Simultaneous penetrating injury in both eyes (a case report)

This clinical report is aimed to present the tactics of complex treatment in case of the concomitant trauma of the anterior eye segment caused by penetrating injury of the eyeball. The patient applied to us with the simultaneous injury of both eyes with the beak of the bird. Four days later after the injuring we observed in the primary examination the following status of both eyes: penetrating corneal scar across the optical zone, corneal suture, exudate in the aqueous humor, hypopion in the right eye; traumatic cataract, in the right eye with lens subluxation, rupture of lens capsule and efflux of the lens material into the anterior chamber; partial aniridia and iridodilysis, on the left eye – swelling cataract. Due to the inflammation, in order to prepare for the surgical intervention the patient was treated with antiinflammatory, antibacterial, antifungal and fibrinolytic agents. The surgeon had to reverse inflammatory reaction, to choose the most appropriate tactic considering the corneal edema, a low visualization, concomitant injury of structures of the anterior eye segment, failure by the accurate IOL calculation. Seven days after the beginning of the treatment the positive dynamics was observed and we performed phacoemulsification of the cataract in the left eye with IOL implantation as well as repair of iridodialysis. Then, in the absence of inflammatory reaction five days later the similar surgical treatment was performed in the right eye.Results of the control examination in the early postoperative period were following: uncorrected visual acuity (UCVA) of the right eye was 0.002, of the left one – 0.3, intraocular pressure of both eyes was normal.We assume that the presented surgical tactics in case of the simultaneous penetrating injury of both eyes is like the delayed primary surgical debridement. Taking into consideration the application of less-invasive techniques, a wide availability of phacoemulsification, in the presence of technical possibilities and competent ophthalmic surgeons the similar combined surgical treatment should be recommended as soon as possible after the injuring for these patients

Comparative pharmacoeconomic analysis of ceffaroline fosamil in the treatment of complicated skin and soft tissues infections

The objective was to evaluate the cost-effectiveness and budget impact of ceftaroline fosamil compared with other intravenous antibiotics with anti-MRSA activity in the treatment of complicated skin and soft tissue infections (cSSTI). The source of data on the efficacy and safety were randomized controlled trials and meta-analyzes devoted to the study of drugs for the treatment cSSTI. Comparison drugs were daptomycin, tigecycline, vancomycin and linezolid. To “overlap” gram-negative infections for vancomycin, linezolid and daptomycin was taken into account levofloxacin and cefoperazone/sulbactam with the share of each of them at 50%. For the efficacy was taken clinical response at day 7-14 after a course of treatment in ITT-population of patients with cSSTI. We calculated the direct medical and indirect non-medical costs associated with premature mortality. The data obtained are the following types of pharmacoeconomic analysis: cost-effectiveness analysis (CEA), budget impact analysis (BIA) and sensitivity analysis (SA). The results of pharmacoeconomic analyzes have shown that the cost-effectiveness ratio (CER) per patient was lowest in vancomycin - 79.613 rub., further follow: ceftaroline - 94.474 rub., linezolid - 118.049 rub., tigecycline - 122.424 rub. and daptomycin - 127.484 rub. Evaluation of cost-effectiveness threshold demonstrated that CER do not exceed the value of “willingness-to-pay ratio” none of the comparators, i.e., they are subject to state reimbursement under the compulsory health insurance system. Analysis of indirect costs per patient associated with premature mortality and the shortfall in GDP gave the following results: at ceftaroline they accounted for 31.391 rub., daptomycin - 78.458 rub., tigecycline - 105.688 rub., linezolid - 151.880 rub., vancomycin - 187.774 rub. The total costs (direct and indirect) per patient were at least in ceftaroline group - 108.094 rub., further follow: daptomycin - 182.102 rub., tigecycline - 203.493 rub., vancomycin - 251.743 rub. and linezolid - 252.151 rub. BIA shows that the transition from comparators to ceftaroline is costs saving overall of the budget: with linezolid - 144.056 rub., vancomycin - 143.649 rub., tigecycline - 95.399 rub., daptomycin - 74.008 rub. SA confirmed these results. Ceftaroline is the best alternative to daptomycin, tigecycline, vancomycin and linezolid. Active implementation of ceftaroline as a drug for the treatment of cSSTI can contribute both to optimize budget spending at various levels

Pharmacoeconomic analysis of Movalis in patients with osteoarthritis and rheumatoid arthritis

Objective: To conduct a comparative cost minimization analysis (CMA) of Movalis with other non-steroidal antiinflammatory drugs (NSAIDs) such as diclofenac, nimesulide, celecoxib and etoricoxib. Methodology: Was conducted search of publications from 1990 to 2014, devoted to randomized controlled clinical trials, a network meta-analysis and systematic reviews (level of evidence: AI) use of NSAIDs in patients with osteoarthritis (OA) and rheumatoid arthritis (RA). The model evaluates economical effectiveness of drugs and the comparison is based on the results of the randomized controlled clinical trials (RCCT), network meta-analyzes and systematic reviews. Since the data RCCT, network meta-analyzes and systematic reviews have shown equal efficacy of NSAIDs, model is a particular drug and CMA consists of one line therapy, providing short-term economic evaluation and impact on the health of patients with OA and RA. Results: The results of used of NSAIDs CMA and treatment of complications in patients with OA and RA showed that the total cost of the Movalis (meloxicam) is lower than another drugs: Voltaren (diclofenac), Nimesil (nimesulide), Celebrex (celecoxib) and Arcoxia (etoricoxib). Costs saving for one patient is favor for Movalis in comparison with the Voltaren was 465 rubles (-8.55%), Celebrex - 1.255 rubles (-23.09%), Arcoxia - 1.274 rubles (-23.43%) for a 1 month of therapy. Sub-analysis of the Movalis compared with the Nimesil (nimesulide) for 15 days of therapy showed that the cost savings per patient is favor for meloxicam will be 1.504 rubles (-117.74%). Sensitivity analysis confirmed these findings: an increase in drug prices Movalis by 25% and reducing the price of the reference drugs by 25%, minimizing the cost figures do not go beyond the parameters of the Movalis that demonstrates the stability of the obtained data in the study

Pharmacoeconomics of dapagliflozin in patients with type 2 diabetes mellitus with inadequate glycemic control

Objectives. To evaluate the cost-effectiveness of dapagliflozin in combination with metformin in the treatment T2DM in comparison with glimepiride and sitagliptin also combined with metformin. Methods. Cost-utility analysis, discounting and economic feasibility assessment were performed. The results are expressed in QALY and ICUR. Pharmacoeconomic analysis showed that the application of the strategy of treatment: metformin + dapagliflozin vs metformin + sitagliptin provided 9.83 and 9.82 QALYs respectively, and the ICUR — 341.413 rubles; metformin + dapagliflozin vs metformin + glimepiride provided 9.82 and 9.47 QALY respectively, and the ICUR — 145.213 rubles. The use of combination therapy metformin + dapagliflozin is economically acceptable treatment strategy compared with combination therapy with metformin + sitagliptin and metformin + glimepiride, as ICUR indicators for dapagliflozin + metformin therapy did not exceed the cost-effectiveness threshold — «willingness to pay ratio» for Russia in any of the compared treatment strategies. Conclusion. Combination therapy metformin + dapagliflozin for treating T2DM provide good value for money for Russian state reimbursement system

Evaluation of the functional activity of CD39 ectonucleotidase in regulatory T cells in children with inflammatory bowel diseases

In connection with the increasing incidence and prevalence of inflammatory bowel disease (IBD), the search for prognostic markers of the effectiveness of therapy is an urgent problem. An imbalance between Th17 lymphocytes and regulatory T cells (Treg) is a major defect in the immune system leading to IBD. Extracellular ATP produced during tissue damage, rebound pro-inflammatory effects, and activates Th17 cell differentiation. Ectonucleotidase CD39 catalyzes the dephosphorylation of ATP to AMP, followed by conversion to adenosine by CD73. CD39 is expressed in various cell types, including Treg. Aim – evaluate the functional activity of CD39+ in Treg in children with IBD using the luciferin-luciferase method.68 children with IBD were examined. Of these, 28 children were in remission, 40 were in exacerbation. The number of Tregs (CD4+CD25highCD127low) expressing CD39 was estimated by flow cytometry. The ATP concentration in supernatants and cells was determined using the luciferin-luciferase test. Results are presented as median (Me) and quartiles (Q0.25-Q0.75). The significance of differences between groups was assessed using the nonparametric Mann–Whitney U test.The relative number of CD39+Treg in patients in remission of IBD was significantly higher than in patients in a state of exacerbation. A decrease in ATP concentration under the influence of CD39+Treg in patients with IBD occurred immediately upon the addition of exogenous ATP. ATP in patients in remission decreased by 44.5% (Me 54.5 (41.5-65.9)), in patients in exacerbation – by 32.5% (Me 67.5 (59.7-71.3)). At the same time, in patients in remission, the decrease in the ATP content after 5 minutes of the reaction was significantly higher than in patients in the state of exacerbation (p = 0.01), after 30 minutes of the reaction, no significant difference was found. It was shown that samples with a smaller number of cells and a lower intensity of CD39 expression in Treg had a higher activity of CD39 ectonucleotidase.For efficient ATP hydrolysis, in addition to the amount of CD39 in Treg, their functional activity is important. The assessment of the catalytic activity of CD39 in Treg in patients with IBD is most informative in the first minutes after the addition of exogenous ATP. In patients in remission, the catalytic activity of CD39 in Treg was higher than in patients in a state of exacerbation

Long-term follow-up of a female patient with Weber–Christian panniculitis

Weber–Christian disease is a rare form of lobular panniculitis characterized by painful subcutaneous nodules on the trunk and limbs commonly concurrent with systemic manifestations and a tendency to relapse. Known are only sporadic cases of a long-term (more than 5-year) followup of patients with Weber–Christian disease. For this reason, there are neither prognostic criteria for the disease no proven conventional treatment option now. The paper describes a clinical case of a female patient with a verified diagnosis of Weber–Christian disease who has a sustained subclinical remission due to low-dose prednisone use and basic antirecurrent therapy

Space Weather and Its Impact on Psycho-Emotional State of the Inhabitants of Different Latitudes

Purpose of the research was to conduct a comparative analysis of the psychological characteristics of the inhabitants of the northern and middle latitudes, depending on their psychological sensitivity to changes in geomagnetic disturbances Materials and Methods: The study included 78 relatively healthy volunteers (women and men, the average age of 44.2[36.7; 54.3] years) living in the polar (Tiksi), subpolar (Yakutsk) and middle (Saratov) latitudes. Monitoring of the studied indicators was carried out during March and April 2016. To achieve this goal, the following methods were used: the Spielberger-Khanin scale for reactive (situational) and personal anxiety; E. Heim's technique for revealing individual coping strategies; the projective psycho-geometric test. Every day, during March and April 2016, the Kp-index, an integral indicator of changing geomagnetic disturbance was used. Depending on the identified matches, the peak values of the reactive anxiety by Spielberger-Khanin and Kp-index (not less than 60% of cases), all volunteers were divided into 2 groups. Group 1 included persons with similar overlap and, therefore, carriers of psychological sensitivity to changes in the action of heliogeomagnetic factors. Group 2 included persons without a specified sensitivity, (i.e., no coincidences). Results: In the course of the study, both coinciding and latitude-related differences in the psychological characteristics of different groups of volunteers were established. In the inhabitants of the polar and subpolar latitudes, especially in Group 1, the behavioral sphere was the most vulnerable (no constructive coping strategies). In addition, their changes in the emotional sphere contributed to the manifestation of aggressiveness and suppression of emotions against the background of general concentration, purposefulness and integrity of the individual. Regardless of the latitude of residence, volunteers, psychologically sensitive to changes in heliogeomagnetic factors, were more constructive in the emotional sphere, and the least in the behavioral, which gives reason to state that, depending on the factors of space weather, the behavior of the individual is the most vulnerable

ОРБИТАЛЬНАЯ ЖИРОВАЯ КЛЕТЧАТКА – НОВЫЙ РЕСУРС ДЛЯ ТРАНСПЛАНТОЛОГИИ

Adipose tissue is widely used in transplantology to fill up volume deficiency as well as the source of cells to treat dysfunctions. Despite the long experience of adipose tissue autotransplantation there is still no guarantee of optimal result in late postoperative period. All these are the reasons to search for new techniques, supplementary factors preventing lysis and fibrosis of graft, and for the most appropriate adipose depots. Study of the current literature allows us to consider orbital adipose tissue as a unique fat depot, having the great potential for transplantology. Жировая ткань широко используется в трансплантологии как для восполнения дефицита объема, так и в качестве источника клеток для коррекции функциональных нарушений. Несмотря на более чем вековой опыт аутотрансплантации жировой клетчатки, до сих пор нет гарантии оптимального результата в отдаленном посттрансплантационном периоде. Это заставляет искать новые методики выполнения отдельных этапов пересадки, дополнительные факторы, предотвращающие лизис трансплантата, сопровождающийся фиброзом тканей, а также наиболее оптимальные источники жировой ткани. Анализ современных литературных данных позволяет рассматривать орбитальную жировую клетчатку как уникальную разновидность жировой ткани, скрывающую огромный потенциал для трансплантологии.

Adaptation students who study on the first course of pharmaceutical faculty to student life

This article presents the results of a questionnaire survey of students who study on the first course of the pharmaceutical faculty of USMA. The purpose of the study was to find out whether students are satisfied with the quality and methods of teaching, identify the existing problems of adaptation of first-year students.В данной статье приведены результаты анкетирования обучающихся на 1 курсе фармацевтического факультета УГМУ. Целью исследования было выяснить, довольны ли студенты качеством и методами обучения, выявить существующие проблемы адаптации студентов-первокурсников