The Journal of V. N. Karazin Kharkiv National University, series "Medicine"

Endogenous intoxication syndrome in rats consuming drinking water with different phosphate contents

2023-12-01T20:29:00+00:00

Abstract. Endogenous intoxication plays a significant role in the pathogenesis of many diseases. The erythrocyte intoxication index and molecular weight medium are informative indicators for its research. The goal is to establish the degree of expression of endogenous intoxication syndrome in white rats against the background of drinking water with different phosphate content for 30 days. Materials and methods. The study was conducted on 36 white purebred male rats weighing 180-200 g, divided into six groups, which for 30 days consumed: the control group – settled water from the city waterworks, the animals of five experimental groups - water with the addition of sodium monophosphate in doses of 100.0; 10.0; 1.0; 0.1; 0.01; mg/dm³ in terms of elemental phosphorus. The level of endogenous intoxication was estimated by the content of molecular weight medium in blood serum at wavelengths λ = 254 and 280 nm and the level of erythrocyte intoxication index, which was determined using the method of A. A. Togaibaev, et al., which is based on the ability of the erythrocyte membrane to absorb methylene blue. Results. It was established that the content of molecular weight medium 254 in the blood serum of experimental animals significantly increased in the 1st group by 65 % (p < 0.05), the content of molecular weight medium 280 in the 1st group by 154 % (p < 0.05), in the 2nd – by 138 % (p < 0.05) and the 3rd – by 64 % (p < 0.05). Consumption of drinking water with added phosphates leads to a significant increase of erythrocyte intoxication index in the 1st group – by 186 % (p < 0.05), in the 2nd – by 142 % (p < 0.05) compared to the control. Conclusions. Consumption of drinking water with different phosphate content for 30 days causes an increase in the level of endogenous intoxication in the body of experimental rats, as indicated by an increase in the permeability of erythrocyte membranes and an increase in the erythrocyte intoxication index and molecular weight medium content, most pronounced at a concentration of 100.0 mg/dm³.

Role of hysteroscopy in the diagnostics of endometrium pathology and in the application of auxiliary reproductive technologies

2023-12-18T10:43:18+00:00

Abstract. The introduction of endoscopic technologies made it possible to significantly expand diagnostic possibilities and clarify the nature of intrauterine pathology when using assisted reproductive technologies. Hysteroscopy allows you to take material for examination from the uterine cavity, and also ensures the carrying out of this procedure for diagnostic purposes as much as possible. Treatment of infertility by hysteroscopy plays a very important role in restoring a woman's reproductive function. The aim of the study was to improve the diagnosis of endometrial pathology through the use of hysteroscopy and targeted biopsy in the restoration of fertility and the use of assisted reproductive technologies. Materials. A clinical and statistical analysis of the results of 88 operative hysteroscopies in patients with infertility, which were divided into two groups, was carried out. The first group included 80 patients (90.91 %) with genital and extragenital pathology. The second group included 8 patients (9.01 %) who did not have concomitant gynecological and extragenital pathology. Hysteroscopy was performed with the equipment and tools of the «KARL STORZ» company. Monopolar and bipolar coagulation was used for hemostasis. Taking into account that pathology of the uterine cavity and endometrial are frequent causes of impaired reproductive function, it was proposed to use hysteroscopy to restore reproductive function. The results. The condition of the mucous membrane of the uterus with the help of hysteroscopy was studied in all clinical observations, since this method of instrumental research allows primarily to examine and evaluate the structural features of the endocervix and endometrial. In observation groups I and II, hysteroscopy was performed in all 88 patients: group 1 in 80 patients (90.91%) with pathological changes of the uterine mucosa and group 2 – in 8 patients (9.01 %) without pathology of the uterine mucosa. At the same time, 4 (3.52 %) women of 2 groups were diagnosed with extragenital pathology, and gynecological pathology was eliminated. The most common were endometrial polyps, chronic endometritis, cervical canal stenosis, and synechiae in the uterine cavity. Endoscopic technologies have expanded the diagnostic capabilities of investigating intrauterine pathology at the stage of fertility restoration and preparation for in vitro fertilization (IVF) and overcoming the causes of infertility. Conclusions. Hysteroscopy with morphological examination of the endometrial remains the main method of diagnosing intrauterine pathology. The obtained data will help the clinician to make the correct diagnosis in a timely manner and develop optimal and individual patient management tactics.

Evaluation of the physical activity in children with functional gastrointestinal disorders

2023-12-01T20:32:07+00:00

Abstract. Functional gastrointestinal disorders have been known for centuries. However, this concept appeared quite recently, and is currently a common pediatric problem. Interest in functional pathology is fully justified and understandable: despite the fact that functional diseases of the gastrointestinal tract do not pose a direct threat to the patient’s life, they significantly reduce the quality of his life. The problem of functional disorders is also complicated by the fact that they affect all strata of society, regardless of age, socio-economic status, gender or race. The active process of studying the clinical and anamnestic features of various nosological forms, predictors of functional disorders, combined functional disorders and prevention approaches is also due to significant economic damage due to direct and indirect costs of their treatment. The prevalence of functional gastrointestinal disorders in the world reaches 40.3 %, and among children's gastro pathology they occupy one of the leading places. More than half of children of various age groups have at least one of the symptoms, which is a cause of concern for both the child and the parents, as well as entails a violation of the microclimate in the family. The peak prevalence of various symptoms of disorders of the gastrointestinal tract occurs at school age and adolescents, who almost fill the appointment of a pediatrician and a pediatric gastroenterologist. If we trace the evolution of ideas about functional disorders of the digestive organs, it can be noted that it changed many times and influenced the understanding of the pathogenesis and, especially, the etiology of this nasology. According to the Rome Consensus IV (2016), functional gastrointestinal disorders are defined as disorders of the interaction of the «gut-brain» axis, taking into account this concept, a lot of time has been devoted to studying the role of various factors: genetic predisposition, infection theory, nature of feeding at an early age, hormonal imbalance, psychological state, food preferences, lifestyle and physical activity. An important aspect of studying predictors of functional bowel disorders is the level of physical activity of children and adolescents. In the process of studying literary data, it was noted that the role of insufficient physical activity in the development of functional gastrointestinal disorders remains not fully determined. Most of the materials are related to the adult population and critically few among children. That complicates the study of forecasting and prevention of a more severe course of functional dyspepsia and irritable bowel syndrome, and, as a consequence, to optimize therapy. The aim of the study was to assess the level of physical activity in children with FGID. Materials and methods. 72 children aged 8–14 with FGIR were observed. I group of study included 26 patients with combined functional dyspepsia (FD) and irritable bowel syndrome (IBS), the II group – 46 patients with FD. The control group included 22 healthy children. The diagnosis of FD and IBS were established based on the analysis of clinical symptoms according to the Rome IV criteria (2016). The PAQ-C questionnaire, developed by K. Kowalski, P. Kroker, and R. Donen, was used to assess PA in children. Research results. The total PA index in children with combined FD and SPC was 1,87 ± 0,07 and was lower compared to the group of children with FD (2,21 ± 0,05; p < 0,05) and the control group (2,75 ± 0,05; p < 0,01). The total PA index in children with FD is lower than in the control group (p < 0,01). Conclusion. Insufficient physical activity can be considered a risk factor for the development of functional gastrointestinal disorders in children.

XGBoost machine learning algorithm for differential diagnosis of pediatric syncope

2023-12-01T20:34:19+00:00

Abstract. The search for new methods of differential diagnosis of syncope types will allow to improve the diagnosis of vasovagal syncope (VVS), syncope due to orthostatic hypotension (OH) and cardiac syncope (CS) in childhood in order to make timely adequate diagnostic and therapeutic decisions. The aim of the study was to develop an effective machine learning model for the differential diagnosis of VVS, syncope due to OH and CS in children. Materials and Methods. 140 patients with syncope, aged 8-17 years, were examined: 92 children with a diagnosis of VVS, 28 children with syncope due to OH and 20 children with CS. A machine learning model was built using XGBoost algorithm for multiclass classification based on input clinical, laboratory and instrumental patient data. Results. The developed machine learning model based on the XGBoost algorithm is effective in the differential diagnosis of VVS, syncope due to OH and CS, which is confirmed by the metrics of accuracy (0.93), precision (0.93 for VVS; 1.00 for syncope due to OH; 0.80 for CS), recall (0.96 for VVS; 1.00 for syncope due to OH; 0.67 for CS), f1 (0.95 for VVS; 1.00 for syncope due to OH; 0.73 for CS), ROC AUC (0.95 for VVS; 1.00 for syncope due to OH; 0.89 for CS), PR AUC (0.96 for VVS; 1.00 for syncope due to OH; 0.79 for CS),Cohen’s Kappa (0.85), and Matthews correlation coefficient (0.85). The most informative parameters of the syncope types differential diagnosis model are OH, paroxysmal supraventricular tachycardia, Hildebrandt coefficient, Calgary Syncope Seizure Score, vitamin B6, average duration of the P-Q interval during 24 hours, duration of tachycardia during 24 hours, stroke index, homocysteine, heart volume, and systolic blood volume. Conclusions. The proposed machine learning model has sufficient efficiency and can be used by pediatricians and pediatric cardiologists for the differential diagnosis of VS, syncope due to OH, and CS in childhood.

The effect of complex therapy on the quality of life in patients with arterial hypertension on the background of gout

2023-12-01T20:35:39+00:00

Abstract. Gout remains the most common type of inflammatory arthritis worldwide. Hypertension (AH) prevails in the structure of comorbid diseases in gout. In patients with hypertension in combination with gout, the problem of choosing treatment tactics remains quite relevant. Aim. To assess the effectiveness of the combination of basic therapy drugs for the treatment of patients with hypertension in combination with gout on quality of life indicators at the primary level of medical care. Materials and methods. Two groups of patients were formed. The first group, 36 patients who received losartan, allopurinol, atorvastatin. The second group, 36 people who received ramipril, allopurinol, atorvastatin. Quality of life was assessed using the SF-36 standardized questionnaire. The patient's functional status was assessed using the HAQ-DI health status questionnaire. Statistical analysis was performed using Statistica 6.1. Results. In the studied groups of patients, the quality of life of patients before and after treatment was evaluated. It was established that before the appointment of treatment, no significant difference was found between the groups according to the SF-36, HAQ-DI questionnaires. In patients of both groups, the indicators of the physical component of health (PCH) and the psychological component of health (PsCH) on the SF-36 scale were reduced, and a greater proportion of patients with minimal and moderate impairment of vital activity according to the HAQ-DI was registered. According to the results of the analysis, it was established that the level of quality of life according to the PCH indicator increased by 21.7 % in the first group and by 20.4 % in the second group (p < 0.01), according to the PsCH indicator – by 18.4 % and 17.5 % (p < 0.01), respectively. A probable decrease in the HAQ-DI indicator was found only in patients who received ramipril compared to the initial data before treatment by 33.3 % (р < 0.05). In patients of the I group, the share of patients with minimal disorders is increasing, and the proportion of patients with moderate disorders is decreasing, and in the II group, the prevalence of minimal and moderate disorders is increasing, which indicates the effectiveness of the prescribed therapy. Conclusions. Complex therapy (losartan or ramipril, allopurinol, atorvastatin) for 6 months in patients with hypertension in combination with gout is accompanied by a significant improvement in the quality of life according to the indicators of PCH (25.1 %, p < 0.01) and PsCH (17.7 %, p < 0.01) and degree of vital activity (25.0 %, p < 0.01).

Status of post-vaccination immunity to diphtheria and tetanus in adults with EBV infection

2023-12-01T20:36:57+00:00

Abstract. Recently, the number of cases of infectious mononucleosis has increased among adults, as well as with the course of the disease for more than 3 months. The Epstein-Barr virus is capable of attacking immunocompetent cells, causing lymphadenopathy, hepato- and splenomegaly, being stored forever in the body's lymphocytes, and causing an immunodeficient state. The aim of the study. To find out the state of post-vaccination immunity to diphtheria and tetanus in adults who have contracted EBV infection. Materials and methods. 79 adults (1 group) with MI were examined: 30 people with a mild (L) form of the disease, 38 people with a moderate (SrT) form, 11 people with a severe (T) form, and 25 adults (2 groups) with chronic EBV infection (CHEBVI). The control group consisted of 41 people (K group). The level of antibodies to diphtheria and tetanus toxin was measured by ELISA according to the instructions. According to WHO recommendations, the protective level of antibodies against these infections was considered ˃ 0.1 IU/ml. The results. It was established that in adults who fell ill with infectious mononucleosis in a mild form, a decrease in the level of antibodies to diphtheria and tetanus below the protective level (˂ 0.1 IU/ml) was not observed. 44.7 % of persons who fell ill with infectious mononucleosis in a moderate form did not have protective levels of antibodies to diphtheria, 34.2 % before tetanus, 54.5 % of people who fell ill with severe infectious mononucleosis did not have a protective level of antibodies against diphtheria and tetanus. The number of adults in the control group who did not have a protective level of antibodies to tetanus was 12.1 %, to diphtheria – 26.7 %. During the examination of 25 adults with CHEBVI, it was established that 76.0 % did not have a protective level of antibodies to diphtheria, 64.0 % to tetanus. Conclusions. In adults who have contracted the acute and chronic form of EBV infection, there is a decrease in the level of anti-tetanus and anti-diphtheria antitoxins, and an increase in the percentage of people without a protective level of antibodies to these infections. The percentage of patients with CHEBVI who did not have a protective level of antibodies was significantly higher than among persons who contracted infectious mononucleosis. The obtained data indicate the need to monitor the immune status of persons who have contracted EBV infection and recommend vaccination in case of a low level of antibodies to diphtheria and tetanus or their absence.

Clinical case of delivery of a pregnant woman with large uterine leiomyoma and rehabilitation in the postoperative period

2023-12-18T11:12:50+00:00

Abstract. Uterine leiomyoma is a benign neoplasm of the smooth muscles of the uterus, which is one of the causes of infertility and miscarriage in women in the modern world. Delivery of pregnant women with large uterine leiomyoma is a current problem, since there is no single and clear opinion regarding the tactics of managing such patients. In the past, most specialists were inclined to perform hysterectomy after cesarean section, as they considered it the safest method of therapy, since myomectomy during cesarean section raised many questions related to complications during surgery and in the postoperative period. This article examines the modern view of specialists and the experience of the authors on organ-preserving tactics for the treatment of large uterine leiomyomas in women during pregnancy and delivery and analyzes rehabilitation in the postpartum period. The aim of the study. The aim of the study was to analyze scientific literature data on the advisability of performing myomectomy during cesarean section and combining the experience of other specialists with our own experience of delivery of pregnant woman with large uterine leiomyoma using a complex of intraoperative preventive measures. Materials and methods. A clinical case of delivery of a pregnant woman with large uterine leiomyoma and rehabilitation in the postoperative period is described. A systematic online study of articles on the topic of myomectomy during cesarean section was conducted. Results and discussion. Data from a significant number of works by other specialists indicate that preliminary substantiation of factors that may complicate surgical intervention (uterine contractility, anatomical localization, number and diameter of fibroids, as well as the presence of large vascular structures), the use of a set of preventive intraoperative measures and modern suture materials can reduce the amount of blood loss and prevent unfavorable postoperative results. Our proposed algorithm of action, including the administration of tranexamic acid before opening the anterior abdominal wall, a long-acting oxytocin agonist and the hemostatic sponge «Surgicel», allows us to minimize the amount of intraoperative bleeding and the risks of uncontrolled bleeding. It should also be noted that the addition of a cesarean section with myomectomy does not affect the course of rehabilitation in the postoperative period. Conclusions. Based on a study of literary sources over the past 10 years and our own research, we can conclude that myomectomy during cesarean section is advisable in the absence of contraindications. A combination of postoperative rehabilitation measures, tactics and techniques of surgical intervention, and prevention of intraoperative blood loss make it possible to ensure high-quality recovery for patients.