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APPLICATION OF DIGITAL TOMOSYNTHESIS IN DIAGNOSING SPINAL TUBERCULOSIS – FIRST CLINICAL EXPERIENCE IN UKRAINE
Get PDFDiagnosis of tuberculous spondylitis is based on the comparison of clinical-laboratory, bacteriological data and radiological methods. Digital tomosynthesis is a new method of X-ray diagnostics for performing with high-resolution limited-angle tomography at short-pulsed exposures in one pass of the tube with reconstruction of several hundred longitudinal sections of the research object without superposition of tissues. Possibilities of tomosynthesis are studied for various clinical situations.
Aim of research. To study and apply the possibilities of digital tomosynthesis in the diagnosis of tuberculous spondylitis, conduct a comparative analysis with other radiological methods.
Materials and methods. Digital tomosynthesis was performed for 95 patients with various spine diseases (select group 8.4 % with tuberculous spondylitis) at the domestic digital roentgen-diagnostic complex with the mode of digital tomosynthesis after performing digital projectional radiography of spine.
Results and discussion. The benefits of tomosynthesis were shown and a comparative analysis with other visualization methods in the diagnosis of spondylitis was performed. Cases of the first clinical application of the method in Ukraine were demonstrated.
Conclusion. Digital tomosynthesis of the spine is a new promising diagnostic tool by which you can obtain qualitative spine images in the form of numerical thin sections with no exaggeration effect. Results are comparable to CT data for detecting bone destruction at lower radiation load levels. Digital tomosynthesis provides better visualization of the small joints of the spine and the ability to evaluate each anatomical element of the vertebra at different depths, helps to detect pulmonary manifestation of tuberculosis
THE STUDY OF THE LEVELS OF METALLOPROTEINASES, CYTOKINES AND LYMPHOCYTE ACTIVATION MARKERS IN SEMINAL PLASMA OF MEN, DEPENDING ON FERTILITY
Get PDFThe study of the concentration of metalloproteinases, pro- and anti-inflammatory cytokines, lymphocyte activation markers in seminal plasma of men with oligosymptomatic forms of chronic inflammation of the urogenital tract (CIUT), depending on the fertility rate are presented in the article.
Quantitative characteristics in male sperm with different forms of pathospermia were studied for matrix metalloproteinases (MMP) -2 and MMP-9 and their inhibitors - tissue inhibitors of metalloproteinases (TIMP)-1 and TIMP-2. It was shown, that during chronic inflammation of the urogenital tract of men are shifting levels of cytokine profile, reducing the concentration of metalloproteinase-2, chemokines - fractalkine and regulated by activation, expression and secretion of normal T-cells (RANTES), sharp increase in IL-8, MCP-1 and elevation of the CD25+ / CD95+, indicating that the disturbance of apoptosis of pathological forms generative cells and their accumulation in the sperm.
The ratio of immunological indices IL-2/IL-4, IL-10/IL-12 was calculated and a significant increase in the IL-10/IL-12 index was noted in the group of individuals with elevated levels of hypercapitated form of sperm, and a reduced proportion of this ratio was observed in the microsomatic morphology of sperm. Prolonged inflammation in the genital area accompanied by depletion of the local immune system, resulting in the development of infertility.
Immunocorrection therapy for men with CIUT should take into account the peculiarities of changes in local immunity and be differentiated depending on the prevalence of certain pathological forms of sperm and changes in the cytokine profile of the seminal plasma
PROGNOSTIC VALUE OF COGNITIVE TESTS AND THEIR COMBINATION IN PATIENTS WITH CHRONIC HEART FAILURE AND REDUCED LEFT VENTRICULAR EJECTION FRACTION
Get PDFImpaired cognitive function (CF) is common among patients with CHF and is an additional factor impairing the quality of life, adherence to treatment, and hence the clinical prognosis in this category of patients.
The aim of this work was to study the prognostic significance of individual cognitive tests, as well as their combination in patients with CHF with a reduced left ventricular ejection fraction (LV EF).
Materials and methods. The study was conducted in the Department of Heart Failure of National Scientific Center "M.D. Strazhesko Institute of Cardiology" National Academy of Medical Sciences of Ukraine, in the period from 01/01/2016 to 04/27/2018. A total of 124 patients with CHF between the ages of 18 and 75 years, II-IV functional classes by NYHA were examined. The cognitive function was assessed using the Schulte test, Mini-Mental State Examination scale (MMSE); HADS scale. Cognitive dysfunction (CD) was considered as MMSE ≤26 points. To construct the survival curves and the onset of the combined critical event (death or hospitalization), the Kaplan – Meier method was used, the significance of the differences between the curves was determined using the log-rank criterion. Differences were considered statistically significant at p <0.05.
Results. The MMSE scale was highly informative regarding the prediction of survival and the onset of a combined critical event (death or hospitalization) in patients with CHF and reduced LVEF even after correction of the compared groups by age and functional class according to NYHA (p=0.025 and p=0.049, respectively). Using the same sample, Schulte showed low prognostic significance regarding survival and reliable informativeness regarding the onset of the combined critical event, which, however, was leveled after correcting the compared samples by age and functional class NYHA (p=0.798 and p=0.240, respectively). The inclusion in the prognostic algorithm of estimating the sum of points on the HADS depression scale allowed increasing the degree of reliability of differences between the compared groups of patients with CD and without CD in terms of both long-term survival and the onset of a combined critical event (death or hospitalization) (p=0.006 and p=0.001 respectively).
Conclusions. The MMSE scale is informative regarding the prediction of survival and the onset of a combined critical event in patients with CHF and reduced LVEF. Schulte's test does not have the prognostic information indicated above, however, the inclusion in the algorithm of the sum of points on the HADS depression scale allows to increase the degree of statistical confidence in the compared groups
INVESTIGATION OF THE CHEMICAL COMPOSITION AND EFFICIENCY OF SEED OIL OF SPINDLE TREE (EUONYMUS EUROPAEA L.) ON THE MODEL OF NON-ALLERGIC DERMATITIS
Get PDFThe aim of the research was to study the chemical composition and effectiveness of the seed oil of Spindle tree (Euonymus europaea L.) on the non-allergic contact dermatitis model.
The oil was obtained by the extraction by petroleum ether from the seeds. The analysis of fatty acids and determination of their quantitative content was carried out using gas chromatography. Determination of carotenoids and tocopherols content in fatty oils was carried out after chromatography on a silica gel column. Investigation of anti-inflammatory action of the Spindle tree seed oil on white rats was carried. Determination of biochemical parameters of blood plasma was performed on the semi-automatic biochemical analyzer BS3000M (Poland).
The yield of oil was 20–28 % of the weight of the seeds. Nine fatty acids were identified in the oil by the gas chromatography, among which 4 are unsaturated (oleic, palmitoleic, linoleic and linolenic), which together make up 87.79 % of all fatty acids from this oil. Spindle tree oil contains 26±5 mg – % carotenoids and 40±5 mg – % tocopherols, which were separated by chromatography on a silica gel column. There were no symptoms of intoxication with the introduction of Spindle tree oil in the stomach of rats and it can be classified in the 4 the grade of danger in accordance with GOST 12.1.005-88.
The anti-inflammatory activity of Spindle tree oil in comparison with the oil of Sea buckthorn on the model of non-allergic contact dermatitis was weaker, but sufficient to recommend it for the treatment of skin diseases in ointments
THE ROLE OF PROTOZOAL INFESTATIONS IN CHRONIC INFLAMMATION EXACERBATIONS IN PATIENTS WITH GENITOURINARY PATHOLOGY
Get PDFThe aim: to study the prevalence of protozoal infestations in cases of acute inflammatory exacerbations in genitourinary clinic.
Materials and methods. The method of polymerase chain reaction was used to examine 158 subjects with chronic inflammation of the genitourinary system exacerbations.
Results. Infestation of the genitourinary system was identified in 72 patients (45.6 %). Trichomonas infestation was identified in 63 (87.5 %) of them. Trichomonas vaginalis was identified in 1 (1.4 %) subject. Other Trichomonas species – in 62 (86.1 %) subjects. 12 (16.7 %) had Trichomonas tenax, and 50 (69.4 %) – Pentatrichomonas hominis. Giardia lamblia was identified in 9 patients – i.e. in 12.5 % individuals with infestation of the genitourinary system, or in 5.7 % among subjects examined for STIs in this study.
Conclusions: High level of Trichomonas infestation of the genitourinary system was identified in subjects with of chronic inflammatory exacerbations of the genitourinary system. In most cases, infestations were caused by Trichomonas species other than Trichomonas vaginalis, as well as by Giardia lamblia. An assumption about a certain role of these pathogens in the onset or further course of inflammatory diseases of the genitourinary system was made
MEDICAL PSYCHOLOGICAL MOODS OF THE DOCTORS STARTING THE TRAINING AT THE QUALIFICATION IMPROVEMENT COURSES (BASED ON THE RESULTS OF THE SOCIOLOGICAL STUDY)
Get PDFThe quality of medical care depends on the training of specialists, carried out, in particular, through continuous medical education.
Aim. To form the recommendations for improving the postgraduate medical education system in the context of the overall reform of the health care system.
Materials and methods. The survey involved 823 doctors who were starting the training at the qualification improvement courses (27.40 % – males and 70.60 % – females) aged from 24 to 50+. In order to realize the purpose of the study we used, as the main method of social psychological information collecting, the method of questioning in the form of standardized (formalized) interview.
Results. Doctors of all specialties used knowledge acquired during previous courses, although with certain differences. Significant difference was found in satisfaction with the level of obtained practical skills during previous courses: 81.04±1.66 % of surgeons, therapeutic, pediatric, dental specialists were very satisfied or rather satisfied, when this indicator in case of doctors of the medico-prophylactic and pharmaceutical specialties was only 39.02±3.00 %. Regarding the level of theoretical knowledge, 85.51±1.49 % of surgeons, therapeutic, pediatric and dental specialists were very satisfied or satisfied with the theoretical part of qualification improvement courses and 57.20±3.05 % of doctors of the medico-prophylactic and pharmaceutical specialties were not satisfied or completely dissatisfied. 85.15±1.50 % of doctors of surgical, therapeutic, pediatric and dental specialties completely or partly used the ideas offered during the previous courses, when 31.82 ±2.87 % of the doctors of the medico-prophylactic and pharmaceutical specialties did not use anything in their practice. 72.42±1.56 % of doctors of all specialties consider that they have not yet reached their own career maximum. Almost half of doctors of all specialties wanted to receive more theoretical and practical knowledge during the courses, although 40.15±3.02 % of doctors of the medico-prophylactic and pharmaceutical specialties were interested in obtaining large volumes of information from their foreign counterparts, while only 4.29±0.86 % of doctors of surgical, therapeutic, pediatric and dental specialties were interested in gaining such information.
Conclusion. The survey indicates the need to change and update the content of the qualification improvement courses work programs, as well as the creation of new ones, which is a prerequisite for the reorganization of the postgraduate medical education system. It is reasonable to create curricula and programs according to the specialties of doctors and basing on the previous survey results concerning queries and expectations
«NOVUMEDICAL» DEVICES ARE THE VECTOR OF REALIZATION OF P4 MEDICINE COURSE
Get PDFThe issues of modern personified preventive medicine, the development of modern methods, courses, technologies of healthy active longevity are in the focus of attention and these issues are relevant. The purpose of the article is to study the influence on prevention of diseases, improving the quality of life by massage and thermal device «NovuМedical» intended for home use.
In the research the analysis of results of the equipment use in 140 patients aged from 61 to 78 years is conducted by the method of comparison and grouping. A significant improvement in the quality of life, stabilization of the psycho-emotional state and blood pressure is noted among 93.5 % of patients. Reduction of pain syndrome is noted among 85 % of patients, reduction in serum cholesterol is noted among 30 %, glucose normalization is noted among 25 % of patients, and 46 % has a tendency to reduce it. A tendency to normalize blood coagulation function is noted among 40 % of patients, that makes prevention and correction of diseases legitimate and necessary, timely with the help of «NovuMedical» devices at home. «NovuMedical» devices allows both to improve well-being, normalize homeostasis, and to form in patients a system of knowledge and skills to improve the quality of life, and include them in active actions for health self-improvement, mental and physical self-improvement. This participatory approach leads to a fundamentally new paradigm of caring and managing health, when not only the social institutions of the state, but also patients themselves are direct and active participants in the process of preserving and strengthening their own health
THE EFFICIENCY OF GLUCOCORTICOID THERAPY IN SECONDARY-PROGRESSIVE COURSE OF MULTIPLE SCLEROSIS
Get PDFWe have investigated the efficacy of pulse-therapy with glucocorticoids (GC) at different time stages (in debuts, at the recurrent stage and at the stage of progression) of secondary progressive course (SPC) of multiple sclerosis (MS) in 70 patients (57 women and 13 men) at the ages from 28 to 67 years (mean age 45±2.5 years). The duration of the disease accounted for 7 up to 34 years (average duration was 19.8±2.3 years). We have conducted 438 courses of GC therapy: at the onsets – 11, at the recurrent stage (RS) – 178 and at the stage of secondary progression-249.The efficacy of hormonal therapy was assessed taking into account the following criteria: the dynamics of regression of neurological symptoms under the influence of the first course of GC therapy at the stage of onsets; a comparative evaluation of remission’s duration after admission and without taking GC at the onsets; duration of RS depending on the duration of remissions after the first course of GC therapy; a comparative evaluation of remissions’ duration after the 1st (at the stage of onset and/or on the RS), and the period of stabilization on the SPS before the last courses of GC; the variants of secondary progression under the influence of GC courses; scores according the EDSS disability scale after the 1st and before the last course of GC therapy; the rate of progression under the influence of the repeated courses of GC therapy.We have defined the three categories of efficacy at the repeated courses of pulse therapy with GC: the moderate efficacy, the low efficacy, the lack of efficacy. We have not observed the high efficacy in patients with SPC.The patients with MFR <1.0, among which the pulse therapy with GC promoted the prolongation of RS, relieved the severe (less often) and moderate (more often) relapses, the outcome of which was accompanied by a moderate and stable neurologic deficit, were subsumed under the subgroup with moderate efficacy (21 individuals). The most favorable progressive variant of progression prevailed in these patients after transformation of RS into SPS.The patients with different rate of MFR (9 – with MFR <1.0 and 12 – with MFR>1.0), with short (more often) and moderate (less often) RS, during which the accumulation of neurological deficit due to the frequent and heavy relapses had occurred, were subsumed under the subgroup with low efficiency (21 individuals). After transformation into SPS, the recurrent variant of progression prevailed in these patients.The patients who were characterized by short RS, by predominance of severe and prolonged relapses, the MFR value greater than 1.0, the steady accumulation of a pronounced and persistent neurologic deficit, a high rate of progression and high scores on the EDSS disability scale more than 6.5 points) were subsumed under the subgroup with the lack of efficacy (28 individuals). After transformation in the SPC, the most unfavorable variant of progression prevailed (21 patients); significantly less frequent were the recurrent (5 patients) and a combination of a steady and recurrent (2 patients) progression. The persistent lack of efficacy of the hormonal therapy in this subgroup of patients was most likely associated with the genetically determined low individual sensitivity to GC.Therefore, the results of our study showed that the efficacy of GC therapy in SPC of MS is determined by the complex interaction of clinical indicators having the prognostic value, as well as by the number of the genetic factors, which require their further observation
PROGNOSTIC VALUE OF KIDNEY FUNCTION PARAMETERS IN PATIENTS WITH CHRONIC HEART FAILURE AND LEFT VENTRICULAR REDUCED EJECTION FRACTION
Get PDFChronic heart failure (CHF) is a complex clinical syndrome characterized by progressive course, unsatisfactory quality of life, poor prognosis and high incidence of concomitant renal dysfunction (RD).
The aim of our work was to study the prognostic value of a number of renal function indicators in patients with CHF and a reduced left ventricular ejection fraction (LVEF).
Materials and methods. 134 patients with stable CHF and reduced (<40 %) LVEF, II-IVNYHA class were examined. Patients were divided into two groups according to the level of GFR: the first group of GFR<60 ml/min./1.73 m², the second – GFR≥60 ml/min./1.73 m². The average follow-up period was 13.4 months, the maximum was 27.5 months.
Results. In 53 patients RD was detected (glomerular filtration rate was ˂60 ml/min/1.73 m²), which was 39.5 %. Patients of both groups did not differ in their main hemodynamic parameters, left ventricular ejection fraction, and pharmacotherapy structure, but were older in age and heavier clinically. After the analysis of survival curves of patients depending on GFR, a group of patients with RD had a significantly worse survival prognosis compared to a group without RD. After adjusting the groups by age and NYHA class, the indicated difference was maintained. The subjects were divided according to median levels: blood urea nitrogen, blood urea nitrogen / creatinine ratio, microalbuminuria, albumin / creatinine ratio in urine.
The long-term survival of the formed groups was analyzed. The level of blood urea nitrogen did not significantly influence the prognosis of patients with CHF and reduced LVEF. At the same time, when the groups were divided, depending on the median value of the blood urea nitrogen / creatinine ratio, there was a significantly higher risk of fatal outcome in the group with lower indices. The level of MAU did not significantly affect the survival of patients. In addition, a comparison of the survival of patients with higher and lower values of the albumin / creatinine ratio in the urine revealed a significantly higher risk of death in patients with higher values.
Conclusions:
1. The presence of RD (GFR˂60 ml/min/1.73 m²) is observed in 39.5 % of patients with CHF and reduced LVEF and is associated with their worst long-term survival.
2. The BUN and MAU do not have sufficient predictive information about the forecast of long-term survival of the above category of patients.
3. At the same time, the values of the BUN/ Сreatinine ratio ˂24.5 and the ACR ˃12.7 indicate patients with CHF who have a higher long-term risk of death
DEVELOPMENT AND IMPLEMENTATION OF A NEW CONCEPT OF CRISIS SITUATIONS SYNDROME: "SYNDROME OF A HYBRID WAR"
Get PDFThe aim of our research was basis of the analysis and research of the current state and trends of emergence and development of crisis situations syndromes to identify their general and specific features inherent in specific crisis situations syndromes at the place where they occurred, factors that influenced their formation and the manifestations they characterized by.
Materials and methods - analysis and systematization of data on the complex impact of stress factors and other manifestations of crisis situations on subjects who find themselves in a zone of military conflict / man-made or natural disaster; formulation of new concepts, strategies and tactics for work in crisis situations.
Results. Common and specific features of the known syndromes of wars are found. It is proved that, by common characteristics, all syndromes of wars can be combined into a single basic category - crisis situations syndrome, which is divided by specific features into specific crisis situations syndromes at the place where they occurred, under what factors they were formed and the manifestations they characterize. A classification of post-traumatic stress disorders as a component of crisis situations syndromes by the mechanisms of their formation and a model of their formation are provided. Definitions are formulated; crisis syndrome and hybrid war syndrome are described. A working table has been developed for analysts for the differential diagnostic of “Crisis Situation Syndromes”.
Conclusions. The technology of objective diagnostic, treatment and prevention of PTSD (post-traumatic stress disorder) and hybrid war syndrome is proposed, which includes the identification of possible etiological factors affecting the formation of crisis states syndromes with differentiation of impact factors, the actual identification with the formation of a differentiated approach to treatment, and prevention development of "coaching" techniques. The technology is based on a comprehensive psychological and ophthalmologic examination. It has been established that the “hybrid war syndrome” is formed both among combatants and non-combatants, for the first time in it the cognitive defeat, both of individual subjects and social groups is fully manifested. In addition, for the first time, in relation to other crisis syndromes, there are social group symptoms, the formation of migratory symptoms, the formation of specific PTSDs, etc