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Clinical and microbiological changes in different types of treatment of acute intestinal infections
Hiv in a region of nigeria
Epidemiological and etiological features of acute intestinal infections caused by conditionally pathogenic flora
Study of the morbidity on epidemic parotitis in chaildhood in the sumy region
Effects of the different spectrums focal low-level laser therapy in thyroid autoimmune disease treatment
Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease
Surgery in pulmonary tuberculosis
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CLINICAL AND MICROBIOLOGICAL CHANGES IN DIFFERENT TYPES OF TREATMENT OF ACUTE INTESTINAL INFECTIONS

Ogunlolu Babajide, 5th year student

Scientific adviser – assist. K.S. Polov’yan

Sumy State University, infectious diseases and epidemiology department


Among the acute intestinal infections (AII), infections caused by conditionally pathogenic microorganisms are becoming increasingly important in Ukraine. The resistance of these pathogens to antibiotics develops rapidly.

The purpose of research is studying the relationship between intestinal microflora status, the dynamics of clinical picture of AII caused by a conditionally pathogenic microorganisms at different types of treatment.

130 hospital records of patients with AII, hospitalized in Sumy regional infectious clinical hospital named after Z.Y. Krasovytskiy were analyzed. The average age of patients was (32,16±2,99) years. There were 83 men (63,9 %) and women 36,1 (34,5 %). Depending on the purpose of medical schemes of treatment all the patients were divided into four groups. The first group of patients (40 persons) received "Bifi-form" from the first day of hospitalization: 1 capsule twice a day for 5-6 days with a basic therapy. The second group (18 patients) received “Norfloxacinum”: 0,4 g twice a day for 3-5 days and “Bifi- form”. The third group of patients received only basic therapy (51 people). Fourth one in addition to basic therapy received “Norfloxacinum”: 0.4 g twice a day 5-day course (21 patients).

Before treatment defecation frequency in all groups of patients ranged from (5,17±0,75) to (7,05±1,05) times a day. Increased body temperature in admission was the same for all patients and it was (37,7±0,03) 0C. During the treatment the abdominal pain disappeared mostly in the 1st and 3rd groups compared with the 2nd and 4th one (at (4,10±0,13) and (4,06±0,19); on (5,11±0,26) and (5,00±0,25) days respectively, p<0,05). Normalization of defecation among patients of 1st and 3rd groups held earlier terms (by (4,85±0,23) and (4,00±0,20), (6,11±0,48) and (5,81±0,25) days, p<0,05) compared with the 2nd and 4th groups. Similar pattern was observed for the duration of fever: for people from the 1st group it was normalized to (2,6±0,19) day, in 3rd group – to (2,97±0,20); in 2nd one – to (4,11±0,37), and in 4th one – to (4,62±0,35), (p<0,05).

Before treatment among 45 people from all groups of intestinal microflora status studies were found the next: normobiocenosis – among 5 (11,1 %), dysbacteriosis 1st degree – among 13 (29 %), 2nd degree – 17 (37,8 % ), 3rd degree – 10 (22,2 %) patients. Before hospital discharge 20 people from the first group showed a trend to restore the quantity of Bifido- and Lactobacterias, reducing the number of conditionally pathogenic microorganisms. Normobiocenosis detected among 3 (15 %), dysbacteriosis 1st degree – among 8 (40 %), 2nd degree – among 7 (35 %), 3rd degree – 2 (10 %) patients. Among 10 examined people from 2rd group normobiocenosis had 1, dysbacteriosis 1 degree – 4 (40 %), 2nd degree – 3 (30 %), 3rd degree – 2 patients. Among 19 patients from 3rd group normobiocenosis had 1 person, dysbacteriosis 1st degree – 7, 2nd degree – 8 (42,1 %), 3 rd degree – 3 (15,8 %) patients. 2 patients from 4th group had dysbacteriosis 1st degree, 4 people – 2nd, in 2 cases there was dysbacteriosis 3rd degree. During the intestinal microflora status studies among patients of 3rd and 4th groups on 5-6 day of disease we saw an increase of hemolytic Escherichia coli number (14,8 %), association with fungi of the genus Candida (3,7 %) to reduce the Bifido- and Lactobacterias.

Conclusions. Detecting violations of microflora at AII indicates the need of probiotics from the first days of illness. To predict adverse effects of the disease the composition of intestinal microflora, systemic and local immunity in the dynamics must be analyzed. It should refuse the antibiotic therapy at AII, such as that prolongs the duration of fever, diarrhea and pain syndromes, inhibits proper obligate microflora of the colon.


HIV IN A REGION OF NIGERIA

J.K. Okafor, V.I. Okam, 5th year students

Scientific advisor – assist. A.I. Piddubna

Sumy State University, infectious diseases and epidemiology department


HIV - infection is one of the greatest medical and social problems all over the world, of which Nigeria is not exempted. It poses treats to the people living in this geographic location.

The purpose of this work was to learn the dissemination of HIV-infection among the various contingents of Nigerian Population. The research tasks were to analyze epidemiological features of HIV-infection in Nigeria, to explore sexual structure of persons with antibodies to HIV 1/2.

Results. There are three main HIV transmission routes in Nigeria: heterosexual sex, blood transfusions, mother-to-child transmission.

Heterosexual sex: approximately 80-95 % of HIV infections in Nigeria are a result of heterosexual sex. Factors contributing to this include a lack of information about sexual health and HIV, low levels of condom use, and high levels of sexually transmitted diseases. Women are particularly affected by HIV; in 2009 women accounted for 56 % of all adults aged 15 and above living with the virus.

Blood transfusions: HIV transmission through unsafe blood accounts for the second largest source of HIV infection in Nigeria. Not all Nigerian hospitals have the technology to effectively screen blood and therefore there is a risk of using contaminated blood. The Nigerian Federal Ministry of Health have responded by backing legislation that requires hospitals to only use blood from the National Blood Transfusion Service, which has far more advanced blood-screening technology.

Mother-to-child transmission: each year around 57,000 babies are born with HIV. It is estimated that 360,000 children are living with HIV in Nigeria, most of whom became infected from their mothers. This has increased from 220,000 in 2007.

Conclusions. The number of HIV-infected persons in a region of Nigeria was increased with every year. Multiple sexual contacts determines the disposition of epidemic in the country, approximately 80-95 % of HIV infections in Nigeria are a result of heterosexual sex. Women are the high risk group to HIV transmission.


EPIDEMIOLOGICAL AND ETIOLOGICAL FEATURES OF ACUTE INTESTINAL INFECTIONS CAUSED BY CONDITIONALLY PATHOGENIC FLORA

Peeta-Imoudu Hope Oghie, 5th year student

Scientific adviser – assist. K.S. Polov’yan

Sumy State University, infectious diseases and epidemiology department


Annually in the world there are nearly one billion cases of diarrhea. In this case, most of them are caused by opportunistic microorganisms from the family Enterobacteriaceae.

The purpose of this study is to note the dynamics of morbidity and etiological structure of acute intestinal infections (AII) caused by opportunistic pathogens in the Sumy region from the years 2000 to 2009.

During this period were the records of 520 patients with AII studied, having being hospitalized in Sumy regional infectious clinical hospital named after Z.Y. Krasovytskiy. There diagnosis was based on clinical, epidemiological and laboratory data. The average age of the patients was (47,54±2,75) years. Among the patients were men 280 (53,85 %), women – 240 (46,15 %).

Upon analyzing the incidence of AII in Sumy region over the past 10 years, we can conclude that the level of AII is relatively stable, which is lower than is observed nationwide. There was an increase in AII incidence in 2002 (161,1 per 100000 of general population), but there was no involvement in the epidemic process the objects of high epidemic risk. In 2008, the incidence in the area amounted to 157,5 per 100000 of general population, while there was an increase of 147 cases. In Ukraine, the year 2009 compared with 2008 shows the increase in incidence of AII by 7,3 %, while in the Sumy region was a decline by 1,1 times. In total incidence of AII in Ukraine, a significant place in household outbreaks was not linked to quality of the food industry. In the Sumy region cases of AII are disparate and unconnected. Also observed was the rise in incidence in April and October (79,6 % surveyed), indicating seasonal influences on the epidemic increase in the incidence of AII, the stimulating effect of ambient temperature on the multiplication of pathogens in food. During analysis of the epidemiological history according to medical records, none of the patients were guality of drinking substandard water, 84,3 % of patients mentioned the use of products of dubious quality or that which does not require thermal processing (dairy, meats, salads, eggs, fish, etc.).

In Sumy region from the years 2000–2005, the proportion of AII with the established pathogen ranged from 40–43,3 %, but in 2008–2009 years due to strengthening logistical support for laboratory services the figure was placed at 58–59 %. We examined the bacteriological confirmation of diagnosis that was carried out in 387 (74,4 %) cases, serology – in 134 (25,8 %). The main etiologic factors were St. aureus (16,5 %), Kl. pneumoniae (16,2 %) and the association of opportunistic pathogens (16 %). In the elderly patients, etiologic agents were: Citrobacter (25,6 %), Enterobacter cloacae (9 %). The patient, who had returned from the Crimea, had the pathogen Gaffnia (0,2 %).

Conclusions. In the Sumy region, a relatively stable incidence of AII. A significant place in household outbreaks was not linked to the quality of the food industry and/or public catering. The main etiological agents of AII in Sumy region are St. aureus, Kl. pneumoniae and association of opportunistic pathogens.


STUDY OF THE MORBIDITY ON EPIDEMIC PAROTITIS IN CHAILDHOOD IN THE SUMY REGION

Unamba Anthonia Chimezie, 5th year student

Scientific adviser – assist. K.S. Polov’yan

Sumy State University, infectious diseases and epidemiology department


Carrying out mass vaccination in Ukraine from 1982 and the introduction of vaccination against epidemic parotitis (EP) on the vaccination calendar helped to reduce the incidence of this infection among children and adolescents. Monitoring the incidence of EP shows typical cyclical disease within the periods of every 4-5 years.

The purpose of this study is to analyze the morbidity of EP in different age groups in Sumy region in the year of 2000–2009 years.

The study of morbidity on EP was according to reports of Urban and Regional sanitary stations for the 2000–2009 years. The maximum patients with EP in 2002 was up to 256 peoples (19,5 per 100000 population), by children aged 10–14 (92,0 per 100000) and 15–19 years (85,8 to 100000). Since 2003 the incidence of EP has decreased significantly – 131 peoples (10,4 per 100000), progressively decreased to a minimum of 25 peoples in 2009 (2,15 per 100000). During the period studied in children under 1 year only in 2000, 2001 and 2006 recorded diseases: under 2 (23,7 per 100000), 1 (8,5 per 100000), 2 persons (22,07 per 100000). Analyzing the incidence of EP in the Sumy region among children of different age groups observed increased incidence approximately twice in children of age from 10–14 years compared with a group of 7–9 years. The maximum incidence of EP among peoples of 20 years and over was in 2007 – 41 peoples (4,28 per 100000).

In Sumy, the maximum incidence of EP was 90 peoples in 2001 (30,7 per 100000), including 23 (10,3 per 100000)of age 20 and older. Illness decline began in 2002 and reached the minimum of 6 peoples in 2009 (2,2 per 100000). Over the entire period, it was 1 case of EP in children under 1 year in 2006 (40,48 per 100000). Also in 2007 happened to increase the number of cases of EP in children aged 10–14 years. Since 2002, the group aged 20 years and older, there was a progressive decline from the peak increase in 2007 – 28 people (12,19 per 100000) compared with 2006 (2,61 per 100000).

The result indicates the need for epidemiological control of vaccination against EP according to plan of preventive vaccinations, the study of post-level immunity after vaccine. It is necessary to investigate the incidence of EP among vaccinated peoples of all ages.


Effects of the different spectrums focal low-level laser therapy in thyroid autoimmune disease treatment

Melekhovets Oksana K., Nteman Dienye, Fiyinfoluva Esan

Sumy State University, General Medicine Department


Background and Objective. Autoimmune thyroid disease (AITD) is the most common organ- specific autoimmune disorder resulting in dysfunction (hyper- function, hypofunction or both) of the thyroid gland. The presently accepted classification of AITD includes chronic autoimmune thyroiditis or Hashimotos thyroiditis (HT), its variants and Graves' disease (GD).

Hashimoto's thyroiditis (HT) has a prevalence rate of 1-4% and incidence of 3-6/10000 population per year. The treatment of choice for Hashimoto's thyroiditis is thyroid hormone replacement by orally administered levothyroxine sodium, usually for life. But there is currently no therapy that is capable of regenerating HT-damaged thyroid tissue.

The objective of this study was to gauge the value of applying low-level laser therapy (LLLT) in HT patients based on both ultrasound studies (USs) and evaluations of thyroid function and thyroid autoantibodies.

Study Design/Materials and Methods. Twenty five patients who were diagnosed with HT, hypothyroid stage were included in the study. All these patients were going levothyroxine (LT4) supplement treatment. First group was consist of 12 patients, who received applications of infra-red LLLT (840 - 900 nm, output power 50 mW), second group was consist of 13 patients, who received applications of yellow spectrum LLLT (600 - 570 nm, output power 50 mW). It was provided 10 applications of LLLT in continuous mode, every day for 20–30 minutes, using the sweep technique, with fluence in the range of 38–108 J/cm2, the same in both groups.

USs were performed prior to and 30 days after LLLT. USs included a quantitative analysis of echogenicity through a gray-scale computerized histogram index (EI). Triiodothyronine, thyroxine (T4), free T4, thyrotropin, thyroid peroxidase (TPOAb) and thyroglobulin (TgAb) antibodies levels were assessed before LLLT and then 1, 2, 3, 6, and 9 months after LT4 withdrawal.

Results. We showed that yellow laser irradiation (600 - 570 nm) increased local thyroid blood flow by 30% compared to that in second group with infra-red laser irradiation (840 - 900 nm). Following the second ultrasound (30 days after LLLT), LT4 was discontinued, if required, reintroduced. The LT4 dosage used pre-LLLT (100 µg/day) decreased in the 9th month of follow-up (50 µg/day; P < 0.0001) in 30% patients of the second group and 16 % patients of the first group.

Conclusion. Our data suggest that both of the spectrums of LLLT promotes the improvement of thyroid function, as patients experienced a decreased need for LT4, but predominantly yellow spectrum laser irradiation is a promising therapeutic tool in the thyroid cells function normalisation.


UNRECOGNIZED HEART FAILURE IN ELDERLY PATIENTS WITH STABLE CHRONIC OBSTRUCTIVE PULMONARY DISEASE

L.B. Vynnychenko, Oloegbe Ohio, students of 6th course

Sumy State University, family medicine department with endocrinology course


Heart failure and chronic obstructive pulmonary disease are both common diseases in the elderly. They have an important impact on quality of life and functional status, show high morbidity and mortality rates, and lead to considerable health-care costs. Although both diseases have been studied extensively, information about the prevalence of heart failure in stable chronic obstructive pulmonary disease patients is lacking. The diagnosis of heart failure is fraught with difficulties, notably in the early phases of the syndrome and in the presence of certain co-morbidities. This is particularly true for chronic obstructive pulmonary disease, as recognition of heart failure in these patients is hampered by similarities in signs and symptoms. Importantly, co-existence of chronic obstructive pulmonary disease and heart failure is plausible in view of overlap in risk factors, notably smoking.

Aim of this study was to define the prevalence of unrecognized heart failure in elderly patients, who were in a stable phase of their disease, diagnosed as chronic obstructive pulmonary disease by their general practitioner.

405 patients 55 years of age and older were available for study. They were classified as having chronic obstructive pulmonary disease and not known with a cardiologist confirmed diagnosis of heart failure. All patients underwent an extensive diagnostic work-up, including medical history and physical examination, followed by chest radiography, electrocardiography, echocardiography, and pulmonary function tests.

Of 405 participating patients with a diagnosis of chronic obstructive pulmonary disease, 83 (20.5%) had previously unrecognized heart failure (42 patients systolic, 41 ‘isolated’ diastolic, and none right-sided heart failure). In total, 244 (60.2%) patients had chronic obstructive pulmonary disease and 50 (20.5%) patients combined with unrecognized heart failure.

Conclusion: Unrecognized heart failure is very common in elderly patients with stable chronic obstructive pulmonary disease. Closer co-operation among general practitioners, pulmonologists, and cardiologists is necessary to improve detection and adequate treatment of heart failure in this large patient population.


SURGERY IN PULMONARY TUBERCULOSIS

Alex Magufwa, student of 5th course

Supervisor - Dr. Madyar Vladmir Vasilovich

Sumy State University, department of general surgery


The role of surgery in the treatment of pulmonary tuberculosis has always been the subject of controversy. Surgery has played an important part in the management of tuberculosis since the 1940s. The first successful treatments for tuberculosis were all surgical. They were based on the observation that healed tuberculous cavities were all closed.

At no stage has there ever been absolute agreement on the indications for surgery and the practice of individual physicians and surgeons has always varied to some degree.

Sauerbrach and Elving introduced thoracoplasty for the treatment of cavitated tuberculosis in 1913. In modified form thoracoplasty or some other collapse procedure remained the standard surgical measure until after the introduction of chemotherapy. With the development of effective anti-tuberculous drugs in the early 1950’s resection became possible without producing an acute excerbation of disease or broncho-pleural fistula.

Indications for surgery. The British Medical Journal in 1967 gave the following indications for operation in pulmonary tuberculosis and is useful as a basis for discussion:

1. Patients with cavitated disease with drug resistance. In our practice we would consider for surgery patients with relatively localized disease with resistant organisms who had failed routine second-line drugs or whose sputum was converting with difficulty or who were having difficulty in tolerating drugs particularly in the presence of a destroyed lobe or lung, a thick-walled cavity or a cavity in the spical segment of the lower lobe. 2. Coin lesions where diagnosis is in doubt and differentiation between tuberculoma and carcinoma is impossible. 3. Recurrent haemoptysis due to residual bronchiectasis. 4. Chronic tuberculous empyema. 5. Recurrent pneumonitis associated with bronchostenosis. 6. Cavity with mycetoma with haemoptyses. 7. Infection with Atypical mycobacteria-organisms which are generally drug resistant.

Modern surgical management. In modern times, the surgical treatment of tuberculosis is confined to the management of multi-drug resistant TB. A patient with MDR-TB(multiple drug resistance tuberculosis) who remains culture positive after many months of treatment may be referred for lobectomy or pneumonectomy with the aim of cutting out the infected tissue. The optimal timing for surgery has not been defined, and surgery still confers significant morbidity. The centre with the largest experience in the US is the National Jewish Medical and Research Center  in Denver, Colorado. From 1983 to 2000, they performed 180 operations in 172 patients; of these, 98 were lobectomies, and 82 were pneumonectomies. They report a 3.3% operative mortality, with an additional 6.8% dying following the operation; 12% experienced significant morbidity (particularly extreme breathlessness). Of 91 patients who were culture positive before surgery, only 4 were culture positive after surgery.

In extrapulmonary TB, surgery is often needed to make a diagnosis (rather than to effect a cure): surgical excision of lymph nodes, drainage of abscesses, tissue biopsy, etc. are all examples of this. Samples taken for TB culture should be sent to the laboratory in a sterile pot with no additive (not even water or saline) and must arrive in the laboratory as soon as possible. In spinal TB, surgery is indicated for spinal instability (when there is extensive bony destriction) or when the spinal cord is threatened. Therapeutic drainage of tuberculous abscesses or collections is not routinely indicated and will resolve with adequate treatment. In TB meningitis, hydrocephalus is a potential complication and may necessitate the insertion of a ventricular shunt or drain.