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Аналіз супутніх захворювань у пацієнтів похилого та старечого віку з вертлюговими переломами стегнової кістки
Get PDFThe frequency of proximal femur fractures is 35 – 40 % in the structure of different skeletal fractures. Elderly people, usually having several somatic diseases, are the main contingent of patients with fractures of this localization. Comorbidities and general condition of patients should be considered for treatment strategy determination.Aim. To study comorbidities structure in geriatric patients with proximal femur fractures and to estimate comorbidities influence on the choice of the treatment strategy.Materrials and methods. 568 case histories of patients, hospitalized in the trauma department of Kharkiv clinical multy-field hospital № 17 with proximal femur fractures during 2008 – 2014, were analyzed.Results. Most of the patients had low energy trauma. 568 patients were included in the research; 205 (36.09 %) of them were males, and 363 (63.91 %) – females. The age of patients ranged from 62 to 97 (the average age 79.2±9.1). Comorbidities were found in 378 patients (66.5 %). The time from the moment of injury to hospitalization ranged from 30 minutes to 4 weeks (25 hours on the average). The average number of bed capacity was 17 days (from 1 to 84 days). In 72.7 % of cases coronary heart disease was found, in 47.6 % - hypertension, and diabetes mellitus – in 10.8 %. One comorbidity was found in 131 patients (34.65%), two comorbidities – in 153 patients (40.47 %), three or more was found in 84 patients (22.22 %). The surgical treatment was applied in 29.5 7% of cases, conservative – in 70.42 % of cases.Conclusion. The elderly patients in 66.5% of cases have comorbidities, and cardiovascular pathology is the most common. The patients with the giving fractures need more detailed examination to select the optimal treatment strategyНайчастіше переломи проксимального відділу стегнової кістки зустрічаються в осіб похилого віку, які вже мають супутні захворювання. Проаналізовано 568 історії хвороб пацієнтів з переломами ПВСК. Супутня патологія виявлена в 378 хворих (66,5 %), в 72,7 % діагностовано ішемічна хвороба серця. Оперативне лікування застосоване лише в 29,57 % хворих. Вибір тактики лікування залежить від супутньої патологі
Цитокиновый ответ после радикальных операций по поводу опухолей толстого кишечника
Get PDFIn cancer patients, who underwent wide planned surgical operations as to a tumor of the colon, in postoperative period immune suppression may be caused by an inflammatory reaction that directly influences the number of postoperative complications.Aim of research – the comparative assessment of the influence of postoperative anesthesia methods on the cytokine response of an organism.Materials and methods. There were examined 102 patients with tumors of the colon. All patients after operations were hospitalized at the department of intensive care. The control group (N=53) was anesthetized by non-steroid anti-inflammatory preparations together with opiates. The studied group (N=49) received the continuous prolonged epidural analgesia within multimodal anesthesia. There were studied the pain level (by 10-point visually analogous scale), influence on the change of anti-inflammatory and inflammatory cytokines on the cytokine response. The levels of IL-1β, IL-4, IL-10 and TNF were studied.Results. The study of cytokines level demonstrated that at 3 day after the operation in the studied group of patients (continuous prolonged epidural analgesia) the level of anti-inflammatory cytokines decreased and the level of inflammatory ones increased. It allows to note the positive influence of the continuous prolonged epidural analgesia on the cytokine response in the organism of patients, operated as to colon tumors.Conclusions. The prolonged continuous epidural analgesia within multimodal anesthesia provides the adequate postoperative analgesia after operations as to colon tumors. In favors the stable anesthesia and excludes periodical exacerbations of pain syndrome. It stimulates anti-inflammatory cytokines production, decreases the cytokine response of the organism to the operative trauma after the surgical treatment of colon tumorsРассмотрено влияние методов послеоперационного обезболивания больных с опухолями толстого кишечника на воспалительную реакцию организма. Обследованы 102 больных с опухолями толстого кишечника. Определены показатели провоспалительных и противовоспалительных цитокинов, а также их связь с разными методами послеоперационного обезболивания. Доказан положительный эффект продленной непрерывной эпидуральной аналгезии на цитокиновый ответ организм
Вплив трансплантованих нейральних прогеніторів на проліферацію клітин гіпокампа після ішемічного ушкодження мозку
Get PDFThe aim of research was to establish the effect of neural progenitors (NP) transplantation on hippocampal cells proliferation after an ischemic brain injury of a mouse.Methods. An ischemic brain injury was modeled by 20-minutes occlusion of both carotid arteries in mice of FVB line with the further reperfusion. In 24 hours after the occlusion NP, separated from the hippocampus of mice of FVB-Cg-Tg(GFPU),5Nagy/J line, transgenous by a green fluorescent protein (GFP) gen, were stereotaxically transplanted in CA1 hippocampus zone of ischemic animals. To reveal proliferating cells, all animals from experimental groups were intaabdominally administered with synthetic nucleoside 5-bromodeoxyuridine (BrdU). For the assessment of hippocampal cells proliferation after the ischemic brain injury and after NP transplantation, the immunohistochemical coloration of brain cuts was realized using antibodies against BrdU.Results. The received data demonstrated that NP transplantation after an ischemic brain injury statistically reliably increases the number of BrdU-positive cells in the dentate gyrus comparing with animals from the control pseudo-operated group and the comparison group without the transplantation.Conclusions. These data allow to suppose that NP transplantation after an ischemic brain injury may influence cells proliferation in the subgranular zone of the dentate gyrus and in such a way stimulate the neurogenesis in the hippocampusМетою дослідження було встановлення впливу трансплантації нейральних прогеніторів (НПК) на проліферацію клітин гіпокампа після ішемічного ушкодження головного мозку миші. Отримані дані показали, що трансплантація НПК після ішемічного ушкодження мозку статистично достовірно збільшувала проліферацію клітин у зубчастій звивині порівняно із тваринами контрольної псевдооперованої групи та групи порівняння без трансплантаці
Роль коморбідної патології у веденні хворих на сполучення бронхіальної астми та хронічного обструктивного захворювання легень
Get PDFThe aim of the study was the revelation of the comorbidity influence in patients with the combined pathology of bronchial asthma and chronic obstructive pulmonary disease on clinical manifestations and symptoms of the disease, system inflammation factors and breath functional parameters.Materials and methods. The study included 140 patients with the combined bronchial obstructive pathology of the mean age 58,56±0,81 years, 74 women, 66 men.All patients underwent the spirometry and bodypletizmography (“Master Screen PFT”, Germany). The test with 6-minutes walking was realized according to the standard protocol. The determination of the clinical course severity and disease prognosis was assessed by BODE index. All patients underwent the clinical analysis of blood, coagulogram, determination of highly-specific C-reactive protein. The level of dyspnea was assessed in all patients by the modified scale of the medical research council (mMRC), and also the index of basic dyspnea (BDI). The general point by the Charlson comorbidity index was calculated for all patients.Results. With the increase of the number of concomitant diseases, the intensity of symptoms and functional disorders, inherent to bronchial asthma and chronic obstructive pulmonary disease increased. At the high level of comorbidity index, dyspnea was reliably more essential (by mMRC) comparing with one of patients with the low and middle level of comorbidity (p<0,05); functional disorders were more intense, realization of a usual activity was complicated (by BDI). Patients with the combined bronchial obstructive pathology with the high comorbidity level had the decreased physical tolerance (in the test with 6-minutes walking) and also reliably worse disease prognosis (higher BODE-index).The increase of comorbidity index was attended by negative changes of volumes, capacities, parameters of bronchial permeability at all levels of respiratory tracts in patients with the combined bronchial obstructive pathology.Patients with the combined pathology with the high comorbidity index had reliably higher indicators of the system inflammation (С-reactive protein, fibrinogen) comparing with patients with the middle and low comorbidity indices (р<0,05). Patients with the middle comorbidity level had the reliably higher content of neutrophils of peripheral blood comparing with one of patients with the low comorbidity (р<0,05).Conclusions. Patients with the combined brionchial obstructive pathology at additional comorbid diseases demonstrated the essential intensification of clinical manifestations and symptoms of the disease, worsening of external breath function indices, intensification of the system inflammation and prognosis worsening. The combination of diseases played also rather important role at the combined bronchial obstructive pathologyВплив супутньої патології на клінічні прояви, діагностику, прогноз і лікування багатьох захворювань багатогранний і індивідуальний.Дослідження присвячене визначенню рівня коморбідної патології хворих на сполучення бронхіальної астми та хронічного обструктивного захворювання легень, а також виявлення впливу коморбідності на клінічні прояви та симптоми захворювання, показники запалення, функцію зовнішнього дихання у цієї категорії хвори
Пневмонії у хворих з порушеннями імунітету: удосконалення способу лікування з використанням імуномодулятору
Get PDFAim of research: to optimize the approach to the treatment of pneumonias in patients on the background of acute leucosis from positions of immunoresistance based on using disodium glutamyl-cysteinile-glycine by the method of extracorporal pharmacotherapy.Materials and methods. Research group – 39 patients with pneumonia on the background of acute leucosis, who underwent the treatment according to the form and stage of the disease on the base of the hematological center “MI city multi-profile clinical hospital No. 4» Dnipro city, 2015–2016. Mean age of patients 31,5±6,5 years, 11 women and 38 men. Patients of the main group were additionally administered with disodium glutamyl-cysteinile-glycine in 2 ml of 3 % solution (60 mg) i/v No. 5 each second day. The parameters of the immune response were studied: Т and В-lymphocytes and their subpopulational composition (CD3+, CD4+, CD8+, CD19+, CD16+, CD56+) by the method of flow laser cytoflourometry (BeckmanCoulter–USA). There were additionally determined; immunoregulatory index, leuco T-cellular index, leuco B-cellular index and index of leucocytes activation; phagocytosis state was assessed by the parameters: phagocytic number, phagocytic indicator, NBT-tests. The state of humoral immunity was assessed by levels of immunoglobulins of classes A, M and G by the method of immunoturbidimetry (BeckmanCoulter–USA).Results. The analysis of parameters of cellular and humoral immunity of patients with pneumonias on the background of AL by the improved method of treatment of pneumonia using the immunomodeling preparation disodium glutamyl-cysteinile-glycine proved the positive influence on the immune reactivity of patients’ organism, manifested by the reliable increase of the relative quantity of the pool of T-helpers (CD4+), NК-cells, increase of immunoregulatory index, PI, PN and increase of humoral immunity indices.Conclusions. The improved method of pneumonia treatment on the background of AL using the immunomodeling preparation disodium glutamyl-cysteinile-glycine by ECPT method proved the positive influence of the immune reactivity of patients’ organism, manifested by the reliable activation of phagocytosis and anti-infectious protection, manifested by the more expressed effect of pneumonia treatment: improvement of the clinical course of disease; decrease of the prognosticated number of ABT days and earlier return to the program treatment of AL. The obtained effects of the improved method of pneumonia treatment in patients with acute leucosis at using the immunomodeling preparation disodium glutamyl-cysteinile-glycine by ECPT method proves the pathogenetic validity of the possibility of optimization of pneumonia treatment from positions of immunoresistanceМета дослідження: оптимізувати підхід до лікування пневмоній у хворих на тлі гострих лейкозів з позицій імунорезистентності на основі застосування глутаміл-цистеинил-гліцин динатрію методом екстракорпоральної фармакотерапії.Дослідження проводилося на базі КЗ «Міська багатопрофільна клінічна лікарня № 4» м. Дніпро. Хворим основної групи вводили глутаміл-цистеинил-гліцин динатрію. Дослiджували показники імунної вiдповiдi.Удосконалений спосіб лікування довів можливість оптимізації лікування пневмонії у хворих з порушеннями імунітету з позицій імунорезистентност
Вивчення структури генотипів вірусу гепатиту с, які циркулюють серед населення регіону України з середнім ступенем урбанізації
Get PDFThe aim of the research is the study of hidden mechanisms of development of the epidemic process of hepatitis C, dynamics of changes of the structure of HCV genotypes that circulate among the population of the Ukrainian region with an average stage of urbanization. The morbidity of AHC for 1993-2016 and the morbidity of the CHC for 2010-2016 of the population of the Rivne region of the Northwestern region of Ukraine were analyzed in the study, as well as the morbidity of these infections was presented compared with other regions of Ukraine (for 2015-2016). The HCV genotypes for the period of 2011-2016 were determined in 70 primary blood donors in whom the HCV genetic markers were firstly detected by RT-PCR method and a change in the genotype structure was showed compared to data obtained in 1996-1997. Sequencing of the core HCV area of 322 n.s. was performed non-type by RT-PCR method of three HCV isolates. Methods of research: epidemiological, molecular-genetic (RT-PCR and sequencing), statistical.Results. The dynamics of HC epidemic virus at the territory of Rivne region of the Northern-Western region of Ukraine is conditioned by the self-reconstruction of HCV population that takes place as a result of evolutionally fixed mechanisms of changeability (3,7±2,09% of persons with 1b HCV subtype at the area core HCV area with size 322 n.s. demonstrated the point natural changeability from 6 to 13 nucleotide sequences) and fluctuations in changeability indices of HCV population. For the last 20 years there was revealed the reliability of differences in the width of prevalence of separate HCV genotypes: decrease of the specific weight of 1b HCV subtype from 85±8,19% to 51,43± 5,97% (p<0,05) and increase of the specific weight of 3а HCV subtype from 10,0±6,88% to 31,43±5,55 % (p<0,05).Conclusions. It gives ground to recommend to realize the permanent molecular-genetic monitoring of HСV by RT-PCR method and sequencing of the part of HCV genome for detecting hidden mechanisms of the development of the epidemic process of hepatitis C at the studied territoryМетою дослідження було вивчення прихованих механізмів розвитку епідемічного процесу гепатиту С, динаміки зміни структури генотипів HCV, які циркулюють серед населення регіону України з середнім ступенем урбанізації. Результати аналізу молекулярно-генетичних досліджень методами RT-PCR та секвенування частини геному HCV дають підставу вважати, що динаміка епідемічного процесу HC обумовлена самоперебудовою популяції HC
Результати дослідження змін якості життя при вродженій патології органа зору у дітей раннього віку
Get PDFAim: the study of changes of life quality components in children of the first three years of life with the congenital pathology of the visual analyzer as an instrument of formation of their social adaptation in future.Materials and methods: forms of the sociological study by the adapted version of the standardized Children’s Visual Function Questionnaire (CVFQ) Felius et al. (2004) – 498 forms, among them 398 – from the main group and 100 – from the control one were the initial material. The scientific base of the study was ambulatory-polyclinic departments of health protection institutions of the city Kyiv that give medical care to children of the first three years of life, especially with the congenital pathology of the visual analyzer. To achieve the aim, it was necessary to use the complex of research methods, based on the system approach, namely: medical-statistical and sociological methods (form questionnaire with the interim report about the aim and tasks of the study for respondents, previous oral voluntary consent for the participation in the anonymous questionnaire).Results: It was elucidated, that most respondents from the main group, as opposite to patients from the control one, had disorders of life quality components by the scale “general vision” and “influence on a family”. Parents of children from the control group estimated the general vision of their children totally in 89,75 ± 1,33 points against 60,25 ± 1,96 by the total estimation of parents of children from the main group (difference was 32,87 %, at р<0,001). In general, the total number of points in the main group was 64,89 ± 1,01 in the main group against 84,67 ± 0,92, by total estimations of the life quality of children of the early age by parents with the difference in 23,4 % (р<0,001).The results of the realized study prove changes of the children’s life quality at vision disorders in the early age that substantiates the expedience of intensifying arrangements on timely revelation and treatment of vision function disorders in children, according to existent medical-technological documents.Conclusions: the studies proved that children with the congenital pathology of the vision analyzer suffer from the loss of life quality components from the early age that motivates the interaction between a family doctor, child ophthalmologist within their competences in giving medical help at vision analyzer function disorders from the first days of child’s life, for realizing the effective supervision of a family, preventing the development of the medical-social maladjustment of both a child itself and its familyВивченні зміни компонентів якості життя у дітей раннього віку з вродженою патологією зорового аналізатора, що обґрунтовує доцільність посилення заходів з їх своєчасного виявлення та лікування із залученням сімейного лікаря та дитячого офтальмолога в межах своїх компетенцій до наданні медичної допомоги, що сприятиме попередженню медико-соціальної дезадаптації дитини та її родин
Рівень якості життя як мішень арт-терапевтичного впливу в комплексному лікуванні хворих на шизофренію
Get PDFAim: to study the life quality dynamics of patients with schizophrenia under the influence of art-therapy in the system of therapy and rehabilitation.Materials and methods: At the research there was realized the complex clinical-psychopathological examination of 125patients of both sexes, 20–45years old (mean age 35,0±2,0 years) with the set diagnosis schizophrenia in the period of stabilization. The main group (participated in art-therapy) included 95 persons (54 women and 41 men). The control group consisted of 30 patients (16 women and 14 men), who received the standard regulated treatment at hospital.Results of research. At the research there was used the system of art-therapy in the complex therapy of patients with schizophrenia and its effectiveness was proved. On the background of the complex therapy including art-therapy, there was observed the fast reduction of the psychopathological symptomatology, normalization of the emotional condition, stabilization of patients’ behavior, improvement of cognitive indices, increase of patients’ psychophysical activity.It was established, that on the background of using art-therapy in the complex treatment of patients with schizophrenia, the life quality index increased by all scales in the main group by 42,4 %, compared with the control– 26,9 %.Conclusions. Under the influence of art-therapy in the complex treatment of schizophrenia there was observed the fast reduction of psychopathological symptomatology, increase of the duration and quality of remission.There was established the high effectiveness of art-therapy compared with the traditional complex treatment as to improving the life quality of patients with schizophrenia.Art-therapy, based on elaborated principles for patients with schizophrenia is characterized by the higher effectiveness, compared with traditionally used methodsУ ході дослідження запропонована система арт-терапії в комплексному лікування та реабілітації хворих на шизофренію та доведено її ефективність. Під впливом арт-терапії у комплексному лікуванні шизофренії відмічається швидка редукція психопатологічної симптоматики, підвищення тривалості та якості ремісії.Встановлена висока результативність арт-терапії в порівнянні з традиційним комплексним лікуванням щодо підвищення якості життя у хворих на шизофрені
Ликвидация передачи от матери ребенку ВИЧ-инфекции и сифилиса в Украине: прогресс и вызовы
Get PDFThe objective of this study is to analyze the indicators of impact and process of EMTCT of HIV and syphilis in Ukraine thus helping to prepare for validation of this process according to the WHO targets and сriteria.Materials and Methods. In this retrospective study were presented the epidemiological and clinical data about 237 women who had syphilis before or during pregnancy and babies born to them (238) from 1999 to 2007 yy. Besides in article were used statistical forms of the Public Health Center and Center for Medical Statistics of the Ministry of Health of Ukraine for the incidence of syphilis and HIV in women of reproductive age, pregnant women and children born to them, including those who were diagnosed with congenital syphilis and HIV infection from 2007 to 2016 yyResults. The analysis of the data from Public Health Center shows that one of the target indicators for the impact of HIV/AIDS has been achieved in Ukraine: the number of new cases of mother-to-child transmission of HIV per 100,000 live births was 20.8 in 2015. But in the same time the indicator of mother-to-child transmission of HIV in Ukraine is still higher than the WHO minimum criterion (≤2%) and was 3.7% according to a cohort of children born to HIV-infected women in 2015, which still does not meet the criteria WHO to validate this process.Despite the main target indicator of CS elimination has been achieved, some process indicators of syphilis as coverage of syphilis testing and treatment of pregnant women have not reached yet.Conclusions. Given the policy of dual elimination of MTCT of HIV and syphilis in Ukraine, an expansion of the PMTCT program on universal access to HIV and syphilis diagnostics and treatment services in pregnant women at high-risk groups is reguired.Цель этого иссследования – проанализировать индикаторы воздействия и процессов ликвидации передачи матери ребенку (ПМР) ВИЧ инфекции и сифилиса в системе профилактики врожденного сифилиса и программе профилактики ПМР ВИЧ в Украине на основе данных ретроспективного исследования, способствуя, таким образом, подготовке к двойной валидации этих процессов в соответствии с целями и критериями ВО
Медико-психологічна допомога для онкохворих на різних етапах лікувального процесу
Get PDFCancer diseases constitute a complex medical, psychological and psychosocial problem. The aim of our research was to identify psychological features of cancer patients at different stages of the treatment and to determine the specifics of medical and psychological care.Contingent and methods. The study was carried out at Kyiv city clinical cancer center during 2014 – 2016. 422 cancer patients attended the survey. 80 of them were at the diagnostic and anticancer treatment choice stage, 187 of respondents were undergoing the primary anticancer therapy, and 155 – re-treatment due to cancer pathology progression.Results. At the different stages of the treatment the need of cancer patients in psychological care were different. That displayed on the preference of forms, conditions, duration and intensity of medical and psychological measures. Psychological care depended on the treatment process stage, treatment type, sex, and the needs of patients. The formation of the positive attitude and availability of psychological interventions as motivating factors was an important practical task.Conclusion. Medical and psychological care in cancer center should be complex, linked to clinical practice tasks, help to recover patients’ mental health, and form an adaptive attitude and effective behavior strategy concerning anticancer treatmentНа різних етапах лікування потреби онкологічних хворих у психологічній допомозі відрізнялися, що відображалося на пріоритетності вибору форм, умов, тривалості та інтенсивності медико-психологічних заходів. Психологічна допомога залежала від етапу лікувального процесу, виду лікування, статі, потреб хворих. Важливим практичним завданням було формування позитивного відношення та доступності психологічних інтервенцій в якості мотивуючих чинникі