[Evolution of insulin therapy: past, present, future].

2021 marks the 100th anniversary of the discovery of insulin, an event that forever changed the lives of people with diabetes mellitus. At present patients around the world experience the miracle of insulin therapy every day. A disease that used to kill children and teenagers in 2 years in 1920 has become a disease that can be controlled with a possibility to lead a long productive life. Over the past century, the great discovery of Banting, Best and Collip has forever changed the world and saved millions of lives. This review is devoted to the history of the development of insulin and its further improvement: from the moment of discovery to the present days. Various generations of insulin are considered: from animals to modern ultrashort and basal analogues. The article ends with a brief review of current trends in the development of new delivery methods and the development of new insulin molecules. Over the past century, insulin therapy has come a long way, which has significantly improved the quality of life of our patients. But research is actively continuing, including in the field of alternative methods of insulin delivery, which are more convenient for the patient, as well as in the development of «smart¼ molecules that will have a glucose-dependent effect.

[Characteristics of purchases of hypoglycemic agents in pharmacy retail sector in 2016-2020 years dynamics].

BACKGROUND: Procurement of medicines reflects the demand and frequency of prescribing certain drugs, which makes it possible to assess the quality of medical care and compliance with standards. The Russian pharmaceutical market is dynamically developing and expanding, therefore, the commercial sector of drug circulation is a significant part of it and should be studied along with public procurement. Given the significant number of patients diagnosed with diabetes mellitus (DM) in our country, we considered it appropriate and interesting to analyze the structure and volume of turnover of antidiabetic drugs in the retail trade over five years. AIM: to assess the dynamics of the cost and sales volumes of hypoglycemic drugs in the commercial sector for 2019-2020 compared to 2016. MATERIALS AND METHODS: The analysis was made on the basis of the data of antidiabetic drugs purchases in Russian pharmacies in 2016 and 2019-2020, according to 95257 pharmacies data. RESULTS: In 2020, compared to 2016, we see a significant increase in the number of packages purchases (+14,952,897 rub.) and the purchases total amount (+9,377,975,722 rub.), in parallel with the increase in average price per box of the hypoglycemic drug +199, 57 rub. The average price for DPP4 decreased. The cost per pack of metformin remains one of the lowest, second only to glibenclamide and gliclazide. The most expensive drugs include GLP1 group representatives. Insulin purchases have halved, when budget for GLP1 have increased by 10 times, for SGLT2 by 9.5 times, and for DPP4 by 2.1 times. In 2020, metformin gliclazide, a combination of glibencladimide with metformin, glibenclamide and vildgaliptin remain leaders in the number of purchased packages. The purchase leaders in terms of budget share are: metformin, gliclazide, liraglutide, vildagliptin and dapagliflozinCONCLUSION: There are positive trends in the demand for more effective innovative hypoglycemic drugs, however, the affordability of drugs still dominates over the feasibility of their clinical use, and a high percentage of drug turnover in the commercial sector might indicates insufficient funding for drug provision for patients with diabetes mellitus.

[The impact of BMI on the course of the acute SARS-COV-2 infection and the risks that emerge during the first year after the hospital discharge. Subanalysis evidence of the AKTIV and AKTIV 2 registries].

BACKGROUND: There is enough evidence of the negative impact of excess weight on the formation and progression of res piratory pathology. Given the continuing SARS-CoV-2 pandemic, it is relevant to determine the relationship between body mass index (BMI) and the clinical features of the novel coronavirus infection (NCI). AIM: To study the effect of BMI on the course of the acute SARS-COV-2 infection and the post-covid period. MATERIALS AND METHODS: AKTIV and AKTIV 2 are multicenter non-interventional real-world registers. The АКТИВ registry (n=6396) includes non-overlapping outpatient and inpatient arms with 6 visits in each. The АКТИВ 2 registry (n=2968) collected  the  data  of  hospitalized  patients  and  included  3  visits.  All  subjects  were  divided  into  3  groups:  not  overweight  (n=2139), overweight (n=2931) and obese (n=2666). RESULTS: A higher BMI was significantly associated with a more severe course of the infection in the form of acute kidney injury (p=0.018), cytokine storm (p<0.001), serum C-reactive protein over 100 mg/l (p<0.001), and the need for targeted therapy (p<0.001) in the hospitalized patients. Obesity increased the odds of myocarditis by 1,84 times (95% confidence interval [CI]: 1,13-3,00) and the need for anticytokine therapy by 1,7 times (95% CI: 1,30-2,30).The  patients  with  the  1st  and  2nd  degree  obesity,  undergoing  the  inpatient  treatment,  tended  to  have  a  higher  probability  of  a  mortality  rate.  While  in  case  of  morbid  obesity  patients  this  tendency  is  the  most  significant  (odds  ratio  -  1,78; 95% CI: 1,13-2,70). At the same time, the patients whose chronical diseases first appeared after the convalescence period, and those who had certain complaints missing before SARS-CoV-2 infection, more often had BMI of more than 30 kg/m2 (p<0,001).Additionally, the odds of death increased by 2,23 times (95% CI: 1,05-4,72) within 3 months after recovery in obese people over the age of 60 yearsCONCLUSION.  Overweight  and/or  obesity  is  a  significant  risk  factor  for severe  course  of  the  new  coronavirus  infection  and  the associated cardiovascular and kidney damage Overweight people and patients with the 1st and 2nd degree obesity tend to have a high risk of death of SARS-CoV-2 infection in both acute and post-covid periods. On top of that, in case of morbid obesity patients this tendency is statistically significant. Normalization of body weight is a strategic objective of modern medicine and can contribute to prevention of respiratory conditions, severe course and complications of the new coronavirus infection.

[The suicidal activity and comorbid mental pathology in persons with gender dystrophia].

According to foreign publications, 58% of patients with gender disorders had additional psychiatric diagnosis, 39.3% had at least one suicide attempt. The data of suicidal activity and mental comorbidity in Russian population of transgenders are absent.Purpose of the study is to assess suicidal activity and mental comorbidity in persons with gender disorders.The retrospective analysis of records of patients applied with complains on gender disorders from January 2014 to April 2021 was applied. The demographic characteristics, life anamnesis, comorbid mental pathology at time of appliance, frequency of suicidal attempts, suicidal thoughts and auto-aggressive behavior were examined. The data of 926 patients with gender disorders were included: FtM 515 (55.7%), MtF 411 (44.3%). The median age of patients applied for care appliance was 24 years (13-65 years). In group of transgender patients 75.2% had no mental illness, except gender disorders. At that, there was high prevalence of comorbid mental pathology (24.8% on average). Usually, it was background mental illnesses and reversible mental disorders, which were not causes of gender disorders. The suicide rate in transgender group was 12.5%. For 1 patient with suicidal experience, there were 1.3 suicidal attempts (from 1 to 5). The significant dependence of increased suicidal activity, depression, auto-aggressive behavior and rate of comorbid mental pathology on age of debut of gender disorders was established. The transgender patients with debut of gender dysphoria in puberty age are most vulnerable to development of any mental pathology. The suicidal activity of patients with gender disorders depends on both social causes and presence of comorbid mental pathology. A number of modifiable risk factors for suicidal behavior were identified: support of relatives, external correspondence to associated gender, early steps to "change gender", earlier apply for medical care, background compensated mental illnesses.

[ACTIV SARS-CoV-2 registry (Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients). Assessment of impact of combined original comorbid diseases in patients with COVID-19 on the prognosis].

AIM: Study the impact of various combinations of comorbid original diseases in patients infected with COVID-19 later on the disease progression and outcomes of the new coronavirus infection. MATERIALS AND METHODS: The ACTIV registry was created on the Eurasian Association of Therapists initiative. 5,808 patients have been included in the registry: men and women with COVID-19 treated at hospital or at home. CLINICALTRIALS: gov ID NCT04492384. RESULTS: Most patients with COVID-19 have original comorbid diseases (oCDs). Polymorbidity assessed by way of simple counting of oCDs is an independent factor in negative outcomes of COVID-19. Search for most frequent combinations of 2, 3 and 4 oCDs has revealed absolute domination of cardiovascular diseases (all possible variants). The most unfavorable combination of 2 oCDs includes atrial hypertension (AH) and chronic heart failure (CHF). The most unfavorable combination of 3 oCDs includes AH, coronary heart disease (CHD) and CHF; the worst combination of 4 oCDs includes AH, CHD, CHF and diabetes mellitus. Such combinations increased the risk of lethal outcomes 3.963, 4.082 and 4.215 times respectively. CONCLUSION: Polymorbidity determined by way of simple counting of diseases may be estimated as a factor in the lethal outcome risk in the acute phase of COVID-19 in real practice. Most frequent combinations of 2, 3 and 4 diseases in patients with COVID-19 primarily include cardiovascular diseases (AH, CHD and CHF), diabetes mellitus and obesity. Combinations of such diseases increase the COVID-19 lethal outcome risk.

[The cognitive status and aspects of life quality of the Russian researchers].

The publications analysis confirms necessity of studying both status of cognitive capacities of researchers and factors associated with cognitive aging. THE PURPOSE OF THE STUDY: To assess cognitive functions and quality of life of researchers of state institutions. MATERIALS AND METHODS: The single-stage section of state institutions was applied to arrange sampling of 53 researchers (28 females and 25 males) aged from 22 to 73 years. The respondents filled questionnaires "Cognitive screening", "Age is not a drawback", "Depression Geriatric Scale", "Russian validated version of QOL questionnaire SF-36". RESULTS: As in general population, among researchers certain decrease in quality of life with age was established. The respondents aged from 50 to 59 years demonstrated lower indices on scales of physical functioning (p = 0.04), body pain (p = 0.03) and role functioning due to physical condition (p = 0.006). At that, indices of vital activity and social functioning tended to improvement with age. The cognitive impairments were absent in 96.23% of researchers aged from 22 to 73 years and they were present in 1.89% of respondents. In 47.17% of respondents aged from 22 to 67 years, no senile asthenia syndrome was observed. The preasthenia was registered in 39.62% of respondents aged from 24 to 69 years. The syndrome of senile asthenia was established in 11.32% of respondents aged 25-73 years. The depression was absent in 83.02% of respondents aged from 22 to 69 years and it was probably present in 7.55% of respondents aged from 25 to 33 and 49 years. CONCLUSION: According to data of complex screening self-testing, it is established that current state of researchers is characterized by availability of complex of problems related to health disorders, decreased cognitive functions, development of premature aging syndrome and presence of significant number of risk factors of health disorders due to high frequency and combination of these factors. The relationship between cognitive functions and quality of life of researchers is established, in particular, according to scales "Physical functioning", "General health", "Vitality", "Social functioning", "Mental health".

Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2¼).

Aim      To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods  The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion      In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

Immunological Approaches to the Treatment of New Coronavirus Infection (Review).

The pandemic of the new coronavirus infection (COVID-19) caused by the SARS-CoV-2 virus has spread all over the world. The large amount of information that appears every day requires comprehension and systematization. The immunological aspects of the virus-host interaction are the core issues in the effective treatment and prevention of COVID-19' development. The review analyzes the known pathways of the viral invasion and evasion, the mechanisms of the cytokine storm, endothelial damage, and hypercoagulability associated with SARS-CoV-2 infection. Clinical data from previous SARS and MERS epidemics is discussed here. We also address the therapeutic approaches based on the basic knowledge of immune response and the blood cells' immune functions, as well as the ways to reduce their hyperactivation. The use of interferon therapy, anti-inflammatory therapy, anti-cytokine therapy, neutralizing antibodies, convalescent plasma, and mesenchymal stem cells, as well as prophylactic vaccines, is discussed.

Gender Characteristics of the Novel Coronavirus Infection (COVID-19) in Middle-Aged Adults.

The aim of the study is to assess the gender-related specifics of the COVID-19 course in patients under 55 years of age. Materials and Methods: This pilot single-center continuous retrospective non-randomized study was carried out in the repurposed infectious diseases hospital of the Privolzhsky Research Medical University (Nizhny Novgorod, Russia). The study inclusion criterion was the age of patients (up to 55 years) and confirmed coronavirus infection. In the groups based on gender differences (25 men, average age 44.0±7.8 years and 32 women, average age 41.9±9.1 years), we monitored complications of COVID-19 such as the transfer of patients to the ICU and the volume of lung damage (determined with CT scans). Results: The course of COVID-19 in male patients younger than 55 was aggravated by concomitant diseases (γ=0.36; p=0.043), among which IHD (γ=1.00; p=0.003) and liver disease (γ=0.58; p=0.007) dominated. Frequency analysis confirmed the high prevalence of coronary artery disease in men (p=0.044). Significant differences between the gender-related groups were noted in the volume of lung lesions: at admission (p=0.050), during hospital treatment (p=0.019), and at discharge (p=0.044). Using the logistic regression method, a relationship was found between the transfer of male patients to ICU and the Krebs index [y= -2.033 + 1.154 male gender + 1.539 Krebs index (χ2=5.68; p=0.059)] and comorbidity [y= -2.836 + 1.081 male gender + 2.052 comorbidity (χ2=7.03; p=0.030)]. The influence of the Krebs index and the male gender on the excess volume of lung lesions was shown [y= -1.962 + 0.575 male gender + 1.915 Krebs index (χ2=7.78; p=0.021)]. Conclusion: In individuals under the age of 55 diagnosed with COVID-19, gender is of significant importance: in men, there is a more pronounced lesion of the lung parenchyma and a more significant change in laboratory parameters. Risk factors for a severe course of COVID-19 in men are coronary artery disease and hepatobiliary disorder. Calculating the Krebs index can be used to assess the risk of disease progression.

[The role of micronutrients in the comprehensive rehabilitation of patients with the novel coronavirus infection COVID-19].

Post-COVID disorders syndrome (PCDS) is an umbrella term for a complex of persistent symptoms that a patient can develop after suffering from COVID-19. The aim of the research was to systematize data on the role of micronutrients in the treatment of PCDS. Material and methods. The authors carried out a systematic analysis of foreign (ncbi. nlm.nih.gov) and Russian (elibrary.ru) scientific publications. Results. The most common symptoms that can persist for a long time after a coronavirus infection can be divided into 4 groups: 1) hypoxic syndrome (respiratory and oxygen deficiency); 2) asthenic syndrome; 3) syndrome of neuropsychiatric disorders; 4) gastrointestinal symptoms. Adequate dietary intake of vitamins and mineral substances is critical for the proper functioning of the immune system and maintenance of the organism functional reserves. The optimal consumption of vitamins D, C and E, zinc and ω-3 fatty acids with ration can be useful for preventing infection, supporting immunity during COVID-19 disease and in the complex of rehabilitation of patients with PCDS. Conclusion. Intake of dietary supplements containing complex of micronutrients can be recommended as a rational adjuvant therapy during the rehabilitation period after COVID-19. However, further research is essential to determine the effective dosage of vitamins and other micronutrients to reduce the manifestations of PCDS.

[International register "Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients (ACTIV SARS-CoV-2)"].

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[The problem of the use of hormonal therapy aimed for sex correction by transgender persons on their own initiative].

BACKGROUND: In recent years, the demand for feminizing and masculinizing hormone therapy has increased significantly among transgender people around the world. There are no such studies in Russia and the amount of medical information on the transgender population is limited. AIM: to assess the number of transgender patients who take hormone therapy without a doctor's prescription and to characterize the medicines they use. MATERIALS AND METHODS: data from 1117 transgender patients were included in to analysis: 44.01% (n=515) of them were trans women, 55.99% (n=630) were trans men. Patients applied to the "Scientific Center for Personalized Medicine" in order to receive medical care. RESULTS: Half of transgender people (53.6%) are already taking hormonal drugs. More often transgender women (76.7%), less often transgender men (32.3%). In this case, only 8.6% turned to endocrinologists for the therapy prescription. Many patients used unlicensed drugs, use irrational schemes and combinations, often overdose. CONCLUSION: A significant number of transgender people start using hormone replacement therapy on their own initiative, without the doctor's supervision. The solution to this problem could be incensement of knowledge level in doctors and patients to create a friendly environment and productive interaction between therapists, endocrinologists and transgender people, as well as the organization of consulting centers within public medical institutions.

[The effect of administration of dietary supplement with calcium and vitamins D3 and B6 on calcium homeostasis and falls incidence in patients with high fracture risk undergoing medical rehabilitation].

Elimination of vitamin D and calcium deficiencies is of particular importance in older patients undergoing medical rehabilitation after a serious illness, surgery or injury and having a high risk of fractures. Preventing falls and fractures, including during the course of rehabilitation, is an important challenge that can be addressed in these patients, in particular through improved nutrition and vitamin D and calcium supplementation. The aim of the study was to evaluate the effect of long-term intake of a complex dietary supplement with calcium and vitamins D3 and B6 on calcium homeostasis and the frequency of falls in patients with high fracture risk undergoing medical rehabilitation. Material and methods. The study enrolled 109 women and 10 men (mean age 65.5±7.9 years) with high fracture risk who were undergoing medical rehabilitation. After baseline examination, 41 patients have been receiving antiresorptive therapy already comprised group 1, and patients who didn't receive osteoporotic therapy were randomized into groups 2 (n=39) and 3 (control, n=39). Patients in groups 1 and 2 for 12 months were prescribed a dietary supplement containing calcium in a daily dose of 200 mg (in the form of citrate 1000 mg), 600 IU of vitamin D3 and 2 mg of vitamin B6. All patients underwent assessment of bone mineral density (BMD), calculation of absolute 10-year fracture risk according to FRAX, assessment of food calcium intake, etermination of biochemical parameters of calcium-phosphorus metabolism and bone remodeling (total calcium, inorganic phosphorus, alkaline phosphatase activity - by colorimetric method in blood serum; immunoreactive parathyroid hormone (PTH) and osteocalcin - by electrochemiluminescence immunoassay in blood serum; ß-isomer of C-terminal telopeptide of type I collagen (CTx) and 25(OH)D in blood plasma - by immunochemiluminescence analysis), cases of falls and fractures were fixed. Results. Average daily intake of calcium in the studied sample (n=119) was 782.9±243.4 mg, and 67.2% of patients consumed less than 800 mg of calcium daily. Vitamin D deficit was detected in 38.4% of the examined, its insufficiency - in 32.8%. An increase in 25(OH)D concentration was noted in groups 1 and 2 after 6 and 12 months (p<0.01), while in group 3 there was no dynamics of 25(OH)D (p>0.05). Patients in group 1 showed an increase in the level of osteocalcin and total calcium after 6 and 12 months, as well as alkaline phosphatase activity after 6 months (p<0.05). In group 3, there was an increase of PTH levels after 6 (p<0.05) and 12 months (p<0.01), CTx and alkaline phosphatase activity after 12 months (p<0.05). In group 1, there was an increase in BMD in the spine (+4.2%, p=0.024), femoral neck (+3.0%, p=0.041), and total femur (+2.7%, p=0.045), in patients of group 2 - an increase in BMD in the spine (+1.8%, p=0.048). In group 1, there was also a decrease in proportion of patients who fell after 6 months (χ2=4.97, p=0.026) and a decrease in the total number of falls after 12 months (χ2=4.89, p=0.027). Group 2 showed a decrease in the number of patients who fell after 6 and 12 months (χ2=48.58, p=0.0034 at both stages of the study) and the number of falls in general after 6 months (χ2=6.02, p=0.0142). Conclusion. The obtained data allow us to recommend prescription of dietary supplements containing calcium and vitamin D3 as a part of complex rehabilitation of patients with high fracture risk.

[Methods for quality of life assessment in children with orphanic diseases].

Orphan (rare) diseases include congenital or acquired diseases, the frequency of occurrence of which does not exceed a certain number established by the laws of various countries. Despite its rarity, the orphan diseases make a significant contribution to the structure of population disability and most of them have no specific treatment. One of the main clinical challenges in these patients is to ensure their high quality of life (QOL). The review describes basic non-specific and specific questionnaires for assessing QOL in children with orphan diseases. An ideal questionnaire for assessing QOL in children with orphan disease should be sufficiently reliable, valid, sensitive and specific, fill out by a child or adolescents on their own, include questions covering as much as possible all areas of life and health aspects - especially those associated with the main decease. The questionnaire should not be too huge and complicated for the patient. From the side of the researcher, the simplicity of the tool in calculating and the ability to use the results for subsequent analysis are important.

[The effect of basic therapy with calcium and vitamins D3 and B6 on muscle strength, movement and balance functions at patients with osteoporosis undergoing medical rehabilitation]. / Vliianie bazovoi terapii kal'tsiem i vitaminami D3 i V6 na myshechnuiu silu, funktsii dvizheniia i balansa u patsientov s osteoporozom, prokhodivshikh meditsinskuiu reabilitatsiiu.

AIM: Study of the effect of taking a complex biologically active food supplement with calcium and vitamins D3 and B6 to the effectiveness and duration of medical rehabilitation effect at patients with osteoporosis and with a high risk of fractures. MATERIAL AND METHODS: We examined 119 men and women with osteoporosis and (or) with a high risk of fractures, beginning a course of medical rehabilitation. The 1st study group (SG1) included 41 patients who had already received antiresorptive therapy. In SG2 and SG3, 39 patients who did not receive pathogenetic therapy of osteoporosis were included by the randomization method. For patients SG1 and SG2, a complex biologically active food supplement Osteomed forte was prescribed to use within 12 months. The dynamics of tensodynamometry, stabilometry and functional tests were evaluated in 20 days, 6 and 12 months after the start of the study. RESULTS: The muscle strength indicators achieved during the 20-day training session compared to the initial level were maintained for 12 months in extensor and flexor of the back at patients within SG1 and SG2, as well as up to 6 months in the lateral flexor of the back at patients of SG1. At patients within SG3, the effect of medical rehabilitation completely regressed after 6 months. Higher stabilization parameters after 6 and 12 months in comparison with the initial level were observed only in patients within SG1 and SG2. The effect achieved during rehabilitation was supported for 12 months in the 'stand on one leg' test within SG1, comparing in contrast to SG3, where a deterioration in the average value of the test indicator was noted. CONCLUSION: Long-term use of food supplements containing calcium salts with vitamins D3 and B6can be recommended to maintain the effect of rehabilitation measures at patients with osteoporosis and with a high risk of fractures, more preferably in combination with antiresorptive therapy.

[Exercise therapy and bracing in patients with osteoporotic compression vertebral fractures]. / Lechebnaia fizkul'tura i ortezirovanie u patsientov s kompressionnymi perelomami pozvonkov na fone osteoporoza.

Osteoporotic vertebral fractures (VF) have a negative impact on quality of life within a year after injury. A recent-onset vertebral body compression fracture in the presence of osteoporosis (OP) is generally accompanied by acute back pain, hypokinesia, and a reduction in daily physical and social activities, further leading to social isolation. Rehabilitation measures are of particular importance to restore quality of life in OP patients, especially in the people who have a history of fractures. Exercise therapy is the mainstay of management in patients with OP and VF; however, pain and limited mobility can be a barrier to exercises. Competent bracing is a method that can assist in reducing pain in VF, stabilizing the spine, and increasing motor activity. The use of an orthosis not only improves quality of life, but also gives an opportunity to take physical exercises. Semi-rigid and elastic corsets are preferable to rigid structures that are less convenient to use and associated with a large number of undesirable phenomena. Wearing a brace continuously (with its obligatory taking off overnight) is rational for 6-8 weeks. Above this period, there is an increased risk of muscle atrophy. It is acceptable to longer use orthoses situationally, if there is a need to be in an upright position, during long walks, trips, or physical exercises.

[Erbium laser application for oral surgery in patients with platelet hemostatic disorders]. / Primenenie érbievogo lazera pri khirurgicheskom stomatologicheskom lechenii patsientov s narusheniiami trombotsitarnogo gemostaza.

Hemostatic disorders are typically associated with prolonged bleeding after or during surgical procedures. The aim of the study was to increase the efficiency of oral surgery in these patients using erbium laser. Selected 46 patients receiving oral surgery were randomly divided in 2 groups: 43 patients with thrombocytopenia, trombocytemia and other platelet disorders treated with erbium laser and a control group of 43 patients without concomitant pathology determined for conventional surgical treatment. No postoperative bleeding was seen in group 1. Conventional procedures were associated with significantly more postoperative pain and epithelization took 1-3 days longer. Erbium laser radiation is an up-to-date method which can be successfully used for oral surgery in patients with hemostatic disorders.

[Nebulized budesonide in the treatment of exacerbations of chronic obstructive pulmonary disease: Efficacy, safety, and effects on the serum levels of soluble differentiation molecules].

AIM: To investigate the efficacy and safety of nebulized budesonide and systemic glucocorticosteroids (GCS) (SGCS) in the treatment of an exacerbation of chronic obstructive pulmonary disease (COPD) and their effects on the serum concentration of soluble leukocyte differentiation antigens. MATERIALS AND METHODS: Seventy-eight hospitalized patients with an acute exacerbation of COPD were randomized into two groups: 1) 37 patients took nebulized budesonide 4 mg/day; 2) 41 patients received intravenous prednisolone. The symptoms of COPD, forced expiratory volume in one second (FEV1) and other spirometric indicators, peripheral blood oxygen saturation (SpO2), and adverse events were studied. The serum levels of the soluble adhesion molecules CD50 (sCD50) and CD54 (sCD54) and the lymphocyte activation molecules CD38 (sCD38) and CD25 (sCD25) were investigated by an enzyme immunoassay. RESULTS: There was a significant resolution of the symptoms of COPD, FEV1, and SpO2 in both groups after treatment. The incidence of hyperglycemia episodes was lower in the budesonide group than in the sGCS group. GCSs caused a decrease in the serum level of soluble interleukin-2 receptor (sCD25) in both groups. A prednisolone cycle, unlike a budesonide one, was found to reduce the concentrations of sCD54, sCD50, and sCD38. CONCLUSION: Nebulized budesonide is an effective and safe alternative to SGCS in treating an exacerbation of COPD. Inhaled GCSs, unlike SGCSs, exhibit anti-inflammatory activity, but exert no immunosuppressive activity.

[Scintigaraphic assessment of viability of the ischemic myocardium while carrying out nitroglycerine-mediated and orthostatic tests].

The work deals with diagnostic possibilities of single photon emission computed tomography (SPECT) of the heart and ECG-synchronized planar scintigraphy (ECG-PS) with 99mTc-tetrophosmine used to determine viability of the ischaemic myocardium in patients presenting with postmyocardium infarction cardiosclerosis. A total of 20 patients diagnosed with Ischaemic heart disease (IHD), functional class III-IV angina of effort, postmyocardium infarction cardiosclerosis were examined. All the patients underwent SPECT of the heart with 99mTc-tetrophosmine, which was carried out at rest and on the background of sublingual administration of nitroglycerine, as well as planar ECG-synchronized scintigraphy of the myocardium according to the protocol: rest - nitroglycerine-mediated - orthostatic tests. Repeat examinations at rest were performed 4-6 weeks after the coronary artery bypass (CAB). The obtained findings showed that sensitivity of perfusion SPECT with 99mTc-tetrophosmine of the myocardium amounted to 85%, specificity to 76%, and diagnostic accuracy to 82%. Calculating the diagnostic parameters of perfusion while using ECG-PS with sublingual administration of nitroglycerine demonstrated that sensitivity of the method amounted to 71%, specificity to 91%, and diagnostic accuracy to 83%. Analyzing the orthostatic test yielded sensitivity equalling 72%, specificity - 84% and diagnostic accuracy - 81%. Sensitivity of assessing myocardial contractility by means of ECG-PS using nitroglycerine amounted to 83%, with specificity of 86% and diagnostic accuracy of 85%. At the same time, sensitivity of the orthostatic test amounted to 80%, specificity to 92%, and diagnostic accuracy to 88%. Hence, carrying out SPECT and ECG-synchronized planar scintigraphy of the heart with 99mTc-tetrophosmine on the background of sublingual administration of nitroglycerine and the orthostatic test makes it possible to simultaneously assess the reserve of myocardial contractility and perfusion, thus strongly suggesting a high informative value of the techniques involved in detecting myocardial viability in patients with postmyocardium infarction cardiosclerosis.

[Use of the syrup prepared on the basis of wild-growing grasses of the Far East, in preventive maintenance of respiratory diseases and microelementoza at children]. / Ispol'zovanie siropa, prigotovlennogo na osnove dikorastushchih trav dal'nego vostoka, v profilaktike respiratornykh zabolevanii i microélementoza u detei.

Working out formula and techology of producing the syrup, which is based on herbs of Far Eastern Region (dog rose; leaves of currant, lime-tree; herbs St. John's wort, parsley. Nettle; licorice) and food dietary supplements--Laminal (the product of processing of brown seaweeds). Here are the results of the research work of chemical contents, energetic value, minor componential contents and microbiological values of syrup. The results of approbation of the syrup on the group of children (who catch a cold very often) showed the increase of coefficient of special immune lymphocytic-monocytical and cell-phagocytal protection. These results allow us to recommend it as a kind of treatment, included in health-improvement program.