Pub Date : 2022-12-30DOI: 10.32345/2664-4738.4.2022.02
D. Koval, A.S. Kolosovych, О.О. Levenets, О.І. Hladiy, A. Mykolenko
Relevance. Modeling the conditions of endotoxicosis by introducing bacterial lipopolysaccharide against the background of toxic liver damage is due to the fact that under such conditions the situation that accompanies almost every chronic pathology, including cardiovascular, is reproduced. The release of substances that play a role in the formation of endogenous intoxication causes heart damage in the absence of cardiac pathology, and in its presence worsens the course and prognosis. However, it should be found out whether these changes are the result of only toxic damage to cardiomyocytes or have another morphological basis and what their dynamics are. Objective: to characterize the morphological changes of the myocardium in experimental chronic endotoxicosis. Materials and methods. The research was carried out by modeling endotoxicosis in 18 laboratory animals for 90 days by daily intragastric injection of tetrachloromethane at the rate of 3-5 ml/kg of body weight and every 6th day by intraperitoneally adding bacterial lipopolysaccharide at a dose of 0.2 mg/kg of body weight. Animals were removed from the experiment by decapitation at 30, 60, and 90 days. Animals were removed from the experiment by decapitation after anesthesia with intraperitoneal administration of sodium thiopental at a dose of 50 mg/kg. The control group consisted of 6 intact animals. For histological examination, myocardial tissue was condensed in paraffin, and deparaffinized sections were stained with hematoxylin and eosin, examined for the detection of neutral glycosaminoglycans and acidic mucopolysaccharides, stained with Alcian blue and PAS-reaction according to standard methods, and examined under a Nikon Eclipse Ci-E light microscope. Results. During researching the myocardium at the light-optical level of experimental animals, after 30 days of chronic endogenous intoxication caused by injection of tetrachloromethane and bacterial LPS, it undergoes changes, first of all, it concerned cardiomyocytes: we observe thinned cells around the vessels and unchanged ones at a distance from the vessels. In some of them, hyperchromia of the nuclei and phenomena of contractile damage and fiber fragmentation were noted. Manifestations from the CMC increased during the next period of the experiment: after 60 days, expressed wave-like deformation of fibers with atrophic changes in muscle cells was detected in the myocardium. Hemodynamic changes were characterized by hyperemia, the number of perivascular hemorrhages increased. On the 90th day of the experiment, in addition to inflammatory manifestations and dystrophic-necrotic changes, cardiomyocyte atrophy in combination with expressed interstitial edema was detected in the myocardial tissue of animals. In the stroma, in addition to small foci of perivascular cardiosclerosis, foci of adipocyte growth were determined. Cardiomyocyte defibrillation and hemorrhages were observed in some areas Conclusion. The intensity of structural
{"title":"DYNAMICS OF PATHOMORPHOLOGICAL CHANGES OF THE MYOCARDIUM IN CHRONIC EXPERIMENTAL ENDOTOXICOSIS","authors":"D. Koval, A.S. Kolosovych, О.О. Levenets, О.І. Hladiy, A. Mykolenko","doi":"10.32345/2664-4738.4.2022.02","DOIUrl":"https://doi.org/10.32345/2664-4738.4.2022.02","url":null,"abstract":"Relevance. Modeling the conditions of endotoxicosis by introducing bacterial lipopolysaccharide against the background of toxic liver damage is due to the fact that under such conditions the situation that accompanies almost every chronic pathology, including cardiovascular, is reproduced. The release of substances that play a role in the formation of endogenous intoxication causes heart damage in the absence of cardiac pathology, and in its presence worsens the course and prognosis. However, it should be found out whether these changes are the result of only toxic damage to cardiomyocytes or have another morphological basis and what their dynamics are. \u0000Objective: to characterize the morphological changes of the myocardium in experimental chronic endotoxicosis. \u0000Materials and methods. The research was carried out by modeling endotoxicosis in 18 laboratory animals for 90 days by daily intragastric injection of tetrachloromethane at the rate of 3-5 ml/kg of body weight and every 6th day by intraperitoneally adding bacterial lipopolysaccharide at a dose of 0.2 mg/kg of body weight. Animals were removed from the experiment by decapitation at 30, 60, and 90 days. Animals were removed from the experiment by decapitation after anesthesia with intraperitoneal administration of sodium thiopental at a dose of 50 mg/kg. The control group consisted of 6 intact animals. For histological examination, myocardial tissue was condensed in paraffin, and deparaffinized sections were stained with hematoxylin and eosin, examined for the detection of neutral glycosaminoglycans and acidic mucopolysaccharides, stained with Alcian blue and PAS-reaction according to standard methods, and examined under a Nikon Eclipse Ci-E light microscope. \u0000Results. During researching the myocardium at the light-optical level of experimental animals, after 30 days of chronic endogenous intoxication caused by injection of tetrachloromethane and bacterial LPS, it undergoes changes, first of all, it concerned cardiomyocytes: we observe thinned cells around the vessels and unchanged ones at a distance from the vessels. In some of them, hyperchromia of the nuclei and phenomena of contractile damage and fiber fragmentation were noted. Manifestations from the CMC increased during the next period of the experiment: after 60 days, expressed wave-like deformation of fibers with atrophic changes in muscle cells was detected in the myocardium. Hemodynamic changes were characterized by hyperemia, the number of perivascular hemorrhages increased. On the 90th day of the experiment, in addition to inflammatory manifestations and dystrophic-necrotic changes, cardiomyocyte atrophy in combination with expressed interstitial edema was detected in the myocardial tissue of animals. In the stroma, in addition to small foci of perivascular cardiosclerosis, foci of adipocyte growth were determined. Cardiomyocyte defibrillation and hemorrhages were observed in some areas \u0000Conclusion. The intensity of structural ","PeriodicalId":52737,"journal":{"name":"Medichna nauka Ukrayini","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46281796","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 : 2022-12-30DOI: 10.32345/2664-4738.4.2022.05
I. Kolosovych, I. Hanol
Relevance. The frequency of development of intra-abdominal hypertension in patients with a complicated course of acute pancreatitis is 60-70% and leads to an increase in the mortality rate up to 62%. Acute peripancreatic fluid collection, occurring in 65.2-88.9% of patients with moderate and severe acute pancreatitis in the early period of the disease, is one of the causes of increased intra-abdominal pressure. Objective: to assess the effect of acute peripancreatic fluid collection on intra-abdominal pressure and the effectiveness of paracentesis with drainage of the abdominal cavity as a method of treatment of intra-abdominal hypertension in patients with complicated course of acute pancreatitis in the early period of the disease. Methods. The study included 60 patients with a complicated course of acute pancreatitis, who were divided into two groups depending on the features of the selected treatment tactics: the main group (paracentesis, drainage of the abdominal cavity was additionally performed) – 30 patients, the comparison group (conservative therapy was applied) - 30 patients. Intra-abdominal pressure indicators were compared in the studied groups and performed a comparative analysis of the dependence of its changes on the amount of exudate removed from the abdominal cavity. Results. When using paracentesis and drainage of the abdominal cavity in the early period in patients with a complicated course of acute pancreatitis, a significant difference was obtained between the intra-abdominal pressure indicators in the studied groups after one day (8.7±1.5 vs. 14.7±3.3 mm Hg (p<0.0001)) and after 7 days (10.5±1.3 vs. 12.7±2.5 mm Hg (p=0.0001)). In the patients of the main group, a decrease in intra-abdominal pressure was observed on the first day after paracentesis, followed by an increase after three days and stabilization after 6 days, and an average negative correlation was found between the amount of exudate removed from the abdominal cavity and changes in intra-abdominal pressure with the Pearson coefficient r = - 0.4418. Conclusions. The use of paracentesis, drainage of the abdominal cavity in patients with complicated course of acute pancreatitis in the early period of the disease can be considered as a safe and effective method of treatment of intra-abdominal hypertension in this category of patients.
关联患有复杂急性胰腺炎的患者发生腹腔内高血压的频率为60-70%，并导致死亡率增加至62%。65.2-88.9%的中重度急性胰腺炎患者在疾病早期发生急性胰周积液，是腹腔内压升高的原因之一。目的：评估急性胰周积液对腹腔内压的影响，以及腹腔穿刺引流治疗急性胰腺炎早期复杂病程患者腹腔内高压的有效性。方法。该研究包括60名急性胰腺炎复杂病程的患者，根据所选治疗策略的特点，他们被分为两组：主要组（额外进行腹腔穿刺和引流）-30名患者，对照组（采用保守治疗）-30名。比较研究组的腹腔内压力指标，并对其变化对腹腔渗出物排出量的依赖性进行比较分析。后果在急性胰腺炎复杂病程的患者早期使用腹腔穿刺引流时，研究组的腹腔压力指标在一天后（8.7±1.5 vs.14.7±3.3 mm Hg（p<0.0001））和7天后（10.5±1.3 vs.12.7±2.5 mm Hg（p=0.0001））之间存在显著差异，3天后增加，6天后稳定，从腹腔排出的渗出物量与腹内压变化之间平均呈负相关，Pearson系数r=-0.418。结论。在这类患者中，在疾病早期对复杂病程的急性胰腺炎患者进行腹腔穿刺引流可以被认为是一种安全有效的治疗腹内高压的方法。
{"title":"FACTORS INCREASING INTRA-ABDOMINAL PRESSURE IN PATIENTS WITH A COMPLICATED COURSE OF ACUTE PANCREATITIS","authors":"I. Kolosovych, I. Hanol","doi":"10.32345/2664-4738.4.2022.05","DOIUrl":"https://doi.org/10.32345/2664-4738.4.2022.05","url":null,"abstract":"Relevance. The frequency of development of intra-abdominal hypertension in patients with a complicated course of acute pancreatitis is 60-70% and leads to an increase in the mortality rate up to 62%. Acute peripancreatic fluid collection, occurring in 65.2-88.9% of patients with moderate and severe acute pancreatitis in the early period of the disease, is one of the causes of increased intra-abdominal pressure. \u0000Objective: to assess the effect of acute peripancreatic fluid collection on intra-abdominal pressure and the effectiveness of paracentesis with drainage of the abdominal cavity as a method of treatment of intra-abdominal hypertension in patients with complicated course of acute pancreatitis in the early period of the disease. \u0000Methods. The study included 60 patients with a complicated course of acute pancreatitis, who were divided into two groups depending on the features of the selected treatment tactics: the main group (paracentesis, drainage of the abdominal cavity was additionally performed) – 30 patients, the comparison group (conservative therapy was applied) - 30 patients. Intra-abdominal pressure indicators were compared in the studied groups and performed a comparative analysis of the dependence of its changes on the amount of exudate removed from the abdominal cavity. \u0000Results. When using paracentesis and drainage of the abdominal cavity in the early period in patients with a complicated course of acute pancreatitis, a significant difference was obtained between the intra-abdominal pressure indicators in the studied groups after one day (8.7±1.5 vs. 14.7±3.3 mm Hg (p<0.0001)) and after 7 days (10.5±1.3 vs. 12.7±2.5 mm Hg (p=0.0001)). In the patients of the main group, a decrease in intra-abdominal pressure was observed on the first day after paracentesis, followed by an increase after three days and stabilization after 6 days, and an average negative correlation was found between the amount of exudate removed from the abdominal cavity and changes in intra-abdominal pressure with the Pearson coefficient r = - 0.4418. \u0000Conclusions. The use of paracentesis, drainage of the abdominal cavity in patients with complicated course of acute pancreatitis in the early period of the disease can be considered as a safe and effective method of treatment of intra-abdominal hypertension in this category of patients.","PeriodicalId":52737,"journal":{"name":"Medichna nauka Ukrayini","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43858738","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 : 2022-12-30DOI: 10.32345/2664-4738.4.2022.01
D. Koval, V.B. Daneliuk, V.V. Pylypiv, A. Mykolenko
Relevance. Abdominal ischemic disease is a general term that characterizes various clinical syndromes of damage to the organs of the digestive system when blood flow is disturbed in the abdominal part of the aorta and its branches, as a result of which there is a disparity of the blood supply of internal organs to their energy needs with the subsequent development of chronic ischemia and necrosis of cells and tissue. Objective. To establish the characteristic features of the dynamics of the remodeling of the blood vessel of the testicles of rats with dosed stenosis of the aorto-iliac segment. Materials and methods. The experiment was conducted on 48 white outbred sexually mature male rats with an average age of 3 months and a weight of 180-200 g. All animals were divided into two groups: experimental group consisted of 36 animals with simulated dosage stenosis of the aorto-iliac segment and control group (12 subjects). All operative manipulations were performed in compliance with the rules of asepsis and antisepsis. Preliminary anesthetization of the animals was carried out with the intramuscular injections of ketamine (50 mg/ml) in terms of 0.083 mg/g of body weight. After performing a laparotomy through a midsection along the white line of the abdominal wall, the abdominal aorta was isolated and compressed by 1/3 of its diameter by applying a silk ligature. The degree of narrowing was controlled using a metal probe with a cone-shaped tip according to the already known method. On the 1st, 3rd, 7th, and 14th day, the animals were taken out of the experiment and an organometric assessment of the condition of the testicles was carried out with the determination of the following parameters: the weight of the organ was determined using a torsion weight VT-500, the length and width were measured using a caliper. After that, pieces of testicular tissue were taken and fixed in a 10% solution of neutral formalin and 96% ethyl alcohol. The obtained paraffin sections with a thickness of 5-7 μm were stained with hematoxylin and eosin, and microscopic examination of a series of histological sections was carried out. Results. A day after the simulation of experimental stenosis of the aorto-iliac segment, a microscopic examination of the structures of the testicle revealed significant swelling of the stroma of the organ. The interstitial tissue was unevenly located between the tortuous seminiferous tubules, the lumen between which was slightly expanded. At the same time, the internal structure of the tubules remained preserved, layers of spermatogenic cells at different stages of maturation were clearly differentiated in them. On the third day of observation, previously identified signs of disorders of organ blood circulation in the testicles continued to increase. The swelling of the testicular interstitial tissue slightly decreased, but it was accompanied by changes in the structure of the cells of the spermatogenic epithelium, the manifestation of whi
{"title":"PECULIARITIES OF THE STRUCTURAL AND FUNCTIONAL REARRANGEMENT OF THE PARENCHYMA OF THE TESTES OF RATS WITH DOSED STENOSIS OF THE AORTO-ILIAC SEGMENT","authors":"D. Koval, V.B. Daneliuk, V.V. Pylypiv, A. Mykolenko","doi":"10.32345/2664-4738.4.2022.01","DOIUrl":"https://doi.org/10.32345/2664-4738.4.2022.01","url":null,"abstract":"Relevance. Abdominal ischemic disease is a general term that characterizes various clinical syndromes of damage to the organs of the digestive system when blood flow is disturbed in the abdominal part of the aorta and its branches, as a result of which there is a disparity of the blood supply of internal organs to their energy needs with the subsequent development of chronic ischemia and necrosis of cells and tissue. \u0000Objective. To establish the characteristic features of the dynamics of the remodeling of the blood vessel of the testicles of rats with dosed stenosis of the aorto-iliac segment. \u0000Materials and methods. The experiment was conducted on 48 white outbred sexually mature male rats with an average age of 3 months and a weight of 180-200 g. All animals were divided into two groups: experimental group consisted of 36 animals with simulated dosage stenosis of the aorto-iliac segment and control group (12 subjects). All operative manipulations were performed in compliance with the rules of asepsis and antisepsis. Preliminary anesthetization of the animals was carried out with the intramuscular injections of ketamine (50 mg/ml) in terms of 0.083 mg/g of body weight. After performing a laparotomy through a midsection along the white line of the abdominal wall, the abdominal aorta was isolated and compressed by 1/3 of its diameter by applying a silk ligature. The degree of narrowing was controlled using a metal probe with a cone-shaped tip according to the already known method. On the 1st, 3rd, 7th, and 14th day, the animals were taken out of the experiment and an organometric assessment of the condition of the testicles was carried out with the determination of the following parameters: the weight of the organ was determined using a torsion weight VT-500, the length and width were measured using a caliper. After that, pieces of testicular tissue were taken and fixed in a 10% solution of neutral formalin and 96% ethyl alcohol. The obtained paraffin sections with a thickness of 5-7 μm were stained with hematoxylin and eosin, and microscopic examination of a series of histological sections was carried out. \u0000Results. A day after the simulation of experimental stenosis of the aorto-iliac segment, a microscopic examination of the structures of the testicle revealed significant swelling of the stroma of the organ. The interstitial tissue was unevenly located between the tortuous seminiferous tubules, the lumen between which was slightly expanded. At the same time, the internal structure of the tubules remained preserved, layers of spermatogenic cells at different stages of maturation were clearly differentiated in them. \u0000On the third day of observation, previously identified signs of disorders of organ blood circulation in the testicles continued to increase. The swelling of the testicular interstitial tissue slightly decreased, but it was accompanied by changes in the structure of the cells of the spermatogenic epithelium, the manifestation of whi","PeriodicalId":52737,"journal":{"name":"Medichna nauka Ukrayini","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47138155","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 : 2022-12-30DOI: 10.32345/2664-4738.4.2022.14
S. Tsuperyak, I. Mochalov
Relevance. Bone-graft materials are widely used in health care and dentistry in particular. The use of osteoplasty techniques in the oral cavity has an increased risk of contamination of the operating field with opportunistic and pathogenic microflora. A number of improvements in such materials have the potential to be used in the treatment of dental diseases. Objective: to analyze current publications devoted to the improvement of bone gratf materials that are used in health care and can be used in dentistry. Methods. An analysis of data obtained during an information search in the online databases "PubMed", "SciELO", "Medcape" and "Science of Ukraine: access to knowledge" was carried out using the keywords "osteoplasty", "bone substitute materials", " bone defects". Results: Despite the predominance in clinical practice of the use of osteoplastic materials of animal origin, the development and improvement of artificial materials looks promising. Such directions can be the improvement of composite materials based on hydrophilic gels which are able to be resorbed in the human body. Modification of ceramic materials and biological glass, improvement of their osteoconductive properties. Inclusion of antibiotics and antiseptics to osteoplastic materials. Inclusion of natural and recombinant biological growth factors in the composition of bone substitute materials. Transformation of osteoplastic material into a system of controlled long-term emission of antibiotics, antiseptics and biological growth factors. Conclusions: Modern osteoplastic materials used in dentistry are mainly high-tech medical products that continue to be improved. The creation of artificial and composite materials with additional antiseptic, antibacterial, osteoinductive and biological properties opens the way to improving the methods of dental treatment and osteoplasty for the needs of dentistry.
的相关性。骨移植材料广泛应用于医疗保健，特别是牙科。在口腔中使用骨成形术会增加手术区被机会性和致病性微生物群污染的风险。这些材料的一些改进有可能用于治疗牙科疾病。目的:分析目前发表的关于改进用于医疗保健和可用于牙科的骨移植材料的文献。方法。对在线数据库“PubMed”、“SciELO”、“Medcape”和“Science of Ukraine: access to knowledge”进行信息搜索时获得的数据进行分析，关键词为“osteoplasty”、“骨替代材料”、“骨缺损”。结果:尽管动物源性骨塑材料在临床应用中占主导地位，但人工材料的发展和改进前景广阔。这些方向可以是改进基于亲水凝胶的复合材料，使其能够在人体中被吸收。改性陶瓷材料和生物玻璃，改善其骨传导性能。在骨成形术中加入抗生素和防腐剂。在骨替代材料的组成中包含天然和重组生物生长因子。将骨塑材料转化为抗生素、防腐剂和生物生长因子的长期可控排放系统。结论:现代牙科骨整形材料主要是高科技医疗产品，并在不断完善。具有额外的防腐、抗菌、骨诱导和生物特性的人造材料和复合材料的创造，为改善牙科治疗和骨成形术的方法开辟了道路。
{"title":"WAYS FOR IMPROVEMENT THE OSTEOPLASTIC MATERIALS FOR DENTISTRY. Review","authors":"S. Tsuperyak, I. Mochalov","doi":"10.32345/2664-4738.4.2022.14","DOIUrl":"https://doi.org/10.32345/2664-4738.4.2022.14","url":null,"abstract":"Relevance. Bone-graft materials are widely used in health care and dentistry in particular. The use of osteoplasty techniques in the oral cavity has an increased risk of contamination of the operating field with opportunistic and pathogenic microflora. A number of improvements in such materials have the potential to be used in the treatment of dental diseases. \u0000Objective: to analyze current publications devoted to the improvement of bone gratf materials that are used in health care and can be used in dentistry. \u0000Methods. An analysis of data obtained during an information search in the online databases \"PubMed\", \"SciELO\", \"Medcape\" and \"Science of Ukraine: access to knowledge\" was carried out using the keywords \"osteoplasty\", \"bone substitute materials\", \" bone defects\". \u0000Results: Despite the predominance in clinical practice of the use of osteoplastic materials of animal origin, the development and improvement of artificial materials looks promising. Such directions can be the improvement of composite materials based on hydrophilic gels which are able to be resorbed in the human body. Modification of ceramic materials and biological glass, improvement of their osteoconductive properties. Inclusion of antibiotics and antiseptics to osteoplastic materials. Inclusion of natural and recombinant biological growth factors in the composition of bone substitute materials. Transformation of osteoplastic material into a system of controlled long-term emission of antibiotics, antiseptics and biological growth factors. \u0000Conclusions: Modern osteoplastic materials used in dentistry are mainly high-tech medical products that continue to be improved. The creation of artificial and composite materials with additional antiseptic, antibacterial, osteoinductive and biological properties opens the way to improving the methods of dental treatment and osteoplasty for the needs of dentistry.","PeriodicalId":52737,"journal":{"name":"Medichna nauka Ukrayini","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45665407","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 : 2022-12-30DOI: 10.32345/2664-4738.4.2022.10
I. Khomenko, Е.М. Khoroshun, V. Makarov, V. Nehoduyko, S. Tertyshnyi, V. Maidanyuk, B. Weiss, S.M. Kornienko
Relevance. The large number of wounded in modern military conflicts “encourages” and in some cases requires revision and modernization of previous views, concepts and theories of medical care providing to wounded during military operations. The optimal concept for the surgical care provision transformation to wounded with soft tissues gunshot defects is to change the approach and tactics of viewpoint at soft tissues gunshot defects which should tactically and strategically rely on the principles of reconstructive and restorative surgery which corresponds to NATO countries medical protocols. Objective: to establish the characteristics of the main and additional diagnostic and treatment schemes the content and volume of surgical care for the injured with soft tissues gunshot defects in the conditions of the III and IV levels of medical care providing in the Military Medical Forces of the Ukrainian Armed Forces. Materials and methods. 342 wounded were included into the study who were treated in the health care system of the Ukrainian Armed Forces from December 2016 to December 2021. 128 of them consisted the main group and 214 - the comparison group. The third level of medical support was formed and implemented at the operational level at the expense of surgical departments (clinics) of the Military Medical Clinical Centers of the Northern and Eastern Regions, medical institutions of the Ministry of Health of Ukraine and provided for the provision of specialized medical assistance: diagnosis of injuries and necessary inpatient treatment of the wounded with the aim of their fastest return to military units or referral to the fourth level of medical care. The fourth level of medical care (highly specialized treatment and rehabilitation) was formed and implemented at the strategic level on the basis of Military Medical Clinical Centers (National, Southern, Central and Western regions Region), research institutes of the National Academy of Sciences of Ukraine and provided for provision of highly specialized medical care using high-tech equipment and highly specialized medical procedures of high complexity. Results. In general, the experience of the Ukrainian Armed Forces medical support during ATO/JFO showed the high efficiency of specialized surgical treatment of the injured with soft tissues gunshot defects in highly specialized departments of treatment and prevention institutions of the IV level using the most effective diagnostic and treatment technologies. We believe that a similar transformation of medical care provision to the wounded took place due to the fact that, in accordance with the proposed and implemented differentiated surgical tactics with a multimodal approach to wounded with soft tissues gunshot defects reconstruction, new staffs of medical companies of brigades and battalion medical posts were proposed and approved during the JFO, the positions of riflemen were introduced paramedics of departments, combat medics of platoons, se
{"title":"DEFINITIONS OF SURGICAL CARE TO WOUNDED WITH SOFT TISSUES DEFECTS GUNSHOT WOUNDS ON THE III AND THE IV LEVELS OF MEDICAL CARE MAINTENANCE DURING THE ATO/JFO","authors":"I. Khomenko, Е.М. Khoroshun, V. Makarov, V. Nehoduyko, S. Tertyshnyi, V. Maidanyuk, B. Weiss, S.M. Kornienko","doi":"10.32345/2664-4738.4.2022.10","DOIUrl":"https://doi.org/10.32345/2664-4738.4.2022.10","url":null,"abstract":"Relevance. The large number of wounded in modern military conflicts “encourages” and in some cases requires revision and modernization of previous views, concepts and theories of medical care providing to wounded during military operations. The optimal concept for the surgical care provision transformation to wounded with soft tissues gunshot defects is to change the approach and tactics of viewpoint at soft tissues gunshot defects which should tactically and strategically rely on the principles of reconstructive and restorative surgery which corresponds to NATO countries medical protocols. \u0000Objective: to establish the characteristics of the main and additional diagnostic and treatment schemes the content and volume of surgical care for the injured with soft tissues gunshot defects in the conditions of the III and IV levels of medical care providing in the Military Medical Forces of the Ukrainian Armed Forces. \u0000Materials and methods. 342 wounded were included into the study who were treated in the health care system of the Ukrainian Armed Forces from December 2016 to December 2021. 128 of them consisted the main group and 214 - the comparison group. \u0000The third level of medical support was formed and implemented at the operational level at the expense of surgical departments (clinics) of the Military Medical Clinical Centers of the Northern and Eastern Regions, medical institutions of the Ministry of Health of Ukraine and provided for the provision of specialized medical assistance: diagnosis of injuries and necessary inpatient treatment of the wounded with the aim of their fastest return to military units or referral to the fourth level of medical care. \u0000The fourth level of medical care (highly specialized treatment and rehabilitation) was formed and implemented at the strategic level on the basis of Military Medical Clinical Centers (National, Southern, Central and Western regions Region), research institutes of the National Academy of Sciences of Ukraine and provided for provision of highly specialized medical care using high-tech equipment and highly specialized medical procedures of high complexity. \u0000Results. In general, the experience of the Ukrainian Armed Forces medical support during ATO/JFO showed the high efficiency of specialized surgical treatment of the injured with soft tissues gunshot defects in highly specialized departments of treatment and prevention institutions of the IV level using the most effective diagnostic and treatment technologies. We believe that a similar transformation of medical care provision to the wounded took place due to the fact that, in accordance with the proposed and implemented differentiated surgical tactics with a multimodal approach to wounded with soft tissues gunshot defects reconstruction, new staffs of medical companies of brigades and battalion medical posts were proposed and approved during the JFO, the positions of riflemen were introduced paramedics of departments, combat medics of platoons, se","PeriodicalId":52737,"journal":{"name":"Medichna nauka Ukrayini","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44781887","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 : 2022-12-30DOI: 10.32345/2664-4738.4.2022.09
А.К. Rushay, M. Baida, О.О. Martynchuk
Relevance. Today there is no generally accepted scope of treatment for nonunion of the tibia. Treatment results are often unsatisfactory. The incomplete process of bone tissue repair is due to the presence of metabolic changes and vascular disorders. This suggests that the use of anti-clotting drugs in the complex treatment may contribute to better treatment results. Objective: to study the effectiveness of the use of antiplatelet drugs bemiparin and tranexamic acid in the complex repair of bone tissue. Materials and methods. 36 patients with tibia nonunion were treated. Complex therapy included surgical treatment (rehabilitation of inflammation and, if present, fistula sequestrectomy), fixation of fragments with ring fixators, antibacterial therapy according to generally accepted principles, conservative therapy of vascular disorders, correction of homeostasis. The comparison group consisted of 42 victims. To correct homeostasis before surgery, 750 mg of tranexamic acid solution was administered intravenously to reduce the risk of bleeding. In 6 hours after surgery, in order to prevent thrombosis, a prophylactic dose of bemiparin (Cibor) 25000 units was administered. The administration was carried out for 7 days. The state of blood homeostasis was assessed on 1, 3 and 7 days after surgery by the following indicators: platelet count, level of soluble fibrin-monomer complexes, prothrombin time, activated partial thromboplastin time, international normalized ratio. The condition of the tibia was assessed by the following indicators: the presence of fluid in the subfascial space, the condition of the fascia, muscles and blood vessels (assessed by ultrasound); asymmetry of the temperature of the feet and legs of healthy and injured limbs (using an infrared non-contact thermometer); the value of intratissue pressure on the tibia (using the Striker apparatus at certain points). The results of tibia treatment after fractures were evaluated using the anatomical and functional scale Modified Functional Evaluation System by Karlstrom-Olerud. Results. There was no significant blood loss during surgery and thromboembolic complications. Clinical data and indicators of intrafascial pressure in the outer and superficial posterior fascial compartments indicated the development of local hypertensive ischemic syndrome. The dynamics of foot thermoasymmetry, ultrasound data are characteristic of subcompensated functional disorders with the theoretical possibility of their recovery. The obtained data indicate a violation of blood flow with a high risk of possible thrombosis, which is an objective basis for the appointment of low molecular weight heparin. The dynamics of most of the examined indicators of blood homeostasis during the prescribed therapy did not differ statistically, but there was a tendency to shift the indicators to the recommended safe zone. Conclusions. Clinical data indicate the high efficacy of Cibor in the complex therapy of septic nonunio
{"title":"USE OF ANTICOAGULANT DRUGS IN THE COMPLEX TREATMENT OF NONUNION OF TIBIA BONES","authors":"А.К. Rushay, M. Baida, О.О. Martynchuk","doi":"10.32345/2664-4738.4.2022.09","DOIUrl":"https://doi.org/10.32345/2664-4738.4.2022.09","url":null,"abstract":"Relevance. Today there is no generally accepted scope of treatment for nonunion of the tibia. Treatment results are often unsatisfactory. The incomplete process of bone tissue repair is due to the presence of metabolic changes and vascular disorders. This suggests that the use of anti-clotting drugs in the complex treatment may contribute to better treatment results. \u0000Objective: to study the effectiveness of the use of antiplatelet drugs bemiparin and tranexamic acid in the complex repair of bone tissue. \u0000Materials and methods. 36 patients with tibia nonunion were treated. Complex therapy included surgical treatment (rehabilitation of inflammation and, if present, fistula sequestrectomy), fixation of fragments with ring fixators, antibacterial therapy according to generally accepted principles, conservative therapy of vascular disorders, correction of homeostasis. The comparison group consisted of 42 victims. \u0000To correct homeostasis before surgery, 750 mg of tranexamic acid solution was administered intravenously to reduce the risk of bleeding. In 6 hours after surgery, in order to prevent thrombosis, a prophylactic dose of bemiparin (Cibor) 25000 units was administered. The administration was carried out for 7 days. The state of blood homeostasis was assessed on 1, 3 and 7 days after surgery by the following indicators: platelet count, level of soluble fibrin-monomer complexes, prothrombin time, activated partial thromboplastin time, international normalized ratio. \u0000The condition of the tibia was assessed by the following indicators: the presence of fluid in the subfascial space, the condition of the fascia, muscles and blood vessels (assessed by ultrasound); asymmetry of the temperature of the feet and legs of healthy and injured limbs (using an infrared non-contact thermometer); the value of intratissue pressure on the tibia (using the Striker apparatus at certain points). \u0000The results of tibia treatment after fractures were evaluated using the anatomical and functional scale Modified Functional Evaluation System by Karlstrom-Olerud. \u0000Results. There was no significant blood loss during surgery and thromboembolic complications. Clinical data and indicators of intrafascial pressure in the outer and superficial posterior fascial compartments indicated the development of local hypertensive ischemic syndrome. The dynamics of foot thermoasymmetry, ultrasound data are characteristic of subcompensated functional disorders with the theoretical possibility of their recovery. The obtained data indicate a violation of blood flow with a high risk of possible thrombosis, which is an objective basis for the appointment of low molecular weight heparin. The dynamics of most of the examined indicators of blood homeostasis during the prescribed therapy did not differ statistically, but there was a tendency to shift the indicators to the recommended safe zone. \u0000Conclusions. Clinical data indicate the high efficacy of Cibor in the complex therapy of septic nonunio","PeriodicalId":52737,"journal":{"name":"Medichna nauka Ukrayini","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44749971","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 : 2022-09-30DOI: 10.32345/2664-4738.3.2022.14
O. Bamigbala, A. O. Ojetunde, C. Okorie
Relevance. The break-up and exit of the dominant follicle into the fallopian tube from the ovary is a physiological event known as ovulation. To determine fertility chances, it is essential to understand the physiology of the ovulatory cycle. Objective. This study assesses the knowledge of the ovulatory cycle (KOC) and associated factors among reproductive-age women in Nigeria. Materials and methods. The research was based on 2018 NDHS data (which was the most current at the time of this study). 90,290 women of reproductive age were taken into account for this investigation. The methods of analysis used are percentage, frequency, chi-square test and Binary Logistic Regression Analysis. p<0.05 was considered to be statistically significant. Results. Only 25% of the 90,290 reproductive women included in the investigation were found to be knowledgeable of the ovulatory cycle. The study revealed that age, region, place of residence (urban), religion, marital status (living with a partner), maternal education (primary and higher education), husband's educational level and women's media exposure had a significant effect on knowledge of the ovulatory cycle. Conclusion. KOC, however, was low (25%), necessitating the development and implementation of reproductive health services through community media campaigns and health promotion. The authors of this study urge the Nigerian Ministry of Health to prioritize improving the reproductive health of women by prioritizing adolescents and those with less education. Additionally, media initiatives might be strengthened to improve women's KOC, which is essential for preventing unwanted pregnancy.
{"title":"KNOWLEDGE OF OVULATORY CYCLE AND ASSOCIATED FACTORS AMONG REPRODUCTIVE AGE WOMEN IN NIGERIA","authors":"O. Bamigbala, A. O. Ojetunde, C. Okorie","doi":"10.32345/2664-4738.3.2022.14","DOIUrl":"https://doi.org/10.32345/2664-4738.3.2022.14","url":null,"abstract":"Relevance. The break-up and exit of the dominant follicle into the fallopian tube from the ovary is a physiological event known as ovulation. To determine fertility chances, it is essential to understand the physiology of the ovulatory cycle. \u0000Objective. This study assesses the knowledge of the ovulatory cycle (KOC) and associated factors among reproductive-age women in Nigeria. \u0000Materials and methods. The research was based on 2018 NDHS data (which was the most current at the time of this study). 90,290 women of reproductive age were taken into account for this investigation. The methods of analysis used are percentage, frequency, chi-square test and Binary Logistic Regression Analysis. p<0.05 was considered to be statistically significant. \u0000Results. Only 25% of the 90,290 reproductive women included in the investigation were found to be knowledgeable of the ovulatory cycle. The study revealed that age, region, place of residence (urban), religion, marital status (living with a partner), maternal education (primary and higher education), husband's educational level and women's media exposure had a significant effect on knowledge of the ovulatory cycle. \u0000Conclusion. KOC, however, was low (25%), necessitating the development and implementation of reproductive health services through community media campaigns and health promotion. The authors of this study urge the Nigerian Ministry of Health to prioritize improving the reproductive health of women by prioritizing adolescents and those with less education. Additionally, media initiatives might be strengthened to improve women's KOC, which is essential for preventing unwanted pregnancy.","PeriodicalId":52737,"journal":{"name":"Medichna nauka Ukrayini","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48201747","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 : 2022-09-30DOI: 10.32345/2664-4738.3.2022.06
V. Pasko
Relevance. Until now, there is an ongoing debate about the value of different indicators of blood pressure (BP) − systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse blood pressure (PBP) as predictors of essential hypertension (EH). In this regard the issue of target BP levels in patients of different ages remains studied incompletely. Objective is to determine peculiarities of 24 hour ambulatory blood pressure monitoring indices in patients with essential hypertension, stage II of different age groups. Materials and methods. ABPM indicators were determined in 130 patients who were divided into 4 groups. 1st group (n=57) – middle-aged hypertensive patients (45-59 years old); 2nd group (n=43) – elderly hypertensive patients (60-74 years old); 3rd group (n=15) – middle-aged patients without EH – control for the 1st group; 4th group (n=15) − elderly patients without EH − control for the 2nd group. Indices of ABPM were determined using a portable recorder ABPM-04 (company "Meditech", Hungary). Measurements of BP were performed every 15 minutes during the day (from 6 to 22 hours) and every 30 minutes at night (from 22 to 6 hours). We determined the following indices: the average daily SBP (mm Hg), the average daly DBP (mm Hg), the average BP (mm Hg); the maximal daily SBP (mm Hg), the maximal daily DBP (mm Hg). The daily index (DI) was also calculated − the percentage of BP decrease at night compared to daytime BP calculated in % DI of SBP, DI of DBP, DI of average BP. Results. In group 1 the average and maximal DBP were lower than in group 2 by 7,4% (p<0,001) and 13,1% (p<0,05), respectively. In group 1, the average daily and maximal SBP decreased by 3,8% and 4,1%, respectively; average heart rate by 3,8%; DI of SBP by 7,8% and DI of average BP by 5,8% but the data were unreliably smaller compared to the data of middle-aged patients. In group 1, the maximal DBP, DI SBP and DBP were not significantly different from the corresponding indicators in the control group. The maximal DBP was higher by 29,3% and amounted to 115,6±21,0 mm Hg and DI SBP and DI DBP are lower by 11,1% and 17,9%, respectively; and were equal to 9,6±7,4 and 13,8±8,1, respectively. In the 2nd group the following parameters decreased unreliably (p>0,05): heart rate by 8,6% and was 63,0±9,1/min., DI SBP by 17,6% and was 8,9±5,5%; DI DBP by 16,1% and was 14,1±7,1%; DI of average BP– by 20,4% and was equal to 11,3±6,1%. Conclusions. It is found that with the age DBP decreases with steadily increased SBP in hypertensive patients. The average daily and the maximal daily DBP are significantly less by 7,4% (p<0,001) and 13,1% (p<0,05) accordingly in elderly patients compared with the middle-aged.
{"title":"PECULIARITIES OF 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING INDICES IN HYPERTENSIVE PATIENTS OF DIFFERENT AGE GROUPS","authors":"V. Pasko","doi":"10.32345/2664-4738.3.2022.06","DOIUrl":"https://doi.org/10.32345/2664-4738.3.2022.06","url":null,"abstract":"Relevance. Until now, there is an ongoing debate about the value of different indicators of blood pressure (BP) − systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse blood pressure (PBP) as predictors of essential hypertension (EH). In this regard the issue of target BP levels in patients of different ages remains studied incompletely. \u0000 Objective is to determine peculiarities of 24 hour ambulatory blood pressure monitoring indices in patients with essential hypertension, stage II of different age groups. \u0000Materials and methods. ABPM indicators were determined in 130 patients who were divided into 4 groups. 1st group (n=57) – middle-aged hypertensive patients (45-59 years old); 2nd group (n=43) – elderly hypertensive patients (60-74 years old); 3rd group (n=15) – middle-aged patients without EH – control for the 1st group; 4th group (n=15) − elderly patients without EH − control for the 2nd group. Indices of ABPM were determined using a portable recorder ABPM-04 (company \"Meditech\", Hungary). Measurements of BP were performed every 15 minutes during the day (from 6 to 22 hours) and every 30 minutes at night (from 22 to 6 hours). We determined the following indices: the average daily SBP (mm Hg), the average daly DBP (mm Hg), the average BP (mm Hg); the maximal daily SBP (mm Hg), the maximal daily DBP (mm Hg). The daily index (DI) was also calculated − the percentage of BP decrease at night compared to daytime BP calculated in % DI of SBP, DI of DBP, DI of average BP. \u0000Results. In group 1 the average and maximal DBP were lower than in group 2 by 7,4% (p<0,001) and 13,1% (p<0,05), respectively. In group 1, the average daily and maximal SBP decreased by 3,8% and 4,1%, respectively; average heart rate by 3,8%; DI of SBP by 7,8% and DI of average BP by 5,8% but the data were unreliably smaller compared to the data of middle-aged patients. In group 1, the maximal DBP, DI SBP and DBP were not significantly different from the corresponding indicators in the control group. The maximal DBP was higher by 29,3% and amounted to 115,6±21,0 mm Hg and DI SBP and DI DBP are lower by 11,1% and 17,9%, respectively; and were equal to 9,6±7,4 and 13,8±8,1, respectively. In the 2nd group the following parameters decreased unreliably (p>0,05): heart rate by 8,6% and was 63,0±9,1/min., DI SBP by 17,6% and was 8,9±5,5%; DI DBP by 16,1% and was 14,1±7,1%; DI of average BP– by 20,4% and was equal to 11,3±6,1%. \u0000Conclusions. It is found that with the age DBP decreases with steadily increased SBP in hypertensive patients. The average daily and the maximal daily DBP are significantly less by 7,4% (p<0,001) and 13,1% (p<0,05) accordingly in elderly patients compared with the middle-aged.","PeriodicalId":52737,"journal":{"name":"Medichna nauka Ukrayini","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48467418","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 : 2022-09-30DOI: 10.32345/2664-4738.3.2022.03
Y. Boiko, V. Moskaliuk
Relevance. The issues of replication and concentration of the human immunodeficiency virus (HIV) in various tissues and body fluids remain insufficiently studied. Solving this problem is hindered by the lack of simple, cheap and accessible methods for quantitative determination of HIV in various tissue samples. Objective is to establish a relationship between the presence of HIV-associated damage of the central nervous system (CNS), the number of CD4+ lymphocytes in the blood, and the level of HIV load in blood plasma and cerebrospinal fluid. The difference between the level of HIV viral load in different tissues and biological fluids may reflect the formation of several independent reservoirs of HIV replication in the human body. Materials and methods. 87 patients with HIV infection with clinical signs of central nervous system damage who had no experience of taking antiretroviral drugs (ARVP) were examined. Paired samples of blood and cerebrospinal fluid were analyzed to determine the level of viral load in both biological fluids, as well as the number of CD4+ lymphocytes in the blood. Results. It was established that the patient's presence of clinical signs of CNS damage was reliably correlated with the level of HIV load in the cerebrospinal fluid (logistic regression, P<0.001) and was not associated with the content of CD4+ lymphocytes or the level of HIV load in the blood (logistic regression, P >0.05). The level of HIV load in the cerebrospinal fluid (CSF) was on average 1.5 lg RNA copies/ml higher (P<0.001) in patients with neurological disorders despite the fact that the mean CD4+-lymphocyte count and HIV load in blood in both groups of patients did not differ. The difference between the HIV load in blood and cerebrospinal fluid of patients with neurological disorders was only 0.8 lg RNA copies/ml. Despite the similar indicators of the content of CD4+ lymphocytes and the amount of HIV in the blood, in HIV-infected patients with clinical signs of CNS damage, the level of HIV load in CSF is 1.5 lg RNA copies/ml higher, compared with patients without symptoms of CNS dysfunction (P <0.001). The difference between HIV load in blood and cerebrospinal fluid in the presence of neurocognitive disorders was reduced to 0.7 lg RNA copies/ml compared to 1.8 lg RNA copies/ml in the group of individuals without signs of CNS damage. The presence of HIV-associated damage to the central nervous system is not statistically related to the content of CD4+ lymphocytes or the level of HIV load in the blood. Statistical analysis showed that a CSF HIV load equal to or greater than 4.00 lg RNA copies/mL (10,000 RNA copies/mL) indicated a significant likelihood of HIV-associated CNS involvement in patients (P<0.001) . Conclusion. The method of determining the level of HIV load in cerebrospinal fluid samples can be used to optimize the diagnostic algorithm of HIV-associated lesions of the central nervous system, differential diagnosis with neurocognitive diso
关联人类免疫缺陷病毒（HIV）在各种组织和体液中的复制和浓缩问题仍然没有得到充分的研究。由于缺乏简单、廉价和可获得的方法来定量测定各种组织样本中的HIV，解决这个问题受到了阻碍。目的是建立HIV相关中枢神经系统（CNS）损伤的存在、血液中CD4+淋巴细胞的数量以及血浆和脑脊液中HIV载量水平之间的关系。不同组织和生物液中HIV病毒载量水平之间的差异可能反映了HIV在人体中复制的几个独立库的形成。材料和方法。对87名没有服用抗逆转录病毒药物经验的有中枢神经系统损伤临床症状的HIV感染患者进行了检查。对血液和脑脊液的配对样本进行分析，以确定两种生物液中的病毒载量水平以及血液中CD4+淋巴细胞的数量。后果研究表明，患者出现中枢神经系统损伤的临床症状与脑脊液中HIV载量水平可靠相关（logistic回归，P0.05）。尽管CD4+淋巴细胞计数和HIV的平均值在神经系统疾病患者的脑脊液中平均高1.5 lg RNA拷贝数/ml（P<0.001）两组患者的血液负荷没有差异。神经系统疾病患者血液和脑脊液中HIV载量之间的差异仅为0.8 lg RNA拷贝数/ml。尽管血液中CD4+淋巴细胞含量和HIV量的指标相似，但在具有中枢神经系统损伤临床症状的HIV感染患者中，CSF中的HIV载量水平高1.5 lg RNA拷贝数/ml，与没有中枢神经系统功能障碍症状的患者相比（P＜0.001）。在存在神经认知障碍的情况下，血液和脑脊液中HIV载量之间的差异降至0.7 lg RNA拷贝数/ml，而在没有中枢神经系损伤迹象的组中为1.8 lg RNA复制数/ml。HIV相关的中枢神经系统损伤的存在与血液中CD4+淋巴细胞的含量或HIV载量水平在统计学上无关。统计分析显示，CSF HIV载量等于或大于4.00 lg RNA拷贝数/mL（10000 RNA拷贝数/mL）表明患者存在HIV相关中枢神经系统受累的显著可能性（P<0.001）。确定脑脊液样本中HIV载量水平的方法可用于优化中枢神经系统HIV相关病变的诊断算法，与非感染性病因的神经认知障碍进行鉴别诊断。做出临床决定的阈值是CSF样本中的HIV载量水平，其等于或超过4.00lg RNA拷贝数/ml，这表明患者中存在HIV相关的中枢神经系统损伤的显著概率。
{"title":"BLOOD AND CEREBROSPINAL FLUID HIV LOAD INPATIENTS WITH HIV-ASSOCIATED NEUROLOGICAL DISORDERS","authors":"Y. Boiko, V. Moskaliuk","doi":"10.32345/2664-4738.3.2022.03","DOIUrl":"https://doi.org/10.32345/2664-4738.3.2022.03","url":null,"abstract":"Relevance. The issues of replication and concentration of the human immunodeficiency virus (HIV) in various tissues and body fluids remain insufficiently studied. Solving this problem is hindered by the lack of simple, cheap and accessible methods for quantitative determination of HIV in various tissue samples. \u0000Objective is to establish a relationship between the presence of HIV-associated damage of the central nervous system (CNS), the number of CD4+ lymphocytes in the blood, and the level of HIV load in blood plasma and cerebrospinal fluid. The difference between the level of HIV viral load in different tissues and biological fluids may reflect the formation of several independent reservoirs of HIV replication in the human body. \u0000Materials and methods. 87 patients with HIV infection with clinical signs of central nervous system damage who had no experience of taking antiretroviral drugs (ARVP) were examined. Paired samples of blood and cerebrospinal fluid were analyzed to determine the level of viral load in both biological fluids, as well as the number of CD4+ lymphocytes in the blood. \u0000Results. It was established that the patient's presence of clinical signs of CNS damage was reliably correlated with the level of HIV load in the cerebrospinal fluid (logistic regression, P<0.001) and was not associated with the content of CD4+ lymphocytes or the level of HIV load in the blood (logistic regression, P >0.05). \u0000The level of HIV load in the cerebrospinal fluid (CSF) was on average 1.5 lg RNA copies/ml higher (P<0.001) in patients with neurological disorders despite the fact that the mean CD4+-lymphocyte count and HIV load in blood in both groups of patients did not differ. The difference between the HIV load in blood and cerebrospinal fluid of patients with neurological disorders was only 0.8 lg RNA copies/ml. \u0000Despite the similar indicators of the content of CD4+ lymphocytes and the amount of HIV in the blood, in HIV-infected patients with clinical signs of CNS damage, the level of HIV load in CSF is 1.5 lg RNA copies/ml higher, compared with patients without symptoms of CNS dysfunction (P <0.001). The difference between HIV load in blood and cerebrospinal fluid in the presence of neurocognitive disorders was reduced to 0.7 lg RNA copies/ml compared to 1.8 lg RNA copies/ml in the group of individuals without signs of CNS damage. The presence of HIV-associated damage to the central nervous system is not statistically related to the content of CD4+ lymphocytes or the level of HIV load in the blood. \u0000Statistical analysis showed that a CSF HIV load equal to or greater than 4.00 lg RNA copies/mL (10,000 RNA copies/mL) indicated a significant likelihood of HIV-associated CNS involvement in patients (P<0.001) . \u0000Conclusion. The method of determining the level of HIV load in cerebrospinal fluid samples can be used to optimize the diagnostic algorithm of HIV-associated lesions of the central nervous system, differential diagnosis with neurocognitive diso","PeriodicalId":52737,"journal":{"name":"Medichna nauka Ukrayini","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48314364","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 : 2022-09-30DOI: 10.32345/2664-4738.3.2022.15
M. Khaitovych, L.L. Pinskyy, О. Temirova, V. Potaskalova, N.O. Saveliieva-Kulyk, V.O. Polovinka
Relevance. Among the professional competencies, a graduate of a medical faculty should not only determine drugs for the treatment of typical diseases, but also be able to correct errors in prescribing; warn, identify and report adverse drug reactions; advise patients on the correct intake of drug, etc., providing effective, safe and economically justified pharmacotherapy. These professional competencies are acquired when studying the discipline "Clinical pharmacology”. Objective – to consider the current data on teaching of the discipline "Clinical pharmacology" to students of medical faculties in European institutions of higher education. Methods. Analysis of data presented in PubMed using the keywords "clinical pharmacology", "undergraduate education", "medical". Results. Clinical pharmacology, as an educational discipline, is based on the data of evidence-based medicine and modern treatment standards, but at the same time teaches the personalized use of drugs (based on deep knowledge of pharmacokinetics and pharmacogenetics), while the patient receives the "right" drug, in the "right" dose, which allows you to minimize the risk of side effects and reduce adherence to therapy. Every £1 invested in clinical pharmacology saves £6 by reducing prescribing errors and adverse drug reactions, tackling polypharmacy and more. In 2018, European experts in clinical pharmacology and therapeutics reached a consensus on the key learning outcomes of students of medical faculties, - 34 competencies were developed (knowledge with 20 subcategories, skills with 11 subcategories, attitudes – with 3 subcategories), a plan for an integrated context-oriented European educational program in clinical pharmacology and therapy. Conclusions. The developed system of problem-oriented, integrated into the educational program of medicine, study of “Clinical pharmacology and therapy" in European institutions of higher education allows to ensure a uniform standard of prescription of drugs by graduates of medical faculties.
{"title":"TEACHING CLINICAL PHARMACOLOGY OF UNDERGRADUATE MEDICAL STUDENTS IN EUROPE: CURRENT TRENDS AND PROSPECTS. Review","authors":"M. Khaitovych, L.L. Pinskyy, О. Temirova, V. Potaskalova, N.O. Saveliieva-Kulyk, V.O. Polovinka","doi":"10.32345/2664-4738.3.2022.15","DOIUrl":"https://doi.org/10.32345/2664-4738.3.2022.15","url":null,"abstract":"Relevance. Among the professional competencies, a graduate of a medical faculty should not only determine drugs for the treatment of typical diseases, but also be able to correct errors in prescribing; warn, identify and report adverse drug reactions; advise patients on the correct intake of drug, etc., providing effective, safe and economically justified pharmacotherapy. These professional competencies are acquired when studying the discipline \"Clinical pharmacology”. \u0000Objective – to consider the current data on teaching of the discipline \"Clinical pharmacology\" to students of medical faculties in European institutions of higher education. \u0000Methods. Analysis of data presented in PubMed using the keywords \"clinical pharmacology\", \"undergraduate education\", \"medical\". \u0000Results. Clinical pharmacology, as an educational discipline, is based on the data of evidence-based medicine and modern treatment standards, but at the same time teaches the personalized use of drugs (based on deep knowledge of pharmacokinetics and pharmacogenetics), while the patient receives the \"right\" drug, in the \"right\" dose, which allows you to minimize the risk of side effects and reduce adherence to therapy. Every £1 invested in clinical pharmacology saves £6 by reducing prescribing errors and adverse drug reactions, tackling polypharmacy and more. \u0000In 2018, European experts in clinical pharmacology and therapeutics reached a consensus on the key learning outcomes of students of medical faculties, - 34 competencies were developed (knowledge with 20 subcategories, skills with 11 subcategories, attitudes – with 3 subcategories), a plan for an integrated context-oriented European educational program in clinical pharmacology and therapy. \u0000Conclusions. The developed system of problem-oriented, integrated into the educational program of medicine, study of “Clinical pharmacology and therapy\" in European institutions of higher education allows to ensure a uniform standard of prescription of drugs by graduates of medical faculties.","PeriodicalId":52737,"journal":{"name":"Medichna nauka Ukrayini","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46638791","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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