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DNA Fingerprinting of Resistant Mycobacterium tuberculosis Isolates in Iran by IS6110-RFLP Method
Get PDFThe objective of the research was to identify resistant Mycobacterium tuberculosis strains and recognize their molecular epidemiology and how they are disseminated in order to determine the cause and the effect of drug resistance and the process of its development.
Materials and methods. Genomic deoxyribonucleic acid obtained from 37 drug-resistant Mycobacterium tuberculosis isolates were examined and fingerprinted by the IS6110- restriction fragment length polymorphism method. The data obtained were then analyzed using SPSS statistics software.
Results. The mean patients’ age was 51 ± 15.5 years. There were 46% of male patients, 67.6% of the patients from urban areas, 86.5% of Iranians, 21.6% of relapsed cases, 8.1% of human immunodeficiency virus-positive patients, and 10.8% of the patients with a history of contact with tuberculosis patient. Based on IS6110 - restriction fragment length polymorphism, 30 different genetic types were observed which indicated a significant variation of this pathogen in Markazi province, Iran. The number of cluster genotypes was determined by 6 clusters; the number of unique types was 24. There were no relationships between age, gender, nationality, residence, close contact with tuberculosis patients, recurrence of tuberculosis, positive human immunodeficiency virus status and clustered or non-clustered strain genotype.
Conclusions. Considering the high genetic diversity in Mycobacterium tuberculosis strains, it can be concluded that, based on IS6110 - restriction fragment length polymorphism, about 65% of cases occurred due to reactivation, and 35% of the cases were due to recent transmission. The information obtained through the molecular typing method can be very effective in future planning for tuberculosis control in Iran
Clinical and Functional Dynamics of Physical Working Capacity and Psychological Adaptation in Patients with Acute Coronary Syndrome at the Stages of Rehabilitation
Get PDFThe objective of the research was to analyze the effectiveness of using suggestive therapy in the patients with acute coronary syndrome by assessing the dynamics of the clinical condition and indicators of anxiety.
Materials and Methods. There were examined 135 patients with non-ST-segment elevation myocardial infarction, 60 patients with the use of the conservative treatment and 75 patients who underwent percutaneous coronary intervention. The dynamics of objective indices, adaptation changes and anxiety indices in the groups of patients with traditional treatment and in the groups of patients with suggestive therapy in addition to the traditional rehabilitation measures, were analyzed.
Results. Analyzing the dynamics of adaptive indices, it was determined that in the group of patients with non-ST-segment elevation myocardial infarction, who were performed conservative therapy, the dynamics was less significant, which is related to the general desadaptative syndrome. Changes in the group of patients undergoing percutaneous coronary intervention and suggestive therapy, with a decrease of blood pressure, heart rate, and a decrease in the index of functional changes from 3.78±0.15 points before the intervention up to 2.92±0.13 points after suggestive therapy (p<0.01) were more significant. In all groups of patients, high levels of reactive anxiety were observed at the beginning of treatment. As a result of treatment, a decrease in anxiety was noted, but more pronounced changes were seen in the group with the use of suggestive therapy (p<0.05).
Conclusions. The use of suggestive therapy methods when treating the patients with acute coronary syndrome is an important intervention, that provides a comprehensive approach considering all the components, enhances the patients’ adaptive abilities in the rehabilitation phase, improves the quality and effectiveness of restorative treatment. The use of suggestive therapy at the rehabilitation stage improves the clinical course, reduces anginal manifestations, stabilizes blood pressure and increases exercise tolerance
Cardiovascular Dısease Risk in Patients with Obstructıve Sleep Apnea Syndrome
Get PDFObstructıve sleep apnea syndrome is a clinical syndrome characterized by recurrent partial or total obstruction of the upper respiratory tract. The main symptoms are snoring, excessive daytime sleepiness and witnessed apnea. It is a disease that affects 3% to 7% of the middle-aged population. Studies and meta-analyzes have shown that cardiovascular diseases are more common in patients with obstructıve sleep apnea syndrome. Comorbid conditions such as obesity, metabolic syndrome and smoking are higher in obstructıve sleep apnea syndrome patients than in the general population. In addition, hypoxia-reperfusion injury due to intermittent oxygen desaturation occurring in obstructıve sleep apnea syndrome patients, endothelial dysfunction, increased sympathetic system activity, platelet activation, monocyte increase, which play the main role in arteriosclerosis, decreased and increased low-density lipoprotein cholesterol may also be the reason for the frequent occurrence of cardiovascular diseases. The development of cardiovascular disease in obstructıve sleep apnea syndrome patients is an important cause of morbidity and mortality. Evaluating white blood cell neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, lymphocyte/monocyte ratio, hematocrit, platelet distribution width, red cell distribution width, C-reactive protein, and monocyte/high-density lipoprotein cholesterol ratio in the follow-up of obstructıve sleep apnea syndrome patients may be helpful in predicting the development of cardiovascular diseases. Whether obstructıve sleep apnea syndrome patients have metabolic syndrome or smoking should be questioned. Obstructıve sleep apnea syndrome, obesity, smoking and depression are increasingly prevalent diseases worldwide, leading to significant mortality and morbidity. Therefore, multicentre studies involving different societies are needed
Effectiveness of Treating Patients with Stable Ischemic Heart Disease and Co-Existent Paroxysmal Atrial Fibrillation with Mebicar
Get PDFAtrial fibrillation is a disturbance of heart rhythm, which is characterized by frequent contractions of atrial muscle fibers. Stable ischemic heart disease, arterial hypertension, heart failure, obesity are risk factors for progression of atrial fibrillation. Psycho-emotional stress, anxiety and depression can be the cause of atrial fibrillation paroxysm as well.
The objective of the research was to study the effect of mebicаr in the treatment of paroxysmal atrial fibrillation considering anxiety-depressive symptoms.
Materials and Methods. Observations were performed on patients with stable ischemic heart disease and co-existent paroxysmal atrial fibrillation using clinico-psychopathological research method (structured interview). The level of stress was determined on the L. Rider scale and the 10-Item perceived stress scale; the level of anxiety and depression was determined by means of the Hospital Anxiety and Depression Scale and the Patient Health Questionnaire-9. The evaluation of the free radical oxidation state was carried out using a spectrophotometric method to determine the activity of catalase, glutathione peroxidase, superoxide dismutase in the blood serum.
Results. As a result of the analysis, it was found that the higher the level of anxiety-depressive disorders, the more frequent paroxysms of atrial fibrillation. High level of stress was found in 37.50% of men (p<0.01) and 31.25% of women (p<0.05) in Group 2b. The manifestations of the clinical level of anxiety and depression in men of Group 2b (p<0.05) were detected.
Conclusions. The analysis of electrocardiogram indices showed the signs of atrial fibrillation (p<0.05), repolarization abnormalities (p<0.001), left ventricular hypertrophy (p<0.05), and the appearance of extrasystoles (p<0.001). Echocardiographic indices showed the signs of diffuse cardiosclerosis, severe left atrial dilatation (p<0.05) and reduced myocardial contractility, which was statistically confirmed. The use of anxiolytic medication – mebicar – during treatment helped significantly improve the clinical and hemodynamic parameters, which confirmed treatment effectiveness
Secondary Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease
Get PDFOsteoporosis in patients with broncho-pulmonary pathology is associated with the fact that the inflammatory process has a direct effect on bone metabolism. A large number of pro-inflammatory cytokines, which play an important role in the pathogenesis of obstructive pulmonary diseases, is involved in the regulation of bone resorption. In addition, patients with chronic obstructive pulmonary disease (COPD) of severe and extremely severe degrees, according to GOLD recommendations, receive inhaled glucocorticosteroids (GCS), and in ineffective inhaled GCS-therapy COPD patients are prescribed systemic steroids; that has an undesirable effect on bone marrow state.
The purpose of the work was to investigate the peculiarities of bone metabolism disorders in patients with COPD. There were examined 26 patients with COPD of the III-IV degrees, groups C and D aged 65.3±3.15 years. Spirography, bone mineral density study were performed; ten-year risk of osteoporotic fractures was evaluated using FRAX; content of calcium, phosphorus, alkaline phosphatase in blood serum were determined.
As a result of laboratory studies and densitometry, 84.6% of patients were diagnosed osteopenia. The average T-criterion was within (–1.83±0.17) SD (standard deviation) and was significantly lower than in healthy persons (–0.56±0.10) SD, (p<0.001). The degree of reduction of bone mineral density depended on the degree of reduction of FEV1 and COPD degree (r=0.65; p<0.01), as well as on the duration of the disease (r= –0.43; p<0.01). The ten-year risk of osteoporotic fractures in patients with COPD was high and was 5.65%±1.63%, as opposed to 2.13%±0.61% (p<0.001) in practically healthy individuals.
Thus, severe functional disorders in COPD, a durable anamnesis of the disease contribute to a decrease in bone mineral density and to an increase in the risk of osteoporotic fractures
A 10-Year Histopathologic Audit of Uterine Cervical Biopsies in Warri, Nigeria
Get PDFThe objective of the research was to determine the types, patterns of uterine cervical lesions and specific age distributions in which they occur.
Methods. The data for this study were obtained from the records of patients seen in consultations in the Department of Histopathology, Central Hospital Warri during the 10-year period from 2007 to 2016. Relevant clinical information was extracted from the available histopathology records and permission for this study was conformed with the provision of the Declaration of Helsinki in 1995.
Results. The study revealed that the peak age range for malignant neoplasm was between 40-49 years (27.52%) with the general age range between (20-80 years) mean age 52.39±13.69. Non-keratinizing squamous cell carcinoma constituted majority of squamous cell tumours (55.05%), while the keratinising variety was the second most common (26.61%) one. The study further revealed that ectocervical fibroepithelial polyps were more common than endocervical tumours especially in the reproductive years (30-50 years) with only one case of atrophic polyp recorded in a woman in the sixth decade. The study documented that 58 (22.48%) of the cervical biopsies were inflammatory with most cases occurring in the ectocervix (94.80%). Most cases of inflammation of the cervix (cervicitis) were disposed between 30 and 59 years with the peak age group occurring in the 4th age group (30-39 years).
Conclusions. This audit of uterine cervical biopsies established that malignant tumours were the most common neoplasms. Squamous cell carcinomas accounted for most carcinomas. Similarly, leiomyoma was demonstrated as predominant stromal tumour.  
Complications of Urogenital Chlamydial Infection in Women
Get PDFThe objective of the research was to identify the spectrum of complications in women with chronic urogenital chlamydial infection.
Materials and methods. There were examined 128 women with chronic inflammatory diseases of genital organs at the age of 16-40 years who were diagnosed with urogenital chlamydial infection and 25 apparently healthy women. In both women with chlamydial infection and healthy ones, urogenital chlamydial infection was diagnosed based on the data of clinical examination and the results of laboratory tests (the identification of chlamydial morphological structure on the pathologic specimens stained according to the Romanowsky-Giemsa method; the identification of chlamydial antigens using the direct immunofluorescence technique; the study of Chlamydia trachomatis antibody titers using the enzyme-linked immunosorbent assay).
Results. According to the results of our study, chlamydiae were the most common causes of inflammatory lesions of the urogenital organs in women of different ages leading to different reproductive complications and affecting females mostly at the age of 21-30 years. In women of Group I and Group II, chronic chlamydial disease was detected; disease duration ranged from 6 months to more than 2 years. Miscarriages, infertility (primary, secondary), ectopic pregnancy (tubal, ovarian) were the severest and the most numerous reproductive complications in the examined patients.
Conclusion. Chronic chlamydial infection is the most common disease of the female urinogenital organs leading to a wide spectrum of complications including infertility (primary, secondary), miscarriages, ectopic pregnancy (tubal, ovarian), chronic abdominal pain, sexual dysfunction (low libido, hypo/anorgasmia, painful intercourse, neurotic symptoms)
Resources and Indicators of Activity of the Urological Service of the Ivano-Frankivsk Region in Dynamics for 2008-2017
Get PDFAccording to the national system of medical-statistical accounting and reporting, data on human resources supply, network, staffing, structure, logistics and indicators of the activity of the urological service in Ukraine and Ivano-Frankivsk region were analyzed.
It is shown that the urological service of the Ivano-Frankivsk region is characterized by the sufficient provision of qualified personnel, a wide infrastructure in health care institutions of different forms of ownership, the equipment of which allows performing modern mini-invasive interventions only in certain public medical institutions of the secondary level, in еhe Regional Clinical Hospital and in some private health care institutions.
It has been determined that despite the performance of the network optimization over the past decade and the reduction of urological beds, their average use continues to decrease, and the average duration of patients’ treatment remains high, indicating irrational use and excessiveness of inpatient urological care
Dynamics of Indicators of Structural and Functional State of the Heart in the Post-Infarction Period Depending on the Presence of Decompensated Heart Failure
Get PDFEchocardiographic indicators in decompensated heart failure demonstrate a high prevalence of structural and hemodynamic abnormalities. In the patients with decompensated heart failure in the early and late post-infarction period, echocardiographic indicators were found to significantly differ from those recorded in the patients without heart failure. Thus, reduced ejection fraction, increased end-diastolic volume and end-diastolic dimension indicate left ventricular systolic dysfunction and left ventricular cavity dilation. Since echocardiography of the heart and the pulmonary artery enables real-time estimation of cardiac filling, signs of systolic dysfunction and pulmonary congestion, it may serve as a predictor of decompensated heart failure development in the early and late post-infarction period.
The objective of the research was to determine the main echocardiographic indicators in terms of rapid monitoring of deterioration in the main parameters of left ventricular overload for early diagnosis of decompensated heart failure, as well as structural and geometric remodeling of left ventricular myocardium in the early and late post-infarction period.
Materials and methods. There were examined 160 patients with acute myocardial infarction. Depending on the development of decompensated heart failure in the early and late post-infarction period, the patients were divided into two subgroups being homogeneous by age and gender.
Results. The results obtained indicated significant hemodynamic changes in the patients with decompensated heart failure in the post-infarction period. They included significantly lower values of ejection fraction indicating left ventricular systolic dysfunction and the signs of left ventricular cavity dilation as evidenced by the increase in left ventricular end-diastolic volume and end-diastolic dimension. The tendency for an increase in left ventricular posterior wall thickness and interventricular septal thickness, as well as left ventricular myocardial mass, left ventricular myocardial mass index and left ventricular radius to wall thickness ratio indicated concentric left ventricular remodeling.
Conclusions. Modern management of patients with decompensated heart failure should be guided by an objective value of left ventricular ejection fraction as it plays a key role in selecting management strategy for this cohort of patients since a significant reduction in this parameter indicates cardiac decompensation. Pulmonary artery pressure and concentric left ventricular hypertrophy play a significant role in cardiac failure development as well. 
Peculiarities of the Course and Provision of Medical Care to Patients with Acute Coronary Syndrome in the Precarpathian Region
Get PDFAbstract. Cardiovascular diseases are the first ones in mortality among other diseases. Particular attention should be paid to patients after acute coronary syndrome, since their quality of life, the possibility of restoration of work capacity.
Objective of the research. To evaluate indicators of medical care provision for patients with acute coronary syndrome in the Precarpathian region.
Materials and methods. The medical-geographical indicators, data of the local registry (2014-2018) included clinical and objective parameters, peculiarities of the course, rehabilitation and treatment of patients with acute coronary syndrome.
Results. The peculiarities of the course of acute coronary syndrome, clinical characteristics of patients depend on the form of IHD and the applied method of ACS treatment. There is an increase of the number of PCI performance and the reduction of TLT, the percentage of admission of patients up to 2 hours remains low. The increase of PCI performed in the districts of the region in the dynamics from 2014 to 2018 has been determined, as well as the geographical peculiarities of the Ivano-Frankivsk region. The percentage of patients’ undergoing rehabilitation after acute coronary syndrome remains low.
Conclusions. The Precarpathian region has a number peculiarities that are related to the location of the region. Taking into account the characteristics will contribute to the improvement of the organizational model of medical care provision in the region