Regression Of Clinical Symptoms Research Articles

Clinical features, diagnostics and treatment of FGF23 secreting tumors: series of 40 clinical cases

Tumor-induced osteomalacia is an acquired rare disease manifested by hypophosphatemic osteomalacia due to excessive secretion of fibroblast growth factor 23 (FGF23). FGF 23 is a non-classical hormone secreted by bone tissue (osteocytes) and regulates phosphorus metabolism.The aim of this work is to present clinical experience in the diagnosis, treatment and rehabilitation of patients with tumor-induced osteomalacia. 40 patients with clinically-confirmed tumor-induced osteomalacia were included in the study, 34 of whom had the tumor localized, 27 underwent surgical treatment and 21 achieved stable remission. The median age was 48 [41; 63] years, 43% were men, the time left from the the onset of the disease was 8 [4; 10] years. Biochemical findings were hypophosphatemia 0.47 [0.4; 0.53] mmol/l, a decrease in the tubular reabsorption phosphate 62 [52; 67]%, and an increase in alkaline phosphatase of 183 [112; 294] units/l. At the time of diagnosis, 100% had multiple pathological fractures, only 10% could move independently, and 77.5% classified the pain as unbearable (8-10 points according to the 10-point pain syndrome scale ). Among the methods used to detect tumors, the most sensitive were scintigraphy with tectrotide with SPECT/CT 71.4% (20/28) and MRI 90% (18/20). In 35% of cases, the tumor was localized in soft tissues and in 65% in bone tissue; The tumor was most often detected in the lower extremities, followed by the head in frequency of localization. 18 patients currently have no remission and they receive conservative treatment (phosphorus and alfacalcidol n=15 and burosumab n=3). In case of achieving remission (n=21), regression of clinical symptoms and restoration of bone and muscle mass was observed. Extensive excision of the tumor without prior biopsy resulted in the best percentage of remission - 87%. Tumor-induced osteomalacia is characterized by severe damage to bone and muscle tissue with the development of multiple fractures, muscle weakness and severe pain syndrome. In laboratory diagnostics, attention should be paid to hypophosphatemia, a decrease in the tubular reabsorption phosphate index and increased alkaline phosphatase. The use of functional diagnostic methods with a labeled somatostatin analogue to the subtype 2 receptor and MRI with contrast enhancement are the most accurate methods of topical diagnostics. In case of localization of the tumor, a wide excision without a preliminary biopsy is recommended.

THU462 Clinical Features & Management Of FGF23 Secreting Tumors: Series Of 40 Clinical Cases

Abstract Disclosure: S. Gronskaia: None. Z. Belaya: None. L. Rozhinskaya: None. T. Dubovitskaya: None. E. Mamedova: None. E.A. Pigarova: None. M. Degtyarev: None. S. Rodionova: None. Y. Buklemishev: None. D. Babaeva: None. V. Vladimirova: None. N. Tarbaeva: None. S. Serzhenko: None. A. Grigoriev: None. L. Dzeranova: None. V. Karpenko: None. A. Karasev: None. R. Fedotov: None. I. Ulyanova: None. D. Trukhina: None. N. Toroptsova: None. O. Lesnyak: None. N.G. Mokrysheva: None. G.A. Melnichenko: None. I. Dedov: None. Introduction: Tumor-induced osteomalacia is an acquired rare disease manifested by hypophosphatemic osteomalacia due to excessive secretion of fibroblast growth factor 23 (FGF23). FGF 23 is a non-classical hormone secreted by bone tissue (osteocytes) and regulates phosphorus metabolism.The aim of this work is to present clinical experience in the diagnosis, treatment and rehabilitation of patients with tumor-induced osteomalacia. Materials and methods: 40 patients with clinically-confirmed tumor-induced osteomalacia were included in the study, 34 of whom had the tumor localized, 27 underwent surgical treatment and 21 achieved stable remission. Results: The average age was 48 +/- 14 years, 43% were men, the time left from the the onset of the disease was 8 +/- 6 years. Biochemical fundings were hypophosphatemia 0.47 [0.4 ; 0.53] mmol/l, a decrease in the tubular reabsorption phosphate 62 [52 ; 67]%, and an increase in alkaline phosphatase of 183 [112 ; 294] units/l. At the time of diagnosis, 100% had multiple pathological fractures, only 10% could move independently, and 76.3% classified the pain as unbearable (8-10 points according to the 10-point pain syndrome scale ). Among the methods used to detect tumors, the most sensitive were scintigraphy with tectrotide with SPECT/CT 71.4% (20/28) and MRI 90% (18/20). In 55% of cases, the tumor was localized in soft tissues and in 45% in bone tissue; The tumor was most often detected in the lower extremities, followed by the head in frequency of localization. 18 patients currently have no remission and they receive conservative treatment (phosphorus and alfacalcidol n=15 and burozumab n=3). In case of achieving remission (n=21), regression of clinical symptoms and restoration of bone and muscle mass was observed. Extensive excision of the tumor without prior biopsy resulted in the best percentage of remission - 87%. Conclusion: Tumor-induced osteomalacia is most common in the middle age people. It is characterized by severe damage to bone and muscle tissue with the development of multiple fractures, muscle weakness and severe pain syndrome. In laboratory diagnostics, attention should be paid to hypophosphatemia, a decrease in the tubutar reabsorption phosphate index and increased alkaline phosphatase. The use of functional diagnostic methods with a labeled somatostatin analogue to the subtype 2 receptor and MRI with contrast enhancement are the most accurate methods of topical diagnostics. In case of localization of the tumor, a wide excision without a preliminary biopsy is recommended. Presentation: Thursday, June 15, 2023

Radiofrequency ablation as a method of choice for the treatment of lower extremity varicose veins disease

The aim of the work is to improve the radiofrequency ablation (RFA) protocol in order to minimize disease recurrence and to improve the life quality of patients with lower extremity varicose veins disease (LEVVD).
 Materials and methods. An open-label, prospective study of the effectiveness of a modified RFA protocol for the treatment of 210 consecutive patients with clinical grade C2-C6 of LEVVD was conducted. The effectiveness and safety of the procedure were evaluated by the anatomical success of vein obliteration, the dynamics of the severity of venous pathology according to the VCSS scale, quality of life indicators determined using the AVVQ-UA questionnaire, and development of postoperative complications.
 Results. Sonographic control was conducted in the first 48 hours, 7 days and 1 month after the RFA procedure and recorded 100 % occlusion of the great saphenous vein, obtaining the effect of “radiofrequency crossectomy” in the jugular area. After 6 months and 1 year of follow-up, 208 (99.1 %) patients experienced vein occlusion and 2 (0.9 %) patients had partial vein occlusion within 1 cm of the sapheno-femoral junction without pathological reflux. After 2 years the partial occlusion was diagnosed in 4 (1.9 %) patients.
 During the first 2 weeks after treatment, 64 (30.5 %) patients reported complications, which didn’t require treatment. However, in 2 (0.9 %) cases asymptomatic distal DVT and in 1 (0.5 %) EHIT II were diagnosed. Anticoagulant therapy was prescribed. Regression of clinical symptoms with a statistically significant difference in the VCSS score (p < 0.001) was observed 6 months after RFA. The application of the proposed RFA protocol made it possible to statistically significantly improve the quality of life indicators 1 month after treatment by 3.36 ± 0.81 (р < 0.001) with further positive dynamics.
 Conclusions. The application of the proposed RFA protocol in patients with LEVVD has a good safety profile, allows to minimize disease recurrences, performing the effect of “radiofrequency crossectomy”, and has a positive effect on the regression of clinical symptoms and quality of life indicators.

РЕЗУЛЬТАТЫ КАТАМНЕСТИЧЕСКОГО НАБЛЮДЕНИЯ И ОСОБЕННОСТИ ТЕЧЕНИЯ COVID-19 У ПАЦИЕНТОВ С НЕЙРОЭНДОКРИННОЙ КЛЕТОЧНОЙ ГИПЕРПЛАЗИЕЙ МЛАДЕНЦЕВ

Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare interstitial lung disease in children. The clinical features of the disease are characterized by tachypnea, moist rales/crepitus, retraction of compliant chest areas and delayed weight gain. The disease is diagnosed using the NEHI clinical scale coupled with the computed tomography of the chest organs. The clinical manifestations of NEHI regress as the child grows, but may persist up to the age of 10 y/o. The purpose of the research was to characterize the course of NEHI including the features of COVID-19 and the impact of passive smoking in children below the age of 8 y/o. Materials and methods: a single-center longitudinal study with follow-up observation of 29 patients with NEHI in January 2012 - December 2022 aged 8 months to 8 years old, 21 of which had COVID-19. Results: 20 of 29 patients with a known follow-up have undergone the long-term oxygen therapy (LTOT) at home lasting from 2 weeks up to 5.5 years (Me 1 year and 2 months; IQR 6 months - 4.5 years). Bronchial asthma was diagnosed in 2. 8 (28%) were diagnosed with atopic dermatitis, 6 (21%) with mental retardation, 3 (10%) with acute urticaria, and 2 (7%) with allergic rhinitis. Gastroesophageal reflux disease (GERD) was diagnosed in 7, all requiring LTOT. The frequency of episodes of respiratory infection was maximum in the first 2 years of life, amounting to 16 episodes per 2 years (Me 7; IQR 4 to 10), and the maximum frequency of hospitalizations during this age period was 5 (Me 2; IQR 1 to 2). Children-passive smokers were diagnosed with malnutrition more often (75%, p=0.449) and required LTOT more often (75%, p=0.694), were more often hospitalized (42%, p=0.422). Despite the possible need for LTOT patients with NEHI had COVID-19 in the form of nasopharyngitis in the majority of cases (89%). Only 8 out of 14 patients had symptoms of NEHI after 5 years of age, and only 1 out of 5 after 7 years. Malnutrition (body mass index for the age<-2) in the first year of life was diagnosed in 13 (45%) children. Malnutrition persisted in 9 out of 24 (37%) by the second year of life, in 5 out of 19 (26%) by the third year, and in 2 out of 14 (14%) by the fourth year of life. Not a single child died. Conclusion: the course of NEHI is characterized by the absence of lethal outcomes, frequent respiratory infections that led to hospitalizations in the first 2 years of life, mild course of COVID-19, regression of clinical symptoms and malnutrition as the child grows, comorbidity with atopic diseases and GERD. The priority should be given to the prevention of passive smoking in children with NEHI.

Experience of biological therapy in severe forms of chronic rhinosinusitis with nasal polyps in the conditions of regional healthcare

To analyze our own experience, clinical and organizational features of the application of the method of biological therapy in patients with severe forms of recurrent CRSwNP. 25 patients with severe and moderate forms of CRSwNP were examined, who, in a round-the-clock hospital (model CSG 36.018) was treated with Dupilumab, in the form of subcutaneous injections of 300 mg/2 ml 1 every two weeks. The diagnosis was confirmed on the basis of anamnestic data, SNOT-22 quality of life questionnaires, visual endoscopic examination, evaluation of CT data (Lund-Mackay scale), laboratory data. The effectiveness of treatment was monitored after 16 weeks, based on endoscopic examination data, evaluation of CT and SNOT-22 data. In 3 observations, a study of pathomorphological material for tissue eosinophilia was performed. The duration of the course of treatment ranged from 10 to 56 weeks. The most striking clinical effect was observed for signs such as sense of smell and nasal breathing (in some cases-after the first injection). The degree of regression of polyps according to CT and endoscopic examination was more prolonged in time, the same dynamics was observed in the level of total IgE. In a number of patients, the phenomenon of eosinophilia growth was observed against the background of treatment (with regression of clinical symptoms). Pathomorphological examination confirmed a high level of tissue eosinophilia as one of the fundamental signs of Th2 inflammation. One patient with concomitant chronic tubar dysfunction had an improvement in hearing. All patients with AD noted a subjective improvement in disease control (a decrease in the frequency and severity of choking attacks). The cancellation (break in treatment) of treatment was accompanied by a gradual return of symptoms in all patients at various times. Patients who have not achieved an acceptable level of control of CRSwNP,that meets the criteria of Th2 inflammation can be considered as candidates for the use of targeted biological therapy. With strict compliance with the selection criteria, there is a good clinical effect, primarily in relation to nasal symptoms (sense of smell and nasal breathing) and improved control of asthma symptoms.

Shigella-associated mild encephalitis with reversible splenial lesion in Hospital Center Delafontaine, Saint-Denis, France: a case report

BackgroundMild encephalitis with reversible splenial lesion of the corpus callosum (MERS) is a clinical/radiological syndrome characterized by hyperintense signal changes in the splenium of the corpus callosum visible on diffusion weighted imaging (DWI) in the brain Magnetic Resonance Imaging (MRI) associated with various neurological symptoms. Progression is usually favorable with disappearance of the MRI brain lesion and regression of clinical symptoms over a few days to a few weeks. The exact pathophysiology remains unclear. MERS can be associated with various pathogens.Case presentationWe report here a paediatric case of MERS associated with Shigella flexneri infection. A five-year-old boy with no relevant past medical history presented with symptoms such as headache, fever, profuse diarrhea and hallucinations.A brain Magnetic Resonance Imaging performed on Day 2 of the symptoms revealed hyperintense signal changes of the splenium of the corpus callosum in T2 FLAIR sequence. This infection had a favorable outcome after antibiotic therapy. No further recurrence of symptoms was observed and a follow-up clinical examination eight weeks later was normal. A follow-up brain Magnetic Resonance Imaging three months after discharge was also normal and the hyperintense signal changes of the splenium of the corpus callosum had disappeared completely.ConclusionsMERS is a clinical/radiological syndrome with a generally good prognosis.We believe that this is the first description of a case of Shigella-associated MERS.It is useful to know about this condition to help distinguish it from acute disseminated encephalomyelitis.

Efficacy of cytoflavin in optimizing the pharmacotherapy of traumatic brain injury

Objective. To study the efficacy of Cytoflavinum optimizing the pharmacotherapy of traumatic brain injury.Material and methods. We examined 45 patients with mild to moderate traumatic brain injury aged 25 to 54 years. The patients were divided into two groups depending on the prescribed treatment. The first index group included 25 patients with traumatic brain injury who received complex therapy: Cytoflavinum against the background of standard therapy in accordance with clinical guidelines for the treatment of traumatic brain injury. Cytoflavinum was injected intravenously, once a day, 10 ml in 200 ml of 0.9% sodium chloride solution at a rate of 60–80 drops/min (3–4 ml/min) daily for 7 days. The second control group included 20 patients with traumatic brain injury who received only standard therapy. In accordance with the purpose of the study, laboratory blood parameters and their correlation with the parameters of the antioxidant status were determined, and the dynamics of the clinical condition of patients was assessed.Results and conclusion. The administration of Cytoflavinum to patients contributed to a more pronounced positive dynamics of laboratory blood parameters in comparison with the control. Optimization of the pharmacotherapy of traumatic brain injury by the administration of Cytoflavinum made it possible to achieve a more pronounced regression of clinical symptoms and reduce the duration of hospitalization in comparison with the control group of patients.

Стан прооксидантно-антиоксидантної регуляції у хворих на серозні менінгіти

Актуальність. Серозні менінгіти займають провідне місце серед уражень центральної нервової системи, питома вага яких у структурі нейроінфекцій коливається від 25 до 70 %. Дисбаланс у функціонуванні прооксидантно-антиоксидантної системи відіграє провідну роль у пошкодженні нервових клітин та призводить до їх загибелі. Мета дослідження: дослідити показники прооксидантно-антиоксидантної регуляції в динаміці захворювання у хворих на серозні менінгіти. Матеріали і методи. Під спостереженням перебували 64 хворі на серозні менінгіти віком від 18 до 74 років. Спектрофотометричним методом визначали вміст у сироватці крові хворих на серозні менінгіти стабільних метаболітів оксиду азоту — нітритів, показників спонтанної та метал-каталізованої окисної модифікації білка, а також активність каталази. Контрольну групи становили 30 здорових осіб. Результати. У хворих на серозні менінгіти при госпіталізації на тлі домінування клінічних ознак загальноінтоксикаційного, загальномозкового, менінгеального синдромів виявлено підвищення (р < 0,0001) показників спонтанної та метал-каталізованої окисної модифікації білка, вмісту нітритів у поєднанні з низькою (р < 0,0001) активністю каталази у сироватці крові порівняно зі здоровими людьми. На початку другого тижня загальноприйнятого лікування певне регресування клінічної симптоматики у хворих на серозні менінгіти супроводжувалось поглибленням дисбалансу показників прооксидантно-антиоксидантної регуляції в бік процесів вільнорадикального окислення, який залишався й на момент виписки хворих зі стаціонару. Висновки. У хворих на серозні менінгіти при госпіталізації виявлено дисбаланс показників прооксидантно-антиоксидантної регуляції, який поглиблювався на другому тижні загальноприйнятого лікування та залишався на момент виписки хворих зі стаціонару.

General principles of uncomplicated cystitis therapy during pregnancy

Urinary tract infections during pregnancy are associated with severe complications. Earlier initiation of antibiotic treatment for acute uncomplicated cystitis, reduces the various complications.Objective. To assess the effectiveness of fosfomycin in the treatment of acute uncomplicated cystitis during II and III trimester of pregnancy.Material and methods. The study included 74 pregnant women who had acute uncomplicated cystitis in II or III trimesters. All patients received fosfomycin trometamol 3.754 g (equivalent to 3 g fosfomycin) as antimicrobial therapy for acute uncomplicated cystitis. The drug was prescribed to 24 pregnant women in the II, and 50 in the III trimester of pregnancy.Results. After treatment with fosfomycin signs of acute cystitis gone in all patients. At the same time, regression of clinical symptoms was noted during the next days after therapy in 95.9% (n = 71) of cases. Repeated microbiological test of the middle portion of urine was performed 7 days after the end of antibiotic therapy. In 94.6% (n = 70) cases, total elimination of the pathogen was achieved. In 5.4% (n = 4) cases, there was a significant decrease of colonization Follow-up for three months showed the absence of recurrence of acute cystitis in all pregnant women who were included in the study.Conclusion. Fosfomycin is a highly effective drug in the treatment of uncomplicated cystitis during pregnancy.

Ефективність антагоністів альдостерону у хворих на інфаркт міокарда, ускладнений гострою лівошлуночковою недостатністю із збереженою систолічною функцією лівого шлуночка

Актуальність. Гострий інфаркт міокарда (ГІМ) залишається провідною причиною смертності в Україні та світі загалом. Мета. Аналіз впливу еплеренону на перебіг захворювання у хворих на ГІМ, ускладнений розвитком гострої лівошлуночкової недостатності (ГЛШН) із збереженою фракцією викиду лівого шлуночка. Матеріали та методи. Обстежено 137 хворих на ГІМ з елевацією сегмента SТ, ускладнений ГЛШН. Пацієнти розподілені на дві групи: 1-ша група — 65 хворих, які отримували еплеренон, 2-га група — 72 хворих, які не приймали препаратів із групи антагоністів альдостерону. Усі хворі отримували базисну терапію. З них 87 хворим проведена тромболітична терапія. Оцінено клінічні прояви серцевої недостатності (СН), результати ЕхоКС, концентрації N-термінальної мозкової фракції натрійуретичного пропептиду (NT-pro BNP). Результати. Доведений регрес клінічної симптоматики СН, який корелював із позитивною динамікою NT-pro BNP і розмірів камер серця на фоні прийому препарату у складі комплексної терапії ГІМ. Крім того, на фоні тривалого систематичного прийому еплеренону відзначена достовірна позитивна динаміка прогностичних маркерів перебігу післяінфарктного періоду у досліджуваних пацієнтів. Висновки. Застосування еплеренону спричинює гальмування процесів ремоделяції ЛШ у хворих на ГІМ, сприяє контролю об’єму рідини, що зумовлює зменшення та поступовий регрес проявів СН навіть після перенесеної ГЛШН.

Скарлатина на фоне токсикодермии у ребенка: клинический случай и краткий обзор

В статье представлен случай скарлатины на фоне токсикодермии у девочки 12 лет. Клиническая картина, скорее всего, возникла из-за сочетания этиологических факторов, таких как бактериальная инфекция и аллергическая реакция на экзотоксины. Течение болезни осложнялось поражениями слизистой носа, зева и кожи. Парентеральное введение глюкокортикоидов, антибактериальной терапии, антигистаминных препаратов привело к регрессированию клинических симптомов и предотвратило развитие осложнений. Иногда трудно дифференцировать этиологию токсикодермии в сочетании со скарлатиной. Врачи должны обследовать всех пациентов с аллергодерматозами на наличие бета-гемолитических стрептококков и антител.

Posterior Reversible Encephalopathy Syndrome after caudal epidural steroid ınjection: A case report

AbstractBackgroundCaudal epidural injections are easy, effective, and safe methods and are good options for patients with low back pain and radicular lower extremity pain. Although various complications related to the technique of the procedure or the drugs used in the procedure have been described, Posterior Reversible Encephalopathy Syndrome (PRES) has not yet been defined for this intervention.CaseIn this case report, we describe a case of PRES, which we supported with MRI findings in our patient who developed convulsions, changes in consciousness, and vision loss after being administered with caudal epidural steroid, and whose imaging findings regressed with the regression of clinical symptoms during the treatment process.ConclusionAlthough PRES is rarely reported, it should be kept in mind that it is a complication that can develop after caudal epidural steroid injection.

Case of endovenectomy and stenting with functioning arteriovenous fistula in extended post-thrombotic occlusion of deep veins

We describe herein a case of surgical treatment of a 32-year-old female patient presenting with multilevel post-thrombotic occlusion of deep veins of the left lower limb. Laboratory study revealed high-risk hereditary thrombophilia (homozygous mutation of PAI-1, MTR, heterozygous mutation of MTHFR, MTRR, ITGA2). The first stage included endovenectomy from the common femoral vein with creation of an arteriovenous fistula between femoral vessels. An attempt of endovascular stenting of iliac veins was initially unsuccessful. After 3 months, the woman was rehospitalized to undergo successful endovascular operation with stenting of the iliac veins and common femoral artery on the background of the functioning arteriovenous fistula. The clinical outcome of the operation was good. Follow-up ultrasonographic examinations (ultrasound duplex scanning) were performed at 3, 6, 10 and 13 months after the second operation. The findings of ultrasound duplex scanning at 13 months showed that the stented segments of deep veins were freely patent, with the arteriovenous fistula functioning well. There were no signs of impairments of central haemodynamics, with significant regression of clinical symptoms. The total score by the Villalta scale as compared with the baseline values decreased from 13 to 5. Given the pattern of deep vein lesions, complexity of open and endovascular operations, and the presence of thrombophilia, we decided to abstain from disuniting the arteriovenous fistula. This case report demonstrates possibility, efficacy and safety of long functioning of an artificial arteriovenous fistula in a particular patient cohort.

Clinical efficacy of Heptrong in patients with non-alcoholic liver disease in real clinical practice (pilot study)

The purpose of the study: to assess clinical efficacy, dynamics of liver steatosis, effect on insulin resistance and hypolipidemic, ammonia level, systemic inflammation of the Heptrong in patients with non-alcoholic fatty liver disease (NAFLD) and dyslipidemia with obesity.Materials and methods. The study included 40 patients (23 men), age Me 48 (41–53) years, BMI Me 30.5 (28–34) kg / sqm. Inclusion criterion: presence of fatty hepatosis in ultrasound and the ALT level is more than 1.5 norms. Asthenia (AVS) was detected in 78% of patients, abdominal pain in 65% (hepatomegaly, chronic cholecystitis), flatulence in 26%, dyspepsia in 32%. In 36% of patients there was arterial hypertension, in 54% of cases — insulin resistance, in 72% of cases — dyslipidemia with hypertriglyceridemia. Before therapy, patients had an increase in the level of ALT up to 1.9 norms, AST up to 2.1 norms, GGTP up to 1.8 norms, total bilirubin — 1.4 norms, glycated hemoglobin — 1.2 norms, HOMA index up to 1,3 norms, total cholesterol up to 1.3 norms, triglycerides up to 1.4 norms, CRP up to 1.2 norms and ferritin up to 1.3 norms, combined with an increase in CRP and leukocytes up to 1.2 norms. According to the results of liver FIBROSCAN, hepatic steatosis was detected in all patients, Me CAP 295 (254–343), liver fibrosis was detected in 32% of cases (Me 6.4 (5.4–7.6) kPa). The level of ammonia in the peripheral blood on an empty stomach was Me 72 (42–91) mmol / l (with a norm of up to 54 mmol / l). Heptrong was prescribed in the form of 3 courses of 10 intramuscular injections according to the scheme 3.0 ml-3 ml-6.0 ml-6.0 ml-9.0 ml-9.0 ml-6.0 ml-6.0 ml-3.0 ml-3.0 ml for 3 months.Resaults. After 1 month of Heptrong therapy according to the scheme, there was a significant decrease (p≤0.05 according to the Wilcoxon criterion) in the frequency of AVS, pain and dyspeptic syndrome, the level of bilirubin, ALT, CRP, ferritin, ammonia, GGTP. After 3 courses of therapy, the examined patients showed further regression of clinical syndromes. During examination and communication, a positive trend was noted on the scales of quality of life and level of anxiety. Revealed a decrease in Me ALT by 31% (p <0.05); decrease in AST by 28% (p <0.05); GGTP — by 33% (p <0.05); glycated HB — by 15% (p <0.05); CRP — by 10% (p <0.03) ; ferritin — by 11% (p <0.05), ammonia — by24% (p <0.05); HOMA — index by 15% (p <0.04); total cholesterol — by 12% (p <0.05); triglycerides — by 20% (p <0.05); LDL — by 19% (p <0.05); HDL + 18% (p <0.05); Liver steatosis (dВ / m²) –26% (p <0.05); Liver fibrosis — reduction of 1 stage (Metavir) in 28% of patients. A positive response to therapy correlated (r> 0.3) with the patient’s age, male gender, BMI, Homa index, LDL, CRP, ammonia, ferritin.Conclusions. During the course of treatment with Heptrong, patients with NAFLD experience regression of clinical symptoms, stigma of systemic and local inflammation, correction of metabolic disorders, and improvement in the quality of life.

Formation of a cohort of anticovid plasma donors with high-titer antibodies neutralizing SARS-CoV-2

Background. The application of convalescent plasma (CP) is currently seen as a feasible therapeutic approach in the treatment of COVID-19.Aim. To analyze the experience of recruiting a donor cohort from COVID-19 convalescents for banking of CP as part of a pilot project at the Moscow Healthcare Department.Materials and methods. A retrospective research included 493 COVID-19 convalescents as potential CP donors, all examined at the Sklifosovsky Research Institute for Emergency Medicine. CP was banked using the plasmapheresis method. Only those donors with a documented medical history of COVID-19, which was confi rmed by polymerase chain reaction of SARS-CoV-2 RNA in pharyngeal swabs, and no sooner than 14 days after complete recovery were eligible for donation. Viral neutralizing activity (VNA) was chosen as the key characteristic of the immunological viability of CP. All the donors having VNA titers were characterized in terms of gender, age, time interval since the disease onset, regression of clinical symptoms and clinical features of the COVID 19 course.Results. Effective (1:160 or more) and acceptable (1:80) VNA titers were found in 21.1 % and 24.75 % of donors, respectively. Signifi cant predictors for a donor having a high VNA titer included: male sex, age over 36 years and verifi ed viral pneumonia. The absence of a signifi cant body temperature response (38.5 °С) can be considered as a negative marker of a potential donor.

Regression in the Symptoms and Discal Hernia in Case of Lumbar Radiculopathy

BACKGROUND: Discogenic lumbar radiculopathy has a favorable potential for survival; the regression of clinical symptoms may outpace the subsidence of discal hernia.
 AIM: The objective of the study is comparing the clinical data and the results of magnetic resonance imaging (MRI) in patients with discogenic lumbar radiculopathy over 1 year of observation.
 MATERIALS AND METHODS: Thirty-two patients (13 males at the average age of 39.1 ± 11.8 years) with discogenic lumbar radiculopathy confirmed by MRI were examined in the study. The intensity of pain condition was assessed using the numerical rating scale; disability was assessed using the Oswestry disability index. Sixteen patients were subjected to repeated MRI.
 RESULTS: Statistically significant (p < 0.01) reduction of the average pain intensity and intensity of disability more than 2 times was observed as early as in the first 2 weeks. Gradual reduction of pain and disability was observed during the year. Reduction of discal hernia by more than 50% was observed on average after 8.7 ± 4.7 months.
 CONCLUSION: In the case of discogenic radiculopathy, the reduction of pain and related disability far outstrips the regression of the herniation of intervertebral disk.

Influence of treatment and rehabilitation programs on clinical and functional indicators of occupational obstructive pulmonary disease

Based on the existing concept of COPD pathogenesis, treatment and rehabilitation measures should be aimed at normalizing the functioning of the mucociliary system and forming an energy-saving stereotype of breathing. In this regard, the inclusion of flutters as breathing simulators in the complex of treatment and rehabilitation programs is scientifically justified. 43 patients with moderate-severity PCOS were examined without exacerbation. The subjects were divided into 2 groups: 1 (main) — 22 patients receiving FT, and 2 (comparison) — 21 patients without FT. To assess the effectiveness, we used data from functional indicators, the results of the 6-minute walking test (6MWD) and standard questionnaires CAT, mMRC, SGRQ. The state of the respiratory muscles was assessed by the size of the chest area and indicators of endurance to static loads of the back and abdominal muscles. Studies were conducted before the start of therapy and 3 months after its end. Use of FT leads to a signifi cant regression of clinical symptoms, a signifi cant increase in OFB1, positive shifts in the CAT, mMRC and 6MWD test results, increased strength and endurance of respiratory muscles and improved quality of life. This proves the feasibility of including FT in the complex of treatment and rehabilitation measures for PHOBL.

Osteomalation under the mask of spondyloarthritis

Objective. To demonstrate the possibility of having a spondyloarthritic mask of osteomalacia in patients of both sexes.Materials and methods. Two clinical cases of osteomalacia occurring under the mask of spondyloarthritis in patients treated at the Clinical Rheumatology Hospital of Saint-Petersburg, Russia, as well as similar cases described in the literature, were analyzed.Results. In the cases described, patients were diagnosed with a disease from the group of spondyloarthritis based on a number of individual symptoms, such as pain in the lower back and stiffness, as well as instrumental examination data. At the same time, with in-depth evaluation, the pain in the lower back did not did not met to the inflammatory pain ASAS criteria, and there were also no signs of general laboratory activity of the disease. The conventional therapy for spondyloarthritis was ineffective. With the re-evaluation of clinical, laboratory and instrumental data, the diagnosis was changed to osteomalacia. Appointment of adequate therapy with vitamin D after a review of the diagnosis resulted in both a regression of clinical symptoms and an improvement in laboratory parameters.Conclusions. If the patient has pain in the lower back, especially without clear signs of inflammatory, no signs of general laboratory activity, further examination is necessary to clarify possible osteomalacia. Spondyloarthritis should be only diagnosed in cases with the secondary nature of symptoms excluded.

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.

Anti-recurrent Immunocorrection in Gynecology Andrology and Proctology

The article provides evidence of clinical experience with the use of Arecur® for the treatment of endocervicitis and dysplasia of the cervix, endometrioma, chronic bacterial prostatitis, and for postoperative rehabilitation in patients after removal of hemorrhoids. Arecur® contains exogenous peptides of natural origin – anti-infective proteins of the group of defensins and RJP-1 and has antibacterial, antiviral, anti-inflammatory and antitumor activity. In the study groups, in which Arecur® was assigned to the patients, were reported significantly better clinical efficacy results. The ability of exogenous peptides to mobilize T-lymphocytes to identify and destroy infected and atypical cells determines the elimination of human papilloma virus and creates the conditions for reducing the risk of malignant cell transformation of cervical canal. Arecur®, by enhancing the immune supervision of ectopic endometrial cells, promotes regression of clinical symptoms and prolongation of inter-relapsing intervals in patients with endometriosis. In chronic bacterial prostatitis Arecur® increases the efficiency of etiotropic and symptomatic therapy. After surgical removal of hemorrhoid lesions, Arecur® provides more positive dynamics of rehabilitation, improves patients' quality of life and prevents complications. The obtained results allow us to reasonably recommend Arecur® as a medicine for anti-recurrent immunocorrection in gynecology, andrology and proctology.