Психосоматические функциональные расстройства в пульмонологической практике

The relevance of studying psychosomatic disorders in somatic clinical practice (including pulmonary practice) stems from the significant prevalence of these disorders, as well as the difficulties in making a differential diagnosis and choosing the most effective tactics for patient management.The aim of this review was to analyze the available publications on the problem of psychosomatic functional disorders in pulmonary practice, such as hyperventilation syndrome (HVS), including HVS associated with Severe Acute Respiratory Syndrome-related CoronaVirus 2 (SARS-CoV-2) infection, vocal cord dysfunction, and psychogenic cough. The article discusses clinical features of different variants of functional disorders and accompanying psychopathological symptoms (panic attacks, generalized anxiety, etc.), as well as psychogenic factors of their manifestation and changes in the clinical features over time. The corresponding section briefly summarizes current ideas about approaches to effective treatment of this group of disorders and prevention of their chronification.Conclusion. The clinical heterogeneity of psychosomatic functional disorders in pulmonological practice has been demonstrated, as have important aspects of the diagnosis and treatment of these disorders.Актуальность изучения психосоматических расстройств (ПСР) в соматической клинике (в т. ч. пульмонологической практике) продиктована значительной распространенностью рассматриваемой патологии, а также трудностями проведения дифференциального диагноза и выбора наиболее эффективной тактики ведения пациентов.Целью настоящего обзора явился анализ доступных публикаций по проблеме функциональных ПСР в пульмонологической практике – гипервентиляционный синдром (ГВС), включая ГВС, ассоциированный с перенесенной коронавирусной инфекцией SARS-CoV-2 (Severe Acute Respiratory Syndrome-related CoronaVirus 2), дисфункция голосовых связок и психогенный кашель. Обсуждаются клинические, клинико-динамические особенности различных вариантов функциональных расстройств и сопутствующей психопатологической симптоматики (панические атаки, генерализованная тревога и пр.), а также психогенные факторы их манифестации. Кратко резюмированы современные представления о подходах к эффективной терапии расстройств этой группы и профилактики их хронизации.Заключение. Продемонстрирована клиническая гетерогенность функциональных ПСР в пульмонологической практике, представлены важные аспекты диагностики и терапии данных нарушений

Transforming growth factor β1 (TGF-β1) in patients with endocrine ophthalmopathy and Graves’ disease: A predictor of treatment efficiency

Current therapeutic approaches to the treatment of endocrine ophthalmopathy (EOP) are based on nonspecific immunosuppression with glucocorticosteroids (GCs) and radiation therapy of the eye orbits. However, some patients exhibit resistance to the treatment. In a previous study, we have detected high levels of soluble cytokine receptors: sTNFα-R1, sTNFα-R2, sIL-2R, and the TGF-β1 cytokine in euthyroid patients with long-lasting non-treated EOP and Graves’ disease (GD). TGF-β1 level was significantly higher in the patients with EOP compared to healthy individuals, and increased with prolonged EOP duration, thus suggesting activation of the factors regulating immune system which promote suppression of the autoimmune process. The aim of this work was to study the dynamics of TGF-β1 and cytokine receptors: sTNFα-R1, sTNFα-R2, sIL-2R in the course of immunosuppressive therapy with high doses of GCs, as possible predictors of treatment efficacy. The study included 49 patients (98 eye orbits) with GD of euthyroid state and subclinical thyrotoxicosis, and the persons with EOP in active phase, who had not previously treatment for EOP. Concentrations of TGF-β1 cytokine, sTNFα-RI and sTNFα-R2, sIL-2R, antibodies to the thyroid-stimulating hormone receptor (rTSH), free fractions of thyroxine (fT4) and triiodothyronine (fT3), TSH in blood serum were determined in blood serum. Ultrasound examination of the thyroid gland (ultrasound of the thyroid gland), multi-layer computed tomography (MSCT)/magnetic resonance imaging (MRI) of the orbits were also performed. The patients were administered immunosuppressive therapy with high doses of HCs (methylprednisolone) in the course of pulse therapy, at a standard dosage of 4500-8000 mg, taking into account the severity and activity of the EOP clinical manifestations. The examination was carried out 3, 6, 12 months after starting the treatment. 3 and 6 months after the GC administration, more than 30% of patients remained resistant to treatment. The levels of TGF-β1 did not change significantly in the patients with positive EOP dynamics. In the patients resistant to GC treatment, the level of TGF-β1 was significantly decreased compared with patients who showed positive clinical dynamics. The level of sNFR1 and sNFaR2 did not change significantly. There were no significant differences in the levels of antibodies to rTSH, thyroid hormones in the patients resistant to GC treatment and with positive dynamics.Immunosuppressive therapy with high-dose of methylprednisolone in pulse therapy regimen showed high efficacy and good tolerability, while some patients remain resistant to treatment. Lower levels of TGF-β1 cytokine at initial time and during the treatment allow usage of TGF-β1 levels as a biomarker of the activity of the process, treatment efficiency, and prognosis of the disease. Activation of TGF-β1, a fibroblast growth factor, may contribute to the development of fibrosis, strabismus, and diplopia

Опыт применения ритмической периферической магнитной стимуляции при пояснично-крестцовой радикулопатии

Introduction. Lumbosacral radiculopathy is а leading cause of long-term disability. Taking into a consideration the duration of treatment radiculopathy, the risk of developing adverse reactions when taking analgesics, non-steroidal anti-inflammatory drugs, the physiotherapeutic method — repetitive peripheral magnetic stimulation may become a promising method of therapy.Aim of the study. Assessment of the effectiveness of the complex treatment for patients with lumbosacral radiculopathy using the course of the repetitive peripheral magnetic stimulation.Materials and methods. Forty patients with lumbosacral radiculopathy were enrolled in the open non-randomized study, were divided into 2 parallel groups. The patients of the 1st group received a course of traditional treatment and a course of the repetitive peripheral magnetic stimulation. The patients of the 2nd group were treated with the traditional treatment without the course of the stimulation. A magnetic stimulator MagPro (Magventure, Denmark) was used for repetitive peripheral magnetic stimulation.Results. A significant difference (p <0.001) was registered regarding the reduction of pain syndrome and the improvement of the functional status after treatment in both groups. 14 (70 %) patients of the first group achieved a pain visual analogue scale relief by 50 % after 10 repetitive peripheral magnetic stimulation sessions, while 6 (30 %) patients did this after 15 repetitive peripheral magnetic stimulation sessions. We did not observed a statistically significant differences (p >0.05) in pain syndrome, functional status, anxiety level at the end of follow-up between the groups.Conclusion. We did not receive the benefits of the repetitive peripheral magnetic stimulation course in comparison with a traditional treatment of a lumbosacral radiculopathy. Further placebo-controlled studies to study the effect of repetitive peripheral magnetic stimulation on pain and anxiety in patients with back pain and radiculopathy are required.Введение. Пояснично-крестцовая радикулопатия является частой причиной стойкой и длительной утраты трудоспособности. Если принимать во внимание длительность лечения радикулопатии, риск развития нежелательных реакций при приеме анальгетиков и нестероидных противовоспалительных препаратов, перспективным направлением терапии становится применение физиотерапевтического метода — ритмической периферической магнитной стимуляции.Цель исследования – оценить эффективность комплексного лечения с применением курса ритмической периферической магнитной стимуляции у пациентов с пояснично-крестцовой радикулопатией.Материалы и методы. В открытом нерандомизированном исследовании приняли участие 40 пациентов с пояснично-крестцовой радикулопатией, которые были разделены на 2 группы. Пациенты 1-й группы получали курс традиционного лечения и курс ритмической периферической магнитной стимуляции. Больные 2-й группы — курс традиционного лечения без применения курса магнитной стимуляции. Для проведения стимуляции был использован магнитный стимулятор MagPro (Magventure, Дания).Результаты. Было показано достоверное различие (р <0,001) в отношении уменьшения интенсивности болевого синдрома, улучшения функционального статуса по окончании курса терапии в обеих группах. У 14 (70 %) пациентов 1-й группы уровень болевого синдрома уменьшился по визуально-аналоговой шкале на 50 % после 10 сессий ритмической периферической магнитной стимуляции, у 6 (30 %) больных — после 15 сессий. При оценке болевого синдрома, функционального статуса, уровня тревожности не было зарегистрировано статистически значимого различия (р >0,05) параметров между группами на момент завершения лечения.Заключение. Полученные результаты не показали преимущества курса ритмической периферической магнитной стимуляции у пациентов с пояснично-крестцовой радикулопатией в сравнении с курсом традиционной терапии. Требуются дальнейшие плацебо-контролируемые исследования для изучения влияния магнитной стимуляции на болевой синдром и уровень тревожности у пациентов с болью в спине и радикулопатией

ИЗУЧЕНИЕ ЕСТЕСТВЕННЫХ РЕГУЛЯТОРНЫХ Т КЛЕТОК И ИХ МОЛЕКУЛЯРНОГО МАРКЕРА FOXP3 У ЧАСТО БОЛЕЮЩИХ ДЕТЕЙ ДОШКОЛЬНОГО ВОЗРАСТА, ПРОЖИВАЮЩИХ В УСЛОВИЯХ АНТРОПОГЕННОЙ НАГРУЗКИ

The study presents the review of recent literature on microbial resistance in children suffered from reccurent respiratory infaction (RRI). Special aspects of immune system in children with allergy and acute respiratory infection are discussed. We report the description of natural regulatory T lymphocytes subpopulations and their transcription factor FOXP3 in frequently ill children. Dynamic changes in Treg concentration and expression of FOXP3 in groups of healthy, children with RRI and children with combination of RRI and allergy are described. It is proved that in case of allergy despite its aetiology and severity, children have increased concentration of CD4+CD25hi in blood. We suggest that in children with RRI and allergy an insufficient function of Treg is compensated by the increased number of cells and in this case they have a remission of allergy. Treatment of acute allergy by topical or inhaled glucocorticosteriods leads to the increased expression of molecular marker FOXP3 and can be considered as one of their modes of action. В статье представлены современные данные отечественной и зарубежной литературы по проблеме противоинфекционной резистентности часто болеющих детей. Обсуждаются особенности иммунитета при острых респираторных инфекциях у детей с аллергическими заболеваниями. Представлена характеристика субпопуляций естественных регуляторных Т лимфоцитов и их транскрипционного фактора FOXP3 у часто болеющих детей. Описана динамика изменения содержания Treg и экспрессия FOXP3 у здоровых, часто болеющих и часто болеющих детей с аллергией. Установлено, что при аллергических заболеваниях у детей, независимо от их нозологии и тяжести течения, в крови повышено процентное содержание CD4+CD25hi. Высказано предположение, что дефект функции Treg у часто болеющих детей с аллергией полностью или частично компенсируется за счет повышения численности клеток: в этом случае развивается ремиссия аллергического заболевания. Применение местных или ингаляционных глюкокортикостероидов при лечении обострения аллергического заболевания приводит к повышению экспрессии молекулярного маркера FOXP3, что можно рассматривать как один из механизмов их терапевтического действия

Узкополосная фототерапия и препарат натриевой соли синтетического дипептида гамма-D-глутамил-D-триптофана в качестве комбинированного метода лечения псориаза: комплексная и сравнительная оценка

The paper presents the results of a comparative study of various immunosuppressive treatment methods of medium severity vulgar psoriasis (PASI from 10 to 20). The parameters used were PASI indices, p53 apoptosis marker expression indices, and expression indices of T-regulatory cell marker Foxp3. The study involved 96 patients, from 18 to 60 years old, divided by randomization into three groups. Patients in the 1st group (n = 32) received narrow-band phototherapy according to a 4-day regimen. We used the Waldmann UV-7002K instrument and F79/120W-TL01 lamps generating radiation with a maximum emission at a wavelength of 311 nm. We started with a dose of 0.05–0.1 J/cm2, subsequently increased by 0.05–0.1 J/cm2 for each procedure, in the absence of erythema. In total, patients received 12–15 procedures, with a course dose of 4.7–7.65 J/cm2. In the 2nd group (n = 32), patients were treated with the sodium salt of the synthetic gamma-D-glutamyl-D tryptophan dipeptide. Patients of the 3rd group (n = 32) underwent combination therapy, which included both methods described above. As a result of treatment, the greatest decrease in the PASI index, as well as the level of expression of the marker of Foxp3 T-regulatory cells, was observed among patients who received the combined regimen. The data obtained indicate the high therapeutic efficacy of narrow-band phototherapy in combination with the sodium salt of the synthetic gamma-D glutamyl-D tryptophan synthetic dipeptide. It was also noted that the immunohistochemical marker p53, reflecting the cellular renewal of psoriatic papule keratinocytes, is an informative molecular-cellular indicator of the effectiveness of narrow-band phototherapy.В работе представлены результаты сравнительного исследования различных иммуносупрессивных методов лечения вульгарного псориаза среднетяжёлой степени (PASI от 10 до 20). В качестве оцениваемых параметров использовали индекс PASI, уровни экспрессии маркера апоптоза р53 и экспрессии маркера Т-регуляторных клеток Foxp3. В исследование были включены 96 пациентов в возрасте от 18 до 60 лет, разделённые методом рандомизации на три группы. Пациенты в 1-й группе (n=32) получали узкополосную фототерапию по 4-дневной схеме. Использовали прибор «Waldmann UV-7002K» и лампы F79/120W-TL01, генерирующие излучение с максимальной эмиссией на длине волны 311 нм. Начинали с дозы 0,05 – 0,1 Дж/см2, повышая в последующем на 0,05 – 0,1 Дж/см2 каждую процедуру, при отсутствии эритемы. Всего пациенты получали от 12 до 15 процедур с курсовой дозой облучения 4,7 –7,65 Дж/см2. Во 2-й группе (n=32) пациентам проводили терапию натриевой солью синтетического дипептида гамма-D-глутамил-D-триптофана. Пациентам 3-й группы (n=32) проводили комбинированную терапию, включающую в себя сочетание двух вышеописанных методик. В результате лечения наибольшее снижение индекса PASI, а также уровня экспрессии маркера Т-регуляторных клеток Foxp3 наблюдали среди пациентов, получивших комбинированную схему. Полученные данные свидетельствуют о высо- кой терапевтической эффективности узкополосной фототерапии в комбинации с препаратом натриевой соли синтетического дипептида гамма- D-глутамил-D-триптофана. Также было отмечено, что иммуногистохимический маркер р53, отражающий клеточное обновление кератиноцитов псориатической папулы, является информативным молекулярно-клеточным показателем эффективности узкополосной фототерапии

Relationship of depressive disorders with hypertension, its control and other metabolic risk factors in the Tyumen Oblast population of men and women. Data from the study “Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation” (ESSE-RF)

Aim. To study the association between depression and metabolic cardiovascular risk factors, hypertension (HTN) and its control in a random sample of Tyumen Oblast population of men and women aged 25-64 years.Material and methods. The study object was a random sample of the population of the Tyumen and the Tyumen Oblast aged 25-64 years, examined as part of the ESSE-RF epidemiological study. The study included 1658 participants. Among them, 30,3% (n=503) were men, while 69,7% (n=1155) — women. Mean age was 48,9±11,4 years. The prevalence of metabolic risk factors (hyperlipidemia, carbohydrate metabolism disorder, obesity), hypertension and the likelihood of its control in men and women with different levels of depressive disorders diagnosed using the HADS scale were assessed.Results. Compared with participants without depression, persons with psychological disorders were significantly more likely to have HTN (55,5% vs 47,6%, p<0,01), elevated levels of total cholesterol (TC) (63,9% vs 54,0%, p<0,01) and low-density lipoproteins (LDL) (66,7% vs 60,3%, p<0,05), carbohydrate metabolism disorders (8,3% vs 5,2% p<0,05), obesity (49,2% vs 37,7%, p<0,01). Significantly more often hypertensive subjects without depression took antihypertensive drugs effectively (odds ratio (OR) — 1,747, 95% confidence interval (CI), 1,001-3,053) and controlled blood pressure (OR — 1,533, 95% CI, 1,05-2,36). There was no association between the use of antihypertensives and the level of depressive disorders. Among women with depression (HADS>7), dyslipidemia (65,5% vs 57,4% for TC, p<0,05; 71,0% vs 62,9% for LDL, p<0,05), carbohydrate metabolism disorders (10,1% vs 5,2%, p<0,01), obesity (53,3% vs 43,2%, p<0,01), HTN (60,6% vs 45,6%, p<0,01) were more common. Men with clinical depression were more likely to have HTN (69,0% vs 47,7%, p<0,05), with a high level of depression — hyperlipidemia (58,9% vs 46,7% for TC, p<0,05; 67,1% vs 53,9% for LDL, p<0,05). Women with elevated depression levels were less likely to take antihypertensive drugs (30% vs 49,4%, p<0,01) and control hypertension (13,8% vs 21,2%, p<0,05).Conclusion. The data obtained confirm the association of depressive disorders with metabolic risk factors and the likelihood of HTN control, which is especially significant among women

3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial

Background Liraglutide 3\ub70 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes. Methods In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3\ub70 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219. Findings The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2\ub77 times longer with liraglutide than with placebo (95% CI 1\ub79 to 3\ub79, p<0\ub70001), corresponding with a hazard ratio of 0\ub721 (95% CI 0\ub713\u20130\ub734). Liraglutide induced greater weight loss than placebo at week 160 (\u20136\ub71 [SD 7\ub73] vs 121\ub79% [6\ub73]; estimated treatment difference 124\ub73%, 95% CI 124\ub79 to 123\ub77, p<0\ub70001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group. Interpretation In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3\ub70 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes. Funding Novo Nordisk, Denmark

A randomized, controlled trial of 3.0 mg of liraglutide in weight management

BACKGROUND Obesity is a chronic disease with serious health consequences, but weight loss is difficult to maintain through lifestyle intervention alone. Liraglutide, a glucagonlike peptide-1 analogue, has been shown to have potential benefit for weight management at a once-daily dose of 3.0 mg, injected subcutaneously. METHODS We conducted a 56-week, double-blind trial involving 3731 patients who did not have type 2 diabetes and who had a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of at least 30 or a BMI of at least 27 if they had treated or untreated dyslipidemia or hypertension. We randomly assigned patients in a 2:1 ratio to receive once-daily subcutaneous injections of liraglutide at a dose of 3.0 mg (2487 patients) or placebo (1244 patients); both groups received counseling on lifestyle modification. The coprimary end points were the change in body weight and the proportions of patients losing at least 5% and more than 10% of their initial body weight. RESULTS At baseline, the mean (±SD) age of the patients was 45.1±12.0 years, the mean weight was 106.2±21.4 kg, and the mean BMI was 38.3±6.4; a total of 78.5% of the patients were women and 61.2% had prediabetes. At week 56, patients in the liraglutide group had lost a mean of 8.4±7.3 kg of body weight, and those in the placebo group had lost a mean of 2.8±6.5 kg (a difference of -5.6 kg; 95% confidence interval, -6.0 to -5.1; P&lt;0.001, with last-observation-carried-forward imputation). A total of 63.2% of the patients in the liraglutide group as compared with 27.1% in the placebo group lost at least 5% of their body weight (P&lt;0.001), and 33.1% and 10.6%, respectively, lost more than 10% of their body weight (P&lt;0.001). The most frequently reported adverse events with liraglutide were mild or moderate nausea and diarrhea. Serious events occurred in 6.2% of the patients in the liraglutide group and in 5.0% of the patients in the placebo group. CONCLUSIONS In this study, 3.0 mg of liraglutide, as an adjunct to diet and exercise, was associated with reduced body weight and improved metabolic control. (Funded by Novo Nordisk; SCALE Obesity and Prediabetes NN8022-1839 ClinicalTrials.gov number, NCT01272219.)

INTERDISCIPLINARY CLINICAL PRACTICE GUIDELINES "MANAGEMENT OF OBESITY AND ITS COMORBIDITIES"

Clinical guidelines have long been one of the working tools of the modern doctor, helping him quickly navigate the most effective proven methods of treatment and prevention of various diseases, and also to adapt these methods to the specific tasks of their patients and to achieve maximum personalization of treatment. Clinical  practice guidelines are drawn up by professional non-profit associations and are approved by the Scientific Council of the Ministry of Health of the Russian Federation, while often one recommendation is prepared by two or even three associations. The peculiarity of the recommendations offered to your attention is that not only endocrinologists, but also therapists, cardiologists, gynecologists, gastroenterologists, and experts of many other specialties are involved in the prevention and treatment of obesity. The Multidisciplinary Working Group presents this a project in a multidisciplinary journal to bring together the efforts of several professional associations that associated with the need to pay attention not only to obesity itself but also to comorbid conditions. We are looking forward to constructive criticism and a comprehensive discussion of the problem on the pages of our journal

Prevalence of headache disorders in students of medical university according new Classification of Headache Disorders 3rd edition (2013)

The aim of our study was to estimate the prevalence of headache disorders using the newly published third edition International Classification of headache Disorders-3beta and evaluate their previous treatment in students of the Urals State Medical University. Methods: The study population consisted of 1042 students (719 females, 323 males, mean age 20.6, range 17-40). All were interviewed using a semi-structured validated interview conducted by a neurologist or by trained senior medical students. Results: 1-year prevalence of headache in students was 93% (females 95%, males 88%), prevalence of headache during the last month-68% (66% among females, 54% among males), during the last week-46% (48% among females, 32% males) and point prevalence -17% (17% among females, 17% among males). 1-year prevalence of episodic tension type headache was 74.5%, among females -73%, among males- 77%. 1 -year prevalence of migraine without aura was 24%, among females - 28%, among males -14%. 1-year prevalence of migraine with aura was 3.8%, among females — 5.6%, among males - 0.6%. 1-year prevalence of chronic tension type headache-3%, chronic migraine -1% and medication overuse headache-3 %. Only one third of students (35%) had consulted because of headache. Most students (75%) used analgesics or NSAIDs for the acute treatment of headache, only 2% used triptans. Only 0.2% of students received prophylactic treatment. Conclusion: Prophylactic and treatment strategies must be developed to manage the high prevalence of headache disorders in students.Задачей нашего исследования было изучение распространенности головных болей с использованием недавно опубликованной Международной классификации третьего пересмотра - 3 бетта, а также оценка предшествующего лечения головных болей у студентов Уральского государственного медицинского университета. Методы: Исследуемая группа включала 1042 студентов (719 женщин и 323 мужчины средний возраст 20,6 лет, возрастной интервал 17-40). Все студенты были проинтервьюированы с использованием полуструктурированного интервью, проведенного специально обученными студентами, а также врачом неврологом. Результаты: Распространенность головных болей у студентов в течение 1 года до интервью была 93% (95% у женщин, 88% у мужчин), распространенность головных болей в течение последнего месяца была 68% (66% среди женщин, 54% среди мужчин), в течение последней недели головные боли имели 46% студентов (48% среди женщин, 32% среди мужчин) и 17% студентов имели головные боли в день интервью (17% женщин, 17% мужчин). Распространенность эпизодических головных болей напряжения у студентов в течение 1 года до интервью была 74,5% (73% среди женщин и 77% среди мужчин). Распространенность мигрени без ауры у студентов в течение 1 года была 24% (28% среди женщин и 14% среди мужчин). Распространенность мигрени с аурой была 3,8% (5,6% среди женщин и 0,6% среди мужчин). Распространенность хронических головных болей напряжения в течение 1 года была 3%, хронической мигрени -1% и головных болей, связанных с избыточным употреблением анальгетиков 3 %. Только треть студентов (35%) обращались к врачам в связи с головными болями. Большинство студентов (75%) использовали анальгетики или НПВП для купирования головных болей, 2% использовали триптаны. Только 0,2% студентов получали профилактическое лечение по поводу головных болей. Вывод: Необходима разработка профилактических и лечебных мероприятий для снижения высокой частоты головных болей у студентов