Medical perspectives (Medicni perspektivi)

4-12

Authors: Sapegin V.I., Sapegin I.D., Ilchenko F.N.

In acute experiments on rabbits there were studied changes in oxygen tension in the intestinal wall tissues, acid-base balance and limited proteolysis and its inhibitors in intestinal venous blood, protective action of L-lysine escinat (0,15 mg/kg / single dose), thiotriazolin (25 mg/kg / single dose), aprotinin (gordox) (10,000 units/kg / single dose) in sequential modeling of standard levels increasing of intra-abdominal hypertension (IAH) — 50, 100, 150, 200, 250, 300, 350 m H2O, and also of tolperison (mydocalm) (5 mg/kg / single dose) on modeling of stable 3-hour IAH 200 m H2O. The IAH modeling was performed by means of stand of our construction. Under the influence of IAH the compensated metabolic acidosis in intestinal venous blood with a compensative hyperpnoe develops, decline of oxygen tension in tissues and activating of a limited proteolysis as well as decline of its inhibitors activity in intestinal venous blood occur. By the degree of metabolic acidosis prevention investigational preparations were distributed as follows gordox > thiotriazolin = L-lysine escinat = mydocalm, and by prevention of decline of oxygen tension in tissues — thiotriazolin > L-lysine escinat > mydocalm > gordox, it is is connected with different rate of methabolic products excretion into the blood, due to the influence on blood circulation and transcapilary exchange. By the degree of prevention of proteolytic activity and inhibitory potential changes, investigational preparations were distributed as follows: gordox > mydocalm > thiotriazolin > L-lysine escinat, this is connected with inhibition of proteolysis in gordox, and in other ones – with reduction of ischemic damage of tissues. Owing to different mechanism of action thiotriazolin, L-lysine escinat and mydocalm may be simultaneously recommended for a conservative treatment of patients with intraabdominal hypertension syndrome.

18-24

Authors: Pertseva T.O., Lykholat O.A., Gurzhiy O.V.

Investigation of mucociliary clearance (MCC) condition in 90 patients with COPD was performed according to the stage of the disease by determining the level of biochemical indicator of sputum - medium weight molecules (MWM). To determine the effect of chronic inflammation in the respiratory tract on a general condition of the organism, MWM content in blood serum was investigated. To reduce the influence of comorbidity on MWM content in blood serum, patients with COPD without or with mild comorbidity in remission were selected, and the results were compared with those of healthy people (control group, n = 20). The results showed a direct correlation between the severity of airflow limitation and concentration of MWM in sputum, this was accompanied by increasing of viscosity and adhesive performance of sputum and violation of the optimal conditions of MCC functioning. The fact established allows to use determination of MWM content in sputum of COPD patients as a noninvasive and accessible for pulmonology practice method, which allows to quickly and adequately assess MCC condition and aggregate of metabolic abnormalities in patients’ respiratory tract. Chronic inflammation in respiratory tract is accompanied by disorders of determined indicators in the serum as well, but increase of MWM content in sputum is specific, while the accumulation of MWM in serum of patients with COPD is not specific.

33-39

Authors: Gashynova K.Y.

Exceptional importance of exacerbations for COPD course prognosing was reflected in the GOLD, 2011, where the number of exacerbations during the past year has been recognized as one of the main criteria of the future risks for patients. The aim of study was to determine the anthropometric indicators that increase the risk of re-hospitalization due to acute exacerbation of COPD. A retrospective analysis of medical records of inpatients who were hospitalized with COPD exacerbation to therapeutic department of CI "Dnipropetrovs’k sixth municipal clinical hospital" of Dnipropetrovsk regional council" during three years was done. It was established that neither sex, nor height, nor weight affect the rate of hospitalization due to COPD exacerbations. Older age is not a factor that increases the risk of hospitalization due to COPD exacerbation (despite the fact that the majority of hospitalized patients were elderly patients, 37% of them were persons of potentially working age). Severe exacerbation of COPD may occur in any patients with, even one year, experience of the disease. Among anthropometric indices, the most important predictor of re-hospitalization due to exacerbation of COPD is BMI<18.5, so its calculation is advisable in long-term observation of patients.

43-49

Authors: Dudka T.V., Huhlina O.S.

Global Initiative for diagnosis, treatment and prevention of COPD has recently included roflumilast (R) - an inhibitor of phosphodiesterase-4 (PDE-4) as a new therapeutic agent to the recommendations for the management of patients suffering from COPD with severe and moderate course. Objective. To investigate the efficacy of roflumilast, ursodeoxycholic and ribonucleinic acids in patients with COPD with an accompanying chronic non-stone cholecystitis. Materials and methods. The study involved 40 patients with COPD stage II-III, in the acute phase with an accompanying CNC in the acute phase and 20 practically healthy individuals (PHI). Patients of the control group (group 2) received berodual, UA500 mg overnight for 30 days, under the conditions of infective exacerbation of COPD - antibiotic therapy. Group 1 (study, 20 people) received roflumilast 500 mg additionally once a day, nucleinas 500 mg 3 times daily for 30 days. Results and discussion. The results obtained in the study of the dynamics of treatment and their analysis indicate that exposure to complex therapy, amelioration, reducing the signs of exacerbation of COPD and CNC, a significant improvement of quality of life in patients of group 1 were noticed sooner. Figures of external respiration functions(FER) in dynamics of treatment in patients with COPD with an accompanying CNC show higher efficiency of the proposed therapy too. In particular, the rate of forced expiration for the first second after treatment in patients of group 1 increased by 31,5% (p<0,05), while patients in group 2 - by 14,0% (p<0,05) probable presence of intergroup differences (p<0,05). Taking into consideration the fact that the treatment of patients of group 1 included antioxidant preparation H - dynamic performance and the intensity of lipid peroxidation were significantly different from baseline in all periods of observation. For instance, the content of MA (malonic aldehyde) in plasma after treatment in group 1 decreased by 1,7 times (p<0,05), while in group 2 - 1,2 times (p<0,05) with significant difference between groups (p<0,05). Biochemical analysis of blood and bile for bilirubin after treatment indicates its significant reduction in patients of group 1 - by 1,7 times in blood (p<0,05) and 27,7% (p<0,05) in bile.In patients of group 2, due to the influence of the UA, bilirubin in bile decreased by 7,8% (p<0,05), and the content of bilirubin in blood decreased by 13,0% (p<0,05). Conclusions. The use of roflumilast in combination with berodual, ursodeoxycholic and ribonucleinic acids in patients with COPD and in acute CNC promoted faster, than under conventional therapy (6-7 days), elimination of symptoms of both acute comorbid conditions. Combined therapy of patients with COPD stage II-III of the CNC in the acute phase, which included inhalation therapy with berodual, ursodeoxycholic acid, roflumilast and nuclineas helped to reduce the intensity of oxidative stress, endotoxemia, renewed the activity of the components with antioxidant protection and natural detoxification system.

57-66

Authors: Ancheva I.A.

Placental dysfunction occurs in 17-35% of pregnant women. Iron deficiency anemia complicating pregnancy and childbirth affects fetal development. In its turn, pregnancy contributes to the rapid progress of iron deficiency anemia. The aim of the study was to evaluate the morphological and immunohistochemical features of the placenta in its dysfunction in women with anemia during pregnancy. The study was performed on clinical bases of the Department of Obstetrics and Gynecology №1 of ONMedU (Odessa) and pathologic department of SI " IPOG NAMSU" (Kiev). The complex dynamic examination of pregnant women with subsequent examination of the placenta was performed. Patients were divided into 3 groups. 1st group consisted of pregnant women with physiological pregnancy and childbirth (n=10), 2nd group included women suffering from anemia during pregnancy (n=10); 3rd group consisted of women with pregnancy accompanied with placental dysfunction and anemia (n=10). Organometric, macroscopic, general histological, micrometer, histochemical and immunohistochemical methods were used. It is shown that reduction of incidence of regeneration - proliferative marker Ki -67 in the nuclei of villous syncytial structure is more pronounced in the development of placental dysfunction against a background of anemia during pregnancy.

70-73

Authors: Pogorelov A.V.

The study of 68 patients with chronic disorders of cerebral circulation (CDCC), i.e. having lacunar ischemic stroke, was carried out. It was found that patients are aware of asthenia in 57.35% and in target study asthenia is revealed without exception. The study revealed the correlation of amplitude (mcV) of P3-N3 component of visual evoked potential and clinical asthenia (r=0,41), estimated by the clinical asthenia scale MFI-20. It is concluded that in the absence of other factors of asthenia, amplitudes of long-latency phase of evoked response (P3-N3) in patients with cerebrovascular diseases may be the criterion of the so-called "neural fatigue", in order to determine the dynamics of the progression of disease and the demand in use pathogenetic therapeutic action.

84-89

Authors: Kryzhanovsky D.G., Marchenko N.A., Freivald V.A.

There was studied the profile of drug resistance to the main (I line) and reserve (II line) antituberculosis drugs in patients with MDR and XDR tuberculosis, depending of the case of the disease. According to the randomized retrospective research 200 patients with MDR and XDR tuberculosis, who received treatment in the clinic of hospital Municipal institution «Dnipropetrovsk rigional clinical association «Phthisiology» Dnipropetrovsk regional Council» during the period 2010 – 2012 were involved. Data about patients contained the data on a case of the disease and the results of the test of drug sensitivity to MBT. XDR – TB was revealed in 7.5% of patients with MDR tuberculosis. In patients with MDR tuberculosis as compared with patients with XDR tuberculosis «new cases» were diagnosed in 19.5% against 18.5% (p <0.05). In patients with MDR tuberculosis and with XDR tuberculosis resistance to the antituberculosis drug more commonly developed to S - 88.5%, E - 55% and Z - 24%. The presence of MDR-TB and XDR-TB prevails in patients, who underwent previous courses of treatment with anti-TB drugs in case history as compared with patients with «new cases» of treatment. The development of resistance to anti-TB drugs depends on the availability of these drugs in the previous treatment regimens.

97-102

Authors: Chernokur A.A.

The article reflects the current trends in the treatment of diseases of the larynx, accompanied by stenosis and impaired fonatory function, such as laryngeal papillomatosis and double-sided paresis of the recurrent larynx nerve. Actuality of surgical treatment of bilateral paresis of the recurrent larynx nerve is due to the fact that a significant proportion of patients with this disease are persons of vocal professions and functional result of the operation determines the quality of life, professional suitability. Using semiconductor laser causes a good functional outcome in this pathology treatment. The aim of the study was to improve the effectiveness of treatment of patients with laryngeal papillomatosis and with bilateral paresis of the recurrent larynx nerve. All patients underwent surgery with using semiconductor laser "Lika - surgeon." Results of treatment made it possible to draw a conclusion that microlaryngoscopy with laser vaporization of papillomas can reduce frequency of relapses by 15.4% during the first year after surgery as compared to the control group. Using of semiconductor laser in patients with bilateral paresis of the larynx allows to more effectively restore compensated breathing through upper airways as compared with the control group. Application of laser in phonosurgery allow to save a good voice function in 76.9% of patients.

112-120

Authors: Sіrenko O.Yu.

The objective was to evaluate the frequency of cardiovascular risk factors and hypertension in patients with rheumatoid arthritis depending on body weight. The study involved 100 patients with rheumatoid arthritis and stably selected therapy for more than 6 months at the age from 45 to 65 years (mean age 53,19 ± 5,40 years). Traditional cardiovascular risk was assessed, taking into account risk factors by SCORE scale and amended for patients with RA. The levels of total cholesterol, triglycerides, C-reactive protein, serum creatinine, body mass index, body area index were determined. Arterial hypertension was diagnosed in 41 (41%) patients with rheuma¬toid arthritis and was associated with traditional risk factors (age, obesity), rheumatoid factor, hyperuricemia and the duration of glucocorticoid therapy. Obesity and excess body mass occurred in the majority of patients with rheumatoid arthritis, herewith the highest level of inflammation indicators and risk of cardiovascular events was in overweight patients. Obesity was associated with duration of rheumatoid arthritis, the activity of the inflammatory process, the duration of glucocorticoids taking. It is found that the traditional SCORE scale does not fully reflect the risk of cardiovascular events in rheumatoid arthritis. Identification of hypertension and obesity increases the information content of the risk assessment of cardiovascular events in rheumatoid arthritis.

127-130

Authors: Dronik I.I.

The results of the comparative study and the importance of free radical oxidation in causing purulent process in 46 patients with chronic generalized periodontitis I-II severity degree are presented. The aim - to study the characteristics of lipid peroxidation and antioxidant system in patients with generalized periodontitis, to establish the role of antiradical protection changes in suppurative inflammation in periodontal tissues. We found a substantial reduction of activity of key enzymes of antioxidant systems - superoxide dismutase and catalase in patients with chronic generalized periodontitis with suppuration of periodontal pockets, as compared with the rate in patients with septic foci in periodontal structures. It was stablished that lipid peroxidation is important in the development of purulent inflammation in periodontal tissues in patients with chronic generalized periodontitis, as evidenced by the significantly large accumulation of MDA and hydrate lipids in plasma and especially in the cellular elements of the blood (red blood cells) than in patients without this complication.

135-140

Authors: Gudaryan A.A., Shandyba S.I.

The article presents the results of a comparative study of using osteoinductive and osteoconductive material for bone osteoplastic grafting used to perform operations in the treatment of 60 patients with generalized periodontitis with diabetes mellitus type 2. It was found that by using different types of materials osteoplastic bone growth occurs differently. It was found that in preserved walls of bone pockets a mixture of osteoinductive material «Bio-Oss», combined with osteoconductive material osteoplastic «BondBone» prepared in platelet-rich plasma using collagen membranes «Bio-Gide» is enough and appropriate to use. This technique allowed achieving full recovery of bone in 86.2% of patients bone defects with. It was found that by using natural osteoplastic material «Bio-Oss» with extensive periodontal regeneration of alveolar bone defects in patients with generalized periodontitis associated with diabetes mellitus type 2 it is necessary to use membranes of polylactic acid to prevent migration of particles of osteoplastic material in the wound.

146-153

Authors: Abaturov A.E., Stepanova Y.Y., Gerasymenko O.N.

The aim was to study the peculiarities of rotavirus infection in children with various genotypes of the lactase gene LCT. Molecular genetic studies of LCT13910 gene polymorphism by polymerase chain reaction with electrophoretic detection were determined in the Institute of Genetic and Immunological basis of pathology and pharmacogenetics of "Ukrainian Medical Stomatological Academy", Poltava. According to the results of molecular genetic studies, all children were divided into three groups: the first group included 45 children with genotype C/C-13910, the second - 22 children with genotype C/T-13910, the third - 3 chil¬d¬ren with genotype T/T-13910. It is proved that in infants with rotavirus, the most common (63%) is genotype C/C-13910 of LCT gene. It is shown that a less severe form of the disease, which in most cases occurs without fever, a less duration of vomiting syndrome, a high incidence of respiratory syndrome, a less duration of illness are the peculiarities of rotavirus infection in children with genotype C/C-13910 LCT gene. Tendency to severe course with febrile fever, severe diarrhea, a high frequency of occurrence of expressed ketone blood syndrome, longer duration of disease may be considered to be features of rotavirus infection course in children with genotype C/T-13910 LCT gene.

159-164

Authors: Schudro S.А.

The main recommendations on health promotion and formation of healthy lifestyles, hygiene education of children and adolescents, formulated in the concept of the European Regional Bureau of World Health Organization are considersed. Low efficiency of clinical and preventive strategies in medicine, which is almost exhausted its resources requires the development of new health-preserving strategies. We have proposed health-defining technology at school, which includes an assessment of health status of adolescents by its components and determines compensatory-adaptive potential, total risk stratification, therapeutic and preventive measures, immediate and long-term evaluation of effectiveness, prediction of further health status of adolescents. The system of treatment and preventive measures should be based on close interaction of school family-environment and have four components: physical, psychological, social and psycho-social. Implementation of health-defining technologies in general education establishments allowed to improve effectiveness of treatment and prophylaxis by 22.4% (20.3% - without optimizing actual nutrition, 24.5% − with optimization of actual nutrition at the expense of Vitrum junior and natural honey).

169-177

Authors: Kapustinskaia O.A.

The aim of the research - analysis of the structure and dynamics of the morbidity among eva¬cuated population, the peculiarities of pathogenesis of the most widespread forms of circulatory system (CS) pathology in the remote period after the accident at the Chernobyl Nuclear Power Plant. Materials and methods. Three groups of persons evacuated from Chernobyl zone of alienation were researched: persons aged 10-17 (6517 persons), 18-39 (496 persons), 40-60 (458 persons). The data on the individual radiation doses which affected thyroid gland were selected at the State Register of Ukraine on persons affected by the Chernobyl disaster. Morbidity rate was estimated per 103 man-year for 5-years periods of monitoring. The main results: Time from the moment of Chernobyl accident affected the formation of morbidity structure of evacuated population. It was fixed two peaks of morbidity incidence - initial and in 12 years. The most essential changes in CS morbidity of evacuated population were fixed 26 years later mainly in cere¬brovascular diseases. The coronary artery disease takes the first place in the morbidity structure. Significant dif¬ferences were detected at age-specific aspect. The evacuated adult population aged 18-39 years was the most vulnerable for the development of CS diseases. Adverse health effects confirmed the necessity of further research of CS morbidity with the differentiation of doses affected thyroid gland.