Features of the course of chronic spontaneous urticaria in patients with Common variable immune deficiency and hypogammaglobulinemia.

Chronic spontaneous urticaria is a common disease that can be associated with various autoimmune, infectious (viral, bacterial, parasitic) and non-infectious inflammatory diseases, as well as occur in the symptom complex of other diseases, such as primary immunodeficiencies (PID). Currently, data about the features of the course of chronic spontaneous urticaria in patients with PID are accumulating. In this article we present two clinical cases of patients with common variable immune deficiency and one clinical case of a patient with hypogammaglobulinemia, suffering from chronic spontaneous urticaria. The article describes peculiar properties of IVIG replacement therapy at the course of urticaria in these patients. The discussion section presents data from the world literature and offers key provisions for further investigations.

Depression with Mixed Features (for DSM-5): Distinguishing Indicators Imaginary Coherence EEG Rest

Background: The neuronal correlates of depression with mixed traits (according to DSM-5) at rest have not been studied. Objective: to determine the indicators of imaginary coherence of EEG-rest, which distinguish patients with depression with mixed features (according to DSM-5) from patients with depression without mixed features and healthy subjects, and also to trace the dependence of the identified neurophysiological characteristics on the diagnostic belonging of the symptom complex to bipolar II type or recurrent depressive disorder. Patients and methods: on a background free from drug therapy, 80 patients with depression with mixed features (XD; n = 40 — with bipolar II disorder (XB) and n = 40 — with recurrent depressive disorder (XR)), 80 patients with depression without mixed traits (TD; n = 40 — for bipolar II type (TB) and n = 40 — for recurrent depressive disorder (TR), as well as 80 healthy subjects (N). The study groups were matched by sex and age. The study used clinical-psychopathological, psychometric, neurophysiological and statistical research methods. According to the Kruskal–Wallis criterion for independent samples the parameters of imaginary coherence (modulo) of standard frequency ranges (delta (δ) — 0.5–4 Hz, theta (θ) — 4–8 Hz, alpha (α) — 8–13 Hz, beta-1 (β1) — 13–20 Hz, beta-2 (β2) — 20–30 Hz, gamma (γ) — 30–45 Hz) between pairs of 14 cutaneous standard EEG derivations (according to the “10–20” system) in three (XD, TD and N), and then in five (XB, XR, TB, TR and N) comparison groups. Post-hoc analysis was performed using the U-test. The significance level was adjusted according to the Bonferroni correction. Results: three indicators were identified: α-ICoh(C3–P4), β1-ICoh(C3–P3) and β2-ICoh(F3–C4). For all three parameters, the H-test values for the “Group” factor (n = 3 and n = 5) were highly significant. In this case, α-ICoh(C3– P4) — XD = TD, XD < N, TD < N; β1-ICoh(C3–P3) — XD < TD, XD < N; TD < N; β2-ICoh(F3–C4) — XD > TD; XD > N, TD > N. The groups of patients with XD within the framework of recurrent depressive and bipolar II disorders significantly differed in terms of β1- ICoh(C3–P3) — XR > XB. At the level of statistical trends, in type II bipolar disorder — XB > TB according to α-ICoh(C3–P4), and in recurrent depressive disorder — XR > TR according to β2-ICoh(F3–C4). Conclusion. Thus, depression with mixed features can be considered in terms of dysfunctional interactions of the left frontal, bilateral central and parietal cortical zones, depending on the diagnostic affiliation of the depressive symptom complex and reflecting violations of automatic and voluntary regulation of affect, cognitive and behavioral changes.

THE USE OF THE HERBAL PREPARATION EVIKA IN THE TREATMENT OF PREMENSTRUAL SYNDROME

Предменструальный синдром (ПМС) - патологический симптомокомплекс, который значительно снижает качество жизни женщины. Несмотря на то, что этиология и патогенез до настоящего времени изучены недостаточно, определены направления в диагностике, лечении и профилактике, которым необходимо следовать. Лечение ПМС должно быть дифференцированным, учитывающим состояние общего и репродуктивного здоровья женщины, сопутствующие заболевания, степень тяжести ПМС, переносимость терапии и т. д.В настоящее время все более широкое применение в лечении ПМС находят фитопрепараты (ФП). Целью исследования явилось изучение эффективности фитопрепарата «Эвика» в лечении ПМС легкой и средней формы. Полученные результаты свидетельствуют об эффективности данного препарата в устранении вегетососудистых, отечных и психоэмоциональных симптомов ПМС, что определяет «Эвику», как препарат выбора у пациенток с ПМС, выраженной вегетососудистой и психоэмоциональной симптоматики. Premenstrual syndrome (PMS) is a pathological symptom complex that significantly reduces a woman's quality of life. Despite the fact that the etiology and pathogenesis have not been studied enough to date, the directions in diagnosis, treatment and prevention that need to be followed have been identified. Treatment of PMS should be differentiated, taking into account the state of a woman's general and reproductive health, concomitant diseases, the severity of PMS, the tolerability of therapy, etc. Currently, herbal medicines are increasingly used in the treatment of PMS. The aim of the study was to learn the effectiveness of the herbal medicine "Eviсa" in the treatment of mild and moderate PMS. The results obtained indicate the effectiveness of this drug in eliminating vegetativevascular, edematous and psychoemotional symptoms of PMS, which defines "Evica" as the medication of choice in patients with PMS, vegetativevascular and psychoemotional symptoms.

MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN ASSOCIATED WITH COVID-19: RESULTS OF A MULTICENTER STUDY

Coronavirus disease 2019 (COVID-19) in children in most cases is asymptomatic or mild, and its most severe late complication is multisystem inflammatory syndrome in children (MIS-C). The aim of the study is to find clinical, laboratory and instrumental characteristics, description of therapeutic tactics, including determination of the profile of patients requiring Tocilizumab prescription and the outcomes of MIS-C associated with COVID-19. Materials and methods of research: 245 children aged 3 months – 17 years old were included in the pilot prospective multicenter open-label comparative study with MIS-C associated with COVID-19, verified based on CDC criteria (2020). Results: the median age of patients was 8 [5; 10] years, boys predominated among the patients (57.1%); MIS-C manifested itself as a combination of the symptom complex of Kawasaki disease (KD, 53.1% of patients), more often of atypical form, cardiovascular (66.1%), gastrointestinal (61.2%), neurological (27.3%) symptoms and signs of detection of the urinary (29.4%) and respiratory (19.6%) systems; macrophage activation syndrome (MAS) was diagnosed in 19.5% of patients. Therapy included glucocorticosteroids (97.6%), antibiotics (95.5%), anticoagulants (93.9%), intravenous immunoglobulin (34.7%), vasoactive/vasopressor support (31.8%), Tocilizumab (15.1%), mechanical ventilation (2.4%), extracorporeal membrane oxygenation (0.4%). Patients receiving Tocilizumab, statistically significantly more often compared with patients without this therapy, were in the intensive care unit (ICU, 86.5% versus 40.9%, p<0.001), more often required vasopressor therapy (70.3% versus 25%, p<0.001), had statistically significantly higher markers of laboratory inflammatory activity. Treatment in 47.8% of cases was carried out in an ICU; one child has died. In 4.1%, according to echocardiography, coronaritis, ectasia of the coronary arteries without the formation of persistent aneurysms were detected. Conclusion: MIS-C associated with COVID-19 has clinical signs of KD, often of the incomplete form, accompanied by arterial hypotension/shock, MAS, which requires intensive therapy, and the prescription of Tocilizumab.

Long COVID a New Derivative in the Chaos of SARS-CoV-2 Infection: The Emergent Pandemic?

Coronavirus disease 2019 (COVID-19) is a multisystem illness caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can manifest with a multitude of symptoms in the setting of end-organ damage, though it is predominantly respiratory. However, various symptoms may remain after acute SARS-CoV-2 infection, and this condition is referred to as “Long COVID” (LC). Patients with LC may develop multi-organ symptom complex that remains 4–12 weeks after the acute phase of illness, with symptoms intermittently persisting over time. The main symptoms are fatigue, post-exertional malaise, cognitive dysfunction, and limitation of functional capacity. Pediatric patients developed the main symptoms of LC like those described in adults, although there may be variable presentations of LC in children. The underlying mechanisms of LC are not clearly known, although they may involve pathophysiological changes generated by virus persistence, immunological alterations secondary to virus–host interaction, tissue damage of inflammatory origin and hyperactivation of coagulation. Risk factors for developing LC would be female sex, more than five early symptoms, early dyspnea, previous psychiatric disorders, and alterations in immunological, inflammatory and coagulation parameters. There is currently no specific treatment for LC, but it could include pharmacological treatments to treat symptoms, supplements to restore nutritional, metabolic, and gut flora balance, and functional treatments for the most disabling symptoms. In summary, this study aims to show the scientific community the current knowledge of LC.

Cervical musculoskeletal impairments in migraine

Background Neck pain is common and disabling amongst individuals with migraine. Cervical musculoskeletal interventions are often sought but there is currently no evidence to support such interventions for this population. Improved understanding of how cervical musculoskeletal impairments present in migraine can elucidate neck pain mechanisms and guide clinicians and researchers in the management of patients with migraine and neck pain. Main body Migraine hypersensitivity is a major consideration when assessing for cervical impairments as it can aggravate migraine and confound findings. Current evidence of cervical impairments in migraine is limited by disregard for the different underlying causes of neck pain and possible influence of hypersensitivity. Findings of cervical musculoskeletal impairments are mixed within and across studies, indicating that different forms of neck pain are present in migraine. Some migraineurs have neck pain that is part of the migraine symptom complex and therefore exhibit little or no cervical musculoskeletal impairment. Others have a cervical source of neck pain and therefore exhibit a pattern of cervical musculoskeletal impairments akin to that of cervical disorders. The presence of cervical musculoskeletal dysfunction may or may not be related to migraine but knowledge of this is currently lacking which impacts decision making on management. Cervical musculoskeletal interventions may be indicated for migraineurs with identified cervical dysfunction but other factors requiring further clarification include determination of i) patient specific outcomes, ii) impact of co-existing migraine referred neck pain, and iii) potential moderating effects of migraine hypersensitivity on treatment efficacy. Conclusions Physiotherapists should seek a combination of cervical impairments through skilful assessment to identify if cervical musculoskeletal dysfunction is present or not in individual patients. The relevance of cervical dysfunction to migraine and influence of co-existing migraine referred neck pain need to be established through detailed evaluation of pain behaviours and further research. Future clinical trials should define expected treatment outcomes and select individuals with cervical musculoskeletal dysfunction when investigating the efficacy of cervical musculoskeletal interventions.

Clinical case of SARS-CoV-2-associated multisystem inflammatory syndrome

The clinical course, features of diagnostic examinations and difficulties in verification of the new nosology of multisystem inflammatory syndrome associated with SARS-CoV-2 in 15-year-old girls are described. The girl was taken to the Kyiv Regional Children's Hospital No. 2 with complaints of fever, intoxication syndrome, general weakness, dizziness, vertigo, lack of urine during the day. The child was examined by a consilium of doctors, examined in the laboratory and instrumentally, after a carefully collected epidemiological history revealed possible contact with a patient with coronavirus infection at the place of study and identified a probable case of multisystem inflammatory syndrome associated with SARS-CoV-2. According to the results of our own observations during the pandemic, this nosology was found in patients who relapsed into coronavirus infection in clinical or subclinical form and for the period of hospitalization had a clinical symptom complex of Kawasaki with similar symptoms. This disease is new today, has a variety of clinical manifestations and pathological features that are a problem for clinicians. After all, at present there are no unified protocols for the diagnosis and treatment of MIS-C (multisystem inflammatory syndrome) and each doctor relies on their own experience and previously described cases. This case of multisystem inflammatory syndrome will help practicing clinicians in the early stages to diagnose the disease and provide qualified care to patients. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: multisystem used for setting fire syndrome, 15-year-old girl, kawasaky-like symptoms, SARS-CoV-2, intravenous immunoprotein, acetophene, glucocorticosteroids.

Management of Computer Vision Syndrome with Saindhava Jala Seka and Triphala Ghritapana - A Case Study

Computer vision syndrome (CVS) is a symptom complex in which symptoms develop due to long screening time and improper postures while using computers. Ayurveda has mentioned Shushkakshipaka under Sarvagat Netra Roga. The symptoms of CVS and Shushkakshipaka when corelated, it denotes imbalance of Vata and Pitta Dosha. These vitiated Doshas carried by Siras to the eyes. When Doshas accumulated in eye the condition develops, called as Shushkakshipaka. Over use of Internet, Computers, Electronic devices increasing the risk factors about maintaining the normal vision. For the management of the CVS case, the Saindhava Jala Seka and Abhyantara Triphala Ghritapana is chosen from Sushrut Samhita. Triphala Ghrita is beneficial for complete maintenance of physiology of eye. The Guna Karma of Saindhava and Triphala Ghrita are Vata-Pitta Shamaka and both having Chakshushya properties. The main purpose for this study is to find safe and effective treatment without untoward effect in the management of CVS along with respective ergonomics advice. The required clinical tests done to observe the effectiveness of the combination of local and systemic treatment. The dryness in the eyes and associated symptoms can be resolved with the local treatment like Seka. Both the treatment modalities in combination have potential to give local and systemic relief improving the symptoms of CVS.

Infant colic: where is the line between norm and pathology, the role of disruption of the intestinal microbiome

Infant colic is one of the most common functional disorders of the gastrointestinal tract in children of the first year of life, worsening the condition of both the child himself and the psychological climate in the family. Infant intestinal colic is a multifactorial symptom complex that requires differential diagnosis between norm and pathology. Until now, there is no clear understanding of the criteria for the need for dietary and drug correction of this condition. The article presents an analysis of the modern literature on the problem of intestinal colic in infants The pathogenesis of functional intestinal colic is determined by a combination of reasons, including the immaturity of the central nervous system, hypothalamic-pituitary system, regulation of the intestinal innervation and the enzymatic system, a certain dependence on psychosocial factors has also been identified, the intestinal microflora has a great influence. H. Kianifar et al. (2014) in the findings of a study noted that a multiprobiotic (seven strains of probiotics and fructooligosaccharides) significantly improved colic symptoms, in particular a reduction in crying time, (82.6%) compared with placebo (35.7%) on day 7 of intake (p < 0.005). On day 30, treatment success was 87% and 46% in the synbiotics and placebo groups, respectively (p < 0.01). The results of a domestic study by I.N. Zakharova et al. (2016) multiprobiotic, which showed that after the use of a multistrain probiotic, intestinal colic remained in 3 (10%) children of the main group and in all children in the placebo group. After taking the probiotic, 80% of children showed normalization of stool, and in the placebo group, stool disorders (loose, watery stools or no stool with the need to empty after an enema) were recorded in 87% of children. Cases from clinical practice with experience of using a multistrain probiotic for colic are shown.