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№3' 2020


Kharkiv Medical Academy of Postgraduate Education, Ukraine
Clinical and therapeutic value of adipokines in patients with chronic kidney disease
5 - 9
This review is devoted to the analysis of the role of adipokines in formation of pathological changes in renal function and structure. The patients with chronic kidney disease have a high risk of cardiovascular disease. Currently, the role of systemic hormonal and metabolic factors in the pathogenesis of the kidneys is growing. A promising area of pathogenetic prevention and treatment of kidney disease is an interdisciplinary approach, whereat the adipokine imbalance is of particular interest. Adipose tissue and its messengers, adipokines, are known to be highly associated with kidney disease. Adipocytes are metabolically active cells, producing the signaling lipids, metabolites and protein factors, i.e. adipokines. The interaction of adipose tissue with the kidney is called the adipose kidney axis, being important for the normal functioning of the body, as well as its response to an injury. It has a strong therapeutic potential in respect of the growing rates of chronic kidney disease. Adipocyte hypertrophy is often accompanied by the development of tissue fibrosis, hypoxia, and secretion of pro−inflammatory cytokines (such as tumor necrosis factor or interleukin, which triggers the cell inflammation). Dysfunction of adipose tissue contributes to the development of cardiovascular disease at the local and systemic levels. Thus, for the early diagnosis of chronic kidney disease into the diagnostic program, in addition to the generally accepted indices, the determination of adipokines: for example, serum leptin, adiponectin, omentin, visfatin, microalbuminuria, blood lipid spectrum, intrarenal and functional status of the kidneys with the assessment of functional renal reserve is recommended to be included. Early detection of the disease, new approaches to its diagnosis and treatment can help in reducing the risk of a high incidence and mortality from renal disease.
Key words: chronic kidney disease, nephropathy, adipokines, leptin, resistin, adiponectin, visfatin, omentin.
Danylo Halytsky National Lviv Medical University, Lviv, Ukraine
Changes in oxygenation in children with respiratory failure
10 - 13
Acute respiratory failure is a component of the multiorgan dysfunction syndrome and a common cause of death among the children treated in intensive care units. Readiness to wean a patient from a mechanical ventilation is determined by a set of indices, including the data on the level of hypoxemia and its ability to regress under the influence of oxygen therapy. The indices such as the paO2/FiO2 and SpO2/FiO2 ratios are valid for determining the severity of hypoxemia. In order to study the dynamics of changes in SpO2/FiO2, paO2/FiO2, oxygenation index and the one of frequent shallow breathing in the children with acute respiratory failure as well as to substantiate the criteria for their readiness to wean from pulmonary ventilation, a prospective, observational cohort investigation in patients aged from 1 month to 18 years was performed. The patients of group I received pulmonary−protective strategy of mechanical lung ventilation, II − in addition to it received the diaphragm−protective strategy. The ratios of SpO2/FiO2 and paO2/FiO2, oxygenation index and frequent shallow respiration index were calculated. Weaning was considered successful if the patient did not require a respiratory therapy after extubation for the next 48 hours. The primary endpoint of the assessment was the duration of weaning from mechanical ventilation, the secondary ones were the SpO2 / FiO2, paO2 / FiO2, oxygenation index, the one of frequent shallow breathing. Significant differences in SpO2 / FiO2 and paO2 / FiO2 indices were found on days 5 and 9 of the study. It was found that at paO2 / FiO2 values less than 200 and SpO2 / FiO2 less than 265 the prognosis of weaning is unfavorable.
Key words: children, oxygenation, mechanical ventilation.
V. T. Zaitsev Institute of General and Emergency Surgery, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
Kharkiv National Medical University
Kharkiv Medical Academy of Postgraduate Education
Use of enterosorption to prevent endotoxemia in acute intestinal obstruction
14 - 17
The relevance of studying the measures to prevent the development of endotoxemia in acute intestinal obstruction is stipulated with an increasing incidence of multiple organ failure in debilitated patients and infectious−toxic shock. The development of endotoxemia is often accompanied with a secondary infection. Toxic effects of bacteria in small intestine, the trigger of which is their translocation and transformation of the small intestine into a focus of microbial invasion, prolongs the postoperative period, which increases the length of stay in the surgical hospital. Much attention is paid to the pathogenesis of the development of small bowel contamination syndrome, which results in changes in intestinal biocenosis and increased intoxication of the body, which worsens the patient general condition. To examine the results of entersorption as a method of detoxification and control of infectious and toxic complications in the patients with an acute intestinal obstruction before surgery to optimize surgical tactics and prevent post−surgery complications, a study was conducted in 36 patients with different stages of the disease. The effectiveness of detoxification in the combined treatment of an acute intestinal obstruction has been confirmed, which is indicated by the reduced pain, regression of radiological signs of obstruction in the patients and early normalization of their main clinical, laboratory and instrumental parameters. The use of the method of enterosorption as part of a comprehensive approach in the period after surgery contributed to the early restoration of intestinal motility, reducing the number of complications, improving the general condition of patients. Thus, the method of enterosorption is one of the most effective of modern detoxification methods, which determines its relevance and further prospects to study this problem.
Key words: acute intestinal obstruction, endotoxemia, enterosorption.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Indications for pancreatoduodenal resection in treatment of chronic pancreatitis complicated forms
18 - 22
Chronic pancreatitis is a recurrent progressive disease accompanied by fibrosis and fibrocystic degeneration of the pancreatic parenchyma. There are remained the unexplored issues of progression of fibrosis in the pancreas parenchyma, which lead to a rapid enlargement of the head, the development of complications that require a resection surgery. To develop a differentiated approach to the choice of surgical treatments and indications for pancreatoduodenal resection in complicated forms of chronic pancreatitis, a study was performed in 137 patients underwent resection and drainage surgery. Pancreatoduodenal resection was accomplished in 12 patients. Instrumental research methods were used: multidetector (64−slice) computed tomography with 3D reconstruction, magnetic resonance imaging, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography. Two clinical examples are given. Indications for pancreatoduodenal resection in patients with chronic pancreatitis were expressed fibro−inflammatory process in the area of the pancreas head, suspected development of oncological pathology. Progressive fibrotic changes in the pancreas parenchyma, mainly in the head, occurring in some patients, associated with stellate cell activation and fibrogenesis, they lead to the development of biliary and portal hypertension, stimulation of oncogenesis. It is concluded that with the progression of fibro−inflammatory process in the pancreas head with the development of complications (pancreatic, biliary and portal hypertension), as well as in case of impossibility to exclude the tumor, the surgery of choice is pancreatoduodenal resection. The presence of severe fibrosis in the pancreas parenchyma reduces the risk of developing pancreatic fistula when performing pancreatoduodenal resection.
Key words: complicated forms of chronic pancreatitis, pancreatoduodenal resection, fibro-inflammatory process, pancreatic fistula
Kharkiv National Medical University
V. T. Zaitsev Institute of General and Emergency Surgery, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
V. N. Karazin Kharkiv National University, Ukraine
Causes of adverse surgery effects in treatment of patients with esophagus stenotic diseases
23 - 27
Esophageal stenosis requires a responsible approach to the choice of rational treatment tactics. Intraoperatively, bleeding, interponate necrosis, complications associated with the wrong choice of the path of the interponate imposition to the neck, damage to the nutrient vessel (the arcade rupture), pleural leaves during the formation of the thoracic tunnel, n. vagus and its branches, pneumothorax, hemothorax, uncontrolled mediastinal bleeding, the need for drainage of the pleural cavity due to injury to the latter, iatrogenic splenectomy, membranous tracheal tear. Post−surgery complications are developed at different times after esophagoplasty. Most often, early postoperative complications occur because of the wound: bleeding and failure of the sutures of the anastomosis line. Complications resulted from the respiratory system are as follows: tracheobronchitis, pleurisy, "congestive", nosocomial pneumonia and atelectasis, pleural empyema. In the remote post−surgery period, the patients may experience: stenosis of the esophageal (or pharyngeal) anastomosis, adhesions, fistulas, reflux, peptic ulcers of the esophagus, pain, inflections and excess loops, complications associated with mechanical trauma of implant, scar−altered cancer esophagus, polyposis of the colon, various disorders associated with primary trauma, nonspecific complications. Damage to the recurrent nerve in patients causes constant hoarseness and difficult swallowing. Occasionally there are cardiac arrhythmias in the form of atrial fibrillation, "sympathetic" pleurisy, reflux, post−vagotomy symptom and dumping syndrome, delayed gastric emptying due to insufficient dilated pyloromyotomy in the patients with a combination of stenosis of the esophageal lumen and esophageal lumen hernia.
Key words: esophageal stenosis, esophageal anastomosis, postoperative complications.
V. T. Zaitsev Institute of General and Emergency Surgery, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
Kharkiv National Medical University, Ukraine
Morphological evaluation of effectiveness of necrofasciotomy and infiltration with ozonated saline area of deep circular burn of skin with underlying tissues complicated by compartment syndrome
28 - 33
Compartment syndrome is one of the complications of tissue damage of various origins, the basis of which is the compression of blood vessels and disruption of blood supply to tissues due to an increased local pressure in the closed space of the fascial sheath. The consequences of compartment syndrome can be local and general. An effective treatment of compartment syndrome in burns is to perform a necrotomy, which due to decompression helps to reduce intra−tissue pressure and diminish the scale of necrotic changes in tissues. In order to morphologically evaluate the effectiveness of necrofasciotomy, as well as the one in combination with infiltration of ozonated saline area of deep circular skin burns with underlying tissues, complicated by compartment syndrome, an experimental study was conducted. Circular deep burns, complicated by the formation of compartment syndrome, were simulated in 18 WAG rats. To reduce the pressure in the burned and surrounding tissues, surgical interventions such as necrofasciotomy were performed, which provided a notable reduction in pressure. In parallel, infiltration of damaged tissues with ozonated saline was performed, which was bubbled for 15 minutes at a dissolved ozone concentration of 4.0±0.2 mg / l, which improved microcirculation and reduced tissue hypoxia. The findings indicate that the compartment syndrome is characterized by a significant severity of general pathology. Performance of necrofasciotomy of a burn wound with its infiltration by ozonated physiological solution in comparison with just necrofasciotomy has more positive medical effect, and efficiency of these medical measures increases when they are performed at early terms (day 1) of formation of a burn wound in comparison with late terms (day 3).
Key words: burns, surgical treatment, compartment syndrome, histological examinations.
Kharkiv National Medical University, Ukraine
Modern principles of management of women with abnormal uterine bleeding, taking into account the blood coagulation system state
34 - 40
Abnormal uterine bleeding in women of childbearing potential requires effective emergency care. To determine the features of disorders in the hemostasis system, 120 women were directly examined at the time of bleeding on admission to the hospital, during treatment on days 5−7 of the menstrual cycle, as well as after 6−12 months from the end of treatment. Determination of congenital and acquired defects of the hemostasis system became the main criterion for the selection of combined and isolated forms of abnormal uterine bleeding. Treatment measures for patients were etiopathogenetically selected and individually the intensity of bleeding, the degree of anemia, coagulation parameters were taken into account. The staged treatment involved stopping the bleeding, regulating the menstrual cycle and further preventing the bleeding. It has been found that uterine bleeding in reproductive age in the absence of etiopathogenetic treatment leads to the development of posthemorrhagic anemia. The severity and nature of bleeding is determined by the presence of defects in the platelet system of the hemostasis system with impaired platelet aggregation function. The study of total coagulation potential, primary hemostasis and the state of intravascular hemocoagulation in the patients using the methods for estimating the amount of platelet aggregation allows to detect and differentiate disorders in the hemostasis system. According to the results of the study, it can be concluded that the use of fibrinolysis inhibitors in the patients with abnormal uterine bleeding helps to increase the activity of the blood coagulation system and complete cessation of bleeding on the 2nd−5th day. Prophylactic administration of antifibrinolytic drugs from the first day of the menstrual cycle reduces blood loss, stabilizes menstrual function and significantly improves the psycho−emotional state of patients.
Key words: abnormal uterine bleeding, blood clotting, fibrinolysis inhibitors.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Etiopathogenetic aspects, clinical and diagnostic criteria as well as comprehensive approach to treatment of metabolic syndrome in women of reproductive age
40 - 44
The development of metabolic syndrome in women of reproductive age is one of the most common causes of anovulatory infertility, miscarriage in early pregnancy. In this pathology treatment in women there is used a comprehensive approach, which aims to restore specific functions, i.e. menstrual, secretory and reproductive ones. Important points are the detection of metabolic disorders in the patients before the formation of polycystic ovaries, normalization of body weight. In order to study the clinical effectiveness of the herbal drug "Glucemedin" in the combined treatment of metabolic syndrome in 40 women of reproductive age, a clinical and laboratory investigation was performed, also transvaginal ultrasound and body mass index were determined. In the first group of patients as the main treatment the metformin was prescribed hydrochloride as monotherapy in a dosage of 500 mg 2 times a day, in the second there was added phytodrug "Glucemedin" in a dosage of 1 capsule 3 times a day. The combined treatment showed a more pronounced dynamics of reduction of total and free cholesterol, low−density lipoprotein, triglycerides, atherogenic factor, decreased body mass index compared with the patients receiving metformin monotherapy. Based on analysis of the results of clinical and laboratory studies a high clinical efficiency of the herbal phytodrug "Glucemedin", which is stipulated with the pronounced effect on lipid spectrum of blood. The presence of natural components being a part of the phytodrug "Glucemedin", their high bioavailability, safety of the drug, no side effects and contraindications indicate its pronounced clinical effectiveness and feasibility of inclusion into the treatment of metabolic syndrome in women of childbearing age.
Key words: metabolic syndrome, lipid profile, body mass index, transvaginal ultrasound, Glucemedin, clinical efficiency, combined treatment, women of reproductive age.
Kharkiv Medical Academy of Postgraduate Education
Military Medical Clinical Center of the Northern Region, Kharkiv, Ukraine
Features of clinical manifestations of post−traumatic neuropathies and plexopathies resulted from gunshot and non−gunshot injuries of extremities
45 - 48
The number of traumatic injuries to nerve stems and plexuses is steadily increasing in peacetime during armed conflicts and terrorist acts. In wartime, peripheral nerve injuries are much more common, and a great deal of the knowledge about peripheral nerve damage and repair is based on combat experience. The study of the clinical course of post−traumatic neuropathies and plexopathies contributes to the development of clinical and neurological criteria and compensatory−restorative responses in traumatic lesions of the peripheral nervous system, helps to assess the functional significance of various parts of the nervous system when compensating a damaged functional unit. To study the features of clinical manifestations of post−traumatic gunshot and non−gunshot neuropathies and plexopathies, 63 patients underwent clinical and neurological examination with topical and clinical diagnoses, collection of detailed anamnesis and complaints, electroneuromyography and ultrasound examination. Movement disorders, characterized by peripheral paresis or plegia of the corresponding muscle group and accompanied with a reduced or lost tendon and periosteal reflexes, were common. Sensitivity disorders were a combination of prolapse (anesthesia, hypoesthesia) and irritation (paresthesia, hyperpathy, hyperesthesia). Autonomic disorders (vascular, secretory and trophic) in traumatic neuropathies differ depending on the clinical individuality of peripheral nerves. Vascular disorders were more often detected with partial damage to nerve structures and were accompanied by local edema. Of the secretory disorders, the most constant sign of impaired nerve conduction was sweating disorder. In the clinical picture of the pain syndrome, i.e. causalgia, the pain sensations by type of burning dominated. The intensity of the pain syndrome in severe cases was very high, in some cases the pain was exacerbated by irritation of the senses. The clinical picture of causalgia is characterized by an increased pain when warming the injured limb and it reduced when cooled, that is a "symptom of a wet rag." Knowledge of clinical features allows the detection of the peripheral nervous system lesions at the early stages of pathology, performance of dynamic clinical and neurological observation and treatment, timely use of modern additional research methods to address further treatment tactics that restore limb function, improve quality of life.
Key words: post-traumatic neuropathy and plexopathy, peripheral nervous system, gunshot wounds of nerves and plexuses.
SI "Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine", Kharkiv, Ukraine
About the need to create personalized rehabilitation programs for patients with demyelinating pathology
49 - 52
In most patients with multiple sclerosis there are developed the pelvic dysfunction, which significantly affects their general condition, impairs quality of life and may even lead to autoaggressive tendencies. Erectile dysfunction in multiple sclerosis is one of the manifestations of pelvic disorders, characterized by clinical heterogeneity and polyetiology. In most cases, the pathogenesis of sexual dysfunction in multiple sclerosis is mixed and is an integrative result of focal spinal cord injury and the patient's personal response to the disease, as well as changes in partnerships and social relationships. Erectile dysfunction in multiple sclerosis is characterized by clinical heterogeneity. The opinion is expressed about the need to develop differentiated personalized programs for its correction in patients taking into account different pathogenetic variants. Regional specifics are no less important in establishing such programs. In order to clarify the pathogenetic variants of erectile dysfunction among 33 men from the Western region of Ukraine with remitting type of multiple sclerosis in the post−performance period, a study was conducted, where three such variants were identified. This is a predominantly the disorder of suprasacral regulation of erection, sacral regulation of erection and psychogenic erectile dysfunction. A variant of erectile dysfunction with a predominant impairment of the sacral regulation of erection was defined as prognostically unfavorable. The obtained data are expected to be used in the development of neurorehabilitation personalized programs for patients with demyelinating pathology, taking into account the regional specifics.
Key words: demyelinating pathology, multiple sclerosis, remitting course, erectile dysfunction, regional specifics.
Kharkiv National Medical University, Ukraine
Features of capillary blood flow in patients with pathology of intranasal structures and nasal breathing disorders
53 - 59
The investigation of the vascular microcirculation system is important for diagnosis, assessment of the severity and nature of pathological processes in human body, monitoring the effectiveness of treatment. Monitoring the state of microcirculation in impaired respiratory function of the nose helps to study the subtle mechanisms of regulation of vascular−tissue relations. To do this, there were used the biomicroscopic methods to study capillary blood flow, one of the most relevant and promising is optical capillaroscopy of the nail bed. This method makes it possible to identify at the evidence level the peculiarities of the functioning of the peripheral circulatory system by the state of the capillary system and to evaluate the effectiveness of treatment by the rheological properties of blood in hematological practice. There were examined 145 patients by means of computer capillaroscopy to study the rate of capillary circulation in the patients with pathology of intranasal structures and nasal breathing disorders. All patients underwent a complete clinical examination, routine instrumental examinations, and computer capillaroscopy using a video capillaroscope with a visual magnification of up to 550 times. The obtained images were stored and processed according to a special software. During the characterization of the capillaroscopic picture there were evaluated: pathological tortuosity, change in the caliber of arterioles and venules, disorganization of the capillary network, the number of functioning capillaries. Changes in the speed and nature of capillary blood flow (accelerated, slow, stasis) were observed. The optical capillaroscopy method allows not only to visually assess the condition of microvessels, but also to determine such an important parameter as blood circulation, actually, it can replace the study of laser Doppler. Such data will be important in the diagnosis of respiratory and olfactory disorders and the formation of adequate tactics for their treatment.
Key words: microcirculation, microcirculatory tract, capillary circulation, nasal obstruction, nasal breathing disorders, pathology of intranasal structures, computer capillaroscopy.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Profit Municipal Enterprise "City Clinical Hospital № 30" of Kharkiv City Council, Kharkiv, Ukraine
Morbidity in Ukrainian children with diseases of upper airways, ear and papillary process: modern aspects
60 - 66
To determine the main trends in an incidence of childhood diseases of the upper airways, ear and papillary process, the data of the official state statistical information of the Ministry of Health of Ukraine were studied. The dynamics of prevalence and morbidity of children with these diseases in 2009−2017 were analyzed. An increase in the prevalence and incidence of respiratory diseases among the citizens and residents of rural areas by 26.8 % and 30.3 %, respectively, and a decrease in the above indices in urban children by 4.1 % and 3 % respectively were recorded. The incidence and prevalence of ear and papillary process diseases among the urban population increased by 31.8 % and 23.5 % in 2017 compared to 2009, in contrast to the incidence in rural residents for the same diseases (6.2 % and 1.7 %). The tendency of increase in the incidence and prevalence of diseases of the ear and papillary process in children aged 0−14 years by 12.5 % and 10.3 %, and in adolescents these were by 5 % and 11.1 %, respectively. The prevalence of acute pharyngitis and tonsillitis increased by 35 %, laryngitis and tracheitis it did by 20 %, for allergic rhinitis this was by 21.4 % with a decrease in the prevalence of chronic diseases of the tonsils and adenoids by 19.4 % among children aged 0−17 and 16.4 % respectively. The inexpediency of allocating such nosologies as chronic rhinitis and chronic laryngitis for statistical accounting of the state of upper airways morbidity has been determined. It is established that the lack of significant dynamics of morbidity for certain diseases of the ear and papillary process was due to clinically incorrect formation of groups of nosologies for statistical accounting. Prospects for further research to address shortcomings and improve the quality of specialized care have been outlined.
Key words: morbidity and prevalence of diseases of the upper airways, ear and papillary process, statistical accounting, children of Ukraine.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Comparative assessment of β−defensin levels in patients with chronic eczema of varying severity
67 - 71
The infectious nature of the process in microbial eczema or complications of bacterial infection of true eczema indicates an impairment in the immune system, especially innate immunity. Primary pathogen receptors, the complement system, phagocytosis, interferons, and endogenous antibiotic peptides play a crucial role in the body's innate defense. The first line of defense is provided by antimicrobial peptides, which are non−specific factors of humoral immunity, and have endotoxin−neutralizing and immune modulatory activity, as well as act against a wide range of microorganisms. One of them is defensins, which are cationic amphipathic peptides with a length of 30 to 42 amino acids with a three−stranded β−plate structure containing three disulfide bonds. The main producers of human β−defensins (Human Beta Defensin) are various epithelial cells, including keratinocytes. Defensins have antibacterial, antiviral, antifungal and antiparasitic effects. β−defensins are active against gram−positive and gram−negative bacteria, in addition, they exhibit anti−yeast activity. In patients, the severity of dermatosis was determined based on the calculation of EASI (Eczema Area Severity Index), the content of Human Beta Defensin was done with enzyme−linked immunosorbent assay, in the serum of patients with chronic eczema, it was increased 15.9 times compared to the control group. Quantitative levels of Human Beta Defensin 2 have been shown to be closely related to the disease severity. The content of Human Beta Defensin 2 in the serum of patients with chronic eczema may be a marker of the dermatosis severity.
Key words: chronic eczema, true and microbial eczema, pathogenesis, β-defensin, severity.
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Clinic and complications of COVID−19 coronavirus disease with pathogenesis elements
72 - 79
The longer the COVID−19 coronavirus pandemic lasts, the more information about its clinical manifestations is accumulated. The incubation period of COVID−19 ranges from 2 to 14 days, rarely up to 3 weeks, but in a significant number of cases an infection is not accompanied with the appearance of clinical symptoms. Currently, the following variants of the clinical course of COVID−19 can be identified as follows: viral load; subclinical; slight; uncomplicated with damage to only the upper respiratory tract; mild pneumonia, severe pneumonia, acute respiratory distress syndrome, etc. The clinical course of COVID−19 depends on the severity, the criteria of which are the intoxication manifestation, the degree of fever and the dominant syndrome. Mild / moderate forms are manifested by frequent increase in body temperature up to 38 ° C, respiratory symptoms, headache, myalgias, palpitations and general malaise. Patients stop distinguishing smells and feel the taste of food. Approximately from the 7th to the 9th days of the disease there are problems with breathing, which indicates the impairment of the lower respiratory tract and the beginning of the second phase of the disease, and its course is regarded as severe. Severe forms of the disease can also be manifested by impaired coordination of movements, slurred speech. In 1 to 4 % of patients there is developed the psychosis in the form of hallucinations. In the elderly, COVID−19 may be accompanied by delirium, lowering blood pressure. The risks of adverse disease are associated with somatic diseases: cardiovascular and nervous systems, respiratory tract, hormonal disorders, etc. Otitis, sinusitis, sepsis, bronchopulmonary infection, thrombosis, myocarditis etc. can be the complications of COVID−19. Computer tomography is an instrumental test that demonstrates the damage of lungs with coronavirus and allows to assess its severity.
Key words: coronavirus infection, COVID-19, clinical variants, severity, pneumonia, acute respiratory distress syndrome.
V. N. Karazin Kharkiv National University
Kharkiv National Medical University, Ukraine
Age features of some forms of herpesvirus infection
79 - 82
Epstein−Barr virus occupies an important place in the structure of infectious lesions of herpesvirus etiology. In order to study the age−related course of chronic infection caused by Epstein−Barr virus, a study was conducted with involvement of 141 patients. According to the results of our study, we found that a chronic infection caused by Epstein−Barr virus is characterized with polymorphism of clinical symptoms, there are certain features of its manifestations depending on the age of patients. Among the clinical manifestations of the infection, chronic tonsillitis, chronic fatigue syndrome and peripheral lymphadenopathy were most often found. Peripheral lymphadenopathy, hepatolienal syndrome and chronic tonsillitis were most common in the patients aged 18−25 years, prolonged subfebrility was noted in the age group of 26−35 years, and chronic fatigue syndrome, arthralgia and myalgia among were observed in the patients aged 36−45 years. A study of the recurrence rate in patients with chronic infection caused by Epstein−Barr virus of different age groups revealed that patients aged 18−25 and 26−35 years had 1−2 recurrences during the year, and those aged 36−45 years had 4 ones and more. Analysis of the results of laboratory studies showed that the patients with chronic infection caused by Epstein−Barr virus, compared with the control group showed a significant increase in erythrocyte sedimentation rate, relative lymphocytes and monocytes, as well as a decrease in absolute and relative neutrophil content, indicating leukocyte blood formula, characteristic of the viral etiology of the disease associated with Epstein−Barr virus. There was no correlation between the clinical analysis of blood with age of the patients with chronic infection caused by Epstein−Barr virus.
Key words: herpesvirus infection, chronic Epstein - Barr virus infection, disease course, clinical and laboratory parameters, immune system.
Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine, Dnipro, Ukraine
Clinical significance of expression rate of miRNA−29a in patients with chronic viral hepatitis C
83 - 86
Chronic viral hepatitis C is an urgent problem of hepatology. During the rapid development of epigenetics, small molecules, namely microRNA and microRNA−29a are actively studied in liver pathology. For this purpose, the level of miRNA−29a expression was studied in 74 patients having chronic viral hepatitis C with the first HCV genotype. Aberrant hyperexpression of miRNA−29a in the patients, the ability to differentiate the patients with chronic viral hepatitis C with sensitivity and specificity of the model of ROC analysis Se = 67.57 % and Sp = 90.91 %, DE = 79.24 % compared with healthy individuals. The expression of miRNA−29a was studied in the patients with chronic viral hepatitis C, who had a poor experience with antiviral therapy with interferon−containing protocols. The expression level of miRNA−29a was determined according to the manufacturer's protocol using the TaqMan® microRNA reverse transcription kit (Applied Biosystems, USA).The mean level of miRNA−29a expression in the patients with chronic viral hepatitis C (Me) and in groups of patients was assessed depending on previous experience of antiviral therapy. Aberrant hyperexpression of miRNA−29a was detected in the patients with chronic viral hepatitis C. In naive patients the level of miRNA−29a expression was 1.65 (1.27; 2.28) conventional units and in the patients with failed antiviral therapy according to regimens containing interferon was 1.64 (0.79; 2.20) conventional units compared with the control group (p = 0.002, H), which may reflect the potential mechanism of persistence of HCV infection. Thus, the expression level of miRNA−29a can be an additional biomarker in the pathogenesis of chronic viral hepatitis C, which can be used in the monitoring and treatment of patients, become the basis for prescribing the patients more effective protocols of targeted antiviral drugs and allow personification of treatment tactics.
Key words: chronic viral hepatitis C, previous experience of antiviral therapy, miRNA-29a, aberrant hyperexpression.
Kharkiv National Medical University, Ukraine
Maria Medical Center, Kharkiv, Ukraine
Modern aspects of ultrasound diagnosis of endometrioid heterotopias of pelvic cavity organs
87 - 92
Diagnosis of endometrioid heterotopias of the pelvic cavity is often complicated, because at the initial stage there are no characteristic sonographic signs of this pathology. However, transvaginal ultrasound can be used as the main imaging method in the patients with suspected endometriosis. Due to a wide variety of forms and degrees of endometriosis, the similarity of clinical signs of other diseases, frequent asymptomatic course of the disease are objective difficulties in the correct and timely diagnosis of endometrioid heterotopias of the pelvic cavity. Ultrasonography can be used both to detect and to monitor the dynamics of endometriosis. Transvaginal sonography allows a qualitative detection of endometrioid heterotopias of the pelvis and with a high probability to reveal endometrioid cysts, hydrosalpinx, hematosalpinx, peritoneal endometriosis and is considered the best method of visualization of the endometrium. There were examined 57 patients with various forms of endometrioid heterotopias of the pelvic organs by transvaginal ultrasonography, which was performed on the 5th−9th day of the menstrual cycle. Adenomyosis of various degrees has been diagnosed, which should be understood as a disease consisting of ectopic location of endometrial glands and stroma as well as muscle changes. Due to the variety of forms and degrees of endometriosis, combination with clinical signs of other diseases, often asymptomatic course of the disease, which leads to severe damage to the reproductive system, there are objective difficulties in correct and timely diagnosis of endometrioid heterotopias and pelvic cavity organs. Modern visual methods of transvaginal ultrasonography are the key to correctly determining the stage and extent of endometriosis, which will directly affect the choice of treatment.
Key words: endometriosis, heterotopia, ultrasound diagnostics, pelvic cavity.
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