[Asthenic disorders correction with Recognan]. / Korrektsiya astenicheskikh sostoyanii preparatom Rekognan.

Asthenia, asthenic syndrome, asthenic condition, asthenic reaction, asthenic disorders are terms that describe the state of «impotence¼. Fatigue that occurs against the background of habitual physical or intellectual stress for a person, and persists after rest, is asthenia. For people of the older age group, the term senile asthenia syndrome is used. Asthenia manifests itself with increased fatigue and exhaustion, mood instability, increased irritability, sleep disorders. Asthenic conditions manifest themselves along with a decrease in physical activity, increased cognitive and mental fatigue. Asthenic syndrome (AS) are considered as an integral part of cardiovascular diseases (CVD), as one of the manifestations of cerebrovascular pathology. Senile asthenia syndrome (SAS) is a geriatric syndrome characterized by an age-associated decrease in the physiological reserve and functions of many body systems, including cognitive functions. One of the drugs that has a positive effect on the severity of AS and improves the state of cognitive functions is the domestic drug Recognan (citicoline). The effectiveness of Recognan in the treatment of AS in patients with CVD, SAS, and post-COVID asthenia has been shown. It is recommended to prescribe Recognan orally at 500 mg / day for 30 days. Recognan has a nootropic and antiasthenic effect.

[Recognan (citicoline) efficacy and safety in cognitive impairment correction of various nosological forms]. / Effektivnost' i bezopasnost' Rekognana (tsitikolin) pri korrektsii kognitivnykh narushenii razlichnoi etiologii.

Insufficiency of a choline derivative (acetylcholine) can lead to the development of cognitive impairment (CI). One of the most well-known and well-studied medical drugs (MD) containing choline and having neuroprotective properties is citicoline (Recognan). A number of studies have demonstrated the effectiveness of Recognan in relation to mild CI, chronic cerebrovascular diseases (CVD), acute vascular disorders (including post-traumatic genesis). Recognan improves memory and other cognitive functions in healthy young people against the background of asthenia due to stress or increased cognitive and emotional stress or infection, and also has a preventive effect on fading cognitive functions in the process of age-related changes. The duration of neuroprotection can reach 6 months or more - up to 12 months, depending on the patient's condition. Therapy regimens include two-stage Recognan prescribing: with CVD intramuscularly (i/m) at 1000 mg /d for 30 days, in the acute period of ischemic stroke, i/m or intravenously (i/v) at 1000 mg every 12 hours from the first day after diagnosis, 3-5 days after the start of therapy, with preservation functions of swallowing, it is possible to switch to per oral (p/o) drug administration.

[Meloxicam clinical effects]. / Klinicheskie effekty meloksikama.

Pain syndromes, acute and chronic, against the background of inflammatory diseases (such as osteoarthritis (OA)), degenerative-dystrophic changes (involutive process, trauma) or systemic diseases (rheumatoid arthritis, etc.) dictate a steady increase in the intake of nonsteroidal anti-inflammatory drugs (NSAIDs). The choice of the most «safe NSAID¼ is based on the assessment of the toxicity index (the ratio when blocking cyclooxygenase (COX)) and the development of relative risks (the benefit/risk ratio). As well as those adverse events that can be detected with individual sensitivity to a specific NSAIDs, taking into account the anamnesis of previous diseases and intolerance to NSAIDs, existing chronic diseases (gastrointestinal tract, cardiovascular system, type 2 diabetes mellitus), limiting the appointment of NSAIDs. Considering these circumstances, the NSAID meloxicam (Amelotex) can be recommended for the treatment of various genesis pain syndromes. A number of studies have demonstrated the efficacy and safety of meloxicam with different methods of its administration (per oral (p/o), intramuscularly (i/m)) in the treatment of pain syndrome in the lower back, with OA, etc. Recent studies concern intravenous (i/v) meloxicam (30 mg) administration with moderate and severe postoperative pain syndrome. Today, the most commonly pain therapy scheme using meloxicam includes step-by-step administration of injectable and oral forms: meloxicam i/m (1.5 ml) for 3-5 days, followed by a transition to p/o (7.5-15 mg) intake for 14 days, or complex therapy with meloxicam (Amelotex), with muscle relaxant and B vitamins.

[Methods of medical rehabilitation in the complex program therapy for patients with cervicobrachialgia caused by pathological dental occlusion]. / Metody meditsinskoi reabilitatsii v programme kompleksnoi terapii patsientov s tservikobrakhialgiei, obuslovlennoi patologicheskoi dental'noi okklyuziei.

Chronic pain syndromes in the neck and shoulder girdle are one of the important clinical problems due to their high prevalence. In addition, it's of great interest to study the mutual influence of the musculoskeletal system pathology, balance organs and dentoalveolar system due to the possible negative impact of these structures on each other which surely affects the treatment timing and its results. OBJECTIVE: To develop a diagnostic algorithm and a comprehensive program for the treatment and rehabilitation of patients with cervicobrachialgia combined with pathological dental occlusion. MATERIAL AND METHODS: The study involved 90 persons of both genders aged 18 to 55 years consisted of 3 clinical study groups (25 patients) and one control group (15 healthy persons). The clinical groups included 75 patients with chronic myofascial pain syndrome in the neck and shoulder girdle resistant to drug therapy, with temporomandibular joint (TMJ) dysfunction and/or pathological dental occlusion (PDO). The groups were formed depending on the chosen treatment methods: manual therapy was used in the 1st group; in the 2nd group - dental treatment aimed at correcting PDO; in the 3rd group the manual therapy was used together with the correction of the jaws' occlusal relationship. RESULTS: In the study course the most effective algorithm for the diagnosis and rehabilitation of patients with cervicobrachialgia caused by pathological dental occlusion was determined. Positive clinical results were noted in patients of all three groups; however, in the 3- group where manual therapy and complex dental treatment were carried out the results are not differing significantly from the controls. The study showed that in patients with myofascial pain syndrome at the cervical and shoulder levels caused by TMJ dysfunction and pathological dental occlusion it's advisable to include manual and osteopathic diagnostics in the algorithm. Manual muscle testing, posture tests in combination with 3D X-ray imaging and computerized functional studying the maxillofacial region should be used to identify etiology-pathogenesis links between these conditions. These methods are also applicable for quality control of treatment. CONCLUSION: Thus, as a study result the diagnostic algorithm was developed; it allows to determine the relationship of pharmacoresistant pain syndrome of the cervicobrachial region with dental pathology at high degree of accuracy; and a comprehensive interdisciplinary approach to the therapy and rehabilitation of this combined pathology was proposed.

[Medical rehabilitation of children with bronchial asthma]. / Meditsinskaya reabilitatsiya detei s bronkhial'noi astmoi.

Medical rehabilitation of children suffering from bronchial asthma is based on the complex use of natural therapeutic factors, drug, non-drug therapy and other methods in order to achieve control over the disease and long-term remission. The use of non-drug technologies is necessary taking into account the pathogenesis of the bronchial asthma development and is aimed at relieving bronchospasm, reducing the activity of allergic inflammation in the bronchi, improving their drainage function, strengthening the respiratory muscles and increasing exercise tolerance. When carrying out rehabilitation measures it is important to observe the basic principles of medical rehabilitation. An individual medical rehabilitation program is drawn up taking into account the assessment of the child's clinical condition at each stage with the diagnosis of the initial rehabilitation status, the establishment of a rehabilitation diagnosis and an assessment of the rehabilitation potential. The article presents the data of the analysis of scientific publications and our own research allowing to draw up an algorithm for the formation of an individual program of medical rehabilitation for children with bronchial asthma.

[Cobalamin in the complex treatment and prevention of cognitive impairment]. / Kobalamin v kompleksnoi terapii i profilaktike kognitivnykh narushenii.

Cognitive impairment (CI) develops not only in structural damage to the central nervous system, but also in encephalopathies of dysmetabolic and deficiency etiology. Recently, special attention is focused on the appearance of CI due to the deficiency of cobalamin (vitamin B12) and folic acid (FA), the change in the level of homocysteine (HC). To detect vitamin B12 deficiency is possible by examining key biomarkers in serum based on a decrease in the levels of vitamin B12 and holotranscobalamin, and levels of methylmalonic acid (MMA) and HC. The article presents an analysis of studies conducted in Norway, Korea, India, and other countries to assess the risks of CI in the presence of reduced levels of vitamin B12 in the elderly, which demonstrated a decrease in brain volume in the elderly (according to MRI data) in combination with altered test parameters that assess cognitive functions. In many studies, female patients with reduced levels of vitamin B12 predominated among the studied patients. Also, some studies have demonstrated the effectiveness of complex CI therapy with the inclusion of vitamin B12 (both for oral and intravenous administration). Oral vitamin B12 therapy at a dose of 1000 µg has been shown to be adequate for the treatment of vitamin B12 deficiency. Also, the administration of vitamin B12 for prophylactic purposes is recommended for patients with subnormal or borderline concentrations of vitamin B12 in the blood serum.

[Chondroitin sulfate role in the complex rehabilitation of elderly people with chronic pain syndrome]. / Rol' khondroitina sul'fata v kompleksnoi reabilitatsii lits pozhilogo vozrasta s khronicheskim bolevym sindromom.

The article presents the data of the latest domestic and foreign original studies, the results of a number of meta-analyses, conclusions of randomized clinical trials (RCTs), and other scientific studies that prove the effectiveness and necessity of mandatory inclusion in the treatment of chronic pain syndrome of the stage of non-invasive non-pharmacological therapy. One of the promising areas of pharmacotherapy for degenerative-dystrophic joint lesions is the use of chondroprotectors (CP), in particular chondroitin sulfate (CS). According to new Clinical Recommendations of Ministry Health (MH) of the Russian Federation (RF) «Chronic pain in patients of elderly and senile age¼ (2020), according to which the purpose of CS is recommended for patients older than 60 years with joint pain and contraindications to non-steroidal anti-inflammatory drugs (NSAIDs) or senile asthenia for the purpose of pain relief and the prevention of exacerbations of pain. A high level of reliability and persuasiveness of the recommendations was noted (1A) of CS use. Most of the CS is available in the form of forms for oral use, the bioavailability of which, according to clinical studies, is 13-38% due to the destruction of the CS molecules in the gastrointestinal tract. Intramuscular (i/m) administration of the drug can increase the bioavailability of CS, which can not only increase the effectiveness of therapy, but also lead to a more rapid development of the symptomatic effect. In Russia available parenteral forms of CS (Chondroguard) pharmaceutical quality, efficacy has been proven in randomized clinical trial (RCT) MH RF. To relieve pain in the joints, it is recommended to use parenteral forms of CS (Chondroguard) at a dose of 100-200 mg per day, every other day, the total duration of the course of treatment is 25-30 injections.

[Prospects for the use of antioxidant pharmacopuncture in metabolic syndrome]. / Perspektivy primeneniya farmakopunktury antioksidantnymi sredstvami pri metabolicheskom sindrome.

OBJECTIVE: The purpose of the study was to further reveal the mechanisms and therapeutic capabilities of the pharmacopuncture method (the introduction of drugs into the area of reflexotherapy points) in metabolic syndrome. In previously published materials on the problem, we pointed out the efficacy of the pharmacopuncture antioxidant Ubiquinone Composite (as a pilot study), similar in effect to the drug Coenzyme Composite (Heel, Germany). The present work develops this topic by further comparing the characteristics of pharmacopuncture with the presented drugs. MATERIAL AND METHODS: The study included 160 patients (103 women and 57 men) with metabolic syndrome. In addition to clinical parameters, lipid and carbohydrate metabolism, atherogenic index, catalase and superoxide dismutase activity, the level of prooxidant processes, and the presence of insulin resistance were evaluated. In the clinical phase, the patients were divided into four groups. In group 1, treatment was limited to standard medication, in other groups, pharmacopuncture was additionally performed. In the 2nd group, physiological solution (placebo) was used as an agent, in the 3rd and 4th groups - the drugs Ubiquinone compositum and Coenzyme compositum, which differ mainly in antioxidant effect. RESULTS AND DISCUSSION: It was found that pharmacopuncture with both drugs leads, in general, to comparable positive results, significantly superior to the effectiveness of other methods. However, certain differences were noted within these groups: in the case of using the drug Ubiquinone compositum, a predominant decrease in blood pressure and dyslipidemia is observed, and when using the drug Coenzyme compositum, a shift in insulin resistance against the background of regression of disbalance in the peroxidation system. On the one part, the presented data show about the therapeutic breadth of the effects of pharmacopuncture, and on the other part, they demonstrate the possibility of a differentiated influence.

[The application of the physical factors for the medical rehabilitation of the children presenting with neurogenic dysfunction of the bladder].

This article describes the modern technologies for the medical rehabilitation of the children presenting with neurogenic dysfunction of the bladder aimed at improving the act of urination at all levels of innervation. The most frequent variant of neurogenic dysfunction of the bladder in the children is the hyper-reflexive one; it is this variant in which the most pronounced disorders of urodynamics due to intravesical hypertension and detrusor hypoxia are observed. The urodynamic disorders are known to contribute to the formation of the characteristic clinical picture associated with the hyper-reflexive urinary bladder dysfunction in the children characterized by the mandatory urination syndrome, pollakiuria, imperative urges, and mandatory urinary incontinence in the combination with enuresis. The treatment of urinary bladder dysfunction includes both behavioural and medication therapeutic modalities. The "golden standard" for the pharmacotherapy of neurogenic bladder dysfunction of the hyper-reflexive type in the childhood is the use of M-cholinoblockers, such as oxybutynin. The popularity of the physiotherapeutic methods is attributable to their influence on the main links of pathogenesis, the absence of side effects, and the possibility of application in the children of the early age. The combined treatment of neurogenic bladder dysfunction includes the use of a wide range of physiotherapeutic methods the action of which is aimed at regulating the act of urination at all levels of innervation of the bladder, normalizing the tone of the muscles of the bladder, eliminating sphincter insufficiency, improving circulation and accelerating the maturation of the neuromuscular apparatus of the pelvic organs. At present, the natural and preformed methods of physiotherapy are finding the wide application for the management of neurogenic dysfunction of the bladder in the children in the conjunction with therapeutic physical exercises, massage, and the biological feedback (BFB) technique.

[The application of invasive and non-invasive reflexotherapeutic methods for the improvement of tolerance to the influence of seasonal meteorological factors and correction of bronchial asthma].

The present study included 94 patients presenting with bronchial asthma (BA) who underwent the controlled treatment during one year. The treatment consisted of basal anti-asthmatic therapy in combination with acupuncture reflexotherapy or a complex of non-invasive reflexotherapeutic methods (CNIRTM) designed to increase the effectiveness of correction of asthma, to improve the clinical status of the patients, to decrease by more than two-fold the frequency of unstable episodes of the disease showing the well-apparent seasonal dependence, and to diminish the consumption of pharmaceuticals (reduction of the mean daily dose of prednisolone by 31% and 37% in comparison with its 79% increase in the patients receiving the standard treatment). Moreover, it was shown that the achievement of clinical and preventive effect of the application of non-pharmacological methods may be associated with the activation of the mechanisms of adaptation to the stress factors (such as correction of the cortisol blood level and parameters of the immune status, etc.) and the increase of the patient's tolerance to their influence.

[The adaptive mechanisms of cardio- and angioprotective action of reflexotherapy].

The adaptive mechanisms of action of reflexotherapy are analysed. It was shown in physiological and biochemical experiments on the whole organism, the isolated hearts and strips of resistive arteries of animals that stimulation of acupuncture points by different physical factors increased the activity of opioid, antioxidative, and other stress-limiting systems, reduced secretion of corticosteron during stress, stimulated biosynthesis of stress proteins, induced cyto- and cardioprotective effects, prevented or limited functional and structural hyperadrenal damages. Clinical investigations demonstrated significant hypothensive, anti-ishemic and anti-arrhythmic effects of reflexotherapy, improved resistance of healthy subjects and patients with cardiovascular diseases to physical and emotional loadings.