Vestnik Vitebskogo Gosudarstvennogo Meditsinskogo Universiteta

7-18

Authors: Petrovich D.M., Kunder E.V., Volkova М.V.

Abstract. The publications of the last decade reflect the renaissance of the problem of studying the relationships between spondylarthrites and inflammatory bowels diseases. Intestinal inflammation is most often the primary process and precedes spondylarthritis. The main events of the immunopathogenesis are considered to be migration of immune cells from the lymphoid structures of the bowels to the synovial tissue, presentation of arthritogenic structures and activation of immune inflammation in the synovium. A similar spectrum of proinflammatory cytokines is involved in the pathological process. This review presents modern data about the relationships between spondylarthrites and inflammatory bowels diseases. New possibilities of the laboratory examination of patients to prognosticate the development of inflammation in the intestines and the locomotor system, as well as to assess the inflammatory activity are discussed. The possibilities of high-tech treatment of inflammatory bowels diseases and spondylarthrites are analyzed. Key words: spondylarthrites, inflammatory bowels diseases, autoantibodies.

27-36

Authors: Belyaeva L.E., Fedchenko A.N., Lazuko S.S., Ligetskaya I.V.

Abstract. Objectives. To determine the influence of fish oil administered to pregnant rats while modelling in them chronic unpredictable stress on their offsprings’ behaviour in different age periods. Material and methods. The experiments were carried out on 4-month pregnant rats (n=40) divided into the «control» and «stress» groups. Each of these groups was further subdivided into two subgroups of animals. Experimental groups included animals, which received intragastrically 0,2 ml of the starch solution as a gavage once a day during the whole period of pregnancy, and rats receiving the equivalent volume of fish oil containing eicosapentaenoic and docosahexaenoic acids at the daily dose of 60 mg/kg. Chronic unpredictable stress was modelled by food deprivation during one day with the provision of free access to water on the 2nd, the 9th and the 16th days of pregnancy; upright immobilization of rats in the plastic box filled with water (t=23±2°C) up to the level of the neck during 20 minutes on the 4th and the 11th days of pregnancy; the imitation of a predator presence (contact with Felis excrements during one day) on the 6th and the 13th days of pregnancy. After the delivery of offsprings the maternal cannibalism level was assessed during 10 days. Then the behaviour of the offsprings was studied in the «open field» test at the age of 1 and 3 months. Results. Under the influence of fish oil the maternal cannibalism level in the «control» and «stress» groups decreased from 5,1% to 1,4% and from 34,1% to 4,9%, respectively. Prenatally stressed rats’ offsprings were more passive and demonstrated increased levels of anxiety and emotionalism as well as lower exploratory activity in the «open field» test. Fish oil administration to the «stress» group rats during pregnancy significantly limited the severity of the behavioural changes of the prenatally stressed offsprings both at the age of 1 month and 3 months, especially in female rats. Conclusions. The introduction of fish oil to pregnant female rats from the «stress» group considerably limits the development of stress-related behavioural disorders in their offsprings. The efficacy of such fish oil administration is higher in prenatally stressed female rats than in male ones. Key words: prenatal stress, fish oil, «open field» test.

48-54

Authors: Yupatov G.I., Pryshchepenka V.A., Kornilov A.V.

Abstract. Objectives. To determine the level of blood serum hyaluronidase activity in patients with hepatic cirrhosis. Material and methods. Blood serum hyaluronidase activity was defined by the rivanol clot method. Hyaluronidase activity determination is based on the formation of the clot of rivanol with hyaluronic acid which is in an inverse proportion to the depolymerization of the latter under the effect of hyaluronidase activity of various origin. The serum titer, in which the activity was determined, as well as the size of rivanol clot were estimated. 32 patients suffering from cirrhosis of the liver were examined. Severity class of the disease was by Child-Pugh A (n=5), B (n=12), C (n=15). 18 out of these cases (56%) were men and 14 (44%) women. The average age of the studied group made up 54+10,82 years. The control group included 24 donors from the blood transfusion station, 12 out of them (54%) were men and 10 (46%) women. The average age of the control group made up 40,5+10,1 years. Results. As a result of the study of blood serum hyaluronidase activity of the patients having hepatic cirrhosis it was established that the serum titer in which hyaluronidase activity was determinated in the patients with cirrhosis of the liver made up 1/8000–1/16000 which was 2-4 times higher than the maximum titer of serum in the group of donors (1/4000). It was determined that in patients suffering from hepatic cirrhosis on the 7th day of treatment a decrease of hyaluronidase activity (р<0,05) was observed. At the same time, the level of hyaluronidase activity despite the provided treatment was reliably higher than that in the donors (р<0,05). Key words: hyaluronidase activity, hepatic cirrhosis.

63-69

Authors: Kozlovsky V.I., Simanovich A.V.

Abstract. Objectives. To evaluate the benefits of arterial blood pressure (ABP) self-monitoring. Material and methods. The study involved 352 patients with arterial hypertension (AH) of the 2nd degree of risks 2-3, who were divided into two groups. Group 1 did not use the blood pressure self-monitoring method, patients in the second group independently measured their blood pressure during one year. The analysis of the adherence to the treatment one year before and after inclusion in the survey was made, in 12,8±1,2 months we estimated the number of adverse events, including transient ischemic attacks, strokes, cases of unstable angina pectoris, myocardial infarctions, paroxysmal atrial fibrillation, deaths from cardiovascular diseases, emergency calls, hospitalizations, visits to the out-patient department apropos of cardiovascular diseases. Results. The adherence to the therapy one year before inclusion in the study in both groups, as well as in the first group after one-year observation did not have any statistically significant differences. In the second group after one year of observation there were significantly more patients taking antihypertensive agents (AHA) daily, significantly less patients who took antihypertensive agents only on the increase of blood pressure or did not take them at all (p<0,05) compared to the period one year before the inclusion in the survey. In the group of patients with blood pressure self-monitoring we observed significantly fewer visits to the polyclinic, emergency calls, hospitalizations, as well as the smaller total number of strokes, myocardial infarctions, deaths from cardiovascular diseases, the total number of cardiovascular events (strokes, myocardial infarctions, paroxysmal atrial fibrillation, cases of unstable angina pectoris) and the total number of events (strokes, myocardial infarctions, paroxysmal atrial fibrillation, cases of unstable angina pectoris, visits to the out-patient department, emergency calls, hospitalizations) within one year of observation. Conclusions. Long-term arterial blood pressure self-monitoring is an inexpensive and effective method that allows to control effectively the level of blood pressure, improve treatment adherence, reduce the risk of adverse events development in patients with arterial hypertension. Key words: arterial hypertension, self-monitoring of blood pressure, treatment effectiveness.

77-84

Authors: Onegin E.V., Biardouskaya H.M., Domarenko T.N., Danilova G.S., Motyuk I.N.

Abstract. The article describes a rare progressive disease of the central nervous system, hereditary mitochondrial pathology – subacute necrotizing encephalomyelitis (Leigh syndrome). There is a list of diseases for differential diagnosis: neuromuscular diseases, myasthenia gravis, fatty acids metabolism disorders, organic acidemias, cardiomyopathies, autoimmune multiple endocrine syndrome of type II, and diabetes mellitus. Two cases of clinical observation of lethal Leigh syndrome are described. In the first case, the disease began at the patient’s age of 1 year. Complaints of the lack of support on the right leg, unsteadiness in the sitting and standing position, loss of movements coordination appeared. The girl was repeatedly observed in the hospital, and was treated for celiac disease, viral encephalitis. She was consulted by a geneticist. Frequent mutations of SURF1 gene were revealed. In the second case, the disease manifested itself when the patient’s age was 1,2 years. Muscle weakness and hypotrophy progressed. The level of lactate in the blood increased. A heterozygous carriage of 845delCT SURF1 gene mutation was revealed by a geneticist. These two cases of clinical observation of fatal Leigh syndrome are discussed herein. The combination in the clinical picture of the progressive course of the disease, muscle hypotonia, vital functions disorders, beginning in the first year of life, increased level of lactate in the blood, symmetrical lesions in the region of basal ganglia and the brain stem on magnetic resonance study allowed to suspect a hereditary demyelinization disease of the brain. Leigh syndrome was confirmed with the help of genetic testing. Both cases had a fatal outcome. The cause of death was progressive respiratory and cardiovascular failure. Specific lesions of the nervous system were confirmed at autopsy. There are algorithms of clinical and paraclinical diagnoses. Key words: children, mitochondriopathies, subacute necrotizing encephalomyelitis, lacticemia, diagnosis, gene SURF1 mutation, treatment.

93-98

Authors: Savelyeva N.N.

Abstract. The aim of this research was to study the nature of changes in the population and subpopulation composition of the peripheral blood lymphocytes and TOLL-receptors expression on the immunocompetent cells in patients with chronic generalized periodontitis (CGP) of the 1st-2nd degree of severity associated with parasitic invasions (enterobiasis, toxocariasis, giardiasis). Immunological studies were conducted in 540 patients with CGP of the 1st-2nd degree of severity with parasitoses (main groups). The comparison group consisted of 90 CGP patients of the 1st-2nd degree of severity without parasitoses, the control group included 30 people without periodontal diseases and any chronic pathology of other organs and systems. It was found out that in periodontitis of the 1st severity degree, there was a tendency towards the reduction in the number of CD3+ - and CD4+ - lymphocytes, while in periodontitis of the 2nd severity degree we observed a significant (p<0,05) decrease in the number of CD3+- and CD4+-cells and in patients with periodontitis of the 1st-2nd degree of severity there was a significant increase in the number of CD95+-cells, increase of Th2-cells portion and imbalance in Th1/Th2-cells ratio, T-lymphocytes proliferative activity decrease, compared to the individuals from the control group. The investigation of TOLL-receptors (TLR) showed that in patients with CGP of the 1st severity degree associated with parasitoses, and mostly in patients with CGP of the 2nd severity degree associated with parasitoses, both the number of the peripheral blood monocytes, expressing TLR-2 and TLR-4, and density of their expression were reduced, compared to the control group and patients with CGP of the 1st-2nd degree of severity without parasitoses. The number of T-lymphocytes of the peripheral blood, expressing TLR-2 and TLR-1 remains within the norm. The revealed peculiarities in the population and subpopulation composition of the peripheral blood lymphocytes and the TOLL-receptors expression indicate that the immune status of CGP patients with parasitoses differs from that of CGP patients without parasitoses, and the identified peculiarities in immunoreaction exert influence on the nature and severity of periodontitis. Key words: chronic generalized periodontitis, parasitoses, lymphocytes, Toll-receptors.

106-113

Authors: Famin A.V.

Abstract. The historical analysis of the application of hospital substitution technologies in surgery in different countries of the world has been made. The state of matters concerning this problem in the public health service of the Republic of Belarus has been analyzed. The process of teaching surgical diseases with the emphasis on hospital substitution technologies in the Educational Establishment «Vitebsk State Order of Peoples’ Friendship Medical University» has been studied, the ways of its perfection have also been considered. The development of hospital substitution technologies should be aimed at the introduction of new advanced techniques, overcoming of the anxiety factor which sometimes attends the introduction of any novelty while optimizing the training of doctors and paramedical personnel. The creation of comprehensive multidisciplinal program of hospital substitution technologies within the framework of concrete surgical subjects, as well as the combination of students’ theoretical training with mastering definite practical skills and algorithms of actions in the «Center of simulation medicine» may contribute to the realization of this plan. Key words: surgery teaching, hospital substitution technologies.