Etiopathogenetic Treatment Research Articles

A clinical case of acute polyneuropathy, with the onset of bilateral facial nerve palsy in an early childhood

BACKGROUND: The differential diagnosis of peripheral nervous system damage depends on a thorough collection of history, comprehensive assessment of clinical manifestations, and dynamic examination of the patient. This article describes a clinical case of acute polyneuropathy in a young child, which began with gastrointestinal symptoms and bilateral facial neuropathy. CLINICAL CASE DESCRIPTION: The article presents a case of a child with an atypical course of acute polyneuropathy, which began with bilateral facial neuropathy combined with gastrointestinal complaints and pain syndrome. Features of the clinical presentation of the disease required extended laboratory and instrumental testing. Protocols for instrumental verification of diagnosis included nerve conduction studies examining neural conduction and axonal excitability of the affected facial nerve and the healthy side. Additionally, the functional status of the peripheral nerves in the upper and lower limbs was assessed. Polyneuropathic alterations revealed through nerve conduction studies confirmed diagnostic lumbar puncture to determine the presence of neuroinfectious processes. Magnetic resonance imaging of the brain, brachial, and lumbosacral plexuses using intravenous contrast showed the nature and prevalence of a lesion. Based on the overall clinical, laboratory, and instrumental examination data of the patient, “acute inflammatory demyelinating polyneuropathy” was diagnosed; timely etiopathogenetic treatment was initiated. CONCLUSION: In children, the course of a neuroinfection may be atypical. Sometimes, when dissociating the clinical manifestations of the disease from the results of a standard laboratory and instrumental test, expert diagnostic techniques should be used for differential diagnosis purposes.

Clinical manifestations of elements of oral mucosa infection in patients with lichen ruber planus

Annotation. The purpose of the study is to investigate the features of the local manifestation and clinical course of lichen planus in the oral cavity. The relevance of the mentioned problem is due to the growing share of patients with lichen planus, the undefined etiology and pathogenesis of this disease, the lack of a single point of view on treatment tactics and the search for opportunities for more effective treatment. 21 patients who were diagnosed with lichen planus with manifestation on the mucous membrane of the oral cavity were examined. The age of the patients ranged from 28 to 57 years. The studied patients were divided into 2 groups: the first – the main one (12 patients), which received a standard treatment scheme; the second – control (9 patients) included patients who received an etiopathogenetic treatment scheme with the inclusion of appropriate drugs. All patients underwent clinical examinations of the manifestation of the local status in the form of an assessment of pain, hyperemia, swelling, in points as follows: 1 point – no sign, 2 – slightly expressed, 3 – expressed, 4 - significantly expressed. As a result of observing the manifestations of the primary impression elements in the oral cavity, the following results were obtained. In the group of patients who received standard treatment, the healing of the primary elements of the impression of lichen planus had significantly less positive dynamics, in contrast to the group of patients who received the proposed treatment scheme. All local manifestations of the impression elements on the mucous membrane of the tongue, cheeks, and lips, which were taken into account during the examination, showed a significantly positive effect of the proposed treatment on the local signs of healing of the impression elements of the oral mucosa in lichen planus red (p<0.05). Analyzing the obtained indicators of the clinical manifestation of pain, hyperemia, swelling of the mucous membrane of the oral cavity of the patients, their positive dynamics and synchronicity are noticeable in patients of both groups. In case of lichen planus of the mucous membrane of the oral cavity, local clinical manifestations have significantly positive dynamics when using the proposed etiopathogenetic scheme of treatment (p<0.05). It was revealed that the treatment of lichen planus should be complex and etiopathogenetic, which should combine general and local treatment. The proposed etiopathogenetic scheme of treatment will reduce the recovery time of patients with lichen planus of the oral cavity by 4-5 days and improve the social adaptation of patients.

Ювенильная форма болезни Гентингтона: клинический случай из практики педиатра

Background. Huntington's disease (Hd) is a hereditary neurodegenerative disease with an autosomal dominant type of inheritance and manifested by motor, behavioral and mental disorders. The essence of the mutation is an increase in the trinucleotide repeats of "cytosine – adenine – guanine" (cAG) in the first exon of the HTT gene encoding the huntingtin protein, more than 35. Aim. The purpose of the presentation of this clinical case is to consider the features of the clinical picture and the course of the disease of the juvenile form of Hd. In addition to the rarity of the disease, the dependence of the onset and course of the disease on the number of cAG repeats in the HTT gene, rapid progression and lack of etiopathogenetic treatment, which inevitably leads patients to disability, and later to death, is of interest. Results. The article presents a clinical case of a juvenile form of the disease in an 11-year-old boy with the first symptoms of Hd at the age of 4. Conclusion. The presented clinical case provides an opportunity to verify the difficulty of the juvenile form of Hd and its diagnosis, for which sometimes the only method is genetic analysis.

Clinical and Morphological Parallels in the Etiopathogenesis of Secretory Otitis Media

Introduction. According to global statistics, secretory otitis media (SOM) ranks first among middle ear infections. This pathology is believed to be characteristic of the pediatric population; however, recent global statistics indicate an increase in the percentage of SOM cases among the adult population. Information about adult-onset SOM varies, with no consensus on the causes of its occurrence. Diverse clinical presentation of the condition, often unsatisfactory treatment outcomes, and a high percentage of recurrences have necessitated a more in-depth study of the etiological factors associated with adult-onset SOM.
 The objective of the research was to determine clinical and morphological parallels in the etiopathogenesis of adult-onset SOM as well as to establish the relationship between the clinical, otoscopic, and endoscopic presentations and pathomorphological changes in the tubal tonsils in these patients.
 Materials and Methods. Sixty-eight (38 men and 30 women) patients with SOM at the age of 18 to 65 years were examined. Fifty-three patients were diagnosed with unilateral pathological process, while in 15 individuals, bilateral SOM was observed. All the patients underwent a comprehensive assessment of their complaints, collection of their medical history, and a full ear, nose, and throat examination using conventional methods, optical techniques, video endoscopy of the nasopharynx and tubal tonsils, and otomicroscopy. In 15 patients, to exclude a malignant process, tissue samples from the tubal tonsils were taken for pathological examination.
 Results. One of the causes of adult-onset SOM could be pathomorphological changes in the tubal tonsils, specifically their inflammation, hypertrophy, and in some cases, tumours. The clinical course and stages of SOM development depend on the duration of auditory tube obstruction. Inflammation of the tubal tonsils usually results in catarrhal and serous SOM, while hypertrophy or hyperplasia of the tubal tonsils is observed in patients with mucous SOM.
 Conclusions. Pathomorphological changes in the tubal tonsils have been established as one of the reasons for developing SOM in adults. Both the clinical presentation of SOM and the stage of its progression depends on the type of pathomorphological changes, their localization (upper or lower pole), and the duration of auditory tube obstruction. A prolonged, recurrent, and treatment-resistant course of SOM may be associated with hypertrophy of the tubal tonsil or tumours. Clinical and morphological parallels identified by us will enable timely utilization of effective etiopathogenetic treatment of SOM and prevent the occurrence of complications.

Clinical and immunological efficacy of the immunomodulating hexapeptide arginyl-alpha-aspartyl-lysyl-valyl-tyrosyl-arginine in the complex postoperative treatment of children with acute osteomyelitis

The recurrent and persistent nature of osteomyelitis, like as associated high morbidity of patients, prolonged hospitalization and expensive treatment require development of new approaches in therapy and pathogenetic justification of the immunotropic drugs usage in complex etiopathogenetic treatment of this disorder. Our objective was to evaluate the clinical and immunological efficacy of hexapeptide (HP), arginyl-alpha-aspartyl-lysyl-valyl-tyrosyl-arginine implemented in the complex treatment of acute osteomyelitis in children during the postoperative period. 19 children aged 8-15 years with acute osteomyelitis (AOM) were studied: the study group 1 (SG1, n = 11) received a standard treatment at all the disease stages; in study group 2 (SG2, n = 8), the standard therapy was supplemented with a medical drug Imunofan, containing hexapeptide (НP) as the active substance. Prior and after the course of drug treatment, we determined the following parameters: the contents of T cells (CD3+CD19-, CD3+CD4+, CD3+CD8+, CD3+CD4+/CD3+CD8+) and B cells (CD3-CD19+), NK (CD3-CD16+CD56+) by means of Cytomics FC-500 (“Веckman Coulter”, USA), the levels of serum IgA, IgM, IgG (ELISA tests), assessment of phagocytic activity of neutrophil granulocytes (NG) with determining the ratio of actively phagocytic NG (%PhAN), capture processes (PhN, PhI) and the completeness of phagocytosis (%D, DI) tested with S. aureus (strain No. 209). In the studied groups with AOM, a decreased content of T lymphocytes, T helper cells, T lymphocytes, NK cells was revealed, along with unchanged content of B lymphocytes. In SG2, the increased IgA and IgG levesl have been shown. We have also revealed a deficiency of phagocytic function associated with the processes of phagocytosis completion. The use of immunomodulatory therapy with an HP-containing pharmaceutical drug in combination with standard treatment was associated with restoration of immunological parameters to the reference values of healthy children, thus leading to shorter febrile period, milder manifestations of intoxication, earlier periods of reconvalescence from purulent-inflammatory process, and reduced hospital stay. The obtained positive clinical and immunological effects demonstrate the expediency of targeted immunomodulatory therapy including a pharmaceutical HP-containing drug as the active substance in the complex postoperative treatment of children with AOM. Restoration of the disturbed mechanisms of anti-infectious immunity in AOM under usage of immunomodulating HP contributes to more effective elimination of pathogens and, as a result, improvement of the clinical course of the disease, as well as prevention of chronic inflammatory processes and aggravation of immune system dysfunction.

Парез горизонтального взора – какую тактику ведения выбрать

Purpose. To analyze the success of using prisms in conjugate horizontal gaze paresis compared to other treatment methods. Material and methods. The study involved 30 patients with conjugate horizontal gaze paresis. The average age of patients at the time of treatment was 57.8±6.68 years. The average period of clinical follow-up for strabismus symptoms in patients after the appropriate treatment was 12.6±3.8 months. The patients were divided into two groups: the first group (main group) of 15 patients who underwent prismatic correction in combination with etiopathogenetic treatment and 15 patients (control group) who underwent etiopathogenetic treatment without prismatic correction. Results. The treatment results were evaluated according to three criteria: absence of abnormal head posture (AHP) and diplopia, as well as elimination of esotropia. Based on our data, the AHP angle did not reveal statistically significant difference at the stage before treatment (p=0.999), however, during treatment in the first group (using prismatic correction), it was 4.4 times less than in the second group (p<0.001). Similar data were obtained in relation to esotropia. Results of the statistical analysis showed that during treatment, frequency of binocular single vision exposed a statistically significant increase (p<0.05) in both the first and second groups. Conclusion. Thus, for 15 patients with conjugate horizontal gaze paresis, prismatic correction made it possible to create conditions for shifting the image perceived by a patient to a straight field of gaze, as well as to eliminate the occurrence of induced heterotropia and diplopia in the attempt to look straight and, accordingly, the formation of AHP. The proposed method provided an opportunity to reduce complaints and improve the patients' quality of life. Key words: conjugate horizontal gaze paresis, diplopia, abnormal head posture, Fresnel prisms

Differentiated disorders of the immune system in acute hematogenic and acute posttraumatic osteomyelitis in children

Osteomyelitis is an inflammation of bone and bone marrow caused by the spread of S. aureus from a local focus by the hematogenous route or from an open traumatic fracture; it is difficult to treat and remains a serious problem. The condition for spreading of the infectious process into bone is the effect of S. aureus and its impaired elimination due to immune system (IS) dysfunction. Controversial information on the immunopathogenetic mechanisms of acute osteomyelitis needs study, which would allow the development of sound immunotherapy. Purpose of the study: to specify the variants of antibacterial immune protection disorders in children with acute hematogenous and acute posttraumatic osteomyelitis. Materials and methods. Children 8-15 years old (n = 22) were studied: Study Group 1 (SG1, n = 12) – with acute hematogenous osteomyelitis (AHO); Study Group 2 (SG2, n = 10) – with acute post-traumatic osteomyelitis (APTO). The comparison group (CG) – 13 healthy children. Tested: Tlymphocytes (CD3+CD19- , CD3+CD4+, CD3+CD8+), B lymphocytes (CD3- CD19+), NK (CD3- CD16+CD56+) and TNK (CD3+CD16+CD56+) lymphocytes, neutrophil granulocytes (NG, CD16, CD32, CD64) (FC-500 Beckman Coulter, USA); the level of serum IgA, IgM, IgG (ELISA). Phagocytic function of NGs in relation to S. aureus was assessed: the number of actively phagocytizing NGs (%PhAN), capture processes (PhN, PhI) and killing activity (%D, DI). Results. In both groups was revealed a decrease of T lymphocytes, T helpers, TCTL and NK quantity (p1-4 < 0.05). In AHO, the levels of IgA, IgM, IgG did not differ from that in GS, while in APTO the levels of IgA and IgG increased (p1, 2 < 0.05). The density of CD64, CD16, CD32 receptor expression on NG in the studied groups has been a different equipping, predetermining an incompetence of the phagocytic function: in AHO associated with abnormalities in the function capture and killing, in APTO only with the S. aureus digestion. Conclusion. The revealed combined defects of IS functioning necessitate the development of new approaches in the treatment of AHO and APTO in children, pathogenetically substantiating the use of immunotherapy in the complex etiopathogenetic treatment. This approach will contribute to the restoration of mechanisms of anti-infective immunity, timely elimination of pathogens, improve the clinical course of the diseases, prevent the chronic inflammatory process.

Prospects of etiopathogenetic treatment of Huntington’s disease

Huntington’s disease is a serious inherited neurodegenerative disorder characterized by of motor, cognitive and psychiatric features. The disease is caused by an abnormally expanded CAG repeat expansion in the HTT gene and the production of mutant huntingtin protein.The disease usually manifests in adulthood, but the manifestation in childhood and youth is also described, which is noted in 5–10 % of cases. The disease predominantly affects the neostriatum, resulting in a characteristic clinical picture.The most promising approaches to etiotropic therapy of Huntington’s disease are a number of DNA- (CRISPR/Cas9 system) and RNA-directed methods (antisense oligonucleotides, RNA interference), methods that directly reduce the level of mutant gentingtin (chimera molecules), as well as approaches based on inactivating the DNA mismatch repair system using the FAN1 enzyme.

Neurogenic Аrthropathy, Сhronic Osteomyelitis, Diabetic Foot: Differential X-Ray and MSCT Diagnostics

X-ray and MSCT-differential diagnostics between neurogenic arthropathy, diabetic osteoneuroarthropathy (DONAP), complicated by osteomyelitis and chronic osteomyelitis, has not been studied enough.The purpose of the study was to study the MSCT semiotics of various variants of neurogenic arthropathy, DONAP complicated by osteomyelitis and chronic post-traumatic osteomyelitis in order to substantiate etiopathogenetic treatment. In 44 patients with neurogenic arthropathy, DONAP, complicated by osteomyelitis and chronic osteomyelitis, the results of polypositional radiography, MSCT were studied before treatment for the purpose of differential diagnosis. Single center retrospective study. MSCT and x-ray revealed differential diagnostics differences between neurogenic arthropathy, DONAP, complicated by osteomyelitis and chronic osteomyelitis. They are manifested by the localization of destructive processes, characteristic changes in the angles of the foot and a violation of the architectonics of the bones, concomitant changes in blood vessels and soft tissues. Neurogenic arthropathy is characterized by disorganization of the joints, bone resorption, giving the impression of surgical amputation, sharpening of the ends of the metatarsal bones, a symptom of «pestle in a mortar», a violation of the structure of spongy bones. DONAP is manifested by pronounced destructive changes in the midfoot, collapse of the tarsal bones with defects, fragmentation, vascular calcifications (Menckeberg), a «pathological» reference line, an increase in the Meary angle, a decrease in the angle of the calcaneus, and a «rocking foot», increased density of the calcaneus. Chronic osteomyelitis is characterized by an isolated lesion of one or more bones; the presence of a fistulous tract, focal disorders of the trabecular pattern, a decrease in the density of adjacent bones, the presence of isolated foci of sclerosis.

Clinical, laboratory changes and fibroblast growth factor in patients with myocarditis

Annotation. The relevance of the problem of diagnosis and treatment of myocarditis in the world and in Ukraine is growing. The prevalence of myocarditis is up to 20% of all non-coronary heart lesions. According to the results of the study of the sudden death causes in young people, the detection of inflammatory lesions of the myocardium varies in the range of 2-42%. The article analyzes the course of acute myocarditis of unknown etiology in 48 adult patients (31 patients with a moderate-severe course and 17 patients with a severe course), establishes clinical features of the course of the disease and laboratory markers associated with the severity of the course of the disease and myocardial fibrosis. The severity of the course of the disease was determined based on the volume of myocardial damage, the stage and functional class (FC) of heart failure, the presence of systolic heart dysfunction and life-threatening rhythm and conduction disorders. Statistical processing of the research results was carried out using the created database of examined patients in the StatSoft Statistica v 10.0 program, with a known number of observations (n). The Mann-Whitney test was used to determine differences between quantitative traits. Spearman's rank correlation coefficient was calculated to determine the degree of statistical dependence between indicators. It was established that myocarditis mostly had a course of moderate severity (64,6 %) with the presence of heart failure of II A stage in 54,8 % of inspected patients, and was accompanied by combined complex rhythm and conduction disorders in 38,7 % of patients. A reliable correlation was established between the increase in markers of inflammation (CRP, fibrinogen), cardiomyocyte lysis (CFC-MV) and fibroblast growth factor 23 (FGF-23), which indicates an increase in profibrotic processes as a result of myocardium inflammatory damage. It is important to carry out a detailed study of the clinical features of myocarditis with the further perspective of developing diagnostic methods for timely etiopathogenetic treatment and forecasting the adverse course of the disease.

THE INFLUENCE OF AN INFECTIOUS AGENT ON THE DEVELOPMENT OF HYPERPLASTIC PROCESSES OF THE ENDOMETRY IN THE EARLY REPRODUCTIVE AGE

The problem of hyperplastic processes of the endometrium (HPE) in women of reproductive age is a potential cause of reduced fertility and the risk of developing oncological pathology, which has been steadily increasing in recent years, attracting the increased attention of clinicians.
 The aim: to analyze the role of an infectious agent in the development of hyperplastic processes of the uterine mucosa in women of early reproductive age for the formation of risk groups for the occurrence of endometrial hyperplasia and polyps.
 Materials and Methods: 90 patients in early reproductive age were examined, who were divided into groups: the main group included patients with histologically verified atypical hyperplastic pathology of the endometrium (polyps of the uterine body and atypical hyperplasia of the endometrium) (n = 60). The control group consisted of 30 healthy volunteer patients of the same age category. The patients of the main group underwent a diagnostic hysteroscopy with endometrial biopsy, material was collected from women of the control group with prior consent using Peipel-biopsy with subsequent examination of the material. Bacteriological analysis of the material from the uterine cavity included the study of aerobic and anaerobic flora using a set of selective differential diagnostic nutrient media.
 Results and Discussion: Data on the role of microbial and viral factors in the development of atypical endometrial hyperplasia in women of early reproductive age are given. The structure of microbial insemination of the uterine cavity in such women has been established. Cytomegalovirus antigens in hyperplastic endometrium were found in 38.3 % of cases. The obtained data make it necessary to carry out high-quality infectious screening for the formation of risk groups regarding the occurrence of hyperplastic changes of the uterine mucosa.
 Conclusions: In patients of early reproductive age with atypical hyperplasia of the endometrium, the persistence of bacterial agents in the uterine cavity in insignificant concentration was noted in all examined, viral - in 38.3 %, which reflects the significant etiological role of bacterial and viral infection, which participates in the implementation of the inflammatory process and formation of hyperplastic pathology. Pathogenetic features of bacterial-viral infection of the genital tract of patients with hyperplastic endometrial pathology determine the need for high-quality infectious screening with the formation of risk groups and subsequent etiopathogenetic treatment.

MICROSTRUCTURAL ORGANIZATION OF PERIODONTIUM UNDER CONDITIONS OF COMPLEX CORRECTION AGAINST THE BACKGROUND OF EXPERIMENTAL TEN-WEEK OPIOID EXPOSURE

In order to develop an adequate scheme of drug correction of periodontal tissue damage on the background of long-term action of the opioid analgesic nalbuphine, experimental studies were performed using the drugs pentoxifylline and ceftriaxone. The study was performed on male rats (24), which were divided into 3 groups. And the group is a control group. Group II – administration to rats of opioid analgesic in increasing doses for 10 weeks, where the initial dose was – 0.212 mg / kg, 9-10 weeks – 0.283 mg / kg. Group III – administration of pentoxifylline (7-10 weeks) and ceftriaxone (9-10 weeks) at a dosage of 2.86 mg against a 10-week opioid effect (from 0.212 to 0.283 mg / kg). For histological examinations, fragments of the dental segment of rats were collected using complex decalcification of the hard tissues of the dental organ. Microscopic studies in animals at 10 weeks of opioid action indicated pronounced inflammatory-dystrophic changes in periodontal tissues, which were manifested by necrotic changes in the mucous membrane of the gums, dystrophic periodontal damage and vascular disorders. Drug correction with pentoxifylline and ceftriaxone on the background of ten weeks of opioid action led to a protective effect on the microstructural organization of periodontal tissues of rats. Although complete restoration of periodontal structures in comparison with the control did not occur, however, the use of etiopathogenetic treatment contributed to a certain stabilization of the inflammatory process. The results showed that the use of pentoxifylline and ceftriaxone prevented the generalized progression of dystrophic changes in the periodontium with long-term opioid action, compared with the detected pathological changes in periodontal tissues in animals under ten weeks of opioid administration without corrective action.

Diagnosis of Liver Cirrhosis on the Background of Mutations H63D of the HFE Gene and H1069Q of the ATP7B Gene in associated with Hemochromatosis and Wilson's Disease (Clinical Case)

The purpose of the study was to ilustrate the analysis of etiological factors of liver cirrhosis using clinical and anamnestic data and the results of instrumental, laboratory and genetic researches. Materials and methods. The data of anamnesis and objective examination, results of instrumental, laboratory and genetic research methods are evaluated and analyzed. Modern protocols and medical literature were used. Results and discussion. Clinical case of the patient, 52 years old. Complaints of weakness, pain in the left hypochondrium, taste of iron, convulsions of the upper and lower extremities. Laboratory and instrumental methods of research allowed to establish the following indicators in the patient: erythrocytopenia, thrombocytopenia, neutropenia, persistent lymphocytosis, lecopenia, decreased platelet count, increased average erythrocyte volume and average hemoglobin content in one erythromycin distribution, albuminemia, increased beta globulin, decreased albumin to globulin ratio, increased liver enzymes (ALT, AST, bilirubin direct) and GGT, blood iron metabolism (COPD and iron levels), iron saturation and iron ferritin saturation, negative immunological analysis for antinuclear antibodies (ANA), HbS Ag and anti-HCV were not detected. The patient was consulted by a hematologist, lymphoproliferative diseases were excluded. On the basis of data on hepatosplenomegaly, portal hypertension, varicose veins of the esophagus, lymphadenopathy, excluding nonalcoholic fatty liver disease, alcoholic fatty liver disease, viral hepatitis, autoimmune hepatitis, biliary cirrhosis, diagnosed with a diagnosis on the detection of mutations that cause hemochromatosis and Wilson's disease. Molecular genetic studies have shown the following results: the H63D mutation of the HFE gene in the heterozygous state and the H1069Q mutation of the ATP7B gene in the heterozygous state were detected. Mutation testing and phenotype prediction based on genotype opens up prospects not only for personalized therapy, but also for the development of new treatment strategies. The literature provides data about new therapies with different mechanisms of action and discusses studies on Bis-choline tetrathiomolybdate in patients, pre-clinical studies of a novel chelator methanobactin and animal studies exploring cures for WD with gene therapy using adeno-associated vectors that introduce ATP7B into liver cells. Conclusion. The clinical case showed the need to involve specialists in various specialties and a set of research methods to establish the etiology of liver cirrhosis and further etiopathogenetic treatment and the formation of risk groups for primary prevention among relatives

RWD61 Analysis of the National Database of the Russian Federation on the Safety of Medicines for Etiopathogenetic Treatment covid-19 in Clinical Practice (REAL-WORLD DATA; RWD)

RWD61 Analysis of the National Database of the Russian Federation on the Safety of Medicines for Etiopathogenetic Treatment covid-19 in Clinical Practice (REAL-WORLD DATA; RWD)

Evaluation of amoxicillin efficacy in the pharmacotherapy of bronchopulmonary diseases in children

In recent years, the rational treatment of bronchopulmonary diseases in children has been developing in all directions and is of great importance in modern pediatrics. Medical statistics in different countries record a steady annual increase in the number of cases of respiratory infections, recurrent bronchitis, and bronchopneumonia. One of the main components of adequate etiopathogenetic treatment of bacterial infections, regardless of the severity and localization of the inflammatory process, is the rational choice of antibacterial agents. The urgent problem has been the safe pharmacotherapy of a growing organism, taking into account the etiology and pathogenesis of diseases, in accordance with the standard of treatment. The aim of this study was to evaluate the effectiveness of the drug Amoxicillin, depending on the severity of the course, complication and comorbidity in children receiving inpatient treatment at the Tashkent Pediatric Medical Institute Clinic.

Bone Involvement in Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by a wide variability of clinical manifestations due to the potential involvement of several tissues and internal organs, with a relapsing and remitting course. Dysregulation of innate and adaptive immune systems, due to genetic, hormonal and environmental factors, may be responsible for a broad spectrum of clinical manifestations, affecting quality of life, morbidity and mortality. Bone involvement represents one of the most common cause of morbidity and disability in SLE. Particularly, an increased incidence of osteoporosis, avascular necrosis of bone and osteomyelitis has been observed in SLE patients compared to the general population. Moreover, due to the improvement in diagnosis and therapy, the survival of SLE patient has improved, increasing long-term morbidities, including osteoporosis and related fractures. This review aims to highlight bone manifestations in SLE patients, deepening underlying etiopathogenetic mechanisms, diagnostic tools and available treatment.

Гастроэзофагеальная рефлюксная болезнь и коррекция ее проявлений у пациентов перед офтальмохирургическими вмешательствами

Purpose. Evaluation of the frequency of extraesophageal manifestations in the structure of gastroesophageal reflux disease (GERD) in patients admitted for ophthalmic surgery. Material and methods. The preoperative state of 76 patients with extraesophageal manifestations of GERD was analyzed. The assessment of the adequacy and effectiveness of drug therapy, algorithms for diagnosing extraesophageal manifestations of GERD is given, our own clinical case is presented to illustrate the complexity of diagnosing extraesophageal manifestations of GERD. Results. A group of 76 people with extraesophageal manifestations of GERD (21 %) out of 363 patients with GERD admitted for treatment in 2019 was studied. In 25 people (33 %), the extraesophageal form of GERD was not diagnosed before admission to the hospital. Of these, in 17 people GERD proceeded under the guise of cardiological pathology, in 8 people - under the guise of bronchopulmonary pathology. Conclusion. GERD occupies a leading position among diseases of the upper gastrointestinal tract (more than 30 %). About 21 % are atypical manifestations of GERD. Modern etiopathogenetic treatment of GERD makes it possible to effectively stop the symptoms of the disease, avoid polypharmacy, undesirable drug interactions and unreasonable refusal of planned surgical treatment for patients with ophthalmic diseases. Keywords: gastroesophageal reflux disease, extraesophageal manifestations, cardiological and bronchopulmonary “masks”, ophthalmic surgery.

Особенности поражения почек при системных заболеваниях соединительной ткани

Системные заболевания соединительной ткани (СЗСТ) — достаточно большая гетерогенная группа заболеваний, имеющих определенные характерные клинические проявления и нарушения иммунорегуляции, приводящие к образованию аутоантител. Субклинические или явные признаки вовлечения почек имеют значительное усугубляющее влияние на клиническое течение СЗСТ. Нарушение функции почек характерно для таких СЗСТ, как системная красная волчанка (СКВ), ревматоидный артрит (РА), системная склеродермия, синдром Шегрена, аутоиммунные миопатии (дерматомиозит и полимиозит). На современном этапе, учитывая доступность многих диагностических манипуляций и возможности этиопатогенетического лечения, терапевтам, ревматологам и нефрологам необходимо своевременно заподозрить наличие заболевания почек у пациентов с СЗСТ и принять необходимые меры по диагностике и лечению. Современные стратегии классификации и лечения СКВ скорректированы с учетом результатов биопсии почек, что значительно улучшило прогноз поражения почек при этом заболевании. Одно из наиболее тяжелых поражений почек у пациентов с СЗСТ — это почечный склеродермический криз (ПСК), характеризующийся тяжелой гипертонией, прогрессирующим снижением функции почек и тромботической микроангиопатией, своевременное назначение ингибиторов ангиотензинпревращающего фермента таким пациентам показывает значительный эффект в борьбе с ПСК. Контроль активности основного заболевания улучшает функцию почек у большинства пациентов с синдромом Шегрена, аутоиммунными миопатиями и РA. С другой стороны, хроническое использование иммунодепрессантов и нестероидных противовоспалительных препаратов, а также сопутствующие заболевания, такие как диабет, гипертония и сердечно-сосудистые осложнения, могут являться основными причинами поражения почек у пациентов с ревматическими заболеваниями. Кроме того, первичные заболевания почек с длительным анамнезом могут привести к проявлениям, имитирующим первичные ревматологические расстройства. В этом обзоре мы фокусируемся на диагностике нарушений функции почек вследствие основного заболевания, побочных эффектах препаратов и принятии решений о своевременном соответствующем лечении.

Features of Diseases of the Anterior Part of the Eye in Patients after COVID-19

There are quite systematic data of the ophthalmic manifestations in SARS-CoV-2, on the presence of conjunctivitis in patients with COVID-19, as well as on the detection of viruses in the lacrimal fluid and eye tissues. And, although ophthalmic manifestations are considered rather rare for COVID-19 and are not included in the list of important for diagnosis, there is not enough reliable data on the inflammatory processes of the eye’s anterior part and their connection with COVID-19, as well as those arising against the background of the treatment.Purpose. To study the development of inflammatory diseases of the anterior part of the eye in patients who have undergone the new coronavirus infection COVID-19.resu. In the Department of Infectious and Allergic Eye Diseases of the Helmholts National Medical Research Center of Eye Diseases, 88 patients with confirmed transferred new coronavirus infection COVID-19 of varying severity were observed. The main method of laboratory diagnostics is the detection of SARS-CoV-2 RNA in swabs from the nasopharynx, the patient’s sputum. Serodiagnostics of COVID-19 includes the determination of IgG-, IgM-antibodies to SARS-CoV-2 in the blood in an enzyme-linked immunosorbent assay.Results. Acute conjunctivitis associated with COVID-19 is quite rare and is an early sign of the disease. In the complex nonspecific topical therapy of viral conjunctivitis in COVID-19, along with etiopathogenetic systemic treatment, local eye medications with immunomodulatory and antiviral activity should be used. Conjunctivitis during a pandemic may be the only sign of COVID-19. The development of allergic conjunctivitis in COVID-19 is possibly associated not only with the effect of a viral agent, but also depends on the toxic effect of drugs used in the complex treatment of this disease. The increase in the number of patients with episcleritis after the postponed coronavirus infection needs further detailed study, with the analysis of laboratory data from this group of patients and the accumulation of clinical material.Conclusion. Ophthalmic manifestations in COVID-19 are very different, affecting various structures of the eye, occur at different periods — both during the course of the disease and after clinical recovery, and, of course, need further consideration, study and structuring.

Внепищеводные маски гастроэзофагеальной рефлюксной болезни: частота, особенности диагностики и подготовки пациентов к офтальмохирургическим операциям

Purpose. Evaluation of the frequency of gastroesophageal reflux disease (GERD) in the structure of somatic diseases of patients admitted to ophthalmic surgery, features of the manifestation and difficulties in diagnosing. Material and methods. The analysis of the preoperative state of 1213 patients with pathology of the gastrointestinal tract (GIT) was carried out. The frequency of GERD with typical and extraesophageal manifestations was studied. The assessment of the adequacy and effectiveness of drug therapy is given. Results. Pathology of the gastrointestinal tract in the structure of nosological forms of somatic diseases of patients entering ophthalmic surgery is 5–6%. GERD accounts for 30% of their number. Typical clinical manifestations of GERD occurred in 287 patients (79.1%). Of these, 203 people. (70.7%) were able to compensate for the disease, received adequate therapy with proton pump inhibitors. In 84 patients (29.3%), heartburn and epigastric discomfort persisted. In 76 patients (20.9%) with GERD, its extraesophageal manifestations were revealed. Have 29 people. (38%) they manifested themselves in the form of retrosternal pain. A paroxysmal dry cough, asthma attacks arising after eating, the appearance and aggravation of nocturnal symptoms of bronchial asthma disturbed 35 people (46%). Complaints of burning tongue, hoarseness, soreness when swallowing, sore throat, periodic laryngospasm were observed in 12 patients (16%). Conclusion. GERD takes the leading place among diseases of the upper gastrointestinal tract (more than 30%). About 21% are atypical manifestations of GERD. The most clinically significant among them, limiting the possibility of conducting planned surgical treatment, are cardiological and pulmonary masks. Modern etiopathogenetic treatment of GERD makes it possible to effectively stop the symptoms of the disease, avoid polypharmacy and unreasonable refusal in planned surgical treatment for patients with ophthalmic diseases. Key words: gastroesophageal reflux disease, extraesophageal manifestations, ophthalmic surgery.