yes, yes, what kind of disease is it, what are its manifestations, and how is it diagnosed? russian sclerosis is an extremely serious disease of the central nervous system, that is , a disease in which the brain and spinal cord are affected. what causes it is currently not known for sure, but there are a number of risk factors, provoking moments, including viral infection, a special role is given to the epstein-barr virus, a certain genetic predisposition, certain geographical conditions of residence of individuals. of those last factors, it there is smoking, vitamin d deficiency, but all these factors, they affect the sum together, and it is certain that there must be something completely different, the main provoking moment that causes the processes of demyelination, that is , the destruction of nerve cells, is still unclear and not revealed to this day. processes of neurodegeneration, the death of these nerve cells, processes of neuroinflammation, but... not

in the usual sense in which we are used to perceiving it, but this is a chronic, smoldering so-called inflammation, including what leads to the loss of nerve cells of their membranes, to death of the neurons themselves and is manifested by various clinical neurological symptoms. it is not for nothing that russian sclerosis is called an organic chameleon, because it is rather a diagnosis of exclusion, we put russian sclerosis in the very last place after we have ruled out a whole series, not only neurologists. but completely different diseases or conditions. and how is it diagnosed? today, in russians, sclerosis is not diagnosed only clinically, it is a neuroradiological diagnosis of this disease, and in some cases it also requires additional laboratory tests examinations, namely the study of the cerebrospinal fluid of the cerebrospinal fluid due to the presence of so-called oligoclonal bands and immunoglobulin g, i.e. only by mri this diagnosis is incorrect, only by...

the clinic is also impossible, because officially there was such a publication where the list of those diseases and conditions that have a similar clinical picture to russian sclerosis, numbering up to 100, and a complex medical history, that is, we must understand in great detail from childhood and ask what happened then, whether these episodes that were similar or typical, as they can be in russian sclerosis, a certain set of complaints, a certain neurological examination and... what a neurologist sees with a hammer, an mri examination, certain neuroradiological findings, which also need to be able to correctly interpret and evaluate, and in some cases this study laboratories tatiana, you know, one more question, you said diagnosis, how is the diagnosis carried out, but i read that russian sclerosis is still often called a relapsing disease, if we have already made a diagnosis of russian sclerosis, why do we call it a relapsing disease? what is obviously meant is that... at the very

beginning of the disease, up to 80 people with it have a so -called remitting-relapsing course, that is , periods of deterioration, that is, the manifestation of clinical manifestations, alternating with periods of stability and improvement, and it happens that during during this remission, this period of improvement, the symptoms can completely disappear, and even if an experienced neurologist looked at her somewhere, he would not see the symptoms of the disease, but unfortunately... russians sclerosis is an autoimmune disease, and the main distinction and trait of all autoimmune diseases is that they are permanent, they do not go anywhere , and sooner or later, whether this remission will last for several months or several weeks or several years and even several decades, but the next episode of deterioration in the case of this remitting it will be of the relapsing type, 5% of people have people, have...

a progressive type of the course of the disease from the very beginning, and unfortunately, this is the most dramatic option, because disability, i.e. loss of human function, occurs very quickly, and in fact, until recently , there were actually no drugs that affected this type of course, it's interesting, but look at the manifestations, there are a lot of people, for some reason there is some association, if the word sclerosis is there, then it is related. with elderly people and with memory loss, there is a concept of such cerebral atherosclerosis, general atherosclerosis, this is a ribovascular disease that progresses with atherosclerotic, sclerotic changes, well, this is really such a game, probably words, because what was meant by the russian sclerosis, with russian sclerosis, when it was first described back in the 18th century, those morphological changes that were found in the brains of people with rusyn were described pathologically. sclerotic plaques,

and that's why there was such a certain, already erroneous inconsistency of terminology, well , to be honest, we work so much and... so neurologists, doctors of related specialties who are related to the diagnosis of this disease, that today such people who confuse these two concepts is much, much less, and unfortunately, that's when we are talking about cerebral metorosklosis, it is really a disease of older people, multiple sclerosis in our regions is a disease of the young, but there are certain time frames, frames after all, these are all very relative terms, when even taking the ukrainian population, we have such averages the age range of the onset of the manifest of these diseases is 20-40 years, when you take the population of people in ireland, in denmark - it is 35-40 and more years, that is, in general , there are some peculiarities of our geographical, that in our country it is a disease of young people, but there are cases of children are described in the literature in general, well, it’s very strange,

but the first case of children’s multiple sclerosis concerns a child of one and a half years old, we certainly have not seen such cases, the youngest patient we observed is a six-year-old child and... at the same time , the age limits are moving when i saw a patient after the age of 65, where these symptoms first appeared, i cut it off for a long time, looked for other alternative diagnoses, thought no, it can’t be, but this also exists and this also happens, it’s interesting, by the way, i want to our viewers to say that i read in the reference literature that now, at least as of 2021, there are about 21,000 people with russian sclerosis registered in ukraine, and all over the world, again, this is an estimate, because a lot of countries do not report in general, this information, somewhere around 2.9 million patients, well, that is, we see how tetyana ivanovna says that, after all, time frames are changing, and the number of people is getting sick more. tatyana

ivanovna, your algorithm of actions for a person who has learned that, unfortunately, he has this diagnosis, what to do next? well, first of all, this diagnosis still needs to be confirmed. in a highly specialized hospital or with specialists who have a broader understanding, that is , the center of russian sclerosis needs people who deal with exactly this problem, well , there is not even a question of a center of russian sclerosis, because what is a center of russian sclerosis, these are just those people who know more neurologists who know more about that problem, and in recent years, well, a lot of neurologists are experienced, and they can suspect without necessarily being, being treated in the center of russian sclerosis, but nevertheless you still need to go to, well... at least a fourth-level highly specialized hospital, where there are specialists who see many such patients, because not every region, not every place has such centers , and especially with the war, now it is probably not so easy to migrate and travel, but the first time, when there is such a suspicion, i

still highly recommend finding a specialist who will be geographically closest to you and contact him so that there is no mistake, because once again, a diagnosis of russian sclerosis is a diagnosis exclusion, it is necessary... to include everything and only under that condition we already understand that, unfortunately, it is still russian sclerosis. it is necessary to have highly qualified specialists who will help neuroradiologists to suggest that this is exactly what it is, and sometimes it is very little and not enough to do an mri of the brain, it may be unremarkable, and it may not be possible to fulfill the criteria either, because there are certain radiological criteria for making a diagnosis, it is necessary to do spinal cord, in some cases it is necessary to do certain virological examinations. because and infection and lymeborreliosis, and we had cases of neurosyphilis, cases of neurosyphilis, and so on, all this can also confuse this picture, but to get to a specialist, don’t save your time, don’t save, maybe at times on the road, on picking up, don’t

pay attention on the fact that you may not get to that specialist right away, well, there are certain rules, a specialist also has his own rhythms and regimes, he may be busy, and therefore... you still have to find and get there, where you will be helped. and in relation, we will return to the question a little statistics, why do we say more that there are more russian skunks. it is obvious that there are no more. our diagnosis has improved. many specialists, we now work together, we have taught ophthalmologists to diagnose, we have taught family doctors to diagnose, orthopedists, because a person can walk with his hands , leg weakness and go for treatment and treat ver'. logical problems of going to an orthopedist or practicing a vertebrologist and so on, when they pay attention, and there is great happiness, apparently, that we already have access now, for example, i have already started the registration process in ms base, this is a world organization where we can

fill in the actual number of our patients so that we understand how many there are, the war has disrupted a lot of things, a huge migration, a large number of patients have gone abroad, because they are... they are helped there, they are helped there in terms of diagnosis and treatment, this is one side of the coin, on the other hand, many patients from there come to us again because it is easier to get to a... specialist, it is easier for us to do an mri, it is easier for us to get the answer very quickly, which is needed, the same pulse therapy, it would be good if there were no patients and there was no need for this, but we are talking exactly about the problem and this is exactly what you need to know. tatyana ivanovna, since, as you already said, this is more of a disease of younger people, and well, i know people who, upon learning about the diagnosis, gave up so much that they did not even want to live, and i have heard a lot that russian... sclerosis is verdict do you think it's a verdict? absolutely not, especially we are talking about the last few

decades, when so many appeared highly effective drugs, that a person works absolutely adequately in social life, in the environment, feels very comfortable in his family environment, he can travel, he can raise children, all borders are open to him, all opportunities are open, but there is one thing, but.. first of all, this person must consult a specialist in time, must receive treatment in time, and that treatment must be permanent, although, again, in recent years , there have been drugs that do not need to be taken constantly, and this is the so-called therapy. immune reconstitution, it is enough to take several courses of treatment in life, and in many cases the disease is controlled, that is , it is said that russian sclerosis is now a disease that heals. yes, it is incurable, but it is a disease that can be treated, you need to be lucky enough to find exactly the

drug that will help in each specific case, and regularity, do not modify the doses, do not take breaks, when there is time to come for monitoring on time to the doctor, not only to you, when the drug was issued, but when some questions arise, the second important point is that there comes a time when the primary drugs do not work, and then one must be able to switch to that therapy, which is more highly effective and will help, and not for life, as prescribed, this is such a common mistake, and a person has been sitting on a drug that does not work for years and tens of years , that is, the question is also the patient himself, i know patients who come to them regularly like clockwork, we see them regularly, we can modify them, and there are patients who say, but i did not know, and i did not hear, but this is your health, this is your life, you should know better than a doctor sometimes. you must be able to read about each of those drugs, you must go to the forums, you must, well

, listen now with the possibilities of television, the internet, we say a lot of things, but the forums and broadcasts and specialists must be those who understand it, and therefore, now the question is exactly what, well, it does not apply only to multiple sclerosis, it applies to any medical problem, any medical, any disease, very often when a person hears some... diagnosis, and in this in the case of russian sclerosis, they begin to think about some unconventional methods, and what do you say about it? er, i will say this, of course everyone has the right to try everything, we can never, each person has his own way of thinking about everything, and he may not believe the doctor, because in my practice there was already so much experience when the drug is given free, which is highly effective with proven clinical effectiveness, a huge number of clinical studies to... you give the input, and the person does not want it, and that person is better off trying non-traditional methods, the answer is

just one thing: the general rule is that russian sclerosis must be properly treated with medication and disease-modifying therapy from the moment of diagnosis, whether it will be the diagnosis that i count my active participation at the stage of preclinical manifestations, even when there is no clinic, or at the stage of the first clinical episode, which did not happen for a few more years, even a dozen years... so time was lost, now we can do it at the very beginning, but from this moment of the first episodes, when we see that the disease will be prognostic behave unfavorably, you need to take disease-modifying therapy, everything else is up to you, so that it does not harm, but look, disease-modifying therapy, as far as i know, is a very expensive treatment, and if you take western countries, then in the west these drugs are covered by insurance , we don't have insurance. people with multiple sclerosis are simply not insured, is there any help from the state in this case

to receive this expensive, but very effective therapy. back in 2007, a group of our professors, who were working in ukraine russian sclerosis, we wrote the following proposals, a project that was submitted to the ministry of health, that this is very important, and since 2007, not all of our patients, of course, but a certain percentage were able to receive disease-modifying therapy, but such a basic series . i.e., which is only in the case of a remitting course and in such cases of non-gross disability, in recent years it was conducted even more intelligently, i.e. in each region a person and an institution were identified who managed... these patients, and when the number of patients who needed this therapy was submitted , then in that is how it was basically provided, but there is one but, that is the question, that is, the state provides, the question is one but, first of all, then it was not one hundred percent provision of patients, then some data was submitted by doctors, well, not quite correct, let’s say this, because, well, few people i wanted to sit

and prescribe, keep these statistics, keep those databases and enter them, but... where this was done, for example, in our region, where we administered these patients, we always had these drugs, and other things, but this the fact that these drugs are already for highly active rusinosclerosis, which are much more expensive, the state does not purchase, in fact, these are expensive drugs, and in fact only a really rich country can afford it, i do not want to give an analysis and assessment of that now, because i understand that there were things where money was spent in an unknown way and unknown way. and that is why my position is still to talk about the fact that there should be provision for such patients, and the blame, but it should be strict control, a specific patient, a specific drug and specifically see if it is indicated, or if it already makes no sense, it is possible already give, or is it the other way around you can give meaning and support this patient, that is

, everything becomes more like this, again , it is electronicized, it becomes more open, but... we still have to deal with it, at the moment, in the regions, we do it purely like this on a public voluntary basis, well, but i think that progress is going in that direction, and with regard to those non-traditional methods, but please, the only thing i want to say is that you need, well , i think, to believe in god, because there are different methods that go to different, to different forces, like they say, patients turn, regarding different diets, unconventional use, starvation. a lot has been written about it, we have talked a lot about it and are still talking about it, it should not cause harm, that is the main thing, without fanaticism, it is better to consult with whether it is beneficial for russian sclerosis, you know, it may not cause harm, but does it help , well, you see, diet, when to speak, and in general, a healthy diet will probably help every person, and vitamins, and

the sun in a normal amount, the same vitamin d, that is, these are the general rules of every person's existence. but there are no specific ones diets, there are no specific measures of any kind, well, what can’t be done, the enemy for people with russian sclerosis is some indications, contraindications, yes, these are infections, that is, when we understand that it is covid, then there is no need for a person with multiple sclerosis to go to crowded places, it is necessary to be vaccinated first, there should not be a question whether i should be vaccinated or not, this generally applies to any vaccination against influenza, only live vaccines are not allowed, it is necessary... to sanitary hygiene, distancing, all this must be observed, that is, the biggest enemy - this is infections, another enemy is smoking, it is strictly forbidden, there is smoking, there are already some recent publications, but these are certain contraceptives, very long-lasting in women, well, this is the case again, it is still being studied, direct sun,

but the sun is needed, because where vitamin d is produced, it is best with sunlight, but again... that's all, but the main thing is that each person has his own type of disease course, his own type of immune system response, and the main contraindication is not to take pathogenetic therapy, pathogenetic disease-modifying , therapy that affects the very essence of the disease, this is the main contraindication, well , look, many people who, unfortunately, are tangential to this issue, wonder, what? can this disease be inherited? russian sclerosis is not a disease that is transmitted by inheritance, but when we talked with you at the beginning, mr. yuri, we said that there is a certain genetic predisposition, and there are many such studies: genetics is a great force that affects the mutation of these genes, why this

happens, this is all being studied, and another 28 or so 25 years ago... the work at our department was on genetics, it was fashionable and now we are further in that direction, it is not transmitted by heredity, but nevertheless in the literature there are described cases in our clinical practice, in my database there are patients, where relatives, parents, children, aunts, even indirect relatives are sick in the family, there is one family where seven members of one family had this disease, it happens in different ways, well... now we have such families somewhere, now there are literally 12, but in general there is no need to be afraid of it, there is no need to be afraid to give birth to children, and in general, when i'm talking, because there was such a period. when i almost had to stand during childbirth, in maternity hospitals, to give birth, when they heard that a woman had multiple sclerosis, the obstetrician-gynecologists were afraid, no, a woman should behave and

give birth according to obstetric indications like any healthy woman, and pregnancy, childbirth, it absolutely does not affect the very essence of this disease, it is just a disease, as it is laid, it will continue to behave as it is, after the birth of the child, well here the most important thing is to... not get sick, i wish everyone good health, look, one more question, almost at the end, we talked with you, tenyana ivanovna, mostly about achievements, about how important it is to immediately make the correct diagnosis, how immediately to start treating this disease, to follow the first rules, to certain rules that you have already focused on, but are there any certain ones associated with russian sclerosis, well, with the treatment of russian sclerosis. for the problem in the world, in general in ukraine, in particular, what should possibly be changed? what should be changed? worth to change the psychology of each person, and

to take their health very seriously, it is worth changing, well, probably at the state level, so that our patients have access to absolutely all drugs, in the world of scientific achievements, pharmacology, it is worth continuing the search. the possible factor or factors that cause this disease, which affect the occurrence of exacerbations, its progression, the search for those factors that can mitigate the course of this disease, of course, the search for pharmaceutical effective drugs, and perhaps the most important - it's the availability of those drugs, well, there is this drug, but it should be available to every patient, it's the fact that we need to talk about this disease, we don't need to be ashamed, we need to unite. we had a meeting last week for people with multiple sclerosis and i invited a gynecologist in addition to answering questions, you know, we couldn't talk for four hours and we

understand that there are these simple simple questions that people just do not know, i.e. availability, contact with information, to that doctor, to that specialist, organizing certain meetings, because we understand, everyone has a job, we can't always say it correctly, but we find... time to discuss these very important questions, to communicate with the world, that's what war is, and i will say , this is a very huge tragedy, they gave up, like every person, a doctor is also a person, there are certain questions and so on, but if i understood for myself that it is necessary to go to those international congresses, to join, to read those international publications, to be in courses of what is done in the world, which achievements, what achievements, to contact with ... our colleagues from abroad so that we do not fall behind, that we are at the same level as we were before the war, that we can bring to our patients that little bit of that hope, and

maybe not even a tiny bit, that russian sclerosis is not a sentence, that we can overcome it together, optimism for the patient, because those patients who are fighting, who are positive, who are determined, it didn't work out that way, i won't be offended, i don't i will sit closed in my shell, we will search, we will take those steps. i i will believe that doctor, and the doctor has a patient who is committed to him, who is open to communication, it is much easier, and then together we can take the steps that need to be taken. i thank you very much , tetyana ivanovna, because it was a very good motivational address to all those affected by this problem, or their relatives, and in the end it was also a very good motivational address to all doctors. i thank you very much , tetyana ivanovna, for all your work, for your sensitivity to... for the way you help them, thank you for participating in today's program, since it was you who talked about the fact that after all the devil is not as scary as he is portrayed, and he is not such a monster, this russian sclerosis,

as it is sometimes called, thank you very much, thank you, very nice, it was an espresso interview , we talked today about multiple sclerosis, a difficult disease, a complex disease, but today i hope you have understood something about this disease, namely the understanding of this disease. is very important in order to live with it and overcome it. my name is yuriy fizar, it was an espresso interview, and today my guest is this tetyana ivanivna negrych, doctor of medical sciences, professor, head of the neurology department of the lviv national medical university and head of the russian sclerosis center at the lviv regional hospital. before meeting! tired of heavy and bulky saws, then strong saws from

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zima's big broadcast. two hours of airtime, two hours of your time. two hours to learn about the war and how the world lives. two hours to keep up with economic and sports news. two hours in the company of favorite presenters, presenters who have become like family to many, as well as distinguished guests of the studio. events of the day in two hours. vasyl zima's big broadcast. a project for smart and caring people. in the evening - unordinary a look at the news. good health, ladies and gentlemen, my name is mykola veresen. sharp presentation of facts and competent opinions. and in america they also say, let's have better roads , we will have even better roads. a special look at the events in ukraine, there will be some katsaps on the border of kyiv and beyond. what kind of world does mr. norman dream of, can we imagine it? all this in an informational marathon with mykola veresny. saturday 17:10, sunday 18:15 at espresso.

greetings to all viewers of espresso, yana yavomelnyk and this is the news: six people were injured through russian arrows of sumy oblast, the enemy attacked 16 settlements of the region during the day, inflicting 71 blows, the national police reported. the occupiers fired mortars, artillery, drones, rocket launchers and rockets. two apartment buildings, six shops, two cars, administrative premises in the department were damaged.