ARCHIVES OF THE BALKAN MEDICAL UNION

401-403

Authors: Camelia C. DIACONU

Chronic heart failure is a syndrome that appears in the evolution of a large majority of cardiovascular diseases. The main risk factors for chronic heart failure are arterial hypertension, coronary heart disease, diabetes mellitus, obesity, dyslipidemia etc. Over the years, researchers have been intensively studied new approaches and treatments to prevent the development of heart failure, to slow the evolution or to increase survival in patients with this syndrome. Dyslipidemia is a risk factor for chronic cardiovascular diseases, especially coronary heart disease. HMG-CoA reductase inhibitors (statins) are largely used for the treatment of hypercholesterolemia and coronary heart disease. Considering the beneficial effects of statins for the prevention and treatment of cardiovascular diseases, some studies suggested that these drugs can be beneficial in the context of chronic heart failure1-3. However, a “cholesterol paradox” has been recognized in patients with heart failure: although hypercholesterolemia is a risk factor for coronary artery disease, low cholesterol seems to be associated with a poor prognosis in patients with already installed heart failure, as compared with those without heart failure4-6. This is named “the cholesterol paradox”. There are multiple possible explanations for this paradox. Cholesterol is a marker of nutritional status in patients with mild to moderate heart failure. The congestive hepatopathy of patients with chronic heart failure may lead to decreased liver synthesis of cholesterol2. Also, the intestinal congestion in these patients may impair the absorption of cholesterol7. Studies have found that low serum cholesterol is secondary to the severity of the heart failure, as in other chronic diseases. However, it is not yet known if low cholesterol is the cause of a worse prognosis in heart failure or it is only a marker of more severe disease. On one hand, statins have pleiotropic effects that could be beneficial in heart failure, such as stabilization of atheromatous plaques, inhibition of proinflammatory cytokine activity and even antiarrhythmic effect8. On the other hand, statins may be harmful in patients with heart failure, raising their susceptibility to infections, because lipoproteins remove bacterial endotoxins from the circulation9. Treatment with statins reduces the level of coenzyme Q10, which plays a role in the mitochondrial respiration and influences the contractile activity of the myocardium10. The serum level of coenzyme Q10 is inversely correlated to mortality of patients with heart failure10. A meta-analysis of 15 studies including 45,110 patients with heart failure, from whom 22,471 were treated with statins, revealed that patients who received a statin had a lower all-cause mortality rate and rehospitalization for heart failure11. Two studies, CORONA and GISSI-HF, suggested that patients with systolic heart failure do not benefit from initiation of statin therapy12,13. CORONA trial suggested that rosuvastatin might be beneficial in patients with ischemic heart disease and systolic heart failure, with NT-proBNP value <868 pg/mL12. The negative results of these two studies are in contrast with numerous other small studies which have demonstrated the beneficial effects of statins in heart failure patients14. The clinical trials did not search if patients already taking a statin, who develop heart failure, benefit from continuation of statin treatment. Until further studies will clarify these issues, it seems reasonable that patients already on statin for another strong indication, developing heart failure, should continue the statin. Patients with systolic heart failure, with a left ventricle ejection fraction <35%, should receive a statin, according to CORONA trial results12. The decision to start a statin in patients with heart failure with preserved ejection fraction is usually based upon other indication, such as high LDL-cholesterol values or documented atherosclerotic vascular disease.

411-416

Authors: Irina BAGMUT, Igor KOLISNYK, Anna TITKOVA , Svetlana GRAMATIUK, Liudmyla SVYRYDENKO

The objective of the study was to evaluate the intracellular cyclase cascade under the conditions of chronic fluoride intoxication in white rats of the Wistar population. Materials and methods. The study was conducted from 2009 to 2014 in the Department of Biochemistry and vivarium of Kharkiv National Medical University MOH, Kharkiv, Ukraine. The study was performed on white rats of the Wistar population. In these rats, we administered intragastric, in the morning, on an empty stomach, a solution of sodium fluoride at a rate of 20 mg/kg of body weight. In this way, the development of fluoride intoxication was simulated. The duration of oral administration of the drug was 1.5 months. The intracellular metabolism was assessed in plasma, liver, kidneys, spleen, and brain cortex. The energy components of the adenylate cyclase system, adenosine monophosphate (AMP), adenosine diphosphate (ADP), adenosine triphosphate (ATP), inorganic phosphorus and ions of Mg2+, guanylate cyclase, phosphodiesterase, were measured. The organs and tissues content of cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP) and absorption of Са2+ by the liver membranes microsomes and synaptosomes of the brain were also determined. Results. The increase in the content of cAMP and a decrease in the level of cGMP were observed in the blood plasma of animals, whereas a decrease in the concentration of cAMP and an increase in the amount of cGMP were observed in the liver, kidneys and spleen. In the cerebral cortex, a decrease in adenylate cyclase activity and cAMP content has been established. At the same time, the activity of guanylate cyclase, phosphodiesterase, and cGMP content increased. Conclusions. Analysis of the absorption of Са2+ membranes by macrosomes of the liver and brain synaptosomes revealed a decrease in basal and К+– stimulated absorption of calcium ions by membrane preparations of nerve cells. In the liver, the К+-stimulated and basal absorption of Са2+ ions was significantly less than in the brain.

422-430

Authors: Denys SHYIAN , Olga AVILOVA, Irina LADNAYA

Background. Pollution of the environment poses major risks for human health. Chronic exposure to some well-absorbed but slowly eliminated xenobiotics can lead to their bioaccumulation in living organisms. The objective of the study was to describe the organometric changes occurring in thymus of male rats under tryglycidyl ether of polyoxypropylenetriol exposure. Material and methods. 40 WAG matured male rats were divided randomly into two groups. The first group served as a control included 8 animals. The second group of 32 rats, 8 rodents in each, were treated via gavage by aqueous solutions of tryglycidyl ether of polyoxypropylenetriol (TEPPT) in a dose of 1/10 LD50 in conversion to 5.75 g/kg during 7, 15, 30, 45 days. All animals were sacrificed on the term defined by experimental design. Thymus specimens were dissected out and measurements of the linear dimensions (length, width, height) using digital caliper were taken. The mass and volume of the thymus were counted. Limits of the thymus morphometric indices’ variability in intact and experimental groups were calculated. Results. The research indicates that tryglycidyl ether of polyoxypropylenetriol exposure caused marked organometric changes in rats’ thymus. 100% effect on all morphometric indices of the thymus under impact of TEEPT in a dose of 1/10 LD50 on the 7th, 15th, 30th and 45th day was noted. However, more pronounced changes were observed on 7th and 30th days. The study revealed that IndT of the control group, which is related to the length and width of the thymus, has the greatest limits of the parameters’ fluctuations and their significant variability. IndHL of the control group, which is associated with the height and length of the thymus, has the lowest fluctuation limits of the parameters. In our opinion, this is connected, first of all, with the peculiarities of the structure and form of the rats’ thymus. Conclusions. Thymus shows active response on the induced xenobiotic and these data can be successfully extrapolated from experimental animals to humans.

438-444

Authors: Dmytro IVANOV, Liybov SAVYTSKA, Veronika KULACHEK

Introduction. Kidney Disease Outcomes Quality Initiative (KDIGO) Group proposes the estimated glomerular filtration rate (eGFR) and albuminuria rate for a combined risk of clinical outcomes in patients with chronic kidney disease (CKD). However, the decline rate of eGFR can vary independently of the baseline eGFR. The objective of the study was to improve the prognostic efficacy in chronic kidney disease (CKD) stage 1-3 due to new significant factors of CKD progression detected by renal stress test via the water-salt loading with 0.5 % sodium chloride solution, at a rate of 0.5% of the body weight. Material and methods. In a single-centre prospective study, during 3-year follow-up period, from January 2016 to December 2018, 108 patients with CKD stage 1-3 (a, b) were examined. There were two groups: patients with rapidly progressive CKD whose eGFR throughout one-year follow-up decreased by 3 ml/min/1.73 m2 and more (59 patients), and the group with a stable CKD, whose eGFR throughout one-year follow-up did not decrease or has decreased by less than 3 ml/min/1.73 m2 (49 patients). Results. No relationship between the renal functional reserve, stimulated GFR and a decline in eGFR throughout the year was found. The change in urine creatinine on the background of the water-salt loading was positively correlated with changes in eGFR throughout the year. Spearman’s correlation coefficient was rs 0.4 (p-0.02). The OR of decline in eGFR by more than 3 ml/min/1.73 m2 throughout the year, with a decrease in urine creatinine level by more than 2 mmol/L, was 4.7 (95 % CI 1.9-12.0). Conclusions. Improving the functionality of the renal stress test via the water-salt loading by measuring urine creatinine can help to identify the high-risk group for disease progression.

455-460

Authors: Lilia D. TODORIKO , Igor O. SEMIANIV, Olga S. SHEVCHENKO, Tetiana M. BILOUS, Marianne M. SEMIANIV, Rostislav S. SHEVCHENKO, Volodymyr V. YAKYMETS

The objective of the study. To identify glutathione S-transferase M1 (GSTМ1) gene polymorphism in patients with tuberculosis depending on Mycobacterium tuberculosis (MBT) resistance. Material and methods. The study involved 100 patients with newly diagnosed pulmonary tuberculosis (TB), who had been hospitalized in Chernivtsi Regional TB Dispensary. The control group consisted of 50 healthy individuals. Genomic DNA was isolated from the whole venous blood. GSTM1 polymorphic areas were isolated by means of multicomplex polymerase chain reaction, according to the protocol for instantaneous analysis of polymorphism by Arana et al (1996). Deletion of gene corresponds to the lack of appropriate strips in the electropherogram. Results. An analysis of the occurrence of alleles and genotypes of GSTM1 gene in patients with pulmonary tuberculosis regarding the MBT resistance version allowed to establish that, under the conditions of pulmonary tuberculosis infection, GSTM1 gene deletion mutation can be found in one out of five (21.87% of cases), and the occurrence due to the MBT resistance version is: with newly diagnosed tuberculosis (NDTB) – 17.39%, with multidrug-resistant tuberculosis (MDR-TB) 35.0% and polyresistant pulmonary tuberculosis (PRTB) 20.0%, respectively. According to the nature of the distribution of allelic gene GSTM1, a favorable functional 1 allele prevails (73.29%) in the normal inbreeding among patients and deficiency of heterozygosity among healthy people, which generally forms a normal population distribution for the European race. Conclusions. According to the nature of allele distribution of GSTM1 gene, the favorable functional 1 allele prevails (73.29%) in case of normal inbreeding in patients (F=0,20, р>0,05) and lack of heterozygote in healthy individuals (F=0.28 р=0.033), which in general forms a normal population distribution [OR=14.06, р=0.005].

467-472

Authors: Oksana S. KHUKHLINA, Oksana D. LIAKHOVYCH , Ludmila V. KANIOVSKA, Vera O. SHUPER, Iryna B. HORBATIUK, Olha Ye. HRYNIUK

The objective of the study was to determine the characteristics of bone mineral density in patients with osteoarthritis (OA), non-alcoholic steatohepatitis (NASH) and obesity. Material and methods. 90 patients were examined and distributed into three groups: group 1 (n = 30) consisted of patients suffering from OA of knee joints, grade 2-3 according to Kellgren and Lawrense classification,with normal body weight (mean BMI 22.88±0.39 Kg/m2); group 2 (n = 30) – patients with OA with NASH and obesity (mean BMI 34.38±0.69 Kg/m2). The control group consisted of 30 healthy subjects of the corresponding age. The average age of patients was 62.3±5.7 years.The bone mineral density (BMD) at the level of the proximal femoral bone was evaluated on a dual-energy X-ray densitometer using the STRATOS apparatus DMS-APELEM (France) under a densitometry cabinet based on the Swedish-Ukrainian Medical Center “Angelholm”, Chernivtsi, Ukraine. The diagnosis of osteoporosis and low BMD was done according to the criteria of the ISCD Official Positions, 2007 (revised in 2015). Statistical analysis was performed using SPSS Statistics 20 Multilingual. Results. Osteoporosis and low BMD were found to be significantly higher in patients with osteoarthritis compared with those from the group withosteoarthritis, NASH and obesity. Conclusions. In patients with isolated osteoarthritis, a significant decrease of bone mineral density was found, especially in the intertrochanteric region of the femur. In individuals suffering from OA, the risk of fractures was higher than in those with concomitant NASH and obesity. The difference was significant only in the case of osteoporotic and femur fracture, without considering BMD.

480-485

Authors: Daiana DEBUCEAN , Petru MIHANCEA, Marius S. POP

Introduction. The face and its associated structures (cranial, oral, dental) form one of the most complex areas of the human body, hence the diversity of the anatomical and functional pathologies at this level. Sometimes, the approach from the perspective of only one medical specialization may lead to symptomatology improvement or even remittance, but there are many situations when relapse occurs over time; the effect was treated, but not the cause in its totality. Proper diagnosis, selection and implementation of the most appropriate therapeutic approach require the involvement and collaboration of a multidisciplinary team. The objective of the study was to highlight the advantage of combining manual therapy and myofunctional therapy, along with general relaxation, in patients with a mandible opening limitation in order to regain the harmony of the neuromuscular control and temporomandibular arthrokinematics. Material and methods. 46 patients were divided into 3 groups: group 1 benefited from manual therapy alone, group 2 only myofunctional therapy; group 3, manual therapy together with myofunctional therapy. Results. The data confirm the increased efficacy of the combined therapy used with group 3 compared to the groups where only one type of therapy was applied. Therefore, it is confirmed the importance of involving the multidisciplinary team in addressing the patient with temporomandibular joint dysfunctions. Conclusions. The short- and medium-term outcomes of combined therapy demonstrate the reduction of symptoms without recurrence, an improvement in dental functioning and, as a consequence, an increase in the quality of life of this patient population.

492-496

Authors: Mirena P. VALKOVA , Ivanka I. VELEVA, Velina N. GUERGUELTCHEVA, Presian S. BURGOV

Introduction. Vascular risk factors have been associated with cognitive decline, although their simultaneous effects on cognition are unclear. The aim of our study was to examine the additional impact of some of the most important risk factors (ageing, arterial hypertension (AH), chronic ischemic heart disease (CIHD), tobacco-usage and alcohol) on cognitive functions of patients with diabetes mellitus (DM). Material and methods. We examined 115 patients (average age 62.47±10.60 years; 49 males, 66 females) with DM (mean disease duration 9.28±6.88 years), admitted between 2016-2017 in the Neurology Clinic of the University Hospital „Sofiamed“, Sofia, Bulgaria. We used the following neuropsychological battery: Mini Mental State Examination (MMSE), Isaack Set Test, 10 words memory test, Digit Symbol Substitution Test, Trail Making Test A and B, Clock drawing test, Logic memory test (subscale of Wechsler memory scale IV ed.), Benton visual retention test (var. A, form E). The results were summarized in tables. All the results were analyzed in 95% confidence interval. Results. Ageing was associated with a poor cognitive performance in almost all examined cognitive domains, except MMSE. CIHD is associated with low Digit Symbol Substitution Test points and more omissions and size errors on Benton Visual Retention Test. Conclusions. Ageing is associated with decline in visual and verbal memory, executive functions and visual-spatial abilities in cases with DM. CIHD leads to additional alternating attention deficits in patients with DM. AH, tobacco-usage and mild and moderate alcohol drinking are not significantly associated with additional cognitive dysfunctions in cases with DM.

503-507

Authors: Tetiana V. MELNYK , Sergiy A. BONDAR

Introduction. Lichen planus (LP) is a chronic poly-etiologic dermatosis by the mechanism of its development, manifested by papular rash on the skin and mucous membranes, severe itching. The objective of the study was to determine and analyze the levels of endogenous intoxication markers in blood plasma of the patients with lichen planus depending on severity and duration of the disease. Materials and methods. 48 patients, 20 men and 28 women, participated in the study. 31 patients had suffered from dermatosis for about 2 years, and 17 patients for over 2 years. Mild LP was diagnosed in 17 patients and moderate LP in 31 patients. The blood levels of homocysteine (HC), carbonyl groups of oxidative modified proteins (CG-OMP) and medium molecular weight peptides (MMWP) were determined in all the patients. Results. Significantly increased blood plasma levels of HC, MMWP and CG were found in patients with lichen planus as compared to the control group. The patients with severe and prolonged course of dermatosis had more evident disturbances in the content of endogenous intoxication markers than those with short and mild course of the disease. Conclusions. A significant increase in the levels of homocysteine, MMWP and carbonyl groups of oxidative modified proteins was found in the patients with LP, being indicative of an essential role of endogenous intoxication processes in the pathogenesis of lichen planus.

514-521

Authors: Halyna PAVLYSHYN, Kateryna KOZAK

Introduction. Overweight and obesity is a global epidemic among children of all age groups. Obese children are at increased risk of insulin resistance, cardiovascular disease (including arterial hypertension), as well as bone fractures and psychological problems. In this regard, insulin resistance has become one of the most serious health concerns in overweight and obese children. The objective of the study was to investigate the specifics for carbohydrate metabolism in overweight and obese children, to identify the key factors for insulin resistance and to develop a regression analysis-based prognostic model to predict its occurrence. Material and methods. In 90 obese and 20 overweight children aged between 10-17 years, anthropometric measurements, history data collection and laboratory investigations were performed. Multiple regression analysis has been used to develop a mathematical model for prediction of insulin resistance. Results. Such variables as weight, body mass index, waist and hip circumferences, abdominal type obesity, family history, duration of breastfeeding (if any), birth weight, sedentary lifestyle, leptin and adiponectin levels and dyslipidemia were closely related to fasting glucose levels and insulin/insulin resistance indices. Conclusions. Abdominal obesity, male gender, family history of abnormal carbohydrate metabolism, insulin levels, duration of breastfeeding and plasma leptin levels have been defined as main predictors of insulin resistance in overweight and obese children and were included in regression equation for the index of insulin resistance using the method of multiple regression analysis.

540-548

Authors: Mariana I. DIMOVA-GABROVSKA, Desislava G. DIMITROVA

Introduction. Early childhood diet is of critical importance for the processes of tooth dentition, formation of organic matrix, mineralization and maturation of dental structures. The involvement of inorganic elements in the building up of bone and teeth tissue in childhood is an essential process, determining the achievement of their peak density. Considering the scientists’ interest in oral health, with emphasis on childhood and increasing of caries incidence at this age, it is necessary to investigate deeply the issue at national level as well. The objective of the study was to investigate the dietary intake of inorganic elements – calcium, phosphorus, magnesium, fluorine, sodium, and iron in children with early childhood caries. Material and methods. The dietary mineral intake of 53 children, aged 3-6 years, diagnosed with early childhood caries, was studied by the 24-hour dietary recall method. The data revealed by parents’ responses were processed statistically, compared to the referent values for inorganic elements intake in this age. Results. The results of investigated group of children revealed an average daily intake of calcium of 473.4±222.5 mg, phosphorus 745±177 mg, fluorine 0.8±0.37 mg, magnesium 139±43 mg, iron 6.7±4.64 mg, and of sodium 1159±529 mg. Conclusions. The detected lower intake of calcium, magnesium, fluorine could be considered as risk factor for caries development and the other elements are associated with children’s general health status. The specificity of the needs and health status requires complex caries treatment starting in early childhood together with adequate diet.

555-560

Authors: Gina GHEORGHE, Gabriela CEOBANU, Madalina ILIE, Ana Maria A. STANESCU, Ovidiu G. BRATU, Camelia C. DIACONU

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with unknown etiology and incompletely elucidated pathogenesis. It implies the loss of tolerance to the inner self, which leads to perturbations in the immune system, with production of autoantibodies. SLE is characterized by multisystem involvement, the evolution of these patients being directly influenced by the severity of organ complications. The most common pattern seen in patients with SLE is a combination of musculoskeletal, skin, renal, central nervous system, cardiovascular, hematologic and gastrointestinal manifestations. The gastrointestinal symptoms are commonly seen in patients with SLE, the main pathological mechanisms involved being mesenteric vasculitis, intestinal pseudo-obstruction and protein losing enteropathy. Neurological manifestations are also frequent among these patients and they correlate with a high rate of morbidity and mortality. This review aims to analyze the correlation between gastrointestinal and neurological manifestations in SLE and their impact on the quality of life.

571-575

Authors: Mihaela HOROI , Serban V. BERTESTEANU, Bogdan POPESCU, Raluca GRIGORE, Marie-Paule THILL

The ENT practitioner has a principal role for diagnosis, treatment and clinical recovery of vestibular schwannoma patients. These tumors require a special attention, concerning the treatment and the follow-up, because of their location in a deep anatomical region, very rich in vascular and neurological elements. If surgery is chosen as the best treatment modality, the vascular related complications, during surgery or immediately after surgery, can be disastrous for the patient. The surgeon must have the anatomical knowledge and appropriate skills. The anatomy of the venous system has an individual variability, with an impact to the procedure’s surgical risks. The objective of this publication is to synthetize the local venous anatomy and surgical practices in case of venous bleeding at the level of the pontocerebellar angle.

581-584

Authors: Nicolae BACALBASA, Irina BALESCU, Cristian BALALAU, Mihaela VILCU, Iulian BREZEAN

Anal cancer is a rare digestive malignancy with high propensity to spread via lymphatic route, leading to the apparition of metastases at the level of superficial inguinal and perirectal stations. However, prophylactic irradiation of all these fields is not recommended due to the inacceptable high risks of complications when compared to the rates of metastases. Therefore, sentinel lymph node biopsy has been routinely associated in order to determine which cases present lymphatic metastases and could benefit most after irradiation. This is a literature review of the largest studies conducted on the subject of sentinel lymph node biopsy in anal cancer patients.

591-595

Authors: Daniel I. MIHALACHE, Bogdan SOCEA , Alexandru C. SMARANDA, Anca A. NICA, Alexandru C. CARAP, Ovidiu G. BRATU, Ana Maria A. STANESCU, Florin GROSEANU Mihai C.T. DIMITRIU, Vlad D. CONSTANTIN

Introduction. Mesh reinforcement is generally considered the standard of care in hernia repair. Infection is a common complication following hernia repair. Infection of the mesh is a complex problem. Knowledge of new treatment strategies is necessary for surgeons performing abdominal wall reconstruction. Case presentation. We present the case of a 68-year-old woman, who presented with a non-traumatic entero-atmospheric fistula at the site of the hernia repair, which had been done 2 years previously through the implantation of a dual mesh. The fistula has appeared one year previously. The treatment consisted in a complete removal of the infected mesh and segmentary enterectomy. The abdominal wall was repaired through a tissular procedure and the skin was left to close per secundam. The postoperative outcome was favorable. Conclusions. Following excision of infected mesh, multi-staged abdominal wall reconstruction can be considered. Biologic or biosynthetic mesh is recommended when repairing incisional hernias following excision of infected mesh and likely represent the patient’s best chance for a definitive hernia repair. Negative pressure wound therapy closure should be considered in higher-risk patients. Mesh infection is a complex complication that is commonly encountered by surgeons performing hernia repair. Prevention through patient optimization should be performed whenever appropriate. However, when patients develop a mesh infection, most of them will require a complete mesh excision and recurrent hernia repair.