TREATMENT OPTIMIZATION IN MANAGEMENT OF COMBINED PATHOLOGY - ARTERIAL HYPERTENSION AND POST-COVID SYNDROME IN ELDERLY PATIENTS.

OBJECTIVE: The aim: Purpose of the study. Our research is aimed at the increase in the treatment effectiveness for combined pathology, namely, arterial hypertension (AH) and post-COVID syndrome in elderly patients at the stage of providing medical care by family medicine general practitioners with the use of statins, anti¬platelet agents, as well as endothelial-protective drug - L-arginine and anxiolytic effect - mebicar against the background of basic antihypertensive therapy. PATIENTS AND METHODS: Materials and methods: The study included treatment and observation of 50 elderly patients with hypertension and post-COVID syndrome. The average age was 68.7«1.89 years. RESULTS: Results: The use of mebicar with moderate tranquilizing (anxiolytic) effect and endothelium-protector - L-arginine in the comprehensive treatment of elderly patients with combined pathology - AH and post-COVID syndrome contributed to the elimination of the main clinical symptoms (headache, poor sleep) in a shorter time; provided significant decrease in the level of systolic blood pressure, reactive anxiety, the decrease in total blood cholesterol, and improvement in blood rheology. CONCLUSION: Conclusions: Treatment optimization for combined pathology - arterial hypertension and post-COVID syndrome in elderly patients with the use of L-arginine and mebicar in comprehensive treatment, improves the quality of patients' life, reduces the treatment duration.

Preventive Effect of Mebicar and Ginsenoside Rg1 on Neurobehavioral and Immunological Disruptions Caused by Intermittent Unpredictable Stress in Mice.

OBJECTIVES: Ginsenoside Rg1 and mebicar have been reported to have broad efficacy spectrum, including anti-anxiety and anti-stress. These drugs have been used not only for treatment but also for the purpose of increasing resistance from disease. A specific aim of this study was to investigate whether mebicar or ginsenoside Rg1 can prevent physiological changes resulting from intermittent unpredictable stress (IUS). METHODS: Seven week-old Balb/cByJ mice were administered orally with mebicar (10 mg/kg) or ginsenoside Rg1 (10 mg/kg) starting from a week before they were exposed to IUS until the end of the experiment. IUS, which consists of psychological stress and physical fatigue, was set as 3 bouts (24 h/bout) exposure in a 2-week period. RESULTS: IUS caused hyperactivity and anxiety-like behavior, which were not inhibited by mebicar or ginsenoside Rg1. IUS mice treated with mebicar or ginsenoside Rg1 recovered rapidly from anxiety-like behavior induced by the multiplexed stress compared to the mice not orally treated with mebicar or ginsenoside Rg1. Mebicar or ginsenoside Rg1 could not prevent the decrease of brain-derived neurotropic factor by IUS exposure. However, mebicar or ginsenoside Rg1 prevented elevation of serum corticosterone and secretion of proinflammatory cytokines from splenocytes due to IUS exposure. CONCLUSIONS: This study suggests that mebicar or ginsenoside Rg1 may have little preventive effect on neurobehavioral disruption by IUS exposure, but mebicar or ginsenoside Rg1 shortened the lasting duration of the anxiety caused by exposure to a novel environment. The anti-stress effect of mebicar and ginsenoside Rg1 may be restricted in peripheral stress responses.

[An experience of using mebicar in patients with autonomic dysfunction associated with anxiety disorder]. / Opyt primeneniia mebikara u patsientov s vegetativnoi disfunktsiei, sochetaiushcheisia s kognitivnymi narusheniiami i trevozhnym rasstroistvom.

BACKGROUND: Cognitive impairments are one of the most frequent and maladaptive factors in patients with autonomic dysfunction associated with anxiety disorder. The majority of anxiolytics manage to compensate anxiety but suppress cognitive functions. MATERIAL AND METHODS: Fifty-four patients with autonomic dysfunction and anxiety disorder, including 39 women (mean age 25±6.7 years) and 15 men (mean age 27±8.4 years), were treated with mebicar during 3 months. RESULTS AND CONCLUSION: A reduction in the degree of autonomic dysfunction and anxiety symptoms as well as a significant improvement of cognitive functions were noted. Mebicar showed a good tolerability and minimum drug-related adverse events, and can be recommended as a first line anti-anxiety remedy in wide clinical practice.

[A dyad approach to the treatment of attention deficit hyperactivity disorder]. / Diadnyi podkhod k lecheniyu sindroma defitsita vnimaniya c giperaktivnost'yu.

AIM: To study anxiety in adolescents with attention deficit hyperactivity disorder (ADHD) and their mothers and to evaluate the efficacy of a dyad approach (simultaneous treatment of the mother and the child) to ADHD treatment. MATERIAL AND METHODS: Thirty-four adolescents, aged 12-15 years, with ADHD and their mothers were studied. All participants of the study received anxiolytic treatment: children were treated with noophen (500 mg per day 45 days) and their mothers received adaptol (1500 mg per day 45 days). In the comparison group with the same clinical/psychological characteristics, anxiolytic therapy with noophen was used only in adolescents. RESULTS: Symptoms of anxiety were found in 61.7% of adolescents with ADHD and in 79.4% of the mothers. After the dyad therapy, an improvement was noted in 73.5% of adolescents and 69.7% of the mothers. There was an improvement in 63.3% of patients in the comparison group. CONCLUSION: The results demonstrate the high efficacy of the dyad approach in treatment of ADHD with comorbid anxiety disorders.

[An open comparative observational study of the efficacy and safety of adaptol in anxiety-asthenic disorders in patients with chronic cerebral ischemia]. / Otkrytoe sravnitel'noe nablyudatel'noe issledovanie effektivnosti i bezopasnosti preparata adaptol v terapii trevozhno-astenicheskikh rasstroistv u bol'nykh s khronicheskoi ishemiei golovnogo mozga.

AIM: To assess the efficacy and safety of adaptol in anxiety-asthenic disorders in patients with chronic cerebral ischemia (CCI). MATERIAL AND METHODS: Forty-nine patients with CCI and comorbid anxiety-asthenic disorder were randomized to standard treatment group (20 patients) and main group which consisted of 29 patients treated with adaptol (500 mg 2 times daily for 6 weeks) in addition to standard treatment. The efficacy of treatment was assessed with HADS-A, HADS-D, FAS and SF-36. Physical fatigue was evaluated using cycle ergometry test. RESULTS: After 6 weeks, anxiety symptoms were stopped in the most of the patients of the main group (72.4%). The threshold during cycle ergometry was higher in the patients of the main group compared to the comparison group (132.2 vs 114.0 VT, respectively) and the patients experienced less fatigue after the test. Quality-of-life was improved by >10% in patients treated with adaptol and did not changed in the patients of the comparison group. CONCLUSION: The addition of adaptol to standard treatment of patients with CCI allows to stop symptoms of anxiety, increase the tolerance to load and improve quality-of-life.

[Pharmacotherapy of anxiety disorders in patients with chronic cerebral ischemia]. / Farmakoterapiya trevozhnykh rasstroistv u patsientov s khronicheskoi ishemiei golovnogo mozga.

AIM: To compare the effects of the daytime anxiolytic adaptol and the tranquilizer/nootropic drug noophen on target symptoms related to anxiety spectrum disorders in patients with chronic cerebral ischemia (CCI). MATERIAL AND METHODS: Sixty-two patients with CCI and comorbid anxiety spectrum disorders were randomized to adaptol group (n=29) and noophen group (n=33). Results of treatment were assessed with CGI, MFI-20, HADS-A and HADS-D, MMSE. RESULTS AND CONCLUSION: Both drugs showed the comparable efficacy and speed of achievement of anxiolytic effect. Anxiety symptoms were stopped in 79.0% of the patients. Adaptol was superior to noophen in regard to nonspecific somatic symptoms (р=0.037). Asthenia and sleep disorders have decreased significantly in the noophen group. Use of target symptoms in the individual choice of anxiolytic therapy in patients with anxiety spectrum disorders associated with CCI can increase treatment efficacy.

[Experimental comparative study of the analgesic activity of the diurnal anxiolytic mebicar, amitriptyline, and diazepam].

It is established that mebicar, amitriptyline, and diazepam administered intraperitoneally at therapeutic doses increase the pain thresholds in mice as manifested in "hot plate" analgesia test. Mebicar was more effective than diazepam and not inferior to amitriptyline in increasing the pain thresholds at earlier time points.

[Determination of biurea in flour and its products by liquid chromatography-tandem mass spectrometry].

A novel method was established for the determination and identification of biurea in flour and its products using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The biurea was extracted with water and oxidized to azodicarbonamide by potassium permanganate. The azodicarbonamide was then derivatized using sodium p-toluene sulfinate solution. The separation was performed on a Shimpak XR-ODS II column (150 mm x 2.0 mm, 2.2 microm) using the mobile phase composed of acetonitrile and 2 mmol/L ammonium acetate aqueous solution (containing 0.2% (v/v) formic acid) with a gradient elution program. Tandem mass spectrometric detection was performed in multiple reaction monitoring (MRM) scan mode with a positive electrospray ionization (ESI(+)) source. The method used stable isotope internal standard quantitation. The calibration curve showed good linearity over the range of 1-20 000 microg/kg (R2 = 0.999 9). The limit of quantification was 5 microg/kg for biurea spiked in flour and its products. At the spiking levels of 5.0, 10.0 and 50.0 microg/kg in different matrices, the average recovery o biurea was 78.3%-108.0% with the relative standard deviations (RSDs) < or = 5.73%. The method developed is novel, reliable and sensitive with wide linear range, and can be used to determine the biurea in flour and its products.

[Clinical efficiency of combined therapy using adaptol for atopic dermatitis].

AIM: To study the effect of the daytime anxiolytic adaptol on the efficiency and tolerability of combination treatment for atopic dermatitis (AD). SUBJECTS AND METHODS: Eighty patients with different clinical forms of AD were examined and then divided into 2 identical groups. The patients' mean age was 30.7 +/- 11.2 years; the mean disease duration was 20.2 +/- 12.8 years. Group 1 patients (n = 40) received standard treatment involving disintoxication therapy, prednisolone 30-60 mg/day, antihistamines, phototherapy (20 sessions), topical steroids and topical emollients. Group 2 patients (n = 40) took additionally adaptol as 3 tablets (1500 mg) daily. The efficiency of therapeutic measures was evaluated in 2 steps: by taking into account the changes in the scoring atopic dermatitis index (SCORAD) and the Dermatology Life Quality Index (DLQI) scores 4 weeks following the initiation of treatment and once more after 12 weeks. RESULTS: There was a tendency for the more pronounced decrease in SCORAD scores in Group 2 (using adaptol) versus Group 1 (standard treatment) to 9.8 +/- 2.57 and 10.8+ +/- 2.64, respectively. There were drops in SCORAD scores by 4.1 and 3.6 times, respectively. Twelve weeks after 12 weeks of treatment initiation was 7.1 +/- 2.13 scores in the adaptol group; on the contrary, this indicator increased slightly due to evolving recurrences and amounted to as many as 11.9 +/- 2.41 scores on the average. In Group 1, DLQI improved by 73% following 4 weeks and decreased by 1% after 12 weeks while in Group 2, it improved by 81% following 4 weeks and continued to improve up to 85% after 12 weeks. CONCLUSION: Comparison of examined dermatology indices in AD patients receiving standard treatment and treatment including adaptol gives proof to the great value and efficiency of using adaptol during an exacerbation and in the postrecurrence period.

[Parallel pharmacological correction of myocardial dysfunction, cognitive and psychopathological disordres in patients with congestive heart failure].

Was examined 92 patients with congestive heart failure III-IV FC with fraction of emission left ventricle < 45% against coronary artery disease. Patients of control group received basic therapy (according to recommendations of the Ukrainian society of cardiology), the 1 group--in addition received a preparation of Vazonat within 15 days intravenously in a dose of 1000 mg a day further are out-patient within 1 month on 250 mg 3 times per os; the 2 group--under the same scheme a preparation of Vazonat and a day tranquilizer of Adapto in a dose of 500 mg twice a day throughout all term of supervision. It is established that addition of Vazonat to basic treatment leads to additional effect concerning improvement of indicators cardio-hemodynamic, to improvement congestive functions. Joint appointment of preparations of Vazonat and Adaptol against basic treatment leads to more expressed improvement congestive functions, to progressive reduction of degree of trouble, depression.

[Asthenic disorders in children and their differentiated treatment].

OBJECTIVE: To study clinical/psychological characteristics of neurasthenia and residual asthenia and to assess the efficacy of noofen and adaptol in the treatment of these disorders. MATERIAL AND METHODS: Authors examined 30 adolescents with neurasthenia and 30 with residual asthenia. The Multidimensional Fatigue Inventory (MFI-20), A.M. Vein questionnaire, Spilberger-Khanin questionnaire, The Test of Variables of Attention (TOVA) were used. Patients were divided into two equal groups (n=30), each included 15 patients with residual asthenia and neurasthenia. Patients of the first group received adaptol in dosage 1000 mg daily and patients of the second group received noofen in dosage 500 mg daily. The duration of the study was 30 days. RESULTS AND CONCLUSION: The significantly higher levels of fatigue, inattention and exhaustibility were identified in patients with residual asthenia. Adolescents with neurasthenia were characterized by higher anxiety. The higher efficacy of adaptol in treatment of neurasthenia (80% in adolescents with neurasthenia and 60% of patients with residual asthenia) was shown. Noofen was more effective in treatment of residual asthenia (66.7% of adolescents with neurasthenia and 86.7% with residual asthenia.

[Efficacy of adaptol and the possibility of its differential use in patients with anxiety disorders after myocardial infarction].

AIM: To evaluate the efficacy and safety of adaptol in a dose of 1500-2000 mg/day in combination therapy for anxiety disorders (AD) in the early post-myocardial infarction period. SUBJECTS AND METHODS: The trial included 94 patients with AD who were divided into a study group of 60 patients and a control group of 34 patients. In addition to basic therapy, the study group took adaptol in a dose of 1500-200 mg/day for 30 +/- 2 days; the control group received basic therapy only. RESULTS: The drug given in a dose of 1500-2000 mg/day in the patients with AD in the early post-myocardial infarction period was found to have high anxiolytic, autonomically normalizing, stress-protective activities and a positive effect on heart rate variability just one month after treatment. The highest efficacy of Adaptol was observed in patients with baseline hypersympathicotonic and normal autonomic responsiveness. CONCLUSION: Adaptol proved to be more effective in patients with baseline hypersympathicotonic and normal autonomic responsiveness, which permits the drug to be differentially used in relation to the baseline type of autonomic responsiveness.

[Psychoautonomic disorders in patients with hypertension, stage I and possibilities of their treatment].

The article is devoted to the study of psychoautonomic features of patients with essential hypertension stage 1. The authors present the results of the clinical and psychological examinations of 62 patients with this pathology. These results show an increase in the levels of state and trait anxiety, which confirms the leading role of the psycho-emotional sphere in the formation of hypertensive reactions. This study evaluated the efficacy of the drug adaptol usage during 8 weeks in daily dose 1500 mg divided into three parts in the treatment of this group of patients. The results clearly demonstrate the positive effect of adaptol on psychoautonomic adaptation of patients with essential hypertension stage 1.

[Attention deficit syndrome in adults: clinical, psychophysiological features and treatment].

The authors present the results of examination of 34 patients, aged from 18 to 30 years, with attention deficit hyperactivity disorder (ADHD) (ICD-10 item F90.0). The study has shown that inattentive type of ADHD is noted in 50%, combined type in 38.3% and hyperactivity/impulsivity type in 11.7% of patients. Adult patients with ADHD also have a high level of anxiety and asthenic disorders. This study evaluated the efficacy and safety of adaptol in dosage 1500 mg daily during 8 weeks in the treatment of this group of patients. The high efficacy (improvement in 64,7% of cases) and safety of adaptol confirmed by the data of clinical, psychological and neurophysiological studies.

Stone compositions in Turkey: an analysis according to gender and region.

OBJECTIVE: To evaluate the compositions of the kidney stones obtained from different regions of Turkey and to present the gender and regional differences. METHODS: The study included 6453 kidney stones obtained from patients from different parts of Turkey. All of the stones were obtained using ureterorenoscopy, percutaneous stone surgery, laparoscopic or open stone surgery, or extracorporeal shock wave lithotripsy. X-ray diffraction crystallography method was used for analysis. RESULTS: At the end of the analysis, 11 different stone types including calcium oxalate (Ca-ox) monohydrate (whewellite, COM), Ca-ox dihydrate (weddellite, COD), uric acid, cystine, struvite, biurea, xanthine brushite, quartz, whitlockite, and dahlite were determined either in pure or mixed conditions. Of the stones, 80.4% were Ca-ox (55.7% COM, 5.9% COD, 18.8% COM + COD), 4.8% uric acid, 3.1% cystine, and 3.3% were phosphate stones (dahlite, brushite, struvite, whitlockite). The remaining 8.4% of the stones were in mixed form with different combinations. Of the patients, 4411 were men (68.3%) and 2042 were women (31.7%). CONCLUSION: Ca-ox was the most frequently encountered stone type in our country as it is worldwide. The distribution of the other stone types is different than the other countries. The information about the structure of the stone has significant contribution to the understanding of the stone formation etiology, programming of the treatment process, and prevention of the recurrences. The study is significant in presenting the stone profile of Turkey.

[Efficiency of using the anxiolytic adaptol in the combination therapy of arterial hypertension in women].

AIM: To evaluate the effect of the anxiolytic adaptol on blood pressure (BP) level in its concurrent use with a fixed dose angiotensin-converting enzyme (ACE) inhibitor/diuretic combination on quality of life and on the correction of psychoautonomic disorders. SUBJECTS AND METHODS: The trial included women aged 40-60 years with the verified diagnosis of Stage 2B arterial hypertension (AH), risk 2, and a disease history of at least 5 years. A study group received a fixed dose ACE inhibitor/diuretic combination once daily and adaptol 500 mg twice daily for 2 months. A comparison group had only the fixed dose ACE inhibitor/diuretic combination once daily without adaptol. RESULTS: By the end of one-month therapy, a more pronounced statistically significant BP reduction was achieved in the study group receiving the ACE inhibitor/diuretic combination and adaptol than in the comparison group. The quality of life was improved in 6 of the 8 items in the study group and in 3 items in the comparison group. The total scores of psychoautonomic disorders decreased from 48.7 to 25.8 in the study group and from 47.8 to 38 in the comparison one. CONCLUSION: It is expedient to combine antihypertensive therapy and anxiolytics in female hypertensive patients with autonomic dystonic disorders.

[Neurophysiological monitoring of the efficacy of the complex therapy of vascular and posttraumatic encephalopathy].

Authors have studied the efficacy of adaptol and neyromidin in the combined treatment of patients with chronic cerebral circulation insufficiency and consequences of closed head injury using neurophysiological monitoring which included dynamic evaluation of central conductivity, neuropsychological tests and analysis of blood BDNF levels. Severe autonomic disorders, anxiety and low level of learning observed in all patients are correlated with neurophysiological (increased central conductivity time) and neurotrophic (decreased blood BDNF levels) profiles. These indicators may change throughout the treatment. The combination of adaptol and neyromidin enhanced greatly the efficacy of combined treatment. The received data allow recommending neurophysiological monitoring for treatment optimization of numerous neurological diseases that demand neuroplasticity stimulation.

[A case of effective psychogenic ventricular arrhythmia treatment with the anxiolytic Adaptol].

There is a presents a clinical case of idiopathic ventricular arrhythmia developing in a 27-year-old young woman with anxiety neurosis successfully treated with the anxiolytic Adaptol used in daily dosage 1500 mg during a month.

[Correction of psychoemotional status in patients with chronic bacterial prostatitis].

AIM: To comparatively analyze the efficiency of combination treatment in patients with chronic prostatitis. SUBJECTS AND METHODS: Psychometric and psychological methods, such as the Hamilton depression rating scale and the Hamilton anxiety rating scale, determination of the types of an attitude toward illness, and the personality rating questionnaire, were used to examine 80 men with chronic bacterial prostatitis (CBP) who were allocated to 2 groups. A study group received levofloxacin in combination with adaptol for 10 days; a control group had antibacterial therapy only. RESULTS: The patients receiving adaptol were ascertained to have a more evident normalization of mental disorders, as shown by the scales, as lower scores: 4.9 +/- 0.6 for irritability, 5.7 +/- 0.6 for reactive aggression, 5.1 +/- 0.7 for shyness, and as a higher score (up to 5.2 +/- 1.3) for sociability (p < 0.05). There was a pronounced reduction in diurnal mood variations, which is indicative of relief of anxiety and depressive disorders. CONCLUSION: The use of adaptol in a dose of 500 mg thrice daily for 10 days as part of the combination treatment of patients with an exacerbation of CBP permits correction of the mental status and improves the quality of life of patients in a shorter period of treatment.

Injectable hydrogels from segmented PEG-bisurea copolymers.

We describe the preparation of an injectable, biocompatible, and elastic segmented copolymer hydrogel for biomedical applications, with segmented hydrophobic bisurea hard segments and hydrophilic PEG segments. The segmented copolymers were obtained by the step growth polymerization of amino-terminated PEG and aliphatic diisocyanate. Due to their capacity for multiple hydrogen bonding within the hydrophobic segments, these copolymers can form highly stable gels in water at low concentrations. Moreover, the gels show shear thinning by a factor of 40 at large strain, which allows injection through narrow gauge needles. Hydrogel moduli are highly tunable via the physical cross-link density and the length of the hydrophilic segments. In particular, the mechanical properties can be optimized to match the properties of biological host tissues such as muscle tissue and the extracellular matrix.