Medicni perspektivi

On the issue of creating an algorithm for assessing safety culture in modern healthcare institutions

2024-07-03T11:14:32+03:00

Healthcare institutions with a high culture of patient safety are characterized by the appropriate level of mutual trust of employees, a general understanding of the importance of patient safety issues, the presence of an effective system of preventive measures to ensure the safety of both medical personnel and the patient, which has been implemented. Moreover, maintaining a high safety culture requires an understanding of certain norms of behavior and attitude towards the patient from the stand point of ensuring his maximum safety, which contributes to compliance with treatment standards and the development of safe behavior. The aim of the study was to create and scientifically substantiate an algorithm for analytical assessment of the level of safety culture in modern healthcare institutions. The research was conducted on the basis of the Dental Medical Center of Bogomolets National Medical University. Hygienic and medical-sociological methods and methods of expert assessment and statistical analysis were used in the work. Expert assessment maps of the leading components of safety culture served as the material of the conducted research. The organizational and target structure of the scientific work provided for the determination of the structural features of the leading components of safety culture and the development of a scoring scale for their assessment, the implementation of an expert evaluation of the specified components and the establishment of the degree of consistency of the opinions of experts, the calculation of the weighting coefficients of the influence of various components on the formation of a certain level of safety culture and the justification of objective statistical approaches to assessing the level of safety culture. In the course of the conducted research, a high degree of consistency of experts’opinions was revealed and the values of weighting coefficient swere calculated, which made it possible to develop generalized formulas for determining the values of indicators of the level of safety culture provision in modern healthcare institutions from the standpoint of assessing the degree of influence on the level of safety culture of the leading characteristics of dangerous actions of a person (doctor, specialist, etc.) (Component No. 1), identifying the degree of influence on the level of safety culture of both strengths and weaknesses in creating a safe medical environment (Component No. 2) and establishing the degree of influence on the level of safety culture of dangerous production factors inherent for medical environment (Component No. 3). It is substantiated that the process of creating an algorithm for analytical assessment of the level of safety culture in modern healthcare institutions should involve the implementation of the following stages: establishing the degree of expression of the leading indicators that are components of each of its main components, using special scales (1ststage), determining the values indicators of ensuring the level of patient safety culture for each of the components using the appropriate generalized formulas (2^ndstage), evaluation and meaningful interpretation of the values of indicators of the level of safety culture based on quantitative criteria (3^rdstage), determination of collective, group or personalized, according to the content, strategies application of preventive measures aimed at increasing the level of safety culture in each specific case (4^thstage).

Optimization and standardization of the work of a health care facility during a chemical accident

2024-07-03T11:28:14+03:00

During the years of war, as a result of aviation and missile attacks, a significant number of health care facilities in various regions of Ukraine were destroyed, and the complexity and intensity of their work increased significantly. If the readiness of hospitals and their employees to treat gunshot and explosive injuries is established, in the case of mass destruction of chemically hazardous enterprises and the threat of the enemy using weapons of mass destruction, including chemical weapons, there is a need for special training of health care facilities to work in the in conditions of chemical threats. The aim of the work was justification of the development and set of measures for the implementation of standard operating procedures in the event of a chemical incident. The legal documents and recommendations of the Ministry of Health of Ukraine, management of the World Health Organization and the Red Cross on the topic of the study were used. The research methods: bibliosemantic, analytical, modeling were applied. It is established that the special management group, which includes representatives of various services, is of decisive importance in the effective management of a health care facility during a chemical incident: administration; communication department; security department; management of nurses and the department of infection control; human resources department; pharmacy; intensive care unit; department of engineering maintenance and repair; laboratory; kitchen; laundry; cleaning service and waste management. The most important measures of response to a chemical incident that ensure the safety of medical personnel and patients are the organization of a triage zone and a decontamination area for chemically affected persons. Based on the above, to prepare a health care facility for work during a chemical incident, it is necessary to develop a response plan, which consists of special administrative and management decisions and provides for regular staff training.

Strategies for Healthcare Disaster Management in the Context of Technology Innovation: the Case of Bulgaria

2024-07-03T11:44:19+03:00

In Bulgaria, integrating technology and innovation is crucial for advancing sustainable healthcare disaster management, enhancing disaster response and recovery, and minimizing long-term environmental and social impacts. The purpose of the study is to assess the impact of modern technological innovations on the effectiveness of disaster management in health care in Bulgaria with a focus on Health Information Systems (HIS), Telemedicine, Telehealth, e-Health, Electronic Health Records, Artificial Intelligence (AI), Public Communication Platforms, and Data Security and Privacy. These innovations, when integrated effectively, can significantly strengthen Bulgaria's preparedness and response capabilities, improving efficiency and reducing the environmental footprint of disaster interventions. Collaboration with technology experts, research institutions, and international organizations is essential for successful implementation. The research aims to assess how these technologies can enhance disaster management efficacy, adopting a methodical approach using Systematic Literature Reviews (SLRs). Systematic Literature Reviews (SLRs) utilize precise criteria for research selection and evaluation to reduce bias, systematically compiling and analyzing data from various studies to offer evidence-based insights. They are crucial for uncovering research gaps, indicating areas needing further exploration. Findings highlight the transformative potential of technology integration in streamlining communication, data management, and operational efficiency. The study underscores the urgent need for an integrated approach and a culture of innovation within the healthcare sector, emphasizing ongoing assessment and adaptation of technology-based strategies. While acknowledging limitations and calling for further research, the study provides valuable insights into Bulgaria's healthcare disaster management strategies and sets the stage for future investigations to refine and expand upon these strategies. It advocates for a strategic framework guiding the efficient integration of technology into disaster management, aiming for resilient and patient-centric healthcare systems.

Influence of substituted quinones on the excretory function of the rat kidney and evaluation of the prospects of their use as potential diuretics

2024-07-01T11:50:48+03:00

Diuretics are widely used to treat pathologies of various genesis. However, the development of side effects during their long-term use remains a problem of traditional treatment regimens. The search for diuretics that would be aimed at inhibiting a key target molecule that is involved in the regulation of salt or water balance in the kidney, and certainly have a low level of toxicity and side effects, is an urgent task for researchers. Our preliminary screening of substituted quinones using in silico and in vitro methodology identified a number of effective compounds that outperform or compete with diuretics. The compounds are not "classic" carbonic anhydrase II inhibitors, but the pronounced diuretic effect of a number of compounds requires additional explanation. Therefore, the aim of the work was to study the effect of substituted quinones on the excretory function of rat kidneys to assess the prospects of their further structural modification and use as potential diuretics. Considering the experimental data, it should be noted that compounds AVD-6, AVD-7, AVD-8 and AVD-9 have pronounced diuretic activity. Thus, according to indicators of excretory indices of electrolytes, it is possible to note the predominant influence of compounds AVD-6, AVD-7, AVD-8 and AVD-9 on excretion of sodium, potassium and chlorine from the body. Compounds AVD-6, AVD-7, AVD-8 and AVD-9, in contrast to Hydrochlorothiazide, which blocks carbonic anhydrase in the proximal part of the convoluted tubules and accelerates the excretion of potassium with from the urine, have a much lower excretory index as for these ions. Thus, our conducted research made it possible to identify a new, little-known class of hybrid molecular structures, namely (N'-(4-[(aroyloxy)imino]cyclohexa-2,5-dien-1-ylidene) aroylhydrazides (AVD-6, AVD-7, AVD-8 and AVD-9), which, in addition to affecting the excretory function of the kidneys, have significant diuretic activity and are potential diuretics.

Graphical modeling of additive color mixing. Analyses of electromagnetic effects as colors of the vision analyzer

2024-07-01T12:45:01+03:00

The human visual analyzer is a high form of evolution. Some jellyfish can distinguish light and dark objects with sensitive cells. Squids, octopuses, and nautiluses from Cephalopods family have eyes with which they can see objects. Visual information is processed in the brain. In fishes, the visual analyzer evolved. Fishes living below 100 m depth inhabit a world with blue light. The authors consider the evolution of vision in these fishes due to the lowest absorption of blue and violet colors of electromagnetic waves from the optical spectrum. Subsequently, on land, in humans vision evolved towards the green color. Green is the most prevalent color on the land. In humans, three light-sensitive cones evolved – S, M, and L. S cones are most sensitive to blue, M – to green, and L – to red color in the spectrum. Some humans retain sensitivity of S to genetic changes and disorders. Additive color mixing is a high form of color perception in humans. The additive mixing of different colors achieves a new color in the human visual analyzer. Remarkably, different individuals perceive observed images in varying manners. Mixing neighboring colors on the spectrum gives one, two, or three colors. This process is estimated using graphical modeling. The graphical modeling with two colors allows for the creation of additive colors. One, two, or three additive colors can be obtained. The production of colors results from the light sensitivity of S, M, and L cones. An analysis that physically demonstrates the mixing of green and red colors, resulting in the colors yellow or orange. When blue and red are mixed, the resulting colors are green, yellow, and orange is proposed. The additive mixing of blue and yellow gives green. The subjective nature of visual perception, influenced by the viewer’s heightened sensitivity to one of the colors, becomes evident in the presence of two colors. Notably, when the background is violet, the sensitivity of the blue cones diminishes.

Characteristics of base materials and acrylates used in removable prosthetics in dental practice (review)

2024-07-01T13:02:06+03:00

One of the actual problems of modern orthopedic dentistry is the development of optimal materials that, by their physical and chemical properties, would be most biocompatible with the mucous membrane of the oral cavity. The purpose of this work was to substantiate the use of base materials and acrylates for the manufacture of removable prostheses and to increase the effectiveness of orthopedic treatment of patients with complete or partial absence of teeth basing on the review of literary sources. A literature review was conducted using PubMed, Web of Science, SCOPUS, Google Scholar from 2019 to January 2024. There was no restriction on the date of publication or language. Searches were conducted according to MeSH (Medical Subject Headings) using the following search terms: "removable prosthetics", "removable prostheses", "dental base materials", "acrylates", "materials science", "adaptation". A total of 82 sources of literature were selected and processed during the primary analysis. After systematization of the selected information using general scientific methods, 70 most relevant sources remained. Exclusion criteria: publications that did not meet the purpose of this review, publication language other than English and Ukrainian. Used methods: bibliographic and analytical. The relation between the properties of the materials from which the prosthesis is made and the mucous membrane of the prosthetic bed was revealed, and the direct dependence of the quality of the prosthesis, the period of wearing, and the level of oral hygiene was determined. The base material must be easy to use so that the prosthesis can be manufactured and repaired without the use of a significant number of technological processes and equipment. The most common and popular material for manufacturing the bases of partial and complete removable prostheses are acrylates due to their low cost and the simplicity of the application technology, which does not require expensive equipment. The analysis of these literature sources showed that the percentage ratio of the composition of removable prostheses, which includes acrylic plastic, is more than 80%. However, except all existing advantages, they have a number of disadvantages. The main unsatisfactory quality of acrylic prostheses is their negative impact on the tissues of the prosthetic bed, which is reflected in the sensitivity of the mucous membrane and the phenomena of inflammation. Most often, this is manifested as a result of the reproduction of pathogenic microflora, which is concentrated on the surface of the base of the prosthesis. It is worth remembering that removable prostheses are inherently combined irritants that have a whole set of negative effects on the mucous membrane of the prosthetic bed, leading to its chronic inflammation. The above-described negative properties of acrylic plastic became the impetus for the creation of other types of materials. This problem is extremely urgent, and despite the serious resources spent on its elimination, so far no optimal way to increase not only the functionality and durability of the service, but also the safety of using removable orthopedic constructions has been found.

Comparative assessment of difficulty scales for removal of the third molar of the lower jaw depending on its position

2024-07-01T13:20:07+03:00

Retention (delayed eruption) of the third molar is one of the most common pathologies in the outpatient practice of a dentist-surgeon. Such a pathology can very often be complicated by inflammatory diseases, such as pericoronitis, periostitis and other more serious diseases. Therefore, early warning and most gentle removal of the causative tooth determines the professionalism of the dental surgeon. A large number of indexes of difficulty of removal of the third molar have been proposed by different authors, but none of them is considered universal and optimal for different clinical cases. The level of complexity is most clearly characterized by a scale that takes into account not only radiological but also clinical and demographic indicators. Such scales exist in modification or in more recent literary sources. Having chosen the most clear and correct scale, it is possible for the surgeon to clearly assess the entire level of complexity and responsibility for surgical intervention on removing the third molar, thereby obtaining the most effective result, minimizing complications both during the operation and after a while. The purpose of the study: justification of the selection of the difficulty rating scale for the removal of the third molar of the lower jaw, depending on its position. The study analyzed and compared 18 basic scales of complexity that are most often used by surgeons before removing the impacted third molar of the lower jaw. Data sources that were used for the search were taken from Medline, PubMed, Google Scholar, Minerva library databases. Each of the difficulty scales was presented and translated into Ukrainian for convenient use in the practice of a dental surgeon. A general table was provided where a comparative analysis of the difficulty scales was made according to thirty parameters. It is shown that the Cosme Gay-Escoda C. scale has the most indicators for preoperative assessment of complexity. There are many difficulty scales for preoperative assessment for the removal of impacted third molars of the lower jaw. Some of them have radiological evaluation criteria, some have clinical criteria, and only the Pernumbuco index (2017), Zhang X. (2019), and Cosme Gay-Escoda C. (2022) scales also have demographic indicators. However, the latter has the largest number of criteria, according to which the difficulty of removing the third molar of the lower jaw is calculated.

Analysis of the world experience on the approaches to the definition of disability: on the way to reforming the system of medical and social expertise

2024-07-01T13:34:07+03:00

The Ukrainian system of medical and social expertise needs to revise its conceptual and methodological foundations in accordance with the realities of the current development of social sciences in the world and demand of the state regarding the modern understanding of disability. The purpose of the study was to analyze international experience and legislation on policy towards persons with disabilities and systematic approaches to the criteria of violation of functioning and the possibilities of determining the status of "person with disabilities" using the basic principles of the International Classification of Functioning (ICF), Impairment and Health to create optimal approaches to determining the criteria for disability in Ukraine. The study was based on the analysis of available scientific literature and legislative documents of developed countries on the understanding of the concept of "person with a disability". The scientometric databases used were Scopus, Web of Science, Google Scholar, and MedLine. Data from the official websites of the Political Department of the European Parliament, WHO, the United Nations, UNICEF, the World Bank. According to the results of the study, it is determined that a single state body is responsible for determining the status of a person with a disability in sustainable development countries using a multidisciplinary approach. The author identifies 3 main components that most developed countries assess when determining disability: economic, medical and social. At the same time, the main criterion is decreased performance. It has been established that since 2022, Spain has completely switched to the criteria of the International Classification of Functioning in determining the signs of disability, basing the severity of a person's condition as a degree of disability on a percentage decrease in the person's functioning. Some European countries use selective categories of the ICF.

Clinical case of funicular myelosis in combination with a concomitant genetic predisposition to folate cycle disorder

2024-07-04T10:20:39+03:00

Funicular myelosis (subacute combined degeneration) is a disease characterized by the development of degeneration of the posterior and lateral cords of the spinal cord. Funicular myelosis is a neurological complication of vitamin B₁₂ deficiency, which occurs as a result of reduced intake of vitamin B₁₂ with food, malabsorption, in connection with taking some drugs (metformin, proton pump inhibitors, and nitrous oxide), with invasion by Diphyllobothrium latum. The disease is usually characterized by the presence of paresthesias, the development of sensitive ataxia, and impaired gait. The aim of the work was to demonstrate a clinical case of funicular myelosis in a young patient in order to improve the diagnostic process, paying attention to the genetic profile and identifying a concomitant predisposition to folate cycle disorder. A clinical case of funicular myelosis in a 39-year-old woman is described. The patient came to the neurology department with complaints of numbness in the upper and lower limbs, periodic shooting pains along the spine when the head is tilted forward. During the neurological examination, the following was observed: a decrease in vibrational, muscle-joint, discrimination sensitivity in the upper limbs, paresthesias in the distal parts of the limbs, and sensitive ataxia. According to the results of the magnetic resonance imaging (MRI) of the spinal cord, a lesion of the posterior cords on the long segment (C2-Th1) was found, which corresponds to the subacute degeneration of the spinal cord, which arose due to the deficiency of holotranscobalamin (active B₁₂). The patient received appropriate treatment and was discharged home. Subsequently, the patient was found to have a concomitant genetic predisposition to folate cycle disorder and the development of thrombophilia. A year later, the woman again came to the neurological department. We carried out a repeated examination, evaluation of the results of the MRI of the cervical spine and other examinations in dynamics. According to the results of the literature analysis, additional markers for the diagnosis of funicular myelosis (in particular, homocysteine), the causes of hyperhomocysteinemia and its effects on the body were described. Timely detection and treatment of vitamin B₁₂ deficiency is quite important, since in severe cases the development of spastic paraplegia is possible. Recovery of lost functions depends on the extent of spinal cord damage and the duration of the disease. If anemia is observed together with neurological symptoms, it is necessary to be especially attentive to possible funicular myelosis and to carry out appropriate diagnostic searches. And when detecting hyperhomocysteinemia, it is advisable to take into account other factors that can cause an increase in the level of homocysteine, in addition to a deficiency of vitamins B₆, B₁₂ and folic acid.

Orthodontic and orthopedic rehabilitation of adult patients with congenital cleft lip and palate (clinical case)

2024-07-04T11:05:33+03:00

Congenital cleft lip, alveolar process, hard and soft palate are common anomalies of the development of human organs and in terms of frequency occupy one of the first places among other defects of the human body. The clinical study and treatment of cleft lip and palate, malocclusions that accompany this defect have always been of great interest in orthodontics and orthopedic dentistry. This is due to the fact that malocclusions in this group of patients are complex and difficult to treat, as morphological changes are combined with significant functional disorders. The aim of the work was to demonstrate a clinical case of orthodontic and orthopedic rehabilitation of patients with congenital bilateral cleft lip and palate after cheilouranoplasty. A clinical case of a complex treatment of a 25-year-old female patient with bilateral cleft lip, alveolar process, hard and soft palate after cheilouranoplasty performed in childhood is presented. During the clinical examination, an irregular shape of the upper dentition was established due to its sharp narrowing and alveolar shortening in the area of canines and first premolars. A deep reverse bite was formed, a false progeny with a sagittal fissure of up to 10 mm, bilateral vestibular crossbite, contact on the first and second molars of the upper and lower jaws was observed, adentia 12, 22, 23. With a sharp narrowing of the upper dentition at the first stage of orthodontic treatment, Nord's apparatus was used. At the second stage, the brace technique was applied, namely, the straight arch technique. After expanding, lengthening the upper dentition, creating space for missing teeth, reducing the size of the lower dentition by removing 34, 44, the patient continued treatment at the orthopedic department. At an appointment with an orthopedic dentist, after an objective and subjective examination, according to Kennedy the patient was diagnosed as III class, I subclass of the upper jaw. Defects of the alveolar process of the upper jaw, formed as a result of adentia, connection of the oral cavity with the nasal cavity in places of non-union of the alveolar process were established. In this clinical situation, the manufacturing of a complete esthetic-cosmetic structure, namely a metal-ceramic dental bridge with obturating parts is indicated. Thus, the demonstrated clinical case can be considered as one of the methods of a complex orthodontic and orthopedic rehabilitation of adult patients with congenital cleft lip, alveolar process and palate.

Dental rehabilitation of a patient with a decrease in bite height due to pathological abrasion of hard tooth tissues (clinical case)

2024-07-04T11:18:31+03:00

At the present stage of diagnostics and treatment of dental diseases, morphofunctional disorders of the dento-maxillary system associated with a decrease in the height of occlusion are becoming more common. In the scientific literature, this pathological condition is described under the name "occlusion" that decreases. The reasons that cause it include partial or complete loss of teeth, irrational prosthetics and untimely restoration of dentition defects, doctors' mistakes in the restructuring of the masticatory apparatus, and a generalized form of pathological abrasion of hard tooth tissues. The purpose of the study – demonstration of a clinical case of pathological abrasion of hard tissues of teeth with a decrease in bite height, complicated by defects in the dentition. Patient S., 47 years old, applied for orthopedic help with complaints of anatomical deformity, significant abration of teeth on the upper and lower jaws, increased sensitivity to various types of irritants, partial absence of teeth, impaired masticatory function, periodic clicking in the temporomandibular joint, aesthetic and phonetic defects. Based on the data obtained, we established the following diagnosis: generalized form of pathological abrasion of hard teeth tissues, subcompensated form of reduced bite height, complicated by defects in the dentition of the upper jaw – class I according to the Kenedy classification, lower jaw – class III according to the Kenedy classification. The loss of chewing efficiency according to Agapov was 68%. Patient S. was recommended a two-stage orthopedic treatment, which involves preliminary separation of the bite with the help of individual vinyl mouth guards which have an increasing thickness of 2, 4 and 6 mm, made for the lower jaw.The planned treatment period with each of the muscle relaxant splints will be 2 months. Subsequently, 15, 14, 13, 12, 11, 21, 22, 23, 24 will be restored with one-piece metal crowns with ceramic cladding, and the final defects in the lateral areas will be restored with a clasp prosthesis with a locking system of fixation. The included defect of the lateral part of the lower jaw is planned to be restored with a metal-ceramic bridge-like prosthesis with a support on 47, 45, 44, and the worn-out hard tooth tissues will be completely restored with photopolymer material. In patients with a reduction in bite height of more than 2 mm, it is advisable to carry out treatment in two stages. At the first stage, we normalize the occlusal height and rebuild the function of the masticatory muscles. At the second stage, we provide rational prosthetics. Orthopedic rehabilitation with myorelaxing splints of increasing thickness makes it possible to correctly rebuild myostatic reflexes and prevent functional disorders in the TMJ. Any case of complex treatment of patients with a decrease in bite height due to pathological abrasion of the hard tooth tissues deserves the attention of both scientists and dentists in practical health care.

Gottron's carcinoid papillomatosis of the skin (clinical cases)

2024-07-04T11:37:35+03:00

Gottron's carcinoid papillomatosis of the skin is a rare and little-studied disease. The number of available scientific publications does not exceed several dozens, in Ukraine, in the last ten years, 2 works devoted to this pathology have been published. However, in parallel with the increase in diagnostic capabilities in a multidisciplinary hospital, there are periodically cases of establishing a diagnosis: Gottron's carcinoid papillomatosis of the skin. The lack of a clear understanding of the diagnostic and treatment algorithm creates additional difficulties in the treatment of Gottron's carcinoid papillomatosis of the skin. The course and features of this disease, namely: the presence of various concomitant pathologies, duration and unsatisfactory results of treatment, low patient compliance, etc., make its study relevant. This prompts a more detailed study and analysis of cases of successful treatment. The purpose of our work was to analyze a clinical case of treatment of Gottron's carcinoid papillomatosis of the skin in a multidisciplinary hospital using a multidisciplinary team approach, as well as to summarize the data related to the incidence, features of the clinical course and treatment of this disease given in scientific publications. A clinical case of successful treatment of a patient with Gottron's carcinoid papillomatosis of the skin is presented, a model of the interaction of a vascular surgeon at the stage of restoring the patency of the main arteries and preservation of the limb, a surgeon of the purulent-septicsurgery department at the stage of local and systemic treatment, a pathologist at the diagnostic and post operative stage, and a dermatologist for improvement of topical exposure and ambulatory monitoring is shown. Therefore, the analysis of this clinical case convincingly testifies to the successful capabilities of a multidisciplinary hospital in the treatment of Gottron's carcinoid papillomatosis of the skin, which can be taken into account when determining the treatment tactics of this disease. Coverage of this and similar cases in scientific publications of this rare disease will improve clinician awareness and treatment outcomes.

Deletion of cyclin dependent kinase inhibitor 2a gene as a marker of oropharyngeal carcinomas non-associated with human papillomavirus and its prognostic value

2024-07-01T14:45:44+03:00

Patients with human papilloma virus associated oropharyngeal squamous cell carcinoma generally have better treatment outcomes and prognosis compared to those with non-papillomavirus-associated oropharyngeal squamous cell carcinoma. However, prognostic evaluation for non-papillomavirus-associated oropharyngeal squamous cell carcinoma remains a problem that could be solved through the molecular mechanisms of squamous cell carcinoma for the purpose of further development of target therapies. Detection of cyclin dependent kinase inhibitor 2a gene deletion in oropharyngeal squamous cell carcinomas can have clinical significance as it may serve as a prognostic marker and potentially guide treatment decisions. To investigate and analyze cyclin dependent kinase inhibitor 2a gene alterations in oropharyngeal squamous cell carcinoma comparing with clinical data (age of the patient, TNM stage), their histological features and occurrence of papillomavirus infection markers (p16 expression). Formalin-fixed and paraffin-embedded samples after transoral radical surgery of oropharyngeal tumors from 26 male patients with average age 57.35±10.33 years were studied. Histological, immunohistochemical analyses and fluorescent in-situ hybridization were performed to assess histological features, p16 expression, and cyclin dependent kinase inhibitor 2a gene gene abnormalities respectively. Homozygous deletion of cyclin dependent kinase inhibitor 2a gene was statistically analyzed and compared with p16 expression, age, and occurrence of nodal metastases in investigated patients. Our study demonstrated that the patients with non-papillomavirus-oropharyngeal squamous cell carcinoma with cyclin dependent kinase inhibitor 2a gene homozygous deletion had the highest risk of the nodal metastases development. Our findings suggest that not only detection of the loss of p16 expression, but also the evaluation of homozygous cyclin dependent kinase inhibitor 2a gene deletion might be predictive of worse outcome specifically in oropharyngeal squamous cell carcinomas.

Pathomorphology of severe Grade 3-4 hepatic encephalopathy in decompensated cirrhosis patients with acute-on-chronic liver failure

2024-07-01T15:05:39+03:00

The study was aimed to determine of the most significant pathomorphological signs of severe hepatic encephalopathy (HE) in deceased cirrhotic patients with acute-on-chronic liver failure (ACLF) syndrome based on changes of the glioneuronal complex and the level of tissue ammonia. Using pathohistological, histochemical, and immunohistochemical methods, the cerebral cortex, thalamus, striatum, and cerebellum of 21 deceased patients with acutely decompensated liver cirrhosis with ACLF syndrome and HE Grade 3-4 were examined in comparison with control group, which included 30 deceased patients from acute cardiovascular failure. The study revealed that during HE Grade 3-4 as a component of ACLF, in all studied brain regions, there was a reliably (p<0.05) higher histochemical level of tissue ammonia (up to 500%), increased numbers (up to 215.69%) of apoptotic neurons (according to caspase-3), reduced (up to 119.60%) level of synaptophysin, increased expression of glutamine synthetase (up to 253.02%) and aquaporin-4 (up to 481.81%) associated by reduced (up to 296.81%) expression of glial fibrillary acidic protein in astrocytes, increased (up to 11-fold) numbers of Alzheimer type 2-astrocytes, expansion of perivascular and pericellular «edematous» spaces (up to 890.81%), increased numbers of amyloid bodies (up to 5-fold), increased area of immunopositive material of CD68+ microgliocytes (up to 114.78%) with an increase (up to 71.91%) in the proportion of CD68+ amoeboid microglia. The above-mentioned changes confirm that the loss of consciousness and other psychoneurological manifestations of severe HE Grade 3-4 are due to compound ammonia-associated changes in the components of the glioneuronal complex, namely: adaptive remodeling and dystrophic changes in astrocytes, reduced synaptic transmission and apoptotic neuronal death, reactive changes in microglia with a small proportion of microgliocytes involved in phagocytosis, cytotoxic brain edema and dysfunction of the glymphatic system

Conections between platelets amino acids profile and known cardiometabolic risk factors in patients with coronary artery disease and atrial fibrillation

2024-07-02T09:55:58+03:00

The aim of our work was to identify the relationship between platelet amino acid profile and cardiometabolic risk factors in patients with coronary heart disease and atrial fibrillation. 300 patients were examined, who were divided into 3 groups: the first (I) – 149 patients with coronary artery disease (CAD) and without arrhythmias, the second (II) – 123 patients with CAD and paroxysm of atrial fibrillation (AF) and the control group (CG) – 28 patients without CAD and arrhythmia. The platelets amino acid (AA) profile was determined by ion exchange liquid column chromatography. Cardiometabolic risk factors studied: total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), lipoprotein α (Lpα), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), C-reactive protein (CRP), interleukin-6 (IL-6), trimethylamine (TMA) and trimethylamine-N-oxide (TMAO). Significant increase of isoleucine (10.73%), leucine (12.63%) and decrease of threonine (23.05%), serine (5.06%), glycine (32.21%), valine (30.83%) levels in platelet AA profile was observed in patients with CAD and AF compared to patients with CAD without arrhythmias, p<0.05. Also, significant increase of apolipoprotein B (29.91%), CRP (40.93%), IL-6 (22.93%), TMA (16.13%) and TMAO (57.54%) and decrease of TMA/TMAO ratio (26.16%) was found in CAD with AF patients compared to CAD patients without arrhythmia, p<0.05. The highest number of correlations was found between platelets AA profile and TMA/TMAO ratio (total number =7), TC (total number =7) and fibrinogen levels (total number =6). In addition, most correlations were found between glycine (total =12), threonine (total =6), glutamate (total =6), valine (total =6), and cardiometabolic risk factors. The level of glycine in platelets is correlated with most cardiometabolic risk factors, such as: age (r=-0.305), BMI (r=-0.351), TC (r=-0.304), LDL (r=-0.348), ApoA1 (r=0.373 ), ApoB (r=-0.347), IL-6 (r=-0.315), TMAO (r=-0.654), TMA/TMAO ratio (r=0.688), prothrombin index (r=0.317), activated partial thromboplastin time (r=-0.365) and fibrinogen level (r=-0.396), p<0.05. So, in our work, the relationship between platelets AA profile and cardiometabolic risk factors in patients with CAD with AF was revealed. According to the results of the correlation analysis with known cardiometabolic risk factors, an important pathogenetic role of the glycine, threonine, valine and glutamate platelets levels in CAD and AF patients was revealed.

Association between glycosylated hemoglobin and newly diagnosed hypertension in a non-diabetic kosovar population: a cross-sectional analysis

2024-07-02T10:43:58+03:00

Diabetes mellitus is a common disease followed by cardiovascular complications, it is a metabolic syndrome with multiple etiology that is characterized by chronic hyperglycemia. Hypertension is a serious health condition that is significantly associated with the risks of heart, brain, kidney, and other diseases. Glycosylated hemoglobin (HbA1c) is diagnostic means of diabetes when fasting (venous) glycemia figures are 126 mg/dl (7.0 mmol/l). The purpose of this study is to focus on the diagnosis, and the treatment of the population with diabetes, identifying the necessary targets to guarantee clinical efficacy. Managing diabetes is challenging, and smoking can complicate it. People with diabetes who smoke often need larger doses of insulin to keep their blood sugar near normal levels. To assess the amount of vitamin D bound to hemoglobin, the study analyzed a number of laboratory parameters in patients with type 2 diabetes. The importance of this study is the estimation of the amount of enzyme-linked immunosorbent vitamin D. Laboratory parameters of diabetic patients were divided into three categories based on increased levels of glycosylated hemoglobin. Vitamin D levels were analyzed in these categories with increased HbA1c values. The influence of smoking and hypertension on laboratory parameters of diabetic patients was analyzed. The observations were carried out in the form of a database, and the methods that allowed the results for all parameters were followed. The data on the homogeneity of the selected information groups cover 150 patients diagnosed with diabetes mellitus, 40.67% were men, 59.33% were women. Similarly, (in fasting patients), a high OGTT-2-hour glucose level, the hemoglobin test indicates [A1C(HbA1c)] level, cardiovascular disease, and serum vitamin D. Overall, 47.33% of the patients were deficient in vitamin D. Decreased levels of vitamin D were associated with increased levels of glycosylated hemoglobin, while 22% were deficient. As a result, 74.67% of tobacco users had hypertension. Vitamin D deficiency may increase in patients with diabetes, with increased levels of glycosylated hemoglobin.

Predicting the dynamics of heart rate variability in patients with type 1 diabetes against improving glycemic control

2024-07-02T11:49:46+03:00

The aim of the study: to analyze the effect of improvement of glycemic control on heart rate variability changes in patients with type 1 diabetes against the background of insulin therapy correction and to predict this dynamics based on the parameters of continuous glucose monitoring. We examined 49 patients with the level of glycosylated hemoglobin ≥7% and <10% without late diabetic complications. The average age – 32.0 (21.5; 38.0) years, the average disease duration – 9.5 (5.0; 17.5) years. The study was based on the simultaneous registration of heart rate variability and continuous glucose monitoring before and 3 months after correction of insulin therapy. Logistic regression analysis and ROC-analysis were used to predict the changes. After 3 months, the patients had significant decrease in the level of glycosylated hemoglobin, glycose variability, and a decrease in the frequency of hypoglycemic episodes. Heart rate variability increased in 73.5% of persons. The presence of hypoglycemia, standard deviation of blood glucose levels and glomerular filtration rate after treatment turned out to be prognostic factors for the predicting improvement in heart rate variability (the proportion of correct prediction of the patient's actual belonging to one or another prognostic group was 76.39%). Based on the calculation of the theoretical values of the positive result probability using the logistic equation, a detailed scale for predicting changes in heart rhythm variability for type 1 diabetes patients was proposed: up to 0.07 – a low probability of a positive result; 0.07-0.29 – the probability of a positive result is below average; 0.29-0.51 – a moderate probability of a positive result; 0.51-0.90 – high probability of a positive result; more than 0.90 – a very high probability of a positive result. We found that improvement of glycemic control leads to an increase in both frequency and time characteristics of heart rate variability. The increase in the likelihood of improvement of heart rate variability in patients with type 1 diabetes was more likely to be associated with reduced glycose variability and fewer hypoglycemic episodes. We developed a predictive mathematical model of heart rate variability based on the continuous glucose monitoring parameters for type 1 diabetes with sensitivity of 88.0% and specificity 68.18%, AUC 0.739 (p=0.001).

Side effects and hypersensitivity reactions to corticosteroids

2024-07-02T12:00:01+03:00

The relevance of the topic under study is due to the fact that patients receiving large or repeated doses of corticosteroids often suffer from hypersensitivity reactions or side effects from taking this category of drugs. As a result, this poses a serious problem for healthcare authorities, as the scientific understanding of this phenomenon is still at an early stage. The purpose of study is to comprehensively disclose the various types of mechanisms underlying corticosteroid hypersensitivity, as well as to develop recommendations for more accurate methods of diagnosis, treatment, and prevention of this reaction. To achieve this goal, this theoretical study used various methods, including analysis, deduction, abstraction and generalization, and the method of synthesis. The results of the study underscore the broad spectrum of applications for corticosteroid drugs in medicine, highlighting their systemic effects and potential for side effects and hypersensitivity reactions across various bodily systems. These adverse reactions encompass hyperglycemia, hypertension, respiratory issues, visual impairments, skin conditions like contact dermatitis, bone tissue complications, and behavioral disorders, notably in children. Administering corticosteroids in COVID-19 treatment necessitates caution due to the potential for life-threatening immediate hypersensitivity reactions, which may be mistaken for disease progression. The results and conclusions of this study, which were formed using the above methods, may lead to a more accurate diagnosis of hypersensitivity to drugs such as corticosteroids, and may also contribute to the development of effective preventive measures. This study is of practical importance for dermatologists, allergists and immunologists, as well as researchers working in the field of rheumatology, allergology and immunology.

Microbiological profile and antimicrobial susceptibility of bacteria associated with urinary tract infections in Ukrainian adults

2024-07-02T12:47:32+03:00

The aim of the study was to analyse the microbial profile of the urinary tract infections (UTIs) due to urolithiases and to study susceptibility to antibiotics in its causative agents. The main method of the research was bacteriological. Antimicrobial susceptibility testing was conducted by serial microdilution assay in accordance with recommendations of the European committee on antimicrobial susceptibility testing (EUCAST). For present study 128 unique urine samples were collected from patients with UTIs associated with urolithiasis. Among all collected specimens, 78% (n=100) gave clinically significant growth. Among all examined participants, 88.9% of women (64/72) and 64.3% of men (36/56) had confirmed UTI; in the study, female/male ratio was 1.4 (χ2=9.76; p<0.05). Microorganisms identified in our study predominantly belonged to Bacteria (93.4%), and yeasts of Candida genus comprised only 6.6%. Among all, 66.1% were representatives of Enterobacterales (n=80), particularly, Escherichia coli (38.0%), Klebsiella oxytoca (15.7%), Klebsiella pneumoniae (2.5%), Enterobacter cloacae (5.8%), Proteus mirabilis (4.1%). Isolates of Pseudomonas aeruginosa comprised 3.3%. Among gram-positive isolates, Staphylococcus spp. (14.1%) and Enterococcus spp. (9.9%) were identified. Regarding female/male distribution, the biggest proportion of gram-positive bacteria were isolated from women, statistically significant results were obtained for sex distribution of S. saprophyticus (p<0.05). Antimicrobial susceptibility of Enterobacterales was variable, and the best results were obtained for carbapenems, novel antibiotics (cefiderocol, ceftolozane-tazobactam and ceftazidime-avibactam), aminoglycosides and tigecycline. There were 9 isolates with production of carbapenemases and resistant to all relevant β-lactam antibiotics. All isolated Staphylococcus spp. were β-lactamase producers, one isolate of S. saprophyticus demonstrated methicillin-resistance. To summarise, there is an ongoing outbreak of multidrug-resistant infections in Ukraine and causative agents of UTIs are among the most important contributors. Availability of data on the local antimicrobial susceptibility profile may guide the informed decision making in etiotropic treatment, therefore, contribute to global efforts in rational drug use and fight the resistance escalation.

Results of surgical treatment of patients with acute destructive diverticulitis of the colon using minimally invasive technologies

2024-07-02T13:03:10+03:00

Among the diseases of the colon, diverticular disease occupies one of the leading positions, the frequency of which is currently 1.2 cases per 1000 people. Complications in this condition develop in 5% of cases and account for 3-5% of all patients with acute abdominal diseases. Surgical intervention is required in 15% to 30% of such patients. The mortality rate after surgical treatment of acute complications of the diverticular disease remains high, ranging from 7% to 25%. The purpose of our study was to compare the outcomes in the treatment of patients with acute destructive diverticulitis of the colon using traditional surgical treatment versus minimally invasive technologies. In the study, 114 patients diagnosed with acute destructive diverticulitis were examined. Group I consisted of 56 patients who underwent initial surgical interventions employing minimally invasive methods like laparoscopy, laparoscopic-assisted techniques, or percutaneous drainage guided by ultrasound. Group II comprised 58 patients who underwent the first surgical intervention through laparotomy access. The data of our study show that the overall proportion of patients with complications was higher in Group II – 20 (34.5%) compared to 6 (10.1%) in Group I (p=0.005). The application of diverse surgical methods did not notably impact the mortality rate, with 6 (10.3%) fatalities in Group II compared to 2 (3.6%) in Group I (p=0.2). Stoma creation was more frequent in Group II, in 40 (67%) patients, whereas in Group I, the occurrence of stomas was lower, in 15 (25.9%) cases. The average period to stoma closure was 5 months in Group II and 2 months in Group I. There was observed a decrease in the time of urgent surgery from 143±13.5 minutes in Group II to 65.7±15.2 minutes in Group I (p<0.01) and the duration of the first hospitalization from 14.2±1.8 days to 5.6±0.7 days, accordingly (p<0.01). When dealing with primary anastomosis or severe peritonitis, utilizing a laparoscope for dynamic laparoscopy allows for real-time monitoring of the abdominal cavity and early identification of complications, eliminating the need for scheduled laparostomy. The research data demonstrate that, while not affecting mortality, minimally invasive methods have several significant advantages, including a reduction in the number of complications, a decrease in the proportion of patients with stomas, a reduction in the time to reconstructive surgery, and a decrease in the duration of urgent surgery and the length of hospitalization.

Altruistic values among students of Nursing, Midwifery, Physiotherapy, and Health Psychology: a cross-sectional study

2024-07-02T13:16:54+03:00

Aim – to study the altruistic values of o group of nursing, midwifery, and physiotherapy students, and how these values evolved throughout academic years and across study programs. The study used a descriptive correlational design. The data were collected from students in the bachelor’s degree programs in nursing, midwifery, and physiotherapy, and in the master's degree program in health psychology (students in this program have completed bachelor’s degrees in nursing, midwifery, or physiotherapy). The Faculty of Natural Sciences at the University of Shkodra “Luigi Gurakuqi”, Albania offers bachelor’s degree programs in nursing, midwifery, physiotherapy and a professional master's degree in health psychology. During the academic year 2022-2023, the number of active students was 756. A total of 457 students participated in this study: 175 from the nursing program, 130 from the midwifery program, 107 from the physiotherapy program, and 45 from master program. Data were collected from December 1, 2022, through January 31, 2023, with an online questionnaire. Two tools were used in this study: a demographic questionnaire and the Altruism Scale used by Űmmet and colleagues. The mean score on the Altruism Scale was 2.9±0.78. A one-way ANOVA revealed that there was a difference in mean altruism score between at least two groups (F (3, 452) = [3.232], p=0.02). Tukey’s HSD Test for multiple comparisons found out that the mean value of altruism was different between the bachelor students in nursing and bachelor students in physiotherapy (p=0.011, 95% CI = [0.0498, 0.5448]). Compared to others, bachelor students in nursing had higher level of altruism and bachelor students in physiotherapy had lower level of altruism. Conclusions: The results showed that it is precisely the feeling of altruism that people have, which made them choose nursing as a profession. Since altruism is so important for the nursing profession, topics related to altruism should be included in nursing curricula.

Assessment of adolescent physical development using body mass index and body self-perception

2024-07-02T13:33:41+03:00

Underweight or overweight in children and adolescents is a serious public health problem. Self-perception is an important factor in promoting health, especially during adolescence. The purpose of this study is to assess the characteristics of self-perception of children with low body weight, normal body weight, overweight and obesity. This study was conducted in Kharkiv secondary schools in November 2021. The total number of participants was 14,853, of which 8,290 were girls and 6,563 were boys, aged 10-17 years. Using an online questionnaire, adolescents indicated their body weight and height, and also assessed their own health preserving activities. Diagnosis of being underweight, overweight and obesity was carried out in accordance with World Health Organization (WHO) standards. Body self-esteem was assessed using the following questions: “What do you think about your body?”; “How satisfied are you with your health?”; “How satisfied are you with yourself?”; “How can you assess your own health?”. According to the results of the examination based on BMI, it was found that 63.1±2.4% of adolescents have normal body weight. Overweight was detected in 12.3±1.1%, obesity – in 2.4±0.5%. 17.4±1.3% of participants were underweight, and 4.8±0.7% had body mass deficit. By their own assessment, 75.0% of children considered themselves to have “normal” body weight, another 15.0% considered their weight “more than normal,” and about 10.0% of adolescents considered themselves “lean.” Among boys, 61.0% had normal body weight. About 16.5% of boys were considered overweight, and 3.8% of boys were obese. Insufficient body weight was found in 14.08% of respondents, and 4.6% had big body mass deficit. Among girls, the percentage of participants with normal body weight was 64.8%. 8.95% of participants were considered overweight, 1.35% were obese. Almost 20.0% were underweight; a large deficiency was detected in 5.0% of girls. In order to carry out health promotion activities among schoolchildren, the sexual characteristics of self-perception of one's own body and health problems among adolescents should be taken into account. Boys were almost twice as more satisfied with themselves and their health than girls, regardless of how they perceived their body (p<0.01). The number of boys with overweight and obesity was twice as high as girls (20.0% vs. 10.0%). At the same time, almost one in four girls and one in five boys were underweight and/or had body mass deficit. The systematic collection and analysis of data on the health-preserving behavior of adolescents is an important component of the development and creation of health care programs for the children's population of Ukraine.

Health and school difficulties of children in foster care in the experience of their foster parents

2024-07-02T13:56:00+03:00

The period of compulsory school attendance is a mentally very challenging period for children in foster care, which can be impacted by complex developmental trauma stemming from the child's experience in foster care with cumulative and chronic traumatic events in his/her biological family. These events have taken place over a long period of time in interpersonal relationships usually related to caregivers, in the form of abandonment of the child by the caregiver, changing caregivers, lack of safe space and necessary support for the child from the family and school, and/or deficiencies in the provision of coordinated health and social care for both the child and the foster parents. The paper presents research findings supported by a statistical analysis of health and school difficulties in children in foster care related to their school attendance. The purpose of the research was to support the quality and coordination of services of non-profit organizations providing social, health and educational services to foster families and their children during school attendance to support the school success and well-being of children. The study was implemented as part of a dissertation at the University of South Bohemia in České Budějovice in the Czech Republic on the topic of promotion of the health, social and psychological well-being of school-aged children in the context of their school and family environment. The authors carried out a questionnaire survey in the Czech Republic among a selected sample of respondents, who were foster parents of children aged 6 to 15 attending primary school in the Pardubice Region. In a total sample of 102 respondents, we identified two different groups. One group – 64 respondents with healthy children and another group – 38 respondents with children with health difficulties. The aim of the research was to compare the assessments of the intensity of school difficulties of children in foster care in groups of respondents with or without a child with health difficulties or mental illness in their foster care. The hypothesis of a difference in assessments of school difficulties in children with/without health difficulties was formulated and statistically tested (H₀: ratings of the intensity of difficulties are the same in both groups). Statistical testing of the hypothesis utilised the non-parametric Mann-Whitney test with the test results being significant at the level of significance p<0.05. Correlation was observed for each difficulty and exploratory cluster analysis shows their interrelationships. The study results according to the foster parents' assessment show a high intensity of difficulties of school-aged children in foster care in their inclusion in the classroom in establishing relationships with classmates (p-value =0.9), in a negative attitude towards learning and lack of motivation to learn (p-value =0.7) experiencing nervousness, internal tension and staying focused when learning. In addition, when comparing the groups of respondents with healthy children and children who have health difficulties/mental illness, there was a statistically significantly higher intensity of difficulties in the group of respondents with children with health difficulties when doing prep work for the classes (p-value =0.00075).

Diagnostic value of the gingival cytogram in school-age children suffering from chronic gastritis and duodenitis

2024-07-02T14:10:05+03:00

In recent years, there has been an increase in the incidence of morbidity associated with digestive organ pathology in the pediatric population. The oral cavity is the digestive tract opening, sharing a common ectodermal origin with it. The changes in the cytogram of the oral mucous membranes can signal about exacerbation of pathological processes in the gastrointestinal tract. The aim of this work: to identify the features of gingival cellular composition in school-age patients with chronic gastritis and duodenitis in order to improve diagnostic methods at the disease stages. Examinations of the gingival cytogram in children aged 12-17 years with chronic gastritis and duodenitis (27 individuals with the disease in acute stage, 30 – in remission) were carried out. The control group included 28 children who did not have any somatic pathology by the results of the examination. For cytological examination, imprint smears from the gingival vestibular surface of the upper and lower jaws were made. The smears were fixed and stained by the May-Grunwald Pappenheim method, and then examined using a microscope with an immersion system. The percentage of epithelial cells and connective tissue cells was calculated per 100 cells. The number of pathologically altered epithelial cells was determined: with vacuolated cytoplasm, with nucleus deformation. In children with chronic gastritis and duodenitis disorders in the gingival cellular composition with a predominance of dystrophic components were found, that was manifested by a decrease in the proportion of epithelial cells at terminal stages of differentiation, an increase in the proportion of cells with cytopathological phenomena, polymorphonuclear leukocytes and lymphocytes. Changes in the cytogram were especially expressed in the phase of disease exacerbation. Knowing the phases of the wound process, based on the timing and sequence of the cellular ensembles seen in the cytogram, it is possible to control the disease periods, and timely apply measures to prevent exacerbations. This diagnostic method is especially indicated for children who have relative and absolute contraindications for fibroesogastroduodenoscopy.

Results of biochemical and histological studies after restoration of bone defects using cellular technologies in dental patients

2024-07-02T15:08:01+03:00

Objective of the research was to find out the effectiveness of the use of osteoplastic materials based on the multipotent mesenchymal stromal cells of the adipose tissue during surgical treatment for restoration of bone defects in dental patients. The clinical material included examination of 79 patients who underwent replacement of bone defects of the alveolar processes and/or an alveolar part of the appropriate jaw by means of different osteoplastic materials and their combinations or without their application (the control group). Acid phosphatase activity in the oral fluid of patients was determined by means of the unified “end point” method. Alkaline phosphatase activity in the oral fluid was determined using a set of reagents produced by the company “Filisit-Diagnostika” (Ukraine). Oral fluid mineralization index (MI) of patients was calculated according to the ratio of enzymatic activity of alkaline phosphatase (ALP) to acid phosphatase (AP) according to the formula: MI=ALP/AP. Histological material was taken at the stage of installation of a dental implant. It was established that the use of a composition based on multipotent mesenchymal stromal cells of adipose tissue, platelet-enriched blood plasma and bone tissue substitute containing hydroxyapatite contributes to the improvement of regenerative processes in the bone tissue of the jaws, which is confirmed by a 28.68% decrease in acid phosphatase activity, an increase by 25, 97% of alkaline phosphatase activity in the oral fluid of group B patients and, accordingly, a 77.08% increase in the ratio of alkaline to acid phosphatase. According to the results of histological studies and phase-contrast microscopy, after 6-8 months of observation, in patients of group B, the areas of jaw defects were filled with newly formed bone tissue, identical to native bone, and the resulting trepanobioptas had the structure of cancellous bone with osteoblastic elements forming a chain around osteoid tissue. Having analyzed the results of biochemical and histological studies it was established that application of an osteoplastic composition based on the multipotent mesenchymal stromal cells of the adipose tissue, bone tissue substitute with hydroxyapatite and platelet-rich plasma allows restoration of bone defects of the alveolar processes and an alveolar part of the appropriate jaw in shorter terms. The method is an optimal alternative to traditional osteoplastic materials to be used in modern dental practice and dental implantation.

Indicative features of tissue and microbial sensitization in the pathogenesis of generalized parodontitis associated with rheumatoid arthritis

2024-07-02T15:08:03+03:00

In the literature, there are not enough studies that reflect the role and place of tissue and microbial sensitization in patients with generalized parodontitis (GP) associated with rheumatoid arthritis (RA). In our opinion, the research of these components will help to better understand the etiopathogenetic mechanisms of development of GP against the background of RA, which will improve the formation of preventive and therapeutic measures for this disease treatment. The purpose of the research was to determine the location and integration features of tissue and microbial sensitization in the pathogenesis of generalized parodontitis associated with rheumatoid arthritis. Immunological studies were carried out in 335 people, who were divided into 4 groups: Group 1 – the main – consisted of 136 patients with GP on the background of RA; Group 2 – control – 71 people with GP without signs of RA; Group 3 – comparison – 128 people without GP, but with diseases of the musculoskeletal system not related to RA and Group 4 – 30 practically healthy people. To determine microbial and tissue sensitization, we used inhibition reaction of migrating lymphocytes with microbial antigens of streptococci and staphylococci, tissue antigens (bone and synovial). A high frequency of microbial sensitization to streptococcal and staphylococcal antigens was established in patients with GP on the background of RA and in patients with GP without signs of RA. The parodontal focus turned out to be an active focus of microbial sensitization in patients with GP associated with RA and in patients with GP without signs of RA. Established sensitization to bone antigen in a small number of patients (27-33%) with GP, which was significantly more frequent (61-80%) in patients with GP associated with RA, indicates that in the latter, allergy is to a greater extent due to tissue systemic damage to connective tissue than GP. However, a certain allergy to bone tissue in GP may indicate the inclusion of an immune component in the pathogenesis of GP. The presence of microbial and tissue sensitization in patients with GP and RA indicates that similar and cross antigens of streptococcal and staphylococcal microorganisms with connective tissue are a potential trigger for the development of both GP and RA, which is a reason to consider GP and RA comorbid diseases with similar pathogenetic mechanisms of development.

Study of the neuroprotective properties of metformin in rats with type 2 diabetes mellitus and brain injury induced by intracerebral hemorrhage

2024-07-03T10:36:02+03:00

The aim of this study was to study the effect of metformin (Met) on the formation of the conditional passive avoidance skills, markers of neurogenesis and oxidative stress in the brain of rats with acute intracerebral hemorrhage (ICH) in the setting of streptozotocin-nicotinamide-induced diabetes. Type 2 diabetes mellitus (T2DM) was induced in rats via the intraperitoneal injection of streptozotocin (STZ) and nicotinamide (NA), ICH – by microinjection of bacterial collagenase into the striatum. Rats were randomly divided into four groups: 1 – intact animals (n=8), 2 – T2DM (n=9); 3 – T2DM+ICH (n=7); 4 – T2DM+ICH+Met (n=7). The passive avoidance test was used to evaluate behavioural activity. Advanced oxidation protein products (AOPP) and lactate were measured by spectrophotometry, advanced glycation end products (AGEs) by quantitative fluorescence, level of 8-hydroxy-2-deoxyguanosine (8-OHdG) was assessed by enzyme-linked immunosorbent assay (ELISA). Histopathological examination was performed using general histological staining techniques and immunohistochemical methods for assessment of expression of endothelial NO-synthase (eNOS), Growth Associated Protein 43 (GAP43), Hypoxia-inducible factor 1-alpha (HIF-1α), neural cadherine (N-cadherine) and vascular endothelial cadherine (VE-cadherine). In this study, metformin had nootropic (anti-amnestic) activity and decreased oxidative stress markers (AGEs, AOPPs and 8-OHdG) levels by 29.1% (p<0.001), 24.9% (p<0.015) and 29.3% (p<0.05) respectively, which indicates its positive impact on the course of free radical oxidation reactions intensified by both diabetes and intracerebral hemorrhage. The study provides additional information on neuroprotective properties of metformin and the emphasizes possibility of using metformin in diabetic patients at risk of hemorrhagic stroke. Considering the increase in VE-cadherin expression by the drug, it is possible to predict its positive effect on the function of blood-brain barrier. This study may serve as a reference for the feasibility of studying the clinical efficacy of metformin under these conditions.

Peculiarities of the blood system of animals under the conditions of consumption of drinking water containing chlorates

2024-07-03T10:56:50+03:00

In modern conditions, providing the population with high-quality drinking water is becoming an increasingly urgent hygienic, scientific, technical, and social problem. Chlorine dioxide can be an alternative reagent for disinfecting drinking water. However, as with chlorine, dangerous by-products, particularly chlorites and chlorates are formed. The processes of development of morphofunctional changes in homeostasis remain insufficiently studied in this aspect. The objective is to determine the nature and peculiarities of changes in hematological indicators in the blood of animals due to the chronic impact of various concentrations of chlorates in drinking water to establish criteria for the hygienic assessment of their adverse effects on the body. The test animals were given drinking water with different concentrations of chlorates daily for 6 months: group 1 – control, group 2 – chlorates at a dose of 0.2 mg/dm³, group 3 – chlorates at a dose of 0.7 mg/dm³, and group 4 – chlorates at a dose of 1.2 mg/dm³. Evaluating the results of experimental studies, it should be noted that the most pronounced changes are observed in groups of animals that received chlorates in concentrations of 0.7 and 1.2 mg/dm³: a gradual decrease in the absolute number of leukocytes, the absolute and relative number of lymphocytes, relative to the indicators of the control group can be observed. In groups of animals that received chlorates in concentrations of 0.7 and 1.2 mg/dm³, a decrease in the absolute number of erythrocytes was observed during the 90 days of the experiment. It was established that the severity of the effects depended on the dose of chlorates and the time of exposure. Thus, the nature and features of changes in hematological indicators in the body of experimental animals during a chronic sanitary-toxicological experiment under the influence of chlorates in drinking water may indicate that chlorates affect the indicators of the blood system, being the indirect signs of disorders of other functional systems in the body, namely – slowing of redox reactions, hypoxic manifestations, reduction and weakening of the immune response and reactivity, etc.