Received Complex Therapy Research Articles

Dynamics of bone tissue metabolism in the complex treatment of chronic posttraumatic osteomyelitis of long bones

Introduction: Chronic post-traumatic osteomyelitis is a complex problem of modern traumatology and orthopedics, affecting, in addition to medical, social and economic aspects of healthcare. When planning treatment, it is necessary to take into account the metabolic state of the bone tissue, since the effect of an infectious pathogen goes far beyond the classical lytic process, disrupting the balance of bone formation and bone resorption in various ways. The study is devoted to the study of the dynamics of parameters reflecting the metabolism of bone tissue in patients receiving complex therapy for chronic post-traumatic osteomyelitis of long bones. Aim: To study the dynamics of metabolic disorders of bone tissue in patients with orthopedic infection of long bones and large joints under conditions of ongoing complex etiotropic and compensatory therapy for 6 months, the timing of bone tissue consolidation within 2 years from the moment of surgery. Materials and methods: The study was prospective, observational, comparative, exploratory, involving 138 patients with post-traumatic chronic osteomyelitis of the long bones. Complex therapy included a combination of surgical treatment with antibacterial, anti-inflammatory therapy and drug correction of the revealed disorders of bone metabolism. The timing of the consolidation of bone defects after treatment and the dynamics of indicators of bone metabolism were studied. Results: The similarity of the periods of consolidation of different segments in the conditions of the described therapy was shown; the time period corresponding to the most pronounced dynamics of changes (correction) of violations was determined (3 months from the beginning of treatment); shows the effectiveness of metabolic therapy for the treatment of osteoarticular infections in various anatomical segments of the extremities. The results corresponds both to the results of the previous study and to the pathophysiological aspects of bone metabolism described in the literature. Conclusion: the timing of consolidation in the treatment of metabolic disorders is generally similar; the greatest changes in the parameters of bone metabolism are recorded within 3 months after the start of therapy. Also, the metabolic therapy regimen can be considered as universal for all segments.

Efficacy of hyperbaric oxygenation in the complex treatment of women suffering interstitial cystitis/painful bladder

Introduction. Interstitial cystitis/painful bladder (IC / BMP) is a rare, chronic, and disabling disease. Treatment of IC / BMP is empirical in the scope of physiotherapy procedures, taking antidepressants, pentosan sodium salt sulfate, intravesical administration of lidocaine and heparin, as well as various types of surgical interventions — mainly aimed at relieving the symptoms of the disease. The effectiveness of the latter does not exceed 60%, and symptoms return even when a period of remission seems to have occurred. The article presents the experience of our clinic in treating women with IC / BMP using hyperbaric oxygenation (HBO).Purpose of the study. To study the effectiveness of HBO in complex therapy patients suffering IC / BMP in the form of ulcerative lesions.Materials and methods. The study included 40 women, average age 60.1 ± 10.5 years, with the classic form of IC / BMP. All patients were examined and included in the study according to the NIDDK criteria. The patients were divided into 2 groups: Group I — women who received complex therapy with HBO (n = 20), Group II — only complex therapy (n = 20). Group I women received treatment: transurethral coagulation of Gunner's lesion zones, bladder hydrodistension, tricyclic antidepressants, intravesical instillations of lidocaine, dimethylsulfoxide, and a course of HBO. HBO consisted of 10 sessions (40 min, 2 ATM). Group II patients received the same IC / BMP therapy as the group I women, to the same extent, but without HBO.Results. Indicators of the PUF scale after 6 months of therapy in Groups I and II were 14.2 and 21.2 points, respectively. The average score in Group I was 3.48, in Group II — 5.13 according to the visual analogue pain scale. The cystometric capacity of the bladder in both groups after treatment was stable, its value was at least 320 ml. The number of urinations after combined therapy with HBO after 1, 3 and 6 months was 12 times a day. Whereas it was 14 times a day in Group II after 1 month, and it was 15 times a day after 3 and 6 months.Conclusions. The index of IC assessment, indicators of the visual-analogue pain scale, the cystometric capacity of the bladder, and the number of urinations improved after standard treatment but were significantly worse than in patients who received HBO additionally. Treatment with HBO leads to a statistically significant improvement, only in combination with the therapy, both according to questionnaires, and the function of accumulation and emptying of the bladder. For patients with IC/BMP who had ineffective standard treatment, it makes sense to conduct HBO, which can be an important stage of therapy and contribute to a longer remission of the disease.

A case of primary gastric melanoma

Primary gastric melanoma is an extremely rare disease. Melanoma of upper gastrointestinal tract usually occurs as metastasis from a primary skin tumor in 1 to 4 % of cases. The paper describes a case report of primary gastric melanoma in a female patient who received complex therapy at the State Healthcare Institution Ulyanovsk Regional Clinical Oncology Dispensary.

Оценка влияния системной энзимотерапии на иммунные реакции при урогенитальной хламидийной инфекции

Assessment of the severity of immunological disorders in patients with hlamydia trachomatis (CT) infection and the effectiveness of antibacterial therapy in combination with systemic enzyme therapy for the eradication of pathogenic pathogen and correction of detected violations of the immune system. 84 patients with identified CT infection were divided into 2 clinical groups: group 1 (42 people) received antibiotic therapy with doxycycline monohydrate for 10 days, 100 mg 2 times a day (the first dose of 200 mg) at regular intervals (daily dose of 200 mg, course - 2.0 g.) in combination with phlogenzyme, 3 tablets 2 times a day within 14 days. The second clinical group (42 people) received only doxycycline monohydrate therapy at the same doses as in the first clinical group. In all patients with CT infection (84 people) and in the control group (32 practically healthy people), the activity of immune reac-tions in the body was additionally assessed by the level of cytokines (-INF, IL-1, IL-4, IL-6), circulating immune complexes (CIC), lactoferrin (LF) and 2-macroglobulin in blood serum. The level of CEC in the blood serum of patients with CT infection is significantly higher than the standard indicators (by 1.83 times) compared with the indicators of the control group (106.1+/-5.12 conventional units versus 57.8+/-3.39 conventional units, p<0.05). The level of -IFN in the blood serum of patients with CT infection is 1.64 times lower than in the control (28.9+/-4.15 pkg / ml and 47.3+/-4.26 pkg / ml, p<0.05), and indicators of IL-1 in blood serum - 3.12 times higher; the level of IL-6 is 2.13 times higher (p<0.001); the level of IL-4 is 1.65 times higher (p<0.05). The Lf level in patients with CT infection exceeded 2.37 times the indicator in the control group (1742.0+/-112.15 ng / ml and 732.1+/-36.11 ng / ml, p<0.001), 2-macroglobulin - in 1, 36 times (2.59 - 0.21 mg/l and 1.9 - 0.47 mg / l, p<0.001). The efficiency of clinical and microbiological cure in patients with CT infection, who received complex therapy with doxycycline monohydrate and phlogenzyme, was 97.6%. With monotherapy (doxycycline monohydrate), the effectiveness of clinical and microbiological cure was significantly lower - 78.6%, statistically significant (OR=11.2; 95% CI 1.3-247.9; p=0.007). The fact of a decrease in the activity of Th-2 type of the cellular link of immunity in patients with CT infection receiving systemic enzyme therapy drug was established. One of the pathogenetic mechanisms of CT infection is an imbalance in the cytokine profile, which manifests itself in an increase in the level of cytokines of the Th-2 (IL-6) type and a decrease in the Th-1 (-IFN) type. With the predominant production of pro-inflammatory cytokines (IL-1, IL-6), the dynamics of CT infection becomes chronic. A decrease in the reserve capacity of the proteolytic enzyme system during CT infection with a subsequent increase in the level of 2-macroglobulins in the blood contributes to the dysregulation of local inflammation processes and the formation of immune disorders. With a long course of CT infection, it is most advisable to use (as a basic pathogenetic therapy) systemic enzyme therapy (phlogenzyme). The effect of systemic enzyme therapy on immune responses in C. trachomatis enhances the activity of the Th-1 type of cytokines (-IFN) and a decrease in the level of 2-macroglobulins and pro-inflammatory cytokines (IL-1, IL-6) in the blood. Systemic enzyme therapy can significantly increase the effectiveness of antibiotic therapy and reduce the risk of side effects. The theoretical argumentation of the pathophysiological mechanisms of disorders in the interaction of the most important functional systems made it possible to substantiate new conceptual approaches to the therapy of CT infection, taking into account the level and specific disorders in the universal systems of homeostasis regulation. In particular, a pathophysiological basis has been provided to substantiate the advisability of combining antibacterial therapy with systemic enzyme therapy drugs to correct systemic immunological disorders in patients with CT infection.

Peculiarities of management of endometrioid ovarian cysts in patients of reproductive age

The wide spread of endometriosis disease, absence of the onset of a period of stable remission, high frequency of recurrence of the disease cause the existing problems of management of endometriosis. The objective: to study the effectiveness of various treatment regimens for endometriomas in patients with previously realized reproductive potential. Materials and methods. 44 women aged 17 to 49 years were examined: the first group consisted of 25 healthy nonpregnant women, the second group included 19 women, with endometriomas receiving the traditional (subgroup 2a) and complex (subgroup 2b) treatment.Results. It was revealed that in patients receiving traditional therapy, at the end of the course of treatment, the initial activation of the humoral unit of the immune system was observed, which indicated the need for immunocorrection. In patients receiving complex therapy, normalization of the body’s immune homeostasis, stabilization of the processes of apoptosis and proliferation, the main links in the etiopathogenesis of endometriosis, was noted, which indicated an improvement in the effectiveness of the treatment. The control ultrasound in the dynamics at 1 and 3 months in patients who continued to receive complex therapy, revealed a decrease in the size of pathological formation and a pronounced antiproliferative effect on the hyperplastically altered endometrium, diagnosed before the start of treatment in 21,05% of patients. After 3 months of treatment, there was no need for an endometrial biopsy in this group of patients.Conclusions. With the use of a comprehensive approach to the treatment of endometriomas normalization of the body’s immunodeficiency parameters, regression of the endometriomas and the absence of hyperplastic endometrial processes are noted, which allows to recommend this scheme for further us.

Precursors of the treatment failure of mycobacteriosis in patients with HIV

Purpose. Analyze the dynamics of clinical and laboratory parameters, the outcomes of the disease on various treatment regimens. To identify the main markers of unfavorable outcome or protracted course of the disease. Materials and methods. The study included 70 patients with HIV and mycobacteriosis who received complex therapy (antiretroviral and specific antibacterial drugs). Depending on the outcome of the disease, two groups were distinguished: clinical cure (n = 38) and lethal outcome (n = 32). The clinical manifestations of pathology, laboratory indicators at different stages of treatment, the scheme and terms of the therapy being carried out were analyzed on the basis of data from medical histories and ambulatory patient records. A statistical analysis was performed, the efficacy of therapy was evaluated using the Kaplan-Meier method, the macrolide in the first line of antibacterial therapy used was taken as the basis. Results. All patients who died developed a disseminated form of the process. In cases when MAI developed within the unmasking immune restoration syndrome patients were prognostically more favorable (p &lt;0,05). In the clinical cure group, a significantly higher level of CD4 lymphocytes was recorded before treatment (33,3 ± 7,1 versus 9,9 ± 3,2 cells / μl, p &lt;0,05). A significant difference in the level of CD4 persisted after a month of complex therapy (79,0 ± 13,4 versus 32,2 ± 9,1, p &lt;0.05). In addition to higher immunity values, the first group also had a higher hemoglobin level after a month of treatment (108,3 ± 3,2 g / l versus 76,7 ± 5,2 g / l, p &lt;0,05). The regression of intoxication and fever was observed earlier in the cure group. When studying the used macrolide basis for the treatment of mycobacteriosis, it was found that survival term was significantly higher among patients who received clarithromycin in the first line (Kaplan – Meier, p &lt;0,05 Breslow, Tarone-Ware). According to this sample, the introduction of aminoglycoside to the treatment regimen did not make significant changes in the timing and prognosis of treatment. Conclusion . Prolonged persistence of the symptoms of the disease, persisting deep immunodeficiency and anemia of moderate or severe degree are associated with an unfavorable outcome. According to this sample, clarithromycin should be considered the drug of choice for the treatment of mycobacteriosis in HIV.

The role of combined treatment of metastatic colorectal cancer inpatients with liver metastases.

e16026 Background: Combined treatment for patients with metastatic colorectal cancer (mCRC) offers better long-term outcomes and chemotherapy can increase the rate of hepatic resectability for patients with initially inoperable disease. Methods: The analysis included 132 patients diagnosed with mCRC having metastases in the liver treated from 2015 to 2020. Of these, 62 (47%) were men and 70 (53%) women. The average age of the patients was 63 years. At the beginning of the treatment, the overall condition of all patients met ECOG 0-1 points. Primary metastatic CRC had 93 (71%) patients. A total of 39 (29%) patients were diagnosed with advanced disease. Localization of the primary tumor in 25 patients (18.9%) was in the right part of the large intestine and 107 (81.1%) in the left part of the colon. At the time of the sample, metastases were detected only in the liver in 73 patients (55.3%). In the remaining 59 (44.7%) other organs were affected besides the liver. Various types of surgical treatment of metastases in the liver received 42 (31.8%) patients. The decision on the choice of chemotherapy was made by the attending physician on the basis of the recommendations of NCCN and RUSSCO, taking into account the molecular genetic characteristics of the tumor. The decision to apply and choose the method of surgical treatment was taken in conjunction with the surgeon. Results: From the general population of patients receiving complex therapy, 2 groups were identified, between which a comparison was made. The first group (group A) was 42 (31.8%) patients who received some surgical treatment of the liver. The second group (group B) included 90 (68.2%) patients, who for some reason or another, did not receive any surgical treatment. The groups are fairly homogeneous in their characteristics. The median overall survival (OS) in group A was 40.1 months, and in group B, 22.3 months. A similar trend continued in subgroup analysis. The calculation of the PFS was complicated by the fact that surgical operations were given at different stages of complex treatment. Three-year survival in group A was approximately 50%, and in group B, 28%. "Five-year" survival (In those patients who were observed from the start of the study for all 5 years) in group A was 15 %, and in group B, 5,5%. Conclusions: The inclusion of modern surgical techniques in the complex therapy of metastatic colorectal cancer, if possible, at any stage, can significantly increase the life expectancy of patients.

Impact of the Synbiotics and Urate-Lowering Therapy on Gut Microbiota and Cytokine Profile in Patients with Chronic Gouty Arthritis.

The main goal of our study is the impact evaluation of complex urate-lowering therapy with the synbiotic addition on fecal microbiota and cytokine profile in patients with primary gout. During our study, 130 men (mean age 55.5 ± 9.4 years) with gout (duration 7.7 ± 7.1 years) were examined. All patients were divided into two treatment groups. The main group (n = 68) was taking allopurinol at 300 mg per day dose and additionally a synbiotic. The comparison group (n = 62) received allopurinol monotherapy without synbiotic intake. The therapy duration was 3 months. Evaluation of therapy efficiency was marked by blood uric acid changes, cytokine levels, CRP and fecal microbiota condition. After treatment, stabilization of the gut microbiota parameters was observed, which was leading to normalization uricemia levels (40.3% vs. 21%, p <0.01) in the main group patients. Addition of synbiotic to allopurinol leads to a blood uric acid lowering (18.7% vs. 13.3%, p <0.01), CRP reduction (75% vs. 26.3%, p <0.01) as well as decrease of cytokines level: IL-1β, IL-6, IL-8, IL-10 and TNFα (all p <0.001). After a 3-month gout treatment, a group of patients who received complex therapy with synbiotic inclusion showed signs of disease remission characterized by inflammation activity reducing, fecal microbiota condition normalization and a more pronounced decrease in laboratory markers comparing to control group.

Use of Nordic walking in the complex treatment of lower urinary tract symptoms in chronic prostatitis

Lower urinary tract symptoms (LUTS) caused by chronic prostatitis (CP) are a common condition. Standard antibiotic therapy is often not justified, since bacterial prostatitis is presented in up to 10% of the cases, while there is no effect on the risk factors for the development and relapse of the disease. This study is aimed at one of the main risk factors for LUTS - a sedentary lifestyle. To increase the effectiveness of treatment for LUTS in men using the Nordic Walking technique. 84 patients with CP were examined, which were divided into 3 groups. The 1st group (control) included 32 patients who received standard antibacterial therapy. In the 2nd group (primary) - 32 patients who received complex therapy (antibiotic therapy + 4-week course of Nordic walking). The third group (comparison) included 20 patients who were prescribed monotherapy - Nordic walking for 4 weeks. The dynamics of clinical manifestations was assessed using CP Symptom Scale (NIH-CPSI) and the international symptom index for diseases of the prostate IPSS; the volume of residual urine, uroflowmetric data, and the level of leukocytes in the secretion of the prostate gland were estimated. Laboratory studies showed a significantly faster decrease in the number of leukocytes in the secretion of the prostate gland on the 7th and 14th day in the primary (2nd) group (p<0.001). Clinical symptoms according to the NIH-CPSI and IPSS scales significantly regressed in the primary group on the 14th and 28th days of therapy. Uroflowmetric data and the volume of residual urine improved more significantly in the primary group by the 14th and 28th days. Patients receiving combined therapy showed significantly better treatment results in the form of faster normalization of prostate secretion, regression of clinical symptoms, improved urine flow rate and a decrease in residual urine volume after 4 weeks of therapy. When choosing management algorithm for patients with LUTS, it is advisable to use an integrated approach: in addition to antibiotic therapy, Nordic walking is recommended 3 times a week for at least 4 weeks.

MODERN METHODS OF COMPLEX CORRECTION OF PSYCHOSOMATIC DISORDERS IN PATIENTS WITH EXTERNAL GENITAL ENDOMETRIOSIS

The aim: About 10% of socially active women of reproductive age suffer from endometriosis, is determined by the frequent occurrence of menstrual and reproductive functions disorders, and pelvic pain syndrome in patients. The difficulties of therapeutic treatment of chronic pain syndrome in external genital endometriosis (EGE) are associated with polymorphism of pain mechanisms, and delayed diagnosis and treatment. The aim of the study is to improve the effectiveness of the treatment of external genital endometriosis. Material and methods: We examined 60 female patients of reproductive age, 40 - with histologically verified diagnosis of external genital endometriosis and 20 healthy women. We used the following methods of examination: general clinical, instrumental, endoscopic, morphological, the Visual Analogue Scale (VAS) to quantify pain, the Beck Depression Scale and the SF-36 questionnaire. Results: Before the treatment of patients with EGE, VAS scale scores indicated pain in 100% of patients, the indicators of depression and level of anxiety go beyond the normative. The results of the pre-treatment questionnaire indicated lower quality of life scores on the scales of physical and mental health components. As a result of treatment there was significant decrease in the manifestations of pain, depression and anxiety, with women receiving complex therapy (hormone therapy got antidepressants and non-drug correction methods). Сonclusions: Chronic pelvic pain syndrome associated with EGE and accompanied by an unfavorable psychological state, depressive states, anxiety symptoms, and psychosomatic disorders. New approaches to the treatment of clinical manifestations of EGE are needed, taking into account patients' psycho-emotional status and the life quality analysis. We pathogenetically justified the use of drugs that affect the psychosomatic status of patients with EGE and showed that they could significantly improve the quality of life.

THE EFFECTS OF ALLOFERON (ALLOKIN) IN THE THERAPY OF METABOLIC SYNDROME (A PILOT STUDY)

The aim of this work was to study the influence of treatment with alloferon (allocin) in combination with pyrogenal and cytokine therapy on the parameters of immunity, systemic inflammation, levels of herpesvirus replication and biochemical profile of patients with metabolic syndrome to search for new approaches to the treatment of the early stages of the disease. Markers of systemic inflammation and immunity, including key cytokines and lymphocyte subpopulations, were investigated. It was found that 1 month after the start of the study in patients receiving only allokin, there were signs of activation of humoral immunity. In patients receiving complex therapy, there were signs of activation of the cell-mediated mechanisms of adaptive immunity. These changes persisted after 6 months and were not accompanied by signs of systemic inflammation when evaluated at 1 and 6 months. The results of further observation showed that in patients receiving complex therapy, there were positive changes in lipid profile, which were the most prominent at the end of the study. Thus, in this study it was shown that in patients with metabolic syndrome complex immunomodulatory therapy, including allokin, pirogenal, ingaron and Roncoleukin, led to the activation of the cellular link of adaptive immunity, without causing a long-term increase in the level of markers of systemic inflammatory response. During long term observation the patients had positive dynamics of the main markers of the lipid profile, and a reduce in the level of serum markers of systemic inflammation. These delayed effects can apparently be associated with immunomodulatory effects of therapy, including the possible activation of regulatory CD4+CD25+Foxp+ cells, which, according to the literature, have a protective effect in obesity, reducing insulin resistance.

Methodological aspects of adaptive kinesitherapy

The use of robotic technologies in the treatment of post-stroke patients is considered the gold standard of modern rehabilitation. The global disadvantage of most devices is the inability to provide real interaction with the environment (movement in space). The aim of the study was to develop methodological programs using the mobile robotic WO:EX platform. The WO:EX technology allows to perform a wide range of active-passive movements (steps and rotations) with real displacement in space. The study involved 28 individuals (the main group#1 receiving adaptive kinesitherapy (AK) with a clinically confirmed diagnosis of stroke. The leading symptom was hemiparesis. The time after a stroke was 1-3 months. The control group#2 consisted of 16 patients. All patients received complex therapy. АК included: 1)passive articular gymnastics; 2)active-passive walking forward and with side rotations; 3)training step to the side; 4)axial coordination training; 5)training of static and dynamic stability; 6)training of axial support (lower limb); 7)difficult coordinated step; 8)step on the step. Treatment results are objectified by the Bartel index (BI), Rivermid index (RMI), the Scandinavian stroke scale (SSS), and test of the quality of perception of the surrounding space (QPSS).Tabled 1BIRMISSSQPSS#1before42,3+622,5+330,1+457,8+5#1after57,2+840,1+340,6+672,5+4#2before39,5+820,2+729,1+353,6+7#2after45,5+532,5+135,3+760,9+4The obtained data indicate significant (at p <0.05) differences in the both groups before and after treatment, while the results in group # 1 using adaptive kinesitherapy were significantly higher. Open table in a new tab The obtained data indicate significant (at p <0.05) differences in the both groups before and after treatment, while the results in group # 1 using adaptive kinesitherapy were significantly higher. Thus the WO:EX technology allows to achieve greater space mobility and stability.

Modern ways to improve effectiveness of food allergy treatment in children

Aim. To evaluate the effectiveness and safety of a multi-strain probiotic in children with various clinical manifestations of food allergy. Materials and methods. Under the supervision there were 192 children aged from 3 months to 3 years with skin, gastrointestinal and combined (skingastrointestinal) manifestations of food allergies. Patients of the main group received complex therapy and a multistrain probiotic. Patients in the control group did not receive probiotic. Clinical assessment of symptoms during the treatment was conducted (initially and after 30 days). Results. The use of a multistrain probiotic in children with various clinical manifestations of food allergy during 30 days showed improvement of skin and gastrointestinal symptoms of food allergy. The overall effectiveness of therapy in children of the main group was 80.3% versus 68.6% in the control group. Probiotic tolerance was good; no adverse reactions were noted. Conclusion. The inclusion of a new generation probiotic in the complex therapy of food allergies helps to improve the course of the disease and increase the effectiveness of treatment.

THE EFFECT OF ANTIOXIDANT THERAPY ON THE SEVERITY OF THE COURSE, THERAPY EFFICACY AND DURATION OF REMISSION IN PATIENTS WITH PSORIASIS

The prevalence of psoriasis has accentuated the high relevance of searching new approaches towards its treatments. This article describes the connection between the development of the clinical picture and lipid peroxidation, and studies the expediency of using drugs with antioxidant properties as a component of the treatment. The products of lipid peroxidation regulate cell proliferation and permeability of cell membranes, thus the function and structure of the skin is directly dependent on the level of lipids and phospholipids. Patients with either mild or severe psoriasis have been found out to demonstrate some changes in the blood serum: increased cholesterol, triglycerides and free fatty acids, as well as a change in the ratio of the fractional content of phospholipids in erythrocyte membranes. Taking into account the above mentioned factors of psoriasis, we can suggest that it would be reasonable to include antioxidants into the integrated therapy. Antioxidants are the group of biologically active substances that possess an ability to interact with various reactogenic oxidants, reactive oxygen species and other free radicals that leads to their full or partial inactivation. During this study resveratrol was added to standard psoriasis therapy. The scope of laboratory research included: diagnosis of changes in the blood biochemical analysis taken on an empty stomach in the morning to investigate the content of total protein, albumin, bilirubin, low and high density lipids, phospholipids, cholesterol, alanine aminotransferase, aspartate aminotransferase. It has been found out the reduction of symptom in the patients who received complex therapy modified with resveratrol was more marked than in patients who received standard therapy only. A more intensive decrease in infiltration, erythema, desquamation, and itching has been clinically observed as well.

Особливості менеджменту ендометріоїдних кіст яєчників у пацієнток репродуктивного віку

The wide spread of endometriosis disease, absence of the onset of a period of stable remission, high frequency of recurrence of the disease cause the existing problems of management of endometriosis. The objective: to study the effectiveness of various treatment regimens for endometriomas in patients with previously realized reproductive potential. Materials and methods. 44 women aged 17 to 49 years were examined: the first group consisted of 25 healthy nonpregnant women, the second group included 19 women, with endometriomas receiving the traditional (subgroup 2a) and complex (subgroup 2b) treatment. Results. It was revealed that in patients receiving traditional therapy, at the end of the course of treatment, the initial activation of the humoral unit of the immune system was observed, which indicated the need for immunocorrection. In patients receiving complex therapy, normalization of the body’s immune homeostasis, stabilization of the processes of apoptosis and proliferation, the main links in the etiopathogenesis of endometriosis, was noted, which indicated an improvement in the effectiveness of the treatment. The control ultrasound in the dynamics at 1 and 3 months in patients who continued to receive complex therapy, revealed a decrease in the size of pathological formation and a pronounced antiproliferative effect on the hyperplastically altered endometrium, diagnosed before the start of treatment in 21,05% of patients. After 3 months of treatment, there was no need for an endometrial biopsy in this group of patients. Conclusions. With the use of a comprehensive approach to the treatment of endometriomas normalization of the body’s immunodeficiency parameters, regression of the endometriomas and the absence of hyperplastic endometrial processes are noted, which allows to recommend this scheme for further use. Key words: endometriosis, reproductive age, immunodiagnostics, ultrasound, immunotherapy.

Arterial hypertension in young

The aim of the study was to increase the effectiveness of treatment of arterial hypertension (AH) in young people with clinical signs of autonomic dysfunction.Materials and methods. The study included 65 men with hypertension aged 30–40 years (mean age 35.6±4.3 years). In 32.3 % of patients with hypertension was 1 and 67.7 % – 2 degree. The control group consisted of 20 healthy men. All examined individuals were assessed for clinical status, measurement of office BP, daily monitoring of blood pressure. The assessment of autonomic dysfunction was carried out using the questionnaire (A. Vane, 2003). To assess the situational anxiety and personality questionnaire used anxiety Ch. D. Spielberger (1973) in Yu. L. Hanin adaptation. Non-specific changes in the functional state of the central nervous system were assessed by analyzing the heart rate variability on the ECG complex of the Holter monitoring.Results. After treatment, target blood pressure levels were achieved in 23 (76.7 %) patients of the 1st group and 31 (88.6 %) in the second group. Patients with hypertension and clinical signs of autonomic dysfunction, who received complex therapy with the addition of ethyl methyl hydroxypyridine succinate, showed a more pronounced increase in total HRV, decreased activity of the sympathetic part of the autonomic nervous system and the recovery of autonomic balance according to the time of HRV. After a course of combined therapy with the addition etil methylhydroxypyridine succinate was observed marked reduction in the level of reactive anxiety by 41 % (p&lt;0.001) and personal anxiety by 37.8 % (p&lt;0.001), which indicated an improvement in the psycho-emotional state in these patients. Thus, the addition of ethylmethylhydroxypyridine succinate to the complex therapy of young men with hypertension and the clinical signs of autonomic dysfunction has a positive effect on clinical symptoms, contributes to the restoration of the autonomic balance and correction of the psycho-emotional state.

New insights into the prevention of viral infections in patients with bronchial asthma

One of the main concepts today in the management of asthma is the control of the disease. Worldwide research suggests that viral respiratory infections are the most common cause of dyspnea and asthma exacerbations in children and adults. The purpose of our study was to prove the feasibility of using Rimantadine hydrochloride in patients with asthma, in order to prevent viral infections. Patients in the main group received complex therapy including Rimantadine hydrochloride, namely at a dose of 100 mg twice a day for 15 days. The majority of patients, namely 86.6 % (n=52), reported a deterioration in their health status in cases of acute respiratory infections and flu. Also, our patients in 81.6 % (n=49) cases complained of a prolonged reduction in the function of external respiration after the disease, in addition 48.3 % (n=29) of patients needed help from the doctor to decide on the change in therapy for more low step. Our study continued the flu epidemic of 2017–2018, we came to the conclusion about the incidence of viral infections such as influenza. So we have found that out of 30 patients in the main group, only 4 men were ill and the disease was not serious. Patients in the comparison group had more negative outcomes from 30 patients, 11 were ill, of which 7 patients were referred for emergency care or were hospitalized.

Restoration of Speech Functions in Patients with Aphasia in the Early Rehabilitation Period of Ischemic Stroke

Objectives. To study the efficacy of complex therapy including daily speech therapy and two courses of Cellex in patients with aphasia in the early recovery period of ischemic stroke (IS). Materials and methods. Forty patients in the early recovery period of IS in the basin of the left middle cerebral artery with moderate or severe aphasia were studied. Twenty patients received complex therapy, including daily sessions with a speech therapist/aphasia specialist for 10 days using an improved method followed by self-study using educational materials and two 10-day courses of Cellex injections; the other 20 patients received only speech therapy. Treatment efficacy was evaluated using an automatic “Aphasia patient study program,” the Goodglass–Kaplan scale, and the modified Rankin scale. Results and conclusions. Patients of both groups achieved significant improvements in speech functions, communicative abilities, and functional recovery (p < 0.01); patients receiving complex therapy including two courses of Cellex injections showed significantly higher levels of rehabilitation (p < 0.05). These results allow the inclusion of Cellex into the complex restorative treatment of patients with poststroke speech impairments to be recommended.

Терапевтичні вектори лікування ендометріоїдних кіст яєчників

The objective: to study clinical and anamnesis features in patients with ovarian endometriomas and to improve existing algorithms of treatment women with ovarian endpmetriomas. Materials and methods. The study included 32 patients aged 18 – 49 years with ovarian endometriomas and 50 healthy women. A general clinical, sonographic, immunological examination was conducted. Results. The analysis of the study data revealed the I degree of insufficiency of the adaptive link and the I–II degree of insufficiency of the nonspecific link of the immune system. In 74.51% of cases surgical treatment of the pathological process was carried out. As a conservative therapy and in the postoperative period the patients received complex therapy with immunomodulators, drugs of indole-3-carbinol, combined oral contraceptives with gestagen. Conclusion. The application of our proposed complex therapy of ovarian endometriomas in women of reproductive age showed a high recovery rate and a low relapse rate. Key words: ovarian endometrioma, reproductive age, immune dysfunction, treatment.

THE PATHOGENETIC SUBSTANTIATION OF EFFICIENCY OF PHOTOPHERESIS IN ATYPICAL VARIANTS OF LICHEN PLANUS

Lichen planus (LP) is an autoimmune disorder which is characterized by long lasting, recurrent course of a disease and by poor response to treatment (including systemic corticosteroids and cytostatics). Cutaneous and mucosal LP may present in atypical forms, several can transform to cancer with statistical confidence. Earlier, we have confirmed high clinical efficacy of photopheresis — method of adoptive immunotherapy in treatment of patients with typical LP.Target: research of clinical efficacy of photopheresis in complex trearment of atypical forms of cutaneous and mucosal LP.Materials and methods. There had been carried out a study of the clinical and immunological efficacy in two groups of patients: patients receiving complex therapy, which includes photopheresis with routine therapy (delagil, doxycycline and topical corticosteroids (I groupe — 23 patients) and receiving complex therapy, which includes photopheresis with single injection of methotrexate in dose of 10 mg with routine therapy ( II groupe — 18 patients).Results. In I group of patients immunological disorders were similar with results of earlier immunological studies in patients with lypical LP, among them increase in the number of CD16+-cells. In the II groupe immunological disorders were characterized by the rise of amount and activity of CD3+CD8+-lymphocytes. The high efficacy of Group I patient treatment was accompanied by the restoration of their tolerance to the skin antigenic structures, while maintaining the possibility for transendothelial migration of CD16 + cells. The effect of the treatment in Group II patients was also pronounced; however, due to the use of methotrexate, no normalization of the patients’ immune parameters was observed.Conclusion. The data obtained confirms the high clinical efficacy of photopheresis in both groups of patients and its pathogenic validity in patients suffering from atypical lichen ruber planus.