Концепция синдромальных диагнозов остеоартрита и боль в спине как причина неэффективности медикаментозной терапии

Osteoarthritis is considered a peripheral joint disease and is often ignored when discussing the prevalence and treatment of back pain. Traditionally, clinical guidelines from various countries are devoted to the treatment of nonspecific back pain (lower back pain), although this diagnosis is syndromic and is absent in ICD-10. Therefore, in real clinical practice, such diagnoses as osteochondrosis and dorsopathy simultaneously exist. The treatment strategies for back pain do not take into account chronic inflammation directly related to pro-inflammatory cytokines and oxidative stress, which makes drug therapy ineffective. It is advisable from the first days of therapy to choose parenteral forms from the group of symptomatic slow-acting drugs containing chondroitin sulfate (Chondroguard®), which will accelerate the onset of the analgesic effect and increase the effectiveness of pathogenetic therapy.Остеоартрит рассматривается как заболевание периферических суставов и часто игнорируется при обсуждении распространенности и терапии боли в спине. Традиционно клинические рекомендации различных стран посвящены лечению неспецифической боли в спине (боли в нижней части спины, БНС), хотя диагноз БНС синдромальный и отсутствует в МКБ-10, поэтому в реальной клинической практике наблюдается одномоментное существование таких диагнозов, как остеохондроз и дорсопатия. Современные стратегии терапии боли в спине не учитывают хроническое воспаление, которое напрямую связано с провоспалительными цитокинами и окислительным стрессом, что снижает эффективность медикаментозного лечения. Целесообразным выбором лекарственных средств является использование с первых дней терапии парентеральных форм препаратов из группы симптоматических медленнодействующих средств хондроитина сульфата (Хондрогард®), что позволяет ускорить наступление обезболивающего эффекта и повысить эффективность патогенетической терапии

Влияние фотонов ближней ультрафиолетовой области на рост и развитие свеклы сахарной (Beta vulgaris L. ssp. vulgaris var. saccharifera Alef.) в условиях закрытой агробиотехносистемы

Relevance and methodology. In order to determine the effect of near-ultraviolet radiation with a wavelength of 380 nm on the growth and development of a sugar beet hybrid plant, Smena was grown for 82 days under LED lighting with phytolamps and under conditions of increased UV-A intensity of the light range (an increase in the UV/PPFD ratio (0.027) compared with the control (0.0075) while maintaining the ratio of the remaining sites spectrum). The study was carried out on the basis of the digital software package "Synergotron" with a controlled internal environment.Results. An increase in the share of UV-A in the illumination spectrum leads to a significant change in the biometric indicators of plants – the aboveground biomass increases by 2.2 times compared to the control, and the mass of the underground part (root crops), on the contrary, decreases by 86.9%. At the same time, the share of root crops in the total biomass of plants decreases from 60% in the control to 30%. The morphological structure of the leaf apparatus changes: the proportion of petioles increases significantly compared to leaf blades (64.8% of petioles in aboveground biomass, whereas in the control 30%). Probably, an increase in the share of UV-A in the spectrum can favorably affect the cultivation of leaf forms of beets and other root crops. UV-A radiation leads to a change in the chemical composition of root crops, in particular, a decrease in the accumulation of dry substances (by 1.58%) and a decrease in sugar content (by 1.8%). An increase in the proportion of UV-A in the irradiation spectrum changes the parameters of chlorophyll fluorescence and contributes to an increase in the maximum quantum yield of Fv/Fm, non-photosynthetic quenching of NPQ fluorescence and a decrease in the real quantum yield of photosynthesis Y(II), as well as the electron transport rate (ETR).Актуальность и методология. С целью определения влияния ближнего ультрафиолетового излучения длиной волны 380 нм на рост и развитие растения свеклы сахарной гибрида Смена выращивали в течение 82 суток при светодиодном освещении фотолампами и в условиях усиления интенсивности УФА диапазона света (повышение отношения UV/PPFD (0,027) по сравнению с контролем (0,0075) при сохранении соотношения остальных участков спектра). Исследование проводили на базе цифрового программного комплекса «Синерготрон» с регулируемой внутренней средой.Результаты. Увеличение доли УФ-А в спектре освещения приводит к существенному изменению биометрических показателей растений - надземная биомасса увеличивается в 2,2 раза по сравнению с контролем, а масса подземной части (корнеплоды), наоборот, снижается на 86,9%. При этом доля корнеплодов в общей биомассе растений снижается с 60% в контроле до 30%. Изменяется морфологическая структура листового аппарата: существенно возрастает доля черешков по сравнению с листовыми пластинками (64,8% черешков в надземной биомассе, тогда как в контроле 30%). УФ-А излучение приводит к изменению химического состава корнеплодов, в частности, понижению накопления сухих веществ (на 1,58%) и снижению сахаристости (на 1,8%). Повышение доли УФ-А в спектре облучения изменяет параметры флуоресценции хлорофилла и способствует повышению максимального квантового выхода Fv/Fm, нефотосинтетического тушения флуоресценции NPQ и снижению реального квантового выхода фотосинтеза Y(II), а также скорости электронного транспорта (ETR)

Комплексный подход к выбору терапии у пациентов с остеоартритом при первичном обращении к врачу. Консенсус экспертов (обзор литературы и резолюция)

Osteoarthritis (OA) is the most common pathology of the musculoskeletal system and is a serious medical and social problem. OA is of particular importance in elderly and senile people due to the high frequency of comorbid pathology. Pain relief is a priority in the formation of individual therapeutic programs for patients with OA, starting from their first request for medical assistance. At the same time, due to the ambiguity of existing clinical recommendations, most experts note a number of difficulties in prescribing treatment for patients with OA.The article presents a consensus position of experts regarding a complex approach to the choice of therapy in patients with OA at the initial visit to the doctor. The article discusses: current clinical guidelines for the management of patients with OA; most common problems in the management of patients with OA in real clinical practice; goals of treatment strategies for OA taking into account the risk factors for its progression; an algorithm of pain relief during initial treatment in patients with OA; prevention of OA exacerbations with the use of basic structure-modifying drugs; recommendations for the choice of non-steroidal anti-inflammatory drugs.According to experts, a rational approach to the treatment of OA is based on the combined use of non-drug and pharmacological methods with constant monitoring of therapy regimens and side effects. These recommendations can be considered disease-modifying strategies that in many cases allow improving functional status and achieving long-term remission in patients with OA.Остеоартрит (ОА) – наиболее распространенная патология опорно-двигательного аппарата, являющаяся серьезной медико-социальной проблемой. Особое значение ОА приобретает у лиц пожилого и старческого возраста из-за высокой частоты коморбидной патологии. Купирование болевого синдрома является приоритетным при формировании индивидуальных терапевтических программ для пациентов с ОА, начиная с момента их первичного обращения за медицинской помощью. Вместе с тем из-за неоднозначности существующих клинических рекомендаций большинство экспертов отмечают ряд сложностей при назначении лечения больным ОА.В статье представлена согласованная позиция экспертов, касающаяся комплексного подхода к выбору терапии у пациентов с ОА при первичном обращении к врачу. Рассмотрены имеющиеся на сегодняшний день клинические рекомендации по ведению пациентов с ОА, наиболее часто возникающие проблемы при курации больных ОА в реальной клинической практике, цели лечебных стратегий при ОА с учетом факторов риска его прогрессирования, алгоритм лечения боли у пациентов с ОА при первичном обращении и профилактики обострений ОА с использованием базисных структурно-модифицирующих препаратов, рекомендации по выбору нестероидных противовоспалительных препаратов.По мнению экспертов, рациональный подход к терапии ОА основан на комбинированном использовании немедикаментозных и фармакологических методов при постоянном мониторинге режимов терапии и побочных эффектов. Данные рекомендации можно рассматривать как болезнь-модифицирующие стратегии, позволяющие во многих случаях улучшить функциональный статус и добиться длительной ремиссии у пациентов с ОА

SARS-CoV-2 (COVID-19) as a predictor of neuroinflammation and neurodegeneration: potential therapy strategies

The pandemic caused by the SARS-CoV-2 virus (COVID-19) made it necessary to evaluate in more detail the processes of neuroinflammation as an integral component of the pathogenesis of viral infection. The acute neuroinflammatory response includes the activation of resident tissue macrophages in the CNS and the subsequent release of various cytokines and chemokines, which probably activates oxidative stress, causing long-term neuronal damage. This makes urgent the search for drugs with indirect anti-inflammatory effects with proven effectiveness. From this point of view, it is worth further studying the treatment of patients with COVID-19 with dipyridamole, which, with its antiviral activity and anti-inflammatory effect, inhibiting acute inflammation and progressive fibrosis, is the drug of choice, especially for patients with early signs of elevated D-dimer concentrations and pronounced clinical symptoms of microangiopathy

Cervicogenic headache: pathogenesis, clinical features, diagnosis, therapeutic approaches

The concept of cervicogenic headache (CGH) comprises the types of headaches having different origins, which are associated with pathology in the cervical spine and its other structural areas. CGH is induced by diverse pathogenetic mechanisms and has different clinical manifestations so it is referred to different classification categories. The anatomic and pathophysiological causes of CGH, its clinical picture, and therapeutic principles are discussed. In clinical practice, more and more preference has been recently given to combined analgesics, ketorolac and nimesulide in particular

Acute cerebrovascular accidents associated with sars-cov-2 coronavirus infection (Covid-19)

Acute cerebrovascular accidents (ACVIs) associated with COVID-19 coronavirus infection are one of the most talked about problems in the medical community. To date, the true incidence of stroke in patients with COVID-19 remains unclear. So far, the published literature has been limited to case reports, case series, and observational cohort studies. The article analyzes possible risk factors, especially the age of patients, pathogenetic and clinical correlations of ACVA and SARS-CoV-2 (COVID-19). A clinical case of an 82-year-old patient with ischemic stroke and COVID-19 infection is described

Sugar-beet complex of Russia: stateand directions of development

The complex estimation of state of sugar-beet complex of the Russian Federation has been made. The basic indices of sugar beet production and processing such as area under crop, yield, croppage, sugar content, forecasted sugar yield, and production of sugar from beet are presented. Particular attention has been given to the analysis of sugar-beet industry of the Central Federal District and its separate regions. A high potential of raw-material base development in Central Federal District and, in particular, Central Black-Earth Region has been revealed. Thus, in Russia, about 53% of sugar beet sown annually is located in Central Federal District. In the District, areas under the crop were 607.4 thousand hectares in 2016 and increased by 8.7% in comparison with 2015. Also, in the structure of croppages, Central Federal District has the greatest position as providing 58.5% of overall production, and the Central Black Earth Region рrоduсеs 88–89% of the District sugar beet croppage. Over the period of 2005–2014, Central Federal District has surpassed Privolzhsky Federal District by 23.3% and Siberian Federal District by 25.3% in sugar yield per 1 hectare; but it is slightly inferior to Southern Federal District and North-Caucasian Federal District in this respect (by 3 and 12.6% accordingly). These achievements were promoted by favorable soil and environmental conditions during vegetation and harvesting of sugar beet, perfection of the crop cultivation technology and modernization of sugar industry. On the whole, Russia is the leader in beet sugar production (5 million tons) that provides 90% level of self-sufficiency. Strengthening of material and technical base, as well as development and introduction of resources-economy technologies can become the priority directions of the sugar-beet complex steady development in an effort to realize the policy of imported products substitution

On the mechanisms of the synergistic action of tolperisone, meloxicam and B vitamins in the treatment of peripheral pain syndromes

Introduction: The combined use of non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and group B vitamins is a promising direction for combined pharmacotherapy of peripheral pain syndromes.Purpose: to analyze the molecular mechanisms of the synergism of the muscle relaxant tolperisone, a non-steroidal anti-inflammatory drug meloxicam and vitamins B1, B6 and B12 as part of complex pharmacotherapy of pain.Materials and methods: differential chemoreactome analysis of NSAID molecules and muscle relaxants, proteomic analysis of the effects of B vitamins.Results: Synergistic interactions are maintained by (1) inhibiting cyclooxygenase-2 and leukotriene A4 hydrolases; (2) inhibition of the effects of IL-1β, TNFα, NF-kB, TLR4, RANKL, matrix metalloproteinases; (3) antioxidant effect (increased expression of superoxide dismutase-1 and glutathione peroxidase). Group B vitamins enhance the effects of tolperisone and meloxicam due to the manifestation of independent anti-inflammatory (neutralization of homocysteine, decreased expression of pro-inflammatory cytokines TNFα, IL-1b and factor NF-kB activity), analgesic (modulation of opioidergic pathways) and neuroprotective effects (support of amino acid expression, metabolism and neuro lipids, ATP synthesis and remyelination).Conclusions: The triple scheme “tolperisone + meloxicam + vitamins B1 / B6 / B12” is characterized by a number of undeniable advantages: (1) lack of dependence, (2) anti-inflammatory effect, (3) neuroprotective and remyelinating effects, (4) elimination of muscle hypertonicity. Such combination therapy can be used in patients of various age groups with comorbid conditions (diabetes mellitus, arterial hypertension, cerebrovascular diseases, gastrointestinal diseases) and does not require an increase in NSAIDs and significantly reduces the risk of side effects

FEATURES OF THE OUTBREAK OF THE COMMUNITY-ACQUIRED PNEUMONIA CAUSED BY MYCOPLASMA PNEUMOINIAE AT CHILDREN IN KHABAROVSK REGION

Aim. To study the features of outbreak of community-acquired pneumonia caused by M. pneumoniae in children in the Khabarovsk region during the autumn-winter period 2016 - 2017. Materials and methods. A study was conducted of 30 clinical samples - smears from the posterior pharyngeal wall and sputum samples obtained from patients with community-acquired pneumonia due to M. pneumoniae. Samples were examined for the presence of mutations in the 23S rRNA gene of M. pneumoniae. Results. The age ofthe patients was from 2 to 16 years. In two cases, family foci of the incidence of community-acquired pneumonia occurred. In 19 samples, a mutation was detected in 23S rRNA of M. pneumoniae. Conclusion. The data obtained indicate that in the development of the outbreak of community-acquired pneumonia caused by M. pneumoniae in children in the Khabarovsk region in the autumn-winter period 2016 - 2017, macrolide-resistant strains of the pathogen were involved

Influence of photons of the near-ultraviolet radiation on the growth and development of sugar beet (<i>Beta vulgaris</i> L. ssp. <i>vulgaris var. saccharifera</i> Alef.) in a closed agrobiotechnosystem

Relevance and methodology. In order to determine the effect of near-ultraviolet radiation with a wavelength of 380 nm on the growth and development of a sugar beet hybrid plant, Smena was grown for 82 days under LED lighting with phytolamps and under conditions of increased UV-A intensity of the light range (an increase in the UV/PPFD ratio (0.027) compared with the control (0.0075) while maintaining the ratio of the remaining sites spectrum). The study was carried out on the basis of the digital software package "Synergotron" with a controlled internal environment.Results. An increase in the share of UV-A in the illumination spectrum leads to a significant change in the biometric indicators of plants – the aboveground biomass increases by 2.2 times compared to the control, and the mass of the underground part (root crops), on the contrary, decreases by 86.9%. At the same time, the share of root crops in the total biomass of plants decreases from 60% in the control to 30%. The morphological structure of the leaf apparatus changes: the proportion of petioles increases significantly compared to leaf blades (64.8% of petioles in aboveground biomass, whereas in the control 30%). Probably, an increase in the share of UV-A in the spectrum can favorably affect the cultivation of leaf forms of beets and other root crops. UV-A radiation leads to a change in the chemical composition of root crops, in particular, a decrease in the accumulation of dry substances (by 1.58%) and a decrease in sugar content (by 1.8%). An increase in the proportion of UV-A in the irradiation spectrum changes the parameters of chlorophyll fluorescence and contributes to an increase in the maximum quantum yield of Fv/Fm, non-photosynthetic quenching of NPQ fluorescence and a decrease in the real quantum yield of photosynthesis Y(II), as well as the electron transport rate (ETR)