Medical perspectives (Medicni perspektivi)

13-20

Authors: Poslavska O.V., Shponka I.S.

Cancers of unknown primary localization (CUPL) are a heterogeneous group of metastatic neoplasias for which a standardized diagnostic examination did not determine the primary localization of the origin. In 5% of histological form of CUPL is squamous cell carcinoma, which, in the case of an isolated lesion of the cervical lymph nodes is treated as a "favorable phenotype". Tactics of treatment of such a CUPL is suggested in both primary local squamous cell carcinoma (SCC) of the, head and neck with regional lymph nodes involvement (T1-3N1-3M0) and in 25% -30% of patients leads to a 5-years survival rate. This calls for the use of an immunohistochemical method for the accurate verification of the histological form of an isolated metastasis of the cervical lymph nodes and use of the appropriate therapy. In the work 62 samples of isolated lesions of the cervical lymph nodes with carcinomas without another established primary localization for the period 2015-2017 were investigated. The control group consisted of 12 samples of SCC of the head and neck of the known localizations. The immunohistochemical panel of markers included Cytokeratin Pan, Vimentin, CD45, S100, Cytokeratin HMW, Cytokeratin 7, Cytokeratin 20, p63, TTF1. The parameters of the areas, perimeters and “roundness” of the nucleus were determined in the ImageJ pro­gram. The aim of the study was to investigate the complex of morphological, morphometric and immunohistochemical characteristics of SCC without primary localization with isolated lesion of the cervical lymph nodes, in comparison with other histological forms and control group of SCC of the head and neck of the known localizations to improve diagnostic algorithms. A difference in the distribution of histological forms for all CUPL with isolated lesion of the cervical lymph nodes was determined in the predominance of SCC, in comparison with the general distribution of histological forms for all CUPL. Similarity of morphometric parameters of metastatic SCC of subgroup 1 (phenotype of Cytokeratin, Pan AE1 / AE3 (+) / Cytokeratin HMW (+) / p63 (+) / Cytokeratin 20 (-) / TTF1 (-) / Vimentin (- / +) / Cytokeratin 7 (- / +)) with samples of the control group of SCC of the head and neck of known localizations. The es­tablished decrease in the size and "roundness ratio" of the nuclei of the SCC cells is a reflection of the weighting of cellular atypia and correlates with the polymorphism of the nuclei and decrease in the degree of differentiation of the SCC.

26-34

Authors: Kuryata O.V., Muhammad Muhammad, Mytrokhina O.S.

The combination of chronic heart failure and atrial fibrillation is considered one of the most prognostically unfavorable alliances among cardiovascular diseases. Now the need for new markers as potential targets for therapeutic intervention is being actively discussed. To date, active study of cardiorenal syndrome continues, which in turn leads to an active search for drugs that reduce nephrologic risk, especially in the category of people with a combined cardiovascular pathology. The aim of the study was to compare the effects of irbesartan and ACE inhibitors on the level of galectin-3, β-2-microglobulin, albuminuria and end glycation products (AGE) in patients with chronic heart failure with atrial fibrillation and impaired renal function. The results of the effect of drugs in patients with chronic heart failure and atrial fibrillation are presented and analyzed. The data indicate the need for more careful attention to this group of patients, namely, the need to diagnose the functional of the kidneys, which is very important for the development of effective interventions aimed at preventing the progression of these diseases.

46-52

Authors: Mankovsky G.B.

Aim of the study – to investigate the prevalence of earlier non-diagnosed type 2 diabetes mellitus and prediabetes using different diagnostic approaches in patients with angiographically confirmed ischemic heart disease. Materials and methods. We studied 89 patients with ischemic heart disease, mean age 62+3,6 years. All patients had angiographically confirmed atherosclerotic lesions of coronary arteries. No patient had previously diagnosed diabetes mellitus or hyperglycemia in anamnesis. All patients underwent the detailed examination to reveal hidden diabetes or prediabetes, earlier non-diagnosed: glucose tolerance, fasting plasma glucose, glycated hemoglobin were measured and standard oral glucose tolerance test was performed. Results. Based on the results of fasting plasma glucose and oral glucose tolerance test, diabetes mellitus was diagnosed in 14 (16%) patients studied, elevated glycated hemoglobin suggesting the presence of earlier non-diagnosed diabetes was found in 11 (12%) patients. Each of the 3 diagnostic approaches used allowed to diagnose patients with non-diagnosed earlier type 2 diabetes mellitus and there were no statistically significant differences in the prevalence of earlier non-diagnosed diabetes depending on the method of diagnostics used, p>0.05. Prediabetes was diagnosed much more frequently – in 47 (53%) patients while measuring glycated hemoglobin, in 43 (48%) patients based on fasting plasma glucose levels and in 28 (31%) patients according to elevated plasma glucose levels 2 hours after taking glucose. Conclusions. Our data revealed high prevalence of earlier non-diagnosed type 2 diabetes mellitus and prediabetes in patients with ischemic heart disease. The measurement of fasting plasma glucose, glycated hemoglobin and oral glucose tolerance test contribute each other in diagnostics of diabetes and prediabetes in the majority of cases.

60-66

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

The aim of the study was a comparative analysis of components in liberal and restrictive fluid resuscitation and their effectiveness. 90 patients with multiple trauma divided into two groups, depending on the fluid resuscitation type (liberal or restrictive) were studied. Infusion components in 1st day, intraoperative blood loss, ICU and hospital stay length, number of complications and lethality were investigated. Restrictive fluid resuscitation type in multiple trauma was characterized by a decrease of total infusion volume in ml/kg in 1st day by 34.8%, including crystalloids – by 34.2%, colloids – by 71.4% with a constant volume of FFP and erythrocytes. Balanced crystalloid solutions were used more often, and solutions of potassium and magnesium asparaginate and glucose, high-molecular HES and dextranes were not used at all. Blood components were introduced earlier. Volume of intraoperative blood loss decreased by 34.0%, the frequency of complications – by 1.6 times, the mortality rate – by 2 times.

71-78

Authors: Lуtvуn К.Yu.

48 patients aged from 21 to 54 years, infected with human immunodeficiency virus (HIV) and presence of diseases of the central nervous system (CNS) were examined. CNS diseases included cerebral tuberculosis, viral encephalitis (caused by Epstein-Barr Virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV)), encephalitis of unspecified etiology, cerebral toxoplasmosis, fungal meningitis. 29 (60.4%) of the patients were discharged from the hospital with a clinical improvement, and 19 (39.6%) of the patients died as a result of CNS disease. Significant differences in the content of the myelin basic protein (MBP) in the cerebrospinal fluid (CSF), depending on the outcome of the disease, were determined. The Median of MBP in deceased patients was 2.9 times higher than in the survived patients - 4.00 (1.90-7.70) ng/ml vs. 1.40 (0.99-2.00) ng/ml (p=0.002 U). An inverse correlation between the content of MBP in the CSF and the time from the determination of the HIV status to the manifestation of neurologic symptoms (rs=-0.30, p<0.05) was found. According to the results of the ROC analysis, the high risk of unfavorable course of HIV-associated CNS diseases is predicted when the concentration of MBP in the cerebrospinal fluid increases by more than 2 ng/ml (68.4% sensitivity, 75.9% specificity, 72.9% accuracy). The highest level of this protein was observed in patients with fungal lesions of the central nervous system (6.6 (1.9-7.8) ng/ml), and the lowest MBP level – in the group of patients with unspecified encephalitis (0.99 (0.9-1.1) ng/ml), which correlated to more favorable outcomes of the disease. The MBP in cerebrospinal fluid can be an important diagnostic and prognostic marker of HIV-associated neurological diseases.

85-91

Authors: Rossokha Z.І., Kyriachenko S.P., Gorovenko N.G.

The scientific literature presents contradictory data about influence of folate metabolism genes polymorphism on development of risk of reproductive disorders. The aim of the study was to determine the role of MTHFR, MTRR, MTR1 gene polymorphism in the development of reproductive disorders by evaluation of genetic risk models of inheritance. 658 patients with reproductive disorders from all Ukrainian regions were examined. The data from population studies presented in the online resource (1000 genomes) served as comparison group. There were no reliable risk models for polymorphic variants of MTHFR gene. We identified 3 and 4 significant inheritance models for MTRR and MTR1 genes respectively. The best inheritance models were the dominant model for MTRR gene and the additive model for MTR1 gene. The polymorphic variants frequencies of the studied genes did not differ among men and women. Further analyse is necessary for evaluation of genetic polymorphism and intergenic interactions influence on reproductive disorders risk, taking into account folate metabolism indices and exogenous factors.

97-103

Authors: Grek L.

The aim of the work is to ascertain the efficiency of the use of an offered way of the complex treatment of the patients with genital endometriosis and combined benign pathologies of genitals and СРР. A differentiated approach to treatment and analysis of its effectiveness was conducted among the patients of the 1st and 2nd study groups (85 patients) with the severe and moderate pain syndrome according to the VAS scale. On the basis of analysis of immunohistochemical markers ER, PGR, Ki-67, VEGF, COX-2 in glands and in stroma the therapy was developed: Severe pain syndrome was eliminated in all patients within 3 months of treatment. A moderate level of pain was noted in 77.65%, after 12 months of observation in 16.47% of women, the remaining 83.53% noted a weak level of pain by VAS scale (p<0.05). The level of depression dropped (from 11,22±0,5 baseline to 5,98±0,24 in a year, p<0,001) by the Hamilton scale. This indicates the effectiveness of treatment.

111-119

Authors: Mashchenko I.S., Kucherenko T.O.

The purpose of this study was to determine the efficacy of using Wobenzim as a general therapy in the complex treatment of generalized periodontitis. 61 patients, I-II degree of severity, with tooth safety in an amount of at least 90%, without concomitant general pathology requiring treatment for the current time were examined. Comparative effectiveness of treatment was studied in 2 groups similar in all clinical indices. The main (31 people) patients, along with the symptomatic treatment received Wobenzim; control (30 people) - polytherapy (immunocorrecting, antioxidant, antimicrobial agents). As a result of the generally accepted clinical, paraclinical, immunological and biochemical studies conducted during the treatment and at long-term follow-up, it was found that the use of systemic enzyme therapy in this category of patients ensures rapid regression of the main clinical symptoms (on days 6-7), elimination of pathogenetic links of the disease more than in 90% of treated patients and the onset of remission for at least 6-12 months. It is characteristic that during the monotherapy with Wobenzim, positive results of treatment of generalized periodontitis were achieved, similar to those with the use of complex standard therapy, including administration of a number of medications with targeted action on pathogenesis mechanisms of the disease. From the position of evidence-based medicine, the expediency of replacing a broad arsenal of medicines in the complex treatment of generalized periodontitis with certain pharmacological preparations with a systemic effect is justified.

125-130

Authors: Sorokina E.Yu., Belykh L.S., Panin A.N., Nikitina E.V., Kovrizhin I.A., Strah O.P.

Potential mortality in acute pancreatitis (AP) is 5%. Patients with AP represent II type of intestinal insufficiency, which occurs on the background of dyspeptic syndrome and increased intra-abdominal pressure (IAP). IAP is a differentiated indicator. With the increase of IAP more than 10 mm Hg, intra-abdominal hypertension (IAH) arises. Increasing IAP to this level is considered as safe. Monitoring of IAP level allows to achieve better clinical results. Totally 47 patients with acute pancreatitis were examined. Depending on the function of the gastrointestinal tract and the selected type of starting nutritional support (NS), they were divided into 2 groups. The first group consisted of IAH patients of I degree and dyspeptic syndrome who underwent parenteral nutrition (PN) with 3-component compounds begun on the 2nd day of disease and after restoration of gastrointestinal tract function a late enteral feeding (LEF) was performed. In the second group, patients with AP were initially diagnosed with elevated IAP at a safe level and dyspeptic syndrome. They were prescribed early enteral nutrition (EEN) with specialized blends from the 2nd day of disease. In 2 days a significant reduction in pain syndrome with the persistence of dyspeptic syndrome and intestinal insufficiency (II) was recorded. In patients with intra-abdominal hypertension, total parenteral nutrition is the effective method of nutritional support, against which, after 5 days manifestations of dyspeptic syndrome and IAP indices decrease to a safe level. Therefore in-time detection of high level of intra-abdominal pressure in patients with acute pancreatitis can help to choose a more rational method of nutritional support.

138-143

Authors: Oprya Ye.V.

In order to identify the clinical features of schizophrenia associated with somatic diseases, 186 patients with schizophrenia (50 patients with schizophrenia with cardiovascular diseases, 42 patients with schizophrenia with type 2 diabetes, 44 patients with schizophrenia with obesity and 50 patients with schizophrenia without chronic somatic diseases) were surveyed. Socio-demographic, clinical-dynamic and clinical-psychopathological features of schizophrenia (according to PANSS scale), connected with somatic diseases in a comparative aspect with patients with schizophrenia without somatic pathology were studied. It was found that somatic pathology combined with schizophrenia aggravates psychopathological symptoms, modifies clinical manifestations of schizophrenia and is associated with decrease in the level of social realization of patients, increase in the number of hospitalizations and a significant course of psychotic process. Among clinical features of schizophrenia with somatic disorders there was defined: in cardiovascular diseases - the presence of hallucinatory behavior, hypochondrial ideas and anxiety-depressive symptoms; in type 2 diabetes - hallucinatory activity in combination with excitement, impulsivity, hypochondrial ideas, depressive symptoms, and attention deficit, in obesity - the prevalence of negative symptoms over positive, expressed social rejection, depletion of social contacts and the presence of depressive experiences.

148-159

Authors: Abdulaziz Abdullah Alqarni, Radhi Ghanem Alanazi, Anthony Morgan, Ahmed Saud Alharbi, Faisal Fahad Aljuaid, Abdulrahman Mohammed Aldawsari, Faisal Khaled Almugrin, Abdulaziz Nasser Alaskar, Yazeed Mohammed Aldhfyan, Abdullah Abdulrahman Alqeair

Motor Vehicular Accidents claim about 1.2 million lives and injure more than 10 million people annually worldwide. The injuries caused by MVAs can be analyzed based on the type of injury, injury severity score, Glasgow Coma Scale and required blood transfusion. Methodology: A total number of 190 patients were included in this retrospective study from January 01, 2010 to December 31, 2015. The study aimed to determine the correlation between the type of injuries and GCS, ISS, and blood transfusions in the patients suffering from Motor Vehicle Accidents, who were presented to the Emergency Department at the King Khalid Hospital. All the data of the patients fulfilling the inclusion criteria were collected from the database at medical records department of the hospital. Results: Majority of the patients were adults Saudi male. 68.9% of the patients did not sustain shock, and 75.8% of patients did not require a blood transfusion. Patients with head, neck, chest, abdominal, internal organ, pelvic or spinal injuries conferred a statistically significant higher mean ISS. Patients with abdominal or internal organ injuries had a statistically significant higher mean units of blood transfused. GCS was seen to be lower in the head, neck, chest, abdominal, internal organ, spinal and other injuries. Conclusions: The study documents a significant correlation between the type of injury and GCS, ISS, and blood transfusion in victims of road traffic accident. Emergency physician and the caregivers should be more careful about the injuries associated with lower GCS. Patients sustaining injuries of certain parts related to high ISS (i.e., head, chest, abdominal, internal organ, pelvic) should be addressed on priority basis.