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The basics of local clinical manifestations of superficial bladder cancer
of microangiopathies, severe gestoses during second half of pregnancy, threat of miscarriage, signs of intrauterine fetal hypotrophy or macrosomia. Thus, adequate preparation to pregnancy and its favorable course raise the prospect for a diabetic woman to have a full-term pregnancy and deliver a healthy baby. A patient's self-control of carbohydrate metabolism plays a leading role in the process.
Conclusions
1. Pregnancy complications could be observed more frequently in patients with late DM compensation: there were 10% of therapeutic abortions, 20% of spontaneous miscarriages, 40% of pre-
eclampsia; premature delivery took place in 20%, 10% of the patients had intrapartum hemorrhage, chronic intrauterine fetal hypotrophy and macrosomia were found in 30% of cases each.
2. Pregnancy outcomes significantly improved with pregnancy planning, and adequate and timely control over glycemia. Thus, there were no abortions or miscarriages in patients with the factors above taken into account; frequency of preeclampsia (15%), premature delivery (10%), chronic intrauterine fetal hypotrophy (20%) and macrosomia (15%) was lower than in the group of patients with the late DM compensation.
References:
1. American Diabetes Association. Preconception care of women with diabetes, Diabetes Care - 23: S. 65-68, - 2000.
2. Barbour L. A. (2009). Diabetes in PregnancyEndocrine Secrets, McDermott M ed. Mosby Elsevier. Philadelphia: - 47-64.
3. Casson I. F., Clarke C. A., Howard C. V., McKendrick O., Pennycook S., Pharoah POD et al. (1997). Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study. Br Med J; 315: 275-78.
4. Dheen S. T., Tay S. S., Boran J. et al. (2009). Recent studies on neural tube defects in embryos of diabetic pregnancy: an overview. Curr Medicinal Chem; 16: 2345-54.
5. HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcomes. NEJM 2008; 358: 1991-2002.
6. Javanovic L., Knopp R. H., Brown Z., Conley M. R., Park E et al. (2001). Declining insulin requirement in the first trimester of diabetic pregnancy. Diabetes Care; 24 (7): 1130-6.
7. International Association of Diabetes and Pregnancy Study Groups Consensus Panel: recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-691.
8. Landon MB. (2007). Diabetic nephropathy and pregnancy. Clinical Obstet Gynecol; 50: 998-1006.
9. Rossing K., Jacobsen P., Hommel E., Mathiesen E., Svenningsen A., Rossing P., Parving H. H. (2002). Pregnancy and progression of diabetic nephropathy. Diabetologia; 45 (1): 36-41.
10. Sacks D. A., Feig D. S., Amy Liu I-L et al. (2006). Managing type 1 diabetes in prgnancy: how near normal is necessary? J Perinat; 26: 458-62.
11. Temple R. C., Aldridge V. J., Murphy H. R. (2006). Prepregnancy care and pregnancy outcomes in women with type 1 diabetes. Diabetes Care; 29: 1744-49.
12. Ter Braak E. W., Evers I. M., Erkelens D., Visser G. H. (2002). Maternal hypoglycemia during pregnancy in type 1 diabetes: maternal and fetal consequences. Diabetes/Metab Res Rev: 18 (2): 96-105.
13. Yang J., Cummings E. A., O'Connell C. (2006). Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol; 108: 644-50.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-75-77
Babakulov Sharaf Hamrakulovich, Navruzov Sarimbek Navruzovich, Babakulova Shahlo Hamidullaevna, National cancer research center of Uzbekistan E-mail: drsharof@mail.ru
The basics of local clinical manifestations of superficial bladder cancer
Abstract: According to a study The stage of the patients in both groups expressed LIR were observed. Mainly observed mild LIR bladder of 63.7% and 66.7% respectively of the studied groups. In contrast, with T1 stage were pronounced bladder LIR, which in the main group amounted to 73.2% in the control — 81,8%. Therefore, reasonable LIR in the main group was 16.1%, in the control of 36.3%. The results indicate the existence of a relationship between LIR and the tumor stage in the bladder. Keywords: bladder cancer, probiotics, transurethral resection, microflora, relapse.
Treatment of patients with bladder cancer is a difficult and not solved problem. Difficulties due to many factors: late detection of the disease, early emerging complications, frequent recurrence of the tumor and high risk of progression. Despite the fact that chemotherapy drugs and means of immunotherapy are widely used to prevent recurrence after TUR in patients with bladder cancer, many aspects recurrent in programme h plus adjuvant therapy continues to be a matter for discussion and at the present time. Unsolved questions remain about the indications and contraindications to this method, regimes and dosages, as well as methods of preventing unwanted side effects and complications [1; 4; 5,].
Objective: to Study the severity of local inflammatory reactions in superficial bladder cancer.
Material and methods: The object of the study were 167 patients with bladder cancer (BC), the subject of the study — bladder cancer at stage Ta and T1N0M0. Of the total number of surveyed 133 (79,6%) patients had stage BC T1N0M0, and 34 (20.4 per cent) — TaN0M0. The ratio of the frequency of occurrence of BC in men and women was almost 3:1. The age of patients ranged from 27 to 83 years, averaging — 56,3+0.4 years.
In the study of the anamnestic data of 167 patients with BC TA-1N0M0 stage, 52,0% — the duration of the disease was
Sectiom 6. Medical science
3 months, from 29.7% to 6 months. and 18.3 per cent — up to 1 year. Being subjective, this figure indicates that there is some effacement of the clinic BC, as evidenced by the presence of a six-month or more history exactly 48% of patients. Depending on the method of tactics of combined treatment BC, patients were divided into 2 study groups. A control group of 80 patients with bladder cancer Ta-1N0M0 stage, treated in the period 2005 to 2013. In this group of patients after traditional preoperative preparation conducted TUR. Then, at 57 (71.2%) of patients in the postoperative period was intravesically installation diluted in 50ml saline drug Doxorubi-
cin in the dose of 50mg. 23 (28,8%) patients after TUR, adjuvant intravesical therapy was conducted.
Results and discussion: The study of the severity of local inflammatory reactions (LIR) from the bladder according to the accepted gradations showed that upon admission to the hospital she was typical in all patients and was not specific genders.
Upon further study of the severity of local inflammatory reactions observed that in the majority of cases occurred LIR expressed from the bladder patients BC (table.1).
Table 1. - The distribution of patients according to the severity of BC LIR, n-109
№ Graduation LIR main, n-67 control. n-42 Total
1 Expressed 41 (61,2%) 27 (64,3%) 68 (62,3%)
2 Reasonable 13 (19,4%) 7 (16,7%) 20 (18,3%)
3 Poor 13 (19,4%) 8 (19,0%) 21 (19,2%)
In both groups dominated the number of patients with severe LIR bladder for 61.2 and 64.3%, respectively. In contrast, the proportion of patients with moderate or mild LIR in the studied groups was observed in identical quantities not exceeding 1/3 of the total surveyed population. Overall, the analysis testified to the presence of strong LIR in patients with BC, i. e. 62.3%. This fact indicates the presence of the original parallelism of the inflammatory proTable 2. - The distribution of patients a
cess bladder in the background of a cancer that can be caused by as with concomitant infection, or by reducing local protective immune mechanisms against the background of atypical cells.
To determine the severity of LIR bladder depending on the stage of superficial bladder cancer in the study was subjected to 21 patients with One-stage and 88 patients with T1 stage disease (table. 2).
)rding to the severity of BC LUR, n-109
№ Graduation LIR main n-67 control. n-42
Та-, n=11 ^-n=56 Та-, n=9 n=33
1 Expressed - 41 (73,2%) - 27 (81,8%)
2 Reasonable 4 (36,3%) 9 (16,1%) 3 (33,3%) 4 (12,1%)
3 Poor 7 (63,7%) 6 (10,7%) 6 (66,7%) 2 (6,1%)
As can be seen from table 2, when The stage of the patients in both groups expressed LIR were observed. Mainly observed mild LIR bladder of 63.7% and 66.7% respectively of the studied groups. In contrast, with T1 stage were pronounced LIR, which in the main group amounted to 73.2% in the control — 81,8%. Therefore, rea-
Table 3. - Characterization of the severity of
sonable LIR in the main group was 16.1%, in the control of 36.3%. The results indicate the existence of a relationship between LIR and the tumor stage in the bladder. Consequently, this is the basis for the study of their severity depending on the size of the primary tumor. (table. 3).
LIR depending on the size of the tumor, n=109
№ Graduation LIR <1sm 1,5sm <2sm >2sm Мulti. Total
1 Expressed - 8 29 21 10 68
2 Reasonable 1 5 6 6 2 20
3 Poor 6 8 7 - - 21
Total 7 21 42 27 12 109
According to the obtained results, more expressed LIR is typical of patients with tumor up to 2 cm, 2 cm and more is 38.5 and 24.8%, respectively. So, for tumors up to 1 cm is mainly observed mild LIR is 6.4%, with less than 1.5 cm — 19,2%. Multicentric tumor growth was accompanied by a pronounced LIR, which was observed in 10 of 12 patients.
Thus, the analysis of the severity of local inflammatory reactions of the mucosa of MP shows their dependence on the stage of disease and tumor size. The majority of patients at admission to hospital have a pronounced inflammatory reaction which in turn dictates the need for research on infection, and targeted antimicrobial therapy.
References:
1. Matos T., Cufer T., Cervek J. et al. Prognostic factors in invasive bladder carcinoma treated by combined modality protocol (organ-sparing approach). Int. J. Radiat. Oncol. Biol. Phys. - 2000;46 (2):403-9.
2. Van Rhijn B. W., Burge M., Lotan Y. et al. Recurrence and progression of disease in non-muscular-invasive bladder cancer: from epidemiology to treatment strategy//Eur. Urology. - 2009. - Vol.56, No 3. - P. 430-442.
3. Kanmani P., Satis-Kumar R., Yuvaraj N. et al. Probiotics and its functionality valuable products-a review.//Critical reviews in food science and nutrition. - 2013. - Vol.53, No 6. - P. 641-658.
4. Kawai K., Miyazaki J., Joraki A. et al. BCG immunotherapy for bladder cancer: current understanding and perspectives on engineered BCG vaccine//Eur. Urology. - 2009. - Vol.56, No 3. - P. 430-442.
5. Cancer Science. - 2013. - Vol. 14, No 1. - P. 22-27.
A spectrum of the opportunistic and associated diseases in patients with natural course of the HIV-infection
6. Babjuk M., Burger M., Zigeuner R. et al.//EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update -2013//Eur. Urology. - 2013. - Vol. 64, No 4. - P. 639-653.
7. Ikeda M., Motoshima T., Kurosawa K. et al. Efficacy and safety maintenance intravesucal instillation therapy with dacillisCalmette-Guerin and epirubicin for non-muscle-invasive bladder cancer.//Hinyokika Kiyo. - 2013. - Vol. 59, No 3. - P. 153.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-77-79
Bayjanov Allabergan Kadirovich, Research Institute of Virology, Ph. D. (candidate of Medical Science) Musabaeva Nargiza Erkinovna, Research Institute of Virology, Researcher E-mail: saodat.us@mail.ru
A spectrum of the opportunistic and associated diseases in patients with natural course of the HIV-infection
Abstract: The research has been aimed at studying of a degree of incidence of the opportunistic and associated diseases in patients with natural course of the HIV-infection. Development of a number of opportunistic diseases is the basic indicator of HIV-infection progression. Up to date, there are a number of scientific papers dedicated to studying of the opportunistic infections [1; 2]. Among the HIV-infected patients, tuberculosis [3] is mainly developed infection out of the opportunistic infections, which is one of the basis reasons for patients' death rate. The risk of tuberculosis reactivation in the HIV-infected patients with positive tuberculine test is 7-10% within a year, and 20-70% of new cases of active tuberculosis in the developing countries. Virus infections (CMV, virus hepatitis C, etc.) [4; 7] also have active influence on the immune system. It is known that the opportunistic diseases under the HIV-infection mutually aggravate the immune system state at the same time facilitating fast transition of the HIV-infection to the end stage of the disease. This is why there is a need to study a spectrum of the opportunistic diseases for the purpose of timely therapy of both the region-specific opportunistic diseases and the HIV-infection [5; 6; 8; 9].
Keywords: opportunistic diseases, chronic virus hepatitis B, C and D, cytomegalovirus infection, tuberculosis, lymphoma, chorioretinitis, pneumocystic pneumonia.
Materials and methods. The analysis of the opportunistic and associated diseases has been performed in 104 patients with natural course of the HIV-infection.
Among the examined patients 64 ones were male (61.5%), and female — 40 (38.5%). Average age of the patients was 39.9 years. Infection contamination periods in the examined patients varied from 2 to 10 years amounting in average to 5.20±0.31 years.
The opportunistic and associated diseases have been verified based on clinical-laboratory studies. Cytomegalovirus infection, virus hepatitis B, C, D and herpes simplex virus were identified on the basis of polymerase chain reaction (PCR). Pneumonogra-phy and head computed tomography were applied. Consultation
As you can see in the table, the HIV-infection in male-patients at the time of detection was observed at later stages as compared with women-patients (P<0.01). This was probably due to late seeking medical advice.
with an ophthalmologist together with eye-ground analysis were carried out in order to study eye damage under the cytomegalo-virus infection.
Results and discussion. In the course of patients allocation by gender and clinical stages the following fact should be taken into account that the number of male-patients at advanced HIV-infection stages (clinical stages 3-4) was practically twice as much as the female patients — 53 (50.9%) against 20 (19.2%) patients under P< 0.05. At detection of the HIV-infection 10 (9.60%) examined patients had the 1st clinical stage of the disease. 21 (20.2%) patients had the 2nd clinical stage, and — 30 (28.8%) patients had the 3rd clinical stage of the disease. 43 (41.4%) patients were under AIDS stage (4th clinical stage) (Table 1).
Allocation of patients with natural course of the HIV-dis-ease in accordance with the World Health Organization Classification (WHO) for the adolescents and the adults, depending on CD4-lymphocytes count, is shown in Table 2.
Table 1. - Allocation of the HIV-infected patients by gender and clinical stages of the disease (n=104)
HIV-infection stage Male-patients Female-patients Total
1st clinical stage 4 6.30 6 15.0 10 9.60
2nd clinical stage 7 10.,9* 14 35.0* 21 20.2
3rd clinical stage 19 29.7 11 27.5 30 28.8
4th clinical stage 34 53.1* 9 22.5* 43 41.4
Total 64 100 40 100 104 100
*P< 0.05
