Medicni perspektivi, 2017;22(3 part 1).
2017 Vol. XXII N 3 part 1
Key words: lung function, X-ray, DLCO
Abstract. The role of functional research in the diagnosis of chronic nonspecific lung diseases of professional etiology. Basanets A.V., Ostapenko T.A. The article presents the analysis of the clinical examination 126 of miners exposured to coal dust in concentrations significantly exceeding maximum allowed ones. Indicators of external lung function were analyzed. The study found that the rate of DLCO is an informative criterion for the diagnosis of early signs of pulmonary ventilation disorders which testifies to disorder of gas exchange process. The obtained results demonstrate that the frequency of pathologically decreased DLCO index (<80% from the proper values) increased proportionally to the prevalence of pulmonary fibrosis according to X-ray of the chest and were observed in 9,7% of patients with radiological signs of pulmonary fibrosis in the basal parts of the lungs (group I), in 33,3% of subjects with radiological signs of pulmonary fibrosis in basal parts and lower lobes (group II) and in 84,8% of the surveyed miners (group III) with diffuse pulmonary fibrosis.
Key words: сhronic obstructive pulmonary disease, chronic obstructive pulmonary disease of occupational etiology, analysis of course, analysis of amount of lethal cases
Abstract. Chronic obstructive pulmonary disease and lung cancer: multifocus juidgment on the problem. Pertseva Т.О., Konopkina L.I., Beresovskiy V.N., Myronenko O.V., Botvinikova L.A., Abramenkova N.A. Questions about such comorbidity as chronic obstructive pulmonary disease (COPD) and lung cancer are discussed in the scientific literature already for about 50 years. Nevertheless, many statements are still not clear for today. Some authors argue that COPD and lung cancer are different diseases that can have only a common etiological factor – smoking. Others consider COPD as a "precancerous" disease due to the presence of both common with lung cancer pathogenetic links and similar pathomorphological changes. Stuff members of the department of Internal Medicine 1 of the SE “Dnipropetrovsk medical academy of Health Ministry of Ukraine” analysed incidence of lung cancer in long-term (from 5 to 15 years) followed-up COPD patients. Specific features of the course of COPD in this cohort of patients were evaluated. Also, according to the results of the annual reports of the occupational pathology department of the municipal institution "Dnepropetrovsk clinical regional center of medical and social expertise", the analysis of the number of deaths from lung cancer due to COPD in disabled people of occupational etiology was made. It was shown that more than 7% of patients with COPD developed lung cancer. They all were males, all were smokers with a high "pack / year" index, had severe bronchial obstruction and were treated irregularly. Disabled people due to COPD of occupational etiology also often develop lung cancer. This cohort is annually the largest among the dead with established occupational diseases in the Dnepropetrovsk region. It is concluded that: 1) male-smokers suffering from COPD with severe bronchial obstruction and using inadequate medication constitute a risk group for developing lung cancer; 2) COPD of occupational genesis can be considered as a "precancerous" disease.
Key words: occupational pathology, clinical discipline, medical high school
Abstract. Problems and prospects of teaching professional pathology as a clinical discipline in medical universities. Kapustnik V.A., Kostyuk I.F., Byazrova V.V., Steblina N.P. Reforms of health care in Ukraine activate the role of higher educational institutions of medical profile in the training of doctors, able to solve complex issues for prevention of development of diseases, their early detection and treatment and rehabilitation of patients. In recent years, less attention is paid to the study of occupational diseases. The paradox of teaching professional pathology in medical schools of Ukraine is that, as a result of reorganization of medical education number of academic hours for teaching of occupational diseases is reduced three times approximately. Hence, in public health practice there are difficulties and shortcomings in conducting preliminary and periodic medical examinations, issues of occupational competency examination, prevention of general and occupational diseases. Teaching of occupational diseases in medical school is a very important pedagogical task. The article argued the need of increasing the number of hours to prepare students on professional pathology in medical schools.
Key words: chronic obstructive pulmonary disease, alpha-2-macroglobulin, genetic predisposition
Abstract. Role of α2M gene polymorphism in development of chronic occupational COPD in Ukrainian coal miners. Basanets A.V., Dolynchuk L.V. COPD is a multi-factorial disease (MFD), where hereditary predisposition and environmental factors (including work conditions) play an important role. Gene α2M affects the proteolysis/anti-proteolysis system and may be important for heriditary predisposition to COPD.Materials and methods. The ratio between the polymorphic alleles of the genes encoding α2M were investigated in 72 underground coal miners with COPD (mean age 53,7±5,8 years, mean work experience 21,8±4,8 years), and in 79 healthy miners (mean age 48,2±5,6 years, mean work experience 20,2±4,5 years). Allele variants of α2M gene were revealed using PCR with restriction fragment-length polymorphism detection. Results. The frequency of genotypes α2M*IIe/IIe distribution in COPD patients and in control groups was 38,2% and 49,2%; α2M*IIe/Val -51,4% и 54,4%; and α2M*Val/Val - 9,7% and 6,3% respectively. The tendency to the COPD risk development was revealed in pathologic gene α2M*Val carriers in comparison to the control (OR=1,09; 95% CI: 0,66-1,8), as well as in pathologic genotype α2M*Val/Val carriers (OR=1,59; 95% CI: 0,43-6,13). The association between genotypes α2M*IIe/IIe і α2M*IIe/Val and relatively low risk of COPD in miners was revealed by odds ratio method (OR=0,99; 95% CI: 0,49-2,00; OR=0,89; 95% CІ: 0,44-1,77;). No statistically reliable differences were obtained by χ² method for α2M gene polymorphisms between miners with COPD and control ones. Conclusion. The results of this study suggest that α2M gene polymorphism is not strongly associated with COPD in cohort of Ukrainian coal miners.
Key words: chronic obstructive pulmonary disease, hypertension, thrombocytic activity, endothelium
Abstract. Features of thrombocytic element of homeostasis in patients with chronic obstructive pulmonary disease (COPD) concomitant with hypertension (H). Kovalenko O.M., Rodionova V,V., Voronina N.O. The aim of the work was to study and compare the activity of thrombocytic element of hemostasis in patients with H and comorbid patients with COPD in combination with hypertension (H) in the stable course of diseases on the background of baseline therapy. A total of 53 patients were examined, of whom 21 had comorbidity of COPD and H, 22 had H and 10 almost healthy persons of the corresponding age. Indicators of blood pressure, anthropometry, spirometry with post-bronchodilation test were determined. The functional activity of thrombocytes (tr) was studied using the turbidometric method by specifying the amount, degree of adhesion, spontaneous aggregation of thrombocytes and the degree, rate of aggregation of tr and the activity of Willebrand factor in stimulation of adenosine diphosphate (ADP), collagen and tr aggregation thrombin. An increase in the functional activity of tr in patients with both H and in combination of COPD and H was revealed. With comorbidity, thrombocytic activity is more pronounced, indicating additional damage to vascular endothelium and an increased risk of thrombotic and atherothrombotic complications.
Key words: occupational morbidity, occupational hazards, record of service, age
Abstract. Occupational morbidity in Kharkiv Region over the period 2006-2015. Melnyk O.G., Borovyk I.G., Dyuldyeva T.А., Ryabokon А.I., Mоrgun Т.М. Occupational morbidity in Kharkov region has been researched over the period 2006-2015. The dynamics of the number of patients with occupational diseases in this region is practically the same as in Ukraine but there are some differences. Most of such patients are males. However, the number of females increased over this period. The employees exposed to occupational hazards with the 20-29-year record of work comprise the biggest share of all the victims. They were followed by the employees with the record of work amounting more than 30 years, 10-19 years and, finally, less than 10 years. According to the age, the biggest number of patients is among workers at the age of 50-59. They are followed by those who are in their sixties. The third biggest number is among 40-49 aged, the fourth – 30-39 aged, and the fifth – 20-29 aged. The biggest share (39.89-50.60%) in the structure of occupational diseases is chronic bronchitis, COPD and pneumoconiosis. The next common disease (25.90-33.80%) is occupational hearing loss. It was revealed that 5-8% of the total number of workers suffer from four occupational diseases, 52-62% – from two-three, one occupational diseases was detected in 32-40% of employees accordingly. The presence of 2-4 occupational diseases points to the combined exposure to occupational hazards of machine engineering workers. During this period, the biggest number of the victims (79.17-90.43%) was registered in machine engineering due to regional peculiarities of economics. The fact that the victims are mostly people aged 50-59 years and over 60, having a long record of service indicates the necessity to implement the technique of protection of workers by time. The highest rate of morbidity was observed in Kharkov Tractor Plant and Kharkov Malyshev Plant. Thus, it is vitally important to conduct preventive activities in these enterprises first and foremost.
Key words: Occupational diseases, harmful working conditions, restoration of health, professional longevity of workers
Abstract. Analysis of activities of the city center for the treatment of occupational diseases and some aspects of the experience of cooperation with the Social Insurance Fund against Industrial Accidents and Occupational Diseases of Ukraine in the city of Dnipro, Dnipropetrovsk region. Glinyanay L.A., Rodionova V.V., Gashynova K.Yu., But N.A., Ischenko N.P., Rovenskaya N.I., Sobko S.V., Halytsyna O.I., Tsmay G.Y. Aim: to analyze the activities of the city center for treatment of occupational diseases and the results of cooperation with the Social Insurance Fund against Industrial Accidents and Occupational Diseases of Ukraine in the city of Dnepr on the basis of the study of the center's performance for the period 2014-2016.There was carried out the analysis of patients’ case histories, which underwent follow-up and treatment in 2014–2016. Among the treated patients there were 1060 women (31%) und 2361 men (69%). The average age of patients was 40.6–71.2 years. The average age of patients working in harmful conditions for the period of establishing the diagnosis of occupational disease was: 50-54 years (15%), 55-60 (40%) and over 60 years (23%). The average length of service in hazardous working conditions was 17.6-19.4 years. The revealed occupational pathology in 90.7% of patients was accompanied by disability.The analysis of the activity of the center of occupational pathology for 2014-2016 was carried out on the basis of statistical reports of the hospital.The structure of occupational morbidity according to the Center of Occupational Pathology completely corresponds to the structure of occupational morbidity in Ukraine: the first place is associated with respiratory diseases (pneumoconiosis, chronic bronchitis), the specific gravity being up to 70% with a tendency to increase. The number of patients with vibration sickness increases as well as cases of intoxication with chemicals. Indicators of the number of patients with arthrosis, radiculopathy, radiculoneuropathy and others are at the same level. Conclusions: The diagnosis of occupational diseases is established mainly when patients are referred to specialized medical institutions (occupational pathology centers). Occupational pathology is diagnosed lately, with the development of disability in patients. To improve diagnosis, treatment, rehabilitation of persons working in harmful working conditions, active cooperation between general practitioners, specialist: prophpathologists, representatives of the Social Insurance Fund against accidents at work and occupational diseases is necessary.
Key words: deforming arthrosis, gonarthrosis, occupational disease, workers of mining industry, clinical presentation, metabolic disorders
Abstract. Peculiarities of clinical presentation of deforming osteoarthritis in mining industry workers. Basanets A.V., Bulavko M.M. The paper presents data gathered by retrospective analysis of clinical picture of deforming arthritis peculiarities, patients’ occupational history as well as peripheral and venous blood findings in patients with deforming arthritis parameters of knee joints of occupational genesis. In this contingent of patients it was found the presence of a number of risk factors of development of musculoskeletal system pathology, including overweight, long record of service, associated with considerable physical activity and long stay in a forced working position, knee joint trauma, work in conditions of hostile microclimate (high and low temperature, high humidity and high air speed), in some cases – in combination with vibration influence. The clinical picture of the disease in these patients is rather demonstrative and characterized by the presence of pain syndrome, disorder of the knee joint function and in some cases by walking disturbances, which affect the quality of life and work capacity. The presence of metabolic disorders (increased level of alkaline phosphatase and decreased level of total calcium of venous blood) was also established, this may have an adverse effect on the clinical course of deforming arthritis in the future.
Key words: medical examinations, medical records, occupational hazards
Abstract. Problematic aspects of preventive examinations. Tkach S.I., Borovyk I.G., Zaharov O.G. The expert evaluation of medical records was conducted taking into account preventive examinations, namely outpatient charts, lists and charts of those workers who have to undergo regular medical check-ups; final acts of regular medical check-ups. The medical record based on the results of preventive examinations of 1821 workers over the period of 2012-2016 was researched. These workers come from different regions of Ukraine, namely Dnepr, Krivoy Rog, Pavlograd, Yuzhnoukrainsk, Kremenchuk, Cherkassy, Chernihiv, Sumy, Odessa, Kyiv, Simferopol, Berdyansk, Uzhgorod, Kherson, Poltava, Kharkov. Most of the doctors from commissions which conducted medical examinations did not do thematic advanced training on Professional Pathology. The most common gaps in organizing medical examinations, medical record keeping of 1821 workers, the extent of examinations of workers exposed to occupational hazards over the period of 2012-2016 were denoted. The list of activities to improve the quality of preventive and regular medical check-ups was prepared. It includes such aspects as occupational medical service in Ukraine, practical training for doctors on Professional Pathology, and improvement of the existing examination practice of the workers exposed to occupational hazards.
Key words: hypertension, osteoarthritis, arterial blood pressure daily monitoring, antihypertensive therapy
Abstract. Changes of indicators of daily monitoring of blood pressure in patients with arterial hypertension in combination with osteoarthritis under the influence of antihypertensive therapy. Rodionova V.V., Khmel O.S. Objective: to investigate the effect of antihypertensive therapy on changes in daily monitoring of arterial pressure in patients with arterial hypertension in combination with knee osteoarthritis. Materials and methods: 44 patients at the age of 40-65 years were examined, 29 of them were patients of the main group with hypertension stage II, AH stage 2 in combination with OA of knee joints of II stage according to Kellgren-Lawrence. During the study patients were administered antihypertensive therapy with Amlodipine 5 mg and Lisinopril 5 mg once a day per os for 10 days. 15 practically healthy individuals comparable by age and sex were selected as a control group. Results: in patients with arterial hypertension combined with OA after the treatment there was a tendency to normalization of majority of blood pressure indicators, in particular, reduction in blood pressure indices during day and night, normalization of daily diastolic arterial pressure and DBP indices, morning SBP and DBP elevation and DBP during the day. Spearman correlation method showed that the waist volume in patients before treatment significantly correlated with the indices of the daily index of SBP and DBP (r=-0.42 and r=-0.44, respectively, p<0.05). Conclusion: in patients with arterial hypertension in combination with osteoarthritis under the influence of antihypertensive therapy with Lisinopril 5 mg and Amlodipine 5 mg there was a reliable tendency to normalization of blood pressure values, which helps to reduce the risk of cardiovascular events.
Key words: chronic obstructive pulmonary disease, COPD under-diagnosis,COPD risk factors, smoking, quality of life, spirography
Abstract. Detection rate and features of clinical course of chronic obstructive pulmonary disease among professional staff of closed type. Cherepii N.V., Mostovoi Yu.M., Rasputina L.V. Diagnostics of chronic obstructive pulmonary disease (COPD) is one of the difficult medical problems. The main COPD risk factor is smoking (including passive one). Other COPD risk factors are air pollution with industrial waste, fuel combustion products and discharge gases. Unfavorable occupational conditions, weather conditions and climate (fog and humidity), infections could also be considered as COPD risk factors. Study objective is to evaluate the incidence of COPD among individuals who consider themselves healthy within a professional team of a closed type and to define special features of the disease course. Methods and materials. The study was conducted in several phases: the first phase was filling in an original questionnaire in order to identify COPD symptoms and risk factors, the second stage – computer spirography with bronchodilator response. The study involved employees of a company of a closed type in Khmelnytska oblast which consider themselves healthy undergo medical examinations twice a year. We established that 216 people (41.1%) and under the questionnaire scored 18 or more points, thus evidencing a high risk of COPD development. Of them there were 115 women (53.2%) and 101 men (46.8%). We found undiagnosed COPD in 79 individuals (14.3%), including 31 women (39.2%) and 48 men (60.8%). Most often, patients with newly diagnosed COPD complained of cough, shortness of breath, wheezing and frequent respiratory infections. We revealed that 53 persons (67.1%) with newly diagnosed COPD were smokers and 49 (28.1%) were smokers without COPD. Evaluation of basic parameters of quality of life presented no statistically significant difference existing in the main parameters of quality of life in groups of patients with COPD and without COPD.
Key words: bronchial asthma, montelucast, glencet, control
Absctract. Features of treatment of bronchial asthma patients in the industrial region. Kirieieva T.V., Bielosludtseva K.O., Zhulay K.V. 30-80% of patients with bronchial asthma (BA) have concomitant allergic rhinitis (AR), which significantly complicates the control of the disease. Today antileukotriene and antihistamine drugs are used as a preventive treatment of exacerbations of AR. They are also recommended as an additional agents of asthma treatment on the background of basic therapy with inhaled corticosteroids (ICS). The aim of our study was to analyze additional therapeutic efficiency of selective blockers of leukotriene receptors and antihistamines on the degree of asthma control in patients on the basic therapy of BA with concomitant AR, to assess clinical efficiency and safety of the combined agent “Glencet Advance” (Glenmark Pharmaceuticals LTD, India). We prospectively examined the main group – 45 asthmatic patients with concomitant AR. The patients were divided into two subgroups, according to the prescribed additional treatment. Subgroup 1 – 22 asthmatic patients with concomitant AR, who received inhaled corticosteroids as a basic treatment and subgroup 2 – 23 patients, who received combined drug "Glencet Advance", 1 tablet once a day before bedtime, in addition to the basic treatment. At vistit 1 all patients of the main group had uncontrolled course of asthma. After a month of basal treatment, the condition of patients both of subgroup 1 and subgroup 2 improved significantly: in most patients FEV1, daily PWV fluctuation decreased and the number of additional quick-acting medications decreased sharply. At the same time, more expressed positive dynamics of condition was determined in patients of subgroup 2 as compared to subgroup 1. After 6 months there were many benefits of additional use of Glencet Advance in patients of subgroup 2. They had significantly less number of disease exacerbation episodes (especially exacerbations requiring hospitalization) compared with patients of subgroup 1. In this regard they quickly reached the long-term control, which made it possible not only to refuse from the use of additional emergency medications, but also to reduce the dose of basic drugs. This significantly decreased the cost of treatment, improved the quality of life and ability to work of patients with asthma. During the semiannual observation there were no signs of the negative effect of “Glencet Advance”on the condition of patients with asthma.
Key words: nosocomial infection, microbiological monitoring, opportunistic microorganisms, antibioticresistantance
Abstract. Revealing of antibiotic-resistant strains of microorganisms in patients with signs of postoperative purulent-inflammatory infections in surgical departments of industrial city. Finkova E.P., Moskalenko L.M., Novikova E.Yu., Stepanskiy D.O, Sladkova L.M., Krushinska T.Yu., Daragan G.M., Titarenko O.A., Tatyanenko M.M. Monitoring of susceptibility to antimicrobial agents of bacteria causing purulent-inflammatory infections related to different species and families was carried out. The study was conducted in surgical, urological and traumatological departments during the year 2016. Classical bacteriological methods were used for isolation and identification of pathogens. Their sensitivity to antibiotics was studied using the disk diffusion method. The antibiotic resistance analysis was carried out by the instrumentality of computer program WHONET. The leading pathogens isolated from surgical patients with postoperative purulent-inflammatory infections (Staphylococcus spp., Enterococcusspp., Enterobacteria and non-fermenting gramnegative bacilli Pseudomonas aeruginosa and Acinetobacter baumannii) were established to have asignificant (33%) level of antibiotic resistance. The highest frequency of resistant strains isolation was noted in patients of urological departments (60.0%). The patients of traumatology departments harbour resistant bacteria in 51% cases, and more than a quarter of patients of surgical departments were infected with them. The species spectrum of resistant microorganisms in different departments was approxomately the same, but there was difference in a frequency of individual species detection. Eight species of pathogens were tested. Resistant strains prevailed in non-fermenting gramnegative bacilli (45.0%), Enterobacteria (40.0%) and Staphylococci (12.0%). Non-fermenting gramnegative bacilli had resistance to ciprofloxacin, ceftazidime, cefepime, cefepazone, while preparations of the aminoglycoside and carbapenem group retain selective efficacy. Circulating strains of Enterobacteria were the most resistant to cephalosporins II and III generations, semisynthetic penicillins, but they are sensitive to protected cephalosporins and preparations of carbapeneme group. Most Staphylococcus strains were resistant to penicillin, oxacillin, erythromycin, levofloxacin, and bevancomycin, linezolid, fusidine are the drugs of choice.
Key words: chronic obstructive pulmonary disease, 24-hour Holter ECG monitoring, heart rate variability, nebivolol
Abstract. Effect of nebivolol in the complex treatment on 24-h Holter ECG monitoring data in patients with chronic obstructive pulmonary disease caused by occupational dusts. Fesenko O.V., Myronenko O.V. Influence of a complex treatment with β-blocker on the data of 24-h Holter ECG monitoring in patients with chronic obstructive pulmonary disease (COPD) caused by occupational dusts was established. The decrease of premature ventricular beats in nebivolol in a complex treatment in patients with COPD has been shown. The decrease of frequent monomorphic and absence of coupled repetitive ventricular extrasystoles (VE), as well as tendency to the decline of monomorphic occasional and polymorphic VE with the administration of nebivolol in a complex therapy after 6 months of treatment was shown. The use of nebivolol in a complex treatment results in the decline of sympathetic activity. At the end of supervision period in patients of the nebivolol group the increase of indices characterizing heart rate variability (HRV) – SDNN and SDNNi, as well as increase of rMSSD and pNN50 was established, this testifies to the decrease of sympathetic and increase of parasympathetic activity of the autonomic nervous system (ANS). After 6 month of treatment worsening of the respiratory function was not registered. The administration of nebivolol in a complex therapy in patients with occupational COPD does not worsen respiratory status, being safe for this category of patients.
Key words: arterial hypertension, diabetes mellitus type 2, losartan potassium, endothelin-1, von Willebrand factor, thrombomodulin
Abstract. Dynamics of endothelial dysfunction disorders in patients with arterial hypertension and high cardiovascular risk in conditions of antihypertensive therapy. Pertseva N.O., Turlyun T.S. The aim of the study was to increase the efficiency of early diagnosis and optimize treatment of endothelial dysfunction in patients with AH and high cardiovascular risk. 54 patients with AH and high cardiovascular risk were followed. Of the 2a (n=29) subgroup took losartan potassium, 2b (n=25) – antihypertensive drugs without ARB II. Within 12 months in all patients, , such special clinical and laboratory parameters as: serum level of markers of endothelial dysfunction (endothelin-1, thrombomodulin and von Willebrand factor) except for general clinical examination were studied. A significant increase in the indices of ED (ET-1, von Willebrand factor, thrombomodulin) in patients with AH and high cardiovascular risk was found in comparison with the regional norm. This indicates to violation of the endothelium integrity, vasoconstriction and increased thrombus formation in the vascular wall of the isolated group of patients. According to the correlation and ROC analysis it was found that the best dynamics of ED indices in both subgroups was against the background of blood pressure stabilization, lipid spectrum decrease and abdominal obesity indicators and this is associated with the use of preparations based on ARB II in therapy.
Key words: chronic obstructive pulmonary disease, pulmonary surfactant system, mediomolecular peptides, tiotropium bromide
Abstract. Dynamics of levels of endogenous intoxication and activity of the pulmonary surfactant system in the course of complex treatment of patients with chronic obstructive pulmonary disease with the inclusion of tiotropium bromide. Zuban A.B., Оstrovsky М.М. The results of present study demonstrate the characteristics of endogenous intoxication and activity of pulmonary surfactant system before and in the course of treatment of chronic obstructive pulmonary disease (COPD). 64 patients with chronic obstructive pulmonary disease and 20 practically healthly persons were observed. All patients with chronic obstructive pulmonary disease were randomised into four groups (due to stages of diseases). Some of them additionally used tiotropium bromide in a dose of 5 mcg (Spiriva® Respimat® "Behringer Ingelheim"). The level of mediomolecular peptides in blood serum and activity of pulmonary surfactant system were investigated. The results evidence for increase of the levels of these markers in patients with chronic obstructive pulmonary disease. The dynamics of investigated data corresponded to the stage of disease and increased simultaneously with the progress of chronic obstructive pulmonary disease. Application of the drug tiotropium bromide (Spiriva® Respimat® "Behringer Ingelheim") in the treatment of chronic obstructive pulmonary disease contributes to faster improvement of clinical and laboratory symptoms, compared with patients who received traditional therapy. Additional administration of tiotropium bromide improved levels of medium molecular peptides in blood serum and activity of pulmonary surfactant system. The foregoing points to the effectiveness of tiotropium bromide usage in the complex therapy of chronic obstructive pulmonary disease.
Key words: essential hypertension, coronary heart disease, daily blood pressure profile, heart rate variability, miners
Abstract. Influence a complex treatment on the level of arterial blood pressure and heart rhythm variability in miners with essential hypertension and concomitant ischemic heart disease. Fesenko V.I., Potabashniy V.A. The aim of our study was to prove the effectiveness of drug therapy with beta-adrenoblocker nebivolol (Nebilet®, BERLIN-CHEMIE AG, Germany) in combination with the angiotensin converting enzymeinhibitorenalapril (ENAP®, KRKA, Slovenia) in the treatment of miners with arterial hypertension and concomitant ischemic heart disease. A total of 88 miners underwent general clinical examination, ECG at rest, ambulatory monitoring of blood pressure and ECG. The observation period was 3 months. It was shown, that the treatment of the mining industry workers with arterial hypertension and coronary artery disease with the combination of beta-blocking agent Nebilet and the angiotensin converting enzyme inhibitor ENAP is well tolerated by patients. This therapy improves the daily profile of blood pressure and positively affects the variability of the heart rate, which will reduce the risk of sudden cardiac death in this category of patients.
Key words: microbiota of the throat, nasal microbiota, microbial landscape, frequency of the microbial isolation, industrial region
Abstract. Features of microbial landscape isolated from mucous membranes of nose and throat of industrial region inhabitants. Finkova O.P., Tyshchenko I.V., Bondareva O.O., Moskalenko L.M., Tatyanenko M.M, Zdorik O.V., Shyrokhyh K.A. The results of bacteriological study of mucus from throat (818 specimens) and nose (796 specimens), collected in outpatient conditions in industrial region inhabitants (Left Bank, Dnipro city) are analyzed. 509 strains of microorganisms from throat and 302 from nose were isolated. Strains of pathogens and conditional pathogens in the oro- and nasopharynx of healthy individuals were revealed. Staphylococcus aureus is the dominant causative agent of both microbiotes with a high isolation frequency, especially from the nose. Pathogenic Streptococci and yeast fungi are also isolated from the throat, and from the nose – Haemophilus influenzae. The frequency of other pathogens isolation is not high.
Key words: combined pathology of asthma and COPD, echocardiography, left ventricular hypertrophy, left ventricular diastolic dysfunction, pulmonary hypertension
Abstract. Сardiohemodynamics conditions in patients with combined pathology of asthma and COPD. Nazarenko K.V. Asthma and COPD are the most common of chronic respiratory diseases. Although they have different specific characteristics, in some patients there are simultaneously signs of both diseases, they have a combined pathology of asthma and COPD (asthma-COPD overlap-ACO). The aim of the study was to evaluate the condition of cardiohemodynamics in patients with concomitant pathology of asthma and COPD. Patients with asthma (n=34), COPD (n=17) and ACO (n=140) were included in the study. Methods. Morphofunctional parameters of the heart were studied during the echocardiography in B- and M-modes according to the standard procedure on the VIVID E9 system (General Electric). Results. In patients with ACO and COPD the left ventricular ejection fraction was significantly lower as compared with that of patients with asthma. The left ventricular myocardial mass index (LVMI) was the highest in patients with ACO, but there was no significant difference from LVMI of patients with asthma and COPD. Systolic pulmonary artery pressure (PASP) was higher but not significantly in patients with COPD and ACO, and its with FEV1<80% was detected. PASP was significantly higher in patients with ACO with more severe bronchial obstruction, as compared with patients with FEV1>80%. When comparing cardiohaemodynamics in patients with ACO, performance was beyond the normal limits.LV hypertrophy (LVH) was quite common in patients with obstructive lung diseases and was detected in 50% of patients with asthma, 47% of patients with COPD and in 60% of patients with ACO. Signs of diastolic LV dysfunction were detected in 47% of asthma patients, 71% of patients with COPD and 54% of patients with ACO. Echocardigraphic signs of pulmonary hypertension were found in 41% of patients with asthma, 59% of patients with COPD and 46% of patients with ACO. We analyzed the differences in cardiohemodynamics in patients with ACO with different degrees of bronchial obstruction (the GOLD criteria were applied). A significant increase in LVMI in patients with a different degree of clinical symptoms, in particular, dyspnea (which was estimated by the mMRC scale), a significantly higher PASP was revealed in patients with more severe dyspnea. In patients with a higher BODE index (2–3), the values of the relative thickness of the wall of the left ventricle and the PASP were significantly higher and isovolumic relaxation time was lower. The characteristics of cardiohaemodynamics of patients with ACO were analyzed depending on age. With age, the indicators characterizing the development of LV hypertrophy significantly increased, with changes being more pronounced in patients aged ≥70 years. PASP was higher in patients over 70 years. Patients with ACO with excessive body weight and, especially with obesity, were significantly higher in the signs of LV hypertrophy. Conclusions. In patients with combined pathology of asthma and COPD, significant violations of intracardiac hemodynamics and high prevalence of hypertrophy, diastolic left ventricular dysfunction, pulmonary hypertension, vascular atherosclerosis were revealed, which are associated with increased cardiovascular risk. Particularly significant changes in intracardiac hemodynamics were detected in patients with ACO of older age with concomitant metabolic disorders, obesity in particular, and with more pronounced manifestations of bronchial obstruction.
Key words: COPD, exacerbation, hospitalization, nutritive status
Abstract. Influence of nutritive status on the prognosis of chronic obstructive pulmonary disease in industrial region residents. Gashynova K.Yu. Aim of the work – to evaluate the impact of changes in nutritional status on the probability of exacerbations and hospitalizations in outpatients with COPD due to exacerbations. Material and methods. Outpatients with COPD in remission were included in the prospective study. Lung function, anthropometric data (sex, age, height, weight) were assessed; body mass index (BMI) was calculated. Additional indicators were measured to characterize the nutritional status: % of fat tissue (% FT) and tissue free from fat % (% FFT). The results obtained were processed using descriptive and analytical statistics. Results of the work. Data of 112 patients (GOLD I-IV) were selected for the final analysis. All patients were divided into two main groups: Group I – without exacerbations within 12 previous months (n=51); Group II – with one or more exacerbation over the past year (n=61). This group was also divided into those who were not hospitalized (subgroup II A, n=24) and those who had at least one hospitalization due to COPD exacerbation over the past year (subgroup II B, n=31). Significantly (p=0.002) lower FFT% was found in patients with exacerbations during the last year, compared with those with a stable disease course (29.00 [23,10-33,70]% and 32.50 [31,40-36,20]% respectively). Significantly (p=0.015) higher percentage of patients with low muscle mass was established among patients with a history of exacerbations. Conclusions. These results allow to suggest that low FFT% increases the likelihood of COPD exacerbations. In men, low FFT% could be considered as a predictor of hospitalization due to exacerbation. At the same time FT % in outpatients does not influence on the occurrence of exacerbations and the likelihood of hospitalizations in COPD.
Key words: the negative production factors, specific functions of a man's organism
Abstract. Influence of production factors on specific functions of the male organism. Tkachishin V.S. The main notions about specific functions of a male organism are resulted in article. The basic negative production factors which result in their infringement are described.
MATERIALS UKRAINIAN SCIENTIFIC CONFERENCE WITH INTERNATIONAL PARTICIPATION «TOPICAL ISSUES OF OCCUPATIONAL DISEASES IN UKRAINE»