CLINICAL CRITERIA OF SHORT-TERM PREDICTION OF THE EFFECTIVENESS OF BLASTOCYSTOSIS TREATMENT WITH CO-TRIMOXAZOLE

Abstract

SUMMARY. Modern medicine offers a wide range of drugs with similar effects, which makes it difficult for clinicians to choose a specific one. This problem can be solved by using a prognostic approach, when the results of treatment with a specific drug can be predicted at the beginning of treatment. In this regard, the development of predictors of the effectiveness of treatment of blastocystosis with cotrimazole is relevant.

Patients and Methods. To determine the prognostic value of clinical symptoms, a retrospective analysis was performed in 135 patients with blastocystosis aged 17 to 54 years who received treatment with co-trimoxazole in combination with symptomatic therapy. As a result, alternative groups were formed: with good (group A, n=7) and satisfactory (group B, n=48) therapeutic effect. Group A included patients in whom, 1 month after the start of therapy, the degree of regression of clinical symptoms was generally ≥31 %, and group B included patients in whom it was ≤30 %. The criterion for short-term prognosis was the effectiveness of treatment 1 month after the start. To develop prognostic criteria, we used the heterogeneous sequential Wald-Genkina procedure.

Results and discussion. It was found that high prognostic informativeness was characteristic of such symptoms as lymphadenopathy (J=3.35), heaviness in the right hypochondrium (J=1.41), degree of symptom manifestation (J=1.33), joint pain (J=1.21), and vegetative-visceral dysfunction (J=1.06).

Moderate prognostic value was established for the duration of the disease (J=0.91), body temperature (J=0.84), the presence of dizziness in the patient (J=0.97), muscle pain (J=0.84), decreased performance (J=0.67), and memory impairment (J=0.60), while low predictive properties were noted for patient age (J=0.48), tachycardia (J=0.33), and headache (J=0.20).

Testing of the prognostic algorithm on the study group (n=135) showed that correct predictions accounted for 80.2 %, uncertain predictions for 15.6 %, and false predictions for 4.2 % of cases.

Conclusions. Using Wald-Genkina’s heterogeneous sequential procedure, an algorithm was developed for short-term (up to 1 month) prediction of the effectiveness of cotrimazole therapy in patients with blastocystosis, which established the values of prognostic coefficients for each symptom grade and their overall prognostic informativeness.

The most informative prognostic clinical symptoms were lymphadenopathy (J=3.35), heaviness in the right hypochondrium (J=1.41), manifestation of symptoms (J=1.33), and joint pain (J=1.21).

Testing of the algorithm on the study group (n=135) at a 95 % confidence level established its high effectiveness, since the proportion of false predictions was 4.2 % and did not exceed the specified confidence level; correct predictions accounted for 80.2 %, and uncertain predictions accounted for 15.6 % of cases.