Method for correction of thrombophilic disorders accompanying pregnancy

FIELD: medicine.

SUBSTANCE: haemostatic values, endothelial dysfunction characteristics, diagnosed genetic forms of thrombophilia and habitual miscarriage are detected; the detected disorders are assessed in points depending on the gestational age. That is followed by calculating the total score, and therapy is prescribed depending on the total score. The case follow-up involves changing the therapeutic regimen with the total score variations.

EFFECT: method enables assessing objectively and standardising the therapeutic options in thrombophilic disorders accompanying pregnancy.

1 tbl, 2 ex

 

The invention relates to medicine, namely to obstetrics and gynecology, and can be used in the diagnosis and treatment of thrombophilic disorders of hemostasis during pregnancy.

Relevance

Currently thrombophilia in the development of pathology of pregnancy (preeclampsia, preeclampsia, placental insufficiency, a syndrome of delayed fetal growth, fetal hypoxia, premature detachment of the placenta) into a separate group of risk factors. A particularly important role it plays in women with recurrent miscarriage and some forms of extragenital pathology. There is no common approaches and standards that define how one should interpret the results gemostaziogramma; in any stages of pregnancy and what drugs and regimens to use for the correction of thrombophilia. The opinion of modern scholars, in General, indicate the importance of the correction of thrombophilic disorders in pregnancy. However, the number of methods of hemostasis makes a significant confusion in the interpretation of his condition. Also recognized is the importance of periods of gestation, history of the patient and the availability of extragenital pathology. However, there is no clear and consistent guidelines that determine the type of treatment, duration and n is the most informative parameters. In connection with the above is relevant to this patent application, which presents a unified system of assessment of the severity of disorders of hemostasis including the period of gestation, history of the patient, allowing on the basis of the amount of points to choose the most optimal course of therapy.

The prior art method of scoring risk of thrombotic complications in patients gynecological when hormone replacement therapy (RU 2231981, 10.07.2004). Spend anamnestic and clinical research aimed at identifying the patient universal risk factors of thrombophilia. Then count the total number of points that make the conclusion about the degree of risk of thrombotic complications (high, medium, low) and decide on the possibility and feasibility of hormone replacement therapy. This method determines only the predisposition to thrombosis, but does not take into account the state of gemostaziogramma, parameters which are varied, require periodic inspection and determine the thrombophilic risk of developing complications during pregnancy. In addition, the known method does not allow to choose an adequate complex therapy.

There is a method of prediction of the degree of risk of thrombogenic complications of gestation, based on you is ikenie integral indicator of coagulation, to plan and supervise the administration of anticoagulant therapy (RU 2429478, 20.09.2011). This method, however, does not account for all of the most informative indicators of gemostaziogramma, not correlates the received data with a period of gestation and does not allow you to choose the differentiated complex therapy of thrombophilic disorders, as well as to perform correction.

The closest to the offer (the prototype) is a method of detection and correction of thrombophilic complications during pregnancy based on the research of indicators of hemostasis, homocysteine, availability of genetic forms of thrombophilia (Jobava AM Role of molecular and genetic factors of thrombophilia in the Genesis of non-developing pregnancy and the beginning of a miscarriage. Abstract. dis. on saisc. exercises. step. KMN. - M., 2005, C.11-16). However, the existing method does not contain a study of the current markers of endothelial dysfunction, and in the selection of therapy is not considered the impact of the totality of revealed violations with regard to gestation. In addition, in the known method in contrast to the declared not made the score the severity of the revealed infringements taking into account gestation, has not developed a scheme of complex prescription, allowing you to standardize and systematize the approach to therapy thrombophilias the x violations.

The aim of the invention is the prolongation of pregnancy, prevention and timely comprehensive treatment of thrombophilic disorders.

The technical result of the claimed invention is objectification and standardization selection of therapy thrombophilic disorders during pregnancy. The method is as follows: determine the indices of hemostasis, indicators of endothelial dysfunction, the presence of the genetic forms of thrombophilia and syndrome habitual pregnancy loss and evaluate the identified violations in points. Increased fibrinogen 1.5 times at 37-39 weeks of gestation is estimated at 1 point, the increase in 2 and more times at 34-36 weeks 9-12 weeks - 2 points, 3 points to 8 weeks inclusive and 19-33 weeks, 4 points - at 13-18 weeks. Prothrombin index (PTI) to 125% at 37-39 weeks is estimated at 1 point, 2 points in terms 34-36 and 9-12 weeks, increased to 126% and over up to 8 weeks of pregnancy and in 19-33 weeks - 3 points, 4 points in the period 13-18 weeks.

The decrease partially activated thromboplastin time (APTT) to 21-24 seconds at 37-39 weeks is estimated at 1 point, 2 points in 34-36 and 9-12 weeks, reducing to 20 seconds and less in the period up to 8 weeks inclusive and 19-33 weeks - 3 points, 4 points - at 13-18 weeks; decrease in international normalized ratio (MPE) to 0,7-0,8 dollar at 37-39 weeks berame the activity is estimated at 1 point, 2 points in 34-36 and 9-12 weeks, reducing to 0.6 and less in the period up to 8 weeks inclusive and 19-33 weeks - 3 points, 4 points - at 13-18 weeks; increase index chromodynamics potential (ITP) for 3-5 dollar at 37-39 weeks of gestation is estimated at 1 point, 2 points in 34-36 and 9-12 weeks, 3 points to 8 weeks inclusive and 19-33 week, an increase of $ 6 or more at 13-18 weeks - 4 points; any increase in soluble complexes of monomers of fibrin (RCMP) at 37-39 weeks estimated at 1 point, 2 points - at 34-36 weeks, 3 credits in 9-12 weeks and at 30-33 weeks, increased in 2 times or more in the period up to 8 weeks inclusive and 19-29 weeks - 3 points, 4 points in the period 13 to 18 weeks; any increase in the level of D-dimer at 37-39 weeks of gestation is estimated at 1 point, 2 points - at 34-36 weeks, 3 credits in 9-12 weeks and 30-33 weeks, increased 1.5 times or more in the period up to 8 weeks inclusive and 19-29 weeks 3 points, 4 points in the period 13 to 18 weeks; increased concentrations of homocysteine (HZ) to 5.1 mmol or more gestation between 37 and 39 weeks is estimated at 1 point, 2 points in 9-12, 30-36 weeks, 3 points to 8 weeks inclusive and 19 to 29 weeks, 4 points in the period 13-18 weeks, increasing the concentration of metabolites of nitric oxide (NO) at any level in any period of pregnancy is estimated at 1 point, any level of reduction in any period - 2 points; increased levels of fibronectin (FN) from 500 up to 700 mg/l at 37-39 weeks of gestation is estimated at 1 point, p is increased to 701 mg/l and more at 30-36 weeks in 2 points, 3 points in the period 9-12, 19-29 and up to 8 weeks inclusive, 4 points in the period 13 to 18 weeks; regardless of the duration of pregnancy, the presence of a single genetic thrombophilia is estimated at 4 points, 5 points - the presence of 2 or more forms; the presence of 2 or more spontaneous abortions of any period in history or 1 or more of miscarriage after 12 weeks assessed at 2 points. Next calculate the total score and a score of 1-2 designate the basic treatment: folic acid (folacin) 5 mg per day in combination with polyunsaturated fatty acids (omega-3) 1 capsule 3 times a day until the end of pregnancy. Shall be a further study of hemostatic parameters after 4 weeks. A score of 3-5 assign basic therapy and one of the 3 drugs rate per 4 weeks: magnesium citrate (Magne-B6-Forte) 1 tablet 3 times a day in any period of pregnancy, or escin (aescusan) 2 tablets 3 times a day, or oneplant 50 mg 1 tablet 2 times a day not earlier than 13 weeks of pregnancy. Shall be a further study of hemostatic parameters after 4 weeks. A score of 6-8 assign basic therapy and the combination of the 2 drugs for 4 weeks: acetylsalicylic acid (trombas) 100 mg 1 time a day during meal not before 19 weeks of pregnancy, or dipyridamole (chimes) 25 mg 3 times a day, or pentoxifylline (trental) 100 mg 3 p is for a day in combination with escin (aescusan) 2 tablets 3 times a day, or innoplanta 50 mg 1 tablet 2 times a day not earlier than 13 weeks, or diosmin (phlebodia-600) 1 tablet 2 times a day, or pevita 2 capsules 3 times a day. Shall be a further study of hemostatic parameters after 4 weeks. A score of 9-11 assign basic therapy and sulodexide (vessl due f, angoflex) 1 vial 2 times a day/in or/m 2 weeks, then 1 capsule orally 2 times daily for 2 weeks. Shall be a further study of hemostatic parameters after 4 weeks. If the score 12-18 assign basic therapy and one of the drugs for 2 weeks: Fraxiparine 0.3 ml of 1 times a day subcutaneously, or Fragmin 0.2 ml 1 per day subcutaneously, or therapy 40 mg 1 time per day subcutaneously, or Tibor 2500 1 times a day subcutaneously. Shall be a further study of hemostatic parameters after 2 weeks. A score of 19 or more prescribed basic therapy and one of the drugs for 2 weeks: Fraxiparine 0.6 ml 1 per day subcutaneously, or Fragmin 0.4 ml of 1 times a day subcutaneously, or therapy 80 mg 1 time per day subcutaneously, or Tibor 3500 1 times a day subcutaneously. Shall be a further study of hemostatic parameters after 2 weeks.

Research parameters

The study of hemostasis was carried out using the following methods.

Determining the concentration of fibrinogen in plasma gravimetric method and R.A. Rutberg and with the use of extract of thromboplastin, incubation in a water bath, drying, and further weighed on a torsion elastic scales. The normal concentration of fibrinogen in this method 1,84-5 g/L.

The definition of partially activated thromboplastin time (APTT) were performed as determining clotting time recalcification platelet-poor plasma in terms of the standard contact and phospholipid activation. As APTT-reagent used set of the APTT test" firm "Technology Standard" (Russia) with a buffer mixture of kaolin and Catalina. APTT is a measure of the activity of the internal path of the withdrawal rate varies within 20-40 seconds.

Prothrombin index (PTI) was determined as the ratio of prothrombin time in healthy donor and patient, expressed as a percentage. Prothrombin time was determined by the method of Quick using reagent thromboplastin - "Techplast" company "Technology Standard" (Russia). PETIT defines the external coagulation pathway and is normally 80-110%.

MPE (international normalized ratio). The results of the prothrombin time in healthy individuals vary depending on the type of reagent - tissue factor (thromboplastin), used in different laboratories. Figure MPE was introduced into clinical practice in order to standardize the test results PTV. proizvoditeli reagent (tissue factor) for the test PTV must specify the ISI (international sensitivity index) for reagents. MITCH shows the activity of tissue factor produced in this batch of reagent in comparison with the standardised sample. Is MITCH usually between 1,0 and 2,0. MPE is calculated as the ratio of PTV patient to normal PTV, erected in the value of the ISI used in the test reagent. INR=(PTV patient/PTV norm).

Thromboelastography (definition ITP) whole blood was carried out on the device thromboelastogram company hellige in Norwegian (Germany). We determined the parameters chronometric (r+k) and structural coagulation (ma, ETC.). ITP - index chromodynamics potential is determined by the table based on the measure ma. The principle of thromboelastography is graphic registration processes of the formation of fibrin, his retraction and fibrinolysis. Normative values for r+k are 19-27 mm, ma - 48-52 mm, ITP - 6-12 $

The definition of the aggregation activity of platelets to ADP was performed on aggregometry "Chronolog" (USA) by the method of the photoelectric registration of the dynamics of light transmission of a sample of platelet-rich plasma under stirring with a stimulator of aggregation by adenosine diphosphate (ADP) at a final concentration of 1×10-3M is evaluated maximum amplitude of aggregation, normative fluctuations are 30-50%.

Definition RCMP and D-dimer were carried out using protointerface what about the test Niewarowski S., Gurevich V. (1971) and ethanol test Godal H.I., Abilgaard U. (1966). Positive RCMP and increased D-dimer indicate the circulation of active thrombin in the blood, i.e. the existence of trombini - DIC.

Determination of homocysteine in plasma venous blood of patients. Women of all groups research on homocysteine was performed before treatment. Venous blood was taken in tubes with anticoagulant (EDTA) on an empty stomach in the morning. Collection of samples of blood is one of the important stages in the measurement of homocysteine in plasma. Blood sampling is carried out 12 hours after the last meal. After sampling blood was collected their immediate centrifugation and collection of plasma. Plasma samples were stored at -20°C. the Concentration of HZ was measured by the method immunochemiluminescence analysis fluorescently markers.

Determination of metabolites of nitric oxide (NOx). Fluorometric method for measuring the concentration of NOx. The total concentration of stable metabolites of nitric oxide (NOx-determined by the intensity of fluorescence of 2,3-diaminonaphthalene, the reaction product of 2,3-diaminonaphthalene (DAN) and nitrite in an acidic environment (Misko et al., 1993) with modifications (Lei et al., 1999).

Determination of the level of fibronectin (FN) were performed using the method immunother entogo assay (ELISA). Currently described many different variants of ELISA, but in our work we have focused on solid-phase, where the solid phase was used polystyrene. The use of solid phase allows you to simplify the process of separating the components of the reaction due to the immobilization of one of the components in the solid phase and removing substances that are not participating in the reaction. From solid-phase methods, we chose the "sandwich" - option, due to its high sensitivity, superior to all other schemes of solid-phase ELISA. Description of method: the 96 well plates were senzibilizirani first MAT (monoclonal antibody) 4 In (10 μg/ml) in carbonate-bicarbonate buffer pH of 9.5. The wells were made in 100 μl of standard antigen dilutions and test sera were incubated for 1 h at t=37°C and then added 100 μl of the conjugate of the second MAT with peroxidase. After incubation at t=37°C for 1 h was made of 0.4% solution of o-phenylenediamine and citrate-phosphate buffer pH of 4.7 with 0.1% hydrogen peroxide. After 20 min the reaction was stopped by 50% sulfuric acid. Reading of the results was performed on a spectrophotometer "Titertek Multiskan, Flow at a wavelength of 490 nm.

For research on thrombophilic mutations genomic DNA from blood samples was isolated by the standard method using proteinase K and subsequent phenol extraction and precipitation with ethanol Detection of mutations was performed by PCR using fluorescence-labeled allele-specific primers. PCR was performed in 30 μl of buffer solution containing 50 mm KCI, 1.5 mm MgCI2, 10 mm Tris-HCI, pH 8.5, 250 mm of each deoxynucleoside, 20 pmol of each primer and 0.5 units of Taq DNA polymerase. For amplification we used thermal cycler "GeneAmp PCR System 2400" company Perkin-Elmer (USA). The PCR conditions were as follows: 30 cycles: 94°C - 30 sec, 60°C 30 sec, 72°C - 1 min Amplificate was purified on columns HR-S300 (Amersham Pharmacia Biotech). Fluorescently-labeled DNA fragments were analyzed on the device for kapillyarnogo electrophoresis "Multigen" production NPF APG-biotech (Russia). Conducted random checks of the results by direct sequencing of pre-amplified DNA fragments containing the region of the supposed mutation. Method of scoring: the increase In fibrinogen 1.5 times at 37-39 weeks of gestation is estimated at "1 point", above in 2 and more times at 34-36 weeks 9-12 weeks of pregnancy - in "2 points", increasing the concentration of fibrinogen in 2 and more times up to 8 weeks of pregnancy, 19-29 weeks and 30-33 weeks assess the "3 points", and the increase of fibrinogen in 2 and more times at 13-18 weeks assess the "4 points".

Prothrombin index at any level at 37-39 weeks is estimated at "1 point", increased to 125% in terms 34-36 weeks 9-12 weeks was evaluated as "2 points", the increase of 126% or more to 8 weeks baie is amenesty (inclusive) evaluated as "3 points", a similar improvement in terms 19-29 and 30-33 weeks was evaluated as "3 points", and the increase of 126% over the period 13 to 18 weeks of pregnancy was evaluated as "4 points".

The decrease partially activated thromboplastin time at any level at 37-39 weeks assessed as "1 point". Reduction to 21-24 s 34-36 and 9-12 weeks of pregnancy is estimated at "2 points", reduced to 20 seconds and less in pregnancies up to 8 weeks, inclusive, and 19-29 and 30-33 weeks assess the "3 points", and a similar reduction in 13-18 weeks of pregnancy is estimated at "4 points".

The decrease in international normalized ratio at any level at 37-39 weeks of gestation to assess "1 point". Reduced to 0,7-0,8 Euro 34-36 and 9-12 weeks of pregnancy to assess the "2 points", reduced to 0.6 and less than in pregnancies up to 8 weeks, inclusive, and 19-29 and 30-33 weeks assess the "3 points". A similar decrease to 0.6 and less 13-18 weeks of pregnancy - the "4 points".

Index increase chromodynamics potential of any level at 37-39 weeks of gestation is estimated at "1 point", increase any level 34-36 and 9-12 weeks of pregnancy is estimated at "2 points", an increase of $ 3-5 in pregnancies up to 8 weeks inclusive and 19-29 and 30-33 weeks assess the "3 points", and an increase of $ 6 or more at 13-18 weeks of pregnancy is estimated at "4 points".

Increasing soluble to the of ElexV monomers of fibrin 3-4 times and less at 37-39 weeks of gestation is estimated at "1 point", a similar increase in the period 34-36 weeks of pregnancy is estimated at "2 points", and in the period 9-12 weeks - in the "3 points". The increase in 2 times or more in the period up to 8 weeks inclusive and 19 to 29 weeks of gestation is estimated at "3 points", increased 3-4 times and less at 30-33 weeks of gestation is estimated at "3 points", and increased in 2 times or more in the period 13 to 18 weeks of pregnancy is estimated at "4 points".

Increased levels of D-dimer in 2 times and less at 37-39 weeks of gestation is estimated at "1 point", a similar improvement in 34-36 weeks is estimated at "2 points", and in 9-12 weeks and 30-33 weeks in the "3 points". Increased levels of D-dimer in 1,5 times more than in pregnancies up to 8 weeks inclusive and 19-29 weeks assess the "3 points", and in the period 13 to 18 weeks in the "4 points".

Increased concentrations of homocysteine 5.1 mmol or more gestation between 37 and 39 weeks is estimated at "1 point", 9-12, and 34-36 30-33 weeks in the "2 points", 19-29 weeks and up to 8 weeks old, in the "3 points" and in the period 13 to 18 weeks in the "4 points".

Increasing the concentration of metabolites of nitric oxide at any level in any period of pregnancy is estimated at "1 point", any level of reduction in any stage of pregnancy is estimated at "2 points".

Increased levels of fibronectin from 500 to 700 mg/l at 37-39 weeks of gestation is estimated at "1 point", increasing 701 mg/l and more in gestational age 34-36 and 30-33 weeks assessing what is in the "2 points", a similar improvement in terms 9-12, 19-29 and up to 8 weeks including estimated at "3 points", and in the period 13 to 18 weeks in the "4 points".

Regardless of the length of this pregnancy, the presence of a single genetic thrombophilia, regardless Homo - or heterozygosity, estimated at "4 points", and the presence of 2 or more forms in the "5 points".

The presence of 2 or more spontaneous abortions of any period in history or 1 or more abortions after 12 weeks - is estimated in the "2 points".

Next, the sum of the points available criteria and indicators regardless of the method of the study specific indicators.

A score of 1-2 is assigned scheme No. 1: therapy folic acid (folacin) 5 mg per day 1 time per day in combination with polyunsaturated fatty acids (omega-3) 1 capsule 3 times a day until the end of pregnancy.

Shall be a further study of hemostatic parameters after 4 weeks.

A score of 3-5 is assigned to the basic scheme No. 1 and one of 2 drugs (scheme 2):

1. magnesium citrate (Magne-B6-Forte) 1 tablet 3 times a day in any pregnancy rate at 4 weeks;

2. escin (aescusan) 2 pills 3 times a day / oneplant 50 mg 1 tablet 2 times a day not earlier than 13 weeks course for 4 weeks.

Shall be a further study of hemostasis through 4 is eaten.

A score of 6-8 are assigned the base scheme No. 1 and the following combinations of drugs for 4 weeks (scheme 3):

1. acetylsalicylic acid (trombas 100 mg) 1 tablet 1 time a day during the meal (not before 19 weeks of gestation), or dipyridamole (chimes) 1 tablet (25 mg) 3 times a day, or pentoxifylline (trental) 1 tablet (100 mg) 3 times a day

in conjunction with:

2. escin (aescusan) 2 tablets 3 times a day, or oneplant 50 mg 1 tablet 2 times a day not earlier than 13 weeks, or diosmin (phlebodia-600) 1 tablet 2 times a day, or pewit 2 capsules 3 times per day.

Shall be a further study of hemostatic parameters after 4 weeks.

A score of 9-11 is assigned to the base circuit # 1 and circuit # 4 at 4 weeks:

1. sulodexide (vessel due f, angoflex) 1 vial 2 times a day/in or/m 14 days, then 1 capsule orally 2 times daily for 2 weeks.

Shall be a further study of hemostatic parameters after 4 weeks.

A score of 12 to 18 are assigned the base scheme 1 and scheme No. 5 for 2 weeks:

1. Fraxiparine 0.3 ml of 1 times a day subcutaneously for 14 days, or Fragmin 0.2 ml 1 per day subcutaneously for 14 days, or therapy 40 mg 1 time per day subcutaneously for 14 days, or Tibor 2500 - 1 times a day subcutaneously for 14 days.

Shall be a further study of hemostatic parameters after 2 weeks.

A score of 19 or more, naznachen the basic scheme 1 and scheme No. 6 for 2 weeks:

1. Fraxiparine 0.6 ml 1 per day subcutaneously for 14 days, or Fragmin 0.4 ml of 1 times a day subcutaneously for 14 days, or therapy 80 mg 1 time per day subcutaneously for 14 days, or Tibor 3500 - 1 times a day subcutaneously for 14 days.

Shall be a further study of hemostatic parameters after 14 days.

Thus, the initial course of therapy is 14-28 days depending on the amount of points and the selected scheme. The lack of effectiveness of therapy with repeated study of hemostasis is assigned to the transition to the following schema.

The specific implementation of the method.

Overall, from 2003 to 2011 were surveyed 750 pregnant women with thrombophilic disorders of hemostasis from the 1st trimester of pregnancy (6 weeks of gestation and before delivery.

visit 1 - 6 weeks of pregnancy.

At inclusion in the study, all pregnant women were systematic study of hemostasis by the following methods.

In pregnant women during routine study of hemostasis evaluate the following parameters: the duration of the pregnancy, the indicators of hemostasis: the level of increase in the concentration of fibrinogen and prothrombin index; the reduction partially activated thromboplastin time and international normalized ratio; the level of the index chromodynamics potential, soluble complexes of monomers and fibrin D-dimer.

Consequently, the sustained fashion assesses indicators of endothelial dysfunction: the level of increasing concentrations of homocysteine and fibronectin and changes in the concentration of metabolites of nitric oxide.

It is the presence of genetic forms of thrombophilia and syndrome habitual pregnancy loss.

On the first visit held ultrasound and a blood test for human chorionic gonadotropin to confirm that developing and intrauterine pregnancy. Also conducted a study of anthropometric data (body mass index, weight, height). When ultrasound is estimated the presence of the ovum, its size and location, the presence of the embryo, the tone of the uterus, the condition of the cervix.

When detecting signs of threatened abortion (hypertonicity of the uterus) is assigned to antispasmodic therapy drotaverine 1 tablet (20 mg) 3 times a day.

When detecting signs retrohaling hematoma is a standard step therapy: 1st stage: dydrogesteron 40 mg daily (1 tablet 4 times a day) for 2 weeks, tranexamic acid 1 tablet 4 times a day for 5 days, 2nd stage: after 5 days - Wobenzym 2 tablets 3 times a day and Actovegin, 1 pill 3 times a day for 4 weeks.

visit 2 - 11 weeks of pregnancy.

On the visit are assessed complaints, conducted physical examination, palpation of the abdomen, measurement of body mass, listening to the fetal heart using B-dop. Is prenatal screening in the first trimester.

With hypertonicity of the uterus (stored or identified): utrogestan 400 mg per day orally, the NIF is a yiping 10 mg 4 times a day until 17 weeks of gestation with ultrasound at 17 weeks. If earlier treatment of hypertonicity of the myometrium was effective, the patient is assigned micronized progesterone (utrogestan) at a dose of 200 mg per day orally.

If there retrohaling hematoma: phase organization dydrogesterone 40 mg per day orally, Wobenzym 3 capsules 3 times a day for 4 weeks. The newly formed bruise - patient treatment: MgSO425% 30 ml + 200 ml of physiological solution (0.9% NaCl) 1 time per day for 5 days intravenously; dydrogesterone 40 mg per day orally; Actovegin 2 tablets 3 times a day; cranecam 500 mg + 200 ml of physiological solution (0.9% NaCl) 1 time per day for 5 days intravenously. After 5 days - ultrasound, dydrogesterone 40 mg per day orally; Actovegin 2 tablets 3 times a day; cranecam 1 tablet 3 times a day. At discharge: utrogestan 600 mg per day orally for up to 17 weeks of pregnancy with ultrasound at 17 weeks; Actovegin 2 tablets 3 times a day for 2 weeks, Wobenzym 1 capsule 3 times daily for 8 weeks.

Hemostasiogram. In the presence of thrombophilia - correction of disorders of hemostasis according to the above approach control gemostaziogramma 1 time in 14-28 days depending on the extent of the violations.

3rd visit - 17 weeks of pregnancy.

Objective inspection, complaints, Palpa the Oia, bimanual vaginal-abdominal examination with assessment of the cervix to avoid isthmic-cervical insufficiency (ICN). Listening to fetal heart rate monitoring using B-dop. Triple test (estriol, P, β-HCG). Ultrasound - measured the following parameters: tone Oxytocics, the state of the cervix (length, area internal OS).

With hypertonicity of the uterus: inpatient treatment: MgSO425% 30 ml + 200 ml of physiological solution (0.9% NaCl) 1 time per day for 5 days intravenously, utrogestan 600 mg per day of oral nifedipine 10 mg 4 times a day; 5 days - ultrasound, utrogestan 600 mg per day orally; nifedipine 10 mg 4 times a day. At discharge: utrogestan 600 mg per day of oral nifedipine 10 mg 4 times a day with ultrasound at 22 weeks.

If there are signs ICN: correction according to traditional methods.

Hemostasiogram. In the presence of thrombophilia - correction of disorders of hemostasis according to the above approach control gemostaziogramma 1 time in 14-28 days depending on the extent of the violations.

4 visit - 22 weeks of pregnancy. Objective inspection, complaints, palpation, auscultation of the fetal heart. Ultrasound - measured the following parameters: tone Oxytocics, the state of the cervix (length, area internal throat), Doppler of the uterine-placental-fetal is robotica (loader) (uterine artery (MA), umbilical artery (AP), middle cerebral artery of the fetus (SA), the spiral arteries, the aorta of the fetus), with normal values of the control at 28 weeks. All patients are to undergo preventive treatment of placental insufficiency: limonta 1 tablet 1 time per day, Actovegin 2 tablets 3 times a day for 2 weeks.

With hypertonicity of the uterus: utrogestan 600 mg per day of oral nifedipine 10 mg 4 times a day, Magne-B6 2 tablets 3 times per day up to 28 weeks of pregnancy with ultrasound at 28 weeks.

If there are signs ICN: correction according to traditional methods.

When violations loader diagnosed placental insufficiency, it is necessary inpatient treatment: Actovegin 5 ml + 200 ml of physiological solution (0.9% NaCl solution) intravenously No. 3 1, 3, 5 day; trental 5 ml + 200 ml of physiological solution (0.9% NaCl solution) intravenously No. 3 on 2, 4, 6 day. Hemostasiogram. In the presence of thrombophilia - correction of disorders of hemostasis according to the above approach control gemostaziogramma 1 time in 14-28 days depending on the extent of the violations.

5 visit - 28 weeks of pregnancy.

Objective inspection, complaints, palpation. Listening to the fetal heart. Ultrasound - measured the following parameters: tone Oxytocics (with the increase in the previous study), the state of the cervix (length, area DNAs is Rennie throat), Doppler loader (MA, AP, CA, spiral artery, the aorta of the fetus). Fetometry to avoid delay syndrome fetal growth (sdfd).

Hemostasiogram. In the presence of thrombophilia - correction of disorders of hemostasis according to the above approach control gemostaziogramma 1 time in 14-28 days depending on the extent of the violations.

With hypertonicity of the uterus: utrogestan 600 mg per day of oral nifedipine 10 mg 4 times a day before 34 weeks of gestation with ultrasound at 34 weeks.

If there are signs ICN: correction according to traditional methods.

When violations loader diagnosed placental insufficiency (PI), it is necessary inpatient treatment: Actovegin 5 ml + 200 ml of physiological solution (0.9% NaCl solution) intravenously No. 3 1, 3, 5 day; trental 5 ml + 200 ml of physiological solution (0.9% NaCl solution) intravenously No. 3 on 2, 4, 6 day. When identifying sdfd diagnosed MO - patient treatment: Actovegin 5 ml + 200 ml of physiological solution (0.9% NaCl solution) intravenously No. 3 1, 3, 5 day; trental 5 ml + 200 ml of physiological solution (0.9% NaCl solution) intravenously No. 3 on 2, 4, 6 day.

6 visit - 34 weeks of pregnancy.

Objective inspection, complaints, palpation. Listening to the fetal heart. Ultrasound measured the following parameters: tone Oxytocics (with the increase in the previous the future study), the state of the cervix (length, area internal throat), Doppler loader (MA, AP, CA, spiral artery, the aorta of the fetus). Fetometry to avoid delay syndrome fetal growth (sdfd). The course is conducted prevention of placental insufficiency: limonta 1 tablet 1 time per day, Actovegin 2 tablets 3 times a day for 2 weeks.

With hypertonicity of the uterus: utrogestan 200 mg per day of oral nifedipine 10 mg 4 times a day for up to 36 weeks of pregnancy with the subsequent abolition of 36 weeks.

When violations loader diagnosed placental insufficiency (PI), it is necessary inpatient treatment: Actovegin 5 ml + 200 ml of physiological solution (0.9% NaCl solution) intravenously No. 3 1, 3, 5 day; trental 5 ml + 200 ml of physiological solution (0.9% NaCl solution) intravenously No. 3 on 2, 4, 6 day. When identifying sdfd diagnosed MO - patient treatment: Actovegin 5 ml + 200 ml of physiological solution (0.9% NaCl solution) intravenously No. 3 1, 3, 5 day; trental 5 ml + 200 ml of physiological solution (0.9% NaCl solution) intravenously No. 3 on 2, 4, 6 day.

Hemostasiogram. In the presence of thrombophilia - correction of disorders of hemostasis according to the above approach control gemostaziogramma 1 time in 14-28 days depending on the extent of the violations.

7 visit - 38 weeks of pregnancy.

Objective checks, the, complaints palpation. Listening to the fetal heart. Hemostasiogram. If necessary, the correction of violations, or a total abolition of therapy aimed at correcting thrombophilic disorders of hemostasis.

8 visit - rods traditional obstetric indications and according to traditional tactics.

Late postnatal period 4 and 14 days after birth.

The study gemostaziogramma, when deviations from the physiological norm solution of the question of the necessity of consulting a hematologist for selection of therapy.

In the described unified approach to the interpretation of the pathology of hemostasis during pregnancy and developed a differentiated method of correction of thrombophilic disorders of hemostasis was successfully carried out pregnancy in 750 patients. In all cases, the pregnancy ended in a timely birth with the birth of a living and healthy children weighing not less than 3000 grams. In any case, was not identified sdfd of the fetus, the development of severe forms of preeclampsia, fetal asphyxia, antenatal fetal death, as well as cases of detachment of normally located placenta and abnormal bleeding in the third and early postpartum period.

Clinical case 1.

Pregnant L, 27 years. History burdened 1 by a miscarriage at 9 weeks of gestation. Before pregnancy to cause nevynashivaniya were surveyed. On admission (visit 1) at 6 weeks of gestation - had no complaints. In the study of gemostaziogramma, factors of endothelial dysfunction and thrombophilic mutations were identified that were present thrombophilia in the amount of 10 points (change 2 hemostasis and 1 form of genetic thrombophilia). Was diagnosed with the genetic form of thrombophilia in the form of a homozygous mutation inhibitor of plasminogen activator type 1 and change indicators APTT and ITP. A pregnant woman was appointed therapy according to the developed scale: folic acid 5 mg per day (folacin 1 ton per day), DHA (omega-3) 1 capsule 3 times a day, sulodexide (vessel due f, angoflex) 1 vial 2 times a day/in or/m 14 days, then 1 capsule orally 2 times a day for 14 days.

Further, since the amount of points does not exceed 10, and the study of hemostasis was performed 1 time in 4 weeks, with each study were recalculated the scores. As a result, by 30 weeks of pregnancy, the amount of points dropped to 8 points in the result it was possible and necessary to change the course of therapy: acetylsalicylic acid (trombas 100 mg) 1 tablet 1 time a day during meals in conjunction with figure 1: folic acid 5 mg per day (folacin 1 ton per day), DHA (omega-3) 1 capsule 3 times a day. At 34 weeks, according to the research of parameters of hemostasis was found to further decrease b is low to 5, in connection with what was done changing therapy: magnesium citrate (Magne-B6-Forte) 1 tablet 3 times a day in combination with scheme 1: folic acid 5 mg per day (folacin 1 ton per day), DHA (omega-3) 1 capsule 3 times a day. At 38 weeks of therapy aimed at correcting disorders of hemostasis was discontinued. It is important to note that at sufficiently expressed disorders of hemostasis in early pregnancy the patient, due to the application of the developed way of doing, during the whole period of gestation found no signs of threatened abortion, signs of placental insufficiency, sdfd and preeclampsia. Birth occurred after normal vaginal delivery at 39 weeks of gestation. Born live, full-term girl, without malformations, weight 3600 grams, height of 54 cm, with a score on the Apgar 8/9 points. Complications during childbirth, third, early and late postnatal period have been identified.

Clinical case 2.

Pregnant H., 32 years. From the anamnesis - 2 spontaneous abortion in the period from 12 to 16 weeks. At the reception in the study of indicators of hemostasis identified is the lack of genetic forms of thrombophilia, but the score was 6 weeks 22 points. This showed evidence of endothelial dysfunction and significant deviations of most of the parameters of hemostasis. At the time of inspection of patientce there were signs of threatened abortion, and on ultrasound was determined retroareolar hematoma size 1×2 cm Was an appropriate treatment of threatened abortion and retrohaling hematoma (described above). Also based on the amount of points was assigned therapy: Fraxiparine 0.6 ml 1 per day subcutaneously in combination with scheme 1: folic acid 5 mg per day (folacin 1 ton per day), DHA (omega-3) 1 capsule 3 times a day. In 8 weeks by ultrasound signs retrohaling hematoma were not identified, however, remained hypertonicity of the uterus, resulting in the continued treatment of threatened abortion (described above). Also according to the study of hemostasis scores decreased to 20 - continued therapy fraxiparina 0,6 subcutaneously in combination with scheme 1: folic acid 5 mg per day (folacin 1 ton per day), DHA (omega-3) 1 capsule 3 times a day. Further research was conducted hemostasis 1 every 2 weeks during each study were recalculated the scores. In 12 weeks by ultrasound pathology there were no discontinued the treatment of threatened abortion. According to the study of hemostasis - the score was 20 - therapy was continued. In 22 weeks by ultrasound showed signs isthmic-cervical insufficiency, was established obstetric pessary. According to the study of hemostasis - the score was 20 - tera the Oia was continued. At 32 weeks according to hemostasis - the score was 18, which helped to change the course of therapy on Fraxiparine 0.3 in conjunction with figure 1: folic acid 5 mg per day (folacin 1 ton per day), DHA (omega-3) 1 capsule 3 times a day. At 34 weeks of pregnancy, the patient showed evidence compensated MO and held stationary treatment (described above), while the analysis of parameters of hemostasis, the score was already 10. In connection with what was done changing therapy based on the scale: folic acid 5 mg per day (folacin 1 ton per day), DHA (omega-3) 1 capsule 3 times a day, sulodexide (vessel due f, angoflex) 1 vial 2 times a day/in or/m 14 days, then 1 capsule orally 2 times a day for 14 days. The study of hemostasis spent 4 weeks. At 38 weeks was removed obstetric pessary, and the analysis of parameters of hemostasis was found to further decrease points to 5, and therefore were changing therapy: magnesium citrate (Magne-B6-Forte) 1 tablet 3 times a day in combination with scheme 1: folic acid 5 mg per day (folacin 1 ton per day), DHA (omega-3) 1 capsule 3 times a day. According to the ultrasound signs of MO was absent. According to clinical examination of the development of preeclampsia have been identified. The pregnancy ended at 39-40 weeks timely delivery through the birth canal. Begot whom I live full-term boy weighing 3100 grams, 52 cm, with a score on the Apgar 8/9 points. Complications during the postpartum period have been identified.

SCHEME 1

SCHEME 1 (basic): folic acid 5 mg per day (folacin 1 ton per day)+

Polyunsaturated fatty acids (omega-3) 1 capsule 3 times a day.

SCHEME 2: magnesium citrate (Magne-B6-Forte) 1 tablet 3 times daily or

escin (aescusan) 2 tablets 3 times a day or oneplant 50 mg 1 tablet 2 times a day (not before 13 weeks of pregnancy).

SCHEME 3: acetylsalicylic acid (trombas 100 mg) 1 tablet 1 time a day during the meal (not before 19 weeks of gestation) or

dipiridamol (chimes) 1 tablet (25 mg) 3 times a day, or pentoxifylline (trental) 1 tablet (100 mg) 3 times a day +

escin (aescusan) 2 tablets 3 times a day or oneplant 50 mg 1 tablet 2 times a day (not before 13 weeks of pregnancy) or

diosmin (phlebodia-600) 1 tablet 2 times a day or pewit 2 capsules 3 times per day.

SCHEME 4: sulodexide (vessel due f, angoflex) 1 vial 2 times a day/in or/m 14 days, then 1 capsule orally 2 times a day.

Figure 5: Fraxiparine 0.3 ml of 1 times a day subcutaneously for 14 days or Fragmin 0.2 ml 1 per day subcutaneously for 14 days or

therapy 40 mg 1 time per day subcutaneously for 14 days or Tibor 2500 - 1 times a day subcutaneously for 14 days.

SCHEME 6: Fraxiparine 0.6 ml 1 per day subcutaneously for 14 days or Fragmin 0.4 ml 1 per day enter the tenderly 14 days or

therapy 80 mg 1 time per day subcutaneously for 14 days or Tibor 3500 - 1 times a day subcutaneously for 14 days.

INTERPRETATION of RESULTS:

1-2 points - basic therapy: scheme 1, the monitoring hemostasis 1 every 4 weeks;

3-5 points - therapy: circuits 1+2, the control of hemostasis 1 every 4 weeks;

6-8 points - therapy: schema 1+3, the control of hemostasis 1 every 4 weeks;

9-11 points therapy: schema 1+4, control of hemostasis 1 every 4 weeks;

12-18 points therapy: schema 1+5, control of hemostasis 1 every 2 weeks;

19 points or more therapy: schema 1+6, the control of hemostasis 1 time in 2 weeks.

PRIMARY COURSE: 14-28 days,

the lack of effectiveness of therapy - go to the following diagram.

The correction method of thrombophilic disorders of hemostasis during pregnancy, including the definition of indicators of hemostasis, indicators of endothelial dysfunction, the presence of the genetic forms of thrombophilia and syndrome habitual pregnancy loss, characterized in that the increase of fibrinogen 1.5 times at 37-39 weeks of gestation is estimated at 1 point, the increase in 2 and more times at 34-36 weeks 9-12 weeks - 2 points, 3 points to 8 weeks inclusive and 19-33 weeks, 4 points - at 13-18 weeks; prothrombin index to 125% at 37-39 weeks is estimated at 1 point, 2 points - in terms 34-36 and 9-12 weeks, increased to 126% and over up to 8 weeks of pregnancy and in 19-33 week 3 credits, 4 points in the period 13 to 18 weeks; decrease partially activated thromboplastin time before 21-24 seconds at 37-39 weeks is estimated at 1 point, 2 points in 34-36 and 9-12 weeks, reducing to 20 seconds and less in the period up to 8 weeks inclusive and 19-33 weeks - 3 points, 4 points - at 13-18 weeks; decrease in international normalized ratio up to 0,7-0,8 dollar at 37-39 weeks of gestation is estimated at 1 point, 2 points in 34-36 and 9-12 weeks, reducing to 0.6 and less in the period up to 8 weeks inclusive and 19-33 weeks - 3 points, 4 points - at 13-18 weeks; increase index chromodynamics potential for 3-5 dollar at 37-39 weeks of gestation is estimated at 1 point, 2 points in 34-36 and 9-12 weeks, 3 points to 8 weeks inclusive and 19-33 week, an increase of $ 6 or more at 13-18 weeks - 4 points; any increase in soluble complexes of monomers of fibrin at 37-39 weeks is estimated at 1 point, 2 points - at 34-36 weeks, 3 credits in 9-12 weeks and at 30-33 weeks, increased in 2 times and more in the period up to 8 weeks inclusive and 19-29 weeks - 3 points, 4 points in the period 13 to 18 weeks; any increase in the level of D-dimer at 37-39 weeks of gestation is estimated at 1 point, 2 points - at 34-36 weeks, 3 credits in 9-12 weeks and 30-33 weeks, increased 1.5 times or more in the period up to 8 weeks inclusive and 19-29 weeks - 3 points, 4 points in the period 13 to 18 weeks; increased concentrations of homocysteine to 5.1 mmol or more gestation between 37 and 39 weeks is estimated at 1 point 2 ball is a - in 9-12, 30-36 weeks, 3 points to 8 weeks inclusive and 19 to 29 weeks, 4 points in the period 13-18 weeks, increasing the concentration of metabolites of nitric oxide at any level in any period of pregnancy is estimated at 1 point, any level of reduction in any period - 2 points; increased levels of fibronectin from 500 to 700 mg/l at 37-39 weeks of gestation is estimated at 1 point, up to 701 mg/l and more at 30-36 weeks - 2 points, 3 points in the period 9-12, 19-29 and up to 8 weeks inclusive, 4 points in the period 13 to 18 weeks; regardless of the duration of pregnancy, the presence of a single genetic thrombophilia is estimated at 4 points, 5 points - the presence of 2 or more forms; the presence of 2 or more spontaneous abortions of any period in history or 1 or more abortions after 12 weeks assessed at 2 points; calculate the total score and a score of 1-2 designate the basic treatment: folic acid 5 mg per day in combination with polyunsaturated fatty acids 1 capsule 3 times a day until the end of pregnancy; a score of 3-5 set the base therapy and one of the 3 drugs rate per 4 weeks: magnesium citrate 1 tablet 3 times a day in any period of pregnancy, or escin 2 tablets 3 times a day, or oneplant 50 mg 1 tablet 2 times a day not earlier than 13 weeks; a score of 6-8 assign basic therapy and the combination of the 2 drugs for 4 weeks: and metilsalicilata acid 100 mg 1 time a day during meal not before 19 weeks of pregnancy, or dipyridamole 25 mg 3 times a day, or pentoxifylline 100 mg 3 times a day in combination with escin 2 tablets 3 times a day, or innoplanta 50 mg 1 tablet 2 times a day not earlier than 13 weeks, or diosmin 1 tablet 2 times a day, or pevita 2 capsules 3 times a day; a score of 9-11 assign basic therapy and sulodexide 1 vial 2 times a day/in or/m 2 weeks, then 1 capsule orally 2 times daily for 2 weeks; if the score 12-18 assign basic therapy and one of the drugs for 2 weeks: Fraxiparine 0.3 ml of 1 times a day subcutaneously, or Fragmin 0.2 ml 1 per day subcutaneously, or therapy 40 mg 1 time per day subcutaneously, or Tibor 2500 1 time per day subcutaneously; a score of 19 or more prescribed basic therapy and one of the drugs for 2 weeks: Fraxiparine 0.6 ml 1 per day subcutaneously, or Fragmin 0.4 ml of 1 times a day subcutaneously, or therapy 80 mg 1 time per day subcutaneously, or Tibor 3500 1 time per day subcutaneously; further research is being conducted hemostasis 1 time in 4 weeks with a score of 1-11 1 or 2 times per week with a score of 12 or more, at each study recalculated the scores, the results of therapy or continue, or to change depending on the amount of points.



 

Same patents:

FIELD: medicine.

SUBSTANCE: blood total cholesterol and triglyceride concentrations are determined. An initial heart rate, systolic (SBP) and diastolic (DBP) blood pressure are measured; a gradually increasing submaximal exercise test is conducted. The maximum and minimum DBP, SBP, the maximum heart rate at each stage of the test, as well as SBP, DBP and heart rate are measured in 30 s, 2, 4 and 6 minutes upon completion of the test. That is followed by detecting an abnormal reaction of SBP to the test with an increase of SBP less than 33 mmHg as compared to the initial SBP, or a decrease of SBP at the following stage as compared to the previous stages by more than 10 mmHg starting from the third stage. The abnormal delayed post-exercise heart rate recovery with a decrease of the heart rate by less than 8 beats/min for the first minute or by less than 12 beats/min for the first two minutes after completion of the exercise is determined. The test length is recorded. A ten-year risk of the fatal cardiovascular event is calculated by formula taking into account the above parameters.

EFFECT: invention enables reliable individual prediction taking into account all the hemodynamic parameters specified above and ensures avoiding false positive and false negative results.

3 ex

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine, namely to laboratory diagnostics, and can be applied for diagnostics of sepsis, caused by bacteria, which contain a gene NDM-1. For this purpose samples with the bacteria, which contain the gene NDM-1 are subjected to an exposure to ultraviolet probing irradiation, and smears of a patient's blood are analysed. The following analysis of the secondary fluorescence is carried out, with the preliminary multiple measurement of totalities of values of levels of spectral components of the secondary fluorescence from calibrating samples with the bacteria, which contain the gene NDM-1 (pathology), samples of the blood smears, not infected with the bacteria, which contain the gene NDM-1 (norm). After that, totalities of the obtained values of levels of spectral components are determined by pathology and norm as diagnostics criteria, in each analysis of the patient's blood smear samples in a real time mode analogically totalities of the values of levels of spectral components of the secondary fluorescence are multiply measured. The obtained totality of the values of levels of spectral components of the secondary fluorescence as a spectral sample is alternately compared with the preliminarily obtained diagnostics criteria of norm and pathology, the nearest approximation to one of the diagnostics criteria, which determines a diagnosis, is determined. Also claimed is an automatic device.

EFFECT: group of inventions ensures reduction of mortality among the population, the timely beginning of treatment of the said sepsis, resistant to standard antibacterial therapy.

4 cl

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine. A system for introduction of medications to a patient contains a supplying device for introduction of liquid medications and/or nutrients to the patient; the first measuring device for measuring the patient's urine parameters; the first analytic device for an analysis of the measured patient's urine parameters and the first computing device for computing the first parameters of the medications, intended for introduction to the respective patient on the basis of the analysed measured urine parameters. The second measuring device is intended for measuring the urine quantity, sampled from the patient's organism. The second analytic device is applied for the analysis of the measured urine quantity, and the second computing device is applied for computing a balance of fluid media in the patient's organism on the basis of the quantity of the sampled urine and the quantity of liquid medications and/or nutrients, supplied by the supplying device and computing the second parameters of the medication. The supplying device supplies the respective medications with general parameters of the medication, computed on the basis of the first parameters of the medication and the second parameters of the medication. A method of determining parameters of the medications, intended for introduction to the patient, is disclosed.

EFFECT: inventions provide an automatic supply of a medication with taking into account the urine parameters.

10 cl, 1 dwg

FIELD: medicine.

SUBSTANCE: peripheral venous blood of pregnant women suffering from threatening recurrent miscarriage is examined. The peroxynitrite and NO-tyrosine concentrations are measured in 6-12 weeks of gestation. That is followed by calculating a peroxynitrite/NO-tyrosine ratio. If the derived value is less than 11%, a short-term effect of the standard preserving therapy is predicted. If the value falls within the range of 11.0% or more, a prolonged effect of the standard therapy and a gestation course with no threatening miscarriage in the 2nd and 3rd trimesters are predicted.

EFFECT: more accurate prediction, enabled timely correction of medical and preventive measures for the purpose of prevention of late miscarriage; the method is easy to implement and properly reproducible.

3 ex

FIELD: medicine.

SUBSTANCE: with underlying breathing support, infusion-transfusion, antibacterial, rheological and disaggregation therapy, enteral and parenteral nutrition, correction of aqueous-electrolytic disorders, dynamic laboratory control, replacement renal therapy is conducted. When determining two or more blood values within: hypernatraemia more than 150 mmole/l, hyperosmolarity more than 300 mosmole/l, creatinine more than 200 mcmole/l, urea more than 20 mmole/l, an average molecular level is detected. In case this value is higher than 0.8 standard units intermittent replacement renal therapy in the form of intermittent hemodiafiltration is conducted while in case an average molecular level is lower than than 0.8 standard units intermittent replacement renal therapy in the form of intermittent haemodialysis is conducted.

EFFECT: method enables preventing developing gross organ failure at the early stages of the organ dysfunction.

6 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: patient's blood serum one-dimensional electrophoresis is performed, and an electrophoretic distribution spectrum of serum protein is evaluated. If the proteins with molecular weight 128, 114, 21 kDa are found, paranoid schizophrenia is diagnosed; the proteins with molecular weight 88 and 32 kDa enable diagnosing simple schizophrenia, while acute polymorphic psychosis is shown by the proteins with molecular weight 65 and 38 kDa.

EFFECT: using the given technique enables performing the differential diagnosis of simple, paranoid schizophrenia and acute polymorphic psychosis, and prescribing an individual therapy of a patient adequate to the diagnosis.

3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to obstetrics, and concerns a method for determining a severity of gestosis in pregnant women. Substance of the method consists in analysing venous blood by the Radiometer ABL 5 blood gas analyser and determining a partial oxygen pressure in venous blood. If the partial oxygen pressure in venous blood is 36 to 42 mm Hg, a mild gestosis is stated; if the partial oxygen pressure in venous blood is 43 to 51 mm Hg, a moderate gestosis is diagnosed; the partial oxygen pressure in venous blood falling within 52 to 61 mm Hg shows a severe gestosis. The method can be applied in pregnancy pathology wards, resuscitation and critical care units in obstetric hospitals for determining a severity of gestosis in pregnant women to optimise the therapeutic approach to managing pregnant women.

EFFECT: method provides higher accuracy, information value, sensitivity, objectivity of determining the severity of gestosis.

3 ex

FIELD: medicine.

SUBSTANCE: early diagnosing of developing allergic sensitisation in infants is ensured by single determination of urea excretion of breast milk alpha-lactoalbumin within a period from 7th to 21st day of an infant's life. If the infant's urea alpha-lactoalbumin exceeds 40 ng/mg, a risk group of an allergic pathology is stated.

EFFECT: using the given method enables the non-invasive procedure of determining the risk of developing allergic sensitisation in infants, and additionally stating a familial allergic predisposition.

2 cl, 1 tbl

FIELD: medicine.

SUBSTANCE: after beginning a meal, a human blood glucose concentration Gi is intermittently measured over a period of time Δti, and a blood plasma glucose gain ΔG(pl)i, an amount of glucose received by insulin-dependent tissues ΔG(tis)i, an amount of glucose consumed by the metabolic processes ΔG(met)i, an amount of glucose consumed by the metabolic processes in the insulin-dependent tissues ΔG(tm)i are determined over the above period of time Δti. That is followed by measuring an amount of glucose ΔG(∑)i consumed by an individual over the above period of time Δti, as ΔG(∑)i=((ΔG(met)i-ΔG(tm)i)+ΔG(tis)i+ΔG(pl)i)/K4, wherein K4 is a coefficient taking into account the amount of blood glucose, except for liver glucose that provides a basis to calculate the amount of energy consumed by the individual with food over the above period of time Δti.

EFFECT: method enables measuring during meals and assessing the amount of energy consumed by the individual over small periods of time, controlling the energy consumption through time taking into account the individual characteristics of specific digestion.

11 cl, 2 ex, 4 dwg

FIELD: medicine.

SUBSTANCE: prostate cancer grade is predicted by a biochemical analysis of blood serum for a level of matrilysin and a soluble Fas-antigen (sFas). If the total concentration is up to 7.0 ng/ml, a non-malignant process is stated; the total concentration falling within 7.0 to 12.0 ng/ml shows a moderate grade, while a high grade is stated if the total concentration exceeds 12.0 ng/ml.

EFFECT: invention enables predicting the prostate cancer grade exactly on the basis of an integrated assessment of serological risk factors correlated with the Gleason's pattern.

1 tbl, 3 ex

FIELD: veterinary medicine.

SUBSTANCE: aminoseleton is administered subcutaneously to animals in combination with symptomatic preparations - magestrofan, uteroton, tetragidrovit and etiotropic preparation. As etiotropic preparation the combination antimicrobial agent is used containing cefotaxime, neomycin, prednisolone, emulsifier, monoglyceride, vaseline oil, in the following ratio of components, wt %: cefotaxime - 7.0%, neomycin - 1.0%, prednisolone - 0.2%, emulsifier - 3.0%, monoglyceride - 1.0%, vaseline oil to 100.0, which is administered intrauterine 2-3 times with the 24-hour intervals in a dose of 20 ml.

EFFECT: invention improves therapeutic efficacy in chronic and latent endometritis.

3 tbl, 3 ex

FIELD: agriculture.

SUBSTANCE: agent for mastitis prevention comprises glycerine and distilled water and as antimicrobial agent it comprises 20% anavidin solution, with the following component ratio, wt %: 20% anavidin 1.5-2.5; glycerine 7.5; distilled water to 100.0. The agent forms on the teats the solid transparent polymeric antimicrobial film after application, preventing the penetration to the teat canal of pathogenic microflora, and also facilitates softening of the teat skin.

EFFECT: agent is easy to produce and apply, treatment with the claimed agent prevents effectively mastitis in lactating cows.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to gynaecology, reflexotherapy and pelotherapy. A method includes carrying out a course of antibacterial and/or antiviral therapy, which is started on 5-7 day of a menstrual cycle. From 5-7 day of the following menstrual cycle a course of pharmacopuncture is performed by introduction of homeopathic preparations into acupuncture points (AP). On 1, 3, 5, 7, 9, 11 and 13 days of the course Traumel C is introduced into points E36 (2), V31 (2), V32 (2), V33 (2), V34 (2). On 2, 4, 6, 8, 10, 12, 14 days of the course Ovarium compositum is introduced in AP Rp6 (2). Simultaneously with the course of pharmacopuncture or starting from 5-7 day of the following menstrual cycle a course of pelotherapy is carried out. Introduction of gel, based on the Dead Sea mud, is performed rectally for 30 minutes, 1 time per day.

EFFECT: method ensures recovery of the two-phase menstrual cycle due to normalisation of endometrium and vagina biocenosis, improvement of local immune and vegetative status, increases duration of remission.

4 cl, 2 ex

FIELD: medicine.

SUBSTANCE: group of inventions refers to veterinary science and is applicable for treating mastitis in cows. The declared agent contains veterinary Vivaton - 10%, ASD-2 - 4%, Bursanatal - 6% and 0.9% normal saline up to 100%. The method involves administering the declared agent with underlying general strengthening and stimulating therapy. The agent is intra-cisternal into an involved one-quarter of a dug in a dose of 5 ml daily once a day using a syringe in number of 3-5 procedures.

EFFECT: using the declared group of invention enables providing higher efficacy in treating mastitis in cows.

2 cl, 7 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to the field of veterinary and is intended for activation of reproductive function in Karakul sheep. A biological preparation, including a female placenta extract and vitamins, is characterised by the fact that it additionally contains phytoextracts (in which a physiological solution is used as an extractant) of seeds of desert forage plants - annual Salsola: Salsola sclerantha C.A.M, Gamanthus gamocarpus Mog, Climacoptera lanata Pall., and phytoextracts (in which the physiological solution is used as the extractant): of rhizomes of Sweet flag (Acorus calamus L.) and caper (Capparis spinosa L.) in a ratio placenta extract: phytoextracts as 1:2 and a water-soluble vitamin-amino acid complex "Chiktonic", with the following component ratio, ml: an extract of female placenta 100, a phytoextract of seeds of Salsola sclerantha C.A.M. 30, a phytoextract of seeds of GamanthusgamocarpusMog 40, a phytoextract of seeds of Climacoptera lanata Pall. 40, a phytoextract of rhizomes of Sweet flag (Acorus calamus L.) 40, a phytoextract of seeds of caper (Capparis spinosa L.) 50, the water-soluble vitamin-amino acid complex "Chiktonic" 2.

EFFECT: application of the claimed preparation contributes to activation and normalisation of reproductive function in sheep, increases synchronicity of passing ewes in the state of readiness and fertility.

3 tbl, 1 ex

FIELD: veterinary medicine.

SUBSTANCE: method comprises intracisternal administration of masticef at a dose of 5 ml with 24-hour intervals 2-4 times. The biogenic stimulator is used as a preparation obtained from pig spleen (BSS) by ultrasonic homogenisation, heating the homogenate, and its cooling, supernatant precipitation followed by removal of ballast proteins by centrifugation or ultrafiltration. The biogenic stimulator is administered subcutaneously in the upper third part of the neck in 1-3-5-7 days of treatment at a dose of 30-35-40-45 ml, respectively.

EFFECT: method enables to increase the effectiveness of treatment of all forms of mastitis in cows, to the reduce treatment time, and to reduce the term of milk rejection.

4 tbl, 3 ex

FIELD: chemistry, pharmacology.

SUBSTANCE: biologically active composition for improving sexual function in men includes powder of antlers of Maral, or Manchurian wapiti, or sika deer, and additionally contains powder of leaves or rhizomes with roots of Rhaponticum carthamoides, taken in specified ratio (version).

EFFECT: composition makes it possible to extend spectrum of highly efficient preparations for improvement of sexual function in men with minimal quantitative content of highly effective components from plant and animal raw material, demonstrating action synergism as components of composition.

4 cl, 6 tbl, 2 ex

FIELD: veterinary medicine.

SUBSTANCE: against the background of lymphotropic injections of enzaprost F (prostaglandin F) and antibiotic in half-daily doses a course of lymph-stimulating injections is carried out in the subcutaneous tissue in the projection of the inguinal rings, which is administration into the interspinous ligament thickness of the spine at the level of L2-L6 of 1 ml per 5 kg of animal weight of mixture consisting of 32 IU lydase, 500 thousand IU roncoleukin, 0.1 ml butomidore, 4 ml of 2% lidocaine solution, and 5 ml of 40% glucose solution.

EFFECT: method enables to increase the effectiveness of therapy while reducing the probability of development of side effects and relapses of disease by increasing the drainage function of the lymphatic system, acceleration of lymph flow and processes of neogenesis while reducing the duration of treatment and reduction of daily doses.

1 tbl

FIELD: medicine.

SUBSTANCE: blood is examined for angiogenic factors, namely soluble fms-like tyrosine kinase (sFlt-1) and placental growth factor (PIGF). An angiogenic factor (Ka) is calculated by formula: Ka=sFlt-1/PlGF×10. If Ka is 10 or less, the pregnant woman is stated to require no admission to hospital, no case follow-up; doctor's appointments are scheduled. If Ka falls within the range of 10 to 50, the pregnant woman is admitted to hospital, wherein foetal monitoring, Doppler monitoring are performed; an amniotic fluid index (AFI) is calculated; a therapy aiming at the uterine-placental blood flow improvement is prescribed for 10 days. The amount of infusion makes 400 ml a day. The prescribed preparations are Actovegin, Trental, Instenon, Carnitini chloridum. Control ultrasonography, Doppler monitoring, foetal monitoring, AFI and Ka measurements are performed 2 weeks later. The pregnant woman is discharged from hospital if observing no negative trends. If Ka falls within the range of 50 to 100, the pregnant woman is admitted to hospital, wherein foetal monitoring, Doppler monitoring are performed, and AFI is measured; a therapy aiming at the uterine-placental blood flow improvement is prescribed for 14 days The amount of infusion makes 800 ml a day. The prescribed preparations are Actovegin, Trental, Instenon, Carnitini chloridum. Control Doppler monitoring and foetal monitoring are performed every 3 days; 2 weeks later control Ka is measured. If the trend is positive, the pregnant woman may be discharged from hospital, while no positive trend requires another 2 weeks of the therapy. If Ka is 100 or more, but less than 150, the pregnant woman is admitted to hospital, wherein foetal monitoring, Doppler monitoring are performed, and AFI is measured; a therapy aiming at the uterine-placental blood flow improvement is prescribed for 14 days. The amount of infusion makes not less than 800 ml a day with the same preparations prescribed. Those are added with the preparations for homeostasis correction, including Fraxiparine, Fragmin, Clexane optionally. Control Doppler monitoring and foetal monitoring are daily. Hypamnion also requires measuring control AFI. If a gestational age is less than 34 weeks, respiratory distress syndrome (RDS) should be prevented by administering the preparation Dexon 24 mg according to the schedule: 6 mg every 12 hours 4 times. Control Ka is necessarily measured after 2 weeks of the treatment. If the trend is positive, the pregnant woman may be discharged from hospital, while no positive trend requires another 2 weeks of the therapy. If Ka is 150 or more, and the gestational age is more than 34 weeks, the therapeutic approach is the same, as for Ka being within 100 to 150, control Doppler monitoring, foetal monitoring are performed twice a day, as well as measuring AFI. If observing no foetal weight gain for 2 weeks of the therapy or the functional state of the foetus deteriorates, a Cesarean section is performed. If the gestational age is 34-36 weeks, the therapeutic approach and follow-up are the same as for the gestational age of 34 weeks, except for the prevention of foetal RDS. However, if observing the deterioration of a foetal movement pattern or the functional status of the foetus, a Cesarean section is performed according to the foetal monitoring and Doppler monitoring findings. If the gestational age is more than 36 weeks, and Ka is 150 or more, pre-mature delivery is applied.

EFFECT: optimal selection of the therapeutic approach ensured by determining the values reflecting the severity of the cardiovascular disorder directly in the uterine-placental complex and mother's and foetus's compensatory capacities.

5 ex

FIELD: veterinary medicine.

SUBSTANCE: suppositories comprise active substance triphenyl-(3,5-di-tret-butyl-4-hydroxybenzyl) phosphonium bromide in an amount of 1%. As the pharmaceutically acceptable carriers the suppositories comprise "polyethylene glycol-6000" (30%), higher fatty alcohols C16-C21 (0.6%), calcium stearate (0.8%) and sucrose (42.8%), foaming agents contain citric acid (10%), sodium bicarbonate (14.8%).

EFFECT: agent has high bactericidal, antimycotic, antioxidant activity, provides high curative and preventive effect for treatment and prevention of puerperal purulent-catarrhal endometritis in farm animals.

2 cl, 3 tbl, 5 ex

FIELD: chemistry.

SUBSTANCE: invention relates to a method of obtaining mineral silicic water (MSW), intended for application for medical purposes. The method of obtaining includes hydrolysis of tetraethoxysilane in the TEOS mixture: ethanol: water, acidified by HCl. Nanosol is obtained at a temperature of 55-65°C for 1.5 hours with evaporation of ethanol to the volume reduction by 1/3, then, dilution of the obtained nanosol with a physiological solution NaCl is carried out in 2 steps with equal portions of the physiological solution, preliminarily heated to 40-50 in a ratio of volumes of the initial nanosol: physiological solution 1:7 with 15-minute interval. After each dilution a temperature of the solution is kept in the range of 55-65°C.

EFFECT: increase of the compound application efficiency.

1 ex

Up!