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№1' 2020


Kharkiv Medical Academy of Postgraduate Education, Ukraine
Current aspects of coronary heart disease diagnosis and treatment
5 - 10
Among the cardiovascular diseases associated with atherosclerosis, chronic coronary heart disease, including angina, is the most common form. It is the myocardium lesion that develops as a result of an imbalance between the coronary circulation and metabolic needs of heart muscle. The presence of angina symptoms often indicates a pronounced narrowing of one or more coronary arteries, but also occurs in non−obstructive arterial impairment and even in normal coronary arteries. Factors of functional damage to the coronary arteries are spasm, temporary platelet aggregation and intravascular thrombosis. Today there are opportunities not only to use the therapy with proven effectiveness, aimed at reducing the risk of complications, including fatal, but also to treat angina (ischemia), which improves the patient's life quality. The drug protocol includes the ones with a proven positive effect on this disease prognosis, which are mandatory if there are no direct contraindications to use, as well as a large group of antianginal or anti−ischemic drugs. The choice of a particular drug or its combinations with other drugs is carried out in accordance with generally accepted recommendations: taking into account the individual approach, the severity of angina, hemodynamic parameters (heart rate and blood pressure, presence of comorbid conditions). If drug therapy is ineffective, the option of coronary myocardial revascularization (percutaneous coronary angioplasty or coronary artery bypass grafting) is considered. Due to the high mortality and morbidity rates of coronary heart disease worldwide, one of the priorities of practical health care is the prevention of diseases caused by atherosclerosis.
Key words: coronary heart disease, angina, family physician, prognosis, drug therapy.
V. N. Karazin Kharkiv National University
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Multiple endocrine neoplasia in practice of primary care and family phyisicians
11 - 15
Multiple endocrine neoplasia is characterized with a predisposition to tumors involving two or more endocrine glands. The four main forms of the disease are inherited as an autosomal dominant syndrome or may occur sporadically. In addition to these four forms, six other syndromes are associated with the presence of multiple endocrine and other neoplasms of the organs: hyperparathyroidism − jaw tumors, Carney complex, von Hippel−Lindau disease, neurofibromatosis type 1, Cowden syndrome and McCune − Albright syndrome. The diagnosis of multiple endocrine neoplasia syndrome can be established in humans by one of the three available criteria: clinical features, family history, genetic analysis. Mutation analysis during these syndromes is useful in clinical practice to confirm the clinical diagnosis; identifying family members who tolerate the mutation and need to be screened, and identifying family members who do not tolerate the mutation. Syndrome of multiple endocrine neoplasia (Wermer syndrome) is characterized by the presence of a triad of tumors, including tumors of the parathyroid glands, pheochromocytoma and tumors of the parathyroid gland. It occurs less frequently in combination with Hirschsprung's disease, caused by the absence of vegetative ganglion cells in the intestine terminal parts, that leads to colonic enlargement, severe constipation and obstruction. This syndrome may be associated with cutaneous lichen amyloidosis, the clinical manifestations of which are pruritus and lichenoid lesions, usually located in the upper back. A clinical case of MEN2 syndrome in a 52−year−old patient is presented. It is noted that for such patients, in addition to timely syndromic rather than component diagnosis of this endocrine multipathology, the spread of neoplastic process in medullary thyroid cancer to its capsule and surrounding tissues, as well as the presence of metastases in peripheral lymph nodes are important. As a rule, such patients cannot be timely cured.
Key words: multiple endocrine neoplasia, endocrine tumors, genetic analysis, family history.
State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine
Changes in small intestine microflora in patients with acute intestinal obstruction
16 - 18
Among urgent surgical diseases of abdominal cavity, an acute intestinal obstruction is the most difficult to be diagnosed and treated. Leading factor, determining the development of pathophysiological processes is considered to be the progressive manifestations of enteric insufficiency syndrome, resulting in intestinal barrier impairment, negative changes in ecology of intestinal flora, increased endotoxins. To identify the small intestine microflora in acute intestinal obstruction and determine the role of dysbiotic disorders in clinical manifestations of main pathological process, a study was conducted in 60 patients with mechanical intestinal obstruction. The small intestine has a relatively rare microflora, consisting mainly of gram−positive facultative aerobic microorganisms, streptococci, lactobacilli. The distal ileum in nearly 30−55 % of healthy people contains scanty microflora, and yet the flora of this area differs from the microbial population of the higher gastrointestinal tract due to higher concentration of gram−negative bacteria. Optional−anaerobic coliform bacilli, anaerobic bifidobacteria and fusobacteria, bacteroids, the number of which starts exceeding the one of gram−positive species, are presented in significant quantities. Distal to the ileocecal valve there are significant changes in the microflora quantitative and species composition. Obligatory anaerobic bacteria become the predominant part of microflora, exceeding the number of aerobic and facultative anaerobic bacteria. The bacterial flora in different parts of gastrointestinal tract has its own specifics and is quite constant, as a result of the interaction of many factors, regulating the bacterial population in small intestine. The most important among them are: acidity of gastric juice, normal peristaltic activity of the intestine, bacterial interactions and immune mechanisms. Disorders of the intestine motor and evacuation function with its obstruction lead to slow passage of the chyme and contamination of the upper gastrointestinal tract with new types of microbes. There is a syndrome of small intestine excessive colonization, which means an increased concentration of bacterial populations in it, similar in species composition to the colon microflora. Pathological intra−intestinal contents become a source of endogenous infection and re−infection of the patient, leads to internal digestive disorders, which is manifested by syndrome of malabsorption of proteins, carbohydrates and vitamins.
Key words: acute intestinal obstruction, small intestinal microflora, conditionally pathogenic microorganisms, intestinal biocenosis.
State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv
Communal Healthcare Institution "O. I. Meshchaninov, Kharkiv City Clinical Hospital of Emergency and Urgent Clinical Care", Ukraine
Possibilities of immunology studies in estimation of validity of burn wounds for skin plasticity
19 - 24
Immunological features of burn disease largely reflect the state of general and local changes caused by the action of thermal factors. They are fundamental in formation of physiological repair of damaged tissue and disorders of the local immune system, lead to disruption of protective mechanisms with increased risk of occurrence and progression of local and systemic complications. It is the period of burn shock that is one of the main ones in the course and consequences of burn disease. In patients, the burn septicemia period even starting from the third day is characterized by severe immune changes, frequent generalization of inflammation and infection. Since one of the main tasks in treatment of patients with thermal trauma is the earliest possible recovery of lost skin, which consists in early surgical treatment (excision of necrotized tissues followed by simultaneous or delayed autodermoplasty), it is necessary to take into account metabolic disorders and changes in immune reactivity, affecting reparation of damaged tissues. To study the main immunological parameters in treatment of skin burn defects and their impact on the results of skin grafting, 17 patients with deep burns were examined. The main indices of metabolic status and immune reactivity in t surgical treatment of skin lesions, namely, innate immunity, humoral and cell components of immunity, metabolism (phagocytic activity of neutrophils, oxygen−dependent metabolism of neutrophils, concentration of peptides) differentiation clusters CD22 +, CD25 +, HLA−DR +) were examined. It is established that the corresponding changes in the indices can be the markers to predict the results of skin grafting. In this research it was found that with an unfavorable result of autodermoplasty in the patients with deep burns significant changes in immune reactivity and metabolic disorders were revealed. Altered immune reactivity due to increased circulating immune complexes and medium molecular weight peptides that provide opsonization and elimination of cytotoxic antigens in patients with deep burns may affect the results of skin grafting in surgical treatment of skin defects.
Key words: burns, immune reactivity, dermatoplasty, metabolic state, autological skin transplantation.
State Institution "V. T. Zaitsev Institute of General and Emergency Surgery of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine
Choice of surgery tactics in patients with high risk of anastomotic leak development
25 - 28
Intestinal resection is one of the most common surgeries performed on urgent indications, the most difficult is the decision in favor of the formation of primary anastomosis in the case of primary infection of abdominal cavity, multiple defects of the intestinal wall, as well as the general serious condition of a patient. In order to improve the methods of diagnosis and prevention of post−surgery complications, as well as personification of surgical tactics of treatment in the patients undergoing anastomotic surgeries in intestine, the results of treatment of 96 patients were analyzed. The level of serum cryoglobulins was determined by the method of A. E. Kalovidoris with modifications. The results of surgical treatment were evaluated according to the classification of D. Dindo et al. (2004). The use of cryoglobulin levels before surgery can significantly affect surgical tactics: at a low degree it is possible to perform resection of a segment of small intestine with the formation of primary small intestinal anastomoses; at average − it is possible to perform small−intestinal anastomoses with unloading intestinal stoma or with the location of the anastomosis extraperitoneally (if possible) and decompression of the anastomosis with an incubation probe; at high − it is expedient to supplement performance of an anastomosis with a variant of an enterostomy or "delayed" anastomoses, at a severe general condition of patients it is expedient to form final small intestinal stoma. Determining the level of cryoglobulinemia as a marker of the prognosis of failure of the sutures of intestinal anastomoses and the use of differentiated surgical tactics depending on the level of this index contributes to a significant improvement in direct results of surgical treatment of the patients undergoing resection of small intestine segments. The proposed tactics virtually eliminate the implementation of multi−stage surgical interventions and helps to reduce the duration of treatment of patients, reduce the level of post−surgery complications and mortality.
Key words: cryoglobulinemia, surgical treatment, small intestine, anastomoses.
Kharkiv National Medical University, Ukraine
Features of hemostasis system in women with thrombophilia as one of causal factors for unsuccessful attempts in extracorporeal fertilization
29 - 32
Excessive activation of blood coagulation, imbalance in coagulation potential, presence of endotheliopathies, local hemorrhages and microthrombi in the area of blastocyst invasion may be common in the mechanism of implantation losses in thrombophilia. One of the ways to optimize the results of extracorporeal fertilization is the prevention of thrombotic complications. Despite the achievements of modern morphology, some issues concerning the pathogenesis of infertility and habitual miscarriage remain poorly understood. To assess the system of hemostasis in women with thrombophilia as one of the causative factors of unsuccessful attempts in extracorporeal fertilization, a study of 63 patients was conducted, which included hormonal, genetic studies, HLA−typing, ultrasonography, hysterosalpingography, determination of infectious profile and was performed depending on clinical situation. The study of the hemostasis system included the determination of total coagulation potential, analysis of primary hemostasis, fibrinolytic system, the state of intravascular hemocoagulation and antiplasmin potential of blood. The state of intravascular hemocoagulation was assessed by the concentration in blood plasma of pathological hemocoagulants, i.e. soluble complexes of fibrin monomers and fibrinogen−fibrin degradation products. The results of the study showed that in women with a thrombophilia history and unsuccessful attempts in extracorporeal fertilization, there is a pathological activation of the hemostasis system, which plays a significant role in the pathogenesis of unsuccessful fertilization attempts. In thrombophilia, a subclinical form of chronic disseminated intravascular coagulation develops, the leading link in the development of which is the activation of platelet−vascular hemostasis with subsequent involvement into the process of coagulation potential due to a decrease in the anticoagulant blood system.
Key words: thrombophilia, hemostasis system, extracorporeal fertilization, infertility.
SO "Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine
Immune checkpoint blockade in breast cancer therapy
33 - 38
Despite advances in early detection and treatment, breast cancer remains the deadliest oncopathology for women worldwide. Today there is an urgent need for new approaches to this disease treatment. Recently, immune therapy, especially inhibitors of immune checkpoints, has taken the lead when fighting against cancer. Blocking immune checkpoints is an effective approach to enhance the effector T cell function. Immune checkpoint blockers, namely inhibitors of cytotoxic T−lymphocyte−associated antigen 4 (CTLA−4), programmed cell death protein 1 (PD−1) and ligand 1 of programmed cell death protein 1 (PD−L1) are approved by the US Food and Drug Association (FDA) to be used in various solid tumors, refractory cancers with microsatellite instability, classical Hodgkin's lymphoma. In March 2019, the first inhibitor for the treatment of breast cancer was approved, i.e. atezolizumab (anti−PD−L1) in combination with nab−paclitaxel in the patients with metastatic triple−negative breast cancer, which aroused the interest of experts in the study of immunotherapeutic agents for the treatment of these patients. The review presents the results of using the inhibitors of immune control points in monotherapy and in combination with standard methods of antitumor treatment (chemotherapy and radiotherapy, targeted therapy) in patients with breast cancer. Information on potential biomarkers of response to immunotherapy in breast cancer is presented.
Key words: breast cancer, checkpoint inhibitors, biomarkers of response.
Kharkiv Medical Academy of Postgraduate Education
Communal Non&minus
Profit Institution Regional Center of Oncology, Kharkiv
Eva Medical Center, Kharkiv, Ukraine
Cyclin−dependent kinases 4/6 inhibitors in combination with aromatase inhibitors in treatment of metastatic breast cancer (clinical observation)
39 - 41
It is known that a complete recovery in patients with generalized tumor is impossible, but the use of effective treatment regimens can significantly inhibit the development of the disease. The main goal of treatment of metastatic breast cancer is to increase overall survival, time to disease progression, improvethe quality of life, to prevent serious complications. In recent years, the standard of first−line hormone therapy in postmenopausal patients has been the use of aromatase inhibitors. Recently, a new class of drugs has emerged that can increase the effectiveness of hormone therapy, which significantly strengthens the position of this method in metastatic breast cancer. A clinical trial of PALOMA−2 and its findings are presented: the palbociclib + letrozole protocol as first−line therapy in postmenopausal patients with estrogen−positive Her2 new negative advanced breast cancer improves the objective response rate and clinical efficacy compared to letrozole monotherapy. The overall incidence of adverse responses was higher in patients treated with palbociclib + letrozole compared with placebo + letrozole. This clinical case demonstrates the possibility of long−term effective disease control in metastatic breast cancer. Literature data and personal experience show high efficacy of the combined protocol of hormone therapy and inhibitors of cyclin−dependent kinases 4/6. The use of such protocols is advisable in patients with multiple bone metastases, while achieving an effective reduction of pain. The use of such regimens is possible in patients with a low ECOG score who cannot tolerate chemotherapy with more severe toxicity.
Key words: metastatic breast cancer, aromatase inhibitors, palbociclib.
Kharkiv Medical Academy of Postgraduate Education
V. N. Karazin Kharkiv National University, Ukraine
Analysis of clinical and anamnestic parameters in children with epilepsy of different age groups
42 - 47
According to epidemiological studies, it has been determined that from 0,5 to 1,0 % of children have epilepsy. As well it is considered as one of the most common chronic neurological diseases of childhood. Epilepsy is a multi−etiological disease, the clinical course of which is characterized by spontaneous uncontrolled functional disorders arising from hypersynchronous electrical discharges in the cerebral cortex. This study was aimed to investigate the features of clinical manifestations and anamnestic data in children of different ages, suffering from different epilepsy forms. We examined 1,017 patients aged from 3 months to 17 years. All patients were assessed for somatic and neurological status, electroencephalography, magnetic resonance imaging of the brain, if necessary the laboratory tests and consulting other specialists were performed. The analysis of findings shows that the most common is symptomatic epilepsy compared to idiopathic and cryptogenic. The prevalence of idiopathic epilepsy increases in early school age and enhances as much as possible in adolescence. In patients with cryptogenic epilepsy, forms with focal onset, generalized and unclassified seizures were identified. Cryptogenic epilepsy was mostly diagnosed in children under 10 years, likely indicating a disruption of physiological connections and morphofunctional immaturity. The symptomatic epilepsy according to the localization of focal disorders was divided into: temporal, frontal, parietal, occipital and multifocal. The major symptoms of epilepsy are observed in primary school and adolescence. In preschool age, the most common is frontal localization of the focus, parietal ; in primary school − temporal, occipital and parietal, in early − multifocal. Etiological factors of symptomatic epilepsy include the CNS congenital malformations, CNS perinatal lesions, traumatic brain injury, neuroinfections etc. Thus, due to the findings we determined the etiological and trigger factors that led to the development of pathological conditions, including epilepsy.
Key words: children, epilepsy, clinic, medical history, etiologic and trigger factors.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Degenerative disc disease in young people. Medical imaging techniques
48 - 52
Degenerative changes of intervertebral discs is a very complicated process as a result of interaction of many factors: genetic, environmental, physical activity. Abnormalities in the vertebrae structure create the preconditions for the overload of the vertebral motor segment, which contributes to the spread of degenerative lesions and increases the risk of spinal injuries. Degenerative disc disease is one of the most common causes of back pain. The process of degeneration begins at a young age and in adulthood it often becomes widespread with a predominance of one or another localization. Methods of medical imaging occupy an important place in diagnosis of musculoskeletal pathologies. Radiography assesses the changes only in bone structures, but does not allow the visualization of soft tissues, which include not only the ligaments of the vertebral motor segment, but also the intervertebral discs. Magnetic resonance imaging is the most effective method for diagnosing degenerative changes in intervertebral discs. Possibilities of ultrasound examination in the diagnosis of early stage degenerative disc disease have not been studied enough. There were examined 147 patients aged 18−27 years with clinical and neurological signs of degenerative disease of cervical and lumbar spinal discs. Ultrasonic semiotics showed changes within the pulpal nucleus as an increased echogenicity and displacement back towards the fibrous ring, fibrous ring thinning, which indicated the disc protrusion. In patients with pain in neck and lower back, fragmentary imaging of the fibrous ring and prolapse of the disc contents into the lumen of spinal canal, indicating the development of hernias was found. The presence of herniated discs of cervical and lumbar spine in all cases coincided with the results of magnetic resonance imaging, and protrusion did in 91,4 % of cases. Thus, among medical imaging the ultrasonography is the most accessible and informative method for diagnosing degenerative changes in intervertebral discs of cervical and lumbar spine.
Key words: degenerative disc disease, ultrasonography, cervical and lumbar intervertebral discs.
Kharkiv National Medical University, Ukraine
Features of psycho−emotional disorders in young patients suffering from chronic radiculopathies of vertebrogenic genesis
52 - 55
According to current notions, the development of neuropathic pain includes the mechanisms of peripheral and central sensitization, the emergence of a generator of pathologically enhanced excitation, pathological illogical system, on the basis of which a specific clinical form of pain is formed. The neuropathic nature of pain is observed in 30−40 % of the patients suffering from back pain. In order to study the psycho−emotional disorders in relation to the duration of chronic pain in young people suffering from the vertebrogenic lumbosacral radiculopathy, 97 people were examined. To estimate pain syndrome a visual−analog scale and DN4 questionnaire was used, for reactive and personal anxiety level we involved the Spielberger − Khanin test, the Beck's inventory was applied for the depression level, MFI−20 for objectification of asthenic manifestations was utilized. Complaints of the patients were divided into specific (nociceptive and neuropathic pain syndrome) and nonspecific. Non−specific complaints in the examined patients included disorders of the emotional sphere, which had the following structure: asthenic, anxiety, depressive and their combinations, as well as the presence of somatoform symptoms, which was confirmed by neuropsychological testing. In the analysis of the dependence of frequency and severity of emotional disorders on the duration of chronic pain, the patterns were found to increase the frequency of all emotional dysfunctions, reduce the severity of anxiety and increase depression with the same severity of asthenic ones. According to the results of this study, the following conclusions were made: the severity of anxiety disorders decreases with increasing duration of the disease, and the depressive disorders increase. The severity of asthenic syndrome did not differ significantly in this category of patients with any duration of chronic pain.
Key words: chronic vertebrogenic lumbosacral radiculopathies, asthenic, anxious, depressive disorders, young patients.
Petro Mohyla Black Sea National University, Mykolaiv, Ukraine
Kharkiv National Medical University, Ukraine
Concept of information processes organization in human visual system
56 - 60
Recent studies have shown that both traditional and modern (electronic) visual media significantly affect the processes occurring in the visual system of children and adolescents, iin the development of which the concept of controlled and uncontrolled elements is used. When studying the adaptation of the visual system to a visual load, ensuring the uptake, transmission and processing of visual information, its structural and functional organization is taken into account. The proposed summarized scheme of information processes in the visual system takes into account and significantly supplements the main provisions of the object−oriented model of selective visual attention, based on current methods of intelligent data processing. The results of the study indicate the complexity of the visual information transformation path from a visual stimulus to the creation and awareness of the image, occurring in the higher parts of the brain. The whole apparatus of encoding, transmitting, processing and perceiving visual information is useless if the guidance and focusing unit does not provide a clear and undistorted image of the objects of the outside world on the retina. In case of any malfunctions of the first unit or in the presence of defects in the visual system, the processes of finding compensation for this condition and modes of operation are started, which allows to obtain the most complete and high−quality perception of visual objects. These processes can lead to the formation of a visual system with sufficiently high visual functions or monocular one, if the compensation of existing problems will have a high "price". With the help of the proposed concept of organization of information processes in the visual system it is possible to assess the role of each of its considered blocks not only in the perception of visual information, but also the formation of this system in children and adolescents.
Key words: visual system, information processes, visual information.
Municipal Non&minus
Profit Enterprise of the Kharkiv Regional Council "Regional Clinical Hospital", Kharkiv, Ukraine
Use of combined nucleotide drug in treatment of ophthalmic manifestations of Sjogren’s disease
61 - 63
Ophthalmic lesions in Sjogren's disease are among the most pronounced, they significantly complicate the patient's life. Along with Sjogren's disease, there is the so−called Sjogren's syndrome, which is a similar lesion of the salivary and lacrimal glands, which develops in 5−25 % of the patients with systemic connective tissue diseases and in 50−75 % with chronic autoimmune diseases. The main sign of damage to the lacrimal glands is the development of dry keratoconjunctivitis, which in severe cases can lead to complications in the form of corneal ulcers, up to the threat of perforation. The study of the effectiveness of various drugs in the treatment of symptomatic therapy showed that the problem of achieving a lasting effect of correction of ophthalmic manifestations has not been currently solved. In order to study the effectiveness of the drug "Encad−Biolik®" (Kharkiv, Ukraine) to stimulate the reparative processes of the cornea as part of the complex therapy of Sjogren's disease were examined 15 patients (30 eyes) who received the drug "Encad−Biolik®" in the form of intramuscular injections and bath phonophoresis. The duration of treatment was 8.0 days, the time of complete epithelialization of the cornea made 7.4 days. In the eyes of two patients who had corneal ulcers, the process was stopped, resulting in a slight cloud−like turbidity. The results of the study demonstrate that the use of the drug "Encad−Biolik®" in the patients with Sjogren's disease was not accompanied by side effects and reduced the duration of corneal epithelialization, duration of treatment, and improved structural results in corneal healing.
Key words: Sjogren's disease, "Encad-Biolik®", cornea, epithelialization.
V. N. Karazin Kharkiv National University, Ukraine
Analysis of expediency to use platelet−enriched plasma for treatment of androgenetic alopecia
64 - 67
A detailed analysis of the published data on the use of platelet−enriched plasma for the treatment of androgenetic alopecia has been performed. Based on the results, it has been suggested that platelet−rich plasma may be considered as a new treatment for pathological hair−related conditions, including androgenetic alopecia. Information on platelet morphology, characteristics of biologically active substances released from activated platelets have been provided. It has been substantiated that platelets play a crucial role in hemostasis and tissue regeneration by stimulating the cell chemotaxis, proliferation, differentiation, angiogenesis and deposition of the extracellular matrix. Among the many active components of platelets involved into the recovery of damaged tissue, the growth factors have been particularly noted. The influence of growth factors on the regulation of hair growth cycles has been established. Based on the analysis of their biological effects, the diversity of their action in the regulation of hair growth has been emphasized. Characteristic features of some growth factors, insulin−like growth factor (IGF), have been determined and described, their role in damaged tissue repair, angiogenesis, proliferation and cell differentiation has been noted. The practical experience of application of platelet−enriched plasma in various branches of medicine is summarized, proposals concerning the use of this method as a new way of treatment of androgenetic alopecia have been provided. The question of standardization of this method, study and substantiation of differentiated use of platelet−enriched plasma depending on the stage of androgenetic alopecia in men and women remains debatable.
Key words: androgenetic alopecia, platelet-enriched plasma, platelets, growth factors.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
V. N. Karazin Kharkiv National University, Ukraine
Influence of genotypic variability of M. Tuberculosis on the course of tuberculosis with multiple drug resistance
68 - 71
Tuberculosis is infectious and socially dependent disease, being now one of the most pressing issues in practical health care. As well the usual types of tuberculosis infection, chemoresistant tuberculosis is spreading rapidly in the world. The WHO estimates that about 500,000 people on the planet are infected with M. tuberculosis, which is resistant to standard anti−tuberculosis drugs. The probability of successful treatment decreases with emergence of new genotypes of M. tuberculosis with total resistance. In the modern epidemiology of tuberculosis, it is important to identify genotypes on certain signs, allowing to address issues such as their origin, identification of the infection source, possible routes and factors of transmission, as well as to reveal cases and spread of resistance to anti−tuberculosis drugs. To evaluate the therapy efficiency of multidrug−resistant tuberculosis patients with revealed genotypic variability during treatment, 10 patients with chemoresistant pulmonary tuberculosis having M. tuberculosis genotypic variability were treated. In these patients, the clinical, laboratory and radiological dynamics of disease in intensive phase of treatment were studied. Analysis of treatment results for patients with chemoresistant tuberculosis with genotypic variability of M. tuberculosis was evaluated by the intoxication syndrome dynamics of, the timing of closure of the decay cavities and cessation of bacterial excretion. The study found that the genotypic variability of M. tuberculosis is characterized by the change of less virulent genotypes of M. tuberculosis to more virulent. Signs of intoxication have been shown to change from less virulent M. tuberculosis genotypes to M. tuberculosis Beijing genotypes. Genotypic variability of mycobacteria in hospital suggests that hospitalization in tuberculosis facilities is a risk of exogenous tuberculosis superinfection. Studying the influence of genotypic variability of M. tuberculosis on the course of multidrug−resistant tuberculosis requires more extensive research, being a very relevant and promising area in phthisiology.
Key words: Mycobacterium tuberculosis, genotypic variability, VNTR-genotyping, treatment.
State Institution "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine", Dnipro
Bogomolets Institute of Physiology, National Academy of Sciences of Ukraine, Kyiv, Ukraine
MicroRNA−122 as a biological marker of chronic viral hepatitis C
72 - 75
New epigenetic markers are being studied in various countries around the world to diagnose, predict, and treat the patients with chronic viral hepatitis C. Epigenetics is currently studying the hereditary changes in gene expression or phenotype that are not related to the changes in DNA sequence. One field of epigenetics is the expression of RNA that does not encode a protein, namely miRNA, which is a molecule 18−22 nucleotides in length that plays a crucial role in regulating gene expression. Circulating miRNAs are a new genetic material that can be isolated from a patient's blood. The expression level of a particular miRNA has different biological and clinical effects. By means of its determination in various miRNAs it is possible to predict development of diseases. In order to study the baseline expression of miRNA−122 in patients with chronic viral hepatitis C with the first HCV genotype, 74 patients were examined. Diagnosis and monitoring of the patients was performed according to the local protocols and bioethical standards. The level of miRNA−122 expression in patients with chronic viral hepatitis C with the first HCV genotype was established by reverse transcription. Studies show that the level of miRNA−122 expression in the patients with HCV and healthy individuals showed significant variability. The obtained data indicate that the expression level of miRNA−122 in patients is 29 times higher than in healthy individuals at p = 0.0001 (U; Z). This can be an additional biomarker as an index of the presence of chronic viral hepatitis C and can be further used in practice. Therefore, the high level of miRNA−122 expression in subjects (≥ 8.771 rel. units (Log10 miR−122 ≥ 0.939 rel. units)) may be the basis for further screening of patients for HCV infection. The prospects of using this index, which will allow to personalize the diagnosis and treatment tactics for patients, that, in turn, will contribute to the implementation of the WHO global strategy for the elimination of viral hepatitis.
Key words: chronic viral hepatitis C, miRNA-122, elimination of viral hepatitis, biological marker.
V. N. Karazin Kharkiv National University
Municipal Non&minus
Profit Enterprise of the Kharkiv Regional Council "Regional Clinical Infectious Diseases Hospital", Kharkiv, Ukraine
Ways to solve the problem of prevention and main rehabilitation measures in toxoplasmosis in Ukraine
76 - 82
One of the most pressing health problems worldwide is the fight against such common and socially significant parasites as toxoplasmosis. Epidemiology, prevention and rehabilitation of patients require careful study, as this invasion can lead to termination of pregnancy, stillbirth or birth of children with abnormalities of the central nervous system and visual organ, as toxoplasmosis chorioretinitis can result in complete loss of vision. It is known that congenital toxoplasmosis can be detected in decades by multifocal lesions of the central nervous system, auditory analyzer. Toxoplasmosis is characterized by polymorphism of clinical manifestations, which complicates the diagnosis of this disease; so far there are no specific methods of its prevention and rehabilitation programs. The causative agents of many parasitosis are potential biological threats, a number of these diseases, including toxoplasmosis, are associated with many immunodeficiency conditions, including HIV. The research aim was to improve the monitoring, regulation and improvement of the parasitological situation regarding toxoplasmosis in Ukraine by introducing a system of preventive measures against this invasion; development and use in the practice of medical institutions of methods of rehabilitation of patients with various forms of toxoplasmosis. Recommendations have been given to women on the prevention of congenital toxoplasmosis when planning a pregnancy. The need to improve the monitoring system and main ways to solve problems in diagnosis, prevention and rehabilitation of patients with toxoplasmosis, especially for the population at high risk has been demonstrated. The priority tasks are the development of leading parasitologists of Ukraine methodological recommendations, protocols and algorithms of actions for diagnosis, treatment, prevention and rehabilitation of patients with toxoplasmosis, the creation of appropriate regional centers, establishing a comprehensive national program to combat toxoplasmosis.
Key words: toxoplasmosis, parasitosis, prophylaxis, rehabilitation.
Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine, Dnipro, Ukraine
Clinical parallels in infectious diseases of the central nervous system in patients with HIV
83 - 87
A retrospective analysis of medical records of 451 patients with HIV infection showed that the most common clinical manifestations of cerebral tuberculosis are as follows: headache, fever ≥ 38.0 °C, meningeal symptoms; in toxoplasmosis encephalitis these are headache, paresis of cranial nerves and extremities, incoordination, cognitive disorders, dysarthria, fever ≥ 38.0 °C and convulsions; in mycotic lesions of the CNS they are headache, coordination disorders, positive meningeal symptoms, disturbances of consciousness, cognitive disorders, visual disorders, cranial nerve deficiency, convulsions and dysarthria. The clinical picture of bacterial (exacted) meningitis was dominated by positive meningeal symptoms, headache, fever, impaired consciousness. At the same time, in such neurological manifestations of central nervous system lesions as cranial nerve paresis, mono− and hemiparesis, visual, coordination and speech disorders, which mostly accompany cerebral toxoplasmosis, cerebrovascular diseases, brain tumors, encephalitis of unspecified etiology. Thus, the analysis suggests that the clinical manifestations of various etiologies of lesions of the central nervous system are often nonspecific and probably are stipulated with common morphological changes in brain tissue, which may be associated with the neuropathological effects of HIV, as well as a large impact co−infection.
Key words: HIV infection, opportunistic infections, central nervous system, main symptoms.
Kharkiv Medical Academy of Postgraduate Education
V. N. Karazin Kharkiv National University, Ukraine
Life quality of patients with newly diagnosed pulmonary tuberculosis when using alcohol
88 - 92
Interest to the studies of life quality by scientists and practitioners is constantly growing, as this unique approach allows to fundamentally change the traditional view of the problem of the disease and the patient. By investigating the quality of life as an integral index of the patient's condition, it is possible to assess the complex impact of the disease on the patient's life, to compare the effectiveness of various interventions, to predict the disease course. However, the problem of assessing the quality of life in patients with tuberculosis under conditions of alcohol consumption remains poorly understood. To establish the level of quality of life in patients, 102 men with newly diagnosed tuberculosis, with preserved sensitivity to anti−tuberculosis drugs were examined. The AUDIT test was used to assess their alcohol consumption, and the MOS SF−36 questionnaire was used to analyze the quality of life parameters. The study also assessed quality of life parameters and alcohol consumption in groups with varying prevalence of tuberculosis and the presence of mycobacteria or no bacterial excretion. According to the findings, the following conclusions can be drawn: pulmonary tuberculosis leads to a decrease in quality of life with the greatest depression in the group of patients who abuse alcohol; quality of life indices are significantly lower in patients with advanced tuberculosis and bacterial excretion, while the level of alcohol consumption in these groups is significantly higher than in patients with localized forms and lack of bacterial excretion. Interestingly, when interviewing patients, none of them rated their health as "excellent", answering the first question of the SF−36 questionnaire, and 100 % of respondents to question 11 answered "definitely not" to the statement "I expect my health to deteriorate". The obtained research data on the parameters of quality of life in patients with tuberculosis can be used to achieve the highest effectiveness of therapy and targeted psychosocial rehabilitation.
Key words: tuberculosis, alcohol, quality of life, bacterial excretion.
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