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THE EFFICACY OF ERADICATION OF SMALL INTESTINAL BACTERIAL OVERGROWTH IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE
Get PDFBackground. Emerging evidence suggests a strong interaction between the gut, gut microbiota and liver. Derangement of gut flora, particularly small intestinal bacterial overgrowth (SIBO), occurs in a large percentage of patients with non-alcoholic fatty liver disease (NAFLD) and plays an important role in its pathogenesis.
Aim. Study of the frequency of SIBO in various forms of non-alcoholic fatty liver disease, as well as the possibilities of its pathomorphosis as a result of eradication of SIBO as a result of the use of rifaximin or multicomponent probiotic.
Material and methods. There were investigated 125 patients with non-alcoholic fatty liver disease (70 men, 55 women aged 18 to 65 years, mean age 37±6.7 years) developed at obesity or type 2 diabetes mellitus, including 85 patients with liver steatosis (group1) and 40 patients with non-alcoholic steatohepatitis (group 2). Patients with concomitant SIBO (70 patients) was treated with rifaximin or multicomponent probiotic. As the main endpoints of the study, the frequency of achieving eradication of SIBO was evaluated (estimated from the results of a repeated H2-lactulose hydrogen test after treatment), as well as a decrease in the severity of liver steatosis by steatometry and a decrease / normalization of transaminase levels 3 months after the start of the treatment. Secondary endpoints included the change in BMI and the HOMA-IR index 3 months after the start of the treatment.
Results. SIBO in patients with non-alcoholic fatty liver disease was significantly more frequent than in control (p <0.005), and in patients with non-alcoholic steatohepatitis – significantly more often than in patients with liver steatosis (80 % vs 47.1 %, P <0.01). Eradication of SIBO after use of rifaximin was recorded in 30 of 36 patients with non-alcoholic fatty liver disease (83.3 %), including 16 of 20 patients with steatosis (80 %) and 14 of 16 (87.5 %) patients with non-alcoholic steatohepatitis. In the group of patients taking multicomponent probiotics after treatment, eradication of SIBO was noted in 12 of 36 patients (33.3 %), including 7 patients with steatosis (35 %) and 5 patients (31.3 %) with non-alcoholic steatohepatitis
Conclusion. The investigation shows that the eradication of small intestinal bacterial overgrowth has the positive influence on the natural course of NAFLD and use of rifaximine should be discussed as a perspective therapeutic strategy at this patholog
IMPROVEMENT OF POSSIBILITIES OF TREATING PNEUMONIAS IN PATIENTS ON THE BACKGROUND OF ACUTE MYELOBLAST LEUCOSIS IN THE ASPECT OF IMMUNORESISTANCE MECHANISMS
Get PDFAim: to analyze the influence of the immunomodeling preparation glutamyl-cysteinyl-glycine disodium (glutoxim) on indices of cellular and humoral immunity in patients with pneumonias on the background of acute myeloblast leucosis to form new approaches to the improvement of treating pneumonias in patients with immunity disorders.
Materials and methods. The research group - 37 patients with pneumonia on the background of acute myeloblast leucosis, who underwent the program treatment on the base of the hematological center “MI city multi-profile clinical hospital №4” Dnipro city, 2014-2015. The age of patients from 23 to 45 years old; 10 women and 27 men. The diagnosis of leucosis and pneumonia forms was verified corresponding to modern conventional clinical and morphological criteria. Patients from the main research group (n = 18) were prescribed with glutamyl-cysteinyl-glycine disodium by the scheme 2 ml of 3 % (60 mg) i/v № 10 in mornings, summary dose - 300 mg. Indications of immunograms were studied: Т-lymphocytes, В-lymphocytes and their subpopulation composition (CD3 +, CD4 +, CD8 +, CD19 +, CD19-, CD16 +, CD56+) using the flowing laser cytofluorimetry. Immunoglobulin levels were determined by the method of immunoturbometry. Indications of immunograms were assessed in the treatment dynamics. The statistical processing – using packages of applied programs «Excel» and «Statistic 10».
Results. According to the analysis of indices of the cellular and humoral immunity of patients with pneumonia on the background of acute myeloblast leucosis, the process of glutamyl-cysteinyl-glycine disodium use proved the statistically reliable activation of phagocytosis and anti-infectious defense indices. The dynamics of humoral immunity indices also proved the positive influence on the state of the immune reactivity of the organism with the reliable increase of ІgА and Іg М, responsible for neutralization of infectious agents and bacterial toxins.
Conclusions: The use of the ummunomodeling preparation glutamyl-cysteinyl-glycine disodium (glutoxim) in patients with pneumonia on the background of acute myeloblast leucosis results in the improvement of indices of cellular and humoral immunity and phagocytosis activation. The research results prove the possibility of optimization of approaches to treating pneumonias in patients with severe immunity disorders by using immunomedeling therapy by glutamyl-cysteinyl-glycine disodium (glutoxim). 
THE FEATURES OF BLOOD SUPPLY OF CORPUS CALLOSUM AND THE STRUCTURE OF ITS HEMOMICROCIRCULATORY CHANNEL
Get PDFToday we know the location of the sources of arterial blood delivery to the corpus callosum and we can approximately say, where are situated the venous vessels that the blood outflows from it to, but it is absolutely unknown, what is the intermediate link – the blood microcirculatory channel.
Aim of research. The aim of our research is in identification of the ways of venous outflow from corpus callosum and in clarification of the principle of structural organization of its hemomicrocirculatory channel.
Materials and methods. In the work are used the median total preparations of the corpus callosum (together with septum pellucidum and cerebral fornix formations) of 10 men 36–60 years old. Histological paraffin sections, colored by hematoxylin and eosin and according to Van-gieson were made of these preparations, and the methods of plastination of the corpus callosum tissues in epoxy resin with further creation of polished sections of different width and serial fine sections of blocs, for which coloration served the 1 % solution of blue methene for 1% borax solution, were also used.
Results. It was established, that the arterial microvessels, starting from vascular plexus that covers the upper surface of corpus callosum, penetrate it as arterioles along interfunicular connective tissue septs that divide its commissural funicles between them. The arterioles are prolonged directly in venous microvessels that can be related to gathering venules. These direct microvascular communications, coming through the thickness of corpus callosum, can be named perforating arteriolovenular anastomoses. The aforesaid collector venules, localized in the lowest sections of interfunicular interlayers, are the direct inflows of venous channel of septum pellucidum. In general system of blood supply of corpus callosum the main arteries on the one side and the veins of septum pellucidum – on the other, are not accompanied by the vessels of opposite type.
Conclusions. The blood microcirculatory channel of corpus callosum is the complexly branched in its thickness net of resistive, metabolic and capacitive microvessels, placed on the running way between arterial channel of soft cerebral tunic that covers the upper surface of corpus callosum and collector veins of septum pellucidum, situated below it. The direct shunting tracts between them are perforating arteriolovenular anastomoses
PREDICATORS OF SATISFACTION AND DISSATISFACTION OF MEDICAL WORKERS WITH THEIR WORK IN MEDICAL INSTITUTION
Get PDFThe resulting criterion of assessment of staff management effectiveness in health protection institution is a satisfaction of medical workers with their work. So, it is important to know the predictors of satisfaction and dissatisfaction with the work.
The aim of the research was in determination of the predictors of satisfaction and dissatisfaction with the work in medical institution.
There was carried out the interrogation of 395 doctors (52 %) and hospital nurses (48 %) of the institutions of Kyiv city (Ukraine) by the form (response 81 %), formed of 12 questions and 3 answers “Yes”, “No”, “Not decided) (α of Cronbach 0,82). Pearson’s consent coefficient (χ2) was used for determination of the differences in the answer structures.
The reliable difference in the index of general satisfaction of doctors (95 % DІ: 69,87 %; 76,31 %) and hospital nurses (95 % DI: 70,10 %; 75,39 %) was not revealed. Analogously there were not revealed such differences in the index of general dissatisfaction of doctors (95% DІ: 17,97 %; 24,09 %) and hospital nurses (95 % DІ: 16,76 %, 21,80 %). The structures of answers to the question about patients’ attitude did not reliably (р<0,05) differ (94,12 % of doctors, 79,52 % of hospital nurses answered “YES”), about improvement of medical help at material stimulation by patients (20 % of doctors, 13,25 % of hospital nurses – “YES”), about the choice of own profession again (41,18 % of doctors, 20,48 % hospital nurses – “NO”).
It was determined that the predicators of medical workers’ satisfaction with their work are an attitude of colleges, patients, leader, climate in collective, and the ones of dissatisfaction – a salary, management system, labor conditions
POSSIBILITIES TO IMPROVE THE THERAPY OF THE PATIENTS WITH URETERAL CONCRETIONS
Get PDFThe aim of the given study was to improve the results of treatment of patients with concretions of the upper third of the ureter.
Materials and methods. The clinical trial was carried out as a non-interventional open, controlled, in two groups of patients with baseline control. The inclusion criteria concerned the patients with concretions of the upper third of the ureter 0.7-0.9 mm in size, which had one session of an extracorporeal shock-wave lithotripsy (ESWL), and after the procedure the size of the concretions fragments was up to3 mm. The study involved 60 patients, all patients in the main group (n = 30) were treated using phytotherapy, within 1 month starting with basic therapy under hospital conditions and continuing with preventative treatment in an outpatient setting. The control group (n = 30) received baseline therapy (up to 10 days) at the stationary stage.
Results and discussion. In patients of the main group, fragments of concretions came out significantly faster, namely: in the main group, the fragments came out in 21 patients (70.0 %), while in the control group in 15 patients (50.0 %) (p1- p2, p <0.05) to the 7th day, and in the main group, the fragments came out in one patient more than 14 days, and in the control group – in 5 patients, p <0.05. The "stone path" in the bottom third of the ureter was in 1 patient (3.3 %) of the main group and in 3 patients (10.0 %) in the control group (p1-p2, p <0.05). The "stone path" departure time in patients of the main group was 2 days, and in patients of the control group it was 4.1 days from the time of its formation (p1-p2, p <0.05). Bacteriuria was observed in the main group on the 10th day 6.6 % less relative to the control group.
Conclusion. At comparing the obtained results in patients of both groups in 1 month it was noted that high efficacy of the treatment was registered in 6 (20 %) patients of the main group and in 3 patients (10 %) of the control group (p <0.05), moderate efficiency was registered in 23 (76.7 %) patients of the main group and in 22 (73.3 %) patients of the control group respectively, low efficacy was registered in 1 (3.33 %) patient in the main group and 5 (16.7 %) patients of the control group (p <0,05), which points to the effectiveness of Urolesan capsules use in complex therapy of patients with concretions of the one third of ureter
PREVALENCE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN PATIENTS WITH CORONARY HEART DISEASE AND ARTERIAL HYPERTENSION
Get PDFThe prevalence of chronic obstructive pulmonary disease among patients with cardio-vascular diseases is higher than in general population. At the same time the one of problems of internal medicine is a timely diagnostics of chronic obstructive pulmonary disease.
The aim of the work was the study of prevalence of chronic obstructive pulmonary disease among patients with cardio-vascular diseases, especially arterial hypertension and coronary heart disease.
Materials and methods. The retrospective analysis of statistical cards of patients, who were on stationary treatment at therapeutic departments, was carried out to estimate the prevalence of combination of chronic obstructive pulmonary disease with arterial hypertension. The target examination of 136 patients was realized for revelation of chronic obstructive pulmonary disease. All patients were interrogated by the original modified questionnaire of assessment of short breath by medical research council (mMRC), test for assessment of chronic obstructive pulmonary disease (CAT) and underwent spirography with bronchodilatation test.
Results. It was established, that 10,2 % of patients had the combination of chronic obstructive pulmonary disease with arterial hypertension. Among persons, who were on treatment as to the stable coronary heart disease and had not obstructive disease of respiratory organs in anamnesis, in 26,4 % the chronic obstructive pulmonary disease was diagnosed for the first time
MULTIPLE PREGNANCY, ANTENATAL CARE PROBLEMS AND THEIR SOLUTIONS RESULTS
Get PDFAim of the work. The aim of our study is to summarize the course of pregnancy and delivery in multiple pregnancies in modern conditions.
Materials and methods. The analysis of the pregnancy course, labor and perinatal outcomes was carried out in 182 women with diochorionic and 86 patients with monochorionic twins and 40 women with a singleton pregnancy. Multiple pregnancies were proved to be a monochorionic (MH) and diochorionic (DH) that is a high risk factor for perinatal complications. The research included clinical and laboratory examination metods, study of hormonal function of fetoplacental complex (FPC), transvaginal ultrasound examination. Statistical processing of data was carried out using the package of applied programs Microsoft Office Excel 2010 and StatSoft Statistica 6.1.
Results and discussion. In the analysis of pregnancy the abortion threat was detected in 51 (59.3%) women with monochorionic and 34 (62%) women with diochorionic twins. Preeclampsia during pregnancy complicated in 26 (30.2%) and 43 (23.6%) patients, with monochorionic and diochorionic placentation type, respectively. A frequent complication of both the MH and DH twins was anemia, which was found in more than half of the surveyed (56.9 and 51%, respectively). Delivery in the case of multiple pregnancies is also much more complicated and is terminated surgically three times more often than in singleton births. The most frequent indications for operative delivery were first breech fetus, fetal distress during pregnancy and childbirth, FGR, severe preeclampsia, premature detachment of normally situated placenta, anomalies of labor activity. These perinatal losses were equally observed both after cesarean section and after spontaneous labor and amounted to 4% at monochorionic and 1.7% at diochorionic twins.
The frequency dependence of identified lesions at pregnancy with twins was established by chorionic. Careful observation of the patients with multiple pregnancies in the antenatal period, the prevention of the most frequent complications, ultrasound monitoring of early pregnancy allows a differentiated approach to the management of pregnancy and childbirth, helping to reduce perinatal morbidity and mortality.
Conclusions. Multiple pregnancies occur with a large number of complications compared with singletons. Thus, the increase of frequency of multiple pregnancy influences the obstetric and perinatal indicators, pushing this issue in a number of the most pressing issues of modern obstetrics and perinatology
THE FEATURES OF ATHEROSCLEROTIC PROCESS DEVELOPMENT AND ACUTE CORONARY SYNDROME COURSE IN PATIENTS WITHOUT DYSLIPIDEMIA
Get PDFThe aim is to study the conditions of appearance and the features of course of the acute coronary syndrome (ACS) in patients with normal rates of lipid metabolism and to assess the influence of additional risk factors (uinary acid, C-reactive protein, fibrinogen) on the development of atherosclerotic process by assessment of surrogate markers of atherosclerosis the thickness of intima-media complex (TIMC) of carotid arteries (СА), the presence of atherosclerotic plaque (AP) in CA, the value of ankle-brachial index (ABI)) in patients with ACS without dyslipidemia (DLP).
Materials and methods. The study included 66 patients without DLP (50 men and 16 women, the mean age - 53,7±10,6 years) with ACS, divided in groups depending on its forms: 1 group – patients with instable angina (IA), 2 group – patients with myocardium infraction (MI) without ST segment elevation and 3 group – patients with MI with ST segment elevation. The level of serum acid, C-reactive protein, fibrinogen in blood serum were detected and ultrasound examination of СА with detection of CA TIMC, presence of atherosclerotic plaque and measuring of arterial pressure on upper and low extremities with ABI calculation was carried out.
Results. Among examined patients MI with ST segment elevation was diagnosed in 33 persons (50,0%); MI without ST segment elevation – in 18 (27,3%) and IA – in 15 (22,7%). The complicated ACS was observed in 20 (30,30%) persons. The value of CA TIMC among patients with MI with ST segment elevation was reliably higher than in patients with MI without ST segment elevation (р<0,001), and ABI was reliably lower in persons with MI and ST segment elevation (р<0,05) and IA (р<0,05) than in patients with MI without ST segment elevation. Correlative analysis demonstrated the interconnection between the levels of inflammation indicators (C-reactive protein, fibrinogen) in the blood serum and the value of CA TIMC and ABI.
Conclusions. The persons without DLP need additional examination (detection of C-reactive protein, fibrinogen levels in blood serum, ultrasound of CA and detection of ABI) for more precise evaluation of ACS risk. 
THE RARE REGULAR TRISOMY 17: FREQUENCY AND PHENOTYPIC PORTRAIT
Get PDFThis paper presents the data from our own research of frequency of full regular trisomy 17 (T17) based on 1808 samples of miscarriages, 1572 medical induced abortions at 5-11 weeks of gestation, and 9689 samples of invasive prenatal tests done between 11 and 24 weeks of pregnancy. The frequency of full T17 in all miscarriages was 1/152 and in medical induced abortions - 1/524; the population frequency of T17 in the first trimester accounted for 1/454.
Additionally, it presents the data on the proportion of T17 of all autosomal trisomies structure in different periods of fetal development. When performing invasive prenatal testing we detected 4 cases of T17 that represented 0, 58 % of autosomal trisomies among fetuses of 11-22 gestational weeks.
Furthermore, the paper introduces a symptom-complex of fetal abnormalities that are typical of regular full trisomy 17
ONCOLOGIC OUTCOMES OF RADICAL PROSTATECTOMY AND PROGNOSTIC STRATIFICATION IN PATIENTS WITH CLINICALLY LOCALLY ADVANCED PROSTATE CANCER
Get PDFOncologic outcomes of radical prostatectomy in 106 patients with clinically locally advanced prostate cancer were demonstrated. The mean follow-up was 50.6 (12-129) months. 5-year recurrence-free survival was 47.7 %, 5-year cancer-specific and overall survival - 85.8 %. Patients were devided into three different risk groups: low risk patients had PSA level <20 ng/ml, biopsy Gleason score ≤6 and absence of the seminal vesicle invasion of cancer; intermediate risk was noted when the patient had only one of poor prognostic factors (PSA ≥20 ng/ml or biopsy Gleason score≥7 or presence of cancer invasion to the seminal vesicle) and high risk patients had 2 or 3 poor prognostic factors. For patients of low, intermediate and high risk the biochemical reccurence rates were 14.3 %, 37.1 % and 70.2 %, respectively (p=0.002). The patients of intermediate and high risk had clinically significant higher risk of biochemical reccurence than those of low risk with odds ratio 3.0 and 8.5, respectively. Such grouping may help in guiding the individualized treatment for these patients