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Особливості стану мікроциркуляторного русла у хворих з наслідками черепно-мозкової травми
Get PDFThe aim of the given research was to analyze peculiarities of microvasculature condition in patients with traumatic brain injury (TBI) consequences and to determine its influence on traumatic brain disease course.Methods. The assessment of the microvasculature structural characteristics (total capillary length; the arterial and venous links length, caliber, tortuosity factor and tone; perivascular edema value) was carried out in 103 patients with TBI consequences using capillaroscopy method with Angio Pro software. Neurological status was evaluated by Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI), cognitive condition – by Montreal Cognitive Assessment (MoCA), level of anxiety and depression – by HADS scale. The percentage of peripheral blood leukocytes in the apoptosis (АnV+) and necrosis (РІ+) stages, as well as reactive oxygen species (ROS+) level were studied using flow cytometry method.Results. Increased tortuosity coefficient of arterioles and venules, increased arteriolar tone, and a tendency for venules lumen to expand with formation of venous stasis phenomena and moderately pronounced signs of perivascular edema were diagnosed in patients with different severity of TBI consequences. The relationship between morphological and clinical parameters intensified in older age groups. Thus, in adult patients the cognitive functioning level (by MoCA test) depended on the capillary total length (r=0,416, р=0,002), and tortuosity coefficient of arterioles was higher under conditions of progressing disease (r=0,301, р=0,027) and several syndromes combination in the clinical picture (r=0,317, р=0,019).Conclusion. Stagnant microcirculation type with moderate perivascular edema signs formation is inherent in patients with TBI consequences. ROS+ concentration increasing adversely affected the capillary length and contributed to perivascular edema growth. The share of leukocytes in necrosis and apoptosis stages correlated moderately with tortuosity coefficient of arterioles and venulesУ 103 хворих з наслідками черепно-мозкової травми (ЧМТ) методом капіляроскопії з програмним забезпеченням Angio Pro проведено оцінку структурних характеристик мікроциркуляторного русла. Встановлено, що для хворих з наслідками ЧМТ притаманний застійний тип мікроциркуляції з формуванням ознак помірного периваскулярного набряку. Підвищення концентрації активних форм кисню негативно впливало на довжину капіляра та сприяло зростанню периваскулярного набряку. Частка лейкоцитів в стадії некрозу та апоптозу помірно корелювала з коефіцієнтом звивистості артеріол та вену
Порівняльна ефективність методів лікування уповільнення моторики шлунку у хворих на цукровий діабет 1-го типу
Get PDFActuality. Deceleration of the gastric motor-evacuative function (M-EF) in patients with diabetes mellitus (DM) must be considered as an initial manifestation of gastroparesis that worsens the life quality of persons of able-bodied age and favors the labile course of the main disease. For today the questions of individualized approach to the use of symptomatic therapy are not finally solved and the treatment algorithm of correction of diabetic gastroparesis (GP) symptoms is not elaborated.Aim of research – to compare the effectiveness of acupuncture sessions with preparation of symptomatic therapy that has prokinetic properties in complex treatment of DG.Materials and methods: there were examined 66 patients with DM type 1, stratified in: the first group (n=23) patients, who underwent 30 sessions of acupuncture during three months according to the set instruction of points, in addition to the treatment complex, and the second group (n=23) – three-month course of prokinetis itopride was added in day dose 150,0 mg, while patients of the control group (n=20)received the standard treatment complex without preparations of symptomatic therapy for normalization of gastric M-EF. All examined in dynamics underwent determination of the severity degree of DG clinical course using three-minute questioning of patients «Gastroparesis Cardinal Symptom Index» (GCSI), and also 13С-octane respiratory test (13С-ORT), assessment of carbohydrate metabolism – by parameters of glycemic control (prandial and postprandial glycemia, glycated hemoglobin).Results. In 69,7 % of patients with DM type 1 the manifestations of symptoms of gastric motility deceleration were diagnosed and proved by the conclusion of 13С-ORT. In 21,7 % (10 persons) of patients of the first group was revealed deceleration of time of half-evacuation of the gastric content into duodenum of the light degree and in 28,3 % (13 patients) – of the middle severity, whereas in examined of the second group bradigastria of the light degree is present in у 26,1 % (12 patients), of the middle degree – in 23,9 % (11 patients). According to the results of additional observations the direct moderate correlation was revealed between the sum of points of GSCI questioning data and 13С-ORT results (r=0,45, p<0,05), and also the strong direct connection (r=0,76; p<0,05) between the state of compensation of carbohydrate metabolism (НbA1C, %) and degree of deceleration of gastric motility by indices of 13С-ORT. The change data testify to the pathogenetically grounded connections between the state of carbohydrate metabolism compensation and gastric functional properties.Conclusions. There was established the reliably better dynamics of carbohydrate metabolism indices after three-month treatment course in patients of the first group: glycated hemoglobin decreased by (∆(–26,28) %), and correspondingly the levels of prandial (∆(–10,75) %) and postprandial (∆(–23,30) %) glycemias and improvement (∆(–14,63) %) of gastric M-EF was observed, whereas at using prokinetic itopride 150 mg/day during three months this effect is less reliably expressed: glycated hemoglobin decreased by ∆(–21,34) %, glycemia on an empty stomach by ∆(–16,85) %, postprandial glycemia by ∆(–13,36) %, and gastric motility dynamics is less expressed (∆(–6,49) %). So, acupuncture must be considered as the more effective treatment method at deceleration of gastric motility in patients with diabetes mellitus type 1Дослідження виконано для визначення ефективності сеансів акупунктури у порівнянні із прокінетиком у 46 хворих на діабетичний ґастропарез. Протягом трьох місяців основній ґрупі (n=23) обстежених щомісячно проведено по 10 сеансів акупунктури, а ґрупі порівняння (n=23) використано 150 мг/добу ітоприду. Встановлено, що більш ефективним методом симптоматичної терапії слід вважати акупунктур
Аналіз особливостей організації медико-психологічної допомоги для пацієнтів онкологічного профілю
Get PDFThe ideas and internal setting of patients about psychological help mainly provide the parameters and specificity of organization and realization of medical-psychological help.Aim of research – to define the features of organization of medical-psychological help for cancer patients on the base of study of their needs and settings as to psychological influences.Contingent and methods of research. The interrogation of 245 cancer patients (134 women and 111 men) about the need for medical psychological help was realized on the base of Kyiv city clinical oncological center during 2012–2015 using the specially elaborated questionnaire. In the process of analysis of the received data patients were divided in 3 groups, depending on the stage of treating process: group 1 (G1, n=80) included patients at the diagnostic stage, group 2 (G2, n=86) – primary patients, 3 group (G3, n=99) – patients at the repeated visits as a result of relapse or continuation of disease.Results. In cancer patients at the different stages of treating process and with different stages of the course of pathology took place the psychological features that caused the differentiation of clinical tasks and forms of medical-psychological help. The important factor was the accessibility of psychological help: information for patients about the presence of specialist on psychic health, the schedule of psychological arrangements, the presence of psycho-educative materials directly in departments. Taking into account the fact that the people, who surround patient and closely communicate with him/her, also undergo the high distress level, there was the practical necessity for elaboration of medical-psychological arrangements for the relatives and friends of patients, for the medical staff. The involvement of patients into participation in psychological arrangements can be raised by the modeling of motivational factors. Conclusion. Medical-psychological activity in oncological medical institution must be the complex one, connected with the tasks of clinical practice, must help to renew the psychic health of patients, to form in them the adaptive attitude and effective strategy of behavior as to antitumor treatmentУстановки та потреби онкологічних пацієнтів на різних етапах лікування відрізнялися, що відображалося на пріоритетності вибору форм, тривалості та інтенсивності медико-психологічних заходів. На звернення за психологічною допомогою впливав ряд мотивуючих та демотивуючих факторів, відповідно їх моделювання дозволило збільшувати кількість пацієнтів залучених до психологічних заходів. Медико-психологічна допомога має бути комплексною та диференційовано
Обгрунтування загальних та диференційованих підходів до комплексної лікувально-реабілітаційної допомоги співзалежній родині хворих на алкогольну залежність чоловіків
Get PDFAim – The grounding of general and differentiated approaches to the complex treatment-rehabilitation help to co-dependent family of men with alcoholic addiction (AA).Contingent. 160 men with AA and their wives and also 50 married couples, women, whose husbands had not alcoholic problems.Methods. Clinical-psychopathological and psychodiagnostic using the battery of AUDIT-like tests, elaborated by the composite authors under the guidance of I.V. Linsky and also the scales of anxiety and depression of M. Hamilton HDRS and HARS, the scale of assessment of psychosocial stress level of L. Reader and the methodology of determination of stress-resistance and social adaptation of Holms and Rahe. Psychosocial features of functioning of women were studied by psychodiagnostic method using the methodology of “Determination of subjective control level” of J. Rotter (in adaptation of E. F. Bagin) and questionnaire “The methods of overcoming behavior” of S. Folkman, R. Lazarus (in adaptation of L. I. Vasserman, E. A. Trifonova); the features of family functioning, inherent to examined persons, were established using methodology of “Analysis of family anxiety” of E. Eidemiller, B. Yustitskis and the scale of structural interview for identification of family type of V. A. Abramov and co-authors.Results. The aim of complex treatment-rehabilitation help for co-dependent family is an activation of the resource adaptive possibilities of the family and formation of the ability in men in women to solve the private and family problems (of alcoholic and non-alcoholic genesis) independently.The main directions, additional foundations, principles and conditions of realization of the complex treatment-rehabilitation help to co-dependent family were determined. The algorithm of its use was created.Psychotherapeutic component of treatment-rehabilitation process was characterized. It was accented, that psychotherapeutic work with co-dependent wives of patients with AA must have more differentiated character and be individualized, depending, first of all, on the clinical variant of women’s existent maladjustment and the type of family maladjustment co-dependence (FMC). The given parameters become the main criteria of differentiation of psychotherapeutic influences at determination of the content filling of psychotherapeutic interventions and also “sensitivity” to the different psychotherapeutic techniques.Conclusions. The positive result of introduction of this system becomes possible not only at the expense of using the treatment-rehabilitation influences but also in connection with positive changes of social and family relations of women (acceptance of social environment (context), where she lives and functions)Hа базі Київської міської наркологічної клінічної лікарні «Соціотерапія» протягом 2012–2015 рр. було обстежено 160 чоловіків, хворих на алкогольну залежність (АЗ), та їх дружин, а також 50 подружжів, чоловіки в яких не мали алкогольних проблем. На основі виділення клінічних варіантів дезадаптації дружин алкогользалежних чоловіків та типів родинної дезадаптивної співзалежності, обґрунтовані загальні та диференційовані підходи до комплексної лікувально-реабілітаційної допомоги співзалежній родин
Перспективи використання коренів зубів при зубному протезуванні зі зруйнованою біфуркацією
Get PDFAim of research: to elaborate the gentle way of orthopedic treatment of teeth at complete destruction of their crown fragment and destroyed bifurcation.Material and methods. We examined and admitted for treatment 37 patients with complete destruction of tooth crown fragment and destroyed bifurcation of low molar teeth (from 24 to 56 years; mean age was 44±4,38 years). At the treatment of patients the “Method of compensation of tooth crown defect at destructed bifurcation”, elaborated by us, was used. Electrofulguration destruction of pathologically changed tissues of periodont on the fragment of bifurcation was carried out using electrosurgical device – “Electric fulgator SVAROG”. After that the prosthesis was realized.Results demonstrated that the elaborated method of compensation of tooth crown defect at destroyed bifurcation with disjunction of roots and removal of damaged tissues on the fragment of bifurcation allows avoid its extraction and provide the integrity of dental range.Conclusion. The usage of offered gentle method of teeth roots preservation at dental prosthesis allows remain them and use as support for different constructions of dental prosthetic appliances Метою роботи було на підставі проведених досліджень розробити щадний спосіб ортопедичного лікування зубів з повним руйнуванням коронкової їх частини та зруйнованою біфуркацією. Результати, отримані внаслідок проведеного лікування з використанням електрохірургічного методу за запропонованим нами способом, показали можливість збереження коренів зубів з використанням їх в якості опори різних конструкцій зубних протезі
Джерела адикції та види «соціально-прийнятних» форм адиктивної поведінки у жінок з порушенням здоров’я сім’ї
Get PDFAim – determination of the sources of addiction and study of AB in women with disorders of family interaction for revelation of targets of the further psychocorrectional work with this contingent of married couples.Contingent - 321 married couple (MC), who asked for help because of disorder of family relations and “socially accepted” addictive behavior in women (studied group, SG). As the groups of comparison were also studied 50 MC with disorder of family health, in which women had not problems of addictive type (group of comparison 1, GC 1) and 50 conventionally harmonic MC (group of comparison 2, GC 2).Methods. Clinical-diagnostic and psychodiagnostic with use of АUDIT T. Baboor test, battery of АUDIT-like tests (composite authors under the supervision of I.V. Linsky) and the author methodology for revelation of disorders, connected with passion for sports (fitness) for amateurs of SPORT-UDIT.Results. There were separated three types of “socially accepted” addictive behavior, inherent to women with disorders of family relations that have akin pathogenetic mechanisms: behavior one (excessive passion for work, shopping, watching TV, internet, reading, computer games or games of chance; the main sources – shopping, work– 34,6 %; chemical one (intake of alcohol, tobacco, sedative-hypnotic preparations; the main source – tobacco)– 33,3 %; physiological one (excessive passion for food, sex, fitness, tea/coffee)– 32,1 %. These types of addictive behavior can be both isolated and combined with each other, creating in such a case the effect of mutual induction of adductive potential of person that has a negative influence on the family health status by the principle of vicious circle.Conclusions. The established clinical and pathogenetic features of addictive behavior formed the base at elaboration of the system of psychological correction and psychoprophylactic support of family health at dependent behavior in womenНа основі клініко-психологічного і психодіагностичного обстеження 421 подружньої пари, серед яких у 321 подружньої пари діагностовані порушення сімейних стосунків та адиктивна поведінка у жінок, визначені джерела адикції та види «соціально-прийнятних» форм адиктивної поведінки, притаманні даному контингенту. Описані патогенетичні взаємозв’язки між адиктивними проявами й порушенням здоров’я сім’ї. Отримані результати лягли в основу розробки системи психологічної корекції та психопрофілактичної підтримки здоров’я сім’ї за наявності адиктивної поведінки у жіно
Ефективність застосування назубних шин з антисептичним покриттям при переломах нижньої щелепи
Get PDFPurpose of the study: the purpose of our study is an increase of efficiency of jaws fractures treatment by elaboration of the new method and new means of prevention of creation and adhesion of dental scurf on splinting dental constructions.Materials and methods. For improvement of hygienic state of oral cavity we offer the methodology of covering teeth and splints with enamel coat with antiseptic preparation. The base of enamel coat is Ftorlak, prepared according to classic recipes. For providing antiseptic effect and preventing adhesion of bacterial scurf on dental surface and splinting constructions we used Decamethoxin that was injected in ftorlak at the rate 25 mg of dry mass for 100 ml (0,025% solution). In our research we carried out the deep study and analysis of indices of oral cavity hygiene in patients with mandibular fractures, not depending of localization of the fracture line.Results. At study of the data of Fedorov-Volodkina index in the group of comparison was observed the significant worsening of hygiene index during the whole period of observation. Thus, at the beginning of study (first day) index was 1,18±0,10; as at 7 day – 2,50±0,24; as at 28 day – 3,99±0,18. At the same time in the main group at the beginning of research the difference with group of comparison was insignificant– 1,22±0,09 (р1>0,05) In further we observed the insignificant worsening of index, but it was reliably better than in the group of comparison: as at 7 day – 1,69±0,21 (р2<0,05); as at 28 day – 1,78±0,09 (р3<0,05).Analyzed the results of study of Green–Vermillion index (simplified index of the oral cavity hygiene), we had at the beginning of research (first day) the unreliable difference between the group of comparison (0,30±0,09) and main one (0,29±0,09) (р1>0,05). At 7 day we had the reliably better result between the group of comparison (1,26±0,17) and the main one (0,50±0,11) (р2<0,05). As at 28 day was observed the reliably better result between the group of comparison (2,29±0,22) and the main group (0,83±0,21) (р3<0,05)РНР (index of hygiene efficiency) at the beginning of research (first day) had unreliable difference between the group of comparison (0,29±0,09) and the main one (0,30±0,09) (р1>0,05). At 7 day we had the reliably better result between the group of comparison (1,59±0,21) and the main group (0,69±0,09) (р2<0,05). As at 28 day was observed the reliably better result between the group of comparison (2,04±0,22) and the main one (1,12±0,18) (р3<0,05).Gingivitis index (Silness-Loe) at the beginning of study had unreliable difference between the group of comparison (0,31±0,08) and the main one (0,31±0,11) (р1>0,05). At 7 day we had the reliably better result between the group of comparison (1,40±0,20) and the main group,69±0,08) (р2<0,05). As at 28day was observed the reliably better result between the group of comparison (2,39±0,19) and the main one (0,89±0,12) (р3<0,05).Studied the PMA index we had at the beginning of research (first day) unreliable difference between the group of comparison (9,96±0,95) and the main group (10,07±0,92) (р1>0,05). At 7 day we observed the reliably better result between the group of comparison (35,20±1,05) and the main one (2,06±0,91) (р2<0,05). As at 28 day we had the significant reliably better difference between the group of comparison (64,96±2,25) and the main one (31,15±0,95) (р3<0,05).Conclusion. Carried out the detailed analysis of the methods of observation, we created an algorithm of diagnostic of the oral cavity state and the state of dental tissues at mandibular fractures. Using this algorithm we carried out the study of patients, who underwent the treatment according to the standard scheme and application of splints with antibacterial coat. Antibacterial enamel coat favors the decrease of adhesion of microbial scurf and dental plaque at the treatment of mandibular fractures that prevents the development of inflammatory processes in parodentiumМетою нашого дослідження стало підвищення ефективність лікування переломів щелеп, шляхом розробки нового методу та нових засобів запобігання утворення та адгезії зубних відкладень на шинуючих назубних конструкціях. Проведено клінічне дослідження ефективності використання назубних шин з антисептичним лаковим покриттям при лікуванні переломів нижньої щелепи . Отримані результати показують значну позитивну клінічну ефективність антисептичного лакового покриття в покращенню гігієни порожнини рота та профілактиці запальних процесів пародонт
Особистісні патерни у хворих з вугровою хворобою
Get PDFAcne it is an actual problem of the modern dermatology and psychodermatology. In patients of near 20 years old acne usually regresses, but in 10–20 % dermatosis becomes chronic.Aim of research – study of the personal features of patients with acne.Materials and methods. 142 patients with chronic acne took part in the research – main group (MG), 75 female persons and 67 male ones, and 70 interrogated without dermal or whatever chronic somatic pathology – the group of comparison (GC), 35 girls and 35 boys, respectively. Freiburg personal questionnaire of В (FPI-B) form was used as diagnostic instrument.Results. Patients with acne had more intense neurosality, depression, irritability, reactive aggression, shyness, emotional lability, introversion, in somatically healthy persons were observed communicativeness, equability, openness and extraversion, р<0,05. In the structure of manifestation of personal features among interrogated from MG the part of persons with low neurosality, depression, reactive aggression was less and the one with middle level of inclination to depressive reaction and reactive aggression, low openness, introversion was more, р<0,05. In patients with acne were separated several specific personal profiles: neurotic, introverted-depressive, aggressive-labile, sensitive, compensated ones.Conclusions. Thus, in patients with acne were revealed personal features that distinguished them from the persons without chronic dermal pathology. In patients with chronic course of acne was revealed the growth of neuroticism, psychic instability, raise of situational aggression, inclination to depressive reaction, introversion, decrease of communicativeness, raise of shyness. Destabilizing influence of personal features on the state of psychological and psychosocial adjustment indicated the necessity of elaboration of the complex program of medical-psychological helpВугрова хвороба – це актуальна проблема сучасної дерматології та психодерматології. У хворих з хронічним перебігом акне виявлено наростання невротизації, психічної нестабільності, підвищення ситуативної агресивності, схильність до депресивного відреагування, інтровертованості, зниження комунікабельності, підвищення сором’язливості. Дестабілізуючий вплив особистісних рис на стан психологічної та психосоціальної адаптації, вказував на необхідність розробки комплексної програми медико-психологічної допомог
Когнітивні порушення при психічних розладах у хворих на гiпертензивну енцефалопатiю: ефективність лікувально-реабілітаційних заходів
Get PDFAim – to determine the clinical-psychopathological risk factors of the early development of psychical disorders in patients with hypertensive encephalopathy.Methods: informational-analytical, clinical-anamnestic, clinical-neurological, psycho-diagnostic, statistical.Results. It was established, that psychic disorders in persons with hypertensive encephalopathy can be corrected not only by medicamental means, directed on normalization of arterial pressure, but it is also possible to add the cognitive training of patients to the rehabilitation process that gives the significant medical-social effect. Conclusions: The solution of problem is in the plane of interdisciplinary studies that are concentrated on the neurological-psychological status of patientsСтан психічного здоров’я пацієнтів із гіпертензивною енцефалопатією залежить від обраної стратегічної задачі лікувально-реабілітаційного процесу. При цьому великого значення у цьому процесі має статус когнітивної сфери, діагностування й реабілітація якої, як правило, лишається поза рамками традиційного лікування. Виявлення когнітивних проблем можливо через дослідження мовної комунікації людини, як достовірно прогностичну інформативну ознаку психічного стану пацієнт
Исследование новых биомаркеров воспаления у пациентов с ишемической болезнью сердца и сопутствующим сахарным диабетом 2 типа
Get PDFThe prevalence of coronary disease among adult population of Ukraine is 9 %. This parameter increases with age and is 5–7 % at the age of 45–64 years and 10–14 % at the age of 65–84 years. In 2011 52 mln of European people at the age of 20–79 years suffered from diabetes mellitus and, according to prognostications of Diabetes International Federation, this rate will increase till 2030 up to 64 mln. People with coronary disease and concomitant diabetes mellitus are more inclined to the proinflammatory changes and thrombus creation comparing with ones, who do not suffer from diabetes mellitus. At present it is known, that inflammation plays the important role in atherogenesis, including initiation, development of the vascular wall injury, atheroma instability and appearance of thrombotic complications.Atherosclerosis is considered as the long-term, torpid chronic inflammation in vascular intima. Such conception explains the connection between inflammation mediators and risk factors of atherosclerosis development. The changes of basal level of the new inflammation markers (Galectin-3, P-selectin) in patients with CD in combination with diabetes mellitus type 2 remains unstudied for today;The aim of research is the study of the role of new pathogenetic markers of inflammation in patients with coronary disease and concomitant diabetes mellitus, elaboration of the methods of their correction, elaboration of the new approaches to therapy using the received resultsМногочисленные клинические и экспериментальные данные свидетельствуют о ключевой роли воспаления в развитии атеросклеротического поражения и его осложнений. Сочетание ишемической болезни сердца и сахарного диабета 2 типа приводит к взаимотенцирующему эффекту в отношении увеличения смертности больных. Полагают, что новые маркеры воспаления могут быть предикторами развития ишемической болезни сердца у лиц с бессимптомным атеросклерозо