№2' 2017


Kharkiv Medical Academy of Postgraduate Education
City Clinical Hospital № 1, Sumy, Ukraine
The effect of eplerenone on the galectin−3 dynamics and the state of post−infarction remodeling in patients with right ventricle myocardial infarction
5 - 10
Mainstreaming of urgent reperfusion strategy in treatment of myocardial infarction with ST−segment elevation has made it possible to achieve significant results in reducing hospital mortality. However, development and progression of heart failure is still a frequent complication of both acute period of myocardial infarction, increasing the risk of death, and a factor significantly aggravating the long−term prognosis in such patients. The key role in formation of acute myocardial dysfunction is played by activation of renin−angiotensin−aldosterone system, the effects of which consist in development of endothelial dysfunction, myocardium hypertrophy, activation of inflammation and fibrosis. Additional administration of aldosterone antagonists in patients with myocardial infarction and reduced systolic function of the left ventricle is accompanied by a significant improvement in survival rates. The study comparing the results of treatment with eplerenone and traditional therapy was performed with the purpose to evaluate the effect of selective aldosterone antagonist eplerenone on the dynamics of galectin−3 and the state of post−infarction remodeling in patients with right ventricle myocardial infarction against a background of the Q− myocardial infarction of the left ventricular posterior wall. All patients were performed Doppler echocardiography on the 4th−5th day of myocardial infarction and 6 months after it. Galectin−3 concentration was determined on the 2nd day of myocardial infarction and 6 months after it using immunoenzyme assay. Significant reduction in the size and volume of the left and right ventricle, reduction of the diameter of the left and right atria, increase in left ventricle ejection fraction and right ventricle shortening fraction were noted in the dynamics of the treatment, normalization of the left and right ventricle diastolic function was registered after 6 months of therapy. Our findings demonstrate that addition of eplerenone to standard therapy in patients with right ventricle myocardial infarction against a background of the Q−myocardial infarction left ventricle posterior wall is associated with a significant improvement of systolic function and diastolic filling of the left a significant reduction of galectin−3 concentration within the 6−month follow−up.
Key words: eplerenone, right ventricular myocardial infarction, galectin-3, myocardial remodeling, diastolic dysfunction.
Ukrainian State Research Institute of Medical and Social Problems of Disability, Ministry of Health of Ukraine, Dnipro, Ukraine
The features of structural and functional state of the heart in patients with hypertension after stroke
11 - 19
Structural and functional characteristics of the heart state were investigated in patients with grade 3 hypertension in the remote period after ischemic stroke. All patients were performed circadian blood pressure monitoring, Doppler echocardiography, ultrasonography of brachiocephalic arteries. Left ventricular hypertrophy occurred in almost half of the patients. The persons with concentric and eccentric left ventricular hypertrophy had diastolic and systolic dysfunction (increase in size and index of left atrial end−diastolic size and volume, end−systolic index size and end−diastolic volume), left ventricle compensatory hypertrophy (increased thickness of the posterior myocardial wall and interventricular septum, and myocardial weight and mass index). The patients with hypertension with eccentric hypertrophy were characterized by right ventricular diastolic dysfunction (increased are and right atrium area index). At concentric remodeling the patients with the history of stroke demonstrated a significant reduction in end−diastolic volume and size and their indices and increase in the thickness and relative thickness of the left ventricle myocardium posterior wall. In all cases, these changes were due to duration of uncontrolled arterial hypertrophy, constitutional features, remodeling of the heart and blood vessels. Determining the factors influencing the structural and functional features of the heart in patients with hypertension should be the basis for stratification of total cardiovascular risk and development of individual programs for rehabilitation of disabled persons with this disease.
Key words: arterial hypertension, stroke, heart remodeling, heart structures.
V. N. Karazin Kharkiv National University
V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
Hypertension degree and frequency of administration of certain groups of cardiac drugs in patients at the annual follow−up stage of pace−maker implantation
19 - 23
At present permanent endocardial pacemaking and cardiac resynchronization therapy are recognized and effective methods of treatment of severe rhythm and conduction disorders, as well as chronic heart failure resistant to medication therapy. Pacemaking significantly improves the quality of life and reduces the death rate of the patients. Arterial hypertension is the most common comorbid pathology in patients with implanted pacemakers. Despite the fact that pacemaker implantation normalizes ventricular pump function and improves the quality of life of patients, it can cause blood pressure instability and progression of hypertension. This investigation evaluated the frequency of administration of major groups of cardiac drugs in patients with pacemakers at the annual stage of observation, depending on the degree of hypertension. The results showed that at the annual stage of pacing in patients with arterial hypertension, the frequency of administration of beta−adrenoblockers, Ca antagonists, ACE inhibitors, angiotensin II receptor blockers, antiarrhythmic drugs and inhibitors of HMG CoA reductase increased. The frequency of administration increased due to the increase in arterial hypertension degree. The patients with implanted pacemakers require individualized medication approach, taking into account the degree of arterial hypertension, in particular, strengthening anti−ischemic, anti−hypertensive and anti−arrhythmic therapy.
Key words: pacing, hypertension, drug therapy, annual follow-up period.
Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
Long−term results of cardiac surgery in patients with infective endocarditis
24 - 27
Surgery for infectious endocarditis is the most important method of treatment. Studies on long−term follow−up of the patients who were performed valvular prosthesis implantation relate mainly to the occurrence of complications and repeated operations in this regard. However, assessment of clinical, instrumental and laboratory indicators associated with a fatal risk, analysis of their dynamics depending on the presence of concomitant pathology, are still relevant for practical health care. Our investigation allowed studying the long−term prognosis in 53 operated patients with infective endocarditis, as well as the factors influencing the course of the disease. The patients underwent grafting of one or two valves (aortic and mitral), mitral valve plastic surgery. During five years of observation, nine patients died, in three cases due to non−cardiac events. The analysis of clinical instrumental findings obtained at different observation times in these patients indicated that they had higher creatinine level, lower creatinine clearance level, higher content of NT−pro−BNT natriuretic peptide compared to the surviving patients. The obtained data allowed concluding that the risk of death in patients who underwent cardiac surgery for infectious endocarditis is associated with reduction in the renal function and increase in the level of NT−pro−BNT, which indicates myocardial dysfunction development.
Key words: infective endocarditis, cardiac surgery, atrial fibrillation, survival.
V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
The choice of photosensitizer and light parameters for endobronchial endoscopic photodynamic therapy
28 - 32
Postoperative complications in thoracic surgery are a frequent cause of deaths, they extend the period of treatment, lead to disability. One of the causes of is airway obturation with mucus, phlegm, blood clots. A group of high−performance, versatile and safe methods of treatment includes low−energy laser radiation. Antimicrobial photodynamic therapy (PDT) is a method for inactivation of microbial cells by radiation source with the corresponding wavelength and photosensitizer. In order to identify the most promising for photodynamic therapy photosensitizers, antiseptics, optical absorption spectra of antiseptics, most commonly used in medical practice, have their own color, peaks of optical absorption of which lie within the visible and near infrared spectral bands, was monitored. Aqueous solutions of: methylene blue, gentian violet, fuchsin, brilliant green as well as solutions of eosin, n tolluidin blue, furacilin at dilution of 1:5000, dioxydine, iodine dicirine were investigated. Spectrophotometry was conducted on the solutions proposed with SF−56 spectrophotometer in spectral range 190−1100 nm. The antibacterial effect of photodynamic therapy was studied in relation to one of the major causative agents of acute and chronic purulent inflammation of the tracheobronchial tree Staphylococcus aureus. The findings of the investigation demonstrate a marked photodynamic effect of methylene blue with the visible part of the spectrum and ultraviolet radiation. To develop a method for treatment of inflammatory diseases in patients with tracheobronchial pathology by the use of endoscopic photodynamic treatment, laser light of the red spectral range was selected. Laser radiation coherence allows sending it to the optical fibers, which is impossible for the LED light of the same power. Methylene blue was shown to be the most effective.
Key words: photodynamic therapy, antiseptic photosensitizers, antibacterial activity.
Kharkiv National Medical University, Ukraine
Neck gastrostomy at esophagogastroplasty
32 - 36
Formation of esophageal anastomosis at esophagogastroplasty is associated with a high incidence of complications. The main cause of mortality after esophagogastroplasty is the failure of esophageal anastomosis. The results of surgical treatment of patients with scar strictures of the esophagus after the burns were investigated with the purpose to improve the results of esophagogastroplasty by prevention of postoperative complications. The method of surgery included extirpation of the esophagus with simultaneous transhiatal esophagogastroplasty with formation of a single esophagogastroanastomosis and contact gastrostomy on the left side of the neck. Intraoperatively nasogastric tube was applied in patients with partial failure of the formed esophagogastroanastomosis as a postoperative complication was not removed and it was used for enteral feeding and limited the zone of the anastomotic failure until its closure. The developed method of one−step transhiatal esophagogastroplasty with single esophagogastroanastomosis and contact gastrostomy on the left side of the neck in patients with extended postburn esophageal stricture in the state of compensation and subcompensation can be considered as the treatment of choice.
Key words: esophagogastroplasty, neck gastrostomy, transhiatal approach.
Kharkiv National Medical University, Ukraine
The state of endometrial receptors at hyperplastic processes in perimenopausal women
37 - 40
Endometrium hyperplasia in patients of childbearing age is one of the causes for reproductive health aggravation. The diagnosis of endometrial hyperplasia is based on subjective morphological criteria of changes in the endometrium tissue. In the perimenopausal period the hormonal status of women undergoes profound restructuring. To determine the condition of the endometrium we examined the patients in the perimenopausal period with glandular and adenomatous hyperplasia. It was revealed that the condition of endometrial receptors in patients with diffuse glandular endometrial hyperplasia showed increased expression of progesterone receptor at increased or maintained level of expression of estrogen receptors. Expressed glandular hyperplasia against a background of preserved level of expression of estrogen receptors was characterized by a slight increase in the level of proliferation marker K−67. A distinctive feature of adenomatous hyperplasia was expression estrogen and progesterone receptors but the level of Ki−67 proliferation was negative. The women with hyperplastic processes in perimenopausal period have a certain level of proliferative activate nuclei of endometrial cells in the uterine mucosa due to the amount of cellular genetic material. Therefore, the use of diagnostic criteria for endometrial receptors assessment may help to predict the course of the disease and differentiated approach to choosing treatment strategy in patients with endometrial hyperplasia.
Key words: endometrial hyperplasia, progesterone receptors, estrogen receptors, proliferation markers.
Kharkiv National Medical University, Ukraine
The state of hyperplastic endometrium depending on enzymes activity in perimenopausal women
41 - 44
Proteolytic enzymes are one of the mechanisms for controlling the functions of organs and tissues, playing a regulatory role in the molecular mechanisms of biological processes, i.e. cell division, differentiation and morphogenesis. The family of matrix metalloproteinases is a group of related zinc−containing proteolytic enzymes (endopeptidases) destroying the basal membranes and extracellular matrix under physiological and pathological conditions. In gynecological practice, one of the most common diseases associated with restructuring and proliferation of the epithelial tissue is endometrial hyperplasia. The purpose of this study was to examine the state of the endometrium in perimenopausal period and match the degree of activity of matrix metalloproteinases and their tissue inhibitors at endometrial hyperplasia. Histological scrapings of the uterine cavity revealed morphological characteristics typical of a simple and complex form of endometrial hyperplasia. Multiple increase in the levels of expression of MMP−1 and MMP−9 and TIMP−1 expression and gene TIMP−2 was revealed, indicating significant disorders of the enzyme activity of the extracellular matrix. Determination of the concentration of matrix metalloproteinases (MMPs−1, MMPs−9) and their tissue inhibitors (TIMP−1, TIMP−2) in the endometrium can be used for predicting development of hyperplasia and diagnosis of the degree of the pathology with the purpose to develop the most effective treatment. The findings of this study can also promote quantitative risk assessment of occurrence of hyperplastic processes and predict their development before clinical manifestation.
Key words: endometrial hyperplasia, matrix metalloproteinases, tissue inhibitors, perimenopausal period.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Treatment of exo− and endocervicitis associated with nonspecific mixed infections of the lower genitals in women of reproductive age
44 - 47
A marked increase in infectious and inflammatory diseases in women under the age of social and reproductive activity has been noted. The frequency of dysbiosis of vaginal biotopes and cervical inflammatory diseases associated with nonspecific mixed infection, does not tend to decrease. Treatment of nonspecific exo− and endocervicitis involves the use of antibacterial, anti−inflammatory drugs predominantly of local action, in particular vaginal suppositories characterized by high bioavailability, absence of damage to saprophyte automicroflora, easy use, avoiding the risk of adverse reactions, prevention of background (precancerous) diseases of the cervix, that is of particular medical and social importance. A study was conducted in which the clinical efficacy of vaginal suppositories containing chloroquinaldol (quinofucine) was studied at exo− and endocervicites associated with nonspecific mixed infection of the lower genitalia in women of reproductive age. All patients underwent a comprehensive examination including clinical, gynecological, cytomorphological, bacteriological studies, simple and complex colpocervicoscopy. Treatment of patients with exo− and endocervicitis was performed by intravaginal application of chinofucin (1 suppository 2 times a day for 7−10 days). The results of the treatment showed that on the 7th day of treatment the patients secretion from the genital tract reduced, the phenomena of dyspareunia were absent, the level of leukocytes in the vaginal discharge and cervical canal reduced. By the 10th day, reduction in the number of epithelial cells was noted, lactobacillary microflora dominated in the microbial composition of the vaginal biotope, the purity of the vagina corresponded to grade 1−2. Thus, the use of vaginal suppositories of chinofucin (Lekhim, Ukraine) containing chlorquinaldol, in patients with nonspecific exo− and endocervicitis promotes effective eradication of pathogenic cocco−bacillary microflora without suppressing the saprophytic autoflora of the vaginal biotope, has a pronounced anti−inflammatory effect, promotes restoration of microbiocenosis, that allows the use of this medicine in infectious and inflammatory diseases of the vagina and cervix in women of reproductive age.
Key words: exocervicitis, endocervicitis, nonspecific infections, vaginal suppositories сhinofucin, clinical efficiency, women of reproductive age.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Placental dysfunction
47 - 51
The review of the lithosphere reflects the prevalence, etiology, pathogenesis, occurrence of placental dysfunction in pregnant women. The main pathogenetic mechanisms of its occurrence are presented. The physiological changes in the organism of the pregnant woman leading to formation of syndrome of endothelial dysfunction in the fetoplacental complex, observed even in the physiological pregnancy, are indicated. The forms and degrees of placental dysfunction are described. Particular attention is paid to formation of the fetal development delay syndrome as a consequence of placental dysfunction in pregnant women. The main instrumental diagnostic methods detecting the presence of placental dysfunction are indicated. The relationship between the onset of placental dysfunction and the presence of thrombophilic conditions in pregnant women is reflected. The indications for hospitalization in the obstetric hospital in the presence of placental dysfunction are indicated. Widely used in treatment of placental dysfunction pharmacological drugs are described indicating the pathogenetic mechanisms of their effect on the causes of its occurrence. The literature data indicating the efficacy of L−arginine, low−molecular heparin, aspirin, dipyridamole in treatment of placental dysfunction, the use of which results in a significant improvement in the state of a woman and the intrauterine fetus due to improvement in blood circulation in the utero−placental−fetal circulation, normalization of endothelial function, changes in the system of hemostasis in the presence of thrombophilic conditions in pregnant women, are reported. The ways of correction of hypogalactia in the early postpartum period in pregnant women with placental dysfunction are featured.
Key words: placental dysfunction, diagnosis, treatment.
M. I. Sitenko Institute of Spine and Joints Pathology of the Spine of National Academy of Medical Sciences of Ukraine, Kharkiv
Medical Diagnostic Center «MDC&minus
LUX», Kharkiv, Ukraine
Modern treatment of vertebrogenic cervicobrachialgia by CT controlled local injection therapy
52 - 54
Degenerative changes in the vertebral motor segments of the cervical spine are often accompanied by pain syndrome in the upper limb. An effective method of treatment of vertebrogenic cervicobrachialgia is introduction of steroids directly to the changed parts of the vertebral motor segments that form the pain syndrome. This study evaluates the results of treatment of vertebrogenic cervicobrachialgia after local injection therapy in the foraminal opening of the affected segment under the control of computed tomography. Intensity of pain syndrome was determined using visual analogue scale. Evaluation of the regression of pain syndrome was performed immediately after injection, 7 days, 3 months, one year later. The results of the study showed that this technique is an effective and safe component of complex treatment of such patients. Positive results of treatment of vertebrogenic cervicobrachialgia manifesting by regression of pain syndrome during the first week were achieved in 44.3 % of patients, and in the first three months in 97.9 % of patients with persistent clinical result during the year.
Key words: cervicobrachialgia, CT control, local injection therapy, foraminal blockade.
M. I. Sitenko Institute of Spine and Joints Pathology of the Spine оf National Academy of Medical Sciences of Ukraine, Kharkiv
Regional Hospital Center for Emergency Medical Care and Disaster Medicine, Kharkiv, Ukraine
Peculiarities of MRI at visualization of burst fractures of the lower thoracic and lumbar spine
55 - 59
At burst vertebral fractures, magnetiс resonance imaging allows to assess the state of intervertebral discs, ligaments, presence of hematoma and thereby predict the course of spinal segment regeneration. To study the distribution of the hematoma and to establish the presence of other factors arising during a burst fracture of the vertebral body affecting the course of regeneration of the vertebral body, MRI diagnosis was performed in 42 patients with incomplete burst fracture (А3.1), incomplete explosive fracture with cleavage (A3.2), complete burst fracture (А3.3), a burst fracture with distraction (AB), a burst fracture with rotation (AC) according to the classification of F. Magerl et al. (1994). The results of the investigation allowed the following conclusions. Magnetic resonance imaging is an informative method of diagnosis of burst fractures of the spinal column and can predict the course of deformity development and regeneration processes of vertebral body. Only MRI can diagnose rupture of the ligament and disc, predict the course of residual deformation of the spinal column and choose the right method of treatment −− conservative or surgical. In the majority of cases burst fracture is accompanied by hemorrhage in the area of the anterior longitudinal ligament, of different sizes, allowing statement that in some patients regeneration of the vertebral body at burst fractures of type A occurs in the form of periosteal regeneration with formation of osseous adhesion along the hemorrhage through the intervertebral disc to the adjacent body.
Key words: MRI, burst fracture, spine.
National Center of Oncology, Baku, Azerbaijan Republic
Breast cancer: epidemiology, risk factors, pathogenesis, diagnosis, prognosis
60 - 64
Breast cancer is currently one of the five most common cancers in the world. An important role in its development is played by genetic factors, reproductive system diseases. Heredity factor in breast cancer development constitutes about 5−10 % of all breast carcinomas, and the majority of them are associated with autosomal dominant germline BRCA1 mutations and genes BRCA 2. In 10−20 % of cases the disease is triple negative, in which the tumor is histologically poorly differentiated ductal carcinoma. It is characterized by an aggressive course, early appearance of visceral metastases and, consequently, poor prognosis. The main method of early diagnosis of breast cancer is screening ultrasound and X−ray mammography. Microcalcifications of cluster forms are considered a pathognomonic sign of carcinoma. Determination of estrogen and progesterone receptors has a practical importance in breast carcinoma. When estrogen receptor is positive, the hormonal therapy efficiency exceeds 70 %, while at negative −− no more than 10 %. Among the most important prognostic factors are the size and location of the tumor; nature of regional lymph nodes; stage of the disease; histological type of tumor; degree of the tumor differentiation; the presence of hormone receptors in the tumor; the presence of menstruation in women of reproductive age.
Key words: breast cancer, risk factors, pathogenesis, diagnosis, prognosis.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Relevance the issues of breast cancer etiology and pathogenesis
65 - 67
Every year dry figures of statistics demonstrate the increase in the number of newly diagnosed cases of breast cancer. Search for the mechanisms and risk factors leading to breast cancer is actively conducted by many world laboratories. Epidemiological data are accumulated with a rather high speed, however, and there is no consensus on the causes of this disease. The time period from the first cancer cell to death of the patient after the tumor has reached a critical mass is called −− «the natural history of breast cancer». In this regard, the concept of actual and potential growth rate is distinguished. Average actual doubling time of the primary tumor is 90−110 days. Rapidly growing tumors with doubling time less than 30 days, with moderate growth and doubling time of 90−100 days and slowly growing with a doubling time of 110 days can be identified. The largest percentage of patients with moderate tumor growth approximates 60 %. It is assumed that formation of metastases is a long process starting at the early stages of «natural development of history» and increasing over the time. However, it was further shown that formation of blood vessels in the tumor, angiogenesis, may begin with 100−200 cells well before the clinical onset of the tumor, within the first 20 doublings. Metastasis process is dynamic and continuous from beginning to end. B. Fisher suggested that lymphatic and hematogenous dissemination occurs simultaneously, thus metastases in regional lymph nodes are not the stage of the tumor development, and show the ability of the tumor to metastasize and are a marker of hematogenous tumor dissemination. It is suggested that breast cancer at the stage of clinical evidence is already a systemic disease.
Key words: breast cancer, epidemiology, pathogenesis, oncology.
Kharkiv Regional Clinical Cancer Center, Ukraine
Clinical course of Paget's breast cancer at organ−preserving surgery
68 - 72
Paget's breast cancer, a rather rare disease, is a special type of cancer characterized by an eczematous lesion of the nipple with development of a tumor in the breast. The issue of treating such patients is urgent. In this regard, a study was conducted to investigate the clinical manifestations of Paget's cancer in patients with isolated areola and nipple lesions at organ−preserving surgical treatment. The results showed that the frequent clinical signs of the disease are eczematous ulceration of the nipple and areola, peeling, itching, bleeding from the affected area. The appearance of the tumor in the remaining tissue after surgery confirms Paget's transitory theory that cancer in situ is an intraepithelial stage in development of invasive breast cancer. The cancer recurrence rate is high: morphological investigation demonstrates infiltrative ductal cancer, immunohistochemical −− luminal type A. A retrospective evaluation of «development» of Paget's cancer in time showed its malignancy, despite the initial favorable clinical manifestations, the absence of focal formation and lesion of the regional lymphatic reservoir. Therapeutic tactics in patients with Paget's cancer should be the same as with typical histological forms.
Key words: Paget's breast cancer with isolated lesions of the areola and nipple, clinical presentation, diagnosis, treatment.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Microsatellite instability and characteristics of endometrial cancer
73 - 77
Despite the developments of medicine and biology in the field of oncology, endometrial cancer occupies a leading position in the structure of oncogynecological pathology. On the basis of the fact that this pathology is a multifactorial disease, and taking into account the role of genetic factors in the development of this pathology, it is expedient to investigate genetic disorders, in particular, microsatellite instability phenomenon. In order to study the specific features of the clinical course of endometrial cancer, taking into account the genetic and pathomorphological characteristics of the tumor, 342 patients were examined, of them 115 had microsatellite instability phenomenon. microsatellite instability was established in the tumor tissue by polymerase chain reaction. The results of the study showed that microsatellite instability is a frequent genetic disorder in patients with endometrial forms of endometrial cancer and is not typical for non−endometrioid forms. A reliable correlation of the presence of microsatellite instability with the degree of tumor differentiation and localization of the process in the uterus was established. Increase in the number of microsatellite disorders occurs during the perimenopause. The parameters of three−year disease−free survival of patients over 40 depend on microsatellite instability of the tumor phenotype −− the presence of this type of genetic disorders is accompanied by worsening of the results of treatment. Microsatellite disorders in stage I−III endometrial cancer of correlate with more frequent relapses of the disease. The presence of microsatellite instability in patients with endometrial cancer was accompanied by a significant reduction in three−year disease−free survival in patients with both endometrioid and non−endometrioid forms of endometrial cancer.
Key words: endometrial cancer, microsatellite instability, stage, age, histostructure, relapse-free survival.
Kharkiv National Medical University, Ukraine
Improvement of quality of life in patients with pain syndromes and dysphagia of various etiology
78 - 85
This work assessed quality of life in the dynamics of the traditional therapy with addition of Movixicam OTD (Switzerland) on the example of groups of patients with pain and dysphagia against a background of various neurological disorders as well as battle combined brain and maxillofacial injury. In addition to clinical and neurological examination, international questionnaires, visual analogue scale of pain (VAS) and a questionnaire MOS SF−36, allowing objective estimation of the state of the patients were used. Comparison of the results before and after the treatment allowed estimating the dynamics of the patient's perception of their pain and quality of life. The study showed high efficacy of the drug Movixicam OTD in treatment of patients with pain syndrome of various etiologies against a background of dysphagia. Therapeutic effect of different degree was observed in 98 % of patients. The therapy resulted in a significant regression of the pain intensity, and therefore the degree of restriction of motor function. The indices of the quality of life in all cases had a positive trend, which undoubtedly influenced both the physical and psychological adaptation of patients. Ease of application of oral dispenser forms of meloxicam in the form Moviksikam ODT expands its range of application even in patients with impaired swallowing function. A very important advantage is that the drug does not increase the risk of myocardial infarction, heart failure, edema and hypertension, which makes possible its use in patients with acute and chronic circulatory disorders amid rheumatic diseases and associated cranial and maxillofacial injuries.
Key words: pain syndrome, dysphagia, therapy, moviksikam ODT.
Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine, Dnipro, Ukraine
Prognosis of the risk of long−term disability prolongation at traumatic brain injury
86 - 88
To describe a mathematical model for predicting the risk of disability prolongation in a long−term period of traumatic brain injury, the data of two groups of patients with consequences of traumatic brain injury of varying severity and duration of posttraumatic period for more than 2 years were analyzed. According to the results of correlation analysis, 15 indicators that were associated with prolongation of disability in the long−term period of traumatic brain injury were selected. The indicators included patient`s age at the time of injury, current unemployment, absence of family, active pre−morbid somatic diseases, presence of subdural, epidural, intracranial hematoma, basal skull fracture or postponing hematoma evacuation or decompression craniotomy in acute period of trauma, severity of vestibular dysfunction, the results of the MoCA−test, rating from 0 to 5 in categories of energy and drive functions, control of voluntary movement functions, sensation of pain, conversation and walking functions assessed by the Brief Core Set of the international classification of functioning for TBI, as well as detection of pathological EEG types (II−V types of EEG according to Zhyrmunska) and disturbances of cerebral vessels reactivity resulting from visual load test. Predictive coefficients (PCs) were calculated for each indicator by means of Wald analysis. The sum of coefficients determines the risk of disability prolongation. According to logit−regression analysis, the maximum values of the total score were determined, which allowed to form the following groups of risk of disability prolongation: very low risk, low risk, moderate risk, high risk, and very high risk. Based on the data from clinical examination, past history and additional instrumental findings, using the methods of logit−regression analysis, a scale to assess 15 indicators, which allows a healthcare specialist to predict the prolongation of disability in patients in a long−term period of TBI with 91.0 % accuracy was created. The model provides the opportunity to identify the groups of patients in a long−term period of traumatic brain injury with high and very high risk of disability prolongation for optimization of treatment strategy.
Key words: traumatic brain injury, long-term period, disability, prediction.
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