Effectiveness Of Various Treatment Regimens Research Articles

The influence of therapeutic physical factors on the dynamics of the clinical condition and quality of life of patients with peri-implantitis

BACKGROUND: The use of dental implants, being the gold standard in the dental rehabilitation of edentulous patients, is often accompanied by the development of inflammatory complications leading to loss of the implant. Common methods in dental practice for the prevention and treatment of peri-implantitis based on local antiseptic and antibacterial drugs and periodic measures of professional oral hygiene are limited and do not contribute to solving the existing problem.
 AIM: Assessment of the clinical effectiveness and dynamics of the quality of life of patients with peri-implantitis during complex therapy using mesodiencephalic modulation, ozone therapy and their combination.
 MATERIALS AND METHODS: the study was carried out with the participation of 116 patients with peri-implantitis of classes I and II according to S.A. Jovanovic. All patients were divided into 4 groups using simple fixed randomization. The first group (control; n=28) received standard dental therapy, including professional oral hygiene and local use of antiseptics. In the second group (comparison group 1; n=29), in addition to standard therapy, a course of ozone therapy was performed, for which the peri-implant area was irrigated with ozonated saline solution with an ozone concentration of 2.5–5.5 μg/ml for 15 minutes. In the third group (comparison group 2; n=30), standard treatment was supplemented with a course of MDM therapy. Patients of the fourth group (main group; n=29), along with standard treatment, received complex treatment, including a course of ozone therapy and MDM therapy. The results were assessed after the end of therapy based on the dynamics of dental indices, the osseointegration parameter of the implant and the level of quality of life of the patients.
 RESULTS: A course of use of various treatment regimens was accompanied by a significant improvement in the clinical and dental status of patients, but the severity of the effect was different in the groups. To a lesser extent, positive changes were identified in the control group. Additional course use of therapeutic physical factors (ozone and MDM therapy) was accompanied by a significant increase in regression of complaints and improvement in objective indicators of dental status. Achieving the maximum positive result was clearly evident in the main group with the complex use of the studied physiotherapeutic factors. The use of the correlation adaptometry method to assess the clinical effectiveness of various treatment regimens for peri-implantitis made it possible to establish that under the influence of the integrated use of ozone and MDM therapy, the most pronounced decrease in mutual correlations between the studied parameters is observed. This indicates an increase in functional reserves and adaptive capabilities of patients in the main group.
 CONCLUSION: the results obtained convincingly prove the high effectiveness of the complex use of therapeutic physical factors in the implementation of a therapeutic strategy aimed at eliminating inflammatory manifestations in the area of dental implants and improving the quality of life of patients.

Evaluating antibiotic regimens for streptococcal toxic shock syndrome in children.

Streptococcal toxic shock syndrome (STSS) is a severe consequence of infections from Streptococcus pyogenes. The early identification and timely intervention with appropriate anti-infective agents are pivotal for managing pediatric STSS. This study evaluates the effectiveness of various treatment regimens for STSS in children. Clinical data of children with STSS resulting from β-hemolytic streptococcal infections in two hospitals were retrospectively analyzed from January 2009 to April 2023. Additionally, literature from the China National Knowledge Infrastructure on pediatric STSS was examined. Antimicrobial treatments were categorized into four groups based on their compositions, with an additional categorization for adjunct therapeutic drugs. Of 32 confirmed STSS cases, all displayed sensitivity to ampicillin, β-lactam antibiotics, and vancomycin, but resistance to clindamycin, erythromycin, and tetracycline. From the literature, 23 studies with 50 cases were extracted, leading to a total of 82 patients for evaluation. The efficacy rates varied significantly among the four treatment groups. Notably, the standard penicillin-containing group exhibited the highest efficacy (86.4%), while the group with macrolides/unused antibiotics registered a 0% efficacy rate. The other two groups demonstrated efficacy rates of 32.1% and 42.3%. For pediatric STSS, Streptococcus pyogenes shows notable sensitivity to ampicillin. Implementing timely β-lactam antibiotics, specifically penicillin, in conjunction with clindamycin and intravenous immunoglobulins enhances the treatment success rate.

Glucose metabolism, gut-brain hormones, and acromegaly treatment: an explorative single centre descriptive analysis.

Active acromegaly is associated with impaired glucose metabolism, which improves upon treatment. Treatment options include surgery, medical therapy with somatostatin analogues (SSA) and Pegvisomant (PEG), and irradiation. The objective of the study was to describe the differential effect of various treatment regimens on the secretion of glucose, insulin, glucagon, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) in patients with acromegaly. 23 surgically treated, non-diabetic patients with acromegaly and 12 healthy controls underwent an oral glucose tolerance test (OGTT) and subsequently isoglycaemic intravenous glucose infusion on a separate day. Baseline hormone concentrations, time-to-peak and area under the curve (AUC) on the OGTT-day and incretin effect were compared according to treatment regimens. The patients treated with SSA (N = 15) had impaired GIP-response (AUC, P = 0.001), and numerical impairment of all other hormone responses (P > 0.3). Patients co-treated with PEG (SSA + PEG, N = 4) had increased secretion of insulin and glucagon compared to patients only treated with SSA (SSA ÷ PEG, N = 11) (insulinAUC mean ± SEM, SSA + PEG 49 ± 8.3nmol/l*min vs SSA ÷ PEG 25 ± 3.4, P = 0.007; glucagonAUC, SSA + PEG 823 ± 194pmol/l*min vs SSA ÷ PEG 332 ± 69, P = 0.009). GIP secretion remained significantly impaired, whereas GLP-1 secretion was numerically increased with PEG (SSA + PEG 3088 ± 366pmol/l*min vs SSA ÷ PEG 2401 ± 239, P = 0.3). No difference was found in patients treated with/without radiotherapy nor substituted or not with hydrocortisone. SSA impaired the insulin, glucagon, and incretin hormone secretions. Co-treatment with PEG seemed to counteract the somatostatinergic inhibition of the glucagon and insulin response to OGTT. We speculate that PEG may exert its action through GH-receptors on pancreatic δ-cells. Clinical trial registration NCT02005978.

Profile: Maternal and Child Health Surveillance System in peri-urban areas of Karachi, Pakistan

A Maternal and Child Health Surveillance System (MCHSS) was set up by the department of pediatrics and child health, Aga Khan University, Pakistan in peri-urban areas of Karachi to provide a platform for various research projects. It was established in five low-socioeconomic communities in a stepwise manner between 2003 and 2014. The total area currently under surveillance is 18.6 km2 covering a population of 302,944. We maintain a record of all births, deaths, pregnancies, and migration events by two monthly household visits. Verbal autopsies for stillbirths, deaths of children under the age of five years and adult female deaths are also conducted. For over a decade, the MCHSS has been a platform for a variety of studies describing the burden of various infectious diseases like typhoid, pneumonia and diarrhea, evaluation of effectiveness of various treatment regimens for neonatal sepsis, assessment of the acceptance of hospitalized care, determination of the etiology of moderate to severe diarrhea, assessment of burden and etiology of neonatal sepsis and a multi-center cohort study measuring the burden of stillbirths, neonatal and maternal deaths. More recently we have also established a bio-repository of the well-characterized maternal and newborn cohort. Through a well-established MCHSS, we aim to provide concrete evidence base to guide policy makers to make informed decisions at local, national, and international levels.

Cryoglobulinemic vasculitis associated with HCV infection: still a problem?

The review presents the main data on the problem of cryoglobulinemic vasculitis associated with HCV infection. The options for the course are considered, and modern diagnostic criteria, the choice of tactics, and the effectiveness of various treatment regimens are presented. The use of modern antiviral drugs makes it possible to achieve the eradication of the virus in 95 % of patients. However, in some patients, clinical and immunologic markers of vasculitis persist despite viral clearance. The article discusses the concept that the persistence of B-cell clones after achieving a sustained virological response may underlie the pathogenesis of HCV-independent CV reactivation.

The effectiveness of treatment for dirofilariasis in dogs

Livestock industry – dog breeding is of great importance in human activities. Infectious and invasive diseases are a deterrent to the breeding and improvement of dog breeds. Not only do they cause significant economic damage to dog breeding, but they can also be dangerous to humans. Such diseases include dirofilariasis – an invasive disease that is transmitted through intermediate hosts – blood-sucking mosquitoes. The urgency of dirofilariasis is also due to the difficulties of therapy, because effective drugs of imported production are not available due to high cost, and the arsenal of domestic counterparts is small. The aim of the study was to establish the effectiveness of various treatment regimens for dog dirofilariasis. For this purpose, dogs infected with Dirofilaria immitis used specific drugs immiticide (AS – melarsomin), stronghold (AS – selamectin), doxycyl (AS – doxycyclini hydrochloridum), advocate (AS – imidacloprid, moxidectin). The main indicators of the effect of drugs were extensefficiency and intensefficiency. Studies have shown that with the intensity of microdirofilariasic invasion below 20 larvae in 1 cm3 of dog blood and in the absence of clinical manifestations of the disease extensefficiency and intensefficiency of concomitant use of immiticide and stronghold, doxycyl and stronghold, immiticide and advocate, doxycyl and advocate on the 15th day of the experiment was 100.0 %, 100.0 %, 100.0 %, 83.33 and 86.81 % respectively. With the intensity of microdirofilariasic invasion from 20 to 40 larvae in 1 cm3 of dog blood, the extensefficiency and intensefficiency of the proposed treatment regimens were respectively 100.0 %, 83.33 and 88.46 %, 66.66 and 82.54 %, 66.66 and 80.20 %. On the 180th day of treatment and during the year in all experimental groups of dogs, regardless of the intensity of the invasion of microdirofilariae in the blood of animals were not detected. Immunochromatographic rapid test, starting from 30 days of the experiment, was negative for adult females of D. immitis. The results of the research allow us to recommend the proposed treatment regimens in the effective control of dog dirofilariasis caused by D. immitis.

Tumor-Associated Macrophages in Gliomas—Basic Insights and Treatment Opportunities

Simple SummaryMacrophages are a specialized immune cell type found in both invertebrates and vertebrates. Versatile in functionality, macrophages carry out important tasks such as cleaning cellular debris in healthy tissues and mounting immune responses during infection. In many cancer types, macrophages make up a significant portion of tumor tissue, and these are aptly called tumor-associated macrophages. In gliomas, a group of primary brain tumors, these macrophages are found in very high frequency. Tumor-associated macrophages can promote glioma development and influence the outcome of various therapeutic regimens. At the same time, these cells provide various potential points of intervention for therapeutic approaches in glioma patients. The significance of tumor-associated macrophages in the glioma microenvironment and potential therapeutic targets are the focus of this review.Glioma refers to a group of primary brain tumors which includes glioblastoma (GBM), astrocytoma and oligodendroglioma as major entities. Among these, GBM is the most frequent and most malignant one. The highly infiltrative nature of gliomas, and their intrinsic intra- and intertumoral heterogeneity, pose challenges towards developing effective treatments. The glioma microenvironment, in addition, is also thought to play a critical role during tumor development and treatment course. Unlike most other solid tumors, the glioma microenvironment is dominated by macrophages and microglia—collectively known as tumor-associated macrophages (TAMs). TAMs, like their homeostatic counterparts, are plastic in nature and can polarize to either pro-inflammatory or immunosuppressive states. Many lines of evidence suggest that immunosuppressive TAMs dominate the glioma microenvironment, which fosters tumor development, contributes to tumor aggressiveness and recurrence and, very importantly, impedes the therapeutic effect of various treatment regimens. However, through the development of new therapeutic strategies, TAMs can potentially be shifted towards a proinflammatory state which is of great therapeutic interest. In this review, we will discuss various aspects of TAMs in the context of glioma. The focus will be on the basic biology of TAMs in the central nervous system (CNS), potential biomarkers, critical evaluation of model systems for studying TAMs and finally, special attention will be given to the potential targeted therapeutic options that involve the TAM compartment in gliomas.

COVID-19 in patients with chronic lymphocytic leukemia: a Moscow observational study

We describe a retrospective cohort, 156 patients with chronic lymphocytic leukemia (CLL) diagnosed with COVID-19, analyze factors associated with a severe disease course and the effects of various treatment regimens. Anti-SARS-CoV-2 IgG and IgM levels are significantly lower. Patients with CLL are more likely to have a severe course of COVID-19, with IL-6 levels acting as a consistent biomarker of disease severity. Ten patients had recurrent episodes, fatality rate of 20%. Overall survival did not differ between patients receiving ibrutinib monotherapy and anti-CD20 antibodies ± chemotherapy. It seems that the immunodeficiency inherent to CLL influences outcomes to a larger degree than does the treatment. Glucocorticoids are not associated with significant OS improvement whereas anti-cytokine compounds usage seemed to be beneficial in patients with mild pulmonary involvement. Our data attest to the necessity of reorganizing health care for patients with CLL. Early administration of effective antiviral compounds and tailored vaccination protocols are warranted.

Treatment of Ewingʼs sarcoma in children and adolescents: new vision

Introduction. Over the past decades, a significantly greater understanding of the morphology and molecular biological characteristics of tumors of the Ewing sarcoma family (ESFT) has been achieved. More than 70 % of relapses occur within 2 years from the date of diagnosis. In about 2/3 of cases, relapse occurs in distant places; this type of relapse is especially common in patients who initially have metastases. On the contrary, isolated local metastasis most often (in 1/5 of cases) occurs in patients with a localized form of the disease. In half of the patients, a relapse of the disease was detected during a routine examination, was asymptomatic and was a chance find.Purpose of the study – to evaluate the effectiveness of anti-relapse treatment in patients with ESFT, to develop an algorithm for a personalized approach, to improve the results of overall and relapse-free survival in children and adolescents with ESFT.Materials and methods. Our study included patients with a confirmed diagnosis of Ewing sarcoma (ES), who received treatment from 2008 to 2019. The analysis of follow-up data was closed on 19.02.2021. The study included 274 patients aged 6 months to 18 years, the average age was 11.6 years. Up to 1 year in our study there were 2 children. Twelve (4.3 %) patients went out of follow-up within 2 to 9 months from the start of treatment; we did not include them in the subsequent analysis. Analyzed were 262 patients with ES who received treatment according to the protocols at the Research Institute of Pediatric Oncology and Hematology of the N.N. Blokhin National Medical Research Center of Oncology. A relapse of the disease was revealed in 48 (18.3 %) children out of 262 – the study group; 58 (22.1 %) patients showed disease progression during treatment. In 70.8 % (34/48) patients had an isolated relapse, in 14 (29.2 %) cases – a combined one. The defeat of only the lung tissue with a relapse of the disease occurred in 19/48 (39.6 %) cases, local relapse without metastasis – 7/48 (14.5 %) cases. In general metastatic lung disease occurred in 66.6 % of cases. The defeat of the brain and lymph nodes occurred in 4 %. Most of the patients were in the group from 11 to 17 years, inclusive – 38/48 patients, which amounted to 79 %. All 48 patients from the study group received anti-relapse therapy depending on the duration of the disease relapse. For late relapses the primary treatment regimen was used: alternating courses of chemotherapy with vincristine/doxorubicin/cyclophosphamide and etoposide/ifosfamide. In early relapses two regimens were most used: vincristine/topotecan/cyclophosphamide and vincristine/irinotecan/temozolomide (VIT). The positive response rate with the antirelapse VIT regimen was 60 %, and the time to progression was 7.6 months. With the topotecan regimen the response rate was 45 % and the time to progression – 7 months.Results. The overall survival (OS) rate of patients when a relapse was detected was significantly (p £ 0.05) higher when compared with the group of patients who had progression of the disease, which is associated with the effect of anti-relapse chemotherapy. When analyzing OS of patients with ES it should be noted that the 5-year survival rate of all patients (n = 262) was 66.3 ± 3.3 %, compared with the group of patients with confirmed relapse (n = 48) – 53 ± 8.1 %. The median in the group of patients with relapse was 39.3 months. The follow-up time in the group with recurrent ES disease averaged 52.2 ± 32.3 months (from 12.6 to 142 months). OS of patients was analyzed depending on the interval of disease recurrence. The Interval No. 1 was from the beginning of the main treatment to the first relapse, with a median of 37.2 months. Interval No. 2 – from the date of the first relapse to the date of the second relapse with a follow-up time of 58.8 ± 29.1 months (from 28.6 to 108 months), the median was not reached. The second relapse occurred significantly less frequently than the first relapse (p = 0.000001).Conclusion. The outcome for patients with recurrent ES remains poor, and a standard approach to their treatment has not yet been established. Standard first and second lines chemotherapy can be effective in most patients in terms of reducing symptoms and increasing the time to further progression, but complete remission remains hard to reach. Further multidisciplinary study of prognostic factors, effects of various treatment regimens and protocols, study of the inclusion of targeted drugs in the therapy program is required.

National systemic lupus erythematosus prospective cohort in Saudi Arabia: A study protocol.

Systemic Lupus erythematosus (SLE) is a chronic multisystem, multifactorial inflammatory autoimmune disease. The SLE patients have 3 times increased risk of mortality based on international data with ethnicity playing an important impact on patients’ morbidity and mortality. Descriptive studies from Saudi Arabia showed variation in clinical features from one region to another. Moreover, reliable inference from these studies is limited by study methodology and lack of translational data using biological samples to understand clinical phenotypes of Saudi SLE patients.The aim of this report is to describe the prospective study protocol of the National Systemic Lupus Erythematosus Cohort in Saudi Arabia. The purpose of this cohort study is multifold: first, to examine clinical characteristics and molecular phenotypes of Saudi SLE patients in relation to local environment and practices/lifestyles; second, to assess long-term outcomes of SLE in Saudi population and factors that influence favorable outcomes; third, to compare the effectiveness of various treatment regimens in Saudi SLE population.This study is a longitudinal prospective cohort study of adult, Saudi SLE patients using open cohort study design. Primary outcomes include disease-related outcomes (activity, improvement, and organ damage) and patient-reported outcomes (quality of life). Secondary outcomes include physiological and molecular modifications associated with changes in disease activity states.Results and analysis are in on-going study.This study provides a source of reliable data for clinical and translational research. This will allow us to have a holistic approach to SLE pathogenesis especially in Saudi population and may take us a step further toward much more personalized medicine.This protocol has been registered in NIH ClinicalTrial.gov (ClinicalTrial.gov identifier: NCT04604990) on October 27, 2020.

Modulating the Heat Stress Response to Improve Hyperthermia-Based Anticancer Treatments.

Simple SummaryHyperthermia is a method to expose a tumor to elevated temperatures. Heating of the tumor promotes the effects of various treatment regimens that are based on chemo and radiotherapy. Several aspects, however, limit the efficacy of hyperthermia-based treatments. This review provides an overview of the effects and limitations of hyperthermia and discusses how current drawbacks of the therapy can potentially be counteracted by inhibiting the heat stress response—a mechanism that cells activate to defend themselves against hyperthermia.Cancer treatments based on mild hyperthermia (39–43 °C, HT) are applied to a widening range of cancer types, but several factors limit their efficacy and slow down more widespread adoption. These factors include difficulties in adequate heat delivery, a short therapeutic window and the acquisition of thermotolerance by cancer cells. Here, we explore the biological effects of HT, the cellular responses to these effects and their clinically-relevant consequences. We then identify the heat stress response—the cellular defense mechanism that detects and counteracts the effects of heat—as one of the major forces limiting the efficacy of HT-based therapies and propose targeting this mechanism as a potentially universal strategy for improving their efficacy.

Comparative efficacy of various treatment regimens for children 2-5 years old with symptoms of acute viral rhinosinusitis

In an open, randomized prospective comparative clinical study in parallel groups of patients with a diagnosis of acute respiratory infection, acute rhinosinusitis, 107 children aged 4-5 years took part. The purpose of this study was to compare the effectiveness of various treatment regimens for acute viral rhinosinusitis in children. We compared the treatment effectiveness of acute viral rhinosinusitis using the herbal medicine Sinupret in the form of oral drops, standard treatment and standard treatment supplemented with topical antibacterial drugs. The objectivity of treatment effectiveness evaluation was based on the complaints' dynamics, the changes' presence in the mucous membrane of the nasal cavity within 10 days: at the initial visit, after 3 days, on the 7th and 10th days after the initial examination. A follow-up visit was also scheduled for the 14th day. The analysis of the obtained data revealed that the Sinupret usage in the complex treatment of children with viral etiology acute rhinosinusitis contributes to a more pronounced positive symptoms' dynamics compared to children who did not receive Sinupret. Sinupret eliminates mucostasis, which contributes to a faster restoration of the drainage and ventilation function of the auditory tube, restores mucociliary clearance, improves the condition and well-being of children, improves the effectiveness of therapy and shortens the treatment time.

ПРИМЕНЕНИЕ МАРКЕРОВ ХРЯЩЕВОГО РЕМОДЕЛИРОВАНИЯ ДЛЯ ОПРЕДЕЛЕНИЯ УРОВНЯ ДЕГРАДАЦИИ ГИАЛИНОВОГО ХРЯЩА И ОЦЕНКИ ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ ПАЦИЕНТОВ С 0-1 РЕНТГЕНОЛОГИЧЕСКИМИ СТАДИЯМИ ГОНАРТРОЗА

The article presents the results of determining the levels of markers of cartilage remodeling of type II collagen (CTX II) in urine and oligomeric matrix protein of cartilage (COMP) in blood plasma in patients of the main group with 0-1 radiological stages of osteoarthritis of the knee joint and the control group, which are compared with clinical data, results of MRI and ultrasound studies. The authors evaluated the effectiveness of various treatment regimens for osteoarthritis in groups with different levels of cartilage metabolism. In patients with a high level of cartilage tissue degradation, monotherapy was accompanied by a statistically significant increase in "MRT-WORMS, sum", while in patients on combination therapy, stabilization of the process (assessed by "MRT-WORMS, sum") was noted.

Effectiveness of various treatment regimens for calves with dyspepsia in Novgorod region

The situation with dyspepsia of young animals in the postnatal period in agroindustrial companies of Russia remains tense due to a high mortality rate. Specialists are not always able to cover a wide range of drugs currently available on the market, although the success in combating the disease depends on a timely introduction of highly effective drugs and various combinations of treatment regimens into practice. The paper presents the findings of studies on the use of various treatment regimens for dyspepsia of newborn calves, with the inclusion of an immunomodulator. The studies have shown high therapeutic efficacy of both antibacterial drugs Cobactan and Neopen, and their use in combination with the drug Phosprenyl. Laboratory studies of morphological and biochemical parameters of blood demonstrated significantly improved concentration and percentage of the drugs. In the course of treatment with basic drugs, the immunomodulator Phosprenyl enhanced their action and positively affected the percentage composition of the leukoformula. Daily clinical examination of young experimental animals showed that treatment with Cobactan, especially in combination with Phosprenyl, is most effective in terms of fastening recovery and safety of calves.

Peculiarities of management of endometrioid ovarian cysts in patients of reproductive age

The wide spread of endometriosis disease, absence of the onset of a period of stable remission, high frequency of recurrence of the disease cause the existing problems of management of endometriosis. The objective: to study the effectiveness of various treatment regimens for endometriomas in patients with previously realized reproductive potential. Materials and methods. 44 women aged 17 to 49 years were examined: the first group consisted of 25 healthy nonpregnant women, the second group included 19 women, with endometriomas receiving the traditional (subgroup 2a) and complex (subgroup 2b) treatment.Results. It was revealed that in patients receiving traditional therapy, at the end of the course of treatment, the initial activation of the humoral unit of the immune system was observed, which indicated the need for immunocorrection. In patients receiving complex therapy, normalization of the body’s immune homeostasis, stabilization of the processes of apoptosis and proliferation, the main links in the etiopathogenesis of endometriosis, was noted, which indicated an improvement in the effectiveness of the treatment. The control ultrasound in the dynamics at 1 and 3 months in patients who continued to receive complex therapy, revealed a decrease in the size of pathological formation and a pronounced antiproliferative effect on the hyperplastically altered endometrium, diagnosed before the start of treatment in 21,05% of patients. After 3 months of treatment, there was no need for an endometrial biopsy in this group of patients.Conclusions. With the use of a comprehensive approach to the treatment of endometriomas normalization of the body’s immunodeficiency parameters, regression of the endometriomas and the absence of hyperplastic endometrial processes are noted, which allows to recommend this scheme for further us.

Investigation of the efficiency of various antidepressant replacement regimens in the development of SSRI-induced apathy syndrome

Selective serotonin reuptake inhibitors (SSRI)-induced apathy syndrome occurs in 5–20% of patients taking these drugs. Objective: to investigate the possibility and advantages of switching patients with SSRI-induced apathy to treatment with a SSRI and norepinephrine reuptake inhibitor. Patients and methods. The investigation enrolled 105 depressive patients without psychotic symptoms, who were observed to develop symptoms of SSRI-induced apathy during SSRI antidepressant monotherapy for at least 6 months. The patients were randomized to groups: 1) 35 patients were switched to milnacipran (Ixel 50–100 mg/day) with simultaneous antidepressant replacement; 2) 35 patients were prescribed milnacipran with a 2-week gradual discontinuation of the previous SSRI; 3) 35 patients were switched to combined therapy with milnacipran 50–100 mg/day and sulpiride (Eglonyl 50 mg/day). The latter was prescribed to test the hypothesis for the benefits of combined correction of SSRI-induced apathy syndrome. The duration of the investigation was 3 months. Changes in the condition of the patients were assessed during their visits before and 1, 2, 4, 8, and 12 weeks after changing therapy. The efficiency of antidepressant therapy was studied using the 21-item Hamilton Depression Rating Scale (HDRS-21) and the Clinical Global Impression (CGI) rating scale; the changes in the severity of asthenic manifestations were examined according to a subjective asthenia assessment (Multidimensional Fatigue Inventory (MFI-20)). The UKU side effect rating scale was used to verify side effects. Results and discussion. A significant (p<0.05) pronounced thymoleptic effect of various treatment regimens (simultaneous and gradual replacement with monnacipran monotherapy, as well as a milnacipran-sulpiride combination) was confirmed at week 4 of treatment. There was a reduction in SSRI-induced apathy syndrome when switching to treatment with milnacipran or milnacipran-sulpiride in 71.4–80% of patients. Different therapy replacement regimens showed varying changes in the reduction of heterogeneous asthenoapathic symptoms. A favorable safety profile was established for both monotherapy with milnacipran and its combination with sulpiride. Conclusion. The antidepressant milnacipran (up to 100 mg/day) exhibits a high efficacy and a good tolerance in case of SSRI-induced apathy syndrome, as well as by a pronounced thymoleptic effect, including when combined with the antipsychotic sulpiride (50 mg/day).

Epidemiology and Treatment of Calcinosis Cutis: 13 Years of Experience.

Background:Calcinosis cutis is a rare condition associated with different diseases, which is difficult to manage.Aims and Objectives:In this retrospective study, the epidemiology of calcinosis cutis and the effectiveness of various treatment regimens in its management were assessed in a single center.Materials and Methods:The data of 34 patients suffering from calcinosis cutis (male:female = 12:22; mean age = 48.6 ± 18.6 years) treated at our department between 2003 and 2016 were analyzed retrospectively.Results:Dystrophic, idiopathic, metastatic subtype, and calciphylaxis occurred in 70.6%, 11.8%, 5.9%, and 11.8% of the cases, respectively. Underlying diseases of dystrophic calcinosis included autoimmune connective tissue disease, skin trauma, cutaneous neoplasm, and inherited disorder in 58.3%, 20.8%, 12.5%, and 8.3% of the cases, respectively. Extremities were most frequently affected (n = 18). In the management, diltiazem was most frequently used in monotherapy with partial response in five of eight cases. Other drugs in monotherapy or in combination were administered in single cases. Surgical treatment resulted in least partial response in all of the cases followed (n = 7).Conclusion:Dystrophic was the most common subtype and autoimmune connective tissue disease was the most frequent underlying disease. We conclude that lower doses of diltiazem have only partial efficiency, and surgical therapy is at least partially effective in localized calcinosis.

Effects of Various Treatment Regimens on the Survival of HER2-positive Breast Cancer Patients with Brain Metastasis

Overexpression of HER2 (human epidermal growth factor receptor 2) occurs in around 20% of breast cancers. This particular subtype is known to be very aggressive and had the worst prognosis prior to the introduction of targeted therapy. The development of anti-HER2 therapies such as trastuzumab and pertuzumab has shown to dramatically improve the prognosis of patients with HER2-positive breast cancer.

Зуд кожный хронический при заболеваниях внутренних органов у больных многопрофильного стационара

Introduction. Chronic itch is a frequent symptom of internal diseases and causes a significant decrease in the patients’ quality of life.&#x0D; Objectives were to study the structure of internal diseases that cause chronic itch in patients in a multidisciplinary hospital, and the features of chronic itch in these diseases; to evaluate the effectiveness of various treatment regimens for chronic itch in these diseases; to evaluate the possibility of widespread use in clinical practice of the Numeric Rating Scale for the measuring the se-verity of chronic itch in the initial diagnosis and in the determination the effectiveness of treatment.&#x0D; Patients and Methods. Chronic skin itching was studied in patients with various diseases undergoing inpatient treatment at the Burdenko Main Military Clinical Hospital. The study included 125 patients: 20 (16%) with chronic renal failure, 17 (13.6%) with liver diseases, 24 (19.2%) with myeloproliferative, 32 (25.6%) with lymphoproliferative and 32 (25.6%) endocrine diseases. In-dividual antipruritic therapy was selected for each patient with different systemic pathology, considering diseases that cause itching.&#x0D; Results. The most effective drugs in the treatment of chronic itching in patients with chronic renal failure were sorbents, gabapentin and capsaicin in the form of an ointment or cream, with cholestasis - cholestyramine, ursodeoxycholic acid, rifampicin and tacrolimus in the form of an ointment, with true polycythemia - antihistamines and mast cell inhibitors, with Hodgkin's lymphoma and mycosis fungoides - mast cell inhibitors, gabapentin and ointments with glucocorticosteroid additives, with diabetes mellitus - antihistamines, mast cell inhibitors and external therapy with calamine, menthol, capsaicin and glucocorticosteroids, with hypothyroidism - emollients. In patients with myeloproliferative and lymphoproliferative diseases and hyperthyroidism chronic itching completely disappeared only after effective treatment of the underlying disease.&#x0D; Conclusion. For each form of itching and for each patient individual therapy should be selected. The most effective treatment for chronic skin itching associated with systemic origin is the successful treatment of the underlying disease. The numerical rating scale is a reliable scale for measuring the severity of itching, however, it cannot consider all the complexity and features of itching.

Особливості менеджменту ендометріоїдних кіст яєчників у пацієнток репродуктивного віку

The wide spread of endometriosis disease, absence of the onset of a period of stable remission, high frequency of recurrence of the disease cause the existing problems of management of endometriosis. The objective: to study the effectiveness of various treatment regimens for endometriomas in patients with previously realized reproductive potential. Materials and methods. 44 women aged 17 to 49 years were examined: the first group consisted of 25 healthy nonpregnant women, the second group included 19 women, with endometriomas receiving the traditional (subgroup 2a) and complex (subgroup 2b) treatment. Results. It was revealed that in patients receiving traditional therapy, at the end of the course of treatment, the initial activation of the humoral unit of the immune system was observed, which indicated the need for immunocorrection. In patients receiving complex therapy, normalization of the body’s immune homeostasis, stabilization of the processes of apoptosis and proliferation, the main links in the etiopathogenesis of endometriosis, was noted, which indicated an improvement in the effectiveness of the treatment. The control ultrasound in the dynamics at 1 and 3 months in patients who continued to receive complex therapy, revealed a decrease in the size of pathological formation and a pronounced antiproliferative effect on the hyperplastically altered endometrium, diagnosed before the start of treatment in 21,05% of patients. After 3 months of treatment, there was no need for an endometrial biopsy in this group of patients. Conclusions. With the use of a comprehensive approach to the treatment of endometriomas normalization of the body’s immunodeficiency parameters, regression of the endometriomas and the absence of hyperplastic endometrial processes are noted, which allows to recommend this scheme for further use. Key words: endometriosis, reproductive age, immunodiagnostics, ultrasound, immunotherapy.