Scientific Bulletin of the Uzhhorod University. Series «Medicine»

Cisterna magna double-injection model of hemorrhagic stroke in experimental rats for the study of communicating hydrocephalus

2024-11-27T09:55:09+02:00

Objectives. The cisterna magna double-injection model of hemorrhagic stroke (CMDIM) was tested in this research to see its validity in provoking communicative hydrocephalus. Background. Subarachnoid hemorrhage (SAH) is a devastating disease resulting in high mortality and is a common cause of chronic post-hemorrhagic hydrocephalus (PHH), which affects up to 20% of the survivors. The occurrence of hydrocephalus after SAH is a crucial factor in predicting a poor prognosis, including damage to the brain parenchyma, a prominent cause of disability that, if sufficiently severe, may also lead to patient mortality. In the case of PHH, the mechanisms leading to pathogenesis are poorly understood. Small animal models in basic and preclinical sciences constitute an integral part of testing new hypotheses before translation to clinical practice. Methods. Experimental animals were divided into two groups. The first group (control group – CG) was without surgery. In the second group, a 0.15 ml blood injection into cistern magna was followed by a 0.15 ml blood injection 48 hours later. The surgery was performed in sterile conditions under general anesthesia; experimental animals in the surgical group were positioned supine, and blood was taken from the lower third on the ventral aspect of the tail. After this, the rat was turned prone, and the head was fixed in a stereotactic frame. Under magnification of surgical loups, an incision was made in the suboccipal region followed by dissection of neck region muscles. Gentle flexion of the rat head allowed by not rigid head fixation gave the possibility to widen the space between the occipital bone and C1 lamina for better cisterna magna visualization. After meticulous hemostasis, the incision was closed using a stapling device. The second surgery was performed with the same steps, except for more proximal puncturing (above the lower third on the ventral aspect of the tail) of the tail artery. We defined hydrocephalus as ventricular volume on histological evaluation, which was > +3 SDs above the mean in control animals. Results. Thirty-seven operations were done on 20 rats with 20% posthemorrhagic postoperative mortality. Hydrocephalus in the surgical group occurred in 45% of rats, according to the histological investigations. Conclusion. Based on the findings, CMDIM is effective in generating posthemorrhagic hydrocephalus with acceptable mortality.

Results of surgical treatment of patients with critical limb ischemia and analysis of factors affecting patency arterial reconstruction

2024-11-27T09:58:40+02:00

Introduction. The growing trend in the number of patients with coronary artery disease of the lower extremities and poor treatment results prompts the scientific community to search for new opportunities for prevention, early diagnosis, and effective treatment of this disease. A separate group consists of patients with critical limb ischemia (CLI), in whom the outcome of surgical treatment is influenced by many factors: age, diabetes, genetic factors, multisegmental atherosclerotic lesions. Despite the various modifications of angiosurgical reconstructions and the progressive development of endovascular technologies, the number of amputations of NC has not significantly decreased. The goal of the work. In a group of patients with critical ischemia, risk factors that may have an impact on reducing the effectiveness of surgical treatment should be studied. Materials and methods. The results of surgical treatment of 60 patients with CINC who underwent arterial reconstruction from 2017 to 2021 were analyzed. Among the laboratory methods of examination, the concentration of fibrinogen, PT%, CD62P, Sirt 1, Sirt 6, IL6, IL-8, PLA2, PCSK9 was studied in all patients. The results. Among concomitant diseases associated with vascular pathology, arterial hypertension was observed in 81.7%, coronary artery disease in 58.3%, and diabetes mellitus was detected in 38.3%. In the analysis of laboratory parameters, a pronounced statistical dependence of fibrinogen in relation to PCSK9 and a statistical dependence of fibrinogen, PCSK9 to CD62P were noted. As for the choice of the method of surgical revascularization in patients with KINK, 36.7% underwent deep fundoplasty, 31.6% underwent femoral-knee shunting, and 15% underwent hybrid intervention. Conclusions. Timely arterial reconstruction in patients with critical ischemia allows to preserve the limb and promotes effective healing of the ischemic wound. The results of the laboratory analysis showed a statistical relationship between PCSK9, fibrinogen and CD62P, which indicates the importance of identifying thrombosis predisposition factors and hemostasis activation markers. The obtained data can contribute to individual risk stratification of possible postoperative complications, namely, optimization of preoperative and perioperative management of patients with critical ischemia of the lower extremities.

Diagnosis and treatment of varicothrombophlebitis in patients with open trophic ulcers

2024-11-27T10:08:30+02:00

Introduction. The occurrence of such a complication as acute varicothrombophlebitis in patients with trophic disorders and open trophic ulcers due to varicose veins and/or postthrombophlebitic syndrome significantly worsens the prognosis of the disease. Improving the results of treatment of this group of patients is quite relevant and not fully studied in the literature. Aim. To improve the results of treatment of patients with decompensated chronic venous insufficiency complicated by acute varicothrombophlebitis, develop and implement a diagnostic and treatment algorithm in clinical practice. Materials and methods. On treatment in the surgical clinic named after Andriy Novak, Uzhhorod, during the period from 2011 to 2016, treated 80 patients with decompensated chronic venous insufficiency complicated by acute varicothrombophlebitis (VTP) of the large and small saphenous vein. Of these, 41 patients had open trophic ulcers due to varicose veins, 39 due to post-thrombotic syndrome (PTS). VTP in the first group of patients occurred in the large saphenous vein (LSV) in 37, in the small saphenous vein (SSV) in two, in the second group, respectively, in 35 and in two. According to computer planimetry, trophic ulcers up to 10 cm2 were observed in 10 and 9 patients of the first and second groups, respectively, up to 20 cm2 – in 18 and 15, over 20 cm2 in 13 and 15 patients. Research results and their discussion. The following types of VTP were observed in the first group: total varicothrombophlebitis with flotation of the top of the thrombus in the femoral vein was observed in 8 patients. In 18 patients, the process did not reach the saphenofemoral confluence by 8–10 cm, in 13 – to the lower third of the thigh. In two patients with VTP SSV, the transition of the thrombotic process to the flounder sinuses was observed. In patients of the second group, a floating thrombus in the femoral vein was not observed, in 15 the thrombus was localized at a distance of 12 cm from the sapheno-femoral junction, in 7 – at the level of the lower third of the thigh. In two patients with VTP SSV, the transition of the process to the calf sinuses was observed. In two patients with a combination of affected LSV and SSV, the thrombus reached the middle third of the thigh in the MPV system and passed to the sural sinuses on the lower leg. Due to the threat of pulmonary embolism (PE), 26 (32.5%) patients of the first group underwent urgent phlebectomy, which included: crossectomy (CE), if necessary, thrombectomy, short stripping and distal catheter scleroobliteration. Almost 8 people underwent thrombectomy, CE, short stripping, distal catheter scleroobliteration. In 15 patients with 18 CE, short stripping with distal catheter scleroobliteration. Three patients of this group underwent radiofrequency ablation (RFA) of the LSV due to the thrombosed area of the LSV. In the 1st group of patients, in the presence of horizontal reflux in the area of the trophic ulcer, 51 (64%) patients underwent echosclero obliteration of penetrating veins. Conclusions. Treatment of patients with CVI in the decompensation stage with trophic ulcers complicated by acute varicothrombophlebitis is aimed at eliminating the thrombotic process in embolic forms of thrombophlebitis, correcting violations of venous hemodynamics, and eliminating purulent-trophic defects. The use of vacuum therapy contributes to the early cleaning of wounds from layers of fibrin and areas of necrosis, the reduction of the area and depth of the wound, the growth of granulations, and the acceleration of marginal epithelization.

Treatment of patients with inflow varicothrombophlebitis

2024-11-27T10:14:56+02:00

Introduction. The study of acute varicothrombophlebitis and the development of rational methods of diagnosis and treatment of this disease is due to its relevance among diseases of the veins of the lower extremities. The importance of HFTP is related not only to its possible transfascial spread into the deep vein system, but also to frequent pulmonary embolism (PE), which still requires refinement in the correctness of treatment approaches. Aim. Development and implementation in clinical practice of minimally invasive methods of treatment of inflow acute varicothrombophlebitis depending on the clinical state of chronic venous insufficiency according to CEAP in isolated inflow varicothrombophlebitis and in the transition of the process to the trunk of the great saphenous vein. Materials and methods. In the surgical clinic of the KNH “ZOKL named after A. Novak” Uzhgorod were treated 37 patients with tributary VTP in the BSV basin from 2018 to 2023. There were 8 (21.6%) men, 29 (78.4%) women. In 29 (78.4%) patients, isolated thrombosis of varicose changed veins and collaterals without transition to the trunk of the BSV were observed, in 8 (21.6%) patients. The VTP was transferred to the trunk of the BSV. The clinical distribution of patients according to the international classification of CEAP was as follows: patients with clinical class C2-2, C3-15, C4-11, C5-6, C6-3, where the majority of patients 20 (54.1%) had clinical class C4– 6. Research results and their discussion. In 6 patients with localization of the process in the medial additional branch of the BSV, sclerotherapy was performed at the point of confluence with the BSV, phlebocentesis from the distal part of the vein and scleroobliteration of the tributary. In two patients with thrombophlebitis in the external pubic vein, puncture sclerotherapy was performed at the point of confluence with the BSV followed by miniphlebectomy of the thrombosed tributary. In 7 patients with thrombophlebotic occlusion of the medial intersaphenous vein, scleroobliteration was performed at the confluence of the BSV and SSV with phlebocentesis of the thrombosed vein. In connection with the danger of the spread of thrombotic lesions due to incompetent veins to the deep venous system in the case of thrombotic occlusion of the veins of Leonardo, it was considered inadvisable to use phlebocentesis. Patients should be transferred to indirect anticoagulants. In patients with thrombotic occlusion of the vein of Leonardo and the absence of failed permeating veins, sclerotherapy of the thrombosed tributary at the point of confluence with the BSV was performed against the background of medical treatment. In 8 (21.6%) out of 37 patients, in addition to the thrombosed tributary, the BSV trunk was also partially involved in the pathological process of varicose transformation. Conclusions. The main task of treatment of inflow varicothrombophlebitis is surgical methods of preventing the transition of the process to the trunk and non-progressive perforant veins. The transition of inflow varicothrombophlebitis to the trunk of the BSV, clinical manifestations of CVI C4-6 according to CEAP, expand the indications to increase the volume of surgical intervention.

Gastroduodenal ulcer bleeding in patients with comorbid diseases: features of the clinical course and treatment tactics

2024-11-27T10:20:21+02:00

Introduction. Gastroduodenal ulcerative bleeding is one of the most frequent cases requiring emergency medical care. The prevalence of gastroduodenal bleeding reaches 170 cases per 100,000 of the adult population. Despite progress in the treatment of such patients, the overall mortality rate for ulcerative bleeding is 10–15%, and the mortality rate for surgical interventions at the height of bleeding is 20–40%. Severe comorbid diseases in 60–90% of patients worsen their condition and significantly increase the risk of mortality after surgical intervention in acute ulcerative gastroduodenal bleeding. The purpose of the study: to improve the immediate and long-term results of treatment of patients with gastrointestinal ulcerative bleeding in conditions of polymorbidity by studying the features of the clinical course and tactics of treatment of gastroduodenal ulcerative bleeding. Materials and methods. An analysis of the results of clinical examination and treatment of 215 patients with ulcerative gastroduodenal bleeding was carried out. The average age of the patients was 51.4±0.54 years. There were 116 (53.9%) men and 99 (46.1%) women. The main observation group included 163 (75.8%) patients with bleeding from acute and chronic ulcers of the stomach and duodenum with severe comorbid diseases. The control group consisted of 52 (24.2%) patients with gastroduodenal bleeding from acute and chronic gastric and duodenal ulcers without severe comorbid diseases. Bleeding was diagnosed in all patients based on clinical signs and fibroesophagogastroduodenoscopy. To stop bleeding, we used methods of non-operative (endoscopic + medication) and operative hemostasis. Results and their discussion. In patients of the main group, the symptoms of gastrointestinal ulcerative bleeding were atypical, and the leading sign of bleeding in this category of patients was the presence of melena – in 88.4% of cases. In 14 (8.6%) patients with comorbid diseases due to an atypical clinical picture, gastroduodenal bleeding was diagnosed untimely, which subsequently affected the quality of medical care. For 206 (95.8%) patients with acute gastroduodenal ulcerative bleeding, the main direction of treatment was endoscopic hemostasis and prescribing courses of hemostatic therapy. Among the endoscopic methods of stopping bleeding, circumcision of the bleeding vessel with vasoconstrictor and sclerosing solutions was performed in 74 (35.9%) patients; clipping was used in 68 (33%) patients; argon plasma coagulation – in 36 (17.5%) and the use of combined methods – in 28 (13.6%) patients. Gastroduodenal ulcerative bleedings that could not be stopped by medication and endoscopic methods of hemostasis, as well as recurrent bleedings, were subject to surgical correction. 38 (17.67%) patients underwent the following operations: ulcer excision – in 17 (44.74%) patients, ulcer exteriorization – in 8 (21.1%) patients followed by duodenoplasty and pyloroduodenoplasty, sectoral resection of the stomach – in 6 (15.79%), gastric resection according to Billroth-I – in 4 (10.53%) patients and stitching of an ulcer – in 3 (7.89%) patients. Conclusions. The clinical symptomatology of gastrointestinal ulcerative bleeding in patients with comorbid diseases is atypical and in 8.6% of cases it is diagnosed late. Complex treatment of ulcerative gastroduodenal bleeding in patients with comorbid diseases with the use of modern methods of endohemostasis and conservative therapy in most cases allows to achieve the final stop of bleeding.

HONORED DOCTOR OF UKRAINE, DOCTOR OF MEDICINE, PROFESSOR AT THE DEPARTMENT OF SURGICAL DISEASES OF THE MEDICAL FACULTY OF UZHHOROD NATIONAL UNIVERSITY VASYL RUSYN – 75

2024-11-27T12:27:42+02:00

HONORED DOCTOR OF UKRAINE, DOCTOR OF MEDICINE, PROFESSOR AT THE DEPARTMENT OF SURGICAL DISEASES OF THE MEDICAL FACULTY OF UZHHOROD NATIONAL UNIVERSITY VASYL RUSYN – 75

Forensic toxicological examination of physical evidence with the aim of determining the etiological factors of mass poisoning with the use of combat toxic substances

2024-11-27T12:18:20+02:00

Hostilities during a war are always accompanied by the undermining and destruction of various spheres of life in the areas where they take place. People's health and lives are at great risk because the enemy deliberately destroys social spheres, the economy, the environment, and kills people. Ukraine is no exception. The enemy is doing this deliberately, cynically violating the rules of engagement, peace agreements and UN resolutions. In such a difficult time for our country, we understand that there is a huge threat of using chemical weapons, among other types of weapons, to massacre military and civilians, because conventional means of warfare are not very effective for the aggressor in practice, and our side is not fully prepared for military operations with the use of chemical weapons of mass destruction, because we do not have the proper experience. In recent years and today, we see that against the background of the possible use of such weapons, new trends are emerging that are an alternative to the use of weapons of mass destruction: the deliberate destruction of facilities with nuclear and chemical components, targeted damage to civilian industrial facilities to achieve the goal in the armed confrontation of countries. The purpose and objective of this work was to analyze modern widespread scientific data on the types of chemical warfare agents and their identification in order to increase knowledge about the possibilities of forensic toxicological research in conducting forensic medical examination in the event of mass poisoning using chemical warfare agents. The author notes in her study that during the war on the territory of Ukraine, many infrastructure facilities were destroyed, huge human losses were incurred, but the resistance of Ukrainians to the enemy continues and therefore there is a possibility of using weapons of mass destruction of chemical origin. One of the tasks of forensic medicine is to assist healthcare authorities in improving the quality of treatment and prevention work: reducing morbidity, mortality, improving the quality of medical services, preventing medical errors, injuries, poisoning, etc. In this regard, forensic medical examination is appointed in the event of various emergencies, including mass poisonings caused by the enemy's use of weapons of mass destruction. The author provides historical facts of the use of chemical warfare agents during military conflicts, the first of which date back to BC. The author indicates the legal acts prohibiting the military use of chemical warfare agents and notes that today the maximum amount of CWA is stored in the United States and the aggressor country, and China, France, India, etc. also have such weapons. The author analyzes the opinions of scientists about the effectiveness of the use of toxic substances in the First World War: it was largely exaggerated by the psychological shock of using chemical warfare agents as a new, previously unknown weapon. The lack of means of protection against those poisonous substances also played a role in this exaggeration. But, given the progressive development of the chemical industry, the experience of sporadic use of new “proven” CWAs at different times, and the availability of personal protective equipment in the military, a rather horrifying picture of its use at the present stage is emerging. The author goes on to provide various classifications of toxic substances, among which the following are more acceptable for the military medical service and forensic physicians: tactical (by the nature of the effect on a living organism), by the speed of the onset of the damaging effect, by the behavior on the ground in combat conditions, forensic (by the mechanism of action on the body). Analyzing the complex of measures to protect against CWA, the author notes that the following algorithm must be in place: indication or detection, degassing, disinfection, as well as the use of personal protective equipment (gas masks, insulating breathing apparatus, raincoats, rubberized fabric suits together with filtering skin protection, antidotes, protective creams, and chemicals) and collective chemical protection. These actions are also accompanied by the collection of anamnesis, epidemiological data, determination of the clinical picture of poisoning and directly – forensic toxicological research (general and targeted), which uses methods for the isolation, detection and quantification of toxic substances and is carried out in the forensic toxicology departments of the Bureau of Forensic Medicine. The peculiarities of forensic toxicological analysis are: a huge variety of objects of analysis (biological fluids, internal organs of corpses, food, household items, drug residues, clothing, etc.); a small amount of toxic substances, the need to study toxic substances in the presence of their metabolites and impurities of biological material; the need to evaluate the results of the analysis, since the use of highly sensitive reactions and methods can detect not only the compound that caused the poisoning, but also some other substances – constituents of body cells and tissues, as well as medicinal substances used for therapeutic purposes as an antidote. The rules for conducting forensic examinations (studies) in the forensic toxicology departments of the Bureau of Forensic Medicine regulate the methodology for conducting such studies, which helps to provide poisoned people with qualified medical care. The joint work of the forensic service with clinicians and the military is an important factor in providing qualified medical care and eliminating the consequences of the use of chemical warfare agents by the enemy. One of the many links in establishing the cause of mass poisoning of the military and the population is the forensic toxicological examination of physical evidence carried out in the forensic toxicology departments of the Bureau of Forensic Medicine. The use of chemical warfare agents during the war is a crime that has material evidence, which is subject to forensic examination. In such cases, lawyers should be educated about the possibilities of forensic toxicological research in the conduct of forensic medicine in the event of mass poisoning from the use of CWA.

Paraclinical evaluation of the effectiveness of treatment of chronic catarrhal gingivitis in patients-soldiers of the Armed Forces of Ukraine

2024-11-27T10:43:23+02:00

Introduction. Chronic catarrhal gingivitis is one of the most common periodontal diseases, most commonly found among military personnel of the Ukrainian Armed Forces. Constant stress, physical and psychological strain, as well as specific conditions of service may contribute to the development of this disease. Despite its prevalence, the problem of effective treatment of chronic catarrhal gingivitis in the military is still insufficiently studied. Today, there is a need to develop more effective and personalised treatment approaches that take into account the specificities of military service and, importantly, the psycho-emotional state of this cohort of patients. Objective: to evaluate the clinical efficacy of our proposed treatment complex for the management of chronic catarrhal gingivitis in patients-soldiers of the Armed Forces of Ukraine. Methods. Treatment of chronic catarrhal gingivitis was carried out in 22 patients – military personnel of the Armed Forces of Ukraine, in particular: 12 patients (54,54 %) were treated with the treatment complex developed by us (main group) and 10 patients (45,46 %) were treated according to the traditional method (control group). To quantify the clinical signs of periodontal tissue damage, the following were determined: papillary marginal-alveolar index (PMA); papillary bleeding index (PBI); the hygienic state of the oral cavity was characterised by the Greene J. Vermillion J index (OHI–S). The effectiveness of the treatment of periodontal tissue diseases was assessed by the following criteria: «stabilisation», «clinical well-being», «improvement», «no change» and «deterioration». Results. As a result of the study, it was found that in patients with chronic catarrhal gingivitis treated with the help of the treatment complex developed by us, «stabilisation» of the periodontal tissue condition was objectified in 66,67 % of the treated patients compared to 20,0 % of patients in the control group, in whom chronic catarrhal gingivitis was treated according to traditional methods, p1<0,01. At the same time, in patients with chronic catarrhal gingivitis of the main group, a reduction in the values of paraclinical indices was determined in relation to the baseline data: РMA – by 95,38 %, РВІ – by 80,56 %, OHI-S – by 50,0 %, p,p1<0,01. Conclusions. Thus, the results of clinical trials convincingly proved the effectiveness of the treatment complex developed by us for the management of chronic catarrhal gingivitis in patients-soldiers of the Armed Forces of Ukraine, which was confirmed by the positive dynamics of paraclinical indices РMA, PBI, OHI-S and «stabilisation» of periodontal tissue condition.

Study of indicators of young patients’ dental health and their correlation with dental cervical pathology

2024-11-27T10:47:53+02:00

Introduction. Dental health is an important component of a person’s overall health. Objectives. To assess young patients’ dental status, analyze possible correlations between its indicators and dental cervical pathology. Materials and methods. The survey of 272 people (174 women and 98 men) aged 18-44 years included a clinical examination, an index assessment of the condition of dental hard tissues and periodontium and identification of the level of oral hygiene. Depending on the type and presence of dental cervical pathology the patients were divided into the study groups. Results. The prevalence of dental caries among the examined was high (92.6%), the intensity corresponded to the average level (CFE of teeth 8.34±5.27). Patients with erosion (E) were diagnosed with local enamel hypoplasia 6.9 times more often than patients with wedge-shaped defect (WSD), and 3.6 and 5.8 times more often when compared with patients with cervical caries (CC) and without cervical dental pathology, respectively (p<0.05). A correlation was observed between the development of local enamel hypoplasia and E, systemic enamel hypoplasia and CC (p<0.05). The prevalence of inflammatory diseases of periodontal tissues was 64.0%. The average indicators of PMA index corresponded to a mild degree of severity of gingivitis. Gingival recession was diagnosed 4.8 times more often in patients with associated dental lesions than in patients without cervical pathology. A correlation between gingival recession and WSD was observed (p<0.001). In the examined with WSD, gingival recession was diagnosed 2.8 and 5.6 times more often when compared with the examined with CC and without dental cervical pathology, respectively. Gum recession increased the prevalence and intensity of hyperesthesia (p<0.05). A correlation was determined between the values of the bleeding gums index and the indices of plaque Green-Vermillion and Sillness-Loe (p<0.05). Conclusions. A significant number of those examined required comprehensive treatment of dental pathology and professional oral hygiene. It is recommended to take into account the established correlations between the indicators of dental health and dental cervical pathology when developing therapeutic and preventive measures to increase their effectiveness at the individual level.

Sedation in dentistry and out-patient maxillofacial surgery. Theory and practice

2024-11-27T10:59:13+02:00

In recent decades, the use of medical procedural sedation in outpatient settings has gained considerable popularity due to the expansion of treatment options for the doctor and increased comfort for the patient. Moderate medical sedation allows patients to better tolerate medical and diagnostic manipulations, avoid operative stress and associated anxiety, fear and pain. This is of great importance to a wide range of patients. For example, patients with accompanying arterial hypertension, with heart rhythm disturbances and myocardial ischemia, provided that sedation is carried out during outpatient interventions, avoid the possibility of decompensation of cardiac pathology. For children, the elderly, or patients with special needs, any hospitalization associated with forced separation from family is associated with psychological trauma. Therefore, it is important to carry out medical and diagnostic procedures under sedation in outpatient settings that are small in terms of trauma and duration. The advantages of ambulatory anesthesiology include economic expediency, convenience for the patient, reduction of the risk of thrombotic complications and hospital infection, and increased efficiency of hospital beds. Modern anesthesiology has a rich arsenal of techniques and drugs for anesthetic support of outpatient operations, but the issues of finding the optimal scheme for sedation, assessing its adequacy, and means of monitoring the patient's condition remain relevant and require in-depth study. This review presents modern recommendations for procedural sedation in adults and children in outpatient settings. The definitions of sedation, psychoemotional comfort and discomfort are thoroughly described and introduced. A special emphasis is put on pathophysiology of psychoemotional discomfort and peri-operative stress. According to modern data, the objectives to be achieved by an anesthesiologist have been reviewed: provision of psychoemotional inhibition (as a basis of comfort staying in a dental chair), but not depression of consciousness as it used to be before. With much detail it analyzes complication occurring during anesthesia; their correlations with age. concurrent conditions, anesthetic agent and doctor’s professional level are highlighted. The article presents a clinical picture of sedation depending on the depression of consciousness, respiration, and hemodynamics (ADA and ASA, 2016). It depicts thoroughly the state of minimal sedation (anxiolysis), moderate sedation (awake sedation), deep sedation and general anesthesia. Special attention is paid to the provision of patient’s safety related to supporting airway patency and hemodynamics. The article presents methods of sedation from the position of modern global data and personal experience of authors. Methods to medication administration are mentioned: enteral, parenteral, including intra-nasal which is fairly popular of late. Special attention is paid to specific problems of sedation, presence of motion activity, psychoemotional agitation, compulsive coughing. Potential causes of these events are described, in particular, correlation between psychoemotional agitation with dysregulation of GABA-ergic and dopaminergic systems. Current data on the intra-operative monitoring are presented, as an important component of the patient’s safety during sedation. Additionally to Harvard Standard, it is recommended to use capnograpy and monitoring of sedation depth through bispectral index.

Transcutaneous oximetry of angiosomes of maxillary and facial arteries in systemic lupus erythematosus

2024-11-27T11:52:48+02:00

Introduction. Systemic lupus erythematosus (SLE) is a chronic disease that belongs to the group of rheumatic diseases and is characterized by autoimmune damage to connective tissue and blood vessels with the development of necrosis, hemorrhages, and thrombosis of various areas of soft tissues, including the oral cavity. In the early stages of periodontitis, signs of damage can be observed in the microvessels of the gums and adjacent parts of the periodontium caused by a violation of their perfusion with oxygen (tcpO2) The aim of the study. To determine the transcutaneous tension of oxygen and carbon dioxide in angiosomes of the maxillary and facial arteries in patients with SLE with affected periodontium. Materials and methods. The work analyzed the results of the examination of 50 patients with SLE (10 men and 40 women) aged 20 to 55 years, who were treated in the rheumatology department of the KNP "ZOKL named after A. Novak" ZOR. Depending on the form of the course, 10 patients were selected, who underwent transcutaneous determination of tcpCO2 and tcpO2 in the angiosomes of the maxillary and facial arteries. Results: the highest values of tissue perfusion with oxygen are observed in the angiosomes of the upper jaw (230 mm Hg) compared to the angiosomes of the lower jaw, where this indicator fluctuated within 81 mm. mercury Art. the highest mean values of transcutaneous tension of carbon dioxide were observed in patients with a severe form of SLE. The tension of tcpO2 in the upper jaw is greater than in the lower one, taking into account the greater branching of the collateral blood flow in the upper jaw due to the anastomoses of m. buccinator and m. masseter. At the same time, tcpCO2 reaches its maximum value in the zone of the lowest tcpO2 indicators both on the upper and lower jaw. Conclusions: The lowest value of transcutaneous oxygen tension was found in patients with a severe form of SLE, where the IPR was 1.14±2.6 on the lower jaw (p>0.05). The highest index of transcutaneous tension of carbon dioxide was found in patients with a severe form of SLE both on the lower and upper jaw (p>0.05).

Lateral approach sinus lift: literature review and clinical case

2024-11-27T12:09:16+02:00

Introduction. After the removal of the upper jaw molars and before implantation in this area, 54.2% of patients require augmentation of the floor of the maxillary sinus (sinus lift). Research methodology and methods. A review of modern references in English in the PubMed database was conducted and a clinical case from own practice was analyzed. Results and discussion. Lateral approach sinus lift is the leading method of augmentation of the maxillary sinus floor. The advantage of the lateral approach over the crestal approach is the ability to see the Schneiderian membrane and the maxillary sinus during the manipulation. During sinus lift, autografts, allografts, xenografts, and alloplastic materials can be used for bone plastic surgery. Due to its high osteogenic capacity and osteoconductive and osteoinductive properties, autograft material is considered the gold standard. Sinus lift can be performed as a separate pre-implantation intervention or with the simultaneous installation of an implant. Clinical case. A 38-year-old man complained about missing a tooth. According to conebeam computed tomography, the residual bone height in the area of planned implantation was 1.55 mm. It was decided to perform a lateral approach sinus lift. Bone defect was filled with 5 mm3 of autologous bone chips, then the mucoperiosteal flap was returned to its place and fixed. Radiographic follow-up examinations 10 days and 3 months later revealed no inflammation and adequate sealing of the autograft. Conclusions. Lateral approach sinus lift is a reliable and predictable method of augmentation of the maxillary sinus floor. The success of sinus lift depends on the individual characteristics of the patient, the practical experience and manual skills of the doctor, the selected materials and tools, as well as on the appropriateness of the treatment method to the clinical situation of the given patient.

Evaluation and comparison of the influence of unilateral posterior and anterior crossbite on the musculo-articular condition of the maxillofacial apparatus

2024-11-27T12:14:20+02:00

Crossbite is characterized by the reverse relationship of one or more teeth and includes many varieties. A peculiarity of the crossbite itself is a characteristic lesion of only one half-arch or both arches bilaterally with an impact on functional structural development. The most frequent and those that have the greatest impact on the functioning of the entire dentition apparatus are unilateral posterior and anterior crossbites. Studying and understanding the impact of crossbite on chewing on the functioning of the maxillofacial apparatus is the way to achieve a healthy stomatogenic system. The purpose of the study is to analyze and compare the impact of unilateral posterior and anterior crossbite on the functioning of the musculo-articular complex and its impact on the occurrence of TMJ dysfunctional conditions. In total, 47 people aged from 7 to 39 years were examined, respectively during the period of variable and permanent bite. Depending on the type of bite, the patients were divided into two groups. The first group included 26 people aged from 7 to 34 years with a unilateral posterior crossbite. The second group included 21 patients aged 7–39 years with an anterior crossbite. Both groups used basic research methods (clinical examination, palpation of masticatory muscles and temporomandibular joints) and additional ones (photometry, axiography, electromyography). This comparative study between unilateral anterior crossbite mastication and unilateral posterior crossbite mastication was performed based on the frequency of masticatory cycles in reverse order and yielded the following data. The results showed that the prevalence of chewing cycles in reverse sequence in anterior crossbite (not involving any posterior premolars and/or molars) was approximately 8–9% on the crossbite side and approximately 7–13% on the healthy side. The percentage of back-to-back masticatory cycles in patients with unilateral posterior crossbite was significantly higher than in healthy or anterior crossbites, showing a prevalence of 59% with soft bolus and 72% with hard bolus. Thus, the impact of a malocclusion on masticatory function depends on the functional role of the teeth involved in the malocclusion, and, accordingly, the impact of the anterior teeth on the masticatory cycle in the frontal plane is significantly different from that of the posterior teeth.

Evaluation of the level of prostaglandin E2, thromboxane B2 and leukotriene B4 in kidneys in simulated Hayman's nephritis under the influence of cell-free cryopreserved biological agents

2024-11-27T10:28:27+02:00

Introduction. A kidney disease characterized by the deposition of immune complexes on the glomerular basement membrane is called membranous nephropathy (MN). Although the ultimate goal of treatment for this organ-specific autoimmune disease is to terminate the immune response to PLA2R or other podocyte antigens, the slow decline in circulating antibody titers after treatment puts podocytes at risk of further damage. Cell-free cryopreserved biological agents (CFCBA), in particular, cryopreserved placental extract (CEP), spleen cryoextract (CES) and conditioned medium of mesenchymal stem cells (MSC-CM) attracted our attention as potential means for the treatment of patients with MN. The purpose of the study is to characterize the level of prostaglandin (Pg) E2, thromboxane (Tx) B2 and leukotriene (LT) B4 in the kidneys of rats with simulated Heyman's nephritis under the influence of cell-free cryopreserved biological agents. Materials and methods. Autoimmune nephritis (AIN) was reproduced according to the method of Heymann W.R. and sang Research on the effectiveness of CFCBA in AIN was conducted on 42 male sheep. On the 70-th day of the experiment, the rats were removed from the experiment and the kidneys were excised. To obtain a homogenate, the kidneys were washed with cold (+4°C) isotonic 1.15% KCl solution and homogenized. The content of PgE2, LTB4 and TxB2 was determined by the enzyme-linked immunosorbent assay method using standard kits for enzymelinked immunosorbent assay (Neogen Corporation, USA). Research results and their discussion. Experimental studies have shown that in rats, against the background of the development of AIN, there is a multiple increase in the content of eicosanoids in the kidney tissue. The use of the reference drug canefron caused a decrease in the content of the studied eicosanoids in the kidney tissues of rats with AIN by 19.0–23.6% on average. Against the background of the introduction of the investigated CFCBA, the most pronounced changes were noted from the side of LTB4 content. The evaluation of the level of TxB2 in the kidneys of rats with AIN against the background of CFCBA administration showed that the specified eicosanoid decreased most significantly (р˂0.001) against the background of MSC-CM application (44.4%). The introduction of CES and CEP led to a relative decrease in the level of PgE2 in the kidney tissues of rats with AIN by 26.4% (p˂0.001) and 26.7% (p˂0.001), respectively. Conclusions. Against the background of the introduction of CEP, the content of LTB4 in rats with AIN decreased (p=0.005) by 42.9%. The assessment of the PgE2 content in the kidney tissues of rats with AIN showed that the most clearly indicated indicator decreased (р˂0.001) against the background of the introduction of MSC-CM (43.5%). Similarly, the content of TxB2 decreased most significantly (р˂0.001) against the background of the use of MSC-CM (44.4%).

Features of the colon microbiome in mild COVID-19

2024-11-27T10:39:17+02:00

Introduction. The stability of the composition and physiological functions of the colon microbiome is maintained by specific mechanisms of symbiosis with the macroorganism, which was formed in the process of long-term adaptation of coexistence in the form of a single ecological system. Identification of the features of the colon microbiota of patients with infectious pathologies, including COVID-19, continues to attract special attention of scientists. The purpose of the study: to investigate and analyze the human colonic microbiome in mild COVID-19, including in a comparative aspect with the indicators of practically healthy individuals. Materials and methods. Microbiological (bacteriological and mycological) examination of clinical material (stool) was performed in 24 patients with covid-associated communityacquired pneumonia of mild severity and in 29 healthy volunteers who did not have any complaints of gastrointestinal disorders and considered themselves to be practically healthy. The study participants included 52.84% (28) women and 47.16% (25) men. The average age of the study participants was 40.16±5.25 years (from 29 to 48 years). Clinical material (the last portion of fresh feces) was collected with a sterile spatula and placed in sterile pharmacy vials. Isolation and identification of isolated pure cultures were performed according to generally accepted methods. An electronic database was created in Excel® 2016 (Microsoft). Statistical analysis was performed using MS® Excel® 2016™ and Statistica® 7.0 (StatSoft Inc., USA). The reliability of data for independent samples with a distribution of arrays close to normal was calculated by the Student's t-test, with uneven distribution – by the Wilcoxon-Mann-Whitney U test. Differences were considered significant at p<0.05. Results. It has been established that in patients with mild coronavirus infection, a stable tendency to decrease the population level of bifidobacteria and a statistically significant decrease (P<0.05) in the bacteria of the genus Lactobacillus is formed in the colon. In contrast, in the colon of patients with COVID-19, there is a stable tendency to increase the population level of enterobacteria of the genus Proteus, bacteria of the genus Staphylococcus and yeast-like fungi of the genus Candida. The population level of Escherichia coli practically does not change, but in patients with mild COVID-19 it reaches the highest level in the colon (9.49±0.90 LgKUO/g). There is a 60.05% decrease in bifidobacteria and a 3.92-fold decrease in lactobacilli in the colon of patients with mild COVID-19. The decrease in the population level and the role of bacteria of the genus Bifidobacterium and Lactobacillus in the Quorum sensing system contributes to a decrease in their protective functions and control over microbiota self-regulation, which leads to colon contamination with conditionally pathogenic enterobacteria E. coli with altered properties, E. coli Lac-, enterobacteria of the genus Proteus, Klebsiella, Enterobacter and Citrobacter. Conclusion. The decrease in the number of bacteria of the genus Bifidobacterium and Lactobacillus in the colon biotope in patients with mild COVID-19 contributes to the contamination of the intestine with conditionally pathogenic enterobacteria, the population level of which reaches values at which the development of infectious and inflammatory processes is possible.

IN MEMORY OF PHD IN MEDICINE, ASSOCIATE PROFESSOR DOLHOSH MARIIA YURIIVNA

2024-11-27T12:29:17+02:00

IN MEMORY OF PHD IN MEDICINE, ASSOCIATE PROFESSOR DOLHOSH MARIIA YURIIVNA

Quality of life of patients with osteoarthritis of the temporomandibular joint as a criterion for the effectiveness of rehabilitation intervention

2024-11-27T12:24:00+02:00

Introduction. The widespread prevalence of osteoarthritis of the temporomandibular joint and the need for a multidisciplinary approach to correcting its symptoms make it necessary to create rehabilitation programs using modern means of physical therapy from the standpoint of a functional approach. Рurpose: to evaluate the effectiveness of the use of physical therapy in patients with temporomandibular joint osteoarthritis based on the dynamics of quality of life indicators. Materials and methods: 48 people with diagnosed osteoarthritis of the temporomandibular joint were examined. In people of group 1 (23 people), it was corrected by wearing individual relieving splints. Individuals of group 2 (25 people), in addition, received a course of physical therapy – therapeutic exercises for masticatory muscles, facial muscles, tongue, front surface of the neck and a course of Transcutaneous electrical nerve stimulation using the unipolar technique for masticatory and temporal muscles. The duration of correction in both groups was 1 month. Quality of life was assessed using the OHIP-14, SF-36 questionnaires. Research results. In patients with temporomandibular joint osteoarthritis, deterioration of the quality of life was determined both in terms of dental dysfunction (according to the OHIP-14) and non-specific health-related quality of life (according to the SF-36). According to the results of the corrective intervention, the overall positive dynamics of the OHIP-14 scale in group 1 was 45.2% (from 44.94±1.19 points to 24.62±1.03 points), in group 2 - by 71.1% (from 45.18±1.13 points to 13.04±0.49 points) (p<0.05). The result of the application of restorative intervention in both groups was a statistically significant improvement of the studied indicators of the SF-36 subscales relative to the initial parameters (p<0.05) (except for the “Social” Function subscale of the SF-36 questionnaire), but with a statistically significant advantage of the indicators of group 2 compared to the group 1 (p<0.05). This can be justified by the active functional influence on the musculo-articular components of the dysfunction, and not only by the passive relief provided by the splint. Conclusions. The means of physical therapy should be used to improve the quality of life of patients with osteoarthritis of the temporomandibular joint and increase the effectiveness of dental orthopedic correction.