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GENDER DIFFERENCES IN THE EFFECT OF ANTIULCER DRUGS AND PLACENTA CRYOEXTRACT ON THE INTENSITY OF LIPID PEROXIDATION AND THE ACTIVITY OF THE ANTIOXIDANT SYSTEM IN EXPERIMENTAL HEPATITIS WITH ETHANOL-INDUCED CIRRHOSIS 抗溃疡药物和胎盘冷冻提取物对实验性肝炎酒精性肝硬化脂质过氧化强度和抗氧化系统活性影响的性别差异
Pub Date : 2023-09-30 DOI: 10.31612/2616-4868.4(26).2023.15
Illia V. Koshurba, Fedir V. Hladkykh, Mykola O. Chyzh, Mykhailo M. Marchenko, Yurii V. Koshurba, Volodymyr B. Hrishyn
Introduction. It is well recognized that drug metabolism products in the liver can induce oxidative stress and mitochondrial dysfunction, leading to the development of hepatocellular injury. As a potential agent capable of counteracting the hepatotoxic effects of drugs, we focused our attention on a domestic biotechnological preparation – cryopreserved placental extract (CPE). The aim. To characterize gender differences in the effect of esomeprazole, clarithromycin, metronidazole (E/C/M), and CPE on the intensity of lipid peroxidation and the activity of the antioxidant system in tetrachloromethane (CCl4) hepatitis with a background of ethanol-induced cirrhosis (ETCM). Materials and methods. The study was conducted with varying levels of sex hormones on 112 male and female rats. Chronic ETCM was induced by administering a 50.0% oil solution of CCl4 at a dose of 8 ml/kg body weight of the animals twice a week, in combination with a 5.0% ethanol solution for drinking over a period of 45 days. The content of TBA-RP in liver homogenates was determined spectrophotometrically by the method described by Asakawa T. et al. Catalase activity in liver homogenates was determined spectrophotometrically according to the method of Korolyuk M.A. and co-authors. Results. The most pronounced increase in lipid peroxidation processes was observed in females with chronic ETCM-induced liver damage and administration of antiulcer drugs following ovariectomy, resulting in a TBA-RS content of 36.1±2.79 μmol/kg of tissue. Administration of E/C/M in animals with chronic liver damage led to a suppression of the antioxidant system, as evidenced by a decrease in catalase activity in liver tissues. Conclusion. The combined use of anti-ulcer drugs and CPE on the background of chronic ETCM mitigated the activation of lipid peroxidation processes, which was indicated by a statistically significant (p < 0.001) 2.7-fold lower content of TBA-RP in liver homogenates. Additionally, it was established that the administration of CPE was accompanied by a statistically significant increase in catalase activity in females, more prominently than in males. In females without changes in hormonal status, the introduction of CPE resulted in a growth (p < 0.001) of catalase activity by 75.0%, with the most significant increase observed in females after ovariectomy – catalase activity statistically significantly (p < 0.001) increased by 2.6 times compared to the indicators of females not administered with CPE. The administration of CPE in female rats without altering hormonal status was accompanied by a twofold (p < 0.01) increase in the antioxidant-prooxidant index compared to male rats, indicating more pronounced antioxidant properties of CPE in female rats.
介绍。肝脏内的药物代谢产物可诱导氧化应激和线粒体功能障碍,从而导致肝细胞损伤的发生。作为一种潜在的能够对抗药物肝毒性作用的药物,我们将注意力集中在国内的生物技术制剂-胎盘提取物(CPE)上。的目标。探讨埃索美拉唑、克拉霉素、甲硝唑(E/C/M)和CPE对四氯甲烷(CCl4)型肝炎伴乙醇性肝硬化(ETCM)患者脂质过氧化强度和抗氧化系统活性影响的性别差异。 材料和方法。研究人员对112只雄性和雌性老鼠进行了不同水平的性激素测试。采用50.0%的CCl4油溶液(剂量为8 ml/kg体重),每周2次,与5.0%乙醇溶液联合饮用,连续45天诱导慢性ETCM。采用Asakawa等人描述的分光光度法测定肝脏匀浆中TBA-RP的含量。采用分光光度法测定肝脏匀浆中过氧化氢酶活性,方法采用Korolyuk ma . 结果。在卵巢切除术后,慢性etcm诱导的肝损伤和服用抗溃疡药物的女性中,脂质过氧化过程的增加最为明显,导致TBA-RS含量为36.1±2.79 μmol/kg。慢性肝损伤动物服用E/C/M可抑制抗氧化系统,肝组织过氧化氢酶活性降低。结论。慢性ETCM背景下联合使用抗溃疡药物和CPE减轻了脂质过氧化过程的激活,这一结果有统计学意义(p <0.001)肝脏匀浆中TBA-RP含量降低2.7倍。此外,研究还发现,服用CPE后,女性过氧化氢酶活性显著升高,且明显高于男性。在激素状态没有变化的女性中,CPE的引入导致了生长(p <0.001),过氧化氢酶活性提高了75.0%,其中女性卵巢切除术后过氧化氢酶活性的提高最为显著——有统计学意义(p <0.001),与未接受CPE治疗的女性相比,这些指标增加了2.6倍。在不改变激素状态的情况下,雌性大鼠服用CPE可伴发两倍(p <0.01),与雄性大鼠相比,抗氧化-促氧化指数增加,表明CPE在雌性大鼠中具有更明显的抗氧化特性。
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引用次数: 0
GUT MICROBIOTA AND CARDIOMETABOLIC RISK FACTORS IN CORONARY ARTERY DISEASE PATIENTS WITH ATRIAL FIBRILLATION 冠状动脉疾病合并心房颤动患者的肠道微生物群和心脏代谢危险因素
Pub Date : 2023-09-30 DOI: 10.31612/2616-4868.4(26).2023.09
Iryna O. Melnychuk
The aim: To estimate gut microbiota composition peculiarities in patients with coronary artery disease (CAD) and atrial fibrillation (AF) and to evaluate their connections with known cardiometabolic risk factors (CRF). Materials and methods: 300 patients formed 3 groups: I group – 149 CAD patients without rhythm disorders, II group – 124 patients with CAD and AF paroxysm and control group (CG) – 27 patients without CAD and arrhythmias. 16-S rRNA sequencing checked gut microbiota composition. CRF which was explored are total cholesterol (TC), triglycerides (TG), low density lipoproteins (LDL), high density lipoproteins (HDL), lipoprotein α (Lpα), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), C-reactive protein (CRP), interleukin-6 (IL-6), trymetilamine (TMA) and trymetilamine-N-oxide (TMAO). Results: The significant changes of gut microbiota composition were found in CAD patients with AF paroxysm in comparison with CAD patients without arrythmia as increasing Actinomycetota phulum (P<0.05); increasing Actinobacter Spp. and decreasing Blautia Spp., Roseburia Inulinivorans, Bacteroides Thetaiotaomicron (P<0.05). Moreover, Actinobacter Spp., Akkermansia Muciniphila, Streptococcus Spp., Bacteroides Thetaiotaomicron, Bifidobacterium Spp. have the highest amount of significant correlations with CRF (body mass index, LDL levels; P<0.05). By the ROC-analysis we found the acceptable role of Lactobacillus Spp., Bifidobacterium Spp., Bacteroides Thetaiotaomicron, Blautia Spp., Actinobacter Spp. and Eubacterium Rectale in AF paroxysm occurrence in CAD patients (area under ROC-curve (AUC)<0.7). We found gut microbiota combinations with highest AUC for AF paroxysm in CAD patient: all of them include Actinobacter Spp (Actinobacter Spp. + 0.32 * Streptococcus Spp., AUC = 0.9008; 1.56 * Actinobacter Spp. – Blautia Spp., AUC = 0.9008;1.84 * Actinobacter Spp. – Akkermansia Muciniphila, AUC = 0.9008). AF paroxysm duration in CAD patients depends of plasma IL-6, TMAO, fecal Actinobacter Spp. and Akkermansia Muciniphila by the linear multifactorial regression analysis (AF paroxysm duration = 0.68*(Actinobacter Spp., lg/CFU/ml) – 3.33*(Akkermansia Muciniphila, lg/CFU/ml) – 0.6*IL6 – 0.34*TMAO – 0.98). Conclusions: Gut microbiota condition is closely connected with occurrence AF of paroxysm in CAD patients. To find out the new ways of gut microbiota and CRF correction will be interesting in future investigations.
目的:评估冠状动脉疾病(CAD)和心房颤动(AF)患者肠道微生物群组成的特殊性,并评估其与已知心脏代谢危险因素(CRF)的关系。材料与方法:300例患者分为3组:ⅰ组-无心律失常的CAD患者149例,ⅱ组-合并心律失常的CAD患者124例,对照组(CG) -无心律失常的CAD患者27例。16-S rRNA测序检查肠道微生物群组成。研究的CRF包括总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、脂蛋白α (Lpα)、载脂蛋白A1 (ApoA1)、载脂蛋白B (ApoB)、c反应蛋白(CRP)、白细胞介素6 (IL-6)、甲苯胺(TMA)和甲苯胺- n-氧化物(TMAO)。 结果:冠心病合并心房颤动发作患者的肠道菌群组成与非心律失常患者相比有显著变化:放线菌群数量增加(P<0.05);放线菌(Actinobacter Spp.)数量增加,蓝藻菌(Blautia Spp.)、红玫瑰菌(Roseburia Inulinivorans)、拟杆菌(Bacteroides Thetaiotaomicron)数量减少(P<0.05)。其中,放线菌、嗜粘杆菌、链球菌、拟杆菌、双歧杆菌与CRF(体重指数、LDL水平)的显著相关性最高;术中,0.05)。通过roc分析,我们发现乳酸杆菌、双歧杆菌、拟杆菌、蓝杆菌、放线菌和直肠真杆菌在冠心病患者房颤发作中的作用是可以接受的(roc曲线下面积(AUC)& 0.7)。我们发现CAD患者房颤发作AUC最高的肠道菌群组合为放线菌Spp(放线菌Spp + 0.32 *链球菌Spp, AUC = 0.9008;1.56 *放射线杆菌Spp. - Blautia Spp., AUC = 0.9008;1.84 *放射线杆菌Spp. - Akkermansia Muciniphila, AUC = 0.9008)。经多因素线性回归分析,冠心病患者房颤发作时间与血浆IL-6、TMAO、粪便放线菌和嗜粘杆菌有关(房颤发作时间= 0.68*(放线菌,lg/CFU/ml) - 3.33*(嗜粘杆菌,lg/CFU/ml) - 0.6*IL6 - 0.34*TMAO - 0.98)。 结论:冠心病患者发作性心房颤动的发生与肠道菌群状况密切相关。寻找肠道菌群和CRF校正的新途径将是今后研究的热点。
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引用次数: 0
DYNAMICS OF CHARACTERISTICS OF THE GLYCEMICAL PROFILE OF PATIENTS WITH CORONARY HEART DISEASE AND OBESITY AFTER TREATMENT 冠心病合并肥胖患者治疗后血糖特征的动态变化
Pub Date : 2023-09-30 DOI: 10.31612/2616-4868.4(26).2023.04
Olga V. Gridneva
Introduction. Cardiovascular diseases (CVD) have the status of an epidemic, as they have high levels of prevalence and are the main cause of disability and mortality both in Ukraine and in the world and cause a significant increase in health care costs. Among all CVDs, coronary heart disease (CHD) ranks first. Many studies confirm a high percentage of CHD among all CVDs, especially in comorbidity with hyperlipidemia and obesity. Therefore, when treating CHD disease with obesity, it is necessary to take into account the effectiveness of the applied pharmacological agents and determine the dynamics of pharmacological intervention. The aim. To determine the dynamics of indicators of the glycemic profile in the comorbid course of CHD and obesity after the treatment. Materials and methods. It was conducted a randomized controlled single-center prospective study case-control, which is based on the analysis of the results of 130 people aged 25–85 were examined, who were divided into 3 groups: 70 persons (main group) with CHD on the background of obesity and 35 people with isolated coronary artery disease (comparison group) and control group (25 practically healthy people). The studied groups were randomized by age and gender. Results. Before treatment, a probable predominance of daily glucose levels was determined in patients main group to the patients comparison group and controls. According to the results of the glucose tolerance test (GTT), an improbable excess of fasting glucose levels and after a glucose load was determined in CHD with obesity (respectively 5.64±1.92 and 7.08±2.25 mmol/l) compared to the isolated of CHD (respectively 5, 15±2.22 (p=0.791) and 6.20±3.15 (p=0.403) mmol/l) and control group (respectively 5.32±0.49 (p=0.685) and 5.42±0, 51 (p<0.001) mmol/l). After treatment, recovery of blood glucose levels was determined. Conclusions. It was established that the characteristics of the dynamics of glucose metabolism indicators can be used as an indicator of the effectiveness of the treatment in the comorbidity of obesity and CHD. The obtained results indicate that the characteristics of glucose metabolism in the comorbidity of CHD and obesity must be taken into account to ensure therapeutic and preventive measures.
介绍。心血管疾病具有流行病的地位,因为它们的发病率很高,是乌克兰和世界致残和死亡的主要原因,并导致保健费用大幅增加。在所有心血管疾病中,冠状动脉心脏疾病(CHD)排名第一。许多研究证实,冠心病在所有心血管疾病中所占比例很高,特别是与高脂血症和肥胖合并症。因此,在治疗冠心病合并肥胖时,需要考虑所应用药物的有效性,确定药物干预的动态。 的目标。探讨治疗后冠心病与肥胖共病过程中血糖指标的动态变化。 材料和方法。本研究采用随机对照、单中心前瞻性病例-对照研究方法,在对年龄在25 - 85岁之间的130人进行结果分析的基础上,将其分为3组:肥胖背景的冠心病患者70人(主组)、孤立性冠状动脉疾病患者35人(对照组)和对照组(实际健康人25人)。实验组按年龄和性别随机分组。 结果。在治疗前,确定患者主要组的每日血糖水平可能高于患者对照组和对照组。葡萄糖耐量试验(GTT)结果显示,与冠心病分离组(5.15±2.22 (p=0.791)和6.20±3.15 (p=0.403) mmol/l和对照组(5.32±0.49 (p=0.685)和5.42±0.51 (p= 0.001) mmol/l相比,肥胖冠心病患者空腹血糖水平和葡萄糖负荷后血糖水平分别为5.64±1.92和7.08±2.25 mmol/l)。治疗后测定血糖恢复情况。 结论。建立了糖代谢指标的动态特征可以作为肥胖合并冠心病治疗效果的指标。本研究结果提示,在冠心病合并肥胖的合并症中,必须考虑糖代谢的特点,以确保治疗和预防措施。
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引用次数: 0
DYNAMICS OF KINESIOPHOBIA AND PHYSICAL FUNCTIONING PARAMETERS IN THE ELDERLY ADULTS WITH SARCOPENIC OBESITY UNDER THE INFLUENCE OF THE PHYSICAL THERAPY PROGRAM 在物理治疗方案的影响下,老年肌肉减少型肥胖患者运动恐惧症和身体功能参数的动态变化
Pub Date : 2023-09-30 DOI: 10.31612/2616-4868.4(26).2023.13
Nazar P. Koval, Mariia H. Aravitska
Aim: to determine the effectiveness of a physical therapy program for the elderly with sarcopenic obesity in terms of the kinesiophobia and physical functioning parameters. Materials and methods: We examined 106 elderly people, who were divided into 3 groups. The control group consisted of individuals with normal body weight and they had no sarcopenia. The main group 1 consisted of individuals with sarcopenic obesity and a weak therapeutic alliance; they were given general recommendations for modifying the diet and expanding physical activity. The main group 2 included patients with a strong therapeutic alliance. A one-year physical therapy program with the use of kinesitherapy, massage, dietary intervention, patient education, the elements of cognitive training and occupation therapy was developed for them. The dynamics were assessed by Tampa Kinesiophobia Scale, Fullerton Fitness Test, Edmonton Frail Scale. Results: Elderly people with sarcopenic obesity have a high level of kinesiophobia (Tampa Kinesiophobia Scale), their physical status (coordination, balance, strength, flexibility, endurance, agility) significantly lags behind that of their peers (Fullerton Fitness Test), they suffer from the frailty (Edmonton Frail Scale). After applying the developed physical therapy program, it was possible to state that the individuals of the main group 2 showed a statistically significant (p <0.05) improvement in their physical functioning parameters relative to the indicators of their peers and initial parameters, a reduction in the frailty, decreasing in the level of kinesiophobia. The low level of the therapeutic alliance, despite the awareness of the negative consequences for the health, led to unsatisfactory implementation or non-implementation of the recommendations provided for the elderly with sarcopenic obesity and was associated with no improvement in the physical status, signs of frailty, kinesiophobia. Conclusions: The developed physical therapy program for elderly patients with sarcopenic obesity against a background of a high level of the therapeutic alliance showed a statistically significant improvement in all studied indicators of kinesiophobia and physical functioning parameters compared to the initial level and the indicators of people with low levels of the therapeutic alliance.
目的:确定老年肌肉减少型肥胖患者的物理治疗方案在运动恐惧症和身体功能参数方面的有效性。 材料与方法:对106例老年人进行调查,将其分为3组。对照组由体重正常且没有肌肉减少症的个体组成。主要组1为肌肉减少型肥胖患者,治疗联盟较弱;他们得到了关于调整饮食和扩大体育活动的一般性建议。主要组2包括治疗联盟强的患者。为他们制定了为期一年的物理治疗计划,包括运动疗法、按摩、饮食干预、患者教育、认知训练和职业治疗的要素。采用坦帕运动恐惧症量表(Tampa Kinesiophobia Scale)、富勒顿体能测试(Fullerton Fitness Test)、埃德蒙顿体弱量表(Edmonton虚弱量表)进行动态评估。结果:老年肌肉减少型肥胖患者存在高水平的运动恐惧症(坦帕运动恐惧症量表),其身体状况(协调性、平衡性、力量、柔韧性、耐力、敏捷性)明显落后于同龄人(富勒顿体能测试),存在虚弱感(埃德蒙顿虚弱量表)。应用开发的物理治疗方案后,有可能说,与同龄人和初始参数相比,主组2的个体在身体功能参数方面表现出统计学上显著(p <0.05)的改善,虚弱程度降低,运动恐惧症水平降低。尽管意识到对健康的负面影响,但低水平的治疗联盟导致不满意的实施或不实施为老年肌肉减少型肥胖患者提供的建议,并且与身体状况、虚弱迹象和运动恐惧症没有改善有关。 结论:在高水平治疗联盟背景下,开发的老年肌肉减少型肥胖患者物理治疗方案与初始水平和低水平治疗联盟人群相比,运动恐惧症和身体功能参数的所有研究指标均有统计学意义上的改善。
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引用次数: 0
IMPOSTORS AMONG FAMILY DOCTORS 家庭医生中的骗子
Pub Date : 2023-09-30 DOI: 10.31612/2616-4868.4(26).2023.11
Iryna L. Vysochyna, Volodymyr V. Kramarchuk, Tetiana O. Yashkina
Introduction. Human resources policy issues in medicine have always played a significant role in ensuring quality medical care for the population. Young specialists face high labor market demands and constant management pressure, without having ready adaptation strategies. The beginning of a success story is always challenging, and sometimes the impostor syndrome can have its influence. Persistent self-doubt leads to emotional exhaustion and the development of a cynical attitude towards others, which can further transform into burnout syndrome. THE AIM: To analyze the prevalence of the impostor phenomenon among young doctors in the field of “General Practice – Family Medicine” and explore potential correlations with burnout syndrome. MATERIALS AND METHODS. We conducted an anonymous cross-sectional survey of 27 young family doctors using The Clance Impostor Phenomenon Scale and Maslach Burnout Inventory Human Services Survey for Medical Personnel. The research procedure adhered to accepted moral norms, rights, interests, and personal dignity of the participants, in line with the principles of bioethics outlined in the Helsinki Declaration “Ethical Principles for Medical Research Involving Human Subjects” and the “Universal Declaration on Bioethics and Human Rights (UNESCO)”. RESULTS. All respondents demonstrated a certain level of impostor syndrome severity, which might be related to a shift in professional role – the transition from intern to independent practitioner – a family doctor. Every fourth intern already showed signs of emotional exhaustion and depersonalization, with 7% having developed burnout syndrome. It is not excluded that these changes are linked to working conditions and military actions on the territory of Ukraine. CONCLUSIONS. Nearly half of the respondents were categorized under intermediate burnout syndrome profiles (Overloaded, Ineffective, Detached), which can be corrected with timely identification and effective management. Without exception, all respondents exhibited various degrees of the impostor phenomenon. The impostor syndrome is closely related to emotional exhaustion (p=0.002) and depersonalization (p=0.000214) within the structure of burnout syndrome, allowing for the development of new correction approaches and optimization of burnout prevention strategies.
介绍。医学人力资源政策问题一直在确保人口获得优质医疗服务方面发挥着重要作用。年轻的专家面临着高劳动力市场需求和持续的管理压力,没有现成的适应策略。成功故事的开始总是充满挑战,有时骗子综合症也会产生影响。持续的自我怀疑会导致情绪衰竭和对他人愤世嫉俗的态度,这可能进一步转化为倦怠综合征。 目的:分析“全科-家庭医学”领域年轻医生冒名顶替现象的流行情况,并探讨其与职业倦怠综合征的潜在相关性。 材料和方法。我们采用Clance冒名顶替现象量表和Maslach医务人员职业倦怠量表对27名年轻家庭医生进行了匿名横断面调查。研究过程遵循公认的道德规范、参与者的权利、利益和个人尊严,符合赫尔辛基宣言《涉及人体受试者的医学研究的伦理原则》和《世界生物伦理与人权宣言》(教科文组织)中概述的生物伦理原则。结果。所有受访者都表现出一定程度的骗子综合症的严重程度,这可能与职业角色的转变有关-从实习生到独立从业者-家庭医生的转变。四分之一的实习生已经表现出情绪衰竭和人格解体的迹象,7%的实习生出现了倦怠综合症。不排除这些变化与乌克兰境内的工作条件和军事行动有关。结论。近一半的受访者被归类为中度倦怠综合征(超负荷,无效,超然),这可以通过及时识别和有效管理来纠正。无一例外,所有受访者都表现出不同程度的冒名顶替现象。在倦怠综合症的结构中,冒名顶替者综合症与情绪耗竭(p=0.002)和去人体化(p=0.000214)密切相关,这有助于开发新的纠正方法和优化倦怠预防策略。
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引用次数: 0
LEFT VENTRICULAR REMODELING IN HEART FAILURE (PART ІI): PHENOTYPIC HETEROGENEITY AS A RATIONALE FOR PERSONALIZED PATIENTS` MANAGEMENT 心力衰竭患者左心室重构(上):表型异质性作为个性化患者管理的基本原理
Pub Date : 2023-08-04 DOI: 10.31612/2616-4868.3(25).2023.03
T. Chursina, A. Kravchenko, K. Mikhaliev
Aim: to provide a literature review of the current conсepts on phenotypic heterogeneity of left ventricular (LV) remodeling in heart failure (HF), and highlight the significance of such a diversity for an implementation of personalized patients` management. This paper is a second part of the review, devoted to the current state of pathophysiology of LV remodeling in HF. Material and methods. The thematic scientific papers, published predominantly during the last decade, constituted the study material. The research methodology involved bibliosemantic method and structural and logical analysis. Results and discussion. HF is a heterogeneous, multifactorial and rising epidemic syndrome. To date, the LV ejection fraction (EF) is used as a substantial criterion for HF classification and management. However, the existing research data has revealed the significant overlapping between different LV EF-based HF patterns in terms of the risk factors, comorbidities and disease modifiers; bidirectional transitions of LV EF due to disease treatment and progression; myocardial fibrosis and dysfunction; effectiveness of neurohumoral inhibitors etc. Moreover, the «spectrum» paradigm has been recently proposed, positioning HF as a spectrum across different phenotypes. Particularly, each HF phenotype is the result of a patient-specific trajectory, being an exceptional and unique «track» for the heart transition towards different remodeling patterns. The HF phenotyping may be an innovative approach to the study of myocardial remodeling and HF, which is potentially an important prerequisite for the development of individualized patients` treatment. Personalized medicine can offer the particular options for managing HF patients, that, in turn, will better identify responders, non-responders, and those at high risk of adverse events, and ultimately improve of the treatment efficacy and safety. Conclusions. The baseline heterogeneity of the structural and functional patients` characteristics, including those describing the LV remodeling, and their dynamic change over time, creates a spectrum across overlapping HF phenotypes, challenging a categorical HF classification based solely on LV EF. Such an approach to treat the HF phenotypic heterogeneity may provide further insights into the pathomechanisms, related to LV remodeling in HF, and has the potential to improve the personalized patients` management.
目的:对目前关于心力衰竭(HF)左心室重构表型异质性的研究进行文献综述,并强调这种多样性对实施个性化患者管理的意义。本文是综述的第二部分,主要介绍HF患者左心室重构的病理生理学现状。材料和方法。主要在过去十年发表的专题科学论文构成了研究材料。研究方法包括文献语义分析法和结构逻辑分析法。结果和讨论。HF是一种异质性、多因素和流行性上升的综合征。到目前为止,左心室射血分数(EF)被用作HF分类和管理的重要标准。然而,现有的研究数据显示,不同的基于左心室EF的HF模式在风险因素、合并症和疾病修饰因素方面存在显著重叠;由于疾病治疗和进展导致的左心室EF的双向转换;心肌纤维化和功能障碍;神经体液抑制剂的有效性等。此外,最近提出了“光谱”范式,将HF定位为不同表型的光谱。特别是,每种HF表型都是患者特定轨迹的结果,是心脏向不同重塑模式转变的特殊而独特的“轨迹”。HF表型可能是研究心肌重塑和HF的一种创新方法,这可能是开发个性化患者治疗的重要前提。个性化医疗可以为HF患者的管理提供特定的选择,从而更好地识别有反应者、无反应者和不良事件高危人群,并最终提高治疗效果和安全性。结论。结构和功能患者特征的基线异质性,包括描述左心室重塑的特征,以及它们随时间的动态变化,在重叠的HF表型之间产生了一个谱,这对仅基于左心室EF的分类HF提出了挑战。这种治疗HF表型异质性的方法可以进一步深入了解与HF左心室重塑相关的病理机制,并有可能改善个性化患者的管理。
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引用次数: 0
ORGANIZATION OF SAFETY WHEN PROVIDING COSMETOLOGICAL SERVICES AND PREVENTION OF RISKS OF COMPLICATIONS AND DEVELOPMENT OF INFECTIOUS DISEASES 提供美容服务时的安全组织,预防并发症和传染病发展的风险
Pub Date : 2023-08-04 DOI: 10.31612/2616-4868.3(25).2023.10
K.L. Hordiichuk, S. Hordiichuk, V. Shatylo, S. Poplavska, O.V. Horai, Z. Sharlovych
Introduction. The article presents the results of a medical and sociological study among consumers of cosmetology services regarding the quality of services and the state of safety, cases of infectious complications, problematic issues of regulatory support. The aim of the study. To establish the risks and factors of complications and diseases of infectious origin as a result of performed cosmetology procedures. Materials and methods. Bibliosemantic, medico-sociological research among consumers of cosmetology services, analysis of current regulatory documents, medico-statistical, system analysis and logical generalization methods were used. Research results and their discussion. According to the results of a medical and sociological study, a relationship between cosmetology services and infectious complications was established in 23% of respondents. 10% of consumers of cosmetology services had a history of contraindications, as well as allergic reactions to cosmetic products and materials, 29% have a tendency to allergic reactions, but continue to carry out cosmetology procedures. 93% of respondents are cautious and do not rule out the possibility of infection with the human immunodeficiency virus, parenteral viral hepatitis B and C, as well as fungal, staphylococcal and other infections in case of non-compliance with the anti-epidemic regime and the rules of asepsis. Based on the analysis of the regulatory and legal support for the development of the field of cosmetology and the prevention of infection in the field of services for the public, it was found that there is a direct connection between the irregularity of cosmetology practice and the spread of diseases, including those of infectious origin, which leads to the insecurity of consumers and poses a threat public health. Conclusions. On the basis of the conducted research, cases of infectious complications among consumers of cosmetology services have been established, which are related to the non-regulation of the activity of the field of cosmetology in legislative, regulatory and regulatory documents. In order to minimize risks, prevent infectious complications and preserve public health, it is necessary to adopt and improve at the state level normative legal acts related to cosmetology, to settle the issues of personnel training, to bring the standards of safety approaches in cosmetology closer to the level of the standards in force in the industry Health Care.
介绍。这篇文章介绍了在美容服务消费者中进行的一项医学和社会学研究的结果,涉及服务质量和安全状况、感染并发症病例、监管支持方面的问题。研究的目的。确定因进行美容手术而引起的并发症和感染性疾病的风险和因素。材料和方法。采用文献语义学研究、美容服务消费者医学社会学研究、现行规范性文件分析、医学统计学、系统分析和逻辑概括等方法。研究结果及其讨论。根据一项医学和社会学研究的结果,23%的答复者认为美容服务与感染并发症之间存在关系。10%的美容服务消费者有禁忌症史,以及对化妆品和材料有过敏反应,29%有过敏反应倾向,但仍继续进行美容手术。93%的答复者持谨慎态度,不排除在不遵守防疫制度和无菌规则的情况下感染人类免疫缺陷病毒、肠外病毒性乙型和丙型肝炎以及真菌、葡萄球菌和其他感染的可能性。根据对美容领域发展的监管和法律支持以及为公众服务领域预防感染的分析,发现美容实践的不规范与疾病的传播,包括传染性疾病的传播之间存在直接联系,这导致消费者的不安全,并对公众健康构成威胁。结论。根据所进行的研究,已确定了美容服务消费者中感染性并发症的病例,这与立法、监管和规范性文件对美容领域活动的不管制有关。为了最大限度地减少风险,预防传染性并发症和维护公众健康,有必要在国家一级通过和完善与美容有关的规范性法律行为,解决人员培训问题,使美容安全方法的标准更接近保健行业现行标准的水平。
{"title":"ORGANIZATION OF SAFETY WHEN PROVIDING COSMETOLOGICAL SERVICES AND PREVENTION OF RISKS OF COMPLICATIONS AND DEVELOPMENT OF INFECTIOUS DISEASES","authors":"K.L. Hordiichuk, S. Hordiichuk, V. Shatylo, S. Poplavska, O.V. Horai, Z. Sharlovych","doi":"10.31612/2616-4868.3(25).2023.10","DOIUrl":"https://doi.org/10.31612/2616-4868.3(25).2023.10","url":null,"abstract":"Introduction. The article presents the results of a medical and sociological study among consumers of cosmetology services regarding the quality of services and the state of safety, cases of infectious complications, problematic issues of regulatory support. The aim of the study. To establish the risks and factors of complications and diseases of infectious origin as a result of performed cosmetology procedures. \u0000Materials and methods. Bibliosemantic, medico-sociological research among consumers of cosmetology services, analysis of current regulatory documents, medico-statistical, system analysis and logical generalization methods were used. \u0000Research results and their discussion. According to the results of a medical and sociological study, a relationship between cosmetology services and infectious complications was established in 23% of respondents. 10% of consumers of cosmetology services had a history of contraindications, as well as allergic reactions to cosmetic products and materials, 29% have a tendency to allergic reactions, but continue to carry out cosmetology procedures. 93% of respondents are cautious and do not rule out the possibility of infection with the human immunodeficiency virus, parenteral viral hepatitis B and C, as well as fungal, staphylococcal and other infections in case of non-compliance with the anti-epidemic regime and the rules of asepsis. Based on the analysis of the regulatory and legal support for the development of the field of cosmetology and the prevention of infection in the field of services for the public, it was found that there is a direct connection between the irregularity of cosmetology practice and the spread of diseases, including those of infectious origin, which leads to the insecurity of consumers and poses a threat public health. \u0000Conclusions. On the basis of the conducted research, cases of infectious complications among consumers of cosmetology services have been established, which are related to the non-regulation of the activity of the field of cosmetology in legislative, regulatory and regulatory documents. In order to minimize risks, prevent infectious complications and preserve public health, it is necessary to adopt and improve at the state level normative legal acts related to cosmetology, to settle the issues of personnel training, to bring the standards of safety approaches in cosmetology closer to the level of the standards in force in the industry Health Care.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041646","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}
引用次数: 0
EFFECTIVENESS OF CORRECTION OF GERIATRIC STATUS OF ELDERLY PATIENTS WITH MOVEMENT CONSEQUENCES OF TOTAL KNEE ARTHROPLASTY USING PHYSICAL THERAPY 物理治疗对全膝关节置换术后运动不良的老年患者老年状态矫正的效果
Pub Date : 2023-08-04 DOI: 10.31612/2616-4868.3(25).2023.02
Ch.V. Petruniv
The aim of the study was to evaluate the effectiveness of the influence of the developed program of physical therapy on the parameters of the geriatric status of elderly patients with motor consequences of total knee arthroplasty in the long-term period after surgery.  Material and methods. 80 elderly people were examined. The control group consisted of 24 people without joint endoprostheses with no signs of geriatric syndromes. The comparison group consisted of persons with a knee joint endoprosthesis and sarcopenia with low rehabilitation compliance with respect to rehabilitation intervention. Representatives of the main group with a knee joint replacement and sarcopenia were engaged in a physical therapy program using functional training on the Prosedos platform, therapeutic exercises, massage, kinesiology taping, nutrition correction, and patient education. The effectiveness of the program was evaluated by the dynamics of the Senior Fitness Test, Tinetti-test (Performance-Oriented Mobility Assessment), Geriatric Depression Scale, Tampa Kinesiophobia Scale.  Results. The geriatric status of the examined patients was characterized by muscle weakness (statistically significant lag in parameters of physical status - coordination, static and dynamic balance, strength, flexibility, endurance, dexterity compared to their peers according to the Senior Fitness Test, Tinetti-test), high risk of falling, kinesiophobia and psycho-emotional depression, which increases the risk of loss of autonomy and death. The developed program of physical therapy revealed an improvement in the condition of the patients of the main group due to the influence on the links of the pathogenesis of geriatric syndromes due to the improvement of balance and gait parameters, reduction of the risk of falling and fear of movements, improvement of the psycho-emotional status in comparison with the initial indicators in all studied parameters (р<0.05). The low rehabilitation compliance of patients in the comparison group, despite the awareness of the risks of poly morbidity, was associated with the lack of improvement in the condition after a similar observation period.  Conclusions. Elderly patients with the consequences of total knee arthroplasty and signs of geriatric syndromes need to develop physical therapy programs that take into account and correct the specifics of each condition, which will increase the overall effectiveness of rehabilitation measures.
本研究的目的是评估开发的物理治疗方案对全膝关节置换术后长期运动后果的老年患者老年状态参数的影响的有效性。材料和方法。对80名老年人进行了检查。对照组由24人组成,没有关节假体,没有老年综合征的迹象。对照组由膝关节内假体患者和肌肉减少患者组成,康复干预依从性较低。膝关节置换术和肌肉减少症的主要组的代表参与了一个物理治疗项目,包括Prosedos平台上的功能训练、治疗练习、按摩、运动学胶带、营养矫正和患者教育。采用老年人体能测试、运动能力测试、老年抑郁量表、坦帕运动恐惧症量表等量表对项目效果进行动态评价。结果。被检查患者的老年状态以肌肉无力为特征(根据老年人体能测试,tinetti测试,身体状态参数-协调,静态和动态平衡,力量,柔韧性,耐力,敏捷性与同龄人相比有统计学上显著滞后),跌倒风险高,运动恐惧症和心理情绪抑郁,这增加了自主性丧失和死亡的风险。开发的物理治疗方案显示,与所有研究参数的初始指标相比,由于平衡和步态参数的改善,跌倒风险和运动恐惧的降低,心理情绪状态的改善,对老年综合征发病机制的联系产生了影响,主组患者的病情得到改善(p <0.05)。对照组患者的康复依从性较低,尽管意识到多发病的风险,但在相似的观察期后病情没有改善。结论。有全膝关节置换术后果和老年综合征迹象的老年患者需要制定物理治疗方案,考虑并纠正每种情况的具体情况,这将提高康复措施的总体有效性。
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引用次数: 0
ARTERIAL HYPERTENSION AMONG MEDICAL WORKERS. ANALYSIS. EVALUATION 医务工作者的动脉高血压。分析。评价
Pub Date : 2023-08-04 DOI: 10.31612/2616-4868.3(25).2023.07
О. Tolstanov, L. Gordienko
The aim. To examine the impact of individual medical and social factors, including work experience, lifestyle and living conditions, excess body weight, metabolic syndrome, types of circadian rhythms of blood pressure, and heredity, on the frequency of arterial hypertension (hypertensive disease - HD) formation. Materials and methods. The study involved the collection of anamnestic data, conducting interviews, performing objective examinations, and monitoring blood pressure in 391 medical workers, predominantly from therapeutic, surgical, and intensive care backgrounds. The obtained data were statistically processed using probability assessment criteria, risks assessed through odds ratio (OR), and ROC analysis. The results. The study revealed that only 33% of medical workers have a normal body weight. The risk of developing hypertensive disease (HD) is 3.24 times higher in the group with excess body weight and 8.72 times higher in the group with obesity compared to the examined subjects with normal body weight (p<0.0001). Daily blood pressure monitoring results showed a statistically significant difference in 12 out of the 21 studied parameters (p<0.05) between patients with HD, with and without metabolic syndrome. This indicates that the presence of metabolic syndrome affects the severity of hypertensive disease. Additionally, a statistically significant difference (p<0.05) was observed in the distribution of circadian rhythm types of blood pressure between groups with and without hypertension. It was established that there is a predominance of unfavorable types of circadian blood pressure rhythm in medical worker groups experiencing high professional psycho-emotional stress (78.1-85.5%). Recognizing the risk factors for HD occurrence in medical workers can significantly enhance the effectiveness of a comprehensive hypertensive disease prevention program, leading to reduced blood pressure levels and a lower frequency of complications. Conclusions. It has been established that excess body weight is a risk factor for the development of hypertensive disease (HD) in medical personnel. The presence of metabolic syndrome has been proven to affect the severity of the hypertensive disease course. There is a certain association between disruptions in circadian blood pressure rhythms, professional psycho-emotional stress, and the development of arterial hypertension in medical workers of certain specialties. The prognostically significant threshold level of work experience for the formation of a group at an increased risk of developing HD is 11 years.
目标。研究个人医疗和社会因素,包括工作经验、生活方式和生活条件、超重、代谢综合征、血压昼夜节律类型和遗传,对动脉高血压(高血压病HD)形成频率的影响。材料和方法。这项研究涉及391名医务工作者的记忆数据收集、访谈、客观检查和血压监测,这些医务工作者主要来自治疗、外科和重症监护背景。使用概率评估标准、通过比值比(OR)评估的风险和ROC分析对获得的数据进行统计处理。结果。研究显示,只有33%的医务工作者体重正常。与正常体重的受试者相比,超重组和肥胖组患高血压疾病(HD)的风险分别高出3.24倍和8.72倍(p<0.0001),有或没有代谢综合征。这表明代谢综合征的存在会影响高血压疾病的严重程度。此外,在高血压组和非高血压组之间,血压昼夜节律类型的分布存在统计学显著差异(p<0.05)。研究表明,在经历高职业心理情绪压力的医务工作者群体中,血压昼夜节律的不利类型占主导地位(78.1-85.5%)。认识到医务工作者HD发生的危险因素可以显著提高综合性高血压疾病预防计划的有效性,从而导致血压水平降低和并发症的频率降低。结论。已经证实,超重是医务人员患高血压疾病(HD)的危险因素。代谢综合征的存在已被证明会影响高血压病程的严重程度。在某些专业的医务工作者中,昼夜血压节律的紊乱、职业心理情绪压力和动脉高血压的发展之间存在一定的联系。形成HD风险增加的群体的工作经验的预测显著阈值水平为11年。
{"title":"ARTERIAL HYPERTENSION AMONG MEDICAL WORKERS. ANALYSIS. EVALUATION","authors":"О. Tolstanov, L. Gordienko","doi":"10.31612/2616-4868.3(25).2023.07","DOIUrl":"https://doi.org/10.31612/2616-4868.3(25).2023.07","url":null,"abstract":"The aim. To examine the impact of individual medical and social factors, including work experience, lifestyle and living conditions, excess body weight, metabolic syndrome, types of circadian rhythms of blood pressure, and heredity, on the frequency of arterial hypertension (hypertensive disease - HD) formation. \u0000Materials and methods. The study involved the collection of anamnestic data, conducting interviews, performing objective examinations, and monitoring blood pressure in 391 medical workers, predominantly from therapeutic, surgical, and intensive care backgrounds. The obtained data were statistically processed using probability assessment criteria, risks assessed through odds ratio (OR), and ROC analysis. \u0000The results. The study revealed that only 33% of medical workers have a normal body weight. The risk of developing hypertensive disease (HD) is 3.24 times higher in the group with excess body weight and 8.72 times higher in the group with obesity compared to the examined subjects with normal body weight (p<0.0001). Daily blood pressure monitoring results showed a statistically significant difference in 12 out of the 21 studied parameters (p<0.05) between patients with HD, with and without metabolic syndrome. This indicates that the presence of metabolic syndrome affects the severity of hypertensive disease. Additionally, a statistically significant difference (p<0.05) was observed in the distribution of circadian rhythm types of blood pressure between groups with and without hypertension. It was established that there is a predominance of unfavorable types of circadian blood pressure rhythm in medical worker groups experiencing high professional psycho-emotional stress (78.1-85.5%). Recognizing the risk factors for HD occurrence in medical workers can significantly enhance the effectiveness of a comprehensive hypertensive disease prevention program, leading to reduced blood pressure levels and a lower frequency of complications. \u0000Conclusions. It has been established that excess body weight is a risk factor for the development of hypertensive disease (HD) in medical personnel. The presence of metabolic syndrome has been proven to affect the severity of the hypertensive disease course. There is a certain association between disruptions in circadian blood pressure rhythms, professional psycho-emotional stress, and the development of arterial hypertension in medical workers of certain specialties. The prognostically significant threshold level of work experience for the formation of a group at an increased risk of developing HD is 11 years.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48609888","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}
引用次数: 0
Effectiveness of pain treatment for patients with mine-blast wounds depending on the number of localizations in military mobile hospitals 地雷炸伤患者疼痛治疗的有效性取决于军事流动医院的本地化数量
Pub Date : 2023-08-04 DOI: 10.31612/2616-4868.3(25).2023.05
V. Horoshko, I. Kuchyn
 Patients with gunshot wounds suffer from chronic pain in 70% of cases, and those with mine-blast wounds – in 83.3% of cases. Civilian patients, after serious injuries, in 11-40% of cases. Unfortunately, there is not enough data to study the causes of such a high frequency of pain chronicity. Therefore, the study of the results of pain treatment at the stage of treatment in military mobile hospitals may be able to reveal the reasons for such a high frequency of chronicity. Methods. The treatment of 280 patients with mine-blast wounds was analyzed. The intensity of pain was diagnosed using a visual analog scale. The Shapiro-Wilk test was used to check the distribution of quantitative indicators for normality. The law of distribution differed from the normal one, the median value (Me) and interquartile range (QI-QIII) were given to present quantitative indicators, and the comparison of indicators in the two groups was performed by the Mann-Whitney test. To analyze the dynamics of indicators, the Friedman criterion for linked samples was used, and the posterior comparison was performed using the Bonferroni correction. For qualitative indicators, the absolute frequency of the trait and the relative frequency (%) are presented, and the chi-square test with the correction for continuity was used to compare the two groups. In all cases, the critical level of significance was set at 0.05. Results. The analysis of pain intensity according to the VAS, before anesthesia, upon admission to military mobile hospitals, showed that patients experienced high-intensity pain reaching 7 points. This indicates a lack of effective pain control both at the initial stage of treatment and during evacuation. After anesthesia, VAS data indicate the presence of moderate pain – 4 points. The intervals between analgesic treatments averaged 6 hours. Although the effectiveness of analgesia according to VAS was low. Conclusions. Patients with mine-blast injuries have a very high risk of chronic pain – 57.5% higher than in injured patients in civilian life. The study results point to ways to improve treatment outcomes for this category of patients. Achieving high-quality pain control at the stage of treatment in military mobile hospitals and maintaining the continuity of treatment during an evacuation can potentially reduce the incidence of pain chronicity.
枪伤患者的慢性疼痛发生率为70%,而地雷炸伤患者的慢性疼痛发生率为83.3%。平民病人,在严重受伤后,在11-40%的病例中。不幸的是,没有足够的数据来研究如此高频率的慢性疼痛的原因。因此,通过对军队流动医院治疗阶段疼痛治疗结果的研究,或许可以揭示出如此高的慢性发生率的原因。方法。分析280例地雷炸伤患者的治疗方法。疼痛强度采用视觉模拟量表进行诊断。采用Shapiro-Wilk检验检验定量指标分布是否符合正态性。不同于正态分布规律,以中位数(Me)和四分位间距(QI-QIII)表示定量指标,两组指标比较采用Mann-Whitney检验。为了分析指标的动态,对关联样本使用Friedman准则,并使用Bonferroni校正进行后验比较。定性指标给出性状的绝对频率和相对频率(%),两组间比较采用连续性校正的卡方检验。在所有情况下,临界显著性水平设为0.05。结果。根据VAS进行疼痛强度分析,在麻醉前,进入军队流动医院时,患者经历了7分的高强度疼痛。这表明在治疗初期和撤离期间缺乏有效的疼痛控制。麻醉后,VAS数据显示存在中度疼痛- 4分。镇痛治疗间隔平均为6小时。虽然根据VAS镇痛效果较低。结论。地雷炸伤患者发生慢性疼痛的风险非常高,比平民生活中的受伤患者高57.5%。研究结果指出了改善这类患者治疗效果的方法。在军事流动医院治疗阶段实现高质量的疼痛控制,并在后送期间保持治疗的连续性,可潜在地减少慢性疼痛的发生率。
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Klinichna ta profilaktichna meditsina
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