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INTESTINAL HOMEOSTASIS AND HIV-INFECTION (REVIEW)

Authors: Dyachenko A.G., Gorobchenko K.M., Savinova E.V., Miroshnechenko E.A.,Shkrioba O.A.

Pages: 259-272

Abstract

  

Permanent balance between microbiota, intestinal barrier and mucosal immune system is the basis of the normal intestinal homeostasis. HIV infection leads to significant violations of the immune status and structural damage of the intestinal mucosa that is a threat barrier function. The weakening of the immune pressure leads to disbiotic processes and microbial translocation that causes chronic activation of the immune system and the progression of HIV infection. Although the introduction of combined antiretroviral therapy is a great achievement in the treatment of HIV infection remains a need for some additional measures aimed to restorethe structure and functional integrity of the intestinal epithelium.

The hypothesis that probiotic administration protects the gut surface and can delay progression of HIV infection to the AIDS was proposed in 1995. Over the last five years, new studies have clarified the significance of HIV-1 infection of the gut associated lymphoid tissue (GALT) for subsequent alterations in the microflora and breakdown of the gut mucosal barrier leading to pathogenesis and development of AIDS. Current studies show that loss of gut CD4+ Th17 cells, which differentiate in response to normal microflora, occurs early in HIV-1 disease. Microbial translocation and suppression of the T regulatory (Treg) cell response is associated with chronic immune activation and inflammation. Combinations of probiotic bacteria, which upregulate Treg activation, have a promising effect in suppressing pro inflammatory immune response in models of autoimmunity including inflammatory bowel disease and provide a rationale for use of probiotics in HIV-1/AIDS. Disturbance of the microbiota early in HIV-1 infection leads to greater dominance of potential pathogens, reducing levels of bifidobacteria and lactobacillus species and increasing mucosal inflammation. The interaction of chronic or recurrent infections and immune activation contributes to nutritional deficiencies that have lasting consequences. As discussed here, current and emerging studies support the concept that probiotic bacteria can provide specific benefit in HIV-1 infection.

Key words: intestinal microbiota, intestinal barrier, dysbacteriosis, HIV infection.

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CEREBROPROTECTIVE ACTIVITY OF PIRACETAM UNDER COADMINISTRATION WITH HYPOGLYCEMIC, ANTIOXIDANT OR ANTIPLATELET DRUGS IN EXPERIMENTAL DIABETES

Authors: ZhyliukV.I., MamchurV.I., LievykhA.E., Petruk N.S.

Pages: 273-282

Abstract

  

The paper presents the results of research of piracetam cerebroprotective activity under coadministration with hypoglycemic, antioxidant or antiplatelet drugs in rats with hyperglycemia.

Research was carried out on 70 white rats weighing 250–300 g. Experimental diabetes was initiated by subcutaneous injection of alloxan monohydrate. On the 11th day after administration of alloxan the animals were randomized in 7 groups : I – intact (distilled water); II – diabetes (distilled water); III – diabetes + piracetam (500 mg/kg); IV – diabetes + piracetam (400 mg/kg) + metformin (500 mg/kg); V – diabetes + piracetam (400 mg/kg) + pioglitazone (10 mg/kg); VI – diabetes + piracetam (400 mg/kg) + thiotriazoline (100 mg/kg); VII – diabetes + piracetam (400 mg/kg) + acetylsalicylic acid (50 mg/kg). Experimental combinations and distilled water were administered intragastrically for 20 days.

We assessed content of protein oxidative modification markers and total level of nitrates/nitrites in homogenates of neocortex using spectrophotometric analysis. Ultrastructural studies of neocortical tissue were performed using a transmission electron microscope TEM-100-01 according to the standard plan.

We found that experimental model of diabetes was accompanied by the development of carbonyl stress and led to overproduction of nitric oxide in neocortex. Piracetam, when used with metformin, thiotriazoline or acetylsalicylic acid, significantly reduced content of early and late markers of protein molecules degradation (aldehydephenylhydrazones and ketonephenylhydrazones) and decreased level of nitric oxide stable metabolites. Coadministration of piracetam with pioglitazone did not result in considerable effect on content of these substances. We established that the use of all experimental drug combinations did not provide full recovery of ultrastructural changes in the neocortex; however, coadministration of piracetam with thiotriazolin, acetylsalicylic acid and metformin, but not with pioglitazone, led to a significant limitation of destructive changes in neurons and synaptic mechanism. Cerebroprotective activity of the combinations did not depend on the presence of hypoglycemic properties.

Key words: piracetam, metformin, pioglitazone, thiotriazoline, acetylsalicylic acid, protein oxidative modification, nitric oxide, diabetes, neocortex.

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THE EFFECT OF LAPROXIDES ON BLOOD SERUM PHOSPHORESCENCE INTENSITY IN SUBACUTE TRIAL AND ITS PROGNOSTIC VALUE

Authors: Kucheriavchenko M.A.

Pages: 283-291

Abstract

  

Introduction. The investigatedxenobiotics are employed to produce plastic, epoxide resins, varnishes, enamels, paints, foam plastic and et cetera. The study of pathophysiological mechanisms triggering structural and metabolic disorders in response to prolonged subtoxic exposure on the body was commissioned by the absence of prognostic characteristics of potential danger, which laproxides can constitute for hematothermal animals and humans. The study showed that determination of integral intensity of blood serum phosphorescence would become a promising methodological approach in early diagnosis of blood serum protein capacity. Considering its high sensitivity and informative value, phosphorescence enables to detect abnormalities when studying electron excitation states of molecules, photochemical reactions, fast molecular transition dynamics, structures and properties of chemical and biological systems. Properties and differences of protein exchange and their conformational compact structure tend to develop with the progression of the impairment. Previous studies have confirmed that alteration of qualitative properties of proteins is always associated with the impairment of their main functions, such as enzyme, hormone, receptor, transport, structural, mechanical, supporting, reserve, substrate-energetic, contractile, electro-osmotic, energy transforming, cogenic, gene regulating, immunologic, anti-toxic, neutralizing and hemostatic functions.

The aim was to determine the effect of laproxides in response to prolonged subtoxic exposure on the indices of blood serum phosphorescence in white rats and assess its prognostic value.

Material and Methods. The study implied determination of blood serum phosphorescence intensity in animals exposed to peroral exposure to epoxide-containing oligo-ethers in dosages of 1/10; 1/100 and 1/1000 DL50 during 45 days. New substances (the trade name “Laproxides”) were employed, namely triglycidyl ether of polyoxypropylene triol with molecular mass 303 (L-303) and ethylene glycol propylene epoxide with molecular mass 500 (L-500). Aqueous solutions of the substances at the above mentioned doses were administered endogastrically with a metal feeding tube on an empty stomach in the morning. The control group received corresponding doses of drinking water.

Discussion. The study of laproxides L-303 and L-500 effect showed a significant increase in blood serum phosphorescence intensity in the group of animals in response to peroral exposure to xenobiotics in 1/10 and 1/100 DL50 dosages in spectral lines of excitation light 297; 313; 334; 365; 404 and 434 nm. In 1/1000 DL50 the substances did not exert any effect on blood serum phosphorescence intensity rate. Thus, high levels of phosphorescence intensity indicate that laproxides at subtoxic doses of 1/10 and 1/100 DL50 induce the development of significant amount of reactive molecules, capable to condition chain reactions of lipids, proteins, nucleic acids and other biological substrates oxidation. The results show that these compounds are capable of changing conformational properties of proteins, nucleic acids and nucleotides, as well as their functional activity, resulted from the formation of free radical membrane pathology.

Key words: xenobiotics, laproxides, blood serum phosphorescence.

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INFLUENCE OF IRON NANOPARTICLES ON INTESTINAL MICROFLORA OF RATS WITH IRON DEFICIENCY ANEMIA

Authors: Doroshenko A.M., Dybkova S.M., Rieznichenko L.S., Gruzina T.G., UlbergZ.R., Chekman I.S.

Pages: 292-299

Abstract

  

According to the WHO data, iron deficiency anemia (IDA) is one of the most widespread pathological states as well as social problem. IDA is also one of the most important causes of intestinal dysbacteriosis. Varieties of oral iron preparations are widely prescribed as a part of medical care for patients with IDA. However, iron of existing oral antianemic drugs is not usually effectively absorbed. It may lead to elevation of intestinal iron content. The excess of iron in intestine can also result in dysbacteriosis. Moreover, existing antianemic drugs are not usually effective and safe. Thus, either IDA or oral iron supplementation may cause intestinal dysbacteriosis. Therefore, synthesis and development of new classes of biosafe and biocompatible antianemic drugs is an urgent task. Iron nanoparticles are promising in this direction. Due to high biological activity of iron nanoparticles, preclinical study of their effectiveness and safety for IDA treatment should include determining of their impact on intestinal microflora. The aim of this work was to study the influence of iron nanoparticles on intestinal microflora under conditions of oral administration to rats with IDA.

Substance of 40 nm sized spherical zero-valent iron nanoparticles (FeNPs) used in this study have been synthesized according to the original protocol of chemical condensation in water medium by iron (III) chloride reduction. We studied biological activity of FeNPs, as potential pharmacological substance with antianemic properties, on the model of IDA using Wistar female rats. IDA in experimental animals was modelled using iron deficiency diet. The experimental treatment course of rats with IDA included 10 days oral administration of FeNPs at/in therapeutic (12 mg/kg) dose. Commercial preparation based on pharmacological substance ferri (III) hydroxydi polymaltosum complexus was used as comparison drug in therapeutic dose. The status of microflora in lower part of rats’ gastrointestinal tract after experimental treatment course has been determined using standard microbiological protocols.

According to microbiological tests, rats fed with iron deficient diet demonstrated intestinal dysbiosis. In this case, there was a significant reduction of the protective microflora (bifidobacteria and lactobacilli). After 10 days of experimental treatment course (either with FeNPs or comparison drug), we observed normalization of quantitative parameters of protective and transient intestinal microorganisms in rats with IDA up to a level of healthy animals. However, recovery of number of sulphite-reductive clostridia in anemic animals’ gut, which had been receiving FeNPs, was more effective than in the case of comparison drug administration. FeNPs are possessed by favourable effect on the gastrointestinal tract microflora in case of IDA. Therefore, FeNPs are perspective as biosafe and biocompatible pharmacological substance for development of new class antianemic preparations.

Key words: iron nanoparticles, anemia, iron deficiency, dysbacteriosis, intestinal microflora, normalization.

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References

 
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IMMUNOMORPHOLOGICAL AND MORPHOMETRIC CHARACTERIZATION OF CENTRAL AND PERIPHERAL ORGANS OF IMMUNOGENESIS IN MICE UNDER PUTRESCINE ADMINISTRATION TO EXPERIMENTAL ANIMALS

Authors: Zilfyan A.V., Avagyan S.A. 

Pages: 300-307

Abstract

  

We studied the influence of exogenously administered putrescine on morphofunctional state of the central and peripheral organs of immunogenesis of experimental animals. White mice were exposed to single intravascular administration of putrescine (Sigma, USA) at a concentration of 10-9 mg/mL per 100 g animal body weight. Animals were euthanized in 2 and 8 hours after putrescine administration observing all standards set forth by the Yerevan State Medical University (YSMU) Committee on Bioethics for investigations involving laboratory animals.

Structural changes corresponding to the notion of “accidental involution” occurred in the cortical layer of thymus in experimental animals 8 hours after putrescine administration. Structural shifts manifested as a targeted activation of B-dependent zones and layers were observed in spleen and lymph nodes. The performed immunomorphological studies revealed that activation of B-dependent zones expresses a marked increase in number of B-lymphocytes containing IgG, as well as an increase of IL-1α content in these cells. It is not excluded that putrescine at rather low concentrations (similar to those determined in blood serum of intact mammals) in spleen and lymph nodes exerts targeted immunomodulating action and selectively activates B-lymphocytes populations, which, in turn, are responsible for activation of humoral immunity reactions.

Key words: putrescine, organs of immunogenesis, structural shifts, B-lymphocytes, interleukin 1 α, immunomodulation.

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References

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STUDYING OF REPARATIVE PROPERTIES OF A NEW COMBINED OINTMENT ON THERMAL BURN MODELS IN RATS

Authors: Tsulun O.V. 

Pages: 308-315

Abstract

  

Introduction. Burn can be defined as a tissue damage caused by a variety of agents such as heat, chemicals, electricity, sunlight, or nuclear radiation. Treatment of burns has an important medico-social significance in order to speed up the recovery of injured people and return them working ability. One of perspective directions is to create preparations that possess antioxidant properties, have sufficient reparative anti-inflammatory effect, and are safe.

My aim is to assess the effect of a topical ointment with licorice extract, coenzyme Q10 and dihydroquercetin (further mentioned as LCD ointment) on healing of partial thickness burn wounds in rats.

Material and Methods. Burns were modeled on 20 albino rats, weighting 260–300 g under ketamine (100 mg/kg) anesthesia by pouring hot molten wax at 80°C into pattern of 4 cm2 placed on depilated skin on one side of the animals. Rats were divided into four groups: group 1 – control group; group 2 – treated with LCD ointment; group 3 – treated with methyluracil ointment (reference-drug); group 4 – treated with ointment containing rutin, coenzyme Q10 and licorice extract (further mentioned as LCR ointment). Ointments were applied topically once a day. I performed evaluation by measuring wound contraction and recording the period of epithelialization.

Results and Discussion. Topical application of ointments LCD and LCR enhanced significantly healing of burn wounds. The mean period of epithelialization was significantly reduced in topical LCD ointment (by 31.5%) group and LCR ointment (by 20.4%) group as compared to the control.

Conclusion. I established that ointments LCD and LCR promoted healing of burns and exhibited evident reparative activity on the model of wax-induced burn wounds in rats. Ointments LCD and LCR reduced epithelialization period by 6.8 and 4.4 days respectively, compared to the control group. Planimetric parameters showed that burn area decreased by 63.5% on day 5 and by 98.2% on day 15 in LCD treated group; in LCR ointment group percentages of wound contraction were 44.6% and 94% respectively, which exceeded reference-drug. Therefore, ointments LCD and LCR have expressed reparative activity; they can become promising drugs for further pharmacological studies to use in clinical practice.

Key words: dihydroquercetin, licorice extract, thermal burn, reparative properties, ointment.

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CEREBROSPINAL FLUID AS AN ENVIRONMENT WITH RADIOPROTECTIVE PROPERTIES

Authors: Absettarova A.I., Kakura S.I., Oleynikova O.K.Pikaluk V.S.Bessalova Ye.Yu. 

Pages: 316-322

Abstract

  

Our aim is to analyze a xenogenic cerebrospinal fluid as radioprotectivebiological substrate. The article is devoted to revealing and studying of the morphological changes of the irradiated Wistar rats' bone marrow, blood, hypophysis and peripheral glands after parenteral injection of xenogenic cerebrospinal fluid in different periods of postnatal development (newborn, immature, mature). Lactating cows aged 4–6 years were taken as cerebrospinal fluid donors. We studied the effect of cerebrospinal fluid using certain anatomical and histological methods.

It was found out that cerebrospinal fluid preparation caused different inhibiting effects on destructive processes in cells of some organs; it is associated with the presence of broad spectrum of biological active substances in mammalian cerebrospinal fluid. The evident radioprotective effect was proved by the analyses of the destructive processes degree in red bone marrow cells of the rats exposed to total body radiation at 5 Gr and 3- and 10-times infusions of cerebrospinal fluid. Findings testify to activating of regenerator and strengthening processes of all sprouts of red marrow at the correction of consequences of irradiation by introduction of cerebrospinal fluid. However, the least degree of expression of these processes is noticed in the old age group: there is, probably, cerebrospinal fluid with the decline of activity of adaptation mechanisms. Morphofunctional indexes and age-dependent dynamics were revealed using white rats after xenogenic CSF parenteral injections at various ontogenetic periods.

Nowadays, cerebrospinal fluid is considered to be a morphological substrate at the homeostasis anatomophysiological component; it also participates in the intersystemic nervous and endocrine regulation. These facts allow us to formulate a new scientific conception of xenogenic cerebrospinal fluid morphophysiological regulatory effects. That provides their systemic cognition at leading intention to disclose liquor’s regulatory physiological role at an organism. Considering none immunopathological response onto injection of cerebrospinal fluid and the complex assessment of its anatomophysiological effects, we set up challenging perspectives to develop a directional bioactive drug based on cow’s cerebrospinal fluid. This drug can be applied in fields of medical and veterinary science, animal breeding and experimental morphology.

Key words: cerebrospinal fluid, radiation, bone marrow, nervous, endocrine, immune regulation.

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References

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SHIFTS IN CONTENT OF INTERLEUKINS IL-1 alpha, IL-2, IL-6 AND gamma-INTERFERON, PROLACTIN AND INSULIN-LIKE GROWTH FACTOR IN ORGANS OF IMMUNOGENESIS UNDER THE CONDITIONS OF PUTRESCINE ADMINISTRATION TO EXPERIMENTAL ANIMALS

Authors: Zilfyan A. V.,Avagyan S. A. 

Pages: 323-330

Abstract

  

Method of immune enzyme assay (ELISA) was employed to study the shifts in content of immunocytokines, prolactin, and insulin-like growth factor-1 in the central and peripheral organs of immunogenesis in mice. Single intravascular administration of putrescine was performed at rather low doses similar to levels determined in blood serum of small laboratory animals (rats and mice). Animals were euthanized by decapitation under the Nembutal narcosis in accordance with the strict requirements of Yerevan State Medical University (YSMU) Committee on Bioethics for investigations involving laboratory animals.

Shifts revealed in thymus of experimental animals signified putrescine-dependent immune-suppressive effect regarding the selective inhibition of IL-2, IL-6 and γ-IFN synthesis in the central organs of immunity. High indices of IL-1a, IL-6 and prolactin were recorded in the spleen and nodes of experimental animals 8 hours after the putrescine administration. It is not excluded that under conditions of our experiment, IL-6 high levels in spleen and lymph nodes were also conditioned by stimulant effect of prolactin towards B-lymphocytes populations (this effect is induced by relatively high levels of prolactin); besides that, similar mechanism of prolactin direct stimulating influence on B-lymphocytes in the aspect of IL-1a synthesis by B-lymphocytes is described in the literature.

It is also known that the enhanced synthesis of γ-IFN in immunocompetent cells is accompanied with the marked activation of specific T-lymphocytes sub-populations: T-suppressors and T-killers possessing the cytotoxic activity. Therefore, we might make an assumption: exogenous putrescine administered by us to the animal organism at rather low concentrations directly and/or indirectly inhibits the activity of cytotoxic T-lymphocytes sub-populations.

Key words: putrescine, organs of immunogenesis, B-lymphocytes, immunocytokines, prolactin, immunomodulation.

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CYSTATIN C – A MARKER OF RENAL AND MYOCARDIAL DYSFUNCTIONS IN PATIENTS WITH ISCHEMIC HEART DISEASE ASSOCIATED WITH INITIAL STAGES OF CHRONIC KIDNEY DISEASE

Authors: Kravchun P.G., Mykhailova Yu.O., Lapsina L.A.

Pages: 331-338

Abstract

  

Introduction. Renal dysfunction in patients with chronic heart failure (CHF) plays a key role as a risk factor and predictor of unfavorable prognosis, marker of increasing the frequency of hospitalizations and deaths. In recent years cystatin C as a marker of early diagnosis of glomerular functions, staging and prognosis of chronic kidney disease (CKD) is often used for assessment of renal function. There are a lot of publications about the role of cystatin C as an independent biomarker of cardiovascular events, including myocardial dysfunction in patients without primary renal impairment.

Our aim was to access the cardiorenal interactions in patients with CHF associated with CKD I–II stage by determining the levels of cystatin C.

Material and Methods. We examined 103 patients with CHF. 58 patients with CHF and CKD comprised group 1; group 2 – 45 patients with CHF without CKD. Serum creatinine was measured by Jaffe-method, the levels of cystatin C – by ELISA, glomerular filtration rate (GFR) was calculated by MDRD formula; also used echocardiography, kidneys ultrasound.

Discussion. We determined the increase of creatinine levels in patients with CHF and CKD in 58 % cases, cystatin C – in 78 % cases; the decrease of GFR – in 76.1 % cases, in patients with CHF without CKD – in 42 %, 64 % and 68.9 % cases respectively.

The increase of cystatin C levels was more significant than the classical indicators of glomerular function (creatinine and GFR) in patients with CHF and CKD and without CKD in general groups, also in such subgroups as: 1) patients with preserved systolic function (ejection fraction>45%) and systolic dysfunction (ejection fraction≤45%), 2) patients with presence of left ventricular hypertrophy, 3) with normal values of GFR (GFR ≥ 90 ml/min/1.73 m2) and a moderate decline of GFR (GFR ≤ 89 ml/min/1.73 m2). Thus, cystatin C can be considered as an earlier marker of renal function disorders. We found correlations between ejection fraction and left ventricular mass index with cystatin C. Perhaps, cystatin C contributes to formation of hemodynamic disturbances. Early stages of CKD in patients with CHF potentiate disorders of renal function and play the role as an additional risk factor forprogression of heart failure.

Assessment of cystatin C in CHF with CKD and without CKD patients can help doctors in daily practice to improve the quality of early diagnosis and prognosis.

Key words: chronic heart failure, chronic kidney disease I - II stage, cystatin C, glomerular filtration rate (MDRD), creatinine.

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References

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CONTENTS OF COBALT, NICKEL AND LEAD IN THE “MOTHER-PLACENTA-FETUS-NEWBORN” SYSTEM UNDER PHYSIOLOGICAL CONDITIONS

Authors: Tarasova I.V., Turova L.O., Kasian S.M., Shvydun K.O. 

Pages: 339-345

Abstract

  

Our aims was to study the contents of trace elements (Co, Ni, Pb) in biological fluid of the pregnant women and newborns. The objects of investigation were 30 women with physiological pregnancy and 30 healthy full-term newborns. We measured levels of these trace elements in the serum, erythrocytes, cord blood and placenta. The content and balance of microelements were analyzed by the atomic absorption spectrophotometry method using aspectrophotometer C 15-M1 with a flame atomizer(“Selmi”, Ukraine).We also characterized the features of transplacental migration of these micronutrients to a fetus. We studied the placenta barrier function and deposition of cobalt, nickel and lead. Our research proved that lead retained less in the placenta of a pregnant woman than nickel. Thus, nickel can be more vulnerable to the fetus, because of its toxic effect during the prenatal period. We also reported that placenta plays an important role in balance of trace elements in the fetus; it performs a barrier and depot functions. Unfortunately, the placenta barrier function is relatively weak against lead, nickel and cobalt. Although, the placenta can accumulate a greater amount of nickel (accumulation index – 275.8 %) than lead (accumulation index – 204.0 %) and, especially, cobalt (accumulation index – 121.2 %).

Key words: placenta, fetus, full-term newborn.

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References

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THE PREVALENCE OF RISK FACTORS AMONG INFERTILE COUPLES IN THE CHERNIVETSKY REGION OVER TIME

Authors: Tymchenko O.I., Koba O.P., Mykytenko D.O., Maksiyan O.I., Lynchak O.V.

Pages: 346-352

Abstract

  

Introduction. In conditions of decreasing birthrate, the infertile couples as well as couples with reproductive losses could be as a reserve of increasing birthrate. These families want, but cannot have got their own children. A sequential detection and study of complex cases and mechanisms of infertility development allows us to determine the exact individual strategy of treatment. In the same time, the measures of primary prevention (based on the prevention of negative influence of different risk factors) are efficient on a population level. Even in a case of reproductive clinics activity, the prevention measures on a primary stage of pregnancy planning are necessary and urgent. Many factors, which could be important in human pathology development, should be taken into account in order to prognostication of individual reproductive health status. That is why process of regional investigation results extrapolation to the other regions without analysis of their features is inadequate and ineffective.

The aim is to determine the infertility development risk factors prevalence between people of the Chernivetsky region over time.

Material and Methods. The primary materials were 273 special registration cards for cases of infertile couples in the Chernivetsky region (in 1999–2003 and 2012–2013).The cases of healthy children birth were taken as control (1010). The risk was calculated as Odds Ratio indicator, including 95 % confidence interval. The infertility risk factors prevalence was determined by comparison of infertile couples percentage in 1999–2003 and 2012–2013. The critical level of statistical criterions was accepted as P ≤ 0.05.

Discussion. In 1999–2003 the main infertility risk factors were chronic female and male infections (OR = 4.02 95%CI:3.35–4.82 and 4.82 95%CI:4.18–5.61 accordingly). In comparison with 1999–2003 / 2012–2013, we noticed the absence of differences in prevalence of extragenital and endocrine pathology, chronic infections, professional risks as well as smoking between infertile couples. Over time between infertile women and men, we detected increasing of educational level and fraction of unemployed individuals. Moreover, 7-time increasing of fraction of couples, who used paid medical services, was shown as well as 4-time increasing of fraction of couples, whose total income allows them to use paid medical services.

Key words: infertility, married couples, risk factors.

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References

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THE IMPACT OF SOCIAL AND ECONOMIC FACTORS OF PATIENTS ON THEIR ADHERENCE TO MEDICATIONS AFTER ISCHEMIC HEART DISEASE IN AL-NAJAF CITY

Authors: Diaa Kareem Abd-Ali, Halima Yusuf Al-Rubaiyee

Pages: 353-364

Abstract

  

Cardiovascular disease (CVD) remains a global health problem that affects millions of people worldwide. This disease affects people at all ages; it's not a disease of the elderly. Thus, this study is conducted to establish a data base for the patient adherence to medications and the impact of social and economic factors on such adherence after ischemic heart disease in Al-Najaf City.

Our aim was to assess patients’ adherence to medications after ischemic heart disease (IHD), to assess the social and economic factors of the patients, which may affect their adherence to medications, and to find out the impact of social and economic factors on patients’ adherence to medications.

Material and Method. We carried out a cross-sectional study in Al-Najaf Health Directorate, Al-Sadder Medical City and Al-Najaf Center for Heart Diseases and Surgery from June 5, 2013 to April 10, 2014. A non-probability sampling (purposive sample) of 102 patients diagnosed medically as the ischemic heart disease patients (angina and myocardial infarction) were included in the study. We collected the data using the semi-structured questionnaire, which consisted of three parts: 1) socio-demographic and clinical data form; 2) patient adherence to medications scale; 3) socioeconomic factors of a patient. The data were described statistically and analyzed using the descriptive and inferential statistical analyses.

Results and Discussion. Our results reveled a deficient in the patients’ adherence to medications. Moreover, there was a significant impact of the social and economic factors on the patients’ adherence to medications after ischemic heart disease.

Conclusion. We found a deficient in the patients’ adherence to therapeutic recommendations, specifically to medications use. Certain defects were with the social and economic factors, which could enhance the patient adherence to medications. The intensive comprehensive wide population-based studies should be conducted to assess the factors, which affect the patient adherence to medications after the IHD suggesting a suitable solution for these factors to improve the level of patient adherence. The health education program should be implemented to increase patients’ knowledge about importance of adherence to medications, certain factors that may affect their adherence, and possible ways to solve this problem.

Key words: impact, patient adherence, ischemic heart disease.

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References

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MEDICAL AND PSYCHOLOGICAL FEATURES OF QUALITY OF LIFE OF YOUNG ADULTS AFTER CONGENITAL HEART SURGERY

Authors: Kasianova A.Yu., Lebid I.G.

Pages: 365-372

Abstract


Modern cardiosurgery opportunities of highly qualified specialists can help patients with congenital heart disease (CHD) to improve significantly their health and life longevity, but at the same time, many patients still complain of weakness, fast tiredness, bad mood and low quality of life.

Our aims was to identify medical and psychological features of low quality of life of adult patients of younger age after congenital heart surgery.

Material and Methods. The study involved patients (aged 19 ± 2.8 years) with surgically corrected inborn congenital heart disease. The psychodiagnostics included the study of the quality of life and the identification of signs of anxiety and depression in the patients.
Discussion. We identified gender differences in the quality of life of young adult patients with CHD: namely, every day activities of men were significantly limited due to their physical condition, – it either precedes or follows the worsening of their emotional status – but women had rather high indices of life quality. However, both men and women displayed a dramatic limitation of social contacts. Young adult patients with surgically corrected CHD displayed significant limitation of social contacts, decrease in communication levels due to the worsening of their physical and emotional condition. 42 % of male and 50 % of female patients displayed the symptoms of anxiety and/or depressive disorders.

Conclusion. Having analyzed practical advantages and possible disadvantages of different foreign questionnaires, which are adapted in Russian to assess the quality of life, we found out that MHFLQ (Minnesota Living with Heart Failure Questionnaire) is very simple and easy to use in individual analysis. However, it does not allow us to differentiate the calculation of component parts of mental, physical and social functioning for a specific group of patients. At the same time, the MOS SF-36 (36-Item Short Form Health Survey) and WHOQoL-bref (World Health Organization Quality of Life) methods allow us to assess a specific influence of physical, mental and social components on the quality of life. Unfortunately, these surveys have displayed different results. The HADS (Hospital Anxiety Depression Scale) method provides an opportunity to single out a patients’ risk group characterized by a clinical level of depression and anxiety. The implementation of active and timely psychodiagnostics and psychocorrection measures will help adult patients with the inborn congenital heart disease after the surgery to improve their quality of life.

Key words: congenital heart disease, adult patients, cardiosurgery, quality of life, anxiety, depression.

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ASSOCIATION BETWEEN HYPOVITAMINOSIS D AND METABOLIC SYNDROME IN OBESE PATIENTS WITH CORONARY HEART DISEASE

Authors: Orlovskyi V.F, Hordina M.A., Orlovskyi O.V., Skoropad Yu.I.

Pages: 373-380

Abstract


Introduction. Metabolic syndrome(MS) is a problem of the 21st century in industrialized countries. Hypovitaminosis D is a risk factor, which may cause development of metabolic disorders. D-deficiency is usually registered in obese patients. Our aim was to find the association between metabolic syndrome and vitamin D levels in obese patients.

Material and Methods. We examined 62 obese patients with coronary heart disease: 33 patients with MS (aged 63.9 ± 1.69 years with BMI 35.1 ± 0.59 kg/m2) and 29 without MS (aged 66.9± 2.25, (p >0,05); with BMI 34.9 ± 0.57kg/m2). 25(OH) vitamin D3 levels were measured by the immunoassay analysis. Insulin resistance was estimated by fasting blood insulin, HOMA-IRQUCKI and НОМА%S.

Discussion. Serum 25(OH)D3 levels were significantly lower in MS obese patients than in obese patients without MS (39.2 ± 2.11 vs 46.5 ± 2.97, p < 0.05). The low 25(OH)D3 levels correlated with BMI, total cholesterol, triglycerides, high and low density lipoproteins, insulin, and HOMA-IR (p<0.05). After stratifying the study population according to 25(OH)D3 concentrations, patients in the lowest quartile showed a markedly increased prevalence of MS compared with those in the highest quartile (68.8 vs 25 %). Using the one way analysis of variance (ANOVA), we revealed that patients in quartile IV (with the highest 25(OH)D plasma level (53.9–70.7 nmol/l)) had significantly lower blood glucose (p = 0,007) and fasting insulin (p < 0.001). Moreover, there was better performance sensitivity of peripheral tissues insulin that is likely to lower the level of HOMA-IR index and raise the QUCKI index (p < 0.001). They also maintained a more favorable performance lipids levels: significantly lower concentrations of total cholesterol (p < 0.001), triglycerides (p < 0.001), but higher HDL levels (p = 0.020). We did not find any significant difference between quartiles I and IV for anthropometric indicators, as well as HOMA%S.

Conclusion. A strong association exists between hypovitaminosis D and MS in obese patients independently/disregarding / from BMI and waist circumference. This indicates that the association between low 25(OH)D levels and MS is not merely induced by vitamin D deposition in fat tissue and hypovitaminosis D in patients with obesity may contribute to the development of metabolic changes, such as atherogenic dyslipidemia and insulin resistance that are components of MS.

Key words: vitamin D, obesity, metabolic syndrome, insulin resistance.

mgordina@yandex.ru

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EVALUATION OF THE EFFECTIVENESS OF SURGICAL TREATMENT OF BENIGN BREAST DISEASES

Authors: Yazykov O.V., Leonov V.V.

Pages: 381-389

Abstract


Introduction. Up to 70 % of the female population of Ukraine has benign breast diseases, so it is extremely important to treat these patients. We know that sector resection of breast is aimed at the elimination of pathologically altered focus, but this method does not provide satisfactory aesthetic results. Scar deformation of the breast, the loss of its natural appearance after surgery significantly reduces the quality of life of patients, which can be a convincing evidence of the low efficiency of sector resection.

Our aim is to analyze the effectiveness of breast benign surgery using traditional and modified techniques.

Material  and Methods. We studied the results of treatment of 151 patients with benign breast diseases: 106 women were operated using the developed methods, sector resection of the breast was performed on 45 patients performed. We used the instruments SF-36v2TM to assess quality of life; we used BEQ before surgery, in 3 and 12 months after surgery to assess the aesthetic satisfaction tool. We estimated radicality and validity of operations from the results of histological examination of removed tissue.

Discussion. The analysis of questionnaires for three observation periods revealed that sector resection of the breast did not change the health-related quality of life of patients (51.9 and 46.08 vs. 50.8 and 47.75 points before surgery for PCS and MCS, respectively (MID ˂ 2). At the same time, a significant negative impact on the aesthetic component of quality of life made the results of surgical treatment unsatisfactory. However, the developed operations enhanced health-related quality of life of patients in a year (53.7 and 53.8 vs. 51.01 and 43.57 points before surgery for PCS and MCS respectively, p = 0.01; MID ˃ 2). For instance, significantly increased the satisfaction of the aesthetic state of breast (3.82 and 3.78 vs. 3.58 and 3.53 points before surgery for satisfaction with attributes level of self-confidence, p ˂ 0.05). Polycystic breast lesions in more than 20 % of cases expressed proliferative and degenerative changes. Therefore, the maximum removal of tissue is the prevention of breast cancer. Due to the high probability of dysplastic changes in fibroadenomas in patients older than 35 years (10 %), we believe that observation and conservative treatment is unacceptable.

Key words: breast benign lesions, mini-invasive operations, plastic and reconstructive surgery, quality of life.

yazikov@i.ua

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