Adequate Correction Research Articles

Nasolabial Appearance in 5-Year-Old Patients with Repaired Complete Unilateral Cleft Lip and Palate: A Comparison of Two Different Techniques of Lip Repair.

Different surgical techniques are available to adequately correct the primary cleft lip deformity; however, when compared, none of these techniques have proven superior with regard to achieving optimal aesthetic results. Thus, the aim of this retrospective study was to assess the nasolabial appearance in patients with unilateral cleft lip and palate (UCLP) at age five with reference to two techniques for primary cleft lip repair used in our service: Pfeifer’s wave-line procedure and Randall’s technique. A modified Asher–McDade Aesthetic Index was applied to appraise the nasolabial area by means of 2D photographs of non-syndromic five-year-old patients with a UCLP. In this context, three parameters were assessed: 1. nasal frontal view; 2. shape of the vermilion border and philtrum length; and 3. the nasolabial profile. Five professionals experienced in cleft care were asked to rate the photographs on two occasions. Overall, 53 patients were included in the final analysis, 28 of whom underwent lip repair according to Pfeifer; 25 were treated employing Randall’s technique. Statistically significant differences between the two techniques regarding philtrum length and vermilion border were found (p = 0.046). With reference to the other parameters assessed, no significant differences were determined. The results suggest that Randall’s cleft lip repair may allow for more accurate alignment of the vermilion border and more adequate correction of the cleft lip length discrepancy in comparison to Pfeifer’s wave-line technique.

Náhle vzniklá percepční nedoslýchavost u dětí: přehled dia­gnostiky, terapie a prognóza

Introduction: Sudden sensorineural hearing loss (SSHL) is an acute condition in children. Universal guidelines for treatment and dia­gnosis are not defined. Use of objective dia­gnostic methods in hearing threshold level verification is necessary. Standardized follow-up care is essential for adequate correction of hearing impairment. Methods and material: This retrospective study analysed 14 patients suffering from SSHL, hospitalized between 2016 and 2019 in a tertiary centre. Age, gender, affected side, hearing threshold level, symptoms, cause and treatment were compared. Hearing loss was classified according to the WHO methodology. The recovery rate was assessed by Siegel’s criteria. Results: All children were treated with an initial dose of 5 mg/kg/day of methylprednisolone intravenously. A complete recovery in our group was achieved in 6 cases (43%). The rate of treatment failure was 75% for the left side and 16.7% for right side SSHL. Patients with the presence of tinnitus have a 54.5% chance of hearing restitution, as compared to 35.3% in patients without tinnitus. The risk of treatment failure for children aged 5–10 years, 10–15 years and 15–18 years is 33%, 83% and 20% respectively. We did not observe any effect on hearing recovery for the other analysed parameters. Conclusions: Better hearing recovery was observed in children with tinnitus, the right affected side and a higher severity of initial hearing loss. At the age of 10–15 years, the chance of hearing recovery was three times lower than in other age groups. Key words sudden sensorineural hearing loss – children – correction of hearing impairment

Haematinic deficiency in pregnancy: another HELLP mimic.

Haematinic deficiency is not uncommon in pregnancy. Folate deficiency is more common than B12 deficiency because of the increased uptake of folate in pregnancy, and the fact that B12 stores take much longer to deplete. Described here are five cases of anaemia in pregnancy secondary to severe haematinic deficiency with subsequent management and pregnancy outcomes. In the majority of cases, the women were proteinuric, but systemically well and normotensive. Thrombotic thrombocytopenic purpura and HELLP were both considered, but the identification of very abnormal folate levels of less than 3 μg/L in all and low B12 deficiency in the majority made haematinic deficiency the most likely diagnosis. They all received high dose folic acid, parenteral vitamin B12 and oral iron and made good haematological recoveries. Adequate antenatal correction of vitamin deficiency like this avoids bone marrow suppression and helps minimise poor obstetric outcomes associated with pre-existing anaemia including post-partum haemorrhage.

Conservative Therapy of Pressure Ulcers Using Physical Methods (Review)

In Russia and European countries, the incidence of pressure (decubitus) ulcers in sedentary patients with severe comorbidities, spinal trauma, and cerebral accident sequelae varies from 3 to 40 %, reaching 80 % in the chronic critical illness. The final result of conservative treatment of pressure ulcers (PU) with adequate correction of comorbidities and proper care of the immobilized patient depends largely on the choice of local interventions. Aim of the review: to demonstrate the range of effective methods of physical treatment of pressure ulcers suitable for conservative treatment. Materials and methods. We selected and analyzed 80 scientific publications. Sources were selected from the PubMed, Scopus, and RSCI databases of medical and biological publications. The following methods were covered: negative pressure wound therapy, ultrasonic methods, hydrosurgical treatment, plasma flows, laser therapy (including low-level laser therapy), «hardware» acceleration of regenerative processes, including electrical stimulation, as well as a combination of these methods. Results. The variety of physical methods of wound treatment, on the one hand, provides an opportunity to select an individual therapy program. On the other hand, each method has its own limitations and contraindications. That is why in practice various combinations of these methods are reasonable. Conclusion. For several objective reasons, no reduction of PU incidence in clinical practice is expected. Therefore, studying the issues of evidence-based clinical effectiveness and economic feasibility of various conservative techniques of decubitus treatment to find best solutions in this area is warranted.

On the Effect of Stellar Activity on Low-resolution Transit Spectroscopy and the use of High Resolution as Mitigation

We present models designed to quantify the effects of stellar activity on exoplanet transit spectroscopy and atmospheric characterization at low (R = 100) and high (R = 100,000) spectral resolution. We study three model classes mirroring planetary system archetypes: a hot Jupiter around an early-K star (HD 189733 b); a mini-Neptune around an early-M dwarf (K2-18 b); and terrestrial planets around a late-M dwarf (TRAPPIST-1). We map photospheres with temperatures and radial velocities (RV) and integrate specific intensity stellar models. We obtain transit spectra affected by stellar contamination, the Rossiter–McLaughlin effect (RME), and center-to-limb variations (CLV). We find that, at low resolution, for later-type stars, planetary water features become difficult to distinguish from contamination. Many distributions of unocculted active regions can induce planetary-like features of similar amplitudes in the case of a late-M dwarf. Atmospheric characterization of planets around late-type stars will likely continue to suffer from degeneracy with stellar activity unless active regions' parameters can be constrained using additional information. For the early-K star, stellar contamination mostly manifests itself through a slope at optical wavelengths similar to Rayleigh scattering. In all cases, contamination induces offsets in measured planet radii. At high resolution, we show that we can determine the origin of H2O and CO detection signals and lift the degeneracy observed at low resolution, provided sufficient planet RV variation during transit and adequate correction for the RME and CLV when required. High-resolution spectroscopy may therefore help resolve issues arising from stellar contamination for favorable systems.

166Holmium\u201399mTechnetium dual-isotope imaging: scatter compensation and automatic healthy-liver segmentation for 166Holmium radioembolization dosimetry

BackgroundPartition modeling allows personalized activity calculation for holmium-166 (166Ho) radioembolization. However, it requires the definition of tumor and non-tumorous liver, by segmentation and registration of a separately acquired CT, which is time-consuming and prone to error. A protocol including 166Ho-scout, for treatment simulation, and technetium-99m (99mTc) stannous phytate for healthy-liver delineation was proposed. This study assessed the accuracy of automatic healthy-liver segmentation using 99mTc images derived from a phantom experiment. In addition, together with data from a patient study, the effect of different 99mTc activities on the 166Ho-scout images was investigated. To reproduce a typical scout procedure, the liver compartment, including two tumors, of an anthropomorphic phantom was filled with 250 MBq of 166Ho-chloride, with a tumor to non-tumorous liver activity concentration ratio of 10. Eight SPECT/CT scans were acquired, with varying levels of 99mTc added to the non-tumorous liver compartment (ranging from 25 to 126 MBq). For comparison, forty-two scans were performed in presence of only 99mTc from 8 to 240 MBq. 99mTc image quality was assessed by cold-sphere (tumor) contrast recovery coefficients. Automatic healthy-liver segmentation, obtained by thresholding 99mTc images, was evaluated by recovered volume and Sørensen–Dice index. The impact of 99mTc on 166Ho images and the role of the downscatter correction were evaluated on phantom scans and twenty-six patients’ scans by considering the reconstructed 166Ho count density in the healthy-liver.ResultsAll 99mTc image reconstructions were found to be independent of the 166Ho activity present during the acquisition. In addition, cold-sphere contrast recovery coefficients were independent of 99mTc activity. The segmented healthy-liver volume was recovered fully, independent of 99mTc activity as well. The reconstructed 166Ho count density was not influenced by 99mTc activity, as long as an adequate downscatter correction was applied.ConclusionThe 99mTc image reconstructions of the phantom scans all performed equally well for the purpose of automatic healthy-liver segmentation, for activities down to 8 MBq. Furthermore, 99mTc could be injected up to at least 126 MBq without compromising 166Ho image quality.Clinical trials The clinical study mentioned is registered with Clinicaltrials.gov (NCT02067988) on February 20, 2014.

Assessment of iron metabolism disorders and adequate treatment of anemic syndrome in patients with breast cancer on the background of adjuvant chemotherapy

Early and adequate correction of the anemic syndrome (AS) of cancer patients can prevent deterioration in the quality of life and be considered as a reserve for increasing the effectiveness of treatment for breast cancer (BC). The aim of the study was to assess the status of iron using modern methods of ferrokinetics in breast cancer patients on the background of adjuvant chemotherapy for early diagnosis and adequate treatment of AS. The object of the study included 21 breast cancer patients with a relatively favorable prognosis, with luminal types A and B (Her 2 / neu positive or negative), three times negative type. The examination was carried out in the postoperative period, against the background of adjuvant chemotherapy. The main metabolites of ferrokinetics were studied: hepcidin 25 (GP25); ferritin (FR); soluble transferrin receptors (rRTP); transferin (TRF); iron (Fe); erythropoietin (EPO); CRP and IL-6 indicators. AC correction was performed (ferinject, epotin-alpha, B12). 10 (47.6%) patients with breast cancer had AS. Most of them were diagnosed with IDA with microcytic, hypochromic characteristics of erythrocytes, low concentration of FR, Fe, GP25, IL-6, CRP, and high levels of TRP and rRTP. Functional iron deficiency (FDF) was established in some patients. In contrast to patients with IDA, they had a high concentration of FR, CRP and significant production of GP25, IL-6. The EPO level was not optimal for the majority of patients with AS. In isolated cases, during treatment with recombinant erythropoietins, a deficiency of vitamin B12 (cyanocobalamin) was revealed. The rational use of iron preparations, vitamins, and recombinant forms of EPO made it possible to restore Fe metabolism, stabilize the hemoglobin level, and also improve the condition of most breast cancer patients. The obtained data on IL-6, GP25, CRP indicate a certain relationship between them in the development of anemia with VDF in breast cancer patients and the need for further study of the characteristics of iron metabolism in cancer patients.

Two-Step 3D-Guided Supramalleolar Osteotomy to Treat Varus Ankle osteoarthritis.

Success of valgus-type supramalleolar osteotomy (SMOT) depends on adequate correction of malalignment, which can be hard to achieve with current 2-dimensional (2D) planning and operative techniques. A personalized digital 3-dimensional (3D) workflow to virtually plan and perform a 2-step 3D-guided medial opening (MO) SMOT has the potential to improve precision of correction. Computed tomography (CT)-based Proplan medical 3D models were made to virtually plan the desired MO SMOT, and exported to 3-Matic medical to develop patient-specific 2-step cutting and wedge guides. Workflow accuracy was tested in this limited clinical pilot study (3 patients) by comparing the virtual planned position of the osteotomized distal tibial fragment with the 1-year post-MO SMOT configuration. Two millimeters or less translation deviation in every plane was defined as accurate. Primary outcome analysis of the osteotomized distal tibial fragment deviation showed a median translation in all planes of 0.7 (range 0-8.2) mm (interquartile range 1.55) with an excellent interrater reliability of the measurements (intraclass correlation coefficient 0.998). There was a strong reduction in ankle pain as reflected by an increase of the AOFAS-AH score and decrease of NRS pain score with an unrestricted hindfoot motion 1 year after surgery. 3D virtually planned bone cutting and wedge guides is a promising approach associated with minimal postoperative deviation from the desired correction in medial opening supramalleolar osteotomy.

Minimally Invasive Distal Chevron Osteotomy for Symptomatic Bunionette: Clinical and Radiologic Results of a 31-Case Retrospective Study.

Background:Bunionette is a common forefoot deformity that usually leads to significant discomfort. Multiple surgical techniques have been described for correcting bunionette. The purpose of this study is to analyze the clinical and radiologic outcomes of a new surgical technique via minimally invasive distal Chevron osteotomy of the fifth metatarsal without fixation, trying to find an effective technique with fewer complications.Methods:We retrospectively analyzed the data of 28 patients (31 feet) who presented with symptomatic bunionette that was resistant to conservative treatment and who underwent surgery at our center from February 2018 to February 2020. A minimum follow-up of 20 months was obtained (mean follow-up 26 months, range 20–37). Clinical results were evaluated using the visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) score; 5 different radiologic parameters were analyzed.Results:After surgery, the mean AOFAS score increased by 29 points (P < .001) and the mean VAS scores decreased by 6 points (P < .001). An adequate radiologic correction was observed with a decrease in the M4–M5 intermetatarsal angle from 10.3 to 4.8 degrees (P < .001), metatarsophalangeal angle by a mean of 16.05 degrees (P < .001), and lateral deviation angle of the fifth metatarsal from 8.5 to 0.97 degrees (P < .001). Moreover, the length of the fifth metatarsal and the forefoot width was reduced (P < .001). The only complication was an asymptomatic delay in bone healing, but a complete bone consolidation was achieved after therapy.Conclusion:The proposed surgical technique shows a good correction capacity with excellent clinical and radiologic results and low complication rates.Level of Evidence: Level IV, retrospective case series.

Spectacle correction in the complex of therapeutic measures for primary angle closure glaucoma. Preliminary report

PURPOSE. To improve the effectiveness of primary angle closure glaucoma (PACG) treatment in the initial stage in patients with hyperopia.MATERIAL AND METHODS. The study observed 18 patients (36 eyes) with the initial stage of PACG who also had low (8 subjects, 16 eyes) or moderate (10 subjects, 20 eyes) hyperopia. Study patients were divided into two groups: the main group — 12 patients (24 eyes) aged 43–67 years (mean age 55.6±1.1 years); the control group — 6 patients (12 eyes) aged 48–60 years (mean age 56.4±2.4 years). Prescribed treatment in the main group: selection and application of universal progressive correction, then laser iridecotomy (LIE) and management without pilocarpine instillations. Prescribed treatment in the control group: selection and application of monofocal correction for near vision, then LIE and instillations of 1% pilocarpine solution 3 times a day. All patients underwent visometry with correction, refractometry, ophthalmoscopy, tonometry, tonography, gonio-scopy, optical coherence tomography of the anterior eye segment, ultrasound biometry. Indicators of hydrodynamics and parameters of the anterior chamber were recorded before using spectacles correction, after the start of correction, after LIE, and 1 month after the start of all therapeutic measures.RESULTS. The use of progressive spectacle correction led to a significant decrease of true intraocular pressure (IOP) (p&lt;0.001), an improvement of aqueous humor outflow (p&lt;0.05) and an increase in the size of anterior chamber angle (p&lt;0.001). Performing LIE in patients of the main group did not significantly change these indicators. The results obtained in this group made it possible to abandon the use of pilocarpine. In patients of the control group, the improvement in aqueous humor outflow (p&lt;0.001) and increase in the size of anterior chamber angle (p&lt;0.002) were more significant after LIE than after prescription of adequate monofocal correction for near vision (p&lt;0.02–0.05 and p&lt;0.2, respectively).CONCLUSION. The use of progressive spectacle correction in patients with hyperopia and initial stage of PACG before LIE leads to normalization of hydrodynamic parameters and an increase in the magnitude of anterior chamber angle without the use of miotic drugs. Prescription of progressive spectacle correction is advisable in these patients as a part of the complex of therapeutic measures aimed at normalizing ocular hydrodynamics.

Translated article] Minimally invasive surgical treatment options for osteoporotic vertebral fractures OF4

Introduction and objectiveThe incidence of osteoporotic vertebral fractures (OVFs) is increasing. The importance of their diagnosis and treatment lies in their frequency and the morbidity they cause in patients.The classification proposed for OVFs by the German Society of Orthopaedics and Traumatology (DGOU) recommends surgical treatment for vertebral fractures classified as OF4. Most of these fractures will require anterior bracing as an adjunct to posterior fixation because of the significant loss of vertebral body structure.In elderly patients, minimally invasive surgery (MIS) allows their treatment given the lesser tissue aggression and systemic repercussions. We present the results of the treatment of OF4 vertebral fractures using minimally invasive techniques in the Spine Unit of our hospital. Material and methodsRetrospective study of 21 patients with OF4 osteoporotic fractures in the thoracolumbar transition treated in our centre. Six patients who underwent open posterolateral fusion or isolated vertebroplasty were excluded. The series consists of 15 cases (13 females and 2 males), with a mean age of 72.2, studied by computed tomography and magnetic resonance imaging. Clinical and analytical data were collected to decide the most appropriate surgical technique.In six cases a retropleural/retroperitoneal MIS approach was performed for partial corpectomy with expandable vertebral substitute plus long posterior percutaneous fixation (technique 1). In the remaining nine cases long posterior percutaneous fixation+vertebroplasty of the fractured vertebra (technique 2).Radiological measurements were taken pre-surgically, post-surgically, at 6 weeks and 3 months, determining the fracture angle, kyphotic deformity, compression and wedging percentage and deformation angle.To assess functional outcome, patients completed the Oswentry Disability Index before surgery and at 3 months. ResultsThere were no intraoperative complications of note. In the corpectomy group the mean hospital stay was 9.4 days, with a mean operative time of 250min, a postoperative haemoglobin loss of 3.3g/dL and two patients were transfused.In the percutaneous fixation and vertebroplasty group the mean was 5.55 days, surgery time 71min and loss of 1.6g/dL haemoglobin. There was one post-surgical haematoma requiring transfusion.None of the patients had to be reoperated during follow-up.Radiological measurements showed adequate correction with both techniques which was maintained over time with minimal loss.In functional outcomes assessed with the Oswentry, patients following technique 1 suffered greater worsening (15%) than those treated with technique 2 (10%). ConclusionsIn OWF classified as OF4, percutaneous fixation associated with vertebroplasty could be an alternative to corpectomy in older patients with comorbidities, in whom functional recovery is more important than radiological correction.The use of MIS surgery together with improvements in the prevention and treatment of osteoporosis may improve clinical outcomes in the treatment of this type of fracture.

Conjoint Fascial Sheath Suspension for Severe Blepharoptosis through Palpebral Margin Incision.

Conjoint fascial sheath suspension can achieve pleasing surgical efficacy and dynamic eyelid movement in the treatment of severe ptosis. In recent years, the palpebral margin incision technique has been applied for double-eyelid blepharoplasty, which is characterized by inconspicuous scarring, short convalescence, and natural-looking outcome. However, studies of the application of this technique in the treatment of ptosis are scarce. This article aims to evaluate the efficacy and safety of conjoint fascial sheath suspension for treating severe blepharoptosis through palpebral margin incision. From March 2019 to January 2021, 32 patients (37 eyelids) underwent treatment with the modified technique. Preoperatively, levator muscle function and margin reflex distance 1 were documented. Correction effects, symmetry results, and complications were also evaluated postoperatively. Adequate or normal correction was achieved in 33 eyelids (89.2%), and 31 patients (96.9%) obtained good or fair symmetry results. Common complications were undercorrection and conjunctival prolapse, which were both observed in four eyelids (10.8%), followed by overcorrection and hematoma. The modified technique provides physical eyelid elevation and inconspicuous scarring and is effective for treating severe ptosis. Satisfactory functional and esthetic results could be obtained simultaneously without severe complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Staged correction of pulmonary atresia, ventricular septal defect, and collateral arteries.

ObjectivesPulmonary atresia (PA) with ventricular septal defect (VSD) and systemic‐pulmonary collateral arteries (SPCAs) presents with variable anatomy with regard to the pulmonary vasculature, requiring personalized surgical treatment. A protocol consisting of staged unifocalization and correction was employed.MethodsSince 1989, 39 consecutive patients were included (median age at first operation 13 months). In selected cases, a central aorto‐pulmonary shunt was performed as the first procedure. Unifocalization procedures were performed through a lateral thoracotomy. Correction consisted of shunt takedown, VSD closure, and interposition of an allograft between the right ventricle and the reconstructed pulmonary artery. Echocardiographic data were obtained postoperatively and at interval follow‐up.ResultsIn 39 patients 66 unifocalization procedures were performed. Early mortality was 5%. Seven patients were considered not suitable for correction, of which four have since died. One patient is awaiting further correction. A correction was performed successfully in 28 patients. Operative mortality was 3% and late mortality was 11%. Median follow‐up after the correction was 19 years. Eleven patients required homograft replacement. Freedom from conduit replacement was 88%, 73%, and 60% at 5, 10, and 15 years respectively. Right ventricular function was reasonable or good in 75% of patients. All but one patient were in NYHA Class I or II.ConclusionsAfter complete unifocalization 30/37 patients (81%) were considered correctable. The staged approach of PA, VSD, and SPCAs results in adequate correction and good functional capacity. RV function after correction remains reasonable or good in the majority of patients.

Structure of the drug treatment adherence in elderly patients with mild cognitive impairment and psychopathological symptoms

Background. The high prevalence of pre-dementia cognitive impairment in the elderly, their poor prognosis with a frequent transition to dementia, polymorbidity with somatic pathology determine the need for adequate correction of all somatic diseases. This increases the importance of treatment adherence.&#x0D; Aim. To assess the structure of drug treatment adherence in elderly patients with mild cognitive impairment (MCI) and psychopathological symptoms.&#x0D; Material and methods. An observational study of 264 patients diagnosed with mild cognitive impairment was conducted. The average age was 68.51.4 years. Of these, 17.6% were men, and 83.3% were women. The patients were divided into two groups: with psychopathological symptoms (main group, n=189) and without psychopathological symptoms (comparison group, n=75). Research methods used: clinical-psychopathological, psychometric, statistical by using Statistica 7 software for Windows OS. The Pearson's chi-squared test, the nonparametric MannWhitney U test, and the correlation analysis with calculation of Spearmans rank correlation coefficient (r) were used.&#x0D; Results. The adherence (compliance) of the study participants in relation to general therapeutic recommendations is represented by social, emotional and behavioural compliance. The total score of general compliance in the main study group was 45.4229.7, in the comparison group 51.0932.3 points (p=0.031). In the main group, half of the participants (49.7%) had a low total score of general compliance, less than half of the participants had an average total score, only 4.8% of the participants showed high compliance with therapeutic recommendations. Increased depression correlates with low overall, social and emotional competence (r=0.512). Severe agitation and aggression correlate with low behavioural and emotional competence (r=0.589). Statistically significant correlations were found between psychotic symptoms and low behavioural compliance (r=0.151 and r=0.145).&#x0D; Conclusion. The overall medication compliance rates are lower in patients with affective and psychotic symptoms; an increase in the number of affective, psychotic, behavioural disorders in patients with mild cognitive impairment correlates with low overall, social, emotional and behavioural compliance.

POSA195 Assessment of Consumption of Antidepressant Drugs in Ukraine in 2015-2019

The issue of mental health is acute in our time. The World Bank notes a significant (50 %) increase in mental illness over two decades, beginning in the 1990s. Among persistent health and disability disorders in Ukraine, neuropsychiatric disorders rank third among men (11.3 %) and second among women (16.5 %). Therefore, it is essential to timely identify mental illnesses and provide appropriate and adequate correction, including antidepressants, to improve patients' quality of life. The study aimed to establish outpatient and hospital consumption in 2015-2019 in Ukraine of antidepressant drugs (N06A according to ATC classification).

Quaternion Integers Based Higher Length Cyclic Codes and Their Decoding Algorithm

The decoding algorithm for the correction of errors of arbitrary Mannheim weight has discussed for Lattice constellations and codes from quadratic number fields. Following these lines, the decoding algorithms for the correction of errors of length cyclic codes over quaternion integers of Quaternion Mannheim weight one up to two coordinates have considered. In continuation, the case of cyclic codes of lengths and has studied to improve the error correction efficiency. In this study, we present the decoding of cyclic codes of length and length 2 (where is prime integer and is Euler phi function) over Hamilton Quaternion integers of Quaternion Mannheim weight for the correction of errors. Furthermore, the error correction capability and code rate tradeoff of these codes are also discussed. Thus, an increase in the length of the cyclic code is achieved along with its better code rate and an adequate error correction capability.

Сравнительная характеристика эффективности применения гексапептида и азоксимера бромида в комплексном лечении детей с вторичным пиелонефритом

Objective. Secondary pyelonephritis occurs in children in a distant period after adequate surgical correction of congenital obstructive pathology due to long-lasting shifts of immunologic resistance. Patients and methods. The authors treated 80 children aged 5 to 15 years with secondary pyelonephritis with preserved renal function against hydronephrosis, megaureter, vesicoureteral reflux. Immunological parameters were assessed at the child's admission to the hospital and 3 months after in-patient treatment. Initial changes of immunological reactivity in the patients substantiated the treatment tactics. Group 1 consisted of 40 patients, whose complex treatment included the immunomodulator, the active ingredient hexapeptide; Group 2 consisted of 40 patients, whose complex treatment included the tablet preparation of Polyoxidonium, the active ingredient azoximer bromide. Results. Inclusion of and azoximer bromide in treatment of children with secondary pyelonephritis was found to lead to increasing of IgA, IgG, B-cells amount, phagocytosis rate and natural killer number; and to decreasing of the amount of T-lymphocytes and CD4-cells. Inclusion of hexapeptide in treatment of secondary pyelonephritis in children increases level of phagocytic activity of neutrophils, amount of natural killer cells, CD3–/CD19+-cells, CD3+/CD4+-lymphocytes number. Conclusion. Inclusion of immunotropic preparations in complex treatment of secondary pyelonephritis in children is justified in case of detection of above-mentioned disturbances. Key words: secondary pyelonephritis, immunocorrection, hexapeptid, children, azoximer bromide

The role and place of bronchodilative and anti-inflammatory therapy for chronic obstructive pulmonary disease in patients with newly detected respiratory tuberculosis

Introduction. The relevance of the problem of managing patients with concomitant infectious and non-infectious pathology is beyond doubt, a third of patients suffering from tuberculosis have COPD as a comorbidity, which re-quires adequate therapy to improve the prognosis of the patient’s treatment as a whole. Objective: to evaluate the effectiveness of various options for bronchodilatory and anti-inflammatory therapy in patients with newly diag-nosed pulmonary tuberculosis secondary to COPD. Ma-terials and methods. A simple prospective comparative study included 210 patients divided into 3 groups: 124 pa-tients with TB+COPD; 46 patients with drug-susceptible TB (TB DS)+COPD; 40 patients with multidrug-resistant TB+COPD. The selection of treatment regimens was car-ried out with an assessment of the best efficiency, includ-ing inhaled glucocorticosteroid in combination with a long-acting β2-adrenergic agonist (IGCS/LABA) into the treatment regimens in the intensive phase of the course of TB. Duration of the follow-up is 6–9 months with assess-ment of X-ray pattern, bacterial shedding and smear neg-ativity as criteria for curing TB. Results. In patients with TB+COPD, the best effect of minimizing the severity of broncho-obstructive syndrome (reduction of dyspnea ac-cording to mMRC and CAT test) was obtained during ther-apy with a combination drug (long-acting anticholinergic drug and long-acting β2-agonist (LAAC/LABA) with good tolerance. In patients with TB DS+COPD, positive dynam-ics in the reduction of the severity of cough, dyspnea, CAT test was obtained in the ICS group in comparison with patients taking short-acting anticholinergic drugs (SDA). For patients with MDR+TB COPD, ICS/LABA showed the optimal effect on the severity of COPD symptoms. Against the background of taking IGCS/LABA in both groups, there was an increase in the number of patients achiev-ing smear negativity, cessation of bacterial shedding and closure of decay cavities, in comparison with the CAAC group, without any side effects. Conclusion. Adequate correction of broncho-obstructive syndrome in patients with COPD, including the use of bronchodilators (LABA) and anti-inflammatory drugs (IGCS) in the intensive phase of treatment of newly diagnosed pulmonary TB due to the main and additional effects of drugs, can improve the effectiveness of tuberculosis therapy

Short-Term effects of laparoscopic sleeve gastrectomy on anatomical &amp; biochemical parameters in morbidly obese Iraqi Patients

Background: Osteoporosis Background: With the worldwide and national increased prevalence of obesity and high failure rates of conventional methods of treatment, bariatric surgeries (especially laparoscopic sleeve gastrectomy) offer a safe and rapid therapeutic way for correction of obesity and its numerous related clinical complications. Aim: The current study examined the short-term effects of laparoscopic sleeve gastrectomy on anatomical &amp; biochemical markers in morbidly obese patients and investigated whether or not there was gender difference in the changes of these markers.Patients and methods: 65 morbidly obese (BMI≥40) patients undergoing laparoscopic sleeve gastrectomy were enrolled. Pre-operative &amp; 4-week-post-operative assessment of anatomical parameters included body weight, height &amp; calculation of body mass index (BMI). Similar biochemical assessment included lipid profile, fasting blood sugar (FBS), Hemoglobin, renal function tests and liver enzymes. Results: Patients of both sexes showed statistically significant reduction of body weight, BMI, FBS and improved serum levels of lipid profiles, renal function tests and liver enzymes. Many pre-operative abnormally high-level percentages were normalized or markedly decreased, with no statistically significant difference between males and females except for ALT changes. Discussion: Sleeve gastrectomy is very effective in improving body weight, BMI and lipid profiles by altering the anatomy and physiology of the stomach towards less food consumption, and also damping the secretion of hunger-stimulating hormones. The BMI reduction improves insulin sensitivity and FBS levels. Better glycemic &amp; blood pressure control improve renal function, while improving HDL levels reduces liver steatosis and improves serum liver enzyme levels. The main disadvantage is reduced hemoglobin level due to macronutrient and micronutrient deficiencies. Conclusion: Laparoscopic sleeve gastrectomy provides a permanent safe therapeutic choice for morbid obesity. The presence of vitamin and nutritional deficiencies after surgery is a common disadvantage mandating adequate pre-operative correction of the deficiencies, adequate post-operative supplementation and regular long follow-up.

Insulin resistance in the ХХІ century: multimodal approach to assessing causes and effective correction

In a broad sense, insulin resistance (IR) is the impairment of the biological response of target tissues to insulin stimulation. IR plays a leading role in the development of metabolic syndrome, the global prevalence of which continues to grow, despite the significant efforts of medical systems. The multicomponent nature of metabolic syndrome implies its complex and heterogeneous pathogenesis, knowledge about which is annually updated with new details as a result of scientific research.This review systematizes the results of recent studies on risk factors and pathogenetic links in the development of IR, prospects and existing experience of using these data in clinical practice with an emphasis on assessing the level of melatonin and vitamin D. The issue of timely and reliable laboratory confirmation of IR is relevant not only for endocrinologists, but also for specialists in almost all areas. In clinical use apart from indirect methods of IR-assessment like HOMA-IR, there is an informative test intact proinsulin.Recently, the increasing attention of researchers is attracted by such factors of the development of IR as vitamin D deficiency and disturbances in chrono- and biorhythms. Today, their role in the pathogenesis of IR can be considered proven, which makes it possible to consider vitamin D and melatonin as therapeutic agents in an integrated approach to the prevention and correction of IR. Statistical analysis of the research results of the “DILA” Medical Laboratory and clinical data provided by the Department of Endocrinology of the O.O. Bogomolets National Medical University also showed an association of vitamin D and melatonin levels with IR.Thus, a review of scientific sources over the last 5 years clearly demonstrates the growing urgency of the problem of IR and metabolic syndrome, the need to reconsider their management from assessing traditional etiopathogenetic factors (alimentary) to taking into account the maximum spectrum of genetic aspects and exogenous impacts. An important place among the latter belongs to an objective assessment of the vitamin D and melatonin levels for adequate pharmacological correction.