Wiadomosci lekarskie最新文献

Objective: Aim: To determine the effect of the developed complex treatment of patients with peritonitis on the dynamics of humoral factors of nonspecific reactivity in the course of the disease.

Patients and methods: Materials and Methods: The study included 124 patients with toxic and terminal stages of peritonitis, who were divided into 3 groups. Group I (main) included 39 patients whose complex treatment included cytochrome C. Group II (main) included 41 patients whose complex treatment included cytochrome C and a solution containing levocarnitine and arginine hydrochloride. The comparison group comprised 44 patients who did not receive the specified drugs. The patients underwent determination of the levels of fibronectin, ceruloplasmin, and procalcitonin in the serum during the course of the disease.

Results: Results: In patients of the I and II main groups, the use of the proposed treatment contributed to the optimization of the production of acute phase proteins: a decrease in procalcitonin production during the study, optimization of ceruloplasmin and fibronectin production, especially in the II main group. In patients of the comparison group, decompensation in the production of humoral inflammatory factors was determined, associated with a significant increase in fibronectin production, a decrease in ceruloplasmin content, and an increase in procalcitonin throughout the entire period.

Conclusion: Conclusions: The use of cytochrome C and a solution containing levocarnitine and arginine hydrochloride in the complex treatment of patients with disseminated peritonitis helps to optimize the production of acute phase proteins, which leads to a decrease in inflammation and the preservation of factors of nonspecific humoral activity at a subcompensated level.

Objective: Aim: The purpose was to identify the morphological and functional features of the colonic mucus barrier in patients with symptomatic uncomplicated diverticular disease and acute uncomplicated diverticulitis.

Patients and methods: Materials and Methods: In the research, three groups were formed. Group 1 included fragments of the mucous membrane of the large intestine, which were collected from 12 people during autopsies. The results of autopsies and histological examination of the material did not reveal any gastrointestinal pathology. Group 2 included biopsies of the mucous membrane of the large intestine from the area of the diverticulum of 34 patients with symptomatic uncomplicated diverticular disease. Group 3 included biopsies of the mucous membrane of the large intestine of 26 patients with acute uncomplicated diverticulitis. Histological (hematoxylin and eosin staining), histochemical (PAS reaction) and immunohistochemical (mouse monoclonal antibodies to Mucin 2 (MUC2) and Mucin 4 (MUC4)) staining methods were used. A morphometric study was also carried out.

Results: Results: In patients with diverticular disease, the authors identified disturbances in the morphofunctional state of the mucus barrier of the colon, the structure and function of goblet cells contained in its mucous membrane, characterized by a decrease in the thickness of the mucus layer covering the surface of the mucous membrane; a decrease in the size and number of goblet cells with a decrease in their mucus-producing ability; a change in the mucin profile, characterized by a violation of the content of MUC2 and MUC4. These changes were greatest in patients with acute uncomplicated diverticulitis compared with patients with symptomatic uncomplicated diverticular disease.

Conclusion: Conclusions: The identified disturbances in the morphofunctional state of the mucus barrier of the colon, structural and functional changes in goblet cells may be one of the mechanisms for the development of acute uncomplicated diverticulitis and symptomatic uncomplicated diverticular disease.

Objective: Aim: To establish the peculiarities of the hormonal background in women with abnormal uterine bleeding and extragenital disorders.

Patients and methods: Materials and Methods: The study involved examination of 100 women of reproductive age with concomitant ED and AUB (MG). CG included 50 healthy women. MG women were additionally divided into subgroups depending on the detected pathological changes in the uterine cavity. When examining the hormonal status, concentrations of FSH, LH, estradiol, progesterone, and leptin in BS were determined. Additionally, the level of 25-hydroxyvitamin D ((25-OH) D) was determined.

Results: Results: The decrease in FSH level in subgroups of GP, PSL, EH, EHL was 1.8-2.4 times (KWT, p<0.01). LH in BS of MG patients was statistically lower than that of CG patients (MWT, p=0.0083). The lowest level of LH was registered in patients with EHL, which was 2 times lower than this indicator in CG. A statistically significant increase in the level of estradiol was registered in 73% of MG patients (MWT, p=0.044). The lowest level of progesterone was registered in patients with EHL - 8.40, which is 4.7 times lower than in CG (MWT, p=0.0021). A statistically significant increase in the level of leptin in BS was observed in MG patients (KWT, p=0.0021). The highest level of leptin was found in women with AFP, 2.3 times higher than CG indicators. A statistically significant correlation between the level of leptin and BMI (r=0.86, p=0.011) and a statistically significant (p=0.023) correlation between the level of leptin and estradiol in BS of patients of the examined groups (r=0.42) were revealed. In 87% of MG women, vitamin D deficiency was observed in BS (KWT, p=0.03). A statistically significant (p=0.01) negative correlation between the level of estradiol and vitamin D in the BS of female patients was revealed (r=-0.61, p=0.01).

Conclusion: Conclusions: Women of reproductive age with AUB and ED were found to have disorders in the hypothalamic-pituitary-ovarian system. Most patients are characterized by an elevated level of leptin, the concentration of which is closely correlated with BMI, and an elevated level of estradiol is correlated with the level of vitamin D.

Objective: Aim: To study the impact of bariatric interventions on changes in the parameters of the intestinal microbiome.

Patients and methods: Materials and Methods: The research method is a prospective observational cohort monocentric study. 112 patients were included in the study. All patients had indications for surgical obesity treatment due to IFSO criteria. All patients were offered surgical treatment. 53 patients who consented to the operation formed the study group. 59 patients who refused surgical treatment formed the control group. The result of the study was evaluated one year after the start of treatment. The studied group of patients underwent bariatric interventions. The control group consisted of 59 obese patients who were treated conservatively.

Results: Results: evaluating criteria was: %EWL (percentage of excess weight loss), comorbidity regression, life quality improvement. Overwhelming majority of surgically treated patients with gut microbiome composition improvement reached %EWL≥50. Patients who didn't have improvements in gut microbiota composition had insufficient efficacy of surgical treatment.

Conclusion: Conclusions: 1) Surgical treatment of obesity leads to the positive changes in the gut microbiota. 2) Operated patients, who had positive dynamics in changes of gut microbiota demonstrated sufficient efficacy of surgical treatment due to %EWL. 3) Firmicutes/Bacteriodetes ratio and Bacterioidetes/Faecalibacterium ratio can be one of the criteria of the efficacy of surgical treatment of obesity. 4) Patients of the control group, had positive dynamics of changes in gut microbiota much rarely than operated patients and the effectiveness of obesity treatment was insufficient.

Objective: Aim: Type 2 diabetes mellitus (T2DM) is a widespread disease that leads to many complications if not adequately controlled. The pandemic and its limitations on healthcare access impaired the management of chronic conditions. The aim of our study was to examine its effects in context of different antidiabetic therapies on key health related factors in patients with T2DM.

Patients and methods: Materials and Methods: To the study we enrolled 598 adult patients with diagnosed T2DM treated in diabetology outpatient department of the University Clinical Centre (UCC) of the Medical University of Warsaw. Data on body weight, glycated hemoglobin (HbA1c), and creatinine concentration were collected throughout the first COVID-19 pandemic wave and compared to the results obtained before the 4th of March, 2020 (1st confirmed COVID-19 case in Poland).

Results: Results: The HbA1c mean baseline level was 7.15% (±1.39) and increased significantly (7.34% (±1.37), p=0.02) during observation. Importantly, the attendance of patients for HbA1c testing decreased by 57.82% in comparison to the pre-pandemic period. Similarly, creatinine concentrations increased (from 1.27 mg/dl (±0.76) to 1.34 mg/dl (±1.02), (p=0.004)). The increase in creatinine concentration was significantly lower in the group treated with regimens including metformin compared to other regimens. Somewhat surprisingly, the mean body mass remained unchanged.

Conclusion: Conclusions: The pandemic period had a significant impact on the tested biochemical parameters. The lesser changes of renal parameters in the group of patients treated with metformin confirms its nephroprotective effect and its value as a first-line treatment in T2DM.

Objective: Aim: To assess the impact of BMI and diet control on variation in response to metformin monotherapy in Iraqi people with type 2 DM.

Patients and methods: Materials and Methods: a cross-sectional study included 150 patients who met specific criteria, such as being between 30 and 70 years old, diagnosed with type 2 diabetes, and on a daily dose of 1000 mg metformin as a monotherapy for at least three months. Data collected included body mass index (BMI) and glycemic control parameters such as: glycated hemoglobin (HbA1c) levels, fasting blood glucose levels, fasting serum insulin levels, HOMA-IR, and insulin sensitivity. The patients according to their metformin response classified into two groups based on HbA1c as following: poor (HbA1c≥6.5% and good (HbA1c≤6.5%) responder's patients.

Results: Results: The statistical analysis suggests that there is no meaningful distinction in glycemic control parameters when comparing good and poor responders within specific BMI subgroups and among individuals practicing diet control. However, in a broader context, it is evident that glycemic control parameters tend to be lower in patients with lower BMI and those who are following a controlled diet.

Conclusion: Conclusions: The correlation between diet control and BMI with glycemic control in diabetic patients, underscoring the significance of lifestyle adjustments in the management of diabetes.

Objective: Aim: To carry out a comprehensive evaluation of treatment modification for patients with seasonal allergic rhinitis (SAR) complicated by anxiety-neurotic disorders.

Patients and methods: Materials and Methods: Patients with SAR in the acute stage on the background of anxiety disorders were studied. Immunological studies were carried out, an assessment of the dynamics of indicators of the quality of life of patients, the level of anxiety / depression was assessed. In the clinical group, a variant of therapy modification was proposed.

Results: Results: Significant changes in the subpopulation ratio of lymphocytes, an increase in the immunoregulatory index, which indicated the severity of the immunological process, were revealed in SAR patients in the acute stage against the background of anxiety disorders. At the same time, a significant activation of the humoral link of immunity was observed: an increase and a significant increase in IgE in the blood serum and an increase in the content of sIgA in the nasal secretion. In most patients, eosinophilia was found in the peripheral blood and in the rhinocytogram before treatment. In the study of the quality of life of patients, changes in many parameters were found.

Conclusion: Conclusions: The combination of "Nazafort Allergy Protection" and Atarax seems to be the most successful, which significantly improved the physical and psycho-emotional state of patients with SAR, complicated by anxiety and neurotic disorders. This combination led to an increase in the stress resistance of patients.

Objective: Aim: To investigate the effect of ivabradine on the hemodynamics and contractility of the myocardium and the features of NT-pro-BNP production in patients with stable ischemic heart disease after endovascular revascularization of the myocardium depending on the number of affected coronary arteries during 12 months of therapy.

Patients and methods: Materials and Methods: The object of the study was 120 patients with stable coronary artery disease: angina pectoris of functional class III with heart failure IIA FC III with preserved and moderately reduced ejection fraction of the left ventricle, who underwent coronary artery stenting. The examined patients were randomized according to the number of affected coronary vessels and the method of treatment.

Results: Results: Ivabradine in patients with stable ischemic heart disease after 12 months of therapy had a significant beneficial effect on the structural and functional parameters of the myocardium (contributed to the reverse remodeling of the left ventricle), which did not depend on the number of stented coronary arteries (p<0.05). In patients with stented one coronary artery, all structural and functional indicators of the heart after 12 months of treatment reached the values of practically healthy individuals from the control group. The use of ivabradine in patients with stable ischemic heart disease with heart failure with preserved and intermediate ejection fraction of the left ventricle after coronary stenting made it possible to ensure the correction of a number of clinical and pathogenetic links of the disease, which generally contributed to the improvement of metric and volumetric parameters of the heart.

Conclusion: Conclusions: Ivabradine made it possible to significantly increase the effectiveness of standard therapy, which was manifested by a faster recovery of the geometry and contractility of the left ventricle. Therefore, the use of ivabradine along with standard therapy was appropriate for such a contingent of patients. The management of patients with stable coronary heart disease should combine adequate (surgical and pharmacological) treatment of the underlying disease, further individual medication correction of symptoms and circulatory disorders inherent in coronary heart disease and heart failure.

Objective: Aim: To calculate the average score of situational anxiety level and compare the risk of developing cardiovascular complaints in higher education students from the country in the martial law and the country in peacetime according to the respondents' level of situational anxiety. To analyze the impact of place of residence on the frequency of complaints among students with an elevated level of situational anxiety in both countries.

Patients and methods: Materials and Methods: Descriptive and inferential statistics: cluster method, qualitative analysis method; exploratory observational analytical short-term case-control study. The State-Trait Anxiety Inventory (STAI) [1] questionnaire was used to calculate the situational anxiety level indicator. Calculations were conducted using Excel and MedStat software.

Results: Results: The research results demonstrated higher level of situational anxiety among students who belonged to higher educational institutions in the country under the martial law. The odds ratio is 0,42 (95% CІ 0,27-0,66), indicating that the elevated level of situational anxiety was encountered more frequently in the study group compared to the control group of students.

Conclusion: Conclusions: The average score of situational anxiety level was found to be higher among students from a country where the martial law has been implemented. The presence of the martial law in the country was identified as a factor associated with an increased risk of complaints from the cardiovascular system among students. The risk of developing cardiovascular complaints in the context of elevated situational anxiety is confirmed.

Objective: Aim: To determine the effectiveness of treatment of temporomandibular joints muscle and joint dysfunction with occlusive splints based on the analysis of axiography data.

Patients and methods: Materials and Methods: 274 (two hundred and seventy-four) patients aged 18 to 44 years with a diagnosis of temporomandibular joints dysfunction before and after treatment.

Results: Results: All patients with signs of temporomandibular joints dysfunction before treatment had a violation of the movement trajectory of the lower jaw: deviation - 68.7%, diflexion - 31.3%. When opening and closing the mouth, asymmetric shifts of the lower jaw of more than 2 mm were observed. After treatment with occlusive splints, the correct trajectory of opening and closing the mouth was noted: the number of patients with a trajectory violation decreased by 89.1%, and the amount of displacement of the lower jaw during opening and closing the mouth in 92.4% of patients decreased on average to 0.9 mm. When analyzing the movements of the lower jaw in the sagittal plane, deviations of the trajectory of the lower jaw were found in 79% of clinical cases. After the treatment using occlusive splints, 93.4% of cases of mandibular movement trajectory violations in the transversal plane were eliminated, and 78.1% of patients had a reduction in displacement volume to 0.9 mm. When analyzing the movements of the lower jaw in the sagittal plane, deviations of the trajectory of the lower jaw were found in 79% of clinical cases. After the treatment using occlusive splints, 93.4% of cases of mandibular movement trajectory violations in the transversal plane were eliminated, and 78.1% of patients had a reduction in displacement volume to 0.9 mm.

Conclusion: Conclusions: Movement trajectories of the lower jaw in the sagittal plane improved in 80.1% of patients, normalization of the position of the lower jaw in relation to the neuromuscular trajectory was achieved in 93.4% of clinical cases. According to the analysis of the parameters, this treatment should be considered effective.