Degree Of Severity In Patients Research Articles

Особливості клінічної складової континууму психологічної адаптації-дезадаптації у хворих дерматологічного профілю з різним рівнем вітальної загрози

Purpose: to investigate the state of the clinical component of the continuum of psychological adaptationmaladaptation in patients with a dermatological profile with diseases of various levels of vital threat, in order to develop, in the future, personalized psychocorrection programs for this category of patients. Contingent and research methods. On the basis of informed consent, in compliance with the principles of biomedical ethics and deontology, we examined 120 dermatological patients who were treated in three branches of the clinic “Dr. Zapolska Clinic” during 2020-2021, namely: 60 patients with non-vital dermatological diseases (seborrheic keratosis L82, condylomas A63.0, angiomas D18.0, pigmentation disorders L80), and 60 patients with dermatological diseases posing a vital threat ( melanoma C43, basal cell carcinoma C44, skin carcinoma D04). The results. Among patients with dermatological diseases, there are both psychologically adapted and maladapted individuals, regardless of the vitality/non-vitality of the pathological process. Among persons with signs of psychological maladjustment with non-vital dermatological diseases, the majority are persons with individual signs of maladjustment or with manifestations of neuroticism with a high level of psycho-emotional tension, while in the sample of patients with vital diseases and the presence of maladaptive manifestations, persons with high neuroticism and psycho-emotional tension predominate , as well as patients with pronounced pathopsychological symptoms of syndromic and/or nosological delineation. In patients with a dermatological profile with signs of psychological maladjustment, the clinical picture is dominated by anxious (mainly in patients with non-vital diseases) and depressive (mainly in patients with vital diseases) radicals, and auxiliary psychopathological constructs are represented by manifestations of somatization, obsessive-compulsive symptoms, interpersonal sensitivity and phobic anxiety. Affective symptomatology is most pronounced in patients with maladjustment with vital dermatological diseases, it is less pronounced in patients with non-vital skin pathology, and the severity of individual indicators of anxiety-depressive response in the examined subjects without signs of maladaptation does not differ significantly in the examined depending on the nature of the dermatological pathology (non-vital or vital). The presence and intensity of maladaptive pathopsychological-affective reactions of varying degrees of severity in patients with dermatological pathology are not clearly associated with the vitality of the dermatological process, but are based on more complex mechanisms of the mutual influence of biological predisposition and psychological and psychosocial factors, the mosaic combination of which determines the individual’s resource capabilities for constructive acceptance the fact of the presence of a dermatological disease and the development of an adequate strategy for its mastery, regardless of the severity of the disease. Conclusion. The identified regularities should be taken into account when developing treatment-rehabilitation and psycho-prophylactic measures in patients with dermatological pathology with different levels of vital threat.

25200 Public versus private drug insurance and psoriasis degree of severity in patients with prescribed biologics in Canada: A retrospective cohort study

Background: Previous studies in autoimmune and inflammatory disorders suggest that drug insurance negatively affects access to biologics in patients covered under public drug insurance plans (PubDIP) in comparison to private plans (PrivDIP).

Changes of hematological indices in patients with diffuse toxic goiter

Objective. To reveal the incidence of various morphological types and degrees of the anemia severity in patients with diffuse toxic goiter.
 Materials and methods. Data of medical histories of 157 patients, operated for diffuse toxic goiter in 2012 yr were analyzed. In accordance to hematological indices estimated there were outlined two Groups of patients: Group I – 98 patients with diffuse toxic goiter and mild anemia, average age (39.4 ± 1.4) yrs old, 57 (58.2%) women and 41 (41.8%) men, and Group II – 59 patients with diffuse toxic goiter and middle degree of the anemia severity, average age (41.1 ± 1.7) yrs old, 48 (81.4%) women and 11 (18.6%) men. Levels of hemoglobin, hematocrit, quantity and average volume of erythrocytes, average content of hemoglobin in one erythrocyte, average concentration of hemoglobin in the erythrocytes were determined in the blood analysis.
 Results. Microcytic type of anemia was noted in 89.8% of patients with anemia of middle degree of severity, while a normocytic one – in 10.2%; in mild anemia – in 87.8 and 12.2% patients, accordingly. Hypochromic and normochromic types of anemia with equal rate were revealed in mild anemia and anemia of middle degree of severity: hypochromic – in 94.9%, normochromic – in 5.1% patients.
 Conclusion. Diffuse toxic goiter is characterized by more frequent development of mild (62.4%), microcytic (88.5%), hyperchromic (94.9%) anemia, caused by iron deficiency.

Changes in the Dynamics of Treating Patients with Generalized Periodontitis and Hypertension Depending on the Method of Treatment

Calcium and its compounds play an important role in the regulation of many functions of the body. The concentration of calcium ions in the serum is one of the important constants of homeostasis.
 The objective of the research was to study the level of total calcium, ionized calcium, and phosphorus in patients with stage II hypertension and generalized periodontitis of II degree of severity, depending on the method of treatment.
 Materials and methods. The main group consisted of 70 patients with generalized periodontitis of II degree of severity and stage II hypertension who were divided into 4 groups. The comparison group consisted of 30 patients suffering from generalized periodontitis of II degree of severity without hypertension who were divided into similar 4 groups depending on age and type of treatment. The control group included 17 patients of corresponding age with healthy periodontium and without somatic pathology.
 Results. Twelve months after starting treatment, in younger patients of the main group receiving basic therapy, serum phosphorus level increased by 0.03 mmol /l, and in the older ones, it increased by 0.04 mmol/l. In younger and older patients of the comparison group, serum phosphorus level increased by 0.05 mmol/l. The patients who received basic therapy in combination with the proposed scheme of treatment had higher level of phosphorus than those who received basic therapy only. Twelve months after starting treatment, serum level of total calcium decreased in young and older patients of the main group and comparison group receiving basic therapy. An obvious improvement of treatment 12 months after its starting was observed in all the patients of the main group and comparison group who received basic therapy in combination with the proposed scheme of treatment.
 Conclusions. The improved treatment scheme was more effective for treatment of generalized periodontitis of II degree of severity in patients with stage II hypertension.

CLINICAL AND LABORATORY EFFICIENCY OF TREATMENT OF WOMEN WITH PERIODONTAL DISEASES ON THE BACKGROUND OF BACTERIAL VAGINOSIS

Introduction. There is currently no tactic for dental examination and treatment of women suffering from bacterial vaginosis (BV), although chronic catarrhal gingivitis, periodontitis of initial and first degree of severity in patients with this pathology has been proven. The frequency of detection of BV in modern women aged 18-45 is 67-89%. The main pathogens of BV are Gardnerella vaginalis and Atopobium vaginae.
 Aim. To determine clinical and laboratory effectiveness of the treatment scheme for women with periodontal diseases on the background of bacterial vaginosis.
 Materials and methods. Diagnosis of BV was established by an obstetrician-gynaecologist based on the Amsel criteria. 54 women aged 18-45 were examined. The examined women were divided into two groups, depending on the intended scheme of integrated treatment. Determination of the degree of inflammation of the periodontal period was carried out according to the PMA indices (modified by S. Parma), KPI by Leus. The quality control of the treatment was performed by PCR method, the presence of Gardnerella vaginalis and Atopobium vagina, the amino test of oral liquid, the quantitative activity of alpha amylase and the concentration of sIgA in saliva. Representatives of the first control group (26 women) were prescribed the common course of treatment, namely: local treatment therapy (oral baths of the solution of the medicine “Stomatophyte” after morning and evening hygiene procedures, application of “Mergagil-denta” (7 days); general therapy (metronidazole 250 mg every 8 hours for every 7 days, probiotic “Symbiter acidophilic concentrate” for 21 days). Women of the second experimental group (28 patients) were treated according to the scheme we patented. Their local treatment included: oral baths with the medicine “Stomatophyte” after morning and evening hygiene procedures (7 days), tablets for resuscitation “Lizak” for 1 tab. every 6 hours (5 days), application of “Metrogil-denta” for 20 minutes twice a day. After using “Stomatophyte” (10 days), use “Symbiter omega” for 21 days in silicone caps for the night after the completion of the use of “Metrogil-Denta”. General medicines for patients in the 2nd group: clindamycin 150 mg every 6 hours (7 days), probiotic “Symbiter acidophilic concentrate” per unit (21 days). Evaluation of the treatment results was carried out 14 days, 3, 6 and 12 months after the end of the course treatment.
 Results. In the examined two groups, there was a disorder in the condition of periodontal tissues. In women of the first group chronic catarrhal gingivitis was registered in 11.5%, chronic generalized periodontitis of initial degree - in 57.69%, chronic generalized periodontitis - in 30.77%; in patients of the 2nd group – in 10.71%, 64.29% and 25% respectively. None of the 54 patients had clinically intact periodontal disease. The PMA and Leish KPI indices in women of the 1st group after the treatment did not have a significant difference with the initial results, while the rates of patients in the second group decreased significantly, indicating a decrease in inflammation in the periodontal tissues. The concentration of sIgA after the end of the treatment course was higher in women of the 2nd group, which suggests a higher efficacy of the proposed method of treatment.
 Conclusions. Comparing the conventional and patented treatment regimen, it has been determined that traditional treatment is significantly less effective. Clinical methods of examination are insufficient to control the quality of treatment of women with BV and manifestations of periodontal disease, since a specific microflora appears in the oral cavity of this contingent of patients. In order to objectify clinical results, it is advisable to use a study of local immunity factors, such as saliva alpha-amylase and sIgA. To control the presence of IB pathogens as an express method, an amino test should be used, and in the case of its positive result, PCR should be used to detect Gardnerella vaginalis and Atopobium vaginae.

Irrelevance of anti‑nAChR cytoplasmic loop antibody in the degree of myasthenia gravis.

Anti‑nicotinic acetylcholine receptor(nAChR) antibody in myasthenia gravis(MG) usually refers to that against the extracellular domain(ECD) of nAChR. However, growing evidence has indicated that there also exists the nAChR antibody against the nAChR cytoplasmic loop(CL) in patients with MG. Some studies have demonstrated that the anti‑CL antibody may play a protective role in animal models of experimental autoimmune MG. However, to date, limited or no information is available as to whether anti‑CL antibody plays a beneficial role in patients with MG. In this, we examined the levels of anti‑CL and anti‑ECD antibodies in the sera of 76patients with MG from the MG sample bank of our department, including 29generalized MG(gMG) and 47ocularMG(OMG) cases, as well as 40healthy controls by radioimmunoassay. We also analyzed the correlation between anti‑CL antibody levels and the degree of severity in patients with MG. Our results revealed that among the 76patients with MG, 61serumsamples(80.3%) were positive for anti‑ECD nAChR antibody, among which 38(38/61, 62.3%) were positive for anti‑CL antibody. The levels of anti‑ECD antibodies in gMG were higher than those in OMG; however, the levels of anti‑CL antibodies in gMG were comparable with those in OMG. No clear correlation was observed between the anti‑ECD antibody levels and those of anti‑CL antibody. Taken together, our findings provide the first clinical evidence of the possibly different role of anti‑CL antibody in patients with MG compared to its role in animal models of MG. Anti‑CL antibody may not exert a beneficial effect in patients with MG, but may play an as yet udetermined role in the development of MG.

FEATURES OF SENSORIMOTOR DISTURBANCES IN DIFFERENT PERIODS AFTER ISCHEMIC STROKE

The aim of the study was to investigate the clinical and neurophysiological features of sensorimotor disturbances in patients at different time periods after ischemic stroke. Methods. The study involved 133 patients with ischemic stroke in the right and left cerebral hemispheres in the late recovery (58) and residual (75) periods. There were 35 controls. Were performed transcranial magnetic stimulation, evoked abdominal reflexes and somatosensory evoked potentials. Results. It was shown that functional recovery processes are continuing with varying degrees of severity in patients and in a year after stroke. Conclusions. Persistence and severity of sensorimotor disturbances, as well as compensatory opportunities, defined afferent component of poststroke deficit, which implies an additional impact in this area to expand the possibilities of neurorehabilitation in patients after stroke.

Clinical Severity of β-thalassaemia/Hb E Disease Is Associated with Differential Activities of the Calpain-Calpastatin Proteolytic System

Earlier observations in the literature suggest that proteolytic degradation of excess unmatched α-globin chains reduces their accumulation and precipitation in β-thalassaemia erythroid precursor cells and have linked this proteolytic degradation to the activity of calpain protease. The aim of this study was to correlate the activity of calpain and its inhibitor, calpastatin, with different degrees of disease severity in β-thalassaemia. CD34+ cells were enriched from peripheral blood of healthy individuals (control group) and patients with mild and severe clinical presentations of β0-thalassaemia/Hb E disease. By ex vivo cultivation promoting erythroid cell differentiation for 7 days, proerythroblasts, were employed for the functional characterization of the calpain-calpastatin proteolytic system. In comparison to the control group, enzymatic activity and protein amounts of μ-calpain were found to be more than 3-fold increased in proerythroblasts from patients with mild clinical symptoms, whereas no significant difference was observed in patients with severe clinical symptoms. Furthermore, a 1.6-fold decrease of calpastatin activity and 3.2-fold accumulation of a 34 kDa calpain-mediated degradation product of calpastatin were observed in patients with mild clinical symptoms. The increased activity of calpain may be involved in the removal of excess α-globin chains contributing to a lower degree of disease severity in patients with mild clinical symptoms.

Clara cell 16 protein in COPD sputum: A marker of small airways damage?

The development of chronic obstructive pulmonary disease (COPD) in smokers and their susceptibility to infections is not fully understood. Recent evidences suggest that Clara cells play a part in host defense, immunomodulatory response and airways remodelling through the production of specific factors such as Clara cell 16 (CC-16). This protein has never been related to patients' lung function tests, blood gases parameters and diseases severity. To evaluate a possible correlation between CC-16 expression in sputum, measured by a new methodological approach, and the degree of severity in patients with moderate and severe COPD. We also analyzed possible correlations between CC-16 and cytological sputum population, arterial blood gases and lung function. We analyzed 20 patients, mean age 72.95, classified on the basis of the global initiative for chronic obstructive lung disease guidelines (GOLD 2006). The samples were processed for cytological analysis and CC-16 levels were assessed by Western blot. We found lower levels of CC-16 in severe COPD compared to moderate ones (p<0.027). No statistically significant differences were found between CC-16 expression and sputum cellularity (except for macrophages), arterial blood gases, and spirometric parameters. Multiple linear regression analysis of CC-16 versus functional and cytological parameters showed no significance. We found a significantly different expression of CC-16 in COPD patients, according to their stage of severity, as defined by the GOLD 2006 guidelines. Considering CC-16 properties in innate immunity, a possible link between protein expression, innate immune system, and COPD infectious exacerbations may be hypothesized but further investigation are needed.

Lung Function and Severity of Mitral Stenosis

Objective: To correlate the degree of severity in patients with rheumatic mitral stenosis to pulmonary function data and to their respiratory symptoms. Methods: Pulmonary function and the MCR questionnaire on respiratory symptoms were made in 43 patients with simple mitral stenosis (SMS), and 79 patients with advanced mitral stenosis scheduled for valve replacement surgery (MVR). Results: All the patients in the two groups had restrictive and obstructive patterns. They had reduced forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), peak expiratory flow rate, maximal flow after exhalation of 75, 50 and 25% of FVC and single-breath carbon monoxide diffusing capacity (DL_CO) and increased total airway resistance, resistance during expiration, and residual volume (RV). The SMS group tended toward more normal values. The MVR group had lower values for all the parameters, specially FVC, FEV₁, DL_CO and higher RV. The MVR group had a significantly higher prevalence of cough, phlegm and acute chest illness than the SMS group. Conclusion: The study confirmed the restrictive and obstructive pattern of pulmonary dysfunction in patients with rheumatic mitral stenosis which related with the severity of mitral stenosis and with respiratory symptoms.

Chronic hepatitis and cirrhosis: evaluation by means of MR imaging with histologic correlation.

To characterize the relationship between findings on magnetic resonance (MR) images and histologic changes in chronic liver disease, a prospective study was performed in 100 patients with chronic hepatitis and cirrhosis and 28 healthy subjects. Biopsy specimens, obtained in all patients before MR imaging, were evaluated with the histologic activity (HA) index; MR images were obtained with short inversion time inversion-recovery (STIR) and spin-echo sequences. On STIR images, normal livers were iso-intense to fat. Significant differences (P < .001) existed between signal intensity of normal livers and that of diseased livers, which were brighter than normal livers on STIR images. The ratio of signal intensity of liver to that of fat on STIR images was associated with an HA index grouped by severity (P < .05): Patients with higher HA scores had a brighter liver. Signal intensity ratios on MR images were statistically significantly associated with periportal and lobular necrosis and portal inflammation. The signal intensity of liver on STIR images is associated with the degree of histologic severity in patients with chronic liver disease.

Introduction and critical comparison of clinical scores for characterizing the degree of morbidity of patients with cystic fibrosis

Scoring systems for evaluation of the degree of severity in patients with cystic fibrosis are critically evaluated. Cross-sectional comparison of Shwachman's score, Cooperman's score, Taussig-NIH score, Bernese score and Huang score reveals that advantages and disadvantages of each score exist. In early days used as a marker of disease progression, later on integrated in research studies for patients survival, the scoring systems loose their power due to the possibility of computerized data storage of unlimited variables. Computerized networking allows immediate access to all measured data of an individual or of groups of patients with detailed criteria. Analysis of such data are less vulnerable for mistakes than individually scored patients data; scoring systems in cystic fibrosis will probably become an historical measure.