Publishing House of Ivano-Frankivsk National Medical University
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Pathogenetic Justification for the Use of Folates for the Prevention of Congenital Malformations
Get PDFThe frequency and severity of congenital malformations (CMF) do not tend to decline in modern society. CMF for etiologic factors are referred to the pathologies of a multifactorial nature. Among the many causative factors of CMF there is a hereditary predisposition. The objective of the study was to increase the effectiveness of complex individualized prophylaxis of congenital malformations in women with polymorphic alleles of genes of folate cycle enzymes, the second phase of the detoxification system through the use of diagnostic, preventive, and therapeutic measures. Materials and methods. 120 women of reproductive age who live in the city of Odessa and the Odessa region were examined. The alleles of the genes of the folate cycle enzymes of methylenetetrahydrofolate reductase (MTHFR), 5-methyltetrahydrofolate homocysteine methyltransferase reductase (MTRR), glutathione-S-transferase M1 (GSTM1), folate acid, cyanocobalamin were determined. Results of the study and their discussion. The determination of the polymorphic alleles of the genes of the folate cycle enzymes of methylenetetrahydrofolate reductase (MTHFR), 5-methyltetrahydrofolate homocysteine methyltransferase reductase (MTRR), glutathione-S-transferase M1 (GSTM1), low folate, cyanocobalamin indicates the presence of a hereditary predisposition to the emergence of CMF, before and during pregnancy. Polymorphism of genes that control the synthesis of GSTM1 may alter the activity of detoxification enzymes. Expression of genes of GSTM1 enzymes begins in the embryonic period. Glutathione-dependent detoxification plays a key role in disinfecting of DNA peroxides. Mistakes of metabolism, functions of the corresponding enzymes are realized by chromosomal abnormalities and the risk of the occurrence of CMF, which requires the use of antioxidant therapy before and during pregnancy. Conclusions. It was found that a high (about 55%) frequency of the polymorphic alleles of the genes of folate cycle enzymes MTHFR (homozygous – 10.0%, heterozygous – 16.7%), 5 MTRR (homozygous 12.5%, heterozygous – 15.5%) , the second phase of the GSTM1 detoxification system (homozygous – 13.3%, heterozygous – 15.8%), the content below the reference values of folic acid in 26.7%, cyanocobalamin – in 63.4% of observations indicates a hereditary predisposition and may contribute the emergence of CMF, which explains the expediency of timely use of preventive measures including folates, antioxidants
Clinical Aspects of Combination of Ceramic and Acrylic Occlusal Surfaces
Get PDFThe objective of the research was to develop and substantiate the methods of constructing the occlusal surfaces when manufacturing aesthetic fixed restorations through the combination of different materials.Materials and methods. The study included 65 patients with ceramic and acrylic occlusal surfaces of aesthetic fixed dental prostheses. Group I included 21 patients with a combination of ceramic and acrylic occlusal surfaces. Group II included 22 patients with a combination of ceramic occlusal surfaces. Group III included 22 patients with a combination of acrylic occlusal surfaces. The patients were observed 3, 6 and 12 months after prosthetic repair.Results. The greatest increase in the occlusal contact surface area of fixed restorations was observed in Group I, that is, when combining dental prostheses with ceramic and acrylic occlusal surfaces. Considering uneven abrasion of the occlusal surfaces, we do not recommend to combine different materials when veneering the occlusal surface of the antagonistic teeth.Conclusions. This study demonstrated the important role of the correct combination of materials when veneering the occlusal surfaces. Physical and chemical properties of materials, namely the abrasion resistance play a significant role in the long-term denture functioning.The smallest increase in the occlusal contact surface area was observed in Group II when combining ceramic occlusal surfaces. It was due to a good abrasion resistance of ceramics as compared to acrylic resin as well as the presence of the glazed layer which prevents the premature abrasion of the occlusal surfaces of the antagonistic teeth due to lower surface roughness.The combination of acrylic resin and ceramics when constructing the occlusal surfaces of fixed restorations in Group I demonstrated the highest rate of the increase in the occlusal contact surface area – 9.93%. It was due to a low hardness of acrylic resin and its high surface roughness. In addition, there was observed an uneven abrasion of the occlusal surfaces resulting in periodontal tissue overload, thereby negatively affecting denture functioning
Kappa-splints application for the treatment of pathological dental hard tissues abrasion in combination with dentition defects and dentition deformations
Get PDFResearch objective: to develop and implement a new clinical method of producing a set of kappa-splints for splint therapy: treatment and prevention of various forms of pathological teeth abrasion in combination with dentition defects and dentition deformations, which will enable to prevent significant disorders in the dentition.Materials and Methods: 36 patients aged 30-59 have been selected for the targeted research with a generalized form of pathological tooth wear in combination with dentition defects and dentition deformations.Results: After studying the movements of conventional hinge axis in articulate heads of TMJ with the help of condylograph «Cadiax Compact», some asynchronous, asymmetrical bias of articulate heads during the movements of the mandible were revealed in patients with pathological tooth wear in combination with dentitiondefects and dentition deformations. While examining, the patients complained about the aesthetic defects due to the abrasion of teeth and the change of their colour, the discomfort while closing, chewing and phonetic disorders. In the clinical picture of these patients, the typical symptoms of TMJ dysfunction can be singled out, such as pain and crunch in joints, fatigue of chewing muscles and pain in the muscles, the displacement of the mandible to the side during vertical movements, a feeling of fullness in the ears, headaches and bruxism. Dentition deformations were presented as a violation of the occlusal curve. The results indicate on the presence of functional TMJ disorders and masticatory muscles dysfunction in pathological teeth abrasion in combination with dentition defects.So, in most cases, temporary prosthesis structures and occlusal splints can be applied to normalize occlusive correlations at the dysfunction of TMJ and masticatory muscles. Gradual lifting of occlusion has been done due to a set of kappa-splints in terms of 14 days, 1 month and 3 months from 1.0 to 5.0 mm to the full restoration of occlusal height, depending on the severity of pathological teeth abrasion. It is the gradual application of a kappa-splints’ set which allows prevention of further tooth wear; it doesn’t influence the periodontium of teeth; it’s aesthetic and does not violate the pronunciation of sounds. The material, which a kappa-splints set is made of, provides better fixation and bite separation with optimal thickness throughout the dentition, which allows the lower jaw to take a position that helps to restore the functional balance of the entire dentition.Conclusions:1. According to the results of the research it has been established that the orthopedic treatment with the help of occlusive splints at the preparatory stage for the patients with occlusive disorders at pathological dental hard tissues abrasion in combination with dentition defects, periodontium tissue disease and dentition deformations are urgent for the normalization of occlusive correlations of the jaws.2. After studying the movements of conventional hinge axis in articulate heads of TMJ with the help of condylograph «Cadiax Compact» and eliminating the symptoms of stress in masticatory muscles of the patients with occlusive disorders at pathological dental hard tissues abrasion, it is the gradual application of a kappa-splints set, made of hard transparent plates of Ercodent Ercodur material (Germany) with a thickness of 1.0 to 5.0 mm, which allows prevention of further tooth wear, normalization of occlusive correlations of the jaws, separating a bite with optimum thickness throughout the dentition, thus the lower jaw takes a position at which the state of functional equilibrium of the entire dentition is restored
DEVELOPMENT OF SIMULATION CENTER AND TRAINING PROGRAMMES IN IVANO-FRANKIVSK PERINATAL CENTER
Get PDFCurrent system of medical education in Ukraine needs improvement and reforms in order to enhance the proficiency of doctors and paramedics. Training of practical/technical skills, communication, as well as teamwork skills is considerably important.The use of simulation techniques and methods in medical education is called simulation training in medicine. Medical skills are acquired through cognitive (knowledge) and psychomotor (practice) skills. The first medical simulation centers appeared in Ukraine in 2006 according to the order of the Ministry of Health Care of Ukraine.On June 20, 2013, a new simulation training center was opened in Ivano-Frankivsk on the base of Regional Perinatal Center. Similar medical simulation centers were opened in the second half of 2013 in Volyn and Vinnytsia regions under the Ukrainian-Swiss Mother and Child Health Programme, which started in the area of perinatology. Their goal is to improve the teamwork of all specialists involved in the process of delivery and neonatal intensive care,as well as to engage internship doctors and senior medical students in clinical skills training programmes.The use of simulation techniques and training programs offers a powerful platform to study and practice clinical reasoning behaviors and patterns
Clinical Effectiveness of Using Aesthetic Fixed Prosthetic Appliances with Combined Occlusal Surface
Get PDFThe objective of the research was to evaluate the clinical effectiveness of using aesthetic fixed prosthetic appliances with combined occlusal surface.Materials and methods. The study included 30 patients who were divided into 2 groups: Group I included 20 patients with combined occlusal surface of the crowns; Group II included 22 patients with ceramic occlusal surface of the crowns. The patients were observed 3, 6 and 12 months after prosthetic repair.Results. 6 months after prosthetic repair, the occlusal contact surface area in Group I increased by 0.79%, while in Group II, it increased by 1.4%.12 months after prosthetic repair, the occlusal contact surface area in Group I and Group II increased by 2.37% and 5%, respectively.The aforementioned data indicated that the occlusal contact surface area increased as the period of ceramic fixed prosthetic appliance wearing increased.When combining the occlusal surface in dental prostheses, the occlusal contact surface area increased approximately 2 times slower. The study demonstrated convincingly that crowns burnt on a zirconium dioxide frame were a better choice as compared to cast framework made of nickel-cobalt-chrome alloy. In case of cast frameworks, the indicators of crown margin discrepancy were worse than in case of milled frameworks - 15% versus 5%, respectively. In addition, one cast framework crown (5%) in Group II was remodeled and one crown (5%) was recemented.Conclusions. Aesthetic fixed prosthetic appliances with combined occlusal surface demonstrated high functional and aesthetic characteristics. The use of the USHPS system showed a decisive advantage of milled frameworks and combined occlusal surface over traditional cast ceramic frameworks.The combination of high mechanical, strength and tribological properties of zirconium dioxide and high biological as well as aesthetic properties of ceramic materials helped reveal high clinical characteristics of aesthetic appliances with combined occlusal surface.
On Dynamics of Gender-Specific Mortality Among the Population of the Republic of Belarus in the Second Half of the XX – the Beginning of the XXI Centuries
Get PDFAim of the study: to evaluate the dynamics and to make a comparative analysis of male and female mortality among the population of Belarus Republic during 1959 – 2015.Materials and methods. The data on natural population movement in the Republic of Belarus during 1959 – 2015 have been analyzed in the research work. Crude and standardized mortality rates have been calculated using the direct standardization according to the world standard (Standard “World”), approved by WHO. JoinPoint software was used to investigate time trends as well as office suite MSEXCEL 2010.Results of the study. The minimum values of male and female crude and standardized mortality rates were established in 1964. Throughout the study period, the male population mortality rate grew 1.8-fold (based on crude rates – 2.4-fold), the female population mortality rate – 1.6-fold (based on crude rates – 2.2-fold). During 1985 – 2005, the differences in crude mortality rates among men and women grew 1.2-fold, and during 1962 – 2011, the differences in standardized rates increased 1.8-fold. Since 2003, the mortality rate among men and since 1999, the death rate among women has declined with an annual decrease rate to be more than twice as high as compared to an annual mortality increase registered during its growth.Conclusion. Since the 1960s, the changes in population age structure of the male and female population affected the crude mortality rates. The male and female mortality growth is due to an increased unfavorable impact of combined environmental factors. The adaptive capacity of women to sustain environmental changes contributed to their later entry into the period of mortality growth, as compared to men. The mortality rate reduction in men since 2003 and the excess of a decrease over an increase rate is associated with a set of state measures aimed at protecting and strengthening the public health in the republic
The Role of Endothelial Dysfunction Markers in Pregnant Women with Chorion Detachment, Included in the Program of Auxiliary Reproductive Technologies
Get PDFAn urgent medical and social problem is the restoration of reproductive function of womenwho suffer from infertility, which became possible due to auxiliary reproductive technologies. Women with induced pregnancy make thegroup of a high-risk on miscarriage, due to interrelated processes –immunological disorders and endothelial dysfunction that occur in the body of pregnant women after the use of extracorporal fertilization programs, and can lead to the chorion detachment and the formation of subchorionic hematomas.The purpose of the study is to determine the role of endothelial dysfunction as one of the leading factors that determine the development of a local non-progressive chorion detachment in infertile patients included in the program of auxiliary reproductive technologies.Materials and methods. We have examined 130 pregnant women, who were divided into groups: the control group included 30 women, whose pregnancy occurred in the natural cycle and with uncomplicated gestational course; the main group – 50 patients with induced pregnancy and risk factors of the occurrence of chorion detachment, who wereperformed the proposed pre-gravidapreparation; the comparative group – 50 pregnant women who received a standard scheme of pregnancy management before and after in-vitro fertilization. A general clinical examination, ultrasound examination, homocysteine level determination, endothelin-1 and nitrogen oxide metabolites were performed.Results. In women included into the program of auxiliary reproductive technologies with local chorion detachment were recorded changes of vascular endothelial function with a possible increase in endothelin-1 production and a decrease of the nitric oxidesynthesis. During the induced pregnancy with the presence of subchorionic hematoma, an increase of the level of endothelium-damaging factor of homocysteine was noted.Conclusions.This study identifies the parameters that reflect the main links of endothelial dysfunction and can be used as markers of local chorion detachment
Long-Term Effects of Articular and Extra-Articular Damage in Adult Patients with Juvenile Idiopathic Arthritis and Different Immunogenic Markers
Get PDFTo assess the long-term effects of juvenile idiopathic arthritis in adulthood, unified diagnostic methods for articular and extra-articular lesions should be used which depend on the juvenile idiopathic arthritis variants, the disease activity and treatment. The objective of the research was to compare the clinical manifestations in adult patients with different juvenile idiopathic arthritis-specific immunogenic markers and to evaluate their impact on the long-term articular and extra-articular damage.Materials and methods. We observed 132 young patients with different juvenile idiopathic arthritis variants. According to genetic/immunological markers the following groups were formed: Group I - 38 positive human leukocyte antigen B27 patients; Group II - 13 positive antinuclear antibody patients; Group III - 26 positive rheumatoid factor/anti-cyclic citrullinated peptide patients and Group IV - 55 patients with all negative markers. Long-term effects of juvenile idiopathic arthritis were estimated by the articular juvenile arthritis damage index (JADI-A) and the extra-articular juvenile arthritis damage index (JADI-E). Descriptive statistics, the Student’s T-test, the Fisher’s exact test and Mann-Whitney U-test were performed.Results. 70 women and 62 men with the disease duration of 13.6±9.3 years at the age of 24.3±8.3 years were included into the study: 12 (9.1%) patients with positive rheumatoid factor polyarthritis, 30 (22.7%) patients - with negative rheumatoid factor polyarthritis, 32 (24.2%) patients with persistent oligoarthritis, 19 (14.4%) patients with extendent oligoarthritis, 20 (15.2%) patients with entesitis-related arthritis and 19 (14.4%) patients with systemic arthritis; there were no patients with psoriatic arthritis. There were no differences between groups in age, disease-modifying antirheumatic drug cumulative dose, mean dose of prednisolone and quality of life according to the SF-36. In Group I, the delay in the diagnosis was more than one year (18.6±24.2 months). In this group, less painful (p<0.005) and deformed (p<0.01) joints as compared to Group ІІІ, and higher levels of the ESR and C-reactive protein as compared to Group ІV were found, although the Juvenile Arthritis Disease Activity Score index in childhood was lower (p<0.005) as compared to Group ІІ. They received a lower cumulative dose of the glucocorticoids as compared to Group II (p<0.01), respectively. They had lower (p<0.01) JADI-E as compared to Group II (1.31 ± 1.49) and lower (p <0.01) JADI-A as compared to Group III. In Group III, the diagnosis was made the fastest in comparison with other groups (6.4±8.4 months, p<0.05); more painful joints (p <0.05) and ankylosis (p<0.05) were observed as compared to Group I, JADI-A was significantly higher (p<0.05) in Group III as compared to Group I. The most pronounced JADI-A was found in Group III, while in Group I and Group II, this index was the lowest. JADI-E was the most pronounced in Group II, and the most favorable course was found in Group І and Group ІІІ (p<0.05).Conclusions. Presence of anti-cyclic citrullinated peptide/rheumatoid factor in adults with juvenile idiopathic arthritis has negative impact on joint damage (JADI-A) indicating the need for aggressive therapy in both childhood and adulthood. Presences of antinuclear antibodies are associated with more often extra-articular damages in adulthood as compared to other groups
Changes in the Levels of Pro-Inflammatory Cytokines in Patients with Generalized Periodontitis and Hypertension, Depending on the Method of Treatment
Get PDFInflammatory mediators have an important role in the pathogenesis of periodontal disease. One of the leading mediators of the initiation of the pathological process is interleukin-1 (IL-1) – an endogenous pyrogen, a lymphocyte-activating factor. Numerous pro-inflammatory effects of interleukin-1β (IL-1β) occur in synergy with tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6), effects on hematopoiesis, participates in nonspecific anti-infective defense.The objective of the study is to determine levels of interleukin-6 and tumor necrosis factor alpha (TNF-α) in patients with hypertension II stage and generalized periodontitis of the II degree depending on the treatment method.There were examined 30 patients with hypertension of the II stage and with generalized periodontitis of the II degree. Patients’ age ranged from 35 to 54 years. These patients were divided into two groups. The control group included 10 patients without general somatic pathology and with healthy periodontitis of the same age. The result of the analysis of tumor necrosis factor alpha (TNF-α) in patients in the first group before the treatment was 10.69±2.33 pg/ml. After the treatment this indicator was 6.97±1.57 pg/ml (p>0.1) in patients of the first group.In patients of the second group the tumor necrosis factor alpha (TNF-α) was 9.49±2.2 pg/ml; after the treatment according to the offered scheme this figure decreased up to 2.77±0.9 pg/ml (p<0.01). The level of tumor necrosis factor alpha (TNF-α) in the control group was 1.5±0.77 pg/ml.Interleukin-6 was 9.91±2.04 pg/ml before the treatment in the first group. After the treatment according to the standard scheme, the level of interleukin-6 was 6.33±0.97 pg/ml (p>0.1). In the second group, before the treatment the level of interleukin-6 was 9.65±2.41 pg/ml; after the treatment according to the offered scheme it was 2.62±0.5 pg/ml (p<0.01). In the control group the interleukin-6 level was 2.24±0.51 pg/ml.Analyzing the obtained results after the treatment in both groups we can conclude: after the treatment of generalized periodontitis of the II degree in patients with hypertension of the II stage, indices of pro-inflammatory cytokines decreased and ranged in normal limits; in patients from the second group (who received the offered scheme of treatment -including medicines) indexes of pro-inflammatory cytokines were significantly lower than in patients with the standard treatment scheme; the proposed scheme of treatment is more effective for treatment patients with generalized periodontitis of the II degree and hypertension of the II stage