Pub Date : 2020-09-30DOI: 10.15587/2519-4798.2020.212710
V. Lychko
– patients with severe IS (average score on the NIHSS scale 24.06±0.29). Results. In the control group, there was a significant decrease after exposure to adrenaline solution. The reaction to adrenaline in patients with IS was almost absent. It indicates a decreasing of erythrocytes β-adrenoceptors (β-ARs) sensitivity to stimulants due to their desensitisation. In patients with moderate severity, erythrocytes are more reactive than in patients with more severe IS. erythrocytes a of a specific response of cells to biologically active substances and depends on the functional of the sympathoad renal system
{"title":"Modern possibilities of diagnosis of cell’s membrane-receptor complex dysfunction in the acute period of ischemic stroke","authors":"V. Lychko","doi":"10.15587/2519-4798.2020.212710","DOIUrl":"https://doi.org/10.15587/2519-4798.2020.212710","url":null,"abstract":"– patients with severe IS (average score on the NIHSS scale 24.06±0.29). Results. In the control group, there was a significant decrease after exposure to adrenaline solution. The reaction to adrenaline in patients with IS was almost absent. It indicates a decreasing of erythrocytes β-adrenoceptors (β-ARs) sensitivity to stimulants due to their desensitisation. In patients with moderate severity, erythrocytes are more reactive than in patients with more severe IS. erythrocytes a of a specific response of cells to biologically active substances and depends on the functional of the sympathoad renal system","PeriodicalId":21672,"journal":{"name":"ScienceRise: Medical Science","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85503076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-30DOI: 10.15587/2519-4798.2020.213870
O. Boiko, Y. Volkova
The aim: to evaluate the informativeness of the content of SP-D in the blood of patients with combined thoracic trauma as a marker of the severity of traumatic illness and the impact of the proposed modifications of the intensive care algorithm on treatment outcomes.Material and methods. The basis of this study is a statistical analysis of the results of a comprehensive examination of 92 patients with thoracic trauma. Control points were 1st, 3rd, 7th and 12th day of treatment. The severity of the injury was determined according to the ISS scale, the condition of patients at the time of admission according to the ARASNE II scale, the level of SP-D in the blood, the degree of pulmonary hypertension, the number of bed-days in the intensive care unit (IC). 3 groups of patients were identified. Group I - standard IC protocol, group II - standard IC protocol with the addition of ceruloplasmin, group III - standard IC protocol with the addition of a solution of D-fructose-1,6-diphosphate sodium salt of hydrate. Parametric statistics methods were used to process the obtained data.Results. In patients of group I, the maximum numbers of SP-D in the blood were determined, which had a positive strong correlation during the entire observation period with the frequency of pulmonary complications and the duration of treatment in the IC department. In group II, the administration of ceruloplasmin neutralized the negative effect of oxidative stress on the surfactant, so the average SP-D in the blood only on the 3rd day exceeded the reference values by 20 %, which affected the lack of correlations between pulmonary parenchyma and duration of treatment. In group III, the addition of a solution of D-fructose-1,6-diphosphate sodium salt hydrate had a positive effect on the general condition of patients as a whole, but throughout the study period SP-D figures in the blood exceeded the starting and reference, which affected the presence of strong and medium positive correlation between them, the degree of pulmonary hypertension and the length of stay in the IC department.Conclusions. In patients with combined thoracic trauma, it is important when planning patient management tactics to diagnose the content of surfactant protein SP-D in the blood during the entire period of stay in the intensive care unit. The level of SP-D in the blood of patients with combined thoracic trauma is a highly informative diagnostic marker of the functional state of the lung parenchyma (surfactant). An increase in its numbers three times indicates the beginning of the development of acute lung injury syndrome (exudative phase). Reduction of its figures in the course of respiratory distress syndrome by half the values in the exudative phase indicates the beginning of the proliferative phase and improvement of patients. The leading mechanism for the development of acute lung injury syndrome in patients with combined thoracic trauma. There is oxidative stress, so the appointment of ceruloplasm
{"title":"Role of surfactant protein SP-D in the diagnosis of pulmonary complications in patients with combined thoracic injury","authors":"O. Boiko, Y. Volkova","doi":"10.15587/2519-4798.2020.213870","DOIUrl":"https://doi.org/10.15587/2519-4798.2020.213870","url":null,"abstract":"The aim: to evaluate the informativeness of the content of SP-D in the blood of patients with combined thoracic trauma as a marker of the severity of traumatic illness and the impact of the proposed modifications of the intensive care algorithm on treatment outcomes.Material and methods. The basis of this study is a statistical analysis of the results of a comprehensive examination of 92 patients with thoracic trauma. Control points were 1st, 3rd, 7th and 12th day of treatment. The severity of the injury was determined according to the ISS scale, the condition of patients at the time of admission according to the ARASNE II scale, the level of SP-D in the blood, the degree of pulmonary hypertension, the number of bed-days in the intensive care unit (IC). 3 groups of patients were identified. Group I - standard IC protocol, group II - standard IC protocol with the addition of ceruloplasmin, group III - standard IC protocol with the addition of a solution of D-fructose-1,6-diphosphate sodium salt of hydrate. Parametric statistics methods were used to process the obtained data.Results. In patients of group I, the maximum numbers of SP-D in the blood were determined, which had a positive strong correlation during the entire observation period with the frequency of pulmonary complications and the duration of treatment in the IC department. In group II, the administration of ceruloplasmin neutralized the negative effect of oxidative stress on the surfactant, so the average SP-D in the blood only on the 3rd day exceeded the reference values by 20 %, which affected the lack of correlations between pulmonary parenchyma and duration of treatment. In group III, the addition of a solution of D-fructose-1,6-diphosphate sodium salt hydrate had a positive effect on the general condition of patients as a whole, but throughout the study period SP-D figures in the blood exceeded the starting and reference, which affected the presence of strong and medium positive correlation between them, the degree of pulmonary hypertension and the length of stay in the IC department.Conclusions. In patients with combined thoracic trauma, it is important when planning patient management tactics to diagnose the content of surfactant protein SP-D in the blood during the entire period of stay in the intensive care unit. The level of SP-D in the blood of patients with combined thoracic trauma is a highly informative diagnostic marker of the functional state of the lung parenchyma (surfactant). An increase in its numbers three times indicates the beginning of the development of acute lung injury syndrome (exudative phase). Reduction of its figures in the course of respiratory distress syndrome by half the values in the exudative phase indicates the beginning of the proliferative phase and improvement of patients. The leading mechanism for the development of acute lung injury syndrome in patients with combined thoracic trauma. There is oxidative stress, so the appointment of ceruloplasm","PeriodicalId":21672,"journal":{"name":"ScienceRise: Medical Science","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80759844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-30DOI: 10.15587/2519-4798.2020.213827
J. Ivanova, V. Prasol, K. Miasoiedov, Lyana Al Kanash
The aim . To investigate the reduction of wound healing time of various etiologies on the background of diabetes mellitus with arteries and veins with the help of combined treatment with the use of heterografts. The article uses the results of treatment of 18 patients with chronic wounds of different etiology with diabetes which were treated in the department of vascular disease in “Institute of General and Emergency Surgery Named after V.T. Zaitsev NAMS of Ukraine” in 2019–2020 years. All patients had diabetes of II type, and 8 of them had III and IV level of limb ischemia according to Fontaine, and 7 of them had chronical venous insufficiency (CVI) C6 (according to CEAP), and 2 patients were diagnosed arterial and venous pathologies, one patient had vast chronic post-traumatic wound of a shin. All patients underwent analysis of clinical, laboratory, non-invasive and invasive methods of patients’ examination to determine the degree of the main blood flow disturbance, the nature of collateral blood circulation and microcirculation of the level of wound contamination, as well as the phase of the wound developing. Among the patients of the studied group with CVI, 2 patients underwent femoral shin shunting, 2 patients underwent hybrid reconstructive surgery, and 4 patients underwent endovascular interventions on the shin’s arteries. Patients with CVI underwent scleroobliteration of disabled perforators under ultrasound navigation. The patients were prescribed the following scheme: compensation of diabetes, metabolic therapy, antibacterial, anticoagulant and angiotropic therapy, physical therapy, local treatment: photodynamic therapy and staged closure of tissue defects by a heterograft membrane. Results . The area of wounds surface in the patients with obliterating lesions of the arteries of the lower extremities before the start of treatment was in average of 391.3±100.42 cm 2 , against the background of complex treatment and wound closure with a heterograft on days 10–12 of treatment – 4.72±0.63 (p<0.01), and complete closure of the wounds was achieved within 3 weeks. In the patients with chronic venous insufficiency after performing sclerobliteration of incompetent perforants and PDT, the wound area was 16.92±0.18 cm 2 , on days 7–10 – 7.82±0.68 3 (by 50.63 %, p<0.01 ), and complete healing of the tissue defect was reached by the 4th week. Conclusions. Use of a heterograft, namely the amniotic membrane makes it possible to achieve shorter periods of healing of chronic wounds in patients with diabetes mellitus. The healing is 2-3 times faster than other modern methods of treatment. It reduces cost of treatment and reduces the period of disability. Shorter treatment period also reduces workload on medical staff and improve the quality of life of patients with diabetes mellitus. Faster wound cleaning lowers risks of local infectious complications
{"title":"Treatment of chronic wounds of patients with diabetes mellitus using heterografts","authors":"J. Ivanova, V. Prasol, K. Miasoiedov, Lyana Al Kanash","doi":"10.15587/2519-4798.2020.213827","DOIUrl":"https://doi.org/10.15587/2519-4798.2020.213827","url":null,"abstract":"The aim . To investigate the reduction of wound healing time of various etiologies on the background of diabetes mellitus with arteries and veins with the help of combined treatment with the use of heterografts. The article uses the results of treatment of 18 patients with chronic wounds of different etiology with diabetes which were treated in the department of vascular disease in “Institute of General and Emergency Surgery Named after V.T. Zaitsev NAMS of Ukraine” in 2019–2020 years. All patients had diabetes of II type, and 8 of them had III and IV level of limb ischemia according to Fontaine, and 7 of them had chronical venous insufficiency (CVI) C6 (according to CEAP), and 2 patients were diagnosed arterial and venous pathologies, one patient had vast chronic post-traumatic wound of a shin. All patients underwent analysis of clinical, laboratory, non-invasive and invasive methods of patients’ examination to determine the degree of the main blood flow disturbance, the nature of collateral blood circulation and microcirculation of the level of wound contamination, as well as the phase of the wound developing. Among the patients of the studied group with CVI, 2 patients underwent femoral shin shunting, 2 patients underwent hybrid reconstructive surgery, and 4 patients underwent endovascular interventions on the shin’s arteries. Patients with CVI underwent scleroobliteration of disabled perforators under ultrasound navigation. The patients were prescribed the following scheme: compensation of diabetes, metabolic therapy, antibacterial, anticoagulant and angiotropic therapy, physical therapy, local treatment: photodynamic therapy and staged closure of tissue defects by a heterograft membrane. Results . The area of wounds surface in the patients with obliterating lesions of the arteries of the lower extremities before the start of treatment was in average of 391.3±100.42 cm 2 , against the background of complex treatment and wound closure with a heterograft on days 10–12 of treatment – 4.72±0.63 (p<0.01), and complete closure of the wounds was achieved within 3 weeks. In the patients with chronic venous insufficiency after performing sclerobliteration of incompetent perforants and PDT, the wound area was 16.92±0.18 cm 2 , on days 7–10 – 7.82±0.68 3 (by 50.63 %, p<0.01 ), and complete healing of the tissue defect was reached by the 4th week. Conclusions. Use of a heterograft, namely the amniotic membrane makes it possible to achieve shorter periods of healing of chronic wounds in patients with diabetes mellitus. The healing is 2-3 times faster than other modern methods of treatment. It reduces cost of treatment and reduces the period of disability. Shorter treatment period also reduces workload on medical staff and improve the quality of life of patients with diabetes mellitus. Faster wound cleaning lowers risks of local infectious complications","PeriodicalId":21672,"journal":{"name":"ScienceRise: Medical Science","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81536280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-30DOI: 10.15587/2519-4798.2020.213053
O. Filyk
The aim of this study was to determine the significance of factors such as transthyretin levels, right diaphragm thickening fraction, amplitude of left diaphragm dome movements, stroke volume index (SVI), cardiac index (CI), SpO2/FiO2 ratio and transthyretin/C-reactive protein in unsuccessful weaning from AV in children with various forms of ARF at the stage of weaning from mechanical ventilation (MV). Materials and methods. We complete the prospective single-center cohort study and enrol 67 patients 1 month - 18 years old with hypoxemic and hypercapnic-hypoxemic acute respiratory failure (ARF). 46 of them need invasive mechanical ventilation (MV) for more than 3 days. We divide them into 1 st group (n=35, they were successfully weaned) and 2 nd group (n=11, they need reintubation and MV within the next 48 hours). We performed ultrasound examination of diaphragm, prolonged non-invasive monitoring of hemodynamic parameters to determine SVI, CI, SpO 2 with esCCO technology (estimated continuous cardiac output), NIHON COHDEN; determination of transthyretin (TTR) with G-Biosciences/Geno Technology, (USA) kit. Data were recorded on the first day of MV (d1), on 3rd, 5th, 7th day of treatment (d 3 , d 5 , d 7 ). Logistic regression method was used to make a predictive model of the probability of unsuccessful weaning from MV. Results. We have established (formula 1), that the risk of unsuccessful weaning from MV in patients with hypoxemic ARF increases with low values of transthyretin serum level, right hemidiaphragm thickening fraction, SVI and high CI. R= -12,008 + 0,242*(TTR, ng/ml) + 1,720*(right hemidiaphragm thickening fraction, %) + 1,711*(SVI, ml/beat/m 2 ) – 3,120*(СІ, l/min/m 2 ) (1). The risk of unsuccessful weaning from MV in patients with hypercapnic-hypoxemic ARF (formula 2) increases with low values of transthyretin serum level, amplitude of left hemidiaphragm movement, SVI, SpO 2 /FiO 2 and transthyretin/C-reactive protein ratio. R= - 42,233 + 0,389*(TTR, ng/ml) + 22,189*(amplitude of left hemidiaphragm movement, mm) + 1,120*(SpO 2 /FiO 2 ) + 2,885*( SVI, ml/beat/m 2 ) + 14,944*(TTR/CRP) (2). Conclusions. The level of transthyretin and SVI in addition to the indicators of thickening fraction of right hemidiaphragm and CI in children with hypoxemic ARF and the amplitude of left hemidiaphragm movements, ratios SpO 2 /FiO 2 and transthyretin/C-reactive protein in children with hypercapnic-hypoxemic ARF might affect the process of weaning from MV. Thus, acute malnutrition with diaphragmatic dysfunction and hyperdynamic type of blood circulation reduce the likelihood of successful weaning from MV and worsen clinical outcome in children with different types of ARF
{"title":"Prognosis of difficult weaning from mechanical ventilation in children with acute respiratory failure","authors":"O. Filyk","doi":"10.15587/2519-4798.2020.213053","DOIUrl":"https://doi.org/10.15587/2519-4798.2020.213053","url":null,"abstract":"The aim of this study was to determine the significance of factors such as transthyretin levels, right diaphragm thickening fraction, amplitude of left diaphragm dome movements, stroke volume index (SVI), cardiac index (CI), SpO2/FiO2 ratio and transthyretin/C-reactive protein in unsuccessful weaning from AV in children with various forms of ARF at the stage of weaning from mechanical ventilation (MV). Materials and methods. We complete the prospective single-center cohort study and enrol 67 patients 1 month - 18 years old with hypoxemic and hypercapnic-hypoxemic acute respiratory failure (ARF). 46 of them need invasive mechanical ventilation (MV) for more than 3 days. We divide them into 1 st group (n=35, they were successfully weaned) and 2 nd group (n=11, they need reintubation and MV within the next 48 hours). We performed ultrasound examination of diaphragm, prolonged non-invasive monitoring of hemodynamic parameters to determine SVI, CI, SpO 2 with esCCO technology (estimated continuous cardiac output), NIHON COHDEN; determination of transthyretin (TTR) with G-Biosciences/Geno Technology, (USA) kit. Data were recorded on the first day of MV (d1), on 3rd, 5th, 7th day of treatment (d 3 , d 5 , d 7 ). Logistic regression method was used to make a predictive model of the probability of unsuccessful weaning from MV. Results. We have established (formula 1), that the risk of unsuccessful weaning from MV in patients with hypoxemic ARF increases with low values of transthyretin serum level, right hemidiaphragm thickening fraction, SVI and high CI. R= -12,008 + 0,242*(TTR, ng/ml) + 1,720*(right hemidiaphragm thickening fraction, %) + 1,711*(SVI, ml/beat/m 2 ) – 3,120*(СІ, l/min/m 2 ) (1). The risk of unsuccessful weaning from MV in patients with hypercapnic-hypoxemic ARF (formula 2) increases with low values of transthyretin serum level, amplitude of left hemidiaphragm movement, SVI, SpO 2 /FiO 2 and transthyretin/C-reactive protein ratio. R= - 42,233 + 0,389*(TTR, ng/ml) + 22,189*(amplitude of left hemidiaphragm movement, mm) + 1,120*(SpO 2 /FiO 2 ) + 2,885*( SVI, ml/beat/m 2 ) + 14,944*(TTR/CRP) (2). Conclusions. The level of transthyretin and SVI in addition to the indicators of thickening fraction of right hemidiaphragm and CI in children with hypoxemic ARF and the amplitude of left hemidiaphragm movements, ratios SpO 2 /FiO 2 and transthyretin/C-reactive protein in children with hypercapnic-hypoxemic ARF might affect the process of weaning from MV. Thus, acute malnutrition with diaphragmatic dysfunction and hyperdynamic type of blood circulation reduce the likelihood of successful weaning from MV and worsen clinical outcome in children with different types of ARF","PeriodicalId":21672,"journal":{"name":"ScienceRise: Medical Science","volume":"597 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88685066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-30DOI: 10.15587/2519-4798.2020.213906
Oleksandr Pyetkov, I. Polivenok, Yuri Skibo, V. Boyko
Reducing surgical trauma is one of the obvious ways of reducing perioperative risks and improving surgical techniques, which is also very positively perceived by patients. Hybrid coronary revascularization (HCR) is one of the ways of minimizing surgical trauma during coronary revascularization. Objectives: to note the tactical and technical aspects of the minimally invasive left internal mammary artery-left anterior descending artery bypass (mini-LIMA-LAD) and HCR, which allow benefiting from these techniques of myocardial revascularization over the traditional ones. Materials and methods: Between 2011 and 2019, 39 mini-LIMA-LAD operations were performed at the SI “V. T. Zaycev IGUS NAMSU”. The average age of patients was 60.6±8.2 years, 5 (13 %) of patients were female. In nine patients mini-LIMA-LAD was the first (in eight) or second (in one) stage of the planned HCR. Results and discussion: There were no perioperative deaths, myocardial infarctions or conversions. At a median follow-up time of 49.5 [Q1; Q3: 34.3; 70.6] months one patient died 13 months after surgery. Four patients had angina recurrences at different times. The article discusses the tactical and technical aspects of mini-LIMA-LAD and HCR, which allow benefiting from these techniques of myocardial revascularization over the traditional ones. Conclusions : Mini-LIMA-LAD and HCR on its basis are a low-traumatic alternative to traditional coronary bypass through sternotomy with acceptable early and long-term results. They have a much better cosmetic effect, especially for women, but are more demanding in surgical technique and tissue handling. The strategy of coronary revascularization described, unlike other less traumatic techniques, does not require expensive additional equipment and can be performed by regular means
{"title":"Tactical and technical aspects of minimally invasive left internal mammary artery – left anterior descending artery bypass and hybrid coronary revascularization on its basis","authors":"Oleksandr Pyetkov, I. Polivenok, Yuri Skibo, V. Boyko","doi":"10.15587/2519-4798.2020.213906","DOIUrl":"https://doi.org/10.15587/2519-4798.2020.213906","url":null,"abstract":"Reducing surgical trauma is one of the obvious ways of reducing perioperative risks and improving surgical techniques, which is also very positively perceived by patients. Hybrid coronary revascularization (HCR) is one of the ways of minimizing surgical trauma during coronary revascularization. Objectives: to note the tactical and technical aspects of the minimally invasive left internal mammary artery-left anterior descending artery bypass (mini-LIMA-LAD) and HCR, which allow benefiting from these techniques of myocardial revascularization over the traditional ones. Materials and methods: Between 2011 and 2019, 39 mini-LIMA-LAD operations were performed at the SI “V. T. Zaycev IGUS NAMSU”. The average age of patients was 60.6±8.2 years, 5 (13 %) of patients were female. In nine patients mini-LIMA-LAD was the first (in eight) or second (in one) stage of the planned HCR. Results and discussion: There were no perioperative deaths, myocardial infarctions or conversions. At a median follow-up time of 49.5 [Q1; Q3: 34.3; 70.6] months one patient died 13 months after surgery. Four patients had angina recurrences at different times. The article discusses the tactical and technical aspects of mini-LIMA-LAD and HCR, which allow benefiting from these techniques of myocardial revascularization over the traditional ones. Conclusions : Mini-LIMA-LAD and HCR on its basis are a low-traumatic alternative to traditional coronary bypass through sternotomy with acceptable early and long-term results. They have a much better cosmetic effect, especially for women, but are more demanding in surgical technique and tissue handling. The strategy of coronary revascularization described, unlike other less traumatic techniques, does not require expensive additional equipment and can be performed by regular means","PeriodicalId":21672,"journal":{"name":"ScienceRise: Medical Science","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84873552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-30DOI: 10.15587/2519-4798.2020.213516
K. Mykhnevych
The aim : to study the energy parameters of the circulatory system in heart failure in patients with acute coronary syndrome (ACS) against the background of coronary artery bypass grafting (CABG), depending on the degree of myocardial contractility decrease. Materials and methods . In 48 patients with ACS in the perioperative period energy parameters of blood circulation have been determined: flow power (FP), oxygen reserve (OR) and circulatory reserve (CR). FP reflects the useful power of the myocardium, OR – the correspondence of oxygen absorption by tissues to their needs, CR is an integral energy parameter. Patients have been divided into 2 groups: group CF1 (n = 18) – patients with an ejection fraction (EF) of less than 40 %, group CF2 (n = 30) – patients with EF of at least 40 %. The same treatment has been performed in both groups. Results . The initial energy parameters of circulation were significantly reduced, more so in the CF1 group. During treatment, FP, OR, and CR in the CF1 group increased more slowly than in the CF2 group, and remained significantly lower by the end of the study. The initial CR was highly correlated with the need for dobutamine, the duration of postoperative artificial blood circulation, and postoperative mechanical ventilation, so CR can also be used as a predictive criterion. Conclusions . Determination of energy indicators of blood circulation allows you to fully assess the state of the circulatory system, predict the course of its insufficiency and monitor the effectiveness of its treatment. The severe decrease in myocardial contractility, accompanied by a decrease in the EF to 40 % or lower, slows down the recovery of energy parameters of circulation and requires the search for more effective methods of intensive therapy
{"title":"Energy of blood circulation in primary reduction of myocardial contractility","authors":"K. Mykhnevych","doi":"10.15587/2519-4798.2020.213516","DOIUrl":"https://doi.org/10.15587/2519-4798.2020.213516","url":null,"abstract":"The aim : to study the energy parameters of the circulatory system in heart failure in patients with acute coronary syndrome (ACS) against the background of coronary artery bypass grafting (CABG), depending on the degree of myocardial contractility decrease. Materials and methods . In 48 patients with ACS in the perioperative period energy parameters of blood circulation have been determined: flow power (FP), oxygen reserve (OR) and circulatory reserve (CR). FP reflects the useful power of the myocardium, OR – the correspondence of oxygen absorption by tissues to their needs, CR is an integral energy parameter. Patients have been divided into 2 groups: group CF1 (n = 18) – patients with an ejection fraction (EF) of less than 40 %, group CF2 (n = 30) – patients with EF of at least 40 %. The same treatment has been performed in both groups. Results . The initial energy parameters of circulation were significantly reduced, more so in the CF1 group. During treatment, FP, OR, and CR in the CF1 group increased more slowly than in the CF2 group, and remained significantly lower by the end of the study. The initial CR was highly correlated with the need for dobutamine, the duration of postoperative artificial blood circulation, and postoperative mechanical ventilation, so CR can also be used as a predictive criterion. Conclusions . Determination of energy indicators of blood circulation allows you to fully assess the state of the circulatory system, predict the course of its insufficiency and monitor the effectiveness of its treatment. The severe decrease in myocardial contractility, accompanied by a decrease in the EF to 40 % or lower, slows down the recovery of energy parameters of circulation and requires the search for more effective methods of intensive therapy","PeriodicalId":21672,"journal":{"name":"ScienceRise: Medical Science","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81853787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-30DOI: 10.15587/2519-4798.2020.213126
O. Pavlova
Methotrexate (MTX) is a cornerstone of therapy worldwide for juvenile idiopathic arthritis (JIA). Despite the fact that fibrosis molecular mechanisms as well as MTX elimination and fibrosis indexes were studied a lot there is still not enough information for adolescence. The aim was to study dynamics of molecular-cellular mechanisms activation of fibrotic processes development in the liver in adolescents with juvenile idiopathic arthritis treated with methotrexate by determining the content of fibroblast growth factor and hepatocyte growth factor. Materials and methods: A total of 68 children with juvenile idiopathic arthritis, were enrolled in the study. 25 boys (36.8 %) and 43 girls (63.2 %) were examined. Children were divided into four groups in accordance with cumulative dose (CD) of methotrexate. The following data were analyzed: liver function tests (aspartate aminotransferase (AST) (U/L), alanylaminotransferase (ALT) (U/L)), lactate dehydrogenase (LDH) (U/L), adiponectin (μg / ml), BFGF (pg / ml), HGF (pg / ml), liver fibrosis indexes APRI and FIB-4 Score. Results. Positive effect of JIA treatment with MTX on the liver is noted. When CD MTX reaches 1 and3 grams, liver state studying is needed. When the CD MTX of1 gram is reached, regulatory mechanisms are involved that provoke liver regeneration. When the CD MTX reaches3 grams, the liver condition may deteriorate, which in the future can lead to irreversible processes of liver fibrosis. Conclusions : Thus, it is important to control possible liver disorders in adolescence treated with MTX. Monitoring the processes of liver fibrosis is appropriate at all stages of JIA treatment, but it is most advisable when the MTX cumulative dose is reaching 1 and3 grams
{"title":"Fibroblast growth factor and hepatocyte growth factor in adolescents with juvenile idiopathic arthritis treated with methotrexate","authors":"O. Pavlova","doi":"10.15587/2519-4798.2020.213126","DOIUrl":"https://doi.org/10.15587/2519-4798.2020.213126","url":null,"abstract":"Methotrexate (MTX) is a cornerstone of therapy worldwide for juvenile idiopathic arthritis (JIA). Despite the fact that fibrosis molecular mechanisms as well as MTX elimination and fibrosis indexes were studied a lot there is still not enough information for adolescence. The aim was to study dynamics of molecular-cellular mechanisms activation of fibrotic processes development in the liver in adolescents with juvenile idiopathic arthritis treated with methotrexate by determining the content of fibroblast growth factor and hepatocyte growth factor. Materials and methods: A total of 68 children with juvenile idiopathic arthritis, were enrolled in the study. 25 boys (36.8 %) and 43 girls (63.2 %) were examined. Children were divided into four groups in accordance with cumulative dose (CD) of methotrexate. The following data were analyzed: liver function tests (aspartate aminotransferase (AST) (U/L), alanylaminotransferase (ALT) (U/L)), lactate dehydrogenase (LDH) (U/L), adiponectin (μg / ml), BFGF (pg / ml), HGF (pg / ml), liver fibrosis indexes APRI and FIB-4 Score. Results. Positive effect of JIA treatment with MTX on the liver is noted. When CD MTX reaches 1 and3 grams, liver state studying is needed. When the CD MTX of1 gram is reached, regulatory mechanisms are involved that provoke liver regeneration. When the CD MTX reaches3 grams, the liver condition may deteriorate, which in the future can lead to irreversible processes of liver fibrosis. Conclusions : Thus, it is important to control possible liver disorders in adolescence treated with MTX. Monitoring the processes of liver fibrosis is appropriate at all stages of JIA treatment, but it is most advisable when the MTX cumulative dose is reaching 1 and3 grams","PeriodicalId":21672,"journal":{"name":"ScienceRise: Medical Science","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89577096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-30DOI: 10.15587/2519-4798.2020.213104
V. Skoryk, V. Korsunov
Hypoxemic respiratory failure (HRF) or acute respiratory distress syndrome is the most common and severe complication in patients with COVID-19, requiring oxygen and ventilation support. Non-invasive ventilation methods (NIV) allow to maintain adequate oxygenation in patients with HRF, but it remains unclear which NIV regimen is more effective for reducing the need for invasive ventilation and improving outcomes. The aim. To compare the effect of different non-invasive lung ventilation strategies, namely CPAP+PSV and CPAP without PSV on the results of intensive care of patients with HRF caused by SARS-nCoV-2 (COVID-19). Materials and methods. A prospective single-center study of 59 patients with severe SARS-nCoV-2 (COVID-19) with HRF was performed. Depending on the type of NIV, patients were divided into two groups: in patients of group 1 (n=46) respiratory support was performed in CPAP mode without PSV, in patients of group 2 (n=13) - CPAP+PSV. All patients underwent clinical blood tests, biochemical studies aimed at assessing the severity of COVID-19, visualization of lung tissue (chest radiography, ultrasound to determine the profile of B and C), monitoring of gas exchange, echocardiography to assess the state of central hemodynamics. Statistical analysis of the results was performed using the program “Statistica 10”. Estimated mean values, standard deviation. The relative risk (RR) of adverse events was assessed. Results. The use of CPAP without PSV improves the results of intensive care of patients with severe coronavirus disease with the development of HRF. Conclusions. CPAP NIV is a promising method of respiratory support in patients with moderate to severe ARDS caused by SARS-nCoV-2 virus (COVID-19), which needs further study
{"title":"Effect of different variants of non-invasive ventilation on the course and outcomes in patients with hypoxemic respiratory failure caused by SARS-nCoV-2 ( COVID-19)","authors":"V. Skoryk, V. Korsunov","doi":"10.15587/2519-4798.2020.213104","DOIUrl":"https://doi.org/10.15587/2519-4798.2020.213104","url":null,"abstract":"Hypoxemic respiratory failure (HRF) or acute respiratory distress syndrome is the most common and severe complication in patients with COVID-19, requiring oxygen and ventilation support. Non-invasive ventilation methods (NIV) allow to maintain adequate oxygenation in patients with HRF, but it remains unclear which NIV regimen is more effective for reducing the need for invasive ventilation and improving outcomes. The aim. To compare the effect of different non-invasive lung ventilation strategies, namely CPAP+PSV and CPAP without PSV on the results of intensive care of patients with HRF caused by SARS-nCoV-2 (COVID-19). Materials and methods. A prospective single-center study of 59 patients with severe SARS-nCoV-2 (COVID-19) with HRF was performed. Depending on the type of NIV, patients were divided into two groups: in patients of group 1 (n=46) respiratory support was performed in CPAP mode without PSV, in patients of group 2 (n=13) - CPAP+PSV. All patients underwent clinical blood tests, biochemical studies aimed at assessing the severity of COVID-19, visualization of lung tissue (chest radiography, ultrasound to determine the profile of B and C), monitoring of gas exchange, echocardiography to assess the state of central hemodynamics. Statistical analysis of the results was performed using the program “Statistica 10”. Estimated mean values, standard deviation. The relative risk (RR) of adverse events was assessed. Results. The use of CPAP without PSV improves the results of intensive care of patients with severe coronavirus disease with the development of HRF. Conclusions. CPAP NIV is a promising method of respiratory support in patients with moderate to severe ARDS caused by SARS-nCoV-2 virus (COVID-19), which needs further study","PeriodicalId":21672,"journal":{"name":"ScienceRise: Medical Science","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86034489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-31DOI: 10.15587/2519-4798.2020.208987
O. Grishchenko, Svitlana Korovay, Sevindzh Shahin Kizi Mamedova
In the structure of labour, the frequency of caesarean section should not exceed 15%. Therefore, it is extremely important to clearly define clinical situations in which caesarean section can be abandoned and, conversely, identify pregnant women in whom it is advisable to plan a caesarean section to prevent urgent situations. The aim of the study was to study the structure of indications for emergency abdominal delivery in a level III medical department - the urban perinatal center of Kharkov to optimize childbirth tactics. Material and methods. Clinical and statistical analysis of pregnancy and childbirth histories of 550 women in labour who gave birth in the Kharkov city perinatal center during 2018-2019 was performed. The structure of the indications and the caesarean section frequency was analysed depending on clinical and anamnestic data using descriptive statistics methods, χ 2 criterion and calculation of the odds ratio (OR) using the PSSР statistical software package. Results . The highest OR values were in diabetes mellitus, burdened gynecological history and cardiovascular diseases (OR more than 5.0). Gestational hypertension, first labour, genital tract infections, nervous system diseases, preeclampsia, obesity of the digestive system diseases, large fetus and vegetative-vascular dystonia (OR from 2.108 to 4.113) had a lesser effect, myopia, first pregnancy, and late reproductive age (OR from 1.619 to 1.958). Conclusion . The most common causes of emergency caesarean section were weak labour (29.5%) and fetal distress (13.2%). In 20.9% of women - concomitant diseases of the mother and large fetus. Indications for emergency caesarean section most often occurred in women in labour with diabetes mellitus, weighed down by a gynecological history and with cardiovascular diseases
{"title":"Cesarean section in the perinatal center of iii level - indications and risk factors","authors":"O. Grishchenko, Svitlana Korovay, Sevindzh Shahin Kizi Mamedova","doi":"10.15587/2519-4798.2020.208987","DOIUrl":"https://doi.org/10.15587/2519-4798.2020.208987","url":null,"abstract":"In the structure of labour, the frequency of caesarean section should not exceed 15%. Therefore, it is extremely important to clearly define clinical situations in which caesarean section can be abandoned and, conversely, identify pregnant women in whom it is advisable to plan a caesarean section to prevent urgent situations. The aim of the study was to study the structure of indications for emergency abdominal delivery in a level III medical department - the urban perinatal center of Kharkov to optimize childbirth tactics. Material and methods. Clinical and statistical analysis of pregnancy and childbirth histories of 550 women in labour who gave birth in the Kharkov city perinatal center during 2018-2019 was performed. The structure of the indications and the caesarean section frequency was analysed depending on clinical and anamnestic data using descriptive statistics methods, χ 2 criterion and calculation of the odds ratio (OR) using the PSSР statistical software package. Results . The highest OR values were in diabetes mellitus, burdened gynecological history and cardiovascular diseases (OR more than 5.0). Gestational hypertension, first labour, genital tract infections, nervous system diseases, preeclampsia, obesity of the digestive system diseases, large fetus and vegetative-vascular dystonia (OR from 2.108 to 4.113) had a lesser effect, myopia, first pregnancy, and late reproductive age (OR from 1.619 to 1.958). Conclusion . The most common causes of emergency caesarean section were weak labour (29.5%) and fetal distress (13.2%). In 20.9% of women - concomitant diseases of the mother and large fetus. Indications for emergency caesarean section most often occurred in women in labour with diabetes mellitus, weighed down by a gynecological history and with cardiovascular diseases","PeriodicalId":21672,"journal":{"name":"ScienceRise: Medical Science","volume":"130 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73513412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-31DOI: 10.15587/2519-4798.2020.203968
G. Voinarovska, E. Asanov
The aim. To review the current literature to study the prevalence and early diagnosis of the combined course of ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD).Results. The combination of IHD and COPD is one of the common comorbid conditions, especially in older age. With this mixed pathology, the course of both coronary heart disease and COPD worsens and the risk of adverse events increases. Diagnostic-treatment and rehabilitation programs in combination with coronary heart disease and COPD complication. This requires a comprehensive approach and consideration of the pathogenesis features of each disease. In coronary heart disease, especially in older age, diagnostic measures should include targeted detection of COPD and vice versa.Conclusions. Despite numerous studies of the IHD-COPD tandem, the issues of prevalence, course, and life expectancy in older patients with this comorbid pathology have not been adequately addressed. Causes of comorbidity are common features of pathogenesis, clinical symptoms and risk factors. At the same time, the combination of coronary heart disease and COPD raises debating questions about diagnosis, treatment and rehabilitation, especially in the elderly and aging. It is in this direction that the focus of future research on the combination of IHD and COPD should be directed. Purposeful study will help to develop directions for correction, prognosis and prevention of this comorbid pathology, especially in elderly patients
{"title":"Ischemic heart disease and chronic obstructive pulmonary disease: the topical problem of comorbidity in internal medicine","authors":"G. Voinarovska, E. Asanov","doi":"10.15587/2519-4798.2020.203968","DOIUrl":"https://doi.org/10.15587/2519-4798.2020.203968","url":null,"abstract":"The aim. To review the current literature to study the prevalence and early diagnosis of the combined course of ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD).Results. The combination of IHD and COPD is one of the common comorbid conditions, especially in older age. With this mixed pathology, the course of both coronary heart disease and COPD worsens and the risk of adverse events increases. Diagnostic-treatment and rehabilitation programs in combination with coronary heart disease and COPD complication. This requires a comprehensive approach and consideration of the pathogenesis features of each disease. In coronary heart disease, especially in older age, diagnostic measures should include targeted detection of COPD and vice versa.Conclusions. Despite numerous studies of the IHD-COPD tandem, the issues of prevalence, course, and life expectancy in older patients with this comorbid pathology have not been adequately addressed. Causes of comorbidity are common features of pathogenesis, clinical symptoms and risk factors. At the same time, the combination of coronary heart disease and COPD raises debating questions about diagnosis, treatment and rehabilitation, especially in the elderly and aging. It is in this direction that the focus of future research on the combination of IHD and COPD should be directed. Purposeful study will help to develop directions for correction, prognosis and prevention of this comorbid pathology, especially in elderly patients","PeriodicalId":21672,"journal":{"name":"ScienceRise: Medical Science","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73638495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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