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THE IMPORTANCE OF THE STUDY OF THE HEMODYNAMICS OF THE UTERINE TUMORS BY THE METHOD OF DOPPLEROMETRY IN THE TWO- AND THREE-DIMENSIONAL ECHOGRAPHY MODES FOR DIFFERENTIAL DIAGNOSTICS OF SIMPLE, PROLIFERATING LEIOMYOMAS AND UTERINE SARCOMAS (REVIEW OF LITERA
Get PDFThe article analyzes modern literature data on the importance of studying the hemodynamics of uterine tumors with dopplerometry in two - and three - dimensional regimens of echography for differential diagnosis of simple proliferating leiomyomas and sarcomas of the uterus. It is shown that the differential diagnosis of benign and malignant tumors using the dopplerometry is based on various features of the blood supply of these tumors. On the basis of the analysis of literature data, it was concluded that in the dopplerometry evaluation of benign, borderline and malignant tumors of myometrium in the two-dimensional regime, there were differences in the localization of the detected vessels in the CDM regimen, in the rates of vascular blood flow and vascular resistance in pulse dopplerometry. For a simple leiomyoma, the absence of a central intra-node localization of blood vessels in the CDM regimen, a low rate of arterial and venous blood flow, as well as an average resistance of arterial blood flow in the regime of impulsive dopplerometry are most typical; in a leiomyoma with eating disorders, the absence of a central intra-node localization of blood vessels, a low rate of arterial and venous blood flow in combination with high arterial resistance were more often observed. For the proliferating leiomyoma, the central intra-node localization of the vessels and the average blood flow velocities with low and medium resistance are characteristic. For sarcoma of the uterus, there is abundant vascularization both around the periphery and in the center, high blood flow rates and low resistance. The authors emphasize that there is information about the low specificity of this gradation, since the detection of a central type of vascularization and low resistance values can be in simple myomatous nodes with edema, eating disorders and destruction, and leads to diagnostic errors and suspicion of malignancy. In the three-dimensional dopplerometry mode for simple leiomyomas, low indices of volume perfusion indices were characteristic, and for proliferating leiomyomas and sarcomas of the uterus – high indices of volume perfusion indices exceeding those in the uterus as a whole.
Based on the review of the literature, the authors concluded that the presently available echographic and dopplerometric two- and three-dimensional markers are characterized by high sensitivity, but very low specificity. The low specificity of the known ultrasonic and dopplerometric criteria combined with the rarity of cases of sarcoma in the uterus against the background of a large number of similar echographically and dopplerometrically leiomyomas lead to low diagnostic accuracy of ultrasound diagnostics. This situation requires a further continuation of the scientific search for differential diagnostic ultrasound criteria by leiomyomas and sarcomas of the uterus using modern technologies, including three-dimensional echography
THE ROLE OF GROUP EDUCATIONAL PROGRAMS IN MODIFICATION OF THE CARDIOVASCULAR RISK MAIN FACTORS
Get PDFAim – to study the influence of Healthy Schools "Healthy Lifestyle Basis" education on modifying of cardiovascular risk main factors.
Materials and methods. 57 patients with cardiovascular diseases were examined. General clinical examination, anthropometric examinations (body weight, height, body mass index, and body composition), blood pressure measurement, and cholesterol determination, as well as its fractions in blood, were carried out before and after training course. The educational cycle included 9 lessons.
Results. It was found that Healthy Schools education contributes to better both systolic and diastolic blood pressure monitoring. Thus, initially target blood pressure levels (<140/90 mmHg for patients without diabetes mellitus and <140/85 mmHg in case of diabetes) were observed in 49 % of patients, at the end of the training cycle – in 67 %. At the same time, the patients’ anthropometric parameters (BMI, fat and muscle tissue content, visceral fat) as well as cholesterol and its atherogenic serum fractions, did not change significantly. The patients’ education did not affect motivation level for their lifestyle improvement. So the number of patients consuming less than5 grams of table salt per day and over400 grams of vegetables and fruit did not change significantly. The level of physical activity between the examined patients did not change.
Conclusion. The training course “Healthy Schools: Healthy Lifestyle Basis" contributes to improvement of blood pressure level monitoring, but does not significantly affect behavioral risk factors and does not lead to improvement of lipid metabolism monitoring in patients with cardiovascular disease. It is necessary to search for new more effective preventive care models for patients with high cardiovascular risk
IL-4 POLYMORPHISM IN PATIENTS WITH ACUTE BRUCELLOSIS IN THE REPUBLIC OF AZERBAIJAN
Get PDFCurrently, there are isolated data on the relationship between IL-4 polymorphism (C-589T) and susceptibility to brucellosis. Therefore, the purpose of the study was to determine the frequency of polymorphism of IL-4 (C-589T) in patients with acute brucellosis.
Materials and methods: the article presents the results of surveys of 120 patients with acute brucellosis. The control group consisted of 30 practically healthy persons. The diagnosis of brucellosis was based on complaints, anamnesis, epidemiological and clinical data, and the results of a specific study. The definition of the polymorphism of IL-4 (C-589T) was performed for all patients in the main and control group. A detailed description of patients with brucellosis is presented. Among the observed prevailed men and young people of working age.
Results: A mild degree was established in 74 (61.66 %) patients, while severe - only in 11 (9.17 %) patients. It was determined that the genotype CT (65.83 %) was significantly more common among patients with brucellosis than in the control group, where the frequency of this genotype was only 16.66 %. While the CC genotype was 3.2 times more common among healthy individuals than among patients in the main group (76.67 % versus 24.17 %), it was found that the CC genotype of the IL-4 gene was 13 times more common in patients for acute brucellosis with mild progress than with severe.
Conclusions: The genotype IL-4 (C-589T) SS is significantly associated with the mild course of brucellosis
INFLUENCE OF CONCOMITANT ARTERIAL HYPERTENSION ON ACTIVITY OF INFLAMMATORY PROCESS IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA
Get PDFThe aim of the work was to determine the diagnostic value of the markers of surfactant protein D (SP-D) and C-reactive protein (C-RP) in patients with community-acquired pneumonia (CAP) with concomitant arterial hypertension (AH) and its effects on the activity of the inflammatory process.
The study included 79 people. Among them, 63 patients with CAP and 16 healthy individuals who were a control group. Depending on the presence of hypertension, the patients were divided into two groups. The first group included 26 patients with CAP with AH, the second – 37 patients with CAP without AH. All patients were given general-clinical methods of examination, radiography of the chest organs in two projections. Plasma levels of SP-D and C-RP were determined.
Reliable connection (p<0.05) was determined between the presence of AH and the probability of occurrence of CAP (OR - odds ratio 2.27 [95 % CI 1.05–4.94]). The level of SP-D and C-RP in patients with AH on the first day was significantly higher than in healthy subjects (p<0.05). In patients in the first group, SP-D levels were significantly higher (p<0.05) for the first, third and ninth day relative to the second group. The existence of a direct tie of average strength between the presence of AH and SP-D (R=0.41, p<0.05) has been determined. The presence of a direct correlation link of mean strength (R=0.38; p<0.05) between the AH and the level of C-RP indicates that arterial hypertension in patients with CAP increases the activity of the systemic inflammatory response
INDICATORS OF RESPIRATORY SYSTEM IN CONDITIONS OF CHRONIC ACTION OF HARMFUL ENVIRONMENTAL FACTORS WITH TYPE OF BODY CONSTITUTION
Get PDFThe article presents the results of the study of the peculiarities of the respiratory system functioning in unfavorable environmental conditions in workers involved in industrial production and agrarian sector, taking into account the type of constitution of their bodies. Investigation of the influence of the complex of anthropogenic factors associated with production on the parameters of the respiratory system revealed a significant level of interconnection of the investigated parameters with anthropometric indicators.
During the experiment, a significant decrease in the functional lung capacity in the studied subjects involved in industrial production was shown, compared with the control group and workers of argo-industrial production. Such a trend may be evidence of functional violations of tracheobronchial conduction, which is indirectly confirmed by the values of the Tifno index, which is the main method of an objective assessment of respiratory tract imperfections, and which is characterized by significantly lower values in the group of workers involved in industrial production compared with residents relative to environmentally friendly areas.
The analysis of the pneumatachographic survey performed on the basis of the Pignier index revealed some differences in the functional parameters of the respiratory system in the groups of hyposthenics (capacity of the lungs) and hypersthenics (maximum volume velocity of 75 %). In the group of normosthenics, intergroup differences were found for the values of functional lung capacity in comparison with all groups, and for the Tifno index, the reliable difference between the indicators was noted only between the group of industrial workers and the control group
ENERGY HOMEOSTASIS OF THE ARTIFICIAL BLADDER IN EXPERIMENTAL CONDITIONS
Get PDFPatients with malignant neoplasms of the bladder or severe anatomical and functional bladder abnormalities are the candidates for cystectomy and orthotopic urine diversion. The distal portion of the ileum is the most frequent anatomical organ, which is used for the formation of the urinary conduit. The formation of a urinary reservoir from the ileum that is unable to perform new functions, and mainly programmed to isolate enzymes, digest food and absorb nutrients, salts and minerals changes the energy exchange in the ileum wall under the influence of urine.
The aim of the research is the examination of energy metabolism changes in the ileum wall during the formation of artificial bladder in experimental conditions conducted on mini-pigs. Experimental studies were performed on 21 female mini-pigs with an average age of 6 to 14 months. The duration of the experiment was 12 months. An imbalance of the ATP-ADP-AMP system was observed in the transplant tissue of the graft in different postoperative periods. Changes in the level of ATP are characteristics of the development of tissue ischemia.
Results. The values of the adenosine nucleotides sum (the energy potential indicative of the respiration rate of mitochondria) and the phosphorylation index were lower at different times of observation in the transplant tissue. The energy charge value was lower to a lesser extent relative to the control.
Conclusion. The revealed changes in the level of adenosine nucleotides confirm the severity of the disturbances of the energy homeostasis in the transplant tissue at all stages of the observation
MEDICAL AND SOCIAL CHARACTERISTICS OF PHYSICIANS ATTENDING POSTGRADUATE TRAINING COURSES (SOCIAL SURVEY)
Get PDFThe paper studies professional, social and psychological aspects concerned with a practical activity of physicians referred to attend postgraduate training courses at Danylo Halytsky Lviv National Medical University.
Aim. To develop the recommendations on the improvement in the system of postgraduate medical education under the conditions of general reform in the health care system.
The research was done by the survey method in the form of standardized (formalized) interview that was applied as the main approach to the process of collecting social and psychological information.The survey included 823 physicians referred to attend postgraduate training courses at Danylo Halytsky Lviv National Medical University. The working experience of postgraduate course attendants was the following: up to 5 years – 25.39±1.52 %, 5–10 years – 21.39±1.43 %, 11–15 years – 11.79±1.12 %, 16–20 years – 9.96±1.04 %, 21–30 years – 16.89±1.31 %, more than 30 years – 14.58±1.23 %.
The majority of questioned medical workers (74.24±1.52 %) feel calm and happy at their working place. However, the received data indicates that 23.09±1.47 % of the responders feel disturbance and 1.94±0.48 % experience fear at work. The analysis of the research results allowed differentiating five sharp problems which are very topical and significant at the medical institution where the physicians have been performing their practice. They can be ranged in the following way: the job compensation (42.93±2.09 %), absence of modern medical equipment (26.65±1.87 %), organization of the working process (22.90±1.78 %), reorganization (7.69±1.13 %), extra documentation (7.33±1.10 %). The carried out survey permitted to determine the psychological atmosphere at medical institutions there the course attendants have been practicing. The conflicts are not a characteristic feature of medical institutions, since almost half of the responders indicated the absence of conflicts with higher managers (52.86±1.74 %), direct managers (43.01±1.73 %), subordinate personnel (43.38±1.73 %). This index is somewhat lower concerning the colleagues and patients. It amounts for 36.33±1.68 % and 33.17±1.64 % respectively.
The physicians practicing in medicine and prevention as well as dentistry branches are most disturbed by the lack of financial sources. More than a half of responders (73.86±2.70 %) indicated it by their answers. Other responses included the absence of perspectives – 68.18±2.87 %, extreme, stressful living conditions – 25.38±2.68 %, personal present health status – 20.08±2.47 %, personal lack of confidence – 9.47±1.80 % (the number of responses was not restricted).
The carried out work has showed the necessity of introducing the specialized course “State medical policy”. It should be aimed at delivering the information on the status, perspectives, reforming changes and the expected outcomes resulting from these factors in the branch of medicine. In order to decrease the negative influence of the professional burnout, it is recommended to plan the specialized training classes that are directed on the prevention of the listed above phenomena
COMPARISON OF QUALITY OF LIFE OF PATIENTS WITH LOCAL DISTRIBUTED BREAST CANCER FORMS AFTER CHEMOTHERAPY IN REGIONAL AND SYSTEM REGIMES
Get PDFFor several decades, breast cancer (BC) undoubtedly ranks first in the structure of oncopathology and is the most common cause of the loss of working capacity of the female population in most countries. Considering the increasing quality of care for patients with breast cancer, there is the need for standardization and implementation of methods to assess not only quantitative but also qualitative component of a comprehensive opinion on the results of therapy. Therefore, an important indicator to be taken into account is the quality of life (QL) of a patient.
Definition of QL of patients with inoperable forms of locally advanced breast cancer before and after neoadjuvant courses of systemic polychemotherapy (SPCT) and selective intra-arterial polychemotherapy in combination with systemic (SIAPCT).
154 patients with LA BC T4A-DN0-3M0, who received comprehensive treatment on the basis of the Donetsk regional antitumor center and the University clinic of the Odessa National Medical University during the period from 2000 to 2017, who received SPCT or SIAPCT as a neoadjuvant course, were included in the study.
According to the quality of life during the treatment period, wavelike dynamics with a clear advantage of selective intra-arterial polychemotherapy over the system was observed. According to the quality of health between groups, the marginal statistically significant difference in favour of regional PCTs was formed.
In a detailed study of each of the options found stable symptomatic scale dependent components of the integral index of quality of life on the severity and duration of intoxication syndrome. On the basis of the results obtained, the statistical advantage of the RMRM remains with the regional PCT.
The QL study is a reliable, informative and economical method for assessing the health status of the patient, both at the group and at the individual level. In cancer studies, the evaluation of QL is an important criterion for assessing the effectiveness of treatment and has a prognostic value
SUBSTANTIATION FOR THE TECHNOLOGY OF OBTAINING ANTIMICROBIAL SPRAY ON THE BASIS OF SILVER AND COPPER CITRATES
Get PDFFormation and development of the veterinary pharmacy and veterinary drugs market in Ukraine is an urgent issue. In order to prevent infection of the mammary gland in cows after milking, the nipples are treated with a suitable disinfectant for complete immersion or spraying. However, the agents for the prevention of mastitis, presented in the Ukrainian market, are expensive and there is a need to develop domestic veterinary preparations of different forms of release.
This work is a continuation of research on the development of the composition and technology of a means for antiseptic treatment of nipples and udders of cattle, in the form of a spray, in order to prevent microbial contamination and prevent mastitis.
To obtain a stable veterinary drug based on citrate of silver and copper, the dissolution regimes of the substances were investigated, the order of introduction of the active ingredients and auxiliary substances into the solution, the duration and the rate of stirring during dissolution. It is established that the most optimal are the following technological modes of spray preparation: dissolution temperature 20-220С, mixing time from 10 to 15 minutes, with stirring intensity from 150-200 sec-1. The selected technological regime ensures the stability of the veterinary drug "Argocide-copper" during storage for 12 months. The technology of obtaining a spray in the conditions of industrial production of veterinary preparations of LLC "Brovafarm" (Brovary, Ukraine) is developed. Critical stages and critical control points in the production process of a veterinary preparation of antiseptic action are determined
ESTIMATION OF THE EFFECT OF PLATELET RICH PLASMA PRODUCTS IN THE INTEGRATION OF POLYPROPYLENE MESH IMPLANT IN BIOLOGICAL TISSUES. EXPERIMENTAL MODEL IN RATS
Get PDFThe aim of the research is to determine morphological changes in the area of implantation of the polypropylene mesh implant and to determine the effect on the integration of the prosthesis of locally introduced adipose tissue and platelet rich plasma.
Materials and methods. The experiment was performed on 36 sexually mature males of the Wistar line rats. The experiment simulated, studied and quantified local morphological responses and changes in developing in biological tissues that are in contact with implanted highly porous lightweight (80 g/m2) mesh implant in isolation and also in conditions of local administration of fatty graft and platelet rich plasma.
Results: Assuming introduction of adipose tissue and platelet rich plasma in the zone of integration of mesh alloprosthesis under the influence of introduced regenerative cytokines as well as stromal stem cells activated by them there is an earlier activation of regenerative processes, enhanced angiogenesis which determines the optimal nature of the integration of the prosthesis with the formation of thin collagen fibers in more early terms minimizing excess peri-prosthetic fibrosis. Isolated introduction into the implantation zone of fatty suspension determines similar changes that have a slightly less pronounced character. These changes are quantitatively studied and the results obtained are statistically significant.
Conclusions: Applying a fatty graft together with platelet rich plasma in the area of implantation of the lung polypropylene prosthesis, there was an accelerated tissue reaction from the integration of the prosthesis.
Mesenchymal stem cells of adipose tissue that is a target for plasma cytokines enriched with thrombocytes have a more pronounced effect in stimulating reparative processes provided that they are simultaneously administered with PRP compared with isolated administration without PRP. The use of platelet rich plasma and adipose tissue design has a significant positive effect on local angiogenesis. Under conditions of improved angiogenesis and other stimulating factors in the conditions of introduction of adipose tissue and PRP, the integration of the prosthesis occurs with significantly lower peri-prosthetic fibrosis