Dry Eye Syndrome (Xerophthalmia)

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system, in which the immune system mistakenly attacks the myelin sheath of nerve fibers in the brain, spinal cord, and optic nerves. Damage to myelin disrupts the transmission of nerve impulses and leads to numerous neurological symptoms. Etiology The exact causes of multiple sclerosis are unknown. It is believed that the development of the disease is promoted by a combination of factors such as: • genetic predisposition, • environmental factors (infections, vitamin D deficiency, stress, smoking). Pathogenesis Immune cells (lymphocytes) penetrate the blood–brain barrier and damage myelin. As a result, inflammation develops, and over time, destruction of the nerve fibers (axons) themselves may occur. Forms of Multiple Sclerosis • Relapsing-remitting (RRMS) — the most common form, characterized by alternating periods of relapses and remissions. • Secondary-progressive (SPMS) — initially presents as RRMS, then gradually transitions into a progressive form. • Primary-progressive (PPMS) — gradual worsening of symptoms without distinct remissions. • Progressive-relapsing (PRMS) — a rare form in which disease progression is accompanied by periodic relapses. Symptoms The clinical picture is diverse and depends on which parts of the nervous system are affected. Possible manifestations include: • weakness in the limbs, muscle spasticity, • numbness, tingling, sensation of “electric shocks” in the body, • urinary and bowel dysfunction, • visual disturbances (diplopia, blurred vision, blindness in one eye), • problems with coordination, balance, and gait, • chronic fatigue, dizziness, • cognitive impairments (memory, attention), • depression and emotional instability. Diagnosis The diagnosis is made based on a combination of findings: • MRI of the brain and spinal cord — detection of demyelinating lesions, • Evoked potentials — assessment of nerve impulse conduction speed, • Cerebrospinal fluid analysis — detection of oligoclonal antibodies, • Clinical presentation and history of relapses. Treatment The main goals of therapy are to reduce disease activity, slow progression, and alleviate symptoms. Disease-modifying therapy (DMT): • interferon-beta, • glatiramer acetate, • monoclonal antibodies (natalizumab, ocrelizumab, alemtuzumab), • oral medications (fingolimod, dimethyl fumarate, etc.). Management of relapses: high doses of corticosteroids (e.g., methylprednisolone). Symptomatic therapy: medications to relieve spasticity, pain, fatigue, and urinary problems. Rehabilitation: physiotherapy, therapeutic exercise, psychological support. Prognosis Multiple sclerosis is a chronic and currently incurable disease. However, modern medications can significantly slow disease progression and maintain quality of life for many years. Most patients, especially those who start treatment early, retain mobility for decades.

Relapsing polychondritis is a rare but serious disease in which the body's immune system mistakenly begins to attack its own cartilaginous tissue. Cartilage is the flexible material that forms our ears, nose, certain joints, the trachea, and even parts of the heart. When this tissue is damaged, inflammation, pain, and changes occur. The disease is called relapsing because it usually progresses with recurring episodes: there are times when the disease is active, and then it weakens or almost disappears. After this calm period, inflammations may appear again. What are the main signs? Most often, the disease first affects the cartilage of the ears. A characteristic feature is unilateral or bilateral damage to the outer ear. The ear becomes red, painful, and swollen, while the earlobe usually remains unaffected. Many patients describe that their ears burn or hurt even when touched. It may lead to the development of "soft ears" or a "cauliflower ear" appearance. The next common symptom is inflammation of the nasal cartilage. The nose may become red, painful, and over time deformed, creating the so-called "saddle nose" appearance. Another symptom is damage to the throat, trachea, and bronchi, which is also quite common. Unlike other symptoms, this one can be life-threatening by causing softening of the tracheal rings, known as chondromalacia. This can lead to critical narrowing of the trachea—stenosis—and result in suffocation. Patients may develop hoarseness, shortness of breath, ineffective dry cough, and pain in the front of the neck. The disease can also affect the joints. A characteristic feature is damage to the cartilaginous connections of the sternum, which causes chest pain. Peripheral joints may also be affected, leading to swelling and pain. Among the relatively rare symptoms are inflammatory eye diseases, up to blindness; skin manifestations such as various rashes, nodules, ulcers; hematopoietic system disorders leading to aplastic anemia; and genitourinary involvement, up to renal failure. These symptoms are much rarer than the main ones (ears, nose, and airways), but their occurrence can make the disease life-threatening. There are no specific laboratory or special tests for this disease; diagnosis is based on a combination of clinical signs and examinations. Laboratory tests show no specific markers. A complete blood test may reveal elevated inflammatory markers, anemia, or leukocytosis. Instrumental studies include CT and MRI to assess airway damage. Biopsy is sometimes used but is not always conclusive. Considering the difficulty of diagnosing this disease, unfortunately, patients often reach rheumatologists too late. They are treated by ENT specialists, pulmonologists, ophthalmologists, therapists, and are referred to rheumatologists at rather advanced stages of the disease. Therefore, close collaboration among narrow specialists is very important for the patient’s benefit. In the past, this disease had a fairly high mortality rate due to late diagnosis and ineffective treatment. Today, the development of medicine, especially in the field of autoimmune disease diagnosis and treatment, has led to much higher effectiveness in early diagnosis and treatment of this disease.

Visiting a cardiologist is important not only if you already have health problems, but also for preventive assessment of your heart health. There are several warning signs and risk factors that should not be ignored. Main reasons to see a cardiologist 1. Chest pain or tightness Especially if the pain radiates to the arms, neck, or back. 2. Shortness of breath or difficulty breathing Even after minor physical activity. 3. Rapid or irregular heartbeat Palpitations, shortness of breath, or pounding heartbeat. 4. High blood pressure If blood pressure is persistently high and medications do not help. 5. Family history of heart disease If close relatives had heart disease at a young age. 6. Diabetes Diabetes significantly increases the risk of heart disease. 7. High cholesterol (hypercholesterolemia) Elevated cholesterol levels in the blood. 8. Swelling of the legs and shortness of breath May indicate heart failure. Prevention and treatment The main goal of prevention is to avoid the development of heart disease and reduce risk factors. Treatment, however, is aimed at managing and addressing existing problems. Myocardial infarction (heart attack) A heart attack develops when blood flow in a part of the heart muscle decreases or stops completely, causing damage. The most common symptom is chest pain or discomfort, which may radiate to the shoulder, arm, scapula, neck, or jaw. Other possible symptoms include: • shortness of breath, • nausea, • severe weakness, • cold sweat, • feeling of fatigue. What to do If you experience these symptoms, seek medical help immediately. Self-medication is extremely dangerous and can lead to serious consequences.

Fungal skin infections are considered one of the most common skin diseases in the world, primarily caused by the fungi Trichophyton, Microsporum, and Epidermophyton. Prevalence According to research, about 20–25% of the world's population will experience a fungal skin infection at least once in their lifetime. Fungal infections can affect people of any age, but they are most common in children and athletes. They are characterized by high contagiousness and frequent recurrence. Fungal infections are also common among populations living in hot and humid climates. Clinical Manifestations The clinical picture of a fungal infection depends on the type of fungus, the area of infection, and the patient's immune system. The main manifestations include circular, pink-red patches with distinct outlines, where the center often remains white or normal skin color. Sometimes, there is itching, burning, scaling, or even the formation of small blisters, especially in the spaces between the toes or on the scalp. Diagnosis To diagnose a fungal infection, a skin scraping is performed to detect fungi. In some cases, a culture is performed to determine the type of fungus. Treatment The treatment for fungal skin infections depends on the area and severity of the infection. • Mild and moderate cases – topical antifungal agents are used first. • Severe or widespread cases – systemic antifungal drugs are used for 2–6 weeks, with the dosage being individualized. In some cases, the course of treatment may be extended to reduce the risk of recurrence. Prevention • Maintain personal hygiene rules and do not share personal items. • Take a shower after sweating. • Do not leave certain areas of your skin moist. • Do not walk barefoot in public restrooms, saunas, or locker rooms. • Wear clean, dry, cotton underwear. • Keep your nails short and clean. • Do not share sports equipment, towels, or other personal items with other people. • When working with soil, wear protective clothing such as gloves, boots, long pants, and long-sleeved shirts. • Note that pets can be a source of fungal infections, so it is necessary to monitor their hygiene and health status. Conclusion Fungal skin infections are common but treatable diseases. Successful treatment and prevention require a comprehensive treatment plan, including topical and systemic therapy, hygiene measures, and patient education. Awareness of fungal skin infections and timely treatment reduce sanitary issues and the spread of the disease in society. Furthermore, promoting a healthy lifestyle, including strengthening the body's defense mechanisms, plays an important role in preventing fungal infections.