Established Methods Of Treatment Research Articles

OPTIMISATION OF MOGAR GRAIN COOKING METHOD FOR PRODUCTION OF FOOD CONCENTRATE «TALCAN»

The possibility of using mogar grain for the production of food concentrates based on the traditional national dish "Talkan" is considered. "Talkan" is a national food concentrate that has been used for centuries as a staple food for long-distance trekking by representatives of various cultures. Traditionally, talkan is prepared from various cereals, especially millet, wheat and barley. Adding boiling water and butter makes a hearty porridge, and adding butter and sugar makes a delicious dessert.The difficulty lies in the careful handling and preparation of the mogar grain. When cooked intensively, the grain can easily overcook, resulting in all the valuable nutrients being leached into the broth. In addition, improperly prepared mogar can burn during further roasting. To determine the optimal parameters of mogar hydrothermal treatment and to create a high-quality food concentrate based on the national dish "Talkan", a complex experiment was conducted using modern methods of experiment planning.The experiment tested a number of variables including temperature limits and duration of cooking, as well as temperature, duration and intensity of stirring during drying and roasting of mogar. The study showed that the most favourable conditions for mogar grain include cooking at an initial temperature of 15-20 °C for about 60 minutes, gradually reaching 100°C.The established methods of hydrothermal treatment served as a basis for the development of specialised equipment for the preparation of mogar grain to produce tulkan.

Pulmonary hypertension: modern methods of treatment and ways of their long-term development.

Introduction: The purpose of this work is to review the main pathogenetic mechanisms of the development of PH, as well as modern established methods of treatment of various types of PH and to consider new, most relevant and promising possibilities of therapy for this pathology. Etiology, pathogenesis and epidemiology: In the modern structure of diseases, pulmonary hypertension plays a significant role, affecting about 1% of the population. However, each of its five main groups has its own characteristics. The causes of pulmonary hypertension can be a polyetiological violation of the processes of endotheliocyte apoptosis and angiogenesis, passive transmission of increased pressure from the left heart to the small circulatory system, chronic hypoxia, leading to vascular remodeling, and many others. In general, it is worth noting that, despite the multiplicity of etiological factors, the main pathogenetic link in the development of pulmonary hypertension is endothelial dysfunction. Treatment and promising areas of research: This article discusses the main established approaches to the treatment of pulmonary hypertension: general recommendations for patients, drugs used as supportive nonspecific therapy, as well as specific conservative and radical methods of treatment. In addition, the main modern directions of scientific research in the field of treatment of pulmonary hypertension are described. Such promising methods as the use of stem cells, gene therapy and epigenetic drugs are considered. Conclusion: Despite active research and many different drugs intended for the treatment of pulmonary hypertension, this pathological condition remains an urgent health problem. Thus, the search for new points of application of therapy and fundamentally new methods of treatment of pulmonary hypertension remains relevant to this day.

A Comprehensive Review on the Management of COVID-19-Associated Mucormycosis (CAM): The New Basics

The outbreak of coronavirus disease (COVID-19), which comes with several comorbidities, was declared a pandemic in early 2020 by World Health Organization (WHO). Glucocorticoids that are used in severe cases of COVID-19 as therapeutic measures may lead to opportunistic fungal infections in such patients. Mucormycosis is one of these infections and mostly occurs in immune-compromised patients such as those who undergo transplant surgeries. However, it rarely develops in COVID-19 patients, although many cases of COVID-19-associated mucormycosis (CAM) have been found in developing nations, like India. CAM usually develops between 15 days to a few months after hospitalization or complete recovery from coronavirus disease. It is an uncommon yet serious infection that further agitates the severe symptoms of COVID-19 disease. Patients with diabetes mellitus and other comorbidities are likely to be at a higher risk for developing mucormycosis. Concurrent glucocorticoid therapy possibly heightens the risk as it increases blood glucose levels. Dentists, as frontline healthcare workers, maybe the first to be presented with oral manifestations and therefore need to pay special attention. In light of the available pieces of evidence, this review highlights the basics of the underlying condition starting from the pathology, causative factors, and clinical manifestations, including the oral cavity, to diagnosis, treatment, and prevention of mucormycosis with both conventional and advanced approaches. We limited this study to the basic and established methods of CAM management and treatment along with the statistical updates. Other antifungal drugs and novel microbiological peptides are in development and need future studies for their elucidation.

Clinical case of type I interferonopathy: homozygous STAT2 gain-of-function mutation

The article is devoted to an extremely rare variant of type I interferonopathies associated with a homozygous gain of function (GOF) mutation in the STAT2 gene in a 5-year-old child. This genetic defect was first described in 2019, and so far only 3 cases are known in the world with a similar pathology. Here we present the fourth clinical case and our experience in managing a patient with STAT2 GOF. The article presents the key aspects of the pathogenesis, clinical picture based on the analysis of all known cases of the disease. The absence of established criteria and methods of treatment for this disease is due to the rarity and relative novelty of the described nosology. We present the experience of treatment using a JAK kinase inhibitor, followed by an assessment of the effectiveness of the therapy and side effects. The patient's parents agreed to use the information, including the child's photo, in scientific research and publications.

Cerebral metastasis of malignant pheochromocytoma 28 years after of disease onset

Abstract Background Malignant pheochromocytoma is a very rare disease; moreover, brain metastasis is extremely rare, and there have been only a few published reports. Therefore, there are no established methods of treatment as of yet. We describe an extremely rare case of a patient with malignant pheochromocytoma that metastasized to the brain who was treated 28 years after the onset of pheochromocytoma, and review the relevant literature. Case description A 58-year-old man who had first been diagnosed with malignant pheochromocytoma 28 years earlier presented with right hemiplegia. We performed initial magnetic resonance imaging that showed a coin-like enhanced region in the left deep parietal lobe. His symptoms were stable after stereotactic radiosurgery was performed; however, the tumor size had not changed. Twelve months later, a new necrotic area, likely a result of irradiation, had grown in the peritumoral region. His symptoms worsened day by day, prompting us to perform craniotomy and total tumor removal. His catecholamine levels remained stable, and there were no perioperative events. His condition rapidly improved and there were few sequelae. Conclusion Cerebral metastasis from malignant pheochromocytoma is extremely rare; surgery of patients with low catecholamine levels may be performed safely.

Group analytic therapy for compulsive users of internet pornography

Increasing numbers of patients presenting problems with internet pornography have led to changes in the culture and practice of group analytic therapy at the Portman Clinic. The addictive element of this new form of artificial, sexual stimulation has to be recognised as part of the harm it produces. Group members spontaneously develop some of the principles and practice of established methods of addiction treatment, especially the 12-step programme, by helping each other manage their compulsion. This self-help function of the group coexists alongside the psychodynamic perspective, in which the meaning of harmful sexual behaviour is explored and understood. Certain individuals are more vulnerable to excessive use of pornography because of early developmental problems and current difficulties in their sexual relationships, resulting from internal conflicts about their sexuality. The group provides intimacy without sexualisation, primarily through a sibling transference. The therapist embodies an ability to think about the complexity of the sexual abuse that the pornography portrays. He or she works towards a truer perception of reality for group members, in which the false solutions of compulsive sexual behaviour are seen to be what they are: impediments to healthy development.

Atrial fibrillation: established and innovative methods of evaluation and treatment.

5% to 8% of 70-year-olds and some 10% of persons over age 80 have atrial fibrillation (AF). Selective literature review. New scoring schemes (CHA(2)DS(2)-VASc score, HAS-BLED score) have been introduced to enable more accurate estimation of the risk of stroke and hemorrhage in patients with AF. These scores are calculated on the basis of clinical data (left ventricular dysfunction, hypertension, age, diabetes, prior stroke, vascular diseases, sex, renal or hepatic dysfunction, bleeding, labile INR values, consumption of medications and alcohol) and are used to determine the potential indication for, and appropriate type of, anticoagulation in the individual AF patient. Hemodynamically unstable patients with rapid AF should undergo DC cardioversion at once. Patients with permanent AF should be given beta-blockers, calcium antagonists, or digitalis for rate control, with a target rate below 110/minute. A recently introduced drug, dronedarone, is used for rhythm control and has relatively few side effects. Patients with AF and impaired left ventricular function should be given amiodarone. Rhythm control has not been found to prolong life any more than rate control. Patients with a CHA(2)DS(2)-VASc score of 2 or above should be orally anticoagulated. Those with a score of 1 can be treated with aspirin (75 to 325 mg daily); those with a score of 0 do not need antithrombotic treatment. A HAS-BLED score of 3 or above is associated with a high risk of bleeding. Pulmonary vein isolation is an established method of treating symptomatic AF, with a success rate of 60% to 80%. Surgical procedures are possible in AF patients who need additional cardiac surgery. The treatment strategy for AF must be individualized on the basis of the patient's clinical manifestations. The mainstay of treatment is anticoagulation; the indication for anticoagulation depends on the patient's age, underlying disease, and left ventricular function.

Use of Nitinol Shape Memory Alloy Staples (Niti Clips) after Cervical Discoidectomy: Minimally Invasive Instrumentation and Long-Term Results

Anterior cervical discoidectomy with or without fusion is a well established surgical remedy for cervical prolapsed intervertebral disc (PIVD) disease. If fusion is done by an iliac bone graft then internal fixation is commonly used to keep the graft in position. This study was conducted to determine the efficacy and tolerability of shape memory alloys, especially NiTi (nickel titanium) clips in the stabilization of grafts following anterior cervical discoidectomy. 133 NiTi clips were applied in 119 patients between January 2002 and December 2008. The patients age ranged from 38-60 years. There were 66 male and 53 females. Various indications for fixation of the spine included degenerated cervical spondylosis with single level PIVD (105) and two level PIVD in 14 patients. The cine mode fluoroscopy confirmed the perioperative correct placement of grafts and clips in all the patients. Follow-up ranged from 2 to 8 years (mean: 4.6 years). Single level discoidectomy was performed in 105 patients and two level disc removal was done in 14 patients. A single NiTi clip was applied in all the cases except for 14 cases of two level PIVD. No procedural complication or adverse reaction to the clip was noted. There was no movement at the operated level in dynamic lateral view X-ray of cervical spine at the 1st postoperative day as well as on follow-up. Graft extrusion was seen in one patient on the 2nd day after surgery and was reoperated. Bony fusion occurred in all patients after 9 - 12 months of surgery. There was no incidence of breakage or dislodgement of the clip from the site where it was inserted. No artifact was noted in cervical MRI done in 33 patients. NiTi clips are a simple alternative for cervical spine stabilization after discoidectomy. Their insertion is simple, minimally invasive, does not require any special set of instruments and they are much more economical than other established methods of treatment. These clips are accepted well by human tissue and do not interfere with MRI.

Endoscopic Endonasal Approach for Clipping of Ruptured and Unruptured Paraclinoid Cerebral Aneurysms: Case Report

We present a case in which clip ligation of both a ruptured and an unruptured paraclinoidal segment aneurysm is performed with only the endoscopic endonasal approach in 1 setting. A 42-year-old woman, a Hunt and Hess grade 2 patient, presented with aneurysmal subarachnoid hemorrhage. An arteriogram revealed an irregular 10-mm right paraclinoidal aneurysm projecting posteromedially and a 5-mm wide-necked right ophthalmic artery aneurysm projecting superomedially. The patient was taken to the operating room where clipping of both aneurysms was performed through the use of an endonasal endoscopic approach with a pedicled nasoseptal flap reconstruction. Such an approach allowed excellent visualization without drilling of the clinoid process or mobilization of the optic nerve and potential control of the proximal and distal internal carotid artery. An intraoperative arteriogram showed obliteration of both aneurysms with patency of the surrounding vasculature. The patient did well postoperatively and was subsequently discharged home without any neurological deficits. An endoscopic endonasal approach was immediately safe and effective for the clipping of both paraclinoidal aneurysms. Although there were benefits achieved from this particular unconventional approach, surgical clipping via traditional craniotomy and endovascular coiling are the established methods of aneurysm treatment and should always be primarily considered. More cases will determine the efficacy and safety of this approach, which should be attempted only by very experienced teams trained in both cerebrovascular and endonasal neurosurgery.

Recent advances in nonsurgical management of localized prostate cancer

limited to clinical stage T1 or T2, oncological outcomes are believed to be comparable for most men undergoing RP, external-beam radiation, or brachytherapy. Therefore, the basis upon which patients select the primary therapy has shifted toward the consideration of treatment-related morbidity and health-related QOL. Although the probability of eradicating prostate cancer is increased by increasing the radiation dose, classic radiotherapy techniques at doses of more than 70 Gy result in high rates of severe rectal and bladder toxicity. Threedimensional (3D)-conformal radiotherapy and, more recently, IMRT have been shown to improve local control and signifi cantly decrease the side effects, thus improving patient health-related QOL. With recent advances in transrectal ultrasound image-guided and computer-based treatment planning systems, prostate brachytherapy has been widely accepted as a safe and effective treatment for localized prostate cancer. In Japan, the use of iodine-125 as a seed source was legally approved in 2003, and since then the number of these procedures has been increasing dramatically. A number of innovative local therapeutic approaches have been investigated for men with localized prostate cancer, including HIFU, cryotherapy, and thermal therapy. Most of these approaches have not yet suffi ciently matured to be considered as standard therapy for men with prostate cancer, but these investigational treatments appear promising. With continuing technological refi nements, some of these could become established methods of treatment in future. On the other hand, although classical hormonal treatment for men with localized prostate cancer is widely used in clinical practice, its particular role remains to be elucidated, and further study is warranted to establish its clinical signifi cance. In this issue of the International Journal of Clinical Oncology, leaders in the fi eld review the current status and future perspectives of recently developed nonsurgical treatment modalities for localized prostate cancer. I believe these review articles will be useful to aid in our understanding of recent progress in the management of prostate cancer. Received: July 27, 2007

Is Garlic Alternative Medicine?1–3

Garlic has been used medicinally since antiquity. In virtually every early civilization known, such as ancient India, Egypt, Rome, China, and Japan, garlic was part of the therapeutic regimen for a variety of maladies. Therefore, the ancient medicinal tradition of garlic use would qualify it as a folk medicine or as an alternative or complementary medicine. But is garlic an alternative to established methods of disease prevention or treatment? Scientists from around the world have identified a number of bioactive substances in garlic that are water soluble (e.g., S-allyl methylcysteine), and fat soluble (e.g., diallyldisulfide). Mechanisms of action are being elucidated by modern technology. The validity of ancient medicine is now being evaluated critically in cell-free systems, animal models, and human populations. Preventive and therapeutic trials of garlic are still in early stages. There are many promising lines of research suggesting the potential effects of garlic. The current state of knowledge does not recognize garlic as a true alternative, but it will likely find a place for garlic as a complement to established methods of disease prevention and treatment. Our goal should be to examine garlic together with other agents to evaluate its possible efficacy and toxicity under conditions of actual use in humans.

Evidence-based reproductive surgery: tubal infertility

The goal for any infertile couple is to explore all reasonable attempts to achieve pregnancy. The couple with infertility resulting from tubal disease has two therapeutic options to achieve this goal: reconstructive tubal surgery and in vitro fertilization. However, the increasing demand for new techniques of assisted reproduction has called into question the value of the more established methods of treatment for tubal infertility. There are some causes of tubal infertility for which surgery has virtually no chance of success. For these situations, in vitro fertilization is clearly the only therapeutic option. For other situations, the decision-making process requires detailed discussion on the effectiveness, adverse effects and cost of the procedures. Endoscopic evaluation of the tubal mucosa is essential for the selective application of tubal surgery. The available evidence shows that tubal surgery can be as, or more, effective as in vitro fertilization for cases of filmy adhesions, mild distal tubal occlusion and proximal obstruction. It may, however, be reasonable to discuss in vitro fertilization with any couple without pregnancy 12 months after tubal surgery. In women with moderate to severe distal tubal disease, the diminishing success rates from surgery suggest that in vitro fertilization should be considered as the first line of treatment. In the case of unsuccessful reconstructive surgery, or if a hydrosalpinx is irreparably damaged, a salpingectomy prior to in vitro fertilization has to be considered. Tubal surgery has indisputable benefits for the patient if infertility is cured by the intervention. A successful tubal repair gives the patient the possibility of conceiving more than once without further treatment. It also gives the couple the psychological advantage of being able to conceive spontaneously. Probably the most pragmatic viewpoint is to consider reproductive surgery and in vitro fertilization as complementary options that are directed towards increasing the overall probability of achieving a pregnancy in the most efficient manner.

Evidence-based decision making—the six step approach

The basic concept of evidence-based medicine proposes to make health related decisions based on a synthesis of internal and external evidence. Internal evidence is composed of knowledge acquired through formal...

Two-Stage Reconstruction With Autografts for Knee Dislocations

Traumatic knee dislocations are severe injuries that involve damage to the anterior cruciate ligament, the posterior cruciate ligament, and the lateral or medial ligamentous structures. There are no established methods of treatment. The objective of the current study was to report the clinical outcome of a two-stage autologous reconstruction on nine knees (eight patients). The mean followup was 40.1 months. The first stage of the reconstruction was done at a mean of 2 weeks after the injury, and the posterior cruciate ligament was reconstructed by an arthroscopically assisted technique using contralateral autogenous hamstring tendon as the graft material. Three months later, the second stage of the reconstruction was done for the ligaments that had not healed with conservative treatment. Arthroscopically assisted anterior cruciate ligament reconstruction was done on all of the knees using the ipsilateral autogenous hamstring tendon or bone-patellar tendon-bone as the graft material. At the same time, a medial collateral ligament reconstruction using an autogenous semitendinosus tendon was done on one knee, and reconstruction of the posterolateral ligamentous structures using a biceps tendon was done on three knees. Each of the knees that was reconstructed was capable of full extension, and the mean degree of passive flexion was 139.5 degrees +/- 5.2 degrees. The mean side-to-side difference in anteroposterior total laxity (KT-1000 arthrometer, manual maximum) was 2.3 +/- 1.9 mm. None of the knees had lateral or medial instability. All of the injured ligaments were able to be reconstructed with autografts, and severe contracture was able to be prevented. A good clinical outcome can be achieved when two-stage reconstruction is used for traumatic knee dislocations.

Novel Approaches to the Management of Graves` Ophthalmopathy

Severe Graves' ophthalmopathy constitutes a complex therapeutic challenge and treatment outcome often is not satisfactory. Established methods of treatment include high-dose glucocorticoids, orbital radiotherapy and orbital decompression. Recently, the use of intravenous glucocorticoids has been shown to provide more favorable results than oral glucocorticoids. Novel treatments under investigation include somatostatin analogues, intravenous immunoglobulins and antioxidants. Low-dose immunosuppressive drugs (namely cyclosporine and, possibly, methotrexate) might be useful as an adjunct to established methods, particularly in view of a glucocorticoid-sparing action. Because cytokines play an important role in the pathogenesis of the disease, cytokine antagonists, which are currently evaluated in rheumatoid arthritis and other autoimmune conditions, might constitute in the future a valuable tool for the management of eye disease. Prevention of Graves' ophthalmopathy would be desirable, but so far it is limited to secondary prevention (arrest of progression of subclinical disease to clinical disease) and tertiary prevention (avoidance of deterioration or complications of clinical disease): among preventive measures smoking withdrawal is probably the most important one. Primary prevention (in the absence of disease) is only speculative, but oral tolerance induction or vaccination with the offending antigen(s) might prove beneficial for prevention of Graves' ophthalmopathy in genetically susceptible individuals.

Urethral condylomas. A therapeutic challenge

Very diverse treatment recommendations exist in the literature on HPV lesions of the urethra. There are no treatment guidelines from the specialist societies. Both these factors have led to a very wide spectrum of heterogeneous treatment strategies in hospitals and medical practices of various specialties. Primary and secondary treatment of urethral condylomata by practitioners as well as a specialized HPV center was evaluated. One hundred and five patients with condylomata of the urethra were studied. Most had been previously treated, often several times, by a variety of specialists. We treated all regardless of prior treatment status with laser therapy. A high percentage of patients treated with different methods in medical practices but also at our high-technology center sometimes showed serious treatment complications and numerous recurrences. Most established methods of treatment for condylomata on the external genitalia are not necessarily applicable to the urethra. About 20% of urethral condylomata can only be reached by endoscopy. Co-existing urethral malformations as well as complications of therapy are reasons for early cooperation with the urologist or HPV center.

Endoscopic hemostasis: something old, new, borrowed and now blue

Endoscopic hemostasis: something old, new, borrowed and now blue

Use of MR-controlled laser-induced thermotherapy in recurrent squamous epithelial carcinoma of the head-neck area

The management of patients with recurrent carcinomas of the head and neck that had been treated before by surgery, radiation, and/or chemotherapy presents a considerable problem. The value of the MR-controlled laser-induced thermotherapy (LITT) was analysed as a new palliative treatment modality. LITT was used in five patients with recurrent head and neck squamous cell carcinomas, who had undergone established methods of treatment. One patient with a primary laryngeal carcinoma, who refused surgery, was treated by LITT in addition to radiation. A Nd:YAG laser was used to deliver laser light via an applicator directly into the tissue and to produce tumor necrosis. Using two special MR thermosequences (Thermo-TurboFLASH-, modified FLASH-2 D-Sequenfe) the laser process was controlled on line. The necroses were measured by a static and dynamic area calculation program based on a pixel evaluation. The induced tumor necroses ranged from 4 cm3 to 28 cm3. In all cases the MR thermosequences showed a loss of the signal up to 15 mm around the top of the applicator. In the post-interventional T1 sequences with intensified contrast, the coagulation necroses were represented as hypovascular areas. No side effects were seen and five of the patients felt an improvement of clinical symptoms. LITT as a minimal invasive, MR-controlled method may be a good alternative in palliative therapy of head and neck carcinomas.

Pathophysiology and management of esophageal varices

Established methods of diagnosis and treatment of bleeding esophageal varices continue to be studied with further clarification of acute and chronic management strategies. New endoscopic and radiologic techniques have been introduced that provide additional or alternative approaches. The question of prophylactic variceal therapy remains in the noninvasive arena and elective invasive methods continue to carry a significant morbidity, but there are attempts to define the patient most at risk of bleeding and rebleeding. The next few years should see a rationalization of treatment algorithms as experience is gained with newer modalities used alone or in combination.

An introduction to minimally invasive therapy

Minimally invasive therapy (MIT) has as its basic premise the reduction of iatrogenic trauma to the patient by surgeon, physician or radiologist. This approach must also imply that the therapeutic procedure succeeds in its aim of cure in a manner no less effective than is currently achievable by established methods of treatment. Acceptance of this principal has many identifiable sequelae, including profound changes in hospital design, increasingly expensive technological instrumentation, more sophisticated teaching and learning patterns, and a massive redirection of health care financial resources. These changes cannot be contemplated at leisure, because they are dynamically imperative and progressing with relentless rapidity, being directly driven by the consumer. It is vital that this shift in clinical emphasis should be appreciated so that future planning can be undertaken with some rationality.