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HEMORRHAGIC PROGRESSION OF CONTUSION IN PATIENTS WITH MILD TRAUMATIC BRAIN INJURY ON THE ROUTINE REPEAT HEAD COMPUTED TOMOGRAPHY
Get PDFComputed tomography (CT) scan is a standard for the diagnosis of intracranial pathology after traumatic brain injury (TBI). Hemorrhagic progression of contusion (HPC) is frequently seen on repeat CT, but its clinical and radiological significance in case of mild TBI is not well define.
The aim of the study: to evaluate the result of routine repeat head CT in patients with mild TBI and brain contusions.
Materials and methods: retrospective analysis of management of patients with mild TBI (Glasgow Coma Scale (GCS) score – 13 to 15) and cerebral contusion. All patients were treated at the Kyiv City Clinical Emergency Hospital between 2016 and 2017.
Results: within 202 patients with mild TBI, 87 (43.1 %) met the inclusion criteria and were selected for detailed analysis. There were 69 (79.3 %) men and 18 (20.7 %) women. The mean age of the patients was 43.8±12.7 years (17–82 years). The average time between trauma and CT was 3.3 hours. The average volume of contusion on the initial CT was 1.9±0.6 cm3 (0.2–9.6 cm3). The average time of routine CT was 6.8 hours (range 4–24 hours) after the initial scans. HPC was found in 24 (30.7 %) of 87 cases. The average volume of brain contusion on the repeat CT was 2.3±0.5 cm3 (0.2-17.1 cm3). In 3 (3.4 %) patients the size of the hematoma increased. Clinical deterioration occurred in 10 (11.5 %) patients. Six (6.9 %) patients were operated after a CT scan due to HPC with midline shift in 4 cases and increasing of subdural hematoma – 2 cases. Four of these patients had clinical deterioration, and 2 patients were neurological stable. Patients with HPC at admission had lower points of GCS, fractures of the skull (both p <0.001), subdural blood collection (p=0.002), a higher average duration of treatment 8.1±4.2 vs 14.3±5.2 days (p=0.0001), and mortality rate 0 vs. 3 (12.5 %) (p=0.02).
Conclusions: Routine repeat CT in patients with mild TBI with brain contusions is aimed to find a patients with s high risk for clinical deterioration. One third of patients with mild TBI and brain contusion experienced HPC. Patients with HPC often have unfavorable clinical course with higher average duration of treatment, delay surgical treatment and mortality rate
COVID-19 AND STIGMATISATION OF HEALTHCARE PROVIDERS
Get PDFThe aim: this study presents a Coronavirus Stigma Scale for Healthcare Providers that indicates the social stigmatisation rate and severity toward healthcare providers to a certain extent. This paper aims at raising awareness on the stigmatisation of healthcare providers who sacrifice their own lives for patients diagnosed or are at risk of being infected with COVID-19.
Methods: the study uses a 12-item 5-point Likert-type Coronavirus Stigma Scale for Healthcare Providers, which was constructed based on the previously shortened and modified HIV Stigma Scale. The scale was distributed online to healthcare providers, and all the results obtained were then saved to an Excel file. Correlations were determined by using ANOVA and the independent t-test. Percentages, averages, figures and rates were calculated with SPSS.
Results: the population of the study comprised 136 participants in total; 40 male and 96 female. Reliability and validity studies were conducted using Cronbach’s alpha and factor analysis. The stigmatisation rate toward healthcare providers was found to be significantly high, and the stigmatisation level was found to increase significantly with increasing age (p<0.05).
Conclusions: the mistreatment of stigmatised healthcare providers during a pandemic where the need for them is elevated results in adverse outcomes; therefore, anti-stigma programmes need to be developed. It would be wise to find solutions such as acknowledging the stigma and introducing anti-stigma programmes
PROGNOSIS OF POSTOPERATIVE PROGRESSION OF GLAUCOMA OPTIC NEUROPATHY AT PRIMARY OPEN-ANGLE GLAUCOMA
Get PDFSearch for new informative markers and methods of prognosis prediction glaucomatous optic neuropathy (GON) in primary open-angle glaucoma (POAG) is an urgent task. We have established efficiency surgical treatment of POAG, but the progression of GON is observed in 10–15 % patients. It is known that the main mechanism of GON is apoptotic death retinal ganglion cells, a marker of which is recognized as tumour necrosis factor-α (TNFα), Fas-ligand (FasL) and a soluble form of the Fas-receptor (sFas/APO-1).
The aim of the study: to find out the possibility of using apoptosis factors (TNFα, FasL and sFas/APO-1) to predict postoperative progression of GON at POAG.
Methods. 69 patients (69 eyes) with POAG stage I–III were examined, who underwent trabeculectomy with implantation of an Ex-Press shunt. In intraocular fluid (IOF) markers of apoptosis was determined by the method enzyme-linked immunosorbent assay. Repeated ophthalmological examination was performed in 1 year. The control group consisted of 25 patients who were operated on about phacoemulsification of cataracts. For statistical and regression analysis used software package GLZ (Statistica 10, StatSoft, Inc. USA) and module of analysis of operational characteristics of regression models – ROC-diagrams (MedCalc 18.9.1, MedCalc Software, Belgium).
Results. Multivariate regression analysis showed that the progression of GON determine the content in IOF of TNFα and sFas/Apo-1 before surgery and intraocular pressure after three months. Based on these indicators, it is calculated satisfactory model of GON progression prediction with 95.4 % accuracy. One-factor logistic regression analysis proved the influence of the content of TNFα, FasL and sFas/Apo-1 for the presence or absence of progression of GON during the year after operations: direct dependence took place for TNFα and FasL and inverse – for sFas/Apo-1. The critical limits of the content in the IOF markers are calculated apoptosis, in which the progression of GON is unmistakably predicted during year after surgery.
Conclusions. The obtained results prove the significant influence of the studied markers apoptosis on the progression of GON after surgery. Direct pathogenetic influence belongs to TNFα and FasL
VALIDATION OF THE SPECTROPHOTOMETRIC PROCEDURE FOR DESLORATADINE ASSAY IN TABLETS APPLYING THE UNCERTAINTY CONCEPT OF THE STATE PHARMACOPOEIA OF UKRAINE
Get PDFAim. This work aimed to validate an assay procedure for desloratadine tablets by direct spectrophotometric method.
Materials and methods. A pilot-scale batch of the pharmaceutical preparation Alerdez, film-coated tablets containing 5 mg of desloratadine, manufactured by PJSC SIC “Borshchahivskiy CPP”, Ukraine, was used as an object of the study. A UV-Vis spectrophotometer Lambda 25 (Perkin Elmer), analytical balance Mettler Toledo XP 205DR, and class A volumetric apparatus were used in the study. Validation of the procedure was performed following the metrological approach of the State Pharmacopoeia of Ukraine (SPhU), whose requirements for the target uncertainty and bias, which rest on the risk assessment of making incorrect decisions on compliance (a confidence level of 95 %), were translated into criteria for all validation characteristics recommended by ICH. All calculations were made in normalised coordinates. The linearity, accuracy and precision (repeatability) were studied in a single experiment using nine different concentrations that uniformly covered the range of ±30 % from the nominal concentration of desloratadine. For validation of the procedure, an SPhU reference standard of desloratadine was used.
Results. The experiment design and validation characteristics being tested were in full compliance with ICH Q2(R1) recommendations. All performance characteristics conformed to the criteria recommended by the SPhU. Requirements for the target uncertainty (1.6 %) and bias for any systematic source of variation (≤0.51 %, negligible in relation to 1.6 %) were established. The analytical procedure was specific – the absorbance from the placebo solution was insignificant (A %=0.36). The procedure met the requirements for linearity, accuracy, and precision at the repeatability level. The residual standard deviation s0 was 0.34 (≤ 0.84); correlation index Rc was 0.9998 (≥0.9991); intercept а was 0.045 (less than its confidence interval ∆a=1.14). The confidence interval for recovery ∆Z, which was used as a precision estimate, was 0.55 % (less than the target uncertainty). The mean recovery, which was used as an accuracy estimate, statistically insignificantly deviated from 100% (|Zmean ‑ 100| = 0.022 %).
The confidence interval for the intermediate precision ∆intrawas 0.33 % (less than the target uncertainty). The developed analytical procedure was found to be robust.
Conclusions. A spectrophotometric procedure suitable for the assay of desloratadine in film-coated tablets Alerdez with content limits of ±5 % was validated by the SPhU approach
PECULIARITIES OF STATE OF PROTECTION AND AGGRESSION FACTORS IN PATIENTS WITH DIABETES MELLITUS TYPE II AND GASTROESOPHAGEAL REFLUX DISEASE
Get PDFDiabetes mellitus is one of the most serious problems of the clinical medicine. This is determined by the fact that it is followed by multisystemic affects, as well as complications on the side of other organs and systems, among which a special place is occupied by gastroesophageal reflux disease. As for the combination and mutual influence of diabetes mellitus and gastroesophageal reflux disease, this issue has not been studied yet, the data of modern literature are not complete and quite contradictory.
The aim of the study: to investigate the state of the factors of aggression and protection of the oesophageal mucosa in patients with diabetes mellitus type II with concomitant gastroesophageal reflux disease without associated pathology.
Method. There were two groups of patients under observation. The first group included 45 patients with diabetes mellitus type II with concomitant gastroesophageal reflux disease (26 men and 19 women). The second group included 38 patients with gastroesophageal reflux disease without associated pathology – 20 men and 18 women. By sex, age, body weight, Helicobacter pylori infection, smoking and alcohol consumption, both groups were comparable. The surveillance program included determining the compensation ratio of carbohydrate metabolism and the state of the factor. The antioxidant protection factor was assessed by the level of catalase activity in the blood serum, as well as by the diameter of the celiac trunk and the blood flow velocity in it. Statistical processing of the obtained data was carried out with the aid of the program WINDOWS STATISTIKA 6.0. For all types of analysis, differences were considered statistically significant with p<0.05.
Results. During the study, we found that in patients with diabetes mellitus type II with concomitant gastroesophageal reflux disease, as well as in patients with gastroesophageal reflux disease without associated pathology, the level of pH-metry was reduced, but with varying measures of confidence. At the same time, we found that patients with GERD without associated pathology had a decrease in the blood flow velocity in the celiac trunk. Concurrently, we ascertained that the decrease in the blood flow velocity in patients of both groups reduced the diameter of the celiac trunk.
Conclusions. In patients with diabetes mellitus type II, concomitant gastroesophageal reflux disease has a subtle clinical presentation that is affected by a significant decline in mucosal sealing protection factors. In patients with GERD without associated pathology, typical clinical manifestations, accompanied by inflammation, acid regurgitation and dyspepsia, are more vivid
RESEARCH ON THE SELECTION OF EXCIPIENTS AS THE RATIONALE FOR THE COMPOSITION OF THE TABLETS WITH DRY EXTRACT OF SANGUISORBA OFFICINALIS
Get PDFThe aim. The aim of the research was to study the effect of different groups of excipients on the pharmaco-technological propertiesof the powder mass for tabletting in the development of the composition of the tablets with dry extract of Sanguisorba officinalis for complex therapy of the gastrointestinal tract diseases.
Materials and methods. Objects of study - dry extract Sanguisorba officinalis, 25 excipients used in the production of tablets by the method of direct compression, grouped into five groups of factors (fillers based on sugars and microcrystalline cellulose, disintegrants, glidants and lubricants), samples of powder masses. Studies on the determination of pharmaco-technological properties (fluidity, bulk density, bulk density after shrinkage, degree of compressibility, Hausner ratio, and angle of repose) of the obtained powder masses were carried out according to the methods of the State Pharmacopoeia of Ukraine, Second edition. The method of mathematical planning of the experiment was used in the work, the obtained results were subjected to variance analysis, and the ranked series of advantages were placed, in which the excipients were placed in the sequence of their influence on the studied pharmaco-tecnological parameters.
Results and discussion. The influence of excipients (factors) on the pharmaco-technological properties (responses) of the powdered tablet masses with the construction of ranked benefits was studied using a five-factor experiment, a hyper-Graeco-Latin square. The results of the analysis of variance showed that glidants have the greatest influence on the fluidity, the bulk density and the bulk density after shrinkage. Neusilin US 2 significantly affects the fluidity of the powder masses and Hausner ratio, the talc having the greatest effect on the bulk density and the bulk density after shrinkage of the powder masses. The representative of the disintegrants group – Sodium starch glycolate most influences the compressibility index, the sugar-based filler – Pearlitol 500 DC – on the angle of repose.
Conclusions. The effect of 25 excipients on the pharmaco-technological characteristics of the powdered tablet masses with dry extract of Sanguisorba officinalis was studied. It was found that among the sugars-based fillers equally good results were shown in the powder masses with Compri sugar, Tablettose 80 and Pearlitol 500 DC; among the microcrystalline cellulose based fillers is Prosolv 90; among glidants – Neusilin US 2; no comparison was made of the disintegrants and lubricant excipients from the studied list of leader substances. The results of the studies indicate the possibility of obtaining tablets by the direct compression method, and further study of their pharmaco-technological characteristics will allow to establish the optimal composition of excipients
LIVER ABSCESSES: A 10-YEAR VINNYTSYA UNIVERSITY STUDY
Get PDFAccording to MEDLINE database there were about 1278 papers on liver abscess published in a period from 2001 to 2015.
The aim of the study is to improve liver abscess treatment results comparing minimally invasive and traditional operative techniques.
Materials and methods. 137 patients were included in the study and divided on two comparison groups. Traditional methods were used for the treatment of 66 participants of the control group (48.2 %). For 71 patients (51.8 %) of the general group the mini-invasive drainages were predominating.
Results. Cholangiogenic causes of liver abscesses were found in 41 patients (29.93±3.91 %), cryptogenic ones – in 37 (27.01±3.79 %), haematogenous causes – in 29 (21.17±3.49 %), contact ones – in 16 (11.68±2.75 %), posttraumatic ones – in 11 (8.03±2.32 %) and purulent destruction of metastases – in 3 (2.19±1.25 %).
Single abscesses occurred more often – in 117 (85.40±3.02 %), multiple once – in 20 (14.60±3.02 %). Mostly 3, 6 and 7 liver segments were damaged – 19 (13.88±2.95 %), 35 (25.55±3.73 %), 44 (32.12±3.99 %).
In control group, the abscess drainage via laparotomy was performed on 58 patients (87.88±4.02 % of 66 ones) versus 21 (29.58±5.42 % of 71 ones) in general group. Percutaneous drainage was used in 8 (12.12±4.02 %) and in 44 (61.97±5.76 %) cases respectively. 6 or 8.45±3.30 % laparoscopic interventions were used only in the general group. Finally, mini-invasive drainages were applied in the greater part of general group - 50 (70.42±5.42 %) versus 8 ones (12.12±4.02 %) in control group.
Conclusions. Minimally invasive liver abscess drainages showed a significant reduction of postoperative complications from 24.24±5.27 % in the control group to 12.66±3.95 % in the general group, shortening of hospital terms from 14.6±1 in control to 5.2±0.8 days and decreasing of mortality from 7.58±3.26 % to 2.82±1.96 %
BASIC FIBROBLAST GROWTH FACTOR AND ADIPONECTIN IN ADOLESCENCE WITH JUVENILE IDIOPATHIC ARTHRITIS TREATED WITH METHOTREXATE
Get PDFMethotrexate has been applied clinically for juvenile idiopathic arthritis (JIA) treatment for decades. It is recommended for use globally, according all modern guidelines. Despite the fact that fibrosis molecular mechanisms as well as methotrexate (MTX) elimination and fibrosis indexes were studied a lot there is still not enough information for adolescence. Adiponectin, fibroblast growth factor and fibrosis indexes in adolescents with JIA treated with methotrexate were studied in this work.
The aim was to study dynamics of molecular-cellular mechanisms activation of fibrotic processes development in the liver in adolescents with juvenile idiopathic arthritis treated with methotrexate.
Materials and methods: A total of 68 children with juvenile idiopathic arthritis, were enrolled in the study. 25 boys (36.8 %) and 43 girls (63.2 %) were examined. Children were divided into three groups in accordance with the methotrexate dose. The following data were analyzed: ESR (mm/hour), C-reactive protein (mg/l), Hemolytic activity (CU), circulating immune complexes, (g/l), ALT (U/l), AST (U/l), Adiponectin (mcg/ml), BFGF (pg/ml), APRI index, FIB-4 Score.
Results: According to our results when patients start using MTX they have significantly positive effect. Therefore, when analyzing all parameters liver pathologies may occur before MTX use. When MTX used, its proinflammation and antifibrotic effects lead to normalization of all organs and systems, as well as joints and liver. Also, long-term MTX use can lead to adverse effects.
Conclusions: So, it is important to control possible liver disorders in adolescence treated with MTX. According to our study results we find out that there are decreasing of liver damage parameters in patients which started using MTX
INTENSITY OF INVASION IN EMERIOSIS OF RABBITS IN DIFFERENT METHODS OF KEEPING
Get PDFOne of the important problems in raising rabbits is eimeriosis, regardless of the method of maintenance. The disease affects animals of all ages, causing weight loss, feed conversion, morbidity and death.
The aim. Study of the prevalence and diagnosis of rabbit eimeriosis by different housing technology to improve methods of disease control.
Methods. The experiment was conducted during 2017–2019 in farms with different capacities in four regions of Dnipro, Zaporizhia, Kharkiv and Sumy. A total of 20 farms for keeping rabbits of different breeds were surveyed.
Results. Studies of rabbit farms on business and private ones found that the most common infestation was with the following species of eimeria: Eimeria perforans, E magna, E. media, E. irresidua, E. piriforms and E. іntestinalis. It is proved that the extensiveness of rabbit infestation when kept in farms in metal cages, under the conditions of sanitary and hygienic regime and timely disinvasion of premises, was in the range of 42–15 % in autumn-winter period, and 19–6 % in spring-summer. According to the survey of homestead farms, rabbits kept in wooden cages on deep litter, the level of invasion in the autumn-winter period was 100–56 % and in the spring-summer – 70–29 %.
Conclusions. Keeping rabbits in metal cages in compliance with sanitary and hygienic standards and timely disinvasion reduces the level of extensiveness of the invasion
STRESS-STRAIN DISTRIBUTION IN THE MODEL OF RETROCALCANEAL BURSITIS BY USING HEEL-ELEVATION INSOLES
Get PDFThe aim of this study is the analysis of the equivalent stress on the rear foot structures in retrocalcaneal bursitis, when using heel-elevation insoles of different heights (10 mm and 20 mm).
Methods – mathematical calculations of the Achilles force required in the heel-off of the gait stance phase in the conditions of lifting the heel by 10 mm and 20 mm. A 3D-simulation foot model with an enlarged retrocalcaneal bursa was created. The analysis was carried out by the finite element method to calculate and study the stress and strain in the rear foot structures.
Results. When using a 10.0 mm height heel-elevation insole, the calf muscle strength, which must be applied to the heel-off of the gait stance phase, was 19.0 % less than without support and 26.8 % less in 20.0 mm insole. Accordingly, analyzing the simulation results in terms of von-Mises stress, the maximum stress observed on the Achilles tendon decreases by 20.0 % and by 30.0 %. The total deformations maximum in the model when using heel-elevation insoles decreased up to 18.1 % and they were localized not in the tendon, but in the bone structures of subtalar joint.
The maximum values of the total deformation of the model in the case of 10.0 mm and 20.0 mm heel-elevation insoles were 91.67 mm (–20.2 %) and 80.04 mm (–30.3 %), respectively, compared 114.92 mm in the absence of insoles. When using insole with a height of 10.0 mm, the stress in the retrocalcaneal bursa decreased by 20.0 % and was equal to 14.92 MPa compared to 18.66 MPa, and when using a 20.0 mm insoles - by 30.0 %.
Conclusions. It was found that when using 10.0–20.0 mm heel-elevation insoles, the stress distribution in the rear foot structures was significantly reduced by an average of 20.0-30.0 % and correlated with the height of the insoles