Granulomatosis with polyangiitis, complicated by ocular adnexa lesion and vascular changes in retina and choroid (literature review with a clinical case)

Granulomatosis with polyangiitis (GPA) is manifested as ocular pathology in almost a third of patients, which can either be detected at the onset of the disease or occur in the late stages. The pathological process involves the orbit, sclera, episclera, cornea, conjunctiva, eyelids, nasolacrimal system, optic nerve, retina and choroid. Lesion of eye and its surrounding structures determines the severity of the pathological process, the patient’s quality of life and prognosis. The article presents a clinical case of a 38-year-old man with an unfavorable course of GPA, lesion to upper and lower respiratory tract, kidneys, and musculoskeletal system. The authors consider ocular manifestations in the context of a systemic disease. An ophthalmological examination of the patient revealed changes in sclera and choroid, which had not previously been described in detail in the literature. The patient underwent cataract phacoemulsification in the right eye with implantation of a posterior chamber intraocular lens. The dynamics of clinical manifestations of eye lesion in the near future is positive, but in the long term it remains doubtful due to pronounced changes in the orbit and adnexa of the eye against the background of ongoing small vessels vasculitis. Early consultation with an ophthalmologist and optical coherence tomography in patients with GPA are necessary at any stage of the disease. The clinical case is presented with consideration to the CARE 2021 recommendations.

Influence of heliogeophysical and climatic factors on the cardiovascular system: a literature review

Despite many years of studying the influence of climatic and heliogeophysical factors on the human body, many issues remain unresolved. On the one hand, this is due, to the diversity and complexity in the study of the natural factors themselves, and on the other hand, to the ambiguous influence of the latter on various functional body systems of the studied groups; these groups, in turn, are heterogeneous depending on the studied problem, and, in addition, different statistical methods are not always applied correctly. The review presents an analysis of modern data reflecting the influence of heliogeophysical and climatic factors on the human cardiovascular system. According to the literature, the most significant of the climatic and heliogeophysical factors are such environmental parameters as temperature, atmospheric pressure, and solar activity. Above factors was found to have a strong influence on cardiovascular system, which is expressed in the development stroke, myocardial infarction and sudden coronary death. Changes in external environment parameters increased the number of calls from the population to emergency services, and their impact on the urban and rural population differed. At the same time, the delay in a cardiovascular event with a change in ambient temperature ranged from 1 to 3 days. Solar anomalies and related indices caused an increase in the number of myocardial infarctions and strokes 1-2 days after the anomalies, while an increase in the number of hypertensive crises was noted 3 days before these anomalies. There is a J-shaped relationship between temperature changes and the risk of cardiovascular events, and a V-shaped relationship between atmospheric pressure and mortality from coronary events with a minimum of mortality at an atmospheric pressure of 760 mm Hg. It has also been shown that diabetes mellitus, male sex and older age were significant factors that increase the risk of cardiovascular events with changing weather conditions.