The Journal of V. N. Karazin Kharkiv National University. Series «Medicine»

5-12

Authors: A. V. Bolotskykh, Yu. S. Rudyk, M. M. Udovychenko, T. V. Lozik

Insulin resistance (IR) leads to structural abnormalities in the heart. Purpose of the study is to investigate the levels of serum Gal-3 levels (sGal3), THF-alpha (TNF-a), Nt-proBNP, HOMA index and insulin and their relationships in non-diabetic patients with heart failure with preserved left ventricular ejection fraction (HFpEF). Forty five non-diabetic patients (27 males and 18 females; mean age 60.4.1±9.7 years) with HFpEF were examined. Patients with diabetes mellitus were excluded. The serum sGal3, TNF-alpha, Nt-proBNP and insulin levels measured in serum by ELISA, according to manufacturer’s instructions. Homeostasis Model Assessment (HOMA) index was calculated as a measure of IR at fasting state (IR=fasting glucose × fasting insulin/22.5).The echocardiographic parameters were measured with M- and B-mode and calculated following the American Guidelines of Echocardiography Society. Continuous variables are expressed as median (25th, 75th percentile). For nonparametric Spearman’s correlation analysis and Mann-Whitney U test were used. All statistical tests were 2-tailed, and p < 0.05 was considered statistically significant. It was found, that IR often occurs in non-diabetic patients with HFpEF. The sGal3, TNF-alpha and insulin are significantly increased in HFpEF patients with IR and without T2DM our study shows an association of the IR, TNF-alpha and sGal3 with echocardiographic parameters in the non diabetic with HFpEF. This fact may indicate the influence of IR on fibrogenesis process and thus facilitate the processes of myocardial remodeling.

17-22

Authors: M. S. Maltseva, D. E. Volkov, D. O. Lopin, M. I. Yabluchansky

37 patients (22 men and 15 women) with implanted pacemakers (PM) in DDD/DDDR and VVI/VVIR modes were investigated. Systolic blood pressure (SBP) and diastolic blood pressure, QTc interval duration, QRS complex duration, heart rate, end-systolic and end-diastolic volume, left ventricular ejection fraction , the thickness of the posterior wall of the left ventricle and interventricular septum, left ventricular myocardial mass, anterior-posterior size of the left atrium, right atrium and right ventricular were evaluated before, during acute postoperative period (3-5 days) and six months after pacemaker implantation. Patients were divided into classes 1 (normal QTc (320-440 ms)) – 17 (46 %) of the patients) and class 2 (long QTc (> 440 ms)) – 20 (54 %) patients) of QTc interval duration. For data processing were used standard statistical procedures by Microsoft Excel. PM implantation, increasing to a greater extent initially normal and less – an elongated QTc interval duration, to 6 months period leads them to the same level of values in both QTc interval duration classes. Increase of SBP and QRS complex duration in the class 2 demonstrates the need for more intensive monitoring and drug management in these patients.

28-32

Authors: D. E. Petrenko

It was prospective analysis of 36 patients with idiopathic scoliosis in order to compare the intraoperative and early postoperative blood loss after ventral and posterior corrective spinal fusion. All patients were divided into two groups: group 1 – 18 patients (14 females and 4 males) with a mean age of 17,2 ± 3,4 years treated with ventral corrective spinal fusion and group 2 – 18 patients (17 females and 1 male) with a mean age of 15,9 ± 3,4 years with posterior corrective spinal fusion. Mean values and standard deviation of the time of surgery, intraoperative blood loss, transfusion volume, hemoglobin, blood volume loss and drainage loss and number of fused spinal levels were evaluated. The results were compared using the Mann-Whitney test (p ≤ 0,05). It was found that group 1 had a lower intraoperative blood loss, the average volume of blood transfusion and blood loss drain in the early postoperative period compared with group 2. It was concluded that ventral corrective spinal fusion is associated with less intraoperative and early postoperative blood loss which is probably due to the less traumatic access and length of the spine instrumentation.

38-42

Authors: I. V. Shanina

Functional blood circulation values were prospectively investigated in 100 patients (46 – women, 54 – men) with permanent pacemakers and in 29 patients (10 – women, 19 – men) – with cardiac resynchronization therapy (CRT) with mean age 69 ± 7 years in different observation stages taking into account QRS complex duration classes (class 1 – under 120 ms (normal), 2 – 120-149 ms (long) and 3 – more than 150 ms (significantly elongated)). Medication support was included beta-blockers; amiodarone; renin-angiotensin-aldosterone system inhibitors: angiotensin converting enzyme and angiotensin II inhibitors; antithrombotic agents; oral anticoagulants; statins and diuretics. Ventricular rate of spontaneous and stimulated rhythm; systolic and diastolic blood pressure; ejection fraction, end-diastolic and end-systolic volumes of the left ventricle; interventricular septum thickness and left ventricular posterior wall, right atria and ventricle sizes were evaluated. The results showed that QRS complex widening associated with greater deviation of functional blood circulation values from physiological norms. Permanent pacing with medical support had no significant impact on the functional blood circulation values, and CRT contributed reverse remodeling higher in class 3 of QRS complex duration. Also it was concluded that there is a necessity of medical support improvement.

48-51

Authors: K. G. Uvarova, M. M. Saprykina, M. A. Ahmed, I. B. Oyebamire, N. V. Makienko, M. S. Maltseva, E. P. Kamenskaya, M. I. Yabluchanskiy

The interaction of diseases for their clinical features, severity type, quality of life of patients and preferable drug therapy are reviewed on the example of clinical case. Clinical examination, diagnosis and choice of optimal drug management are outlined in patient with polymorbid pathology.

5-9

Authors: I. M. Kolomytseva, D. E. Volkov, D. A. Lopin, M. I. Yabluchansky

The study included 162 patients (89 men and 73 women) aged 69 ± 10 years who underwent permanent pacing about atrio-ventricular block, permanent atrial fibrillation and sick sinus node syndrome with pacing modes DDD/DDDR and VVI/VVIR as well as chronic heart failure (CHF) with cardiac resynchronization therapy (CRT-P and CRT-D). Clinical features of patients were evaluated according to the functional class (FC) CHF. Patients with pacemakers the most frequent had II and III CHF FC which more often associated with myocardial infarction, stable angina, diabetes mellitus, atrial fibrillation, stage IIA and IIB CHF. It is concluded that patients with ECS require optimization of medical interventions.

16-20

Authors: Y. F. Kutasevych, О. O. Levchenko, M. M. Popov

Impaired glucose tolerance (IGT) is the most wide-spread complication of long-term therapy of severe dermatoses with glucocorticoid hormones among possible steroid-induced disturbances of carbohydrate metabolism being also a component part of the conception « state prior to the development of diabetes». The mentioned complication leads to the development of cardiovascular pathology which in its turn worsens both the general state of the patient and aggravates the dermatosis course. In this connection the work on prophylaxis and therapy of steroid-induced IGT with metformin preparation having a number of therapeutic effects on human organism besides main hypoglycemic activity in patients with skin diseases was carried out.

27-32

Authors: M. M. Popov, V. B. Olenych, O. M. Savvo

The immune status and nature of immune frustration of children of different ages with the cerebral asthenic syndrome (CAS), who were prematurely born with perinatal defeat of the central nervous system (CNS) was studied. The obtained data argue that these children have the expressed imbalance among Тh-cages (Th1, Th2, Treg) and cytokines that shows the potential risk of inadequate reaction of these children on infectious and noninfectious immunogenes.

38-44

Authors: M. F. Shustval, T .I. Lyadova, O. V. Volobueva

In conducting of complex examination (clinical, laboratory, virological, instrumental) of 186 patients with infectious mononucleosis acute myocarditis was diagnosed in 50 (26,9 %) cases. In 10 % of patients myocarditis was asymptomatic but the clinical picture was veiled by primary infectious process. Drug treatment of viral myocarditis of infectious mononucleosis must include antiviral drugs (acyclovir), drugs that affect the inflammatory, autoimmune and allergic processes, restoration and maintenance of hemodynamic, metabolic drugs, symptomatic therapy.

50-73

Authors: М. S. Maltseva, D. E. Volkov

Clinical importance of QT interval duration in patients with permanent pacemakers (PM) is discussed in the review. Physiological interpretation, methods of heart rate frequency normalization, changes under PM and role of pacing optimization parameters, reactions on medications in patients with spontaneous and stimulated rhythm, meaning for life quality and survivability of patients with permanent PM are considered.

84-88

Authors: O. E. Tomina

The article describes the main indications for insulin therapy, insulin agents and their characteristics depending on the origin, methods of producing and action duration. The article elucidates the methods of insulin injection and injection technique. Also, this article presents the insulin therapy regimen: the conventional and basal-bolus therapy, the daily insulin demand depending on the DM period and its distribution throughout a day. Besides, the article deals with the morning hyperglycemia syndromes, their differential diagnostics and therapeutic approach.

95-97

Authors: Teaching staff of the Department of Internal Medicine № 2, Clinical Immunology and Allergology, Kharkiv National Medical University

THE 70TH ANNIVERSARY OF EMINENT SCIENTIST, TALENTED DOCTOR-CARDIOLOGIST KRAVCHUN PAVLO GRYGOROVICH IS DEDICATED