Репозиторий Университета

© 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología Case history of a small girl outlet with epilepsy, followed by scleroderma skin damage and uveitis, neurovasculitis with white matter foci in brain on the side of skin lesion in two months, immunologic disease activity. Resistance to conventional immunosuppressive therapy forced us to initiate the treatment with tocilizumab. It was well tolerated and led to significant improvement of brain, ocular and skin manifestations.

© 2018 Izdatel'stvo Meditsina. All rights reserved. This research was aimed at the pharmacological analysis of dermotropic activity ofCaragana jubata (Pall.) poiraqueous extract on the model of atopic contact dermatitis induced by 2,4-dinitrochlorobenzene in male rats. It was found that the aqueous C. jubata extract exhibited expressed dermotropic activity as manifested by reducing thickness of the skin fold by 47% (p = 0.05) and decreasing severity of the onset of contact dermatitis on the average by 38% (p = 0.05). Histological examination showed positive trends in the regeneration of skin lesion. Hematologic examination showed normalization of peripheral blood parameters in animals affected by contact dermatitis. Calculations of the index of inhibition of the inflammatory response confirmed anti-inflammatory effect of the aqueous C. jubata extract.

© 2018, Media Sphera Publishing Group. All Rights Reserved. Objective. To develop therapeutic programs for treatment of depression with panic attacks on the basis of their clinical and psychopathological features. Material and methods. A total of 100 in-and outpatients, aged from 18 to 60 years, with depression of mild and moderate severity with panic attacks were studied. The investigation was carried out using clinical, psychopathological and psychometric (the Atypical Depression Diagnostic Scale (ADDS), the Montgomery—Asberg Depression Rating Scales (MADRS), and the Sheehan Anxiety Rating Scale (ShARS)) methods. The patients were assessed on admission, on the 1st, 2nd, 4th and 8th weeks with subsequent processing and defining standard indicators. Three therapeutic groups were formed: the 1st group received therapy combining an antidepressant and a tranquilizer; the 2nd group an antidepressant, a tranquilizer and a mood stabilizer; and the 3rd group an antidepressant, a tranquilizer and an antipsychotic agent. The time course of expression of the signs of depression, anxiety and frequency of panic attacks was analyzed. Results. The highest efficacy in the form of reduced signs of depression and anxiety was observed in the 3rd group on the 1st week of therapy. No significant differences in reduction of depression and anxiety were found between the 1st and 2nd groups. In the 1st therapeutic group, there was an increase in the frequency of panic attacks together with the reduction in their expression and decrease in the severity of depression as compared to the 2nd and 3rd groups. At the same time the 3rd therapeutic group was characterized by a maximally expressed decrease in the frequency of panic attacks already on the 1st week of therapy. Conclusion. The study has shown that the use of antipsychotic drugs in addition to therapy with antidepressants and tranquilizers is the most effective way to stop depression.

© 2018, Media Sphera Publishing Group. All Rights Reserved. Diabetic polyneuropathy is the most often complication of diabetes mellitus. However, patients with diabetes may have other neuropathies, which need to be recognized and treated. Chronic nnflammatory demyelinating polyneuropathy is the most common non-diabetic polyneuropathy in patients with diabetes. The article discusses the classification, clinical features of diabetic and nondiabetic polyneuropathies, modern methods of diagnosis and approaches to treatment.

© Bionika Media Ltd. Objective. To carry out a systems analysis of the data available in the current literature on the impact of vitamin D deficiency on the risk of endometriosis and reproductive cancer, as well as on the possibilities of vitamin D supplementation in order to treat and prevent these diseases. Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in Pubmed on this topic. Results. The paper describes the mechanisms by which vitamin D is involved in the processes of inflammation, immunomodulation, and proliferation, as well as the role of its deficiency in pathogenesis of pathological proliferation and inflammation in endometriosis, breast cancer, and ovarian cancer. It gives the data of clinical trials confirming the role of vitamin D deficiency in the progression and negative effects of endometriosis and carcinogenesis, the possibility of vitamin D supplementation for the prevention and adjunct therapy of reproductive cancer and endometriosis. Conclusion. It is necessary to conduct further studies to experimentally and clinically evaluate vitamin D deficiency in endometriosis and cancer. Currently, vitamin D supplements should be prescribed to patients with this pathology if they have been found to have a low blood level of 25(OH)D3.

© 2018 Center for Ancient Philosophy and the Classical Tradition. All rights reserved. The article is devoted to the analysis of the evident scientific method of Galen, which establishes the necessity of correct diagnosis of diseases, determination of true symptoms and causes of diseases, which results in the choice of the exact method of treatment. The article focuses on how Galen seeks to achieve reliable knowledge based on an undeniable logical necessity. Logical reliability is contrasted with "dialectical", that is, probabilistic judgments, often leading to the opposite of what was originally asserted in them. Probabilistic judgments were characteristic of the Stoic philosophical school, with which Galen hotly argues, asserting his understanding of truth. Truth, in his opinion, is achieved through facts based on true premises. The criterion of truth for Galen is the study of the device of a living organism, and the logical conclusions depend on the accuracy of knowledge of human anatomy. Thus, the nature of the proof judgments of Galen depends on their practical content and not on the formal and logical structure offered by the Stoics when studying the functions of the human body, which ultimately leads to incorrect methods of treatment.

© 2018 Dynasty Publishing House. All rights reserved. Thrombocytopenia (TCP) includes a huge range of diseases and syndromes with different causes and pathogenetic mechanisms. TCP is defined when platelet count less than 150 × 109/L. the Diagnostic search when TCP should begin with the establishment of a pathogenic variant with subsequent verification of the main reasons for TCP. This allows you to select pathogenetic therapy of the disease (glucocorticoids, immunosuppressants, anticoagulants) and to influence the basic process.

© 2018 Dynasty Publishing House. All rights reserved. The objective: To study the effectiveness and long-term outcomes of sclerotherapy for ovarian endometriomas and to substantiate the conditions and indications for minimally invasive intervention. Patients and methods: We analysed 124 interventions performed by the technique of aspiration (sclerosing) therapy of endometrioid ovarian cysts. The patients' age varied from 18 to 42 years, averaging 26.4 ± 4.2 years. The mean diameter of ovarian endomeriomas varied from 25 to 65 mm. In 84 (67.7%) of observations, pathological process was unilateral, in 72.3% - bilateral. 43 (34.6%) women had disease recurrence after previously performed cystectomy, in 28 (22.6%) endometrioid cysts were located in the only ovary and in 7 (5.6%) patients ultrasonography found that the ovary contralateral to endometrioid tumour was sharply decreased and its sections lacked the signs of antral follicles after preceding cystectomy. In fact, in 35 (28.2%) patients endometrioma was diagnosed in the only ovary. All patients after aspiration therapy of endometriomas received dienogest (2 mg) + ethinylestradiol (0.03 mg) (Siluette®, «Gedeon Richter»). Results: The recurrence rate of endometriomas during the first 12 months of follow-up was 38.7%, during the first 3 months of follow-up this parameter did not exceed 9.7%. Within 7-12 months after intervention spontaneous pregnancy occurred in 36.3% (46) of women, ending with childbirth in all cases (with the use of contraception 25 patients - 46%). Conclusion: Sclerotherapy of ovarian endometriomas with ultrasound monitoring of intervention is a minimally invasive method of treating women of reproductive age, ensuring preservation of ovarian reserve. It is not a monotherapy, its outcome is in many respects determined by the adequacy of postoperative hormonal treatment.

© 2018 Dynasty Publishing House. All rights reserved. Exosomes (vesicles with the size of 30-150 nm) are formed in multivesicular bodies (MVB) by invagination of early endosome membranes and mediate intercellular interactions. Exosomes are secreted by various kinds of cells, their content might be represented by proteins, lipids and nucleic acids, which reflect the functional state of donor cells. The effect of exosomes on recipient cells depends on their quantity and characteristics of their «load». Comparatively recently, placental exosomes secreted by various placental cells have been isolated from blood of pregnant women. A specific protein - placental alkaline phosphatase (PLAP) - has been determined for these exosomes. PLAP-positive exosomes can be found in maternal blood as soon as in the first trimester of pregnancy, their number increases with maturation of the foetus and reaches its maximum by the moment of birth. Although the functional significance of placental exosomes is still investigated, some authors relate changes in the placental exosome profile (their number and composition) to placental dysfunction underlying the development of complications of pregnancy. Isolation of exosomes from blood of pregnant women (fluid biopsy) and determination of their biological characteristics might be regarded as early noninvasive diagnosis of structural and functional placental abnormalities. The appearing evidence of blastocyst-secreted exosomes and their role in modulating maternal immunity and endometrial receptiveness during implantation are also promising. The review presents data about the biogenesis, structure and functions of exosomes and the role of placenta-associated exosomes in the development of physiological and complicated pregnancy, and also about the possibility of using exosomes as a marker of the state of the blastocyst in assisted reproductive technologies, in particular, in oocyte donation and surrogate motherhood.

© 2018 Dynasty Publishing House. All rights reserved. Post-partum depression arises following pregnancy and childbirth, it is a severe disorder threatening the wellbeing of both mother and baby. In the affected families, there is a higher risk of the child's impaired emotional, social and cognitive development. Post-partum depression is one of the most common complications of the postnatal period. The disease prevalence varies from 6.5 to 12.9% and more in countries with low and middle levels of income and life. We analysed 62 Russian and worldwide literature sources published in the PubMed, Google Scholar databases and in Russian medical periodicals over the period 2002-2017 on this theme, we also translated the original Edinburgh Postnatal Depression Scale. This systematic review presents current ideas of the causes of postpartum depressions, methods of treatment and prevention.

© 2018 Dynasty Publishing House. All rights reserved. Objective: Development and justification of a differentiated approach to diagnosis and treatment of ectopic extratubal pregnancies. Patients and methods: 37 patients with histologically verified diagnosis «Ectopic pregnancy» were examined, in whom the ovum was located outside the uterine tubes. In 26 cases it was cervical pregnancy, in 8 - ovarian pregnancy, and 3 pregnancies within a caesarean scar. Diagnostic and treatment methods: 2D- and 3D-transvaginal echography, including power Doppler sonography; hCG testing in blood and urine, laparoscopy, hysteroresectoscopy. Results: A system of examining and treating patients with rare ectopic pregnancies has been developed, in which step-by-step measures for optimization of diagnostic and therapeutic processes are presented. The main attention is paid to organ-sparing technologies, including metroplasty and intrauterine surgery in caesarean scar ectopic pregnancy, and also intrauterine surgery in cervical pregnancy. Conclusion: The presented system permits to optimize diagnosis and treatment of patients with ectopic extratubal pregnancies with preservation of the reproductive function.

© 2018 Dynasty Publishing House. All rights reserved. The objective: To enhance the efficacy of diagnosis and treatment of various kinds of intrauterine pathology in women with infertility using minimally invasive hospital-substitute methods. Patients and methods: We made a complex examination and treatment of 226 female patients with infertility and various intrauterine pathologies aged 22 to 45 years. Minimally invasive interventions were performed using an office hysteroscope, without cervical fixation or dilation of the cervical canal, and in some cases without anaesthesia, which permitted to reduce traumatization of patients during highly informative diagnostic screening and surgical treatment of the diagnosed intrauterine pathology. Results: According to the findings of office hysteroscopy, all patients were divided into 3 groups: group 1 included 110 (49%) women with endometrial polyps, group 2 - 30 (13%) women with polyps of the cervical canal, group 3 - 86 (38%) women with intrauterine synechiae. All women were treated in outpatient settings, laser destruction of intrauterine synechiae and polypectomy of the cervical canal and uterine cavity were performed. 22 (10%) patients with complete or almost complete obliteration of the uterine cavity by fibrinous adhesions and 12 (5%) women with multiple small endometrial polyps were hospitalised. 148 (65%) patients 3-6 months after intervention underwent control office hysteroscopy. No pathology was found in 129 of them, in 5 patients single adhesions were found after complete obliteration, in 2 - endocervical polyps and in 12 - endometrial polyps. Pregnancy occurred in 51 (22%) patients from group 1, in 19 (9%) and 34 (15%) from groups 2 and 3, including pregnancies after assisted reproductive technologies. Conclusion: Office hysteroscopy as a hospital-substitute method of examination and treatment of female patients with infertility conditioned by intauterine pathology has demonstrated its high efficacy.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The article discusses issues related to the long-term administration of macrolide antibiotics for a bronchoectatic disorder of the pulmonary system in children. The relevant information about the results of long-term intake of macrolides in adults and children, the effective dose titration, possible toxic effects of therapy, including the development of cardiotoxic effect and ways to prevent it, has been enlightened in detail. It has been noted that a limited number of clinical studies involving children determine the need for studying the possibility to extrapolate adult treatment.

© 2018 Russian Association of Endocrinologists. All rights reserved. The development of effective methods of obesity treatment with the goal of preventing many associated diseases is among the priorities of modern biomedical research. In 2016 glucagon-like peptide-1 analog (GLP-1) liraglutide 3 mg (Saxenda®) was approved in the Russian Federation for the treatment of obesity. This review presents literature data on the effects of GLP-1 and liraglutide on appetite and body weight as well as an analysis of the effectiveness and safety of drug Saxenda based on the results of major clinical trials.

© 2018 Pirogov Russian National Research Medical University. All rights reserved. Perioperative antimicrobial prophylaxis (PAP) involves administration of antimicrobial agents (AMA) to patients undergoing a surgical intervention and aims to reduce the risk of postoperative infectious complications, especially at surgical sites. In the present work we assess efficiency and safety of AMA used for prevention of postoperative infectious complications. In the course of our study we pre-analyzed 576 medical histories of post-op patients aged 18 to 87 years (mean age M ± SD was 57.4 ± 14.5 years), of which 347 (60.2%) were male and 229 (39.8%) female. Only 481 histories were selected for final analysis. We assessed the choice of antibacterial therapy, the frequency of adverse reactions (AR) and infectious complications and the type of the latter. PAP regimens were consistent with the official guidelines in 207 (43.04%) cases. PAP recommendations were ignored in 274 cases (56.96%), and the timing was wrong in 364 cases (75.7%). Incorrect dosages were administered in 225 cases (46.8%). We also discovered an association between irrational PAP regimens and 1) the length of patient's stay in the intensive care unit (p = 0.003 and p < 0.005), 2) the frequency of reoperations associated with infection (p = 0.001), 3) mortality rates (p = 0.002), and 4) isolation of strains with multidrug resistance (p = 0.016). We conclude that PAP regimens for the inpatients of surgical wards are often compromised by failure to comply with the official guidelines, wrong timing and incorrect dosage, which negatively affects hospital statistics.

© 2018 Medical Education. All rights reserved. Clinical signs and course of pulmonary disease of Fedor M. Dostoevskiy (1821 - 1881) has been analyzed in the article on the basis of memoirs of contemporaries and physicians who followed the writer up to the end of his life. Diagnostic hypotheses of the disease and the cause of death have been discussed.

© 2018, Stolichnaya Izdatelskaya Kompaniya. Aim. To study the erythrocyte electric charge (EEC) in patients with metabolic syndrome (MS) depending on glycemia levels. Material and methods. 112 patients (45 men and 67 women, age 61.4±7.2 years) with MS (MS duration 8.7±5.2 years) were studied. EEC level was detected by the method of adsorption of a positive cationic dye (cationic blue O) on the surface of the erythrocyte plasma membrane up to the complete neutralization of their negative charge, followed by photometry of the solution and calculation of the number of charges on the erythrocyte cell surface. All statistical analyses were done using Statistics 10.0 software. Results: Abdominal obesity was registered in 100% of patients, hypertension - in 73%, fasting hyperglycemia - in 75%, dyslipidemia - in 80% of patients. Mean glycated hemoglobin (HbA1c) level in patients with MS was 7.3±1.9%. The mean EEC level in group of MS patients (1.59±0.05×107) was significantly lower than in the control group (1.67±0.03×107), p < 0.05. In patients with MS and fasting hyperglycemia the EEC levels were significantly lower than in those without fasting hyperglycemia (1.58±0.05×107 vs 1.64±0.03×107, respectively; p < 0.001). Significant negative correlations between EEC and age (r=-0.43, p < 0.05), average duration of MS (r=-0.87, p < 0.05), average plasma glucose concentration (r=-0.6, p < 0.05), average duration of fasting hyperglycemia (r=-0.83, p < 0.05), and blood HbA1c level (r=-0.56, p < 0.05) were found in patients with MS. Conclusion: Significantly lower values of EEC are observed in MS patients with increasing age, duration of MS, and duration of hyperglycemia. Negative correlation between HbA1c and EEC was also shown.

© 2018 Copyright O. Zolnikova et al. We have reviewed the currently published results on a role of the gut microflora in a prevention of acute respiratory infections. The main biological properties of probiotic bacteria are presented in a context of their modulating activity on an inflammatory immune response. Available data on the reduction of a possible risk, duration, and severity of respiratory infection symptoms during a probiotic medication intake were analyzed. Potential antiviral probiotic mechanisms have been reviewed and discussed.

© 2018 Stavropol State Medical University. All rights reserved. The reactivity of T-cells in a screening cell migration test (SCMT) in vitro in patients with recurrent erysipelas and healthy individuals to immunomodulatory drugs - Derinat, Roncoleukin, Gamma-plant, Leikinferon - have been studied. Significant differences in migratory activity of leucocytes (MAL) in respond to a variety of immunomodulators, depending on their concentration, have been determined. It is assumed that the acceleration of MAL to certain concentrations of studied immunomodulators can be interpreted as an indicator of the "SOS" response, and the introduction of immunomodulators in this period may have a disadvantageous effect on inflammation and the formation of immune response.

© 2018 Dynasty Publishing House. All rights reserved. The objective. To determine age-related specificities of microcirculation-tissue systems in children from varied age groups. Patients and methods. We analysed the results of examining healthy children aged 3 to 17 years and also young people under 25 years of age with the use of nail-fold capillaroscopy (n = 65) and laser Doppler flowmetry(n = 50). Results. According to capillaroscopy, no significant differences in microcirculation parameters in children of varied age have been obtained, but as has been found, diameters of all parts of capillaries and the width of perivascular spaces increased to some extent with children's age. Also, the density of first-line capillaries increased with age in the examined patients. The average microcirculation values obtained by LDF did not show any statistically significant difference between children from the age group 7 to 13 years and children aged 13 to 18 years. Microcirculation parameters are not dependent on a patient's age. The average values of PI may be used as reference parameters for diagnosing microcirculation impairments in children with varied pathologies. Conclusion. The capillaroscopy values and basal microcirculation values that we have obtained may be used in practically healthy children for comparison with such values in children with varied pathologies, which might be helpful in diagnosing various diseases and disorders at early stages and exercising control over treatment with selection of individual pharmacotherapy.