The diagnostic criteria and treatment strategy, which are used for patients with acute gouty arthritis in primary health care practice is given in the article. The algorithm of primary medicine doctor’s action in the management of patients with the acute gout attack is represented.
Introduction: Vascular endothelium function interruption has the main role among mechanisms of development and progression of chronic kidney disease. In numerous
experimental and clinical studies, it was proved that activated vascular endothelium is a structural and functional unit that matches processes of inflammation with intravascular coagulation, fibrinolysis and haemorheological disorders.
The aim: To identify special features of endothelium morphological structure in kidney vessels, coronary arteries and aorta during chronic kidney disease.
Materials and methods: Based on autopsy materials, we conducted a morphological study of patients (n = 20) aged 45 to 55 years who were observed in cardiac and
neurological hospitals for 5-7 years. We removed kidney, heart and aorta samples from patients. For the study, a histological and immunohistochemical methods were used.
Results and conclusions: Morphological study of vessels endothelium of kidneys, heart and aorta demonstrated that in the majority of observations intima underwent
profound pathological changes, manifested by different degrees of disorganization of endothelial lining and violations of structural and functional organization of the
endotheliocytes, subendothelial layer, basal membrane. These pathological processes in all cases had similar features with the development of immune inflammation.
Inflammatory infiltration was represented by macrophages, mast cells, plasma cells. Biological mediators of the presented cells can aggravate the damage to endothelial
cells. Indirect signs of low ability to restore the structure of the vessel wall and endothelial lining may be a weak expression of the VEGF and bcl-2 vascular endothelial
growth factor.
The aim: To determine efficacy and safety of allopurinol and febuxostat in treatment of patients with CKD to reduce the sUA level and analyze its influence on glomerular filtration rate (GFR).
Materials and methods: The study included 45 CKD patients (stages 3b-5) without other severe/decompensated diseases and contraindications to the allopurinol/febuxostat. All patients underwent a comprehensive clinical and laboratory examination, and were divided into the study groups: Group I (28 patients, 61,3±3,2 y.o., CKD3b-12, CKD4-10, on hemodialysis-6 patients) received febuxostat, Group II (24 patients, 60,7±4,1y.o., CKD3b-9, CKD4-10, on hemodialysis -5 patients) took allopurinol.
Results: Achievement of the target level of sUA was significantly often registered in Group I: after 1 month – in 45.5% (in group II – in 15.9%, p<0.001); after 3 months – in 67.5% (in group II – 21.2% p<0.01); after 6 months, these figures were 90% and 37.1%, respectively (p<0.01). sUA level <300 μmol/l was accompanied by significant positive GFR changes in group I patients; in group II there was a gradual progression of GFR deterioration in 31.8% of patients.
Conclusions: In patients with pre-dialysis stages of CKD febuxostat demonstrates renoprotective abilities. Use of febuxostat in patients with CKD stage 3b-4 and in patients on hemodialysis is safe and more effective for target sUA level achievement than the use of allopurinol.
Introduction. The skin biopsies of 30 patients with androgenetic alopecia before and after treatment with platelet-rich plasma in combination with 2 % minoxidil were examined by immunohistochemistry. Goal. The study looked at immunohistochemical changes in the scalp biopsies of patients with stage I-II androgenetic alopecia according to the Ludwig scale and to identify possible changes after injection of platelet-rich plasma in combination with topical 2 % minoxidil lotion. Materials and methods. Skin biopsies of 30 patients with androgenetic alopecia were examined using an immunohistochemical study before and after treatment, which lasted 3 months and included 3 sessions of PRP (once per month) and topical application of minoxidil 2 % lotion twice a day. Results. It was found that androgenetic alorecia is accompanied by inflammatory perifollicular infiltration by T-lymphocytes CD3 +, CD4 + and CD8 +, macrophages (CD68 +); imbalance of germ polypeptides VEGF, TGF-β1, EGFR; accumulation of oxidative stress enzymes eNOS and iNOS; accumulation of pathological fraction of collagen IV. Injections of platelet-rich plasma in combination with topical administration of 2 % minoxidil as a treatment for androgenetic alopecia lead to normalization of immunohistochemical parameters of the skin, which indicates the possibility of using this combination for long-term therapeutic effect. Conclusions. This study complemented the understanding of the pathogenesis of AGA and serves as a basis for improving treatment regimens for this pathology. However, additional studies are needed to further study the pathomorphology of androgenetic alopecia and to standardize the technique of using platelet-rich plasma in patients with this disease.
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