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CURRENT ASPECTS OF PROGNOSTIC SIGNIFICANCE OF RISK FACTORS IN CARDIOVASCULAR PATHOLOGY (LITERATURE REVIEW)

Аuthors: S. A. Semenchuk

Pages: 863–873

Abstract

         

Introduction. Coronary artery disease (CAD) is one of the important causes of cardiovascular morbidity and mortality globally, giving rise to more than 7 million deaths annually. In Ukraine, the number of patients increased by 60 332 person only in 2014.

Of the total cost of CVD in Europe, around 53 % (€ 111 billion) is due to health care costs, 26 % (€ 54 billion) to productivity losses and 21 % (€ 45 billion) to the informal care of people with CVD.

Evidence supports an association between CAD trends with major cardiovascular risk factors. Despite the rapid development of medical educational institutions on healthy lifestyle, the main reasons for the growth of cardiac pathology in Ukraine and abroad are modifiable factors of CVD, such as high blood pressure, diabetes, obesity, metabolic syndrome, abnormal lipids, tobacco use, and physical inactivity.

Comorbidity of chronic liver disease with cardiovascular diseases might be of particular interest to the study of cardiac problems. In this case the pathogenic mechanisms could be started and progress the condition of each disease.

The key links of the pathogenesis of these diseases are atherogenic dyslipidemia, chronic systemic inflammation, endothelial dysfunction and hemodynamic disturbances.

The most common form of chronic liver diseases is nonalcoholic fatty liver disease: its prevalence in different populations reaches 33 %, including among patients with obesity – 90 % of diabetes mellitus 2 type – 60–70 % with metabolic syndrome.

The findings of a literature review noticed the importance of assessing hepato-cardiac risk in patients with comorbidity CAD and liver pathology and optimization of drug therapy that will improve the course and prognosis of each disease.

Purpose. Summarize the data of the modern literature views on issue of risk factors in cardiovascular disease.

Keywords: coronary artery disease, comorbidity, risk factors, atherogenic dyslipidemia, endothelial dysfunction.

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SCREENING OF PARAMETERS OF METABOLISM, INFLAMMATION AND HEMOSTASIS IN PATIENTS WITH ISCHEMIC HEART DISEASE AND DIFFERENT CONDITIONS OF GALLBLADDER, WHO UNDERWENT CORONARY BYPASS GRAFTING

Аuthors: L. Strilchuk, D. Besh, O. Rafalyuk

Pages: 874–880

Abstract

         

Ischemic heart disease (IHD) is often accompanied by increase of gallbladder (GB) disorders frequency. Such tendency is very important for patients, planning to undergo coronary bypass grafting (CBG). Our aim was to investigate the changes of metabolic, inflammation and coagulation parameters in dependence of GB condition in patients with IHD, who underwent CBG. We analyzed data of 98 patients (40 % acute myocardial infarction, 60 % unstable angina pectoris), which were divided into groups according to GB condition.

It was established that laboratory parameters of patients with IHD before CBG were dependent of GB condition. Patients with intact GB had only subclinical violations of hemostasis. Patients with sludge and GB cholesterosis differed by lower level of hematocrit. Patients with bent GB body had minimal levels of erythrocyte sedimentation rate (ESR), blood glucose level and urea on the background of maximal values of hemoglobin, cholesterol, hematocrit and general fibrinogen. Patients with GB neck deformations had the lowest levels of leucocytes, ESR, aspartataminotransferase and potassium and the highest levels of glucose and general bilirubin. Patients with cholelithiasis had the highest values of leucocytes of peripheral blood and serum urea on the background of minimal values of hematocrit.

In conclusion we can state that sludge and GB cholesterosis are accompanied by minimal levels of hematocrit and hemoglobin, cholesterol, β-lipoproteids on the background of inflammation and cytolysis activation. Bent GB body was accompanied by disturbances of lipid metabolism on the background of inflammatory answer imbalance. In patients with GB neck deformations we found low activity of inflammation on the background of carbohydrate metabolism disorders and tendency to thrombosis. Cholelithiasis was characterized by prominent inflammation and deceleration of blood coagulation. Patients after cholecystectomy were characterized by imbalance of blood coagulation parameters, marked inflammation and dislipidemia, which were associated with structural criteria of heart and pathological changes of circumflex and right coronary arteries.

Keywords: gallbladder, sludge, GB neck deformations, cholelithiasis, cholecystecomy, inflammation, dyslipidemia.

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ANALYSIS OF LUNG CANCER INCIDENCE IN WOMEN IN SUMY REGION

Аuthors: M. Kononenko,  I. Vynnychenko,  Y. Moskalenko,  S. Tarasenko,  L. Pustovgar,  O. Smorodska,  M. Serdiuk

Pages: 881–890

Abstract

         

Lung cancer (LC) is one of the most important and complex problems of modern oncology in developed countries. Primary LC is the most common malignancy after epithelial skin cancer. Nowadays it is the main cause of death from cancer all over the world. In Sweden, Denmark, Iceland incidence rates among women higher than men one.

The aim of this work was to analyze trends in the development of LC among women of Sumy region in the period of 2012–2016 years.

Analysis of epidemiological data of LC among population of Sumy region during the period 2012–2016 showed that the average prevalence was 43.3 per 100 000. The average value of prevalence of LC among women was 9.97 ± 0.98 ‰ (coefficient of variation was 9.73 %). Clear trends in dynamics of indicators (decrease or increase) were not found. Variation of indicators for the last 5 years was insignificant (less than 10 %). During this period prevalence of LC among women of Sumy region was less than Ukrainian nationwide indicators (9.97 vs. 13.2 per 100,000, respectively). Dynamics of Ukrainian nationwide and regional indicators were not clearly defined.

Sumy region is characterized by low levels of incidence of LC among women in comparison with Ukrainian nationwide and world indicators. For the observation period (2012–2016) the highest incidences of LC among women were observed in Glukhovskyy and Burinskyy districts, where indicators are corresponded to Ukrainian nationwide. Women aged after 70 suffer from LC more often. Tendency to "rejuvenation" of cancer was observed. Growth of the level of incidence rate among women of Sumy region was not observed

Keywords: lung cancer, women, Sumy region, prevalence.

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ANALYSIS OF SOME INDICATORS OF OF PERIPHERAL ARTERY DISEASES IN SUMY REGION

Аuthors: I. D. Duzhiy, A. S. Nikolaeinko, V. M. Popadinets

Pages: 891–896

Abstract

         

Rationale. According to the literature, every year the number of arterial diseases of the lower limbs in Ukraine is increasing, but in the Sumy region this issue has not been studied at all.

Purpose. To study and analyze some epidemiological indicators in patients with pathological processes of peripheral arteries in the Sumy region.

Materials and methods. A retrospective study was carried out by statistical analysis of the dynamics of the main indicators of peripheral arterial diseases in our region. Influence on the incidence of peripheral arteries in the environment of various regions of the Sumy region has been studied, but the correlation between air pollution, incidence and morbidity in these regions has not been established. Considering the territorial location, high incidence rates occurred in the southwestern regions of the Sumy region (Romensky, Lipovodolinsky, Nedrigailovsky), and in the northern (Shostka), at the same time low morbidity – in the northern regions (Shostka, Konotopsky).

Conclusions. Thereby, it is advisable to continue studying of the ecological and territorial impact on the morbidity of the population, namely the composition of drinking water, the level of microelementosis and the nature of nutrition.

Keywords: incidence of peripheral arteries, ecology, territorial location.

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EXUDATIVE PERICARDITIS IN HERPESVIRUS INFECTION TYPE 6

Аuthors: O. B. Lys, Ya. F. Tolstyak

Pages: 897–900

Abstract

         

Introduction. Humanherpesvirus 6 (HHV-6) is a beta herpes virus that is closely related to human cytomegalovirus. It was discovered in 1986, and HHV-6 literature has expanded considerably in the past 10 years. This article provides an overview of the clinical case related to herpesvirus type 6, its clinical association with cardiac and therapeutic approaches to correcting this disease.

Purpose. Retrospective analysis of clinical case patient in which viral pericarditis came against the backdrop of persistent blood virus type 6.

Material .We report a case of 35-year-old woman, in which developed signs of congestive heart failure with changes characteristic of exudative pericarditis.

Discussion. The reason has been proven infection caused by human herpes virus 6 (HHV6) type. Thus, we believe that local HHV6-induced immunosuppression, occurs against a background of chronic HHV6-infection leads to development of exudative pericarditis.

Keywords: clinical case, pericardity, herpesviruses infection 6.

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ANALYSIS OF ASSOCIATION OF BSMI-, APAI-, TAQI- POLYMORPHIC VARIANTS IN THE VDR GENE WITH СHRONIC GENERALIZED PERIODONTITIS

Аuthors: I. G. Fomenko, E. S. Shershneva, A. Yu. Lopatka, Y. I. Dubovyk, О. А. Obukhova, V. Yu. Harbuzova

Pages: 901–909

Abstract

         

Introduction. Nowadays the role of vitamin D and vitamin D receptor (VDR) in the development of common multifactor diseases, including diabetes mellitus, multiple sclerosis, cancer of various localizations, arterial hypertension, ischemic stroke, skin diseases etc. is actively studied. Participation of vitamin D in bone remodeling and mineralization processes, as well as its importance in the inflammatory reactions and immune response regulation, determine its important role in the pathogenesis of periodontitis. Since the mineral density reducing of the bone tissue of the jaw alveolar processes is a favorable background for the detrimental effect of periodontopathogenic microflora, the question about association between periodontitis and mineral metabolism regulation disorders attracts the attention of dentists more and more. The problem of VDR gene polymorphisms influence on the probability of the periodontitis onset and progression is also in the range of studied issues. In recent years a lot of studies have been conducted in different countries but their results are quite controversial.

Purpose. To analyze the association between VDR gene BsmI, ApaI, TaqI polymorphisms and сhronic generalized periodontitis development.

Materials and Methods. The buccal epithelial cells of 116 patients with сhronic generalized periodontitis and 67 control subjects were used. VDR gene BsmI (rs1544410) ApaI (rs7975232) and TaqI (rs731236) (rs9934438) polymorphisms genotyping was performed using PCR-RFLP (polymerase chain reaction with following restriction fragment length polymorphism analysis) techniques. Statistical analyses were performed using Statistical Package for Social Science software (SPSS, version 17.0, Chicago, IL, USA). All statistical tests were two-sided, the value of P < 0.05 was considered as significant.

Results. The data obtained in present work demonstrated that distribution of VDR gene BsmI, but not ApaI and TaqI polymrophisms genotypes was statistically different between periodontitis patients and control group (P = 0.046, P = 0.084, P = 0.085 resp.). Herewith logistic regression analysis revealed the risk for chronic generalized periodontitis development in patients with BB genotype (BsmI polymorphism) was higher than for individuals with bb genotype (OR = 3.143; Р = 0.009). Heterozygotes aA (ApaI polymorphism) had a higher risk for chronic periodontitis than aa-genotype carriers (OR = 2.208; P = 0.029). It has been also shown that probability of chronic periodontitis development in patients with Tt-genotype (TaqI polymorphism) was higher compared to subjects with TT-genotype (OR = 2.082; P = 0.028).

Conclusion. VDR gene BsmI, ApaI, TaqI polymorphisms are associated with сhronic generalized periodontitis development in Ukrainian population. BB genotype (BsmI polymorphism), aA genotype (ApaI polymorphism) and Tt genotype (TaqI polymorphis) are related to increased risk for chronic generalized periodontitis compared with main allele homozygotes.
Keywords: vitamin D receptor (VDR), gene polymorphism, periodontitis.

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FEATURES OF CONTENT AND BALANCE OF IRON, COPPER AND ZINC IN MOTHERS’ HAIR AND THEIR PREMATURE NEWBORNS’ HAIR

Аuthors: I. I. Shkolna, V. E. Markevich

Pages: 910–916

Abstract

         

Pregnancy, as a physiological condition, is associated with the need for essential trace elements, including Fe, Cu and Zn, whose balance is required for normal function of both pregnant women and their fetus. Violation of their admission to the mother body can lead to a delay in intrauterine growth and fetal development and to be one of the factors of preterm labor.

Materials and methods. We investigated the content of Fe, Cu and Zn in the hair of 40 mothers and their children. Children and their mothers were divided into three groups. Group I consisted of mothers and their newborns, who were born with an extremely low birth weight (ELBW) during gestation period 24–28 weeks. Group II included women who gave birth to newborns with very low birth weight (VLBW) in the gestation period 29–31 weeks. Group III consisted of mothers who gave birth to children with a low birth weight (MMT) in the period of gestation 32–36 weeks. The contents of trace elements were studied with an atomic absorption spectrophotometer C-115 MI.

Conclusions. We set average content and content ratios of trace elements (Fe, Cu and Zn) in the hair of women and their premature babies who were born prematurely in different periods of gestational process. It is established that the content of Fe, Cu and Zn in the hair of children is smaller than that of their mothers, regardless of gestational age. Ratio coefficient of hair Cu of the mother/Cu of the baby was lower in the group of mothers and their children, born at a later date of gestation, indicating the active participation of the placenta in copper transporting at the final stages of intrauterine development. In hair of deep premature infants, compared with their mothers, iron was dominated due to the bigger needs of the fetus in it in the early stages of fetal development.

Keywords: essential micronutrients, preterm labor, hair, premature infants.

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  1. Krajewski P, Chudzik A, Pokrzywnicka M, Kalinka J, Kwiatkowska M. Macro-, micro- and trace elements concentrations in mother’s and newborn’s hair and its impact on pregnancy outcome: a review. Archives of Perinatal Medicine. 2009;15(2):67–71.
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  3. Khoushabi F, Shadan MR, Miri A, Sharifi-Rad J. Determination of maternal serum zinc, iron, calcium and magnesium during pregnancy in pregnant women and umbilical cord blood and their association with outcome of pregnancy. Mater Sociomed. 2016;28(2):104–107. doi: 10.5455/msm.2016.28.104-107.
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PUNCTURE LASER MICRODISCECTOMY: IMMEDIATE AND LONG-TERM RESULTS OF SURGICAL TREATMENT IN PATIENTS WITH MULTIPLE HERNIAS OF THE CERVICAL SPINE

Аuthors: M. V. Khyzhniak, Yu. E. Pedachenko, O. F. Tanasiychuk, A. M. Furman, Y. A. Bodnarchuk

Pages: 917–923

Abstract

         

Introduction. Osteochondrosis is degenerative-dystrophic disease of the spine, which affects the population of the most able-bodied age creating economic and social difficulties and leads to disability and disability. The first manifestations of osteochondrosis appear at the age of 20-30 years, and in the population over 50 years the frequency of the disease reaches up to 90 %, is more often observed in men who are engaged in heavy physical labor

To date, we know about the discogenic origin of osteochondrosis, which makes it possible to act purposefully on the disc, as the cause of its development, which was the impetus for the development of mini-invasive methods of treatment, one of which was puncture laser microdiscectomy.

Standard open methods of surgical treatment of herniated intervertebral discs are associated with high traumatization of soft tissues, bone structures of the spine, which as a result can lead to the development of a number of complications. Minimally invasive techniques to which the puncture laser microdiscectomy refers also do not have these drawbacks.

Lesions of adjacent intervertebral discs are often accompanied by the formation of a clinically significant, hernia at one level and protrusion or a hernia in an adjacent segment.

Purpose. to evaluate the immediate and long-term results of surgical treatment of patients with multiple hernias of the cervical spine operated using the method of puncture laser microdiscectomy.

Materials and methods. The results of 79 operations performed in patients with multiple hernias of the cervical spine performed in the department of minimally invasive and laser spinal neurosurgery were analyzed. in the period from 1997 to 2016. Of the 79 patients, 47 men and 32 women. The average age of the patients was 38.5 ± 0.9. As shown in Figure 1, patients with anamnesis of disease up to 6 months prevailed.

All operations were performed under local anesthesia with mild premedication.

Despite the multilevel pathology, one and the same puncture of the skin consistently changed the direction of the needle. The passage of the needle to the fibrous ring was monitored by fluoroscopy. The pulse power was 20 W, the pulse duration was 0.3 seconds, the interval was 0.4 seconds, the total power was from 200 to 400 J (depending on the disk degeneration).

In the postoperative period, patients were allowed to get up 2 hours after surgery, prescribing antibiotics, using a semi-rigid cervical orthosis for up to 2 weeks. Hospitalization in the hospital was 24 hours.

Conclusions. Puncture laser microdiscectomy allows:

- minimize surgical trauma;

- reduce the risk of postoperative sedimentation;

- is a safe, cost-effective method of surgery, reducing the length of stay of patients in a surgical hospital and reducing the terms of postoperative rehabilitation.

Keywords: multiple hernias of the cervical spine, puncture laser microdiscectomy.

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References

  1. Mironov SP, Nazarenko LM, Cherkashov AM, Burlakova TM. Lechenie osteohondroza poyasnichnogo otdela pozvonochnika metodom lazernoy diskektomii. [Treatment of osteochondrosis of the lumbar spine using laser discectomy]. Moscow: Vestnik travmatologii i ortopedii im. N.N. Priorova, 1999, (2), 19-23 pp.
  2. Nikolaev AP, Lazarev AF, Smirnov II. Metod lazernoy dekompressii v lechenii diskogennyih porazheniy pozvonochnika. [The method of laser decompression in the treatment of discogenic lesions of the spine]. Moscow: Kremlevskaja medicina, 1999, (1), 5-6 pp.
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  7. Jacobs W, Tulder M, Arts M, Rubinstein S, Middelkoop M, Ostelo R, Verhagen A, Koes B, Peul W, Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Journ. Eur. Spine. 2011. (20). 513–522.

EVALUATION OF THE EFFECTIVENESS OF PREVENTIVE AND POSTOPERATIVE ANALGESIA IN PATIENTS WITH FACIAL BONE FRACTURES

Аuthors: І. І. Bilozetsky

Pages: 924–929

Abstract

         

Objectives. To establish the efficiency of Diclofenac retard in preventive and postoperative analgesia in the treatment of facial bone fractures.

Material and methods. We examined 32 patients, for whom we perform surgery on facial bone fractures. They were randomized into three treatment groups. Patients from I group received oral ketorolac 10 mg after surgery, group II – prolonged diclofenac 100 mg during postoperative period, III – prolonged diclofenac 100 mg once before surgery and during postoperative period. A 100-mm visual analog scale (VAS) was used to assess the pain, and the quantitative parameters were checked every hour for 8 hours and then at 24, 48, 72 hour after the intervention. Edema was determined by the method used in similar studies Ustun et al., (2003). The trism of chewing muscles was measured as the distance between the incisors of maximum mouth opening. Edema of the face and trism were determined on days 1, 3, 5, 7.

Results. All patients complained of pain, swelling of the face and limitation of mouth opening during postoperative period. The analysis of the level of pain sensation showed significant differences between the analgesic effects of proven treatment programs. It was found that during the first postoperative hour, the lowest intensity was observed in treatment with retarded forms of diclofenac during the pre- and postoperative period. From the third to the sixth hour of the postoperative period there was an increase in pain in all groups, and in the first two groups the quantitative index of its value was significantly higher than in the third group. Although significant differences were observed among the patients from group I and II.

The fastest pace of pain relief was in patients from the third group with predominance of analgesic efficacy of diclofenac compared to ketorolac. A similar dynamics is established during 24, 48 and 72 hour of the postoperative period. The analysis of the quantitative values ​​of the study of trism and edema of the face indicated positive dynamics on the 5th and 7th day with the finding of the most effective results using retarded forms of diclofenac, whereas in group I, positive dynamics was observed on the 8th day.

Conclusions. The study results allow us to conclude that preventive analgesia is the most effective in the direction of postoperative anesthesia, reduction of inflammation in the area of operation and in restoring the function. The use of retarded forms of diclofenac indicated significantly more potent analgesic and anti-inflammatory effects in comparison with ketorolac in patients after surgical management of facial bone fractures.

Keywords: facial bone fractures, non-steroidal anti-inflammatory drugs, visual scale of pain, trism.

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TREATMENT OPTIMIZATION IN PATIENTS WITH BRONCHIAL ASTHMA WITH REGARD TO GLN27GLU POLYMORPHISM IN THE Β2-ADRENERGIC RECEPTOR GENE

Аuthors: L. N. Prystupa,  A. M. Bondarkova, I. O. Makagonov

Pages: 930–938

Abstract

         

Effectiveness of BA treatment depends on multiple factors, including genetic. Gln27Glu polymorphism in the ADRB2 gene is the most common and well-known.

Study Objectives: to optimize treatment in BA patients with regard to Gln27Glu polymorphism in the ADRB2 gene.

Materials and Methods: 195 patients with bronchial asthma have been examined. Patients were divided into two groups according to the dosing: group I – 164 patients receiving low doses; group II – 25 patients receiving medium doses in terms of the equivalent amount of budesonide. Control level was determined by means of Asthma Control Questionnaire and measurements of forced expiratory volume in 1 second (FEV1) before and after dose corrections of inhaled GCs and LABA. In case of poor asthma control, treatment correction was performed as follows: the patients receiving low doses of inhaled GCs and LABA (< 400 μg per day) had their doses increased to medium doses (400−800 μg per day); the patients receiving medium doses had their doses increased to high doses (> 800 μg per day). The treatment lasted 4 weeks. Further study consisted in comparative analysis of clinical efficacy of background therapy in patients who did not achieve asthma control and were additionally given 24 μg formoterol – in group A, and 18 μg tiotroprium bromide – in group B. Control level was evaluated after 4 weeks. Gln27Glu (rs1042714) polymorphism in the ADRB2 gene was detected using polymerase chain reaction with subsequent analysis of restriction fragment length polymorphism by means of separation with agarose gel electrophoresis. To compare the groups before and after treatment correction, Wilcoxon signed-rank test was used.

Results: Control level evaluation after treatment correction showed that Glu27Glu genotype carriers in the group I had no improvement in BA control (р = 0.2 by Wilcoxon), while Gln27Gln and Gln27Glu genotype carriers (р = 0.04 and р = 0.001 by Wilcoxon) improved BA control, which was confirmed by FEV1 values (Fig. 1). Thus, there was no difference in FEV1 values before and after treatment correction (р = 0.8 by Wilcoxon) in Glu27Glu genotype carriers in group I, while Gln27Gln and Gln27Glu genotype carriers (р = 0.01 and р = 0.001 by Wilcoxon) had their FEV1 values increased. Patients in group II demonstrated no significant improvement in control level with regard to the genotypes of Gln27Glu polymorphism in the ADRB2 gene. As for FEV1 values, they were increased in Gln27Gln and Gln27Glu genotype carriers (р = 0.048 and р = 0.004 by Mann-Whitney), while Glu27Glu genotype carriers had no difference in FEV1 values (р = 0.5). Significant increase in FEV1 values was observed in Gln27Gln genotype carriers in group А (р = 0.048 by Wilcoxon) and in Gln27Gln, Gln27Glu and Glu27Glu genotype carriers in group B (р = 0.033, р = 0.003 and р = 0.007 by Wilcoxon), while in Gln27Glu and Glu27Glu genotype carriers (group A) this difference was absent (р = 0.1 and р = 0.07 by Wilcoxon).

Conclusions: It was proved that Glu27Glu genotype carriers had worse control level as compared to Gln27Gln and Gln27Glu genotype carriers; high doses of inhaled GCs and LABA in combination with tiotroprium bromide in the carriers of Glu27Glu genotype of Gln27Glu polymorphism in the ADRB2 gene is more effective in achieving control over the disease than additional formoterol 24 μg per day.

Keywords: bronchial asthma, β2-adrenergic receptor gene, Gln27Glu polymorphism, control level, long-acting β2-agonists, inhaled corticosteroids.

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GOUTY NEPHROPATHY: EVALUATION OF ASSOCIATION BETWEEN GOUT AND MICROPROTEINURIA

Аuthors: M. Franchuk

Pages: 939–944

Abstract

         

Background. According to the literature, the frequency of kidney damage in patients with gout varies in rather large limits from 30 % to 70 %. Today scientists distinguish the concept known as "gouty nephropathy", which characterizes all renal pathology that occurs due to gout. Pathogenesis of gouty nephropathy is associated with hyperproduction of uric acid and imbalance between tubular secretion and urat reabsorption processes. But there is no clear opinion that hyperuricemia is a marker of renal dysfunction or risk factor. This contradictory opinion is due to the fact that it is difficult to estimate the early stages of gouty nephropathy. This process undergoes a long time subclinically and is diagnosed only at later stages of the disease. The first harbinger of kidney damage is increasing of microproteins in urine – microproteinuria.

Materials and methods. 103 patients with chronic gouty arthritis were examined. All patients were male, without history of kidney dysfunction. Determination of microproteins in urine by ELISA method allowed to suspect subclinical course of gouty nephropathy. Therefore, patients were divided into 2 groups: I (n = 58) – patients with subclinical gouty nephropathy (56.3 %), II (n = 45) – control group, patients without kidney damage (43.7 %). All calculations were carried out on a personal computer using “STATISTICA”. Also, Spearman's correlation coefficients are established.

Results and discussion. It was found that patients with subclinical gouty nephropathy recorded a higher incidence of arterial hypertension and metabolic syndrome. Concomitant osteoarthritis, diabetes mellitus and dyslipidemia were found almost identically frequently in both groups. Also, patients with gouty nephropathy show longer duration of the disease, greater radiologic changes, high hyperuricemia, tophi, lost work capacity, a greater number of affected joints and more frequent changes in the general urine analysis.

Conclusion. It was shown that gouty nephropathy develops in 56.3 % of patients with chronic gout arthritis, and manifestets by microproteinuria in the early subclinical stages. Predictors of the gouty nephropathy development with a high degree of reliability (p < 0.005) are: duration of the disease more than 10 years, obesity, the presence of tophi, arterial hypertension, hyperuricemia, increased triglycerols and low-density lipoproteins.
Keywords: gouty nephropathy, microproteins, microproteinuria, gout, hyperuricemia.

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CHARACTERISTICS OF DAILY BLOOD PRESSURE PROFILE ASSOCIATED WITH THE DEVELOPMENT OF DIASTOLIC DYSFUNCTION OF THE LEFT VENTRICLE IN MIDDLE-AGED AND ELDERLY PATIENTS WITH HYPERTENSION

Аuthors: G. A. Kosova

Pages: 945–956

Abstract

         

Objective. To study the relationship of the structural and functional state of the heart and features of daily profile of blood pressure in hypertensive patients and chronic heart failure with preserved ejection fraction, in middle-aged and elderly.

Materials and methods. The study included 150 patients with essential hypertension II stage, which, depending on age were divided into 2 groups. Group I included 60 elderly patients (41.7 % males) and 90 middle-aged patients was Group II (53.3 % males). The average age in groups was 64.0 (61.5; 66.0) years in group I and 51.0 (47.0; 55.0) in group II. Assessment structural and functional state of the heart was performed using the transthoracic echocardiography, pulse-wave Doppler device "Philips HD 7 Diagnostic Ultrasound System ", sensor 2.0/2.5 MHz by the standard method. Features of daily blood pressure profile were analyzed according to the daily monitoring of blood pressure (CardioTens «Meditech Ltd», Hungary).

Results. In the group of middle-aged patients with diastolic dysfunction of LV, the level of the average SBP and DBP, as well as the indicators of blood pressure overload of SBP and DBP, at day and night time, was associated with deterioration of the LV diastolic function. The negative effect of the increase in DBP hypertension time index and the variability of DBP during the night time at the diastolic function of LV (peak E and peak A, E/A ratio), established in patients with arterial hypertension in the elderly, was confirmed by the results of correlation analysis in a subgroup with an impaired diastolic function of LV, in which the DBP hypertension time index during the day, the speed and index of morning increasing of the DBP, were associated with the impairment of the diastolic function of LV.

Keywords: chronic heart failure, diastolic function of the left ventricle, elderly patients, daily monitoring of blood pressure.

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  1. Palmiero P, Zito A, Maiello M, Cameli M, Modesti PA, Muiesan ML, Novo S, Saba PS, Scicchitano P, Pedrinelli R, Ciccone MM. Left Ventricular Diastolic Function in Hypertension: Methodological Considerations and Clinical Implications. J Clin Med Res. 2015;7(3):137–44.
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SERUM LEVELS OF CIRCULATING ENDOTHELIAL CELLS AS A MARKER OF ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Аuthors: B. O. Koshak

Pages: 957–963

Abstract

         

Background. Ankylosing spondylitis (AS) is a disease affecting musculoskeletal system. Mortality rate among patients with AS is 1.5 times higher than in general population. The causes of death include cardiovascular disease and chronic renal failure.

Now it is clear that the presence of chronic systemic inflammation is an important predictor of cardiovascular (CV) disease due to development of endothelial dysfunction and subsequent atherosclerosis, atherothrombosis, remodelling of the vascular wall and myocardium and, therefore, it represent the main cause of numerous life-threatening adverse conditions.

Tasks of the research: To asses endothelial function by establishing the relationship between the level of circulating endothelial cells in the blood and the degree of endothelial dysfunction in patients with AS.

Materials and methods: A total of 110 patients with ankylosing spondylitis (AS) were examined with the use of standard diagnostic methods: disease activity, lipid profile, ultrasound assessment the carotid intima media thickness, evaluation endothelium-dependent vasodilatation in response to reactive hyperemia. Clinical activity of the disease was determined using the disease activity index BASDAI, BASFI functional index, index BASMI metrology, quality of life ASQoL. The determination of the level of circulating endothelial cells (CEC) in peripheral blood, which is considered a marker of damage and dysfunction of the endothelium, was performed out according to J. Hladovec.

Results: Elevated levels of CEC were detected in 84 % of cases. It was established that most often the increase of the level of CEC is observed in patients with II and III degree of activity. There were clear relationships between the parameters of the course of AS and the studied parameter: ESR (rs = 0.378, p < 0.05), CRP (rs = 0.451, p < 0.05), BASDAI (rs = 0.369, p < 0.05) and demonstrated the dependence of the level of CEC in peripheral blood on the use of adequate anti-inflammatory therapy.

Conclusions. We assume that a significant relationship between levels of circulating endothelial cells and the degree of endothelial dysfunction in patients with AS exits, suggesting that the level of CEC is a marker of endothelial dysfunction in patients with AS.

Keywords: ankylosing spondylitis, endothelial dysfunction, circulating endothelial cells.

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CLUSTERING OF PATIENTS WITH BRONCHIAL ASTHMA WITH REGARD TO THE GENOTYPES FOR ВСІ1 POLYMORPHISM IN THE GLUCOCORTICOID RECEPTOR GENE

Аuthors:V. V. Kmyta, A. M. Bondarkova, N. Yu. Polishchuk, Ju. A. Popovich, R. S. Lesnyh, L. N. Prystupa

Pages: 964–973

Abstract

         

Phenotyping of patients with bronchial asthma (BA) allows providing individual approach to diagnosis and treatment of such patients.

Phenotype-specific approach to BA patients is extremely important, because it insures not only timely and correct diagnosis, but also correct background therapy.

It is well-known that BA is a heterogenetic and multifactorial disease, which results from many external and internal factors, and it is the combination of the mentioned factors that determine a particular BA phenotype.

Thus, the aim of our study was to perform a cluster analysis in patients with adult-onset bronchial asthma with regard to ВсІ1 polymorphism in the glucocorticoid receptor gene.

Materials and methods. We examined 187 patients with persistent BA, who were undergoing hospital treatment in pulmonary departments at Sumy Regional Clinical Hospital; the patients had all appropriate clinical, laboratory and instrumental examinations according to the GINA recommendations.

ВсІ1 polymorphism was identified using polymerase chain reaction with subsequent analysis of restriction fragment length polymorphism by method of Fleury I. et al. with modifications.

Statistical analysis was performed using SPSS–21 Statistical program; clustering of patients was conducted by means of hierarchical cluster analysis in the same program.

Results. The first cluster (n = 69) predominantly consisted of women (71 %) having partial or poor BA control, aged 40 to 59, with adult-onset type of asthma; mainly with normal body mass; burdened allergological history; high blood levels of eosinophiles and IgE; decreased FEV1 (within 60 to 80 %); long-term use of systemic glucocorticosteroids in the setting of background therapy with medium and high doses of inhaled corticosteroids and long-acting beta 2-agonists; and with C/G genotype of ВсІ1 GR gene polymorphism in 68.1 % of patients.

The second cluster (n = 31) included 67.7 % of women aged 39 to 62, with increased body mass index (BMI): 74.2 % of subjects had obesity, 25.8 % – had overweight, of which 100 % had increased waist-to-hip ratio (WHR); with increased levels of cholesterol and low density lipoproteins; normal level of eosinophiles; decreased FEV1 (within up to 60 %); severe uncontrolled course of disease in the setting of background therapy with inhaled corticosteroids, long-acting beta 2-agonists and systemic glucocorticosteroids; with frequent exacerbations; and with G/G genotype of ВсІ1 GR gene polymorphism in 74.2 % of patients.

The third cluster (n = 87) predominantly contained men with an early BA onset, having well-controlled or partially controlled BA course; with no genetic factor in past medical history; with healthy weight and WHR; normal FEV1 (over 80 %) and normal laboratory parameters; 36.8 % of subjects having C/G genotype and 40.3 % – С/С genotype of ВсІ1 polymorphism.

Conclusions. Cluster analysis of adult patients with adult-onset of BA with regard to the genotypes of ВсІ1 polymorphism demonstrated 3 different BA subphenotypes that differed from each other in sex, BA course and control, values of respiratory function, BMI and inflammatory markers.

Keywords: bronchial asthma, cluster analysis, phenotypes, obesity, BcI1 polymorphism.

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EVALUATION OF THERAPY EFFICACY IN PATIENTS WITH RHEUMATOID ARTRITIS ACCOMPANIED BY NON-ALCOHOLIC STEATOHEPATITIS

Аuthors: S. I. Smiyan, L. V. Dankiv

Pages: 974–981

Abstract

         

Patients with rheumatoid arthritis (RA) have intrinsic damage to the hepatobiliary system. In the presence of liver steatosis, favorable conditions for the development of obesity and dyslipidemia are created. Therefore, the development of pathogenetically-based treatment of patients with RA in combination with non-alcoholic steatohepatitis (NASH) is relevant.

Purpose of the study. To study the effect of standard and modified therapy in patients with RA, including the inclusion of essential phospholipids and L-glutathione in the treatment of patients, changes in clinical manifestations and morphological and functional disorders of the liver in patients with RA in combination with NASH.

Materials and Methods. 123 patients with RA were examined, which were divided into 2 groups: patients without liver damage – 65 persons (control group) and liver deficiency – 58 persons (group I). Patients in the number of 58 (47.15 %) persons with concomitant NASH, which in turn were divided into two subgroups. Тhe group I B consisted of patients in the amount (n = 35 (60.34 %)), which besides the standard one received modified therapy with essential phospholipids and L-glutathione for 1 month. The study of the effectiveness of treatment was based on the study of the dynamics of clinical manifestations, data objective and laboratory and instrumental methods of examination.

Results. In the analysis of the dynamics of arthralgic status in the visual analogue pain scale (VAS), after the treatment in control group and in subgroups IA and I В, a significant reduction of pain sensation was noted. The dynamics of reduction of manifestations of pain, dyspepsia, asthenic syndromes, in a bijective examination, it was stated that the decrease in liver size in patients of the І В subgroup after treatment. Regarding the complaints and symptoms that showed liver damage in patients with rheumatoid arthritis in the control group, the absence of both pain and dyspeptic syndromes was noted. When conducting an analysis of the hardness of the hepatic parenchyma by the method of elastography of the shift wave, there is a significant (p < 0.05) decrease in liver hardness in patients of the І В subgroup, which in the treatment of modified therapy was used. Significant decrease in the level of ALT, AST, GGT, АLР, total bilirubin and the increase in total protein after treatment among individuals and іn subgroup compared with the I A subgroup and control group of patients. The conducted analysis of the dynamics of the lipid profile of the blood after treatment indicates a significant (p < 0.05) decrease in its plasma concentration in the blood of subjects of subgroup I В and in comparison with subgroup I A and control.

Keywords: rheumatoid arthritis, essential phospholipids, nonalcoholic steatohepatitis, low density lipoprotein, rigidity of the liver parenchyma.

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MECHANISMS OF ATP-LONG PREPARATION INFLUENCE ON ANIMAL WORK CAPACITY DURING EXPERIMENTAL MODELING OF PHYSICAL LOADS

Аuthors: L. Gunina, Yu. Vinnichuk, Ye. Nosach, V. Bezuglaya, Ye. Rosova

Pages:  982–994

Abstract

         

Intensive continuous training and competitive loads, peculiar for modern elite sport, in the face of metabolism intensification and exhaustion of intracellular content of high-energy compounds contribute to pathology process activation primarily in myocardium. In addition to continuous and intensive physical loads against the background of chronic under-recovery, the combination of high loads with intensive mental activity and chronic psychoemotional stress is crucial in the development of abnormal changes in athlete cardiovascular system. Therefore, permanent intensive physical loads necessitate systematic and substantiated application of cardioprotectors ‒ means for protection of the myocardium. Their action is not connected with the improvement of heart pump function directly, but is mediated by optimization of the processes of energy generation and expenditure, correction of respiratory chain function, normalization of balance between the intensity of the processes of free-radical oxidation and antioxidant defense, direct impact on cardiomyocytes, thus preventing the formation of myocardial metabolic remodeling. However, many pharmacological preparations widely used in clinical cardiological practice, and all trimetazidine and meldonium based drugs, in particular, are not allowed to be used in elite sport due to their recent prohibition by the World Anti-Doping Agency. The main cause of fatigue that occurs during intensive physical loads is the lack of adenosine triphosphoric acid – the major high-energy compound, the biological significance of which has been recently revealed to be much more than just the direct energy donation. Unfortunately, the usage of cardioprotectors in today’s sport appears to be almost systemless and without accounting for the basic points of their metabolic action application, whereas the list of utilized preparations is rather narrow and mainly includes metabolic means. For this very reason, the application of non-prohibited in the practice of athletic preparation, ATP-based medicines seems to be quite logical for the sake of maintenance of functional status and further structural rearrangements of the myocardium. However, the mechanisms of their action on physical work capacity stimulation have been studied insufficiently, thus necessitating organization of the given experimental study under conditions of modeling continuous and intensive physical loads of inbred Wistar rats. It has been demonstrated that in the main group of animals, subjected to physical loads (treadmill running), in the face of intraperitoneal administration of 0.12 g/kg daily dose of ATP-long, equal to therapeutic dosing of preparation, the basis for endurance parameter increase is the reduction of oxidative stress expression within red-cell membranes with the decrease of resulting prooxidant-antioxidant coefficient from 2.23 in control to 1.22 in the main group, pH value normalization in venous blood of animals and increase of its oxygen saturation to 88.3 ± 1.1 %, which approximately corresponds to saturation at the level of 89.8 ± 1.2 % in intact animals. These changes contribute to the improvement of blood oxygen transport function, which is of crucial importance during aerobic activities, and create prerequisites for normalization of electrocardiographic characteristics of animals’ heart condition. When assessing physical performance changes in the dynamics of the experiment revealed that the end of the observation of animals in the control group while treadmill running a because of regular exercise increases on 42.3 % compared with intact rats. However, the intraperitoneal administration of ATP-long core group of animals reliably against these animals in the control group, an increase in the run until exhaustion is 20.2%, indicating that stimulation of the body ergogenic performance and, accordingly, direct/indirect ergogenic properties of the drug. Study findings allow to suggest that exogenous ATP in combination with magnesium and potassium ions and essential amino acid, histidine that form structural basis of ATP-long preparation, is both the modern cardioprotective and ergogenic means to be used in the practice of athletes preparation.

Keywords: physical working capacity, sport, physical activity, macroergic phosphates, ATP, oxidative homeostasis, pH, oxygen saturation, myocardium.

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