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Прогнозування перебігу ВІЛ-інфекції та пошук предикторів розвитку СНІДу та легеневого туберкульозу
Get PDFHIV-infection is the most urgent problem of health protection because of the high morbidity level, polymorphism of clinical manifestations, high risk of the unfavorable results development and significant economic losses, caused by the prevalence of persons of working age among infected people. But factors that favor the pulmonary tuberculosis development in HIV-infected patients remain unexplained and need separate studies.Aim of the research – to increase the prognostication of HIV-infection course based on determining predictors of progression to AIDS stage and pulmonary tuberculosis development.Materials and methods. The retrospective cohort analysis of 1498 HIV-infected patients, among which 491 had IV clinical stage of HIV-infection during the observation period (2003–2015, was realized. The statistical analysis was realized using Cox regression.Results of the research. At the analysis of predictors of HIV-infection progression to ІV clinical stage the binary analysis revealed five important ones: male sex (HR=0,644, 95 %CI [0,518-0,800], р=0,000), patients’ age (HR=1,016, 95 %CI [1,002-1,029], р=0,022), infection duration >3 years (HR=1,252, 95 %CI [1,200-1,306], р=0,000), initial level of СD4 lymphocytes less than 350 cells/mcl (HR=0,997, 95 %CI [0,996-0,998], р=0,000) and parenteral way of HIV transmission (HR=1,478, 95 %CI [1,090-2,004], р=0,012). The multiple analysis of Cox proportional intensities determined independent predictors of HIV-infection progression to ІV clinical stage as: male sex (HR=0,627, р=0,000), infection duration >3 years (HR=1,222, р=0,000), parenteral way of HIV-infection transmission (HR=0,627, р=0,000), and primary level of СD4 lymphocytes < 350 cells/mcl (HR=0,997, р=0,000). The independent predictors of the pulmonary tuberculosis development in HIV-infected patients were determined as: male sex (HR=0,517, р=0,000), presence of VHC-co-infection (HR=0,433, р=0,000) and HIV-infection duration > 3 years (HR=1,177, р=0,000).Conclusions:1. The independent predictors of HIV-infection progression to ІV clinical stage as: male sex infection duration >3 years parenteral way of HIV-infection transmission and primary level of СD4 lymphocytes < 350 cells/mcl.2. The independent predictors of the pulmonary tuberculosis development in HIV-infected patients were determined as: male sex presence of VHC-co-infection and HIV-infection duration > 3 yearsВ дослідженні наведений пошук предикторів прогресування ВІЛ-інфекції до термінальної стадії СНІДу.Проведено ретроспективне когортне дослідження 1498 ВІЛ-інфікованих пацієнтів, серед яких у 491 протягом періоду спостереження (2003–2015 рр.) буладіагностована IV клінічна стадія ВІЛ-інфекції. Незалежними предикторами прогресування ВІЛ-інфекції до ІV клінічної стадії виявлені: чоловіча стать (HR=0,627,p=0,000), тривалість інфікування ВІЛ >3 років (HR=1,222, p=0,000), парентеральний шлях передачі ВІЛ-інфекції (HR=0,627, p=0,000) та початковий рівень СD4 лімфоцитів <350 кл/мкл (HR=0,997, p=0,000). Предикторами розвитку легеневого туберкульозу в ВІЛ-інфікованих пацієнтів виявлені: чоловіча стать (HR=0,517, p=0,000), наявність ВГС-коінфекції (HR=0,433, p=0,000) та тривалість інфікування >3 років (HR=1,177, p=0,000
Систематизація чинників ризику формування станів дезадаптації у студентів в сучасних умовах
Get PDFAim of the work: To systematize pathogenetically important factors of adaptation disorders in students of the medical university.Materials and methods of research: the complex examination of 412 students of І–ІІІ years of Kharkov national medical university, 17–22 years old, was realized, observing principles of bioethics and deontology.All examined persons were divided in three groups:1 group – 215 of students-dwellers of the Eastern Ukraine; 2 group – 87 students-dwellers of Lugansk and Donetsk regions, who entered Kharkov national medical university before the beginning of ATO; 3 group – 110 students-migrants from ATO zone.Research methods: clinical-anamnestic, psychodiagnostic, statistical.Results. The research results demonstrated that students-migrants express the higher level of adaptation disorders compared with ones of І and ІІ groups. Students relate to factors that influence adaptation complications: life stereotype change, difficult learning material, severe learning discipline, necessity to work out missed activities and lectures. The stress factors for students-migrants are a necessity to adapt in the new collective, abrupt change of the life stereotype, new social status - constrainedly migrated persons.Expressed manifestations of anxiety and depression are typical for patients with adaptation disorders (in overwhelming majority students of ІІІ group).It was established, that deviations of scales of depression, hypochondria, hysteria, psychopathy, psychasthenia are typical for personal profiles of women with maladjustment signs. Men with adaptation disorders most often demonstrate deviations of scales of hypochondria, depression, hypomania, schizophrenia. Conclusions. Students relate to factors that influence adaptation complications: life stereotype change, difficult learning material, difficult terminology, necessity to work out missed activities and lectures. The risk factors of adaptation disorders formation for students-migrants are a necessity to adapt in the new collective, abrupt change of the life stereotype, new social status – CMP; high indices of anxiety and depression; prevalence of psychopathic, hysterical and depressive featuresВ дослідженні проведено вивчення предикторів формування станів дезадаптації студентів.Встановлено, що у формуванні порушень адаптації студентів медиків лежить багатофакторна обумовленість, у якій біологічні, соціальні і психологічні фактори представлені в нерозривному комплексі, що визначає специфіку клінічних проявів дезадаптивних станів та шляхи їх корекції та профілактик
Гігієнічна оцінка якості та способу життя молоді
Get PDFThe paper presents the results of the study of life style and quality of female students of higher educational institutions.Aim of research: to estimate life quality indices and their connection with socio-hygienic factors of life activity of girls 17 – 22 years old for substantiating arrangements of the active prophylaxis of health disorders of the female contingent of the early active reproductive age.Materials and methods. 284 female students of higher educational institutions of city Sumy (І group (n= 135)– 17 – 19 years old, ІІ group (n= 149) – 20 – 22 years) took part in the research. Their life quality was estimated using the non-specific questionnaire «SF-36», socio-hygienic factors were studied using the specially elaborated form.Results of research. There were determined quantitative characteristics of the physical (67,03±1,30 points) and psychological (59,69±1,26 points) components of health. Values of physical and psychological components of health of girls 20 – 22 years old are reliably lower comparing with the younger age group (17 – 19 years). Age differences of the parameter “Physical component of health” appear at the expanse of decreasing a mark of the routine role physical functioning and a mark of the general health status of girls 20 – 22 years old comparing with girls of 17 – 19 years. The psychological heath component reliably differed in the chosen age diapasons mainly at the expanse of the role emotional functioning decrease in girls of II group. It was established, that the parameter “General health status” is a system-creating factor of the life quality for the contingent of female students in general by the number of correlations. The role physical functioning, which high mark is connected with the absence of limitations for physical loads, high level of the general health status and emotional condition that helps in everyday activity, is an important factor in the group of girls of 17 – 19 years. Age features of the life quality of female students 20 – 22 years old are in the fact that the social functioning has a reverse correlative connection with the physical functioning, role physical functioning and general health status and prove the fact of the priority of the high level of the motivation, volitional effort, purposefulness for providing the high level of the social functioning. Conclusions. The life quality of female students depends on a series of socio-hygienic factors, such as: education of the mother, physical activity level, smoking, alcohol intake, pathologies of the respiratory system, digestion, nervous and reproductive systems. Quantitative characteristics of the dependence of the life quality on the complex of factors allow to substantiate arrangements of the prophylaxis of health disorders of the female contingent of the early reproductive age scientificallyМетою роботи було оцінити показники якості життя та встановити їх зв’язок із соціально-гігієнічними чинниками життєдіяльності дівчат 17–22 років для обґрунтування заходів профілактики порушень здоров’я жіночого контингенту раннього активного репродуктивного віку. За допомогою неспецифічного опитувальника «SF-36» та спеціально розробленої анкети визначені кількісні характеристики окремих компонентів якості життя, виявлено вікові особливості системоутворюючих чинників якості життя у різних вікових група
Исследование причин разброса данных о распространённости мышечно-суставной дисфункции височно-нижнечелюстных суставов у стоматологических больных
Get PDFAim of research. To study biopotentials of chewing muscles and possible noise phenomena in temporomandibular joints in dental patients, who have two and more symptoms of a muscle and joint dysfunction of a temporomandibular joint with no complaints for pains in chewing muscles at movements of a lower jaw as ones of criteria for substantiating appropriateness of setting the diagnosis of a temporomandibular joint dysfunction.Materials and methods. The group of 136 persons with 2,3,4 and more symptoms of a temporomandibular joint dysfunction, deviations in the work of the joint, but no complaints for pains at movements of a law jaw and chewing was formed of patients of the dental clinic. Results of research. The artrophonographic study demonstrated that patients with 2 and 3 symptoms related to a muscle and joint dysfunction of a temporomandibular joint, demonstrate disorders in the work of a temporomandibular joint (56,6% of patients) and ones with 4 and more symptoms – in 64,1%. The electromiographic study revealed the absence of disorders of biopotentials of chewing muscles in all 136 patients.Conclusions. One can make a conclusion that a muscle and joint dysfunction of a temporomandibular joint must not be diagnosed in these patients. The repeated examination, realized in 6 months proved the absence of worsening of a condition of chewing muscles and temporomandibular joint in such patients. Assessments of the prevalence of this disease, presented in literary sources, are overestimated unreasonably in a series of casesНа базе проведенных исследований обосновано положение о том, что основой постановки диагноза мышечно-суставной дисфункции височно-нижнечелюстного сустава должно быть не только наличие симптомов, относимых к этому заболеванию, а установленные с помощью электромиографии нарушения биопотенциалов жевательных мышц . Диагностика данного заболевания, не учитывающая этого положения, необоснованно завышает показатели распространенности мышечно-суставной дисфункции височно-нижнечелюстного сустав
Фенотипические характеристики генерированных дендритных клеток для проведения иммунотерапии у больных раком поджелудочной железы
Get PDFAim. The aim of our research was to study quantitative and phenotypic features of dendritic cells (DC) from peripheral blood monocytes for immunotherapy in patients with pancreatic cancer (PC).Materials and methods. DC were used as natural adjuvants in the composition of anticancer vaccines in complex treatment of PC patients. DC phenotypic maturity was estimated using flow cytofluorometry.Results and discussion. The analysis of DC quantity and vitality has shown that in all PC patients it managed to grow a sufficient number of viable DC for immunotherapy. The expression level of CD83, CD86 и HLA-DR differentiation antigens on DC generated in vitro significantly increased during immunotherapy in PC patients.Conclusion. The obtained data can be put into the basis for development of the protocols of DC use as natural adjuvants in the composition of anticancer vaccines in the standard schemes of PC patients’ treatmentЦелью исследования было изучение фенотипических характеристик дендритных клеток (ДК), полученных из моноцитов периферической крови у больных раком поджелудочной железы (РПЖ). ДК использовались в качестве естественных адъювантов в составе противоопухолевых вакцин при комплексном лечении больных РПЖ. Установлено, что уровень экспрессии молекул CD83, CD86, HLA-DR возрастал на каждом этапе проведения иммунотерапи
Аналіз стану здоров’я у дорослих із коригованою вродженою вадою серця (на прикладі атріовентрикулярної комунікації)
Get PDFThe estimation of the surgery was carried out, the most common forms of the disorder, which occur after surgical treatment in adult patients with atrioventricular communication, were determined. The aim of research was to investigate the main clinical and echocardiography changes occurred in adults after surgery directed to atrioventricular communication for the further dispensary system improvement.Methods. Retrospective analysis of the spread of congenital heart disease - atrioventricular communication in 12 adults aged 18-28 years treated in Municipal Institution Lviv Regional Children's Hospital during 2009-2016. Statistical methods included relative and average values calculation, their average errors, the assessment of the probability of difference between the obtained results in the comparable groups using Student's t test. Results. It was found that both men and women after atrioventricular communication surgical treatment in childhood had poor quality of life due to physical and emotional condition worsening. Significant part of the patients still suffered from mitral and tricuspid insufficiency, heart failure of 1-2 degree, pulmonary artery regurgitation of 1 degree, and chamber hypertrophy.Conclusion. The mentioned group of patients needs lifelong medical care by specialists (cardiologists, surgeons, psychologists, physitians and other) for timely qualified care, prescriptions determination, and reoperations within optimal termsПроаналізовано безпосередні та віддалені результати хірургічного лікування дорослих хворих із атріовентрикулярною комунікацією за період 2009–2016 рр., вивчені клініко-анамнестичні прояви повної та неповної атріовентрикулярної комунікації (АВК) і особливості їх поєднань з іншими вродженими вадами серця. Проведена оцінка ефективності хірургічного втручання, виявлені найпоширеніші форми вади у прооперованих пацієнтів. Вироблено основні принципи вибору диспансерного спостереження за такими пацієнтами у дорослому віц
Аналіз адгезивної дисфункції ендотелію при резстентній артеріальній гіпертензії
Get PDFAim: To examine the antihypertensive activity of Telmisartan and Bisoprolol at resistant hypertension.To evaluate the features of resistant hypertension and endothelial vasomotor and adhesive dysfunction.Methods: The level of adhesion molecules s-ICAM-1, L-selectin and matrix metalloproteinase-9 was determined by ELISA with regard to vasoactive function of the brachial artery, which is determined through the flow-dependent vascular dilatation sample. Determination of Nitrogen oxide was conducted on data metabolites of total Nitrogen (NOx) by determination of Nitrite ion after colorimetric reaction with Griess reagent using SF-46 spectrometer (Russia).Results. The studies have shown that six-month treatment by Telmisartan and Bisoprolol in most patients (22 patients) was accompanied by target levels of blood pressure achievement, and was observed in 14 patients resistant to the treatment. The additional inclusion in complex treatment Aliskiren 150-300 mg per day was also accompanied by normalization of blood pressure.Conclusion.1. The function of endothelial adhesion and appearance of endothelial dysfunction occur prior to hypertension clinical and morphological signs.2. Induced hypertension increase of sICAM-1 and L-selectin and matrix metalloproteinase-9 is a marker of hypertension severity and the treatment efficiency.3. Telmisartan and Bisoprolol significantly reduce the adhesive endothelial dysfunction and contribute to the achievement of target blood pressure levelsПроведені досліджененя показали, що шестимісячна терапія телмісартаном і бісопрололом у більшості пацієнтів (22 хворих) супроводжувалась досягненням цільових рівнів артеріального тиску, а у 14 хворих відмічалась резистентність до проведеної терапії. Додаткове включення в комплекс лікування аліскірену 150–300 мг на добу супроводжувалось усуненням резистентност
Влияние материнской инфекции на морфо-функциональное состояние коры надпочечников недоношенных плодов
Get PDFAdrenals as the one of main organs that reacts to a stress have the extreme importance for the normal organism development. Despite numerous researches in the perinatal period, the problem of pregnancy infections on the morpho-functional state of adrenals of fetuses was not completely studied.Methods. Organs were taken from incisions of premature fetuses (gestational age 24-36 weeks). The material was divided in 3 groups: control, chronic intrauterine hypoxia and infections. The study included two adrenals, investigated histologically and immunohistochemically.Results. Mother’s infectious pathology has the more harmful effect on fetuses’ adrenals than a “pure chronic intrauterine hypoxia”. Іn fetuses was reveled a hypoplasia of glomerular zone. In all groups were observed nidi of cytolysis and spongyocytes resorption in the bundle zone with cortisol production increase. In a fetal cortex is observed the exhaustion of its functional activity.Conclusions. These data testify to adaptive reactions of fetuses’ adrenals as a response to antigen stimulationУстановлено, что многие заболевания, возникшие в разные периоды онтогенеза, являются результатом нарушений, происходящих во внутриутробном периоде. Надпочечники, как один из главных органов, активно реагирующих на стресс, крайне важны для нормального развития организма. Несмотря на многочисленные исследования в перинатальном периоде, проблема влияния инфекции беременной на морфо-функциональное состояние надпочечных желез плода практически не изучен
Ефективність полегшувального лікування нападу у школярів з фенотипом тяжкої бронхіальної астми
No full textThe study aimed at improving relieving treatment of bronchial asthma attacks in children of school age with a severe phenotype of the disease.Materials and methods. On the base of pulmonological department of the Regional Pediatric Hospital (Chernivtsi) 57 school-age children with severe persistent asthma were examined, the attack period was determined in 48 patients (84,2 %). The severity of bronchial obstruction syndrome on patients’ admission to the hospital during the exacerbation period was assessed by point scale. Therapeutic tactics in the period of attack was assigned according to the protocol for diagnosis and treatment of asthma in children. It was determined that in patients with severe bronchial asthma for the purpose of desobstruction short-acting inhalation β2-agonists, steroids of systemic effect and methylxanthines preparations (Euphylline) were administered for oral and intravenous use in various combinations with one another. 80,0 % of children with severe bronchial asthma received steroids of systemic effect, the average duration of the course was 2,9±0,19 days. Most children with severe bronchial asthma (52,9 %) in acute period of the disease received infusion therapy with methylxanthines (Euphylline), the average duration of infusion therapy in children with severe pathology persistence lasted 3,3±0,24 days. Systemic use of glucocorticosteroids and infusion therapy with methylxanthines (Euphylline) possess distinct clinical effect, since it was considered appropriate to analyze the frequency of their administration during the first three days of hospital treatment.Result. Relieving treatment with steroids of systemic effect during 3 days the attack severity regress was observed on the seventh day of hospitalization compared to the first day, so reduce relative risk of preserving severe bronchial obstruction reached 80 %, the reduce attributive risk was 67 % with the number of patients to be treated – 1,5 children. Intravenous Euphylline administration in children with severe variant of the disease causing regression of bronchial obstruction, the reduce relative risk of severe bronchial obstruction on the seventh day of hospitalization in patients with severe bronchial asthma reached 74 %, reduce attributive risk was 63 % with the number of patients to be treated – 1,5 children.Conclusions. Thus, these data give reason to prove the value of initial three-day course administration of steroids of systemic effect and intravenous Euphylline administration in the treatment of attack period in children with severe bronchial asthmaУ дослідженні показано, що триденний курс системних глюкокортикостероїдів порівняно з коротшим терміном їх призначення характеризувався вірогідним ризиком регресу бальної оцінки тяжкості нападу на 7-й день стаціонарного лікування. Також продемонстровано, що довенне введення еуфіліну на тлі застосування інгаляційних β2-агоністів короткої дії та системних глюкокортикостероїдів асоціювало з ризиком зменшення тяжкості нападу на 3-й та 7-й день стаціонарного лікуванн
Вибір тромболітика для лікування тромбоемболії легеневої артерії
Get PDFAim of the study was to choose the optimal thrombolytic therapy for massive and submassive TEPA.Materials and methods. 102 patients with massive and submassive embolism of lungs (Miller index > 17) were arbitrarily divided for administrating 100 mg of the recombinant tissue activator of plasminogen (r-tPA) or 3 mln of UN of streptokinase. The control multi-spiral computer tomography of breast organs (MSCT BO) or angiopulmonography (APG) was realized in 2–3 days after thrombolysis. For calculating the statistical importance of the difference of the number of patients by the concomitant pathology and sex, there was used χ2 with Ets correction. Mann-Whitney criterion was used for calculating the difference by age.Results. There was established the advantage of using r-tPA in hemodynamically unstable patients. There was established the advantage of using streptokinase in patients with the disease duration more than 1 day. There was proved the effectiveness of repeated sessions of thrombolysis. There was established, that it’s possible to prevent hemorrhagic complications of thrombolysis if to reveal its contraindications accurately.Conclusions. Alteplase must be used in hemodynamically unstable patients due to the faster effect comparing with streptokinase. Alteplase or streptokinase must be used for hemodynamically stable patients with massive and submassive pulmonary embolism. The repeated TLT is equally effective as thromboembolectomy at insufficient effectiveness of thrombolysis. For preventing hemorrhagic complications, the detail examination of patients is necessary to reveal possible sources of fatal bleeding and determination of contraindications to TLTТромбоемболія легеневої артерії (ТЕЛА) –захворювання з високим рівнем летальності. Досліджені результати лікування 102 пацієнтів з ТЕЛА після тромболізису. Встановлено що при масивній та субмасивній ТЕЛА доцільно застосовувати як альтеплазу так і стрептокіназу. Перевагу альтеплазі слід надавати при лікуваннігемодинамічно нестабільних пацієнтів, а стрептокіназі у пацієнтів з тривалістю захворювання більше 1 доб