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CHRONIC VIRAL HEPATITIS C: CLINICO-EPIDEMIOLOGICAL FEATURES, MODERN DIAGNOSIS AND TREATMENT METHODS, INTERRELATION WITH AUTOIMMUNE DISORDERS

Аuthors: M. D. Chemych, A. G. Lishnevska

Pages: 749–760

Abstract

         

Chronic viral hepatitis C is an urgent problem of modern medicine. The medical and social significance of hepatitis C is determined by a wide spread, a progressive increase in the incidence, a variety of clinical manifestations, a high probability of formation of chronic liver pathology and extrahepatic lesions. According to expert estimates, up to 1 billion people have been infected with the hepatitis C virus, and the number of patients with hepatitis C is about 200 million. Now there is a pandemic of hepatitis C, which is 4–5 times higher in scale and number of infected than HIV infection.

The purpose of this work is to analyze the literature data on the clinical and epidemiological features of the course of hepatitis C and on the basic principles of diagnosis and modern treatment of this disease. Considerable attention is paid to factors influencing the course and results of antiviral therapy (AVT) and on autoimmune abnormalities in patients with hepatitis C when developing scientific sources.

The causative agent of hepatitis C is the RNA virus, which belongs to the family Flaviviridae. The source of infection is patients with acute and chronic hepatitis C. The mechanism of transmission of infection is parenteral. Hepatitis C is characterized by a long, often perennial, asymptomatic course, which is why patients do not seek medical help. At this time, it is possible to detect a periodic increase in ALT activity, minor violations of liver biosynthesis without significant changes in the patient's condition. Therefore, the disease is often found in the stage of intensive morphological changes in the hepatic tissue, cirrhosis, less often – hepatocellular carcinoma. During the activation of the infectious process, the condition of the patient depends on the degree of hepatic insufficiency, in general similar to that in chronic hepatitis C: marked general weakness, significant weight loss, loss of appetite and other dyspeptic manifestations; Possible symptoms of hemorrhagic syndrome. Most patients have a cytopenic syndrome (anemia, leukopenia, thrombocytopenia). In women, there may be various violations of the menstrual cycle, infertility, in men – a violation of spermatogenesis.

Treatment according to the standards of care for patients with chronic HCV infection consists of interferon alfa-2а or alfa-2в (PEG-IFN) in combination with ribavirin for 24 or 48 weeks, depending on the genotype. In Europe in 2011 were allowed for the treatment of infection caused by the first genotype of the hepatitis C virus, telaprevir and bocepreviir. These drugs are direct-acting antiviral agents of the 1st generation; they belong to the group of protease inhibitors and are prescribed in combination with PegIFN and ribavirin. Patients are also prescribed non-interferon treatment of antiviral treatment.

The existence of prognostic factors for the efficacy of antiviral therapy in patients with chronic hepatitis C has been proved. Determination of the factors that can predict the effectiveness of treatment makes it possible to adjust antiviral therapy regimens, reduce the number and severity of unwanted side effects, improve quality of life and reduce the cost of treatment. Recently, it is said about the personalization of treatment, taking into account the characteristics of both the virus and the human body. Viral factors include the HCV genotype and the initial level of viral load. The main factors are interferon-lambda-3 (IL28B) polymorphism, liver damage (fibrosis and steatosis) and metabolic factors (body mass index, or insulin resistance).

The data of scientific researchers do not reject the fact about the possibility of the influence of viral hepatitis C on the triggering of autoimmune reactions. It was found that autoantibodies are detected in 55% of CHC patients.

Keywords: viral hepatitis C, antiviral therapy, autoimmune hepatitis.

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ANXIETY AND DEPRESSION DISORDER IN CHILDREN WITH SOMATIC PATHOLOGY

Аuthors: D. S. Riabokon, N. O. Riabokon

Pages: 761–767

Abstract

         

Depression, anxiety and combined anxiety and depression disorder are urgent problems of modern clinical and social psychiatry.

According to the present estimation risk of developing a depression, anxiety or anxiety and depression disorder during a lifetime averages 15–20 %.

The frequency of depression in pediatric population varies widely from 0.4–0.7 to 40%. Closer to adolescence the prevalence of depression reaches 30%, and the average age of its occurrence is close to 9 (years).

The aim of this study was to determine the prevalence of anxiety and depression disorders among the patients of somatic departments of Sumy Regional Children's Clinical Hospital, to study the features of psycho-emotional sphere of pediatric patients with anxiety and depression disorders.

Materials and Methods: 547 children aged 6–14 years who were treated in somatic departments have been examined, 114 children from psycho-neurological department of Sumy Regional Children's Clinical Hospital, as well as 997 children who consulted a child psychiatrist in the outpatient department of Sumy Regional Clinical Psycho-Neurological Health Centre.

Anxiety and depression disorder was diagnosed according to the criteria of ICD-10 and DSM-V. Clinical and psychopathological, somatoneurological, pathopsychological methods (depression assessment scale CDRS-R, the scale of reactive and personal anxiety by Spielberger – Khanin) have been used, as well as socio-psychological interviewing and questionnaires.

52.7 % of all the children with somatic pathology examined have anxiety and depression disorder. The study has proven that 100% of parents of children with anxiety and depression disorder did not pay attention to the high anxiety state and depressive symptoms of their child. It was found that moderate and high anxiety levels and depression affected the current functional somatic disease of the child, as well as the level of psychosocial adaptation.

Wide interaction between psychiatrists and specialists of general practice is of current interest nowadays. While providing a specialized care for children with somatic diseases it is necessary to pay attention to the identification of clinical forms of anxiety and depression to solve the problem not only of the resource of required psychological help, but also of primary and secondary prevention of anxiety and depression disorder.

Keywords: anxiety, depression, frequency, children, somatic diseases.

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CLINICAL AND ANAMNESIS FACTORS AFFECTING THE COURSE OF ATHEROSCLEROSIS PERIPHERAL ARTERIES OF THE LOWER EXTREMITIES

Аuthors: E. D. Yarovaya

Pages: 768–778

Abstract

         

Introduction. Atherosclerosis of peripheral arteries of the lower extremities (PAD) is an independent predictor of increased risk of cardiovascular complications, which determines the quality and length of life.

The purpose of research: to examine the role of clinical and anamnestic indicators of atherosclerosis in peripheral arteries of the lower extremities.

Materials and Methods. The study involved 100 men with PAD of average age 60.7 ± 0.9 years IIA–IV stages of lower limb ischemia. Besides clinical tests, we performed determination of glomerular filtration rate (GFR), ankle-brachial index, selective coronary angiography (SCG), Doppler ultrasound of the lower extremities and carotid arteries (CA) with the estimation of intima-media thickness (IMT), echocardiography, Holter monitoring.

Results and discussion. A group of hypertension (55 patients) had more abuse diastolic function of left ventricular (p = 0.038), signs of left ventricular hypertrophy (p = 0.001). Among patients with type 2 diabetes (28 patients), there is a higher incidence of heredity burdened by CVD (p = 0.02), coronary artery disease (p = 0.006), recurrent myocardial infarction (MI) (p = 0.02). Group DL patients (73 patients) had a higher incidence of recurrent myocardial infarction (p = 0.02), more frequently were observed two vascular coronary arteries during the SCG (p = 0.02). Patients with a family history for CVD (60 patients) had a higher incidence of critical ischemia of the lower limbs (p = 0.005) and type 2 diabetes (p = 0.02). Patients with obesity (42 patients) had a greater frequency of left ventricular hypertrophy (p = 0.02) and a lower prevalence of hypertension (p = 0.037). At patients with CVA (13 patients) was found a higher functional class of angina pectoris (p = 0.009). At patients with coronary artery disease was detected (37 patients): the average age of the manifestation of PAD was significantly lower (p = 0.001), more higher IMT (p = 0.003) and higher frequency of CA atherosclerosis (p = 0.0002), GFR was significantly lower (p = 0.004), the probability of decline in renal function – 72 % (p = 0.0043); it was independent direct association with the CA atherosclerosis (p = 0.05) and inverse association with patient’s age (p = 0.01).

Conclusions.

1. The presence of a family history for CVD among PAD patients is associated with a higher degree of ischemic lesions of arteries of the lower extremities (p = 0.005) and registration of type 2 diabetes (p=0.02), which is prognostically adverse cardiovascular events and is connected with coronary artery disease (p = 0.006).

2. The incidence of CHD among PAD patients is associated with early manifestation of PAD (p = 0.001), more severe clinical manifestations of lower limb ischemia (p = 0.02), carotid disease (p = 0.0002) and reduced GFR (p = 0.021). This recurrent MI was associated with dyslipidemia (p = 0.02) and type 2 diabetes (p = 0.02).

Keywords: peripheral artery disease, ischemic heart disease, cardiovascular risk.

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CHARACTERISTICS OF ARTERIAL STIFFNESS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE ALONG WITH CHRONIC HEART FAILURE

Аuthors: L. B. Vynnychenko, A. O. Pryvalova

Pages: 779–785

Abstract

         

The aim of study was to assess indicators of vascular stiffness in patients with chronic obstructive pulmonary disease (COPD) along with chronic heart failure (CHF). The total number of patients under study was 94. They were matched by age and sex in all study groups. Patients with COPD have made up the 1st study group (n = 56). The 2nd group consisted of patients with COPD along with the CHF (n = 20). The control group consisted of male smokers with no evidence of COPD and CHF (n = 18). Applanation tonometry with contour analysis of pulse wave was made for measuring the central aortic pressure and carotid-femoral pulse wave velocity (PWV) using the SphygmoCor device (AtCor Medical, Australia). The following parameters were assessed: systolic, diastolic, pulse pressure in the aorta, augmentation pressure in the aorta, PWV. Investigation results showed that COPD patients have stable significant increase of central arteries stiffness that is evident as increase of PWV in the aorta (9.7 ± 0.9 m/s and 6.3 ± 0.6 m/s correspondingly) and increase of pressure augmentation (9.1 ± 0.05 mmHg and 6.1 ± 0.9 mm Hg, correspondingly) compared with patients in the control group. The increase of arterial stiffness grows synchronously with the severity of disease. There was found significant more increased PWV in patients with COPD along with CHF compared with those without CHF and it was 12.8 ± 0.7 m/s and 9.7 ± 0.9 m/s correspondingly. In both study groups there has been observed significant increase of PWV in patients with body weight index (BWI) < 24.9 kg/m2 compared to those who have BWI > 25 kg/m2.

Keywords: chronic obstructive pulmonary disease, chronic heart failure, arterial stiffness, pulse wave velocity, augmentation pressure.

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  19. Nazarova OA, Maslennikova OM, Fomin FYu. Otsenka elasticheskih svoystv sosudov v klinike vnutrennih bolezney [Evaluation of the elastic properties of blood vessels in the clinic of internal diseases]. Ivanovo, 2007. 96 p.
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OPTIMIZING THE PREVENTION OF CORONARY HEART DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS DEPENDING ON GENOTYPE OF GLUCOCORTICOID RECEPTOR GENE BCL1 POLYMORPHISM

Аuthors: O. V. Savchenko

Pages: 786–793

Abstract

         

Purpose. The purpose of our review is to justify the ischemic heart disease (IHD) prevention in individuals with rheumatoid arthritis (RA) depending on Bcl1 polymorphism of glucocorticoid receptor (GR) gene.

Patients and methods. Study involved 76 RA patients with no concomitant cardiovascular diseases aged over 40 as well as 96 healthy individuals. In the research, we used routine examination of RA diagnosis, SCORE scale, biochemical and molecular genetic methods (polymerase chain reaction with the following analysis of restriction fragments’ length by Fleury I. et al., 2003). Atorvastatin dosage was adjusted according to the guidelines of Association of Cardiologists of Ukraine, 2011. Statistical analysis of the obtained results was conducted using SPSS-17 software.

Results and discussion. To evaluate the efficiency of IHD prevention in patients with RA, we considered the average levels of low-density lipoprotein cholesterol (LDL-C) depending on the Bcl1 polymorphism of GR gene. The dynamics of LDL-C concentration was evaluated after 4 weeks. We estimated its target content considering cardiovascular risk by SCORE scale. The study revealed that after 4 week treatment with atorvastatin, LDL-C level in RA patients with C/C genotype decreased by 20.9 %, with C/G – by 10 % and with G/G – by 3 %. Considering that LDL-C level had not decreased to the target concentration in 16 (21.1 %) homozygous carriers of the G allele, their dosage of atorvastatin was doubled for another 4 weeks. This resulted in adequate decrease of LDL-C level.

Conclusions. Treatment of RA patients with G/G genotype of Bcl1 polymorphism of GR gene with the double recommended dose of atorvastatin considering cardiovascular mortality risk by SCORE scale provides for required LDL-C level within 4 weeks if started from the beginning of treatment period. Such approach makes it possible to improve IHD prevention in individuals with RA.

Keywords: rheumatoid arthritis, ischemic heart disease, low-density lipoprotein cholesterol, Bcl1 polymorphism, glucocorticoid receptor.

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References

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Purpose. The purpose of our review is to justify the ischemic heart disease (IHD) prevention in individuals with rheumatoid arthritis (RA) depending on Bcl1 polymorphism of glucocorticoid receptor (GR) gene.

Patients and methods. Study involved 76 RA patients with no concomitant cardiovascular diseases aged over 40 as well as 96 healthy individuals. In the research, we used routine examination of RA diagnosis, SCORE scale, biochemical and molecular genetic methods (polymerase chain reaction with the following analysis of restriction fragments’ length by Fleury I. et al., 2003). Atorvastatin dosage was adjusted according to the guidelines of Association of Cardiologists of Ukraine, 2011. Statistical analysis of the obtained results was conducted using SPSS-17 software.

Results and discussion. To evaluate the efficiency of IHD prevention in patients with RA, we considered the average levels of low-density lipoprotein cholesterol (LDL-C) depending on the Bcl1 polymorphism of GR gene. The dynamics of LDL-C concentration was evaluated after 4 weeks. We estimated its target content considering cardiovascular risk by SCORE scale. The study revealed that after 4 week treatment with atorvastatin, LDL-C level in RA patients with C/C genotype decreased by 20.9 %, with C/G – by 10 % and with G/G – by 3 %. Considering that LDL-C level had not decreased to the target concentration in 16 (21.1 %) homozygous carriers of the G allele, their dosage of atorvastatin was doubled for another 4 weeks. This resulted in adequate decrease of LDL-C level.

Conclusions. Treatment of RA patients with G/G genotype of Bcl1 polymorphism of GR gene with the double recommended dose of atorvastatin considering cardiovascular mortality risk by SCORE scale provides for required LDL-C level within 4 weeks if started from the beginning of treatment period. Such approach makes it possible to improve IHD prevention in individuals with RA

THE IMPACT OF ЕNРР1 GENE K121Q POLYMORPHISM ON THE DEVELOPMENT OF CONCOMITANT CARDIO-VASCULAR DISEASES IN PATIENTS WITH TYPE 2 DIABETES

Аuthors: I. V. Marchenko, V. Yu. Harbuzova, Ye. Ye. Marchenko, O. A. Obukhova, O. V. Ataman

Pages: 794–798

Abstract

        

Diabetes mellitus (DM) is the most common endocrine pathology among persons of working age. The number of such patients is constantly increasing in all countries, exceeding currently 330 million people, which suggests the global epidemic of diabetes in the modern world. In Ukraine identified more than 1 million 200 thousand of such patients, and the majority of them (85–90 %) suffering with type 2 diabetes. In the overall mortality of patients with diabetes, 75 % of the mortality from cardiovascular disease (CVD). Therefore, the risk of myocardial infarction, ischemic stroke in diabetic patients increased in 2-3 times in comparison with the similar indicators in individuals of the same age without carbohydrate metabolism disorders. The important role of ENPP1 gene in the development of calcification of the vascular wall and insulin resistance is proven. This contributes to CVD on the one hand, on the other hand – to type 2 diabetes. Timely detection of genetic markers, the elimination of modified risk factors and individualization of therapy, along with determining long-term outcomes for a particular patient will significantly improve the efficiency of all activities of preventive and curative work.

Materials and Methods. Venous blood of 163 patients with T2DM and 110 healthy individuals (control group) was used for genotyping. Analysis of K121Q polymorphism ENPP1 gene (rs1044498) was examined by PCR-RFLP with the following restriction fragment length analysis of the allocation of them by electrophoresis in agarose gel. Statistical analysis was performed by using the software package SPSS-17. The value of P < 0.05 was considered as significant.

Results. Genotyping of patients with type 2 diabetes and patients of the control group at the K121Q polymorphism has allowed establishing the frequency with which there are certain variants of ЕNРР1 gene depending on the presence or absence of concomitant cardiovascular pathology.

Analyzing the frequency of genotypes of К121Q polymorphism gave an opportunity to assert that there is no statistically significant difference in the distribution of allelic variants among patients with type 2 diabetes with concomitant CHD (χ2 = 0.482; P = 0.488), arrhythmia (χ2 = 1.031; P = 0.310), myocardial hypertrophy(χ2 = 0.422; P = 0.516), myocardial infarction (χ2 = 0.307; P = 0.579). The exception was only of cerebrovascular pathologies, namely the development of ischemic stroke. Among patients with type 2 diabetes and ischemic stroke, people with K/K genotype was revealed in 48.8 % cases and with K/Q + Q/Q genotype – 51.2 %. The frequency of polymorphic variants in patients with type 2 diabetes without stroke was of 70.5 and 29.5 %, respectively. Thus, in patients with type 2 diabetes carriers of the minor allele (K/Q + Q/Q) the risk of ischemic stroke was significantly higher than in individuals for the major allele (K/K) (χ2 = 6.361; P = 0.012).

Conclusion. It was found that patients with type 2 diabetes carriers of the minor allele (K/Q + Q/Q) occurrence of ischemic stroke was noted significantly more likely than in individuals for the major allele (K/K). There is no association between the K121Q polymorphism of ENPP1 gene and the development of comorbidities such as coronary heart disease, myocardial infarction, myocardial hypertrophy and arrhythmia in patients with type 2 diabetes.

Keywords: type 2 diabetes mellitus, ENPP1 gene, allelic polymorphism, cardiovascular diseases.

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References

  1. Chernyavska IV. [Poednannya tsukrovogo diabetu 2 typu ta sertsevo-sudynnoyi patologiyi: struktura, osoblyvosti klinichnogo profilyu i zminy metabolizmu]. Klinichna endokrynologiya ta endokrynna hirurgiya. 2015;4(52):31–36.
  2. Marchenko IV, Prasol DA. [Asotsiatsiya K121Q-polimorfizmu gena ektonukleotyd pirofosfatazy/fosfodiesterazy 1 (ENPP1) u patsiyentiv iz tsukrovym diabetom 2-ho typu z riznymy velychynamy IMT]. J. Clin. Exp. Med. Res. 2015;3(4):543–549.
  3. McAteer JB, Prudente S, McAteer JB, Bacci S. The ENPP1 K121Q polymorphism is associated with type 2 diabetes in European population. Diabetes. 2008;57:1125–1130.
  4. Tang ST, Shen XR, Tang HQ. Association of the ENPP1 K121Q polymorphism with susceptibility to type 2 diabetes in different populations: evidence based on 40 studies. Endocr. J. 2014;61(11):1093–1103.
  5. Stolerman ES, Manning AK, McAteer JB. Haplotype structure of the ENPP1 gene and nominal association of the K121Q missense single nucleotide polymorphism with glycemic traits in the Framingham Heart Study. Diabetes. 2008;57:1971–1977.
  6. Chen MP, Chung FM, Chang DM. ENPP1 K121Q polymorphism is not related to type 2 diabetes mellitus, features of metabolic syndrome, and diabetic cardiovascular complications in a Chinese population. The Review of Diabetic Studies. 2006;3(1):21–30.
  7. Lazarevic G, Milojkovic M, Tasic I. PC-1 (ENPP1) K121Q polymorphism in overweight and obese type 2 diabetic coronary heart disease patients. Acta Cardiologica. 2008;63(3):323–330.
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  11. Rozumenko I.A., Garbusova V.Y., Ataman Y.A., Polonikov A.V., Ataman A.V. K121Q Polymorphism of the ENPP1 gene is related to acute coronary syndrome in Ukrainian patients with normal but not enhanced body mass index. OnLine J. Biol. Sci. 2014;14(4):271–276.
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CLINICAL AND LABORATORY CHARACTERISTICS OF ENTEROVIRAL MENINGITIS IN ADULTS

Аuthors: A. V. Sokhan

Pages: 799–805

Abstract

        

The aim is to detect and characterize clinical symptoms and laboratory abnormalities in adult patients with enteroviral meningitis.

Materials and methods. 39 cases of enteroviral meningitis in adults were analyzed. The average age of the patients was 24.05 ± 0.91 years. Among them were 20 men and 19 women. The comparison group consisted of 12 patients without diseases of the central nervous system. We analyzed the clinical symptoms, indicators of complete blood count, clinical analysis of cerebrospinal fluid (CSF), as well as the level of neuron-specific enolase (NSE), lactate, LDG, cortisol, creatine kinase and cholinesterase in the CSF of patients at the time of admission and on 10–12 day of treatment.

Results. The disease is characterized by acute onset with fever, headache, photophobia, sore throat, cough, dyspeptic symptoms. Patients hospitalized at 3.33 ± 0.27 day of illness. Noteworthy is the absence or weak expression of meningeal signs in more than 76 % of cases. In the clinical analysis of the CSF we discovered two types of change – in 24 (61.54 %) cases dominated lymphocytes, while in 15 (38.46 %) predominated neutrophils. In the first day after admission CSF levels of creatinine kinase and lactate was significantly higher and levels of cortisol, cholinesterase and lactate dehydrogenase was significantly lower compared with the control group (P ˂ 0.05).

Conclusions. Enteroviral meningitis is found mostly in young people. It is characterized by acute onset with typical symptoms of meningeal syndrome, but meningeal signs in most patients are mild (61.54 %) or negative (15.39 %). Clinical analysis of CSF is characterized by typical for aseptic meningitis changes, but in 38.46 % cases neutrophil level was above 50 %. In the acute phase there is a significant increased CSF level of cortisol, lactate, NSE, CK and decrease of LDH and cholinesterase, which can be used in differential diagnosis and evaluation of pathogenic disorders.

Keywords: enteroviral meningitis, clinical symptoms, cerebrospinal fluid analysis.

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References

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EVALUATION OF SALIVA CRYSTALLIZATION DURING ORTHODONTIC TREATMENT IN CHILDREN

Аuthors: A. V. Pachevska, Ju. V. Philimonov

Pages: 806–812

Abstract

         

Recently a lot of new diagnostic technologies are implemented in all branches of medicine, which are based on the micromorphological picture of dried biological liquids.

Aim. To study the variation in shaping crystalline aggregates of children aged 7–16 years with non-removable orthodontic equipment.

Materials and methods. Drops of the biological liquid were applied on a skim object-plate placed horizontally. Volume of the drop was 0.2 mL. Diameter of the drop on object-plate was 5–7 mm. Average thickness – approximately 1 mm. At a temperature of 20–25 degrees and relative humidity of 65–70 % the samples were dried. The dried drop (facies) was examined under the microscope and photographed.

Results. As the results of quantitative research we can identify the following types of oral fluid system: facies that cover an area of salt crystals up to70–75 %, facies that cover an area of salt crystals up to 20–70 %, facies that cover an area of salt crystals up to 20 %. As a result of microscopy we have identified 3 groups of saliva structuring: in the central (salt area) of the drug there is indicated the only structure of crystals dendritic processes, which tend to merge with themselves. Peripheral zone is wide and free of crystal. Crystallization starts in the transition zone. In another group in the central area of the salt drug there are isolated single cruciform crystals with less fewer dendritic processes. Peripheral zone is narrowed, has radial cracks and multidirectional shallow cracks. The process of crystallization starts in the protein area (extended transition zone). In the third group the central zone of salt drug there are a lot of amorphous structures, single chips of crystals and dendritic formations. Peripheral (protein) zone is narrow, look like a strip with many randomly distributed fissures and crystal-like formations. Dried drop of saliva of children of 7–16 years is characterized by a clear picture of large crystalline structures which go from the center of a drop and merge forming so-called horsetails or ferns. Quantitative indicators of morphological characteristics of crystalline aggregates of mixed saliva: the length of the crystal to the point of branching, the angle of branching, the number of generations of branches of the 1st, 2nd, and others orders, crystal width, crystal length, number of microbranches on the length of the crystal. Quality indicators: uneven thickness of one figure, asymmetry of branches, availability of symmetric and asymmetric processes, the rods without branching with long microprocesses, asymmetry, cross-shaped crystals. Using of fixed orthodontic equipment led to disruption of saliva crystallization. The most movers were for a 6-month treatment of orthodontic appliances.

Conclusions. Crystallographic methods can serve as a sensitive indicator of the functional state not only of the oral cavity, but of the whole organism in general. Crystallography of the oral fluid can be seen as fairly simple, economical, non-invasive and informative way of testing the condition of the body as a whole and state of cavity of mouth.

Keywords: saliva, crystallization, dento-alveolar anomalies, non-removable orthodontic equipment.

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  11. Pancu G. Evaluation of caries activity using the micro-crystallization saliva index (IMK). Rev Med Chir Soc Med Nat Iasi. 2006;110(1):206–211.

MODERN ASPECTS OF ANTENAL OBSERVATION IN MULTIPLE PREGNANCY

Аuthors: I. M. Nikitina, A. B. Sukharev

Pages: 813–822

Abstract

         

The study was conducted in the perinatal center of Sumy (Ukraine) at the Department of Obstetrics and Gynecology, Sumy State University. Information was collected by interviewing and examining pregnant women using special research methods. Besides, medical histories of children born from multiple pregnancies were analyzed. The purpose of the study was to analyze the course of pregnancy and childbirth with multiple pregnancies in modern conditions.

The data were collected from 182 women with dichoric pregnancy, 86 with monochorionic and 40 with singleton pregnancy.

The aim of our study and summarize the course of pregnancy and delivery in multiple pregnancies in modern conditions.

The analysis of the pregnancy course, labor and perinatal outcomes was carried out at 182 women with duo chorionic and 86 patients with monochorionic twins and 40 women with a singleton pregnancy. Multiple pregnancy was proved to be a monochorionic (MH) and duo chorionic (DX) that is a high risk factor for perinatal complications. The research conducted clinical and laboratory examination metods, research hormonal function fetoplacental complex (FPC), transvaginal ultrasound examination. Statistical processing of data was carried out using the package of applied programs Microsoft Office Excel 2010 and StatSoft Statistica 6.1.

During the analysis of pregnancy abortion threat was detected in 51 (59.3 %) women with monochorionic and 34 (62 %) women with duo chorionic twins. Preeclampsia during pregnancy complicated in 26 (30.2 %) and 43 (23.6 %) patients with monochorionic and duo chorionic placentation type, respectively. A frequent complication of both the MH and DH twins was anemia, which was found in more than half of the surveyed (56.9 and 51 %, respectively). Delivery in the case of multiple pregnancies also occur much more complicated and is three times more than in singleton births terminated surgically. The most frequent indications for operative delivery were first breech fetus, fetal distress during pregnancy and childbirth, retarded fetal growth (RFG), severe preeclampsia, premature detachment of normally situated placenta, anomalies of labor activity. These perinatal losses equally observed both after cesarean section and after spontaneous labor and amounted to 4 % at monochorionic and 1.7 % with duo chorionic twins.

The frequency dependence of identified lesions at pregnancy with twins was established by chorionic. Careful observation of the patients with multiple pregnancies in the antenatal period, the prevention of the most frequent complications, ultrasound monitoring with early pregnancy allows a differentiated approach to the management of pregnancy and childbirth, helping to reduce perinatal morbidity and mortality.

Based on the conclusions we propose practical recommendations. The recommendations, which were made as a result of the research were realized in the work of the perinatal center

Multiple pregnancies occur with a large number of complications compared with singletons. Thus, the increase in the frequency of multiple pregnancy influences the obstetric and perinatal indicators, pushing this issue in a number of the most pressing issues of modern obstetrics and perinatology.

The prospect of further research requires further study of the problems of antenatal surveillance in multiple pregnancies, prevention of gestational complications, optimization of labor, prevention of perinatal losses.

Keywords: multiple pregnancies, miscarriage, threat of premature birth, transvaginal ultrasonography.

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MEDICAL AND PREVENTIVE MEASURES FOR HEALTH MAINTENANCE IN SPECIALIZED AND VOCATIONAL TRAINING

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

Pages: 823–830

Abstract

         

The article reveals the problem of medical and preventive care for adolescents enrolled in vocational education, which is caused by the global spread of chronic diseases among children and adolescents, decreased fertility and increased mortality rates among people of working age. The result of the study among vocational students in Kharkov aged 14–15 found that 64 % of them have chronic diseases of different severity, defined distribution of this pathology between systems. As the physical development (PD) is an integral indicator of health, it is influenced by the variety of external and internal factors. Under the influence of long-acting adverse factors PD level decreases.

The results of a study showed that in the hierarchy of values ​​and priorities of future workers health does not occupy leading positions. During the study significant differences in the functional activity of major systems of organism were identified. Also, using adolescent attitude survey, we identified the health factors that, in their opinion, affect health and measures for its preservation. Low levels of non-specific resistance and functional activity of major organs and systems were found. The results indicate low motivation of healthy individual behaviors and lack of centralized activities during vocational and professional training. The most effective of the proposed solutions is timely conducted career guidance activities during pre-profile (at school) education involving all professional experts, including doctors. 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. The foregoing will fully organize healthcare of teenagers to combine the activities of education, health, administration and other departments implement promising areas in maintaining the health of students of vocational schools – primary and reproductive labor potential of society is necessary for a more inclusive attitude of teenagers to their health.

Keywords: young, professional self, occupation, health, medical and preventive measures.

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CONTENT OF CYTOKINES IN CHRONIC HEART FAILURE WITH OVERWEIGHT AND OBESITY DEPENDING ON THE LEFT VENTRICLE EJECTION FRACTION

Аuthors: P. P. Bidzilya

Pages: 831–837

Abstract

         

Today the prevalence of chronic heart failure (CHF) occurs with high mortality in patients despite improved methods of diagnosis and treatment. Probably, this is due to the involvement of new components to the pathogenetic process of CHF which are poorly influenced by conventional therapy. The main pathogenetic factors of CHF were considered the hemodynamic and humoral changes, however, in recent years in the development and progression of the disease proved the role of immune inflammation. Activation of immune-pathologic reactions promotes and contributes to the progression of CHF through an influence on myocardial remodeling, systolic and diastolic function of the left ventricle (LV). One of the most studied markers of immune-pathological changes is proinflammatory and anti-inflammatory cytokines. In patients with CHF demonstrated an increase in blood activity of proinflammatory interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and anti-inflammatory interleukin-10 (IL-10), and the degree of changes directly correlated with disease severity. The traditional predictor of current CHF is LV ejection fraction (LVEF), which reflects myocardial contractility. The presence of low LVEF (systolic dysfunction) is associated with more severe CHF and worse survival of patients. There is an inverse correlation of LVEF and blood levels of proinflammatory IL-6 and tumor necrosis factor-α (TNF-α) and anti-inflammatory IL-10. Last decade, continued increase in the number of patients with overweight and obesity, volume reached worldwide non-infectious epidemic. Obesity is accompanied by structural and functional reorganization of the heart, excessive activation of the inflammatory cytokine cascade, humoral and metabolic disorders, which are the main pathogenic components in the development and progression of CHF.

Given the above, a small number of works that have studied the level of serum cytokines in CHF with overweight and obesity depending on LVEF, the chosen direction of research is relevant and timely

Purpose - to investigate the serum content of cytokines interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and their ratios in CHF patients with overweight and obesity depending on left ventricle ejection fraction (LVEF).

Materials and methods. Totally 116 patients were examined. The main study group included 104 patients with CHF II–III functional class with normal weight, overweight and obesity I–III degree. The comparison group consisted of 12 patients with chronic forms of ischemic heart disease, arterial hypertension, without overweight, and clinical and instrumental signs of CHF. In accordance with the purpose of the study and depending on LVEF (calculated by Simpson method), patients with CHF were divided into 2 subgroups: with reduced LVEF ˂ 45 % (33 patients) and preserved LVEF ≥ 45 (71 patients). Calculating the body mass index defined normal, overweight and degree of obesity. By ELISA method in the serum was determined the levels of IL-6, IL-10 and TNF‑α. With calculation method defined the ratios of cytokines IL‑6/IL‑10 and TNF-α/ IL-10.

Results. It is established that in CHF with overweight and obesity the levels of proinflammatory IL-6, TNF-α and anti-inflammatory IL-10 were significantly higher than those without CHF. Maximal values of cytokines occurred in patients with reduced LVEF that significantly exceeded the indexes of the group with CHF without left ventricle systolic dysfunction. These changes were accompanied with significant negative correlation dependence between the levels of IL-6, IL-10, TNF-α and LVEF. The ratio IL-6/IL-10 in CHF was significantly lower than that of patients without CHF, but dependent on systolic function of the myocardium is not established.

Conclusion. In CHF patients with overweight and obesity, the presence of left ventricle systolic dysfunction associated with more severe immune-inflammation changes that occurred with significant predominance of the content of proinflammatory IL-6, TNF-α and anti-inflammatory IL-10.

Keywords: heart failure, cytokines, overweight, obesity, left ventricle ejection fraction.

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EARLY RESULTS OF TREATMENT BY RADIOFREQUENCY DENERVATION OF THE FACET JOINTS IN PATIENTS WITH LOWER LUMBAR PAIN SYNDROME

Аuthors: M. V. Kvasnitskyi

Pages: 838–846

Abstract

         

Introduction. The high prevalence rate of degenerative-dystrophic spine injury and with low effectiveness of spondylarthrosis therapy makes research relevant to the treatment of low lumbar pain syndrome caused mainly by spondylarthrosis by an innovative minimally invasive method of high-frequency denervation of the facet joints.

Study purposes. To determine the effectiveness of the radiofrequency denervation of facet joints on the elimination of pain syndrome in patients with lower lumbar pain syndrome with spondylarthrosis predominated.

Materials and methods. The analysis of early and long-term results of treatment by the method of high-frequency denervation of facet joints was held with the help of Radionics apparatus 1RFG-1A/RFG-1B on 136 patients (73 men and 63 women aged from 44 to 81 years) with lower lumbar pain syndrome with the leading clinical manifestation of arthrosis of the articular joints. The control group consisted of 31 patients (15 women and 16 men aged from 42 to 83 years) with a lower lumbar pain with spondylarthrosis dominated, which were treated conservatively.

Study results. Immediately after the treatment, a reliable result of treatment of chronic low-lumbar pain syndrome was obtained both in the main and in the control group with all structural and morphological changes of the spine, both on the Oswestry disability scale and on the visual analogue scale of pain. At the same time, there is a clear and reliable difference between the control group and the control group immediately after the treatment, which proves the high efficiency of the method of high-frequency denervation of the facet joints. Three months after the treatment in both groups, its reliable result was obtained only in the main group during high-frequency denervation of the facet joints.

Conclusion. Both early and long-term treatment results attest to the efficacy and safety of high-frequency denervation of the facet joints in patients with lower lumbar pain syndrome with domination of spondylarthrosis.

Keywords: spondylarthrosis, radiofrequency denervation of the facet joints.

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CONDITIONS AND FACTORS OF COMPLIANCE FORMATION

Аuthors: A. V. Kustov

Pages:847–855

Abstract

         

The study of the literary sources, the personal medical observations and the experience of teaching of the medical psychology for university students in which the compliance problem is reflected, allow to make the conclusion that for its planned solution there is no convenient conceptual model that would allow to take into account the main components of the formation of the patient`s compliant behavior. This publication presents a model for studying of the compliance problem from the standpoint of a systems approach. Three main factors (patient, physician, family) are distinguished, in the interrelationship of which reveals the possibilities of diagnosing of the genesis and forms of the compliance distortions, as well as psycho-correctional or psychotherapeutic activities of the doctor. Taking into account that the behavior of a person, including a patient, is realized more often at the subconscious and unconscious level, the identified factors can serve as a guide for the purposeful integrated study of this urgent psychological problem in medicine. The factors and conditions that we have identified in the formation of compliance can form the basis for the development of the preventive and psychocorrectional program, including the diagnostic and therapeutic components. An important task is the creation of the general and specific recommendations for the implementation of the compliance stimulating behavior in patients aimed for activating the resource opportunities within the limits identified by us.

Keywords: compliance, patient and physician factors, family factor, family types, stigmatization, alexithymia.

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IMPACT OF BIOFLAVONOIDS ON HEART BIOCHEMICAL INDICES IN MALE AND FEMALE RATS WITH HYPERHOMOCYSTEINEMIA.

Аuthors: A. V. Melnik

Pages: 856–862

Abstract

         

Introduction. Hyperhomocysteinemia (HHC) is a recognized independent risk factor for cardiovascular disease. One of the biochemical mechanisms of cardiotoxic action of excess homocysteine ​​is the development of oxidative stress. Today, such drugs as bioflavonoids (genistein, quercetin, etc.) are increasingly used for cardioprotection which exhibit antioxidant and anti-inflammatory properties. Along with this, it is shown that genistein also reveals hypohomocystinemic effect on acute methionine HHC. However, bioflavonoids’ ability to adjust the disruption of free radical processes in the myocardium of male and female rats under conditions of HHC remains unexplored.

The aim of the study was to explore the effect of bioflavonoids quercetin and genistein which induce hyperhomocysteinemia damage to cardiomyocytes and changes in the state of antioxidant systems of the heart in male and female rats.

Materials and methods. Experiments were performed on 80 white laboratory male and female rats (220–280 g). For hyperhomocysteinemia model of rats, D, L-homocysteine thiolactone (intragastral 100 mg/kg a day, 28 days,) in 1 % starch solution was used. Some animals in addition to homocysteine thiolactone was treated with genistein (2.5 mg / kg body weight i.g.) or quercetin (25 mg / kg body weight i.g.) for 28 days.

In myocardium, NADPH-oxidase activity, superoxide dismutase, content of malondialdehyde, protein carbonyl groups was determined. In blood serum, content of homocysteine, aspartatе aminotransferase activity and creatine phosphokinase was evaluated. Statistical processing of the results was performed using the program Statistica SPSS 17.0.

Results and discussion. Applied pharmacotherapy prevented decrease in activity of superoxide dismutase and glutathione deficit under the conditions of HHC in male and female rats, the mentioned action is more expressive under genistein. In addition, the introduction of bioflavonoids inhibits the growth of oxidized glutathione, activation of NADPH-oxidase and processes of free radical oxidation of lipids and proteins in male and female rats, but the effectiveness of genistein was higher than of quercetin. Under these conditions, genistein showed more expressive, membrane-stabilizing effect on cardiomyocytes in males and females than quercetin.

Conclusion. It was established that under the conditions of HHC applying of genistein only constrains effectively the development of oxidative stress in male and female rats.

Keywords: hyperhomocysteinemia, oxidative stress, myocardium, genistein, quercetin, sex.

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