Library

Actual

Modern approaches to neuroprotective therapy of ischemic stroke

Authors:

L.V. Stakhovskaya1, E.A. Tyutyumova2*, A.I. Fedin2

1-way research institute of cerebrovascular pathology and stroke of the Federal State Budgetary Institution “Russian National
Research Medical University named after N.I. Pirogov »Ministry of Health of Russia, Moscow, Russia; 2
FSBEI in Russian National Research Medical University named after N.I. Pirogov »Ministry of Health of Russia, Moscow, Russia

The results of a series of domestic clinical trials are given to study the effectiveness and safety of the drug Mexidol in patients with cerebrovascular disorders, in particular with ischemic stroke (AI). It is emphasized that the use of Mexidol is associated with a more complete and rapid regression of focal neurological deficiency. Good tolerance of treatment with Mexidol and the absence of significant undesirable side effects are noted. It is recommended to use the drug in forms for enteric and parenteral use in patients with AI.
Key words: ischemic stroke, treatment, Mexidol.

Modern criteria for rational diagnosis and treatment of cerebrovascular diseases

Authors:

, ,

Cerebrovascular diseases (CVP) are an “archive” medical and social problem of modern medicine, as they give the highest indicators for incidence, mortality and disability in almost all countries of the world, which is associated with the aging of the planet and an increase in the number of risk factors. So, for example, on average about 460–560 thousand strokes are recorded annually in Russia, of which up to 200 thousand end in death, and of the surviving patients, at least 80% remain disabled, despite the rapid development of diagnostic and therapeutic medical technologies, hundreds of publications and dissertations about the effective treatment of this pathology.

Dodemic cognitive disorder. Directions of therapy

Author:

Sokolova L.P.

The problem of cognitive deficiency affects almost every person on the planet, huge socio-economic, ethical and moral losses that society carries are associated with it. In the world, according to WHO, about 47 million people suffering from dementia live. The annual number of new cases of the disease is almost 10 million. The most complex functions of the brain should be understood by the cognitive functions by which the process of rational cognition of the world is carried out. It is the cognitive status that determines the success of a person in society in the profession, in the family. A decrease in cognitive functions is always perceived painfully and significantly worsens the quality of human life.

Modern protection strategies for hypoxic-itchemic brain damage

Authors:

S.N. Yanishevsky*, N.V. Gypsy, S.Yu. Golokhvastov, R.V. Andreev, I.V. Litvinenko, O.S. Karpova, V.A. Yakovlev

*FSBVOU in "Military Medical Academy named after CM. Kirov ”, St. Petersburg, Russia

To date, there are two complementary directions in the management of patients with ischemic stroke: the maximum early blood flow restoration (reperfusion) and the protection of brain tissue from ischemic lesion (neuroprotection). The main goal of neuroprotection is to intervene in the events of the ischemic cascade, block the links of the pathological process, prevent the death of nerve cells in the ischemic partial shade zone and expand the “therapeutic window” for reperfusion therapy. The use of drugs with neurotrophic, antioxidant and neuroregenerative effects is pathogenetically substantiated at all stages of rehabilitation treatment after a stroke. Ethylmethylhydroxypyridine is succinate (Mexidol) is a derivative of amber acid. The drug has antihypoxic, membrane, nootropic, anticonvulsant, anxiolytic effects. When studying the neuroprotective drug, Mexidol in patients with strokes, the absolute majority of researchers, a positive effect was noted in the form of a pronounced regression of neurological deficiency, wider possibilities for subsequent early rehabilitation. In 2017, the results of a multicenter prospective double blind placebo-controlled study of the effectiveness and safety of Mexidol with prolonged consistent therapy in patients in the acute and early restoration periods of the hem-step-mesh stroke (Epica) were published. The results of the study demonstrated the best positive dynamics of the restoration of impaired neurological functions in the early prescription of Mexidol and the continuation of therapy up to 2 months. During the study, the safety of prolonged use of Mexidol was proved.

Keywords: stroke, acute period, neuroprotection, succinate, therapy efficiency, therapy safety.

Problems of pharmacotherapy of elderly patients

Author:

Ushkalova E.A.

By the beginning of 2013, the share of people aged 65 and older amounted to an average of about 13%in Russia, and in some regions - 28%. It is predicted that in the global structure of the population by 2050 it will be 22%. In Russia, by the beginning of 2021, an increase in the number of people aged 65 years and older to 22.9 million people, 80 years and older - 5.5 million people are expected; 100 years and older - 7266 people. The fastest growing group of population in economically developed countries is 80 years of age and older.
The data of evidence -based medicine on the effectiveness and safety of drugs (drugs) in the elderly are extremely limited, since the age> 65 years remains one of the main criteria for non -inclusion in randomized controlled studies (RCTs).
Meanwhile, the effectiveness and safety of therapy in elderly patients can differ significantly from those in middle and young people, which is associated with age -related changes in physiology, leading to changes in pharmacokinetics and pharmacodynamics of many drugs.
Other factors that complicate pharmacotherapy in elderly people include: “fragility” (frailty), somatic and mental comorbidity and polypragmasia associated with it, social factors (loneliness, helplessness, poverty), low learning and low commitment to treatment.

The role of antioxidants in the prevention and treatment of patients with a high risk of cardiovascular complications

Authors:

L.A. Shchepanevich1*, M.M. Tanashian2, Yu.A. Nikolaev1, V.Ya. Polyakov1, M.A. Pervuninskaya1, K.V. Antonova2

1FGBNU "Research Institute of Experimental and Clinical Medicine", Novosibirsk, Russia;

2FGBNU "Scientific Center of Neurology", Moscow, Russia

The purpose of the study is to study the influence of Mexidol on the indicators of the lipid spectrum in patients with very high risk of cardiovascular complications (MTR) suffering from type 2 diabetes (SD2).
Material and methods.

Within 3 months, prospective observation of two groups of patients was carried out, the main risk factor for vascular complications in which was SD2. The speed of reaching the target level of blood lipid indicators with standard therapy with statins (1st group) and when supplementing the basic therapy with Mexidol (2nd group) was compared. The determination of lipids in blood serum was carried out by the enzymatic colorimetric method (reagents Boehringer Mannheim, Germany).

Results.

The positive influence of Mexidol, prescribed at the starting stage of statins, on the indicators of lipid spectrum in patients with high and very high risk of MTS, the underlying disease in which was SD2, was noted.

Key words: cardiovascular complications, type 2 diabetes, dyslipidemia, prevention, Mexidol

The effect of Mexidol on physical performance and lactate in the blood of rats in conditions of light desingronosis

Authors

, , ,

The purpose of the study.

The study of the influence of Mexidol on the dynamics of rats of rats after light or dark deprivation on the swimming dough model with load, as well as an assessment of the state of glycolytic processes in these conditions. Material and methods. The experiment was performed in the spring on 70 rats of the Wistar line. Three groups (30 animals) were in the natural conditions of lighting. One group was not exposed to any influences. Two other groups were presented with physical activity and 30 minutes before it was administered intramuscularly either a physiological solution or Mexidol. Four other groups (40 individuals) 10 days were in the conditions of dark or light deprivation before the presentation of physical activity and received either a physiological solution or Mexidol before the test after the abolition of deprivation. The physical activity model has been chosen a method of forced swimming rats with an additional load daily for 5 days. In the blood serum, the lactate level was determined by the colorimetric method.

Results and conclusion.

Mexol increased the performance of rats in a swimming test in natural lighting conditions and with light desinghronosis, contributed to the formation of cross adaptation to physical exertion under natural lighting conditions and prolonged this condition under the conditions of desinchronosis, did not change the content of lactate in the blood of rats after physical activity in the natural conditions of lighting and dark -skinned deprivation and prevented it light deprivation.

Key words: Mexidol, light and dark deprivation, performance, lactate.

Frequent neurological symptoms of Long-Covid and their correction paths

Author

Tatyana Maksimovna Ostroumova, Ph.D., assistant department of nervous diseases and neurosurgery of the Institute of Clinical Medicine named after N.V. Sklifosovsky FGAOU in the First MGMU named after THEM. Sechenova
of the Ministry of Health of Russia (Sechenov University)

A significant number of patients reports preserved symptoms after the suffered Covid -19, which lead to violation of everyday activity and worsen the quality of their life. One of the first term “Long-Covid” was used by the patient Eliza from Italy as a hashtag on Twitter in May 2020, describing her own experience of residual symptoms after recovery. In September 2020, a group of thirty -nine doctors, each of which suffered from the long -term consequences of Covid -19, joined the group of supporting patients with “constant symptoms of a suspect or confirmed Covid -19”, after which this term began to actively appear in the media and scientific publications. In December 2020, experts of the National Institute of Health and Medical Aid of Great Britain (National Institute for Health and Care Excellence, Nice) proposed a classification that includes the terms (up to 4 weeks from the beginning of symptoms), continuing symptomatic covid (4–12 weeks) and post -bond syndrome (> 12 weeks).

The effectiveness of Mexidol in patients of different age groups with chronic brain ischemia with cognitive disorders (the results of subanalysis of the international multicenter randomized double blind placebo-controlled study of memes)

Authors:

V.V. Zakharov1, O.N. Tkacheva2, 3, E.A. Mkhitaryan2, 3, A.I. Fedin2

1 FGAOU VO "First Moscow State Medical University named after THEM. Sechenov »Ministry of Health of Russia
(Sechenov University), Moscow, Russia;
2 FGAOU in Russian National Research Medical University named after N.I. Pirogov »Ministry of Health of Russia,
Moscow, Russia;
3 Russian gerontological scientific and clinical center of the FGAOU in the Russian National Research
Medical University named after N.I. Pirogov »Ministry of Health of Russia, Moscow, Russia

Summary
is the purpose of the study. To evaluate the effectiveness of consistent therapy with Mexidol and Mexidol Fort 250 compared to placebo in patients with chronic brain ischemia (chemical) of different age -related subgroups. Material and methods. Subanalis of data of an international multicenter randomized double-centered placebo-controlled study of Memo, in which 318 patients (25% of men) aged 40 to 90 (median 60) years participated. The effectiveness of treatment was estimated in three age groups: 40-60 (n = 163), 61–75 (n = 141) and 76–90 (n = 13) years. As the primary final point of efficiency, the axis considered the increase in the dynamics of the amount of points on the MOCA scale in the form of an absolute difference between the amount of points before the start of treatment and on the 75th day of therapy. As a secondary endpoint of efficiency, the speaker was considered by the amount of points on the following questionnaires and scales: a test of digital symbol replacements, a questionnaire for the quality of life of the SF-36, a scale of subjective assessment of asthenia MFI-20, a Vein vegetative impaired questionnaire, a Bek anxiety scale, a thinetti motor activity scale.

Results.

The positive dynamics of the severity of cognitive, emotional and motor disorders in groups 40-60 and 61–75 years after 75 days of therapy was detected in patients who received both Mexidol and placebo, however, in patients receiving Mexidol, these changes turned out to be more pronounced, which indicate the higher values ​​of the absolute difference in the amount of the points of the studied indicators.

Conclusion.

The results of the study have shown that in patients with Khim, a significant improvement in cognitive and motor functions, improving the quality of life, a decrease in the severity of autonomic disorders, asthenia
and anxiety after 75 days of therapy were observed against the background of the use of Mexido compared to placebo. The
results indicate the appropriateness of the use of Mexidol for the treatment of patients of different ages with chemicals.

Key words:

Cognitive disorders, chronic brain ischemia, Mexidol, Mexidol Fort 250, ethylmethylhydroxypyridine succinate, examination of memes.

Pharmacotherapy in post -industry rehabilitation

Authors

, , ,

The existing methods of pharmacotherapy in the recovery period of a stroke used to correct motor, affective and cognitive disorders were carried out. Data on the conditions for the use and effectiveness of botulinum toxin, oral muscle relaxants, selective reversal inhibitors of serotonin, acetylcholinestin inhibitors and a glutamatergic transmission in post -stroke neurorebilitation, recommendations for their rational and safe use are given.
The clinical effectiveness of Mexidol, which has a multimodal effect on a wide range of post -stroke disorders, especially with prolonged consistent therapy, was discussed The integrated use of post -industry rehabilitation agents with the determination of individual tactics on the basis of the clinical picture of the patient and the established rehabilitation goals has been recommended. To solve problems associated with improving motor, cognitive and affective functions, as well as self -care and quality of life, the inclusion of Mexidol in the complex therapy of patients with the consequences of a stroke looks promising. A continuation of high -quality clinical studies is required to assess the effectiveness of pharmacological agents regarding post -industry disorders.

Key words: stroke, hemiparesis, spasticity, depression, dementia, neurorebilitation, pharmacotherapy.

Arterial hypertension: how to help the brain?

Authors:

, ,

Within the framework of the 17th National Congress of therapists with international participation, which was held in Moscow from October 12 to October 14, 2022, a satellite symposium of the Vectorfarm company-“Brain: Myshin organ of arterial hypertension. Minimization of a negative forecast. ” It discussed the issues of conducting polymorbid patients and the possibilities of the drug therapy used.

With the first report-“The leading of patients with chronic brain ischemia from the perspective of evidence-based medicine”-said the neurologist, professor of the Department of Nervous Diseases Faculty of Faculty of Medicine at the first MGMU named after THEM. Sechenova of the Ministry of Health of Russia, MD V.V. Zakharov. (Read more Read more).

Head of the Department of Therapy and Polymorbid Pathology named after Academician M.S. VLUSI FSBEI HPE RMANPO of the Ministry of Health of the Russian Federation, professor, MD O.D. Ostroumova made a report "Interdisciplinary consultation of a patient with arterial hypertension." (Read more Read more).

Senior Researcher of the Federal State Budgetary Institution "Scientific Center for Neurology", Ph.D. A.A. Zavrzhzhaev presented the report “The neurological characteristics of the patient with arterial hypertension. What should be paid to. " (Read more Read more).

Concluding the symposium, prof. O.D. Ostroumova noted that at present the possibilities of medical specialists in the correction of cognitive disorders are quite wide. Of course, research in this area will continue, since there are still many “white spots” in it. But even what is known now allows you to look with confidence in the future.

Oxidate Stress in the Pathogenesis of Chronic Headache

Authors:

AI Fedin

Translated from Zhurnal Nevrologi I Psikhiatrii Imeni SS Korsakova, Vol. 124, no. 10, pp. 35–40, October,
2024. Original Article Submitted September 9, 2024. Accepted September 16, 2024.

Place of publication:
Neuroscience and Behavioral Physiology, Vol. 55, no. 3, march, 2025

Summary: This Report Presents New Data on the Development of Oxidate Stress (OS) In Chronic Headache (HA). The Main Biochemical Characteristics of OS Are Pressented. Changes in Mri Spectroscopy and Biochemical
Marcers Confi Rmsing the Development of OS in Migraine Ar Described. The Absence of Signifi Cant Differences in Measures of OS in Migraine with and Without Aura Is Emphasized. Pathophysiological Differences Between Migraine and Chronic Tension Headache, In Which OS is not Detected, Are Demonstrate. Possible Activation of Trpa1 Ion Channels and Calcitonin Gene-Reled Peptide in OS, Which Provokes Migraine Attacks, IS Discussed. Directions for Drug Correction of OS in Chronic Headache Are Consedered.

Arterial hypertension - oxidative stress as a pathogenetic target of treatment of chronic cerebrovascular insufficiency

Authors:

E.I. Chukanova, A.S. Chukanova, D.D. Andrianov

FGAOU in Russian National Research Medical University named after N.I. Pirogov "of the Ministry of Health of Russia
(Pirogov University), Moscow, Russia

Place of publication: a journal of neurology and psychiatry named after S.S. Korsakova / t. 125, No. 1, 2025

Resumes of
arterial hypertension (hypertension) as the main modified risk factor for the development of acute and chronic cerebrovascular accident failure, often leading to a progressive decrease in cognitive status, physical activity, requires early detection and effective pathogenetic therapy. The breadth of the therapeutic effects of the drug Mexidol (ethylmethylhydroxypyridine succinate) contributes to its widespread use. The high security profile of Mexidol and the lack of drug interactions make its use promising in the complex treatment of patients with cardiovascular diseases.

Keywords : arterial hypertension, oxidative stress, cerebrovascular insufficiency, cognitive functions, endothelial sensitivity, G-PROTEIN COUPLED Receptor 91, succinate, ethyl-methylhydroxypyrididine, mexidol.
Information about the authors:
Chukanova E.I. -https://orcid.org/0000-0002-32919615
Chukanova A.S. -https://orcid.org/0000-0003-0940-782X
Andrianov D.D. -https://orcid.org/0009-0000-6917-4277
Author responsible for correspondence: Chukanova E.I. -E-mail: chukanova-lena@yandex.ru
how to quote:
Chukanova E.I., Chukanova A.S., Andrianov D.D. Arterial hypertension is oxidative stress as a pathogenetic target of treatment of chronic cerebrovascular insufficiency. Journal of neurology and psychiatry named after S.S. Korsakova. 2025; 125 (1): 84–90. https://doi.org/10.17116/jnevro202512501184

Information about the authors:
Vlasova A.S. -https://orcid.org/0000-0002-6835-3393
Petrov S.A. -https://orcid.org/0000-0002-1566-2299
Renzyak E.V. -https://orcid.org/0007-0007-2258-2207
Author responsible for correspondence: Vlasova Anastasia Sergeevna-E-mail: okula-83@mail.ru
How to quote:
Vlasova A.S., Petrov S.A., Renzyak E.V. Neuroprotective therapy for age -related macular degeneration. Bulletin of ophthalmology. 2024; 140 (6): 152–158. https://doi.org/10.17116/oftalma2024140061152

Neuroprotective therapy with age -related macular degeneration

Authors:
A.S. Vlasova1, S.A. Petrov1, 2, E.V. Renzyak1, 3

1anchoo DPO “West Siberian Institute of Postgraduate Medical Education”, Tyumen, Russia;
2FGBUN FIC "Tyumen Scientific Center of the Siberian Branch of the Russian Academy of Sciences", Tyumen, Russia;
3bu Khanty-Mansiysk Autonomous Okrug-Ugra District Clinical Hospital, Khanty-Mansiysk, Russia

Place of publication: Bulletin of ophthalmology / vol. 140, No. 6, 2024

Resume
age macular degeneration (VMD) is a chronic multifactorial degenerative disease of the eyes, which is considered one of the main causes of irreversible blindness around the world. Despite numerous studies, there is no consensus regarding the predominant pathological mechanism leading to the death of photoreceptors. The IDMD is a disease based on molecular and cellular disorders, ultimately leading to the degeneration of photoreceptors. The review article presents the data of foreign and domestic researchers on the study of pathophysiological mechanisms for the development and progression of photoreceptor degeneration, scientific developments are given in relation to modern methods of therapeutic correction of identified disorders, and also presents promising areas of drug neuroretinoprotection, requiring confirmation in clinical studies.

Keywords: age -related macular degeneration, neuroprotection, retinoprotection, peptide bioregulators, antioxidants, ethylmethylhydroxypirine succinate.

Information about the authors:
Vlasova A.S. -https://orcid.org/0000-0002-6835-3393
Petrov S.A. -https://orcid.org/0000-0002-1566-2299
Renzyak E.V. -https://orcid.org/0007-0007-2258-2207
Author responsible for correspondence: Vlasova Anastasia Sergeevna-E-mail: okula-83@mail.ru
How to quote:
Vlasova A.S., Petrov S.A., Renzyak E.V. Neuroprotective therapy for age -related macular degeneration. Bulletin of ophthalmology. 2024; 140 (6): 152–158. https://doi.org/10.17116/oftalma2024140061152

Possibilities of neurocytoprotheiation during reperfusion therapy

Authors:
I.A. Schukin1, 2, I.A. Koltsov1, 2, M.S. Fidler1, A.P. Glukhareva1

1FGAOU in Russian National Research Medical University named after N.I. Pirogov »Ministry of Health of Russia
(University Pirogov), Moscow, Russia;
2FGBU "Federal Center for Brain and Neurotechnology" of the Federal Medical and Biological Agency of Russia, Moscow, Russia

Place of publication: a journal of neurology and psychiatry named after S.S. Korsakova / vol. 124, No. 12, issue. 2, 2024

Summary of
acute cerebral circulation disorders (ONMK) occupy the second place among the causes of deaths and are the third most important cause of disability. In the structure of the ONMK, ischemic stroke (AI) takes first place. Damage to the substance of the brain during AI is a complex cascade of pathophysiological reactions, including neo -driving, oxidative stress, exaytotoxicity and apoptosis. One of the most actively developing areas of treatment of patients with AI is reperfusion therapy (RT). The use of neuroimagingalization-CT perfusion and MRI has significantly expanded the indications for the RT. One of the possible directions for expanding the capabilities of the Republic of Tatarstan is its joint use with neurocytoprotective therapy, which would increase the efficiency and safety of the RT. The review is devoted to research on the effectiveness of a combination of neurocytoprotheiation and TLT under AI.

Keywords: ischemic stroke, reperfusion therapy, thrombolytic therapy, mechanical thromboembolectomy, reperfusion damage, neuroprotection, cytoprotection, neurocytoprotheiation.
Information about the authors:
Schukin I.A. - https://orcid.org/0000-0002-6308–9706
I. Koltsov - https://orcid.org/0000-0002–9900-4073
Fidler M.S. - https://orcid.org/0000-0001-6464-521X
Glukhareva A.P. - https://orcid.org/0009-0004-4867–2102
Author responsible for correspondence: I. Schukin -E-mail: ivashchukin@gmail.com
how to quote:
Schukin I.A., Koltsov I.A., Fidler M.S., Glukhareva A.P. The possibilities of neurocytoprotext during reperfusion
therapy. Journal of neurology and psychiatry named after S.S. Korsakova. 2024; 124 (12 Issue 2): 75–88. https://doi.org/10.17116/jnevro202412412275

Assessment of the effectiveness of ethylmethylhydroxypyridine of succinate with alcohol withdrawal

Authors:
E.N. Yakusheva, A.V. Schulkin, Yu.V. Abalenikhina

Place of publication: psychopharmacology and biological narcology / t. 15, No. 1, 2024

Ryazan State Medical University named after Acad. I.P. Pavlova, Ryazan, Russia

Annotation
relevance. A disorder caused by the use of alcohol (ethanol) is a destructive state in which there is a violation of energy and metabolic processes, as well as the activation of processes of free radical oxidation. That is why the use of antioxidants, in particular the original domestic drug ethylmethydlhydroxypyridine of succinate, is pathogenetically substantiated in the complex therapy of this pathology.
The goal is to study the effectiveness of ethylmethylhydroxypyridine of succinate in intravenous, intramuscular and intravenous methods of introducing ICR mice in modeling alcohol withdrawal.
Materials and methods. The study was performed on healthy, free from the pathogenic flora of mice, outbuilding ICR runoff at the age of 9-10 weeks. In an average mass of 25.4 ± 0.2 g. Alcoholic dependence in animals was modeled with a gradual increase in ethanol in a drinker from 1 to 3, 6, 10 % every 2 days. Upon reaching
a concentration of 10 %, animals were given 1 bottle of alcohol with 1 bottle of water every other day and 2 bottles of alcohol on intermediate days. The position of the bottles (left / right) changed between each access session to alcohol. After 6 weeks of animals, a solution of 10 % alcohol was removed. The introduction of ethylmethylhydroxypyridine of succinate and saline
(control group) 2 times a day for 7 days began. The drug was administered intravenously (50 and 100 mg/kg), intramuscularly (50 and 100 mg/kg) and intravenous (100 and 150 mg/kg).
Results. This study establishes that ethyl methylhydroxypyridine is succinate (Mexidol® with intravenous (50 and 100 mg/kg), intramuscular (50 and 100 mg/kg) and intravenous (100 and 150 mg/kg) administration 2 times a day for 7 days with manifestations of alcohol dependence in alcohol dependence in the mice of
the ICR, possesses a pronounced Pharmacological activity, which is manifested in a decrease in the volume of alcohol consumption, improved horizontal and vertical activity in the “open field” test, improving the coordination of movements, reducing the severity of the withdrawal syndrome revealed in the test to the
nesting . MG/kg), intramuscular (50 and 100 mg/kg) and intravenous (100 and 150 mg/kg) introduction of ICR for mice, have a pronounced therapeutic effect in the modeling of alcohol withdrawal:
ethylmethylhydroxypydine sequisinate; Healthy SPF mice ICR.

How to quote
Yakusheva E.N., Schulkin A.V., Abalenikhina Yu.V. Assessment of the effectiveness of ethylmethylhydroxypyridine of succinate with alcohol withdrawal //
Psychopharmacology
and biological narcology. 2024. T. 15, No. 1. S. 61–68. Doi: https://doi.org/10.17816/phbn625395

 

1 2 3 4 5 13

THE INFORMATION IS INTENDED FOR HEALTHCARE AND PHARMACEUTICAL PROFESSIONALS. THIS INFORMATION IS NOT INTENDED AS A SUBSTITUTE FOR MEDICAL ADVICE.

Source of photos and images Shutterstock.com