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Neuropathy is a damage, disease, or dysfunction of one or more nerves especially of the peripheral nervous system. One of the most common disease causing neuropathy is diabetes mellitus. Diabetic neuropathy is a serious consequence that arises when nerve tissue is damaged by prolonged hyperglycemia. It affects a considerable portion of those who have the disease. This article covers every component of this complexed disease. We will discuss the definition, etiology, risk factors that patients can control and that are uncontrollable, and forms of neuropathies linked to diabetes such as peripheral, autonomic and focal. For more clinical approach signs and symptoms, diagnostic methods which are a mix of clinical evaluations, neurological exams, electrophysiological testing, and, in certain situations, imaging modalities and complicated nature of treating diabetic neuropathy will be explored. Moreover, challenges in treating this disease and future directions and research will be elaborated. What is more it interdisciplinary care will be explored as a key element in addressing complexed nature of diabetic neuropathy. In addition to highlighting the complexity of neuropathy in diabetes mellitus and emphasizing the vital significance of early recognition and specialized interventions for the best possible patient outcomes, the article aims to present a thorough grasp of diabetic neuropathy.

Background: Еndoscopic neurolysis of the sciatic nerve has proven itself as a low traumatic and effective technique of treatment for deep gluteal pain syndrome and sciatic nerve neuropathy. Until now, there have been no publications dedicated to the parietal peritoneum damage after endoscopic sciatic nerve decompression. Clinical case description: A 70-year-old female patient with deep gluteal pain syndrome and sciatic nerve neuropathy on the right side and failure of a conservative treatment. According to the VAS scale, the severity of pain syndrome was 10 cm. The severity of the motor dysfunction, according to the BMRC scale, was 4 points. The severity of the sensitive dysfunction, according to the Seddon scale, was 3 points. The functional activity of the lower limb, according to the LEFS scale, was 48 points. The instrumental investigation of the sciatic nerve included MRI, ultrasound, and ENMG. Endoscopic sciatic nerve decompression was performed in the prone position with saline irrigation using the technique published before. After the surgery, an ultrasound study and a CT scan were performed, which determined the presence of a free fluid in the abdominal cavity, and edema of the right retroperitoneal space. The patient underwent laparoscopy, which revealed the area of the parietal peritoneum damage in the lower floor, with a free saline fluid detected in the abdominal cavity, which was evacuated. The patient was discharged from the hospital on the 10th day after the surgery. 6 months after the surgery, the functional activity of the lower extremity, according to the LEFS scale, was 52 points. Pain syndrome, according to the VAS scale, was 8 cm. The severity of the motor dysfunction, according to the BMRC scale, was 4 points. The severity of the sensitive dysfunction, according to the Seddon scale, was 3 points. The performed surgical endoscopic treatment was rendered ineffective. Conclusion: The method of endoscopic sciatic nerve decompression with saline pumping has a risk of the following complication: damaging the parietal peritoneum, saline penetration into the abdominal cavity, edema of the retroperitoneal space. To decrease the risk of this complication, it is necessary to observe the specific surgical conditions such as: controlled hypotension in a patient and a low pressure in the arthroscopic pump, the time of surgery not exceeding 1 hour, and the saline consumption not exceeding 10 liters. It is also crucial not to perform the dissection and neurolysis too proximal to the piriformis area.

Introduction Sciatic nerve neuropathy is common pathology. Development of endoscopic method of decompression and neurolysis is extremely prospective. Objective Analyze the results of endoscopic decompression of sciatic nerve at a 1-year follow-up. Material and methods 15 patients (11 females – 79 %, 4 males – 21 %) were included into the study and were treated in the period from 2018 to 2022. Endoscopic sciatic nerve neurolysis and decompression were performed. Mean age of the patients was 47 ± 16 years. The severity of pain according to VAS was 8 ± 1. Motor dysfunction according to the BMRC scale was 2.6 ± 1.7 points. Degree of sensitive dysfunction according to Seddon scale was 2.9 ± 0.9 points. Functional activity of the lower limb according to LEFS scale was 49 ± 7 points. Results The severity of pain one year after surgery according to VAS scale decreased to 2.8 ± 2.6 cm. Degree of motor dysfunction according to BMRC scale became 4.4 ± 0.8 points. Degree of sensitive dysfunction according to Seddon scale became 3.7 ± 0.4 points. Functional activity of the lower limb according to LEFS scale increased to 68 ± 8.7 points. Efficacy of surgery in our study was 80 % (12 patients), there was one complication after surgery (6.7 %). Discussion Our study obtained clinical results that are comparable with the data of domestic and world literature. Conclusion Endoscopic decompression of sciatic nerve is an effective and low-traumatic method with a low rate of complications, which allows for pain relief, promotes restoration of function of the sciatic nerve and lower extremity.

Objectives. To study the effect of fatty acid amides on nociceptive sensitivity and gait patterns during pharmacological blockade of GPR18 receptors in healthy animals and in rats with peripheral neuropathy. Material and methods. The studies were carried out on white male Wister rats (n=86), divided into 11 groups. The effects of fatty acid amides with ethanolamine and glycine upon blockade of GPR18 receptors after the administration of a PSB-CB5 antagonist on gait parameters (footprint area and intensity, as well as hind limb transfer rate), nociceptive reactions in normal rats and in animals with experimental peripheral neuropathy were studied. Results. Single intraperitoneal injections of the G-protein-coupled membrane receptors antagonist GPR18 at a dose of 1 mg/kg to intact rats did not cause any significant changes in Randall – Sellitto test, Hot-plate test and gait patterns. Injections of one of the fatty acid amides (palmitoylethanolamide, stearoylethanolamide, palmitoylglycinamide) at a dose of 1.5 mg/kg to rats with experimental peripheral neuropathy caused a significant decrease in the nociceptive response to mechanical and thermal stimuli, thereby providing an analgesic effect, which was also confirmed by gait analysis. Against the background of GPR18 receptors blockade in rats with neuropathy, palmitoylglycinamide had a pronounced analgesic effect, which is reflected in significant changes in the values of nociceptive sensitivity, as well as the gait parameters studied. However, after the administration of palmitoylethanolamide to animals with GPR18 receptors blocked, reliable results were obtained only when test Hot-plate and fingerprint area were registered, whereas after the introduction of stearoylethanolamide no statistically significant data were obtained. Conclusions. It has been shown that the pronounced analgesic effect after the administration of palmitoylethanolamide and stearoylethanolamide is mediated through the interaction with orphan receptors. At the same time, the antinociceptive effect of palmitoylglycinamide probably occurs through the activation of other, non-orphan, receptors.

Background: Posttraumatic axillary nerve neuropathy is a widely spread pathology, more often seen after a shoulder joint trauma. It can also appear as a complication after orthopedic surgeries, for example, after the Latarjet procedure for shoulder stabilization. The technique of open axillary nerve decompression is very popular but has a number of disadvantages: a large trauma of soft tissue, severe bleeding, a high rate of complications, and also a poor cosmetic effect. The endoscopic surgical technique of decompression is an effective and less traumatic alternative to open procedures. Clinical case description: We present the results of endoscopic transcapsular axillary nerve decompression in 5 patients with a clinical picture of neuropathic pain syndrome, hypoesthesia in the deltoid area, hypotrophy of the deltoid muscle, who were operated from 2018 to 2021. The mean age of patients was 44.414.9. An original surgical technique of decompression was developed and applied to all the patients which included arthroscopy of the shoulder joint with diagnostic and treatment components and transcapsular endoscopic axillary nerve decompression in the beach-chair position. The statistical analysis was performed using the MannWhitney U test. According to the VAS-scale, the severity of pain syndrome before the surgery was 64.6 points, while 6 months after the surgery it decreased to 1.40.5 points (p 0.05). According to the DASH scale, the function of the shoulder joint before the surgery was 77.66.9 points, and 6 months after surgery it increased to 125.2 points (p 0.05). According to the BMRC scale (M0M5), the strength of the deltoid muscle before the surgery was 20.4 points, and after the surgery it increased to 4.40.5 points (p 0.05). The range of motion in the shoulder joint was as follows: before the surgery flexion 10745.6, extension 10249, external rotation 2213.6; 6 months after the surgery flexion 15425.6, extension 15622.4, external rotation 508 (p 0.05). The thickness of the middle portion of the deltoid muscle according to the US was 7.21.04 mm before the surgery, 11.81.44 mm after the surgery (p 0.05). All the patients (100%) at a long-term follow-up noticed complete relief of pain and regression of the neurological symptoms. Conclusion: The achieved results allow us to characterize the method of endoscopic transcapsular decompression as a reproducible, minimally invasive and highly effective technique, providing pain relief to patients, curing neurological and intraarticular pathology, thus promoting early restoration of the upper limb function in the treated group of patients.

Sciatic nerve (SN) injury associated with total hip arthroplasty (THA) is a challenging issue due to the high prevalence of the complications. However, there is no consensus about the injury mechanism, surgical treatments, indications and timing for the surgeries which necessitates the studies. The objective was To perform a comparative analysis of the dynamics in clinical, neurological and electrophysiological parameters in patients with sciatic nerve injuries associated with THA performing various surgical treatments. Material and methods The study included 61 patients who were hospitalized between 2005 and 2021. Patients were divided into two groups being homogeneous in terms of gender, age and severity of neurological deficit. Microsurgical neurolysis of the sciatic nerve trunk was performed in group I (n = 32) and was added by direct electrical stimulation of the sciatic nerve at the level of injury in group II (n = 29). Clinical, neurological status and electroneuromyography parameters of the patients were assessed preoperatively and at 6 months of surgery. Results All patients showed pain relief with VAS score decreasing from 6 (5.5; 8) to 4 (2; 6) in group I and to 3 (1; 5) in group II (p < 0.001). Functionality of the lower limb scored preoperatively 31 (24.5; 40.5) on the ODI scale in group I and 27 (21; 36) in group II. The patients showed positive dynamics postoperatively with improved lower limb function due to decreased neuropathic pain syndrome scoring 28 (20; 34.5) in group I and 16.5 (8.5; 21.75 ) in group II (p < 0.0001). Conclusions The findings suggested the advantages of the electrical stimulation method in combination with microsurgical neurolysis of the sciatic nerve over the use of microsurgical neurolysis alone with decreased intensity of the pain syndrome and functional insufficiency of the lower limb.

Relevance The brachial plexus is a complex anatomical structure the passes through three narrow anatomical spaces including the interscalene space, the space between the first rib and the clavicle (thoracic aperture), the space between the anterior chest wall and the pectoralis minor muscle. Compression of the brachial plexus and the vascular band can occur at the sites. Endoscopic approach to the brachial plexus is a promising surgical trend to allow neurolysis and decompression of the plexus with minimal trauma and blood loss and a good cosmetic result. The purpose was to explore topographic anatomy of the brachial plexus and surrounding structures and determine the possibility of endoscopic approach to the brachial plexus. Material and methods The shoulder and neck were dissected in 5 fresh cadavers. The study was performed at Trauma and Orthopaedics department of the Russian Peoples Friendship University and Department of pathological anatomy at the Buyanov’s Moscow State City Hospital between 2021 and 2022. Results The pectoralis minor muscle was detached from the coracoid process to endoscopically approach to the subclavian part of plexus. The lateral aspect of the subclavian muscle was detached from the clavicle to endoscopically approach to the thoracic aperture. Portals were produced at the supraclavicular fossa to endoscopically approach to the supraclavicular part of the plexus in the interscalene space considering the topographic anatomy of the jugularis external vein and accessory veins. The mean distance from the coracoid tip to the penetration point of the musculo-cutaneous nerve to the conjoint tendon was 3 cm. The mean distance between the anterior chest wall and the clavicle (width of thoracic aperture) was 1.86 cm. The mean distance between the sternal end of the clavicle to the point of passage of the subclavian artery under the clavicle was 5.7 cm. The mean width of the interscalene space was 1.4 cm. Discussion Aspects of topographic anatomy of the brachial plexus were examined in cadaveric studies of Sidorovich R.R. (2011), Chembrovich V.V. (2019), Anokhina Z.A. (2021), but endoscopic approach to the brachial plexus and possibility with endoscopic surgery were not discussed in the studies. Foreign cadaveric studies of Akaslan I. (2021), Koyyalamudi V. (2021), Costabeber I. (2010), Akboru (2010) were performed to examine topographic anatomy of the brachial plexus. The only study reporting the possibility of endoscopic approach to the brachial plexus and endoscopic anatomy was performed by Lafosse T. (2015). Our cadaveric series reported the possibility of endoscopic approach to the brachial plexus at the three levels for the first time in Russian literature. Conclusion Topographic anatomy of the supraclavicular and infraclavicular portions of the brachial plexus was examined in our series. The study showed the possibility of endoscopic approach to the brachial plexus at the interscalene space, thoracic aperture and subclavian area.

Theproteasome inhibitor bortezomib (Velcade) has demonstrated clinical activity in patients with multiple myeloma (MM). We report the activity of borte-zomib plus dexamethasone in 60patients with relapsed and refractory myeloma. The patients had a median age of 65 years (range, 38—79 years). The median number of previous treatments was 3 (range, 1-9). For patients who received bortezomib plus dexamethasone the overall response rate was 73%. 38% patients achieved CR. CR in patients receiving bortezomib plus dexamethasone earlier vs later (≤ 3 и ≥ 4 line chemotherapy) were: 48% vs 27,5%. Bortezomib is active in patients with relapsed MM, including elderly patients. Side effects were predictable and manageable; principal toxicities were hematological, gastrointestinal, and peripheral neuropathy. The most common adverse events reported were asthenia (52%), neuropathy (53%), thrombocytopenia (32%), anemia (30%). Neuropathy greater than grade 2 was more frequent in patients who received 3 or more prior therapy regimens.

We used the bortezomib (velcade) plus MP (VMP) in 24 previously untreated patients with multiple myeloma (MM). The patients had a median age of 73 years (range, 65–83 years). For patients who received velcade plus MP the overall response rate was 62.4 %. 33.2 % patients achieved complete remission (CR+n-CR). The median duration of the CR was 10.3 months. Side effects were predictable and manageable. The most common adverse events reported were asthenia, neuropathy, neutropenia and anemia. Serious adverse events were rare. These results establish VMP as a new standard of care in elderly untreated patients with multiple myeloma. VMP is highly active and well tolerated in elderly patients (> 75 years) with newly diagnosed multiple myeloma.

We used the bortezomib plus dexamethasone (VD) and bortezomib plus MP (VMP) in 56 previously untreated elderly patients with multiple myeloma. The patients were 65–89 years old. For patients who received bortezomib plus MP the overall response rate was 83%. 33.3% of patients achieved complete response (near-complete response + complete response) (based on EBMT criteria). For patients who received bortezomib plus dexamethasone the overall response rate was 73%. 34.6% of patients achieved complete response. Median overall survival in patients treated with bortezomib plus dexamethasone and bortezomib plus MP has not been reached. Median event-free survival was 15 and 17 months respectively. Side effects of bortezomib were predictable and manageable. The most common adverse events reported were asthenia, neuropathy, neutropenia and anemia. Serious adverse events were rare. These results establish VMP and VD as modern strategies in therapy of elderly untreated patients with multiple myeloma. VMP and VD is highly effective and well tolerated in elderly patients (> 65 years) with newly diagnosed multiple myeloma.

Background: Thoracic outlet syndrome compression of the brachial plexus in the area between the clavicle and the first rib is a commonly spread and important pathology. It occurs, as usual, after a trauma or due to an anatomical malformation of this area. Thoracic outlet syndrome can be combined with a shoulder joint pathology. In the case of a conservative treatment's failure, the standard surgical procedure is decompression of the brachial plexus in the thoracic aperture. This procedure is usually done via an open approach. The development of the endoscopic surgical technique of decompression allows reducing the risk of complications and recurrences, improving the cosmetic result and relieving the rehabilitation period. Clinical case description: A 73-year-old female patient with a clinical picture of posttraumatic brachial plexopathy and a massive shoulder rotator cuff tear. The patient underwent a conservative treatment for 6 months after the trauma without a significant improvement. To confirm the diagnosis, ENMG and an ultrasound investigation of the brachial plexus, as well as MRI of the shoulder joint were performed. Simultaneous shoulder joint arthroscopy with subacromial spacer implantation and brachial plexus decompression in the thoracic aperture were performed to the patient. According to the VAS-scale (Visual Analogue Scale), the severity of pain syndrome before the surgery was 10 cm, while 6 months after the surgery, it decreased to 1 cm. According to the DASH scale (Disabilities of the Arm, Shoulder, and Hand), the dysfunction of the of shoulder joint before the surgery was 76 points, while 6 months after the surgery, it decreased to 12 points. The range of motion in the shoulder joint before the surgery was as follows: flexion 105, abduction 95, external rotation 15, which increased to 160, 165, and 45, respectively, 6 months after the surgery. Conclusion: The results allow us to characterize the method of simultaneous shoulder joint arthroscopy and endoscopic decompression of the brachial plexus in the thoracic aperture as a low-traumatic and effective technique. The technique provides complete brachial plexus decompression in the thoracic aperture which promotes restoration of the function of the upper extremity and shoulder joint, and elimination of pain syndrome from the upper extremity area.

Diabetes is now one of the most common chronic diseases. Its incidence is increasing, and thus the number of people suffering from its health complications is increasing. In 2015, 3 million people in Poland suffered from diabetes, and it is estimated that this number will increase to 4 million by 2040. Acute complications of diabetes include i.a. hypoglycemic or lactate and hypermolar comas. Chronic complications include, for example, microangiopathies (retinopathies, nephropathy) as well as macroangiopathies and neuropathies. Neuropathy is the result of too much glycemia and can affect as many as 2/3 of diabetic patients. Everyday pain sometimes makes it impossible to perform the simplest activities, and an optimal treatment plan is difficult to develop. At the same time, it can be prevented with regular exercise, regular glycemic control and a proper diet. In this paper, we present a literature review on neuropathy and neuroarthropathy as a complication of diabetes and other diseases, with particular emphasis on painless fractures.

Introduction: B vitamins are necessary for the proper functioning of the nervous system, taking part in the synthesis of neurotransmitters, RNA and DNA and acting as cofactors in many cellular metabolic pathways. The body does not store them, so they need to be replaced daily. Mild deficiencies can cause non-specific neuropsychiatric disorders, and deep and persistent - serious, fatal disease states that require intensive supplementation, such as beriberi disease or Korsakoff's syndrome. Materials and methods: My work is based on the articles published in PubMed, medical books and websites. I was looking for the key words such as ‘biotin‘, ‘brain’, ‘homocysteine’, ‘niacin’, ‘pantothenic acid’, ‘riboflavin’, ‘thiamin’, ‘neuropathy’. Results: B vitamins seem to enhance the analgesic effect of NSAIDs. There is evidence of supportive action in the treatment of low back pain and diabetic neuropathy. There is no reliable evidence of improved cognitive function in patients with Alzheimer's disease or other types of dementia. Conclusions: due to the low toxicity, very few side effects and experimental findings, it seems reasonable to administer B vitamins in numerous pain syndromes, such as neuropathies and back pain syndromes. However, we need more randomized clinical trials to create universal recommendations and finally confirm the positive effects of these substances in neurological diseases.

Background. Neuropathies of the lumbar plexus trunks, in particular those of the femoral nerve, are the most common complications of lateral interbody fusion of the lumbar spine. Modeling of this surgical intervention in normal animals experimentally makes it possible to assess the degree of its trauma to the nervous structures, and to understand what is the reason for the persistence or aggravation of neurological symptoms iatrogenic injuries or the existing pathology progression. Purpose to study histological and morphometric changes in the femoral nerve in the long-term periods after the lateral interbody fusion modeling of the canine lumbar spine. Study design an experimental prospective continuous uncontrolled study. Materials and Methods. Discectomy via lateral approach was performed in 18 mongrel dogs (aged 2-3 years, mass 13.2-17.6 kg) at the level of L4-5 и L5-6, interbody titanium implants were mounted, the lumbar spine was stabilized with a wire device for external fixation within 30 days. Clinical and neurological evaluation was performed, as well as histological investigation of the femoral nerves from the side of surgical approach. Results. In the early postoperative period a temporary decrease in the femoral nerve function was observed, which was manifested by the disorder of the support function and muscle weakness of the pelvic limbs, decrease in the knee reflex, the foot support shift to the metatarsal pad. Later, until the end of the study (18 months), the general condition of all animals was satisfactory, there were no disorders of the limb support function and motor reflexes. After six months, in the femoral nerve there was 4-fold decrease in the proportion of large fast-conducting myelin fibers D10 m and 3-fold increase in that of the small ones. The mean axon diameter and myelin thickness were 62% and 53% of the norm. After 12-18 months, the dimensional characteristics of myelin fibers were restored. During the entire experiment, 4-6% of myelin fibers were reactively and destructively altered. Conclusions. The modeling of the lateral interbody fusion of the lumbar spine in normal animals experimentally demonstrated the absence of neurological symptoms after 6-18 months, which indicated low invasiveness of the surgical intervention. Nevertheless, the subclinical reactive and destructive changes in the myelin fibers of the femoral nerve revealed 6 months after the surgery indicated the need for preventive anti-neurotic therapy.

This review analyzed the domestic and foreign literature on brachytherapy of choroidal melanoma using ruthenium ophthalmic applicators. The review highlights the historical aspects of radiation treatment, from the first experience of using ionizing radiation in the treatment of malignant neoplasms to modern methods of brachytherapy; presents the radiobiological foundations of radiation therapy; considers the issues of radiation pathomorphosis, reflecting the nature of pathological changes in the choroidal melanoma tissue during brachytherapy; shows the dependence of the effect of exposure ionizing radiation from the phase of the cycle of cell division; and also describes the presence of changes characteristic of the response to ionizing radiation in unirradiated tissues. The analysis of various post-radiation complications, both early and late, was carried out in some detail, with emphasis on the possibility of predicting and preventing them in real clinical practice. A comparison is made in terms of the frequency of development of various post-radiation complications in the works of domestic and foreign authors, as well as a comparison with the effect of ionizing radiation from other radioactive isotopes. Recommendations of experts are given regarding the correct calculation of the dose to the sclera and medication support, based on many years of experience in the use of ruthenium ophthalmic applicators for brachytherapy of choroidal melanoma. The risks of developing such late complications as radiation maculopathy and radiation neuropathy have been demonstrated, especially in pre-equatorial tumor localization. The possibilities of modern methods of instrumental diagnostics for studying the processes occurring in the area of the tumor, as well as changes in the surrounding tissues, are shown, which determines the feasibility and importance of further study of this issue.

Background and Objectives: The sweat-gland activity is associated with the functional state of small sympathetic nerve fibers that are subject to destructive changes in a amount of pathologies, for example, such as diabetic peripheral neuropathy and rheumatoid arthritis. In this work, we have solved the problem of visualizing sweat pores on the skin surface using dynamic differential thermography. Materials and Methods: Based on the wavelet analysis of the fingers phalanges skin temperature fluctuations, it was found that the sweat-gland activity forms spectral components at frequencies of about 0.1 Hz and higher. As a result, it was proposed to consider the temperature signal as a twocomponent one. It is believed that the low-frequency component less than 0.1 Hz is mainly due to hemodynamics, the high-frequency component is mainly due to the functioning of the sweat glands and sweating. To implement differential thermography, the difference between the current frame and the frame delayed by 10 s relative to it was used. Results: As a result, this made it possible to isolate spatial high-frequency information corresponding to sweat pores on the dynamic thermogram. Testing with a sharp breath showed that the signal level of the differential thermogram characterizes the level of the sweat-gland activity that changes over time. Building an integral map of sweat-gland activity by averaging differential thermograms over the entire registration period makes it possible to assess the spatial distribution of sweat gland activity time. The given example of an integral map showed a decrease in the spatial density of functioning sweat glands in a patient with type 2 diabetes mellitus compared with a normal subject. Conclusion: Thus, differential thermography and integral maps of the sweat-gland activity can find application in the field of medicine and physiology for quantitative diagnosis and monitoring of therapy for sympathetic nerve fibers dysfunction, which is relevant in a number of socially significant diseases.

Introduction: Optic neuropathies are a broad group of diseases in which the dominant disturbance is damage to the optic nerve, often irreversible. Underlying causes of neuropathy are both genetic and environmental. Despite limited treatment options, much research is currently being done on substances that could improve optic nerve function and alleviate the clinical consequences of optic nerve damage. Purpose: This article describes current findings in both the optic nerve neuropathy pathophysiology and diagnosis of the disorder, as well as treatment options and future perspectives. State of knowledge: The pathogenetic cause of neuropathy is mainly demyelination within the neural sheath, often caused by inflammation. It is characterized by progressive loss of vision. The most common genetic cause of optic neuropathy is mitochondrially inherited Leber hereditary optic neuropathy (LHON) and is characterized by mostly sudden and painless loss of visual acuity. Toxic neuropathies are a group of diseases caused by heavy metals, pharmaceuticals, methanol and carbon monoxide. Nutritional neuropathy is mainly related to vitamin B1, B9 and B12 deficiency, and is a rare example of neuropathy that can be curable at the early stage of the disease. Another group of neuropathies is caused by ischemia and can be divided according to the place of the optic nerve affected – AION (anterior ischemic optic neuropathy) and PION (posterior ischemic optic neuropathy). Conclusions: The therapeutic options in the treatment of optic neuropathy strictly depend on the causative factor. Nutritional deficiencies are treated with appropriate supplementation, so it is vital to truly determine the missing vitamins and elements.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a peripheral neuropathy, predominantly motor neuropathy, with a progressive or relapse-remitting course. Fatigue is a condition characterized by a physical or mental feeling of lack of energy or lack of motivation for action, which is often present in patients with CIDP.Objective: to assess the severity of asthenia in CIDP patients.Patients and methods. Examinations were made in 34 inpatients treated for documented CIDP that met the international European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria. A study group included patients with CIDP, whereas a comparison group consisted of volunteers without psychiatric illness, who were compensated for somatic diseases.Results and discussion. In the patients with CIDP, the level of fatigue was found to be much higher than normal. Approximately half of the CIDP patients had obvious asthenia. However, the level of fatigue did not correlate with the severity of the course of CIDP.Conclusion. The findings suggest that fatigue is important in patients with CIDP that should be taken into account in the treatment of these patients.

Polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes (POEMS) syndrome is a rare paraneoplastic syndrome associated with Castleman disease, monoclonal gammopathy of undetermined significance, symptomatic hemoblastosis or systemic autoimmune diseases. Slow development, nonspecifity of most clinical manifestations and lack of awareness of physicians are the main reasons for the late access to medical care and a long, sometimes many years, diagnostic search. Even after diagnosis, the use of modern methods of immunosuppressive, immunomodulating or antitumor therapy is significantly limited by the difficulties of taxonomic classification of the diagnosis, the lack of unified therapeutic approaches, and related unresolved issues of profiling and drug provision of patients. The article provides an overview of the basic information about the pathogenesis and clinical manifestations of POEMS syndrome. Using the example of a patient with Castleman’s disease, the difficulties of primary diagnosis of POEMS syndrome and the problems of interdisciplinary interaction of doctors of various specialties are demonstrated. The significance of endocrine disorders in the diagnosis and treatment planning is analyzed.

Objective. In this work we analyzed the current literature data about the retinal damage in cardiovascular diseases and diabetes mellitus (published from 2005 to 2020). The damage of retinal vascular bed and optic nerve represents a relevant problem in the modern world in view of the significant prevalence, severity of retinal irreversible damage leading to disability, and in relation to comorbidity with cardiovascular diseases (CVD). Methods. Publications on selected topic were analyzed from 2005 to 2020. The search was carried out using the electronic databases of the Google Academy (https://scholar.google.com/), PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), eLIBRARY.ru (https: //www.elibrary.ru/) and foreign and national journals devoted to cardiology, therapy and ophthalmology. Results. The analysis of literature showed that atherosclerotic lesion of the microvascular retinal bed is a significant risk factor for acute coronary syndrome myocardial infarction (MI) and stroke. However, the identity of atherosclerotic processes occurring in the retinal vascular bed and in the peripheral arteries remains open. A strong association was shown between hypertensive retinopathy (HR) has with MI, congestive heart failure (CHF) and CHD mortality in large-scale population-based studies such as ARIC and Rotterdam Study. The question of the predictive significance of GR, depending on its degree, remains debatable. There are consistent evidence on the association between HR and CHD and CHF. Diabetic retinopathy (DR) represents a neurovascular complication of diabetes. In predominantly clinical work, there is evidence of the significance of DR as a risk marker for Stroke, diabetics peripheral neuropathy, autonomic cardiac neuropathy, thickness of carotid intima-media, micro albuminuria. A number of other major clinical works has not shown a significant association between DR and stroke. A significant drawback of investigation of the relationship between DR and CVD is a lack of population studies on this topic. Conclusions. Despite the use of modern diagnostic methods and a fairly large number of studies of the eye vascular bed and retina, the data about their relationship with CVD remain scare and contradictory, which is largely due to the limited size of the studied samples, the variability of the estimates, and a complexity of the pathway of atherosclerosis and CVD. The study of association between CVD and retinal pathology in the Russian population with using of automatic assessment of the microvascular bed provides a unique opportunity to solve some contradictory aspects and obtain new data.

Background and Objectives: Interest in the study of the human’s sweat glands activity is due to the close relationship of their activity with human body’s peripheral regions sympathetic innervation. The increased activity of sweat glands and secretion occurs not only due to thermoregulation, but also is a response to the psychoemotional load and the physiological and drug tests. Sweat gland activity’s disruption manifests itself in pathologies such as diabetes mellitus, chronic heart failure, hyperhidrosis, thyrotoxicosis, and Parkinson’s disease. Thus, the search for a method for quantifying the sweat glands activity on the surface of a human body based on physical methods is relevant for biomedical diagnosis. Materials and Methods: The primary thermographic data were recorded using a ThermaCam SC 3000 thermal imaging camera, FLIR Systems (Sweden) with a 34/100 macro lens, in the spectral range of 8–9 μm with a temperature sensitivity of 0.02°C and a resolution of 320  240 pixels with a frequency 5 frames per second. The measurements were performed in laboratory conditions with a stable ambient temperature of 23 ± 0.2°C and the absence of forced convection. Simultaneously with temperature measurements, the volumetric blood flow was monitored using a KL-72001 photoplethysmographic sensor (Taiwan) at a wavelength of 800 nm. Results: The both hands reaction to a breathing test was observed. The dynamics of changes in the active sweat pore count, temperature and blood flow was analyzed. Using an algorithm for processing thermograms that implements the suppression of low-frequency and high-frequency spatial components of temperature fluctuations, and the subsequent detection of local minima, makes it possible using the infrared thermography method to study not only the temperature dynamics, but also the sweat glands activity. Conclusion: Thus, the thermographic recording of the limb’s reaction to a respiratory test using the algorithm for detecting the sweat pore count can be positioned as a tool for studying the body’s sympathetic response to a functional load. The method is interest for the prophylactic detection of small vessel’s neuropathy’s various forms in diabetes mellitus, thyroid disorders and Raynaud’s syndrome.

Chronic inflammatory demyelinating polyneuropathy (CIDP) in patients with diabetes mellitus (DM) occurs approximately 9—11 times more frequently than in the general population.Objective: to assess the characteristics of CIDP in the presence of DM.Patients and methods. A total of 109 patients with CIDP diagnosed according to the international EFNS/PNS criteria were examined. Seventeen patients had type 1 or 2 DM; the remaining 92 patients did not.Results and discussion. The patients with CIDP and DM were found to have significantly more obvious neurological deficit, lower levels of selfservice, and a shorter time to diagnose CIDP than those with CIDP without DM.The concurrence of CIDP and DM is ambiguously assessed. On the one hand, there are indications of a strict correlation between these conditions, and on the other, the absence of this association. Our study showed that more obvious neurological deficit in DM can be related to the additional damaging impact of chronic hyperglycemia as impaired metabolism of nerve fibers and deterioration of their trophism. The autoimmune nerve damage occurring in CIDP is superimposed on the already existing impairments in the microcirculation and dysfunction of peripheral nerves, thereby increasing their damage.Conclusion. The course of CIDP in the presence of DM differs from that of «pure» CIDP, which should be taken into account in managing these patients.

Purpose: to determine the effectiveness of the developed program for the restoration of upper limb function in traumatic and compression-ischemic injuries of the peripheral nerves. Material & Methods: the study involved 173 patients who were divided into 2 main rehabilitation groups: group I – patients with acute traumatic damage to the peripheral nerve or plexus (132 people), group II – patients with compression-ischemic (tunnel) neuropathies and plexopathies (41 people). The study was conducted on the basis of the Institute of Neurosurgery acad. A. P. Romodanova of the National Academy of Medical Sciences of Ukraine” (2015–2018) and on the basis of neurological departments No. 1 and No. 2 of the Kiev City Clinical Hospital No. 4 (2017–2019). To assess impaired motor function of the nerve and sensitivity, a 6-point scale was used according to the method of R. B. Zachary, W. Holmes, N. Millesi. The Boston Questionnaire (Boston Carpal Tunnel Questionnaire) was used to assess the severity of symptoms, activity, and participation in daily life. Results: during the initial examination, we found that in the majority of patients of the 1st rehabilitation group, motor disorders on a 6-point scale were at the level of M1-M2 in 27,3% and 31,8% of individuals, respectively, and M3 in 15,9% of patients. In patients of the rehabilitation group II, the indicators of motor disorders were not so pronounced: patients with impaired motor function at the level of M2-M3 prevailed (34,1% and 24,4% of patients, respectively). According to the scale of functional disorders of the Boston questionnaire, the patients with the studied groups experienced the greatest difficulties when bathing and putting on clothes – 17,4%, doing homework – 13,6% of people, fastening buttons on clothes – 15,2%. In patients of the rehabilitation group II, approximately the same results were observed. In the main group, we used the program of rehabilitation measures that we developed, in the comparison group, the program that is used in the hospital for this category of patients. The therapy lasted 3 months. Upon repeated examination in patients of the main І rehabilitation group, motor disorders decreased under the influence of physical therapy, which were used in them. In the main group, a greater number of patients (12,3%) showed normal strength in the affected limb (M5), in the control group this indicator was lower (7,5%). Movements with overcoming the weight of the limb (M3) and movements with overcoming the resistance (M4) were observed in 24,6% and 30,8% of patients in the main group, which significantly exceeds similar indicators of the control group. Conclusions: as shown by the results of studies, physical therapy and occupational therapy in the complex treatment of people with traumatic and compression-ischemic neuropathies of the upper limb contributed to a more intensive restoration of arm functions and increased results of motor therapy. The following rehabilitation measures are most effective for this category of patients: kinesiotherapy, taping, massage, physiotherapy, mechanotherapy and hydrotherapy.

Purpose: to develop an algorithm of rehabilitation measures in people with compression-ischemic neuropathies of the upper limb. Material & Methods: the study involved 67 patients with compression-ischemic neuropathy of the upper limb, among whom were 43 (64.2%) men and 24 (35.8%) women. The duration of the disease ranged from 3 to 18 months. The age of the examined varied from 18 to 67 years, on average 42,3±9,4 years. The study was conducted on the basis of the neurological department and the physiotherapy department of the Kiev city clinical hospital No. 4 of Kyiv in the period from 2017 to 2019. We used the following research methods: analysis and synthesis of literature data, content analysis of medical records, rehabilitation examination. Results: an important condition for the treatment of tunnel neuropathies is an integrated approach, which should have the following components: a comprehensive rehabilitation examination to determine the main rehabilitation problems; statement of tasks with prediction of the final result; selection of appropriate individual and optimal physical therapy means for each patient. An algorithm of physiotherapeutic intervention has been developed, including the use of the following measures: kinesitherapy with neurodynamic mobilization, taping, stimulating massage, instrumental physiotherapy, mechanotherapy and hydrotherapy. The proposed algorithm of physical therapy measures differed from standard programs in that it allowed to formulate the goals of the rehabilitation process taking into account a differentiated approach to solving the problem of rehabilitation of patients with compression-ischemic neuropathies of the upper limb with varying severity of motor function disorders; had a comprehensive, multidisciplinary approach to solving the problems of patients with this pathology. Conclusions: the development of an algorithm of physiotherapeutic intervention for people with compression-ischemic neuropathies of the upper limb is an urgent problem due to the fact that compression-ischemic neuropathies of the upper limb often lead to a decrease in the patient's quality of life and long-term disability. When developing an algorithm of rehabilitation measures, it is necessary to take into account: individual features of the functional state of patients with this pathology, the presence and severity of motor and sensory disturbances, which depend on which particular nerve of the arm is affected (median, ulnar or radiation), the nature of the lesion, age, professional activity and patient needs.

Cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS) is a slowly progressive ataxic disorder characterized by the triad of cerebellar impairment, bilateral vestibular hypofunction, and sensory polyneuropathy. The paper describes a clinical case of this syndrome in a 40-year-old patient who has been followed up by hematologists for polycythemia vera for 10 years.

Mutations in the LMNA gene cause developing of several phenotypes, both with isolated involvement of cardiac, muscle, adipose and bone tissues, and with their combination. The dominance of cardiovascular signs in the clinical performance and false clarity in nosology definition can cause underestimation of subclinical markers of other systems partaking. It leads to an incorrect interpretation of the true disease etiology, failure in genetic diagnostics, and untimely determination of the correct management and prognosis. The article presents clinical cases that demonstrate both the most typical manifestations of laminopathy and rare combinations of symptoms, which represent a certain diagnostic difficulty.

Purpose: to assess the quality of life of people with traumatic injuries of the peripheral nerves of the upper limb during surgical treatment. Material & Methods: analysis of scientific and methodological literature; questionnaires, methods of mathematical and statistical data processing. To assess the quality of life, we used the “Brief Health Status Assessment Questionnaire” (MOS SF-36) and “Methodology for assessing the quality of life of a patient” by D. M. Aronov, 2002. SF-36 consists of 36 questions grouped into 8 scales: physical functioning, role-playing activities, bodily pain, general health, vital functions, social functioning, emotional state and mental health. The methodology for assessing the quality of life of a patient according to D. M. Aronov (2002) consists of 17 questions. The technique allows you to evaluate how much the patient considers his life to be full and with what he associates changes in the quality of life. The study was conducted on the basis of SI "Institute of Neurosurgery named after acad. A. P. Romodanova, National Academy of Medical Sciences of Ukraine", Department of Reconstructive Neurosurgery. The examination involved 27 patients with traumatic injuries of the peripheral nerves of the upper limb. All patients underwent surgical treatment. Results: an assessment was made of the physical and psychological health of individuals with traumatic neuropathies of the upper limb according to SF-36. It was revealed that patients with this pathology by the physical health component scored an average of 28 to 71 points. The mental health indicators of these patients did not differ significantly from physical health (30–67 points). In general, among patients, an average level of quality of life was observed – in 74.1% of cases. A low level of quality of life was found in 4 patients (14.8%), a high level in 3 (11.1%). After assessing the quality of life of patients with traumatic neuropathies of the upper limb using the “Methods for assessing the quality of life of a patient” by D. M. Aronov (2002), we found the following: the main reason for the decline in the quality of life of 88.9% of patients was the need to perform surgery on the affected upper limbs, prolonged treatment and the need for rehabilitation courses. Conclusions: a decrease in the quality of life in patients with traumatic neuropathies of the upper limb is due to the need to be treated, a decrease in activity in everyday life, restrictions on leisure and work, a change in the attitude of friends, friends and colleagues, and a decrease in wages.

BACKGROUND: Diabetes is very widespread disease. More and more patients suffer from hyperglycaemia and low levels of insulin because of obesity, aging and wrong diet. The most important in treatment based on health condition is to normalize glucose level. It is recommended to treat patients to avoid many complications of hyperglycaemia, e.g. cardiovascular diseases, stroke episodes, neuropathy or nephropathy. The most common cause of death are cardiovascular problems and renal failure. MATERIAL AND METHODS: A proper review of published literature provide to define laboratory indexes, risk factors, complications to precise methods of treatment among patients with diabetes. RESULTS: The problem of growing number of people suffering from diabetes is an important issue to find solutions to conduct their treatment. Basic method is a change of diet and body loss. The most important medicament in treatment is metformin. To achieve the best results of conducting therapy should be extended by pioglitazone or liraglutide. Also addition of aspirin lower dyslipidemia problems. Such a combination provides to minimise side effects of sickness. CONCLUSIONS: Number of people suffering from DM is still and will be growing over the next years. It is significant to diagnose these people because untreated diabetes provides to many complications e.g. stroke or acute coronary syndrome. It is important to examine patients correctly what allows to turn on correct treatment. Basic standards in treatment should contain lower glucose levels, avoid complications to enhance life quality. . Expanded therapy is also concentrated on hypertension, acidosis and ketoacidosis coma to obtain beneficial effects.

Aim. The present article assesses the state of the central part of the auditory analyser in children with type 1 diabetes.Materials and methods. The study included 71 children with type 1 diabetes mellitus who were treated at the Endocrinology Department of the Children’s Territorial Clinical Hospital from September 2017 to February 2018. The children’s age ranged from 7 to 15 years (8±2.6). Group A comprised 34 children who were fi rst diagnosed with type 1 diabetes, with the duration of clinical manifestations not exceeding 3 months; whereas group B included 37 children who had been suffering from type 1 diabetes for 1–5 years. The control group was represented by 30 children of the same age group without a somatic pathology (group K). The functional state of the central part of the auditory analyser was assessed when studying brainstem evoked potentials of short, middle and long latency.Results. In the course of studying short-latency brainstem evoked potentials at a broadband-click stimulus frequency of 10 Hz and an intensity of 70 dB, the latent periods of peaks and peak-topeak intervals were analysed in groups A, B and K. Statistically signifi cant differences were observed for I and V latent periods of peaks, as well as for the I–V inter-peak interval. At a click stimulus intensity of 70 dB, peaks and peak-to-peak intervals of middle-latency brainstem evoked potentials revealed differences in the values of NO, PO, Na, Pa and NO–PO between the groups of patients with type 1 diabetes and the control group. Greater statistical differences, as compared to the control group, were observed in the latent periods of long-latency brainstem evoked potentials for interval P1 in group A and intervals P2 and N2 in group B (unfavourable course) during 100 dB stimulation at a repetition frequency of 1 Hz in a time window of 50 ms. The presence of differences between groups A and B in the parameters of peak P2 (p ≤ 0.07), as well as peak intervals P2–N2, N1–N2, N1–P1, N2–P2 and N1–P2, may indicate signifi cant differences in the centres of the auditory analyser (p ≤ 0.1). At the same time, the maximum activity of the studied parameters was found in the group of patients with newly diagnosed type 1 diabetes.Conclusions. The study of different types of brainstem evoked potentials, characterising the central parts of the auditory analyser, in children with type 1 diabetes allowed the authors to register functional disorders both in the brainstem segment and in the cortical structures. This fact indirectly indicates initial manifestations of diabetic neuropathy in the studied category of patients and can be used in the future for diagnosing CNS disorders.

Carpal tunnel syndrome is the most common form of compression-ischemic neuropathy, found in clinical practice. Purpose: to evaluate functional disorders of the upper limb in individuals with carpal tunnel syndrome using the Boston questionnaire (Boston Carpal Tunnel Questionnaire, BCTQ). Material & Methods: analysis and synthesis of data from scientific and methodological literature and the Internet information network were used; survey, medical history, mathematical methods. To assess the functional state of the affected upper limb during the initial examination, we used the Boston Carpal Tunnel Questionnaire (BCTQ), which consists of two scales: the Symptom Severity Scale (SSS) and the Function Status Scale (FSS), which was filled by the patient on his own. The study was conducted on the basis of the Kiev City Clinical Hospital No. 4 in the period from 2017 to 2018. The study involved 37 patients with CTS, of which 21 – women (56,8%) people, 16 – men (43,2%) people. Results: analyzed pain and sensory disorders on the scale of symptom severity (Symptom Severity Scale, SSS) and functional disorders on the scale (Function Status Scale, FSS) of the Boston questionnaire. During the initial examination of patients with CTS, we found that mainly moderate (24,3%) and severe pain (37,8%) in the affected upper limb prevailed in patients, which over the past 2 weeks led patients to wake up at night: 1 time – 32,4% of patients, 2–3 times – 29,7% of people. During the day, 29,7% of patients complained of moderate pain in the arm and 43,3% of people were worried about severe pain. Most patients (48,7%) indicated that pain lasts from 10 minutes to 60 minutes. For functional disorders, the greatest difficulties for patients occurred when fastening buttons on clothes – 83,8%, opening a bottle – 86,5% and doing homework – 79,9% of people. Conclusion: an initial examination of patients with carpal tunnel syndrome indicated pain in the affected limb, numbness, decreased sensitivity, muscle weakness on the severity scale of the symptoms of the Boston questionnaire were observed. On the scale of functional impairment, we found difficulties that arose in patients performing everyday activities and self-care.

Background: Diabetes mellitus (DM) has a negative impact on all organs. This is due to insufficiency of blood supply and the disruption of the trophic function of the nervous system. One of the most serious complication of DM is diabetic foot caused be vascular and neurological reasons. Correction of vascular disorders is effectively treated by modern therapeutic approaches, but the damage of nervous system has been studied insufficiently. Aims: To investigate the dynamics of damage to the vegetative nervous system on the laboratory model of DM. Materials and methods: DM in rats was induced by injection of streptozotocin at a dose of 65 mg/kg in citrate buffer (DM group). The control group of rats received a citrate buffer equivalent (CB group). Rats with DM were given a maintenance therapy with insulin in a dose of 2 units/kg/day. On 42 days of experience, a round wound with a diameter of 2 cm on the back of the animals was observed. Before the DM simulation, then on the 42, 50, 58 and 66 days of its development, an electrocardiogram (ECG) was recorded in the rats at a frequency of 2 kHz digitising in a state of calm wakefulness and after cold exposure. For 5 minutes ECG fragments, heart rate and heart rate variability (HRV) in the temporal domain were calculated, characterising: 1) the total heart rate variability (tHRV) according to SDRR, SDHR, KVRR and KVHR; 2) the effect of the parasympathetic department of the autonomic nervous system (aANS) for RMSSD and pNN3; 3) the contribution of the sympathetic department of the ANS (sANS) by SDAvgRR, SDAvgHR. The spectral parameters were estimated in the frequency domain: the total power of the spectrum is TR (range: 0–2.5 Hz), the powers in the low and high frequency ranges are LF (range: 0.2–0.8 Hz) and HF (range: 0.8–2.5 Hz) LF/HF. Weekly, the tail withdrawal time was measured in a temperature pain test (55°C). Results: During the development of diabetes, the level of glucose in the blood increased 4–7 times compared with the normal level. The reaction time of the pain test in rats with DM increased by 20%–30% at the end of the experiment. At 42 days, the development of bradycardia (267 beats/min) was observed in rats with DM. The indicators of tHRV decreased by a factor of 2 due to a decrease in the contribution of sANS. The reaction to CP in the SD group differs from the norm by the severity of the individual components of the HRV structure, which indicates functional denervation of the heart and the development of diabetic neuropathy. Conclusions: As the diabetes progressed, signs of neuropathy were observed. The overall HRV parameters decreased, the ratio of the contributions of sANS and pANS to the regulation of heart rate changed, and the temperature sensitivity decreased.

A critical analysis of the concept of child neuropathy syndrome is submitted, and also described the difficulties of its diagnosis in the initial stages of formation. The existing approaches to understand this disorder are analyzed. Today neuropathy in child psychiatry is most often interpreted as one of of abnormal development forms - as dysontogenesis of the nervous system, characterized by increased excitability combined with increased exhaustion. Diagnostic difficulties are caused by the fact that there is no common opinion at the understanding of neuropathy, its criteria and dynamics. Moreover, clinical-psychopathological differences, associated with the peculiarities of etiopathogenesis require clarification. Its relationship with such evolutionary dynamic factor as ontogenetic is not sufficiently clear.

Diabetic polyneuropathy (DP) occupies the third place among the most common neurological disorders, affecting a significant portion of diabetes patients, and is characterized by progressive lesions of nervous fibers. While normalizing carbohydrate metabolism is crucial for treating DP, metabolic compounds that integrate into nervous tissue metabolism have received considerable attention. Despite their therapeutic attractiveness and significant spread in clinical practice, the amount of data pertaining to pharmacoeconomic properties of these compounds remains limited. Given significance of this problem and due to availability of new clinical data on comparative effectiveness of two of such drugs, a research effort was undertaken to evaluate the pharmacoeconomic properties of Cocarnit combination drug compared to Milgamma drug, as well as with components of Cocarnit purchased separately. Aim. To evaluate comparative pharmacoeconomic performance of therapy using Cocarnit combination drug, Milgamma, and Cocarnit components purchased and administered separately in the context of Russian healthcare. Methodology. Current analysis was performed from perspective of Russian state healthcare system within context of mandatory medial insurance system. Modelling horizon was 3 years. Randomized clinical trial directly comparing the safety and efficacy of investigated drugs (Cocarnit and Milgamma) as well as long-term randomized clinical trials of other metabolic drugs for treatment of diabetic neuropath and general dynamic of diabetic neuropathy response to metabolic treatment were used as data sources for this PHe. The number of patients in each simulated group was 1000 people. A Markov model was constructed to assess the costs and utility effects of treating diabetic neuropathy with comparator compounds, with simulated treatment protocols being based on existing Russian standards of diabetic neuropathy treatment. The model accounted for existing data regarding long-term outcomes and recurrence rates of diabetic neuropathy undergoing metabolic treatment. Model did not account for mortality resulting from diabetes proper and treatment costs associated with addressing the underlying primary condition (Type I and Type II diabetes). The cycle length was 1 week. QALY improvements were used as surrogate endpoints, since the existing clinical trial data indicates that the only significant difference between the drugs being compared is their quality of life effects. Since clinical trial data contained only SF-36 quality of life data, a widely used mapping algorithm found in peer-reviewed literature was utilized to convert from SF-36 to EQ-5D in order to properly evaluate QALY differences. Upon completion of modelling, the following types of analysis were performed: cost minimization analysis (CMA) for “Cocarnit/Cocarnit components purchased separately” comparator pair (CMA was used here since utility, efficacy and safety values for this case will be strictly equal), budget impact analysis (BIA) for “Cocarnit / Cocarnit components purchased separately” comparator pair, Cost-utility analysis for “Cocarnit / Milgamma” pair. Sensitivity analysis was used to verify the robustness of the results. Discounting was performed at rate of 5%. Results. Cocarnit has demonstrated promising results, showing superiority over separately purchased and administered components in CMA (with CMA factor of -2 752 082 rubles) and budget impact analysis, which indicated that use of Cocarnit instead of separate metabolite components would result in reduction of budget burden totaling 1 458 603 per 100 000 of Russian Federation population (accounting for prevalence of diabetic neuropathy) within 3 years. During cost-utility analysis it was found that Cocarnit is superior to Milgamma demonstrating greater overall quality of life and a CUR of 552,34 rubles (while Milgamma has a less favorable CUR of 555,41 rubles) per patient. It also had ICUR of 208,88 rubles per patient, indicating a low cost per one QALY gained and high pharmacoeconomic expediency within context of pharmacoeconomic expediency analysis. Sensitivity analysis has shown that results remain robust to price increases up to 25%. Conclusion. These results demonstrate that Cocarnit has favorable pharmacoeconomic characteristics and indicates high expediency of using it in Russian healthcare system, and allows us to recommend further research into clinical and pharmacoeconomic properties of this drug.

For decades taxanes are used as a part of classical schemes for treatment of malignant tumors of various localizations including breast cancer. Peripheral neuropathy is an adverse reaction which impairs both quality of patients’ lives and treatment efficiency. To prevent or reduce the impact of peripheral neuropathy factors contributing to its development and mechanisms that are involved need to be known. This article is a review of the current status of our understanding about the mechanisms underlying the development of taxanes induced peripheral neuropathy.

Objective: to determine the incidence of complications after treatment of shaft fractures according to the inter-regional Specialized Traumatological Medical and Social Expert Commission in Kharkiv and Kharkiv region. Methods: we studied the incidence of nonunions, osteomyelitis, radial nerve neuropathy in 773 patients with shaft fracture of the extremities, who underwent primary examination at the MSEC for the period 01.01.2016-31.12.2018. Among them, 96% were patients of preretirement age. There were 461 patients with tibia fractures, forearm -- 49, femur -- 173, humerus -- 90. The frequency of nonunion in subgroups is analyzed depending on the method of fragments fixation. Results: after bone fragments osteosynthesis at isolated tibia fractures nonunion was found in 11.9% of cases, at intramedullary blocking nail -- 16.0%, external rod fixators -- 3.0%, Ilizarov fixator -- 18.4%, plaster cast bracing -- 7.6%. After treatment of femur fracture with plate osteosynthesis, nonunion was found in 9.4%, after intramedullary nailing -- in 12.8%. At humerus fractures and forearm fractures which were treated with plate osteosynthesis, nonunion was recorded in 19.0 and 28.6% of patients respectively, and radial nerve neuropathy - was observed in 25.0 and 26.4%. The incidence of osteomyelitis at internal osteosynthesis was 2.9- 7.7%.Conclusions: osteosynthesis was used in 36.6% of cases of tibia shaft fractures and was the most common used method of fragments fixation in isolated shaft fractures: 64.9% -- femur; 75.6% -- humerus; 100.0% -- forearm bone fragments. The second most frequent method of fixation was intramedullary nailing osteosynthesis. The main complication of treatment was fragments nonunion, and in the case of plate osteosynthesis at humerus and forearm fractures was radial nerve neuropathy. [ABSTRACT FROM AUTHOR]

Total joint replacement (TJR) in the presence of severe joint degradation and arthralgias in patients with rheumatic diseases (RDs) is one of the effective ways to improve the functional status of patients and their quality of life. In recent years, there has been an increase in the number of such knee and hip replacements worldwide. Despite advances in medicine in the 21st century, up to 5% of TJRs culminate in early complications, in which there are irreversible joint changes that cause joint functional loss and persistent pain and, in 2–3% of cases, require early re-revision surgery.Subjects and methods. The investigation included 2142 patients with rheumatoid arthritis (RA) and osteoarthritis (OA) who underwent knee or hip joint replacement (KJR or HJR) at the V.A. Nasonova Research Institute of Rheumatology during the period 1998 to 2016: HJR in 1177 patients and KJR in 965. The patients with RA had 467 HJRs and 651 KJRs (a total of 1118 operations). A comparison group consisted of patients with OA who underwent710 HJRs and 314 KJRs (a total of 1024 operations). Postoperative surgical complications, such as superficial or deep suppuration, joint dislocation, periprosthetic fractures, sciatic and/or peroneal neuropathies, aseptic instability of endoprosthesis components, and complications of wound and ligamentous apparatus, were considered within 2 years after surgeryResults and discussion. Overall, the frequency of local complications after HJR and KJR was comparable and amounted to 7.22 and 7.25%, respectively (p=0.83), but their pattern greatly differed: there were a larger number of periprosthetic fractures after HJR than after KJR (3.48% and 0.93%; p

Objective: diagnostics of erectile disorders within men with diabetic autonomic neuropathy and detection of rehabilitation methods of patients with erectile dysfunction (ED) affected diabetes mellitus (DM).Materials and methods. Thirty patients with DM were examined (15 patients with type 1 and 15 patients with type 2 respectively). Patients with DM had ED mainly of severe form (IIEF-5 from 6 to 16 points). According to the results of conducted examination the patients were prescribed the course of conservative therapy including hosphodiesterase in hibitors of type V, anticholinesterase drugs, drugs of thioctic acid. Conservative therapy was combined with shock wave therapy in the area of the penis. The group for comparison consisted of 15 healthy men (volunteers) without signs of ED (IIEF-5 21–22 points). Immune-enzyme analysis was used for detection of sex hormone status. Ultrasound, dopplerographic and X-ray methods were used for conduction of angiography of pool vessels of internal pudendal artery (IPA). Electroneuromyography of penis nerves was conducted.Results. According to the conducted research patients with DM were diagnosed with cavernous fibrosis, angiosclerosis of IPA and penis vessels in 100 % cases. Axonopathy of motor and sensory nerves of penis was detected in 100 % cases, stenosis and occlusion changes in IPA were detected in 42.9 % cases causing disorder and insufficiency in arterial perfusion in IPA pool.Conclusion. Denervation changes in sensory and motor nerves of penis and hemodynamicly significant perfusion disorders in IPA pool were principal pathogenetic factors of ED within the patients with DM. Decrease of reaction of IPA to the pharmacological stimulation was noted within patients with DM, which was caused by the angiosclerosis and loss of arterial wall elasticity. There was noted inefficiency of conservative therapy within patients with DM and ED at severe stage.

The information about epidemiology and clinical polymorphism of neuropathies is summarized on the base of Russian and foreign literature. The algorithm of clinical observation in patients with polyneuropathy is presented.

On the basis of treatment results of 28 patients, the authors suggested that the clinical method of diagnostics allowed performance of topical diagnostics of injury using bedside test. It would help to choose a therapeutic approach in each clinical case.

Aims. The aim of the present study was to investigate the role of chronic low-grade inflammation in the development of the diabetic neuropathy and the possibility of its medical treatment with fenofibrate (145 mg/day). Materials and Methods. This trial included 60 patients with type 2 diabetes mellitus. The serum levels of several factors were measured: tumour necrosis factor-? (TNF-?), interleukin-1? (IL-1?), interleukin-6 (IL-6), C-reactive protein (CRP), markers of oxidative stress (malondialdehyde levels), haemostasis, uric acid, glycaemic and lipid profile and the peripheral status (electromyography, total symptom score [TSS] and neuropathy impairment score in the lower limbs [NIS-LL]). Follow-up was at 24 weeks. Results. A significant negative correlation was found between the excitation rate of the sural nerve and levels of TNF, IL-6 and CRP (p

Objective: to study the causes and clinical manifestations of disease in children referred for hospitalization in children infectious diseases hospital in Saratov with a diagnosis of «acute flaccid paralysis». Material and methods: 157 children with the diagnosis on admission of the guide «acute flaccid paralysis». Conducted clinical examination and laboratory tests included a general analysis of cerebrospinal fluid, urine, virological examination of nasal swabs and faeces, with the definition of a serological ELISA method and RPHA immunoglobulins to influenza, rubella, and enterovirus, immunological study of blood, cerebrospinal fluid PCR, electromyography of the affected limbs. Results. 77 patients (49%) with the disease associated with the violation of the musculoskeletal system were registered. In the other cases revealed polyneuropathy was not of poliovirus etiology. Etiological nature of the disease could be explained by 54% of patients. In 37 (46%) patients the diagnosis was formulated in accordance with the severity of paralysis. One child was diagnosed with a vaccine-associated poliomyelitis. Conclusion. The diagnosis of «acute flaccid paralysis» used as administered requires a detailed interpretation in a hospital.

The literary data analysis, permitting to characterize the mechanisms of the damage and morphological changes in nervous system in case of electrical trauma, is presented. A role of electrical current injury in a development of neurological pathology is regarded in detail

A cadaveric kidney transplantation (KT) combined with distal venous splenorenal anastomosis is suggested as the surgical method for type 1 diabetes treatment (Shraer T.I.). This kind of operation was performed in 3 patients with the late stage of diabetic nephropathy (plasma creatinine 0,35–0,49 mmol/l). The results of our analysis showed positive influence of the above mentioned surgical treatment, reflect on the diabetes nephropathy, neuropathy and angiopathy.

Results of numerous studies give definitive evidence that phenofibrate affects activity of PPAR-a receptors in liver and thereby decreases the level oflipids responsible for the development of atherosclerosis (VLDL, small dense LDL); simultaneously, it increases the level of anti-atherogenic HDL.Activation of PPAR-a receptors in vascular cells decreases activity of inflammation markers, such as C-reactive protein, TNF-a, IL-6, fibrinogen,etc. These effects of phenofibrate eventually lead to reduced risk of macro- and microvascular diabetic complications.

AIMS: To elucidate the prevalence of delayed gastroduodenal transit in patients with type 1 diabetes mellitus (DM1) compared with controls havingunaffected carbohydrate metabolism. MATERIALS AND METHODS: The study included 159 DM1 patients and 128 ones with symptoms of dyspepsia and normal carbohydrate metabolism. The presenceof food remains in the stomach after the 12-hour fast (detected by oesophagogastroduodenoscopy) was regarded as a delay of gastroduodenal transit. RESULTS: In a group of DM1 patients, 13.70% of the cases had endoscopically confirmed delay of food evacuation from the stomach. No signs of gastroparesiswere documented in the control group. CONCLUSIONS: Certain patients with DM1 suffer a marked impairment of gastroduodenal transit (13.7% of the cases in the present study). This disorderaffects the time of onset of carbohydrate absorption. Therefore, such patients need their mealtimes to be chosen on an individual basis.

In recent decades, a promising area of physiotherapy has been intensively developed In Russia and abroad - magnetic therapy, based on the use of various types of magnetic fields for preventive, curative and rehabilitative purposes. The use of high-intensity pulsed magnetotherapy is promising. The effectiveness of the method in a number of diseases of childhood, which has an active stimulating effect on the state of the neuromuscular apparatus, has been proven.

The purpose of work was to determine the mechanisms of pathologic morphogenesis of the toxic neuropathy caused by etoposide taking into consideration all complex the neuro-vascular-desmal relationship disturbances in peripheral nerves, their motor and sensor segmental centers. It has been shown in the experiments on 86 white rats that single intravenous injection of etoposide at dose of 22 mg/kg body weight induse peripheral neuropathy. The complex of morphologic methods included the neurohistological and electronic microscopic methods of the research, the histochemical markers for study transmissivity of the vessels of the circulatory bed on the light microscopic and ultrastructural levels was used. The recommendations of the Interagency Committee of Neurotoxicology were considered to choose the methods of the research. The presence of 3 stages of morphogenesis has been established - phase of primary axonal reaction (3d day of experiment), phase of disturbance of the microcirculation of peripheral nerves and their segmental centers (7th day of experiment), phase of degenerative changes (15th day). Etoposide-indused neuropathy features are determined by a singularity of interdependent reactive changes, alteration and compensation processes in sensory and motor neurons, glial cells, microcirculatory bed and connective tissue.