Complex Treatment Of Patients Research Articles

#860 The role of immunocorrection in the treatment of patients chronic pyelonephritis

Abstract Background and Aims Chronic pyelonephritis in the structure of extragenital pathology in pregnant women occupies a leading place due to the high prevalence, complicated course of pregnancy and childbirth. Chronic pyelonephritis (CP) triggers a cascade of reactions, primarily immune, at the systemic and local levels. With HP the role of the immune system in pregnant women is not only a pathological process occurring in the kidneys, but also takes into account a number of changes in the restructuring of the immune system of a pregnant woman. In relation with the above, the study of the role of the immune system of pregnant women with chronic pyelonephritis is of great interest. To study the effectiveness of immunocorrective therapy in the complex treatment of patients with chronic pyelonephritis. Method 43 pregnant women with CP were examined, the average age was 28.3 ± 0.2 years. The study included clinical research methods (survey, questionnaire, objective examination). Of the laboratory methods a general analysis of blood, urine, urine analysis according to Nechiporenko, tank. urine culture, biochemical blood tests and instrumental (ultrasound) research methods. Cellular immunity was studied by monoclonal antibodies, humoral immunity was studied by Mancini immunodiffusion. Among the surveyed women, the first group of upp was pregnant women (n = 14) receiving traditional therapy. The second group of 13 pregnant women with CP on the background of traditional therapy received ozone therapy (basic treatment + 400 ml of saline solution ozonated to a concentration of ozone in a liquid of 4 mg/l, intravenously, drip). The third group of 15 pregnant women with CP - with traditional therapy received ozone therapy and immune-regulating therapy with polyoxidonium. Results The characterization of clinical and laboratory data on the background of therapy showed significant shifts, as lower back pain decreased by 85.71%, 92.31% and 93.33%, respectively, in both the first and second and third groups. Indicators such as dysuria decreased by 92.85%, 92% and 93% (respectively in the first, second and third groups). Leukocyturia decreased significantly on the fifth day by 71.43%, 84.62%, 86.67% (in the first, second and third groups, respectively). Results indicators of eradication of pathogens after treatment in combination with traditional therapy with ozone and immune-correcting therapy, they were significantly better than in the ozone therapy group against the background of traditional therapy and in the traditional treatment group (86.6%, 84.6% and 64.28%, respectively). As a result of the study, significant decreases in cellular immunity indicators, in particular CD3, CD4, were revealed before the treatment of patients and CD8 and revealed a significant increase in IgA, IgM. After the treatment in the treatment group in combination significant increases in the number of CD3, CD4 and CD8 were revealed by traditional therapy with ozone- and immune-regulating therapy (by 76.1%, 64.68% and 58.3%, respectively), compared with the group of women who received only ozone therapy against the background of traditional therapy and in the group of traditional treatment (66.23%, 59.54%, 54.2% and 61.12%, 54.68%, 51.4%, respectively), and normalization of immunoglobulins A was noted and M. Conclusion Along with the improvement of clinical and laboratory data in CP normalization of cellular and humoral immunity indicators was noted in pregnant women. Additional assignment to traditional therapy for chronic pyelonephritis of pregnant women, ozone therapy and therapy for correction of the immune system is a more effective treatment method.

Supportive local treatment of diseases of the distal colon of various inflammatory genesis in the outpatient department

Introduction. Currently, along with the improvement of the scheme of combined drug therapy with first-line anti-inflammatory drugs, important importance is attached to adjuvant topical methods of treating diseases of the distal colon of various inflammatory genesis.Aim. Evaluate the clinical efficacy of the drug on sodium hyaluronate as an adjuvant topical agent in the complex treatment of patients with diseases of the distal colon.Materials and methods. A comparative analysis of the results of drug treatment of 97 patients with diseases of the distal colon of various inflammatory genesis, which were divided into two groups, was carried out. In 46 (47.4%) patients of the I (control) group, standard drug therapy with basic anti-inflammatory drugs was performed; 51 (52.6%) patients – II (main) group, the standard program of drug treatment was supplemented with instillations into the rectum of the drug on sodium hyaluronate (0.8 mg of hyaluronic acid in 1 ml). The comparative assessment of the results of treatment took into account the severity of clinical, laboratory and endoscopic manifestations of the disease.Results. In patients of the main group, there was a significant reduction in the healing time of erosions and ulceration of the mucous membrane of the distal colon compared with patients in the control group (29.4 ± 5.7 days, respectively, versus 52.8 ± 6.2 days). Also, in patients of the main group, it was possible to achieve stable clinical and laboratory remission of the disease at an earlier time, restoration of patients’ ability to work, and improvement of their quality of life.Conclusion. The results obtained by us allow us to recommend the drug on sodium hyaluronate as an additional topical drug for the medical treatment of chronic diseases of the distal colon of various inflammatory genesis in outpatient settings.

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.

Outcomes of combined treatment of patients with acute lumbodynia

Introduction. Acute dorsalgia is a common reason to seek outpatient medical care in Russia. The clinical picture usually includes muscular-tonic and pain syndromes. The most common form of dorsalgia by localization is acute lumbar pain (lumbodynia).Aim. To evaluate the effectiveness of Spascuprel®, Traumeel S in the complex treatment of patients with acute lumbar pain in real-world clinical practice.Materials and methods. We conducted a non-interventional, prospective, observational study of 110 outpatients aged 26 to 65 years. Patients received a standard on-demand therapy with nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, Group 1 received Spascuprel® and Traumeel® C, and Group 2 received centrally acting muscle relaxants. The effectiveness of treatment was assessed using the visual analogue scale (VAS) of pain intensity and the limitations of various activities in daily living were measured using the Roland – Morris questionnaire. Consideration was given to the exacerbation duration, the need for additional intake of NSAIDs, and the number of cases of pain exacerbation within 60 days from the start of participation in the observational study.Results. Under treatment, pain intensity showed statistically significant decreases in VAS scores (from 61.0 to 35.5 scores out of 100 according to VAS by Day 7 and to 19.5 scores by Day 14 of treatment in Group 1, from 61.2 to 41.1 and to 25.8 scores in Group 2, respectively (p < 0.05)). A more rapid decrease was observed in VAS pain intensity score from baseline in Group 1. Over 2-month observation period, group 1 had less exacerbations (p < 0.05) and fewer cases of need for additional intake of NSAIDs (p < 0.05). The frequency and severity of adverse events did not differ between two groups.Conclusion. A more rapid decrease in VAS pain intensity scores and reduction in the need for NSAIDs were noted in the group of patients with acute dorsalgia who used Traumeel® C and Spascuprel® in addition to standard NSAID therapy.

Динаміка показників оксидантно-антиоксидантних реакцій у післяопераційному періоді у хворих на поширений перитоніт

Purpose - to determine the effect of the developed treatment of patients with peritonitis on the dynamics of indicators of oxidant-antioxidant reactions and to justify the need for the use of the proposed drugs in the complex treatment of peritonitis. Matherials and methods. The study included 124 patients with toxic and terminal stages of peritonitis, who were divided into 3 groups: the Group I included 39 patients in whose complex treatment we included cytochrome C; the Group II included 41 patients whose complex treatment included cytochrome C and a solution containing levocarnitine and arginine hydrochloride; the Comparison group included 44 patients in whom the specified drugs were not used. The content of diene conjugates, reactive oxygen species (ROS), S-nitrosothiols, superoxide dismutase (SOD), carbonyl groups, and sodium nitrite was determined in the patients. Statistical processing of the study results was performed using the Statistical software EZR v. 1.64. Results. In patients of the Group I and the Group II, the use of the proposed treatment contributed to the optimization of oxidant-antioxidant reactions: a decrease in the production of diene conjugates, ROS, S-nitrosothiols, carbonyl groups, sodium nitrite during the study, optimization of SOD production, especially in the Group II. In patients of the Comparison group, decompensation in oxidant-antioxidant reactions was determined, associated with a significant increase in the production of diene conjugates, ROS, S-nitrosothiols and a decrease in SOD during the entire period. These trends developed against the background of an increase in the content of nitric oxide products and the activation of processes associated with the oxidative modification of blood plasma proteins. Conclusions. The use of cytochrome C and a solution containing levocarnitine and arginine hydrochloride in the complex treatment of patients with disseminated peritonitis helps to optimize oxidant-antioxidant reactions, which leads to a decrease in the manifestations of inflammation. 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 all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Perioperative pain optimization in the age of the opioid epidemic.

The opioid epidemic remains a constant and increasing threat to our society with overdoses and overdose deaths rising significantly during the COVID-19 pandemic. Growing evidence suggests a link between perioperative opioid use, postoperative opioid prescribing, and the development of opioid use disorder (OUD). As a result, strategies to better optimize pain management during the perioperative period are urgently needed. The purpose of this review is to summarize the most recent multimodal analgesia (MMA) recommendations, summarize evidence for efficacy surrounding the increased utilization of Enhanced Recovery After Surgery (ERAS) protocols, and discuss the implications for rising use of buprenorphine for OUD patients who present for surgery. In addition, this review will explore opportunities to expand our treatment of complex patients via transitional pain services. There is ample evidence to support the benefits of MMA. However, optimal drug combinations remain understudied, presenting a target area for future research. ERAS protocols provide a more systematic and targeted approach for implementing MMA. ERAS protocols also allow for a more comprehensive approach to perioperative pain management by necessitating the involvement of surgical specialists. Increasingly, OUD patients taking buprenorphine are presenting for surgery. Recent guidance from a multisociety OUD working group recommends that buprenorphine not be routinely discontinued or tapered perioperatively. Lastly, there is emerging evidence to justify the use of transitional pain services for more comprehensive treatment of complex patients, like those with chronic pain, preoperative opioid tolerance, or substance use disorder. Perioperative physicians must be aware of the impact of the opioid epidemic and explore methods like MMA techniques, ERAS protocols, and transitional pain services to improve the perioperative pain experience and decrease the risks of opioid-related harm.

Choice of Adjuvant Radiotherapy Facility in Major Salivary Gland Cancer.

Undergoing surgery and adjuvant radiotherapy (aRT) at the same facility has been associated with higher overall survival (OS) in head and neck squamous cell carcinoma. Our study investigates whether undergoing surgery and aRT at the same academic facility is associated with higher OS in major salivary gland cancer (MSGC). The 2006-2018 National Cancer Database was queried for patients with MSGC undergoing surgery at an academic facility and then aRT. Multivariable binary logistic and Cox proportional hazards regression models were implemented. Of 2801 patients satisfying inclusion criteria, 2130 (76.0%) underwent surgery and aRT at the same academic facility. Residence in a less populated area (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.16-2.45), treatment without adjuvant chemotherapy (aOR 1.97, 95% CI 1.41-2.76), and aRT duration (aOR 1.02, 95% CI 1.01-1.04) were associated with undergoing surgery and aRT at different facilities on multivariable logistic regression adjusting for patient demographics, clinicopathologic features, and adjuvant therapy (p < 0.01). Five-year OS was higher in patients undergoing surgery and aRT at the same academic facility (68.8% vs. 61.9%, p < 0.001). Undergoing surgery and aRT at different facilities remained associated with worse OS on multivariable Cox regression (aHR 1.41, 95% CI 1.10-1.81, p = 0.007). Undergoing surgery and aRT at the same academic facility is associated with higher OS in MSGC. Although undergoing surgery and aRT at the same academic facility is impractical for all patients, academic physicians should consider same-facility treatment for complex patients who would most benefit from clear multidisciplinary communication. 4 Laryngoscope, 2024.

The effectiveness of magnesium compounds in the complex treatment of patients with arterial hypertension with concomitant chronic obstructive pulmonary disease

Introduction. The combination of arterial hypertension and chronic obstructive pulmonary disease (COPD) is associated with an increased risk of cardiovascular complications. During exacerbations of COPD, almost every second patient has hypomagnesemia. In particular, intravenous magnesium (Mg) administration in stable patients with COPD has been shown to improve lung function and respiratory muscle strength. Numerous publications report positive impact of various magnesium compounds causing the decrease in blood pressure. The above justifies the expediency of further studying the effectiveness of magnesium compounds in hypertension with concomitant COPD. The aim of the study. To determine the effectiveness of a fixed combination of magnesium and vitamin B6 in the complex treatment of patients with hypertension accompanied by COPD. Materials and methods. 60 patients with stage II hypertension and concomitant COPD were subjected to clinical examination. The data of office and home blood pressure monitoring was supplemented with spirometry, electrocardiography, laboratory tests and results of EQ-5D, mMRC, CAT. Results. Treatment with the additional fixed combination of magnesium and vitamin B6 (MgB6) in patients with hypertension accompanied by COPD reduced complaints and improved quality of life from (52.6 ± 3.4) points to (74.2 ± 3.8) points (р less than 0.001). In 25 (83.3 ± 6.8 %) patients treated with MgB6, it was possible to achieve the target blood pressure; while in the control group similar results were obtained only in (26.6 ± 8.1%) (р less than 0.001). Aplication of a fixed MgB6 combination in patients with hypertension and COPD reduced the frequency of tachycardia from (23.3 ± 7.7)% to (3.3 ± 3.3)% (р less than 0.02), and frequency of supraventricular extrasystole from (36.7 ± 8.8)% to (13.3 ± 6.2)% (р less than 0.05). Improvement of repolarization processes was observed in (46.7 ± 9.1)% of patients who additionally received FC MgB6 and only in (16.7 ± 6.8)%, (p less than 0.02) of the control group. Complex treatment with the addition of a fixed combination of MgB6 contributed to the improvement of spirometry parameters: FEV1 – from (55.9 ± 3.0) to (65.8 ± 4.4) (р less than 0.05) and FEV1/FVC – from (62.3 ± 3.1) to (71.6 ± 3.4) (р less than 0.05). Conclusion. Complex treatment of patients with arterial hypertension and chronic obstructive pulmonary disease, in which a fixed combination of magnesium and vitamin B6 is added to the basic treatment, improved the clinical course of comorbidities, bioelectrical activity of the heart, reduced blood pressure, improved spirometry and quality of life.

Efficiency evaluation of the Neuromidin in the treatment of pain of the patients with discogenic lumbosacral radiculopathy: results of a multicenter post-registration prospective open comparative trial

Evaluation of the effect of Neuromidine on the dynamics of pain syndrome in the treatment of patients with discogenic lumbosacral radiculopathy. Patients with a confirmed diagnosis of discogenic lumbosacral radiculopathy no more than one year old and moderate intensity of pain syndrome on a visual analog scale were included in the main group (OH, n=62, age - 53.1±15.6 yrs) and the comparison group (HS, n=40, age - 53.7±12.9 yrs). OG patients received Neuromidine (15 mg/1 mL 1 once a day IM for 10 days, then 20 mg 3 times a day for 8 weeks) in addition to the standard drug therapy, HS patients received only standard drug therapy. The duration of the study was 8 weeks. The degree of decrease in the intensity and dynamics of pain syndrome, activity and frequency of pain in the lumbar spine, changes in the level of physical activity, and the severity of emotional disorders were evaluated. The level of inflammatory markers in the blood and the dynamics of monosynaptic spinal H-reflex parameters were evaluated. Before the study, there were no statistically significant differences there were no results of clinical and laboratory-instrumental examination between groups. After 8 weeks, the reduction of pain by VAS in the main group was statistically significant in contrast to the comparison group (p=0.0001). In the main group there was a statistically significant increase in the mean cognitive impairment score (p=0.0029), as well as an improvement in psycho-emotional state with a significant decrease in GAD-7 (p=0.0002) and PHQ-9 (p=0.0096). After 8 weeks of therapy, IL-6 level in the main group was statistically significantly lower (p=0.0027) than in the comparison group. The results of H-reflex study revealed an increase in its amplitude and some shortening of latency at the end of Neuromidine therapy. The drug had no undesirable side effects and was well tolerated. Administration of Neuromidine 15 mg/1 ml once a day intramuscularly for 10 days followed by 20 mg 3 times a day for 8 weeks has an effective analgesic effect as adjuvant therapy in patients with discogenic lumbosacral radiculopathy. The inclusion of Neuromidine in the complex treatment of patients with pain syndrome in discogenic radiculopathy is superior in efficacy to standard drug therapy.

Assessment of the treatment effectiveness of men with mild and medium degree of erectile dysfunction.

. Aim: To assess the effectiveness of monotherapy and complex treatment of patients with erectile dysfunction depending on its severity. Materials and Methods: Men with moderate and mild erectile dysfunction took part in the study, who, in turn, were divided into groups, depending on the treatment, with the evaluation of the results of the International Index of Erectile Function (MIEF-15), the state of cavernous hemodynamics and the function of the vascular endothelium before and after treatment. Results: In patients with an average degree of severity, who received complex treatment including a course of low-energy shock wave therapy, against the background of taking sildenafil and L-arginine, the best results were obtained in the quality of erection and increased cavernous blood flow, which positively affected satisfaction with sexual intercourse and overall satisfaction. It has also been proven that the function of the endothelium was improved in patients receiving L-arginine, due to which there was a probable decrease in endothelin-1. A probable improvement of erectile function was obtained in the group of patients with a mild degree who received L-arginine, and there was no statistical difference from the indicators in the group who received sildenafil, which was confirmed by the data of dopplerography. Conclusions: Patients with an average degree of erectile dysfunction require comprehensive treatment. The use of L-arginine can be an alternative to phosphodiesterase type 5 inhibitors in the treatment of mild erectile dysfunction.

Modified Acceptance and Commitment Psychotherapy in Complex Treatment of Comorbidity of Post-traumatic Stress Disorder and Mild Traumatic Brain Injury

The objective: approbation of the effectiveness of modified Acceptance and Commitment Therapy in a complex treatment of patients with comorbidity of posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). Materials and methods. 329 veterans from three clinical groups: individuals with PTSD (n=109), with mild TBI (n=112) and with comorbid PTSD + TBI (n=108), underwent a course of combined therapy lasting 8 weeks: in addition to standard therapy, they received psychotherapeutic intervention (psychoeducation with elements of motivational interviewing and acceptance and commitment therapy for PTSD) and transcranial direct current stimulation (tDCS). The evaluation of the effectiveness of the treatment, in addition to a comprehensive psychodiagnostic examination before and after the therapy, included the Quality of Life Assessment Scale (O. Chaban). Results. Based on the obtained data, we can assume that representatives of the PTSD group, who initially evaluated the quality of social aspects of their lives more negatively, after the therapy looked more positively at the emotionally colored spheres of life (sex and mood). At the same time, after the therapy, the feeling of satisfaction with life was more positively assessed by those patients who were more satisfied with their life conditions before the therapy, and a higher assessment of the quality of life after the therapy was observed in those patients who, even before the therapy, had a higher level of satisfaction with your sex life. Summarizing the obtained data, it can be asserted that as a result of the therapy, the best results in the direction of increasing self-esteem of the quality of life were achieved precisely in relation to patients with PTSD/TBI. Conclusions. Complex treatment of patients with comorbid PTSD and TBI using modified acceptance and Acceptance and Commitment Therapy in combination of standard treatment and tDCS is a promising individual treatment methodology in this patient population.

The first results of the international multicenter clinical study RheoSTAT-CP0669 on the effectiveness and safety of infusion solution Rheosorbilact® in the complex treatment of patients with burns

Mechanization and urbanization are accompanied by an increase in the prevalence of burns. A burn causes both local damage and systemic inflammatory response that leads to inadequate oxygen delivery to vital organs and inadequate elimination of metabolites. Infusion therapy for burns aims to restore perfusion and prevent ischemia. The implementation of effective dynamic schemes of infusion therapy has led to a decrease in mortality, however, an excessive amount of injected fluid does not improve the patient’s volumetric status, instead increasing tissue swelling and causing a number of complications. Therefore, doctors are faced with the question of choosing the optimal infusion therapy, which will allow maintaining the patient’s status at the needed level called normovolemia. According to the results of the open, blinded evaluation of the randomized controlled trial RheoSTAT-СР0669, administration of Rheosorbilact to patients with burns by intravenous infusion at a dose of 200-400 ml/day for 3 days significantly improves the clinical condition, reduces the manifestations of (poly-) organ failure and endogenous intoxication. Small-volume infusion therapy with Rheosorbilact causes a statistically significant decrease in the breathing rate, a decrease in endogenous intoxication and the intensity of inflammation, as well as positive dynamics of the blood gas composition. Administration of the drug in this mode has a favorable safety profile: it does not lead to fluid overload, associated complications, or other serious undesirable side effects, and does not cause a clinically significant increase in blood lactate level. The RheoSTAT-СР0669 study substantiates the feasibility of using Rheosorbilact in the complex therapy of burns.

SST 2 AS A MARKER OF THE TREATMENT OF PATIENTS AFTER MYOCARDIAL INFARCTION WITH ACCOMPANYING ARTERIAL HYPERTENSION ON THE BACKGROUND OF TREATMENT WITH MELDONIUM AND FOLIC ACID

Coronary artery disease (CAD) is one of the leading reason of mortality in Ukraine and all over the world. Arterial hypertension (AH) is the most common manageable factor in cardiovascular morbidity. Every third Ukrainian suffers from this disease. The presence of AH in a patient often becomes the reason for the further development of stable coronary artery disease (SCAD) due to the close pathogenetic connection of both pathologies. sST2 is a modern marker of cardiac fibrosis, which can help to evaluate the effectiveness of the underlying treatment for the patients with SCAD and concomitant AH.&#x0D; The aim. To study the possibility of using sST2 as a marker of the effectiveness of treatment of patients after a myocardial infarction with accompanying arterial hypertension on the background of treatment with meldonium and folic acid.&#x0D; Materials and methods. During our study we observed 40 patients with SCAD FC II-III and concomitant AH stage III, who had an acute myocardial infarction and underwent percutaneous coronary intervention with balloon angioplasty and stenting. All examined were divided into 2 groups of 20 patients each. The first group received standard treatment. The second group in addition to standard treatment, received a combination of folic acid and meldonium. In the course of the work, a detailed analysis of the results of general clinical, laboratory and instrumental examination methods was carried out. Laboratory study of sST2 levels in blood plasma was carried out by quantitative enzyme immunoassay.&#x0D; Results. We observed improvement of all Echocardiography parameters in patients of both groups. Somewhat more significant changes were recorded in the analysis of end systolic diameter of left ventricle. So, if in the first group the decrease in this indicator occurred gradually and amounted to an average of 7-8% after 6 months of treatment, then in the group of combined application of meldonium and folic acid against the background of traditional therapy, a significant reduction in ESD by 10.5% was recorded. The indicator decreased from 4.2 cm to 3.8 cm (p&lt;0.05). Also there was a different trend regarding the dynamics of thickness of the posterior wall during systole. In the first group the reduction of this indicator at the end of the study was 5.7% (p&gt;0.05). In the second group this indicator decreased from 1.13 cm to 1.11 cm after 1 month of treatment and to 0.89 cm after 6 months. That is, the decrease in the first stage was only 1.8% (p&gt;0.05), and then 26.9% (p&lt;0.05). In the course of the study, an increase in LVEF was found among patients with SCAD with concomitant AH. The increase in this indicator after 6 months was 3-4% among all the examined, regardless of the applied drug therapy.&#x0D; We observed the decrease in the concentration of sST2 in both groups of patients. However, it was reliable only among patients to whom, in addition to standard treatment, we added a combination of meldonium and folic acid. In the group of patients on SCAD with concomitant hypertension, a weak direct correlation between the level of ST2 and LVMI was established. The correlation coefficient in this case was r=0.1033 (p&gt;0.05).&#x0D; Conclusions. In the course of our study, the feasibility of using sST2 as a marker of the effectiveness of treatment of patients after a myocardial infarction with accompanying AH against the background of treatment with meldonium and folic acid was established. Application of myocardial cytoprotectors reliably reduced the concentration of a sST2, which makes their use in the complex treatment of patients after MI with concomitant AH reasonable.

COMPLETE REHABILITATION OF ORTHODONTIC PATIENTS AND PREVENTION OF RECURRENCES

Emotional instability of children leads to the development of oral habits or adaptive type of swallowing. They are ways of adaptation to existing chronic stress. Oral habits play an important role in the appearance of number of orthodontic anomalies of the occlusion or worsen the conditions of treatment of such a patient.&#x0D; The purpose of the study. Improving the effectiveness of the complex treatment of maxillomandibular anomalies among the patients with pathological occlusion, with primary swallowing and oral habits is important. Only an etiological approach to such clinical cases gives the desired result.&#x0D; Materials and methods. The article is based on a clinical and laboratory study conducted among patients aged 12-15 years who have oral habits (sucking fingers or other objects, breathing through the mouth, resting the head on the hands, sleeping in an uncomfortable position, having a primary swallowing). 15 people of the comparison group without maxillomandibular anomalies, oral habits, with normal swallowing and 60 patients with acquired maxillomandibular anomalies were examined. An important point of the clinical examination was the external oral examination with determination of the way of swallowing and breathing, determination of the condition of the TMJ. The patients were given the STAI testify, a secret questionnaire in order to identify stress factors that affect the body, and the relationship between the presence of a stress factor and the appearance of changes in the maxillofacial area was studied. We studied and analyzed the data of computed tomograms of 60 patients with acquired maxillomandibular anomalies, deformities, 15 tomograms of persons of the norm group. X-ray methods included examination of the patient on a spiral computed tomography scan TOSHIBA Aquilion PRIME 160-slices MODEL TSX-302A / 1C. The scan was performed according to a specially developed protocol. The results of the cephalometric study before and after the treatment were evaluated, and they were compared with the results of the clinical examination.&#x0D; Results. The obtained results of the STAI testify to the state of chronic tension of patients, a feeling of emotional relief during the period of using an oral habit. The results of the examination and photo report confirm pronounced changes in the symmetry and proportionality of the face, where there is an oral habit. Patients had complex treatment with non-removable Appliance (Hyrex, MARPE), braces systems in combination with myogymnastics.&#x0D; If there was a primary swallowing or hidden mouth breathing, the treatment began with labial therapy with FroggyMouth Appliance (France). The results of a cephalometric study confirm the presence of an acquired rather than a congenital deformation of the facial skeleton. Adaptive changes on the part of the maxillomandibular and the muscular system indicate the long-term effect of oral habits on the maxillofacial area and confirm the existence of a functional facial matrix.&#x0D; Conclusions. Constant systematic struggle with oral habits and atipical swallowing in the complex treatment of patients with maxillomandibular anomalies is an important and necessary stage. Only elimination effect of the etiological factor can prevent a relapse of a disease. The long-term results of the treatment indicate that after the treatment, the clinical and cephalometric characteristics of the maxillomandibular bones and the muscular apparatus normalize in patients.

Clinical assessment of the periodontal tissues during complex treatment of patients with chronic generalized periodontitis using herbal rinse

BACKGROUND: Preserving the effect of periodontal disease treatment and choosing an individual oral care program are urgent issues in dentistry.&#x0D; AIM: To examine the clinical dynamics and index indicators of the state of the oral cavity in patients with mild but chronic generalized periodontitis (CGP) before and after complex treatment using a mouthwash (“Art-Dental Expert”; LLC “KorolevPharm”).&#x0D; MATERIALS AND METHODS: The study was conducted in the main (using “Art-Dental Expert” mouthwash) and control (using 0.05% solution of chlorhexidine bigluconate) groups of patients with mild CGP. The state of periodontal tissues was assessed using a simplified hygiene index (OHI-S, Green–Vermillion), probing bleeding index (BOP), papillary–marginal–alveolar index (PMA), and the index of the need for periodontal disease treatment (CPITN).&#x0D; RESULTS: The main group showed positive dynamics of changes in the indices characterizing the state of the periodontium, with a significant difference in indicators when compared with the control group.&#x0D; CONCLUSION: The use of “Art-Dental Expert” mouthwash for the treatment of patients with mild CGP has a fast and stable prolonged clinical effect with normalization of qualitative and quantitative indicators of the state of periodontal tissues. The “Art-Dental Expert” mouthwash can be recommended for long-term use.

Combined Orthodontic and Prosthetic Treatment of a Patient with Angle Class II Division 1 Malocclusion: A Case Report

Abstract Skeletal class II division 1 malocclusion is primarily characterized by maxillary protrusion, mandibular retrusion or a combination of both. Treatment modalities for these patients are different depending on the age and the severity of the case. In adult patients with skeletal class II division 1, where the discrepancy is very severe, orthodontic and orthognathic surgery combined are often necessary to ensure an appropriate treatment, while prosthodontic treatment may be a challenge due to the skeletal discrepancies of the maxilla and the mandible. This clinical report presents a 45-year-old patient with a diagnosis of Angle Class II division 1 malocclusion. After clinical and radiographic observation and consultation with an orthodontist and maxillofacial surgeon, a combination of surgical and orthodontic therapy was proposed. Considering that the patient refused the surgical procedure due to fear, orthodontic therapy was carried out first, which improved the aesthetic and functional characteristics, but did not give results in increasing the vertical dimension of the occlusion. Therefore, further therapy was prosthetic, and was carried out by making all-ceramic maxillary and mandibular fixed dental prostheses; the patient was successfully rehabilitated and the anteroposterior discrepancy between the dental arches was corrected. Combined orthodontic and prosthetic treatment can be a good option in the complex treatment of patients with skeletal class II division 1 malocclusion providing functional rehabilitation of the stomatognathic system and improving facial appearance and the quality of life of the patient.

The effectiveness of the use of the drug based on silver proteinate in acute and exacerbation of chronic rhinosinusitis

AbstractIntroduction. The presence of opportunistic pathogens within the nasal cavity is one of the important factors in the pathogenesis of acute rhinosinusitis and exacerbation of chronic rhinosinusitis. On top of that, the frequently prescribed ill-founded and uncontrolled use of antibiotics leads to the development of immunoresistance, which contributes to the lack of effectiveness of conservative treatments. This article discusses the therapeutic option for patients with acute rhinosinusitis and exacerbation of chronic rhinosinusitis in the form of a silver proteinate drug in the complex treatment.Aim. To evaluate the effectiveness of the silver proteinate drug in the complex treatment of acute rhinosinusitis and exacerbation of chronic rhinosinusitis.Materials and methods. A total of 60 adult patients of both sexes aged 20 to 50 years were included in the study. The first study group (a treatment group) included 30 patients (15 with acute rhinosinusitis and 15 with exacerbation of chronic rhinosinusitis). The second group (a comparison group) also included 30 patients (15 with acute rhinosinusitis and 15 with exacerbation of chronic rhinosinusitis). The treatment group received the silver proteinate drug + decongestants + irrigation therapy + topical corticosteroid therapy as part of the complex treatment. The comparison group received standard therapy: irrigation therapy (solutions to rinse nasal cavities) + decongestants + topical corticosteroid drugs.Results. Comparative analysis of re-assessment scores for the patients’ status against the timing of use of the silver proteinate drug (Sialor®, tablets for solution for topical use, 200 mg) in the complex treatment showed pronounced improvement in the form of rapid relief of symptoms of the disease and recovery in patients with acute rhinosinusitis and exacerbation of chronic rhinosinusitis in both study groups.Conclusion. This brings us to the conclusion about the effectiveness and safety of the silver proteinate drug Sialor® in the complex treatment of patients with acute rhinosinusitis and exacerbation of chronic rhinosinusitis, which allows us to recommend it for widespread use in otorhinolaryngological practice.

Prospects for the use of Lipster Mint cream in the complex treatment of herpes zoster

Objective — to investigate the clinical efficacy of Lipster Mint cream in the complex treatment of patients with herpes zoster. &#x0D; Materials and methods. The study included 15 patients (11 women and 4 men) with acute herpes zoster. The age of the patients ranged from 38 to 70 years. The patients had severe clinical symptoms (typical vesicular rash, itching of varying intensity, burning sensation, intense pain along the affected nerves and sleep disturbance). The localization of pathological foci was unilateral: in 12 patients on the skin of the trunk, in 1 patient on the buttock and in 2 patients on the skin of the thigh. All patients reported a decrease in quality of life due to the disease. The complex treatment included Valavir, one of the valacyclovir drugs, according to the recommended regimens, which was administered orally in 1000 mg tablets three times a day for 7 days. Acute herpes-associated pain and heartburn were relieved with analgesics and topical application of Lipster Mint cream, manufactured by Farmak (Ukraine), which contains acyclovir 5 % and menthol. A distinctive advantage of Lipster Mint is that it contains the highest dose of acyclovir permitted for topical products — 5 %, as well as menthol which cools and reduces itching. The effectiveness of treatment of herpes zoster was assessed by the dynamics of clinical symptoms and subjective feelings on the 2nd, 5th and 10th days of treatment. &#x0D; Results and discussion. As a result of the treatment, positive dynamics of all clinical manifestations was achieved. Inflammatory phenomena such as swelling and hyperemia of the skin significantly decreased, the appearance of fresh herpes rash stopped within 24 hours, body temperature normalized on the 2—3rd day, general condition improved, pain and discomfort in the affected areas significantly decreased, partial epithelialization of erosions and the appearance of crusts were observed on the 5—7th day. With the topical application of Lipster Mint, under the influence of menthol, from the first minutes of application, patients significantly reduced the sensations of burning, tingling and pain in the areas of skin lesions. &#x0D; Conclusions. Despite the available arsenal of specific and non-specific antiherpetic drugs, treatment of patients suffering from herpes zoster continues to be an urgent medical problem that requires further improvement and individualized approach. Our clinical observations indicate the effectiveness of the systemic drug Valavir and the topical drug Lipster Mint cream in the complex treatment of herpes zoster, which makes it possible to reduce postherpetic neuralgia in the areas of skin lesions and improve the quality of life of patients.

DIFFERENTIATED HYPEROSMOLARY THERAPY IN CEREBRAL EDEMA IN PATIENTS WITH CRANIOCEREBRAL INJURY

to study the pathophysiological aspects of cerebral edema and compare the effectiveness of using 15% mannitol solution and hypertonic 3.5%, 7%, 10% sodium chloride solution in the complex treatment of patients with head injury. Material and methods:90 patients from 18 years old to 68 years old with various traumatic brain injuries and inhibition of consciousness level from 4 to 13 points on the Glasgow coma scale were examined. Results:infusion of mannitol at the indicated dosage reduced ICP after 30 minutes by 42, 3%, and after 120 minutes it remained below the initial data by 23.9%. Infusion of a 3.5% NaCl solution already by the 30th minute led to a decrease of ICP by 48.6%, and by the end of 120 minutes the ICP remained below the initial data by 35.9%. Infusion of a 7% NaCl solution already by the 30th minute led to a decrease in ICP by 55.4%, and by the end of 120 minutes the ICP remained below the initial data by 39.9%. Infusion of a 10% NaCl solution already by the 30th minute led to a decrease in ICP by 58.4%, and by the end of 120 minutes the ICP remained below the initial data by 45.9%. Conclusions:the decrease in ICP within 30 and 120 minutes after the introduction of hyperosmolar solutions is more pronounced with iv administration of 3.5%, 7%, 10% NaCl solution relative to 15% Mannitol in calculated dosages, which should be borne in mind in patients with concomitant cardiac and renal pathology.

Primary and secondary constipation: causes of occurrence, methods of correction

Constipation develops in up to 30% of the adult population of economically developed countries. The main reason for the occurrence of constipation are lifestyle features: inactivity and unbalanced nutrition. During constipation, motor, absorptive and secretory functions of the large intestine change. Treatment of patients with constipation begins after determining the cause of constipation and excluding lesions of the large intestine that could provoke constipation. Both soluble and insoluble dietary fibers should be increased in the diet. The main approach to treatment is the use of combined therapy, and if the effect is insufficient, laxatives administration is recommended.&#x0D; Objective — to evaluate the effectiveness and safety of using the multicomponent laxative EasyDo in the treatment of patients with functional constipation and irritable bowel syndrome (IBS) with constipation.&#x0D; Materials and methods. The study involved 28 patients with functional constipation/IBS with constipation, who met the Rome IV criteria (2016). Women prevailed in this group, 19 (68.0%). IBS with constipation was diagnosed in 15 (53.6%) cases, and functional constipation in 13 (46.4%) subjects. Patients were administered EasyDo (Prakruti Products Pvt Ltd, India), which includes a mixture of natural extracts of medicinal plants, namely: Operculina turpethum, Cassia fistula, Terminalia chebula, Glycyrrhiza glabra 2 tablets in the evening. Besides, recommendations were given to change the lifestyle, to add dietary fibers into the diet with individual selection of the dose. The dynamics of the following symptoms were evaluated: lack of regular bowel movement, difficulty in defecation, feeling of incomplete emptying, flatulence, etc. The intensity of each of these symptoms was assessed with the use of a 5‑point Likert scale.&#x0D; Results. The analysis of EasyDo effectiveness was carried out after three weeks of the drug administration. All patients noted positive changes, but the degree of positive dynamics was different. After the treatment, the number of bowel movements per week increased. Three or more stools without unproductive straining were recorded in 21 (75%) patients. The severity of complaints in most patients has significantly decreased.&#x0D; Conclusions. The obtained results demonstrated the following EasyDo effectiveness: considerable in 21 (75%) patients, moderate in 6 (21.4%) patients, no effects in one (3.6%) patient. The combination of plant components in EasyDo has a mild laxative effect, it is well tolerated and can be recommended in the complex treatment of patients with constipation.&#x0D;