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CASPASE-DEPENDENT ACTIVATION OF CASCADE CYTOKINES IN YOUNG PATIENTS WITH AUTOIMMUNE THYROIDITIS IN COMBINATION WITH GASTROESOPHAGEAL REFLUX DISEASE
Get PDFThe aim of the study: to assess the role of caspase-1 and IL-18 in the implementation of the inflammatory response in young patients with autoimmune thyroiditis (AIT) associated with gastroesophageal reflux disease (GERD).
Materials and methods. The study was conducted in two groups of patients homogeneous by gender and age. The first group included 42 patients with an isolated AIT and the second group – 120 patients with a comorbid course of AIT and GERD. The contingent of the surveyed was students. Median age was from 18 to 25 years: 23.1±1.2 years in group with isolated AIT and 21.9±2.7 years in group with combined pathology. The activity of caspase-1 was determined using “Elabscience” kits, USA (China) by immunoassay method. The content of IL-18 was investigated using commercial kits “Bender MedSystems GmbH” (Austria) according to the proposed methods by immunoassay method. Statistical data processing was carried out using the local universal software package Statistica Basic Academic 13 for Windows En Local. Methods of non-parametric statistics were used: Kruskal-Wallis test, median test, Mann-Whitney test.
Results. It has been found that caspase-1 is activated in patients both in the isolated course of AIT and in its combination with GERD. At the same time, a significant increasing in the synthesis of IL-18 was established, which has pro-inflammatory and autoimmune effects. Re-examination after 2 months of caspase-1 and IL-18 in examined persons determined decreasing their levels, but control results were not achieved.
Conclusion. In young patients, the combination of GERD and AIT, as well as an isolated AIT is accompanied by an increasing the levels of caspase-1 and IL-18 in blood serum related to inflammatory process in the thyroid gland and esophageal mucosa with autoimmune component. These biomarkers may reflect the severity of clinical course of diseases and serve as prognostic indicator of outcome in case of comorbidity
STAGES OF BIOFILMS FORMATION BY THE LEADING PATHOGENS IN CHILDREN WITH PYELONEPHRITIS ON CONGENITAL HYDRONEPHROSIS BACKGROUND DEPENDING ON CHILD’S AGE
Get PDFThe aim: to study the stages of primary and secondary biofilms formation by the leading pathogens in children with pyelonephritis on congenital hydronephrosis background depending on child’s age.
Materials and methods. Venflons, catheters, urine were used as material for microbiological study. Identification of microorganisms was provided with MICRO-LA-TESTÒID kits. Isolates were tested for ability to form biofilms in Petri dishes with d=40 mm. The morphological structure of the biofilms was studied by scanning electron microscopy.
Results: The study of structural and functional features of biofilms formation by leading pathogens of in children with pyelonephritis on congenital hydronephrosis background depending on child’s age revealed a number of features and patterns. In addition to the classical stages of biofilms formation as 3D structure there was found a dissemination of planktonic cells with the release of bacteria or loss of single fragments that spread throughout the body and attach to the substrate with the formation of a new or secondary biofilm. In children under 3 years it was shown that the cocci attachment to the substrate appeared faster than in gram-negative rods and had appearance of separate structures. The longest stage of primary biofilms formation in young children was the co-aggregation. Detecting an ability to colonize with the formation of a secondary biofilm in isolates established that the longest stage was re-adsorption and the shortest was re-aggregation, which lasted 2 hours in all detected pathogens. In middle-aged children, the duration of adhesion stage was reduced by 1-2 hours compared with it in young children.
Conclusions. Scientific data about the stages of biofilms formation by microorganisms, causative agents of pyelonephritis in children was updated. Adhesion stage of isolates from elder children with pyelonephritis on background of congenital hydronephrosis underwent faster in the formation of secondary biofilms than in primary, and it formed the possibility for chronic process and the development of recurrences. The duration of each stage in biofilms formation by causative agents of pyelonephritis in children with congenital hydronephrosis depended on the age of the child and the properties of microorganism
Comparison of pathological changes in the study of dogs affected by parvoviral enteritis and intestinal yersiniosis
Get PDFAim of the study: to examine the pathological changes in dogs that died due to confirmed intestinal yersiniosis and parvoviral enteritis and establish trends for characteristic organ lesions for both diseases in comparison, then evaluate our findings with the existing published material of sufficient evidence quality regarding differential postmortem diagnosis of spontaneous intestinal yersiniosis and parvoviral enteritis in dogs.
Materials and methods: the study examined the cases of 25 dogs from 2 month to 1.3 y.o. of various breed, gender that died due to either confirmed Canine parvoviral enteritis (CPV) infection or intestinal yersiniosis and subsequently divided into two groups based on their diagnosis.
The definitive diagnosis has been confirmed by performing rapid ELISA diagnostics (SensPERT®, VetAll Laboratories, Kyunggi-Do, Korea) for CPV and serological tests for Y. enterocolitica sera AT were performed using yersiniosis antigens from the "Component set for serological diagnosis of animal yersiniosis" (Kharkiv, NSC IEKVM, TS 46.15.091-95) in accordance with the "Interim guidelines for the use of a set of components for serological diagnostics". A dilution of 1: 200 has been considered as the diagnostic titer.
After the definitive diagnosis had been confirmed, the animals were divided into two groups, depending on diagnosis: CPV (n=14) or IY (n=11). The autopsies of twenty randomly (10 from each group) selected dog corpses have been conducted utilizing standard methodology.
Results: according to the results of autopsy of dogs afflicted by CPV, the main pathological changes were found in the small intestine – catarrhal-desquamative inflammation (in 100 % of cases), serous-hemorrhagic mesenteric lymphadenitis (90 %) large intestine (70 %) in the stomach (60 %), in the liver (50 %), in other organs – less than 40 percent of cases and most notably caused lung damage (edema and local atelectasis) in 90 % of the animals in the study, which was not the case for intestinal yersiniosis with only 20 % incidence of lung damage.
Conclusions: Spontaneous intestinal yersiniosis in dogs was pathologically manifested by pronounced catarrhal-desquamative processes mainly in the stomach and small intestine (70, 100 and 80 % of cases, respectively), inflammation of the mesenteric lymph nodes (90 %) and large intestine (80 %), dystrophy and congestive processes in the liver (80 %). Low incidence and type of lung damage (congestive hyperemia in 20 % of reviewed cases compared to 90 % of local atelectasis add edema in CPV group) was noteworthy. Cases of 25 animals that died due to either confirmed CPV or Y. enterocolitica infection were analyzed, and 20 animal corpses were autopsied during study. Dogs that died from intestinal yersiniosis had significantly higher frequency of pathological findings in kidney (200 %) and liver (60 %) in particular. Changes in stomach and large intestine were also more frequent. At the same time, we observed a lower frequency of pathological changes in spleen (33 % lower), heart (25 % lower) and the lowest frequency was in lungs (77 % lower) presented by edema and local atelectasis in animals afflicted by yersiniosis compared to CPV. Incidence and manifestation of pathological findings was mesenteric lymph nodes and abdominal cavity were similar, and could not be considered during posthumous diagnostics
Effect of the complex physical therapy on the upper extremity function, functional independence and cognition in post-stroke patients
Get PDFMotor dysfunction and cognitive impairment (CI) are the most prevalent and disabling among the stroke consequences. CI decreases the effectivity of motor rehabilitation, but motor dysfunction itself may also influence the manifestations and progression of CI. So development and study of novel physical therapy tactics, which are aiming to target both of these syndromes, becomes a subject of great interest nowadays.
The aim of study was to evaluate the impact of different physical therapy approaches on the upper extremity function, cognition and functional independence in patients in 1 year after ischemic stroke.
Materials and methods. Totally there were 72 patients examined in the 1-year period after first-ever anterior circulation ischemic stroke. Neurological status, upper extremity function and functional independence were assessed with the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment (FMA), modified Rankin Scale (mRS) and the Functional Independence Measurement (FIM). Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Trail-making Test A and B tests (TMT). Patients in Group 1 received secondary stroke prevention therapy and performed the exercises complex for general muscle function improvement for 2 months; patients in Group 2 also performed the exercise complex for paretic hand function improvement for 2 months.
Results. After 2 months of physical therapy a significant increase of the FIM “Self-care”, “Transfer” and therefore subtotal motor and total scores was observed in patients in Group 2; in Group 1 significant improvement was observed only in “Transfer” and subtotal motor scores. Adding of the hand exercise to the physical therapy complex (Group 2) appeared to be more beneficial for the upper extremity motor function. Patients in Group 2 after 2 months showed increase of the FMA “Wrist” score by 40 % (p<0.05), “Hand” score by 42.8 % (p<0.01) and “Total motor function” by 30.1 % (p<0.05), and the “Total motor function” score in Group 2 was 10.9 % higher in comparison with the Group 1 (p<0.05). In cognitive status significant differences compared to baseline level were observed only in Group 2; MoCA score increased by 14.3 % (p<0.05) and TMT-B performance time decreased by 14.8 % (p<0.05). Baseline MoCA score correlated with FMA “Wrist” (r=0.32; p=0.028), “Hand” (r=0.49; p=0.001) and “Total motor function” (r=0.46; p=0.004) scores. TMT-B score showed significant correlation with the FMA “Wrist” (r=-0.032; p=0.025), “Hand” (-0.45; p=0.009), “Speed/coordination” (r=-0.023; p=0.036) and “Total motor function” (r=-0.42; p=0.023).
Conclusion. Adding of exercise for hand function improvement into the physical therapy complex for post-stroke patients contributes to better upper extremity motor performance and therefore is more favourable for patients’ functional independence. Upper extremity motor impairment, especially hand and wrist dysfunction, are associated with worse cognitive performance. Hand function and fine motor skills improvement could be beneficial for the patients’ cognition. Further research is needed in regard to the prognostic significance of these findings and their impact on the treatment and rehabilitation strategies
Analysis of the hospitalization time impact on hospital mortality from acute myocardial infarction
Get PDFDiseases of the circulatory system and their most severe form – acute myocardial infarction (AMI) – is one of the most important problems of modern medicine due to the steady increase in morbidity, negative impact on quality of life, early disability of patients. 19.5 % of patients die from AMI, 50 % among which die 90-120 minutes after the first symptoms of the disease.
The aim of the research was to analyse the impact of hospitalization on the mortality of patients with AMI and predict the risk of death in case of untimely hospitalization of this category of patients.
Materials and methods. We have conducted a retrospective analysis of 876 medical records of patients diagnosed with AMI who were treated in the cardiology department of Kharkiv Regional Clinical Hospital in 2019. During the study, we have used retrospective, logical, medical and statistical methods. Odds ratios and a 95 % confidence interval were also calculated.
Results and discussion. The research revealed the impact of hospitalization on the organization of medical care and hospital mortality of patients with AMI. It was found that the largest share of patients with AMI, both among the dead and those who left the hospital, were hospitalized in the period from 2 to 12 hours from the onset of the disease (49.6 % and 52.33 %, respectively), as well as in period after 24 hours – 28.00 % and 21.70 %, respectively. The largest share of patients with AMI, regardless of the time of hospitalization were persons older than 60 years. The results of the analysis showed that in the period up to 2 h from the onset of the disease, the share of hospitalized patients with more severe heart muscle damage (presence of Q wave) was 91.35 % against 8.65 % of patients with AMI without ST segment elevation. It should be noted that in almost 50 % of cases, patients with AMI without ST segment elevation were hospitalized after 24 h from the onset of the disease. At the same time, the largest share of deaths in this group of patients was observed in the hospital stay from 12 to 24 hours. According to the results of the research, risk factors for fatal outcome in AMI were identified, in particular male gender, the presence of an established ECG diagnosis of NSTEMI, conducting SKA in patients with AMI. It was also found that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %.
Conclusions. The obtained data indicate a strong relationship between the time of hospitalization and the organization of medical care and hospital mortality of patients with AMI. It is reliably established that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %: HS is 0.483 (95 % CI 0.238 – 0.981), p=0.175
Immune response and phagocytosis of children with streptococcal tonsillitis and infected with the herpes virus type 6.
Get PDFThe aim of the work is to study the indicators of cellular and humoral immune response and FAN of patients with tonsillitis in children infected with HHV-6 type.
Materials and methods of research. In 72 children aged 3–15 years (mean age 8.42±1.44 years), patients with streptococcal tonsillitis of moderate severity, the levels of the main subpopulations of blood lymphocytes were determined using monoclonal antibodies by solid-phase enzyme-linked immunosorbent assay, phagocytic activity of neutrophils (FAN) using the nitrosine tetrazolium reduction test (HCT test) and serum IgA, IgM, IgG levels by radial immunodiffusion. The studies were carried out in the acute period and in the period of convalescence. Mathematical and statistical processing of the data obtained was carried out using Microsoft Excel 2003 and Statistica 6.0 programs. The significance of differences between the mean values was determined using the Student's test (t).
Results. Different mechanisms of formation of pathological process at streptococcal tonsillitis at children depending on the concomitant HHV-6 type infection are revealed. In patients with mixed infection in the acute period of tonsillitis determine the signs of deficiency of the cellular immune system with the maximum deviation of CD-lymphocytes (t=3.13 vs. t=2.16 in mono-infection), the tension in the humoral link of the immune response Ig deviation (t=1.63 against t=0.91 in mono-infection) on the background of phagocytosis violation in terms of FAN deviation (t=3.22 against t=2.01 in mono-infection). By the period of convalescence, the restoration of the imbalance of specific and non-specific protection factors does not occur. Increased IgG content in the acute period is one of the features of streptococcal tonsillitis in children on the background of HHV-6t infection.
Conclusions. Concomitant VGL-6 type infection in children with streptococcal tonsillitis affects the mechanisms of formation of the inflammatory process and the reactivity of patients, forming the preconditions for adverse outcomes of the disease. The obtained results can be the basis for early detection of herpes virus infection in patients with tonsillitis, will help to optimize the management of patients in different periods of the disease
Synchronous multiple primary malignant neoplasms: a case report of malignant peritoneal mesothelioma and neuroendocrine rectal tumor
Get PDFWe report a rare case of synchronous malignant peritoneal mesothelioma of the biphasic histological type and neuroendocrine tumor (NET) of the rectum without history of asbestos exposure.
During 2 years since manifestation of the disease the patient underwent 3 cytoreductive surgeries (CRS): removal of the tumor of the sigmoid mesentery, resection of the rectosigmoid junction completeness of cytoreduction (CC) 0 (2017), omentectomy and partial parietal peritonectomy CC-0 (2017), atypical resection of S2, S4, S5 liver, the removal of the abdominal tumor with left-sided en-block hemicolectomy, partial parietal peritonectomy, argon-plasma coagulation of tumor foci on the mesentery of the small intestine CC-2 (2018) and Transanal Minimally Invasive Surgery-removal of neuroendocrine rectal tumor (2017). The patient underwent hyperthermic intraperitoneal chemotherapy (HIPEC) twice (during 2nd and 3rd CRS). Different regimens of HIPEC were performed: cisplatin + doxorubicin (2017) and metamycin C (2018). The patient received 4 courses of adjuvant chemotherapy with cisplatin plus pemetrexed in 2017 and 3 courses of the chemotherapy with gemcitabine and carboplatin plus bevacizumab in 2018.
The patient survived 21 months after the detection of malignant peritoneal mesothelioma in 2017 and died 4 months after the last cytoreductive surgery from the progression of the disease.
Histological subtype of MPMP remains important factor in the prognosis of the disease even on the early stages though patient had received the most aggressive variant of special treatment. Minimally invasive treatment tactics of NET demonstrated clinical effectiveness.
 
Stage interventions in the treatment of patients with malignant diseases of the common bile duct terminal segment complicated by acute mechanical jaundice
Get PDFObstructive mechanical jaundice is a well-researched complication of various diseases and causes, yet considering patients` condition with malignant diseases according to the stage of the malignant process, severity of complications and etc. Selection of the most appropriate method of surgical treatment is always an option where it is essential to consider finding a way between efficiency and surgical trauma.
The aim of the research is to optimize the results of surgical treatment of patients with malignant tumours of the common bile duct terminal segment complicated by acute mechanical jaundice.
Materials and methods: patients over 18 y.o. with duodenal obstruction; the presence of other active cancer pathology or blood diseases.
The research was performed on 2 different groups divided according to the use of biliary passability restoring method concluding the preferability of minimally invasive methods of bile duct decompression.
Results: minimally invasive methods are not inferior to the effectiveness of biliary decompression comparing to open methods, have a number of advantages, such as minimal invasiveness, relative safety, low incidence of complications and mortality
Conclusions: the introduction of the developed algorithm for surgical treatment of blastomatous mechanical jaundice with the consistent use of antegrade and open methods, as well as antegrade, retrograde and “rendezvous” techniques in surgically incurable patients allowed to reduce the number of early postoperative complications from 32.7 % to 13.3 %, the number of complications requiring surgery – from 5.8 % to 1.3 % and the level of postoperative mortality – from 11.5 % to 2.7 %
Determination of occlusal connections in patients with congenital cleft lip and palate before and after their orthopedic rehabilitation
Get PDFThe aim of this study was to define and analyze the reproducibility of occlusal relationships according to the results of occlusogram in jaw closure using quantitative analysis of occlusion in adult patients with congenital cleft lip and palate before and after their prosthesis with different versions of dentures and types of their constructive features.
Materials and methods. The study was conducted on 37 patients with congenital cleft lip and palate, 11 (29.73 %) of whom had right-sided clefts, 11 (29.73 %) – left-sided and 15 (40.54 %) – bilateral.
The number of occlusal contact points was measured for all patients before the treatment and after the orthopaedic rehabilitation.
Research results. Significant differences were found between the number of occlusal contact points before (unusually small number) and after orthopaedic treatment (significant increase), regardless of the type of cleft (p<0.001). Such conditions in the oral cavity significantly complicate the tactics of orthopaedic rehabilitation, which affects the need to find more complex options for combinations of fixed and removable orthopaedic structures.
Conclusion. Based on the conditions and objectives of this study, the application of the basic principles of a multidisciplinary approach determine the possibility of rehabilitation of such patients by orthopedic methods by making different versions of orthopedic structures. Adequate and high-quality prosthesis for defects and deformations of the teeth rows and occlusion in patients with CCLP leads to improved occlusal relationships and increase in the number of occlusal contact points
Optimization of treatment and prevention of generalized periodontal diseases with the use of transgingival photoactived disinfection
Get PDFThe aim of the study is to develop protocols for the treatment and prevention of generalized periodontal disease using a nozzle that designed for transgingival photosensitizer activation.
Methods. Analysis of available variants of irradiation nozzles for photoactivated disinfection. Circuit design and construction of authors’ irradiation nozzle for transgingival photosensitizer activation.
Results. Based on the analysis of data, there was developed a nozzle design that allows treating periodontium areas within 4-6 teeth, evenly distributes the required power of laser radiation, and can be used in hard-to-reach areas of the oral cavity. Based on the above calculations, a nozzle for transgingival photosensitizer activation was created (jointly with Fotonika Plus, PE). To optimize the PAD procedure, there was created a protocol of transgingival photoactivated disinfection to be applied at the stage of professional oral hygiene, using the created irradiation nozzle NOU-9 of authors’ design, and diode 2 W laser LIKA-surgeon with a wavelength of 660 nm. The result is the accelerated procedure of transgingival photoactivated disinfection.
Conclusions. The development of photoactivated disinfection technology allows supplementing the traditional treatment of generalized periodontal diseases. Studies of non-invasive, transgingival method of photosensitizer activation have recently become popular. This, in turn, carries a lower probability of cross-infection and less traumatization of periodontal tissues during the manipulation. The use of PAD cannot lead to resistance of the microflora in contrast to pharmacological antibacterial preparations. Carrying out PAD does not require any complex manual skills, the purchase of expensive equipment, provides an opportunity for widespread introduction of technology. The use of the therapeutic complex and protocols of PAD that were developed can significantly reduce the duration of the procedure, resulting in improved comfort for both the doctor and the patient. The NOU-9 irradiation nozzle allows reaching hard-to-reach areas of the oral cavity, distributing laser radiation efficiently and evenly on periodontal tissues. The LIKA-surgeon 2 W laser with a wavelength of 660 nm provides the operating parameters required to activate the photosensitizer. Due to low-intensity radiation, it is possible to enhance regenerative processes in the periodontium after traumatic intervention. Clinical studies on the antibacterial efficacy of the technology are ongoin