Main Course Of Treatment Research Articles

The Phenomenon of Integration of Religious Practices as an Auxiliary Tool in Contemporary Medicine: Ukrainian Hospital Chapels in Modern Times

The relevance of the research topic is ensured by the wide integration of such religious practices as an aid in contemporary medicine. The article describes the activities of more than 15 currently operating famous hospital chapels. The histories behind the foundation of each of them are analyzed, and the facts of public participation and the leadership of hospitals in the establishment of chapels at medical institutions are given. Special attention is paid to the characteristics of the psychological support component as an auxiliary factor along with the main course of treatment. For clarity of the descriptive part, the study presents nine drawings, emphasizing the diversity and uniqueness of each of the described religious objects. It has been established that chapels at hospitals, in addition to their function as psychological support, also serve as support for spiritual orientation, as well as an additional area for the direct expansion of religious influence in society. At the same time, it is believed that the peculiarity of this kind of integration of religious practices into medical rehabilitation is that the spiritual component of treatment, even at the placebo level, can contribute to the patient's recovery process. In the course of the study, insufficient public coverage of comprehensive information on the functioning of hospital chapels was revealed, and it was also found that Ukrainian and foreign scientists did not study the issue of hospital chapels in the latest relevant publications.

HIV-Associated Multiple Drug Resistant Tuberculosis in a Pregnant Woman: Clinical Course, Treatment Efficacy and Perinatal Outcomes

A clinical case of HIV-associated multiple drug resistant tuberculosis in a pregnant woman is presented. The clinical situation was complicated since during the main course of treatment this patient had two pregnancies and delivery with an interval of less than 2 years, and the onset of the disease occurred during the early period in the first pregnancy. This case demonstrates effective treatment of the specific disease and favorable perinatal outcomes. The article assesses medical tactics, analyzes the time of diagnosis, complex therapy, the choice of the way of delivery, considers the need for interdisciplinary interaction at all stages of observation to improve the quality of care.

Features of the cytokine profile and the effectiveness of radical treatment of focal infection in patients with psoriasis

Background. Focal infection (FI) are important trigger factors for the development of psoriasis, which means they can aggravate the course of dermatosis, including due to an increase in certain pro-inflammatory cytokines in the blood.
 Aim. To study the cytokine profile of patients with psoriasis in the progressive period of the disease, as well as to assess the effect radical treatment of focal infection on the course of dermatosis.
 Material and methods. Prospective comparative non-randomized study included 52 patients with psoriasis vulgaris, aged 18 to 65 years, who signed a informed consent. The first group consisted of patients who underwent radical treatment FI (16 people), the second those who did not treat FI (16 people), and the third group consisted of patients in whom FI was not detected (20 people).
 Cytokine concentrations were measured in the progressive stage of the disease in 52 patients with psoriasis and 20 individuals in the control group (healthy individuals).The spectrum of detected cytokines included: IL-1, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17A, as well as INF- and INF-. For the detection of all cytokines, except for IL-17A, reagents from Vector-Best, Russia were used. The Human ELISA MAX Deluxe Set (BioLegend, USA) was used to determine the concentration of IL-17A.
 During the main course of treatment (0, 2 and 4 weeks), as well as the follow-up of patients (12, 24 and 52 weeks), the severity of psoriasis was assessed with the calculation of the PASI index. At the end of the study (week 52), the number of relapses and the total duration of remission were recorded.
 Results. The level of IL-8 was increased in 90,6% of psoriasis patients with FI. In this case, significant differences were obtained in comparison with the group of patients with psoriasis without diagnosed FI and with the control group, in which an increase in the concentration of IL-8 was noted, respectively, in 65% and 30% of cases. A moderate positive correlation was found between the IL-8 level and the PASI index (rs = 0,48; p = 3,6 104). The levels of INF- and IL-6 in psoriasis patients with FI were increased, respectively, in 15,6% and 21,9% of cases and significantly differed from the group of practically healthy individuals (p 0,05), differences from the group of patients with psoriasis without FI was not identified. The concentration of TNF- did not differ in all three groups. The level of IL-17A was significantly increased in comparison with practically healthy individuals both in the group of psoriasis patients with FI and in the group of patients without FI (Me = 3,3 and 4,3 pg/ml versus 0,2 pg/ml). The concentrations of five interleukin cytokines, namely IL-1, IL-2, IL-4, IL-10 and INF-, did not exceed the upper limit of the reference range in all patients of the experimental (patients with psoriasis) and control groups.
 Evaluation of the PASI index during the observation of patients in the first and second groups showed significantly lower values of this indicator for weeks 24 and 52 in the first group (0,2 vs. 7,0; p = 0,02 and 0,1 vs. 7,2; p = 0,002). The relative risk of disease recurrence in the absence of radical treatment for FI was 2,6 (CI 1,1 to 5,2).
 Conclusion. Data were obtained showing the role of IL-8 and focal infection, with the presence of which its increased production is associated, in the worsening of the course of psoriasis with the frequent development of relapses. Important preventive measures leading to a decrease in the number of relapses of psoriasis are timely diagnosis and radical treatment of focal infection.

EPIDEMIOLOGY AND PROGNOSTIC FACTORS IN PATIENTS WITH SUBDURAL HEMATOMA

SDH was first described in 1658 and in 1914 trauma was recognized as one of the causes. Acute SDH is more common in younger population while chronic is common in the elderly with the peak of incidence of 7.35/100000 per year in the age group 70-79 years. Trauma is one of the main causes of SDH although in 30-50% of patients direct trauma to the head can be omitted. Other predisposing factors include: anticoagulant therapy, epilepsy, and hypertension. The aim of the study was to determine risk factors and prognostic factors for the occurrence of SDH, also to show what age group is most at risk for developing chronic and acute SDH. Identify the diagnostic steps in proving SDH and the best method of treatment. The study includes 267 patients treated in the period from 1.1.2019 to 31.12.2019 at the Clinic for Neurosurgery CCS. SDH was diagnosed by neurological examination and brain CT in all patients and all were treated conservatively or surgically. The analytical statistics were used parametric and non-parametric tests of difference. The study included 185 men and 82 women of middle age 68 ± 17.19 years. Most patients were between 6-8 decades. Multiple changes in CT were observed in 63.3% of patients. Chronic SDH had 50.5% of patients and 45.6% had acute SDH. The most common symptoms were headache, psycho-organic syndrome, and hemiparesis. Patients with a GCS score of more than 8 had a better prognosis and outcome. Surgical treatment was the main course of treatment in our study. CT with / without contrast is the gold standard in detecting SDH. Men are at higher risk for the occurrence of SDH. Symptoms can occur later in the clinical presentation so we need to take caution when performing neurological examination. Factors that can lead us to suspect possible SDH are: age, gender, type of injury, clinical presentation, and time of occurrence.

The effectiveness of the main course of chemotherapy for drug-resistant tuberculosis

SummaryThe article is devoted to the effectiveness of treatment of tuberculosis with MDR-TB and XDR-TB mycobacteria after the main course of chemotherapy. The treatment of tuberculosis with multiple and broad MD MBT is a com-plex and urgent task. Prescribing the latest generation of drugs (thioureidoiminomethylpyridinium perchlorate, bedaquiline, linezolid) in the complex composition of tu-berculosis therapy with MDR and XDR-MBT significantly increases the effectiveness of the main course of treat-ment, compared with the control group, respectively (85.0% and 65.8%). Мaterials and methods. The main course of chemotherapy was completed by 119 patients with pulmonary tuberculosis with drug-resistant patho-gen, who were diagnosed for the first time, treated in anti-tuberculosis hospitals in St. Petersburg and on an outpatient basis in St. Petersburg “Inter-district Petro-grad-Primorsky TB dispensary No 3”. Clinical, radiological, and laboratory data are presented. All patients were iden-tified with Mycobacterium tuberculosis with multiple and broad drug resistance MBT. The patients were divided into 2 groups: the main group (OG) — 40 people, received the latest generation drugs; 79 patients (KG) — received standard therapy without the inclusion of the latest gen-eration of drugs. Half of the patients in all age groups were identified during a preventive examination (50.4%), a third when applying for complaints (31.9%), and one — when examining for contact with a patient with tubercu-losis. Infiltrative tuberculosis was most often diagnosed in 75 (63.0%), disseminated tuberculosis was detected in 20 (16.8%), and fibrocavernous pulmonary tuberculo-sis — in 24 (20.2%). The decay phase was diagnosed in 88 (73.9%) patients. Three-quarters of the studied patients had 90 comorbidities (75.6%). Results and discussion. The groups are comparable in terms of clinical, radiologi-cal, and bacteriological parameters. By the fourth month of the therapy, the cessation of bacterial excretion was significantly more often determined in patients taking bedaquiline, thioureidoiminomethylpyridinium perchlo-rate, linezolid as part of HT, compared with the group not receiving the above drugs 47.5% and 35.4%, respectively, (p<0.05); by the end of the intensive phase of treatment, the cessation of bacterial excretion occurred in OG in 92.0%, KG — 57.0% (p<0.001). Conclusions. The inclu-sion of drugs thioureidoiminomethylpyridinium perchlo-rate, bedaquiline, linezolid in the complex chemotherapy of tuberculosis with multi-resistant tuberculosis increases the effectiveness of the main course of treatment com-pared to the KG.

MELATONIN AND GRHELIN AS “EARLY” PROGNOSIS MARKERS OF PROGRESSION OF ARTERIAL HYPERTENSION AND OSTEOARTHRITIS IN THE CASE OF THEIR COMORBIDITY

The aim: Of the study was to investigate the effect of melatonin on the serum levels of ghrelin in patients with hypertension combined with osteoarthritis in order to identify them as informative and reliable markers of early diagnosis of progression of these comorbid diseases. Material and methods: To achieve the goals and objectives of this study, 60 patients with hypertension combined with osteoarthritis were involved and examined, in particular, serum ghrelin and melatonin levels were determined twice and divided into two groups. Results: It was found that in patients of group I on the background of the four-week main course of treatment with the addition of melatonin (3 mg 1 time per day before bedtime), the average value of ghrelin increased by an average of ± 2.05 ng/ml (p <0,05). In patients of group II, who, in addition to their usual treatment, did not receive additional melatonin, the dynamics of ghrelin growth was lower, on average increased by ± 0.54 ng/ml (p <0.05). It was also found that the higher the BMI, the lower the serum ghrelin in the examined patients (r = -0.56, p <0.01). Conclusions: The data obtained show the correlation between ghrelin and melatonin concentrations (r = +0.72, p < 0.001) in patients with hypertension associated with OA. Therefore, indicators of their levels can be used as "early" reliable prognostic markers of development and progression of these mentioned comorbid pathologies.

Генетические факторы риска эффективности лечения при туберкулезе

Прогноз лечения при туберкулезе, как мультифакториальном заболевании, зависит от взаимодействия генетических и средовых факторов, поэтому перспективным является выявление генетических маркеров, которые могут обусловливать состояние иммунологической резистентности организма и тем самим эффективность его излечения. Представлены результаты наблюдения принимавших основной курс лечения 337 больных различными формами туберкулеза легких. Из них у 259 определяли методом аллель-специфичной ПЦР варианты делеционного полиморфизма генов GSTM, GSTT и CYP2E1. The prognosis of treatment for tuberculosis, as a multifactorial disease, depends on the interaction of genetic and environmental factors, therefore, the identification of genetic markers that can determine the state of immunological resistance of the body and thereby the effectiveness of its cure is promising. The results of the observation of 337 patients with various forms of pulmonary tuberculosis taking the main course of treatment are presented. Of these, 259 were determined as indicators-markers of genetic identification, allele-specific PCR variants of deletion polymorphism of the GSTM, GSTT and CYP2E1 genes.

NITRIC OXIDE METABOLISM IN PATIENTS WITH COMMUNITYACQUIRED PNEUMONIA ASSOCIATED WITH CORONARY HEART DISEASE AND THE POSSIBILITY OF ITS MEDICAMENTOUS MANAGEMENT

The aim: To assess the metabolic by-products of nitric oxide in peripheral blood before and after the medicamentous management in patients suffering from community-acquired pneumonia associated with coronary heart disease. Materials and methods: We have examined 102 patients with community-acquired pneumonia aged from 50 to 65 years, of which 58 patients were diagnosed with coronary heart disease (CHD). The complex treatment of patients with coronary heart disease was supplemented by the additional use of tivortin aspartate, which was taken orally with food at the dose of 5 ml (1g) 3 times a day for 15 days. The NO content in blood plasma was assessed by the concentration of the amount of final NO metabolites (NO3 + NO2), identified by means of the photocalorimetric method. Results: The content of (NO3 + NO2) in peripheral blood of patients with CAP was slightly higher (6.83 ± 0.29) μmol/l as compared to the group of apparently healthy individuals (5.19 ± 0.14) μmol/l, while in patients with CAP associated with CHD it has markedly increased to (12.74 ± 1.09) μmol/l. Against the background of administered treatment, the index of (NO3 + NO2) in patients with coronary heart disease has decreased to (5.76 ± 0.33) μmol/l, while in the group of patients who were not given tivortin aspartate additionally, this index has even slightly increased (7.01 ± 0.40) μmol/l. Conclusions: Marked increase of (NO3 + NO2) levels in blood pointed to destabilization of the course of coronary heart disease with CAP, which was eliminated by the involvement of tivortin aspartate (15 days) to the main course of treatment.

Fatal reversible cerebral vasoconstriction syndrome: A systematic review of case series and case reports

ObjectiveTo describe patient characteristics, radiological findings and the clinical course of adults with fatal reversible cerebral vasoconstriction syndrome (RCVS). MethodsA systematic literature search from January 1, 2000, until December 31, 2018, was performed using PubMed, EMBASE, Scopus, Cochrane reviews, LILACS and Scielo. Studies reporting RCVS in adult patients with fatal outcomes were included. Results430 studies were initially identified, 179 full-text articles were reviewed, and 9 publications describing 12 subjects were included. The vast majority of the reports were from the U.S. Most of the female cases occurred during postpartum. All patients had a headache on initial presentation, although only 42% had thunderclap headache. A CT scan was performed on 67% of the patients. Imaging results were diverse, with a tendency toward cerebral hemorrhage followed by mixed cases. The main course of treatment included steroids (58% of the patients), with only 42% receiving nimodipine. The time to death ranged from 4 to 14 days, with a median of 9.2 days (SD ± 3.2). ConclusionWe found that the majority of fatal cases reported in the literature are most likely related to postpartum angiopathy. We established a tendency in the onset of brain hemorrhage and the combination of infarction and brain hemorrhage. We described various markers for poor prognosis, including focal signs, the presence of hemorrhage and infarct in the first diagnostic image obtained and the need for invasive interventions. The majority of fatal cases in our report occurred in women, with over half of those cases during the puerperium period.

Clinical and Laboratory Investigation of Children with Systemic Lupus Erythematosus (SLE) Referring to Lupus Clinic of Dr. Sheikh Hospital, Mashhad, Iran

Background: Systemic lupus erythematous (SLE) is a multisystemic and autoimmune inflammatory disease characterized by production of autoantibodies against different cellular components. We aimed to investigate children with SLE in terms of clinical symptoms and laboratory findings who referred to Lupus clinic.Materials and Methods: In this cross-sectional study, 36 children with SLE referring to lupus clinic of Dr. Sheikh hospital, Mashhad-Iran, were enrolled for one year. Clinical symptoms and involvement of different organs were completely checked and recorded at the time of diagnosis of lupus disease based on questionnaire information. The patients with nephritic manifestations of lupus underwent needle biopsies of kidneys, with the samples being examined by light microscope and immunofluorescence to investigate the extent of renal involvement. The main course of treatment included steroid- cyclophosphamide (injection and oral), hydroxychloroquine - mycophenolate (Cellcept) and Azathioprine. Then, response or lack of treatment response as well as the extent and severity of relapse were recorded based on questionnaire. Results: In this study, out of 36 lupus patients, 30 were female (83.3%). The mean age was 9.15±4.28 years. Lupus nephritis, musculoskeletal manifestations, hematological manifestations, cutaneous manifestations, and neurological manifestations existed in 20 (55.6%), 11 (30.6%), 9 (25.0%), 7 (19.4%), and 4 (11.1%), respectively. There was no significant relationship between the age plus gender and lupus clinical manifestations. However, there was a significant relationship between relapse of disease and lupus nephritis (p

Functional state of the autonomic nervous system, adaptation, homeostasis and reactivity of the organism in the clinic of tuberculosis and sarcoidosis

In recent decades, the shift in priority in the treatment of patients with pulmonary granulomatosis in the direction of etiotropic therapy and reduced attention to the state of the macroorganism led to a decrease in the effectiveness of treatment. In modern conditions, when carrying out complex therapy for patients with tuberculosis and sarcoidosis, insufficient attention is paid to the state and dynamics of adaptation, resistance, homeostasis and reactivity of the organism. At the same time, the dynamics of these processes in patients is insignificant, the homeostatic balance of the organism is not restored, and the reactivity of the organism remains at the pathological level, with the predominance of paradoxical, hyporeactive and areactive types. This is due to the continuing influence on the regulatory centers of the vegetative system of not diagnosed, latent, ongoing tuberculosis intoxication. Undetected specific intoxication causes in patients activation of the sympathetic department, suppression of parasympathetic and development of dysfunction of the autonomic nervous system. Its dysfunction leads to a decrease in vascular supply of the organism, a high tension of anabolic processes, and a further change in the functional activity of both parts of this system when pathology develops. In addition, the emergence of vegetative dysfunction leads to a high consumption of plastic materials, energy resources, a decrease in the functional reserves of the body, a decrease and depletion of the body’s defense systems, its anti-inflammatory potential and the reactivity of the organism as a whole. These changes lead to an extension of the main course of treatment and the formation of expressed residual tubercular and sarcoidosis in the respiratory organs. To restore these disorders, it is necessary to carry out complex therapy with the inclusion of a personified appointment of activators of protective systems under the control of monitoring their effectiveness.

Change in homeostasis of the body and the outcome of tuberculosis in the treatment of antituberculous medicines

Fundamental research in the field of physiology revealed the important role of the state of homeostatic balance of the body in the emergence, development and outcome of human diseases, including granulomatous respiratory diseases- tuberculosis and sarcoidosis. To assess the homeostasis of the body in clinical conditions, various research methods are used - immunological, biochemical, hormonal and functional. However, in the daily work they can’t always be performed for technical and economic reasons. Proposed a new available diagnostics criterion of homeostasis based on the study of the quantitative and qualitative characteristics of the leukocytic formula of peripheral blood at the Department of videopornonoelia the First St. Petersburg state medical University Academy I. P. Pavlov. Among them types of adaptive reactions, leukocyte- lymphocytic index, entropy and redundancy of indicators of leukogram, monitorama blood, the degree of homeostasis and types of reactivity of an organism. During their approbation in the clinic high information content was revealed: more than 70% of the examined patients with tuberculosis of respiratory organs had defective types of adaptive reactions (intense), indices of proliferation and differentiation of monocytes were changed, and reactivity of the organism was characterized by pathological types (hyperreactive, paradoxical, hyporeactive and areactive). Treatment of patients with anti-tuberculosis drugs partially improved homeostasis, but its full recovery at the end of the main course of treatment did not occur. For better treatment in complex therapy, it is necessary to activate the body’s protective systems with the use of adaptogens (drugs, medicinal plants, physical factors: ultrasound, ultra-high-frequency inductothermy, alternating magnetic field on the regulatory centers of the suprasegmental apparatus of the autonomic nervous system). Monitoring of the state of homeostasis is most convenient to carry out using the proposed new available criteria for its evaluation.

The skin test with tuberculous recombinant allergen AT successful treated patients with lung tuberculosis

38 patients with newly diagnosed tuberculosis, immediately after the end of the main course of treatment, when they were transferred to the third group of dispensary supervision (6-9 months) and when they were removed from the dispensary supervision (2-3 years later), a skin test with an allergen tuberculous recombinant was made. The positive skin test with tuberculosis recombinant allergen was defined at 20 patients - 13 mm. At the moment of removing to the III group only one skin test with tuberculosis allergen recombinant became negative, 19 (94,5%) patients had positive reactions - 13±2,3 mm. At the time of discharging from dispensary the positive reactions were determined at 16 (80%) cases - 10±2,3 mm, p0,05. In this group, 13 (65%) patients had normergic skin tests with tuberculosis allergen recombinant and 7 (35%) - hyperergic tests. At the time of removing to the III group at five from seven patients with hyperergic tests the results remained the same, median and at the moment of discharging from tuberculosis service only one patient had the hyperergic skin test with tuberculosis allergen recombinant - 18mm. Among patients with normergic skin tests with tuberculosis allergen recombinant at the time of group III removing median was 11±2,1 mm. At the last dynamic control the normergic results were determined at 15 (75%) patients and the tests median remained almost unchanged - 10±1,8 mm, the differences are reliable compared to the initial data (p0,05). In group which included 18 patients with negative skin tests with tuberculous allergen recombinant, the skin response stayed negative throughout all examination period except for one patient so patients of this group had not only clinical, radiological and bacteriological, but immunological signs of involution of the tuberculosis process. The study of the influence of clinical, epidemic and social factors to skin reaction showed that first group patients were significantly more likely to be unemployed (30% versus 5,5%; p0,05) whereas in second group married patients were reliably registered (61,1% versus 25%; p0,05). Other factors differed unreliably.

Abstract 4768: Characteristics of patients diagnosed de novo with AJCC7 stage III or regionally advanced cutaneous melanoma and trends in adjuvant therapy: An analysis of the SEER cancer registry in the United States

Abstract Background: The v1.2018 National Comprehensive Cancer Network guidelines adopted nivolumab and dabrafenib/trametinib as potential adjuvant therapies for selected patients (pts) with AJCC7 stage III/regionally advanced melanoma. There is a need to understand which patient characteristics may affect adjuvant treatment choices and what lessons can be learned from the era of adjuvant interferon-alfa and ipilimumab. This study aimed to describe characteristics and use of adjuvant therapy in pts with stage III/regional melanoma. Methods: Pts newly diagnosed with invasive melanoma were identified in the US Surveillance, Epidemiology, and End Results (SEER) cancer registry (most recent 5 years: 2010 -2014; n = 106,195). Stage III melanoma was defined based on the AJCC7 classification (n = 7,669); pts classified as AJCC7 stages I/II but with reported lymphatic metastasis were considered regionally advanced and included (n =169). Pt characteristics measured at the time of the diagnosis are reported by treatments (systemic and radiation) initiated as the main course of treatment in the 4 months post-diagnosis. Results: Of 7,838 pts with stage III/regional disease at diagnosis from 2010-2014, 1,414 (18.0%) received radiation therapy (± systemic), 1,001 (12.8%) received systemic therapy (± radiation), 443 (5.7%) received radiation + systemic therapy, and 5,866 (74.8%) were not treated with either radiation or systemic therapy. Table 1 reports selected patient characteristics by treatment received. Conclusions: The results of this study indicate that many pts with stage III/regional melanoma, even those not treated, have risk factors known to be associated with worse prognosis. Use of radiation therapy or adjuvant systemic therapy was rare during the study period (2010-2014). It remains to be determined how the new treatment landscape will change the use of adjuvant therapy. Table 1.Stage III1/regionally advanced melanomaRadiation (± systemic)(n =1,414 )Systemic (± radiation) (n = 1,001)Systemic + radiation (n = 443)Neither2 (n =5,866 )Age at diagnosis, median (Q1-Q3)65 (55 - 76)58 (48 - 68)61 (51 - 71)62 (51 - 73)Males, %57.351.174.337.6LN classification (from TNM), %N145.347.545.461.9N2 (includes N2c)35.334.139.726.7N319.118.114.011.4Ulceration, %Yes20.325.29.339.0No22.824.38.846.3Unknown56.950.581.914.7Number mitoses per square mm, %None1.62.70.94.71 - 514.818.84.539.3≥ 615.018.27.924.3Unknown68.660.386.731.7LN involvement (any), %91.494.091.693.91 LN33.637.431.857.72 - 3 LNs25.326.323.922.5&amp;gt; 3 LNs19.216.818.57.5Unknown number of LNs13.313.617.46.2Microscopic nodal metastasis3 (regardless of the number of LNs)20.231.28.861.7Satellite / in-transit without LN involvement (N2c), %5.32.62.55.2LN, lymph node; TNM, tumor/node/metastasis (TNM) classification of malignant tumors. [1] Stage III melanoma was defined based on the American Joint Committee on Cancer (AJCC) 7 edition classification; [2] Radiation therapy and chemotherapy are reported in the SEER with moderate sensitivity (80% and 68%, respectively) and high specificity. This implies the "Neither" category may include some false -negative (i.e., treated) pts.[3] Includes pts identified with clinically occult (microscopic) LN metastases only, pts with isolated tumor cells only in LN, and/or pts who underwent sentinel LN biopsy and were found to have LN metastasis. Citation Format: Ahmad Tarhini, Sameer Ghate, Antonio Nakasato, Raluca Ionescu-Ittu, Sherry Shi, Briana Ndife, Rebecca Burne, François Laliberté, Mei S. Duh. Characteristics of patients diagnosed de novo with AJCC7 stage III or regionally advanced cutaneous melanoma and trends in adjuvant therapy: An analysis of the SEER cancer registry in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4768.

Клінічна ефективність корекції стану мікробіоти піхви у жінок з порушеннями репродуктивного здоров’я і післяпологовими ускладненнями в анамнезі

Vaginal flora plays an important role in the functioning of the reproductive system. The objective: was to evaluate the efficacy and tolerability of vaginal suppositories of Florica (producer «Lekhim-Kharkiv») in maintaining a normal balance of vaginal microbiota to prevent recurrences of bacterial vaginosis, aerobic and mixed vaginal dysbiosis. Materials and methods. 45 women of reproductive age (from 22 to 35 years) with burdened reproductive (miscarriage, premature birth) and obstetric (postpartum purulent-septic diseases) history were under observation. Results. Application to maintain a normal balance of the vaginal microbiota and prevent the development of dysbiotic processes after the completion of the main course of treatment of BV and aerobic vaginitis of vaginal suppositories Florica, which contain a specially treated mass of live lactic bacteria in optimal quantities to maintain a healthy balance of the microflora of the female sexual sphere (5107 Lactobacillus acidophilus and Bifidobacterium) allows to reduce the frequency of recurrence of BV in 2.9 times. Conclusion. The frequency of recurrence of BV in routine clinical practice is 35.0% during 6 months of observation, which indicates the need to develop effective measures to prevent the recurrence of vaginal dysbiotic processes. Key words: vaginal microbiota, vaginal dysbiosis, bacterial vaginosis, aerobic vaginitis, topical therapy.

Clinical and radiological characteristics of the course of the newly diagnosed tuberculosis spondylitis in adults and the effectiveness of the main course of antimycobacterial therapy

Study objective – set the frequency of detection of the newly diagnosed tuberculous spondylitis, the features of clinical and radiological manifestations of it and the effectiveness of the main course of antimycobacterial therapy.Materials and methods. To establish the frequency of a specific spondylitis in patients in the total number of cases of osteoarticular tuberculosis, a retrospective analysis of 197 patient history records for the period 2001–2015 was conducted. 38 medical records of subjects who were treated in the extrapulmonary tuberculosis department of the Municipal Institution Regional Tuberculosis Clinical Dispensary of Zaporizhzhia Regional Council. The average age of patients was 50.3 ± 2.3 years. There were 14 (36.8 %) women and 24 (63.2 %) men. Study results were processed by modern methods of analysis on a personal computer using statistical software package Statistica® for Windows 6.0 (Stat Soft Inc., AXXR712 D833214FAN5).Results. It was established that for the period of 2001–2015 the frequency of cases of newly diagnosed tuberculosis spondylitis in the total structure of osteoarticular tuberculosis was 74.1%. The following features of the course of newly diagnosed tuberculosis spondylitis were established on the basis of the study of its clinical and radiological manifestations. In 84.2 % of cases, tuberculosis spondylitis develops predominantly as an independent disease. In all 100 % of cases there is an imperceptible start, slow progression and presence of local pain of varying degrees of severity in the area of vertebral column lesion. In 100 % of cases, the disease is accompanied by a destructive process of vertebrae bone tissue, including 84.2 % of floating abscess, and 86.9 % of simultaneous lesion of 2 adjacent vertebrae of the vertebral column. In 39.4 % of cases, it is accompanied by complications of a neurological nature. Assessment of effectiveness of the main course of antimycobacterial therapy in category 1 patients with the newly diagnosed tuberculosis spondylitis revealed that among 22 patients who received complete main course of treatment without operational intervention, it was effective in 86.3% patients.Conclusions. The frequency of newly diagnosed tuberculosis spondylitis is 74.1 %. The obtained data on the peculiarities of the course of the newly diagnosed tuberculosis spondylitis indicate a significant process severity that requires long-term treatment. The main course of antimycobacterial therapy for category 1 patients is quite effective, but given the severity and duration of the healing of a specific process, it is not long enough. There is high percentage of cases of refusal from inpatient treatment indicating the need for constant work among patients in relation to treatment adherence.

ЭФФЕКТИВНОСТЬ ХИМИОТЕРАПИИ С ПРИМЕНЕНИЕМ БЕДАКВИЛИНА У БОЛЬНЫХ ТУБЕРКУЛЕЗОМ ЛЕГКИХ С ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ ВОЗБУДИТЕЛЯ

The objective: to evaluate the efficiency of chemotherapy with bedaquiline in pulmonary tuberculosis patients with multiple drug resistance Subjects and methods. The chemotherapy efficiency was studied in 70 tuberculosis patients with extensive (XDR) or multiple (MDR) drug resistance who were treated in clinics of Central Tuberculosis Research Institute All patients were divided into 3 groups: Group 1 (10 persons) included MDR TB patients, Group 2 (32 persons) included pre-XDR TB patients, Group 3 (28 persons) included XDR TB patients Results of the study. High treatment efficiency in this difficult category of pulmonary tuberculosis patients with MDR and XDR was achieved when bedaquiline was added to the chemotherapy regimen Upon the completion of the main treatment course with bedaquiline, in the group of patients with MDR and pre-XDR the sputum conversion was achieved in 100%, and in XDR tuberculosis patients the sputum conversion rate made 893% The long-term treatment course with bedaquiline promoted the fastest sputum conversion, healing of cavities in the lungs of patients with disseminated tuberculosis and XDR, and it was not associated with a higher frequency of adverse events

Abstract WP132: Fatal Reversible Cerebral Vasoconstriction Syndrome: A Systematic Review of Case Series and Case Reports

Introduction: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches and constriction of cerebral arteries related with stroke. Hypothesis: To describe the patients characteristics, radiological findings and clinical course of adults patients with fatal RCVS. Methods: A systematic literature search using MEDLINE and EMBASE was performed up to March 6, 2017. Studies reporting RVCS in adult patients with fatal outcomes were included. Results: Of 368 initially identified studies, 121 full text articles were reviewed, of which 6 publications describing 10 subjects were entered. The vast majority of the reports came from the U.S except for one report form Denmark that included a male patient. Almost all the cases occurred during pregnancy or post-partum. Only 40% subjects had a history of migraine. The clinical presentation involved headache although only 20% presented with thunderclap headache and 14.3% had seizures. A CT was performed in 71.4% of the patients and the rest had an MRI. Imaging results were diverse with trend towards PRESS and ICH. The main course of treatment included steroids in 70% of the subjects and only 30% received nimodipine. Time to death ranged from 7 to 24 days with a median of 11 days. Conclusion: Most of the time RCVS has a benign course, however we described fatal cases from the literature mostly related with post-partum angiopathy. We found a trend in the onset with PRESS, ICH and diffuse cerebral edema with less subjects using nimodipine as main treatment. We described some markers for worse prognosis. Table 1 Description of studies Fig. 1

Evaluation of a software module for adaptive treatment planning and re-irradiation

BackgroundThe aim of this work is to validate the Dynamic Planning Module in terms of usability and acceptance in the treatment planning workflow.MethodsThe Dynamic Planning Module was used for decision making whether a plan adaptation was necessary within one course of radiation therapy. The Module was also used for patients scheduled for re-irradiation to estimate the dose in the pretreated region and calculate the accumulated dose to critical organs at risk. During one year, 370 patients were scheduled for plan adaptation or re-irradiation. All patient cases were classified according to their treated body region. For a sub-group of 20 patients treated with RT for lung cancer, the dosimetric effect of plan adaptation during the main treatment course was evaluated in detail. Changes in tumor volume, frequency of re-planning and the time interval between treatment start and plan adaptation were assessed.ResultsThe Dynamic Planning Tool was used in 20% of treated patients per year for both approaches nearly equally (42% plan adaptation and 58% re-irradiation). Most cases were assessed for the thoracic body region (51%) followed by pelvis (21%) and head and neck cases (10%). The sub-group evaluation showed that unintended plan adaptation was performed in 38% of the scheduled cases. A median time span between first day of treatment and necessity of adaptation of 17 days (range 4–35 days) was observed. PTV changed by 12 ± 12% on average (maximum change 42%). PTV decreased in 18 of 20 cases due to tumor shrinkage and increased in 2 of 20 cases. Re-planning resulted in a reduction of the mean lung dose of the ipsilateral side in 15 of 20 cases.ConclusionThe experience of one year showed high acceptance of the Dynamic Planning Module in our department for both physicians and medical physicists. The re-planning can potentially reduce the accumulated dose to the organs at risk and ensure a better target volume coverage. In the re-irradiation situation, the Dynamic Planning Tool was used to consider the pretreatment dose, to adapt the actual treatment schema more specifically and to review the accumulated dose.

ОСОБЕННОСТИ ТЕЧЕНИЯ БЕРЕМЕННОСТИ, ПЕРИНАТАЛЬНЫЕ ИСХОДЫ И РЕЗУЛЬТАТЫ ЛЕЧЕНИЯ ТУБЕРКУЛЕЗА У ЖЕНЩИН БЕЗ ВИЧ-ИНФЕКЦИИ

The objective of the study is to investigate the specific course of pregnancy, perinatal outcomes and treatment results in HIV negative female patients. Subjects and Methods . Medical files of 109 pregnant tuberculosis patients were analyzed who were followed up in Krasnoyarsk Regional TB Dispensary no. 1 from 2010 to 2014. Results . The part of children prematurely born by mothers ill with tuberculosis was practically compatible with the overall national cohort of live-born children (6.8% in the analyzed group versus 5.7% in the national cohort for 2014). The part of children with congenital abnormalities born by mothers suffering from tuberculosis turned out to be twice lower versus the overall national cohort of live-born children (1.4% versus 3.0% in 2010 and 2.9% in 2014). The efficiency of the main treatment course in pregnant women without multiple drug resistant tuberculosis, of which 3.8 ± 0.3 months of tuberculosis treatment coincided with pregnancy was practically the same as treatment efficiency for the overall cohort of patients in Krasnoyarsky Kray (66.2% in the analyzed cohort versus 60.3-72.7% in the regional cohort for 2010-2014). In the pregnant with multiple drug resistant forms of tuberculosis, treatment efficiency was lower versus the regional cohort (30.4% in the analyzed cohort versus 41.1-60.2% in the regional cohort for 2010-2014).