Publishing House of Ivano-Frankivsk National Medical University
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Prognostic Assessment of the Inflammatory Process Activity in Sarcoidosis of Respiratory Organs: Potential Use of C-reactive Protein and TNF-α
Get PDFThis research work is devoted to the development of new additional criteria for the activity of inflammatory process in sarcoidosis of respiratory organs. The objective is to assess the effectiveness of performed treatment of sarcoidosis of respiratory organs by using low-cost highly-sensitive inflammatory markers.Materials and methods. The study involved 68 patients with lung sarcoidosis before and after the three-month treatment. In addition to general-clinical methods of examination, patients with sarcoidosis were also determined the levels of TNF-α and СRP.Results and their discussion. Patients with active lung sarcoidosis had 17.6 times (p<0.05) increased level of CRP in bronchoalveolar lavage fluid and 9.0 times (p<0.05) increased levels in peripheral blood serum; the levels of TNF-α increased by 4.98 times (p<0.05) in bronchoalveolar lavage fluid and by 3.2 times (p<0.05) in peripheral blood serum as compared to the findings in the control group of patients. The study showed that in the group of patients, where the efficacy of the prescribed therapy was noted, the level of CRP decreased by 2.76 times (p<0.05) in bronchoalveolar lavage fluid and by 2.58 times (p<0.05) in peripheral blood serum, and the concentration of TNF-α decreased by 3.87 times (p<0.05) in bronchoalveolar lavage fluid and by 2.06 times in peripheral blood serum as compared to the initial indices.Conclusions. The decrease of TNF-α level in bronchoalveolar lavage fluid on the background of three-months treatment correlated (r=0.89; p<0.05) to the changes in peripheral blood serum; at the same time the decrease of TNF-α level in peripheral blood serum correlated (r=0.82; p<0.05) to the decrease of CRP in peripheral blood serum of patients with sarcoidosis of respiratory organs.
The State of the Hemomycocirculatory Bed of Adventitia of Varicose Veins of the Small Pelvis in Women with Chronic Inflammatory Diseases of the Internal Genital Organs
Get PDFHemomicrocirculatory system – is a complex structure that reacts in every pathological process even before the clinical period and takes the first blow. The study of microhemocirculation will provide an opportunity to solve the important for practical medicine questions of pathogenesis of many diseases, as for the prevention and treatment of regional disorders of blood circulation.The objective of the research is to study the state of the hemomicrocirculatory bed (HMCB) of adventitia of varicose veins of the small pelvis (VVSP) in women with chronic inflammatory processes of the organs of the small pelvis (CIPOSP).Materials and methods of research. To evaluate the restructuring of the HMCB of adventitia of VVSP, the operating material of 12 women of reproductive age was used. Mainly, there were pieces of the ovarian vein. The study of the HMCB in the vein wall was performed by the non-injecting method of silver impregnation according to V.V. Kupriyanov. To standardize the results, the condition of the HMCB of adventitia of the venous wall in norm was studied in 5 women of reproductive age, who died as a result of various traumas.Results of the research. After the performed studies, the structural-morphological changes of the HMCB of the adventitia of the small pelvis veins were revealed. The dilation of capillaries, postcapillaries, postcapillary venules was observed. The diameter of the vessels of the HMCB of the ovarian vein adventitia was: venule – 94.21 ± 1.38 μM in comparison with the norm – 48.78 ± 1.60 μM (p<0.001); post-capillary venules – 46.76 ± 1.04 μM in comparison with the norm – 28.29 ± 1.1.01 μM (p<0.001); the capillaries were 11.22 ± 0.14 μM in comparison with the norm – 8.24 ± 0.16 μM (p<0.05), arterioles – 29.02 ± 0.76 μM in comparison with the norm – 25.19 ± 1.15 μM (p<0.01). The architectonics of the arterioles is almost unchanged. Lumen of venules is filled with formed elements. The structure of capillaries is polymorphic. The capillary net was localized and concentrated or was formed as a thick planar net, the capillaries were expanded. There were arterio-venulous anastomoses. Endothelial nuclei are shortened. In some preparations, the diameter of the arterioles corresponded to the diameter of the collection venules. Conclusions:1. The first discovered by us changes in HMCB of adventitia of varicose veins of the small pelvis in women with CIPOSP can be one of the pathogenetic links of the development and progression of the varicose vein itself, which in turn aggravates the course of chronic inflammation. 2. The timely appointment of drugs that improve microcirculation will enable to prevent the development of dystrophic changes in the vein wall, improve the course of chronic inflammatory processes and reduce or completely eliminate the syndrome of “chronic pelvic pain”
Teaching of Pneumonia on a Cycle of Specialization “General Practice – Family Medicine”
Get PDFPneumonia remains an urgent medical and social problem. The urgency of this problem is not stressed by only the significant prevalence, but also by quite high rates of morbidity and mortality and significant economic losses due to this disease.The purpose of work is to improve the quality of the training for interns – on the specialty “General Practice – Family Medicine” by improving the teaching of the topic “Pneumonia” and practical classes.Discussion. Postgraduate education includes training of medical interns – general practitioners to work independently on primary health care. Great importance in the education of interns – general practitioners is given to the development of practical skills.Conclusion. Further improvement of practical training of interns – general practitioners on the specialty “Pneumonia”, perfection of practical training of a doctor – is a complex process that requires not only organizational measures, improvement and specification of standardized clinical protocols, textbooks, but also continuous improvement of academic, medical diagnostic, educational work, materials and technical support of study
THE EFFICIENCY OF THE USE OF INDIVIDUAL REMOVABLE DENTAL BITE SPLINTS FOR CORRECTION OF DENTAL DEFORMATIONS DEGREE IN PATIENTS WITH DENTURE DEFECTS
Get PDFObjective: introduction of prevention methods and increase of the treatment efficacy of teeth deformations using individual dental bite splints. Materials and methods: The results of clinical examination of 67 patients of different age (20 to 59 years) with the existing dentition defects before and after use of individual removable dental bite splints are given in this article. The results of the work: the objective study showed a difference in data of the distances between certain points of the teeth surrounding the defect without dentition deformations and in their presence (distances АВ in the control and experimental groups was respectively 7.16 ± 0.19 mm and 4.32 ± 0.19 mm, АD -7.62 ± 0.19 mm and 4.16 ± 0.20 mm, ВС - 7.49 ± 0.19 mm and 4.07 ± 0.19 mm, СD – 6.96±0.19 mm and 3.67±0.19 mm). After the performance of the preparation of the patients with the dentition defects and deformations of the teeth with the use of individual dental bite splints to the prosthetic repair in several stages, it became possible to reduce significantly indexes of the distances in the presence of pathology and bring them closer to physiological data (АВ - 5.85 ± 0.21 mm, AD - 6.09 ± 0.18 mm, BC - 6.22 ± 0.19 mm, and СD- 5.73±0.19mm). Conclusions: The use of individual removable dental bite splints gave the possibility to improve significantly the prosthetic efficacy by normalizing the occlusal relations and chewing load onto the displaced teeth in the area of dentition defect
Changes in Humoral and Cellular Immunity in Tertiary Peritonitis
Get PDFThe objective of the research was to give a comparative characteristic of parameters of humoral and cellular immunity in the development of secondary and tertiary peritonitis.Materials and methods. The research enrolled 109 patients with secondary peritonitis, 20 of whom developed tertiary peritonitis. Changes in humoral and cellular immunity were evaluated by serial blood tests for the determination of leukocyte count, the relative number of lymphocytes, Ig A, M, and G levels, as well as by counting the phagocytic index, the phagocytic number and the leukocyte intoxication index. The statistical processing of the obtained data was made using the STATISTICA 5.0 software (StatSoft, USA).Results. All the patients were divided into 2 groups: the group of patients with secondary peritonitis (n=89) and the group of patients with tertiary peritonitis (n=20). In the development of tertiary peritonitis, leukocytosis, relative lymphocytopenia and high values of the leukocyte intoxication index persisted during the entire observation period. In tertiary peritonitis, the phagocytic index was significantly lower only on the day of hospitalization. In the group of tertiary peritonitis, the phagocytic number decreased significantly until the 7th day after surgery. Ig A, M and G levels were lower since admission and subsequently decreased as compared to the results in the group of patients with secondary peritonitis.Conclusions. 1. Tertiary peritonitis is the most severe form of abdominal sepsis with high rates of mortality and rather difficult early diagnosis. 2. With the development of tertiary peritonitis, leukocytosis increases and relative lymphocytopenia develops. 3. The reduction in phagocytic index is indicative for the prognosis of tertiary peritonitis. 4. Ig A and M levels are significantly lower, and the leukocyte intoxication index is high at the time of hospitalization in patients who subsequently develop tertiary peritonitis
Epigenetic Regulation of Gene Activity in Epithelial Cells of Nasal Mucous Membrane in Patients with Polypous Rhinosinusitis
Get PDFNowadays, a wide clinico-laboratory polymorphism of “polypous rhinosinusitis” is observed. It suggests the potential role of heredity in the formation of the disease indicating the necessity of studying the role of genetic factor in the formation of various clinico-pathogenic variants of polyposis in detail.The objective of the research was to study the degree of functional abnormalities in the epithelial cell genome of the nasal mucous membrane in patients with polypous rhinosinusitis using the cytogenetic methods.Materials and methods.The article presents the results of cytogenetic study of 70 patients with various types of polypous rhinosinusitis (aspirin-intolerant and allergic). Hereditary predisposition to the disease was determined applying clinical and genealogical analysis.Results.Significant differences in the quantitative characteristics of the functional state of the nasal epithelial cell genome by the criterion of chromatization indices, the nucleolar index, the indices of the heteropyknotic X chromosome and pathologically altered nuclei were found in patients with aspirin-intolerant polypous rhinosinusitis as compared to those with allergic polypous rhinosinusitis as well as the control group.The identified changes serve as a criterion of the reduction in the activity of the transcriptional-translational processes in aspirin-intolerant polypous rhinosinusitis.Conclusions.The studied changes in the parameters of the functional state of the epithelial cell genome in the nasal mucous membrane provided an objective confirmation of hypothesis about epigenetic nature of pathology formation
Treatment of Serous Otitis Media
Get PDFSerous otitis media is a serosal inflammation of the mucous membrane of the auditory tube and the tympanic cavity which develops on the background of Eustachian tube dysfunction. It is characterized by the presence of seromucous exudate in the tympanic cavity. The disease occurs more often in children than adults.
The objective of the research was to compare the effectiveness of different methods of treating serous otitis media.
Materials and methods. The study included 46 patients with serous otitis media at the age of 22-55 years. There were 26 females and 20 males who were treated as inpatients and outpatients in the department of microsurgery of ENT-organs in Ivano-Frankivsk Central City Clinical Hospital during 2012-2016. Disease duration ranged from 10-15 days to 1 month. In all the patients, serous otitis media developed on the background of persistent allergic rhinitis. All the patients underwent comprehensive examination: their complaints as well as anamnestic data were analyzed, ENT examination including the endoscopic examination of the nasal cavity and the nasopharynx, otoscopy, audiometry, impedancemetry and laboratory investigations was performed. All patients were divided into 2 groups: Group I included 21 patients receiving conservative therapy for allergic rhinitis and serous otitis media; Group II comprised 25 patients receiving conservative therapy for allergic rhinitis and treatment of serous otitis media applying myringotomy and bypass surgery of the tympanic cavity.
Results. The analysis of the study revealed that in 9 patients of Group I, an improvement in hearing occurred on the third-fourth days after treatment. In 12 patients, treatment was ineffective. 14 patients of Group II who underwent myringotomy with the evacuation of the fluid from the tympanic cavity and subsequent injection of glucocorticoids into the tympanic cavity noted an improvement in hearing immediately after the procedure or the day after. In 11 patients of Group II, a thick mucous exudate was obtained during myringotomy. These patients underwent bypass surgery. The shunt was removed after a thorough cleaning of the tympanic cavity as well as the restoration of the auditory tube function.
Conclusions. Myringotomy is more effective and rational method of treating serous otitis media. Myringotomy with subsequent bypass surgery is recommended for patients with a thick mucous exudate in the tympanic cavity in order to prevent chronic adhesive otitis as well as to perform a complete sanation of the tympanic cavity and to restore the auditory tube function
Some Structural and Chemical Changes in Endocardial Endothelium of Rats in Emotional and Pain Stress Complicated by Hypercholesterolemia
Get PDFThe objective of the research was to study the content of some neutral lipids of endocardial endothelium in rats in relation to structural changes occurring in it, in the co-existence of emotional and pain stress, as well as alimentary hypercholesterolemia. Materials and methods. The electric-impulse model was used for stress modeling. Alimentary hypercholesterolemia was modeled feeding animals an atherogenic diet. The concentration of triacylglycerols, free and esterified cholesterol were examined using the method of thin-layer chromatography performed on silica gel. The concentration of free fatty acids was determined using the radiochemical method. The state of endocardial endothelium was studied with the help of light microscopy; the impression smears obtained from macro preparations of ventricle were analyzed.Results. In co-existence of stress and hypercholesterolemia, significant increase in free cholesterol as well as free fatty acid concentration was noticed. This essentially exceeded the analogical indices under the action of stress only. Structural changes in the endocardium followed by desquamation of separate endotheliocytes were the result of stress reaction. In the action of both pathogenic factors, this process was intensified; layer-by-layer exfoliation of endotheliocytes was observed. Conclusions. In acute emotional and pain stress, changes in lipid spectrum of membrane structures of endocardial endotheliocytes the main manifestation of which is the accumulation of free cholesterol in cells and increase in the levels of free fatty acids take place. The increase in the number of desquamated endothelial cells is the result of stress action as well. Alimentary hypercholesterolemia significantly increases such pathological changes.
Assessment of Comorbidity as a Risk Factor for Edematous Pancreatitis Considering IL-4 (C-590T) Gene Polymorphism
Get PDFThe comorbidities affect the course of pancreatitis significantly; however, this effect has not been evaluated from the perspective of genetic component.The objective of the research was to analyse concomitant chronic diseases as potential risk factors for edematous pancreatitis considering genetic predictors.Materials and methods. The epidemiological analysis of comorbidities (cholelithiasis, urolithiasis, ischemic heart disease, past viral infection) as risk factors for edematous pancreatitis was performed. Polymorphic variants of the IL-4 (rs 2243250) gene being identified in 123 patients and 40 healthy individuals were also involved.Results. In patients with edematous pancreatitis, urolithiasis was observed more frequently than in the control group - by 37.30% (χ2=18.62, p<0.001). The presence of cholelithiasis insignificantly increases the risk of edematous pancreatitis in the future (RR-1.156; 95% CI: 0.972-1.374). The presence of urolithiasis increased the risk of edematous pancreatitis twofold (RR-2.039; 95% CI: 1.346-3.090; p<0.05).Conclusions. 1. Cholelithiasis increases the probability of developing edematous pancreatitis in carriers of the mutant T-allele of the IL-4 gene by 3.7 times (RR=3.69; OR=10.13; 95% CI OR: 3.17-32.42; p<0.05). 2. In the C-allele carriers of the IL-4 (C-590T) gene, the risk of developing acute pancreatitis is twice higher in the presence of urolithiasis or ischemic heart disease, and almost five times higher in case of past viral infection (p<0.05)
Assessment of Periodontal Tissue Status in Patients with Generalized Periodontitis and Essential Hypertension
Get PDFVascular disorders play a significant role in the development of dystrophic inflammatory process. There is a direct correlation between the degree of damage to blood vessels in the jaw and a depth of the destructive process in periodontal tissue. A certain role is played by endogenous factors, such as: age, vitamin deficiency, diabetes mellitus, essential hypertension and others. Clinical and epidemiological studies using pathological techniques showed significant changes in vascular wall of the artery in the periodontium, the interdental artery in particular. Atherosclerosis, essential hypertension and periodontal pathology were proven to occur in individuals older than 40 years.The objective of the research was to determine periodontal tissue status in patients with stage II hypertension and generalized periodontitis of II degree of severity.Materials and methods. The study involved 36 patients with stage II hypertension and generalized periodontitis of II degree of severity (the main group). The patients’ age ranged from 35 to 54 years. The control group included 10 patients of corresponding age without generalized periodontitis and somatic pathology. To assess the status of periodontal tissues, we applied the Papillary-Marginal-Attached Index and the Community Periodontal Index of Treatment Needs. When diagnosing periodontal disease, the classification of M.F. Danilevskyi was used.Results. The analysis of the indicators of the Community Periodontal Index of Treatment Needs index showed the following results: in patients of the main group, the index was 2.38±0.07 points (p<0.001) pointing out a need for a course of professional oral hygiene. In patients of the control group, the index was 0.5±0.17 points indicating that there was no need for treatment, however, there was a need for improving oral hygiene. The indicators of the Papillary-Marginal-Attached Index in the main group were 55.49±1.96 points pointing out a severe degree of gingivitis.Conclusions. According to the analysis of the indicators of the Community Periodontal Index of Treatment Needs index (2.38±0.07), the patients of the main group had low hygiene level requiring a course of professional oral hygiene