Metabolic drugs in cardiological practice. What is metabolic therapy? Metabolic therapy in gynecology
Metabolic therapy is a method of correcting metabolism for the improvement, rehabilitation and treatment of people. It is now known that any tissue of the body has the ability to regulate metabolism by autocrine, paracrine or endocrine mechanisms. Depending on the source of regulatory molecules, three options for metabolic therapy can be divided: autogenous, allogeneic and xenogeneic.
To achieve the goals of metabolic therapy, various factors and medical technologies are used. Let's look at some metabolic therapy options.
Metabolic therapy through the influence of biophysical factors on the body. When exposed to various physical factors (heat, cold, vibration, massage, ultrasound, electromagnetic vibrations, hypoxia, etc.), the homeostasis of metabolites in the body tissues is temporarily disrupted. This initiates the inclusion of nonspecific (stress-related) and specific (neurohumoral and metabolic) reactions, which serve to return the parameters of the internal space of the body to their original state. Such endogenous reactions, triggered by exogenous physical factors, often return metabolic parameters to the optimal range for a given age. They are used to treat many diseases. The physiotherapist must select the strength of the physiotherapeutic effect on the body so that optimal reactions develop that ensure treatment of the disease. For group metabolic therapy, hypobaric oxygen therapy is used. In the Republic of Belarus there are pressure chambers in which many diseases are treated by keeping patients under conditions of low atmospheric pressure (high-altitude model). In Vitebsk there is a pressure chamber with 20 seats. Good results have been obtained in treating patients with bronchial asthma, hypertension, diabetes mellitus, etc. After treatment in a pressure chamber, the nonspecific resistance of the patient’s body increases. This medical technology improves the performance and resilience of people in extreme situations. It is advisable to support the treatment of patients in a pressure chamber with biologically active food additives. Of interest to xenobiology are climatic pressure chambers (including mobile ones), in which, with the help of chemicals, a modified atmosphere is created that is useful for the treatment of diseases of the lungs and other organs. This is a method of targeted introduction of xenobiotics into the body through the lungs.
Therapy with exogenous low molecular weight bioregulators and macromolecules. All medicines are divided into natural (biogenic) and foreign (xenobiotics). Natural drugs are natural products of living organisms and they are able to be included in cellular metabolism (amino acids, hexoses, fatty acids, vitamins, hormones, blood and tissue preparations, etc.). These substances are characterized by biocompatibility and are used to achieve metabolic therapy goals. Xenobiotics are normally absent from the human body or are found in trace amounts. These drugs are obtained through the process of organic synthesis or they can be extracted from other organisms (microorganisms, plants, etc.). These substances are the object of study in pharmacology. The boundary between biogenic drugs and xenobiotics is arbitrary, since their final effects are realized at the metabolic level using the same molecular mechanisms. Currently, more than 30 groups of biologically active substances of plant origin are known: α- and γ-benzopyrene derivatives, lignans, quinones, iridoids, plant indoles, polysulfates, isothiocyanates, terpenoids, carotenoids, dolechols, stilbenes, phytosterols, lectins, low-molecular peptides, etc. For example, based on the analysis of the content of low molecular weight nitrogen-containing substances in the extracts of the Sasola collina Pall herb, their following use is justified:
· to stimulate reduced protein metabolism through the additional introduction of a full set of amino acids, including 8 essential amino acids;
· to maintain metabolism in nervous tissue, muscles and kidneys due to the additional production of amino acids with branched radicals (valine, leucine, isoleucine);
· to stimulate urea formation in the liver and the formation of conjugates of metabolites and xenobiotics as components of the antitoxic function of the liver (aspartate, citrulline, ornithine, taurine);
· to maintain insulin biosynthesis and the manifestation of insulin-like effects.
Among the large number of low-molecular bioregulators of animal origin, a special place is occupied by peptide bioregulators: endogenous “cytomedins”, which control gene expression and protein synthesis, “cytamins” - nucleoprotein complexes, as well as “cytogens” - preparations from various tissues that are capable of specific action in different tissues. regulate protein metabolism.
Now about 40 percent of the drugs included in the State Pharmacopoeia of the Republic of Belarus are of plant origin. Medicines from plants make up over 30 percent of all medicines produced in the world. In recent years, the interest of scientists in medicinal plants has increased markedly. Their attention is focused on such seemingly long-known plants as valerian, dried grass, viburnum, hawthorn and many others. And the whole point is that modern equipment and new research methods make it possible to rethink the place of a particular plant among other medicinal products, and to study the biologically active substances that make up medicinal plants at a higher level. New prospects are also opening up for the development of more advanced technology for the production of already known drugs, as well as for the creation of new highly effective drugs.
The effectiveness of herbal preparations is largely explained by the fact that the biologically active compounds they contain have a complex effect on the human body, causing a certain therapeutic effect. Biologically active substances are formed during the life of plants and animals and effectively affect metabolic processes in the cells of the body, have a strong antiseptic, anti-inflammatory, antimicrobial, soothing, astringent, tonic, softening effect.
Medicinal plants have another advantage: they are a natural source of a number of vital microelements - manganese, copper, cobalt, molybdenum, zinc, iron. With homeopathic medicines and biologically active food supplements, the body receives the microelements it needs. Their deficiency leads to serious diseases.
Homeopathic medicines and dietary supplements are especially often prescribed for the following diseases:
· for diseases of the musculoskeletal system and muscular system;
· for diseases of the respiratory system;
· for diseases of the digestive tract;
· for pain;
· for diseases of the central nervous system.
An important law of homeopathy is the law that states that an increased dose of a medicinal substance suppresses the system, a moderate dose can paralyze it, and a small (homeopathic) dose has a stimulating effect.
The cause of exacerbation of a number of diseases, such as bronchial asthma, asthmatic bronchitis, may be the excessive use of antibiotics, drug therapy, chemicals in everyday life, gas pollution and air pollution from industrial enterprises, which causes real outbreaks and epidemics of allergic diseases. This is why homeopathic remedies are now acquiring particular value, since they allow the doctor to prescribe antibiotics only in the most extreme cases. When prescribing homeopathic remedies, the patient’s age and duration of the disease, developmental characteristics, constitution and heredity, characteristics of reactions to environmental factors, as well as tolerance of drugs and other influences, previous and concomitant diseases, causes of the development of the disease and its exacerbation, clinical features, are taken into account. the presence of allergies, previous treatment and other factors.
The raw materials for homeopathic medicines are: minerals (30%), animal materials (10%) and plant materials (60%), from which about a thousand homeopathic medicines are prepared. Medicines are prepared in the form of drops, powders, grains, ointments. It should be noted that some homeopathic medicines are prepared, as in herbal medicine, from plant materials. Herbal treatment is the effect on the body of plant molecular agents, which is toxic, and in this sense, undoubtedly, inferior to homeopathic treatment.
The minerals that make up homeopathic preparations are actively involved in the regulation of many physiological functions, which include, in particular, the transport of oxygen to every cell of the body, the production of discharges leading to muscle contraction, and a variety of actions that ensure the normal functioning of the central nervous system. Mineral elements are necessary for growth, vital functions, restoration and maintenance of healthy tissue and bones.
The famous American scientist F.D. Moore (1959) proposed the concept of “metabolic care”, which correctly characterizes the principles and essence of metabolic therapy. He and other scientists expressed the opinion about the need to create specialized laboratories for monitoring metabolism in surgical, pediatric, oncology and other clinics.
The greatest advances have been made in the technology of intravenous metabolic therapy (parenteral nutrition). The following drugs are commonly used for parenteral nutrition.
Squirrels. The body can be provided with proteins by intravenous administration of whole blood, red blood cells, plasma, albumin and amino acid mixtures. Only with the help of amino acid mixtures containing a full set of essential amino acids can protein metabolism in cells be adequately maintained.
Carbohydrates. For intravenous nutrition, solutions of glucose, fructose (metabolized faster than glucose), maltose (has an osmotic activity half that of glucose), sorbitol (easily converted into fructose), xylitol (included in the pentose phosphate pathway of carbohydrate metabolism) are used. , glycerol (close in caloric value to glucose, but has twice the osmotic effect).
Lipids. Fat emulsions used for intravenous nutrition must have the properties of chylomicrons (intralipid, lipofundin-S, liposin-2, venolipid, emulsan). These preparations contain vegetable oil and emulsifiers to stabilize the emulsion. It is necessary to introduce into the body essential fatty acids containing 2 or 3 double bonds (linoleic and linolenic). Considering the introduction of substrates for lipid peroxidation in the form of substances with unsaturated fatty acids, care should be taken to provide additional antioxidants (vitamins E, C, carotenes, etc.).
Essential microelements(contents are normal< 50 мкг/г ткани). При натуральном питании к ним относятся железо, йод, кобальт. При внутривенном питании следует дополнить цинком, медью, селеном, хромом, молибденом; фтор относится к полуэссенциальным элементам.
Vitamins. A balanced multivitamin preparation should include vitamins that act as cofactors for enzymes of the general catabolic pathway (B 1,2,3,5,6, lipoic acid), as well as biotin, ascorbic acid, folic acid, cyanocobalamin, and the amount of fat-soluble vitamins.
For enteral correction of metabolism, natural substances and their components can be used in the form of biologically active additives - nutrients. Nutrients complement daily food with essential components. The main forms of production of natural biologically active additives are teas, mixtures, liquid extracts, dry lyophilized extracts, granules and capsules (in the presence of irritating components).
Metabolic therapy through influencing endogenous regulators of metabolism: components of autocrine, paracrine, endocrine, neurotransmitter and other regulatory mechanisms. To illustrate this point, it is enough to recall the molecular mechanisms of interaction of morphine or endogenous peptides (endorphins) with opioid receptors in the brain or the biosynthesis of leptin in fat cells as a way to regulate appetite and the expenditure of energy resources through the hypothalamus. In the functioning of these complex molecular processes, biologically active food additives can contribute both the elements necessary for the synthesis of control (regulating) molecules and natural analogues of such molecules. For example, the presence of amino acids with branched radicals can determine the positive neurotropic effect of preparations from the herb Salsola collina Pal and other medicinal plants.
Cellular metabolic therapy involves influencing metabolism through the introduction of autogenous, allogeneic or xenogeneic cells. For example, to prevent diabetic angiopathy, the injection of beta cells from the pancreatic islets of newborn piglets or rabbits is used. It is assumed that such cells can complement the work of similar cells in the patient’s body. However, in our opinion, it is more likely that the breakdown products of these cells in the body can act as activators for the functioning or proliferation of the body’s own endocrine cells.
Metabolic therapy should be based on fundamental molecular processes and determined by the molecular mechanisms of the development of pathological processes:
· metabolic processes are interconnected and have a certain direction (vector of transformations). The strength of the xenobiotic's effect depends on the ability of its active principle to objectively influence the direction of metabolite exchange, i.e. Metabolism fragment vector.
· The general metabolic strategy is to preferentially convert hydrophilic metabolites into hydrophobic ones, which leads to permanent accumulation of lipids (cholesterol) as a person moves through the life scale. In this regard, systems for hydrophilization of metabolites (for example, two stages of neutralization of xenobiotics) and excretion of hydrophobic molecules (liver and bile excretory organs) should be supported.
· Metabolic therapy should depend on the primary mechanisms of cell damage and death (apoptosis or necrosis); on the type of underlying pathological process (hypoxia, inflammation, trauma, etc.); on the state of communications (blood and lymphatic vessels, nerves); on the characteristics of the patient’s interaction with the environment (circadian rhythms, the effect of physical factors, food composition, the state of the central nervous system analyzers, features of the homeostasis of substances, etc.).
The widespread introduction of metabolic therapy technologies requires the development and improvement of the legislative framework for the use of parapharmaceuticals, dietary supplements and genetically modified nutrition. This is a new problem for the Republic of Belarus. In the USA and the countries of the European Union, GLP and GCP rules are used to study the pharmacological activity of xenobiotics and the safety of their effects on humans.
GLP rules
Since 1976, when the rules of Good Laboratory Practice (GLP) were first proposed in the United States, technologies for preclinical testing of xenobiotics - potential drugs and other biologically active substances - have been improved in many countries. The main goal of GLP is to ensure the reliability of the results of preclinical tests of natural and synthetic xenobiotics, guaranteeing their safety for humans and animals. In 1992, Russia adopted the Rules for Preclinical Evaluation of the Safety of Pharmacological Drugs (GLP, ZV 64-126-91). Main objectives of the Rules:
· ensure high quality and reliability of preclinical testing of the safety of pharmacological agents;
· create a modern and functionally reliable administrative structure of the testing center to carry out preclinical studies in accordance with international requirements;
· develop and implement clear documentation of preclinical trials into the practice of the center (protocol, standards for research methods; data registration form and final report);
· determine the requirements for test substances and reference preparations;
· ensure testing of standard biomodels on animals and guarantee the necessary conditions for their maintenance, feeding, use in experiments and humane treatment;
· create a service for the quality assessment of tests performed, rules for their control and issuance of a conclusion based on the results of the inspection.
The safety study of xenobiotics (new original potential drugs) is carried out in full: general toxicity (acute, subacute, chronic, local irritant effect, cytotoxicity), specific toxicity (drug dependence, antigenicity, teratogenicity, mutagenicity, carcinogenicity), pharmacokinetic studies (absorption , distribution, excretion, metabolism, bioavailability), general pharmacological action and pyrogenicity of injectable xenobiotics.
All chemical compounds have varying degrees of biological activity (BA) - the ability to affect living matter.
The variety of types of biological activity is determined by:
1) a variety of biological objects and a variety of reactions occurring in them;
2) depends on: the method of entry of the substance into the body, the dose; from physical form; on modes of administration;
3) on the presence or absence of additional influences (physical factors, temperature, humidity, etc.);
4) on the method, principle of selection, observation of biological objects and analysis of the information received.
The goals of determining the types of biological activity of chemical compounds:
· compounds that have beneficial properties (treatment of diseases, expansion of physiological and intellectual capabilities) are well found;
· detection of xenobiotics harmful to the body, since the danger lies in the further manifestation of their action (mutagenicity);
· finding such biological activities that can cause irreversible, uncontrollable, dangerous, unpredictable disturbances in the biological balance of natural ecosystems;
· finding chemical compounds that can be reagents and can lead to the development of fundamentally new research methods;
· accumulation of knowledge that allows one to predict the types of AD based on the chemical structure of the substance.
The desired ratio of introduction of the number of new chemical compounds is studied according to the hourglass principle: grains of sand - chemical compounds; narrow field - a system where compounds are tested for biological activity. Those substances that have crossed the isthmus are promising. The accumulation time is determined by the ability of the isthmus to pass substances (BA area).
The entire array of foreign chemical compounds is subjected to biological testing. We are talking about the organization of a testing system - its significance, the formation of an information array of the foundation of scientific knowledge about the biological activity of foreign chemical compounds.
The final result is certification of each of the xenobiotics according to their biological properties (biological passport).
The use of complex metabolic therapy in the treatment of patients with polycystic ovary syndrome.
Rastegaeva A. A.
The use of complex metabolic therapy in the treatment of patients with polycystic ovary syndrome.
Rastegaeva A. A.
Scientific supervisor: Ph.D., assistant S.N. Gribova
Federal State Budgetary Educational Institution of Higher Education Saratov State Medical University named after. IN AND. Razumovsky Ministry of Health of the Russian Federation
Department of Obstetrics and Gynecology, Faculty of Pediatrics.
Polycystic ovary syndrome (PCOS) is the most common cause of menstrual and reproductive dysfunction in women. The frequency of this pathology is 70% in the structure of endocrine infertility.
Purpose of the study: assessment of the effectiveness of complex metabolic therapy in patients with PCOS.
Materials and methods of research: 37 women with PCOS aged 19 to 32 years were observed. The patients were randomized into two groups. Group 1 consisted of 18 women who received complex therapy according to generally accepted methods. The 2nd group included 19 women who, in addition to basic therapy, received the metabolic complex “Korilip” from Altpharm, Russia. Patients with PCOS were selected based on the Rotterdam criteria if women had anovulation, hyperandrogenism, polycystic ovaries on ultrasound, an increase in the concentration of free serum testosterone over 8.9 nmol/l, total testosterone over 2.5 nmol/l, LH level over 10 IU/l, LH/FSH ratio > 2.5.
Research results: The duration of the disease was 4.21±0.65 years. The age at menarche was 12.98±1.8 years; menarche was later in 2 (8.5%) patients. Amenorrhea was diagnosed in 6 (16.2%) patients, oligomenorrhea - in 7 (18.9%). About 90% of patients had primary infertility. Visceral obesity was noted in 8 (21.6%) patients, insulin resistance - in 8 (21.6%), functional hyperprolactinemia in 6 (16.2%). In 19 (52.4%) patients, BMI was within normal limits and averaged 23.3; they did not have obvious androgen-dependent dermatopathies or hirsutism. Ultrasound diagnosed an increase in the volume of the ovaries: the volume of the right ovary averaged 15.5 cm3, the left - 14.8 cm3. During therapy, in patients of the 1st group, positive dynamics were noted on 13±1.02 days, in patients of the 2nd group - on 9±1.02. The volume of the ovaries in patients of group 1 decreased by 1.2 times; in patients of group 2 - 1.5 times.
Conclusions: The use of the Korilip metabolic complex in complex therapy allows reducing the treatment time for PCOS by 1.4 times.
Catad_tema Chronic cerebral ischemia - articles
Therapy of chronic cerebral vascular insufficiency
Published in the magazine:"Directory of a polyclinic doctor"; No. 8; 2006; pp. 75-79.
M.Yu. Martynov, I.A. Shchukin, A.A. Nikonova, I.E. Serdyuk, A.P. Glukhareva
Russian State Medical University, Department of Neurology and Neurosurgery
The increase in the population of elderly and senile people in recent decades leads to an increase in the prevalence of diseases associated with this age group, including ischemic cerebral disease. The term “ischemic cerebral disease” was proposed by N.K. Bogolepov to combine a variety of acutely and chronically developing ischemic disorders, which are based on a discrepancy between the metabolic needs of brain tissue and substances entering the brain from the blood.
Ischemic cerebrovascular accidents include acute (transient and persistent cerebrovascular accidents) and chronic forms. The development of acute cerebrovascular accidents is usually preceded by chronic, long-term changes in the brain caused by an increasing deterioration in the blood supply to the brain and changes in its metabolic needs.
Pathogenesis of ischemic brain damage
The functioning of the brain requires large amounts of energy. At the same time, nervous tissue has limited energy resources, so an indispensable condition for maintaining its functional activity is consistently high perfusion. To meet the constant need of brain tissue for energy substrates and oxygen, about 14% of the total volume of circulating blood normally flows through the brain, which makes up approximately 2% of the total human body weight. At the same time, the brain utilizes about 20% of the total oxygen consumed by the body. On average, cerebral blood flow in people 20-35 years old is 75-80 ml per 100 brain matter per minute and decreases by 2.5-3.5 ml every ten years, reaching 60-65 ml at the age of 70 years and older. The most significant changes in cerebral blood flow are observed in the frontal, temporal and parietal regions. Glucose consumption in young people is 5.5-7.0 mg per 100 g of brain matter per 1 minute and also decreases with age. The addition of vascular diseases and risk factors accelerates the involution-induced decrease in cerebral blood flow, which contributes to a more significant decrease in the production of neurotransmitters, disruption of electrogenesis processes and limitation of brain functionality.
In recent years, the main stages of the pathophysiological cascade of brain damage during acute ischemia have been established. It has been shown that the transition of reversible hemodynamic, cellular and molecular changes in the area of the ischemic penumbra into persistent ones with the formation of a zone of necrosis is associated with the severity of glutamate “excitotoxicity”, with the activation of intracellular enzymes and the accumulation of intracellular Ca 2+, increased synthesis of nitric oxide, and the development of oxidative stress and local inflammatory response, damage to the BBB and microcirculatory disorders. At the same time, it has been revealed that, despite the presence of universal patterns, the process of cerebral ischemia is largely individual and the features of its course are determined by the state of collateral circulation, characteristics of brain metabolism, the status and reactivity of the endocrine and immune systems. As a result of the studies, a position on the dynamic nature and potential reversibility of ischemic damage was formulated. With chronic cerebral ischemia, there is also a decrease, although not as pronounced as in the penumbra during a stroke, in cerebral blood flow with hypoxia of brain tissue and a cascade of biochemical changes, which entails diffuse changes in the substance of the brain.
Etiology of ischemic cerebral circulatory disorders
The main etiological factors of ischemic cerebrovascular accidents are atherosclerosis, hypertension or arterial hypertension and their combination.
With age, especially in people over 70 years of age, the importance of atherosclerotic lesions of the extra- and intracranial sections of the main arteries of the neck and head increases, and not only the severity of stenosis plays a role, but also the spread of the process to other vascular areas. The role of severe arterial hypertension as the main cause is somewhat reduced. At the same time, the frequency of combination of atherosclerotic lesions of the great vessels of the neck and head with mild and moderate forms of arterial hypertension is increasing. IHD is of great importance, especially complicated by myocardial infarction, which probably reflects a decrease in compensatory capabilities to maintain adequate central (cardiac) and cerebral hemodynamics. A certain role in the development of chronic cerebrovascular insufficiency is played by disturbances in the rhythm of cardiac activity, especially of a paroxysmal nature, which can lead to a decrease in systemic blood pressure and transient episodes of cerebral ischemia. Diabetes mellitus also plays a role in the development of chronic cerebrovascular insufficiency, but its effect is small, being an additional factor that accelerates the atherosclerotic process and affects blood rheology and endothelial function. In patients with vertebrobasilar insufficiency, the condition of the cervical spine (osteochondrosis) is important. Changes in the rheological properties of blood, which are represented by increased viscosity of blood and plasma, aggregation activity of blood cells, and fibrinogen levels, also have a significant impact on the progression of cerebrovascular insufficiency. A certain role, especially in younger people, is played by hereditary predisposition, alcohol abuse, smoking, excess body weight, the development of metabolic syndrome, and insufficient physical activity.
Diagnosis of chronic cerebral vascular insufficiency
Diagnosis of chronic cerebral vascular insufficiency is carried out on the basis of anamnestic, clinical and instrumental methods. Data from additional and laboratory research methods such as computed tomography and magnetic resonance imaging, Doppler ultrasound and duplex scanning, study of the hemostatic system and 24-hour blood pressure monitoring are extremely important for making a diagnosis, selecting therapy and determining the prognosis. The use of neuroimaging research methods - computer and magnetic resonance imaging in patients with chronic cerebrovascular insufficiency allows us to study the state of external and internal liquor-conducting spaces, white and gray matter, and identify previously suffered strokes. In addition, a combined analysis of MRI (CT) results, ultrasound data, clinical features of the course of vascular diseases and risk factors allows us to predict with a certain degree of probability the possibility of developing a stroke and its probable location. The results of CT and MRI studies performed over time indicate a certain sequence of changes in the liquor-conducting spaces and in the substance of the brain as cerebral vascular insufficiency increases. The earliest changes are manifested by a slight expansion of the external (mainly in the frontal and parietotemporal regions) and internal liquor-conducting spaces and changes in the white matter in the form of “caps” near the anterior and posterior horns. These changes are nonspecific and are also detected in elderly, and especially senile, people without vascular diseases and risk factors, reflecting involutional processes. With the progression of the vascular process in the brain, changes in the liquor-conducting spaces and in the substance of the brain become more pronounced. Further expansion of the subarachnoid spaces and the ventricular system is observed. Changes in the white matter of the brain extend to the periventricular and deep regions and are represented by extensive, often merging areas of high signal intensity on T2-weighted MRI images. In approximately 50% of those examined, focal changes in the brain substance are detected, reflecting previous, clinically undiagnosed (“silent”) strokes. Zones of “silent” ischemia are predominantly localized in the deep parts of the cerebral hemispheres and usually do not exceed 10-15 mm in diameter.
| Clinical diagnosis
Initial manifestations of the disease The earliest form of chronic cerebrovascular pathology is the initial manifestations of cerebral circulatory failure (E.V. Schmidt). The disease is characterized by a combination of neurosis-like complaints. Patients report frequent headaches, unsystematic dizziness, sleep disturbances, decreased memory and mental performance. Characteristic is a decrease in mood. Meteorological dependence appears, that is, patients become sensitive to changes in atmospheric pressure, during which fluctuations in blood pressure are noted. Upon examination, signs of autonomic dysfunction are revealed - increased distal hyperhidrosis, acrocyanosis, increased lability of blood pressure and heart rate when performing ortho- and clinostatic tests. A neuropsychological examination reveals a decrease in the pace and quality of mental activity, signs of depression and asthenic syndrome. Disease progression With further development of the disease, small cysts are diagnosed in the gray and white matter, most often reflecting asymptomatic acute cerebrovascular accidents. At the same time, there is no direct correlation between the severity of neurological symptoms and changes in the brain, which in some cases may be due to the localization of the pathological process in functionally “silent” areas of the brain. Clinical manifestations of cerebrovascular insufficiency at this stage are characterized by a combination of emotional (depressive, asthenic, hypochondriacal disorders) and cognitive (decreased ability to remember and retain information, decreased quality and pace of mental activity) disorders. Small-focal, diffuse neurological symptoms appear, represented by oculomotor, vestibular and coordination disorders. A number of patients have minimal motor impairments, mainly when performing fine movements in the hand, reflecting a programming defect. In general, the disease does not significantly reduce the ability to work and does not complicate the social adaptation of patients. The progression of cerebrovascular insufficiency is manifested not so much by an increase in the severity of a particular syndrome, but by the complication of its clinical picture and the simultaneous formation of several syndromes. In elderly and senile patients, as a rule, there is a combination of two or more neurological syndromes indicating diffuse damage to brain tissue. Less commonly, the disease occurs with a predominance of damage to any particular system. The predominant involvement of subcortical formations in the process is manifested by akinetic-rigid syndrome (parkinsonism syndrome), which is mainly represented by hypokinesia and changes in muscle tone. Atactic disorders in CHMN are heterogeneous in their genesis and to a certain extent depend on the stage of cerebrovascular insufficiency. In the early stages of the disease, they are predominantly caused by cerebellar and/or vestibular dysfunction. The progression of the pathological process leads to severe static and coordination disorders and is often associated with dysfunction of the frontal lobes. Disruption of corticonuclear connections is accompanied by the formation of pseudobulbar syndrome, including dysarthria, dysphonia, forced laughter and crying, and reflexes of oral automatism. Intellectual-mnestic disturbances acquire a distinct character and are usually more pronounced in patients with pseudobulbar syndrome. Memory sharply decreases, especially for current events, elements of aphasia, agnosia, and apraxia appear. In severe cases, orientation in space, time, and one’s own personality becomes difficult; deceptions of perception and confabulation may appear. |
The use of ultrasound scanning allows one to assess the nature and direction of blood flow through the vessels, the linear and volumetric velocity of blood flow through the extra- and intracranial parts of the vascular bed, the degree of narrowing of the arteries, the presence and characteristics of collateral blood flow, and the state of vasomotor reserves. Duplex scanning or ultrasound angiography is recommended to clarify the structure of the atherosclerotic plaque and the mechanism of stroke (arterio-arterial embolism). According to duplex scanning data, changes in the intima-media index, the extent of damage to the vascular bed, the degree and localization features of stenotic processes, and the presence of collateral circulation are determined.
Rheoencephalography allows you to obtain information about the blood supply to the cerebral vessels, the state of vascular tone and venous outflow from the cranial cavity, as well as the effect of the cervical spine on the vertebral arteries and adjust the prescription of vasoactive drugs. Rheoencephalography makes it possible to detect vertebrogenic effects on the vertebral arteries from the cervical spine. Normally, during the test, there are no significant changes in the amplitude and shapes of rheographic waves, while with a compressive effect on the vertebral arteries from the cervical vertebrae, a significant asymmetry (more than 30%) of the amplitude of the signals occurs in combination with signs of increased vascular tone. Angiographic studies can be recommended to obtain more complete information about the condition of the extra- and intracranial parts of the vascular bed, to clarify the cause of cerebral vascular insufficiency and methods of treating the patient. The most commonly performed is magnetic resonance angiography.
The study of the hemostasis system reveals an imbalance of the procoagulant and anticoagulant systems with a lack of natural anticoagulants, changes in the rheological properties of blood, which are manifested by an increase in spontaneous and induced aggregation of formed elements, viscosity of blood and plasma.
Fundus examination, ECG and ECHO-CG registration (detection of mural thrombi), determination of high and low density lipids, atherogenicity index and other biochemical blood parameters are of diagnostic value. Taking into account these parameters allows not only to improve the quality of diagnosis, but also to more rationally plan treatment measures.
Treatment of chronic cerebral vascular insufficiency
Treatment of chronic cerebrovascular insufficiency should include interventions aimed at the underlying disease against which it develops (atherosclerosis, arterial hypertension, heart disease, diabetes, etc.), correction of the main syndromes, improvement of cerebral hemodynamics, rheological properties of blood, and administration of metabolic therapy.
Blood pressure correction
One of the most significant indicators that require adequate correction is blood pressure. In older people with long-term arterial hypertension, changes in the daily rhythm of blood pressure may be observed with excessive or, on the contrary, insufficient decrease or increase at night. In these cases, it is mandatory to conduct 24-hour monitoring to correct blood pressure taking into account the data obtained. Preference should be given to long-acting antihypertensive drugs, but the selection of drugs should be made taking into account the individual characteristics of the patient and his response to the prescribed drugs. Individually based selection of antihypertensive drugs based on the results of pharmacogenetic studies is very promising. The most optimal figures for systolic blood pressure against the background of drug correction in such patients are 130-150 mmHg. A separate group of patients is represented by patients with multiple stenotic processes. The increase in blood pressure in these cases may be compensatory, aimed at maintaining adequate cerebral perfusion, and its correction in these cases should be especially careful.
Correction of rheological properties of blood
Correction of the rheological properties of blood is extremely important. The use of antiplatelet drugs is justified in case of increased aggregation activity of platelets and erythrocytes. At the same time, in these cases, smokers should stop smoking or reduce the number of cigarettes they smoke. The most commonly prescribed are acetylsalicylic acid, dipyridamole, pentoxifylline, cinnarizine, clopidogrel, ticlopidine in individually selected doses. When taking these drugs, as well as when changing the dosage or switching to taking another drug, it is necessary to re-monitor the indicators of spontaneous and induced aggregation activity of platelets and erythrocytes. It is also possible to use nicotinic acid preparations, but it is necessary to take into account the possibility of tachycardia, discomfort in the heart and behind the sternum, and difficulty in venous outflow from the cranial cavity. More difficult is the correction of increased blood and plasma viscosity. To normalize these indicators, it is recommended to optimize the drinking regime, sharply reduce or stop smoking and drinking alcohol, and normalize blood pressure. It should also be noted that the presence of concomitant dyslipidemia worsens the rheological properties of the blood and makes it difficult to normalize them, therefore, in such patients, along with the prescription of antiplatelet drugs, it is necessary to use cholesterol-lowering drugs, as well as a diet. Anticoagulants are prescribed for cardiac arrhythmias in combination with the presence of a blood clot in the left side of the heart according to echocardiography. Preference is given to indirect anticoagulants. When taking drugs of this group, monitoring of the international normalized ratio (INR) is mandatory. Optimal INR numbers are 2.5-3.0. It must be remembered that in elderly people with concomitant liver pathology, titration of the anticoagulant dose and monitoring of the INR should be carried out especially carefully. In case of severe atherosclerotic damage to the internal carotid arteries (stenosis more than 70%), along with antiplatelet agents and lipid-correcting therapy (diet, statins), the issue of reconstructive surgery on the internal carotid arteries can be discussed.
Application of metabolic agents
Along with the prescription of drugs that affect blood pressure and the rheological properties of blood, metabolic agents occupy a large place in the treatment of chronic cerebrovascular insufficiency. The use of metabolic drugs can improve metabolic processes in the brain, reduce the acute and long-term consequences of ischemic damage in the form of the development of excessive synthesis of nitric oxide, oxidative stress, increased BBB permeability, activation of microglia, microcirculation disorders, and trophic dysfunction. For these purposes, nootropic and amino acid drugs, neurotransmitters (glycine, Semax, piracetam, Actovegin, Cerebrolysin, gliatilin, etc.) are used.
| Common mistakes
It should be taken into account that in people of older age groups, in the presence of concomitant somatic diseases, a decrease in the intensity of metabolic processes in the body, and impaired elimination of drugs, the risk of developing unwanted side effects from complex pharmacotherapy increases. The combination of various diseases often requires the use of a large number of drugs, which can lead to changes in their pharmacological activity (mutual potentiation or antagonism) or the development of allergic reactions. Some groups of drugs may be contraindicated for use in patients with several different diseases. Due to frequent concomitant diseases and complications, in the management of these patients, in addition to a neurologist, the participation of a therapist, cardiologist, endocrinologist and doctors of other specialties is desirable. |
A summary of the manufacturer's information on drug dosing in adults is provided. Before prescribing the drug, read the instructions carefully.
One of the combination drugs that has a metabolic effect and an effect on the vascular system of the brain is fezam. Phezam is a synergistic combination of piracetam (400 mg) and cinnarizine (25 mg). The action of Phezam is carried out due to piracetam, which enhances energy metabolism, has a neuroprotective effect, increasing the resistance of brain cells to hypoxia, facilitates the transmission of impulses in synapses, and due to cinnarizine, which has a vasodilating effect due to blocking L-type calcium channels and enhancing the antihypoxic effect piracetam. In addition, cinnarizine affects the rheological properties of blood, reducing spontaneous and induced platelet aggregation and improving the elasticity of erythrocyte membranes. Studies conducted by domestic neurologists (A.N. Boyko et al., 2002) showed that taking Phezam helps reduce the severity of subjective symptoms, improve kinesthetic tests and cognitive functions, quality of life indicators, social adaptation of patients, including the elderly with chronic cerebrovascular insufficiency. It is important to note the safety of Fezam and a small number of contraindications.
The body of a healthy person is balanced and metabolic processes occur in it. Each of them involves certain substances.
Speaking about complex metabolic therapy, not everyone knows what it is. It treats many diseases at the cellular level using naturally occurring metabolites.
This approach allows you to restore the functioning of all organs and systems in the human body. The method stimulates reserve cells, which begin to perform all the functions of damaged or dead ones. Metabolic therapy is used in the treatment of sclerosis, uterine fibroids, mitochondrial and monogenic diseases, and decreased spinal cord function.
The results of treatment are visible after 2-3 weeks, a course is carried out using special drugs.
When using therapy, you need to be careful to avoid negative consequences. Most importantly, treatment can begin only according to the indications of a specialist and is carried out in combination with other drugs. No side effects were found from the therapy, while it itself helps strengthen the immune system and remove harmful toxins from the body.
Ways to detoxify the body
When wondering what metabolic therapy is, you need to remember that detoxification is the removal of harmful toxins and poisons accumulated by the body at the cellular level. Harmful substances interfere with the proper functioning of all organs and systems. Substances enter the body from food, the environment, and during viral diseases.
A person is able to cope with toxins on his own; they are eliminated through the kidneys, liver and respiratory tract. But lately, even a healthy body has found it difficult to remove all accumulated substances, since it is constantly exposed to the negative effects of the environment. Natural detoxification of the body is especially difficult for urban residents.
Symptoms
The human body gives signals that indicate the body is being poisoned by toxins. There is a decrease in immunity, the patient becomes more and more susceptible to viral diseases.
Chronic fatigue, malaise, and fatigue also appear. A person gets up in the morning already tired and unable to work. The nervous system reacts more painfully to changes in mood, depression and stress may occur.
The hormonal background also experiences stress and sudden jumps in the amount of hormones. This manifests itself in the accumulation of excess weight and sweating. Your appearance deteriorates, your hair and nails split, your complexion takes on an unhealthy tint. Excess weight provokes gastrointestinal disorders.
All these symptoms may indicate a large amount of toxins, and the body is not able to eliminate them on its own.
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The meaning of detoxification
When considering metabolic therapy and what it is, you need to know that detoxification must be comprehensive. It has its main points and principles:
- Reducing harmful effects on the body. City residents need to spend more time in the fresh air, drink clean water and give preference to natural products.
- Maintain personal hygiene. Toxins from the air settle on the skin and are subsequently absorbed through the pores. Therefore, it is necessary to cleanse the skin in a timely manner and apply a specially selected cream to it, which will serve as a kind of protective film.
- Proper nutrition. A balanced diet rich in vitamins will help the body cope with the load. During detoxification, you need to forget about harmful fried, smoked and fatty foods.
- Removing poisons and strengthening the body. Poisons are removed in different ways; this will be discussed a little later. Afterwards you need to help the body strengthen the immune system and normalize the functioning of all organs and systems. Vitamin complexes and nutritional supplements will cope with this task.
Diet as a way to detoxify
Weight loss diets are different from cleansing diets. Weight loss diets can cause the formation of new toxins due to the breakdown of fats and changes in metabolism.
The cleansing diet includes drinking at least 3 liters of fluid daily. This could be water, natural juices, fruit drinks, green tea and soups. The menu should be rich in fiber, it helps bind toxins and remove them from the body. A similar substance is found in legumes, fresh herbs, vegetables and fruits.
Salt consumption should be limited, as it retains water in the body, preventing it from cleansing itself of poisons. A ban is imposed on flour products; you need to eat more cereals and white meat.
Physical activity is an effective way to detoxify
Strengthening the immune system and cleansing the body of toxins at home is possible through physical activity. A large amount of toxins come out along with sweat. Increased sweating occurs during physical activity, sports and banal exercises in the morning.
It is not necessary to play sports professionally and reach heights. It is important to devote at least 30 minutes a day to physical activity. This could be morning exercise or jogging, brisk walking, swimming or yoga.
In addition to eliminating toxins, sports help normalize metabolism, which is important during detoxification.
Cleansing the body with medications
When considering metabolic therapy, what it is, you should know that medications can quickly and effectively cleanse the body of toxins. As a rule, purification occurs with drugs from the sorbent group. The formula of these medications binds toxins and removes them naturally.
The most popular and inexpensive remedy is activated carbon. The structure is porous, absorbs toxins like a sponge and removes them. The medicine has a small area of effect, which is why it is inferior to other drugs.
The drug of Russian origin "Polysorb" based on silicon dioxide is a more modern and effective drug. It is produced in the form of a liquid suspension, which speeds up its action. The drug is used to alleviate the symptoms of poisoning, toxicosis in pregnant women, and allergic reactions.
Another well-known sorbent is Smecta, a drug produced in powder form. It can be used by children and pregnant women.
It is possible to cleanse the body with the help of herbal products. Lignin is available in the form of tablets or powder. The drug has a strong effect on toxins and is able to remove heavy metal salts from the body.
Physiotherapy
Physiotherapy is a surefire way to heal the body and has a wide range of treatments that will help get rid of toxins. First of all, this is a thermal effect, during which poisons are released with sweat. These include visiting a sauna and steam bath, at which time the skin pores are open, which helps to quickly get rid of accumulated harmful substances.
In addition to heat, the body is exposed to cold for no more than 3-4 minutes. It's called a cryosauna. This procedure stimulates the immune system and normalizes metabolism in the body. That is, you don’t need to constantly rely on the help of medications, but you need to adhere to the “help yourself” credo.
Extreme detoxification measures for complex poisoning of the body
These methods are possible only in emergency and complex cases according to a doctor’s indications. These include gastric lavage and deep cleansing of the intestines using large amounts of water up to 30 liters in one procedure.
Your doctor may prescribe plasmapheresis. This is the purification of blood from toxins using special equipment. The procedure is indicated for severe poisoning, allergic reactions, and for cleansing the skin of rashes.
Help yourself: ways to protect the body from toxins and strengthen the immune system
It is impossible to completely protect the body from the effects of toxins, but you can reduce their amount through proper nutrition and exercise.
It is recommended not to use toxic household chemicals containing chlorine and phosphates in everyday life. You can replace it with baking soda, vinegar and lemon juice. If it is impossible to refuse cleaning agents and detergents, you need to use simple powders and gels with a minimal composition.
Natural cosmetics will help protect the body from a large number of toxins, since most products contain harmful chemicals. Before purchasing, you need to carefully study the composition for the content of phosphates and sulfates. Face masks, hair masks and scrubs can be prepared at home using natural ingredients.
You can strengthen your immune system with the help of vitamin complexes (since the diet cannot always provide the daily norm of useful microelements), hardening, and daily walks in the fresh air.
Conclusion
Periodically, you need to cleanse your body of toxins using the above methods. A course of metabolic therapy will help you get rid of harmful substances in a timely manner, preventing unpleasant symptoms and complications.
Symptomatic therapy
Symptomatic therapy is designed to eliminate or significantly weaken not only unpleasant, painful subjective sensations for a person, but also various unfavorable symptoms caused by both hypoxia and the negative consequences of etiotropic and pathogenetic treatment. For these purposes, a huge arsenal of medicinal and non-medicinal methods and means is used that eliminate or reduce various minor pathological changes in the body, including anxiety, pain, and negative emotions.
Metabolic therapy
For many decades, if not more, scientists, practitioners, and pharmacologists have been trying to develop drugs that would stabilize impaired body functions regardless of the etiological factor, naturally, without replacing certain specific therapy with this drug. The basis for the implementation of their therapeutic activity is the modulation of metabolic processes, which is manifested by an increase in the body’s adaptation processes. The creation of this group of drugs is based on the following principle: metabolic agents, to one degree or another, must be natural substrates, or they (the drugs) modulate their de novo synthesis. Naturally, the action of metabolic drugs should be realized under pathological conditions. In other words, the specified group of drugs (metabolics; protectors; antihypoxants; antioxidants) must, under conditions of stress (damage, disease), prevent or reduce the damaging effects of hypoxia, preserve the integrity of oxidative phosphorylation (ATP production) > preserve the target organ and/or the body as a whole .
Metabolic therapy makes it possible to maintain or replace some vital functions of the body until their autoregulation is restored, when the long path of recovery will be controlled by the restored autoregulated functions themselves.
In the last century, 40% glucose administered intravenously was used as a metabolic agent with some success, then it was combined with B vitamins, and clinicians of those times used large and sometimes megadoses of these vitamins to treat debilitating diseases. It must be admitted that these measures really significantly improved the condition of patients with myocardial infarction, pneumonia, and severe stress. No less interesting and effective metabolic drug was Cahors - church wine. It had high energy value, and was used even in pre-revolutionary Russia. We foresee skeptical and indignant outcries from adherents of evidence-based medicine, but it worked, and behind such prescriptions lay the practical experience of many thousands of doctors, thousands of lives saved. This must be treated with respect.
It is also necessary to recall the scientific research of alchemists, who many centuries ago used succinic acid as an “elixir of life,” which in the 21st century has become a leading metabolic drug.
Several decades ago, taking into account the pathophysiological processes occurring during hypoxia, Labori proposed the use of a polarizing mixture in critical conditions. The combination of glucose, insulin, potassium and magnesium significantly reduces the damaging effects of hypoxia due to the energy substrate glucose, the reserves of which are quickly depleted in severe illnesses and injuries, restoration of cell polarity (injection of K + and Mg + into it promotes the normal functioning of the membrane, prevents / reduces the development calcium paradox), plus the anabolic effect of low doses of insulin. This list goes on and on.
But let us, without rejecting and further applying the experience of our teachers, return to today.
One of the most effective and promising ways to prevent and treat hypoxic/ischemic damage, and therefore treat various severe pathologies in intensive care practice, is the use of antihypoxants - pharmacological agents that weaken or eliminate hypoxic disorders (hypoergosis) by maintaining and increasing energy production in the mitochondrial oxidative phosphorylation system . The founder of this direction was V.M. Vinogradov, under whose leadership the first “true” antihypoxic agents were created - gutimin and amtizol, which were successfully used in critical conditions with ischemic and hypoxic disorders. These drugs and the drugs that are now used in clinical practice suppress or weaken the activation of LPO - FRO, which also helps to improve the energy potential of the cell.
