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№4' 2015


Kuban State Medical University, Ministry of Health of Russian Federation, Krasnodar, Russian Federation
Congress of the European Society of Cardiology (London, 2015): results of the most important clinical trials
5 - 12
A report on the six scientific sessions Hotline of Congress of the European Society of Cardiology (2015) dedicated to the general topic «Environment and heart» is presented. The highest interest of the Congress participants was attracted by the results of 28 specially selected research. The tactics of biochemical diagnosis of myocardial infarction, the problem of early detection and treatment of cardiac remodeling, the effectiveness of cyclosporine were presented at Session 1 «Acute myocardial infarction». The ways to reduce the risk of atrial fibrillation recurrence were discussed at Session 2 «Atrial fibrillation/pacing». Session 3 «Diabetes/pharmacology» evaluated cardiovascular safety of sitagliptin, the effectiveness of prolonged dual antiplatelet therapy in patients with type 2 diabetes mellitus with concomitant cardiovascular disease. The subject at Session 4 «Hypertension» was treatment (Telmisartan, Spironolactone, Amiloride, and others) of patients with hypertension and at least one risk factor for cardiovascular complications. Session 5 «Heart failure» examined research results, which define the role of early detection of fluid retention in the lungs, effectiveness of percutaneous intracoronary gene delivery at sarcoplasmic reticulum calcium ATPase deficiency, diagnosis and treatment of Chavez' disease. A new non−invasive technique for measuring fractional flow reserve using computed tomography was presented at Session 6 «Coronary artery disease».
Key words: cardiovascular diseases, clinical trials, Hot Line sessions.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
The content of procalcitonin and galectin−3 in the blood of patients with community−acquired pneumonia and concomitant chronic heart failure and without it
13 - 16
Procalcitonin (PCT) content is measured to assess the likelihood of bacterial infection as well as to justify antibiotics prescription. Plasma concentrations of galectin−3 (Gal−3) are used to predict outcomes in patients with congestive heart failure (CHF). The influence of comorbidities on blood concentrations of PCT and Gal−3 in patients with CHF remains unexplored. The purpose of the work was to evaluate the changes in levels of PCT and Gal−3 in patients with community−acquired pneumonia (CAP) with and without CHF. The trial was performed at therapy department of Kharkiv City Clinical Hospital No. 25. Exclusion criteria were severe CAP, valvular heart diseases, dilated or hypertrophic cardiomyopathy, functional class (FC) 1 or 4 CHF, young age. The study included 109 patients with CAP and concomitant CHF (group 1) and 30 patients with isolated CAP (group 2). The content of PCT and Gal−3 in the blood was determined on admission. In patients with CAP and concomitant CHF plasma concentrations of PCT (0.41±0.03 ng/ml) and Gal−3 (34.15±2.01 ng/ml) were higher than in patients with isolated CAP (0.25±0.02 and 19.70±2.62, respectively; in both cases p < 0.05). Correlation analysis did not show any relation between the levels of PCT, Gal−3 and FC of CHF. Blood plasma concentrations of PCT and Gal−3 in patients with CAP and concomitant CHF are significantly higher than in patients with isolated CAP and are not associated with FC of CHF. When assessing the results of determining of biomarker concentrations in patients with CAP, the presence or absence of CHF should be considered.
Key words: community-acquired pneumonia, chronic heart failure, procalcitonin, galectin-3.
Kharkiv National Medical University, Ukraine
The role of cytokine in differential diagnosis and treatment optimization at community acquired pneumonia in patients with diabetes mellitus
17 - 19
Dysfunction of immune system or its any link leads to formation of immunodeficiency disease, primary (congenital) or secondary (acquired), with development of immune system decompensation hereafter. In accordance with the WHO nomenclature genetically determined organism inability to realize any link of immune response is commonly understood as immunologic insufficiency. Primary immunodeficiency diseases are characterized by early clinical realization of immunopathology, have pronounced hereditary character and are inherited, as a rule, by recessive type. Hyper−IgE−syndrome (Job syndrome) is a primary immunodeficiency with autosomal−dominant and autosomal−recessive inheritance. The clinical presentation of Job syndrome is characterized by recurrent skin abscesses, recurrent pneumonia with formation of pneumocele, eczematous dermatitis, increasing blood IgE level. We present a clinical case of hyper−IgE−syndrome in a child with recurrent pneumonias, streptococcal impetigo, eosinophilia, increased blood IgE up to 15114 IU/ml. Our patient had typical phenotypic signs (prominent forehead, deep−set eyes, wide nose bridge, progenia) which are characteristic for Job syndrome. Treatment of the child was performed according to the recommendations for therapy of patients with primary immunodeficiency: medical−hygienic procedures on skin, broad spectrum antibiotics for treatment of bacterial infections, antifungal medicines, immunoglobulin IV. The condition of the child against a background of therapy is satisfactory, physical development corresponds to the age, pneumocele is not formed. The child is under medical supervision of a pediatrician, pulmonologist, allergologist for prevention of severe irreversible complications.
Key words: pneumonia, cytokines, diabetes mellitus, antibiotic therapy.
Kharkiv National Medical University, Ukraine
Topical issues of diagnosis and treatment of pyelonephritis in early−age children
24 - 27
Urinary tract infections represent the most common bacterial infection in children under 2 years. Questions of treatment and diagnosis of pyelonephritis in infants and toddlers are topical issues due to the increasing prevalence of the disease, peculiarities of course, difficulties of diagnosis, and limited options of antibacterial therapy in children under 3 years. One hundred ninety−eight histories of children with pyelonephritis (92 cases of infants and 106 cases of 1−3−year−old children) were analyzed. The diagnosis was made and treatment was administered according to the national standards. Age and gender peculiarities of prevalence (decrease in prevalence in boys with age in contrast to increase in girls), clinical presentation (increase in oligosymptomatic or asymptomatic course of pyelonephritis), pathogenetic mechanisms of development (high level of urogenital abnormalities and vesicoureteral reflux) and etiology (shift to Gram−negative bacterial infection, decrease in antibacterial sensitivity) of pyelonephritis in children under 3 years were revealed. Every other patient with pyelonephritis had one or more risk factors for urinary tract infections such as compromised obstetric and gynecological history, pathology of pregnancy and labor, hereditary predisposition, phymosis, gastrointestinal disorders (constipations, disbacteriosis), rickets etc. Increase in pyelonephritis morbidity, high frequency of oligosymptomatic or asymptomatic course in infants and toddlers demand laboratory and instrumental investigations of the children with risk factors for early detection of urinary tract anomalies and pyelonephritis. With due account for potential recurrent and chronic course of pyelonephritis in children (particular with urodynamic problems), alternation of causative factors, heterogeneous spectrum of bacterial infection in different regions regular microbiological monitoring as well as detection of microbial associations are necessary for eradication of the infection.
Key words: pyelonephritis, early-age children, diagnosis, treatment, microbiological monitoring.
V. T. Zaytsev Institute of General and Urgent Surgery (NAMS), Ukraine
Diagnosis and treatment tactics at mediastinal neoplasia
28 - 32
Variable manifestations of the clinical course, difficulty in the diagnosis of mediastinal tumors and cysts characterize this pathology as one of the most difficult chapters of thoracic surgery. Tumors and cysts of the mediastinum have been known to surgeons for a long time, they are the cause of extremely severe physical and mental suffering of the patients, and often pose a threat to the life of the patients. Providing surgical care to the patients with tumors and cysts of the mediastinum is a difficult and is not always solvable task, one of the main roles in which is played by timely diagnosis and specialized surgical care. Mediastinal tumors are difficult to diagnose and treat because they often have a long asymptomatic period of growth and clinical manifestations in the form of compression of the mediastinum occurring with the tumor enlargement. The so−called mediastinal compression syndrome is a serious problem for management in the perioperative period, especially alarming is tracheobronchial obstruction, significantly increasing the anesthetic and operating risk. In view of the histogenesis of tumors, more than a hundred of their morphological variants can occur. At the same time, topography of the heart, great vessels, trachea, esophagus does not allow accurate preoperative diagnosis, verification of the diagnosis and determining the treatment policy. Accurate information about the frequency of occurrence of various tumors of the mediastinum is not available. According to some authors, it makes 2 cases per 1 million population, or 0.5−7 % of all tumors. From classical studies it is known that clinical diagnosis of mediastinal tumors is extremely difficult, and the frequency of individual symptoms described by various authors, range from 20 to 80%. Access to and the amount of surgery cannot always be determined according to the studies and changes in the performance of audit and evaluation of mediastinal tumor size and its relation to surrounding structures.
Key words: mediastinal neoplasia, diagnosis, surgery, videothoracoscopy.
Kharkiv National Medical University, Ukraine
Formation of an artificial stomach after gastrectomy
32 - 36
Gastrectomy is the leading radical method of treatment for gastric cancer. A significant number of patients have clinically significant postgastrectomy syndromes. The main factor affecting the incidence of digestive disorders is the choice of the method of reconstruction of the digestive tract after gastrectomy. The review of literature revealed recent data on the possibilities of forming a so−called artificial stomach during the recovery phase after gastrectomy. These data show a decrease in the number of postgastrectomy syndromes in formation of small and colonic reservoirs. However, according to many studies, the benefits of reconstruction method have to be determined. Thus, the literature suggests that, despite development of a significant number of reconstructive surgeries after gastrectomy, new methods of reconstruction aimed at improving the quality of life of patients with gastric cancer need to be developed.
Key words: gastrectomy, postgastrectomy syndromes, gastroplasty.
Kharkiv National Medical University, Ukraine
Modern approaches to diagnosis and treatment of cervical incompetence
37 - 41
The aim of this study was to determine the clinical and diagnostic features and the state of hemodynamics in the descending branches of the uterine artery using Doppler ultrasound in cervical incompetence (CIN) before pregnancy and to evaluate the effectiveness of modern methods of its correction. The study involved 85 pregnant patients at risk of CIN, the main group, and 20 healthy women included in the control group. The main group was divided into two clinical groups: group 1 included 48 women with CIN, who before pregnancy were treated with fillers based on hyaluronic acid, group 2 included 37 women with CIN, who, in addition to rehabilitation of the vagina, did not receive any treatment before pregnancy. The blood flow in small vessels of the cervix in women at risk for CIN was investigated. It was found that decrease in peripheral resistance index at three levels of cervical perfusion in the descending branch of the uterine artery, peripheral and stoma areas of the cervix, as well as increased resistance to blood flow in the central area, allow establishing the risk of CIN. Therefore the patients are recommended correction with biorevitalisation methods using fillers based on hyaluronic acid before pregnancy. The parameters of Doppler blood flow investigation in the uterine arteries, as well as the history data, palpation assessment of cervix, transvaginal ultrasound diagnosis may serve as an additional diagnostic test and determine CIN risk development during pregnancy. Hemodynamic changes revealed in the descending portion of the uterine artery, and three levels of cervical perfusion, are apparently related to the compensatory−adaptive changes in the cervix at CIN.
Key words: cervical incompetence, Doppler investigation, diagnosis, treatment.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Auxiliary reproductive techniques in women with infertility following surgery for tubal pregnancy
42 - 46
The frequency of abdominal pregnancy in Ukraine amounts to 15.4 per 1,000 pregnancies. 47 % of patients urgently admitted to hospital are patients with abdominal pregnancy. Tubal pregnancies amount 93−98.5 % of all abdominal pregnancies. Pregnancy in intramural portion of the uterine tube amounts 2−4 %, in the isthmian portion 12−13.4 %, in the ampullar portion 78−83.6 %. Tubal pregnancy in both fallopian tubes occurs with a frequency of 1:20000. In 50−82 % of cases, women with infertility have a combination of several types; herewith they have tubal−peritoneal infertility in 43−60 %, endocrine in 30−40 %, endometriosis in 25 % of cases. One of the causes of combined (tubal and peritoneal−endocrine) infertility, present in 32−80 % of patients operated due to tubal pregnancy, is removal of the fallopian tubes, performed in 61.3 % of surgeries; it leads to poor blood supply of the ovaries with the development of deficiency syndrome. 7−27 % of patients with a history of tubal pregnancy have its relapse. Women who were removed both fallopian tubes have ovary deficiency syndrome and severe depression aggravating the quality of life. The effectiveness of ART applied to women with combined infertility who had tubal pregnancy is 30 %. Despite the improvement of assisted reproduction techniques, gametal cells and embryos produced during IVF are subject to influence of ROS (reactive oxygen species), reducing the effectiveness of ART. The use of modified CBS schemes with melatonin allows increase of the number of oocytes, improvement of the degree of their maturity and quality and increase of the rate of clinical pregnancies among women with infertility and ovaries deficiency syndrome by 55.3 %. Application of cryoextract of placenta in patients with combined infertility after surgical treatment of tubal pregnancy using IVF programs is quite promising. Since correction with melatonin is not effective in 100 % of cases, a promising method is the use of cryoextracts of placenta for its correction in ART programs in patients with combined (tubal peritoneal and endocrine) infertility after surgical treatment for tubal pregnancy.
Key words: auxiliary reproductive techniques, tubal pregnancy, cryoextracts of placenta.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Immunity state in fertile women with chronic recurrent vaginal candidiasis
47 - 49
The present time is marked by rapid growth of non−specific infectious and inflammatory diseases of the lower genitals of women of reproductive age, including chronic recurrent vaginal candidiasis (HRVC) making 35 % in the overall dysbiotic process s of the vaginal biotope. Modern investigations have established that a chronic relapsing course of vaginal candidiasis is caused by the features of anti−infection protection of the genital tract; the trigger of the disease is reduction of the resistance of the host organism as a whole. The humoral link of local immunity and humoral and cellular link of systemic immunity were studied in 40 women of reproductive age with HRVC. The control group consisted of 30 women with vaginal normocenosis. Assessment of the findings of humoral immunity investigation demonstrated increase in local levels of IgA, IgG, decreased concentrations of Gimp, IgA and lysozyme, which suggested disorders of the non−specific immune response in anti−infection protection of the genital tract. The study of cellular and humoral systemic immunity revealed decreased subpopulations of CD3+, CD4+, CD8+, immunoregulatory index (CD4+/ CD8+), NK (CD16+), percentage of phagocytosis and CIC at unchanged rates of IgA, IgM, IgG, indicating disorders in the immune response regulation in this form of dysbiosis. These findings suggest the presence of imbalance of immunoregulatory mechanisms regulating anti−infection protection of the genital tract responsible for the chronic recurrent course of vaginal candidiasis and promoting reduction of the overall immunoreactivity of the organism in women.
Key words: local and systemic immunity, chronic recurrent vaginal candidiasis, fertile age.
Prof. M. I. Sytenko Institute of Spine and Joint Pathology, NAMS of Ukraine, Kharkiv, Ukraine
Investigation of stress−strain state in femur model with the appliance for distal defect replacement
50 - 56
The distal femur is most likely to experience the risk of the greatest static and dynamic loads, therefore, the use of metal implants to replace the post−resection defects is optimal at surgical treatment of patients with tumor lesions of this area. These implants are subject to cyclic mechanical stress, resulting in breakage of the implant components observed, thus research on optimization of interrelation of the components of endoprosthesis are conducted constantly. Based on the results obtained by mathematical modeling of implant−femur system, the authors identified the optimal interrelation between the components of the endoprosthesis depending on the length of the femur resection.
Key words: femur distal portion, mathematical simulation, modular implants in bone tumors, implant fracture, stress-strain states.
Prof. M. I. Sytenko Institute of Spine and Joint Pathology, NAMS of Ukraine, Kharkiv, Ukraine
The results of surgical treatment for shoulder instability accompanied by Hill−Sachs lesions
57 - 60
According to Ukrainian and foreign authors, the percentage of recurrence after reconstructive surgery for shoulder instability with Hill−Sachs lesion is 2.8−30 %. The purpose of the work was to analyze the results of surgical treatment of patients with shoulder instability accompanied by Hill−Sachs lesion. The results of treatment of 63 (53 men, 84.1 % and 10 women, 15.9 %) patients of working age (16−63 years old) with traumatic anterior instability of the shoulder joint with Hill−Sachs lesion, who were treated in hospital at Prof. M.I. Sytenko Institute of Spine and Joint Pathology (National Academy of Medical Science of Ukraine) within the period from 2009 to 2014 were analyzed. Sixty−four shoulder joints were operated, of them 38 right (59.4 %), 26 left (40.6 %), one patient was operated on the both shoulder joints. All patients were divided into three groups according to the defect volume and therefore the type of surgery performed. The comparison group consisted of patients with subcapital torsion humeral osteotomy, operated before 2009 with similar damage, excluding the value of the defect. The results of treatment were estimated as 90−100 points (excellent result) while in patients who underwent torsion subcapital osteotomy the results did not exceed 80 points within a period of 6 months follow−up (60 ? 80 points) and a year later reached the level of 65 to 85 points and were assessed as satisfactory. In group 4 recurrent dislocation of the humerus within the period of 6 months and 1 year after the surgery were not recorded, as the patients did not complain of pain. The type of surgery depends on the defect volume. Determining the defect of the humeral head can more accurately determine the volume of surgical treatment for each patient. Poor results of treatment in group 4 are mainly due to the presence of restriction of movement in the shoulder joint, largely due to abduction and external rotation.
Key words: shoulder joint instability, Hill-Sachs injury, treatment outcome.
S. P. Grigoriev Institute for Medical radiology, NAMS of Ukraine, Kharkiv, Ukraine
Prospects of the use of molecular markers in cancer of ovaries
61 - 65
Cancer of ovaries is one of the most urgent and difficult issues of clinical oncology. It makes about 30 % of all gynecological malignant diseases and is responsible for almost fifty percent of death among them. The present−day success of molecular−genetic research in oncology allows to consider malignancy as illness characterized by clonal evolution of transformed cells in the tissue. Importance of laboratory diagnosis ovarian cancer is undoubtful as in 10−20 % of cases biopsy cannot give the material containing tumor cells. Determination of molecular−biological markers in the tumor tissue can give additional information about biological behavior of the tumor, about the quickness of her growth, capacities to metastasize and invade the tissues, stability to chemotherapy. At present much attention is paid to the study of markers, characterizing apoptosis, proliferation of cell and angiogenesis including p53, Bcl−2, Ki−67 and VEGF proteins. Expression of р53 in the tumor tissue can serve as a marker to forecast survival of patients and resistance to adjuvant therapy. Activity of р53 is required for some forms of apoptosis, and its mutations are associated with the aggressiveness of the disease course and stability of tumor cells to chemotherapy or radiation therapy. Proteins Bcl (Bcl−2 and Bax) play a key role in apoptosis inducing or inhibiting it. The majority of researchers believe that expression of Bcl−2 is not the prognostic factor of efficiency of chemotherapy at cancer of ovaries. However others suppose that stability of tumors to chemotherapy, starting apoptosis, is due to the high level of Bcl−2 production. Proliferative activity of the tumor can be assessed by the degree of Кі−67 expression. Correlation between the amount of cells, expressing Кі−67 and the degree of malignancy has been established. The tumors expressing Кі−67 in over 20 % of cells suggest a high risk of relapse. Expression of VEGF in malignant tumors combines with strengthening of its metastatic activity and shortening of progression−free survival. VEGF has been established to be present in tumors in 97 % of patients with ovarian cancer, in 56 % of patients the expression was estimated as expressed. There is direct correlation between frequency of VEGF expression and stage of disease (stage 1−2 −− 13.5 %, stage 3 −− 41.4 %). The publications about the clinical value of these markers for the patients with ovarian cancer are not numerous. Markers p53, Bcl−2, Ki−67 and VEGF play an important role in disease development and can influence the results of treatment and survival. Meantime complex study of markers of apoptosis, proliferation and angiogenesis has not been conducted yet, validating practical expediency and prospects of these works.
Key words: cancer of ovaries, molecular-biological markers, apoptosis, proliferation, angiogenesis.
Kharkiv National Medical University, Ukraine
The effectiveness of adjuvant chemoradiotherapy in patients with non−small−cell lung cancer
65 - 68
The purpose of the work was to study the effectiveness of various treatment options for stage 3A NSCLC using neoadjuvant and adjuvant chemotherapy and adjuvant radiotherapy. The study involved 89 stage 3A NSCLC patients treated at the thoracic department of Kharkov Regional Clinical Cancer Center from 2010 to 2014. The surveyed patients were divided into three groups. The first group (comparison) included 38 patients who received the following treatment: radical surgery followed by 4 cycles of adjuvant chemotherapy according to standard regimens. Patients of the second group (27 patients) received 2 cycles of preoperative chemotherapy before surgery and 3−4 weeks after the surgery they were conducted 4 courses of adjuvant chemotherapy. The third group consisted of 24 patients who underwent radical surgery followed by 2 cycles of chemotherapy and irradiation of the mediastinum on the linear accelerator VARIAN. One−year survival rate in group 1 was 57.2 %, in group 2 −− 75.3 %, in group 3 −− 81.2 %. Local recurrences in group 1 after one year of observation were found in 5 patients, in group 2 −− 2 patients, and in group 3 were not revealed. The two−year survival rate in group 1 was 47 %, in group 2 −− 66.1 %, in group 3 −− 73.8 %. Preoperative neoadjuvant chemotherapy gives partial effect less than in half of patients with NSCLC, thus its use is not always appropriate. Maximum 2−year survival of patients is observed after two cycles of chemotherapy after surgery and then radiotherapy. Radiotherapy allows reduction in the number of local recurrences.
Key words: stage 3A non-small cell lung cancer, polychemotherapy, surgery, radiotherapy, pathomorphism, complications, survival.
Kharkiv Medical Academy for Postgraduate Education, Ukraine
Prospects of mesenchymal stromal cells application in prevention and therapy for diabetic retinopathy
69 - 71
Diabetic retinopathy is the most common microvascular complication of diabetes mellitus and a leading cause of vision loss among people of working age, making a complex economic and social problem. In recent years, mesenchymal stromal cells are considered a new direction in regenerative medicine due to their multi−functionality and the ability to paracrine secretion of angiogenic factors, cytokines and immunomodulatory substances. The analysis of the literature suggests that the presence of immunomodulating properties, the ability to self−renewal and differentiation allow to consider mesenchymal stromal cells promising agents for prevention prophylaxis and treatment of diabetic retinopathy. The advantages of their therapeutic application may include the ability to migrate to the site of tissue damage, lower risk of side effects at infusion of allogeneic cells and absence of ethical issues related to the use of human embryonic cells.
Key words: diabetic retinopathy, placental mesenchymal stromal cells, type 2 diabetes mellitus.
Kharkiv National Medical University, Ukraine|Kharkiv Regional Clinical Hospital - Center of Emergency Medical Care and Disaster Medicine, Ukraine|Kharkiv City Hospital No. 13|Regional Clinical Hospital of Infectious Diseases, Kharkiv, Ukraine
Clinical analysis of fatal outcome due to influenza A (H1N1)pdm complicated by pneumonia caused by Klebsiella pneumoniae in the post−pandemic period during extracorporeal membrane oxygenation
72 - 77
The article describes a case of influenza A (H1N1) pdm in adult complicated by pneumonia possibly caused by hypervirulent strain of Klebsiella pneumoniae (hvKP) in the post−pandemic period, ECMO. The clinical data, instrumental and laboratory investigation, especially pathological changes were studied, the effectiveness of antibiotic therapy and ECMO was assessed. To assess the prospects for the survival of the patient Cox regression method was used. Influenza A (H1N1) pdm developed in a patient of middle age without underlying risk factors of death. Antibiotic therapy, administered in accordance with the protocol of providing clinical care, proved to be ineffective. Analysis of the probability of nosocomial pneumonia, including with the criteria of CPIS scale, was done. The authors suggest the development of community−acquired pneumonia against a background of influenza A (H1N1) pdm possibly caused by hypervirulent strain Klebsiella pneumoniae (hvKP). There is special anxiety about the resistance of the strain to carbapenems and linezolid. Differential diagnosis with nosocomial pneumonia and ARDS was considered. Pathologic changes in the lungs and other organs were examined. Pathogenetic model of destruction of the respiratory system in case of pneumonia caused by hypervirulent strain Klebsiella pneumoniae (hvKP) was suggested. The pathogenic properties of influenza A (H1N1) pdm virus in the post−pandemic period are responsible for severe course of the disease, including in the patients without underlying risk factors of death. The analysis of the clinical observation suggests that pneumonia complicating influenza could develop like сommunity−acquired pneumonia due to strain Klebsiella pneumoniae possibly by (hvKp) which is characterized by a high degree of resistance to antibiotics. There is special alarm about the resistance of the strain to carbapenems and linezolid. ECMO procedure does not allow to restore the basic functions of lung parenchyma fast enough.
Key words: influenza A (H1N1)pdm, fetal outcome, post-pandemic period, pneumonia, Klebsiella pneumoniae (hvKP), clinical analysis, pathogenetic model of pneumonia development, extracorporeal membrane oxygenation.
Kharkiv National Medical University, Ukraine
Pathogenetic role of infusion component in traumatic disease in geriatric patients
78 - 83
The aim of the work was to increase the effectiveness of treatment of critical condition in geriatric patients and improve their quality of life after discharge from the hospital on the example of traumatic disease by means of differentiated approach to the choice of the complex intensive therapy. A long complex clinical, instrumental and laboratory dynamic study of hemodynamic, biochemical parameters, as well as markers of endothelial dysfunction and apoptosis in was done in 92 geriatric patients with multiple injuries the time of admission and within the period from the 1st day to 1 year from the date of injury. The effectiveness of the proposed complex intensive therapy was assessed in a prospective, randomized, open comparative clinical study in 48 patients in the period 2011−2015. Given the lack of significant differences in the statistical analysis of hemodynamic parameters in patients of groups 1,2 and 3, administration of GEK 200/0.5 6 % from the date of admission makes it a drug of choice in geriatric patients in intensive care, providing effective endothelioprotection. Administration of monoinfusion with GEK 200/0.5 6 % reduced the number of complications in the late period of traumatic disease in elderly and old patients. Endothelial dysfunction in geriatric patients with polytrauma lasts a year or more from the date of injury; are natural and unidirectional, have periods of recession and recovery. The degree of damage, the consistency of compensatory possibilities and the ability to restore endothelial function in geriatric patients with multiple injuries depends on the type of infusion component in the complex intensive therapy.
Key words: geriatric patients, traumatic disease, pathogenesis, intensive therapy.
Kharkiv National Medical University, Ukraine
Correction of postoperative cognitive dysfunction in geriatric patients after surgery
84 - 87
The aim of the work was correction of postoperative cognitive dysfunction in geriatric patients after surgery. The study involved 96 elderly patients with surgical abdominal pathology undergoing urgent surgery under general anesthesia by thiopental sodium with mechanical ventilation. Patients in group 1 were treated according to the protocol, group 2 −− adding Tiocetam, group 3 −− Cytoflavin. After surgery, patients were transferred to the intensive care unit. The study was conducted in 6 stages: prior to surgery and on the 1st, 2nd, 5th, 12th and 30th day after it. Geriatric patients with acute surgical abdominal pathology had certain cognitive dysfunction, primarily determined by age in the preoperative period. Postoperatively, the state of cognitive functions was significantly affected by the duration of surgery and in the first two days − the intensity of stress reactions. The return of cognitive functions to baseline state occurred only 30 days after surgery. Tiocetam and Cytoflavin promote earlier restoration of cognitive functions, on day 5 after surgery; later the state of cognitive functions improves and on day 30 day significantly exceeds the initial level, with more pronounced effects of Cytoflavin due to the ability of these drugs to reduce the influence of stress reactions caused by duration and intensity of the operation on the state of cognitive functions.
Key words: geriatric patients, postoperative period, cognitive dysfunction.
Kharkiv National Medical University, Ukraine
The choice of drugs for analgesia in geriatric patients with polytrauma
88 - 91
The aim of the work was the search of effective drugs for postoperative analgesia in acute and early period of traumatic disease in geriatric patients for securing the most effective analgesia with the least negative clinical effects. The study involved 89 patients with multitrauma aged 66.16±3.81 with ISS 24.3±4.2, and severity of state by APACHE−II 15.2±4.4. The patients with brain injury were excluded. The common intensive care was done for all patients. The patients were divided into 3 statistically indistinguishable groups depending on the given analgesic. Group 1 (n = 28) was administered morphine (0.13±0.02 mg/kg every 46 hours), in group 2 (n = 30) nalbuphine (0.12±0.02 mg/kg every 46 hours), group 3 (n = 31) infulgan (1000 mg every 6 hours), if it was necessary nalbupfine was added. Intensity of pain by 100−point visual analog scale (VAS), daily dose of opiates, glycemia, cortisolemia, the concentration of IL−6, IL−8 were studied on admission, on day 1, 3, 7 and 14 day after surgery. On admission glycemia, cortisolemia, concentration of IL−6, IL−8 were in strong direct correlation with the level of ISS and APACHE−II (r ? 0.68±0.10), as well as the daily dose of opiates. The daily dose of morphine in group 1 decreased from 0.79±0.14 mg/kg on day 1 to 0.28±0.14 mg/kg on day 7, the dose of nalbuphine in group 2 −− from 0.87±0.15 to 0.32±0.10 mg/kg. On day 14 opiates were withdrawn. In group 3 the daily dose of nalbuphine decreased from 0.29±0.14 mg/kg on day 1 to 0.08±0.12 mg/kg on day 7, on day 14 opiates were withdrawn. Nalbuphine was required in group 3 in patients with maximal level by ISS and APACHE−II. The level of stress markers decreased in all groups, but in group 3 decreasing of levels of IL−6 and IL−8 were observed (from 14.91±4.51 and 92.3±21.7 pg/ml on day 1 to 8.21±1.35 and 70.2±16.1 pg/ml on day 14, respectively). In group 1 morphine side effects were observed, 16 patients had somnolence, 8 had nausea, 2 itching, 9 respiratory depression. Morphine, nalbuphine and infulgan have the same analgesic effectiveness postoperatively in elderly patients with multitrauma. At the same time morphine and nalbuphine do not eliminate the cause of pain, i. e. release of inflammatory mediators. Infulgan provides analgesia pathogenically by decreasing inflammatory mediator concentration in the blood.
Key words: pain syndrome, polytrauma, geriatric patients, morphine, Nalbuphine, Infulgan, interleukins.
Federal Research Center of Medical Preventive Technologies of Population Health Risk Management, Perm, Russian Federation|Acad. E. A. Wagner Perm State Medical University. Ministry of Health of Russian Federation, Perm, Russian Federation
Laboratory diagnosis of liver disease in persons working at exposure to chemical substances
92 - 96
The persons working in contact with chemicals may develop pathological process in the liver, irrespective of the nature of the substance and pathways in the body. The aim of this work was to evaluate the functional state of the liver as the main target organ exposed to industrial chemicals using laboratory parameters. Employees of oil and metallurgical industry, working in conditions of exposure to chemical factors, were investigated. Working conditions and occupational exposure were evaluated; chemical−toxicological diagnosis was made, specific markers of toxicant load were determined; epidemiological analysis was performed. The likelihood of early response of the liver to chemical exposure was assessed by disorders of polymorphism of genes responsible for detoxification of CPOX and enzymes CYP−450. The causal relationship between the adverse factors in the production process and the frequency of certain types of responses were investigated. The basic laboratory syndromes, reflecting the reaction of the liver in response to exposure to any chemical substance in the organism of the employee while in the working area even below the maximum allowable concentration were investigated: increased activity of oxidative processes; depletion of the functional status of the antioxidant protection system; imbalance of protein spectrum of blood serum with hypoalbuminemia; disturbance of lipid (hypercholesterolemia in combination with hypertriglyceridemia) and disorders of carbohydrate metabolism. Metabolic disorders of those working in conditions of exposure to chemical substances are formed on the genetic basis of disturbed polymorphism of genes responsible for detoxification (CPOX and CYP−450), which should be considered at formation of risk groups. The use of complex analysis of gene polymorphisms in the survey of workers exposed to chemicals can prevent the risk of developing pathology in workers most sensitive to the action of xenobiotics.
Key words: laboratory syndromes, xenobiotics, occupational hepatotoxins, individual sensitivity.
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