Diagnosis and treatment of chronic pelvic pain syndrome

Subject. One of the features of the current stage of development of Russian health care system is a targeted approach to physically challenged children; these are not only children with disabilities, but also children with autism spectrum disorder. Special programs based on behavior modification have been developed for teaching oral hygiene to children with autism, in addition to traditional oral hygiene education modern gadgets are now increasingly being used. A pediatric dentist needs to integrate into modern youth trends, create methods for motivating children to oral hygiene using modern propaganda tools, including interactive ones, using smart technologies and augmented reality, which significantly increase involvement of the population. Purpose — is to compare the effectiveness of modern methods of preventing dental diseases in children with autism spectrum disorders in the subjects of the Ural Federal District. Methodology. The research materials were data from the annual reports of the lider specialist pediatric dentist of the Ministry of Health of the Russian Federation in the Ural Federal District, the available techniques and best practices in prevention of dental diseases in children with autism spectrum disorders. Results. A comparative analysis confirms the importance and relevance of measures for the primary prevention of dental diseases in children with autism spectrum disorders. Conclusions. The most promising are Smart-technologies, the great social significance of the result of the implementation of projects is unconditional. Low costs for the introduction and maintenance of the product Smart-technologies for the prevention of dental diseases, ensure the implementation of projects in practice, including this category of children. Taking into account national federal project “Electronic Health”, there is the possibility of introducing Smart-technologies into the practice of medical organizations. Given the relevance of the problem and the novelty of the solution, combined with the low cost of implementing this technology, the importance of ongoing projects is assessed as high.

Diabetes mellitus is one of the most common chronic diseases, the incidence of which is steadily increasing. Approximately 1 in 11 adults in the world today has diabetes. Diabetic polyneuropathy is a common complication of diabetes mellitus and leads to a decrease in the quality and life expectancy of patients, increases the risk of disability. The pain form of diabetic polyneuropathy has a particularly negative effect on the quality of life. It includes both acute (Ellenberg’s neuropathy and acute insulin-induced neuropathy) and chronic forms. The article discusses modern ideas about the pathogenesis of pain diabetic polyneuropathy, as well as risk factors, clinical symptoms and diagnostic methods (electroneuromyography, quantitative sensory testing, sudomotor function, skin biopsy, confocal biopsy of the cornea) of the disease. In most patients, the pain form of diabetic polyneuropathy is accompanied by autonomic disorders. Treatment of painful diabetic polyneuropathy is a difficult task, including the correction of risk factors (glycemia level, patient lifestyle), as well as pathogenetic and symptomatic therapy. As symptomatic therapy, adjuvant analgesics are used, namely drugs from the group of anticonvulsants (gabapentin, pregabalin) and antidepressants (duloxetine). The use of alpha-lipoic acid is the basis of pathogenetic therapy. As a universal antioxidant, alpha-lipoic acid is an absolutely safe drug with a proven effect in the treatment of painful diabetic polyneuropathy and can be recommended for use in clinical practice.

Subject. The health status of children and adolescents is one of the most acute medical and social problems. It is known, that with dental diseases, changes occur not only in the immunological profile of the oral fluid, but also in morphology of the oral tissues. New approaches to the traditional cytological study of buccal epithelium such as analysis of the cytogram with the isolation of various types of cells, as well as the detection of cytological abnormalities of cells, allows us to evaluate the reactivity of the oral mucosa in pathological processes. According to WHO recommendations (2013), groups of children 5-6, 12, 15 years of age are the global indicator age groups for monitoring disease trends and comparisons on an international scale. The objective of the study is to assess the health status of children age 5-6, 12, 15 with non-invasive methods. It is based on the results of a clinical and laboratory examination of 179 children, attending organized children's groups. Children underwent a comprehensive dental examination, which included a questionnaire according to the WHO method, an external examination of the maxillofacial region, an examination of the oral cavity, identification of pathology of hard tooth tissues. Methodology. We studied the change in the dental status of patients, indicators of oral fluid and basal epithelium with age, in order to prognostically use non-invasive assessment methods in a comprehensive health examination, planning and evaluating the effectiveness of prevention programs. Results. It was noted that the dental health status of children 5-6, 12, 15 years old can be assessed as satisfactory, while dental, laboratory and cytological health indicators worsen with age. Non-invasive methods for assessing the dental status of patients can be used in a comprehensive examination of children's health, planning and evaluating the effectiveness of prevention programs.

OBJECTIVE To determine the prevalence of insomnia and the effectiveness of its treatment in patients with a painful form of diabetic polyneuropathy (DPN). MATERIAL AND METHODS Fifty patients with the painful form of DPN were randomly divided into 2 groups: the standard therapy group (ST) and the extended therapy group (ET). In the ST group, a single lesson on sleep hygiene was conducted, in the ET group there were 3—4 face-to-face individual sessions for the treatment of insomnia for two weeks. Both groups were interviewed at the time of hospitalization, after 3 and 6 months. The severity of polyneuropathy and the nature of neuropathic pain were assessed using the Neuropathic Neuropathy Impairment Score in the Lower Limbs (NIS-LL) and the Neuropathy Total Symptom Score — 9 (NTSS-9); the intensity of pain was assessed using a Visual Analog Scale (VAS). Sleep disorders were analyzed using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). RESULTS Sleep disorders of varying severity were observed in 82% of patients in the initial survey. In both groups, improvement in sleep quality was noted during treatment, but significantly better results were in the ET group, the ISI score after 6 months was 7.15±2.08 for the ST group and 3.07±2.49 for the ET group (p<0.0001). In the ST group, there was no significant decrease in the intensity of pain and the severity of polyneuropathy in dynamics. In the ET group, a significant decrease in NTSS-9 and VAS scores was found during the initial survey and after 6 months (p<0.0001). The intensity of pain also significantly decreased in the ET group compared with the ST group (p<0.0001) at the end of follow-up, which indicates the importance of sleep normalization in the treatment of neuropathic pain. CONCLUSION Most patients with the painful form of DPN have insomnia. Treatment of insomnia has shown its effectiveness as part of a multimodal approach to the managing of neuropathic pain in DPN and improving the quality of life of patients.

Polyneuropathies are a heterogeneous group of diseases that can be caused both by a primary lesion of peripheral nerves, and secondarily, against the background of various somatic diseases. The most common cause of chronic polyneuropathy is distal symmetrical diabetic polyneuropathy. In clinical practice, it is important to be aware of dysimmune polyneuropathy, such as Guillain Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and paraproteinemic polyneuropathy, which lead to severe motor impairment and disability in patients. Identification of the cause of polyneuropathy requires real art, which includes knowledge of the clinical, electrophysiological picture and variants of the course of the disease, as well as a wide range of conditions leading to their development. Timely diagnosis of polyneuropathies and early assignment of etiological and pathogenetic therapy reduce the risk of developing irreversible changes in peripheral nerves caused by axonal degeneration. In the treatment of polyneuropathy of various origins, a special place is occupied by B vitamins, which have a neurotropic effect. Cyanocobalamin is a pathogenetic therapy in patients with diabetes who take metformin for a long time and who developed polyneuropathy due to vitamin B₁₂ deficiency. In one patient, a combination of several variants of polyneuropathies is possible. The article presents a clinical case of a patient with type 1 diabetes mellitus (DM) who developed dysimmune chronic inflammatory demyelinating polyneuropathy (CIDP) associated with DM on the background of distal symmetrical painless diabetic polyneuropathy after a COVID- 19 infection. A feature of the development of CIDP was the acute onset of the disease. Variants of the clinical picture, ENMG criteria, as well as features of treatment, the effectiveness of therapy and the prognosis of CIDP in patients with DM are discussed.