[Treatment of toxic hepatitis in COVID-19 patients].

BACKGROUND: The article reflects the clinical significance of the early diagnosis of toxic hepatitis in patients who have undergone a new coronavirus infection with the determination of clinical and laboratory predictors of the response to therapy. A dynamic analysis of the effectiveness of toxic hepatitis therapy in patients of three experimental groups and a control group is presented. AIM: The aim of the present study is to increase the effectiveness of the treatment of toxic hepatitis in patients who have undergone COVID-19. MATERIALS AND METHODS: On the basis of the newly created infection centers of the Central Clinical Hospital "RZhD-Medicine" and Vishnevsky 3-rd Central Military Clinical Hospital 996 patients with COVID-19, who had clinical and laboratory signs of toxic liver damage (cytolytic and/or cholestatic syndromes) against the background of COVID-19 therapy. RESULTS: On the 14th day from the start of therapy in group 3, there was a significant decrease in the clinical manifestations of jaundice in 163 (72.8%) patients, on the 21st day of treatment, this symptom was stopped in all patients. In groups 1 and 2, the decrease in clinical manifestations of jaundice was significantly lower - 122 (55.2%) and 134 (58.8%); p<0.05. At the end of therapy, no manifestations of jaundice were observed in all experimental groups, while in the control group, symptom reduction was achieved only in 47 (14.5%) patients. CONCLUSION: The use of drugs with hepatoprotective effect in the form of monotherapy in groups 1 (UDCA) and 2 (ademethionine) showed a low therapeutic effect with positive dynamics of clinical and laboratory indicators of toxic hepatitis activity. The use of combined treatment in group 3 (UDCA and ademethionine) demonstrated the maximum therapeutic effect, pronounced positive dynamics in the form of normalization of clinical and laboratory indicators of toxic hepatitis activity.

[Diagnostics and treatment of non-alcoholic fatty liver disease with concomitant asthenic syndrome].

AIM: Analysis of the effectiveness of therapy for non-alcoholic fatty liver disease (NAFLD) with severe asthenic syndrome. MATERIALS AND METHODS: In the period from 2017 to 2019, on the basis of the gastroenterology center of the Vishnevsky 3-rd Central Military Clinical Hospital, 247 patients with NAFLD, including those at the stage of steatohepatitis, and severe asthenic syndrome were examined and treated. The main group included 124 patients, the control group 123 patients. All patients underwent complex laboratory and instrumental diagnostics and neuropsychological research using the subjective asthenia assessment scale (MFI-20). In both groups, domestic drugs were included in the therapy regimen: from the 1st to the 10th day, Heptrong solution 3 ml intramuscularly in the morning; from the 1st to the 60th day UDCA 250 mg orally, 3 capsules at bedtime, Omega-3 forte 1000 mg, 2 capsules in the morning with meals. In group I patients received additionally from the 1st to the 10th day intravenous drip Cytoflavin 10 ml + 0.9% NaCl solution 200 ml; pentoxifylline solution 5 ml + 0.9% NaCl solution 200 ml. Then, from the 11th to the 60th day, Cytoflavin inside, 2 tablets 2 times a day. Pentoxifylline inside 400 mg 1 tablet 3 times a day. All patients underwent neuropsychological examination using the subjective asthenia rating scale (MFI-20). RESULTS: The effectiveness of treatment in patients of both groups was assessed by clinical, laboratory data and neuropsychological studies. In the main group, a significant reduction in asthenic syndrome was achieved against the background of diagnosed NAFLD compared with the control group. CONCLUSION: The early inclusion of patients with NAFLD and severe asthenic syndrome in the treatment regimen, in addition to the basic therapy of Cytoflavin, achieved a significantly high therapeutic effect in the form of normalization of the main clinical, laboratory and instrumental parameters, as well as a significant reduction in the manifestations of asthenia.

[Cervical dystonia: ways to improve the effectiveness of botulinum therapy]. / Tservikal'naya distoniya: puti povysheniya effektivnosti botulinoterapii.

Cervical dystonia is one of the most complex movement disorders, in which type A botulinum toxin (BTA) preparations are used. A significant number of types of dystonic installation of the head and neck determines a large number of different muscle patterns, sometimes with outwardly similar manifestations. Objective difficulties in choosing the actual pathological muscle pattern for subsequent injection in some cases determine the low effectiveness of botulinum therapy. Given this situation, it is necessary to adapt the anatomical approach to the correct choice of dystonic muscles in order to improve the results of botulinum therapy of cervical dystonia.

[Sleep disorders in patients with cervical dystonia]. / Narusheniya sna u patsientov s tservikal'noi distoniei.

AIM: To clarify the structure of sleep disorders in cervical dystonia and assess their relationship with anxiety and depressive disorders, as well as the impact on quality of life. MATERIAL AND METHODS: Twenty-five patients diagnosed with cervical dystonia (CD) were examined using neurological and psychometric methods (HADS, HAM-D, TAS, SCID-II, SF-36, PSQI). Polysomnographic study was performed using a Somnolab 2 system (Weinmann, Germany). RESULTS: Nineteen patients (76%) from the total sample showed increases in anxiety and depression. Sleep disorders were detected in all patients diagnosed with anxiety and depressive disorders. According to questionnaires, anxiety, depression, and sleep disturbances were significantly correlated with patients' quality of life. The most common sleep disorders were intrasomic disorders (waking up during sleep) (n=19; 76%), less common were presomnic (n=8; 32%) and postsomnic (n=11; 44%). Motor symptoms caused sleep disturbances only in 10 patients (40%). The specific features of sleep disorders in patients with CD detected by polysomnography are a decrease in the representation of delta-sleep, along with an increase in the phase of REM sleep, compared to physiological normal values. CONCLUSIONS: Sleep disturbances (mainly frequent waking during sleep) are widely represented in patients with cervical dystonia, are comorbid to anxiety and depressive disorders and significantly correlate with the poorer quality of life.

[Clinical efficacy of neurometabolic therapy of dissomical disorders in asthenic syndrome]. / Klinicheskaia éffektivnost' neirometabolicheskoi terapii dissomnicheskikh rasstroistv pri astenicheskom sindrome.

AIM: To analyze the efficacy of cytoflavin in the complex treatment of sleep disorders in asthenic syndrome. MATERIAL AND METHODS: One hundred patients with sleep disorders and asthenic syndrome of various etiology and severity were studied. The patients were divided into three groups depending on the type of therapy: the first group received intravenous infusions of cytoflavin for 10 days; the second group, in addition to cytoflavin, received per os melatonin (3 mg or 5 mg) at bedtime; the third group in addition to cytoflavin received per os zopiclone (7.5 mg) at bedtime. RESULTS: On the 14th day of the study, a decrease in severity or complete relief of asthenia manifestations (according to the SHAS scale) and, accordingly, improvement or normalization of sleep in 97% of patients was found. At the same time, during polysomnographic study, the data obtained are characteristic for improving the quality of sleep phases mainly in the first and second groups of patients and, to a lesser extent, in the third group. CONCLUSION: Cytoflavin effectively suppresses the main manifestations of asthenic syndrome, including sleep disorders.