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EPIDEMIOLOGY OF DISEASES ASSOCIATED WITH BIOMINERALIZATION IN SUMY REGION

Аuthors: A. M. Romaniuk,  R. A. Moskalenko,  S. V. Tarasenko, V. A. Smiyanov,  O. V. Kravets,  I.-М. S. Zakorko,  А. М. Piddubnyi

Pages: 583–592

Abstract

         

Diseases associated with biomineralization (DAB) are diseases with biomineral deposits formation, which have a significant impact on the disease course and prognosis. These nosologies include hole-, nephro-, sialo-, pancreo-, prostatolithiasis, vessels and heart valve atherocalcinosis, calcification in the case of cancer diseases of the thyroid gland, uterus and of other locations. Most of diseases associated with biomineralization result in formation of pathological biominerals of calcium phosphate nature. Reasons, which lead to increased prevalence of DAB, extremely vary: environmental, social, economic, climatic, metabolic diseases.

The aim of the work is epidemiology analyzing of diseases associated with biomineralization among population in Sumy region and Ukraine.

Results. DAB deserve our attention as the most common diseases in Ukrainian population, and such diseases as cholelithiasis, ischemic heart disease (IHD) and thyroid cancer (TC) are statistically accounted.

The average prevalence of cholelithiasis was higher in Sumy region than average Ukrainian index 1.37 times in 2012–2016 years, as the rate of disease spread. On average the cholelithiasis morbidity increased yearly in Sumy region by 1.17%, in Ukraine it decreased by 3.15%. The average prevalence of IHD was lower in Sumy region in 1.24 than the national one. However, the prevalence of IHD in Ukraine reduced, while this index was increased in Sumy region during 2012–2016 years. The average mortality rate from IHD was lower in 1.27 in Sumy region than the national one during 2012–2016 years. A clear tendency is not observed in the change of mortality indexes from IHD, both in Ukraine and in Sumy region.

Index of TC morbidity increased during 2012–2014 years in Sumy region and it decreased during 2015–2016 years, but it was higher in Sumy region in 1.79 than the national index during 2012–2016 years. Dynamics of national index of TC morbidity is not clear.

Conclusion. The course of diseases such as cholelithiasis, coronary heart disease, thyroid cancer associated with pathological biomineralization. The influence of calcification in the development of these nosology is multidirectional: on the one hand biomineralization complicates their course, the other - increases the body's ability to resist this disease. Investigation of biomineralization requires a multidisciplinary approach, as its biological and clinical significance needs to be studied in detail.
Keywords: pathological biomineralization, cholelithiasis, ischemic heart disease, epidemiology.

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References

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IMPACT OF OBESITY ON RESPIRATORY FUNCTION PARAMETERS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Аuthors: O. M. Radchenko,  L. I. Pylypiv

Pages:  593–596

Abstract

         

Introduction. Сhronic obstructive pulmonary disease (COPD) is one of the topical issues in modern medicine. Disease prognosis often depends on its comorbidity. Due to influence on pulmonary mechanics and system inflammation, obesity is one of the significant and prevailing factors for emergent and progressive respirator system dysfunction.

Purpose. Estimation of obesity influence on respiratory function parameters in patients with COPD was the objective of our research.

Materials and methods. It has been examined 145 patients with СOPD, where 42 of them had normal body weight, 41 suffered from overweight, and 62 suffered from obesity. Each patient was examined by anthropometric measuring of body mass index using Quetelet formula, as well as defining respiratory function parameters by means of computer spirometry.

Results and conclusion. It has been discovered that the heavier body weight those patients had, the worse all of the respiratory function parameters they experienced. Unlike patients with normal body weight, in patients with obesity there were considerably lower parameters of forced expiratory volume in 1 second, forced vital capacity, Tiffno's index, peak expiratory flow, that indicates more severe run of bronchobstructive syndrome in this type of patients.
Keywords: chronic obstructive pulmonary disease, obesity, respiratory function parameters.

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UKRAINIAN CAREER-ORIENTED CENTERS FOR CHILDREN AND ADOLESCENTS

Аuthors: G. N. Danylenko, A. N. Shvets, J. N. Shvets

Pages: 597–607

Abstract

         

Relevance of the research topic is due to the need of ways to improve the youth career-guidance work in Ukraine in the conditions of globalization and integration processes. Integration of our country's into the international scientific and educational space, the dynamic development of the market economy, which causes a rapid change in the professions' world, set new quality requirements for professionals of all specialties; so the study and adoption of progressive ideas and experience of other countries' professional orientation is quite essential.

As it was shown by the study of literature, there is a clear system of cooperation between different institutions and agencies aimed at continuous improvement of career guidance in Europe set up. This important work is carried out with the involvement of enterprises in the work of professional guidance and is based on the close cooperation of educational institutions and employment centers. The European system of vocational training is recognized by the international community as one of the best and its vocational guidance work is an example of young people's preparation for the choice of profession.  

Professional orientation in Ukraine corresponds to the concept of continuing education throughout the whole life. Solutions of career guidance tasks are defined in the National Doctrine of Education Development (2002), Ukrainian "Educational Law" (1991), "Employment Law" (1991), Concept of the state system of the professional orientation of population (2008), "Plan of cooperative actions of the Ministry of Labour and social policy of Ukraine regarding the improvement of state employment services and educational administration' (2008) as well as other legal documents.

Professional orientation can’t be targeted and effective without clear, scientifically-based information about the specifics of occupations, their requirements for personal psycho-physiological qualities. Ignorance of the psychological content of the profession can have negative consequences when choosing or changing profession, profile training, employment, holding professional consultation. Therefore, a career guidance providing has the leading role.

Indicators of successful vocational guidance system in the country is a large number of successful professional careers, fast entry of young people into the labor market, a developed system of further education, general satisfaction of the young citizens with their professional lives, and thus, the quality of life in general.
Keywords: career guidance, career guidance centers, teenagers, professional self-determination, choice of profession.

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FEATURES OF CLINICAL COURSE OF VIBRATIONAL DISEASE IN WORKERS OF DIFFERENT OCCUPATIONAL GROUPS

Аuthors: V. A. Kapustnik. N. K. Sukhonos, V. M. Tverezovskyi

Pages: 608–613

Abstract

         

Vibration disease (VD) is one of most common among occupational diseases. It is presented in 5–18 % of total quantity of occupational diseases. It’s known that formation and character of clinical signs of vibration disease depend on many exogenous factors such as low environment temperature and local cooling of workers’ hands, significant static and dynamic load, which depends on hand mechanized tools, physical effort, and enforced working pose. Additional cooling influence increases pathogenic vibrational action and hasten development of vibrational disease. In addition, different physical characteristics of vibration can influence the character and expressiveness of organism reactions. To study special features of vibration diseases course in different occupational groups we performed comparison of clinical data in choppers, polishers, and tool-makers.

Aim. The aim of current study is to find out the features of clinical course vibrational disease in workers of different occupational groups.

Materials and methods. There have been included 107 patients with VD due to local vibration of I and II degree. Among surveyed patients there were 30.9 % of tool-makers, 46.7 % of coppers, and 22.4 % of polishers. Control group (CG) included 22 healthy volunteers. Complex examination included detailed complaints acquisition, anamnesis, studying of occupational route, and superficial examination.

For clarification and confirming of VD diagnosis we used several additional clinical-physiological methods, such as capillaroscopy of nails, electrothermometry, pallistesiometry, cold test, dynamometry with estimating of maximal wrist power and exercise tolerance of forearm muscles, and wrists and arm joints X-ray.

Discussion. During analysis of VD course in different workers we have made such outcomes. Clinical course of VD in every group had its own features. Pain syndrome was the most complicated in coppers and tool-makers, which had both functional and degenerative-dystrophic changes in upper limbs. Polishers had mainly mild course of VD with predominance of angiospasms attacks. Upper limbs polyneuropathy was predominate in tool-makers group.
Keywords: vibrational disease, choppers, polishers, tool-makers.

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LOCAL IMMUNITY DISORDERS OF ORAL CAVITY IN CHILDREN WITH CYSTIC FIBROSIS

Аuthors: R. S. Nazaryan, M. V. Tkachenko, N. I. Kovalenko

Pages: 614–623

Abstract

         

Actuality: The nature of the pathological changes of the oral cavity tissues and teeth in cystic fibrosis is not described sufficiently in the literature. Further study of the dependence of dental diseases development in children on primary somatic disease is necessary.

Objective: Determination of the relationship between the state of microbiota of oral cavity and the level of the local immune reactivity in children with cystic fibrosis.

Materials and methods: For this goal 41 children aged 2 to 17 years were examined. The basic group included children with cystic fibrosis (n = 23) who were diagnosed with periodontal and tooth disease, and group of control consisted of their coevals without concomitant somatic pathology and who had not cystic fibrosis (n = 18).

The survey included patients' medical history, clinical examination of the oral cavity, definition of the Green-Vermillion hygiene index and gingivitis index (PMA), urease activity by the reaction of urea to form ammonia and lysozyme by the bacteriological method using a substrate suspension Micrococcus lysodeicticus.

Degree of dysbiosis of oral cavity was determined by enzymatic method after A. P. Levitsky and others by correlation of the relative activity of urease and lysozyme. For evaluation of local immunity state the levels of immunoglobulins IgA, IgM, IgG and secretory immunoglobulin sIgA were determined by ELISA.

Results and discussion: The study found significant increase of urease activity in 2 times and reduction of lysozyme activity almost in 1.5 times in the saliva of children with cystic fibrosis compared with the healthy children. While there were decrease of secretory IgA concentration in 1.3 times and increase of concentrations of other immunoglobulins such as IgA – 2 times, IgG – 1.4 times and IgM – 1.5 times in children with cystic fibrosis compared to the group of control. Disorders of local immunity were accompanied by the growth of oral dysbiosis by 3 times. Most of the sick children were marked unsatisfactory and poor state of oral hygiene due to Green-Vermillion index, moderate and severe degree of gingivitis after the papillary-marginally-alveolar index. The maximum violations had been registered in children at the age of 2 to 3.

Conclusions: Low level of oral hygiene of children with cystic fibrosis is accompanied by significant increasing of oral cavity dysbiosis degree, which indicates a damage of microbiota caused by first of all decrease of antimicrobial protection.

Local immunity suppression of the oral cavity, which is characterized by decreasing activity of lysozyme and content of secretory IgA in saliva of sick children, is marked in children with cystic fibrosis.

Keywords: lysozyme, urease, immuneglobulins, oral cavity, cystic fibrosis.

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MARKERS OF DIABETIC NEPHROPATHY IN PATIENTS WITH ARTERIAL HYPERTENSION III STAGE AND TYPE 2 DIABETES MELLITUS AND THEIR CORRECTION

Аuthors: O. M. Chernatskaya, N. V. Demikhova, F. B. Golubovskaya, S. Ya. Udovychenko

Pages: 624–631

Abstract

         

No doubt that diabetes mellitus is a global epidemic nowadays. In addition, such patients are especially vulnerable to hypertensive injury. Furthermore, the coexistence with arterial hypertension has a significant impact of the poor prognosis. Previous studies have indicated that microalbuminuria is an independent risk factor for the decline in renal function as well as cardiovascular morbidity. Therefore, published guidelines advocate screening of microalbuminuria for patients with diabetes mellitus.

The purpose of our study was the determination of markers of nephropathy for patients with diabetes mellitus and arterial hypertension and the comparison of nephroprotective action of telmisartan and lisinopril for improving treatment.

We examined 175 patients in our clinical trial. They were treated in Sumy City Clinical Hospital № 1 during 2015-2016 years. 100 people from the first group had coexistent pathology, 50 people from the second had only arterial hypertension, 25 persons were healthy. Half persons from the first group were treated by telmisartan, another half consumed lisinopril. We evaluated glycated hemoglobin by biochemical method and albuminuria with the help of enzyme immunoassay. All data were analyzed with the help of statistical methods (Excel 2013). In addition, we evaluated the Student criteria (t), Pearson ratio (r) and the veracity of differences (p) for assessment results. The results of the study show the positive correlation between albuminuria as a basic marker of diabetic nephropathy and glycated hemoglobin (r = 0.52; р < 0.001), systolic (r = 0.25; р < 0.01), diastolic blood pressure (r = 0.31; р < 0.01), duration of diabetes mellitus (r = 0.61; р < 0.001). Moreover, the measuring of albumin to creatinine ratio is more expensive, but also more direct than determination only albuminuria. As a result there is the decrease of albuminuria, glycated hemoglobin in all patients with diabetes mellitus in the dynamic of treatment because of nephroprotective action of the drugs.

In conclusion, determination of albuminuria, glycated hemoglobin as markers of nephropathy is necessary for patients with type 2 diabetes mellitus and arterial hypertension not only for improving kidney disorders, but also for prevention cardiovascular complications. Our study shows that nephroprotective action of telmisartan is less good than of lisinopril. So, telmisartan is recommended for patients with type 2 diabetes mellitus and arterial hypertension not only because of antihypertensive effect, but also for organoprotective action.

Keywords: diabetic nephropathy, albuminuria, glycated hemoglobin, nephroprotection, type 2 diabetes mellitus.

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INGROWN NAILS ASSOCIATED WITH MYCOSIS: VIEWS ON THE PROBLEM

Аuthors: A. R. Vergun, B. M. Paraschuk, I. A. Makagonov

Pages: 632–642

Abstract

         

Prospectively examined for fifteen years 403 patients with ingrown nails affected by mycosis, aged 48 to 72 years, comprehensively treated in municipal offices 4 city hospital, clinical polyclinic №2 in Lviv using systemic antimycotic therapy, local therapy, including antifungal lacquer and surgical removal of the nail plate. At 115 people, aged 42–65 years (76 men and 39 women) diagnosed polyonychomycosis and trichofitial subungual hyperkeratosis with secondary ingrown nails – the main group. Other 276 patients constituted the control group. In patients with onychomycosis, especially in severe destructive forms subungual hyperkeratosis, noted large deterioration of microcirculation. Rheographic prevailed spastic type curves (P < 0.01). Index open capillaries was reduced by 31 %. Patients in both groups mainly was amazed hallucs left foot – in 188 people, at least – the right foot (in the other 133 patients), the presence of pathological ingrown nail plates hallucs both feet and other fingers ascertained in 82 patients. Patients of the main group carried out a three-day adjuvant systemic fungicide therapy daily intake of 400 mg itraconazole, which continued for the next 4 days (first 2 postoperative days) as pulse therapy. A similar dose at weekly intervals was carried out following a five-day 2–3 cycle pulse. Surgical treatment was performed according to standard algorithm given pathological eponychial changes. In patients with primary advantage of providing low-impact methods of excision of the nail with access via onycholisation structure and wedge resection of the nail. When combined incarnation of onychomycosis and acute eponychial abscess, comply with disclosure abscess, excision of abnormal tissue eponychial hyperhranulation and focal necrosis; removal of the nail plate, enlarged partial marginal matrixectomy in the ingrowth area. When combined with onychomycosis and nail incarnation acute eponychial abscess, performed an autopsy ulcer, excision of abnormal tissue eponychial hypergranulation and focal necrosis; removal of the nail plate, enlarged partial marginal matrixectomy in the ingrowth area. Other patients (control group) used a typical removal nail – operations such as Dupuytren's – complete removal of the nail plate under the guise of "classical" pulse therapy with itraconazole and terbinafine, in 45 cases this intervention combined with simultaneous excision of the modified cuticle and plastic – operations such as Bartlett (plastic local tissue) and Meleshevich. We have differentiated two types of destructive complicated onychomycosis associated with nail incarnation, in which the combined treatment of surgery used onychektomy. Arguing that the removal of the nail plate in patients with destructive onychomycosis with secondary incarnation nail advantageously carried out through onycholisation structure with simultaneous correction of pathological bed changes and cuticle, which in combination with antifungal treatment provides positive dynamics of regenerative type cytologic picture and shorter healing onychektomy wounds 18 – 27 days to 12–25 days, with good early and long-term results.Type of transaction cytograms onychektomy wounds in the study group on the 10th day of the post-operative period is stated as the regenerative-inflammatory to 24.81 %, 75.19 % in the regenerator (p = 0.031). In these embodiments the control group were respectively 53.12 % and 46,88 %. The advantage of regenerative option cytological picture shows the correct choice of treatment strategy and accelerate wound healing after removing nail in patients of the main group.

Keywords: Destructive onychomycosis, ingrown nail, antifungal therapy, removal of the nail plate.

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THE PHENOMENON OF INHIBITED MORTALITY WITHIN INCREASED PREVALENCE OF CORONARY HEART DISEASE

Аuthors: E. G. Bulich,  I. V. Muravov

Pages: 643–655

Abstract

         

Introduction. Incidence of the disease is not always reflected his danger. This provision applies to most diseases and especially coronary heart disease. In the pathogenesis of this disease, there are two mechanisms (ischemic preconditioning, and the ability to develop chronic conditions, that is "delaying danger" for the future) able to reduce its dangers.

Purpose. Therefore, to assess the real risk of coronary disease is advisable to use specific population indicators of the heart, which has the necessary information in an implicit form.

Materials and Methods. The condition for receiving such information is cluster analysis, which allows us to consider the link between disease prevalence and mortality from it in different subpopulations as a manifestation of "dose-response" relation. Were analyzed epidemiological parameters for coronary heart disease among people of working age in Ukraine for 15 years (1999–2013).

Results and its discussion. It is shown that although the prevalence of the disease is the "supplier of death", but the relationship between the number of registered diseases and mortality in coronary heart disease is far from proportional. It revealed the phenomenon of mortality deceleration, reduce mortality and improve the viability with increasing prevalence of coronary heart disease among working-age population of Ukraine in 1999–2013, respectively. This phenomenon is only partially dependent on the characteristics of the region and shows similarity to similar changes that are inherent in infectious diseases. The obtained data indicate that inhibition of mortality based on biological mechanism, which cannot be reduced only to the features of the pathogenesis of coronary heart disease. To understand mortality braking phenomenon can be further prospective epidemiological studies to disease using the principle of "dose-effect" and cluster analysis.

Keywords: epidemiology, coronary heart disease, the principle of "dose-effect", cluster analysis, mortality deceleration phenomenon, mortality, population viability.

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EPIDEMIOLOGICAL FEATURES AND WAYS OF IMPROVING PREVENTION OF ACUTE RESPIRATORY VIRAL INFECTIONS

Аuthors: M. D. Chemych,  N. G. Malysh,  T. M. Goncharova,  M. F. Siver

Pages:  656–664

Abstract

         

Acute respiratory viral infections remain relevant problems of the health care system for many years. Considering the rapid spread of the viruses among the population, the severity of clinical symptoms and existence of complications, the question of prevention and treatment is still actual until now.

For exploring the epidemic process of acute respiratory viral infections in 2005–2016 years we used information from the statistical reports of the Main Department of the State Sanitary and Epidemiological Service of Ukraine in Sumy region and applied analytical and descriptive techniques of the epidemiological research. Fluorescent microscopy and polymerase chain reaction were used for diagnosis of influenza and acute respiratory viral infections. For determination the population immunity to influenza we carried out hemagglutination inhibition reaction with various types of dry influenza diagnostics and examined the indicators of specific antibodies at titers 1:40 and more in donor’s blood.

It was established that the incidence of influenza decreased from 784.7 per 100 thousand population to 33.7 (p < 0.05), but the frequency of acute respiratory viral infections has grown from 3045.5 per 100 thousand population to 15326 (p < 0.05) on the contrary. The incidence of influenza and acute respiratory viral infections among children is higher than among adults (p < 0.05). There is a strong tendency of reduction the frequency of detection of adenoviruses, RS-viruses and parainfluenza viruses in clinical material from patients with severe respiratory disease (p < 0.05). The growth rate of detection the influenza virus B antigens was +8.2%. The main feature of the epidemic season 2009–2010 is the beginning of circulation new pandemic strain of influenza A (H1N1) California. With consistently high level of herd immunity to influenza B virus (99.8 %), in the donors' serum were found the antibodies to influenza A(H1N1) virus in the diagnostic titers in 76.9% of cases and to influenza A (H3N2) virus in 95.1% which indirectly indicates the wide spread of these viruses in Sumy region.

Using medicines and methods that promote the normalization of the immune system and increasing of non-specific resistance to infectious agents, timely application of the sanitary and anti-epidemic measures in the focus of infection should be a key component in dealing with the emergence and spread of influenza and other acute respiratory viral infections.
Keywords: acute respiratory viral infections, influenza, trendency, herd immunity, prevention.

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MILD TBI WITH 13-15 POINTS BY GLASGOW COMA SCALE: IS THIS INJURY MILD?

Аuthors: A. A. Andreіev,  O. E. Skobska,  A. E. Andreіev,  N. V. Kadzhaya,  A. S. Gotin

Pages: 665–673

Abstract

         

141 cases of TBI (age 38.3 ± 14.3 years; male/female 2.5:1) with the GCS score of 13–15 points in the first 24 hours post trauma were analyzed. According to CT results, all patients divided into 5 subgroups: no pathological CT finds (n = 40), type I brain contusion (n = 25), type II brain contusion with cranial vault fracture (n = 30), type II brain contusion with cranial vault fracture and traumatic intracranial hemorrhages (n = 30), type II brain contusion with temporal bone pyramid fracture (n = 16). Standardized examination protocol was used. Self-reported symptoms (ex.: headache, dizziness, general weakness, double vision etc.) and clinical finds (spontaneous nystagmus, instability in Romberg test etc.) were rated in range scale and analyzed with discriminant analysis method. The most qualitative discrimination of cases with intracranial pathological CT-finds was made by the following clinical signs: male, age over 60 years, injury of high velocity, alcohol intoxication, post-traumatic loss of consciousness 15 minutes or more, vomiting 2 or more times, amnesia, posttraumatic seizures, meningeal signs and scull-base fracture symptoms: Battle's sign, hematympanum, rupture of the eardrum. In order to examine the diagnostic value of detected clinical signs the ROC-curve analyze was performed.

As a result of calculating the area under the ROC-curve (AUC) good informativeness (AUC of 0.793 to 0.7) showed the following clinical signs: age over 60 years, meningeal signs, traumatic loss of consciousness for more than 10 minutes, Battle's sign, rupture of the eardrum, hematympanum, posttraumatic seizures; AUC of less than 0.7: male, injury of high velocity, alcohol intoxication, vomiting 2 or more times, anterograde amnesia. We proposed a diagnostic algorithm with the use of small (Se – 80,6 %, Sp – 30,05 %) and major risk factors (Se – 25,8 %, Sp – 84,9 %). The highest rate of positive CT-scans is associated with the presence of at least one large or two small risk factors.
Keywords: Mild TBI, Glasgow coma scale, computed tomography, sensitivity, specificityMild TBI, Glasgow coma scale, computed tomography, sensitivity, specificity.

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  1. Joseph B, Pandit V, Aziz H, Kulvatunyou N, Zangbar B, Green DJ, Haider A, Tang A, O’Keeffe T, Gries L, Friese RS, Rhee P. Mild traumatic brain injury defined by Glasgow Coma Scale: Is it really mild? Brain Inj. 2015;29(1):11-6. doi: 10.3109/02699052
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EFFECTIVENESS OF HYPERTENSION STANDART TREATMENT IN PATIENTS WITH TYPE 2 DIABETES

Аuthors: V. I. Vdovychenko, V. V. Kulchytskyj, I. A. Makagonov, O. Ya. Levus

Pages:  674–679

Abstract

         

Introduction. One of the most urgent problems of modern medicine is the problem of course and treatment of type 2 diabetes mellitus because of the high prevalence and high rates of mortality and disability. However, it was proved that 70–80 % of patients with type 2 diabetes were diagnosed with hypertension, which leads to death in approximately 50 % of patients and significantly increases the risk of complications of diabetes. But the problem of choosing drugs that are most optimally reduce blood pressure in patients with type 2 diabetes and hypertension remain still unresolved.

Purpose. The aim was to analyze the effectiveness of drug treatment of hypertension in patients diagnosed with type 2 diabetes and hypertension, receiving one or more antihypertensive drugs.

Materials and Methods. The study analyzed the case histories of 74 patients diagnosed with type 2 diabetes and concomitant essential hypertension who were hospitalized in endocrinology and therapeutic outlets 4 City Clinical Hospital Lviv during the period from 2011 to 2013. Among them, 30 were men and 44 were women. The age of patients studied ranged from 39 to 80 years, average age – 62.5 years. For the duration of diabetes patients were divided as follows: duration of diabetes for 5 years – 12 people, 5–10 years – 24 people, 10–20 years – 26 people, more than 20 years – 12 people.

Discussion. An analysis of medical records revealed that a total of 74 patients studied target blood pressure (systolic of <140 mmHg and diastolic <80 mm Hg) was achieved in 33 people, which is 44.59 % of the total number of observations . Group of 35 patients took several groups of drugs for high blood pressure (study group). Target values ​​achieved in 17 (48.57 %) people. Of the 74 patients treated for hypertension in diabetes, 39 people received a monotherapy antihypertensive agents – group comparisons. Target blood pressure values ​​achieved in 16 (41.03 %) of them. Thus, the difference between the effectiveness of treatment in the study group and the comparison group can be considered reliable. The most effective drugs for monotherapy of hypertension in type 2 diabetes were Angiotensin II Blockers (all patients the main group and 80 % of patients in the comparison group who took Angiotensin II Blockers achieved target blood pressure) and ACE inhibitors (50 % achieved target blood pressure). Analysis of the effectiveness of drug therapy of hypertension with type 2 diabetes conducted based on case histories of patients showed that the optimal drug for monotherapy were angiotensin receptor blockers (80 % of patients achieved target blood pressure) and ACE inhibitors (38.46 % achieved target blood pressure ), indicating the need for finding ways to optimize the antihypertensive therapy in patients with type 2 diabetes, but the effectiveness of monotherapy was only 41.03 % of cases.

The most effective in terms of achieving target blood pressure in patients with essential hypertension and concomitant type 2 diabetes with a combination of drugs and different combinations of antihypertensive drugs in combination with glycemic correction.
Keywords: type 2 diabetes mellitus, arterial hypertension, comorbid diseases.

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References

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FLUORESCENT SPECTRUM FEATURES OF SAMPLES OF DIPHTHERIAL TOXOID NATIVE PURIFICATION

Аuthors: I. V. Yelyseyeva, A. O. Doroshenko, E. M. Babych, L. A. Zhdamarova, V. I. Belozerskij, T. V. Gorbach

Pages:  680–689

Abstract

         

Introduction: The functional properties of proteins are determined by their conformation structure, which is stabilized by two classes of strong bonds and a three classes of weak bonds. The diphtherial toxin is a protein molecule consisting of two mutually independent globular domains A and B, held together by disulfide bridges. Detoxification of diphtheria toxin is a process of breaking it’s native three-dimensional conformation under the influence of formaldehyde and heat. Precedents of reversion of toxoid’s toxicity are known. According to current regulations of national authorities there are no specific requirements to test this ability. So there is a need to attract special testing methods. Fluorimetry is widely used in studies of nucleic acids and proteins structure, dynamics and function. It’s considered that changings of the intensity of glow and fluorescence maxima location should indicate an effect of some factor as the breaking cause of spatial configuration and change of biological properties of the protein as its consequences. The way to control detoxifying diphtheria toxin by determining fluorescence intensity is known in the literature.

Purpose: The aim of the study was to determine the characteristics of the fluorescence of various series of native purified diphtheria toxoid (NPDT).

Materials and Methods: The fluorimetry of four samples of NPDT made at the PJSC Pharmstandart-Biolek enterprise, on the Hitachi 850 fluorimeter was carried out. Results: Maximums of fluorescence in all the samples studied were in the range of excitation waves from 336 to 340 nm, typical for the fluorescence of proteins. The peak of emission level was recorded in the sample № 1 of NPDT, made in 2007 (395 conventional units), the minimum of fluorescence - in the sample № 4 made in 2015 (266 conventional units).

Discussion: As known from the literature the fluorescence intensity of untreated samples of diphtheria toxoid during and immediately after detoxification was much lower than our results for NPDT fluorescence intensity (from 12 to 26 conventional units), whereas the native diphtheria toxin was characterized by even lower emission levels (from 2 to 9 conventional units). Obviously, in the process of detoxification of diphtheria toxin and in further storage of toxoid denaturation process occurs in the protein molecules, which are shown in the loosening of the protein globules release tryptophan residues, which increases the intensity of fluorescence emission. The degree of denaturation is definitely related to the level of specific (immunogenic) activity of a sample of diphtheria toxoid. So if the activity is maintained, it is likely we are talking about the first denaturation step - functional transition within the native protein structure. At full unfolding of the amino acid chain of a protein the specific activity of diphtheria toxoid is obviously lost on that a relative increase of the level of fluorescence emission of NPDT samples may indicate. In the case of unexplained quenching the fluorescence of the sample we can suggest the possibility of reversion to its toxicity. These data indicate that fluorimetry may be used for the monitoring of conformational changes in the samples of diphtheria toxoid and become a tool for the regulation of vaccine quality control through the introduction of demonstration of the dynamics of the fluorescence spectra in the production. Screening of the fluorescence spectra of turned out samples of toxoid in the process of storage can help to identify the series, the quality of which is in doubt.
Keywords: ischemic heart disease, microvascular angina, endothelial dysfunction, dry carbon dioxide baths, interference therapy.

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ANALYSIS OF ALLELIC VARIANTS OF CFTR (RS 113993960), PRSS1 (RS 111033565) AND IL-4 (RS 2243250) GENE COMBINATIONS FROM THE POINT OF VIEW OF EDEMATOUS PANCREATITIS RISK IN NORTH BUKOVINA POPULATION

Аuthors: S. I. Ivashchuk,  L. P. Sydorchuk

Pages: 690–697

Abstract

         

Gene mutation is often studied in association with pancreatitis. However, genetic research focuses on the single-nucleotide polymorphism study and does not analyze the complex influence of several genes polymorphisms on pancreatitis risk. The aim of the research was to study the combined influence of genes CFTR (rs 113993960), PRSS1 (rs 111033565) and IL-4 (rs 2243250) polymorphisms from the point of view of edematous pancreatitis risk.

Genetic studies have been performed for 123 patients, among whom there were 23 (18.7 %) women and 100 (81.3 %) men. The genotype distribution among the examined patients and healthy people for the selected genes has been determined.

The distribution of polymorphic variants of CFTR (rs 113993960), PRSS1 (rs 111033565) and IL-4 (rs 2243250) genotype combinations showed no statistically significant difference between the group of patients and the control one. 52.47 % of patients were the owners of NN/GG/CC genotype combination. 38.61 % of patients with pancreatitis had the unfavorable T-allele of gene IL-4 in their genotype combination (NN/GG/CT-, or NN/GG/TT). The remaining combinations of genes CFTR/PRSS1/IL-4 genotypes were met in rare cases (1–3 people). The incidence of minor TT-genotype of gene IL-4 was 7.50 % in control group and 8.91 % – in patients. Gene CFTR (delF508) mutation in the heterozygous state occured in 4.69 % of patients and 2.50 % of the healthy. The analysis of polymorphic variants of genes CFTR (rs 113993960), PRSS1 (rs 111033565), IL-4 (rs 2243250) genotype combination, depending on the type and etiology of edematous pancreatitis, showed no statistically significant difference in the frequency of genotype combination between the patients with acute or chronic pancreatitis exacerbation, and of alcoholic or biliary origin. Most of the patients were the carriers of a combination of favorable genotypes (NN/GG/CC): with acute pancreatitis – 57.81 %, with chronic pancreatitis exacerbation – 43.24 %, with alcoholic pancreatitis – 56.25 %, with biliary pancreatitis – 45.95 %. 29.69 % of patients with acute pancreatitis, and 37.5 % with alcoholic pancreatitis had an unfavorable T-allele of gene IL-4 in the genotype combination (NN/GG/CT, NN/GG/TT), also this allele was detected in 54.05 % of patients with chronic pancreatitis exacerbation, and in 40.54 % with biliary pancreatitis. Among the patients with pancreatitis who had unfavorable T-allele of gene IL-4 in their genotype combination (NN/GG/CT-, or NN/GG/TT), 29.69 % were with acute pancreatitis, 37.5 % – with alcoholic one; 54.05 % – with chronic pancreatitis exacerbation, 40.54 % – with biliary pancreatitis. The epidemiological analysis showed that the analyzed genes PRSS1 (365G > A), IL-4 (C-590T) and CFTR (delF508) genotype combinations are not risk factors of acute edematous or chronic pancreatitis exacerbation, neither of alcoholic nor of biliary origin.

Keywords: gene, polymorphism, pancreatitis, genotype, edematous, alcoholic, biliary.

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  11. Ivashchuk SI, Sydorchuk LP. Association of the genes IL-4 (C-590T), TNF-α (G-308A), PRSS1 (R122H) and CFTR (delF508C) with cytolysis syndrome activity in patients with acute edematous pancreatitis. Arch Balk Med Union. 2016;51(1):41-45.
  12. Ivashchuk S, Sydorchuk L. Level of reactive response of peripheral blood neutrophil granulocytes of patients with acute pancreatitis depending on genes polymorphism of CFTR (delF508C), PRSS1 (R122H), IL-4 (C-590T) and TNF-α (G-308A). The Pharma Innovation Journal. 2016;5(8):96-100.
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EVALUATION OF EFFECTIVENESS OF ORIGINAL SORBENT APPLICATOR FOR TREATMENT OF EXPERIMENTAL PSEUDOMONAS BURN INFECTION

Аuthors: G. M. Cherniakova, V. V. Minukhin

Pages: 698–702

Abstract

         

Introduction: Pseudomonas aeruginosa is the leading pathogen among the causative agents of burn infections in the patients. It has a multiple natural resistance to antibiotics [3, 4]. One of the ways of overcoming drug resistance is the search and implementation in practice of new drugs with antimicrobial activity, including the medicines for the topical treatment [5].

Purpose: The objective of this study was the evaluation of antibacterial activity of the sorbent applicator which was developed by us on the basis of highly dispersed nano-sized silica with immobilized antimicrobial mixture for the treatment of experimental model of burn Pseudomonas infection in mice.

Materials and Methods: The research was conducted on 90 6‑month male mice NMRI line weight 18–20 grams. We used for experiments a model of the contact thermal burn with some our additions. After burning the experimental animals were infected by daily agar culture of multidrug resistant clinical strain of P. aeruginosa 3101, obtained from a patient with burns. Microbiological studies of burn wounds in experimental animals were carried out.

Results and Discussions: It was found that the application of new original sorbent applicator for 3 days decrease the number of microbial cells in the wound below the critical level (105). In this experimental group the amount of purulent discharge from the wounds, swelling, redness and infiltration of tissues were reduced in comparison with the other groups. Earlier cleansing of the wounds and acceleration of reparative processes were observed.

Conclusions: The findings proved that the sorbent applicator exhibits antibacterial properties against multidrug resistant clinical strain of Pseudomonas aeruginosa and can be a prospective complex drug for the topical treatment of Pseudomonas infective burns.
Keywords: burn wound, topical treatment, Pseudomonas infections, sorbent applicator.

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EFFECT OF APOE GENE TRANSFECTION ON HEPATOCYTE STRUCTURE IN EXPERIMENTAL ATHEROSCLEROSIS

Аuthors: A. V.  Biloshytska

Pages: 703–712

Abstract

         

Topicality. Atherosclerosis is the most common and most threatening disease in the world and in Ukraine. Pathology of the digestive system including the liver may worsen disease. All current treatments have only a temporary effect. Gene therapy is becoming more promising treatment for multifactorial diseases. Search is being carried in the world for more effective and convenient mechanism for transferring the desired DNA segments to target organs.

Goal. To study the preventive effect of apoE gene transfection on the hepatocyte structure in experimental atherosclerosis.

Materials and methods. Experimental atherosclerosis was simulated by the classical Anichkov’s method by feeding animals with cholesterol. All experimental animals were divided into 3 groups: 1 – intact rats, 2 – rats which simulated atherosclerosis, 3 – rats for which prevention of atherosclerosis was conducted. As a preventive measure, apoE gene transfection was used (at a dose of 50 mkg DNA for the animal). The animals were taken out of the experiment by decapitation under light ether anesthesia. To investigate the fate we always used the right slice of the rat’s liver. Further research conducted by the conventional method. Histological sections were stained; ultrathin sections were studied by electron microscope.

Results. Experimental atherosclerosis leads to fatty hepatocytes. Violated microscopic and ultramicroscopic structure of hepatocytes. We watched a lot of necrotic cells and non-nuclear hepatocytes. Ultramicroscopic study of damaged cells showed a lot of lipofuscin and mielin structures. The number of mitochondrias and glycogen was sharply reduced. Lipids were in a large number of almost cells. Transfection of apoE gene promotes better recycling of exogenous lipids that were morphologically manifested in reducing the number of large lipid droplets in cytosol, reducing of lipofuscin granules and myelin structures, preserves the structure of the hepatocyte nucleus.

Conclusions. ApoE gene transfection protects the hepatocyte structure during the experimental atherosclerosis.
Keywords: еxperimental atherosclerosis, apoE gene, transfection, hepatocytes.

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COMPLEX ASSESSMENT OF PARAMETER CHANGES OF HOMEOSTASIS IN RATS WITH EXPERIMENTAL GASTRITES

Аuthors: S. Gushcha,  B. Nasibullin,  E. Bakholdina,  A. Oleshko,  N. Kalinichenko

Pages: 713–719

Abstract

         

Chronic gastritis is an important medical and social problem. Application of modern diagnostic techniques and drugs are not always effective, so the search for new methods of treatment, their comprehensive study is relevant. Dealing with these issues requires the making of experimental models that accelerate the solution of the problem.

Objective: To make a model of chronic gastritis, adequate to its pathogenesis and to study the system changes in organism of rats. Experimental chronic gastritis (CG) in white rats caused by the introduction into the stomach of the solution of potassium permanganate (potassium permanganate choice due to its fibrosing effect on the blood vessels of gastric wall). The development of CG accompanied by activation of lipid peroxidation (elevated levels of malondialdehyde), inhibition of the activity of the antioxidant system (catalase activity decreased) and increased content seromucoid (inflammation activation). Established imbalance protein-synthesizing function of the organism, the activity of the immune system; ion regulating kidney function. This confirms that the gastritis is the system pathological process. The received data clarify the understanding of the pathogenesis of this disease and create an experimental basis, which allow expanding the development of diagnosis and treatment of this pathology.
Keywords: experimental chronic gastritis, white rats, parameters of homeostasis.

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ASSOCIATION OF T-786C POLYMORPHISM OF THE ENDOTHELIAL NITRIC OXIDE SYNTHASE GENE WITH RHEUMATOID ARTHRITIS IN COMBINATION WITH OBESITY, DIABETES MELLITUS TYPE 2 AND ARTERIAL HYPERTENSION

Аuthors: O. P. Bukach

Pages: 720–727

Abstract

         

Introduction. A high level of cardiovascular comorbidity, especially in disease, is the most significant predictor of premature death of patients with RA. The role of polymorphisms of T-786C in the promoter of eNOS gene in the formation of RA and its most frequent concatening diseases – DM, AO and hypertension, and complications of RA in the existing literature is limited and existing data are contradictory and related to individual diseases and their pathogenetic mechanisms [12, 22]. Therefore, we have analyzed the frequencies of alleles and genotypes of T-786C polymorphism of the gene endothelial nitric oxide synthase (eNOS) in patients with rheumatoid arthritis (RA) in combination with abdominal obesity (AO), arterial hypertension (AH) and diabetes mellitus type 2 (DM2).

Material and Methods. The study involved 60 patients with rheumatoid arthritis (RA), and 20 healthy individuals. The average patient age was (of 48.03 ± of 14.91). The disease duration ranged from 1 to 32 years (of 12.17 ± 8.83). Study of gene polymorphism T-786C eNOS was performed by polymerase chain reaction (PCR). Statistical processing of results was carried out using computer programs Microsoft Excel 2007 and IBM SPSS Statistics® 23.0.

Results. It was found that among patients with RA with concomitant hypertension I And II degree, often registered in carriers of the favorable T allele of eNOS gene (T-786C): for AG I 5.67 times (p < 0.001), while AG II – 8.67 times (p < 0.001), respectively. A clear dependence of the changes of body weight, severity of obesity, and frequency of occurrence to separately and polymarble pathology in General (AO, DM2 and hypertension) in patients with RA taking into account the analyzed polymorphic variants of the gene are not established. The nature of allelic distribution of the T-786C polymorphism of eNOS gene in the population as a whole is dominated by the wild T allele over the mutant S-allele (65,0 % versus 35,0 %; c2 = 28,80; p < 0.001) in patients with RA – 35.0 % [OR = TO 4.31, 95 % CI = 2,51-7,40, p < 0.001], control 15.0 % (p > 0.05) with a significant excess of heterozygosity (F = -0,33; c2 = 4,49; p = 0,034), which, however, overlaps the normal distribution in the experimental group and in General does not violate the expected population equilibrium Hardy-Weinberg.
Keywords: rheumatoid arthritis, abdominal obesity, arterial hypertension, diabetes mellitus type 2, gene T-786C eNOS, polymorphism.

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MAIN DIRECTIONS OF PROTEOMIC RESEARCHES IN BREAST CANCER

Аuthors: M. G. Mazur,  T. V. Pyatchanina

Pages: 728–736

Abstract

         

The review focuses on the application of proteomics analysis areas to implement the results obtained in clinical practice for prevention, screening, diagnosis, prognosis and treatment of breast cancer. The results of the few studies on the role of extracellular matrix in breast tumor genesis considered to improve prevention. In the development of new screening programs are important results of the study of the relationship of features of tumor progression and specific protein markers of tumor tissue and urine. Improved diagnosis is impossible due to the identification of signatures of protein markers molecular subtypes of tumors, as well as the implementation of the results of the study of post-translational modifications of proteins associated with tumor progression. Proteomic profiling to identify target proteins chemotherapy action also represents new opportunities for the development of innovative medicines and to control the invasive properties of cancer by affecting the proteins of the tumor microenvironment. Proteomic profiling to improve the prognosis of the disease involves the identification and validation of a number of protein biomarkers: associated with the degree of histological grading (G1, G2, G3) tumors; proteomic markers predicting of metastasis, markers predicting response to neoadjuvant systemic therapy, as well as related to progression-free survival of patients after adjuvant chemotherapy. The results are of practical importance in the stratification of patients for the purpose of neoadjuvant and adjuvant systemic chemotherapy. In addition, the method is considered innovative use of LC-MS/MS for the identification of protein markers. Separately elucidated the question of the progressive development of methods of verification and validation of the results of research in modern experiments using proteomic analysis.
Keywords: breast cancer, trends of proteomic analysis, mass spectrometry-based combined method LC–MS/MS.

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STUDY OF ASSOCIATION OF C+70G POLYMORPHISM OF EDNRA GENE WITH BODY MASS INDEX IN PATIENTS WITH ISCHEMIC ATHEROTHROMBOTIC STROKE

Аuthors: T. B. Oleshko,  V. S. Yurchenko,  T. M. Oleshko,  V. Yu. Harbuzova

Pages: 737–743

Abstract

         

Introduction. Since endothelin-1 (EDN1) discovery by Japanese scientists led by Yanagisawa et al. in 1988 attention of scientists around the world is focused on its investigation. This is due to its high power vasoconstriction effect which is the highest then any known endogenous substances. EDN1 interaction with endothelin receptor type A (EDNRA) causes stable vasoconstriction and proliferation of smooth muscle cells and thus contributes to progression of endothelial dysfunction, which is the pathophysiological basis and predictor of ischemic stroke. It is known that the early stages of stroke are associated with increased levels of EDN1 and activated EDNRA smooth muscle cells of the brain causing vasospasm. Thus, EDNRA is one of the key points, which determines the development of cardiovascular disease and ischemic stroke in particular.

Aim. The aim of the present study was to determine the association of the EDNRA C+70G polymorphism with ischemic atherothrombotic stroke in subjects with different body mass index (BMI)

Materials and methods. The study group included 170 unrelated Ukrainian patients with a mean age of 64.7 ± 0.73 years who had IAS. The control group consisted of 124 individuals with the absence of cardio-vascular pathologies. The main methods of research were the polymerase chain reaction method (PCR-RFLP) followed by analysis of restriction fragment length analysis when allocating of them by electrophoresis in agarose gel. Statistical analysis was examined by using SPSS-17 program. The differences were considered statistically significant with a P-value <0.05.

Results. It was found that in patients with stroke ratio of homozygotes for the major allele (C/C), heterozygotes (C/G) and homozygotes for the minor allele (G/G) is 24.1 %, 57.6 % and 18.2 % and in the control group - 29.0 %, 50.0 % and 21.0 %, respectively. The differences between the frequency of these genotypes group of patients with stroke and control groups were not statistically significant (P = 0.426). Each study group was divided into two subgroups according to BMI (˂ 25 kg/m2 and ≥ 25 kg/m2). A statistically significant difference in the distribution of genotypes of control group patient with different levels of BMI was not found (χ2 = 0.334; P = 0.846). However, similar comparison of BMI ˂ 25 kg/m2 and a BMI ≥ 25 kg/m2 patients with stroke confirmed this association (χ2 = 6,092; P = 0.048). Logistic regression found that patients with BMI ˂ 25 kg/m2 which are carriers of heterozygous genotype had greater risk of stroke by almost 3.7 times (P = 0,049; OR = 3,684), compared to those with homozygotes for the major allele.

Conclusion. There was no association between C+70G polymorphism of EDNRA gene and development of ischemic atherothrombotic stroke. However, after taking into account such risk factors as BMI increased risk of stroke was found to be 3.7 times higher in the carriers of C/G genotype with BMI ˂ 25 kg/m2.
Keywords: endothelin type A receptor, gene polymorphism, ischemic stroke.

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COMMEMORATIVE DATES: VASYL BRATUS’

Аuthors: P. Fomyn, N. Kobyletskyi, S. Kozlov

Pages: 744–748

Abstract

         

On the occasion of the 100th anniversary of the birth of V. D. Bratus', the outstanding public health organizer, statesman, surgeon-scientist, corresponding member of the National Academy of Sciences and the Academy of Medical Sciences of Ukraine, Honored Worker of Science of Ukraine, laureate of the State Prize of Ukraine, Bogomolets Prize, Doctor of Medical Sciences, professor of  Bogomolets National Medical University.

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