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The moderate degree of conditionally of an unfavorable outcome is observed at BMI > 30.0 kg/m2 (RR = 1.99; EF = 49.75 %); EF < 50 % (RR = 1.93; EF = 48.19 %); resting HR > 80 bpm (RR = 1.89; EF = 47.09 %); Thrombolysis (no) (RR = 1.85; EF = 45.95 %); LVDD E/A > 1; (RR = 1.75; EF = 42.86 %) LVmass > 200 g. (RR = 1.63; EF = 38.65 %); ESD > 3.5 sm.
(RR = 1.54; EF = 35.06 %); SDNN < 100 ms.; (RR = 1.51; EF = 33.77 %). Conclusion:
The most informative in terms of forecasting the development of RMI in patients with Q-MI, is the presence of EPAP, AH, left ventricular hypertrophy, the presence of diabetes and excess body weight.
References:
1. Belenkov Y. N., Mareev V. Y. Cardiovascular continuum//Journal of Heart Failure. - 2002. - Vol. 3, № 1(11). - P. 7-11.
2. Ginzburg M. L., Martsevich S. Y., Kutishenko N. P., Deev A. D., Fokin A. V., Diniels E. V. The study of factors affecting the long-term prognosis of patients with myocardial infarction. Russian National Congress of Cardiologists - 2011. When 1-position of the journal "Cardiovascular therapy and prevention". - 2011. - 10(6): 75.
3. Greenfield P. Major risk factors as antecedents of fatal and nonfatal coronary heart disease/P. Greenfield, M. D. Knoll, J. Stam-ler//JAMA. - 2003. - Vol. 290, № 7. - P. 891-897.
4. Sheehan E. N. Methods for forecasting and modeling in socio-sanitary research. - M., 1986. - 207s.
5. Wood D. European recommendation on coronary prevention: implication for secondary preventions and rehabilitation/D. Wood// 7th World Congress of Card. Rehabilit. - Manyla, 2006. - P. 24-35.
6. Nikishin A. G., Kurbanov R. D., Pirnazarov M. M. Time of hospitalization and outcome of acute myocardial infarction in elderly patients in the Central Asian region//Cardiovascular therapy and prevention. - 2012. - T. 11, № 2. - P. 53-56.
7. Martsevich S., Kutishenko N., Ginzburg M., Deev A., Drozdova L. Influence of prehospi-tal and in-hospital cardiovascular therapy use on short-term and long-term prognosis in patients with acute myocardial infarction//Eur J Preventive Cardiology. - April 2013. -20 (Suppl 1), 84. - P. 482.
Murodov Alijon Salimovich, Teshaev Oktyabr Ruhullaevich,
Ruziev Umid Sanokulovich, Tashkent Medical Academy, Uzbekistan E-mail: saodat@mail.ru
Effect of photodynamic therapy and CO2 laser in the microbial landscape of purulent wounds in the experiment
Abstract:
Objective: To evaluate the antimicrobial effect of photodynamic complex and CO2 laser in the treatment of purulent
wounds in the experiment.
Materials and methods. purulent wound model reproduced in 80 male rats by MP Thick (2002) with some modification. Animals from the third day were divided into 4 groups: 1) 20 rats with physiological regeneration; 2) 20 rats with standard therapy, and 3) 20 rats PDT; 4) rats 20 inclusion complex treatment with conventional methods, the CO2 laser (JZ- 3A) 3 times daily until the wound cleansing from necrotic raids and PDT. Microbiological studies conducted by the conventional method at the 1st, 3rd, 7th and 10th day of the experiment.
Results. The discharge from the festering wounds were sown mainly St. Aureus; Proteusmirabilis and E. Colli, polyresistance possess antibiotic. If a high level of contamination of tissue wounds (1 x 10 6-9 CFU/g) was determined prior to treatment the animals of all groups, the carrying out of the integrated laser and PDT contamination was 10 2-10 5 cfu/g for 3-7 hours, and the final deadline for all groups It noted a progressive decrease in the level of microbial contamination, especially with PDT and CO2 laser is below the critical value.
Conclusions: Photodynamic therapy in a CO2 laser complex has a strong antimicrobial activity in the treatment of purulent wounds.
Keywords: purulent wounds, microbial contamination, laser, photodynamic therapy.
Modern wound infection manifesting in various forms 35-45 % of the patients surgical hospitals, the problem is not only the clinical but also general biological [1; 5; 7]. Increasing the number of purulent diseases and postoperative complications, a higher incidence of infection and generalization ofvarious types of toxic and allergic reactions, an unsolved problem of purulent infection in surgery. The steady increase in the number of microorganisms that are resistant to commonly used antibiotics, stimulates both the development
and implementation of the health practice of new antibacterial drugs and the improvement of surgical techniques of the local treatment of purulent wounds, including the impact of physical methods [3; 4; 6]. To resolve this issue in recent years successfully used laser photodynamic therapy (PDT) [6; 10; 13]. PDT has recently attracted attention of researchers because of its high efficiency. An-two antimicrobial photodynamic therapy characterized by a wide specter actions and, unlike antibiotics, practically complete absence
Effect of photodynamic therapy and CO2 laser in the microbial landscape of purulent wounds in the experiment
of side effects and the inability of microorganisms to develop resistance to this factor. Its essence is a selective oxidative destruction of pathogenic microorganisms with simultaneous exposure of the pho-tosensitizer (the dye) and the optical radiation with the appropriate wavelength. From the excited state of the photosensitizer generate reactive oxygen species (singlet oxygen), inducting damage various cell structures and death of microbial cells [2; 3; 11; 12].
Objective
To evaluate the antimicrobial effect of photodynamic complex and CO2 laser in the treatment of purulent wounds in the experiment.
Materials and methods
80 white mongrel male rats were used for experimental research. purulent wound model reproduces all rats as recommended by M. P. Tolstoy (2002), with the introduction of a modification [7]. In the pre-depilated and twice treated with antiseptics site skin-femoral gluteal region with a diameter of 2.5 cm was excised skin and subcutaneous tissue to the superficial fascia, crush injuries and underlying muscles region, introduced a 24-hour suspension of the mixture of microbes (museum strains of Staphylococcus aureus and Escherichia coli), containing in 1 ml. 109 microbial cells in a volume of 2 ml. In order to create a seal, to prevent injury and contamination of the surrounding organisms to the edges of the wound stitched plastic ring with a side height of 1.2 cm. and 2.5 cm. in diameter, fixed ring with two sides, inserted into a dry sterile gauze ball and imposed suggestive nodal joints. This 2 rats died of generalized infection. Festering wounds in rats were formed after 48 hours and had all the classic signs of inflammation. Animals from the third day were divided into 4 groups depending on the treatment method: 1st group (18 rats) — monitoring the natural course of wound healing; 2nd group (20 rats) — the traditional method of treatment (debridement, ceftriaxone, levomekol; 3rd group (20 rats) — PDT was performed after removing the gauze ball, and treatment with a solution ofhydrogen peroxide with the application of sterile gauze ball moistened with 0.005 % aqueous solution of methylene blue (MS) to the wound surface layer of 1-2 mm., with full closure of the wound surface. Then opaque bandage was applied after 30 min irradiation of installing applications performed FDE-1 (Uzbekistan) with a power density of200 mW/cm2; duration 10 min. on the daily total of 6 treatments [10]. The animals of Group 4 (20 rats) underwent complex treatment including conventional methods of CO2 laser (JZ-3A) 3 times daily until the wound cleansing from necrotic raids and PDT in the same conditions. To evaluate the antimicrobial action taken tissue samples obtained from a wound and bottom walls at the 1st, 3rd, 7th and 10th days after its application.
To assess the effectiveness of the treatment was carried out a thorough dynamic monitoring of the general state of the animals, the local course of the wound process, the progress of wound healing (speed dermal contraction, existence and disappearance of redness around the wound, the rate of formation of primary and secondary scab, the nature of discharge from the wound — its color, smell, quantity). Microbiological studies were carried out by the usual method. Digital material is treated by variational statistics.
Results and its discussion
When determining overall characteristics of the selected agents it was found that they mainly represented by staphylo-cocci and gram-negative flora. The leading role in microbiological study of discharge from septic wounds took St. Aureus (62.5 %);
Proteusmirabilis (54.8 %); E. Colli (50.8 %) and a small amount Str. Pyogenus (12.5 %). It should be noted that the above listed organisms are major pathogens of purulent infection in surgery.
In the study of the sensitivity of microorganisms to antibiotics has been identified to the stability of the most widely used antibiotics. They were susceptible to cephalosporin, fluoroquinolone and aminoglycoside antibiotics last generation, in particular, they were the most sensitive to tsiproflaksatsine, ceftriaxone, and less sensitive to penicillin and erythromycin. In addition, they were multidrug-resistant to several antibiotics at the same time. These results indicate that the microflora isolated from septic wounds, often a MDR.
Together with the high quality microbiological studies we identified CFU, which today are the most informative as possible to determine the level of microbial contamination of the wound per 1 g of tissue. The results of the study showed that before treatment in all groups of animals determined by the high level of contamination of tissue wounds, an average 1 x 10 6-9 CFU/g. On the third day simulation of purulent wounds destructive level of microbial contamination was in the animals in Group 1 10 5-10 9 CFU/g, the animals of the 2nd group receiving standard treatment — 10 4-10 6 CFU/g in rats 3 - the second group received treatment only PDT — 10 3-10 6 CFU/g, and in the 4th animals receiving comprehensive treatment of us was revealed the lowest level of microbial contamination, making 10 2-10 5 CFU/g.
On the 7th day from the start of treatment of purulent wounds indicators of microbial contamination of the animals in Group 1 were kept at the same level. A significant reduction in microbial load of 1 gram of tissue contact was observed in the animals of group 4 (10 2-10 5 CFU/g), whereas the animals of the 2nd and 3rd groups averaged 10 3-10 6 CFU/g. On the 10th day of observation in almost all groups noted a progressive decrease in the level of microbial contamination. However, in the group of animals receiving combined treatment with PDT antibiotic therapy and CO2 laser was observed sustained reduction in the level of microbial contamination of tissue below the critical wounds.
The results show a strong antimicrobial effect of the proposed method of treatment of purulent-destructive. According to the literature, PDT — is a three-treatment, two component (photosensitizer and light) are exogenous external factors, the third essential component of the It is an endogenous factor — oxygen [9; 10; 11]. When exposed to light of a specific wavelength and photosensitizer energy begins to produce singlet oxygen and other reactive oxygen species that cause oxidative damage to various molecules (proteins, unsaturated fatty acids, nucleic acids), and cell structures (membranes, enzyme systems, genetic apparatus, etc.), that entails inactivation of pathogens [9; 10; 11]. On the other hand, the main target of PDT in vivo conditions in a vascular system, particularly capillary endothelial cells ofthe [10; 11; 12]. Apparently, the violation ofperfusion with hypoxemic subsequent necrosis is an important goal of cell death in addition to the direct damage to cellular structures [13; 14].
Conclusions:
1. Photodynamic therapy in a CO2 laser complex has a strong antimicrobial activity in the treatment of purulent wounds.
2. Complete the application of PDT and CO2 laser leads to earlier eradication microbial wound surface, helping to accelerate the purification and healing of purulent wounds.
References:
1. Abaev J. K. Surgeon Directory. Wounds and wound infektsiya. - Rostov n/D: Phoenix, 2006.
2. Bazhenov L. G., Sadykov R. A., Mirishova Sh. I., Bazhenov S. Possibilities of photodynamic therapy in inhibition growth of fungi candida//Immunopathology, Allergology, Infectology. - 2010. - № 1. - S. 217-219.
3. Baranov E. V., Buravsky S. K., Tretyak S. I. Antimicrobial photodynamic therapy in complex treatment of patients with purulent septic pathology//Proceedings of the scientific-practical conference with international. - Grodno, 2011. - S. 3-5.
4. Beschastnov V. V., Pevnev A. A., Malakhov N. I., Moscow A. E. The results of microbiological monitoring of the treatment of festering wounds in a general surgical hospital//Clinical medicine. - 2009. - № 2. - S. 53-56.
5. Ginyuk V. A. Using phototherapy for the treatment of purulent wounds and the possibility of its use in patients with acute medi-cine//Military medicine. - 2010. - № 3. - S. 79-83.
6. Derbenyov V. A., Azimshoev A. M., Sharifov A. D. Photoditazine in someone complex treatment of purulent wounds//Russian bio-therapeutic journal. - 2007. - № 1. - S. 14-16.
7. Ivankov M. P. The use of wound dressings with silver nanostructure in the complex treatment of purulent wounds//Abstract. diss ... k. m. n. - M., 2014. - 22 р.
8. Kum I. V., Zhmakin A. I., Beetle I. G. Microbiological study the efficacy of photodynamic therapy in colorectal surgery//Medical Journal BGMU. - 2007. - № 1. - S. 58-60.
9. Meerovitch I. G., Stratonnikov A. A., Ryabov A. B. et al. Optical absorption studies of sensitizers in biological tissues in vivo//Russian biotherapeutic journal. - 2004. - Vol. 3, № 2. - Р. 54-55.
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12. Luksiene Z., Zukauskas A. Prospects ofphotosensitization in control ofpathogenic and harmful micro-organisms//Journal ofApplied Microbiology. - 2009. - Vol. 3. - P. 1-6.
13. Tavares A., Carvalho C., Faustino M. et al. Antimicrobial photodynamic therapy: study of bacterial recovery viability and potential development of resistance after treatment//Mar. Drugs. - 2010. - Vol. 8. - P. 91-105.
Zufarova Shakhnoza Alimjanovna, Professor, Department of Obstetrics and Gynecology, Tashkent Pediatric Medical Institute Muftaydinova Shakhnoza Kiemitdinovna, Assistant of the Department of Obstetrics and Gynecology of Andijan State Medical Institute E-mail: evovision@bk.ru
The effectiveness of individual pregravid preparation at early and late stages of pregnancy in women with hyperandrogenism
Abstract: Individualized complex therapeutic measures conducted for the purpose of correction and prevention of GA TF
with in pregravid preparation, reduces the level of active androgens and hemostasis parameters to values close to normal, and
reduce the incidence of pregnancy loss.
Keywords: Hyperandrogenism, pregnancy, pregravid preparation.
The main task of modern obstetrics is to reduce the number of reproductive losses, and the relevance of miscarriage is not in doubt, since it is the most frequent complication.
The main task of modern obstetrics is to reduce the number of reproductive losses, and the relevance of miscarriage is not in doubt, since it is the most frequent complication. Despite the progress in recent years, advances in the prevention and treatment of this disease, the frequency of NB is stable and high enough. Thus, according to different authors, it is from 2 % to 55 %, reaching 80 % of the first trimester [2; 3]. No degradation of NB frequency points to the difficulties encountered in the management of this group of patients. On the one hand, they are due to multifactorial etiology and pathogenetic mechanisms of disease. On the other — the imperfection of diagnostic methods used and the lack of adequate monitoring of complications arising during pregnancy.
Fetal loss syndrome — a new term that emerged in recent years and includes [4]:
- one or more spontaneous abortions or developing pregnancy on term of10 weeks or more;
- Stillbirth;
- Neonatal death;
- Three or more spontaneous abortions before 8 weeks of embryonic development.
The aetiology of the syndrome of fetal loss is extremely varied and depends on many factors. Some of them lead directly to abnormal embryo tab, others create unfavorable conditions for its normal development.
The main causes of pregnancy loss: genetic, endocrine disorders, infectious and inflammatory diseases, immunological mechanisms and thrombophilia. By genetic factors often involve embryonic chromosomal abnormalities, which appear as a result of the merger of the two parent cells with point mutations in the chromosome set, arising from a violation of the process of meiosis.
Purpose of the study
To study the efficacy of individualized comprehensive pregravid preparation of patients with hyperandrogenism of various origins in order to reduce the frequency of complications during pregnancy, childbirth and CPR warning.
Materials and methods
The work is based on the results of clinical and hormonal inspection 19 pregnant women aged 21 to 41 years (mean age: 29 ± 0.9 years), including 14 pregnant women from the prospective
