Medical perspectives (Medicni perspektivi)

13-19

Authors: Biletska E.M., Shtepa O.P., Kalinicheva V.V., Valchuk S.I.

In recent years the steady trend to growth of the technogenic load of the environment closely correlates with deterioration of the health status of the population, chronic diseases and worsening of demographic indicators. One of the main threats to human health from contamination with heavy metals is associated with the influence of lead, which contributes to the development of chronic diseases of the nervous, hematopoietic, endocrine, renal and bone systems. In the process of studying the properties of zinc, its use as an osteoprotective agent is becoming more actual. In connection with the foregoing, the aim of our study was to study the content of zinc in bone tissue in low-dose isolated and combined effects of various forms of lead and zinc under the experimental conditions. For the experiment, sexually mature Wistar rats with a body weight of 150-170 g were selected, with the following randomization into six experimental and one control group, eight rats in each one. The data obtained and their comprehensive analysis allow to fully suggest the formation of a bioantagonistic relationship between lead and zinc in the bone at the level of the latter, observed both in the isolated action of lead and in combination with zinc. Along with this, our results correspond with the data of other researchers on the osteoprotective properties of zinc under the action of even low-dose levels of lead, especially of its nanoacqualate form (zinc citrate).

25-32

Authors: Volosovets A.O.

Arterial hypertension can cause a pronounced negative influence on the state of the cerebral vascular system and lead to significant microtraumatization of the walls of the vessels and disruption of vascular autoregulation. This predictor has the greatest influence on the onset of ischemic stroke of atherothrombotic and lacunar subtypes, however, hypertension occurs almost in all patients with acute cerebral ischemia. Interesting and not at all presented in modern scientific literature is the question of the relationship of oscillation of blood pressure with the period of the onset of the focus of ischemia, which predetermined the purpose of our work. The purpose of our study was to determine the relationship between deformation of the profile of fluctuations in blood pressure of patients in the acute period of ischemic stroke, depending on the time of the occurrence of cerebrovascular accident. We examined 300 patients who suffered acute ischemic stroke (men - 196, women - 104) aged 42 to 84 years (average age - 65.2 ± 8.7 years). All patients were divided into 3 groups according to the period of the day when an ischemic stroke occurred: 1 group (n=146), patients suffering from cerebral ischemia during the day (8.00-14.59); In group 2 (n=107), patients stroke was observed in the evening (15.00-21.59); Group 3 (n=47), patients had an ischemic stroke at night (22.00-7.59). For the 1st group of patients who have had ischemic stroke during the day and as a rule with an increase in blood pressure, a marked increase in blood pressure was at 12.00 and 15.00 and a tendency towards compensatory parasympathetic effect in the form of blood pressure decrease at night (over-dipper) was typical. At the same time, in the 2nd group of patients with stroke in the evening, elevated blood pressure at 18.00 and 21.00 and parasympathetic activity disorders with prevalence of insufficient reduction of blood pressure in the evening and during sleep (non-dipper) was observed. For patients with a nocturnal stroke (3rd group), there were two peaks of elevated blood pressure at 9.00 and 21.00 and a significant increase in night-peaking at night, which usually resulted in a cerebrovascular catastrophe. Sharp changes in human biorhythm significantly affect the violation of the regulation of the vegetative-vascular system and lead to a breakdown in the regulation of vascular tone with the emergence of phenomena of "vegetative storm" and sharp increase in blood pressure by the type of "night peacker". This effect is also caused by chronic alcohol intoxication, presumably due to the toxic damage of the hypothalamic-pituitary complex due to the high permeability of the blood-brain barrier in this area of the brain due to over-active hormonal-regulatory diffusion.

40-48

Authors: Pysarevska K.O., Zharinov O.I.

The aim - to create a model for predicting long-term sinus rhythm retention after electrical cardioversion (ECV) based on individual patients characteristics. 141 patients with persistent AF who were planning to have sinus rhythm restoration, underwent general clinical examination, ECG and transthoracic echocardiographic. In 6 months after ECV patients were divided into two groups: 83 patients maintained sinus rhythm for 6 months (group I), recurrence of AF was observed in 58 patients (group II). The results of the ROC analysis determined statistically significant parameters that contribute to long-term retention of the sinus rhythm: non-modifiable (age, history and duration of the last episode of arrhythmia, combination of background diseases), modifiable (smoking, antiarrhythmic therapy, severity of heart failure by NYHA). A multifactorial prognostic model is created with the help of the modern approach of creating scorecards. This allowed in the form of a numerical characteristic to determine the probability of a long retention of the sinus rhythm. The selection of factors for the scoring model was in accordance with the criteria of the power of their influence on the retention of the sinus rhythm. The scoring model was created for predicting long-term retention of sinus rhythm after electrical cardioversion based on the individual characteristics of a patient with a persistent form of AF. The model has a high sensitivity (92.77%) and specificity (70.69%) and allows to predict the further course of the disease and to correct the therapy on time.

56-61

Authors: Tsarev A.V., Usenko L.V.

The article presents the results of a comparative study of control and safety of two technologies of therapeutic hypothermia in intensive care in patients with TBI: an estimate of the rate of its induction, control of its maintenance, dynamics of attaining normothermia. A total of 24 patients with a severe TBI divided into 2 groups were examined: I (n=12) – therapeutic hypothermia with "Blanketrol II" (CSZ) with the use of non-invasive technology to achieve the target core body temperature (Tco) of 34-34.50C; II group (n=12) – carrying out therapeutic hypothermia «Blanketrol - II» with the use of an esophageal device for hypothermia to achieve Tco - 34-34,50С. The mean time from the moment of induction to achievement of the target Tco in group I was 9.5±2.39 hours, in group II – 9±2.70 hours (p>0.05). The maintenance period Tco at the level of ≤34.50C in the II group was greater – 10.5±5.78 compared with 6.83±3.95 hours in patients of the I group (p<0.05). Control of the warming process was significantly higher in group II, which was reflected by a lower mean of Tco value at 24, 28 and 32 hours. There were no clinically significant adverse effects in therapeutic hypothermia.

68-73

Authors: Krishtafor D.A., Klygunenko O.M.

The aim of the study was to determine the effect of quantitative and qualitative changes in fluid resuscitation on the dynamics of markers of the shock state in patients with multiple trauma. 73 patients with multiple trauma were divided into two groups, depending on the fluid resuscitation type (liberal or restrictive). The parameters of hemodynamics, hourly diuresis, general blood test, coagulogram, acid-base and gas composition of blood were studied. A decrease in the infusion volume in traumatic blood loss due to the restriction of the crystalloids and colloids volume allowed to effectively reduce such manifestations of shock as hypotension, tachycardia and acidosis, to provide an adequate rate of diuresis. In restrictive infusion group the duration of vasopressor support was shorter, the fluctuations in peripheral blood parameters were less pronounced, coagulation normalized earlier, positive water balance was significantly lower, mortality and the number of complications were reduced. Restriction of fluid resuscitation volume allows to successfully treat shock and decrease multiple organ dysfunction, number of complications and mortality.

81-86

Authors: Schevchenko-Makarenko O.P., Schostakovych-Korets'ka L.R., ChykarenkoZ.O., Tkachenko V.D., Lisnicha O.O.

The article presents the adap­tation data of the quality of life questionnaire (QOL) in patients with chronic viral hepatitis C (CVHC). Ball score of QOL of patients with CVHC was 5.09±1.04, 2nd group (with co-infection with HIV / HCV) - 4.60±1.13, control group - 5.92±0.52 (p<0.05)). The results of the analysis show that co-infection HIV / HCV is a serious problem for patients and significantly affects QOL. The use of the QOL questionnaire for chronic liver disease is a sensitive tool for measuring QOL in patients with CVHC and co-infection HIV / HCV. This informative and economical method can be implemented to assess the patient's health both at the group and individual levels in patients with chronic liver disease in the population of Ukraine.

92-97

Authors: Zakharov S.V.

A comparative analysis of the sensitivity and specificity of immunoblotting against other non-treponemal and treponemal reactions was carried out in 215 patients with early forms of syphilis. A high diagnostic efficiency of immunoblotting in patients with early latent syphilis was established. It was found that only in case of primary syphilis, immunoblotting is inferior to Immunofluorescence reaction; this test can be used for differential diagnosis between hidden syphilis and false positive reactions to syphilis.

99-103

Authors: Loskutov O.Ye., Oleinik O.Ye., Synegubov D.A.

Friendship lasting for 20 years (to the jubilee of Ukrainian-German Association of Orthopedist Traumatologists)