Medicni perspektivi, 2018;23(2).

     Title of the issue

Content

 2018 Vol. XXIII N 2

Published
2018-06-19

THEORETICAL MEDICINE

Rodynskyi O., Basysta K., Guz L. Neurochemical and behavioral processes in gerontogenesis in conditions of experimental hyperglycemia

https://doi.org/10.26641/2307-0404.2018.2.133691

Key words: experimental diabetes, experimental hyperglycemia, alloxan, diabetic encephalopathy, glial fibrillary acidic protein

Abstract. Neurochemical and behavioral processes in gerontogenesis in conditions of experimental hyperglycemia. Rodynskyi O., Basysta K., Guz L. Many researchers are increasingly interested in the relation between diabetes and diabetic encephalopathy. At the moment, there are various experiments where this issue is considered. But despite prolonged studying, it is impossible to investigate this problem to the end. Cognitive deficit in hyperglycemia is also connected with aging. In the aging processes as in hyperglycemia the same pathogenetic factors play a role in the aging of the brain. It is also necessary to deeply analyze the neurochemical processes occurring in the brain in diabetes mellitus. The high incidence of complications is caused by tissue metabolism impairment in hyperglycemia. The study of neurochemical bases of brain activity is one of the leading and promising directions in the modern neuropathology. Scientists of different countries are searching for neurospecific damage markers of the brain substance in hyperglycemia.

  

Poslavska O.V., Shponka I.S. Squamous cell carcinoma of unknown primary localization: isolated lesion of cervical lymph nodes

https://doi.org/10.26641/2307-0404.2018.2.133692

Key words: CUT, squamous cell carcinoma, lymph nodes of the neck, ImageJ

Abstract. Squamous cell carcinoma of unknown primary localization: isolated lesion of cervical lymph nodes. Poslavska O.V., Shponka I.S. Cancers of unknown primary localization (CUPL) are a heterogeneous group of metastatic neoplasias for which a standardized diagnostic examination did not determine the primary localization of the origin. In 5% of histological form of CUPL is squamous cell carcinoma, which, in the case of an isolated lesion of the cervical lymph nodes is treated as a "favorable phenotype". Tactics of treatment of such a CUPL is suggested in both primary local squamous cell carcinoma (SCC) of the, head and neck with regional lymph nodes involvement (T1-3N1-3M0) and in 25% -30% of patients leads to a 5-years survival rate. This calls for the use of an immunohistochemical method for the accurate verification of the histological form of an isolated metastasis of the cervical lymph nodes and use of the appropriate therapy. In the work 62 samples of isolated lesions of the cervical lymph nodes with carcinomas without another established primary localization for the period 2015-2017 were investigated. The control group consisted of 12 samples of SCC of the head and neck of the known localizations. The immunohistochemical panel of markers included Cytokeratin Pan, Vimentin, CD45, S100, Cytokeratin HMW, Cytokeratin 7, Cytokeratin 20, p63, TTF1. The parameters of the areas, perimeters and “roundness” of the nucleus were determined in the ImageJ pro­gram. The aim of the study was to investigate the complex of morphological, morphometric and immunohistochemical characteristics of SCC without primary localization with isolated lesion of the cervical lymph nodes, in comparison with other histological forms and control group of SCC of the head and neck of the known localizations to improve diagnostic algorithms. A difference in the distribution of histological forms for all CUPL with isolated lesion of the cervical lymph nodes was determined in the predominance of SCC, in comparison with the general distribution of histological forms for all CUPL. Similarity of morphometric parameters of metastatic SCC of subgroup 1 (phenotype of Cytokeratin, Pan AE1 / AE3 (+) / Cytokeratin HMW (+) / p63 (+) / Cytokeratin 20 (-) / TTF1 (-) / Vimentin (- / +) / Cytokeratin 7 (- / +)) with samples of the control group of SCC of the head and neck of known localizations. The es­tablished decrease in the size and "roundness ratio" of the nuclei of the SCC cells is a reflection of the weighting of cellular atypia and correlates with the polymorphism of the nuclei and decrease in the degree of differentiation of the SCC.

  

Savchenko O.A., Shponka I.S. Analysis of the level of expression of pancytokeratins in epithelial and granulocellular tumors of the ovaries

https://doi.org/10.26641/2307-0404.2018.2.133693

Key words: epithelial ovarian tumors, granulo-cellular tumors, immunohistochemistry

Abstract. Analysis of the level of expression of pancytokeratins in epithelial and granulocellular tumors of the ovaries. Savchenko O.A., Shponka I.S. Differential diagnosis of ovarian neoplasms is carried out among groups of epithelial and granulocellular tumors and remains an actual problem of oncogynecology. In general, epithelial tumors  occur (up to 60%), but granulocellular cell tumors account for up to 5% of all ovarian neoplasia. Materials and methods. A retrospective study of 43 observations of ovarian tumor lesions over the period of January-December 2017 was conducted in the work. The aim of the study was to analyze the complex of morphological and immunohistochemical characteristics of Cytokeratin, Pan AE1 / AE3 - negative phenotypes and Cytokeratin, Pan AE1 / AE3 - positive phenotypes of ovarian neoplasia to improve diagnostic algorithms. Results. The phenotype of epithelial ovarian tumors in 100% of observations corresponds to pancytokeratin Cytokeratin, Pan AE1 / AE3 "+", in its turn the phenotype of granulocellular tumors basically responded to expression of the Cytokeratin marker, Pan AE1 / AE3 "-" in 62.5%; and the variant in the part of the cells "+" / "-" Cytokeratin, Pan AE1 / AE3 was found in 37.5% of granulocellular tumors, regardless of their malignant potential. Thus, granulocellular tumors have variable expression of the Cytokeratin marker, Pan AE1 / AE3 and require the inclusion of other diagnostic IGH markers in the primary panel.

  

CLINICAL MEDICINE

Kuryata O.V., Muhammad Muhammad, Mytrokhina O.S. Changes of the level of galectin-3, β-2-microglobulin, albuminuria and end glycation products in patients with chronic heart failure and atrial fibrillation under the influence of treatment

 https://doi.org/10.26641/2307-0404.2018.2.133695

Key words: chronic heart failure, atrial fibrillation, galectin-3, β-2-microglobulin, albuminuria, glycation end products

Abstract. Changes of the level of galectin-3, β-2-microglobulin, albuminuria and end glycation products in patients with chronic heart failure and atrial fibrillation under the influence of treatment. Kuryata O.V., Muhammad Muhammad, Mytrokhina O.S. The combination of chronic heart failure and atrial fibrillation is considered one of the most prognostically unfavorable alliances among cardiovascular diseases. Now the need for new markers as potential targets for therapeutic intervention is being actively discussed. To date, active study of cardiorenal syndrome continues, which in turn leads to an active search for drugs that reduce nephrologic risk, especially in the category of people with a combined cardiovascular pathology. The aim of the study was to compare the effects of irbesartan and ACE inhibitors on the level of galectin-3, β-2-microglobulin, albuminuria and end glycation products (AGE) in patients with chronic heart failure with atrial fibrillation and impaired renal function. The results of the effect of drugs in patients with chronic heart failure and atrial fibrillation are presented and analyzed. The data indicate the need for more careful attention to this group of patients, namely, the need to diagnose the functional of the kidneys, which is very important for the development of effective interventions aimed at preventing the progression of these diseases. 

  

Khaniukov O.O., Vasylieva L.I., Yehudina Ye.D, Kalashnykova O.S. Modern tactics of managing patients with pulmonary arterial hypertension associated with systemic connective tissue diseases

https://doi.org/10.26641/2307-0404.2018.2.133696

Key words: pulmonary arterial hypertension, systemic connective tissue diseases, systemic scleroderma

Abstract. Modern tactics of managing patients with pulmonary arterial hypertension associated with systemic connective tissue diseases. Khaniukov O.O., Vasylieva L.I., Yehudina Ye.D., Kalashnykova O.S. A review of the literature on the problem of one of the rare manifestations of systemic diseases - pulmonary arterial hypertension is presented. The necessity of early and thorough differential diagnosis, verification of the diagnosis using invasive methods for assessing central hemodynamics is substantiated. A model for screening patients with systemic scle­roderma, which simplifies the determination of indications to set the research methods that allow to verify the diagnosis is proposed. Modern approaches to drug therapy are described, and questions of improving the patients’ survival with this prognostically unfavorable pathology are discussed.

  

Mankovsky G.B. Diagnostics of impaired carbon metabolism in patients with ischemic heart disease

https://doi.org/10.26641/2307-0404.2018.2.133698

Кey words: diabetes mellitus, prediabetes, fasting plasma glucose, glycated hemoglobin, oral glucose tolerance test, ischemic heart disease, coronarography

Abstract. Diagnostics of impaired carbon metabolism in patients with ischemic heart disease. Mankovsky G.B. Aim of the study – to investigate the prevalence of earlier non-diagnosed type 2 diabetes mellitus and prediabetes using different diagnostic approaches in patients with angiographically confirmed ischemic heart disease. Materials and methods. We studied 89 patients with ischemic heart disease, mean age 62+3,6 years. All patients had angiographically confirmed atherosclerotic lesions of coronary arteries. No patient had previously diagnosed diabetes mellitus or hyperglycemia in anamnesis. All patients underwent the detailed examination to reveal hidden diabetes or prediabetes, earlier non-diagnosed: glucose tolerance, fasting plasma glucose, glycated hemoglobin were measured and standard oral glucose tolerance test was performed. Results. Based on the results of fasting plasma glucose and oral glucose tolerance test, diabetes mellitus was diagnosed in 14 (16%) patients studied, elevated glycated hemoglobin suggesting the presence of earlier non-diagnosed diabetes was found in 11 (12%) patients. Each of the 3 diagnostic approaches used allowed to diagnose patients with non-diagnosed earlier type 2 diabetes mellitus and there were no statistically significant differences in the prevalence of earlier non-diagnosed diabetes depending on the method of diagnostics used, p>0.05. Prediabetes was diagnosed much more frequently – in 47 (53%) patients while measuring glycated hemoglobin, in 43 (48%) patients based on fasting plasma glucose levels and in 28 (31%) patients according to elevated plasma glucose levels 2 hours after taking glucose. Conclusions. Our data revealed high prevalence of earlier non-diagnosed type 2 diabetes mellitus and prediabetes in patients with ischemic heart disease. The measurement of fasting plasma glucose, glycated hemoglobin and oral glucose tolerance test contribute each other in diagnostics of diabetes and prediabetes in the majority of cases.

  

Pertseva N.O., Khrustaleva L.O. Assessment of the dynamics of depressive disorders in patients with coronary heart disease depending on the method of restoration of blood supply to the heart

https://doi.org/10.26641/2307-0404.2018.2.133699

Key words: ischemic heart disease, myocardial revascularization, depression

Abstract. Assessment of the dynamics of depressive disorders in patients with coronary heart disease depending on the method of restoration of blood supply to the heart. Pertseva N.O., Khrustaleva L.O. The aim of the study was to assess the symptoms of depression during a 1-years observation in patients with coronary heart disease, depending on the method of restoration of blood supply to the heart. The study included 215 patients with ischemic heart disease who during 2010-2016 received treatment in the departments of cardiology, interventional cardiology and cardiac surgery of KU «Dnepropetrovsk Regional Clinical Center of Cardiology and Cardiosurgery DOR». All patients underwent invasive coronary angiography and were administered conservative or surgical treatment - aortocoronary bypass grafting or stenting of the coronary arteries. The level of depression was determined by Zung’s Self-Rating Depression Scale – SDS three times: at the initial stage of treatment, after three months and 1 year after treatment. It was determined that in patients with IHD, the frequency of depressive states and conditions close to them varies from 81.97% (95% CI 70.53 to 89.62) in patients who are prescribed bypass and to 98.55% (95% CI 92.24 - 99.74) in patients with conservative treatment. The vast majority of patients in all groups are represented by patients with mild or masked depression. 4.71% of cases of true depression in the coronary artery stenting group and 5.8% – in the conservative treatment group were revealed. According to the correlation analysis, the dependence of the average depression level on the chosen treatment method was found (ρ=0.19; р=0.027). The choice of a surgical or conser­vative method of treatment can affect general level of mood and indirectly – quality of life in the long-term period.

  

Krishtafor D.A., Klygunenko O.M. Comparative characteristics of liberal and restrictive fluid resuscitation in multiple trauma

https://doi.org/10.26641/2307-0404.2018.2.133939

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

Abstract. Comparative characteristics of liberal and restrictive fluid resuscitation in multiple trauma. Krishtafor D.A., Klygunenko O.M. The aim of the study was a comparative analysis of components in liberal and restrictive fluid resuscitation and their effectiveness. 90 patients with multiple trauma divided into two groups, depending on the fluid resuscitation type (liberal or restrictive) were studied. Infusion components in 1st day, intraoperative blood loss, ICU and hospital stay length, number of complications and lethality were investigated. Restrictive fluid resuscitation type in multiple trauma was characterized by a decrease of total infusion volume in ml/kg in 1st day by 34.8%, including crystalloids – by 34.2%, colloids – by 71.4% with a constant volume of FFP and erythrocytes. Balanced crystalloid solutions were used more often, and solutions of potassium and magnesium asparaginate and glucose, high-molecular HES and dextranes were not used at all. Blood components were introduced earlier. Volume of intraoperative blood loss decreased by 34.0%, the frequency of complications – by 1.6 times, the mortality rate – by 2 times.

  

Kondratiuk V.A. Parenchymal-stem segmental portal vein embolization as a stage of preparation of patients with malignant liver tumors to surgical treatment

https://doi.org/10.26641/2307-0404.2018.2.133940

Key words: portal portal embolization, hepatic resection

Abstract. Parenchymal-stem segmental portal vein embolization as a stage of preparation of patients with malignant liver tumors to surgical treatment. Kondratiuk V.A. Article presents results of the study of the parenchymal-stem segmental portal vein embolization (PVE) efficacy, performed in patients with advanced malignant liver tumors and a marginally small hepatic residue as preoperative preparation. The technical efficiency of PVE was studied by comparing 218 patients who underwent parenchymal-stem segmental modification of PVE (main group) and 124 patients who underwent other PVE modifications (comparison group). It was noted that in the main group PVE was followed with 6.1% lower percentage of complications (6.0% versus 12.1%), which allowed to perform a successful technical EEV in 205 (94.0% main and 124 (83.9%) the comparison group. Radical liver resection was performed in 286 (83.6%) of the total amount of patients, 192 (88.1%) – in the main group, and 94 (75.8%) – in the comparison group. Thus, the introduction of parenchymal-stem segmental embolization of the portal vein allowed to expand the range of operability of patients with advanced malignant liver tumors by 12.3% (from 75.8% to 88.1%).

Lуtvуn К.Yu. Diagnostic significance of the determination of myelin basic protein in cerebrospinal fluid in HIV-associated neurological diseases

https://doi.org/10.26641/2307-0404.2018.2.133941

Key words: HIV infection, HIV-associated neurological diseases, myelin basic protein, cerebrospinal fluid, ROC-analysis

Abstract. Diagnostic significance of the determination of myelin basic protein in cerebrospinal fluid in HIV-associated neurological diseases. Lуtvуn К.Yu. 48 patients aged from 21 to 54 years, infected with human immunodeficiency virus (HIV) and presence of diseases of the central nervous system (CNS) were examined. CNS diseases included cerebral tuberculosis, viral encephalitis (caused by Epstein-Barr Virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV)), encephalitis of unspecified etiology, cerebral toxoplasmosis, fungal meningitis. 29 (60.4%) of the patients were discharged from the hospital with a clinical improvement, and 19 (39.6%) of the patients died as a result of CNS disease. Significant differences in the content of the myelin basic protein (MBP) in the cerebrospinal fluid (CSF), depending on the outcome of the disease, were determined. The Median of MBP in deceased patients was 2.9 times higher than in the survived patients - 4.00 (1.90-7.70) ng/ml vs. 1.40 (0.99-2.00) ng/ml (p=0.002 U). An inverse correlation between the content of MBP in the CSF and the time from the determination of the HIV status to the manifestation of neurologic symptoms (rs=-0.30, p<0.05) was found. According to the results of the ROC analysis, the high risk of unfavorable course of HIV-associated CNS diseases is predicted when the concentration of MBP in the cerebrospinal fluid increases by more than 2 ng/ml (68.4% sensitivity, 75.9% specificity, 72.9% accuracy). The highest level of this protein was observed in patients with fungal lesions of the central nervous system (6.6 (1.9-7.8) ng/ml), and the lowest MBP level – in the group of patients with unspecified encephalitis (0.99 (0.9-1.1) ng/ml), which correlated to more favorable outcomes of the disease. The MBP in cerebrospinal fluid can be an important diagnostic and prognostic marker of HIV-associated neurological diseases.

  

Zozulia I.S., Nesukai V.G. Clinincal variants of trancient neurological deficit in patients with the neck osteochondrosis

https://doi.org/10.26641/2307-0404.2018.2.133942

Key words: vertebral basilar system, transient ischemic attacks, neck osteochondrosis, clinical syndromes

Abstract. Clinincal variants of trancient neurological deficit in patients with the neck osteochondrosis. Zozulia I.S., Nesukai V.G. With the purpose of studing frequency and variability of clinical symptoms there were observed 130 patients after transient ischemic attack (TIA) in a vertebrobasillar pool  (VBP) on a background of neck osteochondrosis, verified from MRI, CT data or sciagraphies of the neck portion of the spine with functional tests. The analysis did not include patients with the signs of acute or past chronic stroke. After systematization of complaints  and symptoms four clinical syndromes were selected: ophthalmic (OPS), vestibuloatactic (VAS), cochleovestibular (CVS) and  local neurological symptoms (LNS) among which VAS and CVS appeared in 27.9 and 31.2% of young patients, respectively, and in 33.3 and 27.3% of the elderly ones. In patients with OPS, visual impairment was more frequent (in 63.6% of patients) and predominantly in women with a frequency of 62.5%, in patients with VAS - dizziness, which occurred in 74.2% of women and 90.0% of men, with  CVS - noise in the ear (68.4%) without a gender difference, in patients with LNS the frequency of hemiparesis/hemiplegia was 34.5% and prevailed in patients of the older age group (50.0 versus 15.4% in young patients).

  

Rossokha Z.І., Kyriachenko S.P., Gorovenko N.G. Comparative evaluation of genetic risk models of reproductive disorders caused by MTHFR, MTRR, MTR1 gene polymorphism

https://doi.org/10.26641/2307-0404.2018.2.133943

Key words: inheritance models, reproductive disorders, polymorphic variants, MTHFR, MTRR, MTR1, genes

Abstract. Comparative evaluation of genetic risk models of reproductive disorders caused by MTHFR, MTRR, MTR1 gene polymorphism. Rossokha Z.І., Kyriachenko S.P., Gorovenko N.G. The scientific literature presents contradictory data about influence of folate metabolism genes polymorphism on development of risk of reproductive disorders. The aim of the study was to determine the role of MTHFR, MTRR, MTR1 gene polymorphism in the development of reproductive disorders by evaluation of genetic risk models of inheritance. 658 patients with reproductive disorders from all Ukrainian regions were examined. The data from population studies presented in the online resource (1000 genomes) served as comparison group. There were no reliable risk models for polymorphic variants of MTHFR gene. We identified 3 and 4 significant inheritance models for MTRR and MTR1 genes respectively. The best inheritance models were the dominant model for MTRR gene and the additive model for MTR1 gene. The polymorphic variants frequencies of the studied genes did not differ among men and women. Further analyse is necessary for evaluation of genetic polymorphism and intergenic interactions influence on reproductive disorders risk, taking into account folate metabolism indices and exogenous factors.

  

Banakhevych R.M., Akimova К.В., Pariienko K.O. Prevention of complications after surgical treatment of colpocystocele

https://doi.org/10.26641/2307-0404.2018.2.133944

Key words: cystocele, surgery, complications, prophylaxis, rehabilitation

Abstract. Prevention of complications after surgical treatment of colpocystocele. Banakhevych R.M., Akimova К.В., Pariienko K.O. 78 women with the diagnosis of cystocele were examined. The average age of the examined women was 61.5±9.3 years, the age of women in the control group was 56.7±1.8 years (p>0.05). The results of postoperative treatment in postmenopausal women are evaluated. After the treatment on the day 33 after the ope­ration, the cytological aspirate from the vaginal cavity testified to the completion of the healing process of the vaginal wall surface in the physiological regime in 93.8% of the women in the main group and in 63.3% of the women in the comparison group. Inflammatory type of smear is established in 5.8% of women in the main group and in 32.0% of wo­men in the comparison group (p<0.05). Development of purulent process in the surgical intervention zone was observed in 1 (2.1%) patients of the main group and in 3 (10.0%) patients in the comparison group (p<0.05). The activation of reparative processes was observed against the background of treatment with preparations containing promestriene.

  

Grek L. Pathogenetic aspects of treatment of patients with genital endometriosis and syndrome of chronic pelvic pain in combination with

https://doi.org/10.26641/2307-0404.2018.2.133945

Key words: genital endometriosis, "proliferative syndrome", СРР, ER, PGR, Ki-67, VEGF, COX, treatment

Abstract. Pathogenetic aspects of treatment of patients with genital endometriosis and syndrome of chronic pelvic pain in combination with "proliferative genital syndrome". Grek L. The aim of the work is to ascertain the efficiency of the use of an offered way of the complex treatment of the patients with genital endometriosis and combined benign pathologies of genitals and СРР. A differentiated approach to treatment and analysis of its effectiveness was conducted among the patients of the 1st and 2nd study groups (85 patients) with the severe and moderate pain syndrome according to the VAS scale. On the basis of analysis of immunohistochemical markers ER, PGR, Ki-67, VEGF, COX-2 in glands and in stroma the therapy was developed: Severe pain syndrome was eliminated in all patients within 3 months of treatment. A moderate level of pain was noted in 77.65%, after 12 months of observation in 16.47% of women, the remaining 83.53% noted a weak level of pain by VAS scale (p<0.05). The level of depression dropped (from 11,22±0,5 baseline to 5,98±0,24 in a year, p<0,001) by the Hamilton scale. This indicates the effectiveness of treatment.

  

Starostina О.А. Determination of mean values of the number, perimeter and area of CD34-positive vessels and evaluation of VEGF expression in skin biopsy specimens of patients with vascular forms of rosacea

https://doi.org/10.26641/2307-0404.2018.2.133946

Key words: vascular forms of rosacea, CD34, VEGF, age groups

Abstract. Determination of mean values of the number, perimeter and area of CD34-positive of rosacea vessels and evaluation of VEGF expression in skin biopsy specimens of patients with vascular forms. Starostina О.А. Rosacea is characterized by marked involvement of the central face with transient or persistent erythema formation, telangiectasias, inflammatory papules and pustules and hyperplasia of the connective tissue. The formation of telangiectasia of the surface and intermediate sections of the dermis is an important chain of pathogenesis of vascular forms of rosacea. Modern literature sources allow to attribute this disease to the group of angioproliferative diseases, which are based on the activation of the inflammation and angiogenesis. This leads to the need of studing the mechanisms of vascularization due to growth factors of the vascular components or their receptors in rosacea. The aim of the study was to calculate the mean values of the perimeters and areas of CD34-positive vessels, to evaluate the intensity of expression of the VEGF marker in the skin biopsies of patients with vascular forms of rosacea and to determine the possible dependence of these parameters on the age of the patients. In the work, an immunohistochemical analysis of the material of 11 patients aged 21 to 63 years (mean 40,0±12,49, median 36 years) with a clinical diagnosis of the vascular form of rosacea was performed. Branching, dilatation and induration of the capillary mesh were the typical changes in the dermis in vascular forms of rosacea. which were observed throughout the length of the incisions with an increase in the direction "from the top down", especially around the sebaceous glands and hair follicles. It was established that the mean values of the number, perimeters, and areas of CD34-positive vessels in rosacea biopsy specimens, as well as the levels of VEGF expression, were significantly higher than those of healthy skin (all p<0,05).

  

Mashchenko I.S., Kucherenko T.O. Clinical and pathogenetic substantiation of the use of Wobenzim in the complex treatment of generalized periodontitis

https://doi.org/10.26641/2307-0404.2018.2.133947

Key words: generalized periodontitis, wobenzym, monotherapy

Abstract. Clinical and pathogenetic substantiation of the use of Wobenzim in the complex treatment of generalized periodontitis. Mashchenko I.S., Kucherenko T.O. The purpose of this study was to determine the efficacy of using Wobenzim as a general therapy in the complex treatment of generalized periodontitis. 61 patients, I-II degree of severity, with tooth safety in an amount of at least 90%, without concomitant general pathology requiring treatment for the current time were examined. Comparative effectiveness of treatment was studied in 2 groups similar in all clinical indices. The main (31 people) patients, along with the symptomatic treatment received Wobenzim; control (30 people) - polytherapy (immunocorrecting, antioxidant, antimicrobial agents). As a result of the generally accepted clinical, paraclinical, immunological and biochemical studies conducted during the treatment and at long-term follow-up, it was found that the use of systemic enzyme therapy in this category of patients ensures rapid regression of the main clinical symptoms (on days 6-7), elimination of pathogenetic links of the disease more than in 90% of treated patients and the onset of remission for at least 6-12 months. It is characteristic that during the monotherapy with Wobenzim, positive results of treatment of generalized periodontitis were achieved, similar to those with the use of complex standard therapy, including administration of a number of medications with targeted action on pathogenesis mechanisms of the disease. From the position of evidence-based medicine, the expediency of replacing a broad arsenal of medicines in the complex treatment of generalized periodontitis with certain pharmacological preparations with a systemic effect is justified.

  

Sheiko S.О., Kolb N.О. Optimization of treatment of patients with arterial hypertension in combination with coronary heart disease

https://doi.org/10.26641/2307-0404.2018.2.133948

Key words: arterial hypertension, ischemic heart disease, combined therapy

Abstract.Optimization of treatment of patients with arterial hypertension in combination with coronary heart disease. Sheiko S.О., Kolb N.О. Arterial hypertension (AH) is one of the most important risk factors for atherosclerosis, mainly coronary heart disease (CHD) and damage to the brain vessels. Especially often there is a combination of CHD and hypertension. There is a great need in systematizing the approaches to antihypertensive therapy in patients with coronary artery disease, as well as treating coronary artery disease in patients with hypertension. The aim of this work was to study the clinical efficacy and adherence to treatment of patients with hypertension in combination with CHD with a fixed combination of β-adrenoblockators bisoprolola fumarate (5 mg) and calcium channel blockers - amlodipine (5 mg) (alothedine). The use of alotdine in patients with hypertension and coronary artery disease with a high cardiovascular risk provides a significant anti-ischemic effect in combination with a clear antihypertensive effect. Normalization of daily blood pressure monitoring in patients at high risk shows a significant positive result which affects the long-term prognosis of the disease and the development of complications. The fixed combination of bisoprolol and amlodipine provides a high degree of patients’ adherence to treatment.

  

Sorokina E.Yu., Belykh L.S., Panin A.N., Nikitina E.V., Kovrizhin I.A., Strah O.P. Assessment of gastrointestinal dysfunction in selection of an effective method of nutritional support in patients with acute pancreatitis

https://doi.org/10.26641/2307-0404.2018.2.133950

Key words: acute severe pancreatitis, intraperitoneal pressure, dyspepsia, intestinal insufficiency, nutritional support methods

Abstract. Assessment of gastrointestinal dysfunction in selection of an effective method of nutritional support in patients with acute pancreatitis. Sorokina E.Yu., Belykh L.S., Panin A.N., Nikitina E.V., Kovrizhin I.A., Strah O.P. Potential mortality in acute pancreatitis (AP) is 5%. Patients with AP represent II type of intestinal insufficiency, which occurs on the background of dyspeptic syndrome and increased intra-abdominal pressure (IAP). IAP is a differentiated indicator. With the increase of IAP more than 10 mm Hg, intra-abdominal hypertension (IAH) arises. Increasing IAP to this level is considered as safe. Monitoring of IAP level allows to achieve better clinical results. Totally 47 patients with acute pancreatitis were examined. Depending on the function of the gastrointestinal tract and the selected type of starting nutritional support (NS), they were divided into 2 groups. The first group consisted of IAH patients of I degree and dyspeptic syndrome who underwent parenteral nutrition (PN) with 3-component compounds begun on the 2nd day of disease and after restoration of gastrointestinal tract function a late enteral feeding (LEF) was performed. In the second group, patients with AP were initially diagnosed with elevated IAP at a safe level and dyspeptic syndrome. They were prescribed early enteral nutrition (EEN) with specialized blends from the 2nd day of disease. In 2 days a significant reduction in pain syndrome with the persistence of dyspeptic syndrome and intestinal insufficiency (II) was recorded. In patients with intra-abdominal hypertension, total parenteral nutrition is the effective method of nutritional support, against which, after 5 days manifestations of dyspeptic syndrome and IAP indices decrease to a safe level. Therefore in-time detection of high level of intra-abdominal pressure in patients with acute pancreatitis can help to choose a more rational method of nutritional support.

  

Muslin V.P., Pohorielov O.V. Meldonium and neuroprotection. Theory, experiment and clinical practice

https://doi.org/10.26641/2307-0404.2018.2.133951

Key words: meldonium, cerebral protection, cerebral glycolysis, acute cerebral ischemia

Abstract. Meldonium and neuroprotection. Theory, experiment and clinical practice. Muslin V.P., Pohorielov O.V. In this review the possibilities of correction of brain metabolism in cases of acute cerebral ischemia (ACI) under using meldonium were considered. The biochemical specificity of this remedy in Krebs cycle, influence on cerebral glycolysis, by activating the stress-limiting system, lactate-glutamate and glycogen mechanisms of the biochemical shunt were discussed. There were described effects of meldonium on cerebral processes that can be conditionally separated into carnitine-dependent and carnitine-independent. Results of experimental research of meldonium proved certain metabolic influence on NMDA receptor system. The analysis of the results of experimental and clinical studies makes it possible to consider that any neuroprotective pharmacological remedies have comparatively low efficacy in cases of acute cerebral ischemia. Meldonium effects do not differ from others similar neuroprotective remedies in such cases. In experimental works meldonium can improve metabolism in central nervous system (CNS) and would be considered as a pharmacological remedy that creates conditions for optimizing and economizing metabolism of the CNS. Meldonium in experimental conditions (predominantly in mice) can help to optimize metabolism of glucose in the CNS, especially aerobic glycolysis that creates opportunities to form economizing way of the basic metabolism. In target usage of the drug in the experiment a "smooth exit" from the ischemic state and decrease of the negative effects of oxidative stress is possible. Possible areas and clinicaly unproved efficiency of the drug in ACI should be considered while planning therapy of ACI and at the stages of rehabilitation.

  

Oprya Ye.V. Peculiarities of clinical development of schizophrenia with comorbid somatic disorders

https://doi.org/10.26641/2307-0404.2018.2.133952

Key words: schizophrenia, cardiovascular diseases, diabetes mellitus of type II, obesity, clinical-psychopathological characteristics

Abstract. Peculiarities of clinical development of schizophrenia with comorbid somatic disorders. Oprya Ye.V. In order to identify the clinical features of schizophrenia associated with somatic diseases, 186 patients with schizophrenia (50 patients with schizophrenia with cardiovascular diseases, 42 patients with schizophrenia with type 2 diabetes, 44 patients with schizophrenia with obesity and 50 patients with schizophrenia without chronic somatic diseases) were surveyed. Socio-demographic, clinical-dynamic and clinical-psychopathological features of schizophrenia (according to PANSS scale), connected with somatic diseases in a comparative aspect with patients with schizophrenia without somatic pathology were studied. It was found that somatic pathology combined with schizophrenia aggravates psychopathological symptoms, modifies clinical manifestations of schizophrenia and is associated with decrease in the level of social realization of patients, increase in the number of hospitalizations and a significant course of psychotic process. Among clinical features of schizophrenia with somatic disorders there was defined: in cardiovascular diseases - the presence of hallucinatory behavior, hypochondrial ideas and anxiety-depressive symptoms; in type 2 diabetes - hallucinatory activity in combination with excitement, impulsivity, hypochondrial ideas, depressive symptoms, and attention deficit, in obesity - the prevalence of negative symptoms over positive, expressed social rejection, depletion of social contacts and the presence of depressive experiences.

  

Safarova Sain Sattar The impact of metabolic changes in type 2 diabetes on bone turnover

https://doi.org/10.26641/2307-0404.2018.2.133953

Key words: diabetes mellitus, insulin, bone remodeling

Abstract. The impact of metabolic changes in type 2 diabetes on bone turnover. Safarova Sain Sattar. This article carried out analyzes which helps to identify risk factors associated with bone metabolism changes, and to determine indicators that are informative in terms of predicting the risk of low-traumatic fractures observed in patients with type 2 diabetes mellitus. This study revealed some correlation between serum insulin level, bone metabolism markers and bone mass density determined at the lumbar DXA in patients with type 2 diabetes mellitus. This suggests that the presence of type 2 diabetes in anamnesis aggravated violation of disturbances of bone remodeling, thus contributing to the development of osteoporosis. The purpose of this study was to identify complex relationships between the mineral, organic component of bone and the risk of fractures under the influence of metabolic changes associated with type 2 diabetes. This study suggests that obesity and hyperinsulinemia can not be bone-protective factors, this is confirmed by the growing body of evidence that points to the importance of measuring bone remodeling markers in combination with bone mineral density in assessing and predicting the risk of fractures. Clarification of the role of insulin in assessing bone health remains a matter of debate.

  

Abdulaziz Abdullah Alqarni, Radhi Ghanem Alanazi, Anthony Morgan, Ahmed Saud Alharbi, Faisal Fahad Aljuaid, Abdulrahman Mohammed Aldawsari, Faisal Khaled Almugrin, Abdulaziz Nasser Alaskar, Yazeed Mohammed Aldhfyan, Abdullah Abdulrahman Alqeair. Injuries Type and its Relation with Glasgow Coma Scale, Injury Severity Score and Blood Transfusion in Road Traffic Accident Victims

https://doi.org/10.26641/2307-0404.2018.2.133954

Key words: injuries type, Glasgow Coma Scale, injury severity score, blood transfusion, road traffic accident

Abstract. Injuries type and its relation with Glasgow Coma Scale, injury severity score and blood transfusion in road traffic accident Victims. Abdulaziz Abdullah Alqarni, Radhi Ghanem Alanazi, Anthony Morgan, Ahmed Saud Alharbi, Faisal Fahad Aljuaid, Abdulrahman Mohammed Aldawsari, Faisal Khaled Almugrin, Abdulaziz Nasser Alaskar, Yazeed Mohammed Aldhfyan, Abdullah Abdulrahman Alqeair. Motor Vehicular Accidents claim about 1.2 million lives and injure more than 10 million people annually worldwide. The injuries caused by MVAs can be analyzed based on the type of injury, injury severity score, Glasgow Coma Scale and required blood transfusion. Methodology: A total number of 190 patients were included in this retrospective study from January 01, 2010 to December 31, 2015. The study aimed to determine the correlation between the type of injuries and GCS, ISS, and blood transfusions in the patients suffering from Motor Vehicle Accidents, who were presented to the Emergency Department at the King Khalid Hospital. All the data of the patients fulfilling the inclusion criteria were collected from the database at medical records department of the hospital. Results: Majority of the patients were adults Saudi male. 68.9% of the patients did not sustain shock, and 75.8% of patients did not require a blood transfusion. Patients with head, neck, chest, abdominal, internal organ, pelvic or spinal injuries conferred a statistically significant higher mean ISS. Patients with abdominal or internal organ injuries had a statistically significant higher mean units of blood transfused. GCS was seen to be lower in the head, neck, chest, abdominal, internal organ, spinal and other injuries. Conclusions: The study documents a significant correlation between the type of injury and GCS, ISS, and blood transfusion in victims of road traffic accident. Emergency physician and the caregivers should be more careful about the injuries associated with lower GCS. Patients sustaining injuries of certain parts related to high ISS (i.e., head, chest, abdominal, internal organ, pelvic) should be addressed on priority basis.