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Классы пульсового артериального давления и клинические признаки пациентов на годовом этапе медикаментозной терапии после постоянной электрокардиостимуляции
Get PDFThe aim of study was to assess the changes of patient’s clinical signs in pulse pressure classes at the annual stage after pacemaker implantation and drug therapy.Methods. It is included 220 patients at the annual stage of the drug therapy after pacemaker implantation divided in pulse pressure (PP) classes (I - very low PP - less than 20 mmHg, II - low more than 20 - less than 40 mmHg, III - the norm - 40 - 60 mmHg, IV - high more than 60 - less than 80 mmHg, very high PP - more than 80 mmHg). We evaluated the frequencies of occurrence of the postinfarction cardiosclerosis, functional classes (FC) of stable angina; stages and severity of arterial hypertension; diabetes mellitus, forms of atrial fibrillation; FC and stages of chronic heart failure (CHF). Student's t-test was used.Results. It is necessary to strengthen antihypertensive therapy of patients with implanted pacemakers, especially in IV and V PP classes.Conclusion. At the annual stage after pacemaker implantation drug therapy helps to reduce the frequency of clinical signs of patients in low and high PP classes, accompanied by their concentration in III PP classЦелью работы было оценить изменение клинических признаков пациентов в зависимости от уровня пульсового артериального давления (ПАД) на годовом этапе после имплантации кардиостимуляторов и медикаментозной терапии. Результаты показали улучшение клинической картины, что характеризовалось снижением частоты встречаемости клинических признаков пациентов в низких и в большей мере в высоких классах, сопровождаясь их концентрацией в III классе ПА
Визначення рівня β2-мікроглобуліну як прогностичного маркеру перебігу хронічної лімфоцитарної лейкемії
Get PDFDisease prediction is rather important for the modern medicine. In the age of new and complex prognostic markers, β2–microglobulin is still simple, but important survival predictor in chronic lymphocytic leukemia (CLL) patients. The use of new biological markers is very expensive and not available for routine analysis in all regions. In contrast, β2–MG is significantly cheaper and simpler in its realization, as well as it is affordable for many non-specialized laboratories.Aim. To analyze β2–MG level prognostic significance and its correlation depending on the disease stage, tumor volume and response to treatment in CLL patients.Methods. 98 CLL patients, 37 women aged 42-75 years (average age 62.5 years) and 61 men aged 38-82 years (average age 62.5 years) were examined by us.All the patients had general clinical examination, lymphocytes immunophenotyping in peripheral blood or bone marrow – phenotype СD 5+, СD 19+, СD 20+, СD23+, β2–MG using ECLIA method (Electro-chemiluminescence immunoassay). Cobas 6000, Roche Diagnostics (Switzerland) analyzer and test system were used. Reference values were 0,8–2,2 mg/l.Results. In result of the study of β2–MG level in chronic lymphocytic leukemia (CLL) patients on the different stages of the disease, it was found, that β2–MG level correlates with CLL stage, directly depends on tumor volume, and is a reliable prognostic marker of response to treatment in CLL patients. β2–MG level >3,5 mg/l in blood serum is a bad prognostic predictor, which points to the high risk of disease.Conclusion. β2–MG level correlates with the disease stage, tumor volume, and is a reliable prognostic marker of response to treatment in CLL patientsПроведено визначення рівня β2-мікроглобуліну (β2 МГ) у хворих на хронічну лімфоцитарну лейкемію (ХЛЛ) на різних стадіях хвороби. Встановлено, що рівень β2-МГ корелює зі стадією ХЛЛ, знаходиться в прямій залежності від об’єму пухлинної маси, є надійним прогностичним маркером відповіді на лікування у хворих на ХЛЛ. Рівень β2 МГ>3,5 мг/л в сироватці крові є поганим прогностичним провісником і свідчить про високий ризик хвороб
Оцінка ефективності лікувально-реабілітаційних заходів у пацієнтів з першим психотичним епізодом з урахуванням біологічних ритмів
Get PDFThe aim of this research was in evaluation of efficacy of treating-rehabilitating arrangements in patients with the first psychotic episode taking into account biological rhythms.Materials and methods: The study included 130 patients with the first psychotic episode. The characteristic of biological rhythms was carried out according to Estberg scale, evaluation of life quality according to SF-36 scale.Results: The psychoeducational program was realized in stages and included informational (explanation to patient and relatives of the necessity to take medicaments and visit doctors, the features of disease manifestation, prognosis), therapeutical (prevention of autoaggressive tendencies), social (overcoming of patient’s stigmatization, formation of support by family members) and final stages (formation of new forms of reaction in the case of aggravation). According to the distribution in groups of daily working activity, the psychoeducational arrangements with patients of the first group was realized in second half of day, and with ones of the second and third group – in first half.Conclusions: As a result of the study it was established, that the use of clinical protocols of treatment together with psychoeducational program taking into account biological rhythms in patients with the first psychotic episode leads to the improvement of their life quality. So, the further studies in this field are the priority direction in psychiatry to improve the prophylactic, treating and rehabilitating arrangementsДослідження базувалось на обстеженні пацієнтів із першим психотичним епізодом. Психоосвітня програма включала інформаційний, терапевтичний, соціальний ізаключний етапи тапроводилась згідно до розподілу по групам з урахуванням індивідуального хронотипу. Встановлено, що поєднання клінічних протоколів лікування із психоосвітніми заходами з урахуванням біоритмів призводить до покращення стану хворих, їх якості житт
Покращення показників імунітету у ВІЛ-інфікованих осіб з хронічною токсоплазмовою інвазією та недостатньою імунореконституцією на тлі антиретровірусної терапії за допомогою препарату рибонуклеїнової кислоти
Get PDFAim of the work. To study the possibility of additional correction of immunologic imbalance by ribonucleic acid medication in HIV-infected persons, infested by Toxoplasma gondii, who receive antiretroviral therapy and did not attain immunoreconstitution.Methods of research. 60 HIV-infected persons, seropositive as to Toxoplasma gondii infestation were examined. All patients received antiretroviral therapy (ART) during no less than 6 months, but the number of СD4+Т-lymphocytes in them did not exceed 350 kl/mcl of blood. The immune-enzyme method was used for determination of titres of specific anti-toxoplasmosis IgG and IgМ; general IgM, IgA, IgG, and also IL-2, IL-4, IL-10, INF-γ, TNF-2α. The number of CD4+ Т –lymphocytes was determined by cytofluorimetric method. The one group of 30 persons received ribonucleic acid medication in dose 1500 mg a day during 1-st month and during 2-d and 3-d month - 750 mg a day; other group of 30 patients did not receive medication. The statistical processing was carried out in Exсel, using Student t-criterion.Results. In HIV-infected persons with toxoplasmosis infestation comparing with healthy ones were revealed the increased levels of proinflammatory cytokines - TNF-α (2,47±0,11 pg/ml against 1,90±0,04 pg/ml, P<0,001), INF-γ (10,82±0,38 pg/ml against 4,13±0,12 pg/ml, P<0,001), and anti-inflammatory ones IL -4 (1,74±0,08 pg/ml against 0,81±0,09pg/ml, P<0,001) and IL-10 (11,64±0,31 pg/ml against 6,70±0,13 pg/ml, P<0,001). The persons, who received ribonucleic acid medication comparing with ones, who did not receive it, demonstrated the increase of IL-2 (2,83±0,11 pg/ml against 2,28±0,11 pg/ml, P<0,001) and INF-γ (11,29±0,25 pg/ml against 9,98±0,26pg/ml, P<0,001), instead of it TNF-α decreased (2,25±0,08 pg/ml against 2,50±0,09 pg/ml, P<0,05). After 3-d month of treatment IL-10 (7,73±0,22 pg/ml against 9,83±0,30 pg/ml, P<0,001), TNF-α (2,23±0,10 pg/ml against 2,53±0,09 pg/ml, P<0,05)levels decreased, and INF-γ increased (10,37±0,11 pg/ml against 9,86±0,20 pg/ml, P<0,05). In the group of patients, who did not receive medication the relapse of toxoplasmatic encephalitis appeared in two cases.Conclusion. It was established, that HIV-infected persons, with Toxoplasma gondii infestation, who took ART but with insufficient immunoreconstruction, demonstrated the increased levels of several proinflammatory (TNF-α, INF-γ) and anti-inflammatory (IL-4, IL-10) cytokines. After the treatment using ribonucleic acid medication the levels of СD4 + Т-lymphocytes, IL-2 and INF-γ increased and IL-10 decreased that eliminated the risk of toxoplasmatic encephalitis developmentВстановлено, що у ВІЛ-інфікованих осіб із токсоплазмовою інвазією були підвищеними рівні цитокінів: TNF-α, INF-γ, ІЛ-4, ІЛ-10. Після застосування препарату рибонуклеїнової кислоти впродовж 1місяця спостерігалося зростання рівнів ІЛ-2 та INF-γ, натомість, знижувався TNF-α. Після 3-го місяця лікування знизилися рівні ІЛ-10 та TNF-α, зросла кількість CD4+Т-лімфоцитів та усувався ризик токсоплазмозного енцефаліт
Варіабельність артеріального тиску в гострому періоді мозкового інсульту – сучасний погляд на проблему
Get PDFThe question of prospects of using the data of variability of arterial pressure as a base of predictor of development, course and consequences of brain stroke is considered on the base of studied literature.Methods of research: E-data base Medline and PubMed was used for thorough searching for literature on studied questions.Results. The results of scientific literature analysis testify to the connection between variability of arterial pressure and hypertrophy of left ventricle, endothelial dysfunction, development of new cases of auricles fibrillation. According to AP day monitoring, the direct positive connection between the mass index of myocardium of left ventricle and SAP and DAP variability was found. It is indicated, that SAP variability in childhood is a predicator of arterial hypertension development in adulthood. It is shown, that VAP growth can be a predicator of both first and secondary stroke. There are also the data about independent prognostic value of 24-hour variability of arterial pressure as to cardio-vascular events. The duration of study of 24-hour variability of arterial pressure and the number of publications on this question is underlined and insufficiency of information about long-term variability of arterial pressure is noted. It is accented, that in modern assessment of clinical importance of different parameters of arterial pressure variability the change of priority from 2-hour to long-term monitoring of arterial pressure “from visit to visit” is observed.The urgent need in elaboration of accessible methods of assessment of long-term variability of arterial pressure (VAP) that would supply the doctors-practicians with additional information as to the stroke risk and possible consequences is felt.Conclusions. Long-term variability of arterial pressure can be considered as a predictor of stroke development and as independent factor of influence on consequences of undergone brain stroke. It is shown, that the problem of arterial pressure variability is polyhedral and needs further deep studyМетою дослідження було опрацювання даних сучасних літературних джерел щодо можливості використання даних варіабельності артеріального тиску в якості предиктора розвитку, перебігу та наслідків мозкового інсульту. Підкреслюється важливе значення варіабельності артеріального тиску як фактору ризику інсультів та їх наслідків. Наголошується, що в сучасній оцінці клінічної значущості різних параметрів варіабельності артеріального тиску спостерігається зміна пріоритету від 24-годинного до довгострокового моніторування артеріального тиску «від візиту до візиту
Озонотерапія аденоміозу у безплідних жінок з гіпотиреозом
Get PDFAim of research – specification of hormonal-immunologic shifts and increase of the effectiveness of sterility treatment in patients with adenomyosis and hypothyroidism.Materials and methods. There were examined 90 women with the primary sterility, who participated in the program of auxiliary reproductive technologies (ART) – extracorporal fertilization ART, among them 60 with adenomyosis and hypothyroidism (main group), the control group included 30 patients without thyroid pathologies without gynecological diseases. The main group was divided in 2 clinical groups: 30 patients, who underwent the traditional treatment and 30 whom the ozone therapy was additionally prescribed to. The methods of ultrasound examination, MRT, determination of the hormonal and immunologic status, cytokines state before and after the treatment were used.Results. At adenomyosis at the background of hypothyroidism were determined the changes of hypophysis and ovary function that may be caused by the increase of thyrotropic hormone (TTG), follicles stimulating hormone (FSH), luteinizing hormone (LH) and prolactin secretion. Adenomyosis, associated with hypothyroidism disturbs the cellular and humoral immunity, favors shifts in the cytokine link of immunity. At the further observation over patients of the main group, the ART extracorporal fertilization program demonstrated its more effectiveness in sterility treatment by the ozone therapy (26,7 %), comparing with the traditional treatment (16,6 %).Conclusions. The use of ozone therapy favors normalization of hormonal and immune parameters in women with adenomyosis and thyroid pathology, resulting in the increase of auxiliary reproductive technologies (ARD) effectivenessМета дослідження – уточнення гормонально-імунологічних зсувів і підвищення ефективності лікування безпліддя у хворих на аденоміоз та гіпотиреоз. Застосування озонотерапії в комплексному лікуванні безпліддя у жінок з аденоміозом та гіпотіреозом сприяє нормалізації ендокринної функції гіпофіза та яєчніків, активізації клітинного імунітету, відновленню цитокінового статусу, підвищенню ефективності допоміжних репродуктивних технологі
Особенности распространенности и течения негоспитальной пневмонии
Get PDFAim. To reveal gender-age features, season prevalence, specificity of prevalence and course of severe community acquired pneumonia to raise the effectiveness of the course prognostication, improvement of the diagnostics of patients with community acquired pneumonia of severe course by optimization of the assessment of the clinical-functional state of patients.Materials and methods. For attaining the set aim there were examined 88 patients with the diagnosis “severe community acquired pneumonia”, who underwent the treatment at 3 clinical departments of Dnipro city: MI “Dniprovetrovsk municipal clinical hospital № 2, DRC”, MI “Dniprovetrovsk municipal clinical hospital № 6,DRC” MI “Dniprovetrovsk municipal clinical hospital № 16, DRC” that are the clinical bases of SI “Dnipropetrovsk medical academy, MHP of Ukraine”. Patients were divided in 2 groups depending on the clinical group of pneumonia and also on gender sign. All patients underwent the assessment of the clinical-functional status, careful collection of the anamnesis, clinical-laboratory examinations.Results. In the result of research were received reliable data about differences of features of season prevalence of morbidity, dependence of disease course severity on age and sex, risk factors of severe course of community acquired pneumonia were formed.Conclusions. Severe community acquired pneumonia has its season prevalence that differs from the known epidemic periods. SCAP is more hard in men, especially of elder age group that led to the more frequent necessity of hospitalization of such patients in ICВ статье показаны результаты исследований по поводу выявления гендерно-возрастных особенностей, распространенности, сезонности и течения тяжелой негоспитальной пневмонии. Основной точкой приложения полученной информации должно стать повышение эффективности прогнозирования течения заболевания, улучшение диагностики больных на негоспитальную пневмонию тяжелого течения путем оптимизации оценки клинико-функционального состояния больных. Опубликованные данные были получены исходя из данных проспективного анализа за год динамического наблюдения за пациентам
Определение возможности развития угрожающего состояния у пациентов с диабетическим кетоацидозом
Get PDFThe aim of the research was to create a mathematical model for determining a possibility of the threatening condition development in patients with diabetic ketoacidosis using methods of mathematical statistics.Methods. There were examined 43 patients with diabetes mellitus decompensation, who underwent intensive therapy by the offered method. Patients were divided in two groups depending on the presence of the threatening condition: group 1 – patients without hepato-intestinal dysfunction (12 persons); group 2 –patients with hepato-intestinal dysfunction (31 persons). All indicators were registered at admission to the department of intensive care at first, third and fifth day after the treatment. The method of logistic regression was used for constructing the mathematical model.Results. There were revealed 5 most important indicators for determining the threatening condition, used as prognostic factors for estimating the complications probability. The model for assessing the data, used for ROC-analysis, was constructed.Conclusions. The elaborated mathematical model of the possibility of the threatening condition development in patients with DKA allows to diagnose not only dangerous tendencies in real time, but also to use medical strategies for preventing and restoring hepato-intestinal and multiple organ dysfunction in these patientsИсследование посвящено определению возможности развития угрожающего состояния у больных с диабетическим кетоацидозом. Разработана математическая модель прогнозирования риска развития гепато-интестинальной дисфункции/недостаточности. Полученные результаты математического моделирования могут быть использованы для углублённого понимания наиболее значимых патологических процессов у больных с диабетическим кетоацидозом, что позволит на более ранних сроках начинать их профилактику и лечени
Анализ осложнений, возникших в периоперационном периоде, при использовании различных режимов инфузионной терапии
Get PDFAim: To realize the clinical analysis of post-surgical complications in patients, who received intraoperative infuse therapy by the method of the restrictive mode of fluid resuscitation and purposeful fluid therapy for providing the adequate and stable hemodynamics in perioperative period and also for preventing the complications development.Materials and methods: the study was realized in 176 patients, who underwent surgical interventions in orthopedic oncology. The restrictive mode of fluid resuscitation was applied in 88 cases, and in 88 ones – the purposeful fluid therapy. The central hemodynamics was studied by the method of Cubichek tetrapolar rheography, coagulogram indications, dieresis speed, blood serum creatinine, frequency of postoperative nausea and vomit and enteroparesis were studied.Research results: the frequency of coagulopathy observations at purposeful fluid therapy didn’t reliably exceed the frequency of coagulopathy in patients with the restrictive mode. Patients, who underwent purposeful fluid therapy demonstrated the decrease of dieresis speed, postoperative nausea and vomit and enteroparesis reliably more seldom. At providing purposeful fluid therapy, there was observed the more stable hemodynamics, whereas patients with the restrictive mode of resuscitation reliably more often needed for the additional hemodynamic correction, which needed the use of vasopressors in 67 % of cases and unplanned increase of infusion therapy volume in 36 % of cases.Conclusions: the risk of complications of GIT and kidneys decreases at using purposeful fluid therapy, and the more stable postoperative hemodynamics comparing with the restrictive mode is guaranteedВ статье проведен сравнительный анализ частоты неблагоприятных событий, которые могли быть обусловлены использованием режимов интраоперационной инфузионной терапии, у 176 пациентов, перенесших хирургические вмешательства в онкоортопедии. Было выявлено, что при применении целенаправленной инфузионной терапии уменьшается риск возникновения осложнений со стороны ЖКТ и почек и обеспечивается более стабильная послеоперационная гемодинамика по сравнению с рестриктивным режимо
Характеристика факторів, що обтяжують клінічний перебіг та порушують якість життя хворих з поєднаною патологією бронхіальної астми та хронічного обструктивного захворювання легень
Get PDFThe article studies factors that complicate the clinical course and disturb the life quality of patients with the chronic bronchial-obstructive pathology. Aim. To study factors that complicate the clinical course and disturb the life quality of patients with ACC for their rational modification.Materials and methods. All patients underwent: collection of anamnesis and general clinical examination, evaluation of the function of external respiration, clinical symptoms and risks.Results. At this work there were found factors that complicate the clinical course and life quality of patients with combined bronchial-obstructive pathology, especially clinical ones, such as expressed short breath, decrease of tolerance to physical loads and functional parameters of the external respiration. Conclusions of this work correspond to introduced recommendations as to the treatment of patients with ACC: effective anti-inflammatory and broncholytic therapy with the special accent on timely detection and adequate treatment of a concomitant pathologyВ статті досліджено фактори, що обтяжують клінічний перебіг та порушують якість життя хворих на хронічну бронхообструктивну патологію. Практичні висновки даної роботи відповідають впровадженим рекомендаціям щодо лікування хворих на сполучену бронхообструктивну патологію: це ефективна протизапальна та бронхолітична терапія з особливим акцентом на своєчасне виявлення та адекватне лікування супутньої патологі