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DIAGNOSTIC VALUE OF MORPHOLOGICAL CHANGES IN GASTROESOPHAGEAL REFLUX DISEASE IN BIOPSY MATERIAL OF THE DISTAL ESOPHAGUS IN ADOLESCENTS SICKLY WITH ACUTE RESPIRATORY DISEASES
Get PDFThe article dedicated to the problem of the diagnostic value of morphological changes in gastroesophageal reflux disease in the biopsy of the distal esophagus in pubertal children of childbearing age.
Aim of the research is to investigate the diagnostic value of morphological changes in gastroesophageal reflux disease in esophageal biopsy material in adolescents sickly with acute respiratory diseases.
Methodology. The objective of the study was achieved through examination of 90 adolescents (10 to 16 years old, average age 13.1±3.54 years) kept under observation at the Children’s Clinical Hospital No. 9 of Kyiv and on the basis of the Department of Pediatrics No. 1 Center of Primary Health Care No. 4 of the Desnianskyi district of Kyiv. All adolescents belonged to the group of sickly with a number of respiratory diseases averaging 6-8 times a year, lasting from 8 to 18 days (on average 12.8±5.41 days). All children have undergone endoscopic examination of the esophagus, stomach and duodenum with the esophagus mucosa biopsy using the OLYMPUS GIF-P3 flexible fiberscope.
Results. It was found that the least valuable diagnostic feature in the morphological examination of the mucous membrane of the distal esophagus in the pain-causing children with GERD was thickening of the epithelium with a sensitivity of 13,0 %, a specificity of 96.0 %, and total value of 65.0 %. It has been proved that hyperplasia of cells of the basal layer of the mucous membrane of the distal esophagus at the GERD in the infected children is 46.7 % (specificity – 93.3 %, the total value is 75.6 %). Increase in the number of papillae and their prolongation in 33.3 % cases (sensitivity – 33.3 %, specificity – 93.3 %, overall diagnostic value – 70.8 %).
Conclusion. The peculiarity of the morphological manifestations of GERD in childbearing children is dystrophic changes in keratocytes in the superficial parts of the multilayer squamous epithelium, which are detected at 100.0 % of patients (specificity is 93.3 %, total value is 96.8 %), with parakeratosis centers at 13.3 % of cases. It has been shown that a frequent and diagnostically valuable indication is inflammatory infiltration of the esophageal mucosa, which are verified in all cases (100.0 %, with dilatation and hyperemia in 46.7 % of patients (specificity – 40.0 %, total value – 81.3 %)
RESULTS OF ANALYSIS AND FORECASTING OF THE MAIN FINANCIAL INDICATORS OF THE HEALTH INSURANCE MARKET DEVELOPMENT IN UKRAINE
Get PDFIn recent years Ukraine against the background of systemic crisis trying to reform socially-oriented areas of society, including voluntary health insurance, which must combine market and social burdens. Under these conditions, an important scientific and practical research is forecasting financial indicators of domestic insurance companies.
Aim. Conducting analysis and forecasting of the basic indicators that characterize the financial state of development of the domestic health insurance market.
Materials and methods. Research materials were selected from the official websites of the National Commission which carry out state markets regulation of financial services and the League of Insurance Organizations of Ukraine for 2009–2018 years. We used historical, analytical and comparative, systematic, logical, hypothetical-deductive, mathematical and statistical methods.
Results. To forecast the financial indicators of the health insurance market in Ukraine (gross insurance premiums and payments; operations transferred to reinsurance, including non-residents; net insurance premiums and payments) for 2019–2020 years; the time interval was set from 2009 year. According to the results of the calculations, we obtained regression models for different financial indicators (6 models). With the help of the selected mathematical tools, the main financial indicators of the market development for 2019–2020 years were forecasted. The analysis of the data revealed that the highest value growth rate (%) in 2020 year will be characteristic of reinsurance operations, including those transferred to non-residents (49.06 %) and the lowest - to gross insurance payments (14,41 %).
It is established that the indicator of net insurance payments since 2010 year has been steadily decreasing (from 78.19 %), and according to the forecasted data in 2019 year it may be equal to 46.77 %, and in 2020 year – 44.98 %, the trend will continue to decrease. However, this indicator since 2016 year (53.9 %) and the data forecast for 2019–2020 years are in the regulatory range (from 30.0 % to 60.0 % for different types of insurance activities).
Conclusions. According to the results of the research, it is established that in spite of the financial and economic crisis since 2014 year, the domestic health insurance market is characterized by positive dynamics of growth of the main financial indicators (gross insurance premiums and payments, net insurance premiums and payments). At the same time, there is a tendency to decrease the level (%) of net insurance payments indicator from 78.19 % in 2010 year to the forecast in 2020 year – 44.98 %
USE OF MELDONIUM IN THE TREATMENT OF PATIENTS WITH CORONARY ARTERY DISEASE AND CONCOMITANT ARTERIAL HYPERTENSION
Get PDFCoronary artery disease (CAD) remains one of the leading causes of mortality and disability in Ukraine. Arterial hypertension (AH) is one of the most common diseases and a leading risk factor for coronary artery disease.
The aim of the work is to evaluate the antianginal activity of meldonium in the complex therapy in patients with CAD with stable angina and concomitant AH.
Materials and methods. The study included 82 patients with CAD, stable angina pectoris II–III functional class, including 52 patients with concomitant AH stage II. The patients were divided into 2 groups. Patients in group 1 were prescribed meldonium at a dose of 750 mg/d for 2 months in addition to basic therapy for the underlying disease. Patients in group 2 continued basic antianginal, disaggregant, hypolipidemic therapy.
Results. The use of meldonium led to a decrease in the frequency of angina attacks and the need for nitroglycerin. From the 1st month of therapy and up to 2 months treatment decreased it consumption by 63 and 82.3 % respectively. Adding meldonium to basic therapy led to a likely reduction in shortness of breath, episodes of palpitations, tinnitus, and headache. In all patients, after the treatment, an increase in exercise tolerance was observed, which was more pronounced in the group where patients were receiving meldonium. In the group of patients receiving meldonium, normalisation of blood pressure was faster and more pronounced.
Conclusions. Meldonium has antianginal activity, which is manifested by an increase in the physical tolerance of patients, a decrease in the frequency of angina attacks, the need for sublingual nitroglycerin intake and improvement in the well-being of patients. Additional use of meldonium promotes faster and better normalization of blood pressure. The use of meldonium in the complex therapy of patients with stable angina and concomitant AH allows to increase the effectiveness of traditional antianginal therapy and to improve the quality of life of such patients
USE OF PLATELETS RICH PLASMA AS A FACTOR OF THE REDUCTION OF THE RISK OF EARLY POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH POSTOPERATIVE VENTRAL HERNIAS
Get PDFNon-tensioned allohernioplasty with a polypropylene mesh implant has several disadvantages associated with the local occurrence of non-specific long-lasting inflammatory reactions in response to a foreign body. Excessive exudation in the implantation zone leads to the formation of seromas, requiring puncture aspiration, which significantly increases the treatment time. In the long-term, chronic prolonged inflammatory process leads to the formation of coarse connective tissue, which explains the development of biomechanical complications. Growth factors, introduced by platelet rich plasma (PRP), stimulate the release of regenerative cytokines, reduce local inflammatory manifestations in the integration of homoplastic grafts and reduce the incidence of postoperative complications.
Aim: through the use of plasma enriched with platelets reduce the severity of early postoperative complications in patients with postoperative ventral hernias.
Materials and methods. A clinical study was performed in the surgical department of the center for reconstructive and restorative medicine (university clinic) of the Odessa National Medical University (ONMedU) in the period from 2013 to 2019: 84 patients were operated because of postoperative ventral hernia. The average age of patients was 60.1±7.6 years. The size of hernial defects was on average 8.2 cm. The average BMI was 31.8 kg/m2. According to indications, patients underwent a standard surgical extent of intervention: hernia repair, allohernioplasty of the anterior abdominal wall with a lightweight (80 g/m2) polypropylene implant. After the plastics of the main group, a prosthesis implantation zone was infiltrated with activated autologous PRP, which was prepared by double centrifugation, in a volume of 14–38 ml. There was a control group in which PRP infiltration was not performed. The cavity above the mesh implant was actively drained by Redon for 2–4 days. An ultrasound examination was performed and, if necessary, fine needle aspiration of serous fluid over the mesh was done.
Results. The evaluation of the postoperative period (up to 28 days) in patients of both groups. In none of the cases were manifestations of allergic, pyrogenic, local inflammatory or infectious complications. According to the quantitative assessment of early postoperative complications as well as the assessment of the degree of pain syndrome subjectively, according to VAS, the postoperative period in the main and control study groups was almost identical. The need for puncture aspirations and the total volume of discharge was significantly less in the main study group. The dependence of the severity of the effect of the proposed technology on such factors as the size of the hernial defect, the nature of plastics, and body mass index was noted. The greatest efficacy was demonstrated in the group of patients undergoing plastic surgery with the placement of a mesh implant in direct contact with subcutaneous fatty tissue for large-sized hernias (W2+) in the presence of concomitant obesity.
Conclusions: the risk of development and the severity of fluid accumulations in the area of allohernioplasty can be predicted taking into account such risk factors as the size of the hernial defect, the nature of plastics, the presence of concomitant pathology, overweight. The technique of soft tissue infiltration in contact with a polypropylene prosthesis is safe, without significantly increasing the risk of local or systemic complications. The proposed method significantly reduces the risk of development and the severity of fluid accumulations in the area of implantation of the prosthesis. The effectiveness of technology is significantly higher compared to groups of patients with a high risk of seromas formation
EXPERIMENTAL STUDY OF ANTIMICROBIAL PROPERTIES AND ACUTE TOXICITY OF THE PEO-BASED COMBINED SUPPOSITORIES
Get PDFAim. The research of antimicrobial and toxicological parameters of a promising pharmaceutical composition with indole-3-carbinol and meloxicam in the form of rectal suppositories.
Materials and methods. The research of antimicrobial activity was carried out in vitro by diffusion in nutrient agar in the modification of "holes" on the reference strains of common pathogens Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Bacillus subtilis, Candida albicans.
Adult rats were used for the study of acute toxicity. Suppository mass were administrated in the largest possible volume rectally or orally. The animals were periodically monitored according to the experimental plan – the assessment of physiological parameters before administration and after 6, 12, 18, 24 hours, at 3, 7 and 14 days. The animals were removed from experiment and necropsy provided after 1, 3, 7, and 14 days.
Results. The sizes of zones of inhibition of the microorganisms growth were most significant (from 19.27±0.61 mm of E. coli to 40.80±0.42 mm of S. aureus) near sample of the combined composition suppository compared with other combination of active substances and excipients.
During the observation of animals for 14 days and the study of internal organs after autopsy, deviations in physiological (weight, temperature, activity, respiratory rate) and macroscopic morphological indicators of animals from reference values were not detected.
Conclusion. According to the results of microbiological studies, a moderate antimicrobial effect of suppositories of combined composition in relation to all the studied pathogens was revealed. The absence of manifestations of acute toxicity allows us to conclude that the pharmaceutical composition can be classified as practically non-toxic substances.
The obtained results allow us to recommend a pharmaceutical composition with indole-3-carbinol and meloxicam on a polyethylene oxide basis in the form of suppositories for further preclinical studies of specific pharmacological effects as a prostate protective agent
SWOT-ANALYSIS OF MODELS OF ORGANIZATION OF PROVISION OF PRIMARY HEALTH CARE IN THE UNITED TERRITORIAL COMMUNITIES
Get PDFThe article analyzes the strengths, weaknesses, potential opportunities and threats in the process of forming and making appropriate management decisions to integrate health facilities into united territorial communities (UTC) infrastructure, or other options, in the process of decentralization. The basic package of new legislative and regulatory documents has been worked out, which envisages radical changes and systemic reforms, decentralization of power - transfer from the executive bodies to local self-government bodies of a considerable part of powers, resources and responsibilities. A number of reform changes have been identified, which may lead to the expected institutional, organizational and structural-functional changes of the existing public health management system in Ukraine and changes in the individual functional characteristics of the entities of this system. The differences between medical reforms in terms of administrative reform, the role of UTC in this process, in relation to a number of other European countries are considered. On this basis, possible options for the development of events in the context of territorial governance of these processes in the system of health in Ukraine have been proposed. In order to continue scientific research in this direction, the next stage of the evolution of the formation and adoption of appropriate management decisions in the UTC is to consider the cooperation of the UTC in the creation of joint infrastructure medical facilities, their governing bodies, implementation of projects of activity, financing and maintenance
PECULIARITIES OF TLR-2 (ARG753GLN) AND TLR-4 (ASP299GLY) POLYMORPHISM PREVALENCE IN PATIENTS WITH ACUTE BRUCELLEIS AND CARDIOVASCULAR SYSTEM DISEASES
Get PDFCurrently, there are single data on the relationship between TLR-2 polymorphisms (Arg753Gln) and TLR-4 (Asp299Gly) polymorphisms and susceptibility to brucellosis. Therefore, the aim of the study was to determine the frequency of TLR-2 (Arg753Gln) and TLR-4 (Asp299Gly) polymorphisms in patients with acute brucellosis with cardiovascular lesions in the Republic of Azerbaijan.
Materials and methods: 178 patients with a brucellosis clinic were examined. According to the criteria for inclusion in the study, only 120 people fully met all the criteria, which made up the main group. The control group consisted of 30 healthy individuals. TLR-2 (Arg753Gln) and TLR-4 (Asp299Gly) polymorphisms were also determined for all patients in both groups. In order to assess the state of the cardiovascular system, an electrocardiogram was recorded, blood pressure was measured, and an ultrasound scan of the heart was performed for all patients.
Results: it was found that 93 patients (77.50±3.13 %) with acute brucellosis had some or other signs of impairment in the work of the cardiovascular system, identified clinically or as a result of functional examination. Among carriers of the Asp / Gly genotype of the TLR-4 gene, an increased risk of brucellosis with CVS diseases was determined (χ2=30.19; p <0.0001; OR=24.29; 95 % CI [5.45 – 108.37]), while the carriage of the homozygous genotype Asp / Asp, by contrast, had a protective effect on the development of brucellosis (OR=0.06, 95 % CI [0.02 – 0.20]). Among the carriers of the Arg / Gln genotype and the Gln / Gln genotype of the TLR-2 gene, a significantly increased risk of brucellosis with CVS diseases was determined (χ2=5.68; p=0.02; OR=3.10; 95 % CI [0.99 – 9.67]) and (OR=2.48; 95 % CI [0.53 – 11.61]), respectively. While the carriage of the homozygous Arg / Arg genotype, by contrast, was rarely seen in patients with brucellosis (OR=0.28, 95 % CI [0.10 – 0.74]).
Conclusions: The Asp / Gly genotype of the TLR-4 gene was 12.7 times more frequently detected in patients with acute brucellosis with CVS diseases than in healthy individuals and 9.5 times more often than in patients without CVS diseases (p<0.05). The Arg / Gln genotype of the TLR-2 gene was 2.4 times more frequently detected in patients with acute brucellosis with CVS diseases than in healthy individuals (p<0.05)
MANAGEMENT OF POSTOPERATIVE PERITONITIS IN LOW-RESOURCES SERVICES
Get PDFBackground. Postoperative peritonitis (PP) reminds one of the most difficult complications in abdominal surgery with mortality rate 22.3 – 90 %.
Methods. In Ivano-Frankivsk Regional (tertiary level) Clinical Hospital (Ivano-Frankivsk, Ukraine) during 2010–2017 were operated 8762 patients with acute and chronic diseases of digestive system (appendicitis, pancreatitis, cholecystitis, bowel obstruction, complicated ulcer of upper gastrointestinal truck, mesenteric vessels thrombosis, abdominal adhesion diseases, hernia, Chron’s diseases, abdominal trauma), among them in 209 (2.4 %) patients developed PP. Local PP (abscess of abdominal cavity) had 142 (67.9 %), diffuse PP – 67 (42.1 %) patients.
Results. Clear local symptoms of peritonitis were absent in 178 (85.1 %) of 209 patients. General complication, such as acute respiratory failure had 95 (45.5 %), cardiovascular insufficiency – 68 (32.5 %), hepato-renal dysfunction - 46 (22 %) patients with PP. 129 (61.7 %) patients were treated by minimally invasive approach: 24 patients had laparoscopic lavage with drain of abdominal cavity abscess and 105 - ultrasound guided drain of abscess with catheter. 80 (38.3 %) patients had re-laparotomy (RL): 61 (91 %) from 67 with diffuse PP, 19 (13.4 %) from 142 patients – with local PP. 46 (57.5 %) patients underwent one RL, 26 (32.5 %) – two, 8 (10 %) patients – three RL. With increasing numbers of RL, increase mortality rate: after first RL died 7 (15.2 %) of 46 patients, after second RL – 12 (63.2 %) of 19, after third RL 6 (75 %) of 8 patients.
Conclusions. Together with standard surgical methods and precise technique were used lavage of abdominal cavity with 8 – 12 litres of antiseptic solutions, solution for peritoneal dialysis intraabdominally, nasointestinal drain tube, what was favourable for faster treatment of abdominal sepsis, reducing number of RL and postoperative mortality
DETERMINATION OF MOLECULAR GENETIC MARKERS IN PROGNOSIS OF THE EFFECTIVENESS OF TREATMENT OF MALIGNANT INTRACEREBRAL BRAIN TUMORS
Get PDFIntracerebral malignant brain tumors remain one of the most complex problems of neuro-oncology. Today, promising results of the use of targeted drugs have been received, which determine the important diagnostic and predictive value of molecular genetic markers of glial and metastatic brain tumors.
Aim: The study of the prevalence of MGMT (O6-methylguanine-DNA methyltransferase) and PTEN (phosphatase and tensin homologue deleted on chromosome 10) gene expression by real time polymerase chain reaction in tumor tissue of gliomas and brain metastases.
Materials and methods: From thirty patients were received tumor material (29 cases of glioma III-IV degree of anaplasia and one case of metastatic brain lesion of adenocarcinoma). The normalized expression of MGMT and PTEN genes was determined by real-time polymerase chain reaction.
Results: In all 30 (100 %) patients with tumor fragments, we determined normalized expression of MGMT and PTEN genes. In most cases, 53 % of the observations (16 out of 30 patients) showed a low normalized expression of MGMT gene (<40 c. u.) and a low normalized PTEN expression rate of 73 % (22 out of 30 patients) (<40 c. u.). The average expression level of the MGMT gene in the range from 40 to 100 c. u. (6/20 % of patients) was considered prognostic favourable for the response to temozolomide chemotherapy.
Conclusions: The study of MGMT gene expression, a chemotherapy marker for temozolomide, indicates a trend toward correlation between expression levels and therapeutic efficacy. The study of the expression of the PTEN gene, the blocker of the PI3K / AKT signal pathway, indicates a different degree of expression of this enzyme in the tumour samples studied. The predictive value of the indicator for target therapy is appropriate in comparison with the EGFR mutation. Further profound analysis of the results is required with increasing number of sampling and observation period
INFLUENCE OF “NOVUMEDICAL” EQUIPMENT ON NON-SPECIFIC RESISTANCE OF THE ORGANISM TAKING INTO ACCOUNT ADAPTATION REACTIONS
Get PDFStudies have shown the effectiveness and perspective of using «NovuMedical» devices for the purpose of primary and secondary prevention of diseases, increasing the personal interest of patients in extending the period of active longevity due to regular recovery at home. The preventive effect of the equipment is not directed against the symptoms of the disease, but to increase the body's resistance. Before treatment, the normal type of adaptive response was detected in 75 % of patients, the workout reaction was noted in 45.4 %, the calm activation reaction – 23.2 %, the reaction of increased activation in 6.2 % of cases, and the stress response was recorded in 25.2 %. After the treatment, the workout reaction was detected in 44.1 % of cases, the calm activation reaction – 22.2 %, the increased activation zone – 33.3 %. The preformed factors used in the apparatuses are a bioregulator in the broad sense of modulating the physiological functions of the body, which makes it possible to “rejuvenate” the sick organism, at least to equalize the biological and passport age, to restore the original potential of sanogenetic reactions. Apparatus for home use can be the basis for the primary population prevention and secondary individual prevention of a wide range of diseases and premature aging