Аuthors: Hetmanska V. M., Zakorko I.-M. S., Moskalenko Y. V., Moskalenko R. A., Diachenko О. О.
In most industrialized countries with a high level of urbanization diseases of the cardiovascular system are the leading cause of morbidity and mortality. Every year about 9.4 million people die from cardiovascular diseases. One of the causes of cardiovascular disease is an amyloidosis. Its incidence in the population, according to recent data, is 1 in 50 thousand of people, there is a tendency to more frequent detection of cases.
The aim of the study is to analyze the literature to determine different proteins’ role in the etiopathogenesis of amyloidosis of the cardiovascular system.
Amyloid deposition in the heart may have different anatomical allocation, including atrial, ventricles, perivascular spaces such as heart valve leaflets, and in some cases – in the cardiac conductive system. Amyloidosis of the heart is established or by the help of positive cardiac biopsy with the presence of amyloid infiltration, or by an increase of left ventricular wall > 12 mm, in the case of arterial hypertension (AH) absence or absence of other potential causes of the genuine LV hypertrophy with a positive cardiac biopsy.
Among amyloid proteins, which affect a heart, there are such types: AL-amyloidosis (amyloid of light chains), family amyloidosis (F), senile systemic amyloidosis (SSA), isolated atrial amyloidosis (IAA) and the secondary (AA) amyloidosis.
Recently amyloidosis of heart went out of the category of rare diseases; it has become possible thanks to the different methods of research, including the possibility of studying the heterogeneity of the protein composition of amyloid fibril formation. However, systemic amyloidosis and particularly amyloidosis of the heart continue to belong to diseases, which are diagnosed difficult, considering the non-specific symptoms of disease, a small suspicion among physicians with regard to amyloidosis and multiple organ destruction.
Keywords: amyloidosis, cardiovascular system, amyloid proteins, heart failure, atherosclerosis, biomineralization.
Аuthors: O. O. Chuhay
Introduction. Despite all attempts of doctors, pneumonia remains a common medical and social problem in the 21st century both in developing and developed countries. According to WHO, pneumonia is an acute, usually, infectious disease predominantly of the respiratory part of the lungs / respiratory bronchioles and alveoli / with the presence of exudate with neutrophil content in the alveoli and is seen on X-ray as infiltrative darkening of the lungs. Currently, bioflavonoids are often used as an accompanying therapy to correct disturbances, induced by long-lasting inflammatory process. There are over 150 such biologically active substances with similar properties. Flavonoids possess antioxidant, membrane-protective, angioprotective, anti-inflammatory, immunomodulating properties, etc. Quercetin has the most powerful antioxidant action among flavonoid substances.
Purpose: to investigate the influence of korvitin on indices of cell-mediated and humoral immunity in experimental pneumonia development.
Materials and Methods. Experimental investigation was performed on 30 guinea pigs (males) weighing 180–220 g, distributed into 5 groups, 6 animals in each: I group – intact guinea pigs (control); II group – guinea pigs with experimental pneumonia on the 6th day; III group – guinea pigs with experimental pneumonia on the 10th day; IV group – guinea pigs with experimental pneumonia on the 20th day; V group – guinea pigs with experimental pneumonia under the action of korvityn. This antioxidant was injected in the dose 40 mg/kg intraperitoneally for 7 days (from 13 to 20 day). Experimental pneumonia was induced by intranasal introduction of Staphylococcus aureus culture to animals by the method of V. N. Shlyapnikov and co-authors. The animals were decapitated on the 6th, 10th and 20th day of EP development. Amount of T- and B-lymphocytes (CD3+ and CD19+) in the blood was determined by the method of E. F. Chernushenko, L. S. Kogosova. The level of circulating immune complexes was determined by the method of V. Haskova, J. Kaslik.
Discussion. Both early and late periods of EP were characterized by the disturbance of immune system functioning. Experimental pneumonia in guinea pigs was accompanied by inhibition of cell-mediated immunity, which was marked by the decrease in T-lymphocyte level in the blood. Simultaneously, activation of humoral immunity was observed, marked by increase in B-lymphocytes and CIC in the blood in early and late periods of EP. This condition may be caused by the nature of the agent itself. Since EP in guinea pigs was caused by Staphylococcus aureus, which is a gram-positive bacterium, activation of humoral immunity plays a significant role in combating this infection. Medication «Korvityn» prevented further development of immune system imbalance, limiting inflammatory reaction. This effect may be caused by anti-inflammatory and immunomodulating properties of Korvityn, which may be recommended as an accompanying therapy in pneumonia.
Keywords: pneumonia, Korvityn, humoral immunity, cell-mediated immunity.
Аuthors: V. V. Vaslovych, L. D. Pichkur, T. A. Malysheva, S. T. Akinola, S. A. Verbovska, O. K. Toporova, N. S. Shuvalova
Introduction. Human umbilical cord derived mesenchymal stem cells (UCd-MSC) are multipotent. They are able to migrate to the sites of central nervous system damage, contribute to the restoration of the number of endogenous oligodendrocytes, produce immunomodulatory effects and are able to synthesize antiinflammatory cytokines (IL-10).
Purpose. To investigate the effect of UCd-MSC and IL-10 on the processes of de- and remyelination of nerve fibers of the spinal cord of rats with experimental allergic encephalomyelitis at the ultrastructural level.
Materials and methods. The study was performed on 23 white female rats, weighting 210 g. The relapsing course of EAE was obtained by inserting Freund's adjuvant into the rat’s hind limb pads. Six groups of animals were formed. 18 rats from EAE were intravenously or suboccipitaly administered in different combinations of IL-10 (0.1 μg) and MSC no transfected (1 million) and MSC (1 million) transfected with the IL-10 gene. Electron microscopy was used to investigate the ultrastructural changes in the lumbar spinal cord of experimental animals at the 35th and 60th day of the experiment. Also, the ratio of the width of the myelin sheath (MS) to the diameter of the axial cylinder (AC) was determined on the semi-thin sections. Statistical analysis of the results was performed using non-parametric rank discriminant Kruskel–Wallis analysis followed by application of the U-Mann-Whitney criterion using STATISTICA 6.1 statistical software package.
Results. In animals of all experimental groups, the peak of EAE was observed for 19–20 days and developed a chronic remitting flow. In the comparison group (EAE), part of the oligodendrocytes already in the early stages are in a para apoptotic state, the degree of which increases over time. Reactive modified swollen forms of oligodendroglia, along with destructive, are more often represented in the study group III EAE + IL-10. Hypertrophic oligodendrocytes are more likely to be detected after the introduction of MSCs. Oligodendrocytes of group V (EAE + MSK transfected with IL-10 gene) for 60 days of study have signs of functional tension (swollen mitochondria with crysts fragmentation). In all experimental animal groups, with the exception of the comparison group, a reduced degree and demyelination area with a simultaneous partial reduction of the intralamilar and almost complete – periaxonal edema. In the study group III (EAE + IL), none of the terms of the study showed normalization of the structure of myelin membranes. Figures of remyelination of nerve fibers in all experimental groups were detected already on the 35th day of the study. The ratio of the thickness of the myelin sheath to the diameter of the axial cylinder is statistically significantly reduced relative to the comparison group in all treated groups except for the III (EAE + IL) for 35 days and III (EAE + IL) and V (EAE + MSC (T) at 60 days of the experiment.
Conclusions. MSCs help reduce interlamilar, periaxonal edema and demyelination in animals with EAE.Suboccipitaly introduced into CSF IL-10 does not produce statistically significant effects, however, to some extent, strengthens the effect of MSC.In all animal groups and in all terms, MSCs promote stimulation of remyelination processes.
Keywords: experimental allergic encephalomyelitis, mesenchymal stem cells, morphological changes, interleukin-10.
Аuthors: L. M. Yaremenko, S. E. Shepelev, L. P. Вidna, A. N. Grabovoi
Introduction. Ischemic brain damage may was caused by a violation of synaptic transmission after primary thromboembolism. One of the proteins, synaptic pulse transfer and axonal transport is tau-protein. The scientific literature has extensively studied the detection of tau protein in Alzheimer's disease, and is practically was not described in cases of ischemic brain damage in conditions influencing the body of immunomodulator of the new generation. Therefore, the purpose of the work was to study the peculiarity of the expression of tau protein in the sensomotor cortex in the modeling of transient ischemia against the background of the prior sensitization of the brain antigen and immunocorrection of their effects.
Materials and Methods. Studies performed were on 135 male Wistar rats. Histological, immunohistochemical, densiometric and statistical methods of investigation were used. Immunohistochemical reaction performed was according to the manufacturer's protocol with a polyclonal rabbit antibody against tau protein 1: 200 (Thermo, USA). EnVisionTM FLEX Detection System (Dako, Denmark) used was to visualize reaction products. Sections contrasted with Gyll Hematoxylin.
Discussion. It has been established that sensitization with the brain antigen leads to diffuse degenerative changes in the cerebral cortex accompanied by an increase in the expression of the tau protein. Previous sensitization by the brain antigen leads to an increase in the severity of brain damage and the potentiation of the expression of the tau protein in acute circulatory disturbance. The use of immunophan provides a reduction in the expression of tau protein in the sensorimotor cortex caused by both sensitization of the brain antigen and its combination with transient disturbance of cerebral blood flow.
Keywords: brain, sensitization by brain antigen, brain ischemia, tau-protein, imunophan.
Аuthors: A. V. Sokhan
Introduction. Due to neuroinfections there is a violation of the barrier function of blood-brain barrier (BBB), accompanied by the penetration of various substances into the tissues of the central nervous system that change the metabolism and may have a toxic effect on the central nervous system. Determination of the level of permeability of the BBB in patients with meningitis is not sufficiently studied and promising direction of diagnosis.
Purpose. Determine the diagnostic value and predictive significance of albumin levels in CSF of patients with acute neuroinfections.
Materials and Methods. For the purpose of the study, 164 patients with a confirmed etiology of neuroinfection were examined. We observed patients with meningococcal, pneumococcal, HSV 1, 2, EBV, VZV, HHV-6, and enteroviral meningitis. As a control group, we used data from 15 ARI patients with meningism. In addition to analyzing the clinical course of the disease, cerebrospinal fluid (CSF) level of albumin upon admission to the hospital and on the 10th–12th day of treatment was determined.
Results. The level of albumin in the CSF depend both on the severity of the patient's condition and on the etiology of neuroinfection. In patients with severe course on the first day of treatment, the content of albumin in the CSF was higher compared with patients of moderate severity in both viral and bacterial neuroinfections (P < 0,001). Among the viral meningitis, high rates of albumin were found in patients with VZV of meningitis (P < 0.0001). There was no significant difference in CSF albumin levels of survivors and non-survived patients. On the 10th –12th day of treatment, the albumin level decreased in patients of all groups (P < 0.05), but remained high in bacterial neuroinfections compared with viral meningitis (P < 0.001).
Conclusions. The level of albumin in the CSF of patients with acute neuroinfections depends both on the severity and etiology of the disease. The highest levels of albumin are observed in patients with bacterial meningitis on the first day of hospitalization. The level of albumin in the CSF of meningitis patients does not matter in the prognosis of the lethal outcome of the disease.
Keywords: meningitis, cerebrospinal fluid, albumin, blood-brain barrier.
Аuthors: O. V. Rusanov,Y. D. Chumachenko
Introduction. Diabetic foot syndrome complicates the course of diabetes mellitus in 4–25 % of patients. The identification of the genetic components of type 2 diabetes is the most important part of research in diabetes, since the identification of candidate genes for diabetes will influence all efforts to understand the pathogenesis of the disease, its complications, diagnosis, treatment and prevention.
Purpose. The purpose of the study was to investigate the possible connection of the C677T polymorphism of the methylenetetrahydrofolate reductase gene with the development of diabetic foot syndrome.
Materials and Methods. The subject of the study was 154 patients with type 2 diabetes, complicated by diabetic foot syndrome, and 124 practically healthy individuals. To determine the polymorphism of the C677T gene, a polymerase chain reaction method was used, followed by an analysis of the length of the restriction fragments. The static analysis was performed using the SPSS 17.0 software package.
Results. The distribution of homozygotes by the main allele (C/C), heterozygote (C/T) and homozygote in the minor allele (T/T) amron patients with DFS was 39.0 %, 46.8 % and 14.3 %, respectively, in practically healthy people – 46 %, 48.4 %, 5.6 % respectively (P = 0.056 for χ 2-Pearson criteria). In homozygote T / T, the risk of developing DFS is greater than that of carriers of the main allele (C/C and C/T) (OR = 2.79; P = 0.02).
Conclusion. The M7FR gene of the C677T-polymorphism is associated with the development of diabetic foot syndrome in the Ukrainian population. In the homozygote for the minor allele T / T, the risk of developing VDS is greater than that of the carriers of the minor allele.
Keywords: diabetic foot syndrome, diabetes mellitus, endothelial dysfunction, gene polymorphism, methylene tetrafolate reductase.
Аuthors: O. L. Beley, M. Y. Goncharuk-Khomyn
Introduction. Given the inconsistency of existing data about the prospects and effectiveness of using blood plasma derivatives and the problem of optimizing dental rehabilitation approaches among older patients, the question of analyzing the success rate of implants inserted during the modification of iatrogenic intervention algorithms with the use of L-PRF and PRGF products remains relevant.
Purpose. To analyze the influence of blood plasma products enriched with thrombocyte-leukocyte elements and growth factors on the short-term results of dental implantation among elderly patients.
Materials and Methods. 46 patients among patients of University Dental Clinic (Uzhhorod) (24 females and 22 males) aged from 60 to 75 years with distal unrestricted defects of dental rows at the area of mandible were selected to take part in the study by their own agreement. In all patients implantation at the one side of the jaw was carried out according to the classic protocol (preparation of the area of osteotomy according to the classical pattern, implant placement with further suturing), but on the other side it was provided with the additional use of plasma derivatives in the form of L-PRF (21 patients – study group 1) and PRGF (25 patients – study group 2). All patients were diagnosed using cone-beam computer tomography (Planmeca ProMax 3D Classic). The assessment of the stability of dental implants was carried out by frequency resonance analysis using the Ostell device (Sweden). The assessment of bone tissue quality was performed by the Lekholm-Zarb scale, while the bone density estimation was performed in Hounsfield units in accordance with the Misch’s recommendations using Planmeca Romexis® Viewer software.
Results. Over the course of three months peri-implant lesions were registered among 9 implants (6.97 % of the total). From the standpoint of evaluating the implants success in each group, we can distinguish the following: in the group with the implementation of the classical protocol of implantation (control), the number of unsuccessful implants was 5 out of 53 (9.43 %); in the group where the implantation was performed using L-PRF the number of unsuccessful implants was 2 implants out of 40 (5.0 %) (study group 1); in the group where the implantation was performed using PRGF the number of unsuccessful implants was 2 out of 36 (5.56 %) (study group 2). The level of peri-implant complications in all study groups, given the size of the samples being studied, and the short observation period did not exceed 10 %, which can be considered an acceptable indicator of the effectiveness of the iatrogenic interventions. Potential factors that negatively impacted on the success rate of implants include the female gender among elderly patients and low density of bone tissue. Resorption rates of peri-implant bone level in the areas of L-PRF and PRGF use were lower compare to the control group, which confirms the fact that plasma derivatives contribute to retention of baseline parameters of bone tissue at least in the approximate time after implantation.
Conclusion. During the implementation of differentiated approach of dental implantation with the use of blood plasma products in the form of L-PRF or PRGF, it was determined that the use of platelet-leukocyte fibrin substrate contributes to better stabilization of dental implants 3 months after implantation procedure, and the use of both types of plasma blood derivatives reduces the dynamics of bone tissue reduction at the peri-implant region in a similar period of observation.
Keywords: L-PRF, PRGF, dental implant, success rate.
Аuthors: M. D. Chemych, V. V. Il’yina, N. I. Il’yina, N. G. Malysh, T. I. Fotina
Leptospirosis remains an issue of common zoonosis in many regions of the world. The level of morbidity depends on climatic conditions, sanitary and hygienic and economic conditions, and remains high every year in many countries, including Ukraine.
The aim of the work: to analyze the epidemiological situation and morbidity of leptospirosis in certain regions of Ukraine; to identify the dominant pathogens of the disease; to study the features of the clinical course of the disease and modern approaches to diagnosis.
Materials and methods. Official statistics was used, and patients with leptospirosis who were treated at the Sumy Regional Infectious Hospital named after Z. Krasovitsky were examined. A retrospective epidemiological analysis of leptospirosis in the Sumy oblast during 1994–2016 was carried out.
Results. In Ukraine, from 1993 to 1999, there was an increase in the incidence of leptospirosis, and since 2000 it has been gradually decreasing. Enzootic territories with leptospirosis are located around 373 settlements (practically in all regions of Ukraine). The most affected are Kyiv, Cherkasy, Kirovograd, Ivano-Frankivsk, Ternopil, Chernihiv oblasts and Kyiv, which account for 35–40 % of the total incidence of this infection in Ukraine. Among patients with leptospirosis, persons of working age (59.4 %), males (69.8 %), and rural residents (69.8 %) dominate. From the late 90's – early 2000's, a tendency towards an increase in the number of diseases caused by leptospirals of serotypes Icterohaemorrhagiae (> 60.0 %) is observed in Ukraine. In the Sumy region, 52.3 % of the patients were infected with tuberculosis, 31.0 % were in the natural, and 16.7 % had no source of infection. Currently, in the territory of the region in natural cells predominate leptospiri serogroups Grippotyphosa, in the smaller number – Pomona, Hebdomadis. In anthropogenesis centers, the leptospirosis of the serogroups Pomona, Grippotyphosa, Tarasovi, and Icterohaemorrhagiae prevail. Leading clinical symptoms: intoxication, fever, kidney and liver damage. To date, modern laboratory diagnostic methods – PCR and ELISA – are used to confirm the diagnosis.
Conclusions. Leptospirosis is an important common zoonosis, the level of which depends on climatic conditions, sanitary and hygienic and economic conditions. Among the pathogens, the leptospiri serotypes are dominated by Icterohaemorrhagiae. The leading clinical symptoms are intoxication, fever, kidney and liver damage. Modern diagnostic methods – PCR and ELISA – should be used to confirm the diagnosis.
The clinical course of leptospirosis in the Sumy region and other regions of Ukraine is not significantly different from the classical one. The leading syndromes are intoxication, hemorrhagic, kidney and liver damage.
Keywords: leptospirosis, epidemiology, morbidity, clinic.
Аuthors: Tsv. Vitkova, R. Enikova, M. Stoynovska
The current European legislation assigned the responsibility for food safety to the food producers and traders. The introduction and functioning of HACCP systems strives to achieve serious medical goals – consumer’s health protection, minimizing the risk for foodborne toxicoinfections, infections and intoxications, for chemical contamination and additives, as well as for other specific hazards. The approach is entirely preventive. The current experience has revealed numerous omissions and discrepancies in HACCP elaboration and functioning referring to the real extent of the hazard. This paper presents results from a critical analysis of the performance of HACCP systems in the production of confectionary, ready-to-serve foods, pasteurized egg products, sterilized canned foods, etc., highlighting the major defects in hazard analysis, adequacy of the critical points, correction activities, and verification procedures. Suggestions are provided concerning the optimization of the relationships between the producers and the control authorities aiming to eliminate the established system discrepancies.
Keywords: HACCP, microorganisms in foods, microbiological criteria, pasteurized egg products, confectionery products, vegetable canned foods, ready-to-serve dishes.
Аuthors: I. I. Vakalyuk, N. G. Virstyuk
Introduction. Coronary heart disease remains the main cause of mortality in middle and elderly ages in most countries of the world and leads to a high level of disability of the able-bodied population. In turn, nonalcoholic fatty liver disease often occurs on the background of cardiovascular diseases and is closely associated with the prothrombotic state. Moreover, the liver plays an immediate role in hemostasis, since most coagulation factors, anticoagulant proteins and components of the fibrinolytic system are synthesized by its parenchymal cells.
Aim. The aim of this study is to evaluate the effectiveness of antiplatelet therapy in patients with postinfarction cardiosclerosis on the background of nonalcoholic fatty liver disease in the stage of steatosis.
Materials and Methods. We examined 249 patients (aged 54.2 ± 5.3 years) with stable coronary heart disease. Among them 160 patients without nonalcoholic fatty liver disease (Group I) and 89 patients with nonalcoholic fatty liver disease in the stage of steatosis (Group II) were identified. Patients of Group II were divided according to the compliance with lifestyle recommendations. General-clinical examination, electrocardiography, echocardiography, coronary angiography, liver ultrasound, evaluation of liver functional state and platelet haemostasis, determination of the blood vascular soluble adhesion molecules levels were revealed to all patients. All patients received standard therapy, which included acetylsalicylic acid at a dose of 75 mg per day.
Discussion. It was established that the effectiveness of antiplatelet therapy by platelets aggregation activity parameters depended on the presence of nonalcoholic fatty liver disease and, accordingly, applied approaches to lifestyle modification. In particular, adequate effectiveness of antiplatelet therapy in patients without nonalcoholic fatty liver disease was proved. In addition, such effectiveness took place in patients with liver steatosis in the case of following by the recommendations of lifestyle modification. Nevertheless, a sufficient control of platelet haemostasis in such patients was not achieved under the influence of a three-month treatment. This necessitates the use of prolonged antiplatelet therapy in this category of patients. Consequently, the inclusion of recommendations of lifestyle modification to the complex treatment of the patients with stable coronary heart disease combined with nonalcoholic fatty liver disease in the stage of steatosis contributes to more effective control of platelet haemostasis and endothelial function compared with those who do not follow by the appropriate recommendations.
Keywords: stable coronary heart disease, nonalcoholic fatty liver disease, antiplatelet therapy.
Аuthors: I. H. Mudrenko
Actuality. A wide range of psychopathological comorbid disorders, including suicidal manifestations is observed in patients with dementia. Most often are met ideational types in the form of antivital mood, thoughts. The involvement of the neurodegenerative process in autoaggression is proved.
Purpose: to study the clinical features of patients with various types of dementia with high risk of suicide.
Materials and methods. There were examined 213 people with different clinical forms of dementia (vascular, caused by Alzheimer's disease of mixed type). The clinical-anamnestic method (clinical interview, observation, collection of complaints, anamnesis), psychometric (MMSE scale, Hamilton scale, method for determining suicide risk), Method of Statistical Processing of the Results were used.
Results of the research. The article highlights the relationship between the clinical features of patients with various types of dementia and the risk of suicide. The predictors of suicide in patients with dementia of Alzheimer and non-Alzheimer types are formulated on the basis of obtained data. The most important predictors in dementia caused by Alzheimer's disease are: early onset of the disease, atypical dementia or dementia of mixed type, mild cognitive impairment, comorbid depression; in case of vascular dementia, the predictor of suicide risk (SR) is a subcortical impression of white matter of the brain (leukoencephalopathy); in the mixed type of dementia process the SR was high in combination of dementia in Alzheimer's disease with early onset and subcortical vascular dementia, signs of dementia in Alzheimer's disease with late onset and unspecified vascular dementia, atypical dementia in Alzheimer's disease and multiple myocardial vascular dementia with additional depressive and hallucinatory symptoms.
To the factors of anti-risk of suicidal behaviour in dementia as a result of Alzheimer's disease are referred: early onset of the disease, severity of dementia, additional mixed psychopathological symptoms; in case of vascular dementia –presence of delusion in the clinical picture; in mixed dementia – combination of clinical signs of dementia in Alzheimer's disease with early onset and mixed or unspecified vascular dementia, the absence of comorbid psychopathological symptoms.
The obtained data are the symptoms-targets for the prevention of suicide in patients with dementia.
Keywords: vascular dementia, mixed dementia, dementia in Alzheimer's disease, suicidal behaviour, clinical predictors.
Аuthors: V. F. Orlovsky, L. B. Vynnychenko, N. V. Demikhova, O. G. Gayvoronska, R. V. Bezsmertna
An increased risk of developing cardiovascular complications was found in patients with community-acquired pneumonia (CAP). The literature review suggests that pneumococcal pneumonia, elder age, renal insufficiency, chronic obstructive pulmonary disease (COPD) and insulin-dependent diabetes mellitus are risk factors for cardiovascular events (CVE) in patients with pneumonia. The purpose of this study was to identify the peculiarities of the course of pneumonia in patients with CAP, to establish additional factors that lead to CVE.
A prospective study was conducted in 420 patients who were treated in the pulmonary and therapeutic departments of the Sumy Clinical Hospital No 1. Among them, men were 241 (57 %), women were 179 (43 %). The average age of patients was 56.1 ± 18.5. We evaluated the incidence of CVE, such as acute pulmonary edema, new cases and worsening of cardiac arrhythmias and worsening of chronic heart failure in patients with CAP. Patients with CVE were compared with those who did not have such events to identify additional factors that increase or reduce the risk of such complications.
The results of our research showed that CVE occurred in 51 (13 %) hospitalized patients with CAP. CVE in patients with CAP were more likely to occur in persons older than 65 years of age with atrial fibrillation (AF), hyperlipidemia and late admission. The most commonly in patients with CAP in combination with hyperlipidemia worsened the course of chronic heart failure (CHF). With a high pneumonia severity index (PSI), there is a high risk of pulmonary edema. Both risk factors, hyperlipidemia and high ITP, contribute almost equally to the onset of arrhythmia. The duration of treatment for patients with CVE was statistically higher, however, the early outcomes of patients with and without CVE did not differ statistically. Statins are drugs that improve the prognosis of patients with NF in combination with CVD.
Keywords: community-acquired pneumonia, cardiovascular events, atrial fibrillation, hyperlipidemia.
Аuthors: N. A. Maiura, M. G. Kononenko
Fitz-Hugh Curtis syndrome is an important and understudied factor that significantly affects the quality of life of patients. To date, there are no diagnostic standards that would enable to verify the Fitz-Hugh-Curtis syndrome. In the article on the example of a clinical case we considered the contemporary ideas about etiology and pathogenesis of Fitz-Hugh-Curtis syndrome as the causes of pain in the right upper quadrant of abdominal cavity. A 52-year woman presented with right-upper quadrant pain and digestive disorders during long time after laparoscopic cholecystectomy with no organic reason. Clinical and anamnestic features allow us to find the real reason of complaints and to use target antibacterial therapy. Widening of the ideas about the Fitz-Hugh-Curtis syndrome and orientation of general physicians and surgeons to the search for signs of generalized chlamydia is a direction of improvement of individual therapeutic and diagnostic tactics which helps to optimize the therapeutic process and avoid unnecessary surgical interventions.
Keywords: Fitz-Hugh-Curtis syndrome, perihepatitis, chlamydiosis, postcholecystectomy syndrome.
Аuthors: О. Kadykova
Introduction. Coronary artery disease and obesity have many common pathogenic mechanisms that lead to the development and growth of heart failure severity. Previous studies have indicated that the attention of scientists was focused on the study of the role of polymorphisms of genes at the pathogenesis of cardiovascular diseases and associated conditions. In particular, a number of studies have found that certain genotypes of polymorphisms of genes associated with neurohumoral activation, endothelial dysfunction, immune inflammation and adipocytokine and lipid metabolism disorders are associated with the pathogenesis of heart failure. There is evidence that the efficacy of treatment in patients with cardiovascular pathology depends, in particular, on genomic polymorphisms. At the same time, work in this direction is quite contradictory and the association of genetic polymorphisms with therapeutic efficacy in them is significantly different in different populations, which leads to the continuation of research in this direction.
The aim of the study. To evaluate the influence of different schemes of standard therapy of heart failure in patients with coronary artery disease and obesity with unfavorable genotypes of polymorphisms of genes and, in case of obtaining the likely differences, to develop differentiated treatment of this cohort of patients.
Materials and methods. As a result of randomization, two subgroups of observation were formed: 1 subgroup – 22 patients with coronary artery disease and obesity with unfavorable combinations of genotypes receiving enalapril in a daily dose of 20 mg, carvedilol in a daily dose of 50 mg and spironolactone in a dose of 50 mg per day; 2 subgroups – 20 patients with adverse combination of genotypes, patients with coronary artery disease and obesity who received lisinopril in a daily dose of 20 mg, nebivolol in a daily dose of 10 mg and eplerenone in a dose of 50 mg per day. The effect of therapy on the state of carbohydrate, lipid metabolism, anthropometric and cardiohaemodynamic indices was investigated.
Results and discussion. The study showed positive influence of standard therapy on indexes. There was a significant decrease in the levels of systolic blood pressure, diastolic blood pressure and heart rate in both subgroups. In the analysis of the effect of selected therapy on carbohydrate metabolism rates, no significant deviations were detected. A study of lipid profile in both subgroups after treatment an increase antiatherogenic fraction of high-density lipoproteins and decreasing levels proaterogenic triglycerides, low-density lipoproteins, very low-density lipoproteins and atherogenic factor. The study of changes in the parameters of cardiohaemodynamics demonstrated that the normalization of morpho-functional parameters of the heart was observed on the background of treatment, which was manifested by the decrease of end-systolic volume, end-diastolic volume, end-systolic size, end-diastolic size, mass of myocardium of left ventricular, and an increase of ejection fraction in both subgroups.
Conclusions. In short, analysis of the dynamics of indicators in patients with coronary artery disease and obesity with adverse combinations of genotypes showed that as a result of complex therapy there was an improvement in clinical picture, lipid profiles and cardiohaemodynamic indexes. At the same time, there was no significant difference in the shifts in the indices when different treatment schemes were used.
Keywords: heart failure, coronary heart disease, obesity, standard therapy, adverse combination of genotypes.
Аuthors: V. Z. Netyazhenko, P. P. Bidzilya, V. G. Kadjaryan
Today, chronic heart failure (CHF) is one of the main causes of death and disability among patients with cardiovascular disease. Despite the fact that significant progress has been made in the treatment and diagnosis of CHF, mortality rates remain high. The possible explanation for this is the increase in the age of the human population and the involvement of other mechanisms that have not yet been investigated to the pathogenesis of the disease. Recently, more and more attention of researchers is devoted to the study of the components of the exchange of adipocytokines, biologically active substances, which produced by visceral fatty tissue. One of the most interesting representatives of adipocytokines is adiponectin, which has a number of metabolic and pleiotropic effects. Scientists have proven a significant role in the pathogenesis of diabetes mellitus, lipid metabolism disorders, obesity and cardiovascular pathology. There are a number of studies that examined the effects of adiponectin on the development, course, and results of CHF. Disseminating thoughts of researchers regarding changes in the level of adiponectin in CHF conditions, some of them have shown hypoadiponectinemia, but more and more works have recently shown an increase in adiponectin content and its negative prognostic effect. The World Health Organization has reported obesity as a non-infection epidemic. The abdominal type of obesity and overweight remain one of the main predictors of the onset and progression of many diseases, and CHF in particular. However, recently, more and more works show the better course and results of disease in patients with moderate obesity. This was called as "obesity paradox". Taking into account the foregoing, the study of the effect of adiponectin content in serum on various pathogenetic components of CHF in patients with overweight and obesity is relevant and timely, in order to further develop prognostic criteria and therapeutic effects.
Purpose: to investigate clinical course of CHF, structural and functional changes in the heart, lipid, carbohydrate, adipocytokines metabolism and markers of systemic inflammation in patients with overweight and obesity depending on the serum content of adiponectin, to assess its prognostic effects on the five-year course of the disease.
Materials and methods. Totally 84 patients with CHF II–III functional class (FC) with overweight and obesity I–III degree were examined. Patients were divided into 2 groups depending on adiponectin content in blood serum. To the І group entered 21 investigated, with adiponectin content higher than 31,5 (40,4 [37,3; 47,2]) mcg/ml, the ІІ group was presented by 63 patients with the level of adiponectin lower than 31,5 (12,3 [8,50; 18,7]) mcg/ml. All patients were subject standard clinical, biochemical and to echocardiographic research, in obedience to the existent generally accepted guidelines. Content of adiponectin in serum of blood were measured by ELISA method. Statistical analysis were conducted by means of the licensed package of statistical software’s (Statistica 6.0).
Results. The high content of adiponectin in blood serum of patients with CHF with overweight and obesity was accompanied by higher heart rate, FC of disease, left atrium size, left ventricle posterior wall diameter, left ventricle myocardial mass index1, degree of calcinosis mitral and aortal valve, degree of regurgitation of mitral and tricuspid valve, increasing prevalence of subjective, objective symptoms of the disease, frequency CHF III FC, the content of IL-6, IL-10, TNF-α, the ratios of adiponectin/resistin, TNF-α / IL-10, the incidence of five-year mortality and total cumulative endpoint. At the same time, there were lower systolic blood pressure, left ventricle ejection fraction, very low-density cholesterol and triglycerides contents and resistin/adiponectin ratio. The obtained data indicate that the high content of adiponectin results in a heavier course of CHF in the conditions of overweight and obesity, which is manifested by the deepening of violations of clinical, echocardiographic, laboratory and humoral links pathogenesis of the disease.
Conclusion. The high content of adiponectin in serum of blood in patients with overweight and obesity characterized by a severe course of CHF and has a negative prognostic influence on the results of the disease for five years.
Keywords: heart failure, overweight, obesity, adiponectin.
Аuthors: О. D. Kibar, V. O. Kosovska, T. M. Kosovska, O. R. Shylo
Introduction. Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality globally. The severity of the course of CAP in childhood depends on difficulties with concomitant pathology, the state of the endocrine system and the immunity of the organism, especially among people living in conditions of endemic iodine deficiency.
The aim of the study was to study the features of intracellular distribution of iodine in the blood of children with community-acquired pneumonia (CAP) living in iodine deficiency areas.
Materials and methods. We investigated 74 children with CAP aged 4–14 years (45 children with moderate and 29 with severe pneumonia) and 35 healthy children. The severity of pneumonia in children was assessed according to the classification criteria of the disease. All children were assessed the level of iodine in the urine; inorganic iodine, total and organificated iodine in the blood.
Results. According to iodine median we detected mild iodine deficiency in all study groups (36.2 μg/L, 63.8 μg/L and 61.9 μg/L, respectively (p ˂ 0.05)). When examining the intracellular pool of iodine of patients from group I showed an inverse relationship between the levels of iodine distribution for organic and inorganic iodine (r = -0.737, p < 0.05), which tends to decrease depending on the severity of pneumonia. A close correlation between the levels of total and organic iodine (r = 0.538, p < 0.05) Data of group II patient indicate a slight decrease in the level of total and organificated iodine, as well as a moderate increase in the concentration of inorganic iodine in the blood of patients. These changes are less pronounced when compared with the results of group I, but statistically significant (p < 0.05). It has been established not significant reduction in organic and total iodine and not much increase in the level of inorganic form compared with the control (p ˂ 0.05). When carrying out the correlation analysis among Group I patients, we proved a close соrelation between the changes in the intracellular pool of iodine and the clinical and laboratory data characterizing the severity of the pathological process in pneumonia. In particular, a close relationship was found between the concentration of inorganic iodine and the sum of scores on the Pneumonia Severity Index (r = 0.783; p < 0.05). These data confirm the effect of severe pneumonia on changes in intracellular distribution of iodine in children.
Conclusions. The revealed changes in the indices of the intracellular pool of iodine and its distribution in the child's body are directly proportional to the severity of CAP.
Severe course of СAP in children could be caused by disruption of iodine organification in the body. Reduction in organic and total iodine and an increase in the level of inorganic form during persistent iodine deficiency lead to more severe course of pneumonia in children.
Keywords: pneumonia, iodine deficiency, intracellular iodine distribution.
Аuthors: M. P. Мelnychuk
Introduction. Prostate specific antigen (PSA) is a biochemical marker that is routinely used in prostate cancer detection, active surveillance and prognosis. In order to improve sensitiveness of PSA, additional parameters were developed such as PSA coefficient, PSA density, PSA velocity. In last decade a lot of investigations have been directed at the study of PSA role in prostate intraepithelial neoplasia diagnostics. Previous investigations had controversial results due to different approaches and patient numbers.
Purpose. To determine PSA role and significance in prostate intraepithelial neoplasia (PIN) diagnostics.
The use of total PSA, PSA coefficient, PSA density and PSA velocity in patients with high grade and low grade PIN was studied.
Materials and methods. The results of examination of 230 patients with PIN were assessed. Patients were divided into three clinical groups: high grade PIN (n = 156), combination of high and low grade PIN (n = 36) and low grade PIN (n = 38). PIN was diagnosed through prostate biopsy or after transurethral prostate resection. Such PSA characteristics as totalPSA, freePSA, PSA coefficient, PSA density and PSA velocity were studied with PIN grade consideration.
Discussion. There was a difference in values of PSA characteristics between high grade PIN and low grade PIN. Compared with normal values low grade PIN had no changes except minimal increase of total PSA (M = 6.1 ± 0.2 ng/ml). PSA coefficient, PSA density and PSA velocity had normal ranges in case of low grade PIN. This is an evidence of low diagnostic value of PSA parameters in low grade PIN detection. Low grade PIN benign prostate hyperplasia has similar properties according to investigation.
PSA parameters in high grade PIN cases differ a lot from those of low grade PIN and normal prostate. It was determined that high grade PIN influences similar way on PSA as prostate cancer. Patients with HGPIN had increased total PSA level (М = 8.4 ± 1.1 ng/ml), PSA coefficient value less than 20 % (М = 18.3 ± 1.3 %), increased PSA density level (M = 15.1 ± 1.8 ng/ml/сm3) and high ranges of PSA velocity.
Further study is required to stratify all PIN patients into groups of high malignisation risk in order to perform detailed examination and treatment.
Keywords: prostate specific antigen, high grade and low grade prostate intraepithelial neoplasia, PSA density, PSA velocity.
Аuthors: М. D. Chemych, N. G. Malysh, N. І. Іlina, V. V. Іlina
Rationale. Due to the stability of the natural cells of tularemia, the considerable spread of Francisella tularensis in nature, the multiplicity of routes of transmission of the pathogen, the complexity of the diagnosis and the severity of the clinical course of tularemia determine its significance in modern infectious pathology.
Purpose. Evaluate the epidemiological situation with tularemia in Ukraine and the world, to investigate the probable risks of its complication.
Materials and methods. The paper uses PubMed databases, EMBASE, reporting materials of the department of especially dangerous infections, field observations data and laboratory research results of the Sumy Regional Laboratory Center of the Ministry of Health of Ukraine. When processing materials used methods of epidemiological, statistical research, Excel program, Statistica 6.0.
Results. Tularemia is an endemic disease for non-arctic and paleoartic regions, found mostly in the northern hemisphere. In Ukraine and in adjacent to its borders, states of isolated cases of a disease on tularemia are registered. The main reservoirs of Francisellatularensis and sources of infection are rodents. Among the carriers a special place is occupied by ticks. Infection of people occurs more often in natural cells.
Conclusions. It is likely that the current epidemiological situation is "the tip of the iceberg", since this disease, due to its multiplicity, is not aetiologically verified, and the cases of tularemia that appear are hidden under the mask of other diseases. For objective assessment and prediction of the epizootic and epidemiological situation with tularemia in the region it is necessary to conduct a complete epidemiological monitoring.
Keywords: tularemia, Francisella tularensis, epidemiological situation, rodents, ticks.
Аuthors: I. Makagonov, A. Vergun, O. Vergun
Introduction. The most common background disease of the cervix is ectopia of the cylindrical epithelium (cervical ectopy). Pathological states of the vaginal part of the cervix are one of the leading problems in the structure of gynecological diseases in reproductive age women. The frequency of cervical ectopy is 38.8 %, and in the presence of other gynecological diseases it increases to 49.2 %.
Purpose. The aim of the study was to evaluate the efficacy and safety of the original medicinal product in the pharmacological form of vaginal tablets containing terinidazole 200 mg, neomycin sulfate 100 mg (65,000 IU), nystatin 100,000 IU, prednisolone sodium metasulfobenzoate 4.7 mg.
Materials and Methods. The complex examination of 98 patients of reproductive age with the firstly diagnosed or recurrent cervical ectopy with concomitant bacterial vaginosis was carried out and the results of clinical and laboratory studies of the efficiency and safety of complex treatment were analyzed. The main group included 49 women in whom, in order to normalize the state of the vaginal microbiota, the original complex drug containing ternidazole 200 mg; neomycin sulfate 100 mg (65,000 IU); nystatin 100,000 IU; prednisolone sodium metasulfobenzoate 4.7 mg (Tergynan, Laboratories du Docteur E Bouchara Recordati, France) was administrated intravaginally one tablet per day for ten days. The comparison group included 49 patients, for whom the correction of the vaginal microbiota state was carried out in accordance with the current recommendations.
Discussion. After the end of the treatment, there was a decrease in the total bacterial mass, the frequency of the detection of opportunistic microorganisms with an increase in the dynamics of the Lactobacillus spp. pool in the amount of more than 106 CFU/ml which persisted for the next three menstrual cycles in 46 (93.9 %) of the patients in the main group and in 29 (59.2 %) in the comparison group. As a result of the treatment, in 16 (32,7 %) patients of the main group and 11 (22,4 %) of the comparison group (P < 0,05) absence of cervical ectopy was diagnosed by colposcopy. High efficiency in correction of dysbiotic disorders, changes in the qualitative and quantitative composition of the microflora of the vaginal biotope, long-term positive clinical effect and good tolerability, reduction of the need for the destruction of the focal point of the lesion (elimination of the cervical ectopy in 32.7 % of women) allows to recommend the inclusion of vaginal tablets with an optimized composition into the complex treatment of reproductive age women with cervical ectopy with the concomitant bacterial vaginosis. The obtained results of our research data suggest that a significant frequency of recurrence of cervical ectopy in women of reproductive age is caused by ignoring the assessment of the state of the vaginal microbiota and the corresponding sanation before surgical interventions on the cervix.
Keywords: cervical ectopy, bacterial vaginosis, vaginal microbiota, complex treatment.
Аuthors: I. V. Marchenko, Ye. A. Harbuzova, Ye. I. Dubovyk, Ya. D. Chumachenko
Introduction. Type 2 diabetes mellitus (T2DM) is a multifactorial disease with leading genetic determinism. Full-genome association studies identified a large number of polymorphic loci associated with type 2 diabetes. One of the candidate genes is the Ectonucleotide Pyrophosphatase/Phosphodiesterase 1 (ENPP1) gene. Studies in humans have shown a correlation between ENPP1 polymorphisms, including rs997509 and type 2 diabetes mellitus, obesity, insulin resistance and metabolic syndrome in different populations of the world.
Purpose. Study of rs997509 polymorphic variant associations of ENPP1 gene with type 2 diabetes mellitus in patients with obesity in the Ukrainian population.
Materials and Methods. Venous blood of 317 patients with type 2 diabetes mellitus and 302 controls. All learners were genotyped was carried out using method of polymerase chain reaction with further analysis of restriction fragment length.
Discussion. The results of the study show that among the patients without obesity the ratio of genotypes in the experimental and control groups is not significantly different (P = 0.709). Among patients with type 2 diabetes and obesity, the distribution of genotypes C/C, C/T and T/T was 81 %, 19 % and 0 %, and in subjects without diabetes 92, 4 %, 7.6 % and 0 % (P = 0.024). There is a significant difference in the distribution of genotypes by rs997509 polymorphism among obese individuals. The method of binary logistic regression revealed a reliable association of the studied polymorphism with type 2 diabetes in the group as a whole (P = 0.017) and in the subgroup with obesity (P = 0.029).
Conclusion. It was shown that risk of T2DM development in T allele carriers is significantly higher compared to C/C homozygotes in patients with obesity (OR = 3.230; P = 0.023).
Keywords: type two diabetes mellitus, PC-1 gene, Ectonucleotide Pyrophosphatase/Phosphodiesterase 1, allelic polymorphism.
Аuthors: V. G. Mishchuk, G. V. Grigoruk
Introduction. Obesity is the cause of various diseases of the gastrointestinal tract, including dyskinesia of the large intestine with constipation, diverticular disease, polyposis of the large intestine. Among obese individuals, association with functional constipation is observed in 24.9 % of patients. Obesity is accompanied by various types of eating disorders, and violations of eating behavior contribute to constipation, abdominal pain and changes in sensitivity of serotonin receptors in the gut wall.
The purpose of the study is to investigate the nature of changes in eating behavior, its association with serotonin levels in patients with irritable bowel syndrome (SBS) and constipations on the background of obesity.
Materials and methods. The paper analyzes the frequency of various types of behavioral disorders identified by the Dutch Eating Behavior Questionnaire (DEBQ) and the level of serotonin in each of them. In patients with IBS and constipation on the background of obesity and IBS with constipation as an independent disease.
Results. Emotional type of eating behavior was found in patients with IBS and constipation on the background of obesity more than in half of cases, which is 1.86 (p ˂ 0.05) times more often than in patients without excessive body weight. The external type was found in 13.46 % and 16.67 % of patients in both groups. In IBS with constipation as a distinct disease, restrictive type of eating behavior was found 1.9 times more often (57.69 %, p ˂ 0,05) than in IBS with constipation on the background of obesity (29.76 %). The lowest concentration of serotonin in the blood of patients with IBS with constipation was observed in restrictive type of eating behavior (23.3 ± 1.4 ng/ml). In external and emotional variants, serotonin levels were slightly higher and equaled 28.9 ± 1.5 and 32.5 ± 1.3 ng/ml, respectively. In the obese subjects on the background of obesity, serotonin levels in the blood were elevated compared to healthy subjects without disturbances in eating behavior (39.11 ± 2.99 ng /mg) to 103.5 ± 3.4ng/ml with a restrictive and up to 208.3 ± 18.7 and 215.6 ± 14.4ng/ml, p1,2 ˂ 0.05 in external and emotional types.
Conclusion. In case of eating disorders in patients with IBS with constipation on the background of obesity there are more severe violations of serotonin levels, especially in the external and emotional types, and timely correction of eating behavior will improve the mechanisms of regulation of these comorbid pathologies.
Keywords: irritable bowel syndrome with constipation, obesity, eating behavior, serotonin.
Аuthors: F. O. Volokh, K. A. Arkhypova, A. I. Fisun, V. O. Malakhov
The present work is a part of the multidisciplinary study on optimizing therapy for chronic neurological disorders. This part of research is dedicated to an assessment of treatment efficiency and monitoring rehabilitation process of patients with hypertensive encephalopathy of early- and middle-stage. The article presents the results of the study of the state of the membrane-cellular complex of erythrocytes in order to reveal functional changes, diagnosis and prognosis of chronic cerebral ischemia of hypertonic genesis of various stages (hypertensive encephalopathy (HE) of the first (I) and the second (II) stages) in the course of the therapy. For this purpose, a comprehensive study of the structural and functional state of the sympathoadrenal system, as a leading link in the pathogenesis of cardiovascular and cardiocerebral diseases, has been performed. The examination of blood cell membrane adrenergic activity, as an important criterion of the nervous and cardiovascular systems, during the course of patients’ treatment has been carried out using a complex of physical and biochemical methods. Thus, we have opted for two techniques of in vitro adrenergic receptors sensing via monitoring drug-induced red blood cells' response to a beta-blocker (propranolol). The first one refers to a change in osmotic fragility of red blood cell membranes under the effect of beta-blocker and exploits a principle of hemolysis inhibition in the presence of beta-blocker which binds to beta-adrenergic receptors (beta-ARs) thus reducing the damage degree. Beta-ARs activity is numerically expressed by beta-ARM index. The second one is about tracing dielectric characteristics of blood cells using extra-high frequency (EHF) dielectromentry. The concept of dielectric blood sensing involves iterative measuring blood samples under in vitro effect of adrenergic-like substances (beta-blockers, adrenalin) using the waveguide-based reflectometry at a fixed frequency of 39.5 GHz. The main strategy of the study is to detect reproducible permittivity changes (Δε*) as a response to the pharmaceutical action of beta-blocker. Both methods were performed as the repeated measurements of the parameters under study during the therapy at the beginning, on 10th day, and 60th day of follow-up.
The analysis has shown a clear correlation between the level of beta-adrenergic activity and the stage of HE. It was revealed that the degree of beta-adrenergic receptors activity of erythrocytes decreases with the progression of HE. Specifically, the quantitative assessment of beta-adrenergic receptor activity of erythrocytes between 26 and 45 units and even above should be considered a sign of hyperadrenergic states caused by pathological process.
The obtained results of the dielectric examination also allow monitoring the functional state of adrenergic activity of patients in the course of treatment at the cellular level. It has been shown that dielectric in vitro reactions of blood cells under the influence of beta-blocker depend on the physiological state of patients. The change in the effect size and its sign of erythrocyte dielectric permittivity specifically reflects the direction of the pathological process. Reduction of dielectric reactivity of blood cells in response to in vitro effects of beta-blockers from -0.3 to +0.3 units should be considered a prognostic indicator, which depends on the severity of HE. Thus, determining the index of permittivity of erythrocytes and comparison between groups in patients with HE is advisable in order to predict the transition of pathology from one stage to another. Relative values of dielectric permittivity correlate with the parameters of beta-ARM, thus indicating the relationship between the dielectric characteristics and the structural/functional properties of blood cells depending on the physiological state of a patient. The data obtained by the methods applied are well-correlated and are of great interest for monitoring efficiency of treatment for chronic neurological conditions.
Keywords: beta-adrenergic activity, hypertensive encephalopathy, ЕHF dielectrometry, osmotic fragility, erythrocytes.