white, alignment=TA_CENTER)

class Marker(Flowable):
    def __init__(self, text, key): super().__init__(); self.text = text; self.key = key
    def wrap(self, w, h): return (0, 0)
    def draw(self):
        self.canv.bookmarkPage(self.key)
        self.canv.addOutlineEntry(self.text, self.key, 0, 0)

class Doc(BaseDocTemplate):
    def afterFlowable(self, fl):
        if isinstance(fl, Marker):
            self.notify('TOCEntry', (0, fl.text, self.page, fl.key))

def cover(c, d):
    c.saveState()
    c.setFillColor(colors.HexColor('#12355B')); c.rect(0, 0, W, H, fill=1, stroke=0)
    cols = ['#0F8B8D', '#E4572E', '#F29E4C', '#2E9E5B', '#C2368D', '#2F6FDE', '#D4A017', '#4B3F9E']
    for i, col in enumerate(cols):
        c.setFillColor(colors.HexColor(col)); c.rect(i * W / 8, H - 22 * mm, W / 8, 22 * mm, fill=1, stroke=0)
        c.rect(i * W / 8, 0, W / 8, 14 * mm, fill=1, stroke=0)
    c.setFillColor(colors.HexColor('#F29E4C')); c.circle(W - 35 * mm, H - 75 * mm, 38 * mm, fill=1, stroke=0)
    c.setFillColor(colors.HexColor('#0F8B8D')); c.circle(25 * mm, 70 * mm, 45 * mm, fill=1, stroke=0)
    c.setFillColor(colors.HexColor('#E4572E')); c.circle(W - 20 * mm, 40 * mm, 22 * mm, fill=1, stroke=0)
    # medical cross
    c.setFillColor(colors.white); cx, cy = W / 2, H - 100 * mm
    c.roundRect(cx - 8 * mm, cy - 24 * mm, 16 * mm, 48 * mm, 4 * mm, fill=1, stroke=0)
    c.roundRect(cx - 24 * mm, cy - 8 * mm, 48 * mm, 16 * mm, 4 * mm, fill=1, stroke=0)
    c.setFillColor(colors.white); c.setFont('DV-B', 34)
    c.drawCentredString(W / 2, H - 165 * mm, 'CLINICAL HANDBOOK')
    c.setFont('DV-B', 16); c.setFillColor(colors.HexColor('#FFD6A0'))
    c.drawCentredString(W / 2, H - 180 * mm, 'Outpatient Recommendations, Diagnoses')
    c.drawCentredString(W / 2, H - 189 * mm, 'and Treatment Plans')
    c.setFont('DV', 10); c.setFillColor(colors.white)
    c.drawCentredString(W / 2, H - 205 * mm, 'English translation of the attached 31-page Russian-language document')
    c.drawCentredString(W / 2, H - 212 * mm, '(file DOC-20260813-WA0001)')
    c.restoreState()

def later(c, d):
    c.saveState()
    c.setFillColor(colors.HexColor('#12355B')); c.rect(0, H - 11 * mm, W, 11 * mm, fill=1, stroke=0)
    cols = ['#0F8B8D', '#E4572E', '#F29E4C', '#2E9E5B', '#C2368D', '#2F6FDE', '#D4A017', '#4B3F9E']
    for i, col in enumerate(cols):
        c.setFillColor(colors.HexColor(col)); c.rect(i * W / 8, H - 13 * mm, W / 8, 2 * mm, fill=1, stroke=0)
    c.setFillColor(colors.white); c.setFont('DV-B', 8.5); c.drawString(15 * mm, H - 7.5 * mm, 'CLINICAL HANDBOOK')
    c.setFont('DV', 8); c.drawRightString(W - 15 * mm, H - 7.5 * mm, 'Outpatient Recommendations and Treatment Plans')
    c.setFillColor(colors.HexColor('#12355B')); c.circle(W / 2, 9 * mm, 4.6 * mm, fill=1, stroke=0)
    c.setFillColor(colors.white); c.setFont('DV-B', 8); c.drawCentredString(W / 2, 7.8 * mm, str(d.page))
    c.restoreState()

doc = Doc('/tmp/workspace/handbook/Clinical_Handbook_English.pdf', pagesize=A4, title='Clinical Handbook (English translation)',
          author='Translated from Russian', leftMargin=15 * mm, rightMargin=15 * mm, topMargin=20 * mm, bottomMargin=17 * mm)
fr = Frame(15 * mm, 17 * mm, W - 30 * mm, H - 37 * mm, id='f', leftPadding=0, rightPadding=0, topPadding=0, bottomPadding=0)
doc.addPageTemplates([PageTemplate('cover', [fr], onPage=cover), PageTemplate('main', [fr], onPage=later)])

story = [NextPageTemplate('main'), PageBreak()]

# intro page
h1 = S('h1', fontName='DV-B', fontSize=20, leading=24, textColor=colors.HexColor('#12355B'), spaceAfter=8)
story += [Paragraph('About this handbook', h1)]
story += [Paragraph('This handbook is a complete English translation of a 31-page Russian-language set of outpatient clinical records, '
                    'recommendations and treatment plans. The content is organised into topic cards, one per diagnosis or topic, '
                    'in the same order as the original file. Every drug, dose, duration, date and instruction from the source is retained. '
                    'The small tag on each card shows the page of the original document where the card starts.', body), Spacer(1, 5)]
story += [Paragraph('Colour guide', S('h2', fontName='DV-B', fontSize=13, leading=16, textColor=colors.HexColor('#12355B'), spaceAfter=5))]
legend = [('Diagnosis', '#D64545'), ('Examination plan / Investigations', '#2F6FDE'), ('Treatment / Prescriptions', '#2E9E5B'),
          ('Recommendations', '#F08A24'), ('Dispensary observation group', '#7B4FC9'), ('Complaints', '#C2368D'), ('Objective findings / Anamnesis', '#0F8B8D')]
rows = [[Paragraph(t, lab)] for t, c in legend]
lt = Table(rows, colWidths=[75 * mm])
lt.setStyle(TableStyle([('BACKGROUND', (0, i), (0, i), colors.HexColor(c)) for i, (t, c) in enumerate(legend)] +
                       [('TOPPADDING', (0, 0), (-1, -1), 3), ('BOTTOMPADDING', (0, 0), (-1, -1), 3), ('LINEBELOW', (0, 0), (-1, -1), 2, colors.white)]))
story += [lt, Spacer(1, 8)]
story += [Paragraph('Translator notes', S('h2b', fontName='DV-B', fontSize=13, leading=16, textColor=colors.HexColor('#12355B'), spaceAfter=5))]
for t in ['Text in square brackets [ ] marks places where the source was unclear, garbled, or where the translator clarifies the original wording.',
          'Brand names of drugs are kept in Latin letters as in the Russian original. Standard Russian medical abbreviations are expanded; see the abbreviation list at the end.',
          'The source contains personal data (a few patient surnames) and template fields marked "print"; these are kept as they appear.',
          'This is a translation of a clinical document for reference. Always verify doses and indications against the original and current local protocols before clinical use.']:
    story.append(Paragraph(escape(t), bul, bulletText='\u25cf'))
story.append(PageBreak())

story.append(Paragraph('Contents', h1))
toc = TableOfContents()
toc.levelStyles = [S('toc0', fontSize=8.6, leading=12.2, leftIndent=0, firstLineIndent=0, rightIndent=14)]
toc.dotsMinLevel = 0
story += [toc, PageBreak()]

for i, cd in enumerate(cards):
    dark, light = PAL[i % len(PAL)]
    dark = colors.HexColor(dark); light = colors.HexColor(light)
    key = 'c%d' % i
    title = cd['title']
    banner = Table([[Paragraph(str(i + 1), numst), Paragraph(escape(title), ttl), Paragraph('Source p. %d' % cd['page'], srcst)]],
                   colWidths=[11 * mm, W - 30 * mm - 11 * mm - 22 * mm, 22 * mm])
    banner.setStyle(TableStyle([('BACKGROUND', (0, 0), (-1, -1), dark), ('VALIGN', (0, 0), (-1, -1), 'MIDDLE'),
                                ('TOPPADDING', (0, 0), (-1, -1), 6), ('BOTTOMPADDING', (0, 0), (-1, -1), 6),
                                ('LEFTPADDING', (0, 0), (-1, -1), 5), ('RIGHTPADDING', (0, 0), (-1, -1), 6),
                                ('LINEBEFORE', (1, 0), (1, 0), 1.2, colors.white)]))
    els = []
    first = True
    cur = None
    for it in cd['items']:
        if it[0] == 'label':
            cur = it[1]
            col = lcol(cur)
            t = Table([[Paragraph(escape(cur.upper()), lab)]], colWidths=[None], hAlign='LEFT')
            t.setStyle(TableStyle([('BACKGROUND', (0, 0), (-1, -1), col), ('TOPPADDING', (0, 0), (-1, -1), 2),
                                   ('BOTTOMPADDING', (0, 0), (-1, -1), 2.5), ('LEFTPADDING', (0, 0), (-1, -1), 7), ('RIGHTPADDING', (0, 0), (-1, -1), 7)]))
            els += [Spacer(1, 4), t, Spacer(1, 3)]
        else:
            col = lcol(cur) if cur else dark
            txt = escape(it[1])
            if it[0] == 'b':
                st = ParagraphStyle('bb', parent=bul, bulletColor=col, bulletFontName='DV-B', bulletFontSize=9)
                els.append(Paragraph(txt, st, bulletText='\u25cf'))
            else:
                st = note if txt.startswith('(') and txt.endswith(')') else body
                els.append(Paragraph(txt, st))
    story += [Marker(title, key), Spacer(1, 6)]
    head = [banner, Spacer(1, 2)] + els[:3]
    rest = els[3:]
    story.append(KeepTogether(head))
    story += rest
    story.append(Spacer(1, 10))

story.append(PageBreak())
story.append(Marker('Abbreviations and glossary', 'gloss'))
story.append(Paragraph('Abbreviations and glossary', h1))
gl = [('AH', 'Arterial hypertension'), ('BB', 'Blood biochemistry'), ('BCA', 'Brachiocephalic arteries'), ('BMI', 'Body mass index'),
      ('BP / HR', 'Blood pressure / heart rate'), ('CBC', 'Complete blood count'), ('CHD', 'Coronary heart disease'),
      ('CKD', 'Chronic kidney disease'), ('COPD', 'Chronic obstructive pulmonary disease'), ('D1 / D3', 'Dispensary observation groups'),
      ('DM', 'Diabetes mellitus'), ('ECG / Echo-CG', 'Electrocardiography / echocardiography'), ('EGDS', 'Esophagogastroduodenoscopy'),
      ('EMS', 'Emergency medical service'), ('ET', 'Exercise therapy (therapeutic physical training)'), ('FNS', 'Functional insufficiency of joints'),
      ('GERD', 'Gastroesophageal reflux disease'), ('GFR', 'Glomerular filtration rate'), ('GP', 'General practitioner'),
      ('HP', 'Helicobacter pylori'), ('IM / IV', 'Intramuscular / intravenous'), ('NSAIDs', 'Non-steroidal anti-inflammatory drugs'),
      ('NOSh', 'Pain rating scale used in the source (numeric rating scale)'), ('OU / OD / OS', 'Both eyes / right eye / left eye'),
      ('POA', 'Primary osteoarthritis'), ('PT', 'Physiotherapy'), ('RFO', 'X-ray fluorographic examination'),
      ('SMT', 'Sinusoidal modulated currents'), ('TPF', 'Transpedicular fixation'), ('TRUS', 'Transrectal ultrasound'),
      ('VATS', 'Video-assisted thoracoscopic surgery'), ('N10, N20...', 'Number of procedures, injections or units in the course')]
gt = Table([[Paragraph('<b>%s</b>' % escape(a), body), Paragraph(escape(b), body)] for a, b in gl], colWidths=[40 * mm, W - 30 * mm - 40 * mm])
gt.setStyle(TableStyle([('ROWBACKGROUNDS', (0, 0), (-1, -1), [colors.HexColor('#E2ECFC'), colors.white]),
                        ('VALIGN', (0, 0), (-1, -1), 'TOP'), ('TOPPADDING', (0, 0), (-1, -1), 3), ('BOTTOMPADDING', (0, 0), (-1, -1), 3)]))
story.append(gt)

# cover page is page 1: first flowable is Spacer on the cover template
story.insert(0, Spacer(1, 1))
doc.multiBuild(story)
print('done')

@@ PAGE 1
# Diabetes Mellitus (DM) - Recommendations
## Recommendations
- HbA1c once every 6 months.
- Urinalysis and albuminuria test once a year.
- Blood biochemistry (BB): total cholesterol, LDL, triglycerides (TG), creatinine, GFR calculation, potassium, total protein, total bilirubin, ALT, AST, uric acid, glucose - once a year.
- ECG once a year.
- Consultation with a podotherapist (foot specialist), ophthalmologist and neurologist once a year.
- Blood test for hormones: TSH, free T4, anti-TPO antibodies.
- Nutrition: up to 6 meals a day, limiting easily digestible carbohydrates with a high glycemic index and animal fats (20 bread units).
- Dosed physical activity (walking) 150 minutes per week.
# Herpes Zoster (left buttock and thigh), moderate pain syndrome
## Examination plan
- Neurologist consultation.
## Treatment
- Diclopol 100 mg 1 time/day.
- Pregabalin 75 mg at night with subsequent dose titration until the analgesic effect is reached, not exceeding 600 mg per day, then gradual dose reduction to full withdrawal.
- Amitriptyline 25 mg per schedule.
- Physiotherapy (PT).
# Coxarthrosis (right stage 1-2, left stage 3-4); Aseptic Necrosis of the Left Femoral Head; Vertebrogenic Lumbalgia
Coxarthrosis right side stage 1-2, left side stage 3-4. Aseptic necrosis of the head of the left femur. Vertebrogenic lumbalgia, moderately expressed pain syndrome, chronic course.
## Examination plan
- Complete blood count (CBC), urinalysis, blood biochemistry (BB), PSA, ECG.
## Treatment
- Chondroprotector courses of 3 months: chondroitin 1200 mg per day; or Structum 500 mg 2 times/day for 3 months; or solution Mucosat 2.0 IM every other day, N15; or glucosamine 1.5 g per day (Dona 1 sachet per day for 3 months) - 2 times a year; or solution Alflutop 1.0 IM 1 time/day, N20.
- For pain: nimesulide 100 mg 2 times/day or meloxicam 15 mg per day; NSAID ointments topically 2-3 times/day for pain; exercise therapy (ET).
- Exercise therapy for the joints. Calcium-rich diet. Avoid overloading and overcooling.
- Aceclofenac (Aertal) 100 mg 2 times/day for pain, after meals, 10-14 days.
- Omeprazole 20 mg per day for the duration of NSAID use.
- Topically on painful areas: NSAID gels/ointments 2-3 times/day (ketoprofen, Naiz).
- Chondroprotectors as a long course, minimum 3 months, 2 times a year (Chondromed, Structum 500 mg x 2 times/day, or Donica (Dona) 1500 mg 1 time/day, or solution Chondroitin sulfate (Mucosat) 2.0 IM 1 time/day every other day, N30).
- Calcium and vitamin D3 preparations 500 mg/400 IU, 1 tablet 2 times/day for 3 months, 2 times a year.
- Pregabalin 75 mg: 1 capsule (days 1-2), 2 capsules (days 3-4), 3 capsules (days 5-14).
- Sirdalud 4 mg 1 tablet in the evening - 10 days.
- Xefocam 8 mg 1 tablet in the morning - 5 days, then Aertal 100 mg 1 tablet in the morning - 7 days.
- Detraven 1000 mg 1 tablet 3 times/day - 5 days.
- Given the persistence of the pain syndrome: Reneira 75 mg 1 capsule in the evening - 5 days, then 1 capsule 2 times/day - 10 days, with gradual withdrawal by reducing the intake to 1 capsule in the evening.
- Gabapentin 300 mg, 1 capsule 1 time a day (days 1-5), 2 times a day (days 6-10), 3 times a day (days 11-15), 4 times a day (days 16-21), with subsequent withdrawal.
# Acute Hemorrhagic Cystitis; Urolithiasis (in history)
## Examination plan
- Urinalysis and CBC to be repeated on 20.03.2023.
- Repeat urologist examination on 20.03.2023 at 13.00, room 433 (in 4 days).
## Treatment
- Fosfomycin 3 g, single dose at night.
- Furagin 100 mg, 1 tablet 3 times a day for 7 days.
- Canephron 2 dragees 3 times a day for 10 days.
- Kidney herbal teas (cornflower flowers, birch buds, bearberry, pol-pala) 3-4 times a day for 10 days.
@@ PAGE 2
- Ibuprofen 1 tablet 2 times a day for 5 days.
- No-shpa 1 tablet 3 times a day for 7 days.
- Plentiful drinking regimen.
- Warmth on the bladder area.
# Primary Osteoarthritis (POA) of Hand Joints and Knees; Osteoporosis; Bilateral Carpal Tunnel Syndrome
## Diagnosis
- Primary osteoarthritis (POA), osteoarthritis of the hand joints stage 1, gonarthrosis stage 1. Functional insufficiency of joints (FNS) 1.
- Osteoporosis L1-L4 (T-score -3.8).
- Carpal tunnel syndrome on both sides.
## Examination plan
- Anti-CCP antibodies (to exclude rheumatoid arthritis).
## Treatment
- Therapeutic physical training (exercise therapy).
- Chondroprotector courses of 3 months, 2 times a year: Structum 500 mg 2 times/day for 3 months.
- Topically: ketoprofen gel + compresses with Dimexide on the hand joints.
- For pain: Naiz 1 tablet 2 times/day.
- Omeprazole 20 mg 30 minutes before breakfast.
- Vitamin D 50,000 IU per week.
- Calcium D3 Nycomed Forte 1 tablet 2 times/day.
- Alendronic acid 70 mg 1 tablet once a week.
# Arterial Hypertension (AH) - List of Investigations
## Investigations
- Blood pressure (BP) and heart rate (HR) profile.
- Complete blood count.
- Urinalysis.
- Blood biochemistry: determination of the concentration of glucose, urea, creatinine, cholesterol, potassium, sodium, calcium.
- GFR (by the Cockcroft-Gault formula).
- ECG.
- Echocardiography (Echo-CG).
- Ophthalmologist consultation.
# Chronic Helicobacter-associated Antral Gastritis; Unspecified Anemia
## Diagnosis
- Chronic Helicobacter-associated antral gastritis, mildly expressed, mildly active, with focal complete intestinal metaplasia grade 1 (+), with qualitative atrophy grade 1 (+), HP+ (06.02.2024).
- Eradication in history (2018; stool antigen test for H. pylori negative from 26.01.2024).
- Anemia, unspecified.
## Examination plan
- Control of eradication in 6-8 weeks: 13C urea breath test or stool antigen test for H. pylori (exclude antibiotics and PPIs (omeprazole, pantoprazole, etc.) for 2 weeks before the test).
- EGDS (esophagogastroduodenoscopy) with biopsy per OLGA, once in 3 years.
## Treatment
- Pantoprazole 40 mg 2 times/day for 14 days.
- Ulcavis (bismuth) (film-coated tablets, 120 mg) orally 120 mg 4 times a day, 30 minutes before meals; the last dose may be taken at night.
- Tetracycline (film-coated tablets, 100 mg) orally 500 mg 4 times a day for 14 days (prescription on the card).
- Metronidazole (tablets 250 mg) orally 500 mg 3 times a day, during or after meals, for 14 days.
- Alternative: omeprazole 20 mg, 1 capsule 2 times/day for 14 days, 30 minutes before meals; amoxicillin 1000 mg (without clavulanic acid), 1 tablet 2 times/day for 14 days; clarithromycin 500 mg, 1 tablet 2 times/day for 14 days.
# Spine Examination Findings and Dispensary Plan
## Objective findings
- The volume of active movements is limited in the lumbar spine, palpation of the paravertebral points (PVP) is painful, myofixation of the lumbar region, no tension symptoms.
- The volume of active movements is limited in the cervical spine, palpation of the paravertebral points is painful, myofixation of the neck region.
## Examination plan
- According to the Resolution of the Ministry of Health of the Republic of Belarus dated 16.12.2024, N173 "On the procedure for conducting dispensarization of the adult and child population".
## Recommendations
- Healthy lifestyle, work and rest regime, full healthy sleep, avoid overcooling, excessive physical and psychoemotional load, exercise therapy in a gentle regime according to the general strengthening method.
# Vertebrogenic Left-sided Lumboischialgia
Unstable mild pain syndrome.
## Dispensary observation group D1
@@ PAGE 3
## Prescriptions
- Hygiene of postures and movements.
- Exclude work associated with prolonged stay in a forced position, lifting and carrying heavy objects, frequent bending of the trunk. Therapeutic physical training (exercise therapy) on a long-term basis.
- Chondroprotector courses 1-2 times a year, outpatient: Alflutop 1 ml IM 1 time a day, N20, or Mucosat 2 ml IM every other day for 1 month, then Chondrosamine 1 capsule 2 times a day for 2 months.
- With an increase in the pain syndrome - a short course of NSAIDs (Arcoxia 60 mg 1 tablet 1 time a day, or Aertal 100 mg 1 tablet 2 times a day, or Movalis 15 mg 1 tablet 1 time a day), together with muscle relaxants (Tizalud 4 mg 1 tablet 1 time a day, or tolperisone 150 mg 1 tablet 3 times a day - 10 days).
# Examination Findings: Oral Cavity, Pharynx and Lymph Nodes
Lips without cracks and ulcerations, no induration on palpation. Visible mucous membranes of the oral cavity and pharynx are clean, no plaque. Mucosa of the cheeks without plaque, unchanged. Mucosa of the floor of the mouth without visible changes and formations. Tongue moist, clean, without pathological plaque, cracks, ulcerations. Gum mucosa of normal color, without visible changes. Tonsils of normal structure, not enlarged, no plaque.
Peripheral lymph nodes: lymph nodes accessible to palpation (posterior cervical, anterior cervical, submandibular, parotid, supraclavicular, subclavian, axillary, ulnar) and inguinal are not enlarged, painless, mobile, not fused with the skin.
# Styloiditis (right)
## Diagnosis
- Styloiditis on the right.
## Dispensary observation group D1
## Prescriptions
- Diclopentil 1 tablet 2 times/day for 7 days, after meals.
- Omeprazole 20 mg 1 tablet 2 times/day for 10 days.
- Topically: Dimexide gel + Troxevasin gel + diclofenac gel 3 times/day.
- Elastic bandaging.
- Physiotherapy (PT): electrophoresis with novocaine, ultrasound therapy with Dimexide, N10.
- If conservative therapy is ineffective - decide on a blockade.
## Investigations
- X-ray of the right wrist joint in two projections.
# Allergy - Recommendations
- Hypoallergenic environment at home (remove carpets and other dust collectors, frequent wet cleaning, frequent airing, control of mold fungus, etc.).
- Hypoallergenic diet with limitation of obligate allergens (citrus fruits, chocolate, whole milk, chicken protein, coffee, exotic fruits, etc.).
# Bilateral Carpal Tunnel Syndrome; Vertebrogenic Cervicalgia
Carpal tunnel syndrome on both sides. Vertebrogenic cervicalgia, mild pain syndrome, exacerbation.
## Dispensary observation group D1
## Prescriptions
- 1. Avoid lifting heavy objects and prolonged stay in a forced position.
- 2. Neuromidin 20 mg, 1 tablet 3 times a day for 1-2 months.
- 3. B-group vitamins, 1 tablet 1 time/day (Milgamma, Borivit).
- 4. Trental 100 mg, 1 tablet 1 time a day after meals for 1 month.
- 5. With an increase in the pain syndrome - a short course of NSAIDs (Aertal 100 mg, 1 tablet 2 times a day for 5-7 days) together with omeprazole (20 mg, 1 capsule 2 times a day).
@@ PAGE 4
# Acute Respiratory Infection (ARI) - Recommendations
- Gargle the throat with Furasol / Furacilin / chamomile 3-4 times a day.
- Irrigate with Phytospray / Hexaspray / Orasept up to 4 times a day.
- Septolete Total / Anzibel / Dequadol lozenges - dissolve up to 4 times a day.
- Plentiful warm drink, vitamin C 1000 mg per day, in a complex with B and D vitamins, zinc, selenium.
- At a temperature above 38.5: paracetamol / ibuprofen / Ibuklin.
# Varicose Veins of the Lower Limbs, C3sEpAsPr; Infected Wounds of the Right Shin
## Recommendations
- Treatment by a surgeon at the polyclinic at the place of residence (dressings daily until the wounds heal) or in a surgical hospital.
- Surgical treatment of varicose veins is not indicated at present.
- Elastic compression (elastic bandaging, compression hosiery (knee-highs, stockings) of compression class 2).
- Venotonics (Detralex 1000 mg 1 tablet 1 time a day, or Venolek 600 mg 1 tablet 1 time a day, or Phlebodia 600 mg 1 tablet 1 time a day) in courses of 1 month, 2-3 times a year.
# Benign Prostatic Hyperplasia (clinically); Chronic Prostatitis, Exacerbation
## Examination plan
- CBC and urinalysis to be done on 08.09.2023; repeat urologist examination on 11.09.2023, room 433, at 17.50, to assess the dynamics of treatment.
## Treatment
- Ciprofloxacin 500 mg, 1 capsule 2 times a day for 7 days, after meals.
- Tamsulosin 1 capsule 1 time a day at night for 1 month.
- Pentoxifylline 100 mg, 1 tablet 3 times a day for 10 days.
- Indomethacin suppositories: 1 suppository 1 time a day for 6 days.
# Heel Spur (right)
## Diagnosis
- Heel spur on the right.
## Examination plan
- X-ray of the right heel region.
## Prescriptions
- 1. Naiz 100 mg, 1 tablet 2 times/day for 10 days.
- 2. Laser, 10 sessions, on the heel region.
- 3. Ketorol gel 3 times/day topically.
- 4. Wearing comfortable shoes, orthopedic insoles.
# Pregnancy 28-29 Weeks; Gestational Pyelonephritis; Asymptomatic Bacteriuria
Pregnancy 28-29 weeks. Gestational pyelonephritis, latent course. Asymptomatic bacteriuria.
## Examination plan
- Urine by Nechiporenko, quantitative [as written: "k-l"].
- Urine culture for flora and sensitivity to antibiotics.
## Treatment
- Observation by the general practitioner (GP) and the surgeon at the place of residence.
- Canephron 2 dragees 3 times/day for up to 1 month.
- Positional therapy.
- Plentiful warm drink 1.5 - 2 L/day.
- With ASYMPTOMATIC BACTERIURIA of 10^5 and above - antibiotic therapy according to the results of the urine culture (drug of choice: Cefpotek 200 mg 2 times/day for 10 days, or Megacef 500 mg 1 tablet 2 times/day for 10 days).
# Lifestyle in Coronary Heart Disease (CHD) and Arterial Hypertension (AH)
- 1. Follow a hypocholesterolemic diet: exclude the use of butter, pork, eggs, offal, high-fat dairy products; limit sweets, sweet drinks, red meat, easily digestible carbohydrates; give preference to whole-grain cereals; vegetables and fruits (3-5 servings a day), fish (mackerel, herring, tuna, salmon), fat-free fermented milk products, the use of olive and rapeseed oil, nuts (walnuts, almonds, hazelnuts), sesame, white meat (turkey, chicken). Regular physical activity; if 150 minutes of moderate-intensity activity per week is impossible - activity according to ability and state of health. Normalization of body weight until a BMI of 20-25 kg/m2 is reached, and a waist circumference of less than 80 cm in women. Refusal of alcoholic drinks in hepatotoxic doses and of tobacco in any form. Refusal of smoking in any form.
@@ PAGE 5
- 2. Control of BP and HR twice a day with keeping a diary. Target BP figures should be less than 140/90 mm Hg. Limit the use of table salt (less than 5 g/day).
- 3. Daily consumption of at least 200 g of vegetables and 200 g of fruit.
- 4. Weight reduction. BMI less than 25 (BMI = body weight (kg) / height^2 (m2)). Waist circumference in men should be less than 94 cm, in women less than 88 cm.
# J45.8 Mixed Asthma
- 1. Inhaled budesonide 200 mcg 2 times a day, 1 dose regularly, rinse the throat after use; if the effect is insufficient, double the dose. If poorly tolerated: formoterol/beclomethasone 60, 2 doses 2 times a day.
- 2. Prednisolone 5 mg, 3 tablets in the morning for 5-7 days.
- 3. Theophylline 200 mg at night for 10-15 days.
- Inhalation: Pulmovent Combi 1 ml + saline 4 ml for 10 days.
- Inhalation: fenoterol 2 doses during attacks.
# Minor Cardiac Anomalies (MARS); Frequent Ventricular Extrasystole; Vitamin D Insufficiency
## Diagnosis
- 2. Diagnosis: MARS (minor anomalies of the heart): patent foramen ovale (PFO)? atrial septal defect (ASD)? false chord of the left ventricle (LV).
- Frequent ventricular extrasystole with episodes of trigeminy (in history per Holter ECG monitoring 2021, 2022). Heart failure stage 0 (H0).
- Vitamin D insufficiency (14).
- Dyslipoproteinemia.
- Bacteriuria.
## Dispensary observation group D3
## Prescriptions
- 1. Refuse strong tea, coffee, caffeine-containing drinks ("Coca-Cola", "energy drinks") and alcoholic drinks.
- 2. Limit the influence of stress factors, avoid emotional overstrain. Use relaxation techniques and autogenic training (psychotherapy sessions, psychological counseling).
- 3. Exclude smoking.
- 4. Establish a daily routine, provide full sleep and rest (at least 8 h), reduce the time spent in conditions of electromagnetic radiation (mobile phone, computer, etc.).
- 5. Increase physical activity in a dosed manner in accordance with the capabilities of the body: do not allow overfatigue, tiredness; exclude excessive physical loads (lifting weights, weightlifting).
- 6. In the diet exclude chocolate, fried, spicy and too hot food; include foods rich in potassium and magnesium.
- Magne B6 (Magnefar B6, biopharm) 2 tablets at night for 1 month.
- Hawthorn, Potassium + Magnesium 0.5, 1 tablet 2 times a day for 2 weeks.
@@ PAGE 6
- OMEGA 3 (fish oil) 1000 mg 2 times a day for 2 months.
- Vitamins - continue the intake.
# Medial Epicondylitis (right); Damage to the Biceps Tendon at the Right Elbow Joint
## Diagnosis
- Medial epicondylitis on the right. Damage to the biceps tendon at the right elbow joint.
## Examination plan
- X-ray of the elbow joint.
## Prescriptions
- Nimesil 100 mg, 1 sachet 2 times a day for 2 days, then aceclofenac 100 mg, 1 tablet 2 times a day for 10 days.
- Nolpaza 40, 1 tablet a day for 14 days.
- Naiz gel topically 3-5 times/day (up to 10 days) + sling (kerchief) bandage for 3 weeks.
- Cryotherapy 6 sessions, electrophoresis with lidocaine 6 sessions.
- Limitation of heavy physical loads for 1 month.
- Dimexide gel at night.
- Midocalm 150 mg, 1 tablet 2 times a day for 15 days.
# Medial Epicondylitis (left)
## Diagnosis
- Medial epicondylitis on the left.
## Examination plan
- X-ray of the elbow joint.
## Prescriptions
- Nimesil 100 mg, 1 sachet 2 times a day for 2 days, then aceclofenac 100 mg, 1 tablet 2 times a day for 10 days.
- Nolpaza 40, 1 tablet a day for 14 days.
- Indovazin gel topically 3-5 times/day (up to 10 days) + elastic bandaging.
- Limitation of heavy physical loads.
- Dimexide solution 1 teaspoon : 5 teaspoons of water, compresses for 1 hour 3 times a day for 2-3 weeks.
- Dimexide gel at night.
- Orthosis (wrist supports).
# Medial Epicondylitis of the Left Elbow Joint - Second Plan
## Examination plan
- Ultrasound (US) as scheduled.
- X-ray: registered (appointment recorded).
- Return after treatment to the traumatologist.
- Blood biochemistry, rheumatologist.
## Prescriptions
- Wearing a soft-fixation orthosis; remove at night.
- Celecoxib 200 mg, 1 tablet 2 times a day for 10 days [as written: "2р 2д"], then Diaflex 50 mg, 1 tablet 2 times a day for 10 days.
- Omez 20 mg, 1 tablet 1 time a day for the duration of NSAID intake.
- Naiz gel 2-3 times a day topically.
- Limit heavy physical loads.
- Cyclo 3 Fort, 1 tablet 2 times a day for 14 days.
# Lateral Epicondylitis (right)
## Diagnosis
- Lateral epicondylitis on the right.
## Examination plan
- (not specified in the source)
## Prescriptions
- Oxiten 20 mg, 1 tablet a day for 1 month.
- Naiz gel topically 3-5 times/day (up to 10 days) + elastic bandaging.
- Limitation of heavy physical loads.
- Compress with Dimexide solution for 5 minutes 2 times a day.
- Cryotherapy N5.
- Shock-wave therapy N10.
@@ PAGE 7
- Wearing an orthosis (wrist supports).
# Trigeminal Neuralgia (left); Left Ankle Joint Swelling
Neuralgia of the left trigeminal nerve, persistent mildly expressed pain syndrome, protracted course.
## Treatment
- Artoxan IM 1 time/day for 3 days.
- Pregabalin 75 mg, 1 capsule x 1 time/day for 14 days.
- Vasonit 600 mg, 1/2 tablet x 2 times/day for 1 month.
- Arcoxia 90 mg, 1 tablet x 1 time/day for 7 days.
## Objective findings
- Left ankle joint is swollen, painful on palpation, movements are painful and limited.
# Pollinosis (rhino-conjunctival and bronchospastic? syndrome), Exacerbation
Pollinosis: rhino-conjunctival and bronchospastic? syndrome, exacerbation. Sensitization to tree pollen.
## Examination plan
- Spirometry (respiratory function test) with a bronchodilator test, sputum analysis, CBC, blood biochemistry.
## Treatment
- Avamys 2 sprays 1 time/day for a month.
- Nixar 20 mg, 1-2 tablets 1 time/day.
- Lecrolin eye drops, 2 drops 3-5 times/day.
- Dexamethasone 1 mg/ml, 5.0, 1-2 drops in both eyes for 7-10 days.
- Pulmovent Combi 0.5 mg/0.25 mg, 1.0 in 3 ml of saline, for 7-10 days.
- Beclomethasone 250 mcg, 1 dose 2 times/day, by inhalation.
# ARI / Viral Infection - General Treatment Recommendations
(Heading not shown in the source; this block follows the pollinosis plan.)
- Plentiful drink, vitamin C up to 1000 mg/day, zinc, vitamin D.
- For hyperthermia above 38.5: Ibuklin 1 tablet / ibuprofen 400 mg, paracetamol 500 mg.
- Antiviral drugs: Angrimax Neo 1 capsule 3 times a day for 5 days; Vitavirin 1 sachet 1 time a day for 7 days; Ingavirin 90 mg, 1 capsule 1 time a day for 7 days; Flustop 75 mg, 1 tablet 2 times a day for 5 days.
- Antibiotics: Augmentin (Amoxiclav) 1000 mg 2 times a day for 7 days; azithromycin 500 mg 1 time a day for 5 days; Megacef 500 mg 2 times a day.
- Pharyngospray / Hexaspray / Orasept / Ingalipt - irrigate the throat 3-5 times a day.
- For sore throat: Furasol - gargle 2-3 times a day; Grammidin - dissolve 3 times a day.
- For nasal congestion: Galazolin gel (xylometazoline) into the nose, 1 dose.
- Antihistamines: Allerway Express 5 mg, 1 tablet 1 time a day; Fenkarol 50 mg, 1 tablet 2 times a day; Cetrin 10 mg 1 time a day; loratadine 10 mg, 1 tablet 1 time a day.
- For wet cough: ACC 600 mg/day, ambroxol 30 mg, 1 tablet 3 times a day.
- For dry cough: Herbion with plantain, 10 ml 3-5 times a day.
- Nifuroxazide 200 mg 4 times/day, Smecta 1 sachet 3 times/day, Regidron / Normohydron 1 sachet per day, Linex 1 capsule 3 times/day.
- Drotaverine 40 mg, 2 tablets 3 times/day for pain; paracetamol 500 mg at a temperature above 38.5.
# Hemorrhoids
- Detralex 3 tablets per day (1 tablet in the morning, at midday and in the evening) for 4 days, then 2 tablets per day (1 tablet in the morning and in the evening) for the following 3 days, during meals.
- Natalsid 1 suppository 2 times/day.
- Nigepan 1 suppository 2 times/day.
- Baths with furacilin or chamomile.
# ARI. Acute Rhinopharyngolaryngitis
## Diagnosis
- ARI. Acute rhinopharyngolaryngitis.
@@ PAGE 8
## Prescriptions
- Strict voice rest!
- Gentle diet.
- Augmentin 1000 mg, 1 tablet 2 times/day for 7-10 days.
- Phytospray - spray the throat 3-4 times/day.
- Alkaline inhalations (Borjomi, Minskaya-4) through the nose 2-3 times a day.
- Homeovox 2 tablets, dissolve every hour for 6 days.
- Cetrin (loratadine) 1 tablet in the evening for 10 days.
# ARI in Pregnant Women
- Paracetamol at a temperature of 38.5 and above; plentiful warm drink; Argento-kea Nanolar - irrigate the throat 3 times a day for 5 days; Aquamaris 1-2 sprays into each nasal passage several times a day (2-6 times a day).
# Non-erosive GERD; Gastric Erosions; Chronic Antral Gastritis; Overweight
## Diagnosis
- Non-erosive gastroesophageal reflux disease (GERD) with clinical manifestations of moderate severity.
- Gastric erosions (27.04.2023).
- Chronic antral gastritis, mildly expressed, inactive, with mild atrophy and focal mild incomplete intestinal metaplasia, HP- (04.05.2023).
- Excess body weight (BMI = 26.8 kg/m2).
## Examination plan
- (not specified in the source)
## Treatment
- Pantoprazole 40 mg, 1 tablet 2 times/day 30 minutes before meals - 4 weeks, then 1 tablet 1 time/day in the morning - 4 weeks.
- For heartburn: Pepsan 1 sachet 3 times/day before meals; Alginomax 2-4 tablets, chew 30 minutes after meals.
- Itomed 50 mg, 1 tablet 3 times/day for up to 4 weeks.
## Recommendations
- Diet, adherence to the meal regimen. Sleep with the head end raised by at least 15 cm. Choice of clothing: avoid wearing tight clothing and tight belts. Limitation of physical exercises associated with strain of the abdominal press and increased intra-abdominal pressure. Quit smoking!!! 3-4 meals a day. Exclude overeating. Do not take a horizontal position after meals for at least 1.5 h before sleep. Exclude or limit fatty foods (cream, butter, fatty fish, pork, goose, duck, lamb). Limit fried dishes and fast food. Exclude spicy and sour food. Consuming very hot or cold food [as written; a "not" appears to be missing in the source]. Limit alcohol and carbonated drinks. Limit or exclude foods that promote hypotonia of the lower esophageal sphincter: strong tea, coffee, chocolate, green onion, garlic, tomatoes and citrus fruits, mint drinks and mint.

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# Day-Stay Unit Infusion Regimen (from 08.04.25)
(Heading in the source reads "in ODP from 08.04.25"; the abbreviation ODP is not expanded.)
- Sol. Dexamethasoni 4 mg - 2.0 + Sol. Analgini 50% - 2.0 + Sol. Euphyllini 2.4% - 5.0 + Sol. NaCl 0.9% - 100.0, IV drip, N5.
- Sol. Furosemidi 1% - 2.0, IV jet, N5.
# Coronary Heart Disease: Atherosclerotic Cardiosclerosis; Bradyarrhythmia; Arterial Hypertension
## Diagnosis
- CHD: atherosclerotic cardiosclerosis.
- Aortic valve insufficiency grade 1-2.
- Sinus bradycardia, frequent SV (supraventricular) extrasystole, paroxysm of unstable accelerated atrial rhythm, transient sinus arrest (max RR 3732 msec) per Holter ECG monitoring of 01.12.2023.
- Arterial hypertension grade 2, risk 4. Heart failure H1.
## Dispensary observation group
## Prescriptions
- Diet.
- Aspicard 75 mg, 1 tablet 1 time/day.
- Equapril 5/10 mg, 1/2-1 tablet 2 times/day under BP control.
- Preductal OD 80 mg, 1 tablet 1 time/day for 2 months, 2 times a year.
- Tiolin 200 mg, 1 tablet 3 times/day for 1 month, 2 times a year.
- Zelenin drops 20-30 drops at a heart rate below 50 per minute.
- Pacemaker implantation is not indicated at the time of examination, given the absence of clinically significant manifestations of bradysystole.
## Investigations
- Control Holter ECG monitoring in 2-3 months.
- Repeat examination.
# Gout (tophaceous); Possible Olecranon Bursitis
## Diagnosis
- Gout, gouty arthritis, tophaceous form, chronic intermittent course, exacerbation. Functional insufficiency of joints (FNS) 2.
- Bursitis of the elbow joint?
## Examination plan
- Surgeon consultation (bursitis of the elbow joint?).
## Treatment
- Diet N6, refusal of alcohol; continue febuxostat 80 mg per day.
- Arcoxia 120 mg, 1 tablet 1 time/day for 7 days.
- Colchicine 0.5 mg 2 times/day for 10 days, then 1 tablet 1 time/day for 1.5-2 months.
- Methylprednisolone 4 mg, 2 tablets in the morning, reducing the dose by 1/2 tablet every 5 days.
# Dry Eye Discomfort
- Tear substitutes with hyaluronic acid for a feeling of discomfort in both eyes, on a long-term basis (Optinol Intensive, Artelac, Hylo-Care).
# Herpes Zoster (Shingles)
@@ PAGE 10
- Acyclovir 800 mg at 7:00, 11:00, 15:00, 19:00, 23:00.
- Nimesulide 100 mg 2 times/day.
- Loratadine 10 mg 1 time a day.
- Pregabalin 75 mg at night.
- Treat the eruptions with brilliant green.
# Urolithiasis - General Recommendations
- Plentiful drink 1.5 - 2 L/day, diet.
- Canephron 50 drops 3 times/day for 1 month and then in courses 2-3 times/year, or Cyston 2 tablets 2 times/day for 1-2 months in courses 2-3 times/year.
- Herbal uroseptics (pol-pala, bearberry, cowberry leaves) for 10 days of each month for up to 6 months.
# Relief of Hypertensive Crises
- With a sharp rise in BP: Captopril 50 mg, 1 tablet (no more than 3 tablets per day under BP control); or Moxonidine 0.4 mg, 1 tablet (no more than 2 tablets per day under BP control).
# Shoulder Pathology; Alopecia Areata; Erosive GERD; Hiatal Hernia; Gastritis; CHD
## Diagnosis
- Incomplete rupture of the supraspinatus tendon on the right. Tenosynovitis of the tendon of the long head of the biceps on the right.
- Alopecia areata.
- Erosive GERD with esophagitis grade A (26.05.22). Axial hernia of the esophageal opening of the diaphragm.
- Chronic mildly expressed inactive antral gastritis without atrophy and metaplasia. HP-.
- CHD: atherosclerotic cardiosclerosis. AH grade 2, risk 3. Heart failure H1.
## Examination plan
- Ultrasound of the right shoulder joint, surgeon consultation.
## Treatment
- Co-Amlessa 8/10/2.5, 1 time/day.
- Electrophoresis with lidocaine - 7 sessions; LMT - 7 sessions.
- Meloxicam 15 mg, 1 tablet in the evening for 2 weeks.
- Sirdalud 2 mg, 1 tablet 2 times/day for 5-10 days.
- Massage, exercise therapy.
# Contusion - Recommendations
- Physiotherapy (magnetotherapy, laser therapy, UHF) on the site of injury in the absence of contraindications; cold on the 1st day to the site of injury.
- Indovazin gel topically 2 times a day.
- Aceclofenac tablets 100 mg, 1 tablet x 2 times/day for pain, 7-10 days, with simultaneous intake of omeprazole capsules 20 mg, 1 tablet x 1 time/day.
# Reducing Cardiovascular Risk
- 1. Rational nutrition with limitation of animal fats, easily digestible carbohydrates; in AH - limitation of fluid and salt.
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- 2. Physical activity for more than 30 minutes a day.
- 3. Maintaining a normal weight (BMI not more than 25, waist circumference in men less than 94 cm).
- 4. Control of BP level, target figures not higher than 140/80.
- 5. Total cholesterol - from 3.1 to 5.2 mmol/L; HDL - more than 1.68 mmol/L in women and 1.42 mmol/L in men; LDL - less than 3.9 mmol/L; triglycerides - from 0.14 to 1.82 mmol/L.
- 6. Fasting glucose level less than 6.0 mmol/L.
- 7. Smoking cessation.
# Acute Mixed Conjunctivitis on the Background of ARI
## Diagnosis
- OU (both eyes): acute mixed conjunctivitis on the background of ARI.
## Treatment
- Miroseptin drops, 1 drop 4-5 times/day for 7 days in both eyes.
- Moxifloxacin drops, 1 drop 4 - times/day for 7 days in both eyes [number missing in the source].
- 3. Loratadine tablets, 1 tablet at night for 7 days orally.
- 4. Laferon drops, 1 drop 6-8 times/day for 10 days in both eyes.
- 5. From 13.01 add Dexamethasone drops, 1 drop 3 times/day for 5 days in both eyes.
- 6. Rinse the conjunctival cavity with furacilin solution.
# COPD Stage 4 with Multiple Cardiovascular Comorbidities
## Diagnosis
- COPD stage 4, emphysematous type, outside exacerbation. Respiratory failure (RF) stage 1.
- CHD: atherosclerotic and post-infarction (2017) cardiosclerosis, stenosing coronary sclerosis. CABG / mammary-coronary bypass (2017).
- AH stage 2, risk 4. Heart failure H2A (NYHA functional class III).
- Stenosing atherosclerosis of the brachiocephalic arteries. Subocclusion of the external carotid artery (ECA) on the right.
- Colloid cysts of both lobes of the thyroid gland.
- Adrenal mass, hormonally inactive.
- Chronic calculous cholecystitis in remission.
- Organic anxiety disorder, F06.4.
- OD - immature (cataract), OS - incipient cataract OU.
- Diffuse bilateral atrophic bronchitis stage 1-2.
## Examination plan
- Once a year: complete blood count, urinalysis, blood biochemistry: determination of the concentration of glucose, urea, creatinine, cholesterol, potassium, sodium, calcium. GFR. BP self-monitoring. Electrocardiography. Echocardiography. Ophthalmologist consultation.
@@ PAGE 12
## Treatment
- Co-Amlessa 8/10/2.5 mg x 1 time/day, Rosulip 5 mg in the evening, ASA 75 mg in the evening, L-thyroxine 150 mcg in the morning.
- Course intake of expectorants (ACC 600 mg per day or ambroxol 30 mg 3 times/day).
- Tiotropium bromide (Spiriva Respimat) 2.5, 2 inhalations 1 time a day, permanently.
- Beta-2 agonists during suffocation attacks; nebulizer inhalations during suffocation attacks: Pulmovent Combi 1 ml + saline 3 ml.
- Seretide Multidisk metered-dose powder for inhalation 50 mcg/dose, 250 mcg/dose, 2 inhalations 2 times/day.
- Beclomethasone/formoterol 100/6 mcg, 2 inhalations 2 times a day, permanently.
- Breathing exercises.
# Palliative Care Home Visit - Patient 1 (Kartsev)
Kartsev. Examination: narcotics [unclear in source]. Body temperature 36.4 °C. BP 125/70 mm Hg. Pulse 68 per minute. Examination for scabies and pediculosis: not found.
## Complaints and condition
- Complaints of general weakness, pain in the epigastric region, pain in the area of the tumor formation, headache, mucous discharge with blood clots from the tracheostomy, periodic rise in BP.
- The patient lies in bed, does not move around the apartment, turns over independently. Care is provided by his wife. Does not speak, communicates in writing. Feeding is carried out through a gastrostomy, breathing through a tracheostomy.
- To relieve the pain syndrome he takes ketorolac 2.0 up to 2 times/day, analgin 2.0 1 time/day IM, diphenhydramine 1.0 1 time/day IM, papaverine 2.0 1 time/day IM; the analgesic effect is insufficient. Chronic pain syndrome on the NOSh scale (numeric rating scale) - 4 points.
- On examination: on the lateral surface of the right thigh there is a wound 5 cm by 10 cm, hyperemic, without discharge, covered with a crust; in the area of the chin on the right there is a tumor formation, hyperemic, up to 3 cm, with insignificant recurrent bleeding.
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## Examination plan
- The patient was offered hospitalization in the palliative care department of GGKB N4; the patient categorically refused. The possible consequences of refusing the above-mentioned types of medical interventions were explained to the patient and relatives in an accessible form. A written refusal was drawn up.
## Treatment
- Dynamic observation by the GP.
- Provision of palliative medical care in accordance with the order of the Ministry of Health of the Republic of Belarus N842 of 11.06.2024 "On the organization of palliative medical care for the adult population".
- Protective bed rest. Breathing exercises.
- Medical rehabilitation: exercise therapy sessions (strengthening the muscles of the lower limbs, massage of the limbs).
- Avoid overcooling and staying in one position for more than 2 hours. Follow the "5 pillows" rule when feeding. Control of the patient's body position: change the body position at least once every 2 hours, including at night, observing the order and the absence of restrictions for one or another position: low semi-sitting position, position on the side, position on the back. The low semi-sitting position should coincide with mealtime. At each movement, inspect the risk areas. Do not subject them to friction; position the patient in bed in a position that ensures comfortable stay, using devices to hold the body in an optimal position that reduces pressure on the skin and areas of bony prominences.
- Hygienic treatment of the wound with chlorhexidine 1 time/day, application of levomekol 1 time/day, application of a sterile dressing to the wound area.
- Prevention of pressure sores (anti-decubitus mattress), elimination of unevenness and folds on underwear and bed linen; use of underwear made of natural fabrics (preferably with seams outward); use of bed linen made of natural fabrics (preferably a fitted sheet for better tension on the mattress).
- BP and HR profile.
- Diet balanced in proteins, fats and carbohydrates, with limitation of easily digestible carbohydrates.
- Observance of a regimen of dosed physical activity.
- To relieve the pain syndrome, start intake: according to the scheme tramadol 50 mg, 1 tablet 2 times/day (8:00, 20:00), at the same time, at equal intervals.
- Evaluation of the analgesic effect on 10.07.2025.
- Analgin 2.0 1 time/day IM (22:00 if necessary).
- Diphenhydramine 1.0 1 time/day IM (22:00 if necessary).
- Papaverine 2.0 1 time/day IM (22:00 if necessary).
@@ PAGE 14
- Continue taking drugs for chronic diseases: Ramilong 10 mg, 1 tablet 1 time/day long-term (under BP control).
- Rosuvastatin 10 mg, 1 tablet 1 time/day long-term.
- Ferrum Lek 1 tablet 3 times/day (under CBC control).
- Folic acid 1 mg, 2 tablets 3 times/day.
- Omeprazole 20 mg 1 time/day in the morning, long-term.
- Gefal 1 tablespoon 30 minutes after meals, long-term.
# Palliative Care Home Visit - Patient 2 (Metastatic Lung Cancer)
Body temperature 35.8 °C. BP 100/60 mm Hg. Pulse 60 per minute. Examination for scabies and pediculosis: not found.
## Complaints and condition
- Contact with the patient is unavailable due to the deterioration of her general condition. According to relatives, she has not eaten for 4 days, drinks in small amounts, has been unavailable for contact for 4 days, swelling of the lower limbs, constantly with closed eyes, "tosses about in bed".
- The patient lies in bed, does not react to stimuli, sometimes opens her eyes. On examination: icteric skin, dark spots on the soles of the feet. Assessment of the chronic pain syndrome on the NOSh scale is impossible.
## Objective findings
- Condition of moderate severity.
- Skin icteric.
- Throat: did not open her mouth.
- Peripheral lymph nodes: peripheral lymph nodes accessible to palpation (posterior cervical, anterior cervical, submandibular, parotid) are not enlarged, painless, mobile, not fused with the skin.
- Mammary glands: no lumpiness, contour even. Skin icteric, no edema, erythema, peeling, ulcerations. Nipple anomalies: no inversion, retraction, crusts, no discharge.
- Lungs: breathing weakened, no wheezes.
- Edema of the lower limbs: yes.
- Heart sounds rhythmic, muffled.
- Cardiac murmur: none.
- Tapping (costovertebral) symptom negative on both sides.
- Abdomen enlarged in size.
- Stool into a diaper.
- Urination free, painless, into a diaper.
## Diagnosis
- Central glandular disease of LNDB [abbreviation unclear in source] with mts in NDLL [unclear in source], in the mediastinal lymph nodes, with ingrowth into the pericardium, T2a N2 M0, stage IIIA.
- Condition after VATS (video-assisted thoracoscopy) on the right: biopsy of bifurcation lymph nodes from 16/11/23.
- Condition after 2 courses of neoadjuvant polychemotherapy (PV).
@@ PAGE 15
- Progression (01.2024): mts in the mediastinal lymph nodes on the right, mts in the liver, mts in the spleen.
- Condition after 15 courses of targeted therapy (Alectinib at RNPC OMR named after N.N. Alexandrov from 22.01.2024 to the present). Mts in the bones of the skeleton, pathological fracture of the body of the L1 vertebra without stenosis of the spinal canal (04.25). Lumbalgia, persistent pronounced pain syndrome.
- Condition after stabilization by transpedicular fixation (TPF) at the Th12-L2 level with transplantation of autobone fragments with a cortical layer, 19.05.2025. Condition after 2 courses of targeted therapy (Alecensa).
- Progression (08.2025): new mts in the liver (subtotal lesion). Clinical group "46" [as written; probably 4b].
## Concomitant diagnosis
- Anemia of malignant neoplasm, moderate severity.
- CHD: atherosclerotic cardiosclerosis. Atherosclerosis of the aorta and coronary arteries. Fibrosis of the ring and cusps of the aortic valve without valve dysfunction, mitral valve with mitral regurgitation grade 1, regurgitation on the pulmonary artery grade 1. Paroxysmal form of atrial fibrillation, outside paroxysm.
- AH grade 2, risk 4. Heart failure H1.
- Fatty degeneration of the liver, liver cysts. Lipomatosis of the pancreas. Cysts of both kidneys.
## Treatment
- An emergency medical service (EMS) team was called.
# Allergic Contact Dermatitis; Allergic Rhinitis
Unspecified allergic contact dermatitis, widespread, recurrent course. Unspecified allergic rhinitis (sensitization to library dust?).
## Examination plan
- Evaluation of immune indicators: immunoglobulins A, M, G, E, phagocytosis, circulating immune complexes (CIC), CBC with leukocyte formula; biochemical indicators: CRP, RF, ASO; total protein, AST, ALT, GGT, glucose, total bilirubin; blood for thyroid hormones (exclude hypothyroidism).
- On a scheduled basis at the place of residence: blood for a food allergy panel (Helix N2810).
## Treatment
- Hypoallergenic environment at home (remove carpets and other dust collectors, frequent wet cleaning, frequent airing, control of mold fungus, etc.).
- Hypoallergenic diet with limitation of obligate allergens (citrus fruits, chocolate, whole milk, chicken protein, coffee, exotic fruits, etc.).
- Skin care: application of emollients 2-4 times a day (Dexpanthenol (Bepanthen), Oilatum, Locobase, Physiogel, Topicrem, Apteker (prescription N14,15), Farmakos "Atopic", etc., of your choice); use of special cosmetic products for washing and caring for dry skin. Daily shower for 10-15 minutes with water at 35-36 degrees, without rubbing the skin with washcloths; blot the skin after washing, do not rub. In winter use softening agents with a greasier composition.
@@ PAGE 16
- Care cream Ezmitop 1 time/day on problem areas of the skin, long-term.
- On the foci of dermatitis: Advantan (Elocom, Lokond, Momederm) 1 time/day as a short course until subsidence; on foci with weeping (infection) Triderm or Triacutan 1 time/day; on the face and skin folds - hydrocortisone ointment 1 time/day + increase the application of emollients to 4-6 times a day.
- For itching: a second-generation antihistamine (desloratadine, loratadine, cetirizine, Nixar, etc.) 1-2 times/day after meals for up to 1 month. Glycine (Gromecin) 0.1, 2 tablets under the tongue before bedtime for 1 month. If ineffective - consultation with a dermatologist of GOKVD (correction of treatment).
- For nasal congestion: 1) "Shower" of the nasal passages with saline solutions using the "Aquamaris" device 2 times a day for 5-7-10 days. 2) Nasal spray with GCS (Nasonex, Avamys, Flixonase, Morezon, Moris, etc., of your choice), 1-2 doses 2 times/day for 5 days, then 1 time a day for 5-7-10 days, then "on demand" 1 time a day. 3) Orally: first-generation antihistamines (Fenkarol) 25 mg 2-3 times a day or second-generation (cetirizine, loratadine, desloratadine, Nixar, etc., of your choice) 1 tablet 1 time a day.
# Ankle Joint Osteoarthritis?; Hyperuricemia
## Diagnosis
- POA (primary osteoarthritis) of the ankle joint?
- Hyperuricemia.
## Examination plan
- X-ray of the ankle joint.
- Control of uric acid in 1 month.
## Treatment
- Diet N6; Milurit 100 mg 1 time/day.
- Normalization of body weight.
- Orthopedic insoles.
- For pain, topical NSAIDs 2-3 times/day.
# Gastric Erosions; Functional Dyspepsia; Chronic Constipation; Liver Cyst
## Diagnosis
- Gastric erosions (12.07.2025). Chronic antral gastritis, mildly expressed inactive, without atrophy and metaplasia, HP- (15.07.2025).
- Functional dyspepsia, mixed variant, with clinical manifestations of moderate severity.
- Chronic constipation of unspecified etiology, moderate severity.
- Liver cyst (per abdominal ultrasound of 15.01.2025, in S2 - 11*10 mm).
- Excess body weight (BMI = 27.4 kg/m2).
## Examination plan
- Colonoscopy (FCS) as scheduled under general anesthesia (due to adhesions in the history).
## Treatment
- Omeprazole 20 mg (or esomeprazole 20 mg), 1 tablet 2 times/day for up to 8 weeks.
@@ PAGE 17
- Itomed 50 mg, 1 tablet 3 times/day before meals for up to 4-8 weeks, or trimebutine 300 mg, 1 tablet 1-2 times/day for up to 4 weeks.
- Pepsan 1 sachet 30 minutes before meals, on demand.
# Invitation for Fluorography (RFO)
Invited to undergo VD [abbreviation unclear in source] and fluorography (RFO).
We inform you that you belong to the category of persons who have not undergone an X-ray fluorographic examination (hereinafter - RFO), live in a territory subject to periodic radiation control and are in a risk group for the development of lung diseases.
In this connection we explain that on the basis of the order of the Ministry of Health of the Republic of Belarus of 23 May 2012, N 622 on the approval of the "Clinical guidelines for the organization and conduct of anti-tuberculosis measures in outpatient healthcare organizations"; the resolution of the Ministry of Health of the Republic of Belarus N28 of 16.03.2010 "Instruction on the procedure for organizing the dispensary examination of citizens affected by the Chernobyl disaster and other radiation accidents" you must undergo RFO.
For the purpose of early detection of this lung pathology, we ask you to go to the State Healthcare Institution "Gomel Central City Polyclinic" for an X-ray fluorographic examination in room N139, from 8:00 to 13:15 and from 14:00 to 19:30 (bring your passport). If you underwent RFO in another healthcare institution, please provide the data on completion of this type of examination to your district general practitioner.
# CHD with Persistent Atrial Fibrillation
## Diagnosis
- CHD: atherosclerotic cardiosclerosis. Persistent form of atrial fibrillation (AF). Fibrosis of the aortic valve and mitral valve. Mitral valve insufficiency grade 1-2, tricuspid valve grade 2. Heart failure H1. AH grade 1, risk 3.
## Examination plan
- ECG on 13.03.2025.
- Transesophageal echocardiography on 13.03.2025 to check for thrombi in the left atrial appendages.
- Return on 13.03 after the examination for referral to the on-duty cardiology department for restoration of sinus rhythm.
# Tinnitus? Vertebrogenic Cervicocranialgia?
## Diagnosis
- Tinnitus? Vertebrogenic cervicocranialgia?
@@ PAGE 18
## Recommendations for examination
- MRI of the brain, vessels.
- Ophthalmologist (fundus).
- Ultrasound of the brachiocephalic arteries (BCA).
- X-ray in functional positions.
- Blood biochemistry (creatinine, urea, AST, ALT, bilirubin, cholesterol, TG, LDL, APV [unclear in source]), KA [unclear in source]).
- Repeat appointment with the results of the additional examination.
## Recommendations for treatment
- Betahistine (Polvertic, Betastaz, and others) 24 mg 2 times a day for 1 month.
- Cavinton (vinpocetine) 10 mg 3 times a day for 1 month.
- Lucetam 1200 mg 1 time a day in the morning for 1 month.
- Neuromultivit 1 tablet a day for 1 month.