Optical coherence tomography angiography as an indicator of the efficacy of treatment for choroidal neovascularization

Background: Choroidal neovascularization (CNV) occurs in as much as 11.3% of patients with pathological myopia, and is a major cause of visual disability associated with irreversible loss of central vision. The advent of optical coherence tomography angiography (OCTA) has opened up new opportunities for objective documentation and real-time qualitative and quantitative evaluation of CNV in the course of therapy. Purpose: To assess the efficacy of anti-vascular epithelium growth factor (VEGF) therapy with ranibizumab in CNV associated with pathological myopia using OCTA. Material and Methods: Thirty seven anti-VEGF-treatment naive patients (37 eyes) with myopic CNV were involved in the study. All study participants received an intravitreal ranibizumab injection (in accordance with the manufacturer’s recommendations) followed by as needed (PRN) retreatment. Results: Complete subretinal fluid resorption with adherence of the neurosensory retina was observed in all the 37 eyes; the mean number of intravitreal ranibizumab injections required was 4.56 ± 0.1. Over the 18-month follow up period, best-corrected visual acuity (BCVA) improved from 0.12 ± 0.03 to 0.42 ± 0.04 in 27 eyes (72.97%). OCTA patterns of CNV activity tended to fade, with the characteristic presence of isolated long filamentous vessels having a “dead tree” appearance. Conclusion: Application of OCTA, an information-rich modality, in pathological myopia, facilitates a personalized approach to determining the need for anti-VEGF therapy and selecting the mode of administration of anti-VEGF agents based on the CNV activity

CLINICAL AND NEUROLOGICAL MANIFESTATIONS OF DRUG-RESISTANT EPILEPSY AND OPTIMIZATION OF PATIENT TREATMENT

Aim – to study the clinical and neurological manifestations in patients with drug-resistant epilepsy and optimize the therapy. Materials and methods. Fifty patients with drug-resistant epilepsy were examined. Of these, 28 were females and 22 were males; their average age was 32.6±11.4 years. All patients had true pharmacoresistant epilepsy, i. e., the seizures occurred on the background of adequate polytherapy with anticonvulsants; the use of anticonvulsants had no effect on the course of the disease. All patients underwent clinical and neurological examination. The patients were blindly divided into two therapeutic groups: the main group consisted of 25 patients who were prescribed with the combined therapy, which included a biologically active polypeptide at a dose of 10 mg/day for 20 days with a subsequent transition to hopantenic acid (500 mg twice a day for 2 months). The second group did not receive these drugs. For the anticonvulsant therapy, both groups received the combinations of valproic acid (30 mg/kg at two daily doses) and carbamazepine (5 mg/kg at three daily doses). The significance of differences was determined by the paired and unpaired Student’s t-test. The differences were considered statistically significant at p <0.05. Results. The data on the occurrence of subjective and focal neurological symptoms indicated the prevalence of complaints characteristic of general cerebral symptoms in the form of headaches, dizziness, as well as subjective symptoms of cerebral asthenia. In addition, some patients complained of short-term memory impairments. In most cases, drug-resistant epilepsy developed on the background of organic brain damage. In 87.2±6.9% of cases, we encountered a Chvostek sign indicating an increased excitability of the nervous system. Both groups of patients showed positive yet different clinical dynamics: the number of seizures decreased in 40% of patients taking the polypeptide regulator and hopantenic acid, and in 28% of patients in the comparison group (p<0.05). Conclusion. In order to optimize the anticonvulsant therapy, it is recommended to prescribe a combination of valproate and carbamazepine; to increase the efficacy of the combined therapy it is recommended to add the polypeptide regulator and hopantenic acid

Intrarenal hemodynamics and impaired tubular functions in patients with systemic lupus erythematosus

Objective. To identify intrarenal hemodynamic disorders in patients with systemic lupus erythematosus (SLE), to assess their prognostic role, and to reveal an association between tubular dysfunction and intraglomerular hemodynamics. Subjects and methods. Twenty-nine SLE patients, 86.2% of them were diagnosed as having a renal lesion, were examined. The levels of ethanolamine, uric acid, calcium, and phosphorus were determined in their daily urine and serum; the renal functional reserve (RFR) was estimated to detect intrarenal hemodynamic disorders. Results. In the patients with SLE, RFR was considerably smaller: by an average of 6.0% (-25.9; 49.5%) than that in the control group: by an average of 30.9% (16.6; 46.8%);

ПЕРЕВАГИ ДЕПО-ПРОВЕРА І ДИДРОГЕСТЕРОНУ ПРИ ГІПЕРПЛАСТИЧНИХ ПРОЦЕСАХ ЕНДОМЕТРІЮ

Results of the conducted researches showed that the depot pro-belief renders more expressed anti-proliferative effect up to atrophy endometria. Didrogestron in that dose which causes secretor transformation endometria isn't capable to inhibit an ovulation, and at hyper plastic processes endometria along with leveling of gyperplazy endometria wasn't observed the morfofunctsional of changes characteristic for an atrophy of a mucous uterus.Резюме. Результаты проведенных исследований показали, что депо-провера оказывает более выраженный антипролиферативный эффект вплоть до атрофии эндометрия. Дидрогестрон в той дозе, которая вызывает секреторную трансформацию эндометрия не способен ингибировать овуляцию, а при гиперпластических процессах эндометрия наряду с нивелированием гиперплазии эндометрия не наблюдалось морфофункциональных изменений характерных для атрофии слизистой матки. Резюме. Результати проведених досліджень показали, що депо-провера надає більш виражений антипроліферативний ефект аж до атрофії ендометрія. Дідрогестрон в тій дозі, яка викликає секреторну трансформацію ендометрія не здатний пригнічувати овуляцію, а при гіперпластичних процесах ендометрія поряд з нівелюванням гіперплазії ендометрія не спостерігалося морфофункціональних змін характерних для атрофії слизової матки

SURVIVAL RATES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: REGIONAL REGISTRY DATA

There has been an increase in the survival rates of patients with systemic lupus erythematosus (SLE) in recent decades.Objective: to determine the survival rates of SLE patients in the Republic of Tatarstan.Subjects and methods. The records of SLE inpatients treated at the Nephrology and Rheumatology Departments of the Republican Clinical Hospital in 2004 to 2018 were retrospectively analyzed. Demographic data (gender, age at onset of the first signs of the disease, age at diagnosis of SLE, its duration, labor activity, and disability), clinical manifestations of the disease (damage to the  musculoskeletal system, skin and mucous membranes, kidneys, as well as serositis, neuropsychological disorders), and 5-, 10- and 15-year survival rates were analyzed. A hierarchical cluster analysis was used to group patients on the basis of the similarity in the measured characteristics.Results and discussion. A total of 256 SLE patients (230 females and 26 males) were followed up. The median age at onset of the first symptoms of the disease for females and males was 29.0 [21.0; 38.0] and 25.5 [18.0; 37.0] years, respectively; the age at SLE diagnosis was 30.0 [23.0; 41.0] and 25.5 [18.0; 37.0] years. The main clinical manifestations of the disease were damages to the musculoskeletal system (n=199 (77%)), skin and mucous membranes (n=168 (66%)), and kidneys (n=155 (61%)), neurological disorders (n=39 (15%)) and serositis (n=83 (32%)). In the above period, 29 patients died in the study group; there are no data on 10 patients. The 5-, 10-, and 15-year survival rates of patients in our group were 93.7, 90.8, and 86.4%, respectively; those in patients with lupus nephritis (LN) were 90.4, 86.6, and 82.1%; those in hypertensive patients were 89.5, 84.6, and 79.3%. A cluster analysis identified four clusters. The most important criteria for grouping the patients into clusters were the presence of antiphospholipid syndrome (APS), LN, and hypertension. Cluster 1 included patients with LN and hypertension; Cluster 2 comprised those with APS, LN, and hypertension. Cluster 3 consisted of patients having hypertension only; Cluster 4 included those with LN only. In Cluster 2, the 10- and 15-year patient survival rates decreased to 77.9 and 70.1%, respectively.Conclusion. In our study, 5-, 10-, and 15-year patient survival rates were 93.7, 90.8, and 86.4%, respectively. Gender and age at SLE diagnosis did not affect death rates. The risk of death was significantly higher in patients with LN and hypertension