Pathomorphosis of Extrapulmonary Tuberculosis in Children

Aim. To study clinical and epidemiological aspects of pathomorphosis of extrapulmonary tuberculosis clinical forms.Materials and Methods. Retrospective analysis of 138 case histories in children aged to 15 years, obtaining extrapulmonary tuberculosis treatment in a specialized children\u27s hospital during 1988-2015 was carried out. Among them, in 103 children, clinical forms of extrapulmonary tuberculosis combined with respiratory tuberculosis and in 35 children independent forms of extrapulmonary tuberculosis were found. Studied stage (1988-2015) was divided into 3 periods: I – 1988-1997, II – 1998-2007, III – 2008-2015.During 2008-2015, incomparison to previous periods, the number of cases of peripheral lymph node tuberculosis (PLN), meninges and central nervous system tuberculosis, bones and joints tuberculosis, and ocular tuberculosis decreased. In 2008-2015, the share of combined forms of meninges and central nervous system tuberculosis and ocular tuberculosis remained at 1998-2007 level. During 2008-2015, skin tuberculosis was not diagnosed. Nevertheless, in 2008-2015, in6.8±10.2 % of cases extrapulmonary tuberculosis combined with miliary tuberculosis, and in 5.8±10.4 % of cases the process characterized by lethal outcome, moreover 4.9±10.7% from them – in recent years. It is important that during period I, in 19.6±13.2 % of cases extrapulmonary tuberculosis combined with respiratory tuberculosis in reverse development phases, during period II – in 12.9±19.3 % of cases, during period III – in 23.8±21.2 % of cases.Conclusion. Despite the reduction, extrapulmonary tuberculosis combined with severe forms of respiratory tuberculosis, which led to lethal outcome in children in 5.8±10.4% of cases. Tuberculosis epidemiological situation worsening, reversion of severe forms of tuberculosis with the development of extrapulmonary one and several organs injuries in children shows the necessity of social, preventive and therapeutic measures intensification among children

Improvement of Possibilities of Treating Pneumonias in Patients on the Background of Acute Myeloblast Leucosis in the Aspect of Immunoresistance Mechanisms

Aim: to analyze the influence of the immunomodeling preparation glutamyl-cysteinyl-glycine disodium (glutoxim) on indices of cellular and humoral immunity in patients with pneumonias on the background of acute myeloblast leucosis to form new approaches to the improvement of treating pneumonias in patients with immunity disorders.Materials and methods. The research group - 37 patients with pneumonia on the background of acute myeloblast leucosis, who underwent the program treatment on the base of the hematological center “MI city multi-profile clinical hospital №4” Dnipro city, 2014-2015. The age of patients from 23 to 45 years old; 10 women and 27 men. The diagnosis of leucosis and pneumonia forms was verified corresponding to modern conventional clinical and morphological criteria. Patients from the main research group (n = 18) were prescribed with glutamyl-cysteinyl-glycine disodium by the scheme 2 ml of 3 % (60 mg) i/v № 10 in mornings, summary dose - 300 mg. Indications of immunograms were studied: Т-lymphocytes, В-lymphocytes and their subpopulation composition (CD3 +, CD4 +, CD8 +, CD19 +, CD19-, CD16 +, CD56+) using the flowing laser cytofluorimetry. Immunoglobulin levels were determined by the method of immunoturbometry. Indications of immunograms were assessed in the treatment dynamics. The statistical processing – using packages of applied programs «Excel» and «Statistic 10».Results. According to the analysis of indices of the cellular and humoral immunity of patients with pneumonia on the background of acute myeloblast leucosis, the process of glutamyl-cysteinyl-glycine disodium use proved the statistically reliable activation of phagocytosis and anti-infectious defense indices. The dynamics of humoral immunity indices also proved the positive influence on the state of the immune reactivity of the organism with the reliable increase of ІgА and Іg М, responsible for neutralization of infectious agents and bacterial toxins.Conclusions: The use of the ummunomodeling preparation glutamyl-cysteinyl-glycine disodium (glutoxim) in patients with pneumonia on the background of acute myeloblast leucosis results in the improvement of indices of cellular and humoral immunity and phagocytosis activation. The research results prove the possibility of optimization of approaches to treating pneumonias in patients with severe immunity disorders by using immunomedeling therapy by glutamyl-cysteinyl-glycine disodium (glutoxim)

Assessment of Risk Factors of Septic Complications of the Puerperium

Postpartum purulent-septic complications (PPSC) and their problems are most urgent for modern obstetrics due to their significant frequency. Maternal sepsis is one of the leading causes of maternal mortality around the world, accounting for about one-tenth of the global number of maternal deaths. Understanding the risk factors for the development of septic complications of puerperium is important for preventive strategies.Aim. To study the possibility of forming high-risk groups on the basis of analysis of anamnestic data and the course of puerperium in women with PPSC as part of the preventive measures for the development of such complications.Materials and methods. The first stage of the study involves a retrospective analysis for the allocation of risk factors for the development of PPSC in women, who underwent inpatient treatment for this pathology - main group (n=108); сontrol group (n=35) – parous with uncomplicated flow of the postpartum period. Prospective research enrolled 65 pregnant women with extragenital pathology and/or complicated pregnancy (group 1); 30 pregnant women without severe concomitant somatic pathology with physiological course of pregnancy (group 2). The following were taken into account: age, obstetrical and gynecological history, extragenital pathology, laboratory diagnostic data. Differences in mean values were considered significant with a probability level of at least 95 % (p<0.05).Results. To the risk factors for the development of PPSC, we classified as follows: gynecological diseases in history: menstrual dysfunction, chronic inflammatory diseases of the genital organs, bacterial vaginosis; complications of pregnancy and labor: preeclampsia, preterm labor, premature rupture of membranes, long anhydrous span, chorioamnionitis, weakness of labor, genital tract ruptures, placental attachment pathology, operative vaginal birth, bleeding; concomitant extragenital pathology: diabetes, obesity, diseases of the urinary system, diseases of the cardiovascular system, respiratory diseases, varicose disease, anemia.Conclusions. The connection between the presence of concomitant somatic pathology, the complicated course of pregnancy and labor and the subsequent development of septic complications in the postpartum period have been established. Prediction of the risk of their occurrence at the stage of pregraviditic preparation, with various complications of pregnancy and childbirth, especially in women with extragenital pathology, differential prevention will reduce the frequency of PPSC

Cypc19*17 Polymorphism as a Risk-factor for Nsaids-induced Ulcers

The new risk-factors for peptic ulcers induced by the use of nonsteroidal antiinflammatory drugs, such as polymorphism of different isoenzymes of cytochrome P450 were considered in the article. The aim of the research was to study different genetic polymorphism of several ferments CYP2C9 and CYP2C19 in inclination to NSAIDS-gastropathies by the way of estimation the risk of appearance of Helicobacter pylori (HP)-positive or Hp-negative NSAIDS- induced peptic ulcers, complicated or not with upper gastrointestinal bleeding.124 persons were examined (76 men, 48 women in the age of 56,2+/–9,1 years) with Hp-positive or Hp-negative NSAIDS-induced peptic ulcers, that were performed genotyping of isoferments of cytochrome system (CYP2C9, CYP2C19). Based on investigations of 5 different isoenzymes (CYP 2C9*2, CYP 2C9*3, CYP 2C19*2, CYP 2C19*3 and CYP 2C19*17). It was founded that peptic ulcers are strictly associated only with CYP 2C19*17-genotype, possibly due to its involvement in arachidonic acid metabolism and gastroprotection. Thus, polymorphism CYP 2C19*17 can be considered as one of the risk factors for NSAID-gastropathy though the future researches are needed

Indicators of Respiratory System in Conditions of Chronic Action of Harmful Environmental Factors with Type of Body Constitution

The article presents the results of the study of the peculiarities of the respiratory system functioning in unfavorable environmental conditions in workers involved in industrial production and agrarian sector, taking into account the type of constitution of their bodies. Investigation of the influence of the complex of anthropogenic factors associated with production on the parameters of the respiratory system revealed a significant level of interconnection of the investigated parameters with anthropometric indicators.During the experiment, a significant decrease in the functional lung capacity in the studied subjects involved in industrial production was shown, compared with the control group and workers of argo-industrial production. Such a trend may be evidence of functional violations of tracheobronchial conduction, which is indirectly confirmed by the values of the Tifno index, which is the main method of an objective assessment of respiratory tract imperfections, and which is characterized by significantly lower values in the group of workers involved in industrial production compared with residents relative to environmentally friendly areas.The analysis of the pneumatachographic survey performed on the basis of the Pignier index revealed some differences in the functional parameters of the respiratory system in the groups of hyposthenics (capacity of the lungs) and hypersthenics (maximum volume velocity of 75 %). In the group of normosthenics, intergroup differences were found for the values of functional lung capacity in comparison with all groups, and for the Tifno index, the reliable difference between the indicators was noted only between the group of industrial workers and the control group

Experimental Approval of the Efficacy of the Combined Composition Rectal Cream New Test-samples in the Conditions of Acute Complicated Anal Fissure in Rats

Anal fissure (AF) is one of the most common anorectal problems. The severity of the disease, the chronicity of the pathological process and frequent complications lead to a sharp deterioration in the quality of life of patients. An important place in the treatment of anal fissure is occupied by drugs that affect its key mechanism of pathogenesis, namely, reduce the muscle tone of the internal anal sphincter and have anti-inflammatory, analgesic, and reparative properties.Aim: conducting of screening studies of the effectiveness of new test samples of rectal cream of the combined composition (RCCC) on the model of acute complicated anal fissure in rats and determining the optimal composition of the potential drug.Materials and methods. The research was conducted on the basis of the Central Scientific Research Laboratory of the National Pharmaceutical University (CSRL NUPH) in the spring (April) season of 2015 on the female rats.A study of test specimens of the rectal cream of the combined composition was performed on a modified model of acute anal fissure. The effectiveness of the treatment was evaluated in terms of (0 to 2) severity of edema, hyperaemia, local bleeding, purulent necrotic processes, scapular formation, anatomical defect, and a general indicator of the severity of the pathological process (by the sum of the points for all the criteria that were analyzed). The level of proinflammatory PGE2 in serum was determined by the immune enzyme method.Results. The RCCC sample No. 4 showed the most expressive therapeutic effect among the four samples under study, and had credible benefits to the inhibitory effect on purulent-necrotic processes, as expressed by the differences in the overall rate of the pathological process (6 days: 5.83±0.47 points against 7.00±0.37; 7.83±0.31 under the influence of RCCC No. 2, No. 3, respectively, and for 11 days 5.00±1.03 versus 6.83±1.28 points (p=0.08 ) under the influence of RCCC No. 1). The ability of RCCCs No.1 and No.4 to reduce the level of pro-inflammatory PGE2 in blood serum of rats compared with CP in 1.8 and 2.0 times, respectively, contributed to accelerating epithelization and scar formation. The advantages of RCCC No. 4 on the comparison of the ointment "Proctozan" with the reduction of the period of epithelization of the defect of the mucous membrane of the anal canal for 3 days (for 7 days – RCCC No. 4, for 10 days - ointment "Proctozan").Conclusions. The rectal cream of the combined composition No. 4 showed the greatest efficacy, had advantages over the comparison ointment "Proctozan", and is promising for the creation on its basis a new drug for the treatment of anal fissures

Matrix Metalloproteinase-9 and Inflammation in Different Types of Multiple Sclerosis

Different clinical courses of multiple sclerosis, heterogeneity of its clinical implications, different effect of immunomodulatory therapy for the same clinical forms implies various pathogenetic mechanisms of central nervous system damage at this disease. Applicability of immunological and biochemical markers for the estimation of immunocorrecting and anti-inflammatory therapy efficacy is important. This research aims at improvement of pathological process stages diagnostics at multiple sclerosis and further therapy optimization depending on the activity of the inflammatory process. In the article matrix metalloproteinase-9 rate was assessed in 135 patients with multiple sclerosis of different course types and at different activity stages of the pathological process. The highest matrix metalloproteinase-9 rates were in patients with relapsing-remitting type at the stage of exacerbation, with the lowest rate being in patients with primary-progressive multiple sclerosis. Determination of matrix metalloproteinase-9 rate allows to assess the degree of inflammatory process expression and to monitor the efficacy of multiple sclerosis treatment

Results of Radical Surgical Treatment of Cholangiocarcinoma

Radical operations of cholangiocarcinomas are connected with the great number of post-operative complications, and lethality reaches 15-30 %. The most debatable questions remain the choice of the operation type depending on localization and spreading of a tumor and also the expedience of using mini-invasive technologies as a preoperational preparation to the radical surgical treatment. We would like to share the little experience of the radical surgical treatment of cholangiocarcinomas.The research aim is to analyze results of radical surgical treatment of patients with cholangiocarcinoma.Matherials and methods. We have analyzed the outcomes of surgical treatment in 18 patients with cholangiocarcinomas. Tumor localization was determined according to the Bismuth-Corlett classification. Type 1 tumors were found in 2 (11.1 %), type 2 in 4 (22.2 %), type 3А in 5 (27.8 %), type 3B in 4 (22.2 %), type 4 in 1 (5.6 %), and distal localization in 2 (11.1 %) patients. As biliary decompression, 9 (50 %) patients underwent percutaneous transhepatic biliary duct drainage (PTBD), and another 9 (50 %) patients were operated without preoperative biliary decompression Pre-operative embolization of portal vein branches with the aim to increase the low volume of liver after anticipated resection was performed in 4 (22.2 %) patients.Results. After the embolization of portal vein branches, the estimated residual volume of hepatic parenchyma increased from 33.4 % to 45.7 %. Patients with cholagiocarcinomas of different localization performed the radical operations: isolated hepaticocholedochus resection in 5 (27.8 %) patients, hepaticocholedochus resection combined with Taj Mahal hepatic resection in 1 (5.6 %), right hemihepatectomy in 5 (27.8 %), left hemihepatectomy in 4 (22.2 %), extended right hemihepatectomy in 1 (5.6 %), and pancreoduodenal resection in 2 (11.1 %) patients. Complications of radical surgeries were observed in 4 (22.2 %) patients. Lethal outcomes occurred in 3 (16.7 %) patients.Conclusions. Radical operations are attended with complications in 22,2 % and lethality in 16,7 %. As a preoperative preparation it is possible to use mini-invasive interventions for the biliary decompression and increase of hepatic parenchyma volume

Method of Stimulation of Pharmacy Workers Involved in the Government Program “Available Medicines”

The aim is to study the current state of the organization of work in pharmacies under the government program “Available medicines” and to create proposals for the improvement of material incentives to increase the motivation of workers of such pharmacies.Materials and methods. The research used the general methods of scientific knowledge: analysis and synthesis, analogy and comparison; method of questioning to determine the actual state and opinions of specialists on the organization of work in the conditions of pharmacy participation in the program "Available medicines".Results and discussion. In the course of the study, the problem of lack of incentives and motivation for the work of pharmacy workers under the Government program "Available medicines" has been highlighted. According to the results of the survey of specialists of three different forms of pharmacy' ownership, participating in the program of reimbursement of the cost of drugs, it was found that the volume and intensity of work of workers has significantly increased, and wages have remained at the same level. The number of operations performed by employees in such pharmacies has considerably increased, which is related to the registration and maintenance of recipes under the program "Available medicines". The questionnaire survey has showed that the best option for optimizing the organization of remuneration in the prevailing conditions would be to pay extra for work (overpays). It was found that the number of recipes taken by one pharmacist per day varies considerably in different pharmacies, and there are also differences in the duration of the work of pharmacies under the reimbursement program during the month. To increase the motivation of pharmacists to work in the prevailing conditions, the method of calculating the additional payment for work in the conditions of the program "Available medicines" for each chemist's worker is offered individually in accordance with the post based on a formula that takes into account the intensity of labor using the intensity coefficient and the percentage of the additional payment.Conclusions. The conducted researches have shown that the increased intensity of labor, which takes place in pharmacies working under the program "Available medicines", is the basis for the calculation of additional payments. The application of the system of material stimulation of the work of pharmacists based on the proposed methodology will allow compensating additional labor of specialists, taking into account the intensity of their work

Medical Genetic Counseling Of Women With Congenital Heart Diseases Of Fetus

Aim of the work. Determine the effectiveness of prenatal diagnosis of congenital heart defects in the fetus and the informativeness of different markers used in the medical-genetic counseling of pregnant women..Materials and methods. The analysis of the results of medical genetic counseling of pregnant women with fetal heart diseases was carried out. The effectiveness of using different methods of prenatal diagnosis in 67 pregnant women is estimated. The data of somatic, genealogical and reproductive anamnesis, biochemical markers of chromosomal pathology of the 1st and 2nd trimester of pregnancy, and the spectrum of the detected fetal heart disease were studied.Results of the research. It was found that 46 (68.7 %) women had somatic diseases: pathology of the cardiovascular system (11.9 %); endocrine system - at 8 (11,9 %); respiratory disease – 3 (4.5 %) and urinary system – 2 (3.0 %). 13 (19.4 %) out of 67 women had acute respiratory viral infections in the first trimester of pregnancy. In 4 (6 %) cases - bad habits. The first time pregnant were 31 (46.3 %) women, 21 (31.3 %) – the second time, 10 (14.9 %) in the third, and 5 (7.5 %) in the fourth or more times. In history, 58 (86.6 %) women did not have reproductive function disorders, 8 (11.9 %) had unauthorized miscarriages and frozen pregnancy. The burden of gynecological anamnesis was observed in 12 (17.9 %) women, and hereditary - in 6 (9.0 %) women. In the structure of congenital defects of the heart, false anatomical anomalies were found more often: hypoplasia of the left heart organs – 14 (20.9 %), tetralogy of Fallot - 9 (13.3 %). Biochemical markers of chromosomal pathology in the first trimester in 11 (16.4 %) women recorded indicators that are characteristic of the risk of chromosomal pathology, and in the second trimester – in 9 (13.4 %). Two pregnant women used a NIPT (non-invasive prenatal test) test that did not detect chromosomal abnormalities in the fetus. In 8 cases, invasive prenatal diagnosis of the fetus was recommended, which was carried out by three women, and five refused.Conclusions. The peculiarities of somatic (in 46–68.7 % of women), reproductive (in 8-11.9 % of women) gynecological anamnesis (in 12–17.9 % of women), which can be the risk factors of congenital fetal heart disease, are revealed. In the structure of congenital defects of the heart of the fetus more often revealed hypoplasia of the left heart organs – 14 (20.9 %), tetralogy of Fallot – 9 (13.3 %). In 11 (16.4 %) women recorded indicators of biochemical markers, characteristic for the risk of chromosomal pathology, in the first trimester, and – in 9 (13.4 %) pregnant women – in the second trimester. Comparative data on prenatal diagnosis of congenital heart defects in the fetus of chromosomal, monogenic and multifactorial etiology are given. On the basis of the obtained results an algorithm of medical-genetic counseling of this contingent of patients was offered