ГОРМОНАЛЬНЫЕ СДВИГИ И ИНТЕНСИВНОСТЬ СВОБОДНО-РАДИКАЛЬНОГО ОКИСЛЕНИЯ В КРОВИ БОЛЬНЫХ С НЕВРОПАТИЯМИ ЛИЦЕВОГО НЕРВА

Pathochemical characteristic features of facial nerve neuropathy (FNN) have been more accurately defined. Heterogeneous patochemical pattern of facial nerve neuropathy has been shown to be dependent on the severity of the disease, intensity of free radical oxidation processes, and hormonal status of the patient. We have found reliable distinctions in dynamics of free radical oxidation processes, and hormo-nal status in the blood of the patients with moderately severe and severe forms of facial nerve neuropathies. In facial nerve neuropathies we observed regulatory effects of cortisol and somatotropic hormone; in facial nerve neuropathywith moderate severity the hormones of thyroid group were seen to be switching off, falling out the processes regulating metabolism. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) were found to have regulating effects, especially in the acute phase of the disease. Different dynamics of the hormones in patients with high and low free radical oxidation levels suggests that the oxidative stress intensity could be associated with regulatory effects of the hormones . The results of correlation analysis confirm the reliable distinctions in free radical oxidation characteristics andand cortisole levels, STH, FSH and LH levels.Уточнены патохимические особенности невропатии лицевого нерва. Показана гетерогенность патохимической картины невропатии лицевого нерва в зависимости от степени тяжести заболевания, интенсивности процессов СРО в остром периоде НЛН и от гормонального статуса ребенка. Выявлены достоверные различия динамики процессов свободно-радикального окисления и гормонального статуса в крови при средне-тяжелом и тяжелом течении НЛН. Показаны регуляторные эффекты кортизола и соматотропного гормона и отмечено выключение из регуляции метаболизма при НЛН средней тяжести гормонов тиреоидной группы, выявлено регулирующее влияние ФСГ и ЛГ. Выявлена достоверная корреляция характеристик СРО и уровней кортизола, СТГ, концентраций ФСГ и ЛГ

«ЭПИЛЕПТИЧЕСКИЙ» ДЕБЮТ ПОДОСТРОГО СКЛЕРОЗИРУЮЩЕГО ПАНЭНЦЕФАЛИТА У ПОДРОСТКА

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Digitizing a Face-to-Face Group Fatigue Management Program: Exploring the Views of People With Multiple Sclerosis and Health Care Professionals Via Consultation Groups and Interviews.

BACKGROUND: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS) and is the main reason why people with MS stop working early. The MS Society in the United Kingdom funded a randomized controlled trial of FACETS-a face-to-face group-based fatigue management program for people with multiple sclerosis (pwMS)-developed by members of the research team. Given the favorable trial results and to help with implementation, the MS Society supported the design and printing of the FACETS manual and materials and the national delivery of FACETS training courses (designed by the research team) for health care professionals (HCPs). By 2015 more than 1500 pwMS had received the FACETS program, but it is not available in all areas and a face-to-face format may not be suitable for, or appeal to, everyone. For these reasons, the MS Society funded a consultation to explore an alternative Web-based model of service delivery. OBJECTIVE: The aim of this study was to gather views about a Web-based model of service delivery from HCPs who had delivered FACETS and from pwMS who had attended FACETS. METHODS: Telephone consultations were undertaken with FACETS-trained HCPs who had experience of delivering FACETS (n=8). Three face-to-face consultation groups were held with pwMS who had attended the FACETS program: London (n=4), Liverpool (n=4), and Bristol (n=7). The interviews and consultation groups were digitally recorded and transcribed. A thematic analysis was undertaken to identify key themes. Toward the end of the study, a roundtable meeting was held to discuss outcomes from the consultation with representatives from the MS Society, HCPs, and pwMS. RESULTS: Key challenges and opportunities of designing and delivering an integrated Web-based version of FACETS and maintaining user engagement were identified across 7 themes (delivery, online delivery, design, group, engagement, interactivity, and HCP relationships). Particularly of interest were themes related to replicating the group dynamics and the lack of high-quality solutions that would support the FACETS' weekly homework tasks and symptom monitoring and management. CONCLUSIONS: A minimum viable Web-based version of FACETS was suggested as the best starting point for a phased implementation, enabling a solution that could then be added to over time. It was also proposed that a separate study should look to create a free stand-alone digital toolkit focusing on the homework elements of FACETS. This study has commenced with a first version of the toolkit in development involving pwMS throughout the design and build stages to ensure a user-centered solution

Вирусный менингоэнцефалит, осложненный отеком головного мозга и комой: эффективность комплексной терапии с применением l-лизина эсцината

The article presents a clinical case of a 14-year-old patient with viral meningoencephalitis complicated with cerebral edema and a brain coma caused by herpes simplex viruses. Comprehensive etiopathogenetic therapy was not sufficiently effective due to the late referral for medical help and the late start of treatment. It has been shown that the use of the L-lysine escinate preparation up to 10 intravenous injections in a single dose of 0.15 mg/kg twice a day, even in the later stages of encephalitis, which has an extremely severe course due to cerebral edema development, is highly effective due to its multifactorial actions.Представлено клиническое наблюдение пациента 14 лет с вирусным менингоэнцефалитом, осложненным отеком головного мозга и комой, вызванным вирусами простого герпеса. Комплексная этиопатогенетическая терапия имела недостаточную эффективность в связи с поздними обращением за медицинской помощью и началом лечения. Показано, что L-лизина эсцинат при внутривенном введении курсом 10 инфузий в разовой дозе 0,15 мг/кг 2 раза в сутки даже на поздних сроках энцефалита, осложненного отеком головного мозга и имеющего крайне тяжелое течение, высокоэффективен за счет своего многофакторного действия.

Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child.

BackgroundPrenatal exposure to certain anti-seizure medications (ASMs) is associated with an increased risk of major congenital malformations (MCM). The majority of women with epilepsy continue taking ASMs throughout pregnancy and, therefore, information on the potential risks associated with ASM treatment is required.ObjectivesTo assess the effects of prenatal exposure to ASMs on the prevalence of MCM in the child.Search methodsFor the latest update of this review, we searched the following databases on 17 February 2022: Cochrane Register of Studies (CRS Web), MEDLINE (Ovid, 1946 to February 16, 2022), SCOPUS (1823 onwards), and ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP). No language restrictions were imposed.Selection criteriaWe included prospective cohort controlled studies, cohort studies set within pregnancy registries, randomised controlled trials and epidemiological studies using routine health record data. Participants were women with epilepsy taking ASMs; the two control groups were women without epilepsy and untreated women with epilepsy.Data collection and analysisFive authors independently selected studies for inclusion. Eight authors completed data extraction and/or risk of bias assessments. The primary outcome was the presence of an MCM. Secondary outcomes included specific types of MCM. Where meta-analysis was not possible, we reviewed included studies narratively.Main resultsFrom 12,296 abstracts, we reviewed 283 full-text publications which identified 49 studies with 128 publications between them. Data from ASM-exposed pregnancies were more numerous for prospective cohort studies (n = 17,963), than data currently available for epidemiological health record studies (n = 7913). The MCM risk for children of women without epilepsy was 2.1% (95% CI 1.5 to 3.0) in cohort studies and 3.3% (95% CI 1.5 to 7.1) in health record studies. The known risk associated with sodium valproate exposure was clear across comparisons with a pooled prevalence of 9.8% (95% CI 8.1 to 11.9) from cohort data and 9.7% (95% CI 7.1 to 13.4) from routine health record studies. This was elevated across almost all comparisons to other monotherapy ASMs, with the absolute risk differences ranging from 5% to 9%. Multiple studies found that the MCM risk is dose-dependent. Children exposed to carbamazepine had an increased MCM prevalence in both cohort studies (4.7%, 95% CI 3.7 to 5.9) and routine health record studies (4.0%, 95% CI 2.9 to 5.4) which was significantly higher than that for the children born to women without epilepsy for both cohort (RR 2.30, 95% CI 1.47 to 3.59) and routine health record studies (RR 1.14, 95% CI 0.80 to 1.64); with similar significant results in comparison to the children of women with untreated epilepsy for both cohort studies (RR 1.44, 95% CI 1.05 to 1.96) and routine health record studies (RR 1.42, 95% CI 1.10 to 1.83). For phenobarbital exposure, the prevalence was 6.3% (95% CI 4.8 to 8.3) and 8.8% (95% CI 0.0 to 9277.0) from cohort and routine health record data, respectively. This increased risk was significant in comparison to the children of women without epilepsy (RR 3.22, 95% CI 1.84 to 5.65) and those born to women with untreated epilepsy (RR 1.64, 95% CI 0.94 to 2.83) in cohort studies; data from routine health record studies was limited. For phenytoin exposure, the prevalence of MCM was elevated for cohort study data (5.4%, 95% CI 3.6 to 8.1) and routine health record data (6.8%, 95% CI 0.1 to 701.2). The prevalence of MCM was higher for phenytoin-exposed children in comparison to children of women without epilepsy (RR 3.81, 95% CI 1.91 to 7.57) and the children of women with untreated epilepsy (RR 2.01. 95% CI 1.29 to 3.12); there were no data from routine health record studies. Pooled data from cohort studies indicated a significantly increased MCM risk for children exposed to lamotrigine in comparison to children born to women without epilepsy (RR 1.99, 95% CI 1.16 to 3.39); with a risk difference (RD) indicating a 1% increased risk of MCM (RD 0.01. 95% CI 0.00 to 0.03). This was not replicated in the comparison to the children of women with untreated epilepsy (RR 1.04, 95% CI 0.66 to 1.63), which contained the largest group of lamotrigine-exposed children (> 2700). Further, a non-significant difference was also found both in comparison to the children of women without epilepsy (RR 1.19, 95% CI 0.86 to 1.64) and children born to women with untreated epilepsy (RR 1.00, 95% CI 0.79 to 1.28) from routine data studies. For levetiracetam exposure, pooled data provided similar risk ratios to women without epilepsy in cohort (RR 2.20, 95% CI 0.98 to 4.93) and routine health record studies (RR 0.67, 95% CI 0.17 to 2.66). This was supported by the pooled results from both cohort (RR 0.71, 95% CI 0.39 to 1.28) and routine health record studies (RR 0.82, 95% CI 0.39 to 1.71) when comparisons were made to the offspring of women with untreated epilepsy. For topiramate, the prevalence of MCM was 3.9% (95% CI 2.3 to 6.5) from cohort study data and 4.1% (0.0 to 27,050.1) from routine health record studies. Risk ratios were significantly higher for children exposed to topiramate in comparison to the children of women without epilepsy in cohort studies (RR 4.07, 95% CI 1.64 to 10.14) but not in a smaller comparison to the children of women with untreated epilepsy (RR 1.37, 95% CI 0.57 to 3.27); few data are currently available from routine health record studies. Exposure in utero to topiramate was also associated with significantly higher RRs in comparison to other ASMs for oro-facial clefts. Data for all other ASMs were extremely limited. Given the observational designs, all studies were at high risk of certain biases, but the biases observed across primary data collection studies and secondary use of routine health records were different and were, in part, complementary. Biases were balanced across the ASMs investigated, and it is unlikely that the differential results observed across the ASMs are solely explained by these biases.Authors' conclusionsExposure in the womb to certain ASMs was associated with an increased risk of certain MCMs which, for many, is dose-dependent

Ранний нейроборрелиоз у детей, синдром Баннварта (клинические наблюдения)

The problem of ixodic tick-borne borreliosis remains relevant due to its ubiquity, high incidence, especially in the Northwestern Federal District, a variety of clinical manifestations, as well as the possibility of chronization, including in children.Purpose: to describe our own clinical observations of Bannwart syndrome, which developed during the dissemination of the pathogen.Results. Bannwart syndrome is pathognomonic for borreliosis symptoms, including a triad of clinical manifestations: serous meningitis, single- or bilateral lesion of facial nerves, polyneuropathy. Timely clinical and adequate laboratory diagnostics determine the favorable course of the disease.Проблема иксодовых клещевых боррелиозов сохраняет свою актуальность в связи с повсеместной распространенностью, высокой частотой заболеваемости, особенно в Северо-Западном ФО, разнообразием клинических проявлений, а также возможностью хронизации, в том числе и у детей.Цель: описать собственные клинические наблюдения синдрома Баннварта, развившегося в период диссеминации возбудителя. Результаты. Синдром Баннварта является патогномоничным для боррелиоза симптомом, включающим триаду клинических проявлений: серозный менингит, одно- или двустороннее поражение лицевых нервов, полиневропатию. Своевременная клиническая и адекватная лабораторная диагностика определяют благоприятное течение заболевания

Creating a FACETS digital toolkit to promote quality of life of people with multiple sclerosis through Participatory Design

In this paper, we report on the first stages of creating a stand-alone digital toolkit focusing on the homework elements of FACETS (Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle). FACETS is an evidence-based face-to-face fatigue management group programme for people with multiple sclerosis. This paper details the participatory design process from requirements elicitation to initial prototyping and how offline activities linked to each session have been mapped in the digitised solution (mobile app)

Hormonal shifts and intensity of free radical oxidation in the blood of patients with facial nerve neuropathies

Pathochemical characteristic features of facial nerve neuropathy (FNN) have been more accurately defined. Heterogeneous patochemical pattern of facial nerve neuropathy has been shown to be dependent on the severity of the disease, intensity of free radical oxidation processes, and hormonal status of the patient. We have found reliable distinctions in dynamics of free radical oxidation processes, and hormo-nal status in the blood of the patients with moderately severe and severe forms of facial nerve neuropathies. In facial nerve neuropathies we observed regulatory effects of cortisol and somatotropic hormone; in facial nerve neuropathywith moderate severity the hormones of thyroid group were seen to be switching off, falling out the processes regulating metabolism. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) were found to have regulating effects, especially in the acute phase of the disease. Different dynamics of the hormones in patients with high and low free radical oxidation levels suggests that the oxidative stress intensity could be associated with regulatory effects of the hormones . The results of correlation analysis confirm the reliable distinctions in free radical oxidation characteristics andand cortisole levels, STH, FSH and LH levels