Medicni perspektivi

Lipoleiomyoma of the uterus in a woman of reproductive age (clinical case)

2024-10-18T13:50:59+03:00

Uterine lipoleiomyoma is one of the variants of uterine leiomyoma, which is histologically represented by the presence of mature fat and smooth muscle cells. The relevance of the coverage of this clinical case is determined by the extreme rarity of the development of uterine lipoleiomyoma in women of reproductive age. The purpose of this work was to record this clinical case in the world statistics of lipoleiomyoma, to evaluate methods of diagnosis and differential diagnosis, to determine the role of early diagnosis of uterine lipoleioma in the subsequent tactics and scope of surgical treatment. Data from the medical records of a 41-year-old inpatient were analyzed. In addition to the generally accepted clinical and biochemical methods of blood and urine examination, electrocardiogram, ultrasound examination of the pelvic organs, the level of ovarian tumor markers in the blood (CA 125, HE4 and the ROMA index) was determined. The diagnosis of the disease was based on the data of pathohistological and immunohistochemical studies. Based on the results of a review of the medical literature, analysis of articles obtained as a result of a search of PubMed, SCOPUS, Web of Science, MedScape databases, the current state of the problem is highlighted, literary data related to the incidence, features of the clinical course, diagnosis and treatment of uterine lipoleiomyoma are summarized. The clinical case presented in the article demonstrates an incidental finding of a uterine lipoleiomyoma in a woman of reproductive age, measuring 30x25x20 cm, originated subserously from the body and cervix of the uterus, in the area of its isthmus. Under this condition, it occupied the entire Douglas space, the area of the sacro-uterine ligaments and the parietal peritoneum, intimately adjacent to the sigmoid and rectum, to the ureters and iliac vessels. The peculiarity of this clinical case is that sonographically uterine lipoleiomyoma was hidden under the "mask" of a dermoid cyst of the right ovary. Macroscopically, it differed from a typical lipoleiomyoma by the purple-bluish color of its outer surface and soot-colored, fine-lobed spongy structure on the section. The diagnosis of uterine lipoleiomyoma was verified only on the basis of pathohistological and immunohistochemical research. Microscopically, the lipoleiomyoma had a mesenchymal structure with a pronounced vascular component and consisted of mitotically inactive bundles of smooth muscle cells and mature adipocytes. Immunohistochemically, a positive reaction for caldesmon, desmin, smooth muscle actin alpha of tumor cells and for S.100 (DAKO, polyclonal) fatty cells was detected, which confirmed the hypothesis of direct transformation of smooth muscle cells existing in the leiomyoma of the uterus into fatty cells. This clinical case should complement the global statistical indicators of diagnosis of uterine lipoleiomyoma in women of reproductive age. Lipoleiomyoma should be considered as the primary diagnosis in case of detection of a large uterine tumor in women with excess body weight and be removed immediately after diagnosis, otherwise it is impossible to exclude its malignancy. For the planned diagnosis of neoplasms of the female genital organs, preference should be given to non-invasive research methods: magnetic resonance or computer tomography with contrast enhancement. The problem of these tumors lies in their unpredictable histogenesis, the unexpected presence of fat in the microscopic structure, and in the visual similarity to sarcomas. Verification of the diagnosis is carried out on the basis of pathohistological and immunohistochemical studies of the tumor preparation. Uterine lipoleioma can have a purplie-bluish color and develop by a broad base from the body and cervix of the uterus, as a result of "lipomatous" metaplasia of the uterine leiomyoma existing in a woman. Regular preventive examinations of women of all ages are crucial for timely detection of this rare neoplasm.

Comprehensive Medical and Psychological Rehabilitation in War Trauma (clinical case)

2024-10-15T14:59:04+03:00

The purpose of the work was to analyze a clinical case of the course of war trauma and presents the experience of providing comprehensive medical and psychological clinical rehabilitation to a patient who suffered as a result of a terrorist attack. Patient D., 65 years old, sustained a mine-blast injury (MBI) to the right upper limb extremity during shelling. The optimal restoration of the functions of the upper injured limb and the patient's health (physical, somatic, mental) was carried out according to the algorithm of comprehensive medical and psychological clinical rehabilitation. As a result of the course of comprehensive medical and psychological clinical rehabilitation, significant positive dynamics was observed, including a decrease in edematous, painful, and inflammatory syndromes. The range of motion in the right upper limb and cervical-thoracic spine increased. Supination and pronation of the right hand became clearer and less painful (from 8 to 2 points), movement in the fingers of the right hand increased and became more steady, a clear pulsation appeared in the area of the skin defect on the right forearm, regression of pain in the elbow and shoulder joints on the right was noted, and the patient began to walk without a mobilization bandage. The course helped to reduce anxiety (from -1.82 to 0.85), asthenic symptoms (from 0.48 to 3.71), obsessive-phobic symptoms (from -1.96 to 1.74), and autonomic disorders (from -0.83 to 2.03). Low cortisol levels (61 nmol/l) in against acute stress indicated the development of post-traumatic stress disorder. Upon completion of the rehabilitation course, cortisol levels rose to a healthy level (246 nmol/l), indicating the effectiveness of the process of restoring the psychophysiological state and adapting to a stressful situation. War trauma is a complex and severe condition that requires an integrated approach to treatment and rehabilitation, covering not only physical but also psychological and social aspects of patients' health.

Methodical approach to determining the main parameters of the evacuation system for the wounded with the use of different types of transport

2024-10-18T13:01:58+03:00

The timeframe for evacuating the wounded is a critical factor that largely determines the fate of a wounded soldier. Even at the initial stage of the war waged by the russian federation against Ukraine, there were almost no frontline ambulances, and there was a critical shortage of ambulances. At present, despite significant efforts to provide the Armed Forces of Ukraine with weapons and military equipment, as well as material and technical means, including medical equipment and property, in particular through international technical assistance, the problem of the lack of the required number of specialised medical evacuation vehicles has not been fully resolved. From this point of view, the issue of correct formulation of requirements for the rational composition and specially equipped various types of vehicles (including sanitary transporters, ambulances), including general use, the system of evacuation of the wounded, and determining the possibility of its further improvement through the methodological apparatus is relevant. The purpose of the article is to present a methodological approach to determining the main parameters of the system of evacuation of the wounded of an operational group of troops with the involvement of various types of transport. The formation of a model of the casualty evacuation system as a mass service network (MSN) will minimise the time spent waiting for medical care by wounded personnel, determine the rational composition of forces and means of the tactical casualty evacuation system. To model the system and processes of evacuation of the wounded from the battlefield during hostilities, including their transportation to medical facilities located in the depths of the third logistics zone, the mathematical apparatus of the theory of mass service was used. In particular, we are talking about the devices of queuing systems (QS) and MSN. The existing system of military evacuation of the wounded and sick is a four-tier system in which all wounded with moderate and severe severity are evacuated. Based on this, the system of evacuation of the wounded can be represented as an MSN, which has a number of features. First of all, this MSN is an open queuing network (OQN), i.e. the flow of requests to enter the network is unlimited, homogeneous and comes from an external independent source. As a result of the calculations, data were obtained on the values of network parameters (average number of applications in queues – 119.47 applications/hour, average number of applications in the network – 158.53 applications/hour, average waiting time for applications in queues for service – 11.95 hours, average time of application stay in the network – 15.85 hours) and the parameters of each QS operating in the MSN – transmission coefficient, incoming flow intensity, load factor, average number of busy channels, average number of applications per QS, average queue length, average waiting time for an application in the service queue, average time for an application to stay in the QS. Analysing the calculated data, from the point of view of creating a rational OQN, the casualty evacuation system achieves maximum efficiency when its productivity in processing the incoming flow of requests is maximised, and the minimum values of such parameters as the number of requests for service in the queue and the number of service channels operating in the network are minimal.

Informatization of the processes of administration of the quality of medical services in surgical hospitals

2024-10-18T13:33:32+03:00

Among the various forms of quality control of the provision of medical care, self-control and internal control of the quality of medical services are the most effective and significant. Currently, there is no comprehensive information technology and algorithm for recording data on the provision of medical services and determining their quality. The goal is to develop and analyze the effectiveness of business processes and an algorithm for quality control of the performance of medical services in a surgical health care institution by establishing their daily accounting in the information system, control of indicators characterizing the safety and quality of their performance, as well as an opportunity to assess the dynamics changes in indicators for making management decisions. In the study, an analysis of literary sources was carried out, business processes were formulated, and on the materials of a retrospective analysis algorithms for the use of information technologies were developed based on the methods of generalization, comparison, content analysis, system-analytical and logical analysis, a graphic analysis was performed to increase the clarity of the presentation of the material. The research was approved by the Biomedical Ethics Committee. For the first time, as a result of the work of the internal quality commission, daily and summarized forms of reports on the work of the medical center, which have five sections are obtained. The statistical indicators of the operation of the surgical unit for any period are fixed, formed in an automated mode and analyzed. Clinical data characterizing all prescribed procedures applied are subject to analysis, and the results provide an opportunity to isolate from the records the disorders and complications reflected in the reports. The quality control of the use of antibiotics, the frequency of their use for preventive and therapeutic purposes is also carried out. The section that contains multivariate epidemiological control of the work of the treatment facility, as well as the section that shows the quality of medical record keeping and patient care is important. Together with the inpatient chart, e-mails of medical appointments are analyzed, patient falls are recorded, appointments and monitoring of patient care, pain assessment after surgery, allergic reactions are recorded, as well as a retrospective audit of the charts regarding the justification of the appointment of antimicrobial therapy. Control of patient safety and the quality of the provided medical services requires constant verification of their implementation and paying attention to be up to standards, the occurrence of deviations and complications. The application of a specially developed algorithm based on information technologies, aimed at daily accounting of medical services and obtaining data on deviations in their application, makes it possible to make urgent management decisions and influence the improvement of the qualifications of personnel who provide such services.

Clinical course of atrial fibrillation in patients who experienced coronavirus disease (COVID-19): results of a 6-month follow-up

2024-10-16T14:43:01+03:00

Atrial fibrillation (AF) is the most common extrapulmonary complication of the past SARS-CoV-2 infection. According to experts, almost 20% of patients with past COVID-19 have a history of atrial fibrillation and the incidence of new paroxysms of this arrhythmia ranges from 10 to 18%. Referring to the studied patients who experienced COVID-19 more than 6 months ago, the subjective perception of cardiac arrhythmia is the most frequent complaint, reported by approximately two-thirds of patients. The aim of our study was to determine the course of atrial fibrillation in patients after past 2019 coronavirus disease (COVID-19) during a dynamic 6-month follow-up after the initial hospitalization for atrial fibrillation in the specialized department of cardiac arrhythmias of the SI “National Scientific Center” “M.D. Strazhesko Institute of cardiology, clinical and regenerative medicine of the National Academy of Medical Sciences of Ukraine” depending on the clinical and anamnestic, demographic, anthropometric factors, the results of laboratory research methods and the received treatment. 36 patients were included in the study, 27 of them formed the first group, which included patients in whom the course of atrial fibrillation improved against the background of recommended antiarrhythmic treatment after initial hospitalization for AF and past COVID-19, who at the time of hospitalization had a negative PCR test, of which 17 were women and 10 were men, aged 62.38±1.83 years. The second group consisted of 9 patients including 4 women and 5 men, aged 69.88±2.60 years in whom the course of atrial fibrillation neither changed nor worsened. We determined that the number of patients in whom the course of atrial fibrillation improved during the 6-month follow-up was three times greater than those in whom the course of this arrhythmia neither changed nor worsened (75% and 25%, respectively). Patients with a more favorable course of atrial fibrillation were younger (on average by 7.5 years), three times less likely to suffer from diabetes and not often had arterial hypertension of the III stage, than those examined, in whom the course of this arrhythmia did not change or worsen. Systemic inflammation and severity of heart failure significantly worsen the course of AF within 6 months after the hospital stage of treatment. However signs of deterioration of lipid metabolism are characteristic of patients with an unfavorable course of atrial fibrillation during 6 months after hospitalization, which is probably caused by the activation of systemic inflammation in them. The improvement of the prognosis of the examined patients was probably influenced by the appointment of antiarrhythmic drugs, such as: amiodarone, flecainide, beta-blockers, statins – from the "up-stream" therapy drugs.

Ventricular arrhythmias occurring in myocardial infarction patients with acute ST-segment elevation within the first 24 hours after primary percutaneous coronary intervention and their prognostic value

2024-10-16T15:04:04+03:00

Reperfusion therapy in myocardial infarction patients with acute ST-segment elevation significantly reduced the frequency of ventricular tachycardia and ventricular fibrillation, however, such arrhythmias still occur in 6-8% of patients, posing a threat to their lives.The aim of the study was to determine the nature of ventricular arrhythmias occurring in myocardial infarction patients with acute ST-segment elevation within the first 24 hours after primary percutaneous coronary intervention, and their prognostic value regarding the development of complications during the inpatient treatment phase. The study involved 82 individuals (mean age: 62,4±10,2 years; male: 69,23 (58,6-78,92)%, female: 30,77 (21,08-41,4)%). Within 24 hours after the infarct-related artery stenting, all patients underwent a 24-hour Holter ECG monitoring. The course of the disease was analyzed based on the presence of risk factors such as hypertension, diabetes mellitus, past COVID-19, and obesity. Ventricular rhythm disturbances were represented mainly by premature contractions. They occurred significantly more frequently in patients with arterial hypertension (883,71 (96,0; 986.0); p=0,02; p=0,03; p=0,02, compared to patients with a history of COVID-19, diabetes, and obesity, respectively) and in those with past COVID-19 (711,3 (125,0; 846,5); p=0,01; p=0,04, compared to individuals with diabetes and obesity, respectively). Isolated premature ventricular complexes, pairs, triplets were recorded, and in individuals with arterial hypertension and past COVID-19 “runs” of ventricular extrasystoles and episodes of nonsustained monomorphic and even polymorphic ventricular tachycardia, such as Torsades de Pointes, (under the condition of combined risk factors) were noted; predominantly in these patients during the hospital phase such сomplications as ventricular fibrillation and asystole,with sudden cardiac arrest developed. The obtained results is an evidence of electrical myocardial instability and indicate that myocardial infarction patients with acute ST-segment elevation, in addition to myocardial revascularization, require optimization of pharmacological treatment. The use of intravenous beta-blockers as part of complex treatment prevented the occurrence of life-threatening ventricular arrhythmias during the inpatient treatment phase.

Clinical symptoms of combined abdominal and thoracic trauma in peacetime

2024-10-16T15:40:12+03:00

Combined thoracic and abdominal trauma is considered one of the most severe in the structure of polytrauma, which causes a high frequency of complications – 33-72% and a mortality rate of up to 34%. The purpose of the study was to ensure the quality of the provision of medical services to victims with combined abdominal and thoracic trauma, through clinical assessment of the most significant symptoms and systematization of their manifestations aimed at justifying diagnostic and treatment measures. We conducted a prospective analysis of clinical manifestations in 44 victims with combined abdominal and thoracic trauma, who were treated at the city clinical hospital 16 of Dnipro in the period from 2019 to 2023. The average age of the victims was 41.5±2.4 years, men predominated – 40 (90.9%) people. In 40 (90.9%) victims, only 2 anatomical sites were damaged, 3 anatomical sites were damaged in 3 (6.8%) victims, 4 or more anatomical sites were damaged in 1 (2.3%) injured person. All victims were operated on. Multiple injuries of abdominal organs were observed in 14 (31.2%) victims. Among the injuries of the chest cavity, the most common cause was a lung contusion – 36.4% of cases. Exclusion criteria from the study were craniocerebral injury and contusion or injury to the heart as components of a combined injury. Also, the study did not include victims who received resuscitation measures during admission or at the stage of emergency care. Collection of complaints and anamnesis, examination, palpation, percussion and auscultation were used as research methods. The obtained information made it possible to determine the sequence of use of hardware and instrumental diagnostic methods. For better systematization of clinical symptoms, the latter were divided into three components – abdominal, thoracic and hemodynamic. The most frequent complaint was pain in the abdomen and in the chest area, respectively 75.6% and 82.9%. In the structure of the hemodynamic component, the victims most often complained of a feeling of general weakness – 73.2%. The accuracy of the symptoms detected during the diagnosis of damage to the abdominal organs ranged from 6.8% (Kulenkampf's symptom) to 93.2% pain of the abdominal wall. The diagnostic accuracy of Rozanov's symptom, which indicated damage to the spleen was 68.2%. Despite the fact, that such a symptom as pain during palpation of the chest occurred in 81.8% of victims, its diagnostic efficiency remains quite low – 54.5%. On the other hand, such a symptom as bone crepitation, with an accuracy of 95.5%, allowed us to assert the presence of rib fractures in the victims and hint at the probability of injury to the chest or abdominal organs, which we observed in 44.4% and 88.9% of cases, respectively. Damage to the lungs was also ascertained due to the sufficiently high diagnostic accuracy of the auscultatory symptom – weakening of breathing – 70.5%. Hypotension below 90 mm Hg. (45%; 50%), tachycardia (81.8%; 59.1%) and pallor of the skin (56.8%; 65.9%) showed sufficiently high diagnostic accuracy during the diagnosis of possible intraabdominal and intrapleural bleeding, respectively. The combination of damage to the organs of the abdominal and thoracic cavities was characterized by multifaceted clinical manifestations and signs of multisymptoms. Most of the symptoms taken separately had low accuracy regarding the presence or absence of a certain intracavitary post-traumatic pathology (from 6.8% to 43.2%); however, the combination of several of them indicated the multiplicity of damage to the organs of the abdominal cavity (from 41.7% to 100%). The best diagnostic accuracy was shown by Rozanov's symptoms – 68.2%, which indicated damage to the spleen and crepitation of rib fragments – 95.5%, as well as auscultatory weakening of breathing – 70.5%, which indicated lung damage.

Abdominal vacuum therapy is a component of DAMAGE CONTROL SURGERY tactics for combat trauma to the abdomen

2024-10-17T11:25:36+03:00

The goal of the study was to improve the outcomes of surgical care and treatment for patients with combat-related abdominal injuries at different levels of medical support during combat operations by using abdominal vacuum therapy as a component of Damage Control Surgery tactics. At the II level of combat medical support within the Damage Control Surgery tactics, abdominal vacuum therapy was applied to 75 wounded male combatants with a combat abdominal injury, aged 37.4±8.3 years (main group). The comparison group consisted of 87 wounded patients aged 37.5±10.2 years, operated on using Damage Control Surgery tactics with drainage of the abdominal cavity and suturing of the skin only. 40.0% of the wounded in the main group and 46.0% of the comparison group were admitted with signs of traumatic shock of various degrees. According to the AdTS scale, 78.7% of the wounded in the main group were admitted in a serious condition, 21.3% – in an extremely serious condition; in the comparison group, 74.7% were in severe condition, 25.3% were in extremely severe condition. In 57.3% of the wounded of the main group, abdominal vacuum therapy was carried out in the irrigation-flow mode. 24.0% used standard bandages for abdominal vacuum therapy, 76.0% used partially improvised ones. The level of negative pressure was set in the range of 40-125 mm Hg in constant mode. Intra-abdominal pressure was measured by a standard method (through the bladder) at admission and after surgery. The assessment of the state of the abdominal cavity in the I and III phases of Damage Control Surgery was carried out according to the Abdominal Cavity Index scale – an integral assessment expressed in points based on factors that can be assessed visually during surgery. The volume of surgical interventions in the 1st phase of the Damage Control Surgery tactic depended on the nature of the damage to the abdominal organs and the condition of the wounded. After the completion of Phase I of Damage Control Surgery tactics, all wounded were evacuated by road medical transport and medical helicopters to the next level of medical support, with abdominal vacuum therapy during evacuation in the main group and Damage Control Resuscitation measures. Under the effect of abdominal vacuum therapy, the reduction of intra-abdominal pressure in the main group was pronounced (Δ=9.2; p<0.01) than in the comparison group (Δ=6.1; p<0.01). Abdominal vacuum therapy during the II phase of the Damage Control Surgery tactic made it possible to clean the abdominal cavity better (p<0.0001) than in the comparison group and provided better preparation for the implementation of the III phase of this tactic. As a result, reliable protection from external factors, active prevention of intra-abdominal pressure and rehabilitation of the abdominal cavity during the application of abdominal vacuum therapy during the II phase of Damage Control Surgery tactics in the main group of wounded after obstructive resections of the small intestine in the I phase made it possible to completely abandon terminal stomas in the III phase (in the comparison group – 5) in favor of the formation of small bowel intestinal anastomoses, and during obstructive colon resections, the number of terminal colostomas in the main group was reduced to 50.0% (in the comparison group -90.9%, р=0.004), also in favor of the formation anastomoses, which significantly improved the functional results of providing assistance to the wounded with a combat abdominal injury. The use of abdominal vacuum therapy during phases I-II of the Damage Control Surgery (DCS) tactics allows for the optimization of the scope of surgical interventions in phase III of Damage Control Surgery and significantly improves the functional outcomes of surgical care and treatment for patients with combat abdominal injuries at various levels of medical support during combat operations.

Respiratory disease detection in lung auscultation with convolutional neural networks and CVAE augmentation

2024-10-17T11:43:13+03:00

The main purpose of this work was to investigate the possibility of detecting respiratory diseases in audio recordings of lung auscultation using modern deep learning tools, as well as to explore the possibility of using data augmentation by generating synthetic spectral representations of audio samples. The ICBHI (International Conference on Biomedical and Health Informatics) dataset was used for training, validation and augmentation. The dataset includes lung auscultations of 126 different subjects, there are a total of 920 sounds, of which 810 have signs of chronic diseases, 75 of non-chronic diseases and 35 with no pathology. The stage of data preprocessing includes discretization to 4kHz frequency, as well as filtering of frequency bands that do not carry information value for the task. In the next step, each sample was transformed into a frequency spectrum and Melspectrograms were generated. To solve the problem of class imbalance, the required number of synthetic spectrograms generated by convolutional variation autoencoders was added. At the stage of building the model, the methods of classical convolutional neural networks were used. The quality of the obtained algorithm was evaluated using a 10-fold cross-validation. Also, to assess the generalization of the proposed method, experiments were performed with the split of audio recordings into training and test sets using patient grouping. Qualitative evaluation of the model was performed using sensitivity, specificity, F1-score and Cohen’s kappa. A score of 98.45% F1-score was achieved for the 5-class classification problem which can contribute to the development of ways to synthesize and augment sensitive medical data. In addition, a cons of existing methods in the generalization of the obtained predictions were revealed, which opens the way for further research in the direction of clinical respiratory diseases detection.

General immunologic reactivity of patients with COVID-19 and its relation to gene polymorphism, severity of clinical course of the disease and combination with comorbidities

2024-10-17T11:54:01+03:00

The aim of the study is to identify and evaluate the general immunological reactivity of patients with COVID-19 and its relationship with gene polymorphism, severity of the clinical course of the disease and combination with comorbidities. A cohort study was conducted involving 204 patients with COVID-19 diagnosed with community-acquired pneumonia of mild, moderate, and severe degrees who also had comorbidities: endocrinopathies (46 patients), cardiovascular diseases (82 patients), and comorbidities of the ENT organs, connective tissue, gastrointestinal tract, chronic kidney disease (CKD), which were grouped into the group "other comorbidities (76 patients). Among the patients there were 51.97% (106) women and 48.03% (98) men. The average age of patients was 55.93±8.75 years. The polymorphism of the NOS3 (rs2070744), FGB (rs1800790) and TMPRSS2 (rs12329760) genes was determined by real-time polymerase chain reaction (qualitative determination). The overall immunological reactivity was detected and evaluated based on the analysis of 14 integral leukocyte indices: leukocyte shift index, absolute leukocyte count/erythrocyte sedimentation rate (ESR) ratio index, lymphocyte-granulocyte index, lymphocyte index, immunological resistance and reactivity index, and others. The overall immunological reactivity of the body of patients with coronavirus infection increases in the presence of the wild-type T-allele of the eNOS gene (rs2070744) in the patient's genotype, especially the CC genotype, by 21.98-57.89% (p≤0.029-0.001), against the background of a decrease in the index of nonspecific reactivity and the ratio of agranulocytes to ESR – by 23.0 (p=0.039) and 15.74% (p=0.044), indicating the onset of specific immunological reactions in the active infectious process. Carriers of the mutational A-allele of the FGB gene (rs1800790) and the TT genotype of the TMPRSS2 gene (rs12329760) showed higher immune reactivity and resistance, which was significantly confirmed by the level of increase in immune reactivity by 6.31-17.21% (p=0.007) and 22.05-35.78% (p≤0.06-0.004), respectively, against the background of a slightly higher rate of allergy (especially in owners of the AG genotype of the FGB gene – by 68.18%, PAG=0.017), a higher ratio of agranulocytes and ESR – by 18.30-21.84% (p≤0.008-0.007) and 19.46-31.07% (p=0.023), with a higher ratio of lymphocytes and eosinophils – by 13.35-19.20% (p≤0.002-0.001). The influence of the wild-type T-allele of the eNOS gene (rs2070744), the A-allele of the FGB gene (rs1800790) and the TT genotype of the TMPRSS2 gene (rs12329760) on the immunological reactivity of the body of a patient with coronavirus infection was revealed.

Gender-associated features in diabetic kidney disease

2024-10-17T12:49:44+03:00

Diabetic kidney disease (DKD) is the leading cause of end-stage renal failure. Evidence indicates gender differences in the progression of this disease. This study aimed to determine gender differences in prevalence and identify gender-associated risk factors contributing to the development of diabetic kidney disease in individuals with type 2 diabetes mellitus (T2DM). The cross-sectional study included 132 patients with T2DM ranging in age from 50 to 65 years. Subjects were stratified by sex (80 women and 52 men). Gender differences have been studied in relation to the incidence and prevalence of DKD, their phenotypes and clinical manifestations, and several risk factors that have different effects on both sexes. The outcome of clinical kidney function assessment showed that 70% subjects were diagnosed with DKD (71% of women and 67% of men). The study indicated an association between the duration of T2DM and urinary albumin levels, as well as between arterial hypertension and triglyceride levels, which are independent risk factors for DKD development. Notably, older women with T2DM have a higher prevalence of DKD than older men. The albuminuric component of DKD was more frequently observed in men. Additionally, men were more likely to have adverse risk factors, including dyslipidemia, lower high-density lipoprotein cholesterol, and glomerular filtration rate, which are factors involved in the mechanisms of DKD. In summary, the results indicate that: 1) women with type 2 diabetes mellitus are at a higher risk of developing a normoalbuminuric phenotype of diabetic kidney disease, while men are at a higher risk of developing an albuminuric phenotype of diabetic kidney disease leading to renal failure and end-stage renal disease; 2) gender differences are most noticeable among older adults and may have significant implications for the development of more effective diagnostic and treatment methods for diabetic kidney disease, tailored to individual needs.

Dynamics of endothelial function in patients with arterial hypertension with different cardiovascular risk against the background of antihypertensive therapy

2024-10-17T14:45:04+03:00

The aim of the work was to investigate the dynamics of endothelial markers in patients with arterial hypertension with different cardiovascular risk under the influence of the prescribed treatment during a year of observation. The first group (with a moderate risk of cardiovascular events) included 48 patients with arterial hypertension (AH). The second group consisted of 54 patients with hypertension and a high risk of cardiovascular events, namely type 2 diabetes. Each group of patients was randomized into two subgroups by blood pressure (BP) medication. In patients of subgroup 1a (n=29) and subgroup 2a (n=35) – the main subgroups – the therapy necessarily included the angiotensin II receptor antagonist losartan potassium in a dosage of 50-150 mg/day, depending on the blood pressure level. Patients of subgroup 1b (n=19) and subgroup 2b (n=19) – comparison subgroups were treated with antihypertensive drugs of other first-line groups according to the data of the unified clinical protocol for the treatment of hypertension. According to the ROC analysis, it was determined that the dynamics of endothelin-1 (ET-1) indicators after 9 and 12 months of therapy (a decrease of 12% or more from the initial level) can predict the normalization of indicators of the coagulation and anticoagulation systems with indicators of sensitivity and specificity – 85% (95% CI 62.1-96.6%) and 92.9% (95% CI 76.5-98.9%), respectively. A decrease in the level of Willebrand factor (fV) by 23% or more due to such a treatment time can be used as a prognostic sign in determining the regression of endothelial dysfunction with sensitivity – 75% (95% CI 50.9-91.2%), specificity – 100% (95% CI 87.5-100%). According to the given data, both in the group with moderate and with high cardiovascular risk, there is a relationship between endothelial dysfunction (ED) and the duration of hypertension, indicators of the lipid spectrum and abdominal obesity – factors that increase the viscous resistance of the blood circulation, as well as platelet hyperactivity in the bloodstream. We have also established that according to the dynamics of ET-1 indicators after 9 and 12 months of therapy (decrease by 27% or more from the initial level), it is possible to predict the normalization of indicators of the coagulation and anticoagulation systems with indicators of sensitivity – 81.8% (95% CI 59.7-94.7%), specificity – 90.6% (95% CI 75-97.9%). A decrease in the level of fV by 24.5% or more after a year of treatment can be used as a prognostic sign in determining the regression of endothelial dysfunction with sensitivity – 68.2% (95% CI 45.1-86.1%), specificity – 71.9% (95% CI 53.3-86.2%). The obtained results testify to the dominant role of type 2 diabetes as a factor in platelet disorders of hemostasis. Taking into account the positive dynamics of the above-mentioned markers of ED during the year of treatment, their relationship with the reduction of blood pressure, indicators of the lipid spectrum and abdominal obesity, it should be noted the positive effect of angiotensin II receptor blockers (BRA II) as endothelioprotective drugs. Considering the irrefutable literary data about the absence of thrombomodulin in the blood stream, even its insignificant appearance indicates the presence of endothelial dysfunction. Determining the state and dynamics of changes in endothelial function under the influence of prescribed therapy will make it possible to improve the diagnosis of endothelial function disorders and increase the effectiveness of treatment of patients with hypertension and various cardiovascular risks.

Peculiarities of the format of genetic blood systems in patients with oral lichen planus

2024-10-17T14:55:14+03:00

The number of patients with oral lichen planus (OLP) has increased due to the raise of aggressive forms of the disease (erosive, ulcerative and hyperkeratotic forms) with a possible risk of malignancy. There are isolated researches which indicate a genetic determinism to OLP, but more often these conclusions are based on insufficiently adequate and out of date methods, which make it impossible to correctly interpret the obtained data. The aim was to identify a genetical predisposition with a programmed risk to the oral lichen planus. The main group – 278 patients with the OLP (aged 26-65 years). The control group – 298 people (blood donors) who didn’t have dental diseases, as well as diseases of internal organs and systems. The groups were homogeneous by gender and age. In our research we used such methods: clinical, radiological, immunogenetic, statistical methods were used. The erosive form of OLP was associated with 0(I) group in 54.2±0.4% of cases, while the hyperkeratotic form was associated with group 0(I) only in 28.7±1.8% of cases. B(ІІІ) and AB(ІB) groups were less often associated with the erosive form of OLP and were observed in 17.3±0.1% and 2.0±0.1% of cases, respectively. The integration of A(ІІ) group in the erosive form of OLP was 30.5±0.1%, but the indicator was higher than in individuals with B(III) and AB(IV) groups. Hyperkeratotic form of OLP was more often observed in A(II) carriers than in 0(I) and was 44.1±0.1% versus 28.7±1.8%, respectively. With blood group B (ІІІ), the relationship with OLP is not traced. Correlative relationship with erythrocyte blood antigens of the ABO system in patients with oral lichen planus was established. Risk groups for the development of erosive and hyperkeratotic forms of lichen planus in patients with gastrointestinal tract pathology O(I)>A(II)>B(III) – with erosive form and A(II)>O(I)>B(III)) – with hyperkeratosis.

Comorbidity in in patients with relapsing-remitting multiple sclerosis

2024-10-17T15:12:16+03:00

Multiple sclerosis is a chronic autoimmune inflammatory disease that affects the brain and spinal cord. The most common form of this disease according to the type of its course is relapsing-remitting multiple sclerosis. Comorbidity in multiple sclerosis is an urgent problem of modern neurology, since it can influence such factors as the time of diagnosis, the rate of disease progression and the rate of patient disability, the number of exacerbations and the patient’s quality of life. The purpose of the work was to study and characterize comorbidity in patients with relapsing multiple sclerosis. To conduct this study 105 patients with a diagnosis of relapsing-remitting multiple sclerosis were enrolled. All patients were assessed using the Multiple Sclerosis Neurological Disability Severity Scale (EDSS). Study participants were divided into two groups – Group 1 and Group 2 – based on EDSS scores. Separately, study participants were divided into groups based on the principle of receiving pain-modifying therapy. In the 1st study group, concomitant diseases were in 57 (78.1%) patients, in the 2nd group – in 100% (p=0.010). In patients who did not receive pain-modifying therapy, 57 (98.3%) of those examined had concomitant diseases, in those who received such treatment – in 32 (68.1%), which was statistically significantly less (p<0.001). In the first place in terms of the frequency of concomitant pathology among all examined patients were diseases of the gastrointestinal tract, which also dominated in the 1st and 2nd observation groups, in the second place – diseases of the urinary system, in the third place – eye diseases, and in the last place, by the frequency of concomitant diseases – cardiovascular diseases. Comorbidity in multiple sclerosis is an extremely relevant problem in modern neurology due to its significant impact on the clinical picture of the disease, its course and the degree of disability of the patient. Digestive system disease is one of the most common comorbid conditions in multiple sclerosis. The number of patients with comorbid conditions is higher among patients with a moderate degree of disability and among patients not taking disease-modifying therapy, but the relationship between the degree of disability, treatment and comorbid conditions requires further study.

Psychoeducation of higher education seekers with using of the resource-oriented model of stress resiliency in war conditions

2024-10-18T10:11:13+03:00

The article presents the study results of resiliency modalities and the content of psychoeducational measures for higher education seekers in war conditions. The purpose of the study was to increase the effectiveness and to balance resiliency modalities use by higher education seekers in war conditions while using psycho-educational measures. 174 seekers of higher education were examined, including 144 students of the 4th-6th year of the medical faculty and the faculty of medicine and pharmacy of the Dnipro State Medical University, specializing in 222 «Medicine» (main group) and 30 students of the 4th-5th year of the metallurgical and electro-metallurgical faculties of the Ukrainian State University of Science and Technology (comparison group). A psychodiagnostic method using the resource-oriented model of stress resiliency "BASIC Ph" was employed. The first stage involved a statistical analysis of resiliency modalities and their average scores in both groups. In all participants of the main group, it was found that the highest average score was registered in the resiliency modality “Cognitive strategy”. The lowest score was observed for the “Social support” modality. In all participants of the comparison group, it was found that the “Cognitive strategy” modality, as in the main group, had a clear advantage over other modalities, and the lowest score was already observed for the “Emotions” modality. These results formed the basis for creating psychoeducational measures for stress resiliency among higher education seekers in wartime. Psychoeducation for higher education seekers was conducted from September to November 2023, including lectures and individual conversations upon request. The «BASIC Ph» model of stress resiliency was utilized as a framework for determining optimal human resource utilization during crises, with six modalities forming individual style of resiliency. It is crucial to identify dominant modalities and develop those that are less effective. The identified stress resiliency modalities provided a conceptual basis for developing of psychoeducational measures to enhance their effective and balanced use in war situations among higher education seekers. During psychoeducational work with higher education seekers, their resiliency models were analyzed, interpreted, and balanced. Study results should be taken into account in psychological support efforts for higher education seekers in war and post-war time.

Oral microbiocenosis state under different approaches of replacing dental crown defects

2024-10-17T15:29:03+03:00

Dental caries is one of the most common health problems. The aim of the research was to study the spectrum of microbiota, which is part of the dental biofilm, and its biological properties. The study involved 90 participants of the study group and 20 of the control group. Dental plaque and saliva were used as principal clinical specimens. The main research method was bacteriological. All samples from study participants were positive for microbiota. At the initial collection of material, 395 unique isolates were obtained: 338 from patients with caries and 57 from healthy volunteers. The microbiocenosis of the oral cavity associated with the development of caries contained such eudodominants as Streptococcus mutans, Peptostreptococcus spp., Fusobacterium spp., Prevotella spp. and dominants Streptococcus pyogenes, Enterobacterales, Prevotella spp. and Candida albicans. In contrast the eudominants of the healthy oral cavity were microorganisms with known commensal properties, in particular Streptococcus salivarius, Aerococcus viridans, Veillonella spp. After the dental treatment, significant shifts in the taxonomic composition of the dental biofilm were observed. Therefore, the composition of the oral cavity microbiocenosis in participants who underwent restoration of the dental crown defects with zirconium inserts approached patients to the healthy cohort participants. The eudodominants of the oral microbiocenosis of the participants who underwent direct restoration were S. mitis, Peptostreptococcus spp. and Veillonella spp. In zirconium restoration, the commensals S. salivarius and A. viridans were eudodominants. The obtained isolates of opportunists possessed high virulence properties. Streptococcus spp. cultures were sensitive to norfloxacin screening in only 28.6% of cases. Among cultures of the genus Staphylococcus, 23.8% were methicillin resistant. Representatives of Enterobacterales had chemotherapeutic sensitivity that varied significantly depending on the group of antimicrobial agents. Using disks with phenylboronic acid, ethylenediaminetetraacetic acid and cloxacillin, it was established that Klebsiella spp. were producers of class A carbapenemases (n=3) and contained AmpC (n=3). Carbapenemases were also produced by at least 65.2% of the studied cultures of non-fermenting gram-negative microorganisms. In our study, all obtained isolates were also endowed with the ability to form a biofilm. Therefore, microbiological research in dentistry should be considered as one of the objective methods for assessment of health of the oral cavity and will also have advantages in choosing a method of correcting defects of dental crown parts and in some cases, making an informed decision about the prescription of antimicrobial treatment.

Demographic and clinical characteristics and effectiveness of treatment of patients with combined ocular pathologies by vitrectomy due to retinal detachment

2024-10-18T10:50:52+03:00

Purpose – to evaluate the demographic and clinical characteristics and treatment efficiency of patients by vitrectomy due to retinal detachment against the background of combined eye pathologies. The observation was conducted in the Clinic of Educational Surgery of the Azerbaijan State Medical Institute named after A. Aliyev. The case histories of 500 patients diagnosed with retinal detachment against the background of combined eye pathologies were studied by random sampling, 197 of whom underwent vitrectomy. Data on the demographic and clinical characteristics of these patients were collected. Before the operation, visual acuity and intraocular pressure were assessed. Information on registered complications after the operation, the results of optical coherence tomography on day 10 after treatment, as well as visual acuity indicators were provided for in the observation program and obtained in a standard manner for all patients. The obtained results were processed statistically using the "data analysis" package of the Excel program. The collected data were grouped by variants of features, the specific weight of each group and subgroup in the aggregate was calculated. The obtained data showed that in 197 (34.9±2.2%) patients with retinal detachment against the background of combined pathologies who underwent vitrectomy, the gender difference was not significant. The overwhelming majority of patients were admitted for treatment with a great delay. Basically, combined pathologies of the cornea (16.2%), lens (45.2%) and vitreous body (5.3%) prevailed. Combined eye pathologies in patients with retinal detachment during vitrectomy are often complicated by choroidal rupture (4.1%), increased intraocular pressure (7.6%), diplopia (3.6%), hemophthalmos (2.5%) and cataract (22.8%). The main etiologic factors of retinal detachment against the background of combined eye pathologies are myopia (50.3%), eye injuries (30.9%).

The incidence of benign and malignant tumors among adults with long-term physical disabilities

2024-10-18T11:02:16+03:00

People with long-term physical disabilities also suffer from different types and nature of tumors as well as general population. Unfortunately, the information about the frequency of these diseases among the specified contingent is very deficient. The objectives of the study were to determine the incidence of benign and malignant neoplasia among the adults and elderly with physical disabilities and to indicate the risk factors for the appearance and development of tumors in this population. In this descriptive survey, 186 people, living in the largest home on the Balkan Peninsula for adults and elderly people with long-term physical disabilities were studied in 2021. 82.79% of the residents were over 51 years of age and almost all of them are inhabited by two residents. 42.47% of the respondents were men and 57.52% – women. Data on the demographic characteristics of the respondents, including their personal lifestyle and self-reported diagnosis of presence and/or history of a tumor formation, were collected through a semi-structured interview. The verification of the collected information about the incidence of benign and malignant lesions among adults with physical disabilities was carried out by means of the application of the second research method – content analysis based on the medical records. For processing and analysis of the collected data, it was used statistical software – IBM SPSS Statistics V21.0. The results showed a significantly high rate in the prevalence of tumor formations in the sample – 24.19%. The pre-cancerous formations have the highest incidence among residents – 42.22% with the most common variant – chronic form of cholecystitis combined with cholelithiasis (37.77%). Prostatic hyperplasia and uterine leiomyoma are the leading benign lesions in male residents – 11.11%, in female respondents – 11.11% respectively. The predominant form of cancer is breast carcinoma – 8.88%. The research found a high prevalence of tumor formations among adult patients with long-term physical disabilities. The harmful impact of a number of behavioral habits and health determinants significantly contributes to this negative tendency.

Transcranial electrical stimulation in post-traumatic stress disorder and brain injury: possibilities of tuning neuronal networks

2024-10-18T11:10:13+03:00

Transcranial direct current stimulation (tDCS) in the treatment of post-traumatic stress disorder (PTSD) is used to strengthen the inhibitory control of amygdala activity. However, there are still limited meta-analytic studies examining different tDCS protocols on core PTSD symptoms and the relationship between stimulation parameters and effect size. The objective is to investigate the effectiveness of such an intervention, which is a complex combination of a psychotherapy program with tDCS in the treatment of patients with PTSD and mild traumatic brain injury (mTBI) by assessing their level of functioning. 329 veterans (PTSD (n=109), mTBI (n=112), PTSD + mTBI (n=108) were examined using WHODAS 2.0. Standardized treatment was provided as well as psychotherapeutic intervention - a combination of psychoeducation with motivational interviewing and acceptance and commitment therapy for PTSD and tDCS. Clinical targets of therapy in the PTSD group were symptoms of intrusion, avoidance, hyperactivation and protocol of tDCS was dorsolateral prefrontal cortex arousing stimulation. In PTSD + TBI group clinical targets were neurocognitive symptoms, intrusion symptoms, avoidance, hyperactivation and tDCT protocol was motor cortex-supraorbital area inhibitory stimulation. The targest for TBI group was neurocognitive symptoms and tDCS protocol was occipital region exciting stimulation. The long-term effectiveness and the impact on neuroplasticity processes allow considering transcranial direct current stimulation as a promising method of neurorehabilitation of patients with a combination of posttraumatic stress disorder and mild traumatic brain injury.

Socio-demographic portrait of the applicant and the main motives for choosing the "Therapy and rehabilitation" speciality

2024-10-18T11:18:30+03:00

Rehabilitation and psychological support are becoming today's most urgent issues due to russian armed aggression. These needs will be long-lasting and increasingly significant. Since 2023, the Program of Medical Guarantees in Ukraine has been expanded regarding rehabilitation assistance. Additionally, volumes of the state-commissioned training of bachelors and masters in the speciality of "Therapy and rehabilitation" have been increased. It is well known that the quality of specialists trained by higher educational institutions largely depends on the motives behind the career choice. Knowledge about a student's socio-demographic status and his/her motivations to become a physical therapy and occupational therapy specialist can help understand future challenges and opportunities for the profession's development. This information can aid in elaborating strategies to promote the profession in the educational services market and to attract more applicants to choose the speciality 227 "Therapy and rehabilitation". The research aimed to compose the socio-demographic characteristics of the applicant for training in the speciality 227 "Therapy and rehabilitation", to investigate the motivational aspects of career choice and to establish the factors significant for motivation formation. To achieve this goal, a voluntary anonymous survey of 39 domestic applicants enrolled to complete the bachelor's degree program in speciality 227 "Therapy and rehabilitation" at Dnipro State Medical University was conducted. It was determined that the contingent of applicants is represented mainly by persons aged 16-18 (74%) with an active life position (90%). Additionally, most are familiar with the specifics of medical professions (62%) and have had previous personal or professional contact with physical therapy and occupational therapy (78%). The future career decision was mostly independent (84%), conscious, and influenced by the balance of internal and external motivational factors. It was typically made one to two years before taking degree course (72%). The primary motives for choosing the speciality 227 "Therapy and rehabilitation" while understanding its demand in today's conditions by applicants (82%) were "interest in medical science" (95%), "the desire to help others" (95%), "the opportunity to obtain a prestigious profession" (90%), "possibility of guaranteed employment" (90%) and "material interest/financial independence" (87%). Future specialists are aware of the importance of controlled acquisition of knowledge and skills (90%), the need for daily independent work (80%), and the significance of gaining practical experience during training (95%). They aim to achieve professionalism (59%), enhance communication skills (31%), build endurance (31%), and cultivate persistence (28%) and empathy (28%). Most applicants entering the speciality 227 "Therapy and rehabilitation" are goal-oriented, highly motivated, and prepared for rigorous study, which is the key to developing into competent and competitive specialists.

Toxicological characterization of the insecticide metofluthrin and assessment of the carcinogenic risk to human health due to its chronic inhalation effect

2024-10-18T11:29:23+03:00

The aim of the investigation is the toxicological characterization and analysis of the danger criteria of the insecticide metofluthrin with an assessment of the carcinogenic risk to health caused by chronic inhalation exposure to the substance at the level of the maximum possible concentrations in the air environment of human life. The analysis of scientific reports of the US Environmental Protection Agency (US EPA) and the European Chemicals Agency (ECHA) on the toxicological properties of metofluthrin was carried out. The assessment of the risk of the development of carcinogenic effects due to chronic inhalation exposure to metofluthrin was carried out taking into account the average daily dose of the substance that can enter the human body during the natural life span (LADD) and the carcinogenic potential factor (SF) in accordance with domestic guidelines. Classification of levels of carcinogenic risk was carried out using domestic and international approaches. It was established that the limiting criteria for the danger of metofluthrin are the average lethal concentration in air (LC₅₀=1080 mg/m³) and the size of the zone of chronic action (Z_ch=7.46), which characterizes the danger of occurrence of chronic intoxication due to long-term inhalation exposure. According to these indicators, metofluthrin is classified as a dangerous substance (hazard class 2). The key effects of the toxic action of metofluthrin are determined – neurotoxicity, hepatotoxicity and nephrotoxicity. The threshold non-genotoxic oncogenic potential of metofluthrin according to the phenobarbital type was established. Individual carcinogenic risk under different scenarios of chronic inhalation exposure to metofluthrin was calculated. The substance concentration of 3.54 mg/m³ leads to a high level of risk (1.5×10^-3), which is considered unacceptable for production conditions and the population. At concentrations of 0.28 mg/m³ and 1.0 mg/m³, the risk is estimated as average and acceptable for production conditions (1.1-4.1×10^-4). The risk of exposure to a concentration of 0.14 mg/m³ is classified as low and acceptable for the population (5.7×10^-5). Thus, the results obtained in the study indicate that such concentrations of metofluthrin in the air as 0.14 – 0.28 – 1.0 mg/m³ are safe for human health, subject to compliance with medical and sanitary regulations at the stage of production and application of insecticides based on metofluthrin as prescribed.

Study of the relationships of polymorphisms of the folate cycle genes with the levels of homocysteine and folic acid as risk factors of cardiovascular disorders in the post-covid period

2024-10-10T11:52:01+03:00

Enzymes of the folate cycle participate in the process of remethylation of homocysteine (HC) to methionine, where folates are coenzymes for methyl transfer. The aim of the work was to identify the interrelationships of gene polymorphisms of associations between folate cycle enzyme gene polymorphisms and cardiometabolic risk factors such as increased serum homocysteine levels and folic acid deficiency in patients in the post-covid period. In 51 patients who suffered from COVID-19, a general clinical and laboratory examination, and assessment of serum homocysteine and folic acid concentrations by immunoenzymatic method was carried out. Polymorphisms of the genes: methylenetetrahydrofolate reductase (677C>T and 1298A>C), methionine synthase-reductase (66A>G) and methionine synthase (2756A>G) were determined by real time polymerase chain reaction. For each of the named polymorphisms, the examined patients were divided into 3 groups according to the nucleotide alleles in the corresponding position: 1) homozygous dominant, 2) heterozygous and 3) homozygous recessive. For the methylenetetrahydrofolatereductase gene at position 677, serum levels of homocysteine and folate did not differ between the groups 1 and 2 with genotypes 677 C/C (n=26) and 677C/T (n=21), (p>0.05); in group 3, the recessive genotype 677 T/T was found in only 4 people (8%), that did not allow comparison of indices. The distribution of patients into 3 groups according to the genotype of the same gene at position 1298 revealed that the recessive 1298 C/C mutation in group 3 (n=9) associated with an increased homocysteine level (19.56±1.89 μmol/l), versus 10.68±0.76 (p=0.012) and 11.63±1.25 μmol/l (p=0.013) in groups 1 and 2, with no difference in folate levels between groups. Group 3 differed by a higher degree of obesity, a higher frequency of hypertension disease and chronic heart failure (in 85% of patients in group 3, against 41 and 50% in groups 1 and 2), a higher number of platelets, a longer duration of hospitalization due to COVID-19, a higher level of D-dimer. The study of groups of patients, divided depending on the genotype of methioninesynthase reductase at position 66, showed that carriers of the recessive homozygous 66 G/G mutation (group 3, n=15) had increased serum homocysteine level (16.56±1.64 μmol/l) in comparison with individuals of group 1 (n=17) 66 A/A (10.28±1.17 μmol/l; p=0.004) and group 2 (n=19) 66 A/G (11.32±1.17 μmol/l, p=0.013). In group 3, a longer duration of hospitalization due to COVID-19 was noted (17.15±1.65 vs. 11.88±0.97 days, p=0.008), higher frequency of hypertension (67% vs. 35%) and heart failure (67% against 29%) compared to group 1. The use of a molecular genetic approach made it possible to establish that the presence of recessive mutations of the folate cycle genes is associated with a potential predisposition to hyperhomocysteinemia, thrombophilia, severe forms of cardiometabolic complications and coronavirus disease.

Effect of celecoxib and paracetamol on the functional state of the central nervous system, pain sensitivity, and physical endurance of rats with acute heat injury

2024-10-10T12:20:07+03:00

Acute heat injury (AHI) is a serious condition caused by an excessive increase in body temperature, usually due to prolonged exposure to high environmental temperatures or intense physical activity in the heat. Without timely treatment, heat stroke can lead to severe damage to the central nervous system with cerebral edema, profound disturbances in the water-salt balance and internal organs, coma and death. Since the effectiveness of drugs for the treatment of thermal injuries has not been proven, the search for new thermoprotective agents with different mechanisms of action, in particular inhibitors of the arachidonic acid cascade, is urgent. In a preliminary screening study on the AHI model in rats, it was found that among cyclooxygenase (COX) inhibitors, the highly selective COX-2 inhibitor celecoxib and the analgesic-antipyretic paracetamol are the most effective in preventing hyperthermia and improving the course of the recovery period. The purpose of this study was to determine the impact of the specified screening leaders on the functional state of the central nervous system, pain sensitivity and physical endurance in the recovery period of heat injury. The AHI model was reproduced on adult white male rats according to the previously proposed and validated method by means of a 30-minute exposure at +55°C. Animals were divided into 4 groups with 8 rats in each group: intact control, control pathology, paracetamol group and celecoxib group. Based on the results of the study, it was established that celecoxib exhibits a pronounced thermoprotective effect, probably improves the state of the central nervous system in terms of behavioral reactions and physical endurance of animals in the recovery period after acute heat injury. At the same time, paracetamol after acute heat injury does not have a distinct positive effect on the functional state of the central nervous system, moderately improves the physical endurance of rats and is inferior to celecoxib in all the studied parameters. These results open new opportunities for the development of approaches to the treatment of AHI and confirm the different effectiveness of the use of celecoxib and paracetamol in thermal injuries.

Effectiveness of extracorporeal shock wave therapy in comparison with other methods of treatment of patients with plantar fasciitis: literature review

2024-10-16T10:42:56+03:00

Plantar fasciitis (PF) is one of the most common causes of pain in the heel area, which is associated with the presence of inflammation in the plantar fascia and is most often localized in the medial part of the heel area. Extracorporeal shock wave therapy (ESWT) is a method of hardware treatment that has been used in orthopedics and traumatology for the past decades. One of the main diseases successfully treated with this method is plantar fasciitis. The aim of the work was to determine the effectiveness of extracorporeal shock wave therapy in the treatment of plantar fasciitis compared to other methods of conservative treatment based on the literature review. Research literary sources from scientific electronic databases PubMed, Medline and other sources of scientific and medical information were analyzed. A literature search was performed using search queries specifying the method under study and plantar fasciitis, namely: «Extracorporeal Shockwave Therapy», «Plantar Fasciitis», «Conservative Treatment», «Physiotherapy». During the search, 473 scientific articles devoted to the treatment of plantar fasciitis were selected. Given the large number of articles and the desire to present up-to-date data, the query was limited to the last 9 years (from 2015 to 2023) and 417 articles were selected. Articles devoted to other methods of treatment of PF (conservative and surgical) and articles devoted to the use of ESWT in orthopedic and traumatological diseases of other localizations were excluded from the search results. At the second stage of the search, articles devoted exclusively to the treatment of PF by the ESWT method were excluded, and sources comparing the effectiveness of ESWT treatment with other methods of conservative treatment were selected (31 articles). The main results – it was determined that extracorporeal shock wave therapy continues to remain one of the main methods of conservative treatment of PF, which has been used for the last decades. It has proven its high efficiency and safety in the treatment of PF. Compared with other methods of conservative treatment of PF, extracorporeal shock wave therapy remains one of the most effective, it is successfully used in the treatment of PF.

Modern views on the etiology and role of microbial persistence in the development of inflammatory processes in the periodontal complex (review)

2024-10-16T10:59:17+03:00

Alveolar tissue diseases cause the appearance of dentition defects, thereby reducing the patients' work capacity and quality of life. The purpose of this research was to investigate, modern views on the etiology of periodontitis and the role of microbial persistence in the development of inflammatory processes of periodontal complex basing on a review of literary sources. Literature review was conducted using PubMed, Web of Science, Scopus, Google Scholar from 2018 to March 2024. There were no restrictions on the date of publication or the language of scientific sources. Searches were conducted according to MeSH (Medical Subject Headings) with using the following search terms: "periodontitis", "oral mucosa", "gums", "dental plaque", "periodontium", "traumatic occlusion", "microorganisms". In total, during the initial analysis 82 literary sources were selected and processed, after further systematization of the selected information using general scientific methods, 70 of them remained. Used methods: bibliographic and analytical. Generalized periodontitis is a chronic inflammatory-dystrophic process that occurs as a result of various factors. In the pathogenesis of this disease, the key role is played by the inflammatory process, which is a complex interaction of microcirculatory, hematological and connective tissue reactions to the lesion. Local (exogenic) and general (endogenic) causative factors are distinguished. The main factors that cause pathological changes in periodontium are bacterial biofilm, traumatic occlusion and various anatomical anomalies. Dental plaque occupies a special and main place among the causes of periodontitis. At present, leading pathogenetic links in the development of the inflammation in the periodontium, in particular, the disruption of free radical oxidation, the processes of peroxide oxidation of lipids and proteins, the disorder of the functional state of the antioxidant system, the formation of oxidative stress, as well as the humoral link of adaptive immune protection and cytokinesis, have not been sufficiently studied. There is no doubt about the role of the microbial factor in the etiology of periodontal diseases, but the penetration of microbes into the periodontium does not always lead to the development of the disease, because the organism has a number of protective mechanisms that counteract the development of inflammation.

Promoting a culture of respect in cardiothoracic surgery: navigating challenges in understanding unethical behaviour

2024-10-16T11:20:59+03:00

Unprofessional behaviour in the workplace, such as bullying, harassment, and discrimination, remains common in the cardiothoracic surgery unit. Despite its prevalence, there is little consensus on what constitutes unprofessional behaviour in the workplace of a cardiothoracic surgeon. In this review, we aim to narrow down the definition of unprofessional behaviour among cardiothoracic surgeons, identify its prevalence and the factors contributing to it, as well as explore potential preventive and support measures. We searched the MEDLINE and Web of Science databases (2000-2022), focusing on publications within psychology, medicine, general surgery, and cardiothoracic surgery for inclusion in a focused review. The current review identified 89 papers that highlight the complexity of defining unprofessional behaviour and its prevalence in cardiothoracic surgery units. Psychosocial professional challenges, hierarchical relationships within the medical team, and a high-stress environment may prompt unprofessional behaviour, which can manifest in both overt and covert actions. Such behaviour negatively mpacts medical services for patients, the psycho-emotional state of employees, and the overall functioning of the medical institution. The most effective support measures are characterized by being proactive, anticipating potential problems before they occur. Unprofessional behaviour should be considered an organizational concern, not merely an issue between individual team members. This perspective is essential for fostering a healthy work environment. The leaders of cardiothoracic surgery, given their high status and authority, play a pivotal role in this regard; their focus on inclusiveness of employees with lower status or responsibility is crucial for promoting a culture of psychosocial safety. This culture should be characterized by trust, honesty, and mutual respect, ensuring that every team member feels valued and respected. By prioritizing these values, leaders can minimize the risk of unprofessional behaviour, ultimately leading to an improvement in the quality of medical services for patients, an improvement in the psycho-emotional state of employees and the functioning of the organization as a whole.

Therapeutic potential of phytocompounds of Bacopa monnieri (L.) Wettst (literature review)

2024-10-16T11:34:13+03:00

The aim of the work was to evaluate the pharmacological effects and therapeutic potential of individual compounds and extracts of B. monnieri based on the analysis of data from scientific periodicals regarding chemical composition and biological action. Theoretically significant were the studies of the materials of the scientific-metric database PubMed and Google Scholar over the last five years regarding the chemical composition and biological action of extracts based on B. monnieri and their individual components. The search query was carried out by the Latin name of the plant, with the exception of publications related to botanical research. In separate PubChem searches, names of individual phytocompounds were used to establish structure and distribution in plants. The SuperPred web server was used to predict therapeutic potential. The authors analyzed the chemical composition of the extracts, presented the structural and pharmacological characteristics of bacosides and their aglycones: bacosin and juubogenin, cucurbitacin E, loliolide, betulinic and asiatic acids and the flavonoid oroxindin. The mechanism of action of bacoside on β-amyloid is characterized and illustrated. Using machine learning, the prospects for using the main compounds of bacopa to create drugs were calculated taking into account the ATC classification, their biological effects and alternative plant sources were given. Experimental animal studies of whole aqueous or ethanolic extracts of B. monnieri have been found to support a cognitive enhancement effect. The extract was not toxic to humans. Numerous clinical trials show the effectiveness of the use of extracts in the treatment of anhedonia, depression, Alzheimer's disease, Parkinson's disease, dementia and hyperactivity. An analysis of clinical studies in Ukraine shows that drugs based on B. monnieri can be used in the complex treatment of cognitive impairment associated with dyscirculatory encephalopathy in adults and perinatal CNS damage in children. Considering the amphiphilicity of bacosides and the non-toxicity of extracts, they can be involved in the development of various dosage forms with a wide range of therapeutic applications. Further study of the pharmacological action of B. monnieri and the development of drug technology for solid and liquid dosage forms based on it are promising.