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CLINICAL-LABORATORY MARKERS OF FIBRILOGENESIS DISORDERS IN THE SEVERITY OF PYELONEPHRITIS IN CHILDREN
Get PDFAim of the research: to establish the role of undifferentiated connective tissue dysplasia, as a manifestation of violation of fibrillogenesis, in the severity of the course of pyelonephritis in children.
154 children with pyelonephritis from 3 to 18 years were examined. As a result of catamnestic surveillance, they were divided into 2 groups: I – 92 persons, children with chronic pyelonephritis in which were diagnosed 3 or more episodes of relapse of pyelonephritis during the year, and II – 56 children with acute pyelonephritis, in which during the year no relapses were noted. The control group were 65 somatically healthy children of the same age (III - health-control). All children had a routine comprehensive clinical and laboratory examination and clinical and laboratory markers of a fibrillogenic disorder were established.
In children with chronic pyelonephritis, the frequency of all analyzed complaints was significantly higher than in children with acute pyelonephritis without relapses: frequent headaches – 56.52 % versus 25.0 %, appetite loss – 28.26 % vs. 19.64 %, frequent abdominal pain – 52.17 % vr. 32.14 %, increased fatigue – 41.30 % vr. 28.57 %.
In children with chronic pyelonephritis, phenotypic signs of undifferentiated connective tissue dysplasia (UCTD) were significantly more marked, such as joint hypermobility (in 52.0 % of children versus 5.4 %), asthenic body structure (59.0 % vs. 26.78 %), visual disturbance (84.8 % vs. 32.14 %), chest deformity (42.4 % vs. 8.9 %), scoliosis (52.17 % vs 10.7 %), arachnodactyly and predisposition to bleeding were observed only in children of the 1st group (22.5 % and 4.34 % respectively).
In practically all children with chronic pyelonephritis, the values of free and bound oxyproline fractions in blood plasma were significantly increased (47.14±0.03 μmol/l and 40.08±0.03 μmol/l, respectively), according to arithmetic meanings, reliably differing from the data of children with acute pyelonephritis (17.65±0.01 μmol/l and 17.22±0.02 μmol/l), in which these oxyproline fractions were elevated only in 12.0 % and 16.0 % of the subjects.
In 97.0 % of children with chronic pyelonephritis, the level of oxyproline in urine was elevated and significantly exceeded the level of excretion of oxyproline in urine in children with acute pyelonephritis.
The presence of UCTD in a child plays an important role in the process of chronic pyelonephritis, and children with its manifestations have a heavier course of disease with frequent relapses, therefore, the presence of signs UCTD is prognostically unsuccessful, which dictates the need for the appointment of metabolic therapy in the first episodes of the disease in children, if they have clinical and laboratory manifestations of UCTD
THE ROLE OF PEPSINOGENES AND SOME INTESTINAL HORMONES IN PATHOGENESIS OF GASTROESOPHAGEAL REFLUX DISEASE
Get PDF80 patients with gastroesophageal reflux disease (GERD) were examined. The diagnosis of GERD was based on the history of the disease, complaints of patients, the results of daily monitoring of pH in the lower third of the esophagus, data of fibroesophagogastroduodenoscopy, chromoendoscopy, 13C-octanoic breath test, gastrin-17 (G-17) concentration, pepsinogens I and II (P I and II) and cholecystokinin-pancreozymin (C-P) in serum.
After 24 hours pH monitoring of the lower third of the esophagus in 40 patients with GERD, the predominance of acid was found, and the other 40 patients had mixed refluxes. In patients with predominance of acid reflux, the mean values of half-life of solid food evaluation (T1/2) according to 13C-octanoic breath test was (45.25±1.34) min. With the predominance of mixed refluxes in patients, there was a tendency towards hypokinetic motility of the stomach, indicating a slowdown in half-life of solid food evaluation from the stomach up to (139.24±11.87) min. With the predominance of acid reflux also was observed a significant reduction in the concentration of G-17 and C-P, an increase in P I and a decrease in the concentration of P II. Hypergastrinemia, high levels of C-P and P II (37.44±3.41) μg/l (p<0,05) were diagnosed with the predominance of mixed refluxes
PARANOID SCHIZOPHRENIA NEGATIVE SYMPTOMS FEATURES IN CASE OF PRESENCE OF MUSICAL EAR
Get PDFIn our work, we propose one of the options for a prognostic criterion, which at the beginning of the disease can provide sufficient evidence to predict the form and severity of negative symptoms in schizophrenia.
Aim. To investigate the influence of the presence of ear on music on the degree of severity of deficiency symptoms in paranoid schizophrenia.
The study was conducted on the basis of the third clinical department of the Lviv Regional Clinical Psychiatric Hospital for the period of 2015. 40 patients with paranoid form of schizophrenia, aged 18 to 35, were examined, of which: group I – 20 patients with advanced ear on music (average age 28.60±1.01 years) and group II – 20 patients with no ear on music (average age 27.30±1.15 years). The main methods of studying the observation groups were: clinical-psychopathological, pathopsychological, and statistical. The pathopsychological study of the evaluation of negative symptoms was conducted using the "Qualitative Assessment Scale for Positivity, Negative and General Psychopathological Syndromes" (PANSS – Positive and Negative Syndrome Scale), namely, its PANSS-NS subscale. Comparison of the probability of the difference between the average indices of unrelated groups was carried out using the Mann-Whitney method, comparing the relative parameters of the distribution structure by the xi-square criterion.
Analysis of the results of the study shows that in patients with developed ear on music, the level of deficiency symptoms of negative symptoms under the PANSS-NS subclass is 2.2 times lower (p <0.01) than in patients with no developed ear on music: 2.04±0.14 against 4.46±0.17 points, respectively. Comparing the key indicators of the PANSS-NS subscale in patients with paranoid schizophrenia with advanced ear on music, it was found that the manifestations of "Violations of abstract thinking" (N5 – 2.35±0.15 points), "Violation of spontaneity and smoothness in the conversation" (N6 – 2.30±0.15 points) and "Stereotyped thinking" (N7 – 2.20±0.16 points). All these negative symptoms were in patients with muscular earache with significantly lower scores: from lack of severity (1 point) to weakness (3 points). The lack of expressiveness (1 point) was most common in N4 "Passive-apathy social strangeness " - 35.00±10.67 % of patients, very weak severity (2 points) - for N1 "Blurred passion" - 75.00±9.68 % of patients (p <0.05 with the proportion of negative symptoms 1 and 3 points), weakness (3 points) - for N5 – 45.00±11.12 % of patients (p <0.05 with the proportion of negative symptoms 1 point ) The highest proportion (70.00±10.25 %, p <0.05 with a share of negative symptoms of 6 points) of patients with paranoid schizophrenia without ear on music had a high severity (5 points) of rigidity and stereotyping of thinking (N7).
The obtained data prove the influence of the factor of the presence of ear on music on deficit syndrome, as well as on the forms and degree of severity of negative symptoms in paranoid schizophrenia
ESTIMATION OF RESERVES FOR IMPROVING THE RESULTS OF PATIENTS WITH MULTIPRESISTANT PULMONARY TUBERCULOSIS IN THE APPLICATION OF SURGICAL METHODS BASED ON ANALYSIS OF THE EFFICIENCY OF CONSERVATIVE TREATMENT OF A SPECIFIED COHORT
Get PDFIn order to improve the results of treatment of patients with multi-resistant pulmonary tuberculosis with the use of surgical methods, the effectiveness estimation of conservative treatment of 176 patients with this form of tuberculosis according to cohort analysis data in two districts of Kyiv were done.
In the list were included following parameters: type of the tuberculosis, its clinical-radiological form and the prevalence of the process, the results of conservative treatment in patients who completely finished the course of anti-TB chemotherapy and the results of conservative treatment of 81 patients who had indications for surgical treatment but had not been operated. Processing of the materials of the study was carried out with the use of licensed software products included in the Microsoft Office Professional 2007 package. The predicted results of treatment were calculated on the condition of surgical intervention.
Out of the total sample of patients, 31.3 % of the patients completed treatment. Mortality was 16.5 %, transferred to palliative care 11.9 %. More than one in three patients (35.2 %) stopped treatment at different times from the start.
According to the clinic of thoracic surgery SU "National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine ", the overall effectiveness of treatment for patients with limited multidrug-resistant tuberculosis with the use of surgical intervention is about 95 % in the absence of mortality. We have modelled the potential results of treatment of the selected cohort in case of the surgical stage is fully and timely applied in a complex of therapeutic treatment. If all 81 patients with indications for surgical treatment used that way, then, with the above efficiency, a complete cure could be predicted in 77 patients (44.5 % of the total number of observations), which in turn would allow predicting the achievement completion of treatment at 64.2 % with complete cure for 60.6 % of patients.
Thus, it is established that the positive result of surgical treatment in the general complex of treatment measures in patients with multidrug-resistant pulmonary tuberculosis is able to improve the results of treatment of this contingent more than twice, reduce the mortality almost by three times, reduce the need for repeated courses of treatment from 7.4 % to 1.7 %, as well as to reduce the epidemiological reservoir of infection due to a significant decrease in the number of patients with failure to treat tuberculosis, interrupted and palliative treatment
RISK FACTORS AND COMORBIDITY IN PATIENTS WITH ATRIAL FIBRILLATION AND ISCHEMIC HEART DISEASE
Get PDFThe aim of the study was to evaluate the risk factors and the incidence of comorbidity in patients with coronary heart disease, depending on the presence of atrial fibrillation.
Materials and methods of research: a retrospective analysis of 222 stories of illnesses of patients with coronary heart disease who undergo inpatient treatment, aged from 39 to 88 years, has been conducted. Depending on the presence of atrial fibrillation, all patients were divided into 2 groups: group 1 (main) - patients with ischemic heart disease with atrial fibrillation (n = 105), group 2 (comparison) - patients with ischemic heart disease without atrial fibrillation (n = 117).
Results. In the group of patients without AF, the proportion of persons with inherited exacerbations of IHD was 64.29 %, while in the main group - 25.0 %, the differences did not reach the statistically significant level, but this relationship is confirmed by the results of the rank correlation analysis - between the presence AP and heredity revealed a significant weak feedback - c=-0.21 (p<0.05). The diseases that were observed in the examined patients with coronary artery disease present acute violation of cerebral circulation, angina pectoris, acute myocardial infarction, hypertension, diabetes, pathology of the kidneys and the thyroid gland, diastolic dysfunction and obesity. The groups differed in the proportion of patients with stroke - in the group with AF, it was significantly (p=0.002) higher - 23.81 %, in compare to 8.55 % in the comparison group.
Conclusions: The presence of atrial fibrillation in patients with coronary heart disease is associated with a high degree of comorbidity. First of all, with the combination of IHD and atrial fibrillation, a high incidence of hypertension, diabetes mellitus, obesity, acute cerebrovascular disorder, kidney disease and thyroid gland is established
TYPES OF ANGIOPATHY IN EXPERIMENTAL AUTOIMMUNE DISEASE IN RATS
Get PDFThe purpose and objectives of this work were to study the nature of the heart, lungs and kidneys angiopathy in rats with a model of systemic autoimmune disease, carrying out comparisons of the results with extravasal morphological manifestations of the pathological process, the state of vascular endothelial function and activity of pro-inflammatory cytokines in the blood. The experiment was conducted on 40 non-linear rats. To simulate the disease animals were injected by complete Freund's adjuvant, a solution of splenic deoxyribonucleic acid cattle, mercaptopurine, methyluracilum and with food rats constantly received sulfate cadmium, lithium hydroxybutyrate and ammonium molybdate. Within two months from the start of the study animals were taken out of the experiment on the background of intraperitoneal nembutal anesthesia. Histological sections of the heart, lung and kidney tissue were stained with hematoxylin -eosin, alcian blue and by van-Gieson, becoming the PAS-reaction. In the animals with the proposed experimental model of systemic autoimmune disease observed morphological characteristics of lesions of the heart blood vessels, lungs and kidneys, the nature of the manifestations of which were interconnected with each other, which confirms the common pathogenetic angiopathy constructions at various diseases in clinical practice. In the genesis of cardiac, pulmonary and renal vessels lesions act the activation of pro-inflammatory cytokines and violation of vascular endothelial function, which has a certain practical significance. In clinical practice, not only purely systemic vasculitis, and other autoimmune diseases should be treated as angiopathy
STUDY OF REPARATIVE PROCESSES OF BONE TISSUE IN RATS USING OSTEOPLASTIC MATERIAL KLIPDENT PL WITH MEMBRANE KLIPDENT MK AND EASY-GRAFT MATERIAL WITH HYPROSORB MEMBRANE
Get PDFAcceleration of the reparative process of bone tissue after surgical interventions is an urgent issue in surgery and dentistry. One of the methods for replacing lost bone tissue is using an osteoplastic material. There is a question in the choice of better material, which will meet all the requirements of the doctor and fully perform its function. This work studies the activity of reparative processes of bone tissue in rats when the titanium screw is screwed into the femur using synthetic osteoplastic material Klipdent PL with membrane Klipdent MK (“Vladmiva” Russia) and Easy-graft material with Hyprosorb (“Sunstar” Swiss) membrane. The obtained results were compared with a control group in which the similar manipulation was performed without the use of an osteoplastic material. The experimental and morphological study was carried out. Conclusions are drawn about the effectiveness of the materials under study
CHANGES OF INTERLEUKINS IN PATIENTS WITH NOSOCOMIAL PNEUMONIA AGAINST A BACKGROUND OF TRAUMATIC BRAIN INJURY: ROLE IN THE DIAGNOSIS AND MONITORING OF DISEASE
Get PDFIntroduction. Nosocomial pneumonia (NP) is the second leading frequency and mortality among nosocomial infections. NP is a frequent complication of severe traumatic brain injury (TBI). The difficulty in diagnosis and monitoring of disease NP on the background of TBI is that the usual signs NP "masked" manifestations of the underlying disease.
The aim of our study was to improve the diagnosis and assess the effectiveness of the treatment of nosocomial pneumonia with clarithromycin by studying of serum interleukins in patients with nosocomial pneumonia on the background of traumatic brain injury.
Materials and methods. We determined levels of TNFα, IL-4, IL-6, IL-8, IL-10. We examined 45 patients with isolated TBI, 44 patients with NP (standard treatment scheme), 49 patients with NP, each therapy with clarithromycin. The control group was 33 relatively healthy people.
Conclusions. The study revealed a significant increase in the concentration of interleukin TNFα, IL-6, IL-8, IL-10 in the serum of patients with NP on the background of TBI compared with patients with isolated TBI and healthy individuals. Our study found significantly lower concentrations of interleukin TNFα, IL-6, IL-8, IL-10 in the serum of patients after treatment with the addition of clarithromycin compared with patients with standard therapy
MINIMALLY INVASIVE METHODS IN TREATMENT OF COMPLICATED FORMS OF CENTRAL LUNG CANCER
Get PDFDespite certain achievements in lung cancer treatment, the essential number of patients is subjected to palliative and symptomatic treatment. Hemoptysis addition is the one of most heavy symptoms of unresectable lung cancer. No less heavy complication is an atelectasis and hypoventilation of a lobe or a whole lung, which clinical image is attended by respiratory failure phenomena or association of purulent-septic pneumonia. The combination of endoscopic hemostasis with roentgen endovascular embolization of bronchial arteries (REEBA) allows to increase patients’ live quality and to prolong it for some time.
In the clinic REEBA has been done in 121 patients with unresectable forms of lung cancer. The causes of surgical treatment refusal were a widespread tumor process, age, and severity of associated pathology.
Hemostasis was achieved in 112 patients. A relapse of pulmonary bleeding was observed in 11 patients, who underwent the repeated REEBA. Lethal outcome was observed in 5 cases. Hemostasis was ineffective in 9 patients.
Thus, the experience of using REEBA and endoscopic hemostasis at complicated forms of unresectable lung cancer allows to increase the life quality and in further to realize chemoradial therapy that gives a possibility to prolong a patient’s life
FEATURES OF STOMATOLOGIC STATUS, TELOMERE LENGTHS AND PHENOTYPE OF IMMUNOCOMPETENT CELLS OF PERIPHERAL BLOOD IN CHILDREN – RESIDENTS OF UKRAINIAN TERRITORIES, CONTAMINATED WITH RADIONUCLIDES
Get PDFObjective of research. To analyze features of stomatological status indexes, relative length of telomeres and phenotype of immunocompetent cells of peripheral blood in children with chronological enamel hypoplasia – residents of Ukrainian territories, contaminated with radionuclides after the Chornobyl NPP accident.
Materials and methods. The object of research is chronological enamel hypoplasia (CEH) of permanent teeth, and lymphocytes of peripheral blood (PB). The subject of research is the state of oral cavity hygiene, caries intensity, gingivitis severity degree, relative telomere length (RTL), and phenotype of immunocompetent cells (ICC) of peripheral blood (PB). Methods of the research: stomatological, immunological (flow cytofluorometry), molecular genetic (fluorescence in situ hybridization-flow cytometry – flow-FISH), statistical.
Results. Two types of the analysis of the stomatologic status, RTL and phenotype of PB ICC were carried out: the first is the comparison of indexes of the combined group of children with anamnesis complicated by radiation (group No. 1 with CEH + group No. 2 without CEH) comparing with the control group No. 3; the second is the analysis of indeces of the group No. 1 comparing with the same markers in children of the groups No. 2 and No. 3. The first stage of the analysis shows thesignificant worsening of oral hygien indices , high DMFTand DMFS in children with permanent dentition, higher degree of gums inflamation and moresignificant RTL shortening in children of the combined group (No. 1 + No. 2) comparing with the control. Changes of the same character, but more expressed observed during the another analysis concerning the children with anamnesis complicated by radiation and CEH comparing with the control. Reliable changes in the content of PB ICC subpopulations in the examined children of all groups were not identified.
Conclusions.
1. Inchildren with CEH, complicated by ionizing radiation (IR) influence in low doses diapason the highest degree of stomatological status disorders comparing with the examined reference and control groups was determined: unsatisfactory and poor oral cavity hygiene according to OHI-S (1.76±0.41, р˂0.0001 and р˂0.0001, respectively) and Silness-Loe index (1.73±0.45, р˂0.0001 and р˂0.0001, respectively); very high intensity of dental caries ((DMFT=7.0±2.29, р=0.003and р˂0.0001; DMFS=8.74±2.58, р=0.0004 and р˂0.0001, respectively); mean degree of gingivitis severity (РМА 47.55±14.27 %, р˂0.0001 and р˂0.0001, respectively).
2. At CEH, which occurs due to the complex of negative factors during first years of life, including IR in residents of territories with effective doses more than 1.0 mSv/year, reliable shortening of relative telomeres length of PB lymphocytes comparing with the control group (15.17±3.20, р=0.0002) was found. Reliable differences in the content of peripheral blood immunocompetent cells when compared the examined groups were not identified.
3. Results of indices of the groups No. 1, No. 2 and No. 3 comparison are agreed with the data, obtained in result of dispersive analysis that allowed to separate the most informative indices concerning stomatological examination of children: OHI-S index (F=34.92; р˂0.001); Silness-Loe index (F=27.01; р˂0.001); dft+DMFT (F=82.23; р˂0.001); dfs+DMFS (F=49.41; р˂0.001); DMFT (F=13.94; р˂0.001); DMFS(F=19.41; р˂0.001); РМА (F=41.25; р˂0.001); RTL (F=7.53; р=0.001)