Репозиторий Университета

© Ruslania 2018. All rights reserved. Drug toxidermia is one of the most common skin diseases. Traditional therapy of drug toxidermia, which includes antihistamines and desensitizing agents, cannot stop manifestations of the pathological process in many cases, while the forced appointment of systemic glucocorticoids can lead to the development of un-desired complications. The review gives a detailed description of various mechanisms of drug toxidermia and provides information about the development of tests to identify patients with increased risk of drug toxidermia.

Under the modern market conditions, the process of development of the methods for the combined rehabilitation of the patients is becoming increasingly more complicated. For the reduction of potential risks and leveling the factors responsible for the uncertain market situation influencing the creation of new methods, it is necessary to carry out the full-scale pilot studies with the use of the marketing analysis methods. The objective of the present work was to create and elaborate the rationale for the graphological structure (the scheme) of the process of exploratory research with a view to the development of the combined rehabilitation methods as exemplified by phyto- and physiotherapeutic modalities. The work is based on the application of the existing approaches to the structural, comparative, systemic, and situational analyses. The proposed graphological structure (scheme) of the exploratory research process consists of 6 stages. Its distinctive features are as follows: a fractional stage by stage evaluation of a variety of issues including the study of physical factors, characteristic of the means of herbal medicine with special reference to the mechanisms of their production and application under the current market conditions, monitoring the marketing environment with the constant focus on the trends and behavior of the target market, the parallel pursuing of serial studies with the application of the iterative procedures; the use of the previously created data bank to expand medical services at the stages of development and maturation of the life cycle, the evaluation of the possibility of establishment of the industry of parapharmaceutical products.

© 2018 Ima-Press Publishing House. All Rights Reserved. Information about a favorable prognosis for a patient, recommendations for activities, and optimal pharmacotherapy are a mainstay in the effective treatment of acute nonspecific low back pain (NLBP). Standard pharmacotherapy for acute NLBP includes nonsteroidal anti-inflam-matory drugs (NSAIDs). However, the longer their administration and larger doses, the higher the risk of side effects are. NSAIDs are contraindicated in some cases. In this connection, it has become necessary to search for new opportunities for the pharmacotherapy of acute NLBP. The results of experimental studies have demonstrated the analgesic and anti-inflammatory effects of high-dose B vitamins. Clinical trials have confirmed the efficacy of Vitamin B complex (thiamine, pyridoxine, and cyanocoba lamin) in the treatment of acute NLBP. The paper considers the practical significance of concomitant administration ofB vitamins and NSAIDs in NLBP and notes the efficacy of milgamma used both alone and in combination with NSAIDs in the treatment of acute NLBP.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Thiscreatic Featuresarticlehead, ofpresentsthisthat clinicalwas theoperated clinicalcase arecasetwice, difficultiesofbut patientfirst in pre-withoperation andneuroendocrineintraoperativedid not lead tumortopicalto recovery. ofdiag-pan-nosis of small size insulinoma. The authors came to the conclusion that topical diagnostics should be complex.

© 2018 Ima-Press Publishing House. All Rights Reserved. The brain is a natural target organ in hypertension and, as shown by some clinical observations, it is affected earlier than other organs and systems. Due to the specific features of the anatomy of cerebral circulation, hypertensive microangiopathy leads primarily to damage to the sub-cortical basal ganglia and deep white matter. Clinically, this is manifested by a concuirence of predominantly subcortical cognitive impairment and emotional and behavioral disorders as depression, emotional lability, and apathy. Some features of depression, such as the prevalence of anhedonia and fatigue and the significant severity of cognitive and somatic symptoms in an elderly person with vascular disease, suggest its organic nature (vascular depression).

© 2018 S. Karger AG.All right reserved. We present a clinical case of a 34 years old female patient who simultaneously developed two rare conditions: microscopic polyangiitis and atypical hemolytic uremic syndrome (aHUS) associated with a polymorphism in diacylglycerol kinase-ε gene (DGKE), which seems to be the first case of aHUS associated with DGKE mutation in an adult patient. We suggest that the patient experienced chronic subclinical course of thrombotic microangiopathy (TMA) since adolescence, because persistent proteinuria and slowly progressive chronic kidney disease were first found when she was at the age of 13. She developed ANCA-associated vasculitis at the age of 34 with dialysis-dependent renal failure and alveolar hemorrhage that were accompanied by an acute episode of TMA. Treatment with high-dose of corticosteroids, cyclophosphamide and plasmapheresis was initiated. Alveolar hemorrhage have been resolved. However, severe hypertension, hemolytic anemia and thrombocytopenia persisted despite treatment. Plasma resistance was considered to be an indication for treatment with eculizumab, which proved to be beneficial. However, kidney function did not recover. Possible interactions between complement system, DGKE and their possible role in the pathogenesis of TMA are discussed.

© 2018, Media Sphera Publishing Group. All rights reserved. This publication was designed to report the experience gained by the Department of ear, nose and throat diseases at I.M. Sechenov First Moscow State Medical University in the matters concerning professional medical education in the framework of the clinical residency. The main factors that contribute to the adequate shaping of the future ENT-doctor are considered. These include the continuity of generations and conservation of the traditions in the combination with the development of the leading areas of scientific, clinical and educational work.

AIM: Efficiency assessment of Granulotec (PD) endodontic sealer for root canal permanent obturation in patients with apical granuloma basing on clinical and radiological data. MATERIAL AND METHODS: Endodontic treatment of 35 teeth with apical granuloma was performed in 22 patients with root canal obturation by means of lateral condensation with Granulotec sealer. Bone remodeling in periapical area has been estimated in 1, 3, 6 and 8 months with PAI index. RESULTS: Endodontic post-operative pain has been observed in 5 (14.3%) cases of 35, pain duration varied 1 to 5 days, NSAIDs use hasn't been required. During observation period 2 teeth have been excluded from the test group (one case of periapical abscess with sinus tract and one case periapical abscess without sinus tract). In the end of observation period complete bone remodeling was observed in 30 cases, the periapical lesion size significant reduction was achieved in 2 cases, periapical lesion stabilization - in 1 case. The overall success rate was 91.4%. The mean PAI value decreased from 4.2±0.2 to 1.4±0.2. CONCLUSION: The Granulotec (PD) use for one visit chronic apical periodontitis treatment allows achieving positive results with low complications risk.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To study clinical characteristics of depression in women and men. Material and methods. One hundred and twenty women, aged from 18 to 65 years, and 67 age-matched men with the diagnosis of recurrent depressive disorder (RDD) (ICD-10 F33) were examined using a specially developed survey. Results. Differences in the clinical picture and course of RDD in women and men were found. RDD in women develops at an earlier age, the number of attacks is greater but remissions are longer. However, complete remission is achieved more frequently in men. Most typical effect in the structure of depression in women is anxiety whereas melancholy prevails in men. Daily mood fluctuations and suicidal thoughts are characteristic of women. Motor retardation and decreased motivation are more frequent in men. Ideas of self-blame, avoidance of contacts with other people, adynamia, persistent sense of fatigue are more common in women. Sleep disorders are equally common in men and women but falling asleep disturbance and lack of sleep feeling are more common in women. Somatic symptoms of depression are generally more common in men as well as concomitant diseases of cardiovascular, respiratory and genitourinary systems. Men are more likely to abuse alcohol and other psychoactive substances. Conclusion. The identified characteristics of depression in women and men allow more accurate diagnosis and treatment recommendations.

© 2018 Authors. The authors substantiate the need to develop a scientific and methodical approach to modernizing business processes of a pharmacy using information technologies. IK FARM LLC pharmacy has been chosen as a model object of the study. The IDEF0 (Integrated Definition Function Modeling) method adopted as a state standard in the US and recommendations of the State Standard of Russia R 50.1.028-2001 have been used for the analysis, systematization and reorganization of business processes. The article offers methodology for optimizing the pharmacy's activities, which includes the building of two models for managing business processes - before and after modernization (AS-IS and AS-WILL). The structure of the AS-WILL model includes new functions: "Plan the pharmacy's activities" (set the goals and objectives of the organization, plan target sales for the next period) and "Monitor the pharmacy's activities" (control the compliance with the rules of drugs' storage and layout, sanitary regime, and rules of property operation). The complex automation of the pharmacy's trading activities ensures these functions through the Magister software. Estimated efficiency of business processes' modernization based on the net present value has indicated that automation of processes will increase net unreduced profit.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The paediatric patient is considered to be a child. However, when it comes to communication with a patient, his consent, implementation of appointments, then the party of interaction is supposed to be an adult. In this regard, the paediatric patient is represented by a child-adult alliance, which allows us to speak of a 'complex patient'. At the same time, his personal agency (the ability to independently formulate a complaint, accept appointments and achieve compliance) changes with the age of a child, coming to him from an adult. This determines the efficacy of screening as well as the main tactics of interaction between the doctor and the patient, explanation, and compliance. Based on the theory of periodization of the personality development, answers are given to the questions: who, a child or an adult, formulates a complaint, who accepts the explanation and who is the subject to compliance? It has been shown that in early childhood (up to 3 years) the patient's subjectivity in the formulation of a complaint and a picture of the disease, the perception of prescriptions and adherence to compliance is provided by the parent. During the pre-school (3-7 years) and primary school (7-11 years) periods, the picture is mosaic: the doctor compares the opinion of the parent and his child to get a picture of the disease, he gives prescriptions to the parent and/or to the child, so both of them can be a subject to compliance. And only in adolescence (12-17 years) a child can be almost a completely independent subject in all aspects of interaction in the doctor-patient system.

Prevalence, risk factors of primary pancreatic tuberculosis, clinical symptoms and data of instrumental and laboratory diagnosis are reviewed in the article. The authors emphasized the peculiarities of differential diagnosis with pancreatic malignancies and advisability of the most informative methods - endoscopy and fine-needle aspiration procedure.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To study the efficacy of various methods of non-drug therapy of diseases manifested by vertigo and dizziness in neurological practice. Material and methods. Referral and final diagnoses were compared after neurovestibular examination of 599 patients (177 men and 422 women), aged 25 to 79 years (mean age 55 years), with various causes of vertigo. Patients underwent vestibular rehabilitation, trainings on the stabiloplatform with biological feedback (biofeedback), repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV). Severity of dizziness on a Visual analogue scale of dizziness (VAS-d) and balance on stabilography before and after a course of vestibular rehabilitation was analyzed. Results. Before neurovestibular examination, the diagnoses of vertebrobasilar insufficiency (44%), hypertensive or atherosclerotic encephalopathy (35%), cervical spondyloarthrosis (8%), autonomic dystonia (11%)) are often considered mistakenly as the causes of vertigo and dizziness. After neurovestibular examination, the diagnoses were as follows: BPPV (39%), phobic postural vertigo (29%), Ménière’s disease (14%), vestibular neuritis (11%), multisensory dizziness in elderly (5%). The effectiveness of repositioning maneuvers in BPPV was 90,2% after the first session and 100% after the second session. After a course of vestibular exercises and trainings on the stabiloplatform with biofeedback, there was the marked improvement in indicators of stabilography and VAS-d in patients with vestibular neuritis, Meniere’s disease, phobic postural vertigo (p<0.05). Vestibular rehabilitation was most effective if started within the first month after vestibular neuritis. There was the high efficacy of complex rehabilitation, including vestibular exercises and trainings on stabilographic platform with biofeedback, in patients with Meniere’s disease. In the rehabilitation of patients with phobic postural vertigo, better results were achieved when vestibular exercises were combined with trainings on stabilographic platform with biofeedback and psychotherapy. Conclusion. The results demonstrated the low accuracy of diagnosis of diseases manifested by vertigo and dizziness and high efficacy of non-drug therapy in most cases, especially BPPV, vestibular neuritis, Meniere’s disease, postural phobic vertigo.

© 2018, Dynasty Publishing House. All rights reserved. The objective is to study the results of treatment of female patients with endometrial hyperplasia considering the 2014 WHO Classification and to make adjustments in tactics of conducting it, based on the individual approach. Patients and methods. Eighty-two (82) female patients at the age from 19 to 47 years (37.5 ± 2.6 years) were examined. Most of them (54/65,8%) were in the reproductive period. Methods of diagnosis: a) 2D and 3D transvaginal ultrasound scan with the use of color Doppler; b) video histeroscopia; C) histologic study of endometrial scratching or macropreparations, removed during the surgery. Results. It has been found in the analysis of the 2014 WHO Classification and Protocol RCOG & BSGE that when EH diagnosed for the first time in women of reproductive age after 3 months of taking NET, it is advisable to use estrogen-progestin products (COCP) for another 3 months with prolongation if necessary for further protection from unwanted pregnancy. The morphological picture of AEH should be carefully estimated, taking into account that in its simplest form total ablation of the endometrium is valid. Conclusion. No algorithm is able to cover all possible clinical situations and to adhere to individual approach in the choice of patient treatment tactics with endometrial hyperplasia.

© 2018 Vitebsk State Medical University. All rights reserved. Objective: To study the efficacy and to establish expedience of antibiotic treatment for diverticulitis. Methods: The retrospective analysis of 141 medical histories was made of patients with acute uncomplicated diverticulitis, who were treated during the period from 2013 to 2016 years. Antibiotics were prescribed to treat 85 (60.3%) patients (the main group), 56 (39.7%) patients (the control group) were not given antibacterial drugs. To assess the treatment effectiveness, a dynamic assessment of the clinical picture and laboratory indicators was performed. In the long-term period patients were questioned to determine the nature of the course and the occurrence of relapses of diverticulitis. Results: The duration of hospitalization of the main group patients was 10.8+3.2 days (M+o), control -11.2+2.6 days (M+o), p>0.05. During the treatment, disease progression was registered in none of the patients. In the main group the body temperature was normalized after 1.6 + 0.4 days, in the control group after 1.7+0.3 days, p>0.05. The level of leukocytes came back to normal in the main group at 2.7+0.8 days, in the control group at 2.9+0.7 days (p>0.05). Long-term results were evaluated in 82 (96.5%) of patients and 55 (98.2%) in the control group. Use of antibiotic treatment in diverticulitis had no effect in the remote period for redevelopment of complications (OR 1.19; CI 0.58-2.44), the need to seek medical care (OR 1.11; CI 0.52-2.34), need for hospitalization (OR 0.95, CI 0.3-2.96) and surgical treatment (OR 1.36, CI 0.34-7.69). Conclusions: The use of antibiotic treatment for diverticulitis does not affect the outcome of treatment and does not determine the further course of the disease. Taking into account the increasing resistance of microorganisms to antibiotics and the need to optimize costs with limited funding for health care, it is advisable to exclude the use of antibacterial drugs for the treatment of uncomplicated diverticulitis.

© 2018, Media Sphera Publishing Group. All rights reserved. The authors describe manifestations of chronic cerebral ischemia (CCI) and present the cases of a combination of primary headache and CCI. Management of patients with CCI and headache and the use of vazobral and its efficacy in treatment of such patients are discussed.

© 2018, Media Sphera Publishing Group. All rights reserved. The main groups of neuroprotectors, which are active in preventing the processes of the death of the nerve cells of vascular, traumatic, toxic and other etiologies and can decrease the severity of cognitive impairment, include phosphatidylcholine, phosphatidylserine, preparations based on ginkgo biloba, group B vitamins, folic acid. Preparations based on ginkgo biloba have the same effect as synthetic nootropics. The antioxidant and membrane-stabilizing effects of neuroprotectors are highlighted. In view of practical applications, attention is given to the advantages of the combinations of different neuroprotectors. Cerebrovin as one of these drugs can be recommended for treatment of cognitive impairment in the elderly.

© 2018, Media Sphera Publishing Group. All rights reserved. Alzheimer’s disease and vascular dementia are two most common causes of dementia in late life. The combination of Alzheimer’s type dementia and vascular dementia is the third most common form of dementia, especially in the elderly. Most clinical forms of dementia are characterized by the presence of «overlap» symptoms of both neurodegenerative and vascular pathology, which makes it expedient to consider mixed dementia as a separate entity characterized by clinical presentations, course and the rate of progression of cognitive decline. Despite the lack of clinical guidelines for management of patients with mixed dementia, it seems appropriate to use strategies that have shown their effectiveness in various types of cognitive impairment.

© 2018, Media Sphera Publishing Group. All rights reserved. The paper describes the history of the Department of Pathoanatomy, I.M. Sechenov First Moscow Medical University (Sechenov University) from its establishment in 1849 to the present time. It gives the names of all the heads of the Department and the features of its development in different periods of its activity.