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Optimization of Diagnostics and Treatment of Nasopharyngeal Cysts
Full text linkNasopharyngeal cysts are typically benign, congenital lesions filled with fluid and encapsulated from surrounding tissues. Both children and adults may present with clinical signs.
The aim of the study was to improve the efficiency of diagnostics and treatment of nasopharyngeal cysts in adults based on the differential diagnosis.
Materials and Methods. The study was carried out at the Department of Otolaryngology with the Course of Head and Neck Surgery, Ivano-Frankivsk National Medical University, Ukraine, and encompassed both outpatient and inpatient-to-outpatient observations. Fifteen (9 females, 6 males) patients with nasopharyngeal cysts at the age of 28 to 51 years were examined. All patients underwent a comprehensive assessment, including a thorough evaluation of their medical history, a standard examination of the ears, nose, and throat (ENT) using conventional and optical techniques, alongside computed tomography (CT) of the nasopharynx and paranasal sinuses, complemented by a general physical examination.
Results. Fifteen patients with nasopharyngeal cysts were examined and treated. In nine (60%) cases, the cyst appeared as a round mass with a dense wall, partially or completely obstructed by the excretory duct and containing dense content, localized in the central region of the nasopharynx. In four (26.6%) cases, the cyst ruptured. Cysts were localized laterally, originating from the fossa of Rosenmüller in three (20%) cases. All patients underwent minimally invasive surgery.
Conclusions. Endoscopic examination, CT, and magnetic resonance imaging are the most informative diagnostic methods for nasopharyngeal cysts. A definitive diagnosis can be made based on pathomorphological examination. The treatment of choice for nasopharyngeal cysts is endoscopic endonasal surgery with a microdebrider and laser coagulation
Features of Inflammatory Syndrome in Patients with COVID-19-Associated Pneumonia and Concomitant Chronic Coronary Syndrome
Full text linkIntroduction. The COVID-19 coronavirus disease caused by the SARS-CoV-2 virus has become an unprecedented challenge for the healthcare system and has taken a leading position among infectious diseases due to its rapid spread and development of complications in various body systems. COVID-19 has been shown to increase the long-term risk of both ischemic and nonischemic cardiovascular diseases. This underscores the need for primary prevention through measures such as vaccination and a deeper understanding of the pathophysiology linking COVID-19 to endothelial dysfunction and systemic inflammation. Patients hospitalized for coronavirus disease often have concomitant cardiometabolic disease. Cardiovascular complications are common in these patients, emphasizing the need for ongoing research to better understand these effects. The role of integral inflammatory indices in patients with coronavirus disease in the setting of chronic coronary syndromes (CCS) is unexplored.
Aim. To identify the features of the course of chronic coronary syndromes in patients with pneumonia caused by coronavirus infection COVID-19, as well as to assess the relationship between the level of inflammatory indices and the severity of the disease.
Materials and methods. 124 patients with COVID-19 were enrolled upon admission to the cardiology department of the Central City Clinical Hospital in Ivano-Frankivsk, the therapeutic department of the Kolomyia Central District Hospital and the therapeutic department of the Verkhovyna Hospital, 124 patients with COVID-19-associated pneumonia were selected, including 92 patients with a history of chronic coronary syndromes (CCS), including 49 patients with a history of acute myocardial infarction, 43 patients with stable angina pectoris and 32 patients without a history of CCS.
Results of the study. The mean age of the examined patients was (66,2±7,8) years in the CCS group and (59,9±8,9) years in the non-CCS group.Among the patients with severe course, there were 36 patients (39,1%) in the CCS group and 10 patients (31,2%) in the non-CCS group. In the CCS group, 4 patients (4,3%) died, and in the non-CCS group, 2 patients (6,2%) died. The BMI in patients with CCS was (28,3 [26,2; 30,9]) kg/m2, in the group without CCS (26,66±3,59) kg/m2 and was higher in the CCS group (p=0,03). The mean number of days from the onset of symptoms to hospitalization in the CCS group was (7 [5;7] days, in the non-CCS group (7 [5;7] days). There was significant difference in the levels of inflammatory indices in the study groups after treatment, lower levels of SIRI 1,12 [0,58; 1,98] vs. 1,71 [0,74; 3,98] (p=0,04), NLR 4,22 [2,79; 5,40] vs. 5,3 [3,8; 9,56] (p=0,03), SII 936,75 [571,30; 1263,16] vs. 1198,75 [784,0; 2627,78] (p=0,008), PLR 154,75 [115,27; 208,09] vs. [124,23; 307,83] (p=0,04), AISI 253,61 [96,18; 437,47] vs.345,28 [229,48; 1040,13] (p=0,01). In the CCS group, a significant increase in the level of the LMR index (p=0,01) and a decrease in the level of CRP/L (p<0,0001) were observed after treatment. According to the results of the ROC analysis, there is a significant prognostic value of the CRP/L marker for mortality in patients with COVID-19 pneumonia and concomitant CVD (AUC = 0,901; 95% CI 0,820 – 0,953; p<0,0001) during hospitalization. The markers NMR, SIRI, NLR, SII, PLR, AISI, dNLR, CRP/L had a significant prognostic value for mortality when observed in the dynamics.
Conclusions. Increased levels of inflammatory indices showed a significant value in predicting hospital mortality from COVID-19 with concomitant CCS in the dynamics but had no prognostic value during hospitalization. Patients who were discharged with recovery or improvement had lower levels of inflammatory indices in the presence of concomitant CCS in the anamnesis.Вступ. Коронавірусна хвороба COVID-19, спричинена вірусом SARS-CoV-2, стала безпрецедентним викликом для системи охорони здоров'я та посіла провідне місце серед інфекційних захворювань через швидке поширення та розвиток ускладнень у різних системах організму. Доведено, що COVID-19 збільшує довгостроковий ризик як ішемічних, так і неішемічних серцево-судинних захворювань. Це підкреслює необхідність первинної профілактики за допомогою таких заходів, як вакцинація та глибше розуміння патофізіології, що пов'язує COVID-19 з ендотеліальною дисфункцією та системним запаленням. Пацієнти, госпіталізовані з приводу коронавірусної хвороби, часто мають супутні кардіометаболічні захворювання. Серцево-судинні ускладнення є поширеними у цих пацієнтів, що підкреслює необхідність постійних досліджень для кращого розуміння цих ефектів. Роль інтегральних показників запалення у пацієнтів з коронавірусною хворобою на тлі хронічних коронарних синдромів (ХКС) є невивченою.
Мета. Виявити особливості перебігу хронічних коронарних синдромів у хворих на пневмонію, спричинену коронавірусною інфекцією COVID-19, а також оцінити взаємозв'язок між рівнем показників запалення та тяжкістю перебігу захворювання.Матеріали та методи. З метою проведення дослідження в міру поступлення у кардіологічне відділення КНП «Центральна міська клінічна лікарня» м. Івано-Франківськ, терапевтичне відділення КНП «Коломийська ЦРЛ» та терапевтичне відділення КНП «Верховинська БЛ» відібрано 124 пацієнти, хворі на COVID-19-асоційовану пневмонію, із яких 92 пацієнтів з анамнезом хронічних коронарних синдромів (ХКС), серед яких 49 пацієнтів мають в анамнезі перенесений гострий інфаркт міокарда, 43 пацієнти зі стабільною стенокардією напруги та 32 без анамнезу ХКС.
Результати дослідження. Середній вік обстежених пацієнтів становив (66,2±7,8) років у групі ГКС та (59,9±8,9) років у групі без ХКС. Серед пацієнтів з тяжким перебігом було 36 пацієнтів (39,1%) у групі ХКС та 10 пацієнтів (31,2%) у групі без ХКС. У групі з ХКС померли 4 пацієнти (4,3%), а в групі без ХКС - 2 пацієнти (6,2%). ІМТ у пацієнтів з ХКС становив (28,3 [26,2; 30,9]) кг/м2, у групі без ХКС - (26,66±3,59) кг/м2 і був вищим у групі з ХКС (р=0,03). Середня кількість днів від появи симптомів до госпіталізації в групі з ХКС становила (7 [5;7] днів, у групі без ХКС (7 [5;7] днів). Спостерігалася достовірна різниця в рівнях показників запалення в досліджуваних групах після лікування: нижчі рівні SIRI 1,12 [0,58; 1,98] проти 1,71 [0,74; 3,98] (р=0,04), NLR 4,22 [2,79; 5,40] проти 5,3 [3,8; 3,9] (р=0,05). 5,3 [3,8; 9,56] (p=0,03), SII 936,75 [571,30; 1263,16] проти 1198,75 [784,0; 2627,78] (p=0,008), PLR 154,75 [115,27; 208,09] проти [124,23; 307,83] (p=0,04), AISI 253,61 [96,18; 437,47] проти.345,28 [229,48; 1040,13] (p=0,01). У групі ХКС після лікування спостерігалося достовірне підвищення рівня індексу LMR (p=0,01) та зниження рівня CRP/L (p<0,0001).
Висновки. Підвищення рівня запальних індексів показали достовірну значення у прогнозуванні госпітальної смертності від COVID-19 з супутніми ХКС в динаміці, проте не мали прогностичної цінності при госпіталізації. У пацієнтів, що виписалися з одужанням чи покращенням виявилися нижчі рівні запальних індексів при наявності супутніх ХКС в анамнезі.
Ключові слова: COVID-19, пневмонія, запалення, ішемічна хвороба серця, хронічний коронарний синдро
Results of Primary Arteriovenous Fistulas Formation with Different Types of Anastomoses in the Early Postoperative Period in Patients on Programmed Hemodialysis
Full text linkThe study includes the analysis of the results of using the different types of arteriovenous anastomoses in the formation of arteriovenous fistulas and their impact on fistula maturation in the early postoperative period. One of the main aspects of the work is to determine the optimal type of anastomosis to ensure the proper functioning of arteriovenous fistula that is an important element of vascular access in patients on renal replacement therapy. It is important to consider such factors as the diameter of formed arteriovenous fistula, the blood flow velocity through it, the incidence of complications and the duration of its functioning. The study also takes into account the impact of patients’ characteristics, such as age, condition of arteries and veins, as well as general health indicators on the results of surgery. Taking these factors into account allows to identify the groups of patients who can benefit most from a particular type of anastomosis.
During the sample period, 384 patients with terminal stage of renal failure aged 20 to 84 years undergoing programmed hemodialysis, the native arteriovenous fistula was formed. It was found that 94.01 % of arteriovenous fistulas were successful in the early postoperative period. The average age of these patients was 44.2 years, while unsuccessful cases developed in people with an average age of 66.8 years. It was also found that within an hour after surgery for the formation of an arteriovenous fistula with the type end-to-side anastomosis, its diameter increases from 2.08±0.42 mm to 2.96±1.68 mm, and the blood flow velocity increases from 21.4±7.6 ml/min to 212.4±74.6 ml/min. The risk factor for effective fistula formation, in addition to age, is the diameter of vessels, anatomical features of the venous system, the presence of concomitant pathology (primarily diabetes mellitus).
The obtained results can serve as a basis for the developing of recommendations for the optimal choice of anastomosis type for certain categories of patients who will undergo renal replacement therapy. The study is aimed at improving the results of surgical treatment and increasing the quality of life of patients with chronic renal failure
Methodology for Occlusal-Articulation Relationships through the T-SCAN System in Treatment with Complete Denture
Full text linkBackground: The exact physiological restoration of the occlusal-articulation balance is a challenge for every dentist. Any tooth restoration, extraction, or prosthetic treatment creates a prerequisite for a change in occlusion
Objectives: To approve a methodology that uses the capabilities of the T-SCAN system to evaluate the occlusal-articulation relationships in the treatment of patients with complete dentures.
Material and methods: The study included 47 patients for prosthetic treatment. The subjects were aged 56 to 81 years (18 men and 24 women). On each one, control of the occlusal-articulation relationship was performed after the treatment with a complete denture. Examination of the occlusal contacts was performed with two-step articulation paper and the T-SCAN system. The minimum sample size of patients was determined based on power analysis for sample-size calculation. Descriptive statistics was used. Statistical significance was assumed at P< 0.05. SPSS version 20.0 was applied for data processing.
Results: More women 51.06 ± 7.29 % and 38.29 ± 7.09 % men were included in the study. The study participants were divided into 4 age groups: under 60 years, 61-70 years, 71-80 years, and over 81 years. It shows that the largest number are patients in the age group 61-70 years (46.81 ± 7.28 %), followed by patients up to 60 years (31.91 ± 6.80 %) and patients 71-80 years (12.77 ± 4.87 %), and the smallest number were patients over 81 years old (8.51 ± 4.07 %). The achieved results give us reason to consider that the articulation of the complete dentures with our proposed methodology ensures the achievement of optimal, harmonious occlusal relationships.
Conclusion: A methodology has been developed to control the occlusion-articulation relationships through the T-SCAN system in treatment with complete denture, which can be used as the method of choice in the presence of technical possibility since optimal, harmonious occlusal relationships can be achieved with it
Structural Changes in Skeletal Muscles and Visceral Fat under the Conditions of Insulin Resistance, Obesity and Hypothyroidism Against the Background of Trace Element Imbalance (Zn, I) in an Experiment
Full text linkThe relevance of the study is due to the constant increase in the incidence of diabetes mellitus, thyroid pathology, the spread of obesity and comorbid conditions. Of particular interest are the scientific data on the participation of zinc in the endocrine function of the pancreas and thyroid gland, the development of structural and metabolic disorders.
The aim of the study was to establish the peculiarities of the structural organisation of muscle and adipose tissue in rats with insulin resistance, obesity and hypothyroidism against the background of zinc and iodine deficiency.
Materials and methods. The study was conducted on sexually mature male rats on a standard vivarium food and drinking diet (control group), on a diet low in zinc or iodine, and fed high-carbohydrate or high-fat diets.
Results. The study revealed a decrease in the zinc content in the blood serum of animals of all experimental groups, in visceral fat – only against the background of a zinc-deficient diet and high-fat feeding, while an increase in the content of the trace element in muscles was observed in rats with zinc deficiency and insulin resistance compared to the control. The animals had a disturbed thyroid profile due to a decrease in thyroid hormone secretion against the background of hyperthyreotropinemia (under conditions of zinc and iodine deficiency, high-fat feeding) and a decrease in thyroid-stimulating hormone (against a high-carbohydrate diet). A significant increase in the HOMA-IR index (especially under high-fructose feeding conditions) characterises the development of diet-induced insulin resistance in animals. Structural changes in skeletal muscles (thigh and shin muscles) and visceral fat are manifested by dystrophic processes in stromal elements, muscle fibers, adipocytes and the vasal component.
Conclusions. When animals are fed diets with a limited content of zinc and iodine, excessive carbohydrate and fat consumption is accompanied by a trace element imbalance. Under such conditions, animals develop hormonal disorders (hypothyroid dysfunction, insulin resistance), and become overweight, including due to increased visceral fat. The detected disorders are consistent with changes in the structural organisation of skeletal muscle and visceral fat, which are interrelated and exacerbate metabolic imbalance
Indicators of Mineral Metabolism in the Oral Fluid in Patients with Gastroesophageal Reflux Disease
Full text linkDisruption of the digestive system in the gastrointestinal tract, namely in gastroesophageal reflux disease, leads to the development of pathological processes in the oral cavity, changing the homeostasis of the viscoelastic gel layer of the esophageal mucosa. Thus, it has been proven that there are reflex connections between the receptor apparatus of the esophageal mucosa and the efferent nerve fibers of the salivary glands, which can be disrupted in GERD. Therefore, saliva is involved in providing effective protection of the esophagus. As a result, the content of mineral components changes significantly: in particular, the level of calcium and enzyme composition.
Aim to study the indicators of mineral metabolism: the content of calcium, alkaline, and acid phosphatases in mixed saliva in patients with gastroesophageal reflux disease.
Methods 60 patients of various ages who underwent inpatient treatment at the IFNMU University Clinic were examined, where pH-metry was performed to determine acidity. The main group consisted of patients diagnosed with GERD, with decreased and increased acidity. The content of indicators of mineral metabolism in saliva was determined as follows: calcium (Ca) - photometric method with arsenase -111; acid phosphatase (AC) was determined by the Hillman method, alkaline phosphatase (AL) by hydrolysis of p-nitrophenyl phosphate at pH -10.4, release of p-nitrophenol and phosphate. The norm of indicators of mineral metabolism was established on 30 practically healthy volunteers. Statistical processing of data was carried out using the Microsoft Excel program by calculating the arithmetic mean.
Conclusions thus, the results obtained indicate that in GERD there is a violation of mineral metabolism in the oral fluid. The oral fluid is the first to come into contact with the reflux agent. This leads to a violation of saliva neutralization, so the study of saliva mineral composition can be considered as an early diagnostic marker for gastroesophageal reflux disease
Diagnosis and Treatment of Chronic Urticaria: The Importance of Autoimmune Aspects and Comorbidity
Full text linkThe study aimed to conduct a comprehensive systematic review of the literature on the autoimmune mechanisms associated with chronic spontaneous urticaria (CSU) in adults, explore the association between chronic urticaria (CU) and autoimmune disorders, analyze two case reports, and develop a diagnostic algorithm considering the autoimmune pathogenesis.
Materials and Methods. The literature review was conducted to study the mechanisms underlying autoimmune CU. Two case reports were analyzed and a diagnostic algorithm for patients suspected of autoimmune urticaria was formulated.
Results. CU significantly impairs patients’ quality of life, posing problems in daily activities and is often associated with concomitant autoimmune diseases. Though the pathogenesis of CSU remains incompletely understood, in recent years, there has been significant progress in understanding the pathophysiology of this condition, prompting researchers to explore new agents, especially biological ones, in cases with severe refractory urticaria. We have developed a diagnostic algorithm aimed at improving the management tactics for CSU and autoimmune pathology, that involves a thorough collection of complaints, medical history, performing a series of basic laboratory tests for specific markers of autoimmune disorders, and expanding their spectrum with detailed differential diagnostics.
Conclusions. CU is an important medical and social issue that requires an interdisciplinary personalized approach to patients. The diagnosis of the condition involves a comprehensive approach, considering potential concomitant autoimmune disorders and detailed laboratory investigations, especially in cases refractory to standard second-generation antihistamine therapy. The treatment of CU, specifically the stepwise therapy protocol based on symptom severity and response to treatment and aimed at reducing symptoms, improving patients’ quality of life, and achieving CU remission, is outlined in various national and international guidelines, and is carried out gradually, involving three lines of therapy
Distribution of Zinc in Muscle, Adipose Tissue and Blood Serum of Rats Under Conditions of Zinc-Deficient, Iodine-Deficient, High-Carbohydrate and High-Fat Diets
Full text linkThe relevance of the study is due to the prevalence of hypothyroid dysfunction, type II diabetes mellitus, and metabolic syndrome. The study was carried out on sexually mature male rats that were on a standard vivarium diet (control group), zinc-deficient, iodine-deficient, high-carbohydrate and high-fat diets. Under the experimental conditions, the distribution of zinc in blood serum, adipose (visceral fat) and muscle (femoral and tibial muscles) tissues was studied. The study showed a decrease in serum zinc content by 13.79-30.89 % (p<0.05) compared to the control group, regardless of diet. The concentration of the trace element in adipose tissue was significantly reduced relative to the control under conditions of zinc deprivation (by 18.37 %, p<0.05), and especially high-fat feeding (by 74.74 %, p<0.001). The increase in the content of the trace element in muscles under conditions of zinc deficiency (by 36.84 %, p<0.001) compared to the same indicator in animals fed a standard diet) is noteworthy. Taking into account the role of the bioelement in the maintenance of thyroid homeostasis, carbohydrate metabolism, and antioxidant potential, the detected changes involving zinc may act as a trigger for changes in the hormonal profile, metabolic and oxidative disorders
ДЕРМАТОГЛІФІЧНИЙ МАЛЮНОК СТОП ХВОРИХ НА ІНФАРКТ МІОКАРДА
No full textMyocardial infarction is a serious disease that can be fatal. Early detection and prevention are crucial to improve the prognosis of patients. Dermatoglyphic studies, which examine skin patterns on the palms and fingers, can help in the early detection of people who are predisposed to myocardial infarction.
The aim of the study was to determine the dermatoglyphic phenotype of the feet in people with myocardial infarction.
The object of the study was foot dermatoglyphs obtained from 60 male subjects (30 patients with myocardial infarction and 30 healthy men without cardiovascular disease as a control group). The dermatoglyphic method and the method of statistical analysis were used.
It was found that in patients with MI, in contrast to the control group, there were loops on the I, II and III fingers and arcs on the V fingers; a decrease in the frequency of curls on the third toe of the left foot and an increase in the frequency of this pattern on the second toes of both feet; an increase in the value of the comb count in the area of the tibial edge of the foot, with a decrease in the values near the fibular edge of the foot. Thus, dermatoglyphic examination is a simple, inexpensive and non-invasive method that can help in the early detection of people who are predisposed to myocardial infarction. This may help in the development of new methods of screening and prevention of myocardial infarction, which may lead to an improved prognosis for patients.Інфаркт міокарду - це серйозне захворювання, яке може призвести до летального результату. Раннє виявлення та профілактика мають вирішальне значення для покращення прогнозу пацієнтів. Дерматогліфічні дослідження, що вивчають малюнки шкіри на долонях і пальцях, можуть допомогти в ранньому виявленні людей, які мають схильність до інфаркту міокарда. Метою дослідження було визначення дерматогліфічного фенотипу стоп у осіб з інфарктом міокарда. Об’єктом дослідження були дерматогліфи стоп, отримані від 60 осіб чоловічої статі (30 осіб, що перенесли інфаркт міокарда, та 30 здорових чоловіків, що не мають серцево-судинної патології, в якості контрольної групи. Використовувалися дерматогліфічний метод та метод статистичного аналізу. Встановлено, що у осіб, які перенесли ІМ, відрізняється від контрольної спостерігались петлі на І, ІІ та ІІІ пальцях та дуги на V пальцях; зниженням частоти завитків на третьому пальці лівої стопи і збільшення частот цього візерунка на других пальцях обох стоп; збільшенням значення гребінцевого рахунку у ділянці тибіального краю стопи за умови зниження величин біля фібулярного краю стопи. Отже, дерматогліфічне дослідження - це простий, недорогий і неінвазивний метод, який може допомогти в ранньому виявленні людей, які мають схильність до інфаркту міокарда. Це може допомогти в розробці нових методів скринінгу та профілактики інфаркту міокарда, що може призвести до покращення прогнозу пацієнтів
КЛІНІЧНЕ СПОСТЕРЕЖЕННЯ ГОСТРОЇ КИШКОВОЇ НЕПРОХІДНОСТІ ВИКЛИКАНОЇ ГІГАНТСЬКОЮ ГРАНУЛЬОЗОКЛІТИННОЮ ПУХЛИНОЮ ЯЄЧНИКА
Full text linkOvarian granulosa cell tumours (OGCT) are non-epithelial neoplasms of the ovaries and belong to the group of granulosa-stromal tumours. The most likely source of these tumours’ development is granulosis of the primordial follicles of the ovary as a result of hormonal imbalance.
The aim of the study is to represent a clinical observation of acute intestinal obstruction caused by a giant ovarian granulosa cell macrofollicular tumour.
A woman, aged 52 years, medical history № 2579, was admitted to the surgical department of Communal Non-Profit Enterprise (CNPE) City Clinical Hospital (CCH) № 1 in Ivano-Frankivsk as an urgent patient with complaints of nausea, vomiting, delayed passage of flatus and defecation, general malaise, abdominal distention. During the laboratory and instrumental examination, a giant tumour of the abdominal cavity was revealed; it has led to the compression of internal organs and the development of small- and large-intestinal obstruction. The operation was performed: middle-median laparoscopy, removal of a giant cyst of the right ovary. Complete hysterectomy with appendages, drainage of the abdominal cavity were also performed.
During the operation, a giant tumour with dimensions of 65x70x50 cm, of dense but elastic consistency, pale-pink in color, with multiple chambers of different diameters filled with cloudy, yellow liquid was revealed. The removed uterus with appendages and a large omentum were also given for pathological examination. Pathohistological examination results included: 15824-8- granulosa-cell ovarian tumour; 15815-7- uterus - plethora; 15818-20-ovary - white bodies, fallopian tube - chronic salpingitis; 15812-4- omentum - focal hemorrhages. The postoperative period was uneventful, the patient was referred to a gynecologist-oncologist for consultation and treatment