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POSSIBILITIES OF USING MINIINVASIVE CATHETER TECHNOLOGIES IN THE TREATMENT OF LUNG BLEEDING
Get PDFAim – improve the results of the treatment of patients with pulmonary bleeding through widespread use of endovascular surgery methods for hemostasis.
Materials and methods. Method of endovascular embolization of bronchial arteries is widely used in our clinic SI «Zaycev V. T. Institute of General and Emergency surgery of NAMS of Ukraine» not only as independent surgery in patients with LB, but also as way of preparation of patients with lung bleeding for planned thorax surgery. The most of the often spread nosological forms complicated by bleeding in our research were polycystic lung disease, chronic obstructive pulmonary disease, bronchiectasis disease, community-acquired pneumonia. Indications to the сatheter embolization procedure of bronchial arteries are the following: conservative treatment failure, hemoptysis in patients with bilateral inflammatory processes who was not prescribed surgical treatment for a range of reasons, absence of gross structural changes, lung resection, mainly in patients with oncologic lung injury, at massive and life-threatening profuse bleedings as a mean of temporary or constant hemostasis. Discussed treatment method is applied only in bleeding or within a 6 – 12 hour after its treatment. Successful result in embolization can be obtained in 79–99 %.
Results. As a result of complete physical examination of patients with LB, it has been established that lung hemorrhage was the result of obstructive bronchitis in 14 patients (42 %), there was chronic obstructive pulmonary disease in 7 (21 %) patients and bronchiectasis was diagnosed in 6 (18 %) patients. In 2 (6 %) patients pulmonary hemorrhage was caused by community-acquired pneumonia. Central lung cancer was detected in 4 (12 %) patients.
Conclusion. Therefore bronchial artery angiography gives high efficiency in solving the problem of hemostasis in oncological and nonspecific lung diseases, for determination of localization and source of bleeding. Endovascular occlusion of bronchial arteries in pulmonary hemorrhage permits:
– to elaborate diagnosis because of the presence of specific angiographic signs of malignant tumour;
– to perform effective endovascular hemostasis;
– to gain time for stabilization the patient with the aim of planned surgical treatment
ANALYSIS OF THE CREATION OF A MODERN PHARMACEUTICAL SUPPORT SYSTEM IN UKRAINE IN A RETROSPECTIVE DEVELOPMENT OF THE STATE AND CIVIL SOCIETY RELATIONS
Get PDFThe effectiveness of the system of pharmaceutical supply to the population depends on the proper interaction of the state and market mechanisms for regulating the interests of all subjects of the pharmaceutical market for the implementation of the social policy of the state regarding the availability of quality and effective medicines for the population. In the context of healthcare reform, the issues of assessing the main stages of the development of the pharmaceutical supply system of the population become especially relevant.
Aim. Determination of key, from organizational, economic and social points of view, stages of formation of the domestic system of pharmaceutical supply of the population, analysis of the main tendencies of its development in retrospect years.
Materials and methods. The materials of the research were selected by the regulatory acts, the data of the specialized literature, certain aspects of activity of subjects of the pharmaceutical market, etc. Methods such as historical, informational-analytical, analytical-comparative, systemic, logical, hypothetical-deductive and generalization were used.
Results. Based on the conducted research, five stages of the formation of the pharmaceutical supply system have been identified and outlined, which differ fundamentally across the range of criteria for analyzing effectiveness in building relationships between the state, civil society and the professional community. These stages were elaborated in accordance with the results of the analysis of the nature of relations between the authorities and society under the conditions of gradual transition from paternalistic to the elements of the patient-oriented model of medical and pharmaceutical services to the population: 1) 1990–1993; 2) 1994–2000; 3) 2001–2007; 4) 2008–2013; 5) from 2014 to the present. It has been proved that the stages of development of the domestic pharmaceutical supply system depend to a large extent on the nature of the influence of external environmental factors: changes of political elites in the country, global and internal financial crises, changes of priorities of the state development, breaking of social consciousness of the population against the background of political crisis, etc. It should be noted that the most important in terms of positive, first of all socio-economic, development characteristics is the fourth stage of formation (2008-2013) of the domestic system of pharmaceutical supply of the population. The last period (since 2014) is characterized by the existence of a crisis of relations between all subjects in the system of pharmaceutical provision of the population against the background of systemic transformations in the state, strengthening of the role of public professional associations and critical raising of public expectations from the state regarding the organization of providing affordable medical care to the population. and pharmaceutical assistance in the face of mass impoverishment.
Conclusion. The basic stages of the formation of the domestic pharmaceutical supply system are defined and their characteristics are envisaged, which allow to form in the future fundamentally new approaches to building rational, economically speaking, and simultaneously socially responsible relations between different subjects in the pharmaceutical market
CLINICAL SPECIFICITY OF ADAPTATION DISORDERS IN STUDENTS
Get PDFAim: To study the clinical features of the adaptation disorders state of medical students.
Material and methods of research: To solve the aim, following the principles of bioethics and deontology, a comprehensive clinical-anamnestic, clinical-psychopathological and psychodiagnostic examination of 412 students of both sexes (216 women and 196 men), Kharkiv National Medical University, average age 18.0±2.0 years. Among the surveyed 215 students of eastern Ukraine; 87 students – residents of Luhansk and Donetsk regions, enrolled in KhNMU to the beginning of the ATO and 110 students – migrants from the ATO zone.
Research methods: clinical, psychopathological, psychodiagnostic, statistical.
Results As shown by the results of the study, 27.0±1.7 % of students from eastern Ukraine, 36.4±1.9 % of students from residents of Luhansk and Donetsk regions who entered KhNMU for the beginning of the ATO and 92.2±3.1 % of students are migrants disadaptive states detected from the ATO zone.
In the course of the work, it was established that disadaptive states of medical students manifest anxiety and depressive disorders. Depressive disorders were characterized by a lowered background of mood, affect of anguish and expectation of unhappiness, psychomotor inhibition, fixation on negative events, depressive self-assessment, reduction of the level of impulses, the presence of moderate and severe depressive episodes on the Hamilton depression scale
Anxiety disorders were characterized by the dominance of the general anxious mood background with a sense of internal tension, anxiety with inability to relax, irritability, aptitude for affinity reactions, hyperesthesia, internal stress, violation of the sleep-wake cycle, presence of moderate and severe anxiety episodes on the Hamilton depression scale, high level of reactive anxiety and personal anxiety on the Spielberger-Khanin scale and excessive nervous and mental voltage on the Nemchin scale.
Conclusions.
Migrant students show a higher level of adaptation disorders, compared to students who enrolled in KhNMU at the beginning of the ATO, in 27.0±1.7 % of the examined I groups, 36.4±1.9 % of the examined II and 92.2±3.1 % III group revealed disadaptive states
The clinical picture of disadaptive states of presentation is a combination of anxiety and depressive symptoms with a predominance of moderate and severe anxiety and depressive episodes, high levels of reactive anxiety and personal anxiety and excessive psychological stress
EVALUATION OF THE INTERNAL PICTURE OF HEALTH IN PATIENTS WITH ACUTE CORONARY SYNDROME IN PRESENTING WITHOUT ST-SEGMENT AFTER PERCUTANEOUS CORONARY INTERVENTIONS AND IN THE PROCESS OF REHABILITATION
Get PDFIschemic heart disease remains an actual problem of modern clinical and rehabilitation medicine. One of the forms of ischemic heart disease (IHD) is an acute coronary syndrome (ACS) in patients presenting without persistent ST-segment, the treatment of which involves the use of conservative treatment and reperfusion techniques. An integral part of the management of patients after acute coronary syndrome is rehabilitation and restoration with the search for methods of changing the attitude of the patient to his health. To improve the rehabilitation of patients it is important to assess the internal picture of health with the formation of the correct attitude of the patient to his health.
Aim. To study the peculiarities of the components of the internal picture of health in patients with acute coronary syndrome in patients presenting without persistent ST-segment in the process of treatment and rehabilitation.
Materials and methods. There were examined 135 patients with ACS presenting without persistent ST-segment, who were divided into the groups depending on the treatment performed; 60 patients with conservative treatment tactics and 75 patients with the performed PCI. The analysis of the internal picture of health was carried out with the help of methods: hospital scale for the detection of anxiety and depression (HADS); patient health questionnaire (PHQ-9); scale for measuring the level of reactive (situational) and personality anxiety of Spielberg-Hanin; SF-36; indicators of the Seattle Quality of Life Questionnaire for Patients with Angine Pectoris (Seattle Angina Questionnaire - SAQ).
Results. The study of the internal picture of health in patients with ACS presenting without persistent ST-segment showed low levels of emotional, sensory, cognitive, value-motivational, behavioral components on the appropriate scales, which also depend on the method of treatment used. The revealed peculiarities of patients with ACS presenting without persistent ST-segment need to increase the knowledge of the patient about the disease and the importance of rehabilitation measures.
Conclusions. In assessment of the internal picture of health in patients with ACS presenting without persistent ST-segment after transcutaneous coronary intervention and in the process of rehabilitation, it has been determined that the course of ischemic heart disease in patients with ACS presenting without persistent ST-segment, both during conservative treatment and in the course of PCI at the stages of rehabilitation, is accompanied by significant changes of the internal picture of health (IPH); the most significant changes in patients with ACS presenting without persistent ST-segment is the value-motivational and behavioral components of the internal picture of health. In order to increase the effectiveness of rehabilitation after ACS, it is advisable to apply programs that will significantly affect the positive changes in the rehabilitation of patients with ACS
DEVELOPMENT OF PREVENTING MEANS FOR RABBITS’ COCCIDIOSIS
Get PDFThe great problem of rabbits breeding today is coccidiosis. An agent of the disease spreads not only through ill animals and is preserved well in the external environment. Oocysts of coccidia live in cells for a long time, so even temporal vacation of an accommodation between placing of rabbits doesn’t prevent infection. It was experimentally proved, that there is a very limited spectrum of means that are coccidiostatics. For preventing and controlling rabbits’ eimeriosis, coccidiostatic means were tested. It is very difficult to annihilate coccidia in vivo and in vitro because of peculiarities of their construction. The aim of the first experiment was to determine the influence of an acidifier Cronocyde L and its components on oocysts of coccidia that allows to determine an optimal composition and concentration of the preparation. At conducting the research, there was used the flotation method of Fulleborn and McMaster one for calculating oocysts. The aim of the second experiment was to determine the influence of the acidifier Cronocyde L standard and Cronocyde L concentrate (1 ml/1l of water) on the intensity of the living mass increment in rabbits. For that there were used clinical, hematological, zootechnical and microscopic methods. Optimal results in the experiment were obtained at using Cronocyde L concentrate and Cronocyde L standard in concentration 0,1 %: maximal growth and health status of rabbits, biochemical indices of blood serum were within the physiological norm. It testifies to the effectiveness of this preparation at eimeriosis of rabbits and to harmlessness for them. The studies, realized under laboratory conditions, prove the effectiveness of the offered means
SELECTION OF A FILLER FOR TABLETS MANUFACTURED WITH DIRECT COMPRESSION METHOD CONTAINING DRY GINGER EXTRACT
Get PDFThe preliminary studies of physico-chemical and pharmaco-technological properties of the dry extract of ginger have determined the need for introduction of different groups of excipients for developing a solid dosage form for the treatment of type II diabetes mellitus.
Aim. To choose the rational filler in the composition of tablets with ginger obtained by direct compression.
Materials and methods. The study object was the dry extract of ginger (DEG) (producer “Megaprom”, Dnepr,Ukraine) and modern excipients for the production of tablets by direct compression: GalenIQ 721 (BENEO-Palatinit Gmb), Flowlac 100 (Meggle Co.), Tablettose 80 (Meggle Co.), Farmaxx (Merck), Microcelac 100 (Meggle Co.), Vivapur 112 and 102 (JRS Pharm), Prosolv HD 90, Prosolv SMCC 50 (JRS Pharm) manufactured in Germany. Pharmaco-technological and physico-chemical properties of the samples were studied according to conventional methods of the State Pharmacopoeia of Ukraine.
Results and discussion. According to the results of the crystallographic analysis, the ability to the moisture absorption, resistance to crushing, disintegration time, fluidity indicators, angle of repose and bulk volume the effect of modern excipients on physicochemical and pharmaco-technological properties of the dry extract of ginger has been studied.
Conclusions. According to the results of microscopic analysis, it has been found, that the rational fillers are GalenIQ 721, Prosolv HD 90, Prosolv SMCC 50, Vivapur 102 and Vivapur 112, as they provide a uniform system and the necessary resistance to destruction. The study of the kinetics of the moisture absorption has shown that addition of the fillers significantly reduces the increase in moisture compared to the dry extract. The mixture with GalenIQ 721 has the lowest parameters of moisture absorption at a relative air humidity of 45 %, 75 % and 100 %. In accordance with the results of the pharmaco-technological studies, it has been found that addition of GalenIQ 721 leads to improved flowability, disintegration, settling qualities; it indicates the feasibility of its inclusion into the composition of the solid dosage form
TRANSFORMATION OF STRUCTURAL COMPONENTS OF MASTICATORY MUSCLES OF IMMATURE ANIMALS IN DIFFERENT STAGES OF MERCAZOLILUM-INDUCED HYPOTHYROIDISM
Get PDFThe aim of the study. The aim of this study was to establish the features of the structural organization of the chewing and lateral pterygoid muscles of immature rats during the developmental stages of experimental hypothyroidism.
Materials and methods. The material for the study was the chewing and lateral pterygoid muscles of 48 white mongrel immature rats-males. The following research methods were used: mercazole-induced hypothyroidism modelling, injection method for studying the bloodstream, histological examination of blood vessels and tissue elements, electron microscopy, morphometric analysis, biochemical methods, statistical evaluation of the results.
Results. A violation of thyroid homeostasis (a decrease in the concentration of thyroid hormones in the blood) has been established. In the bloodstream, edematous changes are observed histologically and submicroscopically. A decrease in the number of hemocapillaries per unit area and the number of hemocapillaries per muscle fiber have been established morphometrically. In muscle fibers, cross striation with vacuolization of endomysia and perimisia is lost. Edematous changes are observed, which are aggravated depending on the duration of experimental hypothyroidism. The glycolytic muscle fibers are more affected, and the changes are aggravated depending on the duration of the experiment. It has also been found out that there is a redistribution in the amount of muscle fibers. There is a tendency to a decrease in oxidative-glycolytic and a significant increase in glycolytic muscle fibers.
The morphological changes that have been found out are accompanied by violations of the macroelement balance, in particular, the content of Ca, P, Mg, which determine the functioning of skeletal muscle tissue.
Conclusion. Thus, at different periods of hypothyroidism, edematous changes occur both in the vascular wall and in muscle fibers, which are aggravated depending on the duration of hypothyroidism and are caused by a decrease in the basic metabolic rate, slowing of redox processes and tissue hypoxia. At the same time, chromotropic substances are released from bonds with proteins and accumulate in the intermediate substance with the subsequent replacement of collagen fibers by mucus-like masses
EVALUATION OF SERUM HIGH-SENSITIVITY C-REACTIVE PROTEIN LEVELS DURING VARIOUS PERIODS OF PREGNANCY IN WOMAN, INFECTED WITH PARVOVIRUS - B19 INFECTION
Get PDFThe aim of the research was analyze of C-reactive protein levels in serum blood samples during various periods of pregnancy in women, infected with parvovirus B19 and in case of presence of clinical complications.
129 pregnant women, infected with parvovirus B19 infection and 16 women with physiological pregnancy during first, second and third trimesters of pregnancy were examined. Depending on the presence or absence of clinical complications each group of pregnant women (I, II, III) was divided into two subgroups. The concentration of C-reactive protein in blood serum was determined by the method of immunoassay analysis using diagnostic sets of reagents (ELISA kits, USA). Statistical processing of data was carried out using the package of applied programs Microsoft Office Excel 2010 and StatSoft Statistica 6.1.
The mean age of pregnant woman in our study was 26±6 years. In the Iand II groups of infected B19 parvovirus pregnant women were identified a significant increasing of C-reactive protein levels compared to controls by 62.5 % and 50.0 % (p<0.05). The largest increasing of C-reactive protein level relative to control values was observed in women with clinical complications in different pregnancy periods (p<0.05).
An increase levels of the marker of systemic inflammation the C-reactive protein in the blood testifies to its active participation in the launch of a complex mechanism for the development of labor activity and the occurrence of fetal disorders, which was confirmed in groups of pregnant women with clinical complications in different periods of pregnancy
TEST-RETEST RELIABILITY OF UKRAINIAN VERSION OF THE HAEMO-QOL QUESTIONNAIRE
Get PDFBackground: Today psychometric characteristics of Ukrainian version of the questionnaire Haemo-QoL remain researched insufficiently. This publication describes the procedure and results of the test-retest reliability of this questionnaire in children with hemophilia A.
Objectives: Study the test-retest reliability of the Ukrainian version of the Haemo-QoL questionnaire for assessing the health-related quality of life (HRQoL) in children with hemophilia A, and determine the possibility of its use in practical and theoretical medicine in terms of time reliability.
Methods. The quality of life assessment (QoLA) was performed using the correspondence method, by interviewing 32 children with hemophilia A (self-report) and 32 parents of the children (proxy-report). The questioning was conducted twice at intervals of 4–6 weeks (primary test and re-test). The Haemo-QoL questionnaire version of age group I (4–7 years old), II (8–12 years old) or age group III (13–16 years) was used to measure the quality of life in children with hemophilia; and three versions were used for parents of children of corresponding age groups. These interviews were analyzed, the correlation between the data of primary test and re-test was determined using Spearman's rho, Pearson correlation coefficients, Wilcoxon’s W criterion, Cohen's d effect size was determined for separate comparisons.
Results: HRQoL indices are not statistically different between tests on all scales (p>0.05), except for the “Family” and “Others” scales (p<0.05). Total HRQoL is statistically different (p=0.0013), however, with a median difference of 0.25 only and an average absolute difference variability of 1.67±1.51 (5.42±2.83 %). Total HRQoL in parent versions did not change statistically, unlike the children’s versions, but the difference between the tests was only 1.32 and Cohen’s d ES - 0.08. For versions Ip, IIp, IIIc/p there was no statistical difference, the versions Ic and II statistically differed (p=0.038; t=–2.39 and p=0.0022; t=–3.98, respectively) with a mean difference of 2.0 and 1.6, respectively.
Conclusion: The Ukrainian version of the Haemo-QoL questionnaire has sufficient test-retest reliability for quantitative dynamic reflection HRQoL in patients with hemophilia A
HYPOMETHYLATING AGENTS IN TREATMENT OF MYELODYSPLASTIC SYNDROME
Get PDFThelkey to the successful treatment of myelodysplastic syndrome is the careful characterization and diagnosis of the disease, which includes clinical, cytogenetic, biological and molecular investigation of individual patients. Today therapeutic approaches to the treatment of such patients are differentiated and depend, first of all, on the subtype of the disease, age, general condition of the patients and the possibility of allogeneic hematopoietic cell transplantation. For young patients, the best option is transplantation, whereas in older patients, the standard of therapy is the use of hypomethylating agents (azacitidine, decitabine). These drugs promote hematologic improvement, elimination of transfusion dependence and prolongation of the duration of both general and leukemia free survival in elderly patients with concomitant pathology.
Despite the fact that therapy with hypomethylating drugs is widely used and has good results, many respondents are losing their response within 1–2 years. Reasons for the development of resistance to this type of treatment are still unclear, and the insensitivity to drugs is associated with very poor prognosis in patients with all subtypes of myelodysplastic syndrome. Such data and the presence of numerous genetic and epigenetic mechanisms for the development of this pathology have prompted the use of combinations of drugs with different application points and are relevant in terms of research. In the literature review, the results of clinical studies on the use of hypomethylating agents in patients with MDS of low and high risk, as in monotherapy and combined schemes are presented.
The nearest prospect of treatment of myelodysplastic syndrome is the creation of new treatment regimens based on a combination of drugs of different pathogenetic direction for the elimination of the dysplastic clone in order to achieve not only long-term remissions, but also lengthening the duration of overall survival, especially for patients with high risk myelodysplastic syndrome