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№3' 2015


M. Gorky Donetsk National Medical University, Ukraine
The role of microelementosis in pathogenesis of respiratory disorders at chronic rheumatic heart disease
5 - 8
The purpose of the work was to evaluate the clinical pathogenic significance of blood cardioprotective (Cu, Zn) and cardiotoxic (Cd, Co, Pb) trace elements (TE) in patients with chronic rheumatic heart disease (CRHD) depending on the changes in ventilating, moisture production, diffusing, conditioning and surfactant lung functions. The study involved 105 patients with CRHD (28 % men and 72 % women) aged from 15 to 60. Blood serum TE content was studied by atomic absorption spectrometry with electrographite atomizer (SolAAr−Mk2−MOZe, UK). Echocardiography, spirography, body pneumography, pneumothermocalorimetry, respiratory moisture production rate and physical−chemical properties of expirates were performed. Significant Cd increase in blood by 9 % with decrease in Cu by 10 %, Zn by 5 % and Pb by 54 % were observed in CRHD that was recorded in 6 %, 22 %, 25 % and 54 % of the patients respectively. Microelementosis participates in pathogenic formation of CRHD that determines formation of pulmonary artery pressure (Co) and pulmonary vascular resistance (Cu, Pb). Development of pulmonary hypertension, enlargement of the right heart ventricle, disorders of moisture production, diffusion, conditioning and surfactantgenous lung function were associated with imbalance of Cd, Co, Cu, Pb and Zn in the blood, the parameters of which change in case of pressure increase in pulmonary circulation. The end−diastolic increase of the right heart ventricle size was accompanied by inhibition of Cu and Zn concentrations at increase of Co content. In the pathogenesis of various respiratory dysfunctions at CRHD the role of each TE has its own characteristics; the levels of cupremia and zinkemia have prognostic significance in relation to progression of pulmonary hypertension and changes of diffusing lungs capacity.
Key words: rheumatism, heart, defects, lungs, trace elements.
Kharkiv Regional Perinatal Center, Ukraine|Kharkiv National Medical University, Ukraine
Efficiency of treatment for polycystic ovary syndrome using operative laparoscopy
9 - 12
In order to determine the efficiency of treatment of polycystic ovary syndrome (PCOS) by operative laparoscopy, clinical statistical analysis of outcomes of 60 operations for ovarian wedge resection in patients with this pathology was performed. The first group included 30 patients (50.0 %) with PCOS who were not identified concomitant gynecological and extragenital pathology, or it was completely eliminated. The second group included 30 patients (50.0 %) with PCOS whose manifestations of concomitant genital and extragenital pathology in varying degrees persisted at the time of the operation or appeared soon after it. The study found that efficiency of treatment using surgical laparoscopy normalized the content of sex and gonadotropin−releasing hormone in the blood plasma, most completely if correction of existing genital and extra−genital disorders was done in the preoperative period. In addition, it is appropriate to include hormonal correction of disorders of leading pathogenetic link of the polycystic ovary syndrome: hyperprolactinemia, hyperandrogenism, insulin resistance. Half of all pregnancies developed after ovulation stimulation occurred in the first 6 months after the surgery. After 24 months the possibility of spontaneous pregnancy becomes extremely low.
Key words: polycystic ovary syndrome, operative laparoscopy, treatment.
V. N. Karasin Kharkiv National University, Ukraine
Surgical tactics and methods of surgical management of complicated diabetic foot
13 - 15
A steady increase in the incidence of diabetes mellitus (DM) has been observed recently. According to the WHO, in 2025 the number of patients will reach 334 million that is 6.3 % of the world population. According to the Ministry of Health, 1.2 million DM patients were registered in Ukraine at the beginning of 2011. At present the questions of timing radical surgery on the foot, the boundaries of amputations and methods for their completion has not been solved. The aim of the work was improving the results of surgical treatment of patients with diabetic foot syndrome by improving the techniques of surgery as well as decrease in the proportion of high amputations and prevention of post−operative complications. The study involved 260 patients with DFS and necrotic processes of the lower extremities. neuropathic form was verified in 161 (62 %) patients, ischemic in 59 (22.7 %), and mixed in 40 (15.3 %). Type II diabetes prevailed (223 patients (86 %), type I diabetes was present in 37 (14 %). Purulent involvement of the soft tissue was diagnosed in 116 patients (44.6 %). 34 patients had local purulent−destructive process. 82 patients (70.6 %) had foot phlegmon. With combination of passive and active drainage infectious complications of surgical wounds were not observed. Four patients with osteomyelitic destructions of the distal foot parts (11.1 %) developed partial eruption of sutures. Mortality rate in patients with bone destruction feet made 6.25 % (9 patients). All lower limb amputations were performed at the level of the tibia 33 (12.7 % of the total number of operated patients). Overall mortality was 8 % (21 patients). In order to improve the effectiveness of surgical treatment of complicated DFS, surgery should be performed as an urgent procedure, under general anesthesia, with obligatory prior complex of diagnostic procedures, an individual approach is required in each case. The use of adequate surgical treatment of soft tissue, bone structures, removable skin−fascia−muscle sutures, combination of active and passive wound drainage, the use of liquid and ointment antiseptics reduces the number of postoperative infectious complications to 11.8 and mortality to 8 %.
Key words: diabetic foot syndrome, complicated forms, surgical treatment.
Kharkiv National Medical University, Ukraine
Etiopathogenetic aspects of genital prolapse in perimenopausal period
16 - 20
Perimenopausal disorders in women with genital prolapse and stress incontinence of urine acquire urgency in the recent years due to their social, economic and psychological significance. In spite of the common opinion about the role of estrogen deficiency in development of dystrophic and atrophic processes of the structures of urinary and genital tract, further investigation of etiologic factors of genital prolapse and stress incontinence is required. The purpose of the research was the study of etiopatogenetic aspects of genital prolapse in perimenopausal women by way of clinical data and history investigation in women with urogenital disorders for determination of perspective directions of prevention and treatment. 15 women with genital prolapse and stress incontinence of urine in a perimenopausal period are investigated. 11 (73.3 %) women were in menopause; 2 (13.3 %) menstruated, 2 (13.3 %) were in postmenopause. The etiopatogenetic features of perimenopausal disorders with genital prolapse and stress incontinence were age of the patients, parity, different obstetric−gynecological complications and diseases, surplus weight, vascular pathology associated with dysplasia of connecting tissues. Further research will allow to open new directions in diagnosis, correction and prevention of the given pathology.
Key words: urogenital disorders, etiopathogenetic aspects, genital prolapse.
S. P. Grigoriev Institute for Medical Radiology, Ukraine
Ways of improving the results of treatment of advanced forms of ovarian cancer
21 - 25
Ovarian cancer (OC) takes the4th place in the structure of oncological diseases of the female reproductive system. One−year survival of ovarian cancer patients is 63 %, three year −− 41 %, five−year −− 35 %. In Ukraine the incidence of ovarian cancer is 16.4 per 100,000 population and death rate is 9.8 per 100 000 population. At present the questions about the optimal sequence of treatments for patients with ovarian cancer with the aim of improving of disease−free and overall survival are investigated. In patients with advanced ovarian cancer neoadjuvant chemotherapy (NCT) can improve the resectability of the tumor, increase the frequency of optimal cytoreductive surgery. Objective effect of NCT in OC reaches 71.6 %. Replacement of cyclophosphamide to paclitaxel in standard combination with cisplatin significantly improved the immediate and remote results of treatment of patients with disseminated ovarian cancer: increased frequency of objective response from 66 to 77 %, disease−free survival from 12.0 to 16.6 months, the average life expectancy from 25 to 35 months. The use of pre− and postoperative intraperitoneal chemotherapy is strongly proposed. Determination of molecular−biological markers (MBM) in the tumor tissue may provide additional information about the biological behavior of the tumor: the rate of its growth, ability to invade and metastasize, resistance to chemotherapy. Prognostic values of markers of apoptosis, angiogenesis, proliferation and other for relapse−free and overall survival of patients are actively studied. A new dynamic analysis of drug resistance and sensitivity in anticancer therapy is provided. However, the most important MBM to predict the course current of the disease and choice of therapy have not been defined. The solution of these problems will lead to individualization of cancer treatment. Introduction to oncology practice of minimally invasive endoscopic technique could contribute the improvement of results of treatment of patients with OC. The procedure allows morphological verification of the tumor, determining the local prevalence and distant metastases in the abdominal cavity, choice of the right tactics of treatment. According to various authors, laparoscopy is preferred over laparotomy in view of the more rapid implementation and the possibility of early beginning of NCT. Laparoscopy allows prediction of resectability with negative predictive value of 100 % and a positive predictive index of 87 %. Cytotoxicity of modern anticancer chemotherapy with its lack of efficacy in many cases and the high price of drugs demonstrates the feasibility of developing new approaches to drug treatment of cancer patients. One of them may be the use of drugs in midget doses (MD) providing their «election» damaging effect on the tumor while maintaining the efficiency that can reduce toxic effects and significant economic effect. Thus, development of new procedures for diagnosis and treatment of ovarian cancer, especially in its advanced forms, based on the study of molecular−biological properties of the tumor, obtained by the application of diagnostic laparoscopy, as well as the introduction of nanotechnology in the creation of anticancer drugs will improve the results of its treatment.
Key words: ovarian cancer, surgical treatment, laparoscopy, molecular biological markers, chemotherapy.
M. Gorky Donetsk National Medical University, Ukraine
Hemodynamic, morphological and functional features of ischemic stroke at atherosclerotic plaques of cerebral arteries
26 - 31
The aim of the study was evaluation the hemodynamic parameters and morphological features of the atherosclerotic lesions of cerebral arteries at ischemic stroke and comparison the results obtained in patients with abnormalities of the cerebral arteries. Hemodynamic, morphological data of 117 patients (a mean age 61.3±1.7 years), with cerebral ischemic stroke in the acute period, were analyzed. All patients were divided into two groups: group 1 −− cerebral atherosclerosis and abnormal cerebral arteries; group 2 −− anomalies of cerebral arteries without cerebral atherosclerosis. All participants were investigated by neurological, laboratory and instrumental methods. Hemodynamic disorders (hyperperfusion, hyproperfusion) were found out. As a result of a comprehensive investigation of patients with cerebral ischemic stroke in atherosclerotic lesions and abnormalities of cerebral arteries, especially according to Doppler's ultrasound of the neck vessels, a combination of atherosclerotic lesions and abnormalities of cerebral arteries is leading to development of severe hyperperfusion in areas of atherosclerotic stenotic lesion and angulation, twisting of cerebral arteries. Hypoperfusion of cerebral arteries in patients were diagnosed with a combination of atherosclerotic plaque more than 80−100 % and pathological twisting of the ICA on the both sides. Due to this fact the clinical features of stroke in patients with atherosclerotic lesions of cerebral arteries were characterized by more severe clinical neurological symptomatic than patients with only abnormalities of the cerebral arteries. Thus, severity and variability of hemodynamic characteristics of patients with cerebral ischemic stroke depend on the size of the atherosclerotic plaque and type of anomalies of cerebral arteries.
Key words: ischemic stroke, cerebral arteriosclerosis, cerebral artery anomalies.
Kharkiv Medical Academy of Postgraduate Education, Ukraine|Central Clinical Hospital of Ukrainian Railroad, Kharkiv, Ukraine
Peculiarities of vegetative dystonia syndrome in patients with posttraumatic epilepsy
32 - 35
It is known that vegetative disorders are often observed in patients with posttraumatic epilepsy. This paper reveals the relationship between autonomic disturbances and changes of the tone in the large vessels of the neck, which manifested by different headache types. Vegetative disorders were also identified in patients with cardiac disturbances, with more pronounced changes observed in patients with cardiac disturbances and headache compared with the patients with cardiac disturbances, but without the headache and those without cardiac disturbances. It was also noted that patients with cardiac disturbances significantly more often than patients without cardiac disturbances complained of headache. Higher frequency of seizures was observed in patients with cardiac disorders. In addition, patients in this group were significantly more likely to have generalized tonic−clonic seizures. According to heart rate variability (HRV) analysis sympathicotonia was significantly more frequent in patients with cardiac disorders. Reduction in the total power of HRV and the predominance of VLF component of HRV was significantly more common in patients of group 2, which may indicate the tension of compensatory mechanisms of autonomic regulation of cardiac activity/ Sympathicotonia was significantly more common in patients with headache and was accompanied by arterial spasm phenomenon according to Doppler ultrasound. Parasympathicotonia was observed significantly more frequently in patients with headache and impaired venous outflow according to Doppler ultrasound. In patients with cardiac disturbances and headache lowest quality of life in accordance with the scale QOLIE 31 was observed. The features of the vegetative status that are characteristic for patients with posttraumatic epilepsy, cardiac disturbances and headache were identified.
Key words: vegetative disorders, cardiac disturbances, headache, posttraumatic epilepsy.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Medical psychological characteristics of the patients with psychosomatic and somatoform disorders in the context of clinical psychophenomenological study
36 - 44
The analysis of the experience of clinical psychophenomenological study of vast numbers of patients suffering from the most common forms of psychosomatic disorders and somatoform disorders presented in our previous works, demonstrates the need for comparison of the data expressed in the peculiarities of personality nosospecific transformation of characteristics of response of patients with psychophysiological features of psychological functioning and medical psychological aspects of the disease. A study of medical psychological characteristics of this cohort of patients will allow, on the one hand, to get information about important aspects of the personality organization of individuals, outlining the range of medical psychological predictors of psychosomatic disorders and somatoform disorders, on the other hand, we compare the obtained psychophenomenological characteristics with the existing pathophysiological ideas and psychotechnical concepts in the field of the competence of medical psychology. To analyze the medical psychological characteristics of the patients with somatoform disorders and psychosomatic diseases, we examined 470 patients with various somatoform and psychosomatic disorders, the patients were divided into 2 groups: a group of patients with psychosomatic disorders (asthma, essential hypertension, peptic ulcer and/or duodenal ulcer), and a group of patients with somatoform disorders (somatoform dysfunction of the respiratory, cardiovascular, digestive systems) with the help of psychodiagnostic method. The investigation allowed to determine medical psychological characteristics of the patient population with somatoform dysfunction of the respiratory, cardiovascular and digestive systems, asthma, hypertension, gastric ulcer and/or duodenal ulcers.
Key words: somatoform disorders, essential hypertension, gastric ulcer, duodenal ulcer, asthma, clinical psychophenomenological study.
Ukrainian Research and Practice Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues, Kyiv, Ukraine
The peculiarities of psychogenic component of psychoendocrine syndrome in functional disorders of the thyroid gland
44 - 50
Modern trends in development of endocrinology are determined by growing interest in health and social factors, clinical psychological nature of the clinical picture of the disease and, in particular, achieving compliance which at replacement therapy is a fundamental factor in controlling the disease. The presence in the clinical picture of the endocrine pathology of variable psychopathological arrangements in the structure of clinical variations of psychoendocrine syndrome, as well as a wide range of stressful factors of the nosogenic−introspective and socio−environmental nature creates dyscompliance predictors that in fact are obligatory present in each nosological form of psychoendocrine syndrome in varying proportions, requires careful comparative analysis in order to select a congruent methodological support of their correction and prevention. In order to indicate and perform comparative analysis of the dynamics of nosogenic stressful factors in psychogenesis of psychoendocrine syndrome in hyperthyroidism and hypothyroidism we examined 60 patients of Ukrainian Scientific−Practical Center of Endocrine Surgery and Transplantation of Endocrine Organs and Tissues with endocrine disorders accompanied by hyperthyroid or hypothyroid states having psychoendocrine syndrome or axial components in the structure of psychopathological disorders using psychodiagnostic, clinical psychopathological and clinical psychophemomenological methods. The study analyzed medical psychological characteristics of psychogenic component of psychoendocrine syndromes in the structure of hyperthyroidism and hypothyroidism.
Key words: psychoendocrine syndrome, hyperthyroidism, hypothyroidism, psychotraumatization.
Ukrainian State Research Institute of Medical Social Problems of Disability of Ministry of Health of Ukraine, Dnipropetrovsk, Ukraine|Dnipropetrovsk State Medical Academy of Ministry of Health of Ukraine, Ukraine
Blood pressure and cognitive functions in patients with arterial hypertension in the remote period after stroke
50 - 54
One of the leading risk factors (RF) of cognitive impairment (CI) is arterial hypertension (AH), which leads to the necessity of examining the interrelation of blood pressure (BP) and cognitive functions (CF) of the patients with arterial hypertension in the remote period after stroke. The study involved 39 patients with stage III АН, with the period after stroke no less than 6 months. All patients got daily BP monitoring, and their СF were examined with generally recognized methods. Slight and moderate CI occurred in 74.2 and 25.8 % of the patients. Patients which survived stroke showed the most significant changes in the processes of memory (in 97.3 %), attention (to 90.6 %), intellect (75.6 %) and thinking (in 64.9 % of the cases). It was shown that the daily minimum systolic ВР and diastolic ВР were associated with attention and thinking, their average daily values with memory, attention and thinking, the maximum with memory. Daytime systolic ВР was associated with memory, attention and intelligence, while the daytime diastolic ВР with memory and attention; variability of daytime systolic ВР− with memory, while the daytime diastolic ВР variability with memory, attention, emotional intelligence. Nighttime systolic ВР was associated with memory and attention, and diastolic ВР with memory, attention and thinking; variability of systolic ВР at night −− with memory and diastolic ВР at night with attention. The distinctive features of the influence of daytime systolic ВР were their impact on the emotional intelligence of patients, the daytime variability of systolic ВР on memory, daytime diastolic ВР on attention and emotional intelligence, nighttime diastolic ВР on thinking, night variability in systolic ВР on memory and night diastolic ВР on the attention of patients. The results of the studies indicate the need in search for new criteria and indices of assessment of daily changes in ВР, which could evaluate their interrelations with cognitive functions as well as develop individual programs for rehabilitation of these patients.
Key words: arterial hypertension, stroke, cognitive functions, daily blood pressure monitoring, rehabilitation.
Kharkiv Medical Academy of Postgraduate education, Ukraine
Efficacy of cryogenically preserved mesenchymal placenta stem cells in correction of oxidative state in type 2 diabetes mellitus
55 - 58
To assess the degree of oxidative stress in experimental animals, the level of primary products of lipid oxidation, diene conjugates, which characterize early stage of peroxidation was determined. Diene conjugates are toxic metabolites, which have a damaging effect on the lipoproteins, proteins, enzymes and nucleic acids. It was found that introduction of cryogenically preserved mesenchymal placenta stem cells (CPMPSC) reduced oxidative stress, as evidenced by reduction in the concentration of diene conjugates by 34 % (p < 0.001). Inhibition of lipid peroxidation intensity influenced by CPMPSC in this case may be the result of activation of antioxidant protection, as evidenced by the increase of the integral index, almost 2−fold in the total antioxidant activity (p < 0.001). It should be noted that increasing the antiradical activity of the system can result from both its enzymatic activity increase (increase in catalase activity, p < 0.05) and non−enzymatic (increasing the concentration of reduced glutathione, p < 0.05) activity increase. Given the important role of oxidative stress in the pathogenesis of diabetic retinopathy (DR), therapeutic correction of pro/antioxidant balance may be effective in prevention of vision loss associated with DR. The absence of convincing results demonstrating the effectiveness of the use of antioxidants in clinical studies may be due to their systemic mode of administration. In this regard, local application of drugs for the restoration of oxidative status may be a promising direction in the prevention of DR.
Key words: cryogenically preserved mesenchymal placenta stem cells, oxidative stress, diabetic retinopathy, experimental animals.
Kharkiv National Medical University, Ukraine
The results of application of L−arginine in patients with primary open−angle glaucoma
59 - 62
The aim of this study was to determine the effect of L−arginine on the performance of nitric oxide and endothelin−1, as well as the progression of primary open−angle glaucoma (POAG). The study involved 162 patients (287 eyes) with primary open−angle glaucoma (POAG). The study group consisted of 82 patients (146 eyes) who received basic therapy along with L−arginine (patent of Ukraine UA 52177 U). the control group included 80 patients with POAG (141 eyes) who received standard therapy. Application of L−arginine in treatment of patients with POAG reduced the activity of inducible NO−synthase by 28.7 % and exerted a correcting influence upon the activity of endothelial NO−synthase. It was found that application of L−arginine in treatment of patients with POAG enhanced the concentration of S−nitrosothiols by 65.0 % and reduced the content of endothelin−1 by 19.6 %. Furthermore, it was shown that the use of L−arginine in the treatment of patients with POAG significantly reduced the incidence of progression of glaucoma (by the visual field changes) by more than 30 %. It is concluded that the use of L−arginine in treatment of patients with POAG reduces the inducible NO−synthase level, has a corrective influence on endothelial NO−synthase, increases the concentration of S−nitrosothiols and reduces the level of endothelin−1. It is also shown that the application of L−arginine in the treatment of patients with POAG helps to reduce the frequency of glaucoma progression. The findings are promising in terms of studying the mechanisms of neuroprotective effect of L−arginine in the treatment of patients with primary open−angle glaucoma.
Key words: primary open-angle glaucoma, L-arginine, inducible and endothelial NO-synthase, S-nitrosothiols, endothelin-1.
Lopatkin Institute of Urology and Interventional Radiology, branch of Fed.State Budget Establishment NMIRC, Ministry of Health of Russian Federation, Russian Federation
Pharmacotherapy of metabolic skeletal lesions against a background of recurrent nephrolithiasis
63 - 69
The data from modern literature on the metabolic involvement of skeletal bone therapy against a background of recurrent nephrolythiasis were analyzed. Basic groups of medication used for this purpose were considered: vitamin D and its active metabolites, bisphosphonates, citrates and thiazides. Usage of vitamin D and its active metabolites (alfacalcidolum and rokaltrolum) in such clinical situation is questionable, mostly because of absence of definite confirmation of non−increasing recurrence risk of nephrolythiasis against a background of such medication usage. In addition, there is information about negative impact of this medication on the cardiovascular system. Combining scheme, including a thiazid diuretic and citric acid salt, has a confirmed, but very weak effect, not always acceptable for clinical use. Bisphosphonates showed comparatively high effectiveness against a background of the available level of safety. Possibility of combining usage of bisphosphonates and thiazid diuretics is discussed, but the data about effectiveness and safety of such treatment are lacking.
Key words: nephrolythiasis, renal osteodystrophy, bisphosphonates, vitamin D, citrates, thiazides.
Kharkiv National Medical University, Ukraine|Regional Clinical Hospital of Infectious Diseases, Kharkiv, Ukraine
Biochemical indicators of cerebrospinal fluid in patients with acute meningococcal end enteroviral meningitis
70 - 74
The studies aimed at determining the criteria of early prognosis of meningitis course for early correction of complex treatment and improvement of its efficiency are relevant at the moment. The purpose of our study was to investigate the clinical and laboratory features of acute meningitis and assess the values of some parameters of cerebrospinal fluid (CSF) in early diagnosis and prognosis of the disease. We analyzed the data from 313 HIV−negative patients with acute meningitis from Kharkiv region for the period 2011−2013. Among them 229 (73.2 %) patients had serous meningitis and 84 (26.8 %) purulent meningitis. The first group included 29 patients with meningococcal meningitis. The second group included 14 patients with acute enteroviral meningitis. The etiology of the disease was confirmed by PCR and bacteriological studies of cerebrospinal fluid. In the first and second groups of patients we determined the levels of cortisol, creatine kinase, lactate, lactate dehydrogenase, total cholinesterase CSF on admission and after 10−12 days of treatment. Analysis of clinical data of CSF investigation showed that the level of cell count was inversely dependent on the severity of the disease (p < 0.0001). Total blood count during the acute phase of the disease showed that only the level of white blood cells was significantly higher in the group with severe disease (p < 0.0001). In patients of the second group lactate and lactate dehydrogenase levels were significantly lower (p < 0.0001) than in the first group. Total creatine kinase levels were significantly (p < 0.0001) higher in the CSF of patients of the first group. Indicators of cholinesterase in the CSF during the acute phase of meningococcal meningitis were inversely related to the severity of the disease (p < 0.0001). Our findings suggest the importance of determining cortisol, lactate, cholinesterase in the CSF to determine the severity of the patient's condition and prognosis of the disease.
Key words: meningococcal end enteroviral meningitis, biochemical parameters of cerebrospinal fluid, early diagnosis.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Qualitative and quantitative determining of peptidoglycan in patients with purulent bacterial meningitis by plasma of silkworm larvae
74 - 76
The aim of this work was to develop a biological method for qualitative and quantitative determination of peptidoglycan (PG) in patients with purulent bacterial meningitis (PBM) using hemolymph of the silkworm (SLP). SLP−reaction was used due to the following reasons. Hemolymph of the silkworm (Воmbix mori ?.) contains natural enzyme prophenol−oxidase that acts as a catalyst for the reaction of interaction of PG with exogenous substrate 3,4−digarettes with formation of melanin. The activity of the enzyme, and therefore, the color intensity is proportional to the concentration of GHGs. Proposed by Japanese scientists in 2003 SLP−test was piloted on a small number of patients; the study did not involve the patients with meningococcal meningitis, the causative agent of which is the main etiological agent in the structure of PBM. Our study involved 38 patients with acute meningitis of different etiology and 10 controls. Live clonally «population» of elite В. mori ?, was obtained from V.N. Karazin University laboratory of embryonic and stem cells. SLP−test of CSF (cerebrospinal fluid) of patients with confirmed diagnosis of bacterial meningitis demonstrated dark coloration of the investigated mixtures, and in patients with viral meningitis and controls coloring of mixtures did not occur. To determine the concentration of PGs in the CSF of the patient according to the degree of coloring, preliminary constructed calibration curve was used. In the acute phase and the recovery period as well as in the dynamics of the disease, the concentration of the studied endotoxin in the CSF of patients with pneumococcal meningitis was statistically higher than in patients with meningococcal meningitis. The results confirm a greater availability of PG in patients with pneumococcal meningitis than in meningococcal meningitis, where the content of PG is insignificant. Visual distinguishing by the intensity of staining of gram−positive pneumococcal from gram−negative meningococcal meningitis was not possible. Qualitative and quantitative SLP−test can be used for early diagnosis and differential diagnosis of acute meningitis, and also for monitoring the effectiveness of antibiotic therapy in patients PBM. In favour of the introduction into clinical practice of innovative ideas is the presence in Ukraine of the Institute of Sericulture of the Ukrainian Academy of Agrarian Sciences, cultivating the silkworm.
Key words: peptidoglycan, plasma of silkworm larvae, cerebrospinal fluid, acute bacterial meningitis.
V. N. Karasin Kharkiv National University, Ukraine
Clinical epidemiological monitoring of antidiphtheria nonspecific immune protection in children on the stages of hepatitis A
77 - 80
The aim of this research was determining and analysis of indices of cellular and humoral immunity (CHI) as well as application of the research results in practice of epidemic supervision for individualization of tactics of immunization of children who survived hepatitis A (HA). Our study involved 405 children of basic group (sick and survived HА) aged 1−14 who were treated at Kharkiv Child's Regional Clinical Infectious Hospital No. 8. The study was conducted in dynamics, namely during hospitalization, on discharge and 6 months after the disease. The control group consisted of 146 healthy age−matched children. The level of titles of specific antibodies to diphtheria, maintenance of T−cell, Т−helper−cell, T−suppressor−cell, concentrations of immunoproteins of class A (IgA), class M (IgМ) and class G (IgG) in the peripheral blood were determined. The degree of immune disorders (DID) was analyzed using the adapted methodology of determination of disorders of heterospecific immunity by Karaulov A. V. The values of index in limits (1.0?33.0) % corresponded to grade 1 of immune disorders; (33.1?66.0) % −− 2I, and over 66.0 % −− grade 3. To make a hysteresisogram (a standard reflection of formula of disorders of the immune system (FDIS) of patients) the coefficient of diagnostic value of Kj was used. Analysis of disorders CHI demonstrated that the degree of the disorders and their variety depended on the stage of epidemic supervision. The most meaningful disorders were distinguished at the level of humoral immunity in the age−matched groups of children aged 7−10 (IIIIgA+ −− increase in the level of serum immunoprotein more than by 30.0 %) and aged 11−14 (IIIIgA+М+ −− increase of the level of immunoprotein more than by 30.0 %), while in those aged 1−6 disorders of CHI were characterized by grade 2−1 changes. Thus, it should be noted that depending on the age of children the stage of disorders also differed. If in children aged 1−6 minimum changes were registered on the first stage of the clinical epidemiological monitoring, simultaneously with the changes of CHI in patients aged 1−6, the proportion of children with the level of antidiphtheria immunity also changed (only titles over 1:80 were considered) within the limits (25.0?5.0) %. In the senior age group (11−14), in contrast to children aged 1−6 on the 3rd stage of the clinical epidemiological monitoring only grade 1 disorders of CHI were registered, that demonstrates clinical epidemiological heterogeneity of children and confirms a requirement in age−dependent individualization of tactics of forming of artificial immunity in a remote period after HА, that must be taken into account at a re−vaccination.
Key words: children, hepatitis A, cellular and humoral immunity.
V. N. Karasin Kharkiv National University, Ukraine
The features of immune regulation in patients with HCV infection
81 - 87
Infectious hepatitis is a serious problem which is still unsolved. According to the WHO data there are millions of infected people with infectious hepatitis throughout the world. Nowadays potential of infectious hepatitis C (IHC) is still high. Wide spread of hepatitis C among the cases of viral hepatitis has also been established in Ukraine. The number of infected people reaches 170−500 mln in the world. The urgency of HCV problem is characterized by the threat of chronization with forming chronic hepatitis, cirrhosis and in some cases of hepatocellular carcinoma. Most of the researchers consider that cooperation of the virus and human immune system is one of the basic factors which determine subsequent manifestation of HCV−infection. It is known that elimination of viruses from the human organism is provided by an adequate immune response and insufficient intensity of immune inflammation which leads to persistence of viral infection. We observed the group of 155 patients treated in Kharkiv Regional Clinical Infectious Hospital with the diagnosis of acute (37) and chronic hepatitis C (118). Clinical investigations, laboratory blood and urine tests, blood biochemistry; ultrasonography of the abdominal region and liver puncture biopsy and some additional examinations were performed. To study the properties of HCV infection the following laboratory methods were used: IEA to identify specific markers of HCV (anti−HCV IgМ, anti−HCV IgG, anti−HCVcore/NS−3, −4, −5) in the blood, to identify HCV RNA. To determine genotypes of HCV, the method of direct sequencing and restriction analysis was used. To identify cytokins, IEA were used. The level of subpopulation of lymphocytes in immunograms was investigated with monoclonal antibodies. Clinical and pathogenic role of the changes in immunoregulation in patients with hepatitis C was studied. The role of integrated analysis of cell and secretory immunity indices, the role of immune response mediator changes in evaluation of corresponding organism reaction against HCV−infection, prognosis of severity and consequences of the disease were shown. Immune status changes regarding virus genotype, course, replicative and biochemical activity were analyzed. Criteria of the course prognosis and outcomes of acute hepatitis C were worked out. The presence in the peripheral blood of patients of anti−HCV NS3 and absence of anti−HCV NS4, anti−HCV NS5 are an important diagnostic criterion of acute hepatitis C (AHC). The presence in the peripheral blood of patients of anti−HCV NS4, anti−HCV NS5 can be used as a marker of chronic HCV infection (ChHC). Immune disorders in patients with AHC during the height of the disease are characterized by imbalance of cellular and humoral immuneregulation, manifested by decreasing of CD3+, CD4+, hyperproduction of CD16+, CD20+, CD25+ −lymphocytes, total IgM. At the same time there are changes in cytokine status, characterized by increase in TNF−?, IFN−?, IL−2, IL−4, and IL−10. The period of clinical and biochemical remission compared with the height of the AHC in most patients is characterized by a decrease of CD16+− lymphocytes, decrease of concentration of IgM (which is high compared to the rates in the control group), and the increase of IgG, combined with increase of TNF−?, IFN−?, IL−2, IL−4 and IL−10. In patients with chronic hepatitis C, the balance of Th1 / Th2 shifts towards subpopulation Th2, that shows a decrease in the level of CD3+, CD4+, CD25+, CD16+ −lymphocytes, IL−2 and IFN−? (cellular immune factors) with activation and hyperproduction CD20+ − lymphocytes, IgM, G and TNF−? and IL−4, IL−10 (humoral immune factors). The immune status of patients with chronic hepatitis C with replicative activity of the pathogen confirmed the detection of HCV−RNA in the blood characterized by decrease of the levels of IFN−?, IL−2, which is accompanied by a significant increase of the TNF− ?, IL−4 and IL−10. It is concluded that specific immune response to antigenic determinants of HCV depends on the form of the disease. The state of immune regulation in patients with HCV infection depends on replicative virus activity, its genotype and biochemical activity of hepatitis C.
Key words: acute hepatitis C, сhronic hepatitis C, immune regulation, сytokines, lymphocyte subpopulation.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Structural changes of the cervix in women with chronic endocervicitis against a background of cervical pseudoerrosion
88 - 92
The paper presents the features of structural changes in the cervix in chronic endocervicitis depending on the history of pregnancy and delivery in women with cervical pseudoerrosion. A comparative analysis of the quantitative parameters of the cervix and endocervix in women with chronic endocervicitis, of whom 132 had a history of births, 34 only abortions in 21 no pregnancy was performed. Statistical analysis allowed us to determine the most important ultrasonographic signs of chronic endocervicitis. It was found that in women with the history of birth the volume (31.8±2.6cm3) and the degree of asymmetry of the walls of the cervix, endocervical heterogeneity (93.9±2.1 %), cyst dispersed suspension of more than 3 mm (43.9±4.7 %), uneven expansion of the cervical canal was significantly higher than in the rest. It was found that in women who had no pregnancy endocervical maximum thickness (7.9±0.8 mm) is higher than in women who had births and abortions only.
Key words: cervix, chronic endocervicitis, pseudoerrosion of the cervix.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Clinical and ultrasound characteristics and comprehensive treatment of women of reproductive age with adhesion process of the pelvic organs
93 - 95
Adhesions of pelvic organs in women result in functional disturbances in the organs themselves and eventually in their morphostructural changes. The aim of the work was to study the clinical efficacy of «Longidaze®» as a monotherapy and as a combined treatment with physical therapy in women of reproductive age with adhesions of pelvic organs. The study involved 85 women of reproductive age with adhesions of pelvic organs, which were divided into group 1 and 2, the main group (n = 30) and control group. Depending on the method of treatment, the patients were divided into groups 1A, I B, each of 15 patients, and group 2A and 2B, similarly. Treatment of patients from group 1A and 2A was carried out by IM injections of Longidaze®, 3000 IU 1 time in 3−5 days, No.10, as monotherapy. Patients from groups 1B and 2B were treated IM injections of Longidaze®, 3000 IU 1 time every 3−5 days No.5, in combination with phonophoresis with the drug to the area of the uterus and appendages projection at a dose of 3000 IU a day, by a course of at least 10−15 procedures. Use as a combination treatment with Longidaze® in patients of groups 1B and 2 B at least by 10−15 procedures contributed to a more accurate visualization of organs at ultrasonography, reduced pain in 26 (86.6 %) patients, phenomena of dyspareunia in 19 (63.3 %) patients after 5−7 treatment procedures, and 2 times shortened the duration of treatment of patients with adhesions of the pelvic organs. Combined use of Longidaze® with phonophoresis with the drug according to the developed protocol, potentiates the effect of the drug, increasing its bioavailability and can significantly reduce the time of treatment of women of reproductive age with adhesive process of the pelvic organs.
Key words: adhesion process of the pelvic organs, transvaginal ultrasonography, combined treatment, "Longidaze®", women of reproductive age.
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