Complex Therapy Of Patients Research Articles

Possibility of enteral tube feeding in severe surgical pathology

Objective. To study the possibility of using new GASTROAXILIUM mixtures in complex therapy of patients with severe surgical abdominal pathology. Materials and methods. The study of characteristics of the developed mixtures was carried out by standard and non-standard methods in an accredited laboratory. Clinical studies were conducted in accordance with the Procedure for conducting studies of the effectiveness of specialized dietary therapeutic and dietary preventive food products. Statistical processing was carried out using analysis of variance. Results. GASTROAXILIUM, specialized food product for tube feeding developed by the specialists of the Research and Production Center for Healthy Nutrition Technologies of Saratov State Medical University named after V.I. Razumovsky, differs from foreign ones in its technological solutions. In the main group a statistically significant reduction in the duration of postoperative intestinal paresis was noted, both in planned and emergency surgeries, in contrast to the comparison group. Conclusions. We consider that the results of the use of daily nutritional complex of oligomeric dry mixtures for enteral nutrition GASTROAXILIUM are in agreement with the literature data, they will successfully complement the scientific data on the necessity for nutritional support and will play an important role in improving the quality of treatment of patients with severe postoperative abdominal pathologies.

QUERCETIN AS A POTENTIAL THERAPEUTIC AGENT IN HYPERTENSION COMPLICATED BY CONNECTIVE TISSUE DYSPLASIA

This article summarizes data on the effect of quercetin during the treatment of arterial hypertension, complicated by connective tissue dysplasia. Currently, numerous studies are being conducted to study the role of various genes in the development of arterial hypertension. One of the risk factors for hypertension, which remains insufficiently studied, is collagen pathology - undifferentiated connective tissue dysplasia (UND). The presence of connective tissue in all organs and systems, its common origin with mesenchyme, smooth muscle, blood, and lymph leads to dysplastic changes in any organ and system. Among the many metabolic agents in the treatment of hypertension in combination with DST, the bioflavonoid quercetin, which has a pronounced antioxidant effect, deserves the most attention. The use of water-soluble quercetin in the complex therapy of patients with hypertension in combination with DST reduces the frequency of recurrence of hypertensive crises in the post-hospital period, reduces the number of complications, leads to a decrease in blood stabilization, pressure, additional hypotensive effect.

ФИЗИОТЕРАПЕВТИЧЕСКИЕ МЕТОДЫ В КОМПЛЕКСНОМ ЛЕЧЕНИИ И РЕАБИЛИТАЦИИ ПАЦИЕНТОВ C ХРОНИЧЕСКИМ ПАНКРЕАТИТОМ

The article analyzes the effectiveness of therapy for patients with chronic pancreatitis with the introduction of physiotherapeutic methods into the complex of measures. The study included 250 patients aged 28 to 67 years diagnosed with chronic pancreatitis. In the main group, patients received an additional course of physiotherapy treatment in addition to standard therapy. In the control group, treatment was carried out according to standards in accordance with clinical recommendations. The obtained results of the study showed that the inclusion of physiotherapeutic methods in the complex therapy of patients with chronic pancreatitis contributes to the complete relief or weakening of pain, a reduction in the period of pain relief, dyspepsia, and helps improve the exocrine function of the pancreas.

Chemotherapy Options in New Patients with Drug Susceptible Tuberculosis and Concurrent HIV Infection

The objective: to compare effectiveness and safety of isonicotinoylhydrazine-O,N' iron (II) sulfate dihydrate with the drug of isonicotinic acid hydrazide group in the complex therapy of patients with drug susceptible tuberculosis and HIV infection.Subjects and Methods. In 2020-2021, 40 patients with HIV infection and drug susceptible respiratory tuberculosis with a positive sputum test were examined in Moscow Regional Clinical TB Dispensary as a part of the post-registration observational study. The subjects were randomized into two groups – Main Group (MG) and Comparison Group (CG). Isonicotinoylhydrazine-O,N' iron (II) sulfate dihydrate was administered to the patients from MG as a part of regimen 1 of chemotherapy (instead of isoniazid). The effectiveness and safety of the investigational drug and comparator were evaluated. The primary effectiveness criteria included resolution of clinical symptoms of intoxication and sputum conversion. The secondary effectiveness criterion was positive X-ray changes. The safety criterion was the absence of adverse reactions.Results. During the study period, no adverse reactions were registered when isonicotinoylhydrazine-O,N' iron (II) sulfate dehydrate was used, as well as isoniazid. Good tolerability was noted as well as high compliance to treatment by patients. Thus, both in terms of effectiveness and safety, isonicotinoylhydrazine-O,N' iron (II) sulfate dihydrate is comparable to isoniazid as part of anti-tuberculosis chemotherapy for patients with drug susceptible tuberculosis and concurrent HIV infection.

Иммуномодуляторы в лечении женщин с хроническим рецидивирующим циститом.

Introduction. Chronic recurrent cystitis (CRC) is one of the most common urological diseases in women. Given the proven role of immune disorders in the development of chronic urinary tract infections (UTIs), insufficient effectiveness of antibacterial therapy, the risk of selection of resistant strains of microorganisms, the advisability of using immunomodulators is justified. The purpose of the study: to evaluate the effectiveness of the immunomodulatory drug Galavit® in the complex therapy of patients with CRC. Materials and methods. The study involved 68 women. The main group consisted of 36 patients who, in addition to antimicrobial therapy, were prescribed a course of Galavit® in the form of intramuscular injections for recurrent cystitis. The control group consisted of 32 patients who, in case of recurrent cystitis, received only standard therapy. The results were assessed 3 and 6 months after the start of therapy based on the clinical manifestations of the disease by filling in the questionnaires of acute cystitis symptoms (ACSS), visual analog scale (VAS) for pain and laboratory data (general urine analysis, urine culture data). Results. The inclusion of Galavit® in the complex therapy of CRC allows not only to quickly and effectively relieve the symptoms of exacerbation of the disease, but also to achieve a long and stable relapse-free period. Only 2 (5.5%) patients had a relapse of cystitis during 6 months of observation after complex therapy using Galavit®, while in the control group, clinical manifestations of relapse were registered in 13 (40.6%) patients. In addition, against the background of the use of Galavit®, the vast majority of women did not have clinically significant bacteriuria up to 6 months of observation (only 2 patients had asymptomatic bacteriuria after 6 months). Conclusion. The use of the immunomodulatory drug Galavit® can be effective not only for the purpose of increasing the effectiveness of the course of antimicrobial therapy during the period of exacerbation of CRC, but also for the prevention of relapses after clinical improvement has been achieved.

Pathogenetic role of changes in the colon mucous barrier in patients with ulcerative colitis and the possibility of correction

The aim of this study was to evaluate the changes in the colon mucosal barrier in patients with ulcerative colitis (UC) and to analyze the efficacy of using Zafacol IQ in the complex therapy of these patients. Materials and methods. A prospective, multicenter, randomized, comparative study was conducted in parallel groups to investigate the efficacy and safety of the Zafacol IQ administration in the complex therapy of patients with UC. 64 patients with left‑sided UC of medium‑severe course in the acute stage were observed. There were 34 men and 30 women among the patients; the average age was (46.6±5.8) years. The diagnosis of UC was established clinically and confirmed endoscopically and histologically. The study included patients suffering from UC for at least 1 year. All patients underwent endoscopic examination of the large intestine with biopsy before treatment and after 6 weeks of therapy. The biopsy was stained with hematoxylin and eosin; the PAS reaction was performed. To determine the content of mucins in colonic mucus and the state of tight junctions, an immunohistochemical study was conducted with mucins (MUC‑2, MUC‑4) and proteins of the tight junction family Claud‑1 and Claud‑7. Before and after therapy, the status of the main bacterial enterotypes (Bacteroidetes, Firmicutes, Actinobacteria), as well as the level of regulatory, butyrate‑producing bacteria (Faecalibacterium prausnitzii, Akkermansia muciniphila) were studied in all patients using the polymerase chain reaction qRT‑PCR method. Results. Before therapy, against the background of the development of clinical symptoms, UC patients had a violation of the integrity of the epithelium with the formation of erosive‑ulcerative defects and changes in the colon mucous membrane with the development of inflammatory cell infiltration and disorders of mucus formation and increased epithelial permeability. Before treatment, changes in the colon microbial landscape were detected in UC patients, with a significant decrease in Bacteroidetes and Firmicutes against the background of an increase in representatives of Actinobacteria and other, mostly opportunistic flora. In addition, a reduction in the regulatory butyrate‑producing bacteria (Akkermansia muciniphila and Faecalibacterium prausnitzii) was fixed in patients with UC. The use of Zafacol IQ in patients contributed to a lower level of clinical activity of the disease, increased the frequency of achieving endoscopic remission of UC after complex treatment, led to a decrease in active neutrophils in the cellular infiltrate, improved mucus formation with tendencies to normalize its quality characteristics, an increase in glycoproteins and glycosaminoglycans, as well as MUC2 in colonic mucus, contributed to a decrease in epithelial permeability and an increase in the expression of Claud­­1 and Claud­­7 in goblet cells with an increase in Bacteroidetes, Firmicutes and Faecalibacterium prausnitzii. Conclusions. The use of Zafacol IQ in the complex therapy of UC patients was effective and safe. This drug in combination with mesalazine contributed to positive clinical dynamics and a lower level of clinical activity of the disease, increased the frequency of endoscopic remission of UC. Pronounced positive morphological dynamics were observed: an improvement in mucus formation, an increase in the intensity of the PAS reaction, an increase in MUC2 in the colonic mucus, a decrease in epithelial permeability, and an increase in the expression of Claud‑1 and Claud‑7 in both goblet cells and in the surface epithelium. Complex therapy with the appointment of ­Zafacol IQ contributed to the normalization of the intestinal microbiome in UC patients — an increase in Bacteroidetes, Firmicutes and Faecalibacterium prausnitzii with a tendency to decrease Actinobacteria.

Overlap of gallbladder dysfunction and irritable bowel syndrome: clinical and microbiological features and therapeutic possibilities

Objective — to analyse the clinical and microbiological features in patients with an overlap between gallbladder dysfunction (GBD) and irritable bowel syndrome (IBS) and a complex assessment of the effectiveness and safety of using ursodeoxycholic acid (Ursis) in these patients. Materials and methods. Under our observation were 115 patients with the overlap of GBD and IBS aged from 19 to 52. The majority of them were women (62.6%). All patients complained of abdominal pain, mostly without clear localization or in the right hypochondrium and along the course of the large intestine. Constipation was diagnosed in 83 (72.2%) patients, and meteorism in 89 (77.4%) patients. Therefore, 62 patients with the overlap of GBD and IBS, who had abdominal pain, constipation and meteorism, were selected for further study. During the study, all patients kept a diary in which the frequency and nature of bowel movements, the severity of abdominal pain, and the degree of meteorism were recorded. All patients before and after treatment underwent an ultrasound examination of the abdominal cavity, which included the study of the contractile function of the gallbladder, the emptying coefficient of the gallbladder, the thickness and density of its wall, and the density of bile. Changes in the main bacterial enterotypes were analyzed by qRT‑PCR using primers targeting 16S rRNA. We studied Bacteroidetes, Firmicutes, Actinobacteria, as well as the content of butyrate‑producing bacteria (Faecalibacterium prausnitzii and Akkermansia muciniphila) and methanogens (Methanobrevibacter smithii and Methanosphaera stadmanae). Results. Before treatment, all patients had abdominal pain of moderate intensity (6.9±0.7 points), mostly without clear localization, constipation, with a frequency of defecation (1.4±0.5) times a week, and meteorism. Before treatment, patients with an overlap of GBD and IBS had changes in the contractile function of the gallbladder with a decrease in the emptying ratio, a thickening of the gallbladder wall and an increase in its density and bile density, as well as a disturbance of the intestinal microbiome (an increase in the number of Firmicutes, Actinobacteria and methanogenic archaea and a decrease in Bacteroidetes and butyrate‑producing bacteria). Conclusions. The use of Ursis® medication in the complex therapy of patients with a GBD and IBS overlap is effective and safe. The aplication of Ursis® led to a more pronounced positive clinical dynamics (a decrease in the intensity of abdominal pain, normalization of the frequency of bowel movements, a decrease in meteorism and an improvement in general well‑being) than in the patients of the comparison group. After treatment with Ursis® the coefficient of emptying of the gallbladder increased, the thickness and density of its wall decreased. The use of the drug Ursis® in the complex therapy of patients with the overlap of GBD and IBS contributed to the improvement of intestinal flora: an increase in the number of Bacteroidetes and butyrate‑producing bacteria (Faecalibacterium prausnitzii and Akkermansia muciniphila), and a decrease in the content of methanogens (Methanobrevibacter smithii and Methanosphaera stadmanae).

Effectiveness and safety of demodecosis blepharitis therapy under dry eye conditions

Purpose: to evaluate the effectiveness and safety of complex therapy in patients with demodex blepharitis and dry eye. Methods. 25 patients with mixed demodex blepharitis and dry eye (50 eyes; 10 men, 15 women; 61.9 ± 5.6 years) were examined before and after treatment with 0.5 % levofloxacin instillation (5 times a day, 5 days); sulfur and metronidazole gel applications (Blefarogel-forte) as part of therapeutic eyelid hygiene (Blepharogel-cleansing, Blepharolotion; starting from day 6, 2 times a day, 45 days); 0.24 % sodium hyaluronate instillation (3 times a day). Therapy effectiveness criteria were as follows: D. folliculorum mite population reduction; positive dynamics of blepharitis objective signs and meibomian gland dysfunction severity (MGD-S, points). Therapy safety criteria included the absence of negative dynamics of OSDI, tear film breakup time (TBUT, s), inferior tear meniscus height (ITMH, µm) and xerosis index (XI, points). Results. As a result of the therapy, statistically significant changes were noted, including mite population reduction (from 9.23 ± 0.81 to 3.54 ± 0.80 imagos); eyelid margins edema intensity decrease (from 3.18 ± 0.39 to 1.30 ± 0.45 points) and hyperemia decrease (from 2.90 ± 0.29 to 0.9 ± 0.3 points); MGD-S decrease (from 2.1 ± 0.3 to 0.95 ± 0.21 points); OSDI decrease (from 43.23 ± 4.70 to 25.10 ± 2.65 points); TBUT increase (from 4.05 ± 0.50 to 5.55 ± 0.50 s); XI decrease (from 5.36 ± 0.49 to 4.04 ± 0.60 points). Conclusion. The treatment of demodex blepharitis and dry eye treatment, including sulfur and metronidazole gel applications, therapeutic eyelid hygiene and 0.5 % levofloxacin and 0.24 % sodium hyaluronate instillation demonstrated a high efficiency and a good safety profile.

Clinical study (phase II) of the efficacy and safety of Longidase (suppositories) in patients with adhesions due to pelvic inflammatory disease: A blinded, placebo-controlled, randomized study

Background. Pelvic inflammatory disease (PID) is a significant gynecological problem. The main treatment strategy involves antibacterial drugs to eliminate the infection in combination with anti-inflammatory, infusion, transfusion, anticoagulant, and desensitization therapy. Chronic inflammatory processes can induce changes in the immune system, thus reducing the effectiveness of treatment, causing adhesions, obstruction of the fallopian tubes, and infertility. It emphasizes the importance of developing new PID treatment methods, including using agents with immunomodulatory, antioxidant, and enzymatic activity that can increase the body's overall resistance to infections. Aim. To evaluate the effectiveness of Longidase® in treating pelvic adhesions to improve the outcomes in chronic PID. Materials and methods. The study included 50 women of reproductive age with established chronic PID and adhesions aged 18 to 42 years with a mean age of 29.4±5.8 years. The subjects were randomly assigned to two groups comparable in their main prognostic features. Patients of the main group (30 people) received treatment with Longidase® 3000 IU 1 suppository rectally once every 3 days, 10 doses, then 1 suppository once every 5 days, 5 doses (the total course is 15 doses of Longidase suppositories 3000 IU). Patients in the control group (20 people) received placebo. The treatment course was 55 days. The patients were followed up for up to 140 days from the start of therapy. Results. The results show no significant changes and the negative effect of the treatment on the blood chemistry parameters in both groups. In 35% of patients in the main group, the level of peptide-bound oxyproline did not change; 46% responded to therapy with its increase and 11% with a decrease, which indicates the activation of the decomposition of collagen proteins and a decrease in their synthesis. Analysis of individual levels of circulating immune complexes (CIC) before and after treatment showed a significant decrease in CIC in the main group (Longidase) vs. control group (36.1±1.4 and 30.8±0.8, respectively), which indicates a decrease in the severity of the inflammation. The pain relief, more pronounced during treatment in the main group than in the control group (30% vs. 15%), is probably due to the resolution of the chronic inflammation and correlates with changes in CIC. The onset of pregnancy in 10 (33.3%) patients in the main group indicates the effectiveness of bovhyaluronidase azoximer (Longidase®) as an anti-inflammatory and anti-fibrotic agent. Conclusion. The study showed the possibility of using Longidase 3000 IU suppositories in the complex therapy of patients with pelvic adhesions due to chronic PID

Secretory IgA and course of COVID-19 in patients receiving a bacteria-based immunostimulant agent in addition to background therapy

Mucosal immunity plays a major role not only in the prevention but probably also in the outcomes of COVID-19. An enhanced production of secretory immunoglobulin A (sIgA) might contribute to the activation of the immune response mechanisms. To assess the levels of sIgA produced by epithelial cells in the nasal and pharyngeal mucosa and those measured in salivary gland secretions and to study the course of COVID-19 following the combined scheme of intranasal and subcutaneous administration of a bacteria-based immunostimulant agent. This study included 69 patients, aged between 18 and 60, who had moderate COVID-19 infection. They were divided into two groups: Group 1 (control group) included 39 patients who received only background therapy, and Group 2 was made up of 30 patients who received background therapy in combination with the Immunovac VP4 vaccine, a bacteria-based immunostimulant agent, which was given for 11 days starting from the day of admission to hospital. The levels of sIgA were measured by ELISA in epithelial, nasal and pharyngeal swabs, and salivary gland secretions at baseline and on days 14 and 30. The combined scheme of intranasal and subcutaneous administration of the Immunovac VP4 vaccine in the complex therapy of patients with COVID-19 is accompanied by increased synthesis of sIgA in nasal and pharyngeal swabs, more intense decrease in the level of C-reactive protein (CRP) and reduction in the duration of fever and length of hospitalization compared to the control group. Prescribing a immunostimulant agent containing bacterial ligands in complex therapy for COVID-19 patients helps to enhance mucosal immunity and improves the course of the disease.

Effectiveness of the drug «Sulfatonic» in the treatment of patients with lumbar dorsopathy

Abstract. Prevention and medical rehabilitation of vertebrogenic pain syndromes continues to be one of the most pressing problems of rehabilitation medicine. Purpose of the study. The purpose of the study was to evaluate the effectiveness of Sulfatonic in the treatment of patients with vertebrogenic lumbar dorsopathy. Material and methods. Complex treatment was carried out on 32 patients with vertebrogenic lumbar dorsopathy with pain, musculo-tonic and neurodystrophic syndrome aged 36–60 years. Patients in the main group, against the background of the basic complex, received general hydrogen sulfide baths based on the «Sulfatonic» agent according to the developed method, patients in the control group received the basic complex. Results. It has been established that the use of general baths based on the «Sulfatonic» product in patients of the main group helps to increase the range of movements in the lumbosacral spine, reduce tension and soreness of the paravertebral muscles, regress the symptoms of tension, pain, improve the psycho-emotional status, with less pronounced dynamics of indicators in patients of the control group. Conclusion. Complex therapy of patients with dorsopathies with long-term pain syndrome using hydrogen sulfide baths based on Sulfatonic is effective. A course of use of «Sulfatonic» dissolved in water at the rate of 35 mg per 100 liters of water in the form of general baths helps to increase the range of motion in the lumbosacral spine, reduce tension, soreness of the paravertebral muscles, regression of tension symptoms, pain syndrome, improvement of well-being and mood, increased activity of patients with lumbar dorsopathy.

Open-label observational study of effectiveness and tolerability of ipidacrine in treatment of patients with diabetic polyneuropathy (DIAMANT study)

Diabetic polyneuropathy (DPN) is one of the most common complications of diabetes mellitus, leading to the development of flaccid paresis, neuropathic pain syndrome, sensitive ataxia, as well as trophic disorders in the distal parts of the lower extremities.The purpose of the randomized, open-label, comparative, prospective study was to evaluate the effectiveness and tolerability of ipidacrine in the complex treatment of patients with DPN.Materials and methods. Patients with DPN (n = 60) were randomized into 2 groups. Both groups received basic therapy (alpha-lipoic acid, B vitamins, gabapentin); in the treatment of patients of the main group (n = 30), in addition, ipidacrine was used (Ipidacrine-SZ, North Star Co., Russia). We have analyzed the intensity of pain syndrome (VAS-P), the average daily dosage of gabapentin, and the results of the neuropathic dysfunctional scale (modified version, NDSm), Pittsburgh Sleep Quality Index, PSQI), Global Rating of Change Scale (GROC), the results of electroneuromyography (ENMG). The total duration of the observation and treatment period was 2 months.Results. After 2 months of therapy in the main group of patients, compared with the control group, there was significantly more complete pain control (VAS-P: 3.0 ± 0.9 vs 3.6 ± 0.8), a decrease in the average daily dosage of gabapentin (390 vs 500 mg/day), reduction in the severity of clinical manifestations of polyneuropathic syndrome (NDSm: 4.4 ± 1.0 vs 4.9 ± 1.0 points) and improvement in sleep quality (PSQI: 6.8 ± 1.3 vs 7.9 ± 1.7). According to ENMG data, patients in the main group showed a significant improvement in the neurophysiological parameters of both motor and sensory fibers, which was significantly more pronounced compared to the control group. A significantly larger proportion of patients in the main group assessed the improvement from the therapy as ‘pronounced’ (GROC: 10/33.3 % vs 6/20.0 %).Conclusions. The use of ipidacrine in complex therapy of patients with DPN can significantly reduce the clinical manifestations of disease and improve the neurophysiological parameters of the peripheral nerves of the lower extremities. Ipidacrine can be considered as a basic drug for the treatment of patients with neurological complications of diabetes mellitus.

Features of coronary heart disease in a cohort of tajik patients and the condition of the vascular endothelium in its different clinical forms

Relevance. In the Republic of Tajikistan, in recent years there has been a steady increase in cardiovascular diseases. In this regard, special attention is paid to coronary heart disease with its various manifestations, which can often cause permanent disability, even death. In recent decades, there has been great interest among research scientists in studying the functioning of the endothelium in various forms of coronary heart disease, as well as in individuals with post-infarction cardiosclerosis as a complication of coronary heart disease. Despite the large number of studies in this area, the role and relationship of some sensitive markers of endothelial dysfunction with the clinical course of various forms of coronary heart disease have not yet been determined. That is why its detailed study is of unconditional clinical interest and provides the opportunity for a deep understanding of its theoretical aspects. Purpose of the study: to study risk factors for cardiovascular diseases and mark­ers of endothelial dysfunction in patients with stable angina pectoris in comparison with patients with post-infarction cardiosclerosis, i.e. previous myocardial infarction.Object and methods. Of 60 patients with various forms of coronary heart disease, whose average age was 62.6 ± 3.5 years, and 20 practically healthy individuals of the same age who made up the control group, three groups were formed: Group I (n = 20) included respondents without coronary heart disease; Group II (n = 30) included patients with stable angina pectoris of functional class II and III; Group III (n = 30) included patients who were diagnosed with post-infarction cardiosclerosis, i.e. previously suffered a myocardial infarction. Endothelial cell dysfunction was detected by determining desquamated endothelial cells, as well as by the activity of von Willebrand factor and the level of homocysteine in the blood plasma.Results. In the examined patients, risk factors for coronary heart disease in the form of arterial hypertension, physical inactivity and obesity were observed with greater frequency in persons with stable angina pectoris of functional class II, in contrast to those with functional class III. Patients with stable angina pectoris of functional class III all had chronic heart failure of varying severity (100%). Most patients had at least three risk factors for coronary heart disease. All persons with post-infarction cardiosclerosis had risk factors for coro­nary heart disease, while arterial hypertension was detected in 100%. Based on the indicators of endothelial dysfunction, it can be said that individuals in group III have a more severe functional and morphological condition (increased homocysteine levels, von Willebrand factor activity and the number of desquamated endothelial cells) compared to group II (p < 0.001).Conclusion. In all forms of coronary heart disease (stable exertional angina of functional class II, III and post-infarction cardiosclerosis), the content of desquamated endothelial cells in the blood serum, the activity of von Willebrand factor and homocysteine are increased. A positive correlation was established between the level of desquamated endothelial cells and the level of homocysteine, von Willebrand factor, fibrinogen and platelets. After complex therapy of patients with various forms of coronary heart disease, the functional state of the endothelium improves (decrease in the level of desquamated endothelial cells, ho­mocysteine, von Willebrand factor).

Effectiveness of Wobenzym in combined therapy of chronic bacterial prostatitis. Results of systematic review and meta-analysis

A systematic review and meta-analysis of research data on the effectiveness of the drug Wobenzym in the treatment of chronic bacterial prostatitis was performed. The aim of this study to evaluate the effectiveness of Wobenzym in the complex therapy of chronic bacterial prostatitis. The analysis included randomized and non-randomized controlled studies of the effectiveness of Wobenzim in the complex therapy of chronic bacterial prostatitis. The search was carried out in the databases CENTRAL, PubMed, ICTRP, eLibrary, ClinicalTrials.gov., Google Scholar, CyberLeninka, search engines. The meta-analysis was conducted using the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Statistical heterogeneity was assessed using the Cochran test and visually when constructing forest plots. A random effects model and a fixed effect model were used. Works published over the entire period were analyzed, 712 publications were identified, of which 9 fully met the stated criteria, all studies were non-randomized controlled. The final analysis included the results of 1292 patients. According to the meta-analysis, it was possible to establish the superiority of complex therapy including Wobenzym compared to therapy without Wobenzym in all studied parameters: eradication of the pathogen, decrease in the number of points on the Quality of Life (QoL) scale, an increase in the linear speed of blood flow in the veins and peak systolic blood flow velocity in the arteries of the prostate gland, maximum urine flow rate, reduction in the number of points of the NIH-CPSI “Pain” subscale (difference 5 points) and NIH-CPSI “Quality of Life” subscale. The use of therapy including Wobenzym in patients with chronic prostatitis leads to a greater increase in the number of CD4+, CD8+ lymphocytes, phagocytic activity of lymphocytes, the level of complement CH-100 and immunoglobulins M, G, A. A systematic review/meta-analysis revealed an objective, statistically significant, positive effect of the drug Wobenzym in the complex therapy of patients with chronic bacterial prostatitis, which is associated with its pathogenetic orientation in relation to this group of patients.

Onychomycosis: modern therapeutic strategies (achievements, problems, prospects)

Objective — to study the effectiveness and safety of the use of Natubiotin drug in the treatment of patients with onychomycosis. Materials and methods. 198 people were included in the study, of which 136 were diagnosed with onychomycosis. Depending on the method of treatment, patients with onychomycosis were divided into two groups: the main group, which consisted of a comparison group (71 patients), in which standard therapy was carried out, and an experimental group (65 people), in which, in addition to standard therapy, they received Natubiotin in a dose of 5 mg once a day for 6 months. The control group included 62 persons without signs of onychomycosis. To assess the severity of onychomycosis, the Onychomycosis Severity Index (OSI) was used, which included the area of the lesion, the localization of the pathological process relative to the matrix, the presence of dermatophytoma or subungual hyperkeratosis. To assess the effectiveness of treatment of onychomycosis, we used the point assessment of the severity of the disease according to Y.F. Kutasevich and T.V. Zimina. In order to assess the quality of life, the Dermatology Life Quality Index (Ukrainian version — Dermatology Life Quality Index, DLQI) was used. The state of skin microcirculation was studied using biomicroscopy of the blood vessels of the nail bed of the affected finger. The growth and body weight of patients, body mass index, blood pressure level were determined. Concentrations of cholesterol, high-density lipoprotein cholesterol, triglycerides, and glucose were studied. Results and discussion. The additional prescription of Natubiotin in the treatment scheme of patients with onychomycosis for 6 months led to statistically significantly better results based on the scale assessment of the shape of the nail plates, the number of affected nails, the area of the affected nail, and the average OSI values compared to standard therapy. The use of Natubiotin in the complex therapy of patients with onychomycosis reliably positively affected the quality of life. DLQI index was less than 5 points in 68.3 % of patients of the experimental group, while only 48.6 % of patients of the comparison group had such values. 6 months after the start of treatment, the patients of the experimental group, in contrast to the subjects of the standard therapy group, had a statistically significantly lower concentration of cholesterol, triglycerides and glucose and a higher content of high-density lipoprotein cholesterol, which indicates the positive effect of Natubiotin on lipid metabolism and glucose level. The number of functioning capillaries per 1 mm3 increased by 46 %, the frequency of microcirculation disorders decreased by 28 %, vascular disorders — by 19 %, and intravascular changes – by 35 % in patients of the experimental group during the 6-month course of treatment. Conclusions. It is recommended to assess the effectiveness of treatment of onychomycosis by the scale assessment of the severity of the disease according to Ya.F. Kutasevich, T.V. Zimina and by OSI index. The use of Natubiotin for 6 months in patients with onychomycosis showed a significant improvement in the clinical picture, particularly in relation to the damage to the nail plates, the number of affected nails, the area of the affected nail, the presence of concomitant mycosis of the skin and subungual changes. Due to the use of Natubiotin, the quality of life of patients significantly improved. After 6 months, most of the patients in the experimental group had DLQI less than 5 points, which indicates a slight impact of the disease on their quality of life after the therapy with the inclusion of Natubiotin. The inclusion of Natubiotin in the course of therapy for 6 months contributed to a significant decrease in the frequency of microcirculation disorders of the nail bed, an increase in the number of functioning capillaries per 1 mm3, a decrease in the percentage of existing microcirculation disorders, vascular disorders and intravascular changes. The results of the study give reasons to recommend the use of Natubiotin in practical work for the treatment of patients with onychomycosis.

Varicose eczema: pathogenetic and clinical-pathological aspects. New treatment paradigms with the use of modern venotonic drugs

Objective — to analyze current perspectives on the pathogenesis, clinical course characteristics, diagnosis, therapeutic methods for patients with varicose eczema (VE) and to identify further research prospects that will enhance treatment efficacy for the dermatosis in question. Materials and methods. Based on a review of the state-of-the-art literature and our own preliminary investigations, we identified the relevance of deeper investigation of the clinical course details of the varicose eczema and the development of therapy incorporating venotonic drugs in the comprehensive treatment. Results and discussion. Varicose eczema manifests as a chronic relapsing condition occurring alongside chronic venous insufficiency, predominantly affecting the lower extremities and impacting up to 20 % of patients aged over 70. The appointment of venotonic agents to VE patients which improve venous microcirculation and lymphatic drainage, as well as slow down the processes of endothelial dysfunction, thereby increasing the effectiveness of treatment and reducing the likelihood of relapses, is pathogenetically justified.The drug of choice for inclusion in the complex therapy of patients with VE is a modern venotonic agent of combined action Flego®, which includes an ultramicronized fraction of bioflavonoids. Conclusions. Further studies of the mechanisms of development and progression of VE will expand the understanding of the pathogenesis and contribute to the optimization of the therapy of this dermatosis.The appointment of venotonic agents is a pathogenetically justified approach to the treatment of patients with VE.The effectiveness and safety of the venotonic agent of combined action Flego® allows to recommend it for inclusion in the complex treatment schemes of patients with VE.

The effect of complex treatment including osteopathic correction on pain intensity and quality of life in patients with chronic tonsillitis

Introduction. The relevance of the problem of chronic tonsillitis is due to the wide spread of the disease and the occurrence of complications associated with it, which, in turn, contributes to the appearance of pain and a decrease in the quality of life. Available information about the role of the palatine tonsils as an important organ of the immune system makes conservative treatment methods more preferable. Conventional conservative treatment is reduced to episodic implementation of individual techniques and remains insufficiently effective. Obtaining in-depth knowledge about the mechanisms of development of chronic tonsillitis necessitates the search for an integrated approach to treatment including non-drug methods. Often, questions about the severity of pain in patients that affect the level of quality of life are not given due attention.The aim is to study the effect of complex treatment including osteopathic correction on the quality of life and intensity of pain in patients with chronic tonsillitis.Materials and methods. In a prospective controlled randomized study conducted at the Department of Osteopathy and the Department of Otorhinolaryngology of the North-Western State Medical University named after I. I. Mechnikov of the Ministry of Health of Russia in the period from 06.2022 to 06.2023, 60 patients with a diagnosis of chronic tonsillitis were included. All patients, depending on the treatment, were divided using the randomization envelope method into two groups — main (n=30) and control (n=30). Patients in both groupsreceived otorhinolaryngological treatment in the form of lavage of the palatine tonsils (five rinsing procedures using an antiseptic solution, the interval between procedures was 2 days). Patients in the main group additionally received osteopathic correction (three procedures with an interval of 14 days). In all patients, before and after completion of treatment, the intensity of pain was assessed using a visual analogue scale (VAS) and quality of life using the SF-36 questionnaire.Results. In patients of both the main and control groups, there was a statistically significant decrease in the intensity of sore throat (p<0,05) after treatment. The increase in the level of quality of life in terms of both physical and psychological components of health was statistically significant (p<0,001) in patients of the main group. The level of quality of life in patients in the control group increased only due to the psychological component (p<0,001) of health, and the indicators of the physical component did not change (p=0,092).Conclusion. The inclusion of osteopathic correction in the complex therapy of patients with chronic tonsillitis in the inter-relapse period helps to reduce the pain and improve the physical component of quality of life compared to traditional conservative treatment alone. The study should be continued with a larger sample.

Assessment of the quality of life in patients with onychomycosis and mycosis of the feet with concomitant non-alcoholic fatty liver disease against the background of complex therapy

Background. Сurrently, much attention is paid to the quality of patients, which is a promising direction of life, allowing to put a complete and objective picture of the disease, determine the most stable method of treatment, and evaluate its results.
 Aims. To evaluate the effectiveness of complex therapy in patients with onychomycosis and mycosis of the feet with concomitant non-alcoholic severe liver disease (NAFLD) using a modified questionnaire-questionnaire of the combined index of quality of life (QL-Index).
 Methods. The combined index of quality of life (QL-Index) was determined in patients with onychomycosis and mycosis of the feet with with concomitant NAFLD before and after complex therapy.
 Results. Analysis of the results of assessing the presence of a combined index of quality of life in 117 patients with onychomycosis and foot mycosis with concomitant NAFLD before treatment showed that the presence of onychomycosis and mycosis of the feet in the majority of respondents has a strong impact on the lives of the respondents (69.2%). After the complex treatment, according to the results of the combined questionnaire-questionnaire of the quality of life index, it was revealed that social activity in patients with onychomycosis and foot mycosis with concomitant NAFLD increased, and the psycho-emotional state improved. The quality of life of patients has improved, which significantly increased the effectiveness of this complex treatment.
 Conclusion. The high efficacy and safety of complex therapy, which included the use of the systemic antimycotic itraconazole in combination with external antifungal drugs, a hepatoprotector and a prebiotic in patients with onychomycosis and mycosis of the feet with concomitant NAFLD.

Results of a prospective open observational study of the use of dornase alfa as part of complex therapy for patients with cystic fibrosis

The article discusses results of a prospective observational study of long-term use of the biosimilar dornase alfa (Tigerase) (Generium, Russia) as part of complex therapy in patients with cystic fibrosis in real clinical practice.The aim was to analyze the outcomes of long-term use of the dornase alfa dornase alfa as part of complex therapy in patients with CF (protocol #DRN-CFR-N01).Methods. The study included patients (n = 165) aged 5 years and older from 11 centers for treatment of cystic fibrosis in the Russian Federation with a confirmed diagnosis of cystic fibrosis who were prescribed dornase alfa by their attending physician.Results. The analysis revealed that exacerbations of chronic pulmonary disease during the treatment with dornase alfa were observed in 29 (17.58%) patients included in the study. At the same time, there were no statistically significant changes in FEV1 and FVC (%) against baseline during the treatment in the study population. Adverse events related to the study drug were recorded in 9 (5.45%) patients.Conclusion. Biosimilar dornase alfa demonstrated a favorable efficacy and safety profile in routine clinical practice, which confirms the results of previously published studies.

Chondroprotectors in complex treatment of non-specific back pain: effectiveness evaluation

Background. Degenerative and dystrophic spinal diseases and associated pain syndrome remain a leading problem for practical health. The symptom-modifying and structurally modifying effects of chondrobrotectors suggest that they may be effective in treating patients with lower back pain (LBP).
 Aim. Study of the efficacy of Ambene® Bio in complex therapy of patients with acute LBP associated with degenerative dystrophic spinal diseases.
 Materials and methods. The article analyzes the results of examination and treatment of 50 patients with dorsopatia and non-specific LBP, who received treatment in hospital in the neurological department of Saratov City Clinical Hospital №9 or outpatient on the basis of the clinic “Artromedcenter” Saratov. Patients are randomly sampled into two groups of 25 people: those who received (core group) and those who did not receive (comparison group) Ambene® Bio therapy. The groups were comparable by sex, age, and clinical manifestations of dorsopathy. Methods of non-parametric analysis have been applied to statistical processing of the study results. The analysis included computing the median (Me) and quartile scale (Q25–Q75 – 25th and 75th percentiles).
 Results. All patients participating in the study noted improvement and reduction of pain syndrome during the treatment. The results of a survey using 100-point VAS indicate that on the 20th day of therapy (visit 2) the lower back pain syndrome significantly decreased from 66.1±8.54 to 23.32±6.76 (p0.05). In the comparison group the VAS dynamics pain was positive, but not so pronounced: before treatment – 70.11±11.43, on the 20th day of therapy – 46.15±9.38. The sum of test points on the Watkins scale in the core group did not exceed 15 points during the study, while in the HS the total scale was close to the value of 24 points.
 Conslusion. The use of Ambene® Bio promotes a faster onset of the analgesic effect – on the 7th day of therapy, pain was practically relieved in 56% of patients in the core group. This made it possible to reduce the dose and shorten the duration of the NSAID course.