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CENTRAL HEMODYNAMICS AND OXYGEN TRANSPORT IN PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME CAUSED BY COVID-19 AND THEIR IMPACT ON THE COURSE AND OUTCOMES OF THE DISEASE
Get PDFThe aim. Determine hemodynamic status and its impact on oxygen transport, frequency of adverse events and outcomes in patients with severe SARS-CoV-2 associated with acute respiratory distress syndrome (ARDS).
Materials and methods. A single-center prospective comparative study was conducted with 29 patients enrolled over the period of July—October 2020 who suffered a severe course of coronavirus disease and bilateral pneumonia associated with ARDS. Based on the estimated cardiac index (CI), patients were allocated to two groups: Group 1 included 14 patients with severe ARDS and CI 1.9 [1.5–2.5] L/min/m2, whereas Group 2 included 15 patients with CI 4.2 [3.2–8.1] L/min/m2 (p=0.001). Patient`s intensive care was regulated by the relevant orders of the Ministry of Health of Ukraine. Statistical analysis of the results was carried out using Statistica 10 software. Statistical significance of parameters was assessed using the non-parametric Wilcoxon criterion. Results were considered significant at p values <0.05. Data are presented as M [25–75]. Relative risk (RR) and odds ratio (OR) of adverse events were calculated.
Results. The severe course of coronavirus disease is associated with significant oxygen transport disorders that increase with hypovolemia. Despite the increase in oxygen delivery in the group with normal CI its high tissue extraction remained, which may be a sign of development mitochondrial distress.
Conclusions. Patients admitted to the ICU with severe COVID-19 may be in a state of hypovolemia and require individual assessment of hemodynamic status and the appointment of infusion therapy. Increased oxygen delivery in patients with normal cardiac index was associated with decreased adverse events rate and statistically significant decrease of mortality rat
VULVOVAGINAL CANDIDIASIS IN COMBINATION WITH BACTERIAL VAGINOSIS IN WOMEN OF REPRODUCTIVE AGE: FEATURES OF PATHOGENESIS AND TREATMENT
Get PDFThe aim. Reducing the recurrence of vulvovaginal candidiasis (VVC) in combination with bacterial vaginosis (BV) in women of reproductive age by studying the pathogenesis and improving the algorithm of treatment and prevention measures.
Materials and methods. During the study, 150 women of reproductive age who had the same clinical manifestations of VVC and BV were selected and divided into 3 groups of 50 women: Group I was treated with an antimicrobial combination drug (miconazole with topical metronidazole), group II – the same drug in combination with probiotic (lactobacilli) in candles, group III – according to the algorithm improved by the authors. In addition, a control group was formed, which included healthy women of reproductive age.
To establish the pathogenesis of VVC in combination with BV in the studied women, the concentration of cytokines and adhesion molecules in the blood before and after treatment was determined and compared with the control group.
The clinical effect of different treatments was assessed at 3, 7, 10, 14 days, and the presence of relapses – 1, 3, 6 months after treatment.
Results. The occurrence of a combination of VVC and BV in women of reproductive age is accompanied by a significant increase in the level of intercellular adhesion molecules (ICAM-1) and vascular cell adhesion molecules (VCAM-1) along with a statistically significant increase in proinflammatory cytokines (interleukin-6) (IL-6), interleukin-8 (IL-8)) and tumor necrosis factor (TNF) - TNF-α. As a result of the application of the algorithm improved by the authors, higher clinical efficiency and the ability to avoid recurrence of VVC in combination with BV in women of reproductive age were obtained.
Conclusions. The authors' substantiated improvement of the algorithm of VVC treatment in combination with BV in women of reproductive age makes it possible to reduce the frequency of their recurrence and restore the biocenosis of the vagina to normal. In the case of this pathology there is an increase in the level of pro-inflammatory cytokines (IL-6, IL-8), TNF-α and ICAM-1 and VCAM-1
Treatment optimization of patients with genital endometriosis
Get PDFThe aim of the research: to optimize the treatment of patients with combined genital pathology, including internal endometriosis (adenomyosis) and inflammatory diseases.
Materials and methods: prospective study has been conducted on 160 women with adenomyosis. There were 24 (15 %) patients with the I degree of adenomyosis spreading, 72 (45.0 %) women with the II degree, 33 (20.6 %) patients with the III degree, and 31 (19.4 %) woman with the IV degree of adenomyosis spreading. Microbial flora analysis included bacterioscopic, bacteriological research methods with determination of sensitivity to antibiotics, and PCR method.
The concentration of cytokines in the culture medium (supernatant) was determined by the enzyme immunoassay.
Results: the obtained data from the study indicate a high percentage of the combination of adenomyosis with chronic inflammatory diseases of the pelvic organs. An immuno-inflammatory reaction preceding adenomyosis is accompanied by the violation of the local cytokine balance. In turn, the increased activity of cytokines and the presence of infectious agents can participate in the relapse of endometriosis.
Conclusion: considering the immuno-inflammatory reaction, accompanied by the violation of the local cytokine balance in the development of adenomyosis. The study substantiates the necessity of using antimicrobial therapy in patients with combined genital pathology, including adenomyosis and inflammatory disease
Immunohistochemical diagnosis of the viability of the strangulation furrow
Get PDFThe aim of the research was to study the possibility of using immunohistochemical markers for the diagnosis of intravital stangulation.
Materials and methods: Fragments of the neck skin from the strnaglulation zone were selected as objects of research. The main study group included 20 deaths due to hanging (10 men and 10 women). For the control group, 10 cases of acute coronary death (5 men and 5 women) were used. Using a complex of IHC markers, the labeling of the epidermis and epithelial structures, the features of cellular immune responses, the manifestation of oxidative steress were studied.
Results: Peculiarities of morphological manifestations of strangulation furrow in mechanical asphyxia were studied. It is established that the key link of its morphogenesis is impaired vascular wall permeability with loss of type IV collagen in the basement membranes of epithelium and skin vessels, migration into tissues of activated CD15+ granulocytes, CD68+ macrophages and CD117+ labrocytes, endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS), fibrinogen protein and transforming growth factor β1.
Conclusion: Such changes in the tinctorial properties of skin and subcutaneous adipose tissue can be recorded by immunohistochemical (IHC) and serve as an important diagnostic criterion for the viability of the formation of the strangulation furrow
The investigation of bacterial adhesion of palatine tonsils epithelial cells in patient with infectious mononucleosis
Get PDFAim. To evaluate the features of pharynx tonsils mucous membrane colonization by pathogenic and opportunistic microorganisms by using the pharynx palatine tonsils epithelium electron microscopic examination of the patients with infectious mononucleosis and acute streptococcal tonsillitis.
Materials and methods. Two patients – patient P., 12 years old with a confirmed diagnosis of infectious mononucleosis and patient A., 8 years old with confirmed acute streptococcal tonsillitis. The patients were taken a bacteriological examination of the mucus and epithelium scraping from the surface of the pharyngeal tonsils. Tissue samples were examined in the electron microscopy laboratory of the Lviv National University.
Results and discussion. 36 tonsils epithelial tissue micro preparations of patient A. and 41 micro preparations of patient P. were studied. Streptococcus pyogenes, Str. pneumoniae, Str. viridans, Сandida albicans, as well as non-pathogenic bacteria: Diphtheroides sp., Neisseria sp., Corynebacterium spp. were identified as result of the patient P. bacteriological examination of mucus from the surface of the pharyngeal tonsils. Staph. aureus, Str. viridans, Str. pneumoniae were identified during a bacteriological examination of patient A. Eosinophils with a two-segmented nucleus, specific granularity, phagocytosed spherical bacteria in the cytoplasm were detected during the histological examination of the materials taken from the surface of the patient’s tonsils with acute tonsillitis. Research showed that bacteria were accumulated not only in the structure of extracellular detritus. Numerous bacteria accumulations were also found in the cytoplasm of the epithelial cells in the patient with infectious mononucleosis. The cell's shape looked like a bunch of grapes.
Conclusions. The electron microscopic examination showed differences in the coccal flora localization: the extracellular localization of bacteria in the patient with acute bacterial tonsillitis and intraepithelial presence of the bacteria in the patient with tonsillitis during infectious mononucleosis were found
Evaluation of the obesity influence on the life quality in patients with bronchial asthma
Get PDFThe obese asthma is characterized by a more severe course. The feature of this comorbid condition is the reduced effectiveness of basic therapy with inhaled corticosteroids, which prevents optimal control of symptoms, requires increasing doses and increases the number of exacerbations and hospitalizations. The problem of life quality (LQ) research in patients with asthma and obesity is highly relevant today, which made it the reason for this study.
The aim of the study was to determine the effect of obesity on LQ in patients with asthma.
Materials and methods. We selected for participating in the study 46 patients with moderate severity asthma. Examination of the patients included: objective examination with an anthropometric evaluation, the test of the LQ with two questionnaires: general one – Medical Outcome Study SF-36 (MOS SF-36) and specialized Asthma Quality of Life Questionnaire (AQLQ).
Results. The increase in body mass index (BMI) in patients with asthma according to the questionnaires MOS SF-36 and AQLQ is associated with significant reductions in viability (r=–0.33, p<0.05), physical activity (r=–0.37, p<0.01), social activity (r=–0.36, p <0.01) and the degree of reduction of the patient's tolerance to adverse environmental factors (r=–0.29, p<0.05)
Conclusions. The presence of concomitant obesity in patients with asthma is associated with significant reductions in the parameters of physical and social activity, viability and with an increase in the subjective pain assessment (according to the questionnaire MOS SF-36) and characterized by significantly lower rates of activity, tolerance to adverse environmental factors and general life quality (according to the AQLQ questionnaire)
The study of fibroblast growth factor-2, sulfated glycosaminoglycans and oxyproline with mitral valve prolapse in combination with type 1 diabetes mellitus
Get PDFThe aim. The aim of the study was to conduct a comparative analysis of fibroblast growth factor-2, the total content and fractions of sulfated glycosoaminoglycans as well as free and peptide-bounding oxyproline as the markers of connective tissue metabolism in young patients with mitral valve prolapse, type 1 diabetes mellitus and the combination of both indications.
Materials and methods. 93 patients between 19 and 33 years old with either mitral valve prolapse, or type 1 diabetes or the combination of both indications were examined. Group 1 was represented by 36 patients with the monomorbid type 1 diabetes mellitus. Group 2 consisted of 33 patients with type 1 diabetes mellitus and mitral valve prolapse. The comparison group included 24 people with diagnosed mitral valve prolapse. The concentration of fibroblast growth factor-2 in blood plasma was determined by the enzyme immunoassay using a Quantikine reagent kit (Human FGF basic Immunoassay), manufactured by R&D Systems, Inc. (USA) and expressed in pg/ml. The total content and fractions of glycosaminoglycans in blood serum were determined by the method of N. G. Stern et al. and expressed in units of optical density. The level of free and peptide-bounding oxyproline in blood serum were determined by the method of P. N. Sharaev and expressed in µmol/L.
Results. Fibroblast growth factor-2 was higher in group 2, where it was 23.7±0.25 pg/ml compared to the control group – 14.20±0.22 pg/ml (p <0.01). There was also a significant difference in the levels of fibroblast growth factor-2 between groups 1 where it equaled 15.33±0.24 pg/ml and 2 – 23.71±0.25 pg/ml (p<0.01). The total content of glycosaminoglycans in comparison with the control group, where it was equal to 9.7±0.62 odu, was higher in all groups of patients: in group 1 it was 12.07±1.04 odu, in the comparison group it was 11.75±0.83 odu, in the group with the combined pathology it was 13.32±1.59 odu (p<0.05). The values of glycosaminoglycans II fraction, were higher in group 2 – 4.96±0.59 odu. The level of peptide-bound oxyproline, just as the level of free oxyproline, significantly increased in patients with comorbid pathology in group 2, compared to the control group: 16.06±1.54 µmol/l versus 8.7±0.81 µmol/l (p<0.01) respectively.
Conclusions. The values of fibroblast growth factor-2, glycosaminoglycans II fraction, free and peptide-bound oxyproline were significantly higher in patients with diabetes mellitus and mitral valve prolapse in comparison with the control group. Fibroblast growth factor-2 was higher in patients with comorbid pathology compared to the monomorbid diabetes patients
Experimental study of the influence of a neogalenical phytocomplex from the shoots of Ledum palustre on the course of acute bronchitis disease in rats
Get PDFThe aim of the experiment was to study the anti-inflammatory effect of the novogalene agent Ledum 50, obtained from Ledum palustre shoots, in a rat model of acute bronchitis.
Materials and methods. Acute bronchitis was initiated by endotracheal administration of 1 % formalin solution. The effectiveness of Ledum 50 was investigated by the number of leukocytes and cell composition in isotonic BAL solution after 24 hours and after 8 days of the experiment. Serum levels of C-reactive protein (CRP), alkaline phosphatase (AP) and CIC were determined. Histological examination of the lungs was carried out.
Results. Endotracheal injection of formalin caused irritation of the trachea and bronchi, excessive formation of bronchial secretions (heavy breathing, wheezing) in all the studied groups. The lethality of animals in the OB group on the 3rd day of the experiment (1 rat) was recorded, in the studied groups there was no death. The level of leukocytes in BAL after 24 hours exceeded the index of the IC group by 9.63 times (p<0.05), after 8 days – by 3.0 times (p<0.05). In the cellular composition of BAL, there was a significant increase in granulocytes (rod- and segmented neutrophils, eosinophils), monocytes and a decrease in the lymphocyte population against the IC group. Such changes were verified in the long term (8 days of the experiment), which indicates an inflammatory process.
In the group of rats that received Ledum 50, leukocytes in the BAL significantly decreased, the number of monocytes and lymphocytes in the BAL decreased, the amount of CIC in the blood serum, CRP and AP normalized. In terms of effectiveness, Ledum 50 significantly exceeded the BAL values of the reference drug. The effectiveness of experimental therapy for acute bronchitis was also verified by studying the histostructure of the airways and the respiratory part of the lungs.
Conclusions. Studies confirm the favorable course of acute bronchitis with Ledum 50 monotherapy. This fact is confirmed by the results of normalization of hematological parameters, leukocytes and BAL cell composition after 7 days of treatment with the claimed agent. This is the basis for further preclinical and clinical studies with the aim of creating an oral drug for the treatment of acute bronchitis
Method of diagnosis and treatment of profusional bleeding from stenosing postbulbar ulcers of the duodenum
Get PDFThe aim. To evaluate the effectiveness of X-ray interventions in arosive bleeding in patients with complicated duodenal ulcer.
Materials and methods. X-ray endovascular interventions were used in 8 patients who developed arosive bleeding as a complication of duodenal ulcer. All patients with signs of gastrointestinal bleeding were examined according to clinical protocols. Hemodynamically stable patients underwent X-ray endovascular interventions.
Results and discussion. In the near future, bleeding stopped in all 8 (100 %, OR–0.04 [0.005–0.29], p=0.03) patients. On day 2, two patients who underwent embolization of their own hepatic artery had a recurrence of bleeding (0.56 [0.065–4.76], p=0.29). Repeated angiography and embolization attempts were ineffective, and both patients died. In patients who underwent gastroduodenal and pancreatouodenal artery embolization, bleeding did not resume. Thus, we obtained good results as 6 out of 8 patients recovered (75 %), despite the severity of their condition and a disappointing prognosis (OR–9.0 [1.0–46.7], p <0.05).
Conclusions. Adherence to the tactics mentioned above in the treatment of bleeding in duodenal ulcer was highly effective, especially in superselective embolization with the detection of bleeding gel. If the presence of arosive bleeding is confirmed, emergency surgical treatment with suturing of the damaged vessel is shown in hemodynamically unstable patients, and endovascular intervention is possible in hemodynamically stable patients. Further studies are needed to determine the criteria for a high risk of arosive bleeding developing in patients with complicated duodenal ulcer as well as to prevent its occurrence through the use of X-ray endovascular interventions
Study on thyroid function test in pregnancy in a tertiary care hospital
Get PDFThyroid disorder is a very common endocrine problem encountered by pregnant women. Maternal thyroid dysfunction is associated with adverse outcome both in mother and fetus.
The aim of the study: to find out the prevalence of various thyroid disorders in pregnant women attending antenatal clinic.
Materials and methods. This prospective cross-sectional study was carried out in the Department of Obstetrics and Gynecology, F.M. Medical College & Hospital, Balasore, Odisha from June 2020 to May 2021. 220 women with uncomplicated singleton pregnancy were included. Serum Thyroid-stimulating hormone (TSH), free T4 (FT4) and free T3 (FT3) were estimated by using electro-chemiluminescence immunoassay technique.
Results. Out of 220 pregnant women screened for thyroid dysfunction, 68 were found to have thyroid disorders. 27.3 % of pregnant women had subclinical hypothyroidism, 1.4 % had overt hypothyroidism, 1.8 % had subclinical hyperthyroidism and 0.5 % had overt hyperthyroidism. Prevalence of subclinical hypothyroidism was 6.36 % when the upper reference limit of TSH level taken as 4 mIU/L. Prevalence of thyroid disorder among pregnant women in the age groups 18–25 years, 26–30 years and 31–40 years were 28.9 %, 32.1 % and 38.9 % respectively. There were 35.5 %, 28 % and 26 % pregnant women with thyroid disorders in the first, second and third trimester respectively. Prevalence of both subclinical and overt hypothyroidism were more in multigravida compared to primigravida.
Conclusion. Our study revealed high prevalence of thyroid disorders in pregnant women and maternal subclinical hypothyroidism was the most common pattern