Vol 24, No 2 (2020)

Aim : to evaluate effects and clinical outcomes of early initiation of sacubitril/valsartan in patients with chronic heart failure with a low ejection fraction. Methods : 30 patients admitted to the clinic for an episode of acute heart failure (AHF) II-IV class NYHA and decreased ejection fraction ≤40% (83.3% of men, mean age 66.0 [58.0-76.0] years) were included into the open study. Patients received the first dose of the study drug no later than 6 hours before discharge from the hospital. The period of active treatment was 26 weeks. At week 12 and 26, the number of patients receiving the target dose of 400 mg/day, as well as the dynamics of symptoms and severity of heart failure (HF) were evaluated. During the entire period of the study, safety parameters were investigated in all patients. Results . 70% of patients (n=21) received the target dose by week 2 77,8% (n=21) received the target dose of 200 mg 2 times a day at week 26. The positive effect in the dynamics of symptoms, as well as the severity of HF in the vast majority of patients were observed, a significant reduction in the severity of the main symptoms of HF was achieved, patients moved to a lower class of HF. 3 patients dropped out due to adverse events (1) and serious adverse events (2). 27 (90%) patients completed the program in accordance with the Protocol. Conclusion . Sacubitril/valsartanis is well tolerated, effective and safety drug in patients with CHF and a low ejection fraction.

Prostate cancer (PC) remains an urgent public health problem, especially in developed countries. The use of immunohistochemical research methods in addition to the morphological classification of prostate adenocarcinomas allows a more accurate diagnosis and prognosis of the disease. The aim of the study is to identify isoforms of P53 using clones of mouse antibodies (D-07 and Y5; Epitomics, USA) in prostate cancer with different proliferative activity and the degree of malignancy. Materials and Methods: The work included surgical material for prostate resection and prostatectomy, as well as biopsy specimens (56 cases in total). An immunohistochemical study was carried out with the Ki-67 marker, as well as with mouse monoclonal antibodies (D-07 and Y5) to the P53 protein, interacting with its “wild” and mutant isoforms. The significance of the difference in the samples was determined using the Mann-Whitney U-test, correlation relationships were determined using the Spearman coefficient. Results: Expression of P53 upon interaction with antibodies D-07 and Y5 was determined in 56.3% and 39.6%, respectively. A statistically significant direct correlation was found between the severity of P53 expression when interacting with Y5 antibodies and the degree of tumor differentiation (rs = 0.567, p <0.05), as well as between the expression level of this protein and tumor proliferative activity (rs = 0.698, p <0.05). Conclusion: Antibodies of clone D-07, interacting with both wild and mutant isoforms of P53 protein, show positive expression in adenocarcinomas of all degrees. Expression of the mutant P53 protein is most pronounced in low-differentiated carcinomas and correlates with high proliferative activity of tumor cells, which may be associated with a loss in the induction of P53-dependent apoptosis.

The article analyzes the state of patients’ visual acuity after successful surgical treatment of retinal detachment. On the basis of gathered data, it was concluded that in case of detachment of the macula only in 50% of cases it is possible to increase visual acuity to 0.4 and higher. Restoration of visual functions continues for at least 6 months after the operation and is determined by the restoration of the structure of the outer segments of the photoreceptor cells. During this time, it is advisable to conduct drug therapy aimed at normalizing blood flow and functional activity of the retina. Visual functions recovery continues for at least 6 months after the operation and is connected with the restored structure of the outer segments of the photoreceptor cells. Important prognostic factors of central vision restoration in the postoperative period are visual acuity before surgery, duration of existence and height of macular detachment. Data on which of the methods of surgical treatment of retinal detachment allows to achieve higher visual acuity are contradictory. There is practically no data on the comparison of the effect on visual acuity of scleral buckling and vitrectomy in the long-term period, in patients with phakic eyes and with artiphakia. On visual acuity after fitting detachment of the macula may affect macular edema, epiretinal membrane formation and retinal folds, and edema of the peripapillary optic nerve head, progressive deterioration of blood flow in the basin of the central retinal artery, short posterior ciliary arteries and ophthalmic artery. It is believed that these factors are significantly more pronounced after scleral buckling than after vitrectomy. Some indicators of optical coherence tomography correlate with visual acuity after surgical treatment of retinal detachment: the state of the articulation line of the external and internal segments of the photoreceptors, as well as the state of the external limiting membrane.

Condylomatosis is a disease characterized by the formation on the surface epithelium of the skin and mucous outgrowths, which can reach significant sizes. The cause of the disease is DNA-containing human papillomavirus (HPV), which have a high affinity for epithelial tissues of the genital organs, esophagus, anal canal and respiratory tract. Clinicians have described various patterns of use of the drug Liсopid in the treatment of condylomatosis. Of interest is the development and further implementation of condylomatosis therapy using a drug based on glucosaminyl muramyl dipeptide in order to correct immunodeficiency states and treat papillomavirus infection. Clinical condylomatosis of the external genitalia is presented. In the study of PCR on HPV, 33 types with a high viral load were detected. Diagnosis: Papillomavirus infection. Condylomas of the external genitalia. The goals of therapy and the treatment regimen: prescribing the drug Liсopid (AO Peptek, Moscow) to activate innate immunity, which allows to get an adequately high immune response at the level of both cellular and humoral local immunity. After the therapy, condylomas of the external genital organs were not found at the examination. The patient notes an improvement, the disappearance of itching. Thus, condylomatosis therapy according to the standard 10 mg Liсopid regimen for 10 days was effective, it contributed to the disappearance of genital warts, the clinical effect persisted for the entire observation period - 3 months. The clinical effectiveness of the drug can be explained by its systemic effect on the correction of immunity through NOD2 receptors.

The article presents the results of the use of speleoclimatotherapy in recreational activities in children of primary school age. In the course of the study, we analyzed indicators of heart rate variability in children depending on the initial vegetative status. In vagotonics and normotonics, there was an increase in the activity of the sympathetic division of the autonomic nervous system, and in sympatotonics, there was a decrease in HRV parameters within the age norm, characteristic of increased activity of the sympathetic division of the autonomic nervous system. Such changes can occur when the adaptive reserves of the child’s body increase. However, when using speleoclimatotherapy during recreational activities, it is necessary to take into account the initial level of vegetative activity of heart rate regulation in children.