Perceptions of Treatment Burden Among Caregivers of Elders With Diabetes and Co-morbid Alzheimer’s Disease and Related Dementias: A Qualitative Study

Many older adults with diabetes (DM) have co-occurring Alzheimer’s Disease (AD) and AD-Related Dementias (ADRD). Complex treatment plans may impose treatment burden for caregivers responsible for day-to-day self-management. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for people with DM-AD/ADRD. Caregivers ( n = 33) of patients with DM-AD/ADRD participated in semi-structured interviews about their caregiver role and perceptions of treatment burden of DM-AD/ADRD management. Qualitative data were analyzed using content analysis (ATLAS.ti). Caregivers reported high levels of burden related to complex treatment/self-management for patients with DM-AD/ADRD that varied day-to-day with the patient’s cognitive status. Four themes were: (1) trajectory of treatment burden; (2) navigating multiple healthcare providers/systems of care; (3) caregiver role conflict; and (4) emotional burden. Interventions to reduce caregiver treatment burden should include activating supportive services, education, and care coordination especially, if patient treatment increases in complexity over time.

Surgical treatment as option in treatment of metastatic hormone-sensitive prostate cancer after prior drug treatment

Currently, there is no consensus on the place of prostatectomy in the complex treatment of patients with metastatic prostate cancer. A description of a clinical case of complex treatment and observation of a patient with prostate cancer with an unfavorable baseline prognosis and the presence of bone metastases with a good clinical result is presented.

Hydrolytic enzymes in therapy of gestosis

The clinical effectiveness o f complex enzymotherapy with preparation Vobenzim in treatment o f gestosis was studied in comparison with traditional therapy. The author analyzes the course оf gestation and delivery, and the state оf neonates in women with nephropathy o f I degree, who got common treatment (28 patients) and complex treatment including Vobenzim (17patients). Positive clinical effect o f complex enzymotherapy in case o f nephropathy is displayed in decreasing of edematic syndrome, eliminating or decreasing o f proteinuria, lowering o f blood pressure and impairment o f fetalhypoxia in labors. It goes along with the reduction o f immune complexes fixed in placenta.

Investigation of the possible effectiveness of osteopathic correction in the complex treatment of children in the first year of life with hip dysplasia

Introduction. Congenital dysplasia of the hip joints is one of the main among congenital diseases of the musculoskeletal system in children and requires a long period of treatment, including in a hospital settings. Standard methods of treatment contain the orthopedic and rehabilitation measures: the use of abduction splints, a complex of physiotherapy exercises, general massage, the use of various physiotherapeutic procedures. Osteopathic correction is not included in the standards of care for this category of patients. At the same time, these standard treatment methods do not always give a desired result, and sometimes even lead to the development of complications. All this facts determines the need to search for additional therapeutic techniques.The aim of the study is to research the possible effectiveness of osteopathic correction as part of the complex treatment of children in the first year of life with hip dysplasia.Materials and methods. The study included 34 children with a diagnosis of hip dysplasia (ICD code-10 — Q65.8). The patients were randomly divided into 2 equivalent groups: study and control. Participants in both groups received standard treatment; the participants of the main group additionally underwent osteopathic correction of the revealed somatic dysfunctions. Before and after the course of treatment, the patients' osteopathic status, the disease clinical manifestations, and the X-ray data of the hip joints were assessed.Results. The inclusion of osteopathic correction in the complex with standard treatment procedures for children of the first year of life with hip dysplasia is accompanied by a statistically significant decrease in the detection frequency of the somatic dysfunctions at the regional and local levels. The median duration of standard orthopedic treatment also decreases (p<0,05).Conclusion. The obtained results demonstrate that the inclusion of osteopathic correction in the complex treatment of children in the first year of life with hip dysplasia shortens the treatment time for patients. It is recommended to continue research in this direction with a larger sample size.

Specific immunotherapy in the complex treatment of ovarian cancer

The article is devoted to the search for new solutions in the field of treatment of malignant ovarian tumors and, in particular, new approaches for overcoming immune resistance in a complex method of therapy. The experience of treating this pathology with an original method of postoperative immunotherapy using autologous immunomodulators, which, due to its simplicity and relatively low cost, should be widely used in gynecological oncology, is considered.

PROSPECTS OF MELDONIUM AND FOLIC ACID USING TO IMPROVE THE CONDITION OF PATIENTS WITH ISCHEMIC HEART DISEASE AND CONCOMITANT HYPERTENSION

Coronary heart disease (CHD) is a leading cause of high mortality, disability and reduced quality of life for patients. At the heart of coronary heart disease - ischemia and activation of oxidative stress. With concomitant hypertension, the condition of patients and the prognosis for the course of their disease deteriorates significantly. The prognosis of coronary heart disease, the occurrence of new hospitalizations or deaths from cardiovascular disease can be further assessed by monitoring ST2 and malonic dialdehyde (MDA). Traditional treatment of coronary heart disease does not always guarantee the achievement of the desired clinical results. That is why it is advisable to use in the complex treatment of patients with coronary heart disease and concomitant hypertension cytoprotectors and drugs that have antioxidant properties, such as meldonium and folic acid. The aim of the research. Detect anti-ischemic activity in meldonium and folic acid and evaluate the effect of these drugs on the level of ST2, MDA in the blood in patients with coronary heart disease and concomitant hypertension. Materials and methods. The research included 80 patients (women - 4, men - 76, aged 57,7 ± 9,8 years) with diagnoses of coronary heart disease: stable angina, functional class II-III (FC), chronic heart failure (CHF) I-IIa, FC II-III ", with concomitant arterial hypertension II-III stages, 2-3 degrees, risk 4 (very high), CHF I-IIa, FC II-III". Patients were divided into 4 groups of 20 patients, respectively: 1) patients who, in addition to basic therapy, were prescribed folic acid at a dose of 0.8 mg / d for six months; 2) patients who, in addition to basic treatment, were prescribed meldonium at a dose of 750.0 mg / d for six months; 3) patients who, in addition to basic treatment, were prescribed folic acid at a dose of 0.8 mg / d and meldonium at a dose of 750.0 mg / d for six months; 4) patients who were prescribed only basic antianginal, disaggregating, hypolipidemic treatment.The number of anginal attacks and doses of nitroglycerin during the day were determined, the results of the test with a 6-minute walk and the plasma concentration of ST2 and MDA before and after 6 months of treatment with meldonium and folic acid were evaluated. Results. Found anti-ischemic activity in meldonium and its combination with folic acid. The combination of these drugs as an adjunct to basic therapy significantly reduced the concentration of ST2. Both drugs alone or in combination reduced the concentration of MDA in the blood of patients. Conclusions. Our research showed the presence of anti-ischemic activity in meldonium, both when added to the basic therapy of patients with coronary heart disease and concomitant hypertension, and when used together with folic acid. In the groups of patients where these drugs and their combinations were used, the frequency of anginal attacks and the number of doses of nitroglycerin used during the day were significantly reduced. The combined use of folic acid and meldonium when added to the basic therapy after 6 months significantly reduced the concentration of ST2 in the blood. Folic acid and meldonium showed pronounced antioxidant properties. At separate adding of these medications to basic therapy or their combined adding significantly decreased the concentration of MDA - a marker of oxidative stress. Therefore, we consider it appropriate to use folic acid and meldonium in the complex treatment of patients with coronary heart disease with stable angina and concomitant hypertension.

Efficiency of “Neo inulin” in the complex treatment of patients with type 2 diabetes

Diabetes mellitus is one of the most serious medical, social, and economic health problems in all countries of the world. The incidence of diabetes mellitus in the world doubles every 10–15 years, acquiring the character of a non-infectious epidemic. Therefore, it is extremely important to search for new drugs that help normalize glycemia, prevent complications of diabetes mellitus, and improve the quality of life of patients. These drugs include “Neo inulin”, which has a hypoglycemic, antioxidant, hepatoprotective and angioprotective effect.The aim: to evaluate the effectiveness of “Neo inulin” in the complex treatment of patients with type 2 diabetes mellitus.Materials and methods. The study involved 18 women (average age – 64.5 ± 8.7 years, average weight – 77.8 ± 11.4 kg) and 3 men (average age – 54.6 ± 12.4 years, average weight – 114 ± 40.2 kg). The average duration of type 2 diabetes was 11.0 (7.0–12.0) years. “Neo inulin” was prescribed as 2 capsules per day for 12 weeks in the complex of basic diabetes therapy To assess the effectiveness of therapy, a study of the quality of life related to health, a biochemical blood test (glycated hemoglobin), a clinical minimum (CBC, OAM, ECG, blood glucose) was carried out, the functional characteristics of tissue blood flow were investigated, and the ankle-brachial index (ABI) was determined. Statistical processing of the results was carried out using the Statistica 6.0 software package (StatSoft Inc., USA). Differences were considered statistically significant at p < 0.05.Results. Statistically significant differences were revealed in the values of all scales of health-related quality of life in patients in the groups before and after treatment with “Neo Inulin”, including the total physical and mental components. An improvement in the functioning of microcirculatory regulation mechanisms was noted, which is confirmed by a statistically significant increase in ABI (1.0 and 0.8 on the right; 0.9 and 0.8 on the left, respectively; p < 0.05) and the coefficient of microcirculation variation (9.2 and 8.3, respectively; p < 0.05). In 57,1 % of cases (12 people), the level of glycated hemoglobin was normalized.Conclusion. The use of a treatment regimen that includes “Neo Inulin” improves the effectiveness of treatment and improves the quality of life of patients with type 2 diabetes mellitus.

Laparoscopy in the treatment of retro-cervical endometriosis

Original approaches to the endometriosis complex treatment by authors are presented in this article. The experience of laparoscopic intrusions in 232 patients is united. The authors prove the necessity of active surgical (conservative or radical) tactics in patients with widespread endometriosis forms. The use of agonists Gn-RG is recommended for preparation before the intrusion and as anti-recidive treatment, especially in patients with combination of genital endometriosis and uterus myoma.

Clinical, immunomodulating and anti-recidive effects of ozone therapy in persistent allergic rhinitis in children

Research оbjective.To determine the effect of ozone therapy on clinical indicators and the state of immunity in children with moderate persistent allergic rhinitis. Material and methods. The study included children aged 5-10 years with moderate persis-tent allergic rhinitis, which were divided into two groups depending on the therapy. The first group of patients with allergic rhinitis received complex conventional therapy, the second group of patients with allergic rhinitis received complex treatment in combination with ozone therapy. Clinical parameters were studied in patients with allergic rhinitis, parameters of im-munological reactivity were investigated during periods of exacerbation of the disease and clinical remission. Results. It was found that the inclusion of ozone therapy in the complex treatment of patients of the second group ensured a faster onset of complete clinical remission (3.7 days earlier than in the first group of patients) and normalization of most immunity parameters, and also increased the expression of toll-like receptors on leukocyte cells. The duration of complete clinical remission in the group of patients with allergic rhinitis who received complex treatment in combination with ozone therapy (9.3 + 2 months) more than doubled (2.4 times) its duration in the group of patients with allergic rhinitis who received complex conventional therapy (3.9 + 0.3 months).

Application of vessel endothelium growth factor inhibitor ranibizumab in complex therapy of retinopathy of prematurity

AIM: To conduct a retrospective study of the application of vessel endothelium growth factor inhibitor ranibizumab in complex therapy of retinopathy of prematurity in Ural State children`s ophthalmological center at State Autonomic Health Institution of the Sverdlovsk Region Multiprofile Clinical Medical Center BONUM in Yekaterinburg. MATERIAL AND METHODS: The study included 17 patients (33 eyes). The gestation age was from 23 to 30 weeks (mean: 26.51.7 weeks), birth weight was from 600 to 1850 g (mean: 867229 g). 8 patients (47%) had APROP, and 9 patients (53%) had ROP stage III, type 1, plus disease. Laser coagulation of the avascular areas of the retina as the start in ROP therapy was performed in three patients with APROP (4 eyes, 12.1%). Intravitreal injection of the anti-VEGF ranibizumab was performed in 17 patients (33 eyes), including patients with previous laser coagulation. The age of the patients at the time of injection was from 7.7 to 15.6 weeks (10.51.9 weeks), PCA from 32.3 to 39.6 weeks (37.01.8 weeks). Patients with stage IVa ROP (5 patients, 6 eyes) underwent 25G or 27G lens sparing vitrectomy. RESULTS: As a result of the complex treatment of ROP, the following results were obtained: complete regression in 13 patients (28 eyes, 84.8%). Partial regression in two patients (2 eyes, 6.1%). ROP progression to stage V in two patients (3 eyes, 9.1%). CONCLUSION: Complex treatment of severe stages of active ROP with laser treatment, IVI injections, ranibizumab, and vitrectomy made it possible to preserve vision in 90.9% of patients.