Method of rehabilitating neurological disorders in children in case of neuroinfections
SUBSTANCE: invention relates to medicine, namely to pediatric neurology, and can be used for rehabilitation of neurological disorders in children in case of neuroinfections. For this purpose, at the background of adequate complex and pathogenetic therapy, parenteral introduction of actovegin in acute period of disease additionally from the first days of disease cytoflavin is introduced intravenously by drop infusion in dose 0.6 ml/kg or 10 ml per day for 3-5 days, elcar perorally in dose 70-100 mg/kg of weight per day for 3-4 weeks. In the period of early reconvalescence pantogam is additionally introduced perorally in dose 50-70 mg/kg of weight per day for 4 weeks. In case if multifocal affection of brain substance is present, gliatilin is introduced intravenously by drop infusion in dose 1 ml per 5 kg of body weight per day in combination with intramuscular introduction of ipidacrine in dose 5-15 mg per day for 7-10 days, after that gliatilin perorally in dose 50 mg/kg of weight per day together with ipidacrine inside in dose 1 mg/kg per day for 4 weeks.
EFFECT: method makes it possible to improve disease outcome due to reduction of frequency of residual neurological deficiency formation with reduction of term of hospital treatment.
This invention relates to the field of medicine, more specifically to the CNS, and is intended for the rehabilitation of children with various neurological disorders.
Acute neuroinfections in children differ in the severity of disease, high mortality (30%) and frequency of residual impacts (from 25 to 50%), resulting from damage to membranes and brain tissue in the acute period of the disease. Moreover, the degree of damage depends on the type and virulence of the pathogen, and the adequacy of compensatory reactions of the host system and the local level. Thus, the most favorable course and outcome of the disease characteristic of meningococcal infection, where residual effects of organic lesions of the nervous system are observed only in 2-3% of cases. Whereas for pneumococcal and Haemophilus meningitis neurological complications is 18-25%. Among viral encephalitis most severe herpes are characterized by the formation of severe organic disorders of the Central nervous system lesions of the cortex and subcortical areas of the brain. Thus, the rate of formation of severe residual neurological deficit with herpes encephalitis is 40-65%.
Follow-up monitoring of patients undergoing neuroinfections, showed that these and other neurological effects of the disease are observed in 60-70% of children. Most often it is a disorder of the nervous system by type of Serebryaniy, astheno-neurotic syndrome, syndrome movement disorders, hydrocephalus, epilepsy. In some cases formed neurological deficit leads to disability and social exclusion of ill child. Therefore, the problem of rehabilitation therapy and rehabilitation is very important.
Known and recognized in rehabilitation are methods of dispensary observation of patients and conducting palindromes symptomatic correction. At the stage of rehabilitation, when already formed certain persistent neurological disorders, the primary goal is the formation of individual-social adaptation of the patient, consisting in the development of speech, intelligence, behavior, emotions, motor skills. Conducted a comprehensive treatment of several experts: child neurologist, psychologist, speech therapist, podiatrist, therapist. Of great importance in the recovery period has sanatorium-resort treatment, including balneological treatments, mud therapy, kinesiotherapy, massage, physiotherapy. However, there is no sequential phased tactic pointrange woodanilling treatment of neurological disorders in the CNS in children that, as a rule, the ear which increases the quality of life of patients due to the formation of residual organic disorders of the nervous system.
Known methods of rehabilitation of children with infectious diseases of the Central nervous system, including the application of methods of physical therapy, exercise therapy, massage, orthopedic correction and medical support with the use of nootropics (pantogram, Cerebrolysin) and vitamins of the B group in the early recovery period as mitigation of the severity of the infectious process [Acute neuroinfections in children // a Guide for physicians edited Apinedo. HP: Medicine, 1986. - S-315]. This scheme rehabilitation treatment and rehabilitation is well established, however, excludes the application of the methods of rehabilitation therapy in the acute period, which increases the risk of developing neurological disorders, provides no reduction of terms of treatment of the disease and, thus, extend the period of stay of the patient in the hospital.
There is a method of rehabilitation of children with consequences of deferred CNS, including the use of vasoactive (Actovegin, instenon) and neuroprotective drugs in combination with HBOT within 10 days, provided that rehabilitation of the liquor, followed palindromes therapy neurological complications of the disease [Rehabilitation of children with consequences of deferred CNS: scheme of rehabilitation therapy. ATV, Cessioni, Apicidin and other REP the flare of Belarus. 2003]. This scheme does not provide for the use of vasoactive and neurometabolic drugs in the acute period of the disease, thus leading to the lack of an adequate vascular and metabolic support damaged tecnam nervous system, and, consequently, a higher risk of developing early persistent neurological deficit, and increased duration of stay of the patient in the hospital.
Closest to the proposed method is a method for phased rehabilitation of children undergoing acute neuroinfections given period, the severity of the disease and the severity of neurological disorders [System rehabilitation therapy in acute CNS in children // HOWTO. Mensuration, Nevstrechennoe, Mevania and other SPb.: 2000. - P.4-16]. The authors propose a system of rehabilitation therapy that includes the use of antimicrobial or antiviral drugs for bacterial or viral neuroinfections, intravenous immunoglobulins in combination with vasoactive and neurometabolic drugs such as Actovegin, trental, instenon, reverse, starting with the acute period of the disease. Moreover, in the early stages of the disease with severe and moderate during infection drugs administered parenterally for 5-7 days, followed by oral application on about is agenie 4-6 weeks. In parallel with the appointment of vasoactive and attributable to funds held symptomatic therapy aimed at the relief of major neurological syndromes (dehydration and protivosudorojna improving neuromuscular conductivity and reducing muscle tone, physical therapy, massage, exercise therapy). However, this schema therapy is mainly aimed at the causative agent for improving the rheological properties of blood and improve blood circulation in the damaged tissues and does not take into account the possibility of elimination of tissue hypoxia as the leading cause of the development of neurological disorders in the Central nervous system by increasing metabolism and elimination of energy in the damaged nerve cells.
To address these shortcomings, the authors propose a new method of rehabilitation of neurological disorders in neuroinfections in children.
The technical result of the present invention is to prevent the development of neurological complications after suffering neuroinfections and improving outcomes through ongoing phased rehabilitation treatment and rehabilitation, as well as in the reduction of treatment time.
This is achieved by the fact that in addition to the ongoing adequate comprehensive etiotropic and pathogenetic therapy, parenteral introduction and tobegin in the acute period of the disease, from the first days of the disease enter cytoflavin intravenously at a dose of 0.6 ml/kg or 10 ml / day for 3-5 days and elcar oral dose of 70-100 mg/kg / day for 3-4 weeks, in the early period of convalescence impose additional pantogram oral dose of 50-70 mg/kg of body weight per day for 4 weeks. The method according to claim 1 of the formula, characterized in that in the presence of multifocal lesions of the brain - intravenous drip gliatilin at a dose of 1 ml per 5 kg of body weight per day in combination with intramuscular injection of ipidacrine dose of 5-15 mg per day for 7-10 days, then gliatilin oral dose of 50 mg/kg of body weight per day together with ipidacrine oral dose of 1 mg/kg per day for 4 weeks.
Brand new is that the authors have discovered and proved the feasibility and effectiveness of synchronous sequential application of vascular, energokorrektiruyuschee and neuroprotective drugs with antibacterial and antiviral therapy. The authors found a dose, duration and sequence of the combined use of the drugs depending on the period of the disease and the severity of the pathological process in the nervous tissue.
The authors found the need for a parallel with etiotropic therapy applications since the early days of the disease complex pathogenetic therapy. The authors in the specified way re is mindout acute CNS, from the first days of the disease, apply cytoflavin. It consists of known pharmacological agents that are widely used in various diseases in isolated form, such as succinic acid, Riboxin, Riboflavin and nicotinamide. Succinic acid is a powerful antihypoxic drug, reducing the formation of free radicals and thereby reducing their damaging effects on cells of the nervous system. Riboxin (inosine) as a precursor of ATP has a strong anabolic effect, increases the metabolism in the vascular wall, and nicotinamide improves the rheological properties of blood and dilates small blood vessels, including the brain, this leads to decrease ischemia in nervous tissues and the restoration of damaged neurons. Riboflavin regulates redox processes, has a metabolic effect by interaction with ATP and activation of vitamin B6 (pyridoxine), which increases the metabolism in brain tissues and catalyzes the synthesis of key neurotransmitters. Riboflavin also has antihypoxant action, participating in the synthesis of hemoglobin, delivering oxygen throughout the body, including the nervous tissues. Together, these active substances have immunomodulatory effects, increasing the body's defenses, napravlenny is to fight infection. Thus, the authors have proved that cytoflavin is the drug pathogenetic infusion therapy.
Parallel assignment elcar from the first days of the disease in developed by the authors of the scheme is new, as earlier in this pathology, and this complex was not used. We have proved its anabolic and energokorrektiruyuschee action in infectious pathology of the nervous system. With the development of infectious process in the nervous tissue is the defeat of neurons, which suffer from energy shortages. This ultimately leads to irreversible cell death. Elcar is an exogenous aid donor of energy to maintain functional activity and morphological integrity of the cells.
The authors proved that the appointment of the drug pantogram already in the early period of convalescence, starting from 5th day of the disease. Pantogram is a metabolite of GABA. He crosses the blood-brain barrier, which determines its pharmacological activity in infectious brain damage. Pantogram as GABA, has intrathecal detoxification effect, as well as a marked neuroprotective effect, as GABA is a structural component of a neuron. The authors have proved the necessity of pantogama on the background of increased seizure activity in patients with infects the s Central nervous system.
The authors for the first time, it was found that the use of the drug gliatilin (alfostserat) with multifocal lesions of the brain in complex with ipidacrine is the most effective in the acute period, provided that their combined effect. Gliatilin, metabolizers in the body is split into choline and glycerol. Choline, released, promotes the synthesis of acetylcholine, thereby improving and restoring neuromuscular transmission. The glycerol as a precursor of phospholipids membranes of neurons, has a neuroprotective action to ensure recovery of the damaged nerve cells. Ipidacrine complex drug with anticholinesterase activity. Inhibiting the synthesis of cholinesterase, ipidacrine contributes to the formation and accumulation of acetylcholine in the synapses. Thus, ipidacrine improves and stimulates neuromuscular transmission to increase the conductivity of the nerve pathways and potentiates the action of gliatilin.
The authors proved that such a combination and sequence of complex therapy with exhaust dosage provides the effect, which leads to better outcomes in neuroinfections in children. In the available literature such methods, rehabilitation and prevention of neurological disorders in children undergoing CNS infection, do not describe the O.
Thus, the claimed method, according to the authors, may be eligible for non-obviousness, novelty, efficiency and inventive step.
This method is as follows. When the primary clinical-neurological examination of the child with CNS infection in the emergency Department of the hospital determine the main clinical symptoms, and the diagnosis is assigned antibacterial or antiviral therapy, as well as pathogenic. In the acute period prescribed Actovegin at a dose of 2.0-5.0 ml within 7-10 days. Additionally, simultaneously with the first days of the disease appoint cytoflavin intravenously at a dose of 0, 6 or 10 ml per day for 3-5 days, concurrently use elcar oral dose of 70-100 mg/kg of body weight per day for 3-4 weeks. In the early period of convalescence, appoint pantogram oral dose of 50-70 mg/kg of body weight per day for 4 weeks. In the presence of multifocal lesions of the brain prescribe intravenous drip gliatilin at a dose of 1 ml per 5 kg of body weight per day in combination with intramuscular injection of ipidacrine dose of 5-15 mg per day for 7-10 days. Then gliatilin is given orally in a dose of 50 mg/kg of body weight per day together with ipidacrine oral dose of 1 mg/kg per day for 4 weeks.
We have developed a method of rehabilitation and prevention nevrol the policy violations in neuroinfections in children passed clinical trials in the treatment of 150 patients with acute infections of the nervous system of various etiologies in age from 1 month to 18 years (group 1). Of these, 50 patients underwent bacterial purulent meningitis, 30 - viral encephalitides, 15 - mononeuropathy, 20 - polyneuropathy. The comparison group (group 2) consisted of 50 patients with purulent bacterial meningitis, 25 - viral encephalitides, 15 - mononeuropathy and 15 people with polyneuropathie receiving standard etiopathogenetic therapy at all stages of rehabilitation. Both groups were representative in terms of gender, age, etiology and severity of the disease. Follow-up surveillance of patients in both groups were held for two years.
Analysis of the obtained data showed that the application of the proposed method has improved the outcomes and to achieve full recovery from 76.2% of children in the first group, and to reduce the incidence of residual neurological deficit. So, in the comparison group, the frequency of patients with neurological defects, including rough, was significantly higher than in the main group, and amounted to 21.5%to 55%. The research found that the use of this method in the treatment of patients with acute CNS allowed to shorten the hospital stay. Thus, the average duration of hospital stay in children of group 1, treated by the proposed scheme, 25.5±3,5 bed-days, whereas in the comparison group this period which has been extended up to 33.8±6.5 days.
The effectiveness of this method of rehabilitation and prevention of neurological disorders in the CNS in children can be confirmed by the following examples.
Example 1. Child D., age 8, case history No. 2592, diagnosis: Vetranary meningoencephalitis, cerebral-cerebellar form, severe. The patient fell ill with chickenpox, 17.04.2008 20.04 - the last day of the rash. 22.04 weakness, dizziness, gait disturbance, single vomiting and temperature rise to 37.8°C. 23.04 - appeared dysarthria, headache, unsteadiness of gait, vomiting 3 times, was urgently admitted to NEEDY. When admitted to hospital, 23.04.2008, a serious condition. Consciousness is impaired to the level of spoor (score of Glasgow). Installation nystagmus in extreme abduction. It staccato. Severe ataxia in the trunk and extremities. Yourself not sitting. When the finger-nose test - miropomazanie. Positive meningeal symptoms. In the study of CSF from 24.04 Placitas was 418/3 (neutrophils - 192, mononuclear cells - 236, protein - 0,146 g/l). From the first day of hospitalization was appointed cytoflavin in a dose of 0.6 ml/kg of body weight per day for 5 days (23-27 .04). In parallel with the proceeds received acyclovir at a dose of 15 mg/kg (450 mg) 3 times a day (23.04-2.05), enteral (interferon - α2) 1 ml per day (28.04-11.05), prednisolone in a dose of 3 mg/kg (60 mg) 3 times in the night, Actovegin 2.0 ml intravenously for 7 days (24.04-30.04) and elcar oral dose of 70-100 mg/kg (20 drops 3 times a day) 24.04. From 30.04 on 19.05 parenteral received gliatilin dose of 1 ml/5 kg body weight (300 mg) in combination with neuromidin (ipidacrine) 7.5 mg per day. With 1.05 in therapy was added pantogram in a dose of 50 mg/kg / day (250 mg 2 times a day). Recovery of neurological status was gradually: cerebral symptoms (vomiting, headaches, lethargy, drowsiness) was maintained for 12 days, meningeal symptoms 8 days. Prior to the discharge (27.05) remained light trunk ataxia, speech fully recovered. Dynamic observation of the child within 2 years revealed no focal neurological symptoms.
Conclusion: this case was protracted for vetrenogo encephalitis. However, the use of treatment method, developed by the authors, resulted in complete recovery of the patient without the development of neurological complications.
Example 2. Child of L., age 11, case history No. 14836, the diagnosis of Viral encephalitis, Epstein-Barr viral etiology, severe, acute. The girl fell ill acutely 19.12.2009, when there are headaches in the background of the rise of temperature (38.3°C). Within 4 days the symptoms remained. 23.12.09 (5 day disease deterioration: a General weakness lethargy, staggering gait. 23.12 was hospitalized in NEEDY with a preliminary diagnosis of SARS. Encephalitis? When postupleniyi a serious condition due to cerebral and focal neurological symptoms. Catarrhal syndrome is not expressed. Conscious, oriented correctly. The movement of the eyeballs in full. Pupils dilated D=S, reaction to light alive. The tongue in the midline. Foncia and swallowing is not broken. Muscle tone is satisfactory, slightly reduced at left parts. Muscular strength 5 points. Deep reflexes increased with hands and feet with the expansion of the reflexogenic zones of the knee reflexes. The abdominal reflexes are symmetric. Sensitivity is not compromised. Expressed in the phenomenon of static and dynamic ataxia (in the trunk and extremities, more left, more in the legs than in the arms). Not worth it and not sitting independently. Meningeal syndrome negative. Somatically without features. In CSF from 25.12.09 lymphocytosis 28/3, Protein 0.2 g/l, mononuclear - 24, neutrophils - 4. In the blood by ELISA revealed Ig M to the virus of Epstein-Barr from 25.12. On the people's Assembly from 23.12.09: US-signs of enlargement of the right lateral ventricle. 24.12.09 performed brain MRI: MRI data for the presence of neoplastic process, demyelinating disease, focal brain is not received. Mr data for the presence of pathological changes of the main vessels of the hunter is not received. On EEG from 31.12.09: slowing of the background rhythm, moderate diffuse violations BEA brain; when hyperventilation - moderate signs lability regulatory systems limbic-reticular complex. Focal seizures are typical apicomplexan no. From the first days of hospitalization received parenteral cytoflavin in a dose of 0.6 ml/kg for 5 days (25.12.2009-1.01.2010). In parallel parenteral were appointed: medovir at a dose of 10 mg/kg (500 mg) 3 times a day (23-29 .12), enteral dose of 1 million per day, metypred at a dose of 10 mg/kg per day (500 mg) from 23 to 25.12, Actovegin 5.0 ml (23.12.09-2.01.10). From 30.12 to 10.01 got Viferon 1 million to 2 times a day rectally. With 25.12 until statement received inside elcar at a dose of 70 mg/ kg per day (40 drops 3 times a day). With 29.12 was appointed gliatilin parenterally in a dose of 1000 mg for 7 days, with 01.01 was added neiromidin 15 mg / day intramuscularly for 14 days. 7.01 1.02 on took pantogram in a dose of 50 mg/kg / day (250 mg 3 times a day). Discharged with advice to continue gliatilin at a dose of 400 mg 1 time per day for 1 month. During therapy cerebral symptoms slowly went away within 2 weeks, the phenomena of static and dynamic ataxia persisted up to 3 weeks. The extract was preserved slight tremor in hands when doing the finger-nose test. Follow-up monitoring of the child revealed no deviations from the side nervously the system.
Conclusion: thus, despite the severe form of the disease, against passable therapy the child has achieved a favorable outcome of the disease without the formation of neurological deficit.
Example 3. Patient D., age 9, case history No. 24545, diagnosed with Acute myelitis mixed viral-bacterial etiology (borreliose-herpesvirus (HHV, WEB). Complications: neurogenic bladder. The SOP. right-sided pneumonia, 2-sided chronic suppurative epitympanic. 2-sided conductive hearing loss. He entered NEEDY 25.12.2010, on the 5th day from the appearance of neurological symptoms with complaints about the dysfunction of pelvic organs, gait disturbance transfer of CRH, Volkhov. From the anamnesis of the disease it is known that since the middle of December, the child was noted moist cough in the background of normal body temperature. 22.12.10 began to complain of abdominal pain, urinary retention, began to pull the right leg when walking. 23.12. peed only sitting in warm water; 24.12 stopped to urinate on their own, was hospitalized in Volkhov CRH, where conducted R-g chest - right diagnosis (S3) pneumonia, examined by a neurologist - with suspected polyneuropathy was transferred to NEEDY. The suction mite child denied. From the anamnesis of life it is known that a child from 2nd pregnancy proceeding with pathological increases in weight, preach what ansia, regional detachment of the placenta from the mother. Weight at birth 3030, DL cm, Apgar - 7/8, was observed on the 1st year of life with pyramidal insufficiency symptom of hyperexcitability. From 2 years of age suffers 2-sided chronic purulent epitympanum, have been conducted on surgical rehabilitation of about ENT pathology. Aggravation with a purulent discharge from the ears is not less than 1 time in 6 months, increased supercooling. At the moment, after intrometadata. 2-sided conductive hearing loss. When entering NEEDY (25.01.11 0.05 h) a serious condition in neurological status. Clear consciousness. A sharp decrease in the spontaneous motor activity, especially in the legs. From CHN hearing loss (conductive 2-sided hearing loss, exacerbation of chronic suppurative otitis media), but otherwise unremarkable. Movement in the hands in full force up to 5 points. Legs sharply reduced volume of active movements, symptome Bogolepov left, rescue positive m Bar, independently tightens his legs to his stomach, moving feet. Muscle strength up to 2 points in the proximal leg, 3 in the proximal. Deep reflexes of the limbs are called, without a convincing difference between the parties, pathological reflexes - abs., Prussia (superficial and deep) - abs. The lack of self defecation, urination. When the village is upline convincing sensory impairment did not nabudis. In the dynamics of the disease was observed the increase of sensing disturbances in conduction type from vermehrung segments to 28.12 when gradual increase of active movements in the limbs. According to the results of the MRI revealed multifocal extensive damage to the spinal cord at the cervical, thoracic and lumbar levels, ENMG data for EOR was not received, when the SMP identified protein-cell dissociation. Together clinical, laboratory, electrophysiological and MRI data diagnosed with acute infectious-allergic myelitis, further results etiological examination, it was found mixed viral-bacterial nature of the disease (blood from 26.12 selected DNA EBV and herpes type 6 and IgM will believe. (3,009 PU) for Borrelia (OP Crete=0,202 PU), IgG antibodies to Borrelia is not detected. Conducted a comprehensive etiopathogenetic treatment. With receipt of child received Lindzen dose of 50 mg/kg per day (2 grams per day with 25.12.2010 on 8.01.2011), Amiksin 0,06 1 time a day inside (25.12-31.12), metypred at a dose of 10 mg/kg per day with a gradual decrease to 2.5 mg/kg per day (25.12.2010-24.01.2011), Actovegin 5.0 ml intravenous drip (25.12.2010 on 17.01.2011). Additionally were appointed in the acute period: cytoflavin in a dose of 0.6 ml/kg for 5 days, elcar in a dose of 100 mg/kg per day (40 drops 3 times per day 26.12 4 weeks), gliatilin at a dose of 1 ml per 5 the g body weight per day (1000 mg per day intravenously with 26.12.2010 by 5.01.2011), neiromidin 5 mg intramuscularly (26.12.2010 by 9.01.2011) and then 10.01 until discharge neiromidin inside 25 mg 1 time a day. On the background of therapy was relatively rapid regression of musculoskeletal disorders with long-lasting sensitive disorders and urinary (bladder weakness); recovery from pneumonia, the stabilization process on the background of ENT pathology.
Thus, the patient had severe acute myelitis viral and bacterial etiology (borreliose-herpetic); the use of complex therapy has led to the almost complete regression of focal neurological symptoms.
Thanks to the application of the proposed method was able to improve outcomes by increasing the percentage of children fully recovered without neurological abnormalities, reducing the frequency of formation of residual neurological deficit, to reduce the duration of hospital stay.
1. The method of rehabilitation of neurological disorders in children with CNS, including adequate comprehensive etiotropic and pathogenetic therapy, parenteral aktovegin in the acute period of the disease, characterized in that it further from the first days of the disease enter cytoflavin intravenously at a dose of 0.6 ml/kg, or 10 ml with the TCI in 3-5 days and elcar oral dose of 70-100 mg/kg of body weight per day for 3-4 weeks in the early period of convalescence additionally impose peptogen oral dose of 50-70 mg/kg of body weight per day for 4 weeks.
2. The method according to claim 1, characterized in that in the presence of multifocal lesions of the brain - intravenous drip gliatilin at a dose of 1 ml per 5 kg of body weight per day in combination with intramuscular injection of ipidacrine dose of 5-15 mg per day for 7-10 days, then gliatilin oral dose of 50 mg/kg of body weight per day together with ipidacrine oral dose of 1 mg/kg per day for 4 weeks.
FIELD: medicine, pharmaceutics.
SUBSTANCE: claimed invention relates to field of pharmacology and clinical medicine and describes pharmaceutical compositions of 2-amino-2-[2-(4-octylphenyl)ethyl]propan-1,3-diole in free form and/or in form of pharmaceutically acceptable salt, where as auxiliary substances they contain lactose, starch and/or starch derivatives, selected from acetylated starch, sodium salt of starch carboxymethyl ether, pregelatinised starch, sodium starch glycolate, gelatin, binding agent, and lubricant with specified ratio.
EFFECT: invention makes it possible to extend possibility for cheaper in industrial manufacturing preparation for treatment of disseminated sclerosis.
7 cl, 16 ex
SUBSTANCE: invention relates to medicine, namely to neurology, restorative medicine, and can be applied in treatment of consequences of infantile cerebral paralysis. For this purpose reflex low temperature impact on nerve plexuses of peripheral artery is performed. Said impact is performed first in lower third of forearm, and after three months in first interdigital space of foot. Cryoapplicator with diameter 2 mm is installed on exposed peripheral artery and double cryogenic impact with duration 10 seconds is performed at temperature minus 186°C. In the period between low temperature impacts complex drug therapy is carried out: in the first two weeks administered are detralex in dose 1 capsule 2 times per day, nicospan in dose 1 tablet 3 times; in the second two weeks grandaxin in dose 0.05 in the morning; spasgan in dose 1 tablet in the afternoon; atarax in dose 1/2 tablet before going to bed.
EFFECT: method ensures definite consistency, which makes it possible to compensate vegetative dystonia syndrome, normalise neuromuscular transmission, reduce muscle spasticity, optimise motor functions of upper and lower extremities and, therefore, improve coordination of movements and supportability of lower extremities.
SUBSTANCE: invention refers to medicine, namely neurology, and is applicable for treating lumbar radicular pain syndrome. That is ensured by single catheterisation of an epidural space, and a microinfusion pump is used for the continuous introduction of 0.2% Ropivacaine for 5-10 days at 2.0-8.0 ml/h until pain syndrome is relieved.
EFFECT: method enables an immediate therapeutic and analgesic effect with low toxicity and reduced risk of treatment-induced complications, as well as reduced length of staying in hospital with safety, inspectability and controllability.
2 cl, 1 dwg, 3 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to pharmaceutics and represents a pharmaceutical composition for multiple sclerosis containing Teriflunomide as an agent and excipients in the following proportions, wt %: Teriflunomide - 3.0-13.5; Lactose and/or Ludipress LCE - 48.5-65.0; Starch - 7.0-16.0; Microcrystalline cellulose and/or Hypromeloza - 20.0-30.0; Collidone VA-64 - 3.5-4.5; Magnesium stearate - 0.8-1.2; Aerosil - 0.8-1.2; Benecel MP-824 - 13.5-15.5.
EFFECT: invention provides the extended range of effective drugs for multiple sclerosis.
SUBSTANCE: invention relates to field of medicine, namely to orthopedics and neurosurgery. Electromyographic examination with making functional tests, assessing active amplitude of movements in joints, degree of arbitrary control of extremity, biomanual skills, is carried out. Data of examination are obtained before and after diagnostic blockage of median nerve with anesthetic. If amplitude of movements in joints increases, functional possibilities of extremity improve, and electrogenesis of forearm muscles reduces by more than 100 mcV, first neurosurgical treatment is performed with carrying out selective neurotomy of motor branches of median nerve. In case of insignificant impact of diagnostic blockage on examination results, first orthopedic treatment is performed.
EFFECT: method extends arsenal of means for determining type of surgical treatment of upper extremity in children with infantile cerebral paralysis.
SUBSTANCE: present invention refers to medicine, namely neurology, and may be used for treating patients with trifacial nerve neuralgia. For this purpose, perivascular fibres of radial artery and trigeminal nerve branch exit points are exposed to low-temperature reflex radiation. It is combined with two exposures of the perivascular fibres of radial artery from a miniapproach in a lower one-third of forearm to a cryocautery device of a tip diameter of 2 mm for 10 seconds at temperature minus 165°C. Then, the trigeminal nerve branch exit points are locally exposed to the cryocautery device of the tip diameter of 2 mm for 30 seconds at temperature minus 160°C. Further, from the second day following the local low-temperature exposure, an integrated drug-induced therapy is prescribed. For this purpose, detralex 1 capsule is introduced twice a day, and nicoshpan is introduced 1 tablet 3 times a day for two weeks. Suture release is followed by the two-week introduction of grandaxin 0.05 in the morning, spasgan 1 tablet in the afternoon, atarax 1/2 tablets for the night.
EFFECT: method provides reducing length of treatment and number of unsatisfactory clinical outcomes with substantial compensation of pain syndrome with formation of prolonged remission of a pathological process ensured by improved peripheral blood flow and correction of vegetative disorders supporting pain syndrome.
SUBSTANCE: invention refers to medicine, and concerns a method for stimulating posttraumatic peripheral neurotisation in a mammal. A method consists in the fact that L-arginine is introduced in a deposit medium of carboxymethyl cellulose sodium salt used to fill a silicone tube, while the created conduit is implanted into an extended nerve rupture.
EFFECT: invention provides a manifested stimulating effect on nerve motion and sensory function recovery, effectively maintaining sensory cell survival and regenerating myelin fibre penetration from the central to peripheral nerve segment.
4 cl, 1 ex, 2 dwg
FIELD: medicine, pharmaceutics.
SUBSTANCE: claimed are: application of combination of flurpirtine and tramadol or their physiologically acceptable salts with weight ratio of flurpirtine to tramadol from 10:1 to 1:14 for pain treatment and application of the same combination for obtaining mediaction for peroral, rectal, intravenous, transcutaneous, or subcutaneous or intracutaneous introduction for pain treatment.
EFFECT: demonstrated is increased efficiency (synergism) of combination in pain treatment and unexpected "anti-vomiting" effect of flurpirtine in combination with vomiting-inducing high dose of tramadol; as well as introduction of combination results in reduction of such side effects as cramps, increased muscle tone and vomiting.
13 cl, 6 tbl
SUBSTANCE: invention refers to medicine and concerns application of epidermal growth factor (EGF) for preparing an injected pharmaceutical composition wherein said composition is administered by infiltration on the periphery of nerve stems and/or ganglia for the purpose of the morphofunctional recovery of peripheral nerves in painful sensorimotor neuropathy accompanying ischemic neuritis. It also relates to a EGF-containing composition wherein this substance may be combined with anaesthetics and analgesics and encapsulated in microspheres.
EFFECT: invention provides reducing neuropathic pain relief.
20 cl, 5 ex, 2 dwg, 16 tbl
SUBSTANCE: invention relates to medicine, namely to physiotherapy, manual therapy. Method includes performing manual therapy with application "soft techniques" methods. Ischemic compression, postisometric relaxation of lumbar quadrate muscle, back erector, multifidus, iliolumbar, trapezoid muscles and mobilisation of blocked spine and peripheral joints. Session of manual therapy is carried out immediately after mud treatment. Mud treatment is carried out by application of mud on the area of back, at temperature 40° C, for 20 minutes. After 30 minutes after manual therapy session vibration massage is carried out. Impact is performed on the area of motor points of trapeziform, subspinous muscles, back erector at the level of breast and lumbar spine from both sides. Area of hypotrophic muscles is influenced with vibration with frequency 60 Hz, with application of notched applicator, for 2 minutes on each field, in accordance with labile method. Area of muscles in hypertonus is influenced with frequency 20 Hz, with application of multi-functional applicator, for 4 minutes on each field, by stable method. During one procedure 4 fields are influenced, each of which includes area of affected muscles from one side. Duration of procedure is 12 minutes. Course of treatment includes 10 procedures.
EFFECT: method increases efficiency of treatment by reducing spine curvature angle and forming muscle corset, which assists in preservation of obtained results of treatment, preventing possible progress of spine deformation degree, biomechanical and neurodystrophic abnormalities and formation of neurological complications.
1 ex, 4 tbl
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention relates to field of pharmaceutics. Lyophilised pharmaceutical composition contains IX factor, more than 90% of whose calcium-binding ability are preserved in storage within 6 months at 25°C and tregalose, taken in amount 0.5%-3% by volume. Method of preparing stable dry composition includes stages of mixing IX factor-containing solution with tregalose 0.5%-3% by volume with obtaining cryoprotective solution. Method of pharmaceutical composition lyophilisation includes stages of freezing pharmaceutical composition containing IX factor and tregalose by 0.5%-3% in volume at temperature -40°C or less, burning pharmaceutical composition at temperature approximately from -20°C to -35°C, reduction of pharmaceutical composition temperature to -40°C or less, drying pharmaceutical composition at the first stage of drying at temperature from 5°C to 20°C at lower pressure, drying pharmaceutical composition at the second stage of drying at temperature from 45°C to 55°C at lower pressure. Method of preparing IX factor-containing lyophilised composition ensures preservation of more than 90% of IX factor calcium-binding ability.
EFFECT: application of composition on the basis of tregalose in amount 0,5%-3% in volume ensures its stability for 6 months of storage at conditions of 25°C.
17 cl, 5 ex, 6 dwg
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to veterinary science, and concerns treating corneal diseases in dogs. For this purpose, mesenchymal cord and placental stem cells received after easy human delivery are used. The mesenchymal stem cells are introduced retrobulbarly in saline solution 1-2 ml containing 0.075-0.20×106 cell/kg. The cells are introduced 1-2 times annually.
EFFECT: method provides the effective treatment of corneal diseases in dogs by creating the depot stem cells in a close proximity to the lesion.
SUBSTANCE: invention relates to medicine, in particular to ophthalmology, and is intended for treatment of inflammatory and trophic cornea diseases. For this purpose silicone-hydrogel soft contact lens, covered from inner surface by silico-dried amnion, is placed on cornea. Amnion with diameter smaller than lens diameter is used. Amnion is fixed on lens by means of polyacrylamide film, saturated with medication. As such means, used is antibacterial, anti-inflammatory, regenerating medication.
EFFECT: method ensures elimination of amnion dislocation under lens and reduction of time of corneal defect epithelisation, which increases treatment efficiency.
3 cl, 3 ex
SUBSTANCE: invention refers to medicine, namely oncology and anaesthesia, and may be used for anaesthetic care for surgical management of oncological patients with accompanied cardiovascular insufficiency. Before the operation, blood 200-250 ml is sampled from a median cubital vein into a blood transfusion container with the anticoagulant Glugicirum 49 ml. Then, the container is added with the complex preparation cytoflavin 0.16I0.02 ml/kg of body weight. After cytoflavin is incubated on autoblood at t -37C for 30 minutes, it is administered intravenously drop-by-drop immediately before the beginning of the anaesthetic care.
EFFECT: method provides improved quality of the anaesthetic care in such patients due to provided adequate correction of haemodynamics and related metabolic homeostatic disorders, prevented developing oxidative stress at all the operative stages, as well as ensured non-specific extra stimulation of the immune system.
1 tbl, 1 ex
SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology, and may be applicable for surgical management of the patients with an ossicular chain pathology. For this purpose, an ossiculoplasty involves graft fixation by a platelet enriched autoblood plasma bunch taken immediately before the operation That is followed by laser coagulation of the bunch.
EFFECT: technique provides improved functional effect and simplified ossiculoplasty, eliminated allergic reactions, eliminated risk of graft rejection, reduced recurrences due to fixation of the repaired elements, reduced risk of dislocation thereof up to formation of the physiological fixation ensured by middle ear soft tissues regeneration.
FIELD: medicine, pharmaceutics.
SUBSTANCE: group of inventions refers to medicine, particularly a method for preparing a therapeutic preparation containing high-purity and stable hemoglobin as an oxygen carrier, a preparation and a method for tissue oxygenation. A method involves destruction of washed red blood cells with the use of hypotonic lysis, filtration, extraction, ultrafiltration, column chromatography, re-ultrafiltration to produce a concentrated hemoglobin solution containing no phospholipids and dimers, blocking of sulphhydryl groups, formation of a cross link by means of bis-3,5-dibromsalicylfumarate, addition of N-acetylcysteine, addition to a pharmaceutically acceptable carrier for producing a drug preparation. The method for tissue oxygenation involves using the produced preparation and is applicable in treating cancer.
EFFECT: group of inventions enables producing high-purity cross-linked tetramer haemoglobin (optionally containing ≥70% of β-β cross-links) with high effectiveness of oxygen transfer, stable at high temperatures and applicable for mammals with no risk of renal damage and vessel constriction.
13 cl, 13 ex, 9 tbl, 17 dwg
SUBSTANCE: invention relates to beekeeping. For prevention of intestinal diseases at the end of wintering the bees are fed twice with an interval of 3 weeks the carbohydrate feeding candy with the addition of blood product in it at the rate of 1 kg candy per 1 bee colony. As blood product the acid hydrolyzate of blood of slaughter animals is used with addition of lactic, benzoic, and succinic acids, which is added to candy in the amount of 1.5 - 2 litres per 35 kg candy.
EFFECT: invention provides more efficient prevention of intestinal diseases of bees, and increase in their productivity.
SUBSTANCE: invention relates to medicine, namely to obstetrics and gynecology and can be used for prevention and treatment of intrauterine growth retardation syndrome. For this purpose medications are administered to pregnant women of risk group in terms of pregnancy, determined in accordance with the critical period of fetus development. At term of pregnancy, equal to 14-18 weeks, administered is natural micronised progesterone in dose 200 mg intravaginally 2 times per day in 30-day course, complex of polyunsaturated fatty acids of family omega-3 in 30-day course, dry water extract of fresh artichoke leaves in dose 2 tablets 3 times per day in 14-day course, levocarnitin in dose 8 drops 3 times per day in 30-day course, instenon 5.0 ml on 5% dextrose in dose 500 ml intravenously 10 injections every second day per course, deproteinised hemoderivate from calf blood with low-molecular peptides and derivates of nucleic acids 5.0 ml on 5% dextrose in dose 500 ml intravenously every second day 10 injections per course, combined polyvitamin complex with micro- and macro-elements and potassium iodide in dose 200 mg per day daily until fetus birth. After that, at pregnancy term 20-24 weeks and 30-34 weeks, respectively, administered is complex of polyunsaturated fatty acids of family omega-3 in 30-day course, levocarnitin in dose 8-10 drops 3 times per day in 14-day course, calcium nadroparin in dose 0.3 ml subcutaneously in 30-day course, dry water extract of fresh artichoke leaves in dose 2 tablets 3 times per day in 14-day course, instenon on 5% dextrose in dose 500 ml intravenously 10 injections every second day per course, deproteinised hemoderivate from calf blood with low-molecular peptides and derivates of nucleic acids 5.0 ml on 5% dextrose in dose 500 ml intravenously 10 injections every second day per course.
EFFECT: method ensures considerable reduction of number of obstetric complications in pregnancy and labour, prevents perinatal loss, increases quality of individual health of born babies.
2 ex, 1 tbl
SUBSTANCE: invention refers to medicine, namely obstetrics, and may be used for preventing preeclampsia. That is ensured by prescribing nicotinic acid tablets 50 mg 2 times a day for 30 days combined with intravenous introductions of actovegin 400 mg/day in 5% glucose 100 ml for the first 5 days in a pregnant woman up to 9 weeks of pregnancy.
EFFECT: invention provides prevention of eclampsia and severe preeclampsia ensured by metabolic and antioxidant action of the preparations used in the presented therapeutic scheme.
SUBSTANCE: method involves the administration of melaxen 18 mg/day, 9 mg at 14.00 and 18.00 in a preoperative period, on the day of operation, the melaxen administration is terminated; it is followed by 3D-multiplex HCT-angiography to determine a path and a diameter of a superficial temporal artery. Then, the operation to the extent of osteoplastic cephalotrypesis, total or subtotal oncotomy is performed; if instant histological result shows malignant glioma of degree III-IV malignancy and the temporal diameter of 2.2 mm and more, it is cannulated, and a thromboresistant catheter is inserted. On the fifth postoperative day, the melaxen administered again; on the tenth postoperative day after suture release, a course of intra-arterial chemotherapy on arterial autoblood with carboplatin infusion pump 150 mg for 5 hours is performed; the chemotherapy is followed by the 1-month melaxen administration.
EFFECT: use of the invention enables better results of the adjuvant chemotherapy, achieving tumour remission.
FIELD: medicine, pharmaceutics.
SUBSTANCE: what is presented is the use of the drug -2-(2-morpholinoethyl)thio-5-ethoxybenzimidazole dihydrochloride (the anxiolytic Afobazole) as a preparation with cardioprotective activity. It is shown that Afobazole (5-10 mg/kg intravenously or intraperitoneally) on various models of myocardial ischemia and heart rhythm disorder exhibits manifested cardioprotective activity observed primarily at the myocardium and may be related to a certain extent to its affinity for sigma1-receptors localised in cardiac myocytes. Antiarrhythmic action of Afobazole is preferentially conditioned by its ability to increase electrical stability of the maycardium directly.
EFFECT: findings entitle recommending the anxiolytic Afobazole to be used in clinical practice as a cardioprotector for the purpose of preventing and treating cardiovascular disorders in the patients suffering cardiophobic and/or asthenic-depressive syndromes burdened by cardiopathies.
1 dwg, 3 tbl, 3 ex