Choice of pharmacotherapy for various clinical forms of dry eye disease

Purpose: to investigate therapeutic effectiveness of several new pharmacotherapeutic agents for dry eye disease (DED) of various severity and ethiological factors.Methods: there were 72 patients under observation with dry eye disease divided into three groups. Group I-DED mild stage 1, Group II-DED stage 2, moderate stage with secondary damage after adenoviral eye infection. Group III-DED, stage 3, severe damage associated with meibomian gland dysfunction. Diagnostics — subjective symptoms, biomicroscopic data and diagnostic tests were assessed and scored: Schirmer test, Norn test, rose bengal and fluorescein staining, OCt assessment of tear meniscus, tear osmolar- ity measurement. the following agents were used as basis therapy in various algorithms: Visine Pure tears or Artificial tear, Hilabak, VitA-Pos and adjunctive anti-infective and anti-inflammatory therapies if needed.Results: Positive therapeutic effect was achieved in all patients. Subjective symptoms and diagnostic test results improved from the first day.Conclusion: Clinical signs improvement and positive trends in diagnostic test results were seen in all of the three groups of variousseverity and ethiology. there was an effort put in every group to personalize pharmacotherapies

MEMBRANE-SАVING ACTION OF TRIMETAZIDINE IN SUBJECTS WITH ACUTE MYOCARDIAL INFARCTION

The article concerns the assessment of functional condition of cell membranes in a variety of pathological conditions, influence of various physical and chemical factors and pharmacological drugs. Aim. To reveal cytoprotection action of trimetazidine in shortand longterm periods of acute myocardial infarction. Material and methods. As controls we used the condition of cell membranes under the age aspects in healthy volunteers (n=106). Into main group we included patients with acute myocardial infarction (n=46), of those to 25 we added trimetazidine to the standard treatment. We studied the level of membrane damage and cytoprotective action of trimetazidine at different stages of treatment by exposure cell membranes to electricity. Results. Inclusion of trimetazidine to MI treatment allows to reduce by 2 days the period of functional membrane condition restoration, that had kept for up to 3 months of observation. Conclusion. Improvement of erythrocyte membranes condition and general condition of patients after acute MI is significantly proved by addition of cytoprotector trimetazidine to the treatment complex

A RETROSPECTIVE STUDY OF PATIENTS WITH HYPERTENSION COMPLICATED BY TRANSIENT ISCHEMIC ATTACKS

This article is devoted to actual problem of cardiology – cerebrovascular complications of hypertension in the form of transient ischemic attack (TIA). TIAS are predictors of stroke, irreversible brain disorders. In order to prevent irreversible pathology will require further analyze the possible aspects that cause complications cerebrovascular in nature in hypertensive patients

Current View on the Postoperative Asthenopic Syndrome Problem in Patients with Corneal Refractive Surgery. Review

Laser technologies of corneal surgery perfection was one of the important events in ophthalmology in the past decades. Despite to the significant success in refractive surgery and the achieved high result in visual acuity, the ideal healing of the cornea, the absence of dry eye syndrome, some patients in the postoperative period present asthenopic complaints. Patients may notice a decrease in visual acuity when working near, difficulty in refocusing from far to near distance, fuzzy, blurred images, red eyes, tearing, periodic or permanent diplopia at different distances in the postoperative period. Adaptation to emmetropic refraction in these patients can cause discomfort, headache and visual fatigue even with insignificant visual loads, which leads to the development of asthenopia and worsening of their subjective status. Corneal refractive surgery leads to changes in the anatomical and optic parameters of the eye, which contributes to the formation of new accommodation-convergence interactions. If the accommodative and binocular functions were disrupted preoperatively, there is a risk of decompensation and development of postoperative asthenopic syndrome (AS). Refractive surgery, saving patients from glasses and contact lenses, can not completely eliminate their existing imbalances between accommodation and convergence. This can be explained with the fact that the existence of a formed pathological system does not cease with the elimination of the etiologic factor. In order to correct the disturbed parameters, additional research methods and effective methods of functional treatment of patients in the postoperative period were suggested. However, most of them are aimed at pathogenetic effects on accommodative muscles, often without taking into account disturbances in the oculomotor apparatus and binocular function. Thus, existing algorithms for investigating and managing patients with refractive disorders do not allow us to identify predictors for the development of asthenopia before refractive surgery, there is no set of preventive restoration measures aimed at restoring accommodative capacity and binocular interaction in the preoperative period to increase satisfaction with the results of surgery in patients at risk of postoperative AS

The Maintenance Algorithm of Patients with Myopia and the Risk of Asthenopia after Keratorefractive Surgery

Purpose. To develop a step-by-step algorithm for managing patients with myopia and the risk of developing asthenopia after keratorefractive surgery (KRS) to optimize the work of the ophthalmologist and increase patient  satisfaction with the results of the operation.Materials and methods. 66 patients (132 eyes) with moderate to high myopia were examined. The special  research methods needed to create an algorithm for managing patients with myopia and the risk of developing asthenopia after corneal surgery were the study of binocular vision, fusional reserves, and a cover/uncover test to identify heterophoria and heterotropy. Results. Based on the identified of PA predictors development and the developed course of functional treatment of accommodation and binocular function disorders in patients with moderate and high myopia, after CLRS, a step-by-step algorithm was developed for managing patients with myopia and the risk of developing PA. Conclusion. Optimization of the ophthalmologist’s work and an increase the patient’s satisfaction with theresults of excimer laser corneal surgery

New Properties of the Heparin-Containing Drug in vitro (Potential Antiviral and Anti-Inflammatory Effects)

Purpose: to study the cytological, immunological and antiviral effects of the HILOPARIN-KOMOD® drug in vitro.Material and methods. We used transplantable cultures of normal cells of the human Chang conjunctiva, and the kidney cells of the Vero monkeys. The cytotoxic effect of the HILOPARIN-KOMOD® was  determined by the effect on the cell viability, and by optical density  (OP) of the monolayer of the Chang conjunctiva cell culture using the enzyme immunoassay (ELISA) with MTT. The effect of the drug on  the functional activity of conjunctival cells was evaluated by the  production of cytokines at the level of their in vitro transcription. The antiviral effect of the drug HILOPARIN-KOMOD® was studied on  the Vero cell line infected with herpes simplex virus type 1 (HSV-1) and HSV type 2 (HSV-2). The viral activity of HSV-1 and HSV-2  and the antiherpetic effect after the drug was evaluated by  polymerase chain reaction (PCR). Results. No significant cytotoxic effect on the metabolism of conjunctival cells of the preparation HILOPARINKOMOD ® in  dilutions from 1/2 to 1/2048 was revealed (in comparison with the  control). The effect of the drug in dilutions of 1/40 and 1/1000 on  the culture of the conjunctival cells resulted in suppression of the  production of interferon λ-1 mRNA (IFNλ-1) and IFNλ-2 mRNA  compared to the control. In the dilution of preparation 1/1000, the  production of mRNA of interleukin-6 (IL-6) was not revealed with  simultaneous presence of IL-10 mRNA. In different dilutions of the  drug, the number of copies of HSV-1 virus DNA decreased in  comparison with the control in all cases, the greatest antiviral effect  was achieved in a 1: 2 dilution. The effect of the preparation  HILOPARIN-KOMOD® on the culture of cells infected with HSV-2 in  dilutions of 1: 2 and 1: 5 led to a decrease in the level of viral replication by 300 and 40 times, respectively.The conclusion. The drug HILOPARIN-KOMOD® has an anti-inflammatory effect that manifests itself in suppressing the synthesis of the mRNA of the acute phase proinflammatory cytokine IL-6 and  stimulating the production of anti-inflammatory IL-10 mRNA, without having a cytotoxic effect on conjunctival cells. The proven antiviral  effect of the drug makes it possible to recommend the inclusion of  HILOPARIN-KOMOD® in the scheme of therapy of patients with viral ophthalmopathology

BONE MINERAL DENSITY AND VASCULAR WALL CHARACTERISTICS IN WOMEN AFTER OVARIECTOMY AND PROLONGED HORMONE THERAPY

Osteoporosis and atherosclerosis are the most socially significant chronic non-infectious diseases. This is due to their high prevalence and medical, social and economic consequences from osteoporotic bone fractures and myocardial infarction and stroke as a result of cardiovascular diseases (CVD). The level of estrogen is essential for the formation and maintenance of bone mass in women. The sharp decline in estrogen levels after bilateral ovariectomy plays the role of trigger factor in the development of complex disorders of the bone and the cardiovascular system. Pathogenetically justified approach to the correction of the estrogen-deficient states is the use of hormone replacement therapy (HRT). To study the effect of HRT on the cardiovascular system and bone mineral density (BMD) we examined 50 women with surgical menopause which received HRT for more than a 10-year period. We studied the anthropometric and biochemical parameters (blood cholesterol and its fractions, fasting blood glucose), performed Doppler ultrasonography of head and neck vessels with measurement of pulse velocity, dual-energy x-ray absorptiometry (DEXA) for BMD estimation. Examination was carried out twice - in the early period after the operation (the first year) and after 10 years. Analysis of the cardio-vascular system and the BMD has demonstrated more severe atherosclerotic vascular changes and a greater decrease in BMD in patients who discontinued use of HRT. The severity of atherosclerosis and the level of the BMD were dependent on HRT use

EFFECTIVENESS OF MELDONIUMIN IN CHRONIC HEART FAILURE PATIENTS

This article discusses the relevance of the high mortality of cardiovascular diseases (CVD) and their complications. Provides an overview of research conducted in the field of treatment of chronic heart failure and other cardiovascular diseases. In treatment notes medications that possess cytoprotective effects that affect cellular metabolism, ionic homeostasis, structure and function of membranes. Proved the feasibility of the introduction of Meldonium in the complex therapy of patients with CHF

Guidelines for the Management of Patients with Herpetic Keratitis/Keratouveitis in the Long Term: from Problem to Solution

Purpose. To identify problems contributed to the development of a chronic course of herpetic keratitis/keratouveitis and to suggest ways to solve them (taking into account the results of virological examination by PCR). Patients and methods. A group of patients (n = 90) with herpetic keratitis/keratouveitis of the prolonged course was under observation. Biological secretions (tears, saliva, blood serum and urine) of patients were investigated for the presence of herpes simplex virus (HSV), varicella-zoster virus (VVZ), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus type 6 (HHV-6), human herpesvirus type 7 (HHV-7) by polymerase chain reaction (PCR). Antiherpetic therapy included systemic oral administration of selective analogues of nucleosides (AN) — valacyclovir and phamcyclovir in daily doses of 2–3 g and 1.5 g, respectively. Local therapy included installations of mydriatic (if necessary), non-steroidal anti-inflammatory agents, antibacterial drugs. Reparative therapy consisted in prescribing conservative installations of HILOPARIN-COMOD® and PARIN-POS® ointment. Results. The clinical picture of herpetic keratitis/keratouveitis was presented by surface forms — 22 cases, deep forms — 68 cases. Positive results of HSV determination were obtained in 34.6 % of the surveyed. VZV was detected in 21 cases (28 %), CMV — in 14.6 %. EBV was detected in 28 cases (37.3 %), HHV-6 — in 37 cases (49.3 %). Genetic material of HHV-7 was found in 32 % of the examined. The results of PCR studies determined the appointment of adequate doses of nucleoside analogues (NA), which led to relief of symptoms in 100 % of cases. Active reparative therapy contributed to complete persistent epithelialization sustained by systemic use of NA in all cases within 4 weeks from the presentation. Conclusion. The results of PCR examination for the production of herpetic viruses in the tear/saliva/blood/urine are crucial to confirm the etiology of keratitis/keratouveitis, as well as determine the appointment of adequate (increased) doses of nucleoside analogues according to the recommended regimens until remission is achieved. Local therapy drugs should be used on the principle of “necessary minimum”. Therapeutic scheme for herpetic keratitis/keratouveitis already in the active stage should include local drugs with reparative effect, contributing to the achievement of persistent epithelialization

Relationship of type 2 diabetes mellitus and cardiovascular pathology: significance of glycemic control on the way to solving the problem

Cardiovascular diseases (CVD) is the most frequent cause of death in diabetes mellitus (DM) patients, and diabetes, in turn, significantly increases the risk of cardiovascular pathology, and therefore the implementation of measures for primary and secondary prevention of complications in patients with DM and CVD is a topical direction of modern medicine. In case of diabetes, CVDs occur 2-5 times more frequently than in persons without this pathology. There is also a high risk of developing conditions such as coronary heart disease (CHD), myocardial infarction (MI), arterial hypertension (AH), acute cerebrovascular disease (ACVD). Thus, 69% of patients with DM have dyslipidemia, 80% - AH, 50-75% - diastolic dysfunction, 12-22% - chronic heart failure (CHF). Mortality from MI among patients with DM is 1.5-2 times higher than among people who do not suffer from this disease, both in the acute stage of MI, and in prolonged observation. Therefore, it is necessary to work out a common approach to this problem on behalf of both cardiologists and endocrinologists, and patients, which will improve the quality of treatment and prevent the development of DM complications.Intensive control of glycemia in patients is essential to prevent the development and progression of DM complications, which is proved by a number of fundamental studies presented in this article. Regular and competent self-control by patients allows maintaining normal or close to normal blood glucose levels. It is a reliable, convenient and patient-friendly way to prevent the development of diabetic complications