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Клінічні та психопатологічні особливості формування та перебігу депресивних розладів та суїцидальної поведінки у онкологічно хворих
Get PDFAim of research. The study of clinical and psychopathological features of formation and clinical course of depressive disorders and suicidal behavior in cancer patients.Materials and methods of research. For attaining the set aim, the complex examination of 154 patients of both genders with a cancer pathology of I and II degree and diagnosed depressive disorders was realized, with observing principles of bioethics and medical deontology. The main group included 103 patients with suicidal behavior signs, the control one - 51 men without suicidal behavior signs.Methods of research: clinical-anamnestic, psychodiagnostic, statistical.Results. There were described the features of the clinical picture of depressive disorders in cancer patients at adaptation disorders, such as depressive reaction, moderate or heavy depressive episode, organic depressive disorder.It was determined, that the true suicidal behavior prevailed in all patients (53,2 % of patients with depressive reaction, 56,5 % of patients with depressive episode, 51,2 % with organic depressive disorder), affective variant of suicidal disorder was observed in 38,1 %, 40,1 % and 44,1 % of patients, respectively; demonstrative-chantage suicidal behavior was observed in 8,7 % of patients with depressive reaction, 3,4 % of patients with depressive episode, 4,7 % – with organic depressive disorder.Patients from the main group demonstrated clinical manifestations of anxiety and depression by the hospital scale, high anxiety and depression by Hamilton scale, great depressive episode by Montgomery-Asberg scale, patients from the control group were characterized by clinical manifestations of anxiety and subclinical depression by the hospital scale, moderately expressed anxiety and depression by Hamilton scale, moderate depressive episode by Montgomery-Asberg scale.It was established, that the high level of suicidal risk and low level of consciousness of death in cancer patients with depressive disorders is a precondition of the suicidal behavior formation.Conclusions. 1. A malignant neoplasm it is a psychotraumatic factor for a patient and leads to the development of depressive disorders and suicidal behavior. 2. The clinical picture of depressive disorders in patients with a cancer pathology is characterized by the predomination of mood inhibition, effect of sorrow and anxiety, immersion into the felling of an acute grief because of a cancer diagnosis, with narrowing of cognitive functions and predomination of the content of a psychic trauma in consciousness.3. The main role in the formation of suicidal behavior of cancer patients is played by high indices of clinical scales of anxiety and depression, combined with the low level of death consciousness, burdened suicidal anamnesisЗ метою вивчення особливостей депресивних розладів та суїцидальної поведінки у онкологічно хворих було проведено комплексне обстеження 154 онкологічно хворих з депресивними розладами.Встановлено, що у формуванні суїцидальної поведінки онкологічно хворих провідну роль відіграють високі показники за клінічними шкалами тривоги і депресії, високий рівень суїцидального ризику та низький рівень самосвідомості смерт
Вплив аторвастатину на клінічні прояви перебігу подагри коморбідної з артеріальною гіпертензією
Get PDFAim of the work was to determine a possible effect of atorvastatin on clinical symptoms of gout, comorbid with arterial hypertension.Materials and methods: 56 patients of middle age with gout and arterial hypertension were divided in groups of the standard treatment (n=26) and one with additional atorvastatin in 20 mg/day (n=30), the observation period was 43±9 days.Results: There were observed the significant decrease of hyperemia of injured articulations (р=0,03 for metatarsophalangeal articulations), insignificant decrease of the circle (р=0,17), increase of motility of involved articulations (р=0,19), compared with the control group, and wasn’t revealed any influence on the pain intensity by VAS and on clinical manifestations of arterial hypertension or office arterial pressure.Conclusion: atorvastatin addition to the standard gout therapy and arterial hypertension has the moderate anti-inflammatory effect, without influencing the pain intensity, arterial pressure and clinical manifestations of arterial hypertensionМетою роботи було встановлення можливого впливу аторвастатину на клінічній перебіг подагри, коморбідної з артеріальною гіпертензією. В порівнянні з групою контролю було виявлено достовірно меншу гіперемію суглобів, деяке зменшення окружності та покращення рухливості уражених суглобів та не виявлено впливу на біль та клінічні симптоми артеріальної гіпертензії. Отже аторвастатин у комбінованому лікуванні проявляє помірну протизапальною дією, не впливаючи на артеріальний тиск та клінічні прояви артеріальної гіпертензі
Функція щитовидної залози у доношених дітей з внутрішньоутробною затримкою росту на тлі терапії рекомбінантним гормоном росту
Get PDFThere was not established any influence of the treatment with the recombinant growth hormone (rGH) on the thyroid function in full-term small-for-gestational age SGA) children. The aim of the research was the study of the level of serum thyroxin of free (Т4) and thyrotropic hormone (TTH) in SGA children before and after rGH treatment; determination of possible influence of a body mass and length at birth, thyroid hormones on the further spontaneous growth.Methods. The research included 58 full-term SGA children (25 with spontaneous growth, 33 undersized), pre-pubertal. The measuring of levels of free T4 and TTG was realized before and in 6 and 12 months after rGH treatment. Results. Indices of free T4 and TTG don’t correlate with a standard deviation score (SDS) of a body mass and length at birth, body mass index and IGF-1. The average level of free T4 was decreasing during the first 6 months of rGH treatment, but remained within norm. TTG didn’t change during the treatment. The change of free T4 doesn’t correlate with the change of SDS of the growth speed during 12 months after rGH treatment.Conclusion. TG level doesn’t correlate with SDS of a body mass and body length at birth. The level of free Т4 decreases at rGH treatment, but it is not connected with TTG increase and doesn’t influence rGH treatment effectiveness. As far as such inessential changes in the thyroid function are not clinically important, frequent observation on the thyroid function at rGH treatment is not substantiated in full-term SGA children. Monitoring in such children must be realized once a year with determining TTG and free Т4 levels in blood plasmaВивчали стан щитовидної залози у доношених дітей з внутрішньоутробною затримкою росту та тлі терапії рекомбінантним гормоном росту. Встановлено зниження рівню вільного тироксину в крові, що не впливало на швидкість росту в перший рік терапії. Компенсаторного збільшення рівню тиреотропного гормону не встановлено. Рекомендований моніторинг функції щитовидної залози 1 раз на рі
Клініко-неврологічні особливості перебігу та когнітивних порушень при ортостатичній гіпотензії у пацієнтів із нейродегенеративними захворюваннями
Get PDF Aim: To optimize the diagnostics of cognitive impairments in patients with neurodegenerative diseases and orthostatic hypotension, based on the estimation of the character of interrelations between clinical-pathogenetic features, degree of cognitive functions impairments and several indices of hemodynamics.Materials and methods. There was realized the general clinical, neurological examination, neuropsychological testing: MMSE, MoCA, FAB, test of memorization of 12 words, drawing of a watch, phonetic speed of speech, semantic speed of speech; orthostatic test. There were examined 105 patients: the first group – patients with AD (33 patients), the second – with PD (35 patients), the third, control group (37 examined persons) – practically healthy people. Groups 1 and 2 were divided in the subgroup А (with orthostatic hypotension) and the subgroup B (with the normal orthostatic reaction).Results. The clinical picture of patients of the subgroup A demonstrated complaints, typical for OH episodes, reliably more often than the one of the subgroup B and control. Complaints for the memory worsening and difficulties at trying to choose a proper word, falling were observed statistically reliably more often in patients with PD and OH. Positive axial reflexes, revival of tendon and periosteal reflexes were revealed more often in the subgroup 1A than in 1B at the neurological examination; in the subgroup 2А – nystagmus, positive axial reflexes, postural instability.According to the results of the neuropsychological test, points of MoCA scale, test of semantic speed of speech, memorization of 12 words; memory and attention domains by subtests of MoCA scale in patients of 1A group were statistically reliably less than in 1B subgroup. Points of patients of 2A subgroup were statistically reliably less than in 2B subgroup by MoCA, FAB scales, by the test of phonetic speed of speech, semantic speed of speech, memorization of 12 words; by subtests of ruling functions, memory and attention of MoCA scale .Conclusions 1. MoCA scale, test of drawing a watch, test of memorization of 12 words, test for semantic and phonetic speed of speech turned out to be more sensitive at orthostatic hypotension.2. At orthostatic hypotension impairments in domains of memory, attention, speech, occur more often in patients with Alzheimer’s disease, in ones with Parkinson disease – impairments of memory, attention, ruling functions, thinkingУ статті розглянуті особливості клінічної картини хвороби Альцгеймера та хвороби Паркінсона при наявній ортостатичній гіпотензії. Проведене порівняння когнітивних функцій вцілому та виділені найбільш вразливі домени при ортостатичній гіпотензії у цих пацієнтів. Визначено найбільш чутливі нейропсихологічні шкали і тести для діагностики когнітивних порушень на фоні ОГ при ХА та Х
Стан подружньої та дитяче-батьківської взаємодії в структурі сімейного функціонування жінок, хворих на параноїдну шизофренію
Get PDFAim. To analyze marriage and parent-child interaction state in the family functioning structure of women having paranoid schizophrenia (PS) for the further identification of possible aims of their psychological correction.Contingent and methods. 100 women, having PS, and their husbands were examined at psychiatric department of Zakarpattya oblast narcological dispensary during 2014 – 2016. The women were aged from 25 to 40 years, and the disease duration was from 2 to 15 years. The approximate age of the husbands did not exceed 7 years between them and their wives. 50 common families were examined as the reference group.The women were examined using clinical and psychopathological, and psychodiagnostic methods, the men – using clinical and psychological, and psychodiagnostic methods.Results. In result of research, substantial violations of marital and parent-child family functioning levels were found in families with women having PS; moreover, both the women with PS, and their husbands found significantly worse indexes concerning all components of this area, comparing to the healthy persons. In families, where the woman has PS, a sufficient deformation of the family interaction on the marriage (90 %) and parent-child (84 %) levels was found in 91 % of cases, which characterized by conflict and aggression high level, family functions ignoring by family members, the lack of attention to the children, the unwillingness to engage in their upbringing, high general level of neuroticism of the family members. In the other 9 %, the signs of family interaction distortion, which were out of its expressed violation indicators range, were found.Conclusion. The obtained data were used as a base for development of the system for medical and psychological measures for optimization of mother-child interaction in women with PSЗ метою аналізу особливостей подружньої і дитяче-батьківської взаємодії як складових родинного функціонування жінок, хворих на параноїдну шизофренію (ПШ), обстежено 100 жінок, хворих на ПШ та їх чоловіків, та 50 звичайних родин. Встановлено суттєвий негативний вплив ПШ на стан усіх рівнів родинного функціонування: подружньої взаємодії, реалізації батьківських функцій та материнсько-дитячої взаємодії. Ці закономірності повинні враховуватися при розробці психокорекційних та профілактичних заходів щодо даного контингент
Вплив поліморфізму гену ITGA2 на тромбоцитарну ланку гемостазу у хворих з гострим коронарним синдромом
Get PDFAim: To study and to estimate the aggregation of platelets as an initial link of hemostasis in patients with ACS depending on ITGA 2 – C 807T gene polymorphism.Materials and methods: there were examined 72 patients, who were on the treatment in the department of the acute coronary pathology of the clinic ”Pheophanya” and in the department of cardiology of Kyiv railway clinic № 2: 27 women (37,5 %) and 5 men (62,5 %) 56 - 87 years old (mean age– 68,1±7,34 years). The research included patients with ACS, developed on the background of the hypertonic disease. Based on the results of gene-interrogation and corresponding to the aim of the examination, all patients were divided in three groups: І included 20 patients with (27,8 %) С/С genotype, ІІ group consisted of 29 patients (40,3 %) with С/Т genotype and ІІІ group included 23 patients (31,9 %) with Т/Т genotype. At the examination of patients was used the algorithm standard thematic card that included the sections of anamnesis, general clinical, instrumental and laboratory study.The study of hemostatic parameters in venous blood was carried out immediately at a patient’s admission in hospital. The study of the functional activity of platelets was realized at a laser aggregometer Biola Aggregation Analyser with the computer analysis of curves of light-transmission and features of platelet aggregates. At that there was studied the presence of spontaneous platelets aggregation and stimulated aggregation with inductors: arachidonic acid (AA), adenosine dyphosphate (ADP), collagen, adrenalin. Concentrations of inductors were chosen according to recommended standards, at that were used least effective concentrations that caused aggregation that increased the sensitivity of the given method in the determination of platelets functional activity.For the molecular-genetic analysis were used samples of patients’ DNA, extracted from venous blood by the sorbent method. C807T and ITGA2 gene polymorphism was determined by the method of polymerase chain reaction (PCR) using the two-prime system.Results: The gene interrogation of patients allowed to reveal that in 82,5 % of patients with ACS prevailed ITGA 2 C/T genotype – 40,3 %, Т/Т genotype was revealed in 31,9 % patients. Thus in 72,1 % of patients with an acute disorder of the coronary blood circulation was observed the mutation of ITGA 2 – Т, gene, responsible for platelets adhesion. The study of the aggregation ability in the studied groups allowed to establish, that in patients of all groups the degree of spontaneous aggregation statistically significantly exceeded control limits, at that the most indices were fixed in the group with Т/Т genotype that exceeded control values in 3,02 times. It is worth noting that the carriage of Т allel was associated with the tendency to the growth of spontaneous aggregation relative to С/С genotype by 34,5 % in С/Т group and reliable increase of spontaneous aggregation in Т/Т genotype group, both relative to С/Т group (by 33 %) and С/С group (by 78,9 %). Analyzing the aggregation ability of platelets with inductors (ADP and AA) the difference in platelets sensitivity was observed only relative to AA-induced aggregation. Thus, in the group of patients with Т/Т genotype the degree of such aggregation exceeded indices of С/С group by 17,3 %, and indices of С/Т group – by 16,5 % (р<0,05 in both cases), at that there was not revealed the essential difference between groups with С/С and С/Т genotype. Analyzing the degree of collagen-induced aggregation in groups it was noticed, that the most indices were fixed in the group with Т/Т genotype – 1,68 times higher than in the control one. T-allel carriage also caused the increase of induced aggregation with collagen relative to С/С genotype by 17 % in С/Т group and reliable increase in Т/Т genotype group, both relative to С/Т (by 43 %) and С/С groups (by 66 %).Conclusions: ACS syndrome development is associated with the presence of T-allel of ITGA 2 gene, observed in 72,1 % of patients. The presence of Т-allel is combined with the acceleration of platelets spontaneous aggregation, increasing their functional activity in patients with Т/Т genotype 3 times comparing with the control group and by 79 % relative to homozygotes with the “native” С/С genotype. Platelets of patients – carriers of Т/Т genotype had the increased sensitivity to collagen, even under conditions of using low concentrations of an inductor that must be taken into account at personification of the treatment tacticsВідомо, що мутація С807 в гені ITGA2 асоційована з ризиком розвитку раннього інфаркту міокарда, ішемічного інсульту, тромбоемболії, тромбозів після ангіопластики та стентування коронарних артерій. У дослідженні представлені результати аналізу поліморфізму інтегрованого рецептора тромбоцитів глікопротеїну GpIa у пацієнтів з гострим коронарним синдромо
Вплив кверцетину на динамику С-реактивного протеїну та віддалений прогноз хворих з інфарктом міокарда правого шлуночка на фоні Q-інфаркту міокарда лівого шлуночка
Get PDFAim of research: to estimate the influence of quercetin on the dynamic of C-reactive protein, course of myocardial infarction and long-term prognosis of patients with myocardial infarction of the right ventricle on the background of Q-MI of the left ventricle.Materials and methods. There were examined 208 patients with myocardial infarction of the right ventricle: the 1st group - 155 patients on the background of the Q-MI of the posterior wall of the left ventricle, and the 2nd group – 53 patients with right ventricle MI on the background of Q-MI of the left ventricle of the circular localization, aged 64.11±0.78 years. Quercetin was prescribed from the 1st day of myocardial infarction: in the 1st group – in 88 (55.5%) patients, in the 2nd group – in 32 (60.4%) patients. The concentration of C-reactive protein in blood serum was determined on the 2nd day of myocardial infarction and in 6 months with enzyme immunoassay analysis using HS-CRP EIA (Vienna, Austria).Follow-up was (30.6±4.5) months. Study endpoints were: cardiovascular death, unstable angina, recurrent myocardial infarction, heath failure hospitalizations and stroke.Results. The therapy by quercetin was accompanied by the reliable decrease of the risk of fatal arrhythmias, early post-infarction angina, manifestations of the acute and chronic heart failure in the acute period of myocardial infarction of the right ventricle. Quercetin prescription was associated with the reliable decrease of the C-reactive protein (р=0.006) levels in 6 months after myocardial infarction. There was established the predictor role of C-reactive protein after 6 months after infarction in the development of recurrent myocardial infarction (11.4%), unstable angina (7.7%) during 30.6 months. The therapy by quercetin in the 1st group was associated with the decrease of the frequency of recurrent myocardial infarctions (р=0.012), heart failure hospitalizations (р=0.0056) and cases of the cardio-vascular death (р=0.039); in the 2nd group – with the decrease of cases of unstable angina (р=0.012) and cardio-vascular death (р=0.01) comparing with patients on the standard therapy.Conclusion. Using of the quercetin in addition to the standard therapy in patients with myocardium infarction of the right ventricle is associated with the reliable decrease of cardiovascular events, particularly cardiovascular death, hospitalizations because of unstable angina and heart failure during 30.6 months of observation and positive dynamics of the C-reactive protein in 6 months after myocardium infarction. The level of C-protein in 6 months after myocardium infarction is an additional risk factor of cardiovascular complications during 30.6 months after myocardium infarction of the right ventricleВикористання кверцетину у хворих з інфарктом міокарду правого шлуночка супроводжується зменшенням кількості фатальних ускладнень гострого періоду, достовірною позитивною динамікою С-реактивного протеїну та зниженням ризику стенокардії та серцевої недостатності через 6 місяців. Встановлено прогностичне значення С-реактивого протеїну, визначеного через 6 місяців після інфаркту міокарду як додаткового фактора несприятливого прогнозу. Доведено, що терапія кверцетином у хворих з інфарктом міокарду правого шлуночка асоціюється з покращенням віддаленого прогнозу протягом 30,6 місяці
Клінічна значимість погіршення функції нирок у хворих з гострою декомпенсованою серцевою недостатністю в залежності від змін NGAL і вихідної функції нирок
Get PDFAim. To determine the value of the renal function worsening (RFW) depending on NGAL and initial renal dysfunction in so-called “wet and warm” patients with acute decompensated heart failure (ADHF).Materials and methods. The prospective study included 141 patients with ADHF 38–85 years old (mean age 66,4±2,2), successively admitted to cardiologic department of Olexandrivska clinical hospital in Kyiv during 2012–2014, 38 patients had RFW, 67 patients underwent the assessment of NGAL in blood serum using enzymatic immune analysis for D1 and last D.Results. RFW by creatinine was in 38 (27 %) of patients and it was absent in 103 (73 %) of patients. RFW group with the increased NGAL content differed from patients without RFW by the more occurrence of hypertonic disease, diabetes mellitus, ІHD and NYHA IV at admission (all p <0,05). At the analysis of patients with RFW depending on MDRD it was established, that patients with MDRD <60 and RFW were essentially older than patients with MDRD in both groups with MDRD > 60 (р <0,05-0,01).Conclusions. RFW in patients with ADHF is connected with the increased intensity of symptoms only at association with NGAL increase in 48 hours. Patients with RFW without NGAL increased didn’t essentially differ from ones without RFWГостра декомпенсована серцева недостатність (ГДСН) залишається провідною причиною госпіталізації хворих у всьому світі. Є достатньо підстав вважати, що погіршення функції нирок (ПФН) є досить гетерогенним за патофізіологією і прогнозом ускладненням ГДСН та репрезентована декількома фенотипами. Визначення таких патофізіологічно обґрунтованих фенотипів у так званих «вологих і теплих» хворих з ГДСН стало метою даного дослідженн
Аналіз захворюваності на сифіліс в Житомирській області
Get PDFThe aim of the study: to analyze the epidemiological situation regarding syphilis in Zhytomyr region for the period from 2013 to 2016.Methods of the research: bibliosemantic, systematic analysis and logical generalization, methods of statistical processing.Results. From 2013 to 2016, the incidence of syphilis among residents of Zhytomyr region increased from 10.1 to 13.9 cases per 100,000 population. During 2013, for the first time with a diagnosis of syphilis were registered 129 patients, and in 2016 - 173 patients. In the structure of morbidity is a prevalence of early syphilis. A special place in the spread of the disease is occupied by patients with latent, asymptomatic forms of infection. It should be noted that from 2013 to 2017 no cases of congenital syphilis were diagnosed. The largest number of patients is recorded in age ranges 20-29 years, 30-39 years, 40 years and older. In the risk area (first of all) there are men and women without permanent place of residence and permanent work that lead to an immoral way of life.Conclusions. The morbidity of the population of Zhytomyr region for syphilis from 2013 to 2016 has a slight tendency to increase. The greatest number of patients belongs to the age groups that belong to the reproductive period and the older age group. Assessing the social status of patients, they concluded that the illness most often registers in persons who do not work and do not studyУ статті розглянуті показники захворюваності на сифіліс в Житомирській області за період з 2013 по 2016 роки. Проаналізовано розподіл хворих з урахуванням віку, статі, соціального статусу. Встановлено, що хвороба має тенденцію до поширення. Зроблено висновок, що тільки активне виявлення хворих, з'ясування ймовірних джерел інфікування, повноцінна санітарно-освітня робота допоможуть покращити епідеміологічну ситуацію в област
Захворювання урбаха-віте (ліпоїдний протеїноз): історія хвороби
No full textLipoid proteinosis is a rare disorder, inherited as autosomal recessive disorder. Patients affected with lipoid proteinosis can show multiple clinical manifestations as a result of progressive hyaline material deposition in skin, mucous membrane and different organs of body. We are reporting a case of 41 year old Saudi male who presented to Dermatology clinic with progressive skin and oral mucosal lesions. Patient presents with different clinical manifestations most importantly hoarseness of voice, restricted tongue movement and attacks of seizure. Biopsy from oral mucosa was taken and revealed hyaline like deposition in the subepithelial tissue, according to the biopsy result and clinical presentations the patient was diagnosed as a case of lipoid proteinosis. Our main objective is to report a large uncharacterized disease in Arab population such as lipoid proteinosis in middle adulthood maleЛіпоїдний протеїноз – це рідкісний аутосомно- рецесивний розлад. 41 річний чоловік Сауді мав ураження шкіри, слизової оболонки рота та інші різноманітні прояви, перш за все, хрипоту голосу. Біопсія виявила відкладення гіаліну. Нашою метою було описати досі не схарактеризовану хворобу арабського населення, ліпоїдний протеїно