Complex Therapy Of Patients Research Articles

Recognan (citicoline) prescribing in cerebrovascular diseases and type 2 diabetes mellitus patients

In a number of clinical studies, Recognan (citicoline) has demonstrated its effectiveness in patients with ischemic stroke, traumatic brain injury, cognitive disorders of various origins, in the complex therapy of asthenic and anxiety-depressive disorders, showing neuroprotective and neuropreparative properties. In recent years, emphasis has been placed on citicoline appointment in the complex therapy of patients with type 2 diabetes mellitus (DM2). In experimental (induced DM2) and clinical studies of patients with cerebrovascular diseases (CVD) and DM2, the effectiveness of Recogan (citicoline) against diabetic retinopathy and diabetic polyneuropathy in more significant clinical changes and negative dynamics absence of important laboratory parameters (blood glucose levels) in acute and stroke recovery periods in patients with DM2. The analysis of research materials allows Recogan to recommend to patients with CVD and DM2.

Evaluation of the efficiency of the method of biological feedback in complex therapy of patients with hypertonus of the chewing muscles

The study included 40 patients aged 20 to 32 years with complaints of fatigue and discomfort in the area of chewing muscles, teeth compression during the day, nocturnal bruxism, crowding of teeth. Two groups were formed: the study group, whose patients underwent splint therapy in combination with biofeedback therapy trainings; in the control group, patients received treatment with splint therapy without the use of biofeedback therapy. Electromyography of the masticatory muscles at rest and during compression were used to diagnose hypertonicity of the masticatory muscles. To assess the psycho-emotional state, a medical and social questionnaire was conducted using questionnaires: «Health Questionnaire», Beck Depression Inventory, Spielberger-Khanin Anxiety Scale, SF-16 Quality of Life Scale. A decrease in the level of depression, anxiety was revealed with the stabilization of emotional sensitivity in relation to other people, emotional involvement in everyday life, and an increase in the quality of life. When comparing electromyographic data at rest and during clenching of teeth in patients of the study group the indicators were lower than in the control group. The effectiveness of biofeedback therapy at the stages of orthodontic treatment using splint therapy was established in the form of a decrease in the activity of masticatory muscles in patients of the study group. In the control group, the index of masticatory muscle activity decreased to a lesser extent. Biofeedback methods have shown a high level of effectiveness in reducing the symptoms of anxiety and depression, improving the quality of life.

Гастроинтестинальные расстройства, ассоциированные с расстройством аутистического спектра

Aim. A synthesis of scientific literature data on the association of autism spectrum disorders (ASD) with gastrointestinal dysfunction and disturbances of the intestinal microbiota. Key points. ASDs belong to a group of neurodevelopmental disorders associated with genetic, epigenetic and environmental factors, and include conditions that are heterogeneous in clinical presentation and severity of psychopathological symptoms. ASD is often comes with various symptoms of gastrointestinal tract dysfunction referred to impaired intestinal barrier permeability. The consequence is the pervasion of external agents (food antigens, toxins, bacterial metabolites) into the blood and initiation or maintenance of the inflammatory process, which is the most important pathophysiological link in ASD. Particular attention is paid to the analysis of the mechanisms of impaired intestinal barrier permeability. It is necessary to develop strategies aimed at reducing the level of inflammation in complex therapy of patients with ASD. Conclusion. Patients with ASD, in addition to psychoneurological symptoms, often present somatic problems, which, however, may not be timely recognized due to their nonspecificity and the difficulty of differentiating behavioral reactions either associated with the disorder or being just a reaction to somatic ill-being.Moreover, the whole complex of clinical manifestations is mediated by a single systemic dysregulation of immunological and metabolic reactions and is inherently a different reflection of one process, requiring profound multidisciplinary treatment and the use of various therapy approaches. Keywords: autism spectrum disorders, neuroinflammation, microbiome, intestinal permeability.

Enterosorption in Complex Therapy of Patients with Drug Addiction

Enterosorption in Complex Therapy of Patients with Drug Addiction

Choline alfoscerate in the correction of cognitive impairment

In preclinical and clinical studies, choline alfoscerate (CA) has proven to be highly effective in the correction of cognitive impairment (CI). The clinical effect of CA is seen in the improvement of mental activity, concentration, ability to remember and recall information, cognitive and behavioural responses, elimination of emotional instability and apathy. Experimental studies have shown the effectiveness of CA in preventing atrophic changes in the cerebral cortex. Based on several studies conducted on the use of CA in the treatment of CI, it can be concluded that oral administration of CA at a dose of 600 mg/day can be recommended both as monotherapy and as part of complex therapy in patients with cerebrovascular diseases such as chronic cerebral ischemia. As part of complex therapy for CI in Alzheimer's disease, a combination of CA at a dose of 1200 mg/day with donepezil at a dose of 10 mg/day may be recommended. Several studies have demonstrated the efficacy of CA in the treatment of post-COVID and post-traumatic CI. The efficacy of CA administration in the treatment of CI (including vascular dementia) following ischemic stroke and transient ischemic attacks has been demonstrated. When CA is taken, there is also a reduction in anxiety and depressive disorders, asthenia, the severity of pain symptoms and changes in coordination. The duration of therapy should be 60 to 90 days, depending on the severity of CI, followed by an observation phase of up to 2 years. For successful treatment with CA, it is necessary to carry out repeated courses of CI treatment. Today, a new drug Cerpechol (600 mg/7 ml) has appeared on the Russian market, which has all the effects of CA. The convenience of the new form (oral solution) makes it possible to use it in patients with swallowing disorders.

Chronic dizziness: modern treatment methods taking into account comorbidity

In most cases, chronic dizziness is persistent postural perceptual dizziness (PPPD), which is often combined with other diseases of the vestibular system and anxiety disorders. In real-life clinical practice, PPPD and comorbid disorders are rarely diagnosed and effective treatments are rarely prescribed, so the development of modern methods for managing patients with PPPD with comorbid diseases is important.Objective: to analyze the typical management practices and evaluate the effectiveness of complex therapy in patients with PPPD and comorbid disorders.Material and methods. We examined 60 patients (mean age – 42.5±13.8 years) with diagnosis of PPPD (according to the diagnostic criteria of the Barany Society) and comorbid diseases. All patients were examined twice: at the beginning and after completion of treatment, which lasted an average of 1 month. Treatment included antidepressants (serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors), anti-anxiety medications, vestibular exercises, an educational program, and cognitive behavioral therapy. Arlevert (a combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as a drug therapy for the treatment of vestibular dizziness in 28 patients. A clinical otoneurological evaluation and videonystagmography were performed to assess vestibular disorders; the severity of dizziness was assessed using an otoneurological questionnaire and the Dizziness Handicap Inventory (DHI); the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Spielberger Anxiety Inventory (STAI) were used to assess anxiety and depressive disorders.Results. None of the 60 patients had previously been diagnosed with PPPD. They were observed with a misdiagnosis of cerebrovascular disease and/or cervical spine pathology and received ineffective treatment. Anxiety and depressive disorders were detected in 32 (53.33%) patients, migraine – in 20 (33.33%) and previous peripheral vestibular disorders – in 8 (13.33%) patients. After one month of treatment in patients with PPPD and comorbid conditions, the severity of dizziness according to DHI decreased from 45.59±15.47 to 29.9±12.56 points (p<0.001), the severity of anxiety according to BAI from 27.50±6.38 to 15.66±4.07 points (p<0.001), the severity of depression according to BDI from 11.91±6.24 to 7.06±4.12 points (p<0.001), the severity of anxiety according to HADS from 13.47±4.16 to 8.60±2.86 points (p<0.001), the severity of depression according to HADS from 6.34±3.72 to 4.31±2.82 points (p<0.001), situational anxiety according to STAI from 50.69±7.13 to 41.26±6.24 points (p<0.001), personal anxiety according to STAI from 54.66±8.21 to 43.78±6.75 points (p<0.001).Conclusion. It was found that PPPD is rarely diagnosed, and anxiety disorders, migraine and peripheral vestibular disorders are very common in PPPD patients. The integrated approach in the treatment of patients with PPPG, taking into account concomitant disorders, has demonstrated high efficacy.

Dynamics of clinical manifestations of gonarthritis in overweight hypertensive women under the influence of complex therapy

The aim of the work was to study the dynamics of clinical manifestations of gonarthritis in women with hypertension and overweight under the influence of complex therapy. Materials and methods. A two-stage study was conducted on the effectiveness of Rosuvastatin and Arginine in the complex therapy for patients with gonarthritis in combination with hypertension and excess body weight. At the first stage, on the basis of the inpatient Rheumatology Department, 198 women hospitalized in the period 2018–2020 were prospectively examined after receiving their informed consent. The follow-up study of the second stage (2019–2021) was carried out at the outpatient department. At the follow-up stage, 134 women were examined. Depending on the accompanying pathology, the patients were divided into three groups. Results. The use of the proposed treatment option in the complex treatment for selected contingent of patients contributed to a significant reduction in the proportion of patients with movement restriction in Group 2 and Group 3 by 62.21 % and 52.12 %, pain during active movements by 24.89 % and 52.12 % and swelling of the joints by 13.8% and 12.65 %, respectively; a decrease in IL-6 levels in Group 2 and Group 3 by 3.64 and 1.36 times, CRP by 1.97 and 1.12 times, and an increase in IL-10 by 3.57 and 1.62 times, respectively; improvements in WOMAC scores in all studied groups with a significant increase in Group 2 and Group 3. Conclusions. The combination of Rosuvastatin 20 mg per day for the 3-month course and Arginine 100 ml intravenously No. 10 with subsequent oral administration of 5 ml 4 times daily for 1 month has been found to increase the effectiveness of treatment for patients with gonarthritis combined with hypertension and overweight, reduce the intensity and duration of joint pain syndrome and significantly improve the functional capacity of joints.

Botulinum toxin preparations in complex therapy of infantile cerebral palsy (literature review)

The relevance of the topic is confirmed by statistical data related to primary childhood disabilities, according to which a number of congenital developmental anomalies and disorders of the nervous system are especially common. Cerebral palsy (CP) occupies a leading position in this regard. It is obvious that complex therapy for patients with cerebral palsy is effective, but it is not of economic benefit to the state, which to a certain extent provides support in the rehabilitation of this category of patients. In this connection, budgetary allocations and contributions from insurance companies both in the Russian Federation and other countries are distributed in a rational manner. Botulinum toxin preparations, used in standard clinical practice to combat focal spasticity syndrome in patients with cerebral palsy, have proved to be a feasible and economically beneficial medical technology. A similar therapy strategy has demonstrated a positive clinical effect. It is also the least expensive technology in the medical armamentarium used for the treatment and rehabilitation of patients with infantile cerebral palsy.

Effect of intravenous iron-carbohydrate complexes in patients with heart failure with reduced ejection fraction and iron deficiency: a meta-analysis of randomized controlled trials

Abstract Background Iron deficiency (ID) has been associated with having the potential to cause heart failure as well as worsening heart failure with reduced ejection fraction (HFrEF). Treatment with a target on ID has been shown to lead to improvement in heart failure patient outcomes. In this study, we performed a meta-analysis of the RCTs to more comprehensively evaluate the effectiveness of intravenous iron-carbohydrate complexes in HF patients with ID. Methods We conducted a systematic literature search on MEDLINE and EMBASE. The search terms included "iron," "iron deficiency," "iron complex," "iron-carbohydrate," "iron sucrose," "heart failure," "HFrEF," and "intravenous." Included studies met the following criteria: (i) a study was published in a peer-reviewed journal; (ii) a study design was a randomized controlled trial; (iii) study enrolled patients with HFrEF and ID, and (iv) a study evaluated intravenous iron-carbohydrate complex. The primary outcome was all-cause mortality during the follow-up. The secondary outcomes were cardiovascular (CV) mortality (deaths due to CV causes), CV admission (hospitalizations due to cardiovascular causes), and HF admission (first hospitalizations due to HF or hospitalizations due to HF worsening). Risk ratios (RRs) with 95% confidence intervals (95%CIs) were calculated with the event/total number in each study and synthesized by a random-effects model. Results We identified 926 articles by the initial database search and additional manual search and retrieved the full text of 18 articles for further review. We then excluded 3 sub-analyses of the included trials to avoid patients’ duplications. Finally, we included 15 RCTs with a total of 3,085 patients (the median or mean age, 62–75 years; female, 25-55%; median follow-up duration, 2–141 weeks). Intravenous iron-carbohydrate complexes were associated with lower risks of all-cause mortality, CV mortality, CV admission, and HF admission, though statistical significance was only observed in HF admission (Figure A-D). CV admission and HF admission provided substantial heterogeneity. Conclusion The results of this meta-analysis showed that intravenous iron-carbohydrate complex therapy in patients with HFrEF and ID was beneficial in lowering the risk of hospitalization due to heart failure. Physicians should be aware of the significance of ID when treating patients with HFrEF.

Possibilities of local therapy of recurrent candidiasis against the background of mixed vaginal dysbiosis

Introduction. The article describes the experience of treating patients with recurrent vulvovaginal candidosis combined with mixed vaginal dysbiosis using a variant of complex local therapy with drugs containing sertaconazole nitrate and benzyl-dimethyl-[3-(myristoylamino) propyl] ammonium chloride monohydrate.Aim. To evaluate the efficacy of local therapy in patients with recurrent vulvovaginal candidosis with underlying mixed non-specific vaginal dysbiosis.Materials and methods. A prospective open randomized clinical trial to evaluate the outcomes of treatment with drugs containing sertaconazole nitrate at a dose of 300 mg (Flucovag®, vaginal suppositories, two times with an interval of 7 days) and benzyl-dimethyl-[3-(myristoylamino)propyl] ammonium chloride monohydrate at a dose of 15 mg (Miramistin® vaginal suppositories once a day at bedtime for 10 days) in women with mixed nonspecific infectious vaginal diseases with underlying recurrent vulvovaginal candidosis (n = 68) was conducted. Methods: vaginal microbiota evaluation with AmpliPrime® Florocenosis/Bacterial vaginosis-FL PCR (NextBio LLC, Russian Federation), vaginal pH, Hay/Ison scoring criteria, antimycotic sensitivity evaluation against Candida spp. (NCCLS standards).Results and discussion. This kind of local complex therapy in patients with recurrent vulvovaginal candidosis combined with mixed vaginal dysbiosis using drugs containing sertaconazole nitrate (Flucovag®) and benzyl-dimethyl[3-(myristoylamino) propyl]ammonium chloride monohydrate (Miramistin®), followed by probiotic contamination showed high clinical (94.1 ± 2.3%) and microbiological (81.9 ± 2.1%) efficacy combined with safety and satisfactory compliance.Conclusion. A comprehensive approach to the treatment of mixed nonspecific vaginal dysbiosis with underlying recurrent vulvovaginal candidosis showed high clinical efficacy and satisfactory compliance.

Psoriasis and metabolically associated liver disease. Justification of hepatotropic therapy in complex therapy of patients with psoriasis

Psoriasis is a chronic, relapsing, immune-mediated inflammatory skin disease characterized by an increased risk of several comorbidities, including metabolic syndrome, type 2 diabetes, and metabolic-associated liver disease (MAFLD). The effect of systemic inflammation and insulin resistance worsens the condition of the liver, and liver disorders negatively affect the course of psoriatic disease.In our research, we studied the effect of additional use of the standard hepatoprotector silymarin and the modern phytosomal complex silibinin in combination with soy phospholipids to local GCS therapy. The functional state of the liver was determined based on the liver fibrosis index (NAFLD Fibrosis Score), and the dynamics of psoriatic skin lesions was monitored using the Psoriasis Area and Severity Index (PASI).The study included 60 patients who were divided into 3 groups: all patients used standard local monotherapy with a topical GCS (mometasone furoate, «Elokom®» drug) for 9 weeks. At the same time, patients of the second group received the classical silymarin drug, and patients from the third group received a modern phytosomal silibinin complex in combination with soy phospholipids («Lesyl®» drug).The results of our study showed that the use of a complex preparation of silibinin in combination with phospholipids demonstrated better dynamics of liver function indicators compared to the usual preparation of silymarin. We also observed the best results of regression of psoriatic rashes according to the dynamics of PASI index in this group.The obtained results prove that the correction of liver disorders in patients with psoriasis will not only have a positive effect on their metabolic background and the state of the body as a whole, but will also contribute to increasing the effectiveness of dermatosis treatment.

Immune Diagnostics and Immunotherapy of Burn Sepsis

The paper analyzes the literature data and authors proper experience in the study of immunopathogenesis and immunodiagnosis of burn sepsis. It argues the issues of effective use of immunocorrection in the complex treatment of severely burned patients.Diagnosis of sepsis after severe burn injury is challenging due to the overlap of signs and clinical manifestations of the hypermetabolic reaction of thermal injury and sepsis. The systemic inflammatory response caused by burns can mimic manifestations of sepsis and complicate its early diagnosis. Considering this, modern immunodiagnostics can serve as an effective tool in identifying damaged key immune markers in burns, determining the severity of immune status disorders in burn disease and the risk of developing septic complications for timely immunocorrection and providing appropriate complex therapy for patients with extensive burns.However, the problem of immunocorrective therapy in severely burned patients remains extremely relevant, debatable and not fully resolved. It is a personalized approach based on immune analysis and clinical recommendations for the complex treatment of burn injury that should be applied in the immunotherapy of burn sepsis to improve the clinical outcomes and, possibly, prevent the development of sepsis in patients with severe burn injury.

Ендоваскулярні втручання в комплексній терапії пацієнтів із портальною гіпертензією і кровотечею з варикозно розширених вен

For today, endovascular procedures, such as embolization of splenic artery, transjugular intrahepatic shunt, and retrograde transvenous obliteration with balloon occlusion are widely applied in the treatment and prophylaxis of variceal bleeding in patients with portal hypertension. Splenomegaly with the development of hypersplenism is one of complications of portal hypertension in patients with liver cirrhosis, which can negatively be influenced on clinical course. Due to that, it can be assumed that the management of hypersplenism in patients with portal hypertension with the applying of splenic artery embolization, could be improve the results of treatment of this group of patients. Purpose - to summarize the own experience of the applying of splenic artery embolization in the complex therapy in patients with portal hypertension that complicated by the variceal bleeding. Materials and methods. This study based on the results of treatment of 36 patients, in which the embolization of splenic artery was applied in the complex management (conventional treatment and endoscopic ligation of varices). The classic method of “chronic” occlusion was used for the embolization. The embolization on the level of the initial portion of the main trunk of splenic artery was performed in 30 (83.3%) of patients. Due to the anatomical peculiarities of vasculature, embolization was performed on the level of middle part of splenic artery in 6 (16.7%) of patients. The effectiveness of the treatment was evaluated by the changes of complete blood count indices and ultrasonography results. Statistical analysis was performed using the program SPSS Statistic for Windows, version 15.0 (IBM Corp., Armonk, NY, USA). Results. The middle age of patients was 55.8±1.6 years. The middle value of Child-Turcotte-Pugh criterion was 2.44±0.08, and MELD score was 16.36±0.99 value. Conclusions. The applying of splenic artery embolization that combined with conventional therapy and endoscopic ligation of varices is appropriate and justified. Embolization of the splenic artery promotes to decrease of appearance of hypersplenism in patients with the portal hypertension with positive influence on follow-up clinical course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

The role of dermatocosmetics in the management of rosacea

Rosacea is a chronic inflammatory disease that affects the facial skin. This pathology is characterized by hyperaemia, erythema, telangiectasia and other manifestations. It is also accompanied by a group of unpleasant symptoms, such as burning sensations, itching, and skin tightness. The pathogenesis of the disease has not been sufficiently studied. But it is generally accepted that it is based on abnormalities in the immune system. In addition, excessive Demodex colonization and exposure to ultraviolet radiation may play a role in the development of rosacea. The incidence rate of rosacea worldwide reaches 5%. It is emphasized that some ethnicities face a greater risk of this disease than others. It is a very difficult task to treat rosacea for a specialist. The therapeutic approach differs in different forms of the disease. There is a wide range of treatments available for papulopustular rosacea, including systemic and topical medications and even physiotherapy. However, the therapy of erythematous rosacea mainly centres around the use of dermatocosmetic care. For patients with rosacea, it is important to choose products that, first of all, can effectively reduce skin redness and discomfort and will be well tolerated. A dermo-cosmetic composition has to have an anti-inflammatory effect and the ability to repair damaged skin. This article presents our own experience of using such drug in the monotherapy of erythematous rosacea and in the complex treatment of papulopustular disease. A significant effect had been achieved at 3–4 weeks of complex therapy in patients with papulopustular rosacea. We present a clinical case report of a 46-year-old patient N. as an example of the effectiveness of therapy.

Сравнительная оценка эффективности использования препаратов с экстрактом предстательной железы в комплексной терапии пациентов с хроническим простатитом.

Introduction. Chronic prostatitis (СР) is an inflammation of the prostate tissue, including non-infectious genesis. This is the most common urological disease in men under 50 years of age and the third most common in people over 50 years of age. A promising and actively studied direction of conservative therapy of the inflammatory process in the prostate gland is the use of drugs of animal origin based on prostate extract. The purpose.This work is devoted to the comparative characteristics of drugs with prostate extract effectiveness in the complex therapy of patients with chronic prostatitis. Materials and methods. Retrospective analysis of medical records of 125 patients with a previously established diagnosis of СР of the II and IIIA, and IIIB categories aged from 22 to 55 years was performed. Depending on the preparation used with prostate extract in the complex therapy of CP, patients were divided into 5 groups. Preparations with prostate extract were used for 20 days. The effectiveness analysis included an assessment of the dynamics of the clinical picture, the results of laboratory and instrumental research methods, as well as questionnaire data on valid questionnaires I-PSS (International System for the Summary Assessment of Prostate Diseases, Lower Urinary Tract Symptoms (LUTS)), IIEF-15 (International Index of Erectile Function), NIH Chronic Prostatitis symptom Scale- CPSI. Results. The analysis of the results showed that the use of Vitaprost® in the complex therapy of СР is accompanied by a decrease in the number of leukocytes in the analysis of prostate secretion, positive dynamics in relation to the total score of the severity of pain syndrome and the patient's assessment of his condition on the NIH-CPSI scale of symptoms of chronic prostatitis, which may indicate a decrease in the inflammatory process in the prostate in general. The effectiveness of therapy in relation to erectile function on the IIEF-15 scale, reduction in the severity of symptoms on the IPSS scale and positive dynamics in relation to urination parameters was also noted. Conclusion. According to the results of the work carried out, it was the use of Vitaprost® that was accompanied by a significant decrease in the symptoms of CP and an improvement in the quality of life of patients, as well as erectile function of patients, an increase in the flow rate of urine, a decrease in the volume of residual urine and intensiveness of inflammation.

Comorbid disorders and therapy of persistent postural perceptual dizziness

Persistent postural perceptual dizziness (PPPD) is the most common cause of vague chronic vertigo and severely limits patients' quality of life.Limited data are available on comorbidities, the typical treatment of patients with PPPD, and the efficacy of combination therapy for PPPD.Objective: to identify comorbid disorders and evaluate the efficacy of complex therapy in patients with PPPD.Material and methods. Sixty patients (mean age 42.5±13.8 years) with PPPD were studied. All patients were prescribed complex treatment that included antidepressants (selective serotonin reuptake inhibitors), vestibular exercises, and an educational program. In 28 patients, Arlevert (combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as drug therapy. A clinical otoneurologic examination, videonystagmography, assessments by Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Spielberger State-Trait Anxiety Inventory (STAI), Dizziness Handicap Inventory (DHI) and otoneurologic examination were performed at baseline and at the end of treatment (mean, one month).Results. All patients had previous misdiagnoses, among which vertebrobasilar insufficiency and chronic cerebral ischemia predominated. Thirty two (53.33%) patients with PPPD had anxiety-depressive disorders (ADD) as the main comorbidity, 20 (33.33%) patients had migraine, 8 (13.33%) patients had previously had peripheral vestibular disorders that were not diagnosed. The severity of dizziness according to the otoneurological questionnaire and the DHI decreased after one month of therapy in the group with PPPD and ADD from 44.00±16.80 to 29.6±12.80 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 49.20±14.04 to 31.60±17.69 points (p<0.001), in the group with PPPD and migraine – from 43.58±16.28 to 28.50±7.20 points (p<0.001). The severity of anxiety and depression according to BAI decreased in the group with PPPD and ADD from 30.00±6.99 to 16.12±4.16 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 28.40±8.35 to 16.60±4.62 points (p<0.001), in the group with PPPD and migraine – from 24.11±3.80 to 14.26±3.43 points (p<0.001). The severity of depression according to BDI decreased in the group with PPPD and ADD from 9.62±5.26 to 6.25±3.20 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 14.80±8.26 to 8.40±5.37 points (p<0.001), in the group with PPPD and migraine – from 11.32±5.10 to 6.53±3.44 points (p<0.001). The severity of anxiety according to HADS decreased in the group with PPPD and ADD from 13.75±3.20 to 9.25±2.43 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 12.40±5.77 to 7.80±3.83 points (p<0.001), in the group with PPPD and migraine – from 14.26±3.16 to 8.74±2.18 points (p<0.001).The severity of depression according to HADS decreased in the group with PPPD and ADD from 4.88±4.12 to 3.88±3.09 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 8.40±3.58 to 5.60±2.88 points (p<0.001), in the group with PPPD and migraine – from 5.74±3.11 to 3.47±2.32 points (p<0.001). Situational anxiety according to STAI decreased in the group with PPPD and ADD from 47.62±6.57 to 40.12±3.68 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 58.20±7.85 to 48.00±7.65 points (p<0.001), in the group with PPPD and migraine – from 46.26±7.01 to 35.68±5.11 points (p<0.001). Personal anxiety according to STAI decreased in the group with PPPD and ADD from 52.25±10.73 to 42.12±7.06 points (p<0.001), in the group with PPPD and peripheral vestibular disorders – from 58.40±5.64 to 48.60±6.77 points (p<0.001), in the group with PPPD and migraine – from 53.32±8.78 to 40.63±5.60 points (p<0.001).Conclusion. Patients with PPPD are often misdiagnosed with cerebrovascular disease. The most common comorbid disorders in PPPD are anxiety disorders and migraine, and less commonly peripheral vestibular disorders. An integrated approach to the management of patients with PPPD, including treatment of comorbid disorders, is effective.

Efficacy of inclusion of vitamin U and provitamin B5 combination in the complex therapy of primary osteoarthritis against the background of gastrogenic exocrine pancreatic insufficiency

Clinical comorbidities at osteoarthritis (OA) complicate its treatment. The number and nature of various comorbid conditions determine the severity of the condition in patients with multimorbidity. However, apart from the common risk factors such as aging and obesity, little is known about the biological plausibility of explaining the co‑occurrence of OA and comorbidities. According to the European Alliance of Associations for Rheumatology, EULAR, and the National Institute of Health and Nursing, the diagnosis and treatment of specific comorbidities, as well as understanding their nature in OA, are important for choosing the best treatment tactics.
 Objective — to investigate efficacy of inclusion of vitamin U and provitamin B5 combination in the complex therapy of patients with primary OA in comorbidity with gastrogenic exocrine pancreatic insufficiency (EPI) for the correction of clinical syndromes.
 Materials and methods. Examinations involved 61 patients with primary OA in comorbidity with gastrointestinal diseases, accompanied by EPI of gastrogenic genesis without exacerbation. The comparison group consisted of 30 practically healthy people. All patients were divided into two comparable groups: group 1 (n=30) received a course of basic therapy drugs, namely: nonsteroidal anti‑inflammatory drugs, chondroprotectors and/or chondrostimulators, antispasmodics, prokinetics, proton pump inhibitors, enzyme agents (pancreatin); group 2 (n=31), in addition to the course of basic therapy, received a course of the vitamin drug combination of vitamin U and provitamin B5, 2 tablets once a day for 6 weeks. The calculation of the WOMAC index (Western Ontario and McMaster University) was used to assess the articular status of patients with primary OA, as well as the effectiveness of the treatment measures. Gastrointestinal Symptom Rating Scale (GSRS) questionnaire was used to assess gastrointestinal symptoms.
 Results. The proposed complex treatment of patients with primary OA with gastrogenic EPI with the additional inclusion of a vitamin preparation combination of vitamin U and provitamin B5 contributed to more significant regression of WOMAC indices compared to that during protocol treatment (the total WOMAC index decreased by 16.03% against 9.10%, respectively) and indicators of the scales of the GSRS questionnaire in comparison with the subgroup that received treatment according to the protocol (in total — by 35.96% vs. 22.19%, p <0.05),
 Conclusions. The study results showed the advisability of using a vitamin medication, a combination of vitamin U and provitamin B5. in the treatment of patients with primary OA with gastrogenic EPI.

The Role of Buspirone in the Treatment of Patients with Paranoid Schizophrenia with Non-Suicidal Auto Aggression Who Have Had a Coronavirus Infection

The relevance of this work is due to the insufficient number of modern studies on the treatment of patients with paranoid schizophrenia with non-suicidal autoaggressive actions or in short: “NSAA”, who have had a coronavirus infection. The aim of the study was to study the role of buspirone in the complex therapy of patients with paranoid schizophrenia with NSAA who had a coronavirus infection. Materials and research methods: 99 patients with paranoid schizophrenia meeting ICD-10 criteria were examined by a continuous, non-randomized clinical method. Fisher’s test was used for statistical evaluation. Results: It was established that the consequence of the coronavirus infection was an increase in the proportion of residual organic changes in the form of manifestations of the dysphoric syndrome, specific changes in the cognitive sphere, and the autonomic nervous system. The manifestations of dysphoria included an increase in the frequency of openly manifested aggression, anxiety, impulsivity, and the implementation of NSAA by the type of affective discharge. The structure of acquired cognitive impairments consisted of changes in thinking by the type of thoroughness, and rigidity of perseveration. Changes in the autonomic nervous system are presented in the form of diencephalic crises. Also, psychotic states not characteristic of the previously examined patients were noted, such as twilight stupefaction, delusional symptoms of Cappgras, Fregoli, and tactile hallucinosis. It has been established that the use of buspirone as part of complex therapy with neuroleptics, compared with monotherapy with neuroleptics, increases the effectiveness of therapy in relation to these clinical manifestations in the studied individuals. Conclusion: The use of buspirone in combination with neuroleptic drugs increases the effectiveness of therapy in relation to the leading psychopathological manifestations in patients with paranoid schizophrenia with NSAA who have undergone coronavirus infection.

Клинический анализ воспалительных заболеваний поверхности глаза после перенесенной SARS-CoV-2 инфекции и эффективность их лечения иммуномодулятором Имунофан

Purpose. To present clinical information about the results of our own observations of inflammatory diseases of the eye surface after a SARS-CoV-2 infection and the effectiveness of complex treatment, including the domestic regulatory peptide Imunofan. Material and methods. There were 19 patients (38 eyes) under observation – 12 women and 7 men, aged from 22 to 57 years. Clinically, all patients had corneal syndrome and redness of the eyes. The control group consisted of 10 people who received standard anti-inflammatory, keratoprotective and desensitizing therapy. The main group included 9 people who, in addition to the standard treatment regimen, received parabulbar injections of Imunofan (50 mcg every other day) in the amount of 10 injections. Before treatment, in order to substantiate the pathogenetic expediency of Imunofan administration, immunoregulatory index (IRI) was calculated. Evaluation of treatment results was carried out on 5, 7, 10 and 20 days of treatment with the calculation of the total index of inflammation. Results. According to the results of the examination, the predominant clinical forms of postcovid inflammation of the eye surface were epithelial keratitis (57.8 %) and keratoconjunctivitis (26.3 %). The results of immunological monitoring of blood serum at the time of the initial visit to the ophthalmologist showed that all patients had IRI changes, while most of them (73.6 % of people) had secondary immune insufficiency, 5 people (26.4 %) had autoimmune disorders. The obtained data substantiate the expediency of using immunomodulators in pathogenetic treatment of this category of patients. Carrying out complex therapy, including the regulatory peptide Imunofan, led to a significant reduction in the symptoms of inflammation by the 7th–10th day of treatment, the timing of complete relief of the inflammatory process was reduced by almost two times. Conclusions. The occurrence of postcovid inflammation of the eye surface with disorders of the immune system is caused by pathogenetic relationships of SARS-CoV-2 infections, and developing by the type of secondary immune insufficiency (73.6 %), or autoimmune disorders (26.4 %). The use of Imunofan in the complex therapy of patients with an inflammatory process of the eye surface after a SARS-CoV-2 infection reduces the time of its relief by two times. Keywords: SARS-CoV-2 infection, inflammatory process of the eye surface, immunomodulator Imunofan

The effectiveness of specialized medical dietary food product in the complex therapy of patients with pancreatitis in the acute stage

Introduction. Dietary nutrition is a physiological therapeutic and prophylactic approach for chronic pancreatitis during an exacerbation. Given the acute reaction of patients to various foods, specialized dietary products designed specifically for this pathology are of great importance. Aim. Evaluation of the clinical efficacy, safety and tolerability of the use of specialized therapeutic nutrition – jelly “Pancreatic” in chronic pancreatitis in the acute stage. Materials and methods. 20 patients of the main group with pancreatitis, along with standard therapy, received a dietary food product twice a day. The dynamics of pain, dyspeptic syndromes and intestinal dysfunction syndrome was studied; dynamics of the ultrasound picture of the pancreas; intestinal motility according to carbolene test; safety and tolerability of therapy by registering side effects and assessing the quality of life according to the SF-36 questionnaire, assessing well-being according to the visual analogue scale, and the organoleptic properties of the medicinal product. The comparison group consisted of 20 patients who received only standard pharmacotherapy. Results. The use of a dietary therapeutic food product is accompanied by a significant decrease in the frequency of nausea, belching, heaviness and flatulence in patients of the main group. The terms of relief or reduction in the intensity of symptoms of bitterness, nausea, heaviness in the abdomen, feelings of rapid satiety, flatulence were significantly lower in the main group (5–8 days compared to the control group (10–14 days). A significant normalization of GGT and CRP levels was established in the main group, while in the comparison group there was only a decrease in CRP. The ongoing complex therapy was accompanied by an improvement in the ultrasound picture of the pancreas, potentiation of the effects of pharmacotherapy and a significant improvement in the quality of life of patients. Conclusions. The conducted studies have shown high efficiency, good tolerability and safety of the therapeutic product “Pancreatic jelly” in the treatment of patients with chronic pancreatitis. Kissel “Pancreas” is recommended by the authors for active use in patients with pancreatitis as a therapeutic diet.