Medicamentous Therapy Research Articles

Nimotuzumab-vinorelbine combination therapy versus other regimens in the treatment of pediatric diffuse intrinsic pontine glioma.

Pediatric diffuse intrinsic pontine glioma (DIPG) is a fatal disease associated with a median survival of < 1year despite aggressive treatments. This retrospective study analyzed the treatment outcomes of patients aged < 18years who were diagnosed with DIPG between 2012 and 2022 and who received different chemotherapy regimens. After radiotherapy, patients with DIPG received nimotuzumab-vinorelbine combination or temozolomide-containing therapy. When nimotuzumab was unavailable, it was replaced by vincristine, etoposide, and carboplatin/cyclophosphamide (VECC). Temozolomide was administered as a single agent or a part of the combination chemotherapy comprising temozolomide, irinotecan, and bevacizumab. Furthermore, 1- and 3-year overall survival (OS), progression-free survival (PFS), and median OS and PFS were analyzed. The median age of 40 patients with DIPG was 97 ± 46.93 (23-213) months; the median follow-up time was 12months. One and 3-year OS were 35.0% and 7.5%, respectively. Median OS was 12months in all patients (n = 40), and it was 16, 10, and 11months in those who received first-line nimotuzumab-vinorelbine combination (n = 13), temozolomide-based (n = 14), and VECC (n = 6) chemotherapy regimens, respectively (p = 0.360). One patient who received gefitinib survived for 16months. Conversely, patients who never received radiotherapy and any antineoplastic medicamentous therapy (n = 6) had a median OS of 4months. Nimotuzumab-vinorelbine combination therapy prolonged OS by 6months compared with temozolomide-containing chemotherapy, although the difference was not statistically significant.

Case of intestinal obstruction by gravel in red-eared slider (Trachemys scripta elegans) solved with medicamentous therapy

Red-eared sliders (Trachemys scripta elegans) are often kept as pets, even though their sale is prohibited in many countries due the invasiveness of this species. This report describes a case of a 4-year-old red-eared slider that presented with a month-long history of lethargy and unwillingness to go into the water and was unsuccessfully treated with antibiotics and corticosteroids. Upon clinical and radiological examination, it was discovered that the patient was suffering from intestinal obstruction caused presumably by gravel stones. Medicamentous therapy consisting of meloxicam, lactulose and Ringer?s solution for reptiles was then started and the turtle managed to pass all the ingested stones via the alimentary tract. Control radiological examination has shown no signs of high-density structures in the lumen of the intestines, and the turtle has made a full recovery. With enterotomy often being considered indicated in chelonians suffering from intestinal obstruction caused by gravel, this is, to the best of the authors? knowledge, the first reported case of this kind resolved solely with medicamentous therapy in a red-eared slider.

Дренажная хирургия с клапаном Ахмеда при увеальной глаукоме

Aim. To evaluate the efficiency of Ahmed valve use for patients with refractory uveal glaucoma (UG). Methods. The effectiveness of the use of the drainage device – Ahmed valve presented on the example of three clinical cases of chronic uveitis with UG. Previosly all the patients had antiglaucomatous surgery, including non-penetrating deep sclerctomy, sinustrabeculectomy, stent surgery with ExPress shunt and subsequent filtering bleb needling Fast scarring was noticed in every case in the area of operation. Prescription of maximal medicamentous therapy was required from 2 to 6 months after the surgery and it was effective for a short period of time. Results. Implantation of Ahmed valve was performed in a period of stable medical remission of uveitis. Postsurgical period was unremarkable, within follow-up for 6–15 months intraocular pressure was normalized without medicamentous therapy, valve position and filtration were stable. Сonclusion. Stent surgery with the use of Ahmed valve for patients with UG gives more stable and prolonged hypotensive effect. Key words: intraocular pressure; uveal glaucoma; antiglaucomatous surgery; Ahmed valve.

Early Coronary Artery Disease in a Female Patient with Discoid Lupus Erythematosus and Hashimoto’s Thyroiditis

BACKGROUND: Atherosclerosis is a chronic inflammatory condition involving the endothelium of the blood vessels, predominant the coronary arteries. Main risk factors are dyslipidemia, hypertension, diabetes, smoking, obesity, and lack of physical activity. Patients with autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis etc., have a twofold increased risk of developing CAD at younger age, compared with the general population. CASE REPORT: A 41-year-old female patient, with history of smoking and dyslipidemia, was admitted to our hospital with acute inferoposterior myocardial infarction. Initially, coronary reperfusion therapy per protocol was administrated and primary percutaneous coronary intervention (PCI) was performed. Multivessel CAD was found, and two stents were implanted on obtuse marginal and circumflex artery. Transthoracic echocardiography (TTE) revealed left ventricle systolic and diastolic dysfunction with segmental hypokinesis. Additionally, the patient was first diagnosed with DLE at the age of 15, but the disease was uncontrolled in the last 7 years. She also has hypothyroidism, regularly treated with hormone replacement therapy. The patient was discharged with medicamentous therapy including dual antiplatelet agents, statin, beta-blocker, angiotensin-receptor blocker, potassium sparing diuretic and proton pump inhibitor. One month later, recoronarography was performed with stenting of left anterior descending artery. TTE showed improvement of the left ventricle systolic function with preserved ejection fraction. The blood test showed elevated levels of antithyroid antibodies. A rheumatologist was consulted, who recommended therapy with hydroxychloroquine and regular follow-ups. CONCLUSION: In younger patients with chronic inflammatory diseases, inflammatory mediators play a significant role in the development of the atherosclerotic plaques, regardless of co-existing risk factors. Therefore, an early cardiovascular assessment is required in these patients for preventing severe or life-threatening cardiovascular events.

Outcomes after staged surgical treatment of children with ileocecal lesions and active extensive inflammation in Crohn’s disease

Introduction. Crohn’s disease is characterized with transmural lesion of the gastrointestinal tract which is frequently localized in the ileocecal region. Despite the achievements in medicamentous therapy, 15–45% of children have to be operated on within 5 years after the diagnosis is verified. Purpose. To substantiate the efficacy of two-stage surgical treatment of children with Crohn’s disease , ileocecal lesion and active extensive inflammation. Material and methods. A single-stage retrospective-prospective study included 43 children with ileocecal lesions and advanced colitis. Two-stage surgical treatment was performed. In the preoperative period, the following parameters were assessed: physical state, clinical activity, anemia and the level of hypoalbuminemia as well as inflammation markers, findings at endoscopy and MRI. Indications for surgical treatment were strictures in the ileocecal region, endoscopic and clinical activity and colon lesion and / or purulent-septic lesions in the perianal region. 39 (90.7 %) children had laparoscopically-assisted surgeries. 4 (9.3 %) children underwent conversions due to a pronounced infiltrative process in the abdominal cavity. Results. Lengths of hospitalization for children with stoma varied from 5 to 20 months (median 8 months). PCDAI index: in 25 (57.8 %) high activity, in 18 (41.2 %) moderate activity. After surgical intervention: 7 (16.2%) children had mild course, 36 children (p 0.05) SES-CD before surgery – all children had high endoscopic activity. In the postoperative period by Rutgeerts scale findings, there was a statistically significant positive dynamics (p = 0.011). Anthropometric parameters (HAZ p 0.05; BAZ p 0.001) and laboratory findings (p 0.001) were statistically significant for positive dynamics too.In the postoperative period: 5 (11.6 %) children developed ligature fistulas; 2 children (4.6 %) had narrowed intestinal anastomosis without passage disorders; 2 (4.6 %) children developed acute adhesive intestinal obstruction. In foreign and Russian publications, postoperative complications were reported in 6 % to 29 %. Conclusions. Crohn’s disease has led to chronic anemia, hypoalbuminemia, chronic bacterial inflammation, reduced physical growth and worsen quality of life. After the two-stage surgical treatment, the statistical analysis demonstrated a significant improvement in mass-growth, laboratory and endoscopic parameters.

Whether exercises and testosterone replacement therapy support a treatment for cardiovascular and atherosclerotic patients with iliac artery stenosis and low total testosterone and high-density lipoprotein cholesterol after endovascular procedure?

Serum levels of testosterone (ST) and high-density lipoprotein (HDL) are generally associated with atherosclerosis in male patients over 50 years with critic iliac stenosis (TASC II A and B) and cardiovascular disease with significant changes in HDL and low-density lipoprotein (LDL). In addition to the standard therapy, combined medicamentous therapy and adequate model of exercise are also important factors as medicines can improve HDL levels and primary bypass and endovascular potency impacting positively on improvement of ST or it can be the following testosterone replacement therapy (TRT) comprising cardiovascular disease prevention and vascular treatment as adjunct therapy options after endovascular and vascular surgical procedures. The aim of the study is to identify the association between HDL and ST after surgical and endovascular intervention on the iliac segment (TASCII A and B), as well as cardiovascular risk factors with modified medium activity (MET) &lt;6 with short interval increase over &gt;6 (MET), with total duration of 30–60 minutes. It also attempts to remodel a patient behavioral pattern, optimize ST levels and link them to outcomes and patency of vascular procedures on the iliac segment. Materials and methods. 108 selected male patients with cardiovascular disease combined with metabolic syndrome and critical iliac artery stenosis (TASC II A and B) were examined during 2014–2018, 4 years after invasive and minimal invasive treatment (54 patients were treated with surgical Dacron reconstruction and 54 patients – with endovascular treatment on short segment of critical iliac artery stenosis (TASC II A and B). Results. In the total population, no difference was observed in changes of constraint-induced movement therapy between the standard exercise group and the control one after 4 years from baseline. However, there was no significant interaction between the effect of exercise trainings and primary bypass potency within 4 years. Conclusions. Primary effects of endovascular procedure and Dacron bypass revascularization raise the risk of elevated testosterone levels after 4 years of group training but does not provide adequate answers to questions as to whether higher levels of ST have any major influence on primary bypass potency preventing further progression of cardiovascular disease and general symptomatic and asymptomatic atherosclerosis. However, exercise and TRT can be potential adjunctive therapeutic options for a future supporting postsurgical and endovascular illiac treatment in cardiovascular patients with low testosterone levels.

Особенности лечения острого подагрического артрита у пациентов с сопутствующей патологией. Часть 1: основные ограничения и нежелательные эффекты лекарственной терапии

Особенности лечения острого подагрического артрита у пациентов с сопутствующей патологией. Часть 1: основные ограничения и нежелательные эффекты лекарственной терапии

Edema of the larynx - an emergency caused by angina Ludovici

Introduction. Laryngeal edema is a rare complication of angina Ludovici. Infections of this region are mostly of dentogenic origin, less often caused by tonsillitis or other infections in the pharynx. We present a case of a patient with laryngeal edema and dyspnea caused by a lower jaw tooth infection and an ipsilateral submandibular abscess. Case outline. The clinical picture of our patient progressed rapidly ? from toothache, painful swelling of the floor of the oral cavity, submandibular and submental regions, bilaterally, all the way to lifethreatening dyspnea. A flexible nasopharyngolaryngoscopy was performed. Swelling of the base of the tongue on the left side was observed, along with pronounced edema of the aryepiglottic fold on the same side, which narrowed the breathing space. Since the breathing space was significantly reduced, the patient was urgently hospitalized. The surgical treatment was carried out in the form of an external incision and drainage of the abscess collection of the left submandibular region, with the use of oxygen support and parenteral therapy, in accordance with the recommendations from the available medical literature. Constant monitoring of saturation levels indicated a significant improvement after just a few hours of medicamentous therapy. Conclusion. The goal of our work is to point out a very rare but serious complication, laryngeal edema, which can lead to airway obstruction even in the first few days of the development of the infection, and endanger the life of the patient.

Features of the management of coronary heart disease in patients with metabolically associated fatty liver disease

Among chronic non-communicable diseases, which make a significant contribution to mortality rates in the developed countries of the world, the leading positions are occupied by diseases of the circulatory system. According to statistics, one million people a year die from cardiovascular diseases in Russia. In an extensive nosological group of diseases of the circulatory system, coronary heart disease is the main cause of death and disability in the adult population. The annual mortality from coronary heart disease among the population of Russia is 27 %. To date, the number of patients with coronary heart disease with comorbid pathology, especially with diseases of the hepatobiliary system, metabolic syndrome, is increasing. The prevalence of metabolically associated fatty liver disease is 20 to 30 % in the population and tends to increase. The combined course of metabolically associated fatty liver disease and coronary heart disease occurs in 14-18 % of cases. Objective: to determine the impact of metabolically associated fatty liver disease on the course of coronary heart disease and the possibility of correcting metabolic disorders to prevent the development of cardiovascular complications. Materials and methods. 35 patients with coronary heart disease and metabolically associated fatty liver disease were examined; they were noted to have more severe clinical course of stenocardia and higher risk of cardiovascular complications, then those patients without liver diseases. Results and its discussion. It was estimated, that using thiotriazoline and ursodeoxycholic acid in addition to standard medicamentous therapy improves clinical course of stenocardia as well as overall quality of life due to high antianginal and antioxidant effects. Conclusions. Hepatoprotective therapy increases possibility of correction of metabolic defects, dyslipidemia, decreases the risk of oxidative stress, prevents development of life threatening cardiovascular conditions and can be used to optimize treatment of comorbid patients.

Venous thromboembolitic complications in children and adults with permanent venous access (literature review)

Introduction. Over the past decades, permanent venous access devices, in particular port systems and peripherally implanted central catheters, has been increasingly introduced in adult and pediatric oncology. As far as central catheters and permanent access devices are foreign bodies in basic veins, quite naturally that they are one more risk factor for thrombosis.Material and methods. The authors searched literature data ( in Russian and English) for the period up to May 3, 2022 using public databases (Embase, Medline/PubMed, Researchgate, medrxiv.org, RSCI/eLibrary). The following keywords were used for the search: “port-system”, “peripherally implanted central catheter”, “totally implanted vascular access device”, “venous thromboembolism”, “VTE”, “venous thromboembolic complications”, “VTEC”, “catheter dysfunction”, “device malfunction”. Available preprints, articles with “in press” or “online first” status, and clinical cases were also included in the analysis.Conclusion. This review discusses prevention, diagnostics and treatment of venous thromboembolic complications in cancer patients using similar implantable devices. In patients with catheter-associated thromboses, of practical interest are various diagnostic and curative algorithms, recommendations on the choice of vascular access, medicamentous therapy as well as variants of surgical intervention.

Surgical Therapeutic Algorithm in Facial Paralysis

Facial nerve paralysis is a debilitating condition with multiple etiologies, with aesthetic, functional, psychological and social impact. Given the complex multitude of causes that may generate such condition, a therapeutic algorithm is mandatory when attempting reconstruction. Severity, timing, patient adherence to a rehabilitation program, status of ipsilateral and contralateral facial nerves and particularities of each patient are all criteria which should be accounted when choosing a treatment option. After initial assessment, a variable treatment panel is available based on condition type include medicamentous therapy, rehabilitation program, dynamic and static procedures surgical procedures, having as primary aim functional restoration achieving aesthetic balanced facial features. This paper summarizes current knowledge in facial paralysis reconstruction and presents an algorithmic approach that eases decision making and therapeutic strategy.

Management of a patient with necrotizing soft tissue infection complicated by sepsis. An authors’ experience

The authors describe their experience in a successful treatment of a patient with necrotizing infection of lower limb soft tissues complicated by sepsis. Their comprehensive approach included two-stage surgical intervention and medicamentous therapy. As a result, the patient has completely recovered.

Characteristics of the post-infarction period in obese patients after percutaneous coronary intervention

Annotation. The study on the metabolic profile in the long-term period after myocardial infarction with comorbidity is relevant. The aim of the work was to examine metabolic profile and echocardiographic parameters in patients with ST-elevation myocardial infarction (STEMI) and obesity following percutaneous coronary intervention (PCI) after a 1-year follow-up. A total of 60 patients with STEMI and obesity were examined. The first subgroup consisted of 20 patients with medicamentous therapy, and the second group – 38 patients with PCI. Adropin, irisin, fatty acid-binding protein 4 (FABP4), C1q/tumor necrosis factor-related protein-3 (CTRP3) were measured by the enzyme-linked immunosorbent assay. The statistical processing of the study results obtained was carried out using the software package “IBM SPPS Statistics 27.0”. The following parameters were increased in patients who received combined medicamentous and PCI therapy before and after the treatment (p&lt;0.05): end-diastolic size (EDS) (by 16.83% and 10.89%, respectively), end-diastolic volume (EDV) (by 45.95% and 18.92% respectively), end-systolic volume (ESV) (by 40.0% and 27.69%, respectively), stroke volume (SV) (by 33.85% and 18.46%, respectively), left ventricular myocardial mass index (LVMMI) (by 18.93% and 10.06%, respectively), adropin (by 27.13% and 47.21%, respectively), irisin (by 2.07 times and 2.75 times, respectively) and CTRP3 (by 15.98 % and 31.96%, respectively), while the following parameters were decreased: systolic blood pressure (by 16.0% and 16.67%, respectively), diastolic blood pressure (by 15.56% and 14.44%, respectively), insulin (by 40 .38% and 48.59%, respectively), glucose (by 10.97% and 15.74%, respectively), atherogenic index (by 6.03% and 12.33%, respectively). Thus, patients with post-infarction cardiosclerosis and obesity have been revealed with increased echocardiographic parameters and imbalanced energy and adipokine metabolism.

Treating Psoriatic Arthritis By TNF –Α Inhibitors: A Case Study

Psoriatic arthritis (PsA) is a heterogeneous seronegative chronic inflammatory spondyloarthritis associated with psoriasis. Doctors consider PsA hard in complex treatment. The purpose of the study is to perform the analysis of clinical data and to identify the features of psoriatic arthriti's and selecting drug therapy.The patient's condition clinical assessment has carried out by using clinical, laboratory and instrumental methods with calculating the Psoriasis Area and Severity Index (PASI), the CASPAR diagnostic criteria and the genetically engineered biological drugs treatment.In the clinical case we studied, a patient with a history of psoriasis has first diagnosed with widespread skin psoriasis at the age of 12, when he carried out medicamentous therapy combined with PUVA. Despite the use of glucocorticosteroids, no complete regression of psoriasis has observed, and the PASI score was 35.3- 36.3 points. At the age of 30, the patient developed lower back pains, enthesitis, the PASI score was of 37.1 points. Nonsteroidal anti-inflammatory drugs were added to the treatment. At the age of 42, he was diagnosed with psoriatic arthritis, activity III, stage II, dactylitis, enthesites, the PASI index was 31.3 points; right-sided active sacroiliitis - radiologically stage 1 (BASDAI 4.2 points), FCS 2-3". According to the CASPAR criteria, 4 points were obtained at the time of the disease diagnosis (current psoriasis - 2 points, familial psoriasis - 1 point, negative rheumatoid factor - 1 point). In 2016, at the age of 48, Adalimumab therapy has started according to the scheme in combination with Methotrexate, as a result it was possible to achieve psoriatic arthritis remission and the skin rashes' regressed and 0 PASI score.The psoriatic arthritis therapy with the use of Adalimumab - TNF-α - inhibitor contributed to the disease's long-term stable remission and completed the psoriatic skin rashes regression.

Гирудотерапия как метод лечения артериальной гипертензии

The article under discussion deals with the treatment of arterial hypertension with the help of hirudotherapy. The author of the article believes that treatment with hirudotherapy (leeches) is widely used for arterial hypertension. It is noticed that carrying out of hirudotherapy changes reactivity of an organism, as a result sensitivity to carried out hypotensive medicament therapy increases. Components of a leech secretion, anti-ischemic influence and unloading of a blood flow allow to reduce a dosage of the applied drug. Treatment of hypertension by leeches practically always improves the well-being and objective condition of the patient, though results of therapy largely depend on the reason of hypertension, duration and intensity of the course, a correct choice of attachment points.

Characteristics of the acute myocardial infarction course in patients with type 2 diabetes mellitus before and after reperfusion therapy

Introduction. Scientific research is currently being done to diagnose and manage comorbid conditions in patients. The importance of studying the pathophysiological mechanisms of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (DM) has been proven. The purpose of the study: to conduct a retrospective analysis before and after reperfusion therapy by evaluating the features of the AMI course in patients with type 2 DM. Material and methods. The study was conducted from January 10, 2020 to January 12, 2021. In total, 74 STEMI patients with or without type 2 DM, aged 59.42±7.66 years were examined at the Intensive Care Unit of the Government Institution “L. T. Malaya National Therapy Institute of the National Academy of Medical Sciences of Ukraine” and the Kharkiv Railway Clinical Hospital No. 1 of the branch “Center of Healthcare” of Public Joint Stock Company “Ukrainian Railway”. Serum levels of insulin, adropin, irisin, fatty acid binding protein 4 (FABP4) and C1q/TNF-related protein (CTRP3) were detected by enzyme-linked immunosorbent assay. Analysis and processing of the findings obtained after examinations were carried out using the computer program IBM SPPS software, version 27.0 (IBM Inc., USA, 2020). Results and discussion. Before the treatment, patients with AMI and type 2 DM had significantly higher values of end-systolic size (ESS) by 5.56%, left atrium (LA) by 10.53%, left ventricular myocardial mass index (LVMMI) by 6.87% and lower values of systolic blood pressure (SBP) by 11.76%, atherogenic index (AI) by 5.80%, glucose by 25.71%, insulin by 39.92%, irisin by 15.34%, FABP4 by 19.76% compared to the values of these indicators 14 days after medicamentous therapy (p&lt;0.05). Patients with AMI and type 2 DM had significantly higher values of adropin by 46.10%, irisin by 20.11%, CTRP3 by 28.78% and lower values of SBP by 17.65%, diastolic blood pressure by 12.38%, heart rate (HR) by 13.73%, pulse by 10.87%, body mass index by 5.57%, weight by 9.52%, glucose by 26.67%, insulin by 40, 75%, total cholesterol by 10.04%, very low-density lipoproteins by 24.75%, low-density lipoproteins by 8.52%, triglycerides by 27.06%, AI by 10.55%, FABP4 by 37.04% before treatment as compared to the values of these indicators 14 days after percutaneous coronary intervention (PCI) (p&lt;0.05). Comparing the studied indicators between subgroups after medicamentous treatment and PCI, a significant decrease in HR by 8.33%, ESS by 4.11%, LA by 9.52%, LVMMI by 5.53%, FABP4 by 21.53% and an increase in the levels of adropin by 36.99%, irisin by 41.88%, CTRP3 by 30.25%, high-density lipoproteins (HDL) by 10.28% were identified (p&lt;0.05). Conclusions. When compared PCI advantages due to the absence of a tendency to the left heart dilatation over the medicamentous therapy, improvements of energy and adipokine metabolism have been observed amid increased levels of adropin, irisin and CTRP3 and decreased levels of FABP4 in patients with AMI and type 2 DM. It should be noted that there has been a significant improvement in the state of energy and adipokine profiles under the conditions of performing PCI.

THE USE OF THORACOPLASTY IN THE TREATMENT OF DESTRUCTIVE PULMONARY TUBERCULOSIS

Despite a decrease in the incidence of pulmonary tuberculosis in the Russian Federation in recent years, among the newly diagnosed patients there remains a significant proportion of patients with bacterial excretion and destructive pulmonary tuberculosis. In patients with destructive pulmonary tuberculosis, surgical treatment is often the only possible method for saving lives. We studied the results of extrapleural posterosuperior thoracoplasty in 42 patients with destructive pulmonary tuberculosis. The comparison group consisted of 30 patients who received medicamentous therapy. The mortality rate for 3 years of follow-up in the conservative treatment group was 36.7%, in the surgical treatment group it was 23.8%, p = 0.237. Among patients with more than 2 years of disease experience, mortality was 45% in the main group, 88% in the comparison group, p = 0.070. In the absence of drug resistance, mortality in the main group was 4%, that in the comparison group – 14.2%, p = 0.283. Mortality in individuals with normal body weight was lower in the group of patients who underwent thoracoplasty than in the comparison group: 17.6% vs. 33.3% (p = 0.202). Among those who did not achieve sputum negative reaction, mortality was lower, and passing to the 3rd group of dispensary care was more common in the surgical treatment group – 41.7% vs. 71.4% (p = 0.077) and 33.3% vs. 21.4% (p = 0.426). Among patients with drug resistance or low body weight or unachieved sputum negative reaction, mortality rates were comparable in both groups. Thus, thoracoplasty, in comparison with conservative therapy, makes it possible to improve treatment results in patients regardless of the length of the disease in groups with Mycobacterium tuberculosis sensitive process, with normal body weight, with preservation of elimination of bacilli. The effectiveness of thoracoplasty decreases in patients with an increase in the disease duration.

Ozone therapy as a component of a comprehensive rehabilitation program for patients after polysegmental pneumonia associated with SARS-CoV2 infection

Aim: to analyze the effectiveness of intravenous ozone therapy in long COVID-19 patients experienced community-acquired polysegmental pneumonia (associated with SARS-CoV2 infection). Materials and methods. The study involved 42 long COVID-19 individuals aged 41–82 years who underwent rehabilitation after community-acquired polysegmental pneumonia associated with SARS-CoV2 infection. The patients were examined and followed up subjectively (by the G. Borg and PCFS scales) and objectively (oxygen saturation, C-reactive protein, ferritin, D-dimer, urea and creatinine, 6-minute walk test). All patients received similar medicamentous therapy, and combined intravenous ozone therapy was additionally prescribed to the main group patients (n = 21): an alternate-day infusion of 200 ml ozonized saline at a concentration of 20 mg/ml and major autohemotherapy (100 ml ozonized saline at a concentration of 30 mg/ml mixed with 100 ml of the patient’s blood), 10 sessions per treatment course. Results. The integrated approach to the complex program of long COVID-19 treatment and rehabilitation for patients after pneumonia associated with SARS-CoV2 infection using intravenous ozone therapy has demonstrated its significant effectiveness based on the objective and subjective findings (P &lt; 0.01). Twice as many patients in the main group (n = 18) achieved endpoints of the study (absence of dyspnea, normalization of blood biochemical markers and oxygen saturation levels, restoration of exercise tolerance) as compared to the control group (n = 9). Conclusions. The use of combined intravenous ozone therapy (alternating infusion of ozonized saline and ozonized saline mixed with the patient’s blood) in the rehabilitation program for patients after experienced community-acquired polysegmental pneumonia associated with SARS-CoV2 infection is pathogenetically substantiated, effective and cost-effective addition to complex health recovery tools.

USE OF NON-DRUG METHODS IN THE TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION

The aim of the study is to optimize the comprehensive treatment of patients with severe arterial hypertension, through the use of multicomponent rational antihypertensive pharmacotherapy, followed by the use of unloading therapeutic exercises. 32 men with severe arterial hypertension were examined. Initially, a clinical, instrumental and laboratory examination, registration of blood pressure and its 24-hour monitoring were carried out. The average daily systolic (ADBPsyst.) and average daily diastolic (ADBPdiast.) blood pressure were determined. A multicomponent rational antihypertensive pharmacotherapy, according to the clinical recommendations for the treatment of arterial hypertension was selected for all the patients. In at least 3 months after the selection of pharmacotherapy, the patients were divided into two groups, comparable in gender, age, severity of the condition, features of the disease course and medicamentous therapy. Patients of the 1st group (active treatment group) against the background of pharmacotherapy were prescribed unloading therapeutic exercises according to a patented technique. The 2nd group of patients continued to take pharmacotherapy and it was used as a baseline group. The average age in the 1st and 2nd groups was 46,3±6,8 and 43,6±7,2 years, respectively. Patients of the 1st group were prescribed unloading therapeutic exercises and in 3 months in both groups the ADBPsyst. and ADBPdiast. were compared. Initially, there was a significant increase in ADBPsyst. and ADBPdiast. compared to the normal range in both groups. These indicators in both groups differed insignificantly. In 3 months after pharmacotherapy, there was a significant decrease in ADsyst. and ADdiast. in both groups, but these indicators remained elevated and did not reach the target level. Then, in the 1st group, unloading therapeutic exercises were included in the comprehensive treatment. Patients of the 2nd group continued to receive pharmacotherapy. In 3 months after including unloading therapeutic exercises in the 1st group, there was a significant decrease in ADBP (syst. and diast.) not only in comparison with the initial data, but also with the data in 3 months after pharmacotherapy. In the 2nd group, these indicators did not change significantly compared to the three-month data. In 6 months, ADBPsyst. and ADBPdiast. in the 1st group were significantly lower compared to similar indicators in the 2nd group, which proves significant clinical effectiveness of unloading therapeutic exercises in patients of the 1st group. The results obtained confirm that patients with severe arterial hypertension have such types of disorders at the cellular-tissue and microcirculatory level that are not eliminated only by drug therapy. For their high-grade correction, along with multicomponent pharmacotherapy, it is necessary to include unloading therapeutic exercises. To optimize the treatment of severe arterial hypertension against the background of receiving multicomponent antihypertensive pharmacotherapy, it is recommended to include unloading therapeutic exercises in the therapeutic complex.

Atrial fibrillation as a contributing factor in the diagnostic algorithm for coronary subclavian steal syndrome and cardiac tamponade following coronary artery bypass graft surgery: a case study

Coronary subclavian steal syndrome (CSSS) is a complication of coronary artery bypass graft (CABG) surgery in patients with coexistent significant subclavian artery stenosis (SAS). It is characterized by a retrograde blood flow through the left internal mammary artery graft from the coronary to subclavian circulation, leading to myocardial ischemia. Current screening for CSSS includes bilateral blood pressure measurement for the detection of a significant inter-arm blood pressure difference. However, the commonly used automated sphygmomanometers have limited accuracy in patients with atrial fibrillation. Consequently, these patients are often underdiagnosed. We present a case of a 73-year-old man with a medical history of atrial fibrillation, peripheral artery disease, and CABG surgery four months before the current event, who came to the emergency department due to progressive dyspnea. The initial diagnostic management showed a large circulatory pericardial effusion, so the patient was admitted to the coronary care unit and underwent pericardial drainage. In the following days, due to a sudden high increase in cardiac troponin, the patient underwent an urgent coronary angiography, which revealed severe left SAS with functional CABG, indicating the occurrence of CSSS. Percutaneous transluminal angioplasty was then performed with an optimal angiographic result. The patient was discharged in good condition with adequate medicament therapy and instructions. This case report highlights atrial fibrillation as a contributing factor for the diagnosis of CSSS and pericardial tamponade after CABG surgery. Furthermore, we suggest a diagnostic approach that can reduce the incidence of both these severe complications.