Modern Guidelines Research Articles

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In February month s. Mr. G.A.Klyachkin opened a hydrotherapy clinic in Kazan. There is an office for treatment with electricity and massage at the Healing Center. The hospital is supplied with all the aids necessary for hydrotherapy and treatment with electricity and massage, according to modern science guidelines. The massage is supervised by a special doctor and a midwife-masseuse. Patients in the hospital use common baths (ordinary, mineral, electric, steam), wipes, wrapped in simple, local baths. In the soul department there is a common soul (Charcot soul, circular, etc.) and various local souls. The free, in need of treatment with water, electricity and massage, are used on an outpatient basis. In addition, according to the statute of the hospital, patients can also be admitted for inpatient treatment. For this, the number of beds for the first time is limited to two, while the number of them is supposed to be increased in the present.

Modern approaches to the conservative treatment of osteoarthritis from the standpoint of evidence-based medicine

Evidence-based medicine plays a leading role in modern clinical practice. The most well-known scales for evaluating the quality of evidence and recommendations based on them are OCEBM (Oxford Centre for Evidence-based Medicine), GRADE (Grading of Recommendations Assessment, Development and Evaluation), NICE (National Institute for Health and Care excellence). Objective: to acquaint readers with modern clinical guidelines for conservative treatment of osteoarthritis (OA), developed on the basis of the principles of evidence-based medicine. GRADE scale is widely used. The greatest authority among professionals have community leaders: ACR (American College of Rheumatologists), EULAR (European Antirheumatic League), OARSI (International Society of Osteoarthritis Researchers), AAOS (American Academy of Orthopedic Surgeons), ESCEO (European Society for Clinical and Economic Studies aspects of osteoporosis, osteoarthritis and musculoskeletal diseases). Their differences are due, in particular, to the use of different scales for assessing the levels of evidence and strength recommendations and relating to the use of SYSADOA (symptomatic slow-acting drugs for the treatment of OA), intra-articular injections of various drugs (corticosteroids, PRP, hyaluronic acid, etc.). The article presents strictly and conditionally recommended methods of conservative treatment of osteoarthritis of the hand, knee and hip joints. Conclusions: modern clinical guidelines are based on objective scales for evaluating evidence and recommendations, respectively, the probability of systematic errors is reduced. Therefore, prescribing according to them OA treatment regimes, we are sure that we choose the most effective among all available approaches.

The Maimonides Model for a Regimen of Health: A Comparison with the Contemporary Scenario.

Rabbi Moses Ben Maimon, known as Maimonides, or The “Rambam” (a Hebrew acronym for his name), was one of the greatest arbiters of all times on matters of Jewish law, one of the greatest philosophers of the Middle Ages, a scientist, and a researcher. In addition, he was a court physician to the Egyptian Sultan. In addition to his monumental work on Jewish law and ethics, his writings on medicine have been considered classics over the generations. The aim of this paper is to assess Maimonides’ health regimen and to compare his dietary recommendations with contemporary dietary regimens. To this end, Maimonides’ recommendations were compared to the modern guidelines of the United States, the Netherlands, and the World Health Organization (WHO), as well as to the Mediterranean diet, which is popular worldwide. Both marked similarities and contrasts were noted between Maimonides’ and modern recommendations. Most of Maimonides’ medical recommendations remain relevant more than 800 years later.

Modern Approaches to Optimal Antithrombotic Therapy for Stable Ischemic Heart Disease

The article highlights the practical aspects of the use of antithrombotic therapy in patients with stable (chronic) coronary artery disease (САD). The САD verification using modern functional and anatomical diagnostic methods are considered. Patients with stable САD represent a heterogeneous group, having various clinical scenarios. Information is provided on the main risk factors for ischemic and hemorrhagic complications that determine the choice of optimal antithrombotic therapy regimens. Modern views on the monotherapy and clopidogrel in САD are presented. The data of the largest international studies CHARISMA and PEGASUS-TIMI 54 on the use of double antiplatelet therapy in patients with stable IHD reflected in modern guidelines are highlighted. Features of new antiplatelet agents (prasugrel and ticagrelol) are described. Based on the results of the COMPASS study, indications for the administration of small doses of rivaroxaban in combination with aspirin for the secondary prevention of cardiovascular complications in patients with stable manifestations of atherosclerosis with a low risk of bleeding are considered. The use of antithrombotic therapy is associated with an increased risk of bleeding and particularly with gastrointestinal bleeding. The information on the use of drugs for the prevention of gastrointestinal bleeding is provided.Antithrombotic therapy can reduce the risk of complications associated with atherothrombosis, however, to improve prognosis a multipurpose intervention is required, including correction of risk factors and the use of drugs from different groups with proven effectiveness. Optimal medical therapy, including antithrombotic drugs, is vital for patients with САD and can successfully prevent adverse outcomes.

Current state, goals and quality standards of outpatient care in rheumatology: position paper of the Professional Association of German Rheumatologists (BDRh)

Even in the era of modern guidelines, the treatment of rheumatic diseases is only as good as the framework of rheumatological care within which the treatment is carried out. The access to high-quality medical treatment for all patients is therefore essentially decisive for the prognosis of the patients. This article describes the current state of outpatient treatment in rheumatology and demonstrates which quality projects, such as treatment contracts, outpatient specialized medical treatment (ASV), digitalization and training as specialized rheumatological assistant (RFA), have been created in order to ensure the treatment of our patients. Furthermore, standards are defined that can guarantee a contemporary and guideline-conform treatment in outpatient rheumatological units. As an example it is an affirmation of the Professional Association of German Rheumatologists (BDRh) for ensuring optimal care for all rheumatology patients through early or emergency rheumatology clinics, treat to target, appropriate delegation of medical duties and diversification of treatment, thus an assurance of the quality and comprehensive treatment in rheumatology. The important topic of safeguarding the next generation of rheumatologists, which is indispensable for this, is also discussed.

Post-Exercise Sweat Loss Estimation Accuracy of Athletes and Physically Active Adults: A Review.

The main purposes of this review were to provide a qualitative description of nine investigations in which sweat losses were estimated by participants following exercise and to perform a quantitative analysis of the collective data. Unique estimations (n = 297) were made by 127 men and 116 women after a variety of exercise modalities in moderate to hot environmental conditions. Actual sweat loss exceeded estimated sweat loss (p < 0.001) for women (1.072 ± 0.473 vs. 0.481 ± 0.372 L), men (1.778 ± 0.907 vs. 0.908 ± 0.666 L) and when all data were combined (1.428 ± 0.806 vs. 0.697 ± 0.581 L), respectively. However, estimation accuracy did not differ between women (55.2 ± 51.5%) and men (62.4 ± 54.5%). Underestimation of 50% or more of sweat losses were exhibited in 168 (54%) of estimation scenarios with heavier sweaters displaying a higher prevalence and trend of greater underestimations in general. Most modern guidelines for fluid intake during and between training bouts are based on approximate sweat loss estimation knowledge. These guidelines will likely have minimal efficacy if greater awareness of how to determine sweat losses and accurate recognition of sweat losses is not increased by coaches and athletes.

Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice

IntroductionEnhanced Recovery After Surgery (ERAS) programs have been shown to improve clinical outcomes in gynecologic oncology, with the majority of published reports originating from a small number of specialized centers....

BASIC FIBROBLAST GROWTH FACTOR AND ADIPONECTIN IN ADOLESCENCE WITH JUVENILE IDIOPATHIC ARTHRITIS TREATED WITH METHOTREXATE

Methotrexate has been applied clinically for juvenile idiopathic arthritis (JIA) treatment for decades. It is recommended for use globally, according all modern guidelines. Despite the fact that fibrosis molecular mechanisms as well as methotrexate (MTX) elimination and fibrosis indexes were studied a lot there is still not enough information for adolescence. Adiponectin, fibroblast growth factor and fibrosis indexes in adolescents with JIA treated with methotrexate were studied in this work. The aim was to study dynamics of molecular-cellular mechanisms activation of fibrotic processes development in the liver in adolescents with juvenile idiopathic arthritis treated with methotrexate. Materials and methods: A total of 68 children with juvenile idiopathic arthritis, were enrolled in the study. 25 boys (36.8 %) and 43 girls (63.2 %) were examined. Children were divided into three groups in accordance with the methotrexate dose. The following data were analyzed: ESR (mm/hour), C-reactive protein (mg/l), Hemolytic activity (CU), circulating immune complexes, (g/l), ALT (U/l), AST (U/l), Adiponectin (mcg/ml), BFGF (pg/ml), APRI index, FIB-4 Score. Results: According to our results when patients start using MTX they have significantly positive effect. Therefore, when analyzing all parameters liver pathologies may occur before MTX use. When MTX used, its proinflammation and antifibrotic effects lead to normalization of all organs and systems, as well as joints and liver. Also, long-term MTX use can lead to adverse effects. Conclusions: So, it is important to control possible liver disorders in adolescence treated with MTX. According to our study results we find out that there are decreasing of liver damage parameters in patients which started using MTX.

Potential effects of COVID-19 on the cardiovascular system

It is known that coronaviruses can cause acute coronary syndrome, arrhythmias, and aggravation of heart failure, mainly due to a combination of a significant systemic inflammatory response and a local vascular inflammation at the level of arterial plaque. In the context of massive SARS-CoV-2infections and the announced pandemic, there is a need to update management of cardiovascular patients in order to reduce COVID-19-related complications. COVID-19 can cause viral pneumonia, as well as extrapulmonary symptoms and complications. A larger proportion of severe COVID-19 patients had a cardiovascular disease or a high cardiovascular risk. The presence of arterial hypertension and other cardiovascular and cerebrovascular diseases is considered as a factor aggravating the course of the disease and increasing the lethality. Severe cases of COVID-19 were accompanied by acute, often lethal, cardiovascular disorders, with an increase in the level of highly sensitive troponins. There is no reliable evidence that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can increase the risk of infection or severe course of COVID-19, so there is no reason to cancel them. The role of inhibition of the renin-angiotensin system in the treatment of COVID-19 remains controversial. COVID-19 treatment boils down to supportive care and treatment for complications. Based on the results of the studies, a large number of cardiovascular complications of COVID-19 can be expected. Their therapy should be carried out strictly according to modern guidelines. Recommendations include antiplatelet agents, -blockers, ACE inhibitors and statins.

Cardiovascular risk stratification in stable coronary artery disease based on prognostic scores and models

According to modern clinical guidelines, the strategy of examination and treatment of a patient with stable coronary artery disease depends on the prognosis. Despite the great number of prognostic models and scores, there is currently no unified approach for cardiovascular risk stratification. The article provides a literature review of the main current prognostic models and scores, taking into account their effectiveness and limitations.

Microstructural analysis of sausage quality

Microstructural analysis of sausage quality

Efficiency (advantages) of ramipril in arterial hypertension and diabetes mellitus from the point of view of evidence-based medicine

AH and diabetes mellitus are comorbid diseases and are interconnected by general pathophysiological mechanisms of development, similar to cardiovascular complications. The presence of a close relationship between AH and diabetes mellitus is due to the importance of activation of the renin-angiotensin-aldosterone system, which underlies the remodeling of the cardiovascular sys­tem and the development of complications. According to modern clinical guidelines, ACE inhibitors are the drugs of choice in the treatment of AH in combination with diabetes mellitus. The use of ACE inhibitors in patients with AH and diabetes mellitus is accompanied by a reduction in the relative risk of cardiovascular outcomes and mortality. A scientific review of major clinical stud­ies with the results of efficacy of ACE inhibitor ramipril in patients with AH and diabetes mellitus is presented. Ramipril has a high affinity for ACE-1 and kinase II enzymes, pronounced clinical and organoprotective effects, proven to influence the prognosis. The HOPE study showed a 22% reduction in cardiovascular outcomes and mortality in high-risk patients treated with Ramipril (p < 0.001), and a 25% reduction in a subgroup of patients with diabetes mellitus. In a large retrospective cohort analysis, ramipril had a lower risk of mortality in patients with AH and diabetes mellitus compared to other ACE inhibitors (captopril, enalapril, fosinopril). In a number of studies (ATLANTIS, MICRO-HOPE, DIABHYCAR) in patients with diabetes mellitus and MAU, ramipril contributed to a significant slowdown of MAU progression and a significant regression of MAU, reducing the risk of diabetic nephropathy by 22%. This confirms the pronounced nephroprotective effect for primary and secondary nephropathy prevention. Several studies (AASK, HOPE, DREAM, ADaPT) using ramipril have shown a 17-36% reduction in the risk of the development of new cases of type 2 diabetes mellitus. Thus, the evidence on the efficacy of ramipril has allowed to expand indications for its use not only for cardiovascular diseases (AH, chronic heart failure, MI), but also for diabetes mellitus and diabetic nephropathy, which significantly differs the drug from other ACE inhibitors.

Vaginal birth after cesarean section – literature review and modern guidelines

Vaginal birth after cesarean section – literature review and modern guidelines

Cardiac risk stratification in stable coronary artery disease

Despite a gradually decreased mortality from cardiovascular diseases, including coronary artery disease (CAD), they remain the main cause of death in the world. In the coming decades, an increased prevalence of CAD is expected. While methods that are more sensitive are used to diagnose CAD and mortality of the acute forms decreases due to high-tech treatment methods, the prevalence of CAD chronic forms is gradually increasing. According to the modern clinical guidelines, examination and treatment of a particular patient with stable CAD depends on its prognosis, since only in high-risk patients myocardial revascularization can improve life prognosis, however, most patients receive unified therapy. Despite the fact that there are many prognostically significant factors, models and indices developed to assess the risk of death and cardiovascular complications in CAD, a unified approach to risk stratification does not currently exist. The article provides a literary review of how historically the main prognostically significant signs were identified (including clinical anamnestic and psychosocial characteristics, comorbidity, data of non-invasive instrumental studies such as electrocardiography, echocardiography, tests with dosed physical activity, invasive coronary angiography and some of the existing prognostic models and indices that can help a practitioner in stratifying the risk of cardiovascular complications in a patient with stable CAD.

A Modern History RAAS Inhibition and Beta Blockade for Heart Failure to Underscore the Non-equivalency of ACEIs and ARBs.

Beta blockers and renin-angiotensin-aldosterone-inhibitors (RAAS-i) including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have been a mainstay of guideline-based medical therapy for heart failure with reduced ejection fraction (HFrEF) for decades. However, initial evidence supporting each of the aforenoted class of drug for heart failure indications was largely found independently of the other two classes with the exception of the addition of BBs to ACEIs. In the initial ACEI trials for HFrEF, few participants were on BBs as BBs were seen as contraindicated in HFrEF at the time. The seminal BB in HFrEF trials had high prevalence of ACEIs use as ACEIs for HF were standard of care by then, but ARBs as a class were still in their infancy. We closely examine the evidence for combinations of BB and ACEIs versus ARBs in HFrEF. In doing so, we demonstrate the lack of evidence for consideration of ARBs to be interchangeable with ACEIs when used in combination with BB and provide evidence that calls in to question the validity of assuming benefits from each drug class are independently cumulative, widening the gap between ACEIs and ARBs when used with BBs. Modern guidelines should emphasize this lack of evidence for the combination use of ARB and BB in HFrEF, except for candesartan. Even as practice moves towards the widespread uptake of angiotensin receptor-neprilysin inhibitors (which contain the ARB valsartan) in heart failure, the distinction has important implications for the ongoing role of combination therapy with BB, which thus far has been assumed, but not proven.

СУЧАСНІ ПОГЛЯДИ НА ЗАСТОСУВАННЯ ЗАХОДІВ ФІЗИЧНОЇ ТЕРАПІЇ В ОСІБ З ІНСУЛЬТОМ

Аbstract. The increase in morbidity and mortality in the world due to stroke necessitates the development of rehabilitation of post-stroke patients. Therefore, various specialized associations in developed countries are developing clinical guidelines for the rehabilitation of patients after stroke, which are based on the principles of evidence-based medicine. Objective. Consider modern approaches to the use of physical therapy in individuals after stroke. Methods. Theoretical analysis and generalization of modern scientific and methodological literature data on the use of physical therapy in people with stroke. Results. One of the main causes of disablement, mortality and long-term disability is the consequences of cerebrovascular injuries. Modern views on the recovery of patients after stroke are based on the concept of the International Classification of Functioning (ICF). According to the recommendations of modern clinical guidelines, rehabilitation of patients with stroke should begin from the first days of the patient’s stay in the hospital. It should be a specialized stroke unit with a multidisciplinary team. Provision of evidencebased care reduces mortality and subsequent disability in stroke patients. Methods of intervention with proven effectiveness in stroke include early verticalization of the patient, balance exercises, performing aerobic endurance exercises. It is believed that interventions aimed at reducing spasticity should not be routinely provided to patients with mild to moderate spasticity. If the manifestations of spasticity interfere with exercise and personal hygiene, then you should use proven means to reduce it. Analysis of the works of domestic scientists has shown that for the rehabilitation of stroke victims, it is proposed to use methods with unproven effectiveness, such as massage, acupuncture and reflexology, thermal treatments, cryotherapy, herbal medicine, magnetic therapy, which does not comply with international guidelines. Rehabilitation of patients after stroke is quite relevant and is being studied constantly. New means of physical therapy are constantly offered. They are analyzed by specialized institutions and reduced to systematic reviews, on the basis of which it is already possible to draw a conclusion about their effectiveness. In order to be familiar with current trends in rehabilitation, it is necessary to constantly follow the international guidelines, which are updated almost every year.

Effect of production system on growth performances and meat traits of suckling Messinese goat kids

The aim of this study was to evaluate the effect of the production system on growth performances and meat quality of suckling Messinese goat kids. At birth, 102 suckling kids were divided into two homogeneous groups for sex and body weight (3.4 kg); animals of the SES group were fed exclusively with spontaneous pasture and kept in the stable during the evening; animals of the ES group were fed exclusively with spontaneous pasture, characterised by the presence of Quercus suber, and kept exclusively outdoors. From birth to weaning, kids were weighed every10 days. At slaughter, carcase yields and meat quality traits on the Longissimus dorsi muscle were studied. Data were subjected to ANOVA. ES group showed the highest final body weight (10.53 kg vs. 9.40 kg; p < .001). As regard the meat traits, ES group showed the lowest final pH (5.63 vs. 5.96; p < .001), the lowest value of Hue (46.24 vs. 62.64; p < .005) and the highest values of cooking loss (ES 25.53% vs. SES 19.60%; p < .05) and shear force (ES 5.04 kg/cm2 vs. SES 3.63 kg/cm2; p < .05). Chemical composition showed similar values in both groups. Meat fatty acid composition showed the highest values of MUFA (45.89% vs. 40.90%; p < .05) and PUFA (0.14% vs. 0.11%; p < .05) and the lowest of ω – 6/ω – 3 ratio (4.89 vs. 6.98; p < .05) and Thrombogenic Index (1.64 vs. 1.98; p < .05) in the ES group. The results confirm the favourable characteristics of goat meat and the relation between the typical production system of goats in the Nebrodi area and their performances. HIGHLIGHTS The production system did not affect the weight of kids at birth, while there were significant differences in kid’s performance in relation to the breeding system. The chemical composition of the LD muscle was not affect by the production system. The production system significantly influenced the fatty acid composition of the meat. The meat quality parameters studied reflect the modern guidelines for a healthy diet recommend, that reduce the animal fat consumption, especially if rich in saturated fatty acids, and could be a tool to identify and characterise a product with Protected Designation of Origin (PDO) as ‘capretto Messinese’.

The fixed combination of diclofenac and orphenadrine in the treatment of acute pain syndromes

Acute pain, especially musculoskeletal and postoperative pain, is widespread pathology associated with quality of life deterioration, temporary disability, a tendency to relapse, and, in some cases, chronicity, so the timely and adequate treatment of this condition is important, including from the point of view of the prevention of serious medical, social, and economic consequences. Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered as first choices in modern guidelines for the treatment of musculoskeletal pain. Centrally acting muscle relaxants and their combinations with NSAIDs are also the basic component of dorsalgia treatment. However, the evidence base is available only for individual muscle relaxants, for orphenadrine in particular. The incorporation of NSAIDs as part of multimodal postoperative analgesia considerably reduces the need for opioids, lowers the risk of developing adverse reactions of the latter, and enhances patient satisfaction with the quality of pain relief. Centrally acting muscle relaxants having analgesic properties, for example tizanidine and orphenadrine, would be appropriate for use as part of multimodal analgesia. The paper discusses the pharmacological properties of a fixed combination of diclofenac and orphenadrine (Neodolpasse ® ), its advantages over monotherapy with individual ingredients, and the results of clinical trials of this combination in spinal pain syndromes and in the postoperative period.

URINARY TRACT INFECTIONS IN CHILDREN

The review addresses the main issues related to the rational pharmacotherapy of urinary tract infection (UTI). UTIs are a common and important clinical problem in children. Among UTI causative agents in children are dominated by gram-negative bacteria, E. coli. According to modern clinical guidelines, the leading direction in the treatment of UTI in children is antibiotic therapy, which should be prescribed taking into account the sensitivity of microorganisms. Drugs of choice for UTI in children: cephalosporins or protected aminopenicillins

Оцінювання цифрової трансформації митниці ДФС Тернопільської області та її вплив на діяльність суб’єктів зовнішньої економічної діяльності

The article examines the basic forms and types of customs control carried out in Ternopil region, evaluates the process of implementation of the WTO agreement on trade facilitation for customs regulation and customs procedures in the region, as well as studies the main aspects of SFS Ternopil Customs. The main aspects of digital transformation of the Customs of the State Fiscal Service (SFS) of Ternopil region are investigated. Based on the analysis of the results of the in-depth survey of 16 respondents, the economic entities engaged in foreign economic activity (FEA), a list of the main positive aspects and issues of SFS Ternopil Customs is formed and the impact of the corresponding changes on the activity of the FEA entities is reflected. The author makes a number of proposals to improve the efficiency of the regional customs authority from the position of the FEA entities. The corresponding study was prepared within the framework of the project «Public Assessment of Regional Customs Authority and Development of Modern Guidelines for Improvement of Customs Control at the Regional Level», implemented by the Public organization «Center for Strategic Development and Reforms» (Ternopil) with the financial support of the European Union.