Medicni perspektivi, 2017;22(4).

    Title of the issue

Content

 

2017 Vol. XXII N 4

 

THEORETICAL MEDICINE

Bondarenko I.M., Zavizion V.F., Artemenko M.V., Hojouj M.I., Maltseva L.O., Bilenkyi І.V., Hurtovyi V.А., Lohvynenko V.V., Prokhach A.V. Possibilities of immunogistochemical investigation in respons prognosis to treatment and modification of treatment activities at luminal breast cancer (literature review)

https://doi.org/10.26641/2307-0404.2017.4.117658

Key words: breast cancer, immunohistochemical investigation, hormonal therapy

Abstarct. Possibilities of immunogistochemical investigation in respons prognosis to treatment and modification of treatment activities at luminal breast cancer (literature review). Bondarenko I.M., Zavizion V.F., Artemenko M.V., Hojouj M.I., Maltseva L.O., Bilenkyi І.V., Hurtovyi V.А., Lohvynenko V.V., Prokhach A.V. This article is concerned with both standard (estrogen and progesterone receptors, Her2/neu and Ki67) immu­nohistochemical investigation in hormonal therapy tactics decision for luminal breast cancer and additional in­vestigation of such hormonal sensibility marker as cyclin D1, Bcl-2, AIB1, Her1, p53, IGF-IR, COX-2 and its influence on modified hormonal therapy impact on tumor. It was shown that tumors expressing Her2/neu, AIB1, Her1, p53 or tumors, that have more than 30% expression of cyclin D1 are resistant to antiestrogen but sensible to aromatase inhibitors. IGF-IR and COX-2 tumors are resistant to aromatase inhibitors. Metformin usage for IGF-IR hyperexpression and oxygenase selective inhibitors for COX-2 expression promotes sensibility increase for aromatase inhibitors.

 

Biletska E.M., Shtepa O.P., Kalinicheva V.V., Valchuk S.I. Study of modification of zinc status of laboratory animals in conditions of low dosage action of lead and zinc in various forms

https://doi.org/10.26641/2307-0404.2017.4.117661

Key words: lead, zinc, elements, bone

Abstract. Study of modification of zinc status of laboratory animals in conditions of low-dose action of lead and zinc in various forms. Biletska E.M., Shtepa O.P., Kalinicheva V.V., Valchuk S.I. In recent years the steady trend to growth of the technogenic load of the environment closely correlates with deterioration of the health status of the population, chronic diseases and worsening of demographic indicators. One of the main threats to human health from contamination with heavy metals is associated with the influence of lead, which contributes to the development of chronic diseases of the nervous, hematopoietic, endocrine, renal and bone systems. In the process of studying the properties of zinc, its use as an osteoprotective agent is becoming more actual. In connection with the foregoing, the aim of our study was to study the content of zinc in bone tissue in low-dose isolated and combined effects of various forms of lead and zinc under the experimental conditions. For the experiment, sexually mature Wistar rats with a body weight of 150-170 g were selected, with the following randomization into six experimental and one control group, eight rats in each one. The data obtained and their comprehensive analysis allow to fully suggest the formation of a bioantagonistic relationship between lead and zinc in the bone at the level of the latter, observed both in the isolated action of lead and in combination with zinc. Along with this, our results correspond with the data of other researchers on the osteoprotective properties of zinc under the action of even low-dose levels of lead, especially of its nanoacqualate form (zinc citrate).

 

Kuzmina A.P., Lazarenko O.N. Arterial hypertension and gout: the current state of the problem
(literature review)

https://doi.org/10.26641/2307-0404.2017.4.117662

Key words: arterial hypertension, gout, antihypertensive drugs, urat-lowering therapy

Abstract. Arterial hypertension and gout: the current state of the problem (literature review). Kuzmina A.P., Lazarenko O.N. An important aspect of the family doctor's work is the management of patients with comorbid pathology. Pathogenetic mechanisms of interrelation, as well as the bi-directionality of the association of arterial hypertension and gout are actively studied. By data analysis of literature, in many developed countries of the world there are shortcomings in the management of patients with gout at the primary stage. There is a need to improve the quality of management and prescription of combinations of basic therapy drugs for the treatment of patients with hypertension in combination with gout at the primary stage.

  

CLINICAL MEDICINE

Volosovets A.O. Analysis of arterial pressure variability in patients with acute cerebral stroke depending on the time of occurrence

https://doi.org/10.26641/2307-0404.2017.4.117663

Key words: ischemic stroke, arterial pressure, patchy vibration, monitoring

Abstract. Analysis of arterial pressure variability in patients with acute cerebral stroke depending on the time of occurrence. Volosovets A.O. Arterial hypertension can cause a pronounced negative influence on the state of the cerebral vascular system and lead to significant microtraumatization of the walls of the vessels and disruption of vascular autoregulation. This predictor has the greatest influence on the onset of ischemic stroke of atherothrombotic and lacunar subtypes, however, hypertension occurs almost in all patients with acute cerebral ischemia. Interesting and not at all presented in modern scientific literature is the question of the relationship of oscillation of blood pressure with the period of the onset of the focus of ischemia, which predetermined the purpose of our work. The purpose of our study was to determine the relationship between deformation of the profile of fluctuations in blood pressure of patients in the acute period of ischemic stroke, depending on the time of the occurrence of cerebrovascular accident. We examined 300 patients who suffered acute ischemic stroke (men - 196, women - 104) aged 42 to 84 years (average age - 65.2 ± 8.7 years). All patients were divided into 3 groups according to the period of the day when an ischemic stroke occurred: 1 group (n=146), patients suffering from cerebral ischemia during the day (8.00-14.59); In group 2 (n=107), patients stroke was observed in the evening (15.00-21.59); Group 3 (n=47), patients had an ischemic stroke at night (22.00-7.59). For the 1st group of patients who have had ischemic stroke during the day and as a rule with an increase in blood pressure, a marked increase in blood pressure was at 12.00 and 15.00 and a tendency towards compensatory parasympathetic effect in the form of blood pressure decrease at night (over-dipper) was typical. At the same time, in the 2nd group of patients with stroke in the evening, elevated blood pressure at 18.00 and 21.00 and parasympathetic activity disorders with prevalence of insufficient reduction of blood pressure in the evening and during sleep (non-dipper) was observed. For patients with a nocturnal stroke (3rd group), there were two peaks of elevated blood pressure at 9.00 and 21.00 and a significant increase in night-peaking at night, which usually resulted in a cerebrovascular catastrophe. Sharp changes in human biorhythm significantly affect the violation of the regulation of the vegetative-vascular system and lead to a breakdown in the regulation of vascular tone with the emergence of phenomena of "vegetative storm" and sharp increase in blood pressure by the type of "night peacker". This effect is also caused by chronic alcohol intoxication, presumably due to the toxic damage of the hypothalamic-pituitary complex due to the high permeability of the blood-brain barrier in this area of the brain due to over-active hormonal-regulatory diffusion.

 

Pertseva N.O., Chub D.I. Glycosylated hemoglobin as a forecast factor of progressing of diabetic nephropathy in patients with diabetes type 1

https://doi.org/10.26641/2307-0404.2017.4.117665

Key words: diabetes mellitus, diabetic nephropathy, glomerular filtration rate, lipidogram, albuminuria

Abstract. Glycosylated hemoglobin as a forecast factor of progressing of diabetic nephropathy in patients with diabetes type 1. Pertseva N.O., Chub D.I. The aim of the study was to propose a mathematical model for prediction of development of diabetic nephropathy in patients with diabetes mellitus by determining the level of glycosylated hemoglobin - as a factor in the development and progression of diabetic nephropathy. A survey of 136 patients with type 1 diabetes was performed in the endocrinology department of the OSH «Clinic of the Medical Academy», Dnipro in 2016-2017. Clinical laboratory examination included: determination of the level of glycosylated hemoglobin (HbA1c), level of blood creatinine, level of albuminuria. The GFR was calculated by the formula CKD-EPI. The obtained results of the study, using methods of correlation and regression analysis, show a clear correlation between the GFR score in patients with diabetes mellitus and the level of glycosylated hemoglobin. Statistical methods of analysis have shown that the level of glycosylated hemoglobin can be considered as an early predictor of development of diabetic nephropathy. The mathematical equation of prognosis for the onset of diabetic nephropathy can be used to determine the prognosis for the development of diabetic nephropathy in diabetes mellitus patients in clinical practice for the timely inclusion of patients with a high prognostic risk in a group requiring more stringent glycemic control.

 

Pysarevska K.O., Zharinov O.I. Model for predicting long-term sinus rhythm retention after electrical cardioversion in patients with persistent atrial fibrillation

https://doi.org/10.26641/2307-0404.2017.4.117666

Key words: persistent atrial fibrillation, electrical cardioversion, prognosis

 Abstract. Model for predicting long-term sinus rhythm retention after electrical cardioversion in patients with persistent atrial fibrillation. Pysarevska K.O., Zharinov O.I. The aim - to create a model for predicting long-term sinus rhythm retention after electrical cardioversion (ECV) based on individual patients characteristics. 141 patients with persistent AF who were planning to have sinus rhythm restoration, underwent general clinical examination, ECG and transthoracic echocardiographic. In 6 months after ECV patients were divided into two groups: 83 patients maintained sinus rhythm for 6 months (group I), recurrence of AF was observed in 58 patients (group II). The results of the ROC analysis determined statistically significant parameters that contribute to long-term retention of the sinus rhythm: non-modifiable (age, history and duration of the last episode of arrhythmia, combination of background diseases), modifiable (smoking, antiarrhythmic therapy, severity of heart failure by NYHA). A multifactorial prognostic model is created with the help of the modern approach of creating scorecards. This allowed in the form of a numerical characteristic to determine the probability of a long retention of the sinus rhythm. The selection of factors for the scoring model was in accordance with the criteria of the power of their influence on the retention of the sinus rhythm. The scoring model was created for predicting long-term retention of sinus rhythm after electrical cardioversion based on the individual characteristics of a patient with a persistent form of AF. The model has a high sensitivity (92.77%) and specificity (70.69%) and allows to predict the further course of the disease and to correct the therapy on time.

 

Pertseva N.O., Еiner K.М. Features of the influence of subclinical hypothyroidism on the cardiovascular system

https://doi.org/10.26641/2307-0404.2017.4.117667

Key words: Subclinical hypothyroidism, lipid metabolism, postprandial hyperlipemia, endothelial dysfunction, variability of arterial pressure, tissue dopplerography, segmenary diastolic function

Abstract. Features of the influence of subclinical hypothyroidism on the cardiovascular system. Pertseva N.O., Еiner K.М. Dysfunction of the thyroid gland has serious consequences for the state of the cardiovascular system. In conditions of deficiency of thyroid hormones, the production of a number of cellular enzymes decreases, that leads to the development of dyslipidemia, insulin resistance, endothelial dysfunction, arterial hypertension, abnormalities in the blood coagulation system, oxidative stress. is a risk factor for cardiovascular disease because associated with dyslipidemia, insulin resistance, arterial hypertension, oxidative stress, endothelial dysfunction, disorders in the blood coagulation system and, thus, atherosclerosis. Subclinical hypothyroidism, as a risk factor for cardiovascular disease, does not have a specific symptomatology, it remains unrecognized for a long time, and by the time the development of manifest hypothyroidism leads to irreversible changes in the cardiovascular system. Detection of abnormalities at the phase of subclinical hypothyroidism and the timely assignment of replacement therapy will avoid an additional risk of cardiovascular pathology. The absence of a unified position in regard to subclinical hypothyroidism does not allow to adopt clear clinical recommendations. Data on the efficacy and need for levothyroxine replacement therapy are contradictory due to the absence of randomized clinical trials. This review article examines mechanisms of the influence of subclinical hypothyroidism on various types of metabolism, methods of diagnosing disorders caused by subclinical hypothyroidism and their modification under the influence of replacement therapy.

 

Tsarev A.V., Usenko L.V. Comparative evaluation of control and safety of therapeutic hypothermia in the intensive care of severe traumatic brain injury

https://doi.org/10.26641/2307-0404.2017.4.117669

Key words: trauma brain injury, therapeutic hypothermia, target temperature management, intensive care

Abstract. Comparative evaluation of controllability and safety of therapeutic hypothermia in the intensive care of severe traumatic brain injury. Tsarev A.V., Usenko L.V. The article presents the results of a comparative study of control and safety of two technologies of therapeutic hypothermia in intensive care in patients with TBI: an estimate of the rate of its induction, control of its maintenance, dynamics of attaining normothermia. A total of 24 patients with a severe TBI divided into 2 groups were examined: I (n=12) – therapeutic hypothermia with "Blanketrol II" (CSZ) with the use of non-invasive technology to achieve the target core body temperature (Tco) of 34-34.50C; II group (n=12) – carrying out therapeutic hypothermia «Blanketrol - II» with the use of an esophageal device for hypothermia to achieve Tco - 34-34,50С. The mean time from the moment of induction to achievement of the target Tco in group I was 9.5±2.39 hours, in group II – 9±2.70 hours (p>0.05). The maintenance period Tco at the level of ≤34.50C in the II group was greater – 10.5±5.78 compared with 6.83±3.95 hours in patients of the I group (p<0.05). Control of the warming process was significantly higher in group II, which was reflected by a lower mean of Tco value at 24, 28 and 32 hours. There were no clinically significant adverse effects in therapeutic hypothermia.

 

Grek L.P. Peculiarities of systemic violations in patients with genital endometriosis in combination with benign diseases of genitalia and syndrome of chronic pelvic pain

https://doi.org/10.26641/2307-0404.2017.4.117670

Key words: genital endometriosis, chronic pelvic pain, cytokines ІL-10, ІL-6, TNF-α, depression

Abstract. Peculiarities of systemic violations in patients with genital endometriosis in combination with benign diseases of genitalia and syndrome of chronic pelvic pain. Grek L.P. The aim of the work is determination of intercommunication of cytokines ІL-10, ІL-6 levels, TNF-α with subjective estimation of pain, processes of the nervous system desadaptation in patients with genital endometriosis in combination with benign hormonal pathology of the genitalia followed by chronic pelvic pain (CPP). There were 120 women in research divided into several groups, depending on visual analogue scale (VAS) and durations of disease: 1st group (n=44), VAS was 7-10 points; 2-d group (n=41) VAS – 4-6 points; 3-d group (n=35) VAS – 0-3 points. Along with progress of CPP there was marked decline of cytokines ІL-10, and increase of ІL-6, TNF -α comparatively with 3-d group (р<0,05); this correlated with the higher points of intensity of pain syndrome in the 1st group, with pain anamnesis duration and increased level of anxiety and depression. Imbalance of cytokines towards the proinflammatory link in definite clinical provoking factors of pain can be considered as a predictor of CPP.

 

Krishtafor D.A., Klygunenko O.M. The dynamics of markers of a shock state in traumatic blood loss depending on fluid resuscitation type

https://doi.org/10.26641/2307-0404.2017.4.117672

Key words: multiple trauma, bleeding, bleeding management, multiple organ failure, liberal fluid resuscitation, restrictive fluid resuscitation

Abstract. The dynamics of markers of a shock state in traumatic blood loss depending on fluid resuscitation type. Krishtafor D.A., Klygunenko O.M. The aim of the study was to determine the effect of quantitative and qualitative changes in fluid resuscitation on the dynamics of markers of the shock state in patients with multiple trauma. 73 patients with multiple trauma were divided into two groups, depending on the fluid resuscitation type (liberal or restrictive). The parameters of hemodynamics, hourly diuresis, general blood test, coagulogram, acid-base and gas composition of blood were studied. A decrease in the infusion volume in traumatic blood loss due to the restriction of the crystalloids and colloids volume allowed to effectively reduce such manifestations of shock as hypotension, tachycardia and acidosis, to provide an adequate rate of diuresis. In restrictive infusion group the duration of vasopressor support was shorter, the fluctuations in peripheral blood parameters were less pronounced, coagulation normalized earlier, positive water balance was significantly lower, mortality and the number of complications were reduced. Restriction of fluid resuscitation volume allows to successfully treat shock and decrease multiple organ dysfunction, number of complications and mortality.

 

Filippova A.Yu., Gubar I.A., Rudakova V.V. Prediction of course and progression of nonalcoholic fatty liver disease in patients with obesity and pathology of the biliary tract with the help of mathematical modeling

https://doi.org/10.26641/2307-0404.2017.4.117674

Key words: nonalcoholic steatosis, nonalcoholic steatohepatitis, obesity, biliary tract, mathematical modeling

Abstract. Prediction of course and progression of nonalcoholic fatty liver disease in patients with obesity and pathology of the biliary tract with the help of mathematical modeling. Filippova A.Yu., Gubar I.A., Rudakova V.V. Determination of the most important functional parameters of the liver, lipid peroxidation (LPO) and antioxidant protection (AOP) markers of endogenous intoxication and indicators of connective-tissue metabolism in patients with non-alcoholic fatty liver disease (NAFLD) associated with obesity and pathology of the biliary tract and development of criteria for predicting the likelihood of the transformation of non-alcoholic steatosis (NAHS) to non-alcoholic steatohepatitis (NASH) using mathematical modeling was performed. The data of patients with different clinical stages of NAFLD in combination with obesity and BT pathology were analyzed: the study group consisted of patients with NASH (n=100) and control group – patients with NAHS (n=100). The diagnosis of NAFLD and pathology of BT was established on the basis of anamnesis, clinical and instrumental (ultrasound imaging of the abdomen) examination. The body mass index was determined according to the Quetelet formula. Thymol test, total protein level and protein fractions in blood serum, the concentration of molecules of average weight (MSM) and their fractional composition were investigated. The condition of the LPO system was evaluated by the concentration of malondialdehyde, schiff bases and intermediate LPO products. The AOP was assessed by the activity of superoxide dismutase and catalase in the hemolysate of erythrocytes. The process of fibrosis was evaluated according to the content of free oxyproline, total oxyproline and protein-binding oxyproline, hexosamines. According to the correlation analysis 30 factors that increase the risk of transformation of NAHS in NASH (p<0.05) were selected. ROC-analysis was conducted with the definition of factor levels that provides the maximum difference between the compared groups in terms of sensitivity and specificity. Logistic regression model was built basing on certain criteria for distinguishing between different NAHP stages. Logistic regression model was built with the coefficients В0=-2,610 and В1=0,157 (p<0.001 by Student's t test and Wald), the adequacy of the model – χ2=131.4; p<0.001. Designed logistic regression model allows to predict the progression of non-alcoholic steatosis to steatohepatitis stage in persons with obesity and pathology of the biliary tract with the help of laboratory data with indicators of sensitivity – 83.0%, specificity – 91.0%, forecast accuracy – 87.0%, validity – 76.1%.

 

Schevchenko-Makarenko O.P., Schostakovych-Korets'ka L.R., Chykarenko Z.O., Tkachenko V.D., Lisnicha O.O. Evaluation of life quality of patients with chronic hepatitis C

https://doi.org/10.26641/2307-0404.2017.4.117677

Key words: quality of life, chronic viral hepatitis C, co-infection HIV / HCV questionnaire, CLDQ

Abstract. Evaluation of life quality of patients with chronic hepatitis C. Schevchenko-Makarenko O.P., Schostakovych-Korets'ka L.R., ChykarenkoZ.O., Tkachenko V.D., Lisnicha O.O. The article presents the adap­tation data of the quality of life questionnaire (QOL) in patients with chronic viral hepatitis C (CVHC). Ball score of QOL of patients with CVHC was 5.09±1.04, 2nd group (with co-infection with HIV / HCV) - 4.60±1.13, control group - 5.92±0.52 (p<0.05)). The results of the analysis show that co-infection HIV / HCV is a serious problem for patients and significantly affects QOL. The use of the QOL questionnaire for chronic liver disease is a sensitive tool for measuring QOL in patients with CVHC and co-infection HIV / HCV. This informative and economical method can be implemented to assess the patient's health both at the group and individual levels in patients with chronic liver disease in the population of Ukraine.

 

 

Duka R.V. Characteristics of the lipid profile in patients with morbid obesity before and after surgical treatment, depending on the type of surgical intervention

https://doi.org/10.26641/2307-0404.2017.4.117678

Key words: morbid obesity, surgical treatment, biliopancreatic shunting, longitudinal gastrectomy, lipid metabolism

Abstract. Characteristics of the lipid profile in patients with morbid obesity before and after surgical treatment, depending on the type of surgical intervention. Duka R.V. Excessive deposition of adipose tissue in the body is often associated with dyslipidemic disorders and various risk factors for cardiovascular disease. The abdominal-visceral form is a serious predictor of cardiovascular mortality. The aim of the study was to establish the prevalence of lipid metabolism disorders in patients with morbid obesity and to evaluate the influence of surgical methods of treatment, namely biliopancreatic shunting in the Hess-Marceau modification and longitudinal gastrectomy in the postoperative period on the degree of correction of dyslipidemia in these patients. 57 patients (36 (63.2%) women and 21 (36.8%) men) with morbid obesity were in-depth examined, age from 21 to 62 years (mean age 40.0±1.38 years), who were under observation at the Department of Surgery N 1, SE "DMA". Significant violations of lipid metabolism in these patients were revealed, which significantly correlated with indicators of excessive body weight. There were established general trends towards a significant decrease (p <0.001) of body mass index and BMI in patients of both groups after 3 months from the start of treatment, which led to a significant improvement in lipid metabolism.

 

Zakharov S.V. Diagnostic capabilities of non-treponemal and treponemal reactions in the early forms of syphilis

https://doi.org/10.26641/2307-0404.2017.4.117679

Key words: early forms of syphilis, serological diagnosis, immunoblotting

Abstract. Diagnostic capabilities of non-treponemal and treponemal reactions in the early forms of syphilis. Zakharov S.V. A comparative analysis of the sensitivity and specificity of immunoblotting against other non-treponemal and treponemal reactions was carried out in 215 patients with early forms of syphilis. A high diagnostic efficiency of immunoblotting in patients with early latent syphilis was established. It was found that only in case of primary syphilis, immunoblotting is inferior to Immunofluorescence reaction; this test can be used for differential diagnosis between hidden syphilis and false positive reactions to syphilis.

  

OUR HEROES OF THE DAY

Loskutov O.Ye., Oleinik O.Ye., Synegubov D.A. Friendship lasting for 20 years (to the jubilee of Ukrainian-German Association of Orthopedist Traumatologists)

https://doi.org/10.26641/2307-0404.2017.4.117681