Proceeding of the Shevchenko Scientific Society. Medical Sciences Peer-reviewed journal "Proceeding of the Shevchenko Scientific Society. Medical Sciences" published by Shevchenko Scientific Society en-US (Oksana Zayachkivska) Tue, 24 Dec 2019 00:00:00 +0200 OJS 60 PROTECTION OF T-LYMPHOCYTES VIA PD-1 RECEPTOR: NEW MOLECULAR MECHANISM OF CANCER IMMUNOTHERAPY <p>After briefly reviewing major forms of cell death and discovery of programmed (cell)<br>death 1 (PD-1) protein and its ligands (PD-L1 and PD-L2), this overview is focused on how<br>PD-1 and PD-1 ligands are involved in a new form of in immunosuppression that represents a<br>new approach to cancer therapy. Namely, tumor cells often kill cytotoxic T lymphocytes<br>through PD-1 mechanisms – hence, PD-L1 inhibitors represent a new molecular mechanism of<br>cancer immunotherapy (Jobin C., Science, 2018, 359, 32-34). Recent translational clinical<br>research also revealed a substantial influence of gut microbiome on response to PD-1-based<br>cancer immunotherapy. The initial discovery was that cancer patients treated with antibiotics for<br>various infections have diminished response to anti-PD-1 therapy. Comparing the fecal<br>microbiota of responders to non-responders revealed increased abundance of Akkermansia<br>muciniphila, Faecalibacteria &amp;amp; Bifidobacteria in patients showing favorable outcomes to<br>anti–PD-1 treatment. (Gopalakrishnan V et al. Science, 2018,359,97-103). Conclusions: 1.<br>Recent studies revealed how inhibition of certain cell death (e.g., cytotoxic T cells) via PD-1<br>leads to increased death of tumor cells. 2. The effectiveness of PD-1-based cancer<br>immunotherapy is greatly influenced by gut microbiome (e.g., firmicutes and clostridia have<br>positive, while bacteroidia exert negative effects). 3. Nevertheless, checkpoint inhibitors (via<br>PD-1, PD-L1) represent a new and effective cancer immunotherapy, even in metastatic<br>melanoma. 4. Thus, the discoverers of PD-1 &amp;amp; PD-L1 rightly shared the 2018 Nobel Prize in<br>Physiology or Medicine.</p> Sandor Szabo Copyright (c) Tue, 24 Dec 2019 00:00:00 +0200 DIAGNOSTICS AND MANAGEMENT OF CEREBRAL ARTERIAL ANEURISM RAPTURES (CURRENT STATE OF AFFAIRS) <p>The review of the literature and our own clinical observations include data from the official statistics of the Ministry of Healthcare of Ukraine concerning new stroke occurrences. One-third of patients are working-age people. Subarachnoid haemorrhage (SRH) constitutes a universal manifestation of the arterial aneurysm (AA) rupture, which results in the rupture of the cerebral angiospasm causing secondary ischemic brain damage.</p> <p>In case of cerebrovascular disease, the mortality rate from the subarachnoid haemorrhage (SRH) constitutes 2.8 per 1,000 people. To achieve positive changes in this epidemiological situation in Ukraine, a State Program “Preventing and Management of Cardiovascular and Cerebrovascular Diseases in 2006-2010” was adopted in 2006. One of its main tasks is to provide high-tech aid to patients with cardiovascular and cerebrovascular diseases.</p> <p>&nbsp;</p> <p>Parenchymal-and-ventricular (64.5%), subarachnoid-parenchymal-ventricular, and subarachnoid-ventricular haemorrhage types were found to be the most common, the latter occurring in 16.7 and 15.9% of cases respectively, whereas ventricular haemorrhage was observed in 2.9% of cases.</p> <p>Non-invasive diagnostics of unruptured intracranial aneurysms and determining of its first rupture risk factors based on its data (shape, size, localization) with the help of appropriate methodologies, allows to immediately apply a respective surgical approach to prevent the occurrence of the first rupture, which may be lethal.</p> <p>Advantages of endovascular treatment at the early haemorrhage stages and higher radical nature of aneurysm elimination using a microsurgical method have been theoretically justified and confirmed under clinical conditions. &nbsp;Specified literary, clinical, and instrumental data raise awareness about the pathogenesis of complications in case of ruptures of intracranial arterial aneurysms and reveal their predicted significance. The choice of the best surgery term and method presents an effective means to reduce the level of post-surgical mortality in case of aneurysmal intracranial haemorrhages.</p> <p>A newly developed and implemented method to determine the degree of the intraoperative angiospasm is described.</p> Andriy Netliukh Copyright (c) Tue, 24 Dec 2019 00:00:00 +0200 EFFECTIVENESS OF DOSAGE FORMS WITH FLURENIZIDE IN PREVENTIVE CARE AND TREATMENT OF DANGEROUS AND CONTROLLED INFECTIOUS DISEASES <p><strong>Introduction.</strong> Creation of an efficient and safe medication is based on the knowledge of the world’s best achievements in medicine and pharmacy. Development of new original medications and dosage forms, study of their specific medicinal properties, application and advantages over well-known brands are important for achieving a high quality medical assistance.</p> <p>The innovative product – substance Flurenizide served as the basis for new dosage forms (solid, semisolid and liquid) intended for preventive care and treatment of dangerous and controlled infectious diseases for human and veterinary medicine.</p> <p>Development and introduction of new efficient antimicrobial, antiviral and antiseptic medications into medical practice is a relevant task today. Variety of microorganisms, their ability to mutate and create forms which are resistant to existing chemotherapeutic medications urges us to seek new and more effective medications for prevention and treatment of infectious diseases. In the early 90's at the Lviv State Medical Institute received an organic compound, patented under the name "Flurenizyd ™. Pharmaceutical and medicines that are used to people and animal"[1].</p> <p>Flurenizyd registered in the State Register of medicines Ukraine as a new drug in original Ukrainian antytuberkulozen and antimicrobial activity (registration № Р.10.00/02305 від 12.10.2000 р.) [2].</p> <p><strong>Materials and methods.</strong> Information search scientific literature. A profound analysis of patent information of Ukrainian and foreign scientists showed that fluorine use in medicine and pharmacy is promising. There are effective substances among them which are suggested for preparing readymade dosage forms and those which have already been applied in production (Florenal, Amixin et al).</p> <p>Research methods were mikrobioloґichni, farmakologichni, farmakotehnologichni and clinical trials.</p> <p>Flurenizide is an important biomolecule with properties which are optimal for having required pharmacological effect – antimicrobial (antituberculosis, antichlamydia), immune modulating, antioxidant, antiradical, hepatoprotective, anti-inflammatory etc.</p> <p>Described new dosage forms (solid, soft and liquid), exhibit higher clinical effect. They are intended for the prevention and treatment of hazardous and controlled infectious diseases in medicine and veterinary medicine. Use Flurenizydu in various dosage forms expand the range of drugs antiviral, antimicrobial and antiseptic action needs to humane and veterinary medicine.</p> Мaria Kovalenko Copyright (c) Tue, 24 Dec 2019 00:00:00 +0200 LYMPHOCYTAR INFILTRATES IN THE THYROID GLAND OF PATIENTS OPERATED ON THE BASIS OF THYROID PATHOLOGY <p><strong>Introduction</strong>. The pathohistological examination of the surgical material of patients operated on for thyroid disease reveals in the thyroid gland a different degree of lymphocyte accumulation: lymphoid follicles, focal and diffuse lymphocytic infiltrates.<strong>Methods</strong>. With aim to determine the composition and features of the localization of lymphocytic infiltrates in thyroid gland a typical pathohistological and immunohistochemical examination of surgical material of 15 patients operated on for autoimmune Hashimoto's thyroiditis, focal thyroiditis and thyroid papillary carcinoma in combination with autoimmune or focal thyroiditis using antibodies to the lymphocytes antigens CD3, CD8, CD20 and CD138 was made. <strong>Results and conclusions</strong>. In Hashimoto's autoimmune thyroiditis and focal thyroiditis CD3 and CD8 positive lymphocytes equally in T-dependent zones and CD20 positive lymphocytes in B-dependent zones of lymphoid follicles were found. In patients with thyroid papillary carcinoma in the tumor and adjacent to the tumor tissue of the thyroid gland moderate infiltration of CD3 and CD8 positive lymphocytes were revealed. The same composition of lymphoid follicles in Hashimoto's autoimmune thyroiditis and focal thyroiditis is an additional argument in favor of the fact that these two diseases are different stages in the development of a single autoimmune lesion. The presence of CD8 positive lymphocytes in the tumor in thyroid papillary carcinoma is a manifestation of the local immune response and is of great clinical and prognostic importance.</p> Volodymyr Vovk, Ulyana Omelyash Copyright (c) Tue, 24 Dec 2019 00:00:00 +0200 ON YEARS OF POTENTIAL LIFE LOST AMONG WORKING AGE POPULATION DUE TO PREMATURE MORTALITY CAUSED BY THE ACUTE MYOCARDIAL INFARCTION <p><strong>Purpose of the study </strong>is to determine the volume of losses of man-years of potential life among the working-age population in Ukraine due to mortality caused by myocardial infarction [I.21, I.22, I.23] in the context of the YLL premature death indicator (years of life lost due to premature mortality) and evaluate the impact of this demographic phenomenon on social and economic life in Ukraine.</p> <p><strong>Materials and methods. </strong>A complete, one-dimensional, continuous, population-based epidemiological research was based on data where the State Statistics Service of Ukraine databases on working-age population mortality caused by the myocardial infarction were used as a source of information for the calculation of the DALY indicator (2002-2015) &nbsp;[І.21; І.22; І.23]. Subsequently, they were summarized and processed using Microsoft Office Excel 2016 spreadsheets. The retrospective, potential demographics, statistical, mathematical, abstract, graphical research methods, the standard methodology for calculating of the YLL premature death indicator, as well as such methods, as copying, deductive awareness, structural, and logical analysis with account for principles of systematicity, were used.</p> <p><strong>Results. </strong>It was confirmed that in 2015, the number of working age population (16-59 years) in Ukraine amounted to n=26,679,376 people (women - n=13,659,004, where P=51.20%; men - n=13,020,372, where P=48.80%) and constituted P=62.39% of the total population in Ukraine (n=42,759,661), with a demographic load indicator - P=607 persons aged 0–15 and 60+ per 1000 population aged 16–59.</p> <p>It has been found that because of premature n=1,931 deaths (men - n=1,773, where P=91.82%, and women - n=158, where Р=8.18%) due to MI [I.21, I.22, I.23] among working-age population (n=26,679,376) in 2015, n=29,315.73 man-years of potential life were under-lived (men – n=25,364.81, where Р=86.52% and women - n=39,50.92, where Р=13.48%), whereas Ukraine did not receive 1,637,386,125 UAH 55 kopiykas to the total GDP</p> <p><strong>Conclusions. </strong>According to YLL premature death indicator, the quantitative and economic estimation of premature years of potential life lost among working-age population as a result of death due to MI [I.21, I.22, I.23], serves as a strong argument for determining nation-wide strategic priorities for government policy-making in the field of promoting and preserving public health among the working-age population in the context of premature death, which carries a financial burden on the GDP of the country.</p> Vasyl Ruden Copyright (c) Tue, 24 Dec 2019 00:00:00 +0200 THIRTIETH ANNIVERSARY OF THE RENEWED SHEVCHENKO SCIENTIFIC SOCIETY. MEDICAL COMMISSION - THE FIRST STEPS <p>The revival of several Ukrainian public organizations took place against the background of changes inherent in the national policy of the Soviet Union in the last years of its existence.</p> <p>The author, one of the participants of the Ukrainian national revival of the 1880-1990s, describes the process of revival and the first steps of the oldest Ukrainian academic scientific organization - Shevchenko Scientific Society, and first of all - its medical committee, among other manifestations of national revival in the late 1980s in Lviv and Ukraine in general.</p> <p>The restoration of non-governmental Ukrainian organizations whose activities ceased in 1939-1940, took place against the backdrop of other events of that time that were significant for the medical community. Close cooperation among doctors, active members of the Society, in national patriotic events of that time, and the restoration of printed media of the Society is emphasized.</p> Oleksandr Kitsera Copyright (c) Tue, 24 Dec 2019 00:00:00 +0200 ALTA ALATIS PATENT [THE SKY FOR THOSE WHO HAVE WINGS] (ON THE OCCASION OF DR. VASSYL LONCHYNA'S ANNIVERSARY) <p>Dr. Vassyl Andriy Lonchyna (October 6, 1949), an American of Ukrainian descent, is a cardio-thoracic surgeon and critical care specialist at the University of Chicago (until 2014). In 2016-2017 he was a US Fulbright Scholar in Ukraine, studying the medical education system. In 2017-2018 he completed a fellowship at The MacLean Center for Medical Ethics at The University of Chicago and edited the book “Difficult Decisions in Cardiothoracic Critical Care Surgery” (Springer, 2019). He is a member of Plast, The Shevchenko Scientific Society (SSS), The Society of Thoracic Surgeons (STS), The European Association for Cardio-Thoracic Surgery (EACTS), The American College of Surgeons (ACS) and The American College of Cardiology (ACC). He has a multifaceted personality with 45 years of physician experience at US clinics. Today, he is an Editor of the journal “Medical Sciences. Proceedings of the SSS”, a lecturer of “Ethics for the physician” course at the School of Bioethics of the Ukrainian Catholic University (Lviv), and an associate of the Cardiac Surgery Department of the Lviv Regional Clinical Hospital. The article briefly presents biographical information on the occasion of Mr. Vassyl Lonchyna's 70th anniversary.</p> Uliana Pidvalna Copyright (c) Tue, 24 Dec 2019 00:00:00 +0200 A COMPARATIVE STUDY OF THE EFFICACY AND HEMODYNAMIC CHANGES OF COMBINED SPINAL EPIDURAL ANESTHESIA AND SPINAL ANESTHESIA FOR TOTAL VAGINAL HYSTERECTOMY <p><strong>Introduction.</strong> The choice of the best anaesthesiologic method for total vaginal hysterectomy surgeries must be based on the results of the assessment of patient's preoperative condition, specific risks of anaesthesia as well as the magnitude of local functional and structural changes, their compensation, technical peculiarities of this surgery, and the need for adequate perioperative anaesthesia while preserving vital functions within an acceptable, safe range. The use of block anaesthesia methods in total vaginal hysterectomy surgeries has several advantages due to reliable protection against surgical stress with minimum systemic impact on the body.</p> <p><strong>Aim.</strong> To compare the effectiveness and safety of spinal - and combined spinal-epidural anaesthesia methods during total vaginal hysterectomy in patients with incomplete uterine prolapse based on the comparative analysis of hemodynamic profiles, quality of intraoperative anaesthesia, and the duration of postoperative analgesia.</p> <p><strong>Methods.</strong> 40 female patients were examined in the gynaecological department of "Lviv emergency hospital" who underwent a planned total vaginal hysterectomy due to incomplete uterine prolapse of II and III degrees. Group 1 (n = 18) included patients who received a combined spinal-epidural anaesthesia (CSE), while group 2 (n = 22) — received classical spinal anaesthesia. Cardiac output (CO) and cardiac index (CI) were monitored using an esCCO module (Life Scope Monitor by Nihon Kohden, Japan). In addition, blood pressure (BP), mean blood pressure (MAP), and heart rate (HR) were measured. The postoperative pain intensity was evaluated using the VAS-scale.</p> <p><strong>Results.</strong> In contrast to group 1, we observed a significant decrease in CO and CI after 30 minutes as well as a decreased MAP - after 60 minutes from the onset of anaesthesia in group 2. A tendency towards hypotension and bradycardia was observed until the end of surgery in both groups. The total volume of infusion for the prevention of hypotension in group 1 was 1,543.75 ± 55.45 ml, which equalled 21.36 ± 1.12 ml / kg of body weight; in group 2, it amounted to 1,835.0 ± 70.7 ml, i.e. 26.17 ± 1.51 ml / kg (p = 0.006); the difference was 18.4%. Immediately after surgery, pain levels in both groups were equal (VAS 0), but after 2 hours of the postoperative period, the pain level of the second group was twice as high - with VAS 4, whereas in the first group it was VAS 2. This difference remained even after 4 following the surgery.</p> <p><strong>Conclusions.</strong> The CSE group needed a significantly smaller volume of infusion compared to the group that received spinal anaesthesia, which indicates a more stable and safe hemodynamic response. This is also confirmed in the study of indicators, such as BP, MAP, CO, CI, and HR during the surgery. During CSE, postoperative analgesia was more effective due to prolonged epidural analgesia. &nbsp;</p> <p><strong>Disclosures.</strong> No conflicts of interest, financial or otherwise, are declared by the authors. &nbsp;</p> <p><strong>The personal contribution of the authors</strong>. The authors of this publication personally conducted all levels of research and literature review, as well as meta-analysis. The authors established the purpose of the study, analysed, and formulated the results upon the study of the topic relevance. The authors have also conducted a comprehensive clinical, laboratory, and instrumental examination and personally treated patients.</p> Nataliya Matolinets Copyright (c) Tue, 24 Dec 2019 00:00:00 +0200 PROBLEMS OF VERIFYING HEMATOLOGICAL NEOPLASMS ASSOCIATED WITH CHORNOBYL RADIATION DISASTER: CASE-BASED REVIEW <p>&nbsp;</p> <p><strong>Introduction: </strong>The elucidation of the impact of radioactive contamination caused by Chornobyl accident on the development of hematogenous neoplasms remains a relevant issue. Therefore, the assessment of cancer incidence due to contamination of extensive territories by radionuclides should be based not just on epidemiological data, but also on specific clinical cases of this disease occurrences because of both deterministic and stochastic effects.</p> <p><strong>The aim</strong> of our study was to analyse clinical cases of hematopoietic and lymphoid cell tumours associated with Chornobyl accident and to detect hematologic neoplasms caused by radiation, elaborate criteria for their differentiation with spontaneous morbidity.</p> <p><strong>Research methods: </strong>Retrospective analysis of available medical records of patients with hematologic neoplasms who are living or lived in Lviv region and whose tumours may be associated with Chornobyl accident in the 25-year period from 1992 to 2017.</p> <p><strong>Results: </strong>We have found that information about officially registered cases of hematologic neoplasms in persons recognized as victims of Chornobyl accident, predominantly those who participated in the elimination of the accident consequences, their children, and displaced persons, remains closed. It was only in six cases that we were able to conduct a retrospective analysis of medical records of persons with hematologic neoplasms associated with Chornobyl accident. Five of these patients are liquidators’ children and one person was resettled from Kyiv region. In fours cases, the disease was diagnosed in childhood and in two other cases, it was diagnosed in adolescence (21 and 25 years old). Four patients were diagnosed with non-Hodgkin's lymphoma, while two others were diagnosed with Hodgkin's disease and acute myeloblastic leukaemia. Based on the analysis, a clinical case of non-Hodgkin's lymphoma most likely associated with Chornobyl accident was described. The paper analyses problems associated with detection of tumours caused by radionuclide contamination as a result of Chornobyl catastrophe.</p> <p><strong>Conclusion: </strong>Cases of neoplasms that may be associated with Chornobyl catastrophe require a comprehensive analysis, long-term patient follow-up and reporting in scientific publications.</p> Yevhen Dzis Copyright (c) Tue, 24 Dec 2019 00:00:00 +0200 RARE LATE COMPLICATIONS OF ACUTE PANCREATITIS AMONG COLOURED POPULATION IN AFRICA (CLINICAL CASE DESCRIPTION) <p>Acute pancreatitis is deemed the most common disease among the population of African countries - 1% of all general surgical conditions. Surgeons associate such indicators with no or limited methods of laboratory and instrumental diagnostics and respective specialists. Most cases of acute pancreatitis and its complications get masked by other false diagnoses and may be successfully treated conservatively subject to a mild disease progression. Medium or severe acute pancreatitis is diagnosed with the help of explorative laparotomy in cases of the “burst abdomen” as a preliminary diagnosis. The article features a description of the clinical progression, diagnostics, and successful treatment of acute pancreatitis complication, which is rare for the African Region – festered post-necrotic pancreatic pseudocyst – in the Baptist Medical Centre (Nalerigu, Northern Ghana).&nbsp; The diagnosis was made based on clinical symptoms, computer diagnostics and consultative telemedical healthcare at the general surgery clinic in Lviv. A program for diagnostics and treatment of the described case is compared against the modern literature data.&nbsp; The article highlights the peculiarities of diagnosing and treating the condition under the specific conditions of the African Region.</p> Anastasiya Furtak, Heidi Haun, Dariy Bidiuk Copyright (c) Mon, 24 Feb 2020 00:00:00 +0200 FUNCTIONAL STATUS OF PROOXIDANT AND ANTIOXIDANT SYSTEMS IN THE LUNGS UNDER EXPERIMENTAL ALLERGIC ALVEOLITIS AND STRESS <p>We have analysed the results of the study of alterations in indices of pro-oxidant (conjugated diene and malondialdehyde) and antioxidant (superoxide dismutase, ceruloplasmin, catalase) systems in guinea pigs’ lungs in experimental allergic alveolitis in the dynamics of EAA development under the conditions of immobilization stress. The study included 62 female guinea pigs weighing 180-220 g, divided into 4 groups: I – intact guinea pigs (n=20), II – guinea pigs (n=14) with EAA under conditions of IS (1<sup>st</sup> day); III – guinea pigs (n=14) with EAA under conditions of IS (2<sup>nd</sup> day); IV – guinea pigs (n=14) with EAA under conditions of IS (34<sup>th</sup> day). The results of the experimental study showed that a significant increase in conjugated diene level in animal lungs was observed at all stages of EAA development under conditions of immobilization stress as compared to a control group, indicating the activation of this marker. The same changes occurred with MDA content, indicating excessive accumulation of this lipid peroxidation product in lung tissue. Intensive synthesis of free radical compounds caused activation of some components of the enzymatic system of antioxidant defence. In particular, a moderate decrease in superoxide dismutase activity in lung tissue is observed in response to an increased level of LOPs at early stages of EAA and immobilization stress development as compared to these indices in intact animals. The same situation is observed with catalase and ceruloplasmin activity in the lungs of guinea pigs with modelled AA and IS.</p> Marta Kovalska Copyright (c) Wed, 25 Dec 2019 00:00:00 +0200 CYTOKINE PROFILE IN PATIENTS WITH REACTIVE ARTНRITIS CAUSED BY EPSTEIN-BARR VIRAL AND CHLAMYDIAL INFECTIONS <p><strong>Introduction. </strong>Currently, reactive arthritis is the most common joint disorder among people of working age. The inflammatory process occurs not only as a result of bacterial infection (urogenital, intestinal or respiratory), but is also caused by viruses (viruses of hepatitis, rubella, herpesviruses, especially EBV, etc.).</p> <p><strong>Methods. </strong>97 patients with ReA have been examined (28 patients with C. Trachomatis, 33 patients with EBV, 19 patients with combined EBV and C. Trachomatis infection, 17 patients ReA with induced by tonsillitis). The level of IL-10, IL-17, IL-23, TNF-α and IFN-γ cytokines has been evaluated in duplicates in blood serum by flow cytometry technique, using magnetic microspheres conjugated to monoclonal antibodies with the help of the BioPlex 200 platform with HRF ( Bio-Rad, USA) using Luminex xMAP® technology and relevant special kits.</p> <p><strong>Results. </strong>We have found a significant increase in the level of TNF-α, IL-17, IL-23 and INF-γ and a decrease in the level of IL-10 in all study groups of patients with combined EBV and C. Trachomatis infection, EBV, C. Trachomatis, ReA induced by tonsillitis as compared with the control group of healthy patients<strong>. </strong></p> <p><strong>Conclusions.</strong> Assessment of the inflammatory process activity level by determining the concentration of cytokines enables to predict the risk of rheumatoid arthritis or other systemic autoimmune pathology in the future.</p> Marta Lomikovska Copyright (c) Tue, 24 Dec 2019 00:00:00 +0200 ANTIVIRAL THERAPY IN PATIENTS WITH HERPES SIMPLEX VIRUS INFECTION AND CONNECTIVE TISSUE DISEASE <p>This short communication presents the results of the investigation of antiviral therapy clinical efficacy in patients with systemic connective tissue disease and chronic recurrent herpes during and after treatment and in the long term, depending on the therapy received. Considering the importance of herpes simplex virus infection as one of the triggers in the development of systemic connective tissue diseases, studying and evaluating the effectiveness of antiviral treatment is an important issue in this group of patients. Based on the data obtained, the clinical efficacy of Inosine pranobex (Novirini) in groups of patients with mild, moderate and severe herpes simplex infection and systemic connective tissue disease was calculated. The results show that use of Inosine Pranobex in patients with a mild course HSV 1/2 infection contributed to headache relief in 82,4%, temperature normalization in 75.0%, and decreases fatigue in 72.2%. In the group of patients with moderate to severe herpes virus infection, who received Acyclovir in addition to Inosine Pranobex, headache was reduced in 73.9%, temperature normalization in 66.6%, fatigue reduction in 65.5% of cases.</p> Natalia Horbal Copyright (c) Tue, 24 Dec 2019 00:00:00 +0200