Tactics Of Therapy Research Articles

Current Issues of Antipyretic Therapy in Children with Acute Respiratory Infections

This article discusses the current issues in the pediatric practice of seasonal incidence of children with acute respiratory infections. The basic etiological aspects of this pathology, specific clinical symptoms typical for different pathogens, causes of bursts of disease in certain periods are described. Special attention is paid to the tactics of antipyretic therapy in different groups of children with fever and acute respiratory diseases, understand the typical errors in its appointment. The author discusses the domestic and foreign results of using ibuprofen to relieve fever in children with this pathology, comparative efficacy and safety data of ibuprofen with other analgesics-antipyretics.

ANTIHYPERTENSIVE THERAPY TACTICS IN HYPERTENSIVE CRISE COMPLICATED BY HAEMORRHAGIC STROKE

Aim. To identify the optimal tactics of antihypertensive therapy (AHT) in patients with hypertensive crise (HC), complicated by haemorrhagic stroke (HS).Material and methods. Forty patients aged 46–87 years, who were hospitalised with HC and HS as its complication.Results. All patients were divided into two groups, according to the median levels of systolic blood pressure (SBP) at 20 minutes after the start of the treatment: SBP >161 mm Hg vs. SBP <161 mm Hg. A significantly better survival was observed in patients with a higher degree of the 20-minute SBP eduction. In addition, patients were divided into tertiles of the 20-minute SBP levels. Participants with SBP 136–149 mm Hg demonstrated a significantly better survival. The degree of SBP reduction at 220 minutes was not significantly associated with survival. Furthermore, the patients were divided into two groups by the rate of SBP reduction. Faster rates were associated with a better survival (PGW=0,002). The second part of the study was focused on the assessment of effectiveness and safety of urapidil hydrochloride (Ebrantil). The patients were randomised into two groups: one group was administered Ebrantil, while another received the standard neuroresuscitation unit treatment. Ebrantil therapy demonstrated a fast and effective SBP reduction at 20 minutes, which was also associated with a better survival.Conclusion. We identified optimal, associated with a better survival, BP levels (136–149 mm Hg) for patients with HC complicated by HS. Target BP levels should be achieved within 20 minutes, as a slower BP reduction is linked to a worse prognosis. Ebrantil is an effective and safe antihypertensive medication.

Synthesis of novel chromene derivatives of expected antitumor activity

Inhibition of tubulin polymerization is one of the important tactics in cancer therapy. Since 4-aryl-4H-chromene derivatives are found to be microtubule-binding agents via interfering with tubulin polymerization so we decide to concentrate our exploration efforts on the combination of this nucleus with 5-, 6-, and/or 7-memebered heterocyclic moieties in a novel series of compounds to explore the effect that might result from this combination. Ten novel compounds were selected for anticancer screening assay against MCF-7 breast cancer cell line in comparison to colchicine as positive control and most of them showed excellent activity.

Blood pressure control in primary care patients with arterial hypertension: analysing the Hypertension Register data

Aim. (1) To investigate clinical characteristics of primary care patients with arterial hypertension (AH), according to the achievement of target blood pressure (BP) levels; (2) to assess the effectiveness of therapeutic measures aimed at achieving target BP and maintaining its long-term control. Material and methods. This retrospective analysis included the data from ambulatory medical records of 5558 AH patients, who attended primary care centres in 2007. Clinical characteristics were compared in patients with achieved vs. non-achieved target BP levels. According to the national AH guidelines (2004), the completeness of examination, pharmaceutical therapy tactics, and frequency of the follow-up were assessed in both groups. Results. Based on the 2007 data, target BP levels were maintained in 28% of AH patients. Mean BP level was 144/87 mm Hg. Patients with optimal BP levels, compared to their peers with inadequate BP control, had significantly (p<0,001) higher prevalence of angina pectoris (40,4% vs. 30,1%, respectively) or previous myocardial infarction (19,4% vs. 8,4%), as well as higher frequency of lipid profile assessment, creatinine measurement, and echocardiography. Mean number of prescribed antihypertensive medications was 2,08 vs. 1,60, respectively. Mean number of clinical visits per year was 4,07 vs. 2,99, while mean interval between the visits reached 72,3 vs. 62,7 days, respectively. Regardless of the target BP achievement, the quality of diagnostic and therapeutic management did not comply with the recommended standards. Conclusion. Patients with optimal BP control were characterised by a more severe clinical course, as well as by a wider scope and higher frequency of diagnostic and therapeutic procedures. At the primary care level, the quality of AH diagnostics and treatment did not comply with the recommended standards; therefore, mean BP levels in the AH Register sample were higher than the target ones.

The significance of electrothermometry indices for organization of adequate infusion therapy in diabetic foot syndrome

Aim. To determine the criteria for conservative infusion therapy with the assessment of its effectiveness using the electrothermometry method. Methods. One of the major complications of diabetes is the diabetic foot syndrome. This diagnosis is established on the basis of clinical data and imaging studies. The resulting parameters are objective, but the specificity, selectivity, and the multiplicity of diagnostic procedures negate the effectiveness of these methods, making it difficult to consequently form treatment strategy. Registration of temperature parameters during different degrees of ischemic disturbances of the lower limbs by electrothermometry was performed with the subsequent formation of the algorithm of conservative therapy. Results. In patients with diabetic foot syndrome determined was the direct correlation between the degree of tissue ischemia of the lower extremities and the variation of temperature parameters. The formation of the course of conservative therapy was performed after evaluating the obtained parameters; its formation was based on the main pathogenetic links. Clinical data and the parameters of electrothermometry served as the method of dynamic control. Conclusion. Despite the achieved successes in the modern diagnosis of the diabetic foot syndrome, there still remains a number of inaccuracies, the key ones among then are the difficulties associated with determining the level of trophic disorders; electrothermometry makes it possible to expand the diagnostic horizons, and the obtained result can serve as a prognostic guide for the formation of the tactics of therapy and as a method of dynamic control.

Fluid therapy tactics in patients with polytrauma during interhospital transportation

The study's aim was to carry out a comparative evaluation of fluid therapy's influence using 130/04 hydroxyethyl (HES) starch and dextrans on hemodynamics values in patients with traumatic shock in polytrauma during interhospital transportation.

Optimization of Therapy Tactics in Patients with Endometrial Hyperplastic Prosesses

Study Objective: The recent developments in molecular genetics have shown that mechanisms regulating proliferation, differentiation, transformation, apoptosis and elimination of epithelial cells form the basis for maintanance of endometrial intactness and function.Design: Prospective study. The study was performed by immunohistochemical analysis (markers p53, p27, Ki67 and cyclin E as well as steroid hormone receptors expression) using 44 patients in premenopausal age.Setting: The aim of the study: to improve diagnostic and therapy practice in patients with endometrial hyperplasy (EH).Patients: N/AIntervention: The endometrial tissue was obtained in D&C with the hysteroscopic control/Measurements and Main Results: In patients with polyps and EH without atypia mt p53 has not been found, however gene mutant products expression was discovered in more than one third of patients with atypical EH (40%). The level of proliferation marker Ki67 in all the samples studied, was raised, but the most high values were detected in bioptates of EH with atypia (23.3% of tagged nuclei in glandular epithelium cells and 11.3% in stromal cells). Expression of estrogen end progesterone receptors was significantly higher (284.14±4.53 and 262.22±6.42 respectively) in glandular without atypia and glandular-cystic EH (110.41±3.55 and 142.69±4.09 respectively). Higher activity of cyclin E (95.0±3.7 in cytoplasma and 30.0±7.3 in endometrial cell nuclei) and low contents of cell cycle protein-inhibitor p27 (39.4±8.1 in cytoplasma and 19.3±8.6 in endometrial cell nuclei) were revealed in endometrial samplings of patients with atypical EH, comparing to patients with polyps and EH without atypia.Conclusion: The estimation of steroid hormone receptors expression, apoptosis and proliferation markers and cell cycle regulators contributes to establishing groups of risk for EH development as well as therapy and management tactics optimization taking into consideration molecular-cellular determinants (rational hormonal therapy, both of apoptosis inductors and antiproliferative agents prescription, and operative treatment in some cases). Study Objective: The recent developments in molecular genetics have shown that mechanisms regulating proliferation, differentiation, transformation, apoptosis and elimination of epithelial cells form the basis for maintanance of endometrial intactness and function. Design: Prospective study. The study was performed by immunohistochemical analysis (markers p53, p27, Ki67 and cyclin E as well as steroid hormone receptors expression) using 44 patients in premenopausal age. Setting: The aim of the study: to improve diagnostic and therapy practice in patients with endometrial hyperplasy (EH). Patients: N/A Intervention: The endometrial tissue was obtained in D&C with the hysteroscopic control/ Measurements and Main Results: In patients with polyps and EH without atypia mt p53 has not been found, however gene mutant products expression was discovered in more than one third of patients with atypical EH (40%). The level of proliferation marker Ki67 in all the samples studied, was raised, but the most high values were detected in bioptates of EH with atypia (23.3% of tagged nuclei in glandular epithelium cells and 11.3% in stromal cells). Expression of estrogen end progesterone receptors was significantly higher (284.14±4.53 and 262.22±6.42 respectively) in glandular without atypia and glandular-cystic EH (110.41±3.55 and 142.69±4.09 respectively). Higher activity of cyclin E (95.0±3.7 in cytoplasma and 30.0±7.3 in endometrial cell nuclei) and low contents of cell cycle protein-inhibitor p27 (39.4±8.1 in cytoplasma and 19.3±8.6 in endometrial cell nuclei) were revealed in endometrial samplings of patients with atypical EH, comparing to patients with polyps and EH without atypia. Conclusion: The estimation of steroid hormone receptors expression, apoptosis and proliferation markers and cell cycle regulators contributes to establishing groups of risk for EH development as well as therapy and management tactics optimization taking into consideration molecular-cellular determinants (rational hormonal therapy, both of apoptosis inductors and antiproliferative agents prescription, and operative treatment in some cases).

Modulatory Effects and Action Mechanisms of Tryptanthrin on Murine Myeloid Leukemia Cells

Leukemia is the disorder of hematopoietic cell development and is characterized by an uncoupling of cell proliferation and differentiation. There is a pressing need for the development of novel tactics for leukemia therapy as conventional treatments often have severe adverse side effects. Tryptanthrin (6,12-dihydro-6,12-dioxoindolo-(2,1-b)-quinazoline) is a naturally-occurring, weakly basic alkaloid isolated from the dried roots of medicinal indigo plants (Ban-Lan-Gen). It has been reported to have various biological and pharmacological activities, including anti-microbial, anti-inflammatory, immunomodulatory and anti-tumor effects. However, its modulatory effects and action mechanisms on myeloid cells remain poorly understood. In this study, tryptanthrin was shown to suppress the proliferation of the murine myeloid leukemia WEHI-3B JCS cells in a dose- and time-dependent manner. It also significantly reduced the growth of WEHI-3B JCS cells in vivo in syngeneic BALB/c mice. However, it exhibited no significant direct cytotoxicity on normal murine peritoneal macrophages. Flow cytometric analysis showed an obvious cell cycle arrest of the tryptanthrin-treated WEHI-3B JCS cells at the G0/G1 phase. The expression of cyclin D2, D3, Cdk 2, 4 and 6 genes in WEHI-3B JCS cells was found to be down-regulated at 24 h as measured by RT-PCR. Morphological and functional studies revealed that tryptanthrin could induce differentiation in WEHI-3B JCS cells, as shown by the increases in vacuolation, cellular granularity and NBT-reducing activity in tryptanthrin-treated cells. Collectively, our findings suggest that tryptanthrin might exert its anti-tumor effect on the murine myelomonocytic leukemia WEHI-3B JCS cells by causing cell cycle arrest and by triggering cell differentiation.

Application of Superantigen SE in Tumor Therapy

Staphylococcal enterotoxins are promising for tumor therapy.Their anticancer effects may be mediated by cytotoxicity,secretion of cytokines and expression of adhesion molecules.However,they are harmful to human for the exotoxin secreted by staphylococcus.In order to improve the effectiveness and diminish the side effects,lots of work has been done,such as targeted therapy,tumor vaccine and tactics for therapy. Key words: Superantigens; Enterotoxins; Neoplasms

CURRENT PRINCIPLES AND TRENDS OF ATRIAL FIBRILLATION PHARMACOTHERAPY

Data on atrial fibrillation (AF) epidemiology and AF influence on the risk of cardiovascular complications are presented. Principles and tactics of AF therapy are discussed in accordance to evidence based medicine and European society of cardiology Guidelines. Algorithms for choice (on the basis of risk stratification) of different antiarrhythmic drugs and anticoagulants are described. Perspectives in improvement of efficacy and safety of AF therapy are reviewed.

CONTEMPORARY PROBLEMS OF EVALUATION OF HYPERTENSION TREATMENT EFFICACY: MASKED HYPERTENSION AND WHITE COAT HYPERTENSION

The implementation of contemporary ambulatory methods of BP level evaluation in clinical practice improved diagnostics of arterial hypertension (HT), but at the same time faced with specific problems. White coat HT (WCHT) and masked HT are characterized by inconsistency between ambulatory and clinical BP levels. Studying of these conditions in patients receiving antihypertensive therapy is important. The WCHT during treatment (target ambulatory BP levels and no control of clinical BP) is observed in 10-20% of patients. The cardiovascular risk in these patients does not differ significantly from the risk in patients with controlled BP. Masked HT (target levels of clinical BP and no control of ambulatory BP) is observed in 5,4-23% of patients. The cardiovascular risk in patients with masked HT is 2,5-3,0 times more than that in patients with controlled HT and comparable with risk in patients with ineffective antihypertensive therapy. Thus, clinical measurements can give inexact data about true BP level in one third of treated hypertensive patients. Therefore the evaluation of cardiovascular risk and correct usage of ambulatory BP measurement is important for choice of therapy tactics in patients with HT.

Diagnosis and correction of disorders of blood aggregate statesin children with burning injury

To reveal the character and dynamics of changes in the aggregate state of blood in children with burning injury and to choose the correction method, 200 children in burn shock were investigated. Hemostasis abnormalities were studied with aт ARP-01 analyzer (Mednord, Tomsk). A tactics for anticoagulation therapy has been chosen. A positive effect was observed from combination of programmed hypocoagulation and the method of reinfusion of autocellular mass after its antibiotic incubation

Postoperative Prevention of Acute Lung Injury

Objective: to analyze the tactics of infusion therapy in old age group patients with generalized peritonitis and to search for ways of preventing acute lung injury in the early postoperative period. Subjects and methods. The adequacy of infusion therapy was analyzed in the treatment of 237 patients above 60 years of age who had generalized peritonitis. The parameters of central hemodynamics and aqueous sectors of an organism were studied by thermod-ilution and integral rheography of the body, radionuclide and thiosulfate tests. In 89 patients, normothermal infusion therapy was performed, by heating the transfused solutions to the body’s temperature. Results and discussion. When the volume of liquid is increased in the region under study, transthoracic impedance regularly decreases and it may be used as a predictor. In the early postoperative period, the scope of infusion therapy should be limited when the functional capacities of the cardiovascular system are diminished. Normothermal infusion therapy contributes to improvements of central hemodynamic parameters, microcirculation, and oxygen balance and reduces the number of pyoinflammatory complications. Conclusion. Normothermal infusion therapy diminishes a systemic inflammatory response and promotes the prevention of acute lung injury. Key words: central hemodynamics, normothermal infusion therapy, transthoracic impedance, acute lung injury.

PAROXYSMAL ATRIAL FIBRILLATION: CHOICE OF CARDIOVERSION THERAPY

Characteristics and classification of different patterns of paroxysmal atrial fibrillation are presented. Main indications to restoration of sinus rhythm are discussed. The features of main medications used to terminate of atrial fibrillation are given. The choice of antiarrhythmic drug is considerate. Necessity of individual approach to therapy tactics is proved.

A clinical perspective research of liver function damage caused by none hepatitis virus

目的 探讨儿童非肝炎病毒感染并发的一过性肝损害的病因和临床诊治要点.方法对573例肝功能损害的患儿进行分析,比较不同程度肝功能损害护肝治疗的价值.结果并发肝损害的573例患儿中,呼吸道感染418例,占10.8%;急性感染性腹泻病患儿101例,占15.6%;新生儿疾病54例,占3%.轻度肝损害492例,护肝治疗与否,统计学上无显著意义;中、重度肝损害135例,护肝治疗与否,统计学上有非常显著意义.结论儿科许多常见疾病都可能并发肝功能的一过性损害,应引起临床医生的高度重视,中、重度肝损害护肝治疗有助于肝功能的恢复。

Ultrastructure of the Blood and Lymphatic Capillaries of the Respiratory Tissue During Inflammation and Endobronchial Laser Therapy

For wide application of low-energy laser irradiation in the pulmonary clinic, study of the structural basis of the therapeutic effect is necessary. The aim of this research is to describe the structural changes of the blood and lymphatic capillaries in the respiratory tissues during inflammation and following laser biostimulation. Comparative ultrastructural study was carried out on 127 open respiratory biopsy specimens from 45 patients with infectious-destructive lung diseases. These patients were divided into two groups,depending on tactic of pre-operative therapy: patients treated by only traditional anti-inflammatory measures and patients receiving additional laser therapy. Heightened permeability of the blood capillary endotheliocytes was noted as the initial stage in the development of the inflammatory reaction.Intensification of the process of permeability is accompanied by interstitial edema, deformation of the interalveolar septa, and structural disorganization of alveolar epitheliumcells.Local lesions of microcirculation result in tissue hypoxia and induce processes of fibrosis. Laser biostimulation promotes reversion of the inflammatory process and stabilizes fibroplastic processes. Basic principles of pathogenetic therapy werestated. It was shown that low-energy laser irradiation satisfies these requirements as an additional method in the therapy of destructive lung diseases.

Vegetative regulation state in children with congenital heart diseases of acyanotic type

State of initial vegetative tonus in 68 children of age from 7 to 13 with congenital heart diseases (of acyanotic type) was studied by mathematical analysis method of cardiac rhythm variability at pre-operation and post-operation periods. It was established, that in patients with congenital heart diseases dynamics peculiarities of vegetative nervous systems state depend on operations conditions and character of initial vegetative tonus in pre-operation period. It was determined, that most unfavourable days with great variation of vegetative characteristics are the 1st, 2 nd and also the 5 th and the 6 th days. The above said should determine therapy tactics with taking into account vegetative regulation.

Treatment of tuberculous spondylitis in persons of elder age groups

The results of the combined early surgical treatment of patients over 55 years of age with tuberculous spondylitis are analyzed. The conservative therapy tactics and surgical treatment method the combination of the radical operation in the tuberculous focus with external fixation of vertebrae by Byrovs apparatus are described. The method applied allows to reduce the terms of the bed postoperative period.

The role of theory in teaching supportive psychotherapy.

Because supportive therapy is not based upon a theory of mind or personality or psychopathology, it should not be thought of as a unique modality of treatment but rather as a body of techniques or tactics that function with various theoretical orientations as a "shell program" functions with a computer's operating system. The therapist's operating system is the theoretical orientation gives direction to his/her interventions. In the past, supportive therapy has generally been explained in terms of its departures from the model of expressive therapy. The techniques and rationales of supportive therapy have now been articulated so that they can be taught along with the techniques and rationales of expressive therapy. It is important that students not absorb the tenets and tactics of expressive therapy as a monolithic model for all therapy. Supervision of psychotherapy should pay ample attention to the "coaching" function aimed at mastering technique, which is as important as teaching about psychopathology or encouraging personal growth.

Problems of the treatment of patients with the first revealed pulmonary tuberculosis, suffering from chronic alcoholism and toxomania in the inter-district dispensary

The problems of the treatment of patients with pulmonary tuberculosis and toxomania are discussed. The proportion of patients of this type among all the patients with pulmonary tuberculosis is determned, and the results of the treatment are estimated. The difficulties of the treatment of these patients in the in u ter-district dispensaries and the peculiarities of the therapy tactics are show.