Prescribing antibacterial drugs

In the appointment of antibacterial drugs for the treatment of the GDH in pregnant women should consider the duration of pregnancy. In the first trimester, at the stage of organogenesis, the fetus is most sensitive to the action of medicinal substances and therefore during this period of pregnancy only harmless drugs are prescribed that do not adversely affect the fetus. In the first and second trimester of pregnancy, the spectrum of antibiotics used for treatment can be expanded. In the postpartum period, antibacterial drugs of various groups can be used, provided that the breastfeeding is suspended.
The duration of antibiotic use is determined by the nature and severity of the disease. Unreasonably long-term antibiotic therapy increases the frequency of side effects of drugs, including the development of dysbiosis, antibiotic-associated diarrhea [3]. In most cases, antibiotics can be canceled 2–3 days after the temperature normalizes. If within 48–72 hours after the start of antibiotic therapy there is no positive dynamics of the disease, the issue of changing antibacterial drugs should be resolved (even in the absence of bacteriological examination results). However, it must be certain that the removal or surgical debridement of the foci of infection (according to indications) has been fully performed (for example, hysterectomy and drainage of the abdominal cavity during obstetric peritonitis; operation for purulent mastitis; instrumental emptying of the uterus during an infected abortion, etc.) . As you know, the causes of the ineffectiveness of antibiotic therapy can be the resistance of the pathogen to this drug, insufficient penetration of the antibiotic into the focus of inflammation, impaired immune status of the woman.

Summarizing the above, it is necessary to emphasize that antibacterial drugs are an important, often the main component of the complex therapy of infectious diseases in obstetric practice; their rational and reasonable use in most cases determines the effectiveness of the treatment, favorable obstetric and neonatal outcomes.

Treatment of Morton’s Neuroma

At the initial stages of the development of the disease is carried out conservative treatment. The first recommendations of the attending physician are: unloading of the feet, periodic use of the metatarsal pads and lifts, wearing shoes with a retrocapital support. The essence of these methods is to reduce the pressure on the nerve trunk. The use of custom-made orthopedic insoles increases the effectiveness of conservative treatment. With their help, it is possible, firstly, to reduce the load on the front area of the foot and restore the state of the transverse arch to normal; secondly, to reduce the pressure of bones and ligaments on the damaged nerve, which allows you to stop the progression of the disease; thirdly, to eliminate the inflammatory process in the nerve fibers and tissues, which significantly reduces or completely eliminates pain; fourthly, to restore the structure of the foot, thereby ensuring the correct gait.
If the pain syndrome is not pronounced, it is possible to use multicomponent compresses with dimexidum, nonsteroidal anti-inflammatory drugs and local anesthetics in combination with muscle relaxants and manual therapy. With insufficient effect, injections of glucocorticosteroids are performed in the interplusar space on the back of the foot, which in half of the cases leads to an improvement in the course of the disease, and in one third of the cases – to complete recovery. If a patient has a deforming arthrosis, it is possible to prescribe chondroprotectors for prophylactic treatment.
In the case of resistance to conservative methods of treatment, patients are offered surgical treatment. In this case, there are several different approaches to the treatment of Morton syndrome surgically.
The most common operation performed under local anesthesia is the removal of the neuroma. Since it is part of the nerve, its hypertrophied and inflamed area is excised. In most cases, this eliminates the pain syndrome, but, as a rule, a small area of unexpressed numbness remains on the foot, which is almost always not felt until the patient touches it. Motor and support functions of the foot do not suffer. The rehabilitation process averages 2-4 weeks, during which the patient is recommended to reduce the load on the foot.
Some surgeons believe that excision of the inflamed area of the nerve as a primary surgical method is too radical. The operation of dissection (release) of the transverse ligament between the metatarsal bones will eliminate the nerve compression. One of the advantages of this method is the absence of sensory disorders. In the event that this operation does not lead to success, excision of the neuroma is possible.
Osteotomy of the 4th metatarsal bone is the least used method of surgical treatment of the pathology under consideration. The essence of the intervention is that due to the displacement of the head of the 4th metatarsal bone after osteotomy (artificial fracture), nerve decompression is achieved. This manipulation is performed under x-ray control through an incision or puncture of the skin, not exceeding 2 mm.
Analysis of the effectiveness of surgical treatment of Morton’s neuroma showed excellent results (complete absence of pain syndrome and other symptoms) in 45% of cases, good results (significant reduction of pain syndrome and almost complete regression of neurological symptoms) – in 32%, in 15% of cases the outcome was satisfactory ( pain syndrome decreased slightly, neurological symptoms persist), in 8% – unsatisfactory (the operation did not bring any improvement). The low effectiveness of surgical interventions is associated with the formation of a true amputation neuroma in the proximal part of the interplusomer nerve….

Diagnosis of Morton’s Neuroma

Clinical diagnosis of this pathological condition is simple. First of all, it is based on the characteristic localization of pain. During palpation of the 3rd interplusar gap for 30–60 s, the patient, as a rule, begins to experience numbness and a burning sensation. Movement disorders are uncharacteristic. Sensory disturbances confirm neural damage.
Speaking of instrumental studies of Morton’s metatarsalgia, it should be noted that magnetic resonance imaging, unfortunately, does not always confirm the clinical diagnosis and in some cases gives questionable results. Performing computed tomography of the foot rarely gives any information due to the lack of mineral deposits in this soft tissue formation. However, due to X-ray methods, it is sometimes possible to determine the bone bite in the place of compression of the neuroma.
Ultrasound examination is one of the leading methods for diagnosing the condition of soft-tissue structures of the foot. However, in our country, the use of ultrasound for the diagnosis of diseases of the peripheral nerves is not sufficiently developed.
The regression of pain syndrome after the treatment and diagnostic blockade of the interplusal nerve with a solution of a local anesthetic is a convincing indication in favor of neuroma.
Pain in the foot and fingers is often observed in clinical practice, in most cases it is caused by deformity of the foot, which occurs in various pathological conditions, in particular with flat-footed or chronic Achilles tendinitis. However, with significant deformity of the feet, a pronounced pain syndrome does not always develop, as, for example, in patients with hereditary spastic paraplegia.
Differential diagnosis of Morton’s Neuroma is conducted with diseases such as synovitis of the metatarsophalangeal joint, stress fractures of the metatarsal bones and metatarsophalangeal joint arthritis, osteonecrosis of the metatarsal heads, neoplastic lesions of bones, lumbar spine disease, radiating pain in the intertarsal gaps.

The mechanism of development of Morton’s neuroma

The mechanism of development of Morton’s neuroma is not well understood, but a number of hypotheses have been proposed. When studying the morphological material, it was concluded that, with this pathology, a thickening occurs on the tarsal tibial nerve, and the researcher believed that this is not a true neuroma, but a pseudoneuroma similar to that which develops in the trunk of the median nerve above its compression site carpal tunnel syndrome. Later, changes that ranged from thickening of the wall to complete obliteration of the lumen of the artery supplying the nerve and adjacent tissues in this area of the foot were described, the conclusion about the ischemic nature of the pathological process was made. At present, it is believed that the starting moment is repeated, multiple microtraumas and nerve compression, which passes between the 3rd and 4th metatarsal bones, as a result of which the transversal interlumbus ligament is thickened, the separation
its on fiber and the formation of edema. The so-called pathological interlaryus ligament of the foot leads to constant compression and displacement of the medial plantar nerve and its accompanying vessels, causing its ischemia. Modern studies have shown that the average size of neuroma is 0.95–1.45 cm in length, and 0.15–0.65 cm in width, that is, it is an elongated, spindle-shaped formation.

Treatments for Morton’s Neuroma

The article describes Morton’s neuroma, presents a clinic of the disease with a description of the nature of the pain syndrome and neurological symptoms. The measures for the prevention and conservative treatment of Morton’s neuroma are described, including the use of orthopedic insoles and other orthopedic aids.

Tunnel or compression syndromes / neuropathies are one of the most common groups of diseases of the peripheral nerves and constitute, according to different authors, from 25% to 40% of all diseases of the peripheral nervous system.
In the scientific literature there is information about two diseases of the foot, which are associated with the name of the American surgeon Thomas George Morton (1835-1903). The first is Morton’s foot, otherwise, the syndrome of insufficiency of the first metatarsal bone, in which the second toe of the foot is longer than the first, which is a factor predisposing to the formation of the hammer-like second toe. The second is Morton’s neuroma, a manifestation of tunnel syndrome in which the nerve that passes between the heads of the 3rd and 4th metatarsal bones suffers. This disease has many synonyms: metatarsalgiya Morton, plantar interdigital neuroma, interplusus neuroma, foot neuroma.
In 1876, Thomas Morton first described the syndrome observed in 12 patients with an “unusual and painful lesion of the 4th metatarsophalangeal joint”. In studying this pathology, Morton suggested that mechanical compression of the nerve with the heads of the metatarsal bones is the main mechanism for the development of the disease.
Compression neuropathies are currently believed to be a polyetiologic disease. In their formation play an important role as a genetic predisposition, and the impact of exogenous and endogenous factors. Among the many etiological factors that cause the development of tunnel neuropathies, it is necessary to highlight the main ones that play a major role in the formation of Morton’s neuroma. These include: transverse flatfoot, wearing close shoes (including shoes
with high heels and narrow nose), acute traumatic injuries and hematomas at the site of localization of nerve fibers, irregular gait with turning the foot inwards, obliterating diseases of the lower extremity vessels, overweight, increased load on the front foot, infectious and autoimmune diseases, changes in the structure of the nerve, lipomas of various types.

Diet №8

Diet № 8 – one of the most popular types of diets, which is used by people suffering from obesity. It provides a portion meal. Thus, a person eats at least six times a day, but the products should not contain more than 100 grams of fat, 150 g of carbohydrates and 100 g of protein.

This is a compromise diet for many. As a rule, most nutritionists tend to remove excess carbohydrates from the human body, resulting in weight loss. Doctors who developed this diet, say that it is enough to use the main rules of the diet, and excess weight will go away.

Important advice! Do not try to choose your own diet on the Internet. This is a futile exercise, for which you will spend a lot of time, and it will not end in your favor. It is better not to regret the funds and ask for help from an experienced nutritionist or trainer. Do not forget that each person is individual, and the nutrition program should be prescribed based on your personal needs.

The diet is based on the concept: we spend more calories, but use less carbohydrates. Thus, all excess fat deposits go away. The body eventually regains its beautiful forms and relief. If you adhere to the basic laws of diet, you will be able to get rid of excess weight. It is proved that people observing the principles of diet number 8, show high results of weight loss after the first weeks.

Thus, we come to the conclusion that a diet is more a system of proper nutrition, rather than a restriction on any food. Nutritionists do not just tell you what you need to do to get rid of excess weight, but also teach you how to eat right. Due to the fact that the intake of carbohydrates is sharply restricted in the diet, the body takes its own fat reserves to get the energy it needs.

The main purpose of diet number 8 is not to starve the body, but to reduce the amount of carbohydrates in the diet, removing from the diet starchy foods that are characterized by nutritional value. The use of a minimum amount of carbohydrates will provide the body with all the useful substances.

This diet provides a full meal. Products are selected with high demands, they should be rich in all the necessary macronutrients and vitamins. In general, the diet consists of fruits and vegetables. It is not recommended to eat vegetables, which contain starch. It is also necessary to refuse the use of spices, as they provoke the appearance of appetite. The diet provides cooking dishes without salt and pepper. Alcoholic drinks, soda and sweets need to be excluded from the diet in principle!

It is important to observe the body’s water balance. A healthy person should drink at least two liters of water a day. Tea, juices and mineral water are not included in the list. An exception can be considered hydrocarbonate mineral water

Diet and nutrition for obesity

The problem of obesity is especially important among a third of the population of our planet. Especially it is common in Western countries, where people have a habit of eating only high-calorie fast foods. In connection with this, several variants of dietary nutrition have been developed, which allows to normalize the processes of nutrition, metabolism and rid of excess weight.

The main principle of dietary nutrition is a sharp rejection of products containing a high amount of carbohydrates. The degree of reduction in the energy value of products should correspond to the weight of the body exceeded. Based on calculations for extra pounds, nutritionists select the optimal food during the diet. Often, with obesity, the energy value of foods is estimated to be higher by forty percent of normal demand. It is important to take into account energy costs for physical activity. During dietary nutrition, obesity is simply necessary for sports, it is not even discussed.

In order to determine the desired mass of a person, nutritionists use standard calculations, taking into account the growth data and the type of human figure. Calculations can also be made using a nomograph. It allows you to accurately calculate the necessary mass for a person. Also, special attention should be paid to energy costs during physical exertion. The symbiosis of dietary nutrition and proper loads gives positive results already in the first weeks of action.

Principles of dietary nutrition for obesity
When creating a diet, it is important to consider all aspects of a balanced diet. You will have to give up high-calorie food. It is necessary to consume enough protein food and vitamins. Entering the diet should not become a shock to the body.

It is especially important to exclude easily soluble sugars from the diet. Science has proven that it is they that activate the lipolytic processes in the body and provoke the deposition of fats. You can replace them with polysaccharides. As a rule, with excess weight, nutritionists recommend diets with an energy value of up to 2000 kcal. Restrictions on food primarily affect carbohydrates. There are times when a person can not do without sugar, then it is necessary to choose substitutes.

To achieve a really good result, you need to exclude from the diet in the first place: porridge, potatoes, flour products and starch. Boiled meat, fish, cottage cheese, chicken eggs and greens should be eaten in sufficient quantities. A natural source of protein can be found in such products: lentils, beans, peas, nuts.

Good to know! People who are obese should not exclude fatty foods from the diet. Scientifically proven that fatty foods containing natural oils have a beneficial effect on the human body. This is explained by the fact that fatty food can saturate a person for a longer time. He does not have to make snacks so often. Therefore, during the treatment of obesity, the patient can consume 70-100 grams of fats daily, of which 20-25 g give a long feeling of satiety, that is, reduce appetite. In addition, food fats inhibit the secretion of insulin, which accelerates the conversion of carbohydrates into fats.

Diet for a set of muscle mass

The main goal of an athlete in bodybuilding is muscle hypertrophy and two components are necessary to achieve it: heavy volume training and appropriate nutrition. The word “diet” in the title means a special diet, and not restrictions on the amount of food you eat.

Who needs a diet to gain weight?

The essence of the diet for a set of muscle mass is to provide the body
a sufficient number of nutrients, which are at the head of anabolic processes in the body.

During training, the body consumes a large amount of energy, which is stored in the muscles and liver in the form of glycogen. Muscle fibers also break down when you lift weights. To restore energy reserves and build new muscle fibers, the body needs a certain amount of food, which is the source of energy.

Principles of proper nutrition are the same for all athletes, but the technique may differ from the goals. A set of muscle mass is most relevant for bodybuilders, as well as for representatives of such power sports as powerlifting, arm wrestling, etc.

Diet for a set of muscle mass has its own characteristics. First of all, we are talking about an excess of calories. The amount of calories consumed under normal conditions and with intensive training can not be the same. What is usually considered the norm for a bodybuilder will be a deficit, which, as a result, will lead to stagnation in growth and even a decrease in muscle mass.

Number of meals

To ensure an even supply of nutrients throughout the day, it is necessary to increase the frequency of receptions and reduce portions. This approach is due to the ability to provide the body with the necessary “building material” throughout the day and not lead to the deposition of fat cells. The effectiveness of frequent meals is confirmed by scientific studies: the anabolic effect lasts 3-4 hours, so if you distribute the entire diet for two or three meals, some of the calories from the eaten portion will go to fat, especially in endomorphs.

Caloric content of food

Each athlete, depending on the weight of his body, the intensity of training and the purpose of training should eat a certain amount of calories daily. When typing muscle mass there is quite a lot. It is difficult and not always possible for beginning athletes, therefore, you need to make a diet in such a way as to provide the body with the necessary amount of nutrients and not overload the digestive system. To do this, the proportion of high-calorie food in a day’s ration should be 70%. Also, when consuming a large amount of protein foods, do not forget about fiber, but its share in the diet should not exceed 30%. Fiber plays an important role in digestive processes, but its excessive amount can lead to results that do not meet the bodybuilder’s expectations “on the mass”.

Features of the diet

When recruiting muscle mass, the main task of an athlete is to provide the body with the right amount of calories. However, they should come mainly from “slow” carbohydrates. Even with such a diet, frequent consumption of sweet and fatty foods will result in an undesirable result – obesity. Sweet, which contains a large number of fast carbohydrates may be consumed in small amounts only after training, when the so-called “carbohydrate window” opens. At any other time of the day, this food is very quickly absorbed from the intestine, leading to a sharp increase in blood sugar levels, which as a result is translated by the body into fat.

As for fats, they can be consumed in small amounts. It is necessary to completely exclude from the diet of animals and saturated fats, which are abundantly present in such products as pork, fat, sausages, butter, margarine, etc. You can consume vegetable oil in small quantities.


The human body is 70% water, so it is very important to constantly update it. It is recommended to drink at least 3 liters of water a day. This amount includes water in its pure form and contained in products, for example, tea, coffee, soup.

What and when to eat

Most of the food you need to eat in the morning. At the same time, for the evening it is necessary to leave protein food, and before dinner, more emphasis on carbohydrate. Just before bedtime, you need to eat cottage cheese or other protein-rich food that does not contain carbohydrates and fats. It should also be remembered that fiber, which is present in vegetables, facilitates the transport of protein foods through the gastrointestinal tract.

Causes of short temper

The considered concept is not considered the best feature, because uncontrollable anger can seriously complicate the existence and disrupt the relationship with the environment. With a nervous excitement, which is often accompanied by anger and aggressiveness, it is difficult to analyze what was said and choose the right words. As a result, the quick-tempered individuals often feel ashamed of their unworthy behavioral manifestations. However, after a rather short period, this situation is repeated under the influence of a number of circumstances.

Spitfire is a very dangerous phenomenon in psychology, as it drives negative emotions into the depths of consciousness, generating mental problems, a frustration of communication and self-perception.

To the reasons provoking excessive temper tantrums, it is possible to attribute various stressors or unjustly caused offenses.

Common factors that cause the condition in question are: regular lack of sleep, bad habits, constant anxiety, improper diet, abuse of low-calorie food, increased anxiety, accumulated fatigue, vitamin deficiency, depression, life troubles.

Often, increased excitability signals the presence of infectious ailments, mental pathologies, digestive tract diseases, diabetes mellitus. In addition, the temper may be caused by dysfunction of the thyroid gland.

Spitfire in the female part of the population often occurs during pregnancy or menopause. This condition is associated with ongoing hormonal changes in the body. The sons of Adam suffer from excessive excitability due to a decrease in the production of the hormone testosterone. Also, science has proved that this feature, if it is a stable characteristic, has a hereditary nature.

Individuals who have low self-esteem often overestimate the bar in front of them. As a consequence, they can not match their own contrived image of the ideal “I”. This causes discord in family relationships, problems in the working environment. The result is a constantly present irritability, firmly rooted in the mind. To avoid this, you do not need to compare your own achievements with the successes of other individuals.

Frustration of intermittent hot flashes

Attacks of aggression, verbal insults, assaults are characteristic signs of excessive temper. Any person can freak out, but often aggressiveness is caused by a disorder of intermittent quick temper, which is more often affected by a strong half of humanity.

A characteristic feature of the described disorder is inadequate response to an insignificant situation, the slightest excuse, criticism, causticity, stress, difficulties in relationships. Each subject is able to flare up, but most still able to control the excessive emotional response, but with the disorder considered, the individual in his own reactions is irresistible. His fury always goes beyond what is permitted and is inclined to recur periodically.

The disorder of faltering temper is called behavioral deviations, characterized by explosive episodes of anger, often reaching apogee. Such outbreaks are disproportionate to the circumstances that gave rise to them. Impulsive aggressiveness is involuntary and is caused by a disproportionate response to any provocation, actual or planned. Some individuals demonstrate affective transformations before a seizure.

The described deviation is a serious mental health disorder that needs to be treated, as it can develop into violence. May be affected by friends, colleagues, relatives. Individuals suffering from such a disorder are at risk of developing other psychiatric abnormalities. Among them are cases of alcoholism and drug addiction. Also described disorder with age often causes problems with myocardium, diabetes, high blood pressure, arthritis. Therefore, the question of how to get rid of hot temper is not without its relevance.

Today, this disorder is classified as a disruptive, impulsive disorder of self-control and behavioral response. Patients suffering from the described deviation show episodes characterized by a variety of bodily symptoms (sweating, palpitations, tightness in the squamous space, twitching). Aggressive behavior is often accompanied by a sense of relief, sometimes accompanied by a sense of pleasure. To replace these feelings comes a belated remorse.

A significant feature of this deviation is the emergence of discrete episodes of lack of resistance to aggressive drivers, leading to serious malicious acts or the destruction of things.

The degree of aggression manifested during an outbreak is not proportional to provocation or to the influence of a psychosocial stressor.

It is difficult to diagnose the described deviation, since it is possible to diagnose only when other mental disorders are excluded, which can also be accompanied by episodes of hot temper, for example, antisocial or borderline personality disorder, manic episode, behavioral disorders.

In addition, similar clinical manifestations can be observed due to Alzheimer’s disease, direct physiological effects of certain chemicals (pharmacopeia drugs, narcotic drugs), head injuries.

The signs of the disorder in question are usually attributed to the following:

– Several discrete attacks of refusal to resist aggressive incentives, causing violent negative emotions or destruction of property;

– The degree of aggression manifested in the outbreak is incommensurable with the psychosocial stressor;

– outbreaks of aggression are not due to the presence of other pathologies of the psyche.