Method of treating patients with non-proliferative diabetic retinopathy

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ophthalmology, endocrinology and restorative medicine, and may be used to treat the patients with non-proliferative diabetic retinopathy. For this purpose, with underlying background individual antidiabetic therapy, endonasal electrophoresis with 0.1% Semax in a daily dose of 700 mcg is applied in a patient lying on his/her back. A bifurcated positive electrode is coated with cotton swabs each of which is moistened with 7 drops of Semax. These electrodes are introduced into the middle nasal passages. At the same time, a cathode spacer of the second negative electrode 8×10 cm is moistened with 2% aminophylline and placed in the back of the neck. The current intensity is 1.2 mA. The exposure length is 20-22 minutes. The therapeutic course is 8-10 sessions, daily or every second day.

EFFECT: provided therapeutic effect in the early stages of the disease, including in the patients with severe comorbidities, as well as slow progression of the retinal pathological process, and stabilised long-term result up to 6 months.

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The invention relates to medicine, in particular for rehabilitation medicine, ophthalmology and endocrinology, namely the treatment of nonproliferative diabetic retinopathy. The method can be used in medical practice in rehabilitation, inpatient and outpatient treatment of patients with nonproliferative diabetic retinopathy and can be used in medical institutions.

Diabetic retinopathy is one of the most frequent and severe complications of diabetes (I, II), developed almost 90% of patients with diabetes at different times after its occurrence. In recent years, registered an increase in the frequency of this pathology, which now became one of the main causes of irreversible blindness in people of working age, which creates a serious medical and social problem in many countries of the world.

Based diabetic retinopathy lies microangiopathy, which is one of the characteristic manifestations of diabetes, which is generalized in nature. Among the various reasons for the development of diabetic retinopathy are immunological, metabolic, hormonal, hemorheological, hypoxic, genetic and other factors, sequentially or simultaneously causing damage to the walls of capillaries in the retina and is Arseniy vascular permeability. The problem of treatment, especially early (preventive) treatment, this disease continues to be very difficult. To date, the treatment of nonproliferative diabetic retinopathy is carried out in several directions - conservative therapy and laser treatment.

For the treatment of diabetic retinopathy is used a large number of drugs (peritol, devaskar, dicine, doxium, aspirin, tocopherol, mega-plasma-antirom and others). However, many of them have not stood the test for efficacy in randomized trials. Recently developed various methods for correction of hemostasis disorders in diabetic retinopathy: the introduction of plasminogen activators, heparin in the form of inhalation, intravascular laser irradiation of blood (Evgrafov VY Diabetic retinopathy: pathogenesis, diagnosis, treatment, 1996). However, despite the application of these methods often fail to achieve the desired functional results, the disease continues to progress. It is known that the most effective method of treatment for diabetic retinopathy at present considered to be the coagulation of the retina (Pluhova O.A., Koeman I.G., Eneva YA. The effectiveness of laser therapy depending on the stage of diabetic retinopathy, 1983; ETDRS report number 19, 1995).

In particular, when non-proliferative stage of retinopathy, it applies with clinically significant macular edema. Edema macular area is one of the main causes of visual impairment in diabetes. Although this condition is an indication to perform focal coagulation, deposition coagulates on edematous retina, as a rule, is quite problematic. In addition, there are cases when this procedure exacerbates the severity of the patient's condition due to the subsequent development of fibrosis (EPI - and subretinal), development of macular edema, the provocation of new hemorrhages in the retina, exudative detachment of the choroid. It should be noted that the stabilization process in patients with diabetic retinopathy with underlying medical conditions (hypertension, nephropathy, General atherosclerosis, arthritis, and others) noted several times less, than patients who are not burdened by these diseases. Thus, despite the availability of coagulation of the retina as the "gold standard" in the treatment of diabetic retinopathy, it does not affect the level of sugar and has its limitations and contraindications.

Therefore, at the present time remains the important question of the study of the new conservative, safe and non-invasive ways to keep the functional integrity of the retina at Bo is lnyh diabetes. As in the initial stages of development of retinopathy is extremely important to maintain normal functioning of the nervous tissue of the retina and optic nerve (Marchenko LN. Neuroprotection in diseases of the retina and optic nerve, 2003), often used combined antioxidant and neuroprotective therapy.

From clinical practice there is a method of treatment of diabetic retinopathy using tissue therapy (biogenic stimulators from the distillation Firth mud - phibbs, a suspension of the placenta). It is known that these drugs affect the metabolism through enzymes have antihypoxic effect and contribute to the resorption of hemorrhages, exudates and stabilization of the pathological process (Georgian E.A., Lakiza CENTURIES, Perminov I.A., Kashentseva LT tissue preparations in treatment of patients with diabetes mellitus, 1981). The disadvantage of this method are many contraindications: acute infectious diseases, acute inflammation, severe liver and kidney dysfunction of these organs, cardiovascular disease, severe hypertension, acute gastrointestinal disorders, active tuberculosis, pregnancy. Notes this complication, as the frequent occurrence of infiltration at the injection suspensions Platz the options. Having initially a tendency to suppurative processes and infiltrations, patients with diabetes require special care when performing data manipulations, which should be done only in a hospital environment. It is not possible to use such drugs in all patients with diabetic retinopathy.

From clinical practice known means, positively influencing the function of neural tissue of the retina - peptide bioregulators (hereinafter Cortexin, epithalamin, ritilin) (RF Patent 2123829, December 27, 1998; Kuznik B. I., Morozov V.G., Khavinson V.H. Cytomedines (25 years of experience in experimental and clinical studies), 1998). These funds regulate the metabolism of nervous tissue, have a positive impact on fibre optic nerve and trigger mechanisms of self-regulation in neurons of the retina, and also capable of increasing the activity of antioxidant blood system and can have a positive effect on carbohydrate metabolism (lowering of blood glucose, glycosuria and level of glycated hemoglobin in patients with diabetes mellitus) (Morozov V.G., Khavinson V.H. New class of biological regulators multicellular systems - cytomedines, 1983). How is that on the background of basic therapy antidiabetic drugs once daily at the same time introducing the complex of peptide bioregulators, ritalin - pairs is bulbaro, and Cortexin and epithalamin intramuscularly to achieve a therapeutic effect. The disadvantage of this method of treatment is the high cost of drugs, and the need for invasive route of administration (by parabulbar injection) and the potential development of future vascular, inflammatory and infectious complications in orbit.

Also known is a method of treatment of patients with nonproliferative diabetic retinopathy with the use of transcutaneous laser irradiation of blood (patent application No. 2008143172/14, 30.10.2008, outside VA, Gurko T.S., Yablokova NV). This method of treatment of diabetic retinopathy is FMS (frontal, temporal and occipital lobe of the brain is simultaneously affected by varying pulsed magnetic field). This improves retinal blood flow (Doppler data), suspended the process of diabetic changes in the retina, in the course of treatment improves the General condition of patients, in particular normal blood pressure without the use of drugs, improve visual function. The disadvantage of this method is the presence of extended contraindications to the use of magnetic therapy in patients with cardiovascular disease, which typically suffer from diabetic PAC the coefficients. These are: pathology of the blood coagulation system, the presence of a pacemaker, systemic blood diseases, thrombosis and recurrent thromboembolic complications, aneurysm of heart, aorta and large vessels, cardiovascular collapse above stage II and severe heart rhythm disturbances and conditions after acute myocardial infarction.

The closest in technical essence to the proposed method is "a Method of treating diabetic retinopathy" (Patent RF №2140302, Appl. 10.10.97,, publ. 27.10.99, BI No. 30). This method involves complex pharmaco-physical therapy eye treatment - preliminary introduction of drugs and effects on eyes low frequency electromagnetic field and a constant magnetic field with the help of physiotherapy apparatus of Infita"which emits a quasi-stationary electric field of low frequency and low intensity, with the use of medicinal substances (emoxipin or dicynone)introduced locally by means shown for this patient: retro, parabulbarno, subkonyunktivalno or drip. Way affects the overall hemodynamics, neuroemotional, microcirculation, and also provides adhesive and anti-inflammatory effect.

The disadvantages of this method are cumbersome procedure is s, its invasiveness, i.e. the need for injections, and also a relatively short period of stability obtained positive effect for 2 months. In addition, the study of the efficiency of this method was conducted in patients with later, preproliferative stage of diabetic retinopathy, i.e. at the stage when, as a rule, the "gold standard" of treatment and absolute indication is laser coagulation of the retina. The disadvantage of this method is the presence of extended contraindications to the use of magnetic therapy in patients with cardiovascular disease, which usually affects the majority of diabetic patients: disorder of the blood coagulation system, the presence of a pacemaker, systemic blood diseases, thrombosis and recurrent thromboembolic complications, aneurysm of heart, aorta and large vessels, cardiovascular collapse above stage II and severe heart rhythm disturbances and conditions after acute myocardial infarction.

The technical result of the proposed method of treatment of nonproliferative diabetic retinopathy is the improvement of the objective functional parameters of the visual analyzer: improved visual acuity; improving peripheral indicators, i.e. foveolar and average speed sets the TCA; reducing the number and depth of absolute and relative cattle; improvement in electrophysiological studies - threshold electrical sensitivity, the lability of the optic nerve and the critical frequency of flicker fusion; increase adaptometry indicators - increase in the rate of adaptation of the visual acuity and adaptation of the light sensitivity of the retina; and therapeutic effect in the early stages of the disease, slow the progression of pathological retinal process in patients with diabetes mellitus, stabilization obtained a positive result in the long term for up to 6 months and the possibility of applying this method in patients with severe concomitant diseases.

This technical result is achieved by introducing the patient to the background of the individual base hypoglycemic therapy of 0.1% solution of the drug Semax, in a daily dose of 700 μg, through the influence of a constant electric current, while the peptide is injected from the anode: forked positive electrode impose cotton pads, each of which is moistened with 7 drops of this drug, the electrodes are injected into the middle nasal passages; at the same time the gasket 8×10 cm moistened with 2% solution of aminophylline, have in the area of the rear surface of the neck and connected to the second the negative electrode current is 1.2 mA, duration of exposure - 20-22 minutes, in the course of treatment 8-10 sessions, sessions performed daily or every other day.

Physical and therapeutic effects of direct electric current on the mechanism of action is based medicinal electrophoresis method, occupies a significant place in the treatment of diabetic retinopathy because of its ability to exert anti-inflammatory, trophic, hyposensitizing and anti-sclerotic effect. When endonasal electrophoresis is used continuous galvanic current, which has a distinct influence on the functional state of the Central and autonomic nervous system, has analgesic properties, helps regulate the functions of the endocrine system, stimulates the processes of regeneration and repair of tissues. Medicinal substances introduced into the body by electrophoresis, come in tissues active in ionic form. In the posterior pole of the eye creates a depot of the drug that allows you to prolong its action, without violating the integrity of the skin and mucous membranes. This is easily overcome hematomyelia barriers and there are no adverse reactions.

So endonasal technique is used in pathological processes, locality is already in the fundus and posterior layers of the vitreous body. Endonasal electrophoresis allows the shortest way to bring the medicinal substance to the posterior pole of the eye. Topographical proximity of the place of introduction of the drug from the pathological focus, and netreflector effects are the advantage of this method of administration.

In recent years, more attention has been paid to studying the properties of neuroprotective drugs that provide effective multilateral impact on many elements of the nervous tissue and the Central nervous system. Preference for treatment of diabetic retinopathy have the funds related to the secondary neuroprotective agents, mechanism of action which aims to interrupt delayed neuronal death. Drugs of this number is required in the treatment of diabetic retinopathy because diabetes is extremely important to protect cellular elements of the retina and optic nerve. Of neuroprotective drugs is the most effective use of neuropeptides, which has, in addition to neuroprotective, also antiischemic and antioxidant properties.

One such medicines peptide is the peptide, developed at the Institute of molecular genetics RAS (patent of the USSR N939440, SS 103/52, 1981). It protects, antioxidant and nootrop, a synthetic analogue of a fragment of ACTH 4-10, heptapeptide, completely devoid of hormonal the th activity (Met-Glu-His-Phe-Pro-Gly-Pro-OH), protected from gidrolizuemye peptidases (C39H55N9O12S, molecular weight 873,97) (Ashmarin I.P. et al. - Nootropic similar adrenocorticotropin 4-10-Semax (15-years experience of development and learning), 1997; Ponomarev-Stepnoi M.A. et al. - Analogue of ACTH 4-10 - stimulator training prolonged action, 1984). The mechanism of action of its aims to improve the conduction of nerve impulses in cholinergic neurons. The peptide contributes to a significant increase in the activity of the enzyme acetylcholinesterase specific structures of the brain (which is accompanied by improvement of the processes of learning and memory formation), affects the conductivity electrotehnicheskogo of the synapse between the two neurons (proved through 14-30 minutes after its administration at a dose of 200 nmol is twofold increase of the coefficient of transmission of nerve impulse), and the conductivity improvement lasts for 5-6 hours the Drug has a long duration of action and high resistance in the body (half-life time of several minutes, and therapeutic effect after a single dose lasts from 24 to 48 hours), and it has no toxic and side influence. This neuropeptide has a positive pharmacological effect on structural elements of the Central nervous system (Ashmarin et al. Not opny similar adrenocorticotropin 4-10 - Semax (15 years experience), 1997), and neural tissue of the optic nerve and retina (Polunin et al. Determination of therapeutic efficacy of a new domestic Semax in diseases of the optic nerve, 2000). And affects the acceleration of regenerative processes of the nervous tissue (which is necessary in the treatment of diabetic ophthalmic and neurological complications). These properties pharmacotherapeutic determine the reason for its use in the initial stages of nonproliferative diabetic retinopathy (in the treatment of nonproliferative diabetic retinopathy Semax up to the present time was not used).

Semax is introduced by the action of a continuous electric current, i.e. the method endonasal electrophoresis, which contributes to neuroelectronic impact on pathological lesions and biological stimulation. Current 1.2 mA has a more stimulating effect compared with rated current 1.0 mA, contributes to a more pronounced activation of blood circulation, provides increased activity of the processes of cellular metabolism and a more active delivery of a drug Semax to the posterior pole of the eye. Thanks to the exposure time in 20-22 minutes in the surrounding tissues and pathological focus creates a stable and rich medicinal depot, pic is bluuuue extending action of the peptide. 2% solution of aminophylline facilitates the efficient delivery of peptide and potentiates its action is due to the antispasmodic and positive hemodynamic effects. The treatment is carried out on the background of basic individual hypoglycemic therapy.

The specified parameters of the physical impact factor, the strength of the electric current of 1.2 mA and the duration of exposure 20-22 minutes, is well tolerated by patients, have a positive impact on the dynamics of the objective functional parameters of the visual analyzer, contributing to the potentiation of neuroprotective, anti-ischemic and anti-oxidant properties of the medicinal product Semak. To date the peptide for the treatment of retinal pathology in diabetes has not been used, and the possibility of its application as a means of rehabilitation therapy in patients with nonproliferative diabetic retinopathy (diabetic retinopathy in General) is not described.

According to the claimed invention, Semax 0.1%entered using a constant electric current, the effect on the pathogenetic mechanism for the development of diabetic retinopathy, the use of this method in the treatment of patients with nonproliferative diabetic retinopathy can improve visual function and to stabilize them at that level for a period of up to 6 m is months. In particular, revealed that the rates of application of this method of treatment in patients with nonproliferative diabetic retinopathy provide significant therapeutic effect with improvement of visual acuity, decrease in the number of relative and absolute cattle, improvement of computer and peripheral electrophysiological parameters and save this functional result up to six months.

Description of the method

The method is as follows: diabetic patient, the treatment of which is on the background of basic individual hypoglycemic therapy, lying spend endonasal electrophoresis 0.1% solution of the drug Semax in a daily dose of 700 μg, forked positive electrode impose cotton pads, each of which moisten 7 drops drug Semax, the electrodes are injected into the middle nasal passages, while the second strip, the negative electrode, the cathode, the size of 8×10 cm, moistened with 2% solution of aminophylline and have in the back of his neck. Current is 1.2 mA, duration of exposure - 20-22 minutes, in the course of treatment 8-10 sessions, sessions performed daily or every other day. The method has a beneficial effect on visual function.

Examples of the method

<> Example 1. Patient F., 62, was observed with a diagnosis of OI - nonproliferative diabetic retinopathy, presbyopia. Diabetes diagnosed 14 years ago, the diagnosis of diabetic retinopathy exposed 2 years ago, the condition was characterized by a slow decrease in visual acuity and subjective sense of deterioration of vision. On initial examination, the visual acuity of the right eye of 0.6, the left - 0,7, not corrects. The fundus of the eye: OI disks of optic nerves pale pink, clear boundaries, the arteries narrow, veins irregularly expanded in the macula - point hemorrhages, microaneurysms, medium size soft exudate under vernaison vascular arcade of the right eye. In the field of vision of both eyes - bilateral peripheral relative scotomas, some of the absolute. On the background of basic individual glucose-lowering therapy assigned endonasal electrophoresis of Semax 0.1% with 2% aminophylline, in the course of 10 sessions. Used current of 1.2 mA, exposure time 20 minutes. As a result of the treatment, the visual acuity improved from right to 0.8, from left to 0.9 to 1.0. When ophthalmoscopy revealed that both eyes decreased significantly the number of hemorrhages, soft exudates on the right under the vascular arcade disappeared. This increased computer static perimetric indices: the foveolar sitecounter the ity of the retina increased in my right eye from 29 to 32 dB, on the left is from 31 to 35 dB. The average sensitivity of the retina increased from 20.8 to 23.5 dB in my right eye, on the left - from 22.2 26.7 dB. Improved electrophysiological indicators: decreased threshold electrical sensitivity from 63 to 56 µa right, from 61 to 54 µa left, grew critical frequency of flicker fusion 30 to 34 Hz to the right, to the left is from 30 to 32 Hz. In the study on adaptometry positively changed the time of adaptation of the visual acuity (average 3.6), decreased the rate adaptation speed 3.8 C. Subjective patient survey noted the improvement in your vision: enhancing brightness, color and contrast of objects.

Example 2. Sick,, 58 years old, diagnosed with non-proliferative diabetic retinopathy in both eyes, clinically significant macular edema in the left eye. Diabetes diagnosed 4 years ago, the diagnosis of diabetic retinopathy exhibited about a year. Noted periodic foggy and reduced vision in his left eye in the last 6-7 months. Visual acuity of the right eye - 1,0, left - 0,5, not corrects. When ophthalmoscopy left eye optic disc pale pink, clear contours, veins are enlarged, twisted. In the macular region - Pravoberezhny swelling of the retina with a diameter of 1.0 DD (the diameter of the optic disc), around a single microa is eurythmy, dot hemorrhages; the visible periphery without gross changes. On the left eye of the peripheral field of view at a white object in the normal Central field of view relative few cattle. On the background of basic glucose-lowering therapy assigned endonasal electrophoresis 0.1% Semax (daily dose of 700 μg) with 2% aminophylline No. 10 was applied current of 1.2 mA, exposure time of 22 minutes, the course of 10 sessions. After treatment, the visual acuity of the left eye was restored to 0.9, foveolar the light sensitivity of the retina increased from 28 to 33 dB, the total light sensitivity - from 18.8 to 23.4 dB. The critical frequency of flicker fusion has improved from 30 to 33 Hz, the threshold electric sensitivity decreased from 62 to 58 μa, the lability of the optic nerve arose from 39,4 to a 44.2 Hz. If adaptometry positively changed the rate of adaptation of the visual acuity (average 2.9), decreased the rate of adaptation of the sensitivity of the retina - 2.8 C. Complaints to feeling of "hazing" view of patient no survey notes the increase of visual acuity and sense of increasing the brightness of the vision.

The proposed method of treatment was conducted on 52 patients. All patients were previously surveyed (52 patients, 104 eyes). All patients had a diagnosis of diabetes mellitus type II, 36 of them are women and 16 men, aged 42 to 70 l is t (the average age of 62.3±5.7 years). The study included patients with diabetes mellitus type II with initial and moderate stages of nonproliferative diabetic retinopathy (in accordance with a modification of the classification of diabetic retinopathy : ETDRS on Liebelei (2004)). The exclusion criterion was laser coagulation of the retina in history and primary open-angle glaucoma. Prescription diagnosis of diabetes ranged from 3 to 12 years old, diabetic retinopathy from 6 months to 8 years.

Ophthalmologic examination of patients was performed according to the General scheme: examination of visual acuity, biomicroscopy, ophthalmoscopy, the study of the field of view on the projection perimeter Octopus 101 at a white object on a specialized diabetes computer program. The function of the inner layers of the retina and axial beam optic nerve was evaluated by the method of determining thresholds electrical sensitivity and lability of the optic nerve. Researched than the critical frequency of flicker fusion; conducted adaptometry in the dynamics (the study of adaptation, visual acuity, and adaptation of the sensitivity of the retina). In addition, there was conducted a special survey to assess subjective changes in the quality of vision. The survey was conducted before, after treatment and after 6 months. Treatment was performed by f is the base of hypoglycemic therapy. Statistical processing of the research results was carried out using the methods of variation statistics, which confirmed their authenticity.

As a result of the proposed treatment method of patients had significant improvement of visual acuity on average by 0.16±0,01 (p<0.05)and the positive dynamics of this indicator was observed in 83.6% of cases. In the long term (6 months) after end of treatment, patients showed a slight decrease in visual acuity compared with the results obtained directly after treatment, this indicator remained significantly above the original results, on average, 16.2% (0,12±0,02) (p<0,05).

The computer static perimetric studies after treatment showed a significant increase in the average sensitivity of the retina in an average of 3.9±0.1 dB (17,7%) (p<0.05) and indicator foveolar speed 5.6±0.2 dB (20,0%) (p<0,05). This decreased size, depth and number of relative and absolute cattle, some of which were transformed into relative. In General, the positive dynamics of the perimeter of the indicators was observed in 82,9% of patients. Perimetric examination in the remote period showed a slight tendency to decline foveolar and average svetachev is titelliste retina, obtained after treatment, which, however, remained significantly elevated compared to the original performance.

Analyzing electrophysiological indices obtained after treatment, the observed increase in performance critical frequency of flicker fusion in the average rate of 6.1±0.1 Hz (20,7%) (p<0,05). Indicator threshold electrical sensitivity decreased on average by 8.1±0.2 µa (12,8%) (p<0,05). Figure lability of the optic nerve has greatly improved on average by 5.8±0.3 Hz (15,6%) (p<0,05). In General, a certain positive dynamics of electrophysiological parameters was noted in 76.9% of cases. After 6 months of treatment there was a slight decrease investigated electrophysiological parameters, which remained significantly higher than baseline values. Positive changes are investigated electrophysiological parameters were preserved in 71,2% of cases. When the statistical processing of the results revealed that the speed of adaptation of the visual acuity decreased after treatment in an average of 39.2% (23,5±4,3, p<0,05). Positive dynamics after treatment was noted in 83,7% of cases. 6 months after treatment positive changes in the rate of adaptation of the visual acuity remained in 78,8%.

In the primary study, the adaptation time of the light sensitivity of the CE is chutki amounted to an average of 15.5±0.7 s, that also turned out to be somewhat worse than the age norm (7-9). After the course of treatment this indicator has improved on average by 32.9%) (5,7±0.6), p<0,05. Positive dynamics was observed in 87.5% of cases. In the long term significantly increased the value of the adaptation speed is preserved in 75,9%.

Thus, the treatment approach in patients with nonproliferative diabetic retinopathy improved clinical and functional characteristics of the visual analyzer: improved visual acuity, decreased the number and depth relative and absolute cattle, increased rates foveolar and the average sensitivity of the retina, improved electrophysiological indices, indices of adaptation of the visual acuity and adaptation of the light sensitivity. The method is effective, which is confirmed by the statistically significant difference between the original and "posttherapeutic" indicators of visual acuity, total and foveolar light sensitivity of the retina, the critical frequency of flicker fusion and adiposetissue indicators, as well as stabilization and conservation received positive treatment results in long-term period up to 6 months.

All patients with nonproliferative diabetic retinopathy after treatment subjects is noted on the improvement of visual acuity and contrast. Adverse reactions or worsening of visual function of patients not reported. Thus, the study showed that the timely inclusion of the peptide in the complex therapy of diabetic retinopathy at an early stage of its development has a beneficial effect on the severity and pace of the recovery processes, contributing to the improvement of visual functions.

Application of the proposed method for the treatment of nonproliferative diabetic retinopathy contributes to effective protection of neural tissue of the retina and optic nerve from the effects of hypoxic damage. Well documented positive clinical dynamics, estimated to increase visual acuity, foveolar and average total sensitivity of the retina and the positive changes the field of view, increased electrical sensitivity and conductivity of the optic nerve, to improve temporal parameters of the adaptation visual acuity and adaptation of the light sensitivity of the retina.

All this allows us to recommend the above method as neuroprotective, antioxidant, anti-ischemic and neuroprotective treatment in complex restorative treatment of diabetes patients with initial stages of nonproliferative diabetic retinopathy.

A method for the treatment of nonproliferative di is piticescu retinopathy by introducing medicinal substances physical factor characterized in that on the background of basic individual hypoglycemic therapy in the prone position, the patient is exposed to a continuous electric current, namely, the conduct endonasal electrophoresis 0.1%solution of the drug Semax, in a daily dose of 700 μg, forked positive electrode impose cotton pads, each of which moisten 7 drops drug Semax, the electrodes are injected into the middle nasal passages; at the same time laying the second negative electrode, the cathode, the size of 8×10 cm, moistened with 2%solution of aminophylline and placed in the posterior surface of the neck; power current is 1.2 mA, duration of exposure - 20-22 min, treatment 8-10 sessions, sessions performed daily or every other day.



 

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SUBSTANCE: present invention refers to medicine and described a water-based liquid composition for activation of intraocular penetration of a compound of formula (I) containing an amide compound, and an agent forming an ionic pair. What is also described is a method for activation of intraocular penetration of the compound presented by formula (I), and using the compound prepared by formula (I).

EFFECT: invention provides activation of penetration of the compound of formula (I), as well as maintaining the pre-set concentration of the drug preparation, even if a periodicity of the composition administration is reduced.

14 cl, 7 tbl, 2 dwg, 4 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to a galvanic particle consisting of zinc, partially copper-plated. A galvanic particle size is equal to nm to 100 mcm, while copper weight therein makes 0.01-10 % of particle weight. The galvanic particles under the invention may be prepared by contact of the zinc particles and a copper salt solution. The invention also refers to a pharmaceutical composition which contains an effective amount of said galvanic particles and a bioabsorbed polymer, and to an oral dosage form containing an effective amount of the galvanic particles under the invention, and a pharmaceutically acceptable carrier. The invention also refers to a method for destruction of drug-resistant microorganisms involving contact of a microorganism and the composition containing the carrier and said galvanic particles.

EFFECT: invention provides preparing galvanic pairs applicable for drug delivery.

16 cl, 19 tbl, 20 ex

FIELD: medicine.

SUBSTANCE: bladder is released, washed with distilled water, and a drug solution is introduced therein. An intrabladder electrode representing a catheter provided with a cylinder on its proximal end and three tips on its distal end, as well as with an electrical conductor with its distal end coupled with a current source. One of the tips is used to fill the cylinder with air or physiological saline, and another one - to introduce drug substances, and the electrical conductor is wired through the third tip. On a proximal end of the catheter, there are window openings for liquid injection and ejection from a bladder cavity. At a level of these openings, inside of the catheter, there is a steel guide presented in the form of a symmetrical single spiral wound with turns touching of the diametre matched with an internal diametre of the catheter, and of the length 1/3 exceeding the length of said openings. An external electrode is presented in one layer of pull-ups made of a combined cloth consisting of elastane, wool and metal in the relation of 1:16:16. The electrode is processed by a conducting gel used to coat pelvic and perineal regions.

EFFECT: improved drug penetration into bladder tissues, including in patients with decreased physiological volume of bladder ensured by more tight adherence of the external electrode to the pelvic and perineal regions and increased skin current conductivity, eliminated direct contact of the intrabladder electrode with a bladder mucosa, avoiding injuries of the bladder walls.

2 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to obstetrics. Method includes performing electrophoresis with galvanic current to pregnant women in terms from 22 to 37 weeks. Electrophoresis is performed with 2.4% of eufyllinum solution in dose 20 ml per one procedure. Impact is performed on uterus projection. Anode is placed on anterior abdominal wall in zone of fundus of uterus projection. Cathode is placed on lumbosacral region. Procedure duration is 20 minutes. Course of treatment includes 5-7 procedures.

EFFECT: method ensures prevention of antenatal death of fetus due to relief of fetoplacental insufficiency manifestations, normalisation of placenta tropphism and elimination of hypoxic state of fetus.

4 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely dentistry, physiotherapy. A method involves application of Nizhneivkinskoe silt sulphide mud bags on the temporomandibular region. Mud temperature is 35-40 degrees. Electrodes are connected to the bags. A current low-intensity current is supplied. A current density is 0.05-0.3 mA/cm2. Exposure time is 10-30 minutes. The procedures are performed every second day. The therapeutic course is 10-20 procedures.

EFFECT: method provides higher clinical effectiveness and may be used in the patients with hemophilia.

4 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry and is intended for treatment of alveolar nerve trauma in dental implantation. Trapezoidal cut starting in retromolar region to medial part of canine is made. By means of apparatus "Piezosurgery" at angle 45° osteotomy in form of a rectangular window is made. Bone autotreansplant is formed. Through obtained bone window inferior alveolar nerve is taken on ligatures. Dental implant is removed. Bone wound is washed with 1% solution of dioxidine and processed through 0.05% miramistin solution for 5 minutes by waveguide from apparatus "Optodan". Bone defect is covered with autotransplant, resorbable membrane "Paradonkol" and muco-periosteal flap. Wound is sewn with interrupted sutures and isolated with film with metronidazole from oral cavity. Phonophoresis with 0.5% hydrocortisone solution, 10-12 procedures per course, amplipulse-phoresis with 2% nicotinic acid 10-12 procedures per course, acupuncture in Valle points - in places of entrance and exit of inferior alveolar nerve from lower jaw, 10-12 procedures per treatment course with measurement of indices of electroexcitability of skin of chin, cheek, mouth angle and pulp of teeth with application of apparatus PARKELL I time per day are performed.

EFFECT: method makes it possible to reduce operation trauma, reduce period of complete recovery of sensitivity in respective zones of face skin and pulp of teeth, innervated by inferior alveolar nerve due to carrying out complex therapy and constant control of indices of electroexcitability of respective face zones.

3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely - to therapy, physiotherapy. A method involves electrophoresis of an area of right hypochondrium. Interstitial carnitine electrophoresis is applied. The area is exposed to sinusoidal modulated currents of modulation frequency 70 - 100 Hz, modulation percentage 25 - 50 %, and marking interval 2-3 seconds. Carnitine is prescribed orally 20-30 minutes before the beginning of the procedure in the form of 20 % aqueous solutions 3 g. The procedures are daily. The therapeutic course is 10 procedures.

EFFECT: method improves clinical effectiveness ensured by better intrahepatic haemodynamics, normalised functional state of the liver, lipid and protein metabolism.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely neurology, physiotherapy and is applicable for treating peripheral and central paralysis and paresis of various aethiologies. A method involves drug therapy and electrical stimulation of paretic muscles. The drug therapy is conducted by the endonasal and superior thoracic electrophoresis procedures with galantamine. The electrical stimulation represents exposure to multiple-modulated bipolar current of frequency 20-120 Hz with package to pause relation 1:1. Additionally the muscles symmetric to paretic ones and a projection of peripheral and vegetative nervous system are treated by the two-side exposure. Duration of a procedure is 10-30 minutes. The therapeutic course is 10-15 procedures either daily, or every second day.

EFFECT: method provides higher clinical effectiveness ensured by exposure on slow and quick motor units, reduces probability of complications, enables recovered natural motor coordination that substantially improves life quality of the patients and their social adaptation, reduces invalidisation.

3 ex, 5 cl

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely neurology, and is applicable for treating damaged intervertebral discs. That is ensured by conservative management. The latter is added by combined dimephosphone therapy by the dimephosphone intake and the electrophoresis procedures with 1.5% dimephosphone solution. The dimephosphone electrophoresis is conducted in 1.5 hours after the morning and evening dimephosphone intake. A cathode is applied directly on a projection of a damaged spine. An anode is applied on an inferior cervical or lumbosacral spine. The therapeutic course makes 15 electrophoresis procedures of 15-20 minutes.

EFFECT: method provides higher clinical effectiveness in damaged intervertebral discs of the cervicothoracic and lumbosacral spine ensured by the selected dose schedule of dimephosphone providing simultaneous intake of dimephosphone introduced orally, from blood into the damaged segment and deposition in subjacent tissues of ionised dimephosphone introduced by the electrophoresis that leads to prolonged therapeutic action of the preparation.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to - physiotherapy. A method involves motion state, dietary nutrition, ingestion of mineral water, mineral water baths. The motion state is partial load or partial load training. The nutrition complies with No. 5 diet. Low-mineralised low-carbonate sulphate-hydrocarbonate sodium-calcium mineral water is taken. The mineral baths are taken with low-carbonate sulphate-hydrocarbonate sodium-calcium mineral water at temperature 36-37°C for 15 minutes; the therapeutic course is 8-10 procedures. Galvanic current electrophoresis is additionally applied. An interscapular region is exposed to an anode with the use of 3% magnesium sulphate, while a lumbosacral region is exposed to a cathode with using 3% sodium thiosulphate. An intermediate layer area of each electrode is 300 cm2, current intensity is 15-20 mA. The procedures are daily. The therapeutic course is 6 procedures. Then the same regions are exposed to electrophoresis with using the same substances by sinusoidally modulated rectified current, II-IV operation modes, by 4-5 minutes for each operation mode. The depth of modulation is 75-100%. The current intensity is 12-25 mA. The procedures are daily. The therapeutic course is 6 procedures.

EFFECT: method provides more effective body rehabilitation ensured by normalised antioxidant system.

3 ex, 6 tbl

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology, ophthalmic surgery, physiotherapy. In case of localization of inflammatory focus in orbit without involvement into the process of paraorbital areas hospitalisation of patient into ophthalmology department of hospital is carried out. Orbitotomy in one or more quadrants is performed. Traditional intensive therapy is carried out. In case of intraorbital complications second stage of treatment is carried out. 1% solution of nicotinic acid is introduced intravenously in dose 2 ml on the first day, with daily 0.5-1.0 ml increase on the following days until maximal therapeutic efficiency is achieved, after that, successively dose is daily reduced by 0.5-1.0 ml to initial dose. Additionally after each injection of nicotinic acid, intravenous drip infusion of 2% pentoxifylline 5 ml on physiological solution in dose 100-200 ml is carried out during 7-15 days. Parabulbarly dexason 0.4% in dose 0.5 ml is introduced. Intramuscularly introduced are lidase in dose 64 U, actovegin in dose 2 ml and proserin 0.05% in dose 1 ml daily during 10 days. Electrophoresis with 0.05% proserin is carried out alternately with 0.5% hydrocortosone emulsion endonasally in case of optic nerve neuritis and bath method - in case of affection of eye-moving muscles with course of 10-15 procedures. If inflammatory process spreads into orbit from anatomically adjacent regions hospitalisation into otolaryngology department or into department of maxillofacial surgery, or neurosurgery or septic department of hospital is carried out. Sanitation of primary focuses of purulent infection is carried out. Traditional intensive therapy, which includes antibacterial, detoxication, desensibilising, immunologic and vitamin therapy, is performed. In case of intraorbital complications second stage of treatment is carried out in ophthalmology department of hospital.

EFFECT: method ensures obtaining early functional and cosmetic effect, prevents spread of inflammatory process into skull cavity.

5 ex, 2 dwg

FIELD: chemistry.

SUBSTANCE: invention relates to a method of producing a peptide, which is characterised by that it involves conversion of the -SH group of the peptide which contains an amino acid residue having an -SH group to an -OH group, said method comprising the following steps from (a) to (c): (a) reaction of the -SH group in the peptide with a methylating agent to convert the -SH group to an -SMe group; (b) reaction of the -SMe group formed at step (a) with a cyanating agent to obtain an intermediate reaction product in form of an ester; (c) converting the intermediate reaction product obtained at step (b) to a peptide which contains an amino acid residue having an -OH group in more basic conditions than conditions at step (b).

EFFECT: improved method.

20 cl, 1 ex

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