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

5-11

Authors: Brynza M. S., Yabluchansky M. I.

49 patients (28 female, 21 male) with implanted DDD/DDDR, VVI/VVIR and CRT pacemakers are investigated. Purpose frequency and dose rate of anticoagulants, antiplatelet agents, direct thrombin inhibitors, cardiac glycosides, amiodarone; ivabradine, diuretics, aldosterone antagonists, beta-adrenergic blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), statins were evaluated before, in acute postoperative period (3–5 days), 6 months and 1 year after pacemaker implantation. Patients were divided into classes 1 (normal QTc (320–440 ms)) – 24 (49 %) patients) and 2 (long QTc (> 440 msec)) – 25 (51 %) patients) of QTc interval duration. To process the data using standard statistical procedures using Microsoft Excel. It was more often prescriptions of new anticoagulants, beta-adrenergic blockers, ARBs, statins to patients in the first year after pacemaker implantation. QTc interval duration lengthening was associated with a greater purpose frequency and doses of amiodarone, diuretics, beta-adrenergic blockers, ACE inhibitors, ARBs and statins. Patients with implanted pacemaker need individualized drug therapy according to QTc interval duration, in particular, enhancing antiischemic, antihypertensive, antiarrhythmic therapy and therapy of chronic heart failure in patients with QTc interval duration lengthening.

19-23

Authors: Kovalyova O. M., Kozhemiaka G. V., Honchar O. V.

Based on a survey of 108 patients with hypertension complicated by chronic heart failure, studied the connection concentration of osteopontin, interleukin-15 in serum and morpho-functional characteristics of the left ventricle of the heart. In patients with CHF osteopontin levels were significantly higher, it revealed a relationship between adverse LV filling state and knots in serum osteopontin, while the level of IL-15 did not show such a relationship. The results indicate the potential value of osteopontin as a biomarker for the diagnosis of CHF.

29-37

Authors: Petrenko O. V., Yabluchansky M. I.

The characteristics of the arterial hypertension (AH) clinical signs according to the types of diastolic blood pressure (DPB) daily profile in comparison with systolic blood pressure (SBP) daily profile types in 82 patients (33 men and 49 women), mean aged 56 ± 11 years, were studied. Statistical analysis was performed on a PC using the «Microsoft Office Excel 2010» and «STATISTICA» programs. It was found that DPB is as important as SPB hemodynamic parameter in patients with AH, and violation of its circadian rhythm leads to AH potentiating. To higher risk of DBP pathological daily profile types prone females, patients with a short history and the initial stages of AH. Evaluation of DBP daily profile carries additional information about the course of the disease and should be performed in all patients with AH.

43-47

Authors: Rudenko T. A.

A comparative assessment of the effect of mineralocorticoid receptor antagonists on changes in galectin 3 and matrix metalloproteinase 1 fibrosis markers has been carried out on 106 examinations (average age (69 + 10.37) years) with type 2 DM and CCF of ischemic nature of I-IV FC according to NYHA with retained systolic function of the left ventricle and manifestations of myocardium dyssynchrony. All the patients were divided into 3 groups depending on the intake of mineralocorticoid receptor antagonists. Myocardium dyssynchrony was assessed according to the generally accepted technique; the volume faction of interstitial collagen was measured using the formula of J. Shirani et al.; galectin-3 and matrix metalloproteinase-1 levels – using the immunoenzyme method according to the manufacturer’s manual. The data was processed using the methods of parametric and non-parametric statistics. It was discovered that the myocardium dyssynchrony development percentage in the group of patients not taking mineralocorticoid receptor antagonists was higher than in the group of patients taking spironolactone or eplerenone. An increase in fibrosis marker levels was shown in the spironolactone intake group compared with the group of patients taking eplerenone. Mineralocorticoid receptor antagonist intake requires blood potassium level control and case monitoring of manifestations of dyssynchrony and myocardial fibrosis.

56-61

Authors: Vizir M. O., Kovalyova O. M.

The aim of this study is to analyze changes in the nesfatin-1 level in hypertensive patients depending on the carbohydrate profile parameters. 83 hypertensive patients aged 33 to 77 years were examined. Nesfatin-1 levels were determined by enzyme immunoassay method. Hypertensive patients have significantly higher levels of adipocytokine than healthy people. Results of data analyses may indicate a possible antihyperglycemic and insulinotropic effect of nesfatin-1 in hypertensive patients with normoglycemia or prediabetes. Confirmation of these processes requires a special study.

68-72

Authors: Oyebamire I., Oyebamire M., Belal S. A. S., Liuta Е. А., Vodyanitska N. А.

Management of patients in therapeutic practice is becoming serious difficulties in view of the large prevalence of comorbidity pathologies of various organs and systems, especially atherosclerosis and arterial hypertension since these diseases is epidemic in recent years. Pancreatic pseudocyst is a localized fluid collection that is rich in amylase and other pancreatic enzymes and it presentation can be ranged from asymptomatic process to major abdominal catastrophe due to complications like infections, hemorrhages, obstruction and rupture. The main difficulty in the management of patients with pancreatic pseudocysts is a lack of effective medical and surgical treatment. Success can only be achieved with an individual approach to the patient with the joint cooperation of doctors of various profiles, as shown by our clinical case.

79-83

Authors: Zolotarova T. V., Brynza M. S., Mehtieva F. B.

The ultimate goal of any prescribed medical therapy is to achieve certain desired results in the patients concerned. Compliance to medical recommendations not only includes patient compliance with medication but also with diet, exercise, or lifestyle changes. Considered a clinical example of the patient of a very high cardiovascular risk with comorbid pathology: arterial hypertension, atrial fibrillation and diabetes mellitus. We have shown with this case as in comorbid patients with high cardiovascular risk could be organized medical treatment without polypharmacy.

93-111

Authors: Tymoshenko O. S.

Review is devoted to difficult-to-control arterial hypertension and possibilities of biofeedback as additional method to standard antihypertensive therapy. Reasons and current approaches to therapy of difficult-to-control arterial hypertension are discussed. Particularities of biofeedback therapy and variants of the technical implementation of the different loops are described. Recent publications that contain data of the effectiveness of biofeedback among hypertensive patients are given. Relevance of this problem among patients with difficult-to-control arterial hypertension is proved.

5-9

Authors: Alumuku M., Okonjo C., Hazem O., Belal S. A. S.

In 102 conditionally healthy volunteers aged from 19 to 30 years (average age is 19,53 ± 11 years) the volatility of heart rate variability (HRV) spectral parameters depending on body mass index (BMI) were evaluated. According to WHO recommendations on the calculation and interpretation of BMI were such groups of volunteers: underweight, normal body weight, overweight, obesity I degree, obesity II degree, obesity III degree. Among HRV parameters were evaluated total power (TP, ms2), power of very low frequency (VLF, ms2), low frequency (LF, ms2) and high frequency (HF, ms2) domains of HRV spectrum in the 5-minute intervals of ECG in I standard lead. The data were processed by methods of nonparametric statistics. It was established that spectral characteristics of HRV in volunteers with normal BMI have a high TP with harmonious relations between VLF, LF and HF domains; decreased or increased BMI provokes TP reduction by decreasing power of all domains of HRV (VLF, LF, HF) with a predominance of VLF proportion and this effect increases with the degree of deviation of the parameter.

18-22

Authors: Lebets I. S., Zaytseva E. M., Letyago G. V.

The purpose of the study was to investigate the clinical symptoms and evolution of juvenile chronic arthritis (JCA) at different stages of it development. 39 children with duration of JCA from 6 months to 5 years in age from 2 to 18 years were examined. All patients underwent clinical examination, indicators of acute phase of inflammation (CRP, sialic acid, seromucoid, glycoproteins), rheumatoid factor, circulating immune complexes, complement, instrumental methods (X-ray and ultrasound, capillaroscopy of nail bed) were evaluated. Activity of the disease was estimated by disease activity score (DAS28). Statistically was determined the relative value (P). It was found that the disease started with monoarthritis (63,37 %). In the future, in half of the patients was formed oligoarthritis with damaging of large and medium-sized joints (68,25 %). In the majority of surveyed disease occurred against the backdrop of the minimal activity of the inflammatory process. On the stages of evolution recurrence of arthritis were observed in one third of children. If duration of the sickness is more than 5 years, it has become less frequent, than in previous years. The absence of clinical and radiographic manifestations of JCA after the abolition of medical treatment within one year, became the basis for the assumption that the disease remission, which was on the third year of the disease 25,93 %, on the fourth – 33,33 %, on the fifth – 36,36 %. The absence of radiographic signs of bone destruction, disability of patients allows interpreting JCA as a positive option of chronic juvenile idiopathic arthritis.

29-31

Authors: Radchenko A. O., Belal S. A. S., Nazarenko E. O.

On 13 conditionally healthy volunteers aged from 18 to 46 years (mean age – 22±7,6 years) the variability of the total power (TP, ms2) of the spectrum, very low frequency (VLF, ms2), low frequency (LF, ms2) and high frequency (HF, ms2) domains of heart rate variability (HRV) in 5 minute intervals of ECG in I standard lead before and 30 minutes after oral admission of 500 mg of mebicar were evaluated. The data were processed by methods of nonparametric statistics. No significant changes in TP, VLF, LF, HF HRV after 30 minutes (maximum time declared by pharmacodynamics action) after administration of 500 mg of mebicar were noted by us. Accordingly, the effectiveness of mebicar as an adaptogen without evidence-based research cannot be postulated.

37-42

Authors: Abiodun M. A., Adegoke E. A., Aduroja A. O., Petrenko O. V.

A clinical case of arterial hypertension (AH) in patient with family history of pheochromocytoma is described. Patient has no classical clinical signs and imaging phenotype of pheochromocytoma, but there are a number of warnings – family history of pheochromocytoma, prevalence of humoral-metabolic regulation and reduced reaction to the respiratory test, CT-signs of nodular hyperplasia of left adrenal gland – which may indicate its possible manifestations in the future, and therefore the monitoring is required.

48-52

Authors: Lakhonina A. I., Filatova A. V., Makienko N. V., Vodyanitska N. A.

Aspects of diagnosis, difficulties in the diagnosis and optimal therapeutic strategies in patient with hypertrophic cardiomyopathy and comorbid conditions such as arterial hypertension, ischemic heart disease, dyslipidemia, diabetes mellitus type 2, stenosis of the left renal artery, obesity are reviewed on the example of clinical case. Hypertrophic cardiomyopathy combined with multimorbidity conditions requires a high-quality medical management, where the main goal is to improve the quality and duration of patient's life. This goal is being achieved by optimizing patient's lifestyle and assigning only the minimum amount of medications. Necessity of careful diagnosis of hypertrophic cardiomyopathy, evaluation of the risk of sudden death and search of optimal treatment in patients with multimorbidity pathology are demonstrated in clinical case.

58-60

Authors: Sharif B. J. R., Liuta E. A.

Acquired heart disease complicated by chronic heart failure (CHF), which significantly impairs the quality of life of patients and worsens the prognosis and remains radical surgical treatment with implantation of prosthetic valve. On the example of a clinical case are shown and discussed the results of a late replacement of the mitral valve in patient with acquired heart defect.

66-69

Authors: Zolotarova T. V., Maroun B., Hanan S., Mehtieva F. B.

The clinical case an adult patient with rare genetically heterogeneous disorder combine with congenital heart diseases and multiple stigmas of disembryogenesis, currently presenting mostly with signs of pulmonary hypertension have been reviewed. Patient is presented with definitive Noonan’s syndrome according scoring system of Van Der Burgt (has 2 major criteria). The data of the laboratory and instrumental diagnostic methods, clinical diagnosis, selection of the optimized treatment and modification of the habit of life are given.

88-101

Authors: Pochinska M. V.

Clinical importance of the pulse pressure (PP) in patients with permanent pacemaker (PM) is discussed in this review. Clinical characteristics, hemodynamic parameters, stimulation parameters, depending on the PP, and the ability to optimize medication with antihypertensive drugs are considered. Implanted pacemaker and CRT are changing the PP, which substantiates the need for additional medical supervision.