Medicni perspektivi, 2018;23(2 part 1)
2018 Vol. XXIII N 2 part 1
Key words: cognitive impairments, heart failure, coronary artery disease
Abstract. Cognitive impairments in patients with heart failure of ischemic genesis. Azarenko V.Ye., Potabashniy V.A., Fesenko V.I., Kniazieva O.V. Heart failure is a complex clinical syndrome with multiple interactions between the myocardium and the brain. These bidirectional interactions are characterized by pathophysiological features that determine the clinical picture, including the presence of cognitive impairment. The study showed that the degree of cognitive impairment depends on the severity of heart failure and correlates with the magnitude of the left ventricular ejection fraction.
Key words: СOPD, hypertension, adhesion of platelets, platelets aggregation, L-arginine
Abstracts. Changes of platelets activity in patient swith COPD and concomitant arterial hypertension under the influence of L-arginine. Kovalenko О.М. Objective: to investigate the influence of L - arginine on platelets activity in patients with COPD and concomitant arterial hypertension. 30 patients with COPD of A - D category combined with hypertension (Н) I - II stage in the state of disease control were examined. In I gr. (n=20) patients received L – arginine (Tivortin) in a daily dose of 4g as additional medication to the basic therapy for 30 days. Patients of II gr. (n=10) received only basic therapy. The adhesion of platelets (pl), induced with adenosine diphosphate (ADP), collagen and thrombin (optical turbidometric aggregatometry method) were determined. Additionaly, in I gr. (n=6) there were determined the level of activated, aggregated, degranulated pl, packing density of pl granules (transmission electron microscopy). Under the influence of therapy in patients of I gr. degree of pl adhesion, degree of induced pl aggregation (collagen, thrombin), rate of aggregation (ADP, thrombin), activity of pl von Willebrandt factor activity (collagen, thrombin) decreased, level of activated, aggregated and degranulated pl decreased; packing density of α - granules increased (p<0.05). In II gr.of patients significant changes in the indices of adhesion and induced aggregation of pl were not detected. In comorbid patients with COPD and arterial hypertension L-arginine (Tivortin) reduces platelet activity and may reduce thrombogenic potential and risk of thrombotic events.
Key words: mitral valve prolapse, connective tissue dysplasia, phenotypic signs, young age
Abstract. Phenotypic symptoms of conjugate tissue dysplasia in persons of young age with mitral valve prolapse. Kuznetsova M.A. In connection with the significant increase in complications, developing in young people with mitral valve prolapse (MVP), the study of phenotypic signs and peculiarities of the formation of this pathology is topical. A survey of 135 young people aged 17-25 years with mitral valve prolapse was conducted. The patients were examined by specialist-doctors: neuropathologist, otorhinolaryngologist, surgeon, traumatologist and oculist to exclude organic pathology; the distribution of phenotypic signs of connective tissue dysplasia depending on degree of MVP was evaluated. It was established that in young people with MVP of 2nd degree external and visceral manifestations of connective tissue dysplasia occur significantly more often than in persons with MVP of 1 degree.
Key words: chronic kidney disease, arterial hypertension, subclinical hypothyroidism, combined antihypertensive therapy
Abstract. The level of proteinuria and the state of endothelial function in patients with chronic kidney disease combined with subclinical hypothyroidism under the influence of combined antihypertensive therapy. Kuryata O.V., Garmish I.P. Our aim was to assess the level of proteinuria and changes in vascular endothelial function in patients with chronic kidney disease (CKD) in combination with subclinical hypothyroidism (SHT) under the influence of antihypertensive combination therapy (valsartan 160 mg and amlodipine 5 mg). We examined 48 patients with CKD I-II stages and AH 1 and 2 degrees. Depending on the functional state of the thyroid gland, patients were divided into 2 groups. Within 12 weeks patients took a fixed combination of amlodipine 5 mg and valsartan 160 mg. Target BP levels were achieved in 19 (86.3%) patients of the main group and 22 (84.6%) of the comparison group. More often violation of brachial artery flow-mediated dilation and higher level of daily proteinuria were found in the main group patients. At the end of the study, the level of daily proteinuria in the main group decreased by 46.03% (p<0.01), and in the comparison group – by 55.3% (p<0.01). SHT can be considered as an additional factor that affects the course of CKD and AH by worsening the state of endothelial function and increasing the level of daily proteinuria. Combination of valsartan 160 mg and amlodipine 5 mg has lead to achieving of target blood pressure levels, improving of endothelial function and decreasing of daily proteinuria in both groups.
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Key words: chronic heart failure, atrial fibrillation, β-2-microglobulin, microalbumin
Abstract. The level of Β-2-microglobulin, albuminuria in patients with chronic heart failure and atrial fibrillation depending on the functional state of the kidneys. Muhammad Muhammad. Despite the advances in the treatment of chronic heart failure (CHF) the mortality of patients remains high. Development of renal dysfunction is one of the most common conditions comorbid with CHF. Atrial fibrillation (AF) is the most frequent arrhythmia in clinical practice, the prevalence of which is increasing. The risk factors and mechanisms of AF development and renal dysfunction largely coincide. The markers of early renal damage in patients with CHF and AF are presented and analyzed. The data suggest that the degree of tubular damages assessed by β-2-microglobulin level in blood serum and AU is not always correlate with changes of GFR, but has significant variability.
Key words: disability, medical and social expertise, criteria of disability, general practitioner
Abstract. Criteria of vital activity lesions as a methodological basis for determining disability. Naumenko L., Borisova I., Berezovskyi V., Fesenko H., Zub T., Chub D. Evaluation of the functional state of the patient is the basis for recognizing him persistently incapacitated. The reform in the field of medicine in our country entrusts the function of the initial selection of such patients to general practitioners and primary care physicians. In 2001, the working group of the World Health Organization approved the International Classification of Functioning, Disability and Health. There are 7 basic parameters for detailing the functioning of a person: the ability to self-service, to move, to work, to orientate, to control own behavior, to learn, to communicate. The ability to self-service characterizes a person's capability to provide own physiological needs, to adhere to own hygiene and to perform daily activities. A person with a preserved capacity for self-service does not depend on other people.The ability to move allows the person to move in space independently: to walk, to run, to overpass the obstacles, to use public transport. If this criterion is limited, the person needs more time to overcome the distance or uses the additional support or needs help from outside. The ability to orient allows the person to analyze the surrounding world with the help of eyes and ears.The ability to communicate provides an opportunity to establish contacts and maintain relationships with other people. For communication spoken, written and non-verbal speech is used. The ability to control one's own behavior consists in the awareness of one's own personality and one's own place in the world, limited by certain norms and rules of behavior. The ability to learn allows the person to perceive, comprehend, accumulate and reproduce the information. Due to this,the person can accumulate knowledge and skills. Ability to work allows the person to perform work according to the level of one’s own education. The definition of criteria for disability and the degree of their severity requires a certain level of medical training for general practitioners and primary care physicians.
Key words: chronic obstructive pulmonary disease, systemic inflammation, serum amyloid A
Abstract. The influence of adequate drug therapy on the clinical symptoms and level of serum amyloid A in patients with chronic obstructive pulmonary disease. Pertseva T.A., Koval D.S. The aim of our research was to study the dynamics of the level of SAA in COPD patients in the stable phase of the pathological process against the background of basic therapy. We studied 37 stable COPD patients with II-IV degree of ventilation violations according to the GOLD classification, distributed in two subgroups depending on the adequacy of taking basic therapy. Stable COPD patients, irrespective of the severity of the course of the disease in conditions of inadequate treatment have greater symptom severity, the number of exacerbations over the past year and the level of SAA than patients taking long-term therapy according to COPD severity. Taking therapy corresponding to the severity of the disease within three months by COPD patients helps to reduce the severity of COPD symptoms to the level of these indicators in patients taking adequate therapy for a longer period of time. Treatment of COPD patients which corresponds to the severity of the disease within three months contributes to a significant reduction of SAA level.
Key words: chronic obstructive pulmonary disease, depressive syndrome, clinical symptoms, functional parameters
Abstract. Possible predictors of depressive syndrome in patients with chronic obstructive pulmonary disease. Pertseva T.O., Konopkina L.I., Guba Yu.V. Recently, the problem of depressive syndrome in COPD patients often attracts the attention of doctors and scientists. It is important to study the relationship between the presence of the depressive syndrome, on the one hand, and the clinical and functional characteristics of COPD patients on the other, in order to determine the categories of patients inclined to develop a depressive syndrome. The purpose of the study: to determine the relationship between the presence of depressive syndrome in COPD patients with the severity of their clinical symptoms of COPD and the level of functional impairments. 52 COPD patients of clinical groups C and D were examined. Depending on the presence of depressive syndrome patients were divided into two subgroups: a subgroup 1 – 15 COPD patients with concomitant depressive syndrome, a subgroup 2 – 37 people without it. The examination included general clinical and functional methods. It was determined that the development of depressive syndrome in COPD patients can be affected by the high severity of clinical symptoms of COPD in general, decreased tolerance to physical activity, long duration of the disease, poor quality of life. At the same time, the levels of functional indicators, in particular, OFV1 and SpO2, may not have a significant relationship with the occurrence of depressive syndrome, even in patients with severe COPD.
Key words: arterial hypertension, chronic obstructive pulmonary desease, daily blood pressure profile
Abstract. Daily profile and variability of blood pressure in patients with arterial hypertension (AH) in combination with COPD. Potabashniy V.A., Fesenko V.I., Burtniak T.Z. To date, despite the improved approach to managing patients with AH, control of blood pressure remains unsatisfactory in some categories of patients. This problem is particularly topical in AH combined with COPD depending on the peculiarities of the course and difficulty in their diagnosis. Thanks to the use of 24-hour monitoring method, it is possible to objectify the true blood pressure profile during the day and diagnose AH at a qualitatively new level. In patients with a combination of AH and COPD, there are certain features of the clinical course that can be determined with the use of 24-hour BP monitoring. A direct relationship between the profile of blood pressure, the clinical groups of COPD, as well as the time of its onset regarding hypertension was revealed.
Key words: pulmonary fibrosis (PF), biomarkers, trypsin-like activity of blood
Abstract. The use of trypsin-like blood activity as a marker of pulmonary fibrosis severity. Rodionova V.V., Karaseva O.V. Purpose – to determine changes in the trypsin-like blood activity and its relationship with acute phase indices of inflammation in patients with pulmonary fibrosis (PF) as a marker of course severity and prognosis of the disease. Materials and Methods: The study included 18 patients: 15 (83%) women and 3 (17%) men, mean age 53±2.5 years. The control group included 15 practically healthy persons. All the examined patients (n=18) were divided into two groups: with mild or moderately severe PF – 8 (44.4%) patients (group I), severe PF – 10 (55.6%) of patients (group II). Duration of the disease - from 1 month. up to 4 years. Patients underwent clinic-laboratory and anthropometric studies, a mMRC questionnaire was used, blood saturation was measured, lung radiography in 2 projections, echocardiography, and if necessary a high-resolution computer tomography etc were performed. Results and discussion: More than half of the patients were overweight (44,4%) or had obesity of І-ІІІ st. (27.8%). The severity of dyspnea according to mMRC scale was 3.0 (3.0-4.0) points in patients of group II and 2.5 (2.0-3.0) points in patients of group I. There was a decrease in C-reactive protein (CRP) in group I and a tendency to increase in patients of group II. When analyzing the indicator of trypsin-like blood activity (TLA), it was found that the median TLA at the beginning of the observation was twice as high as in healthy individuals, direct correlation was established between the level of TLA and the severity of the disease course. After treatment the level of TLA decreased in group I patients. In the severe course of PF, the average TLA level remained high. The progredient course of LF is characterized by severe clinical symptoms, a significant increase in TLA, CRP, reduced O2 saturation, a lack of response to treatment and an unfavorable prognosis. The TLA index can be used as a biochemical marker of the severity of PF along with the CRPindex, O2 saturation and the degree of dyspnoea.
Key words: heart failure, biomarkers, diagnostics, prognosis
Abstract. Role of biomarkers in diagnostics, stratification of risk and prognosis of heart failure. Khanyukov О.О., Sapozhnychenko L.V. Heart failure occupies one of the leading places in the structure of the causes of adult mortality in the world. The issues of timely diagnosis and prognosis of the outcomes of this disease do not lose their relevance due to the high heterogeneity of clinical manifestations and absence of absolutely pathognomonic symptoms. The development of the multimarker diagnostic strategy for management of patients with heart failure is a progressive approach .The review focuses on the synthesis of known evidence data on the role of biomarkers in diagnostics and risk stratification.
Key words: acute myocardial infarction, atrial fibrillation, complication, prognosis
Abstract. Features of the myocardial infarction course in patients with a permanent atrial fibrillation. Yalovenko M.I., Khaniukov O.O. Atrial fibrillation (AF) is the most common cardiac arrhythmias in the population. Nowadays, AF is regarded as potentially lethal arrhythmia, considering the broad range of its negative consequences, not only due to significant deterioration in the quality of the patients’ life, but also due to related significant increase in the incidence of serious complications and death. The presence of permanent AF is associated with a twofold increase in the risk of myocardial infarction (MI) development. The purpose of the research is to study the features of the MI course, the condition of intracardiac hemodynamics, the volume of the cardiac muscle injury in patients with a permanent AF. It was done a retrospective study of 1145 patients’ case histories who were undergoing in-patient treatment for the acute MI on the basis of the CI "Dnipropetrovsk Clinical Association of Emergency Medical Aid". The first group included 134 patients with acute MI without concomitant heart rhythm disorders. The second group consisted of 102 patients with acute MI which arose on the background of a permanent form of AF. The groups were comparable in age and gender. The presence of permanent AF was associated with prognosis deterioration, early hospital mortality in patients with acute MI due to progression of heart failure, development of acute left ventricular insufficiency. A larger amount of myocardial necrosis was observed in patients with permanent AF compared to those with sinus rhythm. Conclusion: the presence of permanent AF impairs the course of acute MI, increases the risk of early hospital mortality, which requires a personalized approach to the management of patients with a permanent AF for preventing the risk of MI developing and thromboembolic complications.
Key words: postinfarction chronic heart failure, galectin-3, AGEs, endothelial dysfunction, cardiac hemodynamics
Abstract. Galectin-3, advanced glycated end-products serum levels, endothelial function and cardiac hemodynamics in post infarction heart failure patients with reduced and preserved ejection fraction. Kuryata O., Zabida A., Sirenko O. Epidemiological studies have reported that the rate of signs and symptoms of heart failure after myocardial infarction is approximately 25%. In addition, approximately 40% of myocardial infarctions are accompanied by left ventricular systolic dysfunction. Aim.. Aim of the study is to evaluate serum levels of galactin-3, AGEs and endothelial function, cardiac hemodynamics in post infarction chronic heart failure patients with different ejection fraction. Materials and methods. All patients are divided into two main groups according to ejection fraction:1st group-20 patients with chronic heart failure with preserved ejection fraction, 2nd group-15 patients with chronic heart failure and reduced ejection fraction. Standard laboratory blood tests for erythrocyte sedimentation rate, haematological parameters, lipid profile, glucose, renal function, echocardiographic examination, endothelial function determine were performed for all patients. AGEs and galectin-3 serum levels were determined. Results. Patients with chronic heart failure and reduced ejection fraction and myocardial infarction in anamnesis had significantly increased left ventricle diastolic volume, left ventricle systolic volume,left ventricle diastolic dimension and left ventricle systolic dimension (p<0.05).AGEs serum level mildly increased in both groups.Galectin-3 level was significantly higher in pts with chronic heart failure and reduced ejection fraction(p < 0.05)and was correlated with age(R=0.74, p<0.05), left ventricle end diastolic volume (R=0.57, p<0.05), left ventricle end diastolic dimension (R=0.48, p<0.05), triglycerides level (R=0.45, p < 0.05). Most of the patients with chronic heart failure with myocardial infarction in anamnesis had endothelial dysfunction, the FMD% level was significantly higher in patients with preserved ejection fraction(p<0.05). Conclusions. Patients with chronic heart failure and reduced ejection fraction are characterized by significantly higher levels of galectin-3, endothelial dysfunction frequency, cardiac hemodynamics abnormalities.
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