Patients Of 1st Group Research Articles

Features of emotional status of smoking patients with ischemic heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Purpose. To study emotional status of smoking patients with ischemic heart disease (IHD). Methods. 277 patients with IHD (angina pectoris II - IV function class) were examined. Patients were divided in two group according to their smoking status. The first group included 139 smoking patients (average age 53.9 ± 0.7 years). The second group included 138 nonsmoking patients with IHD (average age 59.9 ± 0.7 years). A level of anxiety and the depression were examined by the Hospital Anxiety and Depression Scale (HADS), personality characteristics - by the Mini-Mult questionnaire - short form MMPI questionnaire. Results. The groups did not differ in class of angina pectoris and treatment. The patients of 1st group had level of anxiety and depression 6.9 ± 0.3 score and 5.4 ± 0.4 score accordingly. The patients of 2nd group had level of anxiety and depression 8.7 ± 0.4 score (p < 0.01) and 6.8 ± 0.3 score accordingly (p < 0.05). The patients of 1st group had such personality characteristics accordingly: on scale of Hypochondriasis – 54.9 ± 0.7 T-score; on scale of Depression – 50.3 ± 1.1 T-score; on scale of Hysteria – 52.1 ± 0.6 T-score; on scale of Psychopathic Deviate – 45.1 ± 0.8 T-score; on scale of Paranoia – 51.3 ± 0.9 T-score; on scale of Psychasthenia – 47.6 ± 0.9 T-score; on scale of Schizophrenia – 47.6 ± 0.9 T-score; on scale of Hypomania – 49.9 ± 1.0 T-score. The patients of 2nd group had the such personality characteristics accordingly: on scale of Hypochondriasis - 58,1 ± 0,7 T-score (p < 0.01); on scale of Depression – 53.4 ± 1.1 T-score (p < 0.05); on scale of Hysterias – 55.4 ± 0.6 T-score (p < 0.01); on scale of Psychopathia Deviate – 46.9 ± 0.9 T-score (p >0.05); on scale of Paranoia – 55.0 ± 1.1 T-score (p < 0.05); on scale of Psychasthenia – 51.5 ± 1,0 T-score (p < 0.05); on scale of Schizophrenia – 51.3 ± 1.0 T-score (p < 0.05); on scale of Hypomania – 49.6 ± 0.9 T-score (p > 0.05). Conclusion. The smoking patients with ischemic heart disease had less expressed accentuated personality characteristics and lower level of anxiety and depression, in comparison with nonsmoking patients, that should be considered in treatment and rehabilitation.

Quality of life of elderly men and women with ischemic heart disease

Abstract Funding Acknowledgements Type of funding sources: None. The purpose. To study quality of life and emotional status of elderly men and women with ischemic heart disease (IHD). Methods. The first group - 79 elderly (60 years and older) men with IHD (average age 64.81 ± 0.5 years) and the second group - 46 elderly women with IHD (average age 64.2 ± 0.5 years) were examined. All patients of the first and second group had the angina pectoris (II-IV functional class). A level of quality of life was estimated by Seattle Angina Questionnaire of quality of life (SAQ). A level of anxiety and the depression were examined by the Hospital Anxiety and Depression Scale (HADS), personality characteristics - by the Mini-Mult questionnaire - short form MMPI questionnaire. Results. The groups did not differ in class of angina pectoris and treatment. The quality of life in the 1st and 2nd group was accordingly 56.2 ± 1.9 and 48.1 ± 1.6 score on Physical limitation scale (p < 0.05), 44.4 ± 2.3 and 44.8 ± 3.7 score on Angina stability scale (p > 0.05), 54.9 ± 2.6 and 57.8 ± 3.3 score on Angina frequency scale (p > 0.05), 66.8 ± 1.4 and 62.4 ± 1.9 score on Treatment satisfaction scale (p > 0.05), 54.6 ± 1.6 and 49.7 ± 2.2 score on Disease perception scale (p > 0.05), 57.2 ± 1.3 and 52.6 ± 1.5 score on Total score scale of quality of life (p < 0.05). The patients of 1st group had level of anxiety 6.8 ± 0.4 score and level of depression 5.3 ± 0.4 score accordingly. The patients of 2nd group had accordingly 9.2 ± 0.5 score (p < 0.01) level of anxiety and 7.2 ± 0,4 score (p < 0.05) level of depression. The patients of 1st and 2nd group had such personality characteristics accordingly: on scale of Hypochondriasis – 55.5 ± 0.7 and 61.9 ± 1.2 T-score (p < 0.01); on scale of Depression – 48.7 ± 1.1 and 59.2 ± 1.4 T-score (p < 0.01); on scale of Hysteria – 51.0 ± 0.6 and 58.9 ± 0.8 T-score (p < 0.01); on scale of Psychopathic Deviate – 44.3 ± 1.2 and 50.3 ± 1.5 T-score (p < 0.01); on scale of Paranoia – 51.5 ± 1.4 and 59.8 ± 1.9 T-score (p < 0.01); on scale of Psychasthenia – 46.8 ± 1.2 and 55.8 ± 1.5 T-score (p < 0.01); on scale of Schizophrenia – 46.9 ± 1.1 and 56.5 ± 1.6 T-score (p < 0.01); on scale of Hypomania – 45.5 ± 1.9 and 52.9 ± 1.7 T-score (p < 0.01). Conclusion. The elderly women with ischemic heart with disease had worse quality of life and more expressed accentuated personality characteristics and higher levels of anxiety and depression, in comparison with elderly men. The revealed features of quality of life, personality characteristics and emotional status of elderly patients with ischemic heart with disease have to be considered in treatment and rehabilitation.

Complications after radical cystoprostatectomy with various variants of the heterotopic ureteroneocystostomy

Background. Radical cystoprostatectomy is currently considered the most time-consuming operation with a large number of possible complications. Over the past decades, heterotopic reconstruction of the bladder using a segment of the ileum has become the optimal method of urine derivation. To date, we have successfully used a modification of V-shaped heterotopic ileocystoplasty.Objective: to compare early postoperative complications in patients who underwent radical cystoprostatectomy with the formation of a Bricker conduit and with a modified V-shaped heterotopic conduit.Materials and methods. In order to study and compare the complications that occurred in the first 30 days after surgery, we retrospectively selected patients after radical cystoprostatectomy with heterotypic ileocystoplasty. Patients were divided into two groups: 1st — patients with Bricker ileocystoplasty (n = 46), 2nd — patients with modified V-shaped heterotopic ileocystoplasty (n = 49).Results. The greatest number of complications was registered in patients of 2nd group — 19 (41.3 %), in patients of 1st group — 14 (28.6 %). Repeated surgical interventions were required in 6 (12.2 %) patients of 1st group, in 5 (10.8 %) of 2nd group. Fatal outcomes were registered in 3 (6.1 %) patients of 1st group, in 2 (4.2 %) of 2nd group. The number of pyelonephritis in the first 30 days in patients of 1st group was 8.2 %, 2nd group — 23.9 %.Conclusion. Modified V-shaped heterotopic urine derivation is easily feasible. This method should be used in patients with chronic pyelonephritis against the background of previously diagnosed ureterohydronephrosis, which is a fairly frequent consequence of the invasive nature of the growth of bladder cancer with ureteral obstruction.

LEFT VENTRICULAR HYPERTROPHY REGRESSION DURING ANTIHYPERTENSIVE TREATMENT IN RESISTANT HYPERTENSION PATIENTS

Objective: Objective: to determine the predictors of regression of left ventricular hypertrophy (LVH) in treated resistant hypertensive (RH) patients after 2.1 ± 0.1 years of follow-up. Design and method: We studied 51 patients with RH confirmed by the office and ambulatory blood pressure (BP) monitoring despite the use of 3 antihypertensive medications for at least 3 months. During 2 years-period patients had been treated to 12-week rotations of oral daily treatment with spironolactone, nebivolol, torsemide, eplerenone, moxonidine in addition to their baseline triple-combination. Then participants continued to receive the personal most effective fourth-line agent. Patients were divided into 2 groups: 17 patients had LV mass index (LVMI) which was increased or stayed stable after 2 years (1st group), 34 patients with a reduction of LVMI in 2 years (2nd group). Results: Initially there were no significant differences in sex, duration of hypertension, body mass index, office and average 24-h ambulatory BP between the 2 groups. Compared with the 1st group patients from the 2nd group had a higher prevalence of non-dippers (24.3 vs 65 %, P < 0.001, respectively) and larger baseline LVMI (127.3 ± 4.1 vs 147.8 ± 6.5 g/m2, P < 0.01, respectively). Patients with persistent LVH included more subjects with coronary artery disease, chronic kidney disease and had less baseline active renin concentration (all P < 0.05). After 2 years in both groups office and average 24-h BP levels have been reduced, but goal rates were achieved at 28.6 % patients of the 1st group and 44.1 % patients of the 2nd group (P < 0.05). Reduction in nighttime BP was greater in the 2nd group. Initial higher LVMI (β = 0.655; P < 0.0001), baseline 24-h urinary albumin excretion (β = - 0.475; P < 0.0001), active renin concentration (β = 0.442; P = 0.005) were predictors of δ LVMI in multivariate modeling. Conclusions: Regression of LVH is possible in patients with RH in case of BP control, especially at night. Baseline higher LVMI, an increase of active renin concentration, decline of urinary albumin excretion are factors that determine reversibility LVH.

Quality of life after surgical treatment of mitral heart disease

Aim. To evaluate long-term quality of life (QOL) of patients after surgical treatment of mitral valve disease depending on the types of surgical intervention, to identify predictors of a lower QOL after surgery.
 Material and methods. A single-center retrospective study involved 107 patients after isolated correction of primary non-ischemic mitral valve (MV) pathology, who were operated on from 2009 to 2016, and analyzed their long-term QOL. The follow-up period was from 2 to 6 years. 2 groups of patients were formed: the 1st group (n=60) patients who underwent mitral valve replacement (MVR); the 2nd group (n=47) patients who underwent mitral valve repair (MVRep). There were no statistically significant differences between the main clinical and demographic characteristics in reference to the groups. The SF-36 questionnaire was used for studying QOL.
 Results. The indicators of QOL approach the average population levels in both groups. In group MVRep Physical Functioning PF (p=0.02 and 0.01), Bodily Pain BP (p=0.04), Vitality VT (p=0.01) and Social Functioning SF (p=0.001) are higher. There are improvements in physical and mental health components after surgery. Mental and physical components are lower than in the normal population but they dont go beyond average populations indicators. Mental health in the MVRep group is better than in the MVR group (p=0.01). Female gender, dilatation of the left atrium (every 1 mm before surgery), older age (every year) increased the probability of lower QOL in the long term by 84, 11 and 8% respectively.
 Conclusion. Long-term QOL of patients after surgical treatment of mitral valve disease improves both after valve repair and after valve replacement. After MVRep Physical Functioning, Bodily Pain, Vitality and Social Functioning indicators are higher. There are improvements in physical and mental health components. Psychological component of health is higher in patients in the MVRep-group. Female gender, dilatation of the left atrium, older age increase the probability of lower QOL in the long term after mitral valve surgery.

Phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patients.

BACKGROUND: The «gold standart» for surgical treatment of patients with proliferative diabetic retinopathy (PDR is vitreoretinal surgery. However, the question of the timing of the removal of primary cataract in this category of patients remains open.AIM: To evaluate the efficacy of phacoemulsification of primary cataract by the second stage after vitreoretinal surgery of PDR patientsMETHODS: 67 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. This patients were divided into two groups depending on the treatment tactics. In the 1st group patients were subjected to a two–step surgical procedure: vitreoretinal surgery with silicone oil tamponade performed as the 1st step in their treatment; followed by the 2d step, phacoemulsifi tion surgery and silicone oil removal, and the IOL implantation, respectively. In the 2d group phacoemulsifi tion performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity.RESULTS: Visual functions improved in 88.6% of cases in group 1, and in 68.7% in group 2.CONCLUSIONS: Outcomes of the preliminary studies suggest that it is more viable to perform phacoemulsification surgery sometime later along with silicone oil removal on PDR patients with complicated primary cataract. This sequence of treatment procedure ensures a more gentle approach to the anatomic structures of the eye during the first stage (vitreoretinal surgery) and contributes to the reduction in the number of intraoperative and postoperative complications.

Comparative Study between the Use of Regular Folic Acid Supplement versus the Use of L-Methyl Folate in Patients with Methyl Tetrahydrofolate Reductase (MTHFR) Gene Mutation with Recurrent Pregnancy Loss

Background: Methylfolate is the active metabolite of folate that is important for DNA repair, synthetized under the effect of MTHFR (methyl-tetrahydro-folatereductase) enzyme. Patients with MTHFR gene mutation have low levels of biologically active methyfolate. Those patients have high homocysteine levels causing vasculopathy and inadequate feto-maternal circulation. Aim of the Work: To predict the potential benefit of use of methylfolate instead of use of the regular folic acid in patients with MTHFR gene mutation with history of RPL (recurrent pregnancy loss). Subjects and Methods: Study was performed on 100 women. All women had experienced at least two consecutive miscarriages first trimester abortion. All patients were positive of having MTHFR gene mutation. Patients were divided into two groups in terms of 1st trimester drug intake. The 1st group recieved a regular folic acid supplement in a dose of 5 mg per day starting from the day of positive pregnancy test till the end of the first trimester. The 2nd group recieved L-methylfolate supplement in a dose of 1000 mcg per day starting from the day of positive pregnancy test till the end of the first trimester. Then both groups were compared in terms of abortion rates, pregnancy continuation rates and the development of other major obstetric complications. Results: Patients in 1st group had no associated pregnancy related complications in 56%, PE in 14%, PROM in 18% and PTL in 12% of cases. On the other hand, patients in 2nd group had no associated pregnancy related complications in 78%, PE in 6%, PROM in 8% and PTL in 8% of cases 54% of patients on folate group ended in abortion, while only 16% of patients on methylfolate group had abortion. 24% of patients on folate group had PTL, compared to 8% of patient who had had PTL in methylfolate group. 22% of patients in the 1st group continued pregnancy to full term, while 60% of 2nd group continued pregnancy to full term. Conclusion and Recommendations: The use of methyl-folate supplement during the first trimester of in patients with history of RPL and positive MTHFR gene mutation should be a routine practice instead of the regular folate supplement as it improves pregnancy continuation rates and decreases occurrence of associated pregnancy co-morbidities as preterm labor and preeclampsia.

The influence of the degree of sanogenetic education of the population in a subsidized subject of the Russian Federation on dental health

To determine the effect of healthy lifestyle (HLS) on dental health (prevalence and intensity of dental diseases). The study was conducted in the standard age group 35-44 years. According to the results of a sociological survey, two groups were formed: leading HLS (1st group, 30 respondents) and those not leading HLS (2nd group, 34 respondents). The presence and prevalence of caries, its intensity (DMFT index), the hygienic state of the oral cavity (Green-Vermillion index (GRVI) and the effectiveness of oral hygiene (PHP), the state of periodontal tissues (CPITN)) were assessed. The prevalence of caries in group №1 was 77%, in 2nd group - 100%, the average value of the DMFT in group №1 was 8.9±0.2, in 2nd group - 17.1±0.3; the values of the GRVI index differed 5 times (1.1 and 5.2), the PHP index - 9 times (0.2 and 1.8, correspondently). In 2nd group, the high prevalence of dentition defects was revealed (40%), only 6% of patients had a normal periodontal condition, pathological periodontal pockets with a depth of 6 and more mm in patients were 3 times higher (9%) comparing to 1st group (3%). Periodontal care was required 94% of patients in the 2nd group (in 1st group - 72%). Patients in the 1st group took much better care of their teeth: the level of hygiene index was within 1.1 (in 2nd group - 5.2 - poor) Adequate oral hygiene regimen was found in 93% of patients in 1st group and only in 38% in 2nd group. The data obtained indicate not only poor dental health of the population, but also about significant shortcomings in the medical care and the low efficiency of preventive work on the part of the dental service.

Многофакторный анализ дифференциально-диагностических параметров у больных бронхиальной астмой средней тяжести с пульмогенной артериальной гипертензией и эссенциальной артериальной гипертензией

Objective: to analyze differential diagnostic parameters in patients with moderate bronchial asthma with pulmogenic arterial hypertension with essential arterial hypertension. Material and Methods: 25 patients with moderate bronchial asthma with pulmogenic arterial hypertension (the 1st group) and 25 patients with moderate bronchial asthma with essential arterial hypertension (the 2nd group) were included in the study. Both groups of patients received step therapy (berodual + inhaled glucocorticosteroids). All patients underwent complex ultrasound examination of intracardiac hemodynamics, examination of blood flow in the right ventricle excretory tract. Systemic arterial pressure was measured according to N. S. Korotkov’s method. ECG was studied (24-hour monitoring). Cold test (at -20 °C-40 °C) was performed in both groups of patients, blood gas composition and pulmonary ventilation function indices were studied. Results: As a result of research established reliable differences in the spirographic indices, blood gas composition in patients with moderate bronchial asthma with pulmogenic arterial hypertension (the 1st group), and reliable differences in partial pressure of oxygen and carbon dioxide (p < 0,05). The 1st group of patients has also higher values of PaCO2 and reliably (p < 0,0,5) and lower values of PaO2, SaO2 in comparison with the comparison group of patients with bronchial asthma of average severity with essential arterial hypertension (the 2nd group). Our data have shown, that in the 1st and 2nd group patients systolic-diastolic cardiac function indexes reliably (p < 0,05; p < 0,001) differed from those ones in healthy subjects. At the same time systolic pressure in the pulmonary artery in the 1st group patients was higher than in the 2nd group patients, and left ventricular ejection fraction was significantly different from that in healthy people and was lower in the 1st group patients than in the 2nd group. We have revealed a reliable correlation between systolic blood pressure and Sа02 (r = 0,52, p < 0,05), studied after cold test, which confirmed the hypothesis of the formation of pulmogenic arterial hypertension against the background of hypoxia. More pronounced changes of FEV1, Sа02, systolic blood pressure in group 1 patients were to some extent due to significant cold hyperresponsiveness in this category of patients. Conclusions: the results of our studies have shown that the decrease of FEV1, FEV50, FEV75, PaO2, SaO2, increased systolic pressure in the pulmonary artery, signs of right heart hypertrophy, disturbances of systolic-diastolic heart function were more pronounced in moderate bronchial asthma patients with pulmogenic arterial hypertension than in moderate bronchial asthma patients with essential arterial hypertension. The proportion of patients (in %) with rhythm disturbances, especially sinus tachycardia, extrasystoles were detected significantly more frequently in group 1 patients than in group 2 patients, which was due to a more pronounced disturbance of systolic-diastolic heart function, higher systolic pressure in the pulmonary artery in persons with moderate bronchial asthma with pulmogenic arterial hypertension.

Оценка состояния глазной поверхности у пациентов с отягощенным общесоматическим анамнезом. Ранняя диагностика, способы лечения и профилактики

Introduction. Modern computerisation, frequent use of contact correction, surgical interventions on the visual organ and long-term drug installations often lead to the formation and further progression of dry eye syndrome (DES) with subsequent increased sensitivity and inflammatory symptoms on the conjunctiva and cornea. Purpose. Evaluation of the condition of the eye surface in patients with a burdened general somatic history. Development of measures for prevention, diagnosis and comprehensive treatment of this condition. Material and methods. A retrospective analysis of disease histories and medical records of 108 patients (108 eyes) with phacoemulsification of uncomplicated cataract with IOL implantation was carried out. Patients were divided into three main groups based on the presence of burdening factors of somatic status and the course of the postoperative period: I group included patients with unburdened somatic status and no complications during the course of the postoperative period; II group included patients with burdened general somatic history with complications during the course of the postoperative period; 3rd group included patients with burdened general somatic history with complications during the course of the postoperative period. 3rd group of patients used a special scheme to prevent and treat inflammatory reactions from the eye surface. Results. 1st group patients were less likely to complain and had no clinical manifestations of conjunctival and corneal inflammatory responses. Accordingly, this group of patients did not require additional treatment, which is indicative of the low incidence of complications in this category of patients. II group patients who had been identified as predisposing factors for conjunctival and corneal inflammatory reactions and did not receive additional treatment were more likely to experience complaints and the frequency of clinical manifestations was 20% higher than III group patients. Patients in III group required additional treatment in the postoperative period. Conclusion. Prolonged prescription of high doses of drugs of different groups with different preservative and auxiliary substances content in patients after surgical intervention in some cases leads to damage to the conjunctival and corneal epithelium, which in turn causes an aggravation of symptoms of SSG with the development of inflammatory reaction of the conjunctiva and cornea. The application of preventive measures before and after the surgery leads to a significant reduction in the objective manifestations of the eye surface complications and, as a result, a reduction in the number of complaints from patients about discomfort in the postoperative period. Key words: ocular surface, dry eye syndrome, cataract, allergies, tear film stability.

Features of salt enteral solution application in the treatment of various forms of acute pancreatitis

The article presents the results of a retrospective study of the intestinal lavage (IL) with saline enteral solution (SES) effectiveness for the treatment of dynamic intestinal obstruction in acute forms of pancreatitis and pancreonecrosis. Objective: to study improve the results of patients treatment in intestinal paresis by various forms of acute pancreatitis, using IL lavage with the use of SES. Materials and methods. The study included 81 patients: 56 (69.1 %) men and 25 (30.9 %) women, average age 59.3 ± 13.4 years, who were hospitalized in the clinic at different times from the onset of the disease: from 24 hours to 7 days. Patients were divided in two groups: 1st group (46 people) included patients who started IL for the first 3 days after the onset of the disease; 2nd group (35 people) consisted of patients who started IL after 3 days of the disease, 30 patients of 2nd grouphad surgery before IL. Results. Prokinetic effect of IL in gastrostasis and dynamic bowel obstruction improve the quality of conservative treatment (up to 78.3 % in 1st group and 37.1 % in 2nd group); avoid open surgical interventions (up to 6.5 % in 1st group, up to 37.1 % in 2nd group), carry out decreasing invasive effects of drainage of limited focus (in 15.2 % of patients in 1st group, 42.9 % in 2nd group); eliminate the phenomen of gastrostasis within 3 days after IL in both groups. Reduction/elimination of the phenomen of dynamic intestinal obstruction after IL within 24 hours (up to 73.8 % in 1st group, up to 97.1 % in 2nd group), allowed to start early enteral nutrition within 48 hours (in 73.9 % of patients of 1st group, up to 42.8 % patients of 2nd group). Conclusions. Early using of intestinal lavage in the complex therapy of acute forms of pancreatitis is safe and effective and reduces the number of purulent-septic complications, prevents the development of multiple organ failure, reduces the overall mortality, prepares the intestine for early enteral nutrition.

EXOCRINE AND ENDOCRINE PANCREATIC INSUFFICIENCY IN DEVELOPMENT OF ATHEROSCLEROSIS

Objective: To evaluate the effect of chronic pancreatitis (CP) and exocrine insufficiency of the pancreas on the carotid intima media thickness (cIMT) in patients with type 2 diabetes mellitus (DM-2). Materials and methods: 91 patients were examined, they were divided into groups: 1st group-patients with DM-2 (n = 31) group 2nd – DM-2 combined with CP (n = 60). Fasting plasma glucose (FPG), HbA1c, immunoreactive insulin (IRI), HOMA-IR index, C-reactive protein (CRP), serum α-amylase and fecal-1 elastase (FE-1) were assessed. In order to assess the thickness of the cIMT, ultrasound of the common carotid artery was performed. The control group of healthy volunteers was representative by age and sex. Results: In the 1st and 2nd groups, the average value of cIMT was (1.02 ± 0.1 vs 1.21 ± 0.15) mm. Parameters of DM-2 management in the 1st and 2nd groups were (FPG 8.18 ± 0.92vs8.57 ± 1.2) mmol / l; HbA1c (7.23 ± 0.21vs7.49 ± 0.36)%; IRI (20.31 ± 0.9vs22.53 ± 1.2) μIU / ml; HOMA-IR (6.55 ± 1.5vs8.38 ± 2.2) μIU / ml * mmol / l; PSA (1.3 ± 0.12vs6.77 ± 0.31). HOMA-IR correlated with: CRP (r = 0.43, p <0.05 in group 1; r = 0.61, p <0.05 in group 2); FE-1 (r = -0.55, p <0.05 of the 2nd group); and cIMT (r = 0.42, p <0.05 in the 1st group; r = 0.53, p <0.05 in the 2nd group). IRI have relationship with: FE-1 (r = 0.41, p <0.05 in group 1; r = -0.3, p <0.05 in group 2); CRP (r = 0.42, p <0.05 in group 1; r = -0.28, p <0.05 in group 2); HbA1c had close relationships with cIMT (r = 0.38, p <0.05 in group 1; r = 0.51, p <0.05 in group 2). The relationship between cIMT and CRP was related in the 2nd group (r = 0.39, p <0.05); with α-amylase (r = 0.2, p <0.01 2nd group). There was no significant relationship between cIMT and FE-1 in the study. Conclusions: Obtained data allows us to conclude that hyperinsulinemia and insulin resistance have a direct atherogenic effect on the walls of blood vessels. It is established that the accession of the inflammatory process leads to increasing development of atherosclerotic lesions of the vessel, at the same time, the presence of exocrine dysfunction of the pancreas does not have a significant direct effect on the cIMT.

Molecular patterns of oxidative stress in drug-induced nephropathy

Introduction: Drug induced kidney disorder is a frequent adverse event which contributes to morbidity and even incapacitation. The discovery and development of novel biomarkers and local (renal) response mechanisms, are needed for effective prevention of drug-induced nephrotoxicity. Objectives: The main purpose of our study was to investigate the oxidative modifications of proteins in blood plasma and erythrocytes of patients with drug-induced nephropathies. Patients and Methods: Around105 patients were divided into two groups: first group was represented by patients with psychotropic drug-induced nephropathy; the second one consisted of patients received nonsteroidal anti-inflammatory drugs (NSAIDs). Advanced oxidation protein products (AOPPs) were measured by Witko-Sarsat method. Protein reactive carbonyl derivatives (PRCD) were assayed in blood plasma and erythrocytes by the Levine method. Neutrophil gelatinaseassociated lipocalin (NGAL) was determined with the use of a commercially available ELISA kit. Results: Carbonyl derivatives are significantly higher in red blood cells of the 1st and 2nd group patients compared to the control subjects. AOPP statistically increased both in patients with various types of drug nephropathy and in patients with chronic kidney disease (CKD) compared with the control group. The NGAL was significantly higher in all groups compared to the control subjects. Conclusion: The patients with drug-induced nephropathy have increased level of oxidative stress products and response NGAL reaction. The mechanisms that lead to the development of oxidative stress and the production of modified proteins are different in patients treated with different drugs. Establishing patterns of cell-molecular interaction permit the drug-induced nephropathy to be timely diagnosed and therapeutic programs to be optimized.

Magnetic-laser therapy in multidisciplinary rehabilitation of patients with chronic non-specific dorsalgia with high intensity pain syndrome in outpatient care

The effectiveness of the analgesic impact of magnetic-laser therapy (MLT) and its combinations with other methods with have a aproved analgesic effect used for multidisciplinary rehabilitation of patients with chronic nonspecific dorsalgia (CNSD) with marked pain syndrome in a polyclinic has been studied. 107 patients with high intensity pain syndrome (on a VAS scale from 6 to 8 points is severe pain) in CNSD exacerbation phase were included. The patients were divided into five homogeneous groups. All patients were treated with kinesiotherapy (KT). In addition, patients of the 1st group were treated with MLT; patients of the 2nd group were treated with sinusoidal modulated currents (SMT); patients of the 3rd group were treated with ultraphonophoresis with non-steroidal anti-inflammatory drugs (UPP NSAID); patients of the 4th group were treated with complex of MLT and SMT; patients of the 5th group were treated with MLT and UPP NSAID. Pain dynamics was assessed using VAS, while patient functional capabilities - using FAS-9 questionnaire. MLT application in 1st group patients decreased pain and altered functions very slightly (p>0.05). Ten sessions of SMT or UPP together with KT caused transition of severe pain to moderate - from (5.67±0.37) to (3.30±0.26) and from (5.75±0.34) to (3.72±0.31) points, respectively (p<0.001), which allowed to increase significantly the activity of KT. MLT and SMT combination after 8 sessions has caused two-fold pain decrease – from (5.96±0.39) to (2.82±0.25) points (p<0.001) and significantly improved movement biomechanics. SMT or UPP combination with MLT potentiates antinociceptive effect of both modalities, so patient functional capabilities regenerate earlier. This fact allows to apply KT from the first day of rehabilitation, which leads to the reduction of rehabilitation time. Keywords: chronic non-specific dorsalgia, multidisciplinary rehabilitation, kinesiotherapy, magnetic- laser therapy, sinusoidal modulated currents, NSAID ultraphonophoresis.

Clinical Efficacy of Enteral Saline Solution When Used as Part of Combined Treatment for Various Forms of Acute Pancreatitis

The article presents the results of a retrospective study of the effectiveness of intestinal lavage with enteral saline solution for the treatment of dynamic intestinal obstruction in acute forms of pancreatitis and pancreonecrosis. The objective of this study is to improve treatment results in patients with intestinal paresis with various forms of acute pancreatitis with the use of intestinal lavage with enteral saline solution.Materials and methods. The study included 81 patients, 56 (69.1 %) males and 25 (30.9 %) females, the age averaging at 59.3 ± 13.4 years. These patients were hospitalized at different time intervals counting from the onset of the disorder, ranging from 24 hours to 7 days. Patients were divided in two groups depending on hospitalisation prior to the first procedure of intestinal lavage providing there was no counterindications.Results and discussion. Prokinetic effect of intestinal lavage in patients with gastrostasis and dynamic bowel obstruction help improve the quality of conservative treatment (up to 78.3 % in 1st group and 37.1 % in 2nd group); avoid open surgical procedures (up to 6.5 % in 1st group, up to 37.1 % in 2nd group), perform minimally invasive procedures to drain confined lesions (15.2 % of patients in 1st group, 42.9 % in 2nd group); eliminate manifestations of gastrostasis within 3 days following IL in both groups. The reduction/elimination of dynamic intestinal obstruction within 24 hours following IL (up to 73.8 % in 1st group, up to 97.1 % in 2nd group) made it possible to start early enteral nutrition within 48 hours (73.9 % in 1st group, up to 42.8 % in 2nd group).Conclusions. Early use of intestinal lavage in the complex therapy of acute forms of pancreatitis is safe and effective. It reduces the number of purulent-septic complications, prevents the development of multiple organ failure, reduces the overall mortality, prepares the intestine for early enteral nutrition.

Effect of direct current electric field on the rate of wound epithelization in patients with diabetic foot syndrome

The aim of the work: to study the development of wound process in dynamics by means of examination of impression smear from the wounds of patients with diabetic foot syndrome by means of Pokrovska-Makarova method, planimetric examination by means of L. M. Popova method in case of treatment by traditional methods combined with galvanization of an afflicted lower limb and application of interstitial Berlithion electrophoresis.
 Materials and Methods. 113 patients with complicated forms of diabetic foot syndrome were examined and treated. Group 1 of patients underwent a traditional course of treatment, whereas a complex of treatment measures was complemented with galvanization of the affected lower extremity for the patients of group 2 at an early stage of the postoperative period. The patients of group 3 were additionally treated with local interstitial electrophoresis of Berlithion during an early stage of the postoperative period. A control over the dynamics of the wound process was carried out by means of estimating wound impression smears.
 Results and Discussion. A comparison of the rate of the transition of the cytological picture of impression smears from the inflammatory type to the regenerative, regenerative-inflammatory and finally to the regenerative types demonstrated that these processes among patients of 1st group occurred, on an average, during 20 days, among patients of the group 2 during 16 days and group 3 – during 14 days. Reducing the area of injury in patients of group 1 is ≈ 1 % per day, patients in group 2 – 2 %, followed by – 2.1–2.2 % per day and patients in group 3 speed up wound area reduction on an average 3 %. Therefore, under effect of direct current of electric field an inflammatory type of cytogram was found mainly from the 3–4 to 7–8th days compared with the control group, where these phenomena were found from the 3-4 to the 11–12th days. Approximately similar dynamics was found in case of ISEP action with Berlithion. When the wound process is passed into the second phase which is evidenced by the appearance of inflammatory impression smear, the rate of regeneration appeared to be the highest in the group of patients who received interstitial electrophoresis with Berlithion.

Оцінювання нутрітивного статусу у дітей з гострою дихальною недостатністю: проспективне обсерваційне когортне дослідження

Оцінювання нутрітивного статусу у дітей з гострою дихальною недостатністю: проспективне обсерваційне когортне дослідження

Prevention and treatment of post-implantation maxillary sinusitis

The state of the nasal cavity, especially the region of the osteomyomatic complex, plays a significant role in the development of chronic maxillary sinusitis. Odontogenic maxillary sinusitis, as a complication of dental implantological treatment on the upper jaw, is increasingly common. The aim of the study was to increase the effectiveness of prophylaxis and treatment of odontogenic purulent upper jaw sinusitis during reconstructive operations on the alveolar region of the upper jaw. 3 groups of patients were examined: before dental treatment, after dental treatment in the development of odontogenic maxillary sinusitis and 30 patients were selected and examined, who underwent reconstructive surgeries on the alveolar process of the upper jaw and in whom the postoperative period was without complications. The diagnoses of 1st and 2nd group patients required surgical treatment. FESS allows restoring the physiological aeration of maxillary sinuses as naturally as possible, which is important for correct reparative bone regeneration in the alveolar region of maxilla.

Ефективність комбінованого препарату L-аргініну та L-карнітину в терапії пацієнтів з гострим інфарктом міокарда

Мета роботи – оцінити ефективність комбінованого препарату L-аргініну та L-карнітину (КПАК) як доповнення до стандартної терапії в пацієнтів з гострим інфарктом міокарда (ГІМ).Матеріали і методи. У дослідження залучено 60 хворих віком у середньому (48,9±19,2) року з верифікованим діагнозом ГІМ, після перкутанного коронарного втручання. Термін спостереження – 6 тиж. Пацієнти були рандомізовані на дві групи. До 1-ї групи увійшло 30 хворих, які, крім стандартної терапії, отримували КПАК (Тіворель, Юрія-Фарм, Україна) у вигляді внутрішньовенної інфузії 100 мл 1 раз на добу, починаючи з 3–7-ї доби ГІМ протягом 10 діб. До 2-ї групи увійшло 30 пацієнтів, у яких застосовували лише стандартну терапію (подвійна антитромбоцитарна терапія, інгібітори ангіотензинперетворювального ферменту, β-адреноблокатори, статини). Усім пацієнтам проводили ехокардіографію з оцінюванням об’ємних показників та фракції викиду за Simpson, велоергометрію, лабораторні тести. Результати та обговорення. Додаткове призначення КПАК до стандартної терапії зумовило зниження рівня глюкози до референтних значень (6,1±2,8) ммоль/л порівняно з (7,2±3,3) ммоль/л (р<0,05) у пацієнтів 2-ї групи, в якій рівень глюкози так і не наблизився до референтного діапазону. Рівень креатиніну у хворих 1-ї групи під час третього дослідження статистично значуще (р<0,005) знизився порівняно з першим дослідженням (з (124,0±20,1) до (103,6±18,1) ммоль/л). У пацієнтів 2-ї групи цей показник становив (121,2±18,1) та (124,8±17,4) ммоль/л при першому та третьому дослідженні відповідно. Середнє значення порогової потужності навантаження в пацієнтів 1-ї групи досягло (107,5±30,9) Вт та було статистично значуще (р<0,05) вищим порівняно з таким у хворих 2-ї групи ((99,4±24,9) Вт). Відношення різниці подвійного добутку до виконаної роботи (∆ПД/А) у відповідь на субмаксимальне фізичне навантаження у 1-й групі на 15–18-ту добу становило 2,8±1,8, а в групі контролю – 2,4±2,2. До 5–6-го тижня у 1-й групі показник ∆ПД/А статистично значуще (р<0,05) знизився, до 2,1±0,6, порівняно з 2,3±1,4 у 2-й групі. Таким чином, толерантність до фізичного навантаження в пацієнтів 1-ї групи через 5–6 тиж стала вищою, ніж при першому дослідженні, що можна розцінити як сприятливу клінічну ознаку. Показники внутрішньосерцевої гемодинаміки протягом періоду спостереження між групами мали різні тенденції. Так, у пацієнтів 1-ї групи до другого дослідження фракція викиду збільшилася до (51,9±5,0) % порівняно з першим дослідженням ((48,9±5,9) %; р=0,189), а в пацієнтів 2-ї групи до другого дослідження цей показник знизився до (45,6±6,2) % порівняно з першим ((48,1±9,2) %; р=0,201). У пацієнтів 1-ї групи до 5-6-го тижня зафікcовано зниження кінцевосистолічного об’єму до (64,0±18,6) мл порівняно з попереднім дослідженням ((69,9±21,3) мл; р=0,192), тоді як у хворих 2-ї групи цей показник фактично залишився без змін. До кінця дослідження різниця цього показника між групами була статистично значущою (р<0,05).Висновки. З огляду на те, що під час ГІМ виснажується депо карнітину та аргініну, їх дефіцит передбачає можливість застосування КПАК у складі комбінованої терапії в пацієнтів з ГІМ. Застосування КПАК у перші 3–15 діб ГІМ при спостереженні протягом 6 тиж продемонструвало кардіопротективні, нефропротективні та гепатопротективні властивості препарату. Позитивна динаміка рівня глюкози крові та значущі відмінності між групами свідчать про сприятливий вплив КПАК на вуглеводний обмін.

Sodium Valproate versus Continuous Infusion of Haloperidol in Management of Agitated Critically Ill Patients.

AIM:Describe the efficacy and safety of valproate and haloperidol infusion in controlling agitation in the intensive care unit (ICU).MATERIAL AND METHODS:Prospective study on 100 critically ill patients with agitation in Kasralainy Hospital over the period from May 2016 to June 2017.patients were divided into two groups, each group included 50 patients, 1st group patients received Depakene orally, and 2nd group patients received haloperidol by i.v infusion for 72 h. Richmond agitation sedation score and doses of additional sedative drugs were noted and calculated daily in the first three days.RESULTS:Our study showed that valproate was equal in efficacy in controlling agitation; decreasing the RAAS significantly after 48 h from initiation (2.52 ± 0.61 vs 0.28 ± 0.54 with p < 0.001) for Depakene and (2.6 ± 0.67 vs 0.34 ± 0.48 with p < 0.001) for haloperidol. There was also a decrease in the doses of additional sedative drugs used to control agitation (midazolam & propofol) after 48 h from drug initiation. Both drugs therapy was associated with decrease in heart rate (89 ± 20 vs 86.6 ± 13.6 with p = 0.002 for valproate and 99.8 ± 23.3 vs 91 ± 16.7 with p < 0.001 for haloperidol). They did not affect blood pressure. Haloperidol therapy was associated with significant QTc prolongation.CONCLUSION:Valproate was equal in efficacy as haloperidol infusion in controlling agitation in ICU and decreasing the doses of additional sedative drugs used after 48 h from initiation.