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Этиологическая структура внутриутробных инфекций у беременных и новорожденных с осложненным течением раннего неонатального периода
Get PDFAim of research – the study of the etiological structure of intrauterine infection in pregnant and estimation of their influence on the early neonatal period.Materials and methods. The material for the study was venous blood of pregnant, umbilical blood, breast maternal milk, mother’s saliva, newborn’s saliva of 114 pairs “mother-newborn”, divided in two groups – control one of physiological course of pregnancy, childbirth and early neonatal period and the main one with clinical symptoms of IUI. The diagnosis was proved by laboratory serological examinations for determining concentrations of IgM to Mycoplasma hominis, Chlamydia trahomatis, Ureaplasma urealyticum, to the herpes simplex virus and concentration and avidity index of specific IgG to HSV, to the virus of 6 type herpes, to the cytomegalovirus. The cytoscopic method was used together with serological ones to diagnose the cytomegaloviral infection.Research results. The increased concentration of IgM antibodies to M. hominis was revealed in the biological material (venous and umbilical blood) of pairs “woman-newborn) with the complicated course of the neonatal period in 9,1 % of examined persons, in 45,4 % of pairs – IgM to U. urealyticum, and in 81,8 % -to Ch. Trahomatis. IgM to the virus of herpes simplex virus (HVS) were revealed in 19,35 % of samples of venous blood, in 9,67 % of saliva samples and in 6,45 % of samples of breast milk of women; and IgM concentrations to HVS were (0,342±0,06) IU/ml, (0,117±0,04) IU/ml) and (0,438±0,001) IU/ml, respectively. Most samples of the biomaterial included low-avid IgG antibodies to the herpes simplex virus, 76 % of samples of women’s venous blood, 64 % of samples of breast milk and 38,7 % contained low-avid IgG to 6 type herpes virus. The cytomegaloviral infection in this group was diagnosed in 24 % of women and 32 % of newborns. The associated bacterial and viral infection were revealed in 65 % of examined pairs “mother-newborn” with the complicated course of the neonatal period, the triple infection with chlamydias, herpes simplex virus and cytomegalovirus was noted in 14 %; the association of herpes simplex virus, cytomegalovirus and ureaplasma was detected in 5 %. The double chamydia and herpes viral infection of 6 type were observed in 15 % of examined persons, at that these infections were added with ureoplasma in 7 %, with mycoplasma – in 5 %. The mix-infection of urogenital agents – chlamydias and ureaplasma was associated with the cytomegalovirus in 4 % of cases.Conclusions1. As a result of the realized study, the diagnosis was confirmed in all newborns with a suspected intrauterine infection.2. Mix-infections – Chlamydia, associated with viruses of the herpetic group occupy the leading place in the etiological structure of IUI agents, and the neonatal period is most complicated in children with double or triple infection.3. The leading clinical symptoms in children with IUI are the intrauterine development delay, intrauterine pneumonia, conjugated icterus, conjunctivitisИзучено этиологическую структуру внутриутробных инфекций у беременных и проведена оценка их влияния на течение раннего неонатального периода. Установлено, что в этиологической структуре возбудителей внутриутробные инфекции ведущее место занимают микст-инфекции – хламидии в сочетании с вирусами герпетической группы, а неонатальный период наиболее тяжело протекает у детей с двойным или тройным инфицирование
Вплив перенесеної негоспітальної пневмонії на клінічний перебіг ішемічної хвороби серця за результатами ретроспективного аналізу
No full textThe aim of the work: To investigate the effect of the community-acquired pneumonia (CAP) on the clinical course of coronary heart disease (CHD) and the frequency of major cardiovascular events incidence based on the retrospective analysis results.Methods: The retrospective analysis of 203 case histories of patients with CHD (median age 73 years (63.00, 80.50), score on the PSI/PORT – 80 (69; 93)), hospitalized in the therapeutic department because of CAP was performed. The study of the main cardiovascular events was conducted with each patient or his relatives through telephone conversations. The data on readmission and reference of the patient to medical institutions in the consequence of arrhythmic complications, progression of heart failure, destabilization of coronary artery disease within 1 year after the transmitted pneumonia were considered. By cumulative endpoint attributed all fatal and nonfatal cardiovascular events that occurred during the year after CAP.Results: In total, in patients with CHD during 1 year after the transferred CAP was recorded 104 cardiovascular events, 37 (18.23 %) patients needed the re-hospitalization. The most common causes of health aggravation in patients with CHD after CAP were the rhythm and conduction abnormalities, the occurrence or decompensation of pre-existing heart failure and deterioration of angina pectoris. Among the hospitalized patients, 20 (62.5 %) had a combination of 2 or more of the noted complications. The development of acute myocardial infarction was observed in 3 (1.48 %) patients at 7 and 9 days from the moment of admission for hospitalization. The arrhythmias, acute myocardial infarction and decompensation of heart failure were observed with the same frequency in patients of all groups, regardless of the severity of pneumonia and the risk of mortality on the PSI/PORT scale. There were not found the impact on the development of adverse cardiovascular events in patients with CHD after CAP such factors as male gender, presence of anamnesis of transmitted myocardial infarction, arterial hypertension, angina pectoris III-IV FK, previous arrhythmic disorders, and also such traditional factors as smoking and diabetes mellitus.Conclusions: The community-acquired pneumonia exerts an adverse effect on the clinical course of coronary heart disease by increasing the functional class of angina, heart failure progress and the development of arrhythmic; the most common cause of the lethal outcome in patients with coronary heart disease after community-acquired pneumonia is acute heart failure (alveolar pulmonary edema).There was not found the relationship between traditional risk factors, severity of CAP and the development of adverse cardiovascular eventsМетою роботи було дослідити вплив перенесеної негоспітальної пневмонії (НП) на клінічний перебіг ІХС за результатами ретроспективного аналізу. Встановлено, що основними причинами повторної госпіталізації хворих на ІХС після НП були декомпенсація серцевої недостатності, розвиток аритмічних порушень та атеротромботичних подій. Не виявлено зв’язку між традиційними факторами ризику та розвитком несприятливих кардіоваскулярних подій після Н
Нетравматичний субарахноїдальний крововилив:клінічні симптоми – предиктори раннього виходу пацієнтів
Get PDFAim. In this article, we tried to find out whether any of SAH clinical symptoms can be both short-term and long-term predictors for patients.Materials. 144 SAH / unruptured aneurysm patients, treated at Uzhgorod Regional Center of neurology and neurosurgery during 4 years, were examined. The patients were examined on standardized scales (WFNS, Hunt-Hess, GCS), neurovisual and other clinical criteria. The early clinical outcome was determined by GlasgowOutcomeScale.Results and discussion. Considering the given clinical data, we can identify several predictors of a positive early outcome after aneurismal subarachnoid hemorrhage (i.e. 4 – 5 Glasgow Outcome Scale points):- High level of consciousness, according to the GSC scale, at the moment of hospitalization;- Hunt-Hess / WFNS I-II.At the same time, low indicators of these scales in the disease onset are associated with a worse early outcome (1 – 3 Glasgow Outcome Scale points).The young age is SAH risk factor, but it’s not the unambiguous feature for the disease prediction.Also, a hypertension in anamnesis is one of the worse prediction indexes.Conclusion. A correlation between epileptic seizures in SAH onset and higher risk of rebleeding was found out. Therefore, this clinical symptom can be a negative outcome predictor and requires more thorough attention and study.We believe that even patients with good neurological recovery and the relative / complete independence after SAH in future can suffer from anxiety, depression, post-traumatic stress disorder and cognitive impairment, affecting quality of their lives. It should be considered in the long term – with cognitive function study and the use of quality of life scale in routine practice after SAHУ даній статті ми намагались з`ясувати, чи є який-небудь з клінічнихсимптомівсубарахноїдального крововиливу предиктором раннього прогнозу для пацієнтів.Виявлено кореляцію між епілептичними нападами в дебюті захворювання і більш високим ризиком рецидиву кровотечі, що, може бути несприятливим фактором і вимагає, більш ретельної уваги і вивченн
Аналіз особливостей порушення медикаментозного комплаєнсу за гіпокураційним типом у хворих на цукровий діабет 2-го типу
Get PDFAim. To determine features and triggers of hypo-curation type pharmacological compliance violations in patients with type 2 diabetes.Materials and methods. 486 patients with type 2 diabetes mellitus were examined on the clinical basis of therapy, clinical pharmacology and endocrinology department of the State Institution “Zaporizhzhia medical academy of post-graduate education of Ministry of health of Ukraine”.The patients were divided in two groups depending on type 2 diabetes severity levels: 312 patients with DM type 2 of moderate severity formed the first clinical group; the other 174 patients with severe DM type 2 formed the second clinical group.Anamnesis and clinical examination, clinical and psychopathological, and statistical methods were used.Results. In result of research, specific features and triggers of hypo-curation type pharmacological compliance violations in patients with type 2 diabetes were determined.It was found, that pharmacological compliance violations in patients with type 2 diabetes were observed in 76.34 % of cases, in 66.87 % among them hypo-curation type pharmacological compliance violations were identified. Structural components of hypo-curation type pharmacological compliance were determined. Features of carbohydrate metabolism disorders in patients with hypo-curation type pharmacological compliance violations were observed. Incompliance factors as triggers of hypo-curation type pharmacological compliance violations in patients with type 2 diabetes were selected; they were classified, and their correlation was determined.Conclusion. The notion about hypo-curation type pharmacological compliance violations in patients with type 2 diabetes was expanded. That eliminated gaps in scientific knowledge about pharmacological compliance violations in patients with type 2 diabetesВстановлено частоту зустрічаємості та види порушення комплаєнсу серед хворих на цукровий діабет 2-го типу. Досліджено особливості та тригери гіпокураційного типу порушення медикаментозного комплаєнсу у хворих на цукровий діабет 2-го типу, надано їх класифікацію та простежено кореляційні взаємозв’язки. Встановлено структурні складові гіпокураційного типу порушення медикаментозного комплаєнсу та особливості його впливу на порушення вуглеводного обміну у хворих на цукровий діабет 2-го тип
Дослідження особливостей та перспективи становлення страхової медицини в Україні в сучасних умовах
Get PDFIntroduction. The necessity of development and incipience of insurance medicine in today's realities of Ukrainian health care system is caused by the need in qualified medical care for different groups of population depending on their material prosperity, especially for socially disadvantaged people, in stable healthcare financing, and maintaining of the proper level of medical care. The main task is the study of the modern tendencies of development and predicting of future changes in economic and social environment, as well as their influence on healthcare system. The modern development of social insurance in Ukraine confidently shows that the use of nothing but administrative measures is not enough for adequate work efficiency and reforms.Statement of research. In fact, there are a number of modern works in the national scientific literature devoted to attempts to consider the theoretical, historical, financial, economic, organizational and administrative aspects of health insurance, but comprehensive analysis of this issue still needs attention of scientists and society in general. This concept allows designing reasonable and substantiated recommendations for health insurance development.Aim: the study of features and prospects of the insurance medicine system in modern Ukrainian realities.Results and discussion. The choice of heath care model should completely meet the modern requirements in the country. The transition to health insurance should be performed considering the population’s wealth level, and possibilities of payment of part of medical services while maintaining the appropriate social protection for disadvantaged populations. Implementation of mandatory insurance is usually accompanied by the insured attachment to a particular territory which the insurance institution serves; also it should determine the procedure for transfer submission to the certain areas to equalize the financial capacity of the different regions. The existing legislation should provide a certain level of heath care services profitability, and competition in the medical services market will improve the quality of medical care. In future, it should slowly increase health care costs by financing from many different sources, and medical and diagnostic processes management using standards will make clinical management system closer to self-regulating system.Conclusion. Improvement of medical care for persons involved in one or another type of medical insurance by implementation of medical insurance system as an independent commodity and market relations in health care area is the main goal for the current health system in UkraineСтворення системи медичного страхування має розглядатися як багатоаспектний процес, в якому необхідно пов'язати правову, економічну, організаційно-управлінську та мотиваційну складові. Необхідно вибрати найбільш оптимальну для українських умов модель охорони здоров'я із урахуванням менталітету та прогресивності такої моделі. Забезпечення доступності для населення ефективної кваліфікованої медичної допомоги здійснюється за рахунок управлінських, організаційних, інформаційних технологі
Аналіз змін системи згортання крові у хворих на гіпертонічну хворобу в поєднанні з хронічним обструктивним захворюванням легень різного ступеня важкості
Get PDFAim of research was to determine the influence of COPD severity on the plasma hemostasis condition in patients with HT combined with COPD.Materials and methods. 79 patients were examined: 15 almost healthy (control) and 64 patients with stage II HT with concomitant COPD. Depending on the COPD severity, the patients were divided into 3 groups: group A- 11 patients with HT and COPD of the I severity degree; Group B - 28 patients with HT and COPD of the II severity degree; Group B - 25 patients HT and COPD of the III severity degree. Special laboratory tests: coagulation indicators - activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen, soluble fibrin monomer complexes, ancistron test, Lebetox test, and echitox test were carried out.Results: in result of the study it was found that comorbid HT and COPD course is characterized by increased activity of hemostasis system coagulation level, which intensity is associated with bronchial obstruction severity. In particular, COPD of the III severity degree hyperfibrinogenemia, as well as soluble fibrin monomer complexes significant increase were observed in all subgroups of the patients with HT and COPD, accompanied by activation of external pathway of coagulation and combined with accelerated processes of prothrombinase-, trombino- and fibrin formation according to specific snake venoms tests.Conclusion. Comorbid HT and COPD course is characterized by the activation of hemostasis system coagulation level, which intensity is associated with bronchial obstruction severity. Hyperfibrinogenemia and a significant increase of the SFMC content, observed in all subgroups of the patients with HT and COPD, at COPD of the III severity degree are accompanied by activation of external pathway of coagulation and combined with accelerated processes of prothrombinase-, trombino- and fibrin formation according to specific snake venoms tests. The patients with HT combined with COPD of the III severity degree need careful laboratory monitoring to solve the problem of the additional antithrombotic correction necessityМетою дослідження було встановити вплив ступеню важкості хронічного обструктивного захворювання легень на стан плазмового гемостазу у хворих із поєднаним перебігом гіпертонічної хвороби та ХОЗЛ. В результаті роботи виявлено, що коморбідний перебіг ГХ та ХОЗЛ характеризується підвищенням активності згортуючої ланки системи гемостазу, вираженість якої асоціюється із ступенем важкості бронхообструкці
Порушення соціального функціонування у хворих на параноїдну шизофренію з супутньою сомато-неврологічною патологією
Get PDFThe aim was to determine the features of social functioning violation in patients with paranoid schizophrenia and concomitant somatic and neurologic disorders under the influence of neuroleptic treatment and to estimate psychopharmacotherapy efficiency. It is known that patients with schizophrenia often suffer from concomitant somatic pathology. Schizophrenia course, negative symptoms and cognitive disorders may prevent timely treatment and mental health care for patients with paranoid schizophrenia and concomitant somatic and neurologic disorders.Methods. According to the specially designed criteria, the main group with paranoid schizophrenia diagnosis (F 20,0) having somatic and neurologic disorders was determined according to the ICD-10 criteria.Results. On the basis of the obtained results analysis, it should be mentioned, that patients with paranoid schizophrenia and concomitant somatic and neurologic pathology will probably have poor physical and mental health. Thus, stressful events in life of patients with paranoid schizophrenia worsens somatic health and reduces adaptive potential, which in turn affects all areas of personal communication and general quality of life.Conclusion. The features of the concomitant somatic and neurologic pathology influence on social activity and quality of life of patients with paranoidal schizophrenia before and after treatmentДосліджений рівень стресостійкості у хворих на параноїдну шизофренію з супутньою сомато-неврологічною патологією та рівень якості життя як предиктори формування їх соціальної дезадаптації. Розглянутий вплив сомато-неврологічної патології на перебіг параноїдної шизофренії при різному рівні стресостійкості. Це дасть можливість на етапі загострень враховувати ці фактори при призначені фармакотерапії та подальшому етапі реабілітаці
Динаміка вмісту цитокінів крові при шигельозі у дітей з хелікобактерною інфекцією
No full textAim. The substantial incidence of acute enteric infection rate among children, especially associated with such bacterial pathogen as Shigella, makes the search for new methods of management and improved therapeutic approaches a matter of high priority in current medical science. Moreover, prior infection with Helicobacter pylori is considered to be one of the factors which impacts the course of the shigellosis in children. As the course of shigellosis and its consequences depend on balanced action of pro-inflammatory and anti-inflammatory interleukins and at present it is of a great concern, study is focused on assessment of anti-inflammatory interleukins content in blood serum of children with shigellosis and infected with H. Pylori.Methods. The study enrolled 113 children aged from 3 months to 3 years who were divided into two groups: Group 1 (37–32.74 %) represented by patients infected with H. pylori and Group 2 (76–67.26 %) made up by patients without laboratory markers of Helicobacter infection. The levels of IL-1β, TNF-α and IL-4 of blood serum were assessed for all children by means of solid-phase enzyme immunoassay in the acute period and during early convalescence.Results. It has been established that at the peak of the disease the IL-1β and TNF-α levels in patients of both groups were well higher than the indices of healthy children. At the same time in the children of Group 2 the concentration was well higher than the corresponding indices of Group 1 patients. Insignificantly increased levels of IL-4 as well as higher IL-4 content levels in children without background infection in comparison with those infected with H. pylori were revealed. However, in both cases this difference was not relevant. The convalescence period was not characterized by relevant difference of IL-1β and TNF-α indices between the study groups as well as by comparison of these indices in Group 2 and the control group. In the meantime, a significant difference between IL-1β and TNF-α levels is observed between the patients of Group 1 and the control group in the acute period. IL-4 content in blood serum of the children with shigellosis without background infection in the period of convalescence turned out to be well higher in comparison with that in apparently healthy children as well as in the patients infected with H. pylori who had higher IL-4 content, however the difference was not relevant.Conclusions. Present infection with H. pylori has a significant impact on the indices of pro- and anti-inflammatory interleukins of blood serum of the children with shigellosis both in the acute period and at the stages of early convalescence. The data obtained make it possible to deepen the idea concerned with immune pathogenic mechanisms of development and course of shigellosis in children infected with H. pylori and afterwards can be applied for improvement of therapeutic methodsУ дослідженні представлені результати оцінки вмісту про- та протизапальних інтерлейкінів сироватки крові дітей, хворих на шигельоз та інфікованих H.pylori. Отримані дані відображають суттєвий вплив інфікування H. pylori на показники вмісту цитокінів крові хворих на шигельоз як в гострому періоді, так і на етапах ранньої реконвалесценції, та можуть бути використані для подальшого вдосконалення терапії таких хвори
Хирургическое лечение перфоративной пилородуоденальной язвы с применением миниинвазивных технологий без ваготомии
Get PDFAim of the work: to study the effectiveness and expedience of the use of videoendoscopic minimally invasive methods of surgical treatment in patients with perforating pyloroduodenal ulcers.Materials and methods of the research: On the base of the surgical department № 1 of MIHP “Kharkiv city clinical hospital and urgency, named after A.I. Meschaninov” and surgical department of MIHP “Regional clinical hospital – center of urgency and catastrophe medicine” of Kharkiv city in the period 2005 – 2015 were operated 204 patients with perforating ulcer, they were divided in 2 groups: I group (comparison) – 103 (50,5 %) patients, who underwent a vagotomy with an operation, draining the stomach; II group (main) – 101 (49,5 %) patients was divided in subgroups: 1 subgroup 56 patients with a closure or excision of a perforating ulcer without a vagotomy from the laparoscopic access, 2 subgroup – 45 patients, who underwent the same operation volumes from the laparoscopic access. Patients underwent methods of laparoscopic diagnostics and instrumental examination methods. After the operation the remote results were studied in different terms using Visic life quality criteria.Results: In patients of the comparison group took place post-vagotomy motor-evacuating disorders of the functional character in the remote period. In the main group in the remote period the best results were received in the subgroup, where videolaparoscopic interventions were realized with the further use of modern antiulcer preparations taking into account the immunohistochemical proliferation index, received by the study of KI-67 antigen expression. The most number of complications – 16,2 % was observed in patients, who underwent a trunk and selective vagotomy, combined with the closure of the perforating ulcer. The algorithm of the operative practice at this pathology was elaborated based on the received results.Conclusions: The realized studies allowed to determine indications for the videolaparoscopic closure of a perforating ulcer without a vagomomy that is replaced by the prescription of modern blockers of a protonic pumpПроведен сравнительный анализ результатов лечения 204 больных, оперированных по поводу перфоративной пилородуоденальной язвы с применением лапаротомного и лапароскопического доступов. Больным выполнялось как ушиванте перфоративного отверстия, так и иссечение язвенного субстрата с различными видами ваготомии или без нее. Определены показания к выполнению видеолапароскопического ушивания или иссечения краев перфоративной язвы без ваготоми
Ювенільний ідіопатичний артрит у дорослих пацієнтів: аналіз клінічних даних
Get PDFAim. To study the connection of the disease with social and clinical parameters of adult patients with JIA in the anamnesis for improve the observation of them and decrease remote results.Methods. There were examined adults with JIA in the anamnesis, age – 24,3±8,3 years, the disease duration - 13,6±9,3 years, with the assessment of the diagnosis determination, disease activity in the child and adult age (JADAS, VAS), received treatment with glucocorticoids (GC) and its duration, life quality (SF-36), functional activity disorders (HAQ), psychological state, cardio-vascular risk, remote results of JIA (JADI-A, JADI-E).Result. Adult women had the more active disease by JADAS (p<0,05) and JIA remote results by JADI-A took place in them more often (p<0,05). Patients with a higher education had the more disease duration (p<0,05). The influence of social factors on the health state was more (p<0,05) in patients with a finished higher education comparing with ones with an incomplete one, although the life quality (SF-36), anxiety and depression level didn’t differ in these groups. Patients with invalidism, developed as a result of JIA had the worse general state by VAS (p<0,05), glucocorticoids were prescribed longer (p<0,05), JADI-E extra-articular results developed more often (p<0,05), although their psychological state didn’t differ from patients without invalidism. Patients, divided in groups depending on ACCP/RF, ANA, HLA-B27 presence and negative by all markers, differed by the age of the disease start, SF-36, disease activity (DAS28), remote results by JADI-E and JADI-A. The treatment duration and GC cumulative dose didn’t differ in these groups.Conclusions. 1. In female adult patients with JIA was reveled the more disease activity by JADAS and remote articular results of JIA took place more often that testify to the need of the more aggressive therapy and more accurate rheumatologists’ survey for decreasing the number of remote results of this disease. 2. Patients’ education level indicated that the influence of social factors on the health state was higher (p<0,05) in patients with a finished higher education comparing with ones with an incomplete one, although the anxiety and depression level and life quality didn’t differ in both groups, and the psychological state of adult patients with JIA invalidism was the same as in patients without invalidism that testifies to the good social adjustment of JIA patients in the adult age. 3. Clinical differences between groups of patients, divided by immunological parameters (ACCP/RF, HLA-B27, ANA), prove a hypothesis that their pathogenetic mechanisms of JIA development are different and need a differentiated approach to the diagnostics, treatment and observationОбстежено 68 хворих з ЮІА віком старше 18 років, яких розділено на групи за статтю, інвалідністю, рівнем освіти, наявністю ACCP/RF, ANA, HLA-B27 та негативні за всіма показниками не залежно від ILAR класифікації. Значні відмінності між ними, підтверджують гіпотезу різних патогенетичних механізмів розвитку, що потребує диференційованого підходу до діагностики, лікування та спостереженн