scholarly journals Clinical factors associated with unfavorable outcomes in HIV-positive tuberculosis patients

2021 ◽  
Vol 99 (10) ◽  
pp. 28-34
Author(s):  
V. S. Borovitskiy ◽  
M. V. Sinitsyn
Keyword(s):  
Sensitivity And Specificity ◽  
Clinical Manifestations ◽  
Unfavorable Outcome ◽  
Clinical Factors ◽  
Tuberculosis Patients ◽  
Pearson Criterion ◽  
Outcome Group ◽  
Gastrointestinal Candidiasis ◽  
Group 2 ◽  
Group 1

The objective: to identify clinical factors with the highest sensitivity and specificity associated with an unfavorable outcome in the patient with tuberculosis and HIV infection.Subjects. 363 patients with TB/HIV co-infection. Group 1 – 59 (16.3%) patients with the unfavorable outcome, Group 2 – 304 (83.7%) patients with a favorable outcome.Methods: analysis of paired contingency tables by Pearson criterion, quantitative signs by Mann – Whitney test, simple and multiple logistic regression.Results. The following factors promoting unfavorable outcomes in the patient with TB/HIV co-infection with the highest sensitivity and specificity were identified: hemoglobin level (sensitivity – 78.0%; specificity – 73.7%), gastrointestinal candidiasis (72.9% and 84.5%), loose stool (40.7% and 97.4%), no lymphadenopathy (89.8% and 57.2%), and headache (49.2% and 88.5%). The combination of these clinical manifestations provides sensitivity of 78.0% and specificity of 94.4%.A formula is proposed for calculating the probability of an unfavorable outcome in the patient TB/HIV co-infection.

scholarly journals Magnetic resonance imaging in the prone position and the diagnosis of tethered spinal cord

2018 ◽  
Vol 21 (1) ◽  
pp. 4-10 ◽  
Author(s):  
Melissa M. Stamates ◽  
David M. Frim ◽  
Carina W. Yang ◽  
Gregory L. Katzman ◽  
Saad Ali
Keyword(s):  
Spinal Cord ◽  
Sensitivity And Specificity ◽  
Clinical Manifestations ◽  
Tethered Cord ◽  
Control Group ◽  
Motion Sensitivity ◽  
Canal Width ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

OBJECTIVETethered cord syndrome (TCS) is a neurosurgical disorder with varied clinical manifestations believed to result from vascular compromise due to stretch forces on the spinal cord. Conventional supine MRI findings may include a low-lying conus medullaris, thickened or fat-infiltrated filum terminale, or lipoma; however, imaging sensitivity and specificity for tethered cord can be low. The purpose of this study was to evaluate the utility of prone MRI in the diagnosis of tethered and retethered spinal cord.METHODSMedical records were reviewed in 41 patients who underwent surgical release of tethered cord and in whom preoperative prone MRI sequences were available. Patients were divided into Group 1 (new TCS diagnosis) and Group 2 (recurrent TCS after previous untethering). Absolute conus ventral motion and motion as a percentage of canal width between supine and prone positions was measured in these 2 groups via sagittal T2-weighted sequences; these groups were compared with 30 consecutive patients (Group 3) who were classified as the normal control group.RESULTSThe mean ventral motion was as follows: Group 1 (absolute: 0.5 ± 0.5 mm [range 0–2.4 mm]; canal percentage: 3.7% ± 3.9% [range 0%–16.3%]); Group 2 (absolute: 0.4 ± 0.7 mm [range 0–2.6 mm]; canal percentage: 2.2% ± 3.7% [range 0%–14.0%]); and Group 3 (absolute: 3.4 ± 1.3 mm [range 1.4–5.6 mm]; canal percentage: 22.0% ± 7.2% [range 10.5%–36.1%]). Whereas 38/41 surgically treated patients with TCS had diminished (< 10% canal width) ventral motion on preoperative MRI, 30/30 controls had > 10% canal width motion. Sensitivity and specificity were thereby calculated as 92.7% and 100%, respectively.CONCLUSIONSIn the present series, prone imaging is found to be a sensitive and specific tool, and the authors believe it may have a role as supportive evidence in the diagnosis of tethered and retethered spinal cord.

scholarly journals The Systematic Effect of Mesenchymal Stem Cell Therapy in Critical COVID-19 Patients: A Prospective Double Controlled Trial

2021 ◽  
Vol 30 ◽  
pp. 096368972110249
Author(s):  
G Adas ◽  
Z Cukurova ◽  
K Kart Yasar ◽  
R Yilmaz ◽  
N Isiksacan ◽  
...  
Keyword(s):  
Growth Factors ◽  
Critically Ill ◽  
Inflammatory Cytokines ◽  
Clinical Manifestations ◽  
Systematic Effect ◽  
Cytokine Storm ◽  
Group 3 ◽  
Anti Inflammatory ◽  
Group 2 ◽  
Group 1

The aim of this clinical trial was to control the cytokine storm by administering mesenchymal stem cells (MSCs) to critically-ill COVID-19 patients, to evaluate the healing effect, and to systematically investigate how the treatment works. Patients with moderate and critical COVID-19 clinical manifestations were separated as Group 1 (moderate cases, n = 10, treated conventionally), Group 2 (critical cases, n = 10, treated conventionally), and Group 3 (critical cases, n = 10, treated conventionally plus MSCs transplantation therapy of three consecutive doses on treatment days 0, 3, and 6, (as 3 × 106 cells/kg, intravenously). The treatment mechanism of action was investigated with evaluation markers of the cytokine storm, via biochemical parameters, levels of proinflammatory and anti-inflammatory cytokines, analyses of tissue regeneration via the levels of growth factors, apoptosis markers, chemokines, matrix metalloproteinases, and granzyme-B, and by the assessment of the immunomodulatory effects via total oxidant/antioxidant status markers and the levels of lymphocyte subsets. In the assessment of the overall mortality rates of all the cases, six patients in Group-2 and three patients in Group-3 died, and there was no loss in Group-1. Proinflammatory cytokines IFNγ, IL-6, IL-17A, IL-2, IL-12, anti-inflammatory cytokines IL-10, IL-13, IL-1ra, and growth factors TGF-β, VEGF, KGF, and NGF levels were found to be significant in Group-3. When Group-2 and Group-3 were compared, serum ferritin, fibrinogen and CRP levels in Group-3 had significantly decreased. CD45 +, CD3 +, CD4 +, CD8 +, CD19 +, HLA-DR +, and CD16 + / CD56 + levels were evaluated. In the statistical comparison of the groups, significance was only determined in respect of neutrophils. The results demonstrated the positive systematic and cellular effects of MSCs application on critically ill COVID-19 patients in a versatile way. This effect plays an important role in curing and reducing mortality in critically ill patients.

Cerebral oxygenation, vascular reactivity, and neurochemistry following decompressive craniectomy for severe traumatic brain injury

2008 ◽  
Vol 108 (5) ◽  
pp. 943-949 ◽  
Author(s):  
Chi Long Ho ◽  
Chee Meng Wang ◽  
Kah Keow Lee ◽  
Ivan Ng ◽  
Beng Ti Ang
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Reactivity Index ◽  
Outcome Group ◽  
The Mean ◽  
Group 2 ◽  
Biochemical Indices ◽  
Group 1

Object This study addresses the changes in brain oxygenation, cerebrovascular reactivity, and cerebral neurochemistry in patients following decompressive craniectomy for the control of elevated intracranial pressure (ICP) after severe traumatic brain injury (TBI). Methods Sixteen consecutive patients with isolated TBI and elevated ICP, who were refractory to maximal medical therapy, underwent decompressive craniectomy over a 1-year period. Thirteen patients were male and 3 were female. The mean age of the patients was 38 years and the median Glasgow Coma Scale score on admission was 5. Results Six months following TBI, 11 patients had a poor outcome (Group 1, Glasgow Outcome Scale [GOS] Score 1–3), whereas the remaining 5 patients had a favorable outcome (Group 2, GOS Score 4 or 5). Decompressive craniectomy resulted in a significant reduction (p < 0.001) in the mean ICP and cerebrovascular pressure reactivity index to autoregulatory values (< 0.3) in both groups of patients. There was a significant improvement in brain tissue oxygenation (PbtO2) in Group 2 patients from 3 to 17 mm Hg and an 85% reduction in episodes of cerebral ischemia. In addition, the durations of abnormal PbtO2 and biochemical indices were significantly reduced in Group 2 patients after decompressive craniectomy, but there was no improvement in the biochemical indices in Group 1 patients despite surgery. Conclusions Decompressive craniectomy, when used appropriately in protocol-driven intensive care regimens for the treatment of recalcitrant elevated ICP, is associated with a return of abnormal metabolic parameters to normal values in patients with eventually favorable outcomes.

scholarly journals Pro-atherogenic lipid profile in pulmonary tuberculosis patients with concurrent insulin resistance

2021 ◽  
Vol 8 (2) ◽  
pp. 111-114
Author(s):  
Olga Shvets ◽  
Olga Shevchenko ◽  
Zoriana Piskur ◽  
Hanna Stepanenko ◽  
Olha Pohorielova
Keyword(s):  
Insulin Resistance ◽  
Lipid Metabolism ◽  
Pulmonary Tuberculosis ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Tuberculosis Patients ◽  
Group 2 ◽  
Group 1

Background. The problem of studying lipid metabolism in patients with tuberculosis is of interest to scientists around the world. The purpose of the study - to investigate lipid profile in pulmonary tuberculosis patients with concurrent insulin resistance. Materials and methods. Forty-one patients with pulmonary tuberculosis were examined. Insulin resistance index (HOMA-IR), total cholesterol level (TC), triglycerides (TG) level, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, very-low-density lipoprotein (VLDL) cholesterol and atherogenic index (AI) were measured. Results. Group 1 - 26 patients with tuberculosis and insulin resistance (HOMA-IR ˃ 2.7); Group 2 – 15 patients with tuberculosis without insulin resistance (HOMA-IR ˂ 2.7). Group 1 patients had severe course of TB with fever, severe fatigue and weakness, profuse sweating, weight loss, cough and shortness of breath. Median TC indices differed at significant level (p = 0.012): group 1 - 4.82 mmol/l, group 2 - 4.25 mmol/l. TG level was higher in group 1 patients - 1.32 mmol/l than in group 2 patients - 1.28 mmol/l. LDL cholesterol values were higher in group 1 patients - 3.2 mmol/l vs 2.5 mmol/l in group 2. The AI was higher in group1 (p = 0.005): 3.9 units against 2.8 units in group 2 patients. Conclusions. Insulin resistance in pulmonary tuberculosis patients was associated with severe course of the disease, severe clinical manifestations and impaired external respiration. Pro-atherogenic disorders of lipid metabolism in pulmonary tuberculosis patients with concurrent insulin resistance can be considered as the degree of endogenous intoxication.

scholarly journals The role of the new coronavirus infection (COVID-19) in the progression and development of cerebrovascular diseases. A competent choice of pathogenic treatment is the key to success in treatment and prevention. An expert’s view from the ‘red zone’

2021 ◽  
Vol 13 (1) ◽  
pp. 57-66
Author(s):  
V. V. Kovalchuk
Keyword(s):  
Emotional Disorders ◽  
Clinical Manifestations ◽  
Cerebrovascular Diseases ◽  
Recent Experience ◽  
Treatment And Prevention ◽  
State Recovery ◽  
Group 2 ◽  
State Examination ◽  
Group 1

COVID-19 worsens the course of cerebrovascular diseases (CVD), including chronic cerebral ischaemia (CCI). The Actovegin drug, which has long been widely used in CCI treatment, has an antioxidant and endothelium protective effect. It makes sense to study the effect of Actovegin therapy on the clinical manifestations of CCI in patients with a recent experience of COVID-19.Objective: to evaluate Actovegin efficacy in the treatment of CCI in patients with a recent experience of COVID-19.Patients and methods. The study included 440 patients (234 female; 206 male) with a recent experience of COVID-19, suffering from CCI, their average age being 67.8 years (from 54 to 85 years). All patients were broken down into two groups of 220 people (the patients in Group 1 were administrated Actovegin, the ones in Group 2 – were not). All patients were followed up for 90 days; their condition was assessed by the severity of clinical manifestations of CCI, using special scales and questionnaires.Results and discussion. After 90 days of follow-up, the frequency of complaints of cognitive impairment, sleep disorder, dizziness, fatigue, emotional disorders, and headache in Group 1 was significantly lower than in Group 2 (p<0.05). According to Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), Multidimensional Fatigue Inventory (MFI-20), and Spiegel Sleep Questionnaire (SSQ), the average indicators improved significantly more in Group 1 than in Group 2 (p<0.05). The absence of quality of life impairment and their minimal severity were observed in Group 1 in 77.9%; in Group 2 – in 33.7% (p<0.001). Statistically significant differences between the groups of patients were also observed in relation to emotional state recovery according to the Wakefield Questionnaire and the Spielberger State Trait Anxiety inventory.Conclusion. The observational study demonstrated the efficacy of Actovegin in the treatment of main clinical manifestations of CCI in patients with recent COVID-19 experience.

Abstract 1: Antegrade Flow Across an Intracranial Occlusion Can be Reliably Assessed on Ct Perfusion Source Images and it Predicts Recanalization With Intravenous Tpa

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Sachin Mishra ◽  
Muneer Eesa ◽  
Mohammed Almekhlafi ◽  
Emmad Qazi ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Sensitivity And Specificity ◽  
Ct Perfusion ◽  
Large Vessel ◽  
Perfusion Study ◽  
Static Mode ◽  
Group 2 ◽  
Antegrade Flow ◽  
Group 1

Background: We aimed to see if antegrade flow observed on CT Perfusion Source Images (CTPSi) across an intracranial occlusion correlated with first run of DSA and predicted recanalization on DSA or repeat CTA. Methods: Patients with acute ischemic stroke and large vessel intracranial occlusion on CTA who had a CT Perfusion study followed by DSA or repeat CTA 4-6 hours later were included. CT Perfusion parameters were 8 cm coverage in static mode, acquisitions at 5 mm thickness, 5 seconds delay after contrast & 24 passes over 66 seconds. Antegrade flow was defined as the presence of ‘clot enhancement’ sign on the 1st pass of CTPSi and increasing density of contrast permeating the clot and filling the vessel distal to the occlusion on the 2nd and 3rd passes of CTPSi (Fig 1 & 2). This was correlated with the first run of DSA and recanalization was assessed on DSA (Group 1) or repeat CTA (Group 2). Results: Total 56 patients were included. In group 1(n=35), antegrade flow on CTPSI was present in 14/35 patients (40%). All these patients had antegrade flow on DSA and 12 of them showed early recanalization (TICI 2a, 2b or 3). IV t-PA was received by 29/35 patients. The sensitivity and specificity of CTPSi to predict antegrade flow when compared to DSA was 86.7% (95% CI, 59.5 - 98.3) and 95% (95% CI, 75.1 - 99.9) respectively. In Group 2 (n=21), antegrade flow was seen on CTPSI in 13 patients (62%) and all of them recanalized with IV t-PA. Six out of 8 patients without antegrade flow on CTPSi did not recanalize. Conclusion: Antegrade flow across an occlusion can be reliably assessed on initial passes of CTPSi and it predicts recanalization with IV t-PA.

Epicardial obesity as a significant preclinical predictor of atherosclerosis of brachiocephalic arteries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Ott ◽  
G.A Chumakova
Keyword(s):  
Cardiometabolic Risk ◽  
Subclinical Atherosclerosis ◽  
Prognostic Significance ◽  
Clinical Manifestations ◽  
Area Under The Curve ◽  
Visceral Obesity ◽  
Threshold Value ◽  
Group 2 ◽  
Brachiocephalic Arteries ◽  
Group 1

Abstract   Obesity is one of the significant factors of cardiovascular risk. Nowadays it is understood that it is visceral obesity (VO), which has metabolic activity due to the synthesis of adipokines, that determines cardiometabolic risk. The effect of epicardial obesity (EO), as a variant of VO on the formation of cardiometabolic risk (in particular coronary atherosclerosis) is being actively studied. The role of EO in the development of atherosclerosis of other localizations has been little studied. Objective To study the predictor value of EO as well as traditional criteria for obesity: body mass index (BMI) and waist circumference (WC) for the formation of atherosclerosis of brachiocephalic arteries (BCA). Materials and methods The study included 140 men 45.2±4.3 years old with arterial hypertension (AH) of the 1–3 degree and the absence of clinical manifestations and anamnesis of atherosclerosis of any localizations with a BMI of 20–35 kg /m2 and abdominal obesity according to WC ≥94 cm. Patients were divided into two groups depending on the thickness of the epicardial adipose tissue (EAT) measured behind the free wall of the right ventricle by echocardiography. Group 1 consisted of 60 patients with epicardial obesity (EAT ≥7 mm), group 2 included patients without epicardial obesity (EAT &lt;7 mm). Subclinical atherosclerosis of BCA was evaluated in all subjects using duplex brachiocephalic arteries (BCA). Results When assessing the thickness of the intima-media of the carotid arteries (TIM), a subclinical marker of BCA atherosclerosis, higher average TIM values in group 1 (EAT ≥7 mm) were revealed (1.09±0.34 mm versus 0.74±0, 05 mm in group 2 (EAT &lt;7 mm) (p=0.0001). Prevalence of subclinical BCA atherosclerosis from (20–45%) in group 1 patients was found in 57%, in group 2 only 4% (p=0.01). In the first group, hemodynamically significant asymptomatic BCA stenosis (50–65%) was found in 8% of patients. No hemodynamically significant BCA stenosis was detected in the second group. Using ROC analysis, the threshold value of EAT (9.25 mm) was obtained as a risk factor for hemodynamically significant stenoses of BCA (50% or more) with high prognostic significance (the area under the curve was 0.92). Using multivariate analysis of variance, the effect of various criteria of obesity on the formation of BCA atherosclerosis was studied. As a result of the analysis it was revealed that only EAT (p=0.02) influenced the development of BCA atherosclerosis (TIM more than 1.3 mm). WC and BMI did not affect the development of BCA subclinical atherosclerosis (p=0.21; p=0.24, respectively). Conclusions EO (EAT ≥7 mm) is an early marker of BCA subclinical atherosclerosis in contrast to the traditional criteria for obesity (BMI, WC). Patients with EAT of 9.25 mm or more need additional examinations and the appointment of pharmacotherapy aimed at the prevention of secondary complications. Funding Acknowledgement Type of funding source: None

Laboratory indicators of pathological changes in patients with chronic heart failure with metabolic syndrome

2021 ◽  
Vol 66 (2) ◽  
pp. 75-79
Author(s):  
A. P. Roytman ◽  
N. A. Sedova ◽  
M. A. Godkov
Keyword(s):  
Heart Failure ◽  
Metabolic Syndrome ◽  
Chronic Heart Failure ◽  
Clinical Manifestations ◽  
Laboratory Markers ◽  
Number Of Patients ◽  
General Rank ◽  
Group 2 ◽  
Ntprobnp Level ◽  
Group 1

The presence of metabolic syndrome (MS) significantly increases the risk of developing cardiovascular diseases that lead to chronic heart failure (CHF). The values of NT-proBNP, ST-2, and CRP markers and their mutual correlations were studied in 37 patients with chronic heart failure (CHF) without metabolic syndrome (MS) (group 1) and 37 patients with CHF with MS (group 2). The aim of the study was to determine the features of their changes in patients with CHF complicated by MS, and to rank patients by assigning a rank value to the values of NTproBNP, ST2, and CRP concentrations. The average ST2 level was 51±24 ng/ml in group 1 and 62±27 ng/ml in group 2. The average values of CRP in group 1 were 23.1±5.3 mg/l, in group 2-33.0±4.4 mg/l (p<0.05). The NTproBNP level was 2413±1586 PG/ml and 2721±1635 PG/ml in groups 1 and 2, respectively. Correlations between the values of NTproBNP and ST2, NTproBNP and CRP were demonstrated. In the group of CHF with MS, compared with the group of CHF, there were significantly more patients with the most pronounced pathological levels of damage markers: the number of patients with a General rank of 6-9 in the group of CHF with MS was 59%, in the group of CHF without MS-38% (p<0.05). Of the 18 patients who died, 17 were among those who had an overall rank of 6 to 9, only 1 patient who died after hospitalization had an overall rank of 5. At the same time, among 22 patients who had improved CHF in the outcome of hospitalization, 18 patients had a total rank from 0 to 5, and in 4 patients of this category, the clinical manifestations of CHF remained virtually unchanged. The results of ranking the level of the studied laboratory markers indicate that they can be used as a predictor of various outcomes of CHF.

Dynamics of Carbohydrate Metabolism Indices during the Treatment of Pulmonary Tuberculosis Patients with the Use оf Pathogenetic Therapy

2019 ◽  
pp. 21-25
Author(s):  
O.M. Shvets ◽  
O.S. Shevchenko
Keyword(s):  
Insulin Resistance ◽  
Pulmonary Tuberculosis ◽  
Data Processing ◽  
Carbohydrate Metabolism ◽  
Resistance Index ◽  
Tuberculosis Patients ◽  
Insulin Resistance Index ◽  
Pathogenetic Therapy ◽  
Group 2 ◽  
Group 1

Objective. To assess the dynamics of carbohydrate metabolism indices during the treatment of pulmonary tuberculosis patients with the use of pathogenetic therapy Materials and methods. We examined 40 patients with newly diagnosed destructive pulmonary tuberculosis with bilateral infiltrative changes and massive mycobacteria excretion. Exclusion criteria were: HIV infection/AIDS, diabetes mellitus, chronic hepatitis, extrapulmonary tuberculosis and pulmonary tuberculosis without destruction and without bacterial excretion. Standardized four-component anti-TB treatment regimen was prescribed to all patients. The subjects were randomly distributed between two groups of 20 people. The treatment regimen for patients of group 2 was supplemented with a 10-day course of intravenous infusion of xylitol with a volume of 400 ml once a day. An oral glucose tolerance test (OGTT) was performed, fasting insulin levels were determined, the insulin resistance index (HOMA-IR) and body mass index (BMI) were calculated, and clinical manifestations of intoxication were evaluated. For statistical data processing, the Statistica for Windows version 13.2 generalpurpose data processing software package was used. Results and discussion. At the beginning of treatment, patients of both groups had complaints typical for intoxication syndrome and signs of carbohydrate metabolism disorders in the form of the development of insulin resistance. The median value of the HOMA-IR index in group 1 was 3.03, and in group 2 it was 3.36. During the treatment, in group 2, whose patients received xylitol, a decrease in the average term of relief of intoxication symptoms was observed compared with group 1 (7±2 days vs 11±3 days) (p<0.05). In group 2 the median of insulin level decreased at a statistically significant level (p<0.05) (from 16.5 mcU/mL to 11.4 mcU/mL), and the insulin resistance index HOMA-IR decreased from 3.36 to 2.0, which allows us to suppose the positive effect of xylitol on the carbohydrate metabolism of patients with infiltrative pulmonary tuberculosis with destructive changes and mycobacteria excretion. Conclusions. Based on the obtained data, it can be concluded that xylitol has a positive modeling effect on the dynamics of carbohydrate metabolism in patients with destructive pulmonary tuberculosis with bacterial excretion.

Complex medical rehabilitation of adolescents with dentoalveolar pathology in orthodontic treatment

2020 ◽  
pp. 67-78
Author(s):  
A. V. Kokareva ◽  
V. A. Zelenskiy ◽  
I. I. Gaidamaka ◽  
S. A. Pachin ◽  
R. M. Gusov ◽  
...  
Keyword(s):  
Standard Therapy ◽  
Orthodontic Treatment ◽  
Clinical Manifestations ◽  
Main Group ◽  
Medical Rehabilitation ◽  
Physical And Mental Health ◽  
Craniosacral Therapy ◽  
Group 2 ◽  
High Degree ◽  
Group 1

The purpose of the study is to increase the effectiveness of medical rehabilitation of adolescents with dentoalveolar pathology in orthodontic treatment based on the inclusion of florentine waters, therapeutic physical exercise according to the craniovertebral method, and osteopathic craniosacral therapy in rehabilitation regimens. Material and methods. There have been observed 106 adolescents with dentoalveolar pathology on orthodontic treatment. They were distributed into 3 groups by simple randomization: in the main group 2, the patients received gum irrigation with fir extract florentine water, physical therapy exercises (PTE) according to the craniovertebral method and osteopathic craniosacral therapy in combination with the standard therapy; in the main group 1, the patients were prescribed gum irrigation with fir extract florentine water and PTE according to the craniovertebral method in combination with standard therapy; in the group of comparison, the patients had only irrigation of the gums with fir extract florentine water in combination with standard therapy. Results. In the main group 2, 83,1 % of cases noted levelling of clinical manifestations 6 months later, and 97.9 % — 18–20 months later, while the patients who received irrigation with fir extract florentine water (FW) in combination with standard therapy and PTE according to the craniovertebral method had an improvement in 63,5 % and 85.0 % of cases; when using only irrigations with fir extract FW against the background of standard therapy there was an improvement in 49.4 % and 78.1 % of cases; the reduction of the total number of functional disorders and stabilization of the statokinetic system within 6 months were improved by 1,81 (p < 0.01), and after 18–20 months — 2,61 (p < 0,01) times, while using irrigations with fir extract FW against the background of standard therapy and PTE according to the craniovertebral method, the improvement was by 1,38 (p < 0,01) and 1,69 (p < 0,01) times; when using only irrigations with fir extract FW against the background of standard therapy — by 1,27 (p < 0,05) and 1,73 (p < 0,01) times, respectively, which, with a high degree of reliability, has correlated with the improved dental, physical, and mental health. Conclusion. The developed technology of medical rehabilitation of adolescents using florentine waters, therapeutic physical exercises according to the craniovertebral technique and osteopathic craniosacral therapy is viable and pathogenetically justified.

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