Nevin Manimala

Wiad Lek. 2021;74(4):998-1002.

ABSTRACT

OBJECTIVE: The aim: To analyze and calculate CVR in patients with T2DM and concomitant obesity.

PATIENTS AND METHODS: Materials and methods: The selection of patients was carried out based on the Uzhhorod District Clinical Hospital, in the period from November 2016 to January 2020. All patients were divided into 3 groups: 1 (n=93) with T2DM and concomitant obesity, 2 (n=87) with T2DM, 3 (n=39) with obesity. The treatment period lasted 1 year and included dosed exercise for at least 30 minutes per day and dietary recommendations. Patients in groups 1 and 2 received metformin 850 mg twice daily in combination with dapagliflozin 10 mg once daily. CVR was determined at the time of enrollment and after 1 year of treatment using: American College of Cardiology / American Heart Association Guideline on the Assessment of Cardiovascular Risk (2013) (ASCVD Risk) and Framingham Risk Score (FRS).

RESULTS: Results: The data obtained as a result of the study revealed the highest CVR in patients of group 1, in contrast to group 2 and 3 (p<0.05). After 1 year of complex treatment, CVR indicators were statistically significantly reduced in all experimental groups (p<0.05).

CONCLUSION: Conclusions: Determining CVR parameters and exposure to them within 10 years can remove unwanted cardiovascular complications.

PMID:34156019

Wiad Lek. 2021;74(4):992-997.

ABSTRACT

OBJECTIVE: The aim: Study of the dynamics of morphological rearrangement of bone under conditions of immediate occlusive functional load and the effect of splinting of implants with temporary orthopedic structures with the analysis of the coefficient of stability of implants during immediate implantation in the experiment.

PATIENTS AND METHODS: Materials and methods: A series of experiments was performed on 6 male Duroc pigs at the age of 6 months and weighing 40-60 kg. In the course of recent advances, the following methods have been used: the clinical protocol of immediate – implantation of time-consuming clothes, the definition of COEFICIENT, morphometry and light microscopy of the slides, statistical analysis.

RESULTS: Results: By morphometric examination after 3 months the BIC in the series with splinting was 1.68 times higher compared to 1 month. studies, in a series of experiments without splinting – 1.9 times, after 3 months. the difference between implantation experiments with splinting components and without splinting is 1.6 times. During the functional study of the resonant – frequency analyzer, there is an increase in the ISQ in the second and third months after surgery, but this figure is higher in the study using the splint component.

CONCLUSION: Conclusions: Stagnation of the shingle component in the case of intrinsic intraoperative functional juvenile implantation accelerates the dynamics of osteointegration, so that high indicators of the efficiency of the implant stability can be achieved.

PMID:34156018

Wiad Lek. 2021;74(4):973-976.

ABSTRACT

OBJECTIVE: The aim: To study the effect of arterial hypertension on the course of chronic obstructive pulmonary disease in patients with comorbid pathology.

PATIENTS AND METHODS: Materials and methods: The prospective study included 61 patients with COPD: 32 stable male patients with COPD with comorbid arterial hypertension of stage II 1-3 degrees and 29 stable outpatients of men with COPD of clinical groups A-D with impaired respiratory function II-IV according to GOLD. All patients, in accordance with the goals and objectives of the study, were divided into 2 groups: group I consisted of men with isolated COPD, middle age – 56.0 (8.5) years, average duration of the disease – 16.2 (1.3) years, Group II consisted of male patients with COPD and arterial hypertension (AH), middle age – 59.5 (7.5). The patients underwent a general clinical examination, which included an assessment of complaints, anamnestic data, and a physical examination. The severity of COPD was determined on the basis of the frequency of exacerbations during the year, assessment of dyspnea using the mMRS scale, spirographic data. Statistical materials were processed using the STATISTICA 10.0 program.

RESULTS: Results: In group I, 20 patients (69%) complained of dyspnea during exercise, in group II – 25 patients (78%) (p = 0.4), 28 patients (96.5%) complained of cough with vague sputum. group and 30 patients in group II (93.8%) (p = 0.09). When assessing the number of exacerbations over the past year, it was determined that patients with isolated COPD had an average of 1.0 (1.0; 2.0) exacerbations, and patients with COPD and AH – 2.0 (1.0; 3.0 ) (p = 0.06). According to the CAT questionnaire, the following data were obtained: in group I – 9.0 (8.0; 11.0) points, and in group II – 17.5 (10.0; 20.0) points (p = 0.02). When conducting spirographic studies, a statistically significant more expressive bronchial obstruction was found in patients with COPD and comorbid hypertension.

CONCLUSION: Conclusions: The presence of comorbid arterial hypertension leads to the intermittent effect of diseases: according to the results of mMRC and SAT test, ailments for COPD were examined, they have a more severe course of underlying seizure in the presence of concomitant arterial hypertension. Clinical manifestations in patients with COPD and H are more severe compared to clinical manifestations in patients without aggravated diseases of the cardiovascular system. Concomitant arterial hypertension enhances the manifestations of bronchial obstruction, in the same way as with patients with isolated COPD.

PMID:34156014

Wiad Lek. 2021;74(4):957-760.

ABSTRACT

OBJECTIVE: The aim: To evaluate the efficiency of the proposed therapy, which included recommendations for nutrition, physical activity and treatment with rosuvastatin, omega-3 PUFA and ursodeoxycholic acid, on the indicators of the lipid profile in patients with NAFLD and prediabetes.

PATIENTS AND METHODS: Materials and methods: 78 patients with impaired glucose tolerance were examined. According to the inclusion and exclusion criteria, 55 patients with prediabetes and concomitant NAFLD were included in the study. All patients underwent a comprehensive clinical examination, which included anthropometric data collection, objective examination, and venous blood sampling for laboratory tests.

RESULTS: Results: The data obtained after 12 months of proposed treatment revealed a statistically significant improvement of indicators lipid profile in patients with prediabetes and NAFLD. Moreover, no significant difference between mean values of HDLC, LDLC, TG and atherogenic coefficient of almost healthy individuals and the corresponding indicators of treated patients detected.

CONCLUSION: Conclusions: therapy which included recommendations for nutrition, physical activity and treatment with rosuvastatin, omega-3 PUFA and ursodeoxycholic acid significantly improved lipid metabolism in patients with prediabetes and NAFLD.

PMID:34156011

Wiad Lek. 2021;74(4):954-956.

ABSTRACT

OBJECTIVE: The aim: Is to determine the features of hemodynamics and the character of structural and functional changes in the prostate gland in middle-aged infertile males in the conditions of chronic hepatitis.

PATIENTS AND METHODS: Materials and methods: We studied the features of hemodynamics and structural and functional state of the prostate gland in middle-aged males who had suffered from chronic hepatitis with the help of ultrasound scanning, Color-Doppler sonography, and histology, morphology, and statistics.

RESULTS: Results: It was detected that in 3-5 years after chronic viral hepatitis in middle-aged males (the first period), the volume of the prostate gland increases to (27.1±1.2) cm3, and its mass to (28.0±1.7) g compared to the control. Blood flow rates in the prostate gland: arterial blood flow velocity, blood flow diastolic velocity, volumetric blood flow are significantly lower than the control ones. Glandular zone surface decreases to 53% and connective tissue increases to 43%. Epithelium in the secretory area of the gland is compressed.

CONCLUSION: Conclusions: 1.According to the data of ultrasound diagnostics and Color-Doppler sonography, the volume of the prostate gland increases to (27.1±1.8) cm3 and its mass to (28.0±1.7) g at chronic viral hepatitis, compared to the control (21.3±1.5) cm3 and (24.7±1.3) g (р<0.05). Atrophic changes in the prostate gland are manifested with the decreased height of the columnar epithelium of the gland and overgrowth of connective tissue in the stroma of the organ. 2.Angioechometric indices of arterial blood circulation in central and peripheral zone of the prostate decreases to (7.26±0.46) cm/sec and (7.80±0.32) cm/sec respectively compared to the control (18.30±3.10) cm/sec and (17.70±2.90) cm/sec. Venous blood flow rates decrease to (2.45±0.21) cm/sec and (2.60±0.16) cm/sec compared to (5.54±0.8) cm/sec and (5.36±0.03) cm/sec (р<0.05).

PMID:34156010

Wiad Lek. 2021;74(4):940-947.

ABSTRACT

OBJECTIVE: The aim: To carry out a statistical analysis of physical and reproductive health characteristics in women after ineffective reattempts of using assisted reproductive technologies and identify significant medical and social factors contributing to the development of chronic endometritis.

PATIENTS AND METHODS: Materials and methods: We carried out a statistical analysis involving 177 outpatient medical records: group 1 includes 127 women aged under 45 with two or more ineffective attempts of in vitro fertilization; group 2 comprised 50 healthy women without reproductive disorders. The complete physical exam included past history, clinical and gynecologic examination, lab techniques and medical imaging according to outpatient medical records obtained during the follow-up care in Isida-IVF Medical Center LLC. Chronic endometritis was recognized by means of histologic examination of endometrium, with the samples obtained by an endometrial pipelle biopsy on day 4-9 of the menstrual cycle.

RESULTS: Results: The prevalence of pelvic inflammatory disease in patients of group 1 comprised 47.2%, endometritis – 41.7%; p1.2 <0.01. The prevalence of acute endometritis among patients of group 1 comprised 6.3%; p1.2 >0.05 and was associated with an infection after abortion. In group 1, sexually transmitted infections were reported in 67.7% of patients, p1.2> 0.05, bacterial vaginosis was registered 1.5 times more often – 28.4%; p1.2 <0.05. In group 1, single induced abortion was reported in 15.0%, while 2 times it took place in 15.7% (p1.2 <0.05). Laparoscopies were previously performed in 59.8% of women, laparotomies – in 62.2%, while in 25.4% of women these interventions were reperformed. Unilateral salpingectomy, due to ectopic pregnancy, was performed in 25.4% of women, bilateral – in 12.7%. Fallopian tube removal, due to sactosalpinx, was performed in 25.4% of women, unilateral salpingectomy took place in 3.9% of cases. The most significant risk factors of chronic endometritis in groups studied are acute postabortal endometritis, RR (relative risk) = 1.439, p = 0.029 and postoperative peritonitis provoked by the complications of appendectomy, RR = 1.430, p = 0.084. We detected none of significant effects of pelvic inflammatory disease on the development of chronic endometritis (RR = 45.132, Confidence interval (CI) (6.151-331.167), p = 0.001). The analysis of reproductive failures, as a risk factor of chronic endometritis in women of group 1, showed a significant relative risk: with the past history of premature birth, RR = 1.44, p = 0.039, in case of reattempts of induced abortions, RR = 1.5, p<0.001, Spontaneous miscarriage RR = 1.572, p = 0.001. A higher relative risk of developing chronic endometritis was observed during pregnancy – RR = 1.597, p = 0.001.

CONCLUSION: Conclusions: Statistical analysis of women’s reproductive health after ineffective reattempts of using ART revealed that the high rate of fetal interventions, low rate of alternative and safe abortion methods are registered in these women, as well as the nonavailability of any system of health measures after reproductive failures. A significant increase in miscarriage at early stages takes place, as well as the absence of a tendency for preterm labor to decrease in the rate. Maintaining women’s reproductive health is a considerable medical and social issue, whose resolving depends on joint efforts of governmental and public entities, healthcare agencies and the population responsibility for own health. Designing and adopting the program of preconception care and planning for pregnancy in women after ineffective reattempts of using ART, with chronic endometritis as a primary disease, should be the top priority area of a health care system.

PMID:34156008

Wiad Lek. 2021;74(4):915-922.

ABSTRACT

OBJECTIVE: The aim: To carry out a comparative statistical analysis of obstetric and perinatal complications in singleton and multiple pregnancies once assisted reproductive technologies (ART) are applied according to the records taken from archival materials (maternity and delivery records) and identify the clinical features of multiple pregnancy.

PATIENTS AND METHODS: Materials and methods: Over the period of 2017-2019, 522 women gave birth in LELEKA Maternity Hospital LLC after using assisted reproductive technologies and 331 women among them were followed-up in the women’s health center of LELEKA maternity hospital. Among these women (522) with singleton pregnancy 445 women gave birth, while in multiple pregnancy – 77. The statistical analysis of 150 maternity and delivery records was carried out. All pregnant women were divided into two groups: group 1 – 75 women having singleton pregnancy after ART; group 2 – 75 women having multiple pregnancy after ART. Women getting pregnant after ART, or in vitro fertilization (IVF) and five-day frozen embryo transfer to be exact, turned out to be the selection criterion for a comparative statistical analysis. Mathematical methods for research were used as O.P. Mintser (2013) suggested. The reliability of the digit cancellation test was calculated using the Fisher’s exact test and Student’s T-test. Graphs were designed using Microsoft Excel.

RESULTS: Results: The complications of early multiple pregnancy were the following: anemia (47.8% as opposed to 22.9%, p<0.01), placental insufficiency (43.3% in contrast to 22.9%, p<0.01), threatened abortion (41.8% in contrast to 28.6%, p<0.01). The complications in late pregnancy are as follows: preeclampsia (52.7% as opposed to 20.6%, p <0.01), intrauterine growth restriction (20.0% as opposed to 7.4%, p <0.01), anemia in pregnancy (76.4% in contrast to 32.4%, p<0.01), placental insufficiency (47.3% in contrast to 22.1%, p<0.05).

CONCLUSION: Conclusions: Multiple pregnancy is a high risk for anemia in pregnancy, preeclampsia, placental insufficiency, early intrauterine growth restriction and fetal distress in pregnancy and labor. It predetermines the high level of a caesarean section. Therefore, further research aimed at prediction and prevention of obstetric and perinatal complications in multiple pregnancy after ART is currently topical.

PMID:34156004

Wiad Lek. 2021;74(4):849-855.

ABSTRACT

OBJECTIVE: The aim: To assess the effect of the modified combined program of physical therapy and ergotherapy on the indicators of upper limb recovery in the patients with the left unilateral neglect.

PATIENTS AND METHODS: Materials and methods: The study involved 58 patients diagnosed with the right hemisphere stroke followed by neglect syndrome. Patients were randomly divided into main group (MG) and control group (CG) according to the ratio of 1:1. Physical therapy of CG patients included proprioceptive neuromuscular facilitation (PNF), balance training, ergotherapeutic intervention, and exercises improving fine motor skills. Specially developed intervention program of MG patients took into account patient’s individual capabilities and needs. It included PNF, balance training and upright posture correction, constraint-induced movement therapy, dual task activities, stimulation of the affected side in daily activities, targeted therapy. The length of intervention comprised 3 months in both groups.

RESULTS: Results: According to the results of the primary examination, the groups had no differences in demographic variables, clinical history (NIHSS scale, the Glasgow Coma Scale and Albert’s Test) and Fugl-Meyer assessment of upper limb sensorimotor recovery. Statistical analysis of the final scores of the Fugl-Meyer scale confirmed that MG had statistical advantages in all measured items of the motor function domain, as well as in a number of proprioceptive sensitivity indicators.

CONCLUSION: Conclusions: The obtained results confirm better efficacy of the modified program of physical therapy and ergotherapy, received by MG patients.

PMID:34155991

J Med Internet Res. 2021 Jun 22;23(6):e26771. doi: 10.2196/26771.

ABSTRACT

BACKGROUND: Youper is a widely used, commercially available mobile app that uses artificial intelligence therapy for the treatment of anxiety and depression.

OBJECTIVE: Our study examined the acceptability and effectiveness of Youper. Further, we tested the cumulative regulation hypothesis, which posits that cumulative emotion regulation successes with repeated intervention engagement will predict longer-term anxiety and depression symptom reduction.

METHODS: We examined data from paying Youper users (N=4517) who allowed their data to be used for research. To characterize the acceptability of Youper, we asked users to rate the app on a 5-star scale and measured retention statistics for users’ first 4 weeks of subscription. To examine effectiveness, we examined longitudinal measures of anxiety and depression symptoms. To test the cumulative regulation hypothesis, we used the proportion of successful emotion regulation attempts to predict symptom reduction.

RESULTS: Youper users rated the app highly (mean 4.36 stars, SD 0.84), and 42.66% (1927/4517) of users were retained by week 4. Symptoms decreased in the first 2 weeks of app use (anxiety: d=0.57; depression: d=0.46). Anxiety improvements were maintained in the subsequent 2 weeks, but depression symptoms increased slightly with a very small effect size (d=0.05). A higher proportion of successful emotion regulation attempts significantly predicted greater anxiety and depression symptom reduction.

CONCLUSIONS: Youper is a low-cost, completely self-guided treatment that is accessible to users who may not otherwise access mental health care. Our findings demonstrate the acceptability and effectiveness of Youper as a treatment for anxiety and depression symptoms and support continued study of Youper in a randomized clinical trial.

PMID:34155984 | DOI:10.2196/26771

Res Social Adm Pharm. 2021 Jul;17(7):1327-1331. doi: 10.1016/j.sapharm.2020.10.008. Epub 2020 Oct 21.

ABSTRACT

BACKGROUND: Few studies have documented rural community pharmacy disaster preparedness.

OBJECTIVES: To: (1) describe rural community pharmacies’ preparedness for and responses to COVID-19 and (2) examine whether responses vary by level of pharmacy rurality.

METHODS: A convenience sample of rural community pharmacists completed an online survey (62% response rate) that assessed: (a) demographic characteristics; (b) COVID-19 information source use; (c) interest in COVID-19 testing; (d) infection control procedures; (e) disaster preparedness training, and (f) medication supply impacts. Descriptive statistics were calculated and differences by pharmacy rurality were explored.

RESULTS: Pharmacists used the CDC (87%), state health departments (77%), and state pharmacy associations (71%) for COVID-19 information, with half receiving conflicting information. Most pharmacists (78%) were interested in offering COVID-19 testing but needed personal protective equipment and training to do so. Only 10% had received disaster preparedness training in the past five years. Although 73% had disaster preparedness plans, 27% were deemed inadequate for the pandemic. Nearly 70% experienced negative impacts in medication supply. There were few differences by rurality level.

CONCLUSION: Rural pharmacies may be better positioned to respond to pandemics if they had disaster preparedness training, updated disaster preparedness plans, and received regular policy guidance from professional bodies.

PMID:34155979 | DOI:10.1016/j.sapharm.2020.10.008