The aim was to study the structure, routes and algorithms of telemedical network in Odessa region and its impact on the spread of COVID-19 pandemics.
Materials and methods: We have analysed the data of the official reporting documentation provided by the Department of Healthcare of Odessa region. So the description of legislative acts and structure of telmedical network of Odessa region is given. In more detail, we described functions and capabilities of telmedical network COVID-19 pandemics.
Conclusions: Studies have shown that Telemedicine can be used in 5 main directions: Triage and decisions regarding hospitalization to hospitals designed for COVID-19 patients or to other hospitals. Outpatient consulting in COVID-19 patients who stay at home. Coordination of activities of different hospitals; provision of specialized consulting. Training of healthcare providers for counter-epidemic measures and management of COVID-19 patients. Routine consulting in patients with chronic disease and in palliative cases. In all this activities significant benefits were founded. But amount of telemedical consultations are quiet low. As in all viral pandemies remote consultations of patients leeds to lowering in amount of infection of COVID-19 patients.
KEY WORDS: COVID-19, Triage, Telemedicine, Remote Consultation, Health Communication
The aim: To improve the effectiveness of treatment of patients with hypertension using metabolic therapy based on the evaluation of endothelial dysfunction indicators, markers of inflammation, and blood lipid spectrum.
Materials and methods: A clinical study was performed with 72 patients (34 male and 38 female) with stage 2 arterial hypertension of 2-3 degrees, admitted to the cardiology department of the municipal non-profit enterprise “Lviv Emergency Clinical Hospital”. The mean age of patients was 44.8±8.5 years. Patients were divided into 2 groups: Group I was taking quercetin in addition to basic therapy (Ramipril/Amlodipine in individually adjusted dose); Group II – had basic therapy following the clinical protocol. The level of nitric oxide, IL-1, IL-6, TNF-a, CRP, seromucoid, blood lipid spectrum was determined.
Results: There is a significant decrease in the NO and CRP levels. There is a decrease in the TNF-a level by 31.27±2.13 (p<0.01) after the treatment of patients with hypertension. The TNF-a level decreased by 22.2±1.13 (p<0.01) with the use of basic therapy. IL-1 decreased significantly in the two groups, but it was more pronounced in group I, by 40.68±1.67 (p<0.01) and 21.4±2.1 in group II (p<0.05). There is a positive change in the blood lipid spectrum, but the changes were more pronounced in the group of patients receiving metabolic therapy.
Conclusions: The use of quercetin (Corvitin, Quertin) in combination therapy with the combined antihypertensive drug containing ramipril/amlodipine (Egis-Hungary) significantly reduces the levels of nitric oxide, CRP, IL-1, and blood lipid spectrum, which reduces the incidence of complications and progression of hypertension.
KEY WORDS: endothelial dysfunction, TNF-a, IL-1, IL-6, CRP, lipid spectrum, hypertension, amlodipine, ramipril, quercetin
UDC: 616. 24-06: 616.248+616.33-002.44)-092: 612.015.11.-08
Bronchial asthma (BA) and stomach ulcer are among the most common human diseases which remain important medical and social problems in the XXI century. There are combinations of pathologies that burden each other in the practical work of the doctor.
The aim of this study was to establish the peculiarities of changes in the processes of lipoperoxidation and antioxidant protection in the lungs with the development of experimental bronchial asthma (EBA) and experimental stomach ulcer (ESU).
Material and research methods. Experimental studies were performed on 55 guinea pigs (males) weighing 180 — 220 g, divided into 5 groups of 9 animals each, except the first (10 animals). Group I (control) included intact guinea pigs, II — animals with experimental asthma and ESU (5th day), III — guinea pigs on the 19th day of the combined model process, IV — animals with EBA and ESU (26th day), V — guineapigs on the 33rd day of EBA and ESU. For the purpose of detailed analysis and interpretation of indicators of prooxidant and antioxidant systems (AOS) in different days of experiment two periods of development of EBA and ESU were conditionally distinguished: early (5th and 19th days of experiment) and late (26th and 33rd days).
The experimental asthma model was reproduced in guinea pigs by the method of VI Babich, gastric ulcer was simulated according to the method of VI Komarov. Condition of free radical oxidation in the lungs was determined by the content of diene conjugates by the method of VG Gavrylov, MI Myshkorudna, and malonic dialdehyde by the method of EG Korobeynikov. The degree of antioxidant system activity was estimated by the content of enzymes — superoxide dismutase by the method of R. Fried, catalase by the method of R.Holmes, C. Masters, glutathione peroxidase — by the method of OG Arkhipova. Statistical processing of the obtained data was carried out according to the Student’s method.
Conclusions. So, the research of the functional state of the prooxidant system in stomach and lungs of animals in different periods of combined experimental asthma and ulcer showed their gradual increasing with the greatest severity in the 33rd day. It might indicate the intensive accumulation of free radical oxidation products and initial compensatory growth of antioxidant system enzymes. In the later period of EBA and ESU modeling (26th, 33rd days) there is an elevation in the lipoperoxidation on the background of AOS depression, which can be seen as the result of depletion of compensatory reactions aimed at decontamination of LPO products. This leads to a violation of cellular homeostasis and the development of oxidative stress.
The article presents the features of the morphologic structure of intracoronary thrombi and the prognosis of acute ST segment elevation myocardial infarction (STEMI) in patients of different age groups.
Methods: Histological analysis of the aspirated intracoronary clots was performed in 97 patients with STEMI. The patients were divided into two groups: 11 patients aged under 44 (young group) and the remaining older than 45 (older group). The short-term prognosis was determined by: ST-segment resolution, achievement of good coronary flow, myocardial blush, indices of myocardial contractility, and QS wave formation on ECG. The study’s endpoints determined the long-term prognosis: The onset or worsening of angina symptoms, coronary revascularization (PCI or CABG), AMI, and death.
Results: Elderly patients were substantially more likely to have a history of coronary artery disease, as well as angina attacks, or their equivalents, at rest a few days before the onset of STEMI and arterial hypertension. Dyslipidemia was significantly more common in young patients. Formation of microchannels within the thrombi was significantly more common among older patients. Achieving the target quality of microcirculation was substantially more frequent among young patients (p=0.007). The long-term prognosis was better in young patients due to the lower prevalence of the combined endpoint.
Conclusions: Elderly patients were more likely to have intracoronary thrombi with microchannel formation, indicating a longer duration of the thrombotic process. The long-term prognosis after STEMI was significantly better in young patients.
Keywords: Myocardial infarction, coronary reperfusion, coronary occlusion, blood clot, cardiovascular risk factors.
The presence of coagulopathy as part of the systemic inflammatory response syndrome is a characteristicfeature of severe coronavirus disease 2019 (COVID-19). Hematological changes (increased D-dimer [DD],prolonged activated partial thromboplastin clotting time [APTT] and prothrombin time [PT], highfibrinogen levels) have been observed in hospitalized patients with COVID-19, which characterizethe risk of thrombotic events. Against the background of COVID-19 there is endothelial dysfunction,hypoxia and pulmonary congestion, mediated by thrombosis and microvascular occlusion. Up to71.4% of patients who died from COVID-19 had disseminated intravascular coagulation syndrome,compared with only 0.6% of survivors. The main manifestation of COVID-19-associated coagulopathyis a significant increase in DD without a decrease in platelet count or prolongation of APTT and PT,indicating increased thrombin formation and the development of local fibrinolysis. An increase in DDlevels of more than 3–4 times was associated with higher in-hospital mortality. Therefore, COVID-19requires assessment of the severity of the disease for further tactics of thromboprophylaxis. The need forcontinued thromboprophylaxis, or therapeutic anticoagulation, in patients after inpatient treatment fortwo weeks using imaging techniques to assess of thrombosis assessment.