RU2337688C1 - Treatment method of psoriasis combined with chronic opisthorchiasis - Google Patents

Abstract

FIELD: medicine; dermatovenereology.

SUBSTANCE: in steady process stage in the first days of treatment Prasiquantel is introduced in single dose 20 mg/kg in the afternoon. Next days additionally biologically active food additive "Progelvit" is introduced in dosage 1 dessert spoon 2 times a day with meal within 14 days. 7 days later additionally food additive "Progelvit" is introduced in dosage 1 dessert spoon 2 times a day with meal within 14 days.

EFFECT: effective treatment at reduced number of complications due to considerable decrease in dose of Prasiquantel.

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Description

The invention relates to medicine, dermatology, and can be used to treat patients with psoriasis in combination with chronic opisthorchiasis.

Closest to the proposed is a method of treating patients with combined pathology using praziquantel prescribed in a usual dose of 60 mg / kg body weight according to the night schedule in 3 doses with an interval of 4 hours. The effectiveness of deworming was 100%. However, for patients with psoriasis, this treatment causes a complication of the skin process in the form of new rashes, especially on the first day after deworming, accompanied by itching, which required additional detoxification therapy with hemodesis for 5 days (Belyalova I.G. “Psoriasis, stomach condition and bile excretory system in combination with chronic opisthorchiasis. "Abstract of dissertation for the degree of candidate of medical sciences, Tomsk, 1999).

A new technical task is to reduce the number of complications with high efficiency of deworming.

To solve the problem in a method of treating patients with psoriasis in combination with chronic opisthorchiasis, including deworming with praziquantel during the stationary stage of the process, praziquantel is prescribed at a dose of 20 μg / kg of body weight once in the daytime, and the next day biologically active food supplements "Progelvit" 1 dessert spoon 2 times a day with meals for 14 days, after 7 days, an additional intake of biologically active food supplements "Progelvi" is prescribed t "1 dessert spoon 2 times a day with meals for 14 days.

The method is as follows:

Before starting treatment, the patient receives the following treatment on an outpatient basis to transfer the progressive stage of psoriasis to a hospital: detoxification therapy (30% sodium thiosulfate solution 10 ml IV), antihistamines (1 tablet clarithin 1 time per day 10 days), vitamin therapy (Centrum 1 capsule once a day for 30 days), sedatives (grandaxin 1 tablet 2 times a day for 20 days). Outwardly: Unna cream.

The patient also undergoes a general clinical examination (general blood count, general urinalysis, biochemical blood test), ultrasound of the liver, duodenal sounding or enzyme-linked immunosorbent assay for opisthorchiasis for IgG.

When the opisthorchis eggs are in duodenal bile or the titer is increased by ELISA, the patient is dewormed on an outpatient basis.

On an outpatient basis, the patient receives praziquantel in the daytime at a dose of 20 mcg / kg body weight once (after lunch). The next day, continues treatment with Progelvit, 1 dessert spoon 2 times a day for 14 days. Then after 7 days additionally receives the drug "Progelvit" 1 dessert spoon 2 times a day for 14 days.

The dietary supplement “Progelvit” is a plant complex consisting of aspen bark, pumpkin seeds, dill, coriander, cloves, fructose, processed using special technology. Contains essential oils, bitterness, flavonoids, trace elements.

It contributes to the prevention of parasitosis (opisthorchiasis, giardiasis, ascariasis, enterobiasis). Reduces the risk of benign neoplasms (mastopathy, uterine fibroids, prostate adenoma).

Method of application: it is used in adults and children over 12 years of age with the preventive purpose of 1 teaspoon of powder (3 g) 2 times a day with meals for 14 days. It is washed down with liquid not less than 100 ml. In chronic forms of parasitosis and benign neoplasms, it is possible to take 1-2 teaspoon of the powder 3 times a day with meals for 14 days, repeated courses after 7 days. The number of courses is 3-5. In children under 12 years of age, the dose is reduced by 2 times.

Contraindications: individual intolerance to the components of the drug.

Release form: brown powder packed in a plastic bag and box.

TU 9375-002-34483777-02.

Manufacturer: SRC-NT, Berdsk.

The dose of praziquantel is reduced by 3 times compared to usually used due to the combination with a herbal preparation. The dose and regimen of praziquantel are selected based on clinical observations. Treatment of opisthorchiasis is carried out in the stationary stage of psoriasis, so as not to cause exacerbation of the skin process. Praziquantel is prescribed in the daytime and on an outpatient basis for the convenience of the patient, which does not reduce the quality of life, gives a high economic effect, since you do not need to occupy a bed in a hospital. Treatment can be carried out without interruption from the normal life of the patient. After the course of treatment, control sounding was carried out, according to which the effectiveness of the deworming was determined. The course of taking "Progelvita" (14 days) is necessary and sufficient for the treatment of this category of patients. When deworming is performed for a period of less than 14 days, the effectiveness of deworming decreases, and prolonging the course of treatment for more than 14 days leads to additional side effects that are undesirable for patients with psoriasis. In the daytime, the drug is prescribed for the convenience of monitoring patients, in 2 doses to increase the concentration of the drug in order to more effectively deworm. Doses of 1 dessert spoon 2 times a day for 14 days are necessary and sufficient for effective deworming. Additionally, after 7 days, “Progelvit” is prescribed to consolidate the effect. The dose of 1 dessert spoon 2 times a day for 14 days was selected based on clinical observations.

An example implementation of the method on the patient:

Patient Kolesnikov I.E., 49 years old, turned to the Regional Clinical Hospital in Tomsk with a diagnosis of Chronic opisthorchiasis. Chronic non-calculous cholecystitis in the stage of moderate exacerbation. Hypomotor biliary dyskinesia. Concomitant diagnosis: Psoriasis, teardrop-plaque, progressive stage, common, autumn-winter type.

On admission, he complained of heaviness in the right hypochondrium, constant bitterness in the mouth, nausea, decreased appetite, and a sense of anxiety.

From the anamnesis it was found out that the patient suffers from psoriasis for about 5 years. Last exacerbation appeared 2 months ago. Associates with nervous shock. The following treatment:

detoxification therapy (sodium thiosulfate solution 30%, 10 ml w / o No. 10), antihistamines (clarithin 1 tablet 1 time per day 10 days), vitamin therapy (Centrum 1 capsule 1 time per day 30 days), sedatives drugs (grandaxin 1 tablet 2 times a day for 20 days). Outwardly: Unna cream.

The last 1.5 years began to worry about heaviness in the right hypochondrium, periodic pain in this area, intolerance to fatty foods, nausea, a sense of anxiety.

An outpatient general clinical examination, ultrasound, duodenal sounding, ELISA for opisthorchiasis for IgG.

In a general blood test, eosinophilia is up to 9%. In the general analysis of urine - without pathological changes. Indicators of biochemical blood tests are within normal limits.

According to the data of chromatic duodenal sounding, dyskinesia of the gallbladder according to the hypomotor type was detected: cystic bile expired in a large volume up to 90 ml (at a rate of 60 ml), its expiration time was extended to 43 minutes (at a rate of up to 21 min). Hypotension of the sphincter of Oddi was revealed.

Microscopy of bile revealed opisthorchis eggs (up to 5-6 in the field of view). An increase in titer by ELISA for opisthorchiasis to IgG 0.58 (with a norm of 0.29).

According to ultrasound, the gallbladder volume was significantly increased and amounted to 81 cm ³ (with a norm of 40-60 cm ³ ).

Objectively: normosthenic physique. On the skin in the area of the scalp, trunk, elbows and knees, the papules are pink-brown in color, merging into plaques, covered with silver-white scales, which are easily removed by scraping. The psoriatic triad is positive (the phenomenon of stearin stain, the phenomenon of psoriatic film, the phenomenon of pinpoint bleeding). The tongue is coated with white plaque. In the lungs and heart without pathology. The abdomen is soft, with palpation in the right hypochondrium is moderately painful. Positive symptoms of Kera and Murphy.

For the treatment of chronic opisthorchiasis and gallbladder hypotension, a combined method of treatment was prescribed: praziquantel at a dose of 20 mc / kg, and the next day Progelvit 1 dessert spoon 2 times a day with meals for 14 days.

The patient tolerated the treatment well. After deworming with praziquantel no side effects were noted. The appearance of rashes on the skin, itching was not observed. On the 6th day of using Progelvit, the feeling of heaviness in the right upper quadrant disappeared, bitterness in the mouth, there was no feeling of nausea at the end of the treatment, and appetite improved. At the end of treatment of chronic opisthorchiasis, control duodenal sounding, ultrasound were performed. According to fractional duodenal sounding, the volume of cystic bile and the time of its expiration normalized to 61 ml (at a rate of 60 ml) and 22 minutes (at a rate of 21 min). Microscopy of bile revealed single eggs of opisthorchis. According to ultrasound, the gallbladder volume was 54 cm ³ , which is the norm. Within a week after treatment, a regression of psoriasis was achieved. 7 days after the end of treatment, a course of treatment with Progelvit was prescribed, 1 dessert spoon 2 times a day for 14 days. A month after the treatment, the patient noted improvement in well-being, no complaints from the digestive tract, nausea disappeared, appetite normalized. Repeated duodenal sounding was performed. Microscopy did not reveal opisthorchis eggs. The skin process was in a regression stage.

This method treated 12 patients with psoriasis in combination with chronic opisthorchiasis. Side effects from the skin, gastrointestinal tract during treatment with this method was not observed. The effectiveness of deworming was 83.3%.

Thus, the proposed method allows the treatment of patients with combined pathology using an optimally selected combination of a highly effective anthelmintic drug with the biologically active food supplement "Progelvit" obtained from plant materials. This made it possible to triple the dose of highly effective, but also highly toxic praziquantel, and more gently with sufficiently high efficiency (83.3%) to treat patients suffering from psoriasis.

Claims (1)

A method of treating psoriasis patients in combination with chronic opisthorchiasis, which consists in deworming with praziquantel during the stationary stage of the process, characterized in that praziquantel is prescribed on the first day of treatment at a dose of 20 mg / kg once a day, and the next day, biologically active food supplement "Progelvit" 1 dessert spoon 2 times a day with meals for 14 days, after 7 days an additional biologically active food supplement "Progelvit" 1 dessert spoon 2 times a day with meals for 14 days.