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

12-17

Authors: Adu Albert Asare, Daniel K. Sam, Adeyemi Adedayo M., Makharynska O. S.

Thyroid disorders in patients with diabetes mellitus were studied in 196 patients, divided into 4 main groups (hyperthyroidism in patients with diabetes, hypothyroidism in patients with diabetes, euthyroidism in patients with diabetes and diabetes patients without any thyroid pathology). It was found that diabetes and thyroid disorders have been shown mutually influence on each other and proved associations between both conditions. Compensation of thyroid function due to adequate therapy leads to controlled hyperglycemia, positive arterial hypertension disease mode and better diabetes mellitus outcome.

25-32

Authors: Kanishcheva O. V., Yabluchansky M. I., Litvin A. S.

The violation of daily blood pressure (BP) profile is one of the predictors of cardiovascular (CV) morbidity and mortality in patients with arterial hypertension (AH). It is determined by ambulatory BP monitoring (ABPM). The aim of the study was to assess the impact of the chronotherapeutic approach on the level of systolic blood pressure (SBP) and diastolic blood pressure (DPB) and daily BP profile in patients with AH with insufficient degree of sleep-time relative DBP decline. The study included 28 patients with AH with nondipper DBP daily profile in age from 52 to 78 years old. The participants were divided onto two groups. Group 1 included 14 patients, who take all antihypertensive drugs in the morning, group 2 included 14 patients who takе at least one antihypertensive drug at bedtime. All patients underwent 24-hour blood pressure monitoring using the computer system «Cardiosens» (KhAI Medica, Ukraine, with the oscillometric method of BP measurement) when enrolling in the study and after 3 months. The type of SBP and DBP diurnal profile, the mean values of SBP, DBP and hyperbaric indices were determined and compared between groups 1 and 2 at each visit, as well as within groups between visits. The results showed that morning taking of antihypertensive drugs in patients with AH with insufficient degree of DBP decline influences more on SBP while evening taking – on DBP. It was concluded that violation of DBP daily profile in medication therapy of patients with insufficient degree of DBP decline should be provided along with violation of SBP daily profile.

37-45

Authors: Lyadova T. I., Ognivenko O. V., Volobueva O. V., Gololobova O. V., Malanchuk S. G.

The prevalence of polymorphism -1486T/C of the TLR-9 gene was studied in 44 patients with chronic Epstein-Barr virus infection (CEBV). The control group for the study of the polymorphisms prevalence of -1486T/C of the TLR-9 gene was 40 healthy donors. Three main genotypes of -1486T/C of the TLR-9 gene were identified based on the obtained results – TT, TC, CC. Investigation of the occurrence frequency of individual genotypes revealed the dominance of the TC genotype, compared with the homozygous TT and CC genotypes. The study of -1486T/C of the TLR-9 gene polymorphism frequency distribution for different genotypes demonstrated the specificity of changes in the TC genotype in patients with CEBV and the absence of such for the TT and CC genotypes. These results confirm the important role of the TLR-mediated signaling in the pathogenesis of the disease, which is necessary to determine the genetic background associated with the course of the disease and its possible consequences. These are the aspects that will further enable the identification of risk groups among such patients and provide timely therapy.

57-60

Authors: Rudenko T. A., Bilchenko O. V. Khvysiuk M. O., Godlevska O. M., Braslavska A. P.

The study of fibrosis markers was carried out on 72 observed patients (mean age (69 ± 10.37) years) with chronic heart failure (CHF) of ischemic genesis with manifestations of cardiac dyssynchrony (CD) and concomitant type 2 diabetes mellitus – Galectin 3 and matrix metalloproteinase 1. All patients were divided into 2 groups, depending on the presence of CD. The CD was evaluated according to a conventional technique, the volume fraction of interstitial collagen was measured using the formula of J. Shirani and co-authors, the levels of Galectin-3 and matrix metalloproteinase 1 – by the enzyme-linked immunoassay according to the manufacturer's instructions. The data were processed using parametric and nonparametric statistics. It was revealed that the level of fibrosis development was higher in the group of patients with CD than in the group without CD. This indicates the dependence of the development of myocardial sites asynchronous reduction with the presence of interstitial collagen development. That further requires the study of the effect of anti-fibrotic, anti-ischemic and hypoglycemic agents on the progression of CD to prevent subsequent myocardial remodeling.

66-71

Authors: Tselik N. E., Yabluchansky M. I.

The study of the proportion of patients in 82 patients with hypertension in groups of different periods of prolonged QTc per day was performed based on the data of the AM of the ECG, depending on the clinical signs. Depending on the duration of prolonged QTc per day, the patients were assigned to one of three groups: group 1 – the term extended by day of the interval QTc from 0 to 33.3 %, group 2 – from 33.4 to 66.6 %, group 3 – from 66.6 to 100 %. The proportion of patients with hypertension was determined in the groups of the prolonged QTc interval depending on age, sex, weight of patients, type of circadian heart rate index, stage, degree and prescription of EH, presence of coronary heart disease, FC and stage of CHF and diabetes mellitus. According to the AM ECG, an prolonged QTc interval occurs in each patient with hypertension, with an increase of 0 to 33.3 % per day, it is detected in 76 %, from 33.4 to 66.6 % – in 16 % and with 66.7 to 100 % – in 8 % of patients. The existence of a prolonged QTc interval in each patient indicates that in its analysis it is necessary to base on the data of the AM of the ECG taking into account, except for the elongation and lengthening for a day.

78-83

Authors: Boateng H. K., Babiy O. G., Shalkova R. S.

Systemic disorders of connective tissue refer to rare and poorly studied diseases. This group of diseases associated with the variable course and makes it interesting for either medical scientists and researchers or practitioner. Herein we report a case of antisynthetase syndrome with interstitial lung disease complicated by pulmonary thromboembolism. The patient is 71 year old female, who suffered from severe dyspnea, dry cough, intermittent wheezing. Also she had dry eyes, dry mouth, muscle weakness and intermittent pain in large joints, and low grade fever. Physical examination revealed a characteristic heliotrope eye rash, V sign, «mechanic’s hand», peripheral muscles atrophy, dry eyes and mouth, fine crackles to auscultation in basal parts of lungs, soft S1 and S2 heart sounds. Her biochemical profile showed increased creatinekinase, LDH, AsAT, and AlAT Her immunology results were positive to ANA, anti-ds-DNA, anti-ss-A, anti-ss-B and anti-Jo-1 autoantibodies. Based on the obtained data, antisynthetase syndrome was established. It was detected, that progressive dyspnea had been caused by interstitial lung disease and pulmonary thromboembolism. It was confirmed by chest CT-scan and pulmonary angiography. Treatment in this case is mainly symptomatic. It was prescribed glucocorticoids, immunosuppressant, and anticoagulants. This case illustrates the course of the antisynthetase overlap syndrome and difficulties of it management due to the lack of treatment standards and reliable data of the medicine effectiveness.

89-91

Authors: Brynza M. S., Zaporiz’ka V. V., Vasylenko O. A., Volkov D. E.

The disappearance of atrial tachycardia paroxysms after radiofrequency catheter ablation (RFA) of ectopic focus in a left atrium is presented on example of clinical case. Atrial tachycardia paroxysms disappeared after ablation completely.

97-101

Authors: Makharynska O. S., Fagbemi Oluwatoyin O., Doroshenko O. V., Pozhar V. I.

On the example of the clinical case of atrial fibrillation in patient with diabetes mellitus type 2, were discussed molecular mechanisms and therapeutic perspectives, anticoagulation treatment and anti-arrhythmic treatment strategies benefit. Recommendations on lifestyle modification and medicament treatment tactics are described.

109-112

Authors: Makharynska O. S., Lisogorska O. V., Oktiabrova I. I., Adu Albert Asare

On the example of the clinical case of newly diagnosed mural thrombus in patient with post ST-elevation myocardial infarction chronic aneurysm formation, probable risk of further tromboembolism and anticoagulation benefit was discussed. Recommendations on lifestyle modification and medicament treatment tactics are described for prevention of new mural thrombi formation.

118-121

Authors: Oladipo D. L., Swanzy-Krah J., Pochinska M. V.

Permanent pacemaker implantation and medical therapy due to complete atrioventricular block and comorbid cardiac pathology are considered at an example of clinical case. Permanent pacemaker solved the problem of AV-block, however, drug therapy due to arterial hypertension, heart failure and dyslipidemia is not canceled and requires modification.

129-131

Authors: Reng G. J., Kanishcheva O. V., Zhuravka N. V., Yabluchansky M. I.

A clinical case of general somatic complaints in 47 y.o. female, presenting for several years has described. Patient F., presents with uncertain complaints of general character – tiredness, general weakness, loss of energy. During the biennium was examined and treated by gynecologist, endocrinologist, cardiologist, gastroenterologist with no benefit. Anamnesis vita is significant for uterine fibroid. After thorough interviewing was found that patient was done ECG, EchoCG, gastroscopy, thyroid tests but no CBC, urinalysis, general biochemical panel during this two years. The CBC results were stunning and gave answers to all questions.

7-10

Authors: Kravchun P. G., Kadykova O. I., Zalyubovs'ka O. I., Shumova N. V.

The article assesses the contribution of leptin gene polymorphism (Arg223Gln) in the development and progression of obesity in patients with coronary heart disease. 222 patients with coronary heart disease and obesity were surveyed. The study of leptin gene polymorphic locus Arg223Gln was performed by polymerase chain reaction of all examined patients. G allele and G/G genotype of the leptin gene polymorphism (Arg223Gln) are more common among the patients with coronary heart disease and obesity and the frequency of their detection increases with the growth of the degree of obesity.

19-26

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

Blood pressure (BP) circadian rhythm violation, manifested as an insufficient degree of its sleep-time relative decline, is an independent cardiovascular risk factor. The main method of the correction is chronotherapeutic approach, when at least one antihypertensive drug is taken at bedtime. However, most researchers focus on normalizing the daily profile of systolic blood pressure (SBP) and do not pay enough attention to changes in the daily profile of diastolic blood pressure (DBP) and blood pressure in general. The aim of the study was to evaluate the influence of the chronotherapeutic approach on the SBP and DBP levels and the DBP daily profile in hypertensive patients with an insufficient degree of sleep-time relative SBP decline. The study included 12 patients with arterial hypertension (AH) with an insufficient degree of sleep-time relative SBP decline. Participants were divided into two groups: group 1 included patients who take at least one antihypertensive drug at bedtime, group 2 – patients who take all antihypertensive drugs in the morning. All patients underwent 24-hour blood pressure monitoring using the computer system «Cardiosens» (KhAI Medica, Ukraine, with the oscillometric method of BP measuring) when enrolling in the study and after 3 months. The type of SBP and DBP diurnal profile, the mean values of SBP, DBP and hyperbaric indices were determined and compared between groups 1 and 2 at each visit, as well as within groups between visits. The results showed that the SBP daily profile normalization in patients with insufficient degree of sleep-time relative SBP decline from group 2 was achieved only in 11 % of cases, and in group 1 SBP and DBP daily profile normalized in 1/3 patients. In some patients from group 2 SBP and DBP daily profile converted into the overdipper type, while in group 1 overdippers did not appear at the end of the study. It was concluded that conversion of daily DBP profile to overdipper as a consequence of bedtime drug administration requires a review of the accepted treatment strategy.

36-40

Authors: Pochinska M. V., Shevchuk M. I.

Dose factor of the main groups of cardiac medications in five pulse pressure (PP) classes was studied in 220 patients (110 men and 110 women) at the annual stage after pacing, the average age 70 ± 9 years. Patients with the IV and V class of PP require the administration of higher doses of antiarrhythmics, diuretics, calcium channel blockers and ACE inhibitors.

47-50

Authors: Tymoshenko O. S., Yabluchansky M. I., Martynenko O. V.

Parameters of heart rate variability (HRV) were studied in 112 patients with arterial hypertension (AH) aged 58.5 ± 9 years (60 patients with difficult-to-control arterial hypertension (DTCAH) and 52 patients with controlled arterial hypertension (CAH)). The control group was consisted of 20 conditionally healthy persons of the same sex and age. It has been established that patients with AH were characterized by decrease in the level of total power of the HRV spectrum, the power of the high-frequency (HF) and low-frequency (LF) domains of the spectrum, and increase in the level of the very low-frequency spectrum (VLF) and value LF/HF that reflect sympathovagal balance. It has been established that there were more significant disorders in neurohumoral regulation in patients with DTCAH in comparison with patients with CAH, which consist of the predominant adrenergic activation, primarily due to the sympathetic link of the autonomic nervous system. HRV can be used as an effective non-invasive method for the diagnosis and control of DTCAH.

57-62

Authors: Bogun L. V., Lawal Wuraola F., Ivleva O. O., Okhryamkina O. O.

The article emphasizes the necessity of meticulous physical examination of the patient in the modern clinical practice. Two clinical examples of diagonal earlobe crease, also known as Frank’s sign, are given. Both cases describe patients with ischemic heart disease, but age of patients and severity of Frank’s sign differ. The literature data about its frequency in different groups of population as well as the clinical significance and possible underlying pathophysiological mechanisms of Frank’s are shown.

68-70

Authors: Ovda A., Nazarko I. V., Lysenko N. V., Lebedinets V. V.

The patient with the severe course of dermatopolymiositis served as an example for diagnostics, clinical syndromes establishment, and treatment tactics. The importance of the syndrome but not of the nosological diagnosis was marked.

11-15

Authors: Derienko T. A., Volkov D. E., Lopin D. A., Yabluchansky M. I.

We observed 131 patients (70 men and 61 women) aged 69,5 ± 11,6 at the annual stage of drug therapy after implantation of pacemakers in the DDD / DDDR modes, VVI / VVIR and CRT-P / CRT-D. Patients were divided into 2 groups – I and II stage of AH. . In each group, the dose rate was defined in major groups of cardiac drugs at every stage of research. The results showed that the dose coefficient of the major groups of cardiac drugs in patients with pacemaker and AH was determined by the stage of AH, what is more AH stage III required higher doses of diuretics and anti-arrhythmic drugs than AH stage II during the hole period of observation. Patients with implanted pacemaker and AH require more careful titration of the major groups of cardiac drugs, taking into account the stage of AH.

23-26

Authors: Onischenko A. I., Nakonechna O. A., Tkachenko A. S., Kalashnik Yu. M.

The content of MCP-1 and MMP-9 in blood serum of patients with chronic polypoid rhinosinusitis was studied. It was found that this pathology led to a significant increase in MCP-1, which is a marker of fibrosis, in blood serum. The compensatory increase in MMP-9, serving as an antifibrotic factor, is much weaker. Such imbalance between profibrotic MCP-1 and antifibrotic MMP-9 indicates a lack of compensatory adaptation mechanisms of fibrolysis activation and contributes to the development of fibrosis in chronic polypoid rhinosinusitis.

34-39

Authors: Tselik N. E., Shmidt O. Y., Martynenko O. V.

The study was carried out to identify the distribution of QTc during ECG AM depending on clinical features of EH in 82 patients. As classified shortened was considered QTс < 320 ms, as normal > 320 ms and < 440 ms, as classified prolonged was considered QTс > 440 ms. Average, maximum and minimum QTc are registered in every patient during ECG AM. The results confirm low probability of short QTc and demonstrate presence of prolonged QTc in every patient during ECG AM. The largest duration of maximal QTc have adulthood male patients with obesity III st., with low and high circadian index, with II stage and mild EH, with for the first time diagnosed EH and with EH lasting more than 10 years, with mild cardiovascular risk, with diffuse cardiosclerosis, with I and II FC and I and IIA st of HF.

45-48

Authors: Babiy O., Kumpan N.

During the past five decades, dramatic progress has been made in the development of curative therapy for hematologic malignancies, including Hodgkin’s Lymphoma (HL). The therapy responsible for this survival can also produce adverse long-term health-related outcomes, referred to as «late effects», which manifest months to years after completion of cancer treatment. The purpose of this report is to pay attention to the problem of late complications, which develop in distant period after combined therapy of HL on example of illustrative clinical case.

55-58

Authors: Dlamini T., Babiy O. G., Kumpan N. V.

Pericarditis is an important diagnosis to consider in a patient presenting with chest pain. This article describes the common features and management of pericarditis in the general practice setting on the example of clinical case. To the cardiologic department was admitted middle aged male. He complained of sharp retrosternal pain, and fever. The survey revealed distinctive features of pericarditis: pericardial friction rub on auscultation, diffuse PR segment depressions on ECG, pericardial effusion on echocardiography, but etiology was not elicit. Most cases are labeled as «idiopathic» because the traditional diagnostic approach often fails to identify the etiology. The presence of febrile fever and neutrophilic leukocytosis indicates that a bacterial etiology take place. Prompt antibacterial and anti-inflammatory treatment led to recovery of the patient. He was completely free of symptoms and had returned to his pre-morbid state.

63-66

Authors: Kaydalova A. O., Abdel Wahhab O. Dzh., Asaje S. D., Belal S. A. S., Lysenko N. V.

Any disease is the result of the interaction of pathologic process and the patient's personality, so the basis of optimal treatment strategy is physician and patient partnership in the fight for recovery and/or the most beneficial progress of chronic diseases with the highest possible quality and life expectancy. The implementation of this postulate is only possible with correct diagnosis, which presents some difficulties in this case. Due to individual approach we were able to find the optimal treatment and not to harm the patient. We recommend for all who works in practical medicine to put into the basis of the treatment, first of all, the patient's personality.

71-75

Authors: Lutsyk M. V., Nesterenko N. I., Tselik N. E., Martymianova L. O.

On the example of the clinical case of newly diagnosed atrial fibrillation, against the background of ischemic heart disease, diagnostic issues, clinical diagnosis, treatment tactics were considered. The emphasis was placed on the importance of lifestyle, the need for outpatient monitoring, timely examination and correction of patient treatment, including surgical intervention.

81-85

Authors: Nayak S. R., Shevchuk M. I., Skokova N. I., Surya Prabha P.

A clinicalcase offemale patientwith obstructive bronchitisafter right-sided bilobectomy due tocongenitalbronchiectasis which developed on the background of suspected genetic predisposition withclinical signs of respiratory failure, butwithout significant disorders by instrumental examination of the of external respiration function.

91-94

Authors: Radchenko A. O., Makienko N. V., Vodyanitska N. A.

In this article is raised the topic of multimorbidity and polypharmacy on the example of a clinical case with the main diagnosis of Ischemic Heart Disease: Systemic atherosclerosis with predominance of coronary arteries sclerosis. Stable angina class III. Hypertensive heart disease III stage 3rd degree. Aortocoronary bypass. Sick sinus syndrome, tachy-brady form. Constant form of atrial fibrillation-flutter. AV node catheter ablation with pacemaker implantation. Infarction pneumonia of the lingual segments of the upper lobe of the right lung. CHF II-B stage with preserved systolic function of the left ventricle (EF LV 53 %). Very high additional cardiovascular risk. Concomitant conditions: Chronic obstructive pulmonary disease: Chronic obstructive bronchitis 2 degrees severity. Chronic pulmonary insufficiency III degree. Obesity III degree. Diabetes mellitus type 2, medium severity, decompensated. Chronic renal failure, III stage. The ongoing therapy is discussed and recommendations are given to minimize it in order to avoid polypharmacy.

99-101

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

Heart failure is a common cause of high mortality of patients all over the world. Arising on a background of complicated tonsillitis in patients with congenital heart diseases that significantly impairs the quality of life of patients and worsens the prognosis. Radical remains combined treatment of the patient with the elimination of complications. For example, with clinical case report demonstrates and discusses the results of surgical and therapeutic treatment of heart failure with complications in the early postoperative period in a patient with congenital heart disease (bicuspid aortic valve).

107-118

Authors: Martynenko O. V., Zolochevsky O. O., Allena R.

The review involves clinical and experimental data, constitutive modeling, and computational investigations towards an understanding on how mechanical cyclic loads for long periods of time affect damage evolution in a reconstructed bone, as well as, lifetime reduction of bone graft substitutes after advanced core decompression. The outcome of the integrated model discussed in this paper will be how damage growth in femur after advanced core decompression subjected to mechanical cyclic loading under creep and fatigue conditions may be controlled in order to optimize design and processing of bone graft substitutes, and extend lifetime of bone substitutes.

12-18

Authors: Kopytsya M. P., Petyunina O. V., Vyshnevska I. R., Tytarenko N. V., Hilova Y. V.

Numerous studies confirm worse results in diabetic patients with acute coronary syndrome (ACS) compared with non-diabetic patients. Different mechanisms underlie the adverse outcomes of ACS and diabetes mellitus. In this connection, a special place is occupied by the study of new biomarkers that reflect the complex pathogenic processes in these patients. Purpose: to investigate the role of the biomarker GDF 15 in prognosis of adverse outcomes in type 2 diabetes mellitus (DM2T) patients with ACS. Materials and methods: 73 patients with different forms of ACS were screened. Levels of biomarkers: GDF 15, N-terminal pro brain natriuretic peptide (NT-pro BNP) and C-reactive protein (C-RP) were determined. The follow up period was 1 year. Endpoint was defined as lethal outcome. Results: significant differences in GDF 15 level has been found, prognostic value of GDF 15 was estimated in patients with DM2T, using a ROC-analysis. Threshold level of GDF 15 has been determined as 3894 pg/ml, with sensitivity of 64 % and specificity of 75 %. Conclusion: Patients with ACS and DM2T more often had a history of different cardiovascular diseases and risk factors compared to patients without diabetes. GDF 15 level was significantly higher in patients with ACS who had history of DM2T.

24-28

Authors: Martymianova L. O.

Types and prevalence of ventricular rate (VR), systolic (SBP) and diastolic (DBP) blood pressure (BP) orthostatic reactions (OR) in patients with permanent atrial fibrillation (AF) in general cardiovascular risk groups (GCVR) were studied in 137 patients (73 men and 64 women), aged 66.4 ± 9.9 years. VR was measured by the electrocardiography (ECG) on the computer electrocardiograph «CardioLab 2000» and BP – semi-automatic tonometer Microlife BP2BIO. Changes VR, SBP and DBP in the range of ± 5 % were classified as a lack, an increase of 5 % and more – both positive and decreased by 5 % or more – as a negative OR. GCVR calculated in accordance with the scale of SCORE. Patients were classified into groups of GCVR. Statistical evaluation of the results was performed with the parametric estimate of the mean (M) and standard deviation (sd) and non-parametric Student's T-test and Mann-Whitney test methods. It was found that patients with AF have all three types (positive, absent, negative) OR of VR, SBP and DBP, which are stored in all classes GCVR. Optimizing the management of patients with atrial fibrillation, including with and through modification within the GCVR risk factors should take into account deviations in orthostatic reactions of VR, SBP and DBP.

38-42

Authors: Pochinska M. V.

The changes of functional blood circulation parameters in 19 patients (13 men and 6 women) at the annual stage after cardiac resynchronization (CRT) and drug therapy in pulse pressure classes (PP: I - very low PP - less than 20 mm Hg; II – low PP – from 20 to 40 mm Hg; III – normal PP – from 40 to 60 mm Hg; IV – high PP – from 60 to 80 mm Hg; V – very high – more than 80 mm Hg) were studied. The probability of differences between groups was determined with a Mann-Whitney U-test. Normalization of diastolic blood pressure (DBP), heart rate (HR) and left ventricular ejection fraction (LV EF) in all PP classes, systolic BP (SBP), end-systolic, end-diastolic volumes (ESV, EDV) in the III PP class patients at the annual stage after CRT and drug therapy were showed. The tendency of normalization of SBP in the IV class, posterior wall thickness of LV (PWLV), myocardial mass of LV (MMLV) and no change in interventricular septum thickness (IVS), left and right atrium (LA and RA), right ventricular (RV) sizes in all PP classes indicated the need for more active monitoring, careful selection of stimulation parameters and medical support correction of patients in IV PP class.

48-55

Authors: Shlieienkova H. O.

The high frequency of neurological disorders in children deprived of parental care was demonstrated (94.1 ± 2.2 %). The most commonly the syndrome of statokinetic, mental and pre-speaking retardation was diagnosed (49,2 ± 4,7 %, p < 0,001). High frequency disturbances of mental development and neurological status are accompanied by a reduction in the functional activity of the pituitary-thyroid system and the activation of serotonin. Between levels of thyrotropin and serotonin in the blood serum there is a moderate direct correlation (ρ = 0,56), which may indicate the adaptive increasing of the serotonin system activity, designed to compensate the lack of thyroid effects.

62-67

Authors: Bogun L. V.

The article addresses the problem of amiodarone-induced thyroid dysfunction based in the clinical case. The literature data on the pathogenesis, diagnosis of this disease, as well as management tactics for different variants of amiodarone-associated thyroid dysfunction are shown.

73-78

Authors: Oyeleye L., Saja M., Golubkina E. O., Bogun L. V., Yabluchansky M. I.

A clinical case of a patient with uncontrolled hypertension and polymorbidity. The paced breathing test was made, was found prevalence of low frequency influences at the initial stage and its intensification at the resting stage, growth of the total power of heart rate variability spectrum (TP) with respiratory modulation. The course of the disease worsened the appearance of new-onset atrial fibrillation (registered paroxysm on Holter monitoring); the general deterioration of the patient’s state reflected HRV changes on sinus rhythm tracing - significantly reduced TP growth in response to paced breathing, an increase in LF/HF (ratio of low frequency to high frequency waves), as well as switching to the neurohormonal level of heart rate regulation at the resting stage. After the treatment the growth of TP in response to the test has increased and LF/HF level has decreased.

84-92

Authors: Makharynska O. S., Zhuravka N. V.

Clinical importance of the community-acquired pneumonia clinical course and treatment in patients with diabetes mellitus is discussed in this review. Clinical characteristics, immunological parameters, possible drugs regimen, depending on community-acquired pneumonia severity, and the ability to optimize therapy with antibacterial drugs are considered. The features of the appointment of antibacterial drugs in the step-down antibacterial therapy, peculiarities of pneumonia in patients with diabetes mellitus.

112-124

Authors: Belal S. A. S., Zolotarova T. V., Litvin A. S.

Presented lecture is about management of a serious condition – acute kidney injury (AKI). It is intended for students, general practitioners, family physicians, therapists and those who may face with manifestations of AKI, and on which depends its timely diagnosis and the success of therapy. Definition, epidemiology, risk factors, causes, pathogenesis, classification, symptoms, diagnosis and differential diagnosis, treatment, complications, prognosis and prevention of AKI are described.

10-17

Authors: Golubkina E. O.1, Golubkina O. O.2

Were studied the distribution ratios of ultra-low-frequency, low-frequency and high-frequency components of the heart rate variability (HRV) as an indicator of the state of humoral and autonomic sympathetic and parasympathetic elements in regulation of heart rate in 35 patients with arterial hypertension (AH) aged 59 ± 5 years in the paced breathing test. Evaluation of spectral parameters of HRV was performed with the help of hardware and software «Kardiolab» («HAI-Medica»). Patients were divided into 3 groups according to the degree of power reduction of low-frequency and high-frequency waves of HRV during the transition from spontaneous breathing to paced one: 1st group- less than 5 times; 2nd group – 5–20 times; 3rd group – more than 20 times. Statistical analysis was performed by means of parametric and nonparametric methods using Microsoft Excel 7.0. It was found that in patients with hypertension was observed prevalence of humoral effects in comparison with the sympathetic and parasympathetic parameters. The greater was the contribution of humoral component to the HRV spectrum, the lower was the response of HRV to the respiratory modulation.

23-28

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

The frequency characteristics of the clinical signs of arterial hypertension (AH) according to the daily profile type of systolic (SBP), diastolic (DBP) and pulse (PP) blood pressure were studied. The data showed a significant difference in the frequency of occurrence of AH clinical signs, depending on the type of daily profile of SBP, DBP, and PP. It was concluded that in patients with AH determination only SBP daily profile of is not enough, it's necessary to take into account the types of DBP and PP daily profiles also.

32-36

Authors: Voronenko O. S., Brynza M. S., Volkov D. E., Lopin D. O., Martynenko O. V., Yabluchansky M .I.

52 patients (24 male and 28 female) aged 71 ± 8 years, underwent permanent pacemaker implantation were included in the study. Analysis of heart electrical axis (HEA) α angle values distribution was carried out in three dimensions in patience before and after pacemaker (PM) implantation. The data processed in Microsoft Excel with calculation of the average and it’s standard deviation. Significance of differences in data before and after PM implantation was assessed using Friedman ANOVA test and Kendall concordance coefficient. It was found, that α angle values distribution in patients with implanted PM is transformed from a unimodal to bimodal on the permanent cardiac pacing background. It’s assumed, that α angle changes resulting due to right ventricular electrode positioning options during PM implantation. Clarification of the nature of this change requires a special study.

43-47

Authors: Babiy O. G.

The clinical course of myocardial infarction frequently burdened by a variety of complications, which largely determine its scenario and prognosis. Despite advances in the management of this disease, complications can and do occur. These dangers arise from two principal sources: on the one hand, from the local effects of the lesion and the circulatory depression that follows, and, on the other, from the hazards that may attend during active treatment. On example of clinical case is demonstrated severe course of myocardial infarction with development of multiple complications at different stages, but, ultimately, with a favorable outcome. Early, aggressive, and judicious treatment of these complications may substantially decrease the morbidity and mortality associated with this disease.

53-57

Authors: Makharynska O. S., Lebedinska M. M.

Infective endocarditis in intravenous drug abuser is reviewed on the example of clinical case. Clinical examination, the clinical diagnosis, recommendations for surgical treatment, choice of optimal therapy are outlined in patient with infective endocarditis. The features of infective endocarditis in IV drug abused patients were studied.

61-65

Authors: Victor A., Skokova N. I., Petrenko O. V.

A clinical case of chronotherapy of arterial hypertension (AH) with insufficient blood pressure (BP) night decline has described. Patient P., the BP daily means according to ambulatory BP monitoring (ABPM) was 148/84 mmHg, BP circadian rhythm violation with insufficient degree of nocturnal BP reduction. We recommended the patient to change the mode of antihypertensive drug intake from morning to evening in the same dose. After 3 months complete AH control was achieved with normalization of diastolic BP profile.

70-87

Authors: Derienko T. A.

The review is devoted to clinical problems of arterial hypertension (AH) in patients with implanted pacemakers (EKS) and cardiac resynchronization therapy (CRT). Indications for pacemaker implantation and CRT are considered, especially the purpose and effectiveness of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists (ARA, sartans), beta-blockers (BAB), diuretics, calcium channel blockers. We prove that the CRT and cardiac pacing and do not cancel, bur modify drug therapy of AH.