Efficacy Evaluation of Combination Therapy in Patients with Generalized Periodontitis According to the Index Estimation of Periodontal Status: Experimental Randomized Single-Arm Study

Background. Treatment and prevention of inflammatory periodontal diseases represent a serious general medical and social problem, which remains relevant due to the significant prevalence of periodontitis among the population, as well as the associated loss of teeth and the negative impact of periodontal foci of infection on the body as a whole. Chronic generalized periodontitis is difficult to treat: it is only possible to achieve periods of remission. Therefore, it is of great theoretical and practical importance to develop further ways to improve methods for treating inflammatory-dystrophic damage of periodontal tissues in chronic generalized periodontitis.Objective. To perform an index estimation of treatment efficacy in patients with moderately severe chronic generalized periodontitis.Methods. An experimental randomized single-arm study was conducted examining 204 patients diagnosed with moderately severe chronic generalized periodontitis. Patient examination and data analysis were carried out at the Dentistry Department of the Stavropol State Medical University and the Department for General Practice Dentistry of the Kuban State Medical University in 2021–2022. The study included patients aged 35 to 65 years diagnosed with moderately severe chronic generalized periodontitis. Patients with somatic diseases in the decompensation stage were not eligible for the study. The patients were randomly divided into three groups (closed-envelope method). Group 1 was treated using conventional methods. As well as conventional therapy, Group 2 was prescribed vitamin D (Aquadetrim® at a dose of 5000 IU once per day while monitoring vitamin D blood level). The third group of patients was prescribed conventional therapy along with the developed pharmacotherapy, which included vitamin D (Aquadetrim® at a dose of 5000 IU once per day), vitamin A (3.44% oil solution of retinol acetate at a dose of 50 000 IU, 15 min after a morning meal), and 2-ethyl-6-methyl-3-hydroxypyridine (Mexidol® at a dose of 125 mg twice a day). In each patient, the treatment efficacy was analyzed in adjacent oral cavity segments (split-mouth design) according to clinical pocket depth, attachment loss, and bleeding on probing. Also, the authors used the X-ray index to assess the condition of osseous structures and the simplified oral hygiene index. The specified indices were estimated prior to treatment and at one and 12 months following treatment. The statistical analysis of study results was performed using Excel Microsoft Office 2016 (Microsoft, USA).Results. The obtained data indicate that the immediate clinical outcomes (after one month) of combination therapy in patients from all three groups were approximately the same. However, the efficacy of treatment measures in the long-term period (12 months) was different, as evidenced by the dynamics of index values. Only in Group 3 patients, the full implementation of pharmacotherapeutic measures as part of the combination therapy of periodontitis ensured a stable therapeutic effect throughout the entire period of observation.Conclusion. The data obtained 12 months following treatment indicate that the additional prescription of the developed pharmacotherapy contributed to prompt inflammation relief in periodontal tissues, providing a stable treatment outcome and long-term remission

Index Evaluation of Clinical Efficacy of Immunomodulatory and Osteotropic Therapy for Chronic Generalized Periodontitis of Varying Severity: A Prospective Cohort Study

Background. The significant prevalence of chronic generalized periodontitis, the severity of its course, the increase in the number of complicated forms and short-term remissions cause a constant search for new methods and means of its treatment. When choosing the most effective methods of therapy, specialists mostly prefer a complex effect on the main pathogenetic links of the disease, while often losing sight of the body's own defenses, especially in terms of pharmacotherapeutic support and immunity strengthening. This study presents the results of a study of the clinical efficacy of the treatment of chronic generalized periodontitis by means of the developed therapy complex, including the use of immunomodulatory and osteotropic drugs.Objective — to study clinical efficacy of the developed complex immunomodulatory and osteotropic treatment for chronic generalized periodontitis.Methods. A prospective cohort study was conducted in 154 patients aged 20 to 75 with periodontitis of varying severity. Conventional examination of patients was carried out in specialized dental clinics DentoProma (Krasnodar) and Dentalife (Stavropol) based at the Dentistry Department, Stavropol State Medical University (Russia). The study period was 24 months. The patients were divided into a main group of 118 participants and a control group of 36 participants. The comprehensive treatment plan, prescribed to all patients, included proper oral hygiene education, individual and professional dental hygiene, topical anti-inflammatory agents, Vector therapy, open flap debridement, flap surgery, relevant splinting prosthetics (if necessary). The authors developed a comprehensive therapy, which included administration of the immunomodulatory agent Hepon (Immapharma Company, Russia), glucosamine hydrochloride and chondroitin sulfate sodium. All patients of the main and control groups were additionally ranked into subgroups depending on the severity of diagnosed periodontitis: slight (subgroup 1), moderate (subgroup 2) and severe (subgroup 3). The major focus of the study was to establish efficacy of the developed therapy which was defined by the degree of resolution of the inflammatory process and increase in the period of remission. Reflecting the presence and degree of inflammation, dental plaque index and oral hygiene status were considered to be the target indicators. Analysis and statistical processing of the obtained data were carried out using Microsoft Excel (Microsoft, USA).Results. The analysis of the data revealed that the immediate clinical results of the developed complex therapy both in the main group and in the control group were approximately identical. According to the follow-up data obtained one month after the treatment, additional prescription of complex osteotropic treatment to the patients with chronic generalized periodontitis contributed to rapid resolution of infection in the gingival tissues and provided stable treatment results.Conclusion. Introduction of the complex clinical and hygienic treatment promoted resolution of the inflammatory process in the gingival tissues of all patients who received immunomodulatory and osteotropic therapy

Трудности клинико-инструментальной и прижизненной патологоанатомической диагностики рака яичников

Ovarian cancer (OC) ranks 8th among cancers in women. It is a non-visualizable, non-screenable cancer with late onset of symptoms and diagnosis, which translates into low recurrence-free and overall survival rates. The 5-year survival decreases as the OC stage increases. The World Health Organization has predicted a 47 % increase in the OC incidence by 2040 to approximately 434,000 newly diagnosed cases and an annual 59 % increase in OC mortality (up to 293,000 cases). There are several difficulties in the current clinical, imaging, and intraoperative frozen-section diagnosis of OC. Patients seek medical attention when the disease has reached the advanced stage. However, specific treatment often starts late due to a long time between the first patient-physician contact and the histological verification of the diagnosis. It is vital to know the limitations and complexities of diagnostic tools, overcome them in routine practice, and use an interdisciplinary approach to the evaluation of their findings. Goal: to review the difficulties in making clinical, imaging, and intraoperative frozen-section diagnosis of OC based on Russian and worldwide literature data.Materials and methods: articles focused on the diagnostic modalities for OC that had been published in the PubMed, Cochrane Library, and eLIBRARY databases over the past 15 years were reviewed. The review outlines the limitations and difficulties in making clinical, imaging, and intraoperative frozen-section diagnosis of OC based on data from international publications and experience of gynecological oncologists and pathologists of the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine.Рак яичников (РЯ) занимает 8 место среди злокачественных опухолей у женщин и относится к новообразованиям невизуальных локализаций с отсутствующим скринингом и поздней диагностикой, когда манифестирует клиническая симптоматика, что отражается на низких показателях безрецидивной и общей выживаемости. С увеличением стадии процесса сокращается пятилетняя выживаемость пациенток. По прогнозам Всемирной Организации Здравоохранения, к 2040 году заболеваемость РЯ возрастет на 47% с показателем примерно 434000 новых выявленных случаев и с ежегодным увеличением смертности от РЯ на 59% (до 293000 случаев). В своевременной клинико-инструментальной и прижизненной патологоанатомической диагностике РЯ имеется ряд сложностей. Жалобы пациенток при обращении указывают на диссеминированный характер процесса. Однако от момента обращения пациенток за медицинской помощью до гистологической верификации опухоли в большинстве случаев проходит длительный промежуток времени, что отражается на отсроченном начале специального лечения. Знание ограничений и сложностей диагностических методов и их минимизация в практической работе, а также комплексный междисциплинарный подход к их оценке имеет крайне актуальное значение. Цель: провести обзор трудностей клинико-инструментальной и прижизненной патологоанатомической диагностики рака яичников на основе анализа отечественных и зарубежных публикаций. Материалы и методы: Проведено изучение научных публикаций в базах данных PubMed, Cochrane library, elibrary за последние 15 лет, посвященных методам диагностики РЯ. В данной работе приведен обзор ограничений и трудностей клинико-инструментальной и прижизненной патологоанатомической диагностики РЯ на основе международных публикаций и собственного опыта работы онкологов-гинекологов и патологоанатомов Челябинского областного клинического центра онкологии и ядерной медицины

Determining the risk of metastasis of choroidal melanoma: clinical and instrumental criteria

The purpose was to study the prevalence of metastasis of choroidal melanoma (CM) and clinical and instrumental criteria of the risk of such metastasis.Material and methods. A detailed analysis of clinical material for the period of 2000–2018 is presented, involving 304 patients with CM under continuous observation by an ophthalmic oncology center of a multidisciplinary cancer institution. Results. Metastatic lesion of various organs was diagnosed in 66 (21.7 %) patients. The average age of patients at the time of metastatic lesion verification was 55.65 ± 13.4 years, with the number of women patients prevailing (36 patients out of 66, or 54.5 %). Liver metastases were found in 63.6 %, lungs metastases, 4.5 %, multiple metastases — 31.9 % of patients. With regular follow-up, the critical period for metastasis detection was between one to five years — 77.2 % of patients with metastatic lesions and 16.8 % of the total number of the treated patients. The average time of metastasis appearance after the liquidation treatment was 27.75 ± 22.06 months, in cases of organ preservation treatment it was 61.57 ± 50.32 months. A metastatic process was diagnosed predominantly in large (63.6 %) and medium (28.8 %) CM. The risk criteria for metastatic development in CM were found to be: male gender, pre-equatorial localization, fungoid shape, large tumor size, pigmented tumor, transudative retinal detachment, mixed histopathological tumor variant.Conclusion. The established clinical and instrumental criteria of the risk of metastatic lesion in choroidal melanoma should be considered when planning follow-up monitoring of this group of patients