The method of rehabilitation of patients with chronic opisthorchiasis after deworming


(57) Abstract:

The invention relates to medicine, namely to therapy related to the rehabilitation of patients with chronic opisthorchiasis after deworming. The problem is solved by a two-step method of rehabilitation. At the first stage within 10 days at the same time appoint glamoured one capsule in the morning on an empty stomach daily and choleretic drug vicodin 1 tablet 3 times a day after meals. After 10 to 14 days of conducting the second phase of rehabilitation within 5 to 7 days, while at the same time appoint glamoured one capsule in the morning on an empty stomach 1 per day and oxygenated one tablet 3 times a day. Repeat the treatment twice a year. Improving the efficiency of rehabilitation is due to the simultaneous use of drugs with immunomodulatory and choleretic effect and reduce side effects. 1 C. p. F.-ly, 1 table.

The invention relates to medicine, namely to therapy, and concerns the methods of rehabilitation of patients with chronic opisthorchiasis (HO) after deworming due to correction of dysfunctions of the immune system.

Studies have shown, when HO and residual period after the effective degele to frequent recurrent viral and infectious diseases, allergic and autoimmune processes. The presence of immune deficiency is confirmed by the inhibition of T-cell immunity, mainly due helper subpopulations, decreased phagocytic activity of macrophages, an increase in the production of immunoglobulins and the CEC.

Of particular importance are the issues of therapeutic correction of the dysfunction of the immune system, as they largely determine the picture of the current residual opisthorchiasis, including continued after the effective deworming chronic cholecystitis, pancreatitis, hepatitis, etc.

Known methods of rehabilitation of patients HO after deworming. So, a certain effect on the elimination of the CEC provided the use gemodeza, plasmapheresis, hemosorption [1] . But it is invasive, difficult, malaconotinae ways. To stimulate macrophage system used physiotherapeutic methods of rehabilitation of patients after HO-worming affecting the thymus, adrenal glands, spleen (microwave therapy) [2] . However, these methods have a specific effect on the parameters of the immune system, activating only the macrophages, have a short-term effect. Have experience of applying for to the mi properties such as nukleinat sodium, drugs thymus (timolin, timogen, and others), natural antioxidants (ascorbic acid, (-tocopherol), prodigiozana and others [3,4,5], and drugs with immunosuppressive orientation: azathioprine, corticosteroids, delagil, and others [6].

The effect of these methods of treatment are aimed at suppression or stimulation only certain parts of the immune system that, for example, may lead to inhibition of the already low starting levels of the T-system of immunity.

There is a method of combined alternative immune disorders involving sequential multiple assignment of immunomodulators with different mechanisms of action, patients HO [7], namely, that two days before deworming Haloxylon assigned to azathioprine (cytostatic) at a dose of 100 mg per day, then on the background of reception of azathioprine is deworming Haloxylon on a five-day scheme, then enter the 400 ml gemodeza intravenously. Subsequently appointed immune - nukleinat sodium 0.2 g in the morning, three three-day cycle with an interval of 3 days. However, the authors use the method of exposure to altered immune status of patients have asistenciales, it inhibits the capture and detection of antigens, often translates stimulated indicators in immunodeficiency, tears adaptation [6]. Nukleinat sodium assigned after cytostatica, has a slight stimulating effect, provides short-term action. This method can be recommended only if there are specific indications, such as the combination of HO and bronchial asthma, allergies, to prevent a possible increase of bronchospasm and allergic manifestations in the background degelmintization syndrome. It cannot be used in the majority of patients in the residual period HO, as the risk of cytostatic agents above the desired effect. These methods are usually applied before, at the time of deworming and directly after it, which does not allow to achieve effective rehabilitation of patients, as many immune changes are amplified in the process of de-worming as a reaction to the death of the parasites. Exemption from opistorhisov and their eggs usually occurs within 6 months after deworming and therefore early immunotherapy as the stage of rehabilitation is impractical.

The closest the technique is a method of rehabilitation is the Riem choleretic drugs. The method is as follows: nukleinat sodium administered 0.5 g 2 times a day after meals for 14 days followed by a study of the parameters of immunity. If necessary, repeat the course [1, 5] the Drug, as a rule, does not cause adverse reactions. Studies have shown [5, 8], patients with HO immunostimulating effect manifests itself in a slight increase in T-cells, and increases as T and (T - subpopulation and the index T/T practically does not increase, the level of antibodies was not significantly changed. Increased oxygendependent metabolism of neutrophils according to the NBT-test, but they did not reach the level of normal values.

Thus, under the influence of nucleinate sodium complete correction of immune changes are not marked, and the effect was short-lived. The use of nucleinate sodium in patients with HO after deworming did not effectively and does not solve the problem of correction of immune deficiency and chronic processes in the digestive system in this category of patients.

The problem solved by the invention, are improving the efficiency of rehabilitation of patients with HO after deworming, lower side jawline simultaneous application choleretic drugs, biologically active additives (BAA) glyburide, having immunomodulatory activity in a specific mode: simultaneously appoint choleretic drug vicodin 1 tablet 3 times a day and BAD glamoured one capsule in the morning on an empty stomach 1 time a day for 10 days, after 10 to 14 days repeat admission BAD glamoured in combination with choleretic drug oxygenation 0.25 g 3 times a day for 7 days.

A new dietary Supplement, which has an immunomodulatory property is glamoured. Glamoured is derived muramyldipeptide (TIR) - -geptilglycoside - TIR. The main component of glyburide is the original synthetic derivative of the peptidoglycan of the group And of the cell wall of certain bacteria. He has a strong stimulating effect in relation to the major cell populations involved in anti-infective and anti-tumor immune response. Glamoured recommended for clinical use for the treatment of diseases involving immunodepression, Commission on drugs of natural origin Pharmacological state Committee of the Russian Federation Ministry of health for 135 dated 11.11.1997, as BAA. Products are BAD glamoured certified Institute of nutrition 7772.09.916.P. 04 809. 11.97 from 27.11.1997, (copy attached).

Research TIR derivatives in vitro and in vivo have revealed their ability to modulate specific immune response through the activation of macrophage-level-lymphocytes, helper function of T-lymphocytes, as well as a complementary system[9, 10, 11, 12, 13]. There are some literature data on the clinical use of derivative TIR, in particular, licopid for the prevention and treatment of postoperative septic complications, chronic broncho-pulmonary diseases, chronic viral infections [6]. But it is a hydrophilic drug and its bioavailability is less than glyburide.

The method is as follows. Rehabilitation is carried out in two stages. In the first stage, patients HO after 3 - 6 months after deworming appointed at the same time, nicodin (choleretic drug that has both and bactericidal effect) 1 tablet 3 times daily after meals and the BAD glamoured 1 capsule in the morning on an empty stomach daily for 10 days, after 10 to 14 days spend vremenno choleretic drug oxygenated 1 tablet 3 times a day.

After 7 to 10 days after completion of treatment to assess the condition of immunity. If necessary, repeat the treatment after 6 months to consolidate the effect.

The purpose of the first stage BAD glamoured as immunomodulator and nicotine with choleretic and bactericidal action, allows a shorter time, using the synergy of drugs to arrest the inflammatory process in the biliary tract and eliminate the dysfunction in the immune system, as these two pathological process interdependent. Break for 10 to 14 days between stages of rehabilitation is appropriate, because during this period adapts the immune system. In the second stage of rehabilitation fix a positive effect on the immune system and on the state of the biliary system choleretic drug oxygenation without bactericidal effect, as to this period are reduced by the signs of acute inflammation in the biliary system, but is stored hypotension gallbladder.

Thus, the proposed scheme of treatment to achieve the desired positive effect, namely to improve the effectiveness of rehabilitation of patients HO died 1.

As an example of the use of the new method of rehabilitation of patients after HO deworming can serve as a history Smirnova Tatyana, 32 years, were treated at the day care unit of the regional clinical hospital with 10.05.1999 on 22.05.1999. Upon receipt complained of nausea in the morning, bitterness in the mouth, pain and feeling of heaviness in the right hypochondrium after ingestion of fatty foods, frequent colds, bloating, prone to unstable chair (alternating constipation and diarrhea). From history revealed that I had used the river fish. With ten years of age had pains in the right hypochondrium, sometimes accompanied by isterichnost eyes, bitter taste in the mouth, unstable stool, bloating, intolerance of milk. Was prone to frequent colds, suffered from chronic tonsillitis. In outpatient examination in the duodenal contents revealed eggs opistorhisov in large quantities. At endoscopy - duodenitis phenomenon. Treated choleretic drugs, antibiotics, were taken periodically, usually (usually yourself). The disease wore a recurrent nature, with exacerbations several times a year.

About 6 of phenomena exacerbation of chronic acalculous cholecystitis patient were treated by biltricide. After deworming regularly conducted Bessonova tyubazhi with a solution of sorbitol, took cholagogue.

For the 6 months that have elapsed since deworming, the condition has not improved significantly. Was admitted to the Department for an examination and treatment. Objectively, the condition is satisfactory. From respiratory and cardiovascular system without significant deviations from the norm. HELL 110/65 mm RT. Art. , P - 76 minutes, the Abdomen is soft, painful to palpation at the point of the gall bladder. Symptoms Ortner, Kera, Mussi (+). Liver 1 cm stands from under the edge of the costal arch. The spleen is not enlarged. Peripheral edema no. Data on laboratory studies: HB - 130 g/l, ESR - 8 mm/h, the erythrocytes of 4.3 t/l, leucocytes - 4.8 g/l, leukocyte formula unchanged, ACT - 20 ed, ALT - 15 units, total protein - 78 g/l, albumin - 55%.

Ultrasound examination of the abdominal cavity revealed signs of chronic cholecystitis (hardening, thickening and deformation of the walls of the gallbladder). At endoscopy - the phenomenon of focal atrophy of the mucosa of the antrum. When duodenal intubation in bile eggs opistorhisov not identified. When five-time study of the feces eggs glis the Nana helminthological cured. In the study of immune status showed signs of immune deficiency, characterized by the decrease of T-lymphocytes to 1.33 G/l, mainly due to reducing the number of T-subpopulations 0.35 G/l, reduced the index T/T to 1.5, Ig A - 2,96 g/l, Ig J - 17,44 g/l, Ig M of 2.21 g/l, according to the NBT-test (spontaneous - 11,34%, stimulated -14,06%) revealed reduction of oxygendependent metabolism of neutrophils. The level of the CEC raised to 100 conventional units.

The patient exhibited clinical diagnosis of chronic opisthorchiasis, residual period, chronic acalculous cholecystitis in a phase of moderate acute, secondary immunodeficiency syndrome.

The patient received treatment according to the method developed by us BAD gliburida 1 capsule on an empty stomach daily for 10 days, along with nicotina 1 tablet 3 times a day. The treatment was well tolerated, side effects are noted. Stoped signs of exacerbation of chronic cholecystitis. After 10 days (in-and outpatient) treatment continued: BAD glamoured 1 capsule on an empty stomach in the morning every day, while oxygenated 1 tablet 3 times a day after meals. 10 days after the end of therapy BAD gliburida and choleretic drugs in dynamics studies is of 2.51 g/l, Ig M - 1.56 g/l, Ig J of 13.2 g/l, CEC - 60 conventional units, nst-test: spontaneous - of 14.46%, stimulated for 29.3%.

We have analyzed the results of treatment of BAD gliburida with simultaneous appointment choleretic drugs in 20 patients with HO after deworming in age from 21 to 40 years. The treatment was tolerated everything well, adverse reactions to medications were noted.

The results of the research of the immune status are presented in table. As you can see, after a course of rehabilitation of patients after deworming we received a statically significant increase of T-lymphocytes (p <0,05), mainly due helper subpopulations, which undoubtedly had an impact in increasing index T/T from 1.32 0.1 to 1,63 of 0.9 (p <0,05). There was significant reduction of immunoglobulins a, M, E, and CEC with 89,14 5,02 to 52,12 to 3.06 (P <0,05). At the same time, significantly increased the activity of oxygendependent metabolism of neutrophils according to the NBT-test, with spontaneous 10,38 1,02% to 14,42 of 1.34%, stimulated with 13,96 2,14% to 33.26 2,07%.

Clinical observation of patients within 3 to 6 months after treatment in this way showed that they had significantly regressed clinical signs of chronic acalculous cholecystitis, Miami, that speaks of long persistent effect of the proposed method of rehabilitation on the immune system (at least 6 months). To secure this effect, it is recommended to have 2 courses per year on the proposed technique.

Thus, the method of rehabilitation of patients after HO deworming according to the proposed scheme, including the two-step course of rehabilitation with simultaneous appointment of nicotine and BAD glyburide within 10 days at the first stage and using 10 to 14 days in the second phase of rehabilitation within 7 days BAD glyburide and oxygenated, allows to achieve the desired effect, namely to reduce the side effects of HO on the digestive organs (chronic cholecystitis, chronic pancreatitis, hepatitis and others), to achieve a more lasting effect, thereby to increase the efficiency of rehabilitation of patients with HO after deworming.

Sources of information

1. Migdalovitz M., the Clinical significance of immunoregulatory functions of neutrophils in the blood of patients with opisthorchiasis before and in the dynamics after treatment with biltricide. Abstract. dis. ... candles. the honey. Sciences. - Tyumen, 1996, 18 S.

2. Fingers A. I. Pathology of the digestive system chronic opisthorchiasis. Pathomorphosis, calcev A. I. Comprehensive therapy and the immune status of patients with chronic opisthorchiasis // Scientific session dedicated to the 100th anniversary of Novosibirsk. Sat. works. - Novosibirsk, 1994, S. 111.

4. Kashuba, E. A., Krylov Century.. Manankov Century. P. and other immune system in opisthorchiasis in children before and after treatment. // Honey. parasitol. and parasiten. disease. - 1985, No. 2, S. 12 - 16.

5. Boykin C. F. clinical consequences of deferred opisthorchiasis and criteria helminthological recovery. Dis. ... candles. the honey. Sciences. - Novosibirsk, 1990, 130 S.

6. Clinical immunology / edited by A. C. Karaulov. - M.: MIA, 1999, S. 335 - 345, 540 - 570.

7. Stralis A. K. , wolf C. T., Limberg Century. P and other Tuberculosis and bronchial asthma on the background of opisthorchiasis. Tomsk, 1988, S. 160 - 175.

8. Krivtsov L. A., Lawahini N. M. The dynamics of clinical and immunological parameters in opisthorchiasis in children depending on the application of different anthelmintic drugs // Pediatrics, 1990, N 2, S. 51 - 54.

9. Kalugin O. C., Fuchs B. B., Bovin N. In. and other Immunomodulating activity of new derivatives of muramyldipeptide in vitro // bul. the experimental. biology and medicine, 1994, No. 5, S. 510 - 513.

10. Y. Kalugin O. C. Derivatives muramyldipeptide in experiment and clinic // Microbiology of bacterial cell walls and muramil peptides. // Federal. Proc., 1986, v.45, p. 2534 - 2540.

12. Lefrancier P., Lederer E. Muramil-peptides. // Pure and Appl. Chem., 1987, N 59, p. 449 - 454.

13. . K. Immunopharmacology of muramil-peptides. // Federal. Proc., 1986, v.45, p. 2549 - 2551.

1. The method of rehabilitation of patients with chronic opisthorchiasis after deworming, involving simultaneous appointment immunomodulator and choleretic drugs, characterized in that as an immunomodulator designate the BAD glamoured, and rehabilitation carried out in two stages: at the first stage after 3 to 6 months after deworming simultaneously appoint the BAD glamoured 1 capsule on an empty stomach in the morning of 1 times a day, nikodin 1 tablet 3 times daily after meals for 10 days, after 10 to 14 days of conducting the second phase of rehabilitation: at the same time appoint BAD glamoured 1 capsule in the morning on an empty stomach 1 per day and choleretic drug oxygenated 1 tablet three times daily after meals for 5 to 7 days.

2. The method of rehabilitation of patients with chronic opisthorchiasis after deworming under item 1, characterized in that, repeat the treatment 2 times a year.


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