Medical perspectives (Medicni perspektivi)

5-8

Authors: Ditiatkovskaya Ye.M.

History of Allergologic service in Dnipropetrovsk region

14-21

Authors: Borisova I., Reshota V., Nikolishin Z.

Disability is a social phenomenon that can not be ruled out by any society. The potential of society in combating the growth of disability – as a social evil – is determined not only by the degree of understanding of this problem but mainly by economic resources. The risk of developing oc­cupational diseases in the coal industry is 5-10 times higher than in other branches of industry. In Ukraine, about 3 million people work under the harmful conditions of production, 60.0% of them are miners. The study analyzed the dy­namics of disability as a result of occupational diseases in the Lviv region for the period 2015-2017. The results of the study prove that the disability indicators due to occupational diseases tend to grow. The ways to overcome this unfa­vorable tendency should be state measures on improvement of normative and legal documents, coherence between dif­ferent state institutions and strengthening effective state control over hygiene norms in industries with harmful factors.

27-37

Authors: Gashynova K.Yu., Kolisnyk N.S., Dmytrychenko V.V., Kaplan P.Yu., Kuzhevskiy I.V., Hurtovyi V.A., Mizina V.M.

Aspergillus species continue to be an important cause of life-threatening infection in immunocompromised patients. The article presents a clinical case of invasive pulmonary aspergillosis in a patient with acute myeloid leukemia.

44-50

Authors: Dytyatkovska Y., Rodkina I., Yevtushenko M., Grybanova L., Bendetska Y., Romanova A., Koretskaia I.

We have been observing 60 pollinosis patients at the age of 19 to 64 years with clinical manifestations of rhinitis, conjunctivitis, bronchial asthma. The study was conducted in the design of parallel groups. All patients were divided into 2 clinical groups (main and control), depending on the treatment regimen. The main group included 40 patients who received a combined drug Glencet Advance 1 tab. in the evening for 1 month. 20 patients included in the control group received symptomatic local therapy (eye drops, IGCC), β2-short-acting agonists. Results: integral assessment of symptoms in the main group before treatment was 11.50±0.13 and significantly decreased after treatment to 0.68±0.14 (p<0.001). In the control group differences were much less expressed from 11.15±0.22 before treatment to 3.05±0.29 (p<0.001) after treatment. FEV1 (%) in the main group has been improving more intensively (from 55.5±1.14 to 90.7±1.31 (p<0.01). PEF has been improving from 187.5±4.34 l/sec to 406.3±10.73 (p<0.001). In the control group these changes are less expressed for FEV1 (%) from 56.2±1.72 to 78.5±2.18 (p<0.001). PEF l/sec – (from 195.0±6.75 to 320.0±12.50 (p<0.01)). The histamine level decrease (ng/ml) in the main group was reliable – from 4.29±0.52 to 1.40±0.3 (p<0.5). In the control group – from 3.00±0.33 to 2.82±0.31 (there is no veracious data). Change of the total IgE level in serum: veracious decrease from 487.2 to 367.8 in the main group, no veracious decrease in the control group. Conclusions: the use of combined therapy with antihistamines and antileukotriene drugs in patients with pollinosis gives a good clinical effect, which is confirmed by a veracious decrease of histamine and total IgE levels in blood serum, as well as by veracious improvement in FEV1 and PEF.

60-67

Authors: Karaseva O.V., Rodionova V.V.

Purpose: to define clinical prognostic markers for evaluation of inflammation activity and prognosis of complications development in patients with systemic scleroderma. Materials and methods: The study included 32 people, all women, the average age – 43.2±2.23 years. All the examined patients (n=32) were divided into two groups: the main group (n=21) – patients with systemic scleroderma and concomitant pulmonary tissue involvement – pneumosclerosis. Group II (n=11) included patients with systemic scleroderma without signs of pneumosclerosis. The duration of the disease was 8.1±0.03 years. Patients underwent clinico-laboratory and anthropometric studies, chest radiography in two projections, questionnaire of mMRС for assessing the symptoms of dyspnea, blood saturation was measured with a pulse oximeter EchoCG, if necessary – computed tomography of light high resolution was performed and other general clinical studies in accordance with diagnosis, if necessary. Results and discussion: Patients of groups I and II had bilateral reinforcement of the pulmonary pattern mainly in the lower and middle sections. In Group I patients in the basal regions there were also single cyst-like changes, sometimes sections of the honeycomb lung, bronchiectasis, pleural adhesions. Patients of group II showed signs of focal pneumofibrosis (3 patients), who had pneumonia in anamnesis. There was a tendency of increased pressure in the pulmonary artery in patients with the presence of pulmonary tissue lesions, a decrease in the CSR of the left ventricle. When analyzing the data of the rheumatic complex and individual immunogram indices, the level of CIC and rheumatoid factor was higher in patients of group II, and the level of cryoglobulins was significantly increased in group I patients. In patients of group I, in addition to the increase in cryoglobulins, index of С-reactive protein (CRP) and ESR was increased. Conclusion: The affection of the lungs with the development of pneumosclerosis in patients with systemic scleroderma complicates the course of the disease, contributes to worsening of patients’ condition and formation of unfavorable prognosis. The increase in the level of cryoglobulins and CRP can be used not only to assess inflammation activity but also to predict the development of complications, it requires revision of the treatment of the main disease.

71-77

Authors: Kondratska O.A., Grushka N.G., Kaplunenko V.G., Pavlovych S.I., Sribna V.O., Yanchii R.I.

Now it is known that endotoxin of gram-negative bacteria – lipopolysaccharide (LPS) is associated with disturbances of reproductive function in women. To simulate an ovarian dysfunction in endotoxemia and to explore a possible protective action of germanium (Ge) citrate obtained via nanotechnology we used LPS administration into female mice (3 mg/kg). Treatment with LPS caused patho­logical changes in mouse ovaries at 24h post-injection: an impairment of oocyte maturation in vitro, DNA damage in granulosa cells (as estimated by DNA-comet assay) and a decrease in their viability by increasing both necrosis and apoptosis. Pretreatment of mice with Ge citrate (i.p. 100 mkg/kg, 2 injections: 24 h and 1 h before LPS) was effective to reduce genotoxic stress and cell death. Ge citrate administration to LPS-treated mice significantly enhanced oocyte quality (as indicated by improvement in oocyte maturation) that may be due to cytoprotective effect of this compound on surrounding follicular cells. Our results support potential therapeutic application of Ge citrate to improve reproductive function in endotoxemia.

82-86

Authors: Korzh N.V.

Increasing incidence of chronic obstructive pulmonary disease (4th place among all causes of death within the general population) and overweight, as one factor for progression of respiratory tract pathologies (more than 30% of world population suffers from overweight) suggests that further study of pathogenetic characteristics of their combined course and search for new ways of differential pathogenetic therapy are important nowadays. The aim if the investigation is the diagnosis and prognosis of COPD exacerbations in overweight patients. The results of this investigation demonstrate, that overweight is the predictor of COPD progression, that is accompanied by elevations of CRP and IL-6 levels in peripheral blood serum.

89-95

Authors: Kuryata O., Zabida A., Sirenko O.

The available data suggest that heart failure (HF) after myocardial infarction (MI) is a very frequent event. Recent meta-analysis showed that restrictive mitral filling pattern, the most severe form of diastolic dysfunction, was presented in approximately 10% of the patients with preserved ejection fraction. In addition, restrictive pattern was associated with poor outcome. However, the true prevalence and relevance of diastolic dysfunction after MI remains to be elucidated. Objective: study was designed to evaluate the serum level of MMP-2,9, galactin-3 and C-reactive protein (C-RP) in postinfarction heart failure with preserved ejection fraction (HFpEF) patients. Methods: We divided all included patients into two main groups: 1st group – 20 patients with HFpEF and history of myocardial infarction. 2nd group – 18 patients with HFpEF and stable angina. Standard laboratory blood tests for erythrocyte sedimentation rate (ESR), C-RP, haematological parameters, lipid profile, glucose, renal and liver function tests were performed and calculated body mass index (BMI) for all patients. MMP activity assay and galectin-3 serum level was detected for all patients. Results: It was established significant differences between study groups in MMP-2, MMP-9 levels. Particularly, patients with HFpEF with MI in anamnesis had significantly higher MMP-2, MMP-9 levels on 21.8% and 20.7% respectively. The C-RP and leucocytes levels were significantly higher in 1st group pts. Significant differences in MMP-2, MMP-9 were established in 1st group patients in different age groups (p<0.05) (tab. 3). The MMP 2 level was positively correlated with MMP 9 level (R=0.73, p<0.05), the MMP 9 level – with age (R=0.68, p<0.05). There were no significant differences between galectin-3 level in study group. But we estimated significant differences in galectin-3 level between 1st and 2nd subgroups (p<0.05). Conclusion: Serum MMP-2, MMP-9, CRP and galactin-3 were significantly increased in pts with postinfarction heart failure with preserved ejection fraction compare to pts without myocardial infarction in anamnesis.

101-106

Authors: Lipko O.P., Bobrytska V.V., Potapova L.V., Tkachova N.V.

In order to study immunological parameters, including cervical mRNA in patients with persistent papillomavirus infection, 35 patients of the main group (HPV positive) and 42 patients of the control group (HPV negative) were examined. Patients of the main group were divided into three subgroups according to the process prescription and the results of previous immunotropic therapy: IА subgroup – (12 patients) HPV was first isolated, IB (16 patients) - persistence of the virus from one to three years, IC (7 patients) – persistence of the virus from one to three years, immunotropic therapy is ineffective. The level of IL-1, IL-6, IL-8, IL-10, TNF-ɑ, serum interferon, as well as mir25 microRNA expression level was determined. Data have been obtained that the persistence of papillomavirus infection is possible in conditions of deficiency in the level of cytokines IL-1 (45.5%, p<0.05), IL-6 (48.5%, p<0.05), IL-8 (24.2%, p<0.05), increase in the level of TNF-α (37.3%, p<0.05) and a reduced level of serum IFN up to 78.2%. The absence of the effect of HPV elimination is observed in the decrease of the indices from the conventional norm: IL-1 (73.6%, p<0.05), IL-8 (81.3%, p<0.05), IL-10 (25, 0%, p<0.05), TNF-α (77.8%, p<0.05). At the same time, the level of mRNA expression increases by 5.5 (p<0.05) from the median values of the control group. A decrease in the level of humoral immunity along with an increase in mRNA expression can serve as a marker of the resistance of HPV to therapeutic measures and determination the tactics of further therapy of patients with "small” forms of cervical epithelial lesions.

112-117

Authors: Mostovoy Y.M., Demchuk A.V., Konstantynovych T.V., Chichirelo-Kons­tantynovych K.D.

With the purpose to estimate influence of comorbidity at the risk of complications and death due to community-acquired pneumonia (CAP) the retrospective analysis of 1587 case histories of inpatients with CAP (mean age – 48.5±18.4, males – 815 (51.4%), women – 772 (48,6%)) was performed. Comorbidity was observed in 1114 (70.2%). More frequently complications of CAP were developed in patients with chronic diseases than without them (p=0.013). Increased risk of pleural effusion was associated with chronic diseases of digestive system (OR=1.85 (95%CI 1.30-2.26)) and diabetes mellitus (OR=2.35 (95%CI 1.40-3.96)). Risk of sepsis development is higher in patients with nervous system diseases (OR=3.62 (95%CI 1.37-9.56) and drug or alcohol addiction (OR=19.08 (95%CI 7.30-49.82). Risk of pulmonary edema rose in patients with drug or alcohol addiction (OR=24.16; 95%CI 8.07-72.34), malignancy (OR=8.97; 95%CI 1.94-41.49), diabetes mellitus (OR=4.04; 95%CI 1.48-11.01), diseases of nervous (OR=4.04; 95%CI 1.17-13.94), urinary (OR=3.39; 95%CI 1.33-8.64) and cardiovascular (OR=2.29, 95%CI 0.98-5.34) systems. Higher risk of death in patients with CAP was associated with the presence of cardiovascular diseases (OR=2.17; 95%CI 1.11-4.25), diabetes mellitus (OR=2.95; 95%CI 1.20-7.21), drug or alcohol addiction (OR=38.40; 95%CI 15.05-97.98).

123-129

Authors: Razumnyi R.V.

More and more attention of researchers is at­tracted by the so-called "syndrome of mutual burdening" in combined (comorbid) pathology. The aim of the study was to analyze the effect of nonalcoholic fatty liver disease on the functional state of the macrophagal phagocytic system (MPS) in patients with community-acquired pneumonia (CAP). 85 patients with CAP of III-IV clinical group aged 18-55 years were examined. All patients were divided into two representative groups: group I (44 patients) who had CAP comorbid with hepatic steatosis (HS), group ІІ (41 patients) without chronic liver pathology. For evaluation of the functional activity of MPS, phagocytic activity of peripheral blood monocytes with analysis of phagocytic index (FI), phagocytic number (FN), index of attraction (IA) and index of digestion (ID) was studied. The results of the study revealed that in the acute period of CAP, more expressed decrease in the capacity of monocytes/macrophages to phagocytosis, the incompleteness of the phagocytic reaction, and in general, the decline in the functional activity of MPS was observed in patients with CAP comorbid with HS. After the completion of the standard treatment of patients with CAP combined with HS, moderate disturbances in the functional activity of MPS persisted. On the assumption of findings, it can be advisable to consider a further study of the effectiveness of immunotropic medicines usage, with the purpose of correcting MPS disturbances in the complex treatment and medical rehabilitation of patients with CAP comorbid with HS.

136-140

Authors: Khanyukov A.A., Lakiza Т.V., Simonova Т.А., Pryazhnikova L.S., Poleshko V.Yu., Romuz N.A.

Our goal was to analyze the possibilities of impro­ving the diagnostics of CSS and to improve the effectiveness of treatment according to the existing literature and our own experience of long-term care for patients with eosinophilic granulomatosis with polyangiitis or Churg-Strauss syndrome (CSS). The medical histories of three female patients aged 26 to 46-years and a 20-year-old male patient were considered. The duration of the disease before the established diagnosis was 5-17 years. Anamnesis and medical documents analysis showed a typical CSS debut in the form of allergic rhinitis, nasal polyps, which were recurrent after polypectomy, and respiratory disorders, which were regarded as bronchitis or bronchial asthma – corresponding to the first phase, also called the prodromal or allergic stage of CSS. The prodromal period lasts up to 10 years or more and is characterized by various allergic manifestations, more often – pollinosis or bronchial asthma, that is difficult to control. But CSS can be suspected because of low effectiveness of the therapy with inhaled steroids, lack of effect of antibiotics and eosinophilia more than 10% that occurs periodically. Even in the third stage of CSS in systemic manifestations of vasculitis and severe secondary lesions of organs and tissues with functional impairment, constant intake of maintenance doses of corticosteroids and cytostatics allows to achieve stabilization of the process in patients with CSS.

146-153

Authors: Abaturov O., Dytiatkovsky V., Naumenko N., Kulieva A., Bovsunovska K., Filatova I.

The paper presents the data of the association analysis bet­ween the diseases composig the atopic march (AM) in children – atopic dermatitis (AD), seasonal rhinoconjunctivitis (SARC) and perennial allergic rhinitis (PAR), bronchial asthma (BA), with non-atopic allergic diseases – acute and recurrent urticaria (AcU/RecU), Quincke edema (QE), and also with diseases of the digestive system (DS) – functional disorders of the biliary system (FDBS) and reactive pancreatitis (RP). The association between AD and food allergy (FA) in children has been determined, which is recorded as a direct association. A direct association was established between chronic infectious diseases of the upper respiratory tract and the PAR as well as BA. The lack of association between atopic and non-atopic allergic diseases had been confirmed. The association between FDBS and RP and non-atopic allergic diseases in children had been determined – AcU/RecU, QE.