Course Of Conservative Treatment Research Articles

Quality of life in patients with chronic slow-transit constipation according to the PAC-QOL questionnaire and the effectiveness of conservative therapy

Objective — to assess the quality of life (QOL) of patients with chronic slow‑transit constipation (CTC) according to the PAC‑QOL (Patient Assessment of Constipation Quality of Life) questionnaire, as well as the effectiveness of conservative therapy. Materials and methods. The study included 246 patients with chronic (more than 5 years) slow‑transit constipation (CSTC group) and 70 patients without CSTC (reference group). These individuals were examined and treated in the clinics of Bogomolets National Medical University from 2014 to 2023. The onset of chronic slow‑transit constipation often occurred at an average age of 22.2±0.8 years (from 1 year to 67 years) and lasted 20.2±0.7 years (from 5 to 53 years). The average duration of the delayed passage of stool was 9.4±0.3 days (from 3 to 22 days). All patients received an adjusted course of conservative treatment according to the Rome guidelines. The nosospecific PAC‑QOL questionnaire was used to evaluate the patients’ quality of life on their initial visit and 6—8 months after conservative therapy. Results. During the initial assessment, the CSTC group had a mean score of 3.03±0.56 on the «Physical Discomfort» subscale, while the reference group had a mean score of 1.19±0.29. On the «Psychosocial Discomfort» subscale, the CSTC group had a mean score of 2.21±0.52 compared to 0.84±0.18 in the reference group. The mean score for the «Worries and Concerns» subscale was 2.49±0.41 in the CSTC group and 0.77±0.24 in the reference group. The mean score for the «Satisfaction» subscale was 3.31±0.43 in the CSTC group and 0.86±0.28 in the reference group. The PAC‑QOL questionnaire total score was 2.63±0.26 in the CSTC group and 0.87±0.12 in the reference group (p <0.001 for all). After conservative treatment, the PAC‑QOL scores improved by an average of 40.4±20.0% (to 0.68—2.71 points). The cluster analysis revealed that after the course of conservative therapy, the PAC‑QOL questionnaire scores formed three distinct clusters: Cluster I — 0.68—1.39 points (49.2% of patients), Cluster II — 1.40—1.99 points (17.5% of patients), and Cluster III—2.0—2.8 points (33.3% of patients). These clusters represent good, satisfactory, and unsatisfactory results. Conclusions. The PAC‑QOL questionnaire revealed a statistically significant decline in QOL in patients with CSTC (2.63±0.26 points compared to 0.87±0.12 points in the reference group). Modern conservative treatment improved quality of life in 49.2% of cases. 17.5% of cases showed a satisfactory result, while the remaining ones exhibited insignificant or no improvement. Other treatment options, including surgery, should be considered for patients who do not respond to conservative therapy.

Dental gel Cholisal at the stage of conservative treatment of inflammatory periodontal diseases

To study the effectiveness of the drug Cholisal as part of the conservative treatment of chronic periodontitis. We selected 100 patients aged 35 to 65 years of both sexes with a diagnosis of moderate chronic periodontitis in the acute stage with a periodontal pocket depth of 3.5-5 mm. Depending on the tactics of conservative treatment of periodontitis, patients were divided into two groups of 50 people. In the main group, Cholisal dental gel was used as part of complex conservative treatment, and in the control group, Metrogil-denta gel was used. To assess the effectiveness of treatment, a dental examination of patients was carried out with an index assessment of the condition of periodontal tissues and a biochemical analysis of the content of arachidonic acid and prostaglandin E2 in gingival blood, comparing the indicators before treatment and 14 days after the start of treatment. When the drug Cholisal was included in complex treatment, 14 days from the start of treatment, patients experienced a statistically significant decrease in the depth of periodontal pockets from 4.7±0.32 mm to 3.6±0.19, and the Green-Vermillion hygiene index by 60.7%, Silness-Loe plaque index by 73.1%, PMA index by 68.8%, Muhlemann-Cowell bleeding index by 68.0% (p<0.001 compared to baseline). When Metrogil-denta gel was used in complex therapy, the effectiveness of treatment was lower: the depth of periodontal pockets did not change significantly (from 4.5±0.22 mm to 4.2±0.17 mm, p>0.05), reduction in the hygiene index Green-Vermillion was 51.9%, Silness-Loe plaque index - 64.0%, PMA index - 43.7%, Muhlemann-Cowell bleeding index - 45.8% (p<0.001 compared to baseline, p<0.001 compared to the main group). A laboratory study showed that in patients of the main group, after completing a course of conservative treatment, the content of biomarkers of inflammation significantly decreased compared to the initial level (p<0.05), while in patients of the control group the content of arachidonic acid and prostaglandin E2 in the gingival blood during the study period did not change significantly (p>0.05 compared to the initial level). The use of the drug Cholisal in the conservative treatment of chronic periodontitis has demonstrated more pronounced positive dynamics of clinical and biochemical parameters compared to traditional therapy, which suggests its high effectiveness.

Improved range of motion after manipulation under anesthesia versus physiotherapy for stage two frozen shoulder: a randomized controlled trial

BackgroundFrozen shoulder (FS) is a common cause of shoulder pain and stiffness. Conservative treatment is sufficient for the majority of patients with recovery of shoulder function at long term. Manipulation under anesthesia (MUA) is known as a well-established treatment option if conservative treatment fails. It is unknown whether MUA does indeed shorten the duration of symptoms or leads to a superior outcome compared to conservative treatment. The objective of the current trial is to evaluate the effectiveness of MUA followed by a physiotherapy program (PT) compared to a PT program alone in patients with stage two FS. MethodsA prospective, single center randomized controlled trial was performed. Patients between 18 and 70 years old with a stage two FS were deemed eligible if an initial course of conservative treatment, consisting of physiotherapy and an intra-articular corticosteroid infiltration was considered unsatisfactory. Patients were randomized and data was collected with an online data management platform (CASTOR). MUA was performed by a single surgeon under interscalene block and an intensive physiotherapy treatment protocol was started within 4 hours after MUA. In the PT group patients were referred to instructed physiotherapist, and treatment was guided by tissue irritability. The primary outcome was the SPADI score. Secondary outcomes were pain, range of motion, OSS, quality of life and ability to work. ResultsIn total, 82 patients were included, 42 in the PT group and 40 in the MUA group. There was a significant improvement in SPADI, OSS, pain, range of motion and quality of life in both groups at 1 year follow-up. SPADI scores at three months were significantly improved in favor of MUA. MUA showed a significant bigger increase in anteflexion and abduction compared to PT at all points of follow-up. No significant differences between both groups were found for all other parameters. No fractures, dislocations or brachial plexus injuries occurred in this trial. ConclusionMUA in stage 2 FS can be considered safe and results in a faster recovery of range of motion and improved functional outcome, measured with SPADI scores, compared to PT alone at short term. After 1 year, except for slightly better range of motion scores for MUA, the result of MUA is equal to PT.

Orbitoethmoidal foreign body through traumatic penetrating orbital injury

Foreign bodies in the nasal cavity, paranasal sinuses, and orbit are commonly related to high-velocity maxillofacial injuries. Cases of foreign bodies in paranasal sinuses are very rare. They may present with non-specific symptoms which make them easily neglected during history taking and clinical assessment. High clinical suspicion and radiological assessments are essential in patients with high-velocity insult to rule out the possibility of impalement injury. The course of management is determined by the location and type of foreign body. We share a rare case of metallic foreign bodies in the orbitoethmoidal region which took a combined surgical and conservative course of treatment involving a multidisciplinary team.

Evaluation of early functional outcome of arthroscopic decompression in chronic primary sub-acromial impingement syndrome

&lt;b&gt;Background:&lt;/b&gt; Sub-Acromial Impingement Syndrome (SAIS) spectrum ranges from acute inflammation to chronic degeneration of the bursa and of rotator cuff tendons in sub-acromial space. It may lead to a full-thickness tear of rotator cuff tendons and degenerative joint disease of the shoulder girdle leading to functional loss and disability if not treated early and adequately. This study aimed to determine the early functional outcome of arthroscopic sub-acromial decompression in chronic SAIS due to mechanical causes.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; This was a prospective cohort study. Patients were operated on arthroscopically for sub-acromial decompression between September 2018 and March 2020. Thirty-five patients with a range of 20 to 65 years of age diagnosed clinically with primary chronic sub-acromial impingement syndrome meeting the inclusion criteria were included in this study. All the patients under study were initially kept for at least four weeks of a course of conservative treatment and persisted in having symptoms were treated surgically with arthroscopic sub-acromial decompression. The UCLA (The University of California at Los Angeles) shoulder rating scale was used to assess shoulder function. The assessment was done in the pre-operative period, four weeks, 12 weeks, and 16 weeks post arthroscopic sub-acromial decompression surgery.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; Compared to pre-operative UCLA shoulder function score at the end of non-operative conservative treatment, the patients under study showed a statistically significant improvement at the end of the 16th week of post-arthroscopic subacromial decompression (p&amp;lt;0.0001).&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; This study concludes that arthroscopic sub-acromial decompression provides a good functional outcome in patients having primary shoulder impingement due to extrinsic mechanical causes such as shape and slope of the acromion in the absence of significant (total or near total) rotator cuff tear after 16 weeks of follow-up.

Proximal ROw carpectOmy versus four-corner Fusion (PROOF-trial) for osteoarthritis of the wrist: study protocol for multi-institutional double-blinded randomized controlled trial

BackgroundScapholunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) are common types of wrist osteoarthritis (OA). Non-operative treatment consists of pain medication, splinting, and avoiding activities that induce pain. However, in case a course of conservative treatment is unsuccessful, operative treatment is needed. The two most conventional operative approaches for SLAC/SNAC OA are four-corner arthrodesis (FCA) and proximal row carpectomy (PRC). Although FCA is the gold-standard operative technique and may lead to superior grip strength, the evident benefit of PRC is that it obviates any need for hardware removal and controlling for bony union. To date, no high-quality randomized controlled trial comparing FCA and PRC exists. As clinical outcomes seem comparable, a trial that assesses patient-reported outcomes, adverse events, and secondary operations may guide clinical decision making between these two procedures. Thus, the aim of this multi-institutional double-blind randomized controlled trial is to study whether PRC is non-inferior to FCA in treating SLAC/SNAC OA. We hypothesize that PRC is non-inferior to FCA with lower economic expanses.MethodsThe trial is designed as a randomized, controlled, patient- and outcome-assessor blinded multicenter, two-armed 1:1 non-inferiority trial. Patients with SLAC/SNAC-induced wrist pain meeting trial inclusion criteria will undergo wrist arthroscopy to further assess eligibility. Each patient eligible for the trial will be randomly assigned to undergo either FCA or PRC. The primary endpoint of this study is the Patient Rated Wrist Evaluation (PRWE) at 1-year after FCA versus PRC. Secondary outcomes include Quick-Disabilities of the Arm, Shoulder and Hand, EQ-5D-5L, pain, grip strength, wrist active range of motion, radiographic evaluation, and adverse events. Trial design, methods, and statistical analysis plan will be presented here.DiscussionWe present an RCT design comparing FCA vs PRC for SLAC/SNAC-induced OA. The results of this trial will assist in decision making when planning surgery for SLAC/SNAC.Trial registrationClinicalTrials.gov NCT04260165. Registered February 7, 2020.

Синдром сухого глаза на фоне дисфункции мейбомиевых желез у пациента рефракционного профиля (клинический случай)

Purpose. To describe a clinical case of a patient planning keratorefractive surgery, diagnosed with dry eye syndrome (DES) on the background of meibomian gland dysfunction (MGD). Material and methods. Patient S. applied to the Department of laser refractive surgery of S.N. Fyodorov Eye Microsurgery Federal State Institution. She was 27 years old with a diagnosis of moderate myopia in both eyes for possible keratorefractive surgery. She underwent a standard refractive diagnosis and consultation with an ophthalmic surgeon. Results.During biomicroscopy and standard ophthalmological examinations of the ocular surface, patient S. was found to have DES and MGD. It was decided to conduct a course of conservative treatment to restore the ocular surface. Conclusion. Thus, the proposed utility model for the treatment of MGD and the associated DES makes it possible to normalize the secretory work of these glands and, as a result, stabilize the condition of the tear film, which contributes to the safe planning of keratorefractive surgery. Keywords: dry eye syndrome, dysfunction of the meibomian glands, tear film, keratorefractive surgery

Histological features of articular cartilage and bone marrow reparative potential under conditions of coxarthritis in patients with radiographic signs of epiphyseal dysplasia

Coxarthritis in patients with radiographic signs of epiphyseal dysplasia causes disturbances of social adaptation of this patients group at a young age and ensure the relevance of studying the problem of optimizing the orthopaedic treatment of this patients category. Objective. To define the tactics of orthopaedic treatment in such patient category based on study of morphological features of articular cartilage and osteogenic activity of bone marrow stem stromal cells. Materials and Methods. We have clinically examined 68 adult patients having coxarthritis in the presence of radiological signs of epiphyseal dysplasia. In 52 cases we performed total hip and knee arthroplasty that allowed to obtain articular cartilage fragments for histological study and epiphysis bone fragments for study of reparative potential of the bone tissue. Results. In patients having coxarthritis that evolves on the ground of epiphyseal dysplasia by histological and cultural studies we have obtained the data as for deep microstructural disorders in joint cartilage matrix organization as a result of modification of collagen mesh in patients having epiphyseal dysplasia. We have identified the fact of significantly increased bone marrow stem cells proliferative potential at significantly decreased quantity of colony forming fibroblast units in spongious volume unit in epiphysis zone in this patients group which indicates a threat of decompensation of reparatory bone potential risk. Conclusions. Pathological factors of increasingly progressing course of osteoarthrosis in the presence of radiological signs of epiphyseal dysplasia are deep microstructural disorders of joint cartilage matrix organization as a result of modification of collagen mesh and consequent changes of epiphysis of the lower limbs form. There is no possibility of prevention and etiological therapy of coxarthritis evolving from epiphyseal dysplasia, meanwhile there is a threat of decompensation of reparatory bone tissue potential in epiphysis zone in this patient category. Therefore, in patients with coxarthritis and radiographic signs of epiphyseal dysplasia, resistant to the course of conservative treatment, it is advisable do not delay use the method of joint arthroplasty.

Combined endoscopic treatment of patient with «terrible triade»: decompression of brachial plexus in thoracic aperture and interscalene space and arthroscopic subacromial spacer implantation. Clinical case

BACKGROUND: Brachial plexus injury (plexopathy) is a fairly common problem in neurology, neurosurgery, traumatology and orthopedics. Compression of the brachial plexus usually develops in a narrow anatomical space: in the area of the small pectoral muscle, thoracic aperture, interspinous space. In several cases there is a combination of plexopathy and shoulder joint pathology. In a failure of conservative treatment, surgical intervention such as revision and decompression of the brachial plexus can be used. The development of endoscopic methods of decompression allows the minimization of soft tissue trauma, reduces the risk of complications, and accelerates and facilitates the recovery period.&#x0D; CLINICAL CASE DESCRIPTION: Our aim was to describe a clinical case and monitor the results of combined endoscopic intervention in a patient with the "terrible triad": endoscopic decompression of the brachial plexus in the thoracic aperture and interlumbar space and arthroscopy of the shoulder joint with subacromial spacer placement at 6 months after surgery. Patient M., aged 64 years, with the consequences of right shoulder joint trauma: dislocation of the humeral head, damage of the shoulder rotator cuff and development of posttraumatic plexopathy of the right brachial plexus. The patient underwent repeated courses of conservative treatment without any pronounced effect for 1 year after injury. To confirm the diagnosis, the patient underwent electroneuromyography and ultrasound examination of the brachial plexus on the right side and magnetic resonance imaging of the right shoulder joint. After the examination, the patient underwent combined endoscopic intervention: arthroscopy of the shoulder joint with subacromial spacer placement and endoscopic decompression of the brachial plexus in the thoracic aperture and interlumbar space. According to the visual analogue scale (VAS) the intensity of pain syndrome before surgery was 7 cm, 6 months after surgery the intensity of pain decreased to 1 cm according to VAS. According to the disabilities of the arm, shoulder and hand scale (DASH), the degree of upper extremity dysfunction before surgery was 48 points; 6 months after surgery, it decreased to 16 points. The British Medical Research Council scale (BMRC) rated the degree of motor impairment at 3 preoperatively and 0 postoperatively. The degree of sensory impairment according to the Seddon Nerve Damage Rating Scale was 2 preoperatively and 3+ postoperatively. Range of motion in the shoulder joint before surgery: flexion 110, abduction 95, external rotation 15. Six months after surgery: flexion 165, abduction 165, external rotation 45.&#x0D; CONCLUSION: The findings allow us to characterize the technique of one-stage arthroscopy of the shoulder joint and endoscopic decompression of the brachial plexus in the thoracic aperture and interlumbar space as low-traumatic and effective, creating conditions for restoration of the shoulder joint and upper extremity function as well as elimination of pain syndrome in the upper extremity.

Pectoralis Major Transfer for Medial Scapular Winging

Background: Scapular winging is a rare and often misdiagnosed disorder, which can be painful and functionally limited. Medial scapular winging is often due to serratus anterior dysfunction in the setting of a long thoracic nerve palsy. While nonoperative management can be successful, transfer of the pectoralis major with autograft hamstring augmentation to the inferior scapula is an effective operative means of relieving pain and restoring shoulder function in those who fail conservative management. Indications: The patient is a 16-year-old woman with symptomatic medial scapular winging who had a complete workup and 6-month course of conservative treatment, including physical therapy. Thus, we elected to proceed with a 2-incision transfer of the sternal head of pectoralis major transfer with autograft hamstring augmentation to the inferior scapular angle. Technique Description: A 2-incision transfer of the sternal head of pectoralis major with autograft hamstring to the inferior scapular angle is a strong and reliable method of operatively treating medial scapular winging. In addition, performing this operation in the lateral position allows for ease of access to both the anterior and posterior incisions. Results: At 1-year follow-up, the patient had full, painless range of motion of the shoulder with 5/5 strength in all tested planes. She also had returned to all activities, including softball, without restrictions. Discussion/Conclusions: A 2-incision transfer of the sternal head of the pectoralis major with autograft hamstring augmentation to the inferior scapular angle is an effective means of operatively treating medial scapular winging. Multiple studies have shown that this operation improves motion, pain, and function for those who have failed an appropriate course of conservative treatment. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Bone Marrow Stimulation and Biologics for Osteochondral Lesion of the Talus: A Systematic Review and Meta-Analysis of Clinical Comparative Studies

Category: Ankle; Ankle Arthritis; Basic Sciences/Biologics; Sports; Trauma Introduction/Purpose: Osteochondral lesion of the talus (OLT) is a commonly occurring injury, typically treated with bone marrow stimulation (BMS) in the small to medium-sized lesions after a failed course of conservative treatment. The current evidence suggests that biologics can improve chondrocyte growth and differentiation. However, the lack of consensus to date on the efficacy of biologics + BMS for OLT has warranted further investigation. The purpose of this study is to clarify the effectiveness and safety of biologics as an augmentation in BMS by assessing complication rates, continuous functional outcome scores and return to play data compared to BMS alone for OLT. Methods: A systematic review and meta-analysis were performed. The PubMed and Embase databases were searched using specific search terms and eligibility criteria according to the PRISMA guidelines. The level of evidence was assessed using published criteria by The Journal of Bone &amp; Joint Surgery and the quality of evidence using the Modified Coleman Methodology Score. Fixed- effects models were employed if heterogeneity was graded low (I2 &lt;25%), and random-effects models if heterogeneity was graded moderate to high (I2&gt;=25%). Results: For BMS versus BMS + hyaluronic acid (HA), the fixed-effects model for American Orthopaedic Foot and Ankle Society score revealed a mean difference increase that is an improvement of 4.88 (95% CI, 2.33 to 7.44; I2 = 0%; p = 0.0002) points, in favor of BMS + HA. The fixed-effects model for 10mm Visual Analog Scale pain revealed a mean difference decrease that is an improvement of 1.21 (95% CI, 0.70 to 1.73; I2 = 0%; p &lt; 0.00001) points, also in favor of BMS + HA. For BMS versus BMS + concentrated bone marrow aspirate (CBMA), the pooled complication rate was 17/64 (26.6%) versus 11/71 (15.5%), respectively, with a chi-squared test of p = 0.11. The pool revision rate was 15/64 (23.4%) versus 6/71 (8.5%), respectively, with a chi-squared test of p = 0.016. Conclusion: Adjuvant biologic use with BMS may provide superior outcomes, notably that of HA and CBMA, based on the current evidence. Future studies must aim to establish the clinical superiority of the various other biologics + BMS versus BMS alone. These studies must compare the various biologics against one another to determine, if any, the optimal biologic for OLT.

Метод лечения рецидивирующего герпетического кератита на основе послойной кератопластики с фемтосекундным сопровождением (серия клинических случаев)

Purpose. To evaluate the clinical efficacy of lamellar keratoplasty in the treatment of recurrent herpetic keratitis with femtosecond laser-assisted corneal surgery. Material and methods. In two clinical cases, lamellar keratoplasty with femtosecond laser-assisted corneal surgery was performed. Preoperative and postoperative visual acuity, refractometry, keratotopography, pachymetry were examined. Conducted courses of conservative treatment: antiviral, anti-inflammatory, desensitization therapy using vaccination «Vitogerpavak». Results. Evidence of the effectiveness of the proposed method was obtained - stabilization and relief of the inflammatory process, increased visual acuity and cosmetic effect. Conclusion. Cases of successful treatment of recurrent herpetic keratitis after intensive courses of conservative treatment followed by lamellar keratoplasty with femtosecond laser-assisted surgery are presented. The use of femtolaser technologies, which allow dosed excision of the affected tissue at a certain depth according to predetermined parameters, contributes to the achievement of high functional results. Lamellar keratoplasty with the maximum possible excision of scar tissue and its replacement with a donor cornea is a minimally invasive effective method to restore the transparency of the cornea after therapeutic treatment of recurrent herpetic keratitis. Key words: keratoplasty, herpetic keratitis, femtosecond laser

Intra-abdominal Bleeding due to Segmental Arterial Mediolysis and Coexisting Pulmonary Thromboembolism: a Case Report

Segmental arterial mediolysis (SAM) is a rare but important cause of abdominal haemorrhage and is usually treated with endovascular management. Surgical or conservative management can be performed depending on the patient’s situation. Since the course of conservative treatment is not well described in the existing literature, it must be used with caution. We describe the case of a 52-year-old man who was transferred to the emergency department because of abdominal pain, diarrhoea, and haematemesis. On arrival, he was haemodynamically unstable, with a blood pressure of 70/40 mmHg. After he was transfused and stabilised in the emergency department, contrast-enhanced computed tomography (CECT) revealed a haematoma around the transverse colon and ascites, without any evident extravasation. The peripheral branch of the middle colic artery (MCA) showed irregular calibre, suggesting SAM. Since the patient remained stable, we initially chose conservative management. However, a CECT scan performed on the third day of hospitalisation showed coexisting pulmonary thromboembolism (PTE). Because of the need for anticoagulation therapy, we performed open surgery. The pathological examination was consistent with SAM. Anticoagulation therapy was initiated the next day. A CECT scan performed on a postoperative day (POD) 13 showed no PTE. Although the patient defecated haemorrhagic stool and experienced hematemesis on PODs 19 and 23, respectively, colonoscopy, esophagogastroduodenoscopy, and repeated CECT scans revealed no evidence of rebleeding, and no recurrence was observed. Open surgery produced a relatively good postoperative course for the patient. Endovascular management, however, remains a reasonable first approach, considering its reportedly excellent outcomes.

Arthroscopic treatment of type I and II greater trochanteric pain syndrome

The goal of this study was to describe and evaluate endoscopic bursectomy combined with fascia lata lengthening in the treatment of type I and II greater trochanteric pain syndrome recalcitrant to conservative management. This was a retrospective study of 20 patients (7 type I, 13 type II) reviewed with a minimum follow-up of 2 years. The mean follow-up was 44±11 [26–65] months. While significant improvements in pain, mHHS and NAHS were found, 80% of patients still had hip pain graded at≥3 on VAS. The satisfaction rate was 7/10±2 [3–10]. Snapping in the hip had been eliminated in 100% of cases. No complications were observed. This is a minimally invasive surgery that is feasible in patients who have failed an optimal course of conservative treatment. But patients must be informed that pain might not be completely eliminated by this procedure. Level of evidenceIV; retrospective, case series.

AAOS Clinical Practice Guideline Summary: Management of Osteoarthritis of the Knee (Nonarthroplasty), Third Edition.

Management of Osteoarthritis of the Knee (nonarthroplasty) Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies for the nonarthroplasty treatment of osteoarthritis of the knee in adults (ages 17 years and older). The purpose of this clinical practice guideline is to evaluate current best evidence associated with treatment. The scope of this guideline contains nonpharmacologic and pharmacologic interventions for symptomatic osteoarthritis of the knee, including surgical procedures less invasive than knee arthroplasty. It does not provide recommendations for patients with rheumatoid arthritis, arthritis of other joints, or other imflammatory athropathies. This guideline contains 29 recommendations to assist all qualified and appropriately trained healthcare professionals involved in the nonarthroplasty management of osteoarthritis of the knee and provide information for patients. In addition, the work group highlighted the need for better research into intra-articular corticosteroid, hyaluronic acid, and platelet-rich plasma detailing osteoarthritis characterization, including subgroup analyses and osteoarthrosis severity stratification, and clinically relevant outcomes with control subjects for bias and cost-effectiveness analysis. Studies comparing outcomes in patients with mild-to-moderate knee osteoarthritis and an MRI confirmed meniscal tear who have undergone partial meniscectomy after failing to improve with a course of conservative treatment (nonsteroidal anti-inflammatory drugs, steroid injection, and physical therapy) versus those who have undergone partial meniscectomy without a dedicated course of conservative treatment. Prospective randomized trials or prospective cohort studies are still needed to establish efficacy of individual oral nonsteroidal anti-inflammatory drugs within specific subgroups and populations to tailor systemic medications to help increase efficacy and decrease the risk of adverse effects.

Анализ диагностики и лечения хронического гиперпластического ларингита в Республике Беларусь на примере пациентов Добрушского района Гомельской области

Objective. To analyze the current state of diagnosis and treatment of patients with chronic hyperplastic laryngitis (CHL) for the period 2010–2021 in the Republic of Belarus on the example of patients in the Dobrush District of the Gomel Region and to identify shortcomings for the subsequent development of measures to prevent malignant diseases of the larynx. Material and research methods. The material for the study was patients of the Dobrush District of the Gomel Region (61 patients: 39 (64%) men and 22 (36%) women) with a diagnosis of chronic hyperplastic laryngitis who are registered with an otorhinolaryngologist. The median age at diagnosis was 45.6 years (18 to 76 years). In the age distribution, 2 peaks were observed: from 36 to 40 years and from 51 to 55 years – 16% (10 out of 61) of the entire group, 87% of patients were of working age. Results and discussion. Patients with precancerous diseases of the larynx, who are on regular medical check-up in the Dobrush Central District Hospital, were analyzed. Age-specific incidence rates were analyzed and differentiated by gender and place of residence. The analysis of symptoms, the time spent by patients on regular medical check-up, the frequency of visits to the otorhinolaryngologist in the order of regular medical check-up was carried out. All patients had voice changes of various nature and severity: 50 (82%) patients complained of hoarseness, 6 (10%), of hoarseness, 5 (8%) had aphonia. More than half of the patients had the following complaints: feeling of a coma or a foreign body in the throat – 90%, the presence of a cough not associated with colds – 75%, and shortness of breath on exertion – 70% of patients. The median time spent by patients on regular medical check-up was 5 years (from 0 for patients registered in 2021 to 30 years). The frequency of visiting an otorhinolaryngologist in the order of regular medical check-up was from 1 time in 2–4 months (10% of patients) up to 1 time in 5 years (3%), 44% – 1 time per year, 27 (44%) patients received outpatient treatment, 5 (8%) patients received inpatient treatment, and 29 (48%) patients received both outpatient and inpatient treatment. During inpatient treatment, 16 (47%) hospitalized patients underwent surgical treatment to remove hyperplastic areas of the mucosa, the rest received antibiotic therapy, 15 (44%) patients underwent a biopsy. Conclusion. The study revealed a number of problems in the diagnosis and treatment of CHL, the main of which is the establishment of a generalized clinical diagnosis without performing a biopsy and clarifying the form of CHL and, as a result, conducting numerous ineffective courses of conservative treatment, both on an outpatient basis and in a hospital setting. It is necessary to develop a system of measures to improve the effectiveness of treatment of patients with CHL and the prevention of malignant neoplasms of the larynx.

Results of the application of complex physiotherapeutic neurostimulation in optical neuropathies of various genesis

To evaluate the effectiveness of complex physiotherapeutic neuro-ophthalmostimulation in case of ON of vascular origin. The study included 60 patients (120 eyes) with a verified diagnosis of optic neuropathy of vascular origin, who were divided into 2 groups comparable in age, gender and anatomical and functional characteristics: the main group of 30 patients (60 eyes) and the control group - 30 patients (60 eyes), including 24 men and 36 women, mean age was 66.2±4.1 years, disease duration was 4.1±1.7 years. All patients underwent courses of conservative treatment with vitamins according to the available ophthalmological standards, repeating them 1-2 times a year, the last of which was six months before the present study. Physiotherapy courses and patients did not pass. 20 healthy volunteers were taken to create basic indicators of the «norm» of the applied research methods. Patients of the main group used a set of procedures: transcranial magnetic electrical stimulation, endonasal electrophoresis with the drug neuroprotector Semax 0.1%, oxybaric chamber and acupuncture. Patients in the control group were prescribed basic therapy, including taking the vitamin complex BEROCCA for 3 months. Breakpoints: before treatment and at times: 1st week, 12 weeks and 24 weeks after the course of treatment, according to the standard recommendations for international multicenter studies. The following were assessed: visual field boundaries (dilation meridians; in deg.), light sensitivity (MS, MD; in dB), indicators of the state of the retinal ganglion layer (GCS thickness, volume loss): Avg CCG (in µm), FLV, GLV (in %). When evaluating the results in patients of the main group who received complex neurostimulation, the therapeutic efficacy in a week after the end of treatment was 94%, in 12 weeks - in 88% and in 24 weeks - 83%, while in patients of the control group for all studied indicators showed only a positive trend and therapeutic efficacy did not exceed 30-42%. Under the influence of the developed neurostimulating complex, the activity of nerve cells objectively increases, leading to a significant increase in the boundaries of the field of view and light sensitivity and a decrease in global losses of the retinal ganglion complex and optic nerve.

Ultrasound regional lymphotropic therapy for protracted forms of serous otitis media

To improve the method of conservative treatment of patients with protracted forms of SOM by clinically substantiating and developing a method of ultrasound regional lymphotropic therapy. The study included 75 patients (102 cases of diseased ears) with SOM. Previously, they repeatedly underwent outpatient courses of conservative treatment for 1 to 3 months, but all had symptoms of the disease. In the department of otorhinolaryngology, each of the patients with protracted forms of SOM was given a course of ultrasound regional lymphotropic therapy. The criteria of the treatment results were subjective and objective data of a special examination, which included: the presence of relevant complaints, otoscopy, determination of the levels of perception of live speech, indicators of air and bone sound conduction, tonal threshold audiometry, tympanometry characterizing the dynamics of hearing, the airiness of the tympanic cavity, the functioning of the auditory tubes. The examination was performed before and after treatment. Confirmation of the effectiveness of ultrasound regional lymphotropic therapy in protracted forms of SOM was the restoration in 52% of patients of whispering and in 68% of patients of colloquial speech to socially adequate values; a decrease in the level of sound perception thresholds at all frequencies by air conduction; an increase in tonal hearing; a complete restoration of the airiness of the tympanic cavity in 57% of patients (type A tympanogram). A new method of treating patients with protracted forms of SOM has been developed and clinically justified by the combined use of low-frequency ultrasound and medications with lymphotropic effect.

Missing the Bull’s Eye: A Case Report of Tibialis Anterior Hernia

Objectives: Shin pain is a broad term used to describe lower leg pain. It is commonly seen in the athletic/sports population. Various conditions have been claimed to produce leg pain, and muscle herniation is one of these conditions. Muscle herniation is the protrusion of muscle through a defect in the overlying fascia. Although such herniation is common, it is often an underdiagnosed condition in the lower extremity. It usually occurs in athletes, especially in the anterior compartment of the leg, as a result of trauma or due to muscle hypertrophy secondary to strenuous exercise. Herniation diagnosis depends on its clinical presentation as it appears as a palpable soft tissue bulge through a fascia defect; radiological findings are used to confirm the diagnosis. Conservative treatment should be the initial approach, and surgery can be performed if conservative treatment fails. Methods: We present a case of symptomatic anterior lower leg pain, initially diagnosed as a psychosomatic disorder by two orthopedic physicians. However, tibialis anterior hernia in this patient was confirmed after physical examination by a physiotherapist and subsequent referral for ultrasonographic evaluation to a radiologist. The patient underwent an 8-week course of conservative treatment under the supervision of a physiotherapist. This treatment significantly improved the patient’s pain and function. Results: After eight weeks of conservative treatment using Minhaj protocol for Tibialis Anterior hernia, the patient has reported improvement in pain (reduction of score from eight to two on the NPRS scale) and function. The patient returned to his previous level of physical activity following eight weeks of rehabilitation. Discussion: Tibialis anterior hernia should be considered a differential diagnosis in chronic leg pain with palpable soft tissue protrusion. Conservative treatment can be chosen as the primary approach.

Central Retinal Artery Occlusion as a Complication in Invasive Aesthetic Cosmetology: a Clinical Case

Central retinal artery occlusion (CRAO) is a relatively rare form of acute retinal arterial ischemia that results in unilateral vision loss. The incidence of transient vision loss is estimated at approximately 14 cases per 100,000 people per year, while the incidence of CRAO is approximately 1–2 cases per 100,000 people. In the foreign literature, there are more and more publications about the development of iatrogenic vision loss after dermal cosmetic injections. We would like to present a clinical case that should be interesting for both practicing ophthalmologists and specialists of related specialties, especially for cosmetologists. Patient M., 42 years old, came to us with complaints of a sharp loss of vision to light perception in the right eye. From the anamnesis, it is known that two hours earlier, the patient was injected into the temporal region (plasma, anesthetic, epinephrine) in the cosmetology office. Lightning-fast deterioration of vision occurred at the time of the drug administration. The patient arrived at the clinic 2 hours after the onset of complaints. We conducted an ophthalmological examination of the patient, the diagnosis was made: occlusion of the central artery of the retina of the right eye, and immediately performed standard emergency therapy. After a course of conservative treatment in an ophthalmological hospital, a persistent decrease in visual functions and a violation of arterial blood circulation in the central retinal artery basin remained. The progressive increase in the number of minimally invasive cosmetic procedures in recent years, in particular, injections of dermal fillers, is associated with rare, but often fatal complications. This clinical situation should attract the attention of practicing ophthalmologists and cosmetologists to these types of complications, and improve the quality and speed of emergency medical care.