The Effect of Various Types of Basic Therapy on Laboratory and Immunological Parameters in Ankylosing Spondylitis

In this work examined the effect of various types of basic therapy on laboratory, including immunological parameters in ankylosing spondylitis. The influence of basic treatment of patients with ankylosing spondylitis with sulfasalazine, methotrexate and rituximab on laboratory indicators of the disease such as ESR, CRP, fibrinogen and immunological indicators such as IgM, IgG and IgA was evaluated. It has been established that all three basic drugs (sulfasalazine, methotrexate and rituximab) in ankylosing spondylitis have a positive effect on the dynamics of laboratory and immunological parameters. But at the same time, rituximab has a more pronounced and earlier effect.

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.

Nordic Walking in Rehabilitation of Women with Stress Urinary Incontinence after Sling Operations

It is known that urinary incontinence remains one of the most common diseases in women, representing a serious medical and social problem. Practice shows that sling operations without subsequent rehabilitation measures, especially in the long term, do not solve the problem. In urogynecology, the use of physical exercises and physiotherapeutic methods is aimed at restoring impaired urinary functions. A relatively new approach to the rehabilitation of women after sling operations is the inclusion of Nordic walking (NW) into the rehabilitation program. Certain experience in this field has been accumulated in Sverdlovsk Regional Clinical Hospital № 1 (Yekaterinburg). Aim. To improve the efficiency of treatment of female stress urinary incontinence using the technique of NW in rehabilitation programs after sling operations. Material and methods. In Sverdlovsk Regional Clinical Hospital № 1 in Yekaterinburg, NW is included in rehabilitation programs for women with stress urinary incontinence after sling operations. Experience in planning and conducting a four-week course of NW under the physiotherapist guidance has been accumulated. Patients after sling operations (n= 85) were randomized into two groups. Rehabilitation program of patients of the first group (n = 37) included a 4-week course of NW on the background of basic therapy (antibacterial therapy, antispasmodics, anticoagulants), while in the second group (n = 48) only basic therapy was realized. The dynamics of clinical manifestations of stress urinary incontinence was studied, uroflowmetry parameters, PAD-test data, cough test were evaluated; the answers of the patients to the questions of the international questionnaires PFDI-20, PFIQ-7 were analyzed. Results and discussion. The variability of the currently used methods of rehabilitation of patients with stress urinary incontinence requires objectification of the results. The study showed that Nordic walking (NW) is a pathogenetically justified and clinically effective method for rehabilitation of women with stress urinary incontinence after sling operations. The analysis of the rehabilitation activities data based on the dynamics of leading clinical symptoms, PAD test, cough test, uroflowmetry parameters revealed significant differences (p<0.05) between two groups at all follow-up periods: a month, three and nine months. Postoperative objective evaluation of the treatment results correlate with patients’ subjective data: women who completed a course of NW rated their quality of life significantly higher than patients of the control group under the rehabilitation program without inclusion of therapeutic physical factors. The structure of NW classes is based on the understanding that the body response to the physical factors impact is provided by various organs and systems. The inclusion of NW in rehabilitation programs requires adherence to the basic principles of achieving training status. Conclusion. The expediency of NW including in the complex treatment of patients with stress urinary incontinence is due to the regression of main clinical symptoms, reliably significant dynamics of instrumental parameters and test results in comparison with the group that received only basic therapy. The implementation of the therapeutic effect is based on the principle of unity of syndromicpathogenetic and clinical-functional approaches. Clinical-functional approaches is the basis for the implementation of the therapeutic effect.

Cytokine status indicators in children with acute respiratory viral infections after treatment with intranasal interferon-based medicine

Objective: to study the dynamics of local and systemic cytokine production in children with different clinical forms of acute respiratory viral infections (ARVI), including COVID-19, and to assess the effectiveness of local interferon-based therapy.Patients and methods: The study included 180 patients aged from 1 month to 17 years with сonfirmed acute respiratory viral infections (ARVI), including COVID-19. Patients were divided into 2 groups (main and control) of 90 people each. In the main group patients received the intranasal interferon-based medicine Grippferon® in addition to the basic therapy, the control group patients received only basic therapy. The cytokine status was assessed by the content of IFN-α and -γ, IL-1β, IL-8, IL-4, IL-10, IL-17 in blood serum and in nasopharyngeal secretions by enzyme immunoassay kits ("Cytokine", St. Petersburg).Results: Statistically significant differences were revealed in the systemic and local content of individual cytokines in ARVI of different etiologies, depending on the level of damage to the respiratory tract. The use of the interferon-based medicine Grippferon® for intranasal use in children in the early stages of ARVI, including COVID-19, helps to decrease the high content of cytokines IL-1β and IL-8 in the nasopharynx by reducing the viral load. As a result, the duration of catarrhal disease symptoms and intoxication was also significantly reduced as well as the pathogen elimination time.

Retrospective Analysis of Experimental and Clinical Studies of Flakozid in Viral Hepatitis

Introduction. Viral hepatitis (HV) by its socio-economic significance occupies one of the leading places in human infectious pathology, therefore, the development of fundamentally new methods of prevention, diagnosis and treatment, as well as the creation of new antiviral drugs remain relevant. An antiviral herbal drug "Flakozid" has been created in VILAR, which is presented in a dosage form – 0,1 g tablets for oral administration.Аim. To analyze the experimental and clinical efficacy and safety of flakozid therapy in viral hepatitis.Materials and methods. Experimental study of the effect of flakozid on viral hepatitis A (HAV). The AGMK cell culture (BS-C-1 line) and the hepatitis A virus strain HM 175 adapted to it were used in the work. The studies were conducted in two series of experiments using different concentrations of the drug, which was introduced into cultures simultaneously with the infection of HAV. Experimental study of the effect of flakozid on viral hepatitis C (HCV). In the present experiments, a virus-containing culture fluid collected from infected cultures of chicken embryo fibroblasts containing 7,0 lg TCD50/ml of infectious HCV (genotype 1b) was used. The cytotoxic, viricidal and antiviral activity of flakozid was studied using transplanted cultures of pig embryo kidney cells (SPEV) obtained from the collection of cell lines of the D. I. Ivanovsky Research institute of virology of the Ministry of Health of the Russian Federation. In the experiments, a one-day monolayer of cells grown in 96-well plastic culture panels was used. ID50 – the concentration of the drug "Flacozid", which inhibits the development of the virus in the monolayer by 50 %, and CD50 – its minimum concentration, which causes cytotoxic destruction of 50 % of the cells of the monolayer, as well as the CTI – chemotherapeutic index, calculated as the ratio of CD50 to ID50, were determined. A well – known domestic antiviral agent, "Ribavirin", was used as a comparison drug. Clinical studies of flakozid in viral hepatitis A. The results of clinical studies of the antiviral drug "Flakozid" (0,1 g tablets) were analyzed in 258 patients with viral hepatitis A. "Flakozid" was prescribed to patients with a moderate course of the disease, 0,1 g 3 times a day for 20 days against the background of basic therapy: diet, alkaline drinking, Enterodes®. The therapeutic effect was assessed by clinical (weakness, decreased appetite, nausea, vomiting) and biochemical parameters (the level of direct bilirubin, transaminase activity), as well as by the severity of hepatolienal syndrome. Clinical studies of flakozid in viral hepatitis В. The results of clinical studies of the antiviral drug "Flakozid"(0,1 g tablets) were analyzed in 410 patients with acute viral hepatitis B, which was regarded as moderate. "Flakozid" was prescribed against the background of basic therapy: diet and detoxification therapy: 5 % glucose solution, 5 % ascorbic acid solution, "Hemodesi", at a daily dose of 0,3–0,8 g for up to 38 days. The comparison group received the same basic therapy without flakozid. The dynamics of clinical symptoms (general weakness, headache, sleep disorders, dizziness, nausea, vomiting, impaired appetite, itchy skin, pain in the right hypochondrium, jaundice, etc.), data from laboratory examination methods were evaluated, markers of hepatitis B – HBeAg and Australian antigen (HBsAg) were determined every 10 days and indicators of cellular immunity before the appointment and after 21 days of treatment; the absolute number of lymphocytes, the total number of T-lymphocytes, as well as theophylline-resistant and theophylline-sensitive cells.Results and discussion. The results of experimental studies revealed the antiviral effect of flakozid against the hepatitis A virus, confirmed during clinical studies in adult patients. Treatment with flakozid in patients with viral hepatitis A against the background of basic therapy at a daily dose of 0,3 g for 20 days led to a significant reduction in the symptoms of intoxication, a reduction in the jaundice period, normalization of the size of the liver and spleen. Treatment with flakozid as part of complex therapy of patients with acute viral hepatitis B (AHVB) of moderate severity in daily doses of 0,3–0,8 g for 38 days showed its high effectiveness, contributing to a faster disappearance of clinical symptoms of the disease (improvement of the general condition of patients, reduction of the severity and disappearance of clinical symptoms of intoxication, reducing of the jaundice period), normalization of biochemical parameters (reducing the level of bilirubin and transaminase activity), as well as elimination of HBsAg from the blood, stimulation of cellular immunity. "Flakozid" was well tolerated, did not cause allergic reactions. Based on the results of clinical studies, "Flakozid" is approved for medical use as an antiviral agent (registration number 90/248/7). The high antiviral activity of flakozid against the hepatitis C virus in cell cultures was established. In terms of the severity of the therapeutic effect, "Flakozid" was not inferior to ribavirin, and in terms of CTI it was noticeably superior.Conclusion. Treatment with flakozid in patients with viral hepatitis A and B showed its high efficiency, contributed to a faster disappearance of clinical symptoms of the disease, normalization of biochemical parameters, elimination of HCV from the blood, good tolerability. "Flakozid" is recommended in clinical practice in the complex treatment of hepatitis A and B. In vitro experiments have established a high antiviral activity of flakozid against the hepatitis C virus, which justifies the possibility of conducting clinical studies of the drug in patients with the viral hepatitis C.

Ways to increase the effectiveness of treatment of psoriasis patients with dystrophic lesions of the nail plates

Objective — to increase the effectiveness of treatment of psoriasis patients with degenerative changes in the nails, by including in the complex therapy of the topical drug Onychocid® Emtrix, aimed at restoring the integrity of the nail plates. Materials and methods. 38 patients with psoriasis and various forms of onychodystrophy (OD) were examined and treated. The effectiveness of therapy was evaluated based on the results of treatment of patients who were divided into two clinical groups — the main and the comparison ones. Patients in both groups received basic therapy. In addition, patients of the main group were prescribed a combined drug Onychocid® Emtrix, which was applied on the nail plates and under the tips of damaged nails once a day for 3 – 6 months. Results and discussion. Patients with psoriasis are diagnosed with dystrophic changes of nail plates of varying severity. OD of the fingers only was detected in 14 (36.8 %) patients; toes — in 5 (13.2 %); fingers and toes at the same time — in 19 (50.0 %) patients. As a result of complex treatment, in patients of the main group there was an early (already on the 2—4th week of use of the drug Onychocid® Emtrix) improvement of the appearance of deformed nails. After the course of treatment, these patients showed a positive clinical effect, i. e. decrease in thickness, normalization of density, color and structure of nail plates. At the same time, «significant improvement» and «improvement» were noted in 34 (89.5 %), «slight improvement» — in 3 (7.9 %), «no improvement» — in 1 (2.6 %) patients. Conclusions. Treatment of psoriasis patients with dystrophic nail lesions should be complex and focused, including the restoration of the integrity of the nail plates. The inclusion in the complex therapy of patients with psoriatic OD of the combined drug Onychocid® Emtrix increases the effectiveness of treatment, in particular, helps to restore the structure, shape, integrity, thickness and color of the nail plates.

Effect of lisinopril on indicators of electrocardiographic and echocardiographic studies in patients with liver cirrosis

Chronic diffuse liver diseases (CDLD) of various etiologies remain a serious socio-economic and clinical-epidemiological health problem. Every year more than 1 million people die from cirrhosis of the liver of various etiology all over the world. According to the results of a study by a group of authors, it was found that in the Siberian Federal District there is an unfavorable situation in terms of gastroenterological mortality, in particular, hepatological mortality. CCM is characterized by lengthening of the QT interval, electromechanical dyssynchronization, and chronotropic insufficiency. The duration of the QTc interval in the subgroup of patients with liver cirrhosis who received basic therapy and the drug lisinopril (Diroton) was (418.21 ± 2.74 ms) and was significantly lower than in the subgroup of patients receiving only basic therapy. Evaluating the parameters of transthoracic echocardiography among patients with liver cirrhosis, it was noted that during treatment with basic drugs in combination with lisinopril (Diroton), the volume of LV EDV significantly decreased (p < 0.05). The appointment of an ACE inhibitor lisinopril to patients with cirrhosis of the liver as part of complex therapy leads to an improvement in general well-being, a decrease in shortness of breath, an increase in exercise tolerance, an improvement in basic laboratory parameters, as well as an improvement in some morphometric parameters (EDV) and cardiac electrical systole.

Effects of preformed physical factors on blood rheology in patients with chronic post-embolic pulmonary hypertension

Введение. Основу взаимодействия физических факторов и организма составляют электрические и биоэнергетические процессы, вызывающие изменения показателей центральной и периферической гемодинамики, обменных процессов, трофики, дыхания, реактивности и сопротивляемости организма. К таким физическим факторам, в частности, относятся электромагнитные колебания оптического излучения или фототерапия. Цель исследования - оценка эффективности воздействия коротковолнового излучения (фотогемотерапии, ФГТ) и ультрафиолетового (УФ) облучения крови на ее реологические свойства в комплексной терапии больных хронической постэмболической легочной гипертензией (ХПЛГ). Методика. Проведено комплексное клинико-лабораторное обследование 64 пациентов (30 женщин и 34 мужчины), поступивших в клинику с симптомами хронической легочной недостаточности, развившейся после перенесенной тромбоэмболии легочной артерии. Больные ХПЛГ были распределены в 3 группы: 1-ю (контрольную) группу составили 15 пациентов, получавшие только базисное лечение; 2-ю (экспериментальную) группу - 26 больных, получавшие базисную терапию в комплексе с ФГТ; 3-ю (экспериментальную) группу - 23 пациента, которые получали базисную терапию в сочетании с воздействием на кровь УФ облучения. Для ФГТ синим светом и УФ воздействия на кровь применяли аппараты АФС-Соларис (Россия) со светодиодами, излучающими синий свет с длиной волны 450 ± 10 нм, и УФ лучи с длиной волны 365 ± 10 нм. Исследовали вязкость крови на ротационном вискозиметре RotoVisco-100 (Нааке GmbH, Германия) в диапазоне скоростей сдвига от 1 до 150 с-1, агрегацию эритроцитов на колориметре-нефелометре ФЭК-56 М (Россия), показатель гематокрита на гематокритной центрифуге (Autocrit, США). Результаты. У больных 1-й группы после базисного медикаментозного лечения отсутствовали статистически значимые изменения вязкости крови, агрегации эритроцитов и показателя гематокрита. У пациентов как 2-й, так и 3-й группы выявлены статистически значимые изменения реологических свойств крови: снижение вязкости крови, агрегации эритроцитов, показателя гематокрита. Заключение. Оптическое излучение синего света имеет выраженное физиологическое воздействие: вызывает медленный, но пролонгированный положительный эффект на реологические свойства крови. УФ облучение при воздействии на кровь также способствует улучшению гемореологии и циркуляции крови и активирует рудиментарные механизмы, запускающие адаптационные системы организма, ранее не функционирующие. Introduction. Electrical and bioenergetic processes that cause changes in central and peripheral hemodynamics, metabolic processes, trophism, respiration, reactivity, and body resistance are the basis of interaction between physical factors and the body. Such physical factors include, in particular, electromagnetic oscillations of the optical radiation or phototherapy. Aim: to assess the effectiveness of short-wave radiation (photohemotherapy, PHT) and ultraviolet (UV) irradiation of blood on its rheology in the complex treatment of chronic post-embolic pulmonary hypertension (CPPH). Methods. 64 patients (30 women and 34 men) with symptoms of chronic pulmonary insufficiency secondary to pulmonary embolism underwent a comprehensive clinical and laboratory examination. CPPH patients were divided into 3 groups: the 1st (control) group consisting of 15 patients who received only a basic treatment; the 2nd (experimental) group including 26 patients who received a basic therapy combined with PHT; and the 3rd (experimental) group consisting of 23 patients who received a basic therapy combined with UV irradiation of blood. AFS-Solaris devices (Russia) producing light-emitting diode-derived blue light with a wavelength of 450 ± 10 nm were used for FGT, and UV rays with a wavelength of 365 ± 10 nm were used for the UV exposure of blood. Blood viscosity was measured on a RotoVisco-100 (Нааке GmbH, Germany) rotational viscometer at shear rates ranging from 1 to 150 s-1; erythrocyte aggregation was studied with a FEK-56 M (Russia) colorimeter-nephelometer; and hematocrit was measured with a hematocrit centrifuge (Autocrit, USA). Results. There were no statistically significant changes in blood viscosity, erythrocyte aggregation, or hematocrit values in the 1st group after the basic treatment. Statistically significant changes in blood rheology parameters observed in both the 2nd and 3rd groups included decreases in blood viscosity, erythrocyte aggregation, and hematocrit values. Conclusion. Optical irradiation with blue light exerted a pronounced physiological effect evident as a slow but long-standing positive influence on blood rheology parameters. The UV irradiation of blood also improved hemorheology and blood circulation and activated rudimentary mechanisms triggering previously non-functional adaptive systems.

Complex correction of metabolic changes and endothelial dysfunction in patients with ischemic heart disease and eff ort angina of functional class II

Objective: to study the role of free radical processes, disturbances in nitric oxide homeostasis and cholesterol metabolism in the formation of endothelial disorders in patients with chronic heart disease (CHD) with eff ort angina pectoris functional class II (FC); to substantiate the complex correction of disorders. Material and methods. The study included 75 patients with coronary artery disease and eff ort angina FC II at the age of 50.1 ± 10 years old in the course of a year. The patients were divided into 4 groups: 1st group — control, 2nd group — data obtained on the background of basic therapy; 3rd group — basic therapy + atorvastatin; 4th group — a combination of basic therapy with atorvastatin and coenzyme Q10. In all patients, the intensity of lipid peroxidation, the activity of the antioxidant system, the content of NO metabolites and cholesterol metabolism were determined. To assess the functional state of the heart, an ECG study, daily ECG monitoring with the use of the Microvit MT-101 Holter system and blood pressure were performed. Results. The data showed the development of oxidative stress, inhibition of AOD cells and a decrease in the NO metabolites content and impairment of its bioavailability due to atherogenic changes in the vascular wall. Metabolic changes were accompanied by hypertension, ECG changes and anginal attacks. Combined therapy with atorvastatin and coenzyme Q10 against the background of basic therapy caused a positive dynamics of metabolic and functional disorders. Conclusion. The results of complex therapy with an inhibitor of HMG-CoA reductase and coenzyme Q10 proved the effi cacy of the infl uence on oxidation-reduction reactions, endothelial function, total cholesterol, LDL cholesterol, HDL cholesterol and functional parameters of the heart.

Quercetin effectiveness in patients with COVID-19 associated pneumonia

The aim of this work was to evaluate the effectiveness of quercetin addition to the treatment regimen for patients with COVID-19 associated pneumonia. Materials and methods. The effectiveness of two dosage forms of quercetin was studied in 200 patients, who were divided equally into the main and control groups. The main group patients received quercetin in addition to the basic therapy: intravenous drip of Quercetin/Polyvinylirolidone during the first 10 days followed by oral administration of Quercetin/Pectin over the next 10 days. Patients from the control group received only the basic therapy drugs. The study evaluated the dynamics of the disease symptoms (saturation level, respiratory rate, body temperature, cough, general weakness), as well as laboratory markers (C-reactive protein (CRP), ferritin, D-dimer). Results. Two dosage forms of quercetin consistently used in addition to the basic therapy improve pulmonary gas exchange and accelerate the lung function recovery. This is evidenced by a statistically significant majority of patients with positive dynamics in the symptoms of “Saturation level” and “Cough” as well as the meeting a complex indicator of the therapy effectiveness 2 days earlier than in the control group. The treatment regimen applied also helps to stabilize the level of D-dimer in the blood of the main group patients. Conclusions. The use of two dosage forms of quercetin in addition to the basic therapy accelerates the recovery of patients with coronavirus disease associated pneumonia and can help to prevent the progression of COVID-19 associated coagulopathy.