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The Effect of Single Use of Sorbilact and Its Combination with L-Arginine on the State of the Cardiovascular System in Endogenous Intoxication Syndrome of Purulent-Septic Genesis
Get PDFThe preparations of polyhydric alcohols, namely sorbitol-based ones, and their combination with adjuvant therapy, namely L-arginine are sufficiently promising for treatment of purulent-septic complications. The systemic nature of their action makes it appropriate to carry out studies of specific effect on the circulatory system, since their wide homeostatic and pharmacodynamic spectrum is beyond doubt for other systems and organs within the “efficiency-safety” algorithm.The objective of the research was to study the effect of combined use of sorbilact and L-arginine on the cardiovascular system of patients with endogenous intoxication syndrome during the period of developing early secondary autoaggression.Materials and methods. The study included 117 patients who were divided into the following groups: Group I consisted of 31 patients with systemic inflammatory response syndrome; Group II included 27 patients with endogenous intoxication syndrome treated according to 2016 Surviving Sepsis Campaign; Group ІІI comprised 29 patients with endogenous intoxication syndrome who received sorbilact in addition to standard therapy; Group IV included 30 patients with systemic inflammatory response syndrome who received standard therapy as well as sorbilact and L-arginine.Results. Co-administration of sorbilact and L-arginine was accompanied by an increase in stroke volume and cardiac output, activation of left ventricular minute work alongside with a moderate decrease in mean arterial pressure and systemic vascular resistance.Conclusions. The application of sorbilact and L-arginine in patients with endogenous intoxication syndrome provides hemodynamic stability
Teaching of Integrated Management of Patients with Hypothyroidism During the Cycle of Specialization “General Practice - Family Medicine”
Get PDFPathology of the thyroid gland is an actual medical and social problem of our time. It is due to the increasing prevalence of thyroid diseases and the negative impact of thyroid dysfunction on somatic, reproductive and mental health of the population. In addition, hypothyroidism is associated with an increased risk of developing coronary heart disease, myocardial infarction, chronic heart failure and cardiovascular mortality regardless of gender, age, and past cardiovascular diseases.The objective of the research was to improve the quality of training medical interns in the specialty “General Practice - Family Medicine” through the improvement of teaching the topic “The Integrated Management of Patients with Hypothyroidism”.Discussion. Postgraduate education involves training of medical interns specializing in general practice and family medicine to independent work at the primary health care facility. An essential internship component is the assimilation of practical skills.Conclusions. Further improvement of practical training of medical interns in the specialty “General Practice - Family Medicine” when teaching “The Integrated Management of Patients with Hypothyroidism” is a complex process that requires organizational measures, specific algorithms for managing patients, as well as a continuous improvement of academic, medical and diagnostic, educational work and technical support of the classes
Dynamics of Proteo- and Fibrinolytic Activity in Brain Structures of Rats with Diabetes Mellitus Complicated by Carotid Ischemia-Reperfusion
Get PDFThe imbalance in the protease-antiprotease system is an integral part of the pathogenesis of acute disorder of cerebrovascular circulation and diabetes mellitus (DM), but its manifestations in the complication of diabetes by ischemia-reperfusion of the brain have not been investigated yet.The objective of the work – is to study the dynamics of carotid ischemia-reperfusion effect on the proteo- and fibrinolytic activity in brain structures of rats with experimental DM.Rats with the four-month streptozotocin DM were modeled bilateral carotene ischemia during 20 minutes. In homogenates of brain structures, indicators of proteo- fibrinolytic activity were determined after 1 hour from the beginning of reperfusion and during the 12th day of the post-ischemic period.In the absence of DM, the proteolytic activity of all or individual indicators is increased in both periods of the post-ischemic period in the cortex of the frontal and occipital lobes, the fields of hippocampus CA2 and CA3, and during the 12th day in the field CA1. In rats with diabetes, in all brain structures, there are no changes in the lysis of azo-albumin and azo-casein in both terms of observation and lysis of collagen progressively decreases.In rats without DM in the cortex of the studied particles, fields of the hippocampus CA1 and CA2, all or separate indices of fibrinolytic activity are increased in both periods of the post-ischemic period, in the field CA3 – all indices at the 12th day. In the presence of diabetes in the cortex of both studied lobes and the field CA1, the fibrinolytic activity decreases in the late post-ischemic period, in the fields of CA2 and CA3 – during both observation periods.Conclusion. In the brain structures under investigation at both time intervals, the DM eliminates the reaction of low and high molecular weight proteins to the ischemia-reperfusion and suppresses fibrinolytic activity.
Evaluation of Serotonin and Hystamine Exchange in Women with Premature Birth in Different Terms of Gestation
Get PDFIn modern obstetrics and gynecology, the problem of preterm labor is considered one of the most urgent.A significant number of factors affects on the run of pregnancy and it`s result, it`s activity is realized through numerical metabolic interactions, where an important role is given to biogenic monoamines, in particular serotonin and histamine.The aim of the study - to study the features of serotonin and histamine exchange in women`s body with different periods of abortion by determining in the blood the content of biogenic amines level of excretion with daily urine of serotonin 5-oxyindoloacetic acid and activity in the blood serum of the enzyme inactivation of histamine - histaminase.Material and methods of research – there were examined 227 pregnant women, 190 of these had clinical signs of the threat of preterm delivery in the gestation period of 23-36 weeks in the form of premature and timely childbirth.Women with early premature pregnancy, which ended with childbirth in the period from 23 to 27 weeks have a depletion of the functional activity of the serotonergic system.In women with late onset of pregnancy, there is an increasing of the serotoninergic system`s functional state, is probably with inhibition purpose of excessive excitement of stress-implementing systems. In women with a physiological course of pregnancy indicating an increasing of the histamine-histamine system activity with signs of a balance between the synthesis of biogenic amine and its inactivation. In women with early onset of pregnancy the inferiority of the blood system "histamine-histamine" develops, which is confirmed by a significant increasing of biogenic monoamine and reduction in the activity of the enzyme inactivation. In women with onset of pregnancy, there is a probable increasing of the histamine concentration in the blood indicating some exhaustion of "histamine-histaminase" systems with predominance signs of biogenic amine synthesis over its inactivation.Revealed changes in the state of serotonin and histamine in pregnant women indicate the violation of the adaptation mechanisms and the promoting possibility of the preterm labor development
Postural Orthostatic Tachycardia Syndrome in Young Diabetics
Get PDFPostural orthostatic tachycardia syndrome is a condition characterized by imbalance in autonomic reactivity leading to exaggerated heart rate and other symptoms of orthostatic intolerance. In adolescents, it is characterized either by a continuous increase in heart rate of ≥40 bpm as compared to basal heart rate or sustained basal rate of ≥130 bpm. The objective of the research was to compare the characteristics of adolescent diabetics with postural orthostatic tachycardia syndrome with the controls. Methods. Seventy adolescents diagnosed with type 1 diabetes mellitus who were treated at the department of Endocrinology, Government Medical College and Shri Maharaja Hari Singh hospital, Srinagar, J&K, India were selected for the study. Lying to standing test was performed. Heart rate was recorded at the 2nd, 3rd, 5th and 10th minutes. Based on the results of lying to standing test, there were selected 25 diabetic adolescents with postural orthostatic tachycardia syndrome. Their characteristics were compared with age- and sex-matched adolescents using unpaired T test. P< 0.05 was considered significant. Results. We observed a significantly lower body mass index (p=0.027), as well as a significantly higher fasting blood glucose level (p<0.0001) in diabetics with postural orthostatic tachycardia syndrome. Conclusion. It may be concluded that lower body mass index and higher fasting blood glucose level may lead to the development of postural orthostatic tachycardia syndrome in adolescents.
Management of Necrotizing Fasciitis Following Human Bite on the Upper Limb
Get PDFThe authors describe a case of necrotizing fasciitis of the upper extremity resulting from human bite managed successfully, and emphasize the importance of early diagnostic prompt treatmentand prevention
Clinical Peculiarities of the Mixed-Invasion of Giardiasis and Ascariasis
Get PDFIntestinal parasitic diseases are widespread in the territory of almost the entire globe. Among them the most common are giardiasis and ascaridosis. In recent years, more and more cases of combined invasion by these organisms have been registered.
The objective of the research was to study the clinical peculiarities of the course of giardiasis and ascariasis in patients with combined invasion.
Materials in the methods. There were 42 patients under observation, who were divided into 3 groups. The first group (n=14) included patients with giardiasis, the second one (n=14) – patients with ascariasis, the third group (n=14) included patients with mixed infection of giardiasis and ascariasis.
Results. The main clinical syndromes in patients with giardiasis, ascariasis and patients with mixed invasion by both pathogens have been analyzed. In all groups of patients, the manifestations of dyspeptic syndrome were most frequent. Signs of an allergic syndrome were observed as a polymorphic rash on the skin. Data on astheno-neurotic and intoxication syndromes took place somewhat less frequently.
Conclusions. Clinical manifestations in patients with mycobacterial invasions of giardiasis and ascariasis were reported more frequently than in patients with monoinvasion, and more pronounced polymorphism was observed
Quality Assessment of Medical Care at the Stage of Primary Healthcare: the Range of Diagnostic Procedures in Patients with Eczema
Get PDFAccording to the results of studying the ranges of diagnostic measures among 75 patients with eczema, primary health care quality was assessed. The adequacy/completeness of clinical and anamnestic examination of patients with eczema by general family medicine physicians was at the level of (56.5÷59.8)% being characterized by the underestimation of the state of skin derivatives (microelementosis, vitamin deficiency) in (86.7±3.9)% of patients; the constitutional and biological markers, visceral and functional markers of undifferentiated connective tissue dysplasia in (74.7±5.0)% and (74.7±5.0)% of patients, respectively; the influence of unfavorable regional environmental factors, living conditions and professional activity, clinical and morphological evaluation of rash in (49.3±5.8)% of patients. According to the generalized quality index, the adequacy/completeness of clinical and laboratory examination of patients with eczema was at the level of (58.4÷63.4)% being characterized by a low level of examinations aimed at the detection of possible disorders of microelement homeostasis and comorbidity. According to the generalized quality index, the adequacy/completeness of clinical and instrumental examination of patients with eczema was at the level of 66.5 being characterized by a low level of instrumental diagnostics of autonomic homeostasis state, densitometry, anesthesiometry, imaging study of the joints
Differentiated Antiplatelet and Hepatoprotective Therapy in Patients with Stable Coronary Heart Disease on the Background of Nonalcoholic Fatty Liver Disease in Stage of Steatosis
Get PDFThe objective of the research was to evaluate the effectiveness of long-term antiplatelet and hepatoprotective differentiation therapy in patients with postinfarction cardiosclerosis and co-existent non-alcoholic fatty liver disease in stage of steatosis.Materials and methods. There were examined 72 patients with stable coronary heart disease functional classes II-III and co-existent non-alcoholic fatty liver disease in stage of steatosis. All the patients underwent a complete clinical examination; the functional state of their liver and platelet haemostasis were assessed. All patients received standard therapy the effectiveness of which was assessed 3 and 6 months after treatment.Results. The effectiveness of antiplatelet therapy was found to depend on treatment duration, the functional state of the liver and the scheme of antiplatelet and hepatoprotective differentiation therapy. In particular, 6 months after treatment, a positive dynamics of platelet haemostasis was observed in all the patients of Group I. However, the target value of its indicators was achieved in 60.5% of patients. In Group II, the target level of platelet aggregation activity was achieved in 38.3% of patients. The level of liver enzymes was within the control limits in 52.8% of patients. In 47.2% of patients, however, an increase in their level was observed, which necessitated the administration of appropriate hepatoprotective therapy.Conclusions. The developed concept of differentiation treatment of patients with coronary heart disease and co-existent non-alcoholic fatty liver disease in stage of steatosis envisages the need for monitoring the indicators of platelet haemostasis and liver function every three months after the administration of antiplatelet therapy with the possibility of its intensification and the inclusion of hepatoprotective drugs
Mastering the Central Line Placement Techniques Through Effective Resident Training Environment
Get PDFCatheterization of the central vein is one of the fundamental procedures in anesthesiology. Mastering different methods of central venous access is an important part of resident training. At the initial stage residents should master the way of high medial access to the right internal jugular vein that is one of the simplest techniques with the lowest risk of complications for a patient. The operating room can be an optimal training environment where first independent puncture attempts are performed in a stable patient undergoing surgical intervention under general anesthesia. The next stage of training should involve access to other central veins as well performing the procedure in a conscious patient