Patients Of 2nd Group Research Articles

Procalcitonin as New Proinflammatory Marker in Burn Patients

Procalcitonin (PCT) is a 116 amino acid peptide with a sequence identical to that of prohormone of calcitonin but devoid of hormonal activity. The aim of this study was to determine PCT and it using as a new prognostic pro-inflammatory marker in burn patients and determine the role of PCT level as a mortality indicator in survival and non-survival burn patients. The burn patients in this study were divided into four groups according to the percentage of total body surface area burned carry out on (50) burn patients admitted to the burn unit in West Erbil Emergency Hospital in Erbil governorate and (20) apparently the healthy non-burn individuals who regarded as healthy control group (HC) in this study from February 2012 to April 2012. Out of 50 burnt patients, 20 patients were second sampled to follow-up their immune profile. Regarding PCT there were significant differences (P < 0.05) observed between the mean serum concentration of PCT belong to 18 burn patients of 1st group (G1) (1.24 ± 0.82), 23 patients of 2nd group (G2) (1.52 ± 0.76), six patients of 3rd group (G3) (2. 16 ± 0.11), and three burn patients of 4th group (G4) (6.5 ± 2.87) with mean serum concentration of 18 HC (0.02 ± 0.006). Significant differences obtained when compared to G3 (2.16 ± 0.11) versus G4 (6.5 ± 2.87) using the F-test and t-test. Results show that PCT is a highly productive laboratory parameter involving an easy and rapid beside test for diagnosis and prognosis mortality in burn patients.

THE ROLE OF HYPOTHERMIA IN ACUTE ADHESIONS INTESTINAL OBSTRUCTION

Results of intensive care of 68-patients (39- male, 28 female, aged from 23 to 86 years) with intestinal obstruction are summarized. All the patients were divided into two groups: 1st (study) group consisted of 30 patients who have been treated with hypothermal enteral sanation, patients of 2nd group (38 have been treated with intestinal decompression only. Results of treatment were compared by clinical and laboratory parameters. It is demonstrated that intestinal intubation and hypothermal sanation at acute intestinal obstruction are effective methods for elimination of toxic intestinal contents, prevent ischemic damage and stimulate peristalsis of intestinum. The positive final results after this treatment are demonstrated. Lethality was 10,5 and – 21%.

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.

Cytokine and Antimicrobial Peptide Levels in Cholelithiasis

Objective. To study the cytokines and antimicrobial peptides concentrations in patients with cholelitiasis during 1 year treatment before and after the surgery.
 Materials and methods. 38 patients with a cholelithiasis were examined and operated in the Educational-Surgical Clinic of the Azerbaijan Medical University. According to the treatment regimen after the operation the patients were divided into two groups: patients of the 1st group (n = 17) received standard treatment; patients of 2nd group (n = 21), in addition to standard treatment hepatoprotectors, combined enzyme preparations, pre- and probiotics were prescribed. The control group consisted of 14 apparently healthy individuals. The levels of inflammatory cytokines (interleukin-6 and tumor necrosis factor-α) in the blood and antimicrobial peptides (zonulin, calprotectin, and lactoferrin) in feces we studied with enzyme immunoassay method.
 Results. In patients with cholelithiasis of the 1st group, the concentration of interleukin-6 was significantly increased by 5 times (p <0.001), the concentration of tumor necrosis factor-α - by 3.5 times (p <0.001), of zonulin - by 2.2 times (p = 0.012), of calprotectin - by 5.8 times (p <0.001, the concentration of lactoferrin - by 60 times (p <0.001), and in the 2nd group - by 4.8 times (p <0.001), by 3.1 times (p <0.001), on 91.7% (p = 0.011), by 5.8 times (p <0.001) and by 52.8 times (p <0.001) respectively in comparison with the control.
 Conclusions. Standard postoperative treatment supplemented by hepatoprotectors, combined enzyme preparations, pre- and probiotics prescription leads to a positive dynamics of inflammatory mediators concentration and its normalization.

Blood serum amino acid pool violation of in patients with liver cirrhosis

Objective. To investigate serum amino acid pool changes in patients with liver cirrhosis.
 Materials and methods. 95 patients with liver cirrhosis were participated in the study. In the 1st group (class A disease severity according to Child- Pugh score) there were 18 (18.95%) patients, in the 2nd group (class B) - 25 (26.3%), in the 3rd groups (class C) - 52 (54.7%) patients. The amount of free amino acids in blood serum was determined by reversed-phase high-performance liquid chromatography in isocratic elution mode with electrochemical detection.
 Results. Violations of free amino acid reserves were revealed in patients with cirrhosis of the liver with a predominant accumulation of aromatic amino acids: phenylalanine - (162.45 ± 14.12) nmol/ml, tyrosine - (99.05 ± 10.07) nmol/ml, tryptophan - (76.10 ± 12.40) nmol/ml, as well as an increase in the content of proline, lysine, cysteine (p <0.05) . In parallel, the decreasing of free serum amino acids with branched side chain levels were observed: valine - up (150.10 ± 8.92) nmol/ml leucine - up (75.14 ± 5.12) nmol/ml (p < 0.05) and isoleucine - up to (80.40 ± 8.01) nmol/ml.
 Conclusions. The correlation between the second degree of thick guts dysbiosis and increased levels of tryptophan was determined (r = 0.77; p <0.01). III degree thick dysbiosis was correlated with increasing levels of phenylalanine (r = 0.71; p <0.01). In patients of 2nd group the correlations between levels of tryptophan and II degree of intestinal dysbiosis (r = 0.58; p <0.01) and the levels of tyrosine in phenylalanine in III stage intestinal dysbiosis were detected.

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.

Evaluation of the Complications Effectiveness and Frequency When Using Second-Generation Supraglottic Airways in Laparoscopic Interventions in the Trendelenburg Position

Relevance. The supraglottic airways (SA) are now more and more often used as devices of the first choice for providing ventilation during surgical interventions of low trauma and duration, during laparoscopic operations as well. Nevertheless, some concerns remain about the possibility of using these devices in operations accompanied by a significant increase in intra-abdominal pressure, for example, when performing laparoscopy, especially in the Trendelenburg position.Aim of study. Comparison of the efficiency and safety of ventilation, the incidence of postoperative complications when using two different types of SA during laparoscopic surgical interventions performed in the Trendelenburg position.Material and methods. Eighty-three gynecological patients who were scheduled to undergo laparoscopic surgery in the Trendelenburg position were randomly assigned to two groups. In the 1st group, a laryngeal tube was installed for general anesthesia, in the 2nd group patients had a laryngeal mask. The adequacy of ventilation, gas exchange rates, oropharyngeal leakage pressure, rate of successful placement, mean and peak airway pressure at various stages of surgery, as well as the frequency of intra- and postoperative complications were assessed.Results. In all observations, there were normal indicators of gas exchange and capnography, no leakage of the breathing mixture from the circuit. The level of oropharyngeal leakage pressure was statistically different in the groups and was 32 (28; 35) in the 1st group and 28.5 (27; 31.8) cm of water column in the 2nd group. (p=0.007). The time to the onset of ventilation was 19s (18; 21) in the laryngeal tube group, 21s (19; 22.5) in the laryngeal mask group; statistically significant differences were not obtained by this criterion (p=0.059). The first installation attempt was successful in 40 cases (93%) in the 1st group and in 38 cases (95%) in the 2nd group; there was no significant difference in this indicator (p=0.94). The peak and mean airway pressure at the stages of surgery also did not differ. The study did not reveal such intraoperative complications as dislocation of the airway and aspiration of gastric contents. When analyzing postoperative complications, statistical differences were obtained in terms of the level of sore throat 3 hours after removal of SA. In terms of sore throat after 5 minutes, 6, 12, 24 hours, the frequency of hoarseness, no differences were found.Conclusion. 1. The use of different types of 2nd generation supraglottic airways with inflatable cuff (s) provides reliable protection of the upper airway during anesthesia and effective ventilation during laparoscopic surgery in the Trendelenburg position. 2. The laryngeal mask and laryngeal tube did not differ significantly in the frequency of successful insertion, ventilation efficiency, airway pressure levels at various stages of surgery, and the incidence of intra- and postoperative complications. 3. The use of a laryngeal tube provided a higher level of oropharyngeal leakage pressure, while the differences with the laryngeal mask for this indicator were statistically significant.

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.

Non-medicine Methods of Treatment of Gastroesophageal Reflux Disease

Few decades away a problem of throwing of acidic gastric content into an esophagus was reduced to the concept of reflux-esophagitis. In-depth study of pathogenesis of a disease resulted in “gastroesophageal reflux disease” (GERD) term which is acknowledged as leading disease of digestive system in terms of frequency and dangerous complications. GERD formation is determined by influence of numerous factors, however, it is generally accepted, that it is mainly related to insufficiency of lower esophageal sphincter (LES). Also, role of vasoactive intestinal peptide (VIP) in regulation of functional state of LES is determined. In spite of success in field of pharmacology, number of GERD patients has no downward trend which mainstreams search for non-medicine treatment methods. Physical factors affecting pathological processes by influencing regulatory processes are among these methods. Goal of this study is elaboration, scientific justification and clinical implementation of natural and preformed physical factors and acupuncture in treatment of patients with gastroesophageal reflux disease. Materials and Investigation methods: Randomized placebo-controlled study included 137 patients with gastroesophageal reflux disease, 63 (46%) men and 74 (54%) women, at the age of 18 to 65. Investigation included patients with no contraindications for physiotherapy. Patients with Barrett’s esophagus, stricture of esophagus, esophagus ulcer have also been excluded from investigation. Patients were divided into 3 groups: Ist group – 40 GERD patients, including high-frequency electromagnetic field effect and general iodine bromine bathes. II nd group - 67 GERD patients passing acupuncture treatment course. Control group was comprised of 30 GERD patients, receiving placebo MEF therapy. Treatment was carried out without medicines. Therapeutic effectiveness of complex influence of microwave electromagnetic field therapy (MEF-therapy) applied to collar area alternated with general iodine-bromine bathes on clinical manifestations of GERD is determined. Treatment course contributed to reliable decrease of increased count of VIP – a neurotransmitter, regulating LES tonus. In term, it contributed to improve of functional state of LES, reliable decrease of reflux index, and, as a result, improvement of clinical and functional indicators. Estimation of clinical manifestations of a disease among patients of 2nd group displayed positive dynamics of clinical and functional indicators. Round-clock pH-monitoring of stomach and esophageal content shows reliable decreaseof transitory relaxations of LES during single acupuncture procedure and increase of pH of gastric content. Acupuncture course also resulted in decrease of elevated VIP numbers.

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.

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.

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.

Laryngopharyngeal Reflux Alters Macrophage Polarization in Human Papilloma Virus-Negative Squamous Cell Carcinoma of the Larynx in Males.

Among various cells of tumor immune microenvironment (TIME) macrophages have been shown to play a pivotal role in the prognosis of many malignancies including laryngeal squamous cell carcinoma (LSCC). Laryngopharyngeal reflux (LPR) is associated with LSCC and can impact its prognosis. Local factors, particularly pH, can affect cancer growth by altering TIME and tumor associated macrophages phenotype. However, it is still unknown whether and how LPR affects TIME and macrophages polarization in LSCC. In this study we compared macrophage polarization in LSCC of patients with and without coexisting LPR. A total of 63 patients with T1-2 LSCC without (the 1st group, 30 patients) and with coexisting LPR (the 2nd group, 33 patients) were enrolled in the study. Only HPV-negative cases of males were included in the study. Immunohistochemistry was performed to visualize CD68 and CD163 macrophages. The number of macrophages was counted at the central tumor clusters (TC), peritumor stroma (TS) and at the intact laryngeal mucosa (IM) taken from the tumor-negative edge. Samples of the 2nd group patients with LSCC and LPR demonstrated significantly (P<0.05) higher inflammatory infiltration of all the evaluated compartments (TC, TS and IM). CD68+ cells count was comparable in TC and IM of the 1st and the 2nd group patients. In contrast, CD163+ cells were more numerous in the 2nd group patients in TC, TS and IM (P<0.001). Moreover, the number of M2 macrophages was significantly higher than M1 macrophages in patients with coexisting LPR. As a result, CD163/CD68 ratio was significantly (P<0.001) higher in LSCC with coexisting LPR. LPR is associated with altered macrophages polarization and increase of M2-type macrophages in LSCC. The shift in macrophage polarization towards the M2 type in patients with LPR could facilitate LSCC development and progression.

Treatment of cervicogenic headache with application of multicomponent bioregulation drug

Introduction. According to the data of various authors Cervicogenic headache (CH) is met in 2.5 to 70% of population. Diagnostic criteria are described at The International classification of headache (3d revision). CH represents a heterogeneous group of headaches based on functional and organic changes of various anatomical structures of the cervical spine. There are no clinical recommendations for the treatment of patients with CH to date.The purpose of this clinical study is the assessment of the effectiveness of use of Traumeel® S in cervicogenic headache treatment.Materials and methods. 60 patients at the age from 18 to 45, divided into 3 groups were examined. Therapy in various combinations was applied to these patients of all the groups. The 2nd and the 3d groups were treated with the Traumeel® S local injection therapy. The patients of the 4th group were additionally given Traumeel® S in sublingual pill form. The visually analogue scale (VAS), the grading scale of the vertebral neurological symptoms, relapse rate of the CH during a year were applied.Results. The most effective treatment was observed in the 2nd group patients. This was manifested in Better dynamics of pain syndrome and the final result. The CH relapse rate during the year of patients treated with Traumeel® S was significantly lower.Conclusions. Traumeel® S inclusion into combined therapy of CH increases the effectiveness of treatment, helps reduce severity of pain, accelerate the appearance of positive therapeutic effect, operates to reduce severity of vertebral neurological symptoms, reduces frequency of recurrence.

MODERN METHODS OF PATIENTS TREATMENT WITH DENTITION DEFECTS COMBINED WITH FUNCTIONAL DISORDERS OF THE TEMPOROMANDIBULAR JOINT

The aim: The purpose of the research was to increase the efficiency of treatment at patients with dentition defects and functional disorders of the temporomandibular joint. Materials and methods: We examined 140 patients aged from 25 to 65 years with functional disorders of the temporomandibular joint, analysed there diagnostic models in the articulator and 3D scanner, used radiographic methods of examination and condylography. Results: The results of the conducted studies showed that in the 1st group, the biomechanical parameters of temporomandibular joint movements before treatment were significantly lower: 6,4 ± 0,2 mm and 6,8 ± 0,2 mm for right and left temporomandibular joint during protrusion movements; 7,8 ± 0,1 mm and 7,9 ± 0,2 mm during vertical movements; 6,7 ± 0,1 mm and 6,5 ± 0,2 mm during transversal movements. After 12 month of complex and prosthetic treatment with a help of non-removable dentures the magnitude of movements remains at the achieved level at all excursions. As a result, proposed by us comprehensive treatment of functional disorders of the temporomandibular joint is carried out in stages. The proposed design of an individual tire makes it possible to gradually increase the bite height and perfectly forms the occlusal ratio. After 6 and 12 months of the proposed treatment, we have found that the indicators of vertical and protrusion movements of articular heads at patients of 2nd group were significantly better than before treatment. Conclusions: The proposed design of an individual tire makes it possible to gradually increase the bite height and perfectly forms the occlusal ratio.

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&lt;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&lt;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&lt;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&lt;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&lt;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.