RU2301672C1 - Method for treatment of ubeitis of obscure and viral etiology - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: method involves intramuscular administration of galavite in the dose 0.1 g, once per a day for 5 days, but from 6 to 10 days - every other day, and gentamycin also in the dose 80 mg, 3 times per a day for 7 days, and bifidum - liquid bacteriophage of 791 series of production of firm "Vektor" in the dose one-half flask, 2 times per a day, one-half hour before eating, and wobenzym is given in the dose 5 tablets, 3 times per a day for 3 weeks and then in the dose 3 tablets, 3 times per a day for 3 weeks. Method provides eliminating the main clinical symptoms of these diseases based on transient suppression of hyperactivity of lipopolysaccharides of cell membrane, decreasing level of TNF-α, IL-1 and other anti-inflammatory cytokines in increasing activity of microbiocid system of neutrophile granulocytes. Invention can be used in treatment of uveitis of obscure or viral etiology.

EFFECT: improved method of treatment.

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Description

The invention relates to ophthalmology and can be used to treat uveitis (inflammatory eye diseases) of an unclear and viral etiology.

There is a method of treating uveitis by subconjunctival and retrobulbar administration of antibiotics and corticosteroids (Zaitseva N.S., Katsnelson L.A. Uveites, M .: Medicine, 1984, p.277-284).

The disadvantages of the method is that it does not always give a positive effect, does not remove the inflammatory process, which leads to relapse of the disease.

The technical result to which this invention is directed is to reduce the treatment time, eliminate side effects and minimize the recurrence of the disease.

The specified technical result is achieved by the fact that in the method of treatment of uveitis of unclear and viral etiology, including the introduction of drugs, 0.1 g of galavit is administered intramuscularly 1 time per day for 5 days, and from the 6th to the 10th day every other day administered intramuscularly for 7 days, 80 mg of gentamicin 3 times a day, prescribed to drink half a bottle of bifidum 2 times a day half an hour before meals, prescribed 5 tablets of Wobenzym 3 times a day, then 3 tablets 3 times a day for three weeks.

The generally accepted classical treatment regimen does not affect the concentration of intestinal endotoxin in the systemic circulation of patients with uveitis of unclear and viral origin, one of the main reasons for the development of endotoxin aggression, which, apparently, is the main cause of disease recurrence. The etiological factors of the pathogenesis of uveitis of "unclear origin" are gram-negative bacteria of the intestinal microflora (bacteroids, Proteus and Pseudomonas aeruginosa), which against the background of immunodeficiency (2-4-fold increase in the concentration of antibodies to candida) and insufficiency of the intestinal barrier (2-3-fold increase in the content antibodies to bifidumbacteria) leads to a 10-15-fold increase in the concentration of lipopolysaccharide in the general bloodstream, which, against the background of relative insufficiency of anti-endotoxin immunity, causes the development of endotox other aggression.

The inclusion in the treatment regimen of galavit, gentamicin, bifidumbacterium, and wobenzym leads to a decrease in the severity of serological signs of dysbiosis, a twofold decrease in the concentration of intestinal lipopolysaccharide in the general blood flow and significantly reduces the frequency of disease recurrence.

A new comprehensive method for the treatment of uveitis, including the introduction of the above drugs, stimulates the human immune system and, based on the theory of endotoxin aggression (author - professor, MD M.Yu. Yakovlev), differs from traditional methods of treatment using the following.

Among the numerous eye diseases, a special place belongs to uveitis, which is based on the inflammatory process in the choroid of the eye. Understanding of these processes occurring in the eye is difficult due to the fact that researchers are still dominated by the long-rooted idea of the uniqueness of the barrier systems of this important organ, to which inflammatory reactions that are characteristic of other important organs and do not apply only partially systems. Without questioning the accumulated precursors data on the presence of the blood-ophthalmological barrier (GOB) and its uniqueness, the experimental and domestic clinical data obtained by foreign colleagues indicate that, in relation to endotoxins (ET), gram-negative bacteria of the eye of an animal, a human, in particular its barrier system are no different from any other body. This does not contradict the generally accepted concept of the presence of GBD, because according to this theory, in the physiology and pathology of humans, the endotoxin of the intestinal microflora also takes part in ensuring the physiological process of their regulation. It is proved that under the action of endotoxins of gram-negative bacteria, all components of the microbicidal system of neutrophilic granulocytes are inhibited. ET is a lipopolysaccharide (LPS), which is an essential component of the cell membrane of all gram-negative and coccal bacteria. It has a wide range of useful and pathogenic properties due to the presence in its structure of a structural component common to LPS of any origin - the Re-chemotype glycolipid (HLP), which consists of lipid A and three ketodesoxy octanate molecules. It is with glycolipid that the whole spectrum of biological properties common to all endotoxins is associated. LPS shows useful or pathogenic properties depending on its concentration in the general blood flow, which depends on ET transmissive (intestines, liver, hypothalamus, pituitary, adrenal glands) and LPS secreting (kidney, liver, skin, lungs, intestines etc.) of organs and systems and the activity of AEI (anti-endotoxin immunity). The need for the introduction of the term AEI arose recently. It arose as awareness of the importance of intestinal LPS in human physiology and pathology and firmly entered into scientific semantics as a very important component of immune defense (own immunity).

The method of treatment was based on a new methodological approach, which is based on the identification of only those antibodies that, on the one hand, are capable of reacting with LPS of any origin, and on the other hand, interact with exactly that structural component (antigenic determinants) of ET that are responsible for general biological (including pathogenic) properties of LPS, stopping or reducing their activity. Such antibodies are HLP and E. coli 014 antibodies with the common enterobacterial antigen, the titers of which allow for integrated assessment of the activity of the AEI humoral unit. This author’s method of screening assessment of immune status was called "SOIS-IFA." Another method specifically developed for assessing the AEI granulocyte link is LPS test ELISA: it assesses the reserve ability of granulocytes to bind endotoxin, provides information that is very important for researchers and doctors, since it is these leukocyte populations that are the basis of LPS binding and excretory cell blood systems.

ET causes an ophthalmic and histological inflammatory process in the inner membranes of the eye in various doses. ET-indicated uveitis manifests itself as acute inflammation of the membranes of the eyes, the immune reactions caused by it in the eye are accompanied by the activation of a compliment and the release of various kinds of cytokines (TNF-α), enterleukins, enterferons, platelet growth factor, fibroblasts, etc. Inflammation is characterized by temporarily dependent destruction of the GB , which is manifested in two-phase exudation of protein and cell infiltration, consisting of macrophages and granulocytes.

The first link in the interaction between leukocytes and endothelial cells is mediated by selectins, the artificial blocking of which (RIE-selectin) leads to a decrease in the severity of LPS-induced intraocular inflammation. Along with inflammatory cells that infiltrate the anterior segment of the eye with ET-induced uveitis, local immunocompetent eye cells (iris, ciliary body) are also involved in expression and are the main sources of nitric oxide. Other factors take part in the mechanisms of immune damage: interferon-gamma, TNF interleukins and eicasanoids.

Based on the foregoing, it can be assumed that the main clinical symptoms in recurrent uveitis are due to the excessive release of all these compounds from hyperactivated macrophages. Therefore, to eliminate the symptoms of this pathological process, it is necessary to reduce the level of all these compounds.

Galavit, on the one hand, temporarily suppresses LPS hyperactivity, reduces the level of TNF-α, interleukin-1 and other pro-inflammatory cytokines, which accordingly reduces intoxication symptoms, and on the other hand, increases the activity of the microbicidal system of neutrophilic granulocytes.

Galavit is an immunomodulatory anti-inflammatory drug (created and manufactured by Medicor). Galavit is administered intramuscularly at 0.1 g once a day N 5, from the 6th day to 0.1 g every other day up to 10 injections. Galavit diluted in 2 ml of physical. solution.

Gentamicin is an antibiotic of the aminoglycoside group. Gentamicin acts bactericidally, actively penetrating the bacterial cell membrane and disrupting protein synthesis, binding to the 30S subunit of bacterial ribosomes. It has good activity against most gram-negative and some gram-positive bacteria. It is especially effective in the treatment of infections caused by gram-negative organisms. Ineffective against Streptococcus spp., Including Streptococcus pneumoniae, as well as anaerobes.

Gentamacin is prescribed 80 mg 3 times a day for 7 days.

Bifidum is a liquid bacteriophage 791 series manufactured by the Vector company, Novosibirsk. It is prescribed in a half bottle 2 times a day half an hour before meals for a month, improves the intestinal microflora and improves the functioning of the gastrointestinal tract and liver.

The enzyme preparation Wobenzym (manufactured by Mucos Pharma GMBH). Enzymes (enzymes) are involved in the implementation of almost all the vital processes of the body. Reduced enzyme activity often leads to chronic diseases.

Wobenzym is a combination of highly effective enzymes of plant and animal origin with anti-inflammatory, decongestant, fibrinolytic, immunomodulating and secondary analgesic effects. Wobenzym positively affects the course of the inflammatory process, limits the pathological manifestations of autoimmune and immunocomplex processes. Wobenzym increases the lysis of toxic metabolic products and necrotic tissue. Improves resorption of hematomas and edema, normalizes the permeability of the walls of blood vessels. Wobenzym normalizes blood viscosity and microcirculation. Improves tissue nutrition with oxygen and nutrients. Wobenzym has a hypolipidemic, immunocorrective and antioxidant effect, and affects risk factors for reinfarction.

After oral administration, its constituents from 4 to 20% are absorbed into the blood from the small intestine, the rest are involved in digestion and excreted in the feces. In the bloodstream, enzymes bind to antiproteases, maintaining their activity, and reach a maximum concentration 2 hours after administration, which is held for 4 hours. The half-life is 8 hours.

Wobenzym is prescribed 5 tablets 3 times a day for three weeks, and then 3 tablets 3 times a day for three weeks.

The treatment method can be supplemented with an intravenous laser blood irradiation device "UZOR-VLOK", which allows to enhance the synthesis of DNA, RNA in cells, to have a pronounced immunocorrective effect, increase blood flow, have analgesic, anti-inflammatory and detoxifying effects.

The use of this method in the complex treatment of uveitis of unclear and viral etiology proved to be very promising. Clinical testing was carried out at the Department of Ophthalmology of the Department of Eye Diseases of the Russian State Medical University (Moscow), at the Institute of General and Clinical Pathology of the KDO RANS (Moscow), and at the Ophthalmological Clinical Hospital (Moscow).

Example 1

Patient E. at the age of 49, suffered a viral flu, subfebrile temperature appeared. I went to the eye clinic, was hospitalized with a diagnosis of Iridocyclitis of the left eye, after 2 weeks of treatment, the dynamics worsened, the vision of the right eye began to decline, was transferred to a tuberculosis hospital 7 with a diagnosis of Iridocyclitis in both eyes. In that clinic, 1.5 months were treated, but the dynamics worsened, and therefore he was examined at the clinic of the Faculty of Medicine of the Russian State Medical University and diagnosed with uveitis of both eyes of viral origin. Visus upon admission: OD = 0.4, OS = 0.08. The patient was treated for 10 days (comprehensively). The patient was discharged with recovery. Visus OD = 1.0; OS = 0.7 is not corrected.

Comprehensive treatment included the following:

Actipol - 2 drops 6-8 times a day;

Cyclamed - topically 2 times a day, 2 drops each;

Tobrex - 2 drops 6-8 times a day;

Zovirax - put in the eye 3 times a day.

In / in Zovirax - 500 mg 2 times a day (morning and evening);

Neovir - 2 ml intramuscularly No. 5;

Galavit - 0.1 g once a day intramuscularly for 5 days, and from the 6th to 10th day every other day;

Genatmicin - 80 mg 3 times a day for 7 days;

Bifidum - in half a bottle 2 times a day half an hour before meals;

Wobenzym - 5 tablets 3 times a day for 3 weeks, then 3 tablets 3 times a day for three weeks;

Under the conjunctiva - actipol 0.5 ml once a day.

Example 2

Patient L., 76 years old, was treated for 2 months in the clinic for a fracture of the femur (complication is osteomyelitis), after discharge on the right eye (cataract surgery 6 months ago), the clinic was diagnosed with keratitis of the right eye , endophthalmitis with hypopion, was treated there for 2 weeks, the dynamics is negative. Received urgently to the Ophthalmic Clinical Hospital for enucleation, Visus OD at admission - incorrect light projection. The patient was treated in the clinic for 2 weeks, was discharged with improvement: VOD = 0.1-0.2. The eye is calm, the media are transparent, the anterior chamber is deep, the pupil is moderately dilated with medication. Fundus: weakly ophthalmoscopic.

The following comprehensive treatment was carried out:

Genatmicin - 80 mg 3 times a day for 7 days;

Cyclamen - 2 drops in the eye 2 times a day;

Tobrex and nacin - 2 drops topically 5-6 times a day;

Bifidum - in half a bottle 2 times a day half an hour before meals;

Wobenzym - 5 tablets 3 times a day for 3 weeks, then 3 tablets 3 times a day for three weeks;

Galavit - 0.1 g once a day intramuscularly for 5 days, then 0.1 g every other day No. 5.

Example 3

Patient K., 65 years old, after a month of treatment at the clinic for viral keratitis of the left eye, was admitted to the hospital with the phenomenon of corneal ulcer with hypertension and hypopion. Treatment was hampered by the fact that the patient was treated with all possible types of drugs for eye inflammation on an outpatient basis in a private clinic. Visus right eye 1, left 0.02. The following complex treatment was prescribed to the patient in the department:

Actipol - 2 drops 6-8 times a day;

Cyclamed - topically 2 times a day, 2 drops each;

Tobrex - 2 drops 6-8 times a day;

Zovirax - put in the eye 3 times a day.

In / in Zovirax - 500 mg 2 times a day (morning and evening);

Neovir - 2 ml intramuscularly No. 5;

Galavit - 0.1 g once a day intramuscularly for 5 days, then 0.1 g every other day No. 5;

Genatmicin - 80 mg 3 times a day for 7 days;

Bifidum - in half a bottle 2 times a day half an hour before meals;

Wobenzym - 5 tablets 3 times a day for 3 weeks, then 3 tablets 3 times a day for three weeks;

Under the conjunctiva - actipol 0.5 ml once a day.

Visus at discharge 0.8-0.9 of the left eye. Intraocular pressure is pulpatory - normal. The eye is calm.

Claims (1)

A method for the treatment of uveitis of unclear or viral etiology, including the administration of drugs, characterized in that 0.1 g of galavit is administered intramuscularly 1 time per day for 5 days, and from 6th to 10th day every other day, and gentamicin for 7 days, 80 mg 3 times a day, inject the contents of half a bottle of bifidum - a liquid bacteriophage 791 series of the company "Vector" 2 times a day half an hour before meals, inject 5 tablets of wobenzym 3 times a day for 3 weeks, and then 3 tablets 3 times a day for 3 weeks.